区域动脉药物灌注对重症急性胰腺炎损伤的保护作用

目的 采用不同药物区域动脉灌注,观察对重症急性胰腺炎（SAP）肝损伤的保护作用。方法 复制大鼠SAP模型。随机分组后经股动脉插管至腹腔动脉开口处,分别给予善宁（奥曲肽）、改善微循环药物及两种药物联合持续动脉灌注,观察胰腺、肝脏病理改变及血淀粉酶、肝功能的变化。结果 模型建立后6小时各项检查指标明显升高,胰腺坏死、出血,肝脏充血,水肿并有坏死,应用善宁降低了血清淀粉酶,肝功能指标也有改善,胰腺水肿渗出减轻,出血坏死情况改善不明显,肝脏瘀血坏死情况有所好转,应用改善微循环药物降低了血清淀粉酶及肝功能指标,胰腺水肿,坏死得到改善,肝脏瘀血,坏死减轻,两种药物联合应用明显降低淀粉酶及肝功能指标。胰腺、肝脏病理情况也得到明显改善。结论 区域动脉药物灌注是治疗SAP的有效方法,对肝损伤具有保护作用。     

逆行胃左动脉行腹腔干灌注治疗大鼠胰腺炎的模型制作

目的 建立用于治疗大鼠胰腺炎的区域动脉灌注动物新模型,并探讨此模型的技术要点,及其在胰腺炎治疗中的优势。方法 取雄性SD大鼠48只,随机分组为A、B组（各24只）。5%牛磺胆酸钠逆行胰胆管泵入建立重症急性胰腺炎（SAP）模型,A组通过逆行胃左动脉行腹腔干灌注,B组通过左股静脉穿刺输注。输注等量美兰染色液,确定插管部位并观察胰腺局部染色程度和持续时间。而后输注等量治疗药物5-Fu,分别于12 h、24 h处死后,检测血清中淀粉酶,并做胰腺病理检查。结果 通过区域动脉灌注等量美兰染液,发现胰腺局部染色程度明显提高,持续时间明显延长。A组24 h亚组有1只死亡,B组24 h亚组有7只死亡,死亡率有统计学差异（P＜0.05）。A组血清淀粉酶水平明显低于B组（P＜0.05）,A组胰腺病理检查评分分值明显低于B组（P＜0.05）。结论 逆行胃左动脉灌注模型是有效、稳定的大鼠区域动脉灌注模型,通过显著增加胰腺局部药物浓度,从而达到提高治疗SAP的治疗效果的目的。     

区域动脉灌注5-FU改善大鼠重症急性胰腺炎相关的肺损伤

目的 研究区域动脉灌注（regional arterial infusion,RAI）5-氟尿嘧啶（5-fluorouracil,5-FU）对大鼠重症急性胰腺炎（severe acute pancreatitis,SAP）相关的急性肺损伤（acute lung injury, ALI）的作用及其可能的机制。方法 36只健康成年雄性SD大鼠随机分成3组：对照组（C组）、胰腺炎组（SAP组）、区域动脉灌注5-FU治疗组（5-FU组）。逆行胰胆管注射5%牛磺胆酸钠（1 mL/kg）建立SAP模型。5-FU组在诱导SAP模型后立即行区域动脉灌注5-FU（40 mg/kg）治疗,C组和SAP组区域动脉灌注等量的生理盐水。建模成功后分别于12、24 h取标本并处死大鼠,胰腺和肺脏组织送病理学检查,检测肺组织湿干比,肺组织髓过氧化物酶（myeloperoxidase,MPO）活性,血淀粉酶和血中TNF-α、IL-1β、IL-6的含量。结果 与C组比较,SAP组与5-FU组血淀粉酶、血中促炎细胞因子（TNF-α、IL-1β、IL-6）、肺组织湿干比、肺组织MPO均显著升高（P＜0.05）;与SAP组比较,5-FU组上述指标均显著下降（P＜0．05）。光镜下可见SAP组出现明显的肺损伤,5-FU区域灌注治疗后肺损伤减轻,病理学评分下降。结论 区域动脉灌注5-FU对大鼠重症急性胰腺炎相关的急性肺损伤有改善作用,其作用机制可能与抑制促炎细胞因子的过度表达有关。     

TNF-α抑制剂和乌司他定联合应用治疗重症急性胰腺炎的实验研究

目的探讨TNF-α抑制剂和乌司他定联合应用对重症急性胰腺炎（severe acute pancreatitis,SAP）治疗是否有协同治疗作用。方法采用逆行性胰胆管注射5%牛磺胆酸钠制备SAP模型。80只SD大鼠随机分为假手术组（n=20）、SAP组（n=20）、治疗Ⅰ组（乌司他定治疗组,n=20）、治疗Ⅱ组（TNF-α抑制剂联合乌司他定治疗组,n=20）。各组模型建立后12h处死动物,测血清TNF-α、淀粉酶;应用TUNEL检测细胞凋亡并计算凋亡指数（apoptotic index,AI）;免疫组化法检测胰腺组织NF-κB及ET-1阳性细胞表达,对胰腺组织进行病理学检查。结果治疗Ⅰ组、治疗Ⅱ组两组与SAP组相比,除凋亡指数偏高外,其余各项指标均较SAP组低（P〈0.05）;治疗Ⅱ组的TNF-α、淀粉酶、胰腺组织NF-κB和ET-1表达及病理学评分较治疗Ⅰ组明显偏低（P〈0.05）,而细胞凋亡指数比治疗Ⅰ组高（P〈0.05）。结论联合应用乌司他定和TNF-α抑制剂治疗重症急性胰腺炎能更有效抑制重症急性胰腺炎恶化,控制炎症反应,改善胰腺微循环。     

吲哚美辛对重症急性胰腺炎大鼠腹腔器官血流的影响

目的：研究吲哚美辛对重症急性胰腺炎（SAP）大鼠腹腔器官血流，特别是胰腺血流的影响及其作用机制。方法：将大鼠随机分成吲哚美辛治疗组（IN）和重症急性胰腺炎组（SAP）；各组分别有数只大鼠于术后12、24h处死，观察血浆淀粉酶的变化。另设正常对照组。运用多普勒超声测定胰腺局部动脉（相当于胰头、体交界处）、门静脉血流、脾动脉及肠系膜上动脉血流。结果：IN组的血浆淀粉酶明显低于SAP组（P〈0．01）。SAP时，大鼠胰腺局部动脉血流明显下降，且于术后12h时已呈明显下降（与对照组比较P〈0．01）。随胰腺炎的病程进展，胰腺局部血流的下降也更趋严重（24h与12h比较，P〈0．05）。与此同时，门静脉、脾动脉和肠系膜上动脉的血流量也行下降（与对照组比较，P〈0．01）。应用吲哚美辛能改善胰腺、门静脉、脾动脉及肠系膜上动脉的血流量（与SAP组比较，P〈0.01）。结论：吲哚美辛能促使SAP大鼠胰腺血流量增加。     

丹参注射液对重症急性胰腺炎大鼠胰腺NF-κB活化的影响

目的观察重症急性胰腺炎（SAP）大鼠胰腺核因子-κB（NF-κB）活性的变化及丹参注射液对其的影响,从而探讨丹参注射液治疗急性胰腺炎的机理。方法将大鼠随机分为正常对照组、SAP组和丹参治疗组3组,采用腹腔和皮下同时注射L-精氨酸的方法制成大鼠急性胰腺炎模型,分别测量血浆、腹水淀粉酶,并采用免疫组化方法测定胰腺组织中NF-κB的表达。结果与正常对照组比较,SAP组血浆、腹水淀粉酶水平明显增高,胰腺组织NF-κB表达强度升高（P〈0.05）;丹参治疗组上述指标与SAP组相比均有明显下降（P〈0.05）,且胰腺的病理损伤减轻,存活时间更长。结论丹参注射液可能通过降低胰腺组织中NF-κB的表达而对急性胰腺炎的治疗发挥作用。     

胰腺区域动脉持续性灌注奥曲肽对犬重症胰腺炎的影响

目的 观察胰腺区域动脉持续性灌注奥曲肽对犬实验性急性坏死性胰腺炎（ＡＮＰ）的治疗作用。方法 经胰管开口逆行注入５％的牛磺胆酸钠诱导ＡＮＰ模型,犬胰腺区域动脉灌注采用经颈动脉插管、腹腔干动脉持续灌注。３０只杂种犬随机分成３组：对照组（Ａ组）、奥曲肽皮下注射组（Ｂ组）和持续性胰腺区域动脉灌注奥曲肽组（Ｃ组）。结果 模型诱导成功后２４ｈ,Ｃ且与Ａ组平均血清淀粉酶分别为１３２９Ｕ／Ｌ和３２４０Ｕ／Ｌ;平均     

经动脉胰腺局部置管持续灌注奥曲肽治疗重症急性胰腺炎

目的观察奥曲肽选择性动脉介入治疗重症急性胰腺炎（SAP）的疗效。方法将43例SAP患者分为对照组和治疗组，治疗组20例除常规治疗外，应用改良Seldinger法置导管于胰腺病变供血动脉，以奥曲肽25μg／h连续输注24～48h。对照组23例经静脉全身应用奥曲肽，两组疗效进行对比。结果治疗组血液淀粉酶较对照组下降迅速，治疗组与对照组相比差异显著（P〈0．05），临床治愈时间治疗组比对照组明显缩短（P〈0．05），并发症发生率和死亡率治疗组分别为15．00％和10．00％，对照组分别为43．50％和26．10％，差异均有显著统计学意义。结论胰腺局部动脉置管持续灌注奥曲肽治疗SAP较静脉用药有更好疗效，且并发症少。     

区域动脉灌注5-FU诱导大鼠急性胰腺炎腺泡细胞凋亡及Caspase-3表达

目的 探讨区域动脉灌注（regional arterial infusion,RAI）5-氟尿嘧啶（5-fluorouracil,5-FU）对大鼠急性胰腺炎（acute pancreatitis,AP）胰腺腺泡细胞凋亡的影响及其对急性胰腺炎的治疗作用。方法 18只健康成年SD大鼠随机分成3组：对照组（C组）、急性胰腺炎组（AP组）和5-FU治疗组（5-FU组）。各组均行胃左动脉置管,AP组和5-FU组以大剂量雨蛙素（每小时腹腔注射50 μg/kg,连续6 h）诱导建立大鼠急性胰腺炎模型,对照组注射同等剂量的生理盐水。5-FU组在第一次腹腔注射雨蛙素1 h后立即区域动脉灌注5-FU（40 mg/kg）治疗,C组和AP组区域动脉灌注等量的生理盐水。建模成功后3 h取标本并处死大鼠,检测血淀粉酶浓度,RT-PCR法检测胰腺组织内TNF-α、IL-1β、IL-6 mRNA表达水平,胰腺标本送病理学检查,Western blotting法检测胰腺组cleaved Caspase-3的蛋白表达,同时TUNEL法检测大鼠胰腺腺泡细胞凋亡情况。结果 与AP组比较,5-FU组血淀粉酶浓度明显降低（P＜0.05）;胰腺组织内TNF-α、IL-1β、IL-6  mRNA表达水平下降（P＜0.05）;胰腺组织病理学改变减轻;胰腺组织cleaved Caspase-3的蛋白表达增加;胰腺腺泡细胞凋亡增加（P＜0.05）。结论 区域动脉灌注5-FU对大鼠急性胰腺炎有改善作用,其作用机制可能与诱导胰腺腺泡细胞凋亡有关。     

S-腺苷甲硫氨酸对大鼠重症急性胰腺炎的保护作用

目的：探讨S-腺苷甲硫氨酸（SAM）对大鼠重症急性胰腺炎（SAP）的保护作用及机制。方法：采用5%牛磺胆酸钠逆行胰胆管注射制备SAP大鼠模型,将雄性SD大鼠40只,随机分为4组,假手术组（SO组）、急性胰腺炎组（SAP组）、SAM低剂量治疗组（LSAM组）、SAM高剂量治疗组（HSAM组）,每组10只。LSAM组和HSAM组大鼠造模前2 h分别腹腔内注射100mg/kg及200mg/kg SAM,其余各组注射等量生理盐水。造模后6h开腹下腔静脉取血,采用全自动生化分析仪检测各组血清淀粉酶水平,酶联免疫吸附法（ELISA）检测血清中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）的浓度;取大鼠胰腺组织送病理检查,常规HE染色,胰腺病理组织评分采用Schmidt法。结果：与SO组比较,SAP组、LSAM组和HSAM组胰腺病理组织评分及血清淀粉酶、TNF-αI、L-6水平均升高（P〈0.01）;干预性使用SAM后,胰腺病理组织评分及血清淀粉酶、TNF-αI、L-6水平均较SAP组降低（P〈0.01）。HSAM组血清淀粉酶、TNF-α水平低于LSAM组（P〈0.05）,胰腺组织病理评分及血清IL-6水平与LSAM组比较差异无统计学意义。结论：外源性补充SAM能降低炎性因子的表达,对重症急性胰腺炎具有保护作用。     

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.     

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.     

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.     

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.     

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.