0.75%罗哌卡因和0.5%布比卡因用于硬膜外阻滞剖宫产手术的比较

目的 比较０．７５％罗哌卡因和０．５％布比卡因对剖宫产手术硬膜外麻醉的临床效果。为罗哌卡因临床应用提供客观依据。方法 ２０例剖宫产术患者（ＡＳＡⅠ～Ⅱ级）随机分为二组，Ｉ组：０．７５％罗派卡因（ｎ＝１０例），ＩＩ组：０．５％布比卡因（ｎ＝１０例）取Ｌ２－３行硬膜外穿刺，向上置管３ｃｍ，注入１．０％利多卡因５ｍｌ试验量，５分钟后注入首次剂量罗哌卡因或布比卡因８～１５ｍｌ总量不超过２０ｍｌ，结果：两组     

低浓度罗哌卡因和布比卡因分娩镇痛的临床研究

目的 对比低浓度罗哌卡因和布比卡因自控硬膜外分娩镇痛（ＰＣＥＡ）的效果。方法 ５２例单胎初产妇随机分为０．１％罗哌卡因－芬太尼组和０．０７５％布比卡因－芬太尼组。采取双盲法进行视觉模拟镇痛评分（ＶＡＳ）和下肢运动神经阻滞评分（ＭＢＳ）。记录产程时间、生产方式、胎儿心率（ＦＨＲ）及新生儿ＳｐＯ２。结果 两组产妇分娩镇痛效果良好且无显著性差别（Ｐ〉０．０５）。罗哌卡因组和布比卡因组中无运动神经阻滞者分     

硬膜外芬太尼／0.125%布比卡因混合用于分娩止痛的临床观察

本文用双盲法对比研究了在小剂量催产素续点滴，保持宫缩频率和宫缩时间在理想情况下，单纯应用０．１２５％布比卡因１０ｍｌ（Ｂ组）和结合芬太尼２５μｇ间断硬膜外注射时的量效关系。结果：注药后５ｍｉｎＶＡＰＳ值ＢＦ５０组明显少于其他三组（Ｐ＜０．０５），以后１５，３０，６０ｍｉｎ混合用药组的ＶＡＰＳ组均少于单纯布比卡因或单纯芬太尼组，统计学处理有非常显著的差异（Ｐ＜０．０１）。在３０和６０ｍｉｎ，ＢＦ５０     

硬膜外注射芬太尼与丁哌卡因镇痛对孕兔宫血流量及胎兔心电…

探讨硬膜外注射阿片制剂与局麻制剂镇痛对胎兔是否具有抑制作用。方法；将妊娠末期兔５０只随机分成Ａ，Ｂ，Ｃ，Ｄ，Ｅ五组，前四组硬膜外分别注入０．５μｇ／ｋｇ，１μｇ／ｋｇ，２μｇ／ｋｇ，３μｇ／ｋｇ芬太尼与０．３ｍｇ／ｋｇ丁哌卡因混合液，Ｅ组注射单纯丁哌卡因０．３ｍｇ／ｋｇ，注射容积为２ｍｌ。     

罗哌卡因含或不含肾上腺素硬膜外麻醉的药效学和药代动力学

目的观察肾上腺素对１％罗哌卡因硬膜外阻滞的药效学和药动学影响。方法选择ＡＳＡⅠ～Ⅱ级行下腹部手术病人１６例,随机分为两组,每组８例。分别用１％罗哌卡因２ｍｇ· ｋｇ~－１（Ｒ组）和加入１： ２００ ０００肾上腺素的 １％罗哌卡因 ２ｍｇ· ｋｇ~－１（ＲＥ组）行硬膜外阻滞,对比两组药效学和药代动力学指标。结果两组药效学指标、Ｃｍａｘ和ＡＵＣ间均无显著性差异。与Ｒ组相比,ＲＥ组的Ｔｍａｘ明显后延（Ｐ＜０．０１）,Ｋ值明显降低（Ｐ＜０．０５）。结论 １：２００ ０００肾上腺素对１％罗派卡因硬膜外阻滞的药效学没有影响,但可以减缓罗哌卡因的吸收和清除。     

罗哌卡因和布比卡因对豚鼠心室肌细胞L-型钙电流的影响

目的观察罗哌卡因和布比卡因对豚鼠心室肌细胞L-型钙电流(ICa-L)的影响,探讨其心肌负性肌力作用的机制。方法以急性酶解法获得豚鼠的单个心室肌细胞,用标准的全细胞膜片钳技术记录ICa-L。结果100/μmol/L的罗哌卡因和布比卡因分别使豚鼠心室肌细胞ICa-L峰值降低(37±3)%和(42±5)%,两者比较差异有统计学意义(P<0.05);两种药物均使电流密度-电压曲线上移,但不改变激活ICa-L的电压和曲线的形态。罗哌卡因和布比卡因均呈浓度依赖性阻滞豚鼠心室肌细胞ICa-L,半最大抑制浓度分别为212±38、(161±20)μmol/L。结论罗哌卡因和布比卡因均呈浓度依赖性阻滞豚鼠心室肌细胞ICa-L,可能是其产生心肌负性肌力作用的主要机制。     

罗哌卡因用于矫形外科手术后镇痛的效果观察

我院近年来采用ＣＩＥＡ进行术后镇痛 ,本文对比观察不同剂量罗哌卡因和布比卡因的镇痛效果、运动阻滞程度及副作用。1 .资料与方法 :ＡＳＡⅠ Ⅱ级髋、膝、踝关节、拇外翻的矫形外科手术 60例 ,随机分为 3组。Ａ组 2 0例 :采用芬太尼2 μｇ/ｍｌ加 0 1 75 %布比卡因 ;Ｂ组 2 0例 :采用芬太尼 2 μｇ/ｍｌ加 0 2 %罗哌卡因 ,两组的镇痛泵注药速率为 5ｍｌ/ｈ(Ａｃｃｕｆｕｓｅｒ2 75 @型 ) ;Ｃ组 2 0例 :采用芬太尼 2 μｇ/ｍｌ加 0 2 %罗哌卡因 ,镇痛泵注药速率为 2ｍｌ/ｈ(Ａｃｃｕｆｕｓｅｒ1 0 0 @型 )。于全麻诱导前置入硬膜外导管…     

0.75%罗比卡因与0.75%布比卡因腰麻-硬膜外联合麻醉应用于剖宫产手术的评价

目的 比较 ０．７５％罗哌卡因与 ０．７５％布比卡因腰麻硬膜外联合麻醉用于剖宫产手术的可行性。方法 ＡＳＡ－Ⅰ～Ⅱ级初产妇４０例于腰硬联合麻醉下行剖宫产手术,随机、双盲分两组：Ｒ组（ｎ＝２０）腰麻用药为０．７５％罗哌卡因１．２～１．４ｍｌ（９－１０．５ｍｇ）出组（ｎ＝２０）腰麻用药为０．７５％布比卡因,剂量同Ｒ组。术中两组麻醉效应不足时经硬膜外导管补充１．６％利多卡因。术中连续监测呼吸和循环状况,评估麻醉效应,并观察围术期不良反应的发生及新生儿情况。结果 两组最高阻滞平面及达到时间相似（Ｐ＞０．０５）,但Ｒ组感觉和运动神经阻滞起效慢,维持时间短（Ｐ＜０．０５）;下肢运动阻滞程度Ｒ组显著低于Ｂ组（Ｐ＜０．０１）;术中Ｒ组有４例（２０％）发生心动过缓,Ｂ组５例（２５％）出现主观气促感;新生儿 Ａｐｇａｒ评分及脐动脉血气值在正常范围内．两组比较无差异（Ｐ＞０．０５）。结论 ０．７５％罗哌卡因用于硬腰联合麻醉剖腹产手术安全有效,与０．７５％布比卡因相比,下肢运动阻滞弱且恢复迅速。     

罗哌卡因与布比卡因用于腰麻-硬膜外联合阻滞的临床观察

罗哌卡因是一种新型长效酰胺类局麻药 ,与布比卡因有相似的化学结构和药理学特性。本文观察了罗哌卡因与布比卡因在腰麻 硬膜外联合阻滞中的临床应用效果。资料与方法1 资料　选择 4 0例ＡＳＡⅠ～Ⅱ级拟在腰麻 硬膜外联合阻滞下行择期下肢手术病人 ,排除重要脏器功能不全 ,局麻药过敏史 ,酒精或药物滥用史 ,腰麻和硬膜外禁忌证等病人。将病人随机分为罗哌卡因组和布比卡因组。2 方法　术前 30ｍｉｎ常规肌注阿托品 0 5ｍｇ、苯巴比妥钠 0 1ｇ。入室后常规监测ＥＣＧ ,无创血压 (ＮＩＢＰ) ,ＨＲ ,脉搏氧饱和度 (ＳｐＯ2 )。开放静脉 ,…     

罗哌卡因用于腰麻-硬膜外联合阻滞的临床观察

目的 研究罗哌卡因用于腰麻－硬膜外联合阻滞的安全性和有效性。方法 择期行下肢或会阴部病人６０例,１８～７５岁,ＡＳＡⅠ～Ⅱ级,随机分成三组。用１％罗哌卡因,０．７５％布比卡因和１％地卡因各１ｍｌ,分别加入１０％葡萄糖１ｍｌ和３％麻黄素１ｍｌ配成重比重溶液。用ＤｕｒａｓａｆｅＴＭ型联合阻滞配套针于Ｌ３－４间隙穿刺。以０．１ｍｌ／秒的速率蛛网膜下腔给药１．５－２ｍｌ,术中酌情于硬膜外型联合阻滞配套针于     

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.     

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.     

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.