17555名青少年脊柱侧凸普查分析

目的分析17555名青少年脊柱侧凸普查结果。方法应用脊柱侧凸两检法(体检、X线照片),对贵州省六盘水市中心城区9~16岁共计17555名学生普查,体检阳性者行脊柱全长正侧位X线片,采用Cobb法测量,Cobb角≥10°确诊为脊柱侧凸。结果Cobb角≥10°的有184人,阳性率为10.5‰~14.3‰,其中先天性半椎体、脊椎分节不良、脊椎裂8例占4.35%^,特发性脊柱侧凸占95.11%,男女患病比例为1∶1.45。结论在学校进行广泛普查、早期发现、及时治疗是减少手术病例、消灭严重脊柱侧凸畸形的有效方法。     

西安市青少年脊柱侧凸患病率调查及其防治

目的:调查西安市儿童脊柱侧凸的患病率,为脊柱侧凸的防治及建立陕西省脊柱侧凸监控中心提供依据。方法:分别于2002年4～5月、2003年4～5月对西安市城乡25725名7～15岁的中、小学生进行脊柱侧凸普查,采用“三检筛选”普查方法,即体检、波纹照像(Moiretomography)和X线摄片,统计患病率情况并对脊柱侧凸患者进行相应的处理。结果:体检阳性者1389例,男性702例,女性687例;波纹照像阳性者607例,男性295例,女性312例;X线摄片Cobb角≥10°者343例,患病率为1.33%(343/25725)。对10例Cobb角>40°者进行了手术治疗。结论:通过普查,可以早发现、早诊断青少年脊柱侧凸,以便及时防治。     

中华长城内固定器械治疗青少年脊柱侧凸

目的 :观察中华长城器械治疗小儿脊柱侧凸的疗效。方法 :应用中华长城内固定器械矫正青少年脊柱侧凸45例 ,通过比较术前术后的Coob角、顶椎移位、顶椎旋转及身高的变化进行疗效评价。结果 :术前Coob角平均64°,术后平均 2 7°。顶椎移位术前平均 2 1 7cm ,术后平均 1 54cm。身高平均增加 6cm。所有患儿在术后 1年均获得满意的脊柱融合 ,并保留一定的脊柱活动度 ,术后并发症较少。结论 :中华长城内固定器械对矫正脊柱Coob角40°～ 70°脊柱侧凸疗效满意 ,有较好的稳定性     

北京市中小学生脊柱侧凸患病率调查报告

目的:了解北京市中小学生脊柱侧凸的患病率。方法:2005年3月～2006年1月对北京市12个区县、73所医疗卫生监控点学校的57581名中小学生进行了脊柱侧凸普查,首先由学校校医或疾病控制中心的体检医师在学校对学生进行初步体格检查,再由骨科医师对阳性或可疑阳性者进行复查;对医师检查阳性或可疑阳性者到医院行X线摄片检查。结果:共检出脊柱侧凸患者64例(Cobb角≥10°),患病率为0.11%。其中特发性脊柱侧凸59例,占92.19%,女性52例,男性7例,女性患病率显著高于男性(χ2=36.147,P<0.001);先天性脊柱侧凸4例,神经肌肉源性脊柱侧凸1例。结论:北京市中小学生脊柱侧凸的患病率为0.11%,女性患病率明显高于男性。对青少年进行脊柱侧凸普查可以早期发现、及时矫治,对防治脊柱侧凸具有积极意义。     

哈尔滨市青少年脊柱侧凸普查与支具治疗结果分析

[目的]调查哈尔滨市青少年脊柱侧凸的患病率及类型,分析支具治疗的临床效果。[方法]于2005年10月～2009年10月对哈尔滨市城乡32所中、小学校6～16岁的24 362名中、小学生进行脊柱侧凸普查,统计患病率情况。根据特发性脊柱侧凸患者Cobb角大小不同,给予热塑支具治疗(Cobb角20°～40°)。每6个月复查1次,摄站立位全脊柱正侧位X线片,分析治疗结果。[结果]第一检结果阳性1 240名(5.09%),第二检阳性518名(2.13%),其中497名进行第三检,全脊柱正侧位X线片示Cobb角≥10°者423名,患病率为1.74%。特发性脊柱侧凸116例(Cobb角20°～40°)进行热塑支具治疗,支具治疗病例平均随访38个月,84例(72.4%)治疗有效,32例(27.6%)出现脊柱侧凸进展,治疗无效。Cobb角20°～30°组的矫正效果优于Cobb角30°～40°组,两组比较有显著差异(P<0.05)。[结论]通过普查,可以早发现、早诊断青少年脊柱侧凸,以便及时选择适当的方法进行治疗。热塑矫形支具治疗青少年特发性脊柱侧凸能够取得较好疗效,侧凸柔软性好,Cobb角较小,则矫正效果好。     

黑龙江省青少年脊柱侧凸普查分析

[目的]调查黑龙江省青少年脊柱侧凸的患病率.[方法]于2007年4月～2009年5月对黑龙江省城乡28所中、小学校7～15岁的17 525名中、小学生进行脊柱侧凸普查,其中男9 017名,女8 508名.采用"三检筛选"普查方法,即体检、波纹照像和X线摄片,统计患病率情况并对脊柱侧凸患者进行相应的处理.[结果]第1检结果阳性911名(5.20%),其中男448名(占男性总人数的4.92%),女463名(占女性总人数的5.44%).第2检阳性413名(2.36%),男181名(占男性总人数的2.00%),女232名(占女性总人数的2.73%).其中387名进行第3检,摄全脊柱正侧位X线片Cobb's角≥10°者335名,患病率为1.9l%,男147名(占男性总人数的1.63%),女188名(占女性总人数的2.21%).[结论]通过普查,可以早发现、早诊断青少年脊柱侧凸,以便及时防治.     

青少年脊柱侧凸合并腰椎滑脱的术式选择

目的 :探讨青少年脊柱侧凸合并腰椎滑脱患者手术治疗方式的选择,观察脊柱侧凸及滑脱程度的转归。方法:对2002年5月~2011年1月收治的有完整影像学资料的9例青少年脊柱侧凸合并腰椎滑脱的患者进行回顾性分析。年龄10~18岁,平均14.4±2.7岁。功能性脊柱侧凸3例,特发性脊柱侧凸6例;发育性腰椎滑脱3例,峡部裂性腰椎滑脱6例。滑脱节段均为L5/S1,Ⅰ度滑脱4例,Ⅱ度滑脱2例,Ⅲ度滑脱2例,Ⅳ度滑脱1例。3例(1、3、4号)功能性侧凸患儿均行腰椎滑脱后路复位内固定植骨融合术。1例(2号)特发性脊柱胸腰双弯患儿侧凸Cobb角未达到手术干预标准,行单一腰椎滑脱后路复位内固定植骨融合术;2例(5、6号)无滑脱症状的特发性脊柱侧凸患儿行脊柱侧凸后路矫形内固定植骨融合术;3例(7~9号)伴腰椎滑脱症状者同时行后路滑脱复位与脊柱侧凸矫形联合手术。测量患者术前、术后、末次随访时的Cobb角及滑脱相关参数。结果:仅行单一腰椎滑脱后路复位内固定植骨融合术的4例患儿末次随访时的侧凸主弯Cobb角改善率分别为58.1%、11.5%、57.9%、36.7%,滑脱百分比改善率分别为61.3%、76.9%、59.7%、27.3%;2例仅行脊柱侧凸后路矫形内固定植骨融合术患儿的侧凸主弯Cobb角改善率分别为81.8%及68.6%,滑脱百分比改善率分别为71.8%及25.0%;3例同时行腰椎滑脱后路复位和脊柱侧凸矫形内固定植骨融合术患儿末次随访时Cobb角改善率分别为86.2%、75.6%、72.9%,滑脱百分比改善率分别为31.8%、50.0%、67.7%。7例患儿术前有不同程度的腰痛症状,1~4号患儿ODI评分为26.0(21.0~31.0)分,7~9号为23.0(15.0~29.0)分,末次随访时分别为7.0(5.0~10.0)分和6.0(5.0~8.0)分。9例患儿在术后及随访过程中均未出现并发症。结论:对青少年脊柱侧凸合并腰椎滑脱患儿应根据侧凸类型及腰椎滑脱程度选择手术方式,侧凸Cobb角大于40°伴腰椎滑脱所致腰痛症状时,应同时行脊柱侧凸矫形术和腰椎滑脱复位术;若仅满足腰椎滑脱复位内固定或者仅满足脊柱侧凸矫形的手术干预要求,可考虑行单一后路行腰椎滑脱复位内固定术或单一后路脊柱侧凸矫形手术。     

自制栅格推动脊柱侧凸云纹照相学校普查的体会

[目的]探索一种适用于县级医院推广的最简便的脊柱侧凸普查方法。[方法]用自制的栅格,对11¹6岁学生作脊柱侧凸云纹照相学校普查,异常者行脊柱X线检查,发现Cobb角20°以上需防控的患者。[结果]2009年9月16岁学生作脊柱侧凸云纹照相学校普查,异常者行脊柱X线检查,发现Cobb角20°以上需防控的患者。[结果]2009年9月²013年4月,在78 323初中生脊柱侧凸普查中,发现1 179名云纹照相异常,其中,按照自费、自愿的原则,576名学生接受脊柱X线检查,发现337名脊柱侧凸患者,Cobb角10°2013年4月,在78 323初中生脊柱侧凸普查中,发现1 179名云纹照相异常,其中,按照自费、自愿的原则,576名学生接受脊柱X线检查,发现337名脊柱侧凸患者,Cobb角10°¹9°者232例,Cobb角20°19°者232例,Cobb角20°³9°者102例,Cobb角≥40°3例。在41 004小学生中,仅发现21名云纹照相异常,Cobb角10°39°者102例,Cobb角≥40°3例。在41 004小学生中,仅发现21名云纹照相异常,Cobb角10°¹9°者3例,Cobb角20°19°者3例,Cobb角20°³9°者6例,Cobb角≥40°2例。[结论]接受慈善基金赞助,在1139°者6例,Cobb角≥40°2例。[结论]接受慈善基金赞助,在11¹6岁中小学生中,用自制的栅格云纹照相作学校筛查,是适用于基层推广的脊柱侧凸普查方法。     

青少年发育不良性腰椎滑脱症合并脊柱侧凸的临床分析

目的:对青少年发育不良性腰椎滑脱症患者合并脊柱侧凸的情况进行调查并对侧凸情况做术后随访。方法:回顾性分析2007年3月~2017年10月于我院行滑脱复位固定融合手术治疗的28例青少年发育不良性腰椎滑脱症患者,滑脱节段均为L5,依据Meyerding滑脱分度将其分为重度滑脱(Ⅲ、Ⅳ、Ⅴ度)组与轻度滑脱(Ⅰ、Ⅱ度)组。以术前全脊柱正侧位X线片评估两组患者有无脊柱侧凸(Cobb角≥10°诊断为脊柱侧凸)、滑脱情况(滑脱程度、Dubousset腰骶角)以及脊柱-骨盆矢状位参数(骨盆入射角、骶骨倾斜角、骨盆倾斜角)。青少年腰椎滑脱合并的脊柱侧凸分为特发性侧凸和痉挛/疼痛性侧凸两大类,其中痉挛/疼痛性侧凸又分为单纯痉挛性侧凸和"滑脱性"侧凸两种,"滑脱性"侧凸主要由滑脱椎体的旋转造成。对有侧凸的患者测量其末次随访时的侧凸角度以了解侧凸改善情况。结果:发育不良性重度腰椎滑脱15例,年龄12.5±2.6岁,男2例,女13例;轻度滑脱者13例,年龄14.5±2.6岁,男6例,女7例,两组年龄、性别比例及各脊柱-骨盆矢状位参数均无统计学差异(P0.05)。重度滑脱组的Dubousset腰骶角明显小于轻度滑脱组(55.6°±17.0°vs.83.3°±18.4°,P0.05)。28例患者中合并脊柱侧凸者14例,其中重度滑脱组合并脊柱侧凸13例,轻度滑脱组中仅1例符合脊柱侧凸诊断,两组合并侧凸比例有统计学差异(86.7%vs.7.7%,P0.001)。重度滑脱患者术前冠状位平均Cobb角明显大于轻度滑脱患者(18.1°±13.0°vs.4.6°±3.7°,P=0.001)。重度滑脱组中脊柱侧凸的构成情况:特发性侧凸5例,Cobb角11.6°~52.6°,平均30.2°±17.0°;痉挛/疼痛性侧凸8例,其中单纯痉挛性侧凸4例(Cobb角12.5°~17.5°,平均14.8°±2.1°),"滑脱性"侧凸4例(Cobb角11.2°~12.6°,平均11.9°±0.6°)。对13例重度滑脱伴侧凸患者进行术后随访,其中12例获得随访,随访时间为1~100个月(23.8±28.7个月),末次随访时单纯痉挛性侧凸的平均矫正率为92%,特发性脊柱侧凸的平均矫正率为7.5%,"滑脱性"脊柱侧凸的平均矫正率为4%。结论:青少年发育不良性腰椎滑脱症患者中,重度滑脱患者合并脊柱侧凸的比例高于轻度滑脱者,发育不良性重度腰椎滑脱与脊柱侧凸可能具有相关性,其中单纯痉挛性侧凸在滑脱复位固定融合术后可大部分自发矫正。     

胸椎椎弓根螺钉固定矫治青少年脊柱侧凸

目的 :探讨青少年胸椎椎弓根螺钉的固定方法及注意事项。方法 :测量 2 0例正常青少年胸椎椎弓根影像学参数 ,并在此基础上采用自行设计的胸椎椎弓根螺钉固定器械 (Scofix器械 ) ,对 32例青少年脊柱侧凸进行了矫正治疗。结果 :正常青少年T4椎弓根横径最小 ( 3 9± 0 6 6mm) ,胸椎椎弓根中点均位于横突根部上缘与中点之间 ,椎弓根与矢状面夹角在T11、T12为负角 ,T10以上为正角 ,T1最大 ( 35 8°± 0 84°)。 2 7例患者术后平均随访 11个月 ,特发性和先天性侧凸的矫正率分别为 5 7 8%和 46 4% ,无严重并发症。结论 :根据测量结果 ,如选择好进钉点、方向及深度 ,Scofix器械对青少年脊柱侧凸的矫正可获得更好的稳定性和固定强度     

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.