腹腔镜治疗肥胖症的临床分析

目的评价腹腔镜可调节胃绑带术（1aparoscopic adjustable gastric banding,LAGB）治疗肥胖症的临床效果。方法分析我院2005年8月至2010年8月单纯肥胖患者行LAGB治疗的30例临床资料。结果30例患者LAGB均成功,手术时问50～170min,平均85min,出血量5～50ml,无手术死亡及术中并发症,术后住院2—9d,平均5d。术后29例获得随访,随访时间3～62个月,平均21个月,总减重10—76kg,平均27kg,平均减重百分比为54％,均无出现营养不良及其他并发症。26例患者术前肥胖并发症等均有明显改善。结论LAGB治疗肥胖症微创、安全、操作较简单、减重速度可调节、减重效果持久。     

腹腔镜可调节胃绑带术治疗单纯性肥胖症228例

目的评价腹腔镜可调节胃绑带术（LAGB）的减重效果及手术并发症。方法回顾性分析2003年6月至2011年6月间在上海第二军医大学长海医院普通外科同一组医师施行LAGB手术的228例单纯性肥胖症患者的临床资料，观察其术后减重效果及近、远期并发症。结果228例患者中女性155例，男性73例；年龄（32．5＋10．3）岁；术前体质量指数（39．5＋6．3）kg／m。。除1例因显露不佳致中转开腹，其余均经腹腔镜顺利完成手术。术后随访3～70（中位37）月，早期并发症发生率2．2％（5／228），远期并发症发生率32．9％（75／228），其中与绑带相关远期并发症发生率24．6％（56／228）。术后1、3、5年额外体质量减重率（wwL％）分别为（40．5＋30．5）％、（59．5~41．5）％和（58．9±46．4）％。术后1、3、5年EWL％大于50％者所占比例分别为32．8％（64／195）、54．4％（62／114）和54．8％（23／42），大于75％者所占比例分别为0、15．8％（18／114）和21．4％（9／42）。结论LAGB手术死亡率和早期并发症发生率非常低，但远期并发症发生率较高，且术后减重效果欠理想，不宜作为减重首选术式。     

腹腔镜可调节胃绑带治疗单纯肥胖症的临床应用

目的评价腹腔镜可调节捆扎带胃减容术（laparoscopic adjustablegastric banding,LAGB）治疗单纯肥胖症的效果。方法回顾性分析我院2006年3月-2007年5月行LAGB的单纯肥胖症9例的临床资料。结果手术时间130-210min,平均170min;出血量30～100ml,平均60ml。本组无一例中转开腹,无手术死亡病例,术中、术后均未发生并发症。本组均获24-34周（平均29周）的随访,减重9～41kg,平均20．5k,无营养不良症状出现。结论LAGB手术简单、安全,围手术期并发症发生率低,术后可根据需要调节减重速度。对单纯肥胖症病人,LAGB可减轻体重、缓解肥胖并发症和提高生活质量。     

腹腔镜可调节胃束带术与胃袖状切除术治疗肥胖症合并2型糖尿病的近期疗效比较

目的 比较腹腔镜下可调节胃束带术（LAGB）与腹腔镜胃袖状切除术（LSG）治疗肥胖症合并2型糖尿病的近期减重及降糖疗效,并初步分析两种术式减重与降糖疗效间的关系.方法 回顾性分析2010年1月至201 1年12月上海第二军医大学附属长海医院收治的40例肥胖症合并2型糖尿病患者的临床资料.其中行LAGB 14例（LAGB组）,行LSG 26例（LSG组）.采用门诊及远程随访的方式比较两种术式术后1年时间内的减重及降糖疗效.两组术前情况比较采用配对t检验,两组间比较采用重复测量的双变量多因素方差分析,减重及降糖疗效相关性采用线性回归分析.结果 两组患者均经腹腔镜完成手术,无中转开腹,无术中并发症发生.LAGB组患者手术时间为（69±16） min,术中出血量为（31±14） mL.LSG组患者手术时间为（120 ± 15） min,术中出血量为（148±48）mL.两组患者术后均未发生营养不良、电解质紊乱、胃排空障碍、出血、吻合口漏等严重并发症.有2例患者术后出现局部伤口脂肪液化,经换药后愈合.（1）减重疗效：LAGB组和LSG组患者术后体质量、BMI、腰围均呈下降趋势.LAGB组患者术后体质量、BMI、腰围由术前的（117 ±28）kg、（40±8）kg/m2、（118±15）cm下降为术后48周的（94±28）kg、（33±8）kg/m2、（92±15） cm;LSG组患者上述指标由术前的（119±25）kg、（42±6） kg/m2、（123±14） cm下降为术后48周的（74±16） kg、（26±4） kg/m2、（86±13）cm.两组患者多余体质量减少率（EWL）呈上升趋势.LAGB组患者EWL由术后1周7％±2％上升为术后48周的53％±24％,LSG组患者EWL由术后1周11％±4％上升为术后48周的90％±20％.两组上述指标变化趋势比较,差异有统计学意义（F=60.660,74.490,57.650,90.020,P＜0.05）.（2）降糖疗效：LAGB组患者术后糖化血红蛋白、空腹血糖、空腹胰岛素、胰岛素抵抗指数、TG、TC、LDL、HDL由术前的8.1     

腹腔镜下管状胃切除术和可调节胃绑带术对肥胖患者的影响

目的 比较腹腔镜下管状胃切除术（LSG）和腹腔镜下可调节胃绑带术（LAGB）两种手术方式对于肥胖患者的减肥效果以及对于伴随肥胖而产生的2型糖尿病（T2DM）患者的改善情况,探讨何种方式具有优势.方法 检索PubMed、Embase、万方、知网数据库从2000年1月1日-2012年8月17日公开发表的关于LSG和LAGB的文献,采用RevMan 5.0统计软件进行分析,比较通过这两种手术方式后6个月和12个月患者体重的减轻程度以及对T2DM的改善情况,通过选择计算相对危险度（95％ CI）作为效应尺度指标来评估这两种方式的有效性.结果 11篇关于腹腔镜下管状胃切除术和腹腔镜下可调节胃绑带术的比较的研究符合要求,共计1 004例患者.Meta分析显示,对于LAGB,6个月的平均的促进体重减轻（EWL）（年）百分比是33.9％,12个月的EWL（年）百分比是37.8％.对于LSG,6个月的平均EWL为50.6％,而12个月的EWL则达到了51.8％.68例T2DM患者中有42例（61.8％）在经过LAGB手术后病情得到改善或治愈,80例行LSG的T2DM患者中有66例（82.5％）得到改善或治愈.结论 相对于LAGB,LSG是一个更加有效的方式,在改善病态肥胖和T2DM上具有更加良好的效果.     

腹腔镜可调节胃束带术减重疗效及高失访率原因分析

目的评估肥胖患者行腹腔镜可调节胃束带术（LAGB）的长期减重疗效,并探讨LAGB术后高失访率的原因。方法回顾性分析2003年6月至2007年6月间在第二军医大学附属长海医院行LAGB术的226例肥胖患者的临床及随访资料。结果随访至2010年6月,125例（55-3％）患者获得随访．随访时间为3-7年,其中115例（92．0％）患者术后体质量下降,60例（48．0％）减去了额外体质量。失访105例（44．7％）,失访患者年龄偏轻（P〈0．05）;而性别、体质量和BMI则与失访率无关（均P〉0．05）。结论LAGB术是减重手术中相对简单、安全性极高的一种术式;但其术后随访较繁琐．失访率较高,应加强其术后随访。     

腹腔镜袖状胃切除术的围手术期处理

目的总结腹腔镜袖状胃切除术（LSG）治疗病态性肥胖症患者的疗效及其围手术期处理方法。方法回顾性分析2010年5月至2012年12月在第二军医大学长海医院行LsG手术、并获得至少1年术后随访的57例病态性肥胖症患者的临床资料。所有患者均予以充分的术前准备和严格的术后管理．并通过随访了解其术后额外体质量减轻百分率（EWL％）和术前合并症的缓解情况。结果除1例因腹腔广泛粘连中转开腹,其余56例患者均在腹腔镜下完成手术。手术时间（102．0±15．2）min,术中出血（132．3±45．6）ml。无围手术期死亡患者,无吻合口瘘、吻合口狭窄及切口感染发生。术后出血2例。其中1例经输血和止血药等保守治疗止血,另1例行再次腹腔镜探查止血。全组患者术后3、6和12月,EWL％分别为（54．9±13．8）％、（79．0±23．6）％和（106．9±25．1）％,且术前合并症均获得了不同程度的缓解或改善。结论LSG对肥胖症有良好的临床治疗效果,通过加强围手术期管理．可以提高手术安全性和术后疗效。     

腹腔镜袖状胃切除术对肥胖相关疾病的治疗分析

目的探讨腹腔镜袖状胃切除术（LSG）治疗肥胖症及肥胖相关疾病的安全性和有效性。方法回顾性分析2006年12月至2011年7月间在浙江省人民医院接受LSG术的67例肥胖症患者的临床资料。观察术后1年患者体质量指数（BMI）、多余体质量减少率（EWL）以及2型糖尿病、高血压等肥胖相关疾病的改善情况。结果67例患者均顺利完成LSG术。手术时间（78±17）min．术后住院时间（5．0±1．7）d。术后恢复均顺利,无围手术期死亡及术后严重并发症发生。64例（95．5％）患者获得术后1年的随访,BMI由术前的（37．7±4．1）kg／m2下降了（10．4±3．7）kg／m2,EWL为（80．2±27．7）％。2型糖尿病和高血压的治愈率分别为53．8％（7／13）和45．5％（5／11）,缓解率均达100％。高三酰甘油血症（51例）、高尿酸血症（42例）、睡眠呼吸暂停综合征（2例）、骨关节疾病（9例）和棘皮病（8例）等其他肥胖相关疾病也得到治愈或不同程度的改善。结论LSG治疗肥胖症是安全可行的。在明显减轻体质量的同时还能治愈或改善2型糖尿病和高血压等肥胖相关疾病。     

腹腔镜手术治疗219例肥胖症疗效分析

目的探讨腹腔镜下胃肠外科手术治疗单纯性肥胖症及其合并2型糖尿病（T2DM）患者的效果及安全性。方法上海第二军医大学附属长海医院微创外科2003年6月至2010年6月间对219例肥胖症患者进行了腹腔镜下胃肠外科手术,其中201例行腹腔镜下可调节胃绑带术（LAGB组）,13例行腹腔镜下改良简易型胃肠短路术（LMGB组）,5例行腹腔镜下管状胃胃切除术（LSG组）。总结分析该组患者的临床和随访资料。结果LAGB组患者体质量指数（BMI）平均37．9kg／m2,术后6个月及12个月BMI分别为平均32．4kg／mz和29．7kg／m2;43例术前合并T2DM者．11例（25．6％）术后临床部分缓解,16例（37．2％）完全缓解;有26例（12．9％）术后出现并发症。LMGB组患者BMI平均34．7kg／m2,术后6个月及12个月BMl分别为平均31．6kg／m2和26．9kg／m2：10例术前合并T2DM者,2例（20．0％）术后临床部分缓解,7例（70．0％）完全缓解;有2例（15．4％）术后出现并发症。LSG组患者BMI平均43．8kg／m2．术后6个月及12个月BMl分别为平均38．1kg／m2和34．3kg／m2;3例术前合并T2DM者,术后1例达到临床部分缓解,1例完全缓解：有1例术后出现并发症。所有术式组均无围手术期死亡。结论腹腔镜下胃肠外科手术对单纯性肥胖症有效．并能使合并的T2DM得到缓解．同时手术并发症较少。     

同时经腹腔镜手术治疗肥胖症和胆囊结石的体会

目的 探讨同时经腹腔镜手术治疗肥胖症和胆囊结石的技巧、体会.方法 我科从2006年10月至2009年11月期间行腹腔镜可调节胃束带减容术(laparoscopic adjustable gastric banding, LAGB)治疗178例单纯肥胖患者,其中18例合并胆囊结石,同时行腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC),对其临床资料进行回顾性分析.结果 18例肥胖症伴胆囊结石患者同时行腹腔镜手术治疗,全部成功,手术时间为(126±24) min,术中出血量为(50±16) ml;3例术后出现轻度恶心、呕吐,2例腹部穿刺切口轻度脂肪液化,1例腹腔少量积液,均经对症处理痊愈,无腹腔感染等严重并发症发生;术后1、3、6个月来院调整胃绑带松紧度,随访减重效果明显,胆囊结石引起的腹部症状消失.结论 LAGB手术创伤小且减重效果好;对合并胆囊结石者,通过调整LAGB腹壁戳孔位置可同时完成LC手术,无需增加新的腹部戳孔,创伤减少,且不影响LAGB手术效果,可达到同时治疗两种疾病的目的.     

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.     

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.     

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.     

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.