不同容量急性高容量血液稀释用于围术期老年患者的可行性

目的评估对老年患者输注不同负荷容量的6%羟乙基淀粉(HES)实施急性高容量血液稀释(AHH)的安全性和有效性。方法择期全髋置换术患者36例,按输注6%HES15、20和25ml/kg分为Ⅰ组、Ⅱ组和Ⅲ组,每组12例。三组患者均在硬膜外阻滞复合全身麻醉下实施AHH,全麻诱导后,经中心静脉将6%HES以50ml/min输注完毕。术中连续监测心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、外周血管阻力(SVR)、肺血流量(PCBF),同时监测CVP、MAP、HR。记录术中失血量和输液量。结果三组患者的CI、CVP、CO、PCBF及SV,在AHH完毕即刻和术毕较AHH前明显升高(P<0.05)。三组患者的Hb、Hct及血小板在AHH完毕即刻、术毕和术后1d与AHH前相比均降低(P<0.05);Ⅰ组与Ⅱ组患者之间的比较差异均无显著意义。Ⅰ组与Ⅲ组比较,CI、CVP、CO及SV的差异有显著意义(P<0.05);Ⅲ组较Ⅰ组和Ⅱ组的PCBF明显升高(P<0.05)。三组患者的ACT和血乳酸(Lac)在AHH前后差异均无显著意义。结论在硬膜外复合全麻下,对无严重心肺疾病的老年患者,采用6%HES按15ml/kg和20ml/kg以50ml/min快速扩容实施AHH是安全有效的,而25ml/kg对老年患者负荷容量过度。     

羟乙基淀粉200/0.5和羟乙基淀粉130/0.4术前急性高容量血液稀释对结肠癌根治术患者血液流变学的影响

目的 评价6%羟乙基淀粉(HES)200/0.5和6%HES 130/0.4术前急性高容量血液稀释(AHH)对结肠癌根治术患者血液流变学的影响.方法 择期在全麻下行结肠癌根治术患者40例,ASA Ⅰ或Ⅱ级,随机分为2组(n=20),麻醉诱导期间于30 min内静脉输注15 ml/kg HES 200/0.5(Ⅰ组)或HES 130/0.4(Ⅱ组),AHH结束后开始手术.分别于麻醉诱导前(基础状态,T0)、AHH后即刻(T1)、AHH结束后1 h(T2)和术后1 h(T3)时抽取静脉血样,检测全血粘度、血浆粘度、红细胞聚集指数、血小板聚集指数和红细胞压积(Hct).结果 与T0时比较,Ⅰ组T1时全血低切粘度和红细胞聚集指数降低,T1-3时全血中切粘度、全血高切粘度、血浆粘度、血小板聚集指数和Hct降低,Ⅱ组T1-3时全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度、红细胞聚集指数和Hct降低(P<0.05);与Ⅰ组比较,Ⅱ组T2,3时全血低切粘度和红细胞聚集指数降低,T1-3时血小板聚集指数升高(P<0.05).结论 6%HES 200/0.5与6%HES 130/0.4(15 ml/kg)术前AHH均能改善结肠癌根治术患者围术期血液流变学,其中6% HES 130/0.4的效果较好.     

两种羟乙基淀粉行急性高容量血液稀释对小儿血液流变学和凝血功能的影响

目的探讨两种分子量和取代级的6%羟乙基淀粉(HES)130/0·4(万汶)和6%HES200/0·5(贺斯)行急性高容量血液稀释(AHH)对手术患儿的血液流变学、血小板和凝血功能等的影响。方法40例1~12岁的手术患儿随机分为6%HES130/0·4组(V组)和6%HES200/0·5组(H组),术前1h分别输入6%HES130/0·4或6%HES200/0·510ml/kg,测定输液前后血液流变学、血小板功能和凝血功能,并进行比较。结果两组患儿输液后全血粘度低切、中切、高切参数和红细胞压积均显著下降(P<0·01)。V组患儿全血还原粘度低切和高切参数在输液后显著降低(P<0·05)。V组红细胞聚集指数在输液后显著降低(P<0·01)且与H组比较差异有显著意义(P<0·05);两组红细胞电泳指数在输液后显著增加(P<0·05)。两组患儿1min血小板聚集率(PAG1)和最大血小板聚集率(PAGM)在输液前后无显著改变,但是两组间差异有显著意义(P<0·05)。两组患儿输液后凝血酶原时间(PT)均显著延长(P<0·01),但均在正常范围。结论两种不同分子量和取代级的羟乙基淀粉用于1~12岁患儿进行术前AHH,均改善血液流变性,6%HES130/0·4对凝血功能的影响比6%HES200/0·5更小,对血液流变学的改善更好。     

6％羟乙基淀粉130/0.4急性高容量血液稀释用于学龄前患儿血液保护的效果

目的 探讨6％羟乙基淀粉130/0.4急性高容量血液稀释(AHH)用于学龄前患儿血液保护的效果.方法 择期行普外科或骨科手术患儿40例,ASA Ⅰ级,年龄3～6岁,体重11.5 ～ 22.5kg,身高78 ～ 120 cm,按抽签的方法将其随机分为急性高容量血液稀释组(AHH组,n=20)和对照组(C组,n=20).手术开始前,AHH组经颈内静脉输注6％羟乙基淀粉130/0.4 10 ml/kg,输注速率0.3ml·kg-1·min-1;C组常规补液 记录术中液体出入量、术中出血量、尿量及异体输血情况.于AHH前(T0)、AHH结束后即刻(T1)、4 h(T2)、24 h(T3)测定血常规、肝肾功能以及凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]指标.记录术中低钾血症、低钙血症、PT延长、APTT延长和围术期肺水肿、心衰、创面异常出血等发生情况.结果 与C组比较,AHH组尿量升高,T1时Hct、T12时Fib降低,PT和APTT延长,异体输血免除率、PT延长和APTT延长发生率升高(P＜0.05);复方电解质注射液用量、失血量、肝肾功能各指标、血小板计数、低钾血症和低钙血症发生率比较差异无统计学意义(P＞0.05);围术期均无肺水肿、心衰和创面异常出血发生.结论 学龄前患儿采用6％羟乙基淀粉130/0.4 10 ml/kg行AHH时可产生较好的血液保护作用,对内环境影响较小,但可延长凝血时间.     

食管超声多普勒监测急性高容量血液稀释对血液动力学的影响

目的　应用经食管超声多普勒血液动力学监测仪 ,观察全麻下急性高容量血液稀释(HHD)的血液动力学和氧供 (DO2 )变化。方法　选择 1 5例ASAI～II级择期行非心脏手术患者。麻醉诱导插管后持续监测心输出量 (CO)、每搏量 (SV)、心脏指数 (CI)、血流峰速度 (PV)、血流加速度(Acc)和左室射血时间指数 (LVETi) ,每隔 5分钟输入MAP值后计算出系统血管阻力 (SVR)值。麻醉平稳和各项监测完成后 1 0min ,在 30min内输注 6 %羟乙基淀粉 (HES) 2 0ml/kg。记录 6 %HES输注前、输注 1 5和 30min时的各项监测数据 ,并抽取动脉血液样本行血气分析并计算DO2 。结果　与HHD前相比 ,血气各参数 (pH、PaO2 、PaCO2 、BE)均无明显差异 (P >0 0 5 ) ,而 6 %HES输注 1 5和30min血红蛋白 (Hb)含量、红细胞比积 (Hct)均明显下降 (P <0 0 5和P <0 0 1 )。 6 %HES输注 1 5和 30min时的CaO2 比HHD前明显下降 (P <0 0 5 ) ,而DO2 显著增加 (P <0 0 5 )。与HHD前测量值相比 ,6 %HES输注 1 5min ,CO、SV、CI、PV和Acc明显升高 ,SVR显著降低 (P <0 0 5 ) ;6 %HES输注 30min ,SV、PV和Acc进一步升高 (P <0 0 1 ) ,而CO、CI和SVR与 6 %HES输注 1 5min时无明显变化。MAP、HR和LVETi在HHD期间无明显变化。结论　术前输注 6 %HES 2 0ml     

比较不同分子量羟乙基淀粉对术中血液循环及凝血功能的影响

目的多中心、双盲、平行对照比较术中输注国产6%羟乙基淀粉200/0.5(6%HES200/0.5,盈源)和6%羟乙基淀粉130/0.4(6%HES130/0.4,万汶)对术中血流动力学、血液流变学及凝血功能的影响。方法150例择期手术的患者随机均分为Y组和V组。手术开始后,Y组输注6%HES200/0.51000ml,V组输注6%HES130/0.41000ml。分别于麻醉前(T0)、输注开始时(T1)、输注开始后30min(T2)、60min(T3)、90min(T4)、120min(T5)各时点监测患者血流动力学参数,在麻醉前及输注结束后10min抽血检测凝血功能及血液流变学参数。结果与T0时相比,两组患者T1时MAP均明显下降(P<0.05),V组T4、T5时MAP明显降低(P<0.05);T3时V组HR增快(P<0.05),输液结束后两组凝血酶原时间(PT)及部分凝血酶原时间(APTT)均有所延长(P<0.05),纤维蛋白原下降(FIB)(P<0.05),血小板计数(Plt)减少(P<0.05),但两组组间差异无统计学意义;两组液体均可降低全血高、低切变率(P<0.05),对血浆粘度无明显作用。两组术中输血量及晶体输入量差异无明显统计学意义。结论输入6%HES200/0.5或6%HES130/0.41000ml均可有效维持血流动力学稳定,改善机体微循环,但对凝血功能均有尚可耐受的影响。     

羟乙基淀粉130/0.4急性高容量血液稀释对血液流变学和凝血功能的影响

目的 观察6%羟乙基淀粉(HES)130/0.4急性高容量血液稀释(AHH)对高凝状态的恶件肿瘤患者血液流变学和凝血功能的影响.方法 择期在全麻下行胃、肠癌根治术伴高凝状态患者40例,随机分为两组,每组20例.全麻插管后H组输注HES 130/0.4,R组输注复方乳酸钠,均以15～20 ml/kg(25～35 ml/min)输注.分别于AHH前(T0)、AHH结束后即刻(T1)、AHH结束后60 min(T2)和手术结束时(T3)采静脉血检测血液流变学和凝血功能.结果 H组AHH后各时点全血高切粘度、低切粘度、血浆粘度、血细胞比容(Hct)及血小板聚集率明显低于T0时(P<0.05);H组AHH后各时点Hb、血小板计数(Pit)低于R组(P<0.05);H组AHH后各时点部分活化凝血活酶时间(APTT)较R组明显延长(P<0.05),但两组均在正常范围;H组纤维蛋白原(FIB)降低更为显著(P<0.05).结论 HES 130/0.4 AHH用于恶性肿瘤患者能改善血液流变学,改善肿瘤患者的高凝状态,但对凝血功能的影响较小.     

羟乙基淀粉130/0.4用于体外循环心脏外科手术患者的安全性

目的 评价6%羟乙基淀粉130/0.4(6%HES 130/0.4)用于体外循环心脏外科手术患者的安全性.方法 拟在体外循环下行心脏外科手术患者60例,年龄18～64岁,ASAⅡ或Ⅲ级,随机分为2组(n=30):HES组和4%琥珀酰明胶组(GEL组).术中HES组和GEL组分别静脉输注6%.HES 130/0.4和4%琥珀酰明胶7～12 ml·kg-1·h-1维持中心静脉压6～12 mm Hg和/或肺动脉楔压8～15 mm Hg体外循环预充液包括胶体液500～1000ml ICU 中 HES组和GEL组分别静脉输注6%HES 130/0.4和4%琥珀酰明胶60～120 ml/h.维持中心静脉压 6～12 mm Hg和/或肺功脉楔压8～15mm Hg 记求围术期血液动力学指标、红细胞压积,凝血功能指杯.肝、肾功能指标.液体出入量及不良反应的发生情况结果呐种胶体围术期平均用量都接近50 ml·kg-1·d-12组血液动力学,红细胞压枳、凝血功能指标、肝,肾功能指标.淑体出入量和小良反应发生率异无统汁学意义(P>0.05)结论围术期超大剂量6%HES 130/0.4(50ml·kg-1·d-1)可安全地用于体外循环心脏外科手术患者.     

人工胶体液用于急性高容量血液稀释对凝血功能的影响

目的评价不同人工胶体液进行急性高容量血液稀释（AHH）时对凝血功能的影响。方法20例ASAⅠ～Ⅱ级择期手术的良性疾病患者,随机均分为6％羟乙基淀粉组（HES组）和4％琥珀酰明胶组（MFG组）。全麻后输入HES（200／0．5）或MFG,20ml／kg,（25±5）min内输完。分别于AHH前后,由静脉取血检测血常规、凝血酶原时间（PT）、部分激活凝血活酶时间（APTT）、Ⅷ因子活动度（Ⅷ：C）、血管性血友病因子（vWF）、纤维蛋白原（FIB）、血小板膜糖蛋白（GpⅡb／Ⅲa）和血栓弹力描记图（TEG）。同时监测HR、MAP和CVP。结果（1）两组患者AHH后的Hct都降低至30％左右,达到中度血液稀释。（2）两组患者AHH前后血流动力学稳定。（3）与AHH前相比,AHH后两组患者PT、APTT均明显延长,HES组的Ⅷ：C明显下降;两组患者vWF和FIB均明显下降;GPⅡb／Ⅲa无明显变化;两组患者TEG均有凝m功能受损的表现。结论HES和MFG对vWF和（或）Ⅷ因子有抑制作用,APTT的明显延长和TEG的凝血功能受损可能与这一抑制作用有关。AHH后除APTT外各凝血参数均在正常范围内。     

羟乙基淀粉术前急性高容量血液稀释在肺癌手术中的应用

目的观察羟乙基淀粉(HES)术前急性高容量血液稀释(AHH)在全麻复合硬膜外阻滞下肺癌手术患者中应用的可行性。方法ASAⅠ~Ⅱ级患者42例,随机分为观察组(V组)和对照组(C组)。V组:于切皮前50ml/min输入6%HES130/0·41000ml。C组:输注等量复方氯化钠。持续监测MAP、HR、SpO2和PETCO2。分别于稀释前、稀释后、术毕、术后第1天和第7天测定红细胞压积(Hct)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)和纤维蛋白原浓度(Fib)的变化;记录术中输血量和输液量;计算出血量。结果术中两组患者出血量和输液量差异无显著意义,输血量及输血患者人数V组明显低于C组(P<0·05)。V组MAP的变化明显低于C组(P<0·05),稀释后,HR明显减慢(P<0·05),CVP明显升高(P<0·01),但尚在正常生理范围。V组的Hct在稀释后及术中明显低于基础值及C组(P<0·05),但在术毕和术后第1天及第7天两组间差异无显著意义。PT、APTT及Fib组间比较差异均无显著意义。结论全麻复合硬膜外阻滞下肺癌手术患者使用HES施行AHH可有效维持血液动力学平稳及提高患者对失血的耐受性。     

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.     

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.