Blood Viscosity and Shock: The Role of Hemodilution, Hemoconcentration and Defibrination (Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine, nr. 160)

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en Limba Engleză Carte Paperback – April 1984

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ISBN-13: 9783540126201
ISBN-10: 3540126201
Pagini: 224
Dimensiuni: 170 x 244 x 12 mm
Greutate: 0.36 kg
Ediția: Softcover reprint of the original 1st ed. 1984
Editura: Springer
Colecția Springer
Seria Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine

Locul publicării: Berlin, Heidelberg, Germany

Public țintă



I Review of the Literature.- I Viscosity in General.- I.1 Introduction.- I.2 The Concept of Viscosity: Shear Stress and Shear Rate.- I.3 The Behavior of Viscosity: Newtonian and Non-Newtonian Fluids, Hemodilution and Defibrination.- I.4 The Fahraeus-Iindquist Phenomenon and the Inversion Phenomenon.- I.5 Plasma Skimming.- I.6 The Total Cross-Sectional Area of the Vascular Bed and the Flow Rate at Various Places in the Circulatory System.- I.7 The “Average Shear Rate” (4 v/r).- I.8 Internal Viscosity.- I.9 Exceptions to Poiseuille’s Law: Laminar and Turbulent Flow and Rigid and Elastic Vascular Systems.- 1.10 Guyton’s Equation of Circulatory Control.- II Viscosity in Relation to Cardiac Output, Blood Pressure and Peripheral Resistance.- II.1 Factors which Determine the Cardiac Output: The Relationship Between Cardiac Output and Viscosity.- II.1.1 Peripheral Factors.- II.1.1.1 Mean Circulatory Filling Pressure (Psf) Minus the Right Atrial Pressure ÂPra)..- II.1.1.2 The Resistance to Venous Return.- II.1.2 Central Factors.- II.1.2.1 The Pumping Action of the Heart: Hypo- and Hyperactivity.- II.1.3 Equilibrium Values of Cardiac Output and Venous Return Under Normal Conditions.- II.2 Factors which Determine Blood Pressure: The Relationship Between Blood Pressure and Viscosity.- II.3 Factors which Determine Peripheral Resistance: The Relationship Between Peripheral Resistance and Viscosity.- III The Clinical Significance of Viscosity.- III. 1 Introduction.- III.2 Viscosity in the Postcapillary Venular Bed.- III.3 Relationship Between Hematocrit and Optimal O2-Transport Capacity at Varying Shear Rates.- III.4 High Viscosity Syndromes.- III.4.1 Myocardial Infarction, Angina Pectoris and Intermittent Claudication.- III.4.2 Cerebral Infarction.- III.4.3 Shock and Trauma.- III.4.4 Neoplasms.- III.4.5 Genetic Factors: Sickle-Cell Anemia.- III.4.6 Hormonal Factors: Diabetes Mellitus and Oral Contraceptives.- III.4.7 Pre-Eclampsia and Normal Pregnancy.- III.4.8 Toxic Factors: Cigarette Smoking and Alcohol.- III.4.9 Psychic Influences: Stress and Psychosis.- III.4.10 Hypo- and Hyperthermia.- IV Lowering the Viscosity with the Aid of Hemodilution.- IV.l Introduction.- IV.2 Physiological Consequences of Hemodilution.- IV.3 Clinical Applications.- IV.4 Criteria and Limitations.- IV.5 The Colloid Osmotic Pressure and the Colloid Hydrostatic Pressure Gradient.- IV.6 Comparison of Various Transfusion Fluids.- IV.7 Guidelines for Infusion in Case of Threats to the Circulation.- IV.8 Some Critical Remarks with Regard to Hemodilution.- V Lowering the Viscosity by Means of Defibrination with the Aid of Arvin.- V.1 Introduction.- V.2 Properties of Arvin.- V.3 Side Effects of Arvin.- V.4 Antidotes.- V.5 Indications.- V.6 Contraindications.- V.7 Treatment Schedules.- V8 Comparison of Arvin and Heparin.- V.9 Specific Action of Arvin.- V.9.1 The Cardiac Status.- V.9.2 The Microcirculation.- V.9.3 Deep Vein Thrombosis (DVT).- VI Viscometry.- VI.1 Introduction.- VI.2 Problems of Interpretation.- V1.3 Problems Related to the Measurement Techniques.- VI.4 Various Types of Measuring Apparatus.- VI.4.1 Capillary Viscometers.- VI.4.2 Rotation Viscometers.- VI.4.3 The Rheodeer Controlled Stress Rheometer.- VI.5 Alterations in Viscosity with Time, Due to the Factor Aggregation ⇋ Disaggregation.- VI.6 Viscosity Parameters.- VI.7 Determination of the Yield Shear Stress.- VI.7.1 The Casson Plot Method (Extrapolation).- VI.7.2 The Torque Decay Method (Merill 1965).- VI.7.3 The Rheoscan Viscosity Curve (Humphreys 1975).- VI.8 Determination of the Asymptotic Viscosity.- VI.9 Artefacts in the Measurement Methods.- VI.10 Normal Values (in Man) with the Contraves LS 30 According to Humphreys.- II Material and Methods.- VII Material and Methods.- VII.1 General Remarks.- VII.1.1 The Experimental Animals.- VII.1.2 Anesthesia.- VII.1.3 Artificial Respiration.- VII.1.4 General Preparation.- VII.2 Specific Procedures.- VII.2.1 The Series with Extracorporeal Circulation (ECC) or Cardiopulmonary Bypass (CPB).- VII.2.1.1 Surgical Procedures.- VII.2.1.2 Hemorrhagic Shock Protocol.- VII.2.1.3 Monitoring.- VII.2.2 The Intact Series.- VII.2.2.1 Surgical Procedures.- VII.2.2.2 Hemorrhagic Shock Protocol.- VII.2.2.3 Monitoring.- VIII Specific Measuring Methods.- VIII.1 Control of the Degree of Defibrination.- VIII.1.1 Activated Clotting Time.- VIII.1.2 Method of Claus for Determining the Fibrinogen Concentration.- VIII.2 Transcutaneous PO2 Measurement.- VIII.3 Determination of the Colloid Osmotic Pressure (COP).- VIII.4 Measurement of Cardiac Output.- References.- III Results.- IX Paper I Effects of Reduction in Viscosity by Means of Hemodilution (Dextran 40) and Defibrination (Arvin) Using a Shock Model with Extracorporeal Circulation.- X Paper II Effects of Viscosity Reduction by Means of Defibrination (Arvin) and Moderate Hemodilution (0.9% NaCl) in a Shock Model with Intact Animals.- XI Paper III Effects of Changes in Viscosity by Means of Defibrination (Arvin) and Changes in Hematocrit (High and Low Ht) Using a Shock Model with Intact Animals.- XII Paper IV Integration of Blood Viscosity into a Clinical Concept.- XIII Paper V Standardization and Automation of the Measurement of Whole Blood Viscosity.- Summary and Conclusions.- General Summing-Up.