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1.
目的 观察在脑电双频谱指数(BIS)监测下不同剂量舒芬太尼对麻醉诱导时病人异丙酚效应室靶浓度(Ce)及气管插管反应的影响,以探讨舒芬太尼复合异丙酚麻醉诱导的合适用量。方法 择期全麻手术病人60例,ASAⅠ级或Ⅱ级,年龄20-60岁,体重45-80 kg,随机分为3组(n= 20),均静脉注射咪达唑仑0.05 mg/kg后开始靶控输注异丙酚(初始靶浓度为2μg/ml),同时分别静脉注射芬太尼3μg/kg(F组)、舒芬太尼0.3μg/kg(S1组)、舒芬太尼0.45μg/kg(S2组)。待病人意识消失后或BIS降至75以下时静脉注射维库溴铵0.12 mg/kg,BIS降至55以下时进行气管插管,机械通气。调整异丙酚靶浓度维持BIS 40-60。记录入室时(基础值)、气管插管前即刻、插管后即刻、插管后3、5、10、15 min时BP、MAP、HR、BIS及Ce。结果 与F组和S1组比较,S2组插管后即刻和插管后3、5、10、15min时Ce降低(P〈0.05),但F组和S1组各时点比较差异无统计学意义(P〉0.05)。与基础值比较,F组和S1组插管后即刻和插管后3 min时BP、MAP和HR增加(P〈0.05)。与S2组比较,F组和S1组插管后即刻和插管后3 min时BP、MAP和HR增加(P〈0.05)。F组和S1组各时点BP、MAP和HR比较差异均无统计学意义(P〉0.05)。结论 病人在靶控输注异丙酚麻醉诱导时,舒芬太尼抑制气管插管心血管反应的效价是芬太尼的7倍。  相似文献   

2.
目的观察新型肾上腺素受体激动剂右美托咪定(dexmedetomi(iine,Dex)预注对瓣膜置换术患者麻醉诱导期血流动力学和脑电双频指数(bispectralindex,BIS)值的影响。方法选择择期瓣膜置换术患者30例,采用随机数字表法分为两组:Dex组(D组)和对照组(C组),每组15例。D组于麻醉诱导前静脉微量泵预注用生理盐水稀释成50ml的Dex(浓度为4mg/L)0.5μg/kg,输注时间为10min,C组以同样方式输注等体积生理盐水。均以依托咪脂、芬太尼、哌库溴铵、咪达唑仑复合诱导麻醉。记录入室后输注Dex前即刻基础值(T1)、输注Dex后5min(T2)、输注Dex后10min麻醉诱导前时刻(T3)、麻醉诱导后1min(T4)、麻醉诱导后3min(T5)、插管前OPN(T6)、插管即刻(T7)、插管后1min(T8)、插管后3min(Tq)、插管后5min(T10)各时点的心率(heartrate,HR)、有创血压值(artefial blood pressure,ABP)[收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压mean artery pressure,MAP)]和BIS变化。结果全麻诱导前,与T1(92.6±2.5)比较,D组BIS在T2(73.2±1.9)、T3(70.1±2.3)时显著下降(P〈0.05或P〈0.01),C组没有明显变化;全麻诱导期,与T3比较,两组BIS明显下降;气管插管期间,与T6比较,C组在T7时BIS(34.8±2.2)显著增高(P〈0.05或P〈0.01),而D组BIS无明显变化。与C组比较,D组BIS在T2~T5、T7明显降低(P〈0.05或P〈0.01)。全麻诱导前,与T1比较,D组在T2、T3时ABP略有增高,HR显著降低(P〈0.05或P〈0.01);全麻诱导期,与T1比较,两组ABP、HR均下降;气管插管期间,与T6比较,D组DBP、MAP、HR在T7、T8略有升高,T9、T10无明显变化(P〉0.05),C组ABP、HR在B~T10显著增高(P〈0.05或P〈0.01)。与C组比较,D组SBP、MAP在T4-T10和DBP在T3-T10显著增高、HR在T2~T10显著降低(P〈0.05或P〈0.01)。结论静脉预注Dex能明显加深麻醉,BIS降低,减少瓣膜置换术患者气管内插管期心血管反应,血流动力学更加平稳,适合在临床中应用。  相似文献   

3.
目的观察全身麻醉过程中,维库溴铵对脑电熵指数——状态熵(AE)和反应熵(RE)以及脑电双频谱指数(BIS)的影响。方法ASAⅠ级或Ⅱ级择期手术患者60例,随机分为4组(n=15):Ⅰ组为对照组,静脉注射生理盐水;Ⅱ组、Ⅲ组、Ⅳ组为试验组,分别静脉注射维库溴铵0.03、0.06、0.12 mg/kg。麻醉诱导采用异丙酚靶控输注(TCI),当效应室浓度(CE)达到3.5μg/ml时,按组别静脉注射维库溴铵或等容积生理盐水,5 min后静脉注射芬太尼3μg/kg,行气管插管,观察5 min后将Ⅰ组、Ⅱ组、Ⅲ组维库溴铵剂量补足到0.12 mg/kg。记录诱导前即刻、CE达到3.5μg/ml、注射维库溴铵或生理盐水后1、2、3、4、5 min、气管插管前即刻、插管后即刻及插管后1、3、5 min的RE、AE、BIS、HR和MAP。结果与维库溴铵静脉注射前即刻比较,4组静脉注射后各时点RE、SE、BIS、HR、MAP差异无统计学意义(P>0.05);4组间静脉注射前后RE、SE、BIS、HR、MAP比较差异无统计学意义(P>0.05)。与插管前即刻比较,4组插管后即刻及插管后1min时RE、SE、BIS、HR和MAP均升高(P<0.05或0.01);与Ⅰ组比较,Ⅱ组、Ⅲ组、Ⅳ组插管后即刻和插管后1 min RE、SE和BIS降低(P<0.05),但3组间比较差异无统计学意义(P>0.05)。结论在深度镇静且无伤害性刺激时,维库溴铵对脑电熵指数和BIS无影响;存在伤害性刺激时(如气管插管),即使小剂量(0.03 mg/kg)的维库溴铵也可降低脑电熵指数和BIS的升高幅度。  相似文献   

4.
目的 评价瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管系统的影响.方法 选择择期上腹部手术患者60 例,ASAⅠ - Ⅱ级,随机分为3 组(n = 20):瑞芬太尼2 μg/kg组(Ⅰ组),芬太尼4 μg/kg + 艾司洛尔1 mg/kg 组(Ⅱ组)和瑞芬太尼2 μg/kg + 艾司洛尔1 mg/kg组(Ⅲ组).分别注入上述药物、丙泊酚2 mg/kg 和阿曲库铵1.5 mg/kg 后行气管插管,机械通气.记录麻醉诱导前(T1)、麻醉诱导后1 min(T2)、气管插管后即刻(T3)、气管插管后1 min(T4)、3 min(T5)及10 min(T6)的HR、收缩压(SP)、舒张压(DP),并于T1、T2、T4 时分别采集桡动脉血7 ml,测定血浆肾上腺素(Ad)和去甲肾上腺素(NA)的浓度.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组HR、SP、DP 及血浆Ad 和NA 的浓度降低(P 〈 0.05);与Ⅱ组比较,Ⅲ组HR、SP、DP 降低(P 〈 0.05);与T1 比较,T2时3 组HR、SP、DP 及血浆Ad 和NA 的浓度降低(P 〈 0.05);Ⅰ组T3 时HR、SP、DP 升高,Ⅱ组和Ⅲ组差异无统计学意义.结论 瑞芬太尼复合艾司洛尔可更好地预防全麻患者气管插管时的心血管副作用.  相似文献   

5.
目的 比较小剂量瑞芬太尼和芬太尼对小儿经口气管插管血液动力学反应的影响。方法 择期在全身麻醉下行整形外科手术患儿90例,ASAⅠ或Ⅱ级,年龄3-9岁,随机分为3组(n=30):对照组(C组)、芬太尼组(F组)和瑞芬太尼组(R组)。气管插管前5min行麻醉诱导,C组和F组分别静脉注射生理盐水0.2ml/kg或芬太尼2μg/kg,插管前2min三组均静脉注射维库溴铵0.1mg/kg和异丙酚2.5mg/kg,插管前1.5minR组在30s内静脉输注瑞芬太尼1μg/kg。采用直接喉镜行经口气管插管。记录麻醉诱导前(基础值)、诱导后即刻、气管插管时和插管后1、2、3、4、5min时的血压和心率(HR),计算各对应时点HR和收缩压(SBP)的乘积(RPP)。记录插管时间、从插管操作开始至出现SBP和HR最大值的时间(TMAX-SBP和TMMAX-HR)以及从插管操作完成至SBP和HR恢复至诱导后即刻值的时间(TR-SHP和TRR-HR)。结果 与基础值相比,诱导后即刻各组血压均降低,F组和R组降低较C组明显(P〈0.05),C组HR增快(P〈0.05),F组和R组HR保持稳定;气管插管致各组血压、HR和RPP升高(P〈0.05),以C组最为明显,R组最轻;R组TMNAX-SBP和TMMAX-HR长于C组和F组,THR-SBP和TR-HR短于C组和F组(P〈0.05)。结论 与小剂量芬太尼相比,小剂量瑞芬太尼可更有效地抑制小儿经口气管插管的血液动力学反应。  相似文献   

6.
目的 观察急性高容量血液稀释(AHH)对患者靶控输注(TCI)异丙酚时镇静深度的影响。方法 择期全麻患者80例,随机分为4组(n=20):A组、B组、C组气管插管后5min均开始进行急性高容量血液稀释,静脉输注乳酸钠林格氏液8ml/kg,同时30min内静脉输注6%羟乙基淀粉(HES,200/0.5)15ml/kg。B0组为B组的对照组,只静脉输注乳酸钠林格氏液8ml/kg,不进行急性高容量血液稀释。A组、B组、B0组、C组分别以2、4、4、6μg/ml异丙酚效应室靶浓度实施靶控输注至血液稀释结束。监测各组开始血液稀释即刻、5、10、15、20、25、30min时的BIS、AAI、MAP、HR、SpO2及ECG的变化,采集血标本,检测血液稀释前即刻和血液稀释结束时的Hct、Hb。结果 与B0组比较,B组MAP升高,BIS和AAI降低(P〈0.05或P〈0.01),血液稀释结束时Hct、Hb下降(P〈0.01)。随AHH的进行A组和B组MAP逐渐上升,BIS、AAI逐渐下降(P〈0.05或P〈0.01),Bn组和C组的MAP、BIS、AAI无明显变化,4组HR、SpO2差异无统计学意义(P〉0.05);与血液稀释前即刻比较,A组、B组、C组在血液稀释结束时的Hct、Hb降低(P〈0.01),Bn组无变化(P〉0.05)。结论 患者以异丙酚2、4μg/ml效应室靶浓度靶控输注时,急性高容量血液稀释可加深镇静深度,当效应室靶浓度升为6μg/ml时,对其镇静深度无明显影响。  相似文献   

7.
目的评价舒芬太尼复合艾司洛尔对全麻患者气管插管时心血管反应的影响。方法择期上腹部手术患者60例,年龄26~50岁,体重48~75kg,ASAⅠ或Ⅱ级,随机分为3组(n=20):舒芬太尼0.5μg/ks组(Ⅰ组)、芬太尼5μg/kg+艾司洛尔1 mg/kg组(Ⅱ组)和舒芬太尼0.5μg/kg+艾司洛尔1 mg/kg组(Ⅲ组)。3组均静脉注射试验用药、异丙酚1.5 mg/kg和维库溴铵0.1 mg/kg麻醉诱导后气管插管,机械通气。分别于麻醉诱导前(T1)、麻醉诱导后1min(T2)、气管插管后即刻(T3)、气管插管后1 min(T4)、3min(T5)及10min(T6)记录HR,收缩压(SP)、舒张压(DP),并于T1、T2、T4时采集桡动脉血7 ml,测定血浆肾上腺素(Ad)和去甲肾上腺素(NA)的浓度。结果与Ⅰ组比较,Ⅱ组和Ⅲ组HR、SP、DP及血浆Ad和NA的浓度降低(P〈0.05);与Ⅱ组比较,Ⅲ组HR、SP、DP降低(P〈0.05)。与T1比较,T2时3组HR、SP、DP及血浆Ad和NA浓度降低(P〈0.05),Ⅰ组T3时HR、SP、DP升高,T4时HR升高,Ⅱ组、Ⅲ组差异无统计学意义(P〉0.05)。结论舒芬太尼0.5μg/kg复合艾司洛尔1mg/kg可更好地预防全麻患者气管插管时的心血管反应。  相似文献   

8.
目的:观察长效选择性β受体阻滞剂—倍他洛克(metoprolol.美托洛尔)对丙泊酚麻醉诱导气管内插管期的BIS、ICP和血流动力学影响。方法:随机选择鼻蝶入路垂体瘤切除术病人100例,ASAⅠ-Ⅱ级,分为倍他洛克组(工组)和对照组(Ⅱ组),每组50例。工组於麻醉诱导期静脉注射倍他洛克60μg/kg;Ⅱ组静脉注射等容量生理盐水。麻醉诱导采用丙泊酚2mg/kg、芬太尼3μg/kg、罗库溴铵1mg/kg,OSS/A评分0级施行气管内插管.术中持续监测平均动脉压(MAP),心率(HR),颅内压(ICP)和脑电双频谱指数(BIS)。结果:倍他洛克组与对照组在气管插管后1min时的BIS分别为39±11和58±8,前者与插管前相比无显着性改变,而后者则较插管前有明显增高并延续至插管后5min(P〈0.05,P〈0.01),且其组间的显着性差异延续至插管后15min(P〈0.01).倍他洛克组与对照组的MAP和HR在插管后3min和5min,均较插管前明显上升,对照组HR分别为89±11bpm和76±12bpm,MAP分别为122±16mmHg和106±18mmhg,倍他洛克组HR分别为81±12bpm和74±8bpm,MAP分别为111±18mmHg和97±17mmHg。两组相比,对照组的血流动力学显着性上升(P〈0.01),且其组间的显着性差异延续至插管后30min(P〈0.05,P〈0,01)。对照组的ICP於插管后3min上升为14.0±2.3mmHg,舆插管前相比有显着性差异(P〈0.05);插管后5min,15min和30min的ICP分别为14.9±.0mmHg,15.5±2.6mmHg和14.4±2.7mmHg,显着性高於倍他洛克组(P〈0.05,P〈0.01).两组插管后的ICP舆麻醉前比较均有显着性升高(P〈0。01)。结论:倍他洛克能减低麻醉诱导气管插管期的血流动力学波动和ICP升高,并抑制DIS反跳.  相似文献   

9.
厄贝沙坦对高血压患者全麻气管插管血流动力学的影响   总被引:1,自引:0,他引:1  
目的:评价口服血管紧张素受体拮抗剂-厄贝沙坦减轻高血压患者全麻气管插管的心血管反应的临床效果。方法:30例美国麻醉医师协会体验分级(ASA)Ⅰ-Ⅱ级拟在全麻下行胆囊切除术的择期手术患者,随机分为A组(厄贝沙坦组)、B组(对照组),每组15例,分别于服药前、诱导前、插管后即刻、插管后5min,记录上述收缩压(SBP)、舒张压(DBP)、心率(HR)、心率收缩压乘积(RPP)。结果:A组服药后,诱导前SBP下降,插管后3min,5minSBP血压无明显上升,两组SBP、DBP差异明显(P〈0.01)。A、B组麻醉诱导期HR均有所上升,但B组在诱导后3min、5min上升明显(P〈0.05),两组比较在插管后即刻有明显差异(P〈0.01)。RPP,A组在麻醉诱导前后无明显变化,B组在插管后即刻至插管后5minRPP明显升高,两组比较有明显差异(P〈0.05或P〈0.01)。结论:预防性口服厄贝沙坦可明显减轻高血压患者全麻气管插管的心血管反应。  相似文献   

10.
目的探讨腹部手术患者麻醉中持续静脉输注ATP对靶控输注异丙酚效应室浓度的影响。方法择期下腹部手术患者60例,ASAⅠ级或Ⅱ级,年龄44~64岁,体重49~87kg,随机分为3组(n=20):异丙酚组(P组)单纯靶控输注异丙酚维持麻醉;ATP1组和ARP2,组在靶控输注异丙酚的同时,分别以微量泵持续静脉输注ATP 0.4 mg·kg^-1·h^-1和0.6mg·kg^-1·h^-1。术中根据BIS、MAP、HR调整异丙酚血浆靶浓度。当BIS>55或BIS<40时则以0.2μg/ml幅度增加或降低异丙酚靶浓度。术中静脉输注芬太尼,并根据需要使用血管活性药物。于麻醉诱导前即刻(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、切皮前即刻(T3)、切皮后10 min(T4)和60 min(L5)、术毕(T5)、呼之睁眼(L7)以及气管拔管后即刻(L8)记录HR、MAP、SpO2、BIS。记录麻醉全程异丙酚效应室浓度及停止靶控输注后TCI泵所显示的效应室浓度。结果3组一般资料、麻醉时间、芬太尼用量及苏醒时间比较差异无统计学意义(P>0.05)。3组MAP、HR及SpO2维持在正常范围。术中异丙酚效应室浓度:与P组比较, ATP1组在T4至T8时降低,ATP2组在T1至T8时降低(p<0.05或0.01);与ATP1组比较,ATP2组T5至T7时降低(P<0.05)。结论腹部手术患者麻醉中,BIS维持40~55时,ATP 0.4~0.6 mg·kg^-1·h^-1持续静脉输注可降低靶控输注异丙酚效应室浓度,且随ATP用药量的增加,异丙酚用药量相应减少,且不影响苏醒时间。  相似文献   

11.
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 (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.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
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.  相似文献   

16.
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.  相似文献   

17.
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.  相似文献   

18.
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.  相似文献   

19.
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.  相似文献   

20.
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.  相似文献   

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