低氧诱导因子-1α在大鼠脊髓缺血再灌注损伤中的表达

目的　观察低氧诱导因子 1α(HIF 1α)在大鼠脊髓缺血再灌注损伤 (SCII)中的表达变化及其意义。方法　制备大鼠脊髓缺血再灌注损伤模型 ,分别于再灌注后 8、12、2 4h ,3和 5d取腰骶段的脊髓 ,以假手术组大鼠相同阶段的脊髓为对照 ,采用Westernblotting法和免疫组织化学检测伤后脊髓组织中HIF 1α的表达变化。结果　再灌注 8h左右 ,HIF 1α在整个脊髓灰质开始表达上调 ,在 2 4h达峰值 ,在伤后 3d表达回落 ,5d显著减少 ,灰度值在 8、12、2 4h ,3和 5d不同时相 ,分别为 (2 11.3 9± 5 .5 8)、(184.5 3± 6.5 6)、(167.3 9± 5 .76)、(198.44± 3 .98)和 (2 2 8.3 9± 2 .87) ,分别与假手术组比较 ,差异有显著性 (P <0 .0 5 )。HIF 1α在灰质中的表达以中央管周围和前角、后角最为显著。再灌注 2 4h和 3dHIF 1α在脊髓白质出现弱的表达 ,灰度值分别为 (2 3 8.15± 6.87)和(2 3 6.87± 7.41) ,分别与假手术组比较 ,差异有显著性 (P <0 .0 5 )。但在白质后索 ,HIF 1α的表达相对较强。HIF 1α在灰质中主要定位于神经元和星形胶质细胞 ,在白质中主要定位于神经胶质细胞。结论　HIF 1α呈现时序性的表达变化在脊髓缺血再灌注损伤中 ,可能是一种重要的脊髓缺血再灌注损伤的适应性调节。     

异搏定对缺血-再灌注大鼠胰腺细胞凋亡、组织钙及bcl-2、c-myc表达的影响

目的探讨异搏定对缺血-再灌注损伤大鼠胰腺组织钙、胰腺细胞凋亡及凋亡相关基因(bcl-2、c-myc)的影响。方法取Wistar大鼠30只,随机均分为假手术组、缺血-再灌注组及异搏定治疗组。缺血-再灌注组和异搏定治疗组钳闭大鼠腹腔干及肠系膜上动脉15min,再灌注12h,制备胰腺缺血-再灌注损伤模型。异搏定治疗组分别于缺血前15min及再灌注1h后经大鼠尾静脉注射异搏定溶液0.1mg/100g;缺血-再灌注组2次经尾静脉注射等体积生理盐水。再灌注12h后,活杀大鼠取胰腺,进行组织学观察,测定组织钙含量、胰腺细胞凋亡率和bcl-2、c-myc的表达。结果异搏定治疗组大鼠胰腺病理改变较缺血-再灌注组轻微;异搏定治疗组组织钙含量和胰腺细胞凋亡率均明显低于缺血-再灌注组(411.1±55.8)μg/g干重vs(470.9±31.9)μg/g干重;(9.5±2.9)%vs(18.4±3.1)%,P均<0.05;bcl-2、c-myc表达阳性细胞率及荧光指数异搏定治疗组均明显高于缺血-再灌注组(8.7±0.6)%vs(6.9±1.2)%,(13.6±2.4)%vs(10.3±1.9)%;1.72±0.11vs1.41±0.07,1.76±0.19vs1.55±0.13,P均<0.05。结论胰腺缺血-再灌注损伤中存在细胞凋亡机理的参与,异搏定降低胰腺组织钙含量,并促进凋亡相关基因bcl-2、c-myc的表达,抑制细胞凋亡,保护了缺血-再灌注损伤的胰腺。     

大鼠脊髓缺血再灌注损伤后CaMKII的表达及作用研究

[目的]探讨钙调蛋白依赖性蛋白激酶2(Ca MKII)在大鼠脊髓缺血再灌注损伤中作用。[方法]雄性SD大鼠56只,随机分为假手术组(n=8)、实验组(n=48),假手术组暴露肾动脉下腹主动脉,但不阻断,实验组采用Naslund腹主动脉阻断法制作脊髓缺血再灌注损伤模型,于再灌注后0、1、3、7、14、28 d取脊髓标本,HE染色观察脊髓病理变化,免疫组化和Westewrn blot检测Ca MKII的表达情况,TUNEL染色检测神经细胞凋亡。[结果]实验组脊髓组织出现明显病理学改变。Western blot在56KD分子量处可见Ca MKII蛋白特异性条带,假手术组Ca MKII表达较少,实验组0 d即出现Ca MKII表达增多,且随着时间延长表达量逐渐增多,于3 d达高峰后逐渐降低,至14 d时仍高于假手术组(P0.01)。免疫组化结果显示,Ca MKII蛋白主要表达于脊髓神经元胞浆,Ca MKII阳性细胞数的变化趋势与免疫组化结果相似。TUNEL染色示假手术组有少量凋亡细胞散在分布,实验组术后0 d开始出现凋亡细胞增多,3 d达高峰,后逐渐减少,28 d时仍高于假手术组(P0.05)。[结论]脊髓缺血再灌注损伤后Ca MKII表达增加,同时细胞凋亡数增多,Ca MKII可能通过调节细胞凋亡来影响脊髓缺血再灌注损伤。     

促红细胞生成素在大鼠脊髓缺血再灌注损伤中的表达及其意义

目的:观察促红细胞生成素(EPO)在大鼠脊髓缺血再灌注损伤(SCII)中的表达和重组人促红细胞生成素(rhuEPO)预处理对再灌注损伤脊髓神经细胞的作用。方法:将W ister大鼠分为正常组、假手术组、rhuEPO处理组和生理盐水对照组;rhuEPO处理组和生理盐水对照组于术前3h腹腔注射rhuEPO和生理盐水,制备大鼠脊髓缺血再灌注损伤模型。以免疫组化和W estern blot法检测脊髓组织中EPO的表达变化;以原位末端脱氧核糖核苷酸转移酶介导dUTP标记法(TUNEL法)检测细胞的凋亡情况。结果:EPO在无损伤脊髓中即有少量的表达,SCII后8h表达显著上调,于12、24h(12h与24h组比较差异无显著性意义,P>0.05)达高峰,伤后3d表达逐渐下调,5d仍保持较高水平。rhuEPO处理组SCII后8h、12h及24h时神经细胞凋亡水平明显低于生理盐水对照组,差异有显著性意义(P<0.01)。结论:在脊髓缺血再灌注损伤中EPO呈现时序性表达变化,可能是机体内源性神经保护的机制之一;EPO预处理能明显抑制SCII后神经细胞的凋亡。     

周围神经缺血再灌注损伤与神经元凋亡的关系

目的 研究大鼠周围神经缺血再灌注损伤与脊髓神经元凋亡的关系和规律,为临床防治此类神经损伤提供理论依据.方法 采用无损伤动脉夹暂时夹闭大鼠髂总、髂内、髂外及股动脉,不同时间段开放恢复血流再灌注的大鼠周围神经缺血再灌注模型,取脊髓腰骶膨大处脊髓灰质组织通过流式细胞仪检测细胞凋亡率进行分析.结果 各实验组均可检测到凋亡细胞,但各组细胞凋亡率均有所不同.各缺血组神经细胞凋亡率明显高于假手术对照组(P<0.01).缺血4 h组神经细胞的凋亡率高于其他各组,与2、12 h组比较差异具有统计学意义(P<0.05).细胞凋亡率最高出现在缺血4 h再灌注6 h组,缺血4、6、8 h组再灌注72 h后出现细胞凋亡率的下降,甚至低于未灌注组.结论 周围神经缺血再灌注损伤可以引起神经元的凋亡.不同缺血与再灌注时间,神经细胞的凋亡率也不尽相同.     

周围神经缺血再灌注损伤与神经元凋亡的关系

目的 研究大鼠周围神经缺血再灌注损伤与脊髓神经元凋亡的关系和规律,为临床防治此类神经损伤提供理论依据.方法 采用无损伤动脉夹暂时夹闭大鼠髂总、髂内、髂外及股动脉,不同时间段开放恢复血流再灌注的大鼠周围神经缺血再灌注模型,取脊髓腰骶膨大处脊髓灰质组织通过流式细胞仪检测细胞凋亡率进行分析.结果 各实验组均可检测到凋亡细胞,但各组细胞凋亡率均有所不同.各缺血组神经细胞凋亡率明显高于假手术对照组(P<0.01).缺血4 h组神经细胞的凋亡率高于其他各组,与2、12 h组比较差异具有统计学意义(P<0.05).细胞凋亡率最高出现在缺血4 h再灌注6 h组,缺血4、6、8 h组再灌注72 h后出现细胞凋亡率的下降,甚至低于未灌注组.结论 周围神经缺血再灌注损伤可以引起神经元的凋亡.不同缺血与再灌注时间,神经细胞的凋亡率也不尽相同.     

异丙酚对脊髓缺血再灌注损伤大鼠脊髓细胞凋亡的影响

目的 探讨异丙酚对脊髓缺血再灌注损伤大鼠脊髓细胞凋亡的影响。方法成年雄性清洁级Wiser大鼠60只，体重200～250g，随机分为异丙酚组（A组）和缺血再灌注组（B组），每组30只，采用改进的Zivin等的方法制备脊髓缺血再灌注模型，缺血的同时A组腹腔注射异丙酚100mg/kg，B组注射等量生理盐水。每组分别于再灌注6h、1d、2d、3d、7d时处死6只大鼠。根据Tador评分评价大鼠后肢神经功能损伤情况，电镜下观察脊髓的病理学变化，用免疫组化法测定脊髓cyclinD1阳性细胞表达，原位末端标记法（TUNEL法）检测凋亡细胞，计算凋亡指数。结果A组脊髓损伤及后肢神经功能损伤均较B组轻，A组脊髓神经细胞凋亡指数及cyclinD1表达均低于B组（P〈0．05或0．01）。结论异丙酚对脊髓缺血再灌注损伤有一定的保护作用，其机制与下调脊髓cyclinD1表达，抑制神经细胞亡有关。     

脊髓急性缺血后功能障碍的保护

目的采用脊髓间断缺血和缺血预处理 2种干预方法 ,评估 2种缺血预处理方式对脊髓的保护作用并对脊髓缺血时的生理、生化改变进行研究。方法在兔的腹主动脉肾下段阻断主动脉 ,建立脊髓缺血模型。 2 5只兔子随机分为 3组 ,持续缺血组 (10只 )阻断 40min ;间断缺血组 (9只 )将 40min阻断时间分为 2次 ,每次 2 0min ,中间间隔 15min ;缺血预处理组 (6只 )先给予阻断 3次 ,每次5min ,间隔 5min ,之后连续夹闭 40min。手术后分别于 1、6、12、2 4h按照Tarlov分级标准观察下肢肌力 ,并于术后 2 4h抽取脑脊液、解剖取得腰段脊髓。测定脑脊液中谷氨酸、天门冬氨酸含量 ,用TBA比色法测定脊髓组织丙二醛 (MDA)含量 ,尼氏染色观察腰段脊髓神经元细胞受损情况。结果 2个干预组的术后肌力恢复均好于持续缺血组 2 4h后间断缺血组 (3 4± 1 0 )级 ,缺血预处理组 (3 5± 0 8)级 ,持续缺血组 (1 3± 1 4)级 ,P值均 <0 0 5 ;病理 :神经元损害分别为 (18± 10 ) % ,(2 1± 10 ) % ,(4 6±16 ) % ,P值均 <0 0 5 ;脊髓组织MDA预处理组 (176± 2 2 )nmol/g低于持续缺血组 (2 5 2± 47)nmol/g,P <0 0 1。结论间断缺血和缺血预处理均可减轻脊髓缺血后的功能受损情况 ,缺血预处理可减少缺血再灌注后氧自由基的损害     

周围神经缺血再灌注损伤与神经元凋亡的关系

目的 研究大鼠周围神经缺血再灌注损伤与脊髓神经元凋亡的关系和规律,为临床防治此类神经损伤提供理论依据.方法 采用无损伤动脉夹暂时夹闭大鼠髂总、髂内、髂外及股动脉,不同时间段开放恢复血流再灌注的大鼠周围神经缺血再灌注模型,取脊髓腰骶膨大处脊髓灰质组织通过流式细胞仪检测细胞凋亡率进行分析.结果 各实验组均可检测到凋亡细胞,但各组细胞凋亡率均有所不同.各缺血组神经细胞凋亡率明显高于假手术对照组(P<0.01).缺血4 h组神经细胞的凋亡率高于其他各组,与2、12 h组比较差异具有统计学意义(P<0.05).细胞凋亡率最高出现在缺血4 h再灌注6 h组,缺血4、6、8 h组再灌注72 h后出现细胞凋亡率的下降,甚至低于未灌注组.结论 周围神经缺血再灌注损伤可以引起神经元的凋亡.不同缺血与再灌注时间,神经细胞的凋亡率也不尽相同.     

Cyclin D1在大鼠肝缺血预处理和缺血再灌注损伤中早期复灌的表达

目的观察缺血预处理对大鼠肝缺血再灌注损伤复灌早期细胞增殖与Cyclin D1表达的影响,探讨缺血预处理保护作用的机制。方法54只SD大鼠随机分成缺血再灌注组(IR)、缺血预处理组(IP)和假手术组(SO),利用肝原位部分缺血再灌注模型,于复灌后0、1、2、4 h取材,应用流式细胞仪,检测各组肝细胞Ki67抗原表达,同时应用Western blot法检测各组蛋白表达的变化。结果与IR组相比,在复灌后0、1 h,IP组肝细胞Ki67表达率明显增高[(28．86±6．34)％比(19．40±5．35)％,(46．82±9．80)％比(22．40±5．08)％,P＜0．05],同时可见IR组复灌后2h Cy- clinD1蛋白始有表达,而IP组在复灌开始时即有表达。结论缺血预处理可促进肝细胞在缺血再灌注损伤后早期细胞增殖与Cyclin D1的表达,可能是其对缺血再灌注损伤起到保护作用的机制之一。     

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.