胸腔镜辅助下前路病灶清除植骨内固定治疗胸椎结核

[目的]研究胸腔镜辅助下小切口技术前路病灶清除加植骨内固定治疗胸椎结核的临床疗效.[方法]分析2004年6月～2009年6月手术治疗的胸椎结核病人48例,男23例,女25例.按手术方式分为A组(开放手术组)和B组(胸腔镜辅助手术组),记录两组患者术中、术后出m量及手术时间.随访两组患者术后胸背疼痛、脊柱功能及胸椎后凸角矫正改善情况,并进行比较.[结果]A、B两组术中、术后出血鞋及手术时间组间分别比较差异有统计学意义(P＜0.05).48例患者经随访12～48个月(平均20个月),两组术后VAS、ODI及后凸角较术前明显改善(P＜0.05);两组术后VAS、ODI及后凸角改善率组间分别比较差异无统计学意义(P＞0.05),但是术后1周VAS改善B组较A组明显(P＜0.05).A组并发症8例(38.1%)与B组5例(18.5%)比较差异有统计学意义(P＜0.05).[结论]胸腔镜辅助下小切口前路病灶清除植骨内固定能有效地清除胸椎结核病灶,稳定脊柱,熟悉胸椎前方解剖结构,掌握胸腔镜操作技术及手术者之间默契配合是手术成功的关键.     

病灶彻底清除术联合超短程化疗治疗脊柱结核的长期疗效观察

目的探究病灶彻底清除术联合超短程化疗治疗脊柱结核的长期治疗效果。方法选取2009-03-2011-03我院收治的196例脊柱结核患者,随机均分为观察组与对照组,两组均行病灶彻底清除术治疗,观察组术后行超短程化疗,方案为2SHRZ/2~4HRZ,疗程4~6个月;对照组术后行标准化疗,方案为2SHRZ/7~16HRZ,疗程为9~18个月。结果两组入院时、随访3年后的后凸Cobb角、植骨愈合时间、植骨融合率CRP、ESR水平和ASIA功能评分相比,差异均无统计学意义(P0.05);随访3年后两组患者的后凸Cobb角较治疗前均有显著减少(P0.05),实验室指标与神经功能较治疗前也有显著改善(P0.05);观察组副作用的发生率6.12%显著低于对照组的18.37%,差异有统计学意义(P0.05)。结论病灶彻底清除术联合超短程化疗治疗脊柱结核的远期疗效理想,有效改善了患者预后,且副作用发生率更低。     

后路经单侧椎弓根病灶清除植骨内固定治疗胸腰椎结核的疗效分析

目的探讨后路经单侧椎弓根入路病灶清除植骨内固定术治疗胸腰椎结核的临床疗效。方法 2009年1月-2013年1月共97例胸腰椎结核患者符合选择标准纳入研究并分为两组,A组53例接受后路经单侧椎弓根入路病灶清除植骨内固定术,B组44例接受传统后路病灶清除植骨内固定术。两组患者性别、年龄、病程、病变节段、神经功能Frankel分级,以及术前红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、矢状位Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)比较,差异均无统计学意义(P0.05),具有可比性。对两组的手术情况及随访结果进行比较分析。结果两组患者均获随访,随访时间24~60个月。所有患者术后植骨均融合,A、B组植骨融合时间分别为(6.79±1.68)、(6.89±2.00)个月,比较差异无统计学意义(t=—0.251,P=0.802)。两组患者手术时间、术中出血量、术后住院时间比较,差异无统计学意义(P0.05);A组术后引流量明显少于B组(P0.05)。两组术后1年ESR、CRP及末次随访VAS评分均较术前显著降低(P0.05);组间比较差异无统计学意义(P0.05)。两组术后1周及末次随访Cobb角和术后3个月及末次随访ODI均较术前显著改善(P0.05),术后两时间点间比较差异均无统计学意义(P0.05);两组间比较,除术后3个月A组ODI显著低于B组(t=—2.185,P=0.027)外,其余各时间点两组Cobb角和ODI以及末次随访时Cobb角丢失比较,差异均无统计学意义(P0.05)。末次随访时,两组神经功能Frankel分级均较术前有1~2级改善,两组间比较差异无统计学意义(Z=—0.180,P=0.857)。两组患者均未发生内固定物断裂、松动等并发症。结论后路经单侧椎弓根入路病灶清除植骨内固定术治疗胸腰椎结核疗效满意,相比于传统后路手术创伤更小、脊柱稳定性更高、术后功能恢复更快。     

钛网充填异体骨植骨在颈椎结核治疗中的应用

目的 评价前路病灶清除植骨内固定治疗颈椎结核的手术中,采用钛网充填异体骨植骨的临床应用价值.方法 回顾性研究2002年1月至2007年1月间,行前路病灶清除植骨内固定手术治疗且随访2年以上的颈椎结核病例共32例.其中,男性18例,女性14例;年龄18～72岁,平均41.3岁.发病至就诊时间0.5～15.0个月,平均6.9个月.初治患者13例,复治患者19例.根据植骨来源不同分为A、B两组,A组17例采用钛网充填异体骨植骨,B组15例采用自体髂骨块植骨.随访时间2-5年,平均3.5年.比较两组间手术时间、出血量、结核治愈情况、颈椎生理曲度(ARA角)变化、颈脊髓功能(40分评分)及植骨融合率等.结果 切口一期愈合率93.8%(30/32),总治愈率为96.9%(31/32).A、B组间切口一期愈合率及总治愈率差异均无统计学意义(P>0.05).两组平均手术时间分别72、90 min,平均出血量分别为121、198 ml;两组比较差异均有统计学意义(P<0.05).两组组内比较,术前与术后即刻、术前与术后末次随访时、术后即刻与术后末次随访颈脊髓功能差异均有统计学意义(P<0.05);术前与术后即刻、术前与术后末次随访时颈椎绝对旋转角(ARA角)差异均有统计学意义(P<0.05),术后即刻与术后末次随访之ARA角差异均无统计学意义(P>0.05).两组组间比较:术前、术后即刻、术后末次随访之颈脊髓功能及ARA角差异均无统计学意义(P>O.05).结论 在个体化有效抗痨的基础上,应用前路病灶清除减压、一期钛网内充填异体骨植骨内固定治疗颈椎结核,临床疗效满意.     

骨移植在青少年特发性脊柱侧凸后路矫形术的应用研究

[目的]通过不同植骨在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用比较,探讨其临床应用效果.[方法]回顾性分析2000年～2005年行后路钉-棒系统矫形手术的71例青少年特发性脊柱侧凸患者,其中自体骨移植21例(A组),同种异体骨移植23例(B组),自体骨混合同种异体骨移植27例(C组),比较随访第3、9、15、36个月的融合率、Cobb's角丢失率及假关节发生率.[结果]A组平均融合节段7个,B组平均融合节段7.6个,C组平均融合节段8个.随访的第3个月,融合率、Cobb's角丢失率及假关节发牛率A组、B组、C组无显著性差异(P＞0.05).第9个月,A组融合率高于B、C两组,A组与B、C组有显著性差异(P＜0.05),B、C组间无显著性差异(P＞0.05),Cobb's角丢失率及假关节发生率A、B、C组无显著性差异(P＞0.05).第15、36个月,融合率、Cobb's角丢失率及假关节发牛率A、B、C组无显著性差异(P＞0.05).[结论]同种异体骨移植、自体骨混合同种异体骨移植与自体骨移植在青少年特发性脊柱侧凸后路矫形手术中对维持矫形效果可取得相近的近远期临床效果.     

手术时机对胸椎结核伴脊髓损害疗效的影响

目的探讨后路病灶清除脊髓减压植骨内固定治疗伴脊髓损害的胸椎结核的可行性,比较手术时机对术后疗效的影响。方法回顾分析2012年8月—2015年10月收治的26例胸椎结核伴脊髓损害患者临床资料。所有患者行后方经单侧椎弓根入路病灶清除脊髓减压植骨内固定术,其中11例出现脊髓损害症状至手术时间3个月(A组)、15例出现脊髓损害症状至手术时间3个月(B组)。两组患者性别、年龄、病变节段及术前红细胞沉降率、C反应蛋白、病变节段Cobb角、美国脊髓损伤协会(ASIA)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。记录并比较两组患者手术时间、术中出血量、住院时间、围术期并发症发生情况及骨融合时间;比较两组术前及末次随访时Cobb角并计算矫正度;采用ASIA分级评价手术前后脊髓功能。结果两组患者均获随访,随访时间25~60个月,平均41.6个月。术中、术后均无脑脊液漏发生。A组住院时间及围术期并发症均显著少于B组(P0.05);两组手术时间、术中出血量及骨融合时间比较差异均无统计学意义(P0.05)。末次随访时A、B组红细胞沉降率和C反应蛋白比较差异无统计学意义(P0.05),但均较术前明显降低(P0.05)。A组1例T6、7结核术后切口出现窦道,经换药等处理后愈合,20个月骨性融合后取出内固定物,36个月随访时结核无复发;B组1例T4、5结核术后26个月时复发并出现胸椎畸形,予以翻修。其余患者均无内固定物相关并发症或结核复发。末次随访时两组患者病变节段Cobb角均较术前显著改善(P0.05),两组间Cobb角及矫正度比较差异均无统计学意义(P0.05)。末次随访时脊髓功能ASIA分级,A组C级1例、E级10例,B组D级2例、E级13例,均较术前显著改善(P0.05);两组间比较差异无统计学意义(Z=–0.234,P=1.000)。结论对伴有脊髓损害的胸椎结核患者,采用后方经单侧椎弓根入路病灶清除脊髓减压植骨内固定术治疗可以取得满意效果,尽早手术可以缩短患者住院时间、降低围术期并发症发生风险。     

前路减压Zero-p椎间融合器与传统钛板联合cage融合内固定治疗脊髓型颈椎病的疗效比较

目的:比较前路减压Zero-p椎间融合器与传统钛板联合cage融合内固定治疗脊髓型颈椎病的临床疗效.方法:回顾性分析我院2010年1月～2011年10月采用前路减压植骨融合内固定治疗的46例单节段脊髓型颈椎病患者的临床资料,其中使用Zero-p椎间融合器植骨融合内固定22例(A组,n=22),使用传统钛板联合cage植骨融合内固定24例(B组),两组患者年龄、性别比、术前JOA评分、手术节段分布均无统计学差异,比较两组患者术中出血量、手术时间、术后JOA评分及JOA改善率、融合率、吞咽困难发生率和邻近节段退变率.结果:A组手术时间为97.3min,术中出血量86.4ml;B组为103.5min 、90.6ml,两组比较无统计学差异(P＞0.05).A组1例术后发生吞咽困难,B组8例术后发生吞咽困难,两组吞咽困难发生率有统计学差异(P＜0.05).A组术后随访12～31个月,平均21.5个月,B组术后随访13～32个月,平均22.1个月,两组随访时间无统计学差异(P＞0.05);两组术后JOA评分与术前比较均有统计学差异(P＜0.01),A组JOA改善率为61％,B组为63％,两组比较无统计学差异(P＞0.05).两组融合节段均获得骨性融合,A组44个邻近节段有4个节段椎间盘信号发生退变或退变级别加重,B组48个邻近节段有8个节段椎间盘信号发生退变或退变级别加重,两组融合率和邻近节段退变率均无统计学差异(P＞0.05).结论:应用Zero-p椎间融合器和传统钛板联合cage植骨融合内固定治疗单节段脊髓型颈椎病均可取得较好的疗效,但应用Zero-p椎间融合器术后吞咽困难发生率较低.     

小切口技术在胸腰椎结核前路手术中的应用

目的探讨小切口技术在胸腰椎结核前路手术中的应用价值。方法回顾分析2015年1月—2018年1月收治的65例采用后前路联合手术治疗的胸腰椎结核患者临床资料,根据前路手术切口长度分为小切口手术组(A组29例)和传统切口手术组(B组36例)。两组患者性别、年龄、病程、病变节段、美国脊髓损伤协会(ASIA)分级及术前疼痛视觉模拟评分(VAS)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、脊柱后凸Cobb角等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录并比较两组前路手术切口长度、手术时间、术中出血量、术后并发症、住院时间及ESR、CRP;术后采用VAS评分评价疼痛恢复情况;测量脊柱后凸患者病变椎体Cobb角,并计算Cobb角角度丢失及矫正率;根据Bridwell植骨融合标准评定植骨融合情况。结果 A组患者前路手术切口长度、手术时间、术中出血量及住院时间均显著小于B组(P0.05)。两组患者均获随访,随访时间12~29个月,平均20个月。A、B组分别有4例(13.8%)和14例(38.9%)出现术后并发症,发生率差异有统计学意义(χ~2=5.050,P=0.025)。两组术后6个月ESR和CRP均降至正常范围,术后3、6个月及末次随访时两组ESR和CRP差异均无统计学意义(P0.05)。两组患者末次随访时神经功能均较术前明显恢复,两组间比较差异无统计学意义(Z=0.167,P=0.868)。两组术后各时间点VAS评分均较术前显著下降(P0.05);A组术后1 d VAS评分显著低于B组(t=-2.317,P=0.024),但末次随访时两组比较差异无统计学意义(t=-0.862,P=0.392)。两组脊柱后凸畸形患者术后1 d及末次随访时Cobb角均较术前显著减小(P0.05),术后1 d与末次随访时比较差异无统计学意义(P0.05);两组术后Cobb角以及角度丢失和矫正率比较差异均无统计学意义(P0.05)。两组患者末次随访时植骨全部达骨性融合,术后6个月、1年及末次随访时两组植骨融合率差异均无统计学意义(P0.05)。末次随访时两组患者结核病灶均治愈,无结核复发。结论胸腰椎结核前路手术中采用小切口技术可以达到和传统切口手术相似的治疗效果,并且具有创伤小、术后并发症少、患者术后恢复快等优点。     

莫西沙星对复治重症肺结核的临床观察

目的:比较和评价含莫西沙星( MXFX)方案与含左氧氟沙星(LVFX)方案对复治重症肺结核的治疗效果及安全性.方法:将110例复治重症肺结核患者随机分成治疗组(A组)58例及对照组(B组)52例,A组用含MXFX方案;B组用含LVFX方案,疗程结束时两组患者进行比较.结果:满2、3个月时痰菌阴转率A组为69％、79.3％、B组为50％、61.5％,两组对比差异有统计学意义(P＜0.05),满12个月时A组及B组分别为96.6％、90.4％,2组对比差异无统计学意义;疗程末影像吸收有效率、空洞有效率A组89.7％、72.4％,B组75％、53.8％,两组对比差异有统计学意义(P＜0.05);副作用A组29.3％,B组为28.8％,2组对比差异无统计学意义(P＞0.05).结论:MXFX对复治重症结核的疗效可靠,安全性高,且无明显不良反应发生.     

后路病灶清除植骨内固定联合不同入路腰大肌脓肿清除局部化疗治疗胸腰椎结核

目的比较前、后路腰大肌脓肿清除及脓腔内局部化疗联合后路病灶清除植骨内固定治疗胸腰椎结核的临床疗效,探讨后路腰大肌脓肿清除的可行性。方法回顾分析2012年6月—2015年12月治疗的37例胸腰椎结核伴腰大肌脓肿患者临床资料。所有患者行后路病灶清除、植骨内固定术,根据腰大肌脓肿清除的手术入路不同分为A组(21例,行后路脓肿清除及脓腔内局部化疗)和B组(16例,行前路脓肿清除及脓腔内局部化疗)。两组患者性别、年龄、病程、病变节段、术前红细胞沉降率、术前C反应蛋白、腰大肌脓肿侧别、腰大肌脓肿最大横径及纵径、伴随脓肿、脓腔分隔情况、术前病变节段Cobb角、术前美国脊髓损伤协会(ASIA)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。记录并比较两组患者手术时间、术中出血量、术后住院时间、脓肿吸收时间及骨融合时间;观察患者术前及末次随访时的病变节段Cobb角变化情况;采用ASIA分级评价脊髓神经功能。结果除B组手术时间显著长于A组(t=–2.985,P=0.005)外,两组间术中出血量、术后住院时间、脓肿吸收时间及骨融合时间比较,差异均无统计学意义(P0.05)。两组患者均获随访,随访时间18～47个月,平均31.1个月。术中及术后均无脑脊液漏发生。A组4例二次行前方脓肿清除置管化疗。末次随访时所有患者脓肿均吸收,红细胞沉降率及C反应蛋白均正常。两组患者末次随访时病变节段Cobb角均较术前显著改善(P0.05),末次随访时两组间病变节段Cobb角以及矫正度比较,差异无统计学意义(P0.05)。术前9例伴脊髓神经功能损害者中,末次随访时神经功能均改善,与术前比较差异有统计学意义(Z=–2.716,P=0.007)。结论治疗胸腰椎结核伴腰大肌脓肿,单纯后路病灶清除、植骨内固定联合脓肿清除及脓腔内局部化疗可取得良好疗效,但特殊情况下仍需行前路脓肿清除。     

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.     

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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.