胰腺术后胰瘘发生相关危险因素分析（附303例胰腺手术报告）

目的 探讨影响病人胰腺手术后胰瘘发生率的危险因素。方法 回顾性分析2012年2月至2015年1月中国医科大学附属第一医院收治的303例行胰腺手术病人资料,其中术后发生胰瘘50例。对影响术后胰瘘发生的相关因素进行单因素分析及Logistics回归分析。结果 单因素分析结果显示,影响术后胰瘘发生的因素包括性别、病理类型、胰管扩张、手术时间、术中出血量、术前血红蛋白、术前血清总胆红素、术后血清总胆红素（P<0.05）。非条件Logistic回归分析结果显示,影响术后胰瘘发生的独立危险因素为：性别（OR=12.001,95%CI 3.049~47.230,P<0.05）、病理类型（OR=1.605,95%CI 1.108~2.324,P<0.05）、胰管扩张（OR=1.177,95%CI 0.188~0.468,P<0.05）、手术时间（OR=1.641,95%CI=1.173~2.339,P<0.05）、术中出血量（OR=1.096,95%CI 1.094~1.099,P<0.05）、术前血红蛋白（OR=0.888,95%CI 0.823~0.921,P<0.05）、术前血清总胆红素（OR=1.359,95%CI 1.335~1.381,P=0.010）、术后血清总胆红素（OR=1.030,95%CI 1.064~1.004,P<0.05）。结论 男性、手术前后血清胆红素浓度高、壶腹部癌或十二指肠癌是胰瘘发生的独立危险因素,而胰管扩张则可减少胰腺手术后胰瘘的发生。     

胰十二指肠切除术后胰瘘相关危险因素分析

目的 探讨胰十二指肠切除术后胰瘘发生的相关危险因素.方法 回顾性分析2001年6月至2006年6月间97例采用标准胰腺十二指肠切除术(PD)和传统Child法消化道重建患者的临床资料,分别对围手术期可能与胰瘘发生相关的因素进行分析比较.通过单因素分析与多因素分析筛选出与PD术后胰瘘发生相关的因素. 结果 97例PD术后患者中,发生胰瘘13例.单因素分析结果显示,术前血清胆红素水平≥170 mmol/L(P=0.038)、手术时间(P=0.003)、胃肠吻合口下方输入段与输出段之间加做Braun吻合(P=0.034)及术后预防性应用生长抑素(P=0.003)与PD术后胰瘘的发生相关;多因素分析结果显示,术前血清胆红素水平≥170 mmol/L(OR=11.687,P=0.021)是术后胰瘘发生的独立危险因素,而术后预防性应用生长抑素(OR=0.056,P=0.016)是胰瘘发生的保护因素. 结论 术前血清胆红素水平≥170 mmol/L是PD术后胰瘘发生的危险因素,术后预防性应用生长抑素可以减少胰瘘的发生.     

腹腔镜胰十二指肠切除术后胰漏的相关因素分析

目的探讨腹腔镜胰十二指肠切除术后B、C级胰漏发生的预后因素。方法回顾性分析2016年12月～2018年6月83例腹腔镜胰十二指肠切除术的临床资料,对可能与B、C级胰漏有关的围手术期因素进行分析。单因素分析采用χ~2检验,有统计学意义的因素采用非条件logistic回归分析进行多因素分析。结果 83例中11例(13.3%)发生术后B、C级胰漏,其中B级9例(10.8%),C级2例(2.4%)。logistic回归多因素分析显示,术前总胆红素≥171μmol/L (OR=4.636,95%CI:1.080～19.894,P=0.039)、胰腺质地柔软(OR=0.202,95%CI:0.047～0.866,P=0.031)与B、C级胰漏的发生密切相关。BMI≥25(OR=22.347,95%CI:1.462～341.501,P=0.026)、术后未应用生长抑素(OR=0.071,95%CI:0.006～0.799,P=0.032)是胰腺质地柔软患者术后B、C级胰漏发生的相关因素。BMI≥25 (OR=13.474,95%CI:1.258～144.322,P=0.032)、术前采取减黄措施(OR=0.057,95%CI:0.005～0.638,P=0.020)是术前总胆红素≥171μmol/L患者术后B、C级胰漏发生的影响因素。结论胰腺质地柔软及术前总胆红素≥171μmol/L与腹腔镜胰十二指肠切除术后B、C级胰漏发生密切相关。BMI≥25时,此类患者B、C级胰漏发生风险明显增加。当术前总胆红素≥171μmol/L时,宜术前采取减黄措施。对于胰腺质软者,预防性应用生长抑素可在一定程度上降低腹腔镜胰十二指肠切除术后B、C级胰漏发生风险。     

胰十二指肠切除术后胰瘘发生的相关因素分析

目的 探讨胰十二指肠切除术后胰瘘发生的危险因素.方法 回顾性分析2000年5月至2010年5月昆明医学院第二附属医院收治的186例行胰十二指肠切除术患者的临床资料,根据术后是否发生胰瘘将患者分成胰瘘组(39例)和非胰瘘组(147例)进行队列研究.对围手术期可能与胰瘘发生相关的多种因素进行分析,筛选胰十二指肠切除术后胰瘘发生的危险因素.单因素分析采用x2检验或Fisher确切概率法,多因素分析采用Logistic回归模型.结果 186例患者中39例发生胰瘘,其中A级26例、B级10例、C级3例.单因素分析结果显示:术前黄疸时间、术前6个月体质量下降、术前TBil、术前纠正后Alb、术后第3天Alb、胰腺残端游离长度、胰管直径、胰腺质地、腹腔引流管拔出时间是发生胰瘘的影响因素(x2=34.990,20.480,8.212,10.890,13.561,11.505,13.820,4.539,36.590,P＜0.05).多因素分析结果显示:术前黄疸时间＞8周、术前6个月体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软、腹腔引流管拔出时间＞5d是发生胰瘘的独立危险因素(OR=2.229,3.383,1.437,1.273,11.939,P＜0.05).结论 术前黄疸时间＞8周、术前6个月内体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软和腹腔引流管拔出时间＞5d将增加患者胰十二指肠切除术后胰瘘的发生率.     

胰十二指肠切除术后胰瘘的危险因素分析

目的分析胰十二指肠切除术后胰瘘的危险因素,探讨黏膜-黏膜胰肠吻合减少术后胰瘘的可能性。方法回顾性研究我院2000年1月至2004年4月间85例胰十二指肠切除术病例,分析影响胰瘘的术前及术中危险因素,比较不同胰肠吻合方式对胰瘘的影响。结果术后胰瘘总发生率16.5%(14/85),其中黏膜-黏膜组3.57%(1/28),传统套入组22.8%(13/57)。统计学分析显示,胰肠吻合方式、胰管直径及残余胰腺质地为影响胰瘘发生的显著因素;多因素Logistic回归分析表明,胰管直径和胰腺质地为影响胰瘘发生的独立危险因素,P值分别为0.013和0.009,相对危险度(OR)分别为5.276和8.538。结论胰肠吻合方式、胰管直径和胰腺质地是影响胰十二指肠切除术后胰瘘的危险因素,对胰管扩张者(≥3mm)行黏膜-黏膜吻合可显著降低术后胰瘘的发生率,是一种安全可靠的胰肠吻合方法。     

端侧胰管空肠黏膜-黏膜吻合术后胰瘘的危险因素分析

目的 分析胰十二指肠切除术中应用端侧胰管空肠黏膜-黏膜吻合法术后胰瘘的危险因素.方法 回顾性分析我院1994年1月至2008年1月问101例胰十二指肠切除术病例,分析影响胰瘘的术前及术中危险因素. 结果本组胰瘘发生率为9.9%(10/101),单变量分析结果表明术前黄疸程度(χ2=5.814,P=0.016)、黄疸持续时间(χ2=4.17,P=0.041)、胰腺质地(χ2=5.286,P=0.021)、胰管直径(χ2=4.165,P=0.041)、手术失血量(χ2=5.273,P=0.022)是胰瘘发生的危险因素,多因素Logistic回归分析结果表明,胰腺质地(OR=13.355,P=0.023)、术前黄疸程度(OR=12.126,P=0.006)、手术失血量(OR=5.92,P=0.032)是胰瘘发生的独立危险因素.Logistic回归预测方程:P=1/[<1+e-(-6.378+2.592胰腺质地+2.495术前黄疽程度+1.778手术失血量)],此方程预测发生胰瘘的正确性为92.1%.结论 胰腺质地、术前黄疸程度、手术失血最是端侧胰管空肠黏膜-黏膜吻合法术后胰瘘发生的独立危险因素,手术技术提高,减少术中失血量,可降低胰瘘的发生率.     

胰十二指肠切除术后腹内并发症和手术死亡的影响因素分析

目的探讨胰十二指肠切除术（PD）后胰瘘等腹内并发症发生和手术死亡的相关危险因素,为临床有效减少其并发症发生和手术死亡提供理论依据。方法回顾性分析2003年6月至2011年11月期间上海交通大学医学院附属第三人民医院施行标准PD术的78例患者的临床资料,分析手术并发症、胰瘘及手术死亡的影响因素。结果术后发生并发症29例,其中胰瘘13例;手术死亡6例。单因素分析结果显示,影响胰瘘和术后并发症发生的因素有胰腺质地、胰管直径、术前胆道引流、胰管内置支撑管及应用生长抑素（P〈0．05）;未发现与手术死亡相关的因素。多因素分析结果显示,胰管内未置支撑管（OR=1．867,P=0．000）、胰腺质地软（OR=1．356,P=0．046）和胰管直径小于3mm（OR=2．874,P=0．015）者的胰瘘发生率更高;胰管内未置支撑管（OR=1．672,P=0．030）、胰腺质地软（OR=1.946,P=0．042）和胰管直径小于3mm（OR=1．782,P=0．002）者的手术并发症发生率更高;未发现与手术死亡相关的独立危险因素。结论术中胰管内是否置支撑引流管、胰腺质地和胰管直径是PD术后胰瘘和手术并发症发生的影响因素,行PD术应认真考虑这些因素并采取必要措施。     

胰十二指肠切除术后胰漏的影响因素分析

目的 探讨影响胰十二指肠切除术(PD)后胰漏发生的相关影响因素.方法 回顾性分析2007年1月至2012年3月323例PD患者的临床资料,其中男性185例,女性138例;年龄27～82岁.根据是否发生胰漏分为胰漏组52例及非胰漏组271例.对围手术期可能产生胰漏的20个相关因素,如年龄、性别、原发疾病、酗酒史、胆管炎、胆红素、清蛋白、血红蛋白等进行单因素分析及非条件Logistic多因素分析.结果 全部323例PD术后总并发症发生率30.3％(98/323),病死率3.7％(12/323),其中胰漏发生率16.1％(52/323),因胰漏死亡7例.单因素分析显示,两组间原发疾病、术前胆红素、术中出血量、输血量、胰腺质地、胰管直径、胰管支架引流方式、专业组差异有统计学意义(x2=4.072 ～9.008,P＜0.05).多因素分析显示:原发病(OR= 2.091,P=0.001)、胰腺质地(OR=7.715,P=0.040)、胰管直径(OR=5.405,P=0.006)、胰管支架引流方式(OR =4.313,P=0.001)及专业组(OR =6.404,P =0.006)是胰漏的独立危险因素.结论 原发疾病、胰腺质地、胰管直径、胰管支架引流方式及专业组是胰漏发生的独立危险因素.手术精准操作,术中放置胰管支架外引流,成立胰腺外科专业组能够有效降低胰漏的发生率.     

腹腔镜胰十二指肠切除术后胰瘘的危险因素分析

目的:探讨腹腔镜胰十二指肠切除术(LPD)后发生胰瘘的危险因素。方法 :选择我院2016年6月—2018年9月行LPD治疗的124例患者作为研究对象,根据术后是否出现胰瘘分为胰瘘组(37例)和无胰瘘组(87例)。采用调查问卷及查阅临床资料相结合的方式,分析不同特征患者术后胰瘘发生情况,通过多因素Logistic回归分析影响术后胰瘘发生的危险因素。结果:124例患者均顺利完成LPD,术后共37例(29.8%)患者出现胰瘘,其中化学漏20例,B级胰瘘14例,C级胰瘘3例。单因素分析显示年龄、胰腺质地、主胰管直径、术中失血量、肿瘤发生部位、术前总胆红素、术前白蛋白水平与术后胰瘘有关;多因素Logistic回归分析显示年龄(OR=5.028)、胰腺质地(OR=13.543)、主胰管直径(OR=2.502)、术前总胆红素(9.137)及术前白蛋白水平(OR=6.050)为术后胰瘘发生的独立危险因素。结论:LPD术后发生胰瘘的危险因素较多,手术前后加强管理,减少术后胰瘘发生概率。     

胰十二指肠切除术后感染并发症相关危险因素的Meta分析

目的探讨胰十二指肠切除术后感染并发症发生的危险因素。方法收集2005年1月至2016年9月间Pub Med、中国知网、万方等数据库公开发表的有关胰十二指肠切除术后感染并发症危险因素的文献,运用固定或随机模型对各个因素进行合并分析。结果共纳入9项研究、1 386例胰十二指肠切除术患者。Meta分析结果显示,术后感染组患者血清白蛋白水平低于术后非感染组(WMD=-3.56,95%CI:-6.01,-1.10,P=0.005);术后感染组手术时间长于非感染组(WMD=37.65,95%CI:20.81~54.49,P0.0001);围手术期输血的患者术后感染率高于未输血的患者(OR=1.62,95%CI:1.15~2.28,P=0.006);术后发生胰瘘的患者术后感染率高于无胰瘘的患者(OR=4.96,95%CI:2.68~9.18,P0.00001)。术前胆道引流(OR=1.15,95%CI:0.86~1.55,P=0.34)、术中出血量(WMD=35.34,95%CI:-18.37~89.04,P=0.20)、术前总胆红素水平(WMD=-0.16,95%CI:-1.12~0.81,P=0.75)、是否合并糖尿病(OR=1.06,95%CI:0.59~1.91,P=0.85)等因素在两组间无统计学差异(P0.05)。结论低白蛋白水平、手术时间长、输血以及术后胰瘘是胰十二指肠切除术后感染的危险因素,而术前胆道引流、术中出血量、术前胆红素水平、是否合并糖尿病与术后感染并发症无明显相关性。     

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.