Acta anaesthesiologica Scandinavica. Supplementum
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Shock treatment seems optimal when a "balanced" fluid and volume regimen, including both crystalloid (Ringer's acetate) and about 3% colloid, is used. Dextran is the colloid of choice due to its beneficial effects on plasma volume, hemorheology, and microvascular blood flow. Dextrans exert, in addition, inhibiting effects on the shock- and trauma-induced activation of the cascade system, whereby the risk of complications in the form of multiple organ failure is reduced. Infusion of red blood cells, plasma or thrombocytes should be based on a proper assessment of each individual patient's actual need of oxygen transporters and coagulation factors.
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Acta Anaesthesiol Scand Suppl · Jan 1993
ReviewIncidence and aetiology of perioperative hypertension.
The reported incidence of perioperative hypertension associated with coronary artery bypass-graft (CABG) surgery ranges from 30-80%, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. ⋯ Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiologies.
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Acta Anaesthesiol Scand Suppl · Jan 1993
ReviewManipulation of the immunoinflammatory reaction in clinical sepsis.
For many years patients with sepsis and septic shock have been treated with antibiotics, fluids, surgery (if indicated) and, in the more severe cases, inotropic and ventilatory support. During recent years there has been an intensive development of new treatments based on increased knowledge of the pathophysiology. This presentation will focus on treatments modulating the immunoinflammatory response, which are either available in clinical practice today or which will be available in the near future. It is concluded that optimal therapy depends on the stage of the septic disease as well as the gram stain of the causative bacteria.