关节镜下应用深低温冷冻异体跟腱重建膝后交叉韧带

目的 探讨关节镜下应用异体跟腱移植重建膝后交叉韧带(PCL)的方法及疗效。方法 回顾1996年7月—2000年2月在关节镜下应用深低温冷冻异体跟腱移植重建PCL l9例，术中用环锯切取标准化的柱状跟骨栓，确保移植物在股骨及胫骨隧道内紧密嵌插固定，不需要特殊内固定物。术前及术后18个月用Lysholm-Ⅱ评分评定膝关节功能及患肢运动水平。结果 随访19例，随访时间超过18个月，术前Lysholm—Ⅱ评分平均56分(42—64分)，手术后18个月Lysholm-Ⅱ评分平均84分(56—94分)，总优良率88％。结论 应用深低温冷冻异体跟腱重建PCL可有效改善膝关节稳定性，术中股骨及胫骨隧道准确定位、术后系统康复治疗是确保手术疗效的关键。     

关节镜下深低温冷冻异体韧带重建后交叉韧带的疗效分析

目的探讨关节镜下深低温冷冻异体韧带重建后交叉韧带(PCL)的方法和疗效。方法2003年9月～2006年3月,采用深低温冷冻异体韧带重建方法治疗12例膝关节PCL断裂患者。术前及术后6个月用Lysholm和Gillquist评分评定膝关节功能及患肢运动水平。结果12例患者铁6～14个月(平均10个月)随访,术前Lysholm和Gillquist评分平均53分(40～65分),术后6个月Lysholm和Gillquist评分平均87分(60～95分),本组优7例,良4例,中1例,总优良率91．7%。临床症状消失,行走步态正常,关节活动度正常。结论膝关节镜下采用异体韧带重建PCL,可同时达到解剖重建和等长重建的双重目的,可有效改善膝关节稳定性,手术损伤小、康复快,疗效肯定。     

关节镜下股骨双束双隧道胫骨Inlay技术同种异体跟腱移植重建后交叉韧带

目的：探讨关节镜下同种异体跟腱重建后交叉韧带（PCL）的方法，验证股骨双柬双隧道、胫骨Inlay技术重建PCL的临床疗效。方法：2005年9月至2007年8月，采用经深低温冷冻及γ射线照射处理后的异体跟腱对10例PCL损伤的患者行关节镜下PCL重建术，手术方式股骨端为双束双隧道重建，可吸收挤压螺钉固定，胫骨端为Inlay固定。通过物理检查、Lysholm及IKDC评分来评价手术疗效。结果：术后8d内患者体温恢复正常，免疫排斥轻，无感染发生。所有患者术后获6～23个月（平均17个月）随访，终末随访时10例患者术膝胫骨下陷征（Sagsign）阴性，后抽屉试验（PDT）及Lachman征均为阴性或I度。疗效评定采用Lysholm评分和IKDC评分。Lysholm评分中交锁、不稳、疼痛、肿胀、爬楼、下蹲和总分术前术后比较差异有统计学意义，术后优7例，良2例，中1例；IKDC评分中疼痛频率、疼痛程度、规律活动量、活动影响程度、功能自评和总分等术前术后比较差异有统计学意义，术后IKDC评分A级7例，B级3例。结论：同种异体跟腱是重建PCL的可靠替代物，双束双隧道和Inlay技术固定可靠，可减少移植物损伤，是PCL重建的理想技术。     

关节镜下Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带的病例对照研究

目的：探讨关节镜辅助下应用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱,重建膝关节前交叉韧带（anterior cruciate ligament,ACL）和后交叉韧带（posterior cruciate ligament,PCL）的近期临床疗效.方法：2009年1月至2010年6月在关节镜下采用异体肌腱联合应用Rigidfix交叉钉与Intrafix固定钉治疗ACL或PCL损伤34例,分为两组：ACL重建组（A组）和PCL重建组（B组）.A组24例,男19例,女5例;平均年龄（31.83±9.57）岁;在关节镜下移植同种异体肌腱重建ACL,股骨侧用Rigidfix交叉钉固定,胫骨侧用Intrafix固定钉固定.B组10例,其中男8例,女2例;平均年龄（27.20±7.59）岁;在关节镜下移植同种异体肌腱重建PCL,股骨侧用Intrafix固定钉固定,胫骨侧用Rigidfix交叉钉固定.术后即行前后抽屉试验及Lachman试验检查膝关节稳定性,并随访患者18个月以上,采用膝关节Lysholm评分和Tegner评分进行疗效评估.结果：34例均获随访,时间18～26个月,平均（20.79±2.39）个月.所有患者术后疼痛症状消失,前、后抽屉试验及Lachman试验阴性.A组术前Lysholm评分43.04±7.57,术后6、12、18个月增加至85.41±4.68、92.50±3.05和93.45±2.57;术前Tegner评分2.62±0.92,术后6、12、18个月分别增加至7.45±1.14、8.58±0.77和8.95±0.55.B组术前Lysholm评分46.20±8.27,术后6、12、18个月分别增加至86.40±5.14、90.40±2.67和92.00±3.85;术前Tegner评分2.00-0.66,术后6、12、18个月分别增加至7.10±0.99、8.60±0.84和8.80±0.42.两组患者各时间点Lysholm和Tegner评分差异均无统计学意义.所有患者术前Lysholm评分43.97±7.79,术后6、12、18个月分别增加至85.70±4.76、91.88±3.06和93.02±3.01;术前Tegner评分2.44±0.89,术后6、12、18个月分别增加至7.35±1.09、8.58±0.78和8.91±0.51.随访期间无明显排异反应及严重并发症发生.结论：关节镜下采用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带方法简?     

关节镜下经髁间窝入路保留残留PCL纤维和板股韧带重建PCL

目的探讨关节镜下经髁间窝入路保留残留后交叉韧带(PCL)纤维和板股韧带重建PCL的临床效果。方法回顾性分析自2012-04—2014-10诊治的18例PCL损伤,在关节镜下单纯经髁间窝入路保留残留PCL纤维和板股韧带重建PCL。股骨隧道经前外侧入路建立并定位于距股骨髁间线软骨面约1.2 cm、距远点关节软骨面约0.8 cm处,胫骨隧道定位于胫骨后缘下1.0~1.5 cm处。移植物穿过骨隧道后股骨端用Endobutton悬吊固定,胫骨端用Bio-Intrafix及Staple门形钉固定。结果本组手术时间45~92(64.16±13.15)min。术后切口均一期愈合,X线及CT片显示骨隧道形态良好,内固定位置满意。18例均获得随访,随访时间12~18(15.66±2.06)个月。术前膝关节功能Lysholm评分19~46(31.56±8.82)分,术后12个月87~97(92.55±3.42)分;术后12个月膝关节功能Lysholm评分较术前明显提高,差异有统计学意义(t=45.450,P0.001)。结论关节镜下经髁间窝入路保留PCL残留纤维及板股韧带重建PCL操作简单且安全,可获得良好的手术视野,重建韧带的止点定位准确,术后短期效果良好。     

关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带

目的 评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的临床疗效.方法 14例前、后交叉韧带损伤患者在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建.受伤至手术时间平均19.5 d.术后平均随访34.5个月.采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查膝关节的前后松弛度.术前患者屈膝活动度(123.6±2.5)°,Lysholm评分(52.8±2.2)分,伤前Tegner评分平均为(5.9±0.5)分,术前为(1.2±0.9)分.结果 术后患者屈膝活动度(117.9±2.8)°,与术前比较差异无统计学意义(t=1.54,P=0.14).术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%).KT-1000屈膝25°双侧胫骨前后松弛度差值在2 mm以内9例,3～5 mm 4例,6 mm1例.屈膝70°差值2 mm以内10例,3～5 mm 3例,6 mm 1例.Lysholm评分术后提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P＜0.001).术后Tegner评分终末随访时平均为(5.4±0.8)分.手术前后的差异有统计学意义(F=4.2,P＜0.01).11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低.结论 关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能.     

关节镜下双束股四头肌腱和骨块镶嵌固定法重建后交叉韧带

目的探讨关节镜下双束股四头肌腱和骨块镶嵌固定法重建后交叉韧带（PCL）的方法和临床疗效。方法对16例PCL损伤患者选用自体带髌骨骨块双束股四头肌腱作移植物供体,股骨双隧道重建,胫骨端用骨块镶嵌固定法固定,股骨端用挤压钉固定。以膝关节Lachman试验和后抽屉试验及膝关节Lysholm功能评分标准作为疗效评定指标。结果 16例均获得随访,时间13~28个月。术前Lysholm评分为（57.2±7.6）分,术后1年为（85.2±5.4）分、2年为（93.8±5.2）分。术后膝关节Lachman试验及后抽屉试验均为阴性,膝关节不稳症状均消失,关节前后方向稳定性恢复,膝屈伸活动范围正常,无手术并发症发生。结论关节镜下双束股四头肌腱和骨块镶嵌固定法重建PCL符合PCL生物力学解剖重建,胫骨端固定可靠,解决了重建PCL时胫骨隧道容易扩大、固定不稳的问题,短期效果良好。     

膝关节镜手术专用导向器的试制及临床应用

目的：探讨我院自行试制的膝关节镜专用滑臂式导向器用于前交叉韧带(ACL)和后交叉韧带(PCL)重建的临床效果。方法：回顾分析1996年7月--2000年2月应用滑臂式导向器定位，在关节镜下行ACL、PCL重建，随访超过18月患52例，其中ACL重建组33例，PCL重建组19例，重建材料均用深低温冷冻异体跟腱移植，术前及术后18月用Lysholm-Ⅱ评分评定膝关节功能及患运动水平。结果：根据膝关节功能评分(Lysholm-Ⅱ评分)ACL重建组：术前平均48分(36--62分)，术后18月平均86分(58--98分)，优良率90．9％(30／33)。PCL重建组：术前平均56分(42--64分)，术后18月平均84分(56--94分)，优良率89．5％(17／19)。结论：滑臂式导向器定位准确，使用方便，用于关节镜下ACL、PCL重建可获得良好的临床效果。     

关节镜下股骨端保留骨量界面螺钉固定和胫骨端Intrafix系统固定在腘绳肌腱重建后交叉韧带中应用

目的探讨关节镜下股骨端保留骨量界面螺钉固定和胫骨端Intrafix系统固定在腘绳肌腱重建后交叉韧带(PCL)中应用的可行性及近期疗效。方法用腘绳肌腱对31例PCL损伤患者行关节镜下PCL重建术。采用PCL重建技术钻胫骨、股骨骨道,将腘绳肌腱拉入骨道,股骨端用1枚界面螺钉固定并保留隧道内上方的骨皮质,胫骨端用Intrafix固定韧带。结果手术时间40～90(60.16±14.05)min。无滑膜炎、韧带断裂、活动明显受限等并发症。31例均获随访,时间12～18(15.74±2.13)个月。根据Lysholm膝关节功能评分,术前19～49(30.77±11.62)分;术后88～98(92.94±2.26)分(t=28.65,P0.01)。结论关节镜下股骨端保留骨量界面螺钉固定和胫骨端Intrafix系统固定在腘绳肌腱重建PCL操作简便,固定牢固,效果可靠。     

关节镜下胫骨Inlay技术重建后交叉韧带

目的 探讨关节镜下胫骨Inlay技术重建后交叉韧带(PCL)的临床疗效.方法 21例单纯PCL完全断裂接受关节镜下胫骨Inlay技术重建.采用膝关节Lysholm评分和Lachman试验及后抽屉试验作为疗效评价的指标.结果 21例均获随访,时间12～24个月.末次随访时,膝关节Lysholm评分从术前(48±12)分提...     

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.