腰方肌阻滞与腹横肌平面阻滞用于老年患者腹腔镜结肠癌根治术后镇痛的效果对比

目的：比较腰方肌阻滞（QLB）与腹横肌平面阻滞（TAPB）用于老年患者腹腔镜结肠癌根治术后镇痛的效果。方法：将2020年8月至2021年12月于我院行腹腔镜结肠癌根治术治疗的82例老年患者随机分为2组,术后分别采用QLB和TAPB法进行术后镇痛。比较2组患者术后2h、8h、12h、24h疼痛程度及深呼吸或咳嗽时的舒适度。疼痛程度采用疼痛数字评估量表（NRS）评价,舒适度采用Bruggrmann舒适量表（BCS）评价。结果：QLB组患者术后2h、8h、12h、24hNRS评分均明显低于TAPB组（P <0.05）,而且各观察点BCS评分均明显高于TAPB组（P <0.05）。结论：QLB用于老年患者腹腔镜结肠癌根治术后镇痛效果优于TAPB。     

超声引导下低位前锯肌平面阻滞和腰方肌阻滞用于腹腔镜肾癌根治术的比较

目的比较超声引导下低位前锯肌平面阻滞(SAPB)和腰方肌阻滞(QLB)用于腹腔镜肾癌根治术的应用效果。方法选择行腹腔镜肾癌根治术患者90例,男55例,女35例,年龄18～80岁,BMI 19～28 kg/m~2,ASAⅠ或Ⅱ级。将患者随机分为三组:SAPB联合全麻组(S组)、QLB联合全麻组(Q组)和单纯全麻组(G组),每组30例。记录神经阻滞操作时间、神经阻滞起效时间、神经阻滞范围、神经阻滞相关并发症发生情况。记录术后0.5、2、12、24、48 h静息和活动时VAS疼痛评分。记录术中丙泊酚和瑞芬太尼用量、补救镇痛例数、术后48 h内镇痛泵按压次数及患者镇痛满意度评分。结果 S组阻滞操作时间和阻滞起效时间明显短于Q组(P0.05)。术后0.5、2、12、24 h S组和Q组静息和活动时VAS疼痛评分以及术后48 h活动时VAS疼痛评分明显低于G组(P0.05)。S组和Q组术中丙泊酚和瑞芬太尼用量明显少于G组(P0.05),补救镇痛率明显低于G组(P0.05),镇痛泵按压次数明显少于G组(P0.05),镇痛满意度评分明显高于G组(P0.05)。S组阻滞平面集中在T_6—T_(11),Q组阻滞平面集中在T_7—L_1。结论低位SAPB和QLB均可有效缓解腹腔镜肾癌根治术患者术后早期切口痛,减少术中全麻药物用量以及术后镇痛药物用量。与QLB比较,低位SAPB操作更简单、起效时间短,适宜在临床推广应用。     

超声引导下腹横肌平面阻滞用于腹股沟疝成形术病人术后镇痛的效果

目的 评价超声引导下腹横肌平面阻滞用于腹股沟疝成形术病人术后镇痛的效果.方法 择期在椎管内麻醉下行单侧腹股沟疝成形术病人40例,年龄18 ～ 79岁,BMI＜ 30 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将病人分为2组(n=20):生理盐水对照组(C组)和超声引导下腹横肌平面阻滞组(B组),B组术毕在超声引导下行腹横肌平面阻滞,注入0.375％罗哌卡因20 ml,C组给予等容量生理盐水.术后当视觉模拟评分(VAS评分)≥4分时静脉注射曲马多,分别于术后4、6、24、48 h时记录静态和动态VAS评分,分别于术后24、48 h时测定阻滞侧温觉阻滞平面,记录术后病人镇痛总体满意度评分和排气时间,记录腹横肌平面阻滞相关不良反应的发生情况.结果 C组有4例病人使用曲马多镇痛,B组无一例病人需补救镇痛;与C组比较,B组术后VAS评分降低,镇痛总体满意度评分升高(P＜ 0.05或0.01),排气时间差异无统计学意义(P＞0.05);B组术后24 h时阻滞侧温觉平面阻滞率为80％,术后48 h时阻滞侧无一例病人存在温觉阻滞平面;C组术后24、48 h时无一例病人存在温觉阻滞平面.B组未见腹横肌平面阻滞相关不良反应.结论 超声引导下腹横肌平面阻滞用于腹股沟疝成形术病人术后镇痛的效果较好,且安全性较高.     

超声引导下肋下前路腰方肌阻滞对后腹腔镜肾脏手术后镇痛效果的影响

目的观察和比较超声引导下肋下前路腰方肌阻滞(QLB)与低位胸椎旁神经阻滞(TPVB)用于后腹腔镜肾脏手术后镇痛的效果。方法择期行后腹腔镜肾脏手术患者70例,男38例,女32例,年龄18～65岁,BMI 18～24 kg/m~2,ASAⅠ或Ⅱ级。随机分为肋下前路QLB组(QLB组)和低位TPVB组(TPVB组),每组35例。QLB组行超声引导下患侧肋下前路QLB,TPVB组行超声引导下患侧T_(10)横突水平TPVB,两组分别注入0.33%罗哌卡因30 ml,注药后20 min测定感觉阻滞平面。两组术后行羟考酮PCIA。记录术后0～24 h和24～48 h镇痛泵用量、有效按压次数、总按压次数;记录术后2、6、12、24、36、48 h静息时和运动时的NRS评分;记录术后48 h内补救镇痛和低血压、肌力减退、恶心呕吐、嗜睡等不良反应发生情况。结果 QLB组阻滞平面为T_5—L_2,TPVB组为T_5—T_(12)。QLB组术后0～24 h和24～48 h镇痛泵用量明显低于TPVB组(P0.05),有效按压次数和总按压次数明显少于TPVB组(P0.05),术后12、24、36、48 h运动时NRS评分明显低于TPVB组(P0.05),术后48 h内补救镇痛、恶心呕吐和嗜睡发生率明显低于TPVB组(P0.05)。两组低血压和肌力减退发生率差异无统计学意义。结论与低位TPVB比较,超声引导下肋下前路QLB联合羟考酮PCIA在后腹腔镜肾脏手术后镇痛的效果更显著,持续作用时间更长,不良反应更少。     

超声引导下腹横肌平面阻滞对剖宫产产妇催乳素及术后镇痛的影响

目的评价超声引导下腹横肌平面阻滞对剖宫产产妇催乳素(PRL)及术后镇痛的影响。方法选择择期行剖宫产产妇40例,单胎,足月(孕38~41周),年龄20~39岁,体重50~80kg,ASAⅠ或Ⅱ级,采用随机数字表法分为两组,每组20例。C组不实施腹横肌平面阻滞,T组于手术结束即刻在超声引导下行双侧腹横肌平面阻滞。术后所有患者均采用1μg/ml舒芬太尼行PCIA,负荷量2ml,背景输注速率2ml/h,单次剂量2ml,锁定时间15min。若VAS评分3分,静脉注射曲马多50mg行镇痛补救。记录初乳时间及术前30min、术后24、48h产妇血清PRL浓度;记录术后静息状态下2、4、12、24和48hVAS评分,术后24h内舒芬太尼累积消耗量,镇痛补救率,镇痛泵按压次数;术后24h内不良反应发生情况。结果 T组初乳时间明显早于C组(P0.05);T组术后24、48h血清PRL浓度明显高于C组(P0.05);T组母乳喂养成功率明显高于C组(P0.05);T组术后静息状态下2、4、12和24hVAS评分明显低于C组(P0.05);T组术后24h内舒芬太尼累积消耗量明显少于C组、镇痛补救率明显低于C组、镇痛泵按压次数明显少于C组(P0.05);T组术后24h内恶心呕吐发生率明显低于C组(P0.05)。结论超声引导下腹横肌平面阻滞用于剖宫产术后镇痛可促进产妇早泌乳,提高母乳喂养成功率,镇痛效果显著,且不良反应较少,值得在临床推广应用。     

超声引导腹横肌平面阻滞对剖宫产术后镇痛的影响

目的探讨超声引导腹横肌平面(TAP)阻滞对剖宫产术产妇术后镇痛效果的影响。方法择期于腰-硬联合麻醉下行剖宫产术的产妇80例,ASAⅠ或Ⅱ级,随机均分为两组:腹横肌平面阻滞组(T组)和对照组(C组)。T组于术毕行超声引导双侧TAP阻滞,每侧注射0.5%罗哌卡因20ml,C组不阻滞;两组均行PCIA,于术后2、4、6、8、24h时行静息、运动时VAS评分、Ramsay镇静评分及BCS舒适度评分。记录术后24h内PCIA中舒芬太尼用量;记录产妇满意度及不良反应的发生情况;计算术后24h内PCIA有效按压次数与实际按压次数比(D1/D2)。结果与C组比较,术后2、4、6hT组静息及运动时VAS评分明显降低,BCS舒适度评分明显升高(P0.05)。T组术后24h内PCIA中舒芬太尼用量明显少于C组(P0.05),D1/D2及产妇满意度明显高于C组(P0.05)。两组均未发生恶心、呕吐、皮肤瘙痒、胸闷等不良反应。结论超声引导TAP阻滞减少了产妇在剖宫产术后阿片类镇痛药的使用量,增强了术后镇痛效果,提高了产妇的舒适度和满意度。     

超声引导下腹横筋膜平面阻滞与腹横肌平面阻滞在剖宫产术后镇痛中的效果比较

目的 比较超声引导下腹横筋膜平面(TFP)阻滞与腹横肌平面(TAP)阻滞在剖宫产术后镇痛中的效果。
方法 择期蛛网膜下腔阻滞下行剖宫产术产妇60例,年龄20～35岁,体重50～75 kg,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组：腹横筋膜平面阻滞组（TFP组）和腹横肌平面阻滞组（TAP组）,每组29例。术毕TFP组行超声引导下双侧腹横筋膜平面阻滞,TAP组行超声引导下双侧腹横肌平面阻滞,两组均每侧注射0.375%罗哌卡因1.25 mg/kg。术后均行曲马多PCIA,若VAS疼痛评分≥4分,肌肉注射曲马多100 mg行补救镇痛。记录术后6、12、24、36、48 h PCIA中曲马多累积用量;记录术后48 h内曲马多补救镇痛情况;记录镇痛期间恶心呕吐、局麻药中毒、呼吸抑制、穿刺部位血肿、穿刺部位感染、腹膜刺穿造成腹腔内注射等不良反应的发生情况。
结果 与TAP组比较,TFP组术后6、12、24、36、48 h PCIA中曲马多累积用量明显减少 （P＜0.05）,术后48 h内曲马多补救镇痛率明显降低 （P＜0.05）。两组镇痛期间恶心呕吐发生率差异统计学意义。两组均无其他不良反应发生。
结论 与超声引导下腹横肌平面阻滞比较,腹横筋膜平面阻滞可减少剖宫产术后阿片类药物用量,镇痛效果更佳。     

腰方肌阻滞与腹横肌平面阻滞用于腹腔镜结肠癌根治术患者术后镇痛的临床研究

目的评价腰方肌阻滞与腹横肌平面阻滞应用于腹腔镜结肠癌根治术患者术后镇痛的有效性与安全性。方法选取2019年1月～2021年1月拟于我院行腹腔镜结肠癌根治术的患者共计120例。纳入标准:年龄48～75岁,性别不限,ASAⅡ～Ⅲ级,体质指数(body mass index, BMI)18.5～27.9 kg/m~2,行腹腔镜结肠癌根治术,同意参与本试验并签署知情同意书。患者随机纳入腰方肌阻滞组(Q组)和腹横肌平面阻滞组(T组),最终每组各纳入56例患者。Q组患者行腰方肌阻滞;T组患者行腹横肌平面阻滞。使用疼痛数字评分(numerical rating scale, NRS)评价两组患者麻醉后复苏室(postanesthesia care unit, PACU)内、术后2 h、8 h、24 h疼痛程度,并使用BCS舒适评分评价患者术后咳嗽、深呼吸时的舒适度。使用改良Bromage评分评价患者术后运动功能。记录术后24 h内两组患者PCIA按压次数、补救镇痛率以及手术后恶心呕吐(postoperative nausea and vomiting, PONV)、头晕、下肢运动阻滞等不良反应发生率。结果 Q组患者术后2 h、 8 h、 24 h NRS评分均显著低于T组患者,差异有统计学意义(P0.05)。Q组患者PACU内、术后2 h、 8 h、 24 h Bromage评分显著高于T组患者,差异有统计学意义(P0.05)。Q组患者PACU内、术后2 h、 8 h、 24 h BCS评分显著高于T组患者,差异有统计学意义(P0.05)。Q组患者PCIA按压次数、补救镇痛率均显著低于T组患者,差异有统计学意义(P0.05)。Q组患者术后24 h内PONV、头晕发生率显著低于T组患者,但下肢运功阻滞发生率则显著高于T组患者,差异有统计学意义(P0.05)。两组患者术后尿潴留发生率差异无统计学意义(P0.05)。结论腰方肌阻滞用于腹腔镜结肠癌根治术患者术后镇痛效果优于腹横肌平面阻滞,但会影响患者下肢运动功能。     

超声引导下腰方肌阻滞或腹横肌平面阻滞联合舒芬太尼PCIA在阑尾切除术后镇痛中的比较

目的比较腰方肌阻滞(quadratus lumborum block,QLB)与腹横肌平面(transversus abdominis plane,TAP)阻滞联合舒芬太尼经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)在阑尾切除术后镇痛中的效果。方法选择拟于腰-硬联合麻醉下行阑尾切除的患者77例,男44例,女33例,ASAⅠ或Ⅱ级,随机分为QLB组(n=39)和TAP组(n=38)。术后于超声引导下分别在腰方肌后表面以及腹内斜肌和腹横肌之间给予0.25%罗哌卡因20 ml。记录术后4、8、12、24、48h舒芬太尼的消耗量及静息VAS评分;记录术后恶心呕吐、眩晕、皮肤瘙痒等不良反应的发生情况。结果术后12~48hQLB组舒芬太尼消耗量明显少于TAP组(P0.05)。两组不同时点静息VAS评分差异无统计学意义。QLB组术后恶心呕吐[2(5.1%)vs 8(21.0%)]、眩晕[4(10.2%)vs 11(28.9%)]的发生率明显低于TAP组(P0.05)。结论 QLB较TAP阻滞能够更加有效地减少术后舒芬太尼用量及不良反应的发生。     

超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋关节术后镇痛的比较

目的比较腰方肌阻滞(quadratus lumborum block,QLB)和髂筋膜间隙阻滞(fasciailiaca compartment block,FICB)在老年髋关节置换术的镇痛效果。方法选择择期拟行腰麻下全髋关节置换术的老年患者55例,男22例,女33例,年龄65～85岁,ASAⅠ或Ⅱ级,随机分为QLB组(n=28)和FICB组(n=27)。术后分别于超声引导下行QLB和FICB,予0.375%罗哌卡因30ml。所有患者术后行舒芬太尼静脉自控镇痛。记录术后6、12、24、48h镇痛泵按压次数及舒芬太尼用量;记录静息及运动时VAS疼痛评分;记录术后恶心呕吐、眩晕等不良反应情况。结果术后12、24、48h QLB组镇痛泵按压次数及舒芬太尼用量明显少于FICB组(P0.05);术后12、24、48hQLB组运动时VAS评分明显低于FICB组(P0.05),两组不同时点静息时VAS评分差异无统计学意义;QLB组恶心呕吐发生率明显低于FICB组[2(7.1%)vs 9(33.3%),P0.05]。结论腰方肌阻滞较髂筋膜间隙阻滞更能明显减轻髋关节置换术后活动痛,减少阿片类药物的使用及不良反应发生率。     

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.