术后硬膜外镇痛对肺癌根治术病人细胞免疫功能的影响

目的 观察术后硬膜外镇痛对肺癌根治术病人细胞免疫功能的影响.方法 择期行肺癌根治术病人30例,年龄30～64岁,随机分为2组(n=15):术后静脉镇痛组(Ⅰ组)和术后硬膜外镇痛组(E组),术后分别行病人自控静脉镇痛(PCIA)和病人自控硬膜外镇痛(PCEA)72 h.E组麻醉诱导前于T4,5间隙行硬膜外置管.Ⅰ组药物成分为:芬太尼20 μg/ml、咪达唑仑0.1 mg/ml和托烷司琼0.04mg/ml,背景输注速率2 ml/h,PEA剂量1 ml,锁定时间20min;E组硬膜外注射0.25%布比卡因5 ml后行PCEA,药物成分为:0.125%布比卡因、芬太尼2.4μg/ml和咪达唑仑0.05 mg/ml.术后记录VAS评分、Ramsay镇静评分和不良反应的发生情况.分别于麻醉诱导前、术后2 h、1 d、3 d、5 d、7 d时测定皮质醇浓度、CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤细胞(NK细胞)及细胞因子诱导杀伤细胞(CIK细胞)水平.结果 与Ⅰ组比较,E组VAS评分及恶心呕吐发生率差异无统计学意义(P＞0.05),Ramsay镇静评分和皮质醇浓度降低,CD3+、CD4+、NK细胞和CIK细胞水平升高(P＜0.05),CD8+、CD4+/CD8+差异无统计学意义(P＞0.05).结论 术后硬膜外镇痛可改善肺癌根治术病人细胞免疫功能,其效果优于术后静脉镇痛.     

曲马多术后镇痛对妇科肿瘤病人T淋巴细胞亚群、NK细胞的影响

目的 比较曲马多用于妇科肿瘤病人术后静脉自控镇痛(PCIA)与硬膜外自控镇痛(PCEA)对T淋巴细胞亚群、NK细胞的影响。方法 39例妇科肿瘤病人,随机分为两组,Ⅰ组(n=21)为静脉自控镇痛组,E组(n=18)为硬膜外自控镇痛组。两组均用硬膜外麻醉。Ⅰ组曲马多800mg、氟哌啶醇5mg、生理盐水83 ml。E组曲马多400 mg、氟哌啶醇5 mg、生理盐水91 ml。负荷剂量:术毕前15 minⅠ组曲马多100 mg静脉缓注,E组硬膜外给药。PCA泵容量100 ml,背景输注速率2ml/h,单次泵药剂量0.5 ml,锁定时间15 min。术后1、2 d评定镇痛效果(VAS),并于术前30min、术后1、2 d抽取肘静脉血液1.5 ml,采用流式细胞仪检测T细胞亚群(CD3+、CD4+、CD8+)、NK细胞的百分率。结果 两组镇痛差异无显著性(P>0.05)。两组间各时点各免疫指标的差异均无显著性(P>0.05)。E组术后1、2 d NK细胞显著低于术前(P<0.05),Ⅰ组术后2 d NK细胞下降(P<0.05)。两组T细胞亚群指标与术前相比差异无显著性(P>0.05)。结论 曲马多PCIA与PCEA用于妇科肿瘤病人术后镇痛对T淋巴细胞亚群、NK细胞的影响相同。     

镇痛对上腹部术后炎性反应的抑制作用

目的 研究硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA)对上腹部术后炎性反应的抑制作用.方法 上腹部手术患者60例,随机分为两组,每组30例.均选择全麻气管插管加硬膜外麻醉,手术结束时行自控镇痛(PCA).E组行罗哌卡因复合芬太尼PCEA,I组行芬太尼复合氯诺昔康PCIA.负荷剂量3～5 ml+背景剂量2～2.5 ml/h,PCA剂量每次1 ml,锁定时间15 min.采用双抗体夹心ELISA法和免疫透射比浊法检测术后0、6、24、48 h血清白细胞介素(IL)-6、IL-10和C-反应蛋白(CRP)浓度.行VAS疼痛评分.结果 术后6 h,E组和I组IL-6、IL-10均显著升高(P＜0.05);术后24 h,E组IL-6显著降低,IL-10仍升高,I组IL-6、IL-10均较高(P＜0.05),E组和I组CRP均明显升高(P＜0.05).术后6 h,E组IL-6、CRP显著低于I组,IL-10显著高于I组(P＜0.05);术后48 h,E组IL-6、IL-10均显著低于I组(P＜0.05).结论 不同镇痛方式对上腹部术后过度炎性反应均有抑制作用,但PCEA优于PCIA.     

术后不同镇痛方式对老年患者应激反应和凝血功能的影响

目的 观察两种镇痛方式:硬膜外自控镇痛(PCEA)与静脉自控镇痛(PCIA)对老年患者下肢手术后应激反廊及凝血功能的影响.方法 择期行下肢骨科矫形手术的老年患者40例,ASAⅡ～Ⅲ级,随机分为硬膜外自榨镇痛组(PCEA组)与静脉自控镇痛组(PCIA组),每组20例.所有患者均施行腰麻硬膜外联合麻醉.术后PCEA组自硬膜外腔导管给予硬膜外自控镇痛,PCEA药物配制:罗哌卡因225 mg+吗啡8 mg+氟哌利多5 mg加生理盐水配成100 ml混合液,首次负荷苗吗啡2 mg,背景量2.0 ml/h,PCA量1.5 mL/次,间隔时间15 min;PCIA组给予静脉自控镇痛,PCIA药物配制:芬太尼0.2 mg+曲马多1g+氟哌利多5 mg加生理盐水配成100 ml混合液,首次负荷量为上述混合液10 ml静注,背景量2.0ml/h,PCA 量1.5 ml/次,间隔时间15 min.分别于麻醉前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)各时间点静脉采血检测血浆皮质醇(COR)、血糖(BS)和凝血功能:血浆凝血酶原时间(PT),活化部分凝血活酶时间(AFIT),凝血酶时间(TT)及血浆纤维蛋白原(Fg).于手术后12、24、48 h对两组患者进行视觉模拟疼痛评分(VAS).结果 术后12 h及24 h PCEA组VAS低于PCIA组(P均＜0.05).两组患者术毕到术后48 h(TI到T3)COR及BS与术前(TO)时比较降低(P＜0.05或0.01);而组间比较,T2和T3时PCEA组COR及BS均低于PCIA组(P均＜0.05).凝血功能指标PT、APTT、TT自T1到T3与T0比较,两组均延长(P＜0.05或0.01),而组问比较,T1和T3时两组间差异无统计学意义,而T2时上述三项指标PCEA组较PCIA组延长(P＜0.05).PCEA组纤维蛋白原(Fg)T1至T3较T0时降低(P＜0.05或0.01),而PCIA组T1到T3 Fg较T0时虽然有所降低,但差异无统计学意义(P＞0.05);两组间比较,T1和T3时组间差异无统计学意义,仅1、2时PCEA组低于PCIA组(P＜0.05).结论 PCEA和PCIA均能提供有效的术后镇痛,并减轻手术后应激反应和改善凝血功能,但PCEA优于PCIA.     

硬膜外阻滞复合全麻和硬膜外镇痛对食管癌手术患者血浆白细胞介素4及干扰素-γ的影响

目的 比较不同麻醉方法及术后镇痛对食管癌手术患者血浆白细胞介素-4(IL-4)及干扰素-γ(IFN-γ)水平的影响.方法 择期行食管癌或贲门癌手术患者60例,随机均分为四组:Ⅰ组全凭静脉麻醉,术后行静脉自控镇痛(PCIA);Ⅱ组麻醉方法同Ⅰ组,术后行硬膜外自控镇痛(PCEA);Ⅲ组采用静脉麻醉复合胸段硬膜外阻滞,术后行PCIA;Ⅳ组麻醉方法同Ⅲ组,术后行PCEA.于麻醉前(T0)、切皮后2 h(T1)、术毕(T2)、术后24 h(T3)、术后48 h(T4)采集外周静脉血,用酶联免疫吸附法测定血浆IL-4、IFN-γ浓度,以IFN-γ/IL-4评估Th1/Th2亚群比值;于术后24、48、72 h以VAS评估术后镇痛效果.结果 Ⅱ、Ⅳ组患者在静息和活动后各时点的VAS均明显低于Ⅰ组(P＜0.05),Ⅳ组在静息和活动后各时点的VAS均明显低于Ⅲ组(P＜0.05),Ⅱ组在术后72 h的静息VAS和48、72 h活动后VAS也明显低于Ⅲ组(P＜0.05).与T0时比较,Ⅰ、Ⅱ组血浆IFN-γ/IL-4的比值在T2时明显下降(P＜0.05),Ⅲ、Ⅳ组该比值在T3时开始明显下降(P＜0.05).T2时Ⅲ、Ⅳ组血浆IFN-γ/IL-4比值均明显高于Ⅰ、Ⅱ组(P＜0.05),T3、T4时Ⅳ组该比值均高于Ⅰ组(P＜0.05).结论 食管癌开胸手术患者无论术中全麻复合硬膜外阻滞或术毕应用硬膜外镇痛均能减低疼痛,且术后硬膜外镇痛较静脉镇痛效果更明显.     

老年病人开胸术后PCEA与PCIA的效果及对呼吸功能的影响

目的比较老年病人食管癌开胸术后布比卡因、芬太尼硬膜外自控镇痛(PCEA)与芬太尼静脉自控镇痛(PCIA)临床效果及对呼吸功能的影响。方法60例65岁以上ASAⅠ～Ⅱ级择期开胸手术的食管癌病人随机分为两组,每组30例,PCEA组选用0.2%布比卡因加0.0002%芬太尼硬膜外镇痛,PCIA组选用0.001%芬太尼加0.005%氟哌利多静脉镇痛。观察镇痛效果、镇静程度、舒适评分、不良反应,监测RR、SpO2、MAP、HR。并于术前和术后24h测定呼吸功能的变化。结果两组病人视觉模拟评分(VAS)评分均较低,PCIA组高于PCEA组但无明显差异(P>0.05),PCIA组Ramesay法(RSS)镇静评分显著高于PCEA组(P<0.05),布氏评分法(BCS)舒适评分明显低于PCEA组(P<0.05),恶心、呕吐、皮肤瘙痒等的发生率显著高于PCEA组(P<0.05),两组病人对术后镇痛总体满意度评估优秀者PCEA组明显多于PCIA组(P<0.05);两组术后呼吸频率和SpO2均在正常范围,无呼吸抑制发生,PCEA组呼吸功能改善明显优于PCIA组(P<0.05)。结论对于食管癌开胸手术的老年病人,硬膜外布比卡因与静脉芬太尼自控镇痛均安全可行,镇痛效果满意,改善了呼吸功能,综合总体镇痛质量,PCEA组优于PCIA组,但PCEA镇痛需加强硬膜外导管的管理。     

氯诺昔康伍用芬太尼对妇科手术后炎症反应的影响

目的观察氯诺昔康伍用芬太尼用于妇科手术后镇痛对炎症反应的影响。方法择期行妇科手术患者40例,随机分为氯诺昔康术后镇痛组(Ⅰ组)和芬太尼术后镇痛组(Ⅱ组),Ⅰ组于手术后以芬太尼10μg/kg、氯诺昔康0.8mg/kg加入生理盐水稀释至100ml,加入一次性镇痛泵行术后患者静脉自控镇痛(PCIA);Ⅱ组手术后以芬太尼15μg/kg加入生理盐水稀释至100ml,PCIA泵行术后镇痛。分别于术前(T0)、术后第1天(T1)、第3天(T2)测肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)浓度及WBC。结果两组术后疼痛视觉模拟评分(VAS)比较差异无统计学意义;Ⅰ组T2时白细胞数、中性细胞数、单核细胞数明显低于Ⅱ组(P<0.05);两组T1、T2时IL-6均较T0时显著升高(P<0.01),但Ⅰ组IL-6明显低于Ⅱ组(P<0.05);T1时两组IL-10明显升高(P<0.01),Ⅰ组明显高于Ⅱ组(P<0.05)。结论氯诺昔康伍用芬太尼用于妇科手术后镇痛可减轻术后机体的炎症反应。     

不同镇痛方法对肺叶切除术病人红细胞膜ATP酶活性的影响

目的探讨术后不同镇痛方法对肺叶切除术病人红细胞膜ATP酶（ATPase）活性的影响.方法选择40例ASAⅠ～Ⅱ级、行肺叶切除术病人,随机分为病人自控硬膜外镇痛（PCEA）组和病人自控静脉镇痛（PCIA）组,每组20例.PCEA组为0.125%布比卡因加3 μg/ml芬太尼,PCIA组为曲马多3 mg/ml＋芬太尼2 μg/ml＋恩丹西酮0.03 mg/ml.两组手术均在相同全麻下完成.分别于麻醉前、术毕、术后24和48 h抽取肝素抗凝血1ml测定红细胞膜ATPase活性.结果PCIA组ATPase数值在术后24和48 h明显低于PCEA组（P＜0.05）,PCIA组和PCEA组ATPase数值在术后24和48 h与术前比较差异有显著性（P＜0.05）.结论PCEA和PCIA术后镇痛效果优良,但PCIA对红细胞膜ATPase活性有抑制作用,提示PCEA更有益病人术后的康复.     

地佐辛术后镇痛对妇科恶性肿瘤患者血浆儿茶酚胺及免疫功能的影响

目的观察地佐辛用于妇科恶性肿瘤手术患者术后镇痛的效果及对血浆儿茶酚胺和免疫功能的影响。方法择期行妇科恶性肿瘤手术患者60例,随机均分为地佐辛组(D组)和芬太尼组(F组),采用静脉复合全麻,术毕使用患者静脉自控镇痛(PCIA),D组PCIA配方为地佐辛0.8mg/kg加托烷司琼6mg加生理盐水配至100ml,F组PCIA配方为芬太尼0.01mg/kg加托烷司琼6mg加生理盐水配至100ml。记录患者术前(T0)、术毕(T1)、术后2h(T2)、6h(T3)、24h(T4)和48h(T5)的SBP、DBP、HR、SpO2及T1~T5时静息时和活动时VAS疼痛评分、Ramsay镇静评分及恶心、呕吐、低血压、呼吸抑制等不良反应。于T0、T1、T4、T5时抽取静脉血4 ml,其中2 ml采用ELISA法测定血浆肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DOP)水平,剩余2ml采用流式细胞仪测定CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞活性。结果两组患者SBP、DBP、HR、SpO2、Ramsay镇静评分差异均无统计学意义。T2~T4时D组安静时和活动时VAS评分明显低于F组(P0.05)。与T0时比较,T1时两组E、NE、DOP水平明显降低(P0.05或P0.01)。与T1时比较,T4、T5时两组E、NE、DOP水平明显升高(P0.01)。与F组比较,T4、T5时D组NE水平明显降低(P0.05)。与T0时比较,T1、T4时D组CD3+、CD4+、CD4+/CD8+、NK细胞活性明显降低(P0.01),T1时CD8+活性明显升高(P0.01),T1时F组CD3+、CD4+、CD4+/CD8+、NK细胞活性和T4时CD3+、NK细胞活性,T5时NK细胞活性明显降低(P0.05或P0.01)。与F组比较,T5时D组CD3+、CD4+、NK细胞活性明显升高(P0.05或P0.01)。两组患者术后48h不良反应发生情况差异无统计学意义。结论地佐辛用于妇科恶性肿瘤术后镇痛安全有效,与芬太尼比较镇痛效果好,术后应激反应较轻、细胞免疫功能恢复更快。     

不同镇痛方式在胸腔镜肺叶切除术患者术后镇痛效果的比较

目的比较不同镇痛方式在胸腔镜肺叶切除术患者术后镇痛的效果。方法择期行单侧胸腔镜肺叶切除术患者60例,ASAⅠ或Ⅱ级,随机均分为三组:自控椎旁神经镇痛组(PVB组)、自控硬膜外镇痛组(PCEA组)和自控静脉镇痛组(PCIA组)。PVB组在神经刺激仪引导下行术侧T4~5椎旁间隙穿刺插管,PCEA组行T4~5硬膜外穿刺插管。手术结束前30min停用瑞芬太尼;PVB组经椎旁间隙导管注射0.2%罗哌卡因15ml负荷量;PCEA组硬膜外注射0.125%罗哌卡因5ml,PCIA组静脉注射舒芬太尼0.1μg/kg。之后连接镇痛泵PVB组0.2%罗哌卡因,5ml/h,PCA量5ml,锁定时间15min;PCEA组0.125%罗哌卡因,5ml/h,PCA量5ml,锁定时间15min;PCIA组舒芬太尼1.0μg/ml,2ml/h,PCA量2ml,锁定时间15min。记录入室后(T0)、拔出气管导管30min(T1)、术后24h(T2)、48h(T3)、72h(T4)HR、MAP、PaO2、PaCO2;及T1~T4时静息和咳嗽时VAS评分。测定T0、T2~T4时用力肺活量占预计值的百分比(FVC%)、用力1秒呼气量占预计值的百分比(FEV1%),并计算FEV1/FVC;记录镇痛期间不良反应的发生情况。结果与T0时比较,T1时PVB组和PCEA组MAP明显降低、PCIA组MAP明显升高,PCEA组HR明显减慢、而T2时三组HR明显增快(P0.05)。与PCIA组比较,T1时PVB组、PCEA组和T2时PCEA组MAP明显降低,T1时PCEA组HR明显减慢(P0.05)。与PCEA组比较,T1、T2时PVB组MAP明显升高,T1时PVB组HR明显增快(P0.05)。与T0时比较,T1时三组患者PaO2和T1、T2时PCIA组PaCO2明显升高(P0.05)。与PCIA组比较,T1、T2时PVB组和PCEA组PaCO2明显降低(P0.05)。与T0时比较,T2~T4时三组FVC%、FEV1%明显降低(P0.05)。与PCIA组比较,T2~T4时PVB和PCEA组FVC%和FEV1%明显升高(P0.05)。三组FEV1/FVC组间组内差异无统计学意义。与PCIA组比较,T1~T4时PVB组和PCEA组咳嗽时VAS评分明显降低(P0.05)。PVB组和PCEA组患者无一例发生嗜睡,明显低于PCIA组14例(P0.01)。结论胸腔镜肺叶切除后患者自控椎旁神经阻滞镇痛效果完善,有利于术后肺功能恢复,且不良反应发生率低,安全有效。     

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.