老年全膝关节置换术应用连续骨神经阻滞联合单次硬膜外腔吗啡镇痛的效果观察

目的分析和评价老年全膝关节置换术(TKA)应用连续骨神经阻滞(CFNB)联合单次硬膜外腔吗啡镇痛的效果。方法选取2015-03—2016-03间在河南中医药大学第三附属医院接受单侧TKA治疗的82例老年患者。随机分为2组,每组41例。对照组行CFNB镇痛,观察组在对照组基础上联合单次硬膜外腔吗啡镇痛。应用视觉模拟量法(VAS)评测2组患者术后静息、活动状态下的疼痛情况。分析2组术后患侧关节弯曲度及镇痛泵按压次数。结果术后第1、5天观察组患者静息、活动状态的VAS评分低于对照组,患侧关节弯曲度大于对照组,差异均有统计学意义(P0.05)。观察组术后第1、2天的镇痛泵按压次数显著少于对照组,差异有统计意学意义(P0.05)。结论在老年TKA术中采取CFNB联合单次硬膜外腔吗啡镇痛,优于单一CFNB镇痛,且有助于患侧关节功能恢复。     

超声引导下连续股神经阻滞用于全膝关节置换术后的镇痛效果

目的 观察超声引导下连续股神经阻滞(CFNB)用于全膝关节置换术(TKA)后的镇痛效果.方法 拟行单侧全膝关节置换术患者40例,随机均分为两组.PCIA组患者术后持续静脉输注芬太尼镇痛,PCNA组行超声引导下罗哌卡因连续股神经阻滞,两组均持续镇痛2d.记录静息、持续被动运动(功能锻炼)时的VAS评分、患肢主动关节屈曲角度、肌力分级、镇静程度和不良反应发生情况.结果 PCNA组患者术后8、12、24、48 h静息时和术后48 h功能锻炼时VAS评分均明显低于PCIA组(P＜0.05或P＜0.01).PCNA组患者术后24、48 h患肢主动关节屈曲角度明显大于PCIA组(P＜0.01).结论 超声引导下连续股神经阻滞用于TKA术后镇痛效果良好,对肌力影响小,不良反应发生率低,是TKA术后较为理想的镇痛方法.     

持续收肌管阻滞术后镇痛在全膝关节置换术快速康复中的作用

目的探讨持续收肌管阻滞(CACB)术后镇痛在全膝关节置换术(TKA)快速康复中的作用,以进一步优化TKA术后的快速康复方案。方法将90例行单侧TKA的患者按随机数字表法分为CACB组与持续股神经阻滞(CFNB)组,每组45例。所有患者纳入快速康复模式。CACB组手术结束20 min由麻醉医师行术侧收肌管阻滞并留置导管,CFNB组手术结束20 min行术侧股神经阻滞并留置导管。比较两组住院时间、术后静息和活动疼痛数字评分法(NRS)评分、股四头肌肌力、膝关节活动度、膝关节HSS评分、补救性阿片类药物的消耗、术后并发症。结果住院时间CFNB组为(13. 2±2. 98) d,长于CACB组的(11. 9±2. 59) d(P 0. 05);除术后12 h活动NRS评分CACB组高于CFNB组(P 0. 05),两组术后不同时点静息NRS评分和活动NRS评分差异无统计学意义(P 0. 05); CACB组术后第1、2、3、7天膝关节活动度、膝关节HSS评分均高于CFNB组(P 0. 05),CACB组术后1、2、3 d股四头肌肌力均高于CFNB组(P 0. 05)。结论 CACB术后镇痛在TKA中应用能保留股四头肌肌力,缩短住院时间,更有利于快速康复模式的实施。     

人工全膝关节表面置换术后连续股神经阻滞与经静脉患者自控镇痛的随机对照研究

背景:全膝关节表面置换术(total knee arthroplasty,TKA)后重度疼痛的发生率高,患者自控镇痛(patient controlled analgesia,PCA)和连续股神经阻滞(continuous femoral nerve block,CFNB)是TKA后常用的镇痛方法。目的:比较CFNB与经静脉PCA在TKA围手术期镇痛中的有效性和安全性。方法:120例全身麻醉下行单膝TKA的患者,随机分成三组,分别接受CFNB(A组),静脉PCA(B组)和单次股神经阻滞联合静脉PCA(C组)作为术后镇痛方式。观察术后不同时间点静息和活动疼痛视觉模拟评分(VAS)及动态VAS评分与静态VAS评分差值(Δ_(动态VAS-静态VAS)),关节活动度(ROM)及术后吗啡的使用量。同时记录镇痛相关并发症。结果:术后各观察时间点内,A组及C组患者动静态VAS评分均显著低于B组,A组与C组术后VAS评分无差异。A组术后第3天,Δ_(动态VAS-静态VAS)最低。术后第6天,三组Δ_(动态VAS-静态VAS)无差异。C组吗啡使用量及PCA按压次数明显少于B组。术后第6天,三组膝ROM无统计学差异(A组114°,B组111°,C组114°)。A组有2例出现镇痛失败,1例出现术后导管脱落,行静脉PCA补救镇痛。B组术后恶心、呕吐发生率为42%,显著高于A组(8%)及C组(25%)。结论:TKA术后,CFNB镇痛可获得有效的静息镇痛及运动镇痛,有助于关节功能恢复,副作用小,但存在镇痛失败的可能。单次股神经阻滞联联合静脉PCA可减少镇痛不全,PCA用药次数和用量,降低单纯使用静脉PCA镇痛的并发症。     

全膝关节置换术后应用连续股神经阻滞镇痛和静脉自控镇痛的效果比较

目的比较连续股神经阻滞镇痛（CFNB）和静脉患者自控镇痛（PCIA）在全膝关节置换手术（TKA）围手术期的镇痛效果及术后1年膝关节功能评估的随访结果。方法选取2008年11月至2009年10月因膝关节骨关节炎行TKA的患者60例,数字随机分成2组,每组30例（n=30）。分别给予PCIA和CFNB作为术后镇痛方式。两组患者均采用腰麻联合硬膜外麻醉方式。在围手术期,采用视觉模拟（VAS）评分法观察患者的疼痛评分。记录吗啡累计用量,观察患肢肌力,初次下地时间及镇痛相关并发症等指标。在术后1年随访时,根据膝关节学会评分系统（KSS）对患者膝关节功能进行评估。结果在术后6、12、24、36、48h静息状态下,CFNB组的疼痛评分（VAS评分）均比PCIA组明显低（P〈0.05）。术后24h,48h进行膝关节持续被动活动（CPM）时累计吗啡用量均比PCIA组明显低（P〈0.05）。嗜睡、恶心呕吐等不良反应也低于PCIA组。术后1年,两组在膝关节功能评价方面无显著差异（P〉0.05）。结论 CFNB在TKA术中的初期镇痛效果优于PCIA。与PCIA相比,CFNB患者术后不良反应较少,膝关节功能恢复更好,患者的满意程度更高。为TKA术后镇痛策略中一种安全、实用和有效的方法。术后1年,两组患者在功能评估方面无统计学差异。     

收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响

目的探讨收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术(total knee arthroplasty,TKA)后康复的影响。方法将2017年3月—8月拟行初次单侧TKA且符合选择标准的104例患者纳入研究,随机分为试验组(53例)和对照组(51例)。试验组行收肌管阻滞麻醉联合术中局部浸润麻醉镇痛,对照组仅行术中局部浸润麻醉镇痛。两组患者性别、年龄、体质量指数、病因、侧别、病程、术前美国麻醉医师学会(ASA)分级等一般资料比较,差异均无统计学意义(P0.05),具有可比性。比较两组手术时间、住院时间、并发症发生情况,以及术后静息状态及活动时膝关节切口疼痛视觉模拟评分(VAS)、膝关节屈伸活动度、肢体肿胀情况(大腿周径)、步行距离以及步行时切口疼痛VAS评分。结果试验组手术时间较对照组明显缩短(t=–2.861,P=0.005);但两组住院时间比较差异无统计学意义(t=–0.975,P=0.332)。术后试验组1例、对照组2例出现切口渗液,试验组2例、对照组3例出现血肿,两组各1例出现无症状性肌间静脉血栓,试验组14例、对照组15例出现瘀斑;两组以上并发症发生率比较差异均无统计学意义(P0.05)。两组术前静息状态及活动时膝关节VAS评分、膝关节屈伸活动度、大腿周径比较,差异均无统计学意义(P0.05)。但试验组术后2、4、8、12 h时静息状态及活动时VAS评分,术后1、2 d膝关节屈伸活动度,术后出院时步行距离,术后1、2 d及出院时步行疼痛VAS评分、术后1 d大腿周径均优于对照组,差异有统计学意义(P0.05)。结论对于初次TKA患者,采用收肌管阻滞麻醉联合局部浸润麻醉镇痛能够减轻切口早期疼痛,有利于术后早期膝关节活动度和功能的康复。     

连续股神经阻滞镇痛与静脉药物镇痛对膝关节松解术后关节功能影响的比较

[目的]比较连续股神经阻滞镇痛(CFNB)与静脉药物镇痛(IDA)对膝关节松解术后患者膝关节功能的影响.[方法]2008年6月～2011年6月,对29例股骨远端骨折术后膝关节僵直患者采用抽签法进行了随机分组,CFNB组15例,IDA组14例.比较两组患者术后静息状态和被动功能锻炼阶段的VAS评分、补充镇痛药物应用总频次,采用Judet疗效评定法评估松解术后膝关节功能.[结果]CFNB组静息状态及被动功能锻炼阶段VAS评分及补充镇痛药物应用总频次均明显低于IDA组(P＜0.05),主动功能锻炼阶段的膝关节屈曲起始角度、术后12 d屈膝角度平均值分别超过IDA组10.2°及18.1°,术后3个月及6个月屈膝角度平均值分别超过IDA组9.3°及8.7°.CFNB组优秀率80％ (12/15),较IDA组优秀率64％ (9/14)存在统计学差异(P＜0.05).[结论]连续股神经阻滞镇痛能明显减轻术后疼痛、减少补充镇痛药物用量,有利于膝关节松解术后患者膝关节功能的改善.     

连续股神经阻滞联合帕瑞昔布用于全膝置换术后镇痛的效果评价

背景:术后镇痛是全膝关节置换术(TKA)后处理的重要组成,直接影响术后功能恢复,有利于患者早期活动,积极康复锻炼,并降低并发症发生率。多模式联合镇痛方法是目前术后镇痛研究的热点。目的:评估TKA后采用连续股神经阻滞(CFNB)联合帕瑞昔布的镇痛效果和安全性。方法:2006年9月至2011年12月行初次单侧TKA治疗骨关节炎患者80例,随机分为2组,各40例。联合镇痛组,术后使用CFNB联合帕瑞昔布镇痛模式;连续硬膜外镇痛(CEA)组,术后使用硬膜外自控镇痛泵。术后12、24、48 h采用目测类比疼痛评分法(VAS)分别对患膝静息和活动时进行疼痛评分,记录各组术后4、6、8、10 d的膝关节活动范围(ROM);监测副作用如恶心、呕吐、尿潴留、导管相关问题等。结果:80例患者全部获得随访。两组术后12、24、48 h的静息和活动时的VAS评分比较无统计学差异;两组术后4、6、8、10 d 的患膝 ROM 比较无统计学差异;A 组术后尿潴留、恶心、呕吐的发生率均低于 B 组(P<0.05);两组导管相关并发症发生率无统计学差异(P>0.05)。结论:CFNB联合帕瑞昔布镇痛能有效减轻全膝关节置换术后的疼痛,镇痛效果与CEA相当,副作用少,利于早期功能锻炼。     

连续股神经阻滞联合硬膜外吗啡镇痛在老年患者全膝关节置换术中的应用

目的探讨超声引导下连续股神经阻滞(CFNB)联合单次硬膜外腔吗啡镇痛在老年患者全膝关节置换术(TKA)中的应用。方法 80例行单侧全膝关节置换术的老年患者,男35例,女45例,年龄60~79岁,ASAⅡ或Ⅲ级,随机均分为两组:CFNB复合硬膜外吗啡组(FNM组)和CFNB组(FN组)。手术缝合切口时,FNM和FN组经硬膜外导管分别注入0.1%吗啡2ml和生理盐水2ml。手术结束后两组均于超声引导下行0.2%罗哌卡因CFNB。分别记录术后24、48、72、96h时静息状态、主动和被动功能锻炼时VAS评分及患肢被动弯曲度;观察两组患者术后第5天的活动情况和满意度。结果术后24hFNM组静息状态时、主动锻炼和被动锻炼时VAS评分明显低于,膝关节弯曲度明显大于FN组(P0.05或P0.01);FNM组患者术后第5天下床活动评分明显高于,术后满意度评分明显低于FN组(P0.05)。结论超声引导下CFNB联合硬膜外吗啡早期镇痛可明显改善老年患者TKA术后镇痛,康复效果佳。     

全身麻醉联合硬膜外阻滞对腹腔镜结肠癌根治术患者POCD的影响

目的:观察全身麻醉联合硬膜外阻滞对腹腔镜结肠癌根治术患者术后认知功能障碍(POCD)的影响,并分析影响患者POCD发生的因素。方法:以接受腹腔镜结肠癌根治术的80例患者为研究对象,并随机分为对照组和观察组,每组各40例,其中对照组给予全身麻醉,观察组给予全身麻醉+硬膜外阻滞。观察两组患者术后POCD的发生率,比较两组患者简易智力状况检查法(MMSE)评分、镇静镇痛评分及POCD发生率,比较两组患者S-100β、IL-6和TNF-α水平。分析影响POCD发生的因素。结果:两组患者手术前的MMSE得分无明显差别(P0.05),观察组患者手术后1 h和术后1 d的MMSE得分高于对照组(P0.05),发生POCD的例数少于对照组(P0.05),两组患者在术后7 d时的MMSE评分和发生POCD的例数无明显差别(P0.05);两组患者手术前的VAS和Ramsay评分无明显差别(P0.05),术后1 h、术后1 d和术2 d,观察组患者的VAS评分低于对照组(P0.05),Ramsay评分高于对照组(P0.05);手术前两组患者的S-100β、IL-6和TNF-α水平无明显差别(P0.05),术后1 d时,两组患者的上述指标水平均增高(P0.05),但观察组低于对照组(P0.05)。VAS评分、Ramsay评分、麻醉方式、S-100β、IL-6和TNF-α是影响患者发生POCD的危险因素(P0.05)。结论:全身麻醉联合硬膜外阻滞腹腔镜结肠癌根治术可降低患者术后早期发生POCD的概率,可能与该种麻醉方式镇静镇痛效果较好,并可调节相关细胞因子水平有关。     

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.