输尿管软镜钬激光碎石治疗孤立肾肾结石的临床疗效观察

目的探讨输尿管软镜钬激光碎石术治疗孤立肾肾结石的安全性及有效性。方法邵逸夫医院在2011年5月至2014年12月期间使用输尿管软镜钬激光碎石术共治疗14例孤立肾肾结石患者,男8例,女6例;年龄29~75岁,平均54岁。其中,2例为对侧肾切除术后,12例为对侧肾萎缩。术前常规留置F6 D-J管2周。分析手术时间、清石率、出血量、术后住院天数、并发症以及血清肌酐的变化。结果本组14例患者均成功将输尿管鞘放置输尿管上段,输尿管镜鞘放置成功率100%,进镜成功率100%,术中寻找结石成功率100%。14例患者结石大小为1.1~2.5cm,平均(1.7±0.4)cm;术前肌酐78~407μmol/L,平均(166±103)μmol/L;手术时间60~140分钟,平均(87±34)分钟;术中出血量5~50ml,平均(13±12)ml;一期结石清除率达82.6%(12/14),2例行二次输尿管软镜手术,总结石清除率达92.8%(13/14),2例术后出现发热。14例患者术后肌酐为85~340μmol/L,平均(124±62)μmol/L,与术前比较差异有统计学意义(P0.05)。术后住院天数2~4天,平均(2.5±0.7)天。结论输尿管软镜钬激光碎石术治疗孤立肾肾结石是安全有效的。     

超选择性肾动脉栓塞治疗巨大型肾血管平滑肌脂肪瘤

目的评价超选择性肾动脉栓塞(SRAE)治疗巨大型肾血管平滑肌脂肪瘤(RAML)的临床疗效及安全性。方法回顾性分析16例接受SRAE治疗且临床资料完整的巨大型RAML患者的资料,对比分析治疗前后患者临床症状、肿瘤大小、肾功能变化及并发症情况。结果对16例患者共进行26次SRAE治疗,技术成功率100%(26/26);其中1次治疗7例(7/16,43.75%),2次治疗8例(8/16,50.00%),3次治疗1例(1/16,6.25%)。治疗后平均随访(16.60±15.60)个月。至末次随访复查时,瘤体最大径[(9.00±2.80)cm]较治疗前[(12.60±2.40)cm]明显缩小(t=12.41,P0.01),SRAE治疗后患者腰痛、血尿症状均好转,肌酐水平[(79.10±12.80)μmol/L]与治疗前[(76.00±14.90)μmol/L]差异无统计学意义(t=0.89,P=0.39)。14例(14/16,87.50%)SRAE治疗后1~3天出现不同程度发热、局部疼痛或恶心等症状,无严重并发症发生。结论 SRAE可有效控制巨大型RAML破裂出血,缓解RAML相关临床症状,同时可在较大程度上保留正常肾单位。     

移植肾动脉狭窄腔内治疗的中期结果

目的探讨移植肾动脉狭窄经皮血管腔内成形(PTA)及支架置入的安全性及中远期结果。方法回顾性分析2011年1月至2018年12月解放军总医院血管外科收治的18例移植肾动脉狭窄患者的临床资料。结果3例经同侧股动脉,15例经对侧股动脉人路治疗。4例单纯PTA治疗,8例PTA后置入支架,6例直接置入支架。共置入14枚支架,均为球扩式支架,其中2枚为药涂支架,技术成功率100%。平均造影剂用量64ml,治疗前肾动脉狭窄率为50%〜99%,腔内治疗后狭窄率降为10%〜30%。收缩压由术前的(157.2±43.0)mmHg降至术后的(129.8±8.6)mmHg;血清肌酐(SCr)水平由术前的(258.8±214.7)μmol/L降至术后的(176.3±101.1)μmol/L,尿素氮由术前的(15.7±1.6)mmol/L降至术后(10.6±1.1)mmol/L(均P<0.05)。术后中位随访42.4个月(3~93个月),治愈17例,无效1例,1例单纯球囊扩张后术后30 d出现再狭窄,予以置入支架。除1例移植肾动脉出血外无其他并发症。结论移植肾动脉狭窄是导致移植肾失功的常见血管因素,腔内治疗安全、有效。     

支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的影响

目的 评价支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的中、短期影响.方法 回顾性分析2005年3月至2009年12月290例接受腔内修复术的腹主动脉瘤患者的临床资料,根据移植物近端裸区是否超越肾动脉将患者分为肾上组和肾下组.肾上组173例,平均年龄(72±8)岁,男性占85.0%;肾下组117例,平均年龄(71±9)岁,男性占90.6%.记录两组患者术前,术后1周及术后1、3、6、12个月血清肌酐和胱抑素C的检测结果,并依据胱抑素C和血清肌酐计算肾小球滤过率.统计分析两组间及各组不同时间点的肾功能差异.结果 所有患者腔内修复均采用Talent或Zenith支架移植物,其中肾上组有67例使用Talent支架,106例使用Zenith支架;肾下组则分别有25例和92例,两组差异有统计学意义(P＜0.05).两组患者其他术前及术中资料差异无统计学意义.肾上组和肾下组术后1周的血清肌酐为(98±11)μmol/L和(95±13)μmol/L,12个月时为(91±15)μmol/L和(90±12)μmol/L;1周时胱抑素C为(1.01±0.15)mg/L和(0.99±0.10)mg/L,12个月时为(1.03±0.20)mg/L和(1.02±0.21)mg/L,较术前升高,而肾小球滤过率降低(P＜0.05).术后6个月,仅表现胱抑素C升高,肾上组(0.93±0.17)mg/L,肾下组(0.92±0.31)mg/L,依据胱抑素C计算的肾小球滤过率降低(P＜0.05).术后各阶段两组间患者肾功能无差异.结论 与肾动脉开口远端放置支架修复腹主动脉瘤的方式相比,支架移植物裸区覆盖肾动脉开口不会更明显地损害患者肾功能.     

上海浦东地区高尿酸血症的流行现状及影响因素分析

目的:探讨上海浦东地区常住人群中高尿酸血症的患病率及与慢性肾脏病危险因素的关系。方法:对上海浦东地区一个社区中1 024例常住居民进行问卷调查、尿酸、肌酐及慢性肾脏病相关危险因素的检测。采用多因素Logistic回归分析高尿酸血症发生的影响因素。本研究中以尿酸420μmol/L(男性)、360μmol/L(女性)定义为高尿酸血症。结果:在1 024例资料完整的居民中,年龄(56±14)岁,男女比例为404∶620,CKD患者为116例,高尿酸血症患者为182例(17.77%),其中非CKD患者为34例(18.58%),CKD患者为148例(81.42%),且CKD患者中女性高于男性;对高尿酸血症患者和非高尿酸血症患者CKD相关危险因素比较发现高尿酸血症患者年龄[(60±15)岁vs(55±13)岁,P0.01]、SBP[(135±13)mm Hg vs(128±15)mm Hg,P0.01]、DBP[(85.55±8.31)mm Hg vs(82.99±8.55)mm Hg,P0.01]、BMI(26.26±3.47)kg/m2vs(23.91±3.64)kg/m2,P0.01]、腰/臀围比[(0.88±0.05)vs(0.86±0.06),P0.01]、血BUN[(5.41±1.50)mmol/L vs(4.87±1.27)mmol/L,P0.01]、血清肌酐[(127.83±36.56)μmol/L vs(143.17±38.46)μmol/L,P0.01]高于非高尿酸血症组,e GFR[(127.83±36.56)ml·min-1·1.73 m-2vs(143.17±38.46)ml·min-1·1.73 m-2,P0.01]低于非高尿酸血症组,且高血压病(P0.01)、心血管病(P=0.04)和高脂血症(P0.01)比例高于非高尿酸血症患者。单因素回归分析显示年龄、SBP、DBP、BMI、腰/臀围比、BUN、血肌酐、Hb和e GFR与尿酸水平具有相关性;多因素Logistic回归显示性别、SBP、BMI和血肌酐以及高脂血症与高尿酸血症发生独立相关。结论:在上海社区人群中,高尿酸血症的患病率为17.77%,随着CKD的进展,高尿酸血症的发病率增加;相关危险因素包括性别、SBP、BMI、腰/臀围比、血肌酐。     

肾动脉狭窄80例外科治疗

目的 探讨肾动脉狭窄外科治疗方法的选择和疗效.方法 回顾性分析1997年11月到2008年8月80例肾动脉狭窄患者的外科治疗经验.男性53例,女性27例,年龄9～80岁.病变包括动脉硬化42例,大动脉炎23例,肌纤维发育不良11例.共接受外科治疗83人次,其中腹主动脉肾动脉旁路术13例,自体肾移植术5例,肾切除术1例,肾动脉内膜切除术1例,肾动脉狭窄段切除吻合术1例,球囊扩张术14例,支架成形术48例.结果 围手术期死亡1例.63例获得随访,随访时间1～129个月,2例死亡.随访患者血压(135.7±15.8)/(80.1±8.5)mm Hg(1 mm Hg=0.133kPa),较术前(149.8±18.3)/(88±13.6)mm Hg下降(P<0.01).总的降压有效率为65.6%,动脉硬化、大动脉炎、肌纤维发育不良患者的降压有效率分别为50%、73.3%和100%(P<0.05).随访患者肌酐(112.7±53.6)/μmol/L,低于术前(131.7±91.7)μmol/L(P<0.05).结论 肾动脉狭窄通过外科治疗可以有效改善血压和肾功能,动脉硬化病变首选支架成形,肌纤维发育不良性病变首选球囊扩张,大动脉炎性病变首选手术治疗.     

RAPN与LPN治疗孤立肾肾肿瘤的效果比较

目的比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗孤立肾肾肿瘤的效果, 并分析患者术后肾功能和远期生存的影响因素。方法回顾性分析2010年11月至2022年1月在解放军总医院行手术治疗的67例孤立肾肾肿瘤患者的临床资料。男48例, 女19例;年龄(58.6±10.1)岁。按照手术方式不同分为RAPN组(43例)和LPN组(24例)。RAPN组较LPN组的R.E.N.A.L.评分更高[(8.7±1.5)分与(7.9±1.7)分, P=0.042], 两组年龄[(57.4±10.2)岁与(60.9±9.8)岁, P=0.185]、体质量指数(BMI)[(25.7±3.5)kg/m2与(25.1±3.6)kg/m2, P=0.518]及术前血肌酐[(102.9±31.6)μmol/L与(102.3±22.4)μmol/L, P=0.930]差异均无统计学意义。12例术中采用低温处理, 其中RAPN组9例(20.9%), LPN组3例(12.5%, P=0.596)。比较两组手术时间、术中热缺血时间、术中失血量、术后禁食时间、围手术期并发症发生率、术后血肌酐等指...     

祛浊清源汤联合替米沙坦治疗糖尿病肾脏疾病的疗效及对肾功能、肾脏血流动力学的影响

目的 探究祛浊清源汤联合替米沙坦治疗糖尿病肾脏疾病的疗效及对肾功能、肾脏血流动力学的影响。方法 选取2021年3月26日至2022年3月26日衡水市中医医院收治的120例糖尿病肾脏疾病患者作为研究对象,按就诊顺序抽签随机分为两组,对照组(n=60)给予替米沙坦进行治疗,研究组(n=60)给予替米沙坦联合祛浊清源汤进行治疗。比较两组患者临床疗效、肾功能指标、肾脏血流动力学指标、糖代谢指标和用药安全性。结果 研究组总有效率高于对照组(91.67%比73.33%),差异有统计学意义(P<0.05)。治疗后,研究组和对照组患者血肌酐[(75.06±7.15)μmol/L、(81.26±8.28)μmol/L比(89.65±9.16)μmol/L、(89.77±9.25)μmol/L]、尿素氮[(7.15±0.65)mmol/L、(11.81±1.56)mmol/L比(26.59±5.65)mmol/L、(26.91±5.42)mmol/L]、尿白蛋白肌酐比值[(65.13±3.59)mg/g、(115.31±3.65)mg/g比(157.41±9.36)mg/g、(157.75±9.28...     

床旁持续性肾脏替代治疗在心脏移植术后急性肾功能不全患者中的应用

目的 总结床旁持续性肾脏替代治疗(CRRT)在心脏移植术后急性肾功能不全患者中应用的经验,分析其临床结果.方法 2007年9月至2008年9月北京阜外心血管病医院共施行原位心脏移植39例,其中有7例患者心脏移植术后因急性肾功能不全而使用PRISMA CRRT和M100血滤器行连续性静脉一静脉血液透析滤过(CVVHDF)治疗,全血激活凝血时间(ACT)维持在160～200 s.结果 术后生存6例,出院时心功能分级(NYHA)Ⅰ级;死亡1例,死于多器官功能衰竭、严重感染.CRRT时间48～658 h,平均252 h,治疗期间基本少尿或无尿,但血流动力学及内环境维持稳定,停CRRT后肌酐值最高达267.1±68.5μmol/L,随着尿量增多后逐渐下降至正常范围.术后肾小球滤过率(GFR)56.5±19.0 ml/min,与术前比较差异无统计学意义(P>0.05).术后随访6例均生存,随访时间5～13个月(9.7±3.8个月),肌酐值均在正常范围(90.6±26.7μmol/L),与出院时肌酐值(83.2±26.5 μmol/L)比较差异无统计学意义(P>0.05).结论 对心脏移植术后并发急性肾功能不全的患者及时应用CRRT预后良好,术后随访未出现明显的肾功能损害.     

输尿管软镜治疗并发肾功能不全肾结石患者的有效性及安全性分析

目的探讨输尿管软镜治疗并发肾功能不全肾结石患者的有效性及安全性。方法并发肾功能不全肾结石患者49例,均采用输尿管软镜治疗。术前血肌酐水平115~393μmol/L,其中肾功能不全代偿期[血肌酐(115~133μmol/L)]患者21例,肾功能不全失代偿期[血肌酐(133~393μmol/L)]患者28例。结石最大径11~31 mm,平均(21.4±5.5)mm。统计手术时间、手术次数、术后清石率和并发症发生率。结果49例患者中,输尿管软镜一次成功碎石42例,行二次软镜手术7例。术后1周清石率为44.9%(22/49),术后1个月清石率为75.5%(37/49)。术前、术后第1天、1周、1个月血肌酐水平比较,差异无统计学意义(P0.05)。术前、术后第1天、1周血红蛋白水平比较,差异无统计学意义(P0.05)。术后7例患者出现肉眼血尿,2天后自行消失,术后无严重出血患者。术后发热3例(体温38.5℃),应用抗生素后体温正常,无感染性休克患者。结论输尿管软镜治疗并发肾功能不全的肾结石患者,并发症少,安全,有效。     

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.     

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.     

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.