丙泊酚对急性肾缺血再灌注过程脂质过氧化损伤的保护作用

目的　研究丙泊酚对家兔肾上腹主动脉阻断后肾脏脂质过氧化损伤的防治作用。方法　家兔 2 4只 ,随机等分为假手术组 (A组 )、缺血再灌注组 (B组 )和丙泊酚组 (C组 )。肾上腹主动脉阻断 30分钟再灌注 180分钟制成双侧急性肾缺血再灌注损伤 (ARIRI)动物模型。C组于阻断腹主动脉前静脉注射丙泊酚 5mg/kg ,继以微量泵持续输注 2 0mg·kg-1·h-1丙泊酚 15分钟 ,A、B组则以同样方法静注等容积生理盐水作对照。动态检测血中超氧化物歧化酶 (SOD)、丙二醛 (MDA)以及肾皮质中SOD、MDA的变化 ,并在电镜下观察肾组织形态学改变。结果　C组在再灌注期血和肾皮质中MDA浓度明显低于B组 (P <0 0 1) ,SOD活性显著高于B组 (P <0 0 1)。B组电镜见明显急性肾小管损伤及坏死 ,而C组肾小管损伤轻微。结论　丙泊酚对家兔ARIRI有良好保护作用     

缺血预处理对兔主动脉阻断后脊髓一氧化氮、后肢神经功能和肌电图的影响

目的　探讨缺血预处理 (IPC)对缺血预处理对兔主动脉阻断后脊髓功能和一氧化氮(NO)的影响。方法　 2 4只日本大白兔随机分为假手术组 (A组 )、缺血再灌注组 (B组 )和IPC保护组 (C组 ) ,每组 8只。分别于首次预处理即刻 (C 40 )、缺血即刻 (I0 )、缺血 45min(I45)、再灌注后 60min(R60 )和术后 7d处死动物前即刻 (R7d)采血检测血清和R7d脊髓组织NO的浓度。术后观察后肢神经功能的评分、后肢针电极肌电图 (EMG)和脊髓组织病理学的改变。结果　缺血再灌注损伤后B组血清NO浓度较缺血前和A、C组对应时点值显著升高 (P <0 .0 1)。C组R7d血清NO浓度明显低于其他时点及A组R7d测定值 (P <0 .0 5或 0 .0 1)。B组脊髓组织NO浓度显著高于A、C组(P <0 .0 1)。B组后肢神经功能和脊髓病理学评分均显著性低于A、C组 (P <0 .0 5或 0 .0 1) ,其后肢EMG亦较C组有显著性病理改变 (P <0 .0 1)。结论　IPC对家兔主动脉阻断后脊髓缺血再灌注损伤有良好的保护作用 ,其保护作用机制与抑制NO的生成有关。     

腹主动脉局部灌注丙泊酚减轻脊髓缺血-再灌注损伤的研究

目的 建立兔脊髓缺血-再灌注损伤模型,研究经腹主动脉局部灌注丙泊酚对脊髓缺血-再灌注损伤的作用。方法 新西兰大耳白兔30只,随机均分为A、B、C三组,诱导后气管插管,持续监测平均动脉压、心率、脉搏血氧饱和度及肛温。左股动脉切开置管至腹主动脉分出左肾动脉远端1．0cm处,于左肾动脉开口远端0．5cm处阻断腹主动脉,同时阻断双侧髂总动脉,自阻断即刻开始经置入导管分别向阻断的腹主动脉远端灌注5ml／kg丙泊酚溶液（A组）、10％脂肪乳（B组）和生理盐水（C组）,30min后开放。于动物完全清醒即刻、再灌注后6、24和48h对双后肢神经功能进行评分,光镜观察脊髓前角正常运动神经元并计数。结果 清醒即刻、再灌注后6、24和48hA组神经行为学评分明显高于B和C组（P〈0．05）,B、C两组比较差异无统计学意义。三组脊髓前角正常运动神经元中位数分别为11、1和0,A组明显高于B、C两组（P〈0．05）。结论 腹主动脉阻断期间经阻断的腹主动脉局部灌注丙泊酚可减轻脊髓缺血一再灌注损伤。     

丙泊酚在家兔肾下主动脉阻断术中对肾功能的保护作用

目的　探讨丙泊酚在肾下主动脉阻断术中对肾功能的保护作用及其机制。方法　 2 4只家兔随机分为假手术组 (A组 )、阻断组 (B组 )及丙泊酚 (C组 ) ,每组 8只。B、C组肾下主动脉阻断4 0分钟后再灌注 1小时 ,C组于阻断前 10分钟静注丙泊酚 5mg/kg ,继以持续输注丙泊酚 2 0mg·kg-1·h-1至松开前 5分钟 ;余两组以等容量生理盐水作对照。测定给药前 (C-10 )、松开前 (C40 )、松开后 1小时 (R60 )血中内皮素 1(ET 1)水平及尿素氮 (BUN)、肌酐 (Cr)、K+ 、Ca2 + 含量 ,记录阻断前、阻断后、松开后尿量并测定尿 β2 微球蛋白 (β2 MG)含量。结果　 (1)B组再灌注后血浆ET 1水平明显高于阻断前及A组 (P <0 0 5 ) ,C组阻断后及松开后血ET 1较阻断前无明显变化。 (2 )B组R60 时的血浆BUN、血K+ 含量明显高于基础水平 (P <0 0 5 ) ,C组无明显变化。 (3)B组及C组阻断后尿量均明显升高 ,再灌注后B组尿量明显低于阻断前 (P <0 0 5 ) ,B组尿 β2 MG明显高于阻断前及C组 (P <0 0 5 )。结论　肾下主动脉阻断可导致肾小球及肾小管功能障碍。丙泊酚对肾功能有保护作用 ,其机制与其抑制ET 1水平升高有关     

低温生理盐水与腺苷局部灌注对脊髓缺血损伤的保护作用

目的 研究低温生理盐水和腺苷对兔主动脉阻断致脊髓缺血损伤的保护作用。方法 30只成年健康新西兰白兔随机分成3组,每组10只。A组：作为缺血对照：B组,用低温生理盐水局部灌注;C组：用低温生理盐水和腺苷局部灌注。通过阻断兔贤动脉水平的腹主动脉60分钟建立兔脊髓缺血损伤模型。观察3组血流动力学指标,脊髓自由基含量、术后Tarlov评分和脊髓组织病理学改变。结果 3组心率比较均无差异,C组血压于阻断腹主动脉20分钟时下降（P＜0．05）;A组丙二醛增加,超气门物歧化酶减少,而B组和C组变化较轻;A组大部分发生截瘫,B组后肢功能部分恢复,C组后肢功能恢复良好;病理检查示A组中央灰质聚集性坏死,巨噬细胞浸润,尼氏小体消失,核仁模糊,B组和C组脊髓结构较完整。结论 低温生理盐水和腺苷局部灌注具有良好的脊髓保护作用,其方法简便。腺苷可减少三磷酸腺苷（ATP）的耗竭,促进其恢复,并具有神经保护作用。     

缺血-再灌注期心肌组织及血清白细胞介素-1β和白细胞介素-6的变化

目的　观察家兔缺血 再灌注期心肌组织及血清白细胞介素 1β(IL 1β)、白细胞介素 6(IL 6 )的变化和芬太尼对其影响。方法　 2 4只家兔随机分为假手术组 (C组 )、缺血 再灌注组 (IR组 )和芬太尼组 (F组 ) ,每组 8只。IR组行冠状动脉左前降支阻断 30分钟 ,再灌注 3小时 ;F组缺血前 2 0分钟缓慢静注芬太尼 5 0 μg/kg后 ,以 40 0 μg·kg-1·h-1速度维持 ;C组仅分离血管 ,不阻断血流。三组分别于缺血前 5分钟 (I0 )、缺血 30分钟 (I1)、再灌注 1小时 (R1)和 3小时 (R2 )取颈内静脉血 ,并于实验结束时取心肌组织 ,测定血清及心肌组织中IL 1β和IL 6浓度 ,光镜下观察心肌病理结构变化。结果　F组血清IL 1β在R1时达到峰值 ,为I0 的 2 98倍 (P <0 0 1) ,在R2 时下降 (P <0 0 5 ) ;IL 6在R2 时升高 ,为I0 的 1 33倍 (P <0 0 5 )。IR组血清IL 1β在I1～R2 时增高 ,分别是I0 的2 90、4 85和 3 88倍 (P <0 0 1) ;血清IL 6在R1和R2 时持续升高 (P <0 0 1) ,分别为I0 的 1 5 6、1 74倍。F组心肌组织中IL 1β及IL 6含量较C组增高 ,但明显低于IR组 (P <0 0 1)。光镜下F组心肌中度水肿 ,白细胞散在浸润 ;IR组水肿严重 ,白细胞浸润明显。结论　缺血 再灌注时心肌组织和血清IL 1β、IL 6的合成增加 ,芬太尼可     

卡托普利对家兔肾上腹主动脉阻断所致急性肾缺血／再灌注损伤的保护作用

目的 探讨卡托普利（CAP）对家兔肾上腹主动脉阻断致急性肾缺血/再灌注损伤（ARIRI）的保护效果。方法 于肾上阻断腹主动脉血流30min再灌注180min的方法制成双侧ARIRI动物模型,将24只家兔随机等分为假手术组（A组）、缺血再灌注组（B组）和CAP治疗组（C组）。C组于阻断主动脉前5min静注CAP2mg·kg^-1,继之持续输注15minCAP 0.5mg·kg^-1·h^-1。A、B组以等容生理盐水取代CAP。A组不阻断主动脉血流。动态检测血中BUN,Cr,SOD,MDA,AT-Ⅱ,尿β2-MG变化,以及肾皮质中SOD,MDA,AT-Ⅱ和肾组织形态学改变。结果 C组在再灌期血和肾皮质中MDA,AT-Ⅱ浓度明显低于B组（P<0.01)。SOD活性显著高于B组（P<0.01)。血BUN、Cr及尿中β2-MG含量明显低于B组（P<0.05,<0.01),C组光镜下肾小管损伤Paller评分明显低于B组（20.50±7.56vs82.50±16.69,P<0.05)。B组电镜见明显急性肾小管损伤及坏死,而C组肾小管损伤轻微。结论 CAP对家兔肾上腹主动脉阻断所致ARIRI有良好的保护作用。     

卡托普利在家兔主动脉阻断手术中对对脊髓损伤的保护作用

目的研究卡托普利在家兔肾上主动脉阻断手术中对脊髓损伤的保护作用及其机理.方法家兔24只,随机分为假手术组(A组)、缺血组(B组)和卡托普利组(C组).肾上阻断腹主动脉30min后松开,C组于阻断前10min静注卡托普利0.5mg@kg-1,继以0.15mg@kg-1@h-1持续输注至松开前10min.连续监测颈总动脉(BPi)和股动脉(BP2)平均动脉压,记录阻断前10min、阻断后5min、20min、30min以及松开后5min、60min、180min的BP1和BP2值,松开后3h观察胸10和腰3水平脊髓形态学变化,并测定脊髓组织丙二醛(MDA)含量.结果①B组动物阻断后的BP1显著高于阻断前(P＜0.05或0.01),C组阻断后BP1较阻断前无显著变化;B组松开后5、60、180min的血压均明显低于阻断前,C组松开后60、180min的血压比B组明显升高(P＜0.05).②B组脊髓MDA含量明显高于A组(P＜0.01),C组与A组无显著性差异,但明显低于B组(P＜0.05).③B组脊髓病理变化较重,可见大量神经元坏死,C组偶有神经元坏死.结论在家兔肾上主动脉阻断手术中使用卡托普利对脊髓损伤有较好保护作用,其机制与抗过氧化反应及缓解血液动力学波动有关.     

缺血预处理对脊髓缺血损伤细胞内Ca2+变化的影响

目的　观察缺血预处理对脊髓缺血损伤细胞内 Ca2 变化的影响。　方法　将 44只健康新西兰大白兔随机分为三组 :缺血组 2 0只 ,缺血预处理组 2 0只 ,假手术组 4只。缺血组于左肾动脉下夹闭腹主动脉 40分钟后开放灌注 ;缺血预处理组夹闭腹主动脉 5分钟 ,开放 15分钟 ,再次夹闭 40分钟后开放再灌注 ;假手术组动物手术操作同缺血组 ,但不夹闭腹主动脉。分别于夹闭 40分钟后即刻、开放再灌注 2小时、8小时、2 4小时和 72小时各时相点测定脊髓组织 Ca2 含量 ,并评定、记录动物后肢神经功能。　结果　缺血预处理组脊髓组织 Ca2 显著低于缺血组各时相值 ;再灌注 8小时后神经功能评分缺血预处理组明显高于缺血组 (P<0 .0 1)。　结论　缺血预处理具有降低神经元胞浆游离 Ca2 浓度 ,防止Ca2 超载 ,稳定细胞内环境的能力 ,对主动脉阻断所致的脊髓缺血损伤有良好的保护作用。其表现为明显降低瘫痪发生率 ,增加术后神经评分     

脊髓缺血损伤时脑型肌酸激酶与后肢肌电图的变化

目的　观察脊髓缺血损伤时脑型肌酸激酶 (CK BB)和后肢肌电图 (EMG)的变化。方法　 1 6只兔随机分为假手术组和缺血 再灌注组 ,每组 8只。缺血 再灌注组夹闭腹主动脉 4 0min ,检测夹闭前 1 0min、夹闭 4 0min和松夹后 6 0min动脉血中CK BB含量。术后 7d记录后肢神经功能评分和检测肌电活动。结果　与缺血前和假手术组比较 ,缺血 再灌注组CK BB含量明显升高而其神经功能评分显著降低 (P <0 0 5或P <0 0 1 ) ,EMG大量可见自发电位 ,运动单位电位募集类型显著改变 (P <0 0 1 )。结论　监测血清CK BB含量或后肢肌电图变化可反映脊髓缺血性损伤的有无和程度的轻重     

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.     

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.