Amount Of Crystalloid Solution Research Articles

Sufficient Thrombin Generation Despite 95% Hemodilution: An In Vitro Experimental Study.

Guidelines for the treatment of severe bleeding comprise viscoelastic-test-guided use of coagulation factor concentrates as part of their recommendations. The aim of this study is to investigate the effects of substituting fibrinogen, prothrombin complex concentrate, and a combination of both on conventional coagulation tests, viscoelastic test results, and thrombin generation. Blood was drawn from seven healthy volunteers to obtain platelet-free plasma, which later was diluted by replacing 40%, 60%, 80%, 90%, 95%, and 99% with a crystalloid solution. The diluted samples were spiked with fibrinogen concentrate, prothrombin complex concentrate, a combination of both, or a corresponding amount of crystalloid solution. Up to a dilution level of 95%, viscoelastically determined clotting time was significantly shorter in the group substituted with fibrinogen only in comparison with the additional use of prothrombin complex concentrate. Clot firmness and endogenous thrombin potential remained at relatively stable values up to a dilution level of 95% with the substitution of fibrinogen but not prothrombin complex concentrate. Substitution of prothrombin complex concentrate led to an excessive overshoot of thrombin generation. The results of our study question currently propagated treatment algorithms for bleeding patients that include the use of prothrombin complex concentrate for patients without former intake of oral anticoagulants. Even in severely bleeding patients, thrombin generation might be sufficient to achieve adequate hemostasis.

Comparison of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement

Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed.Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group (group PNB, n=147) and peripheral nerve block combined with general anesthesia group (group PNB+ GA, n=134). The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation.The duration of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded.The development of complications within 48 h after operation, therapy after admission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+ GA, and the amount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+ GA (P<0.05). Compared with group PNB+ GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB (P<0.05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement. Key words: Arthroplasty, replacement, hip; Nerve block; Lumbosacral plexus

Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India

To evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. This was a prospective study performed at Bansal Hospital, Bhopal. Predetermined autologous blood was collected in a well-labeled bag containing citrate phosphate dextrose adenine solution after induction of general anesthesia. Then appropriate amount of crystalloid solution was transfused in to the body. All collected autologous blood was transfused back to the patient at the end of the surgery or during the surgery if excessive blood loss occurred. Demographic data, hemodynamic changes (mean arterial pressure, heart rate) before and after donation, complications, and any additional homologous blood requirement were noted. Pre- and postoperative hemoglobin and hematocrit values were compared. In total, 32 patients were included in this study. In our study, mean age was 48.87 years; male-to-female ratio was 1:1.4. The mean amount of autologous blood collected was 461 mL, and the mean amount of blood loss during surgery was 1048 mL. In our study, there was no statistically significant difference was found in mean arterial pressure and heart rate before and after autologous blood collection (P > 0.05). When we compared pre- and postoperative mean hemoglobin and hematocrit levels, there was a statistically significant difference present (P<0.05); this was due to the fact that many patients had meningiomas (15 of 32). Additional homologous blood was required only in 25% of cases (8/32). Of 8 patients, 5 were again cases of deep-seated meningiomas. No complications were observed during or after autologous blood collection. Autologous blood transfusion is a safe, effective, and affordable method of blood transfusion in patients undergoing intracranial surgery. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion.

Effect of low-dose norepinephrine on efficacy of FloTrac/Vigileo system in guiding goal-directed fluid therapy in neurosurgical procedures

Objective To evaluate the effect of low-dose norepinephrine on the efficacy of FloTrac/Vigileo system in guiding goal-directed fluid therapy(GDT)in neurosurgical procedures. Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m2, of New York Heart Association class Ⅰ or Ⅱ, with left ventricular ejection fraction>50%, were divided into 3 groups(n=30 each)using a random number table: control group(group C), group GDT and low-dose norepinephrine plus GDT group(group NE+ GDT). The total volume of fluid infused was calculated according to the 4-2-1 rule, and routine fluid therapy was performed in group C. Fluid therapy was performed according to stroke volume variation(SVV)under the guidance of FloTrac/Vigileo system in group GDT.In group NE+ GDT, fluid therapy was performed according to SVV under FloTrac/Vigileo system guidance, and norepinephrine 0.01-0.03 μg·kg-1·min-1 was intravenously infused at the same time.The total volume of fluid infused, amount of crystalloid solution and colloid solution infused, blood loss, urine volume and requirement for ephedrine were recorded during operation.The pH value, base excess, blood lactate and hemoglobin(Hb)were recorded immediately before skin incision and at the end of operation. Results Compared with group C, the amount of crystalloid solution infused and urine volume were significantly reduced, the amount of colloid solution infused was increased, the requirement for ephedrine was reduced, the concentration of blood lactate was decreased at the end of operation, and the concentration of Hb was increased in group GDT(P 0.05). Conclusion Application of low-dose norepinephrine(0.01-0.03 μg· kg-1·min-1)in neurosurgical procedures does not affect the efficacy of FloTrac/Vigileo system in guiding GDT. Key words: Norepinephrine; Fluid therapy; Neurosurgical procedures

Efficacy of stroke volume variation combined with low central venous pressure-directed fluid therapy in patients undergoing liver cancer resection

Objective To evaluate the efficacy of stroke volume variation(SVV)combined with controlled low central venous pressure(CLCVP)-directed fluid therapy in the patients undergoing liver cancer resection. Methods Seventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 40-60 yr, with body mass index of 20-25 kg/m2, scheduled for elective liver cancer resection under general anesthesia, were divided into 2 groups(n=35 each) using a random number table: routine fluid replacement group(R group) and SVV combined with CLCVP-guided fluid replacement group(SC group). In R group, routine fluid replacement included compensatory volume expansion, physiological requirement, cumulative loss, continued loss (intraoperative blood loss) and 3rd space losses, maintaining mean arterial pressure>70 mmHg, central venous pressure<4 cmH2O and heart rate <100 bpm.Central venous pressure was maintained <4 cmH2O and SVV <12% during operation in SC group.The operation time, total amount of crystalloid and colloid solution infused, urine volume and development of intraoperative hypotension and bradycardia were recorded.Blood samples from the left radial artery and central vein were collected before anesthesia induction and at the end of operation for measurement of the blood lactate concentration, and the oxygen supply index, oxygen consumption index and oxygen uptake rate were calculated.Blood samples from the ulnar vein were collected before anesthesia induction and at the end of operation for determination of serum β2-microglobulin concentrations.The development of intraoperative adverse cardiovascular events was recorded, and the occurrence of postoperative complications was observed. Results Compared with R group, the total amount of crystalloid solution infused was significantly decreased, the total amount of colloid solution infused and urine volume were increased, the incidence of intraoperative hypotension and bradycardia was decreased, oxygen supply index, oxygen consumption index and oxygen uptake rate were increased at the end of operation, and the lactate concentration in arterial blood, serum β2-microglobulin concentration and rate of postoperative pulmonary infection were decreased in SC group (P<0.05). Conclusion SVV combined with CLCVP-directed fluid therapy produces better efficacy than routine fluid replacement in the patients undergoing liver resection. Key words: Stroke volume; Central venous pressure; Liver neoplasms

Emergency department crowding and the performance of damage control resuscitation in major trauma patients with hemorrhagic shock.

Uncontrolled hemorrhagic shock is the leading cause of potentially preventable death in major trauma patients. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation, and damage control surgery, has been highly recommended for trauma patients. This study investigated whether emergency department (ED) crowding was associated with poor performance of the DCR strategies in treating hemorrhagic shock trauma patients. This was a retrospective cohort study in an urban tertiary hospital conducted from January 2010 to December 2013. Major trauma patients who presented to the ED with hemorrhagic shock were included. ED crowding, measured by ED occupancy rate, was categorized into three groups (low, medium, and high). The performance of DCR and inpatient outcomes were analyzed using multivariate logistic analysis. Of the 3,037 major trauma patients assessed, 852 met the inclusion criteria and were enrolled in the study. Patients in the high-crowding group had delayed initiation of transfusion (high vs. medium and low, 2.5 hours vs. 2.1 hours and 1.0 hours, respectively, p = 0.01), received less blood products in the ED (both comparisons p < 0.01), and experienced delays in procedures (4.5 hours vs. 3.3 hours and 2.4 hours, p < 0.01). However, the amount of crystalloid solution was similar among patients in all three groups (p = 0.17). In multivariate analysis, more patients from the high-crowding group developed traumatic coagulopathy in the intensive care unit (29.7% vs. 24.1% and 16.3%, p < 0.01), while no clear relationship was found between ED crowding and 30-day mortality or early lactate clearance rate (p > 0.05). ED crowding was associated with poor performance of DCR for major trauma patients in the ED. New strategies should be implemented to ameliorate crowded conditions and potential adverse outcomes.