血管生长抑素基因抑制胰腺癌裸鼠移植瘤血管生成的实验研究

目的:探讨人血管生长抑素基因对胰腺癌裸鼠移植瘤生长及血管生成的影响。方法:建立人胰腺癌细胞株BXPC-3裸鼠移植瘤模型,应用人血管生长抑素基因质粒转染胰腺癌裸鼠移植瘤,观察移植瘤生长情况。采用免疫组织化学技术检测肿瘤血管内皮生长因子(VEGF)表达情况和微血管密度(MVD)差异,透射电子显微镜观察肿瘤细胞情况。结果:治疗组肿瘤体积明显小于空白对照组和空质粒组(P<0.01),VEGF主要表达在肿瘤细胞的胞质内,治疗组、空白对照组和空质粒组平均灰度分别为179.57±5.22、150.87±3.44和163.40±3.54;阳性单位分别为14.94±2.26、31.26±2.72和29.21±2.95;MVD分别为10.60±74.56、19.33±2.52和18.67±5.29,治疗组与空白对照组和空质粒组比较,差异有统计学意义(P均<0.05)。电子显微镜下治疗组可见大量肿瘤细胞坏死。结论:人血管生长抑素基因能明显抑制胰腺癌裸鼠移植瘤血管生成,促进肿瘤细胞坏死,进而抑制肿瘤生长。     

环氧合酶-2在骨肉瘤中的表达及与血管内皮生长因子相关性的研究

目的 :探讨环氧合酶 2 (COX 2 )在骨肉瘤中的表达及其与肿瘤血管内皮生长因子 (VEGF)的相关性。方法 :应用免疫组织化学染色的方法研究人骨肉瘤组织中COX 2和VEGF的表达。结果 :COX 2在骨肉瘤中表达阳性率为 67 7% ,而VEGF表达阳性率为 5 8 1%。COX 2表达与VEGF表达显著相关 (γS=0 5 676,P <0 0 5 )。结论 :骨肉瘤组织中存在COX 2的高表达 ,COX 2与骨肉瘤的新生血管生成密切相关 ,其高表达可能促进了肿瘤新生血管生成     

环氧合酶2在胰腺癌中表达及其抑制剂对肿瘤生长的抑制作用

目的　研究胰腺癌组织中环氧合酶 2 (COX 2 )的表达及其与临床分期的关系 ;探讨选择性COX 2抑制剂对胰腺癌生长的体内外抑制作用。方法　分别应用免疫组织 (细胞 )化学染色、逆转录聚合酶链反应 (RT PCR)和Westernblot等研究胰腺癌组织和细胞株PC 3及PANC 1中COX 2表达。分析胰腺癌组织COX 2表达与临床TNM分期的关系。应用四唑氮蓝还原法 (MTT)研究选择性COX 2抑制剂Celebrex和NS 3 98对胰腺癌细胞生长的体外抑制作用。观察Celebrex对裸鼠移植瘤 (接种PC 3细胞 )生长的体内抑制作用。结果　COX 2免疫组织 (细胞 )化学染色结果显示 :2 4例胰腺癌组织阴性 3例 ,弱阳性 10例 ,强阳性 11例 ,阳性率 87 5% ;3例慢性胰腺炎组织 1例弱阳性 ,2例阴性 ;胰腺癌细胞株PC 3和PANC 1均为阳性。RT PCR结果显示两株胰腺癌细胞株和胰腺癌组织COX 2mRNA的表达较正常胰腺组织明显上调。Westernblot显示胰腺癌细胞株PC 3、PANC 1中COX 2蛋白表达阳性。胰腺癌组织COX 2表达程度与临床TNM分期呈正相关 (P <0 0 5)。NS3 98和Celebrex体外均呈剂量依赖性地抑制胰腺癌细胞株PC 3的增殖 ,以Celebrex的抑制作用较为显著。而Celebrex体内抑瘤率达 51 6%。结论　COX 2在胰腺癌中表达显著上调 ,其表达程度与胰腺癌临床TNM分期有关。     

α-干扰素对裸鼠移植性人肝癌细胞生长的影响

目的　观察α 干扰素 (INF)对部分肝切除后裸鼠残肝移植性人肝癌细胞生长的影响。方法　将人肝癌组织 (取自人肝癌裸鼠皮下移植瘤模型 ,肝癌细胞株Bel 740 2 )植入 3 0只BALB/cnu/nu裸鼠肝脏 ,建立人肝癌原位移植瘤模型 ,随机分为 3组 ,每组 10只。A组为对照组 ;B组行部分肝切除 (占肝脏总体积 65 % )同时每天注射生理盐水 ;C组行部分肝切除后第 1天起 ,以INF α 3 0 0 0 0 0U /d进行皮下注射。术后 3 0d处死裸鼠 ,测量肿瘤大小和重量 ,计算肿瘤体积及抑瘤率 ,检测肿瘤组织微血管密度 (MVD)及血管内皮生长因子 (VEGF)的表达。结果　B组肝癌组织MVD和VEGF表达较A组明显增强 (P <0 .0 5 ) ,肿瘤重量和体积亦明显增加 (P <0 .0 5 )。C组肝癌组织MVD和VEGF表达较B组明显减低 (P <0 .0 1) ,肿瘤重量和体积亦明显减少 (P <0 .0 1) ,肿瘤生长抑制率达到 63 %。结论　部分肝切除可促进新生血管的形成 ,加速残肝原位移植瘤的生长 ,INF α可抑制瘤组织内VEGF的表达和新生血管的形成 ,同时明显抑制残肝肿瘤细胞的生长。     

赛来昔布对人骨肉瘤类肿瘤干细胞移植瘤微血管生成的影响

[目的] 探讨cox-2抑制剂赛来昔布(Celecoxib)对骨肉瘤类肿瘤干细胞裸鼠移植瘤生长及微血管生成的影响.[方法] 无血清堵养法从骨肉瘤细胞株MG-3中分离出类肿瘤干细胞建立裸鼠移植瘤模型.30只成瘤裸鼠随机分 Celecoxib 组和对照组,Celcoxib:25 mg/ (kg·d),用药15 d,第27 d处死裸鼠,观察肿瘤体积、抑瘤率,免疫组化技术检测VEGF表达及CD34标记的MVD值.[结果] 分离的骨肉瘤类肿瘤干细胞有致瘤性,可以建立动物模型.Celecoxib抑瘤率为23.2%,Celecoxib组裸鼠移植瘤的体积、VEGF的表达、MVD值均显著低于对照组(P＜0.05).[结论] 骨肉瘤类肿瘤下细胞可以建立裸鼠骨肉瘤移植瘤模型.Celeeoxib可以抑制肿瘤生长,减少移植瘤组织VEGF的表达,减少微血管生成,具有抗血管生成作用.     

VEGF_(121)反义核酸抑制裸鼠胰腺癌移植瘤的增殖及血管生成

目的:探讨VEGF121反义核酸对裸鼠胰腺癌移植瘤的增殖及血管生成的影响,探索通过VEGF反义核酸抑制肿瘤生长.方法:将稳定转染有VEGF反义核酸pcDNA3-ASVEGF121的胰腺癌细胞系Bx-PC-3接种于裸鼠背部皮下.将实验鼠分为实验组、对照组和空白组.定期测定裸鼠移植瘤体积,免疫组织化学法检测裸鼠移植瘤VEGF、Flk-1表达水平.测定裸鼠移植瘤微血管密度.结果:VEGF反义核酸转染BxPC-3细胞后,裸鼠胰腺癌移植瘤生长明显减缓.移植瘤VEGF表达明显受到抑制,Flk-1表达水平上调.裸鼠胰腺癌移植瘤微血管密度明显降低.结论:人反义核酸VEGF121能显著抑制裸鼠胰腺癌移植瘤的增殖,并能抑制裸鼠胰腺癌移植瘤的血管生成.     

环氧化酶-2和血管内皮生长因子在胰腺癌组织中的表达及其相关性研究

目的　探讨环氧化酶 2 (COX 2 )和血管内皮生长因子 (VEGF)在胰腺癌组织中的表达及与其生物学行为的相关性。方法　采用免疫组织化学Envision法对 5 1例胰腺导管癌组织中COX 2和VEGF的表达进行检测。结果　该 5 1例胰腺导管癌组织中COX 2和VEGF的表达阳性率分别为 74.5 %和 68.6% ,而二者在 11例癌旁胰腺组织中均未见阳性表达 ;COX 2和VEGF的表达阳性率在临床Ⅲ～Ⅳ期明显高于临床Ⅰ～Ⅱ期 ,淋巴结转移阳性组明显高于淋巴结转移阴性组 ,其差异均有显著性意义 (P<0 .0 5 ) ;COX 2和VEGF的表达与胰腺癌的组织学分级、患者的性别、年龄以及肿瘤的大小和部位无关 (P>0 .0 5 ) ;COX 2的表达与VEGF的表达呈正相关 (r =0 .411,P<0 .0 1)。结论　COX 2和VEGF可能在胰腺癌的发生、发展过程中起着关键性作用 ,二者在血管生成过程中密切相关 ,可能为胰腺癌的治疗提供新的靶点 ,值得深入探讨。     

塞来昔布对裸鼠结肠癌移植瘤放疗增敏作用的机制研究

为探讨环氧化酶-2（COX-2）抑制剂塞来昔布对裸鼠结肠癌移植瘤放疗增敏作用的机制,本研究应用人结肠癌SW480细胞建立裸鼠移植瘤模型,并将32只裸鼠随机分为A组（对照组）、B组（塞来昔布组）、C组（放疗组）和D组（塞来昔布＋放疗组）,观察各组裸鼠结肠癌移植瘤的生长情况,并应用免疫组化法检测移植瘤组织中COX-2、8-catenin、血管内皮生长因子（VEGF）、CD34表达,并对CD34阳性血管进行计数,计算微血管密度（MVD）。结果显示,（1）干预30d后,B、C、D组移植瘤瘤体质量及体积均明显小于A组,P〈0．05;而D组移植瘤瘤体质量和体积明显小于B、C组,P〈0．05。（2）免疫组化检测显示,COX-2、β—catenin、VEGF及CD34在各组移植瘤组织中均呈阳性表达。B、c、D组COx-2、p—catenin、VEGF表达水平及MVD均明显低于A组,P〈0．05;而D组各指标明显低于B、c组,P〈0．05。（3）相关性分析显示,COX-2、VEGF、β-catenin及MVD,各指标两两之间均具有显著相关性,P〈O．05。结果表明,塞来昔布可能是通过抑制wnt信号通路来抑制肿瘤新生血管的生成,最终发挥放疗增敏作用。     

COX-2特异性抑制剂NS-398对胰腺癌生长及肿瘤血管 生成影响

目的:探讨COX-2特异性抑制剂NS-398对胰腺癌生长的影响及其机制。方法:分别用q RT-PCR与Western blot检测不同人胰腺癌细胞株(Bx PC-3、SWl990、Capan-2、Aspc-1、PANC-1)中COX-2及VEGF表达,并用MTT法检测NS-398在体外对人胰腺癌细胞增殖抑制作用;用体外实验最敏感细胞株建立裸鼠胰腺癌原位移植瘤模型,并随机将荷瘤鼠分为实验组和对照组,分别用NS-398与生理盐水处理,比较两组移植瘤的生长情况,并检测肿瘤组织中COX-2、VEGF蛋白表达及肿瘤微血管密度(MVD)。结果:各胰腺癌细胞中均有COX-2及VEGF表达,NS-398呈时间与浓度依赖性抑制各胰腺癌细胞的体外增殖,其中Bxpc-3细胞COX-2与VEGF表达量最高,且对NS-398最敏感。用Bxpc-3细胞建立原位移植瘤的实验组与对照组裸鼠比较,平均肿瘤体积明显减小(20.215 2 mm~3 vs.204.444 4 mm~3),瘤组织中COX-2与VEGF表达及MVD均明显降低(均P0.05)。结论:NS-398对胰腺癌的生长有抑制作用,其机制可能是通过COX-2途径降低VEGF基因表达从而抑制肿瘤血管生成有关。     

血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂抑制胃癌血管生成

目的建立人胃癌裸鼠移植瘤模型，观察血管紧张素转换酶抑制剂（ACEI）及血管紧张素Ⅱ受体拮抗剂（ARB）对胃癌生长和血管生成的影响。方法设立对照组、ACEI组（又分为培哚普利组和卡托普利组）、ARB组（又分为氯沙坦组和缬沙坦组），定期观察各组肿瘤生长情况并测量肿瘤体积，3周后取出肿瘤标本，采用免疫组化测定各组的基质金属蛋白酶7（MMP-7）、血管内皮生长因子（VEGF）的表达和癌周微血管密度（MVD）。结果ACEI组和ARB组移植瘤体积与对照组相比．均明显受到抑制（P〈0．011。ACEI组和ARB组肿瘤组织中的VEGF和MVD与对照组比较，均显著降低（P〈0．05和P〈0．01）。ACEI组对MMP-7的表达具有抑制作用（P〈0．05）；而ARB对MMP-7无显著抑制作用。结论ACEI和ARB能明显抑制人胃癌裸鼠移植瘤的生长以及新生血管的形成。     

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.     

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.