美罗培南联合头孢哌／／舒巴坦与米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎临床观察

目的：观察美罗培南、头孢哌酮／舒巴坦、米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎患者临床疗效。方法：选择泛耐药鲍曼不动杆菌性呼吸机相关肺炎患者48例,应用5％GS（NS）100ml＋美罗培南2g、静脉滴注、1次／8小时、60分钟滴入,5％GS（NS）100ml＋头孢哌酮／舒巴坦3g、静脉滴注、1次／8小时、60分钟滴入,米诺环素0．1g、鼻饲、3次／日,联合治疗10～14天,观察其临床疗效、细菌清除率、肝肾功能、C反应蛋白、降钙素原、血常规和不良反应。结果：联合抗菌治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎临床治愈率62．50％,有效率81．25％,细菌清除率62．50％：治疗过程中对肝肾功能无明显影响,无明显不良反应。结论：美罗培南、头孢哌酮／舒巴坦、米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎患者效果较好。     

216株鲍曼不动杆菌的临床分布与耐药性分析

目的了解本院鲍曼不动杆菌的临床分布和耐药现状。方法应用VITEK-2鉴定系统对216株鲍曼不动杆菌进行微生物鉴定和药敏分析,采用WHONET 5.6软件对药敏结果进行分析。结果2013年1月至2013年12月共分离鲍曼不动杆菌216株,均来自住院患者,其中痰标本的分离率高达83.3%（180/216）,主要抗菌药物的药敏情况为米诺环素敏感率为90.9%,对头孢哌酮/舒巴坦、美罗培南、左氧氟沙星和复方新诺明的敏感率分别为57.1%、44.44%、59.6%和55.2%。对哌拉西林/他唑巴坦、亚胺培南、头孢吡肟、哌拉西林、庆大霉素、氨苄西林/舒巴坦、头孢他啶和环丙沙星的敏感率均低于30.0%。结论鲍曼不动杆菌的感染主要以呼吸内科与ICU最为常见,其中对米诺环素的敏感率最高。     

多重耐药鲍曼不动杆菌的临床分布特征及耐药性分析

目的动态监测多重耐药鲍曼不动杆菌分布及耐药性变迁,指导临床合理用药。方法收集2011年1月至2013年12月本院住院患者各类送检标本,采用DL-96细菌测定系统进行细菌鉴定及药敏试验。结果共分离出多重耐药鲍曼不动杆菌220株,检出率逐年上升,主要分布在ICU(35.9%)、老年病内科(16.8%)和呼吸内科(13.2%);60岁以上患者检出占76.8%;在痰液中共检出170株,占77.3%。多重耐药鲍曼不动杆菌除米诺环素的耐药率21.8%较低外,其他抗菌药物的耐药率均在60.0%以上,特别是头孢菌素的耐药率已达90.0%以上。对于多重耐药鲍曼不动杆菌的治疗临床应根据药敏结果采用两药联合或三药联合。结论制定合理有效的感染控制措施,合理使用广谱抗菌药物,避免及减少多重耐药鲍曼不动杆菌菌株医院感染的暴发流行。     

肝移植术后肺部鲍曼不动杆菌感染13例临床分析

目的探讨肝移植术后肺部鲍曼不动杆菌感染的临床特点、药物敏感情况及预后。方法分析13例鲍曼不动杆菌肺部感染受者的临床特点,其耐药情况及敏感药物,并了解患者的预后。结果在85例肝移植病例中鲍曼不动杆菌感染受者占15%。69%的术后肺部感染发生于术后1周内,症状以发热、咳嗽、咳痰为主,呼吸困难少见。体格检查以肺呼吸音减弱和干、湿啰音为主。外周血白细胞计数及中性粒细胞升高7例。药物敏感试验结果显示84%为多药耐药菌,38%为泛耐药菌,但对多黏菌素B、米诺环素和头孢哌酮钠-舒巴坦敏感。有细菌培养结果后给予敏感抗菌药物。治愈11例,2例死于呼吸衰竭或中毒性休克。结论肝移植术后肺部鲍曼不动杆菌感染的临床特点不典型,对多黏菌素、米诺环素和头孢哌酮钠-舒巴坦敏感,经及时治疗预后尚可。     

三种碳青霉烯类抗菌药物联用头孢哌酮舒巴坦对耐碳青霉烯鲍曼不动杆菌的抗菌活性分析

目的：探讨亚胺培南、美罗培南、厄他培南3种碳青霉烯类抗菌药物与头孢哌酮舒巴坦联用,对耐碳青霉烯鲍曼不动杆菌的抗菌活性。方法分别检测亚胺培南、美罗培南、厄他培南对36株耐碳青霉烯鲍曼不动杆菌的最小抑菌浓度（MIC）值,及3种抗菌药物与头孢哌酮舒巴坦联用的部分抑菌浓度（FIC）指数,计算3种碳青霉烯抗菌药物与头孢哌酮舒巴坦联用累计抑菌率曲线。结果36株泛耐药鲍曼不动杆菌,亚胺培南、美罗培南MIC50为16 mg/L,亚胺培南MIC90为64 mg/L;美罗培南MIC90为128 mg/L。厄他培南MIC50为32 mg/L,MIC90为256 mg/L。亚胺培南、美罗培南、厄他培南与头孢哌酮舒巴坦联用,FIC指数≤0.5、0.5～1、1～2和＞2者分别为1株、16株、14株、5株;1株、17株、13株和5株;0株、1株、30株和5株。三种药物与头孢哌酮舒巴坦联用后,亚胺培南累计抑菌率曲线左移,美罗培南累计抑菌率曲线改变不明显;厄他培南联用后,累计抑菌率曲线轻度右移。结论亚胺培南、美罗培南与头孢哌酮舒巴坦联用对耐碳青霉烯鲍曼不动杆菌多数呈相加或无关作用,厄他培南与头孢哌酮舒巴坦联用呈无关作用;3种碳青霉烯抗菌药物与头孢哌酮舒巴坦对部分耐碳青霉烯鲍曼不动杆菌具有拮抗作用。     

烧伤病房鲍曼不动杆菌耐药性及OXA基因型检测

目的:了解烧伤病房患者创面鲍曼不动杆菌的耐药性和OXA碳青霉烯酶基因携带情况,为预防和控制多重耐药鲍曼不动杆菌医院感染提供依据.方法:收集2013年1月—2015年12月皖南医学院第一附属医院烧伤整形外科收治2572例患者创面分泌物进行细菌培养;使用VITEK2 Compact型全自动微生物检测仪鉴定鲍曼不动杆菌,通过药敏实验检测其对18种抗菌药物的敏感性;应用聚合酶链反应(PCR)方法检测4种OXA碳青霉烯酶基因(OXA-23-like、OXA-24-like、OXA-51-like、OXA-58-like)的携带情况,并对其中10株进行OXA-23-like基因测序.结果:分离出44株鲍曼不动杆菌,对亚胺培南耐药率为79.55%(27株),对米诺环素及替加环素的耐药率较低,分别为20.45%(9株)和31.82%(14株),对庆大霉素耐药率高达100%,对其他抗菌药物也具有较高的耐药率(59.09%~97.73%).所有菌株OXA-51-like基因均为阳性,共有35株OXA-23-like基因阳性(阳性率79.55%),均未检测到OXA-24-like基因和OXA-58-like基因.结论:鲍曼不动杆菌呈多重耐药现象,对米诺环素耐药率最低,我院创面鲍曼不动杆菌主要耐药机制可能与OXA-23-like基因有关.     

亚胺培南耐药鲍曼不动杆菌分子流行病学研究

目的：从基因水平了解多重耐药鲍曼不动杆菌临床感染的流行情况,为控制其流行爆发提供实验数据.方法：收集本院亚胺培南耐药鲍曼不动杆菌29株,用琼脂稀释法测定13种常用抗菌药物对其的最低抑菌浓度（MIC）,采用细菌基因组重复序列聚合酶链反应（REP-PCR）检测上述菌株的分子流行病学特征.结果：29株鲍曼不动杆菌对头孢他啶、头孢吡肟、环丙沙星、左氧氟沙星等的耐药率分别为96.8%、100.0%、100.0%、50%.29株鲍曼不动杆菌分离自ICU、烧伤科、呼吸科3个科室,经REP-PCR检测分为A型13株、B1型7株、B2型5株、B3型4株.结论：我院在3个科室多重耐药鲍曼不动杆菌流行较严重基因分析表明在不同病房不同标本同一时间段内检测出的细菌具有高度同源性;多黏菌素对临床分离的多重耐药鲍曼不动杆菌具有很好的活性.     

综合性ICU住院患者下呼吸道鲍曼不动杆菌感染及耐药性监测

目的调查ICU住院患者下呼吸道鲍曼不动杆菌感染现状及其对临床常用抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法通过法国梅里埃VITEK-2 Compact及ATB细菌鉴定分析仪对ICU住院患者送检的痰液标本进行病原菌鉴定,并用K-B法对分离病原菌进行体外药敏试验。结果 404份痰标本共分离出病原菌385株,其中鲍曼不动杆菌占25.2%。鲍曼不动杆菌对氨苄西林和头孢唑啉100.0%耐药,对哌拉西林、复方新诺明、环丙沙星、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢曲松和氨曲南等抗菌药物的耐药率均高于80.0%,对多黏菌素的耐药率最低。在分离的鲍曼不动杆菌中,多重耐药、泛耐药及全耐药菌株分别占91.7%、29.9%和2.1%。结论鲍曼不动杆菌对常用抗菌药物耐药性严重,临床应加强病原菌的分离培养,根据药敏试验结果合理用药。     

外排泵介导鲍曼不动杆菌多重耐药及其治疗方案研究

目的探讨鲍曼不动杆菌(AB)多重耐药与外排泵相关性,及多重耐药鲍曼不动杆菌(MDRAB)感染的治疗方案。方法收集2011年6月至2012年6月武汉大学人民医院ICU分离鉴定出的AB共116株,进行体外药敏试验,采用PCR方法检测外排泵基因,肉汤倍比稀释法检测最低抑菌浓度(MIC)。结果所收集的116株AB,对β-内酰胺类抗菌药物耐药率较高,特别是头孢噻肟及哌拉西林,高达90%以上;对米诺环素及头胞哌酮舒巴坦耐药率较低,MDRAB检出率达84.48%(98/116);adeB基因总检出率为92.24%(107/116),abeM基因总检出率为88.79%(103/116),adeG基因总检出率为92.24%(107/116),tetB基因总检出率为61.21%(71/116),adeE基因总检出率为0.86%(1/116);MDRAB菌株中adeB、abeM、adeG及tetB外排基因检出率均高于non-MDRAB菌株;SCF、MH单用MIC与联合使用MIC比较,单用均显著高于联用,SCF、MH分别与碳酰氰基-对-氯苯腙(CCCP)联用MIC显著低于SCF与MH联用时的MIC。结论 AB耐药及多重耐药十分严重,外排泵基因adeB、abeM、adeG、tetB是介导AB多重耐药的机制之一,MH与SCF联合应用具有协同和相加作用,外排泵抑制剂与抗菌药物联合可降低抗菌药物的MIC及用量,恢复其敏感性。     

骨科患者伤口感染病原菌的分布及耐药性

目的 分析骨科患者伤口感染病原菌的分布及对抗菌药物的耐药性.方法 连续收集2010年7月至2012年6月河北医科大学第三医院骨科999例住院患者伤口分离出的病原菌,进行菌株鉴定,并采用纸片扩散法进行药敏试验.采用双向纸片法确证超广谱β-内酰胺酶(ESBLs)检测,耐甲氧西林金黄色葡萄球菌(MRSA)检测以头孢西丁纸片法判定.采用WHONET 5.4软件作耐药率统计.结果 999例患者的感染伤口中共分离出无重复病原菌1056株,其中革兰阴性菌739株(69.98％),革兰阳性菌304株(28.79％),真菌13株(1.23％).主要病原菌依次为金黄色葡萄球菌(265株,25.09％),铜绿假单胞菌(245株,23.20％),鲍曼不动杆菌(199株,18.84％)和大肠埃希菌(86株,8.14％)等.革兰阴性菌中,铜绿假单胞菌对头孢哌酮/舒巴坦、环丙沙星、左氧氟沙星和哌拉西林/他唑巴坦的耐药率较低,分别为13.58％,21.25％,21.67％和22.45％,但对复方磺胺甲(口恶)唑的耐药率较高,为98.04％.鲍曼不动杆菌除对头孢哌酮/舒巴坦的耐药率为14.29％外,对其他抗菌药物的耐药率均较高,其泛耐药菌株的检出率为5.53％(11/199).肠杆菌科细菌对亚胺培南和美罗培南全部敏感,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星的敏感性亦较高,耐药率介于1.16％～28.12％.大肠埃希菌和肺炎克雷伯菌中产ESBLs菌株的检出率分别为48.84％ (42/86)和34.38％(11/32).革兰阳性菌中,金黄色葡萄球菌对万古霉素、替考拉宁和利奈唑胺均敏感,但对氨苄西林、青霉素G和红霉素的耐药率很高,分别为100.00％,99.25％和80.06％；MRSA的检出率为41.51％(110/265).肠球菌对红霉素、利福平、左氧氟沙星、高浓度庆大霉素、米诺环素和呋喃妥因的耐药率较高,对替考拉宁和利奈唑胺全部敏感,万古霉素中介株的检出率为4.55％ (1/22).结论 骨科患者伤口感染病原菌种类复杂,以金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、阴沟肠杆菌等为主,且多为多重耐药菌株.     

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.     

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.     

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.