氯普鲁卡因硬膜外阻滞时的药效学和药代动力学

目的通过对氯普鲁卡因（2-CP）在硬膜外阻滞时药效学和药代动力学的研究,探讨不同年龄因素及加入肾上腺素的2-CP进入硬膜外腔后在人体的吸收、分布和消除规律。方法选择ASAⅠ或Ⅱ级、在连续硬膜外阻滞下行择期下腹部手术患者30例,根据年龄和用药的不同随机分为三组,每组10例。青壮年组（C组）,年龄为30-55岁,以3％2-CP 6mg／kg行硬膜外阻滞;肾上腺素组（CE组）,青壮年患者,以3％2-CP6mg／kg加入1：200000肾上腺素行硬膜外阻滞;老年组（CO组）,年龄65岁以上,以3％2-CP6mg／kg行硬膜外阻滞。分别观察局麻药起效时间、运动阻滞起始时间和运动阻滞程度;用高效液相色谱仪测定注药后3、6、9、11、13、15、17、20、30、45、60、90min血浆2-CP浓度。用药代动力学计算程序（3p97）进行血药浓度数据处理,计算药代动力学参数。结果三组的局麻药起效时间、运动阻滞起始时间和运动阻滞程度差异均无统计学意义。三组的血浆药物浓度峰值（Cmax）分别为：（0．47±0．31）、（0．32±0．22）、（0．58±0．39）mg／L;血药浓度达峰时间（Tmax）分别为：（8．71±3．45）、（7．84±3．42）、（6．42±4．84）min;血浆药物浓度-时间曲线下面积（AUC）分别为：（9．16±4．09）、（8．66±3．47）、（7．71±3．82）μg·min^-1·ml^-1;清除速率常数（K）分别为：（0．53±0．48）、（0．45±0．42）、（0．52±0．42）／min。以上参数三组间比较差异均无统计学意义。结论1：200000肾上腺素和年龄对3％2-CP行硬膜外阻滞的药代动力学和药效学无明显影响。     

盐酸氯普鲁卡因硬膜外麻醉的临床观察

目的　评估国产盐酸氯普鲁卡因用于硬膜外麻醉的效应。方法　多中心试验 :择期手术病人 90例 ,随机双盲分为试验组和对照组 ,每组 4 5例。试验组为 3%盐酸氯普鲁卡因 ,对照组为2 %利多卡因。均硬膜外 (L2～ 3 )试验量 5ml后 5分钟 ,一次性注入 13ml(含肾上腺素 1∶2 0万 )。观察麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间、运动阻滞最大程度 (Bromage评分 )、痛觉恢复起始时间、运动恢复起始时间以及呼吸循环的变化和中枢神经系统反应与过敏反应等。结果　 (1)试验组麻醉起效时间、痛觉消失起始时间、运动阻滞起始时间均快于对照组 (P值分别 >0 0 5 ,<0 0 5和 <0 0 5 ) ,痛觉恢复起始时间两组一致 ,运动恢复起始时间试验组快于对照组 (P >0 0 5 ) ;(2 )运动阻滞最大程度两组相似 ;(3)痛觉恢复后 5分钟在疼痛程度上试验组明显重于对照组 (P <0 0 5 ) ;(4)两组呼吸循环变化一致 ;(5 )两组均未见明显不良反应。结论　国产盐酸氯普鲁卡因用于硬膜外麻醉起效快 ,感觉和运动阻滞效果好 ,无明显不良反应     

子宫切除术患者氯普鲁卡因混合罗哌卡因硬膜外麻醉的效果

目的探讨子宫切除术患者氯普鲁卡因混合罗哌卡因用于硬膜外麻醉的效果。方法拟行子宫切除术患者印例，随机分为R、C1-R、C1-R，、C2-R，四组（n=15），硬膜外分别给予0，75％罗哌卡因、1％氯普鲁卡因＋0．75％罗哌卡因、1％氯普鲁卡因＋0，5％罗哌卡因、1．5％氯普鲁卡因＋0．5％罗哌卡因。记录感觉阻滞最高平面、运动阻滞分级及感觉、运动阻滞起效时间、持续时间、术中辅助用药及不良反应。结果与R组比较，其它三组感觉阻滞的起效时间、达最高平面的时间、BromageI、Ⅱ级的起效时间均缩短，C1-R1、C1-R1组感觉阻滞持续时间、运动阻滞的持续时伺缩短，C1-R组Bromage Ⅲ级的起效时间缩短，C1-R组术中低血压发生率升高，内脏牵拉痛发生率降低（P＜0．05）。结论子宫切除术患者1％或1．5％氯普鲁卡因可增强0．5％％罗哌卡因硬膜外麻醉的效果。     

国产氯普鲁卡因硬膜外麻醉用于剖宫产手术的效果观察

目的:观察国产盐酸氯普鲁卡因硬膜外麻醉用于剖宫产手术的临床效果。方法ASAⅠ～Ⅱ级拟行剖宫产手术30例,无创监测病人麻醉前后HR、BP、R、SpO2的变化,麻醉平面、感觉及运动神经阻滞和恢复时间。结果麻醉平面T4至骶神经,起效时间3～5min维持(90±2.66)min。麻醉后HR、BP与麻醉前比较有显著性差异(P<0.01)。结论:国产盐酸氯普鲁卡因硬膜外麻醉用于剖宫产手术起效快,感觉的运动阻滞效果好,无不良反应。     

下腹部手术病人硬膜外注射甲磺酸罗哌卡因的药代动力学

目的测定下腹部手术病人硬膜外注射甲磺酸罗哌卡因的血浆浓度,探讨其药代动力学特征。方法ASAⅠ或Ⅱ级择期行下腹部手术病人12例。硬膜外注射甲磺酸罗哌卡因2 mg·kg~(-1) (8．94 mg·ml~(-1)),注药前及注药后2、4、6、10、20、30、45、60、90、120、180、240、300、360、720和1440 min取中心静脉血3 ml,用高效液相色谱仪测定甲磺酸罗哌卡因血浆浓度,DAS软件分析药代动力学参数。结果甲磺酸罗哌卡因的药代动力学模型符合二室开放模型,血浆浓度达峰值时间为(15±8)min,峰浓度为(1656±717)μg·L~(-1),吸收半衰期为(28±16)min,消除半衰期为(366±104)min,清除率为(0．005 0±0．001 5)L·min~(-1)·kg~(-1),表观分布容积为(2．5±0．6)L·kg~(-1)。研究期间未观察到不良反应。结论甲磺酸罗哌卡因适合于硬膜外麻醉,其药代动力学特征与报道的盐酸罗哌卡因相似,但消除半衰期延长。     

年龄对硬膜外注射氯普鲁卡因药效学和药代动力学的影响

目的 探讨年龄因素对患者硬膜外注射氯普鲁卡因药效学和药代动力学的影响.方法 择期连续硬膜外麻醉下下肢手术患者45例,根据年龄分为A组(≤45岁).B组(46～64岁)和C组(≥65岁),每组15例.以3%氯普鲁卡因6 mg/kg行硬膜外阻滞.硬膜外注药后记录感觉和运动阻滞效果及不良反应发生情况.于注药后即刻、注药后3、6、9、12、15、20、30、45、60和90 min采用高效液相色谱法测定血浆氯普鲁卡因浓度,计算药代动力学参数.结果 与A组比较,C组最高感觉阻滞平面明显升高,感觉和运动阻滞维持时间明显延长(P＜0.05).硬膜外注药后90 min时B组和C组氯普鲁卡因血药浓度高于A组(P＜0.05).结论 随年龄增加,氯普鲁卡因阻滞平面升高,感觉和运动阻滞恢复时间延长,药物代谢减慢.     

肝功能异常病人硬膜外注射罗哌卡因的药效学和药代动力学

目的观察肝功能异常病人硬膜外注射罗哌卡因的药效学和药代动力学特性。方法择期上腹部手术病人20例,10例阻塞性黄疸伴肝功能异常病人(ASAⅢ级)为肝功能异常组(Ⅰ组), 10例肝功能未见异常病人(ASA Ⅰ或Ⅱ级)为对照组(Ⅱ组)。两组均采用硬膜外阻滞复合全身麻醉, T8．9硬膜外穿刺置管,证实在硬膜外后2 min内注入0．75％罗哌卡因(含肾上腺素5μg·ml-1)2 mg· kg-1。记录注药后30 min内感觉和运动阻滞情况,用高效液相色谱法测定注药后0-720 min罗哌卡因血浆浓度,计算其各药代动力学参数。结果硬膜外注药后30 min内,两组感觉、运动阻滞效果差异无统计学意义。两组罗哌卡因的血浆药物浓度-时间曲线均符合二房室开放模型;与Ⅱ组比较,Ⅰ组硬膜外注药后180-720min罗哌卡因血浆浓度升高,消除半衰期延长,曲线下面积增加,清除率降低,消除速率常数减小(P<0．05或0．01)。结论肝功能异常病人0．75％罗哌卡因硬膜外阻滞后30 in内的感觉和运动阻滞效果无异常,但罗哌卡因的代谢明显减慢,血药浓度升高。     

氯普鲁卡因复合芬太尼硬膜外阻滞用于剖宫产的效果观察

目的：观察氯普鲁卡因复合不同剂量芬太尼的硬膜外腔麻醉效果。方法：选择剖宫产手术产妇100例，ASAⅠ-Ⅱ级，随机分为4组。A组为对照组，硬膜外腔注射单纯的3％氯普鲁卡因；B组在硬膜外腔注射3％氯普鲁卡因加入芬太尼1．5μg／ml复合液；C组在硬膜外腔注射3％氯普鲁卡因加入芬太尼2．0μg／ml复合液；D组在硬膜外腔注射3％氯普鲁卡因加入芬太民2．5μ／ml复合液。分别观察和记绿阻滞起效时间、阻滞持续时间、麻醉效果及新生儿Apgar评分。结果：A组的阻滞起效时间和持续时间与B组比较．有显著性差异（P〈0．05）；与C、D两组比较，有非常显著性差异（P〈0．01）。麻醉效果在A组，优者占40％，良占60％：在B组优占60％，良占36％，差占4％；在C组优占92％，良占8％；在D组优占96％，良占4％。四组新生儿娩出后Apgar 5min评分均大于7分．未见新生儿窒息。结论：氯普鲁卡因复合芬太尼用于剖宫产术的硬膜外腔麻醉，阻滞起效时间缩短，阻滞作用时间延长，麻醉效果增强，对新生儿Apgar评分无明显影响。     

氯普鲁卡因与利多卡因用于低位硬膜外麻醉的多中心临床研究

目的 比较氯普鲁卡因与利多卡因用于低位硬膜外麻醉的临床效应.方法 择期下腹部或下肢手术病人120例均分为3%氯普鲁卡因组(A组)和2%利多卡因组(B组).硬膜外注入试验剂量5 ml,5 min后一次性注入追加剂量10 ml.观察麻醉起效时间、痛觉消失时间、最高阻滞平面及时间、痛觉恢复时间、运动恢复时间、肌肉松弛程度以及呼吸、循环功能变化.结果 A组达最高阻滞平面时间(12.1±4.0)min,明显短于B组的(15.4±5.4)min;A组改良Bromage评分评1分的时间(56.8±10.9)min、评0分的时间(67.6±16.9)min,均明显短于B组的(69.1±14.1)min和(80.4±20.7)min(P<0.05).结论 氯普鲁卡因用于硬膜外麻醉起效迅速、感觉和运动阻滞效果好,且运动功能恢复快.     

3%国产盐酸氯普鲁卡因在老年人低位硬膜外麻醉中的临床观察

目的对比观察3%盐酸氯普鲁卡因与2%盐酸利多卡因在老年人低位硬膜外麻醉中的麻醉效果。方法 90例患者随机分为2组:观察组注入3%盐酸氯普鲁卡因4 mL,对照组注入2%盐酸利多卡因4 mL,观察6 min无全脊麻征象再分别给同类药8～10 mL维持麻醉。每组45例。观察痛觉开始减退时间、痛觉完全消失时间、运动阻滞时间、运动恢复时间、痛觉恢复时间。结果观察组和对照组痛觉开始减退时间及运动阻滞时间差异均无统计学意义(P>0.05),而痛觉恢复时间和运动恢复时间,观察组明显快于对照组(P<0.05),特别是运动时间的恢复几乎和痛觉同时恢复。结论 3%盐酸氯普鲁卡因应用于老年人低位硬膜外麻醉时,具有麻醉起效快,效果确切,毒性低,特别具有运动恢复时间快的特点,特别适合于老年人的麻醉。     

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.