血液超极化停搏对体外循环缺血心肌保护的研究

目的：评价含ATP敏感性钾通道开放剂吡那地尔的血液停搏液诱导的心脏起极化停搏在常温与低温体外循环下对缺血心肌的保护效果。方法：18只犬随机分为对照组（A组）、常温血液超极化组（B组）、低温血液超极化组（C组）,每组6只。对照组以4℃标准St.Thomas液（K^ 16mmol/L)为心脏停搏液,常温血液超极化组和低温血液超极化组分别以含吡那地尔50μmol/L的37℃St.Thomas液（K^ 5mmol/L,含血比例1：1）和含吡那地尔50μmol/L和4℃St.Thomas液（K^ 5mmol/L,含血比例1：1）为心脏停搏液。体外循环期间,A组和C组温度保持在26℃-28℃,B组温度保持在35℃-37℃。三组体外循环（CPB）期间,均全心缺血60min,恢复灌注30min。对比观察阻断升主动脉前、后心肌腺苷酸（ATP、ADP、AMP、TAN、EC）含量、心肌超微结构、脂质过氧化物丙二醛（MDA）含量以及血液动力学多项参数的变化。结果：对照组在阻断50min和开放30min,心肌各项指标均显示有明显的缺血和再灌注损害;而血液超极化组损害较轻,特别是低温血液超极化组,损害最轻。结论：含吡那地尔的血液停搏液诱导的超极化停搏,其心肌保护效果明显优于传统的高钾去极化停搏;低温血液超极化停搏又优于常温血液超极化停搏。     

超极化停搏对体外循环中心肌细胞膜微粘度变化的影响

目的比较超极化停搏和去极化停搏对体外循环(CPB)中心肌细胞膜流动性变化的影响,评价超极化停搏液的心肌保护作用. 方法根据随机数字表法将72只家猫均分为3组,每组24只.对照组:不阻断上、下腔静脉和主动脉,仅行并行循环180分钟;去极化停搏组:阻断主动脉60分钟,再灌注90分钟,心脏停搏液使用St.Thomas液(K 16mmol/L);超极化停搏组:心脏停搏液使用含吡那地尔的St.Thomas液(K 5mmol/L),其余处理与去极化停搏组相同.应用荧光偏振法测定心肌细胞膜的微粘度(η),以η的倒数表示心肌细胞膜流动性. 结果去极化停搏组主动脉阻断期间心肌细胞膜η值明显上升,且于再灌注期间进一步升高;超极化停搏组主动脉阻断期间亦呈升高趋势,但各时间点η值均明显低于去极化停搏组(P＜0.01). 结论超极化停搏比去极化停搏能更有效地维持CPB中缺血-再灌注心肌细胞膜的流动性,从而起到更好的心肌保护作用.     

缺血预适应对体外循环心肌保护作用的临床研究

目的：比较单用冷停博液与缺血预适应（IPC）加冷停搏液联合应用在先天性心脏病心内直视手术中的心肌保护效果。方法：先天性心脏病病人20例，随机分为缺血预适应组（IPC组,n=10)和对照组（n=10),IPC组在阻断升主动脉前实施3分钟缺血－5分钟再灌注的缺血预适应，然后阻断升主动脉，灌注冷（4℃）St Thomas‘停搏液，心脏完全停跳后开始心内手术；对照组则不进行缺血预适应方案。两组均于并行循环前，开放升主动脉心脏复跳后30，60分钟时经Swan-Ganz漂浮导管测定各项血液动力学指标，并观察心肌功能恢复情况；于并行循环前，开放升主动脉时取心肌行超微结构检查及ATP，MDA测定，IPC组还监测缺血预适应期间的心电图及动脉血气变化。结果：（1）CPB后IPC组血液动力学指标恢复快（P＜0．05），心肌收缩有力，血压维持良好，需辅用多巴胺等正性肌力药维持血压的病例明显少于对照组（P＜0．05）；（2）升主动脉开放时IPC组心肌超微结构；ATP等的保护明显优于对照组（P＜0．05），MDA的生成明显低于对照组（P＜0．05）；（3）IPC组阻断升主动脉期间ST段降低（阻断30秒时发生），开放升主动脉后ST段在15秒内完全恢复，此期间均未发现明显心律失常；IPC前后血气结果无明显变化。结论：缺血预适应加冷停博液联合应用具有良好的心肌保护作用。     

吡那地尔超极化心脏停搏液对再灌注后细胞因子及心脏功能的影响

目的观察犬体外循环(CPB)再灌注后吡那地尔超极化心脏停搏液与传统高钾心脏停搏液对肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和心脏功能的影响. 方法 12只雄性杂种狼犬随机分为两组,对照组(n=6)主动脉阻断时用4℃ St.Thomas Ⅱ号心脏停搏液(K+ 20 mmol/L),每30分钟灌注1次;实验组(n=6)用4℃含吡那地尔50 μmol/L 的St.Thomas Ⅱ号心脏停搏液(K+ 5 mmol/L),每50分钟灌注1次.两组犬主动脉均阻断150分钟.在转流前和主动脉开放后180分钟时测定TNF-α和IL-6的含量,于转流前、主动脉开放后30、60、120和180分钟时监测血流动力学指标的变化. 结果主动脉开放后180分钟,两组TNF-α和IL-6与转流前比较均明显升高(P<0.01),但两组间比较差别无显著性意义.主动脉开放后120分钟和180分钟,两组平均动脉压(MAP)、心脏指数(CI)、每搏指数(SI)、左心室每搏作功指数(LVSWI)与转流前比较均明显降低(P<0.05),但两组间差别无显著性意义. 结论与传统高钾心脏停搏液比较,吡那地尔超极化心脏停搏液无明显的减轻炎性反应作用,其改善心功能的作用也并不优于传统的高钾心脏停搏液.     

吡那地尔超极化停搏对大鼠离体心脏缺血再灌时心肌线粒体损伤的影响

目的探讨吡那地尔超极化停搏对大鼠离体心脏缺血再灌注时心肌线粒体损伤的影响。方法健康雄性SD大鼠,成功建立Langendorff再灌注模型的80个心脏随机分为5组：对照组（C组）、去极化停搏组（D组）、吡那地尔超极化停搏组（H组）、线粒体ATP敏感性钾通道阻滞剂5-羟葵酸（5-HD）＋去极化停搏组（5-HD＋D组）和5-HD＋吡那地尔超极化停搏组（5-HD＋H组）。以K-H液平衡灌注20 min后（平衡末）,C组阻断主动脉,不予停搏液灌注,使其自然停搏,D组用37℃ST.ThomasⅡ停搏液灌注,H组用37℃超极化停搏液灌注,5-HD＋D组和5-HD＋H组分别用含有100μmol/L 5-HD的37℃ST.ThomasⅡ停搏液或超极化停搏液20 ml/kg灌注,缺血40 min。分别于平衡末及再灌注30 min时取8个心脏,测定心肌线粒体呼吸功能指标[4态呼吸耗氧速率、3态呼吸耗氧速率、呼吸控制率（PCR）及磷氧比（P/O）]、线粒体酶（NADH氧化酶、琥珀酸氧化酶和细胞色素C氧化酶）活性及线粒体膜电位（MMP）,电镜下观察线粒体的超微结构。结果与平衡末比较,各组再灌注30 min时心肌线粒体呼吸功能指标（3态呼吸耗氧速率、PCR及P/O）、线粒体酶活性及MMP降低（P〈0.05或0.01）;与C组比较,再灌注30 min时其余各组上述指标均升高（P〈0.01）;再灌注30 min时H组线粒体的功能及病理损伤最轻。结论吡那地尔超极化停搏能明显改善大鼠离体心脏缺血再灌注时心肌线粒体功能,减轻线粒体超微结构损伤,其机制与开放线粒体ATP敏感性钾通道有关。     

心肌肌钙蛋白检测用于心脏瓣膜置换术中心肌保护措施的评价

目的应用心肌肌钙蛋白评价心脏瓣膜置换术中含血停搏液对心肌保护的优越性。方法将５０例心脏瓣膜置换术患者随机分为冷血心脏停搏液（ＢＣＰ）组和晶体心脏停搏液（ＣＣＰ）组,分别于转流前、主动脉阻断３０分钟和６０分钟、开放主动脉后２０分钟、术后１天、３天和７天采血测定心肌肌钙蛋白Ｔ亚单位（ｃＴｎＴ）及心肌酶谱。结果ｃＴｎＴ的敏感性优于心肌酶谱,ｃＴｎＴ的释放和心肌酶的渗出与心肌缺血时间成正比,主动脉阻断３０分钟以上者差异有显著性（Ｐ＜０．０１和Ｐ＜０．０５）,心脏自动复跳率和术后正性肌力药物的应用ＢＣＰ组均优于ＣＣＰ组（Ｐ＜０．０５）。结论ｃＴｎＴ可作为心脏外科心肌保护措施的常规检测指标,冷血心脏停搏液对长时间缺血心肌的保护作用优于晶体心脏停搏液     

超极化停搏对家猫体外循环时心肌细胞膜脂区域流动性的影响

目的 探讨超极化停搏对猫体外循环(CPB)时心肌细胞膜脂区域流动性的影响.方法 家猫75只,体重3～4 kg,随机分为3组(n=25),CPB组:CPB建立后不阻断上腔静脉、下腔静脉和主动脉,仅行CPB 150 min;去极化停搏组:主动脉阻断60 min,再灌注60 min,心脏停搏液使用高钾St Thomas液;超极化停搏组:心脏停搏液使用含吡那地尔的低钾St Thomas液,余处理与去极化停搏组相同.应用自旋标记-电子自旋共振技术测定CPB时心肌细胞膜脂区域流动性.结果 与CPB组比较,去极化停搏组主动脉阻断30 min后心肌细胞膜脂S和τc均升高,超极化停搏组主动脉阻断60 min后心肌细胞膜脂S和τc均升高(P＜0.01);与去极化停搏组比较,超极化停搏组主动脉阻断30 min后心肌细胞膜脂S和τc均降低(P＜0.01).结论 与去极化停搏相比,超极化停搏能够更好地维持家猫CPB时心肌细胞膜脂的区域流动性.     

吡那地尔预处理和超极化停搏的心肌保护效果研究

ＡＴＰ敏感性钾通道的开放与缺血心肌保护有密切的关系 ,为了解其开放程度及给药方式对心肌保护效果的影响 ,我们拟用不同浓度的吡那地尔 (ｐｉｎａｃｉｄｉｌ) ,分别模拟缺血预处理和心脏超极化停搏 ,观察体外循环中对犬缺血心肌的保护效果。实验方法　 18条犬随机分成 3组 ,每组 6条 :对照组间断灌注 4℃标准Ｓｔ.Ｔｈｏｍａｓ停搏液 (Ｋ 16ｍｍｏｌ/Ｌ) ;预处理组 ,阻断升主动脉后 ,灌注含吡那地尔 10 μｍｏｌ/Ｌ的 4℃充氧Ｓｔ.Ｔｈｏｍａｓ液 (Ｋ 5ｍｍｏｌ/Ｌ) 10ｍｉｎ ,开放循环 5ｍｉｎ ,再阻断升主动脉后实施对照组实验步骤 ;…     

吡那地尔预处理对体外循环犬心肌的保护效果

目的 探讨ATP敏感性钾通道开放剂(KCOs)吡那地尔(Pinacidil)药物预处理对常温及低温犬体外循环(CPB)晶体高钾停搏液间断灌注心肌的保护效果。方法 18条犬随机分为三组,每组6条,分别建立犬的常温及低温CPB全心缺血Pinacidil预处理模型。对照组(A组):低温CPB,主动脉根部灌注4℃St.Thomas停搏液(K~+16mmol/L)10ml/kg,阻断30min复灌一次(1/2首量);B组:常温CPB,主动脉根部灌注37℃含氧Pinacidil液(0.083mg/kg);C组:低温CPB,主动脉根部灌注液同B组。三组心脏均接受60min缺血和30min再灌注。阻断主动脉前,开放后15min、30min测血液动力学改变;并循环5min,阻断循环30min、60min及开放循环20min于左心室取心肌组织,测定心肌腺苷酸含量。结果 再灌注期间C组的血液动力学指标明显好于A、B组(P<0.01),而B组又较A组好(P<0.01)。缺血及再灌注期间C组心肌的ATP含量也明显高于A、B组(P<0.01),B组又高于A组(P<0.01)。结论 Pinacidil预处理时对CPB下缺血心肌具有良好的保护效果,低温的效果优于常温。     

钾通道开放剂心脏超极化停搏保护效果的研究

目的 对比观察大量三磷酸腺苷（ＡＴＰ）敏感性钾通道开放剂吡那地尔对常温／低温体外循环（ＣＰＢ）心脏超极化停跳缺血心肌的保护作用。方法 １８只犬随机分３组,每组６只,低温超极化组（ＬＨ）：阻断升主动脉后,心脏灌注４℃含吡那地尔停跳液,ＣＰＢ血温为２６～２８℃,开放前复温至３７℃,全心缺血６０ｍｉｎ,恢复灌注３０ｍｉｎ;常温超极化组（ＷＨ）：ＣＰＢ血温３５～３７℃,心脏灌注３７地７０含吡那地尔（５０μｍｏｌ／Ｌ）停跳液,余同ＬＨ组;对照组（Ｃ）;无吡那地尔的标准Ｓｔ、Ｔｈｏｍａｓ停跳液,余３７℃含昆那地尔（５０ｕｍｏｌ／Ｌ）停跳液,余同ＬＨ组;对照组（Ｃ）：无吡那地尔的标准Ｓｔ．Ｔｈｏｍａｓ停跳液,余同ＬＨ组,对比观察吡那地尔心脏超极化停跳不同时相各项指标的变化。结果 （１）停复跳情况：ＬＨ组、Ｃ组灌注后心脏停跳较     

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.