肝硬变门静脉高压症患者门体分流术前后血中内皮素,血栓素与前列？…

目的　了解肝硬变门静脉高压症患者、液递物质代谢紊乱及其血流动力学后果。方法　对 30例肝硬变门静脉高压症患者门体分流术前后门脉血中内皮素 (ET)、血栓素 (TXA2 )和前列环素 (PGI2 )进行了水平变化动态临床观察。结果　在门静脉高压症患者门脉血中无论是缩血管物质 (ET、TXA2 )还是扩血管物质 (PGI2 )浓度均比胃肠对照者明显升高 (ERT:10 7.86± 2 5 .92 pg/ml,48.11± 9.40 pg/ml,P=0 .0 0 0 ;TXA2 :34 9.6 7± 198.41pg/ml,15 6 .2 7± 5 4.0 1pg/ml,P=0 .0 0 0 ;PGI2 :46 3.14± 10 8.2 5 pg/ml,2 2 7.2 3± 46 .19pg/ml,=0 .0 0 0 ) ,且二者浓度在门体分流术后均下降 (P=0 .0 0 2 )。结论　门静脉血中内皮素水平的增高对肝硬变患者门脉血管阻力的增加有重要影响 ,并对门静脉高压症的发病机理起重要作用。在肝硬变门静脉高压这一特殊病理生理状态下 ,缩血管物质与扩血管物质之间可能达成一种新的动态平衡。     

复方中药对急性肝损伤大鼠血浆内皮素-1的影响

目的　研究中药对急性肝损伤大鼠血浆内皮素 1的影响。方法　采用放射免疫法测定大鼠血浆内皮素 1(endothelin 1,ET 1)水平。结果　实验组大鼠血浆ET 1水平 ( 163 98± 3 8 5 4 )pg/ml显著低于模型组 ( 2 2 2 5 9± 68 71)pg/ml,P <0 0 5。与对照组 ( 165 2 8± 3 4 13 )pg/ml相比无显著差异。结论　复方中药能显著降低急性肝损伤大鼠血浆内皮素水平。     

SCD14、TNF-α、E-SLT及IL-10在感染发病中的作用及临床意义

目的探讨SCD14、TNF-α、E-SLT及IL-10在感染发病机制中的作用及其意义.方法采用酶联免疫吸附法测定37例腹部外伤合并感染患者及内毒素血症兔模型中可溶性CD14(SCD14)、肿瘤坏死因子α(TNF-α)、E选择素(E-SLT)及白细胞介素10(IL-10)血清浓度变化情况.结果与对照组相比,SCD14与TNF-α在术后第1天开始升高,E-SLT与IL-10在术后合并感染组中于第3天出现增高[(1.61±0.47)μg/ml与(28.63±8.29)pg/ml,(153.6±48.9)ng/ml 与(38.21±10.87)pg/ml,P均＜0.05];在兔内毒素血症中则分别于第30、120min开始增高[(0.50±0.02)μg/ml与(1.00±0.02)pg/ml,(20.9±0.5)ng/ml 与(49.7±0.5)pg/ml,P均＜0.05].结论血清SCD14、TNF-α、E-SLT及IL-10浓度的变化在反映感染发生发展及预后方面具有一定的价值.     

复方中药对肝硬化大鼠肝组织内皮素-1mRNA表达的影响

目的　研究复方中药对肝硬化大鼠血浆及肝组织内皮素 1(endothelin 1,ET 1)和肝组织ET 1mRNA表达的影响。方法　采用放射免疫法测定血浆和肝组织ET 1水平 ,逆转录多聚酶链反应 (RT PCR)测定大鼠肝组织ET 1mRNA表达水平。结果　模型组血浆 (171 99± 2 7 86pg/ml)和肝组织ET 1(80 4 8± 2 1 4 5 pg/ml)较对照组 (114 33± 17 34pg/ml,5 3 2 5± 13 6 4pg/ml,P <0 0 5 )均显著升高 ,肝组织ET 1mRNA表达也较对照组 (0 4 6 74± 0 10 4 5vs.0 14 13± 0 0 2 97,P <0 0 5 )显著升高。治疗组血浆ET 1(12 9 80± 13 15 pg/ml)和肝组织ET 1mRNA表达 (0 30 4 0±0 0 813)均显著低于模型组 (171 99± 2 7 86 pg/ml,0 4 6 74± 0 10 4 5 ,P <0 0 5 )。而治疗组肝组织ET 1(77 36± 18 2 7pg/ml)与模型组 (80 4 8± 2 1 4 5 pg/ml)相比无显著差异。 结论　复方中药能显著降低肝硬化大鼠肝组织ET 1mRNA的表达及血浆ET 1水平。     

肝硬变门静脉高压症患者血红素氧化酶-1的表达

目的　探讨肝硬变门静脉高压症患者脾脏及脾血管血红素氧化酶 (HO ) 1mRNA的表达。方法　应用原位杂交方法检测 2 0例肝硬变门静脉高压症患者脾脏、脾动脉、脾静脉组织HO 1mRNA的表达 ,以 12例脾破裂患者作对照。结果　对照组仅有 4例脾组织可见弱阳性表达 ,平均阳性染色指数为 0 .0 5± 0 .0 1,其脾动、静脉组织未见HO 1mRNA表达。肝硬变门静脉高压症组 18例脾脏HO 1mRNA阳性表达 ,平均阳性染色指数为 0 .68± 0 .12 ,显著高于对照组 (P <0 .0 0 1)。脾动、静脉HO 1mRNA全部表达者 15例 ,脾动、静脉阳性染色指数分别为 0 .5± 0 .1与 0 .5 6± 0 .1,两者差异无显著性 ,(P >0 .0 5 )。结论　肝硬变门静脉高压症合并多种应激原刺激患者HO 1mRNA表达增强 ,HO 1及其代谢产物可能参与门静脉高压症多种病理过程。     

肝癌合并肝硬化患者肝癌切除后机体免疫状态的变化

目的探讨肝癌合并肝硬化患者癌灶切除前后机体免疫状态的变化。方法以肝硬化患者为对照组 ,采用流式细胞技术 (FCM)及ELISA方法分析 18例中晚期肝癌合并肝硬化患者癌灶切除前后外周血T细胞亚群CD4、CD8、CD4 /CD8及Th1/Th2细胞因子IFN γ、IL2、IL10蛋白水平的变化。结果　肝癌切除术后CD4 (33± 3) %、CD4 /CD8(1 1± 0 1)、IL2 (71± 11)pg/ml、IFN γ(90± 15 )pg/ml回升 ,高于术前水平〔CD4 (2 9± 4 ) %、CD4 /CD8(0 9± 0 3)、IL2 (5 7± 15 )pg/ml、IFN γ(78± 13)pg/ml〕 ,但仍低于肝硬化组〔CD4 (37± 4 ) %、CD4 /CD8(1 3± 0 2 )、IL2 (82± 15 )pg/ml、IFN γ(10 4± 2 2 )pg/ml〕(P <0 0 1或P <0 0 5 ) ;CD8(32± 3) %、IL10 (70± 9)pg/ml下降 ,低于术前〔CD8(35± 6 ) %、IL10(81± 15 )pg/ml〕水平但高于肝硬化组〔CD8(2 9± 2 ) %、IL10 (6 1± 10 )pg/ml〕(P <0 0 5 )。结论　癌灶切除后 ,机体免疫功能有明显改善。但仍未恢复到肝硬化患者的水平。     

肝硬变门静脉高压症患者门体分流术前后血中内皮素、血栓素与前列环素动态临床观察

目的 了解肝硬变门静脉高压症患者、液递物质代谢紊乱及其血流动力学后果.方法 对30例肝硬变门静脉高压症患者门体分流术前后门脉血中内皮素(ET)、血栓素(TXA2)和前列环素(PGI2)进行了水平变化动态临床观察.结果 在门静脉高压症患者门脉血中无论是缩血管物质(ET、TXA2)还是扩血管物质(PGI2)浓度均比胃肠对照者明显升高(ERT:107.86±25.92 pg/ml,48.11±9.40pg/ml,P=0.000;TXA2:349.67±198.41pg/ml,156.27±54.01pg/ml,P=0.000;PGI2:463.14±108.25pg/ml,227.23±46.19 pg/ml,=0.000),且二者浓度在门体分流术后均下降(P=0.002).结论 门静脉血中内皮素水平的增高对肝硬变患者门脉血管阻力的增加有重要影响,并对门静脉高压症的发病机理起重要作用.在肝硬变门静脉高压这一特殊病理生理状态下,缩血管物质与扩血管物质之间可能达成一种新的动态平衡.     

急性等容性血液稀释对血浆ET和CGRP水平的影响

目的　探讨急性等容性血液稀释 (ANH)对血浆内皮素 (ET)和降钙基因相关肽(CGRP)水平的影响。方法　选择非心脏手术ASAⅠ～Ⅱ级患者 2 0例 ,麻醉前快速输入复方乳酸钠1 0～ 1 5ml/kg。麻醉后从桡动脉放血 1 0ml/kg ,同时经静脉输入等量的 4 %琥珀酰明胶。观察ANH麻醉前 (T0 )、血液稀释完成后 1 0min(T1 )、2 0min(T2 )、30min(T3 )的血液动力学、血浆ET和CGRP浓度的变化。结果　ANH前后MAP、HR、SpO2 和ECG均较稳定。ANH后 1 0min、2 0min血浆ET水平分别为 (1 4 4 4 7± 1 9 1 7) pg/ml和 (1 5 7 1 7± 1 2 4 5 ) pg/ml,但明显高于ANH前的 (1 2 7 6 8±2 0 92 ) pg/ml(P <0 0 5 )。ANH后 1 0min、2 0min血浆CGRP水平分别为 (5 4 72± 2 5 6 5 )pg/ml和(5 5 32± 1 7 94 )pg/ml,也明显高于ANH前的 (4 4 6 2± 1 6 90 ) pg/ml(P <0 0 5 )。而ET/CGRP比值无明显变化。结论　ANH近期血浆ET和CGRP水平均有一定的增加 ,但ET/CGRP比值的变化无统计学意义 ,同时心血管反应不明显 ,表明血浆ET和CGRP的动态平衡对ANH时的循环稳定起着重要的作用     

前列环素与门静脉高压症高动力循环的关系

目的　探讨前列环素 (PGI2 )和一氧化氮 (NO)在门静脉高压症高血流动力循环中的作用。　方法　 66只雄性SD大鼠随机分成 :肝内型门静脉高压症组 (IHPH组 )、肝前型门静脉高压症组 (PHPH组 )和假手术组 (SO组 )。模型制备 1周后再随机分为 3个亚组 ,即对照组、一氧化氮合酶抑制剂L NNA组、消炎痛组。用药 1周后测定股动脉血浆 6 酮 前列腺素F1α(6 keto PGF1α)和NO2 - /NO3- 浓度 ,应用同位素微球技术行血流动力学研究 ,并对NO、PGI2 水平与血流动力学参数行Pearson相关分析。　结果　 (1 )在基础状态下 ,血浆 6 keto PGF1α浓度 ,IHPH鼠 [(1 1 2 3 85± 1 53 64)pg/ml]和PHPH鼠 [(891 88± 83 1 1 )pg/ml]均显著地高于SO鼠 [(72 5 53± 1 0 5 54)pg/ml] ,P <0 0 5 ;血浆NO2 - /NO3- 浓度 ,IHPH鼠 [(73 34± 4 31 ) μmol/L]和PHPH鼠 [(75 2 1± 6 89) μmol/L]均显著高于SO鼠[(58 79± 8 47) μmol/L] ,P <0 0 5。 (2 )与对照组比较 ,L NNA与消炎痛均显著地降低IHPH与PHPH 2组鼠血浆 6 keto PGF1α和NO2 - /NO3- 的浓度 ,P <0 0 5 ;降低IHPH、PHPH 2组鼠的心脏指数 (CI)、门静脉压力 (FPP)和门静脉血流量 (PVI) ,P <0 0 5 ;显著地增高这 2组鼠的平均动脉压 (MAP)、总外周血管阻力 (TPR)和内脏血     

一氧化氮、内皮素与肝硬化及门静脉高压症病人肝功能的关系

目的　探讨一氧化氮（NO）,内皮素（ET-1）与肝硬化及门静脉高压症病人肝功能的关系。方法　按肝功能Ⅰ,Ⅱ,Ⅲ级分组比较肝炎后肝硬化、门脉高压病人血中的NO（酶法)、ET-1（放射免疫法)水平和肝功能的关系。结果　肝功能Ⅰ级组病人（13例）血中的NO水平远远低于肝功能Ⅱ级组（21例）和Ⅲ级组（21例）的病人［（22.7±2.3)μmol/L对(50.9±6.2)μmol/L和(51.9±5.7)μmol/L,P均<0.01)］,而血浆ET-1水平在肝功能Ⅰ,Ⅱ,Ⅲ级各组之间差异无显著意义［（49.6±8)pg/ml,(55.9±8.6)pg/ml和(54.2±11.2)pg/ml,P＞0.05）］。结论　血清NO在术前估价门静脉高压病人肝储备功能中有重要意义,而ET-1则未见明显价值。     

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.