17-β雌二醇对人胚肾成纤维细胞生物特性的影响

雌激素作为一种多功能的自分泌和旁分泌激素具有生殖功能以外的重要生理作用［１］。雌激素可抑制肾小球系膜细胞合成和分泌胶原,减少系膜基质的聚集,限制肾小球硬化的发展［２］。在间质纤维化的发展过程中,肾成纤维细胞（ｋｉｄｎｅｙ ｆｉｂｒｏｂｌａｓｔ,ＫＦＢ）的增殖起着决定性作用［３］。１７－β雌二醇（１７－β ｅｓｔｒａｄｉｏｌ,Ｅ２）对肾脏病的进展可能具有良性作用,其对ＫＦＢ的影响尚未见报道。本试验拟在细胞水平,观察Ｅ２对ＫＦＢ增生、凋亡及细胞外基质成分（ＥＣＭ）之一的纤连蛋白（Ｆｎ）表达的影响。 一…     

汉防己甲素对增生性瘢痕基质胶原酶活性的影响

目的观察汉防己甲素对瘢痕胶原酶活性的影响，进一步阐明其抗瘢痕作用的机理。方法将汉防己甲素的实验浓度控制在低于细胞增殖抑制范围之内，采用加胶原蛋白底物的SDS—PAGE电泳法分离胶原酶，胰蛋白酶激活后利用湿胶密度扫描仪分析胶原酶的活性。同时采用改良的氯胺T法测量细胞外胶原蛋白量，并分析两者的相关关系。结果在不抑制细胞增殖的情况下，汉防己甲素可显著提高胶原酶的活性，使细胞外胶原蛋白减少，两者呈显著的负相关，此作用强于激素。结论增强胶原酶降解胶原蛋白的活性，减少细胞外胶原沉积是汉防己甲素抗瘢痕作用机理之一。     

汉防己甲素和吉西他滨协同使用对化疗耐药胰腺癌细胞的凋亡诱导作用

目的：研究汉防己甲素对胰腺癌化疗耐药产生与凋亡的影响。方法：分对照组（只加培养基）、吉西他滨组（Gemcitabine组）和汉防己甲素联合吉西他滨组（Tet/Gem组）,后2组采用不同浓度汉防己甲素和吉西他滨作用于人胰腺癌敏感株BxPC-3和吉西他滨耐药株BxPC-3/Gem细胞,通过MTT法检测抗肿瘤药物的细胞毒作用,碘化丙啶（PI）染色检测细胞凋亡。结果：BxPC-3/Gem耐药胰腺癌细胞株耐药指数（RF）为4.70,汉防己甲素作用耐药胰腺癌细胞后其RF降至1.69,证明汉防己甲素可逆转BxPC-3/Gem耐药胰腺癌细胞对吉西他滨的耐药。化疗耐药胰腺癌细胞凋亡在12h、18h、24h,Tet/GEM组与GEM组、对照组比较,差异有非常显著性意义（P〈0.01）。结论：汉防己甲素可以逆转BxPC-3/Gem耐药胰腺癌细胞对吉西他滨的耐药,协同吉西他滨促进对化疗耐药胰腺癌细胞凋亡作用。     

神经母细胞瘤细胞周期素D1的表达检测

目的 探讨细胞周期素Ｄ１表达与神经母细胞瘤（ＮＢ）发生发展的关系及意义。方法 应用原位杂交技术对２０例ＮＢ标本检测。结果 １７例可检测到ｃｙｃｌｉｎ Ｄ１表达，表达指数（ＣＥＩ）４．３％￣５５．３％。年龄〈１岁和神经节神经母细胞瘤标本中ＣＥＩ低于年龄〉１岁及ＮＢ，但无显著性差异。Ⅲ￣Ⅳ期、ＵＦ型及肿瘤广泛转移标本中ＣＥＩ显著高于Ｉ￣Ⅱ及ⅣＳ期、Ｆ型和肿瘤切除者。ＣＥＩ与ＭＫＩ呈正相关，与术后生存时     

中药复方抗癌方抑制人结肠癌细胞株端粒酶活性

目的　了解中药复方抗癌方（ＫＡＦ）对人结肠癌细胞端粒酶活性的影响。方法　将ＨＣ８６９３ 细胞株作为靶细胞,用ＭＴＴ试验测定细胞毒作用,用ＴＲＡＰ半定量法测定端粒酶活性。结果　ＫＡＦ对ＨＣ８６９３ 的半数致死量（ＬＤ５０） 为２５－４％ ;染毒后,端粒酶活性降低（５％ ＫＡＦ组：４６７６－７±４７８．１ ;１０ ％ ＫＡＦ组：３５８１－３±６３２ ．４;空白对照组：６００３．３ ±３３７．９。Ｐ＜０－０５ 或Ｐ＜ ０－０１） ,去除ＫＡＦ２４ 小时后,端粒酶活性仍维持在较低水平（４４９５．０ ±４２３－９,Ｐ＜０－０５） 。结论　ＫＡＦ能抑制人结肠癌细胞端粒酶活性。     

汉防己甲素对马兜铃酸A诱导的人近端肾小管上皮细胞转分化的干预作用

目的：探讨汉防己甲素（tetrandrine,rret）对马兜铃酸A（aristoloehic acid Ⅰ,AAⅠ）诱导的人近端肾小管上皮细胞（HK-2）转分化的拮抗效应。方法：将正常培养的HK-2随机分组：正常组、模型组、汉防己甲素高浓度组、汉防己甲素中浓度组、汉防己甲素低浓度组、泼尼松龙对照组（糖皮质激素组）。48h后观察各组细胞形态的变化,逆转录-聚合酶链式反应方法检测各组E—cadherin、TGF-β1、α-SMA mRNA表达水平,双抗体夹心酶联免疫吸附法测定各组细胞培养液中TGF-β1浓度,流式细胞技术测定各组E—cadherin阳性表达细胞的百分率。结果：汉防己甲素干预组及泼尼松龙对照组E—cadherin mRNA表达水平明显高于模型组（P〈0．05）,相反,其TGF-β1、α-SMA mRNA表达水平明显低于模型组（P〈0．05）;汉防己甲素干预组及泼尼松龙对照组TGF-β1浓度亦明显低于模型组（P〈0．05）;汉防己甲素干预组（中、低浓度）E—cadherin阳性表达细胞的百分率明显高于模型组（P〈0．05）,但汉防己甲素高浓度组和泼尼松龙对照组E—cadherin阳性表达细胞的百分率较之模型组增高不明显（P〉0．05）。结论：一定浓度（10μg／ml）的AAⅠ能诱导体外培养的HK-2转分化,适当浓度的Tet对AAi诱导的HK-2转分化具有明显的拮抗作用;AAI亦能上调TGF-β1的表达,而适当浓度的Tet能拮抗AAI引起的TGF-β1的高表达。     

增生性瘢痕和瘢痕疙瘩组织中TGF—β1及Ⅰ,Ⅲ型胶原基因 …

目的 检测增生性瘢痕（Ｈ）和瘢痕疙瘩（Ｋ）组织中ＴＧＦ－β１及Ⅰ、Ⅲ型前胶原ｍＲＮＡ的表达,了解其相互关系及意义。方法 斑点杂交分析检测Ｈ和Ｋ组织中Ⅰ、Ⅲ前胶原及ＴＧＦ－β１ｍＲＢＡ稳态水平的改变;原位杂交检测ＴＧＦ－β１ｍＲＮＡ在组织中的空间分布。结果 ①Ｋ和Ｈ组织中ＴＧＦ－β１ｍＲＮＡ稳态水平明显高于Ｎ组和Ｓ组;②Ｋ选择性Ｉ型前胶原ｍＲＮＡ表达增强,而Ｈ组织中Ⅰ、Ⅲ前胶原ｍＲＮＡ表达均增强。     

白细胞介素10抑制核因子кB介导的肾小管上皮细胞表达细胞间黏附分子1

目的研究白细胞介素１０（ＩＬ－１０）对人近端肾小管上皮细胞（ＨＫ－２细胞）在促炎症因子肿瘤坏死因子α（ＴＮＦα）作用下表达细胞间黏附分子１（ＩＣＡＭ－ｌ）及其相关核转录途径的影响。方法 用ＨＫ－２细胞作靶细胞，用细胞酶联免疫吸附法（ＥＩＪＳＡ）和Ｎｏｒｔｈｅｒｎ杂交观察ＩＣＡＭ－１的蛋白和基因的表达，以电泳迁移率变动法测定转录因子核因子ｋＢ （ＮＦｋＢ）和激活蛋白 Ｉ（ＡＰ－１）的活性。结果ＴＮＦα呈剂量依赖地诱导ＨＫ－２细胞ＮＦｋＢ的活化及ＩＣＡＭ－１的基因和蛋白表达，这些作用可以被ＮＦｋＢ的抑制剂对甲苯磺－Ｌ－苯丙氨酸氯甲基甲酮（ＴＰＣＫ）所抑制，但ＴＮＦα对ＨＫ－２细胞的ＡＰ－１活性无影响。 ＩＬ－１０（１～ ２０ｎｇ／ｍｌ）可抑制 ＴＮＦα诱导的 ＨＫ－２细胞 ＩＣＡＭ－ｌ基因和蛋白表达及 ＮＦｋＢ的活化。结论ＴＮＦα诱导人肾小管上皮细胞ＨＫ－２的ＮＦｋＢ活化，进而促进ＩＣＡＭ－ｌ基因和蛋白表达，ＩＬ－１０可抑制ＴＮＦα诱导的上述炎症效应。     

大鼠全胃肠外营养后胆汁淤积的发生机制

目的　观察脂肪乳剂对大鼠肝胆汁分泌及肝组织结构的影响，探讨全胃肠外营养（ Ｔ Ｐ Ｎ）后胆汁淤积的发生机制。方法　将４０ 只大鼠随机分成４ 组。对照组予以标准颗粒饲料喂养。３ 组实验组行 Ｔ Ｐ Ｎ５ 天后测定胆汁流量及其成分、最大胆酸排泄量（ Ｔｍ） 和非胆酸依赖性胆流（ Ｂ Ａ Ｉ Ｆ） ，观察肝脏组织学变化。结果　３ 组实验组胆流和 Ｂ Ａ Ｉ Ｆ 均下降， Ｔｍ 亦明显下降，并可见不同程度的肝细胞脂肪浸润和轻度胆汁淤积。结论　短期 Ｔ Ｐ Ｎ 致大鼠胆汁淤积发生，其原因与禁食有关，其机制可能与肝细胞受损、 Ｎａ＋ 、 Ｋ＋ Ａ Ｔ Ｐ 酶活性降低有关，与脂肪乳剂使用无关。     

卵泡基膜中IV型胶原、层粘连蛋白来源的初步探讨

通过离体培养猪、大鼠卵泡颗粒细胞、内泡膜细胞，应用免疫组化技术，观察细胞外基质与卵泡细胞结构和功能的关系，初步探讨卵泡基膜中ＩＶ型胶原、层粘连蛋白（ＬＮ）的主要来源及其生物学意义。结果表明：内泡膜细胞合成、分泌大量的ＩＶ型胶原，颗粒细胞不合成ＩＶ型胶原；颗粒细胞和泡膜细胞合成、分泌大量ＬＮ。由于ＩＶ型胶原属于不溶性蛋白，ＬＮ属于微溶性蛋白，因此卵泡基膜中的ＬＮ主要来源于基膜两侧的颗粒细胞、内泡膜细胞，ＩＶ型胶原主要来源于内泡膜细胞。体外无血清培养大鼠颗粒细胞，单独铺有细胞外基质的主要成分纤粘连蛋白（ＦＮ）、ＬＮ、ＩＶ型胶原时，明显促进颗粒细胞的增殖、分化，孕酮分泌增加；在同时铺有这三个细胞外基质成分时，上述作用最强，颗粒细胞分泌ｃＡＭＰ明显增加，说明ＦＮ、ＬＮ、ＩＶ型胶原具有协同作用，同时说明它们促进颗粒细胞分泌孕酮作用，是通过刺激ｃＡＭＰ水平升高实现的。     

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.     

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.