胸骨下段正中小切口在冠状动脉旁路移植术中的应用

目的总结162例胸骨正中下段小切口行冠状动脉旁路移植手术的经验. 方法 1998年4月～2003年6月,经胸骨下段正中小切口行冠状动脉旁路移植手术162例,包括体外循环下冠状动脉旁路移植术(coronary artery bypass grafting, CABG)77例,CABG联合心内手术13例,非体外循环CABG(off-pump coronary artery bypass grafting, OPCABG)72例. 结果手术死亡1例(0.6%),再手术1例(0.6%),术后并发症9例(5.6%).体外循环手术的主动脉阻断、体外循环及手术时间分别为(74.8±23.1) min、(113.6±31.3) min及(255.5±54.5) min.非体外循环手术时间(195.6±50.6) min.吻合口数目1～5个,(2.4±0.7) 个.术后气管插管时间0～364 h,中位数11 h;恢复室时间1～28 d,中位数3 d;术后住院5～60 d,中位数10 d.胸腔引流量(607.2±443.0) ml,按体重计算为(8.6±6.0) ml/kg.38例输血,输血量(1 161.3±741.2) ml. 结论胸骨正中下段小切口行冠状动脉旁路移植手术创伤小,安全可靠;皮肤切口小;无须特殊器械,操作简单,可获得冠状动脉多支病变充分再血管化的效果,可同时进行其他心内手术.     

胸骨下段正中小切口在心脏外科的应用

目的总结460例胸骨下段正中小切口心脏手术的经验。方法1997年1月~2003年8月,我院共进行各类胸骨下段小切口心脏手术460例,包括先天性心脏病手术100例,瓣膜手术178例,冠状动脉手术168例,动脉瘤手术12例,其它2例。术中未使用任何特殊的手术器械。结果院内死亡4例(0.9%),再次手术3例(0.7%),术后并发症29例(6.3%)。73例非体外循环手术。387例体外循环时间25~1115min,中位数80min;主动脉阻断时间0~164min,(55.8±31.9)min。460例术后气管插管时间0~364h,中位数10h。术后胸腔引流量20~3290ml,中位数350ml;按体重计算,胸腔引流量0.3~42.2ml/kg,中位数5.8ml/kg。术后280例需要输血,输血量(951.1±644.6)ml。术后ICU时间1~28d,中位数2d。术后住院1~60d,(11.6±6.0)d。371例随访7~80个月,(59.2±29.6)月。无远期死亡,症状均明显改善。心功能Ⅰ级169例,Ⅱ级135例,Ⅲ级67例,明显好于术前(Z=-12.57,P=0.000)。心胸比率0.50±0.11(0.41~0.67),与术前相比无显著差异(t=-1.63,P=0.104)。左心室射血分数0.36~0.71(0.606±0.113),明显高于术前(t=3.43,P=0.001)。结论胸骨下段正中小切口心脏手术创伤小,安全可靠;皮肤切口小,美观;无须特殊器械,操作简单易行,在特定病例可获得良好的手术效果。     

经左胸肋间切口实施冠状动脉旁路移植术

目的探讨经左胸肋间切口实施冠状动脉旁路移植术的临床应用与特点。方法我院1996年9月~2005年8月共实施经左胸肋间切口的冠状动脉旁路移植术36例,左侧胸骨旁第4肋间前外侧切口6~10 cm进入胸膜腔,使用M IDCAB专用牵开器,分离左侧乳内动脉与冠状动脉吻合。主要有4种情况:①单纯前降支系统病变;②再次冠状动脉旁路移植术而存在通畅的左乳内动脉至前降支桥;③严重的升主动脉钙化;④合并其他左胸手术。单支病变26例,双支病变3例,三支病变7例。既往介入治疗史5例,冠状动脉旁路移植术史6例。左心室射血分数为(0.562±0.107)。结果36例均成功实施非体外循环心脏跳动下的冠状动脉旁路移植术,远端吻合口1~4个,手术时间(190.4±44.1)m in。合并激光心肌打孔术2例,合并肺癌切除术1例,食管癌切除术1例。无住院死亡病例。32例随访1个月~9年,中位数32月,2例远期死亡。2例术后1年再发心绞痛,1例经介入治疗,另1例再次手术,症状消失。其余患者均没有心绞痛症状。结论经左胸肋间切口实施冠状动脉旁路移植术对某些特殊类型的冠心病患者是安全实用的选择,非体外循环方式下进行此类手术是可行的。     

胸骨下段小切口行非体外循环冠状动脉旁路移植术

目的探讨胸骨下段小切口在非体外循环冠状动脉旁路移植术中应用的效果。方法回顾性分析2012年6月至2014年12月前降支单支病变的冠心病患者行胸骨下段小切口非体外循环冠状动脉旁路移植术19例的临床资料,其中男11例、女8例,年龄59.6(44～68)岁。所有患者均游离左乳内动脉与前降支吻合,其中1例因术中探查见第一对角支近端明显粥样斑块且对角支粗大,遂向上延长切口,全胸骨打开,游离大隐静脉行对角支搭桥,近端吻合于升主动脉,术后1、3、6、12个月进行随访。结果其中1例术中转为常规胸骨正中切口手术,其余18例手术胸骨下段小切口完成,术中血流动力学稳定,无围术期急性心肌梗死及死亡病例,无乳内动脉损伤、无吻合口漏血及恶性心律失常发生,无大出血、二次开胸止血及切口感染等并发症出现,术后住院4～6 d,监护室入住时间、呼吸机辅助通气时间及住院费用均较常规开胸手术明显降低,术后随访期间无心绞痛复发病例。结论胸骨下段小切口行非体外循环冠状动脉旁路移植术,创伤较小,安全可靠;而且是一种操作相对简单,容易掌握及可灵活应变的小切口微创手术,尤其适合于初学小切口冠状动脉旁路移植术术者。     

常规与非体外循环下冠状动脉3支病变旁路移植血管通畅性对比分析

目的　评价非体外循环下冠状动脉旁路移植术 (OPCAB)与体外循环下冠状动脉旁路移植术 (CCABG)治疗冠状动脉三支病变术中旁路早期通畅性。方法　 6 0例 3支血管病变的病人分为OPCAB组和CCABG组 ,每组各 30例。行冠状动脉旁路移植术 ,OPCAB组胸骨正中切口 ,在非体外循环心脏不停跳下完成手术 ;CCABG组建立常规体外循环 ,心脏停跳下完成手术。术中应用即时血流测量技术对旁路血管进行流量测量。对比分析两组术前、术后的各项指标及各血管旁路流量、搏动指数和血流波形。结果　两组病人术前一般情况差异无统计学意义。OPCAB组与CCABG组移植旁路血管分别为 (3 6±0 6 )支与 (4 3± 0 9)支 (P <0 0 1) ;两组前降支及右冠状动脉旁路血流量、搏动指数差异无显著性。CCABG组回旋支序贯旁路和远端吻合口多 ,血流量较OPCAB组高。两组弥漫病变血管旁路血流量小。结论　OPCAB与CCABG治疗 3支病变 ,两组血管旁路早期通畅性差异无显著性。     

胸骨下段小切口非体外循环冠状动脉旁路移植术临床分析

目的探讨在非体外循环下,应用胸骨下段小切口进行多支冠状动脉旁路移植术并完全再血管化的可行性及安全性。方法 2017年5~7月我科共实施胸骨下段小切口非体外循环冠状动脉旁路移植术患者18例,其中男16例、女2例,年龄60.9(45~71)岁,双支病变4例,三支病变14例,其中包含左主干病变3例。结果全组18例患者无术中及术后死亡,手术时间195~360(271.0±32.0)min,术中血流动力学不稳定行主动脉内球囊反搏(IABP)辅助2例,均于术后第2 d拔除,术后发生切口感染1例,经清创后痊愈,术后平均出血量为80~950(270.5±209.7)ml,全部患者术中及术后无输血,搭桥总数61支,平均搭桥根数(3.4±0.6)支,其中乳内动脉桥11支,大隐静脉桥50支,前降支搭桥总数18支,其中左乳内动脉桥11支,静脉桥7支,对角支搭桥10支,钝缘支搭桥18支,左室后支搭桥1支,后降支搭桥12支,右冠状动脉主干搭桥2支,ICU住院时间9~19(13.2±2.7)h,呼吸机使用时间6~17(10.8±2.9)h,术后连续测定肌酸激酶同工酶(CK-MB)及肌钙蛋白I(CTnI)变化,术后第1 d均有不同程度升高:CK-MB 8.8(3.1~28.6)U/L,CTnI 1.5(0.16~4.56)ng/dl;术后第5 d基本恢复正常水平:CK-MB 1.6(0.6~3.3)U/L,CTnI 0.2(0.08~0.57)ng/dl,术后平均住院时间4~7(5.8±0.8)d。结论胸骨下段小切口在多支冠状动脉病变的非体外循环冠状动脉旁路移植术可行、安全,同时切口美观、胸骨稳定性好、术后并发症少、易于掌握,并能在微创伤不借助特殊器械的情况下完全再血管化。     

新型胸壁牵开系统与改良心脏稳定器在左胸小切口冠状动脉旁路移植手术中的应用

目的总结经左前外侧胸部小切口在直视下获取左乳内动脉(left internal mammary artery,LIMA)行冠状动脉前降支旁路移植术的临床价值。方法 2012年5月~2014年6月在全身麻醉非体外循环下完成左前外侧胸部小切口冠状动脉旁路移植手术(minimally invasive direct coronary artery bypass,MIDCAB)200例。术中使用新型胸壁悬吊拉钩在直视下获取LIMA,应用改良稳定器在非体外循环下行前降支旁路移植。138例接受单纯左胸MIDCAB,62例接受左胸MIDCAB与冠状动脉介入相结合的分站式杂交。结果术后呼吸机使用时间(9.1±4.3)h,监护室停留时间(26.4±14.4)h。术后完全无输血156例,44例输红细胞2~6 U(中位数4 U)。1例(0.5%)发生围手术期心肌梗死,该患者出院后死于心力衰竭(死亡率0.5%)。106例术后1周造影复查,2例(2/106,1.9%)左乳内动脉桥闭塞,随即再行常规冠状动脉旁路移植手术,康复出院。197例随访2~26个月,(9.4±6.2)月,无死亡、心绞痛或心肌梗死发生。结论新型悬吊式乳内动脉牵开系统可以在直视下从第1肋上缘开始获取LIMA,使用改良心脏稳定器便于在心脏跳动下完成冠状动脉吻合,从而获得良好的临床效果。     

非体外循环和常规冠状动脉旁路移植术疗效对比

非体外循环冠状动脉旁路移植术 (ｏｆｆ ｐｕｍｐｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓｇｒａｆｔｉｎｇ ,ＯＰＣＡＢ)是在全麻、常温、胸骨正中切口心脏跳动下进行的手术。 1999年 1月至 12月 ,我们共完成ＯＰＣＡＢ手术 46例 ,现与同期完成的常规冠状动脉旁路移植术(ＣＡＢＧ) 4 6例进行疗效对比研究。临床资料　ＯＰＣＡＢ组 46例中男 35例 ,女 11例 ;平均年龄 (6 3 1± 9 3)岁 ;心绞痛分级 2 5± 0 9;平均射血分数 0 49±0 0 8;冠状动脉 (冠脉 )单支病变 6例 ,2支病变 2 3例 ,3支病变 12例 ,左主干病变 5例 ;全组平均移植桥 (2…     

新型胸壁牵开系统与改良心脏稳定器在左胸小切口冠状动脉旁路移植手术中的应用北大核心CSCD

目的总结经左前外侧胸部小切口在直视下获取左乳内动脉（left internal mammary artery,LIMA）行冠状动脉前降支旁路移植术的临床价值。方法 2012年5月~2014年6月在全身麻醉非体外循环下完成左前外侧胸部小切口冠状动脉旁路移植手术（minimally invasive direct coronary artery bypass,MIDCAB）200例。术中使用新型胸壁悬吊拉钩在直视下获取LIMA,应用改良稳定器在非体外循环下行前降支旁路移植。138例接受单纯左胸MIDCAB,62例接受左胸MIDCAB与冠状动脉介入相结合的分站式杂交。结果术后呼吸机使用时间（9.1±4.3）h,监护室停留时间（26.4±14.4）h。术后完全无输血156例,44例输红细胞2~6 U（中位数4 U）。1例（0.5%）发生围手术期心肌梗死,该患者出院后死于心力衰竭（死亡率0.5%）。106例术后1周造影复查,2例（2/106,1.9%）左乳内动脉桥闭塞,随即再行常规冠状动脉旁路移植手术,康复出院。197例随访2~26个月,（9.4±6.2）月,无死亡、心绞痛或心肌梗死发生。结论新型悬吊式乳内动脉牵开系统可以在直视下从第1肋上缘开始获取LIMA,使用改良心脏稳定器便于在心脏跳动下完成冠状动脉吻合,从而获得良好的临床效果。     

杂交(hybrid)手术治疗冠心病多支病变合并房间隔缺损

目的探讨杂交(hybrid)手术治疗冠状动脉病变合并房间隔缺损的可行性.方法2005年6月～9月,我院采用胸骨正中切口非体外循环冠状动脉旁路移植术同期房间隔缺损封堵术治疗冠状动脉病变合并房间隔缺损4例,其中冠状动脉硬化性心脏病(冠心病)3例,右冠状动脉起自肺动脉1例.结果4例手术均成功,手术时间40～80 min,术后24 h胸腔引流量150～300 ml.术中、术后均无并发症.术毕经超声即时测量冠状动脉旁路流量15～40 ml/min,搏动指数1.5～3.0.住院时间8～12 d,平均10 d.4例术后随访2～5个月,超声心动图示未见残余分流.结论杂交(hybrid)手术治疗冠状动脉病变合并房间隔缺损安全可行.     

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.