补肾药膳方影响卵巢去势骨质疏松模型大鼠骨形成机制探讨

目的观察骨形成代谢指标BGP的变化,探讨补肾药膳影响卵巢去势骨质疏松模型大鼠骨形成的机制。方法将60只SPF级雌性SD大鼠随机分为6组,各组10只,正常组、假手术组、模型空白组等选用一般饲料饲养,高剂量药膳组、低剂量药膳组、骨疏康颗粒组等造模1周后进行灌胃。3个月后取大鼠血清标本以ELISA法检测血清BGP水平。结果低剂量组与高剂量组与模空组之间差异无统计学意义,但血清BGP具有下降的趋势,骨疏康组血清BGP水平高于模空组(P0. 05)。结论补肾药膳对卵巢去势绝经后骨质疏松大鼠模型的骨形成代谢指标有一定的改善作用,在改善血清BGP方面弱于BALP、PINP等指标,补肾药膳方影响PMOP症机制值得进一步探讨。     

缺氧诱导因子抑制剂对去卵巢大鼠骨质疏松症治疗效果的研究

目的研究缺氧诱导因子抑制剂对卵巢切除(ovariectomized,OVX)雌性Sprague-Dawley大鼠的治疗效果,比较缺氧诱导因子抑制剂对骨密度的影响。方法在大鼠卵巢切除12周后,使用缺氧诱导因子抑制剂进行治疗。治疗8周后,在实验结束时将大鼠进行安乐死处理,获取大鼠血清、股骨和胫骨。通过生物力学测试,Micro-CT扫描和血清生化分析进行评估。结果与未给药的OVX大鼠相比,缺氧诱导因子抑制剂的全身给药显著降低了骨代谢指标Ⅰ型前胶原氨基末端前肽(type I collagen N terminal peptide,PINP)和Ⅰ型胶原羧基端肽(type I collagen carboxy-terminal peptide,CTX-I),增加了大鼠胫骨骨密度(bone mineral density, BMD),增强了股骨极限载荷、能量和刚度,差异比较有统计学意义(P0.05)。结论缺氧诱导因子抑制剂能有效改善OVX诱导的骨质疏松症。     

骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响

目的研究骨疏宁片联合阿托伐他汀对2型糖尿病合并绝经后骨质疏松症患者骨密度及骨代谢的影响。方法 124例2型糖尿病合并骨质疏松症妇女随机分为治疗组和对照组,治疗组进行骨疏宁片联合阿托伐他汀治疗,对照组单纯予以阿托伐他汀治疗。治疗前及治疗后12个月分别检测两组受试者腰椎1~4和左侧股骨颈骨密度、VAS疼痛评分以及骨代谢指标。结果治疗前,各组受试者骨密度、VAS疼痛评分以及骨代谢指标比较无统计学意义(P0.05)。治疗6个月及12个月,两组患者VAS评分不同程度降低,其中以治疗组骨痛的治疗效果要明显优于对照组(P0.05)。治疗12个月两组L1~4椎体、股骨颈的BMD明显升高(P0.05),而治疗组明显高于对照组(P0.05)。治疗12个月,两组血清I型胶原N端前肽(type 1 collagen N terminal peptide,P1NP)的水平明显升高,而I型胶原羧基末端肽(type I collagen carboxy-terminal peptide,CTX)水平明显下降,和对照组比较,治疗组血清P1NP及CTX水平改变更为明显(P0.05)。结论骨疏宁片联合阿托伐他汀可以显著提高2型糖尿病合并骨质疏松症女性骨密度及降低VAS评分,且能改善2型糖尿病合并绝经后骨质疏松症患者骨代谢异常,值得临床推广。     

脆性骨折患者骨转换标记物的变化及相关性分析

目的 研究基于脆性骨折诊断骨质疏松症患者骨转换标记物的变化及与脆性骨折发生的相关性。方法 收集2019年1月1日至2022年1月1日于南京中医药大学附属南京中医院门诊和住院治疗的确诊为脆性骨折且骨密度检查为骨量减少的中老年女性患者45例为观察组,同时设立骨密度检查为骨量减少、未发生脆性骨折的中老年女性患者71例为对照组。观察组45例,年龄67～78岁,平均(75.58±8.44)岁。对照组71例,年龄61～91岁,平均(75.34±8.58)岁。对比分析两组患者的年龄、身高、体重、身体质量指数(body mass index, BMI)、骨密度、骨转换标记物[骨钙素(osteocalcin, OC)、碱性磷酸酶(alkaline phosphatase, ALP)、Ⅰ型原胶原氨基端前肽(N-terminal peptide of typeⅠcollagen, P1NP)及β-Ⅰ型胶原交联羧基末端肽(C-terminal peptide of typeⅠcollagen, CTX)]及血清Ca²⁺浓度的差异。结果 两组患者在年龄、体重、身高和骨密度T值之间差异无统计...     

慢性间歇性缺氧对大鼠骨代谢及OPG、RANKL基因表达的影响

目的通过建立wistar大鼠慢性间歇性缺氧(chronic intermittent hypoxia,CIH)模型探讨CIH对骨代谢及骨组织骨保护素(osteoprotegerin,OPG)、核因子κB受体活化因子配体(receptor activator for nuclear factor-κB ligand,RANKL)基因表达的影响。方法 20只健康wistar大鼠随机分为正常对照组及CIH组,每组10只。对照组置于空气循环舱内,CIH组于置于间歇性缺氧舱内,每日8 h,共8周。应用双能X线骨密度仪测定大鼠全身、股骨、腰椎骨密度(bone mineral density,BMD),采用ELISA法检测大鼠血清骨特异性碱性磷酸酶(bone specific alkaline phosphatase,BALP)、骨钙素(bone glaprotein,BGP)、Ⅰ型胶原N端前肽(type Ⅰ collagen N terminal peptide,PINP)、Ⅰ型胶原羧基端肽β降解产物(β-C-terminal telopeptide of type Ⅰ collagen,β-CTX)、抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRAP)水平,应用Real-time PCR技术测定股骨OPG、RANKL mRNA相对表达量。结果与对照组相比,CIH组全身和股骨BMD下降[(0.141±0.028)vs(0.122±0.027)和(0.143±0.026)vs(0.125±0.034)]、血清BGP降低[(26.42±3.71)vs(22.05±2.16)]、血清β-CTX和TRAP升高[(132.24±26.25)vs(173.82±22.16)和(20.12±2.43)vs(23.58±2.36)]、股骨组织OPG mRNA相对表达量降低[(1.031±0.125)vs(0.924±0.141)]、RANKL mRNA相对表达量升高[(0.856±0.068)vs(1.113±0.134)],差异均具有统计学意义(P0.05)。结论慢性间歇性缺氧可使骨组织OPG mRNA表达减少、RNAKL mRNA表达增加,影响骨代谢,降低骨密度,增加了骨质疏松的发生风险。     

促胰液素对去卵巢骨质疏松大鼠血清骨转换指标和骨密度的影响

目的 观察促胰液素(secretin,SCT)对去卵巢骨质疏松大鼠骨转换指标和骨密度的影响。方法 采用双侧卵巢去除法制备绝经后骨质疏松大鼠模型,将60只SD大鼠随机分为假手术组、模型对照组、雌激素治疗组和促胰液素治疗组,每组各15只。干预3个月后,测定腰椎骨密度(bone mineral density,BMD),采取ELISA法测定血清I型胶原N前端肽(procollagen I N-Terminal propeptide,PINP)和I型胶原C末端肽(collagen type I C-terminal cross-linked telopeptide,CTX),另使用STRING10.0蛋白相互作用网络分析工具分析骨质疏松相关差异蛋白。结果 与假手术组比较,模型对照组、雌激素治疗组、促胰液素治疗组的PINP含量升高（P＜0.05）,模型对照组的CTX含量升高（P＜0.05）,模型对照组的BMD下降（P＜0.05）,雌激素治疗组和促胰液素治疗组的CTX、BMD含量无显著差异（P＞0.05）;与模型对照组比较,雌激素治疗组、促胰液素治疗组PINP、CTX含量有所下降,而BMD含量升高（P＜0.05）;雌激素组与促胰液素组之间PINP、CTX、BMD含量无显著差异（P＞0.05）。结论 促胰液素能改善去卵巢骨质疏松大鼠的PINP和CTX含量,增加骨密度,抑制骨质丢失,具有较好的抗骨质疏松效果。     

绝经后2型糖尿病患者骨硬化蛋白、PINP、CTX与骨密度相关性研究

目的比较绝经后2型糖尿病患者骨质疏松组、低骨量组、骨量正常组血清骨硬化蛋白(sclerostin,SO)水平,探讨SO与Ⅰ型前胶原氨基末端(N端)前肽(procollagen typeⅠN-terminal propetide,PINP)、Ⅰ型胶原C端肽(typeⅠcollagen carboxyterminal peptide,CTX)、骨密度(bone mineral density,BMD)的关系。方法比较绝经后2型糖尿病患者骨质疏松症组、低骨量组、骨量正常组3组间年龄、绝经年限、糖尿病病程、体重指数、股骨颈及平均腰椎BMD、空腹血糖、糖化血红蛋白、25-(OH)D3、SO、PINP、CTX各指标的差异,并做SO与上述指标的单因素相关性分析和多元线性回归分析。结果 (1)骨质疏松症组年龄、绝经年限显著高于低骨量组、骨量正常组(P均=0.000),低骨量组明显高于骨量正常组(P=0.009、0.002);(2)绝经后2型糖尿病患者中25-(OH)D3缺乏113例(90.4%);(3)骨质疏松症组SO、PINP水平显著高于低骨量组、骨量正常组(P=0.000),低骨量组SO水平明显高于骨量正常组(P=0.045);(4)SO与PINP、年龄、绝经年限正相关(r=0.978、0.194、0.205),与股骨颈BMD、平均腰椎BMD、体重指数负相关(r=-0.518、-0.349、-0.249),多元线性回归分析显示SO与PINP呈正相关(β=7.015,P=0.000)、与股骨颈BMD呈负相关(β=-11.245,P=0.023)。结论 (1)绝经后2型糖尿病合并骨质疏松者SO水平明显增高,与PINP水平呈显著正相关,与股骨颈BMD呈显著负相关;(2)25(OH)D3在绝经后2型糖尿病患者中普遍缺乏。     

雷公藤内酯对睾丸切除雄性大鼠骨丢失的保护作用实验研究

目的探索雷公藤内酯对睾丸切除雄性大鼠的骨丢失保护作用。方法 30只3月龄的雄性大鼠随机分为3组:对照组(Sham组)、睾丸切除组(CON组)和雷公藤内酯治疗组(LGT组),每组10大鼠。行双侧睾丸切除手术或假手术,LGT组术后给予雷公藤内酯治疗12周,并在实验结束时安乐死大鼠,获取血清和大鼠胫骨。这些治疗的效果通过生物力学测试、Micro-CT扫描和血清生化分析进行评估。结果与CON组大鼠相比,雷公藤内酯的全身给药显著降低骨代谢指标[1型前胶原氨基末端前肽(type 1 procollagen amino terminal propeptide,P1NP)和Ⅰ型胶原羧基端肽(type I collagen carboxy terminal peptide,CTX-1)],增加大鼠胫骨骨密度,改善骨小梁参数(骨体积分数、骨小梁厚度、骨小梁数目和骨小梁分离度),增强胫骨极限载荷、能量和刚度,且比较差异有统计学意义(P0.05)。结论雷公藤内酯能有效保护双侧切除睾丸大鼠诱导的骨丢失。     

益肾补骨汤调节去卵巢大鼠骨代谢的作用研究

目的 研究益肾补骨汤对去卵巢大鼠骨代谢的调节作用.方法 取51只大鼠建立去卵巢大鼠模型,另取10只大鼠设置为假手术组.将建模成功的大鼠随机分为尼尔雌醇组、高剂量益肾补骨汤组、中剂量益肾补骨汤组、低剂量益肾补骨汤组及空白模型组,每组各10只,灌胃治疗.对比各组大鼠股骨、胫骨骨密度,骨代谢指标;观察骨组织形态学变化;检测大...     

补肾壮骨方对去卵巢大鼠骨结构和骨代谢作用的研究

目的研究补肾壮骨方对骨质疏松大鼠骨结构和骨代谢的影响及其可能的作用机制。方法用SD雌性大鼠复制去卵巢骨质疏松模型,然后分别灌服补肾壮骨方水提液高剂量(1.4 g/kg)和低剂量(0.7 g/kg)12周。用生化法测定血清钙(S-Ca)、血清磷(S-P)、尿钙(U-Ca/Cr),尿磷(U-P/Cr)以及血清中高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白(low-density lipoprotein,LDL)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)的含量;Elisa法测定I型胶原氨基端前肽(procollagen I N-terminal propeptide,PINP)、I型胶原羧基端肽(collagen I carboxyl terminal peptide,CTX-I)、尿脱氧吡啶啉(deoxypyridine,DPD)、骨钙素(osteocalcin,OCN)的含量;用放免法测定血清碱性磷酸酶(alkaline phosphatase,ALP)的活性;用双能X线(DEXA)法、Viva CT和万能试验机测定骨密度、骨微结构和骨生物力学特性;用Western blot法测定骨组织蛋白酶(cathepsin)K表达。结果补肾壮骨方水提液能升高血清中的钙、磷、HDL-C和PINP的含量,降低血清中TC、TG、LDL、ALP、OCN和CTX-I及尿液中的钙、磷、DPD的含量。同时,补肾壮骨方水提液可以升高去卵巢大鼠股骨的骨密度,改善骨微结构,增加骨强度,降低胫骨Cathepsin K的表达水平。结论补肾壮骨方水提液能够抑制去卵巢大鼠的骨量丢失和骨强度下降,改善去卵巢大鼠的骨代谢,其作用机制可能与抑制Cathepsin K的表达有关。     

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.     

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.