构建大段可控微结构组织工程骨的实验研究

目的 应用仿生设计和光固化快速成型间接构造方法 构建大段可控微结构组织工程骨,观察其与成骨细胞在体外培养条件下的生物相容性.方法 基于对密质骨哈佛系统的简单仿生,应用计算机辅助设计(CAD)软件设计具有微丝架结构的圆柱形支架模型.建模后输入光固化快速成型机,制成树脂模具,充填磷酸钙骨水泥(CPC),800℃下加min熔去模具,制成CPC支架.将兔颅骨成骨细胞与支架复合培养3、7、14d后,于共聚焦激光扫描显微镜(CLSM)、扫描电镜下观察细胞在支架表面及微孔道内部的黏附、生长和增殖情况.结果 支架CAD模型为直径16 mm,长10 mm的圆柱体,内部由5层微丝网平行叠加形成相互连通的三维网架,微丝直径分别为200μm和500μm.制成支架的大体形态及内部三维微结构与设计模型一致,所构成的微孔道孔径范围260～580μm.CLSM下观察:特异性荧光探针标记显示细胞骨架成网状贯穿整个细胞和细胞突起;SEM下观察:培养3d时支架表面有梭型细胞铺展生长,有多个突起,大小10～30μm;7d后细胞在支架表面基本汇合,并向微孔内爬行生长;14d后大量细胞爬行人微孔内.结论 基于哈佛系统简单仿生设计和快速成型技术制备的大段组织工程骨,实现了微结构的完全精确调控,其微孔利于成骨细胞进入,具有良好的生物相容性,为大段组织工程骨的仿生制造提供了实验依据.     

Mimics软件重建距骨模型结合踝后内侧入路治疗距骨后突骨折

目的评价术前Mimics软件重建距骨后突骨折三维模型,结合踝后内侧入路治疗距骨后突骨折的优势。方法回顾性分析北京积水潭医院创伤骨科2015年5月至2019年2月采用术前Mimics软件重建距骨后突骨折三维模型结合踝后内侧入路治疗的7例距骨后突骨折患者资料。男5例,女2例;年龄20~70岁,平均39岁。术前常规行CT检查,应用Mimics软件基于CT扫描数据三维重建距骨后突以明确骨折块大小、数量和移位程度,踝后内侧入路切开复位螺钉内固定治疗距骨后突骨折。术后采用美国足踝外科协会(AOFAS)的踝-后足评分系统评估功能恢复情况。结果本组患者手术时间70~105 min,平均87.1 min。术后早期伤口均愈合良好,无神经、肌腱损伤。所有患者术后随访4~24个月,平均12个月。10~16周复查X线片骨折愈合,未发现断钉、骨不连和畸形愈合及创伤性关节炎等并发症发生。末次随访时AOFAS的踝-后足评分为80~98分,平均87分。结论术前CT影像基于Mimics软件重建距骨后突骨折三维模型可精确定位进钉点和进钉方向,用于踝后内侧入路术中有清楚显露、骨折易复位、置钉方便的优势。     

CT扫描资料间接法建立股骨上段三维有限元模型

目的 建立正常人体股骨上段三维有限元模型，作为今后该部位进一步有限元分析的基础。方法 采用活体股骨上段为对象，应用CT扫描技术，图形数字化方法获取股骨上面三维坐标，输入有限元分析软件ANSYS5．6，通过确定材料特性参数和网格化，建立完整的股骨上段三维有限元模型。结果 建立的三维有限元模型几何形状与材料特性还原良好，网格大小可根据研究者的需要在一定范围内自行调整，可以满足有限元分析的需要。结论 采用CT扫描资料建立三维有限元模型切实可靠；间接法建立三维有限元模型比直接法更加简便，高效，可以更精确地模拟复杂几何形态的实体。     

消炎痛、阿斯匹林及布洛芬对人工假体微孔涂层内骨长入的影响

新骨长入家兔股骨内人工假体的微孔涂层后,就可以为假体提供一个生物的固定。绝大多数进行人工假体植入术的医师希望有更多新生骨组织长入假体表面的微孔涂层内。影响新骨长入微孔涂层内的条件,可以最终引起无骨水泥关节成形术的失败。消炎痛、布洛芬及阿斯匹林可以抑制动物与人的异位骨形成,也可以抑制骨折愈合及骨改建。本研究的目的是探     

股骨上段有限元几何模型的建立与分析

目的建立股骨骨结构三维有限元模型并对其进行分析以指导临床工作。方法在Mimics10.1中直接读取符合Dicom 3.0标准的股骨原始CT数据,经阈值设定、区域增长及形态学操作等生成股骨初始3D模型,后期结合有限元软件ANSYS12.1生成最终的三维有限元网格模型,然后在ANSYS12.1中分别对应用Mimics得到的模型进行分析。结果应用Mimics10.1和Ansys12.1软件建立股骨有限元模型,外形逼真、计算精确。结论 Mimics10.1软件能直接与Ansys12.1软件进行对接,并能根据CT值直接赋值使股骨上段三维有限元模型的建立更加快捷、精确。     

数字化珊瑚羟基磷灰石人工骨的制备及性能研究

[目的]探讨数字化珊瑚羟基磷灰石人工骨的制备方法,并研究其理化及结构性能。[方法]将珊瑚羟基磷灰石粉碎成250～500μm微粒,然后将其与左旋-聚乳酸以不同的质量比(2:1、3:1、4:1、5:1)混合均匀后备用。采用Simpleware3.1软件,通过计算辅助设计构建一数字化的圆柱形模型,通过数控转换,将其生成STL格式的文件,导入快速成型机,采用选择性激光烧结快速成型的工艺,将数字化的模型制备成不同质量比的数字化CHA人工骨支架材料。采用压汞仪、材料力学试验机和扫描电镜对不同质量比的数字化CHA人工骨的理化、结构和力学性能进行分析。[结果]对不同的质量比混合均匀的CHA微粒与左旋聚乳酸混合物,采用计算机辅助设计和选择性激光快速成型的工艺,可以制备出数字化CHA人工骨,其加工精度为+0.1cm;随着CHA含量的增多,亲水率、孔隙率和密度逐渐增加,抗压强度逐渐降低,其抗压强度为1.04～3.70MPa;制备的数字化人工骨均具备微孔样结构,孔与孔之间纵横交错,孔径为150～350μm,随CHA含量的增多,大孔径所占的比例逐渐增多。[结论]采用质量比为3:1～4:1的CHA微粒与L-PLA的混合物为原料,通过计算机辅助设计和选择性激光烧结快速成型的工艺,制备的数字化CHA人工骨其理化、结构性能和力学性能优越,具有作为个性化人工骨材料的应用潜力。     

三维连通多孔钛修饰的人工股骨复合骨形态发生蛋白的实验研究

目的将人工股骨柄表面贴敷复合了骨形态发生蛋白的三维连通多孔钛,观察早期骨长入情况。方法将表面贴敷三维连通多孔钛的犬人工股骨柄直接或通过纤维蛋白胶与骨形态发生蛋白复合,植入犬股骨,植入后2、5周荧光标记,3、6周取材病理观察。结果植入后3周,骨已长入多孔材料一半,植入后6周,宿主骨与假体成为一体,骨长入多孔材料全层;第6周时成骨量明显高于第3周。结论具有三维连通多孔钛表面的假体与骨形态发生蛋白复合后能使骨长入加快,骨整合的程度提高,达到机械锁定和骨整合的双重固定,减少假体松动。     

计算机辅助设计及电子束熔融快速成型金属3D打印技术制备个性化股骨假体

目的探讨计算机辅助设计技术联合电子束熔融快速成型(electron beammelting rapid prototyping,EBM-RP)金属3D打印技术制备个性化股骨假体的可行性。方法采用64层螺旋CT对1具成年男性左侧股骨标本进行扫描,将获得的断层图像数据导入Mimics15.0软件重建股骨三维模型,再应用UG 8.0软件设计个性化股骨假体三维模型;最后导入EBM-RP金属3D打印机打印个性化袖套。结果根据个体化股骨假体三维模型,采用EBM-RP金属3D打印技术成功制备个性化袖套,与SR股骨柄体组配,制成个性化股骨假体。结论通过薄层CT扫描及计算机辅助设计技术可设计与干骺端良好匹配的个性化股骨假体;采用EBM-RP金属3D打印技术可打印具有复杂三维形态、表面微孔、与干骺端髓腔匹配的钛合金个性化股骨假体,该技术具有简便、快速、准确的优点。     

术前CT三维重建提高人工股骨假体匹配度的临床研究

目的探讨选择CT三维重组图像代替X线图像做术前计划是否可提高人工股骨假体与股骨近端髓腔解剖形态的匹配度。方法选择2013年1月至2015年12月,在广州医科大学附属第一医院关节外科接受初次人工髋关节置换的发育性髋臼发育不良(DDH)患者38例(46髋),排除了髋骨关节炎,股骨头缺血坏死,曾行髋关节截骨矫形术,或者CroweⅣ型的患者。在做术前计划时,双盲随机数字法抽选23髋(X线组)使用标准X线图像测量;23髋(CT组)使用CT三维重建图像测量。术中使用非骨水泥股骨柄。记录术前计划与术中使用假体型号的大小,得到两者的符合率,应用卡方检验比较两组符合率的差异。术后2周内两组患者行CT扫描。利用CT自带的测量软件测量股骨近端髓腔的解剖学参数,包括测量代表假体近段匹配度的股骨颈截骨位置,股骨颈截骨远端2.5 cm位置,代表假体远段匹配度的股骨颈截骨远端7.5 cm位置,股骨干峡部位置的髓腔冠状径、矢状径;以及人工股骨假体在同一解剖位置的冠状径、矢状径。股骨髓腔与人工股骨假体径线之间的差值大小代表了两者的匹配度。配对t检验比较两组间匹配度的差异。结果 X线组术前计划与术中使用假体型号的符合率低于CT组(x~2=5.03,P0.05)。X线组患者假体与股骨近端髓腔的匹配度较CT组低,包括股骨颈截骨位置、股骨颈截骨远端2.5 cm位置、股骨颈截骨远端7.5 cm位置和股骨干峡部位置(冠状径差值比较,t=2.234、2.081、2.449、2.245,P0.05;矢状径差值比较,t=2.435、2.033、2.145、2.296,P0.05)。结论 DDH患者选择使用CT重组图像做人工髋关节置换术前计划,可以提高术中使用人工股骨假体的符合率,也能提高术后人工股骨假体与髓腔的匹配度。     

基于偏髓分型应用骨水泥型长短柄假体置换治疗高龄偏髓Ⅰ型粗隆间骨折的有限元分析（英文）

[目的]探讨高龄偏髓Ⅰ型粗隆间骨折行骨水泥型股骨假体置换术后的股骨应力分布,并对比分析长、短假体柄置换后的应力分布差异。[方法]利用螺旋CT对志愿者的右侧股骨进行断层扫描获取图像数据,将图像数据经Mimics软件和建模软件处理后重建股骨三维模型。在此基础上,建立偏髓Ⅰ型粗隆间骨折长、短柄股骨假体及骨水泥套的三维实体模型,最后利用有限元分析软件建立长、短柄股骨假体治疗粗隆间骨折的三维有限元模型,并对该模型进行生物力学分析。[结果]长、短柄假体置换后股骨的应力分布没有发生明显改变,依然是由近端向远端逐渐增加,至内外侧中下1/3交界处达到峰值,再向末端又减小。短柄假体骨水泥-假体柄界面在末端内外侧虽形成应力集中区,且外侧峰值为15.3 MPa,但未超过骨水泥疲劳强度;而长柄假体在骨水泥-假体柄界面远端内外侧及内侧中段形成应力集中区,其峰值也均低于骨水泥疲劳强度。骨水泥重建的股骨距部位未见明显的应力集中区。[结论]骨水泥型长、短柄假体置换治疗高龄偏髓Ⅰ型粗隆间骨折不会引起股骨应力分布的明显改变。长柄假体的松动概率与短柄假体基本相当,但后者由于手术时间短、创伤小、并发症少,可能更适合治疗高龄偏髓Ⅰ型粗隆间骨折。     

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.