亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响

目的探讨亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响。方法回顾性分析14例供肾动脉轻度狭窄的亲属活体肾移植与50例标准亲属活体肾移植供、受者的临床资料。比较两组供者术后血清肌酐(Scr)水平。比较两组受者术后1、3、6个月的Scr水平;比较两组受者移植肾存活率及移植物功能延迟恢复(DGF)、急性排斥反应、肺部感染的发生率。结果两组供者术后Scr水平比较,差异均无统计学意义(均为P0.05)。两组术后1、3、6个月Scr水平比较,差异均无统计学意义(均为P0.05)。两组受者移植肾存活率,DGF、急性排斥反应、肺部感染的发生率比较,差异亦均无统计学意义(均为P0.05)。结论亲属活体供肾动脉轻度狭窄对肾移植受者术后肾功能和并发症的影响不大,可纳入标准供体供肾范围。     

体重指数与早期移植肾功能的关系

目的探讨体重指数(BMI)与早期移植肾功能的关系。方法回顾性研究2003年11月至2014年11月在新疆医科大学第一附属医院肾病科接受同种异体活体肾移植的133例受者的临床资料。根据移植前的BMI将受者分为3组,消瘦组(BMI18.5 kg/m2)、正常体重组(BMI18.5~23.9 kg/m2)、超重肥胖组(BMI23.9 kg/m2)。比较3组受者术后1周的实验室指标[血尿素氮(BUN)、血清肌酐(Scr)、血红蛋白、血清白蛋白、总胆固醇和甘油三酯]、移植肾功能延迟恢复发生率,并对肾移植受者Scr与BMI进行相关分析。结果 3组受者的Scr水平比较差异有统计学意义(P0.05);两两比较,超重肥胖组Scr水平高于正常体重组,差异有统计学意义(Z=-3.408,P=0.01)。3组肾移植受者血红蛋白、血清白蛋白、总胆固醇水平差异均无统计学意义(均为P0.05)。肾移植受者Scr水平与BMI呈正相关(r=0.187,P=0.031),Scr水平随BMI增加而升高。结论 BMI影响早期移植肾功能恢复,肾移植术前控制体重,有助于改善移植肾功能。     

肾移植受者术后早期外周血树突状细胞亚群的动态变化及意义

目的 分析肾移植受者手术前后外周血中树突状细胞(DC)及其亚群骨髓源性DC(mDC)和浆细胞源性DC(pDC)的动态变化,探讨其与排斥反应的关系.方法 检测28例肾移植受者术前,术后1、7和28 d外周血中白细胞总数和单个核细胞数(PBMNC);应用流式细胞术测定DC及其亚群的数量和pDC/mDC.应用酶联免疫吸附试验法测定手术前后血清白细胞介素(IL)-10和IL-12水平.15名健康志愿者作为正常对照.结果 移植组术前外周血DC总数、pDC和mDC数量均低于对照组(P＜0.05),但两组pDC/mDC的差异无统计学意义(P＞0.05).移植组受者术后第1天外周血DC数量骤然降低,然后缓慢上升,第28天恢复至手术前的73.7％;mDC和pDC术后也降低,但mDC恢复较快,pDC恢复缓慢,至术后28 d分别达到术前水平的80.1％和50.1％(P＜0.05).术后第7天,移植组发生排斥反应者mDC数量高于未发生排斥反应者(P＜0.01).受者手术前后IL-10和IL-12的水平变化不明显.结论 DC及其亚群的变化与肾移植受者免疫状态有关,其变化异常提示受者免疫状态不稳定,在受者发生急性排斥反应时,可以作为诊断的参考指标.     

持续低流量血液透析滤过在移植肾功能恢复延迟中的应用

目的 观察移植肾功能恢复延迟(DGF)的受者应用持续低流量血液透析滤过(SLEDF)治疗的效果.方法 术后发生DGF的肾移植受者33例,其中15例采用SLEDF法行肾脏替代治疗(SLEDF组),18例采用普通血液透析治疗(血透组).测定治疗前后两组肾功能,补体C3、C4,C反应蛋白(CRP),以及白细胞介素(IL)-1β、IL-6和肿瘤坏死因子α(TNF-α)的水平.结果 SLEDF组受者移植肾功能恢复时间为治疗后(29±13)d,血透组为治疗后(47±21)d.两组治疗后血肌酐和尿素氮水平均低于治疗前(P＜0.01);两组治疗后IL-1β、IL-6和TNF-α水平低于治疗前,且治疗后SLEDF组低于血透组(P＜0.05);治疗后两组补体和CRP水平有所降低,但与治疗前相比较,差异无统计学意义(P＞0.05).结论 SLEDF的杂合式肾脏替代治疗可有效降低受者体内血肌酐、尿素氮和部分细胞因子水平,有利于移植肾功能恢复,可作为DGF受者过渡期的肾脏替代治疗方法.     

高龄供者血清Klotho水平预测受者术后移植肾功能状态的临床研究

目的探讨高龄供者血清Klotho水平预测受者移植肾功能的可行性。方法选取16例高龄供者和相应27例肾移植受者的临床资料。观察肾移植受者的一般情况。检测高龄供者器官获取手术当日血清Klotho和血清肌酐(Scr)水平。检测肾移植受者术后1、3、12个月的Scr水平,计算估算肾小球滤过率(eGFR),分析供者血清Klotho水平与受者术后移植肾功能的相关性。结果肾移植术中的冷缺血时间为(649±245)min,受者移植物功能延迟恢复(DGF)发生率为26%,急性排斥反应发生率为7%。高龄供者血清Klotho水平为537(245～793)pg/m L,Scr水平为(164±62)μmol/L。受者术后1、3、12个月的Scr水平分别为(136±47)、(132±43)、(133±46)μmol/L,相应的e GFR分别为(52±20)、(52±19)、(53±21)m L/(min·1.73 m~2)。高龄供者血清Klotho水平与受者术后1个月移植肾功能呈负相关(P0.05)。血清Klotho水平预测术后1个月移植肾功能不全的灵敏度和特异度分别为0.909和0.769。结论高龄供者术前血清Klotho水平对受者术后1个月移植肾功能具有预测价值。     

抑炎因子IL-35与移植肾功能延迟恢复关系的研究

目的探讨白细胞介素(IL)-35与移植肾功能恢复情况之间的关系。方法回顾性分析45例心脏死亡器官捐献(DCD)供肾肾移植受体的临床资料。根据肾移植术后是否发生移植物功能延迟恢复(DGF),所有受体分为早期肾功能恢复良好(IGF)组(32例)和DGF组(13例)。比较肾移植术后1、2、3、7、14、28 d及术后3个月、6个月、1年各时间点两组受体的血清肌酐(Scr)和估算肾小球滤过率(e GFR)水平;比较肾移植术后1、2、3、7、14、28 d各时间点两组受体血清和尿液IL-35含量。结果 DGF组受体术后肾功能恢复迟缓,术后7 d时Scr水平高于IGF组,e GFR水平低于IGF组,差异均有统计学意义(均为P0.05)。术后1年,两组受体Scr水平的差异无统计学意义,但e GFR仍存在较大差异,与IGF组相比,DGF组受体术后1年时e GFR仍降低(P0.05)。术后1、2、3、7、14 d,DGF组血清中IL-35含量均低于IGF组,两组比较差异均有统计学意义(均为P0.05);术后28 d,与IGF组相比,DGF组血清IL-35含量反而升高,两组比较差异有统计学意义(P0.05)。术后1、2、3、7 d,DGF组尿液中IL-35含量均低于IGF组,两组比较差异均有统计学意义(均为P0.05);术后14、28 d,两组受体尿液IL-35含量进行比较,差异均无统计学意义(均为P0.05)。结论肾移植术后受体血清和尿液中IL-35含量低与DGF发生存在一定的联系,提示术后早期受体全身和移植肾局部抑炎应答过弱,过度的炎症应答得不到有效控制,可能是DGF发生的重要原因。     

心脏死亡器官捐献供肾与传统尸体供肾肾移植的疗效比较

目的 比较心死亡器官捐赠(DCD)供肾与传统尸体供肾肾移植的疗效.方法 回顾性分析单中心2007年2月至2012年6月的69例DCD供肾肾移植受者的资料,并根据受者年龄(相差10岁以内)、移植次数和免疫抑制剂应用情况,按1∶2的比例匹配同期138例传统尸体肾移植受者,进行资料比较.结果 DCD肾移植组术后移植肾功能恢复延迟(DGF)和原发性移植肾无功能(PNF)的发生率为29.0％和2.9％,而传统尸体肾移植组为13.8％和0,差异有统计学意义(P＜0.05).Kaplar-Meier分析结果表明,DCD肾移植组术后6个月、1年和3年的移植肾存活率分别为95.7％、95.7％和93.3％;而传统尸体肾移植组分别为97.8％、97.8％和96.8％,两组的差异无统计学意义(P＞0.05).两组受者存活率的差异也无统计学意义(P＞0.05).术后7和14d,DCD肾移植组的移植肾肾小球滤过率低于传统尸体肾移植组(P＜0.05),但术后1个月至1年,两组移植肾肾小球滤过率的差异无统计学意义(P＞0.05).结论 虽然术后DGF和PNF发生率较高,但DCD肾移植的长期疗效与传统尸体肾移植相当,DCD供肾可以作为替代传统尸体供肾的良好来源.     

肾移植受者术前血清sCD30水平预测术后急性排斥反应及肺部感染的研究

目的 分析肾移植受者术前可溶性CD30 (sCD30)水平与术后急性排斥反应(AR)、肺部感染以及移植肾功能丧失等临床事件的相关性,探讨利用术前sCD30水平对肾移植受者进行术前风险评估的可行性.方法 将有完整5年随访资料的586例肾移植受者纳入研究.采用酶联免疫吸附试验法检测受者术前sCD30的水平,根据sCD30水平将受者分为高水平组(sCD30＞240 U/ml)、中水平组(sCD30为120～240 U/ml)、低水平组(sCD30＜120 U/ml).比较3组间AR和肺部感染的发生率以及术后5年受者和移植肾的存活率,分析术前sCD30水平与透析时间以及术后发生AR和肺部感染间的相关性.结果 肾移植受者术前sCD30水平显著高于正常健康人群(P＜0.01).随访5年内,低水平组、中水平组和高水平组的AR发生率分别为17.4％(45/259)、29.2％(77/264)和42.9％(27/63),肺部感染发生率分别为20.8％,8.3％和15.9％,3组间AR和肺部感染发生率的两两比较,差异均有统计学意义(P＜0.01).发生AR者的术前sCD30水平为(180.0±89.1)U/ml,明显高于未发生AR者的(135.3±72.7)U/ml( P＜0.01);发生肺部感染者术前sCD30水平为(123.2±75.5) U/ml,显著低于未发生肺部感染者的(150.7±79.6)U/ml( P＜0.01).术前sCD30水平与AR的发生呈正相关(相关系数=0.242,P＜0.01),与肺部感染的发生呈负相关(相关系数=-0.147,P＜0.01).高水平组受者和移植肾5年累积存活率分别为79.4％和69.8％,明显低于低水平组的90.3％和87.3％及中水平组的91.3％和87.6％ (P＜0.05,P＜0.01),而后两组间的差异均无统计学意义(P＞0.05).结论 肾移植受者术前sCD30水平与术后AR和肺部感染的发生具有明显的相关性,可以独立预测术后AR,肺部感染事件及移植肾功能丧失的风险.     

肾移植受者血清同型半胱氨酸水平的变化

目的观察肾移植受者移植前后血清同型半胱氨酸(Hcy)水平的变化,评估其与移植物功能之间的关系。方法横断面回顾性研究选择2013年1月至2014年6月间在解放军第309医院全军器官移植研究所接受首次同种异体肾移植手术且肾功能恢复稳定33例受者为移植组,经临床检查确诊为慢性肾衰竭(CRF)的患者65例为CRF组,30名健康体检人员作为对照组。比较各组血清Hcy、血清肌酐(Scr)和血尿素氮(BUN)水平。连续监测移植组在肾移植术前及术后3、7、14、21 d的血清Hcy和Scr水平,比较肾移植前后血清Hcy水平的变化与肾功能之间的关系。结果 CRF组患者的血清Hcy水平为(25±10)μmol/L,明显高于对照组的(9±4)μmol/L和移植组稳定期的(15±9)μmol/L,移植组的血清Hcy水平亦明显高于对照组,差异均有统计学意义(均为P0.001)。CRF组、移植组和对照组的Scr水平分别为(708±302)μmol/L、(98±23)μmol/L、(72±18)μmol/L,CRF组的Scr水平明显高于移植组和对照组,差异均有统计学意义(均为P0.001)。CRF组、移植组和对照组的BUN水平分别为(18.1±5.9)mmol/L、(10.9±5.3)mmol/L、(4.9±1.3)mmol/L,CRF组的BUN水平明显高于移植组和对照组,差异均有统计学意义(均为P0.001),移植组BUN水平亦高于对照组,差异有统计学意义(P0.001)。移植组患者肾移植术后随着肾功能好转,Scr和血清Hcy水平逐渐降低,其中术后14 d血清Hcy水平降至最低(15±5)μmol/L,与术前的(25±10)μmol/L相比,差异有统计学意义(P0.05)。术后14 d内,移植组肾移植受者的血清Hcy水平与Scr水平呈正相关(r=0.761,P0.05)。结论肾移植受者的血清Hcy水平与移植肾功能相关,联合检测血清Hcy与肾功能指标对预防高Hcy血症和早期评估移植物功能有一定指导意义。     

体质指数对移植肾功能恢复的影响

目的 探讨体质指数(body mass index,BMI)对肾移植术后移植肾功能恢复的影响.方法 回顾性分析2009年5月至2015年3月在昆明医科大学第一附属医院器官移植中心行活体供肾移植术的104例受者的临床资料,根据《中国成人超重和肥胖症预防控制指南》推荐的标准,将所有符合要求的受者分为消瘦组(BMI＜ 18.5 kg/m2)、正常组(BMI 18.5～23.9 kg,/n2)、肥胖和超重组(BMI＞ 23.9 kg/m2),比较3组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年血肌酐(Cr)变化、移植肾功能延迟恢复(delayed graft function,DGF)、1年内急性排斥反应(acute rejection,AR)发生率.结果 消瘦组与正常组DGF和AR发生率差异无统计学意义(P＞0.05);肥胖和超重组DGF及AR发生率较正常组明显增高,差异有统计学意义(P＜0.05).消瘦组、正常组、肥胖和超重组移植肾术后1周、2周、3周、1个月、3个月、6个月及1年Cr变化均与BMI呈正比例关系,体型肥胖的受者Cr较体型瘦弱或正常者高,肾功能恢复慢.结论 BMI是DGF、AR的独立影响因素,肥胖和超重的受者术后发生DGF和AR风险高,Cr达到正常范围所需时间长,移植肾功能恢复慢.     

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.     

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.