布美他尼预先给药对大鼠局灶性脑缺血再灌注损伤的影响

目的 探讨布美他尼预先给药对大鼠局灶性脑缺血再灌注损伤的影响.方法 雄性SD大鼠105只,体重250～300 g,采用随机数字表法,将大鼠随机分为3组(n=35):假手术组(S组)、缺血再灌注组(I/R组)和布美他尼预先给药组(B组).采用大脑右中动脉栓塞法制备大鼠脑缺血再灌注模型.S组不置入栓线;B组于缺血前10 min经尾静脉注射布美他尼30 mg/kg.于再灌注3、24和48 h时行神经功能缺陷评分(NDS),处死大鼠取脑,测定Na+ -K+ -2Cl-协同转运蛋白1(NKCC1)的表达水平和脑含水量,再灌注24h时测定脑梗死体积.结果 与S组比较,I/R组和B组NDS评分、NKCC1表达水平、脑含水量升高,脑梗死体积增大(P＜0.05或0.01);与I/R组比较,B组NDS评分、NKCC1表达水平、脑含水量降低(P＜0.05),脑梗死体积差异无统计学意义(P＞0.05).结论 布美他尼预先给药可减轻大鼠局灶性脑缺血再灌注损伤,其机制可能与抑制脑组织NKCC1表达有关.     

异丙酚对大鼠局灶性脑缺血再灌住损伤时蛋白激酶B活性的影响

目的 评价异丙酚对大鼠局灶性脑缺血再灌住损伤时蛋白激酶B(Akt)活性的影响,以探讨异丙酚脑保护作用的机制.方法 健康SD大鼠90只,体重260～300 g,雌雄不拘,随机分为5组(n=18):假手术组(S组);局灶性脑缺血再灌注组(IR组)、P1-3组阻断大脑中动脉2 h,开放22 h,制备大鼠局灶性脑缺血再灌注模型,分别于再灌注前3 min至再灌注5 min时经股静脉输注生理盐水2.5ml、异丙酚1、2、5 mg/kg(异丙酚采用生理盐水稀释至2.5 ml).于再灌注22 h时行神经行为学评分;测定大鼠脑梗死质量、免疫组化法检测大鼠脑组织caspase-3表达、Western blot法检测Akt活性.结果 与S组比较,再灌注22 h时IR组、P1-3组神经行为学评分、脑梗死质量比升高,脑组织caspase-3表达上调,P1组和P2组Akt活性升高,IR组和P3组Akt活性降低(P<0.05);与IR组比较,P1组和P2组大鼠神经行为学评分,脑梗死质量比降低,腩组织caspase-3表达下调,Akt活性升高(P<0.05).结论 静脉输注异丙酚1、2 mg/kg可通过升高Akt活性,抑制脑组织细胞凋亡,减轻大鼠局灶性脑缺血再灌注损伤.     

异丙酚预先给药对大鼠局灶性脑缺血再灌注时脑组织p-JNK、MMP-9和AQP-4表达的影响

目的 评价异丙酚预先给药对大鼠局灶性缺血再灌注时脑组织磷酸化c-Jun氨基末端蛋白激酶(p-JNK)、基质金属蛋白酶-9(MMP-9)和水通道蛋白-4(AQP-4)表达的影响.方法 健康成年雄性SD大鼠72只,体重250～280g,随机分成4组(n=18):假手术组(S组);脑缺血再灌注组(IR组)于缺血前30 min腹腔注射生理盐水10ml/kg;不同浓度异丙酚预先给药组(P1组和P2组)于缺血前30 min分别腹腔注射0.5%或1%异丙酚10 ml/kg.IR组、P1组和P2组采用线栓法建立大鼠局灶性脑缺血再灌注模型,缺血2 h,再灌注24 h.大鼠清醒后,进行神经功能缺陷评分.再灌注24 h时处死大鼠,处死前1 h股静脉注射2%伊文氏蓝(EB)溶液3 ml/kg,处死后取脑组织,测定含水量、EB含量、p-JNK、MMP-9和AQP-4的表达水平.结果 与S组比较,IR组、P1组和P2组神经功能缺陷评分、脑组织含水量和EB含量升高,p-JNK、MMP-9和AQP-4的表达上调(P＜0.05);与IR组比较,P1组和P2组神经功能缺陷评分、脑组织含水量和EB含量降低,p-JNK、MMP-9和AQP-4的表达下调(P＜0.05);与P1组比较,P2组脑组织p-JNK和MMP-9的表达下调(P＜0.05),神经功能缺陷评分、脑组织含水量、EB含量和AQP-4表达差异无统计学意义(P＞0.05).结论 异丙酚预先给药可通过抑制JNK信号通路的激活,抑制脑组织MMP-9和AQP-4的表达上调,减轻大鼠局灶性脑缺血再灌注损伤.     

帕瑞昔布预先给药对大鼠局灶性脑缺血再灌注时水通道蛋白4表达的影响

目的 探讨帕瑞昔布预先给药大鼠局灶性脑缺血再灌注时水通道蛋白4(AQP4)表达的影响.方法 成年雄性SD大鼠128只,6～8周龄,体重230 ～ 280 g,采用随机数字表法,将其分为4组(n=32):假手术组(S组)、缺血再灌注组(I/R组)、帕瑞昔布5mg/kg组(P5组)和帕瑞昔布10 mg/kg组(P10组).采用线栓法阻塞大脑中动脉2h行再灌注的方法制备局灶性脑缺血再灌注损伤模型.R组和P10组分别于缺血前30 min经颈内静脉注射帕瑞昔布5、10 mg/kg.分别于再灌注2、24h时行神经功能缺陷评分(NDS评分),然后处死大鼠,取脑,确定脑梗死体积,计算脑含水量;HE染色,光镜下观察病理学结果;并测定AQP4表达.结果 与S组比较,其他3组NDS评分和脑含水量升高,脑梗死体积扩大,脑组织AQP4表达上调(P＜0.05或0.01);与I/R组比较,P5组和P10组NDS评分和脑含水量降低,脑梗死体积缩小,脑组织AQP4表达下调(P＜0.05或0.01).光镜下P5组和P10组脑损伤程度明显轻于I/R组.结论 帕瑞昔布预先给药减轻大鼠局灶性脑缺血再灌注损伤的机制与下调AQP4表达有关.     

乳化异氟烷预处理对大鼠局灶性脑缺血再灌注损伤的影响

目的 评价8%乳化异氟烷预处理对大鼠局灶性脑缺血再灌注损伤的影响.方法 健康雄性成年SD大鼠56只,体重250～280 g,随机分为4组(n=14),假手术组(S组)仅分离血管,不留置线栓;脑缺血再灌注组(IR组)、乳化异氟烷预处理组(EIP组)和脂肪乳剂组预处理(FIP组)分别腹腔注射生理盐水、8%乳化异氟烷或30%脂肪乳剂7.5 ml/kg,24 h后制备局灶性脑缺血再灌注模型.于再灌注24 h各组取8只大鼠,进行神经功能缺陷评分,然后处死大鼠,取脑组织,测定脑梗死体积;各组处死6只大鼠,取脑组织,检测细胞凋亡情况,计算细胞凋亡率,并测定Bcl-2、Bax、caspase-3和Cyt C的蛋白表达水平.结果 与S组比较,IR组、EIP组和FIP组神经功能缺陷评分和细胞凋亡率升高,脑组织Bcl-2、Bax、caspase-3和Cyt C的蛋白表达上调(P＜0.01);与IR组和FIP组比较,EIP组神经功能缺陷评分和细胞凋亡率降低,脑梗死体积减小,脑组织Bcl-2蛋白表达上调,Bax、caspase-3和Cyt C 的蛋白表达下调(P＜0.05);IR组和FIP组各指标比较差异无统计学意义(P＞0.05).结论 8%乳化异氟烷预处理可减轻大鼠脑缺血再灌注损伤,其机制可能与上调Bcl-2蛋白表达,下调Bax蛋白表达,减少线粒体释放Cyt C,降低caspase-3活化,抑制神经元凋亡有关.     

8%乳化异氟醚后处理对大鼠局灶性脑缺血再灌注损伤的影响

目的 探讨8%乳化异氟醚后处理对大鼠局灶性脑缺血再灌注损伤的影响.方法 健康成年雄性SD大鼠48只,体重260～300 g,随机分为6组(n=8):假手术组(S组)、缺血再灌注组(I/R组)、低、中、高剂量乳化异氟醚后处理组(L-EI组、M-EI组和H-EI组)和脂肪乳组(LE组).除S组外,均采用大脑中动脉阻闭2 h,再灌注24 h的方法建立局灶性脑缺血再灌注模型.L-EI组、M-EI组和H-EI组分别于再灌注即刻腹腔注射8%乳化异氟醚3.5、7.0、10.5 ml/kg,LE组给予30%脂肪乳10.5 ml/kg,S组与I/R组不给药.再灌注24 h时行神经功能缺陷评分(NDS),取脑组织测定脑梗死体积.结果 与S组比较,其余各组NDS评分升高,脑梗死体积增大(P＜0.01);与I/R组比较,M-EI组和H-EI组NDS评分降低,脑梗死体积减小(P＜0.01),L-EI组和LE组上述指标差异无统计学意义(P＞0.05);与M-EI组比较,H-EI组NDS评分降低,脑梗死体积减小(P＜0.05).结论 8%乳化异氟醚后处理可减轻大鼠局灶性脑缺血再灌注损伤,且与剂量有关.     

亚低温对大鼠局灶性脑缺血-再灌注损伤海马胶质纤维酸性蛋白表达及神经元凋亡的影响

目的评价亚低温对大鼠局灶性脑缺血-再灌注损伤海马胶质纤维酸性蛋白(GFAP)表达及神经元凋亡的影响。方法健康成年雄性SD大鼠72只,体重250~300g,采用随机数字表法均分为三组:假手术组(S组)、脑缺血-再灌注损伤组(IR组)和亚低温组(MH组),每组24只。IR组和MH组采用线栓法进行大鼠脑缺血2h、再灌注制备局灶性脑缺血-再灌注损伤模型。S组分离右侧颈总动脉、颈内动脉及颈外动脉,不置入线栓。S组和IR组置于室温下,MH组于缺血后10min给予亚低温处理并维持3h。分别于再灌注后4h(T1)、6h(T2)、12h(T3)和24h(T4)进行神经功能缺陷(NDS)评分。取海马组织,采用Western blot和RT-PCR检测海马GFAP蛋白和GFAP mRNA表达,采用流式细胞仪检测海马神经元凋亡情况。结果与S组比较,T1~T4时IR组和MH组大鼠NDS评分及海马神经元凋亡率明显升高,GFAP蛋白和GFAP mRNA表达明显上调(P0.05)。与IR组比较,T1~T4时MH组大鼠NDS评分及海马神经元凋亡率明显降低,GFAP蛋白和GFAP mRNA表达明显下调(P0.05)。结论亚低温可减轻大鼠局灶性脑缺血-再灌注损伤,其机制可能与下调海马GFAP表达有关。     

电针预处理对局灶性脑缺血再灌注大鼠皮质神经元pSTAT3蛋白表达的影响

目的 评价电针预处理对局灶性脑缺血再灌注大鼠皮质神经元磷酸化信号转导及转录激活因子3(pSTAT3)蛋白表达的影响.方法 成年雄性SD大鼠45只,体重280 ～ 320 g,采用随机数字表法,将其随机分为假手术组、局灶性脑缺血再灌注组和电针预处理组(n=15).局灶性脑缺血再灌注组采用线栓阻塞颈总动脉和颈外动脉24 h恢复灌注的方法制备大鼠局灶性脑缺血再灌注模型.电针预处理组电针刺激百会穴30 min,处理后24h时制备模型,再灌注24 h时进行神经行为学评分,随后处死大鼠取脑测定脑梗死体积,计算脑梗死体积百分比,采用免疫荧光染色和Westem blot法检测缺血半暗带皮质神经元pSTAT3蛋白的表达.结果 与假手术组比较,局灶性脑缺血再灌注组和电针预处理组神经行为学评分降低,脑梗死体积百分比增加,皮质神经元pSTAT3蛋白表达上调(P＜0.05);与局灶性脑缺血再灌注组比较,电针预处理组神经行为学评分升高,脑梗死体积百分比减少,皮质神经元pSTAT3蛋白表达上调(P＜0.05).结论 电针预处理通过上调皮质神经元pSTAT3蛋白的表达减轻大鼠局灶性脑缺血再灌注损伤.     

异丙酚预先给药对脑缺血再灌注损伤大鼠脑组织葡萄糖转运体-3表达的影响

目的研究异丙酚预先给药对脑缺血再灌注损伤大鼠脑组织葡萄糖转运体-3（GLUT3）表达的影响。方法健康雄性SD大鼠90只，体重290～310g，随机分成3组：假手术组（S组，n=6）、生理盐水组（NS组，n=42）、异丙酚组（P组，n=42）。NS、P组采用线栓法阻断大脑中动脉1h行再灌注，制备大鼠局灶性脑缺血再灌注模型，P组在缺血前10min腹腔注射异丙酚10mg／100g，NS组给予等量生理盐水，S组只作切口，不行缺血。NS、P组分别在再灌注即刻、2h、5h、11h、23h、71h、1周各处死6只大鼠，S组于实验11h处死大鼠，断头取脑，计算脑梗塞体积比，用RT-PCR法测定GLUT3 mRNA表达水平，用免疫组织化学法测定GLUT3蛋白表达水平。结果NS组及P组再灌注期脑梗塞体积比、GLUT3 mRNA及GLUT3蛋白表达均高于S组，与NS组比较，P组脑梗塞体积比降低，脑组织GLUT3 mRNA及GLUT3蛋白表达升高（P〈0．05）。结论异丙酚预先给药可上调脑缺血再灌注损伤大鼠脑组织GLUT3的表达，可能是其减轻大鼠脑缺血再灌注损伤的机制之一。     

异丙酚对大鼠局灶性脑缺血再灌注时NF-κB活化和Bcl-2、Caspase-3基因表达的影响

目的观察异丙酚对大鼠局灶性脑缺血再灌注时NF-κB的活化和Bcl-2、Caspase-3基因表达的影响,并探讨其脑保护的机制。方法 90只雄性Wistar大鼠,采用大脑中动脉线栓法建立局灶性脑缺血再灌注模型,随机将大鼠分为假手术组、缺血再灌注组(I／R)和异丙酚组(缺血前10 min腹腔注射异丙酚100 mg·kg-1)。各组根据再灌注时间不同又分为缺血2 h再灌注2、3、6、12、24、72 h亚组, 每亚组各5只大鼠。于再灌注2、6、12、24 h,采用免疫组织化学染色法分析NF-κB的移位,蛋白质印迹法检测NF-κB的表达量。于再灌注3、6、24、72 h,采用原位杂交法法检测脑组织Bcl-2 mRNA、Caspase-3 mRNA的表达。于再灌注24 h作神经功能缺陷评分及苏木精-伊红(HE)染色观察缺血皮层组织形态学变化。结果与假手术组比较,I／R组缺血侧大脑皮层NF-κB于再灌注2-24 h明显从细胞浆移位于细胞核内,NF-κB和Bcl-2 mRNA、Caspase-3 mRNA的表达量增加(P<0．01),大鼠神经功能缺陷评分升高(P<0．01),组织形态学观察可见皮层水肿、淤血,神经元变性坏死。与I／R组比较,异丙酚组NF- κB从细胞浆向细胞核的移位被抑制,NF-κB和Caspase-3 mRNA的表达量减少(P<0．05),Bcl-2 mRNA 的表达量增加(P<0．05),神经功能缺陷评分降低(P<0．05),缺血大脑皮层组织形态学损伤减轻。结论异丙酚的脑保护作用可能与其抑制NF-κB的活化,上调Bcl-2基因和下调Caspase-3基因的表达,从而抑制神经组织细胞凋亡有关。     

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.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.