雷莫司琼、恩丹西酮、氟哌利多预防妇科盆腔根治术后恶心呕吐及对Q-T间期的影响

目的 比较雷莫司琼、恩丹西酮及氟哌利多用于预防妇科盆腔根治术后恶心呕吐(PONV)的效果及对患者Q-T间期的影响.方法 75例患者随机均分为三组,手术开始2 h左右分别静注雷莫司琼0.3 mg(L组)、恩丹西酮4 mg(E组)或氟哌利多2 mg(F组).记录用药同时及用药后第2、3、5、10、15 min的ECG,分析经HR修正的Q-T间期(QTc).术后2、6、12、24、48 h观察患者PONV及不良反应发生情况.结果 在术后0～12 h内L组PONV的发生率明显低于E、F组(P＜0.05).F组给药后2、3 min Q-T间期较给药前明显延长(P＜0.05).结论 雷莫司琼预防妇科肿瘤患者盆腔根治PONV的效果略优于恩丹西酮及氟哌利多;氟哌利多显著延长Q-T间期.     

恩丹西酮与氟哌利多预防胃癌根治术中恶心呕吐的效果比较

在硬膜外麻醉下行胃癌根治术 ,术中常见恶心呕吐。传统做法是在腹膜切开探查腹膜以前静注半量至全量哌异合剂[1] 或芬氟合剂等辅助药物 ,使患者入睡 ,不感牵引内脏之不适。但其效果并不很理想。笔者预防性使用恩丹西酮收到了满意的效果。资料与方法一般资料　 6 9例ＡＳＡⅠ～Ⅱ级择期胃癌手术患者 ,年龄 41～ 6 9岁 ,随机分成恩丹西酮组 (Ⅰ组 ,2 4例 )、氟哌利多组 (Ⅱ组 ,2 4例 )及对照组 (Ⅲ组 ,2 1例 )。所有患者均无心、肺、肝、肾病史 ,年龄、性别、体重及手术时间各组均无明显差异。术前精神紧张焦虑和自诉平时易恶心者不列入试验组…     

昂丹司琼预防腹腔镜胆囊切除术后恶心呕吐的疗效观察

目的探讨腹腔镜胆囊切除手术后静脉注射昂丹司琼对术后恶心呕吐的预防疗效。方法90例ASAⅠ-Ⅱ级，择期腹腔镜胆囊切除术患者随机分成3组。第1组对照组，术后给予生理盐水5ml。第Ⅱ组氟哌利多组，术后静注氟哌利多1．25mg。第Ⅲ组术后静注枢复宁4mg。观察术后24h患者的恶心呕吐情况。结果第Ⅰ、Ⅱ、Ⅲ组患者恶心呕吐发生率分别为60、0％、30．0％、26．7％。第Ⅱ组与第Ⅰ组之间差异有显著性（P〈0．05），第Ⅲ组与第Ⅰ组之间差异有非常显著性（P〈0．01）。第Ⅱ组与第Ⅲ组之间差异无显著性（P〉0．05）。结论本研究示术毕时静脉注射昂丹司琼4mg与氟哌利多1．25mg均能有效防止、预防腹腔镜术后恶心呕吐。     

骨科手术后静脉自控镇痛胃肠反应的防治

目的：探讨骨科手术后静脉自控镇痛胃肠反应的防治方法。方法：选择ASAⅠ~Ⅱ级、年龄19~89岁、体重42~94 kg的骨科手术后患者400例,随机分为恩丹西酮组、氟哌利多组、地塞米松组和联合组各100例,于手术开始时缓慢注射止吐药物,评估术后24 h患者胃肠反应的状况。结果：氟哌利多组、地塞米松组发生胃肠反应的例数明显多于恩丹西酮组,程度亦较后者严重（P〈0.05）,但前者2组间比较无明显差异。联合组发生的例数明显少于其他3组,程度亦较轻（P〈0.01）。结论：恩丹西酮与地塞米松复合配以小剂量氟哌利多,镇吐效果显著。     

几种药物预防腹腔镜胆囊切除术后恶心呕吐的对比研究

目的比较格拉司琼、氟哌利多、地塞米松单用或合用预防腹腔镜胆囊切除术后恶心呕吐的效果。方法择期腹腔镜胆囊切除术患者160例,于麻醉前随机分为四组,静脉注入各预防性药物,A组：地塞米松10mg;B组：氟哌利多2．5mg;C组：氟哌利多2．5mg＋地塞米松10mg;D组：格拉司琼3mg。观察术后24h恶心呕吐发生率。结果四组术后24h恶心呕吐总发生率分别为78％、63％、25％、28％,C组和D组明显低于A组和B组（P〈0．01）,而C组与D组差异无统计学意义。结论格拉司琼、氟哌利多、地塞米松都有预防腹腔镜胆囊切除术后恶心呕吐的作用,但以格拉司琼和氟哌利多＋地塞米松效果显著,而且氟哌利多＋地塞米松更显示其性价比优越性。     

昂丹司琼与氟哌利多应用于全麻腹腔镜胆囊切除术后恶心、呕吐的临床观察

目的观察比较昂丹司琼与氟哌利多在全麻腹腔镜胆囊切除术后预防恶心、呕吐的临床效果。方法选择择期全麻下行腹腔镜胆囊切除术的患者120例,随机分为3组,每组40例。A组镇痛泵中加入昂丹司琼8 mg,手术结束前静脉注射昂丹司琼4 mg;B组镇痛泵中加入氟哌利多5 mg;C组不加昂丹司琼与氟哌利多。记录各组术后恶心、呕吐发生例数及应用止吐药的例数。结果A组恶心4例,呕吐2例;B组恶心16例,呕吐8例;C组恶心24例,呕吐16例,三组间恶心、呕吐的发生率比较差异均有统计学意义(P<0.05)。结论昂丹司琼与氟哌利多均能降低术后恶心、呕吐的发生率,但昂丹司琼的预防效果优于氟哌利多。     

不同止吐药预防术后PCA恶心呕吐的临床观察

目的　探讨各种止吐药预防术后芬太尼静脉PCA恶心呕吐的效果。方法　选择硬膜外麻醉下行开腹手术患者 83例 ,术毕接PCA泵行芬太尼静脉PCA(PCIFA)。并随机分成四组 ,C组 :不给止吐药 ;M组 :甲氧氯普胺 10mg ;O组 :恩丹西酮 8mg ;N组 :欧必亭 5mg。 结果　N组术后12小时和 2 4小时止恶心、呕吐作用均明显优于其他三组 ;恶心、呕吐发生率O组仅于术后 12小时稍有降低 ,而N组术后 12和 2 4小时下降均明显。结论　欧必亭与恩丹西酮、甲氧氯普胺比较 ,能更有效地防治PCIFA引起的恶心、呕吐     

不同止吐药预防曲马多静脉镇痛后恶心呕吐的疗效观察

目的探讨各种止吐药预防妇科手术后曲马多静脉自控镇痛（PCIA）后恶心呕吐的效果.方法选择ASA Ⅰ～Ⅱ级、在硬膜外麻醉下行妇科手术病人106例,术毕行曲马多PCIA.随机分成五组：C组（对照组）,不给止吐药;M组,甲氧氯普胺10 mg;O组,恩丹西酮8 mg;N组,欧必亭5 mg;A组,阿扎司琼10 mg,观察术后12、24、36 h病人镇痛效果和恶心呕吐发生情况.结果N组术后12、24和36 h止恶心呕吐作用均明显优于其他四组;各治疗组恶心呕吐发生率在术后12及24 h明显低于对照组（P＜0.01）,N组术后12、24、36 h均显著低于其他组（P＜0.05）.结论欧必亭与恩丹西酮、甲氧氯普胺及阿扎司琼比较,能更有效地防治妇科手术后曲马多PCIA引起的恶心呕吐.     

格拉司琼用于预防术后恶心呕吐

目的观察妇科子宫切除术患者术后恶心、呕吐情况，通过新型5-羟色胺，(5-HT3)受体拮抗剂格拉司琼预防术后恶心、呕吐的效果，并与氟沛利多相比较。方法6ID例妇科择期子宫切除术患者，ASAⅠ～Ⅱ级。术前无恶心、呕吐，随机分为3组：A组为格拉司琼组20例；B组为氟沛利多组加例；C组为对照组20例，并分别于术中同时使用镇痛药一格拉司琼组静注格拉司琼3mg加入5％GS20ml，氟沛利多组静注氟沛利多2．5mg。对照组度冷丁50mg于摩菲氏滴管滴入．观察3组患者白手术结束至手术后48h的恶心、呕吐程度并予评估。结果3组患者用药后监测血压、呼吸、心率、血氧饱和度、心电图情况与给药前相比无明显差异，手术后恶心、呕吐情况，氟沛利多组和对照组发生例数明显多于格拉司琼组，程度亦较后者重。结论麻醉性镇痛药最多引起术后恶心、呕吐，而新型止吐剂格拉司琼是一种高选择性的5-HT3受体拮抗剂，通过拮抗中枢化学感受区及外周迷走神经末梢的5-HT3受体，从而抑制恶心、呕吐的发生。注药后无锥体外系症状发生，无血压偏低、无烦躁、无过度镇静等副作用…。对手术后引起的恶心、呕吐具有良好的预防和治疗作用。     

小剂量氟哌利多复合恩丹西酮对腹腔镜下胆囊切除手术后恶心呕吐的预防作用

尽管近年来采取了许多预防措施,各种手术的术后恶心呕吐(PONV)总发生率仍高达20％～37％,高危PONV患者发生率达70％～80％,腹腔镜手术是PONV发生的高危因素.氟哌利多止吐作用和不良反应的发生与剂量呈正相关口].腹腔镜手术是PONV发生的高危因素,所以本研究旨在探讨小剂量氟哌利多复合恩丹西酮对腹腔镜下胆囊切除手术PONV的预防作用和不良反应的发生情况.     

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.