比较吗啡和氯诺昔康术后镇痛对机体免疫功能的影响

目的　比较吗啡和氯诺昔康用于术后镇痛对手术患者免疫功能的影响。方法　 36例ASAⅠ～Ⅱ级静脉全麻下行腹腔镜胆囊切除术患者 ,随机分成三组 ,每组 1 2例。Ⅰ组用 0 .0 3%吗啡PCA镇痛 ;Ⅱ组用 0 .0 2 4 %氯诺昔康PCA镇痛 ;Ⅲ组为生理盐水对照组。分别测定诱导前、拔管前、术后 2 4h、术后 72h血浆内毒素、C 反应蛋白 (CRP)、白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 1 0 (IL 1 0 )及游离白细胞介素 2受体 (sIL 2R)。结果　内毒素含量各组术后均明显升高 ,组间比较无显著性差异。各组CRP术后均升高 ,但术后 2 4hⅡ组升幅最小 (P <0 .0 5 )。术后 72hⅠ、Ⅱ组IL 2仍降低 (P <0 0 5 ) ,Ⅲ组已恢复 (P >0 0 5 )。术后 2 4hⅠ、Ⅱ组IL 6升幅则较Ⅲ组少(P <0 0 5 )。Ⅱ组L 1 0术后升幅较Ⅰ、Ⅲ组显著 (P <0 0 5 )。术后 2 4hⅠ、Ⅱ组sIL 2R术后升高较Ⅲ组明显 (P <0 0 5 )。结论　氯诺昔康术后镇痛控制炎性应激反应比吗啡有效 ,能较好地维持细胞因子平衡 ,缓解术后的免疫损伤     

不同镇痛方法对子宫切除术后病人血清细胞因子水平的影响

目的　评价四种常见不同镇痛方法对子宫切除术后病人血清细胞因子水平的影响。方法　根据镇痛方法的不同,将48例行子宫切除术病人随机分为四组:罗比卡因复合芬太尼硬膜外镇痛组(Ⅰ组,n=12);芬太尼静脉镇痛组(Ⅱ组,n=12);罗比卡因复合曲马多硬膜外镇痛组(Ⅲ组,n=12);曲马多静脉镇痛组(Ⅳ组,n=12)。观察麻醉前、手术后2、24、48和72 h五个时点病人血清细胞因子白细胞介素 6(IL -6)、白细胞介素 10(IL -10)水平的变化。结果　(1)四种镇痛方法均能提供一定的镇痛效果;(2)四组病人术后血清 IL- 6、IL- 10 水平与麻醉前值比较均升高(P<0 .05),一般在术后24 h达峰值。比较血清IL- 6、IL- 10浓度变化,Ⅰ和Ⅲ组抑制这两种细胞因子释放的能力明显强于Ⅱ和Ⅳ组(P<0. 05),与Ⅰ组比较,Ⅲ组更为明显(P<0. 05)。结论　硬膜外局麻药复合阿片受体激动药镇痛模式可更有效地降低术后炎性应激反应。     

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.     

血CRP、IL-6、IL-10在不同类型胆囊切除术中的变化研究

目的探讨日间腹腔镜胆囊切除术与常规胆囊切除术两种手术方法对患者血c反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介素10（IL-10）的影响,比较两种手术对患者身体的损伤程度及优越性。方法90例胆囊疾病患者随机分为两组,60例行腹腔镜胆囊切除术,30例行常规胆囊切除术。其中行腹腔镜胆囊切除术60例病例随机分为两组,30例行腹腔镜胆囊切除术30mjn内完成,30例行腹腔镜胆囊切除术在30min以上完成。比较2种术式手术时间、术前和术后及行腹腔镜胆囊切除术30min内完成和30min以上完成的血C反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介10（IL-10）的变化,术后抗生素使用率。结果腹腔镜组的手术效果明显优于对照组,血CRP、IL-6、IL-10明显低于对照组（P〈0．05）;腹腔镜手术30min内完成的手术效果明显优于腹腔镜手术30min以上,血CRP、IL-6、IL—10明显低于对照组（P〈0．05）。结论日问腹腔镜胆囊切除术是一种安全可靠的手术方法,与传统的开腹手术相比具有创伤小、出血少、术野清楚、切口美观、术后恢复快、抗生素使用率低、住院时间短等优点,将成为胆囊切除术的首选术式。     

曲马多术后镇痛对腹腔镜胆囊切除术患者血清白细胞介素-2和白细胞介素-6水平的影响

目的 研究通过曲马多用于腹腔镜胆囊切除术患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),观察其术后视觉模拟评分(visual analogue score,VAS),镇静(Ramsay)评分以及对血清白细胞介素-2(IL-2)及白细胞介素-6(IL-6)水平的影响,探讨曲马多用于静脉自控镇痛效果及对机体免疫功能的影响.方法 选择40例行择期腹腔胆囊切除术的的患者,ASA Ⅰ或Ⅱ级,用信封法随机分为两组,每组20例:Ⅰ组(芬太尼组),Ⅱ组(曲马多组).观察记录术后2、4、24 hVAS评分,Ramsay评分,以及血清IL-2,IL-6水平,并记录副作用. 结果 两组患者术后2、4、24 hVAS、Ramsay评分、PCIA有效按压次数差异无统计学意义(P＞0.05).与诱导前比较Ⅰ组为(12.4±2.0),Ⅱ组为(12.1±2.1),Ⅰ、Ⅱ组血清IL-2水平术后2h明显升高,Ⅰ组为(16.8±2.4),Ⅱ组为(17.4±2.6)(P＜0.05),持续至术后24 h(P＜0.05),两组组间比较差异无统计学意义(P＞0.05).与诱导前比较,Ⅰ、Ⅱ组血清IL-6水平比较差异无统计学意义(P＞0.05),两组患者术后不同时间点血清IL-6水平比较差异无统计学意义(P＞0.05). 结论 与本研究中芬太尼剂量相比,曲马多用于腹腔镜胆囊切除手术术后镇痛能产生良好的镇痛效果,促进机体的免疫功能并有效地抑制术后应激反应.     

153例肾癌术后生物化疗的临床分析

目的 :探讨肾癌切除术后生物化疗的作用。方法 :对 15 3例肾癌患者按治疗方法分为A、B、C三组 ,A组术后用白细胞介素 (IL) 2 ,B组术后用IL 2和α 干扰素 ,C组术后用IL 2、α 干扰素和氟铁龙联合治疗。结果 :通过随访比较 ,三组早期 (Ⅰ～Ⅱ期 )肾癌患者 5年生存率差异无显著性意义 ,晚期 (Ⅲ期以上 )肾癌患者 5年生存率差异有显著性意义 (P <0 .0 5 )。结论 :氟铁龙、IL 2和α 干扰素联合治疗对晚期肾癌有效     

氯胺酮与芬太尼对细胞因子反应影响的比较

目的　探讨全凭静脉麻醉中镇痛药的选择是否会对上腹部手术所致细胞因子反应产生影响。方法　 2 8例ASAⅠ～Ⅱ级择期上腹部手术患者 ,随机分为丙泊酚 +氯胺酮组 (K组 )和丙泊酚 +芬太尼组 (F组 ) ,接受全凭静脉麻醉 ,分别于麻醉前、切皮前及手术结束后 5min抽取静脉血分离血清 ,用放免法检测血清白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 8(IL 8)。结果与麻醉前相比 ,术后 5min两组IL 2水平明显降低 (P <0 0 5 ) ,IL 6水平明显升高 (P <0 0 5 ) ,而组间无显著性差异 ,两组IL 8水平均无明显变化。结论　氯胺酮和芬太尼对上腹部手术时细胞因子IL 2、IL 6及IL 8反应的影响相似。     

心肺转流下不停跳心脏手术对血浆C反应蛋白及细胞因子水平的影响

目的　比较心肺转流(CPB)下不停跳和停跳心脏手术对患者血浆中C反应蛋白 (CRP)及促炎性因子肿瘤坏死因子α(TNF α)、白细胞介素 8(IL 8)、白细胞介素 10(IL 10)水平的影 响。方法　择期心内直视手术患者20例分为两组:CPB下心脏不停跳组(A组)和CPB下心脏停跳 组(B组);每组各10例。分别于全麻诱导前(基础,T0)、主动脉开放后5min(T1)、CPB停机后5min (T2)、术毕(T3)、术后24h(T4)、术后48h(T5)抽取患者中心静脉血,放免法定量测定TNF α、CRP、 IL 8和IL 10的血浆水平。结果　A组和B组相比较,CRP在T4～T5、IL 10在T3～T5增加显著, 而IL 8在T2～T4降低明显,差异有显著意义(P<0.05)。和T0相比较,A组中CRP在T3～T5、IL 8在T3和IL 10在T2～T5增加显著;而B组中,CRP在T4～T5、IL 8在T2～T4和IL 10在T3～ T5增加明显,差异有显著意义(P<0.05)。结论　心内直视手术时采用CPB下心脏不停跳技术,可 在围术期减轻患者机体炎性反应方面起积极作用。     

良性前列腺增生症三种术式对机体应激影响的比较

目的探讨三种术式治疗良性前列腺增生症所致创伤对应激性神经内分泌免疫反应的影响及其临床意义. 方法分析经尿道前列腺电切除术(Ⅰ组)、耻骨上前列腺摘除术(Ⅱ组)和耻骨后前列腺摘除术(Ⅲ组)各20例手术前后血清白细胞介素-6(IL-6)、皮质醇浓度及T细胞亚群的变化特点. 结果①三种术式患者术后3 h IL-6含量均显著升高,Ⅱ、Ⅲ组明显高于Ⅰ组(P<0.05).Ⅱ、Ⅲ组患者术后3 h皮质醇含量显著升高(P<0.01),而Ⅰ组变化不明显(P>0.05).Ⅱ、Ⅲ组患者术后2 d CD4 /CD8 比值显著下降(P<0.01)且明显低于Ⅰ组(P<0.05),Ⅰ组术后T细胞亚群无明显变化.④3组患者术后3 h皮质醇、IL-6含量均与手术时间及术中失血量显著相关(r=0.51～0.80,P<0.05). 结论开放手术机体应激反应程度高于内镜手术,缩短手术时间、减少术中失血量是减轻有害应激的有效方法.     

精浆中细胞因子检测及其意义

目的　研究精浆中的细胞因子的含量及其对男性生育能力的影响。方法　用ELISA法检测了 15例证明有生育能力的健康男性及 2 7例不育男性精浆中的IL 2 .IL 6、IL 8、TNF α、sIL 2R的含量 ,同时检测了精浆中的SOD、MDA及白细胞。结果　本组男性不育症 (非感染组 )患者精浆中的IL 6、IL 8、sIL 2R水平与有生育能力的男性相比有差异 ,感染组精浆中的IL 2 .IL 6、IL 8、TNF α、sIL 2R的含量与生育组比有明显的差异 (P <0 .0 1)。结论　本研究提示生殖道感染时精浆中的细胞因子与男性不育有密切的相关     

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.     

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.