腕投掷运动时腕关节韧带长度变化的活体研究

目的 探讨腕关节在投掷运动过程中腕关节韧带长度的变化.方法 对6例志愿者腕关节进行CT扫描,获取腕关节在投掷运动过程中的5个位置,即桡偏20°背伸60°,桡偏10°背伸30°,中立位,尺偏20°掌屈30°,尺偏40°掌屈60°时各腕骨、尺桡骨远段的三维重建图像,在重建图像基础上利用Mimics软件测得在腕关节投掷运动过程中掌、背侧腕关节韧带的长度.结果 腕关节由中立位至桡偏20°背伸60°时桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带长度显著伸长,分别延长(3.4±0.5)、(2.0±0.2)、(2.6±0.5)、(2.1±0.4)mm,差异均有统计学意义(P<0.05);腕关节由中立位至尺偏400掌屈60°时背侧桡腕韧带、背侧骨间韧带止于小多角骨部分长度显著伸长,分别延长(1.7 ±0.2)、(3.8 ±0.4)mm,差异有统计学意义(P<0.05).尺月韧带、背侧骨问韧带止于舟骨部分在投掷运动过程中其长度均较中立位时旱增长趋势.结论 腕关节在桡背伸至尺掌屈运动过程中,桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带缩短,提示张力减低,背侧桡腕韧带、背侧骨间韧带止于小多角骨部分伸长,张力增大,尺月韧带、背侧骨间韧带止于舟骨部分于中立位时张力最小,其变化规律有助于指导临床腕关节韧带损伤的修复.     

腕尺桡偏运动时腕韧带长度变化的活体研究

目的 研究腕关节在尺桡偏运动过程中,腕关节韧带长度的变化.方法 对6名志愿者腕关节进行CT扫描,获得腕关节在桡偏20°至尺偏40°内每隔20°的运动范围内各腕骨及尺桡骨远段三维重建图像.男3名,女3名,仅研究单侧右侧腕关节.年龄20～32岁,平均24岁.在腕关节尺桡偏运动过程中,在重建各腕骨及尺桡骨结构图像上以软件测量掌、背侧腕韧带的长度.结果 腕关节尺偏时桡舟头韧带、长桡月韧带、背侧腕间韧带止于舟骨、大多角骨和小多角骨部分的长度较中立位显著伸长,分别伸长(2.4±0.3)mm、(2.3±0.8)mm、(1.2±0.6)mm、(1.2±1.2)mm与(2.6±1.0)mm,差异均有统计学意义(P＜0.05);腕关节桡偏时尺头韧带与背侧桡腕韧带长度显著伸长(P＜0.05),分别为(0.8±0.6)mm和(1.0±0.5)mm.结论 在腕关节尺桡偏运动时,桡舟头韧带、长桡月韧带、背侧腕间韧带于桡偏位缩短,尺头韧带、背侧桡腕韧带长度于尺偏位缩短.这些位置可能使不同腕韧带张力降低,有利于损伤韧带的修复.     

晚期月骨无菌性坏死舟骨环形征的解剖学及生物力学研究

目的明确稳定舟骨近极的韧带及断裂后桡腕关节面应力的改变,阐明舟骨环形征的临床意义. 方法实验分为两部分,分别通过5侧上肢标本的解剖学观察,确定稳定舟骨近极的韧带;通过桡侧、尺侧屈腕肌腱及桡侧、尺侧伸腕肌腱,垂直加载12 kg负荷5分钟,应用压敏薄膜及FPD-305E、FPD-306E系统,分别测量腕关节中立、掌屈、背伸、尺偏及桡偏时,正常及韧带断裂后舟骨窝、月骨窝应力的变化. 结果解剖学观察发现,稳定舟骨近极的韧带为:桡舟头韧带、长桡月韧带及舟月骨间韧带,其中长桡月韧带和舟月骨间韧带起到限制舟骨近极向背侧移位的作用.生物力学研究结果表明,在稳定舟骨近极的韧带断裂后,背伸位时,舟骨窝桡侧亚区应力(0.90±0.43)与正常(0.85±0.15)无差异,但掌侧(0.59±0.20)、尺侧(0.52±0.05)及背侧亚区(0.58±0.23)应力较正常(相对应力为0.77±0.13、0.75±0.08、0.68±0.09)减小;中立、掌屈、桡偏及尺偏位时,舟骨窝内各亚区应力与正常相比增大或无差异;而月骨窝在中立位时,各亚区的应力增大;掌屈、背伸、桡偏及尺偏位时,各亚区的应力减小或无差异. 结论在月骨无菌性坏死ⅢB期,舟骨窝承受的负荷增加,在治疗方法的选择上,应注意矫正舟骨的旋转半脱位,防止后期出现桡舟关节创伤性关节炎.     

腕骨骨间韧带损伤与舟月骨分离的关系

目的探讨实验条件下腕骨骨间韧带损伤与舟月骨分离形成的关系。方法8具新鲜尸体肘关节以远标本,左右各4具。将标本用夹具固定于腕关节动力学参数测试仪,作模拟屈、伸、尺、桡偏运动。并拍摄腕关节中立、前后、侧位片。分别依次切断桡舟月韧带、舟月骨间韧带掌侧部、舟月骨间韧带背侧部及桡舟头韧带。测量舟月角、头月角、舟月间距。结果随着依次切断韧带,舟月角、头月角分别增大至[(B0．0±8．7)°,(?)±s,下同]、(22．0±7．O)°,舟月间距增宽至(2．25±0．46)mm,以上差异均有统计学意义(P＜0．05)。结论实验中舟骨周围骨间韧带切断的顺序及入路符合舟月骨分离背伸、旋后、尺偏的损伤机制,舟月骨间韧带、桡舟月、桡舟头韧带损伤可产生静态舟月骨分离。     

正常腕关节桡腕关节面应力分布的实验研究

目的　明确正常腕关节桡腕关节面的应力分布特点及其与腕关节位置的关系。方法　 5侧标本通过克氏针固定前臂于中立位 ,调整加载支架 ,使腕关节分别处于中立、掌屈 30°、背伸 30°、尺偏 30°及桡偏 1 0°,通过桡侧、尺侧屈腕肌腱、桡侧、尺侧伸腕肌腱 ,垂直加载 1 2kg固定负荷 ,富士压敏薄膜通过腕关节背侧切口置入 ,应用颜色密度测量仪FPD— 30 5E及密度压力转换器FPD— 30 6E分别测量舟骨窝、月骨窝的应力。结果　舟骨窝及月骨窝内应力分布不同 ,且随腕关节位置的改变而变化。结论　正常腕关节桡腕关节面存在两个相对独立的应力分布区 ;桡舟关节并非紧密嵌合 ,舟骨窝内应力分布不均匀 ;桡月关节在腕关节中立、掌屈、尺偏位时嵌合不紧密 ,月骨窝内应力分布不均 ;而在腕关节背伸、桡偏时嵌合紧密 ,应力均匀分布 ;腕关节背伸位时 ,舟骨窝及月骨窝的应力最大     

部分腕骨融合术或切除术对腕关节运动影响的实验研究

目的 研究临床常用的部分腕骨融合术或切除术对腕关节运动的影响程度。方法 将１２侧新鲜上肢处理后,固定于特制的测试架上,在腕背部打入２根或多根克氏针,作舟头骨、舟大小多角骨、舟月骨、月三解骨、桡月骨、ｆｏｕｒ ｃｏｒｎｅｒ、头月骨融合术、舟骨切除＋ｆｏｕｒ ｃｏｒｎｅｒ、舟骨切除＋头月融合术。观测腕关节正常运动活动范围,及作上述不同部分腕骨融合术后腕关节屈曲、伸腕、尺偏、桡偏度数。结果 桡舟月骨融合     

舟月骨分离实验模型建立的新标准

目的探讨实验条件下舟月骨分离模型制作新标准,为临床研究提供实验模型。方法8具未经防腐处理的新鲜尸体标本(肘关节以远标本),左右各4具。依次切断桡舟月韧带、舟月骨间韧带掌侧部、舟月骨间韧带背侧部、桡舟头韧带后,将标本用夹具固定于腕关节动力学参数测试仪,做模拟屈伸、尺桡偏运动,并摄腕关节中立前后位及侧位X线片,测量舟月角、头月角、舟月间距、桡舟间距和舟骨长度。结果随着依次切断上述韧带,舟月角、头月角分别增大至80．0°±8．7°和22．0°±7．0°,舟月间距增宽至(2．3±0．5)mm,桡舟间距增宽至(2．8±1．1)mm,舟骨长度逐渐缩短至(22．3±2．7)mm,差异均具有统计学意义(P<0．05)。结论当舟月角>60°、头月角>20°、舟月间距> 2．0 mm、桡舟间距>2．5 mm、舟骨长度<22．0 mm时,即已达到舟月骨分离的建模标准,其中桡舟间距、舟骨长度的变化能反应舟月骨分离的损伤进程及舟骨旋转性半脱位的程度。     

局限性融合腕舟骨、大、小多角骨的稳定性研究

目的探讨局限性融合腕舟骨、大、小多角骨(scaphoid-trapezium-trapezoid,STT)的稳定性。方法取6具新鲜成人尸体(男4具,女2具)前臂以远标本,依次切断腕关节的桡月韧带、舟月骨间韧带、桡月头韧带、舟大多角韧带、舟头韧带,建立静态舟月分离的腕关节模型。用自行研发的新型STT融合器在标本上模拟STT融合术,并将其固定于腕关节动力学参数仪,分别模拟腕关节背伸35°-掌屈50°、桡偏10°-尺偏30°各5万次极限运动。运动前后摄腕关节正侧位X线片,测量舟骨长度、桡舟间距及桡舟角变化,观察融合器各部分有无松动、变形或断裂,并对数据行统计学处理。结果腕关节各方向极限运动前后,作为局限性融合体稳定性指标的舟骨长度、桡舟间距及桡舟角的差异无统计学意义(P>0.05),极限运动后STT融合器无松动、变形或断裂。结论应用新型STT融合器模拟STT局限性融合术后,在腕关节背伸35°-掌屈50°、桡偏10°-尺偏30°范围内进行各方向极限运动,局限性腕骨融合体不发生位移。应用新型STT融合器行局限性腕骨融合稳定性好。     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

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.