乌司他丁对心脏瓣膜置换术病人脑损伤的影响

目的探讨乌司他丁对心脏瓣膜置换术病人脑损伤的影响及其机制。方法24例心脏瓣膜置换术病人,随机分为乌司他丁组(U组)和对照组(C组),每组12例。U组于麻醉诱导后即刻静脉注射乌司他丁1.2万U/kg,另0.6万U/kg加于体外循环(CPB)预充液中,0.6万U/kg于主动脉开放前约5 min加入CPB机内。C组用等容积生理盐水代替。于麻醉后手术前(T1)、复温至36℃(T2)、停CPB 30 min(T3)、CPB后6 h(T4)抽取颈静脉球血,用放免法测定神经元特异性烯醇化酶(NSE) 浓度、用ELISA法测定S100β蛋白(S100β)浓度,用硫代巴比妥法测丙二醛(MDA)浓度,用黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活性;于T1、T3、T4用放免法测定肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介累8(IL-8)浓度,用ELISA法测定IL-10浓度。结果两组S100β、NSE、MDA浓度在T2-4时高于T1,TNF-α、IL-6、IL-8、IL-10浓度在T3,4时高于T1(P<0.01);U组S100β、NSE、TNF-α、IL-6、IL- 8浓度在T3、4时低于C组(P<0.05或0.01);T2-4时,U组SOD活性高于C组,MDA浓度低于C组(P< 0.05或0.01);U组IL-10浓度在T4时高于C组(P<0.05或0.01)。结论乌司他丁可减轻心脏瓣膜置换术病人的脑损伤,其机制可能与其减少促炎细胞因子释放、增加抗炎细胞因子生成及抗氧化作用有关。     

乌司他丁对心脏瓣膜置换术患者体外循环期间全身炎性反应的影响

目的 探讨乌司他丁对心脏瓣膜置换术患者体外循环期间全身炎性反应的影响.方法 拟行心脏瓣膜置换术的风湿性心脏病患者40例,性别不限,体重39～72kg,年龄27～44岁,ASAⅡ或Ⅲ级,随机分为2组(n=20):对照组(C组)和乌司他丁组(U组).U组于CPB前10 min静脉注射乌司他丁1万U/kg,CPB预充液中加入1万U/kg,C组以等容量生理盐水替代乌司他丁.于CPB前15 min(T1)、CPB 10 min(T2)、CPB结束后30 min(T3)、60 min(T4)时测定血浆白细胞介素6(IL-6)、IL-8、IL-10及肿瘤坏死因子α(TNF-α)的浓度.结果 与C组比较,U组CPB期间和CPB结束后血浆IL-6、IL8和TNF-α的浓度降低,IL-10浓度升高(P<0.05或0.01);与T1比较,T2,3时两组血浆IL-6、IL-8、IL-10、TNF-α的浓度升高(P<0.01).结论 乌司他丁可减低心脏瓣膜置换术患者CPB期间促炎-抗炎反应失衡,减轻全身炎性反应.     

不同剂量芬太尼复合麻醉下心脏瓣膜置换术患者围术期血浆细胞因子和心肌酶的变化

目的 探讨不同剂量芬太尼麻醉下心脏瓣膜置换术患者围术期血浆细胞因子和心肌酶水平的变化。方法 择期行心脏瓣膜置换术患者30例,随机分为3组:F1组、F2组和F3组,每组10例,微量泵分别连续输注芬太尼总量30、60、100μg·kg-1。分别于麻醉前(T1)、体外循环(CPB)转流前(T2)、开主动脉后30 min(T3)、开主动脉后2 h(T4)及术后24 h(T5)采动脉血,测定血浆中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)浓度及肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)活性,并记录三组患者在ICU的滞留时间和拔管时间。结果 与T1比较,三组CPB后TNF-α、IL-6、IL-10、CK、CK-MB升高(P<0.01)。与F1组比较,F2组、F3组T3、T4时TNF-α、IL-6、T4、T5时CK、T3-5时CK-MB降低、T4、T5时IL-10升高(P<0.05)。F3组ICU滞留和术后拔管时间明长于F1组和F2组(P<0.05)。结论 较大剂量芬太尼可抑制CPB诱导的炎性反应和心肌缺血再灌注损伤,但是对于拔管时间和在ICU的滞留时间芬太尼有顶峰效应。     

依达拉奉联合乌司他丁对心脏瓣膜置换术患者脑保护的作用

目的 探讨依达拉奉联合乌司他丁对心脏瓣膜置换术患者围心肺转流(CPB)期脑保护的作用.方法 择期心脏瓣膜置换术患者40例,随机均分为四组.E组于麻醉诱导后静脉滴注依达拉奉0.5 mg/kg,U组于麻醉诱导后静注乌司他丁1.2万U/kg,EU组按照E组和U组的用药量及方法联合给药;C组用等容量生理盐水代替.分别于麻醉后用药前(T0)、主动脉开放后10 min(T1)、4 h(T2)及24 h(T3)采集颈静脉球部血,检测丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-10、神经组织蛋白(S-100β)及神经元特异性烯醇化酶(NSE),并观察术后神经精神并发症的发生情况.结果 与C组比较,T1、T2时E、U、EU组TNF-α、IL-6、MDA、S-100β及NSE降低,IL-10、SOD及T-AOC升高(P＜0.05);与EU组比较,T1、T2时U组TNF-α、IL-6、MDA、S-100β及NSE均升高,IL-10降低(P＜0.05);E组TNF-α、IL-6升高,IL-10降低(P＜0.05);与U组比较,T1、T2时E组TNF-α、IL-6升高,IL-10、MDA降低(P＜0.05).术后随访无谵妄及神经系统阳性体征.结论 依达拉奉联合乌司他丁用于心脏瓣膜置换术麻醉,有利于抑制炎症因子、氧自由基及其他细胞因子之间网络式的级联放大效应,减轻围CPB期脑损伤;其脑保护效应比单用依达拉奉或乌司他丁更具有优势.     

星状神经节阻滞对瓣膜置换术患者颅内静脉血炎性因子及氧化应激指标的影响

目的 观察星状神经节阻滞(SGB)对心脏瓣膜置换术患者颅内静脉血炎症因子氧化应激指标的影响.方法 择期心肺转流(CPB)下心脏瓣膜置换术患者40例,随机均分为两组,SGB组和对照组.SGB组以0.25%罗哌卡因10 ml行右侧SGB,对照组不行SGB,SGB 10 min后开始麻醉诱导.分别于左颈内静脉逆行置管后即刻(T0)、主动脉开放后10 min(T1)、术后2 h(T2)、6 h(T3)及24 h(T4)抽取颈内静脉球部血5 ml,检测血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、丙二醛(MDA)浓度、超氧化物歧化酶(SOD)活性.结果 与T0时比较,两组血浆TNF-α、IL-8、IL-10及MDA浓度在T1～T4时升高,血浆SOD活性对照组在T1～T4时降低(P＜0.05),SGB组在T1～T2时降低(P＜0.05);与对照组比较,SGB组血浆TNF-α、IL-8、MDA浓度在T1～T4时降低(P＜0.05),IL-10浓度及SOD活性在T1～T4时升高(P＜0.05).结论 SGB可以减轻心脏瓣膜置换术患者围CPB期颅内过度炎症反应及脂质过氧化损伤,对减轻脑损伤具有一定积极意义.     

参芪扶正注射液对心脏瓣膜置换术的心肌保护作用

目的研究参芪扶正注射液(SF)对心肺转流(CPB)心脏瓣膜置换术中心肌缺血-再灌注的保护作用。方法48例择期行心内直视瓣膜替换术患者随机均分为两组,治疗组(SF组)应用SF500ml(250ml于阻断主动脉前泵入,250ml至术毕泵完);对照组(C组)以生理盐水500ml同法泵入。在麻醉诱导后15min(T0)、CPB30min(T1)及主动脉开放后30min(T2)、2h(T3)、12h(T4)、24h(T5)检测血清肌酸激酶(CK)及其同工酶(CK-MB)、肌钙蛋白I(cTnI);于T0、主动脉开放后5、10min时从冠状静脉窦取血测定血浆超氧化物歧化酶(SOD)、丙二醛(MDA)浓度。结果两组患者CK、CK-MB在T1~T5时与T0时比较均明显升高(P<0.01);SF组CK、cTnI T2~T5时升高幅度明显低于C组(P<0.01);SF组CK-MBT2~T4时升高幅度低于C组(P<0.05或P<0.01);在主动脉开放后5、10min时,两组SOD含量均有明显下降(P<0.01),而在开放后10minC组下降更明显(P<0.01);MDA含量在主动脉开放后5、10min两组均有明显升高(P<0.05或P<0.01),而C组升高更明显(P<0.01)。结论SF对心肌缺血-再灌注损伤有保护作用。     

乌司他丁对体外循环患者血浆细胞因子水平及呼吸指数的影响

目的 观察乌司他丁对体外循环(CPB)患者血浆细胞因子水平及呼吸指数(RI)的影响。方法选择择期体外循环下行瓣膜替换术患者20例,随机分为乌司他丁组(W组)和对照组(C组),每组10例。分别于诱导后切皮前(T1)、转流30 min(T2)、停CPB 1 h(T3)、4 h(T4)、24 h(T5)抽取动脉血,测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6(IL-6)、IL-10浓度。于T1、T3、T4、T5各时点行血气分析,计算RI。结果 C组T2-5各时点TNF-α、IL-6、IL-10均高于T1(P<0.01),与W组同时点比较亦显著性增高(P<0.01);C组TNF-α/IL-10及IL-6/IL-10的比值在T3-5各时点明显高于W组(P<0.01);T3-5各时点C组的RI较T1及W组同时点显著性增高(P<0.01)。RI与TNF-αIL-6呈正相关,相关系数r分别为0.79和0.78;RI与IL-10呈负相关,相关系数r为-0.75。结论乌司他丁能调整机体促炎系统及抗炎系统动态平衡,从而改善肺功能。     

乌司他丁对心肺转流心内直视术中细胞因子平衡和心肌细胞凋亡的影响

目的探讨乌司他丁对心肺转流(CPB)心内直视术患者细胞因子平衡和心肌细胞凋亡的影响。方法20例择期行二尖瓣置换术患者,随机均分为乌司他丁组(U组)和对照组(C组)。U组给予乌司他丁100万U,其中1万U于转机前静注作过敏试验,99万U加入预充液中;C组用生理盐水代替。于转机前(T0)、转机30min(T1)、CPB停止即刻(T2)、CPB停止后2h(T3)、6h(T4)和24h(T5)采集动脉血,测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)浓度。采用TUNEL法测定两组CPB前和CPB停止后30min右心房的心肌凋亡细胞。结果U组T2~T5时的IL-6、IL-8和TNF-α浓度明显低于C组(P<0·01),而IL-10浓度明显高于C组(P<0·01)。CPB停止后30min,U组心肌细胞的凋亡指数明显低于C组(P<0·05)。结论乌司他丁抑制CPB期间TNF-α、IL-6和IL-8的释放,促进IL-10的释放,有利于细胞因子反应平衡的调节;乌司他丁通过抑制细胞凋亡,减少心肌细胞的死亡,可有效的保护心肌。     

氯胺酮对心脏瓣膜置换术患者血浆粘附分子及心肌损伤的影响

目的 探讨静脉注射氯胺酮对心脏瓣膜置换术患者血浆粘附分子及心肌损伤的影响。方法 20例择期行心脏瓣膜置换术的患者,随机分为氯胺酮组(K组)和对照组(C组),每组10例。K组于麻醉诱导和转流开始时静脉注射氯胺酮 2mg·kg-1,C组则给予等容量生理盐水。分别于麻醉诱导前(T0)、体外循环(CPB)开始后20 min(T1)、升主动脉开放后30 min(T2)、停机后4 h(T3)和24 h(T4)抽取动脉血,测定血浆颗粒蛋白-140(P-selectin)、白细胞粘附分子-1(L-selectin)、细胞间粘附分子-1(ICAM-1)、白细胞介素-6(IL-6)和心肌肌钙蛋白I(cTnI)的浓度。结果 与T0比较,T1-4时两组血浆ICAM-1、P-selectin、L-selectin和IL-6浓度均升高(P<0.01),T2-4时cTnI的浓度升高(P<0.01);与C组比较,K组T2-4时血浆P-selectin、L-selectin、cTnI浓度降低,T1-4时ICAM-1、IL-6浓度降低(P<0.05或0.01)。结论 氯胺酮能降低CPB期间患者血浆粘附分子和IL-6的水平,减轻CPB引起的炎症反应,对缺血再灌注心肌具有保护作用。     

乌司他丁对心肺转流患者血浆S-100β蛋白、炎性因子及认知功能的影响

目的 观察乌司他丁对心肺转流(CPB)下瓣膜置换术患者血浆S-100β蛋白、炎性细胞因子及认知功能的影响.方法 择期行瓣膜置换术患者40例,随机均分为乌司他丁组(U组)和对照组(C组).U组于切皮前静脉注射乌司他丁10 000 U/kg,并在预充液中加入10 000 U/kg;C组给予等容量生理盐水.于给药前(T1)、CPB结束后即刻(T2)、2 h(T3)、6 h(T4)及24 h(T5)抽取颈内静脉血测定血浆IL-6、TNF-α浓度及S-100β蛋白;于麻醉前1d和术后1、3、7d对患者进行评分并判断是否发生术后认知功能障碍(POCD).结果 与T1时比较,T2～T5时两组血浆S-100β蛋白及IL-6、TNF-α浓度均升高(P＜0.05);与C组比较,U组中的S-100β蛋白及IL-6、TNF-α浓度显著降低(P＜0.01);U组2例、C组7例发生POCD( P＜0.05).结论 乌司他丁可减轻瓣膜置换术患者CPB时炎性介质的释放,降低患者术后POCD的发生率.     

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.