中国一类供者二例供肝在体劈离后行肝移植临床报道

目的 总结在体劈离式肝移植的临床经验.方法 回顾性分析2例中国一类心脏死亡器官捐赠(DCD)供者接受供肝在体劈离手术,并将劈离后的供肝移植给4例终末期肝病患者的临床资料.供肝的劈离手术中,在保证供者循环稳定的情况下使用超声吸引刀劈离肝实质,离体劈离肝脏血管和胆道,并对供肝进行修整.供者例1的全肝质量为1800 g,劈离成右三叶供肝和左外叶供肝,右三叶供肝移植给1例成人受者,左外叶供肝经减体积后移植给1例儿童受者.供者例2的全肝质量达2100 g,在体劈离成左右半肝,分别移植给2例成人受者.结果 在体劈离肝实质的手术耗时分别为1h和45 min,离体劈离肝血管和胆道的耗时分别为30 min和40 min.供肝热缺血时间均为0 min,冷缺血时间为120～360 min,移植肝质量与受者体质量比(GRWR)为1.5％～2.2％.肝移植后,1例成人受者出现门静脉血栓形成,经手术取尽门静脉血栓后,行门静脉-腔静脉搭桥,术后早期出现肝性脑病症状,经内科治疗后好转.肝移植后4例受者均恢复顺利,随访期间移植肝功能正常,均未发生排斥反应和感染并发症.结论 对于中国一类供者,实施在体劈离式肝移植是安全可行的,此项术式有望成为扩展供肝来源的重要途径,详细的术前评估技术和精细的手术操作是保证肝移植顺利进行的关键.     

成人间左半肝移植九例报告

目的 观察成人左半肝移植的临床效果,并探讨其可行性.方法 回顾性分析2007年3月至2011年4月间9例成人左半肝移植的临床资料,其中5例为尸体供肝劈离式肝移植,4例为活体左半供肝移植.9例供肝的重量平均为444.6 g(325～570g),移植物重量与受者体重比平均为0.886％(0.65％～1.18％),其中7例包含肝中静脉.6例采用背驮术式,3例采用经典术式.有4例受者因术中门静脉压超过20 mm Hg(2.67 kPa),其中3例结扎了脾动脉,1例接受了脾切除术.术后所有受者均常规使用他克莫司+吗替麦考酚酯+皮质激素的三联免疫抑制方案.术后对受者进行长期随访,观察血管并发症和胆管并发症的发生情况及受者肝功能恢复状况和存活情况.结果 4例活体供者切取左半肝后均未发生严重并发症,肝功能恢复良好.9例受者术后平均随访时间为15.7个月(1～51个月),移植物和受者术后1年存活率均为77.8％(7/9).术后有2例受者死亡,其余7例中1例发生肝功能恢复延迟,6例移植肝功能恢复顺利.术后发生胆管吻合口狭窄1例,小肝综合征1例,门静脉血栓形成1例,肝功能恢复延迟1例,以及腹腔感染2例.结论 在严格选择供、受者的前提下,成人左半肝移植是安全、可行的,且效果良好.     

心脏死亡器官捐献供肝肝移植182例单中心经验总结

目的总结心脏死亡器官捐献(DCD)供肝肝移植的临床效果。方法回顾性分析182例DCD供肝肝移植供、受者的临床资料。根据原发病不同将182例受者分为良性组(135例)及肝细胞癌(肝癌)组(47例)。比较两组受者围手术期情况及1年、3年存活率;总结受者的临床预后及术后并发症发生情况,包括移植物早期功能障碍(EAD)、血管并发症、急性肾损伤(AKI)、肺部感染、急性排斥反应、巨细胞病毒(CMV)感染及胆道并发症。结果两组受者的无肝期、手术时间、重症监护室(ICU)停留时间比较,差异均无统计学意义(均为P0.05)。182例受者的1年人、移植物存活率均为93.1%,3年人、移植物存活率均为84.9%。良性组受者的1年和3年存活率分别为92.5%和88.1%,肝癌组受者的1年存活率及无病存活率分别为95%和91%,3年存活率为78%。两组受者的总体存活率比较,差异无统计学意义(P=0.879)。术后并发症包括胆道并发症26例,血管并发症14例,AKI 34例,肺部感染22例,急性排斥反应11例,EAD11例,CMV感染10例,其中放置T管者的术后胆道并发症的发生率比未放置T管者明显降低(8%比19%,P0.05)。结论 DCD供肝肝移植是治疗各类终末期肝病及肝癌的良好手段,术后短期疗效较好。     

心脏死亡器官捐赠供受者术前及术后早期临床指标对肝移植预后的影响

目的 探讨心脏死亡器官捐赠(DCD)供受者术前及术后早期各项临床指标对受者预后的影响.方法 回顾性分析60例DCD肝移植供受者的临床资料.术前指标包括:供者年龄、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST);受者年龄、血肌酐、胆红素总量(TBil)、国际标准化比值(INR)、白蛋白、终末期肝病模型(MELD)评分、体质量指数;供肝热缺血时间和冷缺血时间.将术后72 h内ALT或(和)AST＞ 1500 U/L定义为术后早期肝功能恢复不良.应用Kaplan-Meier法对受者总体存活进行生存分析,应用log-rank检验进行存活影响因素的单因素分析,进一步应用多因素COX比例风险回归模型筛选独立影响因素.结果 60例DCD肝移植受者1和3年累积存活率分别为76％和62％.供者术前ALT、AST、供肝热缺血时间以及受者术前肌酐、MELD评分、供肝冷缺血时间、术后早期肝功能恢复不良的发生为受者预后的单因素分析影响因素.进一步筛选出热缺血时间(相对危险度=1.318,95％可信区间为1.173～1.481,P=0.000)为DCD肝移植受者预后的独立影响因素.结论 DCD供肝热缺血时间为影响肝移植受者预后的独立影响因素,控制热缺血时间有利于改善DCD受者的预后.     

肝移植后早期并发肝动脉血栓形成手术取栓并动脉重建一例

肝动脉血栓形成是肝移植后严重的血管并发症,常可导致肝坏死、肝功能衰竭、难治的胆道并发症、严重感染等,而使移植物功能丧失,甚至受者死亡,其治疗方法不尽一致,过去通常行再次肝移植,但在目前供者严重短缺的情况下,不得不寻找新的治疗方法.我中心于2011年1月对1例肝移植后早期肝动脉血栓形成受者行手术取栓,同时重建肝动脉,近期效果良好,报道如下.     

成人间活体肝移植94例报告

目的 探讨成人间活体肝移植供者评估、手术方式的选择及术后并发症分析.方法 收集2007年1月至2010年8月同一外科组施行的94例成人间活体肝移植的临床资料.受者年龄18 ～76岁,供者年龄19 ～60岁.94例活体肝移植手术方案包括:左半肝供肝移植2例,右半肝供肝移植92例,44例切取肝中静脉例,48例不切取肝中静脉.分析供受者术前评估、术后并发症及存活情况.结果 所有供者均恢复良好出院,供者并发症发生率为7.4％.随访截止于2011年5月31日,中位随访时间为37个月,死亡8例.供者1年存活率为95.7％,移植物存活率为94.7％.1例发生小肝综合征;1例因急性肝坏死行再次肝移植;24例(25.5％)经胆道造影或磁共振胰胆管成像检查发现胆道吻合口狭窄,但其中9例(9.6％)表现为肝功能异常.结论 活体肝移植是治疗终末期肝病的有效方法,精确的术前评估、合理手术方式选择,采用左半肝或右半肝供肝、含或不含肝中静脉的活体肝移植,在成人间活体肝移植中均能有效的保证供受者安全.     

成人间活体右半肝移植术中变异门静脉右支切取与重建技术

目的 探讨成人间活体右半肝移植术中变异门静脉支(APVB)切取与重建的技巧.方法 2002年1月至2007年4月,共实施70例成人间活体右半肝移植.术前肝脏血管三维CT成像显示供肝动脉及静脉走向,70例右半供肝中有9例门静脉分支变异,其中7例为Ⅱ型变异,2例为Ⅲ型变异.除1例供者行狭窄桥状连接单口切取APVB外,其余8例均采用供者优先的原则即距门静脉主干2～3mm处双口切断APVB.Ⅱ型变异中有2例双口切取其右前、右后支成形为一个开口后与受者门静脉主干吻合,4例右前、右后支分别与受者门静脉左、右支吻合,1例行右前、右后支间狭窄桥状组织连接单口切取后与受者门静脉主干单口吻合.Ⅲ型变异中有1例双口切取其右前、右后支分别与受者门静脉支双口吻合,1例双口切取后行新型的U形血管移植物间置与受者门静脉主干单口吻合.结果 9例受者均无门静脉狭窄或血栓、肝动脉狭窄或血栓以及肝静脉流出道狭窄等血管并发症发生.1例供者术后3 d并发门静脉血栓,手术取栓及门静脉壁修补成形后痊愈.新型的U形血管移植物间置重建术后通畅,无并发症发生.结论 成人间活体右半肝移植术中采用供者优先的原则双口切取APVB、双口吻合重建以及新型的U形血管间置等门静脉重建技术是安全可行的,未增加手术难度,且临床效果良好.     

肝移植术后肝动脉和门静脉并发血栓形成两例

2001年11月至2009年12月间,我中心共行尸体肝移植3100余例次.其中2例患者肝移植术后,肝动脉和门静脉同时发生血栓形成,现报告如下. 病例资料 例1男性,38岁,因"慢性重型乙型肝炎"行原位肝移植.肝移植术后2个月,因胆道并发症(胆道感染、胆道坏死而至胆道铸型)而行二次肝移植.二次肝移植术中,采用5-0 prolene线端端连续吻合供、受者门静脉;供者端以腹腔动脉袢,受者端以肝总动脉与胃十二指肠形成动脉袢,采用6-0 prolene线行间断端端吻合.     

高龄供肝对肝移植术后并发症的影响——148例受者预后分析及思考

目的研究高龄供肝对肝移植术后移植物功能及受者生存率的影响及其干预策略。方法根据供者年龄≥或<60岁1:1配对选取2016年1月—2017年6月期间行肝移植手术患者为研究对象,分为高龄供者(elderly donor,ED,n=74)组和非高龄供者(non-elderly donor,NED,n=74)组。比较分析受者肝功能恢复情况、并发症、移植物及受者生存率。结果ED组移植物早期功能不全发生率为47.3%,显著高于NED组的28.4%(P=0.018);ED组胆道并发症发生率为21.6%,显著高于NED组的9.5%(P=0.041);ED组移植物存活率显著低于NED组(P=0.023)。ED组冷缺血时间>12 h者移植物早期功能不全发生率显著高于<12 h者(70.6%比40.4%,P=0.003)。结论高龄供肝的使用会影响移植物早期功能恢复及其1年存活率,缩短冷缺血时间可以显著降低EAD的发生率,改善受者预后。     

亲属活体供肝移植治疗儿童终末期肝病六例

目的 探讨亲属活体供肝移植(LDLT)治疗儿童终末期肝病的效果,并总结治疗经验.方法 2005年9月至2007年1月对6例终末期肝病患儿进行了LDLT.6例患者中,原发病为肝内外胆管弥漫性囊性扩张症Ⅳ型伴肝硬化1例、肝豆状核变性2例、门静脉海绵样变性3例;供者为患儿的母亲3例、父亲2例及舅父1例,分别切取供者的右半肝1例和左半肝5例作为供肝;在切除受者全部病肝和保留下腔静脉后,对受者施行部分供肝的原位肝移植.术后依据供、受者的临床表现、血液学指标和影像学检查,对活体供肝移植的治疗效果进行评价.结果 术后对供、受者随访了6～21个月.6例供者均健康存活,未发生并发症.6例受者中,1例于术后第4天死于门静脉血栓形成,1例于术后5个月时死于肝内静脉血栓形成,其余4例均长期健康存活.结论 亲属活体供肝移植是治疗儿童终末期肝病的有效方法.术前进行仔细的供、受者选择和完善的影像学检查,术中应用精确的手术技术,术后给予严格的管理是儿童LDLT成功的关键.     

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.