福莫特罗和ICI118551对大鼠成熟破骨细胞骨吸收功能的影响

目的研究选择性β2肾上腺素能激动剂福莫特罗(Formoterol)和阻滞剂ICI118551对体外培养大鼠成熟破骨细胞(osteoclast,OC)功能的影响,探讨β2肾上腺素能受体信号对骨代谢的影响。方法取清洁级出生24h内的SD乳大鼠,长骨干骨髓腔内壁机械分离成熟OC后分别加入不同浓度(10-5mol/L～10-9mol/L)的Formoterol和ICI118551,以抗酒石酸酸性磷酸酶(TRAP)染色观察破骨细胞形态,甲苯胺蓝染色计数骨片上的骨吸收陷窝数目,Image-ProPlus6.0图像软件分析骨片上骨吸收陷窝面积。结果破骨细胞与骨片共培养6天,不同浓度的Formoterol与对照组相比均可增加骨片上OC的骨吸收陷窝数目和面积;随着ICI118551浓度的提高骨片上骨吸收陷窝的数目和面积逐渐减少。结论β2肾上腺素能受体激动剂可促进体外培养OC的骨吸收功能,阻滞剂对OC的骨吸收功能有抑制作用,且呈剂量依赖性。     

重组人骨保护素对聚乙烯颗粒刺激破骨细胞功能的影响

目的通过观察重组人骨保护素（recombinant humanoste oprotegerin，rhOPG）对聚乙烯颗粒刺激破骨细胞功能的影响，探讨rhOPG防治人工关节无菌性松动的可行性。方法取出生24h内新西兰白兔5只，体重80～100g，雌雄不限。分离培养四肢长骨破骨细胞，以1×10^5／mL密度均匀接种于大小为10mm×10mm玻片和8mm×8mm×50μm骨片的24孔板内。根据加入rhOPG及聚乙烯颗粒浓度和密度的不同，玻片培养板和骨片培养板再分别分为1×10^9／mL聚乙烯颗粒培养组（聚乙烯组）、1×10^9／mL聚乙烯颗粒和100ng／mL rhOPG共培养组（聚乙烯／rhOPG组）及空白对照组。于培养1、3、5、7d取细胞玻片行HE、甲苯胺蓝染色，抗酒石酸酸性磷酸酶（trafrate resistant acid phosphatase，TRAP）染色计数阳性细胞数：皮质骨片行甲苯胺蓝染色并用扫描电镜观察骨片吸收陷窝形态。结果TRAP染色后破骨细胞呈玫瑰红色：培养后5、7d，聚乙烯组阳性染色的破骨细胞与对照组、聚乙烯／rhOPG组比较明显增多，差异均有统计学意义（P〈0．05）；对照组与聚乙烯／rhOPG组比较，差异无统计学意义（P〉0．05）。骨片吸收陷窝甲苯胺蓝染色呈蓝紫色：培养5、7d后，聚乙烯组骨片上的吸收陷窝计数与对照组比较明显增多（P〈0．05）；培养后1、3、5、7d，聚乙烯／rhOPG组骨片上的吸收陷窝计数与聚乙烯组比较，差异均有统计学意义（P〈0．05）。结论rhOPG可抑制聚乙烯颗粒对破骨细胞的刺激作用，可用于防治人工关节置换术后的无菌性关节松动。     

两种不同降钙素对体外培养破骨细胞影响的实验研究

目的 观察不同浓度鳗鱼降钙素与鲑鱼降钙素对体外分离培养的破骨细胞数量和活力的影响.方法 从新生幼兔四肢长骨中机械分离出破骨细胞,分别接种于盖玻片及骨薄片上,加入两种不同种类的降钙素,抗酒石酸酸性磷酸酶(TRAP)染色观察盖玻片上破骨细胞的数量和形态,JD801图像分析软件分析骨片上骨吸收陷窝的面积.结果 两种降钙素的各个浓度组(分别是10-12 mol/L、10-10 mol/L、10-8 mol/L)均对贴壁生长的破骨细胞数量有明显抑制作用,并呈剂量相关性.骨吸收陷窝面积分析结果显示,两类降钙素均对破骨细胞吸收功能有明显抑制作用,呈剂量相关性.无论是盖玻片培养还是骨薄片培养,益钙宁和密盖息各相同浓度组间两两对照比较差异均无显著性 (P>0.05).结论 两种不同种类降钙素对体外培养的破骨细胞数量和骨吸收活性的抑制能力相仿.     

氟对破骨细胞骨吸收陷窝的影响

目的 观察氟对大鼠破骨细胞(Osteoclast,OC)形成的骨吸收陷窝的影响。方法 通过机械分离新生大鼠乳鼠四肢长骨方法体外培养Oc,并于1 d后加入含不同浓度氟的培养基,观察氟对OC形成的骨吸收陷窝数量及面积的影响。结果 随染氟剂量的增加,骨吸收陷窝数及陷窝面积逐渐增加,各剂量组与对照组比差异均有显著性(P<0.05),其中尤以4.0mg/L染氟组最为明显(P<0.01)。结论 在一定的剂量范围内,随染氟剂量的增加,OC的骨吸收作用是增强的。     

波尔定对破骨细胞分化及骨吸收功能的影响

目的研究波尔定对NF-κB受体活化因子配体(RANKL)诱导的小鼠单核细胞(RAW264.7)向破骨细胞(OC)分化及骨吸收功能的影响。方法采用RANKL(50 ng/ml)诱导RAW264.7细胞向OC分化,不同浓度波尔定(1、10、20、40、80μmol/L)联合分化培养。培养第4d采用抗酒石酸酸性磷酸酶(TRAP)染色,计算OC样细胞数量;比色法测定TRAP活性;Real-time PCR法检测各组OC标志性基因核因子κB受体活化因子(RANK)、活化T细胞核因子1(NFATc1)和c-fos基因的表达;CCK-8法检测波尔定对OC的毒性。培养至第9d,采用甲苯胺蓝染色并用Leica Qwin图像分析系统计算骨吸收陷窝面积。结果与对照组比较,TRAP阳性OC数量、TRAP活性、OC标志性基因RANK、NFATc1和c-fos的表达量及骨陷窝面积,随着波尔定浓度增加而减少,与对照组比较,20μmol/L、40μmol/L、80μmol/L波尔定可明显减少OC数量和TRAP活性(P0.05,P0.01),下调OC标志性基因RANK、NFATc1和c-fos的表达量及骨陷窝面积(P0.05),但以上浓度波尔定对OC均未产生毒性。结论波尔定对RANKL诱导的RAW264.7细胞向OC的分化及骨吸收功能具有抑制作用。     

重组人骨保护素与重组核因子κb活化因子受体蛋白对破骨前体细胞分化的影响

目的:对比重组人骨保护素(rhOPG-Fc)与重组核因子κb活化因子受体蛋白(rhRANK)对破骨前体细胞分化的影响.方法:采用成骨细胞与破骨前体细胞RAW264.7混合培养,在地塞米松、1,25 (OH) 2VitD3诱导下生成破骨细胞的方法.研究分3组:rhRANK组:10-5 g/L;rhOPG-Fc组:10-5 g/L;空白对照组.作用9d后观察破骨细胞数目和形态,抗酒石酸酸性磷酸酶(TRAP)染色阳性细胞个数,骨磨片吸收陷窝计数.结果:在空白对照组,小鼠成骨细胞与破骨前体细胞RAW264.7混合培养6d后,开始出现多核细胞,9d时可见大量成熟多核细胞,经TRAP染色证实为成熟破骨细胞,而rhRANK组及rhOPG-Fc组TRAP染色阳性多核细胞数较对照组均减少,特别是rhRANK组减少更明显.骨片吸收陷窝计数显示rhRANK组及rhOPG-Fc组较对照组也明显减少,而相对来说,rhRANK组较rhOPG-Fc组更少.结论:rhOPG-Fc与rhRANK均可以有效抑制破骨前体细胞分化成为成熟破骨细胞,且rhRANK较rhOPG-Fc抑制效果更明显.     

淫羊藿苷对破骨细胞活性的影响

目的:观察淫羊藿苷对破骨细胞骨吸收及凋亡的影响,探讨淫羊藿苷的抗骨质疏松作用机制。方法:体外分离、培养兔破骨细胞,与玻片及骨磨片共同培养,用10-7、10-6、5×10-6、10-5mol/L浓度的淫羊藿苷刺激破骨细胞,倒置相差显微镜下观察活体细胞、HE染色、TRAP染色及骨吸收陷窝甲苯胺蓝染色,鉴定破骨细胞,并进行骨吸收陷窝计数和面积测量,吖啶橙染色观察凋亡破骨细胞所占的比例。结果:与空白对照组比较,10-6、5×10-6、10-5mol/L浓度的淫羊藿苷组破骨细胞凋亡率均明显增高,骨吸收陷窝数目、面积明显减少,随浓度增加抑制作用增强,差异有显著性意义(P<0.05)。结论:淫羊藿苷可诱导破骨细胞凋亡,抑制骨吸收,并随浓度增加抑制作用增强。     

M-CSF和RANKL体外诱导培养小鼠破骨样细胞及其骨吸收功能的动态观察

目的以巨噬细胞集落刺激因子(Macrophage colony-stimulating factor,M-CSF)和核因子κB受体激动剂配体(Ligand of receptor activator of NF-κB,RANKL)联合体外诱导小鼠骨髓干细胞分化为破骨样细胞,并对其骨吸收功能进行动态观察。方法分离小鼠四肢骨获取骨髓干细胞,以M-CSF和RANKL诱导培养,将盖玻片及骨磨片置入培养基内,在诱导培养的第3,6,9天分别对盖玻片行抗酒石酸酸性磷酸酶(The tartrate-resistant acid phosphatase TRAP)染色,观察细胞形态和染色情况,并计算破骨样细胞数量;同时对骨磨片进行骨吸收陷窝的观察。结果诱导培养3 d后出现含TRAP(+)颗粒的细胞,可见淡染单核和双核;诱导培养6 d后可见TRAP(+)细胞较诱导培养3 d时增多,仍以双核为主;诱导培养9 d后出现多核巨型TRAP(+)细胞,细胞核达到3个以上。并且随着诱导培养的时间延长,破骨样细胞数量逐渐增长。诱导培养第3,6天骨磨片上均未发现骨吸收陷窝,第九天出现不同形态的呈蓝紫色的吸收陷窝。结论 M-CSF和RANKL联合体外诱导小鼠骨髓干细胞形成破骨样细胞是一种有效的诱导培养方法,本实验在诱导培养第九天发现破骨样细胞具有骨吸收功能。     

骨保护素体外抑制小鼠单核巨噬细胞 成熟分化的实验研究

目的研究骨保护素（Osteoprotegerin, 0PG)抑制核因子NF-KB受体活化因子配体（Receptor activator of nuclear kappa B ligand,RANKL)诱导小鼠单核细胞RAW264. 7成熟分化而导致的溶骨效 应。方法50 ng/mL RANKL诱导RAW264. 7细胞1 d后,加人100 ng/mL 0PG(实验组,即0PG + RANKL组）或不加人0PG(对照组,即RANKL组）分别培养7 d和9 d,经细胞形态学观察其变化,抗 酒石酸酸性碟酸酶（Tartrate resistant acid phosphatase, TRAP)染色法观察TRAP阳性多核细胞,扫描 电镜下观察在骨片上的破骨细胞所致的骨吸收陷窝形成情况。结果对照组培养7 d时,在倒置相 差显微镜、透射电镜、光镜下可见细胞形状为椭圆形或不规则形,胞体明显较KAW264.7细胞增大, 胞核多为6 ~ 10个,扫描电镜下还可见大量伪足形成,而实验组培养7 d后,细胞形状多为圆形,且扫 描电镜下未见明显伪足形成;对照组9 d时可见大量TRAP染色阳性的多核巨细胞（含3个或3个以 上的细胞核）,而实验组中TRAP染色阳性的多核破骨细胞偶见多核巨细胞,培养9 d时很难找到多 核巨细胞;仅用RANKL诱导RAW264.7细胞分化7 d时,对照组中破骨细胞表面可见大量伪足伸出, 并形成明显的骨吸收陷窝,实验组中破骨细胞见少许伪足突出,不能看到明显的骨陷窝形成。结论 单用50 ng/mL RANKL体外连续诱导RAWM4.7细胞7 d时,可以促进成熟的破骨细胞显著分化。 100 ng/mL 0PG培养9 d能有效地抑制破骨细胞的分化,减少破骨细胞的骨吸收效应。     

骨水泥颗粒促进肿瘤坏死因子α诱导的破骨细胞形成及其骨吸收作用

目的:验证骨水泥颗粒对肿瘤坏死因子α(TNFα)诱导的破骨细胞形成及其生物学活性的影响。方法:体外培养外周血单核细胞,对照组加入TNFα和白细胞介素-1α(IL-1α)及巨噬细胞克隆集落刺激因子(M-CSF),实验组并分别加入含有或不含有硫酸钙的骨水泥(PMMA±BaSO4)颗粒。对培养终末细胞作组织化学染色检测破骨细胞标志物抗酒石酸酸性磷酸酶(TRAP)的表达,并以象牙磨片上虫蚀样骨吸收陷窝的形成为指标检测破骨细胞的生物学活性;并比较各实验组中TRAP阳性多核细胞(multinucleatedcells,MNCs)及虫蚀样骨吸收陷窝形成时间的早晚。结果:各组TRAP阳性MNCs的数量无明显差异;PMMA±BaSO4组象牙磨片上骨吸收陷窝的面积均较对照组大,差异具有显著性(P<0.01);并且PMMA±BaSO4组TRAP阳性的MNCs及虫蚀样骨吸收陷窝的形成均较对照组早。结论:PMMA±BaSO4颗粒能够促进TNFα诱导的破骨细胞分化提早发生并促进其骨吸收活性。     

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.