直肠癌全直肠系膜切除经腹腔镜与开腹手术的临床对照研究

目的 :探讨经腹腔镜行全直肠系膜切除的可行性。方法 :36例直肠癌患者分别采用经腹腔镜或常规开腹手术行直肠癌根治术 ,比较两组围手术期的情况与切除标本 ,了解肿瘤切除的彻底性 ,肠旁淋巴结清扫数量的差异。结果 :两组切除标本的直肠系膜均完整 ;腹腔镜组与开腹组淋巴结数分别为 7 9± 0 7与 8 1± 0 9(P >0 0 5 ) ;直肠远切端均无癌细胞浸润 ;腹腔镜组失血 136± 2 1ml ,开腹组失血 35 7± 34ml,差异有高度显著性 (P <0 0 1) ,腹腔镜组手术后肠功能恢复早 (4 3± 5hvs 78± 12h ,P <0 0 5 ) ,围手术期并发症 2组无显著差别。结论 :在熟练掌握开腹全直肠系膜切除 (TME)的基础上经腹腔镜行TME是可行的 ,且患者创伤小、康复快 ,近期治疗效果与开腹手术无差别     

腹腔镜和开腹直肠癌全系膜切除的对照研究

目的:探讨腹腔镜下行直肠癌全直肠系膜切除根治术的临床效果。方法:24例直肠癌患者分为两组。腹腔镜组:采用全直肠系膜切除(LCR)12例。采用经腹腔镜下联合应用超声刀循盆筋膜壁层和脏层的间隙行锐性游离全直肠系膜,切除一个不间断的直肠整体标本。开腹组:12例,采用常规开腹手术。比较两组围手术期的状况、肿瘤切除的彻底性、肠旁淋巴结清扫数量。结果:两组切除标本的直肠系膜均完整,腹腔镜组中无中转开腹,腹腔镜组与开腹组淋巴结数分别为7．9±0．7个与8,1±0．9个(P >0．05);远端直肠均无癌残留;腹腔镜组手术后肠功能恢复早[(45±4．5)h VS(79±11．6)h,P>0.05], 手术中出血量少[(185±41)ml VS(380±48)ml,P<0．01]。结论:经腹腔镜行全直肠系膜切除术 (TME)手术是行之有效的,具有创伤小,恢复快等忧点。     

腹腔镜辅助腹会阴切除与开腹手术的对比研究

目的 :前瞻性评估腹腔镜辅助腹会阴切除和开腹手术这两种技术的优劣性 ,并探讨腹腔镜辅助腹会阴切除的可行性和安全性。方法 :将根治切除的 4 1例直肠癌患者 ,分为腹腔镜组 2 1例和开腹组 2 0例 ,观察两组肿瘤手术切除、并发症、术后恢复和肿瘤复发情况。结果 :两组的手术时间、出血量差异无统计意义 (t=0 .6 0 6 ,P =0 .5 4 8和 t=0 .0 77,P =0 .939)。切除标本的长度、全直肠系膜完整数、肠系膜下动脉高位结扎数、淋巴结切除数等肿瘤学根治方面差异亦无统计学意义 (均 P>0 .0 5 )。腹腔镜组止痛药使用少于开腹组 (χ2 =4 .0 84 ,P =0 .0 4 3) ,腹腔镜组的造口排气时间、起床活动时间均短于开腹组 (t=2 .4 5 5 ,P =0 .0 1 9和 t=2 .6 37,P =0 .0 1 2 ) ,住院时间两组无统计学差异 (t=0 .6 81 ,P =0 .5 0 0 )。两组的并发症发生率大致相同 (均 P >0 .0 5 )。两组随访时间分别为 2 4个月 (6～ 5 8个月 )和 36个月 (7～ 6 6个月 ) (P =0 .1 6 3) ,两组肿瘤早期复发率类似 (P =1 .0 0 0 )。结论 :提示腹腔镜腹会阴切除在技术上不仅是可行的 ,也是安全的     

腹腔镜和开腹直肠癌全直肠系膜切除对机体免疫功能的影响

目的比较经腹腔镜和开腹行直肠癌全直肠系膜切除保留肛门手术对患者免疫功能的影响。方法将 37例行直肠癌全直肠系膜切除保肛术患者分为开腹组 (n =2 1)和腹腔镜组 (n =16 ) ,于术前 1天、术后第 1天、术后第 5天检测血清IL 2、IL 6、TNFα值。术前 1天和术后第 5天检测全血CD3 CD5 6 T细胞和CD3-CD5 6 NK细胞的百分比 ,血清免疫球蛋白IgG、IgM、IgA值。IL 2、IL 6、TNFα值的检测用酶联免疫吸附法 (ELISA) ,Ig的测定用免疫散射比浊法 ,CD3 CD5 6 T细胞和CD3-CD5 6 NK细胞用流式细胞仪进行检测。结果两组手术对CD3 CD5 6 T细胞、CD3-CD5 6 NK细胞、IL 2、IL 6、TNFα和免疫球蛋白的影响差异无显著性意义 (P >0 0 5 )。结论腹腔镜和开腹直肠癌全直肠系膜切除术对患者免疫功能的影响差异无显著性意义。     

腹腔镜与剖腹手术治疗早期子宫颈癌37例临床分析

目的　探讨腹腔镜手术治疗早期子宫颈癌的价值。　方法　对 18例临床Ⅰb～Ⅱa 期宫颈癌施行腹腔镜下广泛全子宫切除和盆腔淋巴结清扫术 (腹腔镜组 ) ,其中Ⅰb 期 17例 ,Ⅱa1例。同期 19例早期子宫颈癌行开腹广泛全子宫切除和盆腔淋巴结清扫术 (剖腹组 ) ,比较两种术式的手术时间、术中出血量、术后恢复情况及手术并发症等。　结果　腹腔镜组平均手术时间 (2 72 8min± 80 3min)与开腹组 (2 2 6 5min± 6 6 8min)无明显统计学差异 (t=1 92 1,P =0 0 6 3)。腹腔镜组平均切除淋巴结 15 6± 5 1个 ,开腹组 16 8± 5 7个 ,两组比较差异无显著性 (t=0 6 74 ,P =0 5 0 5 )。腹腔镜组术后肠道功能恢复时间较开腹组明显缩短 (34 2hvs.6 0 7h ,P <0 0 1)。两组均无严重并发症发生。腹腔镜组术后并发症发生率为 33 3% (6 18) ,开腹组为 31 6 % (6 19) ,两组差异无显著性 (P =0 812 )。　结论　腹腔镜与剖腹手术都可作为子宫颈癌根治术的术式之一 ,腹腔镜手术具有创伤小 ,术后恢复快等优点。     

腔镜与开腹低位直肠癌Miles术的对比研究

目的:探讨腹腔镜低位直肠癌Miles术的临床效果及应用价值.方法:回顾分析120例低位直肠癌Miles术患者的临床资料,其中腹腔镜组50例,遵循全直肠系膜切除原则行腹腔镜低位直肠癌Miles术;开腹组70例,行常规开腹手术.对比两组患者围手术期情况、淋巴结清扫数量、住院时间等指标.结果:两组标本直肠系膜均完整,腹腔镜组...     

腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床安全性对比研究

目的：探讨腹腔镜直肠全系膜切除治疗中、低位直肠癌手术的安全性。方法：回顾性对比分析我院2002年12月～2005年12月开腹直肠癌全系膜切除的病例（开腹组52例），以及2003年1月～2006年6月腹腔镜直肠癌全系膜切除的病例（腹腔镜组49例）。结果：腹腔镜组与开腹组一般资料差异无显著性。与开腹组比较，腹腔镜组术中出血量少[直肠癌前切除术（160±106）ml（n=37）vs（298±186）ml（n=36），t=-3．908，P=0．000；腹会阴联合直肠癌根治术（180±153）ml（n=10）vs（356±170）ml（n=14），t=-2．604，P=0．016]。腹腔镜组肠道功能恢复时间早于开腹手术组[（2．4±1．8）dVS（3．6±1．5）d，t=-3．648，P=0．000]。腹腔镜组总并发症的发生率低于开腹组[14．3％（7／49）g844．2％（23／52），x^2=10．834，P=0．001]。两组清扫淋巴结的数目无差异（12．7±6．5VS13．6±7．0，t=-0．668，P=0．505），下切缘均为阴性。腹腔镜组45例（91．8％）随访2～42个月，开腹组47例（90．4％）随访6～42个月，局部复发率分别4．4％（2／45）、4．3％（2／47）。结论：腹腔镜直肠全系膜切除治疗中、低位直肠癌安全、可行。     

直肠癌淋巴结检出数对病理分期的影响

目的 探讨直肠癌标本获取的淋巴结数对病理分期的影响.方法 将2007年1月至2008年6月接受全直肠系膜切除术的直肠癌患者的手术标本随机分为两组:常规组(n=39),肉眼下用手触摸获取淋巴结;脂肪清除组(n=36),用脂肪清除剂浸泡24 h后再获取淋巴结.比较两组所获取的淋巴结数量,分析其转移情况及病理分期.结果 本研究入组患者共75例,男性42例,女性33例,平均年龄53.2岁.常规组平均每例标本检出14.4(8～27)枚淋巴结;脂肪清除组平均检出36.2(14～62)枚淋巴结,两组差异有统计学意义(t=5.800,P＜0.05).常规组和脂肪清除组T1期分别为4例和5例,T2期分别为9例和6例,T3期分别为24例和22例,T4期分别为2例和3例;两组差异均无统计学意义(Z=0.160,P=0.850).常规组平均每例标本转移淋巴结数为1.5枚,而脂肪清除组为3.2枚,两组差异有统计学意义(Z=3.500,P＜0.05).常规组区域淋巴结为N0、N1、N2者分别为20、12、7例,而脂肪清除组则分别为9、14、13例,两组差异有统计学意义(Z=2.410,P=0.016).结论直肠癌全系膜切除术后标本淋巴结数量变异较大,直肠癌系膜淋巴结转移不但与分期相关,而且与淋巴结数量相关;目前以12枚淋巴结衡量其系膜完整切除与否及病理分期的精准度可能存在问题.     

腹腔镜直肠癌全直肠系膜切除术的学习曲线研究

目的 评估腹腔镜直肠癌全直肠系膜切除术不同阶段的手术效果,探讨腹腔镜结直肠外科医师缩短学习曲线的要点.方法 分析2006年1月至2009年10月由同组医师完成的120例腹腔镜直肠癌全直肠系膜切除术患者的临床资料.按手术先后次序分A、B、C 3组,每组40例,比较各组手术时间、术中出血量、中转开腹率、并发症发生率、住院时间、标本长度和淋巴结清扫数,分析不同阶段的手术效果.结果 3组病例在年龄、性别、病理分期、肿瘤部位、手术方式无显著差异,A组手术时间、出血量及术后住院时间高于B、C组,差异有统计学意义;B、C组间差异无统计学意义.A组中转开腹例数多于B、C组.各组检获淋巴结数目及标本长度无差异.结论 有丰富开腹直肠癌手术经验的固定手术团队,经过40例的学习曲线,可掌握腹腔镜直肠癌全直肠系膜切除手术.     

腹腔镜辅助下结直肠癌手术的疗效分析

目的探讨腹腔镜辅助下结直肠癌手术的可行性、安全性、并发症及近期临床疗效。方法回顾性分析4年间1 1 2例腹腔镜下结直肠癌手术患者的临床资料,包括右半结肠切除2 3例,左半结肠切除7例,乙状结肠癌切除1 5例,D ixon术4 9例,M iles术1 8例。结果1 0 5例手术成功,7例因出血、肥胖及与邻近器官粘连而中转开腹手术,其中左半结肠2例,直肠癌4例。平均手术时间(1 6 1.2±4 8.6)m in,平均出血量7 8.5mL。术后早期并发症8例,无围手术期死亡。结肠癌标本近、远切缘长度分别为(1 4.5±3.2)cm和(1 1.0±2.6)cm,直肠癌标本近、远切缘长度分别为(15.3±2.7)cm和(2.8±1.6)cm。清扫淋巴结平均(8.2±4.6)枚,4 9例淋巴结转移。随访8~4 4个月,随访率9 5.5%。随访未发现戳孔肿瘤种植,局部复发7例(6.5%),远处转移6例(5.6%),总病死率7.5%(8/1 0 7)。结论腹腔镜下结直肠癌手术不仅安全可行,具有微创优势,并可达到与开腹同样的肿瘤根治性效果。     

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.