咪达唑仑联合丙泊酚对全麻老龄患者苏醒期躁动及血流动力学影响

目的探讨咪达唑仑联合丙泊酚对全麻老龄患者苏醒期躁动及血流动力学影响。方法将从2014年1月至2015年2月收治的65岁以上、择期行腹部及骨科手术的全麻手术患者80例作为研究对象,按照入院先后顺序采用单双号数字表法分为观察组与对照组,每组各40例,对照组采用咪达唑仑联合芬太尼进行诱导及维持麻醉,观察组采用咪达唑仑联合丙泊酚诱导及维持麻醉,比较两组患者麻醉诱导前(T_0)、诱导1 min后(T_1)、气管插管前(T_2)、气管插管即刻(T_2)、气管插管第1 min(T_3)、气管插管第5 min(T_4)、气管插管第10 min(T_5)、气管插管第20 min(T_6)患者的MAP、HR变化情况血流动力学状况及全麻苏醒期躁动的发生率。结果观察组T_1、T_2、T_3、T_4、T_5、T_6的MAP及HR水平均较对照组低(所有P0.05);观察组老年全麻患者苏醒期躁动分级Ⅰ级(5.0%vs 22.5%)及Ⅲ级(2.5%vs 17.5%)的比例均显著低于对照组,P0.05。结论咪达唑仑联合丙泊酚更有利于维持全麻老龄患者的血流动力学稳定,降低全麻苏醒期躁动的发生率。     

右美托咪定复合罗哌卡因骶管阻滞在小儿腹腔镜疝囊高位结扎术中的临床效果

目的研究右美托咪定联合超声引导骶管阻滞在小儿腹腔镜疝囊高位结扎术中的临床效果。方法前瞻性纳入2018年1月至2019年12月在六安市人民医院行腹腔镜下小儿疝囊高位结扎术患儿90例。随机数字法将所有患儿分为两组,常规组使用罗哌卡因进行骶管阻滞麻醉,联合组行右美托咪定+罗哌卡因骶管阻滞麻醉。比较两组患儿手术相关情况,包括手术时间、苏醒时间、苏醒室观察时间及镇痛持续时间。比较两组患儿麻醉前(T_1)、完成骶管阻滞后(T_2)、切皮时(T_3)、手术完成时(T_4)、拔除气管导管时(T_5)、苏醒后10 min(T_6)时的心率(HR)、平均动脉压(MAP),及在苏醒期躁动的发生率、躁动评分。结果两组患儿手术时间、苏醒时间及苏醒室观察时间差异无统计学意义,镇痛维持时间常规组短于联合组(P0.05)。T_1时两组患儿HR、MAP差异无统计学意义;T_3～T_5时联合组HR明显低于常规组(P0.05);T_5～T_6时联合组MAP水平低于常规组(P0.05)。常规组患儿苏醒期躁动发生率为22.2%,明显高于联合组的6.7%(P0.05);联合组患儿躁动评分明显低于常规组(P0.05)。结论右美托咪定联合超声引导骶管阻滞在小儿腹腔镜疝囊高位结扎术中可降低术中患儿机体应激反应,保持血流动力学稳定,有效减少术后苏醒期躁动的发生,提高苏醒期质量。     

硬膜外联合全身麻醉对腹腔镜直肠癌根治术患者术中血流动力学及应激反应影响的研究

目的评价硬膜外联合全身麻醉对腹腔镜直肠癌根治术患者术中血流动力学及应激反应的影响。方法选取本院2014年1月至2017年1月择期行腹腔镜直肠癌根治术的患者共计98例,年龄49~70岁。采用随机数字表将所纳入患者随机分为硬膜外联合全身麻醉组(Epidural anesthesia combined with general anesthesia group,EA组)和全身麻醉组(General anesthesia group,GA组),每组患者各49例。记录两组患者麻醉诱导前(T_0)、气腹前(T_1)、气腹后10分钟(T_2)、撤除气腹后10分钟(T_3)、出室即刻(T_4)的收缩压(SBP)、舒张压(DBP)、心率(HR)。于上述各时点抽血检测皮质醇(COR)、C反应蛋白(CRP)及血糖(GLU)浓度。记录两组患者拔管时间、苏醒后疼痛程度、苏醒期躁动、术后恶心呕吐(PONV)发生情况。结果 GA组患者T_2、T_3、T_4时点的SBP、DBP、HR显著高于EA组,差异有统计学意义(P0.05)。在T_2、T_3、T_4时点,GA组患者COR、CRP均显著高于EA组,差异有统计学意义(P0.05)。T_3、T_4时点GA组患者血糖浓度显著高于EA组,差异有统计学意义(P0.05)。EA组患者拔管时间、苏醒后VAS评分、苏醒期躁动发生率均显著低于GA组,差异有统计学意义(P0.05)。结论综上所述,硬膜外联合全身麻醉能够维持腹腔镜直肠癌根治术患者术中血流动力学稳定、抑制机体应激反应、有利于术后早期拔管、抑制术后疼痛及苏醒期躁动的发生,值得在临床中推广使用。     

脑状态指数和Narcotrend指数用于预测全麻苏醒期意识恢复的比较

目的 观察脑状态指数(CSI)和Narcotrend指数(NTI)在全麻苏醒期的变化,探讨两者在预测全麻苏醒期意识恢复中的效能.方法 选择腹腔镜胆囊切除术患者25例,术中靶控输注(TCI)丙泊酚和瑞芬太尼维持麻醉,效应室靶浓度(Ce)分别为2～3 μg/ml和2～4 ng/ml,维持CSI值在40～60.记录全麻苏醒期不同意识恢复水平(对刺激无反应、呼之睁眼、定向力恢复)的CSI、NTI和丙泊酚Ce的变化.结果 CSI、NTI、丙泊酚Ce与苏醒期意识水平变化显著相关,相关系数分别为0.89、0.92和-0.86(P＜0.01).CSI、NTI及丙泊酚Ce预测患者意识恢复水平的概率(Pκ)均大于0.8(P＜0.01).结论 CSI、NTI和丙泊酚Ce均能及时反映全麻苏醒期意识水平的变化.     

全麻苏醒期家长陪伴对患儿麻醉恢复和术后心理的影响

【摘要】〓目的〓探讨全麻苏醒期家长陪伴对患儿复苏效果和术后心理的影响。方法〓对照组患儿手术后由复苏室护士全程照顾,观察和护理。观察组患儿除由复苏室护士照顾、观察和护理外,还选拔一名患儿信任的家长在患儿临近苏醒时进入复苏室陪伴,比较两组患儿复苏时间、全麻苏醒期躁动和术后不良行为发生情况。结果〓两组患儿复苏时间比较(P<0.05)全麻苏醒期躁动发生率比较(P<0.05),术后不良行为发生发生率比较(P<0.01)。结论〓全麻苏醒期家长陪伴可减轻患儿心理创伤,有效地降低全苏醒期躁动和术后不良行为的发生。     

基于循证的全麻苏醒期躁动预防方案在机器人巨结肠手术中的应用实践

目的:构建基于循证的全麻苏醒期躁动(Emergence agitation,EA)预防方案,并评价其应用效果。方法:在最佳证据的基础上,通过小组讨论进行证据FAME属性的评价,针对11条证据进行临床应用并构建质量审查指标,于2020年7月~2021年2月实施循证护理实践,通过基线审查(29例患儿)分析障碍因素,构建全麻EA护理预防方案,并将此方案应用于34例患儿。结果:患儿EA发生率由24.1%降至2.9%,显著低于证据应用前(P<0.05)。医护人员对预防全麻患儿EA的相关知识、态度与行为得分显著高于证据应用前(P<0.05)。结论:基于循证构建的全麻EA护理预防方案可在机器人巨结肠手术中推广,且在实施中应结合临床情景考虑患儿个性化意愿,降低全麻患儿EA的发生率。     

成人全麻后苏醒期躁动的研究进展

全麻后苏醒期躁动(EA)是一种在全麻苏醒早期发生的以精神运动性激动、过度活动以及感知障碍为特点的病理状态。成人EA的整体发生率约为0.25%～19%,如处理不当,可对患者自身和医护人员造成严重危害。本文围绕EA的发生机制,成人EA的危险因素,以及成人EA的诊断、预防、治疗等方面展开论述,为改善全麻患者的恢复质量,减少EA的危害提供参考。     

小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动的影响

目的 探讨全麻诱导前预防性应用小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动(EA)的影响.方法 选择2021年1—3月择期行扁桃体腺样体切除术的患儿97例,男48例,女49例,年龄3～12岁,体重15～50 kg,ASAⅠ或Ⅱ级.采用随机数字表法将患儿分为两组:艾司氯胺酮组(S组,n=49)和对照组(C组,n...     

不同剂量右美托咪定滴鼻预防小儿七氟烷全麻苏醒期躁动的临床观察

目的探讨不同剂量右美托咪定滴鼻对预防小儿七氟烷全身麻醉后苏醒期躁动的效果及用药安全性。方法选取择期行单侧腹股沟斜疝疝囊高位结扎术患儿90例,年龄1~7岁,ASAⅠ级。采用随机数字表法分为3组,每组30例。丙泊酚诱导后带入手术间,分别经双侧鼻孔滴入0.9%氯化钠注射液(S组),右美托咪定0.5μg/kg(D0.5组)和1μg/kg(Dl.0组)各0.5ml,七氟烷吸入麻醉下插入喉罩,术中保留自主呼吸,并在超声引导下行患侧腹横肌平面阻滞,手术结束时停用七氟烷。记录入手术间时(T_0)、插入喉罩时(T_1)、切皮时(T_2)、手术结束时(T_3)、拔出喉罩时(T_4)、苏醒时(T_5)、出PACU时(T_6)各时点的平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_2)、呼吸频率(RR),并记录手术时间、拔喉罩时间、苏醒时间、PACU停留时间、苏醒期躁动情况等。结果与S组比较,D0.5组和D1.0组苏醒期躁动发生率、PAED评分显著降低(P0.05),D1.0组苏醒时间显著延长(P0.05),3组PACU停留时间无显著性差异(P0.05)。结论 0.5μg/kg和1μg/kg右美托咪定滴鼻均能安全、有效地预防小儿七氟烷全麻苏醒期躁动,1μg/kg效果优于0.5μg/kg,但苏醒时间会延长。     

多感官干预对全麻斜视矫正术患儿的影响

目的 探讨多感官干预模式对于全麻斜视矫正患儿苏醒期躁动的影响。 方法 将全麻下行斜视矫正术患儿70例,随机分为对照组和干预组各35例。对照组实施苏醒期常规护理,干预组在常规护理基础上实施多感官干预模式。比较两组苏醒期躁动发生率,疼痛,苏醒期不良反应,苏醒室留观时长,脑电双频指数值＞60、70、80所需时长。 结果 干预组苏醒期躁动发生率、术后疼痛程度、苏醒期敷料挣脱发生率显著低于对照组,干预组脑电双频指数＞80所需时长、苏醒室留观时长显著短于对照组（均P＜0.05）。 结论 多感官干预作为一种全方位、简便易操作的干预模式,能降低全麻患儿苏醒期躁动发生率、减轻术后疼痛、减少苏醒期不良反应发生,提高苏醒护理质量。     

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.