抑肽酶-低钾-右旋糖酐保存液对兔肺缺血再灌注损伤的影响

目的探讨抑肽酶-低钾-右旋糖酐保存液对常温兔肺缺血再灌注损伤的影响。方法成年新西兰大白兔18只,体重0．9～1．5kg,雌雄不拘,随机分为3组（n=6）：对照组（C组）、低钾-右旋糖酐（LPD）组（L组）、抑肽酶＋LPD组（A组）。C组直接阻断左肺门,不灌注肺保存液,L组和A组阻断左肺动脉,待肺膨胀后分别经左肺动脉导管灌注LPD保存液或抑肽酶＋LPD保存液30ml/kg（含抑肽酶150kIU/ml）,灌注结束后阻断左肺静脉,在肺膨胀一半时阻断左主支气管,2h后依次开放左肺静脉、动脉和左主支气管,再灌注90min后处死动物取出左肺,测定肺组织丙二醛（MDA）含量及髓过氧化物酶（MPO）活性,计算肺组织干湿重比（D/W）,观察肺组织病理学变化；分别于缺血前及再灌注15、60、90min检测动脉血氧分压（PaO2）及血清肿瘤坏死因子-α（TNF-α）浓度。结果与缺血前比较,3组再灌注期间血清TNF-α浓度升高,PaO2下降（P＜0．01）；与C组比较,L组、A组再灌注期间肺组织MDA含量、MPO活性降低,D/W升高,血清TNF-α浓度降低,PaO2升高（P＜0．05或0．01）；与L组比较,A组肺组织MDA含量、MPO活性降低,D/W升高,血清TNF-α浓度降低,PaO2升高（P＜0．01）。A组肺组织水肿、渗出、损伤等病理变化较C组和L组减轻。结论抑肽酶-LPD保存液可减轻兔常温肺缺血再灌注损伤,改善肺功能。     

温度对犬肺灌注保存效果的影响

目的评价不同温度灌注和保存犬肺对肺保存效果的影响。方法将24只犬随机分为实验组和对照组两组,每组供、受体各6只。实验组以23℃低钾右旋糖酐(LPD)液灌注后切取右肺保存于10℃LPD液,对照组以4℃LPD液灌注后切取右肺保存于4℃LPD液,其后两组均行左肺移植术。比较两组供体肺组织不同时间段的髓过氧化物酶(MPO)活性、丙二醛(MDA)含量及湿/干重量比(W/D),比较两组受体犬移植前后不同时间肺血流动力学参数以及血气分析指标,并比较病理结果。结果与对照组相比,实验组肺组织灌注后各时间段的MPO活性、丙二醛含量及W/D较低(P0.05)。实验组受体犬移植后的肺毛细血管楔压(PCWP)、平均肺动脉压(MPAP)较低,动脉血氧分压(PaO2)较高,差异均有统计学意义(均为P(0.05)。病理学结果显示,实验组肺组织中性粒细胞浸润、肺泡水肿及损伤等病理变化较对照组减轻。结论在本实验条件下,与4℃灌注+4℃保存相比,23℃灌注+10℃保存的温度对犬肺具有较好的保存效果,更适用于实验肺移植。     

硝酸甘油对移植犬肺的保护作用

目的评价硝酸甘油对犬肺的保护作用。方法将24只犬随机分为实验组和对照组两组,每组供、受体各6只。实验组用含硝酸甘油的低钾右旋糖酐(low potassium dextran,LPD)灌注液灌注供肺,对照组仅用LPD灌注液灌注供肺,留取供犬右肺继续于灌注液中保存至4h,修剪左肺作移植肺,两组受体犬均行左肺移植术。比较两组供体肺组织不同时间的髓过氧化酶(myeloperoxi-dase,MPO)活性、丙二醛(malondialdehyde,MDA)含量和湿/干重量比(W/D),比较两组受体犬移植前后不同时间肺血流动力学参数以及血气分析指标,并比较病理结果。结果与对照组相比,实验组肺组织灌注后各时间段的MPO活性、丙二醛含量均较低(均为P(0.05),两组W/D差异无统计学意义。实验组受体犬移植后的平均肺动脉压(mean pulmonary arterial pressure,MPAP)低于对照组而动脉血氧分压(PaO2)高于对照组(均为P(0.05)。移植后供肺肺组织的病理学结果显示,实验组肺组织水肿、炎性细胞浸润、损伤等病理变化较对照组减轻。结论在本实验条件下,在灌注液中加入硝酸甘油可以在犬肺移植过程中起到保护肺组织的作用。     

不同胆道灌洗方法对大鼠肝内胆管冷保存再灌注损伤的影响

目的观察不同胆道灌洗方法对大鼠移植肝肝内胆管冷保存再灌注损伤的影响。方法应用大鼠原位肝移植模型，将88只SD大鼠随机分为假手术组、胆道非灌洗组、UW液胆道灌洗组、生理盐水（NS）胆道灌洗＋UW液肝内胆道灌注保存组、HTK液胆道灌洗＋UW液肝内胆道灌注保存组、HTK液胆道灌洗＋HTK液肝内胆道灌注保存组。移植肝置于4℃林格液中保存2h后行原位肝移植。移植肝再灌注后24h，检测血清总胆红素（TB）、直接胆红素（DB）、碱性磷酸酶（AKP）、γ-谷酰转肽酶（GGT）及胆汁中GGT、葡萄糖（Glu）含量。在光镜及电镜下观察肝内胆管上皮细胞的形态学变化。结果与非灌洗组比较，胆道灌洗组术后各项指标明显改善（P〈0．01）；HTK液及NS灌洗组较UW液灌洗组术后指标改善明显（P〈0．05）。病理检测发现非灌洗组胆道损伤明显，各灌洗组胆道损伤程度明显改善，HTK液灌洗＋UW或HTK液灌注组对胆管上皮细胞的损伤较轻。结论移植肝冷保存前进行胆道灌洗可以明显减轻胆管上皮细胞的损伤，4℃HTK液灌洗＋4℃UW或HTK液灌注保存效果比较理想。     

犬同种异体左侧单肺移植模型的建立

目的建立稳定、简单、易行的犬同种异体左侧单肺原位移植模型。方法随机选取12对家犬，组成供受体。供体左肺的获取时，通过左肺动脉主干灌注0—4℃的LPD液。切除受体左全肺后，通过吻合供体与受体的左支气管，供体与受体的左肺动脉主干，供体左房袖与受体左心耳，植入供体左肺。通过血气分析监测受体左全肺切除后及供体犬肺植入后1、2h受体的动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）的变化；受体左全肺切除前后及供体犬肺植入后1、2h受体气道峰压（Paw）的变化，记录供体肺脏植入手术时间。结果手术无1例失败，均存活。供体肺脏植入时间平均（35．92±1．73）min。受体左全肺切除后的PaO2、PaCO2和Paw与植入后1、2h的PaO2比较，差异有统计学意义（P〈0．05）；供体植入后1h与2h的PaO2和Paw比较，差异有统计学意义（P〈0．05），而供体植入后Ih与2h的PaCO2比较，差异无统计学意义（P〉0．05）。结论本模型建立简洁，稳定，特别是左房袖与左心耳的吻合，使手术操作更加简单快捷。     

姜黄素和地塞米松对大鼠移植肺缺血再灌注损伤的保护作用

目的：研究姜黄素（CUR）和地塞米松（DXM）对大鼠移植肺缺血再灌注损伤的干预作用。方法：实验分四组进行，CUR组肺移植前3h供、受者腹腔注射CUR溶液；DXM组肺移植前30min受者腹腔注射DXM溶液；载体组肺移植前3h供、受者腹腔注射CUR的溶剂二甲基亚砜；假手术组不进行肺移植。每组分别于恢复血液再灌注2h和24h各处死大鼠6只，采取颈动脉（CA）血和左肺静脉（LPV，移植侧）血，测定血氧合指数（PO2／FiO2）以及血清中丙二醛（MDA）、总抗氧化能力（TAOC）、肿瘤坏死因子（TNF-α）、白细胞介素6（IL-6）的含量；同时行肺组织病理学观察，测定肺湿重与干重比（W／D），以及肺组织中髓过氧化物酶活性（MPO）、MDA、TAOC、TNF-α、IL-6的含量。结果：再灌注2h及24h，CUR组及DXM组LPV血的PO2／FiO2明显高于载体组（P〈0．01）。CUR组与DXM组再灌注2h和24h的肺水肿病理评分和总分明显低于载体组（P〈0．017），CUR组与DXM组再灌注24h的W／D明显低于载体组（P〈0．01）。再灌注2h和24h，CUR组与DXM组肺组织中MPO含量明显低于载体组（P〈0．05，P〈0．01）。再灌注2h时，CUR组和DXM组血清和组织中MDA含量明显低于载体组（P〈0．05），再灌注24h时，CUR组血清MDA含量和DXM组组织中MDA含量明显低于载体组（P〈0．05）。再灌注2h和24h，CUR组肺组织和血清中TAOC含量明显高于载体组（P〈0．01，P〈0．05），而DXM组仅再灌注2h的肺组织和再灌注24h的血清中TAOC含量高于载体组（P〈0．01）。再灌注2h和24h，CUR组和DXM组肺组织中TNF-α和IL-6含量低于载体组。结论：CUR和DXM对大鼠移植肺缺血再灌注损伤具有保护作用，其机制可能与二者具有抗氧化和抗炎作用有关。     

PI3K/AKT信号通路在异丙酚减轻离体大鼠心脏缺血再灌注损伤中的作用

目的 探讨PI3K／AKT信号传导通路在异丙酚减轻离体大鼠心脏缺血再灌注损伤中的作用。方法 成年SD大鼠32只，随机分为4组：缺血再灌注组（I／R组）、异丙酚组（P组）、渥曼青霉素组（W组）和异丙酚＋渥曼青霉素组（PW组），每组8只。建立Langendorff离体心脏灌注模型，灌注压10kPa,灌注速率7．10ml／min，I／R组用K-H液灌注，P组用含50μmol／L异丙酚的K-H液灌注，W组用含100nmol／L渥曼青霉素的K-H液灌注；PW组用含50μmol／L异丙酚＋100nmol／L渥曼青霉素的K-H液灌注，灌注15min，全心缺血30min，再灌注60min。测定再灌注10、40min时冠脉流出液中心肌肌钙蛋白（cTnI）浓度，再灌注60min时测定心肌组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）活性，电镜下观察心肌细胞超微结构。结果 与I／R组比较，P组再灌注期间cTnI浓度明显降低，心肌组织SOD活性升高，MDA含量降低（P〈0．05），其余2组上述指标差异无统计学意义（P〉0．05）；与缺血前比较，P组再灌注40min时cTnI浓度升高，其余各组再灌注期间cTnI浓度均升高（P〈0．05或0．01）。P组电镜下心肌超微结构改变减轻。结论 异丙酚减轻离体大鼠心脏缺血再灌注损伤可能通过PI3K／AKT信号传导通路介导。     

脑腓肽复合山莨菪碱预处理对猪体外循环时肺缺血再灌注损伤的影响

目的探讨δ阿片受体激动剂脑腓肽复合M受体拮抗剂山莨菪碱预处理对猪体外循环（CPB）时肺缺血再灌注损伤的影响。方法雄性健康白猪14头,3～4月龄,体重30～35 kg,随机分为2组（n=7）：对照组和预处理组。对照组给予常规CPB;预处理组CPB前1 h静脉注射脑腓肽和山莨菪碱各1mg/kg。2组主动脉阻断同时灌注改良St.Thomas停搏液。心脏停搏缺血60 min后开放主动脉再灌注缺血心肌,撤出CPB后1 h处死动物。于CPB前10 min、再灌注10、30、60 min时采集动脉血,测定丙二醛（MDA）浓度,并行动脉血气分析。于CPB前10 min和再灌注60 min时取肺组织,计算肺组织湿/干重（W/D）;光镜下观察肺泡损伤程度（LTD）;透射电镜下观察肺组织超微结构。结果与对照组比较,预处理组再灌注期间MDA浓度、W/D和LTD均降低,PaO2升高（P〈0.05或0.01）。电镜下预处理组较对照组的肺组织超微结构损伤程度轻。结论脑腓肽复合山莨菪碱预处理可减轻猪体外循环时肺缺血再灌注损伤。     

缓激肽β2受体拮抗剂在大鼠肺移植缺血再灌注损伤中的保护作用

目的 探讨缓激肽β2受体拮抗剂（HOE-140）对大鼠移植肺功能的影响以及作用.方法 将纯系SD大鼠随机分为3组,即实验组1、实验组2、对照组.对照组的供肺用低钾右旋糖苷液（LPD液）灌洗,并保存18h,然后行左肺移植,于移植后1d测定对照组的气道峰压（PAP）、静脉血氧分压（PO2）、移植肺湿干重比（W/D）、髓过氧化物酶（MPO）活性.实验组1以及实验组2（加HOE-140干预）的供肺用含特异性不可逆DPPⅣ酶抑制剂（AB192）的LPD液灌洗,并保存18h,然后行左肺移植,分别于移植后1d测定受者的各项肺功能指标,并取相同受体肺部组织做病理学检查. 结果 与对照组比较,各实验组的PAP值降低（P＜0.05）,PO2值升高（P＜0.05）,W/D值降低（P＜0.05）,MPO活性降低（P＜0.05）,差异有统计学意义,病理学结果显示实验组2（HOE-140组）均优于对照组及实验组1.结论 缓激肽β2 受体拮抗剂HOE-140能有效降低肺移植肺缺血再灌注损伤,从而改善移植肺功能.     

L－精氨酸在离体肺保存中的作用

目的：研究一氧化氮前体L－精氨酸（L-Arg)在离体兔肺保存中的保护作用。方法：将14只新西兰兔随机分为2组,对照组以改良的Euro-Collins(ECS)液灌注及保存供肺,实验组以L－精氨酸（3mmol/L)加入改良的ECS液中灌注及保存供肺。冷保存6h。以自体血再灌注1h后,做肺静脉血气分析（PvO2),并测定血及肺组织中一氧化 氮（NO）,超氧化物歧化酶（SOD）,脂质过氧化物（LPO）含量及肺组织的超微结构以评价肺保护的效果。结果：再灌注后,实验组比对照组血氧分压显著提高（P＜0．05）。实验组血及肺组织中NO及SOD含量较对照组高（P＜0．05）,LPO含量较对照组低（P＜0．05）,透射电镜检查实验组损伤轻于对照组,结论：肺保存不超过6h时,在改良的ECS液中加入L-Arg用于离体肺的灌注和保存,能减轻肺损伤。     

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.