富血小板血浆与体外冲击波治疗慢性跟腱止点腱病的疗效比较

目的:比较富血小板血浆(platelet rich plasma,PRP)与体外冲击波治疗慢性跟腱止点腱病的临床疗效。方法:2019年2月至2021年8月,根据病例选择最终纳入42例跟腱止点腱病患者,分为PRP组(20例28足)与冲击波组(22例29足)。PRP组男12例,女8例;年龄47.00(28.00,50.75)岁;病程7.00(6.00,7.00)个月;予患侧跟腱止点区域进行富血小板血浆注射治疗。冲击波组男16例,女6例;年龄42.00(35.75,47.25)岁;病程7.00(6.00,8.00)个月;予患侧跟腱止点区及小腿三头肌区域进行冲击波治疗。分别于治疗前及治疗后1、3、6个月采用疼痛视觉模拟评分(visual analogue scale,VAS)及维多利亚体育研究中心跟腱问卷表(Victorian Institute of Sport Assessment-Achilles,VISAA)评分进行疗效评价,并对所有患者进行满意度调查。结果:两组治疗1、3、6个月后VAS及VISA-A评分均较治疗前改善(P<0.05);PRP组治疗6个月后VAS及VISA-A评...     

小腿肌肉离心训练联合体外冲击波治疗慢性跟腱止点腱病的疗效观察

目的观察小腿肌肉离心训练联合体外冲击波治疗慢性跟腱止点腱病的疗效。方法笔者自2015-02—2016-02诊治72例慢性跟腱止点腱病,按随机数字表进行分组,肌肉离心训练组25例,冲击波治疗组25例,小腿肌肉离心训练联合体外冲击波组(联合组)治疗22例。采用VISA-A跟腱病评分表评价疼痛和活动水平,6点Likert评分表评价2组主观满意度。结果所有患者均获得4个月的随访,肌肉离心训练组的VISA-A评分由(50.8±10.4)分提高到(72.5±18.0)分,冲击波治疗组由(50.6±9.8)分提高到(78.6±12.4)分,联合组由(50.2±10.6)分提高到(86.0±15.0)分,3组VISA-A评分均较治疗前有所改善,两两比较差异有统计学意义(P0.05);肌肉离心训练组对治疗满意14例,满意率为56%,冲击波治疗组对治疗满意17例,满意率为68%,联合组对治疗满意18例,满意率为81.8%,两两比较差异有统计学意义(χ2=3.65,P=0.031)。结论小腿肌肉离心训练结合体外冲击波治疗慢性跟腱止点腱病,能显著改善疼痛,提高患者满意率。     

拇长屈肌腱转位治疗顽固性跟腱止点病

目的探讨拇长屈肌腱转位治疗顽固性跟腱止点病的临床疗效。方法对30例顽固性跟腱止点病患者采用跟腱清创、拇长屈肌腱转位的术式进行跟腱重建。采用VISA-A评分评价疗效。结果患者均获得随访,时间25～43个月。VISA-A评分:术前为37. 50分±2. 70分,末次随访时为80. 80分±3. 10分,差异有统计学意义(P 0. 01)。1例因切口愈合不良行清创后重新缝合,其余患者无并发症发生。结论跟腱止点病的手术治疗不仅要去除跟腱腱体的病变,还要创造良好的腱周环境。拇长屈肌腱转位技术治疗顽固性跟腱止点病可获得满意的疗效。     

不同手术方式对跟腱中段腱病的疗效

[目的]评估不同手术方式对跟腱中段腱病的疗效。[方法]66例跟腱中段腱病患者采用手术治疗,根据手术方式不同将患者分成A组微创手术治疗组、B组传统开放手术治疗组,对比两组手术的疗效、手术时间、术中出血量、术后并发症、住院天数。分别在治疗前、治疗后即刻、治疗后4、12个月时用VISA-A跟腱腱病评分表进行评分,并在治疗后12个月时采用Likert评分进行患者主观满意度评价。[结果](1)微创手术治疗组在手术时间、术中出血量、住院天数等方面具有明显优势;(2)VISA-A评分:两组患者在治疗前评分无差异,(P>0.05)。A组治疗后即刻、治疗后4个月及治疗后12个月分别为(85.55±12.11)、(94.58±13.11)、(96.55±10.11),B组则分别为(68.63±7.40)、(78.63±6.58)、(82.38±6.65)。A组治疗后各时间点与治疗前的VISA-A评分差值与B组相比,差异有统计学意义(P<0.05);(3)Likert评分:A组中4例非常满意,25例满意,2例不满意,满意率达到93.8%。B组中没有非常满意者,28例满意,6例不满意,满意率为82.4%。微创手术组满意度明显高于传统开放手术组。[结论]微创手术较传统开放手术在治疗跟腱中段腱病上,围手术期有显著优势,具有更良好的长期临床结果,能够更好地提高病人整体的满意度。     

体外冲击波治疗慢性跟腱炎的临床疗效

[目的]探讨体外冲击波治疗（extracorporeal shock wave therapy, ESWT）慢性跟腱炎的疗效。[方法]回顾性分析2017年6月—2021年10月于骨科门诊行ESWT治疗慢性跟腱炎患者187例。所有患者均接受5次ESWT，间隔1周，每次2000个脉冲（0.45 mJ/mm2,10Hz）。采用疼痛VAS和AOFAS踝与后足评分评价临床效果。[结果]所有患者治疗期间无严重不良反应，随访12个月以上。患者能够恢复运动情况，治疗后3个月为20.9%,6个月为69.0%,12个月时为86.1%。末次随访时，135例疼痛完全缓解，占72.2%;26例低强度运动时不引起疼痛，只在高强度运动时疼痛，占13.9%;10例日常生活不引起疼痛，只在体育运动时疼痛，占5.3%;16例仍然主诉疼痛，占8.6%。随时间推移（治疗前，治疗后3个月，治疗后6个月，治疗后12个月）患者VAS评分显著减小[(7.3±0.9)分,(2.8±0.7)分,(2.4±0.5)分,(2.0±0.7)分, P<0.05]，而AOFAS评分显著增加[(72.1±4.7)分,(83.2±4.7)分,(...     

中医电针联合体外冲击波治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效

目的观察电针联合体外冲击波疗法(extracorporeal shock wave therapy,ESWT)治疗创伤性桡骨茎突狭窄性腱鞘炎的临床疗效。方法选取2013年1月至2015年3月在新疆体育职业技术学院附属运动创伤医院门诊收治确诊的36例创伤性桡骨茎突狭窄性腱鞘炎患者,随机分为ESWT组、电针组和联合组,每组12例。ESWT组只进行ESWT治疗;电针组只进行电针治疗;联合组采用ESWT联合电针交替治疗,即首日采用ESWT治疗,次日采用电针治疗,治疗期间如此循环交替。三组患者在治疗前和治疗后的第1、2、4和8周分别进行VAS疼痛评分,并且在治疗后第8周采用VAS评分加权值评定临床疗效。结果 (1)三组患者VAS评分在治疗后各时间点均比治疗前明显下降,并且联合组又低于ESWT组和电针组(P0.05);ESWT组在治疗后第8周VAS评分改善优于电针组(P0.05);ESWT组及联合组VAS评分逐渐下降,但电针组第8周VAS评分却有升高;(2)联合组治愈率明显优于ESWT组和电针组,ESWT组治愈率优于电针组(P0.05)。结论 ESWT和电针对治疗创伤性桡骨茎突狭窄性腱鞘炎均具有临床疗效,但二者联合治疗明显优于单一治疗,具有近期和远期疗效方面的双重优势,不但可以让ESWT发挥即时的镇痛效果,还能弥补电针治疗远期疗效差的不足。     

中度腕管综合征的体外冲击波治疗效果研究

目的评估体外冲击波(extracorporeal shock wave therapy,ESWT)这一新型的无创性方法对中度腕管综合征(carpal tunnel syndrone,CTS)的治疗效果。方法选取2014年6月-2016年6月收治的CTS患者80例,随机分为A、B两组(n=40)。A组给予ESWT治疗,每周一次,疗程共4周;B组给予口服塞来昔布(200 mg)和维生素B1片(300 mg),2次/d,疗程共4周。两组夜间均采用腕部支具固定。在治疗前和治疗后1、3、6个月采用视觉模拟评分(VAS)、波士顿问卷量表评分(BCTQ)以及中华医学会手外科学会上肢功能评定标准评价患者的临床疗效。结果两组在治疗后1、3、6个月的VAS评分均较治疗前显著改善(P<0.05),但A组的改善程度较同期B组更为显著(P<0.05);A组的Boston SYMPT评分和FUNCT评分均较治疗前显著改善,而B组的Boston SYMPT评分和FUNCT评分仅在治疗后3个月有明显差别,并且均低于同期A组;A组在治疗6个月后的各项评分几乎保持不变,基本趋于稳定,而B组的各项评分却明显增加;随访终末期评价,虽然两组有效率相比差异无统计学意义(P>0.05),但A组的优良率明显高于B组(P<0.05),复发率也明显低于B组(P<0.05)。结论在临床上可以推荐ESWT作为中度CTS患者的一种保守治疗手段。     

医用臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛临床分析

目的 分析腰椎旁注射臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛的临床疗效.方法 慢性腰椎间盘源性疼痛患者120例,随机分为A组和B组.A组60例,注射类固醇激素混合液10 ml联合纯氧20 ml.B组60例,注射类固醇激素混合液10 ml联合注射30％浓度的医用臭氧20 ml.两组患者均给予腰椎椎旁阻滞,每隔1周注射1次,共治疗3次.观察两组患者治前,治疗后1周(短期)、3个月(中期)以及6个月(长期)疼痛VAS评分及Macnab疗效评价,评估各时间点两组患者的临床疗效.结果 两组VAS评分在治疗后1周、3个月、6个月与治疗前比较明显降低,两组治疗前后比较差异有统计学意义(P＜0.05);两组治疗后1周Macnab疗效评价比较差异无统计学意义(P＞0.05),治疗后3个月及6个月时比较,差异有统计学意义(P＜0.05),且B组优于A组.结论 腰椎旁注射臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛临床疗效显著,可作为慢性腰椎盘源性疼痛非手术治疗的方法.     

放散状体外冲击波治疗髌腱炎的时效性研究

目的探索放散状体外冲击波治疗髌腱炎的时效性,同时评价其临床疗效。方法搜集2016年4月至2018年12月间在我院接受放散状体外冲击波治疗或局部封闭治疗的髌腱炎患者资料,筛选出符合入选标准的患者共84例,按照接受的治疗方案分别纳入体外冲击波组(A组)和局部封闭治疗组(B组)。A组38例,其中男性20例,女性18例,年龄21～40岁,平均(29.6±5.5)岁;B组46例,其中男性22例,女性24例,年龄22～39岁,平均(29.6±5.3)岁。通过对比两组患者治疗前后不同时间点的视觉模拟评分(visual analogue score,VAS)和临床疗效,探索治疗可能存在的时效性。结果治疗前,两组患者的VAS评分差异无统计学意义(P0.05)。治疗结束1周时及治疗结束1个月时两组患者的VAS评分差异无统计学意义(P0.05),而治疗结束3个月时A组的VAS评分明显低于B组(P0.05)。两组患者治疗后各时间点的VAS评分均较治疗前降低(P0.01)。与治疗结束1周时相比,A组治疗结束1个月及治疗结束3个月时的VAS评分均有所降低(P0.05),而B组的VAS评分无明显变化(P0.05)。与治疗结束1个月时相比,A组治疗结束3个月时的VAS评分有所降低,但差异无统计学意义(P0.05);B组治疗结束3个月时的VAS评分则有所增高(P0.05)。两组在治疗后各时间点的临床疗效差异无统计学意义(P0.05)。结论放散状体外冲击波对髌腱炎疼痛的缓解具有明显的时效性,疗效较局部封闭治疗持久可靠。但两种治疗方法对疼痛的缓解在时间上各有特点,临床上应根据患者需求灵活选用。     

冲击波复合激痛点注射对颈肩肌筋膜疼痛综合征的治疗效果

目的比较压痛点注射、体外冲击波疗法(extracorporeal shock wave therapy,ESWT)以及ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征的安全性和有效性。方法 2013年5月至2015年2月在门诊诊治的颈肩肌筋膜疼痛综合征患者90例,男48例,女42例,年龄18~65岁,随机分为三组,每组30例。A组:每个压痛点注射复合镇痛液5ml;B组:以压痛点定位冲击点,每次治疗一个或多个冲击点(疼痛区域),每个冲击点次数2 000次;C组:冲击波治疗后,在冲击波诱发的激痛点注射复合镇痛液5 ml。三组的治疗周期均为每周1次,连续治疗3次,治疗时间为5~10min,并随访记录首次治疗前(T0)、首次治疗后即刻(T1)、首次治疗后1周(T2)、2周(T3)、3周(T4)的VAS评分、颈椎的活动度(ROM)评分、症状改善优良率、总有效率。结果 90例患者中81例获得完全随访,B组有3例、C组有2例出现了皮下淤血,3d后消散,无其他不良事件发生。与T0时比较,T1~T4时三组VAS评分均明显降低(P0.05);T2~T4时,三组的VAS评分随着时间的延长、治疗次数的增加逐渐降低;T1时B组和C组的VAS评分明显低于A组(P0.05),T2、T3时C组VAS评分明显低于A组和B组(P0.05),T4时C组VAS评分明显低于A组(P0.05)。与T0时比较,T3时三组ROM评分均明显降低(P0.05),T3时B组和C组ROM评分明显低于A组(P0.05)。末次随访总有效率C组明显高于A组和B组(P0.05),A、B两组差异无统计学意义。结论 ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征无明显损伤、安全、简便、疗效显著、患者满意度高,可作为颈肩肌筋膜疼痛综合征综合治疗的选择。     

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.