肝静脉球囊扩张、支架置入术治疗下腔静脉长段闭塞型布加综合征

目的 探讨肝静脉球囊扩张支架置入术治疗下腔静脉长段闭塞型布加综合征( Budd-Chiari syndrome,BCS)的意义.方法 对40例下腔静脉长段闭塞型BCS经彩超、CT、MR对肝静脉情况进行评估后,先经颈静脉行膈上段下腔静脉造影,观察有无肝静脉开口,再用椎动脉导管结合超滑导丝寻找肝静脉;显示肝静脉后,行肝静脉球扩、支架术.结果 40例BCS中,29例为肝静脉开口处隔膜或主干的短段闭塞,其中隔膜5例、主干短段闭塞24例,成功地对28例进行了肝静脉的介入治疗,其中单纯球扩5例,球扩加支架23例,1例穿刺失败.另11例为肝静脉的广泛阻塞无法行肝静脉的介入治疗.随访26例,平均随访(24.0±1.3)个月,症状复发5例(19.2％),彩超见肝静脉再狭窄或闭塞6例(23％).结论 下腔静脉长段闭塞,多数肝静脉病变仅是开口处隔膜或主干的短段闭塞,采用颈静脉入路行肝静脉球扩支架的方法,可以解除肝静脉梗阻、缓解门静脉高压.     

Budd-Chairi综合征介入治疗的方法与并发症分析

目的 探讨Budd-Chiari 综合征(BCS)介入治疗的方法及并发症的防治.方法 共530 例患者,根据病变的类型或隔膜的形态采用不同的方法:经股静脉直接用球囊扩张下腔静脉(IVC)137 例;IVC 破膜后扩张268 例;经股经颈联合行IVC 破膜扩张97 例;经皮肝穿肝静脉造影后直接破膜、扩张右肝静脉4 例;经下腔静脉行肝静脉破膜扩张9 例;经皮肝穿肝静脉造影、经颈静脉行肝静脉破膜扩张4 例;单纯经颈静脉行左或右肝静脉破膜扩张11 例.结果 介入治疗成功501 例,无肺动脉栓塞和术中死亡.IVC 内置支架411 例,肝静脉内置支架18 例.术中21 例穿通IVC 侧壁,6 例心包内积血,1 例急性心包填塞.支架移位15 例,向上4 例,向下11 例;急性心衰20 例.随访291 例,时间6耀120 个月,23例症状复发.结论 严格掌握介入治疗的适应证,选择适当的介入途径、球囊和支架可以有效的预防严重并发症的发生.     

节段性狭窄闭塞Budd-Chiari综合征的介入治疗

目的　研究Budd Chiari综合征 (BCS)下腔静脉节段性狭窄闭塞合并肝静脉阻塞及血栓形成的介入治疗。方法　本组 13例下腔静脉节段性狭窄闭塞长 2～ 5cm ,其中 8例肝静脉闭塞 ,5例下腔静脉血栓形成。下腔静脉开通术应用房间隔穿刺针。闭塞肝静脉开通术应用RUPS 10 0肝穿装置。用 0 5～ 1 0cm球囊扩张 ,下腔静脉开通后用 1 0～ 2 0cm球囊扩张后放入金属内支架。术后抗凝治疗 3个月。结果　 13例患者成功的进行了经皮穿刺球囊扩张术 (PTA)和血管内支架植入治疗。术后患者肝脾缩小 ,腹水吸收。随访 3～ 2 6个月未见复发及消化道出血。结论　下腔静脉闭塞有血栓形成 ,必须在下腔静脉开通前用药物溶栓治疗。下腔静脉开通后放内支架要避开副肝静脉开口。肝静脉开通成形术应放在BCS介入治疗的首要位置。     

腔内治疗肝静脉阻塞型布加综合征

目的 探讨肝静脉型布加综合征(Buddi-Chiari syndrome,BCS)介入治疗方法和疗效的评估.方法 37例肝静脉型BCS患者,术前常规行腹部彩超检查,CT扫描及肝脏血管重建.采用经颈静脉、经股静脉或二者联合途径行肝静脉穿刺造影及闭塞段的开通.术后给予护肝、抗凝、溶栓治疗.结果 手术成功34例,成功率92％,共开通了38条肝静脉.肝静脉开通后,单纯行球囊扩张患者9例;余25例患者置入肝静脉支架27枚,其中2例患者同时置入了右肝静脉和副肝静脉的支架.闭塞的下腔静脉开通后置入国产Z型支架7枚.肝静脉的压力术前24 ～ 48 cm H2O,平均为(36.0±3.4)cm H2O,介入治疗后即刻下降为11～34 cmH2O,平均(21.0±2.3) cm H2O.术后随访3 ～48个月,平均(23.0±2.0)个月,9例单纯行球囊扩张术治疗的患者中,有4例再次发生狭窄或闭塞,均再次行支架置入治疗.行支架置入的患者23例得到了随访,其中6例发生再狭窄或闭塞(6/23,26％).结论 肝静脉型BCS可根据肝静脉闭塞和肝内侧支建立的情况行介入治疗,可显著降低肝静脉和门静脉压力,改善患者的临床症状.     

青少年布加综合征临床特点及介入治疗

目的 探讨青少年布加综合征(Budd-Chiari syndrome,BCS)临床特点并评估介入治疗的疗效.方法 徐州医学院附属医院自1990年1月至2012年4月收治227例年龄在29岁以下的BCS患者,均经彩超及血管造影证实,其中下腔静脉型87例、肝静脉型105例、混合型35例.通过经皮血管腔内血管成形术(percutaneous transluminal angioplasty,PTA)、血管内支架置入术及置管溶栓术开通闭塞血管.术后给予抗凝治疗、定期随访.结果 227例患者均以门脉高压的症状和体征为最初临床表现.210例患者初次介入手术取得成功,其中下腔静脉阻塞型成功率100％,肝静脉阻塞型85.7％,混合型94.3％.介入治疗成功后的下腔静脉平均压力由术前的(26.52±8.16) cm H2O下降至术后(14.28 ±4.08) cm H2O(P＜0.05).肝静脉平均压力由术前(35.70±13.26) cm H2O下降至术后(18.36±8.16) cm H2O(P＜0.05).术后随访1个月至15年,平均(46±37)个月.再狭窄发生率为21.4％(45/210),其中下腔静脉型狭窄率为13.8％(12/87),肝静脉阻塞型31.1％ (28/90),混合型15.2％ (5/33),肝静脉型患者再狭窄发生率明显高于其他两型.再狭窄患者介入治疗方法同初次治疗,44例再狭窄患者再次介入治疗取得成功.结论 青少年布加综合征患者以肝静脉阻塞型最多见,门脉高压症状和体征为主要临床表现特点,肝静脉型介入治疗后复发率高于其他两型.     

肝静脉阻塞型布加综合征的腔内治疗

目的 总结肝静脉阻塞型布加综合征(Budd-Chiari syndrome,BCS)的腔内治疗经验.方法 回顾性分析32例肝静脉阻塞型BCS的临床资料.分别行下腔静脉球囊扩张成形或支架植入术+脾肾静脉分流术;经股静脉或颈静脉入路肝静脉成形术和经皮肝穿刺肝静脉联合颈静脉和/或股静脉入路肝静脉成形术或支架植入术.结果 2例行经皮肝穿刺肝静脉造影时未发现主肝静脉而放弃治疗,其余病例均成功行肝静脉成形和下腔静脉成形术.肝静脉扩张成形前后测肝静脉压力由术前(43±8)cm H_2O降至术后(16±4)cm H_2O(t=21.23,P<0.01).术后1周原有症状明显缓解,腹水消失,腹胀减轻,胸腹壁曲张静脉塌陷.围手术期发生2例穿刺针道出血,经剖腹止血后痊愈.本组随访25例,随访率78.1%.随访时间5～65个月,平均(26.0±2.0)个月.无支架移位及肝静脉再狭窄或闭塞,胸腹擘曲张静脉消失,食道造影见食道静脉曲张明显减轻.本组无肺栓塞及死亡病例.结论 腔内治疗肝静脉阻塞型BCS方法简便、微创、有效,远期疗效尚有待于进一步观察研究.     

Budd-Chiari综合征的介入治疗：附 355 例报告

摘要：目的 探讨介入治疗在Budd Chiari综合征（BCS）治疗中的作用。方法 355例BCS患者均行下腔静脉造影和经皮肝穿刺肝静脉造影，根据不同病变类型分别采用经皮球囊导管下腔静脉扩张成型术（PTA）或/和内支架（stent）置入术，经皮肝肝静脉开通和扩张成型术（PTRD），经颈内静脉或下腔静脉肝静脉开通和扩张成型术，经皮肝或下腔静脉副肝静脉开通和扩张成型术。结果 经皮球囊导管下腔静脉扩张成型术成功率96.0%（240/250 ），复发率10.0 %（24/240）；经皮肝肝静脉开通和扩张成型术成功率91.4%（32/35 ）；经颈内静脉或下腔静脉肝静脉开通和扩张成型术成功率90.0%（18/20）；经皮肝或下腔静脉副肝静脉开通和扩张成型术成功率100%(10/10)；同时行经皮球囊导管下腔静脉扩张成型术和经皮肝肝静脉开通和扩张成型术30例，成功率93.3%（28/30 ）；经皮肝副肝静脉开通和扩张成型术及下腔静脉球囊导管下腔静脉扩张成型术（PTA）或/和内支架（stent）置入术10 例，成功率90.0%（9/10 ）。严重并发症10 例，占 2.8%(10/355)。结论 介入治疗对某些类型Budd Chiari综合征患者是一种简单、安全有效的治疗方法。     

布—加综合征的介入或半介入治疗

目的　探讨布 加综合征的介入或半介入治疗方法。方法　自 1986年起 ,我们采用多种介入或半介入方法治疗该病 173例 :①下腔静脉PTA76例 ;②下腔静脉PTA加支架置放术 5 9例 ;③经皮经肝静脉再通术 3例 ;④下腔静脉置管溶栓 4例 ;⑤经右心房及股静脉联合破膜、扩张2 2例 ;⑥联合破膜、扩张加支架置入术 17例 ;⑦根治术加支架置放 3例 ;⑧下腔静脉单纯介入治疗后附加其它手术 2 3例。结果　介入治疗即时技术成功率 90 .1% ,半介入治疗技术成功率 10 0 %。治疗前后下腔静脉压力下降范围为 3～ 2 9cmH2 O。发生并发症者 8例。死亡 5例。随访结果 ,下腔静脉单纯PTA后复发率 14.5 % ,下腔静脉PTA加支架置放组复发率仅 1.7% ,联合破膜组复发率18.2 % ,其余各组尚未发现复发。结论　①下腔静脉或肝静脉膜性阻塞或狭窄且无继发新鲜血栓者 ,PTA应为首选疗法。②下腔静脉破膜、扩张后出现弹性回缩者 ,应放置支架。③对于破膜困难者 ,应改行经右心房和股静脉联合破膜术。④下腔静脉病变合并肝静脉闭塞者 ,行下腔静脉介入治疗后可附加降低门脉高压的手术。     

468例布加综合征的介入治疗

目的 总结介入治疗布加综合征(BCS)468 例成功经验.方法 对468 例BCS 患者行下腔静脉(IVC)或经皮肝穿肝静脉(HV)造影,确定病变部位、类型,再用导丝硬头或破膜针穿通阻塞部位、球囊扩张、内置支架.结果 本组468 例,破膜扩张成功437 例,其中IVC422 例(并发IVC 急性血栓形成5 例),HV 15 例,放置IVC 支架352 例,HV 支架2 例,无一例发生肺栓塞.术后肝昏迷1 例,急性心功能不全21 例.359 例获随访6耀126 个月,复发21 例,行再次介入治疗成功.结论 介入治疗BCS 微创、安全、有效,术后并发症少、恢复快,为首选治疗方法;IVC 病变为厚膜(>3mm)、刀削状偏心形厚膜和膈肌上下的IVC 错位者经颈、股静脉双路多角度可以破膜成功;并发IVC 急性血栓形成时也应首先考虑介入治疗;HV 膜性梗阻者经颈经肝联合入路介入治疗可取得良好效果.     

膜性布-加综合征的治疗--介入或手术?

目的　探讨膜性BuddChiari综合症(BCS)的治疗方法,评价放射介入和根治性病变隔膜切除术对膜性BCS的治疗效果。方法　对1990年5月～1997年12月我院收治的342例膜性BCS病人的临床资料进行回顾性分析。结果　手术治疗182例(其中18例为介入治疗失败者),采用常温直视下病变隔膜切除;介入178例,采用经皮腔下腔静脉球囊扩张成形术(PTA)156例,经皮腔下腔静脉球囊扩张成形术及经皮肝肝静脉扩张成形术22例,其中10例加用血管内支架(Stent)放置。手术组随访177例中总有效率898%,复发率102%;介入组总有效率810%,死亡率17%(3例),复发率190%,介入失败112%。结论　大部分膜性BCS病人经PTA或PTA加血管内支架治疗可取得良好效果,对介入治疗失败者、下腔静脉内有血栓者、介入治疗后复发者或下腔静脉内为斜或厚膜的病人应选择根治性膜切除术。     

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.