完全腹腔镜手术治疗成人先天性胆总管囊肿的临床分析

目的:探讨完全腹腔镜胆总管囊肿切除并肝管空肠Roux-en-Y吻合术治疗成人先天性胆总管囊肿的可行性、安全性及疗效。方法:回顾性分析昆明医科大学第一附属医院2014年5月—2016年5月12例行腹腔镜下胆总管囊肿手术治疗患者的临床资料。结果:11例患者完全腹腔镜下完成胆总管囊肿切除+肝管空肠吻合术,1例为减少手术费用在腹腔外行手工肠肠吻合。手术时间240~310 min,平均280 min;术中出血20~150 m L,平均60 m L;术后住院时间5~7 d,平均6.5 d。术后随访2~12个月,未出现手术并发症,无死亡病例。结论:完全腹腔镜下胆总管囊肿切除+肝管空肠Roux-en-Y吻合术治疗成人先天性胆总管囊肿是安全可行的,且具有明显微创优势,可进一步推广。     

腹腔镜胆总管囊肿根治切除、肝管空肠吻合术

目的:探讨腹腔镜下胆道造影和胆总管囊肿根治切除、肝管空肠吻合术的可行性。方法:34例先天性胆总管囊肿患者行腹腔镜下胆道造影,胆囊和囊状胆管完全切除,经脐孔提出空肠行Roux-en-Y吻合和体内肝管空肠吻合手术。结果:胆道造影显示胆管囊状扩张24例,梭形扩张10例。33例腹腔镜下顺利完成手术,手术时间平均4.2h(3.5~6.5h);1例胰腺内胆总管远段囊肿中转开腹手术。4例合并肝管狭窄同时行胆管成形术。术后5~7d患者痊愈出院。31例获得随访,5~40个月未发生术后并发症。结论:腹腔镜下胆道造影简便实用,对指导镜下根治切除囊肿,避免损伤胆胰管连接部和处理肝内胆管狭窄有重要参考价值。     

腹腔镜肝管空肠Roux-en-Y吻合术治疗52例3岁以内婴幼儿先天性胆总管囊肿

目的探讨腹腔镜辅助肝管空肠Roux-en-Y吻合术治疗3岁以内婴幼儿先天性胆总管囊肿的疗效。方法2001年4月～2007年3月,采用腹腔镜技术治疗3岁以内婴幼儿先天性胆总管囊肿52例,其中囊状扩张44例,梭形扩张8例。12例（23%）患儿合并肝门部肝管狭窄,行肝管扩大成形术;采用四孔技术和3～5 mm手术器械完成胆道造影、胆囊和胆总管囊肿壁全层彻底切除;延长脐部切口提出空肠,直视下行Roux—en—Y空肠吻合,然后还纳肠管;经结肠后上提空肠的肝支,镜下将肝管与空肠连续吻合。结果52例在腹腔镜下完成手术,无中转开放手术,平均手术时间226 min（160～455 min）,手术中出血量5～10 ml,无手术中需要输血者。1例肝门胆管狭窄的患儿术后胆漏,持续腹腔引流26 d,自然愈合。术后1～2 d进食,无并发症患儿住院3～6 d。52例术后随访3～72个月,平均32.6月,肝功能正常,无并发胆管狭窄和胆管炎,无结石和胰腺炎发生。结论腹腔镜胆总管囊肿彻底切除肝管空肠Roux—en—Y吻合手术治疗3岁以内婴幼儿先天性胆总管囊肿安全、可靠,镜下放大的手术视野有利于精确的手术操作。     

腹腔镜胆总管囊肿根治术的手术体会及技术改进

目的 总结腹腔镜胆总管囊肿切除、肝管空肠Roux-Y吻合术的临床经验,并探讨其手术技巧和技术改进.方法 2010年11月-2012年11月,共实施腹腔镜胆总管囊肿根治术31例.采用4孔法,先游离胆囊,行胆道造影,然后扩大脐部切口提出空肠,完成Roux-Y吻合,还纳肠管后再切除囊肿,行胆肠吻合术.结果 31例患者,2例中转开腹,29例完成腹腔镜下胆总管囊肿根治术,手术时间为200 ～ 460 min,平均260 min;术后早期并发症3例(9.7％),其中胆瘘1例;术后腹壁切口出血1例;Roux-Y胆袢扭转1例.术后患儿均获得随访,随访时间为3～ 27个月,全部患儿肝功能正常,超声检查无结石形成,未见胆管狭窄及扩张.结论 腹腔镜胆总管囊肿根治术安全可靠,效果满意.     

腹腔镜下应用超声刀行胆总管囊肿切除术

目的：探讨腹腔镜下应用超声刀行胆总管囊肿切除、肝管空肠Roux—Y吻合术的操作技术及优越性。方法：本组45例患儿在腹腔镜下应用超声刀行胆总管囊肿切除,胆道重建术。首先在腹腔镜监视下行胆囊穿刺造影,切除胆囊。然后用超声刀横断囊肿,近端游离至肝总管处切断,远端游离至胰胆管汇合处结扎切断,彻底切除囊肿壁。经脐部2cm切口提出空肠于腹壁外行空肠Roux-Y吻合,肝支30～35cm,然后将肠管送回腹腔经结肠后将肝支拉至肝下,将肝管与空肠端侧吻合。结果：45例患儿均在腹腔镜下应用超声刀完成胆总管囊肿切除、肝管空肠Roux—Y吻合术。手术时间3．5～6．0h(平均4．2h)。术中出血量10～50ml(平均15ml)。全部患儿无术中并发症。术后住院时间3～9d(平均5．5d)。38例获随访,随访时间1个月～1．5年,无吻合口狭窄及粘连性肠梗阻发生,肝功能检查正常。结论腹腔镜下应用超声刀行胆总管囊肿切除、肝管空肠Roux—Y吻合术安全可靠。优点为手术视野清晰,解剖层次清楚,术中出血少、创伤小,术后疼痛轻、切口小,手术瘢痕不明显。     

完全腹腔镜成人胆总管囊肿切除术的技术改进

目的探讨改进的腹腔镜下解剖分离技术以及胆肠吻合技术在完全腹腔镜胆总管囊肿切除术中的应用价值。方法 2013年10月~2016年10月,对10例成人先天性胆总管囊肿行完全腹腔镜下胆总管囊肿切除、胆囊切除、肝管空肠Roux-en-Y吻合。腹腔镜下超声刀锐性分离结合吸引器冲洗钝性解剖法游离并完整切除胆总管囊肿和胆囊,用"一点法"全程全层连续缝合技术行肝管空肠端侧吻合,用腔镜下直线切割吻合器行空肠侧侧吻合。结果全组均成功完成腹腔镜手术,无中转开腹。手术时间150~310 min,平均184.3 min,其中"一点法"肝管空肠吻合时间18~45 min,平均22.7 min。术中出血量30~120 ml,平均50.5 ml。术后第1天疼痛评分1~4分,平均2.0分,肛门排气时间1~3 d,平均2.0 d,术后住院时间5~11 d,平均6.0 d。1例术后少量胆漏,余无围手术期并发症。10例均获得随访,随访时间2~36个月,平均17.2月,1例术后21天因饮食因素导致空肠吻合口炎,保守治愈,无反流性胆管炎、吻合口狭窄等。结论完全腹腔镜下应用超声刀锐性分离结合吸引器冲洗钝性解剖法切除成人先天性胆总管囊肿是安全、有效的。"一点法"全程全层连续胆肠吻合技术能够简化操作及降低腹腔镜下缝合难度,有助于腔镜术式的开展。     

腹腔镜辅助治疗先天性胆总管囊肿的体会

目的探讨腹腔镜辅助下行胆总管囊肿切除、肝总管空肠吻合术根治胆总管囊肿的手术方式及效果。方法对2008年1月至2010年8月间18例在腹腔镜辅助下行胆总管囊肿切除、肝总管空肠Roux—Y吻合术的病例资料进行回顾性分析。手术中均行胆囊造影,了解胆总管扩张情况及肝内胆管、胰腺管情况,同时行腹腔镜胆总管囊肿切除,扩大脐部切口,将空肠提出腹壁外,腹腔外空肠吻合,腹腔镜下肝总管空肠端侧吻合。结果均完全在腹腔镜辅助下完成,手术时间3．5～4．0h。无中转开腹,术后近期无胆漏、肠漏等并发症,术后6～8d出院。结论腹腔镜辅助下行胆总管囊肿切除、肝总管空肠Roux—Y吻合术效果可靠、创伤小、术后恢复快,是治疗先天性胆总管囊肿的较好术式。     

完全腹腔镜下手术治疗新生儿、小婴儿先天性胆总管囊肿70例北大核心CSCD

目的探讨完全腹腔镜下囊肿切除、肝管空肠Roux-en-Y吻合术治疗新生儿、小婴儿先天性胆总管囊肿的安全性及可行性。方法回顾性分析2016年12月~2021年7月70例先天性胆总管囊肿行完全腹腔镜下胆总管囊肿切除、肝管空肠Roux-en-Y吻合术的临床资料。手术年龄10~148 d,(61.7±26.8)d;体重2.6~7.6 kg,(4.7±1.2)kg。TodaniⅠ型58例(Ⅰa型54例,Ⅰb型2例,Ⅰc型2例),Ⅳa型12例。囊肿直径1.1~14.8 cm,中位数5.1 cm。40例(57.1%)产前超声诊断。47例(67.1%)术前有黄疸,11例合并大便颜色变浅,15例合并肝功能损害。结果手术时间135~240 min,(187.9±19.6)min;术中出血2~30 ml,中位数5 ml;术后进食时间4~14 d,中位数6 d;术后住院时间8~33 d,中位数10 d。术后胆肠吻合口漏3例,其中1例合并吻合口狭窄。术后随访7~62个月,中位数33个月。无肠梗阻、胆管炎和胰腺炎。结论完全腹腔镜下囊肿切除、肝管空肠吻合术治疗先天性胆总管囊肿是安全、可行的。     

经腹腔镜行先天性胆总管囊肿根治切除术的技术要点

目的 对经腹腔镜行先天性胆总管囊肿切除，肝管空肠Roux-Y吻合术的关键技术进行探讨。方法 采用四Trocar技术首先行腹腔镜监视下胆道造影后切除胆囊，然后用超声刀游离胆总管囊肿前壁，切开囊肿前壁后，横断囊肿，向近端游离至胆总管与肝总管的交界处，向远端游离至囊肿与胰管的汇合处，彻底切除囊肿壁。经脐部2cm切口提出距Treitz韧带20cm处空肠于腹壁外，行空肠空肠Roux-Y吻合，保留肝支30-35cm，然后将肠管送回腹腔经结肠后拉至肝门下。用5-0可吸收缝线将肝管与空肠端侧吻合。结果 本组8例患儿手术全部成功。手术时间平均为4.8h(3.6-6h)，出血量10-50ml，吻合口直径1.0-1.5cm，术后平均住院时间4.5d(3-8d)。术后随访1-6个月，未发现逆行感染，肠粘连梗阻和吻合口狭窄发生。结论 经腹腔镜行先天性胆总管囊肿切除，肝管空肠吻合术是一种安全可靠的方法。     

腹腔镜下胆总管囊肿切除、肝管空肠吻合、腹腔外空肠吻合术50例报告

目的探讨腹腔镜下胆总管囊肿根治切除、肝管空肠吻合、腹腔外空肠吻合术的技巧和中期疗效。方法对大的囊肿,于囊肿中部切开前壁,再用电钩横断囊肿后壁;对小的囊肿,围绕囊肿周围游离,完整切除扩张胆管。对反复发生胆管炎症的患儿,采用Lilly’s方法游离囊肿。脐部切口扩大至1.5 cm,将空肠提出腹壁外,行空肠Roux-Y吻合。腹腔镜监视下肝管空肠端侧吻合。结果16例患儿行囊肿全部切除,34例患儿行Lilly’s囊肿切除。1例早期手术患儿术前反复发作胆管炎症,囊肿周围紧密粘连,分离中渗血明显中转开腹完成手术。手术时间190-450 min,平均226 min。8例患儿需要输血。术后住院时间6-16 d,平均8 d。49例术后随访3-39个月,平均26个月。术后并发症4例：1例发生胆漏,经腹腔引流后自愈;急性胰腺炎1例,保守治疗治愈;肠粘连肠梗阻1例,保守治疗;肠坏死1例,开腹探查见空肠肝支肠管梗阻坏死,行肠切除和再次胆肠吻合手术。余45例无腹痛、发热、黄疸等症状。无胆管狭窄和反流性胃炎病例,无手术死亡。结论分离囊肿后壁,避免门静脉损伤是最关键的腹腔镜操作;胆肠吻合是腹腔镜最难的技术。腹腔镜下胆总管囊肿根治术疗效满意。     

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.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.