Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2009
Clinical Trial[Effectiveness and safety of using 6% hydroxyethyl starch 130/04 and 4% modified liquid gelatin in neurosurgical patients with massive intraoperative blood loss].
The results of using three infusion solutions, such as 6% hydroxyexyethyl starch (HES) 200/0.5 (HaesSteril), HES 130/0.4 (Voluven), and 4% modified gelatin solution (Gelofusin), were compared in 33 patients with neurosurgical diseases of the brain (supratentorial meningovascular tumors) and predictable massive intraoperative blood loss during acute isovolemic hemodilution and compensation for later blood loss. The evaluation criteria were volemic, hemostatic and cerebrovascular effects. ⋯ The least hemostatic changes were seen in the Gelofusin group. The findings suggest that among the test infusion solutions, Voluven is most effective and Gelofusion is safest.
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Anesteziol Reanimatol · Sep 2009
[Effect of hemotransfusion on brain oxygenation and metabolism in patients with intracranial hemorrhages].
The paper analyzes the impact of anemia correction on the time course of changes in oxygen tension in the brain and on the biochemical composition of brain interstitial fluid (tissue microdialysis) in the affected and conditionally intact hemisphere in 8 patients with intracranial hemorrhages and a reduced awakening level up to 4-8 scores by the Glasgow coma scale. Anemia correction in patients with intracranial hemorrhage was shown to fail to change oxygen tension in the brain and to be followed by a reduction in lactate/pyruvate ratio in the involved cerebral hemisphere. Only in significant anemia (Hb < 7 g/dl), hemotransfusion elevated cerebral perfusion pressure, by increasing mean blood pressure.
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial Multicenter Study Comparative Study[Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study].
Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. ⋯ The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial Multicenter Study[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].
The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial[Target-oriented infusion therapy in patients during myocardial revascularization].
The paper analyzes goal-oriented infusion therapy used during myocardial revascularization on the working heart. Forty-seven patients with coronary heart disease were examined. Group 1 (control) (n = 20) received standard infusion therapy (a combination of colloids and crystalloids (1:1) at a rate of 6-7 ml/kg/h, by being oriented to indices, such as heart rate, blood pressure, central venous pressure, and diuresis rate. ⋯ In this group, a volume load was done at the beginning of an operation until the maximum possible SV resulted from increased preload (global end-diastolic volume index). The goal of infusion therapy throughout the operation was to maintain these values of the latter index. Goal-oriented infusion therapy, the purpose of which was to determine and maintain the individual optimal values of preload, was found to minimize hemodynamic disorders at surgery and to reduce the frequency of use of cardiotonic agents and the duration of artificial ventilation.