双氢埃托啡的燐光测定法及其应用

用药物—染料生成复合物的原理,建立了双氢埃托啡的燐光分析法?椒槊?可检测2ng。适用于动物血药、脑药分析。兔im0.1,0.2,1mg/kg双氢埃托啡后1与5min。血药,脑药与剂量成比例关系,其回归方程为:血药:Y=100.6X+17.73(1min), Y=367.8X+4.34(5min); 脑药:Y=5363 X+275.4(1 min),Y=6084 X+1022(5 min) 式中Y=药物浓度(ng/ml血或ng/g脑),X=双氢埃托啡剂量(mg/kg)。     

Haematological, physiological and survival data in a porcine model of adult respiratory distress syndrome induced by endotoxaemia. Effects of treatment with N-acetylcysteine

The effects of N-acetylcysteine (NAC)--which is supposed to act as a free radical scavenger--were evaluated on lung function, haemodynamics and oxygen transport in a porcine model of pulmonary and cardiovascular failure induced by endotoxaemia. Three pigs, serving as controls, received NAC without endotoxin (E) for 6 h, and no notable physiological changes were found. Five pigs received a continuous infusion of E alone for 6 h and displayed a 90% decrease in leukocyte count and a 66% decrease in platelet count. Physiologically a four-fold increase in venous admixture (Qva/Qt), a nearly 2-3 fold increase in mean pulmonary arterial pressure (MPAP) and a progressive decline in cardiac output (Qt) of 60% were documented. Extravascular lung water (EVLW) increased 66%, mean arterial pressure (MAP) decreased 46% and oxygen delivery decreased 52%, leading to a metabolic acidosis. Three animals died during the observation period. Contrastingly, eight pigs, pretreated with NAC 150 mg.kg-1 which was continued at 20 mg.kg-1.h-1, showed a significantly attenuated response to E. Thus, leukocyte and platelet counts decreased 70% and 48%, respectively. Physiologically Qva/Qt increased 2.5-3 fold, MPAP increased 1.3-2 fold, and Qt decreased 32%. EVLW increased 27%, MAP decreased 27% and oxygen delivery decreased only 33% which kept the pH in the normal range. All animals survived the observation period, a significant difference from the E alone group. Thus, NAC significantly attenuated all monitored haematological and pathophysiological changes in the endotoxin model of ARDS in pigs. In addition to a reported free radical scavenger effect of NAC, our results support the assumption that NAC may counteract leukocyte and platelet aggregation in the lung thereby contributing to the beneficial outcome.     

Local anaesthesia and propofol-fentanyl sedation for carotid artery surgery

Background: In patients undergoing carotid artery surgery with local anaesthesia (LA), a sedative / analgesic pharmacological supplement is appropriate in most cases in order to provide comfort. This adjunct should not preclude continuous clinical neurological monitoring. The aim was to investigate if a combination of fentanyl and propofol to supplement LA would provide comfort for the patient, allow continuous clinical neurological monitoring and absence of difficulties for the anaesthetist, and good conditions for surgery, including insertion of a shunt if this should become necessary. Methods: During a 1-year period low doses of propofol and fentanyl were used to supplement LA in 36 cases of carotid artery surgery in 34 consecutive patients. A shunt was only used if neurological dysfunction occurred. Data on haemodynamics, pulmonary gas exchange, clinical neurological monitoring, and subjective opinions from patients, surgeons and anaesthetists were obtained. Morbidity within 30 days was documented. Results: Conversion to general anaesthesia was undertaken in one patient, previously operated on the same artery, who became unconscious due to a stroke during manipulation of the artery before arteriotomy. No other adverse outcome was found within 30 days. In the remaining 35 cases the procedures were carried out under LA. Stump pressures below 50 mmHg were found in 17/35 cases. Intraoperative neurological dysfunction was detected in 10/35 cases (stump pressures between 23 and 60 mmHg). Shunting was easily performed, and rapidly relieved the neurologic symptoms in all these patients. Intraoperative respiratory and haemodynamic control was satisfactory. Ease of performance, including clinical neurological monitoring, was acknowledged by both anaesthetists and surgeons, and all 33 patients (35 operations) who were accessible for a postoperative interview stated that they would prefer the same regimen in the case of further surgery. Conclusion: The number of cases in this open, uncontrolled study does not permit an evaluation of this anaesthetic and sedative technique in terms of neurological and cardiac outcome. Thus, we simply want to inform about our positive experiences regarding patient acceptance and ease of performance in all relevant respects when fentanyl and propofol are used to supplement LA for carotid artery surgery.