持续性非卧床腹膜透析腹膜炎的致病菌及其耐药性

目的：探讨持续性非卧床腹膜透析（CAPD）腹膜炎的致病菌及其耐药性。方法：回顾性分析109例CAPD腹膜炎的临床表现、致病菌、耐药性和转归情况。结果：43例培养阳性,透出液培养阳性率为39．4％,其中11例为革兰阳性球菌,19例为革兰阴性杆菌,13例为真菌。主要的革兰阴性杆菌包括肺炎克雷白氏杆菌、大肠杆菌、不动杆菌和铜绿假单胞菌。革兰阴性杆菌对氨苄西林的耐药率最高,达85．7％;对阿米卡星的耐药率最低,为17．6％;庆大霉素的耐药率为44．4％;而头孢他啶的耐药率也高达42．9％。所有革兰阳性球菌对万古霉素敏感,大部分（71．4％）对头孢唑林敏感。腹腔内用抗真菌药对真菌性腹膜炎疗效不佳。腹膜炎CAPD的退出率为20．2％（22／109）。结论：革兰阴性杆菌腹膜炎比例有所增加,致病菌对庆大霉素和头孢他啶的耐药性较高,而对阿米卡星较敏感,宜作为经验用药。     

复杂性尿路感染致病菌的耐药性新趋势

目的 探讨复杂性尿路感染致病菌和耐药性的变化。方法 分析从1995年到2001年住院治疗的260例培养阳性的复杂性尿路感染致病菌分布及其对抗生素敏感性。结果 革兰阴性杆菌占77.3％,其中大肠杆菌占44.2％;革兰阳性球菌占16.9％,其中肠球菌占11.6％;真菌占5.8％。大肠杆菌对氨苄西林耐药率最高,达84.1％;对羟氨苄西林/克拉维酸耐药率(21.3％)明显低于对氨苄西林的耐药率(P<0.05);对阿米卡星耐药率明显低于对庆大霉素的耐药率(4.9％比54.3％,P<0.01);致病大肠杆菌对喹诺酮耐药,耐药率为50％-78％;对SMZ/TMP耐药性也高达62.3％。结论 大肠杆菌仍是住院复杂性尿路感染的主要致病菌,但肠球菌、克雷白杆菌、阴沟肠杆菌常见等细菌的比例有所增加。这些细菌耐药性高,部分呈多重耐药,应尽量根据细菌药敏试验调整抗生素。     

腹膜透析相关性腹膜炎经验用药分析

目的 研究华山医院及宝山分院腹膜透析（腹透）相关性腹膜炎的致病菌、耐药性及患者转归,为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性,阳性率为80.2％,其中革兰阳性球菌45例,革兰阴性杆菌21例,真菌2例,革兰阳性杆菌1例,革兰阴性球菌1例,多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有革兰阳性球菌对万古霉素均敏感,但对头孢唑林耐药率高达60.0%,而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1％,所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例,退出率为17.2％（16/93）。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高,目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。     

腹膜透析相关性腹膜炎169例次临床分析及转归

目的探讨腹膜透析相关性腹膜炎的致病菌和耐药性,及其与转归之间的关系。方法回顾性分析169例次腹膜透析相关性腹膜炎的临床资料、致病菌与耐药性,探讨其与转归的联系。结果116例次培养阳性,培养总阳性率达68．6％,近5年高达87．7％。致病菌中G^＋球菌占58例次（50％）,G^-杆菌45例次（38．8％）,真菌6例次（5．2％）,G^＋杆菌、G^-球菌及混合感染7例（6％）。G^＋球菌中最常见为葡萄球菌（56．8％）;G^-杆菌中大肠杆菌阳性率最高（62．2％）。从耐药性看,G^-杆菌对氨苄西林的耐药率最高（76．7%）,对阿米卡星和哌拉西林／他唑巴坦的耐药率较低（2．9%、3．4％）。G^＋球菌对万古霉素均敏感,对利福平和哌拉西林／他唑巴坦的耐药率较低（2．1％、7．9％）。腹膜炎致持续非卧床腹膜透析（CAPD）退出率为10．1％（17／169）,以真菌腹膜炎为主。结论近5年本中心培养阳性率较高,及时采用血培养瓶留取标本很关键。G^-杆菌对阿米卡星和哌拉西林／他唑巴坦较敏感,而万古霉素、利福平和哌拉西林／他唑巴坦宜作为抗G^＋球菌的经验用药。真菌性腹膜炎是导致腹膜透析退出的主要原因。     

368例胆道感染患者胆汁细菌培养结果与药敏分析

目的了解胆道感染主要病原微生物的种类及分布，分析药敏培养结果，为临床合理使用抗菌药提供参考。方法采集的胆汁标本应用生物梅里埃分析产品公司(Analytic Products Incorporation，API)细菌鉴定系统鉴定分离菌株，应用最低抑菌浓度(MIC)法对393株病原微生物进行药敏试验。结果在393株胆汁培养阳性的病原微生物中，革兰阴性杆菌289株(占73．5％)，革兰阳性球菌94株(占23．9％)，真菌lO株(占2．5％)，真菌均为混合感染。药敏结果表明：胆道感染中主要病原茵对头孢吡肟、万古霉素、亚胺培南、氨曲南等有相当低的耐药率，对三代头孢菌素的耐药性较以往有明显提高，对临床广泛应用的氨苄西林、环丙沙星、庆大霉素、哌拉西林等耐药率非常高。结论胆道感染中革兰阴性菌仍居于主导地位，其主要病原菌对氨苄西林、环丙沙星、庆大霉素、哌拉西林等耐药率非常高，而对头孢吡肟、万古霉素、亚胺培南、氨曲南等耐药率较低。     

腹膜透析相关性腹膜炎患者病原菌耐药性及预后分析

目的了解腹膜透析(PD)患者腹膜炎的病原学特点、耐药情况及预后。方法回顾性分析2009年1月至2016年9月四川省人民医院PD中心发生的318例次PD相关性腹膜炎,对病原学种类、耐药性情况及腹膜炎结局进行分析。结果(1)腹膜炎细菌的分布情况:腹透液培养阳性185例次,培养阳性率58.1%。共培养得细菌194株,其中革兰阳性菌131株(67.5%),革兰阳性杆菌49株(25.2%),真菌14株(7.2%)。革兰阳性菌以表皮葡萄球菌和金黄色葡萄球菌为主,分别占25.9%和10.6%。革兰阴性菌以大肠杆菌为主(占40.8%)。(2)腹膜炎致病菌的耐药性分析:革兰阳性菌对青霉素的耐药率较高。革兰阴性菌对氨苄西林的耐药率较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低。真菌呈现出较低耐药性。(3)腹膜炎结局分析:共治愈腹膜炎267例次(83.9%),退出51例次,退出率16.0%,其中拔管转血液透析31例次(9.7%),死亡13例(4.0%),失访7例。(4)腹膜炎复发、再发和重现致病菌分析:腹膜炎复发感染有3例次(0.94%),其中2例次为路邓葡萄球菌感染,1例次为表皮葡萄球菌感染。再发感染有1例次(0.31%)。重现感染有2例次(0.62%)。结论本PD中心导致PD相关性腹膜炎的主要致病菌为革兰阳性菌。革兰阳性和革兰阳性菌都对非加酶抗生素具有较高耐药性,合理选择抗菌药物是治愈PD相关性腹膜炎的关键。     

开放性骨折伤口感染病原菌分布及耐药率监测

[目的]调查开放性骨折伤口感染患者的病原菌分布及耐药趋势,为临床抗菌药物的使用提出合理建议.[方法]对2004年1月～2008年12月本院骨科住院开放性骨折患者各类标本共136例,采用ATB Expression自动细菌鉴定及药敏实验.[结果]136例开放性骨折伤口感染标本中,共分离到细菌151株,金黄色葡萄球菌、铜绿假单胞菌、溶血葡萄球菌、表皮葡萄球菌、大肠埃希菌检出率最高,分别为17.22%、13.24%、11.92%、9.93%、9.27%;MRSA占＞57.70%,革兰阳性球菌占48.34%,革兰阴性杆菌占43.05%,假丝酵母菌属占8.61%.大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)株占28.6%,革兰阴性杆菌除头孢哌酮/舒巴坦未发生耐药外,对氨苄西林、氨苄西林/舒巴坦、头孢唑啉耐药率高达71.4%.葡萄球菌属对甲氧西林的耐药率＞57.7%,除万古霉素未发生耐药外,较敏感的抗菌药物有复方新诺明、呋喃妥因、利福平、四环素.[结论]内源性的正常菌群或来自周围环境中的条件致病菌已成为开放性骨折伤口感染的主要致病菌,因此,早期积极采取正确及时的清创处理及合理使用抗菌药物等,对于预防骨折术后感染有着积极的作用.     

124株腹膜透析相关性腹膜炎致病菌及耐药性分析

目的探讨腹膜透析相关性腹膜炎（PDAP）致病菌的耐药性。方法回顾性分析2008年7月-2012年7月我院腹膜透析中心PDAP患者的临床资料及药敏结果。结果（1）203例次PDAP培养阳性率为59．1％,共培养出致病菌124株。124株致病菌中革兰阳性球菌68株,占54．8％;革兰阴性杆菌28株,占22．6％;革兰阳性杆菌12株,占9．7％;奈瑟茵属5株,占4．0％;真菌11株,占8．9%。其中耐药菌株54株,包括多药耐药菌50株,泛耐药菌4株,本中心PDAP患者尚未培养出全耐药菌。（2）药敏结果：对革兰阳性球菌敏感性较高的前3种药物为：利奈唑胺100％,莫西沙星95．8％,万古霉素95．2％。对革兰阴性杆菌敏感性较高的前3种药物为：阿米卡星85．7％,亚胺培南82．1％,左氧氟沙星75．0％。（3）转归：PDAP患者总治愈率为77．3％。结论PDAP致病菌耐药性的产生导致临床上可供选择的药物减少,临床医牛府采取多种措施延缓致病菌耐药件。     

72例次持续性非卧床腹透腹膜炎分析

目的：探讨持续性非卧床腹透（CAPD）相关性腹膜炎的致病菌及其耐药性。方法：回顾性分析72例次CAPD相关性腹膜炎的致病菌及其耐药性。结果：48例次培养阳性,培养阳性率达67.6%,其中G＋菌占28例次,G-菌16例次,真菌7例次。G＋菌头孢唑啉耐药率66.6%,万古霉素为0,左氧氟沙星为45.8%;G-菌丁胺卡那耐药率20.0%,头孢哌酮/舒巴坦9.1%,庆大霉素40.0%,头孢他啶40.0%,左氧氟沙星53.5%,亚胺培南/西司他丁为0;左氧氟沙星耐药性与头孢唑啉、丁胺卡那、头孢他啶无统计学差异。结论：本中心培养阳性率较目前国内报道为高,离心法培养值得推荐;左氧氟沙星在本中心可作为腹膜炎经验用药。     

单中心腹膜透析相关性腹膜炎致病菌及原因分析

目的:分析腹膜透析相关性腹膜炎感染原因及致病菌菌谱、耐药性变化,为合理用药提供依据。方法:回顾深圳市第二人民医院近5年来腹膜透析相关性腹膜炎患者一般情况、细菌培养及药敏试验、疗效及转归。结果:96例次腹膜透析相关性腹膜炎中,常见的感染原因是不规范操作(28. 1%)及不洁饮食(41. 6%)。培养菌株65例次,其中G+菌31例次(47. 7%),G-菌25例次(38. 5%),真菌8例次(12. 3%),分支杆菌1例次(1. 5%)。本中心最主要的致病菌是G+球菌,以葡萄球菌及链球菌多见,而G-菌感染中以大肠杆菌最为常见。G+菌对万古霉素、利奈唑胺、替加环素无耐药,对青霉素G的耐药率为72. 7%。G-菌对亚胺培南、哌拉西林他唑巴坦、厄他培南无耐药,对阿米卡星(5%)、头孢他啶(5. 2%)及头孢替坦(5. 5%)低耐药,对氨苄西林耐药率为83. 33%。真菌对伊曲康唑、酮康唑、5-氟胞嘧啶无耐药。G+菌、G-菌、培养阴性腹膜炎患者治愈率分别为88%、86. 4%、92. 1%。结论:革兰阳性菌仍是腹膜透析相关性腹膜炎的主要致病菌;腹透液培养阴性的腹膜炎患者治愈率高、预后较好。革兰阳性球菌对青霉素耐药性较高,经验治疗宜首先万古霉素;革兰阴性菌腹膜炎经验治疗可选用氨基糖甙类、头孢他啶或哌拉西林/他唑巴坦。     

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.     

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.     

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.