肛周脓肿病原菌分布及耐药性分析

为探讨肛周脓肿病原菌分布及对常用抗菌药物的耐药性,选取山东省千佛山医院肛肠科2013年9月23日至2014年4月23日收治58例肛周脓肿患者进行研究,对其脓液进行革兰染色、病原菌培养及药敏试验。结果显示,58例患者中,4例未培养出细菌,其余54例共分离出病原菌67株（其中革兰阴性菌54株,占80．6％;革兰阳性菌13株,占19．4％）;检出菌株数居首位的为大肠埃希菌（41株,61．2％）,其次为肺炎克雷伯菌（7株,10．4％）。大肠埃希菌及肺炎克雷伯菌对常用抗菌药物敏感率较低,耐药性较高,尤其是对氨苄西林的耐药性较强,但对头孢西丁、美罗培南、亚胺培南、阿米卡星、厄他培南、替卡西林／克拉维酸、哌拉西林／他唑巴坦高度敏感。多重耐药11例,其中9例为大肠埃希菌感染多重耐药（ESBLS阳性）,2例为葡萄球菌感染多重耐药。9例ESBLS阳性大肠埃希菌感染者对头孢噻肟100％耐药,对头孢西丁、美罗培南、亚胺培南、阿米卡星、哌拉西林／他唑巴坦、厄他培南、替卡西林／克拉维酸未见耐药。结果表明,肛周脓肿病原菌以革兰阴性杆菌为主,治疗时应首选抗革兰阴性杆菌的药物,并采取积极办法应对病原菌的多重耐药,可选替卡西林／克拉维酸、哌拉西林／他唑巴坦等含酶抑制剂的抗菌药物。     

149例革兰阴性杆菌血流感染患儿病原菌耐药分析

目的：了解我院住院患儿革兰阴性杆菌血流感染的病源菌构成及其耐药性,为临床治疗用药提供参考。方法：采用VITEK-2全自动微生物分析鉴定系统和NCCLS（2010年）的判断标准,对2011年儿科149例患儿血标本分离的革兰阴性杆菌进行鉴定和药敏试验。结果：149例患儿的血标本中分离出肺炎克雷伯菌69株,其中产超广谱8内酰胺酶（ESBLs）59株（85．51％）,非产ESBLs 10株（14．49％）;大肠埃希菌30株,其中产ES—BLs 12株（40．00％）,非产ESBLs菌株18株（60．00％）;鲍曼不动杆菌感染26株,其他菌24株。所有产ESBLs肺炎克雷伯菌对亚胺培南、美洛培南、左旋氧氟沙星、环丙沙星耐药率均为0;对β内酰胺类药物的耐药率明显高于非产ESBLs菌株;对哌拉西林、氨苄西林耐药率高达100．00％。他唑巴坦对产ESBLs肺炎克雷伯菌有明显的抑制作用,哌拉西林／他唑巴坦（耐药率为18．64％）对其抑菌作用强于氨苄西林／舒巴坦（耐药率为89．83％）。碳青霉烯类（亚胺培南、美洛培南）是治疗产ESBLs肺炎克雷伯菌感染的满意选择。大肠埃希菌的耐药率低于肺炎克雷伯菌。结论：儿科革兰阴性杆菌血流感染中肺炎克雷伯菌是主要致病菌,产ESBLs肺炎克雷伯菌检出率较高。亚胺培南和美洛培南是治疗儿科产ESBLs肺炎克雷伯菌、大肠埃希菌血流感染的较好选择。     

住院患者尿路感染病原菌分布及耐药性监测

目的通过调查和分析住院患者尿路感染病原菌的分布及耐药状况,为抗菌药物的合理应用提供参考。方法对浙江萧山医院2009年1月～2011年12月住院患者尿培养阳性样本中分离的1033株菌株进行回顾性分析,尿液采用经典型浸片Urieult培养,药敏试验用K—B法进行,采用WHONET5．6软件对药敏试验结果进行分析。结果1033株阳性菌株中,革兰阴性菌681株（65．9％）,革兰阳性菌197株（19．1％）,真菌155株（15．0％）。分离株位居前三位的是大肠埃希菌402株（38．9％）,肺炎克雷伯菌74株（7．2％）和白假丝酵母菌64株（6．2％）。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）检出率分别为60．7％（244／402）和45．9％（34／74）。亚胺培南、美罗培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和阿米卡星对大肠埃希菌和肺炎克雷伯菌显示较高的抗菌活性;肠球菌属、葡萄球菌对万古霉素、利奈唑胺和呋哺妥因耐药率低;假丝酵母菌对氟胞嘧啶、伏立康唑和两性霉素B有较高的敏感率。结论本组住院患者尿路感染病原菌以革兰阴性菌为主,尤以大肠埃希菌居多,监测和分析病原菌种类及其耐药性对指导临床合理用药具有重要意义。     

血培养病原菌分布及耐药性分析

目的分析医院血流感染病原菌的分布特点和耐药情况,为临床预防和控制感染提供依据。方法回顾性分析2011年6月至2014年6月本院临床血培养标本中病原菌的感染特点及其药敏。采用BD BACTEC 9120血培养仪进行血培养,BD Phoenix 100全自动细菌鉴定/药敏分析系统对菌株进行鉴定和药敏试验,真菌药敏采用K-B纸片法,用WHONET 5.6软件进行数据分析。结果 9 116例血培养标本中共检出病原菌896株,阳性检出率为9.8%,其中革兰阴性杆菌491株,革兰阳性球菌350株,真菌37株,厌氧菌9株以及革兰阳性杆菌9株;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦敏感率较高,大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别为49.5%和38.5%;鲍曼不动杆菌的耐药率高于铜绿假单胞菌,多重耐药和泛耐药鲍曼不动杆菌的检出率分别为32.6%和20.9%,多重耐药铜绿假单胞菌的检出率为18.4%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为44.4%和70.4%;未发现耐万古霉素、替考拉宁和利奈唑胺的葡萄球菌和肠球菌;粪肠球菌对抗菌药物的耐药率显著低于屎肠球菌。结论本院血流感染病原菌以肠杆菌科细菌为主,凝固酶阴性葡萄球菌感染不容忽视。临床应高度重视早期血培养,合理使用抗菌药物,有效减少耐药菌株的产生。     

乙型肝炎肝硬化并自发性细菌性腹膜炎的病原学及耐药性分析

目的分析乙型肝炎肝硬化并发自发性细菌性腹膜炎（SBP）患者的腹水病原菌分布及其耐药性,为临床合理使用抗菌药物提供依据。 方法选取2010年1月至2017年12月成都市公共卫生临床医疗中心收治的762例乙型肝炎肝硬化并SBP患者,经患者同意后抽取腹水做病原学鉴定及药敏试验。 结果762例患者中,158例腹水培养结果显示病原菌阳性（阳性率为20.73%,158/762）,共检出病原菌166株,除7例患者为复合菌感染,余151例（95.57%）均为单菌感染。166株病原菌中,革兰阳性菌98株（59.04%）,革兰阴性菌59株（35.54%）,真菌9株（5.42%）,其中产超广谱β-内酰胺酶（ESBLs）病原菌共22株（13.25%）。革兰阳性菌以溶血葡萄球菌、表皮葡萄球菌、科氏葡萄球菌及粪肠球菌为主,占革兰阳性杆菌的59.18%（58/98）;对青霉素G、红霉素、克林霉素、苯唑西林及四环素耐药率最高,而对万古霉素和替考拉宁的耐药率均为0。革兰阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主,占革兰阴性杆菌的72.88%（43/59）;对氨苄西林耐药率最高（62.79%）,而对亚胺培南和美罗培南的耐药率均为0。 结论乙型肝炎肝硬化并发自发性细菌性腹膜炎患者的病原菌以大肠埃希菌、肺炎克雷伯菌和溶血葡萄球菌为主,临床医生应根据腹水病原学鉴定及其药敏试验结果合理使用抗菌药物。     

血液内科病房常见病原菌的耐药性及分布

目的了解血液内科病房常见菌的耐药性及标本来源,为临床经验治疗提供理论依据。方法 2012年3月至2014年3月本院血液内科病房共分离323株病原菌,分离率前4位的病原菌分别是大肠埃希菌(43株)、肺炎克雷伯菌(36株)、铜绿假单胞菌(29株)和鲍曼不动杆菌(23株)。采用WHONET5.6软件对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌进行耐药性分析。结果 43株大肠埃希菌对氨苄西林耐药率为83.1%,对其余17种抗菌药物的耐药率为0.0%~69.8%。36株肺炎克雷伯菌对氨苄西林耐药率为100%,对其余17种抗菌药物的耐药率为0.0%~41.7%,29株铜绿假单胞菌对哌拉西林等11种抗菌药物的耐药率均28%。23株鲍曼不动杆菌对亚胺培南等14种抗菌药物的耐药率均45%。大肠埃希菌标本主要来自血液和尿液,肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌标本主要来自痰液。结论本院血液内科病房分离率前4位的病原菌对临床常用抗菌药物的耐药性差异很大,大肠埃希菌主要引起血流和泌尿道感染,其余病原菌主要引起呼吸道感染。     

676株血培养病原菌种类分布及耐药性

目的：对676株血培养病原菌的种类分布和耐药情况进行分析。方法：采用BecT/Alert3D全自动血培养仪及配套血培养瓶连续监测培养细菌,阳性瓶及时转种。Vitek 2 Compact全自动微生物分析系统对分离的病原菌进行鉴定及药敏。结果：6023例血培养标本中共分离出676株病原菌,居前5位的病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、屎肠球菌和金黄色葡萄球菌。大肠埃希菌和肺炎克雷伯菌中产ESBLs株检出率分别为55.0%和37.3%,非发酵菌中的鲍曼不动杆菌和铜绿假单胞菌对亚胺培南的耐药率分别为70.6%和18.8%,凝固酶阴性葡萄球菌和金黄色葡萄球菌耐甲氧西林检出率分别为88.1%和76.9%。结论：血培养分离的病原菌以大肠埃希菌和凝固酶阴性葡萄球菌为主,且耐药性差异较大。     

肠外瘘并发腹腔感染的病原菌分布及耐药性分析

目的 分析肠外瘘致腹腔感染病人腹腔穿刺液中病原菌分布及耐药率变化。方法 回顾性分析2008-2015年南京医科大学附属金陵医院收治的502例肠外瘘并发腹腔感染病人腹腔穿刺标本的细菌鉴定及药敏结果。对比分析早期组（2008-2011年）及近期组（2012-2015年）的细菌及其耐药变化。结果 502例肠外瘘病人腹腔标本共分离出病原菌874株,其中大肠埃希菌（216株,24.7%）,肺炎克雷伯杆菌（123株,14.1%）占主要部分。大肠埃希菌对亚胺培南的耐药率从早期组的14.3%增加至近期组的25.9%（P=0.026）,而肺炎克雷伯杆菌对亚胺培南的耐药率无明显变化。超广谱β内酰胺酶（ESBL）阴性大肠埃希菌和肺炎克雷伯杆菌对亚胺培南的耐药率高于ESBL阳性菌（P＜0.001）。肠球菌对氨苄西林和莫西沙星的耐药率显著升高（P=0.01;P=0.02）。葡萄球菌属和真菌的抗生素耐药率在前后两阶段无明显改变（P＞0.05）。结论 革兰阴性菌是肠外瘘致腹腔感染的主要病原菌,细菌对抗生素尤其是碳青霉烯类药物的耐药率明显升高,应严密监测以指导抗菌药物的规范化使用。     

2012年北京市海淀医院156例血流感染病原学及耐药性分析

目的：统计北京市海淀医院2012年度血流感染病原菌分布和细菌耐药情况。方法对北京市海淀医院2012年1月1日至2012年12月31日收集的血标本进行细菌、真菌分离培养及鉴定,用WHO-NET 5.6软件以及SPSS 12.0进行描述性统计分析。结果北京市海淀医院2012年度共分离病原菌156株,其中,革兰阳性菌株70株（44.9%）,革兰阴性菌株83株（53.2%）。常见细菌依次为大肠埃希菌32.1%（50/156）、凝固酶阴性葡萄球菌28.8%（45/156）、肺炎克雷伯菌9.0%（14/156）和金黄色葡萄球菌6.4%（10/156）。葡萄球菌中耐甲氧西林金黄色葡萄球菌占9.1%（10/55）,凝固酶阴性葡萄球菌占81.8%（45/55）。大肠埃希菌和肺炎克雷伯菌对青霉素、第1、2代头孢菌素耐药率较高,为38%～85%。对喹诺酮类药物,大肠埃希菌耐药率50%～60%,肺炎克雷伯菌耐药率为15%～30%。葡萄球菌对β-内酰胺类、大环内酯类、氨基糖苷类和喹诺酮类等抗菌药的总体耐药率为30%～86%,未发现对万古霉素及利奈唑胺耐药菌株。结论2012年度血培养分离细菌耐药是普遍现象,应加强细菌性耐药性监测,为临床合理规范使用抗菌药物提供参考。     

248株血液标本检出细菌临床特征及耐药性分析

目的了解血液感染常见细菌分布及耐药特点,为临床血液感染治疗提供实验依据。 方法回顾性分析2010年3月至2013年10月临床阳性血培养资料。 结果共检出细菌248株,分离率排前3位的依次是大肠埃希菌（40.73%）、表皮葡萄球菌（19.76%）和肺炎克雷伯菌（9.27%）。产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌及肺炎克雷伯菌检出率分别为44.55%和20.69%,产酶菌株耐药性严重,检出亚胺培南耐药和美罗培南耐药的大肠埃希菌。甲氧西林耐药金黄色葡萄球菌（MRSA）和甲氧西林耐药表皮葡萄球菌（MRSE）检出率分别为46.67%和69.39%,未发现万古霉素、替考拉宁耐药菌株,葡萄球菌耐药率较低的药物还有利奈唑胺和奎奴普丁-达福普丁。 结论血液感染细菌以肠杆菌科细菌为主,敏感药物为碳青霉烯类。应加强血液感染监测,及时了解其病原菌分布与耐药特点,制定有效的抗菌治疗方案,提高治愈率。     

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.