胸腔镜下前路松解联合后路矫形治疗脊柱畸形

目的:评价胸腔镜下前路松解联合后路矫形对脊柱畸形的治疗效果。方法:回顾性分析我院收治的19例脊柱畸形行胸腔镜辅助前路松解及后路脊柱畸形矫形植骨融合术患者的临床资料及治疗结果。结果:胸腔镜手术时间平均120min,前路松解、阻滞椎间盘平均4.2个。术后14例特发性脊柱侧凸Cobb角平均被纠正到29.4°,4例神经纤维瘤病性脊柱侧凸Cobb角平均被纠正到28°,1例胸椎后凸Cobb角被纠正到58.5°。术后平均随访17.5个月,无矫正度的丢失和其它神经系统及血管损伤并发症。结论:胸腔镜辅助前路脊柱松解是安全、有效的微创手术,联合后路矫形治疗脊柱畸形可获得满意治疗效果。     

经前路松解联合后路固定治疗特发性脊柱侧凸

目的:评价经前路松解联合后路矫形对特发性脊柱侧凸的治疗效果。方法:回顾性分析我院收治的51例(男16例,女35例;年龄8～17岁,平均13.2岁)特发性脊柱侧凸行前路松解及后路脊柱畸形矫形植骨融合术患者的临床资料及治疗结果。结果:本组中行前路松解、植骨,阻滞椎间盘平均2.4个。联合后路椎弓根钉(钩)-棒系统内固定,植骨、融合。术后特发性脊柱侧凸Cobb角<90°者额状平面平均矫正率为57%,矢状面后凸平均矫正率为50%;Cobb角>90°者额状平面平均矫正率为71%,矢状面后凸平均矫正率为74%。术后随访10～35个月,平均随访21.6个月,无矫正度的丢失及其他神经系统及血管损伤并发症。结论:脊柱前路松解安全、有效,联合后路相适应内固定系统矫形、植骨治疗特发性脊柱侧凸可获得满意治疗效果。     

僵硬性脊柱侧凸前、后路松解效果的比较

目的:比较前、后路松解在僵硬性脊柱侧凸分期治疗中的效果,分析前、后路松解的手术适应证。方法:79例僵硬性脊柱侧凸患者(均为先天性或特发性脊柱侧凸患者),分别一期行脊柱前路或后路松解,头颅骨盆环牵引2～5周,平均18d,二期行矫形内固定术。前路松解组40例,其中先天性脊柱侧凸18例,特发性脊柱侧凸22例。后路松解组39例,其中先天性脊柱侧凸19例,特发性脊柱侧凸20例。对两组患者松解术前、术后Cobb角及脊柱畸形改善率、手术时间和手术并发症进行分析比较。结果:前路松解组先天性脊柱侧凸患者的Cobb角由101°矫正至61°,特发性脊柱侧凸由96°矫正至53°;后路组先天性脊柱侧凸由106°矫正至78°,特发性脊柱侧凸由89°矫正至63°,脊柱畸形改善率前路松解优于后路松解(P<0.05)。两组的手术时间、手术并发症均无显著性差异。结论:前路松解的脊柱畸形改善率明显优于后路松解,前路松解更适合于僵硬性脊柱侧凸的一期松解,不适合行前路松解的患者可选择后路松解。     

一期前路松解后路三维矫形治疗重度僵硬性脊柱侧凸

目的探讨一期前路松解后路三维矫形治疗重度僵硬性脊柱侧凸的手术策略,并评价其疗效。方法1997年7月～2003年1月应用一期前路松解后路三维矫形治疗重度脊柱侧凸36例,男9例,女27例;年龄13～39岁,平均17.2岁。其中特发性脊柱侧凸33例,神经纤维瘤病性脊柱侧凸3例。术前冠状面Cobb角85°～116°,平均96.2°;矢状面异常20例。前路行凸侧松解、椎间植骨后,同次麻醉下再行后路CD(4例)、CD-Horizon(5例)、TSRH(10例)或Isola(17例)脊柱内固定器械三维矫形内固定及植骨融合,其中31例行胸廓成形术。结果全部病例随访6～48个月,平均24个月。术后冠状面Cobb角30°～65°,平均47.6°,平均矫正率48.5%;80.6%的患者术后维持或达到矢状面平衡。未发生严重的神经系统并发症,无脱钩、断棒及深部感染。术后气胸2例,创伤性胸膜炎1例,术后2年假关节形成1例,术后11个月躯干失平衡1例。随访1年后矫正度丢失大于10°者2例,平均丢失5.2°。结论对重度僵硬性脊柱侧凸应用一期前路松解、后路三维矫形的方法矫形满意。正确选择病例、术前仔细评估、术中应用SEP及唤醒试验可减少神经系统并发症的发生。其远期疗效尚待进一步观察。     

胸腔镜辅助下治疗特发性脊柱侧凸

[目的]评价胸腔镜下前路松解,前路或后路矫形治疗特发性脊柱侧凸的治疗效果。[方法]回顾本院自2003年7月~2005年12月施行的11例胸腔镜辅助下前路松解,前路或后路矫形治疗特发性脊柱侧凸病例。年龄12~16岁,平均14.6岁。LenkeⅠ型9例,术前冠状面Cobb s角54°~68°,平均59.7°;LenkeⅢ型2例,术前冠状面Cobb s角分别为58°和71°,平均64.5°。Bending X线片侧凸矫正率为21.8%~32.4%,平均26.4%。对11例患者在胸腔镜辅助下,采用等离子冷消融切除椎间盘松解,前或后路矫正。对手术后及随访时,冠状面和矢状面的Cobb s角进行测量,并对手术时间,术中出血量,围手术期并发症及矫正丢失等进行分析。[结果]平均手术时间290 min,平均术中出血171 ml。松解节段5~7个,平均4.4个。9例LenkeⅠ型术后Cobb s角平均20.4°,Cobb s角矫正率平均65.8%;2例LenkeⅢ型术后Cobb s角分别为20°和25°,Cobb s角矫正率平均65.1%;1例术后包裹性胸腔积液,术后平均随访18.6个月;1例出现矫正度丢失14°,无神经系统及血管损伤并发症。[结论]与传统开胸前路胸椎侧凸矫形手术相比,胸腔镜辅助下胸椎松解前后路矫形治疗脊柱侧凸是安全有效的微创手术,可达到与开胸手术同样效果。     

前路胸腔镜下青少年特发性胸椎侧凸矫形的初步临床结果

目的回顾胸腔镜下青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）前路矫形的初步临床疗效。方法 2007年8月~2008年11月行胸腔镜下前路矫形患者8例,均为女性Lenkel A-型AIS患者,平均年龄为13.8岁。对手术前后及末次随访时的胸椎侧凸Cobb角、腰椎侧凸Cobb角、顶椎中点与C7中点垂线或骶骨平分线垂直距离（apical vertebral translation,AVT）、顶椎旋转角、胸椎后凸Cobb角及双肩高度差进行分析。结果所有患者术后随访3~12个月,胸椎侧凸Cobb角平均改善率为71%、矫形丢失率为6%;腰椎侧凸Cobb角平均改善率为60%、矫形丢失率为6%;AVT改善率为73%,丢失率为6%。所有患者顶椎旋转角度均无改善;胸椎后凸Cobb角无改变。双肩高度差除1例患者随访时丢失50%,其余改善率均为100%。结论柔韧度好的Lenkel A-型AIS行胸腔镜下前路矫形可获得良好的冠状面矫形,但矢状面矫形及椎体去旋转效果不佳,长期疗效有待继续观察。     

青少年特发性脊柱侧凸的选择性胸椎融合治疗

目的　探讨青少年特发性脊柱侧凸选择性胸椎融合治疗的适应证。方法　回顾性分析12例行选择性胸椎融合患者术前、术后及随访时的X光像 ,对侧凸类型、侧凸Cobb角、顶椎旋转度、顶椎偏距、侧凸柔韧性、躯干偏移及胸腰段矢状面Cobb角进行测量和分析。患者 12例中男 2例 ,女10例 ,平均年龄 15 1(13～ 18)岁。侧凸均为KingⅡ型 ,其中PUMCⅡb1型 9例 ,Ⅱc3型 3例。所有病例均行选择性胸椎融合 ,平均随访 3 5 (1～ 10 5 )年。结果　手术前后胸弯冠状面Cobb角分别为5 4 0°、19 0° ,平均矫正率 6 2 7% ;腰弯冠状面Cobb角分别为 34 6°、12 5° ,自动矫正率为 6 4 7%。最后随访时 ,胸、腰弯的冠状面Cobb角分别为 18 8°、15 9°;腰弯冠状面Cobb角、顶椎偏距及顶椎旋转度与术后相比无显著变化。术后发生胸腰段后凸 1例 ,最终随访时未见进一步加重。无躯干失平衡现象发生。选择性胸椎融合较后路融合双弯平均减少 3 5个融合节段。结论　对腰弯柔韧性好且度数较小的KingⅡ (PUMCⅡb1和部分Ⅱc3)型特发性脊柱侧凸 ,可安全有效地行选择性胸椎融合     

肋骨结构性支撑植骨在脊柱侧凸前路矫形手术中应用的长期随访

[目的]评价肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中应用的长期随访结果.[方法]回顾性分析术后随访时间超过4年的青少年特发性脊柱侧凸前路矫形手术病例30例,男3例,女27例;年龄12～ 17.5岁,平均14.3岁.侧凸类型包括PUMC Ⅰ b型5例、Ⅰc型5例、Ⅱd1型20例.全部病例均行前路矫形融合手术,植骨方式采用自体肋骨结构性支撑植骨.术前、术后及随访时摄脊柱站立位X线片,测量冠状面及矢状面Cobb角,并观察植骨融合情况,有无假关节形成及内置物并发症.[结果]随访4～10.2年,平均6.3年.融合弯冠状面矫形率术后平均为75.1％,末次随访时矫形丢失平均4.6°;固定融合节段冠状面矫形率术后平均为93.2％,末次随访时丢失平均2.1°;固定融合节段矢状面Cobb角术前与术后比较无显著性差异,末次随访时矫形丢失平均3.1°.13例胸腰段后凸患者术前后凸平均8.3°,术后矫正为前凸平均5.6°,末次随访时保持前凸平均3.7°.全部病例末次随访时均未见假关节形成或内置物并发症.[结论]肋骨结构性支撑植骨在青少年特发性脊柱侧凸前路矫形融合手术中能获得并维持良好的冠状面及矢状面矫形,且融合率高、远期矫形丢失少,是一种可靠、有效的植骨方法.     

经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯10例初步报告

[目的]观察经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯的效果。临床资料:共10例特发性脊柱侧弯(K ingⅡ6例,K ingⅢ3例,K ingⅣ1例)。男6例,女4例;年龄14~21岁,平均17.2岁。冠状面Cobb s角67°~125°(平均91.9°),胸椎侧凸柔软度为19.30%~36.5%(平均28.3%)。[方法]全麻下(单或双肺通气)侧卧位胸腔镜下以顶椎为中心做5~6个椎间盘及纤维环的切除达到松解植骨,术毕改俯卧位行后路三维矫形术。[结果]本组患者均前路成功松解胸椎,手术时间120~150 m in,术中出血量100~200 m l(平均151 m l),术后引流量100~150 m l;同期行后路器械矫形;术后Cobb s角为26°~75°(平均47°),侧弯矫正率51.5%。患者切口Ⅰ/甲愈合。无气胸、呼吸道梗阻、肺部感染以及神经系统并发症。经6~12个月随访,植骨均已融合。无矫形度的丢失及内固定并发症;外形改善明显。[结论]经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯可有效提高手术效果,有很好的安全性,减少手术次数。     

后路椎体截骨内固定治疗僵硬性脊柱侧凸9例报告

[目的]评价后路椎体截骨矫形固定治疗僵硬性脊柱侧凸的临床疗效和适应证的选择。[方法]本院2003年4月~2005年2月采用后路顶椎楔形截骨矫形固定治疗9例僵硬性脊柱侧凸,男5例,女4例;年龄11~23岁,平均14.2岁。先天性侧凸5例,特发性侧凸4例。术前测Cobb s角平均为81.5°,悬吊后平均为67.2°,脊柱柔韧度平均11.5%。伴有神经症状2例,椎管内间隔2例。顶椎截骨平面在T8~11,截骨后采用Scofix器械固定,后路植骨融合。[结果]9例随访6~28个月,平均16.6个月。侧凸Cobb s角平均31.2°,矫正率平均61.3%,矫正丢失率平均2.1%。本组病例全部骨性融合,无断钉、断棒、松动。[结论]后路椎体截骨矫形固定治疗僵硬性脊柱侧凸,适用于中、重度青春期后特发性和重度先天性混合性脊柱侧凸畸形,此方法能一次性完成矫形侧凸,降低神经、血管损伤的发生率,并通过椎弓根系统固定和植骨融合重建脊柱的稳定性,临床疗效肯定。     

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.