胸腰椎肿瘤整块切除后应用3D打印人工椎体重建的安全性和有效性研究

目的:评估胸腰椎肿瘤整块切除后应用3D打印人工椎体重建脊柱稳定性的安全性和有效性。方法:回顾性分析我院2016年5月～2020年1月胸腰椎肿瘤整块切除术后应用3D打印人工椎体重建脊柱稳定性的42例患者。原发性骨肿瘤37例;转移性肿瘤5例。肿瘤均累及胸腰椎。手术实施整块切除,均使用3D打印人工椎体作为前方支撑结构。根据随访超过6个月患者的X线片、CT片评估3D打印假体与相邻椎体融合情况、有无内固定失败。结果:全脊椎切除者39例,矢状切除者3例。使用标准化3D打印人工椎体19例,其中1节段者15例,2节段者3例,3节段者1例;从后路放置15例,从前方放置4例。使用定制化假体23例,其中单节段者7例,2节段者3例,3节段者10例,4节段者2例,5节段者1例;通过椎弓根螺钉拧入假体内置钉孔与后方钉棒系统连接达到自稳19例,从前路放置并通过内置钉孔用螺钉固定于相邻椎体者4例。40例患者获得随访,随访时间3～47个月,中位随访时间22个月。影像学随访超过6个月的患者36例,包含确定融合者9例,可能融合者19例,可能不融合者8例;均无螺钉断裂或拔出、连接棒断裂和假体断裂移位情况;总体融合率为77.8%(28/36)。2例假体下陷超过2mm,但症状轻微未行内固定翻修手术。结论:3D打印人工椎体较大的终板面积有利于防止假体塌陷;微孔结构能促进骨长入增加骨融合;定制化设计能使其与内固定系统连接或直接固定于相邻椎体从而获得更好的即刻稳定性。     

3D打印钛孔结构与实体钛结构椎体的体外生物力学测试分析

【摘要】 目的 通过对3D打印钛孔结构与实体钛结构椎体植入猪腰椎后进行体外生物力学测试,评价其活动范围情况及即刻生物力学稳定性。方法 选取18具新鲜成年猪脊柱标本(L1-L6)随机分配到以下3组：对照组（未置换）、钛孔结构椎体置换组（取出L3椎体行钛孔结构椎体植入)、实体钛结构椎体置换组（取出L3椎体行实体钛结构椎体植入）。测试标本的前屈、后伸、侧屈、轴向旋转角位移运动变化。结果 实体钛结构椎体置换组与对照组在各方位角位移运动范围比较,差异有统计学意义（P < 0.05）;钛孔结构椎体置换组与对照组在各方位角位移运动范围比较,差异有统计学意义（P < 0.05）;钛孔结构椎体置换组和实体结构椎体置换组在各方位的角位移运动范围相比,差异无统计学意义 (P > 0.05),且两种固定状态下各方位的即刻稳定指数比较,差异均无显著性意义 (P > 0.05);结论 两种3D打印人工椎体方法均能获得良好的即刻稳定性,但3D打印的钛孔结构在融合方面优于实体钛结构。     

3D打印个体化人工椎体在多节段脊柱肿瘤切除后脊柱稳定性重建中的应用

目的:探讨3D打印个体化人工椎体在多节段脊柱肿瘤切除后脊柱稳定性重建中应用的安全性和有效性。方法:回顾性分析2017年5月～2019年12月在我院行多节段脊柱肿瘤全切并行3D打印人工椎体脊柱稳定性重建的患者9例,其中男性3例,女性6例;年龄25～64岁,平均41.7±10.5岁,随访18.3±11.4个月(6～36个月)。9例均为原发肿瘤:T5～T7骨母细胞瘤术后复发1例,T7～T8上皮样血管肉瘤1例,T10～T11未分化小圆细胞肉瘤1例,T11～L1软骨肉瘤1例,骨巨细胞瘤5例(T6～T8共2例,T2～T3、T4～T5、T11～L1各1例)。依据肿瘤位置及周围软组织侵袭程度,采取单纯后路手术方式8例,前后路联合手术方式1例行多节段全椎体切除,并通过激光选区融化技术构建个体化3D打印人工椎体进行脊柱稳定性重建。记录手术时间、出血量,通过术后X线片(1个月、3个月、6个月、12个月)及CT(6个月、12个月、24个月)定期复查,之后每6个月复查1次。应用BrantiganSteffee脊柱融合分级评估人工椎体稳定性、界面骨融合情况,手术前及术后1周进行Frankel神经功能评分及疼痛视觉模拟(visual analogue scale,VAS)评分。术后定期观察肿瘤是否复发生原位复发、远处转移以及患者生存情况。结果:所有患者均成功接受多节段脊柱肿瘤切除3D打印人工椎体脊柱稳定性重建术,其中2个节段椎体切除4例,3个节段椎体切除5例。患者手术时间433.3±174.6min(235～740min),术中出血量4816.7±3221.2ml(1000～14000ml)。术前的VAS评分4.1±1.1分,术后7d患者的VAS评分1.2±0.4分,差异具有统计学意义(P0.001)。术前Frankel分级为D级的3例患者术后7d时有2例恢复到E级,1例无明显变化,6例E级患者无明显变化。随访期内3D打印人工椎体与邻近椎体匹配情况良好,无松动、下沉及移位,同时未出现断钉、断棒等内固定失败情况。术后6个月,人工椎体与邻近椎体接触紧密,开始出现界面骨长入,术后12个月,人工椎体与邻近椎体出现骨性连接,发生骨性融合。随访期内7例患者无肿瘤复发转移,1例软骨肉瘤患者术后16个月局部复发,安罗替尼治疗后肿瘤无恶化,1例上皮样血管肉瘤患者全身多发转移于术后18个月死亡,患者中位生存期18个月。结论:3D打印个体化人工椎体可以满足多节段脊柱肿瘤切除后脊柱稳定性重建的要求,精确恢复椎体连续性,精准匹配相邻椎体,自身孔隙结构利于骨的长入,是一种多节段脊柱肿瘤切除后理想的脊柱稳定性重建方法。     

髋膝关节翻修术中的关键问题及3D打印应对之策

人工关节置换术是髋膝关节终末期疾病的有效治疗手段。我国人口老年化逐渐加重,关节置换的患者越来越多,初次置换术后由于假体松动、假体周围感染、假体周围骨折、聚乙烯磨损引起的骨缺损严重影响着患者的预后,需要翻修的患者也逐渐增加。现阶段,人工髋膝关节翻修中主要面临的难题有:骨缺损处理、术前规划、个性化假体需求。随着软件工程技术、材料技术的不断发展,3D打印技术将为复杂的髋膝关节置换翻修带来新的解决方案。3D打印技术在关节外科手术有以下方面的应用:优化术前规划、个性化手术;个性化内固定材料;个性化术中导航模板的制作;个性化假体设计。本文就髋膝关节翻修中的关键问题及3D打印技术在其中的应用进展作简要综述。     

3D打印个体化人工椎体重建胸腰椎骨巨细胞瘤整块切除后脊柱的稳定性

目的:探讨3D打印个体化人工椎体在胸腰椎骨巨细胞瘤整块切除后脊柱稳定性重建中的作用。方法:2017年1月～2019年12月我科共收治10例经病理检查证实且行全脊椎整块切除并用3D打印个体化人工椎体进行脊柱稳定性重建的胸腰椎骨巨细胞瘤患者。其中男性1例,女性9例;年龄38.3±13.7岁。9例为我院初治病例,1例为外院治疗后复发病例。均有不同程度的顽固的局部疼痛,术前疼痛视觉模拟评分(visual analogue scale,VAS)为4.5±1.2分;2例有双下肢不完全性瘫痪伴受累节段以下平面感觉减退,余患者肌力、感觉均正常。脊髓功能Frankel分级D级2例,E级8例。肿瘤部位:胸椎6例,腰椎4例;单节段5例,双节段2例,三节段3例。根据WBB(Weinstein-Boriani-Biagini)分期,肿瘤累及A～D区和B～D区各5例。7例采用单一后路肿瘤脊椎整块切除,3例采用前后路联合的方式行肿瘤全脊椎整块切除;肿瘤切除后均采用3D打印个体化人工椎体和钉棒系统进行脊柱稳定性重建。观察患者的术中术后并发症、术后神经功能、肿瘤控制和3D打印人工椎体的状态。结果:手术时间4.5～12.0h(6.5±2.0h);术中失血2300～11500ml(4600±2444ml)。所有患者术后疼痛均明显缓解,术后VAS评分为1.3±0.5分。术后6例出现脑脊液漏,3例出现胸腔积液,无切口感染和伤口裂开等并发症发生。随访时间为7～33个月(16.0±7.9个月)。2例术前脊髓功能Frankel分级D级在术后3个月均恢复至E级。所有患者均存活,无肿瘤局部复发及肺转移。未见3D打印个体化人工椎体下沉或移位,无内固定松动或断裂。结论:对于胸腰椎骨巨细胞瘤,3D打印个体化人工椎体能够有效重建全脊椎整块切除后脊柱的稳定性。     

皮瓣外科的过去、现在和未来

目的 通过对3D打印钛孔结构与实体钛结构椎体植入猪腰椎后进行体外生物力学测试,评价其活动范围情况及即刻生物力学稳定性。方法 选取18具新鲜成年猪脊柱标本（L₁~L₆）随机分配到以下三组：对照组（未置换）、钛孔结构椎体置换组（取出L₃椎体行钛孔结构椎体植入,简称钛孔结构组）、实体钛结构椎体置换组（取出L₃椎体行实体钛结构椎体植入,简称实体钛组）。测试标本的前屈、后伸、侧屈、轴向旋转角位移运动变化。结果 实体钛组、钛孔结构组分别与对照组在各方位角位移运动范围比较,差异均有统计学意义（均P<0.05）;钛孔结构组与实体钛组在各方位的角位移运动范围比较,差异均无统计学意义（均P>0.05）,且两种固定状态下各方位的即刻稳定指数比较,差异均无统计学意义（均P>0.05）。结论 两种3D打印人工椎体方法均能获得良好的即刻稳定性,但3D打印的钛孔结构人工椎体在融合方面优于实体钛结构。     

基于3D打印技术和微创腰椎椎间孔外椎体间融合术的设计

目的 通过3D打印技术设计微创腰椎椎间孔外椎体间融合术(ELIF),探讨3D打印技术应用于临床研究的快速性和高效性.方法 通过对1名男性健康志愿者(26岁,身高172 cm,体质量67 kg)的腰椎行CT扫描,并采用MimicsV14.0软件进行三维重建,研究椎间孔区域骨性结构和神经结构的解剖关系.模拟切除上关节突,置入椎间融合器与椎弓根螺钉,最后通过3D打印技术得到实物进行验证,通过尸体标本验证ELIF的可行性. 结果 基于3D打印技术设计的ELIF的手术切口是正中线旁开6 cm的纵形手术切口,45°斜向椎体的手术通道,可以充分暴露伤椎的椎间孔区域.通过ELIF手术途径可充分显露目标椎间盘和神经根以及后方的上、下关节突和关节囊,操作简便、直观.ELIF手术可以实现单纯切除上关节突,保留下关节突,通过扩大的椎间孔牵开神经根后可以显露并切除椎间盘,并能完成椎间融合器的置入. 结论 通过3D打印技术设计的ELIF是一种创伤更小、安全、有效的腰椎椎体间融合术式.3D打印技术可以进行精确的手术设计,效率高、速度快、成本低、可操作性强,对真实手术有较好的指导作用.     

腰椎退变性疾病研究的新动态

包括人工间盘置换技术在内的脊柱运动节段保留技术是目前脊柱外科研究的热点之一。很多研究者对应用运动节段保留技术治疗腰椎退变性疾病的临床疗效进行了深入的评估和比较。Zigler等[Spine J，2007，6（5）：S5-S6]比较了人工椎间盘置换术与腰椎融合术在治疗腰椎退变性疾病上的临床疗效差异，随访2—3年，结果显示人工间盘置换术在术后早期（3个月内）可很好地缓解疼痛，     

1例3D打印超长人工椎体植入治疗脊柱脊索瘤的护理

正脊索瘤起源于胚胎脊索的残迹组织,是脊柱最常见的低度恶性肿瘤之一,发病率较低,占原发恶性骨肿瘤的1%~4%~([1])。目前,彻底手术切除结合放疗的综合治疗是脊索瘤的最佳方案[2]。本文报道1例采用3D打印技术量身定做超长人工椎体植入治疗脊柱脊索瘤,手术跨越5个椎体,达19 cm,手术涉及的节段多,术后引流多,住院时间长,且手术方式与以往有很大区别,现总结相关护理体会。     

3D打印技术在腰椎滑脱手术中的应用价值

目的探讨3D打印技术在腰椎滑脱手术中的应用价值。方法将87例择期行腰椎滑脱手术患者随机分为观察组(45例)和对照组(42例),对照组患者采用传统椎间融合术治疗,观察组患者术前使用3D打印技术打印个体化矢状曲度模棒行椎间融合术。比较两组术中情况和疗效。结果术中出血量、术中透视次数及手术时间观察组均显著低于对照组(P0.05)。术后椎体滑脱率两组均较术前显著降低(P0.05),且观察组显著低于对照组(P0.05)。术后即刻、术后12个月固定节段矢状曲度恢复率观察组显著高于对照组(P0.05)。置钉准确率观察组显著优于对照组(P0.05)。JOA评分优良率观察组显著高于对照组(P0.05);ODI术后两组与术前比较均显著降低(P0.05),且观察组术后显著低于对照组(P0.05)。结论术前3D打印制作个性化的腰椎矢状曲度模棒,有助于腰椎椎弓根钉准确置入性,更好地恢复患者正常矢状曲度。近期疗效优于传统手术。     

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.