改良衰弱指数对胸腔镜肺叶切除术老年患者术后肺部并发症的预测价值

目的 评估改良衰弱指数（mFI）对胸腔镜肺叶切除术老年患者术后肺部并发症（PPCs）的预测价值。
方法 回顾性收集胸腔镜肺叶切除术老年患者资料674例,男357例,女317例,年龄65～80岁,BMI<30 kg/m²,ASA Ⅰ—Ⅲ级。评估术后住院期间的PPCs发生情况,根据是否发生PPCs将患者分为两组：PPCs组和非PPCs组。将单因素回归分析中P＜0.1的因素纳入多因素Logistics回归分析,筛选PPCs的独立危险因素。通过受试者工作特征曲线下面积（AUC）评价mFI对PPCs的预测价值。
结果 有108例（16%）患者发生PPCs。单因素分析显示,与非PPCs组比较,PPCs组ASA分级、ARISCAT评分和mFI明显升高（P<0.05）,Hb<100 g/L及术前SpO₂ <95%比例明显升高（P<0.05）,单肺通气时间明显延长（P<0.05）。多因素Logistic回归分析显示,术前mFI升高（OR=2.28,95% CI 1.75～4.52,P=0.007）是PPCs发生的独立危险因素。ROC曲线显示,mFI的预测效能（AUC=0.90,95%CI 0.87～0.93,P=0.001）优于ARISCAT评分（AUC=0.81,95%CI 0.70～0.93,P=0.036）。
结论 术前mFI升高是老年肺叶切除手术患者发生PPCs的独立危险因素,应积极制定以改善衰弱为导向的围术期干预措施,以期降低PPCs的发生率。     

胸腔镜肺切除术后持续咳嗽的多因素分析

目的探讨胸腔镜肺切除术后持续咳嗽(cough after pulmonary resection,CAP)发生的预后因素。方法回顾性分析2014年4月~2016年3月我科650例肺癌胸腔镜肺切除术的临床资料,根据术后是否发生持续咳嗽分为CAP组和非CAP组,单因素分析包括性别、年龄、吸烟史、病理类型、纵隔淋巴结转移、手术侧(左侧或右侧)、手术肺叶(上叶或非上叶)、手术方式、淋巴结切除方式、气管树周围淋巴结切除、离断下肺韧带、出院时合并气胸、出院时合并胸水,采用logistic回归进行多因素分析。结果术后发生CAP 175例,占26.9%。单因素分析显示,年龄、吸烟史、手术侧、切除肺叶、气管树周围淋巴结切除、出院时合并气胸有统计学差异(P0.05)。多因素回归分析显示,年龄(OR=0.616,95%CI:0.424~0.895,P=0.011)、吸烟史(OR=0.656,95%CI:0.432~0.997,P=0.048)、手术侧(OR=1.814,95%CI:1.241~2.652,P=0.002)、切除肺叶(OR=1.789,95%CI:1.214~2.636,P=0.003)、气管树周围淋巴结切除(OR=2.730,95%CI:1.126~6.622,P=0.026)是CAP发生的预后因素。结论持续咳嗽是胸腔镜肺切除术后的常见并发症之一。年龄63岁、无吸烟史、右侧手术、上叶手术、有气管树周围淋巴结切除的患者更易发生CAP。     

胸腔镜肺叶切除术老年患者术前衰弱与术后肺部并发症的关系

目的评价胸腔镜肺叶切除术老年患者术前虚弱与术后肺部并发症(PPCs)的关系。方法收集江南大学附属医院择期行胸腔镜肺叶切除术非小细胞肺癌老年患者, 记录一般资料、衰弱状态、血液指标和手术相关指标等, 根据住院期间是否发生PPCs将患者分为PPCs组和未发生PPCs组, 比较各指标间的差异, 采用logistic回归分析PPCs的独立危险因素, 使用分层分析和交互作用检验进一步分析衰弱与PPCs的关系。结果共纳入行胸腔镜下肺叶切除术非小细胞肺癌老年患者298例, PPCs发生率为22.8%。与未发生PPCs组相比, PPCs组患者白蛋白和FEV1/FVC降低, 年龄、血肌酐、糖尿病比率、COPD比率和术前衰弱率升高(P<0.05)。logistic回归分析结果显示, COPD和术前衰弱是PPCs的独立危险因素。在调整所有风险变量后, 衰弱与非衰弱患者相比, PPCs发生风险增加了171%(OR值=2.71, 95%CI:1.18～4.73, P<0.05)。亚组分析结果表明, BMI和手术时间对衰弱与PPCs之间的关联存在效应修饰作用(交互作用P<0.05)。结论 COP...     

脊柱侧弯矫形手术患者术后肺部并发症的危险因素

目的 分析脊柱侧弯矫形手术患者术后肺部并发症(PPCs)的危险因素。方法 回顾性分析2013年8月至2020年10月择期行后入路脊柱侧弯矫形手术的463例患者病历资料。根据患者术后是否发生PPCs分为两组：PPCs组和非PPCs组。采用倾向性评分匹配和多因素Logistic回归分析脊柱侧弯矫形手术患者发生PPCs的相关危险因素。结果 有154例(33.3%)患者发生PPCs。将性别、年龄、ASA分级、吸烟史、高血压病史、Cobb角作为匹配因子进行倾向性评分匹配,再进行多因素Logistic回归分析,结果显示术中输注异体红细胞(OR=1.983, 95%CI 1.135～3.465,P=0.016)和手术时间延长(OR=1.426, 95%CI 1.112～1.831,P=0.005)是发生PPCs的独立危险因素。结论 手术时间延长、术中输注异体红细胞是脊柱侧弯矫形手术术后肺部并发症发生的危险因素。     

胸腔镜肺切除术患儿术后肺部并发症的危险因素

目的 分析患儿胸腔镜下肺切除术后肺部并发症（PPCs）的危险因素。
方法 回顾性分析行胸腔镜肺切除术566例患儿的临床资料，男334例，女232例，年龄≤6岁，ASA Ⅰ或Ⅱ级。根据患者术后7 d内是否发生PPCs分为两组：PPCs组和非PPCs组。将单因素分析中P≤0.2以及临床认为可能有意义的协变量纳入多因素Logistic回归分析。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）。
结果有123例（21.7%）发生PPCs。多因素Logistic回归分析显示，单肺通气时间长、单肺通气时呼吸频率快、手术医师经验不足是PPCs的独立危险因素，术中最大PEEP升高（最大为7 cmH₂O）是保护因素。预测模型为Logit（P）=-4.410+0.006×单肺通气时间+0.063×单肺通气呼吸频率+0.569×手术医师经验不足（赋值为1）-0.160×最大PEEP值，该模型预测患儿胸腔镜肺切除术PPCs发生率的AUC为0.682（95%CI 0.631～0.734），敏感性76.4%，特异性69.6%。
结论单肺通气时间长、单肺通气时呼吸频率快、手术医师经验不足是患儿胸腔镜肺切除术PPCs的危险因素，术中最大PEEP升高是PPCs的保护因素。     

合并肺切除史肺癌患者再次手术的安全性和最佳手术方式分析

目的探讨合并肺切除史肺癌患者二次手术的安全性和最佳手术方式。方法回顾性分析2007年1月至2016年6月我院69例合并肺切除史肺癌患者的临床资料,其中男53例,女16例,年龄68(45~80)岁。通过单因素方差分析和logistic多因素回归分析,分析患者围术期各指标对术后并发症的影响;通过比较肺叶切除和亚肺叶切除患者的临床数据,确定最佳手术方式。结果二次手术术后90 d死亡率为4.3%,并发症发生率为24.6%。单因素方差分析显示二次手术术后严重并发症发生与术中出血量(P=0.020)、肿瘤大小(P=0.007)、吸烟史(P=0.028)和第一秒用力呼气容积占预计值百分比(FEV1%pre,P=0.018)有关。Logistic多因素回归分析结果显示FEV1%pre77.0%(OR=0.935,95%CI 0.888~0.984,P=0.010)和肿瘤直径≥2 cm(OR=4.288,95%CI 1.375~13.373,P=0.012)是严重并发症发生的独立危险因素。肺叶切除和亚肺叶切除术后死亡率和并发症发生率差异均无统计学意义(P=0.063)。结论合并肺切除史的肺癌患者经过筛选后进行外科手术的术后并发症和死亡率较低,是安全的。在患者心肺功能允许的情况下,二次手术首选肺叶切除+淋巴清扫,应避免全肺切除。     

肺叶切除术后新发房颤单中心双向队列研究

目的探讨肺叶切除术后新发房颤(POAF)的发病情况及相关危险因素。方法采用单中心双向队列研究共纳入2 594例患者, 其中回顾性队列纳入2017年1月至2019年12月期间于我院行肺叶切除患者1 902例, 前瞻性队列纳入2020年8月至2021年7月期间于我院行肺叶切除患者692例。全组女1 348例(51.97%), 男1 246例(48.03%);中位年龄61(54, 67)岁。收集患者临床基线资料和围手术期临床资料, 对纳入变量先后行单因素和多因素logistic回归分析。结果全组无术后院内死亡。术后在院期间随访发现111例POAF事件, 发病率4.28%。多因素回归分析发现:老年(≥60岁)(OR=1.58, 95%CI:1.01～2.47, P=0.044)、经皮冠状动脉介入手术史(OR=2.50, 95%CI:1.04～6.03, P=0.041)、除房颤/房扑外其他心律失常病史(OR=3.96, 95%CI:1.95～8.00, P<0.001)、左肺上叶切除(OR=1.73, 95%CI:1.11～2.68, P=0.015)、术前白蛋白水平偏低(OR=1.07...     

肺癌术后并发症Clavien-Dindo分级≥Ⅱ级危险因素分析的多中心前瞻性队列研究

目的 分析肺癌术后并发症Clavien-Dindo分级≥Ⅱ级的危险因素。方法 纳入2017年11月—2020年1月多中心肺癌手术患者，分析其术后并发症的Clavien-Dindo分级，并采用logistic回归分析确定≥Ⅱ级并发症的危险因素。结果 共纳入388例患者，其中男203例、女185例，平均年龄（56.14±10.36）岁。肺癌术后并发症发生率为25.52%(99/388)，≥Ⅱ级并发症的发生率为20.10%(78/388)。术后最常见的5个并发症分别为：肺炎（6.96%）、持续性肺漏气（>7 d,5.67%）、切口裂开（4.64%）、心律失常（3.87%）和手术后胸腔积液（3.35%）。多因素分析结果显示：开放手术[参照为单孔胸腔镜，OR=2.18,95%CI(1.01,4.70),P=0.047]、扩大切除[参照为亚肺叶切除，OR=2.86,95%CI(1.11,7.19),P=0.030；参照为肺叶切除，OR=2.20,95%CI(1.10,4.40),P=0.026]和手术时间≥3 h[OR=2.07,95%CI(1.12,3.85),P=0.021]是肺癌术后并...     

肺癌患者胸腔镜下肺叶切除术中转开胸危险因素分析

目的分析肺癌患者胸腔镜下肺叶切除术中转开胸的原因、危险因素和近期临床效果。方法回顾性分析2011年3月至2015年11月计划行胸腔镜下肺叶切除术肺癌患者423例的临床资料,男252例、女171例,中位年龄60(24~83)岁。根据术中是否中转开胸分为中转开胸组(45例)和胸腔镜组(VATS组,378例),对比两组临床资料,评估两组术后近期手术效果并分析中转开胸的可能因素。结果导致中转开胸最常见因素为肺门及叶裂间淋巴结与周围血管和支气管紧密粘连,有15(33.3%)例;其次是袖状肺叶切除术,有11(24.4%)例;血管意外损伤致不可控出血有8例,肿瘤侵犯或外侵周围组织有5例,支气管暴露困难有3例,致密胸膜粘连有2例,肺叶裂不全有1例。与VATS组相比,中转开胸组整体并发症发生率(P=0.030)、手术时间(P0.001)、术中失血量(P0.001)高于或长于VATS组。单因素分析发现肺切除类型、肺癌解剖学部位、胸部CT淋巴结情况和肺一氧化碳弥散量(D_LCO)低与中转开胸有关。多因素logistic回归分析提示袖状肺叶切除(OR=5.675,95%CI 2.310~13.944,P0.001)、胸部CT显示肺门淋巴结增大(OR=3.732,95%CI 1.347~10.341,P=0.011)、DLCO≤5.16 mmol/(min·k Pa)(OR=3.665,95%CI1.868~7.190,P0.001)为中转开胸的独立危险因素。结论 VATS中转开胸没有增加死亡率,是降低手术风险的一项措施。术者对具有中转开胸高风险的肺癌患者进行手术方式预选时应慎重。微创术中如有必要中转开胸,必须及时作出决定,以降低术后近期不良后果。     

术前低白蛋白血症与肺切除术后肺部并发症的关系

目的回顾性分析本院2018年1月至2018年12月首次行择期胸腔镜肺切除术且肺功能正常的患者临床资料。按术前48 h内最低血清白蛋白水平分为低白蛋白血症组(<35 g/L)及正常白蛋白水平组(≥35 g/L), 通过倾向性评分匹配2组患者基线信息和术中及术后情况。根据是否发生术后肺部并发症(PPCs), 分为并发症组和无并发症组。采用logistic回归分析筛选PPCs的危险因素。纳入1 127例患者, 并发症组306例, 无并发症组821例, logistic回归分析显示:低白蛋白血症是肺切除术患者PPCs的独立危险因素(OR值=1.643, 95%可信区间1.201～2.249, P<0.05)。倾向性评分匹配后, 正常白蛋白水平组498例, 低白蛋白血症组178例。与正常白蛋白水平组比较, 低白蛋白血症组PPCs总发生率和肺炎发生率升高(P<0.05)。综上所述, 术前低白蛋白血症是肺切除术后患者PPCs发生的危险因素。     

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.