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Martin Sillesen, Theodore Bambakidis, Simone Dekker, Yongqing Li, Hasan B Alam
BACKGROUND: Resuscitation with Fresh Frozen Plasma (FFP) decreases brain lesion size and swelling in a swine model of Traumatic Brain Injury (TBI) and hemorrhagic shock (HS). We hypothesized that brain gene expression profiles following TBI+HS would be modulated by FFP resuscitation. STUDY DESIGN: 15 swine underwent a protocol of TBI and HS, two hours of shock followed by resuscitation with FFP, Normal Saline (NS) or hetastarch (Hextend, HEX, 5/group). After 6 hours, brain RNA was isolated and hybridized onto a Porcine Gene ST 1...
October 7, 2016: Journal of the American College of Surgeons
Fabrizzio Sacchet-Cardozo, Nicoleta Stoicea, Nicholas Joseph, Elisabeth Dewhirst, Michael Essandoh
No abstract text is available yet for this article.
July 21, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Sayed Mahdi Marashi, Zeynab Nasri Nasrabadi, Mostafa Jafarzadeh, Sogand Mohammadi
A 40-year-old male patient with suicidal ingestion of one tablet of aluminium phosphide was referred to the department of toxicology emergency of Baharloo Hospital, Tehran, Iran. The garlic odor was smelled from the patient and abdominal pain and continuous vomiting as well as agitation and heartburn were the first signs and symptoms. Systolic and diastolic blood pressures at the arrival time were 95 and 67 mmHg, respectively. Gastric lavage with potassium permanganate (1:10,000), and 2 vials of sodium bicarbonate through a nasogastric tube was started for the patient and the management was continued with free intravenous infusion of 1 liter of NaCl 0...
July 2016: Acta Medica Iranica
Abdullah S Terkawi, Sarah K Larkin, Siny Tsang, Jessica S Sheeran, Mohamed Tiouririne
BACKGROUND: Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. METHODS: We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014...
October 2016: Journal of Anesthesia
Erica C McKenzie, Melissa M Esser, Sarah E McNitt, Mark E Payton
OBJECTIVE To compare the effects of equivalent volumes of equine plasma and 6% hydroxyethyl starch (600/0.75) solution (hetastarch) administered IV on plasma colloid osmotic pressure (pCOP) and commonly monitored clinicopathologic variables in horses. ANIMALS 6 healthy mares. PROCEDURES In a randomized, crossover study, horses were administered hetastarch or plasma (both 10 mL/kg, IV) 18 months apart. The pCOP and variables of interest were measured before (baseline), immediately after, and at intervals up to 96 or 120 hours after infusion...
July 2016: American Journal of Veterinary Research
Li Wang, Fang Liu, Kunping Yan, Wencan Pan, Lijuan Xu, Huifang Liu, Chengbin Yan, Chao Chen, Hongli Zhu
The objective of this study was to evaluate the effects of polymerized porcine hemoglobin (pPolyHb) on hemodynamic stability and oxygen delivery in a rat model of hemorrhagic shock. Rats underwent controlled hemorrhage, resulting in the loss of 65% of their blood volume in 90 minutes. The results showed that pPolyHb was superior to hetastarch and saline, and similar to whole blood, in restoring hemodynamic stability and reversing anaerobic metabolism caused by hemorrhage. Furthermore, pPolyHb improved oxygen supply and increased blood oxygen content...
May 25, 2016: Artificial Cells, Nanomedicine, and Biotechnology
Madhusudan Upadya, Sonal Bhat, Seema Paul
BACKGROUND: Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension. MATERIALS AND METHODS: This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery...
January 2016: Anesthesia, Essays and Researches
James A Russell, Mark D Williams
Several promising therapies assessed in the adult critically ill in large, multicenter randomized controlled trials (RCTs) were associated with significantly increased mortality in the intervention arms. Our hypothesis was that there would be wide ranges in sponsorship (industry or not), type(s) of intervention(s), use of DSMBs, presence of interim analyses and early stopping rules, absolute risk increase (ARI), and whether or not adequate prior proof-of-principle Phase II studies were done of RCTs that found increased mortality rates of the intervention compared to control groups...
December 2016: Annals of Intensive Care
Ihab Halaweish, Ted Bambakidis, Zhigang Chang, He Wei, Baoling Liu, Yongqing Li, Toby Bonthrone, Ashok Srinivasan, Tess Bonham, Kiril Chtraklin, Hasan B Alam
BACKGROUND: Combined traumatic brain injury (TBI) and hemorrhagic shock (HS) is highly lethal. In a nonsurvival model of TBI + HS, addition of high-dose valproic acid (VPA) (300 mg/kg) to hetastarch reduced brain lesion size and associated swelling 6 hours after injury; whether this would have translated into better neurologic outcomes remains unknown. It is also unclear whether lower doses of VPA would be neuroprotective. We hypothesized that addition of low-dose VPA to normal saline (NS) resuscitation would result in improved long-term neurologic recovery and decreased brain lesion size...
December 2015: Journal of Trauma and Acute Care Surgery
J L Frey
Because precipitous neurological deterioration occurred during blood pressure reduction in a seminal case of lacunar infarction, nine subsequent patients with acute partial or evolving lacunar deficits were treated with hemodilution and blood pressure nonintervention to test the hypothesis that lacunar infarction represents perfusion failure. Isovolemic hemodilution was performed using hetastarch with target hematocrit of 30-33. Pretreatment brain computed tomography, carotid ultrasound, and echocardiography were normal...
1992: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Bari R Morris, Armelle deLaforcade, Joyce Lee, Joseph Palmisano, Dawn Meola, Elizabeth Rozanski
OBJECTIVE: To investigate the effects of in vitro hemodilution with lactated Ringers solution (LRS), hetastarch (HES), and fresh frozen plasma (FFP) on whole blood coagulation in dogs as assessed by kaolin-activated thromboelastography. DESIGN: In vitro experimental study. SETTING: University teaching hospital. ANIMALS: Six healthy client-owned dogs. INTERVENTIONS: Whole blood was collected and diluted in vitro at a 33% and 67% dilution with either LRS, HES, or FFP...
January 2016: Journal of Veterinary Emergency and Critical Care
James A Feix, C Andrew Peery, Tong J Gan, David S Warner, Michael L James, Ali Zomorodi, David L McDonagh
BACKGROUND: Intraoperative intravascular volume expansion with hydroxyethyl starch-based colloids is thought to be associated with an increased risk of post-craniotomy hemorrhage. Evidence for this association is limited. Associations between resuscitation with hydroxyethyl starch and risk of repeat craniotomy for hematoma evacuation were examined. METHODS: Using a retrospective cohort of neurosurgical patients at Duke University Medical Center between March 2005 and March 2012, patient characteristics were compared between those who developed post-craniotomy hemorrhage and those who did not...
2015: SpringerPlus
Sibylle A Kozek-Langenecker
PURPOSE OF REVIEW: Infusion therapy is essential in intravascular hypovolaemia and extravascular fluid deficits. Crystalloidal fluids and colloidal volume replacement affect blood coagulation when infused intravenously. The question remains if this side-effect of infusion therapy is clinically relevant in patients with and without bleeding manifestations, and if fluid-induced coagulopathy is a risk factor for anaemia, blood transfusion, and mortality, and a driver for resource use and costs...
August 2015: Current Opinion in Critical Care
Jamie L Estock, Andrew W Murray, Margaret T Mizah, Michael P Mangione, Joseph S Goode, David E Eibling
OBJECTIVE: Several factors contribute to medication errors in clinical practice settings, including the design of medication labels. The objective of this study was to quantify the impact of label design on medication safety in a realistic, high-stress clinical situation. METHODS: Ninety-six anesthesia trainee participants were randomly assigned to either the redesigned or the current label condition. Participants were blinded to the study's focus on medication label design and their assigned label condition...
March 7, 2015: Journal of Patient Safety
Sandra Ramirez-Arcos, Yuntong Kou, Lin Yang, Heather Perkins, Mariam Taha, Mike Halpenny, Heidi Elmoazzen
BACKGROUND: Sterility testing for cord blood (CB) products is mandatory to prevent transplantation-transmitted microbial infections. Here, the automated BacT/ALERT (bioMérieux) culture system was validated to detect microbial contamination in CB units processed at the Canadian National Public Cord Blood Bank. STUDY DESIGN AND METHODS: A three-phase validation was developed. CB units were prepared with pentastarch (Phases 1 and 2) or hetastarch (Phase 3). In Phase 1, CB was spiked with approximately 100 colony-forming units/mL of Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Bacteroides fragilis, and Candida albicans...
August 2015: Transfusion
Raquel R Bartz, William D White, Tong J Gan
BACKGROUND: Several plasma volume expander alternatives exist to enhance intravascular volume status in patients undergoing surgery. The optimal intravascular volume expander in the perioperative setting is currently unknown. Low molecular weight hetastarch, Voluven® (130/0.4), may have a better safety profile than high molecular weight hetastarch, Hextend® (450/0.7). We examined the clinical and cost outcomes of converting from Hextend® to Voluven® in a large tertiary medical center...
2015: Perioperative Medicine
Mohamad H Tiba, Gerard T Draucker, Brendan M McCracken, Hasan B Alam, Jonathan L Eliason, Kevin R Ward
BACKGROUND: Hemorrhage is the leading cause of death for both civilian and battlefield injuries. Hemorrhage from pelvic vascular wounds is of concern since it is difficult to control before surgical intervention. This has resulted in renewed interest in developing presurgical endovascular approaches to hemorrhage control. However, it is likely that other short-term techniques may be needed as a bridge to such approaches. We tested a prototype device called the pelvic hemostasis belt (PHB) for its ability to reduce or halt blood flow in a lethal model of pelvic arterial injury...
March 2015: Journal of Trauma and Acute Care Surgery
Daniel R Ambruso
Hydroxyethyl starch (hetastarch) is a synthetic glucose compound with extensive clinical use as a volume expander. Because of its red blood cell-sedimenting properties, hetastarch plays a major role in preparation of granulocyte products. Recent concerns have been raised about the use of hetastarch in critically ill patients for the development of renal injury and other severe adverse events. In contrast, granulocyte donors receive much less of this compound during collection procedures, and over many years, minimal toxicity has been documented in these individuals...
April 2015: Transfusion
William W Muir, Yukie Ueyama, Adriana Pedraza-Toscano, Pedro Vargas-Pinto, Carlos L Delrio, Robert S George, Bradley L Youngblood, Robert L Hamlin
OBJECTIVE: To determine the effects of rapid small-volume fluid administration on arterial blood pressure measurements and associated hemodynamic variables in isoflurane-anesthetized euvolemic dogs with or without experimentally induced hypotension. DESIGN: Prospective, randomized, controlled study. ANIMALS: 13 healthy dogs. PROCEDURES: Isoflurane-anesthetized dogs were randomly assigned to conditions of nonhypotension or hypotension (mean arterial blood pressure, 45 to 50 mm Hg) and treatment with lactated Ringer's solution (LRS) or hetastarch (3 or 10 mL/kg [1...
November 1, 2014: Journal of the American Veterinary Medical Association
K Berger, G Francony, P Bouzat, C Halle, C Genty, M Oddoux, E Gay, P Albaladejo, J F Payen
BACKGROUND: Stroke volume variation (SVV) during mechanical ventilation predicts preload responsiveness. We hypothesized that the prone position would alter the performance of this dynamic indicator. METHODS: Two parallel groups of ventilated neurosurgical patients with low tidal volume (6-8 were studied before surgical incision. SVV was measured at T0, T15 and T30 min during a fluid volume expansion (250 mL hetastarch 6% over 30 min) with patients in either the supine (N...
June 2015: Minerva Anestesiologica
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