丙泊酚复合雷米芬太尼麻醉对妇科腹腔镜手术病人苏醒的影响

目的对丙泊酚复合雷米芬太尼或氧化亚氮用于妇科腹腔镜诊疗术后麻醉苏醒、早期拔管进行比较。方法选择ASAⅠ级，临床诊断为不孕，拟于气管内插管全麻下择期行腹腔镜检查及治疗的病人45例，随机分为三组，每组15例。所有病人均为丙泊酚靶控输注（TCI）给药诱导及术中维持麻醉，罗库溴铵维持肌松。A组：插管后维持丙泊酚靶浓度3μg／ml不变，雷米芬太尼根据血流动力学变化按0～1μg·kg^-1·min^-1输注给药，维持血流动力学稳定。B组：待手术开始气腹稳定后，丙泊酚靶浓度降至2μg／ml并维持，通过调整雷米芬太尼的输注给药速度维持血流动力学稳定。C组：丙泊酚TCI和氧化亚氮吸入维持麻醉。呼气末氧化亚氮浓度保持（65±1）％，通过调整丙泊酚的靶浓度来维持血流动力学稳定。三组病人均在手术结束时同时停麻醉药，记录停药后睁眼时间、拔管时间及答问切题时间。结果三组间睁眼时间、拔管时间和答问切题时间差异均有统计学意义（P〈0．05或P〈0．01），B组病人睁眼时间、拔管时间和答问切题时间最短，C组最长。结论低浓度丙泊酚TCI（2μg／ml）复合雷米芬太尼用于妇科腹腔镜诊疗手术，可使病人术后清醒快，恢复迅速。     

不同靶浓度雷米芬太尼对全麻苏醒拔管期心血管反应的影响

目的观察全麻苏醒拔管期不同靶浓度雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行胆囊手术患者40例,ASAⅠ或Ⅱ级,随机均分为四组:雷米芬太尼血浆靶浓度0.6μg/L组(Ⅰ组)、0.8μg/L(Ⅱ组)、1.0μg/L(Ⅲ组)和生理盐水对照组(Ⅳ组)。四组患者均接受丙泊酚、阿曲库铵、芬太尼、1%~2.5%异氟醚复合50%氧化亚氮的全身麻醉。术毕,Ⅰ、Ⅱ、Ⅲ组患者均TCI输注雷米芬太尼,血浆浓度分别为0.6、0.8、1.0μg/L,Ⅳ组TCI输注生理盐水作对照。观察TCI开始前、吸氮时、拔管时、拔管后5、10min的MAP和HR;观察TCI开始后的患者呼吸恢复时间、睁眼时间、拔管时间。结果Ⅰ、Ⅳ组的MAP和HR在吸痰、拔管时较TCI开始前明显升高(P<0.05),Ⅱ、Ⅲ组无明显升高;四组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义。结论雷米芬太尼用于抑制全麻苏醒拔管期心血管反应的合适血浆浓度可能在0.8~1.0μg/L之间。     

全麻苏醒拔管期雷米芬太尼靶控输注对心血管反应的影响

目的观察全麻苏醒拔管期雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行妇科手术患者60例,ASAⅠ~Ⅱ级,随机均分为雷米芬太尼组(A组)和生理盐水对照组(B组)。两组患者均接受丙泊酚、维库溴铵、芬太尼、0·8%~1·0%异氟醚复合50%氧化亚氮的全身麻醉。术毕时送至麻醉复苏室(PACU),A组患者TCI输注雷米芬太尼,血浆浓度为1μg/L,B组TCI输注生理盐水作对照。观察苏醒期患者的平均动脉压(MAP)、HR、呼吸恢复时间、睁眼时间和拔管时间。结果A组患者在吸痰、拔管时MAP、HR无明显变化,B组则明显升高(P<0·05);两组患者呼吸恢复、睁眼、拔管时间差异无显著意义。结论TCI雷米芬太尼可抑制全麻苏醒拔管期的心血管反应,平稳苏醒。     

丙泊酚-雷米芬太尼靶控输注在心脏手术中的应用

目的 观察丙泊酚-雷米芬太尼靶控输注(TCI)在心脏瓣膜置换术和冠状动脉旁路移植术中使用的安全性、有效性以及对术后恢复的影响.方法 择期心脏手术患者150例,以丙泊酚TCI、雷米芬太尼3～5μg/kg诱导,丙泊酚-雷米芬太尼2～8 ng/ml TCI维持,维持脑电双频指数(BIS)于50±10.观察术中血流动力学指标和术后恢复情况.结果 所有患者术中血流动力学平稳,术后恢复良好,无术中知晓.结论 雷米芬太尼[效应部位浓度(Ce)2～8 ng/ml]复合丙泊酚[血浆浓度(Cp)1～2μg/ml]用于心脏手术的麻醉安全有效,血流动力学平稳,有利于术后早期气管拔管.     

丙泊酚诱导时雷米芬太尼对老年患者意识消失的影响

目的研究靶控输注丙泊酚麻醉诱导时雷米芬太尼对老年人意识消失的影响。方法30名老年患者,随机分两组靶控输注雷米芬太尼4ng/ml组(R组)和生理盐水对照组(C组)。10min后同时靶控输注丙泊酚,效应浓度逐步上升(1,2,4μg/ml)。记录BIS、OAA/S、血液动力学变化、丙泊酚效应浓度及用量。结果OAA/S1分时,R组BIS值为62±18,C组为61±11。R组丙泊酚效应浓度为(1·1±0·4)μg/ml,C组为(2·0±0·4)μg/ml(P<0·05)。R组丙泊酚用量为(63±24)mg,C组为(141±34)mg(P<0·01)。结论雷米芬太尼能协同丙泊酚加强对老年人意识消失的作用。     

靶控输注依托咪酯用于全身麻醉维持的可行性研究

目的 探讨靶控输注(TCI)依托咪酯用于全身麻醉维持的可行性.方法 择期全麻手术患者40例,随机分为两组.E组麻醉诱导时TCI依托咪酯和雷米芬太尼;P组TCI丙泊酚和雷米芬太尼.E组术中TCI依托咪酯1～2μg/ml和雷米芬太尼6 ng/ml维持BIS值40～60;P组术中TCI丙泊酚2～4 μg/ml和雷米芬太尼6 ng/ml维持BIS值40～60.检测围术期血糖、血浆皮质醇、醛同酮、促肾上腺皮质激素(ACTH)浓度.记录停药后患者苏醒时间,术后随访术中知晓.结果 两组术中血流动力学均维持稳定.E组术毕皮质醇浓度与术前相比明显降低(P<0.05),术后24 h基本恢复至术前水平,术后48 h较术前明显升高(P<0.05);术毕ACTH浓度与术前相比明显升高(P<0.05),术后24 h基本恢复至术前水平.而P组围术期血浆皮质醇和ACTH浓度均无明显改变.E组苏醒时间长于P组(P<0.05).结论 依托咪酯抑制肾上腺皮质功能,但在24 h内肾上腺皮质即恢复对促肾上腺皮质激素的反应.TCI依托咪酯复合雷米芬太尼可安全用于无肾上腺皮质功能低下患者的全凭静脉麻醉.     

雷米芬太尼复合丙泊酚与复合地氟醚麻醉在脊柱侧弯矫正术中唤醒的比较

目的比较脊柱侧弯矫正术中,丙泊酚复合雷米芬太尼靶控静脉麻醉和地氟醚复合雷米芬太尼静吸复合麻醉的术中唤醒时间及苏醒质量。方法40例择期行脊柱侧弯矫正术患者,ASAⅠ或Ⅱ级,随机均分为丙泊酚复合雷米芬太尼靶控静脉麻醉组(P组)和地氟醚复合雷米芬太尼静吸复合组(D组)。比较停止输注丙泊酚或地氟醚后术中唤醒时间及唤醒质量。结果D组患者自主呼吸恢复时间(5.2±1.8)min,呼之睁眼时间(5.2±1.8)min和指令动作恢复时间(7.1±1.2)min均短于P组[(7.2±1.3)min,(8.3±1.7)min和(9.5±1.0)min](P<0.05)。唤醒成功时,P组患者有4例睁眼勉强,并伴有四肢不自主活动,苏醒质量为2级;D组均为1级。结论术中维持相同的循环指标,D组唤醒时间要短于P组,D组唤醒质量也优于P组。     

全凭静脉麻醉与静吸复合麻醉恢复质量及用药相关费用的比较

目的 比较相同麻醉深度下异氟醚-芬太尼静吸复合麻醉与丙泊酚复合芬太尼或雷米芬太尼全凭静脉麻醉的恢复质量和用药相关费用.方法 ASA Ⅰ或Ⅱ级,择期行下腹部手术患者60例,随机均分为静吸复合组(B组)、芬太尼组(F组)及雷米芬太尼组(R组),分别以异氟醚-芬太尼、丙泊酚-芬太尼和丙泊酚-雷米芬太尼辅以维库溴铵维持麻醉.麻醉深度维持在Narcotrend D0～D2水平,记录术毕停药后患者自主呼吸恢复时间、呼名睁眼时间、拔管时间、定向力恢复时间;观察拔管后即刻、拔管后20 min患者意识状态(OAA/S)、疼痛程度(VAS)及主诉需要镇痛药的例次;术后24 h访视患者,记录有无术中知晓及恶心、呕吐等不良反应;比较三种麻醉方式的用药相关费用.结果 三种麻醉方式术毕自主呼吸恢复时间、呼名睁眼时间、拔管时间的差异无统计学意义,但R组定向力恢复早于B组,其拔管后20 min患者OAA/S评分也高于B组(P＜0.01).R组在拔管后即刻及拔管后20 min VAS明显高于其他两组,主诉需要镇痛药者也多于其他两组(P＜0.01).三组患者术后恶心、呕吐等不良反应发生率的差异无统计学意义.B组麻醉用药相关费用明显低于其他两组(P＜0.01).结论 三种麻醉方式麻醉苏醒速度相近,丙泊酚-雷米芬太尼苏醒质量较好,但麻醉恢复期疼痛明显.全凭静脉麻醉特别是丙泊酚-雷米芬太尼用药相关费用高于异氟醚-芬太尼静吸复合麻醉.     

靶控输注丙泊酚和雷米芬太尼在意识消失和对疼痛刺激反应时的相互关系

目的探讨靶控输注(TCI)丙泊酚和雷米芬太尼的相互关系及对脑电双频指数(BIS)的影响。方法全身麻醉患者100例,根据丙泊酚不同血浆靶浓度随机均分为五组:P1.5组,1.5μg/ml;P2组,2μg/ml;P2.5组,2.5μg/ml;P3组,3μg/ml;P3.5组,3.5μg/ml。待血浆浓度和效应室浓度达到平衡后TCI雷米芬太尼,以血浆浓度0ng/ml为起点,每30秒增加0.3ng/ml,直至患者意识消失及对疼痛刺激(50Hz,80mA,0.25ms强直刺激)无体动反应。记录患者在不同丙泊酚血药浓度下意识消失时和对疼痛刺激无反应时雷米芬太尼的血浆浓度(Cp)和效应室浓度(EC)。结果意识消失时雷米芬太尼Cp50从P1.5组至P3.5组分别为5.0、3.0、2.1、1.2、0ng/ml;疼痛刺激无反应时雷米芬太尼Cp50从P1.5组至P3.5组分别为5.4、4.3、3.9、3.5、3.0ng/ml;疼痛刺激无反应时与意识消失时BIS值的差异无统计学意义。结论BIS值变化与丙泊酚血药浓度呈反比关系,雷米芬太尼对BIS值影响不大。BIS值50～60可以作为丙泊酚和雷米芬太尼静脉复合麻醉时监测意识消失的良好指标。     

小波指数用于麻醉深度监测的研究

目的研究在靶控联合输注丙泊酚和雷米芬太尼时小波指数(wavelet index,WLI)监测麻醉深度的可行性。方法选择30例行腹腔镜胆囊切除或妇科腹腔镜手术的全麻患者。全麻诱导采用血浆浓度靶控输注丙泊酚,从1.5μg/ml开始,达到浓度后1min增加0.5μg/ml,最终达到4.0μg/ml,于切皮前5min开始靶控输注雷米芬太尼4.0ng/ml,至开始缝皮时停止靶控输注丙泊酚和雷米芬太尼。患者麻醉全程同时监测WLI和BIS值。结果随着诱导过程中靶控丙泊酚血浆浓度的增加,WLI和BIS值均呈下降趋势(P0.05),丙泊酚血浆靶浓度为0、1.5、4.0μg/ml时,WLI较BIS值明显升高(P0.01)。缝皮停药后WLI和BIS值均呈上升趋势(P0.05),与BIS值比较,停药后1～6minWLI明显升高(P0.01)。意识消失时WLI(57.8±6.7)和BIS值(57.7±5.7)差异无统计学意义。意识恢复时WLI(82.4±5.9)明显高于BIS值(76.3±5.5)(P0.01)。经Bland-Altman一致性分析,WLI和BIS在诱导和苏醒期间一致性在可接受范围内(偏差为-4.2,2SD为11.7%和-24.7%)。结论在靶控输注丙泊酚和雷米芬太尼进行全麻时,WLI具有和BIS相似的麻醉深度监测作用。     

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.     

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.     

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.