胸腔镜与开胸脊柱前路手术的比较研究

目的评价胸腔镜脊柱前路手术的侵袭性和安全性。方法回顾性分析1998年1月～2003年10月施行的胸椎前路手术516例,按同一标准从中抽取采用胸腔镜脊柱前路手术的118例与开胸脊柱前路手术的113例,两组平均年龄、性别及疾病构成的条件均衡。对两组的围手术期参数、并发症和术后上肢功能进行比较研究。结果(1)围手术期参数:胸腔镜组平均术中出血量(450±53.2)ml,少于开胸组[(760±65.4)ml],差异有显著性(P<0.05);胸腔镜组平均引流量(150±20.2)ml,少于开胸组[(260±50.8)ml],差异有显著性(P<0.05);胸腔镜组平均胸痛持续时间(10±4.2)d,少于开胸组[(42±5.3)d],差异有显著性(P<0.05);平均手术时间和平均拔管时间两组间差异无统计学意义。(2)术后并发症:胸腔镜组并发症发生率为8.5%,开胸组为9.6%,差异无显著性(P>0.05)。(3)上肢功能评分:胸腔镜组术后及术后3个月的上肢功能评分低于开胸组,差异均有显著性(P值均<0.05);而术后6个月及12个月时差异无显著性。结论胸腔镜技术能安全、有效地应用于各种胸椎疾病的前路手术治疗。与传统开胸脊柱前路手术比较,具有组织创伤小、术中出血量少和术后早期上肢功能障碍轻等优势。     

特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的疗效比较

目的对特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的近期疗效进行比较。方法将23例特发性胸椎右侧凸患者分为两组,A组行胸腔镜下胸椎侧凸前路Eclipse矫形术,共8例,均为女性,平均年龄148岁,平均Cobb角54°,Risser征 ～ 。B组行开放小切口前路CDHTSRH矫形手术,共15例,男2例,女13例,平均年龄138岁,Cobb角平均57°,Risser征 ～ 。对两组病例的手术时间、术中出血量、固定节段、术后引流量、矫正效果以及早期矫正丢失等进行分析。结果两组患者在年龄、Cobb角、侧凸柔软性和固定节段等方面均具有可比性。A组平均手术时间(360±72)min,术中平均出血量(629±145)ml,术后平均引流量(500±150)ml,平均固定节段(74±11)个,平均Cobb角矫正率(74±14)%,经6～18个月随访,近期矫正丢失率(86±27)%。B组平均手术时间(246±64)min,术中平均出血量(300±110)ml,术后平均引流量(210±90)ml,平均固定节段(78±09)个,平均Cobb角矫正率(70±12)%,近期矫正丢失率(46±19)%。A组与B组相比,侧凸矫正率相似(P>005),但手术时间、术中出血量、术后引流量,以及早期矫正丢失率等存在显著差异(P<005)。结论胸腔镜下胸椎侧凸前路矫形手术和开放小切口前路矫形手术具有各自的适应证和优缺点。对于青少年特发性胸椎侧凸     

青少年特发性胸椎侧凸胸腔镜辅助前路矫形的疗效

目的 介绍特发性胸椎侧凸胸腔镜辅助小切口前路矫形手术的技术要点和手术适应证选择,并对其临床结果进行分析.方法 2001年7月至2006年1月共进行胸椎侧凸小切口前路矫形手术37例,男4例,女33例,平均年龄14.1岁,冠状面Cobb角平均56°,Lenke分型Ⅰ A 14例,Ⅰ B14例,Ⅰ C 9例,均为胸椎右侧凸,Risser征++～++++,对手术时间、术中出血量、固定节段、矫正效果以及矫正丢失等进行分析.结果 平均手术时间220 min,术中出血量平均320 ml,平均固定节段7.8个,术后Cobb角平均16.8°,平均侧凸矫正率70%,随访18～36个月,平均矫正丢失4.6%,无内固定并发症发生.结论 胸椎侧凸前路胸腔镜辅助小切口矫形手术在减少手术创伤、降低麻醉要求、相对胸腔镜手术更为宽松的适应证选择基础上,可以达到传统开胸前路矫形或后路矫形手术的临床效果、且没有增加手术并发症.     

非胸腔镜下Nuss矫正术治疗漏斗胸

目的 探讨非胸腔镜下微创Nuss术矫正漏斗胸的安全性、有效性和治疗经验.方法 2007年10月至2009年5月,手术治疗48例漏斗胸病儿中男28例,女20例;年龄4～13岁,平均(6.5± 2.1)岁.术前CT示胸廓指数3.76±0.54;其中26例行非胸腔镜下微创Nuss术(非胸腔镜组),22例行胸腔镜辅助下Nuss术(胸腔镜组).结果 两组均顺利完成手术,术中均无死亡、大出血及胸腔脏器损伤等严重并发症发生.非胸腔镜下Nuss组无气胸,血胸等并发症,无需放置胸腔闭式引流管.其手术时间、术后入院时间与胸腔镜组比较,差异有统计学意义(P<0.05).非胸腔镜下Nuss组手术时间24～38 min,平均(25.4±2.6)min;住院3～6天,平均(4.5±1.1)天;术中出血量5～10 ml.胸腔镜组手术时间40～60 min,平均(53.5±3.4)min,住院5～8天,平均(7.0±2.2)天;出血量10～15 ml.两组病儿术后均获随访,随访时间至少3个月,平均10.4个月,均无漏斗胸复发.非胸腔镜手术组1例术后2月出现肋骨矫形板移位,再次手术重新放置肋骨矫形板.结论 非胸腔镜下Nuss术矫正漏斗胸是安全有效的,与胸腔镜辅助下Nuss术相比创伤更小,恢复更快.     

前路与后路矫形融合术治疗腰段和胸腰段青少年特发性脊柱侧凸的疗效比较

目的 分析前路和后路矫形融合术治疗胸腰段和腰段青少年特发性脊柱侧凸(AIS)的临床疗效.方法 2004年1月至2008年8月手术治疗胸腰段和腰段AIS患者42例,均为女性.前路组22例,年龄12～18岁,平均14.5岁;采用侧前方入路,单棒或双棒系统矫正固定融合.后路组20例,年龄11～19岁,平均14.8岁;采用节段椎弓根螺钉内固定融合技术.对两组手术时间、出血量、冠状面和矢状面校正率、融合节段以及SRS-24评分进行比较,并进行统计学分析.结果 术后随访12～63个月,平均28.3个月.前路组与后路组平均手术时间分别为(334±36)和(292±17)min,术中平均出血量分别为(940±207)和(596±227)ml,平均融合椎体数分别为(5.2±0.8)和(6.7±1.2)个;两组差异均有统计学意义(P<0.05).前路组与后路组冠状面腰弯.胸腰弯矫正率分别为(93±5)%和(88±5)%,平均SRS-24评分分别为98和94;两组差异均无统计学意义(P>0.05).结论 后路矫形融合术手术时间较短、出血量较少,能够达到与前路手术相同的矫正率,但融合节段较长.     

前路和后路手术治疗胸腰段特发性脊柱侧凸的临床研究

[目的]对照性研究前路和后路手术治疗青少年胸腰段特发性脊柱侧凸的手术效果.[方法]按照同一标准,从1998年1月～2006年1月手术治疗的231例青少年特发性脊柱侧凸中选出胸腰段脊柱侧凸61例.A组前路手术28例.B组后路手术33例.[结果]随访2～6年(平均 3.5年).手术时间A组4.5 h±0.8 h,B组3.1 h±1.0 h(P＜0.01 ).出血量A组1 400 ml±350 ml,B组1 100 ml±230 ml(P＜0.05 ).术后引流量A组380 ml±190 ml,B组250 ml±150 ml(P＜0.05 ).固定节段A组4.5±0.6个椎体,B组7.1±1.2个椎体(P＜0.01 ).平均矫正率A组75%,B组74%(P＞0.05).剃刀背矫正度A组3.8°±2.4°,B组4.1°±2.6°(P＞0.05).2年后矫正度平均丢失A组4.3°±1.4°,B组5.4°±2.1°(P＞0.05).随访2年无假关节及内固定失败病例.术后交界性后凸角B组发生率高(P＜0.01 ).[结论]畸形的矫正、剃刀背的改善、矫正度的丢失前路和后路相当.后路手术损伤小、出血少,术后引流量少.后路手术容易产生PJK.     

胸腔镜辅助下治疗特发性脊柱侧凸

[目的]评价胸腔镜下前路松解,前路或后路矫形治疗特发性脊柱侧凸的治疗效果。[方法]回顾本院自2003年7月~2005年12月施行的11例胸腔镜辅助下前路松解,前路或后路矫形治疗特发性脊柱侧凸病例。年龄12~16岁,平均14.6岁。LenkeⅠ型9例,术前冠状面Cobb s角54°~68°,平均59.7°;LenkeⅢ型2例,术前冠状面Cobb s角分别为58°和71°,平均64.5°。Bending X线片侧凸矫正率为21.8%~32.4%,平均26.4%。对11例患者在胸腔镜辅助下,采用等离子冷消融切除椎间盘松解,前或后路矫正。对手术后及随访时,冠状面和矢状面的Cobb s角进行测量,并对手术时间,术中出血量,围手术期并发症及矫正丢失等进行分析。[结果]平均手术时间290 min,平均术中出血171 ml。松解节段5~7个,平均4.4个。9例LenkeⅠ型术后Cobb s角平均20.4°,Cobb s角矫正率平均65.8%;2例LenkeⅢ型术后Cobb s角分别为20°和25°,Cobb s角矫正率平均65.1%;1例术后包裹性胸腔积液,术后平均随访18.6个月;1例出现矫正度丢失14°,无神经系统及血管损伤并发症。[结论]与传统开胸前路胸椎侧凸矫形手术相比,胸腔镜辅助下胸椎松解前后路矫形治疗脊柱侧凸是安全有效的微创手术,可达到与开胸手术同样效果。     

电视胸腔镜辅助胸壁小切口肺叶切除术

目的比较电视胸腔镜辅助胸壁小切口与胸部单纯小切口肺叶切除术的临床效果. 方法 64例按手术先后顺序编号,按照随机数字表分为2组,电视胸腔镜辅助胸壁小切口(A组)和单纯小切口开胸手术(B组)进行肺叶切除术. 结果 A组切口长度(5.3±0.6)cm比 B组(8.9±0.5)cm显著缩短(t=-24.360,P=0.000);A组术中出血量(279.7±74.0)ml显著少于B组(331.7±42.5)ml(t=-3.330,P=0.002);A组手术当日引流量(162.5±47.4)ml显著少于B组(202.0±49.2)ml(t=-3.220,P=0.002);A组并发症5例,B组11例(χ2=4.099,P=0.043);A组术后住院(8.0±2.2)d显著短于B组(9.7±1.9)d(t=-3.280,P=0.002);2组手术时间无统计学差异(t=-1.130,P=0.262).57例随访6～12个月,术后6个月A组1例Ⅲa期鳞癌局部复发,B组2例Ⅲa期小细胞肺癌、1例腺癌术后7～8个月远处转移、局部复发,上述4例均于1年内死亡.3例死于与手术无关的其他疾病,余50例无局部复发、远处转移. 结论电视胸腔镜辅助胸壁小切口比单纯微创小切口进行肺叶切除术创伤小、并发症少、恢复快.     

电视胸腔镜辅助小切口与传统开胸肺叶切除术的比较

目的探讨电视胸腔镜下肺叶切除术的临床效果。方法比较2005年1月至2010年12月105例电视胸腔镜辅助小切口行肺叶切除术（胸腔镜组）与84例常规开胸行肺叶切除术（开胸组）手术及术后并发症发生情况。结果胸腔镜组手术时间（144．77±23．75）min,与开胸组（152．25±19．96）min比较差异无统计学意义（k=-1．331,P=0．188）;胸腔镜组术后住院时间（10．03±2．13）d,明显短于开胸组（12．14±2．46）d（r=-3．650,P=0．001）;并发症的比较：术后漏气的发生率两组比较差异无统计学意义（r=0．021,P=0．886）;胸腔镜组术中出血量（193．71±44．66）ml,明显少于开胸组（228．57±41．96）ml（t=-3．161,P=0．002）;胸腔镜组术后第1天的引流量（234．29±44．97）ml,明显少于开胸组（272．86±40．72）ml（t=-3．526,P=0．001）;术后疼痛程度的比较两组差异有统计学意义（X2=35．080,P=0）;术后上肢活动是否受限两组比较差异有统计学意义（r=20．160,P=0）;胸腔镜组术后拔管时间（7．17±2．12）d,明显短于开胸组（9．00±2．41）d（t=-3．194,P=0．002）。结论电视胸腔镜辅助胸壁小切口肺叶切除术安全、可靠,与开胸手术比较,具有手术出血少、术后引流量少、术后疼痛轻、上肢活动不受限及术后胸管引流时间短等优点。     

全胸腔镜与开胸手术治疗肺隔离症的疗效对比

目的探讨全胸腔镜与开胸手术治疗肺隔离症(pulmonary sequestration,PS)的疗效。方法回顾性分析我院2003年1月~2016年3月手术治疗的48例肺隔离症资料,根据患者经济条件,行全胸腔镜手术18例,开胸手术30例。行肺叶切除或隔离肺切除术。比较2组的术中出血量、术后当日胸腔引流量、术后镇痛时间、胸腔引流时间及术后住院时间。结果与开胸组比较,全胸腔镜组术中出血少[(56.1±50.4)ml vs.(120.0±54.2)ml,t=-3.813,P=0.000],术后当日胸腔引流量少[(160.0±56.0)ml vs.(280.0±65.0)ml,t=-6.100,P=0.000],术后镇痛时间短[(2.4±1.2)d vs.(7.6±1.9)d,t=-9.650,P=0.000],胸腔引流时间短[(2.8±1.0)d vs.(5.7±1.5)d,t=-6.755,P=0.000],术后住院时间短[(6.5±2.6)d vs.(10.1±2.8)d,t=-4.160,P=0.000]。2组手术时间差异无统计学意义(P0.05)。术后发生肺部感染、心律失常、肺不张全胸腔镜组分别为1、0、1例,开胸组为3、2、1例,2组差异无统计学意义(P0.05)。结论全胸腔镜手术治疗肺隔离症较传统开胸手术创伤小,术中出血少,疼痛轻,恢复快,住院时间短,是一种可靠安全的手术方式。     

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.