The effect of dextran 70 on the intra- and postoperative behaviour of haemostasis.
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Biomedical subjects
Publications and source records attributed to G Hack.
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Patients who had undergone orthopaedic surgery were investigated. The changes attributable to premedication and narcosis were characterized by a primary fibrinolysis which was accompanied by a slight hypercoagulability. This increased fibrinolytic activity was more pronounced immediately after the beginning of the operation. The post operative changes are characterized by increased ADP-induced aggregation, increased release of platelet factors 3 and 4 and hypercoagulability with reduced fibrinolysis. The reduction in platelets during the operation could be prevented due to the influence of dextran and hydroxyethyl starch (HES). It came further to a slight increase in the activity of factor VII, to an increased fibrinogen polymerization and also to an increased release of platelet factor 4.
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Anaesthesia for the surgical correction of scoliosis with the Harrington technique carries serious risks on account of the impaired cardiac and pulmonary function, the length of the operation, the area involved and the post-operative problems. Based on the experience gained in 32 young persons who had this operation the anaesthetic procedure for these cases is described: it comprises detailted pre- operative examination of cardiac and pulmonary function, continuous monitoring during the operation, a careful technique that takes into account the massive blood loss and stress associated with the operation, a careful technique that takes into account the massive blood loss and stress associated with the operation and close surveillance during the post-operative stage. Controlled hypotension (60 mm Hg) succeeded in reducing the blood loss during operation to 2,500 ml, compared with 4,500 ml without hypotension. If the pre-0perative examinations have established adequate cardiac function, if surgeon and anaesthetist work in close collaboration and if the heart action, pulse, arterial and venous pressure (catheter) and body temperature are continuously monitored, then controlled hypotension offers a means to reduce the, generally massive, blood loss during the surgical correction of scoliosis.
Radiological changes that may occur in the depenent lung when surgery is performed in the lateral position are generally of a transient nature; they disappear when the position of the patient is changed after the operation, but may, in some cases, be demonstrable post-operatively as atelectatic areas. From the second post-operative day onwards, and reaching a peak on the 5th post-operative day, there is an increased incidence of ventilatory disturbances and infiltrations. The course and distribution of these pulmonary disturbances point to post-operative immobilization in the recumbent position as the main causal factor.
An analysis was made of the postoperative course of 158 cases of major surgery performed during 1971-1973. The operations comprised thoraco-abdominal resection of the oesophageal and cardia, abdominal duodenopancreatectomy, partial gastrectomy and enterectomy and partial hepatectomy. 63 per cent of the patients were given artificial respiration either prophylactically immediately after the operation (47 per cent) or at a later stage (53 per cent) on account of respiratory complications (arterial hypoxia below 55 mm Hg pO2). Postoperative mortality for the group of patients who did not have artificial respiration was 46 per cent, as compared with 32 per cent for the artifically ventilated patients - a difference of 14 per cent. The causes for this discrepancy, and especially the role of non-respiratory complications are discussed and the indications for prophylactic postoperative artificial respiration are reviewed.
On 10 patients who had to undergo a ca. 4 hour operation of the lower abdominal region, the pattern of catecholamine excretion before, during and after operation was traced. 1. A decrease of systolic blood pressure on average of 80 mm Hg, in correlation to the concentration of Halothane and Thalamonal, was recorded. 2. The excretion of adrenaline and noradrenalin was significantly lower during anaesthesia as compared with the initial value, suggesting a depression of sympathoadrenal system. 3. The postoperative amount of adrenaline and especially noradrenaline increased markedly, when anaesthesia worn off, postoperative shivering started, and surgical wounds caused pain. 4. The excretion of urine during operation was slightly reduced, the renal output showed normal amounts, when calculated up to 24 hours. The results show, that the combined use of halothane an thalamonal because of its depressant effects on the sympathoadrenal system is capable of reducing the liberation of catecholamines during anaesthesia.
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