尼卡地平控制性降压对腹腔镜下行直肠癌根治术老年患者术后认知功能的影响

为探讨尼卡地平控制性降压对腹腔镜下行直肠癌根治术的老年患者术后认知功能的影响,将择期腹腔镜下行直肠癌根治术的老年患者80例,随机分为控制性降压组和对照组各40例。控制性降压组于手术开始后静脉输注尼卡地平0．5～6μg／（kg·min）行控制性降压,维持平均动脉压（MAP）较麻醉前降低30％左右（不低于60mmHg）。对照组不行控制性降压。两组于麻醉诱导前（基础状态）及术后24h、48h应用简易智能状态检查法（MMSE）评估认知功能。结果显示,控制性降压组术中MAP较对照组明显降低（P〈0．05）;与基础值比较,术后24h、48h两组MMSE评分差异无统计学意义（P〉0．05）;两组患者均未发生术后认知功能障碍。结果表明,尼卡地平0．5～6μg／（kg·min）行控制性降压,对腹腔镜下行直肠癌根治术老年患者术后认知功能无明显影响。     

硝酸甘油复合拉贝洛尔控制性降压的临床研究

目的观察硝酸甘油复合拉贝洛尔控制性降压在骨科手术的应用。方法选择椎体骨折内固定术、椎管内肿瘤切除术和骨盆骨折内固定术患者75例,均选择全身麻醉。所有患者随机分成3组:硝酸甘油组(I组)、硝酸甘油复合拉贝洛尔组(Ⅱ组)和非控制性降压组(Ⅲ组),每组 25例。I组手术开始时以1μg／kg·min-1硝酸甘油行控制性降压,根据血压调整硝酸甘油剂量,内固定毕或肿瘤切除后停止降压;Ⅱ组手术开始时给予拉贝洛尔0．2 mg／kg,同时以1μg/kg·min-1硝酸甘油行控制性降压,根据血压及心率追加拉贝洛尔和调整硝酸甘油剂量;Ⅲ组不行控制性降压。结果Ⅱ组较I组血压容易控制,Ⅱ组硝酸甘油用量与I组比较,差异有统计学意义P<0．01。Ⅲ组出血量及输血量与I、Ⅱ两组相比差异有统计学意义(P<0．05),I、Ⅱ两组降压15 min后的 MAP均较降压前降低30％左右。I组降压15min后的心率与降压前相比,有明显差异,Ⅱ组无明显差异;停止降压15 min后的MAP I组恢复为降压前的109％,Ⅱ组恢复为降压前的94％,Ⅱ组比 I组升压过程更加平稳。结论硝酸甘油复合拉贝洛尔控制性降压可减小硝酸甘油用量,反射性心动过速和反跳性高血压发生率明显减少,低血压状态易于维持,明显减少术中出血量和输血量。     

右美托咪啶和硝酸甘油控制性降压在颅内动脉瘤夹闭术中的比较

目的 比较在颅内动脉瘤夹闭术中右美托咪啶或硝酸甘油控制性降压的效果及对脑氧代谢的影响. 方法 60例行颅内动脉瘤夹闭术患者,采用随机数字表法分为右美托咪啶组(D组)和硝酸甘油组(N组).D组泵注右美托咪啶,首剂量1.0 μg/kg(泵注10 min),0.4 μg·kg-1·h-1～0.8 μg·kg1·h-1维持；N组泵注硝酸甘油,首剂量3μg·kg-1·min-1,10 min后3μg·kg-1· h-1～9μg· kg-1· min-1维持.记录麻醉诱导前(T),控制性降压开始后0(T0)、10(T1)、20(T2)、30 min(T3)和停止降压后30 min(T4)的平均动脉压(MAP)、心率(HR),同时采集桡动脉血和颈内静脉球部血行血气分析,计算脑氧摄取率(cerebral oxygen extraction rate,CERO2). 结果 实施控制性降压后,两组MAP均在30 min内达到目标血压.降压期间,HR:D组T3时(66±10)次/ min低于T0时(76±9)次/min(P＜0.05),N组T3时(86±8)次/min高于T0时(77±8)次/min(P＜0.05)；CERO2:D组T3时(27±6)％低于T0时(35±6)％(P＜0.05)；N组T3时(32±6)％与T0时(34±5)％差异无统计学意义(P＞0.05).D组CERO2与MAP呈正相关(r=0.83).结论 右美托咪啶用于颅内动脉瘤术中控制性降压安全、可靠.与硝酸甘油比较,有减慢HR,降低术中脑氧代谢率的优点.     

顺阿屈库铵临床药效学分析

目的研究顺阿屈库铵在国人中的临床药效过程。方法选择年龄30～65岁择期全麻手术病人100例。静脉诱导用异丙酚2mg/kg、芬太尼4μg/kg。各项循环监测指标稳定5min后,研究分两部分进行。第一部分将病人随机分成七组,每组10例,Ⅰ组25μg/kg、Ⅱ组30μg/kg、Ⅲ组35μg/kg、Ⅳ组40ug/kg、V组45μg/kg、Ⅵ组     

硝酸甘油控制性降压对妇科腹腔镜手术患者眼内压的影响

目的 评价硝酸甘油控制性降压对妇科腹腔镜手术患者眼内压的影响.方法 择期行妇科腹腔镜手术患者40例,ASA分级Ⅰ或Ⅱ级,年龄25～55岁,体重55～ 70 kg,采用随机数字表法,将其随机分为2组(n=20):对照组(C组)和硝酸甘油控制性降压组(N组).静脉注射咪达唑仑0.1mg/kg、芬太尼3μg/kg、维库溴铵0.1 mg/kg和依托咪酯0.3 mg/kg麻醉诱导,气管插管后行机械通气,维持PErCO2 35-40 mm Hg.静脉输注异丙酚8mg·kg-1·h-1和维库溴铵0.1mg·kg-1·h-1麻醉维持,手术开始前3 min时追加芬太尼2μg/kg.术中维持BIS值50～60.手术开始后,N组静脉输注硝酸甘油2-4 μg·kg1·min-1行控制性降压,维持CVP12～14cm H2O,术毕停止降压.分别于麻醉诱导前(To)、气管插管后3 min(T1)、气腹10 min(T2)、30 min(T3)、60 min(T4)、90 min(T5)、120 min(T6)和气腹结束后 10 min(T7)时,记录眼内压和CVP;记录术中高眼压(眼内压＞21 mum Hg)的发生情况.结果 与C组比较,N组T3-6时眼内压降低,T2-6时CVP降低,高眼压的发生率降低(P＜0.01).结论 采用硝酸甘油行控制性降压可有效预防妇科腹腔镜手术中高眼压的发生.     

异氟醚控制性降压对颅内动脉瘤夹闭术病人脑脊液中S100B蛋白含量的影响

目的 对颅内动脉瘤夹闭术病人采用异氟醚控制性降压,测定动脉瘤夹闭前后脑脊液中S100B蛋白含量,研究异氟醚控制性降压对脑功能的影响。方法 择期颅内动脉瘤夹闭术病人30例,ASA Ⅰ～Ⅱ级,随机分为两组:异氟醚降压组(n=15)和异氟醚非降压组(n=15)。非降压组术中吸入异氟醚维持麻醉,呼气末浓度为1.2％。降压组行异氟醚控制性降压,平均动脉压下降幅度30％～40％,夹闭动脉瘤后降低异氟醚吸入浓度,终止降压。分别于降压前、降压后30 min、动脉瘤夹闭后即刻、停止降压后30 min(非降压组于相应时间)测定循环指标变化;于降压前、动脉瘤夹闭后即刻、2、4 h取脑脊液测定S100B蛋白含量。结果 (1)异氟醚降压后30min平均动脉压由诱导前的(95±12)mm Hg降至(59±5)mm Hg,停止降压后30 min血压回升至(75±8)mm Hg。降压后外周血管阻力及心肌收缩加速度下降,但心率及心输出量均无显著性变化。(2)降压组动脉瘤夹闭后4 h脑脊液中S100B浓度明显高于非降压组(P<0.01),而非降压组脑脊液中S100B浓度轻微升高(P<0.05)。结论 在颅内动脉瘤夹闭术中应用异氟醚控制性降压可能加重了术后脑损伤,不利于病人围麻醉期脑功能的保护。     

瑞芬太尼控制性降压对胃癌根治术患者脑氧代谢的影响

目的 探讨瑞芬太尼控制性降压对胃癌根治术患者脑氧代谢的影响.方法 择期行胃癌根治术患者42例,ASA Ⅰ或Ⅱ级,年龄30～64岁,性别不限,体重指数<30 kg/m2,随机分为3组(n=14):对照组(C组)、瑞芬太尼控制性降压组(R组)和硝普钠控制性降压组(N组).麻醉诱导:静脉注射咪达唑仑0.1 mg/kg、芬太尼5 μg/kg、维库溴铵0.08 mg/kg和异丙酚2 mg/kg,气管插管后行间歇正压机械通气,潮气量8～10 ml/kg,呼吸频率12次/min,吸呼比1:1.5,维持呼气末二氧化碳分压30～35 mm Hg.麻醉维持:静脉输注异丙酚50～100 μg·kg-1·min-1和瑞芬太尼0.1 μg·kg-1·min-1,吸入异氟醚(呼气末浓度1.1%),间断静脉注射维库溴铵0.04 mg/kg.开腹膜时C组瑞芬太尼输注速率不变;R组瑞芬太尼输注速率每分钟增加0.05 μg·kg-1·min-1;N组静脉输注硝普钠1 μg·kg-1·min-1,1 min后每分钟增加0.5 μg·kg-1·min-1.R组和N组MAP降至麻醉诱导前的70%但不低于50 mm Hg.记录控制性降压诱导时间和血压恢复时间;于麻醉诱导前、降压前即刻、降压达目标血压10、30 min和停止降压20 min时,记录MAP和HR;采集桡动脉和颈内静脉球部血样行血气分析,计算动脉血氧含量(CaO2)、静脉血氧含量(CjvO2)、动脉.静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)和动脉-静脉乳酸含量差(Da-jvL).结果 R组控制性降压诱导时间和血压恢复时间长于N组,但血压较N组稳定(P<0.05);与C组比较,R组Da-jvO2、CERO2和Da-jvL降低,N组CERO2和Da-jvL升高(P<0.05).结论 胃癌根治术患者瑞芬太尼控制性降压效果良好,可降低脑组织氧耗.     

脊柱手术中应用雷米芬太尼控制性降压的研究

目的对比评价脊柱手术中应用雷米芬太尼或硝酸甘油行控制性降压麻醉的效果。方法30例后路椎间盘(植骨)融合术的病人,年龄18~65岁,随机分为雷米芬太尼组(R组)和硝酸甘油组(N组),每组15例。两组病人麻醉诱导及维持方法相同。R组以雷米芬太尼2μg/kg静注,0·1~0·5μg·kg-1·min-1维持;N组以硝酸甘油2μg/kg静注,0·5~3μg·kg-1·min-1维持,均将MAP降至60~65mmHg,持续60min。观察两组病人术中MAP、CVP、HR变化,失血量及清醒拔管时间的差异。结果降压期间R组的HR显著低于降压前(P<0·05,P<0·01),而N组显著高于降压前(P<0·05)。N组降压5、10、15min时的CVP显著低于降压前(P<0·05),R组与降压前相比差异无显著意义。R组术中失血量明显少于N组(P<0·01)。两组病人清醒拔管时间差异无显著意义。结论雷米芬太尼可有效用于脊柱手术术中控制性降压。与硝酸甘油相比,具有减慢HR、降压平稳、对CVP影响小、失血量少等优点。     

芬太尼同新芬太尼麻醉的回顾;多少剂量能满足

本文研究芬太尼同新芬太尼抑制血液动力学和手术刺激激素的反应有关剂量,选择冠状动脉搭挢80位病人分两组连贯记录,第一组随机双盲试验,40位病人接受一次剂量芬太尼(50或100μg/kg)或新芬太尼(10,20或30μg/kg)测血液动力学同激素浓度(肾素,醛固酮,可地松同儿茶酚胺),分别于诱导,插管,开胸前后。第二组40位病人任意随机选用其中一组接受新芬太尼4种剂量,(1)单次剂量30μg/kg,(2)10μg/kg,(3)0.05μg/kg/min,(4)20μg/kg/min,测量血液动力学及血浆新芬太尼与儿茶酚胺浓度,分别于诱导前后,插管后,开胸及动脉插管,按记录规定血液动力学反应15％或以上增加收缩压(SBP)同激素对照值增加50％或以上,在一组18位病人有血液动力学反应(平均增加SBP22.6±2％),35位患者中59次有     

硝普钠复合控制性降压血流动力学效应的实验研究

麻醉犬接受三种不同药物组合的控制性降压,并观察血流动力学改变。组Ⅰ静滴SNP降压,组Ⅲ静注labetalol 3mg/kg后静滴SNP降压,组Ⅲ静注C_(?)2mg/kg后静滴SNP降压。三组SNP用量分别为31.07±2.16、7.44±1.99和13.21±1.49μg/kg/min,组Ⅱ、Ⅲ降压时不伴有心动过速,心排血量适当下降,低血压容易维持,停用SNP后无反拗性高血压。实验结果表明SNP与labetalol或C_6合用时,降压效应相互协同,SNP用量明显减少,而不良反应相互拮抗,其效果明显优于单独应用SNP、abetalol或C_6进行控制性降压。多种药物复合控制性降压值得推荐。     

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.