心脏死亡器官捐献供肾移植与司法途径标准供者供肾移植术后早期效果分析比较

目的比较心脏死亡器官捐献(DCD)和司法途径标准供者(SCD)供肾移植的早期效果。方法回顾性分析2011年1月至2014年12月在武汉大学人民医院施行的DCD供肾移植74例(DCD组)以及同期施行的SCD供肾移植143例(SCD组)。所有患者均采用抗体诱导和三联免疫抑制方案(吗替麦考酚酯+他克莫司+泼尼松)。随访评价两组受者短期移植肾功能、移植肾和受者短期存活情况,并追踪移植物功能延迟恢复(DGF)、急性排斥反应、肺部感染发生率。采用成组t检验比较两组受者年龄、热缺血时间、冷缺血时间等指标。两组移植肾受者存活情况、DGF发生率、急性排斥反应发生率、肺部感染发生率使用卡方检验进行比较。P0.05为差异有统计学意义。结果截至2015年8月,DCD组随访时间平均(23±13)个月,SCD组随访时间平均(25±17)个月。肾移植术后6个月,DCD组和SCD组受者存活比例分别为93.2%(69/74)和94.4%(135/143),移植肾存活比例分别为90.5%(67/74)和93.0%(133/143),差异均无统计学意义(χ2=0.12和0.41,P均0.05)。DCD组和SCD组DGF发生率分别为28.4%(21/74)和7.0%(10/143),差异有统计学意义(χ2=18.21,P0.05)。术后6个月内DCD组和SCD组急性排斥反应发生率分别13.5%(10/74)和7.0%(10/143),肺部感染发生率分别为14.9%(11/74)和21.0%(30/143),差异均无统计学意义(χ2=2.48和1.19,P均0.05)。术后1、3个月DCD组血清肌酐分别为(149±65)、(132±78)μmol/L,均高于SCD组(t=4.74和2.95,P均0.05),术后6个月两组血清肌酐差异无统计学意义(t=1.22,P0.05)。结论与SCD供肾移植相比,DCD供肾移植术后DGF发生率较高,急性排斥反应增加,短期内移植肾功能较差,其远期存活效果仍需要继续随访观察。     

心脏死亡器官捐献供肾与传统尸体供肾肾移植的疗效比较

目的 比较心死亡器官捐赠(DCD)供肾与传统尸体供肾肾移植的疗效.方法 回顾性分析单中心2007年2月至2012年6月的69例DCD供肾肾移植受者的资料,并根据受者年龄(相差10岁以内)、移植次数和免疫抑制剂应用情况,按1∶2的比例匹配同期138例传统尸体肾移植受者,进行资料比较.结果 DCD肾移植组术后移植肾功能恢复延迟(DGF)和原发性移植肾无功能(PNF)的发生率为29.0％和2.9％,而传统尸体肾移植组为13.8％和0,差异有统计学意义(P＜0.05).Kaplar-Meier分析结果表明,DCD肾移植组术后6个月、1年和3年的移植肾存活率分别为95.7％、95.7％和93.3％;而传统尸体肾移植组分别为97.8％、97.8％和96.8％,两组的差异无统计学意义(P＞0.05).两组受者存活率的差异也无统计学意义(P＞0.05).术后7和14d,DCD肾移植组的移植肾肾小球滤过率低于传统尸体肾移植组(P＜0.05),但术后1个月至1年,两组移植肾肾小球滤过率的差异无统计学意义(P＞0.05).结论 虽然术后DGF和PNF发生率较高,但DCD肾移植的长期疗效与传统尸体肾移植相当,DCD供肾可以作为替代传统尸体供肾的良好来源.     

DCD扩大标准供肾肾移植早期临床效果分析

目的:比较分析心脏死亡器官捐献(DCD)供肾移植中扩大标准供肾(ECD)和标准供肾(SCD)的早期临床效果。方法:回顾性分析2015年1月~2016年4月在我科完成的109例DCD供肾肾移植,其中ECD组36例,SCD组73例。所有供肾均采用单纯低温静态保存。所有患者均采用抗体诱导+他克莫司(FK506)+吗替麦考酚酯(MMF)+泼尼松(Pred)四联免疫抑制方案。分析评价2组患者术后1个月内肺部感染发生率、急性排斥反应发生率、移植肾功能延迟恢复(DGF)发生率以及肾功能恢复情况。结果:ECD组DGF发生率为38.2%,SCD组为20.0%,差异有统计学意义(P0.05);ECD组急性排斥反应发生率为20.6%,SCD组为4%,差异有统计学意义(P0.05);ECD组肺部感染发生率为5.8%,SCD组为6.1%,差异无统计学意义(P0.05);术前、术后1、3、7、14、21、30天血肌酐值,ECD组要高于SCD组(P0.05)。结论:ECD组术后DGF发生率较SCD组高,急性排斥反应发生率较SCD组明显增加,但是两组肺部感染发生率并无明显差异。SCD组肾功能恢复趋势要明显优于ECD组。     

扩大标准公民逝世后器官捐献肾移植术后一年内临床效果分析

目的观察并比较扩大标准供者(ECD)和标准供者(SCD)供肾移植受者术后1年内临床效果。 方法回顾性分析2014年3月至2017年3月空军军医大学西京医院接受公民逝世后器官捐献90例肾移植受者临床资料,按供肾来源分为ECD组(31例)和SCD组(59例)。所有受者均应用免疫诱导及三联免疫抑制方案治疗(吗替麦考酚酯或麦考酚钠肠溶片＋他克莫司或环孢素＋甲泼尼龙)。采用t检验或Mann-Whitney U检验比较两组受者肾移植术后1年内血清肌酐(Scr)水平,采用χ²检验和Fisher确切概率法比较两组受者性别比例、受者/移植肾存活率及急性排斥反应(AR)、移植肾功能延迟恢复(DGF)和肺部感染等并发症发生率。P<0.05为差异有统计学意义。 结果ECD组和SCD组肾移植受者术后Scr水平逐步下降。术后1个月内(术后1、3、7、14和21 d)两组受者Scr水平差异均无统计学意义(t＝0.076、0.905、0.670、0.893和0.048,P均>0.05);术后1～12个月,除术后9个月两组受者Scr水平差异无统计学意义(t＝1.727,P>0.05),其余各时间点ECD组受者Scr水平均高于SCD组,差异均有统计学意义(P均<0.05)。两组受者术后1年受者/移植肾存活率分别为93.1%/80.6%和91.5/84.7%,差异均无统计学意义(P＝0.734; χ²＝0.246,P>0.05)。ECD组和SCD组AR发生率分别为12.9%(4/31)和18.6%(11/59),DGF发生率分别为22.6%(7/31)和22.0%(13/59),肺部感染发生率分别为25.8%(8/31)和11.9%(7/59),其他并发症发生率分别为41.9%(13/31)和28.8%(17/59),差异均无统计学意义(P均>0.05)。 结论与SCD相比,ECD供肾移植仍可获得相当的临床效果。在目前供器官来源严重缺乏的情况下,ECD的合理选择可以扩大供肾来源。     

心脏死亡器官捐献供肾移植单中心60例经验总结

目的 探讨单中心DCD供肾移植的临床效果,总结DCD供肾移植的经验.方法 回顾性分析2011年12月至2013年4月间60例DCD和112例DCD供肾移植的临床资料.结果 依据《中国心脏死亡器官捐献指南》,实施DCD 60例,共捐献肾脏118个,实施肾移植112例.14例受者术后发生移植肾功能延迟恢复(DGF),发生率12.5％,其中未使用LifePort机械灌注冷保存DGF发生率23.1％ (6/26),使用LifePort移植肾DGF发生率9.3％(8/86).14例DGF受者4例切除移植肾,10例肾功能术后16～52 d恢复正常.急性排斥反应发生率6.3％(7/112),其中1例术后第12天移植肾破裂切除肾脏,其余经治疗后逆转.1例受者术后第15天因急性心肌梗死亡,1例术后第7天发生急性心功能衰竭死亡.移植肾存活的105例受者,随访1～15个月,移植肾功能正常.结论 在我国实施DCD切实可行,是符合伦理和我国国情的器官来源根本途径.DCD供肾移植临床效果良好,Lifeport具有清除肾脏残余微血栓、疏通肾脏微血管、评估肾脏功能及预防DGF的良好作用.     

应用LifePort器官转运器改善肾移植效果的大宗临床研究(附573例报告)

目的探讨供肾脉冲灌注保存转运器(LifePort)保存心脏死亡器官捐献(DCD)供肾和扩大标准供体(ECD)供肾对肾移植术后受者肾功能恢复的影响。方法回顾性分析466例器官捐献(DCD+ECD)供者和882例肾移植受者围手术期的临床资料。根据供肾保存方式不同,将309例DCD供者的左右两侧肾脏随机分为LifePort(DCD-LP)组(309例)和DCD冷藏组(309例);132例ECD供者的双侧供肾全部采用LifePort保存并转运,设为ECD-LP组(264例)。分别观察3组受者术后总体情况、术后早期移植肾功能指标、术后并发症发生情况;对比观察肾移植术前零点穿刺肾组织病理学检查结果;比较肾移植术后有否发生移植物功能延迟恢复(DGF)受者的供肾LifePort灌注参数。结果与DCD冷藏组比较,DCD-LP组、ECD-LP组受者的住院时间明显缩短,差异均有统计学意义(均为P0.05)。DCD冷藏组、DCD-LP组、ECD-LP组围手术期的人存活率均为100%,肾存活率分别为99.7%、100%、99.2%,差异均无统计学意义(均为P0.05)。与DCD冷藏组比较,DCD-LP组、ECD-LP组的DGF发生率明显降低,差异均有统计学意义(均为P0.05)。3组受者的术后早期肾功能,急性排斥反应、感染和外科并发症的发生率比较,差异均无统计学意义(均为P0.05)。病理学检查结果显示,采用LifePort灌注能明显减轻肾小管的水肿、变性、坏死。发生DGF者的供肾LifePort灌注阻力指数明显高于未发生DGF者,而供肾LifePort灌注流量则明显低于未发生DGF者,差异均有统计学意义(均为P0.05)。结论 LifePort能有效改善离体DCD和ECD供肾质量,降低术后DGF发生率,促进移植肾功能恢复,并可在离体肾脏维护及评估中对术后恢复情况作出预判。     

应用机械灌注保存心脏死亡器官捐献供肾的效果分析

目的探讨采用机械灌注保存心脏死亡器官捐献(DCD)供肾移植后移植肾功能延迟恢复(DGF)的发生及对早期移植物功能的影响。方法回顾性分析武汉大学中南医院2010年3月至2012年11月期间44例DCD供肾移植受者的临床资料,根据其供肾保存方式不同,分为机械灌注组(n=10)和静态冷储组(n=34例),比较两组受者DGF发生情况和早期移植物功能。结果两组供、受者一般资料具有可比性。术后1周,机械灌注组无受者发生功能性DGF,而静态冷储组功能性DGF发生率为32.4%(1/34),差别有统计学意义(χ2=6.68,P<0.05);机械灌注组DGF发生率为10%(1/10),静态冷储组DGF发生率为29.4%(10/34),差异无统计学意义(χ2=1.15,P>0.05)。机械灌注过程中肾动脉流量小于60mL/min和阻力系数大于0.5mmHg.mL-1.min-1时,受者发生DGF的概率明显增高。结论机械灌注能有效降低DCD供肾移植受者功能性DGF发生率,是临床维持和修复DCD供肾的重要方法;机械灌注阻力系数和流量可以作为临床评估DCD供肾质量的重要参数,也是判断预后的有益指标。     

婴幼儿单供肾成人受者移植39例报道

目的总结婴幼儿单供肾成人受者肾移植的临床近期效果。方法 2014～2016年间接受3岁以下婴幼儿单供肾移植的成人受者39例,依据供者年龄分为0～1岁婴儿供肾组(9例)和1～3岁幼儿供肾组(30例),统计术后1年内肾存活情况、肾功能状况、移植肾功能延迟恢复(DGF)发生率及并发症情况。结果两组术后未见原发性无功能(PNF)和外科并发症导致的移植肾失功病例,婴儿供肾组死亡2例,死因均为间质性肺部感染;幼儿供者组死亡2例,死因分别为肺部感染与不明原因猝死,死亡删失的移植肾存活率两组均为100%。两组受者术后1年的血肌酐水平分别为(74.14±18.52)μmol/L和(91.46±26.91)μmol/L,差异无统计学意义(P0.05)。DGF发生率,婴儿供肾组44.4%(4/9),幼儿供肾组26.7%(8/30),差异无统计学意义(P0.05);两组术后蛋白尿发生率分别为33.3%和36.7%,差异无统计学意义(P0.05)。结论婴幼儿单供肾移植给低体重成人受者,移植肾近期存活效果良好,可扩展器官来源。但是术后早期蛋白尿发生率较高,可能与供肾高滤过损伤有关。     

肾移植术后早期主动减少免疫抑制剂用量的前瞻性研究

目的探讨对肾移植术后受者早期主动减少免疫抑制剂用量的临床必要性和安全性。方法随机选择63例尸体肾移植受者为观察组,58例尸体肾移植受者为对照组,两组受者均采用环孢素(CsA)+麦考酚吗乙酯(MMF)+泼尼松三联免疫抑制方案。于术后第6周对观察组63例受者予以主动减少免疫抑制剂用量(将CsA血药谷浓度维持在200～250 ng/ml,MMF按受者体质量主动减药),术后4～6个月开始按个体状况将MMF用量调至减药前水平。对照组按常规免疫抑制方案治疗。观察两组受者术后6周至1年的血清肌酐(Scr)、血尿素氮(BUN)、CsA血药谷浓度、肺部感染发生率、急性排斥反应(AR)发生率。结果随访1年期间,观察组受者Scr、BUN基本稳定在同一水平,且与对照组比较差异无统计学意义(均为P>0.05)。观察组与对照组的AR发生率分别为8%与9%,比较差异无统计学意义(P>0.05)。两组的肺部感染率分别为8%(5/63)和14%(8/58),比较差异有统计学意义(P<0.05),对照组有2例发展为严重的肺部感染。结论肾移植术后早期主动减少免疫抑制剂用量能有效降低此阶段肺部感染发生率,且AR发生率并没有增加。     

DCD供肾灌注液生物标志物预测肾移植术后移植物功能延迟恢复的临床应用研究

目的 探讨心脏死亡器官捐献(DCD)供肾静态冷保存(SCS)灌注液生物标志物预测肾移植受者术后发生移植物功能延迟恢复(DGF)的可行性.方法 回顾性分析DCD供肾肾移植的64例受者和47例供者的临床资料.根据受者术后是否发生DGF分为DGF组(7例)与即刻肾功能恢复(IGF)组(57例),比较两组供肾SCS灌注液中4种...     

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.