后路椎弓根螺钉系统矫正青少年特发性脊柱侧凸术后主动脉位置变化分析

【摘要】 目的：评价接受后路椎弓根螺钉系统矫正手术的青少年特发性脊柱侧凸患者术前、术后1周和术后2年主动脉相对于脊柱的空间位置变化。方法：研究对象为接受后路椎弓根螺钉系统矫正手术的22例右胸主弯的青少年特发性脊柱侧凸患者。通过三维重建CT测量患者术前、术后1周、术后2年主动脉位置和顶椎旋转畸形情况,测量参数包括主动脉-椎体距离、主动脉-椎体角、主动脉-椎管距离、左侧椎弓根螺钉长度和顶椎旋转角。通过X线片测量胸主弯的Cobb角和胸椎后凸角。结果：术前主胸弯Cobb角为57.5°±9.8°,术后1周矫正至13.6°±6.5°,术后2年时为16.2°±6.8°;主胸弯Cobb角矫正率术后1周时为77.5%,术后2年时为73.3%。术前顶椎轴面旋转角为29.4°±9.3°,术后1周矫正至14.6°±6.9°,术后2年时为17.4°±6.8°;顶椎旋转畸形的矫正率术后1周时为49.5%,术后2年时为39.7%。主动脉-椎体距离在T6～T11节段术前显著大于术后1周（P<0.05）;在T7～T9节段术后2年显著大于术后1周（P<0.05）。主动脉-椎体角在T5～T11节段术前显著大于术后1周（P<0.05）;在T7～T10节段术后2年显著大于术后1周（P<0.05）。主动脉-椎管距离在T7～T11节段术前显著小于术后1周（P<0.05）;在T6～T10节段术后2年显著小于术后1周（P<0.05）。结论：右胸主弯的青少年特发性脊柱侧凸患者中,术后主动脉相对于脊柱的位置较术前向前内侧移位,术后2年较术后向后外侧移位。在使用椎弓根螺钉系统治疗特发性脊柱侧凸的手术中应该避免椎弓根螺钉穿出椎体前皮质或者椎弓根外侧皮质而导致主动脉损伤。     

形状记忆合金脊柱侧凸矫正系统的设计与临床应用

[目的]探讨形状记忆合金脊柱侧凸矫正系统的设计及其临床应用,评价其疗效。[方法]1980年以来本院骨科相继进行了记忆合金棒结合椎板下钢丝矫正系统和记忆合金棒结合椎弓根螺钉矫正系统的设计和临床应用,共计治疗73例特发性脊柱侧凸患者,其中,前者后路一期手术矫形共计68例,后者后路一期矫治特发性脊柱侧凸患者5例。[结果]采用一代系统的68例患者中,完成5a以上完整随访的58人,Cobb角由术前平均54·2°矫正至25·8°,术后5a随访时平均28·3°。采用二代系统的5例患者经过1~4a的随访,Cobb角由术前平均57·8°矫正至17·8°,术后1a以上随访未见矫正丢失。[结论]利用形状记忆和超弹性的属性,形状记忆合金脊柱侧凸矫正系统能够取得较为理想的矫正效果,结合椎弓根钉可以取得更好的三维矫形效果。     

非影像监视下行脊柱侧凸胸椎椎弓根螺钉置入的临床应用

目的:探讨脊柱侧凸胸椎椎弓根螺钉非影像监视下徒手置入的方法及可行性。方法:57例脊柱侧凸患者行后路椎弓根螺钉系统矫形手术,徒手法置入胸椎椎弓根螺钉。术后常规拍摄脊柱全长X线片,随机选取10例患者行CT扫描观察,了解螺钉置入的准确性。结果:共置入胸椎椎弓根螺钉362枚。术后X线片观察到10枚螺钉偏外,4枚螺钉偏下,其中2枚螺钉引起轻微肋间神经痛,3周后完全缓解。CT观察47枚螺钉有2枚螺钉导致椎弓根内壁膨胀内移,没有相应神经症状。主弯Cobb角术前平均60.4°(32°～121°),术后平均18.3°(1°～70°),平均矫正率71.9%(38.1%～98.0%)。结论:徒手法置入脊柱侧凸胸椎椎弓根螺钉是可行的。     

椎弓根螺钉固定在脊柱侧凸治疗中的应用

目的　探讨椎弓根螺钉固定在脊柱侧凸治疗中的应用效果。方法　采用连续或间断椎弓根螺钉固定技术治疗 93例脊柱侧凸患者 ,平均年龄 14 .3岁 ,特发性 5 1例 ,先天性 4 2例 ,术前Cobb角分别为 71.2°和 6 8.3° ,根据畸形程度和脊柱柔韧性 ,采用一次性矫形或分期矫形。结果　特发性侧凸术后Cobb角和矫正率分别为 2 8.7°和 6 1.5 % ,先天性侧凸为 32 .6°和 5 3.8% ,无严重并发症发生。结论　椎弓根螺钉固定对脊柱产生撑开、加压及旋转矫正作用 ,其矫正力大 ;且不占据椎管空间。尽管胸椎椎弓根螺钉固定难度较大 ,风险较高 ,但因其能对脊柱产生撑开、加压及旋转矫正作用 ,矫正力大 ,且不占据椎管空间 ,因此在具备一定技术条件时 ,该方法应被推广应用     

全椎弓根螺钉技术在脊柱畸形矫治术中应用的疗效分析

目的对脊柱侧凸矫治术中应用全椎弓根螺钉技术的疗效进行回顾性分析,并评价其安全性。方法自2002年7月~2004年12月对40例特发性脊柱侧凸患者应用全椎弓根螺钉技术进行矫治,其中男12例,女28例。根据Lenke分型,Ⅰ型16例,Ⅱ型2例,Ⅲ型5例,Ⅴ型7例,Ⅵ型10例。与同期54例应用胸椎弓根、椎板钩联合腰椎弓根螺钉的脊柱侧凸患者进行比较,通过比较2组主侧凸冠状面矫正率、代偿侧凸自动矫正率、躯干平衡指标及矫正度丢失来评价其疗效。并对其中侧凸类型、节段完全一致的10例LenkeⅠ型患者的远端融合节段进行比较。结果随访6~20个月,平均12个月。术前主侧凸冠状面平均Cobb角62.4°,代偿侧凸33.7°,术后矫正率与自发矫正率分别为71.2%与65.4%,优于对照组的59.6%与60.2%,术后矢状面矫正与对照组相比无明显差异;随访中矫正度丢失平均1.9,°亦优于对照组的3.3°。远端融合节段比对照组平均节约1.2个。未发生神经系统并发症。结论掌握脊柱侧凸椎弓根解剖变化(尤其在胸椎),辅助影像学检查及神经功能监测,应用全椎弓根螺钉技术能取得较好的矫形效果及较少的并发症,远期疗效有待进一步随访观察。     

侧弯全节段椎弓根螺钉固定矫治单胸弯特发性脊柱侧凸的下固定融合椎选择

目的:探讨后路侧弯全节段椎弓根螺钉固定矫治单胸弯特发性脊柱侧凸(AIS)时下固定融合椎(LIV)的选择。方法:2003年5月~2003年10月,采用侧弯全节段椎弓根螺钉固定矫治38例单胸弯AIS患者,其中,LenkeⅠA20例,LenkeⅠB18例,均采用站立位胸弯下旋转中立椎(NV)结合骶正线的方法确定LIV。术前摄站立前后、侧位,卧位左右侧屈位片,术后2周、6个月、12个月摄站立前后位和侧位平片,观察手术前后的躯干平衡、失代偿情况。结果:围手术期未出现脊髓、神经根损伤等严重并发症,平均融合8.4个节段。胸弯由术前平均57.4°矫正至术后平均11.3°,腰弯由术前平均26.8°自发矫正至平均4.9°;下固定融合椎的倾斜角由术前平均18.1°纠正至平均3.5°。胸椎矢状面Cobb角由术前平均27.1°改善至平均32.3°;水平面顶椎旋转度由术前Ⅰ~Ⅲ度改善至0~Ⅰ度。经过1年以上的随访,仅1例患者出现轻度失代偿,其余患者躯干平衡良好,未发现失代偿现象。结论:采用后路侧弯全节段椎弓根螺钉技术矫治单胸弯AIS患者时结合站立位下NV和CSVL确定LIV,可在保证矫形效果的同时节省融合节段,保存更多的腰椎活动节段。     

椎弓根楔形截骨USS系统内固定治疗强直性脊柱炎后凸畸形12例近期疗效观察

[目的]探讨治疗强直性脊柱炎后凸畸形的方法和疗效。[方法]根据脊柱侧位X线片测量后凸角度,明确截骨部位,行椎弓根椎体楔形截骨术和脊柱通用系统(USS)双螺纹椎弓根Schanz螺钉内固定术。[结果]后凸畸形矫正度20°~40°,平均矫正32°,外观改善满意。经12~36个月(平均24个月)随访,均达骨性融合,矫正度数无丢失,无椎弓根螺钉松动。[结论]正确选择手术适应证,采用本方法可取得满意疗效。     

应用AIIMS分型评价脊柱侧后凸畸形胸椎椎弓根螺钉置入的研究

目的:探讨AIIMS(All India Institute of Medical Sciences)分型在评价脊柱侧后凸胸椎椎弓根螺钉置人中的应用价值.方法:1996年6月～2008年1月治疗脊柱侧后凸畸形患者73例,从中选取有完整术后CT资料者25例.其中男10例,女15例,年龄13～25岁,平均17.9岁.特发性脊柱侧后凸14例,先天性脊柱侧后凸5例,神经纤维瘤病伴脊柱侧后凸3例,脊髓空洞伴脊柱侧后凸2例,成骨不全性脊柱侧后凸1例.术前主胸弯冠状面Cobb角75°～1420°,平均93.6°;主弯后凸角50.5°～86.2°,平均65.1°.手术方式采用椎板间开窗法行胸椎椎弓根螺钉置入,后路主弯区附件松解和/或顶椎全脊椎切除,三维矫形和360°植骨融合术.术后根据AIIMS分型统计螺钉置人位置及相关并发症.结果:共置入218枚胸椎椎弓根螺钉,15例出现91枚螺钉偏置(41.74%).AIIMS分型中Ⅰ型(螺钉位置可接受型)占96.33%(210/218),Ⅱ型(螺钉位置不可接受型)占3.67%(8/218),无Ⅲ型(并发症型).术中在凹侧建立椎弓根通道时造成椎弓根骨折5例,未予置钉;术中硬膜撕裂4例,其中2例术后出现脑脊液漏,对症治疗5d后愈合;均无脊髓或大血管损伤.术后平均主胸弯冠状面Cobb角39.7°,平均矫正率57.6%,术后平均主弯后凸角35.5°,平均矫正率45.5%.随访1～5年,平均3.1年,冠状面和矢状面平均矫正度未见明显丢失.结论:AIIMS分型能较全面地评价脊柱侧后凸畸形胸椎椎弓根螺钉置入后的位置和并发症情况,有一定临床应用价值.     

胸椎椎弓根螺钉在脊柱侧凸矫形术中的应用效果评价

[目的]评价胸椎椎弓根螺钉在脊柱侧凸矫形术中的应用效果。[方法]2008～2010年采用后路胸椎椎弓根螺钉技术治疗特发性和先天性脊柱侧凸患者26例。根据术后临床表现、矫正率和术后X线片判定胸椎椎弓根螺钉置钉情况,对胸椎椎弓根螺钉在脊柱侧凸矫形术中的应用效果进行评价。[结果]本组病例术后平均矫正率为63.81%,术后患者脊柱长度平均增加6.2 cm;术后X线片判定置入的308枚胸椎椎弓根螺钉中,置钉不良率为16.9%;所有患者术后均无胸部脏器及神经系统损伤表现。[结论]在脊柱侧凸临床治疗中,采用胸椎椎弓根螺钉进行侧凸矫形是有效、安全的方式。     

脊柱侧凸三维矫形术的早期并发症及其预防

目的:探讨脊柱侧凸三维矫形手术的早期并发症及其防治。方法:1995年6月至2003年4月,应用中华长城椎弓根三维矫形系统治疗各型脊柱侧凸487例,男性96例,女性391例;年龄8~33岁,平均14.3岁。术前侧凸Cobb角35°~135°,平均86.6°;后凸5°~68°,平均28.4°。结果:全组病例均安全完成矫形手术,侧凸矫正率45%~98%,平均82.3%,后凸矫正率23%~56%,平均35.8%。术中、术后无脊髓损伤,其它并发症共发生139例次。结论:三维矫正脊柱侧凸仍存在不少并发症,但如术前准备充分、术中术后处理得当,脊髓、神经损伤可获得有效预防。     

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.