| 1. |
- Abildgaard, Lars, et al.
(author)
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Limited effectiveness of intraoperative autotransfusion in major back surgery
- 2001
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In: European Journal of Anaesthesiology. - 0265-0215 .- 1365-2346. ; 18:12, s. 823-828
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Journal article (peer-reviewed)abstract
- Background and objective: The efficiency of intraoperative autotransfusion in scoliosis surgery is poorly known but needs to be evaluated, not least because of the large blood losses in these patients. This is a retrospective analysis of transfusion requirements of 43 such patients. Methods: Records from 43 patients were studied. During surgery, the shed blood was salvaged and washed in an autotransfusion device (AT1000 Auto-transfusion Unit«) and a suspension of red cells was reinfused. Results: Fifty-eight per cent of the intraoperative blood loss was salvaged. The total blood loss during the patients' hospital stay was calculated from the haemoglobin balance, 24% of this loss was salvaged by the device. Moreover, 36 of the patients needed allogeneic blood transfusion. Conclusion: The efficiency of the autotransfusion device was relatively low in relation to the total extravasation, mainly because the postoperative blood loss is substantial.
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| 2. |
- Alberth, Gunnar, et al.
(author)
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Blood loss in prosthetic hip replacement is not influenced by the AB0 blood group
- 2001
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In: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151 .- 1741-9271. ; 167:9, s. 652-655
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Journal article (peer-reviewed)abstract
- Objective: To find out if there is a correlation between AB0 type and the amount of blood lost at operation. Design: Retrospective study. Setting: One county and one university hospital, Sweden. Subjects: 540 patients who underwent primary prosthetic hip replacement under regional anaesthesia. Albumin (n = 298) or dextran (n = 242) were used as plasma substitutes. Main outcome measures: Estimated blood loss and number of units of red cell concentrates transfused. Results: The characteristics of the study groups were similar. In patients given albumin, the mean (SD) intraoperative loss with blood group 0 (n = 100) was 718 (413) ml and 2.7 (1.9) red cell units were given. Those with other blood groups (n = 198) lost 713 (469) ml and were given 2.5 (2.0) units. In patients given dextran with blood group 0 (n = 82), the intraoperative blood loss was 650 (337) ml, the postoperative loss 480 (222) ml and they received 2.1 (2.1) units. The corresponding values in the patients with other blood groups (n = 160) were 665 (351), 498 (208) and 2.5 (2.1) units. Conclusion: Blood group 0 was not associated with increased blood loss.
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| 3. |
- Berg, Sören, 1954-, et al.
(author)
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Albumin extravasation and tissue washout of hyaluronan after plasma volume expansion with crystalloid or hypooncotic colloid solutions
- 2002
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:2, s. 166-172
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Journal article (peer-reviewed)abstract
- Background: Intravascular volume expansion is followed by loss of fluid from the circulation. The extravasation of albumin in this readjustment is insufficiently known. Methods: Twelve male volunteers participated, each in three separate sessions, in a controlled, randomised, open fashion. They received one of the following: albumin 40g/L,(7.1mL/kg, i.e. 500mL per 70kg), Ringer's acetate (21.4mL/kg), or dextran 30g/L (7.1mL/kg). The fluids were infused during 30min and the subjects were followed for 180min. ECG, arterial oxygen saturation and non-invasive arterial pressure were recorded. Haemoglobin, haematocrit, serum albumin and osmolality, plasma colloid osmotic pressure and hyaluronan concentration were determined in venous samples. Results: The serum albumin concentration decreased (P < 0.05, ANOVA) following Ringer's acetate or dextran, whereas serum osmolality was unchanged in all groups. The colloid osmotic pressure decreased (P<0.05) after the Ringer solution. The blood volume increase was estimated from the decrease in haemoglobin concentration and did not differ between the three fluids. The cumulated extravasation of albumin was largest following albumin (10.4 ▒ 5.4g, mean ▒ SD), less following dextran (5.6 ▒ 5.0 g) and negligible in the Ringer group (0.5 ▒ 10.0 g, P < 0.05 against albumin). However, the Ringer solution increased the plasma concentration of hyaluronan drastically. Conclusions: Infusion of hypotonic colloidal solutions entails net loss of albumin from the vascular space. This is not the case after Ringer's acetate. Increased interstitial hydration from the latter fluid is followed by lymphatic wash out of hyaluronan. ⌐ Acta Anaesthesiologica Scandinavica.
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| 4. |
- Good, Lars, 1953-, et al.
(author)
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Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement
- 2003
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In: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 90:5, s. 596-599
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Journal article (peer-reviewed)abstract
- Background. Total knee arthroplasty (TKA) is often carried out using a tourniquet and shed blood is collected in drains. Tranexamic acid decreases the external blood loss. Some blood loss may be concealed, and the overall effect of tranexamic acid on the haemoglobin (Hb) balance is not known. Methods. Patients with osteoarthrosis had unilateral cemented TKA using spinal anaesthesia. In a double-blind fashion, they received either placebo (n=24) or tranexamic acid 10 mg kg-1 (n=27) i.v. just before tourniquet release and 3 h later. The decrease in circulating Hb on the fifth day after surgery, after correction for Hb transfused, was used to calculate the loss of Hb in grams. This value was then expressed as ml of blood loss. Results. The groups had similar characteristics. The median volume of drainage fluid after placebo was 845 (interquartile range 523-990) ml and after tranexamic acid was 385 (331-586) ml (P<0.001). Placebo patients received 2 (0-2) units and tranexamic acid patients 0 (0-0) units of packed red cells (P<0.001). The estimated blood loss was 1426 (1135-1977) ml and 1045 (792-1292) ml, respectively (P<0.001). The hidden loss of blood (calculated as loss minus drainage volume) was 618 (330-1347) ml and 524 (330-9620) ml, respectively (P=0.41). Two patients in each group developed deep vein thrombosis. Conclusions. Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by ~50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.
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| 5. |
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| 6. |
- Metcalf, Kerstin, et al.
(author)
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Aminoguanidine does not influence tissue extravasation of albumin in endotoxaemic rats
- 2001
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:1, s. 112-118
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Journal article (peer-reviewed)abstract
- Background: It is generally maintained that protein and fluid are lost from the circulation under septic conditions. The role played by an increased production of nitric oxide, by the inducible nitric oxide synthase (iNOS), in this process is unclear.Methods: Chloralose anaesthetised male Wistar rats received E. coli lipopolysaccharide (LPS), 3 mg kg−1 i.v., and were studied for 5 h. Mean arterial pressure (MAP) and heart rate (HR) were monitored and haematocrit (Hct) was determined intermittently. Tissue plasma volume and tissue clearances of radiolabelled albumin over the last 2 h of the experiment were determined by a double-isotope method. In 8 rats, 2 h after LPS, aminoguanidine, an iNOS selective blocker, was given i.v. at a dose of 5 mg kg−1. This was followed by a continuous infusion for the duration of the experiment; altogether 20 mg kg−1 was administered. In the control group (n=8), a corresponding volume of saline was infused.Results: Aminoguanidine did not significantly influence Hct, MAP and HR, as evidenced by inter-group comparisons (Mann-Whitney test). Tissue plasma clearances of albumin and tissue plasma volume were similar in both groups.Conclusion: Aminoguanidine at 20 mg kg−1 did not reverse the haemodynamic changes induced by LPS. Neither did the drug affect the tissue plasma clearance of albumin or the tissue plasma volume.
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| 7. |
- Metcalf, Kerstin, et al.
(author)
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Effective inhibition of nitric oxide production by aminoguanidine does not reverse hypotension in endotoxaemic rats
- 2002
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In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 46:1, s. 17-23
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Journal article (peer-reviewed)abstract
- Background: Excess production of nitric oxide (NO) by the inducible NO synthase (iNOS) has been implicated in the pathophysiology of septic shock. Using methaemoglobin (metHb) and the stable NO metabolite nitrate as markers of NO formation, we assessed the effect of iNOS blockade by aminoguanidine (AG) on hypotension and NO formation in endotoxaemic rats.Methods: In 32 male Wistar rats under chloralose anaesthesia, MetHb (at 15 and 330 min, respectively) and plasma nitrate (at 330 min) were determined. Mean arterial pressure, heart rate and haematocrit were monitored. The LPS group (n=8) received bacterial endotoxin (LPS), 3 mg kg−1 i.v. and was subsequently monitored for 5 h. At 2 h after LPS, the LPS+AG20 group (n=8) received AG, 5 mg kg−1, and 5 mg kg−1 h−1 for the remaining 3 h. The LPS+AG100 group (n=8) instead received 25 mg kg−1, followed by 25 mg kg−1 h−1. The NaCl group (n=8) was given corresponding volumes of isotonic saline.Results: AG decreased the LPS-induced rise in plasma nitrate by about 50% in the LPS+AG20 group. MetHb levels, however, were not appreciably reduced by this dose. Both NO metabolites reached control levels after the higher dose of AG. LPS caused a progressive decrease in haematocrit. AG did not influence the LPS-induced hypotension, tachycardia or haemodilution.Conclusion: AG inhibited NO formation in a dose-dependent way. Yet, AG had no haemodynamic effects, suggesting a minor cardiovascular influence of iNOS in this endotoxin model, in parallel to what has been found in microbial sepsis.
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| 8. |
- Zdolsek, Hans Joachim, 1960-, et al.
(author)
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Albumin supplementation during the first week after a burn does not mobilise tissue oedema in humans
- 2001
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In: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 27:5, s. 844-852
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Journal article (peer-reviewed)abstract
- Objective: To measure water balance and changes in distribution, and the effect of giving supplementary albumin, early after a burn injury.Design: Consecutive patients (matched groups) and healthy controls.Setting: National burn unit in a Swedish university hospital.Patients and subjects: Eighteen patients with 18%-90% total burned surface area and 16 healthy male control subjects.Interventions: The patients were given an intravenous infusion of ethanol over 1 h, 0.35-0.60 g/kg body weight, and a bolus of 3.3 to 6.5 g of iohexol. The control subjects were given the same amounts of either ethanol or iohexol. Patients were subdivided into two groups according to whether or not they received supplementary albumin starting 12 h post-burn.Measurements and results: Blood samples were drawn at 20-30 min intervals over 4 h after the start of the infusion. Serum ethanol was measured by headspace gas chromatography, and iohexol with high-pressure liquid chromatography (HPLC). Distribution volume was calculated from the concentration-time profiles. Total body water (TBW) was measured by the ethanol tracer and bioelectric impedance (BIA) techniques, and estimated extracellular water (ECWest) by iohexol tracer. They were all significantly increased after a burn. Excess water was accumulated mainly in the extracellular compartment. It declined towards normal values (those of volunteers) at the end of the week. Albumin supplementation did not influence the amount or distribution of the excess fluid.Conclusion: Body water increases after a burn. Excess water is mainly deposited in the extracellular space. Tissue oedema fluid is not mobilised by albumin supplementation.
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| 9. |
- Zdolsek, Joachim, 1960-, et al.
(author)
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Resuscitation of the severely burned patient
- 2002
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In: International Journal of Intensive Care. - London, UK : Greycoat Publishing Ltd.. - 1350-2794. ; 8, s. 225-231
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Journal article (peer-reviewed)
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| 10. |
- Zdolsek, Joachim, 1960-, et al.
(author)
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Volume replacement/Joachim Boldt.
- 2004
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In: Volume replacement. - Germany : UNI-MED Verlag AG. - 9783895997211 ; , s. -116
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Book chapter (other academic/artistic)abstract
- "This book is not another attempt to create a ""cook book"" on volume replacement of fluid substitution. This book, in contrast, summarizes the up-to-date-knowledge of this topic presented by experts from a wide range of disciplines. Everybody caring for the critically ill will profit from the different chapters at different levels - nurses, students, residents, consultants, and even experts on volume therapy
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