Hämodilution bei Patienten mit peripherer arterieller Verschlußkrankheit im Stadium IIb: Prospektiver randomisierter Doppelblind-Vergleich von mittelmolekularer Hydroxyäthylstärke und kleinmolekularer Dextranlösung

Abstract

Isovolemic hemodilution is a simple method of treating patients with peripheral arterial occlusion disease and hematocrit values of 43% or more. Dextran, a plasma substitute, has been used for that purpose since the early 1950s. However, the use of dextran in some diseases, e.g., hemorrhagic diathesis, kidney insufficiency, and microangiopathy is not without risk. Anaphylactic reaction, too, has occurred in some cases. Since the end of the 1970s hydroxyethyl starch, a plasma substitute, is available for the therapy of microcirculatory disorders and hemorrhagic diathesis. The side effects of hydroxyethyl starch are less serious and anaphylactic reactions are less frequent and moderate in extent. The clinical efficacy of both substances was compared in this survey. It could be stated that middle molecular hydroxyethyl starch is even clinically superior to low molecular dextran because the distance that the patients could walk increased significantly.

Does colloid‐induced plasma hyperviscosity in haemodilution jeopardize perfusion and oxygenation of vital organs?

“…Prior to and 3 , 10, and 13 min after the injection of 2, 4. and ti pCi ' ' ' I I-dog-alhinnin, the specific activity and the haernatocrit (hct: (if venous blood werr incasured and fitted to a linear regression in ordrr t o estimate the specific activity of blood at time of injection. Haematocrit was corrected for trapped plasma according to Chien et al (15).…”

“…This may cause elevation of plasma viscosity; particularly after prolonged or repeated use of 10°h dcxtran 40,000 (6, 7) 6% dextran 60,000/70,000 (8,9), and HES 200,000/0.62 (6,8). Though these changes are rather small (cO.5 mPa-s), and well below values occurring physiologically in late prcgnancy, some authors have hypothesized that organ blood flow and tissue oxygenation might be jeopardized by this plasma hyperviscosity, particularly when it is induced by infusion of dextran solutions (6,7,10,11).…”

Pharmacokinetics of Hydroxyethyl Starch (70/0.5) following Repeated Infusions

“…Repeated infusion of HES (70/0.5) on 5 consecutive days are representative for a commonly used therapeutic drug scheme of HES for patients with special diseases like tinnitus, peripheral arterial disease or transient ischemic attack [11][12][13][14][15][16][17]. The used study dosage of 50 g/day was slightly higher than the clinically preferred application of one unit (500 ml, 6%, 30 g, 200/0.5) a day.…”

Volume Therapy in Patients with Acute Stroke

“…Another positive effect of volume therapy consists of homogenizing erythrocyte flow between the proximal and distal vascular network regions 12 . The data in the literature concerning the optimal hematocrit for volume therapy ranges from 33% to 42%, with a trend to values between 37% and 42% during recent years [13][14][15][16][17][18][19][20][21] . However, "optimal" hematocrit certainly is no fixed value.…”