苯磺酸瑞马唑仑用于病态肥胖患者无痛胃镜检查的效果

目的 评价苯磺酸瑞马唑仑用于病态肥胖患者无痛胃镜检查的效果。方法 择期行无痛胃镜检查的病态肥胖患者60例,年龄24～39岁,ASA分级I～Ⅲ级,BMI>35 kg/m²。采用随机数字表法分为丙泊酚组(P组)和苯磺酸瑞马唑仑组(R组),各30例。2组均先静脉给予舒芬太尼7μg, P组采用丙泊酚1.5 mg/kg进行麻醉,R组采用苯磺酸瑞马唑仑10 mg进行麻醉。待MOAA/S评分<2之后进行内镜操作。术中如有体动分别追加丙泊酚0.5 mg/kg和苯磺酸瑞马唑仑2.5 mg。记录2组患者入室前(T₀)、胃镜置入时(T₁)、胃镜置入后2 min(T₂)、胃镜退出时(T₃)的MAP、HR水平、SPO₂、RR水平,MOAA/S评分,以及苏醒时间和不良反应的发生情况。结果 2组患者T₀时的MAP、SPO₂、HR、RR差异无统计学意义(P>0.05);T₁、T₂时间...     

阿芬太尼或舒芬太尼复合咪达唑仑与丙泊酚在无痛胃肠镜检查的效果

目的 探讨阿芬太尼或舒芬太尼复合咪达唑仑和丙泊酚在无痛胃肠镜检查的效果。方法 选择行无痛胃肠镜检查患者150例,男62例,女88例,年龄30～60岁,体重45～90 kg, ASAⅠ或Ⅱ级。按照随机数字表法分为两组：阿芬太尼+咪达唑仑组(AM组)、舒芬太尼+咪达唑仑组(SM组),每组75例。AM组静脉注射咪达唑仑0.02 mg/kg、阿芬太尼6μg/kg, SM组静脉注射咪达唑仑0.02 mg/kg、舒芬太尼0.06μg/kg。静脉注射丙泊酚1～2 mg/kg至改良警觉/镇静(MOAA/S)评分为0分时停止注射丙泊酚,立即开始胃肠镜操作。记录丙泊酚首次剂量、总消耗量、追加次数。记录起效时间、操作时间、意识恢复时间和PACU停留时间。记录胃镜插入咽喉部(T₁)、结肠镜插入肛门(T₂)、过脾曲(T₃)、过肝曲(T₄)时改良非插管患者行为疼痛量表(BPS-NI)评分。记录患者和内镜医师满意率,低血压、低氧血症、心动过缓、心动过速、呛咳等不良反应发生情况。结果 与SM组比较,AM组丙泊酚首次剂量明显减少(P...     

瑞马唑仑与丙泊酚用于肝硬化患者无痛胃镜检查的有效量及安全性

目的探讨瑞马唑仑与丙泊酚用于肝硬化患者无痛胃镜检查的有效量及其安全性。方法选择行无痛胃镜检查的肝硬化患者54例, 按随机数字表法分为丙泊酚组(P组, 30例)和瑞马唑仑组(R组, 24例)。静脉注射瑞芬太尼0.4 μg/kg后, P组给予丙泊酚(初始剂量1.0 mg/kg), R组给予瑞马唑仑(初始剂量0.1 mg/kg), 采用改良Dixon序贯法决定下一例患者的剂量。记录两组患者入室时(T0)、胃镜置入前(T1)、胃镜置入后(T2)、检查结束时(T3)的MAP、心率、SpO2、呼吸频率、改良警觉/镇静(Modified Observer’’s Assessment of Alertness/Sedation, MOAA/S)评分。记录两组患者低血压、低氧血症、呼吸抑制(呼吸频率<12次/min)、心动过缓、注射痛、恶心呕吐及眩晕等不良反应的发生情况, 记录两组患者苏醒时间及镇静成功率。分析瑞马唑仑与丙泊酚用于肝硬化患者无痛胃镜检查的量效关系, 采用概率单位Probit回归分析法计算瑞马唑仑、丙泊酚用于肝硬化患者无痛胃镜检查的ED50及其95%CI、95%有效量(95% eff...     

不同剂量瑞马唑仑复合舒芬太尼在无痛胃镜检查术中的比较

目的 探讨不同剂量瑞马唑仑复合舒芬太尼用于无痛胃镜检查术的有效性及适宜剂量。方法 选择2021年8—11月拟行无痛胃镜检查术患者160例,男84例,女76例,年龄18～64岁,BMI 18～30 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为四组：丙泊酚2 mg/kg组(P组)、瑞马唑仑0.2 mg/kg组(R1组)、瑞马唑仑0.3 mg/kg组(R2组)和瑞马唑仑0.4 mg/kg组(R3组),每组40例。P组、R1组、R2组和R3组静脉注射舒芬太尼0.1μg/kg行镇痛预处理后,60 s内分别静脉注射丙泊酚2 mg/kg、瑞马唑仑0.2、0.3和0.4 mg/kg,改良警觉/镇静(MOAA/S)评分≤2分时即开始胃镜操作。记录首次镇静成功率、胃镜检查时间、苏醒时间、离院时间。记录术中低氧血症、低血压、体动、呛咳、呃逆、注射痛和术后恶心呕吐等不良反应发生情况。记录患者和内镜医师对麻醉的满意度。结果 与P组比较,R1组首次镇静成功率、低氧血症、低血压、注射痛发生率和内镜医师满意率明显降低,苏醒时间和离院时间明显缩短,体动和呛咳发生率明显升高(P<0....     

瑞马唑仑对脊柱手术中神经电生理监测的影响

目的 探讨瑞马唑仑对脊柱手术中神经电生理监测(IONM)的影响。方法 选择行IONM的择期脊柱手术患者60例,男33例,女27例,年龄18～55岁,BMI 18～24 kg/m²,ASAⅠ—Ⅲ级。将患者随机分为两组：瑞马唑仑组(R组)和丙泊酚组(P组),每组30例。麻醉诱导及维持时R组采用瑞马唑仑,P组采用丙泊酚。记录入室时(T₀)、气管插管即刻(T₁)、停肌松药时(T₂)、停肌松药后30 min(T₃)、50 min(T₄)的HR、MAP和BIS。记录首次诱发运动诱发电位(MEP)的电流强度及其波幅。记录停药后到首次诱发出MEP的时间。记录T₄时体感诱发电位(SEP)和MEP的波幅及潜伏期。记录手术时间、麻醉时间、术中瑞芬太尼用量、血管活性药物使用情况、苏醒时间、拔管时间和不良反应情况。结果 与P组比较,R组T₁—T₄时HR明显增快、MAP明显升高(P<0.05),首次诱发的MEP波...     

瑞马唑仑对老年患者腹腔镜术后苏醒质量的影响

目的 探讨瑞马唑仑与丙泊酚用于全麻诱导和维持对老年患者腹腔镜术后苏醒质量的影响。
方法 选择择期在全麻下行腹腔镜手术的老年患者84例，男41例，女43例，年龄65～80岁，BMI 18.5~25.0 kg/m²， ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：丙泊酚组和瑞马唑仑组，每组42例。麻醉诱导：丙泊酚组静脉注射丙泊酚1～2 mg/kg，瑞马唑仑组静脉注射瑞马唑仑0.15～0.20 mg/kg。麻醉维持：丙泊酚组静脉泵注丙泊酚4～8 mg·kg^-1·h^-1，瑞马唑仑组静脉泵注瑞马唑仑0.5～1.0 mg·kg^-1·h^-1，其余用药相同。记录停药后10、20、30 min的改良警觉镇静评分(MOAA/S)、Steward苏醒评分。分别于麻醉诱导前、术毕即刻、术后24 h抽取肘静脉血，检测血清S100β蛋白、IL-6、丙二醛(MDA)浓度。记录术毕睁眼时间、拔管时间、PACU停留时间。记录术中低血压、注射痛、呛咳、术后恶心呕吐（PONV）等不良反应的发生情况。
结果 与麻醉诱导前比较，两组术毕即刻、术后24 h血清S100β蛋白、IL-6浓度明显升高(P<0.05)，术后24 h血清MDA浓度明显降低(P<0.05)。与丙泊酚组比较，瑞马唑仑组术毕即刻、术后24 h血清S100β蛋白、IL-6浓度明显降低(P<0.05)，睁眼时间明显延长(P<0.05)，注射痛和术中低血压发生率明显降低(P<0.05)。两组停药后10、20、30 min MOAA/S评分、Steward评分、拔管时间、PACU停留时间差异无统计学意义。
结论 丙泊酚与瑞马唑仑对老年患者腹腔镜手术后苏醒质量的影响无明显差异。     

瑞马唑仑用于经皮穿刺椎体后凸成形术患者围术期镇静的效果

目的 探讨瑞马唑仑应用于经皮穿刺椎体后凸成形术(PKP)患者围术期镇静的效果。方法 选择行PKP患者80例,男39例,女41例,年龄60～80岁,BMI 18～24 kg/m²,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组：瑞马唑仑组(RM组)和右美托咪定组(DM组),每组40例。两组依次缓慢静脉注射氟比洛芬酯1 mg/kg、舒芬太尼0.2μg/kg后,RM组静脉输注瑞马唑仑0.2 mg/kg, DM组静脉输注右美托咪定0.3μg/kg,输注时间均为10 min,待两组Ramsay评分为3分时,调整药物的输注速度持续镇静(RM组：0.3～0.5 mg·kg^-1·h^-1;DM组：0.20～0.75μg·kg^-1·h^-1),术中镇静深度保持Ramsay评分为3～5分,BIS 60～80。记录镇静用药前(T₀)、局麻开始时(T₁)、骨水泥注入时(T₂)、苏醒时(T₃)及苏醒后30 min(T     

瑞马唑仑复合丙泊酚用于无痛人工流产术的效果

目的评价瑞马唑仑复合丙泊酚用于无痛人工流产术的效果。方法选择拟行无痛人工流产术的患者210例, 按随机数字表法分为3组(每组70例):瑞马唑仑组(R组)、丙泊酚组(P组)、瑞马唑仑复合丙泊酚组(RP组)。R组给予瑞马唑仑0.2 mg/kg, P组给予丙泊酚2 mg/kg, RP组给予瑞马唑仑0.1 mg/kg+丙泊酚1.0 mg/kg。术中根据需要R组每次追加瑞马唑仑0.05 mg/kg, P组和RP组每次追加丙泊酚0.5 mg/kg。记录3组患者麻醉前(T0)、诱导完成1.5 min(T1)、诱导完成3.5 min(T2)、手术结束(T3)时的MAP、心率、SpO2, 记录3组患者麻醉起效时间、苏醒时间及不良反应(术中体动、注射痛、低血压、呼吸抑制、术后恶心呕吐、术中知晓、过敏)发生情况。于术前15 min和术后45 min采用正负性情绪量表(Positive and Negative Affect Scale, PANAS)评定患者的正负性情绪量值。结果 P组、RP组苏醒时间短于R组(P<0.05), 3组患者麻醉起效时间差异无统计学意义(P>0.05);T1时R组、R...     

甲苯磺酸瑞马唑仑对妇科日间手术患者术后苏醒质量及谵妄影响研究

目的 评价甲苯磺酸瑞马唑仑对妇科日间手术患者术后苏醒质量及谵妄的影响。方法 择期全凭静脉麻醉行日间妇科手术患者118例,年龄18～65岁,体质量40～80 kg, ASAI～Ⅱ级。采用随机数字表法分为观察组和对照组,每组59例。观察组静脉注射甲苯磺酸瑞马唑仑、丙泊酚、顺式阿曲库铵、舒芬太尼行麻醉诱导。对照组在麻醉诱导中以等量生理盐水代替甲苯磺酸瑞马唑仑。记录麻醉时间、手术时间、术中出血、输液量、尿量,以及麻醉起效时间、麻醉药物使用量、苏醒时间和拔管时间。评价患者入PACU时(T₀)、入PACU后10 min(T₁)、出PACU时(T₂)的疼痛VAS评分、苏醒质量Steward评分和镇静Ramsay评分。统计术后苏醒期不良反应及谵妄发生率。结果 2组患者的麻醉时间、手术时间、术中出血量、输液量、尿量、苏醒及拔管时间均无统计学差异(P>0.05)。观察组麻醉起效时间短于对照组,麻醉药物使用量少于对照组,差异均有统计学意义(P<0.05)。T₀、T₁、T₂     

瑞马唑仑在老年肥胖患者无痛胃镜检查中的应用效果

目的 评估瑞马唑仑在老年肥胖患者接受无痛胃镜检查术中的效果及对术后早期神经行为认知状态的影响。
方法 选择无痛胃镜检查的老年患者80例,男41例,女39例,年龄≥65岁,BMI 30~40 kg/m²,采用随机数字表将患者分为两组,每组40例。丙泊酚组（P组）静脉注射丙泊酚1.5 mg/kg;瑞马唑仑组（R组）静脉注射瑞马唑仑0.15 mg/kg。待患者MOAA/S≤1分时进行胃镜操作。记录给药前、胃镜检查后1、3 min、检查结束时和清醒后5 min的MAP、HR和SpO₂;镇静时间、操作时间、恢复时间和不良反应发生情况;在患者清醒后5 min时进行神经行为认知状态检查（NCSE）。
结果 与P组比较,胃镜检查后1、3 min,R组MAP和SpO₂明显升高,镇静时间、恢复时间明显缩短,不良反应发生率明显降低,清醒后5 min时NCSE记忆力测试正确率和计算能力筛查通过率明显升高（P<0.05）。
结论 瑞马唑仑用于老年肥胖患者行无痛胃镜检查能在短时间内使患者达到需要的镇静深度,血流动力学更稳定,不良反应更少,不会降低术后早期神经行为认知状态。     

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.