血脂异常对非肥胖不孕患者IVF/ICSI妊娠结局的影响

目的 探讨在非肥胖不孕人群中血脂异常对IVF/ICSI助孕妊娠结局的影响。方法 回顾性分析2020年10月至2021年12月于江门市中心医院生殖医学中心首次行IVF/ICSI助孕治疗的426例患者的临床资料。依据血脂正常与否分为2组：血脂异常组156例,血脂正常组(对照组)270例。比较分析两组患者的一般情况和妊娠结局。结果 两组患者年龄、不孕年限、抗苗勒管激素(AMH)水平、基础窦卵泡数(AFC)、基础卵泡刺激素(bFSH)、Gn用量、获卵数、受精率、可利用胚胎数、优质胚胎率、种植率、临床妊娠率以及早期流产率差异均无统计学意义(P>0.05)。血脂异常组患者的BMI[(21.99±2.56)kg/m² vs.(21.22±2.62)kg/m²,P=0.003]、HCG日的子宫内膜厚度[(11.68±3.22)mm vs.(11.04±2.67)mm,P=0.049]、新鲜周期平均移植胚胎数[(1.45±0.50)个vs.(1.29±0.46)个,P=0.005]均显著高于对照组。进一步Logistic回归分析校正相关混杂因素后,结果显...     

超重/肥胖患者应用拮抗剂方案添加重组人黄体生成素的临床效果

目的 探讨GnRH拮抗剂方案中添加人重组黄体生成素(r-LH)在超重/肥胖的非多囊卵巢综合征(PCOS)患者IVF/ICSI-ET中的临床效果。方法 回顾性队列研究2019年12月至2021年12月在本院生殖医学科行GnRH拮抗剂方案的208例非PCOS超重/肥胖患者的实验室指标及助孕结局。根据是否添加r-LH将患者分为两组：添加LH组(在添加GnRH拮抗剂日添加r-LH,n=100)和对照组(促排卵过程中未添加LH,n=108)。比较两组患者的基本资料、促排卵情况及临床妊娠结局。结果 两组患者的年龄、不孕年限及体质量指数(BMI)等基础资料比较,差异均无统计学意义(P>0.05)。与对照组相比,添加LH组患者应用Gn时间[(10.45±1.45)d vs.(12.31±1.82)d]及Gn总量[(2 831.56±345.71)U vs.(3 365.47±273.68)U]显著减少(P<0.05),HCG日E₂水平[(9 207.26±2 478.94)pmol/L vs.(6 908.15±2 281.57)pmol/L]及LH水平[(2.65±...     

拮抗剂方案与早卵泡期长效长方案应用于波塞冬2型POR患者IVF-ET结局的比较

目的比较拮抗剂方案和早卵泡期长效长方案在波塞冬2型卵巢低反应(POR)患者体外受精-胚胎移植(IVF-ET)中的应用效果。方法回顾性分析2016年9月至2019年3月在本中心行IVF-ET助孕的波塞冬2型POR患者的197个新鲜周期的临床资料。根据促排卵方案不同分为:拮抗剂方案组(A组,94个周期),早卵泡期长效长方案组(B组,103个周期),比较两组的基本资料和临床妊娠结局。结果两组患者的一般资料比较均无显著性差异(P>0.05)。两组的促排卵实验室指标比较,A组的Gn总量[(2100.27±636.11)vs.(3064.71±877.76)U]和Gn天数[(7.99±1.88)vs.(11.37±2.93)d]显著低于B组(P<0.05);A组HCG日LH水平[(3.09±2.22)vs.(1.29±1.00)U/L]显著高于B组,HCG日内膜厚度[(9.45±2.39)vs.(10.51±2.66)mm]显著低于B组(P<0.05);A组的优势卵泡数[(5.16±2.57)vs.(7.42±3.58)]、获卵数[(6.67±3.51)vs.(8.34±4.28)]、MⅡ数[(5.68±3.19)vs.(7.11±4.20)]、正常2PN数[(3.98±2.35)vs.(4.94±2.92)]、D3可移植胚胎数[(2.60±2.22)vs.(3.45±2.31)]均显著低于B组(P<0.05)。两组的妊娠结局比较,移植取消率(55.32%vs.41.75%)、着床率(35.14%vs.35.85%)、临床妊娠率(54.76%vs.46.67%)、早期流产率(17.39%vs.17.86%)、宫外孕率(0.00%vs.3.57%)及中重度OHSS发生率(0.00%vs.0.00%)组间比较均无显著性差异(P>0.05)。结论对于波塞冬2型POR患者,拮抗剂方案和早卵泡期长效长方案新鲜周期有相似的临床结局,但拮抗剂方案可以节约Gn用量、缩短Gn天数,缩短治疗周期,减轻患者的经济负担和精神压力。因此,拮抗剂方案可以作为波塞冬2型POR患者促排卵方案的选择之一。     

改良超长方案在卵巢低反应患者促排卵治疗中的应用

目的探讨卵巢低反应(POR)患者在体外受精-胚胎移植(IVF-ET)/卵胞浆内单精子注射(ICSI)助孕治疗过程中行改良超长方案和灵活拮抗剂方案对其妊娠结局的影响。方法回顾性分析2013年1月1日至2013年12月31日在本院生殖中心接受IVF/ICSI助孕治疗的515例POR患者的临床资料,根据促排卵方案不同分为改良超长方案组(A组,n=137)和拮抗剂方案组(B组,n=378)。比较两组患者卵巢刺激天数(Gn天数)、Gn用量、HCG日激素水平、子宫内膜情况、平均获卵率、优胚率、受精率、着床率、临床妊娠率、移植周期取消率、流产率及宫外孕发生率等。结果与拮抗剂方案组比较,改良超长方案组的Gn天数[(12.42±2.80)vs.(8.53±2.54)d]、Gn用量[(4 447.81±2 804.28)vs.(1 916.67±622.62)U]、HCG日子宫内膜厚度[(12.15±2.66)vs.(10.53±2.31)mm]、平均获卵数[(2.97±1.50)vs.(2.43±1.52)个]均显著增加(P均0.01),HCG日孕酮(P)水平[(0.46±0.27)vs.(0.56±0.26)nmol/L]、早发LH峰发生率(0vs.12.96%)、优胚率[(51.19±41.17)%vs.(63.72±38.74)%]、周期取消率(41.61%vs.53.17%)显著下降(P均0.05)。改良超长方案组的着床率(33.99%vs.15.15%)、临床妊娠率(48.75%vs.26.55%)显著高于拮抗剂方案组(P均0.01)。两组的流产率和宫外孕发生率比较无显著性差异(P0.05)。结论POR患者行促排卵治疗时,选择改良超长方案可能更有利于改善IVF/ICSI-ET结局,但药物使用成本相对较高。     

微刺激全胚胎冷冻方案在常规IVF-ET治疗失败无优质胚胎患者中的应用

目的探讨微刺激全胚胎冷冻方案在常规IVF-ET治疗因胚胎质量差助孕失败患者中的应用价值。方法收集在本中心行常规促排卵后IVF/ICSI-ET助孕治疗、因无优质胚胎放弃或移植失败后改用微刺激方案助孕的106例患者为研究对象,回顾性分析常规促排卵的124个周期和改行微刺激方案后的156个周期的临床资料。比较不同促排卵方案的各项参数及妊娠结局。结果微刺激组的Gn天数[(7.24±2.41)vs.(10.59±1.81)d]、Gn总量[(656.97±347.17)vs.(2 409.54±726.01)U]、HCG注射日E_2水平[(451.46±350.85)vs.(1 275.93±674.46)pmol/L],以及成熟卵母细胞数[(2.53±2.15)vs.(8.98±5.29)个]等均显著低于常规方案组(P均0.05),但微刺激组的每卵胚胎形成率(39.13%)显著高于常规方案组(12.81%)(P0.05)。常规方案组未获得临床妊娠;微刺激组共70个周期进行冻融胚胎移植,临床妊娠22例,移植周期临床妊娠率为31.43%(22/70),累计继续妊娠率为18.87%(20/106)。且微刺激方案中不同年龄组的胚胎种植率、移植周期妊娠率随着年龄增加显著下降(P0.05)。结论微刺激全胚胎冷冻方案应用于常规IVF-ET治疗失败无优质胚胎的患者可获得较好的妊娠结局,有一定的临床应用价值。     

两种促性腺激素释放激素类似物对IVF-ET临床效果的比较

目的比较国产亮丙瑞林与进口达菲林在IVF-ET改良长方案促排卵中的降调节效果以及对妊娠结局的影响。方法回顾性分析2014年1~12月在吉林大学第二医院生殖医学中心接受IVF/ICSI-ET助孕治疗、应用改良长方案控制性促排卵635个周期的临床资料。根据所用药物的不同分为亮丙瑞林组(256个周期)和达菲林组(379个周期),比较两组患者的一般资料、生殖激素水平、Gn用量和Gn天数、获卵数、受精率、种植率和临床妊娠率等。结果两组患者均达到降调标准,降调第20天生殖激素水平与HCG日生殖激素水平比较无显著性差异(P0.05);两组的Gn用量[(36.54±10.58)vs.(32.56±8.34)支]、Gn天数[(10.32±1.69)vs.(10.57±1.64)d]及获卵数[(10.35±5.72)vs.(10.56±5.35)枚]、受精率(70.58%vs.68.30%)、卵裂率(95.44%vs.95.79%)、优质胚胎率(66.37%vs.60.49%)、种植率(21.75%vs.22.55%)、临床妊娠率(35.78%vs.37.84%)等比较无显著性差异(P0.05)。达菲林组的新鲜胚胎移植周期取消率(70.71%)显著高于亮丙瑞林组(14.84%)(P0.05)。结论在改良长方案促排卵时,国产亮丙瑞林与进口达菲林的降调节效果以及妊娠结局较为相似,并且国产亮丙瑞林更有利于减轻患者的经济负担,不失为IVF-ET降调节的又一个理想选择。     

黄体期长方案与拮抗剂方案应用于不明原因不孕患者IVF/ICSI-ET的助孕结局比较

目的 探讨黄体期长方案和拮抗剂方案应用于不明原因不孕(UI)患者体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的差异。方法 回顾性分析2016年1月至2022年7月于广西医科大学第一附属医院广西生殖医学研究中心首次行IVF/ICSI-ET助孕的278例UI患者(共278个周期)的临床资料。根据促排卵方案不同分为拮抗剂方案组(拮抗剂组，80个周期)和黄体期长方案组(长方案组，198个周期);又按照年龄不同分为≤35岁组(220个周期)和>35岁组(58个周期)。比较各组患者的基本资料、促排卵情况、胚胎发育实验室指标及首次鲜胚移植的妊娠结局等。结果 拮抗剂组和长方案组患者的年龄、体质量指数(BMI)、不孕年限、基础卵泡刺激素(bFSH)、基础窦卵泡数(AFC)均无统计学差异(P>0.05)。拮抗剂组的Gn使用天数[(9.01±1.69)d vs.(11.03±1.71)d]、Gn总量[(1 985.78±702.72)U vs.(2 361.78±803.66)U]、HCG日内膜厚度[(10.37±1.78)mm vs.(11.10±1.82)mm]、...     

拮抗剂方案中不同促性腺激素启动剂量在预期正常反应人群的疗效研究中期随访结果分析

目的 探讨预期卵巢正常反应人群应用拮抗剂方案时，不同促性腺激素(Gn)启动剂量对获卵数及妊娠结局的影响。方法 采用前瞻性、干预性、单中心、随机对照平行研究2021年8月至2022年8月期间在西北妇女儿童医院生殖中心接受治疗的预期卵巢正常反应患者，根据拮抗剂方案中Gn启动剂量不同分为研究组(rFSH启动剂量225 U)48例与对照组(rFSH启动剂量150 U)39例。比较两组患者的基线资料、促排卵用药和获卵情况、胚胎发育情况以及临床结局。结果 两组患者间平均年龄、体质量指数(BMI)、不孕年限、不孕类型、基础激素水平(FSH、LH、E₂、P)等基线资料比较均无显著性差异(P>0.05);研究组Gn总量[(2 287.76±572.00)U vs.(1 653.20±866.56)U]、拮抗剂使用天数[(5.46±1.01)d vs.(4.97±1.09)d]及拮抗剂总量[(1.37±0.26)mg vs.(1.26±0.31)mg]显著高于对照组(P<0.05);两组间获卵数、2PN数、可用胚胎数、优质胚胎数、MⅡ卵率、2PN率、优质胚胎率以及预防OH...     

IVF周期中女性体重指数对冻融胚胎移植周期妊娠结局的影响

目的探讨女性体重指数(BMI)对冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2016年6月至2018年6月在本中心首次行单个复苏囊胚移植的3 424个周期的临床资料,按照女方BMI值(中国标准)分为4组:偏瘦组(BMI18.5 kg/m~2)248个周期、正常组(18.5 kg/m~2≤BMI24.0 kg/m~2)2 300个周期、超重组(24.0 kg/m~2≤BMI28 kg/m~2)742个周期、肥胖组(BMI≥28 kg/m~2)134个周期,再根据不同内膜准备方案将4组分为自然周期、促排卵周期和人工周期3个亚组。比较各组患者的临床妊娠率、种植率、活产率、流产率,以及各亚组临床结局的差别。结果偏瘦组、正常组、超重组及肥胖组的临床妊娠率分别为77.8%、76.7%、74.8%及74.6%,种植率分别为76.6%、76.0%、73.9%及73.9%,活产率分别为67.7%、66.4%、62.9%及61.9%,流产率分别为11.9%、12.8%、14.1%及16.0%,各组间比较均无显著性差异(P0.05)。4组中各亚组比较显示,偏瘦组、正常组和肥胖组中各亚组临床结局没有显著性差异(P0.05),而超重组中促排卵周期亚组的临床妊娠率、种植率和活产率均显著高于自然周期组和人工周期组(P0.01)。结论在调整了患者子宫环境的FET周期,使用高质量的复苏囊胚移植,超重和肥胖并不会降低种植率和活产率,也不会增加流产的风险;且超重患者使用促排卵周期内膜准备方案临床结局较佳。     

卵巢正常反应人群拮抗剂方案中月经周期长短对卵泡发育同步化的影响

目的探讨月经周期的长短在采用拮抗剂方案的卵巢正常反应人群中对卵泡发育同步化的影响。方法回顾性分析2014年1月至2015年11月期间在武汉大学人民医院生殖中心接受IVF/ICSI-ET助孕治疗的236例采取拮抗剂方案促排卵且卵巢反应正常的患者,按月经周期的长短分为短周期组(≤28d,101例)和长周期组(≥29d,135例),分析患者启动促性腺激素(Gn)日、Gn启动后第4天、第7天及HCG日卵泡平均直径的变异系数(CV)、IVF助孕情况及妊娠结局。结果与短周期组比较,长周期组患者平均年龄、BMI、Gn天数、HCG日雌二醇水平、内膜厚度、Gn启动日及Gn刺激第4天卵泡平均直径CV、受精率、卵裂率、优胚率、种植率、临床妊娠率均无显著差异(P0.05);长周期组的窦卵泡个数(AFC)[(14.98±4.24)vs.(11.72±4.29)]及基础黄体生成素(bLH)水平[(4.39±2.28)U/L vs.(3.60±1.51)U/L]、HCG日直径≥14mm卵泡数[(10.06±2.19)vs.(9.98±2.04)]、获卵数[(11.81±4.32)vs.(9.65±4.33)]均明显高于短周期组(P0.05),而基础卵泡刺激素(bFSH)水平[(6.38±1.24)U/L vs.(6.81±1.53)U/L]、Gn刺激第7天卵泡平均直径CV[(0.122±0.045)vs.(0.143±0.055)]、HCG日卵泡平均直径CV[(0.208±0.037)vs.(0.218±0.041)]、Gn总量[(24.88±7.46)U vs.(29.14±9.56)U]、HCG日孕酮水平[(3.78±2.61)nmol/L vs.(4.45±2.23)nmol/L]均显著低于短周期组(P0.05)。结论采用拮抗剂方案促排的卵巢正常反应人群,月经周期较长者促排后卵泡发育同步性可能更好、获卵数更多。     

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.