不同剂量纳布啡复合舒芬太尼用于腹腔镜全子宫切除术后患者自控静脉镇痛的效果

目的观察不同剂量纳布啡复合舒芬太尼在腹腔镜全子宫切除术后PCIA中的效果。方法选择本院择期行腹腔镜全子宫手术的患者120例,年龄40~60岁,体重45~70 kg,ASAⅠ或Ⅱ级,采用随机数字表法随机分为四组,每组30例。术后均采用PCIA,S组给予舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml,SN1、SN2、SN3组分别给予0.2、0.4和0.8mg/kg纳布啡+舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml。记录患者术后1、4、8、12、24、48 h Ramsay镇静评分、PCIA有效按压次数及补救镇痛和术后48 h内不良反应的发生情况。结果术后8、12、24、48 h,与S组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN1组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN2组比较,SN3组Ramsay镇静评分明显升高(P<0.05)。S组和SN1组补救镇痛率明显高于SN2组和SN3组(P<0.05)。术后48 h内SN2组和SN3组恶心、呕吐发生率明显低于S组和SN1组,SN3组嗜睡发生率明显高于SN2组(P<0.05)。结论纳布啡0.4mg/kg复合舒芬太尼2.0μg/kg用于腹腔镜全子宫镇痛效果满意,不良反应发生率低。     

纳布啡与舒芬太尼在后腹膜镜术后镇痛效果的比较

目的观察和比较纳布啡和舒芬太尼在后腹膜镜下肾囊肿去顶术后镇痛中的临床效果。方法选择全身麻醉下后腹膜镜手术患者60例,男38例,女22例,年龄55～78岁,BMI 18～25 kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法将患者分为两组,每组30例。术后所有患者均行PCIA,其中,纳布啡组镇痛药配方为纳布啡100 mg+托烷司琼10 mg;舒芬太尼组为舒芬太尼100μg+托烷司琼10 mg;均用生理盐水稀释至100 ml,背景输注速度2 ml/h,单次剂量1 ml,锁定时间15 min。记录给药后2、4、8、16、32 h和48 h的VAS疼痛评分和Ramsay镇静评分,镇痛泵按压次数,镇痛满意率以及术后不良反应发生情况。结果两组VAS疼痛评分、镇痛泵按压次数差异无统计学意义。与舒芬太尼组比较,给药后8～48 h纳布啡组Ramsay镇静评分明显升高(P0.05),镇痛效果满意率明显提高(P0.05)。纳布啡组恶心呕吐发生率明显低于舒芬太尼组(P0.01)。两组低血压和心动过缓的发生率差异无统计学意义。结论纳布啡用于后腹膜镜术后静脉镇痛效果与舒芬太尼相当,但不良反应更少,患者满意度更高。     

舒芬太尼复合纳布啡用于假体隆乳术后镇痛效果观察

目的:观察舒芬太尼复合纳布啡用于假体隆乳术后镇痛镇静效果和不良反应。方法:选择择期行假体隆乳整形术就医者90例,均采用全身麻醉,术后行静脉自控镇痛。根据静脉自控镇痛药物配比不同,分为纳布啡组(N组)、舒芬太尼组(S组)和舒芬太尼+纳布啡组(SN组)三组,每组30例。观察就医者术后2h、6h、12h、24h时的生命体征,比较各时间点就医者疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分、自控镇痛次数、镇痛效果及不良反应发生率。结果:N组各时间点VAS评分明显高于S组和SN组,差异有统计学意义(P0.05);SN组各时间点的Ramsay评分明显高于N组和S组,差异有统计学意义(P0.05);N组各时间点药物用量,按压次数均高于S组、SN组,差异有统计学意义(P0.05);S组与N组、SN组比较,恶心、呕吐、头晕等不良反应发生率明显升高,差异有统计学意义(P0.05)。结论:舒芬太尼复合纳布啡用于假体隆乳术后静脉自控镇痛,可提供较好的镇痛镇静效果,不良反应发生率低,值得临床推广。     

氢吗啡酮复合纳布啡用于胃肠道手术后PCIA的效果

目的评价氢吗啡酮复合纳布啡用于胃肠道手术后病人自控静脉镇痛(PCIA)的效果。方法择期行胃肠道手术病人600例,年龄18～80岁,BMI≤35 kg/m2,ASA分级Ⅰ～Ⅲ级。按随机数字表法将病人分为2组(n=300):氢吗啡酮组(H组)和舒芬太尼组(S组)。术后48 h内采用PCIA,H组配方为氢吗啡酮10 mg+纳布啡40 mg;S组配方为舒芬太尼100 μg+纳布啡40 mg。2组药物均加生理盐水稀释至100 ml,背景剂量1 ml/h,单次剂量0.5 ml。记录病人术后48 h内VAS评分、镇痛有效按压次数、镇痛泵用药量、不良反应及术后恢复情况。结果 2组术后48 h内VAS评分、镇痛泵用药量和镇痛泵有效按压次数比较差异无统计学意义(P>0.05)。与S组比较,H组术后48 h内头晕、恶心、呕吐发生率降低,首次下床时间缩短(P<0.05)。结论氢吗啡酮复合纳布啡用于胃肠道手术后PCIA的效果优于舒芬太尼复合纳布啡。     

纳布啡复合舒芬太尼对肝切除术后患者免疫功能的影响

目的探讨纳布啡复合舒芬太尼应用于肝切除术患者术后镇痛对免疫功能的影响。方法选择2018年9月至2020年12月拟行开腹左半肝切除术的肝癌患者120例,男65例,女55例,年龄18～64岁,BMI 18～25 kg/m~2,ASAⅠ或Ⅱ级,TNMⅠ或Ⅱ期。采用随机数字表法将患者分为三组:舒芬太尼组(S组,n=38)、纳布啡组(N组,n=42)和纳布啡复合舒芬太尼组(NS组,n=40)。所有患者均给予常规麻醉处理。S组,舒芬太尼2.5μg/kg+托烷司琼10 mg+生理盐水100 ml行术后静脉自控镇痛(PCIA);N组,纳布啡2 mg/kg+托烷司琼10 mg+生理盐水100 ml行术后PCIA;NS组,纳布啡1 mg/kg+舒芬太尼1.25μg/kg+托烷司琼10 mg+生理盐水100 ml行术后PCIA。记录术后6、12、24、48 h的VAS疼痛评分,采用流式细胞术于术前1 d、术后24、48 h测定外周血中T淋巴细胞CD3~+、CD4~+、CD8~+百分比并计算CD4~+/CD8~+比值,采用免疫散射比浊法检测外周血补体C3、C4浓度。记录不良反应的发生情况。结果与S组比较,术后6、12、24、48 h NS组VAS疼痛评分明显降低(P0.05),术后24、48 h N组和NS组T淋巴细胞CD3~+百分比和CD4~+/CD8~+比值均明显升高(P0.05),术后24 h NS组T淋巴细胞CD4~+百分比明显升高(P0.05)。术后24、48 h N组和S组VAS疼痛评分和C3、C4浓度差异无统计学意义。与N组比较,术后24、48 h NS组T淋巴细胞CD3~+、CD4~+百分比、CD4~+/CD8~+比值和C3、C4浓度明显升高(P0.05),NS组术后恶心、呕吐、头晕、呼吸抑制发生率明显降低(P0.05)。结论纳布啡复合舒芬太尼用于肝切除术后镇痛可以发挥强效镇痛作用,减轻手术和创伤应激反应导致的免疫抑制,同时减少不良反应。     

曲马多复合不同剂量舒芬太尼在患儿术后静脉镇痛中的应用

目的 探讨舒芬太尼联合曲马多用于患儿术后镇痛的安全性、有效性和最佳剂量.方法 选择气管插管全麻下择期手术患儿60例,行术后静脉镇痛,随机均分为三组:A组,曲马多10mg/kg+舒芬太尼1.6 μ g/kg+托烷司琼0.2 mg/kg;B组,曲马多10 mg/kg+舒芬太尼2.0 μg/kg+托烷司琼0.2 mg/kg;C组,曲马多10 mg/kg+舒芬太尼2.4 μg/kg+托烷司琼0.2mg/kg.术毕清醒拔管后开启镇痛泵,负荷量2 ml,持续量2 ml/h,PCA 1.5 ml,锁定时问15 min.术后镇痛效果不佳时,单次静推曲马多0.5～1.0 mg/kg作为补救措施.分别于术后2、4、8、12、24、48 h采用VAS评分法和Ramsay镇静评分法评估患儿术后疼痛程度和镇静程度;记录术后48 h舒芬太尼和曲马多总用量、PCA总按压次数和有效按压次数;同时观察术后恶心呕吐(PONV)、皮肤瘙痒、呼吸抑制等不良反应发生情况.结果 术后2、4、8、1 2、24、48hB、C组VAS评分均明显低于、Ramsay镇静评分明显高于A组(P＜0.05),C组Ramsay镇静评分明显高于B组(P＜0.05).C组PONV发生率明显高于A、B组(P＜0.05).与A组比较,B组和C组舒芬太尼总用量增加、曲马多总用量减少、PCA总按压次数减少、有效按压率增加(P＜0.05).结论 曲马多复合舒芬太尼用于患儿术后静脉镇痛安全、有效,最佳镇痛方案是曲马多0.2 mg/kg+舒芬太尼2.0μg/kg+托烷司琼0.2 mg/kg,镇痛及镇静效果满意,不良反应发生率低.     

纳布啡不同镇痛泵参数用于剖宫产术后镇痛的比较

目的：比较三种不同参数纳布啡患者自控静脉镇痛（PCIA）用于剖宫产术后镇痛的效果。
方法：选择剖宫产术后的产妇179例,年龄18～45岁,BMI 20～35 kg/m²,ASA Ⅰ或Ⅱ级,术后均给予PCIA（纳布啡2 mg/kg+托烷司琼8 mg/100 ml,间隔时间15 min,极限量10 ml/h）。将产妇随机分成三组：对照组（C组,背景量2 ml/h,单次按压2 ml,n=60）、低背景量组（L组,背景量1 ml/h,单次按压3 ml,n=62）和无背景量组（N组,背景量0 ml/h,单次按压4 ml,n=57）。记录术后2、6、12、24、48 h静息和活动时VAS疼痛评分、纳布啡消耗量。记录术后48 h内PCIA按压情况、术后首次肛门排气时间、术后住院时间、Ramsay镇静评分和术后恶心呕吐、头晕、感染等不良反应的发生情况。
结果：与C组比较,N组术后6、12 h静息时VAS疼痛评分明显升高（P<0.05）,L组和N组术后24、48 h纳布啡消耗量明显减少,术后首次肛门排气时间明显缩短,头晕发生率明显降低（P<0.05）,N组术后住院时间明显缩短（P<0.05）。与L组比较,N组术后12 h静息和活动时VAS疼痛评分明显升高,术后48 h纳布啡消耗量明显减少,总按压次数和有效按压次数明显增加,术后首次肛门排气时间明显缩短（P<0.05）。三组Ramsay镇静评分和术后恶心呕吐、感染发生率差异无统计学意义。
结论：低背景量（1 ml/h）纳布啡PCIA可在充分镇痛的同时,减少阿片类药物用量,降低相关不良反应发生率,缩短术后首次肛门排气时间,可作为纳布啡PCIA用于剖宫产术后镇痛参数设置的优先选择。     

舒芬太尼联合地佐辛在肩胛骨骨折术后镇痛中的应用体会

目的观察舒芬太尼联合地佐辛在肩胛骨骨折术后镇痛中的应用效果。方法选取90例气管插管全凭静脉麻醉下择期行肩胛骨骨折手术治疗的患者,术后均行PCIA。根据镇痛方案分成3组,每组30例。S组:舒芬太尼3μg/kg+盐酸昂丹司琼0.2 mg/kg。D组:地佐辛0.8 mg/kg+盐酸昂丹司琼0.2 mg/kg。SD组:舒芬太尼1.5μg/kg+地佐辛0.3 mg/kg+盐酸昂丹司琼0.2 mg/kg。3组均用0.9%生理盐水稀释至200 m L,持续静脉泵注,持续给药量为4 m L/h,单次PCIA剂量为1 m L,锁定时间为15 min。观察并记录3组患者术后2、6、12、24、48 h的VAS疼痛评分,Ramsay镇静评分,术后24 h内PCA按压次数,不良反应的发生情况。结果 3组术后各时点的VAS疼痛评分和术后24 h内PCA按压次数比较,差异无统计学意义(P0.05)。与S组和D组相比,术后SD组的VAS及Ramsay镇静评分低,不良反应发生率低,差异均有统计学意义(P0.05)。结论与单用舒芬太尼或地佐辛相比,舒芬太尼联合地佐辛用于肩胛骨骨折术后镇痛,镇痛效果好、不良反应发生率低。     

亚麻醉剂量氯胺酮复合舒芬太尼对食管癌术后患者自控静脉镇痛的影响

目的评价亚麻醉剂量氯胺酮复合舒芬太尼对食管癌根治术后患者自控静脉镇痛(PCIA)的影响。方法择期食管癌根治术患者90例,ASAⅠ或Ⅱ级,年龄55~75岁,随机分为S1组、S2组和SK组,每组30例,术后行PCIA,镇痛药配方分别为舒芬太尼2 μg/kg(S1组),舒芬太尼2.5 μg/kg(S2组),舒芬太尼2μg/kg+氯胺酮90 μg·kg-1·h-1(S3组),各组镇痛药物均加入格拉司琼6mg并用生理盐水稀释至100 ml。所有患者均在手术结束前30 min给予负荷量5 ml,连接静脉镇痛泵,记录患者术后4、8、24、48h的疼痛VAS评分、Ramsay镇静评分、SBP、DBP、HR、SpO2及不良反应发生情况,并记录患者48 h内按压PCIA总次数。结果三组患者术后4、8、24、48hRamsay镇静评分、SBP、DBP、HR、SpO2比较差异无统计学意义。S2组、SK组患者48 h内VAS评分明显低于、PCIA按压总次数明显少于S1组(P0.05),SK组患者48 h内VAS评分明显低于、PCIA按压总次数明显少于S2组(P0.05)。S2组患者术后48h内有2例发生呼吸抑制。结论亚麻醉剂量氯胺酮辅助舒芬太尼用于食管癌根治术患者,能减少术后舒芬太尼用量,缓解术后疼痛,镇痛效果优于单用舒芬太尼。     

丙帕他莫复合舒芬太尼用于妇科腹腔镜术后静脉自控镇痛的效果

目的观察丙帕他莫复合舒芬太尼用于妇科腹腔镜术后静脉自控镇痛(PCIA)的镇痛效果及安全性。方法 60例ASAⅠ或Ⅱ级择期行妇科腹腔镜手术患者,随机均分为两组:丙帕他莫复合舒芬太尼组(PS组):丙帕他莫8 g+舒芬太尼1μg/kg+生理盐水总量100 ml;舒芬太尼组(S组):舒芬太尼2μg/kg+生理盐水总量100 ml。两组镇痛液负荷量5 ml,PCIA镇痛泵维持量2ml/h,追加量0.5 ml,锁定时间15 min。记录术后4、8、12、24和48 h疼痛VAS评分、镇静Ramsay评分及镇痛期间不良反应发生率。结果 PS组与S组术后各时点VAS评分均<2分,两组间差异无统计学意义;S组术后4、8、12 h Ramsay评分明显高于PS组(P<0.05)。镇痛期间不良反应发生率PS组低于S组(P<0.05)。结论丙帕他莫复合舒芬太尼用于妇科腹腔镜术后PCIA镇痛效果确切,不良反应发生率低。     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.