糖尿病骨折患者围手术期的处理

目的　探讨糖尿病 (DM)骨折患者围手术期治疗的特点及DM对骨折手术的影响。方法　回顾分析 97例接受手术治疗的DM骨折患者围手术期血糖调控以及并存疾病的术前诊治情况。对术前准备时间、住院时间、伤口愈合等级、术后并发症发生率及住院费用等与非糖尿病对照组进行对比分析。　结果　 (1)DM骨折组入院后应用胰岛素将血糖控制在目标值 (空腹血糖 :6 0～ 8 0mmol/L ,餐后血糖 :8 0～ 11 1mmol/L) ,手术后期 (PP)胰岛素用量为 (0 5± 0 2 )U·d-1·kg-1,较稳定期[SP :(0 7± 0 2 )U·d-1·kg-1]和手术期 [OP :(0 7± 0 3)U·d-1·kg-1]明显减少 ,有显著性差异 (P <0 0 5 ) ;(2 )DM骨折组入院后新发现合并症 (心电图ST T改变、心律失常、高血压病、血脂异常、泌尿系感染 )病例数多于对照组 ,经过术前对症及改善微循环治疗 ,均耐受了相应的手术治疗 ;(3)DM骨折组比对照组术前准备时间延长 [(16 7± 4 2 )d比 (8 5± 3 7)d]、住院时间延长 [(30 1± 8 6 )d比 (17 6± 5 7)d],西药费、检查费、化验费均增高 ,有显著性差异 (P <0 0 1) ;(4 )手术切口全部甲级愈合 ,DM组与对照组骨折术后并发症发生率分别为 2 0 6 %和 1 0 3% ,无显著性差异 (P >0 0 5 )。结论　有效地控制DM骨折患者血糖 ,合理治     

电视胸腔镜辅助Heller手术治疗贲门失弛缓症

目的探讨电视胸腔镜辅助下Heller手术治疗贲门失弛缓症的可行性、手术方法及疗效。方法2001年3月至2005年12月,19例贲门失弛缓症病人行胸腔镜辅助下Heller手术。结果无中转开胸者,无严重并发症,无死亡病例。手术时间(109·5±7·5)min,胸腔引流(2·5±0·5)d,术后住院(6·5±0·5)d。术后1年以内和1年后病人症状评分由术前2·7±1·1降为1·6±0·7和1·7±0·8,食管末端直径由术前(6·1±1·7)cm降为(4·0±1·1)cm和(3·8±1·1)cm,食管下段括约肌压力(LESP)由术前(28·9±4·1)mmHg降低到(20·1±3·6)mmHg和(19·9±3·3)mmHg,食管末端pH由术前3·4±0·9上升至4·9±1·3和5·0±1·3,同术前相比,4项差异均有统计学意义(P<0·05),而术后远期(>1年)与近期(≤1年)相比差异均无统计学意义(P>0·05)。结论胸腔镜辅助Heller手术技术可行、疗效肯定,值得在有条件的医疗单位推广,但其长期疗效和抗反流作用仍需要大规模的病例和长期随访观察。     

左心室收缩功能低下冠心病病人冠状动脉旁路移植术的中远期效果

目的　总结并分析左心室收缩功能低下冠心病病人行冠状动脉旁路移植手术(CABG)的中、远期效果。方法　34例左心室射血分数(LVEF)低于0 30且不伴左心室室壁瘤的冠状动脉粥样硬化心脏病病人行CABG ,平均年龄(5 8 0±9 4 )岁。冠状动脉造影显示LVEF为0 15～0 30 ,平均0 2 7±0 0 4 ,其中2支病变3例,3支病变31例(包括左主干病变4例)。超声心动显示左心室舒张末直径(LVDD)平均为(6 1 5±8 9)mm ,LVEF平均0 2 8±0 0 7。心功能分级平均为2 9±0 7。体外循环下手术2 6例,非体外循环常温手术(OPCAB) 8例。每例旁路移植2～6支,平均(3 9±0 9)支。随访率94 1% ,随访时间平均(3 5±1 9)年。结果　无手术死亡。早期主要并发症为心功能不全。所有病人心绞痛症状明显减轻,左心室舒张末直径平均(5 5 2±7 1)mm ,LVEF平均0 4 7±0 11。心功能分级平均1 9±0 3。以上指标与术前进行统计学比较,差异均具统计学意义。随访3年生存率为91 9% ,5年生存率为85 7%。5年免除心绞痛为81 3% ,心功能分级为1～3级,平均1 4±0 6。结论　伴左心室收缩功能低下的CABG病人的中、远期疗效满意,充分的术前准备是手术成功关键。     

冠状动脉旁路移植术患者左心室舒张功能的初步评估

目的 评价冠状动脉旁路移植术（CABG）患者左心室舒张功能（LVDF）.方法 采用经食管超声心动图（TEE）技术观察46例不停跳CABG（OPCABG）患者手术前后LVDF的变化.结果 与术前比较，术后经二尖瓣尖脉冲多普勒血流频谱（TMF）的舒张早期充盈波（E波）和舒张晚期充盈波（A波）流速显著加快（P＜0.01）；E波血流时间积分（VTIE）和A波血流时间积分（VTIA）显著增加（P＜0.05或P＜0.01）；E波减速时间（DT）和加速时间（AT）显著缩短（P＜0.05或P＜0.01）；而E/A、A波间期和舒张早期充盈分数（RFF）值差异无统计学意义.术后经左上肺静脉血流频谱（PVF）的S、D和AR波的流速显著加快（P＜0.01）；而S/D、AR波间期和AR-A（AR波间期与A波间期之差）差异无统计学意义.面积减少分数（FAC）和心排血量（CO）显著增加（P＜0.01）.PCWP与AR波直线回归方程：PCWP=2.6＋0.4 AR.结论 CABG患者普遍存在以左心室松弛功能减低为主的舒张功能不全，术后早期收缩功能迅速改善，但舒张功能不全依然存在.TEE可区分心脏的收缩和舒张功能.     

冠状动脉旁路移植术围术期心肌梗死四例

近年来 ,我科开展冠状动脉旁路移植术 (CABG) 15 0例 ,4例围术期发生心肌梗死 (MI) ,经抢救均治愈出院。1　临床资料与方法本组 4例中 ,男 3例 ,女 1例 ;平均年龄 5 4 .0± 1.2岁 ;平均体重 71.5± 2 .0 kg。术前诊断 :冠心病 ,不稳定型心绞痛 ,下壁、前间壁 MI恢复期 ,心功能 级。术前均经心电图 (ECG) ,心脏核素显像及冠状动脉造影确诊为冠状动脉多支病变 ,心功能下降 ,左心室射血分数 (L VEF) 0 .4 0～ 0 .4 5。3例在全身麻醉体外循环下行 CABG,完全再血管化 ,平均移植血管 2 .5± 1.0支 ,采用左乳内动脉及大隐静脉。手术顺利 ,…     

下腹部手术病人硬膜外注射甲磺酸罗哌卡因的药代动力学

目的测定下腹部手术病人硬膜外注射甲磺酸罗哌卡因的血浆浓度,探讨其药代动力学特征。方法ASAⅠ或Ⅱ级择期行下腹部手术病人12例。硬膜外注射甲磺酸罗哌卡因2 mg·kg~(-1) (8．94 mg·ml~(-1)),注药前及注药后2、4、6、10、20、30、45、60、90、120、180、240、300、360、720和1440 min取中心静脉血3 ml,用高效液相色谱仪测定甲磺酸罗哌卡因血浆浓度,DAS软件分析药代动力学参数。结果甲磺酸罗哌卡因的药代动力学模型符合二室开放模型,血浆浓度达峰值时间为(15±8)min,峰浓度为(1656±717)μg·L~(-1),吸收半衰期为(28±16)min,消除半衰期为(366±104)min,清除率为(0．005 0±0．001 5)L·min~(-1)·kg~(-1),表观分布容积为(2．5±0．6)L·kg~(-1)。研究期间未观察到不良反应。结论甲磺酸罗哌卡因适合于硬膜外麻醉,其药代动力学特征与报道的盐酸罗哌卡因相似,但消除半衰期延长。     

心脏瓣膜置换术后中远期疗效分析

目的　分析探讨心脏瓣膜置换术的中远期疗效。方法　 1978年至 2 0 0 1年 12月 ,行瓣膜置换手术 2 14 1例 ,同期随访 16 81例 ,计 80 2 1 1人·年 ,平均 4 77人·年。通过回顾病因、手术方式、瓣膜类型等因素 ,观察术后病人心功能改善情况 ,病死率及并发症等 ,采用t检验 ,多因素回归等统计学方法分析。结果　 92例死亡。总体生存率 5年为 (92 3± 2 2 ) % ,10年生存率为 (90 1± 2 7) %。并发症有血栓栓塞、机械瓣膜功能障碍、瓣周漏、溶血、机械瓣膜感染性心内膜炎。术后心功能 (NYHA)与术前比较有明显的提高。结论　 1.机械瓣置换术后中远期疗效满意 ,病死率及并发症均较低 ;与术前心功能和手术种类直接相关 ;2 .使用保留瓣下结构及三尖瓣成形术对术后心功能恢复有明显效果 ;3.术中良好心肌保护是提高手术成功率的关键。     

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目的　探讨继发性腹膜炎 (SP)急诊手术围手术期液体正平衡与APACHEⅡ评分的关系。方法　根据APACHEⅡ评分 ,将 4 5 5例SP连续病例分为轻症 (<8分 )、重症 (8～ 19分 )和危重病例 (≥ 2 0分 )三组 ,比较三组病例术前、术日和术后第 1日的液体正平衡量。结果　轻症、重症和危重病例术前的液体正平衡量分别为(10 2 4 6 0± 4 0 2 5 7)mL、(2 2 5 8 5 8± 84 4 6 9)mL和 (3392 6 7± 983 31)mL(P <0 0 1) ;术日液体正平衡量分别为 (2 0 0 1 4 0± 716 6 4 )mL、(394 8 2 5± 10 2 4 0 4 )mL和 (5 6 4 1 6 7± 12 4 3 87)mL(P <0 0 1) ;术后第 1日液体正平衡量分别为 (814 5 8± 5 4 7 2 8)mL、(110 9 11± 6 6 7 5 1)mL和 (14 84 78± 72 1 0 4 )mL(P <0 0 1)。结论　无论是术前、术日或术后第 1日 ,SP病例的液体正平衡量与其APACHEⅡ评分正相关。可根据APACHEⅡ评分估测SP病例的液体正平衡量 ,指导其围手术期的液体治疗。     

心脏机械瓣膜替换术后低强度抗凝治疗

目的　探讨适合我国人群心脏机械瓣膜替换术后抗凝治疗的强度。　方法　随访 480例心脏机械瓣膜替换术后患者抗凝治疗的抗凝强度及其并发症等情况 ,并对其结果进行统计学分析。结果　本组患者 42 8例获随访 ,总随访率 89 17% ,共 2 110 0 4病人·年 (Pty)。患者服用进口华法令平均 ( 2 81± 0 95 )mg/d ,国产华法令 ( 2 38± 0 4 6 )mg/d ,2 116份标本凝血酶原时间比值 (PTR)平均 1 4 3± 0 2 6 ,1195份标本国际标准比值 (INR) 1 6 3± 0 4 9。一般性出血 78例次 ,严重出血 19例次 (其中 8例颅内出血死亡 )。总出血率 4 6 0 %Pty ,出血病死率 0 38%Pty ,出血组PTR及INR均显著高于非出血组 (t=1 816 ,P <0 0 5 ;t=2 4 0 7,P <0 0 1)。栓塞 14例 (其中 1例脑栓塞死亡 ) ,栓塞率 0 6 6 %Pty,栓塞病死率 0 0 5 %Pty。 14例患者妊娠 15例次 ,无新生儿畸形发生。　结论　 ( 1)我国心脏机械瓣膜替换术后患者抗凝治疗的主要矛盾是出血 ,应降低抗凝强度以减少出血并发症 ;( 2 )本组采用PTR为1 3～ 1 5 ,INR为 1 5～ 2 0的标准对于预防出血及栓塞较理想 ;( 3)低强度抗凝有利于降低患者出血病死率 ,及妊娠妇女、新生儿的并发症 ,并能改善患者的生活质量。     

吸入性一氧化氮在ETCPC术后早期的临床应用效果

目的　评价吸入性一氧化氮 (INO)在心外管道全腔静脉肺动脉连接 (ETCPC)术后早期疗效。方法　ETCPC术后早期吸入NO者为试验组 ,未吸入NO者为对照组 ,各 16例。记录两组吸入及停用INO前后心排出量、肺血管阻力 (PVR)、呼吸指数、肺动脉 -左房压力阶差 (PLG)。记录两组呼吸机辅助时间、ICU滞留时间、胸腔引流管留置时间及住院时间。结果　试验组NO吸入后呼吸指数从 2 . 6 1±0 .32下降至 1. 4 1± 0 .2 1,t=2 . 35 ,P <0 .0 5 ;PLG(mmHg)从 11± 2降至 7± 3,t =2 .76 ,P <0 . 0 1;氧合指数从 16. 3± 18升高至 191± 2 1,t=2 . 74 ,P <0 .0 1;心指数 (CI ,L·min-1·m-2 )从 2 . 84± 0 . 2 3增加至 3 .12±0 . 2 0 ,t=2 . 2 4 ,P <0 .0 5 ;肺血管阻力从 4 . 2 3± 0 .5 3下降至 3 .77± 1 .4 2 ,t =2 . 2 8,P <0 . 0 5 ;中心静脉压(CVP ,mmHg)从 17 .0± 1 9下降至 15 .0± 1. 2 ,下降约 11 .8% ;INO停用前后各项上述指标未见明显差异。与对照组相比较 ,呼吸机辅助时间从 (76± 2 5 )h缩短为 (5. 6± 19)h ,t=2 . 2 8,P <0 . 0 5 ;重症监护时间从 (6± 2 )d缩短至 (4± 2 )d ,t=2 . 33,P <0. 0 5 ;胸腔引流管留置时间及住院时间差异无统计学意义。结论　INO对ETCPC术后远期疗效无明显影响 ,但     

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.