Annals of surgery
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This study evaluated a possible protective and therapeutic effect of moderate hypothermia in the treatment of severe hemorrhagic shock. A modified Wiggers shock preparation was used. Normothermic dogs (Group I, N = 6) were maintained at normal body temperature throughout hemorrhagic shock and resuscitation. ⋯ After resuscitation and rewarming, stroke volume (mL/beat) and cardiac output (L/min) were lower in hypothermic animals with persistent acid-base derangements (12.6 +/- 2.5, 1.3 +/- 3.0, respectively) compared to hypothermic dogs with acid-base correction (20.1 +/- 3.3, 2.2 +/- 0.3) and normothermic dogs (24.6 +/- 3.0, 3.0 +/- 0.3, p less than 0.05), while myocardial O2 extraction and myocardial lactate production were higher. Results suggest hypothermia decreases the metabolic needs and maintains myocardial contractile function in hemorrhagic shock. Hypothermia may have a beneficial effect and, with normalization of acid-base balance, a therapeutic role in hemorrhagic shock.
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During the period of 1978 to 1986, 66 patients (31 men, 35 women) with a mean age of 28.4 years and various sickle cell hemoglobinopathies underwent 82 surgical procedures; 28 were emergencies. Fifty of the 66 patients had HbSS, 13/66 had HbSC, and 3/66 had HbS-thalassemia. All 66 patients received transfusions, although not for all procedures. ⋯ HbSS hemoglobinopathy had the higher complication rate. The hepatitis B surface antigen was demonstrated in four of 66 (6.1%) patients; ten of 66 (15.2%) developed alloantibodies. The benefits of transfusion therapy should be judged according to clinical needs; not all sickle cell patients need exchange or preoperative transfusion.