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  • 1
    Electronic Resource
    Electronic Resource
    Global tissue oxygenation during normovolaemic haemodilution in young children (1997)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 7 (1997), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sixteen patients (1–8 years) scheduled for major general surgery were chosen for the study. They were divided into two groups according to the replacement solution used for haemodilution (HD); whether 6% middle molecular weight hydroxyethyl starch (HES) or 6% dextran 60 (DEX). After induction of general anaesthesia and pulmonary artery catheterization, a precalculated amount of autologous blood was withdrawn while the patient's autologous blood was simultaneously replaced by either HES or DEX. Autologous blood was retransfused at a minimum haematocrit (Hct.) of 17% or at the end of surgery. The following parameters were measured and/or calculated before and after HD, every 20 min intraoperatively and hourly for 6 h postoperatively: heart rate (HR), mean arterial pressure (MAP), Cardiac index (CI), Hct., arterial and mixed venous oxygen content (CaO2, CvO2) and arterio-venous difference of oxygen content (avDO2), oxygen delivery index (DO2I), oxygen consumption index (VO2I). The cardiovascular system remained stable. There was no significant difference as regards SvO2, despite a significant decrease in CaO2 to 10.8 and 10.0 ml·dl−1 (median values) due to reduction of haemoglobin concentration in the HES and DEX groups respectively. In spite of the low hct. values during surgery DO2I remained in normal range (median value 602 and 710 ml·min−1·m−2) in HEX and DEX group respectively. There was no significant change in VO2I after haemodilution (median value 212 and 243 ml.min−1·m−2) in either group. No statistically significant difference was noticed between either groups regarding: CaO2, CvO2, DO2I, VO2I, and no side effects of the colloids were observed. Isovolaemic haemodilution (Hct. approx;17%) is well tolerated by young children undergoing major elective surgery; global tissue oxygenation was preserved throughout the procedure and both solutions used for haemodilution were equally effective.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.1997.d01-69.x
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  • 2
    Electronic Resource
    Electronic Resource
    The use of plasma substitutes with special attention to their side effects (1987)
    Springer
    World journal of surgery 11 (1987), S. 69-74 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La fraction protéique plasmatique et la sérum-albumine sont capables d'assurer le remplacement du plasma mais elles sont peu abondantes et très coûteuses. Le plasma frais congelé ne doit pas être employé pour rétablir la volémie mais seulement pour corriger les déficiences protéiques de la coagulation et pour traiter les sujets qui ont besoin de transfusions massives de sang. Les solucións colloïdes artificielles évitent le risque de transmission des maladies et sont peu onéreuses. L'effet volémique intravasculaire des solutions colloïdales à base de dextran, gélatine ou amylopectine dépend des caractères physico-chimiques de la solution polymère. Leur demi-vie varie de 2 à 8 heures. En plus de son effet volumétrique, le dextran possède des propriétés antithrombotiques spécifiques. Aucune des solutions colloïdales n'est exempte du risque d'effets indésirables, par exemple des réactions anaphylactiques ou anaphylactoïdes. La fréquence réduite de ces réactions et la possibilité de les prévenir ou de les traiter, justifient l'emploi étendu des solutions colloïdales artificielles pour compenser le choc hypovolémique et l'hémodilution.
    Abstract: Resumen La fractión proteica del plasma y la albúmina sérica humana son sustitutos adecuados del plasma; sinembargo, estos materiales son escasos y extremadamente costosos. El plasma fresco congelado no debe ser utilizado para reemplazo de volumen circulatorio, según la conclusión de una reciente Conferencia de Consenso del Instituto Nacional de Salud de E.U.A., y su uso sólo está indicado en casos de deficiencias documentadas de factores proteicos de coagulatión y en pacientes que requieren transfusiones masivas. Los coloides artificiales son sustancias libres del riesgo de transmisión de enfermedades y de fácil consecusión a bajos costos. El efecto sobre el volumen intravascular de las soluciones coloides a base de dextrán, gelatina o almidón hidroxietílico depende de las características fisicoquímicas de la solución polímera, y su vida media oscila entre 2 y 8 horas. Además de su efecto sobre el volumen circulatorio, el dextrán posee propiedades antitrombóticas específicas. Ninguno de los coloides se halla libre de efectos colaterales indeseables, especialmente de reacciones anafilactoides/anafilácticas. La baja tasa de incidencia de tales reacciones y la buena posibilidad de su prevención y tratamiento, justifica el uso de los coloides del volumen circulatorio en el shock y para efectos de hemodilución perioperatoria.
    Notes: Abstract Plasma protein fraction and human serum albumin are suitable for plasma replacement; however, they are in short supply and extremely expensive. Fresh-frozen plasma should not be used for volume replacement, but for documented coagulation protein deficiencies and for patients who require massive blood transfusions. Artificial colloids are free from the risk of transmitting diseases and easy to provide at low costs. The intravascular volume effect of colloid solutions based on dextran, gelatin, or hydroxyethyl starch depends on the physicochemical characteristics of the polymer solution. For the given colloid, the half-life varies from 2 to 8 hours. In addition to the volume effect, dextran provides specific antithrombotic properties. None of the colloids are free from the risk of untoward effects, such as anaphylactoid/anaphylactic reactions. The low frequency of these reactions and the possibility to prevent and to treat them justifies the use of artificial colloids on a routine basis for shock treatment, volume support, and perioperative hemodilution.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658463
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  • 3
    Electronic Resource
    Electronic Resource
    Hemodilution in Clinical Surgery: State of the Art 1996 (1996)
    Springer
    World journal of surgery 20 (1996), S. 1208-1217 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Acute normovolemic hemodilution entails removal of blood from a patient either immediately before or shortly after induction of anesthesia and simultaneous replacement with cell-free fluid. Nowadays, because of their predictable volume effects, the synthetic colloids (6% dextran 60/70, 6% hydroxyethyl starch 200,000) are preferred as volume substitutes; albumin should be avoided because of its high cost. Hemodilution has experienced a renaissance in recent years, mainly due to the evolving discussion of legal aspects, immunologic changes, viral infections, and a potentially higher cancer recurrence rate associated with the transfusion of homologous blood. Hemodilution should be considered for elective surgical patients free of contraindications and presenting with an initial hemoglobin concentration ≥ 12 g/dl and an anticipated blood loss of ≥ 1500 ml. The efficacy of this method (judged by the need to give homologous blood transfusion) depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra- and postoperative transfusion trigger. In the past, data from clinical trials showed that in healthy subjects a target hematocrit of 20% to 25% (hemoglobin 7.0–8.0 g/dl) is feasible and safe for the patient. The lower the target hematocrit accepted, the more extensive is the monitoring required: Intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by surgical patients without adverse effects. The safety and efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements has been demonstrated in various clinical studies. Hemodilution therefore is regarded an integral part of programs aimed at reducing the need for homologous blood and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage, and carefully adjusted surgical techniques. Hemodilution is feasible and relatively cost-effective, and it minimizes adverse effects associated with transfusion of homologous blood, particularly transmission of viral diseases, immunosuppression, and infectious complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900184
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  • 4
    Electronic Resource
    Electronic Resource
    Acceptable hematocrit levels in surgical patients (1987)
    Springer
    World journal of surgery 11 (1987), S. 41-46 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La grande facilité à disposer de sang ou de constituants a abouti à l'emploi excessif des transfusions sanguines. D'autre part la transfusion de sang présente toujours des risques pour le receveur. L'apparition du SIDA et le fait indiscuté que le sang homologue peut induire une immunosuppression préjudiciable à la résistance des malades chirurgicaux ont conduit à reconsidérer les indications de la transfusion de sang et à favoriser l'emploi d'autres méthodes dont le but est de réduire le nombre des transfusions de sang homologue. En se référant aux données fournies par les études de l'hémodilution péri-opératoire intentionnelle dans la chirurgie élective et aux données fournies par les malades traités par soins intensifs, il a été établi qu'un hématocrit aux environs de 30% est acceptable chez les malades chirurgicaux dés lors que le transport de l'oxygène n'est pas altéré par une réduction de la saturation du sang artériel ou par une perfusion inadéquate. Le mécanisme de base qui intervient pour compenser la réduction de l'oxygénation du sang consiste en une élévation du débit cardiaque et du sang éjecté, ces deux facteurs dépendant d'un retour veineux et d'une fonction myocardique adéquats. Le point de l'hematocrit à prendre en considération doit être déterminé pour chaque malade en fonction de la maladie qu'il présente, du volume de sang circulant, et des besoins réels en oxygène. En fixant ce point à 30% chez les patients qui ne présentent pas d'affections cardiaque ou respiratoire ou encore une augmentation de la demande en oxygène, il est possible de réduire le nombre de transfusions de sang homologue et d'éviter les effects secondaires indésirables de la transfusion.
    Abstract: Resumen La fácil disponibilidad de sangre y de componentes sanguíneos ha resultado en la liberación en el uso de transfusiones. Sin embargo, la transfusión de sangre todavía se halla asociada con riesgos de significación por parte del recipiente. La aparición del SIDA y la evidencia de que la sangre homóloga puede inducir inmunosupresíon y con ello alterar los factores de resistencia de huésped en los pacientes quirúrgicos, ha llevado a reconsiderar las indicaciones para transfusion sanguínea y ha promovido la aplicación de métodos alternativos de autotransfusión con el propósito de reducir el número de transfusiones homólogas. Con base en la información disponible derivada de estudios con hemodilución perioperatoria intencional en cirugía electiva y de pacientes en cuidado intensivo se considera que un hematocrito de 30% es aceptable en pacientes quirúrgicos, siempre y cuando el transporte del oxǵeno no se encuentre alterado por una saturación reducida de la sangre arterial o por perfusión inadecuada. El mecanismo basico de compensación ante una reducida capacidad de oxigenación de la sangre es el aumento en el gas to cardíaco y en el volumen de eyección, factores que a su vez dependen de adecuado retorno venoso y de buena función miocárdica. El nivel crítico del hematocrito debe ser establecido para cada paciente individual en relación a la historia de la enfermedad actual, del volumen circulatorio, y de las demandas reales de oxígeno. Al aceptar un hematocrito preoperatorio de 30% para pacientes libres de enfermedad respiratoria y cardíaca o de demanda aumentada de oxígeno, se puede lograr la reducción en el número de transfusiones de sangre homóloga y evitar los peligrosos efectos colaterales.
    Notes: Abstract The ready availability of blood and blood components has resulted in a liberal use of blood transfusions; however, the transfusion of blood is still associated with significant risks for the recipient. The appearance of the acquired immunodeficiency syndrome and the evidence that homologous blood can induce immunosuppression and thereby impair the host resistance of surgical patients has led to a reconsideration of the indications for blood transfusions. It has also fostered application of alternative methods with the aim of reducing the number of homologous blood transfusions. Based on the data available from studies on intentional perioperative hemodilution in patients undergoing elective surgery, and data from patients in intensive care, a hematocrit level of about 30% is acceptable for surgical patients, provided oxygen transport is not impaired by the reduced saturation of arterial blood or inadequate perfusion. The basic mechanism that compensates for the reduced oxygen capacity of the blood is a rise in cardiac output and stroke volume, both depending on adequate venous return and myocardial function. The hematocrit setpoint has to be determined for the individual patient with regard to the history of the underlying disease, circulating blood volume, and actual oxygen needs. By accepting a perioperative hematocrit level of 30% for patients without respiratory and cardiac disease or increased oxygen demand, respectively, the number of transfusions of homologous blood can be reduced and dangerous side effects can be avoided.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658458
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  • 5
    Electronic Resource
    Electronic Resource
    Der Einfluß von PEEP-Beatmung auf Gesamthämodynamik und regionale Organdurchblutung (1981)
    Springer
    Journal of molecular medicine 59 (1981), S. 1289-1295 
    Details
    ISSN: 1432-1440
    Keywords: Hemodynamics ; Pulmonary circulation ; Regional blood flow ; Heart function ; Artificial ventilation ; Hämodynamik ; Lungenkreislauf ; Organdurchblutung ; Herzfunktion ; Künstliche Beatmung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Den günstigen Wirkungen von PEEP auf die Lungenfunktion stehen ausgeprägte hämodynamische Nebenwirkungen gegenüber, deren Ursachen vor allem in einer Verminderung des venösen Rückflusses bei erhöhtem intrathorakalem Druck sowie in einer Zunahme der rechtsventrikulären Nachlast aufgrund des erhöhten pulmonalen Gefäßwiderstandes zu sehen sind. PEEP führt zu einer Umverteilung des reduzierten Herzzeitvolumens zugunsten von Gehirn, Herz, Nebennieren und Darm, während die Durchblutung von Magen, Pankreas und Schilddrüse überproportional vermindert wird. Die Nierengesamtdurchblutung nimmt in der Regel nur geringfügig ab; eine Änderung der intrarenalen Hämodynamik bedingt jedoch eine Beeinträchtigung der Salz-Wasser-Ausscheidung. Die arterielle Durchblutung der Leber kann bei höheren Stufen von PEEP soweit reduziert werden, daß eine ausreichende O2-Versorgung nicht mehr gewährleistet ist. Unter klinischen Bedingungen können individuell unterschiedliche Voraussetzungen die Änderungen von globaler und regionaler Hämodynamik im günstigen wie im ungünstigen Sinne modifizieren.
    Notes: Summary The benficial effects of PEEP on lung function may be counteracted by its hemodynamic sequenlae induced by a reduction of venous return due to the elevated intrathoracic pressure, and by an increased right ventricular afterload secondary to the rise of pulmonary vascular resistance. PEEP redistributes cardiac output in favor of brain, heart, adrenals and intestines, whereas the perfusion of stomach, pancreas and thyroid is diminished out of proportion to the fall of cardiac output. Total renal blood flow is relatively little affected; however, redistribution of intrarenal blood flow will result in a marked salt-water-retention. Reduction of hepatic artery flow, at higher levels of PEEP, may jeopardice liver tissue oxygenation. — Under clinical conditions, individual differences regarding preexisting cardiopulmonary and peripheral-vascular diseases may modify the PEEP-induced hemodynamic alterations in a wide range.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711178
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  • 6
    Electronic Resource
    Electronic Resource
    Histamine release as cause of acute hypotension following rapid colloid infusion (1970)
    Springer
    Naunyn-Schmiedeberg's archives of pharmacology 267 (1970), S. 433-445 
    Details
    ISSN: 1432-1912
    Keywords: Gelatine ; Dextran 60 ; Hypotension ; Histamine Release
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a series of 133 dogs, 10–20 ml/kg arterial blood were removed and replaced by rapid intravenous infusion of an equivalent volume of various plasma substitutes. Following the infusion of gelatine solutions, an acute fall in arterial blood pressure was observed, but not following the infusion of equal quantities of Dextran 60 or of 0.9% NaCl solution. Measurement of the blood histamine levels as well as the fact that the circulatory effects could be modified by the previous administration of anti-histaminic drugs indicate that the hypotension observed following the rapid infusion of gelatine solutions is due to the release of histamine. Since histamine liberation has also been shown in preliminary studies in man, rapid infusions of gelatine solutions should be avoided in clinical practice, or patients receiving them should be pre-treated with anti-histaminic drugs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00997279
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  • 7
    Electronic Resource
    Electronic Resource
    Die Kälteschwellung des Gehirns und die Begrenzung der Überlebenszeit in Hypothermie (1965)
    Springer
    Journal of molecular medicine 43 (1965), S. 515-517 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Changes of H2O-, Na- und K-Content of the brain in rats and dogs dependent to temperature and time after deep hypothermia up to 0° C and rewarming are beeing described and interpreted as inhibition of active transport of the cations. Thus these changes may serve as an explanation for the abbreviation of survival-time during hypothermia.
    Notes: Zusammenfassung Die Temperatur- und Zeitabhängigkeit der an Ratten und Hunden nach tiefer Hypothermie bis 0° C und Wiedererwärmung zu beobachtenden Veränderungen des H2O-, Na- und K-Gehaltes des Gehirns werden beschrieben. Sie werden als Hemmung des aktiven Kationentransportes gedeutet und geben eine Erklärung für die Verkürzung der Überlebenszeit in Hypothermie.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01486094
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  • 8
    Electronic Resource
    Electronic Resource
    Experimentelle Xenotransplantation in entfernt stammesverwandten Speciessystemen (1971)
    Springer
    Journal of molecular medicine 49 (1971), S. 164-166 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zur Beurteilung der Bedeutung von Zellen (Erythrocyten, Leukocyten, Thrombocyten), sowie Serumkomponenten (präformierte Antikörper, Komplement,γ-Globuline etc.) bei der hyperakuten Abstoßungsreaktion von vascularisierten Xenotransplantaten im entfernt stammesverwandten Speciessystem wurde ein in vitro-Modell der isolierten Xenohämoperfusion von Nieren erprobt, das die separate Untersuchung der einzelnen für die Reaktion verantwortlichen Faktoren erlaubt. In einem Perfusionssystem, bestehend aus Rollerpumpe, Wärmeaustauscher, Perfusionskammer und Capillaroxygenator wurden Rattennieren mit heparinisiertem Vollblut von Hunden perfundiert (n=10). Die Befunde zeigten, daß alle Hauptkriterien der hyperakuten in vivo Abstoßung von Nieren in diesem System (=rapider Anstieg des peripheren Widerstandes mit Sistieren der Blutdurchströmung innerhalb 10–25 min, Stauung und Hämorrhagie des Organes, Endothelnekrosen an Glomerula, Capillaren Arteriolen) ebenfalls bei einer in vitro Xenohämoperfusion dieser Organe regelmäßig zu beobachten sind. Bei entsprechend durchzuführender Variation der Zusammensetzung des Xenohämoperfusates scheint das Testsystem geeignet, einige an der hyperakuten xenogenen Abstoßungsreaktion beteiligte Komponenten des Blutes näher zu definieren.
    Notes: Summary In an aim to evaluate the role of formed elements (erythrocytes, leukocytes, thrombocytes) and of humoral serum components (preformed antibodies, complement,γ-globulins, etc.) in the hyperacute rejection of vascularized xenografts in widely divergent species, anin vitro model of isolated xenogeneic hemoperfusion of the kidneys was devised allowing for separate testing of the different factors involved in the rejection process. In a perfusion system consisting of a roller pump, heat exchanger, perfusion chamber and a capillary oxygenator, rat kidneys were perfused with heparinized blood from dogs (n=10). The results showed that all the main criteria of the hyperacutein vivo rejection of kidneys in this species system (rapid increase of resistance with subsequent cessation of renal blood flow within 10–25 min, congestion and hemorrhage of the organ, endothelial cell damage of glomeruli, capillaries, arterioles) could also be observed in the xenogeneic perfusion of these organsin vitro. By varying the composition of the xenogeneic hemoperfusate, this test system seems to be suited to define more exactly some blood components responsible for the hyperacute xenogeneic graft rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01496813
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  • 9
    Electronic Resource
    Electronic Resource
    Buchbesprechungen (1976)
    Springer
    Journal of molecular medicine 54 (1976), S. 196-196 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01468888
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  • 10
    Electronic Resource
    Electronic Resource
    Buchbesprechungen (1977)
    Springer
    Journal of molecular medicine 55 (1977), S. 659-662 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01482538
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