Läkartidningen
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Review Comparative Study
[Follow up of pediatric care is a good resource of knowledge that can be even better].
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In cases of hypovolaemic shock and trauma, hypertonic saline (HS) resuscitation is beneficial as it results in rapid and efficient fluid redistribution from interstitial and cellular sources to the intravascular compartment. The ensuing haemodilution and reduction in blood viscosity improves venous return and increases preload, while afterload is simultaneously reduced due to the vasodilatory effects of HS. All these changes promote increased cardiac output and improve haemodynamic stability. ⋯ As compared with standard fluid regimens, HS without the colloid, dextran, has not been shown to improve survival rates, whereas HS in combination with dextran may be a superior alternative. In specific categories of trauma patients, (e.g., those with head injuries), HS treatment seems clearly advantageous. Registration of HS solutions is currently under way in several countries.
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During the fifty years since hypotensive anaesthesia, induced hypotension to minimise intraoperative blood loss, became an established routine, there have been few reports of associated cerebral complications. However, evidence of disturbed cerebral function among patients undergoing orthognathic surgery under induced hypotension was obtained in a recent study where the level of adenylate kinase activity in cerebrospinal fluid was used as a highly sensitive biochemical marker of brain cell injury. ⋯ The underlying cause of brain cell injury seems to be complex, and as in all likelihood it is not hypotension per se that is responsible, the effect of the anaesthetic agents used (isoflurane and propofol) has to be considered. It was also noted that hypotension did not improve the clinical outcome of orthognathic surgery, as compared with comparable operations performed under normotension.