罗库溴铵和阿曲库铵肌松作用的对比研究

目的 比较两种短效非去极化肌松药罗库铵在妇科腹腔镜手术全麻中的肌松作用。方法 选择妇科腹腔镜手术病人40例，术前检查无明显肝肾功能损害。随机分罗库溴铵组（Ⅰ组，n1=20例）和阿曲库铵组（Ⅱ组，n2=20例）。麻醉诱导；静注咪唑安定0.1mg/kg，芬太尼5μg/kg，琥珀胆碱1.5mg/kg，丙泊酚1.5mg/kg，经口明视插管，接Datex-OhmedaAS/3麻醉机，用TOF-guard肌松监测仪（丹麦），采用TOF刺激模式，当肌颤搐恢复至T125%时，静注罗库溴铵0.8mg/kg或阿曲库铵0.5mg/kg维持肌松；当T15%-10%时，分别追加罗库溴铵0.4mg/kg或阿曲库铵0.2mg/kg。麻醉维持丙泊酚80-120mg/h和苏太尼40-60μg/h速率用微量注射泵静脉注射，同时吸入氧化亚氮（N2O：O2为1：1）。结果 I组起效时间明显较Ⅱ组短，并且T125%时间，T190%时间以及恢复指数均较Ⅱ组短。Ⅱ组的循环变化主要表现在注药后1，3，5分钟的SBP较注射前呈明显下降，5分钟后呈回升趋势，结论 罗库溴铵比阿曲库铵肌松起效快，恢复较迅速，对循环影响小，是内腔镜手术麻醉时的良好肌松药选择。     

七氟烷对顺式阿曲库铵和罗库溴铵肌松作用的影响

目的：比较七氟烷对顺式阿曲库铵和罗库溴铵肌松效应的影响。方法：择期手术患者240例,随机分为顺式阿曲库铵组（CIS120例）和罗库溴铵组（ROC120例）。两组患者再随机分为丙泊酚组（60例）和七氟烷组（60例）,均静脉注射咪达唑仑、芬太尼和丙泊酚行麻醉诱导,丙泊酚组靶控输注丙泊酚维持麻醉,设定血浆靶控浓度2～6μg/mL,输注丙泊酚5min后静脉注射顺式阿曲库铵0.15mg/kg或罗库溴铵0.6mg/kg;七氟烷组在呼气末七氟烷浓度稳定于1MAC5min后静脉注射顺式阿曲库铵0.15mg/kg或罗库溴铵0.6mg/kg。结果：CIS两组,起效时间差异无统计学意义（P〉0.05）;七氟烷组完全肌松时间、维持时间与丙泊酚组比较均显著延长（P〈0.01）。ROC两组,起效时间差异无统计学意义（P〉0.05）;七氟烷组完全肌松时间、维持时间与丙泊酚组比较均显著延长（P〈0.01）。结论：七氟烷对顺式阿曲库铵及罗库溴铵的肌松均有增效作用。     

罗库溴铵和阿曲库铵联合应用的肌松效应分析

目的探讨罗库溴铵和阿曲库铵联合应用时的肌松效应。方法择期全麻手术女性成年患者147例,丙泊酚和舒芬太尼静脉诱导,输注丙泊酚维持麻醉。面罩辅助或控制呼吸,用加速度仪以连续4次刺激(TOF)方式透皮刺激腕部尺神经,获取肌松药作用起效时间和T1最大抑制程度(Tmax)。按观测项目将患者均分成四组。结果阿曲溴铵ED95为(220.8±3.6)μg/kg,罗库溴铵ED95为(286.3±3.1)μg/kg。0.5×ED95的罗库溴铵与阿曲库铵联合使用,肌松效应达到T1抑制93%~97%时,阿曲库铵的剂量为63.6μg/kg。罗库溴铵0.5×ED95与阿曲库铵63.6μg/kg联合使用,Tmax为(95.3±0.9)%,变异系数1.0%。Ⅳ组中三个亚组的Tmax基本相同,合用组作用起效时间比阿曲库铵组快(P<0.01)。给予肌松药前和注药后5min内,MAP和HR的波动幅度均小于5%。结论罗库溴铵与阿曲库铵合用呈协同作用。当罗库溴铵剂量为0.5×ED95时,为获得T1抑制95%的肌松效应,阿曲库铵的合理用量为63.6μg/kg,比阿曲库铵的ED95减少71.2%。     

肝移植术患者罗库溴铵不同给药方式肌松效果的比较

目的 比较肝移植术患者间断静脉注射(Ⅳ)、静脉输注(CI)和靶控输注(TCI)罗库溴铵的肌松效果.方法 拟行肝移植术的患者36例,性别不限,年龄21～63岁,体重48～80 kg,Child-Pugh评分7～9分,肝功能Child分级B或C级,随机分为3组(n=12):Ⅳ组、CI组和TCI组.采用TOF模式进行肌松监测,Ⅳ组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期T1恢复至25%时、无肝期和新肝期T4/T1(TOFR)恢复至25%时追加0.15 mg/kg.TCI组:麻醉诱导时靶控输注罗库溴铵,初始效应室靶浓度3μg/ml,调整靶浓度,维持T1 5%～10%;无肝期和新肝期开始时暂停TCI,随后以效应室靶浓度0.1μg/ml再次输注,调整靶浓度,维持T15%～10%.CI组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期以30μg·kg-1·min-1的速率开始静脉输注,调节输注速率,维持T1 5%～10%,无肝期和新肝期开始时暂停CI,随后以1μg·kg-1·min-1的速率静脉再次输注,调整输注速率,维持T15%～10%.各组于肌松达最大效应时行气管插管,于缝合腹膜后停止给药.记录麻醉诱导时罗库溴铵肌松起效时间、T1最大抑制程度和气管插管条件满意情况;记录各组无肝期T1 25%恢复时间及TOFR 25%恢复时间,新肝期停药后T125%恢复时间、TOFR 25%恢复时间、TOFR 75%恢复时间、TOFR90%恢复时间及恢复指数;记录罗库溴铵总用量.结果 与Ⅳ组比较,TCI组和CI组气管插管条件满意率、罗库溴铵总用量、麻醉诱导时罗库溴铵起效时间、T1最大抑制程度和各期肌松恢复情况差异均无统计学意义(P＞0.05).肌松效应监测图显示Ⅳ组各期罗库溴铵肌松效应波动较大,TCI组和CI组各期肌松效应较为平稳.结论 采用Ⅳ、CI和TCI给药时,肝移植术患者罗库溴铵肌松起效和恢复情况无差异,而采用TCI或CI给药时,肌松效应较Ⅳ更加平稳.     

罗库溴铵复合麻黄碱预先给药对全麻患者罗库溴铵肌松效应的影响

目的 探讨罗库溴铵复合麻黄碱预先给药对罗库溴铵肌松效应的影响.方法 择期全麻手术患者100例,ASAⅠ或Ⅱ级,年龄23～64岁,体重42～88 kg,身高150～181 cm,随机分为5组(n=20):罗库溴铵组(C组)、罗库溴铵预先给药组(R组)、麻黄碱预先给药组(E组)、罗库溴铵复合麻黄碱预先给药组(RE组)和琥珀酰胆碱组(S组).麻醉诱导前R组、E组和RE组分别静脉注射罗库溴铵0.06 mg/kg、麻黄碱70 μg/kg、罗库溴铵0.06 mg/kg复合麻黄碱70 μg/kg,C组和S组无预先给药.麻醉诱导后4 min时C组和E组静脉注射罗库溴铵0.6 mg/kg,R组和RE组静脉注射罗库溴铵0.54 mg/kg,S组静脉注射琥珀酰胆碱1 mg/kg.采用Cooper法评分标准评定气管插管条件.记录从麻醉诱导时静脉注射罗库溴铵完毕至肌颤搐(Th)降至25%、10%、0的时间(分别为T25、T10、T0)和Th恢复至25%、50%的时间(分别为RT25、RT50)、肌松维持时间(从T0至RT25的时间),麻醉诱导期间每分钟记录1次心率、收缩压、舒张压和平均动脉压.结果 各组气管插管条件差异无统计学意义(P＞0.05);与C组比较,其余4组T25、T10、T0均缩短,S组RT25、RT50缩短(P＜0.05);与RE组和S组比较,R组和E组T0延长(P＜0.05);与S组比较,C组、R组、E组和RE组肌松维持时间延长(P＜0.05).结论 罗库溴铵复合麻黄碱预先给药后罗库溴铵肌松起效时间短于单独预先给药,但对肌松程度和维持时间无明显影响.     

罗库溴铵和维库溴铵在终末期肾衰竭病人临床药效的比较

目的　比较罗库溴铵和维库溴铵在终末期肾衰竭病人中的肌松效应。方法　 2 5例ASAⅢ级行肾移植术病人随机分为罗库溴铵组 (R组 ,15例 )和维库溴铵组 (V组 ,10例 )。麻醉诱导后分别给予 2×ED95剂量的罗库溴铵 (0 6mg/kg)或维库溴铵 (0 1mg/kg)。术中当T1恢复至 2 5 %时 ,追加 0 5×ED95剂量的罗库溴铵 (0 15mg/kg)或维库溴铵 (0 0 2 5mg/kg)。末次剂量后 ,使肌张力自然恢复或给予新斯的明拮抗。结果　初量罗库溴铵的起效时间为 (1 98± 0 4 7)min ,明显短于维库溴铵的 (3 2 5±0 82 )min。初量和追加量的罗库溴铵的肌松维持时间分别为 (4 6 87± 14 6 0 )min和 (34 86± 15 5 7)min,与维库溴铵相似。两组应用拮抗药后 ,恢复指数均显著缩短。结论　对于终末期肾衰竭病人 ,罗库溴铵的起效快于维库溴铵 ,肌松作用维持时间和恢复指数与维库溴铵相似。     

异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响

目的 探讨性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响.方法 择期全麻手术患者240例,年龄20～60岁,ASA分级Ⅰ或Ⅱ级,BMI 20～30 kg/m2,随机分为2组(n=120):顺阿曲库铵组和罗库溴铵组,各组按性别和麻醉药再分4个亚组(n=30):女性异丙酚组、男性异丙酚组、女性七氟醚组和男性七氟醚组.各异丙酚组靶控输注异丙酚,血浆靶浓度2～6 μg/ml,各七氟醚组吸入七氟醚,于靶控输注或待呼气末七氟醚浓度稳定于1.71%5 min后,静脉注射顺阿曲库铵0.15 mg/kg或罗库溴铵0.6 mg/kg.记录肌松起效时间、肌松作用峰值时间、T1 25%恢复时间和TOFR25%恢复时间.结果 与异丙酚麻醉比较,女性患者七氟醚麻醉时,罗库溴铵TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,男性患者七氟醚麻醉时,罗库溴铵起效时间缩短,肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长(P＜0.05或0.01);七氟醚麻醉时与男性患者比较,女性患者罗库溴铵T1 25%恢复时间和TOFR 25%恢复时间缩短,顺阿曲库铵起效时间缩短(P＜0.05或0.01).结论 七氟醚对罗库溴铵肌松的增强作用存在性别差异,男性强于女性;对顺阿曲库铵肌松的增强作用无明显性别差异.     

活体肝移植术供体右半肝切除后罗库溴铵用量的变化

目的 探讨活体肝移植术供体右半肝切除术后罗库溴铵用量的变化.方法 择期拟行右半肝切除术的肝移植术供体病人16例,年龄21～49岁,体重51～86 kg,ASA Ⅰ级.麻醉诱导:静脉注射咪达唑仑和芬太尼,靶控输注异丙酚和罗库溴铵(血浆靶浓度3 μg/ml),采用肌松监测,待T1/Tc=0时进行气管插管,机械通气.气管插管后罗库溴铵血浆靶浓度降至1.0 μg/ml,调整罗库溴铵浓度,维持0相似文献   

肝功能不全门脉高压病人罗库溴铵的肌松效应

目的 观察罗库溴铵在肝功能不全门脉高压病人中的肌松效应。方法 70例ASA I-Ⅱ级择期行上腹部手术的病人分为两组:门脉高压组(M组,n=36),对照组(C组,n=34),其中门脉高压组肝功能均属Child-Turcottee分级法Ⅱ级,对照组肝功能正常。两组病人麻醉诱导均为静脉注射咪唑安定0.02 mg·kg-1、异丙酚1.0 mg·kg-1、芬太尼5μg·kg-1和罗库溴铵0.6 mg·kg-1,同时进行肌松监测。麻醉维持采用吸入异氟烷及间断静脉注射芬太尼,罗库溴铵微量泵持续静注维持肌松,维持T1在10％-20％直至手术结束。记录罗库溴铵起效时间,TOF无反应时间,首次给药后,T110％恢复时间,停药后T125％恢复时间,恢复指数以及每30 min罗库溴铵维持用量。结果 M组病人肌松药起效时间、TOF完全阻断时间、首次给药后,T110％恢复时间、停药后T125％恢复时间及恢复指数比C组病人延长(P<0.01)。M组病人持续输注罗库溴铵用量明显小于C组病人(P<0.01)。结论 肝功能不全的门脉高压病人罗库溴铵起效、维持时间和肌松恢复时间明显延长,维持用量明显减少。     

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.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.