术后早期营养支持对胃肠道肿瘤病人营养状况和细胞免疫的影响

目的 研究术后早期肠内营养支持对胃肠道肿瘤病人的营养状况和细胞免疫功能的影响。方法 将20例经病理证实为胃肠的病人随机分为两组：肠外营养（PN）组和肠内营养（EN）组。PN组术后行TPN支持,能量为125kj.kg^-1.d^-1,氮入量0．2kg/d。EN组术后第1d起经鼻饲管（放置于Treitz韧带下或空肠输出袢下30cm）输注能全力,量为1500－1800ml/d,速度20－75ml/h。分别于术后及术后2,4,8d抽取外周血测定T细胞亚群、NK细胞、血清IL－2（白细胞介素2）,血清前白蛋白（PA）、血清视黄醇结合蛋白（RBP）浓度。结果 （1）术后患者血清PA,RBP浓度较术前有明显下降（P＜0．05,P＜0．01）。经一段时期的EN笔PN支持后基本恢复到术前水平。EN的营养恢复作用与P比无明显差异;（2）术后经EN和PN支持后T细胞亚群恢复到术前水平,NK细胞明显增高（P＜0．05）。结论 术后早期应用EN支持可以改善胃肠道肿瘤病人的营养状况,其增强细胞免疫功能的作用优于PN。     

免疫增强型肠内营养支持在胃癌术后早期的应用

目的　研究术后早期免疫增强型肠内营养支持对胃癌患者的机体营养状况和细胞免疫功能的影响。方法　 3 6例胃癌患者随机分为两组 ,免疫增强型肠内营养 (IEN )组和肠内营养(EN)组。两组患者均从术后第 1天起等热量、等氮量经空肠造口管匀速输注肠内营养制剂。IEN组使用Stresson○R,EN组使用Nutrison○R,共 7d。分别于术前及术后第 2、4、8天采外周血测定T细胞亚群、NK细胞、血清IL 2与TNF α浓度、血清PA浓度、血清RBP浓度。结果　①术后患者血清PA、RBP浓度较术前有明显下降 (P <0 .0 5 ,P <0 .0 1) ,经一段时期的IEN和EN支持后基本恢复到术前水平。②术后经IEN和EN支持后T细胞亚群及NK细胞基本恢复到术前水平 ,且两组间无差异。③IEN、EN组的IL 2较术前均有明显增高 (P <0 .0 5 ) ,以IEN组的增高更为显著(P <0 .0 5 )。IEN组的TNF α较术前有明显下降 (P <0 .0 5 ) ,且与EN组相比差异有显著性 (P<0 .0 5 )。结论　术后早期免疫增强型肠内营养支持可以改善胃癌患者的营养状况 ,其增强免疫功能的作用在某些方面优于常规的肠内营养     

胃肠道肿瘤患者术后早期肠内营养与肠外营养支持的随机对照研究

目的比较胃肠道肿瘤患者术后早期肠内营养（EN）与肠外营养（PN）支持的临床效果，探讨其对细胞因子、细胞免疫功能和蛋白质代谢变化的影响。方法36例胃肠道肿瘤根治术后患者，随机分为早期EN组19例，早期PN组17例，术后1d分别采取EN和PN支持。术前3d和术后1、3、5d检测患者血清TNF-α、IL-1β、IL-6和IL-10水平，淋巴细胞总数及其亚群CD3、CD4、CD8、CD4／CD8和NK细胞，24h尿素和尿肌酐排泄量。比较两组患者的临床恢复指标、并发症发生率等。结果两组术后血清IL-1β、IL-6、IL-10和24h尿素及肌酐排泄量多较术前有不同程度升高，血清TNF-α和淋巴细胞总数（除EN组术后3、5d）明显下降，淋巴细胞亚群分布比例无明显变化。两组间比较：IL-1β、IL-10及TNF-α变化差异无统计学意义，术后EN组IL-6（3、5d）、24h尿素排泄量（3、5d）和尿肌酐排泄量（3、5d）与PN组同期相比明显降低（P〈0．05），淋巴细胞总数（3、5d）较PN组高（P〈0．05）。EN组术后感染并发症发生率、发热时间、住院时间和医疗费用均较PN组低（P〈0．05）。结论胃肠道肿瘤患者术后早期EN支持较PN支持更具优越性，可降低手术应激导致的细胞因子释放和蛋白质分解代谢反应程度，缩短炎症反应时间，降低患者术后感染并发症发生率，缩短住院时间，降低医疗费用。     

术中腹腔灌注化疗及术后营养支持对进展期胃癌术后肠黏膜屏障功能及免疫功能的影响

目的探讨术中腹腔灌注化疗（HIIC）及术后营养支持对进展期胃癌患者肠黏膜通透性和免疫功能的影响。方法将2007年12月至2008年12月间江苏省肿瘤医院胃肿瘤诊疗中心收治的65例进展期胃癌,患者按随机数字表法随机分为EN组（术后早期肠内营养,20例）、HIIC加EN组（HIIC加术后早期肠内营养．22例）和HIIC加PN组（HIIC加术后肠外营养,23例）。分别于术前1d及术后3、7、12d,应用高效液相色谱检测其尿L／M比值,应用流式细胞术检测外周血CD4＋、CD8＋和自然杀伤（NK）细胞比例及CD4／CD8细胞比值。结果术前1d,EN组、HIIC加EN组和HIIC加PN组患者L／M值分别为0．0280＋0．0183、0．0305＋0．0208和0．0298±0．0229;术后3d,3N患者L／M值均明显升高（0．1235±0．0611、0．1648±0．0571和0．1702±0．0628）,与术前比较,差异均有统计学意义（P〈0．05）,其中HIIC加EN组和HIIC加PN组明显高于EN组（P〈0．05）;之后,3组L／M值均开始回落．至术后12d,EN组（0．0278±0．0217）和HIIC加EN组（0．0336±0．0235）L／M值已回落至术前水平（均P〉0．05）。而HIIC加PN组（0．0616±0．0430）仍明显高于术前水平及其他两组（均P〈0．05）。与术前1d相比,术后12dEN组和HIIC加EN组患者CD4＋细胞比例、CD4／CD8比值均明显升高（均P〈0．05）;且HIIC加EN组和HIIC加PN组CD4＋细胞比例显著低于EN组（均P〈0．05）。结论HIIC会加重进展期胃癌患者术后肠黏膜通透性的损伤,并一定程度地抑制细胞免疫功能：而术后早期肠内营养支持能够改善HIIC引起的肠黏膜通透性损害。     

梗阻性黄疸术后早期肠内营养对全身炎症反应综合征的影响

目的观察早期肠内营养对梗阻性黄疸术后全身炎症反应综合征（SIRS）的影响。方法60例梗阻性黄疸患者,随机分为肠内营养（EN）组、肠外营养（PN）组和对照组,术后第1天开始分别接受肠内、肠外营养及普通输液治疗,测定3组患者术前和术后1、3、5、7、9d血清C反应蛋白（CRP）、白细胞介素6（IL-6）和肿瘤坏死因子仪（TNF-α）含量变化,观察术后全身炎症反应综合征（SIRS）及多器官功能不全综合征（MODS）的发生率,以及其他各种并发症发生率。结果EN组术后第3、5、7、9天的CRP、IL-6、TNF-α血清水平较PN组和对照组下降显著（P〈0．05）,PN组与对照组比较无显著性差异;EN组SIRS持续时问（3．26±1．27）d明显短于PN组的（5．314-1．47）d和对照组的（5．69±1．58）d（P〈0．05）;EN组MODS发病率为9．52％,明显低于PN组（23．81％）和对照组（27．78％）（P〈0．05）;EN组术后并发症发生率为19．0％,明显低于PN组（38．1％）和对照组（55．6％）（P〈0．05）,而PN组又低于对照组（P〈0．05）;在感染性并发症方面,EN组明显低于PN组和对照组（P〈0．05）。结论梗阻性黄疸术后早期肠内营养能有效地减轻SIRS,降低MODS发病率,减少术后并发症的发生,促进患者康复。     

重症急性胰腺炎的早期肠内营养支持

目的　研究早期肠内营养支持对重症急性胰腺炎的治疗作用。方法　将 5 0例经证实为重症急性胰腺炎的病人随机分为两组 ,PN组 (2 5例 )和EN组 (2 5例 )。PN组行TPN支持 ,EN组从入院第 1天起经螺旋鼻饲管 (放置于Treitz韧带下 )或术后经空肠饲养管输注能全力 ,能量12 5kJ/kg·d ,氮入量 0 .2 /kg·d。 结果　入院后 1～ 4d患者血清PA、RBP浓度较正常水平有明显下降 (P <0 .0 5 ,P <0 .0 1) ,经 14d的EN和PN支持后基本恢复到以前水平。EN的营养恢复作用与PN相比无明显差异。经 14d的营养支持 ,EN组的感染率明显低于PN组。结论　营养支持治疗可以改善重症急性胰腺炎患者的营养状况 ,且早期应用肠内营养支持是可行的     

胃癌患者根治术后早期肠内营养的临床疗效观察

目的探索进展期胃癌患者根治术后行早期肠内营养（enteral nutrition,EN）的疗效和安全性。方法选择2008年12月至2013年4月期间内蒙古医科大学附属医院收治的70例行根治性手术的进展期胃癌患者,将患者随机分为EN组35例和肠外营养（parenteral nutrition,PN）组35例,记录并比较2组患者的营养指标和康复指标。结果术前2组患者的白细胞计数、血浆清蛋白（ALB）、前清蛋白（PA）及转铁蛋白（TRF）水平比较差异均无统计学意义（P〉0．05）;术后3d和7d,除白细胞计数为EN组低于PN组外（P〈0．05）,ALB、PA及TRF水平均是EN组高于PN组（P〈0．05）。EN组患者的术后住院时间和住院费用均短于或低于PN组（P〈0．05）,而2组患者的术后排气时间和并发症发生率比较差异均无统计学意义（P〉0．05）。结论EN是一种安全、有效及经济的营养补给方法,是进展期胃癌患者术后早期首选的营养支持方法,值得在临床推广。     

全胃切除术后不同营养支持方式对患者免疫功能的影响

目的探讨全胃切除术后不同营养支持方式对患者免疫功能的影响。方法选择行全胃切除术患者33例，随机分为肠内营养组（17例，EN组）和肠外营养组（16例，PN组），分别于手术前后检测外周血补体和免疫球蛋白水平及各种淋巴细胞百分率的变化，并观察感染性并发症发生率及胃肠功能恢复时间。结果术后第1天．两组患者补体、免疫球蛋白及淋巴细胞百分率均较术前明显下降（P〈0．05）；而术后第8天，EN组补体及免疫球蛋白水平较术后第1天有所恢复（P〈0．01），且改变量与PN组比较差异有统计学意义（P〈0．05）。术后第8天，两组患者淋巴细胞百分率及EN组的CD4^＋／CD8^＋较术后第1天有所恢复（P〈0．01）；EN组淋巴细胞百分率的改变量与PN组比较差异有统计学意义（P〈0．01）。PN组术后感染性并发症的发生率（31.3％）高于EN组（5．9％）（P〈0．05）。结论全胃切除术后患者EN支持较PN支持能更好地促进免疫功能的恢复，降低肺内感染的发生率。     

直肠癌Dixon术后早期肠内外联合营养的临床研究

为了探讨直肠癌患者行直肠癌经腹前切除术（Dixon术）后早期肠内营养（EN）与肠外营养（PN）联合应用的临床价值,将64例行Dixon术的直肠癌患者随机分为肠外营养组（PN组）32例和肠内外联合营养组（EN＋PN组）32例。术后早期即给予不同的营养支持治疗,观察患者术后肛门排气时间、术后并发症发生情况及营养指标的变化。结果显示,两组患者均无死亡病例,均未发生吻合口漏,EN＋PN组在术后肛门排气时间等方面明显优于PN组;术后第7天检测各项营养指标,EN＋PN组前白蛋白（PA）、淋巴细胞总数（TLC）高于PN组（P〈0．05）。结果表明,直肠癌Dixon术后早期肠内外联合营养是安全可行的,不但能更好地改善术后患者营养状况及免疫功能,还能促进肠蠕动功能的恢复,并且能降低切口并发症的发生率。     

食管贲门癌术后早期肠内与肠外营养的对比观察

目的探讨食管、贲门癌术后早期应用肠内营养（EN）的可行性、安全性和临床效果，并与肠外营养（PN）进行比较。方法将行食管、贲门癌切除的86例患者随机分为EN组与PN组各43例，分别于术后24h开始进行EN与PN，比较两组术后肠蠕动恢复时间、术后10d体重与术前1d体重下降差值及营养支持费用。结果两组在观察期间均无死亡及严重并发症发生，EN组肠蠕动恢复时间较PN组显著缩短，术后体重较PN组有明显改善，且营养支持费用显著低于PN组（P〈0．05．P〈0．01）。结论食管、贲门癌术后早期应用EN支持安全、可行，不仅有助于肠道功能恢复，善机体营养状态，降低并发症，而且能减少医疗费用。     

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.