BACKGROUND: One of the factors that affect the anesthetic risk is preoperative status especially in geriatric patients. So we studied about followings; 1) Can we use APACHE scoring index when we assess the physical status of geriatric patients preoperatively? 2) Is it meaningful in saying the risk of anesthesia? 3) Which one is more significant in predicting the morbidity and mortality: acute physiologic status vs chronic health status? METHOD: Preoperative status of the geriatric patients (above 65 years old), who were received operation from June 1994 to March 1996 at Hanil General Hospital, were assessed by APACHE scoring index and ASA classification. Age, sex, type of operation, emergency or elective, method of anesthesia, duration of procedure, APACHE scoring index, ASA classification, perioperative complication, postoperative complication is coded by grading or type. RESULT: Perioperative complication was showed statistically significant with acute physiologic score (APS) and duration of procedure. Postoperative complication was showed statistically significant with APACHE score or ASA class. Total complication was affected by duration of procedure and APS score. There was also correlation between ASA class and total complication. Among 265 cases, 1 case expired during operation and 7 cases expired after operation. Causes of postoperative death were pneumonia, hemorrhagic shock etc. CONCLUSION: In geriatric patients, 1) APACHE scoring index is available for preoperative assessment. 2) APACHE scoring index is meaningful in predicting the risk of anesthesia. 3) Perioperative complication was more correlated with acute physiologic status than chronic health evaluation.
Anesthesia ; APACHE* ; Classification ; Emergencies ; Hospitals, General ; Humans ; Mortality ; Pneumonia ; Postoperative Complications ; Shock, Hemorrhagic

Adult ; Aged ; Aged, 80 and over ; Cholecystitis ; complications ; Humans ; Middle Aged ; Shock, Hemorrhagic ; etiology ; physiopathology

Gastrointestinal Hemorrhage ; etiology ; Heat Stroke ; complications ; Humans ; Male ; Middle Aged ; Shock, Hemorrhagic ; etiology

OBJECTIVETo examine the effect of different infusion volume on hemodynamics of portal hypertension (PHT) canines after hemorrhagic shock (HS).

METHODSPHT canine models were made by coarctating a half main portal vein with silk line chronic embolization. Two weeks later, the canine models were assigned to hemorrhagic shock by femoral artery venesection quickly. They were divided into two groups: large volume infusion group (n=6) and small volume infusion group (n=6). Hemodynamics indexes of PHT canines after HS were monitored continuously. We also examined the effect of different infusion volume on hemodynamics.

RESULTSPHT canines showed a series of hemodynamics changes in hemorrhagic shock stage, which aggravated hemodynamics disorder in PHT. After quick infusion, MAP, IVCP, PVP, PVPG, PVBF, HABF, and HBF increased significantly. These indexes in large volume infusion group were higher than those in small volume infusion group. PVR, SVR, HAR decreased significantly. PVP, PVPG, PVBF, HABF, and HBF showed a rebound increase above baseline values in large volume infusion group. The changes of PVP, PVPG, PVBF, HABF, and HBF were parallel with MAP and IVCP and without rebound increase in small volume infusion group. In large volume infusion group PVPG increased earlier and more significant than PVP and exceeded baseline by 13% (2.58 0.37) kPa, so the danger of rebleeding rose greatly. In small volume infusion group PVPG was over 22% (1.67 0.27) kPa lower than baseline, which infers that the danger of rebleeding reduced greatly. SVR and HAR were lower in large volume infusion group. PVP, PVPG, PVBF, HABF, and HBF showed a positive correlation with accumulated vein infusion volume. PVR showed a positive correlation with accumulated vein infusion volume in small volume infusion group. HAR showed a negative correlation with accumulated vein infusion volume in large volume infusion group.

CONCLUSIONSPHT canines after HS show a rebound increase of PVP, PVPG, PVBF, HABF, and HBF above baseline values in large volume infusion group. In small volume infusion group, however, no rebound increase is noticed. Large volume infusion may cause PVP, PVPG, PVBF, HABF, and HBF increase higher than small volume infusion.

Animals ; Dogs ; Hemodynamics ; Hypertension, Portal ; etiology ; physiopathology ; Portal Vein ; physiopathology ; Shock, Hemorrhagic ; complications

20-year-old man presented to our emergency department after he was hit by a forklift. He developed haemorrhagic shock from a subcutaneous haematoma in his left thigh and required monitoring in the surgical intensive care unit. He stabilised with aggressive fluid resuscitation with crystalloids and blood transfusion. The recovery was complicated by an infection of the subcutaneous haematoma. Following open drainage of the infected subcutaneous haematoma, he improved and was discharged. To the best of our knowledge, this is the first reported case of a subcutaneous haematoma causing haemorrhagic shock.
Accidents, Traffic ; Diagnosis, Differential ; Hematoma ; complications ; diagnosis ; Humans ; Male ; Shock, Hemorrhagic ; diagnosis ; etiology ; Soft Tissue Injuries ; complications ; diagnosis ; Young Adult

OBJECTIVETo introduce the concept, methods for calculation and application of "number needs to be exposed (NNE)" in Epidemiological studies.

METHODSData was analyzed from a study on the association between diaspirin cross-linked hemoglobin (DCLHb) with 28-day mortality in patients with severe traumatic hemorrhagic shock.

RESULTSThe crude "number needed to be exposed for one additional person to be harmed" (NNEH) was 3.7 (95% CI: 2.2-11.5) for the exposure to DCLHb. After controlling the confounding bias of the baseline mortality risk, the adjusted NNEH became 2.6 (95% CI: 1.6-8.0) id., on average, among 2.6 patients exposed to DCLHb, one additional case of death would have developed within 28 days after initial hospitalization if the distribution of baseline mortality risk in exposed group had been equal to that in the unexposed group.

CONCLUSIONNNE could be expressed as the estimated average number of persons needed to be exposed for contributing (either developing or preventing for) one additional case of disease or death in a prospective study when compared with the unexposed persons. As a new index for measuring the absolute effect of an exposure, NNE presented the results on epidemiological studies in a more intuitive and understandable manner. Consequently, this method could be favorably accepted by clinicians, health policy makers and the public.

Epidemiologic Studies ; Hemoglobins ; therapeutic use ; Humans ; Logistic Models ; Randomized Controlled Trials as Topic ; Risk ; Shock, Hemorrhagic ; complications ; drug therapy ; mortality ; pathology ; Software ; Wounds and Injuries ; complications

OBJECTIVETo investigate the protective effect of limited fluid resuscitation against intestinal ischemia- reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.

METHODSTwenty- four postpartum rabbits were randomly assigned into sham shock group (group P), shock group without interventions (group P0), conventional fluid resuscitation group (group PNL), and limited fluid resuscitation group (group PLH), and the model of severe uncontrolled hemorrhagic shock was established in the latter 3 groups. The rabbits were sacrificed 4 h later, and SOD activity and MDA content in the intestinal mucosa and the degree of injury to the intestinal mucosa were observed.

RESULTSIschemia-reperfusion injury of the intestine due to uncontrolled hemorrhagic shock resulted in decreased SOD activity and increased MDA content. The MDA content was significantly lower and SOD activity was significantly higher in group PLH than in group PNL (P<0.05), and the intestinal mucosal tissue morphology and intestinal mucosa barrier lesion increased in group PLH.

CONCLUSIONInitial limited fluid resuscitation can relieve intestinal ischemia-reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.

Animals ; Disease Models, Animal ; Female ; Fluid Therapy ; methods ; Intestines ; blood supply ; Pregnancy ; Rabbits ; Reperfusion Injury ; etiology ; prevention & control ; Shock, Hemorrhagic ; complications

OBJECTIVETo investigate the effects of ulinastatin on lung injury in hemorrhagic shock rats.

METHODSTwenty-four normal SD rats were randomly divided into 3 groups (n=8), namely the control group, hemorrhagic shock group (group H) and ulinastatin group (group U). In group H and group U, blood was drawn from the femoral artery over a period of 10 min until a mean arterial pressure of 40 mmHg was obtained. Controlled hypotension was then maintained at 40-/+5 mmHg for 60 min by blood drawing or infusion when necessary. All the blood drawn and an equivalent volume of Ringer lactate solution were subsequently infused for resuscitation. Four hours after the resuscitation, the activity of superoxidedismutase (SOD), content of malondialdehyde (MDA), expression of heme oxygenase-1 (HO-1), wet to dry weight ratio (W/D), and pathologic changes of the lung tissues were measured or observed.

RESULTSCompared with those in the control group, the content of MDA, expression of HO-1 and W/D increased significantly in both group H and group U (P<0.05); these indexes in group U were significantly lower than those in group H (P<0.05). The activity of SOD in group U was significantly lower than that in the control group (P<0.05) but higher than that in group H (P<0.05). Optical microscopy demonstrated milder inflammatory cell infiltration and interstitial edema in the lung tissues in group U than in group H.

CONCLUSIONUlinastatin can lower the content of MDA, W/D and the expression of HO-1, increase the activity of SOD, and reduce histological lung injury in rats with hemorrhagic shock.

Animals ; Glycoproteins ; pharmacology ; Heme Oxygenase-1 ; metabolism ; Lung Injury ; etiology ; prevention & control ; Male ; Malondialdehyde ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic ; complications ; metabolism ; Superoxide Dismutase ; metabolism

Animals ; Carnosine ; pharmacology ; therapeutic use ; Liver ; drug effects ; pathology ; Male ; Rats ; Rats, Wistar ; Reperfusion Injury ; prevention & control ; Shock, Hemorrhagic ; complications ; pathology

OBJECTIVETo determine the effect of albumin administration on lung injury in traumatic/hemorrhagic shock (T/HS) rats.

METHODSForty-eight adult Sprague-Dawley rats were divided into three groups randomly (n=16 in each group): Group A, Group B, Group C. In Group A, rats underwent laparotomy without shock. In Group B, rats undergoing T/HS were resuscitated with their blood plus lactated Ringer's (twice the volume of shed blood). In Group C, rats undergoing T/HS were resuscitated with their shed blood plus additional 3 ml of 5% human albumin. The expression of polymorphonuclear neutrophils CD18/CD11b in jugular vein blood was evaluated. The main lung injury indexes (the activity of myeloperoxidase and lung injury score) were measured.

RESULTSSignificant differences of the expression of CD18/11b and the severity degree of lung injury were founded between the three groups. (P<0.05). The expression of CD18/CD11b and the main lung injury indexes in Group B and Group C increased significantly compared with those in Group A (P<0.05). At the same time, the expression of CD18/CD11b and the main lung injury indexes in Group C decreased dramatically, compared those in Group B (P<0.05).

CONCLUSIONSThe infusion of albumin during resuscitation period can protect lungs from injury and decrease the expression of CD18/CD11b in T/HS rats.

Albumins ; therapeutic use ; Animals ; CD11b Antigen ; metabolism ; CD18 Antigens ; metabolism ; Disease Models, Animal ; Neutrophils ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; drug therapy ; etiology ; metabolism ; Shock, Hemorrhagic ; complications ; metabolism ; Treatment Outcome ; Wounds and Injuries ; complications ; metabolism