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U J Pfeiffer - One of the best experts on this subject based on the ideXlab platform.
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central venous pressure pulmonary artery occlusion pressure intrathoracic blood volume and right ventricular end diastolic volume as indicators of cardiac preload
Journal of Critical Care, 1996Co-Authors: Michael Lichtwarckaschoff, Richard Beale, U J PfeifferAbstract:Abstract Purpose: Central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP) and right ventricular end-diastolic volume (RVEDV) are often regarded as indicators of both circulating blood volume and cardiac preload. To evaluate these relationships, the response of each variable to induced volume shifts was tested. The relationships between these variables and cardiac index (CI) and stroke volume index (SVI) was also recorded to assess the utility of each variable as an indicator of cardiac preload. The responses of the new variable intrathoracic blood volume (ITBV) to the same maneuvers was also tested. To examine the effects of changes in cardiac output alone on ITBV, the effects of infusing dobutamine were studied. Materials and Methods: Ten anesthetized piglets were studied during conditions of Normovolemia, hypovolemia, and hypervolemia. The effects of an infusion of dobutamine were examined under Normovolemia and hypovolemia. Cardiac output was measured by thermodilution, and ITBV was measured by double-indicator dilution. Results: CI was correlated to CVP with r2 = .42 (P ≤ .01), to PAOP with r2 = .43 (P ≤ 5.01), to RVEDV index with r2 = .21 (P ≤ .01), and to ITBV with r2 = .78 (P ≤ .01) (pooled absolute values). Bias (mean difference of the percent changes with Normovolemia = 100%) ± 1 SD; for SVI - ITBV index was 1 ± 22%, for SVI — CVP it was −128 ± 214%; for SVI — PAOP it was −36 ± 46%; and for SVI -RVEDV index it was 1 ± 29%. Dobutamine infusion increased heart rate (to about 190 × min−1) and CI by 30% in Normovolemia and hypovolemia, while ITBV remained basically unchanged. Conclusions: Under the experimental conditions choosen neither CVP, PAOP, nor RVEDV reliably indicated changes in circulating blood volume, nor were they linearly and tightly correlated to the resulting changes in SVI. ITBV reflected both changes in volume status and the resulting alteration in cardiac output. The possibility that ITBV might be cardiac output-dependent was not supported. ITBV, therefore, shows potential as a clinically useful indicator of overall cardiac preload.
Coy, Claudio Saddy Rodrigues - One of the best experts on this subject based on the ideXlab platform.
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Influência do choque hemorrágico na anastomose de cólon em ratos: avaliação com teste de resistência à pressão de ruptura
'FapUNIFESP (SciELO)', 2015Co-Authors: Pereira, Yara Ematne Amaral, Fagundes, João José, Morandini, Rosana Celestina, Ayrizono, Maria De Lourdes Setsuko, Ricardo Bolzam Do Nascimento, Leal, Raquel Franco, Góes, Juvenal Ricardo Navarro, Mantovani Mario, Coy, Claudio Saddy RodriguesAbstract:PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.OBJETIVO: Avaliar o efeito do choque hemorrágico em anastomoses de cólon em ratos, com teste de ruptura à distensão por líquido. MÉTODOS: Foram utilizados ratos da linhagem Wistar, com idade aproximada de 90 dias e peso variando de 310 gramas a 380 gramas. Os animais foram divididos em dois grupos, sendo o grupo G1, composto por 10 animais submetidos à anastomose de cólon em condições de Normovolemia e o grupo G2, composto por 10 animais submetidos à anastomose de cólon em condições de hipovolemia. O choque foi instalado através da retirada de meio mililitro de sangue a cada dois minutos, até que se atingissem valores de pressão arterial média (PAM) de 50mmHg ou volume total de retirada correspondente a 30% da volemia. Foram realizadas dosagens séricas de lactato (mmol/l) no início do procedimento e ao término do mesmo. Os valores séricos médios de lactato ao término da cirurgia foram de 1,91 mmMol/l no grupo G1 e de 3,69 mmMol/l no grupo G2 (p0,05). CONCLUSÃO: A presença de choque hemorrágico, nas condições estabelecidas neste estudo, não exerce influência em anastomoses de cólon em ratos, avaliadas com teste de ruptura à distensão por líquido.23724
Claudio Saddy Rodrigues Coy - One of the best experts on this subject based on the ideXlab platform.
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Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test Influência do choque hemorrágico na anastomose de cólon em ratos: avaliação com teste de resistência à pressão de ruptura
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2008Co-Authors: Yara Ematne Amaral Pereira, Ricardo Bolzam Do Nascimento, João José Fagundes, Rosana Celestina Morandini, Maria De Lourdes Setsuko Ayrizono, Raquel Franco Leal, Juvenal Ricardo Navarro Góes, Mario Mantovani, Claudio Saddy Rodrigues CoyAbstract:PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.OBJETIVO: Avaliar o efeito do choque hemorrágico em anastomoses de cólon em ratos, com teste de ruptura à distensão por líquido. MÉTODOS: Foram utilizados ratos da linhagem Wistar, com idade aproximada de 90 dias e peso variando de 310 gramas a 380 gramas. Os animais foram divididos em dois grupos, sendo o grupo G1, composto por 10 animais submetidos à anastomose de cólon em condições de Normovolemia e o grupo G2, composto por 10 animais submetidos à anastomose de cólon em condições de hipovolemia. O choque foi instalado através da retirada de meio mililitro de sangue a cada dois minutos, até que se atingissem valores de pressão arterial média (PAM) de 50mmHg ou volume total de retirada correspondente a 30% da volemia. Foram realizadas dosagens séricas de lactato (mmol/l) no início do procedimento e ao término do mesmo. Os valores séricos médios de lactato ao término da cirurgia foram de 1,91 mmMol/l no grupo G1 e de 3,69 mmMol/l no grupo G2 (p0,05). CONCLUSÃO: A presença de choque hemorrágico, nas condições estabelecidas neste estudo, não exerce influência em anastomoses de cólon em ratos, avaliadas com teste de ruptura à distensão por líquido
Ricardo Bolzam Do Nascimento - One of the best experts on this subject based on the ideXlab platform.
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Influência do choque hemorrágico na anastomose de cólon em ratos: avaliação com teste de resistência à pressão de ruptura
'FapUNIFESP (SciELO)', 2015Co-Authors: Pereira, Yara Ematne Amaral, Fagundes, João José, Morandini, Rosana Celestina, Ayrizono, Maria De Lourdes Setsuko, Ricardo Bolzam Do Nascimento, Leal, Raquel Franco, Góes, Juvenal Ricardo Navarro, Mantovani Mario, Coy, Claudio Saddy RodriguesAbstract:PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.OBJETIVO: Avaliar o efeito do choque hemorrágico em anastomoses de cólon em ratos, com teste de ruptura à distensão por líquido. MÉTODOS: Foram utilizados ratos da linhagem Wistar, com idade aproximada de 90 dias e peso variando de 310 gramas a 380 gramas. Os animais foram divididos em dois grupos, sendo o grupo G1, composto por 10 animais submetidos à anastomose de cólon em condições de Normovolemia e o grupo G2, composto por 10 animais submetidos à anastomose de cólon em condições de hipovolemia. O choque foi instalado através da retirada de meio mililitro de sangue a cada dois minutos, até que se atingissem valores de pressão arterial média (PAM) de 50mmHg ou volume total de retirada correspondente a 30% da volemia. Foram realizadas dosagens séricas de lactato (mmol/l) no início do procedimento e ao término do mesmo. Os valores séricos médios de lactato ao término da cirurgia foram de 1,91 mmMol/l no grupo G1 e de 3,69 mmMol/l no grupo G2 (p0,05). CONCLUSÃO: A presença de choque hemorrágico, nas condições estabelecidas neste estudo, não exerce influência em anastomoses de cólon em ratos, avaliadas com teste de ruptura à distensão por líquido.23724
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Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test Influência do choque hemorrágico na anastomose de cólon em ratos: avaliação com teste de resistência à pressão de ruptura
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2008Co-Authors: Yara Ematne Amaral Pereira, Ricardo Bolzam Do Nascimento, João José Fagundes, Rosana Celestina Morandini, Maria De Lourdes Setsuko Ayrizono, Raquel Franco Leal, Juvenal Ricardo Navarro Góes, Mario Mantovani, Claudio Saddy Rodrigues CoyAbstract:PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.OBJETIVO: Avaliar o efeito do choque hemorrágico em anastomoses de cólon em ratos, com teste de ruptura à distensão por líquido. MÉTODOS: Foram utilizados ratos da linhagem Wistar, com idade aproximada de 90 dias e peso variando de 310 gramas a 380 gramas. Os animais foram divididos em dois grupos, sendo o grupo G1, composto por 10 animais submetidos à anastomose de cólon em condições de Normovolemia e o grupo G2, composto por 10 animais submetidos à anastomose de cólon em condições de hipovolemia. O choque foi instalado através da retirada de meio mililitro de sangue a cada dois minutos, até que se atingissem valores de pressão arterial média (PAM) de 50mmHg ou volume total de retirada correspondente a 30% da volemia. Foram realizadas dosagens séricas de lactato (mmol/l) no início do procedimento e ao término do mesmo. Os valores séricos médios de lactato ao término da cirurgia foram de 1,91 mmMol/l no grupo G1 e de 3,69 mmMol/l no grupo G2 (p0,05). CONCLUSÃO: A presença de choque hemorrágico, nas condições estabelecidas neste estudo, não exerce influência em anastomoses de cólon em ratos, avaliadas com teste de ruptura à distensão por líquido
Terri G Monk - One of the best experts on this subject based on the ideXlab platform.
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the influence of crystalloid and colloid replacement solutions in acute normovolemic hemodilution a preliminary survey of hemostatic markers
Anesthesia & Analgesia, 2003Co-Authors: Stephanie B Jones, Charles W Whitten, George J Despotis, Terri G MonkAbstract:Acute normovolemic hemodilution (ANH), in which blood for autologous use is collected immediately before the onset of surgical blood loss, is a recommended autologous blood procurement technique for blood conservation. Both crystalloid and colloid replacement fluids have been used to maintain Normovolemia during ANH, but few data are available to justify the use of a particular replacement fluid. Therefore, we designed a prospective, randomized study to determine if the replacement fluid choice affects various coagulation variables and perioperative blood loss. Forty adult patients, ASA physical status 1-3, scheduled for ANH during radical prostatectomy were randomly assigned to one of four replacement fluid groups: (a) Ringer's lactate, (b) 5% albumin, (c) 6% dextran 70 (DEX), or (d) 6% hetastarch (HES). After the induction of a standardized general anesthetic, all patients underwent ANH to a final hemoglobin level of 9 g/dL. Complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, factors V and VIII levels, bleeding time, and thromboelastography (TEG measurements were obtained at similar time points in the procedure. When compared with baseline, activated partial thromboplastin time decreased and factor VIII levels increased in the postanesthesia care unit in both the Ringer's lactate and 5% albumin groups. The DEX and HES groups demonstrated a decrease in TEG maximum amplitude between preoperative and postanesthesia care unit measurements and TEG alpha (angle) was decreased from baseline in the DEX group. The changes in factor VIII, activated partial thromboplastin time, and TEG measurements indicate that HES and DEX may attenuate the hypercoagulability related to surgery.
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acute normovolemic hemodilution can replace preoperative autologous blood donation as a standard of care for autologous blood procurement in radical prostatectomy
Anesthesia & Analgesia, 1997Co-Authors: Terri G Monk, Lawrence T Goodnough, Mark E Brecher, Debra D Pulley, John W Colberg, Gerald L Andriole, William J CatalonaAbstract:Predonation of autologous blood (PAD) is a standard of care for patients undergoing radical prostatectomy, but recent studies have shown that PAD is not cost-effective. Acute normovolemic hemodilution (ANH) is an alternative autologous blood procurement technique that is much less costly than PAD. We compared the efficacy and costs of ANH alone to ANH combined with PAD. Two hundred-fifty patients who predonated fewer than 3 units of autologous blood before radical prostatectomy underwent ANH to a target hematocrit of 28%. Perioperative hematocrit levels, transfusion outcomes and costs, and postoperative outcomes were compared for patients who predonated 0, 1, or 2 units of blood before surgery. A computer model was used to estimate the savings in red blood cells (RBC) associated with each autologous intervention. ANH alone resulted in a 21% allogeneic transfusion rate and contributed a mean net savings of 112 mL RBC in blood conservation (equivalent to 0.6 unit of blood). The addition of 1 or 2 units of PAD reduced allogeneic exposure rates to 6% or 0%, respectively. Overall, patients who predonated blood had a mean net loss of 198 mL of RBC (equivalent to 1 blood unit), due to both an absence in compensatory erythropoiesis and to the wastage of 60% of the blood units donated. Patients who underwent ANH alone had a 60% reduction in mean total transfusion costs ($103 +/- $102) compared with patients who predeposited 2 units of autologous blood in addition to ANH ($269 +/- $11, P < 0.05). We conclude that ANH can replace PAD as an autologous blood option because it is less costly and equally effective. A combination of ANH and PAD can further decrease allogeneic blood exposure, but it increases transfusion costs and wastage. Implications: A patient's own blood can be obtained for use in surgery by predonation or acute normovolemic hemodilution on the day of surgery. Both blood collection techniques decrease the need for blood bank transfusions, but acute normovolemic hemodilution is less expensive and more convenient for patients. (Anesth Analg 1997;85:953-8)