心脏死亡供体经典原位肝移植的单中心临床研究

目的总结心脏死亡器官捐献（donation after cardiac death,DCD）供体供肝获取及应用于肝移植的临床经验和可行性。方法2011年11月至2012年9月,西安交通大学第一附属医院采用Maastricht标准或中国标准,共获取18例DCD供肝,于该院完成经典原位肝移植14例,送往其他移植中心3例,放弃1例。对18例供体与在该院完成肝移植的14例受体的临床资料进行回顾性分析,了解供肝情况、受体围手术期及随访结果。结果18例供体中符合Maastricht标准Ⅲ类5例、V类2例,符合中国标准Ⅲ类（即脑一心双死亡标准器官捐献,donation after brain death plus cardiac death, DBCD）11例。按规范器官获取流程取得供肝。供肝的热缺血时间为11～18min,平均为14．5min;冷缺血时间为90—600min,平均为350min。14例受体均顺利完成移植手术。其中12例受体预后良好,肝功能逐渐恢复,未出现原发性移植肝无功能、血栓形成、排斥反应,但2例出现胆道狭窄并发症,经胆道支架置人术后引流通畅;重症监护室（ICU）治疗时间平均7d,术后住院时间平均23d,病情稳定后出院。1例受体术后2d死于肝衰竭,其供体原发病为冠状动脉粥样硬化性心脏病,需给予大量多巴胺维持其血压;另1例于术后当日死于腹腔内大出血,其供体为重症哮喘、心肺复苏后死亡。12例受体者平均随访时间为6个月,总体存活率为85％,肿瘤患者尚未发现复发转移。结论DCD可以扩大供肝来源且近期效果良好,具有可行性。实施可控型DCD捐献,严格掌握供者适应证、加强器官评估、缩短热缺血时间和冷缺血时间,是保障供肝质量的重要因素。     

采用心脏死亡供者无偿捐献的供肝进行原位肝移植七例观察

目的 观察利用可控的心脏死亡供者捐献的肝脏对受者进行原位肝移植的预后.方法 利用7例心脏死亡供者捐献的供肝对终末期肝硬化患者进行原位肝脏移植术,并对术前和术后的随访数据进行分析,探讨受者采用此种类型供肝移植后的预后情况.结果 7例受者中,除1例于术后第9天死于上消化道出血外,其余6例受者均长期存活,随访时间均大于12个月,中位随访时间为15.7个月,预后均较好.结论 采用符合荷兰马斯特里赫特(Maastricht)分类第Ⅲ型的心脏死亡供者捐献的肝脏对终末期肝硬化患者进行原位肝移植,预后较好.     

心脏死亡供体肝移植12例初步经验

目的总结心脏死亡供体（DCD）肝移植的具体流程和临床经验。方法回顾性分析2008年10月至2012年12月中山市人民医院12例DCD临床资料、供体维护、器官获取、受体围手术期及预后等。结果12例供体均为脑、心双死亡供体,按标准成功完成了肝脏捐献及获取流程。其中3例使用体外膜肺氧合技术（ECMO）维持至器官获取。供肝热缺血时间0-30（16．5±7．0）min。12例受体均顺利植入供肝,无围手术期死亡。术后胆道并发症2例,肿瘤复发1例,死亡2例。结论DCD供体肝移植能获得较满意的效果。通过快速获取器官、合理利用ECMO,能提高器官捐献成功率、减少供肝热缺血时间及冷缺血时间。     

心脏死亡供者供肝移植三例报告

目的 总结心脏死亡器官捐献(DCD)供肝移植的临床经验.方法 共有7例心脏死亡器官捐献者,原发病包括脑出血3例(其中1例合并高血压),颅脑外伤2例,脑基底动脉闭塞1例,颅脑肿瘤(脑胶质瘤Ⅱ级)卒中1例.依据《中国心脏死亡器官捐献指南》实施捐献,采用腹部器官联合快速切取方法切取器官.受者的原发疾病为乙型肝炎后肝硬化(失代偿期)和原发性肝癌.术后预防感染,根据凝血酶原时间采取抗凝治疗,采用他克莫司+吗替麦考酚酯+泼尼松预防排斥反应.结果 有3例供者分别因合并酒精性肝硬化、家属拒绝捐献肝脏和肝脏热缺血时间超过30 min而未能切取肝脏,1例由红十字会协调至其他移植中心,3例完成肝移植.供肝热缺血时间分别为7.5、9和10 min,冷缺血时间为4.5、8.2和6.5h.受者术后随访2～9个月,术后近期无原发性移植物无功能,未发生血栓形成和排斥反应等并发症,肝功能恢复良好,均顺利出院.结论 DCD供肝移植的近期效果良好,选择可控制的中国三类供者、中高度风险的UW评分以及较短的热缺血时间是保障肝移植成功的重要因素.     

公民逝世后器官捐献供肝移植31例临床效果分析

目的总结公民逝世后器官捐献供肝用于肝移植的临床经验及疗效分析。方法回顾性分析2007年1月至2014年12月中国人民解放军第303医院收治的31例公民逝世后器官捐献肝移植病例的临床资料。结果 31例供体中符合中国标准Ⅰ类8例、Ⅱ类3例、Ⅲ类20例。按规范器官获取流程取得供肝。供肝的热缺血时间为2~13 min,平均为9 min;冷缺血时间为240~600 min,平均为350 min。31例受体均顺利完成肝移植手术。其中29例受体恢复良好,肝功能逐渐恢复,未出现血栓形成、排斥反应,4例出现胆道狭窄并发症,经胆道支架置入术后引流通畅;重症监护室(ICU)停留时间平均8 d,术后住院时间平均21 d,病情稳定后出院。受体总体存活率为81%,1例术后2 d死于原发性肝脏无功能,1例死于术后肺部感染,4例肿瘤受者死于肿瘤复发转移。结论公民逝世后器官捐献可以扩大供肝来源且近期效果良好。逐渐完善捐献供体器官功能保护措施,严格掌握供者适应证、加强器官功能评估、缩短热冷缺血时间,是改善临床效果的重要措施。     

心脏死亡器官捐献获取流程探讨

目的总结并进一步探讨心脏死亡器官捐献(DCD)获取流程的初步经验。方法回顾性分析2009年7月至2012年1月期间广州军区总医院28例DCD者的临床资料、供体入选标准及器官获取流程。结果 28例DCD供体均成功实施了器官捐献,其中MaastrichtⅢ类3例(10.7%),MaastrichtⅣ类1例(3.6%),脑-心双死亡捐献(DBCD)供体24例(85.7%)。3例MaastrichtⅢ类供体实施了标准DCD器官获取流程(简称DCD流程),1例MaastrichtⅣ类供体采用DBCD器官获取流程(简称DBCD流程)非体外膜肺氧合(ECMO)模式,24例DBCD采用了DBCD流程ECMO模式。供体器官热缺血时间:DBCD为0 min,MaastrichtⅣ类为18 min,MaastrichtⅢ类平均25 min(22～28 min)。本组共获取了28个肝脏、40个肾脏、2个心脏,分别成功用于肝移植、肾移植和心脏移植。结论我国DCD器官获取可分为DCD流程和DBCD流程,后者又分为ECMO模式和非ECMO模式。ECMO模式可避免器官热缺血损伤且没有伦理学争议,对我国公民DCD器官有着十分重要的作用。     

心脏死亡器官捐献边缘供肝肝移植三例临床分析

目的探讨心脏死亡器官捐献(DCD)边缘供肝应用的可行性。方法回顾性分析吉林大学白求恩第一医院肝移植中心2015年4月至5月施行的3例边缘供肝肝移植供、受者临床资料。结果 3例边缘供肝供者均为男性,包括61岁老年供者供肝1例,重度脂肪变性(肝细胞气球样脂肪变65%)供肝1例,冷缺血时间延长(15.7 h)1例。均实施中国三类标准器官捐献。老年供肝肝移植受者术后肝功能恢复良好,未出现排斥反应。重度脂肪变性供肝肝移植受者术后肝功恢复差,术后1周因移植肝原发性无功能再次行肝移植。冷缺血时间延长供肝肝移植受者术后恢复顺利,术后10 d发生轻度急性排斥反应,将他克莫司由2.0 mg(2次/d)调整为2.5 mg(2次/d),肝功能恢复良好。结论在综合评估供肝状况及合理匹配受者的前提下,边缘供肝能够安全使用,并能取得良好的临床效果。老年供肝可以匹配终末期肝病模型评分低的老年受者;冷缺血时间延长供肝可通过增加灌注次数以适当缓解术后肝功能恢复延迟情况;重度脂肪变性供肝仍应谨慎使用,要综合其他影响供肝的因素及受者状况来决定。     

中国Ⅲ类和Ⅰ类心脏死亡供体在肝移植应用中的近期效果

目的 总结中国Ⅲ类和Ⅰ类心脏死亡供体在肝移植应用中的近期效果.方法 回顾性分析2011年9月-2014年6月在广东佛山市第一人民医院完成的中国Ⅰ类心脏死亡捐献供体(DBD组)和Ⅲ类心脏死亡捐献供体(DBCD组)肝移植的临床资料.结果 DBD组和DBCD组分别有12例和21例受体,两组术前供、受体年龄、原发病、肝功能指标ALT、TBIL、ALB、供肝冷缺血时间、受体MELD评分无明显差异,两组术中出血量、输血量、手术时间、无肝期差异无统计学意义,P＞0.05;DBD组和DBCD组术后中位随访时间分别为8.8个月和20个月,两组肝移植受体和移植物累积生存率均为100％,术后ICU住院时间、术后肝功能恢复时间、术后住院时间、早期并发症、急性排斥反应发病率差异均无统计学意义,P＞0.05.结论 中国Ⅲ类心脏死亡供体(DBCD)肝移植能取得与中国Ⅰ类心脏死亡供体(DBD)肝移植一样的近期效果,详细的供体评估、规范的供体器官获取流程、缩短冷供肝缺血时间、保护供肝胆管周围微血管网、加强围手术期的管理和长期随访是提高中国Ⅲ类心脏死亡供体肝移植受体生存率的关键.     

儿童心脏死亡器官捐献供肝移植治疗儿童遗传代谢性肝病

目的总结儿童心脏死亡器官捐献(DCD)供肝移植治疗儿童遗传代谢性肝病的经验。方法回顾性分析2011年7月至2013年11月南京军区福州总医院肝胆外科完成的2例儿童DCD供肝移植临床资料。受者1为4岁2个月男童,诊断为肝糖原累积症继发肝功能不全、严重低血糖;供者1为3岁8个月男童,因严重病毒性脑炎致脑死亡继发心脏死亡行DCD。受者2为12岁男童,诊断为肝豆状核变性继发肝硬化、脾功能亢进、上消化道出血;供者2为13岁男童,因颅内肿瘤致脑死亡继发心脏死亡行DCD。手术均采用经典原位肝移植术式,受者1和受者2供肝热缺血时间分别为6、10 min,冷缺血时间分别为180、360 min,术中留置胆汁引流管和经胃空肠造瘘管。术后密切监测生命体征和移植肝功能,术后1周内每天行床边彩色多普勒超声监测移植肝血流情况,同时给予抗感染、改善微循环及营养支持等处理,采用他克莫司+甲泼尼龙二联免疫抑制方案。结果受者1和受者2手术时间分别为420、360 min,其中无肝期分别为55、50 min,术中出血量分别为400、300 m L。受者1术后6 h清醒并拔除气管插管,2 d血糖恢复正常,术后7 d移植肝功能恢复正常,术后18 d痊愈出院。受者2术后5 h拔除气管插管,术后12 d出现胆瘘,行经皮肝穿刺胆道引流+腹腔穿刺引流+经内镜逆行胰胆管造影内支架引流治愈,术后1个月出现肝动脉假性动脉瘤破裂出血,行肝动脉介入栓塞治疗,于移植术后2个月痊愈出院。结论儿童DCD供肝是儿童肝移植的理想供肝来源,儿童DCD供肝移植治疗儿童遗传代谢性肝病效果确切;需要熟练、精细的显微外科操作技术预防术后并发症;积极引流和及时行动脉介入治疗是儿童肝移植术后胆瘘和肝动脉瘤破裂出血的有效治疗方法。     

脂肪变性供肝在肝移植中的应用现状与进展

肝移植是终末期肝病最有效的治疗措施,但器官供需的严重失衡已经成为制约肝移植进一步发展的关键因素.因此,如何合理使用边缘性供肝已成为肝移植临床的重点.常见的边缘性供肝有脂肪变性供肝、乙肝表面抗原阳性肝脏、超过60岁的高龄供者捐献的肝脏、冷缺血时间>14 h的肝脏、心脏死亡器官捐献(donation-after-circu...     

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.