幼猪机械通气中异氟醚或七氟醚混合一氧化氮吸入的安全性

目的研究吸入异氟醚或七氟醚混合一氧化氮(NO)在幼猪机械通气中的安全性。方法36头幼猪随机分为6组:Ⅰ组(对照组):单纯机械通气;Ⅱ组(NO组):吸入20ppmNO;Ⅲ组(异氟醚组):吸入1.3MAC异氟醚;Ⅳ组(异氟醚 NO组):吸入1.3MAC异氟醚及20ppmNO;Ⅴ组(七氟醚组)吸入1.3MAC七氟醚;Ⅵ组(七氟醚 NO组)吸入1.3MAC七氟醚及20ppmNO。用麻醉机行间歇正压通气4h,测定各组机械通气前、机械通气1、2、3、4h(T0、T1、T2、T3、T4)的呼吸频率(RR)、呼吸系统总顺应性(Crs)、气道压力(Paw)、潮气量(VT)、分钟通气量(MV)以及呼末二氧化碳分压(PETCO2);测定T0、T2、T4时点动脉血高铁血红蛋白(MetHb)和亚硝酸根(NO2-/NO3-)水平;处死动物后比较各组肺组织湿/干重比、支气管肺泡灌洗液(BALF)中饱和磷脂/总磷脂(DSPC/TPL)及饱和磷脂,总蛋白(DSPC/TP)、肺表面张力和白细胞计数,并行肺组织损伤评分。结果Ⅲ、Ⅳ、Ⅴ、Ⅵ组BALF中DSPC/TP及肺表面张力较Ⅰ组下降(P<0.05),通气结束时Crs较通气前下降(P<0.05),而Ⅱ组无显著性变化(P>0.05);与通气前比较,各组通气结束时MetHb与:NO2-/NO3-水平无变化,各组BALF中白细胞计数、肺组织损伤评分、肺泡扩张度和湿/干重比之间比较差异无统计学意义。结论1.3MAC异氟醚或七氟醚混合20ppmNO吸入可以安全用     

吸入一氧化氮对犬感染性ARDS的效应

目的研究吸入不同浓度一氧化氮(NO)对犬感染性急性呼吸窘迫综合征(ARDS)的效应。方法 感染性ARDS建立后,12只纯处毕格犬随机分成两组,单纯机械通气组(对照组,n=6),机械通气+吸入NO组(NO组,n=6)。NO吸人浓度分别为10、20、40、80 ppm,各浓度吸1 h,然后降至10 ppm吸6 h。通过以下指标变化分析判断吸入NO对ARDS的影响:体、肺循环血液动力学参数;氧合指数(PaO2/FiO2)、分流率(Qs/Qt)、肺动态顺应性(cdyn)、死腔量(VD/VT)及气道阻力(Rrs);外周血中性粒细胞计数;血、尿中亚硝酸根/硝酸根浓度(NO2-/NO3-);血正铁血红蛋白含量及动物存活时间。结果 吸人10、20、40、80 ppm.NO,PaO2/FiO2增加超过50％,Qs/Qt下降<25％,VD/VT下降至0.36,PVRI下降近50％,一定程度改善Cdyn,与单纯机械通气组相应时相点比,差异有显著性(P均<0.01),动物存活时间为(10.2±1.7)h显著高于对照组(4.4±1.2)h(P<0.01);NO浓度由80 ppm降至10 ppm时,改善的Qs/Qt,PaO2/FiO2,PVRI,VD/VT及Cdyn等指标又回落,实验最后阶段,随病程发展,肺部情况恶化;吸入NO可减轻外周血白细胞下降程度,与对照组相比差异有显著性(P<0.01)。结论 吸入10～80 ppm NO可明显降低犬感染性ARDS时肺血管阻力,改善通气,血流比例,对ARDS产生一定的治疗作用。     

吸入一氧化氮对内毒素性急性呼吸窘迫综合征犬肺炎性反应的影响

目的 通过观察吸入一氧化氮(NO)对内毒素性急性呼吸窘迫综合征(ARDS)犬肺组织中肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)及CD11b mRNA表达的影响,从分子水平探讨吸入NO治疗ARDS的机制。方法 12条毕格犬静脉输注内毒素达ARDS后,随机分成两组,单纯机械通气组(C组,n=6),机械通气 吸入NO组(NO组,n=6),NO吸入浓度分别为10、20、40、80 ppm,按顺序各吸入1 h后,降至10 ppm吸6 h。无菌条件下取肺组织,提取肺组织总RNA,采用逆转录-多聚酶链反应技术检测TNF-α、IL-8、CD11b mRNA表达的水平。结果 C组肺组织中的TNF-α、IL-8及CD11b mRNA表达水平高于NO组(P<0.05)。结论 NO抑制炎性反应可能是其对ARDS产生治疗作用的一个方面。     

大鼠烟雾吸入伤后肺表面活性物质磷脂组分含量的变化及意义

为探讨烟雾吸入后肺表面活性物质(PS)磷脂组分含量的变化和可能机理及其与 PS 活性抑制和肺功能损害的关系,采用大鼠烟雾吸入伤模型,分别检测了正常对照及致伤2,6,12和24小时大鼠静态肺顺应性(Cst)、支气管肺泡灌洗液(PALF)表面张力活性、BALF 和肺匀浆总磷脂(TPL)、磷脂酰胆碱(PC)、磷脂酰肌醇(PI)、磷脂酰丝氨酸(Phs)、磷脂酰乙醇(PE)含量、BALF 和肺匀浆中磷脂酶 A_2(PLA_2)活性。结果表明动物伤后 Cst 显著降低;BALF 最小表面张力(STmin)进行性升高;BALF 中TPL 增加,但 PC(%TPL)明显降低,且与 Cst 和 STmin 的变化相关显著;肺组织内 TPL 及 PC 均下降,并与其中 PLA_2活性升高明显相关。结论:烟雾吸入伤早期肺内 PS 磷脂组分含量明显改变,PC 相对含量减少是引起 PS 活性抑制及肺功能障碍的主要原因之一,PLA_2可能在 PS 组分异常和(或)含量减少中起重要作用。     

吸入NO对肺灌洗诱导的急性肺损伤家猪血液动力学及肺气体交换的影响

目的评价吸入一氧化氮(NO)对肺灌洗诱导的急性肺损伤(ALI)气体交换及血液动力学的影响.方法16头健康家猪,麻醉后经气管导管肺内以生理盐水反复灌洗,直至动脉氧分压(PaO2)＜100mmHg达1h,记录气体交换及血液动力学各参数作为急性肺损伤的基础值.随机分为NO组及对照组,NO组吸入20ppm的NO,对照组不予治疗,记录各组每小时的气体交换及血液动力学参数,并观察高铁血红蛋白(MetHb)的改变.结果NO组的MPAP在整个实验过程中显著低于对照组.NO组吸入NO1h后,PaO2即呈上升趋势,4h后从ALI的(65.29±14.37)mmHg升至(114.52±36.5)mmHg,较对照组显著升高.同时Qs/Qt及AaDO2降低.MAP及SVR相对于对照组无显著性改变.MetHb无显著升高.结论在肺灌洗诱导的急性肺损伤家猪,吸入20ppm的NO选择性降低肺动脉压,改善肺氧合,并不引起高铁血红蛋白血症.     

吸入七氟醚、地氟醚对大鼠肺组织超微结构和肺表面活性物质的影响

目的观察不同吸入浓度七氟醚和地氟醚对大鼠肺组织超微结构及支气管肺泡灌洗液 (BALF)中肺表面活性物质相关蛋白-A(SP-A)、磷脂酰胆碱(PC)浓度的影响。方法雄性Wistar大鼠 50只,随机分为5组,每组10只,C组:单纯机械呼吸组;S1组和S2组:分别吸入1．0 MAC、1．5 MAC七氟醚4 b;D1组和D2组:分别吸入1．0MAC、1．5MAC地氟醚4 b。在相应时点处死大鼠,观察肺组织超微结构并测定BALF中SP-A和PC浓度。结果与C组比较,S1、S2、D1、D2组肺泡Ⅱ型上皮细胞微绒毛破坏程度较重,以D1、D2组改变更明显,板层体减少,并呈大量空泡化;BALF中SP-A、PC浓度下降 (P<0．01或0．05)。结论吸入1-0 MAC、1．5 MAC七氟醚或地氟醚4 h可降低肺泡Ⅱ型上皮细胞合成肺表面活性物质。     

L-精氨酸对内毒素诱导急性肺损伤大鼠肺表面活性物质的影响

目的 评价L-精氨酸对内毒素(LPS)诱导急性肺损伤大鼠肺表面活性物质的影响.方法 健康雄性SD大鼠48只,随机分为4组:正常对照组(C组,n=16)、LPS组(n=16)、LPS 3 h+L-精氨酸治疗组(L1组,n=8)和LPS 6 h+L-精氨酸治疗组(L2组,n=8).LPS组、L1组和L2组静脉注射LPS 5mg/kg,C组给予等容量生理盐水.L1组和L2组分别于给予LPS后3 h或6 h腹腔注射L-精氮酸500 mg/kg.L1组和L2组于给予L-精氨酸后3 h(C组和LPS组分别于给予生理盐水或LPS后6、9 h)取8只大鼠,取肺组织,测定表面活性物质结合蛋白A(SP-A)mRNA的表达水平、肺泡灌洗液(BALF)中总磷脂(TPL)和总蛋白(TP)浓度,光镜下观察肺组织病理学结果.结果 与C组比较,LPS组SP-A mRNA表达下调,BALF中TPL浓度降低,TP浓度升高(P＜0.01).与LPS组比较,L1组SP-A mRNA表达上调,BALF中TPL浓度升高,TP浓度降低(P＜0.05或0.01);L2组上述指标差异无统计学意义(P＞0.05).L1组肺损伤程度轻于LPS组和L2组.结论 L-精氨酸可促进肺表面活性物质合成,从而对大鼠内毒素诱导急性肺损伤具有治疗作用.     

前列腺素E_1在酸吸入性急性呼吸窘迫综合征中的肺保护作用

目的　研究静脉注射前列腺素E1(PGE1)能否阻止酸吸入性急性呼吸窘迫综合征(ARDS)的发生。方法　 2 0只新西兰兔在稀HCl经右支气管滴入后随机分成两组 :(1)损伤组 (n =10 )在酸滴入后维持机械通气 ,未行其它治疗 ;(2 )治疗组 (n =10 )在酸滴入后即刻缓慢静注PGE1并维持。在基础状态及酸滴入后记录血气、气道压力并抽动脉血测定 6 K PGF1α、TXB2 、NO-2 /NO-3 和ET 1,动物处死后测定右肺的湿干比 (W /D)值及测定右肺支气管肺泡灌洗液 (BALF)中总蛋白 (TP)的水平 ,并作肺组织形态学观察。结果　治疗组在酸滴入后血氧分压 (PaO2 )显著高于损伤组。治疗组血浆 6 K PGF1α和NO-2 /NO-3 水平显著高于损伤组 ,而血浆TXB2 和ET 1水平显著低于损伤组 ,治疗组右肺W/D和TP显著低于损伤组。损伤组右肺呈弥漫性炎性损伤 ,而治疗组则见损伤呈局灶性 ,且其病理损伤程度较损伤组明显减轻。结论　 (1)酸吸入后即刻应用PGE1可减轻ARDS的范围和严重程度 ;(2 )PGE1保护了肺血管内皮细胞 ,使内源性PGI2 /TXA2 和NO /ET 1的产生保持平衡 ,有利于减轻ARDS。     

不同潮气量机械通气诱发的肺损伤大鼠肺组织中CXCR2表达

目的探讨不同潮气量机械通气大鼠肺组织中巨噬细胞炎性蛋白2(MIP-2)及CXCR2蛋白的表达。方法清洁级Wistar大鼠30只,雄雌不拘,体重200～250g,随机均分为三组。实验前12h禁食,自由饮水。对照组,仅作气管切开插管,不行机械通气;小潮气量组潮气量VT7ml/kg,大潮气量组VT40ml/kg,两组气管切开插管后接小动物呼吸机控制呼吸,调节RR40次/分,吸呼比1∶2,空气吸入,通气4h,建立机械通气诱发肺损伤大鼠动物模型。对照组在气管插管后即刻,余两组在机械通气结束后,立即剖胸,取大鼠肺组织,收集支气管肺泡灌洗液(BALF)。RT-PCR法测定肺组织中CXCR2的mRNA表达、免疫组化测定肺组织CXCR2的蛋白表达和HE染色观察肺组织病理学变化,ELISA法测定肺组织匀浆中MIP-2蛋白水平,测定BALF中PMN计数。结果与对照组和小潮气量组比较,大潮气量组MIP-2蛋白及其受体CXCR2蛋白和mRNA表达增加(P<0.05),灌洗液中PMN计数增加(P<0.05),肺炎症反应明显加重;与对照组比较,小潮气量组上述指标无明显变化。结论大潮气量机械通气引起肺组织中炎症因子MIP-2及其受体CXCR2表达增加,肺组织炎症反应明显,损伤加重,是机械通气相关肺损伤的发生机制之一。     

肺泡表面活性物质肺灌洗对急性呼吸窘迫综合征PaCO_2及PIP的影响

目的 研究肺泡表面活性物质肺灌洗治疗急性呼吸窘迫综合征(ARDS)的效果.方法 用12 ml/kg 0.0225 N的盐酸注入新两兰白兔气管内,纯氧机械通气1h后,将符合PaO_2/FiO_2≤150mm Hg的动物随机分成五组.每组5只.分别用生理盐水(NS组)、浓度为1 g/L(S_1组)、3g/l(S_3组)、6g/L(S_6组)、12g/L(S_(12)组)的肺泡表面活性物质肺灌洗.灌洗容量为10 ml/kg.观察治疗后的PaCO_2和气道吸气峰压(PIP)变化,并对肺标本行病理切片检查.结果 S_3组、S_6组、S_(12)组肺灌洗后PaCO_2明显改善,但效果不能持久.S_3组、S_6组、S_(12)组中肺泡间质允血水肿较NS组、S_1组明显减轻.结论 采用浓度为3g/L以上的外源性肺泡表而活性物质对盐酸诱导的ARDS行肺灌洗治疗可以改善肺通气,但效果不能持久.     

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.