青少年胸椎半椎体脊柱侧凸合并脊髓纵裂的手术治疗

[目的]探讨青少年胸椎半椎体脊柱侧凸合并脊髓纵裂的手术方法及治疗效果.[方法]2001年1月～2007年6月应用一期后路半椎体及骨嵴切除、椎弓根螺钉内固定植骨融合治疗15例患者,男6例,女9例;年龄16～24岁,平均21.2岁.15例均为完全分节半椎体,半椎体位置T113例、T1212例.术后观察脊柱融合、畸形矫正率及内固定稳定情况.[结果]随访19～45个月,平均34个月,术前Cobb's角平均为52.3°±3.8°,术后为10.2°±1.4°,末次随访有1.6°的角度丢失,身高平均增加3.76 cm.均获得良好骨融合,融合时间3～5个月,平均3.6个月.无内固定失败及假关节形成.[结论]一期后路半椎体及骨嵴切除、椎弓根螺钉内固定植骨融合术是治疗青少年胸椎半椎体脊柱侧凸合并脊髓纵裂的有效方法,具有较好植骨融合和稳定性,值得推广应用.     

术中三维影像脊柱导航引导半椎体切除及椎弓根螺钉置入矫治儿童先天性脊柱侧后凸畸形

目的:探讨术中实时三维影像脊柱导航引导下后路椎弓根螺钉置入及半椎体切除矫治儿童先天性脊柱侧后凸畸形的临床疗效。方法:自2010年5月~2013年4月,对18例儿童先天性半椎体脊柱侧后凸畸形患者进行术中实时三维影像脊柱导航引导下进行脊柱矫形手术。其中,男7例,女11例,年龄7.6±2.9岁。术中在实时三维影像脊柱导航引导下经后路置入椎弓根螺钉并切除半椎体后进行矫形。术后通过CT评价椎弓根螺钉位置及半椎体切除情况,术前、术后摄脊柱正侧位X线片,评价矫形效果。结果:手术时间216±55min,术中出血量732±378ml。18例患者共置入椎弓根螺钉127枚(4~12枚/例)。术后CT证实124枚椎弓根螺钉位置准确,置钉准确率97.6%;1枚椎弓根螺钉穿破椎弓根内侧皮质,2枚椎弓根螺钉穿破椎弓根外侧皮质。1例出现椎弓根螺钉切割,1例出现血气胸,置入胸腔闭式引流。无神经损伤并发症病例,无螺钉误置而引起的并发症。术后CT证实18例患者半椎体均完整切除。18例中有16例获得随访,随访时间18.5±8.0个月。16例术前测量冠状面节段性侧凸Cobb角44.5°±11.4°,术后为9.3°±4.7°,末次随访时为9.7°±5.0°,矫正率为(78.2±7.8)%。节段性后凸Cobb角术前测量为32.2°±7.3°,术后为7.2°±3.5°,末次随访节时为7.7°±3.9°,矫正率为(76±9.4)%。侧凸及后凸矫正与术前相比均有统计学意义(P0.01)。末次随访时16例患者均获得骨性融合。结论:术中实时三维影像脊柱导航引导经后路矫治先天性脊柱侧后凸畸形半椎体切除完整,置入椎弓根螺钉准确率高,安全性高,畸形矫正效果满意。     

胸椎半椎体畸形合并脊髓纵裂的手术治疗

目的:探讨胸椎先天性半椎体脊柱侧凸畸形合并脊髓纵裂的手术治疗方法.方法:2003年1月至2007年6月,共收治10例先天性半椎体脊柱侧凸畸形合并脊髓纵裂患者,男4例,女6例,年龄16～22岁,平均17.4岁.均为单个完全分节半椎体,病变位于T11 3例,T12 7例.采用一期后路半椎体及骨性分隔切除内固定矫形治疗,定期随访患者,评价术后矫正率.结果:10例患者均获得有效半椎体及骨性分隔切除,无神经损伤,术前侧凸Cobb角为40°～86°,平均53.6°;术后Cobb角为5°～28°,平均16.5°,侧凸矫正率平均69.3%.随访9～45个月,平均32个月,术后3～5个月截骨间隙达到骨性融合,无内固定失败及假关节形成.末次随访时有1.6°角度丢失.结论:应用一期后路半椎体及骨性分隔切除内固定矫形治疗先天性半椎体脊柱侧凸畸形伴脊髓纵裂效果满意,近期疗效可靠.     

后路截骨矫形治疗低龄先天性脊柱后凸畸形的疗效分析

目的:评价经后路截骨内固定术治疗低龄(10岁以下)先天性脊柱后凸畸形的临床效果。方法:2009年10月~2013年5月采用经后路截骨椎弓根螺钉内固定治疗先天性脊柱后凸患者17例,男6例,女11例,手术时年龄64±21个月(37~109个月)。根据Winter分型:Ⅰ型8例,Ⅱ型4例,Ⅲ型5例。后凸顶椎均位于T10~L2之间。5例伴神经系统畸形。8例行后路椎体切除(PVCR),5例行经椎弓根截骨(PSO),4例行Ponte截骨,截骨后均采用后路自体骨或同种异体骨植骨椎弓根螺钉内固定。统计手术时间、术中出血量及手术并发症,观察矫形效果、内固定并发症、椎体融合情况等。结果:手术时间210±46min(130~300min),出血量650±330ml(200~1300ml);固定融合节段4.9±0.8个(4~6个)。随访34.7±10.4个月(24~51个月),矢状面节段性后凸Cobb角由术前61.5°±14.3°(42°~92°)矫正至术后20.7°±9.0(5°~42°),矫正率为(66.3±8.7)%,末次随访时为17.5°±9.5°(1°~36°),矫正率为(71.5±10.7)%,手术后Cobb角得到显著性改善(P0.01);矢状面平衡术前为-41.3±31.8mm,术后为-43.5±30.4mm,与术前比较无显著性变化(P0.05),末次随访时为-25.6±26.7mm,较术前明显改善(P0.05)。术后出现双下肢无力1例,排尿困难1例,术后2周恢复。术前腰背痛5例、排尿异常1例,术后6个月症状好转。1例患者术后7个月出现近端交界性后凸。随访期间未发现假关节及内固定相关并发症。结论:对低龄先天性脊柱后凸畸形患者早期行后路截骨、椎弓根螺钉内固定可显著改善后凸畸形,但术后不能立即达到脊柱矢状面平衡,而是在术后随生长发育逐渐恢复矢状面平衡。     

后路半椎体切除器械矫正内固定治疗先天性脊柱侧凸

[目的]探讨后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸的临床疗效.[方法]2002年7月～2006年12月,后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸39例,男22例,女17例;平均年龄8.3岁(3～15岁).完全分节性半椎体30例,部分分节性半椎体9例.内固定器械包括ISOLA 16例、CD-Horizon 10例、MOSS-Miami 10例、TSRH 3例.术前后摄站立位全脊柱正侧位片,观察手术前后侧凸的矫正率及躯干平衡情况.[结果]术后随访1～4.5年,平均2.8年,术前冠状面Cobb's角平均48°,术后13°,末次随访平均13.2°,平均矫正率70.2%.矢状面Cobb's角术前平均39°,术后12.1°,末次随访12.7°,平均矫正率68.7%.所有患儿植骨融合牢固,躯干平衡良好.无神经系统并发症,无植入物折断及松动、无感染等并发症,1例出现曲轴现象.[结论]后路半椎体切除、器械矫正内固定对先天性脊柱侧凸是一种安全、有效的矫治方法.先天性脊柱侧凸应提倡早期手术矫治.     

后路矫形固定融合治疗先天性脊柱侧后凸畸形的疗效分析

[目的]回顾性分析15例先天性脊柱侧后凸畸形经后路矫形植骨固定矫正术的治疗效果。[方法]2002年7月～2008年8月,先天性脊柱侧后凸患者15例,男8例,女7例;平均年龄11.6岁。术前拍摄站立位的脊柱正侧位X线片及左右Bending位X线片、CT及全脊柱MRI;其中,先天性半椎体11例,Chiari畸形/脊髓空洞症3例,神经纤维瘤病1例。侧凸Cobb’s角平均78°(35°～156°),后凸平均25°(15°～38°)。对于先天性半椎体引起脊柱侧后凸畸形的患者9例行后路经椎弓根半椎体切除、椎弓根螺钉(美国,史赛克)固定术,2例行后路长节段矫形卢氏环内固定融合术;对于Chiari畸形/脊髓空洞症的3例及神经纤维瘤病1例患者行后路长节段矫形代偿弯固定融合术。[结果]平均手术时间5.5h(3.5～7.5h);平均术中出血850ml(300～2100ml);平均随访43个月(10～82个月),术后侧凸平均28°(11°～38°),矫正率64%;术后后凸平均16°(7°～33°),矫正率36%,均骨性融合;1例神经纤维瘤病患者术中发生大出血,经大量输血后,病情平稳。长期随访发现内固定断裂3例,曲轴现象2例,但无其他术后并发症发生。[结论]先天性脊柱侧后突畸形是复杂的骨骼神经肌肉系统疾病,应针对不同的病因采用个体化治疗方案;其中,半椎体切除短节段椎弓根钉内固定植骨融合对先天性半椎体畸形是有效、安全的方法。     

后路半椎体切除内固定矫治先天性脊柱侧后凸

目的评价后路一期半椎体切除椎弓根钉矫形治疗先天性半椎体所致脊柱侧后凸的临床效果。方法11例患者,平均年龄9.3岁,4例位于胸椎,5例位于腰椎,均为完全分节型,手术采用后路一期半椎体切除,椎弓根器械矫形并植骨融合。结果手术固定节段2-7个椎体,平均3.3个椎体。术后随访6-30个月,平均14.5个月。全脊柱正侧位X线片示冠状面Cobb角由术前平均41.15°矫正至15.35°,平均矫正率61.53％,矢状面Cobb角由术前平均34.15°矫正至13.26°,平均矫正率60.27％,顶椎偏移由术前25.34mm矫正至11.46mm,最后随访时侧凸和后凸Cobb角平均分别为16.86°和14.08°,与术后相比无纠正丢失。无任何手术并发症,无内固定断裂脱落,均融合。结论一期后路半椎体切除椎弓根器械矫形是治疗先天性脊柱侧后凸安全、有效的术式,能够获得满意的矫正。     

全脊柱椎弓根螺钉技术治疗脊柱侧凸疗效观察

目的探讨采用后路全脊柱椎弓根螺钉技术节段内固定治疗脊柱侧凸的疗效和安全性,并总结胸椎椎弓根螺钉的植入方法。方法选取入组患者16例,青少年特发性脊柱侧凸7例,先天性半椎体脊柱侧凸9例,男12例,女4例;年龄12~19岁,平均15.9岁。脊柱冠状面Cobb角为30~82°,而平均为52°。全部采用全脊柱椎弓根螺钉技术后路三维矫形内固定,均获得骨性融合,其中10例行胸廓成形术。结果术中术后无神经、血管并发症。手术切口I期愈合。术后随访3~44个月,平均23.5个月,无术后疼痛,X线正侧位及动态位片未发现断钉、假关节形成。术后平均矫正Cobb角41°,16例患者术后Cobb角平均为11°,矫正率达78.8%。所有患者均在4~8个月内恢复正常的学习生活。结论后路全脊柱椎弓根螺钉技术内固定矫形治疗脊柱侧凸,可获得满意的效果且并发症发生概率低。     

半椎体切除术治疗先天性脊柱侧后弯畸形

目的分析一期后路半椎体切除治疗先天性脊柱侧后凸畸形的手术效果,并探讨手术固定融合节段方案的选择。方法回顾分析15例由半椎体引起侧后凸畸形的患儿,其中男9例,女6例,年龄3～17岁,平均13.5岁。均行后路半椎体切除、矫形内固定及情骨融合手术。结果随访15～68个月,平均40.5个月。术后矫形效果满意,侧凸畸形由术前平均45.3°改善至11.4°（矫正率达68.7%）;后凸畸形由术前的平均35.5°,矫正至11.4°（矫形率达67.9%）,远期矫形丢失率低,植骨融合良好,无内固定物断裂松动等并发症。结论一期后路半椎体切除、椎弓根钉棒系统矫形内固定和植骨融合手术,可以有效矫正青少年脊柱结构性侧后凸畸形。     

后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形

目的:评价一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形的疗效.方法:采用自制的"V"型截骨刀一期后路经椎弓根半椎体切除内周定矫形治疗52例完全分节型胸腰椎半椎体畸形所致的脊柱侧后凸畸形患者.应用术前、术后X线片冠状面节段侧凸角、总侧凸角和代偿侧凸角以及矢状面节段后凸角或前凸角、躯干侧移程度对治疗结果进行评估.结果:手术时间120～310min,术中失血量300～600ml.同定融合椎体节段数2～4个.所有病例随访2年7个月～5年.平均3年5个月.1例术中凸侧节段加压时头端椎弓根被螺钉割裂,向上延长一个椎体固定;2例术后出现神经根性分布的一侧肢体麻木、胀痛,3个月随访时症状消失;3例患者因术中行胸神经根切断,术后出现支配区域柬带感,术后2个月缓解.1例因内同定钉帽切迹导致皮肤溃烂,1年后复查已骨性融合,取出内同定后治愈.1例5个月复查时出现椎弓根被螺钉割裂,延长支具固定6个月,骨性融合后取出内固定.末次随访时节段侧凸角由术前38.5°±6.9°矫正至7.5°±3.0°总侧凸角由术前41.2°±8.1°矫正至9.6°±5.1°,头侧代偿凸由术前17.5°±5.2°矫正至6.20±4.1°尾侧代偿凸由术前17.9°±4.9°矫正至6.1°±3.1°,后凸角由术前29.1°±12.1°矫正至6.2°±4.1°,躯干偏移由术前平均4.5cm矫正至0.4cm.各指标末次随访时与术前比较P<0.01.结论:一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形效果良好.     

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.     

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.