[Intervention-adjusted intraoperative volume substitution--an example of surgical-anesthesiological cooperation]. / Eingriffsadaptierte intraoperative Volumensubstitution--Beispiel chirurgisch-anästhesiologischer Kooperation.

Since 1996 a simple classification of surgical interventions has been used to guarantee adequate intraoperative anesthesiological volume management. Use of this classification, including extension of operation and operative trauma, resulted in 45% less substitution with blood components in comparison to that observed in 1995.

[A comparative study of the effectiveness of 5% human albumin and 10% hydroxyethyl starch (HAES-steril) for correcting hemodynamics and O2 transport in surgical interventions]. / Sravnitel'noe issledovanie éffektivnosti primeneniia pri khirurgicheskikh vmeshatel'stvakh 5% chelovecheskogo al'bumina i 10% gidroksiétil-krakhmala (HAES-steril) po pokazateliam gemodinamiki i transporta O2.

Forty patients subjected to cavitary operations were examined. A high risk of hemodynamic disorders necessitated invasive monitoring; with this aim in view a catheter was inserted for measuring arterial pressure and the Swan-Ganz catheter for measuring the pressure in the pulmonary artery, in which helped monitor the hemodynamics and oxygen transport in the course of hypervolemic hemodilution. Plasma substitutes (one of two) were selected at random. After catheterization of the left radial artery and insertion of the Swan-Ganz catheter in the pulmonary artery through the internal right jugular vein the patients were infused either 5% human albumin or 10% hydroxyethyl starch in a dose of 125 ml every 5 min. The parameters of hemodynamics and oxygen transport were recorded after 500 ml of the solution was infused and the wedge pressure of 18 mm Hg attained. Both agents appreciably improved the mean arterial pressure, central nervous pressure, and wedge pressure. Cardiac index, left ventricular output, and stroke volume increased in both groups, and the pulmonary vascular resistance decreased. Both agents improved oxygen utilization and appreciably decreased hemoglobin level. The positive effect of hydroxyethyl starch on cardiac index, pulmonary vascular resistance, left ventricular output, and oxygen utilization was more expressed; moreover, a lesser dose of this drug was needed than of 5% human albumin (Behringwerke, Marburg, Germany). Loss of plasma caused by surgical intervention was better compensated for with synthetic colloid solutions, such as 10% HAES-steril (Fresinium, Oberurzel, Germany), provided that plasma protein level was at least 3-4 g/dl. The effect of 10% HAES-steril as regards the increase of circulating blood volume is 145%. Due to the hyperoncotic direction of its action it has a positive impact on the hemodynamics and oxygen transport and is needed in lower doses than other colloid solutions.

[Comparative study of the intraoperative effectiveness of 5% human albumin or 10% hydroxyethyl starch (HAES-steril) on hemodynamics and oxygen transport in 40 patients]. / Vergleichende Untersuchung zur intraoperativen Wirksamkeit von 5% Humanalbumin oder 10% Hydroxyäthylstärke (HAES-steril) auf Hämodynamik und Sauerstofftransport bei 40 Patienten.

In 40 patients, whose expected hemodynamic instability during surgery necessitated invasive monitoring (Swan-Ganz catheter) and arterial pressure monitoring the hemodynamic and oxygen transport parameters in conditions of hypervolemic hemodilution were investigated in randomized tests. After insertion of an arterial catheter (arteria radialis) as well as Swan-Ganz pulmonary arterial catheter via the vena jugularis interna, one of the two volume substitutes selected at random was infused in quantities of 125 ml/5 min and the hemodynamic changes were measured after infusion of 500 ml and finally after a wedge pressure of 18 mmHg was reached. Using either solution, the measurements indicated significant increases in mean arterial pressure as well as in central venous pressure (ZVD) and wedge pressure. The cardiac index, left ventricular stroke work index, and stroke output rose consecutively and pulmonary vascular resistance went down in both test groups. In the case of both volume substitutes, there was an improvement in oxygen availability. The hemoglobin content decreased in both groups, though to different degrees in each group. Although the hydroxyethyl starch group registered a greater improvement in the cardiac index, a bigger decrease in pulmonary vascular resistance, a higher rise in the left ventricular stroke work index and a more significant improvement in stroke output, smaller quantities of the volume substitute were required in this group than in the group in which volume substitution was carried out with human albumin 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of prognostic indices based on hemodynamic and oxygen transport variables in shock patients with adult respiratory distress syndrome.

We tested prospectively 30 hypotensive shock patients using a continuous, on-line, real-time hemodynamic and oxygen transport monitoring system with a previously described predictive index, modified for the clinical conditions in our ICU. Continuous monitoring and display of cardiac output and 20 or more derived variables, together with the predictive index, were a feasible and useful approach. Unlike previously documented series of elective postoperative general surgical patients, our series consisted of patients with multiple trauma, myocardial infarction, sepsis, and other medical emergencies as well as postoperative cardiac and general surgical patients, all of whom had respiratory failure (acute respiratory distress syndrome). In addition to these differences, our patients were invariably admitted to the ICU after the nadir of their hypotensive crisis. To compare the continuous recorded values with previous studies that used intermittent measurements, three comparable time intervals were selected; data at these time intervals and the predictions derived from them were in satisfactory agreement with prior studies. Moreover, therapeutic goals based on the median values of survivors of the present series were similar, but not identical, to prior series despite differences in the clinical mix and the later postresuscitation ICU admissions of our series.