Zentralblatt für Chirurgie
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The ideal solution for volume therapy is still under discussion. In cardiac surgery, hemodynamic efficacy as well as the influence of cardiopulmonary bypass (CPB) are of major interest when administering volume. Hypertonic sodium (HS) solutions which have been advocated for resuscitation from hemorrhagic shock may also be of benefit in cardiac surgery patients. ⋯ Infusion of HS-HES after weaning from CPB resulted in overall more improved hemodynamics than volume replacement with 6% HES. Rapid infusion of HS-HES during CPB (within 2 min) was followed by a significant, but shortlasting decrease in MAP (-40 mm Hg) and an increase in the oxygenator volume. Preoperative infusion of HS-HES resulted in a significant improvement in skin capillary microcirculation assessed by lased Doppler technique during and after CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
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Laparoscopic surgery may be associated with increased perioperative morbidity due to respiratory and cardiocirculatory problems. Preoperative assessment requires a diagnostic program including laboratory tests and noninvasive diagnostic studies, and a physical status classification. ⋯ Increased intraoperative morbidity is expected in patients with manifest cardiac failure or severely restricted pulmonary function. In patients with moderate pulmonary dysfunction laparoscopic procedures seem to be associated with the benefit of a better postoperative pulmonary function.
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The i.v. bolus infusion of 4 ml/kg b.w. of hypertonic (7.2-7.5%) saline solution represents a new concept for primary resuscitation from traumatic-hemorrhagic shock; it is called "small-volume resuscitation". Experimental studies have demonstrated that for the case of a 50% blood loss the infusion of 7.2-7.5% NaCl in a dose equivalent to 1/10 of the blood loss effectively restores cardiac filling pressures and cardiac output and significantly increases systemic pressure. ⋯ The superiority of "small-volume resuscitation" using hypertonic-hyperoncotic solution as compared to conventional volume therapy consists of its effects on the microcirculation. Recent clinical trials have revealed the efficacy, practicability and safety of this new therapeutic concept for primary resuscitation from trauma and shock.
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In the following paper a review is given on the development of scoring-systems of severe intraabdominal infections till now. After a critical reflection on various systems a heuristic assessment is shown in the summing-up about their possible utility in the future. At present the APACHE II index, the sepsis score by Elebute and Stoner and the Mannheim peritonitis index meet practically requirements for good scores by different revising questions.