静息态fMRI评估急性酒精暴露对恒河猴脑功能的影响

目的采用静息态fMRI基于分数低频振荡幅度(fALFF)方法评估急性酒精暴露后恒河猴脑功能改变。方法分别对7只健康雄性恒河猴于静脉注射酒精前及注射后10、28、46min进行BOLD fMRI序列及3D结构像扫描,采用fALFF算法获得并比较4个时间点fALFF差异的脑区。结果 4个时间点fALFF总体差异显著的脑区为右侧中央后回、右侧岛叶、右侧小脑、左侧海马旁回、双侧额下回、小脑蚓部、右枕叶、楔前叶、左侧缘上回(P均0.05);静脉注射酒精后fALFF值减低的脑区为双侧额上回、右侧额下回、右侧梭状回、右侧角回、双侧颞上回、右枕叶、左侧外侧沟、左侧中央后回、左侧楔状叶、左侧丘脑、左侧岛叶、前扣带回(P均0.05);静脉注射酒精后fALFF值增高的脑区为右侧额下回、右侧颞中回(P均0.05)。结论酒精暴露急性期脑代谢活动发生显著变化,主要涉及默认网络、奖赏及情绪加工系统、视听皮层等。     

前庭功能的静息态脑功能磁共振成像

目的探讨基于局部一致性(ReHo)、低频振幅(ALFF)和低频振幅分数(fALFF)的静息态脑fMRI技术对于前庭冰水刺激诱导后脑内前庭功能相关区域的BOLD信号变化。方法纳入20名正常志愿者,在10s内将15ml 0℃冰水注入受试者右侧外耳道,采用平面回波序列和32通道头线圈采集受试者的BOLD静息态脑功能成像数据,采用MatLab 7.1和SPM 8进行数据预处理,预处理后的数据采用REST 1.4软件计算获得ReHo、ALFF和fALFF图像。结果ReHo、ALFF和fALFF图像均出现多个脑区激活增加或减低,其中3个参数值增加即激活脑区主要包括岛叶皮层、颞上回、顶下小叶、脑干、海马旁回、小脑半球等,减低即负激活脑区主要包括额上回、额中回、额下回、颞中回、枕下回、楔前叶等。结论人类存在广泛的涉及前庭信息处理的脑皮层及皮层下网络区域,静息态脑功能成像ReHo、ALFF、fALFF分析方法具有较好的一致性,具备定位前庭功能区的潜在能力。     

基于分数低频振幅观察长时程电刺激诱发健康人肢体麻木后脑功能变化

目的 利用静息态功能MRI(rs-fMRI)分数低频振幅（fALFF）观察长时程电刺激（LTES）诱发健康人肢体麻木感后不同脑区功能变化。方法 前瞻性对27名健康人以LTES诱发单侧肢体麻木感,每日1次、每次30 min,持续1周;分别于开始刺激前日及末次刺激次日采集脑rs-fMRI,并于予5 min短时程电刺激后要求受试者采用视觉模拟评分法（VAS）对麻木感进行评分。比较LTES前、后各脑区fALFF,针对存在显著差异脑区分析其fALFF值变化及其差值与VAS评分差值的相关性。结果LTES后双侧顶上小叶、右侧颞中回、左侧海马旁回及右侧缘上回fALFF值降低,而双侧伏隔核、右侧中央后回、左侧小脑及右侧壳核fALFF值升高（P均<0.05）。LTES前、后左侧顶上小叶fALFF差值与VAS评分差值呈负相关（r=-0.422,P=0.029）。结论 LTES所诱发的肢体麻木感涉及感觉运动皮层及情绪等相关脑区,尤以左侧顶上小叶最为重要。     

MR磁化传递对比成像观察新生儿轻度窒息

目的观察MR磁化传递对比(MTC)成像在轻度窒息新生儿中的应用价值。方法对15例轻度窒息新生儿(Apgar评分10分,病例组)及25名正常新生儿(对照组)采集脑常规T1WI、3D-T1WI和T1WI-MTC,计算脑磁化率(MTR),配准于标准新生儿脑模板后行统计分析。采用3dRegAna对病例组MTR与Apgar评分进行回归分析。结果相比对照组,病例组右颞极、左颞下回、左额上回、右缘上回、右眶额皮质、左额中叶、右额中回及左上额叶MTR显著降低;右梭状回、右顶叶下回、右枕中回、右颞中回、右颞下回、右颞上极、右楔叶、右角回、右舌回及右颞上回MTR显著增加。回归分析显示,病例组左中央后回、右颞下叶(前)、右额中回、右颞上极、左眶额皮质及右颞下叶(后)MTR与Apgar评分呈正相关,右壳核、右眶额皮质、左杏仁核、右颞下回、左舌回、右舌回、左颞中回、左枕中回、延髓及右梭状回呈负相关。组间MTR差异有统计学意义、且病例组MTR与Apgar评分呈正相关脑区为右额中叶、右颞极,呈负相关脑区则为右舌叶及右梭状回。结论 MR MTC成像能检出轻度窒息新生儿缺血缺氧脑区;缺血缺氧主要导致新生儿右侧脑损害。     

心律失常射频消融术后焦虑状态患者的静息态MRI低频振幅分析

目的采用低频振幅(ALFF)观察心律失常射频消融术后出现焦虑状态患者的全脑功能活动。方法收集符合纳入标准的26例心律失常射频消融术(RFCA)后焦虑状态患者作为RFCA组,纳入同期年龄、性别相匹配的26名健康志愿者作为正常对照组,2组均行fMRI,对2组有差异脑区的ALFF进行双样本t检验,提取有差异的脑区与汉密尔顿焦虑量表评分进行偏相关分析。结果与正常对照组相比,RFCA组左侧颞中回、右侧壳核、左侧杏仁核ALFF增高,左侧前额叶背外侧皮层(DLPFC)、右侧楔前叶、左侧额中叶、右侧枕中叶ALFF减低差异有统计学意义(Alphasim校正,P0.01)。左侧DLPFC的ALFF值与HAMA评分呈负相关(r=-0.872,P=0.013)。结论心律失常射频消融术后焦虑状态患者在静息状态下存在脑功能的异常,ALFF有助于为该疾病的发病机制提供更多证据。     

针刺治疗老年轻度脑外伤后认知功能障碍的静息态功能磁共振研究

目的利用静息态功能磁共振(rs-fMRI)评估醒脑开窍针刺法对老年轻度脑外伤(mTBI)后认知功能障碍的治疗作用。方法选20例老年mTBI患者为治疗组,20例健康老人为对照组,治疗组在针刺前后行rs-fMRI扫描及蒙特利尔认知评估量表(MoCA)评估,采用比率低频振幅(fALFF)方法,比较治疗组在治疗前后及与对照组之间脑功能的差异。结果老年mTBI组MoCA评分比对照组显著降低,且双侧额叶和顶叶、左侧角回和颞叶等区域fALFF降低;针刺后MoCA评分比针刺前显著升高,双额叶部分区域fALFF值升高。结论老年mTBI后出现多个脑区功能异常,或与认知受损相关,醒脑开窍针刺法可影响双额叶部分区域脑功能,对老年mTBI后认知功能障碍有治疗作用。     

利用静息态功能磁共振探究颈动脉狭窄患者的认知障碍研究

目的采用静息态功能磁共振成像探讨无症状严重颈动脉狭窄患者产生认知障碍的机制。方法对2016年1月至2018年06月南京大学医学院附属鼓楼医院血管外科收治的21例无症状严重颈动脉狭窄患者和招募的21名健康人为对照组行认知量表评估和静息态磁共振检查,前瞻性分析两组人群的认知水平与影像数据的差异。结果患者组简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分明显低于对照组,差异具有统计学意义(P0.001)。与对照组相比,患者组在右脑内侧额上回处低频振幅(ALFF)水平增加,在舌回处ALFF减少;在左侧额下回低频振幅比率较对照组增加;在颞上回局部一致性(ReHo)值较对照组增加,在右侧枕下回ReHo减少。患者组在右背外侧额上回与后扣带皮层的相关性显著低于对照组。影像学差异和认知评分之间没有显着相关性(P0.05)。结论无症状严重颈动脉狭窄存在不同程度的认知障碍,右内侧额上回、左侧额下回、颞上回、右背外侧额上回在与颈动脉狭窄相关的认知障碍的发生中可能起着重要的作用。     

颈性眩晕患者脑功能改变的磁共振研究

目的采用脑功能磁共振技术探讨颈性眩晕患者脑功能的改变情况。方法前瞻性研究2015年6月至2016年6月临床诊断为颈性眩晕患者22例的相关资料,并纳入同期25例健康成年人作为对照。采用眩晕可视化评分(visual analogue scale,VAS)和眩晕残障程度评定量表(dizziness handicap inventory,DHI)评估眩晕严重程度,采用6分分类法评估眩晕的发生频率。对两组受试者进行脑部MR扫描,采集两组受试者脑功能MRI数据,数据分析采用低频振荡振幅(amplitude of low-frequency fluctuations,ALFF)技术,用于评估患者脑功能局部改变情况。将颈性眩晕组和健康对照组的ALFF值进行独立样本t检验;采用REST软件包提取异常脑区的ALFF值,运用Pearson相关性分析探讨脑功能改变与眩晕病程和眩晕严重程度之间的相关性。结果与健康对照组相比,颈性眩晕患者左侧颞上回(体素数=45,t=-3.36)、右侧颞上回(体素数=32,t=-2.82)和左侧缘上回(体素数=57,t=-4.85)区域的ALFF值降低,而左侧小脑(体素数=41,...     

早泄患者右侧大脑半球网络介数中心性与射精功能的相关性

目的:通过对早泄患者脑白质网络节点与边的介数中心性(BC)拓扑属性值的探讨,分析关键脑区及脑区间白质结构连接重要性与患者射精功能的相关性。方法:收集18例早泄患者和22例年龄、学历匹配的正常对照者的一般人口学及临床资料,并采集其大脑T1相结构数据与弥散张量成像(DTI)扫描数据;预处理所有被试T1与DTI数据,使用解剖学自动标记模板(AAL)将大脑分割为90个左右对称的皮质与皮质下区域(定义为脑网络节点),并通过概率性脑白质纤维追踪技术计算不同脑区之间的结构连接(定义为脑网络节点之间的边),同时基于脑连接工具箱(BCT)计算被试脑白质网络节点与边的介数中心性拓扑属性值,最后对节点与边介数中心性属性值进行组间Mann-Whitney U检验,并对统计结果进行错误发现率(FDR)校正,同时对组间差异属性值和患者射精功能进行Pearson相关性分析。结果:①患者组脑白质网络右侧枕上回介数中心性属性值较对照组显著下降(67.78±58.98 vs 281.18±255.26,Z=-3.49,校正后P0.05)。②患者组脑白质网络右侧颞上回介数中心性属性值较对照组显著上升(557.00±322.65 vs 222.91±155.60,Z=3.55,校正后P0.05)。③患者右侧罗兰多壳盖与右侧脑岛之间白质结构连接介数中心性属性值较对照组显著上升(23.83±23.91 vs 4.23±8.39,Z=3.84,校正后P0.05)。④患者组右侧枕上回介数中心性属性值与其性生活时延迟射精的困难程度评分呈负相关(r=-0.51,P=0.03),与其射精发生在想射精之前几率呈负相关(r=-0.61,P=0.01);患者组右侧颞上回介数中心性属性值与其射精太早困扰程度评分呈正相关(r=0.54,P=0.02),与其担心射精时间可能让配偶不满程度评分(r=0.47,P=0.04)呈正相关。结论:早泄患者右侧大脑半球与视觉、情绪相关的皮质出现结构连接的紊乱,其可能参与患者射精过快或射精控制力下降症状的发生,同时可能导致患者出现一系列心理问题。     

丙泊酚人脑中枢作用部位的功能磁共振成像分析

目的应用功能磁共振成像技术（fMRI）研究丙泊酚对健康志愿者脑不同部位功能变化的影响,探索丙泊酚在脑内的可能作用部位。方法采用丙泊酚静脉麻醉的刺激程序：清醒-镇静-意识消失-苏醒的动态过程,丙泊酚麻醉按1．5mg／kg通过恒速泵静脉注射,注射时间均为90s。采用1．5T Philips Gyroscan磁共振系统,运用单次激发平面回波序列（EPI）扫描序列进行脑功能血氧水平依赖（BOI．D）法成像并应用Functool软件进行功能分析。结果丙泊酚麻醉可抑制下丘脑磁共振信号,r值为0．75,信号变化强度为（20．2±11．6）％;可降低额叶信号,r值为0．71,信号降低强度为（37．5±16．7）0A;颞叶信号也受到抑制,r值为0．72,信号变化强度为（33．8±10．4）％。三个部位信号的抑制呈爆发性,变化过程同步,信号降低强度额叶〉颞叶〉下丘脑,但三者间差异无统计学意义。丘脑部位信号也明显降低,r值为0．60,信号变化强度为（3．9±1．6）％,与额叶、颞叶、下丘脑相比,差异均有统计学意义（P〈0．05）。结论丙泊酚麻醉首先抑制下丘脑、额叶、颞叶区域,随后丘脑区域受到抑制,这些区域可能是丙泊酚麻醉作用的靶位。     

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.     

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.     

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.