冠状动脉旁路移植手术中内镜获取与切开获取大隐静脉对照研究的meta分析

目的探讨冠状动脉旁路移植手术中内镜获取大隐静脉与常规切开获取大隐静脉相比是否具有优越性。方法检索2003—2013年国内外关于内镜获取大隐静脉（endoscopic vein harvesting,EVH）与常规切开获取大隐静脉（open vein harvesting,OVH）手术后疗效的临床对比研究,收集相关数据并用RevMan5．0统计软件进行meta分析。结果检索并纳入本次研究的文献共6篇,其中EVH组339例,OVH组344例。meta分析结果示：术后伤口感染、愈合不良在EVH组的发生率较OVH组显著减少（P〈0．05）,术后下肢伤口疼痛程度EVH组显著低于OVH组（P〈0．05）,血肿的发生率在EVH组与OVH组间并无统计学差异（P〉0．05）,EVH获取的静脉桥和OVH获取的静脉桥近期通畅率无显著差异（P〉0．05）。结论和OVH相比,EVH技术切口美观,能在不影响静脉桥的近期通畅率前提下显著降低术后下肢伤口疼痛、愈合不良等并发症,提高患者满意度。     

内窥镜采集大隐静脉行冠状动脉旁路移植术1年随访

目的 总结应用内窥镜采集静脉(endoscopic vein harvesting,EVH)技术获取大隐静脉(greater saphenous vein,GSV)进行冠状动脉旁路移植手术(coronary artery bypass grafting,CABG)后1年随访结果,评估采用EVH技术的手术效果.方法 2009年5月至2010年5月,136例患者应用EVH取GSV进行的非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG),112例开放静脉获取术(open vein harvesting,OVH)取GSV进行的OPCABG.评估71例应用EVH和64例传统手术切口取GSV行OPCABG患者1年随访结果,比较两组患者手术情况、下肢切口并发症、1年后移植血管通畅率以及心理状况.结果 EVH组与OVH组比较,在创面大小、伤口恢复及美观化、伤口感染率、神经功能影响、二次清创缝合率以及下肢切口总体并发症发生率等方面具有明显优势.比较两组患者术后1年移植血管通畅率,EVH组动脉移植血管通畅率96.8％,静脉移植血管通畅率85.7％;OVH组动脉移植血管通畅率94.9％,静脉移植血管通畅率86.4％.两组随访结果中心绞痛再发率、动脉移植通畅率、静脉移植通畅率差异均无统计学意义.EVH组患者心理状况调查结果优于OVH组.结论 与常规OVH方法相比较,EVH技术对获取移植静脉具有更多优势,通过在采集前对患者进行部分肝素化等更具保护移植静脉材料的方法,EVH组也保持了满意的移植血管1年期通畅率.     

内窥镜采集大隐静脉的临床效果及应用体会

目的 通过对比冠状动脉旁路移植术中传统的全程切开采集大隐静脉(open saphenous vein harvest,OVH)与内窥镜辅助采集大隐静脉(endoscopic saphenous vein harvest,EVH)两种术式评价EVH的应用效果和总结应用体会.方法 观察两种术式:(1)获取大隐静脉手术时间;(2)采集大隐静脉总手术时间;(3)修补血管次数;(4)术后并发症;(5)采用VAS(Visual Analog Scale)评分,评估术后4d和第4周下肢切口疼痛.结果 EVH组伤口并发症发生率为10.7%,OVH组为36.7%,两组对比EVH组有明显减少(P<0.01);切口疼痛VAS评分,EVH组术后第4天、第4周分别为(2.4±0.6)和(1.0±0.6),OVH分别为(3.2±0.8)和(1.6±0.8),术后第4天疼痛EVH组明显轻(P<0.01),术后第4周疼痛两组差异无统计学意义(P=0.56);手术时间:采集大隐静脉手术总时间EVH组(39.7±4.2)min,OVH组(40.3±5.3)min,两组差异无统计学意义(P=0.66),获取大隐静脉手术时间EVH组(36.3±3.9)min,OVH组(29.0±5.1)min,两组差异有统计学意义(P<0.01);EVH组修补血管次数(1.7±0.7),OVH组(1.1±0.8),两组差异有统计学意义(P=0.04).结论 EVH和OVH相比显著减少了术后切口并发症和疼痛,不延长总手术时间.     

内镜下与常规切开法采集大隐静脉在冠状动脉旁路移植术中应用的比较

目的探讨内镜下采集大隐静脉应用于冠状动脉旁路移植术(coronary artery bypass grafting,CABG)中的早期临床效果。方法2004年4月~2005年5月,对89例采用内镜下取大隐静脉行CABG(内镜组),在膝关节中部做2 cm切口,应用VasoV iew 5内镜血管采集系统游离获取大隐静脉,并与2003年4月~2005年3月38例采用传统切开法取大隐静脉行CABG(常规组)进行比较,比较2组术后下肢切口并发症、恢复行走时间、患肢疼痛麻木感及肿胀、术后6个月通畅率。结果内镜组取大隐静脉2~3支,平均2.6支;内镜组下肢并发症(6例)与常规组(8例)相比明显减少(2χ=4.197,P=0.040);内镜组患肢疼痛、麻木感7例及肿胀9例与常规组(分别为36、30例)相比明显减少(2χ=89.740,P=0.000;2χ=59.299;P=0.000);内镜组恢复行走时间(2.3±0.9)d比常规组(3.4±1.6)d明显缩短(t=-4.952,P=0.000);内镜组术后6个月通畅率96.0%(48/50)与常规组95.3%(19/20)相比无明显差别(2χ=0.000,P=1.000)。结论CABG中应用内镜下采集大隐静脉能够减少创伤,明显降低术后下肢并发症,减轻术后下肢切口疼痛。     

钬激光与传统手术治疗下肢静脉曲张的临床对照研究

目的比较钬激光与传统手术治疗下肢静脉曲张的临床效果。方法2005年3月~2006年12月,对226例(274条患肢)下肢静脉曲张分别采用钬激光治疗120例(148条患肢)(钬激光组),传统大隐静脉高位结扎加抽剥术106例(126条患肢)(传统组)。结果与传统组相比,钬激光组手术时间短[(38.0±10.8)minvs(61.5±12.3)min,t=-15.294,P=0.000],术后需止痛剂患者比例少[0%(0/120)vs54.7%(58/106),χ2=88.329,P=0.000],下床活动早[(6.2±0.8)hvs(22.5±1.5)h,t=-105.034,P=0.000],术后住院时间短[(3.0±0.5)dvs(8.5±2.5)d,t=-23.632,P=0.000],并发症发生率相近[16.9%(25/148)vs18.3%(23/126),χ2=0.087,P=0.768],1年复发率相近[3.8%(3/78)vs3.1%(2/65),χ2=0.000,P=1.000]。结论钬激光治疗下肢静脉曲张具有能明显缩短手术时间及住院时间,减少切口数量,术后疼痛轻,可早期下床活动等优点。保证疗效...     

内窥镜血管采集系统和间断小切口获取大隐静脉在冠状动脉旁路移植术的应用研究

目的比较内窥镜和间断小切口获取大隐静脉在冠状动脉旁路移植术（coronary artery bypass graft,CABG）中应用的临床效果。方法 2009年8月～2012年8月,连续651例CABG术中,479例（A组）采用内窥镜血管采集系统,172例（B组）采用间断小切口获取大隐静脉,方法由患者决定。比较两组大隐静脉获取时间、切口长度和术后腿部并发症情况。结果 2组获取大隐静脉均获成功,静脉长度差异无显著性。与B组相比,A组获取静脉时间短[（18.01±3.49）min vs.（27.06±4.26）min,t=-27.417,P=0.000],皮肤切口长度短[（3.49±0.87）cm vs.（12.53±1.41）cm,t=-97.587,P=0.000],术后需要止痛剂、切口愈合延迟、下肢水肿的比例低[2.9%（14/479）vs.37.8%（65/172）,χ2=144.303,P=0.000;0（0/479）vs.5.8%（10/172）,P=0.000;1.0%（5/479）vs.18.0%（31/172）,χ2=69.526,P=0.000],但总住院费用高[（8.54±1.43）万元vs.（6.45±0.91）万元,t=17.893,P=0.000]。结论内窥镜血管采集系统获取大隐静脉安全可行,并发症少,美容效果显著,值得推广。     

横断胸骨第2肋间小切口与胸骨正中切口行胸腺切除治疗重症肌无力的对比研究

目的比较横断胸骨第2肋间与胸骨正中切口行胸腺切除治疗重症肌无力的手术效果,以合理选择手术方式。方法回顾性分析1989年6月～2007年5月行胸腺切除术治疗633例重症肌无力患者的临床资料,根据不同的手术切口将其分为横断胸骨组(1989年6月～2007年5月,568例)和正中切口组(1989年6月～1996年5月,65例)。采用独立样本t检验分析手术时间、术中出血量、术后引流量、住院费用、术后住院时间等指标,采用χ2检验分析手术并发症、肌无力危象发生率。结果与正中切口组相比,横断胸骨组手术时间短[(71.1±14.4)min vs(110.0±11.7)min,t=8.829,P=0.000],术中出血量少[(56.4±15.7)ml vs(100.1±11.3)ml,t=9.406,P=0.000],胸腔引流时间短[(1.7±0.4)d vs(3.1±0.6)d,t=8.463,P=0.000],引流量少[(87.6±23.9)ml vs(99.9±11.2)ml,t=2.213,P=0.033],住院费用低[(11833.0±2167.2)元vs(15333.0±4141.4)元,t=2.594,P=0.017],术后住院时间短[(8.6±1.1)d vs(12.2±3.0)d,t=4.503,P=0.000],手术切口短[(7.9±1.2)cm vs(17.3±4.8)cm,t=7.911,P=0.000],切口感染发生率低[0%(0/568)vs 6.2%(4/65),P=0.000],胸骨裂开发生率低[0%(0/568)vs 7.7%(5/65),P=0.000],肺部感染发生率低[0%(0/568)vs 3.1%(2/65),P=0.010],手术后住院期间肌无力危象发生率低[8.8%(50/568)vs 16.9%(11/65),χ2=4.417,P=0.036]。2组术后第1年、第2年、第3年完全缓解率差异无显著性[21.8%(52/238)vs 19.5%(8/41),χ2=0.113,P=0.737;28.2%(67/238)vs 26.8%(11/41),χ2=0.030,P=0.862;31.9%(76/238)vs 31.7%(13/41),χ2=0.001,P=0.977]。结论横断胸骨第2肋间切口胸腺切除术治疗重症肌无力安全性好,手术时间短,创伤小,术中出血量少,胸腔引流和住院时间短,住院费用低,能降低术后肌无力危象和手术并发症的发生率,美观,而且横断胸骨组能取得正中切口组手术同样理想的治疗效果,值得临床推广。     

改良左胸小切口与常规开胸食管癌切除术疗效比较

目的比较改良左胸小切口与常规开胸食管癌切除术疗效,探讨改良左胸小切口食管癌切除手术的临床价值。方法回顾性分析2001年1月~2003年12月62例改良左胸小切口食管癌切除术(改良组)和96例常规左胸切口食管癌切除术(常规组)的临床资料,从术后近期并发症、淋巴结清扫程度、手术时间、术中出血量、术后住院时间和术后1,3年生存率等方面进行对比分析。结果2组均无手术死亡,2组术中淋巴结清扫数目(8.6±3.5 vs.10.3±4.8)无统计学差异(t=1.251,P=0.862),2组手术时间(174.6±65.4)m in vs.(168.4±88.0)m in无统计学差异(t=0.476,P=0.635),改良组术中出血量(322.4±155.3)m l显著少于常规组的(445.7±161.7)m l(t=-4.751,P=0.000);改良组术后近期并发症发生率16.1%(10/62)与常规组20.8%(20/96)比较无统计学差异(2χ=0.542,P=0.462),改良组术后住院时间(11.3±2.4)d显著少于常规组的(14.7±4.1)d(t=-5.905,P=0.000);2组1、3年生存率无显著差异(log-rank分析2χ=3.92,P=0.095;2χ=3.66,P=0.112)。结论改良左胸小切口食管癌切除术创伤小,术后近期并发症率、术中彻底清扫区域淋巴结、远期手术疗效与常规开胸食管癌切除术无差别。     

腔镜与传统甲状腺手术的临床对比分析研究

目的探讨腔镜甲状腺手术的安全性和微创性。方法2003年1月~2005年12月,行甲状腺(良性肿物)手术156例,其中腔镜甲状腺手术64例,传统开放甲状腺手术92例。比较两种术式的手术时间、术中失血量、切口大小、疼痛评分、切口美容评分、止痛药使用率、术后住院时间、住院费用、切口感染率和复发率。结果两组手术均获成功,无出血、声嘶、低血钙等并发症。开放组4例切口积液。腔镜组与开放组相比,失血量少(15±10 m l vs 20±15 m l,t=-2.330,P=0.021),疼痛轻(VAS评分2.5±1.0 vs 5.0±1.6,t=-11.079,P=0.000),切口美容满意度高(VAS评分8.0±1.5 vs 2.0±1.2,t=27.696,P=0.000),止痛药使用少(10例vs 28例,2χ=4.493,P=0.034),但手术时间长(80±20 m in vs 70±30 m in,t=2.330,P=0.021),住院费用高(5 352.7±978元vs 4 738.5±672元,t=4.651,P=0.000)。随访2~30个月,平均13个月,复发5例,其中腔镜组2例,传统组3例。结论腔镜甲状腺手术与传统甲状腺手术相比,具有切口小、美容佳、创伤小、恢复快、安全等优点,是治疗良性甲状腺疾病的理想手术方法。     

直视下小切口与传统长切口采集大隐静脉的比较

目的总结冠状动脉旁路移植术中使用间断小切口采集大隐静脉的经验,并与长切口作比较。方法2004年8月~2005年10月,108例初次择期CABG患者采用间断小切口采集大隐静脉(间断切口组),与2004年2月~7月41例采用长切口取大隐静脉(传统切口组)比较切口总长度、采集时间、下肢切口缝合时间、切口并发症等指标。结果两组间年龄、性别、大隐静脉长度无统计学差异,均未出现与静脉桥血管质量相关的近、远期并发症。与传统切口组相比,间断切口组切口总长度短[(17.8±3.2)cmvs(43.1±4.9)cm,t=-36.878,P=0.000],静脉采集时间长[(49.3±6.6)minvs(29.1±5.4)min,t=17.490,P=0.000],下肢总手术时间相近[(62.4±8.7)minvs(59.8±6.9)min,t=1.718,P=0.088)],切口并发症发生率低[9.3%(10/108)vs22.0%(9/41),χ2=4.303,P=0.038)]。结论间断小切口技术采集大隐静脉虽然较长切口复杂、困难,但在减少术后切口并发症和提高术后美容上优于长切口。     

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.     

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.     

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.