生长激素抗肝纤维化的作用及其机制

目的　探讨重组人生长激素 (rhGH)对肝硬化大鼠在肝功能、门静脉高压等方面的治疗作用及其可能的机制。方法　雄性SD大鼠建立肝硬化模型 ,随机分组 ,分别给予NS、rhGH (333ng/KgBW ,ip ,qd× 7d)处理。 结果　rhGH处理前后肝硬化肝组织GHR的配体结合容量 [fmol/mg ,(31± 4 )vs .(4 0± 7) ]及其mRNA量 (iOD ,pixel)均显著升高 (2 3± 3)vs.(4 2± 8) ;P <0 0 5 ,肝硬化大鼠血清白蛋白 (g/L )显著升高 (2 9± 4 )vs .(37± 7) ;P <0 0 5、ALT活性 (U/L)显著降低 (89± 15 ,6 9± 7;P <0 0 5 ) ,肝硬化肝组织丙二醛含量 (nmol/mg)显著降低 (18 7± 3 2 ,12 0± 2 2 ;P <0 0 5 )、超氧化物歧化酶活性 (U/mg)显著升高 (82 4± 10 8,10 2 9± 76 ;P <0 0 5 )、胶原纤维相对含量 (% )显著降低 (2 2 30± 3 86vs.14 70± 2 0 7;P <0 0 5 ) ,肝硬化大鼠的门静脉压 (cmH2 O)亦显著降低 (14 4± 2 0vs.9 3± 1 5 ;P <0 0 5 )。结论　药理剂量的rhGH能够促进肝硬化大鼠的白蛋白合成、改善肝细胞功能 ,有助于抑制肝组织纤维化、缓解门静脉压力。     

丙氨酰-谷氨酰胺对外科危重患者术后免疫功能的影响

目的　研究丙氨酰 谷氨酰胺 (Ala Gln)对外科危重患者术后免疫功能的影响。方法　将 3 0例外科急症大手术后APACHEⅡ评分大于 12分的患者随机分成实验组和对照组。两组均于术后给予常规外科治疗并于术后第 1～ 3天输入全营养混合液 ,其中实验组的部分氮量由 2 0 %L 丙氨酰 L 谷氨酰胺双肽注射液按每天 0 .5 g/kg体重提供 ,余部分氮量由氨基酸溶液供给。对照组仅用氨基酸溶液为氮源。分别取治疗前 (术后第 1天 )及治疗后第 7天的外周血标本测量CD3 、CD4、CD8、CD4/CD8、IgG、IgA、IgM、总淋巴细胞计数 (TLC)。 结果　实验组IgG、IgA治疗后 ( 14 .12± 3 .70 ) g/L、( 3 .5 1± 1.10 ) g/L较治疗前 ( 9.19± 4.10 )g/L、( 2 .49± 1.2 0 ) g/L显著升高 (P <0 .0 1) ;TLC( 1.13±0 .87)× 10 9/L较治疗前 ( 1.0 3± 0 .79)× 10 9/L显著升高 (P <0 .0 5 )。结论　丙氨酰 谷氨酰胺强化的肠外营养能提高外科危重患者术后免疫球蛋白和淋巴细胞计数 ,提高免疫功能。     

异丙酚与依托咪酯麻醉诱导中血皮质醇和血糖变化的临床研究

目的 :观察异丙酚与依托咪酯麻醉诱导过程中血糖和皮质醇的变化 ,以评价两药物对应激反应的抑制作用。方法 :40例ASAⅠ～Ⅱ级行腹腔镜下胆囊切除术患者 ,随机分为异丙酚组 (A组 ,n =2 0 )和依托咪酯组 (B组 ,n =2 0 )。麻醉诱导A组异丙酚 2mg/kg、B组依托咪酯 0 4mg/kg ,加用芬太尼 2 μg/kg、阿曲库铵 0 5mg/kg。结果 :(1)诱导后血糖A组由 4 5 9± 0 6 7mmol/L增至 4 93± 0 6 3mmol/L ;B组由 5 0 4± 0 5 0mmol/L增至 5 6 7± 0 80mmol/L(P <0 0 5 )。 (2 )血皮质醇A组由 13 6± 5 17μg/L降至 10 4± 5 5 6 μg/L ;B组由 12 3± 5 18μg/L降至 8 37±4 13μg/L(P <0 0 5 )。 (3)诱导后 5分钟 ,A组BP、HR均明显下降 (P <0 0 5 ) ;而B组则上升 (P <0 0 5 ) ,10分钟后恢复至诱导前水平。结论 :异丙酚与依托咪酯均能抑制麻醉插管时的应激反应 ,但异丙酚比依托咪酯更为有效     

远端逆蠕动空肠囊代胃术的临床研究

目的 :比较两种全胃切除术后消化道重建术式的临床应用效果。方法 :两组患者分别行P式Roux en Y食管—空肠吻合术 (P组 )和远端逆蠕动空肠囊代胃术 (D组 ) ,对两组的营养状态、手术效果进行对比研究。结果 :P组手术后 1年体重、血红蛋白、血浆总蛋白和白蛋白分别为 (5 2 .5± 3.8)kg、(98.0± 6 )g/L、(5 2 .0± 2 ) g/L、(2 8.0± 3) g/L ;D组则分别为 (5 9.2± 4 .8)kg、(12 1.0± 5 )g/L、(6 2 .0±4 ) g/L、(35 .4± 2 ) g/L。两组患者各指标差异均有统计学意义 (P <0 .0 5 )。 结论 :远端逆蠕动空肠囊代胃术术后全身营养状况均明显优于传统的Roux en Y吻合术 ,且操作简便 ,不失为一种较好的全胃切除消化道重建术式     

吻合口漏患者结肠组织中基质胶原代谢异常的研究

目的探讨结肠术后患者吻合口漏与结肠组织中基质胶原代谢的关系。方法通过生物化学方法测定 16例吻合口漏患者和 16例对照组患者结肠组织中基质胶原的总量并通过免疫组化分别测定基质胶原Ⅰ ,Ⅲ和基质胶原酶 1,基质胶原酶 13的含量。结果吻合口漏组结肠组织基质胶原的总量和基质胶原Ⅰ ,Ⅲ含量远低于对照组 (t=3 417,t=2 841,t =2 2 6 1,P <0 0 1)。吻合口漏组分别为 (2 2 6± 0 34 ) μg/mg ,(1 0 8± 0 2 3)p·μm2 和 (1 11± 0 2 6 )p·μm2 ,而对照组分别为 (3 33±0 41) μg/mg ,(1 6 3± 0 31)p·μm2 和 (1 39± 0 37)p·μm2 。且基质胶原Ⅰ /Ⅲ的比值吻合口漏组也低于对照组 (t=1 938,P <0 0 5 ) ,分别为 0 97± 0 2 5和 1 17± 0 2 4。吻合口漏组 16例中有 13例基质胶原酶 13阳性 ,而对照组 16例中仅 2例阳性 (χ2 =12 74,P <0 0 1)。结论吻合口漏的发生与术前结肠组织中基质胶原的数量和质量相关 ,可能与基质胶原酶 13的异常表达有关     

联合应用谷氨酰胺和重组人生长激素对严重烧伤患者蛋白代谢的影响

目的　探讨联合应用谷氨酰胺 (Gln)和重组人生长激素 (rhGH)对严重烧伤患者蛋白代谢的影响。　方法　将 6 0例严重烧伤患者随机分为对照组、Gln组及Gln rhGH组 ,每组 2 0例。对照组患者于伤后 1～ 14d口服甘氨酸作为安慰剂 ,并行常规治疗 ;Gln组于伤后 1～ 14d口服Gln 0 5g·kg-1·d-1;Gln rhGH组患者口服Gln(剂量、时间同Gln组 ) ,且伤后 7～ 14d皮下注射rhGH 0.2U·kg-1·d-1。3组患者于伤后 1、7、14d检测其血浆Gln浓度 ,伤后 14、2 1d检测血浆白蛋白水平 ,记录伤后 30d创面愈合率和总住院日。　结果　Gln rhGH组伤后 7d血浆Gln浓度为 ( 4 5 2 .2 8± 2 1.72 )μmol/L,高于对照组 ( 32 5 .12± 2 5 .34) μmol/L(P <0.0 5)。伤后 2 1dGln rhGH组血浆白蛋白水平为( 31.37± 4 .31) g/L,高于对照组 ( 2 6 .16± 3.12 ) g/L及Gln组 ( 2 8.2 6± 3.2 9)g/L( P <0 0 5 )。伤后 30dGln rhGH组创面愈合率高于对照组及Gln组 ,而总住院日少于对照组及Gln组 (P <0.0 5或 0 .0 1)。　结论　联合应用Gln和rhGH能显著提高严重烧伤患者血浆Gln水平 ,促进机体蛋白的合成 ,提高创面愈合率。     

一氧化氮对术后腹膜粘连作用的实验研究

目的研究一氧化氮 (NO)在预防大鼠术后腹膜粘连中的作用。方法 40只大鼠统一制作腹膜粘连模型 ,随机分为对照组和左旋精氨酸组。术后分别腹腔内注射 0 9%NaCl和左旋精氨酸 ,连续 3d。术后 3d随机抽取部分大鼠血样测定NO ,同时取材作病理检查。其余大鼠 2周后乙醚处死开腹观察并记录粘连情况。结果对照组的粘连分级 (3 7± 0 7)重于左旋精氨酸组 (0 9±1 1) ,t=8 6 ,P <0 0 1。对照组血中NO的水平为 (13 9± 1 1) μmol/L ,低于左旋精氨酸组 (32 2± 2 8)μmol/L ,t=2 0 4,P <0 0 1。左旋精氨酸组粘连组织中诱导型一氧化氮合酶 (iNOS)的免疫组化染色分级为 2 5± 0 7强度高于对照组 (0 8± 0 4) ,t=11 1,P <0 0 1。结论一氧化氮在腹膜粘连的预防中起重要作用     

前列腺活检对血清T-PSA F-PSA及F/T比值的影响

目的 :研究经直肠前列腺穿刺活检对血清总前列腺特异抗原 (T PSA)、游离前列腺特异抗原 (F PSA)及游离 /总前列腺特异抗原 (F/T)比值的影响。方法 :对 36例前列腺活检示良性病变的患者 ,分别于活检前及活检后 0 .5h、1周、30d检测T PSA、F PSA值 ,并计算F/T比值。结果 :活检前及活检后 0 .5h、1周、30d患者血清T PSA分别为 (11.76± 7.82 ) μg/L、(36 .90± 2 4 .76 ) μg/L、(2 4 .36± 16 .18) μg/L和 (12 .2 1± 6 .4 9) μg/L ;F PSA分别为 (2 .4 1± 0 .96 ) μg/L、(2 5 .14± 12 .5 6 ) μg/L、(4 .0 2± 1.90 ) μg/L和 (2 .6 1± 0 .87) μg/L ;F/T比值分别为 0 .2 1± 0 .0 6、0 .6 8± 0 .18、0 .15± 0 .0 4和 0 .2 2± 0 .0 5。与活检前相比 ,活检后 0 .5h、1周T PSA、F PSA值显著升高 (P <0 .0 1、P <0 .0 5 ) ;F/T比值活检后 0 .5h显著升高 (P <0 .0 1) ,活检后 1周时显著降低 (P <0 .0 5 ) ;活检后 30d时 ,以上指标与活检前相比 ,差异均无统计学意义 (均P >0 .0 5 )。结论 :前列腺穿刺活检 ,会导致血清T PSA、F PSA及F/T比值的显著升高 ,临床上要获得有意义的PSA的指标 ,最好在活检 30d后检测     

腹部创伤患者术后肠内与肠外营养支持对肠道通透性及全身炎性反应的影响

目的测定腹部创伤患者术后甘露醇 (mannitol,M)和乳果糖 (lactulose ,L)吸收的浓度变化 ,观察肠内营养 (EN)、胃肠外营养 (PN)对肠道通透性及全身炎性反应影响。方法 30例患者随机分为PN和EN组 ,每组 15例 ,计算手术第 1、3、5、7天L M和APACHEⅡ评分。结果PN组L M第5天最高 (0 0 6 1± 0 0 0 2 ) ,与手术第 1天比较 ,差异有显著意义 (P <0 0 5 ) ,APACHEⅡ评分在第 3天最高 ,为 (17 6± 1 8)分 ,较手术第 1天差异有显著意义 (t=2 316 ,P <0 0 5 ) ,L M与APACHEⅡ评分正相关 (r=0 745 ,t=2 2 35 ,P <0 0 5 )。EN组L M第 3天 (0 0 47± 0 0 0 4) ,较手术第 1天差异有显著意义(t=2 35 2 ,P <0 0 5 ) ,APACHEⅡ评分第 3天最高 ,为 (15 9± 2 3)分 ,较术后第 1天差异有显著意义(t=2 35 2 ,P <0 0 5 ) ,L M比值与APACHEⅡ评分正相关 (r =0 730 ,t=2 375 ,P <0 0 5 )。结论与PN相比 ,EN能改善肠道粘膜通透性 ,降低创伤后全身炎性反应     

血清IGF-1和IGFBP-3检测在前列腺癌和前列腺增生诊断中的临床意义

目的 :探讨胰岛素样生长因子 1(IGF 1)、胰岛素样生长因子结合蛋白 3(IGFBP 3)对前列腺癌 (PCa)早期诊断的临床意义。方法 :采用免疫放射分析法 (IRMA)检测 32例PCa、33例良性前列腺增生 (BPH)患者和 18例健康人血清IGF 1、IGFBP 3水平。结果 :PCa组血清IGF 1为 (4 89.9± 171.9) μg/L ,明显高于BPH组 (2 81.2±70 .4 ) μg/L和健康组 (2 5 9.6± 6 4 .8) μg/L ,差异有统计学意义 (P <0 .0 1) ,BPH组与健康组比较差异无统计学意义(P >0 .0 5 )。PCa组血清IGFBP 3为 (6 8.1± 12 .6 ) μg/L ,明显高于BPH组 (5 1.1± 8.8) μg/L和健康组 (4 8.9± 8.1)μg/L ,差异有统计学意义 (P <0 .0 1) ,BPH组与健康组比较差异无统计学意义 (P >0 .0 5 )。结论 :IGF 1、IGFBP 3有可能成为临床上检测PCa的新的瘤标。     

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.     

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.     

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.     

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.     

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.