改良眼镜用于白内障手术患者辅助自滴眼液

目的提高白内障手术患者术后自滴滴眼液的准确性。方法将120例白内障手术患者随机分为对照组和观察组各60例,对照组采用拳式法自滴滴眼液,观察组采用自制改良眼镜辅助自滴滴眼液。结果观察组掌握自滴滴眼液操作时间显著短于对照组,滴眼准确率显著高于对照组,自滴滴眼液时药瓶总污染率显著低于对照组(均P0.01)。结论采用改良眼镜辅助自滴眼液,患者易于掌握,滴药准确性高,能有效避免药瓶药液污染和浪费眼药液。     

无湿化中低流量吸氧在呼吸系统疾病患者中的应用研究

目的探讨无湿化与湿化两种吸氧模式在呼吸系统疾病患者中的应用效果。方法选取2017年4～9月住院的呼吸系统疾病患者400例,按入住病室分为两组各200例。对照组采用常规湿化中低流量吸氧,观察组采用无湿化中低流量吸氧。比较两组不同吸氧时间的舒适度、湿化瓶细菌污染情况、睡眠质量以及执行两种吸氧模式的操作耗费时间等。结果两组患者不同时间点吸氧舒适度比较差异无统计学意义(均P 0. 05)。两组患者湿化瓶细菌污染率比较:吸氧24 h时差异无统计学意义(P 0. 05),吸氧48 h和72 h时对照组湿化瓶细菌检出阳性率显著高于观察组(P 0. 05,P 0. 01)。观察组患者睡眠质量显著优于对照组(P 0. 01);护士执行无湿化吸氧的操作时间比执行湿化吸氧的操作时间显著缩短(P 0. 01)。结论呼吸系统疾病患者实施无湿化中低流量吸氧可减少湿化瓶细菌污染率,提高患者的睡眠质量,缩短护士的操作时间,且不增加患者呼吸道不适感。     

重组生长激素在外科手术后呼吸衰竭治疗中的应用

目的探讨外科手术后呼吸衰竭的患者应用重组生长激素 (rhGH)的效果。方法 80例外科手术后常规停用呼吸机失败的患者 ,按疾病种类分为rhGH组和对照组各 40例 ,rhGH组肌注rhGH 8IU/d。结果机械通气时间在rhGH组平均为 (30± 12 )d ,对照组平均为 (39± 13)d ,t=2 5 38,P <0 0 1。rhGH组血清白蛋白浓度治疗前为 (30± 5 )g/L低于治疗第 8天 (39± 7)g/L ,t=2 6 19,P <0 0 1。rhGH组预测死亡率为 45 % ,实际死亡率为 15 % ,t=1 884,P <0 0 5。结论应用rhGH可缩短外科手术后危重患者机械通气时间 ,使患者成功脱离机械通气 ,降低死亡率     

吸入性一氧化氮在ETCPC术后早期的临床应用效果

目的　评价吸入性一氧化氮 (INO)在心外管道全腔静脉肺动脉连接 (ETCPC)术后早期疗效。方法　ETCPC术后早期吸入NO者为试验组 ,未吸入NO者为对照组 ,各 16例。记录两组吸入及停用INO前后心排出量、肺血管阻力 (PVR)、呼吸指数、肺动脉 -左房压力阶差 (PLG)。记录两组呼吸机辅助时间、ICU滞留时间、胸腔引流管留置时间及住院时间。结果　试验组NO吸入后呼吸指数从 2 . 6 1±0 .32下降至 1. 4 1± 0 .2 1,t=2 . 35 ,P <0 .0 5 ;PLG(mmHg)从 11± 2降至 7± 3,t =2 .76 ,P <0 . 0 1;氧合指数从 16. 3± 18升高至 191± 2 1,t=2 . 74 ,P <0 .0 1;心指数 (CI ,L·min-1·m-2 )从 2 . 84± 0 . 2 3增加至 3 .12±0 . 2 0 ,t=2 . 2 4 ,P <0 .0 5 ;肺血管阻力从 4 . 2 3± 0 .5 3下降至 3 .77± 1 .4 2 ,t =2 . 2 8,P <0 . 0 5 ;中心静脉压(CVP ,mmHg)从 17 .0± 1 9下降至 15 .0± 1. 2 ,下降约 11 .8% ;INO停用前后各项上述指标未见明显差异。与对照组相比较 ,呼吸机辅助时间从 (76± 2 5 )h缩短为 (5. 6± 19)h ,t=2 . 2 8,P <0 . 0 5 ;重症监护时间从 (6± 2 )d缩短至 (4± 2 )d ,t=2 . 33,P <0. 0 5 ;胸腔引流管留置时间及住院时间差异无统计学意义。结论　INO对ETCPC术后远期疗效无明显影响 ,但     

钉砧系统在肥胖患者腹腔镜全胃切除术后消化道重建中的应用

目的探讨腹腔镜全胃切除术后消化道重建采用钉砧头系统(Or Vil)在腔内行食管空肠Roux-en-Y吻合的临床应用价值。方法回顾性分析我科2015年1月～2018年1月采用腹腔镜全胃根治术+D2淋巴结清扫+Or Vil腔内行食管空肠Roux-en-Y吻合消化道重建治疗28例SiwertⅡ、Ⅲ型肥胖胃癌作为实验组,筛选同期年龄、性别、体重指数、ASA分级、病理分期、TNM分期、合并症及肿瘤位置等与实验组组患者无明显差异的28例肥胖胃癌作为对照组,并行腹腔镜全胃根治术+D2淋巴结清扫+开腹辅助食管空肠Roux-en-Y吻合。比较2组患者的术中、术后情况。结果实验组消化道重建时间(48. 6±6. 9) min,明显短于对照组(55. 7±5. 6) min(t=4. 193,P=0. 000);食管空肠吻合时间(12. 5±2. 5) min,明显短于对照组(20. 4±3. 3) min(t=10. 055,P=0. 000);切口长度(5. 2±1. 0) cm,明显短于对照组(10. 7±2. 1) cm(t=12. 469,P=0. 000);术后镇痛时间(2. 6±0. 5) d,明显短于对照组(3. 2±0. 8) d(t=2. 903,P=0. 005);肛门排气时间(3. 2±0. 5) d,明显少于对照组(3. 8±0. 8) d(t=3. 635,P=0. 001);进流质饮食时间(3. 2±0. 6) d,明显少于对照组(4. 0±0. 6) d(t=4. 688,P=0. 000);术后住院时间(7. 8±1. 2) d,明显短于对照组(9. 0±1. 4)(t=-3. 629,P=0. 001)。2组术中冰冻切缘阳性率(3. 6%vs.10. 7%)(χ2=0. 269,P=0. 604)和淋巴结清扫数目[(27. 0±6. 3)枚vs.(27. 5±6. 3)枚,t=-0. 277,P=0. 783]无统计学差异。2组并发症发生率差异无显著性(P 0. 05)。结论腹腔镜全胃切除术后消化道重建采用Or Vil在腔内进行食管空肠吻合操作,可缩短吻合时间,腹部切口小、疼痛时间短促进患者胃肠道功能较早的恢复,加快患者康复的过程。     

硫酸软骨素滴眼液对青光眼白内障联合手术后泪膜变化的分析

目的:观察硫酸软骨素滴眼液对青光眼白内障联合手术后泪膜变化的影响.方法:选取青光眼白内障联合手术45例(45眼),随机分成对照组和干预组.对照组术后用妥布霉素地塞米松眼药水(沈阳兴奇制药生产)滴眼,5次/d,干预组用妥布霉素地塞米松眼药水(沈阳兴奇制药生产)滴眼,5次/d硫酸软骨素滴眼液滴眼,6次/d,分别于手术前1d、手术后1wk、1mo、3m0对所有患者行基础泪液分泌(Sehirmer I)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)检查.结果:对照组与干预组术前SehimerI、BUT、FL差异无统计学意义(P＞0.05).对照组术前与术后1wk、lmo、3mo、SehirmerI、BUT、FL差异具有统计学意义(P＜0.05).干预组术前与术后1wk在SehimerI、BUT、FL差异具有统计学意义(P＜0.05),但术后1mo、3mo后差异无统计学意义(P＞0.05).结论:青光眼白内障联合手术早期泪膜会发生变化,使用硫酸软骨素滴眼液点眼可以加快术后泪膜功能的早日恢复.     

加速康复外科在胆石症围手术期应用的前瞻性研究

目的:探讨加速康复外科(ERAS)在胆囊结石并胆总管结石患者行开腹胆囊切除并胆总管探查取石T管引流术中的临床应用价值。方法:选取2014年2月—2015年1月山东大学齐鲁医院(青岛)普外科因胆囊结石并胆总管结石行胆囊切除并胆总管切开探查取石T管引流术的患者94例,通过纳入、排除标准,将符合条件的患者随机分为ERAS组(围术期采用ERAS处理方案)和对照组(围术期采用传统处理方案)。观察患者围术期肝功能、应激状态等指标变化以及术后恢复情况。结果:符合研究条件并完成本项研究的患者共60例,ERAS组和对照组各30例。两组患者术前空腹血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、血糖、C反应蛋白(CRP)、谷丙转氨酶(ALT)和直接胆红素(DBil)水平比较,差异均无统计学意义(P0.05)。ERAS组术后第5天的TP(t=3.125,P=0.002)、PA(t=3.574,P=0.001)水平均高于对照组,其术后第3天(t=-2.005,P=0.026)和第5天(t=-2.102,P=0.042)的CRP水平均低于对照组。ERAS组患者术后首次排气时间缩短(t=-7.635,P=0.000),术后白蛋白用量减少(t=-2.036,P=0.047),住院时间缩短(t=-3.952,P=0.000),住院费用减少(t=-2.604,P=0.012),术后镇痛效果好(t=-2.306,P=0.025),术后随访期内并发症发生率减少(χ~2=5.079,P=0.024)。结论:ERAS应用于胆囊结石并胆总管结石患者的围手术期可以缩短排气时间,缩短住院时间并减少住院费用。同时ERAS可以优化患者术后营养状况,改善患者疼痛感受,减少术后并发症     

十二指肠离断时机对腹腔镜胃上部癌脾门淋巴结清扫近期疗效的影响

目的探讨十二指肠离断时机对腹腔镜辅助胃上部癌保脾脾门淋巴结清扫近期疗效的影响。方法回顾性分析2016年1月～2018年7月我院127例腹腔镜辅助根治性全胃切除术(脾门淋巴结清扫)的临床资料,57例在淋巴结清扫过程中先离断十二指肠再清扫脾门淋巴结,设为对照组,70例先清扫脾门淋巴结再离断十二指肠设为实验组,比较2组脾门清扫时间、总手术时间、术中损伤、脾门出血和No. 10淋巴结清扫数目、总淋巴结清扫数目、术后肛门首次排气时间、术后首次进流质食物时间、术后首次进半流质食物时间、术后腹腔引流管拔除时间、术后并发症和术后住院时间等。结果对照组脾门清扫时间、总手术时间、术中损伤和脾门出血量分别为(30. 9±4. 2) min、(236. 1±20. 4) min、20例和(27. 0±4. 8) ml,明显长于或高于实验组(26. 0±3. 1) min、(224. 1±18. 6) min、10例和(22. 4±5. 0) ml(t=7. 623,P=0. 000; t=3. 464,P=0. 001;χ~2=7. 535,P=0. 006; t=5. 206,P=0. 000)。实验组No. 10淋巴结清扫数目、总淋巴结清扫数目、术后肛门首次排气时间、术后首次进流质食物时间、术后首次进半流质食物时间、术后腹腔引流管拔除时间、术后并发症和术后住院时间分别为(3. 0±1. 1)枚、(31. 8±6. 9)枚、(3. 9±0. 7) d、(4. 4±0. 8) d、(7. 5±0. 9) d、(9. 3±1. 1) d、11例和(10. 7±1. 2) d,对照组分别为(2. 6±1. 1)枚、(30. 7±7. 4)枚、(4. 0±0. 9) d、(4. 5±0. 8) d、(7. 7±0. 8) d、(9. 5±0. 9) d、10例和(11. 0±1. 2) d,差异均无统计学意义(t=-1. 830,P=0. 070; t=-0. 850,P=0. 397; t=0. 709,P=0. 480; t=0. 770,P=0. 443; t=1. 349,P=0. 180; t=0. 859,P=0. 392;χ~2=0. 076,P=0. 783; t=1. 514,P=0. 132)。结论在腹腔镜辅助胃上部癌保脾脾门淋巴结清扫术中,先清扫脾门淋巴结后再离断十二指肠可缩短脾门清扫时间和总的手术时间,减少术中损伤和脾门出血量,且没有增加术后并发症,可提高手术的安全性。     

股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨粗隆间骨折疗效比较

目的探讨和比较股骨近端防旋髓内钉与股骨近端锁定钢板在股骨粗隆间骨折治疗中的应用价值。方法选择2013-01—2014-12收治的股骨粗隆间骨折患者90例,按照内固定术方法的不同将其随机分为股骨近端防旋髓内钉组(A组)和股骨近端锁定钢板组(B组)。比较分析2组患者手术相关指标、术后相关指标以及术后不同时间髋关节功能Harris评分情况。结果与B组相比,A组手术时间(t=13.68,P0.01)和切口长度(t=8.47,P0.01)均明显缩短,术中出血量(t=6.49,P0.05)和术中输血量(t=5.21,P0.05)均显著减少,术后引流量显著减少(t=12.99;P0.01),术后患侧负重时间(t=5.36,P0.05)和住院天数(t=4.56,P0.05)更短,差异均有统计学意义(P0.05)。2组骨折愈合时间及术后3、6、9个月髋关节功能Harris评分比较,差异无统计学意义(P0.05)。结论股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨粗隆间骨折均具有明显的治疗效果,而股骨近端防旋髓内钉在改善患者临床指标,降低患者经济困难等方面具有一定的优势,更适于老年患者的临床应用。     

体外胆管癌细胞x线照射后细胞周期及放射敏感性变化

目的 :探讨胆管癌细胞经x线照射后存活后代生长特性及放射敏感性的变化。方法 :人胆管癌细胞株和经x线照射后存活后代体外培养 ,测定其群体倍增时间、放射敏感性和细胞周期变化。结果 :胆管癌细胞的群体倍增时间为 (12 0 .0± 2 .8)h ,克隆形成率为 (14.0± 0 .6 ) %,放射敏感性参数SF2为0 .6 2± 0 .0 5。胆管癌细胞照射 6Gy后存活后代群体倍增时间为 (15 2 .8± 11.2 )h(t =3.12 4,P <0 .0 5 ) ,克隆形成率为 (6 .0± 0 .4) %(t=6 .5 2 2 ,P <0 .0 1) ,SF2为 0 .82± 0 .0 6 (t=2 .32 4,P <0 .0 5 )。胆管癌细胞x线照射后出现明显的S期细胞减少和G2 /M期阻滞 ,且有剂量依赖。结论 :胆管癌细胞x线照射后存活后代生长延缓 ,放射敏感性增高 ,呈S细胞减少和G2期阻滞。     

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.     

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.