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B Blauhut

Publications and source records attributed to B Blauhut.

32 records · Page 2Linked to original sources
PubMed1985

Substitution of antithrombin III in shock and DIC: a randomized study.

In 51 shock patients with DIC Antithrombin III (AT III) substitution, heparin or a combination of both substances respectively was administered. In the two groups which had been given AT III substitution the concentration of AT III rose considerably higher than the activity. There was a drop of the platelet count in both groups which had received heparin. C1 esterase inhibitor was diminished in the beginning but spontaneously increased in all groups. This increase was slowest in the group without substitution of AT III. The blood loss in cases of traumatic shock was considerably higher in the group which had received both substances. The consumption of AT III concentrates was slightly higher in the combined therapy group than in the AT III group. The duration of symptoms of DIC was considerably shorter in the two substituted groups than in the heparin group. It is concluded that additional administration of heparin does not improve the effect of AT III substitution in patients with DIC and that side effects such as thrombocytopenia and an increased blood loss are likely to develop when both substances are given simultaneously.

Antithrombin III↗
PubMed1985

[Noninvasive monitoring using echocardiography. II. Determination of cardiac output and comparison of volatile anesthetics].

In order to prove definitely that echocardiography is a noninvasive and safe method that can be used in the perioperative period to assess cardiac function and evaluate the effects of pharmacologic agents on the heart, we have carried out further sonographic studies concerning cardiac output and the effects of volatile anesthetics on left ventricular contractility. In series A (n = 12), we compared different sonographic techniques (uni-dimensional, two-dimensional, pulse Doppler echocardiography) with invasively measuring cardiac output by thermodilution in ICU patients and in the immediate preoperative phase before CABG with a Swan Ganz catheter that was already inserted. M-mode echocardiography proved to be best and correlated well with invasively gained values (y = 0.57 + 0.96x, r = 0.795, p less than 0.01). Use of the Teichholtz formula to estimate left ventricle volumes seems to be imperative. The two-dimensional technique yielded less favorable results, the pulse Doppler method being least informative. In series B (n1 = n2 = n3 = 6) the effects of halothane, enflurane and isoflurane MAC 1.0 and 1.5 on left ventricular performance were assessed in patients undergoing cholecystectomy or gastrectomy under standard anesthetic conditions. The results support the already well-known pharmacologic effects of these drugs, with minimal decrease in contraction with isoflurane. Critical interpretation of the different sonographic parameters, however, is just as important as considering various existing interdependances. Finally, when comparing our numerical values with other 1.0 MAC effects reported in the literature, there was also very good agreement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Substitution of antithrombin III in shock and consumption coagulopathy].

A considerable diminution of the activity of antithrombin III (AT III) is found in the majority of patients in shock with signs of DIC. This results in further propagation of the mechanism of consumption coagulopathy and in a diminished effect of heparin. AT III was substituted in 16 patients who were admitted in shock. When acute consumption coagulopathy was present a greatly increased rate of inactivation of AT III was found. In spite of this fact, a comparison with a similar group of patients in whom substitution was not undertaken demonstrated a highly significant shortening of the duration of DIC and a clinically impressive, but not statistically significant, diminution of the mortality rate.

Antithrombin III↗
PubMed1984

[Antithrombin III substitution in patients in shock].

In a trial involving 61 patients suffering from shock and DIC, the relations between the concentration of heparin, the effect of heparin on coagulation and the activity of AT III were studied. The effect of heparin decreased to one-half when the activity of AT III was 75 per cent of the average normal level. At 50 per cent AT III, the effect of heparin was negligible. When AT III was substituted the disappearance rate of the AT III activity from circulation was considerably increased in the case of acute DIC, while the concentration of AT III when measured immunologically, did not show an increased disappearance. This difference suggests increased consumption of AT III by active serine proteases of coagulation. In patients substituted with AT III, the duration of acute DIC was between 16 h and 19 h, while it was 3.3 days in patients who received heparin. The survival rate of most severe cases of DIC showed a distinct trend towards improvement, but significance was lacking, probably due to the small number of comparable cases. When AT III and heparin were given simultaneously, there was no further shortening of the duration of DIC; however, severe bleeding complications occurred in some cases. The substitution of AT III was calculated on the following basis: In acute DIC an increase in AT III activity of 1 per cent can be expected when 1 unit/kg body weight is given. The same dose of AT III increases the plasma level by 1.8 per cent when the clotting system is unaffected.

Antithrombin III↗
PubMed1983

[Clinical relevance of microaggregates in stored blood].

A survey is given on the clinical relevance of microaggregates in stored blood. Initially the pathophysiology of aggregation led by electrostatic and humoral changes on the surface and membrane of the platelets is presented, and the well known pathomechanisms of embolization as well as the functional pulmonary impact of these emboli are discussed. The ever increasing importance of humoral factors is stressed, the mechanic obstruction of pulmonary capillaries by microaggregates having not that clinical importance as the general opinion in earlier days has been. New therapeutic aspects therefore are mentioned: The blockade of aggregation and the release syndrome by adding aspirin, aprotinin or prostaglandin E 1 to the stored blood, pharmacologically influencing the metabolism of arachidonic acid by inhibiting negative effects of prostaglandins (injecting ibuprofen as inhibitor of thromboxane-synthesis) and stimulating positive prostaglandin effects (infusion of prostacyclin), and finally the application of fibronectin (cryoprecipitates) for increasing the RES-function thus also enhancing the clearance of microaggregates, fibrinogen/fibrin complexes and intestinal serotonin. The latter way only, however, is also clinically feasable. The purely mechanical microfiltration should therefore still be used (3 pints of blood at least, pulmonary damage by trauma, shock or sepsis) and the methods of giving aggregate-poor red cell preparations (buffy coat free or saline washed) should be remembered. For the future one could speculate that more or less complete humoral block might be used in conjunction with a "midi-filtration" (Eckert: 40-100 mu diameter standard blood filter).

Blood Preservation↗
PubMed1982

Substitution therapy with an antithrombin III concentrate in shock and DIC.

In 15 patients admitted to the Intensive Care Unit for shock and with signs of DIC, Antithrombin III (AT III) was substituted. Immediately after the first blood sampling, 1,000 units of AT III was given. This was followed by 500 units AT III after 24 h and after 48 h. A continuous dose of heparin of between 250 and 500 I.U./h was simultaneously given. The following results were obtained: The activity of AT III on admission of 63 +/- 19% increased to 83 +/- 17% 30 min after the initial substitution. There was a clear difference between the recovery of the substituted AT III in acute DIC and in patients in a steady state. AT III recovered in circulation was 47 +/- 15% in the former group but 83 +/- 16% in the latter cases. One unit of AT III per kg body weight increased AT III activity in circulation by 1% in acute DIC but by 1.8% in a steady state. The average half life of the substituted AT III was 4.4 +/- 1.6 h in acute DIC and was 20.2 +/- 4.1 h when the patients were in a steady state.

Adult↗
PubMed1982

[Substitution of antithrombin III in shock patients].

In 15 patients admitted to the operative intensive care unit of the Institute of Anesthesiology for shock and with signs of DIC, antithrombin III (AT III) was substituted together with a continuous infusion of heparin. 1,000 units AT III were given after the first blood sampling. This was followed by 500 units after 24 h and after 48 h. 14 out of the 15 cases could be evaluated. The activity of AT III prior to substitution was below 75% in 10 cases and above 75% in 4 cases. The mean increase after substitution was 16%. The recovery was below 50% in cases with acute DIC whilst it was 90% in cases in a comparatively steady state. One unit AT III per kg body weight increased the activity of AT III in circulation by an average of 1% in acute DIC whilst the increase was 2% in cases without signs of acute DIC. The average half disappearance of the increase of AT III in circulation was 4.25 h in acute DIC but was 19.0 h when acute DIC was not detectable.

Adult↗
PubMed1980

[Prophylaxis of consumption coagulopathy in shock. Dependence of the effect of heparin on the activity of antithrombin III (author's transl)].

In 16 patients admitted in shock, heparin prophylaxis for DIC was carried out. The effect of heparin was monitored by a series of coagulation tests. A distinct relation was found between the effect of heparin on the aPTT and on the thrombin clotting time and the activity of antithrombin III. Even a comparatively slight diminution of this activity resulted in a considerable decrease of the heparin effect on coagulation. Since this effect is of primary importance for the efficacy of prophylaxis of DIC, regular assays of antithrombin III are proposed in shock patients receiving heparin.

Adolescent↗
PubMed1976

[Early influence of acute preoperative haemodilution with human albumin and ringer's lactate on coagulation (author's transl)].

Acute haemodilution was performed in 10 patients scheduled mainly for vascular surgery. Before induction to anaesthesia 910 +/- 29.1 ml whole blood was taken and simultaneously replaced as follows: 50% of that amount with 3,6% albumin solution, another 50% X 3 with lactated Ringer solution. The haematocrit was thus lowered from 39.8 +/- 1.71 to 28.4 +/- 1.7 vol%. Extensive clotting studies were performed to investigate the early influence of haemodilution on the clotting mechanisms in the time span between the end of blood collection and the point of surgical anaesthesia. The group of patients with normal clotting studies prior to haemodilution has shown a slight and short-lasting hypercoagulability. This has been proven by a shortening of r and k in TEG, by a shortening of non-activated Partial Thromboplastin Time (means activation of the XII and XI factor) and also, by the presence of an activated factor Xa and by an increase of maximum platelet aggregation and of platelet factor 3 availability. This mechanism of clotting activation is similar to the one observed after marked blood loss. It was assumed that this minor, early and short-lasting hypercoagulability has no further influence on the well known usual intra- and post-operative changes in clotting mechanisms (intra-op lowered, post-op enhanced coagulability). In contrast to the patients with normal clotting, a clotting defect due to preexisting liver-cell damage becomes worse during the haemodilution, which method in the presence of hepatic insufficiency therefore is contraindicted. A few additional data on input-output, serum and urine electrolytes and on 2,3 DPG have been gathered during our study. They indicate a positive fluid balance and the necessity for a close watch of electrolytes. The possible trend of 2.3 DPG elevation which has also been found might reflect a compensatory mechanism increasing oxygen transport capacity of haemoglobin if the above described method of haemodilution is used.

Adolescent↗