A型肉毒毒素注射治疗脊髓损伤后逼尿肌尿道外括约肌协同失调症

目的评价A型肉毒素（BTX-A）注射治疗脊髓损伤患者尿道外括约肌协同失调症（DESD）的临床效果。方法脊髓损伤致DESD患者15例。男12例,女3例,平均年龄37岁。临床表现排尿无力、排尿等待,需要压腹以助排尿。200 U BTX-A溶解于8 ml生理盐水,使用尿道镜注射针分8点二平面注射于尿道外括约肌,1ml/点。记录治疗前后排尿症状,尿动力学检查,并观察毒副作用。结果治疗后2个月,尿动力学检查结果显示膀胱贮尿和排尿功能有不同程度改善,15例最大尿流率由（9．2±5．0）ml/s增加至（16．2±7．0）ml/s,单次尿量由（182．5±52．0）ml/次增加至（235．5±40．0）ml/次,剩余尿量由（288．7±122．5）ml下降至（155．4±81．2）ml（P＜0．01）；最大膀胱测压容积、膀胱顺应性及充盈末逼尿肌压力术前分别为（113．0±64．8）ml、（15．2±2．0）ml/cm H2O、（52．7±19．2）cm H2O,术后分别为（205．5±75．6）ml、（22．5±9．3）ml/cm H2O及（37．1±7．3）cm H2O（P＜0．01,P＜0．05,P＜0．01）。治疗前需要坐位排尿的8例患者均可以直立排尿。随访2～7个月,疗效稳定。结论BTX-A注射是一种治疗脊髓损伤患者逼尿肌无反射伴DESD的有效方法,长期疗效有待观察。     

良性前列腺增生患者经尿道前列腺切除术后排尿症状改变及分析

目的 研究良性前列腺增生患者经尿道前列腺切除术后排尿症状的变化及其与术前临床参数的关系。方法 对281例良性前列腺增生手术患者进行随访,对其手术前、后排尿症状评分和术前临床资料进行分析。患者年龄（70±6）岁。术前前列腺体积（75±39）ml,血清总前列腺特异性抗原（T—PSA）（5±5）ng／ml,最大尿流率（8±3）ml／s,切除前列腺重量（32±19）g。术前国际前列腺症状评分（IPSS）（24±7）分,生活质量评分（QOL）（4．6±1．0）分,平均梗阻症状（3．6±1．2）分,平均刺激症状（3．5±1．0）分。结果 术后IPSS（7±7）分,生活质量评分（1．2±1．1）分,与术前相比,均明显改善。不同排尿症状改善的幅度不同,平均梗阻症状的改善幅度大于平均刺激症状的改善。术后夜尿和尿频分别为（2．2±1．1）分和（1．2±1．4）分。结论 经尿道前列腺切除患者术后排尿症状明显改善,症状的改善程度与术前IPSS和QOL相关,而与患者年龄、术前前列腺体积、T-PSA、最大尿流率、切除前列腺重量无相关性。梗阻症状的改善优于刺激症状的改善,而夜尿是改善幅度最小的症状。     

膀胱重量与前列腺增生临床参数的相关性研究

目的探讨膀胱重量（Bw）与常用BPH临床参数的相关性。方法81例BPH患者分为尿潴留与非尿潴留组,经腹B超（TAUS）测量其BW,将BW与年龄、国际前列腺症状评分（I—PSS）、生活质量评分（QOL）、前列腺体积（PV）、排尿后残余尿（PVR）、最大尿流率（Qmax）和前列腺特异抗原（PSA）进行相关分析。结果81例患者年龄平均（71．73±5．80）岁,IPSS（15．89±3．44）分,QOL（3．88±0．93）分,PV（61．55±19．67）m1．PVR（71．11±30．83）ml,Qmax（9．93±2．74）ml／s,PSA（3．30±2．63）rig／ml,BW（75．85±18．45）g;两组间年龄、QOL、PV、PRV、Qmax、PSA和BW存在显著性差异,而I—PSS差异无显著性;BW与年龄、IPSS、QOL、PV、PRV、PSA呈显著正相关,相关系数分别为（r=0．587,r=0．481,r=0．816,r=0．911,r=0．784,r=0．864,P〈0．001）,而与Qmax呈显著负相关（r=-0．769,p〈0．001）。结论BW能反映BPH的严重程度,对指导判断BPH严重程度和外科干预时机可能有重要的临床意义。     

前列腺增生手术前后膀胱重量变化的研究

目的 探讨良性前列腺增生（BPH）经尿道前列腺切除术（TURP）手术前后膀胱重量的变化及临床意义。方法 BPH患者63例,其中术后随访资料完整者21例,以相同年龄段无下尿路症状30例男性作为对照组。经腹B超测量膀胱壁厚度并结合膀胱容量按照球形体积公式估算膀胱重量。以尿动力学检查评价膀胱出口梗阻（BOO）和膀胱功能。63例BPH患者术前膀胱重量（97±54）g,对照组为（41±14）g,膀胱重量与梗阻分级（LinPURR）呈正相关（R=0．47）,与最大尿流率（Qmax）呈负相关（R=-0．52）,与残余尿量呈正相关（R=0．48）,差异均有统计学意义（P〈0．01）,与逼尿肌收缩强度（WF）呈负相关（R=-0．40,P〈0．05）。21例患者术前B超估测膀胱重量（UEBW）（99±50）g。结果 21例患者术后UEBW为（56±21）g,与术前比较差异有统计学意义（P〈0．01）。术后UEBW平均下降43．68％,国际前列腺症状评分（IPSS）下降16．81分,Qmax平均增加8．38ml／8。结论 膀胱重量作为一项无创性检查方法,对前列腺增生症进展的监测、术前评估和术后疗效的评价具有临床应用价值。     

良性前列腺增生患者膀胱内前列腺突入测定的临床意义

目的探讨良性前列腺增生（BPH）患者前列腺突入膀胱内的程度对膀胱出口梗阻及逼尿肌功能的预测与评价。方法以经腹超声证实前列腺突入膀胱内的BPH患者为研究组,无突入的患者为对照组,分析两组间临床资料及尿动力学检查结果的关系。结果研究组临床资料中,前列腺体积、残余尿量、急性尿潴留及膀胱小梁化的比率与对照组相比差异有统计学意义（p〈0．05）,膀胱内前列腺突入程度与前列腺体积、残余尿量呈正相关（r分别为0．401,0．342,p值分别为0．013,0．0231）;在尿动力学结果中,研究组排尿期最大尿流率（Qmax）、逼尿肌不稳定及低顺应性膀胱的比率与对照组相比差异显著（p〈0．01）,排尿期最大逼尿肌压力（Pdet.max）及梗阻指数显著高于对照组（p〈0．05）,膀胱内前列腺突入程度与Qmax呈负相关（r=-0．284,p=0．045）,与Pdet．max及膀胱出口梗阻指数（BOOI）呈正相关（r分别为0．252,0．456,p值分别为0．041,0．032）。结论前列腺突入膀胱的BPH患者膀胱出口梗阻及膀胱功能受损的程度明显高于无突入患者;经B超测定膀胱内前列腺突入的程度,可以预测及评价膀胱出口梗阻的程度和膀胱功能的改变。     

经尿道汽化切除治疗伴膀胱出口梗阻的晚期前列腺癌

目的探讨经尿道汽化切除术（TUVRP）或经尿道电切术（TURP）治疗伴膀胱出口梗阻（BOO）的晚期前列腺癌（PCa）的临床疗效。方法伴BOO症状的PCa患者96例,年龄61～92岁,平均75岁。经影像学和前列腺穿刺活检诊断为T3～T4 PCa且经睾丸切除和抗雄激素或放射治疗后仍有排尿困难者75例,有梗阻症状但穿刺活检报告为良性前列腺增生（BPH）或非典型性增生21例。术前确诊为PCa患者采用姑息性TUVRP。术前未明确PCa者按BPH切除,7例术中冷冻切片明确PCa,同时行睾丸切除术,14例术后病理确诊后行睾丸切除术。结果96例患者TUVRP或TURP平均时间（47±11）min,切除前列腺平均重量（26．3±7．2）g。术后并发症包括：拔除导尿管后不能自主排尿18例、急性附睾炎8例、暂时性尿失禁5例、肉眼血尿10例。术后随访15～72个月,平均41个月。失访12例（12．5％）。死于PCa 18例（18．8％）,平均生存37个月。死于其他原因7例。患者术后排尿梗阻症状明显改善,国际前列腺症状评分（IPSS）术前平均29．2±3．5,术后3个月时降至8．1±2．4（P＜0．001）；最大尿流率（Q（max））术前平均（6．8±3．1）ml/s,术后6个月时（15．7±3．1）ml/s（P＜0．05）；PSA术前（84．6±45．1）ng/ml,术后6个月时降为（13．2±12．5）ng/ml（P＜0．05）。7例患者随访期间出现梗阻症状再次电切。存活59例已随访17～96个月,有骨转移31例。结论TUVRP是治疗伴BOO的晚期PCa的安全、有效方法,可迅速缓解梗阻症状,提高患者生活质量。     

膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效探讨

目的探讨膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效。方法经膀胱训练和抗胆碱能药物等常规治疗无效的女性膀胱过度活动症患者8例，年龄23-62岁，平均42岁。患者均有尿急、尿频、夜尿增多症状，无急迫性尿失禁。膀胱镜下将肉毒素A200U注射于膀胱逼尿肌内，散在注射20-30点，并在尿道括约肌注射4点以防止术后尿潴留。记录治疗前及治疗6周后的排尿日记、常规尿动力学检查结果和患者症状改善情况，进行疗效评价。结果8例患者治疗6周后，排尿日记显示日排尿次数由（12．2±2．4）次减至（7．5±2．2）次（P〈0．05），夜尿次数由（2．2土0．3）次减至（1．8土0．4）次（P〉0．05）。尿动力学检查初始尿意时膀胱容量由（132．5±32．8）ml增至（190．2±37．6）ml（P〉0．05），膀胱最大容量由（217．3±34．6）ml增至（320．6±27．4）ml（P〈0．05）。2例治疗前尿动力学检查具有逼尿肌不稳定表现患者，1例逼尿肌不稳定消失，另1例初次不稳定收缩时膀胱容量由126ml增加到194ml。8例患者均未出现尿潴留、尿失禁等排尿并发症及全身不良反应，均对治疗效果满意，疗效持续5-9个月。结论膀胱内注射肉毒素A是治疗女性膀胱过度活动症安全有效的手段。     

三种正位新膀胱术后膀胱功能的临床观察

目的评价3种正位新膀胱术式患者术后膀胱功能。方法胃代膀胱术后患者38例、回肠代膀胱术后31例、乙状结肠代膀胱术后33例,术后1～3个月随访患者排尿状况、上尿路B超、肾图或IVU检查、尿动力学检查,统计学分析比较各组疗效。结果胃代膀胱术后排尿通畅性较好,最大尿流率（17．2±6．2）ml/s,尿路感染发生率5％,膀胱容量（230±56）ml、尿失禁26％、遗尿21％；回肠代膀胱术和乙状结肠代膀胱术后膀胱容量分别为（320±70）ml、（300±60）ml,尿失禁分别为6％、9％,遗尿分别为6％、9％；上尿路梗阻和返流发生率均较低,与胃代膀胱术比较差异有统计学意义（P＜0．05）。结论3种代膀胱术术后膀胱贮尿功能良好,以回肠代膀胱术和乙状结肠代膀胱术后功能更好,胃代膀胱术由于其胃壁的生理特点在新膀胱抗感染和排尿功能方面满意。     

前列腺增生伴逼尿肌无力患者电切术治疗后的临床分析

目的 探讨良性前列腺增生（BPH）膀胱出口梗阻（BOO）致膀胱逼尿肌收缩功能无力（DU）患者的临床诊断及治疗方式.方法 2006年1月至2010年12月经治的60例BPH老年患者,均行经尿道前列腺电切术（TURP）.根据逼尿肌收缩压力（Pdet）分为4组：A组逼尿肌正常组（Pdet＞ 40 cm H2O）,B组逼尿肌无力组（Pdet＜40 cm H2O）,再将B组细分为：B1组（轻度逼尿肌无力组）（20 cm H2O ＜Pdet＜40 cm H2O）及B2组（重度逼尿肌无力组）（Pdet＜20 cm H2O）,分别对其术后的排尿症状进行了2～6年的随访.结果 统计学比较术后A、B组间及B1、B2组间的生活质量评分（QOL）、排尿梗阻症状及刺激症状,差异无统计学意义（P＞0.05）.结论 BPH患者BOO解除后,逼尿肌功能状态可能并不影响下尿路症状（LUTs）的改善.因此对BPH合并DU的患者进行必要的沟通后行手术治疗解除梗阻,可改善患者生活质量.     

膀胱出口部分梗阻大鼠逼尿肌胆碱能和肾上腺素能受体变化的研究

目的观察大鼠膀胱出口部分梗阻后不同时间逼尿肌胆碱能（M）、肾上腺素能β及α1受体的变化。方法40只大鼠分为对照组、假手术组、梗阻2周组和梗阻5周组,每组10只。放射配基法测定逼尿肌M、β及α1受体密度和平衡解离常数。离体逼尿肌条拉力实验观察梗阻2周和5周后逼尿肌对氯化氨甲酰胆碱和异丙肾上腺素产生的收缩和舒张反应。结果4组M受体密度分别为（121．87±15．32）、（122．34±26．56）、（138．66±24．16）和（131．54±23．09）fmol／mg,β受体密度分别为（83．18±7．51）、（82．20±6．24）、（92．21±6．53）和（86．32±5．02）fmol／mg。梗阻组M受体和β受体密度与对照组及假手术组相比,差异有统计学意义（P〈0．05）,梗阻5周组较2周组降低（P〈 0．05）。4组α1受体密度分别为（30．08±3．51）、（31．07±2．99）、（29．56±3．21）和（28．31±1．16） fmol／mg,梗阻组与对照组及假手术组相比,差异无统计学意义（P〉0．05）。对照组M、β、α1受体平衡解离常数分别为（2．18±0．13）、（5．63±0．44）、（4．68±0．34）mmol／L,假手术组分别为（2．54±0．96）、（5．74±0．41）、（4．79±0．42）mmol／L,梗阻2周组分别为（2．22±0．36）、（5．66±0．32）、（4．56±0．33）mmol／L,梗阻5周组分别为（2．32±0．25）、（5．56±0．19）、（4．55±0．18）mmol／L,组间比较差异无统计学意义（P〉0．05）。氯化氨甲酰胆碱和异丙肾上腺素引起逼尿肌条的收缩和舒张均呈浓度依赖性反应（P〈0．05）。结论大鼠膀胱出口部分梗阻后可能引起逼尿肌M、β及α1受体的改变,导致膀胱功能变化。     

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.