高迁移率族蛋白-1在脓毒症所致多器官功能损害中的作用

目的　观察高迁移率族蛋白 1(HMG 1)在脓毒症中的变化规律及其与多器官功能损害的关系。　方法　采用大鼠盲肠结扎穿孔 (CLP)造成脓毒症模型。动物分为正常对照组 ( 10只 )、假手术组 ( 10只 )、盲肠结扎穿孔组 ( 6 0只 )及正丁酸钠治疗组 ( 2 0只 )。留取组织和血标本分别检测HMG 1mRNA表达及器官功能指标。另设实验观察正丁酸钠对脓毒症大鼠的治疗效果 ( 5 7只 )。结果　CLP术后 6～ 72h肝、肺、肾及小肠组织HMG 1mRNA表达均显著增强 (P <0 0 5或P <0 0 1)。正丁酸钠处理可显著降低CLP术后 12及 2 4h动物各组织HMG 1mRNA表达 ,12h血清丙氨酸转胺酶、肌酐水平比未治疗组显著降低 (P <0 0 1) ,2 4h肺组织髓过氧化物酶活性亦明显下降 (P <0 0 1)。早期给予正丁酸钠治疗 ,大鼠 1～ 6d存活率显著高于未治疗组 (P <0 0 5或P <0 0 1)。　结论　HMG 1在诱导脓毒症动物过度炎症反应与多器官功能损害中具有重要作用。     

腹腔感染所致多器官损害与Toll样受体2基因表达的关系

目的　探讨Toll样受体 2 (TLR2 )基因表达与严重腹腔感染所致多器官损害的关系。方法　采用大鼠盲肠结扎穿孔 (CLP)模型造成脓毒症。将 80只大鼠随机分为正常对照组 (n =10 )、假手术组 (n =10 )和脓毒症组 (n =6 0 ) ,留取肝、肺、肾及小肠组织检测TLR2和肿瘤坏死因子 α(TNF α)mRNA表达 ,同时测定血浆中丙氨酸转氨酶 (ALT)、肌酐 (Cr)及肺组织髓过氧化物酶(MPO)、小肠组织二胺氧化酶 (DAO)活性。结果　CLP后 2～ 6h肝、肺、肾及小肠组织TLR2mR NA表达迅速增多 (P <0 .0 1) ,12h达高峰 (P <0 .0 1) ,分别为 0 .818± 0 .0 14 ,0 .95 5± 0 .0 31,0 .82 0± 0 .0 45 ,0 .885± 0 .0 18,并持续至伤后 72h。相关分析结果显示 ,肝、肺、小肠中TLR2与TNF α基因表达呈显著正相关 (P <0 .0 5 0 .0 1) ,肾组织内TLR2与TNF α基因表达无明显相关(P >0 .0 5 ) ;肝、肺、肾、小肠组织中TLR2基因表达分别与ALT、MPO、Cr、DAO水平显著相关。结论　严重腹腔感染可导致多种组织TLR2mRNA持续表达 ,其改变与多器官损害密切相关。     

脓毒症大鼠多器官Toll样受体4基因表达的改变及意义

目的　探讨脓毒症大鼠肝、肺、肾及小肠组织中Toll样受体4(TLR4)基因表达的变化 规律及其意义。方法　雄性Wistar大鼠100只,动物随机分为正常对照组、假手术组、盲肠结扎穿孔 (CLP)致脓毒症组和杀菌/通透性增加蛋白(BPI)治疗组。分别检测肝、肺、肾、小肠组织TLR4、TNF αmRNA表达以及组织、血浆中内毒素水平的改变。结果　CLP后6～12h肝、肺、肾及小肠组织 TLR4mRNA表达显著升高达峰值(P<0.05或P<0.01);BPI早期治疗可显著降低各组织内毒素 水平,CLP后12h肝、肺、肾、小肠组织和24h肾组织TLR4mRNA表达亦明显抑制(P<0.05或 P<0.01)。相关分析显示,肝、肺、肾组织TLR4mRNA表达分别与相应组织及血浆内毒素水平、组 织TNF αmRNA水平均呈显著正相关。结论　CLP后细菌内毒素可迅速侵入血循环和多种组织, 它对于诱导体内TLR4基因表达上调具有显著影响,而TLR4基因广泛表达可能参与了脓毒症的病 理生理过程。     

严重烫伤后高迁移率族蛋白-1基因表达的改变及意义

目的　观察烫伤后肝、肺组织高迁移率族蛋白-1（HMG-1）mRNA表达的变化规律及其与器官功能损害的关系。　方法　采用大鼠35%Ⅲ度烫伤模型,动物随机分为正常对照组、烫伤组和重组杀菌/通透性增加蛋白(rBPI21)治疗组,留取组织和血标本分别检测组织内毒素含量、HMG-1mRNA表达及器官功能指标。　结果　严重烫伤后早期肝、肺组织HMG-1基因表达改变不明显（正常对照组肝组织0.202±0.097;肺组织0.263±0.091）,伤后24h则明显增多(肝组织0.487±0.189;肺组织0.513±0.069,P＜0.05,0.01),且一直持续至伤后72h(肝组织0.687±0.142;肺组织0.520±0.076,P＜0.01)。给予rBPI21治疗可有效抑制肝和肺中内毒素水平的升高,并显著抑制肝、肺组织HMG-1mRNA水平(P＜0.01)。相关分析结果显示,肝组织HMG-1mRNA表达与血清谷丙转氨酶、谷草转氨酶水平、肺组织HMG-1mRNA表达与髓过氧化物酶活性呈显著正相关（P＜0.05,0.01）。　结论　严重烫伤后肝、肺组织HMG-1表达显著增多,且持续时间较长,局部组织HMG-1诱生与烧伤后内毒素介导的重要器官功能损害关系密切。     

内毒素受体Tlr4及CD14基因在脓毒症大鼠肺、肝组织中的表达及其意义

目的 采用盲肠结扎穿孔（CLP）法制备脓毒症模型，探讨脓毒症时大鼠肺、肝组织内毒素受体Th4及CD14mRNA的改变及其意义。方法 50只SD大鼠，随机分为正常对照组（10只）、CLP组（40只），CLP后24、48、72和96h处死动物，留取肺、肝、肾及空肠组织，分别检测Tlr4、CD14mRNA的表达。CLP组24、48、72和96h肺、肝组织Tlr4及CD14mRNA的表达升高，与对照组比较差异有统计学意义（P〈0．05），而肾、空肠组织Tlr4及CD14mRNA的表达与对照组比较差异无统计学意义（P〉0．05）。结论 提示肺、肝组织中Tlr4及CD14基因的表达改变与脓毒症的发生发展过程有密切的关系。     

脓毒症大鼠多器官高迁移率族蛋白B1基因表达的信号机制与意义

目的探讨Janus激酶／信号转导和转录激活因子（JAK／STAT）通路对盲肠结扎穿孔术（CLP）所致脓毒症大鼠多器官高迁移率族蛋白B1（HMGBl）基因表达的影响及其意义。方法采用CLP模型,大鼠随机分为正常对照组（10只）、假手术组（10只）、CLP组（60只）、JAK2抑制剂AG490干预组（24只）、STAT抑制剂雷帕霉素（RPM）干预组（24只）。留取肝、肺、肾、肠组织测定HMGB1mRNA表达和STAT1／3的DNA结合活性。结果CLP后,肝、肺、肾、肠组织中STATl在脓毒症早期即迅速活化,6-12h后活化达高峰。肝、肺组织中STAT3的活化特点与STAT1相似,但相对较弱;在肾、肠组织中未探测到STAT3的活化。同时,CLP组除肾组织HMGB1mRNA表达改变不明显外,肝、肺、肠组织其表达均明显增强（P＜0．05或P＜0．01）。AG490早期处理后24—48h,肝、肠组织HMGB1mRNA表达显著低于CLP组（P＜0．05或P＜0．01）;RPM干预组肝、肺、肠组织HMGB1mRNA表达均呈现不同程度地抑制,其中以肺组织下降幅度尤为明显。结论严重腹腔感染可导致机体主要脏器JAK／STAT通路迅速活化,该信号途径参与了HMGB1mRNA的表达调控过程。     

脓毒症大鼠生物喋呤的组织分布特点和意义

目的　探讨腹腔感染致脓毒症时重要器官生物喋呤及其合成限速酶基因表达的改变和病理生理意义。方法　腹腔感染致脓毒症模型采用盲肠结扎穿孔法(CLP),用反相高效液相分析法和逆转录-聚合酶链反应方法测定24只大鼠肝、肺、肾等组织生物喋呤含量及三磷酸鸟苷环水解酶I(GTP-CHI)mRNA的表达。结果　脓毒症大鼠2h时肝、肺、肾组织生物喋呤含量显著增多［分别为(4.18±0.16)、(2.71±0.32)、(2.45±0.27)ng/g蛋白］,同时不同组织GTP-CHImRNA表达亦明显增强,各脏器功能均表现不同程度地损害(P＜0.05)。相关分析显示,肝、肺组织生物喋呤与反映相应脏器功能的指标呈高度正相关(分别为r=0.7916,P＜0.001和r=0.8004,P＜0.001)。结论　生物喋呤参与了腹腔感染所致脓毒症的发生、发展过程。     

脓毒症大鼠肺组织高迁移率族蛋白B1基因表达的信号转导机制

目的　探讨Janus激酶 (JAK ) /信号转导和转录激活因子 (STAT)通路对脓毒症大鼠肺组织高迁移率族蛋白B1(HMGB1)mRNA表达的调节作用及其意义。方法　采用大鼠盲肠结扎穿孔 (CLP)模型造成脓毒症 ,98只动物随机分为正常对照组、脓毒症组、JAK2抑制剂AG490处理组和STAT抑制剂雷帕霉素 (RPM )处理组。采用逆转录 聚合酶链反应 (RT PCR)测定肺组织HMGB1mRNA表达水平 ,同时测定髓过氧化物酶 (MPO )活性。结果　与正常对照组相比(0 .2 0 7± 0 .0 19) ,CLP组 2、6、2 4h肺组织HMGB1mRNA均显著升高 (P <0 .0 5～ 0 .0 1) ,分别为0 .471± 0 .0 3 5、0 .3 69± 0 .0 2 8、0 .491± 0 .0 42。AG490处理组 2h肺组织HMGB1mRNA表达明显抑制 (P <0 .0 5 ) ,RPM处理组 2、6、2 4、48hHMGB1均显著下降 (P <0 .0 5～ 0 .0 1)。同时 ,AG490、RPM处理组 2 4、48h肺组织MPO活性显著降低 (P <0 .0 5～ 0 .0 1)。结论　JAK/STAT信号通路参与了脓毒症肺组织HMGB1mRNA表达的病理过程 ,抑制其活化有助于下调HMGB1mRNA表达并减轻肺损伤。     

腹腔感染脓毒症时肺内主要模式识别受体表达变化及其与肺损伤的关系

目的观察腹腔感染脓毒症时肺组织内病原菌相关模式分子(内毒素、脂蛋白、DNA)的主要模式识别受体的表达变化及其意义。方法采用盲肠结扎穿孔(CLP)术建立30只昆明种小鼠腹腔感染脓毒症模型,将模型小鼠随机分为CLP组和假手术组,每组各15只鼠,分别于术后8,12和24h取5只鼠处死取右肺组织,采用逆转录聚合酶链反应(RT PCR)法检测肺组织内毒素受体[清道夫受体(SR)、白细胞分化抗原14(CD14)、TLR4]及细菌脂蛋白受体(TLR2)、细菌DNA受体(TLR9)mRNA的表达,酶联免疫吸附实验(ELISA)法检测肺组织内肿瘤坏死因子α(TNFα)含量,采用分光光度计法测定肺组织髓过氧化物酶(MPO)活性。结果与假手术组比较,术后8hCLP组肺组织内CD14mRNA(1.143±0.139,t=0.022,P<0.05),TLR2mRNA(0.418±0.102,t=0.021,P<0.05),TLR4mRNA(0.595±0.052,t=0.0001,P<0.01)和TLR9mRNA(0.743±0.178,t=0.0023,P<0.01)表达上调,其中TLR9mRNA呈持续上调变化,SRmRNA(0.659±0.159,t=0.029,P<0.05)呈持续下调改变;肺组织CD14、TLR4、SR、TLR2和TLR9mRNA的表达变化分别与MPO和TNFα变化呈明显的相关关系(P<0.05或P<0.01)。结论脓毒症发病过程中,肺组织内主要模式识别受体表达变化与肺损伤相关,除LPS外,其他细菌成分也可能参与了肺损伤过程。     

烫伤大鼠肝脏脂多糖结合蛋白和脂多糖受体CD14 mRNA表达的意义

目的　观察烫伤后肠源性内毒素移位与肝组织内毒素增敏系统———脂多糖结合蛋白/脂多糖受体CD14(LBP/CD14)的相互关系及其意义。　方法　采用大鼠 35 %TBSAⅢ度烫伤模型 ,动物随机分为正常对照组、烫伤和重组杀菌 /通透性增加蛋白治疗组。烫伤组和rBPI2 1　治疗组动物于伤后 12h活杀。留取肝组织和血标本分别检测组织LBP、CD14、肿瘤坏死因子α(TNFα)mR NA表达及肝脏功能指标。　结果　烫伤后肝组织内毒素含量显著降增高 (P <0 .0 1) ,且肝组织LBP/CD14、TNFαmRNA表达亦明显增多。给予rBPI2 1　治疗可显著降低肝组织内毒素水平 ,并不同程度抑制组织LBP/CD14、TNFα基因表达。同时 ,rBPI2 1　治疗组动物血清谷丙转氨酶水平显著降低 (P <0 .0 1)。　结论　烫伤后移位内毒素聚积于肝脏 ,可明显刺激机体局部组织LBP/CD14mRNA的表达 ,而组织LBP/CD14表达上调可能是严重烫伤增敏内源性内毒素作用的主要分子生物基础     

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.