己酮可可碱对大鼠内毒素性急性肺损伤炎症反应的影响

目的探讨己酮可可碱对大鼠内毒素(LPS)诱导急性肺损伤(ALI)炎症反应的影响。方法腹腔注射0.01%LPS1mg/kg,16h后在机械通气下气管内滴注1.5mg/kg(0.5ml)LPS建立大鼠内毒素性ALI模型。24只大鼠随机分为生理盐水对照组(C组)、急性肺损伤组(LPS组)和己酮可可碱组(PTX组),每组8只。7h后处死大鼠。酶联免疫吸附法(ELISA)测定支气管肺泡灌洗液(BAL)中肿瘤坏死因子α(TNF-α)、白细胞介素-10(IL-10)的含量,测肺湿/干重比,并观察BAL白蛋白浓度。结果与LPS组相比,PTX组大鼠BAL中TNF-α浓度、肺湿/干重比以及BAL白蛋白浓度显著降低(P<0.05),而IL-10显著升高。结论己酮可可碱能显著抑制内毒素性急性肺损伤大鼠的炎症反应,具有一定的肺保护作用。     

西格列汀对小鼠内毒素性肺损伤时黏蛋白5AC表达的影响

目的评价西格列汀对小鼠内毒素性肺损伤时黏蛋白5AC(MUC5AC)表达的影响。方法 SPF级健康雄性C57BL/6小鼠36只, 6～8周龄, 体质量20～25 g, 按照随机数字表法分为3组(n=12):对照组(C组)、内毒素性肺损伤组(L组)和内毒素性肺损伤+西格列汀组(S组)。L组和S组气管内滴注LPS 3 mg/kg制备小鼠内毒素性肺损伤模型, C组小鼠气管内滴注等量生理盐水。S组于LPS滴注前1 h腹腔注射西格列汀100 mg/kg, C组和L组小鼠于气管内滴注生理盐水前1 h腹腔注射生理盐水。LPS或生理盐水滴注后24 h时经股动脉采血行动脉血气分析测定PaO2及葡萄糖水平, 随后处死小鼠收集支气管肺泡灌洗液(BALF)和肺组织, ELISA法检测血清及BALF IL-6、IL-1β和TNF-α浓度。称重后计算肺组织湿质量/干质量(W/D)比值, HE染色法观察肺组织病理学结果并行肺损伤评分, 采用免疫组化法及免疫组化综合评分法检测MUC5AC的表达, 采用qRT-PCR法检测肺组织MUC5AC的mRNA表达水平。结果与C组比较, L组和S组PaO2降低, 葡萄糖水平、W/D...     

异丙酚对内毒素诱导大鼠急性肺损伤的保护作用

目的 探讨不同剂量异丙酚对内毒素(LPS)诱导大鼠急性肺损伤(ALI)的保护作用。方法 股静脉注射内毒素(LPS)5mg/kg,建立大鼠ALI模型。24只健康雄性Wistar大鼠随机分为四组:对照组(C组,输注生理盐水),LPS对照组(L组,股静脉注射LPS后输注生理盐水),低剂量异丙酚治疗组(Lp1组,股静脉注射LPS后立即输注异丙酚5mg/kg,随后5mg·kg~(-1)·h~(-1)维持),高剂量异丙酚治疗组(Lp2组,股静脉注射LPS后立即输注异丙酚10mg/kg,随后10mg·kg~(-1)·h~(-1)维持),每组6只。于注射LPS后1、2、3、4h抽血并于4h时处死大鼠,酶联免疫吸附法(ELISA)测定血清和支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)水平;测肺湿/干重比;并观察BALF中性粒细胞计数比、蛋白浓度。结果 L组大鼠肺湿/干重、BALF中性粒细胞计数比及蛋白浓度均明显增加(P<0.05),血清及BALF中TNF-α、IL-1β、IL-10水平显著性升高(P<0.01),而异丙酚治疗组的各项指标均较内毒素组减轻,大剂量作用更明显(P<0.01)。结论 异丙酚对内毒素诱导的大鼠急性肺损伤有保护作用,大剂量作用较明显。     

不同剂量6%羟乙基淀粉130/0.4预先给药对大鼠内毒素性急性肺损伤的影响

目的 研究不同剂量6%羟乙基淀粉130/0.4(6% HES 130/0.4)预先给药对大鼠内毒素性急性肺损伤的影响.方法 72只健康清洁级雄性SD大鼠随机分为6组(n=12),对照组(C组)经尾静脉注射生理盐水30 ml/kg;肺损伤组(L组)经尾静脉注射脂多糖(LPS)5 mg/kg;不同剂量6%HES130/0.4组分别经尾静脉注射6%HES 130/0.4 7.5 ml/kg(H1组)、15 ml/kg(H2组)和30 ml/kg(H3组),1 h后再经尾静脉注射LPS 5 mg/kg;H4组经尾静脉注射6%HES 130/0.4 30 ml/kg.各组给药速率均为0.2ml/min.注射LPS后4 h行动脉血气分析,气管插管.每组取6只大鼠,测定肺组织微血管通透性指数(PMPI);每组取6只大鼠,测定支气管肺泡灌洗液(BALF)蛋白浓度、肺组织湿/干重比(W/D)、髓过氧化物酶(MPO)活性,血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)、丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性,观察肺组织病理学.结果 与L组比较,H2组血清TNF-α、IL-1β、MDA浓度和肺组织MPO活性降低,血清IL-10浓度和SOD活性升高,H1组IL-1β浓度降低,H1组、H2组和H3组PMPI、BALF蛋白浓度和W/D均降低(P＜0.05);与H2组比较,H1组和H3组血清TNF-α、MDA浓度和肺组织MPO活性升高,血清SOD活性、IL-10浓度降低,H3组血清IL-1β浓度升高(P＜0.05).H1组、H2组和H3组较L组肺组织损伤较轻,其中H2组损伤最轻.结论 15 ml/kg6%HES 130/0.4预先给药可减轻大鼠内毒素性急性肺损伤,其机制可能与抑制炎性因子释放、减少肺内中性粒细胞聚集和氧自由基生成、改善肺微血管通透性有关.     

内质网IRE1α/XBP1信号通路在小鼠内毒素性急性肺损伤中的作用：与NLRP3炎症小体的关系

目的评价内质网肌醇需要酶1α/X盒结合蛋白1(IRE1α/XBP1)信号通路在小鼠内毒素性急性肺损伤(ALI)中的作用及其与NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体的关系。方法 SPF级健康雄性C57BL/6小鼠36只, 6～8周龄, 体质量25～30 g, 采用随机数字表法分为3组(n=12):对照组(C组)、内毒素性ALI组(ALI组)和内毒素性ALI+STF-083010组(ST组)。ALI组和ST组雾化吸入LPS 3 mg/ml 30 min制备小鼠内毒素性ALI模型, C组雾化吸入等量生理盐水, ST组于雾化吸入LPS前1 h时腹腔注射IRE1α/XBP1信号通路阻断剂STF-083010 50 mg/kg, 其余2组腹腔注射等容量生理盐水。LPS或生理盐水雾化吸入后24 h时处死小鼠, 收集支气管肺泡灌洗液(BALF)并取肺组织标本, 肺组织HE染色后光镜观察病理学结果, 行肺损伤评分并计算肺湿重/干重(W/D)比值;ELISA法测定BALF上清液IL-1β和IL-18浓度;Western blot法检测肺组织p-IRE1α、XBP1s、NLRP3、ASC和...     

七氟烷预处理对脂多糖致大鼠急性肺损伤的保护作用

目的 评价七氟烷预处理对脂多糖(lipopolysaccharide,LPS)所致大鼠急性肺损伤(acute lung injury,ALI)的影响.方法 72只SD大鼠随机分成6组:NS组、LPS组和七氟烷预处理(S-1 h组、S-6 h组、S-12 h组、S-24 h组).通过气管内滴注LPS建立大鼠ALI模型.大鼠在气道内给予LPS或NS后6 h处死,检测不同时间点七氟烷预处理(2.4%,30 min)对支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中白细胞计数、细胞因子TNF-α和IL-1β水平,肺组织髓过氧化物酶(myeloperoxidase,MPO)活性,肺血管通透性及肺组织病理学等的影响.结果 与NS组相比,LPS组肺组织损伤程度,BALF白细胞计数以及TNF-α和IL-1β水平,血管通透性和肺组织MPO活性均显著增高(P<0.01).给予LPS前1 h和24 h七氟烷预处理能降低肺组织MPO活性,BALF中IL-1β水平及白细胞计数(P<0.01),而S-6h组和S-12 h组与IPS组相比无明显差别.七氟烷预处理均能够降低肺血管通透性和BALF中TNF-α水平(P<0.01),且以S-1 h和S-24h组为显著(P<0.01).提示七氟烷预处理对LPS所致肺损伤具有早期和延时的保护作用.结论 气道内给予LPS1 h和24 h前七氟烷预处理对LPS致大鼠ALI具有保护作用.     

c-Jun氨基末端激酶在大鼠内毒素性急性肺损伤中的作用

目的 评价c-Jun氨基末端激酶(JNK)在大鼠内毒素性急性肺损伤中的作用.方法 雄性成年SD大鼠80只,体重250～300 g,采用随机数字表法,将其随机分为4组(n=20):对照组(C组)、急性肺损伤组(ALI组)、SP600125组(S组)和二甲基亚砜组(D组).ALI组、S组和D组尾静脉注射LPS 5 mg/kg,C组尾静脉注射等容量生理盐水;S组和D组给予LPS后,分别尾静脉注射JNK抑制剂SP600125 30 mg/kg或二甲基亚砜0.2 ml.于给予LPS后4 h时,各组处死10只大鼠,回收支气管肺泡灌洗液(BALF)并取肺组织,采用ELISA法检测BALF中TNF-α和IL-1β的浓度,计算肺组织湿重/干重比(W/D比),观察肺组织病理学结果,并进行肺损伤评分.各组其余10只大鼠观察至给予LPS后48 h,记录大鼠生存情况.结果 与C组比较,其余各组BALF中TNF-α和IL-1β的浓度、肺组织W/D比和肺损伤评分升高,生存率降低(P<0.05或0.01);与ALI组比较,S组BALF中TNF-α和IL-1度、肺组织W/D比和肺损伤评分降低,生存率升高(P<0.01),D组差异无统计学意义(P>0.05).结论 JNK的活化参与了大鼠内毒素性急性肺损伤的发生发展.

Abstract：

Objective To evaluate the role of c-Jun N-terminal kinase (JNK) in lipopolysaccharide (LPS)-induced acute lung injury ( ALI) in rats.Methods Eighty male SD rats weighing 250-300 g were randomly divided into 4 groups ( n = 20 each) : control group (group C) ; ALI group; LPS + SP600125 (JNK inhibitor)group (group S) and LPS+ DMSO (the solvent) group (group DMSO) . ALI was induced by intravenous LPS 5mg/kg. In S and DMSO groups, SP600125 30 mg/kg and DMSO 0.2 ml were injected intravenously after LPS administration respectively. Ten animals were sacrificed by exsanguinafions at 4 h after LPS administration in each group. The broncho-alveolar lavage fluid (BALF) was colleted. The TNF-α and IL-1β concentrations in BALF were measured. The lungs were removed for microscopic examination and determination of W/D lung weight ratio. The other 10 animals in each group were observed for 48 h survival rate. Results Intravenous LPS significantly increased TNF-α and IL-1β concentrations in BALF and W/D lung weight ratio, decreased 48 h survival rate and induced histologic damage. Intravenous SP600125 30 mg/kg significantly attenuated the above-mentioned LPS-induced changes. Conclusion Activation of JNK is involved in the development of endotoxin-induced ALI in rats.     

气管滴注法与雾化吸入法建立小鼠急性肺损伤模型及其效果比较

目的：比较脂多糖（LPS）气管滴注法与雾化吸入法建立的小鼠急性肺损伤（ALI）模型,确立更为有效的小鼠肺损伤建模方法。方法20只健康雄性C57BL/6小鼠随机分为生理盐水（NS）气管滴注组、NS雾化吸入组、LPS气管滴注组和LPS雾化吸入组。分别采用气管滴注法和雾化吸入法建立肺损伤模型,5 h后进行小鼠肺湿重/干重（W/D）比值测定、支气管肺泡灌洗液（BALF）蛋白含量测定、细胞分类计数及炎性细胞因子检测。结果与对照组相比,LPS气管滴注组和LPS雾化吸入组小鼠肺W/D比值,BALF中总蛋白浓度,TNF-α、IL-6、MCP-1和IL-1β等多项炎性细胞因子以及中性粒细胞数目均显著升高（P均＜0.05）;NS气管滴注组较NS雾化吸入组炎症背景高;LPS气管滴注组较LPS雾化吸入组各项肺部炎症指标组内差异大。结论雾化吸入方法对于建立小鼠ALI模型更有效。     

氟比洛芬酯预先给药对大鼠内毒素性急性肺损伤的影响

目的 评价氟比洛芬酯预先给药对大鼠内毒索性急性肺损伤的影响.方法 雄性SD大鼠40只,体重190～220 g,随机分为3组:对照组(C组,n=8)、脂多糖组(LPS组,n=16)和氟比洛芬酯组(FA组,n=16).C组尾静脉注射生理盐水(NS)1 ml;LPS组尾静脉注射LPS 5 mg/kg(1 m1);FA组尾静脉注射氟比洛芬酯6 mg/kg(1 m1)后0.5 h注射LPS 5 mg/kg(1 m1).LPS组和FA组于注射LPS后2、4 h时、C组于注射NS后4 h时,各随机处死8只大鼠,取股动脉血样8 ml,行血气分析;采用放免法测定血清血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto PGF1α)的浓度;采用ELISA方法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6和IL-10的浓度.取左肺上叶组织,计算肺组织湿/干重比值(W/D)和肺含水量(LC).注射LPS或NS后4 h时取左肺下叶组织,光镜下观察肺组织病理学结果.结果 与C组比较,LPS组PaO2和PaO2/FiO2下降,PaCO2、W/D和LC升高,血清TXB2、6-keto PGF1α浓度和TXB2/6-keto PGF1α比值升高,血清TNF-α、IL-1β和IL-6浓度升高,FA组W/D和LC升高,血清TXB2和6-keto PGF1α浓度升高,血清TNF-α、IL-1β、IL-6和IL-10浓度升高(P<0.05或0.01).与LPS组比较,FA组PaCO2、W/D和LC降低,PaO2和PaO2/FiO2升高,血清TXB2、6-keto PGF1α浓度和TXB2/6-keto PGF1α比值降低,血清IL-1β、IL-6和TNF-α浓度降低,血清IL-10浓度升高(P<0.05).FA组肺组织病理学损伤较LPS组轻.结论 氟比洛芬酯预先给药可减轻内毒素性急性肺损伤,可能与维持血液TXA2和PGI2平衡及抑制炎性反应有关.     

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.