盐酸戊乙奎醚对心肺转流下心脏瓣膜置换术患者急性肺损伤的影响

目的探讨盐酸戊乙奎醚(PHC)对心肺转流(CPB)下心脏瓣膜置换术患者术后急性肺损伤(ALI)的影响。方法选择择期行CPB下心脏瓣膜置换术的风湿性心脏病患者30例,男18例,女12例,心功能NYHA分级Ⅱ或Ⅲ级,按照随机数字法分为PHC处理组(P组)和对照组(C组),每组15例。麻醉诱导前P组患者静脉注射PHC 0.03mg/kg,C组患者注射等量生理盐水。分别于麻醉诱导前(T0)、手术结束时(T_1)、术后6h(T_2)、12h(T_3)、24h(T_4)抽取血标本测定血浆IL-6、TNF-α和NF-κB等细胞因子水平;分别于T_0、T_1和T_4时监测动脉血气并计算氧合指数(OI);记录麻醉后即刻和手术结束即刻患者的肺动态顺应性参数。记录患者气管导管留置时间、ICU住院时间和术后住院时间等。结果 P组术后气管导管留置时间、ICU住院时间和术后住院时间均短于C组,但差异无统计学意义。与T_0时比较,T_1~T_4时两组血浆IL-6、TNF-α和NF-κB浓度均明显升高(P0.05);T_1~T_4时P组血浆IL-6、TNF-α和NF-κB浓度均明显低于C组(P0.05)。与T_0和T_1时比较,T4时两组OI明显降低(P0.05);T_4时P组OI高于C组,但差异无统计学意义。与麻醉后即刻比较,手术结束即刻C组肺动态顺应性明显下降(P0.05);手术结束即刻P组肺动态顺应性明显高于C组(P0.05)。结论 PHC能有效抑制CPB下心脏瓣膜手术患者的炎症反应、改善肺顺应性、改善组织氧供,促进患者的术后康复,其机制可能与PHC调控NF-κB信号通路的活性、减少IL-6和TNF-α等促炎细胞因子的释放有关。     

甘利欣对体外循环患者急性肺损伤的保护作用

目的 研究甘利欣对体外循环(CPB)所致急性肺损伤的影响及其机制。方法24例风心病心内直视瓣膜置换术患者,随机分为两组,每组12例。甘利欣组(G),麻醉诱导后用10％葡萄糖注射液50ml加甘利欣2.5 mg·kg-1泵入,对照组(C)10％葡萄糖50 ml泵入。于麻醉诱导后10min(T0)、转流后30 min(T1)、开放主动脉后30 min(T2)、术毕(T3)、术后4 h(T4),术后24 h(T5)测血浆TNF-α、IL-1β、IL-11和丙二醛(MDA)的浓度及锰超氧化物歧化酶(Mn-SOD)的活性。测定麻醉诱导后10 min(t0)、体外循环后10min(t1)、30min(t2)、术毕(t3)的呼吸指数(RI)。结果 两组 TNF-α、IL-1β、IL-10、MDA和Mn-SOD在体外循环后均有不同程度的增高。G组TNF-α在T1和T2低于C组(P<0.05),在T1-L3、T5,C组IL-1β高于G组,IL-10低于G组(P<0.05);C组MDA在T2-T4高于G组(P<0.05);C组Mn—SOD的活性在T1、T2低于G组(P<0.05或0.01)。C组的RI在转流后升高,且在t1、t3高于G组。结论甘利欣可抑制心脏瓣膜置换术患者CPB引起的炎性反应,减少氧自由基产生,从而减轻体外循环所致的急性肺损伤。     

还原型谷胱甘肽对心肺转流心内直视手术患儿肺损伤的保护作用

目的 研究还原型谷胱甘肽(GSH)对心肺转流(CPB)心内直视手术患儿肺损伤的保护作用.方法 择期行心脏室间隔缺损修补术患儿30例,年龄2～6岁,体重12～20 kg,随机均分为GSH组(G组)和对照组(C组).G组于预充液中加入GSH 50 mg/kg,并于切皮后即刻静注GSH 50 mg/kg,C组给予等容量5%葡萄糖溶液.分别于切皮前即刻(T1)、主动脉开放后30 min(T2)、停CPB后2 h(T3)、6 h(T4)、12 h(T5)采集桡动脉血,测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)、丙二醛(MDA)浓度和超氧化物岐化酶(SOD)活性,并进行血气分析,计算呼吸指数(RI)和氧合指数(OI).结果 T2～T5时G组血浆MDA的浓度和RI明显低于、血浆SOD活性和OI明显高于C组(P＜0.05).T2～T5时C组TNF-α、IL-8的浓度高于T1时及G组(P＜0.05).结论 GSH可减轻CPB下心内直视手术患儿的肺损伤,其机制可能与抑制CPB的炎性反应及减轻脂质过氧化程度有关.     

抗肿瘤坏死因子α抗体对体外循环肺损伤的保护作用

目的探讨气管内给予抗肿瘤坏死因子α(TNF-α)抗体对体外循环(CPB)中肺损伤的保护作用和机制.方法选择心瓣膜置换术患者20例,用随机抽样法分成两组,每组10例.用药组:于术前和主动脉开放后经气管内插管注入抗TNF-α抗体(1.2μg/kg)2次;对照组:常规CPB手术.测定两组围术期肺动态顺应性和氧合指数,气管内插管时间,同时测定左右心房血液中中性粒细胞计数,TNF-α和丙二醛(MDA)的含量.结果 CPB结束和CPB后各时点肺动态顺应性和氧合指数用药组显著高于对照组(P＜0.01),用药组气管内插管时间比对照组短(P＜0.01),抗TNF-α抗体明显抑制中性粒细胞在肺内的聚集,抑制肺源性TNF -α的释放,减少MDA产生.结论气管内应用抗TNF-α抗体能减轻CPB导致的肺损伤.     

间断肺通气对体外循环肺损伤的保护作用

目的研究间断肺通气对体外循环(CPB)肺损伤的保护作用,并探讨其机制。方法将24例风湿性心脏病患者采用随机数字表法分为两组,处理组(n=13)CPB期间每5min间断肺通气一次;对照组(n=11)CPB期间不通气。所有患者均在术前留取血液标本,术后2h行支气管肺泡灌洗,分别测定支气管肺泡灌洗液(BALF)中的中性粒细胞、总蛋白(TP)、肿瘤坏死因子-α(TNF-α)含量、血清总蛋白以及术前、CPB后1h、4h肺氧合指数(OI)。结果处理组BALF中的中性粒细胞、TP、TNF-α含量较对照组显著降低(P<0.01,P=0.02,0.02),CPB后OI较对照组显著降低(P<0.05);两组CPB后1h、4h其OI均较同组CPB前显著增高(P<0.05)。结论间断肺通气可通过减少白细胞与血管内皮的黏附,减轻肺部炎症反应、内皮细胞损伤等,对CPB所致的肺损伤有保护作用。     

目标导向容量治疗对冠状动脉旁路移植术患者全身炎性反应和早期预后的影响

目的探讨围术期目标导向容量治疗(goal—directed therapy,GDT)对体外循环(cardiopulmonary bypass,CPB)下冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者全身炎性反应和早期预后的影响。方法择期行体外循环下CABG的患者60例,随机分为G、C两组,每组各30例。G组患者在脉搏指数连续心排血量(pulse—indicated continuous cardiacoutput,PICCO)监测指导下行GDT;C组患者根据平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、尿量等指标进行液体治疗。分别于麻醉诱导前(T_0)、转流结束时(T_1)、术毕(T2)、术后6小时(T_3)、24小时(T_4)等5个时间点采取动脉血,测定白细胞介素(IL)—6、肿瘤坏死因子(TNF)—α及Toll受体4(TLR4)的浓度,并行血气分析监测Lac及氧合指数(OI)值。结果与T_0比较,T_1~T_3时两组患者IL—6、TNF—α、TLR4以及血乳酸(Lac)的浓度均明显升高,OI值明显降低(P0.05);T_1~T_3时G组IL—6、TNF-α、TLR4以及Lac的浓度均明显小于C组,而OI明显大于C组(P0.05);G组患者气管导管留置时间、ICU停留时间和术后总住院时间均明显短于C组(P0.05)。结论 GDT可减轻体外循环下CABG患者围术期的全身炎性反应,有利于改善患者的早期预后。     

不同浓度七氟醚对静态膨肺患者心肺转流后肺气体交换的影响

目的评价不同浓度七氟醚静态膨肺对心肺转流(cardiopulmonary bypass,CPB)后肺气体交换及术后气管留管时间的影响。方法择期行CPB下瓣膜置换手术患者75例,男39例,女36例,年龄22～65岁,ASAⅡ或Ⅲ级。采用随机数字表法将患者随机分为三组:每组25例。CPB期间停止呼吸后,予持续静态膨胀,呼吸环路压力维持10cmH2O,膨肺气体采用空气,分别复合吸入1%七氟醚(L组)或2%七氟醚(H组),对照组(N组)不复合吸入七氟醚。分别于切皮前、CPB停机后1、3、6h抽取动脉血行血气分析。计算肺泡-动脉氧分压差[D(A-a)O_2]、呼吸指数(RI)和氧合指数(OI)。记录术后气管留管时间和ICU留观时间。结果与切皮前比较,CPB停机后1、3、6h三组D(A-a)O_2、RI明显升高(P0.05);CPB停机后1h三组OI明显降低(P0.05)。三组不同时点D(A-a)O_2、RI和OI差异无统计学意义。三组CPB停机后1、3、6h发生OI300mmHg的比例、术后气管留管时间和ICU留观时间差异无统计学意义。结论心脏瓣膜置换手术CPB期间,静态膨肺采用10cmH2O压力,复合吸入1%或2%浓度七氟醚,与单纯静态膨肺比较,不能进一步改善CPB后患者肺气体交换,不影响术后气管留管时间和ICU留观时间。     

脂微球化前列地尔对体外循环诱发小儿肺损伤的影响

目的 评价脂微球化前列地尔对体外循环(CPB)诱发小儿肺损伤的影响.方法 择期CPB下行先天性心脏病矫正术患儿27例,年龄100 d～9岁,体重5～22 kg,心功能Ⅰ或Ⅱ级,随机分为2组:对照组(C组,n=12)和脂微球化前列地尔组(P组,n=15).P组预充液中加入脂微球化前列地尔10 ng/ml,麻醉诱导后即刻经中心静脉输注脂微球化前列地尔10 ng·kg-1·min-1至术毕,C组给予等容量生理盐水.于CPB开始前即刻(T1)、主动脉开放后30 min(T2)、2 h(T3)、6 h(T4)及24 h(T5)时取桡动脉血样,行动脉血气分析及中性粒细胞(PMN)计数,采用酶联免疫吸附法测定血浆白细胞介素6(IL-6)、IL-8、IL-10、肿瘤坏死因子α(TNF-α)和基质金属蛋白酶-9(MMP-9)的浓度;计算动态肺顺应性(Cd)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)及呼吸指数(RI).结果 与C组比较,P组OI升高,RI、A-aDO2、血浆IL-6、IL-8、TNF-α、IL-10、MMP-9浓度及PMN计数降低(P<0.05或0.01).结论 脂微球化前列地尔可减轻CPB诱发的小儿肺损伤,可能与其减轻肺组织炎性反应有关.     

地氟醚对心脏瓣膜置换术患者NF-κB表达的影响及意义

将30例心脏瓣膜置换术患者，随机分为地氟醚组和对照组，应用流式细胞仪检测围术期血浆核因子（NF）-κB活性，ELISA法捡测围术期血浆TNF-α水平。结果两组NF-κB、TNF-α水平，体外循环（CPB）后较CPB前显著增加（P均〈0．05），CPB后各时点对照组NF-κB相TNF-α活性显著高于地氟醚组（P均〈O05）。提示地氟醚可能通过抑制NF-κB的表达．进而抑制TNF-α活性．减轻了CPB时的全身炎症反应．发挥心脏保护作用。     

超滤对心肺转流瓣膜置换术患者血液流变学的影响

目的探讨心肺转流(CPB)中超滤对瓣膜置换术患者血液流变学的影响。方法选择需在CPB下行瓣膜置换术的患者40例,随机均分为两组:无超滤组(W组)和超滤组(UF组)。两组患者均采用静-吸复合麻醉,开胸后建立CPB。W组:CPB中不进行超滤;UF组:CPB复温至32℃时开始超滤,直至停机。两组患者分别于术前(T0)、升主动脉阻断后10min(T1)、UF组在超滤时/W组在鼻咽温复温至32℃时(T2)、停机时(T3)、术后24h(T4)和术后36h(T5)采集动脉血检测血浆粘度(PV)、红细胞刚性指数(IR)、变形指数(TK)和聚集指数(Agrbc);同时行动脉血气分析并计算氧合指数(OI)、呼吸指数(RI);记录CPB时间、升主动脉阻断时间、手术时间、超滤液量;术后随访并记录患者的住院天数、ICU时间、术后拔管时间、输血量、引流量和尿量的情况。结果与T0时比较,两组T1～T3时PV明显降低(P0.05);T1～T5时IR、TK、Agrbc明显降低(P0.05)。与T2时比较,UF组T3～T5时IR、TK、Agrbc明显升高(P0.05)。与T0时比较,两组患者T1、T3时OI明显增大,RI明显减小,T4、T5时OI明显减小,RI明显增大(P0.05)。与W组比较,UF组T5时OI明显增大,RI明显减小;UF组患者ICU时间、术后拔管时间、术后输血量均明显减少(P0.05)。结论超滤可改善CPB后的肺功能,有利于瓣膜置换术后患者的恢复;而对红细胞的流变学无明显影响。     

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.     

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.