射频凝血器在原发性肝癌切除术中的应用

目的 探讨射频凝血器在原发性肝癌切除术中的应用价值.方法 回顾性分析2010年1月至2012年2月西安交通大学医学院第一附属医院收治的82例行手术切除的原发性肝癌患者的临床资料,根据其手术方式不同将患者分为射频止血肝切除组(41例)和常规钳夹肝切除组(41例),通过对两组患者的临床资料进行分析,评价射频凝血器的应用价值.计量资料采用t检验,计数资料采用x2检验.结果 射频止血肝切除组平均手术时间(77±28) min,比常规钳夹肝切除组的(129±34) min明显缩短(t=7.432,P＜0.05);射频止血肝切除组肝门阻断4例,较常规钳夹肝切除组的23例明显减少(x2=19.934,P＜0.05);射频止血肝切除组和常规钳夹肝切除组术中出血量分别为(241±214) ml和(751 ±421) ml,术中输血患者比例分别为15％ (6/41)和49％(20/41),两者比较,差异均有统计学意义(t=6.920,x2=11.038,P＜0.05).射频止血肝切除组和常规钳夹肝切除组在术后出血发生率、术后胆汁漏发生率方面比较,差异无统计学意义(x2=0.213,1.822,P＞0.05);射频止血肝切除组术后住院时间为(9±4)d,比常规钳夹组的(12±7)d明显减少(t=2.368,P＜0.05).两组均无围手术期死亡患者.结论 新型手术辅助器械射频凝血器能够有效地控制出血、减少手术时间,缩短术后住院时间,在原发性肝癌手术治疗中有较大的应用价值.     

微波止血分离器在降低肝门板的肝癌切除术中的应用

目的探讨微波止血分离器在降低肝门板的肝癌切除手术中的临床应用价值。方法回顾分析2010年至2012年70例应用微波止血分离器进行的降低肝门板的肝癌切除手术资料,采用微波止血分离器(HeSetor)进行肝门板解剖及断肝,术中仅阻断切除侧肝门;与同期40例常规手术对照组资料进行比较,该组采用常规Pringle阻断肝门及钳夹断肝。结果两组手术均顺利完成。HeSetor结合降低肝门板组手术时间平均(115.4±42.3)min;术中出血量平均(120.0±105.2)ml,术中均无输血;术后肝功能生化检查平均在(6.3±2.7)d恢复;术后并发症发生率为15.7%(11/70),其中胸腔积液5例(7.1%),腹水6例(8.6%);术后平均住院(6.4±3.5)d。常规手术对照组手术时间平均(169.1±86.5)min;术中出血量平均(360.5±153.1)ml,术中3例输血(7.5%);术后肝功能生化检查平均在(9.1±5.6)d恢复;术后并发症发生率为30.0%(12/40),其中胸腔积液5例(15.0%),腹水5例(15.0%),胆瘘2例(7.5%);术后平均住院(11.1±6.3)d。两组间以上指标比较,P值均小于0.05。结论应用微波止血分离器进行的降低肝门板的肝癌切除手术是一种安全可靠的肝切除方法,术中出血少,容易掌握,术后恢复快,值得临床推广应用。     

肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用

目的探讨肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用价值。方法回顾性分析2013年1月至2016年10月在中山市人民医院行肝切除联合腹腔热灌注化疗的20例肝癌自发破裂出血患者的临床资料。统计和分析患者的手术时间、术中出血量、术后并发症、术后住院时间及随访情况。结果患者均顺利完成手术,肿瘤切除后切缘均为阴性,患者无围手术期死亡。手术时间为(204±45)min;术中出血量为100~800 m L,平均270 m L;术后住院时间为(11±4)d。术后发生胸腔积液及腹腔积液各2例,经保守治疗治愈。1例于术后3个月肿瘤复发并死亡,其余恢复良好。结论肝切除联合腹腔热灌注化疗应用于肝癌自发破裂出血是安全、有效的,具有止血确切、防治肿瘤种植转移及复发的优势。     

腹腔镜肝切除术20例临床分析

目的 探讨腹腔镜下肝切除术的可行性及相关技术问题如术中出血的控制、肝实质离断方法和肝断面的处理方法等.方法 自2011年6月至2014年4月共施完全腹腔镜肝切除术20例,对其临床资料进行回顾性分析.结果 20例患者中肝血管瘤10例,肝细胞性肝癌9例,乙状结肠癌肝转移1例.2例位于肝脏第Ⅱ和第Ⅲ段,8例位于第Ⅲ段,7例位于第Ⅵ段,第Ⅳb、Ⅴ、Ⅶ段各1例.平均肿瘤直径（4.7±1.9） cm.肝肿瘤局部切除6例,肝左外叶切除7例,肝右后叶切除2例,肝段切除5例.单独使用超声刀离断肝组织8例,超声刀联合Habib4X射频止血凝固器离断肝组织6例,超声刀联合Endo GIA离断肝组织6例.平均手术时间（196±57） min,术中出血量（380±459）ml,术后出现中等量腹水1例、胆漏1例,顽固性胸腔积液1例,均经保守治疗治愈.术后平均住院时间（9.2±3.5）d.10例恶性肿瘤患者术后随访1～35个月,5例出现肝内复发.结论 在严格掌握手术适应证的前提下,腹腔镜肝切除术是安全可行的;根据肝脏质地的不同,选择不同离断肝实质的器械,可减少术中出血.     

肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除术的初步经验

目的 初步总结肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除的安全性及疗效.方法 2005年4月至2008年5月共对11例肝脏良恶性肿瘤患者行腹腔镜下解剖性肝左外叶切除术(男性7例、女性4例,平均年龄51.7岁).其中原发性肝癌4例,伴不周程度肝硬化;结肠癌术后转移性肝癌1例;肝血管瘤5例(2例合并胆囊结石同时切除胆囊);巨大肝血平滑肌脂肪瘤1例.肿瘤最大径2.1～12.0 com,平均5.8cm,所有肿瘤均位于肝左外叶(Ⅱ、Ⅲ段).结果 手术时间为120～180 min,平均147 min.无中转开腹手术病例,无输血,无手术并发症.术后平均住院5.9 d.结论 对于位于Ⅱ、Ⅲ段的肝脏肿瘤施行腹腔镜下肝左外叶切除术是安全的.     

肝蒂联合右肝静脉阻断在巨块型肝癌切除中的应用

目的评估肝蒂联合右肝静脉阻断在巨块型肝癌切除中的作用和意义。方法对2003年2月至2006年8月中南大学湘雅二医院肝胆外科收治的138例位于右半肝及中央型的巨大肝癌行肝蒂联合右肝静脉阻断,观察肝脏血流阻断时间、手术时间、术中出血量、术后肝功能的变化及术后并发症。结果135例在肝外游离出右肝静脉并加以阻断,3例以小的心耳钳沿腔静脉方向纵行夹住右肝静脉阻断出肝血流。所有病例右侧均顺利阻断肝蒂。肝脏血流阻断时间平均为(18±6)min,手术时间平均为(180±45)min,术中出血400~1200mL,56例术中未输血。术后无一例发生肝功能衰竭。术后膈下感染2例,胆漏4例,经引流自愈。结论在巨块型肝癌切除中,肝蒂联合右肝静脉阻断技术可以有效地减少术中出血,降低术后肝功能衰竭的发生率。     

螺旋水刀在复杂肝脏切除手术中的应用

目的 探讨螺旋水刀在复杂肝脏切除手术中对肝脏组织分离的效果.方法 回顾性分析47例患者使用螺旋水刀进行复杂肝脏切除手术的临床资料,观察术中出血量、手术时间、术后肝功能恢复及术后并发症等指标.结果 本组47例患者中肝脏巨大海绵状血管瘤10例,原发性肝癌34例,其他肝脏肿瘤3例.手术方式包括肝尾状叶切除6例,肝脏Ⅵ段+Ⅶ段切除19例,肝中叶(Ⅳ+Ⅴ+Ⅷ段)切除9例,肝脏Ⅷ段切除5例,肝右三叶切除8例.手术时间(240±85)min,术中出血量(950±650)ml,输血在400 ml以上者13例,占27.7%,术后肝功能在一周左右恢复接近正常,术后平均住院时间(12.5±4.7)d.术后并发症包括腹水6例,胸水4例,肺不张2例,肺部感染4例,无严重并发症及手术死亡发生.结论 螺旋水刀能提高肝脏手术的精准性,减少术中大出血危险和术后并发症发生,在复杂肝脏切除手术中值得推广应用.     

精准肝切除治疗肝胆恶性肿瘤31例

分析基于解剖性肝切除的精准肝切除治疗肝胆恶性肿瘤的方法与效果。选取2014年6月—2015年11月实施精准肝切除手术治疗的肝胆恶性肿瘤患者31例,术前对患者的肝功能、肝脏储备功能及预留肝脏体积等进行综合评估;所有患者以钳夹粉碎法、超声止血刀、PK刀、超声解剖刀和水刀等完成肝切除;观察手术时间、术中出血量、术后并发症及病死率等。31例患者均完成精准肝切除,所有恶性肿瘤切除后切面边缘阴性;手术平均时间为(304.0±35.6)min,术中平均出血量(473.0±24.5)m L;术后2例出现胆瘘,经过非手术治疗后约2周胆瘘消失;2例肝硬化严重患者出现术后肝功能衰竭,总胆红素高达200μmol/L,出现腹水和引流管渗血,经护肝对症治疗后恢复;3例出现严重肺部感染,腹腔脓肿和严重切口感染各2例,均经治疗后痊愈;术后并发症的总体发生率为35.48%;术中及术后无一例死亡,随访期内有2例肝细胞癌患者出现肝内复发,1例胆囊癌患者出现肝转移。精准肝切除是以清晰的肝脏生理解剖、严密地术前评估及精密的手术方案为前提,术中利用手术器械在解剖性肝切除的基础上完成精确地肝脏切除,更有利于减少患者病痛及患者病情的康复。     

腹腔镜解剖性肝切除治疗位于中央部位肝癌单中心经验

目的探讨腹腔镜解剖性肝切除治疗中央部位肝细胞癌的安全性和可行性。方法2015年1月至2019年12月,12例肿瘤位于肝中央部位的肝细胞癌患者在佛山市第一人民医院肝脏外科实施了腹腔镜肝切除;其中男9例、女3例,平均年龄(55.5±6.8)岁,平均肿瘤直径(3.7±2.5)cm,术前肝脏储备功能ICG-R15(3.9±2.82)%,肝功能Child-Pugh分级A级。实施肝Ⅳ~Ⅷ段切除5例、肝Ⅴ~Ⅷ段切除6例、肝Ⅳ段切除1例。统计分析手术时间、手术切缘、术中出血量、术后并发症及住院时间等。结果12例患者均在腹腔镜下完成手术,无中转开腹,平均手术时间(398.8±115.4)min,平均术中出血量(420.8±279.2)ml,有1例输血,术后平均住院时间(9.1±2.2)d,无围手术期死亡病例,术后并发症包括肝断面出血1例、胆漏1例、膈下包裹性积液1例,平均手术切缘(1.2±0.6)cm。结论对位于肝中央部位的肝细胞癌,行解剖性肝Ⅳ~Ⅷ段切除、肝Ⅴ~Ⅷ段切除以及肝Ⅳ段切除是安全、可行的。采取肝内Glissonian鞘外的方法预先控制肝蒂有利于掌握断肝平面,术前精准的评估,术中有效的控制出血以及娴熟的腔镜外科技术能有效帮助术者安全实施手术。     

低中心静脉压联合Habib 4X应用对肝叶切除术中出血量的影响

目的观察控制性低中心静脉压技术联合Habib4X射频止血切割器应用对肝叶切除术中出血量的影响。方法择期全麻下因肝血管瘤需行肝叶切除手术的患者80例,ASAⅠ或Ⅱ级,随机均分为控制性低中心静脉压联合Habib4X组(L组)和正常中心静脉压联合传统缝扎法组(C组)。L组在肝实质完全离断过程中将CVP控制在0～5cm H2O,C组维持CVP在6～12cm H2O。观察两组患者术中总出血量、输血量、输血例数、肝门阻断例数、肝实质离断时间和肝实质离断后及术后24h肾功能变化。结果 L组手术总出血量、输血量、输血率、肝门阻断率、肝实质离断时间明显低于C组(P<0.05)。两组患者尿量差异无统计学意义,肝实质离断后、术后24h肾功能无明显变化。结论控制性低中心静脉压技术联合Habib4X射频止血切割器应用可减少肝叶切除术出血量和输血量。     

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.