体外循环术中小剂量抑肽酶对急性炎性反应的作用

目的 探讨体外循环（ECC）术中小剂量抑肽酶是否能减轻ECC所致的急性炎性反应。方法 将28例首次心瓣膜置换术患者随机分为抑肽酶组和对照组,各14例。于麻醉诱导前、ECC前、ECC后1小时和24小时测定血浆中白细胞介素－10（IL－10）、肿瘤坏死因子－α（TNF-α）和白细胞计数。结果 两组IL－10ECC后1小时比麻醉诱导前明显升高（P＜0．01）,且抑肽酶组明显高于对照组（P＜0．01）;对照组TNF－α和白细胞计数在ECC后1小时和24小时较麻醉诱导前明显升高,且高于抑肽酶组（P＜0．05）。结论 小剂量抑肽酶可抑制ECC所致的炎性反应。     

小剂量氯胺酮对体外循环促炎细胞因子反应及心肌损伤的影响

目的 探讨小剂量氯胺酮对体外循环（CPB）诱发的促炎细胞因子反应及心肌损伤的影响。方法 20例择期瓣膜替换术病人,随机分成氯胺酮组（n＝10）和对照组（n＝10）。氯胺酮组于麻醉诱导和转流开始时按1mg.kg^-1静注氯胺酮,对照组则采用等量生理盐水注射。分别于术前（T1）、CPB60min（T2）、CPB结束后2h（T3)、4h(T4)及24h（T5）各时间点测定动脉血中下列各项指标;肿瘤坏死因子－α（TNF－α）、白细胞介素－6（IL－6）、白细胞介素－8（IL－8）、血浆过氧化脂质（LPO）、心肌肌酸酶同工酶（CK－MB）。结果 与术前（T1）比较,两组TNF－α、IL－6、IL－8、LPO、CK－MB均明显升高（P＜0．05或0．01）;但氯胺酮组T2－T5TNF－α、IL－6、IL－8浓度、T3LPO浓度和T3、T4、CK－MB活性均显著低于对照组（P＜0．05）。结论 小剂量氯胺酮能有效抑制CPB诱发的促炎细胞因子反应和心肌损伤。     

参附注射液对体外循环中炎性反应的影响

目的：观察参附注射液对体外循环（CPB）中肿瘤坏死因子－α（TNF－α）和白细胞介素－6（IL－6）的影响。方法：将20例人工心脏瓣膜置换术患者随机分成参附组和对照组（每组10例）。参附组分别于麻醉诱导前、CPB前及主动脉开放10分钟内分别静脉滴注参附注射液20ml、40ml和40ml，于CPB前、主动脉阻断前、主动脉阻断30分钟，主动脉开放15分钟和60分钟时采用放射免疫法测定两组血心中TNF－α和IL－6的含量。结果：主动脉阻断前、主动脉阻断30分钟、主动脉开放后15分钟和60分钟，对照组TNF－α值均明显高于参附组（P＜0．05），各时点IL－6组间比较差别无显著性意义（P＞0．05）。结论：参附注射液可降低主动脉开放后血浆TNF－α的含量，具有对抗CPB所致的炎性反应的作用，而对CPB中IL－6作用不明显。     

体外循环时心肌细胞上粘附分子的变化及抑肽酶对其表达的影响

目的：观察行心脏瓣膜置换术的病人在体外循环（CPB）前，后心肌细胞间粘附分-1(ICAM-1）及血管细胞间粘附分子－1（VCAM－1）的表达，并探讨抑肽酶对其表面的影响，方法：20例病人被随机均分为抑肽酶组和对照组，分别于手术开始及结束时取右心房心肌标本，采用免疫组化法检测心肌细胞及心肌血管内皮细胞上ICAM－1及VCAM－1的表达（IOD值）。结果：对照组心脏瓣膜我术病人CPB后心肌细胞上和心肌血管内皮细胞（EC）上ICAM－1及VCAM－1的表达较术前有明显增加（P＜0．05），而在抑肽酶组则无明显变化，组间比较，差异有具有显著意义，P＜0．05，结论：CPB时心肌细胞及心肌血管EC上ICAM－1及VCAM－1的表达增高，抑肽酶可通过抑制这些粘附分子的表达而减轻CPB所致的炎症反应。     

抑肽酶对小儿体外循环术后细胞因子的影响

目的：观察小儿体外循环术中，术后细胞因子肿瘤坏死因子（TNF）－α，白细胞介素（IL）－6，IL－8的变化，评价抑肽酶对体外循环炎 反应的抑制作用。方法：19例在体外循环下行心内直视手术的先天性心脏病病儿，随机分为2组，试验组10例，于转机过程中加入凶肽酶4－5万KIU／kg；对照组9例，未用抑肽酶，分别于麻醉后，升主动脉阻断后10min，停机后10min，停机后24h共4个时点采取动脉血，酶标免疫放射法分别测定IL－6，IL－8，TNF－α。结果：对照组IL－6，IL－8，TNF－α于体外循环开始后升高，IL－8，TNF－α于术后24h恢复至基础值，试验组TNF－α各时间点升高不明显，IL－6，IL－8升高幅度低于对照组（P＜0．01，0．05），结论：抑肽酶可能降低体外循环术后IL－6，IL－8，TNF－α等细胞因子水平，从而减轻炎性反应。     

心脏手术中小剂量抑肽酶对中性粒细胞CD11b/CD18表达的影响

目的探讨体外循环术(CPB)中小剂量抑肽酶对全身炎性反应的抑制作用.方法28例首次行心脏瓣膜置换术患者随机分为对照组和抑肽酶组,各14例,于麻醉诱导前、CPB前、CPB结束后1h及24h用免疫流式细胞仪分别测定中性粒细胞表面粘附分子CD11b和CD18的表达.结果CDllb/CD18的表达与CPB时间呈正相关(相关系数r分别为0.644、0.538,P＜0.05),CPB结束后1h及24h对照组CD11b的表达较麻醉诱导前及同时点的抑肽酶组明显上调(P＜0.05);CD18的表达仅在CPB结束后1h明显上调并高于抑肽酶组(P＜0.05),CPB结束后24h表达下调有所缓解,但仍高于麻醉前基础值(P＜0.05).结论CPB所致的炎性反应可能与转机时间有关,小剂量抑肽酶对CPB术后CD11b/CD18表达增加具有抑制作用.     

乌司他丁和抑肽酶对体外循环小儿炎性反应及心肌损伤的影响

目的研究乌司他丁和抑肽酶对体外循环（CPB）小儿炎性反应及心肌损伤的影响。方法选择拟行CPB的先天性心脏病患儿90例,随机分成6组,每组15例：对照组（C组,不使用乌司他丁及抑肽酶）、小剂量乌司他丁组（UL组,乌司他丁1万U/kg）、大剂量乌司他丁组（UH组,乌司他丁2万U/kg）、小剂量抑肽酶组（AL组,抑肽酶7．5万KIU/kg）、大剂量抑肽酶组（AH组,抑肽酶15万KIU/ kg）、小剂量乌司他丁复合小剂量抑肽酶组（UL＋AL组,乌司他丁1万U/kg＋抑肽酶7．5万KIU/kg）。乌司他丁或/和抑肽酶按各组要求剂量在转机前一次性加入预充液中。于CPB前（T1）、升主动脉开放5 min（T2）、CPB结束后30 min（T3）、4 h（T4）抽取动脉血,测定血浆IL-6、IL-8、IL-10、TNF-α、cTnI浓度及CK-MB活性,记录术后辅助通气时间、24 h引流量、心脏复跳情况及围术期多巴胺使用情况。结果与C组比较,在T2～T4时,UH组、AH组、UL＋AL,组血浆IL-6、IL-8、TNF-α、cTnI浓度及CK-MB活性降低;AH组、UL＋AL组IL-10增高（P＜0．05）;UL＋AL组心脏自动复跳率（100％）增高,血管活性药物使用率较低,术后辅助通气时间较短（P＜0．05）;AH组术后出血量较少（P＜0．05）。结论大剂量乌司他丁、大剂量抑肽酶及小剂量乌司他丁复合小剂量抑肽酶,均可通过抑制CPB炎性反应、减轻小儿心肌损伤,小剂量乌司他丁复合小剂量抑肽酶效果更佳。     

乌司他丁对心脏直视手术患者围体外循环期炎性细胞因子和自由基的影响

目的 评价乌司他丁对血浆促炎细胞因子和自然基代谢水平的影响。方法 选择20例拟在CPB下行心内直视手术的先心病患者,随机分为两组,每组10例。乌司他丁组（U组）患者接受乌司他丁1．2万IU／kg,于切后皮至CPB前缓慢静注半量,另半量加入预充液中随转机进入体内。对照组（C组）用等容量生理盐水代替。分别于麻醉后切皮前（T1）、CPB30min（T2）、CPB结束后30min（T3）、4h（T4）和24h（T5）测定血浆TNF－α、IL－6、IL－8和MDA浓度及SOD活性。结果 C组TNF－α在T2、T3明显升高（P＜0．05）;U组仅在T2高于基础值（P＜0．05）,且于T3较C组低（P＜0．05）。C组IL－6于T2即升高,持续至T5;U组无明显变化,于T2明显低于C组（P＜0．01）。C组IL－8于T2升Y高（P＜0．05）,至T3达峰值（P＜0．01）,于T5下降至基础水平;U组只在T3较基础值升高（P＜0．05）,于T2－T6均显著低于C组（P＜0．05－0．01）。两组MDA均在T2升高（P＜0．01）,C组持续至T4,U组持续至T3。C组SOD活性自T2开始降低（P＜0．01）,持续至T3（P＜0．05）;U组无明显变化,且在T2－T4与C组比较有显著性差异（P＜0．05）。结论 乌司他丁可抑制CPB心脏手术导致的全身性炎性反应,减少自由基的产生,从而减轻心肌缺血再灌注损伤。     

乌司他丁对心脏直视术中缺血-再灌注损伤的保护作用

目的：研究乌司他丁对心肺转流（CPB）心脏直视手术中缺血－再灌注损伤的保护作用。方法：20例择期CPB心脏瓣膜手术患者随机均分为对照组（C组）和乌司他丁组（U组），C组不给药，U组给予乌司他丁100万U（其中30万U为麻醉诱导前给予，40万U预充体外循环机内，30万U为开放升主动脉后给予），分别于麻醉诱导后（T1），阻断升主动脉30分钟（T2），再灌注1小时（T3），再灌注2小时（T4）及再灌注3小时（T5）各时间点取静脉血用ELISA法测定样本中下降各指标的水平。肿瘤坏死因子－α（TNF-α），白细胞介素－6（IL－6），白细胞介素－8（IL－8）。结果：两组血清中TNF－α，IL-6，IL－8的浓度，都是在再灌注后与手术前值及阻断主动脉30分钟的值相比有明显的增加（P＜0．05），在T3，T4，T5三个时点C组的TNF－α，IL－6，IL－8的释放明显低于对照组（P＜0．05），结论：在CPB过程中乌司他丁可以通过抑制炎性介质TNF－α，IL－6和IL－8的释放而减轻缺血－再灌注损伤。     

前列腺素E2对急性坏死性胰腺炎大鼠IL—10，TNF—α及IL—β的调控和对肺组织损伤的影响

目的：探讨前列腺素E2（PGE2）对大鼠急性坏死性胰腺炎（ANP）中血清白介素－10（IL－10），肿瘤坏死因子（TNF－α）以及白介素－1β（IL－1β）的含量及肺组织损伤的影响，方法：将SD大鼠91只随机分4组，假手术对照组（n=7)，ANP组（n=28),PGE2前处理组（n=28),BGE2后处理组（n=28)；观察同组不同时间，不同组同时间的IL－1β，TNF－α和IL－10的动态变化，并观察各组肺组织的病理切片。结果：各指标在1h,3h,6h和12hPGE2前处理组和PGE2后处理组与ANP组相比较差异有显著性（P＜0．01），在PGE2前处理组，TNF－α，IL－1β下降更加明显，IL－10升高两组都很明显，而且有PGE2保护的两组，其肺组织损伤出现较迟，较轻，结论：IL－1β和TNF－α在大鼠ANP的全身性反应过程中起重要的递质作用，IL－10能抵抗它们的作用，PGE2能降低ANP大鼠血清中IL－1β，TNF－α含量，提高IL－10含量，减轻肺组织损伤。     

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.