卵母细胞培养时间对单精子胞浆内注射胚胎质量及妊娠结局影响

目的探索单精子卵胞浆内注射(ICSI)前最适合的卵母细胞体外培养时间,即取卵结束到开始ICSI的时间(t),以利于取得高的受精率、优质胚胎率和良好的妊娠结局。方法根据卵母细胞体外培养时间,将患者分为3组:A组为2 ht4 h,(n=174),B组为4 ht6 h,(n=147),C组为t≥6 h,(n=82)。回顾性分析卵母细胞体外培养时间对ICSI患者的受精率、卵裂率、优质胚胎率及临床结局的影响。结果(1)A组与B组受精率(81.5%vs 83.5%)、卵裂率(98.9%vs 97.5%)、优质胚胎率(46.9%vs 45.5%)、植入率(36.7%vs32.8%)、妊娠率(55.2%vs 51.7%)及流产率(12.5%vs 13.2%)比较差异均无统计学意义(P0.05)。(2)C组受精率(88.3%)显著高于A组和B组,差异有统计学意义(P0.05)。C组优质胚胎率(41.6%)、植入率(18.7%)、妊娠率(30.7%)均低于A组和B组,差异有统计学意义(P0.05)。C组卵裂率(98.9%)、流产率(12.0%)与A组和B组比较差异均无统计学意义(P0.05)。结论过长卵母细胞体外培养时间(P6 h)可以有高的受精率,但优质胚胎率降低,不利于改善ICSI患者的临床结局;卵母细胞体外培养2~6h后进行ICSI可以获得较为理想的临床结局。     

精子形态对体外受精结局的影响

目的探讨精子形态对常规体外受精(IVF)及单精子卵胞浆内注射(ICSI)周期的受精率、卵裂率、优胚率及妊娠率的影响。方法将2011年6月至2014年6月在我院行IVF/ICSI治疗的周期根据精子形态进行分组:IVF周期分为A组(正常精子形态2%),B组(2%≤正常精子形态4%),C组(正常精子形态≥4%);ICSI周期分为D组(正常精子形态2%),E组(2%≤正常精子形态4%),F组(正常精子形态≥4%),分别比较各组间受精率、卵裂率、优胚率及妊娠率的差异。结果 IVF周期中C组受精率显著高于B组和A组,差异具统计学意义(P0.05),卵裂率、优胚率及妊娠率在A、B、C组之间则无显著性差异(P0.05);ICSI周期中D组、E组、F组受精率、卵裂率、优胚率及妊娠率无显著性差异(P0.05)。结论畸形精子症会影响IVF周期的受精率,对ICSI周期的受精率无显著性影响。     

早补救ICSI在部分受精失败患者中的临床应用

目的评估早补救卵胞浆内单精子注射(R-ICSI)在常规体外受精部分受精失败周期的临床应用价值。方法回顾性分析2013~2015年在本院行部分早R-ICSI的320个周期的临床资料,根据双极体(2PB)所占比例分组:A组2PB率25%(n=113);B组25%≤2PB率50%(n=151);C组2PB率≥50%(n=56)。比较3组早R-ICSI来源卵母细胞的受精率、卵裂率、优质胚胎率以及临床妊娠率。结果 A、B、C 3组患者的早R-ICSI正常受精率比较无显著性差异(P0.05);A组异常受精率(4.30%)显著低于B组(6.42%)和C组(10.38%)(P0.05);C组2PN卵裂率(90.27%)显著低于A组(96.70%)和B组(95.44%)(P0.05);C组优质胚胎率(46.11%)显著低于A组(62.30%)和B组(58.41%)(P0.05)。3组中早R-ICSI来源胚胎用于移植的比例两两比较有显著性差异(P0.05),且早R-ICSI来源胚胎中优质胚胎的比例两两比较有显著性差异(P0.05)。3组患者移植两枚早R-ICSI来源胚胎的周期比例两两比较有显著性差异(P0.05)。结论对于2PB率50%的患者行早R-ICSI可以取得较理想的胚胎发育结局和妊娠结局。     

不同空气质量指数期间体外受精-胚胎移植助孕结局

目的观察不同空气质量指数期间体外受精-胚胎移植(IVF-ET)的助孕结局。方法将2013年1月至2014年12月在本中心进行IVF-ET治疗的不孕患者,按月均空气质量指数(AQI)分A组(60≤AQI<80)、B组(80≤AQI<100)和C组(AQI≥100)三组,比较各组的获卵数、正常受精率、卵裂率、可利用胚胎率、种植率、临床妊娠率及流产率。结果 A组MII卵率(86.88%)显著高于B组(84.43%)与C组(83.57%)(P<0.05),A组正常受精率显著高于C组(76.11%vs.72.75%,P<0.05),A组可利用胚胎率(53.09%)显著高于B组(49.40%)与C组(48.92%)(P<0.05);三组间卵裂率、胚胎种植率、临床妊娠率及流产率比较均无统计学差异(P>0.05)。结论随着空气质量下降,IVF-ET过程中的卵母细胞成熟率、正常受精率及优质胚胎率有不同程度的下降。     

卵母细胞滑面内质网聚集对MII卵母细胞有效胚胎形成率的影响

目的探讨卵母细胞滑面内质网聚集(SERa)对卵母细胞利用率的影响。方法回顾性分析2013年1月至2014年12月的250周期ICSI治疗患者,根据卵母细胞有无SERa分为两组:SERa+组(至少有1个卵母细胞SERa阳性,A组)50周期;SERa-组(所有卵母细胞均无SERa,B组)200周期。分析两组患者的临床和实验室指标,包括受精率、异常受精率、卵裂率、有效胚胎形成率及卵母细胞利用率。结果与B组相比,A组卵裂率、有效胚胎形成率及卵母细胞利用率显著降低(P0.05),而异常受精率显著增加(P0.05);A组中的SERa-卵母细胞与B组卵母细胞相比,卵裂率、有效胚胎形成率及卵母细胞利用率显著降低(P0.05),异常受精率也显著增加(P0.05);A组中SERa+卵母细胞与SERa-卵母细胞相比,异常受精率显著增加(P0.05),卵裂率、有效胚胎形成率及卵母细胞利用率无显著性差异(P0.05)。结论卵母细胞胞浆内滑面内质网聚集增加异常受精率,降低卵母细胞利用率。     

卵裂球损伤对不同冻融方法胚胎移植后临床结局的影响

目的探讨卵裂球损伤对于不同冷冻方法冻融胚胎移植临床结局的影响。方法回顾性分析2009年1月至2013年12月共821例在本中心进行冻融胚胎移植的患者资料。根据胚胎卵裂球损伤情况分为A组:移植的胚胎均为卵裂球完整胚胎;B组:移植的2枚胚胎有1枚有卵裂球损伤;C组:移植3枚胚胎中只有1枚有卵裂球损伤;D组:移植3枚胚胎中只有1枚卵裂球完整胚胎;E组:移植胚胎均为卵裂球受损胚胎。按照冷冻方法(慢速程序法、玻璃化法)分别比较各组的临床资料和妊娠结局。结果慢速程序法中B、C、D三组临床妊娠率和胚胎种植率与A组相比均无显著性差异(P0.05),而E组临床妊娠率和胚胎种植率显著低于A组(P0.05)。玻璃化法中A组临床妊娠率和胚胎种植率显著高于B、D、E三组(P0.05)。结论移植包含1~2枚卵裂球受损胚胎对于慢速程序化冻融胚胎移植临床结局无显著影响;对于玻璃化冻融胚胎移植,移植胚胎中卵裂球完整胚胎2枚时其临床妊娠率和胚胎种植率显著降低。     

获单卵或双卵周期体外受精方式对治疗结局的影响

目的比较常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)两种授精方式对周期获卵数仅为1～2个患者的治疗结局的影响。方法回顾性分析胚胎移植(ET)168个周期获卵数仅为1～2个的卵巢低反应患者的资料,比较常规IVF组和ICSI组的受精率、卵裂率、优质胚胎率和临床妊娠率等情况。结果ICSI组受精率高于IVF组(分别为83.7%和63.8%,P0.05);IVF组有24.5%周期的卵子全部不受精,高于ICSI组的9.7%(P0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率两组间差异无统计学意义(P0.05)。≥35岁、精液参数不正常时,ICSI组受精率高于IVF组(分别为83.9%和55.6%,P0.05);IVF组有34.8%周期的卵子全部不受精,高于ICSI组的14.3%(P0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间差异无统计学意义(P0.05)。≥35岁、精液参数正常时及35岁、精液参数正常或不正常时受精率、卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间的差异均无统计学意义(P0.05)。结论鉴于获卵数为1～2个的周期采用ICSI治疗并不能提高其优质胚胎率、临床妊娠率。因此我们不建议全部行ICSI治疗,男方精液参数正常或处于临界状态建议行IVF治疗。     

乙型肝炎病毒对辅助生殖患者胚胎发育的影响

目的探讨乙型肝炎病毒(HBV)感染对胚胎发育的影响,为HBV阳性患者改善周期结局,提供更多理论依据。方法收集从2012年1月至2016年9月来我院就诊的4 301个ART周期病理资料,按是否HBV感染分为三组,A组:男方和女方均HBV阴性(n=3 940);B组:女方HBV阳性而男方阴性(n=195);C组:女方HBV阴性而男方阳性(n=166),比较三组的胚胎受精率、卵裂率、可移植胚胎率、优质胚胎率及妊娠率。结果(1)ART患者B组妊娠率明显低于A组(39.8%vs 52.6%),且差异具有统计学意义(P0.05);(2)IVF周期中B和C组的受精率、卵裂率、可移植胚胎率及优质胚胎率与A组相比,差异无统计学意义;(3)ICSI周期中C组受精率明显低于A组(75.1%vs 83.5%),差异有统计学意义(P0.05)。结论 HBV可能通过影响胚胎着床或者子宫内膜而影响周期结局。     

卵母细胞滑面内质网聚集体对临床结局和早期出生结局的影响

目的分析内滑面内质网聚集(sERC)卵母细胞来源胚胎的发育潜能、移植后的临床和新生儿结局,进一步探讨sERC卵母细胞的可用性。方法本研究按照纳入和排除标准,将2016年12月至2018年8月在本院进行单精子卵母细胞胞浆内注射的患者根据获卵中是否出现sERC,分为sERC~+周期组(A组,n=80)和sERC-周期组(B组,n=1 492),比较两组促排卵过程中的临床数据和实验室数据,及两组的临床结局和新生儿结局。在A组中又根据卵母细胞是否出现sERC,进一步分为sERC~+卵母细胞组(A1组,n=140)和sERC~-卵母细胞组(A2组,n=416),分析两组的胚胎发育情况。再根据所移植的胚胎是否来源于sERC卵母细胞,分为:Ⅰ组(n=4),所移植胚胎全部来源于sERC~+卵母细胞;Ⅱ组(n=10),所移植胚胎中的1枚胚胎来源于sERC~+卵母细胞,1枚来源于sERC~-卵母细胞;Ⅲ组(n=50),所移植胚胎均来源于sERC~-卵母细胞;比较3组的临床结局。结果 (1)sERC~+卵母细胞的周期发生率为5.1%,sERC~+卵母细胞的发生率为2.1%;(2)A、B两组的年龄、不孕年限和Gn用量以及HCG日E_2水平和不同促排卵方案比例比较均无显著性差异(P0.05);(3)A组的囊胚形成率显著低于B组(P0.05),两组的成熟卵率、受精率、种植率、临床妊娠率、流产率和活产率比较均无显著性差异(P0.05);(4)A组的新生儿出生体重略低于B组,但无显著性差异(P0.05),两组的出生缺陷发生率相似(P0.05);(5)A1组的受精率和囊胚形成率均显著低于A2组(P均0.05);(6)Ⅰ、Ⅱ、Ⅲ组的种植率、临床妊娠率比较无显著性差异(P0.05),3组均无畸形儿出生。结论卵母细胞内出现sERC可能对受精有影响,对早期卵裂无明显影响,会显著降低囊胚形成率,但本研究尚未发现sERC对妊娠结局和新生儿结局有不良影响。     

IVF助孕中卵母细胞成熟率对ICSI临床结局的影响

目的研究影响HCG日卵母细胞成熟度的临床因素,及卵母细胞成熟度对胚胎发育潜能及妊娠结局的影响。方法回顾性分析本院生殖中心2014年3月至2015年4月行ICSI治疗的不孕患者427例,根据取卵日脱颗粒细胞后卵母细胞成熟度(成熟卵母细胞数与卵母细胞数的比例)分为A、B、C三组,A组为成熟度≥80%,283例;B组成熟度为60%~79%,124例;C组成熟度60%,20例。比较三组患者的年龄、不育年限、促性腺激素(Gn)天数、Gn用量、人绒毛膜促性腺激素(HCG)注射日血清LH,E_2,孕激素(P)、每成熟卵母细胞E_2水平、每卵母细胞E_2水平、成熟卵母细胞数、获卵数、MⅡ卵数、获卵率;2PN受精率、卵裂率、可移植胚胎率、优胚率、囊胚形成率、累积妊娠率、卵巢过度刺激综合征(OHSS)发生率。结果三组的年龄、不育年限无统计学差异(P0.05)。A组和B组Gn天数、用量[(12.46±2.27)d,(2 713.96±976.55)U][(12.23±1.78)d,(2 779.23±1 098.21)U]少于C组[(13.65±3.08)d,(3 365.00±1 125.93)U],差异有统计学意义(P0.05)。HCG日血清E_2:A组[(14 662.80±1 157.38)pmol/L]B组[(13 556.60±1 200.66)pmol/L]C组[(10 560.56±1 338.43)pmol/L],两两比较有统计学差异(P0.05)。HCG日血清LH、P水平、每成熟卵母细胞E_2水平、每卵母细胞E_2水平,三组无统计学差异(P0.05)。成熟卵泡数、获卵数、MⅡ卵数:A组B组C组,差异有统计学意义(P0.05)。A组获卵率(获卵数/≥14mm卵泡数):(99.28%)大于B组(96.24%)、C组(95.21%),差异有统计学意义(P0.05)。正常受精率、卵裂率:A组(86.55%;99.17%)大于B组(78.19%;97.91%)和C组(79.82%;95.60%),有统计学差异(P0.05)。优胚率、累积妊娠率:A组(48.03%;51.59%)和B组(44.58%;48.38%)大于C组(39.62%;35.00%),有统计学差异(P0.05)。三组中重度OHSS发生率间无统计学差异(P0.05)。结论卵母细胞成熟率低可能与卵巢反应不良或对Gn敏感性下降有关;卵母细胞成熟率低可能影响受精及胚胎发育潜能,导致可供移植的胚胎数减少,妊娠率下降。     

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.