应用Sky骨扩张器系统治疗骨质疏松性椎体压缩骨折的临床初步报告

目的 探讨应用Sky骨扩张器系统行椎体后凸成形术治疗骨质疏松性压缩骨折的早期临床疗效.方法 12例骨质疏松症17个压缩性骨折椎体,采用Sky骨扩张器行单侧经椎弓根椎体扩张,扩张高度为14mm,注入医用骨水泥.观察围手术期并发症,测量压缩椎体和后凸畸形恢复程度.采用疼痛视觉模拟评分(visual analogue scale, VAS)随访患者胸腰背部疼痛恢复情况.结果 每个椎体手术时间(52.4±28.7)min(23～90min),骨水泥注射量为(5.4±1.0)ml(3.5～7ml).随访3～6个月,平均4.5月,术前VAS评分为(7.6±1.8)分,术后1天为(2.8±1.1)分,术后3天为(2.6±1.2)分,末次随访时为(2.2±1.0)分.术前椎体前缘高度(13.8±5.3)mm(压缩49.1%±19.1%)、中线高度(9.9±4.6)mm(压缩39.8%±18.4%),术后椎体前缘高度(16.6±4.8)mm(压缩59.1%±17.2%)、中线高度(15.2±4.0)mm(压缩60.6%±16.9%),手术前后单椎体后凸Cobb角为22.3°±8.5°和12.5°±6.4°.1例少量骨水泥渗漏入椎间盘,未出现临床不适,未见其他并发症.结论 采用Sky骨扩张器系统行经皮椎体后凸成形术治疗骨质疏松性压缩骨折安全、有效,其长期疗效尚有待于进一步观察.     

Sky骨扩张器在骨质疏松性椎体压缩性骨折中的初步应用

目的探讨Sky骨扩张器经皮椎体后凸成形术治疗椎体压缩性骨折的临床疗效。方法应用Sky骨扩张器行经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折8例。随访观察患者手术前后疼痛视觉模拟评分(VAS),测量手术前后病椎前缘及后缘高度,并进行比较和统计学分析。结果8例均经椎弓根途径完成手术,手术时间40~70min,骨水泥注入量每个椎体2.5~4.2ml,分布均超过中线。所有患者疼痛缓解,VAS术前为(8.7±1.1)分,术后第3天为(3.5±2.0)分;椎体高度明显恢复,术前骨折椎体前缘平均高度为17.51mm,术后为20.60mm。8例均无并发症发生。结论应用Sky骨扩张器治疗骨质疏松性椎体压缩性骨折创伤小,初步观察安全有效。     

球囊骨扩张器与Sky骨扩张器在经皮椎体后凸成形术中应用的比较研究

目的比较球囊扩张经皮椎体后凸成形术（PKP）与Sky骨扩张器PKP的临床应用结果及优缺点。方法2004年10月至2006年2月分别应用球囊骨扩张器（球囊组）与Sky骨扩张器（Sky组）,对49例患者86个椎体行PKP,其中Sky组24例29个椎体,球囊组25例57个椎体。记录手术时间、术中出血量、骨水泥注射量,观察患者手术前后疼痛和功能改善情况,观察骨水泥在椎体内的分布以及病椎的高度改变。结果所有患者均安全完成手术。以平均每个椎体计算,两组手术时间、出血量、器械材料费用相比较,差异均无统计学意义（P〉0．05）。球囊组平均每侧注入PMMA骨水泥的量较Sky组多（P〈0．05）。两组患者术后VAS和ODI评分均较术前减少（P〈0．05）。X线片观察：球囊组单侧穿刺的32个椎体有24个见骨水泥越过中线到达椎体对侧;Sky组单侧穿刺的28个椎体见骨水泥主要局限在穿刺侧,有6个椎体见少量骨水泥越过中线到达椎体对侧。两组病椎高度均有不同程度的恢复,球囊组椎体前缘和中线高度恢复较明显,Sky组以椎体中线高度恢复较明显。球囊组有4例5个椎体出现椎间隙少量渗漏。Sky组中出现椎间隙骨水泥少量渗漏5例7个椎体,椎体后缘渗漏3例3个椎体,椎旁少量渗漏1例1个椎体。Sky骨扩张器5例退出困难,1例断裂。1例球囊在扩张第3个椎体时破裂。结论球囊扩张PKP与Sky骨扩张器PKP治疗疼痛性压缩骨折均有良好的临床疗效;Sky骨扩张器PKP在单节段椎体中选用较好,球囊扩张PKP对多节段椎体骨折更为适用。     

老年骨质疏松椎体压缩骨折的经皮椎体后凸成形术

目的探讨椎体后凸成形术治疗老年骨质疏松椎体压缩骨折的手术技术及适应证等相关问题。方法用椎体后凸成形术治疗老年骨质疏松椎体压缩骨折20例,采用经皮穿刺双侧椎弓根入路,单枚球囊依次撑开压缩的椎体,每个椎体充填骨水泥平均5·2ml。结果20例患者腰背部疼痛在术后24h缓解并下床活动,椎体高度基本恢复,后凸畸形平均矫正18°。随访6~18个月,患者均恢复伤前生活状况,无脊髓神经损伤、骨水泥漏、肺栓塞等并发症。结论椎体后凸成形术能达到缓解疼痛、恢复椎体高度的目的,是治疗老年骨质疏松椎体压缩骨折的有效方法。但必须熟练掌握椎体后凸成形术的经皮穿刺技术、骨水泥灌注技术及掌握手术适应证,才能保证这一技术的安全性和有效性。     

Sky骨扩张器在经皮椎体后凸成形术中的临床应用

目的:探讨应用Sky骨扩张器行经皮椎体后凸成形术治疗椎体压缩性骨折的临床疗效。方法:应用Sky骨扩张器行经皮椎体后凸成形术治疗8例共9个椎体的压缩性骨折,其中骨质疏松性椎体压缩性骨折6例7个椎体,脊柱转移瘤1例(T7),椎体血管瘤1例(L1)。术前术后行VAS评分,测量手术前后各病椎椎体前缘、中线、后缘高度并进行比较和统计学分析。结果:全组均安全完成手术,平均每个椎体手术时间为42min;失血量平均每例约为20ml;平均每个椎体注入PMMA3.2ml,术前的VAS评分平均为7.8分,术后第1天平均为3.1分,术后1周为2.6分,术后1个月平均2.5分,手术前后差异有显著性(P<0.05)。术前骨折椎体前缘的平均高度为18.21mm,术后为20.52mm(P<0.01);术前骨折椎体中线的平均高度为14.23mm,术后为19.43mm(P<0.01);术前骨折椎体后缘的平均高度为23.98mm,术后为24.59mm(P>0.05)。术后CT检查发现椎体后缘少量渗漏和椎间隙骨水泥渗漏各1例,均无临床症状;1例患者出现椎体后缘渗漏,术后出现大小便功能障碍,经保守治疗后于术后5d大便功能恢复,术后1周小便功能改善。结论:应用Sky骨扩张器行经皮椎体后凸成形术治疗椎体压缩性骨折创伤小、较安全,近期疗效较好,但仍有一定的并发症发生。     

经皮球囊扩张椎体后凸成形术治疗 老年骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折的临床 效果。方法对69例共叨个老年骨质疏松性椎体压缩性骨折的患者,均行经皮球囊扩张椎体后凸 成形术。观察指标为术前术后的疼痛视觉模拟评分（vasal analogue scale,VAS )、椎体高度的恢复及 并发症发生情况。结果 W个椎体均经皮行双侧椎弓根穿刺成功完成手术。所有患者疼痛缓解, VAS术前平均为（7. 52 10. 49)分,术后第3天平均为（2. 38 1 0. 22)分;术后1个月VAS平均为（1. 88 ±0. 12)分。术前骨折椎体前缘高度平均为（15.65 1 0. 68 ) mm,术后椎体前缘高度平均为（23.68 1 0.83) mm,术前术后差异有显著性（P < 0. 05 )。骨水泥注射量每个椎体3.5-7.5@1,平均5.5 ml。骨 水泥少量渗漏到椎间隙1个椎体,沿手术通道反流至椎弓根2个椎体,均无临床症状,渗漏率为 3.23%。结论经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折,能迅速 缓解疼痛,一定程度的恢复椎体高度,临床疗效确切。     

膨胀式椎体成形术治疗椎体破坏31例

目的总结探讨膨胀式椎体成形术（Sky骨扩张器系统）治疗老年骨质疏松性椎体压缩性骨折和椎体肿瘤的临床效果及安全性。方法对31例共59个椎体压缩骨折和椎体肿瘤破坏的患者,应用Sky骨扩张器进行经皮穿刺椎体扩张成形术。观察指标为,术前术后的疼痛视觉模拟评分（vasual analoguescale,VAS）、椎体高度的恢复及并发症发生情况。结果59个椎体均单侧经椎弓根基底穿刺成功完成手术。所有患者疼痛均有明显缓解,VAS术前平均为（8．03±0．27）分,术后第3天平均为（3．0±0．32）分,术后1个月VAS平均为（2．8土0．22）分。术前病椎前缘的平均高度为（17．36±1．28）mm。术后椎体前缘的平均高度为（22．13±0．69）mm,术前术后有显著性差异（P〈0．05）。骨水泥注射量每个椎体3．0～5．0mL,平均4．6mL。骨水泥沿椎弓根针道反流2例,均无临床症状;渗漏到椎管内1例（1个椎体）．2d后出现下肢麻木、疼痛等临床症状,渗漏率为1．7％。结论Sky骨扩张器治疗老年骨质疏松椎体压缩性骨折及椎体转移瘤骨质破坏,可迅速缓解疼痛,能在一定程度上恢复椎体高度,手术操作简便,安全可行。     

后凸成形术结合体位复位治疗创伤性胸腰椎椎体骨折的临床观察

目的：观察在体位复位辅助下后凸成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法：37例新鲜单节段胸腰椎椎体骨折患者,男28例,女9例;年龄24～79岁,平均48岁。通过体位复位及Sky扩张器撑开复位后,经双侧椎弓根穿刺充填自固化磷酸钙人工骨（CPC）。根据Denis胸腰椎骨折的分型：压缩性骨折,B型27例,C型3例,D型5例;爆裂性骨折2例,均为B型。利用体位复位,经皮穿刺,Sky椎体成形器扩张椎体,注入可降解的自固化磷酸钙人工骨。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度丢失率和后凸畸形矫正率,记录分析视觉模拟评分（VAS）及伤椎形态变化。结果：术后随访9～24个月,平均13个月。术后伤椎处疼痛均显著缓解,VAS评分改变从术前平均（7.6±2.5）分降至术后平均（1.8±1.5）分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。结论：在严格掌握适应证、选择合适病例的前提下,采用体位复位辅助下经皮椎体后凸成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形。     

计算机导航辅助下经皮椎体成形术

目的探讨红外线透视导航下经皮椎体成形术治疗骨质疏松性压缩骨折的方法和疗效。方法采用红外线透视导航下经皮椎体成形术治疗骨质疏松性压缩骨折22例(32椎),骨折部位为T6～L4,胸椎14椎,腰椎18椎。压缩程度为20%～90%,其中5例椎体压缩在75%以上。12椎行椎体成形术;20椎行椎体后凸成形术,其中12椎行球囊扩张成形,8椎行sky膨胀式椎体成形。行单椎体注射14例,两椎体注射6例,三椎体注射2例;18椎采用单侧椎弓根注射,14椎采用双侧椎弓根注射。术后行X线及CT检查了解骨折椎体复位情况、椎体容量变化、骨水泥分布及外漏情况,用CT容量分析法观测手术前后椎体的容积变化,观察手术前后疼痛强度评价的直觉模拟评分变化。结果成功对32椎注射骨水泥,无手术中死亡病例,无神经根及脊髓受压,无肺栓塞及心脑血管系统急性反应。每椎手术时间为(18.4±4.5)min,X线照射剂量为(12.2±3.4)dGy,注射骨水泥量为(4.4±2.5)ml,椎体体积由术前的(22.2±8.6)cm3增至术后的(24.8±6.9)cm3,容积变化手术前后差异有统计学意义(P<0.05)。VAS由术前的(8.3±1.6)分下降为术后48h的(2.2±3.7)分,差异有统计学意义(P<0.05)。术后平均随访10(6～16)个月,无严重并发症,无椎体塌陷。结论采用导航系统引导行椎体成形术能明显提高手术精确度和安全性,减少放射线剂量,缩短手术时间,并扩大了手术适应证。     

SKy骨扩张器治疗老年椎体压缩性骨折

目的探讨SKy骨扩张器治疗老年椎体压缩骨折的临床应用价值。方法采用SKy骨扩张器治疗老年椎体压缩骨折11例（13个椎体）,观察手术时间、骨水泥注入量、骨水泥分布及外漏情况;术前、术后3d及随访时测定患者疼痛视觉类比评分（VAS）和并发症情况。结果11例（13个椎体）均单侧穿刺成功,手术时间45～65（50±15）min。骨水泥注射量3～6（4.5±1.5）ml/椎体。骨水泥分布均超过中线,沿针道返流1个椎体,无椎管内渗漏,均无临床症状。11例术后疼痛均缓解,VAS术前为8.9分±1.4分,术后3d为3.4分±1.9分,术前、术后比较差异有显著性（P〈0.01）。11列均获随访,时间3～6个月,随访时VAS为2.6分±3.1分。结论SKy骨扩张器具有可控定向扩张优点,安全有效,且价格较低,值得临床推广。     

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.