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At least 109 records · Page 6Linked to original sources
PubMed1990

Studies of antidote therapy for nisoldipine intoxication in experimental animals.

In anesthetized rats under artificial respiration, intravenous infusion of nisoldipine (0.1 mg/kg x min) caused significant decreases in blood pressure, heart rate, cardiac output and peripheral resistance. The animals died 54.7 +/- 11.1 min after initiation of the infusion. The electrocardiogram showed sinus bradycardia, increasing AV blockade and displacement of the pacemaker into the AV node or the bundle of His. Survival time under nisoldipine infusion increased more than two-fold with simultaneous infusion of calcium gluconate, isoprenaline (isoproterenol) or dopamine. Norepinephrine (noradrenaline) had no significant effect on survival time; the latter decreased to 19.4 +/- 1.6 min by plasma volume expansion with polygeline. All antidotes prolonging survival time also normalized the cardiac output diminished after nisoldipine. Electrocardiographic changes were antagonized only by isoprenaline. Suitable antidotes for intoxication or over-dosage of nisoldipine are calcium salts as well as beta-sympathomimetic drugs; sheer volume substitution and peripheral vascular constriction should not be resorted to.

Animals↗
PubMed1989

[Peroperative autotransfusion in aortic surgery].

Intraoperative autotransfusion of blood by means of a Solcotrans retransfusion bag was used during abdominal aortic surgery in a series of 25 patients. The need for transfusion of blood products, erythrocytes and plasma, decreased from 8.5 units to 4.5, as compared with 26 patients operated during the same period the preceding year (p less than 0.01). Hemoglobin was not lower at any point per- or postoperatively when autotransfusion was used. In contrast to one out of 26 patients operated without autotransfusion (p less than 0.05), seven of 25 patients whose operations involved autotransfusion did not need any donor transfusions. Exposure to potentially contagious donor products may be further decreased by using polygeline (Haemmaccel), and in some cases heat-treated albumin, in stead of plasma. While the mean number of donor transfusions remained relatively high with autotransfusion, the median number of erythrocyte donor transfusions was 0 units preoperatively and one unit postoperatively. An average of 684 ml of blood was retransfused. This corresponds to less than two units of blood. The main decrease in the number of transfusions was due to more careful surgical technique, the use of impregnated vascular grafts, and a changed attitude towards transfusions.

Aged↗
PubMed1994

Haemmaccel, a key for lung preservation?

Several and different solutions have been used for lung preservation but, at present, fluids and solutions are quite alike. In the last years extracellular type solutions have been progressively tested in experimental researches and have shown a better protection vs intracellular one. In this research we have studied the effect of a low-potassium solution normally used as plasma expander (Haemmaccel, HM) on isolated foetal human fibroblasts (WI-38). HM has been compared with Belzer solution (UWS) after 16 hrs incubation at 10 degrees C and low-potassium solutions with dextran 2% and 5% after 6 hrs and 16 hrs incubation at 10 degrees C. Wi-38 cells have been seeded at the density of 9x10(4)/cm2 onto plastic well plates. Cellular viability was measuring using the rate of protein synthesis through the incorporation of 3H leucine in growth medium during a 1 hr incubation at 37 degrees C. The results were expressed as nmol 3 H leu/mg of proteins/minute and presented as means +/- SD; the comparison has been performed by the one way variance analysis test. After 16 hrs incubation at 10 degrees C HM preserves WI-38 cells significantly better than UWS. Comparing HM with LPD 2% and 5% a significant difference both at 6 hrs and at 16 hrs was observed. Our preliminary in vitro results confirm that low-potassium solutions are less toxic on isolated lung cells than intracellular one. Polygelin contained in HM could be considered a suitable colloidal substance that determine a better preservation if compared with Low-Potassium Dextran solutions.

Culture Techniques↗
PubMed1993

Acute hemodilution and autotransfusion in cardiac surgery: a comparison between rather healthy and high risk patients.

The effects of acute normovolemic hemodilution and autologous blood transfusion were studied in open heart patients, compared with rather healthy patients, NYHA class 1-2 and the high risk patients, NYHA class >2. Thirty-nine patients were involved in this study, 15 of them were identified as the rather healthy group while 24 patients belonged to the high risk group. Acute hemodilution was performed after anesthetic induction and before heparinization. Using an equal volume of polygeline 3.5 per cent (Haemaccel) to replace autologous blood removal, the number of patients who needed inotropic support to achieve normal arterial blood pressure was not significantly different between the groups. Following retransfusion of pump perfusate and autologous blood after the termination cardiopulmonary bypass, the number of patients who received additional homologous blood as well as the amount used percase were significantly less in the rather healthy patients. There was none in this group, but half of the high risk patients suffered from serious perioperative complications and one died. We conclude that this technique is safe and benefits blood conservation in rather healthy cardiac patients undergoing open heart surgery, but special precautions against risk should be considered in high risk patients.

Adult↗
PubMed1996

[Changing the use of albumin at the Oslo hospital].

An increasing demand for albumin in Oslo hospitals in the early 1990s instigated measures to reduce its use. During the autumn of 1993 a letter was sent to all doctors at Ullevål hospital informing them about the lack of documentation that albumin supplementation has a positive effect on outcome in critically ill with an albumin concentration of more than 20 g/l. In May 1994 the blood bank at Ullevål hospital stopped supplying 4% albumin solutions. A 20% reduction in use of albumin was observed after the letter of information, followed by a 50% reduction after the 4% solution was withdrawn. It is concluded that greater awareness of lack of information about the effects of albumin in critically ill patients has led to a more restrictive use of albumin. During the same period the use of polygeline increased, leading to the assumption that colloids other than albumin are being used for volume substitution.

Albumins↗
PubMed1996

Hemodilution in complicated high velocity vascular injuries of limbs.

Normovolemic hemodilution with 3,5% polygeline was carried out in fourteen ASA (American Society of Anesthesiologists) Class-I patients, who had developed false aneurysms or arteriovenous fistulas following high velocity injury on limbs. At the end of surgical procedure volume of mean blood drained was 1400.00 +/- 194.46 ml, mean surgical blood loss was 1665.71 (+/- 33.9) ml and fluid balance was 557.14 (+/- 176.40) ml. Arteriovenous oxygen content difference (C(a-v) O2), central venous pressure (CVP), heart rate and mean arterial pressure (MAP) did not show any significant variation from pre-hemorrhage value. Hematocrit (Hct%) and hemoglobin (Hb gm%) showed a highly significant fall following hemodilution and retransfusion. However on the day of discharge Hct% (37.5(+/- 3.88) and Hb gm% (12.84 (+/- 0.82) had increased from post hemodilution value of 28.96 (+/- 1.98) and 10.04 (+/- 0.87) respectively. 71% patients did not need any homologous blood transfusion. Prothrombin time index (PTI%) showed 7.5% fall at the conclusion of blood retransfusion and 3.94% fall on the day of discharge. Technique is safe, avoids use of homologous blood and is thus recommended during surgical correction of complicated high velocity vascular injury of limbs.

Adult↗
PubMedDate not supplied

Skeletal muscle PO2: indicator of peripheral tissue perfusion in haemorrhagic shock.

The following conclusions can be made on the basis of this work: 1) Measurements of skeletal muscle oxygen tension provide an excellent index of tissue perfusion in haemorrhagic shock. 2) Correction of cardiac output and arterial blood oxygen tension in haemorrhagic shock does not necessarily ensure normal tissue oxygenation. 3) In haemorrhagic shock adequate replacement of blood loss using a balanced salt solution in addition to blood replacement is an integral part of the fluid management. 4) Correction of hypovolemia with an equivalent volume of a plasma expander and subsequent reinfusion of shed blood also returns tissue perfusion to normal. However, this treatment results in marked haemodilution and correction of extracellular fluid loss remains inadequate.

Abdominal Muscles↗
PubMed1991

Controlled clinical trials and cross-sectional studies with plasma histamine measurements and histamine receptor antagonists: solving the problem of preoperative H1- + H2-prophylaxis by asking new questions?

The problem of a preoperative histamine H1- + H2 - prophylaxis was tackled by a group of new studies including randomized controlled clinical trials and cross-sectional studies with plasma histamine measurements and administration of H1- + H2 - antagonists to a control group. The first study demonstrated serial histamine release in the induction of anaesthesia up to 4 times in a single patient. Basal plasma histamine levels in resting subjects fell below 100 pg/ml during the time necessary for preparation of the surgical patient. Hence, spikes of elevated plasma histamine concentrations corresponded to histamine release. Although this histamine release very often was less than 1 ng/ml plasma histamine, it created systemic reactions after atracurium. The cut-off point of 1 ng/ml for such anaphylactoid reactions does no longer exist, also lower plasma levels are of patho-physiological significance. The clinical signs of histamine release in the induction of anaesthesia vary from drug to drug. Sometimes tachycardia and hypertension produce the highest likelihood ratio, sometimes tachy- and bradycardia, but no changes in blood pressure as in the case of atracurium. It is concluded that the reasons why histamine release in anaesthesia and surgery is so much underreported and under-estimated include the present paradigms about plasma histamine levels and the "classical picture" of histamine release. Both are no longer valid and need a re-assessment.

Adolescent↗
PubMed1977

[The effect of various substances on the time of survival of rabbits under conditiones of oxygen-delay (author's transl)].

In 30 rabbits, which had accidentally been divided into five groups of different treatment the effect of the substance Persantin, Actihaemyl and Noleptan was investigated in view of the time of survival of the animals and the behaviour of the acid-base-balance and the blood-gases under conditions of oxygen-delay. There were two control-groups. One collective was treated with Haemaccel, the other with Glucose. In those groups treated with Persantin, Actihaemyl and Noleptan the time of survival of the animals is significantly higher in comparison with the animals of the control-groups. The behaviour of the acid-base-balance and the blood-gases in the collective treated with Persantin points to a reduction of the dimension of the metabolic acidosis. This effect cannot be assumed for Actihaemyl because of this investigation. The effect of Noleptan seems to depend on an improvement of the gas exchange in the lungs of the rabbits. The results of this investigation show that the application of Persantin and Actihaemyl might be an interesting enrichment of the medicamental treatment of the intrauterine acidoses.

Acid-Base Equilibrium↗
PubMed1980

H1 + H2-receptor antagonists for premedication in anaesthesia and surgery: a critical view based on randomized clinical trials with Haemaccel and various antiallergic drugs.

Histamine release by drugs used in anaesthesia and surgery has been often demonstrated in human volunteers, but only occassionally in patients. Three questions arose from these studies. (1) Is the incidence of histamine release high in patients during routine anaesthesia and surgery? (2) Can the clinical effects of histamine release in man be prevented by H1 + H2-receptor antagonists? (3) Are there any side-effects of such a premedication? These problems were investigated in patients and volunteers by randomized controlled clinical trials using only one of the histamine-liberating drugs in man, the plasma substitute Haemaccel. This drug was chosen because it causes a reproducible histamine release in man and because its mechanism of action in man is largely known. (1) Out of 600 orthopaedic patients 30 (5%) showed anaphylactoid reactions following Haemaccel infusion. 26 of these had a histamine release of more than 1 ng histamine/ml plasma. Using predictive values this gives an efficiency of the test by nearly 98%. (2) In volunteers the combination of an H1-plus H2-receptor antagonist (dimethypyrindene and cimetidine) completely prevented the clinical effects of histamine release by Haemaccel (9 allergoid and anaphylactoid reactions in the control group, none in the H1 + H2-group). The incidence of histamine release, however, remained unchanged. (3) The premedication was found to release histamine itself. Cimetidine was effective when given alone but especially in combination with chlorpheniramine (4 events out of 7 applications). The clinical side-effects of these premedication were mild since apparently the free histamine was largely blocked at the receptor sites. It is concluded that premedication with a combination of H1- and H2-receptor antagonists is indicated due to the high incidence of histamine release during anaesthesia and surgery induced by various drugs and treatments. Such premedication is effective but associated with mild side-effects. For this reason more extended clinical trials with dimethpyrindene plus cimetidine in patients are necessary before this premedication can be generally recommended.

Adolescent↗
PubMed1988

Prediction of risk for pseudoallergic reactions and histamine release in patients undergoing anaesthesia and surgery: a computer-aided model using independence-Bayes.

A computer-aided model for the prediction of pseudoallergic reactions was developed using prospective data collected from 581 patients in a controlled clinical trial examining pseudoallergic reactions to the plasma substitute Haemaccel (outdated formulation). The multivariate analysis of 22 proposed risk factors was performed using Bayes theorem. This enabled the accurate prediction of 86% of the patients who had a systemic reaction. The clinical use of such system would enable a selection of patients to receive the effective prophylactic measure of pretreatment with H1 plus H2-receptor antagonists.

Anesthesia↗
PubMed1993

Blood transfusion in total hip arthroplasty: guidelines to eliminate overtransfusion.

This study was designed to evaluate the effect of transfusion guidelines on perioperative blood usage with a view to identifying a protocol for transfusion therapy in our hospital. Eighty consecutive patients with normal haemoglobin concentrations presenting for total hip arthroplasty were studied. The maximum allowable blood loss (MABL) was calculated for each patient using the formula of Kallos et al. Blood loss up to this value was replaced with Haemaccel. When the MABL was reached, a haematocrit (Hct) was performed and blood was given if the Hct was less than 30 in men and 27 in women. Otherwise replacement was with Haemaccel. All postoperative complications, duration of hospital stay, and physiotherapy compliance assessments were recorded. A discharge Hct > 36% was the criterion for overtransfusion. The results were compared with findings from a retrospective group before the introduction of these guidelines. Analysis of the data demonstrated a reduction in the frequency of transfusion (97% vs 32% P < 0.05), the volume transfused (2.7 vs 1.3 units P < 0.05), and the incidence of overtransfusion (45% vs 5% P < 0.05) between the two groups of patients. There was no difference between the groups in complication rate, duration of hospital stay or physiotherapy scoring. We conclude that the introduction of guidelines for transfusion in total hip arthroplasty patients has produced a marked reduction in blood usage in our hospital without detrimental effect.

Aged↗
PubMed2005

Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response.

OBJECTIVE: Esophageal Doppler allows continuous monitoring of stroke volume index (SVI) and corrected flow time (FTc). We hypothesized that variations in stroke output index SOI (SVI/FTc) during volume expansion can predict the hemodynamic response to subsequent fluid loading better than the static values. DESIGN AND SETTING: Prospective study in the intensive care unit of a university hospital. PATIENTS: Fifty-one patients with circulatory failure were monitored by esophageal Doppler. INTERVENTIONS: Patients who responded to a first fluid challenge received a second one. Patients who responded to both were classified as responders-responders, and those who did not respond to the second as responders-nonresponders. In these two groups we compared DeltaSVI, DeltaFTc, and DeltaSOI during each fluid challenge and also static values at the end of each fluid challenge. MEASUREMENTS AND RESULTS: After the first fluid challenge DeltaSOI and DeltaSVI were significantly higher in patients who responded to subsequent volume expansion than in patients who no longer responded. ROC curves showed that DeltaSOI was a better predictor of fluid responsiveness than DeltaSVI. During volume expansion a DeltaSOI value of 11% discriminated between responders and nonresponders to subsequent volume expansion with a sensitivity of 91% and a specificity of 97%. There was no significant difference between the two groups for FTc value at the end of first fluid challenge. CONCLUSIONS: Analysis of DeltaSOI during fluid challenge predicts response to subsequent fluid challenge and FTc is not a reliable indicator of cardiac preload.

Adult↗