常规IVF完全/部分受精失败后行早期补救ICSI的应用价值

目的探讨短时受精联合早期补救卵胞浆内单精子注射(R-ICSI)在常规体外受精(IVF)受精失败和低受精周期的临床应用效果。方法回顾性分析653个体外受精-胚胎移植(IVF-ET)周期,根据受精情况将患者分为3组:因IVF全卵不受精行早期R-ICSI者131个周期(A组);因IVF低受精行早期R-ICSI者100个周期(B组);因男方因素直接行ICSI者422个周期(C组)。比较3组患者的一般情况和临床结局。结果 (1)C组原发不孕的比例(68.48%)显著高于A组(56.49%)和B组(51.00%)(P0.05);(2)C组的3PN率(0.77%)显著低于A组(2.25%)和B组(2.91%)(P0.05),B组的优胚率(34.71%vs.41.53%vs.41.84%)和胚胎利用率(56.28%vs.65.87%vs.63.46%)显著低于A组和C组(P0.05);(3)3组的MII卵率、2PN率、囊胚形成率、临床妊娠率、胚胎种植率和流产率比较均无统计学差异(P0.05)。结论短时受精联合早期R-ICSI可有效克服常规IVF受精障碍,显著提高受精率,获得良好的妊娠结局。     

体外受精-胚胎移植多精受精的发生与妊娠结局的关系

目的探讨供精体外受精-胚胎移植(IVF-ET)过程中多精受精的发生率和妊娠结局的关系。方法回顾性分析2013年1月~12月来我院进行新鲜周期IVF-ET治疗的患者,其中长方案IVF-ET组1 388例,短方案IVF-ET组311例,供精IVF-ET组276例。根据多精受精率不同,供精IVF-ET周期分为3组,正常受精组:多精受精率为0;低频多精受精组:0多精受精率≤20%;高频多精受精组:多精受精率20%。比较各组的女方年龄、平均获卵数、正常受精率(2PN)、正常受精优胚率、正常受精可用胚胎率、种植率、临床妊娠率及流产率。结果供精IVF组和IVF长方案组的女方年龄显著低于IVF短方案组(P0.05),平均获卵数和多精受精发生率显著高于IVF短方案组(P0.05)。正常受精组(64.79%)和低频多精受精组的正常受精率(62.46%)显著高于高频多精受精组(43.93%)(P0.05);种植率和临床妊娠率高于高频多精受精组,但差异无统计学意义(P0.05);各组之间的优胚率、可用胚胎率及流产率无显著性差异(P0.05)。结论供精IVF-ET过程中,高频多精受精的发生会显著影响正常受精率,可能会降低种植率和临床妊娠率。     

卵母细胞的脱颗粒时间对短时受精后胚胎质量和妊娠结局的影响

目的探讨运用短时受精进行体外受精In vitro fertilization(IVF)时,去除卵子周围颗粒细胞的不同时间对短时受精后胚胎发育质量和妊娠结局影响。方法选择行IVF助孕的原发和继发不孕,且本周期移植的患者323例,按照卵母细胞不同的脱颗粒时间分为A组103例和B组220例。A组移植短时受精后3h去除颗粒细胞发育的胚胎;B组移植短时受精后20h后去除颗粒细胞发育的胚胎,比较两组胚胎的临床指标和发育参数。结果在年龄、不孕年限、原发/继发、Gonadotropin(Gn)用量、Gn使用天数、移植日的内膜厚度等临床资料及卵母细胞数、meiosis II(MII)卵数、2PN卵数、3 PN卵数、1-pronuclei(1 PN)卵数、2-pronuclei(2PN)分裂数、优质胚胎数、移植胚胎数、种植率等胚胎发育参数方面两组间没有显著性差异(P0.05);但在3-pronuclei(3PN)卵数上两组间差异极显著(P0.01),在种植率和临床妊娠率上两组间差异显著(P0.05)。结论短时受精过程中,在确保患者正常受精的情况下,将剩余的卵母细胞保留颗粒细胞可以改善妊娠结局。     

早期补救ICSI对首次IVF助孕周期临床结局的影响

目的探讨早期补救ICSI对首次IVF周期临床结局的影响。方法回顾性分析2008年1月至2012年12月于本中心行首次IVF治疗的5 029个取卵周期,IVF受精4~6h后根据第二极体的排出情况判断受精与否,对半数以上卵母细胞未受精的患者实施补救ICSI,其余患者继续行常规IVF,比较补救ICSI组(n=413)及常规IVF组(n=4 616)患者的基本情况及临床结局,并计算早期补救ICSI对首次IVF周期临床结局的贡献值。结果早期补救ICSI组原发性不孕患者的比例及不育年限显著高于常规IVF组,输卵管及盆腔因素患者的比例显著低于常规IVF组,基础FSH显著低于常规IVF组,窦卵泡数显著高于常规IVF组(P均0.01);补救ICSI组获得了较多的卵母细胞数[(9.65±5.20)vs.(8.89±5.48)个]及成熟卵数[(8.36±4.56)vs.(7.88±5.01)个](P0.01),但受精数[(6.22±3.70)个]与优质胚胎数[(2.94±2.76)个]均显著低于常规IVF组[分别为(7.05±4.74)个、(3.40±3.03)个](P0.05),同时多原核(≥3PN)胚胎率(5.85%)也显著低于常规IVF组(8.26%)(P0.01);两组患者的种植率、临床妊娠率及流产率比较无统计学差异(P0.05);早期补救ICSI对首次IVF周期双原核(2PN)受精率的贡献值为4.25%,对优质胚胎率的贡献值为3.67%,对临床妊娠率的净贡献值为2.72%,总贡献值为3.49%。结论早期补救ICSI取得了和常规IVF相似的临床结局,有效提高了首次IVF周期的临床妊娠率,是针对IVF周期受精完全失败或低受精的有效治疗手段。     

比较time-lapse培养和常规体外受精胚胎培养对临床结果的影响

目的比较分析延时摄像胚胎观测技术(time-lapse)培养和常规体外受精(IVF)胚胎培养对临床结局的影响。方法回顾性分析2013年10月至2015年1月期间110例time-lapse周期和2 274例常规IVF胚胎培养周期的临床结果。分别在周期受精数≤10和10的情况下,比较time-lapse培养周期和常规IVF胚胎培养周期的卵裂数、D3优质胚胎数、D3优质胚胎率、种植率、临床妊娠率。结果在周期受精数≤10的情况下,time-lapse培养周期组和常规IVF胚胎培养周期组的卵裂数、优质胚胎数、优质胚胎率比较均无显著性差异(P0.05),两组种植率(30.1%vs.35.4%)和临床妊娠率(47.7%vs.55.5%)亦无统计学差异(P0.05)。而在周期受精数10的情况下,time-lapse培养周期组和常规IVF胚胎培养周期组的种植率(56.8%vs.40.0%)和临床妊娠率(77.8%vs.57.5%)均存在显著性差异(P0.05)。结论受精数10的周期通过time-lapse培养,可以获得比常规IVF培养更高的种植率和临床妊娠率。     

常规IVF完全/部分受精失败后行早期补救ICSI的应用

目的探讨常规短时受精联合早期补救卵胞浆内单精子注射(R-ICSI)在常规体外受精(IVF)失败和低受精率周期中的临床应用效果。方法回顾性分析2012年1月至2017年12月在河北省生殖医学中心接受IVF/ICSI-ET助孕治疗的2811个周期的临床资料,根据受精方式不同分为3组:R-ICSI组(210个周期):实施早期R-ICSI;IVF组(2062个周期):行常规IVF助孕;ICSI组(539个周期):直接行ICSI助孕。比较3组患者的一般情况、实验室指标和妊娠结局。结果R-ICSI组的原发不育比例显著高于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。3组患者的平均获卵数、移植胚胎数及MⅡ率比较均无显著性差异(P>0.05);R-ICSI组患者的受精率显著高于IVF组和ICSI组(P<0.05);R-ICSI组患者的2PN率显著低于ICSI组(P<0.05),但与IVF组比较无显著性差异(P>0.05);R-ICSI组的多PN率显著高于ICSI组,但显著低于IVF组(P<0.05);R-ICSI组患者的优胚率、可利用胚胎率及临床妊娠率均显著低于IVF组和ICSI组(P<0.05);R-ICSI组患者的着床率显著低于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。结论常规IVF受精失败及低受精的患者行早期R-ICSI可有效克服受精障碍,提高受精率,获得较好的妊娠结局。     

部分ICSI在体外受精胚胎移植中预防受精失败临床效果

目的探讨部分ICSI(half-ICSI)在IVF-ET中预防受精失败的临床价值。方法回顾性分析2010年3月至2013年3月在本院生殖中心行half-ICSI治疗的77例患者(77个周期)。在77个周期中,一半卵母细胞行常规IVF受精,一半卵母细胞行ICSI治疗。在行half-ICSI患者中,以行IVF的一半卵母细胞是否正常受精进行分组:受精失败组(A组,31例)和受精正常组(B组,46例),对比两组患者的女方年龄、不育年限、不育原因、获卵数、成熟卵比例、优质胚胎率、种植率及妊娠率和临床累积妊娠率,同时比较两组ICSI的正常受精率及异常受精率。结果77个周期中常规IVF的受精率低下占40.2%(31/77),其中完全受精失败占25.9%(20/77)。受精失败组的不育年限比正常受精组长,差异有统计学意义(P0.05)。两组的女方年龄、不育原因、获卵数、成熟卵比例、优质胚胎率、临床累积妊娠率相比较,差异均无统计学意义(P0.05)。常规IVF受精失败组的胚胎移植数多于受精正常组,差异有统计学差异(P0.05),但两组的种植率及妊娠率差异无统计学意义(P0.05)。两组中ICSI的正常受精率和异常受精率差异均无统计学意义(P0.05),但B组的可用胚胎数多于A组,两组差异有统计学意义(P0.05)。结论对于原发不育年限较长,且无明确不育原因的患者可选择行half-ICSI受精方式,其不仅能有效防止受精失败,还能获得较理想的妊娠结局,这是预防受精失败行之有效的方法之一。     

发生早期胚胎发育阻滞的IVF周期临床结局探讨

目的探讨IVF周期中发生早期胚胎发育阻滞现象是否影响患者的临床结局。方法回顾性分析自2008年1月至2012年12月于本院生殖医学中心行IVF治疗且于取卵后第3天行新鲜胚胎移植的3 030个周期,根据移植周期中是否发生早期胚胎发育阻滞现象分为A组(发育阻滞组,移植日至少有1枚胚胎发生早期胚胎发育阻滞)及B组(正常对照组,移植日没有胚胎发生早期胚胎发育阻滞),比较两组患者的一般情况及临床结局。结果 A组患者的基础FSH水平低于B组患者,窦卵泡数多于B组患者,获卵数与成熟卵数均多于B组患者,具统计学差异(P0.01);但A组患者的可用胚胎率、优质胚胎率及移植优质胚胎率均显著低于B组患者(P0.01),同时A组患者的临床妊娠率与活产率均显著低于B组患者,具统计学差异(P0.05)。结论 IVF周期中发生早期胚胎发育阻滞的周期与正常对照组相比有较差的胚胎质量与临床结局。     

卵胞浆内单精子注射在常规体外受精失败病例中的应用

目的评价卵胞浆内单精子注射(ICSI)对常规体外受精(IVF)失败病例的应用效果。方法对于常规IVF受精失败的病人在第2天进行补救ICSI(A组)21个周期,或在下一个周期直接应用ICSI技术治疗(B组)18个周期。分别与因严重少、弱精子症而行ICSI的243周期(对照组)的受精率、优质胚胎率和妊娠率等进行比较。结果A组的受精率、卵裂率、优质胚胎率分别为61.53%、81.73%、72.94%,均比B组的83.87%、97.69%、84.25%显著降低(P<0.05),而两组的多原核率差异无显著性(3.55%vs1.29%,P>0.05)。比较临床妊娠率、种植率和冷冻周期率,B组与对照组均无显著差异,而A组与对照组均有显著差异。结论常规IVF受精失败者可通过第2天补救ICSI或下一周期直接行ICSI而提高受精率和种植率,而后者比前者能获得更好的妊娠结局。     

发育不同步且未行穿刺的大卵泡在取卵日有无卵母细胞对IVF-ET结局的影响

目的研究在取卵当日从发育不同步且未行穿刺抽吸的大卵泡中是否获得卵母细胞对IVF/ICSI-ET的临床结局的影响。方法回顾性分析卵泡发育不同步且未行大卵泡穿刺抽吸的146个IVF/ICSI-ET周期的临床资料。根据取卵日大卵泡中是否获得卵母细胞分为两组:未获卵组(A组,72个周期)和获卵组(B组,74个周期)。比较两组卵母细胞成熟率、2PN正常受精率、2PN卵裂率、优质胚胎率、胚胎种植率及临床妊娠率等的差别。结果 A、B两组的基本情况如女方年龄、不育年限、促性腺激素(Gn)总量、Gn天数、基础和HCG日的FSH、LH、E2、孕酮(P)水平,移植日子宫内膜厚度等,均无显著性差异(P0.05)。A组的卵母细胞成熟率(91.21%)及2PN卵裂率(98.74%)均高于B组(86.46%和96.54%)(P0.05)。两组的平均获卵数、平均移植胚胎数、2PN正常受精率、2PN卵裂率、优质胚胎率、胚胎种植率及临床妊娠率均无显著性差异(P0.05)。结论在控制性促排卵(COH)过程中如出现卵泡发育不同步且未行大卵泡穿刺的患者,可调整Gn用量来调节卵泡发育。在取卵日是否从大卵泡中穿刺获得卵母细胞并不影响临床妊娠结局。     

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.