The Experts below are selected from a list of 64173 Experts worldwide ranked by ideXlab platform

K. Messmer - One of the best experts on this subject based on the ideXlab platform.

  • effects of ultra purified polymerized bovine hemoglobin on the microcirculation of striated skin muscle in the hamster
    European Journal of Medical Research, 1996
    Co-Authors: A Botzlar, D Nolte, K. Messmer
    Abstract:

    Since the beginning of this century, the development of hemoglobin based oxygen carriers has been propagated for replacement of the oxygen carrying properties of red blood cells. A breakthrough has been impeded by problems related to the hemoglobin molecule itself and the ingredients of the solution, resulting in nephrotoxic side effects, limited intravascular half-life, vasoconstrictor potential and potential catalysis of oxygen free radical formation. Using intravital fluorescence microscopy and the dorsal skin fold chamber model of the awake Syrian golden hamster, the microcirculatory changes occurring in the thin striated skin muscle were quantitatively analyzed before and after administration of an ultrapurified polymerized bovine hemoglobin solution (U-PBHb) under the following experimental conditions: (1) Hypervolemic infusion of U-PBHb at approximately 10% of calculated blood volume, (2) isovolemic exchange transfusion with U-PBHBb by replacing approximately 50% of calculated blood volume and (3) severe hemorrhagic shock by acute bleeding of approximately 50% of calculated blood volume to a MAP of 35 +/- 5 mm Hg for 45 min followed by resuscitation with U-PBHb. Control animals received equivalent treatment with vehicle solution, Dextran 60 (M(r) 60,000 D) or Ringer's lactate. The microcirculation was found unchanged after both hypervolemic infusion and isovolemic exchange transfusion with respect to perfusion quality and leukocyte/ endothelium interaction while a decrease of functional capillary density by approximately 25% was observed after exchange transfusion with U-PBHb. After hemorrhagic shock, microvascular perfusion was most efficiently restored by U-PBHb without evidence of arteriolar vasoconstriction or activation of leukocyte/endothelial cell interactions during reperfusion. These data indicate, the U-PBHb exerts no unwanted side effects on the microcirculation either under non-ischemic or post-ischemic conditions. The microcirculatory findings post-resuscitation let U-PBHb appear as a safe resuscitation fluid which is superior to the commonly used resuscitation fluids, Ringer's lactate and Dextran 60.

  • Dextran vs hydroxyethylstarch in inhibition of postischemic leukocyte adherence in striated muscle
    Circulatory shock, 1993
    Co-Authors: C Thierjung, F Hammersen, K. Messmer
    Abstract:

    Microvascular injury associated with ischemia/reperfusion (I/R) is characterized by both "no reflow" and "reflow paradox." Prophylactic isovolemic hemodilution with Dextran 60 to a hematocrit of 30% has been shown to prevent I/R-induced capillary no reflow in striated muscle. The objective of the present study was to analyze whether hemodilution prior to ischemia has the potential to reduce postischemic leukocyte-endothelium interaction, which is known to be one of the major components of I/R-induced reflow paradox. Syrian golden hamsters (n = 21) were fitted with a dorsal skinfold chamber, which contains striated muscle and subcutaneous tissue and allows for repetitive analyses of the microcirculation by means of intravital fluorescence microscopy. Four hr of pressure-induced ischemia and 30 min of subsequent reperfusion (controls, n = 7) resulted in a significant (P < 0.05) increase of microvascular leukocyte accumulation (40,630 +/- 12,731 mm-3) and adherence to the endothelial lining of postcapillary venules (74.2% +/- 11.5%) when compared to preischemic baseline (7,502 +/- 1,700 mm-3 and 3.4% +/- 1.0%, respectively). Recovery was not complete after an observation period of 24 hr reperfusion [13,735 +/- 2,666 mm-3 (P < 0.05) and 18.5% +/- 6.0% (P < 0.05)]. Prophylactic isovolemic hemodilution with 6% Dextran 60 (Dx60) to a hematocrit of 30% (Dx60, n = 7) significantly attenuated postischemic leukocyte accumulation (23,402 +/- 13,837 mm-3; P < 0.05 vs. controls) and adherence (22.6% +/- 6.4%; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  • organ blood supply and tissue oxygenation after limited normovolemic hemodilution with 3 versus 6 Dextran 60
    Infusionstherapie Und Transfusionsmedizin, 1993
    Co-Authors: U B Bruckner, F Kefalianakis, H Krieter, K. Messmer
    Abstract:

    Background: The use of Dextran solutions (DX) for hemodilution (HD) is considered being detrimental due to their effects on plasma viscosity. Methods: 14 splenectomized beagles (12.7+1.3 kg) were anesthetized and randomly assigned to HD to 20 vol% hematocrit (hct) with either 3 or 6% DX-60. The effects of HD upon nutritional organ blood flow (radioisotope-labelled microspheres, O 15 µm), local tissue oxygenation (pO2 multiwire surface electrode), plasma and blood volume (131I-labelled dog albumin distribution), and macrohemodynamics were evaluated with regard to actual changes in hct and plasma viscosity, respectively. Results: Normovolemic HD with either solution resulted in equivalent changes in macrohemodynamics, and plasma and blood volume. Despite the increase in plasma viscosity associated with HD using 6% DX-60 (up to 1.45+0.10 mPa-s), blood flow rose in all organs studied (p Conclusion: In comparison to 6% DX-60, the solution of 3% DX-60 is of equivalent efficacy as volume substitute and in the induction of normovolemic HD. The main advantage of 3% DX-60 solution, however, is the fact that twice as much volume can be administered before the recommended maximal daily dose of 1.5 g/kg DX is reached. Of the rheological factors influencing oxygen delivery, hematocrit thus plays the predominant role, while plasma viscosity is of minor importance.

  • comparison of the effects of volume resuscitation with Dextran 60 vs ringer s lactate on central hemodynamics regional blood flow pulmonary function and blood composition during hyperdynamic endotoxemia
    Circulatory shock, 1993
    Co-Authors: U Kreimeier, M Ruizmorales, K. Messmer
    Abstract:

    Abstract In hyperdynamic porcine endotoxemia the pulmonary as well as macro-and microcirculatory effects of volume substitution using 6% Dextran 60 (DX) vs. Ringer's lactate (RL) were analyzed. Endotoxemia was induced by continuous i.v. infusion of S. abortus equi endotoxin over 3.5 hr. Pulmonary capillary wedge pressure (PCWP) was maintained by titrated infusion of either DX (n = 6) or RL (n = 6). Regional blood flow was analyzed in 290 samples from 12 organs by means of the radioactive microspheres technique (diameter 15 microns). Lung function was impaired in both groups, as reflected by an increase of airway resistance and a decrease of O2 index. More than three times the volume of RL had to be substituted as compared to DX for maintenance of left ventricular filling pressure: cardiac output, however, remained higher with DX treatment (P < 0.05). In both groups, blood flow to the spleen decreased, while liver blood flow (hepatic artery) increased (P < 0.05); cerebral blood flow remained unchanged. In contrast, blood flow to kidneys, gastric mucosa, and intestine was preserved at significantly higher values upon treatment with DX as compared to RL (P < 0.05). It is concluded that volume replacement with 6% Dextran 60 sufficient to maintain stable left ventricular filling pressure is superior to Ringer's lactate infusion in acute endotoxemia; it effectively restores intravascular volume at constant plasma colloid osmotic pressure and--together with its positive rheological properties--favors high cardiac output and high nutritional blood flow.

  • treatment of hemorrhagic hypotension with hypertonic saline Dextran effects on brain surface oxygen tension in experimentally traumatized brain
    Advances in Experimental Medicine and Biology, 1992
    Co-Authors: C Dautermann, L Schurer, Roger Hartl, A Baethmann, F Rohrich, K. Messmer
    Abstract:

    In cases of severe hemorrhagic shock small volumes of hypertonic-hyperoncotic solutions (HHS) are efficient in restoring cardiovascular function immediately (1–3). While the macrocirculatory changes following infusion of HHS after hemorrhagic shock are well understood (4–6), little is known about the effects of this treatment on the central nervous system in particular in the presence of cerebral injury comprising deleted autoregulation and brain edema (7). We have, therefore, investigated the changes in oxygen supply of the brain in the presence of a cryogenic lesion after hemorrhagic shock and infusion of 7.2% NaCl/10% Dextran 60.

A Baethmann - One of the best experts on this subject based on the ideXlab platform.

  • 7 2 nacl 10 Dextran 60 versus 20 mannitol for treatment of intracranial hypertension
    Acta Neurochirurgica, 1994
    Co-Authors: S Berger, Konrad Messmer, L Schurer, Roger Hartl, T Deisbock, C Dautermann, R Murr, A Baethmann
    Abstract:

    Severe head injury is frequently associated with extracranial injuries causing hemorrhagic hypotension. Volume replacement with isotonic fluids not only is therapeutically of limited efficacy but may aggravate posttraumatic brain edema. On the other side, hypertonic/hyperoncotic saline/Dextran solution (HHS) shown to restore cardiovascular function in hemorrhagic shock instantaneously, was found to decrease intracranial pressure in experimental head injury. Currently the therapeutic efficacy of HHS and mannitol on ICP was compared at 24 hrs after a focal cerebral lesion and inflation of an epidural balloon in rabbits. Both solutions given at an equimolar dose rapidly lowered the ICP. After the first injection, ICP reduction was longer maintained with mannitol (189 ± 27 min) as compared to HHS (98 ±14 min), while no difference in duration of lowering ICP was found after the second injection. Due to its blood pressure effects, HHS afforded a higher cerebral perfusion pressure than mannitol. In animals with HHS, the water content of the traumatized hemisphere was increased while the contralateral hemisphere was dehydrated. With mannitol, no differences in water content were found between the injured and uninjured hemisphere. The efficiency of HHS in hemorrhagic shock and intracranial hypertension render the fluid mixture particularly promising in patients with polytrauma in combination with head injury.

  • treatment of hemorrhagic hypotension with hypertonic saline Dextran effects on brain surface oxygen tension in experimentally traumatized brain
    Advances in Experimental Medicine and Biology, 1992
    Co-Authors: C Dautermann, L Schurer, Roger Hartl, A Baethmann, F Rohrich, K. Messmer
    Abstract:

    In cases of severe hemorrhagic shock small volumes of hypertonic-hyperoncotic solutions (HHS) are efficient in restoring cardiovascular function immediately (1–3). While the macrocirculatory changes following infusion of HHS after hemorrhagic shock are well understood (4–6), little is known about the effects of this treatment on the central nervous system in particular in the presence of cerebral injury comprising deleted autoregulation and brain edema (7). We have, therefore, investigated the changes in oxygen supply of the brain in the presence of a cryogenic lesion after hemorrhagic shock and infusion of 7.2% NaCl/10% Dextran 60.

  • treatment of hemorrhagic hypotension with hypertonic hyperoncotic solutions effects on regional cerebral blood flow and brain surface oxygen tension
    European Surgical Research, 1992
    Co-Authors: L Schurer, K. Messmer, S Berger, Roger Hartl, C Dautermann, R Murr, F Rohrich, A Baethmann
    Abstract:

    Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2 % NaCl/10% Dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. HHS was administered in albino rabbits subjected to α-chloralose anesthesia and artificial ventilation with and without hemorrhagic hypovolemia. Hemorrhagic hypovolemia of 30 min duration was induced by withdrawal of approximately one third of the circulating blood volume resulting in a decrease in arterial blood pressure to 40 mm Hg. HHS was studied in addition in normovolemic animals. Cardiac output was rapidly normalized by infusion of HHS in animals with hypovolemia, while it increased intermittently in normovolemic animals. In animals with hemorrhagic shock arterial blood pressure recovered by treatment to approximately 70% of normal, whereas blood pressure remained unchanged after infusion of HHS in normovolemic controls. Cerebral blood flow, which was assessed by H2 clearance at the brain surface, had a range of 43.0–50.3 ml/100 g/min under control conditions. It remained virtually unchanged during hemorrhagic hypovolemia and also after infusion of HHS in normovolemic animals. Treatment of shock by HHS was followed 90 or 120 min later by a moderate increase in regional cerebral blood flow to 61 ml/100 g/min. Local tissue PO2 at the brain surface was obtained by an O2 multiwire electrode in the vicinity of the H2 clearance measurements using a weightless suspension system to avoid compression of the brain surface. Infusion of HHS in normovolemic animals did not affect the O2 supply of the brain. Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2, histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.

C Dautermann - One of the best experts on this subject based on the ideXlab platform.

  • 7 2 nacl 10 Dextran 60 versus 20 mannitol for treatment of intracranial hypertension
    Acta Neurochirurgica, 1994
    Co-Authors: S Berger, Konrad Messmer, L Schurer, Roger Hartl, T Deisbock, C Dautermann, R Murr, A Baethmann
    Abstract:

    Severe head injury is frequently associated with extracranial injuries causing hemorrhagic hypotension. Volume replacement with isotonic fluids not only is therapeutically of limited efficacy but may aggravate posttraumatic brain edema. On the other side, hypertonic/hyperoncotic saline/Dextran solution (HHS) shown to restore cardiovascular function in hemorrhagic shock instantaneously, was found to decrease intracranial pressure in experimental head injury. Currently the therapeutic efficacy of HHS and mannitol on ICP was compared at 24 hrs after a focal cerebral lesion and inflation of an epidural balloon in rabbits. Both solutions given at an equimolar dose rapidly lowered the ICP. After the first injection, ICP reduction was longer maintained with mannitol (189 ± 27 min) as compared to HHS (98 ±14 min), while no difference in duration of lowering ICP was found after the second injection. Due to its blood pressure effects, HHS afforded a higher cerebral perfusion pressure than mannitol. In animals with HHS, the water content of the traumatized hemisphere was increased while the contralateral hemisphere was dehydrated. With mannitol, no differences in water content were found between the injured and uninjured hemisphere. The efficiency of HHS in hemorrhagic shock and intracranial hypertension render the fluid mixture particularly promising in patients with polytrauma in combination with head injury.

  • treatment of hemorrhagic hypotension with hypertonic saline Dextran effects on brain surface oxygen tension in experimentally traumatized brain
    Advances in Experimental Medicine and Biology, 1992
    Co-Authors: C Dautermann, L Schurer, Roger Hartl, A Baethmann, F Rohrich, K. Messmer
    Abstract:

    In cases of severe hemorrhagic shock small volumes of hypertonic-hyperoncotic solutions (HHS) are efficient in restoring cardiovascular function immediately (1–3). While the macrocirculatory changes following infusion of HHS after hemorrhagic shock are well understood (4–6), little is known about the effects of this treatment on the central nervous system in particular in the presence of cerebral injury comprising deleted autoregulation and brain edema (7). We have, therefore, investigated the changes in oxygen supply of the brain in the presence of a cryogenic lesion after hemorrhagic shock and infusion of 7.2% NaCl/10% Dextran 60.

  • treatment of hemorrhagic hypotension with hypertonic hyperoncotic solutions effects on regional cerebral blood flow and brain surface oxygen tension
    European Surgical Research, 1992
    Co-Authors: L Schurer, K. Messmer, S Berger, Roger Hartl, C Dautermann, R Murr, F Rohrich, A Baethmann
    Abstract:

    Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2 % NaCl/10% Dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. HHS was administered in albino rabbits subjected to α-chloralose anesthesia and artificial ventilation with and without hemorrhagic hypovolemia. Hemorrhagic hypovolemia of 30 min duration was induced by withdrawal of approximately one third of the circulating blood volume resulting in a decrease in arterial blood pressure to 40 mm Hg. HHS was studied in addition in normovolemic animals. Cardiac output was rapidly normalized by infusion of HHS in animals with hypovolemia, while it increased intermittently in normovolemic animals. In animals with hemorrhagic shock arterial blood pressure recovered by treatment to approximately 70% of normal, whereas blood pressure remained unchanged after infusion of HHS in normovolemic controls. Cerebral blood flow, which was assessed by H2 clearance at the brain surface, had a range of 43.0–50.3 ml/100 g/min under control conditions. It remained virtually unchanged during hemorrhagic hypovolemia and also after infusion of HHS in normovolemic animals. Treatment of shock by HHS was followed 90 or 120 min later by a moderate increase in regional cerebral blood flow to 61 ml/100 g/min. Local tissue PO2 at the brain surface was obtained by an O2 multiwire electrode in the vicinity of the H2 clearance measurements using a weightless suspension system to avoid compression of the brain surface. Infusion of HHS in normovolemic animals did not affect the O2 supply of the brain. Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2, histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.

L Schurer - One of the best experts on this subject based on the ideXlab platform.

  • 7 2 nacl 10 Dextran 60 versus 20 mannitol for treatment of intracranial hypertension
    Acta Neurochirurgica, 1994
    Co-Authors: S Berger, Konrad Messmer, L Schurer, Roger Hartl, T Deisbock, C Dautermann, R Murr, A Baethmann
    Abstract:

    Severe head injury is frequently associated with extracranial injuries causing hemorrhagic hypotension. Volume replacement with isotonic fluids not only is therapeutically of limited efficacy but may aggravate posttraumatic brain edema. On the other side, hypertonic/hyperoncotic saline/Dextran solution (HHS) shown to restore cardiovascular function in hemorrhagic shock instantaneously, was found to decrease intracranial pressure in experimental head injury. Currently the therapeutic efficacy of HHS and mannitol on ICP was compared at 24 hrs after a focal cerebral lesion and inflation of an epidural balloon in rabbits. Both solutions given at an equimolar dose rapidly lowered the ICP. After the first injection, ICP reduction was longer maintained with mannitol (189 ± 27 min) as compared to HHS (98 ±14 min), while no difference in duration of lowering ICP was found after the second injection. Due to its blood pressure effects, HHS afforded a higher cerebral perfusion pressure than mannitol. In animals with HHS, the water content of the traumatized hemisphere was increased while the contralateral hemisphere was dehydrated. With mannitol, no differences in water content were found between the injured and uninjured hemisphere. The efficiency of HHS in hemorrhagic shock and intracranial hypertension render the fluid mixture particularly promising in patients with polytrauma in combination with head injury.

  • treatment of hemorrhagic hypotension with hypertonic saline Dextran effects on brain surface oxygen tension in experimentally traumatized brain
    Advances in Experimental Medicine and Biology, 1992
    Co-Authors: C Dautermann, L Schurer, Roger Hartl, A Baethmann, F Rohrich, K. Messmer
    Abstract:

    In cases of severe hemorrhagic shock small volumes of hypertonic-hyperoncotic solutions (HHS) are efficient in restoring cardiovascular function immediately (1–3). While the macrocirculatory changes following infusion of HHS after hemorrhagic shock are well understood (4–6), little is known about the effects of this treatment on the central nervous system in particular in the presence of cerebral injury comprising deleted autoregulation and brain edema (7). We have, therefore, investigated the changes in oxygen supply of the brain in the presence of a cryogenic lesion after hemorrhagic shock and infusion of 7.2% NaCl/10% Dextran 60.

  • treatment of hemorrhagic hypotension with hypertonic hyperoncotic solutions effects on regional cerebral blood flow and brain surface oxygen tension
    European Surgical Research, 1992
    Co-Authors: L Schurer, K. Messmer, S Berger, Roger Hartl, C Dautermann, R Murr, F Rohrich, A Baethmann
    Abstract:

    Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2 % NaCl/10% Dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. HHS was administered in albino rabbits subjected to α-chloralose anesthesia and artificial ventilation with and without hemorrhagic hypovolemia. Hemorrhagic hypovolemia of 30 min duration was induced by withdrawal of approximately one third of the circulating blood volume resulting in a decrease in arterial blood pressure to 40 mm Hg. HHS was studied in addition in normovolemic animals. Cardiac output was rapidly normalized by infusion of HHS in animals with hypovolemia, while it increased intermittently in normovolemic animals. In animals with hemorrhagic shock arterial blood pressure recovered by treatment to approximately 70% of normal, whereas blood pressure remained unchanged after infusion of HHS in normovolemic controls. Cerebral blood flow, which was assessed by H2 clearance at the brain surface, had a range of 43.0–50.3 ml/100 g/min under control conditions. It remained virtually unchanged during hemorrhagic hypovolemia and also after infusion of HHS in normovolemic animals. Treatment of shock by HHS was followed 90 or 120 min later by a moderate increase in regional cerebral blood flow to 61 ml/100 g/min. Local tissue PO2 at the brain surface was obtained by an O2 multiwire electrode in the vicinity of the H2 clearance measurements using a weightless suspension system to avoid compression of the brain surface. Infusion of HHS in normovolemic animals did not affect the O2 supply of the brain. Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2, histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.

Roger Hartl - One of the best experts on this subject based on the ideXlab platform.

  • 7 2 nacl 10 Dextran 60 versus 20 mannitol for treatment of intracranial hypertension
    Acta Neurochirurgica, 1994
    Co-Authors: S Berger, Konrad Messmer, L Schurer, Roger Hartl, T Deisbock, C Dautermann, R Murr, A Baethmann
    Abstract:

    Severe head injury is frequently associated with extracranial injuries causing hemorrhagic hypotension. Volume replacement with isotonic fluids not only is therapeutically of limited efficacy but may aggravate posttraumatic brain edema. On the other side, hypertonic/hyperoncotic saline/Dextran solution (HHS) shown to restore cardiovascular function in hemorrhagic shock instantaneously, was found to decrease intracranial pressure in experimental head injury. Currently the therapeutic efficacy of HHS and mannitol on ICP was compared at 24 hrs after a focal cerebral lesion and inflation of an epidural balloon in rabbits. Both solutions given at an equimolar dose rapidly lowered the ICP. After the first injection, ICP reduction was longer maintained with mannitol (189 ± 27 min) as compared to HHS (98 ±14 min), while no difference in duration of lowering ICP was found after the second injection. Due to its blood pressure effects, HHS afforded a higher cerebral perfusion pressure than mannitol. In animals with HHS, the water content of the traumatized hemisphere was increased while the contralateral hemisphere was dehydrated. With mannitol, no differences in water content were found between the injured and uninjured hemisphere. The efficiency of HHS in hemorrhagic shock and intracranial hypertension render the fluid mixture particularly promising in patients with polytrauma in combination with head injury.

  • treatment of hemorrhagic hypotension with hypertonic saline Dextran effects on brain surface oxygen tension in experimentally traumatized brain
    Advances in Experimental Medicine and Biology, 1992
    Co-Authors: C Dautermann, L Schurer, Roger Hartl, A Baethmann, F Rohrich, K. Messmer
    Abstract:

    In cases of severe hemorrhagic shock small volumes of hypertonic-hyperoncotic solutions (HHS) are efficient in restoring cardiovascular function immediately (1–3). While the macrocirculatory changes following infusion of HHS after hemorrhagic shock are well understood (4–6), little is known about the effects of this treatment on the central nervous system in particular in the presence of cerebral injury comprising deleted autoregulation and brain edema (7). We have, therefore, investigated the changes in oxygen supply of the brain in the presence of a cryogenic lesion after hemorrhagic shock and infusion of 7.2% NaCl/10% Dextran 60.

  • treatment of hemorrhagic hypotension with hypertonic hyperoncotic solutions effects on regional cerebral blood flow and brain surface oxygen tension
    European Surgical Research, 1992
    Co-Authors: L Schurer, K. Messmer, S Berger, Roger Hartl, C Dautermann, R Murr, F Rohrich, A Baethmann
    Abstract:

    Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2 % NaCl/10% Dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. HHS was administered in albino rabbits subjected to α-chloralose anesthesia and artificial ventilation with and without hemorrhagic hypovolemia. Hemorrhagic hypovolemia of 30 min duration was induced by withdrawal of approximately one third of the circulating blood volume resulting in a decrease in arterial blood pressure to 40 mm Hg. HHS was studied in addition in normovolemic animals. Cardiac output was rapidly normalized by infusion of HHS in animals with hypovolemia, while it increased intermittently in normovolemic animals. In animals with hemorrhagic shock arterial blood pressure recovered by treatment to approximately 70% of normal, whereas blood pressure remained unchanged after infusion of HHS in normovolemic controls. Cerebral blood flow, which was assessed by H2 clearance at the brain surface, had a range of 43.0–50.3 ml/100 g/min under control conditions. It remained virtually unchanged during hemorrhagic hypovolemia and also after infusion of HHS in normovolemic animals. Treatment of shock by HHS was followed 90 or 120 min later by a moderate increase in regional cerebral blood flow to 61 ml/100 g/min. Local tissue PO2 at the brain surface was obtained by an O2 multiwire electrode in the vicinity of the H2 clearance measurements using a weightless suspension system to avoid compression of the brain surface. Infusion of HHS in normovolemic animals did not affect the O2 supply of the brain. Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2, histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.