强骨胶囊联合鲑鱼降钙素针剂辅助治疗老年骨质疏松性压缩骨折临床观察

目的探讨强骨胶囊联合鲑鱼降钙素针剂辅助治疗老年骨质疏松性压缩骨折临床疗效及影响。方法 257例胸腰椎骨质疏松性骨折患者随机分为3组,观察组口服强骨胶囊同时肌肉注射鲑鱼降钙素注射液,对照I组口服强骨胶囊,对照Ⅱ组肌肉注射鲑鱼降钙素针剂。观察临床疗效,测定治疗前和治疗后骨密度(BMD),血骨钙素(BGP)、血钙、血磷浓度及碱性磷酸酶。尿液中尿钙,尿羟脯氨酸,尿肌酐的含量,并计算尿钙/尿肌酐与羟脯氨酸/尿肌酐比值。结果观察组总有效率明显优于对照I组和对照II组(P0.05)。治疗后,3组BMD明显升高,痛觉评分均明显降低(P0.01),尤其观察组更加明显(P0.05)。治疗后,3组骨钙素较治疗前有明显的升高(P0.05或0.01),碱性磷酸酶和羟脯氨酸/尿肌酐较治疗前有明显的下降(P0.05或0.01),尤其治疗组明显优于对照I组和对照II组。治疗后对照组I组和观察组血钙较治疗前有明显的下降(P0.05),但3组组间无差异性(P0.05)。治疗后,3组血磷和尿钙/尿肌酐较治疗前变化不明显,组间比较无差异性(P0.05)。结论骨胶囊和鲑鱼降钙素治疗老年骨质疏松性骨折疗效肯定,能缓解疼痛,促进愈合和降低骨折的再发生,无明显不良反应。     

鲑鱼降钙素联合海滨疗养因子对老年性骨质疏松症骨密度和骨转换指标影响的研究

目的观察鲑鱼降钙素联合青岛海滨疗养因子综合治疗方案对骨代谢的影响。方法研究组:口服钙尔奇D600 mg每日1次或其他钙片的同时,采用鲑鱼降钙素50IU肌肉注射,每日1次,连用2 w后改为隔日1次,连续使用6个月,同时联合海滨疗养因子,每周3~5次,每次1h以上;对照组:单纯采用口服钙尔奇D600 mg每日1次或其他钙片,连续使用6个月。观察两组及组间用药前后骨密度(BMD)、骨转换指标变化、骨痛和生活能力评价。结果 1骨密度变化:研究组治疗6个月后,腰椎L2-4、股骨颈部的骨密度较治疗前明显升高(P0.05),Ward区骨密度无显著性改变,而对照组各部位骨密度较用药前无明显改变(P0.05)。2血生化中血钙、血磷及碱性磷酸酶指标值:两组生化指标在治疗前后无显著差异(P0.05)。3治疗6个月后血清降钙素的水平明显升高,骨钙素水平明显降低。4疼痛程度改善情况:两组治疗前后疼痛分级比较,研究组疼痛明显改善。5生活质量改善情况(以生活能力提高为指标):研究组生活质量改善有效率为88.5%,而对照组仅为36.2%,两组有效率相比有显著差异(P0.01)。结论鲑鱼降钙素联合海滨疗养因子应用于老年性骨质疏松症患者,不仅能够增加骨密度而且可以减少骨质疏松症引起的疼痛,临床效果确切,患者依从性好,值得临床推广。     

金雀异黄酮对去势大鼠骨质疏松的影响

目的观察金雀异黄酮对实验性骨质疏松大鼠骨密度(bonemineral density,BMD)和血清骨代谢生化指标的影响。方法切除SD雌性大鼠双侧卵巢建立骨质疏松动物模型,给予金雀异黄酮皮下注射,治疗8w后监测大鼠腰椎及股骨的骨密度,检测血清骨碱性磷酸酶(ALP)、血清钙(Ca)、血清磷(P)等骨代谢生化指标。结果去势后的大鼠腰椎及股骨的骨密度降低;采用金雀异黄酮治疗后骨密度明显升高,与阴性对照组的比较差异具有统计学意义(P<0.05),与假手术组比较无显著性差异。假手术组和金雀异黄酮组血清ALP活性低于阴性对照组。结论金雀异黄酮可调节骨代谢,显著提高骨质疏松大鼠的骨密度。     

鲑鱼降素喷鼻剂治疗老年骨性疼痛临床观察

目的 观察鲑鱼降钙素喷鼻剂治疗老年骨性疼痛的疗效.方法 老年骨性疼痛60例,其中:骨质疏松症40例,癌性骨痛20例.应用鲑鱼降钙素喷鼻剂,每日1次,每次100IU,用药前后检测血清碱性磷酸酶(ALP)、骨钙素(BGP)、酸性磷酸酶(ACP).结果 用药后血清ALP、BGP、ACP显著下降,骨痛改善,总有效率87.7%.结论 鲑鱼降钙素喷鼻剂是治疗老年骨性疼痛安全、有效的药物.     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

老年糖尿病女性骨质健康状况及干预情况分析

目的探讨60岁以上老年女性2型糖尿病（type 2 diabetes mellitus,T2DM )患者与非糖尿病患者骨量、骨代谢标志物骨钙素和骨碱性磷酸酶和血清钙、血清磷及其他骨量相关指标的差异,对糖尿病骨病目前的治疗状况进行分析,为糖尿病骨量异常的治疗提供依据。方法 用超声测量40例60 岁以上老年女性非糖尿病患者及46例老年女性糖尿病患者的跟骨骨密度,并检测两组人群的血清 钙、血清无机磷、骨质疏松生化标志物骨钙素和骨碱性磷酸酶。结果 糖尿病组的跟骨骨密度,血清钙均低于非糖尿病人群,骨钙素和骨碱性磷酸酶高于非糖尿病组,二者比较有统计学意义。结论 60 岁以上老年女性糖尿病患者骨量丢失显著重于同龄非糖尿病人群,对糖尿病性骨量减低的干预和治疗应给予足够重视,以期尽量减少和避免骨折等严重并发症的发生。     

德尼单抗联合鲑鱼降钙素治疗老年性骨质疏松的疗效及对患者骨密度、骨代谢的影响

目的探讨德尼单抗联合鲑鱼降钙素治疗老年性骨质疏松的疗效及对患者骨密度、骨代谢的影响。方法 200例老年骨质疏松患者随机分为研究组和对照组,两组患者均口服钙尔奇碳酸钙D片进行基础治疗,对照组采用肌肉注射蛙鱼降钙素。研究组在对照组的基础之上加用德尼单抗。分别在治疗前后评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);检测患者骨密度及骨碱性磷酸酶骨人交联碱性磷酸酶(BALP),Ⅰ型胶原N末端肽/肌酐(Ⅰ型胶原N-端肽)肌酸酐(NTX/Cr),骨钙素(BGP)和β-胶原降解产物(β-CrossLaps)。结果治疗前,两组患者VAS和ODI评分无统计学意义(P0.05)。治疗后,两组患者的VAS和ODI评分较治疗前均有显著改善(P0.05),且研究组改善程度明显优于对照组(P0.05);治疗前,两组患者腰椎(L_(2-4))、股骨颈、大转子以及全髋BMD无统计学意义(P0.05),治疗后,两组患者腰椎(L_(2-4))、股骨颈、大转子以及全髋BMD较治疗前均显著改善(P0.05),且研究组明显优于同期对照组(P0.05);治疗前,两组患者BALP、NTX/Cr、BGP以及β-CrossLaps水平比较无统计学意义(P0.05)。治疗后,两组患者BALP、NTX/Cr、BGP较治疗前均明显上升(P0.05),研究组明显高于对照组(P0.05),而两组患者β-CrossLaps水平较治疗前均明显下降(P0.05),研究组明显低于对照组(P0.05);两组患者治疗前后肝肾功能、尿、血以及粪常规均无明显变化,且在研究过程中均未出现不良情况。结论德尼单抗联合蛙鱼降钙素能够显著改善老年骨质疏松患者的骨密度和骨代谢指标,能够有效缓解患者的疼痛和功能障碍。     

骨碎补总黄酮联合鲑鱼降钙素在慢性阻塞性肺疾病合并骨质疏松症中的疗效

目的研究老年慢性阻塞性肺疾病(COPD)合并骨质疏松症患者应用骨碎补总黄酮联合鲑鱼降钙素对患者的影响。方法 98名COPD合并骨质疏松症患者随机分为两组即治疗组(n=49)、和对照组(n=49)。对照组的患者给予鲑鱼降钙素治疗,治疗组的患者给予骨碎补总黄酮联合鲑鱼降钙素治疗,为期6个月。检测两组患者治疗前后腰椎1-4 (L_(1-4))和股骨颈骨密度改变,VAS评分及ODI评分改善情况,血清转化生长因子-β1(TGF-β1)和白细胞介素17(IL-17)水平改变以及骨代谢指标抗酒石酸酸性磷酸酶(TRACP)和骨碱性磷酸酶(ALP)水平的改变。同时观察治疗期间两组患者出现的药物不良反应情况。结果治疗后6个月后,治疗组腰椎1-4 (L_(1-4))和股骨颈骨密度均显著高于同时期对照组和治疗前(P0. 05);治疗6个月后,治疗组的VAS评分、ODI评分均显著低于对照组同期和治疗前(P0. 05);治疗后6个月后,治疗组TGF-β1和ALP水平显著高于对照组和治疗前,而IL-17及TRACP水平明显低于对照组和治疗前(P0. 05);两组药品不良反应发生率比较差异无统计学意义(P0. 05)。结论骨碎补总黄酮联合鲑鱼降钙素提升COPD患者骨密度,改善骨代谢状态和降低细胞因子水平,可以安全有效防治老年COPD合并骨质疏松症。     

鲑鱼降钙素喷鼻剂治疗老年骨性疼痛临床观察

目的观察鲑鱼降钙素喷鼻剂治疗老年骨性疼痛的疗效。方法老年骨性疼痛60例,其中:骨质疏松症40例,癌性骨痛20例。应用鲑鱼降钙素喷鼻剂,每日1次,每次100IU,用药前后检测血清碱性磷酸酶(ALP)、骨钙素(BGP)、酸性磷酸酶(ACP)。结果用药后血清ALP、BGP、ACP显著下降,骨痛改善,总有效率87.7%。结论鲑鱼降钙素喷鼻剂是治疗老年骨性疼痛安全、有效的药物。     

联用鲑鱼降钙素、阿仑膦酸钠、钙尔奇D治疗老年 骨质疏松症疗效观察

目的评价联合应用鲑鱼降钙素、阿仑膦酸钠、钙尔奇D对老年骨质疏松症患者骨痛症状、骨代谢标记物、骨密度的影 响。方法2011年6月~ 2012年6月间选取原发性骨质疏松症患者45例.随机分为对照组和治疗组.连续治疗24周。所有 患者均每日口服1片钙尔奇D(600 mg);治疗组患者同时每周口服1片阿仑膦酸钠(70 mg).每日经鼻吸人1喷鲑鱼降钙素 (120IU)。各组分别于治疗前、治疗4周后、24周后进行疼痛分级评分。于治疗前、治疗24周后应用双能X线吸收法测定腰 椎L14、左侧股骨颈骨密度,测定血清骨钙素、抗酒石酸酸性磷酸酶浓度。结果治疗组接受治疗24周后骨痛症状明显缓 解,治疗组总有效率优于对照组(P <0. 05)。治疗组24周时骨钙素、抗酒石酸酸性磷酸酶浓度与治疗前相比差异有统计学意 义(P <0.05)。治疗组治疗前后腰椎L14骨密度均值差异有统计学意义(P <0. 05);两组治疗前后左侧股骨颈骨密度差异无 统计学意义(P >0. 05)。结论联用鲑鱼降钙素、阿仑膦酸钠、钙尔奇D治疗老年骨质疏松症临床疗效确切。     

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.     

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.     

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.