双靶向溶瘤腺病毒携带内皮抑素基因对肝癌的抑制作用

目的 构建双调控溶瘤腺病毒,携带小鼠内皮抑素基因(mE),研究其对裸鼠肝癌移植瘤的抗瘤活性.方法 以人端粒酶逆转录酶启动子(hTERT)和缺氧调控元件序列(HRE)调控腺病毒E1a和E1b基因,基因组插入mE基因,构建双调控溶瘤腺病毒CNHK500-mE;在裸鼠模型中观察CNHK500-mE对肝癌移植瘤模型的疗效.结果 CNHK500能够在hTERT阳性的肝癌细胞中增殖[24 h:(16.67±4.04)％;48 h:(65.33 ±7.02)％;P＜0.01],并介导mE高效表达;与空白对照组( 1895.80±323.37) mm3比较,CNHK500-mE和Ad-mE的抑瘤率分别为50.95％[(929.80±211.10) mm3,P＜0.01]和29.99％[(1327.23 ±319.36) mm3,p＜0.05];CNHK500-mE对癌组织间质血管的抑制作用明显强于Ad -mE(P ＜0.05).结论 将mE与溶瘤腺病毒结合,发挥病毒增殖的溶瘤作用和基因产物的血管抑制作用,表现出明显的协同抗瘤作用.     

基因-病毒治疗系统CNHK200-hA的构建及体外初步研究

目的　构建一种结合抗肿瘤新生血管生成的基因治疗与病毒治疗优势的新型肿瘤基因 病毒治疗系统CNHK2 0 0 hA。方法　克隆人抗血管生成基因Angiostatin(k1 5 ) ,命名为hA。利用病毒重组技术将hA插入肿瘤特异性增殖病毒的病毒基因组中 ,通过病毒增殖试验、电镜技术、Westernblot分析、鸡胚尿囊膜试验 (CAM ) ,观察CNHK2 0 0 hA的复制情况、hA基因的表达及其对新生血管生成的抑制作用。结果　构建了一种新型的基因 病毒治疗系统CNHK2 0 0 hA。该治疗系统为E1b 5 5× 10 3 蛋白缺失而保留了腺病毒E1a蛋白的 5型腺病毒 ,能在肿瘤细胞内大量增殖及复制 ,而在正常细胞内增殖能力较弱 ,从而特异性杀灭肿瘤细胞。同时CNHK 2 0 0 hA携带人抗肿瘤新生血管生成基因hA ,能在肿瘤细胞内高效表达hA蛋白 ,其表达量高于传统基因治疗的腺病毒载体系统。电镜证实该治疗系统可在肺癌A5 49细胞株中复制及增殖。CAM试验证实该治疗系统感染肺癌细胞后的培养液上清具有抗新生血管生成的生物活性。结论　基因 病毒治疗系统CNHK2 0 0 hA能在肿瘤细胞中增殖复制 ,并明显提高hA基因的表达量 ,表达产物具有抑制新生血管形成的作用。     

基因-病毒治疗系统CNHK300-小鼠内皮抑素对裸鼠胃癌的抗肿瘤作用

目的探讨新构建的基因-病毒治疗系统CNHK300-小鼠内皮抑素murineendostatin（CNHK300-mE）对胃癌的抑制作用。方法通过胃癌SGC-7901细胞裸鼠皮下移植瘤模型观察该病毒治疗系统对胃癌生长和肿瘤血管生成的抑制作用。用电镜观察该病毒在肿瘤细胞中的复制情况及肿瘤细胞的超微结构改变。用酶联免疫吸附（ELISA）法检测mE基因在体内的表达。用免疫组织化学的方法检测腺病毒外壳蛋白六邻体（hexon）、增殖细胞核抗原（PCNA）及vWF因子相关抗原的表达情况。采用TUNEL法检测细胞凋亡。结果CNHK300-mE能在肿瘤细胞内复制,高表达mE,在第7天时,达到（2115±770）ng/ml（范围1745～3000ng/ml）;明显抑制胃癌皮下移植瘤的生长及瘤内的血管生成,并可引起胃癌细胞的凋亡[治疗组小鼠肿瘤细胞凋亡率（78.4±9.1）%,对照组仅（15.2±0.5）%,P〈0.01],抑制肿瘤细胞增殖[治疗组小鼠PCNA指数（55.0±1.4）%,对照组为（74.1±0.4）%,P〈0.05]。结论CNHK300-mE能在小鼠胃癌内增殖复制,高效表达mE基因,抑制胃癌生长。     

基因-病毒治疗系统CNHK500-p53的构建和体外初步研究

目的构建一种新的基因-病毒治疗系统。方法通过基因操作技术将目的基因表达盒mCMV启动子 p53基因 SV40polyA插入腺病毒E1A基因受端粒酶逆转录酶(hTERT)启动子调控、E1B基因受缺氧反应元件(HRE)启动子调控的增殖病毒载体质粒pSG500的E1A下游,得到腺病毒质粒pSG500-p53;通过pSG500-p53与5型腺病毒右臂的质粒pBHGE3在293细胞中同源重组得到重组病毒CNHK500-p53;利用Westernblot和ELISA法检测病毒E1A、E1B基因和p53抑癌基因的表达;TCID50方法测定病毒滴度;通过增殖实验观察重组病毒的选择性增殖能力;应用细胞病理效应(CPE)实验检测病毒抗肿瘤作用。结果CNHK500-p53的病毒滴度为2×1010pfu/ml,增殖实验证实CNHK500-p53可以选择性地在端粒酶阳性和缺氧微环境的肝癌细胞中增殖,CNHK500-p53所携带的p53基因在肝癌细胞株中的表达量388±34.6μg/L明显高于非增殖型腺病毒载体Ad-p53的76.3±13.17μg/L(P<0.005),并显示了较强的抗肿瘤效应。结论CNHK500-p53是一种具备治疗肝癌潜力的新型基因-病毒治疗系统。     

新型血管生成抑制人内皮细胞抑制素-血管内皮细胞生长抑制因子151治疗胃癌的实验研究

目的研究重组腺病毒表达的人内皮细胞抑制素-血管内皮细胞生长抑制因子151(hENDO-VEGI151)融合蛋白对胃癌的抑制作用.方法构建携带hENDO-VEGI151融合基因的重组腺病毒载体,脂质体介导法包装重组腺病毒Ad IL-3/hENDO-VEGI151.体外检测融合基因的表达及融合蛋白的生物学活性.应用鸡胚绒毛尿囊膜(CAM)模型及荷人胃癌裸鼠模型,进一步观察融合蛋白对活体血管生成的影响和融合基因治疗活体胃癌的疗效.结果用TCID50法测定携带融合基因的重组腺病毒滴度为4.2×1011TCID50/ml;用聚合酶链反应(PCR)、逆转录(RT)-PCR和免疫组织化学方法证实融合基因可被转导入SGC-7901细胞内并稳定高效地转录和表达;Western blot显示融合蛋白可被分泌到胞外发挥作用;融合蛋白可强烈抑制ECV-304细胞生长及鸡胚绒毛尿囊膜新生血管形成.Ad IL-3/hENDO-VEGI151治疗可强烈抑制裸鼠体内种植瘤生长,明显下调肿瘤微血管密度,促进胃癌细胞凋亡.结论 hENDO-VEGI151是一条新型强效的肿瘤血管生成抑制基因,其表达产物可能通过作用于肿瘤新生血管形成的不同环节强烈抑制新血管生成和肿瘤生长,值得进一步研究.     

新型的病毒-基因治疗系统CNHK500-hγ的构建

目的研制出一种新的基因-病毒治疗系统。方法通过基因操作技术将主要晚期启动子(MLP)调控的人干扰素-γ基因插入腺病毒E1A基因受hTERT启动子调控、E1B基因受HRE启动子调控的增殖病毒载体质粒PXC70-HRE-TP的E1A上游,得到腺病毒质粒pSG500-hγ。通过pSG500-hγ与质粒pBHGE3在293细胞中同源重组得到重组病毒CNHK500-hγ。用TCID50方法测定病毒滴度。通过增殖实验观察重组病毒的选择性增殖能力。利用ELISA法检测人干扰素-γ抗癌基因的表达。结果CNHK500-hγ的病毒滴度为4×109pfu/ml,增殖实验结果证实CNHK500-hγ可以选择性地在端粒酶阳性的肝癌细胞中增殖,CNHK500-hγ所携带的人干扰素-γ基因在肝癌细胞株中的表达量(442μg/L)明显高于携带该基因的非增殖型腺病毒载体(120μg/L)Ad-hγ(P<0.005)。结论CNHK500-hγ是一种具备治疗肝癌潜力的新型基因-病毒治疗系统。     

双重调控选择增殖型腺病毒CNHK500的构建及初步研究

目的　研制出一种双重调控的选择增殖型腺病毒载体系统。方法　先后经 2次定点突变重叠聚合酶链反应 (PCR)技术使腺病毒E1A及E1B启动子缺失 ,并将人工合成的人端粒酶逆转录酶启动子和缺氧反应启动子分别插入E1A及E1B基因的上游 ,得到腺病毒载体质粒pSG5 0 0。通过 pSG5 0 0与质粒 pBHGE3在 2 93细胞中同源重组得到重组病毒CNHK5 0 0。扩增、纯化病毒 ,用TCID5 0方法测病毒滴度。通过病毒增殖实验观察重组病毒的选择性增殖能力。结果　成功构建了由双重调控选择增殖型腺病毒CNHK5 0 0 ,病毒滴度为 1.9× 10 10 pfu/ml ,增殖实验结果证实CNHK5 0 0可以选择性地在端粒酶阳性肿瘤中增殖。结论　CNHK5 0 0为肿瘤的生物治疗提供了一种新的策略。     

携带治疗基因的增殖型腺病毒CNHK300-m干扰素-γ的构建

目的 研制出一种携带抗癌基因的选择增殖型腺病毒载体系统.方法 克隆鼠干扰素(IFN)-γ基因序列,利用分子克隆技术将其插入肿瘤特异性增殖病毒的病毒基因组中,得到腺病毒载体质粒pSG300-m IFN-γ.通过pSG300-m IFN-γ与质粒pBHGE3在293细胞中同源重组得到重组病毒CNHK300-mIFN-γ.扩增、纯化病毒,用TCID50方法测病毒滴度.通过病毒增殖实验观察重组病毒的选择性增殖能力,通过Western blot检测腺病毒蛋白的表达,通过双抗体夹心法酶联免疫吸附试验(ELISA)检测重组病毒在不同细胞及不同时相的mIFN-γ表达量.结果 成功构建了携带治疗基因的增殖型腺病毒CNHK300-mIFN-γ,病毒滴度为1.0×109 pfu/ml,增殖实验证实CNHK300-mIFN-γ可以选择性地在端粒酶阳性肿瘤中增殖,Western blot分析结果显示腺病毒的E1A蛋白选择性在端粒酶阳性的肿瘤细胞中表达,ELISA显示CNHK300-mIFN-γ感染端粒酶阳性肿瘤后有大量mIFN-γ的表达,并随着感染的时间表达量也相应上升.结论 CNHK300-mIFN-γ为肿瘤的生物治疗提供了一种新的策略.     

多重调控病毒.基因载体的构建及其体外抗肿瘤活性

目的 构建一种新型的病毒.基因治疗载体.方法 通过克隆技术将人肿瘤坏死因子相关凋亡诱导配体(TRAIL)基因插入质粒载体pBHGE3的E3区,得到由主要晚期启动子(MLP)调控的腺病毒质粒pPE3-hTRAIL,再通过与质粒pSGS00在293细胞中进行位点特异性重组得到E1A、E1B基因分别受hTERT启动子与HRE启动子双重调控的重组增殖型腺病毒,用TCID50方法测定病毒滴度.通过增殖实验观察重组病毒的选择性增殖能力.利用酶联免疫吸附试验(ELISA)检测人TRAIL基因的表达.并进行噻唑蓝(MTT)比色法实验检测其杀伤肿瘤细胞的能力.结果 CNHK500-hTRAIL的病毒滴度为2.39×1010pfu/ml,增殖实验结果证实CNHK500-hTRAIL可以选择性地在端粒酶阳性的人肺癌细胞A549中增殖,其所携带的人TRAIL基因在A549中的表达量(183.12μg/L)明显高于携带该基因的非增殖型腺病毒载体Ad-hTRAIL(24.53μg/L,P<0.01).MTr显示CNHK500-hTRAIL对A549的杀伤能力明显高于携带该基因的非增殖型腺病毒载体Ad-hTRAIL,其半数抑制MOI值分别为17.825、0.197(P<0.01).结论 CNHKS00一hTRAIL是一种具备治疗肺癌潜力的新型病毒-基因治疗系统.     

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.     

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.     

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.     

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.