Zentralblatt für Chirurgie
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Blood transfusion became the subject of major interest because of a possible HIV-infection. It should not been forgotten, however, that HIV-infection is not the only of a wide variety of risks. ⋯ One possibility to avoid risks, is the use of autologous blood. The most important requirement, however, remains to operate with a minimal blood loss.
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Minimal invasive, or more specifically laparoscopic surgery is now the standard procedure in an increasing number of surgical specialties. Inflating the abdomen with CO2 for long periods confronts the anesthesiologist with a number of problems that influence the choice of anesthetic and the monitoring deemed necessary. The increased intraabdominal pressure (IAP) and for some operations the extreme Trendelenburg position can disturb alveolar ventilation and compromise oxygenation. ⋯ Balanced anesthesia or total intravenous anesthesia is to be preferred, and the drugs employed should have rapid elimination kinetics with a short recovery time, since wound closure time is drastically reduced. Inhalational anesthesia alone may inhibit hypoxic pulmonary vasoconstriction thereby unduly increasing oxygen desaturation. The necessary degree of muscle relaxation still remains to be defined.
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Burn treatment is a complex therapeutic regimen, enclosing immediate resuscitation, burn would care and the complete spectrum of surgical intensive care as well as plastic surgical reconstruction. The pathophysiology of a severe burn injury resembles a maximal trauma response by activating a wide variety of mediators, resulting in a generalized tissue edema (capillary leak). ⋯ Sepsis is still the major mortality factor (75%). Besides established methods like skin culturing, future efforts are directed towards the generation of composite skin grafts and an immunological approach to influence or prevent the course of a burn sepsis.
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Randomized Controlled Trial Clinical Trial
[Hypertonic-hyperoncotic volume replacement (7.5% NaCl/10% hydroxyethyl starch 200.000/0.5) in patients with coronary artery stenoses].
To determine the efficacy and safety of intravascular volume augmentation with a hypertonic saline-hyperoncotic HES solution prior to CABG. ⋯ In patients with coronary artery disease, volume augmentation with hypertonic-hyperoncotic solutions may induce transient hypotension and post-infusion hypervolemic left heart failure.