尿动力学联合膀胱尿道造影在女性压力性尿失禁诊断中的价值

目的探讨尿动力学检查联合排泄性膀胱尿道造影在女性压力性尿失禁诊断中的应用价值。方法回顾性分析56例临床诊断为女性压力性尿失禁（SUI）的患者,年龄（59．2±8．2）岁,每例均行尿动力学和排泄性膀胱尿道造影检查,评估膀胱顺应性、逼尿肌稳定性、尿道压、膀胱及尿道的形态。鳍杲尿动力学检查提示最大尿流率（33．6±7．7）mL／s,残余尿（17．8±14．7）mL,膀胱顺应性正常,膀胱容量（356．3±99．3）mL,33例测得腹压漏尿点压（49．8±17．6）cmH2O,最大尿道闭合压（47．4±10．5）cmH2O,功能性尿道长度（2．6±0．6）cm。相关性分析显示病程与腹压漏尿点压高度负相关（r=-0．816,P〈0．01）。排泄性膀胱尿道造影见膀胱颈及近端尿道下移34例,膀胱尿道后角变钝或消失44例,静息期膀胱颈和近端尿道呈漏斗形7例,咳嗽时47例见造影剂从尿道溢出。结论在无影像尿动力学设备的单位,尿动力学检查和排泄性膀胱尿道造影联合应用对SUI的诊断和术前评估具有重要的价值,比单用一种方法更具有临床意义。     

女性下尿路症状患者的尿动力学分析

目的　探讨女性下尿路症状原因及临床意义。　方法　 72例下尿路症状女性患者 ,年龄 8～ 86岁 ,平均 4 8岁。其中排尿困难 4 6例 ,尿失禁 14例 ,尿频 10例 ,夜间遗尿 2例。患者均行尿动力学检测。　结果　 4 6例排尿困难者膀胱容量 6 0～ 80 0ml,其中 2 0例膀胱逼尿肌收缩力为 0 ,2 6例9～ 16 0cmH2 O(1cmH2 O =0 .0 98kPa)。Linp URR图示为Ⅲ级以上梗阻者 19例。尿道静态分布阻力2 5～ 130cmH2 O。膀胱逼尿肌与尿道外括约肌协调性良好者 5例 ,协同失调者 33例。 10例尿频患者膀胱容量 97～ 4 5 0ml,2例排尿期膀胱逼尿肌收缩力为 0 ,8例 31～ 110cmH2 O。Linp URR图示显示Ⅲ级以上梗阻者 2例。 1例急迫性尿失禁者膀胱过度敏感。 6例压力性尿失禁者腹压漏尿点压力 4 4～76cmH2 O。 3例充盈性尿失禁者排尿期膀胱逼尿肌压力为 0 ,尿道静态分布阻力 32～ 4 2cmH2 O。真性尿失禁 4例尿道外括约肌压力 0～ 16cmH2 O ,平均 (8.5± 5 .7)cmH2 O。 2例遗尿患者存在不稳定性膀胱表现 ,排尿期膀胱收缩乏力。　结论　尿动力学检查对女性下尿路症状疾病诊断、治疗、预后判断具有重要指导意义。     

小儿神经源性膀胱与上尿路损害

目的：探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素,方法：对32例脊髓发育不良患儿行尿动力学和影像学检查。结果：18例（56％）有肾和输尿管积水,其中4例伴IV－V级膀胱输尿管返液,19例逼尿肌漏尿点压力大于等于40cmH2O(1cmH2O=0.098kPa)且膀胱顺应性小于等于40ml/cmH2O的患儿中,17例合并上尿路损害,13例逼尿肌漏尿点压力＜40cmH2O且膀胱顺应性＞40ml/c mH2O的患儿中,仅1例有双侧输尿管扩张,差别有非常显著性意义（P＜0．001）,结论：对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查,了解逼尿肌漏尿点压力和膀胱顺应性,确定与上尿路损害有关的危险因素,有助于避免上尿路进一步损害。     

同步膀胱膜部尿道测压的临床意义

目的 探讨同步膀胱膜部尿道压力测定的临床意义。方法 采用ANTEC Duet尿动力学仪同步测定412例泌尿系病人和6例健康者充盈和排尿时的膀胱和膜部尿道压力,肌电图用直肠电极测定。结果 （1）健康人充盈期膜部尿道压,男性为40－50cmH2O,女性为20－30cmH2O,充盈期膜部尿道压高于膀胱压,且全充盈期没有明显变化,排尿时膜部尿道压力明显下降低于膀胱压。（2）逼尿肌尿道协同失调的病人,排尿时膜部尿道压升高,其中逼尿肌外括约肌协同失调（EDES）时合并有肌电活动明显增加,逼尿肌膀胱颈协同失调（DBDS）肌电活动正常,排尿期尿道测压膀胱颈处压力呈斜坡样下降。（3）尿道关闭机制下降或不全时充盈期膜部尿道压明显低,且充盈期膜部尿道膀胱压力差为负值。（4）尿道不稳定充盈期膜部尿道压突然下降且幅度≥15cmH2O。（5）正常尿道腹压传递率为20％－35％,而压力性尿失禁（GUI）病人尿道腹压传递率＜20％。结论 同步膀胱膜部尿道压力测定操作简单,在判断尿道关闭机制的正常与否、逼尿肌尿道的协同与否、尿道稳定性及腹压向尿道的传递效率方面有重要价值。     

女性盆底器官脱垂伴尿失禁患者的尿动力学特征

目的 探讨女性盆底器官脱垂伴尿失禁患者膀胱储尿期和排尿期的尿动力学参数变化. 方法对182例女性尿失禁和盆底器官脱垂患者进行尿动力学检查,其中尿失禁140例,尿失禁伴盆底器官脱垂42例.在统一标准下行尿动力学检查测定膀胱灌注量、排尿量、膀胱顺应性、最大尿流率、最大尿流率逼尿肌压、最小尿流率逼尿肌压、尿道阻力因子(URA)、膀胱梗阻指数(OBI)以及归-化逼尿肌收缩力,评价女性尿失禁患者盆底器官脱垂对膀胱储尿功能和排尿功能的影响. 结果 尿失禁组与尿失禁伴盆底器官脱垂组患者尿失禁病程[(58.1±75.4)与(41.9±55.4)个月]、膀胱灌注量[(295.3±95.8)与(276.5±80.8)ml]、膀胱顺应性[(77.7±122.1)与(51.5±61.9)ml/cm H2O]、最大尿流率[(15.8±12.5)与(14.7±13.9)ml/s]、最小尿流率逼尿肌压[(3.2±5.8)与(2.8±5.5)ml/cm H2O]、归-化逼尿肌收缩力[(7.5±12.8)与(8.2±13.8)cm H2O]相比差异均无统计学意义(P>0.05);而年龄[(58.7±12.2)与(67.1±8.3)岁]、排尿量[(269.2±145.2)与(248.9±135.1)ml]、最大尿流率逼尿肌压[(20.4±16.2)与(25.7±21.3)cm H2O]、URA[(11.3±9.5与(14.8±12.6)cm H2O]、OBI[(15.6±14.5)与(21.7±20.1)cm H2O]2组相比差异有统计学意义(P<0.05).结论高龄女性尿失禁患者更可能伴有盆底器官脱垂,而盆底器官脱垂对膀胱储尿功能无影响,但可影响排尿期相关参数,增加膀胱出口阻力和膀胱残余尿量.     

逼尿肌漏尿点压在神经原性排尿功能障碍上尿路损害评估中的意义

目的　探讨逼尿肌漏尿点压检测神经原性排尿功能障碍患者上尿路损害功能评估中的诊断价值。　方法　 38例神经原性排尿功能障碍患者行尿动力学检查 ,重点进行逼尿肌漏尿点压测定。　结果　以逼尿肌漏尿点压 4 .0kPa(1kPa=10 .2 0cmH2 O)为界将 38例患者分为高压 (n =2 6 )及低压 (n =12 )两组 ,高压组膀胱容量为 (42 2 .95± 183.2 7)ml,低压组为 (46 4 .83± 10 6 .4 3)ml,高压组逼尿肌顺应性较低压组低 ,逼尿肌尿道括约肌协同失调 (DSD)增高。B超、IVU、血尿素氮及血肌酐检查等临床指标检测显示逼尿肌漏尿点压高者上尿路损害机会较低压组显著增高。　结论　逼尿肌漏尿点压测定对神经原性排尿功能障碍患者上尿路损害状态的评估有较大价值。     

肠道新膀胱尿动力学检查的临床意义

目的 探讨全膀胱切除肠代膀胱术后患者新膀胱和尿道的尿动力学特点。方法 全膀胱切除回肠原位新膀胱术患者22例，术后6～55个月，平均28个月。尿动力学检查测定尿流率、剩余尿，充盈期、排尿期膀胱测压、直肠测压、括约肌肌电图和尿道压测定。结果 22例患者最大尿流率2．7～22．1ml／s，平均12．9ml／s；排尿时间17～240s，平均66s；剩余尿5～300ml，平均92ml；最大膀胱容量210～650ml，平均426ml；初次尿意膀胱容量137～540ml，平均296ml；急迫尿意膀胱容量200～620ml，平均388ml。充盈末期膀胱内压均〈50cmH2O，顺应性31～35ml／cmH2O，平均33ml／cmH2O。膀胱容量≤50％时充盈期新膀胱不自主收缩平均1．2次，容量〉50％～100％时2．6次。压力流率测定时患者排尿期新膀胱均未见主动收缩，排尿期最大腹压10～105cmH2O，平均64cmH2O。最大尿道闭合压33～114cmH2O，平均69cmH2O。功能性尿道长度17～56mm，平均37mm。结论 回肠新膀胱具有良好的储尿能力，新膀胱排尿主要依靠腹压和尿道的协同作用，保留尿道的控尿能力是保证术后控尿能力的关键。     

中年女性尿失禁尿流动力学102例分析

目的：探讨尿动力学检查在女性尿失禁诊断中的应用。方法：对102例尿失禁的中年女性患者进行尿流动力学检查,并分析比较尿失禁组（包括SUI组、UUI组、SUI／UUI组）与正常对照组自由尿流率、膀胱压力容积、压力流率及尿道压力的差异。结果：SUI组最大尿流率高于正常对照组（P〈0．05）;较正常对照组,SUI组及suI／UUI组Valsalva漏尿点压力具有明显差异（P〈0．05）;最大尿流率时,SUI组逼尿肌压、最大尿道压及最大尿道闭合压均明显低于正常对照组（P均〈0．05）。结论：尿流动力学检查有助于中年女性尿失禁的诊断及鉴别诊断。     

BPH手术前后尿动力学检查及其临床价值

目的：评价尿动力学检查在BPH诊治中的意义。方法：对80例BPH患者进行详细的手术前后尿动力学检查。结果：80例均有膀胱出口梗阻，其中41例伴有不稳定性膀胱，占52％；78例逼尿肌压力正常或增强；72例尿流率降低，8例正常；手术后3个月，76例症状消失，2例出现并发症经再次处理治愈，不稳定性膀胱24例，占30％，包括6例低顺应性膀胱(术前为低顺应性膀胱)，2例逼尿肌无力(术前为高顺应性膀胱)。与术前相比，膀胱顺应性升高，而膀胱压及尿道降落压降低。结论：本研究表明，详细的、规范的尿动力学检查，可明确BPH患者有无BOO、逼尿肌顺应性和收缩功能及尿道压力。这对于合理选择术式和提高手术疗效有重要的临床意义。     

脑血管意外尿失禁的机制探讨

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。     

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.     

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.     

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.