Compatibility of Different Colloid Plasma Expanders with Perflubron Emulsion

2000 ◽  
Vol 93 (5) ◽  
pp. 1261-1270 ◽  
Author(s):  
Dirk Nolte ◽  
Sven Pickelmann ◽  
Michael Lang ◽  
Peter Keipert ◽  
Konrad Messmer
Keyword(s):  
Body Weight ◽  
Hydroxyethyl Starch ◽  
Elective Surgery ◽  
Autologous Blood ◽  
Microvascular Perfusion ◽  
Oxygen Carriers ◽  
Acute Normovolemic Hemodilution ◽  
Perfluorocarbon Emulsion ◽  
Normovolemic Hemodilution ◽  
Plasma Expanders

Background Perfluorocarbon-based oxygen carriers have been proposed as an adjunct to autologous blood conservation techniques during elective surgery. To date, the effects of perfluorocarbon emulsions at the microcirculatory level have not been studied extensively. In this study the effects of perflubron emulsion on the microcirculation after acute normovolemic hemodilution (ANH) were investigated using different colloid plasma expanders. Methods The dorsal skin fold chamber model and intravital fluorescence microscopy were used for analysis of the microcirculation in the thin striated skin muscle of conscious hamsters (body weight, 40-60 g). Measurements of microvascular perfusion and leukocyte adhesion (n = 6 animals per experimental group) were made before and at 10, 30, and 60 min after ANH (to hematocrit 0.3) with either 6% hydroxyethyl starch 200/0.6 (HES), 3.5% gelatin, 5% human serum albumin (HSA), or 6% dextran 60 (DX-60) followed by intravenous injection of 3 ml/kg body weight of a 60% weight/volume perfluorocarbon emulsion based on perflubron (perfluorooctyl bromide) emulsified with egg yolk lecithin. Results Acute normovolemic hemodilution with HES, gelatin, or HSA followed by injection of perflubron emulsion elicited no alterations of local microvascular perfusion or leukocyte-endothelium interaction as assessed in arterioles and postcapillary venules. However, ANH with DX-60 followed by injection of perflubron emulsion led to a significant reduction of erythrocyte velocity in postcapillary venules and an increase in venular leukocyte sticking that was never observed with DX-60 alone. Conclusions Hydroxyethyl starch, gelatin, and HSA are compatible with perflubron emulsion in the setting of ANH. Only DX-60 appeared to be incompatible with perflubron emulsion, as evidenced by impairment of capillary perfusion.

scholarly journals Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Guo-Xing You ◽  
Bing-Ting Li ◽  
Zhen Wang ◽  
Quan Wang ◽  
Ying Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hydroxyethyl Starch ◽  
The Other ◽  
Acute Normovolemic Hemodilution ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance ◽  
Normovolemic Hemodilution ◽  
Plasma Expanders ◽  
Low Shear

Abstract Background Plasma expanders are widely used for acute normovolemic hemodilution (ANH). However, existing studies have not focused on large-volume infusion with colloidal plasma expanders, and there is a lack of studies that compare the effects of different plasma expanders. Methods The viscosity, hydrodynamic radius (Rh) and colloid osmotic pressure (COP) of plasma expanders were determined by a cone-plate viscometer, Zetasizer and cut-off membrane, respectively. Sixty male rats were randomized into five groups with Gelofusine (Gel), Hydroxyethyl Starch 200/0.5 (HES200), Hydroxyethyl Starch 130/0.4 (HES130), Hydroxyethyl Starch 40 (HES40), and Dextran40 (Dex40), with 12 rats used in each group to build the ANH model. ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders. Acid-base, lactate, blood gas and physiological parameters were detected. Results Gel had a lower intrinsic viscosity than HES200 and HES130 (P < 0.01), but at a low shear rate in a mixture of colloids, red cells and plasma, Gel had a higher viscosity (P < 0.05 or P < 0.01, respectively). For hydroxyethyl starch plasma expanders, the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm. A severe ANH model, with the hematocrit of 40% of the baseline level, was established and accompanied by disturbances in acid-base, lactate and blood gas parameters. At the end of ANH and 60 min afterward, the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) decreased significantly in all groups at the end of ANH. The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH. During the process of ANH, the Dex40 group showed a drop and recovery in SBP, DBP and MAP. The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points (P < 0.05 or P < 0.01). Conclusion Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates. Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders. Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders. During the process of ANH, Dex40 displayed a V-shaped recovery pattern for blood pressure, and HES200 had the advantage in sustaining the DBP and MAP at some time points.

Perflubron Emulsion Delays Blood Transfusions in Orthopedic Surgery 

1999 ◽  
Vol 91 (5) ◽  
pp. 1195-1195 ◽  
Author(s):  
Donat R. Spahn ◽  
Ronald van Brempt ◽  
Gregor Theilmeier ◽  
Jan-Peter Reibold ◽  
Martin Welte ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Autologous Blood ◽  
Oxygen Carriers ◽  
Transfusion Trigger ◽  
Acute Normovolemic Hemodilution ◽  
Parallel Group ◽  
Artificial Oxygen Carriers ◽  
Normovolemic Hemodilution ◽  
Orthopedic Patients ◽  
Colloid Infusion

Background Fluorocarbon emulsions have been proposed as temporary artificial oxygen carriers. The aim of the present study is to compare the effectiveness of perflubron emulsion with the effectiveness of autologous blood or colloid infusion for reversal of physiologic transfusion triggers. Methods A multinational, multicenter, randomized, controlled, single-blind, parallel group study was performed in 147 orthopedic patients. Patients underwent acute normovolemic hemodilution with colloid to a target hemoglobin of 9 g/dl with an inspiratory oxygen fraction (FIO2) of 0.40. Patients were then randomized into one of four treatment groups after having reached any of the protocol-defined transfusion triggers including tachycardia (heart rate &gt; 125% of posthemodilution rate or &gt; 110 bpm), hypotension (mean arterial pressure &lt; 75% of posthemodilution level or &lt; or = 60 mmHg), elevated cardiac output (&gt; 150% of posthemodilution level) or decreased mixed venous oxygen partial pressure (PVO2; &lt; 38 mmHg). Treatments in the four groups were 450 ml autologous blood harvested during acute normovolemic hemodilution given at FO2 = 0.40; 450 ml colloid at FIO2 = 1.0; 0.9 g/kg perflubron emulsion with colloid (total = 450 ml) at FIO2 = 1.0; and 1.8 g/kg perflubron emulsion with colloid (total = 450 ml) at FIO2 = 1.0. The primary endpoint was duration of transfusion-trigger reversal. A secondary end-point was percentage of transfusion-trigger reversal. Results Perflubron emulsion was well tolerated with no serious adverse event attributed to drug treatment. Duration of reversal was longest in the 1.8 g/kg perflubron group (median, 80 min; 95% confidence interval, 60-100 min; P = 0.014 vs. autologous blood, P &lt; 0.001 vs. colloid) followed by the 0.9 g/kg perflubron group (median, 59 min; 95% confidence interval, 40-90 min), the autologous blood group (median, 55 min; 95% confidence interval, 30-70 min) and the colloid group (median, 30 min; 95% confidence interval, 27-60 min). Percentage of reversal was also highest in the 1.8 g/kg perflubron group (97%; P &lt; 0.001 vs. autologous blood; P = 0.014 vs. colloid), followed by 0.9 g/kg perflubron (82%), colloid (76%), and autologous blood (60%). Conclusions Perflubron emulsion (1.8 g/kg) combined with 100% oxygen ventilation is more effective than autologous blood or colloid infusion in reversing physiologic transfusion triggers.

THE USE OF TECHNOLOGIES TO MINIMIZE EXPOSURE TO PERIOPERATIVE ALLOGENEIC BLOOD TRANSFUSION IN ELECTIVE SURGERY

2000 ◽  
Vol 16 (1) ◽  
pp. 228-241 ◽  
Author(s):  
Ian D. Graham ◽  
Dean Fergusson ◽  
Laura McAuley ◽  
Andreas Laupacis
Keyword(s):  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
Elective Surgery ◽  
Aminocaproic Acid ◽  
Allogeneic Blood ◽  
Cell Salvage ◽  
Acute Normovolemic Hemodilution ◽  
Cross Sectional ◽  
Allogeneic Transfusion ◽  
Normovolemic Hemodilution

Background: Despite the growing medical and public interest in reducing exposure to allogeneic blood, little is known about the use of alternatives to allogeneic transfusion. This study was conducted to determine the availability of these technologies in Canadian hospitals and was undertaken under the auspices of the International Study of Peri-Operative Transfusion (ISPOT), a 10-country study of the effectiveness of, attitudes toward, and practices related to the use of alternatives to allogeneic transfusion.Methods: A cross-sectional national mail survey of Canadian hospitals with greater than 50 medical/surgical beds. Chiefs of anesthesia, surgery, and the divisions of cardiac, orthopedic, vascular, and urology were initially mailed a brief postcard asking which of seven technologies were used in their center. This was then followed up with a one-page questionnaire asking how frequently the technologies were used, their thoughts on the appropriateness of the use of the technologies, barriers to their greater use, and reasons for nonuse of the technologies.Results: Response rates to the postcard survey ranged from 70%–98%, depending on the technology and type of surgery, and ranged from 27%–53% for the follow-up questionnaire. All technologies were used most frequently in cardiac surgery. Aprotinin, tranexamic acid, aminocaproic acid, desmopressin, and cell salvage were reported used in over 70% of cardiac surgery centers. Of these, tranexamic acid and cell salvage were the only ones used routinely in some centers. Acute normovolemic hemodilution and erythropoietin were used in 45% and 20% of cardiac centers, respectively. The drugs were used in less than 15% of orthopedic, vascular, and urologic divisions, with the exception of desmopressin in urologic and vascular surgery and aminocaproic acid in urologic surgery. The techniques of cell salvage and acute normovolemic hemodilution were used in 30%–45% of these divisions, with the exception of cell salvage, which was used in less than 15% of urology units. In more than 60% of cases, the technologies were considered to be used “about right,” although an important minority felt that they were underused.Conclusions: In general, alternatives to perioperative allogeneic transfusion were rarely used except in cardiac surgery.

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