机械性伤害性刺激诱发疼痛的脑区定位:功能性磁共振成像研究

目的 应用功能性磁共振成像技术定位机械性伤害性刺激诱发疼痛的脑区.方法 健康男性志愿者20名,年龄20 ～ 40岁,体重指数18 ～ 25 kg/m2,采用300 g von Frey纤维丝刺激志愿者左足心.1周后行功能性磁共振成像扫描,包括10 s的初始采集信号扫描及静息态(20 s)与刺激态(20s)交替循环6次扫描.采用SPM2软件进行图像分析.结果 300 g von Frey纤维丝机械性伤害性刺激诱发疼痛的脑区包括:双侧前扣带回、右侧岛叶和双侧初级体感皮层.结论 机械性伤害性刺激诱发疼痛的脑区包括双侧前扣带回、右侧岛叶和双侧初级体感皮层.     

不同剂量芬太尼对疼痛激活脑区的影响:功能性磁共振成像研究

目的 应用功能性磁共振成像技术,评价不同剂量芬太尼对疼痛激活脑区的影响.方法 选取右利手男性健康志愿者20名,年龄20～40岁,采用随机数字表法,将受试者随机分为2组(n=10):芬太尼1.0 μg/kg组(F1组)和芬太尼1.5 μg/kg组(F2组).300 g von Frey纤维丝刺激受试者左足心作为机械性伤害性刺激.静脉注射各组相应剂量芬太尼.于给药前、给药后5、10、15、20 min时给予机械性伤害性刺激,记录VAS评分.1周后行功能性磁共振成像扫描.扫描序列包括结构像扫描和功能像扫描,其中功能像扫描包括机械性伤害性刺激P1扫描、不同剂量芬太尼的药物扫描(扫描前单次静脉注射芬太尼)和机械性伤害性刺激P2扫描.P1、P2扫描包括10 s的初始采集信号扫描及静息态(20 s)与刺激态(20 s)交替循环6次扫描.给药扫描包括空白平衡扫描4 min和给药后扫描8 min.记录芬太尼给药前后疼痛激活脑区的改变.结果 F1组(P2-P1)激活的脑区:同侧扣带回;F2组(P2 -P1)激活的脑区:双侧扣带回和对侧岛叶.F2组与F1组功能磁共振成像叠加相比(F2组-F1组)可见同侧扣带回激活.结论 机械性伤害性刺激时芬太尼可促进扣带回和岛叶的活动,且与剂量有关,提示这两个脑区可能是芬太尼发挥镇痛作用的靶位.     

正常男女性兴奋的磁共振功能成像研究

目的:利用磁共振功能成像技术探讨在色情录像刺激下正常男女性兴奋在中枢神经系统的差异。方法:健康男性和女性各20例,均为右利手,无性功能障碍史,无任何精神、心理及其他器质性疾病史。用色情录像和非色情录像刺激,每个录像片段60s,每个色情和非色情录像片段之间间隔12s。用GE1.5THD磁共振扫描系统进行血氧水平依赖的功能磁共振扫描,共扫描7.0min。用3DSPGR-T1WI序列进行全脑轴位扫描作为全脑解剖图。结果:在视听相关的性刺激下,男女激活不同的脑区:①女性双侧杏仁核激活,左侧激活体积为(220.52±17.09)mm3,右侧为(155.45±18.34)mm3,左侧明显大于右侧(P<0.05)。而男性仅左侧杏仁核被激活。②正常男性左前扣带回的激活较女性明显,男性左前扣带回激活体积为(420.75±19.37)mm3,女性为(310.67±10.53)mm3,两者差异有显著性(P<0.05);③女性胼胝体压部激活较男性明显(P<0.01),女性激活体积为(473.45±14.92)mm3,男性为(363.32±13.30)mm3。结论:男女性反应在中枢神经系统的激活存在差异,推测男女性脑结构和功能存在不同是这种差异的基础。     

咪唑安定对大鼠丘脑束旁核感受伤害性刺激神经元的干预反应研究

目的 研究咪唑安定对大鼠丘脑束旁核感受伤害性神经元对感受外周伤害性刺激的干预反应。方法 微电极探查束旁核神经元（n=6），对找到的每个感受伤害性刺激神经元均实施以下步骤：（1）记录基础放电（A组）。（2）记录基础的伤害性刺激的放电反应（B组）。（3）平静5min后（原则上放电恢复到刺激前水平），静脉给予咪唑安定0.2mg,2min后记录伤害性刺激下的放电反应（C组）。（4）5min后，静脉给入咪唑安定的特异性拮抗剂吗泽尼0.05mg,2min后记录伤害性刺激的放电反应（D组）。结果 A组和B组差异有显著性，符合外周伤害性刺激使中枢痛敏神经元兴奋的正常重量反应。C组与B组差异有显著性，与A组差异无显著性，提示在咪唑安定的干预下，外周的伤害性刺激不能使中枢痛敏神经元兴奋，即咪唑安定对痛觉有抑制作用。D组与C、A组有显著性差异，而与B组无显著性差异，提示氟吗泽尼拮抗了咪唑安定的抑痛作用后，使中枢痛敏神经元恢复对外周伤害性刺激的敏感性。结论 咪唑安定可以显著性的抑制大鼠丘脑束旁核感受伤害性神经元对外周伤害性刺激的兴奋反应。     

功能和纤维成像在脑功能区胶质瘤中的应用

目的研究功能磁共振成像（fMRI）定位脑运动功能区和弥散张量纤维束示踪成像（diffusion tensor tractography,DTT）显示锥体束与肿瘤位置关系在脑胶质瘤行直接皮质电刺激手术的指导作用。方法对28例邻近或累及脑运动功能区的患者,术前在常规成像基础上,分别行双手握拳刺激策略的血氧水平依赖性功能磁共振成像（BOLD-fMRI）和弥散张量成像（DTI）,经工作站提供的BOLD．fMRI和DTI图像分析软件包获得脑运动功能区的激活图像、二维的部分各向异性伪彩图（fractional anisotropy,FA Color）和三维的白质纤维束示踪图。提供脑肿瘤与脑运动皮质区和运动传导束即锥体束的位置关系信息,制定手术方案。所有患者均行术中皮质直接电刺激定位运动区。术前、术后均行Karnofsky生活状态（KPS）评分,判断患者的状态。结果28例患者的fMRI和DTI获得良好的脑双手握拳运动功能区激活图像和锥体束纤维束走形图像,显示初级运动皮质区、运动前皮质区、辅助运动皮质区等手运动相关的脑功能区和运动传导束——锥体束与肿瘤的位置关系。在术前脑功能磁共振图像指导下,直接皮质电刺激快捷、准确定位初级运动皮质区,发现两者具有良好的一致性。术后患者KPS评分结果较术前提高。结论术前BOLD-fMRI和DTT可于活体、无创地描绘脑运动功能区和锥体束与肿瘤的功能解剖位置关系,优化手术方案,在唤醒麻醉下指导直接皮质电刺激定位运动区的手术,实现最大程度保护患者重要的功能,并最大程度地切除肿瘤。     

成年大鼠全臂丛根性撕脱伤后初级体感皮层可塑性变化的脑电生理研究

目的 探讨成年大鼠一侧全臂丛根性撕脱伤后双侧初级体感皮层可塑性变化的规律。方法 将30只SD雄性大鼠分为6组，分为正常对照组和全臂丛根性撕脱伤术后1d、7d、1个月、3个月、1年共5个时间组，每组5只。采用体感皮层诱发电位（somatosensory evoked potential，SEP）记录法，定量评价一侧全臂丛根性撕脱伤后双侧初级体感皮层（Sm1）可塑性变化的时程。结果 术后不同时间段电刺激患爪正中神经支配区，在双侧Sm1均未诱发出SEP。电刺激健侧前爪正中神经支配区，在健爪同侧Sm1未记录到SEP，只在其对侧Sm1记录到SEP；但不同时间段的SEP位点数目均明显多于正常对照组。结论 成年大鼠的初级体感皮层仍具有可塑性，一侧全臂丛根性撕脱伤后诱发了双侧Sm1动态的功能重组。两大脑半球相对应的同位区域之间存在着维持半球间平衡和协调的特殊机制。健侧前爪体感代表区的扩大可提高健爪的感觉辨别能力，以部分代偿患肢感觉功能的丧失。     

脑fMRI观察电针神门及三阴交穴治疗失眠机制

目的利用fMRI技术探讨电针神门、三阴交穴治疗失眠的机制。方法对7名失眠患者（失眠组）及6名健康志愿者（正常对照组）分别在无任何刺激状态下行静息扫描、电针刺激双侧神门和三阴交穴下行BOLD-fMRI扫描,观察两组受试者的激活脑功能区。采用SPM基本模式中的单样本t检验进行统计分析。结果两组受试者均可见脑岛（BA13）明显激活。但在失眠组,右侧丘脑腹前核、右侧壳核、左内侧苍白球、左侧中央前回（BA9）、双侧尾状核头部被特异性地激活。结论电针神门、三阴交穴治疗失眠的机制可能是电针刺激激活了丘脑腹前核、尾状核、壳核、内侧苍白球、丘脑网状核以及其他睡眠中枢,整合传入和传出的信息,调节睡眠;并可通过不同的通路调畅情志,舒缓压力,达到助眠作用。     

患者全麻诱导后大脑功能网络拓扑属性的变化

目的评价患者全麻诱导后大脑功能网络拓扑属性的变化。方法选择拟行颅内胶质瘤切除术患者22例, 分别于清醒和麻醉诱导气管插管后进行静息态功能磁共振扫描检查。以非手术侧大脑123个感兴趣脑区为网络节点, 以节点间功能连接(Pearson相关)为边构建脑功能网络, 分析网络全局拓扑属性(局部效率、集聚系数、最短路径长度、全局效率、小世界属性值)和节点拓扑属性(节点度、节点效率、介数中心度)。结果最终纳入患者18例。与清醒状态相比, 患者全麻诱导后健侧局部效率和集聚系数降低(P<0.05), 最短路径长度和全局效率差异无统计学意义(P>0.05), 小世界属性值在整个密度范围内都大于1;内侧前额叶皮质、后扣带回/楔前叶、颞叶内侧、前扣带回及丘脑、杏仁核等内侧/中线附近节点的节点度、节点效率、介数中心度降低, 除初级听觉和体感皮层上述指标降低外, 外侧面多个脑区显著升高(P<0.05)。结论全麻诱导后脑功能网络的功能分化受到广泛抑制, 但仍保留功能整合能力;大脑内外侧脑区未出现全麻伴随的反相关抑制现象。     

神经病理性痛诱发小鼠睡眠障碍时丘脑-皮质谷氨酸与神经元活动的关系

目的评价神经病理性痛诱发小鼠睡眠障碍时谷氨酸与丘脑-皮质神经元活动的关系。方法 SPF级健康雄性C57BL/6小鼠28只, 6～8周龄, 体重15～25 g, 采用随机数字表法分为2组(n=14):假手术组(Sham组)和神经病理性痛组(CCI组)。采用结扎坐骨神经干法建立小鼠神经病理性痛模型。于造模前1 d(T0)和造模后3、5、7、14、21 d(T1～5)时测定术侧足机械缩足反应阈和热缩足潜伏期。T3时植入EEG记录电极到视觉皮层, T4时监测6 h EEG的变化, 计算非快动眼睡眠时间、快动眼睡眠时间和觉醒时间占总时间的百分比。T3时利用脑立体定位仪将微丝电极植入到丘脑腹后核(VP)和初级体感皮层(S1), T4时采集VP和S1场电位, 计算各波功率百分比, 同时评价VP和S1局部场电位的相干性。T4时处死小鼠, 取脑组织, 采用质子核磁共振波谱检测丘脑和皮质各脑区神经递质水平。结果与Sham组相比, CCI组T1～5时机械缩足反应阈降低, 热缩足潜伏期缩短, 非快动眼睡眠时间百分比降低, 觉醒时间百分比升高, VP区δ波功率百分比降低, VP和S1区α波功率百分比升高, VP...     

静息态fMRI评估急性酒精暴露对恒河猴脑功能的影响

目的采用静息态fMRI基于分数低频振荡幅度(fALFF)方法评估急性酒精暴露后恒河猴脑功能改变。方法分别对7只健康雄性恒河猴于静脉注射酒精前及注射后10、28、46min进行BOLD fMRI序列及3D结构像扫描,采用fALFF算法获得并比较4个时间点fALFF差异的脑区。结果 4个时间点fALFF总体差异显著的脑区为右侧中央后回、右侧岛叶、右侧小脑、左侧海马旁回、双侧额下回、小脑蚓部、右枕叶、楔前叶、左侧缘上回(P均0.05);静脉注射酒精后fALFF值减低的脑区为双侧额上回、右侧额下回、右侧梭状回、右侧角回、双侧颞上回、右枕叶、左侧外侧沟、左侧中央后回、左侧楔状叶、左侧丘脑、左侧岛叶、前扣带回(P均0.05);静脉注射酒精后fALFF值增高的脑区为右侧额下回、右侧颞中回(P均0.05)。结论酒精暴露急性期脑代谢活动发生显著变化,主要涉及默认网络、奖赏及情绪加工系统、视听皮层等。     

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.