Infusionstherapie (Basel, Switzerland)
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Comparative Study
[Effect of a new 10% hydroxyethyl starch solution HES/270/0.5 on blood coagulation, blood loss and hemodynamics in comparison with 3.5% PPL].
20 patients scheduled for total hip replacement were given 1,000 ml of a new preparation of 10% hydroxyethylstarch (HES) (MW 270,000: 0.5) preoperatively. They were compared to a group of 20 patients who received 1,000 ml of 3.5% plasma protein solution (PPS). HES caused a more pronounced hemodilution than PPS. ⋯ Blood loss and transfusion volume were comparable to HES and PPS until 24 h after the operation. One patient showed generalised flush after HES. This HES preparation is a colloid with volume-expanding properties and appears to be without clinically apparent effects on coagulation (up to a volume of 11).
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Comparative Study
Primary hemostasis in hemodilution--2) Infusion solutions.
Various infusion solutions are used during preoperative hemodilution or for substituting intraoperative blood loss. We examined the influence of saline 0.9%, albumin 5%, dextran 6% gelatin 3.5% and hydroxyethyl starch 6% (HES, mw 40,000 and 450,000) on primary hemostasis using the In-vitro bleeding test (IVBT) on composed blood samples of different hematocrit but constant platelet concentration. ⋯ Saline and albumin had the strongest effect, whereas high molecular weight HES or dextran showed hardly any impairment, if used in a quantity of less than 20% of the blood volume. Autologous plasma seems to be the best substitute in hemodiluted patients, at least if more than 20% of the blood volume has to be substituted by infusion solutions.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparative study of the intraoperative effectiveness of 5% human albumin or 10% hydroxyethyl starch (HAES-steril) on hemodynamics and oxygen transport in 40 patients].
In 40 patients, whose expected hemodynamic instability during surgery necessitated invasive monitoring (Swan-Ganz catheter) and arterial pressure monitoring the hemodynamic and oxygen transport parameters in conditions of hypervolemic hemodilution were investigated in randomized tests. After insertion of an arterial catheter (arteria radialis) as well as Swan-Ganz pulmonary arterial catheter via the vena jugularis interna, one of the two volume substitutes selected at random was infused in quantities of 125 ml/5 min and the hemodynamic changes were measured after infusion of 500 ml and finally after a wedge pressure of 18 mmHg was reached. Using either solution, the measurements indicated significant increases in mean arterial pressure as well as in central venous pressure (ZVD) and wedge pressure. ⋯ In the case of both volume substitutes, there was an improvement in oxygen availability. The hemoglobin content decreased in both groups, though to different degrees in each group. Although the hydroxyethyl starch group registered a greater improvement in the cardiac index, a bigger decrease in pulmonary vascular resistance, a higher rise in the left ventricular stroke work index and a more significant improvement in stroke output, smaller quantities of the volume substitute were required in this group than in the group in which volume substitution was carried out with human albumin 5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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The common features of all different kinds of circulatory shock are a disturbance of the microcirculation and an imbalance between cellular oxygen demand and supply. The pathophysiology is discussed by the example of hypovolemic-hemorrhagic shock, including macrocirculation, humoral regulatory mechanisms, the role of vascular endothelium, and cellular dysfunction. The first aim of therapeutic efforts is the rapid restitution of a normal circulatory volume as a basic requirement for the normalisation of the microcirculation. Actual concepts of volume substitution and transfusion therapy are presented.
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The risks and adverse reactions of fresh frozen plasma (FFP) and coagulation components have changed considerably in the last few years because of the spread of HIV on the one hand, and the advances in preparation and sterilisation of the coagulation components on the other hand. Therefore, the indication for FFP and the various coagulation components deserves permanent consideration. FFP is still the therapeutical means of choice for the treatment of acquired (complex) plasmatic coagulation disorders, even though the (still) small risk of virus transmission in Middle Europe has to be taken into account. ⋯ Finally, the necessity of accurate diagnosing is emphasized. Close cooperation between the physicians in the clinics and in the department of transfusion medicine/hemostaseology reduces unnecessary and inadequate application of coagulation components. This also means an improvement in the patient's therapy.