老年患者择期开腹手术后感染风险因素分析

目的探讨老年患者择期开腹手术后发生感染并发症的危险因素。方法对2010年5月至2012年2月期间笔者所在医院收治的159例接受择期开腹手术的老年患者的临床资料进行回顾性分析。其中38例（23.90％）术后出现感染并发症（感染组）,121例无感染并发症（无感染组）,比较2组患者术前相关生理学指标、健康状况指标、手术指标以及术后感染并发症及死亡情况的差异。结果本组159例患者术后感染并发症发生率为23.90％（38／159）;术后死亡2例,术后病死率为1.26％。单因素及多因素logistic回归分析结果提示,患者术前的营养风险、糖尿病史和慢性呼吸系统疾病是术后感染并发症的独立危险因素。结论术前改善老年患者肺部疾病、糖尿病及营养状态,可能对降低术后感染并发症发生率有益。     

胃肠道肿瘤术后肺脏并发症的临床研究

目的:探讨胃肠道肿瘤手术后肺脏并发症的影响因素及诊治经验.方法:回顾性分析21 5例胃肠道肿瘤手术患者的临床资料,分为肺脏并发症组和无肺脏并发症组,对比分析2组患者的年龄、吸烟史、手术时间、手术部位、术前肺功能及监测术前及术后血气分析等6个相关因素,探讨这些因素与术后肺脏并发症的关系.结果:215例患者中41例发生肺脏并发症;肺脏并发症组患者平均年龄(62.5±5.2)岁,手术时间(3.1±1.2)h,无肺脏并发症组患者平均年龄(54.5±9.4)岁,手术时间(2.9±0.8)h,2组患者差异有统计学意义(P＜0.05).吸烟、上腹部手术、术前FEV1％、FEV1/FVC％、MW％异常者术后发生肺脏并发症的危险性增加(P＜0.05).2组患者术后动脉血气分析指标比较差异有统计学意义(P＜0.05).结论:年龄、吸烟史、手术时间、手术部位、术前肺功能异常可能是胃肠道肿瘤手术患者发生术后肺脏并发症的危险因素,加强术后血气分析监测有着重要临床意义.     

腹腔镜胃切除术后并发症危险因素的Logistic分析

目的 分析胃癌患者腹腔镜胃切除术后并发症发生的危险因素.方法 回顾性分析2009年4月至2011年7月同济大学附属上海第十人民医院76例因胃癌行腹腔镜胃切除术患者的临床资料,根据是否发生并发症分为并发症组(13例)和无并发症组(63例).选取性别、年龄、腹部手术史、术前合并症(心血管疾病、慢性阻塞性肺病、糖尿病、贫血,低蛋白血症、幽门梗阻)、姑息性手术、手术资料(手术时间、术中出血量、消化道重建方式)以及TNM分期、血管神经浸润、术中清扫淋巴结数目等变量进行单因素方差分析,多因素分析采用Logistic回归方程,筛选出与术后并发症相关的危险因素.计量资料用t检验,计数资料用x2检验,等级资料用非参数检验.结果 全组患者中,根治性手术67例,姑息性手术9例.远端胃切除术63例,其中毕I式消化道重建49例、毕Ⅱ式消化道重建14例;全胃切除+Roux-en-Y食管空肠吻合术13例.平均手术时间为(263±72) min,术中平均出血量为(200±191) ml,术中平均清扫淋巴结数目为(17±8)枚.术后病理TNM分期:Ⅰ期25例,Ⅱ期18例,Ⅲ期27例,Ⅳ期6例.老年患者的并发症发生率较高,但性别和年龄对术后并发症的影响差异无统计学意义(x2 =0.68,2.32,P＞0.05).并发症组患者的手术时间比无并发症组要长,但两组比较,差异无统计学意义(t=1.44,P＞0.05);术前单独一种合并症(心血管疾病、慢性阻塞性肺病、糖尿病、贫血、低蛋白血症、幽门梗阻)、术中出血量、术中清扫淋巴结数目不是影响术后并发症发生的危险因素(x2=3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P＞0.05).多因素分析结果提示,毕Ⅱ式消化道重建、术前合并症越多、TNM分期越晚的患者术后发生并发症的可能性就越大( OR =5.54,7.02,2.33,P＜0.05).检验其判别效果得出判对率为81.6％.结论 采用毕Ⅱ式消化道重建、术前合并症较多,TNM分期较晚是胃癌患者腹腔镜胃切除术后并发症发生的独立危险因素.     

腹腔镜辅助胃癌根治术在老年人胃癌中的应用

目的 探讨腹腔镜辅助胃癌根治术在老年胃癌患者中应用的可行性及临床疗效.方法 2007年1月至2009年12月期间,福建医科大学附属协和医院胃外科对255例年龄在65岁以上的老年胃癌患者施行D2根治术,其中行腹腔镜辅助胃癌根治术患者（腹腔镜组）116例,行常规开腹手术患者（开腹组）139例.比较两组患者术中、术后恢复、并发症发生及术后生存情况,并对术后并发症的危险因素进行分析.结果 腹腔镜组术中出血量和术中输血例数均少于开腹组,术后排气时间、进食流质时间和住院时间均短于开腹组,差异均有统计学意义（P＜0.01）;而两组患者手术时间和淋巴结清扫数目的差异无统计学意义（均P＞0.05）.腹腔镜组术后并发症发生率为15.5％（18/116）,明显低于开腹组的28.1％（39/139）（P＜0.05）.是否行腹腔镜手术（P＜0.05）、手术时间（P＜0.01）和术前合并症（P＜0.01）是老年人胃癌术后并发症的独立危险因素;手术时间（P＜0.05）和术前合并症（P＜0.01）是老年人腹腔镜辅助胃癌根治术后并发症的独立危险因素.腹腔镜组和开腹组患者术后平均生存时间分别为23.0和22.5个月,差异无统计学意义（P＞0.05）.结论 老年人腹腔镜辅助胃癌根治术能够达到与开腹手术相同的根治效果,且具有明显的微创优势.手术时间和术前合并症是老年人腹腔镜胃癌根治术后并发症的独立危险因素.     

脊柱后路内固定手术后手术部位感染的危险因素及治疗策略

【摘要】 目的：探讨脊柱后路内固定手术后手术部位感染的相关危险因素及治疗策略。方法：回顾性分析2015年1月~2018年1月在我院骨科行脊柱后路内固定手术患者3780例。其中男性1970例,女性1810例,年龄18~92岁（44.9±18.4岁）,随访1.5±0.3年。根据患者术后1年内是否出现感染分为感染组和非感染组。收集两组患者的年龄（是否＞60岁）、性别、体质指数（body mass index,BMI）（是否＞30kg/m2）、融合节段（是否＞2个）、手术持续时间（是否＞3h）、低蛋白血症（白蛋白是否＜35g/L）、是否贫血、是否合并糖尿病、是否异体输血、术后引流时间（是否＞48h）、失血量（是否＞1000ml）以及是否合并其他部位感染等资料进行独立样本t检验。对阳性结果进行进一步多因素Logistic回归分析,将感染组根据感染灶是否穿破深筋膜分为浅表感染组和深部感染组,收集感染组细菌培养结果,χ2检验分析病原菌构成比。结果：3780例患者中发生手术部位感染患者95例,感染发生率为2.51%,其中男性52例,女性43例,年龄18~82岁（43.5±15.2岁）。单因素分析显示,两组患者在性别、BMI＞30kg/m2、融合节段、贫血、异体输血、术后引流时间以及合并其他感染等因素比较差异无统计学意义（P＞0.05）,而在年龄＞60岁、手术时间超过3h、低蛋白血症（白蛋白＜35g/L）、合并糖尿病和失血量＞1000ml等因素存在统计学差异（P＜0.05）。多因素Logistic回归结果显示年龄＞60岁（OR=5.267,P=0.008）、手术时间超过3h（OR=7.156,P=0.000）、低蛋白血症（OR=4.358,P=0.016）、合并糖尿病（OR=3.578,P=0.005）和失血量＞1000ml（OR=4.659,P=0.007）是脊柱后路内固定术后手术部位感染的独立危险因素。95例脊柱后路手术术后手术部位感染患者根据感染部位分为浅表感染65例,深部感染30例,病原菌构成比比较无统计学意义（P＜0.05）。结论：年龄＞60岁、手术时间超过3h、低蛋白血症、合并糖尿病和失血量＞1000ml的患者行脊柱后路内固定手术术后发生切口感染的风险较高,围手术期应积极采取有效的治疗策略,最大限度降低脊柱内固定术后手术部位感染的发生。     

腰椎骨折行椎弓根钉内固定术后并发手术部位感染的相关因素分析

目的探讨腰椎骨折行椎弓根钉内固定术后并发手术部位感染的情况,并进行相关因素分析。方法纳入2014年2月～2018年2月于本院行椎弓根钉内固定术治疗的256例腰椎骨折患者,调查其术后手术部位感染情况,将手术部位感染患者设为感染组,其余设为非感染组。调查两组患者性别、年龄等一般资料以及骨折节段、手术入路等手术资料,探讨术后并发手术部位感染的独立危险因素。结果 256例术后发生手术部位感染24例,感染率9. 38%;单因素分析显示,感染组与非感染组手术时间、吸烟史、住院时间、合并糖尿病、手术入路、术后引流时间、骨折至手术时间、手术出血量差异有统计学意义(P0. 05);多因素Logistic回归分析显示:手术时间(OR=2. 043)、吸烟史(OR=2. 221)、住院时间(OR=2. 543)、合并糖尿病(OR=2. 549)、手术入路(OR=3. 212)是术后并发手术部位感染的独立危险因素。结论腰椎骨折行椎弓根钉内固定术后手术部位感染率较高,手术时间、吸烟史、住院时间、合并糖尿病、手术入路可增加感染发生风险。     

肝癌肝切除术后感染并发症相关危险因素分析

目的 探讨肝癌肝切除术后感染并发症相关危险因素.方法 对本院近6年来行肝切除术的217例肝癌患者的临床资料进行回顾性分析,对可能引起感染并发症的因素进行统计学分析.结果 217例肝癌肝切除病例根据术后是否发生感染并发症分为感染组（n=33）与非感染组（n=184）.33例中,手术部位感染15例（占45.45％）、肝脏周围感染4例（占12.12％）、远处部位感染14例（占42.42％）;术后死亡3例（占1.38％）.多因素Logistic逐步回归分析显示年龄（P=0.006,0R=2.564）、糖尿病史（P=0.02,OR=1.996）、手术时间（F=0.005,0R=2.237）及胆漏发生率（P＜0.001,0R=7.325）是肝切除术后感染并发症的独立危险因素.结论 年龄、糖尿病史、手术时间及胆漏发生率是影响肝癌患者肝切除术后感染并发症发生的独立危险因素.     

右半结肠切除术后呼吸系统并发症危险因素分析

目的探讨右半结肠切除术后呼吸系统并发症的危险因素及预防措施。方法 2012年6月～2020年5月行右半结肠切除术病人336例,根据术后是否发生呼吸系统并发症,将其分为发生呼吸系统并发症组(25例)和未发生呼吸系统并发症组(311例)。对两组性别、年龄、体质量指数、长期吸烟史、呼吸系统基础疾病、糖尿病、麻醉危险度评分、术前白蛋白、术前血红蛋白、疾病性质、病变位置、手术类型、手术方式、是否遵循完整结肠系膜切除原则、手术时间及术中出血量指标进行单因素分析,对筛选出的有统计学意义的指标进行多因素Logistic回归分析。结果单因素分析显示,年龄≥65岁、合并呼吸系统基础疾病、急诊手术及手术时间3小时与右半结肠切除术后呼吸系统并发症发生相关,差异有统计学意义(P0.05)。多因素Logistic回归分析显示,年龄≥65岁及合并呼吸系统基础疾病是右半结肠切除术后呼吸系统并发症发生的独立危险因素(P0.05)。结论老龄及呼吸系统基础疾病会加大右半结肠切除术后呼吸系统并发症的发生风险,行右半结肠切除术前需筛选高危人群,对老龄及罹患呼吸系统基础疾病的病人应采取合理的预防措施,以减少术后呼吸系统并发症的发生。     

全髋关节置换术后假体周围感染的独立危险因素分析

目的探讨全髋关节置换术后假体周围感染的相关危险因素。方法回顾性分析自2014-01—2017-12完成的516例初次全髋关节置换术,观察术后1年内是否发生假体周围感染,然后分为感染组与未感染组。比较2组在性别、年龄、体重指数、术前血红蛋白、心脏病史、呼吸系统病史、糖尿病史、假体类型、手术时间、术中出血量、术中输血量、引流放置情况方面的差异。结果术后1年内有21例(4.07%)发生假体周围感染。单因素分析结果显示,感染组与未感染组在体重指数、心脏病史、糖尿病史、手术时间方面差异有统计学意义(P <0.05);感染组与未感染组在性别、年龄、术前血红蛋白、呼吸系统病史、假体类型、术中出血量、术中输血量、引流放置情况方面差异无统计学意义(P>0.05)。Logistic多元回归分析结果显示,肥胖[OR=0.216,95%CI(0.998,1.006),P=0.009]与手术时间[OR=1.035,95%CI(1.009,1.060),P=0.007]为全髋关节置换术后假体周围感染的独立危险因素。结论肥胖及手术时间延长是初次全髋关节置换术后假体周围感染的危险因素,而假体周围感染与是否合并基础疾病无关。根据患者的体重情况优化手术策略、缩短手术时间可能有利于降低全髋关节置换术后假体周围感染风险。     

Multivariate Logistic regression analysis of the risk factors of gastrectomy postoperative complications

目的 探讨与胃癌术后并发症有关的危险因素.方法 回顾性分析20 06年6月至2011年10月行胃癌手术病人的临床资料,对术前、术中各种指标进行单因素分析,对其中有统计学意义的变量进行多因素Logistic回归分析,筛选出影响胃癌术后并发症的危险因素.结果 术后并发症与联合脏器切除、Ⅲ～Ⅳ期、肝硬化、全胃切除、术前合并症、术中出血量、手术时间、年龄＞60岁等危险因素相关.结论联合脏器切除、肿瘤分期Ⅲ～Ⅳ期、术前合并症、肝硬化、全胃切除、术中出血量、手术时间、年龄＞60岁为胃癌术后并发症的独立危险因素.     

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.     

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.