Blood volume expansion with hetastarch in acute ischaemic stroke: the effects on local cerebral blood flow and computer mapped EEG

1. We have attempted to confirm the existence of a natriuretic hormone released in response to acute expansion of blood volume. 2. Isolated kidneys, perfused with whole blood at constant pressure, were incorporated within an extracorporeal circulation in recipient rats. In six control experiments urine flow rate, renal blood flow, glomerular filtration rate, filtration fraction, and the fractional excretion of filtered sodium and water were measured for periods of up to 120–140 min thereafter. The same variables were measured in a further 12 experiments in which, after 63 ± 11 min, the rats were volume expanded with equilibrated whole blood (15, 18 or 28 ml/kg body wt.). 3. On average the controls revealed no change in any of the variables measured; volume expansion was followed by increased renal blood flow and fractional excretion of filtered sodium and water, while the filtration fraction fell. 4. In both the control and volume-expansion experiments, there were 12 instances in which the fractional excretion of filtered sodium increased; in 10 of these, including those experiments in which the natriuresis was most marked, there was a closely correlated fall in filtration fraction. 5. In all the experiments changes in the fractional excretion of filtered sodium and water varied in parallel. 6. We conclude that volume expansion (a) changes the concentration of some circulating vasoactive substance(s) and (b) results in natriuresis and diuresis consequent upon a fall in filtration fraction.

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Volume Expansion in Focal Cerebral Ischemia: The Effect of Cardiac Output on Local Cerebral Blood Flow

Neurosurgery ◽

10.1093/neurosurgery/29.cn_suppl_1.40 ◽

1982 ◽

Vol 29 (CN_suppl_1) ◽

pp. 40-50 ◽

Cited By ~ 42

Author(s):

Ted S. Keller ◽

John E. McGillicuddy ◽

Virginia A. Labond ◽

Glenn W. Kindt

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Cerebral Blood Flow ◽

Cerebral Ischemia ◽

Volume Expansion ◽

Focal Cerebral Ischemia ◽

Local Cerebral Blood Flow

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Monitoring cerebral blood flow change through use of arterial spin labelling in acute ischaemic stroke patients after intra-arterial thrombectomy

European Radiology ◽

10.1007/s00330-018-5319-0 ◽

2018 ◽

Vol 28 (8) ◽

pp. 3276-3284 ◽

Cited By ~ 4

Author(s):

Roh-Eul Yoo ◽

Tae Jin Yun ◽

Dong Hyun Yoo ◽

Young Dae Cho ◽

Hyun-Seung Kang ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Arterial Spin Labelling ◽

Stroke Patients ◽

Blood Flow Change ◽

Flow Change ◽

Cerebral Blood Flow Change ◽

Spin Labelling

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Early management of acute ischaemic stroke

Stroke in the Older Person ◽

10.1093/med/9780198747499.003.0009 ◽

2020 ◽

pp. 121-140

Author(s):

Paul Guyler

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Older People ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Clinical Guidelines ◽

Mechanical Thrombectomy ◽

Early Management ◽

Trial Evidence ◽

Endovascular Mechanical Thrombectomy

This chapter, ‘Early management of acute ischaemic stroke’, addresses all the basic issues of thrombolysis as it has evolved over the last three decades. More importantly the journey and controversy concerning thrombolysis in older people is discussed at length with excellent trial evidence from specialist research. A review of all-important thrombolysis trials is succinctly described. New national clinical guidelines are analysed. Endovascular mechanical thrombectomy, which is rapidly developing, is described in detail with a review of the latest trials too. The author also highlights the importance of establishing cerebral blood flow as quickly and as completely and safely as possible.

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Dissociation of local nitric oxide concentration and vasoconstriction in the presence of cell-free hemoglobin oxygen carriers

Blood ◽

10.1182/blood-2006-02-005272 ◽

2006 ◽

Vol 108 (10) ◽

pp. 3603-3610 ◽

Cited By ~ 95

Author(s):

Amy G. Tsai ◽

Pedro Cabrales ◽

Belur N. Manjula ◽

Seetharama A. Acharya ◽

Robert M. Winslow ◽

...

Keyword(s):

Nitric Oxide ◽

Blood Flow ◽

Blood Volume ◽

Volume Expansion ◽

Molecular Volume ◽

Oxygen Carriers ◽

Systemic Hemodynamic ◽

Study Objective ◽

Blood Volume Expansion

Abstract Cell-free hemoglobin's (CFH) high affinity for nitric oxide (NO) could limit CFH's use as an oxygen-carrying blood replacement fluid because it scavenges NO, causing vasoconstriction and hypertension. However, the extent to which perivascular NO levels change following intravascular administration of hemoglobin (Hb) with different molecular dimensions correlates with vasoconstrictive responses in the microcirculation is unknown. The study objective was to determine vasoconstrictive effects following bolus infusions of (1) αα cross-linked Hb; (2) polymerized bovine Hb; or (3) polyethylene glycol-decorated Hb (PEG-Hb), by measurements of in vivo microvessel diameter, blood flow, perivascular NO concentration, and systemic hemodynamic parameters. All CFHs caused reductions in perivascular NO levels, not correlated to microvascular responses. PEG-Hb (largest molecular volume) maintained blood flow, while the others caused vasoconstriction and reduced perfusion. All solutions increased mean arterial pressure due to vasoconstriction and blood volume expansion, except for PEG-Hb, which increased blood pressure due to blood volume expansion and maintenance of cardiac output. In conclusion, perivascular NO reduction is similar for all Hb solutions because NO binding affinities are similar; however, effects on vascular resistance are related to the type of molecular modification, molecular volume, and oxygen affinity.

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