碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎215例报告

目的 评估碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎(PBS/IC)的疗效. 方法门诊治疗215例女性PBS/IC患者,年龄28～69岁,平均(46.1±17.5)岁.临床表现为下腹酸胀/疼痛、夜尿次数多及尿频、尿急.采用碱化利多卡因联合肝素膀胱灌注治疗,将2%利多卡因20 ml+肝素3.75万U+5%碳酸氢钠5 ml的混合液缓慢注入膀胱内,保留45～60 min.每周灌注2次,疗程12～16周.患者治疗前后均行O'Leary-Sant IC问卷表评分.结果 215例随访3～18个月,平均9个月.0'Leary-Sant平均症状评分(ICPI)治疗前为(12.5±4.9)分,治疗3个月后降为(6.5±3.6)分(P＜0.01);问题评分(ICSI)治疗前为(7.4±3.1)分,治疗后降为(3.2±2.0)分(P＜0.01).其中下腹酸胀/疼痛的改善率为71.3%(139/195),夜尿次数改善率为65.3%(109/167),尿频尿急改善相对不明显,为22.9%(24/105).治疗中未见明显不良反应.结论 应用碱化利多卡因联合肝素膀胱灌注能有效改善PBS/IC的临床症状,尤其能明显改善下腹酸胀/疼痛和夜尿次数多的症状,是一种安全有效的方法.     

生长相关蛋白-43在间质性膀胱炎患者膀胱黏膜表达的研究

目的探讨生长相关蛋白43（GAP-43）在间质性膀胱炎/膀胱疼痛综合征（IC/BPS）患者膀胱黏膜组织中的表达情况,以及与患者症状严重程度之间的相关性。 方法通过免疫组织化学法检测GAP-43在31例IC/BPS患者膀胱组织中的表达情况,并通过入院时对全部病例进行症状评分（ICSI）,问题评分（ICPI）和盆腔疼痛、尿频/尿急症状评分(PUF),评估GAP-43的表达与IC/BPS患者症状严重性之间的相关性。 结果31例IC/BPS患者中,ICSI 13～19分,平均（16±3）分;ICPI 7～16分,平均（12±1）分。PUF 16～25分,平均（20±2）分。症状总分37～57分,平均（46±4）分。IC/BPS患者膀胱组织中GAP-43表达水平免疫组化评分为0～6分,平均（5.2±0.3）分。GAP-43在IC/BPS患者膀胱组织中的表达程度与患者的症状严重程度（ICSI+ICPI、PUF、ICSI+ICPI+PUF）之间成正相关（相关系数=0.469、0.611、0.426）,具有统计学意义（P=0.046、0.039、0.008）。 结论GAP-43在IC/BPS患者膀胱组织中的表达与患者的症状严重程度成正相关,提示GAP-43在IC/BPS的发病机制中可能起着一定的作用。     

间质性膀胱炎与女性激素失调的临床相关性研究

目的 探讨间质性膀胱炎(interstitial cystitis,IC)与女性激素失调的临床相关性.方法 回顾性分析2006年1月至2012年4月收治的58例女性IC患者的临床资料.年龄21～76岁,平均(40.2±12.4)岁.病程9～120个月,平均(64.3±55.7)个月.记录患者月经周期第1、12、22天的O'Leary-Sant评分、盆腔疼痛与尿急/尿频(PUF)评分,探讨女性IC患者尿频、尿急、膀胱疼痛等症状与月经周期的关系,以及未绝经患者与绝经患者各项评分的差异,调查女性IC患者伴发性激素失调病的发病情况. 结果51例未绝经患者月经周期第1天膀胱疼痛和尿频、尿急症状发生率最高,分别为54.9％(28/51)和60.8％(31/51)；7例绝经患者症状加重无明显规律性.月经周期第1、12、22天O'Leary-Sant评分分别为26.60±2.37、21.62±1.98、22.40±2.68,第1天与第12、22天比较差异均有统计学意义(P＜0.05),第12天与第22天比较差异无统计学意义(P＞0.05)；PUF评分分别为25.20±1.81、19.95±2.01、20.80±3.01,第1天与第12、22天比较差异均有统计学意义(P＜0.05),第12天与第22天比较差异无统计学意义(P＞0.05).7例绝经患者的O'Leary-Sant评分和PUF评分的平均值均低于未绝经患者,差异均有统计学意义(P＜0.05).本组58例中,子宫肌瘤、乳腺增生、卵巢囊肿、子宫内膜异位症的发病率分别为48.3％(28/58)、41.4％(24/58)、5.2％(3/58)、13.8％(8/58),均高于国内一般人群的发病率30.0％、40.0％、0.3％、7.0％,除乳腺增生外,其他3种疾病的发病率与国内一般人群比较差异均有统计学意义(P＜0.05). 结论 女性IC患者的尿频、尿急和膀胱疼痛等症状主要在月经期加重,且未绝经患者的症状比绝经患者严重；女性IC患者伴发性激素失调病的发病率高于国内一般人群,说明性激素失调可能是女性IC的致病因素之一.     

间质性膀胱炎膀胱组织神经纤维密度与尿流动力学的相关性研究

目的探讨间质性膀胱炎(IC)患者膀胱组织中神经纤维密度与尿流动力学的相关性,明确其在IC发病机制中的作用。方法选取自2013年6月至2016年3月的43例IC患者,均进行盆腔疼痛和尿频尿急症状评分(PUF)、疼痛视觉模拟评分(VAS)、尿流动力学检查膀胱组织行PGP9.5单克隆抗体免疫组化和神经纤维计数。结果尿频评分为(2.8±0.9)分,尿急评分为(2.1±0.8)分,VAS评分为(6.2±2.7)分。最大尿流率、膀胱初感觉容量、初急迫容量、强烈急迫容量、膀胱最大容量、排尿期最大逼尿肌压分别为(18±4)ml/L、(128±57)ml、(163±59)ml、(208±86)ml、(226±94)ml、(33±7)cm H2O。神经纤维密度平均为(5.2±2.2)条/cm2。神经纤维密度分别与尿频、尿急、疼痛评分呈正相关,与膀胱初感觉容量、初急迫容量、强烈急迫容量、膀胱最大容量呈负相关。结论膀胱组织神经纤维密度与膀胱初感觉容量、初急迫容量、强烈急迫容量、膀胱最大容量呈负相关,提示神经纤维密度增高在IC的发病机制中起重要作用。     

肉毒素A联合透明质酸钠治疗间质性膀胱炎的疗效观察

目的 探讨肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗间质性膀胱炎(IC/PBS)的有效性和安全性.方法 53例IC/PBS患者,其中行肉毒素A膀胱内注射联合透明质酸钠膀胱灌注28例(A组),单纯行透明质酸钠膀胱灌注25例(B组).观察并记录患者治疗前及治疗2周、1、3、6个月的临床症状(每日排尿次数、最大排尿容量、VAS疼痛评分)和O'Leary-Sant IC问卷表评分情况,治疗完成后进行疗效评估,并记录不良反应发生情况.结果 A组患者治疗各时间点的每日排尿次数、最大排尿容量、VAS疼痛评分、O' Leary-Sant评分与治疗前相比差异均有统计学意义(P＜0.05);B组患者治疗2周和治疗前比较差异无统计学意义(P＞0.05),其余治疗的各时间点和治疗前比较均有统计学意义(P＜0.05).治疗完成后,两组患者下腹酸胀/疼痛改善率分别为82.1％ (23/28)和68.0％(17/25),夜尿次数多改善率分别为78,6％(22/28)和64.0％ (16/25),尿频尿急改善分别为60.1％ (17/28)和28.0％(7/25),组间疗效评估结果差异均有统计学意义(P ＜0.05,其中尿频尿急改善率差异P＜0.01).A、B两组各有5例在膀胱灌注后出现尿路感染,口服抗生素后缓解.所有患者均完成治疗及随访.结论 肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗IC/PBS能够迅速有效的缓解患者临床症状,较单纯透明质酸灌注能更好地改善IC/PBS所造成的下腹酸胀/疼痛、夜尿次数多和尿频尿急,提高患者生活质量,为治疗IC/PBS提供了一种新的有效方法.     

男性间质性膀胱炎18例临床诊治分析

目的 探讨男性间质性膀胱炎(IC)临床诊断和治疗方法,以提高男性IC的诊治效率. 方法 2010年1 -12月收治男性IC患者18例,患者均表现为明显的耻骨上区和腹股沟区疼痛,并伴有尿频、尿急症状.18例均曾误诊为ⅢB型前列腺炎,且治疗无效.按照NIDDK的IC诊断标准,根据PUF表评分＞15分、钾离子通透试验(PST)阳性以及麻醉下膀胱镜检查发现“红斑征”确诊IC.18例治疗前均行24 h排尿卡记录、尿常规、前列腺液常规及细菌培养等检查,并行麻醉下水扩张治疗.术后口服托特罗定缓释片治疗,每天1次,每次4 mg,疗程1个月;同时术后1周开始行膀胱灌注治疗(2％利多卡因20 ml+肝素3.75万U+5％碳酸氢钠5 ml),每周2次,疗程12周. 结果 18例患者水扩张术后采用PUF表评分和24h排尿卡记录进行随访,随访时间12～25个月,平均19个月,患者症状均获得缓解.治疗前后PUF评分值分别为(19.2±4.1)、(13.6±2.4)分;24 h平均排尿次数分别为(11.5±3.9)、(7.5±4.3)次;24h平均每次排尿量分别为(159.5±30.8)、(241.7±45.3)ml,差异均有统计学意义(P＜0.01). 结论 男性IC与(Ⅲ)B型前列腺炎临床症状相似,可通过PUF评分、PST试验以及麻醉下膀胱镜检查提高男性IC的诊断率,结合水扩张和术后口服托特罗定缓释片联合肝素膀胱灌注治疗可显著改善男性IC患者的临床症状.     

经尿道膀胱电灼术治疗难治性非溃疡型间质性膀胱炎/膀胱疼痛综合征

目的探讨经尿道膀胱电灼术治疗难治性非溃疡型间质性膀胱炎/膀胱疼痛综合征(IC/PBS)的有效性和安全性。方法回顾性分析56例难治性非溃疡型女性IC/PBS患者的临床资料。随机分为试验组(n=35)和对照组(n=21)。试验组先行麻醉下水扩张,再对膀胱黏膜丝球样出血点密集处行经尿道膀胱电灼术。对照组单纯行麻醉下水扩张1次。比较2组患者治疗前1周、治疗后1周及1、3、6月的间质性膀胱炎指数评分(ICSI)及问题指数评分(ICPI)、盆腔疼痛和尿急/尿频患者症状评分(PUF)、24h排尿次数及平均每次排尿量,并观察患者治疗期间的不良事件。结果 56例患者治疗后均随访6月以上,试验组患者治疗后1周及1、3、6月的ICSI评分、ICPI评分、PUF评分、24h排尿次数均显著低于治疗前,平均每次排尿量明显增加,治疗前后比较差异均有统计学意义(P0.01)。试验组患者治疗后1周及1、3、6月的各项评分及24h排尿次数均显著低于对照组相应时间点,平均每次排尿量明显增加,2组比较差异均有统计学意义(P0.01)。试验组患者治疗后1周及治疗后1、3、6月的症状缓解率分别为88.6%(31/35)、82.9%(29/35)、80%(28/35)和71.4%(25/35)。所有患者在治疗期间均未发生明显的不良事件。结论经尿道膀胱电灼术能有效缓解难治性非溃疡型IC/PBS患者的临床症状,其远期疗效有待于进一步观察。     

钾离子敏感试验与间质性膀胱炎PUF评分的相关性研究

目的 探讨钾离子敏感试验(PST)与间质性膀胱炎(IC)盆腔疼痛和尿频、尿急症状(PUF)评分的相关性及意义.方法 IC患者14例.女13例,男1例.平均年龄48岁.临床表现主要为尿频、尿急、膀胱克盈后耻骨上及会阴区疼痛.14例均依据美国糖尿病、消化及肾病协会(NIDDK)IC诊断标准确诊.采用膀胱水囊扩张后碳酸氢钠、利多卡因及肝素钠灌注治疗.治疗前后均行PST评分和PUF评分,并分析二者之间的关系.结果 14例患者治疗前后PST评分中位数分别为4.0、1.0,PUF评分中位数分别为27.5、13.5,治疗前后差异均有统计学意义(P<0.01).PST评分与PUF评分呈正相关(治疗前rs=0.868,t=4.418,P=0.001;治疗后rs=0.779,t=4.300,P=0.001).结论 PST和PUF评分在IC中表现出一致性,可单独作为IC诊断、鉴别诊断、病情严重程度及治疗效果判定的重要指标.     

膀胱水扩张联合灌注透明质酸钠治疗间质性膀胱炎的临床研究

目的:探讨间质性膀胱炎(IC)的临床诊断与治疗方法,评估膀胱水扩张加透明质酸钠灌注治疗IC的临床有效性及安全性。方法:2009年5月~2014年3月采用美国国立糖尿病、消化及肾病协会(NIDDK)制定的标准诊断IC患者60例,均在麻醉下行膀胱镜检查加水扩张术,术后第2~3天用无菌透明质酸钠液40mg/50ml行膀胱灌注,每周灌注1次,疗程12~36周,并且于治疗前和随访6个月时行钾离子敏感实验及膀胱镜检查,观察治疗前后患者盆腔疼痛及尿频评分(PUF)、O'Leary-Sant IC问卷表评分(ICSI/ICPI)、膀胱容量测定和生活质量评分(QOL)的变化。结果:60例患者均完成治疗,随访6~32个月,平均16个月,51例患者症状缓解或消失,PUF评分、ICSI/ICPI评分、膀胱容量、QOL评分明显改善,9例患者效果较差。PUF评分治疗前为(21.18±3.26)分,治疗3个月后降为(10.03±3.60)分,治疗6个月后为(12.17±3.46)分;ICSI治疗前为(12.15±2.08)分,治疗3个月后降为(8.58±2.27)分,治疗6个月后为(8.82±2.52)分。ICPI治疗前为(10.59±2.12)分,治疗3个月后为(7.87±2.56)分,治疗6个月后为(7.95±2.28)分。膀胱容量由(128.32±15.35)ml增加为(296.59±81.20)ml,QOL评分治疗前为(22.71±6.35)分,治疗3个月后升为(43.68±7.62)分,治疗6个月后为(58.25±5.26)分,治疗前后比较差异均有统计学意义(P0.05)。结论:膀胱水扩张联合灌注透明质酸钠能显著改善IC患者的临床症状,提高生活质量,是一种安全有效的治疗方法。     

A型肉毒毒素注射治疗女性尿道疼痛综合征的短期疗效和安全性

目的探讨A型肉毒毒素(BTX-A)注射治疗女性尿道疼痛综合征(UPS)的短期疗效和安全性。方法回顾性分析2021年2—9月四川大学华西医院收治的8例女性UPS患者的病例资料。年龄(47.87±11.33)岁。病程3(1.0, 10.8)年。治疗前疼痛视觉模拟评分(VAS)(5.38±1.92)分, 盆腔疼痛+尿频/尿急症状评分(PUF)(10.75±5.12)分, 女性性功能量表评分(FSFI)(14.53±11.63)分。患者取截石位, 应用100 U BTX-A, 分别于尿道口3、6、9、12点位置, 以及尿道中段和膀胱颈左右两侧注射, 共10针。记录患者治疗后1、3、6个月的VAS、PUF评分、FSFI评分和并发症情况。结果本组8例, 治疗后1、3、6个月的VAS分别为(3.25±2.12)分、(2.88±2.23)分、(2.88±2.23)分, 与治疗前比较差异均有统计学意义(P<0.05);PUF评分分别为(6.63±3.93)分、(6.25±4.03)分、(5.13±3.31)分, 仅治疗后6个月与治疗前比较差异有统计学意义(P=0.03);FSFI评分分别为(14....     

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.     

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.