血液黏弹性检测对ICU创伤性凝血病目标导向输血临床治疗价值

目的探讨检测血液黏弹性对指导ICU创伤性凝血病患者开展目标导向输血的临床价值。方法选取2017年1月至2019年12月62例ICU创伤性凝血病患者按照随机数字表法分成对照组与观察组,每组各31例。对照组采用常规血常规检查指导临床开展目标导向输血治疗;观察组则通过检测血液黏弹性来指导开展目标导向输血治疗。记录两组患者24小时内血制品、晶体输注量及两组患者6、12、24小时凝血功能改善情况。比较两组患者ICU入住时间及预后情况。结果观察组患者24小时内红细胞、血浆、冷沉淀量明显少于对照组,P0.05。观察组6、12小时凝血功能改善率明显高于对照组,P0.05,而24小时凝血功能改善率无明显差异,P0.05。观察组患者ICU入住时间平均为(7.88±2.36天明显短于对照组(9.24±2.74)天,P0.05。观察组患者24小时内好转率,明显高于对照组,P0.05,均无死亡病例。结论血液黏弹性对指导ICU创伤性凝血病患者开展目标导向输血具有重要价值,其可快速改善患者凝血功能,减少血液制品的输入,加速患者康复,缩短其住院时间,对改善预后具有积极作用。     

重组活化凝血因子Ⅶ在肝移植手术中的应用

目的 前瞻性观察应用重组活化凝血因子Ⅶ(rFⅦa)减少肝移植手术出血的临床效果.方法 将60例肝移植患者术前随机分为实验组和对照组,实验组手术开始前15 min给予rFⅦa 80μg/kg静脉注射,对照组予安慰剂.监测两组病例在手术不同时间点的凝血指标变化,计算手术出血量及浓缩红细胞、血浆及血小板的输注量;统计围手术期治疗费用.结果 实验组术中出血量及浓缩红细胞、血浆的输注量[(1245±496)ml,(6.31±4.86)U,(952±814)ml]明显少于对照组[(2496±1713)ml,(10.34±5.36)U,(1849±674)ml]差异有统计学意义(P<0.01).部分凝血酶原时间(APTT)、纤维蛋白原水平(FIB)、血小板计数(PLT),血红蛋白(HB)、血小板输注量、围手术期治疗费用差异无统计学意义(P>0.05).结论 肝移植术中单剂给予rFⅦa能迅速改善外源性凝血系统功能,减少术中出血及输血量,没有明显增加治疗费用.     

乌司他丁对创伤性休克患者肝脏和凝血功能影响的回顾性研究

目的 探讨不同程度创伤性休克患者肝功能、凝血功能的变化及乌司他丁(ulinastatin,UTI)的治疗作用.方法 收集2013年1月～2015年3月唐都医院ICU收治的128名创伤性休克患者病历资料,根据患者损伤严重度评分及住院期间是否应用UTI治疗,分为6组:轻度、中度、重度休克UTI治疗组及轻度、中度、重度休克常规抗休克治疗组.统计分析患者入院时的急性生理学及慢性健康状况评分系统(acute physiology and chionic health evaluation scoring system,APACHEⅡ)评分、总住院时间、ICU住院时间、病死率以及两组患者治疗前后各时间点血AST、ALT、血小板(blood platelet,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆纤维蛋白原(plasma fibrinogen,Fib)、纤维蛋白(原)降解产物[fibrin(agen) degradation products,FDP]、D-二聚体(D-dimer,D-D)的值,分析UTI对不同程度创伤性休克患者的救治效果.结果 ①轻度、中度创伤性休克组,UTI治疗后患者总住院时间分别为(11.0±3.0)、(14.0±4.0)d,较常规治疗组分别降低26.7％、30％;ICU住院时间(6.2±1.8)、(9.5±2.0)d,较常规治疗组分别降低42.1％、33.6％(P＜0.05).②轻度、中度、重度创伤性休克组,UTI治疗7d后患者AST值分别为(46±19)、(68±63)、(258±133)U/L,较常规治疗组分别降低21.1％、29.4％、32.1％;ALT值为(58±16)、(68±25)、(199±53) U/L,分别降低13.9％、41.3％、41.3％(P＜0.05);③轻度、中度创伤性休克组,UTI治疗7d后患者FDP (20.6±3.2)、(32.0±8.5) mg/L、较常规治疗组分别降低42.0％、34.0％;D-D为(2.2±0.5)、(4.0±0.9) mg/L,分别降低35.76％、24.5％;PT为(10.5±1.2)、(11.2±1.2)s,分别降低7.1％、11.4％;APTT为(26.5±2.8)、(34.2±3.1)s,分别降低15.6％、9.6％;Fib为(4.3±0.4)、(4.1±0.4) g/L,分别升高19.3％、22.1％;PLT为(200±24)×109/L、(186±28)×109/L,分别升高9.6％、40.0％(P＜0.05).结论 创伤性休克患者肝功能、凝血功能存在异常,UTI可改善轻中度患者肝功能、凝血功能,缩短总住院时间、ICU住院时间,对改善预后具有积极意义;对重度患者无明显治疗作用.     

rFⅦa对重症急性胰腺炎术中凝血功能及出血量影响的临床研究

目的:前瞻性地观察使用重组活化凝血因子Ⅶ(rFⅦa,诺其)改善重症急性胰腺炎病人术中的凝血功能及减少术中出血量的有效性。方法:将南京军区南京总医院自2008年3月至2009年10月收治的40例重症急性胰腺炎实施胰周坏死组织清除引流术的病人随机分为两组,一组为rFⅦa组(研究组),一组为对照组,观察两组病人手术前后的凝血指标[包括凝血酶原时间(PT)、部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)]和术中出血量。结果:研究组与对照组的PT、INR、术中出血量有显著差异(P0.001),而APTT、FIB两组间差异无统计学意义(P0.05)。结论:rFⅦa能改善病人的外源性凝血功能,减少手术中的出血量。     

人纤维蛋白原在脑外伤合并创伤性凝血病中的临床研究

目的脑外伤合并创伤性凝血病患者进行人纤维蛋白原治疗,对其临床疗效进行分析。方法选取2017年1月至2018年6月本院收治的脑外伤合并创伤性凝血病患者70例,将其随机分为试验组(n=35)与对照组(n=35)。对照组按照脑外伤诊疗常规措施进行治疗,试验组在对照组基础上给予人纤维蛋白原进行治疗,对两组治疗前后格拉斯哥(GCS)评分、神经功能缺损程度评分(NIHSS)评分以及凝血功能指标情况进行比较。结果与治疗前比较,两组GCS评分明显提高,NIHSS评分明显降低,差异具有统计学意义(P0.05);试验组GCS及NIHSS评分改善程度较对照组更显著(P0.05);在凝血功能指标方面,与治疗前比较,两组酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体水平均明显降低,纤维蛋白原(FIB)水平明显提高,差异具有统计学意义(P0.05);试验组上述各凝血功能指标水平改善程度均显著优于对照组(P0.05);与对照组比较,试验组临床用血量、ICU住院时间及病死率均明显降低,差异具有统计学意义(P0.05)。结论对脑外伤合并创伤性凝血病患者进行人纤维蛋白原治疗能够显著改善凝血功能水平,降低神经功能缺损程度以及病死率等,值得临床推广应用。     

血栓弹力图在创伤患者凝血功能障碍治疗中的指导应用

目的探究血栓弹力图在创伤患者凝血功能障碍治疗中的指导应用。方法从本院2018年4月到2019年4月选取60例腹部创伤的患者,将患者随机分成两组,每组30例,一组为对照组,通过经验性输血策略输注成分血。另一组为观察组,通过血栓弹力图指导进行目标导向性输血策略。观察比较两组患者的24小时输血情况,ICU入住时间和住院时间,以及出血相关并发症。结果两组患者的血小板(PLT)、浓缩红细胞(PRBCs)无明显差异,无统计学意义(P0.05),观察组的新鲜冰冻血浆(FFP)明显低于对照组,两组数据存在明显差异(P0.05),具有统计学意义。观察组患者的ICU入住时间(3.65±5.25)天,明显低于对照组(7.53±6.87)天,两组数据存在明显差异(P0.05),具有统计学意义。两组患者出血相关并发症无明显差异(P0.05),没有统计学意义。结论血栓弹力图指导创伤患者凝血功能障碍治疗中,进行目标导向性输血,能够有效减少ICU入住时间,以及血浆输注量,促进患者的治疗。     

大量输血程序对改善腹部创伤性休克患者预后的临床价值

探讨大量输血程序对改善腹部创伤性休克患者预后的临床意义。采取时间阶段抽样法,选取2013年2月—2014年3月收治的腹部创伤性休克患者97例作为观察组;选取2012年1月—2013年2月收治的腹部创伤性休克患者106例,作为常规组。常规组采取腹部外科常规抢救方法,观察组在常规组基础上采取大量输血程序开展抢救。记录两组患者入院24h输血量和输血比例情况,比较两组患者入院时及治疗24h后血常规及凝血功能,以及输血相关并发症和死亡率。观察组患者入院24h平均输注红细胞悬液和新鲜冷冻血浆均为(16.8±3.4)U,比例1∶1;而常规组患者的分别为(20.2±4.1)U、(13.4±3.8)U,比例1.51∶1,两组相比差异具有统计学意义(P0.05)。治疗24h后,观察组患者血小板计数高于常规组,而凝血酶原时间和活化部分凝血活酶时间均低于常规组,差异均具有统计学意义(P0.05)。观察组患者输血相关并发症发生率7.2%,常规组17.0%;观察组患者死亡发生率4.1%,常规组12.3%,差异均有统计学意义(P0.05)。大量输血程序用于腹部创伤性休克抢救可有效改善患者凝血功能,减少输血相关并发症及死亡的发生。     

重组活化凝血因子Ⅶ和抑肽酶在肝移植术中的应用

目的 前瞻性地观察使用重组活化凝血因子Ⅶ（rFⅦa）和抑肽酶对减少肝移植术中出血的有效性和安全性。方法 将中山大学附属第三医院2003—2004年欲行肝移植60例病人术前随机分为3组，第1组为rFⅦa组，第2组为抑肽酶组，第3组为对照组。对3组病人各个时间点的凝血指标、凝血弹性图（TEG）指标进行观察，比较3组术中出血量、输血量、住院时间、住院费用和血管并发症。结果 使用rFⅦa后凝血酶原时间（PT）、TEG中的反应时间（R）和最大幅度（MA）与对照组差异有显著性（P〈0.05）。而部分凝血酶原时间（APTT）、纤维蛋白原水平（FIB）、血小板计数（PLT）和TEG中的血凝块减少速率（LY30）与对照组的差异无显著性（P〉0.05）。抑肽酶组与对照组MA和LY30的差异有显著性（P〈0.05），其他指标无明显改善。rFⅦa组和抑肽酶组术中出血量、输血量均较对照组明显减少（P〈0．05）。结论 rFⅦa能迅速改善外源性凝血系统功能，抑肽酶能改善新肝期的纤溶亢进，未见增加术后血管并发症。     

左西孟旦对心脏手术病人心肌的保护作用及心功能的影响

目的探讨左西孟坦在心脏外科手术中应用的临床价值。方法 2016年12月～2019年5月拟实施瓣膜置换手术治疗的病人60例,采用随机数字表法分为试验组和对照组,每组各30例,试验组围手术期给予左西孟坦治疗,对照组围手术期给予多巴胺治疗,其余治疗措施一致;比较两组病人主动脉阻断时间,体外循环时间,胸腔引流量(心包引流量、纵隔引流量),ICU时间,住院时间和手术并发症;比较两组术前、术后24～48小时血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、脑钠肽(BNP)、术后复查左室射血分数(LVEF)。结果试验组和对照组的主动脉阻断时间分别为(84.2±11.0)分钟和(86.4±10.3)分钟、体外循环时间分别为(121.9±15.8)分钟和(123.0±13.1)分钟、胸腔引流量分别为(344.8±83.9)ml和(351.4±86.2)ml、ICU时间分别为(27.8±4.9)小时和(29.0±5.3)小时、住院时间分别为(19.4±2.8)天和(20.2±3.1)天,两组比较差异均无统计学意义(P0.05);术前,试验组和对照组的血清CK-MB、cTnI、LDH水平比较,差异均无统计学意义(P0.05);术后24小时,试验组血清CK-MB为(110.30±19.63)U/mL、cTnI为(0.264±0.529)ng/mL、LDH为(329.0±73.5)U/mL,对照组分别为(142.91±23.75)U/mL、(0.312±0.540)ng/mL和LDH(381.5±83.0)U/mL,两组比较差异有统计学意义(P0.05);术前,试验组和对照组的BNP、LVEF水平比较,差异均无统计学意义(P0.05);术后72小时,试验组病人的BNP为(788.3±185.7)ng/L,对照组为(1010.6±254.8)ng/L,试验组LVEF为(52.16±4.71)%,对照组为(49.60±3.90)%,两组比较差异有统计学意义(P0.05);试验组手术并发症率为13.33%,对照组为26.67%,两组比较,差异均无统计学意义(P0.05)。结论在心脏外科手术中应用左西孟坦对于减轻手术对心肌造成的损伤、改善术后心功能有一定的价值。     

重组活化因子Ⅶ在心脏手术中的应用:抑肽酶之后的新型药物(英文)

重组活化因子Ⅶ(rFⅦa)最初由美国FDA批准用于治疗凝血因子Ⅷ、Ⅸ缺乏的A型和B型血友病。在欧洲,它的应用范围已经延伸到凝血因子Ⅶ缺乏和血小板功能不全患者的治疗。相继有报道,rFⅦa应用于心脏、肝脏、整形外科和泌尿外科手术等说明书以外的范畴。rFⅦa有一定的疗效,但也存在致病率和死亡率增加的可能风险,故其在临床上的应用仍具有争议。本文对凝血的基本原理、rFⅦa的作用机制以及目前rFⅦa在心脏外科手术中的应用进行综述。在体研究表明,凝血障碍的临床表现不能为经典的凝血途径所解释。原有的凝血模式忽略了血小板的作用以及血小板膜磷脂引起的凝血酶的释放。新提出的以细胞为基础的凝血模式则描述了凝血的启动、放大以及延伸过程。新的模式是通过辨认带有组织因子的血小板或细胞膜来活化特定的凝血因子。rFⅦa在心脏手术中的应用因为影响因素(血液稀释、pH值、体温、血小板计数和血压等)众多而变得复杂。最近的研究证明了rFⅦa适用于心脏手术中的难治性出血,可以减少异体输血、降低二次探查手术的发生率,血栓栓塞的不良反应没有明显增加,但研究证据尚不充分。酸中毒、低体温、血液稀释、血小板耗尽或其他凝血因子缺乏等诸多因素可能会影响rFⅦa的疗效。为明确rFⅦa的安全性和有效性,还需进一步的大型多中心随机对照研究来证实。     

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.