肺癌术后肺部感染危险因素的系统评价与Meta分析

目的 系统评价肺癌患者术后肺部感染（postoperative pulmonary infection in patients with lung cancer,PPILC）的危险因素,为临床医师预防PPILC提供理论参考。方法 计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase和The Cochrane Library数据库,收集分析PPILC危险因素的相关研究。检索时限为2012—2021年。由2名临床医师独自筛选文献并提取数据和评估研究的偏倚风险,交叉核对并达成一致。使用RevMan 5.3软件进行Meta分析。结果 共纳入25项研究,其中病例对照研究20项,队列研究1项,横断面研究4项,共包括15 129例患者。20项病例对照研究和1项队列研究的纽卡斯尔-渥太华量表评分均≥6分;4篇横断面研究的美国医疗保健研究与质量局（Agency for Healthcare Research and Quality,AHRQ）量表评分≥6分。Meta分析结果显示,PPILC的危险因素包括：（1）患者自身因素（4个）：年龄≥60岁、男性、有吸烟史、吸烟指数≥4...     

颈椎手术患者术后发生硬膜外血肿危险因素的Meta分析

【摘要】 目的：系统评价颈椎手术患者术后发生硬膜外血肿的相关危险因素。方法：通过计算机检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网（CNKI）、万方数据库（Wanfang）、维普数据库（VIP）和中国生物医学文献数据库（CBM）,自建库至2023年4月公开发表的有关颈椎手术患者术后发生硬膜外血肿的回顾性或前瞻性研究,2名评价者分别按照纳入与排除标准对所获文献进行文献筛选,采用NOS量表进行质量评价,提纳取入文献的基本信息,包括年龄、性别及体质指数（body mass index,BMI）以及与颈椎术后硬膜外血肿发生相关研究因素（如手术节段、是否合并后纵韧带骨化、手术时间、糖尿病史、高血压病史、吸烟史、非甾体抗炎药的使用以及实验室相关指标等）,通过RevMan 5.4软件进行Meta分析。采用漏斗图对纳入的研究进行偏倚风险分析。结果：共纳入12篇文献,纳入文献的NOS质量评分均在6~8分,其中11篇为高质量研究,1篇为中质量研究。Meta分析显示：男性[比值比（odds ratio,OR）=2.84,95%可信区间（confidence interval,CI）（1.73,4.67）,P＜0.0001]、BMI＞24kg/m2[OR=8.50,95%CI（2.56,25.24）,P=0.0005]、多手术节段（手术节段≥2）[OR=2.26,95%CI（1.42,3.59）,P=0.0005]、手术时长＞2h[OR=1.46,95%CI（1.08,1.97）,P＝0.01]、术前服用非甾体类抗炎药物[OR=3.60,95%CI（1.00,12.99）,P=0.05]是颈椎术后发生硬膜外血肿的危险因素。采用漏斗图对纳入文献最多的影响因素手术节段及术中出血量进行发表偏倚检验结果显示手术节段不存在发表偏倚,而术后出血量存在部分发表偏倚。结论：男性、BMI过大、多节段手术、手术时间长、术前服用非甾体类抗炎类药物等是颈椎术后SEH发生的危险因素。     

颈动脉支架置入术后发生支架内再狭窄危险因素的Meta分析

目的 探讨颈动脉支架置入（CAS）术后发生支架内再狭窄（ISR）的危险因素。方法 检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据库,搜索CAS术后发生ISR危险因素的相关研究,检索时间为建库至2022年1月1日,采用Rev Man 5.4.1软件进行Meta分析。结果 共纳入22篇文献,包括3篇队列研究,19篇病例对照研究。Meta分析结果显示,糖尿病、吸烟、高血压、高脂血症、外周动脉疾病、闭环支架、残余狭窄均是CAS术后发生ISR的危险因素（P﹤0.05）,症状性颈动脉狭窄、开环支架均是CAS术后发生ISR的保护因素（P﹤0.05）。结论 医务人员可参照上述因素对接受CAS的患者进行排查,制定相应的干预措施,以期降低再狭窄的发生率。     

腰椎椎体间融合术后cage后移危险因素的Meta分析

【摘要】 目的：通过系统评价的方法分析影响腰椎椎体间融合术后cage后移（cage retropulsion,CR）发生的危险因素。方法：检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库和维普数据库,收集各数据库建库至2023年4月有关影响腰椎椎体间融合术后CR危险因素的文献,研究类型为队列研究及病例对照研究,采用纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa scale,NOS）对纳入研究进行质量评价,提取纳入研究的基本信息,包括年龄及性别等以及CR发生相关研究因素,如骨质疏松、终板损伤、螺钉松动、梨形椎间隙、cage形状、cage置入深度及手术时长、出血量等。评价纳入研究的偏倚风险后,使用Stata14.0软件进行Meta分析。结果：共纳入16篇相关文献,其中15篇文献为回顾性病例对照研究,1篇为前瞻性队列研究,均为中等及以上质量研究,NOS评分均≥7分。总样本量12667例,其中发生CR者（CR组）326例,未发生CR者（nCR组）12341例,CR发生率为2.83%。Meta分析结果显示：性别（男性）[比值比（odds ratio,OR）=1.264,95%置信区间（confidence interval,CI）（1.003～1.593）,P=0.047]、年龄[效应量标准化平均差（standardized mean difference,SMD）=0.237,95%CI（0.054～0.419）,P=0.011]、骨质疏松[OR=3.126,95%CI（1.040～9.401）,P=0.042]、骨终板损伤[OR=8.161,95%CI（3.711～17.945）,P=0.000]、螺钉松动[OR=7.978,95%CI（3.487～18.255）,P=0.000]、梨形椎间隙[OR=6.037,95%CI（2.381～15.305）,P=0.000]、cage置入深度不足[OR=5.157,95%CI（1.760～15.111）,P=0.003]是腰椎椎体间融合术后发生CR的危险因素。结论：性别（男性）、高龄、骨质疏松、骨终板损伤、螺钉松动、梨形椎间隙、cage置入深度不足与腰椎椎体间融合术后发生CR密切相关,随访期间应对此类患者密切观察,预防发生严重cage移位的并发症。     

颈动脉支架置入术后发生低血压影响因素的Meta分析

目的 探讨颈动脉支架置入术后发生低血压的影响因素。方法 检索Pubmed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据库,搜索颈动脉支架置入术后低血压影响因素的相关研究,检索时间为从建库至2022年8月1日,采用Rev Man5.4.1软件进行Meta分析。结果 共纳入18篇文献,2059例患者,包括1篇队列研究和17篇病例对照研究。Meta分析结果显示,颈动脉球部狭窄、颈动脉分叉处与最窄处距离（≤10 mm）、溃疡斑块均是颈动脉支架置入术后发生低血压的危险因素（OR≥1,P﹤0.05）;高血压、年龄（≥65岁）均是颈动脉支架置入术后发生低血压的保护因素（OR﹤1,P﹤0.05）。结论 医务工作者应针对上述影响因素加强预防管理措施,以降低颈动脉支架置入术后低血压的发生率。     

气管插管非计划拔管危险因素的系统评价

目的系统评价国内外气管插管非计划拔管(UEX)的危险因素。方法计算机检索国内外知名数据库,纳入中英文发表的成人UEX危险因素的研究,进行Meta分析或描述性分析。结果纳入23篇病例对照/队列研究文献,1篇描述性研究文献及2篇案例系列报告文献,合计15 438例气管插管患者,1 376例UEX事件。Meta分析发现男性、经口插管是UEX危险因素,而烦躁、没有使用镇静剂、护士缺乏工作经验及没有标准的撤机流程亦有可能是导致UEX的危险因素。UEX高危时间段包括夜班、撤机阶段及交接班前后1h。较多患者在身体约束的情况下发生UEX。结论为降低UEX,需进一步规范身体约束及镇静管理,加强对高危人群和高危时间段的监护。     

单侧双通道内镜腰椎融合术安全性的荟萃分析

[目的]系统评价单侧双通道内镜（unilateral biportal endoscopic, UBE）辅助腰椎融合术与传统腰椎融合手术的安全性。[方法]检索The Cochrane Library、PubMed、Embase、Web of Science、Clinical Trals.gov、CBM、CNKI、VIP和万方数据库，收集所有UBE与传统腰椎融合手术的对照研究，检索时限均为建库至2022年4月13日，采用RevMan5.3软件进行荟萃分析，对数据不能合并者进行描述性定性分析。[结果]共纳入9篇文献，均为回顾性队列研究，其中高质量文献7篇，中等质量2篇。总共纳入患者796例，其中UBE组365例，传统组431例。荟萃分析结果显示：UBE组和传统组的总并发症发生率（OR=0.94,95%CI 0.57～1.53,P=0.800）、硬膜外血肿发生率（OR=1.16,95%CI 0.38～3.52,P=0.800）、硬脊膜撕裂发生率（OR=1.80,95%CI 0.76～4.30,P=0.180）、感染发生率（OR=0.35,95%CI 0.09～1.30,P=0.120）差异均...     

颈椎前路术后吞咽困难危险因素的Meta分析

【摘要】 目的：系统评价颈椎前路术后发生吞咽困难的危险因素,明确独立危险因素,为颈椎前路手术围术期并发症的防治提供指导。方法：检索万方数据库（WanFang）、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普（VIP）、PubMed、Embase、 Cochrane Library、Web of Science共8个数据库,检索时限从建库至2023年7月15日,搜索关于颈椎前路术后吞咽困难的危险因素的病例对照研究和队列研究,采用纽卡斯尔-渥太华质量评定量表（Newcastle-Ottawa Scale,NOS）对纳入研究进行质量评价和数据提取（包括第一作者、发表年份、研究类型、样本量、评估方式、评估时间及危险因素）,通过Stata12软件进行Meta分析。结果：共纳入29篇文献,其中队列研究4篇,病例对照研究25篇,所有文献均为高质量研究,包括颈椎前路术后吞咽困难患者89571 例,对照组3092967例。年龄[优势比（odds ratio,OR）=1.093,95%置信区间（confidential interval,CI）：1.067~1.120]、女性（OR=2.419,95%CI：1.654~3.539）、糖尿病（OR=2.733,95%CI：2.240~3.333）、病程（OR=4.259,95%CI：2.458~7.381）、手术节段数量（OR=1.791,95%CI：1.718~1.868）、手术节段位置（OR=2.332,95%CI：1.812~3.003）、手术时间（OR=1.434,95%CI：1.110~1.852）、钢板内置物（OR=2.188,95%CI：1.413~3.175）及翻修手术（OR=2.687,95%CI：2.316-3.119）与颈椎前路术后发生吞咽困难相关,而吸烟（OR=1.323,95%CI：0.852~2.056）、高血压（OR=1.006,95%CI：0.591~1.713）、体重指数（body mass index,BMI）（OR=1.037,95%CI：0.929~1.159）、颈椎间盘置换（OR=0.577,95%CI：0.085~3.943）、C2-7角度变化（difference between postoperative and preoperative C2-C7 angle,dC2-7）＞5°（OR=1.716,95%CI：0.925~3.183）等因素与其不相关。结论：女性、高龄、术前病程长、合并糖尿病、双节段或多节段手术、高位颈椎手术、手术时间长、使用钢板及翻修手术的患者颈椎前路术后更易发生吞咽困难。     

老年患者非体外和体外循环冠状动脉旁路移植术围术期脑卒中发生率比较的系统评价和Meta分析

目的比较老年患者（年龄≥65岁）非体外循环冠状动脉旁路移植术（OPCAB）和体外循环冠状动脉旁路移植术（CABG）围手术期脑卒中发生率。方法计算机检索PubMed（1966~2010年）、Cochrane Library（2010年12期）、EMbase（1974~2010年）、中国期刊全文数据库（CNKI,1997~2010年）,中国生物医学文献数据库（CBM,1989~2010年）,辅以手工检索,全面收集所有比较老年患者行OPCAB和CABG围手术期脑卒中发生率的已发表临床研究和灰色文献。评价纳入研究质量,提取有效数据,采用RevMan 5.0软件进行Meta分析。对纳入研究按患者年龄分成4个亚组（65~70岁、70~75岁、75~80岁和〉80岁）或按纳入研究的不同设计方法分组进行亚组分析;排除低质量研究进行敏感性分析。结果共纳入17个研究,均进入Meta分析,其中5篇为回顾性队列研究,12篇为病例对照研究,未检索到随机对照研究。Meta分析共纳入7 275例冠心病（冠状动脉造影明确诊断）患者,其中OPCAB组2 521例（34.65%）,CABG组4 754例（65.35%）。回顾性队列研究亚组[OR=0.25,95%CI（0.10,0.62）]和病例对照研究亚组[OR=0.25,95%CI（0.15,0.41）]分析结果均显示：两组脑卒中发生率差异有统计学意义;各年龄亚组除65~70岁亚组中两组脑卒中发生率差异无统计学意义[OR=0.10,95%CI（0.01,1.68）外,其余3个年龄亚组中两组脑卒中发生率差异均有统计学意义,其OR（95%CI）值分别为0.35（0.21,0.59）,0.14（0.04,0.54）和0.09（0.02,0.38）。病例对照研究亚组敏感性分析结果表明此Meta分析结果稳定,而回顾性队列研究亚组则相反。结论老年患者行OPCAB围手术期脑卒中发生率可能较CABG低,但我们的分析结果仍需纳入更多的多中心大样本随机双盲对照试验进一步证实。     

腰椎术后硬膜外血肿的危险因素和临床转归

目的 :探讨腰椎手术后硬膜外血肿形成的危险因素,并随访血肿清除术后患者神经功能恢复情况。方法:2009年1月~2014年1月在北京医院骨科因腰椎管狭窄症或腰椎间盘突出症行腰椎后路减压椎弓根螺钉内固定术的患者共1225例,术后发生硬膜外血肿致马尾神经功能受损的患者共8例,收集和整理血肿患者的一般资料,并对其血肿清除手术后神经功能恢复情况进行随访。采取病例对照研究的方法,按照每1例腰椎术后硬膜外血肿患者随机选取3例诊断、手术方式及手术医师均相同的24例患者作为对照。对两组患者的年龄、性别、高血压病史、糖尿病病史、非甾体类镇痛药物应用、抗血小板聚集药物的应用、是否为翻修手术,及手术融合节段数、手术时间、术中失血量、输红细胞悬液量、是否输注了冰冻血浆进行多元回归分析,采用多元Logistic回归模型确定每个因素是否为硬膜外血肿形成可能的危险因素,计算其OR(Odd′s Ratio)值。结果 :多元Logistic回归模型回归分析结果显示,手术前危险因素是年龄65岁和翻修手术,手术中危险因素是手术时间120min、失血量600ml、手术中输注了冰冻血浆。血肿清除术后神经功能完全恢复者2例,部分恢复者4例,无恢复者2例。结论:患者年龄65岁、翻修手术、手术时间120min、术中出血量600ml、术中输注冰冻血浆是腰椎手术后硬膜外血肿形成的危险因素;血肿清除术后大部分患者神经功能得到不同程度恢复。     

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.