尼卡地平复合艾洛控制性降压在脊柱手术中的应用

目的探讨尼卡地平复合艾洛在脊柱手术中控制性降压的临床效果及对血流动力学的影响。方法选择择期行脊柱手术的ASAⅠ~Ⅱ级的患者60例,随机分为尼卡地平组(N组,n=30)和对照组(C组,n=30)。两组患者均采用气管插管全身麻醉。术中N组静脉滴注尼卡地平和艾司洛尔,记录两组患者手术过程中血压(SBP、DBP、MAP)和心率(HR)的变化及晶胶体输入量、尿量、输血量和出血量。结果N组患者在控制性降压期间血压明显下降(P<0.01),术中输血量和出血量N组明显少于C组(P<0.01),两组患者HR均维持平稳,晶胶体输入量和尿量组间无差异(P>0.05)。结论尼卡地平复合艾司洛尔可以安全有效地应用于脊柱术中的控制性降压。     

尼卡地平联合艾司洛尔对冠状动脉搭桥期间全身和组织氧合的影响

目的探讨尼卡地平联合艾司洛尔(N E)是否对非心肺转流(CPB)冠状动脉搭桥术(OPCAB)期间全身和组织氧合具有保护作用。方法选择20例行OPCAB病人,随机分为尼卡地平联合艾司洛尔组(N E组)和硝酸甘油联合艾司洛尔组(X E组),每组10例。麻醉诱导后,输注N E或X E混合液维持MAP 70~80 mmHg。于麻醉诱导后(T1)、搭桥前(T2)、前降支(LAD)搭桥(T3)、后降支(PDA)搭桥(T4)、回旋支(LCX)搭桥(T5)、搭桥结束(T6)和术毕(T7)测定血液动力学、动脉血乳酸(Lac)含量和胃粘膜二氧化碳压力(PgCO2)等参数,计算氧供(DO2)、氧耗(VO2)和胃粘膜pH(pHi)。结果OPCAB期间,N E组病人的心指数(CI)明显高于(P<0.05)或等于基线水平;而X E组病人则轻度下降。N E组病人在T4、T5,X E组病人从T3至T6的心脏每搏量指数(SVI)均明显下降(P<0.05);N E组病人的周围血管阻力指数(SVR1)明显下降,且明显低于X E组病人(P<0.05);两组病人的HR术中均明显增加(P<0.05)。输注N E混合液后DO2均高于或等于基线水平(P<0.05),血Lac含量处于正常范围;X E组病人的DO2搭桥期间均下降,特别是LCX搭桥时(P<0.05),而且血Lac含量显著升高并超出正常范围(P<0.05)。N E组病人OPCAB期间的pHi均高于7.35,而X E组病人从T4至T7则低于7.35。结论尼卡地平联合艾司洛尔配方对OPCAB期间全身和组织氧合具有保护作用。     

异丙酚和异氟醚麻醉对硝普钠控制性降压的影响

目的评价异丙酚麻醉对硝普钠控制性降压的影响.方法16例显微神经外科手术患者随机分成两组,待硬脑膜打开后,Ⅰ组(n=8)以100μg@kg-1@min-1异丙酚静滴维持麻醉;Ⅱ组(n=8)以吸入1.3MAC异氟醚维持麻醉.以0.01%硝普钠溶液使MAP降低40%.结果Ⅰ组血压易于下降和维持,停止降压后Ⅰ组MAP显著低于Ⅱ组(P＜0.05);Ⅰ组硝普钠平均剂量显著低于Ⅱ组(P＜0.001),硝普钠总量较Ⅱ组减少53%;两组各时点HR,血浆去甲肾上腺素浓度及尿量无显著性差异;维持降压期间Ⅰ组血浆肾上腺素浓度(PE)显著低于Ⅱ组(P＜0.05).结论异丙酚维持麻醉可增强硝普钠控制性降压效果,减少并发症发生.其机制可能与异丙酚的直接扩血管和交感抑制作用有关.     

尼卡地平、艾司洛尔联合诱导期容量填充对静-吸复合全身麻醉七氟醚用量的影响

目的 观察尼卡地平、艾司洛尔联合诱导期容量填充对静吸复合全身麻醉七氟醚用量的影响.方法 60例择期行脊柱手术的患者.随机均分为四组,诱导期以羟乙基淀粉10 ml/kg快速静滴行容量填充,诱导后插管前1 min时分别静注艾司洛尔1 mg/kg(E组)、尼卡地平20μg/kg(N组)、艾司洛尔1 mg/kg复合尼卡地平20μg/kg(EN组)或生理盐水(C组),于切皮前1 min追加1/2首量药物或生理盐水.记录各组七氟醚用量、清醒、拔管时间及HR、MAP的变化.结果 与C组比较,E组、N组及EN组术中所需七氟醚维持浓度均显著降低(P<0.05),清醒及拔管时间明显缩短(P<0.05).与C组比较.E组HR较慢(P<0.05),但不能完全控制MAP的升高;N组MAP较低(P<0.05);EN组能明显抑制诱导插管及切皮引起的HR、MAP升高(P<0.05).结论 艾司洛尔、尼卡地平联合诱导期容量填充不仅有利于维持血流动力学的平稳,而且能够明显减少静吸复合全身麻醉七氟醚用量、缩短拔管时间.     

尼卡地平和艾司洛尔对血液动力学的影响

目的：对比观察全麻术中单独或联合应用尼卡地平和艾司洛尔对血液动力学的影响，为临床合理用药提供参考依据。方法：45例ASAI－II级择期颅脑手术患者，年龄18－60岁，用1．1－1．3MAC异氟醚吸入麻醉，随机平均分成3组，每组15例，当术中平均动脉压（MAP）超过麻醉前水平15％时，单次静脉注射尼卡地平0．01mg/kg(N组），当心率超过90次／分时，单次静脉注射艾司洛尔1mg/kg(E组）；MAP和心率均达到标准时，单次静注射尼卡地平0．01mg/kg和艾司洛尔1mg/kg（NE组），连续监测给药前后每博输出量（SV），心输出量（CO），血流加速度（ACC），左室射血时间（LVET），全身血管阻力（SVR）等血液动力学参数的变化。结果：N组给药后SVR和MAP分别下降23．7％和12．2％，HR，ACC，PV和CO分别增加11．5％，13．3％，13．1％和15．7％，E组给药后HR，ACC，PV，CO分别减少16.3%,24.9%,10.7%,17.5%，MAP无显著变化，NE组MAP，LHR，ACC，PV分别降低15．3％，16．3％，13．5％和4．4％，SV，CO和SVR无显著性变化，结论：尼卡地来适用于不伴有心动过速的血压升高患者，艾司洛尔适用于心功能良好的单纯心动过速患者，两药合用可以取长补短，适用于伴有心率增快的血压升高患者。     

尼卡地平控制性降压联合中度高容量血液稀释对内脏氧合及全身炎性反应的影响

目的研究尼卡地平控制性降压联合中度急性高容量血液稀释(AHH)对内脏氧合及全身炎性反应的影响。方法神经外科病人10例,麻醉诱导后30min内行中度AHH,使红细胞压积(Hct)降至30%,术中采用尼卡地平控制性降压,并维持MAP在55~65mmHg。观察入室(T0)、血液稀释至目标值(T1)、控制性降压至目标值(T2)、降压达目标值后30min(T3)、降压停止(T4)和术毕(T5)时胃粘膜二氧化碳分压(PgCO2)、PgCO2与动脉血二氧化碳分压差(Pg-aCO2)、胃粘膜pH值(i-pH),测定T1、T3和T5时血清肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)和β2-微球蛋白(β2-MG)含量。结果T1、T2、T5时的i-pH与T0时相比显著降低(P<0·05),T1、T2、T3时的Pg-aCO2与T0时相比明显升高(P<0·05)。T4、T5时的血乳酸(Lac)水平明显高于T0时(P<0·05)。各时点的TNF-α含量较正常值明显增加(P<0·05),而IL-8和β2-MG含量无显著改变。结论中度AHH可能会导致内脏氧合受损,并激发全身炎性反应,联合尼卡地平控制性降压可部分缓解内脏氧合受损和全身炎性反应。     

艾司洛尔与尼卡地平用于预防颅脑术后吸痰拔管时引起的心血管反应

目的探讨单独或联合应用艾司洛尔和尼卡地平用于预防颅脑术后吸痰或拔出气管导管时引起心血管反应的效果。方法选择颅脑择期手术病人80例,ASA为Ⅱ～Ⅲ级,随机分为4组,每组20例。在手术结束后及准备拔管前按组静脉注射不同药物:即对照组(A组)为生理盐水5ml;艾司洛尔组(B组)为1mg/kg;尼卡地平组(C组)为20μg/kg;艾司洛尔+尼卡地平组(D组)为艾司洛尔0.5mg/kg和尼卡地平10μg/kg,分别于拔管前、拔管时或拔管后1、2、3min监测记录MAP和HR的变化情况。结果各组在拔出气管导管前后与基础值相比,A组表现为MAP明显增高和HR明显增快;B组MAP略显升高,而HR却无明显变化;C组MAP接近基础值,但HR进一步增快。D组在MAP和HR接近于拔管前的基础值。结论在拔管前单独应用艾司洛尔可有效抑制心率增快,但不能防止血压升高;单独应用尼卡地平可抑制血压升高,但不能控制心率增快,二者联合应用可以取长补短,能有效抑制吸痰、拔管时引起的心血管应激反应。     

心脏外科围术期应用尼卡地平对心肌能量代谢的影响

目的观察尼卡地平对体外循环(CPB)后心肌能量代谢的影响.方法16例心脏瓣膜外科病人,随机分为对照组(C组,n=8)和尼卡地平组(N组,n=8).N组在麻醉诱导后,开始滴注小剂量尼卡地平(0.5μg@kg-1@min-1)至转机前,给予总剂量为0.5mg@kg-1,不足该剂量者,转机后即刻补足.在转机前即刻、开放主动脉后5min、30min、术毕、术后6h、18h,同时采集动脉血与冠状窦血,测定血乳酸、血糖、血气,由此计算心肌乳酸摄取率(LER)、心肌血糖摄取率(GER)及心肌摄氧指数(MOEI).结果与CPB前相比,C组主动脉开放后GER和LER均明显下降(P＜0.05),至术后6h仍未恢复正常.N组主动脉开放后,GER无明显变化且显著高于C组(P＜0.05);LER显著下降(P＜0.05),但明显高于C组(P＜0.05).两组开放主动脉5min后MOEI明显下降,随后显著恢复(P＞0.05).结论CPB可导致心肌乳酸和葡萄糖代谢受损及恢复延迟,小剂量尼卡地平可明显改善转流后心肌的乳酸与葡萄糖的代谢.     

正颌手术中尼卡地平行控制性降压对术后全身炎症反应综合征的影响

目的 观察尼卡地平用于正颌术中控制性降压对术后全身炎症反应综合征（SIRS）的影响。方法 选取2019年10月-2023年4月于我院拟行正颌手术的199例患者为研究对象，随机分为加深麻醉组（P组） 98例、尼卡地平组（N组）101例。P组采用增加丙泊酚泵注剂量行控制性降压，N组复合泵注尼卡地平行 控制性降压，目标将MAP降至65 mmHg以下，比较两组术后第1天SIRS发生率，术中不同时刻平均动脉压 （MAP）、心率（HR）和麻醉深度患者状态指数（PSI）、术中麻醉用药剂量及拔管时间。结果 N组术后 第1天SIRS发生率为33.66%，低于P组的40.82%，但差异无统计学意义（P ＞0.05）；两组T1~T8时刻MAP 比较，差异无统计学意义（P＞0.05）；N组T2~T7时刻HR高于P组（P ＜0.05）；除T7时刻外，N组T2~T8 时刻适宜麻醉深度例数多于P组，麻醉过深例数少于P组（P ＜0.05）；N组术中丙泊酚使用量小于P组，拔 管时间短于P组（P＜0.05）。结论 尼卡地平用于正颌术中控制性降压效果满意，且有助于维持合适麻醉深 度，缩短拔管时间，但对术后全身炎症反应综合征发生率无明显影响。     

复合用药控制性降压在颅脑手术的应用

目的比较单独用硝酸甘油与硝酸甘油加艾司洛尔,在颅脑手术时行控制性降压的效果。方法34例在异氟烷全麻下行颅脑手术病人,随机分为硝酸甘油组(Ⅰ组,16例)和硝酸甘油复合艾司洛尔组(Ⅱ组,18例),术中MAP降至并维持在60～65mmHg,观察此降压期间血流动力学的变化。结果1.两组各行控制性降压时间无显著差异。2.Ⅱ组硝酸甘油平均用量和总用量比Ⅰ组分别减少42%和39%(P<0.05)。3.Ⅰ组降压后心率明显增快(P<0.05)。Ⅱ组合并使用艾司洛尔50μg·kg-1·min-1后,心率变化不大,各时段心率均慢于Ⅰ组(P<0.01)。4.两组降压所需时间和停降压药后血压回升时间无显著差异(P>0.05)。结论异氟烷全麻下的颅脑手术患者,术中行控制性降压至MAP60～65mmHg,如联合应用硝酸甘油和艾司洛尔,可显著减少硝酸甘油的用药量,并可避免降压过程中的心率增快,使降压过程确切、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.     

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.     

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.     

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.