Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial[Thromboelastographic characteristics of different infusion therapy regimens in healthy bone marrow donors].
Infusion solutions are able to change the hemostatic system. Thromboelastography (TEG) is an integral technique to evaluate the hemostatic system. TEG was used to evaluate the effect of three infusion solutions (6% hydroxyexyethyl starch (HES) 200/0.5 - Hemohes; HES 130/0.4 - Voluven; modified gelatin solution - Gelofusin) on the hemostatic system in 36 bone marrow donors (healthy individuals). ⋯ Hemostatic changes were noted by the end of an operation in all groups; however, these were less pronounced when Voluven was administered. Thus, all colloid infusion solutions have varying effects on the hemostatic system, with a tendency toward both hypo- and hypercoagulation. According to TEG, HES 130/0.4 (Voluven) has a minimal effect on the hemostatic system.
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Anesteziol Reanimatol · Sep 2009
Clinical Trial[Prospects for using hydroxyethyl starch in the complex of intensive care during interhospital transportation of critically ill patients with polytrauma].
The paper analyzes the results of a comparative study of different infusion therapy modalities in victims with polytrauma during transportation to a specialized traumatological center. A combination of crystalloids and dextrans was applied to a control group and hydroxyethyl starch (HES) 130/0.4 was used in a study group. The evaluation criteria were the maintenance of stable hemodynamic parameters during transportation; a negative effect on hemostatic parameters and a preventive effect against the development of multiple organ dysfunction during transportation. Infusion therapy using HES has an advantage by all the parameters estimated.
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Anesteziol Reanimatol · Sep 2009
[Changes in hemodynamics and volemic status during intraoperative blood exfusion in patients with chronic heart failure].
Forty-five patients with dilated cardiomyopathy, NYHA Functional Classes III-IV chronic heart failure with left ventricular ejection fraction 26.98+/-7%, who had undergone surgical left ventricular remodeling using an extracardiac conduit in combination with mitral or tricuspid valve correction and blood exfusion, were examined. Central hemodynamic monitoring was performed, by using a Swan-Ganz catheter in all the patients at surgery. In 11 patients, transpulmonary thermodilution in combination with pulmonary artery catheterization with a Swan-Ganz catheter (PICCO-Plus + VOLEF, Pulsion, Germany) was used in 11 patients to monitor central hemodynamics. ⋯ These data suggested that diminished cardiac pump function was caused by a predominant reduction in global preload, as evidenced by volumetric monitoring. At the same time the changes in CVP, BP, and HR did not reflect the altered volemic status. To prevent destabilization of the circulatory system, blood should be sampled just before extracorporeal circulation after aortic cannulation.
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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.