负压组合式输尿管镜联合输尿管软镜与经皮肾镜治疗复杂性肾结石的比较

目的 比较负压组合式输尿管镜联合输尿管软镜与经皮肾镜处理复杂性肾结石的优劣性。方法 回顾性收集2020年1月至2022年12月东莞市厚街医院复杂性肾结石患者的资料,根据结石大小1:1倾向性匹配后分为两组,各48例。研究组行负压组合式输尿管镜治疗,对照组行经皮肾镜治疗。比较两组结石大小、术后结石清除率、手术前后肾功能、血清炎症因子水平变化和术后并发症发生率。结果 研究组与对照组比较,结石大小分别为[（23.9±2.9） mm vs (24.4±3.0)mm,P=0.399];结石清除率分别为95.83%vs81.25%,P=0.025;术中出血量[（10.4±3.0）ml vs (61.2±10.1)ml,P<0.001];术后CRP两组分别为[（13.1±1.4）mg/Lvs (16.5±1.5)mg/L,P<0.001];术后PCT为[（0.586±0.145） ng/ml vs (0.855±0.149)ng/ml,P<0.001];围手术期总并发症发生率4.17%vs 22.92%,P=0.025,但研究组有1例发生输尿管损伤,放置输尿管支架管痊愈。术后随访1年...     

输尿管软镜与微通道经皮肾镜治疗2～3cm肾盂结石的疗效分析

目的比较电子输尿管软镜下钬激光碎石术(FURS)和微通道经皮肾镜下钬激光碎石术(MPCNL)治疗单发2~3 cm肾盂结石的疗效。方法回顾性分析南京中医药大学附属张家港市中医医院泌尿外科2015年1月至2016年8月收治的56例单发2~3 cm的肾盂结石患者病例资料,32例采用电子输尿管软镜钬激光碎石术(软镜组),24例采用微通道经皮肾镜钬激光碎石术(肾镜组),比较两组手术时间、结石清除率、降钙素原和C反应蛋白的上升量、并发症率、住院时间、治疗费用。结果两组患者性别、年龄、结石最大径、结石负荷比较差异无统计学意义(P0.05)。软镜组结石清除率90.6%(29/32),降钙素原(0.9±0.2)μg/L,C反应蛋白(19.6±0.3)mg/L,并发症1例,肾镜组结石清除率91.7%(22/24),降钙素原(0.8±0.3)μg/L,C反应蛋白(19.3±0.7)mg/L,并发症4例,差异均没有统计学意义(P0.05)。软镜组手术时间(98.3±12.1)min,术后住院时间(5.1±1.6)d,总费用(3.3±0.6)万元;肾镜组手术时间(54.2±7.7)min,术后住院时间(9.3±1.7)d,总费用(2.5±0.8)万元,差异均有统计学意义(P0.05)。结论与经皮肾镜相比较,电子输尿管软镜钬激光碎石术治疗单发2~3 cm肾盂结石安全有效。     

微通道经皮肾镜与组合式输尿管软镜碎石术治疗肾结石比较性研究

目的 比较微通道经皮肾镜与组合式输尿管软镜碎石术两种方式治疗肾结石的疗效和并发症.方法 100例体外冲击波碎石无效的肾结石患者,分为两组,51例患者行微通道经皮肾镜碎石术,49例患者行组合式输尿管软镜碎石术,比较两组患者的手术时间、术中出血量、术后并发症、术后住院时间、术后清除率.结果 51例微通道经皮肾镜组手术时间(53.5±19.6)min,术中出血(75.0±18.5) mL,术后住院时间为(8.0±1.5)d;术后总并发症发生率80.4％:47例结石清除,总清石率为92.16％.49例输尿管软镜组手术时间为(49.0±25.6)min,术中出血(15.2±2.9) mL,术后住院时间为(4.5±0.6)d;术后总并发症发生率为30.6％;32例结石清除,总清石率为65.31％.两者比较手术时间无明显差别;术中出血量、术后住院时间、术后并发症发生率、总清石率微通道经皮肾镜组大于组合式输尿管软镜组;但分组分层发现在多部位、多发结石方面清石率组合式输尿管软镜组优于微通道经皮肾镜组.结论 微通道经皮肾镜在治疗结石负荷＜2 cm、下盏结石、单个结石优于组合式输尿管软镜,但在多部位、多发结石方面清石率组合式输尿管软镜优于微通道经皮肾镜.     

组合式输尿管软镜与电子输尿管软镜治疗10～20mm肾下盏结石的临床疗效比较

目的比较组合式输尿管软镜与电子输尿管软镜联合钬激光治疗10～20mm肾下盏结石的临床疗效。方法回顾性纳入2017年8月至2018年7月符合标准的87例经输尿管软镜联合钬激光治疗10～20mm肾下盏结石患者。其中经组合式输尿管软镜治疗的患者41例(组合式输尿管软镜组,本文称为PolyScope组),经电子输尿管软镜治疗的患者46例(电子输尿管软镜组,称为URF-V组)。比较2组患者在寻石成功率、结石清除率、手术时间、并发症及住院费用等方面的差异性。结果术后3月时,本组患者总的结石清除率为88.5%(77/87),PolyScope组结石清除率为85.4%(35/41),URF-V组为91.3%(42/46,P0.05);PolyScope组和URF-V组的平均手术时间分别为(71.8±11.8)min、(57.8±12.5)min;住院费用分别为(35 489.9±2 394.7)元、(28 190.1±5 677.8)元,组间差异均有统计学意义(P0.05);2组的寻石成功率、住院天数及并发症等比较,其差异均无统计学意义(P0.05)。术后Ⅱ级并发症4例(4.6%),Ⅰ级16例(18.4%)。结论组合式输尿管软镜治疗10～20mm肾下盏结石能取得与电子输尿管软镜相当的治疗效果,值得临床推广。     

超细肾镜治疗1～2cm肾下盏结石的临床疗效

目的:评价超细肾镜治疗1～2 cm肾下盏结石的有效性和安全性。方法:纳入2018年3月—2021年6月于河南中医药大学第一附属医院住院治疗的67例1～2 cm肾下盏结石患者，根据不同手术方式分成超细肾镜组37例和输尿管软镜组30例。比较两组术后3 d结石清除率、术后并发症发生率、手术时间、术后住院时间、术后1 h血红蛋白下降量和术后12 h不同疼痛程度例数。结果:超细肾镜组和输尿管软镜组术后3 d结石清除率分别为91.9%和70.0%,差异有统计学意义(P<0.05);超细肾镜组和输尿管软镜组术后并发症发生率分别为16.2%和26.7%,手术时间分别为(54.43±12.02) min和(59.23±12.00) min,术后住院时间分别为(6.51±1.26) d和(6.30±1.53) d,术后1 h血红蛋白下降量分别为(10.95±3.64) mL和(11.40±3.31) mL,术后不同程度疼痛例数比较，差异无统计学意义(P>0.05)。结论:超细肾镜治疗1～2 cm肾下盏结石是安全、高效的。     

组合式输尿管硬镜联合软镜与经皮肾镜治疗肾盂结石的比较

目的探讨组合式输尿管硬镜联合软镜在治疗2～3 cm肾盂结石中的临床应用价值。 方法回顾性分析云浮市中医院2014年4月至2016年4月收治的87例2～3 cm肾盂结石患者的临床资料,分为组合式输尿管硬镜联合软镜组（40例）和经皮肾镜组（47例）,对两组手术时间、结石清除率、平均住院时间及并发症发生率进行观察对比。 结果纳入研究的两组患者术前一般资料比较差别无统计学意义。组合式输尿管硬镜联合软镜组和经皮肾镜组在结石清除率方面差异无统计学意义（P>0.05）;但组合式输尿管硬镜联合软镜组在手术时间,平均住院时间明显优于经皮肾镜组（P<0.05）;而且组合式输尿管硬镜联合软镜组术中出血量及术后发热率少于经皮肾镜组（P<0.05）。 结论组合式输尿管硬镜结合软镜治疗2～3 cm肾盂结石是安全有效的,具有手术时间短、创伤小,康复快,严重并发症少等优点,值得临床上推广和应用。     

微创经皮肾镜联合顺行组合式输尿管软镜治疗鹿角形肾结石16例报告

目的:探讨微创经皮肾镜联合顺行组合式输尿管软镜处理鹿角形肾结石的有效性及安全性。方法:自2012年3月~2013年6月采用微创经皮肾镜联合组合式输尿管软镜处理鹿角形肾结石患者16例,其中完全性鹿角形结石3例,不完全性鹿角结石13例。结果:所有患者均采用单通道碎石,1例因术中出血,输尿管软镜无法有效碎石,改行二期顺行输尿管软镜钬激光碎石,余15例患者一期联合组合式输尿管软镜成功处理残留结石。平均手术时间(117.5±15)min,一期结石清除率为97.6%(15/16)。术中未出现大出血、尿源性脓毒血症、肠道损伤、胸膜损伤等严重并发症。结论:微创经皮肾镜联合组合式输尿管软镜治疗复杂性肾结石安全有效,在熟练掌握手术操作的前提下可以明显减少并发症,值得临床推广。     

输尿管软镜钬激光碎石治疗孤立肾肾结石的临床疗效观察

目的探讨输尿管软镜钬激光碎石术治疗孤立肾肾结石的安全性及有效性。方法邵逸夫医院在2011年5月至2014年12月期间使用输尿管软镜钬激光碎石术共治疗14例孤立肾肾结石患者,男8例,女6例;年龄29~75岁,平均54岁。其中,2例为对侧肾切除术后,12例为对侧肾萎缩。术前常规留置F6 D-J管2周。分析手术时间、清石率、出血量、术后住院天数、并发症以及血清肌酐的变化。结果本组14例患者均成功将输尿管鞘放置输尿管上段,输尿管镜鞘放置成功率100%,进镜成功率100%,术中寻找结石成功率100%。14例患者结石大小为1.1~2.5cm,平均(1.7±0.4)cm;术前肌酐78~407μmol/L,平均(166±103)μmol/L;手术时间60~140分钟,平均(87±34)分钟;术中出血量5~50ml,平均(13±12)ml;一期结石清除率达82.6%(12/14),2例行二次输尿管软镜手术,总结石清除率达92.8%(13/14),2例术后出现发热。14例患者术后肌酐为85~340μmol/L,平均(124±62)μmol/L,与术前比较差异有统计学意义(P0.05)。术后住院天数2~4天,平均(2.5±0.7)天。结论输尿管软镜钬激光碎石术治疗孤立肾肾结石是安全有效的。     

经皮肾镜及输尿管软镜治疗孤立肾肾盂结石的临床疗效及对肾功能影响的比较

目的 比较经皮肾镜及输尿管软镜对孤立肾肾盂结石的治疗效果及对肾功能的影响。方法 选取2011年7月～2013年6月我院泌尿外科收治的58例孤立肾肾盂结石,其中30例行经皮肾镜钬激光碎石术（经皮肾镜组）,28例行输尿管软镜钬激光碎石术（输尿管软镜组）,对手术时间、出血量、结石清除率进行比较,同时测定2组患者术前24h和术后3、24、48h血尿素氮（BUN）、肌酐（Cr）、血中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。结果 经皮肾镜组结石清除率76.7％（23／30）,输尿管软镜组结石清除率75.0％（21／28）,2组比较无统计学差异（X^2=0.022,P=0.882）。输尿管软镜组出血量（50.3±21.5）ml,显著少于经皮肾镜组（80.2±20.5）ml（t=5.422,P=0.000）;手术时间（60.5±25.1）min,显著长于经皮肾镜组（45.34-10.5）rain（t=-3.045,P=0.004）。术后3h2组血NGAL浓度均明显升高,其中输尿管软镜组从术前（3.6±0.6）μg／L上升到（7.9±0.8）μg／L（g：33.457,P〈0.05）,经皮肾镜组从术前（3.8±0.7）μg／L上升到（6.3±0.5）μg／L（q=22.068,P〈0.05）,输尿管软镜组高于经皮肾镜组,有显著性差异（t=-9.200,P=0.000）,术后24h开始下降,但48h仍未降低至术前水平（q=4.414,P〈0.05;g=8.559,P〈0.05）。2组血BUN、Cr术前后无明显变化（P〉0.05）。结论 经皮肾镜及输尿管软镜均是治疗孤立肾盂结石的有效方法,且2种方法对肾功能均有不同程度影响,但其影响都是可恢复的。     

软镜与微创经皮肾镜治疗 1~2 cm肾结石的疗效观察

目的:比较输尿管软镜碎石术与微创经皮肾镜碎石术治疗1~2 cm肾结石的疗效及术后疼痛程度,评估两者的安全性。方法:回顾性分析在我院接受手术治疗的120例肾结石(1~2 cm)患者,其中输尿管软镜碎石术(软镜组)57例,微创经皮肾镜碎石术(MPCNL组)63例,比较两者的手术时间、术中出血量(按术后血红蛋白下降情况计算)、结石清除率、住院时间、术后疼痛程度、并发症及满意度的差异。结果:两组在年龄、性别、结石大小、手术时间、结石清除率、并发症上没有明显的差异。但MPCNL组的术中出血量和住院时间高于软镜组,术后疼痛程度强于软镜组,患者满意度低于软镜组,差异有统计学意义(P<0.05)。结论:输尿管软镜碎石术治疗1~2 cm肾结石在手术时间、结石清除率、并发症发生率上与微创经皮肾镜碎石术相当,但在术中出血量、平均住院时间、术后疼痛程度、满意度上明显优于微创经皮肾镜碎石术,可以考虑作为1~2 cm肾结石治疗的首选。     

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.