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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathophysiological notions of hemodilution treatment of ischemic seizures with plasma expanders indicates the significance of microcirculation. Microcirculation disorders arise from the interrelations of hemodynamic, vascular, and hemorrheologic factors. It seems that hemodilution with hydroxyethyl starch reduces peripheral microcirculation disorders, thus inhibiting the development of cerebral edema. In the case of subarachnoid hemorrhage, the hemorrheologic factors deteriorate less severely when given antifibrinolytic treatment with Aprotinin. Simultaneous hemodilution with hydroxyethyl starch can counterbalance the already existing changes.
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PMID:[Disorders of microcirculation in subarachnoid hemorrhage and intracerebral hemorrhage]. 338 Sep 29

Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA) or epsilon amino caproic acid (EACA). While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.
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PMID:Antifibrinolytics in cardiac surgery. 2354 66