新辅助化疗后腋窝淋巴结阳性转阴乳腺癌患者前哨淋巴结活检的临床价值

背景与目的：乳腺癌是常见的女性恶性肿瘤,前哨淋巴结活检（SLNB）是早期腋窝淋巴结阴性乳腺癌的标准处理模式,但是经新辅助化疗（NAC）后腋窝淋巴结转阴患者的SLNB存在很大争议,已成为关注焦点。本研究探讨NAC后腋窝淋巴结转阴的乳腺癌患者SLNB的可行性及影响SLNB假阴性率的因素。方法：收集2020年7月—2022年7月海口市人民医院腋窝淋巴结阳性乳腺癌经NAC后腋窝淋巴结降期为阴性的患者45例临床资料,所有患者经染色法行SLNB随后行腋窝淋巴结清除（ALND）,分析前哨淋巴结检出率,假阴性率,准确率等指标,并对可能影响SLNB的假阴性率的因素进行分析。结果：SLNB成功率93.3%,检出前哨淋巴结138枚;准确率90.4%,假阴性率12.5%。肿瘤大小（≤5 cm、>5 cm）与NAC前淋巴结状态（1枚、2枚、≥3枚）对SLNB的成功率、准确率、假阴性率均无明显影响（均P>0.05）;前哨淋巴结检出数目（1枚、2枚、≥3枚）对SLNB准确率（P=0.009）与假阴性率（P=0.002）有明显影响,检出数目越多准确率越高、假阴性率越低。结论：腋窝淋巴结阳性经NAC后转阴的...     

吲哚氰绿荧光显影联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检中的效果对比

目的探讨吲哚氰绿(ICG)联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检(SLNB)中的效果差异。方法回顾性收集2017年6月到2019年2月期间于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗后行SLNB并同时行腋窝淋巴结清扫(ALND)的乳腺癌患者77例,其中通过ICG+亚甲蓝示踪行SLNB的乳腺癌患者46例(ICG+亚甲蓝组),通过核素+亚甲蓝示踪行SLNB的乳腺癌患者31例(核素+亚甲蓝组)。比较2组患者的示踪效果。结果 77例患者中至少检出1枚前哨淋巴结(SLN)者73例,SLN检出率为94.80%,其中ICG+亚甲蓝组43例,核素+亚甲蓝组30例。ICG+亚甲蓝组患者的NAC后前哨淋巴结检出率为93.48%(43/46),平均检出SLN 2.32枚/例,灵敏度为82.61%(19/23),假阴性率为17.39%(4/23),准确率为90.70%(39/43)。核素+亚甲蓝组的SLN检出率为96.77%(30/31),平均检出SLN 2.6枚/例,灵敏度为83.33%(10/12),假阴性率为16.67%(2/12),准确率为93.33%(28/30)。2组的SLN检出率、检出数目、灵敏度、假阴性率及准确率比较差异均无统计学意义(P0.05)。结论 ICG联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后的乳腺癌SLNB中具有相似的SLN检出率、SLN检出数目、灵敏度、准确率及假阴性率,可以推广实施。     

前哨淋巴结阳性Luminal B型早期乳腺癌非前哨腋窝淋巴结状态对预后影响研究

目的研究前哨淋巴结(sentinel lymph node,SLN)阳性的Luminal B(HER2阴性)型早期乳腺癌非前哨腋窝淋巴结状态对预后的影响。方法回顾性分析2008—2014年北京大学第一医院乳腺疾病中心经治的142例临床腋窝淋巴结阴性、SLN阳性的Luminal B(HER2阴性)型早期乳腺癌病例,对其临床病理学特点及与非前哨腋窝淋巴结是否存在转移进行相关性分析,并对非前哨腋窝淋巴结转移病人和无转移病人无疾病存活率(DFS)和总存活率(OS)进行对比分析。结果 142例SLN阳性病人中,平均每例病人检出SLN(2.06±1.26)枚,Spearman双变量相关性分析显示SLN转移数目与非前哨腋窝淋巴结是否存在转移具有相关性(r=0.167,P=0.047),而二元Logistics回归分析显示年龄、体重指数、是否绝经、原发肿瘤T分期、肿瘤组织学分级、脉管癌栓与该组SLN阳性病人非前哨腋窝淋巴结是否转移无相关性。非前哨腋窝淋巴结无转移病人78例(54.9%),DFS为93%,OS为93.1%;非前哨腋窝淋巴结转移病人64例(45.1%),DFS为95.2%,OS为91.9%。经Log-rank(Mantel-Cox)检验,两组在DFS(χ~2=0.011,P=0.918)及OS(χ~2=0.348,P=0.555)上差异均无统计学意义。结论 SLN阳性的Luminal B(HER2阴性)型早期乳腺癌病人,其阳性SLN数目与非前哨腋窝淋巴结是否转移存在相关性,其他临床病理因素无相关性,而非前哨腋窝淋巴结转移组和无转移组DFS和OS差异无统计学意义。     

乳腺癌新辅助化疗后前哨淋巴结活检术的研究

目的 探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后，临床检查腋窝淋巴结阴性行前哨淋巴结活检术（SLNB）。结果57例中检出前哨淋巴结（SLN）53例，检出率93．0％。SLN对腋窝淋巴结状况预测的敏感性为89．7％，特异性为100．0％，准确性为94．3％，阳性预测值为100．0％，阴性预测值为88．9％，假阴性率为5．7％。肿瘤对化疗反应为CR（完全缓解）、PR（部分缓解）和SD（稳定）的SLN检出率分别为100．0％、96．7％和70．0％（P〈0．01）。SLN假阴性3例均为腋窝淋巴结转移数〉4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后。行SLNB可获得与早期乳腺癌SLNB相似的效果。     

乳腺癌新辅助化疗后蓝染法行前哨淋巴结活检术的临床分析

【摘要】 目的 研究乳腺癌患者新辅助化疗后蓝染法行前哨淋巴结活检术(SLNB)的可行性。方法〓回顾性分析2012年1月至2015年6月初诊于广西柳州市工人医院普外四病区的IIA-IIIB期乳腺癌患者69例。所有患者均接受新辅助化疗,疗程4~8个周期,分析新辅助化疗后蓝染法行SLNB的检出率、假阴性率。结果〓入组患者SLNB检出率为85.5%,假阴性率为18.2%;SLNB的检出率因腋窝淋巴结状态不同而存在统计学差异,在不同肿瘤的大小、肿瘤位置、患者年龄和SLNB时注射染料位置无统计学差异,假阴性率在上述不同分组中均无统计学差异。结论〓NAC后蓝染法SLNB可应用于治疗前腋窝淋巴结阴性的乳腺癌患者;对于治疗前腋窝淋巴结阳性的患者则存在风险。增加SLN检出数目可增加NAC后行SLNB的可靠性。     

乳腺癌新辅助治疗前哨淋巴结处理原则

前哨淋巴结活检及新辅助治疗已成为乳腺癌综合治疗的重要措施，也是个体化治疗的重要体现。乳腺癌新辅助治疗具有较高的腋窝淋巴结控制率，如何在乳腺癌新辅助治疗病人中精准、高效实施前哨淋巴结活检引起越来越多的关注。新辅助治疗前后腋窝淋巴结状态的精准评估是实施前哨淋巴结活检的基础。对于新辅助治疗前腋窝淋巴结阴性的病人，推荐新辅助治疗后行前哨淋巴结活检。对于新辅助治疗前腋窝淋巴结阳性，新辅助治疗后淋巴结转阴的病人，需在双示踪、前哨淋巴结检出数≥3枚及阳性淋巴结靶向切除的前提下，进行前哨淋巴结活检，在我国医疗资源现状下，需结合示踪药物的可及性及技术条件，谨慎选择适宜病人。     

老年乳腺癌术后辅助化疗对预后的影响

目的探讨老年乳腺癌的术后辅助化疗对预后的影响。方法收集80例Ⅰ~Ⅲ期≥65岁乳腺癌患者的资料,其中接受辅助化疗有47例,未接受辅助化疗有33例,分析两组的临床病理特点和预后特征。结果与未接受术后辅助化疗的患者比较,接受辅助化疗年龄轻的患者较多(P=0.005)、伴有合并症较少(P=0.040)、腋窝淋巴结转移率高(P0.001)、ER/PR阴性率高(P=0.029)、接受放疗概率高(P=0.005);而在肿瘤组织学分级、肿瘤大小、HER2表达、手术方式、内分泌治疗无明显区别(P0.05)。中位随访期为73个月,辅助化疗组与未辅助化疗组相比,无病生存率(DFS)无明显区别(78.7%vs 90.9%,P=0.147),总生存率(OS)也无明显区别(83.0%vs93.9%,P=0.098)。结论老年乳腺癌患者术后辅助化疗的获益不明显,但对于年纪较轻、伴有合并症较少且伴有腋窝淋巴结转移、ER/PR阴性等高风险因素的患者,应全面综合评估患者的耐受性和获益程度选择术后辅助化疗。     

前哨淋巴结活检术在早期乳腺癌治疗中的疗效分析

目的对比早期乳腺癌行前哨淋巴结活检术(SLNB)与行SLNB加腋窝淋巴结清扫(ALND)后的并发症及远期预后。方法回顾性分析2012年10月至2013年10月50例早期乳腺癌前哨淋巴结阴性患者,并将其分为腋窝淋巴结保留组与腋窝淋巴结清扫组,每组25例。保留组行SLNB治疗,清扫组在保留组的治疗基础上加行ALND。采用SPSS19.0软件进行统计分析,年龄、平均住院时间计量资料用(x珋±s)表示,采用t检验;病理特征、并发症、生存率两组比较采用χ2检验。P0.05时差异有统计学意义。结果 50例患者共检出前哨淋巴结(SLN)87个,平均每例检出1.74个。保留组共检出SLN 42枚,平均检出1.68枚,清扫组共检出SLN 45枚,平均检出1.8枚(χ2=0.180,P0.05)。出现并发症的例数:保留组为4例(16.0%),清扫组为15例(60.0%);平均住院时间:保留组为(6.0±1.1)d,清扫组为(8.3±1.7)d。保留组的术后住院时间及并发症均明显少于清扫组,且两组比较均有统计学意义(t=5.679,χ2=10.272,P0.05)。50例患者随访2~3年,随访率100%。截至2015年6月,两组患者术后两年生存率均为100%,无瘤生存率均为100%。结论 SLNB经济实用、安全可靠、推广方便,能够较准确地预测乳腺癌腋窝淋巴结的分期状态,可以减少不必要的腋窝淋巴结清扫及其术后并发症的发生。     

前哨淋巴结活检对乳腺癌新辅助化疗后腋窝状况评估中的价值

目的 研究前哨淋巴结活检在乳腺癌新辅助化疗后的临床应用价值。方法 选择我院2007年9月至2010年11月期间收治的46例Ⅱ、Ⅲ期乳腺癌患者,接受新辅助化疗后超声检查腋窝淋巴结阴性者为研究对象。所有患者前哨淋巴结活检后行乳腺癌改良根治术及标准腋窝淋巴结清扫,所有前哨淋巴结行病理和免疫组化检查,非前哨淋巴结行常规病理检查。结果 前哨淋巴结活检的成功率、假阴性率、灵敏度、特异性、精确性、阳性预测值、阴性预测值分别是93.5%,3.7%,96.3%,100%,97.7%,100%,94.1%。结论 前哨淋巴结活检结合超声可以较准确的评价新辅助化疗后乳腺癌的腋窝淋巴结状态,对于决定患者是否需要行腋窝淋巴结清扫有一定参考价值。     

乳腺癌新辅助化疗后全腋窝清扫的应用研究

目的探讨在经新辅助化疗降期后的局部晚期乳腺癌患者中,全腋窝淋巴结清扫应用的必要性。方法将2001年至2007年75例经新辅助化疗后获得降期的局部晚期乳腺癌患者分为两组,分别行Kodama改良根治术（KMRM组）和改良根治术Ⅰ式（MRMI组）,比较分析治疗效果。结果两组清扫腋窝淋巴结总数差异有显著性。其中,KMRM组单独送检锁骨下淋巴结125枚,阳性11枚（8．8％）,术后并发症及5年生存率差异均无显著性。结论新辅助化疗后乳腺癌患者的手术方式选择中,化疗前分期仍应作为主要参考依据之一。     

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.     

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.