Administration Of Plasma Expander Research Articles

The Effects of HES 130/0.4 Application on Erythrocyte Deformability in Ureteral Obstructed Rats

Aim: The administration of plasma expanders is crucial for managing critically ill patients across a range of clinical conditions, including major surgery, hemorrhagic shock, and trauma. However, the effects of hydroxyethyl starch (HES) on erythrocyte aggregation remain controversial. For this reason, we aimed to investigate the effects of HES 130/0.4, performed renal insufficiency by experimentally unilateral ureteral obstruction, on erythrocyte deformability. Materials and Methods: A total of 24 rats were divided into 4 groups; Control, HES 130/0.4, Ureter Obstruction (UO) and UO-HES130/0.4. Urethral obstruction groups were treated with ketamine anesthesia with a low abdominal incision and reached to the distal of right ureter and sutured with 2.0 mersilen then waited for 3 weeks for late term renal insufficiency. 20 mL.kg-1 of HES 130/0.4 (Voluven) were infused intravenously to the HES 130/0.4 and UO-HES130/0.4 group. After 24-hour, rats were sacrificed. Deformability measurements were performed using 5% haematocrit in a phosphate-buffered saline (PBS) buffer. Results and Discussion: Relative resistance was increased in all groups compared to the control group (p<0.0001). In all groups, erythrocyte deformability index was found to be significantly higher than the control group (Group C-Group HES, p=0.023, Group C- Group UO, p<0.0001, Group C-Group UO-HES, p<0.0001). UO-HES group had significantly increased erythrocyte deformability index compared with the HES group (p=0.031, p=0.021, respectively). It was determined that HES 130/0.4 application did not change erythrocyte deformability in ureteral obstructed rats (p=0.785). Conclusion: The use of HES 130/0.4 has no negative effects on erythrocyte deformability in ureteral obstructed rats. We think that indications should be used correctly when using HES 130/0.4.

P.1.308: ACUTE ALCOHOLIC HEPATITIS IN CIRRHOSIS PATIENTS WITH HEPATORENAL SYNDROME TYPE I: ROLE OF TRANSJUGULAR PORTO-SYSTEMIC STENT SHUNT

P.1.307 – Table 1. Endoscopic spectrum of ulcerative colitis with diverticulosis (UCD), segmental colitis associated with diverticulosis (SCAD), and acute uncomplicated diverticulitis (AUD) UCD (25 pts.) SCAD (129 pts) AUD (130 pts.) Endoscopic spectrum Mild Moderate Severe A B C D Mild Moderate Severe (8 pts.) (10 pts.) (7 pts.) (72 pts.) (36 pts.) (13 pts.) (8 pts.) (67 pts.) (42 pts.) (21 pts.) Diffuse inflammation 7 (87.5) 9 (90.0) 7 (100) – – – 8 (100) 1 (1.5) 1 (2.4) 7 (33.3) Inflammation of inter-diverticular mucosa 1 (12.5) 1 (10.0) – 71 (98.6) 34 (94.4) 11 (84.6) – 2 (3.0) 12 (28.6) 13 (61.9) Inflammation of peri-diverticular mucosa – – – 1 (1.4) 2 (5.6) 2 (15.4) – 64 (95.5) 29 (69.0) 1 (4.8) Data are given as number (percentage) of patients (pts.). tive pts (4 males, mean age 50) affected by AAH (HCV-RNA and HBV-DNA negative) and presenting type 1 HRS. 4 patients had refractory ascites before the development of HRS. All patients had AAH on cirrhosis. HRS and RA (non responders to common therapy) has been diagnosed according to International Ascites Club (1996). Patients were studied after a minimun of 7 days on a 40 mEq/die sodium diet and without diuretics. During this period of observation renal function continued to worsen despite the administration of plasma expanders and vasocostrictors: patients were submitted to TIPS (stent diameter 10 mm) after a written informed consent. In all patients we compared laboratory parameters before intervention and 4 weeks after TIPS. Results: All stents were successfully established, 4 patients presenting minor complications. Function parameters in the table. Before TIPS After TIPS Serum Creatinine (mg/dl) 5.1±0.8 1.6±0.7* Serum Sodium (mEq/L) 124±3 135±3 Sodium Excretion (mEq/L) 6.6±3 65.0±17* Urine Volume (ml/d) 250±4.1 1040±181* *Paired t-test p<0.001. 3-6 months after 4 patients were listed for liver transplantation (status 2A), 2 patients progressively recovery liver function with abstinence, 1 patient presented a abuse alcholic relapse. Conclusions: Even in presence of AAH TIPS allows a satisfactory treatment of functional renal impairment and it is a valid bridge to liver transplantation.

Paroxysmales nicht-hereditäres Angioödem

Recurrent hypovolaemic shock had been occurring over the last five and four years, respectively, in a 53-year-old woman and a 46-year-old man who had previously been healthy. The attacks were characterized by a tension feeling and sometimes oedema in the limbs, as well as increased thirst. Within a few hours sweating, tachycardia, orthostatic complaints and shock would occur. The woman's systolic blood pressure would fall to 70 mm Hg and the pulse rate rise to 150/min. The man's blood pressure was not measurable by sphygmomanometer during his first attack. Haematocrit rose to 61 and 71.5%, haemoglobin concentration to 20.7 and 21.3 g/dl, respectively. On administration of plasma expanders all abnormal clinical and biochemical changes quickly disappeared, only to recur within weeks or months. The cause of the condition is an increased permeability of the tissue capillaries, while renal, pulmonary and cerebral vessels apparently are unaffected. During ketotifen and tebonin (gingko biloba extract) administration to the man, he required no further hospitalization for nine months, after which he had three severe attacks. The woman had a severe attack of hypovolaemic shock one month on this treatment. The prognosis of capillary leak syndrome is bad.

Die Ösophagus-/Fundus-Varizen-Blutung

Oesophageal and fundic varices belong to the most frequent complications of cirrhosis and portal hypertension. Due to their significant morbidity and mortality, bleedings from oesophageal or fundic varices represent a challenge for the emergency medical team as well as for the gastroenterologist. The patient with a variceal bleeding should be accurately monitored and his/her hemodynamic parameters should be maintained stable with the administration of plasma expanders and blood units when indicated. An antibiotic prophylaxis in this setting--norfloxacin or ceftriaxon--has been demonstrated to significantly reduce morbidity and mortality. Additionally, the early administration of vasoactive compounds, such as terlipressin, somatostatin or octreotide, is associated with beneficial effects in reducing the bleeding. An upper gastrointestinal endoscopy should be generally performed within the first twelve hours from the beginning of the bleeding in order to obtain an accurate diagnosis and to provide an adequate treatment. Endoscopic procedures to control the bleeding include the rubber band ligation, the treatment of the varix with a sclerosing agent or the injection of tissue glue into the varix. In case of recurrent bleeding, beyond the above methods, different techniques, such as the transjugular porto-caval shunt, surgical shunt procedures, as well as embolisation of splanchnic blood vessels, represent additional therapeutic options. However, they are associated with very high mortality rates and their indication has to be discussed case by case by an interdisciplinary team of experts. Future therapies include the optimisation and the improvement of the current medical and endoscopic armamentarium, as well as the application of treatments to novel targets, such as the coagulation cascade.

Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites

Paracentesis-induced circulatory dysfunction (PICD) is a recently described complication that can be prevented with the administration of plasma expanders. The aim of this study was to compare the efficacy of saline versus albumin in the prevention of PICD. Patients were randomized to receive albumin or saline after total paracentesis. Patients readmitted as a consequence of a second episode of tense ascites were treated with total paracentesis and the alternative plasma expander. After randomization, 35 patients received saline and 37 received albumin. Twenty-one patients were readmitted for tense ascites and treated with the alternative expander. Significant increases in plasma renin activity (PRA) were found 24 hours and 6 days after paracentesis when saline was used (baseline, 5.6 ± 5.7; 24 hours, 7.6 ± 6.9; 6 days, 8.5 ± 8.0 ng · mL −1 · hr −1; P < .05 and P < .01 vs. baseline, respectively), whereas no significant changes were observed with albumin. The incidence of PICD was significantly higher in the saline group versus the albumin group (33.3% vs. 11.4%, respectively; P = .03). However, no significant differences were found when less than 6 L of ascitic fluid was evacuated (6.7% vs. 5.6% in the saline and albumin groups, respectively; P = .9). Similar results were observed when analyzing patients who received 2 consecutive paracentesis ( i.e., a significant increase in PRA after saline [ P < .01] without significant variations after albumin). In conclusion, albumin is more effective than saline in the prevention of PICD. Saline is a valid alternative to albumin when less than 6 L of ascitic fluid is evacuated. (H epatology 2003;37:1147-1153.)

Hemodynamic Responses to Dobutamine, Hydralazine and Sodium Nitroprusside Following Pentastarch Infusion during Cardiac Tamponade in Dogs

Background : Cardiac tamponade results in a hemodynamic disorder associated with decreased cardiac output and blood pressure. To improve cardiac output in a subject with cardiac tamponade, cardiotonic drugs and vasodilators with blood volume expander can be used. The purpose of this study was to observe the hemodynamic effects of cardiotonic drugs and vasodilators following administration of plasma expander in the dogs with cardiac tamponade. Method : Three groups of dogs were studied during the induced cardiac tamponade. Following infusion of pentastarch, group I received dobutamine by dripping of 10ug/kg/min, followed by injection of 20ug/kg/min, group II received hydralazine (20 mg, 40 mg) and group III received sodium nitroprusside (5ug/kg/min, 10 g/kg/min). The heart rate, blood pressure, cardiac output and pulmonary arterial occluded pressure were measured. The atrial transmural pressure was calculated by subtracting intrapericardial pressure from mean atrial pressure. Results : Cardiac output was increased in the groups I and II, but mean arterial pressure was increased in only the group I. Atrial transmural pressure was not changed in all three groups. Conclusion : The most pronounced hemodynamic improvements during the cardiac tamponade is observed in group I with pentastarch-dobutamine combination. (Korean J Anesthesiol 1998; 35: 852∼860)

Treatment of snakebite poisoning

The epidemiology, mechanics, prevention, pharmacology, clinical manifestations, and treatment of snakebites are reviewed. Poisonous snakes bite approximately 8000 persons annually in the United States, causing approximately 12-15 deaths per year. Pit vipers (rattlesnakes, copperheads, cottonmouths, and massasaugas) are responsible for 99% of all snakebite poisonings; coral snakes and other foreign exotic species are responsible for the additional 1%. Envenomation is characterized by pain, edema, and ecchymoses at or near the site of venom injection, followed by cardiac, hematologic, neurologic, renal, and pulmonary toxicity. The major clinical finding in most snakebite poisonings is local tissue necrosis. Immediate treatment for snakebite includes limiting movement and placing a constriction band proximal to the site of venom injection. If medical care is more than 30 minutes away, the wound may be incised and suctioned. Antivenin therapy is the mainstay of medical treatment of snakebite, along with administration of plasma expanders, pain medication, diazepam, tetanus toxoid, antiseptics, and antibiotics. Patients who have pain, swelling, ecchymoses, systemic symptoms, or abnormal laboratory findings within 30 minutes to one hour of a bite are probable candidates to receive antivenin therapy. Before receiving antivenin therapy, the patient must be tested for hypersensitivity to the antivenin. Antivenin therapy is most effective when given within four hours of the snakebite. Pharmacists--especially those serving rural areas--should be familiar with current snakebite treatments, both local and systemic, and should be prepared to provide important information and dispel any myths about snakebite poisoning.

A STUDY OF RENAL FUNCTIONS AFTER THE ADMINISTRATION OF CISPLATIN IN ESOPHAGEAL CANCER PATIENTS

Cisplatin including pre- and postoperative chemotheropy was carried out in 16 esophageal cancer patients and various renal functions were monitored after cisplatin administration in total 27 courses. Nephrotoxicity (≥grade 2) occurred in 37.5% of the cases inspite of massive fluid load with diuretics. Renal tubular dysfunction was the main body of nephrotoxicity by cisplatin, accompanied by mild glomerular dysfunction. Both functions were aggravated in the second course of chemotherapy. Hyponatremia (≥130 mEq/l) was observed in 44% of the cases, of which creatinine clearance was worse than that of non-hyponatremic cases. Plasma hormonal changes were monitored in five cases, where aldosteron tended to increase and atrial natriuretic peptide tended to decrease after cisplatin administration. Decrease in serum natrium and insufficient fluid load were conceived to be its reason. It is necessary to improve the infusion therapy regarding to a dose of sodium administration, infusion volume, and administration of plasma expander.

FUNCTIONAL BEHAVIOR OF THE LOW PRESSURE SYSTEM UNDER HIGH SPINAL ANESTHESIA

In order to investigate the functional behavior of low pressure system in hypotension (68±2.1% of the control value of systolic pressure of the aorta) due to high spinal anesthesia, mean circulatory filling pressure (Pms), venous to arterial capacitance ratio (CV/CA), effective compliance (EC) of the low pressure system and, in addition, dynamic performance of right atrium were measured on thoracotomized dogs. Pms and EC were decreased, whereas CV/CA was increased, by spinal anesthesia and restored by administration of plasma expander with an elevation of systolic pressure of the aorta. Among the dynamic performances of the right atrium, the passive filling phase was noted to be an important factor in the venous return mechanism. The control value of filling time ratio was 52±7.6% (average±S.E.) on thoracotomized dogs under nitrous oxide and pancuronium anesthesia. The time ratio was decreased by spinal anesthesia and restored or even increased with an administration of plasma expander. In order to keep the maintenance of the systolic blood pressure well above the control level in the condition of hypotension due to high spinal anesthesia, the vasopressors, such as nor-epinephrine and phenylephrine were needed to be administered after a certain amount of plasma expander had been given (20 ml/Kg). Under such a condition, nor-epinephrine (0.8 μg/Kg/min.) maintained the time ratio of right atrial filling more favorably than phenylephrine (0.03 mg/Kg/min.). Besides, nor-epinephrine immediately decreased an extreme elevation of right atrial wall tension which had been caused by volume effect of plasma expander. With these results, we considered that the important factors for maintaining the functional behavior of the low pressure system in hypotension due to spinal anesthesia would be a volume (its filling pressure) and the compliance.