超声引导下高位髂筋膜阻滞在经导管主动脉瓣置换术中的应用

目的 探索超声引导下高位髂筋膜阻滞用于经导管主动脉置换术的效果。
方法 收集2016年12月至2020年12月监测麻醉下行经导管主动脉置换术患者资料126例,男85例,女41例,年龄65～90岁,BMI 22～25 kg/m²,ASA Ⅲ或Ⅳ,术前诊断为主动脉瓣重度狭窄,NYHA Ⅲ或Ⅳ级且首次经历心脏手术。按照术中是否进行高位髂筋膜阻滞分为两组：对照组（C组,n=56）和联合组（T组,n=70）。C组仅采用监测麻醉,T组采用监测麻醉联合高位髂筋膜阻滞。采用卡钳法进行倾向值匹配。收集并记录性别、年龄、BMI、ASA分级、主动脉瓣口面积、主动脉瓣平均跨瓣压、合并症（冠心病、高血压、糖尿病）。记录手术时间、术中丙泊酚和舒芬太尼用量、术后补救镇痛情况、苏醒时间、ICU停留时间、术后住院时间、术后30 d死亡例数。记录术中呼吸抑制、术后恶心呕吐、谵妄/脑卒中的发生情况。
结果 44对患者资料匹配成功。匹配后,与C组比较,T组术中丙泊酚和舒芬太尼用量明显减少（P<0.05）,术后补救镇痛率明显降低（P<0.05）,术后苏醒时间、ICU停留时间和术后住院时间明显缩短（P<0.05）,术中呼吸抑制发生率和术后恶心呕吐发生率明显降低（P<0.05）。两组其余指标差异均无统计学意义。
结论 超声引导下高位髂筋膜阻滞用于经导管主动脉置换术可减少术中麻醉药物用量,缩短苏醒时间和ICU停留时间,减少术后补救镇痛和不良反应的发生,有助于早期康复。     

超声引导下不同入路髂筋膜间隙阻滞用于老年患者股骨近端防旋髓内针内固定术围术期镇痛效果的比较

目的 比较超声引导下腹股沟韧带上髂筋膜间隙阻滞（S-FICB）与腹股沟韧带下髂筋膜间隙阻滞（I-FICB）在行股骨近端防旋髓内针内固定术老年患者围术期的镇痛作用。
方法 限期行股骨近端防旋髓内针内固定术的股骨粗隆间骨折患者80例,男43例,女37例,年龄65～85岁,ASA Ⅰ—Ⅲ级,随机分为两组：S-FICB组（S组）和I-FICB组（I组）,每组40例。S组和I组分别注射0.4%罗哌卡因40 ml行S-FICB和I-FICB。记录阻滞操作时间、股神经及股外侧皮神经阻滞起效时间及阻滞效果。记录术后2、6、12、24、48 h静息及运动时VAS疼痛评分、自控镇痛按压次数及补救镇痛情况。记录术后不良反应的发生情况。
结果 两组阻滞操作时间、股神经阻滞效果差异无统计学意义。S组股神经及股外侧皮神经阻滞起效时间明显短于I组（P<0.05）,股外侧皮神经阻滞效果明显优于I组（P<0.05）。S组术后2、6、12 h运动时VAS疼痛评分明显低于I组（P<0.05）。两组术后自控镇痛、补救镇痛及不良反应发生率差异无统计学意义。
结论 与I-FICB比较,S-FICB阻滞起效更快,股外侧皮神经阻滞效果更好,患者术后变换体位时镇痛效果更好。     

右美托咪定滴鼻联合髂筋膜间隙阻滞在老年髋部骨折患者围术期的应用效果

目的 探讨右美托咪定滴鼻联合髂筋膜间隙阻滞在老年髋部骨折患者围术期的应用效果。方法 选择择期行腰-硬联合麻醉下髋部骨折手术的老年患者59例,男14例,女45例,年龄≥65岁,BMI 14.1～30.3 kg/m²,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组：右美托咪定滴鼻联合髂筋膜间隙阻滞组(D组,n=29)和髂筋膜间隙阻滞组(F组,n=30)。术前1 d晚间D组给予右美托咪定滴鼻后在超声引导下行患侧髂筋膜间隙阻滞,F组仅在超声引导下行患侧髂筋膜间隙阻滞。记录右美托咪定滴鼻前(T₁)、髂筋膜间隙阻滞后1 h(T₂)、过转运床即刻(T₃)、过手术床即刻(T₄)、摆体位时(T₅)的HR、MAP、SpO₂和疼痛数字评价量表(NRS)评分。记录术前1 d、手术当日及术后1、2 d的汉密尔顿焦虑(HAM-A)评分和里兹睡眠问卷(LSEQ)评分。记录术后7 d内谵妄发生情况及术后住院时间。记录低血压、心动过缓以及术后48 h内恶心呕吐、头晕、...     

超声引导下腹股沟韧带上髂筋膜阻滞对老年患者股骨转子间骨折闭合复位预后的影响

目的 评价超声引导下腹股沟韧带上髂筋膜阻滞对老年股骨转子间骨折闭合复位预后的影响。
方法 选取2018年1月至2020年1月择期行股骨转子间骨折闭合复位手术患者50例,男42例,女8例,年龄78～91岁,BMI 18～25 kg/m²,ASA Ⅱ或Ⅲ级,采用随机数字表法分为两组：全身麻醉联合髂筋膜阻滞组（T组）和全身麻醉组（G组）,每组25例。T组患者在实施全身麻醉前20 min行超声引导下髂筋膜阻滞,于患侧腹股沟韧带上确定好髂筋膜位置,采用平面内操作技术于髂筋膜下给予0.25%罗哌卡因+0.67%利多卡因共30 ml,10～15 min后测定阻滞平面。G组仅接受全身麻醉。术后两组均行PCIA,配方：舒芬太尼150 μg+昂丹司琼24 mg+生理盐水稀释至100 ml,背景剂量2 ml/h,单次剂量0.5 ml,锁定时间15 min。采用VAS评分法评估疼痛程度,VAS疼痛评分≥4分时静脉注射羟考酮0.05 mg/kg行补救镇痛。记录麻醉诱导前（T0）、髓内针固定时（T1）、手术结束即刻（T2）、术后6 h（T3）动脉血乳酸（Lac）和血糖（Glu）浓度。记录手术时间、术中丙泊酚、瑞芬太尼用量、晶体液输入量、胶体液输入量、输液总量、出血量、尿量和去甲肾上腺素使用例数。记录术后6、8、12、24 h静息和运动时VAS疼痛评分,术后24 h内舒芬太尼用量及羟考酮使用例数。记录PACU停留时间、术后住院时间以及恶心呕吐、皮肤瘙痒、肺部炎症、阻滞部位感染等并发症情况。
结果 与G组比较,T1—T3时T组动脉血Lac、Glu浓度明显降低（P<0.05）;T组术中去甲肾上腺素使用率明显降低,术中瑞芬太尼用量、术后24 h内舒芬太尼用量明显减少,羟考酮使用率明显降低（P<0.05）;术后6、8、12 h T组静息及运动时VAS疼痛评分明显降低（P<0.05）;T组PACU停留时间、术后住院时间明显缩短,术后恶心呕吐发生率明显降低（P＜0.05）。两组术中丙泊酚用量、晶体液输入量、胶体液输入量、输液总量、出血量和尿量差异无统计学意义。两组术后皮肤瘙痒、肺部炎症、穿刺部位感染情况差异无统计学意义。
结论 与单独全身麻醉比较,联合超声引导下腹股沟韧带上髂筋膜阻滞降低应激水平,镇痛效果好,减少术后并发症,有助于促进患者术后康复,缩短住院时间。     

经皮穴位电刺激对睡眠障碍老年患者全髋关节置换术后疲劳及谵妄的影响

目的 观察经皮穴位电刺激(TEAS)对睡眠障碍老年患者全髋关节置换术(THA)后疲劳及谵妄的影响。
方法 选择 2020年5—12月择期行单侧THA且术前匹兹堡睡眠质量指数(PSQI)>5分的老年患者100例,男56例,女44例,年龄65～80岁,BMI 19～28 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法分为两组：经皮穴位电刺激组(TEAS组)和非电刺激组(NS组),每组50例。两组均采用超声引导下髂筋膜阻滞联合蛛网膜下隙阻滞,TEAS组在麻醉开始后30 min及术后1、2、3 d的8:00 PM于印堂穴、双侧合谷穴和内关穴行TEAS;NS组不予以电刺激。记录术前1 d、出院当日和术后1个月PSQI评分。记录术前1 d和术后1、2、3、4 d睡眠评分、快动眼（REM）睡眠比例和觉醒次数。记录术前1 d和术后1、3、5 d Christensen疲劳评分,术后1、3、5 d采用意识模糊评估法（CAM）评估谵妄,并于术前1 d和术后1、3、5 d 检测C反应蛋白(CRP)浓度。记录术前1 d和术后1、2、3 d VAS疼痛评分、镇痛泵按压次数、首次下床活动时间、恶心呕吐的发生情况。
结果 出院当日和术后1个月TEAS组PSQI总分明显低于NS组（P＜0.05）。术后1、2、3、4 d TEAS组睡眠评分、REM睡眠比例明显高于NS组,睡眠觉醒次数明显少于NS组（P＜0.05）。术后1、3、5 d TEAS组CAM谵妄评分和CRP浓度明显低于NS组（P＜0.05）。术后3、5 d TEAS组Christensen疲劳评分明显低于NS组（P＜0.05）。两组不同时点VAS疼痛评分差异无统计学意义。两组镇痛泵按压次数和首次下床活动时间差异无统计学意义。两组均未发生恶心呕吐等不良反应。
结论 围术期经皮穴位电刺激可明显改善睡眠障碍老年患者全髋关节置换术后疲劳状态和谵妄的发生,可能与改善术后睡眠状态、降低术后炎症反应有关。     

超声引导下髂筋膜间隙阻滞在老年患者全髋关节置换术中的应用

目的 探讨术前行超声引导下髂筋膜间隙阻滞在老年患者全髋关节置换术中的应用效果。
方法 回顾性分析择期在全身麻醉下行全髋关节置换术的老年患者98例,男40例,女58例,年龄≥65岁,BMI 16～28 kg/m²,ASA Ⅱ或Ⅲ级。根据术前是否行髂筋膜间隙阻滞分为两组：髂筋膜间隙阻滞组（F组,n=43）和对照组（C组,n=55）。根据性别、年龄、BMI、ASA分级、基础疾病、手术方式进行倾向评分匹配。收集手术时间、麻醉时间、术中出血量、术中舒芬太尼和瑞芬太尼用量、术后2、6、12、24、48 h静息和活动时NRS评分、首次下床活动时间、住院时间、术后48 h镇痛满意度评分、术后48 h内患者自控静脉镇痛（PCIA）有效按压次数以及术后48 h内PCIA舒芬太尼用量。记录术后输血、入ICU以及相关不良反应（包括肺部感染、尿路感染、心律失常、术后恶心呕吐、尿潴留、瘙痒、呼吸抑制、嗜睡）的发生情况。
结果 匹配后F组和C组各纳入患者43例。F组术中舒芬太尼和瑞芬太尼用量明显少于C组（P＜0.05）。F组术后2、6 h静息时NRS评分以及术后2、6、12、24、48 h活动时NRS评分明显低于C组（P＜0.05）。F组首次下床活动时间、住院时间明显短于C组（P＜0.05）,F组术后48 h镇痛满意度评分明显高于C组（P＜0.05）,F组术后48 h内PCIA有效按压次数以及PCIA舒芬太尼用量明显少于C组（P＜0.05）。F组术后恶心呕吐及尿潴留的发生率明显低于C组（P＜0.05）。两组手术时间、麻醉时间、术中出血量、术后12、24、48 h静息时NRS评分、术后输血、入ICU以及肺部感染、尿路感染、心律失常、术后瘙痒、嗜睡发生率差异均无统计学意义。
结论 术前行超声引导下髂筋膜间隙阻滞能为老年患者全髋关节置换术后提供良好镇痛,减少镇痛药物的使用,提高镇痛满意度,同时促进患者术后早期恢复。     

不同层面腰方肌阻滞对剖宫产产妇术后镇痛的影响

目的 探讨超声引导下前层胸腰筋膜下和前层胸腰筋膜外实施腰方肌阻滞（QLB）对剖宫产术后镇痛的影响。
方法 选择择期腰-硬联合麻醉下行剖宫产手术的产妇113例,年龄23～39岁,体重50～90 kg,ASA Ⅰ或Ⅱ级,孕期>37周。采用随机数字表法将产妇分为两组：前层胸腰筋膜下阻滞组（S组,n=57）和前层胸腰筋膜外阻滞组（E组,n=56）。所有产妇腰-硬联合麻醉用药相同,术毕连接患者自控静脉镇痛（PCIA）泵,S组术毕行超声引导下前层胸腰筋膜下阻滞,E组行超声引导下前层胸腰筋膜外阻滞。记录首次按压PCIA时间,术后24 h内PCIA有效按压次数以及布托啡诺用量。记录QLB实施后6、9、12、24、48 h静息和活动时VAS疼痛评分、BCS舒适度评分以及阻滞平面存在情况。记录头晕、恶心呕吐、肌力减退等不良反应发生情况。
结果 两组首次按压PCIA时间差异无统计学意义。S组术后24 h内PCIA有效按压次数、布托啡诺用量明显少于E组（P＜0.05）。QLB阻滞实施后不同时点静息和活动时VAS疼痛评分、BCS舒适度评分差异均无统计学意义。S组QLB实施后24 h阻滞平面存在的产妇比例明显高于E组（P＜0.05）。S组头晕发生率明显低于E组（P＜0.05）。
结论 超声引导下前层胸腰筋膜下实施腰方肌阻滞应用于剖宫产术后镇痛效果好,不良反应少,是剖宫产术后镇痛更适宜的阻滞层面。     

不同方式超声引导连续髂筋膜阻滞在髋关节置换术后镇痛效果

目的 对两种不同方式超声引导连续髂筋膜间隙阻滞在髋关节置换术后镇痛效果进行评价。方法 采用前瞻性随机对照研究,纳入新疆医科大学第六附属医院于2016年3月至2017年10月收治的腰-硬联合阻滞麻醉下人工全髋关节置换术（total hip arthroplasty, THA）术后病人60例,男29例,女31例,年龄为65~83岁,平均（66.78±9.32）岁。按照数字随机法分为：①腹股沟韧带上髂筋膜阻滞组（上髂筋膜组）30例,男17例,女13例,年龄为65~84岁,平均（66.13±9.16）岁;②腹股沟韧带下髂筋膜阻滞组（下髂筋膜组）30例,男12例,女18例,年龄为65~82岁,平均（65.80±8.13）岁。在超声引导下行髂筋膜连续神经阻滞后镇痛,设置两组镇痛泵的局部麻醉药物均为0.2%的罗哌卡因200 ml,负荷量20 ml,置管成功后注入,背景量为0。病人自控镇痛（patient controlled analgesia, PCA）10 ml/次,锁定时间为1 h。对病人的静息疼痛、持续性被动疼痛和主观性疼痛等疼痛视觉模拟量表（visual analogue scale, VAS）评分进行记录,对病人的阻滞效果、曲马多用量以及病人满意度进行评价。结果 上髂筋膜组的手术时间为（70.4±12.1） min,下髂筋膜组为（70.8±10.3） min,两组比较差异无统计学意义（P＞0.05）。在静息状态、主被动VAS评分方面,上髂筋膜组均优于下髂筋膜组;上髂筋膜组病人阻滞后各时间点股外侧皮神经支配区的感觉阻滞程度和曲马多使用量优于下髂筋膜组,以上指标比较,两组差异均有统计学意义（均P＜0.05）。两组病人阻滞后各时间点股神经阻滞率和术后镇痛满意度比较,差异均无统计学意义（均P＞0.05）。结论 THA术后采用超声引导下浓度为0.2%罗哌卡因,在THA术后镇痛效果上,腹股沟韧带上连续髂筋膜阻滞明显优于腹股沟韧带下连续髂筋膜神经阻滞。     

超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者围术期镇痛的研究

目的:研究超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期疼痛控制及术后并发症的影响。方法:选择2021年1月至2021年9月收治的老年髋部骨折手术患者127例,按照镇痛方法不同分为连续髂筋膜间隙阻滞组(F组)和静脉镇痛对照组(C组)。其中F组62例,男19例,女43例;年龄66~95(82.4±7.2)岁;股骨颈骨折25例,股骨转子间骨折37例。C组65例,男18例,女47例;年龄65~94(81.4±8.7)岁;股骨颈骨折29例,股骨转子间骨折36例。观察两组患者围术期不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS)、简易精神状态评价量表(minimental state examination,MMSE)评分、警觉-镇静评分(observer''s assessment of alertness/sedation,OAA/S)、改良Bromage评分、术后并发症及患者住院期间情况。结果:F组实施阻滞后30 min、麻醉摆放体位时,术后6、24、48 h的静息及运动VAS低于C组(P<0.05)。F组术前12 h,术后1、3 d的MMSE评分及术后3 d的OAA/S评分高于C组(P<0.05)。F组不良反应发生率、需要额外镇痛人数低于C组(P<0.05)。F组围术期镇痛满意度及住院时间均优于C组(P<0.05)。两组患者在各时间点患肢Bromage评分及术后30 d死亡率比较,差异无统计学意义(P>0.05)。结论:超声引导下连续髂筋膜间隙阻滞可为老年髋部骨折患者提供安全、有效的围术期镇痛效果,改善术后认知功能,减少术后并发症,从而缩短住院时间,提高住院期间生活质量。     

超声引导下腹横筋膜平面阻滞与腹横肌平面阻滞在剖宫产术后镇痛中的效果比较

目的 比较超声引导下腹横筋膜平面(TFP)阻滞与腹横肌平面(TAP)阻滞在剖宫产术后镇痛中的效果。
方法 择期蛛网膜下腔阻滞下行剖宫产术产妇60例,年龄20～35岁,体重50～75 kg,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组：腹横筋膜平面阻滞组（TFP组）和腹横肌平面阻滞组（TAP组）,每组29例。术毕TFP组行超声引导下双侧腹横筋膜平面阻滞,TAP组行超声引导下双侧腹横肌平面阻滞,两组均每侧注射0.375%罗哌卡因1.25 mg/kg。术后均行曲马多PCIA,若VAS疼痛评分≥4分,肌肉注射曲马多100 mg行补救镇痛。记录术后6、12、24、36、48 h PCIA中曲马多累积用量;记录术后48 h内曲马多补救镇痛情况;记录镇痛期间恶心呕吐、局麻药中毒、呼吸抑制、穿刺部位血肿、穿刺部位感染、腹膜刺穿造成腹腔内注射等不良反应的发生情况。
结果 与TAP组比较,TFP组术后6、12、24、36、48 h PCIA中曲马多累积用量明显减少 （P＜0.05）,术后48 h内曲马多补救镇痛率明显降低 （P＜0.05）。两组镇痛期间恶心呕吐发生率差异统计学意义。两组均无其他不良反应发生。
结论 与超声引导下腹横肌平面阻滞比较,腹横筋膜平面阻滞可减少剖宫产术后阿片类药物用量,镇痛效果更佳。     

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.