老年髋部骨折术后谵妄的危险因素分析

目的探讨引起老年髋部骨折患者术后谵妄(postoperative delirium,POD)的主要危险因素。方法回顾性分析2014年5月至2015年1月收治的老年髋部骨折且符合纳入及排除标准的患者289例(股骨转子间骨折157例、股骨颈骨折132例),根据是否出现POD分组,记录并比较两组患者的年龄、性别、骨折部位、术前并存病、受伤至手术时间、手术方式、麻醉方式、手术时间、术中出血量,采用多因素Logistic回归分析老年髋部骨折患者POD的危险因素,观察术后并发症的情况。结果单因素分析显示组间年龄(χ2=13.813,P=0.001)、术前并存病(χ2=19.281,P0.001)、受伤至手术时间(t=5.101,P=0.041)、麻醉方式(χ2=32.632,P0.001)差异有统计学意义。多因素Logistic回归分析示年龄70~80岁和80岁组POD发生率高于年龄70岁组,OR值为3.427(95%CI:1.584,7.415)和6.247(95%CI:1.965,19.862);受伤至手术时间≥7 d组POD发生率高于1~3 d组,OR值为14.279(95%CI:5.391,37.819);术前并存病≥3种组POD的发生率高于≤2种组,OR值为4.069(95%CI:2.024,8.182);全麻组POD发生率高于椎管内麻醉组,OR值为3.988(95%CI:1.848,8.608);POD组和无POD组术后并发症发生率分别为66.7%和42.0%。结论高龄、术前并存病多、受伤至手术时间长、全麻是老年髋部骨折发生POD的危险因素。     

全膝/髋关节置换术患者术前血浆白蛋白浓度与术后谵妄的关系

目的评价全膝/髋关节置换术患者术前血浆白蛋白浓度与术后谵妄(POD)的关系。方法选择本院2021年12月至2022年12月择期在脊椎-硬膜外联合麻醉下行全膝/髋关节置换术的患者500例, 性别不限, 年龄50～90岁, 体质量50～80 kg, ASA分级Ⅰ或Ⅱ级。蛛网膜下腔穿刺成功后抽取脑脊液(CSF)标本, 采用ELISA法测定β淀粉样蛋白42(Aβ42)、总tau蛋白(T-tau)和磷酸化tau蛋白(P-tau)浓度。于术后1～7 d(或出院前)采用意识错乱评估量表(CAM)、谵妄程度评估量表(MDAS)评估是否发生POD及严重程度, 将患者分为POD组和非POD组(NPOD组)。采用logistic回归分析筛选POD的危险因素。采用受试者工作特(ROC)曲线评价血浆白蛋白浓度和CSF生物标志物浓度预测POD的准确性, 进行CSF生物标志物的中介效应分析。结果本研究最终纳入343例患者, POD发生率为23.3%。与NPOD组相比, POD组患者年龄、术前血浆白蛋白浓度和MDAS评分差异有统计学意义(P<0.05)。混杂因素校正前后, 术前血浆白蛋白浓度降低及CSF P-t...     

脑电双频指数监测对老年慢性贫血患者术后谵妄发生率的影响

目的 探讨BIS监测对老年慢性贫血患者腹部手术术后谵妄(postoperative delirium,POD)发生率的影响. 方法 180例择期行全身麻醉手术患者,按随机数字表法分为两组(每组90例):BIS监测组及对照组,对照组采用常规麻醉,BIS监测组维持BIS值于40～60.记录患者入室后(T0)、诱导后(T1)、插管即刻(T2)、插管后3 min(T3)、切皮(T4)、术中1h(T5)及手术结束(T6)各时间点的血流动力学指标.观察记录患者麻醉期间丙泊酚用量、手术时间、拔管时间、清醒时间,及POD发生情况. 结果 BIS监测组谵妄总发生率17.8％,低于对照组的31.1％(P＜0.05);其中,BIS监测组谵妄第1天发生率13.3％,明显低于对照组的28.9％(P＜0.05),第2天发生率5.6％,低于对照组的14.4％(P＜0.05);BIS监测组谵妄持续时间明显低于对照组(P＜0.05).BIS监测组术后清醒拔管时间[(26±8) min]及住院时间[(11.5±2.3)d]显著短于对照组[(41±12) min、(12.6±4.4)d](P＜0.05). 结论 BIS监测下麻醉可降低老年合并慢性贫血患者POD发生率,减少谵妄持续时间.     

帕金森病脑深部电刺激植入术患者术后谵妄的危险因素分析

目的探索帕金森病(PD)患者行脑深部电刺激植入术(DBS)术后谵妄(POD)相关危险因素。方法前瞻性收集2020年10月至2022年5月择期行DBS的PD患者的术前资料、术中资料、术后资料及POD的发生情况。根据术后是否发生谵妄将患者分为谵妄组(52例)及非谵妄组(155例)。对两组患者资料进行组间比较, 并通过logistic回归分析发生POD的危险因素。结果共207例患者纳入研究, 其中有52例(25.1%)患者发生POD。与非谵妄组比较, 谵妄组患者的年龄较大, 术前改良Hoehn-Yahr(H-Y)分级较高, 术后第1天数字分级评分法(NRS)疼痛评分明显较高(均P<0.05)。多因素logistic回归分析显示年龄[校正比值比(OR)1.09, 95%置信区间(CI)1.03～1.16, P=0.002]、术前改良H-Y分级(校正OR 2.67, 95%CI 1.42～5.00, P=0.002)以及术后第1天NRS疼痛评分(校正OR 1.44, 95%CI 1.22～1.70, P<0.001)是DBS POD发生的独立危险因素。结论 PD患者行DBS后谵妄的发...     

高原患者髋关节置换术后谵妄的危险因素分析

目的 探讨全麻下行髋关节置换术的高原患者发生术后谵妄（POD）的危险因素。
方法 选择择期行全麻髋关节置换术的高原患者1 010例,男373例,女637例,年龄24～76岁,BMI 19.0～34.7 kg/m²,ASA Ⅰ—Ⅲ级。根据术后7 d内是否发生谵妄分为两组：POD组和非POD组,采用多因素Logistic回归分析确定行髋关节置换术的高原患者发生POD的相关危险因素。
结果 术后7 d内有120例（11.9%）患者发生POD。多因素Logistic回归分析显示,年龄（每增加10岁,OR=2.106,95%CI 1.616～2.745,P<0.001）、脑梗死病史（OR=9.712,95%CI 3.620～26.055,P<0.001）、术后中重度疼痛（OR=6.826,95%CI 2.991～15.578,P<0.001）以及常居海拔高度3 500～4 500 m（OR=2.844,95%CI 1.448～5.587,P=0.002）和高原红细胞增多症（OR=5.374,95%CI 3.900～7.404,P<0.001）是发生POD的危险因素。
结论 年龄、脑梗死病史、术后中重度疼痛以及常居海拔高度3 500～4 500 m和高原红细胞增多症是高原患者全麻下髋关节置换发生POD的危险因素。     

超声引导下胸椎旁连续阻滞对食管癌根治术老年患者术后谵妄的影响

目的观察超声引导下置管连续胸椎旁阻滞(paravertebral block, PVB)用于开胸手术镇痛对患者术后谵妄(postoperative delirium,POD)的影响。方法选择择期在全麻下接受食管癌根治术的老年患者112例,男55例,女57例,年龄65～75岁,BMI 18.5～30 kg/m~2,ASAⅠ或Ⅱ级,随机分为两组:胸椎旁阻滞PVB组(P组)和静脉自控镇痛PCIA组(C组),P组54例,C组58例。P组使用PVB,C组使用舒芬太尼PCIA。记录术后1、2和3 d患者发生POD的情况;术中丙泊酚和瑞芬太尼的用量;患者术后不同时点静息和咳嗽时VAS评分;术后肺不张、恶心呕吐及皮肤瘙痒的发生情况。结果 P组术后POD发生率明显低于C组(P0.05或P0.01);P组术中丙泊酚与瑞芬太尼用量明显少于C组(P0.01);术后不同时点两组静息时VAS评分差异无统计学意义,咳嗽时P组VAS评分明显低于C组(P0.05或P0.01);P组术后肺不张、恶心呕吐和瘙痒发生率明显低于C组(P0.05或P0.01)。结论全身麻醉联合连续胸椎旁阻滞用于老年患者开胸手术镇痛可以提供更充分的术中与术后镇痛,减少麻醉药物使用,降低POD的发生率。     

ω-3多不饱和脂肪酸对老年胃癌患者术后谵妄的预防作用

目的探讨ω-3多不饱和脂肪酸对胃癌术后老年患者谵妄发生的影响。方法前瞻性收集2015年6月至2018年6月期间于四川大学华西医院胃肠外科行胃癌根治术的老年患者210例,均分为试验组和对照组。2组患者由同一组手术医师及麻醉师完成手术。试验组患者从术后第1天开始在常规治疗措施的基础上,每天额外静脉输注10%的鱼油脂肪乳剂100 mL;对照组患者术后采取常规治疗措施。比较2组患者术后谵妄的情况,以及炎症反应、并发症、住院时间及30 d再入院的发生情况。结果共计205例患者完成研究,其中试验组103例,对照组102例。①对照组共发生谵妄47例,试验组共发生22例,2组患者的谵妄发生率比较差异具有统计学意义(P0.001)。术后1～3 d对照组和试验组各发生谵妄32例和19例,术后4～7天各发生19例和6例,同时点2组的谵妄发生率比较差异均有统计学意义(P0.05)。②术后3 d和7 d,试验组患者的WBC计数、CRP、IL-6、TNF-α、PCT及血糖均较对照组低(P0.05)。③术后试验组共有46例患者发生术后发热,而对照组发生71例,对照组的发热发生率较高(P0.01)。④对照组术后发生切口液化2例,试验组发生轻度乳糜漏1例,2组的切口液化发生率和乳糜漏发生率比较差异均无统计学意义(P0.05)。⑤试验组患者的术后住院时间为(8±1)d,较对照组[(9±2)d]缩短(P0.01);此外,试验组无患者30 d内再次入院,对照组有4例,对照组的30 d再入院率较高(P=0.04)。结论老年胃癌术后使用ω-3多不饱和脂肪酸可以通过控制患者的炎症及应激反应,降低患者术后谵妄的发生,改善短期预后。     

快速康复外科对老年结直肠癌患者术后谵妄的影响

探讨快速康复外科应用于老年结直肠癌患者对术后谵妄发生的影响。回顾2009年1月—2015年5月收治的60岁以上老年结直肠癌手术患者,其中传统组101人,快速康复外科组106人,比较两组患者发生术后谵妄的情况和临床资料。将106例应用快速康复外科组患者中发生术后谵妄的患者与未发生术后谵妄的者进行临床资料的比较。101例传统组患者术后有13例发生谵妄,术后谵妄发生率为12.87%;106例快速康复外科组术后仅有5例发生谵妄,发生率为4.72%(χ~2=4.331,P=0.037)。传统组13例术后谵妄患者中,有7例发作了1 d,4例持续了2 d,持续3 d和4 d的各1例;快速康复外科组5例术后谵妄患者中,3例发作了1 d,持续2 d和3 d的患者各1例,没有持续4 d发作的患者(P0.05)。传统组谵妄患者的住院时间平均为(15±3.24)d,快速康复外科组谵妄患者为(12±1.22)d(t=2.85,P0.012)。快速康复外科组中发生术后谵妄患者的平均年龄为(83.40±4.83)岁,而未发生术后谵妄患者的平均年龄为(71.79±8.91)岁(t=4.974,P0.05);发生术后谵妄患者的平均住院时间为(12.00±1.22)d,也显著长于没有发生术后谵妄患者的住院时间(10.34±1.77)d(t=2.891,P0.05)。应用快速康复外科理念可以有效降低结直肠癌术后谵妄的发生率和平均住院时间,年龄越大的患者发生术后谵妄的可能性越大。     

右美托咪定不同配伍镇痛对腹腔镜结直肠癌手术ASA Ⅲ级患者术后谵妄与胆碱酯酶的影响

目的:探讨右美托咪定配伍舒芬太尼或地佐辛或布托啡诺静脉镇痛对腹腔镜结直肠癌手术ASAⅢ级结直肠癌患者术后谵妄(POD)及胆碱酯酶的影响。方法:共240例腹腔镜结直肠癌手术患者纳入此项前瞻、随机、双盲、对照研究。按随机数表法分为S组(舒芬太尼组)、D组(地佐辛组)与B组(布托啡诺组),每组80例,行复合右美托咪定静脉镇痛。利用护理谵妄筛查量表筛选术后第1天、第2天、第3天POD发生情况,并检测术前及术后第1天、第3天血清胆碱酯酶活性。结果:POD总体发生率为13.79%,3组间POD发生率差异无统计学意义(P0.05),POD患者术前血清胆碱酯酶活性略低于正常值,术后有增高趋势,POD组内、与非POD患者组间相比差异均有统计学意义(P0.05),其他观察指标差异无统计学意义(P0.05)。结论:右美托咪定伍用舒芬太尼或地佐辛、布托啡诺静脉镇痛的腹腔镜结直肠癌术后POD发生率仍高,血清胆碱酯酶活性可部分预测POD的发生。     

术前睡眠质量对老年患者术后谵妄发生的影响

目的探讨术前睡眠质量对老年患者术后谵妄(POD)发生的影响。方法选择择期全凭静脉麻醉下经腹行肿瘤根治术患者,年龄65~86岁,BMI 18~25kg/m2,ASAⅠ-Ⅲ级。术前根据匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)分为睡眠障碍组(≥5分,D组)和睡眠正常组(5分,C组),每组50例,男71例,女29例。两组均采用丙泊酚、舒芬太尼和罗库溴铵进行麻醉诱导和维持,麻醉深度维持在BIS值40~60。记录术中丙泊酚、舒芬太尼、阿托品、麻黄碱、艾司洛尔、硝酸甘油等使用情况,记录麻醉时间、手术时间、PACU停留时间和术后住院时间,记录术后1~5d数字疼痛(NRS)评分和恢复质量评分量表-40(QoR-40)总分。采用意识模糊评定量表(CAM)于术前1d和术后1~5d进行谵妄评估。结果 D组术前PSQI评分明显高于C组(P0.05)。两组患者术中丙泊酚、舒芬太尼用量和血管活性药使用例数差异无统计学意义,麻醉时间、手术时间和PACU停留时间差异无统计学意义。D组术后住院时间明显长于C组(P0.05)。术后1、2和3d,D组NRS评分明显高于C组,QoR-40总分明显低于C组(P0.05)。术后1~5d,两组总计21例(21.0%)发生POD,其中D组15例(30.0%)和C组6例(12.0%),D组POD发生率明显高于C组(P0.05)。D组POD患者的谵妄持续时间明显长于C组(P0.05)。术后2dD组POD发生率明显高于C组(P0.05)。结论术前睡眠障碍可增加老年患者POD发生率并对术后早期恢复质量产生负面影响,应引起重视。     

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 Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

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.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

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.