强力霉素调控表达脑啡肽的永生化大鼠星形胶质细胞株的构建

目的构建受强力霉素（Dox）调控表达脑啡肽的永生化大鼠星形胶质细胞株（IAST）。方法采用脂质体介导法将重组质粒pRevTREhPPE和调节质粒pRevTet-On分别转染逆转录病毒包装细胞PT67；将含有RevTet—On和RevTRE／hPPE病毒上清感染IAST，得到稳定表达脑啡肽的IAST／Tet-On／hPPE细胞株，实时定量PCR检测Dox定量调控该细胞株前脑啡肽原（hPPE）基因的表达，免疫细胞化学及放射免疫分析法检测Dox定量调控该细胞株中脑啡肽的表达。结果IAST／Tet-On／hPPE细胞株中，hPPE基因的表达和脑啡肽的分泌受Dox调控，Dox浓度为100～5000nedml时，随着Dox浓度增高，hPPE基因的表达和脑啡肽的分泌增加，Dox浓度为5000ng／ml时达峰值。结论成功构建了受四环素及其衍生物强力霉素定量调控表达脑啡肽的IAST。     

利用Tet-on调控系统建立人肝癌HepG2Tet-on细胞系

目的 构建可以用强力霉素调控表达的人肝癌HepG2Tet-on细胞系,为进一步研究肝癌相关基因功能奠定基础.方法 用脂质体转染法将pWHE146质粒转染到人肝癌HepG2细胞中,用G418筛选出稳定表达细胞克隆;单克隆分别扩增后,瞬时转染pTRE-hyg-luc质粒;强力霉素诱导表达后,检测荧光素酶表达活性,挑选出受强力霉素调控的低背景、高表达的HepG2Tet-on细胞株.结果 成功构建了一株受强力霉素调控的高表达低背景的HepG2Tet-on细胞株(诱导倍数达154.106倍).结论 HepG2Tet-on细胞株可用于外源基因的真核调控高表达,为研究真核基因功能提供一种可靠的细胞株.     

EphA1基因可控性双稳转内皮祖细胞系EPCsTet-On-EphA1SiRNA的建立

目的建立可调控EphA1基因表达的内皮祖细胞系EPCsTet-On-EphA1SiRNA。方法将pWHE146质粒转染到内皮祖细胞系中,筛选出稳定表达的细胞克隆;扩增后瞬时转染pTRE-hyg-luc质粒,强力霉素诱导表达后,检测荧光素酶活性,挑选出高表达、低背景的受强力霉素调控的EPCsTet-On细胞株;再将重组质粒pTRE-EphA1SiRNA转染入EPCsTet-On细胞株,筛选出稳定表达细胞克隆EPCsTet-On-EphA1SiRNA;通过强力霉素诱导后,利用RT-PCR和Western blotting法检测EphA1基因mRNA与蛋白的表达。结果成功构建了受强力霉素调控的高表达低背景的EPCsTet-On-EphA1SiRNA细胞株;强力霉素可诱导EPCsTet-On-EphA1SiRNA细胞株中EphA1mRNA表达下调,较之未调控组其差异有统计学意义(P<0.05);强力霉素调控EphA1蛋白表达的能力在一定范围内呈剂量依赖性关系。结论成功建立强力霉素调控EphA1基因表达的大鼠双稳转内皮祖细胞系EPCsTet-On-EphA1SiRNA,为深入研究EphA1基因在内皮祖细胞参与肝癌血管生成过程中的作用提供了有效的实验手段。     

猿肾病毒40大T抗原基因永生化大鼠星形胶质细胞株的构建

目的 构建永生化大鼠星形胶质细胞，为转基因细胞移植镇痛提供细胞载体。方法 采用差速粘附法体外分离和培养大鼠大脑皮层星形胶质细胞。利用脂质体将含有猿肾病毒40大T抗原(SV40Tag)基因的质粒pCMVSV40T／PUR转染培养的大鼠星形胶质细胞。经嘌呤霉素1．5μg／ml筛选后，挑选阳性细胞克隆扩大培养并连续传代。PCR、RT-PCR及免疫组化检测阳性细胞克隆中SV40Tag基因的整合情况及其表达，并对传代细胞的胶质原纤维酸性蛋白(GFAP)进行检测。结果 成功获得体外培养的大鼠星形胶质细胞，GFAP阳性表达；筛选获得阳性细胞克隆，连续传代培养近50代；PCR、RT-PCR产物经1．5％琼脂糖凝胶电泳分析显示558bp处有一特异性扩增条带，与阳性对照条带相同，而未转染pCMVSV40T／PUR的细胞无扩增条带，回收片段经测序、比对与SV40Tag的基因序列一致(100％)；同时转染的阳性细胞克隆SV40Tag和GFAP免疫染色阳性。结论 成功地构建了SV40Tag基因永生化的大鼠星形胶质细胞株。     

携带可调控人前脑啡肽原基因逆转录病毒载体的构建及鉴定

目的构建四环素调控的含人前脑啡肽原基因(hPPE)逆转录病毒载体。方法用PCR方法扩增目的基因hPPE,定向克隆入逆转录病毒四环素反应质粒(pRevTRE)中,酶切反应、PCR 及DNA测序鉴定重组逆转录病毒载体pRevTRE/hPPE;在脂质体介导下分别将pRevTRE/hPPE和逆转录病毒四环素调节质粒(pRevTet-on)转入包装细胞PT67,经相应的抗生素稳定筛选得到抗性细胞克隆。RT-PCR鉴定得到阳性产病毒细胞系PT67/Tet-on和PT67/TREhPPE。用NIH3T3细胞测定病毒滴度。结果经限制性酶切分析、RT-PCR及DNA序列分析证实pRevTRE/hPPE中含有hPPE基因。转染有pRevTet-on的FT67细胞病毒滴度为2.6×105 CFU/ml,转染有pRevTRE/hPPE的PT67细胞病毒滴度为3.2×105 CFU/ml。结论成功构建了含有受四环素调控hPPE基因的逆转录病毒载体,建立了能产较高滴度逆转录病毒的包装细胞系,为可调控细胞移植镇痛的研究奠定了实验基础。     

人骨形态蛋白-2可调控系统在大鼠骨髓间充质干细胞的表达

目的构建携带四环素真核诱导表达系统(Tet-on)调控的人骨形态发生蛋白2(h BMP-2)慢病毒载体转染大鼠骨髓间充质干细胞(BMSCs),为骨缺损修复提供可控的成骨活性细胞。方法设计目的基因h BMP-2引物,将扩增纯化的目的基因h BMP-2定向克隆至携带Tet-on的慢病毒GV347载体上并测序鉴定产物。h BMP-2-GV347质粒、空载的GV347质粒分别与辅助质粒共感染293T细胞以收获慢病毒浓缩液。用h BMP-2-GV347慢病毒转染大鼠BMSCs,得到h BMP-2阳性表达细胞,探索转染最佳感染复数(MOI)。用CCK8法比较BMSCs转染前后的增殖活性;强力霉素(DOX)诱导打开Tet-on,real-time PCR、Western Blot和酶联免疫吸附试验(ELISA)检测转染后各组BMSCs中BMP-2蛋白及RNA的表达情况。结果 PCR后得到目的基因h BMP-2,定向克隆至携带Tet-on系统调控的GV347质粒上,经酶切后电泳、测序结果证实成功构建携带可调控系统的h BMP-2-GV347质粒。h BMP-2-GV347质粒与空载GV347质粒分别感染293T细胞后获得h BMP-2-GV347慢病毒浓缩液。在DOX诱导下,h BMP-2-GV347慢病毒载体在293T细胞内表达BMP-2蛋白。h BMP-2-GV347慢病毒载体转染最佳MOI值为9,且转染后的BMSC细胞增殖能力较普通BMSC强,并在DOX浓度为10μg/ml诱导下稳定表达BMP-2蛋白和RNA。结论本研究成功构建携带Tet-on系统调控h BMP-2慢病毒表达载体,转染BMSCs后在DOX调控下可持续高效表达BMP-2蛋白。     

猿肾病毒40大T抗原基因永生化大鼠神经前体细胞株的构建

目的建立猿肾病毒40大T抗原基因(SV40Tag)永生化大鼠神经前体细胞株,为细胞移植治疗和转基因治疗提供稳定的细胞来源。方法利用脂质体介导的基因转染技术将含有SV40Tag的质粒pCMVSV40T/PUR转染原代培养的新生大鼠神经前体细胞,经嘌呤霉素筛选,阳性克隆扩大培养并连续传代。应用巢蛋白抗体进行细胞鉴定,5%胎牛血清诱导细胞分化后,应用免疫细胞化学法检测其分化能力,观察细胞的形态及其生长状况,绘制细胞生长曲线。用RT-PCR、Southern印迹杂交和免疫细胞化学法检测SV40Tag在转染细胞中的表达。结果转染细胞经筛选培养后获得1 个阳性细胞克隆,免疫细胞化学结果显示细胞的巢蛋白和微管相关蛋白2染色为阳性,增殖能力较强。5%胎牛血清可诱导转染细胞分化为微管相关蛋白2阳性和胶质纤维酸性蛋白阳性细胞。Southern印迹杂交结果显示转染细胞基因组中存在SV40Tag cDNA,并可检测到SV40Tag mRNA及其蛋白的表达。转染细胞经扩大培养,命名为永生化神经前体细胞。贴壁培养的神经前体细胞,群体倍增时间为(22.9±2.7)h,传代、冻存和复苏对细胞形态及生长无明显影响。结论成功地构建了SV40Tag永生化的大鼠神经前体细胞株。     

SV40LT抗原基因逆转录病毒载体的构建及其在肝细胞中的表达

目的　构建含SV 40LT抗原基因的逆转录病毒载体并转染鼠肝细胞 ,检测SV 40LT抗原基因在肝细胞中的表达情况 ,为肝细胞移植研究打下基础。方法　利用体外基因重组技术构建含SV 40LT抗原基因的逆转录病毒载体并酶切、测序鉴定 ,脂质体介导转染PA3 17细胞 ,G 418抗性筛选阳性克隆 ,通过NIH 3T3细胞测定病毒滴度 ;分离、纯化大鼠肝细胞后 ,将含SV 40LT抗原基因的假病毒颗粒感染肝细胞 ,用PCR及免疫组化法检测转染肝细胞中SV40LT抗原基因的表达情况。结果　( 1)酶切分析、测序证明重组逆转录病毒载体含有SV 40LT抗原基因 ;( 2 )病毒滴度为 1.3× 10 6 cfu/ml ;( 3 )转染后的肝细胞含有SV40LT抗原基因 ,其表达在转染后 2 4h明显高于 96h(P <0 .0 5 )。结论　成功构建含SV40LT抗原基因的逆转录病毒载体 ,转染后的肝细胞表达有目的基因 ,有望作为肝细胞体外培养的可用技术     

Stra8基因启动子逆转录病毒包装细胞株的建立

目的:建立小鼠Stra8基因启动子控制绿色荧光蛋白EGFP表达(P(stra8)-EGFP)的逆转录病毒包装细胞株,以方便地将P(stra8)-EGFP转导到目的细胞,为生殖细胞鉴定分选提供基础.方法:PCR扩增小鼠基因组DNA中的Stra8基因启动子片段,构建Stra8基因启动子控制表达的EGFP报告基因逆转录病毒质粒.将质粒脂质体法转染PT67病毒包装细胞,G418抗性筛选后,梯度稀释法将包装细胞单克隆化并扩增成多个细胞株.以包装细胞培养上清液感染NIH3T3细胞的所形成的G418抗性阳性细胞数定义病毒滴度,确定高滴度病毒包装细胞株.通过染毒小鼠骨髓间充质干细胞(mouse bone marrow mesenchymal stem cells,MSCs)验证该细胞株的P(stra8)-EGFP转导效果.结果:所建立的病毒包装细胞株培养上清液滴度达到1.3×10(6) cfu/ml.MSC经包装细胞培养上清液感染后,在(retinoic acid,RA)诱导下能表达EGFP蛋白.结论:成功构建了将P(stra8)-EGFP转导到目的细胞的PT67逆转录病毒包装细胞株.     

受强力霉素调控表达的人肝癌HepG2细胞系的建立

目的建立受强力霉素 (doxycycline)调控表达的人肝癌HepG2细胞系。 方法用阳离子脂质体lipofectamine 2 0 0 0 0将pTet on质粒转染人肝癌HepG2细胞 ,通过G4 18筛选得到稳定转染的抗性克隆 ;将抗性克隆细胞分别培养扩增 ,通过 pTRE luc质粒瞬时转染 ,加入终浓度为 1μg/ml的doxycycline诱导剂培养 4 8h后 ,逐一检测每个细胞株的荧光素酶表达活性。 结果第 6号克隆的细胞诱导后荧光素酶的表达活性为 16 76 4 ,而非诱导状态下该细胞株的背景活性为 87,诱导后的活性增加 192倍。结论HepG2 /Tet on细胞株是可调控基因表达的人肝癌细胞株 ,为研究肝癌的发病和基因治疗提供了较为理想的研究工具。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.