Akin联合Chevron截骨术与Akin联合Scarf截骨术矫正拇外翻疗效对比

目的:比较Akin联合Chevron截骨术与Akin联合Scarf截骨术矫正拇外翻的临床疗效。方法:选取2015年3月-2016年10月本院收治的中重度拇外翻畸形患者40例(80只病足)为研究对象,依据治疗方式不同将其分为观察组(Akin+Chevron截骨术,22例,44足)和对照组(Akin+Scarf截骨术,18例,36足),术后随访1年,参照美国矫形足踝协会(AOFAS)评分标准评定疗效,采用疼痛视觉模拟评分(Visual analogue scale,VAS)评估两组术后2个月内胼胝疼痛度,比较两组术前、术后拇外翻角(Hallux valgus angle,HVA)、第一二跖骨间角(Intermetatarsal angle,IMA)及远端关节面固有角(Distal metatarsal articular angle,DMAA),对比患者术后满意度,并记录并发症发生情况。结果:观察组患者畸形矫正优良率为93.18%,低于对照组的94.44%,差异无统计学意义(P0.05);观察组术后1、2个月VAS评分为[(2.10±0.30)分、(1.25±0.18)分]明显低于对照组的[(3.45±0.41)分、(2.67±0.34)分],差异有统计学意义(P0.01);术后1年,两组间HVA、IMA、DMAA比较,差异均无统计学意义(P0.05);术后两组间AOFAS评分比较,差异无统计学意义(P0.05);观察组患者手术满意度高于对照组,差异有统计学意义(P0.01)。术后随访1年,两组患者均未见严重并发症。结论:Akin+Chevron截骨术与Akin+Scarf截骨术治疗中重度HV患者疗效相似,但前者术后2个月内疼痛度低,患者满意度好,值得在临床推广应用。     

跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻

目的探讨跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻的临床效果。方法对32例患者(48足)行Chevron截骨手术治疗,测量手术前后拇趾外翻角(HVA),第1、2跖骨间夹角(IMA)的变化,评估足部疼痛及关节活动恢复情况。结果 29例(44足)获得随访,时间12~16(14.5±4.1)个月;3例(4足)失访。患者对术后临床效果满意,截骨部位愈合时间为4~6周。术前HVA为30°±4.1°、IMA为14°±1.7°;术后3个月HVA为4°±4.2°、IMA为10°±2.4°,术后1年HVA为5°±4.5°、IMA为11°±3.3°,均较术前明显减小,差异有统计学意义(P0.05);术后1年与术后3个月的HVA、IMA比较差异无统计学意义(P0.05)。结论跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻疗效满意。     

Lapidus手术结合正骨手法治疗老年足拇外翻

目的:探讨Lapidus手术结合中医正骨手法治疗老年足拇外翻的临床疗效。方法:2013年3月至2017年10月采用Lapidus手术结合中医正骨手法治疗老年足拇外翻患者53例(87足),男12例(18足),女41例(69足);年龄65～92(76.3±4.8)岁。观察手术截骨固定时间,术前及术后26个月时采用视觉模拟评分法(VAS)进行足部疼痛缓解程度评分,并采用AOFAS评分进行功能评定,比较负重位X线片测量拇外翻角(HVA角),第1、2跖间角(IMA角),跖楔角(MCA角)变化情况。结果:53例(87足)获得随访,时间12～42(26.0±2.7)个月。所有患者第1跖楔关节于6～8个月达到骨性融合,平均4.7个月。术前VAS评分8.06±1.44,与术后26个月2.14±1.98比较,差异有统计学意义(P0.05);术前AOFAS评分53.90±7.89,与术后26个月92.80±2.78比较,差异有统计学意义(P0.05);术前HVA(38.60±2.72)°、IMA(21.90±1.91)°、MCA(20.90±2.20)°,与术后26个月的(17.80±1.94)°、(9.70±2.56)°、(11.70±0.48)°比较,差异有统计学意义(P0.05)。根据AOFAS评分,优74足,良11足,可2足。结论:Lapidus手术结合中医正骨手法治疗老年足拇外翻临床疗效满意,缩短了术中截骨固定时间,保护了截骨端周围的软组织和将骨端融合在最为满意的位置。     

第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻

目的 :探讨第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻的临床疗效。方法:自2015年6月至2017年6月,采用第1跖骨远端Chevron截骨联合软组织松解术治疗拇外翻32例(40足),其中男3例3足,女29例37足;年龄22～80岁,平均57.57岁;病程2～32年,平均14年;轻度9足,中度31足。术前患者合并拇囊炎,伴有第1跖趾关节周围疼痛并存在负重行走时疼痛加重。手术前后拍摄足负重正侧位片,比较拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),并采用美国足踝外科协会拇外翻评分(AOFAS)评价临床疗效。结果:32例患者获得了随访,时间12～24个月,平均15.2个月。术后切口均愈合良好,无感染、跖骨头坏死等并发症发生。术前HVA、IMA分别由(32.08±5.59)°、(11.63±2.24)°减小至术后12个月的(10.31±4.36)°、(5.02±2.34)°,差异有统计学意义(P0.05)。AOFAS评分由术前的56.75±6.42提高至术后12个月的88.80±3.99 (P0.05)。结论:第1跖骨远端Chevron截骨联合软组织松解术治疗轻、中度拇外翻畸形可获得较好的临床效果,为拇外翻治疗提供了更多的选择。     

3D打印导航模板辅助Ludloff截骨矫形术治疗中重度外翻

目的探讨3D打印导航模板辅助Ludloff截骨矫形术治疗中重度外翻的疗效及优势。方法将2013年4月—2015年2月拟行Ludloff截骨矫形术治疗且符合选择标准的28例(28足)中重度外翻患者纳入研究,随机分为两组(n=14):A组为采用3D打印导航模板辅助截骨手术,B组为传统截骨手术。两组患者性别、年龄、患足侧别和外翻分度等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组手术时间、术中出血量;术前、术后即刻及末次随访时,采用美国矫形足踝协会(AOFAS)评分评价患足功能;根据X线片测量外翻角(hallux valgus angle,HVA)、跖骨间角(intermetatarsal angle,IMA)以及第1跖骨长度短缩程度。结果患者均获随访,随访时间18～40个月,平均26.4个月。A组手术时间和术中出血量均显著少于B组,差异有统计学意义(P0.05)。A、B组术后即刻及末次随访的HVA、IMA和AOFAS评分均较术前显著改善,差异有统计学意义(P0.05);术后即刻与末次随访时比较,差异无统计学意义(P0.05)。A、B组间术前、术后即刻及末次随访时的HVA、IMA比较,差异无统计学意义(P0.05)。术后即刻及末次随访时,A、B组间AOFAS评分及第1跖骨长度短缩比较,差异有统计学意义(P0.05)。术后除B组1例发生转移性跖骨痛外,A、B组均无相关并发症发生。结论采用3D打印导航模板辅助Ludloff截骨矫形术,可以达到术前准确制定手术计划、术中实施精准截骨的目的,是治疗中重度外翻的有效方法之一。     

3D打印截骨导板在轻中度拇外翻矫形中的临床运用与疗效分析

目的探讨3D打印通用截骨导板在轻中度拇外翻矫形术中的临床应用及疗效分析。方法轻中度拇外翻手术病人60例,随机分为两组,每组各30例(30足),实验组行截骨导板辅助矫形术;对照组行常规矫形术。比较两组病人创口愈合情况、术后负重位跖间角(IMA)的改善情况,采用美国足踝外科第一跖趾关节评分系统(AOFAS)对术后足踝部功能进行评估。结果所有病例术后创口均Ⅰ期愈合,两组病人在术前负重位IMA和AOFAS评分比较差异无统计学意义(P0.05),两组术后与术前比较均有明显改善,差异有统计学意义(P0.05)。实验组术后IMA为(5.18±0.82)°,对照组为(6.34±0.75)°,两组比较差异有统计学意义(P0.05)。实验组AOFAS评分为(89.05±5.16),对照组为(82.84±5.02),两组比较差异有统计学意义(P0.05)。结论应用3D打印的通用截骨导板术中辅助治疗轻中度拇外翻,与传统手术方案比较能更好地纠正病人IMA,改善术后足部功能。     

拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术治疗重度拇外翻

目的介绍拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术在重度拇外翻治疗中的作用。方法回顾分析我科2007年1月～2017年6月所行拇外翻病例2123例(3865足);其中女性2082例,男性41例;年龄22～84岁,平均56.39岁。重度拇外翻病人207例(253足),其中124例(163足)采用拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术治疗;83例(90足)采用改良小切口第1跖骨截骨术治疗;轻、中度拇外翻病人1916例(3612足),采用改良小切口第1跖骨截骨术治疗。结果全部病例均获随访,随访时间3～30个月。联合手术组术后第1跖趾关节外翻角(HVA)(2.80±1.11)°,第1、2跖骨间角(5.68±1.62)°,通过统计学分析发现联合手术组与仅采用改良小切口第1跖骨截骨术的重度拇外翻组术后HVA差异,存在统计学意义(P=0.044)。术后疗效评定:联合手术组优84.67%,良14.52%,差0.81%。仅采用改良小切口第1跖骨截骨术的重度拇外翻组中,优79.52%,良19.82%,差1.20%。仅采用改良小切口第1跖骨截骨术的轻、中度拇外翻组中,优82.83%;良17.07%,差0.10%。结论对于重度拇外翻病例,采用拇趾近节趾骨截骨术联合改良小切口第1跖骨截骨术对HVA的改善要优于仅采用单一手术,且术后并发症更少,病人满意度更高。     

改良微创Chevron截骨整形术治疗足拇外翻的疗效分析

目的观察改良微创Chevron截骨整形术治疗足拇外翻的临床疗效。方法自2016年6月至2017年6月,对收治的36例(46足)足拇外翻患者行改良微创Chevron截骨整形术。通过美国足踝评分系统(aofas ankle hindfoot scale, AOFAS)对手术前后的临床效果进行评价,同时对比术前及术后6周足拇外翻角(HVA)与第一、二跖骨间夹角(IMA)的角度,以及术后瘢痕的临床疗效评价。结果本组共36例患者,随访10～17个月。AOFAS术后评分平均为89.16分;术后6周,患者HVA术后平均为12.18°;IMA术后平均为6.74°。通过影像学比较HVA角度,其差异无统计学意义(P0.05)。对切口瘢痕处行临床疗效评估,总有效率为96%。患者未见临床复发。结论采用改良微创Chevron截骨整形术治疗足拇外翻可以获得良好的临床效果,且近期疗效较满意。     

针刀干预对膝骨关节炎兔股四头肌肌腱拉伸力学的影响

目的:观察针刀干预对膝骨关节炎(KOA)兔行为学、形态学及拉伸力学的影响,探讨针刀治疗KOA的生物力学效应。方法:24只新西兰雄兔随机分为4组:正常组、模型组、电针组、针刀组,每组各6只。模型组以改良Videman左后肢伸直位固定制动固定6周建立兔KOA模型。电针组电针左侧梁丘、血海、内膝眼、外膝眼,每周3次,治疗3周。针刀组以针刀松解左侧股四头肌肌腱,每周1次,治疗3周。分别于造模措施解除1周后和治疗结束1周后应用Lequesne MG膝关节评估法进行行为学检测,治疗结束1周后进行HE染色和力学测试。结果:行为学治疗前观察显示:在局部疼痛、步态反应、关节活动和关节肿胀方面,正常组与模型组比较差异有统计学意义(P0.05),而模型组、电针组和针刀组之间差异无统计学意义(P0.05)。治疗后结果显示:与正常组相比,模型组、电针组和针刀组在局部疼痛、步态反应、关节活动和关节肿胀上差异均有统计学意义(P0.05);在局部疼痛上,电针组较模型组降低,差异无统计学意义(P0.05),针刀组与模型组比较差异有统计学意义(P0.05),电针组和针刀组之间比较差异无统计学意义(P0.05);在步态改变上,模型组与电针组比较差异有统计学意义(P0.05);针刀组与模型组比较差异无统计学意义(P0.05);在关节活动度方面,电针组、针刀组与模型组相比,差异均有统计学意义(P0.05);在关节肿胀上,电针组和针刀组分别与模型组比较,差异均有统计学意义(P0.01),而电针组和针刀组之间比较差异无统计学意义(P0.05)。力学方面:与空白组相比,模型组的极限载荷显著降低(P0.01),电针组极限载荷有下降趋势(P0.05),针刀组极限载荷有上升趋势(P0.05);与模型组比较,电针组极限载荷升高(P0.05),针刀组极限载荷显著升高(P0.01);与电针组相比,针刀组极限载荷有上升趋势(P0.05)。与空白组比较,模型组的最大位移显著降低(P0.01),电针组和针刀组最大位移均有下降趋势(P0.05),与模型组比较,电针组最大位移有升高趋势(P0.05),针刀组最大位移显著升高(P0.05),与电针组相比,针刀组最大位移有上升趋势(P0.05)。在刚度方面各组数据间均无统计学意义(P0.05)。结论:针刀干预可使行为学及形态学发生明显改变,可显著改善股四头肌肌腱拉伸力学特性,并发挥其生物力学效应从而达到治疗KOA的目的。     

改良Chevron截骨手术治疗中重度足拇外翻的近期疗效

目的探讨采用第1跖骨远端改良Chevron截骨手术治疗中重度足拇外翻的临床效果。方法笔者自2014-05—2015-12采用第1跖骨远端改良Chevron截骨手术治疗20例(22足)中重度足拇外翻,分别对手术前后患者AOFAS评分、VAS评分、拇趾外翻角(HVA)、第1跖骨远端关节角(DMAA)和第1、2跖骨间夹角(IMA)的差异进行统计学分析。结果所有患者获得随访6~48(20±8.5)个月。均获得骨性愈合,无一例发生切口并发症、跖骨头坏死、拇内翻等并发症,末次随访时无足拇外翻复发。2足术后出现拇趾背皮肤麻木;7例末次随访跖趾关节活动范围有所减小,但患者无明显不适。AOFAS评分:术前(58±3.1)分,术后(92.5±5.0)分;VAS评分:术前(6.5±3.1)分,术后(1.6±1.4)分。术后AOFAS评分和VAS评分均较术前有明显改善,差异有统计学意义(t=-11.763,P=0.027;t=3.657,P=0.043)。术后HVA角、IMA角、DMAA角较术前均获较大改善,差异有统计学意义(t=15.032,P=0.006;t=8.588,P=0.037;t=5.038,P=0.026)。结论对于中重度足拇外翻或DMAA增大的足拇外翻,应用改良Chevron截骨手术可获得满意效果。     

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.