离心管内组织工程软骨培养的初步研究

目的　探讨几种材料与软骨细胞的生物相容性 ,离心管内培养形成组织工程软骨。方法　自 3周龄兔分离关节软骨细胞 ,按 3× 10 6细胞 /管于离心管内接种软骨细胞 ,离心 (10 0 0r/min) 5min后连续培养 2周。分别将脱脂脱蛋白骨、羟基磷灰石、糖蛋白微孔膜、胶原海绵和明胶海绵置于离心管底 ,按 3× 10 6细胞 /管加入软骨细胞 ,离心 (2 0 0r/min) 5min后连续培养 2周。含钙组织首先经脱钙处理后 ,与其它组织工程软骨行组织学检查。结果　软骨细胞无支架培养形成软骨 ,具有一定的骺软骨组织学特征。支架材料与软骨细胞有良好的生物相容性 ,均能形成软骨样组织。组织工程软骨具有不同的组织学结构 ,细胞及其细胞外基质形态差异明显。结论　支架材料与软骨细胞具有良好的生物相容性 ,软骨细胞于离心管内培养可形成组织工程软骨     

培养软骨、关节软骨、生长板和半月板的超微结构研究

目的 探讨离心管培养软骨作为移植材料的可能性。方法 3周龄兔关节软骨细胞经离心管培养2周形成软骨,另取6周龄兔肱骨头关节软骨、肱骨近端生长板和半月板,并对4种软骨进行透射电镜观察,比较其软骨细胞和细胞外基质结构。结果 离心管培养软骨具有独特的超微结构,与关节软骨和生长板有一定的相似性,而与半月板有明显区别。4种软骨都形成了各自不同的细胞和细胞外基质特征,离心管培养软骨呈现典型软骨细胞凋亡,生长板表现“黑暗”软骨细胞,关节软骨和半月板未见细胞凋亡。结论 离心管培养软骨具有独特的超微结构,可作为关节软骨和生长板的移植物。     

软骨细胞膜片复合3D打印内支撑构建管状软骨的初步研究

目的 利用猪耳廓软骨细胞制备软骨细胞膜片,与3D打印聚酰胺带孔管状支架结合,构建管状软骨组织,用于气管软骨的缺损重建。方法 用酶消化法分离获得原代猪耳廓软骨细胞,以5×105cells/m L的密度将第2代软骨细胞接种于6 cm细胞培养皿上,在软骨细胞膜片培养环境中培养约14 d,获得完整软骨细胞膜片;4层软骨细胞膜片依次卷叠于3D打印的聚酰胺(PA12)带孔管状内支架上,以构建管状软骨组织复合物;体外静态培养12周或裸鼠皮下培养8周,对形成的管状软骨组织行大体观察及石蜡切片组织学染色鉴定。结果 体外静态培养12周后,半透明管状软骨组织形成,组织学染色可见少量分泌的软骨细胞外基质,质软,弹性差;体内培养8周后,白色管状软骨组织形成,其组织学染色可见大量软骨细胞外基质分泌,质较硬,有一定弹性。结论 利用软骨细胞膜片复合3D打印聚酰胺支架,可构建组织工程管状软骨,有望将其用于气管软骨缺损的修复。     

以PHBV为支架构建组织工程化软骨

[目的]探讨聚（羟基丁酸酯．羟基戊酸酯）（PHBV）多孔材料作为软骨组织工程支架的可行性以及体内外培养方式对软骨形成的影响。[方法]采用“压片-热处理-粒子析出”技术制备PHBV多孔支架。体外分离培养软骨细胞后接种到PHBV支架体外培养2周，期间扫描电镜观察细胞在支架上的生长情况，然后与单纯PHBV支架同植入裸鼠皮下继续培养4、8周后取材，与体外培养至6、10周的细胞一支架复合物同行组织学观察。[结果]电镜观察示软骨细胞在支架上黏附、增殖良好并能分泌细胞外基质；组织学观察示PHBV浅层有新生软骨组织形成，且皮下培养的软骨组织比体外培养的更为成熟。单纯PHBV支架皮下培养没有软骨组织形成。[结论]PHBV可以作为软骨组织工程支架材料。体内培养较体外更有利于组织工程化软骨的形成。     

软骨细胞外基质源性取向支架与骨髓基质干细胞体外软骨组织工程的初步研究

目的 制备关节软骨细胞外基质源性取向支架,观察其对体外培养的骨髓基质干细胞分布排列的影响,探索其用于修复关节软骨缺损的可行性.方法 收集天然猪关节软骨,在PBS溶液中超微湿法粉碎关节软骨,利用差速离心收集细胞外基质悬液;低温超速离心收集沉淀,制备成2%～3%悬液;采用定向结晶与冷冻干燥技术制备取向支架,应用紫外交联及碳化二亚胺交联.光学显微镜及扫描电镜观察支架的形态结构,冰冻切片后组织化学染色对支架进行定性分析;生物力学方法检测支架的力学特性.分离培养兔骨髓基质干细胞,PKH26标记,接种到支架上体外软骨诱导培养,倒置荧光显微镜及扫描电镜观察培养3 d内种子细胞在支架内的黏附、分布及排列方式.结果 制备的支架材料具有垂直取向排列的孔道结构,软骨细胞外基质特异性染色阳性,纵向压缩弹性模量为(2.02±0.02)MPa,横向压缩弹性模量为(0.264±0.16)MPa,具有各向异性的力学特点.体外培养显示骨髓基质干细胞广泛均匀地分布在支架内部,并且在支架材料表层呈平行排列,深层呈柱状排列,类似于天然软骨组织中细胞的排列方式.结论 以关节软骨细胞外基质材料制备的取向性组织工程支架,在生化组成和结构上仿生天然关节软骨细胞外基质,是一种较为理想的软骨组织工程支架.     

兔髂骨骺板软骨细胞体外构建骺板样软骨组织

目的　利用组织工程学技术体外构建骺板样软骨组织。方法　从 4～ 5周龄兔髂骨骺板软骨处获取软骨细胞 ,在离心管内轻微离心后 ,体外培养。行组织学观察。结果　培养至第 7天时 ,细胞呈现定向分化 ,形态与体内骺板软骨细胞相类似 :肥大软骨细胞体积较大、呈圆形或椭圆形 ;增殖、成熟软骨细胞体积小 ,呈圆形或扁圆形 ;细胞周围充满大量的细胞外基质。这些不同分化阶段的细胞形成了分化区带 ,肥大软骨细胞位于上侧 ,增殖、成熟细胞位于中间 ,其次是散在静止软骨细胞。培养第 14天 ,分化区带更加明显 ,增殖、成熟细胞和肥大软骨细胞呈现纵向定向排列。培养第 2 1天 ,组织表面出现膜样的结构。结论　体外构建的骺板样软骨组织与天然骺板的组织学形态极为相似。从髂骨处骺板处获取肥大软骨细胞进行体外构建骺板软骨材料 ,更具有临床实用性     

兔髂骨骺板软骨细胞体外构建骺板样软骨组织

目的 利用组织工程学技术体外构建骺板样软骨组织。方法 从4～5周龄兔髂骨骺板软骨处获取软骨细胞，在离心管内轻微离心后，体外培养。行组织学观察。结果 培养至第7天时，细胞呈现定向分化，形态与体内骺板软骨细胞相类似：肥大软骨细胞体积较大、呈圆形或椭圆形；增殖、成熟软骨细胞体积小，呈圆形或扁圆形；细胞周围充满大量的细胞外基质。这些不同分化阶段的细胞形成了分化区带，肥大软骨细胞位于上侧，增殖、成熟细胞位于中间，其次是散在静止软骨细胞。培养第14天，分化区带更加明显，增殖、成熟细胞和肥大软骨细胞呈现纵向定向排列。培养第21天，组织表面出现膜样的结构。结论 体外构建的骺板样软骨组织与天然骺板的组织学形态极为相似。从髂骨处骺板处获取肥大软骨细胞进行体外构建骺板软骨材料，更具有临床实用性。     

梯度降解软骨支架材料应力刺激下与骨髓基质干细胞复合三维培养的实验研究

[目的]探讨梯度降解软骨支架材料（GDABM）的细胞生物相容性及诱导后的骨髓基质干细胞（MSCs）在三维支架上培养的生物学行为.[方法]将MSCs与复合转化生长因子-β（TGF-β）的胶原共同混合后培养于三维软骨支架材料上,离心管内培养,10次/d,以600 r/min离心10 min.8 h、24 h、72 h、4 d、7 d进行倒置显微镜形态学观察、扫描电镜观察.1～8 d采用MTT法检测细胞增殖活性,描绘生长曲线.通过3H-Proline掺入实验了解材料对MSCs胶原合成的影响.[结果]8 h后MSCs在支架材料上呈球型黏附生长,4 d后MSCs在支架材料上呈菱形或多角型复层生长,包裹于大量细胞外基质内.GDABM组细胞第3 d进入对数增长期,倍增时间为4.75 d,而单纯软骨细胞培养对照组倍增时间为5.25 d.GDABM组与单纯软骨细胞培养对照组比较胶原合成略低,3H-Proline掺入值有显著性差异（P＜0.05）,说明经诱导MSCs的细胞胶原分泌功能仍低于软骨细胞.[结论]经TGF-β诱导和低转速离心应力刺激后的MSCs向软骨细胞功能分化,复合细胞因子梯度降解软骨支架材料具有良好的生物相容性,可作为MSCs的有效载体应用于组织工程化软骨的构建.     

软骨细胞外基质/壳聚糖复合多孔支架和骨髓间充质干细胞构建组织工程软骨

[目的]探讨软骨细胞外基质和壳聚糖制备复合多孔支架,同时并对小鼠骨髓间充质干细胞构建组织工程软骨的可行性进行观察.[方法]以猪关节软骨细胞外基质和壳聚糖为原料,采用冷冻干燥法制备软骨细胞外基质/壳聚糖复合多孔支架.通过扣描电镜观察材料内部结构及孔径大小,液体位移法测定材料的孔隙率,MTT方法检测支架浸提液毒性.将小鼠的骨髓间充质干细胞(BMSCs)分离培养并用TGF-β1成软骨诱导后,与材料复合培养,扫描电镜观察细胞在材料上的生长粘附情况.[结果]软骨细胞外基质/壳聚精复合支架具有疏松多孔结构,孔径大小(159±36)μm,孔隙率为90.5%±2.3%,复合支架中的软骨细胞外基质成分甲苯胺蓝染色、番红O染色均呈阳性,MTT结果显示支架无细胞毒性.诱导的骨髓间充质干细胞在支架表面生长良好.[结论]软骨细胞外基质/壳聚糖复合材料具有合适的孔径和孔隙率,生物相容性良好,是组织工程软骨的良好支架载体.     

可降解高分子丙交酯-乙交酯共聚物(PLGA)三维支架的细胞相容性和鼻软骨组织工程

目的 探讨可生物降解丙交酯-乙交酯共聚物(PLGA)(80∶20)三维多孔支架生物相容性及用于构建组织工程鼻软骨可行性,为临床鼻软骨缺损的修复提供新来源.方法 体外分离培养新生兔关节软骨细胞,采用计算机形态分析和MTT法检测兔软骨细胞在PLGA膜和支架表面粘附、扩展和增殖情况.将培养扩增的兔软骨细胞,按6×106 cels/ml浓度接种于预加工的人鼻软骨外形PLGA多孔支架内,抗坏血酸体外诱导培养4周,形成软骨样组织,倒置显微镜、组织切片、扫描电镜观察人工软骨的组织形态结构.结果 培养开始阶段,软骨细胞在PLGA膜表面粘附较差,以后逐渐增高,24小时接近于对照组;MTT法结果显示,软骨细胞在PLGA支架内培养7天时细胞绝对数量明显增加,而相对增殖率逐渐下降.肉眼观察,培养物为人鼻软骨外形的透明软骨样组织,具有一定弹性和硬度,表面有大量软骨基质形成;倒置显微镜下可见人工软骨周围有大量软骨细胞聚集和细胞外基质形成.组织切片及扫描电镜分析,多孔支架材料的网孔不完整,孔内有大量软骨细胞和细胞外基质,可见典型软骨陷窝样结构.结论 可生物降解PLGA制备的三维多孔支架具有较好生物相容性和可塑性,可用于组织工程鼻软骨体外构建,具有潜在的临床应用价值.     

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.