术中静脉输注不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响

目的 评价术中静脉输注不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响.方法 拟行广泛全子宫加盆腔淋巴结清扫术的宫颈癌患者60例,年龄30～64岁,体重40～75 kg,ASA Ⅰ或Ⅱ级,随机分为3组(n=20),Ⅰ组、Ⅱ组和Ⅲ组分别静脉输注异丙酚50、100、150μg·kg~(-1)·min~(-1).分别于麻醉诱导前即刻、开始静脉输注后1、2、3 h及术毕时行动脉血气分析,记录pH值、总二氧化碳(TCO_2)、碱剩余(BE)、HCO_3~-及乳酸(LA)浓度;取颈内静脉血样2 ml测定血清甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDLL-C)、载脂蛋白A_1(APOA_1)及载脂蛋白B(APOB)的浓度.结果 3组各指标均在正常范围内.与麻醉诱导前即刻比较,静脉输注异丙酚后3组pH值、TC_2、BE、HCO_3~-及APOA_1浓度降低,LA及TG浓度升高,Ⅱ组及Ⅲ组LDL-C浓度降低,Ⅲ组APOB浓度降低(P<0.05或0.01);与Ⅰ组比较,静脉输注异丙酚后Ⅱ组及Ⅲ组pH值、BE、LDL-C及APOB浓度降低,TG浓度升高,Ⅲ组TCO_2、HCO_3~、TC及APOA_1浓度降低(P<0.05或0.01);与Ⅱ组比较,静脉输注异丙酚后Ⅲ组pH值、TCO_2、BE、TC及APOB浓度降低,TG浓度升高(P<0.05或0.01).结论 短时静脉输注异丙酚时患者酸碱平衡及脂质代谢均在正常范围,但有发生代谢性酸中毒及脂质代谢异常的趋势,且与剂量有关.     

丙泊酚复合雷米芬太尼靶控输注行无痛胃镜的临床观察

目的 观察丙泊酚复合雷米芬太尼靶控输注行无痛胃镜检查的麻醉效果及对呼吸、循环的影响.方法 60例ASA Ⅰ或Ⅱ级要求无痛胃镜检查者,随机均分为三组,分别给予丙泊酚人工静注组(A组)、丙泊酚靶控输注组(B组)、丙泊酚复合雷米芬太尼靶控输注组(C组).观察各组麻醉前、麻醉后2 min、置胃镜后2 min、苏醒时的SBP、DBP、HR、RR、SpO2,以及各组胃镜检查时间、苏醒时间、丙泊酚、雷米芬太尼用量及不良反应.结果 麻醉后2 min及置胃镜后2 min B、C组SBP下降,C组DBP下降(P<0.05);三组患者RR下降(P<0.05).三组患者均未出现严重的低血压、心动过缓、呼吸抑制,SpO2均高于96%.C组患者苏醒时间显著缩短(P<0.05或P<0.01),丙泊酚用量显著减少(P<0.01),术中三组患者体动、呛咳等不良反应差异无统计学意义.结论 丙泊酚复合雷米芬太尼靶控输注可为无痛胃镜检查提供安全可靠快捷的麻醉.     

雷米芬太尼复合丙泊酚在老年患者无痛肠镜检查中的应用

目的比较不同剂量雷米芬太尼复合丙泊酚在老年患者无痛肠镜检查中的应用。方法60例ASAⅠ～Ⅱ级无痛肠镜检查老年患者(>65岁),随机分为三组。丙泊酚负荷剂量为0.8mg/kg、雷米芬太尼0.5μg/kg,静注时间各60s,丙泊酚维持量6mg·kg-1·h-1。A组雷米芬太尼维持量0.03μg·kg-1·h-1,B组0.06μg·kg-1·h-1,C组0.09μg·kg-1·h-1,持续输注至肠镜进至回盲部停药。根据患者反应,单次静脉追加丙泊酚10mg,观察并记录患者检查前、丙泊酚给药后、雷米芬太尼给药后、镜检开始后1、5min、退镜完毕后1、5min的MAP、SpO2、HR、BIS、RR、VT、PETCO2和麻醉起效时间、入镜时间、苏醒时间,镇静评分、定向力恢复、术后视觉模拟评分、离院时间以及不良反应。结果镜检中A组MAP、BIS低于B、C组(P<0.05),C组HR慢于A组(P<0.05)。各组给药后、镜检中的MAP、HR、BIS、RR、VT低于检查前(P<0.05,P<0.01),PETCO2高于检查前(P<0.05,P<0.01)。A组丙泊酚用量较B、C组大,苏醒时间、离院时间较B、C组长(P<0.05,P<0.01),BIS下降明显(P<0.05,P<0.01)。所有患者麻醉满意度为100%。结论雷米芬太尼0.06μg·kg-1·h-1配伍丙泊酚用于门诊老年患者无痛肠镜检查较为合适,但应注意注药速度,并加强监测,尽可能避免心动过缓和低血压的发生。     

右旋美托咪啶对鼓室成形术丙泊酚用量及患者苏醒的影响

目的观察右旋美托咪啶(Dex)对鼓室成形术丙泊酚用量及苏醒期疼痛、躁动的影响。方法 60例ASAⅠ～Ⅱ级择期行鼓室成形术患者随机入选Dex组(D组)和对照组(C组),每组30例。D组麻醉前10min予Dex1μg·kg-1静注、术中以0.3μg·kg-1·h-1恒速输注至术毕前30min;C组则相应静注、恒速输注等量生理盐水(NS)。两组均采用丙泊酚复合瑞芬太尼全凭静脉麻醉,并于Narcotrend监测指导下维持相同麻醉深度。观察并记录使用Dex/NS前后(T0、T1)、头部包扎(T2)、拔管(T3)、拔管后5min(T4)、30min(T5)、术后2h(T6)、6h(T7)的心率及血压;记录丙泊酚用量;记录拔管前后RS、RSS、VAS评分及苏醒期芬太尼追加情况。结果相较于C组,D组丙泊酚总用量减少;T2、T3、T4时点RS评分下降同时RSS评分升高;T4、T5、T6时点VAS评分及苏醒期芬太尼追加率、量均降低(P<0.05)。结论全凭静脉麻醉下鼓室成形术中应用Dex,可减少丙泊酚用量、减轻苏醒期疼痛并减少苏醒期躁动发生。     

持续输注丙泊酚药代动力学模型的选择

目的　将四种文献报道的药代动力学模型用于计算机模拟以预测持续输注丙泊酚的 血浆浓度,籍以选择适合中国人的药代动力学模型。方法　选择ASAⅠ～Ⅱ级的择期手术病人16 例,≥65岁(Ⅰ组)病人静脉输注丙泊酚速度60ml/h,<65岁(Ⅱ组)者输注速度75ml/h,抽取动脉血 分析药物血浆浓度,用四种药代动力学模型预测丙泊酚血浆浓度,计算样本加权残差(WR)、绝对值 加权残差(absWR)。结果　Schuttler模型在Ⅰ组病人,中位数加权残差(MDWR)显著小于其他三种 参数(P<0.01),对所有病人输注期间预测浓度 实测浓度的拟合程度最好(P<0.01)。结论　仅 Schuttler药代动力学模型适合用于持续静脉输注丙泊酚期间和停止输注后的药物浓度预测。     

硫酸镁静脉输注对子宫切除术后患者静脉自控镇痛的影响

目的观察静脉输注硫酸镁对术后患者静脉自控镇痛(PCIA)及应激方面的影响。方法40例ASAⅠ或Ⅱ级择期在连续硬膜外麻醉下行子宫切除术的患者,随机分为硫酸镁组(MG组)和对照组(NS组),每组20例。MG组麻醉前给负荷剂量25%硫酸镁25mg/kg,继以200mg/h持续输注48h。NS组给相同体积的生理盐水。于术后4(T1)、8(T2)、18(T3)、24(T4)、48h(T5)记录患者视觉模拟评分(VAS)、镇静-警觉评分(OAA/S)和布氏舒适度评分(BCS),PCIA泵中吗啡的需求量及PCIA的总按压次数(D1)与有效按压次数(D2)的比值(D1/D2),于术前(T0)、T2、T3和术后42h(T6)四个时点抽取静脉血测定血清镁和血清皮质醇(Cor)浓度。记录PCIA的不良反应。结果两组患者镇痛效果均满意,T3时MG组VAS低于NS组(P<0.05),T1、T2时MG组BCS高于NS组(P<0.05)。D1/D2在3～5范围内的病例数于T2时MG组少于NS组(P<0.05),PCIA中吗啡的总需求量MG组显著低于NS组(P<0.01)。血清镁浓度的变化:MG组T2时高于T0时(P<0.01),NS组T2时低于T0时(P<0.01),T2时MG组高于NS组(P<0.01)。血清Cor的变化:MG组和NS组T2时高于T0时(P<0.01),但T2时MG组低于NS组(P<0.05)。结论静脉输注硫酸镁可减少术后吗啡的需求量、降低不良反应及提高患者的早期舒适度,而且能在一定程度上抑制血清皮质醇的升高。     

丙泊酚和依托咪酯对心脏瓣膜置换术患者肌钙蛋白I和超敏C反应蛋白的影响

目的 比较等效剂量丙泊酚和依托咪酯乳剂对心肺转流( CPB)心脏瓣膜置换术患者血清心肌肌钙蛋白I (cTnI)和超敏C反应蛋白(hsCRP)的影响.方法 择期心脏瓣膜置换术患者60例,随机均分为两组:丙泊酚组(P组)术中静脉持续输注丙泊酚3～5 mg·kg-1· h-1,依托咪酯乳剂组(E组)持续输注依托咪酯0.3～0.6 mg·kg-1·h-1维持麻醉.分别于麻醉诱导前(T0)、CPB前(T1)、主动脉开放即刻(T2)、主动脉开放后30 min(T3)、停CPB后4 h(T4)、24 h(T5)采取静脉血,测定血清cTnI和血浆hsCRP浓度.结果 与T0时比较,T2～T5时两组血清cTnI浓度均显著升高(P＜0.01),且E组显著高于P组(P＜0.01);T1～T5时E组血浆hsCRP浓度显著升高(P＜0.01),且明显高于P组(P＜0.01),而P组仅在T4、T5时显著升高(P＜0.01).结论 等效剂量丙泊酚用于CPB心脏瓣膜置换术麻醉维持的心肌保护作用优于依托咪酯乳剂.     

羟乙基淀粉130/0.4对老年患者凝血功能和血小板功能的影响

目的 评价6%羟乙基淀粉130/0.4对老年患者凝血功能和血小板功能的影响.方法 择期行胃肠肿瘤切除术老年患者30例,年龄65～85岁,体重45～85 kg,ASA Ⅰ或Ⅱ级,随机分为HES组和生理盐水组(NS组),每组15例.麻醉诱导气管插管后吸入异氟醚(呼气末浓度0.5%～1.5%)维持麻醉,两组分别于气管插管后以10～15 ml·kg-1·h-1的速率经颈内静脉输注6%羟乙基淀粉130/0.4注射液、生理盐水25 ml/kg.分别于输注前、输注完毕30 min、4 h时肘静脉抽血样,测定血红蛋白浓度(Hb)、血小板计数(Plt),凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、血浆Ⅷ因子和假性血友病因子(vWF),Sunoclot血小板功能分析仪测定玻璃珠激活全血凝固时间(gbACT)、凝血速率及血小板功能.结果 两组输注完30 min、4 h时Hb与Plt较输注前明显降低(P<0.01);两组输注前后PT、AFIT、FIB、血浆Ⅷ因子和vWF差异均无统计学意义(P>0.05);两组输注前后gbACT、凝血速率及血小板功能差异均无统计学意义(P>0.05).结论 术中输注6%羟乙基淀粉130/0.4 25 ml/kg对老年患者凝血功能和血小板功能无明显影响.     

雷米芬太尼复合丙泊酚静脉麻醉的临床应用

目的观察雷米芬太尼复合丙泊酚静脉麻醉的效果。方法全身麻醉下腰椎手术患者60例,随机均分为雷米芬太尼复合丙泊酚静脉麻醉组(Ⅰ组)和静吸复合麻醉组(Ⅱ组)。雷米芬太尼和丙泊酚的负荷量分别为1μg/kg和1mg/kg,雷米芬太尼以0.5μg·kg-1·min-1速率输注。麻醉中通过增减雷米芬太尼0.1μg·kg-1·min-1输注速率调整麻醉深度。丙泊酚按5∶4∶3方案输注,即5mg·kg-1·h-1输注10min,4mg·kg-1·h-1输注10min,20min后3mg·kg-1·h-1恒速输注。观察两组气管插管反应、麻醉效果、苏醒质量。结果两组麻醉效果相同,均可抑制气管插管反应(P<0.01),且Ⅰ组较Ⅱ组明显(P<0.05)。Ⅰ组苏醒质量较Ⅱ组好(P<0.01),不良反应较Ⅱ组高(P<0.01),术中无知晓。结论雷米芬太尼复合丙泊酚用两个注射泵静脉麻醉,采用负荷量加两种以上速率输注全凭静脉麻醉简便易行。     

丙泊酚复合雷米芬太尼静脉输注在颈动脉内膜剥脱术麻醉中的应用

目的 观察丙泊酚复合雷米芬太尼静脉持续输注在颈动脉内膜剥脱术(CEA)麻醉中对血流动力学的影响,探讨适合CEA的麻醉方法.方法 32例ASAⅡ或Ⅲ级拟在全麻下行CEA患者,依据麻醉维持用药方案不同随机均分为雷米芬太尼复合丙泊酚组(R组)和异氟醚复合丙泊酚组(Ⅰ组).在相同麻醉诱导方案完成气管插管后,R组以雷米芬太尼0.1～0.2 μg·kg1·min-1联合丙泊酚3～5 mg·kg-1·h-1静脉持续输注;Ⅰ组以1%～3%异氟醚吸入,并静脉持续输注丙泊酚3～5mg·kg-1·h-1.记录切皮时(T1)、颈动脉阻断前(T2)、内膜剥脱时(T3)、阻断开放后(T4)、缝合切口时(T3)的血流动力学波动情况及术中心血管事件发生率.在麻醉诱导前(TA)、领动脉阻断前(TB)、内膜剥脱时(TC)和颈动脉开放后(TD)采集动脉血行血气分析并检测血糖(Glu),记录pH值和BE的变化.结果 R组患者在各时点HR、SBP的波动均明显小于Ⅰ组(P＜0.05);R组高血压、低血压和心动过速、心动过缓的发生率以及降压药、升压药和艾司洛尔的使用率明显低于Ⅰ组(P＜0.05);两组患者TB、TC、TD时pH、BE均显著低于TA时(P＜0.05),Glu显著高于TA时(P＜0.05);组间比较,R组患者pH值TC、TD时显著高于Ⅰ组,TC、TD时BE显著高于Ⅰ组,Glu显著低于Ⅰ组(P＜0.05).结论 丙泊酚复合雷米芬太尼静脉持续输注在CEA麻醉中对血流动力学影响小,心血管事件发生率低,能明显提高麻醉安全和质量.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

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.