依托咪酯对大鼠海马脑片突触长时程增强的影响

目的 评价依托咪酯对大鼠海马脑片突触长时程增强(LTP)的影响.方法 雄性SD大鼠,断头后取出海马组织,制备厚400 μm的海马脑片.采用细胞外微电极记录技术,记录海马脑片CA1区细胞外群体峰电位(PS).取42张脑片,随机分为6组(n=7):用正常的人工脑脊液(ACSF)灌流海马脑片记录正常的PS,待其稳定后,对照组继续灌流ACSF,不同浓度依托咪酯组分别用含依托咪酯1μmol/L(依托咪酯 1 μol/L组)、2/μmol/L(依托咪酯2 μmol/L组)、5 μmol/L(依托咪酯5 μmol/L组)、10μmol/L(依托咪酯10 μmol/L组)、20 μmol/L(依托咪酯20 μmol/L组)的ACSF灌流,记录PS幅值.另取84张脑片,随机分为12组(n=7):用正常ACSF灌流海马脑片,记录稳定正常的PS 30 min,LIT组继续灌流ACSF,其余各组分别用含依托咪酯l μmol/L(LTP-依托咪酯 1 μmol/L组)、2 μmol/L(LTP-依托咪酯2μmol/L组)、5 μmol/L(LTP-依托咪酯 5 μmol/L组)、10μmol/L(LTP-依托咪酯 10 μmol/L组)、20 μmol/L(LTP-依托咪酯20 μmol/L组)、印防己毒素50 μmol/L(印防己毒素组)、荷包牡丹碱10 μmol/L(荷包牡丹碱组)、CGP35348 5 μmol/L(CGP35348 组)、印防己毒素50 μmol/L+依托咪酯10 μmol/L(印防己毒素+依托咪酯组)、荷包牡丹碱10 μmol/L+依托咪酯10 μmol/L(荷包牡丹碱+依托咪酯组)、CGP35348 5 μmol/L+依托咪酯10 μmol/L(CGP35348+依托咪酯组)的ASCF灌流,记录PS 30 min后,施以100 Hz的高频刺激(HPS),记录PS幅值.结果 与LTP组比较,LTP-依托咪酯2 μmol/L组、LTP-依托咪酯5 μmol/L组、LTP-依托咪酯10 μmol/L组、LTP-依托咪酯20 μmol/L组和CGP35348+依托咪酯组HIS后PS幅值降低(P＜0.05或0.01),印防己毒素组、荷包牡丹碱组、CGP35348组HFS后PS幅值差异无统计学意义(P＞0.05);与依托咪酯LTP 10μmol/L组比较,印防己毒素+依托咪酯组和荷包牡丹碱+依托咪酯组HIS后PS幅值增加(P＜0.01).结论 依托咪酯可通过激活大鼠海马GABAA受体抑制LTP的形成,从而影响学习和记忆功能.     

N受体α4β2亚型在异氟醚抑制大鼠海马突触长时程增强中的作用

目的 评价海马神经元N受体α4β2亚型在异氟醚抑制大鼠海马突触长时程增强(LTP)中的作用.方法 健康成年雄性SD大鼠,取海马组织,制备海马脑片.取70张脑片,随机分为10组(n=7):各组用正常人工脑脊液(aCSF)灌流海马脑片,记录稳定正常的细胞外群峰电位(PS)30 min,LTP组继续给予正常的aCSF灌流,其余各组分别用含异氟醚0.125 mmol/L(I1组)、0.25 mmol/L(I2组)、0.5 mmol/L(I3组)、地棘蛙素0.1 mmol/L(E1组)、1.0 μmol/L(E2组)、地棘蛙素0.1 μmol/L+异氟醚0.25 mmol/L(E1+I2组)、地棘蛙素1.0 μmol/L+异氟醚0.25 mmol/L(E2+I2组)、双氢β-刺酮碱(DHβE)0.1μmol/L(D组)、DHβE0.1μmol/L+异氟醚0.125 mmol/L(D+I1组)的aCSF灌流.采用细胞外微电极记录技术,记录海马脑片CA1区细胞外PS 30 min后,施以高频强直刺激(HFS)15 min,诱发LTP,记录各组HFS结束后5、10、15、20、25、30、40、50、60 min时的PS幅值.结果 与LTP组比较,I1.2.3组、D组、D+I1组、E1+I2组HFS后PS幅值降低,E1.2组HFS后PS幅值升高(P＜0.05),E2+I2组HFS后PS幅值差异无统计学意义(P＞0.05).与I1组比较,D+I1组HFS后PS幅值降低(P＜0.05).与I2组比较,E1+I2组、E2+I2组HFS后PS幅值升高(P＜0.01).结论 异氟醚通过拮抗海马神经元N受体α4β2亚型从而抑制了突触LTP的形成.     

异丙酚对大鼠海马CA1区突触传递可塑性的影响

目的研究异丙酚对海马CAl区突触传递和可塑性的影响。方法断头分离Wistar大鼠海马半脑,制备400μm厚度海马脑片。45张脑片分为六组。脂肪乳剂组和异丙酚组的脑片以印防己毒素预孵30min,然后加入450μl脂肪乳剂或异丙酚(相当于500μmol/L),观察对兴奋性突触后电流(EPSC)的影响。脂肪乳剂长时程增强(LTP)组、脂肪乳剂长时程抑制(LTD)组、异丙酚LTP组、异丙酚LTD组的脑片以90μl脂肪乳剂或异丙酚(相当于100 μmol/L)预孵60 min,给予高频刺激(HFS)或低频刺激(LFS),记录LTP或LTD的发生情况。结果 脂肪乳剂对EPSC无影响(P>0.05);500 μmol/L异丙酚使2/3细胞EPSC下降至基础值的67.5％(P<0.05),使1,3细胞EPSC上升至基础值的140.3％(P<0.05)。脂肪乳剂LTP组给予HFS后EPSC值为基础值的151.6％(P<0.05),脂肪乳剂LTD组给予LFS后EPSC值为基础值的57.9％(P<0.05);异丙酚LTP组给予HFS后,LTP可以产生但不能维持,HFS后EPSC值为基础值的98.8％(P>0.05),异丙酚LTD组给予LFS后EPSC值为基础值的40.8％(P<0.05),明显低于脂肪乳剂LTD组(P<0.05)。结论异丙酚对大鼠海马CAl区突触传递具有双重影响,出现抑制和兴奋两种效果;异丙酚损害大鼠海马CAl区锥体神经元LTP的维持而易化LTD。     

丙泊酚对大鼠海马脑片CA1区长时程增强的影响

目的观察不同浓度丙泊酚对离体大鼠海马脑片CA1区长时程增强(LTP)的影响。方法30张海马脑片分为五组,Ⅰ、Ⅱ和Ⅲ组分别应用浓度为30、10和3μmolo/L的丙泊酚,Ⅳ组用脂肪乳,Ⅴ组不用药物作为对照。利用细胞外记录方式,以海马脑片CA1区群峰电位(PS)为观察指标,首先观察丙泊酚对CA1区基础传递的影响,待基线稳定后,记录高频刺激(HFS)后海马脑片CA1区PS的变化情况。结果Ⅰ、Ⅱ、Ⅲ组应用丙泊酚后PS降低,在持续给药后30min恢复至基线。实施HFS后,Ⅲ、Ⅳ和Ⅴ组的PS较HFS前显著升高(P<0.05,P<0.01);而Ⅰ、Ⅱ组PS与HFS前相比差异无显著意义(P>0.05)。HFS后,Ⅰ组PS显著低于Ⅱ、Ⅲ、Ⅳ和Ⅴ组(P<0.01),Ⅱ组PS也低于Ⅲ、Ⅳ和Ⅴ组(P<0.05)。结论丙泊酚可以抑制大鼠离体海马脑片CA1区LTP的形成。     

异氟醚吸入对老年大鼠长时程增强和脑源性神经营养因子的影响

目的通过观察异氟醚麻醉后老年大鼠海马长时程增强(LTP)和脑源性神经营养因子(BDNF)的变化,探讨术后认知功能障碍(POCD)的可能机制。方法健康雄性20月龄SD大鼠72只,随机分为异氟醚处理组(I组)和对照组(C组),每组36只。I组大鼠异氟醚吸入及维持浓度为1.2%,维持麻醉3h,以大鼠翻正反射的消失和恢复视为麻醉的开始和结束;C组大鼠不吸入麻醉药。I组大鼠分别于麻醉后7和14d断头,C组大鼠直接断头,常规切取海马组织,制备厚500μm的海马脑片,进行LTP斜率和幅值的测定,Western blot法检测BDNF表达水平。结果与C组比较,异氟醚处理后7和14dI组LTP的斜率和幅值均明显下降(P0.05)。与处理后7d比较,处理后14dI组LTP斜率和幅值均有明显升高(P0.05)。与C组比较,处理后7和14dI组BDNF表达水平明显下降(P0.05)。与处理后7d比较,处理后14dI组BDNF表达水平明显升高(P0.05)。结论异氟醚麻醉后,老年大鼠学习记忆能力损害可能持续14d以上,LTP的改变可能参与POCD的发生机制,并且与BDNF表达水平的降低有关。     

JNK信号通路在异氟醚预处理和七氟醚预处理减轻大鼠海马脑片缺氧无糖损伤中的作用

目的 评价c-Jun氨基末端激酶(JNK)信号通路在异氟醚预处理和七氟醚预处理减轻大鼠海马脑片缺氧无糖(OGD)损伤中的作用.方法雄性成年SD大鼠,体重270～290 g,断头处死,剥离海马,制备海马脑片.取大鼠海马脑片96张,采用随机数字表法,将其随机分为8组(n=12):对照组(C组)、OGD组、异氟醚预处理组(Iso组)、七氟醚预处理组(Sevo组)、SP600125+异氟醚预处理组(SP+Iso组)、SP600125+七氟醚预处理组(SP+Sevo组)、二甲基亚砜(DMSO)+异氟醚预处理组(DMSO+Iso组)和DMSO+七氟醚预处理组(DMSO+Sevo组).采用电生理技术,细胞外记录CA1区群锋电位(PS)波幅,计算PS恢复程度.采用碘化丙啶染色法,测定细胞活力.结果 与C组比较,其余各组PS恢复程度和细胞活力降低(P＜0.01);与OGD组比较,Iso组、Sevo组、SP+Iso.组、SP+Sevo组、DMSO+Iso组和DMSO+Sevo组PS恢复程度和细胞活力升高(P＜0.01);与180组比较,SP+Iso组PS恢复程度和细胞活力升高(P＜0.01),DMSO+Iso组PS恢复程度和细胞活力差异无统计学意义(P＞0.05);与Sevo组比较,SP+Sevo组PS恢复程度和细胞活力升高(P＜0.01),DMSO+Sevo组PS恢复程度和细胞活力差异无统计学意义(P＞0.05).结论 异氟醚预处理和七氟醚预处理可通过抑制JNK信号通路,减轻大鼠海马脑片缺氧无糖损伤.

Abstract：

Objective To evaluate the role of c-Jun N-terminal kinase (JNK) signaling pathway in the protective effect of isoflurane preconditioning and sevoflurane preconditioning against oxygen-glucose deprivation (OGD) injury in rat hippocampal slices. Methods Male adult SD rats weighing 270-290 g were anesthetized with ether and decapitated. The hippocampi were removed and sagittally sliced (400 μm thick) and placed in artificial cerebral spinal fluid aerated with 95% O2-5% CO2 . Ninety-six hippocampal slices were randomly divided into 8 groups (n = 12 each): control group (group C), OGD group, isoflurane preconditioning group (group Iso),sevoflurane preconditioning group (group Sevo) , SP600125 + isoflurane preconditioning group (group SP + Iso),SP600125 +sevoflurane preconditioning group (group SP + Sevo), DMSO + isoflurane preconditioning group (group DMSO + Iso) and DMSO + sevoflurane preconditioning group (group DMSO + Sevo). Electrophysiological technique was used to record the amplitude of population spike ( PS) in the stratum pyramidale of CA1 region and the degree of recovery of PS was calculated. The cell viability was determined by propidium iodide staining. Results Compared with group C, the degree of recovery of PS and cell viability were significantly decreased in the other groups ( P ＜ 0.01) . Compared with group OGD, the degree of recovery of PS and cell viability were significantly increased in groups Iso, Sevo, SP+Iso, SP+Sevo, DMSO+ Iso and DMSO + Sevo (P＜ 0.01). Compared with group Iso, the degree of recovery of PS and cell viability were significantly increased in group SP+Iso ( P ＜ 0.01) , while no significant change was found in group DMSO + Iso ( P ＞ 0.05) . Compared with group Sevo, the degree of recovery of PS and cell viability were significantly increased in group SP + Sevo ( P ＜ 0.01) , while no significant change was found in group DMSO + Sevo ( P ＞ 0.05). Conclusion Isoflurane preconditioning and sevoflurane preconditioning can attenuate the OGD injury to rat hippocampal slices through inhibiting JNK signaling pathway.     

异氟醚预处理改善大鼠海马脑片缺氧损伤

目的以大鼠海马脑片为研究对象,采用微电极记录技术,观察异氟醚预处理对海马脑片缺氧损伤后顺向群锋电位(OPS)以及缺氧损伤电位(HIP)的影响。方法 SD大鼠60只,随机均分为五组:空白对照组(C组);实验对照组(EC组);异氟醚预处理组(IP组);iNOS阻断剂氨基胍(AG)组(AG组);异氟醚预处理+iNOS阻断剂组(IPAG组)。IP组给予3h异氟醚预处理,AG组给予iNOS阻断剂处理,IPAG组给予3h异氟醚预处理,同时给予iNOS阻断剂,取脑片后分别给予14min的缺氧处理,观察不同处理对海马脑片OPS恢复以及HIP的不同效应。结果 IP组的OPS的恢复程度、恢复率明显高于C组、EC组、AG组和IPAG组(P<0.05),IP组HIP持续时间明显长于C组、EC组、AG组和IPAG组(P<0.05),HIP的出现时间五组差异无统计学意义。结论异氟醚预处理可明显减轻海马脑片缺氧损伤;用iNOS阻断剂可去除这种保护作用,证明这种预处理作用与异氟醚预处理产生的iNOS有关。     

GABAA受体拮抗药对小鼠痛阈的影响

目的本研究旨在探讨印防已毒素和荷包牡丹碱对小鼠CO2激光痛阈的影响.方法NIH小鼠105只,随机分为七组,每组15只.对照组,注射0.9%生理盐水10ml/kg(NS组);印防己毒素组,注射印防己毒素0.5mg/kg(PTX1组),1.0mg/kg(PTX2组)、2.0mg/kg(PTX3组);荷包牡丹碱组,注射荷包牡丹碱0.5mg/kg(BIC1组)、1.0mg/kg(BIC2组)、2.0mg/kg(BIC3组).所有的药物均经腹腔注射.采用CO2激光作为伤害性刺激,痛阈值以激光脉冲持续时间(ms)表示.结果与NS组比较,PTX1与BIC1组小鼠的痛阈没有明显差异(P＞0.05).PTX2组、PTX3组及BIC2组、BIC3组小鼠的激光脉冲持续时间较NS组延长(P＜0.01),PTX3组、BIC3组分别比PTX2组、BIC2组延长更明显(P＜0.05).结论本研究表明,GABAA受体拮抗药印防己毒素和荷包牡丹碱对CO2激光刺激引起的疼痛有明显的镇痛作用,且呈剂量相关.     

蝇蕈醇和荷苞牡丹碱对大鼠吸入异氟醚时脑环腺苷酸含量变化的影响

目的 观察 GABAA受体激动剂蝇蕈醇和GABAA受体拮抗剂荷苞牡丹碱对大鼠吸入异氟醚时脑cAMP含量变化的影响。方法SD大鼠48只,随机分为对照组,异氟醚组,蝇蕈醇+异氟醚组,荷苞牡丹碱+异氟醚组,蝇蕈醇组和荷苞牡丹碱组。采用cAMP竞争蛋白结合分析法测定大鼠不同脑区cAMP含量。结果 与异氟醚组比较,蝇蕈醇+异氟醚组的翻正反射消失时间明显缩短(P<0.05),而荷苞牡丹碱+异氟醚组却明显延长(P<0.01)。异氟醚组的大脑皮层、脑干的cAMP含量较对照组明显升高(P<0.01)。蝇蕈醇+异氟醚组的大脑皮层、脑干的cAMP含量分别较对照组和异氟醚组升高131％、34％和83％、22％(P<0.05或0.01)。荷苞牡丹碱+异氟醚组的大脑皮层、脑干cAMP含量明显高于对照组,分别较对照组升高41％和60％(P<0.01),其两脑区的cAMP含量与异氟醚组比较却无明显不同。结论 大鼠吸入异氟醚的中枢抑制作用至少部分与GABA能神经元有关。     

GABA_A受体拮抗药对小鼠痛阈的影响

目的　本研究旨在探讨印防已毒素和荷包牡丹碱对小鼠CO2 激光痛阈的影响。方法　NIH小鼠 10 5只 ,随机分为七组 ,每组 15只。对照组 ,注射 0 9%生理盐水 10ml/kg(NS组 ) ;印防己毒素组 ,注射印防己毒素 0 5mg/kg(PTX1组 ) ,1 0mg/kg(PTX2组 )、2 0mg/kg(PTX3组 ) ;荷包牡丹碱组 ,注射荷包牡丹碱 0 5mg/kg(BIC1组 )、1 0mg/kg(BIC2组 )、2 0mg/kg(BIC3组 )。所有的药物均经腹腔注射。采用CO2 激光作为伤害性刺激 ,痛阈值以激光脉冲持续时间 (ms)表示。结果　与NS组比较 ,PTX1与BIC1组小鼠的痛阈没有明显差异 (P >0 0 5 )。PTX2组、PTX3组及BIC2组、BIC3组小鼠的激光脉冲持续时间较NS组延长 (P <0 0 1) ,PTX3组、BIC3组分别比PTX2组、BIC2组延长更明显 (P <0 0 5 )。结论　本研究表明 ,GABAA 受体拮抗药印防己毒素和荷包牡丹碱对CO2 激光刺激引起的疼痛有明显的镇痛作用 ,且呈剂量相关     

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.