线粒体通透性转换孔在七氟醚延迟预处理减轻大鼠心肌缺血再灌注损伤中的作用

目的 探讨线粒体通透性转换孔(mPTP)在七氟醚延迟预处理减轻大鼠心肌缺血再灌注损伤中的作用.方法 雄性SD大鼠80只,体重250～300 g,随机分为5组(n=16):假手术组(S组)、缺血再灌注组(IR组)、七氟醚延迟预处理组(SP组)、mPTP开放剂苍术苷+七氟醚延迟预处理组(A+SP组)和苍术苷组(A组).IR组、SP组、A+SP组和A组采用结扎左冠状动脉前降支30 min后进行再灌注的方法制备心肌缺血再灌注模型.SP组和A+SP组吸入2.5%七氟醚l h,其余组吸入纯氧1 h,停止吸入后24 h进行心肌缺血.A+SP组和A组在缺血前15 min经尾静脉注射苍术苷5 mg/kg.再灌注120 min时采集颈动脉血样,测定血清肌钙蛋白I(cTnI)浓度.然后处死大鼠,测定心肌梗死体积,检测心肌组织Bcl-2及Bax表达水平,电镜下观察心肌超微结构.结果 与S组比较,其他各组血清cTnI浓度升高,心肌梗死体积扩大,Bcl-2表达下调,Bax表达上调(P＜0.05).与IR组比较,SP组血清cTnI浓度降低,心肌梗死体积缩小,Bcl-2表达上调,Bax表达下调(P＜0.05),心肌病理学损伤减轻.苍术苷可取消七氟醚延迟预处理减轻大鼠心肌缺血再灌注损伤的效应(P＜0.05).结论 抑制mPTP开放后可导致Bcl-2表达上调,Bax表达下调,参与了七氟醚延迟预处理减轻大鼠心肌缺血再灌注损伤.     

线粒体KATP通道介导七氟醚预处理对大鼠的脑保护作用

目的 探讨七氟醚预处理对大鼠局灶性脑缺血-再灌注(IR)损伤的保护作用.方法 雄性SD大鼠60只随机均分为七氟醚预处理组(S组)、5-HD+七氟醚预处理组(HS组)、5-羟葵酸(5-HD)组(H组)、IR组和假手术组(C组).采用大脑中动脉线栓法缺血2 h、再灌注24 h制备大鼠局灶性脑IR模型(MCAO).S组于缺血前1 h经半密闭的吸入箱吸入七氟醚(呼气末浓度维持2.4%,持续30 min).HS、H组缺血前或七氟醚预处理前经尾静脉注射5-HD(10 mg/kg).再灌注24 h后用Zea Longa评分法进行神经功能缺陷评分,TTC染色法测大鼠脑梗死容积,免疫组化法测定大脑皮质Bcl-2和Bax蛋白表达.结果 与IR组比较,S组神经功能缺陷评分明显降低,脑梗死容积显著减少(P＜0.05);但HS、H、IR组神经功能缺陷评分和脑梗死容积差异无统计学意义.S组Bcl-2、Bax表达明显高于HS、H、IR组.结论 七氟醚预处理对局灶性脑IR损伤有一定程度的保护作用.其保护作用与mitoKATP通道的激活有关,并可能是通过调控凋亡相关基因Bcl-2和Bax的表达来实现.     

诱导型一氧化氮合酶在异氟醚延迟相预处理心肌保护中的作用

目的研究诱导型一氧化氮合酶(iNOS)在异氟醚延迟相预处理心肌保护中的作用。方法新西兰白兔36只随机分成五组:异氟醚预处理组(n=9),异氟醚持续吸入2h;1400Wa组(n=6),给予选择性iNOS阻滞药1400W;1400Wb组(n=6),于缺血-再灌注前30min给予1400W;异氟醚 1400W组(n=6),给予异氟醚持续吸入2h,在缺血-再灌注前30min给予1400W;对照组(n=9),给予生理盐水。各组建立心肌局部缺血-再灌注模型。监测缺血-再灌注期间血流动力学参数,测定心肌梗死范围,检测iNOS基因水平表达和蛋白表达。结果异氟醚预处理组[(23.98±2.65)%]和对照组[(42.14±3.06)%]相比明显减少心肌缺血-再灌注后心肌梗死范围(P<0.01),异氟醚 1400W组[(42.12%±2.60)%]和异氟醚预处理组相比,1400W可以取消异氟醚的减少心肌梗死范围的作用(P<0.01)。iNOS在基因水平和蛋白表达水平均增加。结论异氟醚延迟相预处理具有抗心肌缺血-再灌注损伤的作用,而且这种作用是由iNOS所介导。     

七氟醚预处理对大鼠脊髓缺血再灌注损伤的影响及自噬在其中的作用

目的 评价七氟醚预处理对大鼠脊髓缺血再灌注损伤的影响及自噬在其中的作用.方法 成年雄性SD大鼠45只,体重420～450 g,采用随机数字表法分为5组(n=9):对照组(Con组)、脊髓缺血再灌注组(I/R组)、七氟醚预处理组(Sevo组)、特异性自噬抑制剂3-甲基腺嘌呤组(3-MA组)和3-MA+七氟醚预处理组(3-MA+ Sevo组).I/R组胸主动脉球囊阻断+体循环低血压制备大鼠脊髓缺血再灌注模型,Sevo组于缺血前24h时吸入3.4％七氟醚2h,3-MA组和3-MA+ Sevo组分别于再灌注即刻和吸入七氟醚前15 min时鞘内注射20出3-MA(10 mmol/L).于再灌注24h时采用神经功能缺陷评分(NDS评分)法评价大鼠神经功能,随后处死取脊髓,Western blot法检测LC3B、Beclin 1、Bcl-2蛋白的表达水平.结果 与Con组比较,I/R组脊髓LC3B、Beclin 1蛋白表达上调,Bcl-2蛋白表达下调,NDS评分升高(P＜0.05);与I/R组比较,Sevo组、3-MA组和3-MA+ Sevo组脊髓LC3B、Beclin 1蛋白表达下调,Bcl-2蛋白表达上调,NDS评分降低(P＜0.05);Sevo组、3-MA组和3-MA+ Sevo组各指标比较差异无统计学意义(P＞0.05).结论 七氟醚预处理可减轻大鼠脊髓缺血再灌注损伤,其机制可能与上调Bcl-2,抑制自噬溶酶体途径,减轻自噬有关.     

七氟醚对心肌缺血-再灌注幼兔心肌细胞凋亡及Fas/FasL蛋白表达的影响

目的探讨七氟醚对幼兔缺血-再灌注心肌细胞凋亡及Fas、FasL蛋白表达的影响。方法取30只日本大耳白幼兔随机均分为三组,缺血-再灌注组(IR组):结扎30min,再灌注120min;七氟醚预处理组(S组):缺血前吸入2.5%七氟醚30min,洗脱15min后处理同IR组;假手术组(C组):只穿线不结扎。观察三组兔心肌细胞凋亡和Fas、FasL蛋白表达情况,电镜观察细胞超微结构。结果心肌细胞凋亡率S组(13.71±6.01)%明显低于IR组(31.33±7.04)%(P<0.05),而C组(3.3±0.5)%明显低于IR组和S组(P<0.05)。S、C组Fas、FasL蛋白表达的平均灰度高于IR组(P<0.05)。电镜显示S组细胞损伤程度小于IR组。结论七氟醚能明显降低幼兔缺血-再灌注心肌细胞的凋亡。     

吸入麻醉药预处理对兔心肌缺血再灌注中心肌细胞凋亡的影响

目的：探讨异氟醚、七氟醚、地氟醚预处理对心肌缺血再灌注过程中心肌细胞凋亡的影响。方法：48只新西兰白兔随机分成6组（n=8)：假手术对照组（P组）、心肌缺血再灌注对照组（IR组）、缺血预处理组（IP组）、异氟醚预处理组（I组）、七氟醚预处理组（S组）、地氟醚预处理组（D组）。除P组外，每组均接受左冠脉前降支3h阻断和3h再灌注。IP组在缺血前接受连续3次每次缺血5min、再灌注5min的预处理，吸入药预处理组在缺血前分别吸入1MAC的异氟醚、七氟醚或地氟醚30min后洗脱15min。取心肌缺血区边缘组织用琼脂糖电泳检测DNA梯带的形成，用流式细胞仪测凋亡指数（AI）。结果：心肌梗死范围占缺血范围的百分比及AI，IP、I、S及D组较IR组显著减少（P＜0．05）。IR组DNA梯带的形成明显，IP、I、S、D组减弱、变模糊。结论：异氟醚、七氟醚、地氟醚预处理能抑制心肌缺血再灌注所致的心肌细胞凋亡。     

阿片受体在异氟醚延迟预处理减轻兔心肌缺血再灌注损伤中的作用

目的 探讨阿片受体在异氟醚延迟预处理减轻兔心肌缺血再灌注损伤中的作用.方法 健康雄性新西兰大白兔40只,体重2.0～2.5 kg,采用结扎左冠状动脉前降支40 min,再灌注120 min的方法制备心肌缺血再灌注损伤模型,随机分为4组(n=10):假手术组(S组)吸入纯氧2 h,24 h后仅动脉下穿线不结扎;心肌缺血再灌注组(IR组)吸入纯氧2 h,24 h后行心肌缺血再灌注;异氟醚延迟预处理组(I组)吸人2%异氟醚2 h,24 h后行心肌缺血再灌注;阿片受体阻断剂+异氟醚延迟预处理组(N组)静脉注射纳洛酮6 mg/kg后10 min,吸入2%异氟醚2 h,24 h后行心肌缺血再灌注.于再灌注120 min时取心脏,计算心肌缺血面积和梗死面积,测定磷酸化p38MAPK蛋白表达水平,观察心肌细胞超微结构.结果 S组心肌细胞完整,排列整齐,线粒体形态正常,糖原丰富;IR组和N组心肌细胞水肿,心肌纤维排列紊乱,线粒体、内质网膜水肿,空泡化;I组心肌细胞水肿程度减轻,心肌纤维排列较完整,线粒体轻度水肿.与IR组比较,I组心肌梗死面积减小,磷酸化p38MAPK蛋白表达下调(P<0.05),N组上述指标差异无统计学意义(P>0.05).结论 阿片受体参与异氟醚延迟预处理减轻兔心肌缺血再灌注损伤.     

缺血后适应对兔短期缺血再灌注心肌细胞凋亡的影响

目的探讨缺血后适应对兔局部短期缺血再灌注心肌细胞凋亡及Bcl-2、Bax蛋白表达的影响。方法18只新西兰白兔随机分成3组，每组6只；假手术对照组（S组）、缺血，再灌注对照组（IR组）、缺血后适应组（Post组）。除S组外，其余两组均接受左冠脉前降支15min阻断和30min再灌注，Post组在15min缺血后接受连续3次每次再灌注30s，缺血30s的后适应。以DNA电泳和TUNEL分析检测兔短期缺血再灌注心肌组织的细胞凋亡情况，免疫组织化学方法检测Bcl-2、Bax蛋白的表达。结果兔IR组缺血区心肌DNA电泳呈现DNA梯形，而Post组和s组未见梯形。Post组心肌细胞凋亡指数显著低于IR组[（28．06±2．92）％，（55．70±13．96）％，P〈0．01]。Bcl-2基因的蛋白表达量Post组高于IR组（10．00±0．89，7．83±1．47，P〈0．05）；Bax基因的蛋白表达量Post组低于IR组（7．50±0．84，9．83±0．98，P〈0．05）。结论缺血后适应显著减少了兔短期缺血再灌注诱导的心肌细胞凋亡程度与上调Bcl-2基因的蛋白表达，下调Bax基因的蛋白表达有关。     

异氟醚延迟预处理对心肌缺血再灌注损伤兔心肌蛋白质组的影响

目的 探讨异氟醚延迟预处理对心肌缺血再灌注损伤兔心肌蛋白质组的影响.方法 成年新西兰大白兔8只,雌雄不拘,体重2.0-2.5 kg,随机分为2组(n=4):缺血再灌注组(IR组)和异氟醚延迟预处理组(IDP组).采用结扎左冠状动脉前降支40 min.再灌注120 min的方法 建立缺血再灌注模型.IDP组持续吸入2%异氟醚2 h,24 h后进行缺血再灌注.于再灌注结束即刻,取左心室前壁心肌组织,进行双向凝胶电泳和质谱分析.结果 与IR组比较,IDP组差异表达的蛋白质有13个,其中10个蛋白质表达上调,3个蛋白质表达下调(P<0.05).质谱分析得到13张肽质量指纹图谱,并成功鉴定出了其中11个蛋白质.结论 异氟醚延迟预处理可减轻兔心肌缺血再灌注损伤,可能与心肌蛋白质组的变化有关.     

Cyclin D1在大鼠肝缺血预处理和缺血再灌注损伤中早期复灌的表达

目的观察缺血预处理对大鼠肝缺血再灌注损伤复灌早期细胞增殖与Cyclin D1表达的影响,探讨缺血预处理保护作用的机制。方法54只SD大鼠随机分成缺血再灌注组(IR)、缺血预处理组(IP)和假手术组(SO),利用肝原位部分缺血再灌注模型,于复灌后0、1、2、4 h取材,应用流式细胞仪,检测各组肝细胞Ki67抗原表达,同时应用Western blot法检测各组蛋白表达的变化。结果与IR组相比,在复灌后0、1 h,IP组肝细胞Ki67表达率明显增高[(28．86±6．34)％比(19．40±5．35)％,(46．82±9．80)％比(22．40±5．08)％,P＜0．05],同时可见IR组复灌后2h Cy- clinD1蛋白始有表达,而IP组在复灌开始时即有表达。结论缺血预处理可促进肝细胞在缺血再灌注损伤后早期细胞增殖与Cyclin D1的表达,可能是其对缺血再灌注损伤起到保护作用的机制之一。     

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.     

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.     

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.