血管内皮生长因子受体启动子驱动双自杀基因联合survivin反义寡核苷酸对结直肠癌细胞及血管内皮细胞的特异性杀伤作用

目的探讨腺病毒介导血管内皮生长因子受体（KDR）启动子驱动的CDglyTK融合基因（AdKDR-CDsbrTK）体系联合survivin反义寡核苷酸（ASODN）对结直肠癌细胞（sw620）及血管内皮细胞（ECV304）的特异性杀伤作用。方法将质粒pAdEasy—KDR-CDglyTK在293细胞内包装、扩增产生重组腺病毒。体外感染表达KDR的SW620、ECV304细胞株,同时用survivin ASODN转染同一细胞株,观察腺病毒的感染效率和ASODN的转染情况。应用RT．PCR和Western印迹检测CDglyTK和survivin基因的表达．MTT法测定两者联合应用对细胞株的杀伤效应和旁观者效应。结果survivin ASODN可转染重组腺病毒感染的细胞,并且两者的转染及感染效率无明显变化。CDglyTK可在SW620、ECV304细胞株高效表达。survivin ASODN可明显降低survivin蛋白表达。各基因治疗组细胞存活率明显低于阴性对照组（P〈0．001）。survivinASODN与AdKDR—CDglyTK基因联用后。随着前药浓度的增加,细胞存活率迅速下降,两者联合作用与单一基因作用相比,差异具有统计学意义（P〈0．05）。但在GCV100μg／ml、5-FC 2000μg／ml时,联合基因治疗组细胞存活率略低于单用AdKDR-CDglyTK,两者间差异无统计学意义（P〉0．05）。Survivin ASODN和AdKDR—CDglyTK联合作用,在前药浓度较低时表现为协同效应,并具有更明显的旁观者效应。结论KDR启动子调控的AdKDR-cDglyTK体系和survivin ASODN基因联合,较单一基因具有更强的特异性杀伤结直肠癌细胞及血管内皮细胞的作用。     

联合基因靶向治疗对乳腺癌细胞及血管内皮细胞的特异性杀伤作用

目的探讨腺病毒介导血管内皮生长因子受体（KDR）启动子驱动的双自杀基因（CDglyTK）联合survivin反义寡核苷酸（ASODN）对乳腺癌细胞（MCF-7）及血管内皮细胞（ECV304）的特异性杀伤作用。方法将质粒pAdEasy—KDR—CD0yTK在293细胞内包装、扩增后,体外感染表达KDR的MCF-7和ECV304细胞株,同步用survivinASODN转染已感染腺病毒的MCF-7和ECV304细胞株,观察腺病毒的感染效率和survivinASODN的转染情况,应用逆转录聚合酶链反应（RT—PCR）和Western blot免疫印迹法检测CDglyTK和survivin基因在转基因MCF-7和ECV304细胞中的表达,MTT法测定两者联合应用对细胞的杀伤效应和旁观者效应。结果SurvivinASODN可转染重组腺病毒感染的细胞,并且survivinASODN的转染率及重组腺病毒的感染率均不受影响,CDglyTK可在两种细胞中高表达,survivinASODN可明显降低survivin蛋白表达。单一survivinASODN基因转染MCF-7和ECV304细胞后,细胞存活率为56．4％±3．8％和55．9％±3．6％,与AdKDR—CDglyTK基因联用后,随着丙氧鸟苷（GCV）和5-氟胞嘧啶（5-FC）浓度的增加,细胞存活率迅速下降,两者联合作用与单一基因作用相比,差异有统计学意义（P〈0．05）。但在GCV100μg／ml、5．FC2000μg／ml时,联合基因治疗组细胞存活率略低于单用AdKDR—CDglyTK组,两者差异无统计学意义（P〉0．05）。SurvivinASODN和AdKDR—CDglyTK联合作用在GCV、5-FC浓度较低时表现为协同效应,并具有更明显的旁观者效应。结论KDR启动子调控的CDglyTK融合基因体系和survivinASODN基因联合应用对乳腺癌细胞及血管内皮细胞具有显著的特异性杀伤作用。     

AdKDR-CDglyTK系统对结直肠癌细胞及血管内皮细胞的靶向杀伤作用

目的研究腺病毒介导的血管内皮细胞生长因子受体(KDR)启动子驱动CD/TK双自杀基因系统对血管内皮细胞及结直肠癌肿瘤细胞的选择性杀伤作用。方法质粒pAdEasy-KDR-CDglyTK和pAdEasy-CMV-CDglyTK在293细胞中包装、扩增后,体外感染表达KDR的ECV304、SW620细胞株和不表达KDR的LS174T细胞株,观察其感染效率并以RT-PCR方法检测转基因细胞CDglyTK的表达,然后给予不同浓度的前药5-氟胞嘧啶(5-FC)及更昔洛韦(GCV)处理,观察该体系对不同细胞株的杀伤效应及其旁观者效应。结果两种病毒滴度均为2.0×1012pfu/ml。两种重组体对各细胞株的感染率相似,其感染率随腺病毒滴度的增高而递增。RT-PCR方法检测发现:除感染AdKDR-CDglyTK的LS174T细胞外,感染AdCMV-CDglyTK的所有细胞及感染AdKDR-CDglyTK的其他两种细胞均有目的基因CDglyTK的表达。该体系治疗结果提示:(1)感染AdCMV-CDglyTK的所有细胞株和感染AdKDR-CDglyTK的ECV304、SW620细胞对前药具有较高的敏感性,且其敏感性差异无显著性意义(均P>0.05),与前两者相比感染AdKDR-CDglyTK的LS174T细胞对前药不敏感(均P<0.001);(2)双自杀基因的疗效优于任一单自杀基因的疗效(均P<0.001);(3)该体系旁观者效应明显。结论KDR基因启动子可调控双自杀基因系统选择性杀伤表达KDR的血管     

KDR启动子驱动的双自杀基因对实体瘤细胞及血管内皮细胞的靶向杀伤作用

目的腺病毒介导KDR启动子驱动的CDglyTK融合基因(AdKDRCDglyTK)体系对实体肿瘤细胞及血管内皮细胞靶向杀伤作用。方法分别将KDR和CMV启动子融合基因腺病毒体外感染表达KDR的ECV304、MCF7、MGC803及SW620细胞株和不表达KDR的LS174T细胞株,并给予不同浓度的前药5FC和/或GCV,观察其对各细胞株的杀伤效应及其旁观者效应。结果两种腺病毒对各细胞的感染率随腺病毒滴度的递增而增加,当MOI为200时,各细胞株均达约100%感染;感染AdCMVCDglyTK的各组细胞和感染AdKDRCDglyTK的ECV304、MCF7、MGC803及SW620对前药具有较高的敏感性,且其敏感性差异无统计学意义(P均>0.05);与其他细胞相比,感染AdKDRCDglyTK的LS174T细胞对前药不敏感(P<0.01);且观察到该体系明显的旁观者效应。结论KDR基因启动子调控的CDglyTK融合基因体系可选择性杀伤实体肿瘤细胞及血管内皮细胞。     

腺病毒驱动KDR启动子介导CD/TK融合基因系统对肝癌细胞的靶向杀伤作用

目的 研究腺病毒介导的KDR启动子驱动CD/TK双自杀基因系统（AdKDR- CDglyTK）对肝癌细胞选择性杀伤作用。方法 将质粒pAdEasy-KDR-CDglyTK在293细胞内包装、扩增后，体外感染表达KDR的BEL-7402细胞株和对照组不表达KDR的LS174T细胞株，并给予不同浓度的前药5-FC和/或GCV，观察该体系对不同细胞株的杀伤效应及其旁观者效应。结果 所得病毒滴度为2.5×10^12pfu/ml。两种细胞的感染率相似，其感染率随腺病毒滴度的递增而增加。RT-PCR方法 检测发现：感染AdKDR-CDglyTK的BEL-7402有目的 基因CDglyTK的表达，感染AdKDR- CDglyTK的LS174T细胞无目的 基因表达。表达KDR的BEL-7402细胞对前药具有较高的敏感性，不表达KDR的LS174T细胞对前药不敏感（F=750.03，P〈0.001）。融合基因的疗效优于任一单自杀基因（F=275.89，P〈0.05）。将感染腺病毒的细胞与未感染细胞以不同比例混合培养，观察到该体系明显的旁观者效应。结论 KDR基因启动子可调控双自杀基因系统选择性杀伤表达KDR的肝癌细胞。     

腺病毒驱动KDR启动子介导CD/TK融合基因系统对血管内皮细胞的靶向杀伤作用

目的　探讨腺病毒介导KDR启动子驱动的融合基因体系,对人脐血管内皮细胞ECV30 4的选择性杀伤作用。方法　将质粒pAdEasy -KDR- CDglyTK在2 93细胞内包装、扩增后,体外感染表达KDR的ECV30 4细胞株和不表达KDR的LS174T细胞株,并给予不同浓度的前药5 - 氟胞嘧啶(5 -fuorocytosine ,5 -FC)和/或丙氧鸟苷(ganciclovir,GCV) ,观察该体系对不同细胞株的杀伤效应及其旁观者效应;并以流式细胞仪检测细胞周期的变化,电镜观察细胞的病变。结果　所得病毒对两种细胞细胞的感染率相似,其感染率随腺病毒滴度的递增而增加;表达KDR的ECV30 4细胞对前药的具有较高的敏感性,不表达KDR的LS174T细胞对前药不敏感(P均<0 . 0 1) ;融合基因的疗效优于任一单自杀基因(P均<0 . 0 1) ;且观察到该体系明显的旁观者效应。流式细胞术检测治疗后ECV30 4细胞G1期比率增多及S期细胞减少(P均<0 . 0 1) ,同时,电镜下可见ECV30 4有凋亡和坏死改变。结论　KDR基因启动子可调控融合基因体系选择性杀伤人血管内皮细胞。     

腺病毒介导双自杀基因选择性杀伤血管内皮细胞

目的研究腺病毒介导的双自杀基因在KDR启动子调控下对血管内皮细胞的选择性杀伤作用。方法应用PCR扩增出KDR启动子序列,分别构建携带KDR启动子和巨细胞病毒(CMV)启动子调控下的CD与TK的融合基因的重组腺病毒AdKDR-CDglyTK、AdCMV-CDglyTK,体外感染脐静脉血管内皮细胞系HUVEC和结直肠癌细胞系LOVO细胞,利用重组病毒携带的GFP基因,在荧光显微镜下观测重组病毒的感染效率,并给予不同浓度的GCV和5-氟胞嘧啶(5-FC),观测杀伤作用,比较两种启动子的转录调控特性。结果成功构建了两种重组病毒,并高效地转染了HUVEC和LOVO细胞。两种重组病毒对两种细胞的转染效率相似,并随重组病毒的感染复数MOI(multiplicityofinfection)增加而升高;以MOI=100的两种病毒分别转染的两种细胞表现出对前药的不同敏感特性:转染了AdCMV-CDglyTK的HUVEC和LOVO细胞以及转染了AdKDR-CDglyTK的HUVEC细胞,对前药的敏感性差异无显著性意义(P>0.05);转染了AdKDR-CDglyTK的LOVO细胞,对前药敏感性低,与其他3组比较,差异存在显著性意义(与其他3组两两间比较,P均<0.001)。结论KDR基因启动子可调控双自杀基因在血管内皮细胞中的特异性表达,有利于实现双自杀基因靶向恶性肿瘤血管内皮细胞的抑癌疗法。     

AdKDR-CDglyTK融合基因系统治疗胰腺癌的实验研究

目的 观察腺病毒介导的KDR启动子驱动的CD/TK融合双自杀基因系统(以下简称为AdKDR-CDglyTK)对胰腺癌的治疗作用.方法 采用培养细胞移植法,将人胰腺癌细胞系Capan-2接种于裸鼠背部皮下,建立裸鼠人胰腺癌移植瘤模型.将20只裸鼠随机分为4组,每组5只.分组方法:Ⅰ组:注射重组腺病毒AdKDR-CDglyTK与前药5-FC与GCV;Ⅱ组:仅注射前药5-FC与GCV;Ⅲ组:仅注射重组腺病毒AdKDR-CDglyTKⅣ组:空白对照,不施加任何处理.重组腺病毒AdKDR-CDglyTK采用瘤体内多点注射,5-FC与GCV给药方法采用腹腔内注射的方法,观察各组小鼠的生存状况及肿瘤体积、瘤重、肿瘤生长抑制率、常规病理等指标;应用透射电镜观察细胞超微结构,用TUNEL法检测细胞凋亡率,比较观察各治疗组的治疗效果;并对各组的肿瘤组织行RTPCR的检测,以了解有无双自杀基因CDglyTK的表达.结果 第Ⅰ组裸鼠移植瘤的生长显著受到抑制,第Ⅱ、Ⅲ、Ⅳ组肿瘤生长情况无明显差别.第Ⅰ组肿瘤细胞凋亡指数为(34.20±4.60)%,较对照组显著增加(P=0.00).结论 AdKDR-CDglyTK联合前药5-FC及GCV对人胰腺癌Capan-2细胞具明显的抑制作用,并且诱导裸鼠体内人胰腺癌Capan-2细胞的凋亡.其可能的机制是通过下调凋亡抑制基因Bcl-2的表达.     

腺病毒介导胞嘧啶脱氨酶基因对直肠癌细胞的杀伤作用

目的 探讨腺病毒载体介导的胞嘧啶脱氨酶（CD）基因转染和CD/5-FC对直肠癌细胞的杀伤作用。方法 用重组腺病毒介导外源CD基因转移到人直肠癌细胞株HR-8348,通过检测腺病毒的转导效率,CD基因表达,以及集落形成实验,细胞存活率测定,裸鼠移植癌治疗实验,观察分析CD/5-FC对癌细胞的杀伤作用,结果 重组腺病毒介导CD基因转染,在癌细胞中得到高效表达。CD/5-FC系统对转染含CD重组腺病毒HR-8348细胞的集落形成,细胞生长均有明显的抑制作用,而对无CD基因转染癌细胞无影响,在转染和未转染CD基因的HR-8348混合体系中,CD/5-FC除了杀伤转染CD基因的癌细胞外,对周围的无CD转染癌细胞也有明显的杀伤作用。表现出很强的“旁观者效应”。裸鼠皮下移植癌治疗实验结果表明,CD/5-FC对HR-8348实体癌生长抑制率为71.5%。结论 CD/5-FC对腺病毒介导CD基因转染的直肠癌细胞有很强的杀伤作用和显著的“旁观者效应”。     

腺病毒介导自杀基因对消化系统肿瘤的杀伤作用

目的观察腺病毒介导的自杀基因对消化系肿瘤的杀伤作用。方法腺病毒介导的自杀基因HSV-TK分别转染结肠癌LOVO细胞、胃癌MGL-803细胞和肝癌BEL-7402细胞,比较腺病毒载体对不同肿瘤细胞的转染效率。加入前药丙氧鸟苷(GCV),通过MTT法检测细胞存活率,观察单纯疱疹病毒1型胸苷激酶/丙氧鸟苷(HSV-TK/GCV)系统对不同肿瘤细胞的杀伤作用和旁观者效应。结果在GCV浓度100mg/L以上时,3种转基因肿瘤细胞均可被HSV-TK/GCV系统完全杀伤;旁观者效应以MGL-803细胞最为明显,与LOVO细胞和BEL-7402细胞相比,差异有显著性意义(P<0.05);腺病毒对肿瘤细胞的转染效率强弱依次为BEL-7402细胞、MGL-803细胞和LOVO细胞。结论重组腺病毒可以作为消化系肿瘤基因治疗的高效载体。HSV-TK/GCV系统对胃癌MGL-803细胞的作用最佳。     

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.     

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.