Introduction
Current management of surgical shock encompasses a number of therapeutic modalities, most of which are based on the "volume replacement" concept. In Part 1 of this report, the rationale for the administration of low molecular weight dextran to patients experiencing major hemorrhage or episodes of shock was outlined.A controversy currently exists over the nature of the circulatory disturbances in shock. This has recently centered about the concept of "microcirculatory sphincter closure" on the one hand, and the influence of "viscosity alteration" on the other. Evidence, primarily based on laboratory animal data, has been presented to support each thesis; no definite conclusions have been reached from this data.Gelin2 showed evidence in man that reduced capillary blood flow occurred in traumatic shock, due to increased viscosity of blood in the microcircuit. Further, improvement in this capillary flow was demonstrated following administration of a viscosity-lowering agent, namely, low viscosity,