利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的临床应用

目的　评价利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的安全性。　方法　经直肠超声引导前列腺 10针穿刺活检术患者 15 0例 ,均因排尿困难就诊。随机分成 3组 ,每组5 0例。第 1组经直肠在前列腺尖部及两侧前列腺精囊连接部注射 1%利多卡因各 3ml;第 2组注射生理盐水 ;第 3组为对照组 ,直接行穿刺活检。穿刺结束时采用视觉模拟评分尺 (VAS)对穿刺过程进行疼痛评分 ;穿刺结束时及术后第 7天评判患者有无并发症及其程度。　结果　利多卡因组、生理盐水组及对照组疼痛评分分别为 1.96、3.98和 3.70 ,利多卡因组疼痛明显减轻 (P <0 .0 5 ) ,生理盐水组与对照组差异无显著性意义 (P >0 .0 5 )。利多卡因组术后无感染发生 ,直肠出血量 (3.96± 0 .39)ml,肉眼血尿发生率 76 % (38/ 5 0 ) ,排尿困难加重发生率 12 % (6 / 5 0 ) ,尿潴留发生率 2 % (1/ 5 0 ) ,轻度血管迷走神经反射发生率 10 % (5 / 5 0 ) ,与生理盐水组和对照组比较 ,差异均无显著性意义 (P >0 .0 5 )。　结论　前列腺尖部及两侧前列腺精囊连接部注射利多卡因局部麻醉 ,能显著降低穿刺过程中的疼痛及不适程度 ,不增加术中及术后并发症 ,推荐在经直肠前列腺穿刺活检术中常规应用。     

两种不同局麻方法在经直肠前列腺穿刺活检术中的镇痛疗效比较

目的比较经直肠超声引导前列腺神经阻滞术和直肠内灌注2％利多卡因凝胶在前列腺穿刺活检术中的镇痛疗效。方法160例接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。A组患者84例，在经直肠超声引导下，于前列腺基底部，左、右两侧精囊与前列腺交接处分别注射1％利多卡因5ml；B组患者76例，于活检前5min直肠内灌注2％利多卡因凝胶10ml。采用视觉模拟评分（VAS）评估两组患者在穿刺活检术中的疼痛程度。结果两组患者在平均年龄（t=0．73）、PSA水平（t=0．34）和前列腺体积（t=0．55）的差异无统计学意义（P〉0.05），具有可比性。A组患者VAS评分0～3分者76例，4～5分者6例，6～10分者2例。B组患者则分别为48例、18例、10例。两组患者VAS评分均值分别为1，2分、2．6分，差异具有高度统计学意义（t=4．73，P〈0.01）。两组患者均未出现局麻药的不良反应。结论经直肠超声引导前列腺神经阻滞术的镇痛疗效明显优于直肠内灌注2％利多卡因凝胶，值得临床推广应用。     

经直肠超声引导下前列腺穿刺活检术的临床意义

目的探讨经直肠超声引导下前列腺穿刺活检术的临床意义。方法对60例PSA〉4ng／ml、直肠指检异常或超声发现异常回声的患者采用前列腺穿刺活检术，其中30例患者采用骶管内麻醉下经直肠超声引导前列腺穿刺活检术，年龄45～86岁，平均68±3．6岁，PSA〈4ng／ml为4例，4-10ng／ml为10例，〉10ng／ml为16例。对照组30例，年龄50-84岁，平均70±3．5岁，PSA〈4ng/ml为3例，4-10ng／ml为9例，〉10ng／ml为18例。对照组采用直肠指检压迫下穿刺或表面麻醉下行经直肠超声引导下穿刺活检。结果骶管内麻醉组阳性率为60％（18／30），患者术中无疼痛表现，对照组阳性率为33％（10/30），患者在术中伴有不同程度的疼痛。结论与常规穿刺相比，骶麻下经直肠超声引导下前列腺穿刺活检术准确性高，疼痛较轻，更能被患者接受，值得临床推广使用。     

前列腺穿刺活检术中不同麻醉方法有效性和安全性比较

目的 比较3种麻醉方法 在经直肠超声引导下前列腺穿刺活检过程中的有效性和安全性.方法 2006年7月至2008年10月,120名因前列腺特异抗原和(或)直肠指检异常接受前列腺12针穿刺活检的患者随机分为4组,每组30例.A组为对照组,未接受任何麻醉;B组在超声引导下于左、右两侧精囊与前列腺交接处分别注射1%利多卡因5ml行前列腺神经阻滞术(PNB);C组在PNB之前5 min直肠内涂抹复方利多卡因凝胶;D组在PNB之前于前列腺两侧叶内分别注射1%利多卡因2 ml.穿刺结束后对患者进行疼痛视觉模拟评分(VAS),并随访7 d了解并发症情况.结果 超声探头进入直肠时C组患者的VAS为(2.7±1.1)分,低于其他3组,差异有统计学意义(P＜0.05),其他3组之间差异无统计学意义(P＞0.05).穿刺过程中D组患者的VAS为(3.9±1.3)分低于其他3组,差异有统计学意义(P＜0.05),其他3组之间差异无统计学意义(P＞0.05).各组患者并发症的发生率差异无统计学意义(P＞0.05).结论 PNB及直肠内利多卡因凝胶局部麻醉不能明显减轻前列腺穿刺过程中的痛苦,PNB联合前列腺内局部麻醉是安全有效的.     

局部浸润麻醉与黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中的应用比较

目的比较前列腺局部浸润麻醉与直肠黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中应用的安全性和有效性。方法将2018年3月至8月中山大学附属第三医院拟行前列腺穿刺活检的疑似前列腺癌患者纳入本研究,前瞻性随机分成两组。实验组采用超声引导下利多卡因于前列腺基底部和精囊腺间交角周围的血管神经束进行局部浸润麻醉;对照组采用利多卡因凝胶直肠黏膜表面麻醉。收集患者穿刺前后基线特征及穿刺后VAS评分、穿刺前后膀胱残余尿、穿刺阳性率、Gleason评分及血尿等相关并发症进行比较。结果共66例患者纳入本研究。穿刺过程中实验组疼痛评分低于对照组。两组间穿刺阳性率、Gleason评分、残余尿、尿潴留、肉眼血尿、发热等没有组间差异。结论局部浸润麻醉比直肠黏膜表面麻醉更能明显缓解经直肠超声引导前列腺穿刺的疼痛,对穿刺阳性率无明显影响,是更安全有效的麻醉方法,但需要一定经验的超声医师引导。     

前列腺周围神经阻滞对前列腺活检的止痛效果

目的:评价以利多卡因前列腺周围神经阻滞在经直肠超声引导前列腺穿刺活检操作中的止痛效果.方法:将120例符合经直肠前列腺穿刺指征患者随机分为三组,每组40例,分别接受2%利多卡因前列腺周围神经阻滞(阻滞组)和2%利多卡因凝胶20 ml经直肠灌入(灌肠组),并设空白对照(对照组).采用10针系统前列腺穿刺,穿刺后立即由专人询问患者的疼痛程度,并记录在10 cm视觉模拟评分尺上.结果:阻滞组较灌肠组及对照组疼痛明显减轻(P<0.01),灌肠组与对照组相比疼痛似有减轻,但差异无统计学意义.结论:利多卡因前列腺周围神经阻滞,在经直肠超声引导前列腺穿刺活检操作中有较好的止痛效果.     

骶麻下经直肠超声引导前列腺穿刺活检术

目的:探讨骶麻下经直肠超声引导行前列腺穿刺活检术的应用价值。方法:我院为60例前列腺特异抗原(pros-tate specific antigen,PSA)>4ng/ml、直肠指检异常或B超示异常回声的患者采用前列腺穿刺活检术。其中研究组30例采用骶管内麻醉经直肠超声引导行前列腺穿刺活检术,45～86岁,平均68岁,PSA<4ng/ml4例,4～10ng/ml10例,>10ng/ml16例;对照组30例采用直肠指检压迫下穿刺或表麻下行经直肠B超引导下穿刺活检,50～84岁,平均70岁,PSA<4ng/ml3例,4～10ng/ml9例,>10ng/ml18例。结果:研究组18例检出阳性,阳性率60%,患者术中无痛;对照组10例检出阳性,阳性率33%,术中患者均有不同程度的疼痛。结论:采用骶麻下经直肠超声引导行前列腺穿刺活检术准确性高,无疼痛表现,更易被患者接受,值得临床推广应用。     

利多卡因加布比卡因局部麻醉在前列腺穿刺活检术中的应用

目的探讨经直肠前列腺穿刺活检引起的疼痛规律，评价利多卡因加布比卡因局部麻醉的镇痛效果及安全性。方法经直肠行前列腺10针穿刺活检患者150例，随机分3组，每组50例，A组在尖部、两侧的前列腺体部与直肠壁间注入利多卡因加布比卡因复合剂（质量浓度为1％利多卡因、0．2％布比卡因、1：20万单位肾上腺素）各3ml，B组在相同位置注射1％利多卡因，C组直接行穿刺活检。对患者术中及术后1周内的疼痛行视觉模拟评分尺评分。结果A、B、C组术中疼痛评分分别为2．2±1．5、2．0±1．5、3．5±1．9，P〈0.01；术后1h疼痛评分分别为2．2土1．3、3．1±1.1、2．8±1．4，P〈0．01；术后1d分别为1．7±1.1、1.8±1．1、1．7±1．3，P〉0.05；术后6d均为0．2土0．5，P〉0.05。A组2例患者出现术后寒战高热，C组1例术后当晚出现低热。术后A、B、C组分别有1、3、4例患者需口服止痛药。结论经直肠前列腺穿刺活检引起的疼痛主要在术中及术后1d之内。联合应用利多卡因加布比卡因局部麻醉能显著降低患者术中、术后的疼痛程度，并能消除单用利多卡因麻醉引起的术后疼痛反弹现象。     

利多卡因预防超声引导经直肠前列腺穿刺活检术疼痛:一项单中心、前瞻性、随机单盲、安慰剂对照临床试验

目的 评价利多卡因预防超声引导经直肠前列腺穿刺活枪术疼痛的有效性和安全性.方法 采用随机化分组方法,将1 80例行经直肠超声引导前列腺穿刺活检术的患者,随机分为试验组(利多卡因组)、生理盐水组(安慰剂生理盐水组)与空白对照组(不使用任何药物),每组60例.试验组患者经直肠在前列腺与精囊连接部两侧各注射2%利多卡因各5ml;生理盐水组注射生理盐水;空白对照组直接行穿刺活检.采用视觉模拟评分尺(VAS)分别在B超探头进入直肠、麻醉术毕、穿刺术毕、穿刺术后20min四个评分点进行疼痛评分,穿刺结束时及术后一周随访评判患者有无并发症及其程度.在临床试验过程中对前列腺穿刺术者、VAS评分操作者、数据评价者与患者实施盲法.结果 在四个评分点对三组患者进行疼痛评分,试验组患者疼痛评分分别为(1.085±1.438)、(1.698±1.708)、(2.030±1.877)、(0.972±1.111),生理盐水组分别为(1.062±1.049)、(2.75 3±2.345)、(3.992±2.406)、(1.020±0.731),空白对照组分别为(0.903±0.901)、(0.088±0.240)、(3.495±1.885)、(1.160+1.094).超声探头进入直肠与穿刺术后20min评分比较差异无统计学意义(P值均0.05);麻醉术毕疼痛评分各组比较差异有统计学意义(P＜0.0001),试验组与生理盐水组、空白对照组比较差异有统计学意义(P值均＜0.05);穿刺术毕疼痛评分各组比较差异有统计学意义(P＜0.0001),试验组与生理盐水组、空白对照组比较差异有统计学意义(P值均＜0.01).3组患者对镇痛效果的满意度分别为91.667%、76.667%与58.333%,各组比较差异有统计学意义(P=0.0001).所有患者除空白对照组发生1例败血症外,均未见严重血管迷走神经反射、严重感染、严重直肠出血、严重血尿及尿潴留并发症.各组并发症的发生比较差异均无统计学意义(P值均＞0.05).无患者出现局麻药中毒症状、尿潴留等并发症.所有患者均完成一周随访,随访期间无严重并发症发生.结论 穿刺术前在前列腺基底部与精囊连接部两侧注射盐酸利多卡因注射液,能显著降低穿刺术中、术后的疼痛程度,具有较好的疗效和安全性.推荐在前列腺穿刺活检术前常规应用.     

老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症分析

目的：探讨前列腺特异抗原增高（PSA〉4/μg/L）老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症发生情况.方法：选取96例PSA增高老年男性患者（69±7岁）进行静脉麻醉下直肠超声引导无痛前列腺12针系统穿刺（静脉麻醉组）,并选取同期进行前列腺周围神经阻滞麻醉下直肠超声引导前列腺12针系统穿刺的51例PSA增高老年男性患者（67±6岁）为对照组.记录穿刺后30 min视觉模拟疼痛评分（VAS）、穿刺时间、麻醉不良事件和并发症发生情况.结果：静脉麻醉组90例（94%）为无疼痛（VAS=0）,6例（6%）为轻度疼痛 对照组21例（41%）为轻度疼痛,30例（59%）为中度疼痛.静脉麻醉组平均VAS评分和穿刺时间分别为（0.1±0.3）分和（5.1±1.3）min,显著低于对照组（3.85±1.2）分和（11.35±3.9）min.静脉麻醉组无一例发生麻醉不良事件.静脉麻醉组术后肉眼血尿、大便带血、发热和尿潴留的发生率分别为55%、15%、5%和3%,与对照组的差异无统计学意义（57%、18%、6%和4%）.结论：对于PSA增高老年男性患者,静脉麻醉直肠超声引导无痛前列腺穿刺具有无痛安全准确的优点.     

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.