异氟醚减少离体鼠肝缺氧-复氧损伤与枯否细胞有关

目的 明确异氟醚减少离体鼠肝缺氧-复氧损伤的作用主要发生在哪一阶段，以及与枯否细胞的关系。方法 将大鼠肝脏取下，置于离体鼠肝灌流仪中，以经95％O2／5％CO2饱和的改良克-林氏碳酸氢盐缓冲液恒压灌流（有氧状态用1．2kPa，缺氧状态用0．2kPa），维持生理pH值和温度，实时监测灌流液中LDH变化。2MAC异氟醚分别用于缺氧期、复氧期和缺氧-复氧期。用GdCl3选择性抑制枯否细胞活性。结果（1）2MAC异氟醚用于缺氧-复氧期和单纯用于复氧期均可抑制LDH升高，而单纯用于缺氧期则无明显作用。（2）2MAC异氟醚和（或）GdCl3组均可抑制肝脏缺氧-复氧后LDH升高。结论异氟醚保护缺氧-复氧肝脏免受损伤的作用主要发挥在复氧期，异氟醚在复氧期发挥保护作用可能与抑制复氧引起的氧自由基爆发有关，其作用与枯否细胞活性密切相关。     

地氟醚、七氟醚和异氟醚预处理对缺氧-复氧心肌细胞内游离Ca2+的影响

目的 观察地氟醚，七氟醚和异氟醚预处理对缺氧-复氧心肌细胞内Ca^2 的影响。方法 将原代培养乳鼠心肌细胞随机分为对照，缺氧-复氧及1.5MAC地氧醚，七氟醚和异氟醚预处理后缺氧-复氧五组，用Fra-2标记细胞内Ca^2 ，荧光光度计进行测定。结果 与对照组比，复氧20分钟时，其余四组细胞内Ca^2 均显著升高；而地氟醚，七氟醚和异氟醚预处理组的升高幅度明显低于缺氧-复氧组；三个吸入麻醉药组间无差异，复氧60分钟，缺氧-复氧组虽有明显下降，但仍显著高于对照组，地氟醚，七氟醚烽异氟醚预处理组则降至对照组水平。结论 地氟醚，七氟醚和异氟醚预处理，可明显减轻缺氧-复氧心肌引起的细胞内游离Ca^2 升高。     

地氟醚,七氟醚和异氟醚预处理对缺氧／复氧心肌细胞损害的保护作用

目的 研究地氟醚，七氟醚和异氟醚预处理对恼肌细胞缺氧／复氧损害的保护作用。方法 原代培养乳鼠心肌细胞，随机分为对照，单纯缺氧／复氧及１．５ＭＡＣ地氟醚，七氟醚和异氟醚预处理５组，实验结束测定乳酸脱氢酶（ＬＤＨ）和肌酸激酶（ＣＫ）活性。细胞存活和凋亡率。结果 与对照组比，单纯缺氧／复氧使ＬＤＨ，ＣＫ和细胞凋亡率升高及细胞存活率显著下降（Ｐ〈０．０１），１．５ＭＡＣ地氟醚，七氟醚和异氟醚预处理显著减轻     

异氟醚对缺氧或复氧肝细胞能量平衡的保护作用

目的观察异氟醚对不同缺氧时间以及复氧后肝细胞能量平衡的保护作用。方法将新鲜分离肝细胞置于krebs缓冲液中,密封容器中通人O2／CO2或N2／CO2(95％：5％)制造有氧或缺氧环境,加或不加异氟醚。实验分六组：有氧组、有氧加异氟醚组、缺氧组、缺氧加异氟醚组、缺氧后复氧组、缺氧后复氧加异氟醚组,观察配对各组用异氟醚后的变化。用高效液相技术测肝细胞内ATP、ADP、AMP水平并计算总腺苷酸和反映ATP供需平衡的能荷(=[ATP 1／2ADP]／[ATP ADP AMP])。结果(1)缺氧30min肝细胞中能荷、ATP的下降与AMP的升高被异氟醚部分逆转,而被复氧完全逆转。(2)缺氧90min肝细胞能荷、总腺苷酸明显下降,复氧可部分提高能荷而不提高总腺苷酸,异氟醚对缺氧和复氧期间的能荷、总腺苷酸均有部分逆转作用。结论临床当量的异氟醚对长期和短期缺氧肝细胞均有能量保护作用,并有效改善复氧后的能量失衡状况。     

地氟醚、七氟醚和异氟醚预处理对缺氧/复氧心肌细胞损害的保护作用

目的　研究地氟醚、七氟醚和异氟醚预处理对心肌细胞缺氧／复氧损害的保护作用。方法　原代培养乳鼠心肌细胞，随机分为对照、单纯缺氧／复氧及 １．５ＭＡＣ地氟醚、七氟醚和异氟醚预处理５组。实验结束测定乳酸脱氢酶（ＬＤＨ）和肌酸激酶（ＣＫ）活性、细胞存活和凋亡率。结果　与对照组比，单纯缺氧／复氧使ＬＤＨ、ＣＫ和细胞凋亡率升高及细胞存活率显著下降（Ｐ＜０．０１）；１．５ＭＡＣ地氟醚、七氟醚和异氟醚预处理显著减轻ＬＤＨ、ＣＫ和细胞凋亡率升高及细胞存活率下降，其中七氟醚减轻作用最强。结论　地氟醚、七氟醚和异氟醚预处理对心肌细胞缺氧／复氧损害有一定的保护作用，七氟醚的保护作用可能更强。     

PI3K/Akt信号通路在乳化异氟醚预先给药减轻乳鼠心肌细胞缺氧复氧损伤中的作用

目的 评价磷脂酰肌醇-3激酶/蛋白质丝氨酸苏氨酸激酶(PI3K/Akt)信号通路在乳化异氟醚预先给药减轻乳鼠心肌细胞缺氧复氧损伤中的作用.方法 Wistar乳鼠60只,乳鼠心肌细胞于24孔培养板原代培养后,采用缺氧2 h复氧2 h建立缺氧复氧模型.乳鼠心肌细胞随机分为6组,每组8孔,正常对照组(C组):按正常条件继续培养4 h;A/R组:制备缺氧复氧模型;EI组:于细胞缺氧前即刻在培养液中加入乳化异氟醚,终浓度为1.68 mmol/L;EI+wortmannin(PI3K特异性抑制剂)组(EIW组):于细胞缺氧前即刻在培养液中加入乳化异氟醚和wortmannin,终浓度分别为1.68 mmol/L和100 nmol/L;wortmannin组(W组):于细胞缺氧前即刻在培养液中加入wortmannin,终浓度为100 nmol/L;脂肪乳组(F组):与细胞缺氧前即刻在培养液中加入30%脂肪乳,终浓度为0.05%.复氧2 h时,取细胞培养上清液测定乳酸脱氢酶(LDH)活性、肌钙蛋白I(cTnI)浓度,心肌细胞匀浆后测定超氧化物歧化酶(SOD)活性与丙二醛(MDA)含量,并测定心肌细胞磷酸化Akt(p-Akt)的表达水平.结果 与C组比较,其余5组上清液LDH活性、cTnI浓度和心肌细胞MDA含量升高,心肌细胞SOD活性降低(P<0.05);与A/R组比较,EI组和EIW组上清液LDH活性、cTnI浓度和心肌细胞MDA含量降低,心肌细胞SOD活性升高,F组除心肌细胞SOD活性升高外(P<0.05),其余指标差异均无统计学意义(P>0.05),W组上述指标差异无统计学意义(P>0.05);与EI组比较,EIW组、W组和F组上清液LDH活性、cTnI浓度和心肌细胞MDA含量升高,心肌细胞SOD活性降低(P<0.05).C组、EIW组、H/R组、F组和EI组心肌细胞p-Akt表达水平依次升高(P<0.05).结论 乳化异氟醚预先给药减轻乳鼠心肌细胞缺氧复氧损伤可能与进一步激活PI3K/Akt信号通路有关.     

七氟醚预处理对小鼠心肌缺血再灌注时环氧化酶-2表达的影响:在体和离体实验

目的 通过在体和离体实验评价七氟醚预处理对小鼠心肌缺血再灌注时环氧化酶-2(COX-2)表达的影响.方法 在体实验健康成年小鼠54只,体重约250 g,6～8周龄,采用随机数字表法,将其随机分为3组(n=18):对照组(C组)、心肌缺血再灌注组(I/R组)和七氟醚预处理组(SP组).采用结扎左冠状动脉30 min再灌注的方法制备心肌缺血再灌注模型.SP组小鼠吸入2.0％七氟醚,15min/次,共3次,间隔15 min.七氟醚预处理后90 min制备心肌缺血再灌注模型.再灌注6、9h时,取心肌组织分别采用Western blot法测定COX-2表达,采用分光光度法测定心肌caspase-3的活性.再灌注24h时测定左室舒张末压(LVEDP).细胞实验采用随机数字表法,将H9C2细胞随机分为3组,每组6皿:对照组(C组)、缺氧复氧组(H/R组)和七氟醚预处理组(SP组).H9C2细胞置于95％N2+ 5％CO2培养箱中孵育14 h后,置于95％O2+ 5％CO2培养箱中孵育3h,建立缺氧复氧模型.SP组H9C2细胞培养基中加入2.0 mmol/L七氟醚,每次孵育15 min,共3次,间隔15 min.七氟醚预处理结束后15 min建立缺氧复氧模型.复氧3h时采用Western blot法测定细胞COX-2的表达水平,采用比色法测定上清液和细胞裂解液LDH活性,计算LDH释放量.结果 在体实验:与C组比较,I/R组和SP组LVEDP升高,心肌组织caspase-3活性增强,COX-2表达上调(P＜0.01);与I/R组比较,SP组LVEDP降低,心肌组织caspase-3活性减弱,COX-2表达下调(P＜0.01).细胞实验结果:与C组比较,H/R组和SP组H9C2细胞COX-2表达上调,LDH释放量增加(P＜0.01);与H/R组比较,SP组H9C2细胞COX-2表达下调,LDH释放量减少(P＜0.01).结论 七氟醚预处理可通过直接下调心肌COX-2的表达,抑制细胞凋亡减轻小鼠心肌缺血再灌注损伤.     

地氟醚预处理对中性粒细胞介导心肌细胞缺氧/复氧损伤的保护作用

目的研究地氟醚预处理对中性粒细胞介导的心肌细胞的缺氧/复氧损伤的保护作用。方法 原代培养的SD乳鼠心肌细胞,随机分为四组:缺氧,复氧组、中性粒细胞介导缺氧,复氧组、地氟醚预处理组、地氟醚预处理 中性粒细胞介导缺氧/复氧组,各组缺氧前时测定乳酸脱氢酶(LDH)、肌酸激酶-MB(CK-MB)活性、肌钙蛋白T(TnT)浓度和心肌细胞搏动频率,复氧后测定LDH、CK-MB活性、TnT浓度、心肌细胞搏动频率、心肌存活率和节律失常发生率。结果 除地氟醚预处理组外,各组缺氧前和复氧后各指标差异均有显著性(P<0.05或0.01)。LDH、CK—MB活性缺氧前和复氧后时的差值、心肌存活率和节律失常发生率在各组间差异有显著性(P<0.01),TnT缺氧前和复氧后的差值组间无明显差异(P>0.05)。组间地氟醚预处理 中性粒细胞介导缺氧,复氧组较中性粒细胞介导缺氧/复氧组LDH、CK—MB活性缺氧前和复氧后的差值及节律失常发生率降低(P<0.01),心肌细胞存活率明显升高(P<0.01),但仍不如单纯缺氧/复氧组上述指标。结论 地氟醚减轻中性粒细胞介导的缺氧/复氧损伤,但不能完全阻断其心肌细胞的损伤。     

颅脑手术中过度通气对颈内静脉球血氧饱和度、脑动静脉氧及乳酸差的影响

目的 观察颅脑手术中异氟醚或异氟醚／N2O麻醉时过度通气对颈内静脉球血氧饱和度和脑动静脉氧及乳酸差的影响。方法 ASAⅠ-Ⅱ级幕上肿瘤病人行择期开颅手术20例,随机分为MAC（1．3MAC）相同的两组,异氟醚组（n＝10,Ⅰ组）：吸入1．5％异氟醚、空气、氧气;异氟醚／N2O组(n＝10,N 组）：吸入0．8％异氟醚、60％－65％N2O、氧气。手术切开硬膜后,于正常通气（PaCO24.7-6.0kPa)、轻度（＜4．7kPa）、中度（＜4.0kPa)、重度（2．8－3．4kPa)过度通气时分别抽取动脉、颈内静脉球部血行血气分析及乳酸测定。监测SjvO2,计算Ca-vDO2及静脉动脉血乳酸差（VADL）。结果 全部病人术中血液动力学稳定,随着PaCO2的降低,两组的SjvO2下降,Ca-vDO2值增加,且PaCO2与SjvO2和Ca-vDO2间存在显著的直线相关性。VADL有上升趋势,但仍在正常范围,在重度过度通气时,这种改变在N组较I组更为显著（P＜0．05）。结论 颅脑手术麻醉期间过度通气可影响脑氧平衡;两组在重度过度通气,尤其是异氟醚／N2O麻醉时出现脑氧供需失衡,故在颅脑手术麻醉中应避免重度过度通气。     

血红素加氧酶-1在七氟醚预处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用

目的 探讨血红素加氧酶-1(HO-1)在七氟醚预处理减轻乳鼠心肌细胞缺氧复氧损伤中的作用.方法 新生健康清洁级SD大鼠15只,日龄1～3d,处死后取心室肌组织,原代培养心肌细胞,以1×106个/ml接种于6孔培养板或以2× 105个/ml接种于24孔培养板,采用随机数字表法,将其随机分为4组(n＝25):对照组(C组)常规培养;缺氧复氧组(H/R组)采用缺氧2h,复氧1h的方法制备心肌细胞缺氧复氧损伤模型;七氟醚预处理组(S+ H/R组)细胞经2.5％七氟醚预处理20min后行药物洗脱10 min,再行缺氧复氧处理;锌原卟啉+七氟醚预处理组(ZnPP+ S+ H/R组)细胞经HO-1抑制剂锌原卟啉3 μmol/L孵育1h后,行七氟醚预处理及缺氧复氧处理.于复氧结束后测定心肌细胞HO-1表达、细胞凋亡率、细胞内游离Ca2+浓度([Ca2+]i)、线粒体膜通透性转运孔(PTP)开放程度、细胞色素C(Cyto C)表达及培养液LDH和CK活性.结果 与C组比较,H/R组心肌细胞HO-1和胞浆Cyto C表达上调,线粒体Cyto C表达下调,培养液LDH、CK活性、细胞凋亡率、[Ca2+]i和PTP开放度升高(P<0.01).与H/R组比较,S+H/R组心肌细胞HO-1和线粒体Cyto C表达上调,胞浆Cyto C 表达下调,培养液LDH、CK活性、细胞凋亡率、[Ca2+]i和PIP开放度降低(P<0.01).与S+H/R组比较,ZnPP+ S+ H/R组心肌细胞HO-1和线粒体Cyto C表达下调,胞浆CytoC表达上调,培养液LDH、CK活性、细胞凋亡率、[Ca2+]i和PTP开放度升高(P<0.01).结论 HO-1表达上调参与了七氟醚预处理减轻乳鼠心肌细胞缺氧复氧损伤.     

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.     

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.     

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.     

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.     

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.     

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.