曲马多与吗啡病人自控镇痛的临床效果比较

目的　比较曲马多和吗啡病人自控镇痛 (PCA)对经腹全子宫切除术病人的镇痛效果。方法　 4 0例病人进行随机、双盲研究。吗啡组 (M组 )PCA单次给药量吗啡 1mg ;曲马多组 (T组 )PCA单次给药量曲马多 2 0mg ;锁定时间均为 10min。术后 4、8、12、2 0、2 8、36h分别观察BP、HR、RR、疼痛评分 (VAS)、恶心、呕吐、镇静评分、眩晕、口干等不良反应。结果　曲马多组与吗啡组病人镇痛效果相似。术后 2 4h曲马多组恶心、呕吐发生率高于吗啡组 (分别为 2 9%vs 11% ,P <0 0 5 ;16 %vs 4 % ,P <0 0 5 ) ;吗啡组产生的镇静作用大于曲马多组 (第一个 2 4h为 34%vs 14 % ,P <0 0 5 )。结论　PCA曲马多对经腹全子宫切除病人可提供满意的镇痛效果 ,但恶心、呕吐的发生率较高     

布托啡诺与吗啡用于腹部手术后硬膜外镇痛效果的比较

目的 研究不同剂量布托啡诺用于腹部手术患者术后硬膜外镇痛的效果及副作用,并与吗啡硬膜外镇痛进行比较. 方法 择期腹部手术ASAⅠ～Ⅱ级患者75例,按术后镇痛用药不同随机分为3组(n=25):M组(吗啡12 mg+0.1%罗哌卡因共150ml),B1组(布托啡诺9mg+0.1%罗哌卡因共150 ml),B2组(布托啡诺12mg+0-1%罗哌卡因共150ml).负荷量为0.25%罗哌卡因5 ml加吗啡2 mg或布托啡诺2 mg,持续背景输注剂量均为1-5 ml/h,按压追加药量均为2 ml/次,按压锁定时间20 min.观察记录3组患者术中芬太尼的总药量;术后1、4、8、12、18、24、36、48 h各时间点的疼痛视觉模拟评分(pain visual analogue scores,VAS);术后1、4、8、12 h的警觉镇静评分(observer's assessment ofalertness/sedation scores,OAA/S);术后48 h内按压总次数及总药量;肛门排气时间;术后镇痛副作用(头痛头晕、嗜睡、呼吸抑制、搔痒、恶心、呕吐、腹胀)的发生情况.结果 术后4 h时间点B1组VAS评分为2.8±1.0,高于M组的2.0±0.7及B2组的2.0±0.9(P<0-05),其余时间点3组间比较差异无统计学意义(P>0.05).M组的头痛头晕、恶心、呕吐,腹胀,搔痒发生例数分别为3、11、7、4、5例,而B1组仅有1例头痛头晕,B2组有2例头痛头晕,1例恶心,发生率均低于M组(P<0.05).3组患者术中芬太尼的总药量、48 h内按压总次数及总药量、术后不同时间点OAA/S评分及肛门排气时间的比较差异无统计学意义(P>0.05). 结论 每天3 mg～4 mg布托啡诺应用于腹部手术后硬膜外镇痛,镇痛效果确切,且其副作用发生率较吗啡明显降低.     

艾司氯胺酮用于腹腔镜结肠癌根治术患者术后镇痛的有效性和安全性观察

目的探讨艾司氯胺酮用于腹腔镜结肠癌根治术全麻患者术后镇痛的有效性和安全性。方法选择2022年2月至2022年7月于郑州大学附属肿瘤医院行全麻下腹腔镜结肠癌根治术的患者89例, 按随机数字表法分为3组:对照组(C组, 30例)、低剂量艾司氯胺酮组(K1组, 29例)、高剂量艾司氯胺酮组(K2组, 30例)。所有患者麻醉诱导和维持方案由其麻醉医师决定, 镇痛药物限于舒芬太尼和瑞芬太尼。根据分组情况配置术后自控静脉镇痛泵:C组, 舒芬太尼1.5 μg/kg+托烷司琼5 mg;K1组, 舒芬太尼1 μg/kg+艾司氯胺酮1 mg/kg+托烷司琼5 mg;K2组, 舒芬太尼1 μg/kg+艾司氯胺酮2 mg/kg+托烷司琼5 mg。记录患者术后48 h的视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分、简易精神状态检查(MMSE)评分、抑郁症自测量表(SDS)评分和术后48 h内镇痛泵按压次数、不良反应(恶心、呕吐、瘙痒、尿潴留)发生情况。结果与C组比较:K1组术后48 h VAS疼痛评分较高(P<0.05), 术后48 h内镇痛泵按压次数较多(P<0.05);K1组、K2组术...     

芬太尼、吗啡PCSA用于心外术后镇痛疗效的随机对照研究

目的　对皮下芬太尼或吗啡病人自控镇痛 (PCA)的疗效及安全性进行评价。方法　将 6 0例ASAⅠ～Ⅲ级心外术后病人随机分成芬太尼与吗啡病人皮下自控镇痛 (PCSA)组 ,其中芬太尼组 2 9例 ,吗啡组 31例。药物配方 :芬太尼组为 1ml药液中含芬太尼 2 5 μg、利多卡因 10mg ;吗啡组为 1ml药液中含吗啡 1mg、利多卡因 10mg ;PCA设置 :负荷量 2ml,单次剂量 1ml,小时限量 10ml,锁定时间 3分钟。于负荷量注射完毕后记录镇痛起效时间 ,并于放置PCSA泵后 2 4、48、和 72小时记录以下指标 :安静、咳嗽和运动时疼痛VAS评分 ,镇静程度 ,PCA需求按压和有效按压次数 ,MAP、HR、RR、SpO2 及副作用。结果　镇痛效果 :芬太尼组镇痛起效时间显著短于吗啡组 (P <0 0 5 ) ;芬太尼组PCA药物用量、需求按压和有效按压次数显著高于吗啡组 (P <0 0 5 ) ;吗啡组恶心、呕吐的发生率明显高于芬太尼组 (P <0 0 5 )。结论　芬太尼、吗啡PCSA操作简单、系统故障发生率低 ,适于较长时间留置     

右美托咪定对术后吗啡自控镇痛效果的影响

目的探讨右美托咪定(Dex)对术后吗啡自控镇痛患者疼痛的影响。方法择期全麻手术患者40例,ASAⅠ或Ⅱ级,随机均分为两组,分别在手术结束前30 min缓慢静注(10 min)Dex0.8μg/kg(Dex组)和对照组(C组)。患者进入麻醉后恢复室静脉缓慢推注吗啡0.05 mg/kg作为负荷量,之后接镇痛泵行PCIA,设定吗啡bolus剂量0.02 mg/kg。记录PCIA开始后1、2、6、12和24 h的VAS、Ramsay镇静评分(RSS)和吗啡累积消耗量;记录术后24 h内恶心、呕吐和寒战等发生情况。结果 PCIA后各时点两组VAS评分和RSS差异无统计学意义。Dex组吗啡累积消耗量明显少于C组(P<0.05或P<0.01)。Dex组术后24 h内恶心、呕吐和寒战的发生率明显低于C组(P<0.05)。结论手术结束前30 min缓慢静注(10 min)0.8μg/kg Dex可显著降低术后吗啡用量,并降低术后恶心、呕吐和寒战等不良反应发生率。     

冠脉搭桥术病人红细胞包蔽吗啡溶液术后镇痛的可行性

目的探讨冠脉搭桥术(CABG)病人红细胞包蔽吗啡溶液(RBC-M)术后镇痛的可行性。方法拟行CABG术的病人50例,随机分为RBC-M组和PCA组,每组25例。拔除气管导管后2 h, RBC-M组给予新鲜配制的RBC-M溶液,剂量为0.14mg/kg;PCA组用0.01%的吗啡进行病人自控静脉镇痛,负荷量2ml,bolus量1 ml,背景输注速率1 ml/h,4 h限量为15 ml,锁定时间10 min。分别于术前、镇痛前及镇痛开始后1、2、3、8、12、24、36、48 h时对病人疼痛、镇静与舒适状态进行评分。持续观察心率(HR)、平均动脉压(MAP)、呼吸频率(RR)和动脉血气;镇痛前后不同时点测定RBC-M组吗啡血清浓度;记录并发症、吗啡用量。结果与PCA组比较,RBC-M组在镇痛开始后2 h内疼痛评分降低,镇静评分升高,HR和RR降低,PaCO2升高;镇痛开始后的24 h内舒适评分升高,镇静评分降低;吗啡用量降低(P<0.05或0.01),恶心、呕吐发生率差异无统计学意义(P>0.05)。RBC-M溶液的药代动力学模型为二室模型,半衰期为15.37 h,清除率为2.1 ml·kg-1·min-1,稳态表观分布容积为0.088 L/kg, 血药浓度时间曲线下面积为7 911.6 ng·ml-1·h-1。结论CABG病人RBC-M进行术后镇痛是安全、有效的。     

氯诺昔康复合吗啡镇痛对肺切除患者术后呼吸功能的影响

目的观察氯诺昔康复合吗啡自控镇痛(PCA)对肺叶切除术患者呼吸功能的影响。方法 40例肺叶切除术患者随机分为氯诺昔康组(L组)和吗啡组(M组),每组20例。PCA泵的镇痛药为吗啡1 mg/ml;同时,L组于术毕和术后12、243、6 h静脉注射氯诺昔康,每次8 mg;M组在相应时点注射生理盐水,记录镇痛12、24、36和48 h VAS评分及镇静程度评分;PCA需求按压次数、有效按压次数及药物用量;术后各种并发症及不良反应发生率;术后24、48和72 h呼吸功能指标。结果两组患者各时点安静痛和咳嗽痛VAS评分差异无统计学意义;镇静程度评分、PCA需求按压次数、有效按压次数及药物用量L组显著低于M组(P0.05);L组恶心发生率显著低于M组(P0.05);L组术后244、8 h的用力肺活量(FVC)、第1秒用力肺活量(FEV1)和FEV1/FVC明显高于M组(P0.05),PaCO2明显低于M组(P0.05)。结论氯诺昔康用于肺叶切除术患者PCA可减少吗啡用量,并有利于呼吸功能恢复。     

严重烧伤病人休克期镇痛的临床研究

目的探讨严重烧伤休克期静脉注射小剂量氯胺酮、芬太尼病人自控镇痛(PCA)的安全性、有效性及对血糖和应激激素的影响。方法60例严重烧伤病人于伤后24 h内入院,随机分为传统镇痛组(CAT组)、静脉注射氯胺酮组(PCIKA组)、芬太尼组(PCIFA组)和氯胺酮、芬太尼联合镇痛组(PCIKFA组),每组15例。CAT组根据病人需要肌注哌替啶50 mg和异丙嗪25 mg,其余三组静脉自控镇痛(PCIA)药物配制为:PCIKA组氯胺酮20 mg/ml 氟哌利多50μg/ml,PCIFA组芬太尼10μg/ml 氟哌利多50μg/ml,PCIKFA组氯胺酮10 mg/ml 芬太尼5μg/ml 氟哌利多50μg/ml,负荷量均为1.5 ml,PCA量1 ml,锁定时间30 min,持续输注量1.5 ml/h。观察并记录镇痛开始前及开始后1、4、8、24、48 h时的HR、MAP、SpO2、视觉模拟评分(VAS)和镇静状态及有无恶心、呕吐、幻觉、呼吸抑制等不良反应。检测镇痛开始前及开始后1、8、24、48 h的血糖和血浆应激激素的水平。结果另外三组病人静脉镇痛效果明显优于CAT组(P<0.01),并且有良好的镇静作用;HR、MAP和SpO2各组间差异无显著意义,各组病人无恶心、呕吐、幻觉及呼吸抑制等不良反应;三组PCIA病人镇痛开始后血糖和血浆应激激素明显降低(P<0.01),各组之间胰岛素水平差异无显著意义。结论严重烧伤病人休克期静脉注射小剂量氯胺酮、芬太尼,病人PCA安全、有效,并降低此类病人的高血糖反应和应激反应。     

硬膜外咪唑安定联合吗啡用于下腹部手术后镇痛

目的 探讨硬膜外注入咪唑安定联合吗啡对下腹部手术后的镇痛效果。方法 36例择期下腹部手术患者,ASA Ⅰ-Ⅱ,随机分为实验组和对照组,各18例。实验组于手术结束时硬膜外注入咪唑安定50ug/kg复合吗啡2mg,对照组择仅使用吗啡2mg,记录术后2h,6h和12h时患者镇痛(VAS)、镇静(Ramsay)评分值。结果 实验组在术后2h时镇痛评分0.91±0.33较对照组1.45±0.38低,而镇静评分1.71±0.57较对照组0.95±0.42高。实验组恶心呕吐发生率在6h,12h时间内较对照组低。结论 硬膜外咪唑安定联合吗啡用于下腹部术后镇痛效果优于单独使用吗啡。     

亚麻醉剂量氯胺酮对雷米芬太尼麻醉术后镇痛的影响

目的研究术中持续输注亚麻醉剂量氯胺酮对雷米芬太尼麻醉术后镇痛的影响。方法择期行胃癌根治术患者40例,随机均分为亚麻醉剂量氯胺酮复合雷米芬太尼组(研究组)和单纯雷米芬太尼组(对照组)。两组均接受雷米芬太尼1μg/kg诱导和0.5μg·kg-1·min-1持续输注;研究组加用氯胺酮0.15 mg/kg诱导和2μg·kg-1·min-1术中持续输注。记录术后患者清醒和拔管时间,气管拔管即刻、术后6、12、24、36和48 h的视觉模拟评分(VAS)、镇静评分、气管拔管前的躁动次数和患者自控镇痛(PCA)总次数。结果研究组患者气管拔管即刻、术后6、12、24、36和48 h的VAS和PCA总次数显著低于对照组(P<0.05或P<0.01),清醒和拔管时间、躁动次数以及镇静评分差异无统计学意义。结论术中持续输注亚麻醉剂量氯胺酮能显著降低雷米芬太尼麻醉术后VAS,减少患者PCA次数,提高患者镇痛满意度。     

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.