帕瑞昔布钠与舒芬太尼在肛肠病术后镇痛的应用

为比较帕瑞昔布钠和舒芬太尼联合应用与单纯应用舒芬太尼在肛肠病术后的镇痛效果和不良反应,将肛肠病术后病人120例随机分为帕瑞昔布钠组和对照组各60例。手术结束时帕瑞昔布钠组静脉注射帕瑞昔布钠40mg和舒芬太尼1．00pg／ml行静脉自控镇痛（PCIA）,12h后帕瑞昔布钠组再静脉注射帕瑞昔布钠40mg;对照组单纯应用舒芬太尼1．50μg／ml行PCIA。观察两组病人术后2,4,6,12h和24h的疼痛强度（VAS评分）、镇痛的补救以及不良反应的发生率。结果显示,与对照组相比,帕瑞昔布钠组术后舒芬太尼用最减少,不良反应发生率降低,术后24h镇痛满意度明显提高（P〈0．05）,而两组12h和24h VAS评分无显著性差异（P〉0．05）。结果表明,肛肠病术后静脉注射帕瑞昔布钠可减少术后舒芬太尼的用量,提高病人术后镇痛效果。     

帕瑞昔布钠对直肠癌患者肾功能和术后镇痛舒芬太尼消耗量的影响

为探讨帕瑞昔布钠短期应用对直肠癌患者术后镇痛和肾功能的影响,本研究选取150例择期直肠癌根治术患者（ASAⅠ～Ⅲ级）随机分为三组,即帕瑞昔布钠组（A组）、帕瑞昔布钠复合病人自控静脉镇痛（PCIA）组（B组）和安慰剂复合PCIA组（C组）。对比分析各组术前、静注帕瑞昔布钠前即刻及静注帕瑞昔布钠后1h、2h、6h、12h、24h、36h和48h的血肌酐和血尿素氮含量;采用视觉模拟评分（VAS）法测定静注帕瑞昔布钠后1h、2h、6h、12h、24h、36h和48h时的疼痛程度;记录各相邻时间点之间舒芬太尼的消耗量。结果显示,三组患者血肌酐、血尿素氮含量组间和组内差异均无统计学意义,P〉0．05;与C组比较,A组患者静注帕瑞昔布钠后1h、2h、6h和12h VAS评分升高,B组患者静注帕瑞昔布钠后1h、2h和6h VAS评分降低,B组患者静注帕瑞昔布钠后1h、2h、6h、12h、24h和36h舒芬太尼各时段消耗量减少。结果表明,短期、少量使用帕瑞昔布钠对肾功能正常的直肠癌患者的肾功能无影响。术后PCIA复合应用帕瑞昔布钠使镇痛更完善,并可减少舒芬太尼术后镇痛消耗量。     

羟考酮联合帕瑞昔布钠对胃癌根治术术后镇痛的影响

目的观察羟考酮联合帕瑞昔布钠对胃癌根治术术后镇痛的影响。方法选择择期胃癌根治术患者60例,采用随机数字表法均分为两组:帕瑞昔布钠+羟考酮组(PO组)和帕瑞昔布钠+吗啡组(PM组)。两组术前30min均给予帕瑞昔布钠40mg预先镇痛,术后均给予患者自控静脉镇痛(PCIA)。PO组缝皮前缓慢静推羟考酮0.03mg/kg,术后羟考酮0.6mg/kg和格拉司琼3mg,生理盐水稀释至100ml入泵。PM组缝皮给予吗啡0.03mg/kg,术后吗啡0.6mg/kg和格拉司琼3mg,生理盐水稀释至100ml入泵。记录两组术后3、12、24和48h患者的静息和咳嗽时VAS评分,术后48h内PCA有效按压次数,镇痛药物追加和上腹部不适感等不良反应发生情况。结果与PM组比较,术后不同时点PO组静息和咳嗽时VAS评分明显降低(P0.05),术后48h内PCA有效按压次数、镇痛药物追加例数明显减少(P0.05),上腹部不适感、恶心呕吐、嗜睡和皮肤瘙痒等不良反应发生率明显降低(P0.05)。结论羟考酮联合帕瑞昔布钠给胃癌根治术患者提供安全有效的镇痛,且不良反应发生较少。     

帕瑞昔布钠对肺癌根治术患者术后镇痛的影响

目的 观察帕瑞昔布钠对肺癌根治术患者术后镇痛效果的影响.方法 拟行肺癌根治术患者40例,随机分为两组,每组20例,分别在麻醉诱导后(研究组)和术毕(对照组)静注帕瑞昔布钠40 mg.术毕患者均行PCIA(吗啡1 mg/ml),并于术后12、24、36 h注射帕瑞昔布钠40 mg.记录患者安静痛和咳嗽痛VAS评分及Ramsay镇静评分;记录PCA需求按压次数、有效按压次数及药物用量.采用放免法测定血浆白细胞介素(IL)-6、IL-8及TNF-α浓度.结果 术后6、12 h研究组安静痛和咳嗽痛VAS评分显著低于对照组(P＜0.05).两组Ramsay镇静评分差异无统计学意义.术后6、12h研究组镇痛药用量均显著少于对照组(P＜0.05).手术结束时至术后24 h研究组IL-6与TNF-α浓度明显低于对照组(P＜0.05).术后12、24 h研究组IL-8浓度明显低于对照组(P＜0.05).结论 术前应用帕瑞昔布钠40 mg可对肺癌根治术患者产生良好的镇痛效果.     

帕瑞昔布钠用于颈椎前路手术后镇痛的临床观察

目的 探讨帕瑞昔布钠在颈椎前路手术后镇痛的效果及安全性.方法 选择全身麻醉下骨科颈椎前路手术后患者60例,随机分为3组（每组20例）：A1组（帕瑞昔布钠40 mg静脉推注,q12 h×6次＋自控静脉镇痛泵组）,A2组（帕瑞昔布钠40 mg静脉推注,q 12 h×6次）,B组（单用自控静脉镇痛泵）.记录术后1、6、12、24、48、72 h的VAS疼痛评分和吗啡用量,观察不良反应率.结果 A1、A2组术后72 h内VAS评分和不良反应发生率均优于B组;A1组吗啡使用量少于B组（P〈0.05）;A1与A2组术后72 h内VAS评分比较差异无统计学意义（P〉0.05）,但A2组的不良反应发生率低于A1组（P〈0.05）.结论 帕瑞昔布钠具有高效和安全的镇痛特性,对于颈椎前路手术后患者镇痛效果良好.     

帕瑞昔布钠复合吗啡与地佐辛复合氟比洛芬酯用于结肠癌患者术后镇痛效果比较

目的比较帕瑞昔布钠复合吗啡与氟比洛芬酯复合地佐辛用于结肠癌手术患者自控静脉镇痛（PCIA）的效果,探讨合适的镇痛方案。 方法选择ASAⅠ-Ⅱ择期行结肠癌手术的患者90例,随机分为帕瑞昔布钠组（P组）、地佐辛组（D组）和芬太尼组（F组）,每组各30例。3组患者均采用气管内插管全身麻醉,术后行PCIA。PCIA设置背景剂量2ml/h,按压剂量2ml/次,锁定时间15min。P组于气管插管前静脉注射帕瑞昔布钠40mg,并于术后12、24、36、48 h静注帕瑞昔布钠40mg,PCIA使用吗啡20 mg+0.9%氯化钠溶液至100ml;D组于气管插管前静脉注射地佐辛5mg,PCIA使用地佐辛30 mg+氟比洛芬酯200mg+0.9%氯化钠溶液至100 ml;F组PCIA使用芬太尼1.0mg+0.9%氯化钠溶液至100 ml。观察3组患者术后30min（T_30min）、2h（T_2h）、4h（T_4h）、12h（T_12h）、24h（T_24h）、48h（T_48h）VAS镇痛评分、Ramsay镇静评分及不良反应的情况;术后48h记录PCIA泵按压次数及患者总体满意度。 结果P组及D组在T_30min-T_12h时点VAS评分显著低于F组（P﹤0.05）;T_30min-T_4h时点,P组Ramsay评分显著低于D组和F组（P﹤0.05）;术后48h内P组、D组患者头晕发生率显著低于F组（P﹤0.05）。 结论帕瑞昔布钠复合吗啡、地佐辛复合氟比洛芬酯用于结肠癌患者术后的镇痛效果确切,不良反应发生率低。     

术前使用帕瑞昔布钠对神经外科手术术后镇痛及凝血功能的影响

目的观察术前使用帕瑞昔布钠对神经外科手术术后镇痛及凝血功能的影响。方法择期全麻下神经外科开颅患者90例,按照随机数表法,均分为两组:帕瑞昔布组钠(P组)和对照组(C组)。P组在手术开始前30min静脉注射帕瑞昔布钠40mg,C组在手术开始前30min静脉注射生理盐水5ml。两组术后均采用舒芬太尼静脉自控镇痛(PCIA)。PCIA配方为舒芬太尼2μg/kg+托烷司琼0.2mg/kg,加生理盐水至120ml。记录两组患者术后2、4、16、24、48h的VAS评分、Ramsay评分,术后48h内PCIA总按压次数及有效按压次数,于帕瑞昔布钠给药前和给药后2h、48h测定凝血功能,并观察术后不良反应发生情况。结果 C组术后2、4、16、24、48hVAS评分明显高于P组(P0.05),术后2hP组镇静满意率明显高于C组(P0.05)。静脉注射帕瑞昔布钠前和注射2h及48h后,两组各凝血指标差异无统计学意义;术后48h内,C组总不良反应发生率明显高于P组(P0.05)。结论静脉注射帕瑞昔布钠40mg用于神经外科术后镇痛可增强舒芬太尼PCIA的镇痛效应,减少不良反应发生率,同时不影响凝血功能。     

帕瑞昔布钠联合盐酸羟考酮缓释片在全膝关节置换术后镇痛中的应用

目的 评估帕瑞昔布钠联合盐酸羟考酮控释片对全膝关节置换（TKA）术后镇痛的临床效果.方法选择单侧TKA术患者60例,分为帕瑞昔布钠组（A组,30例） 及帕瑞昔布钠联合盐酸羟考酮控释片组（B组,30例）.两组术毕即采用静脉注射帕瑞昔布钠40 mg q12 h镇痛.术后24 h起,A组：当视觉模拟评分（VAS）〉5分时,静脉注射帕瑞昔布钠40 mg,随后每隔12 h再静注帕瑞昔布钠40 mg;B组：当VAS〉5分时,静脉注射帕瑞昔布钠40 mg,10 min后口服盐酸羟考酮控释片10 mg,随后每隔12h静注帕瑞昔布钠40 mg并口服盐酸羟考酮控释片10 mg.观察并记录：患者术后24、32、40、48及72 h静息及运动时VAS、Ramsay镇静评分（RSS）,术后48、72 h膝关节被动活动最大可忍受度,药物不良反应情况.结果与A组比较,B组术后32、40、48、72 h的静息及运动疼痛 VAS 评分降低（P〈0.05）,镇静评分增加（P〈0.05）,术后48 h和72 h患者可忍受最大屈曲角度增大（P〈0.05）.两组均未出现严重副反应.结论 帕瑞昔布钠与盐酸羟考酮控释片联合应用符合多模式镇痛趋势,可基本实现TKA患者术后无痛的目标,使患者顺利度过术后疼痛期.     

帕瑞昔布钠超前镇痛的有效性评价:meta分析

目的 采用meta分析方法评价帕瑞昔布钠用于超前镇痛的有效性.方法 检索PubMed、Embase、Cochrane数据库和CNKI数据库,不限定发表时间和语言.收集帕瑞昔布钠应用于超前镇痛的随机安慰剂对照研究.采用改良Jadad法评价文献质量.以术后1、6、12和24h时视觉模拟评分(VAS评分)、术后24 h内吗啡用量、术后恶心呕吐发生情况为评价指标.采用RevMan 5.0.2软件进行meta分析.结果 纳入14项研究,Jadad评分均≥4分,包括1086例患者.分为安慰剂组和术前静脉注射帕瑞昔布钠40 mg组.Meta分析结果显示:与安慰剂组比较,术前静脉注射帕瑞昔布钠40mg组术后1、6、12和24 h时VAS评分降低,术后24 h内吗啡用量减少,术后恶心呕吐发生率降低(P＜0.05).结论 术前静脉注射帕瑞昔布钠40 mg可产生显著的超前镇痛效果,有助于降低术后镇痛的不良反应.     

帕瑞昔布在老年股骨转子间骨折术后镇痛的应用

目的探讨帕瑞昔布应用于老年股骨转子间骨折术后镇痛的临床效果和安全性。方法老年股骨转子间骨折手术患者60例,随机分为帕瑞昔布组（30例）和静脉自控镇痛组（对照组,30例）。比较两组间术后镇痛效果、吗啡累计使用量、不良反应发生数等指标。结果帕瑞昔布组在术后6、12、24h的VAS分值明显小于对照组（P〈0．05）;两组在术后2、48h的VAS分值近似（P〉0．05）。帕瑞昔布组吗啡累计使用量明显小于对照组（P〈0．05）,不良反应发生数亦少于对照组。结论老年股骨转子问骨折患者术后使用帕瑞昔布镇痛效果理想,利于患者康复,不良反应少,安全性高。     

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.