[Effect of plasma substitute solutions on the respiratory function of the blood in hemorrhagic shock of rabbits in the state of wakefulness].
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Acid-Base Equilibrium↗
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Results for “PLASMA SUBSTITUTES”
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[Clinical studies on possible side effects of a plasma substitute on the basis of gelatin (in spinal anesthesia)].
In 265 patients who were infused 500 ml of modified gelatin during spinal anesthesia, examinations for adverse effects were carried out. Only in one case a weak reaction (shivering) was observed. Other clinically manifest side effects could not be detected.
Adolescent↗
The disturbance of hemostasis in septic shock: role of neutrophil elastase and thrombin, effects of antithrombin III and plasma substitution.
In 42 patients with septic shock, 29 of whom underwent substitution with antithrombin III concentrate and fresh frozen plasma for coagulation disorders, the proteinase-inhibitor complexes thrombin-antithrombin III and neutrophil elastase-alpha 1 proteinase inhibitor, were elevated on admission. On admission, the elastase complex was significantly higher in the patients receiving substitution (p = 0.0039), but at the endpoint it was higher in the non-survivors (p = 0.0040). The elastase decrease was confined to the substitution group with the thrombin complex decreasing in both groups. Initially the thrombin complex correlated with prothrombin times and factor XIII, while the elastase complex correlated with creatinine, thrombocyte count and prothrombin times in the late stages. Hemostatic disturbance, thrombin generation and neutrophil elastase release were favorably influenced by substitution. Furthermore, in this uncontrolled pilot study, the survival rate was higher in the treated (16 of 29) than in the untreated (1 of 13) patients, although the treated patients initially had pronounced hemostatic disturbances.
Adolescent↗
Adverse reactions in connection with albumin and other plasma substitutes.
The side effects after the infusion of human albumin solutions, stabilized human serum and a modified gelatin are analysed. Diseases and indications for the application are listed. Intervals between application and side effects as well as frequency and type of symptoms are shown. Different symptoms and intervals allow the conclusion that different pathomechanism are responsible for the adverse reactions. Due to a steady improvement in production and control the number of reported adverse reactions shows a steady decrease.
Cardiovascular Diseases↗
[Transfusion therapy of traumatic shock using plasma substitutes oxyamal and volecam].
The work is devoted to the investigation of efficiency of antishock transfusion therapy by new soviet drugs on the basis of hydroxyethyl starch--Oxyamal and Volecam. The investigation was performed on 30 patients with trauma shock and hypovolemic syndrome. The clinico-laboratory data obtained have shown that transfusion of Oxyamal and Volecam allow to rapidly normalize disturbed parameters of the central hemodynamics and continuously maintain them at the due level.
Adolescent↗
[The effect of intravenous administrations of a plasma substitute solution made from whey on gastric secretory function].
Intravenous injection of the blood-substituting solution from milk serum has exerted a stimulating effect on the stomach secretion in experiments on dogs with stomach fistula. Secretion of acid, a decrease in pH of the juice, an increase in secretion of protein and intensification of the digestive ability of the juice were observed during infusion of the preparation and in the nearest period after it. Infusion of the milk serum preparation with succinate was not followed by activation of the stomach secretion.
Animals↗
[Physico-chemical and biological properties of a new plasma substitute based on hydroxyethylated starch].
Samples of hydroxyethylstarch of M 100-160 kDa, Mn 50-60 kDa and substitution degree 0.6-0.7 were prepared and characterized. Hydroxyethylstarch was shown to be susceptible to cleavage by amylolytic enzymes. All samples of hydroxyethylstarch at 2-4% concentration were compatible with perfluorohydrocarbon emulsion "Perftoran" and exhibited high haemodynamic efficiency. The 6 and 10% solutions of hydroxyethylstarch in 0.9% aqueous sodium chloride normalized haemodynamics in massive blood losses. Hydroxyethylstarch was completely removed from blood-stream. The preparations were shown to be nontoxic.
Chemical Phenomena↗
Assessment of haemodynamic changes and acid-base equilibrium during hypovolaemia and after infusion of plasma substitutes in dogs.
The following haemodynamic values were determined in anaesthetized mongrel dogs: heart rate, systolic blood pressure in the ascending aorta, left ventricular pressure at the peak dp/dt, left ventricular end-diastolic pressure, time interval from Q in ECG to the onset of the systolic wave of dp/dt, time interval from Q in ECG to peak dp/dt, maximum rate of left ventricular pressure rise, femoral arterial flow, and certain indices of left ventricular contractility. It was concluded from the results of these experiments that infusion of a modified gelatin solution Fluigel prevented haemodynamic and metabolic changes produced by experimental hypovolaemia more effectively than infusion of Plasmagel.
Acid-Base Equilibrium↗
[Hydroxyethyl starch as plasma substitute: experiments in isovolamic haemodilution (author's transl)].
Isovolaemic haemodilution to a hematocrit of 10% was achieved by stepwise exchange of blood against 6% hydroxyethyl starch (HES) in 11 splenectomized dogs. All animals survived the actuely performed extreme haemodilution; one animal died 5 days later due to massive bilateral pneumonia. Blood volume as determined by 51Cr-tagged red cells was unchanged at hematocrit 10%; 2 and 5 hours after reaching the minimum haematocrit, blood volume was reduced by 7 and 15% of control. At day 3 after dilution, blood volume was normal again. Thus under conditions of extreme isovolaemic haemodilution the volume effect of hydroxyethyl starch was found inferior to that of dextran 60. Haemodilution with HES was associated with a presistent augmentation of the serum concentration alpha-amylase.
Amylases↗
Oxygen consumption and recovery from surgical shock in rats: a comparison of the efficacy of different plasma substitutes.
Shock was induced in 537 rats by exteriorization of the intestines and occlusion of the superior mesenteric circulation for 1 hour. After 1 hour of this intestinal ischemia shock, oxygen consumption (VO2) decreased to half of the preexperimental values. When no infusion was given, the survival rate at 24 hours was 22%; this was correlated with the degree of restoration of VO2 at 1 hour after shock. VO2 and survival rate improved with infusion of albumin, dextran 40, and dextran 40, and dextran 70. With increasing doses of colloids, both VO2 and survival rate increased; the optimal effect was at the dose of 2 g/kg body weight. When no other therapy was given, colloids at concentrations of 3.5 or 6% solutions had a better effect on survival than the 10% solution. Colloids were more effective than Ringer's acetate when the latter was given in the same volume and up to three times the volume of the colloids.
Animals↗
Reduced quality of clot formation with gelatin-based plasma substitutes.
We have studied, over a wide range of dilutions using techniques of clot weight, thrombelastography and scanning electron microscopy, the physical properties of a blood clot formed in vitro when fresh blood was diluted with gelatin-based colloid solutions compared with crystalloid controls. The colloid solutions tested (3.5% polygeline (Haemaccel) and 4% succinylated gelatin (Gelofusine)) produced clots that had reduced median weight (P < 0.001 and P = 0.018, respectively) and reduced mean shear modulus (P < 0.001) compared with crystalloid controls. Scanning electron microscopy showed that the fibrin formed a less extensive mesh in the presence of the gelatin-based colloids compared with crystalloid. Reduction in clot quality with gelatin-based colloids has not been noted previously and further work is needed to ascertain if this occurs in vivo as these solutions are used frequently in patients who require full haemostatic competence.
Blood Cells↗
Critical haemoglobin concentration in anaesthetized dogs: comparison of two plasma substitutes.
We have explored systemic and regional tolerance to haemodilution during anaesthesia with two different synthetic colloids. Eighteen dogs undergoing mechanical ventilation during anaesthesia with ketamine were submitted to progressive normovolaemic haemodilution with either gelatin (GEL; n = 9) or hydroxyethylstarch (HES; n = 9) administered on a 1:1 ratio. Systemic oxygen delivery was calculated from measurement of thermodilution cardiac output and arterial oxygen content, while systemic oxygen consumption was determined from expired gas analysis. Mesenteric oxygen delivery and consumption were determined using ultrasonic flow measurements, and arterial and mesenteric venous oxygen contents. The critical haemoglobin concentration (i.e. the haemoglobin value below which oxygen consumption becomes oxygen delivery dependent) was mean 3.6 (SD 0.8) g dl-1 in the GEL and 3.5 (1.5) g dl-1 in the HES group. The mesenteric critical oxygen extraction ratio (O2ER) (GEL 50.1 (12.1)%; HES 48.5 (13.4)%) was significant lower than the systemic critical O2ER (GEL 66.1 (8.4)%; HES 67.7 (7.1)%). There were no significant differences between the GEL and HES groups for any of these variables, or in the amount of colloid administered. During the study, oxygen delivery decreased almost linearly with reduction in haemoglobin, indicating a lack of cardiac output response to anaemia during ketamine anaesthesia.
Anesthesia, Intravenous↗
Benefits of blood cell transplant cryopreservation with oxypolygelatine (Gelifundol) plasma substitute.
In two groups of 11 patients with poor prognosis malignancies undergoing high-dose sequential chemotherapy, we have evaluated the cryopreservation of blood cell transplants with oxypolygelatine-containing (55% oxypolygelatine, 6% hydroxyethylstarch, 5% dimethyl sulfoxide) vs standard human serum-containing (55% human serum, 6% hydroxyethylstarch, 5% dimethyl sulfoxide) cryoprotectant mixtures. Evidence is presented demonstrating that substitution of human serum proteins with oxypolygelatine has no detrimental effect either in vitro on the post-thawing recovery of hematopoietic progenitors or in vivo on the capacity of marrow reconstituting function in patients treated with myeloablative cancer therapy and autologous blood cell transplant. Oxypolygelatine is commercially available for clinical use as a plasma expander, is 30-fold less expensive than human serum albumin, is certified free of foreign serum proteins and antibodies as well as free of pyrogen, viral, mycoplasmal and bovine spongiform encephalopathy contaminants. Because of these characteristics, oxypolygelatine permits avoidance of: (1) the use of expensive serum albumin; (2) the fastidious preparation of autologous plasma or serum, and (3) the risk of infection associated with the infusion of allogeneic serum. Because of these practical advantages, we recommend the clinical use of oxypolygelatine as a substitute for human serum proteins for the routine cryopreservation of blood cell transplants.
Adult↗
Rheological properties of commonly used plasma substitutes during preoperative normovolaemic acute haemodilution.
Preoperative normovolaemic acute haemodilution (PNAH) is used to reduce major blood loss during elective surgery. Considerable attention has been paid to colloid osmotic pressure, index of diffusibility and intravascular half-life of the currently available substitutes, but there is little information on their rheological properties from in vivo studies. Forty patients undergoing elective aortic reconstruction were given 4% human albumin (HA), 3.5% dextran 40 (Dxt 40), 6% dextran 60 (Dxt 60), 6% hydroxyethylstarch 200 (HES) or modified fluid gelatin (Gel) during PNAH to produce a packed cell volume (PCV) of approximately 30%. Mean volumes of more than 1000 ml were infused. Blood samples were obtained before infusion, immediately after, and 1.5 h after the end of haemodilution. The following variables were measured: PCV, plasma viscosity, whole blood viscosity at measured and corrected PCV (0.45), and erythrocyte aggregation. Haemodynamic and metabolic variables were determined at the same time. The five substitutes had very different effects on red blood cell aggregation and low shear rate viscosity at corrected PCV. Red blood cell aggregation was reduced in the presence of HA, Dxt 40, but was increased moderately to markedly in the presence of the other substitutes in the following order: HES < Dxt 60 < Gel. The influence of the rheological conditions on tissue oxygenation was assessed by measuring the concentration of lactic acid; this was unchanged after PNAH with HA or Dxt 40, but was increased in the presence of HES, Dxt 60 or Gel.
Adult↗
[On plasma-substituting properties of aminopeptide hydrolysate in the treatment of acute massive hemorrhages in animals].
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Animals↗
Antithrombin III and plasma substitution in septic shock.
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Antithrombin III↗
Statement on normal (whole, pooled) human plasma prepared by Committee on Plasma and Plasma Substitutes of the Division of Medical Sciences, National Research Council.
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Adrenal Insufficiency↗
Prophylaxis of anaphylactoid reactions to a polypeptidal plasma substitute by H1- plus H2-receptor antagonists: synopsis of three randomized controlled trials.
To demonstrate the efficacy of a premedication with H1- + H2-receptor antagonists against histamine-release responses in anaesthesia and surgery 3 randomized controlled trials were conducted in patients, volunteers and experimental animals (dogs). Cutaneous anaphylactoid reactions following infusion of polygeline (Haemaccel) in orthopedic patients were successfully abolished by premedication with 0.1 mg/kg dimethpyrindene (Fenistil) and 5 mg/kg cimetidine (Tagamet). Chlorpheniramine (Piriton) was also useful, but dimethpyrindene was more effective in the doses recommended and used. Side-effects of the premedication were not observed when the 2 drugs were slowly administered (2 min each). Systemic anaphylactoid reactions following infusion of polygeline were completely prevented in volunteers by the same premedication (0.1 mg/kg dimethpyrindene and 10 mg/kg cimetidine). Life-threatening reactions could not be tested in human subjects, but were elicited in experimental animals (dogs). In this species which resembles man in its sensitivity against histamine, in plasma histamine levels and in response to polygeline life-threatening reactions were prevented or in especially severe cases diminished to such an extent by the premedication with H1- + H2-blockers that this premedication was finally judged to be very effective against histamine-release responses of any grade of severity. To confirm this clinically very important hypothesis more clinical trials in patients at risk for anaphylactoid reactions to drugs are urgently needed.
Adult↗