邻近双节段脊髓型颈椎病患者的外科治疗方案研究

目的比较颈前路椎间盘切除植骨融合术(ACDF)和颈前路椎体次全切除融合术(ACCF)对邻近双节段脊髓型颈椎病的治疗效果。方法回顾性分析在我院接受手术治疗的邻近双节段脊髓型颈椎病的50例患者,其中采用颈前路椎间盘切除植骨融合术的患者25例(ACDF组),采用颈前路椎体次全切除融合术的患者25例(ACCF组)。比较两组患者的手术时间、住院时间、出血量,JOA评分和VAS评分以及两组患者手术前后的颈椎曲度和融合节段高度。结果 ACCF组手术时间明显低于ACDF组,术中的出血量明显多于ACDF组(P0.05),但住院时间差异不具有统计学意义(P0.05);两组患者手术后的JOA评分明显高于手术前,VAS评分明显低于手术前(P0.05);但两组患者间的JOA评分和VAS评分差异不具有统计学意义(P0.05)。两组患者手术前的颈椎曲度差异不具有统计学意义(P0.05),手术后3 d以及术后1年随访,ACCF组中患者的颈椎曲度明显小于ACDF组(P0.05);两组融合节段高度均明显高于手术前(P0.05),但两组患者手术前后的融合节段高度差异不明显。结论 ACDF具有出血量少,能更好地改善颈椎曲度,但ACCF具有手术时间短的优点。临床医师应根据患者的实际情况,采用适当的手术方式治疗邻近双节段脊髓型颈椎病。     

颈前路手术治疗3节段脊髓型颈椎病

目的分析颈前路减压融合手术治疗3节段脊髓型颈椎病的临床疗效。方法对124例3节段脊髓型颈椎病患者行颈前路手术治疗,78例行颈前路椎间盘切除减压融合术(ACDF),46例行颈前路椎体次全切除减压融合术(ACCF)。评估术后JOA评分及其改善率、植骨融合情况以及颈椎曲度。结果患者均获得随访,时间:ACDF组13~54(36.7±15.1)个月,ACCF组14~53(33.6±18.7)个月。两组患者术后JOA评分及颈椎Cobb角均较术前显著提高及恢复,差异均有统计学意义(P0.05)。ACDF组在手术时间、术中出血量及颈椎生理曲度恢复程度方面均优于ACCF组,且并发症发生率更低(P0.05)。两组术后JOA评分及其改善率、植骨融合率比较差异无统计学意义(P0.05)。结论 ACDF与ACCF治疗3节段脊髓型颈椎病均可达到满意的神经功能恢复;ACDF治疗后颈椎生理曲度恢复较好,且并发症发生率较低。     

两种前路手术治疗邻近双节段脊髓型颈椎病的临床效果

目的 :比较双节段前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)和单节段前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)对邻近双节段脊髓型颈椎病的治疗结果。方法:对2010年09月~2013年7月应用双节段椎间盘切除减压聚醚醚酮融合器(Polyetheretherketone cage,PEEK cage)植骨融合术及单节段椎体次全切减压钛网植骨融合术进行治疗的54例邻近双节段脊髓型颈椎病患者进行回顾性分析,ACCF组23例,ACDF组31例。比较两组患者基线资料、住院天数、手术时间、出血量、日本骨科协会(Japanese Orthopaedic Association,JOA)评分及疼痛视觉模拟评分(visual analogue score,VAS)的不同。通过测量术前、术后3d、末次随访时的影像学图片,分析两组患者颈椎曲度、融合节段高度及融合率的变化。结果:年龄、性别、病变节段、矢状位序列、植骨材料、住院天数和手术时间两组间差异无统计学意义,ACDF组的出血量显著少于ACCF组(175.4±12.1ml VS 201.3±80.4ml)。ACDF组JOA及VAS评分在术前(13.06±0.81、6.48±1.43)与末次随访时(15.45±1.06、2.97±1.28)比较均有显著统计学意义(P=0.000),ACCF组JOA及VAS评分同ACDF组,术后与术前比较均有统计学意义(P0.05);但组间比较未发现明显差别(P0.05)。两组颈椎曲度和融合节段高度术后3d时较术前均有增加(P0.05),而末次随访时轻度下降(P0.05),ACDF组改善程度明显大于ACCF组(P0.05)。两组均获得了100%的融合率。结论 :在邻近双节段脊髓型颈椎病的手术治疗中,ACDF出血量相对较少,能更好地改善颈椎曲度和维持融合节段高度。     

两种前路手术治疗双节段脊髓型颈椎病的疗效比较

目的比较颈前路椎间盘切除减压融合术(ACDF)和颈前路椎体次全切减压融合术(ACCF)治疗双节段脊髓型颈椎病的临床疗效。方法将43例双节段脊髓型颈椎病患者按治疗方法分为两组,ACDF组23例,ACCF组20例。比较两组手术时间、术中出血量、住院时间、并发症发生率、术后JOA评分、植骨融合率和颈椎生理曲度改善情况。结果患者均获得随访,时间15~46个月。手术时间ACDF组为(106±23)min,ACCF组为(142±35)min;术中出血量ACDF组为(121±76)ml,ACCF组为(208±125)ml;两组两项比较差异均有统计学意义(P0.05)。两组住院时间、并发症发生率、植骨融合率比较差异无统计学意义(P0.05)。末次随访时JOA评分ACDF组从术前(10.32±1.47)分增加到(14.55±1.65)分,改善率62.82%±12.58%;ACCF组从术前(10.21±1.53)分增加到(14.39±1.76)分,改善率59.91%±13.28%;两组比较差异无统计学意义(P0.05)。术后颈椎生理曲度均得到明显改善,但ACDF组优于ACCF组,差异有统计学意义(P0.05)。结论 ACDF和ACCF治疗双节段脊髓型颈椎病均可取得满意的临床疗效,ACDF具有手术时间短、出血少、创伤小等优点。     

椎间隙减压植骨融合术治疗邻近双节段颈椎病的价值

目的探讨椎间隙减压植骨融合术治疗邻近双节段颈椎病的效果。方法随机将2017-02—2018-03间在西华县人民医院治疗的92例邻近双节段颈椎病患者分为2组,各46例。观察组采用椎间隙减压植骨融合术,对照组采用椎体次全切除减压融合术。结果术后2组融合节段高度差异无统计学意义(P0.05),但融合节段Cobb角、T1椎体倾斜角、颈椎曲度均高于对照组。差异均有统计学意义(P0.05)。术前及术后各时间段2组的JOA评分差异均无统计学意义(P0.05)。结论经椎间隙减压植骨融合术与椎体次全切除减压融合术治疗邻近双节段颈椎病,均可获满意效果。但前者在改善融合节段Cobb角等方面更具优势。     

前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病

目的评价前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病(CSM)的临床疗效。方法采用前路手术治疗累及3个节段的CSM患者46例。其中24例行椎体次全切除+单间隙减压植骨融合术(A组);22例行2个椎体次全切除减压植骨融合术(B组)。观察比较两组手术时间、术中出血量、植骨融合率、神经功能改善、颈椎生理曲度恢复情况。结果患者均获得随访,时间15~36个月。手术时间:A组(105±20)min,B组(180±30)min;术中出血量:A组(120±35)ml,B组(210±25)ml;两项指标两组比较差异均有统计学意义(P0.05)。术后3个月植骨融合率:A组为100%,B组为77.3%,差异有统计学意义(P0.05)。神经功能改善优良率:A组为83.3%,B组为81.8%,差异无统计学意义(P0.05)。两组术后颈椎生理曲度均得到明显改善,差异无统计学意义(P0.05)。结论前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段CSM可取得满意的疗效,具有操作相对简单、出血少、手术时间短、植骨融合率高等优点,是减少并发症的安全有效的手术方法。     

两种颈椎前路减压融合术治疗多节段颈椎病

目的比较前路椎间盘切除减压融合术(ACDF)与前路椎体次全切除减压融合术(ACCF)治疗脊髓型颈椎病的临床疗效及影像学结果。方法对40例脊髓型颈椎病分别采用ACDF(24例)和ACCF(16例)治疗。结果本组获随访13～34个月,两组术后、末次随访时JOA评分较术前有显著改善(P<0.05),但组间比较则差异无统计学意义(P>0.05);ACCF组末次随访椎间高度丢失较ACDF组明显(P<0.05),ACDF组颈椎曲度维持优于ACCF组(P<0.05)。结论两种手术均可获得较好的临床疗效,相对于ACCF,ACDF对椎间高度、颈椎曲度的维持更有优势。     

前路选择性椎间隙减压组合椎体次全切除治疗多节段脊髓型颈椎病

目的探讨前路选择性椎间隙减压组合椎体次全切除治疗多节段脊髓型颈椎病的临床疗效。方法对18例累及3个节段的脊髓型颈椎病患者,采用前路选择性椎间隙减压组合椎体次全切除植骨融合内固定术治疗(组合减压组)。观察手术时间、术中出血量及住院时间;术后根据影像学评估内固定稳定性、植骨融合率、颈椎生理曲度的改变;根据JOA评分评估神经功能改善率。并与同期由同一组医师采用两椎体次全切除长节段植骨融合内固定术治疗的8例(长节段减压组)进行比较。结果组合减压组手术时间、术中出血量及住院时间均低于长节段减压组(P0.05);术后两组内固定均稳定,无松动、脱落,融合节段Cobb角两组均较术前改善(P0.05),但术后9个月角度丢失率长节段减压组高于组合减压组(P0.05);术后3个月两组植骨融合率均为100%,JOA评分均有改善,两组间无统计学差异(P0.05)。结论前路选择性椎间隙减压组合椎体次全切除治疗多节段脊髓型颈椎病能够达到充分减压的目的,可以兼顾减压需要和尽可能多地保留颈椎结构,减少并发症,是一种较好的手术方式。     

3种前路手术治疗单节段脊髓型颈椎病的中期疗效比较

目的比较分析颈前路椎间盘切除融合术(ACDF)、颈前路椎体次全切除融合术(ACCF)和人工颈椎间盘置换术(CADR)治疗单节段脊髓型颈椎病的中期疗效。方法回顾性分析自2004-01—2012-01行ACDF、ACCF和CADR手术治疗的79例单节段脊髓型颈椎病。ACDF组44例,ACCF组22例,CADR组13例。比较3组手术时间、术中出血量,术后6、60个月VAS评分、JOA评分、NDI指数、SF-12评分及颈椎曲度。结果 79例均获得61~88(69.8±12.7)个月随访。ACDF组与ACCF组植骨融合时间差异无统计学意义(P0.05)。术后6个月时,ACCF组JOA评分均高于ACDF组及CADR组,ACDF组与ACCF组颈椎曲度优于CADR组,差异有统计学意义(P0.05);而3组VAS评分、NDI指数和SF-12评分比较差异无统计学意义(P0.05)。术后60个月时,ACDF组与CADR组VAS评分、NDI指数低于ACCF组,而SF-12评分高于ACCF组;ACDF组颈椎曲度优于ACCF组与CADR组,且CADR组优于ACCF组,差异有统计学意义(P0.05);而3组JOA评分差异无统计学意义(P0.05)。结论 ACCF在短期内神经功能恢复优于ACDF和CADR,但在随访中期ACCF在症状缓解、生活质量改善及颈椎曲度的维持方面却差于ACDF和CADR。     

两种颈前路手术方式治疗双节段颈椎病

[目的]比较两种颈前路术式治疗双节段颈椎病的疗效。[方法]回顾性分析2010~2014年52例双节段颈椎病患者的临床资料,其中颈前路椎体次全切减压+钛网植骨融合内固定术治疗29例(ACCF组),颈前路双节段椎间盘切除减压+Cage植骨融合内固定术治疗23例(ACDF组)。t检验比较两组平均失血量、平均手术时间、NDI评分。方差分析法比较术后JOA评分改善率、内固定沉降率。[结果]ACCF组平均随访时间(25±2.3)个月,ACDF组为(26±1.9)个月。两组患者神经症状均较术前明显改善,JOA评分及术后2年植骨沉降率差异无统计学意义。两组术中平均失血量、平均手术时间、术后2年NDI评分方面差异有统计学意义。平均失血量:ACCF组为(176±28.2)ml,ACDF组(65.7±16.7)ml,P=0.015;平均手术时间:ACCF组为(70±11.2)min,ACDF组(99±15.6)min,P=0.023;术后2年NDI评分:ACCF组为(9.3±3.3),ACDF组(5.2±1.1),P=0.019。[结论]除非出现病椎平面后方较大致压物,双节段ACDF组不能彻底减压的情况,双节段ACDF术式较单节段ACCF更具优势。     

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.     

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.     

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.     

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.     

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.