三甲氧苄嗪对大鼠心脏保存作用的实验研究

目的 探讨UW、HTK器官保存液以及加入三甲氧苄嗪（TMZ）对大鼠心脏离体低温保存的保护效果。方法 以离体灌注鼠心为研究对象，观察鼠心在UW、HTK保存液中4℃保存8h后，以及在UW液、HTK液中加入10^-6mol/L TMZ后的心功能、心肌ATP及乳酸盐的变化。结果 HTK液保存的心脏，心功能恢复明显优于UW液（P＜0．05），心肌ATP储存量多于UW液（P＜0．05），心肌乳酸盐含量少于UW液（P＜0．05）；在UW液、HTK液中加入10^-6mol/L TMZ后，可显著提高UW、HTK液的心肌保护效果（P＜0．05）。结论 HTK液对离体低温保存鼠心的心肌保护效果优于UW液；TMZ能显著提高UW、HTK保存液的心肌保护效果。     

二氮嗪心脏停搏液对供心的保护作用

目的探讨二氮嗪(diazoxide)心脏停搏液对冷保存供心细胞凋亡的作用。方法用单纯随机抽样法将32只新西兰大耳白兔随机分成4组(每组8只):二氮嗪组(KH液加入50μmol/L二氮嗪),STH组(St.Thomas液),5-HD组(KH液中加入50μmol/L二氮嗪和100μmol/L 5-hydroxydecanoic acid)和KH组(KH液)。兔心分别在相应的心脏停搏液中冷保存(4℃)6h,应用Langendorff灌注模型,在保存前后测左心室发展压(LVDP)、左心室内压上升最大速率(+dp/dtmax),以保存前LVDP、+dp/dtmax值作基数计算保存后的恢复率。用原位末端标记法(TUNEL)检测保存后心肌细胞凋亡,测定保存后心肌组织中三磷酸腺苷(ATP)、丙二醛(MDA)的含量。结果二氮嗪组的LVDP、+dp/dtmax恢复率和心肌组织中ATP含量明显高于其他3组(P<0.05),而心肌细胞凋亡率、心肌MDA含量均明显低于其他3组(P<0.05)。结论二氮嗪心脏停搏液对离体心脏有保护作用,其作用可能与线粒体钾通道(mitochondrial KATP)开放有关;线粒体钾通道阻滞剂5-HD可取消二氮嗪的心肌保护作用。     

超极化心脏保存液对离体大鼠心脏低温保存的保护作用

目的　探讨含K 通道开放剂的心脏保存液(HCS液)对大鼠离体心脏的保存作用。方法　将24只SD大鼠随机平均分为 3 组,分别用 HCS液、UW液、K H液对心脏进行保存。采用Langendorff心脏灌注和工作模型装置进行心脏功能测定,比较 24h后心功能恢复率以及细胞酶学、心肌含水量、pH值变化和能量变化,观察心肌超微结构改变。结果　心脏保存24 h后, K H组左心室功能损伤严重,UW组及HCS组左心室功能损伤较轻。HCS组冠状动脉流量(CF)恢复率较 K H组、UW组好;HCS组冠脉回流液中乳酸脱氢酶(LDH)、磷酸肌酸激酶(CPK)含量及心肌含水量与UW组比较,差异无统计学意义;HCS组 pH值变化最小, ATP含量最高;HCS组心脏复跳时间与UW组基本相同; HCS组心肌保存良好。结论　HCS保存液对大鼠心脏的保存在 24 h内有明显的保护作用,心脏功能恢复率能达到UW液的水平,在能量保护、改善酸中毒方面则优于UW液。     

硫化氢在兔离体心脏保存中的保护作用

目的 研究硫化氢(H2S)在兔离体心脏低温保存中的作用,并探讨其作用机制.方法 获取40只大白兔的离体心脏,应用Langendorff灌注装置对兔离体心脏分别进行灌注后保存.根据离体兔心灌注和保存液的不同,分为5组,每组8只.对照组:单纯Krebs-Henseleit(K-H)液;硫氢化钠(NariS)组:K-H液中加入1 μmol/L的NariS(H2S的供体);NariS+格列本脲(G1i)组:K-H液中加入1 μmol/L的NariS和10 μmol/L的Gli;G1i组:K-H液中加入10 μmol/L的Gli;STH组:单纯St.Thomas液.各组心脏在灌注和保存6 h后,留取心脏标本,检测各组兔离体心脏低温保存6 h后心功能恢复率、心脏复跳时间、心肌三磷酸腺苷(ATP)含量和含水量变化,使用电子显微镜观察心尖部组织的结构变化.结果 心脏保存6 h后,NariS组心脏复跳时间最短、心功能恢复率、心肌ATP含量最高,均优于STH组,但差异无统计学意义(P＞0.05);与NariS+Gli组、Gli组和对照组比较,差异均有统计学意义(P＜0.05).NariS组左心室功能和结构损伤较轻,其次是STH组,NariS+Gli组、Gli组及对照组的左心室功能及心肌组织结构损伤严重.结论 硫化氢在兔离体心脏低温保存6 h内具有良好的保护作用.开放KATP通道可能是硫化氢发挥保护作用的重要机制.     

11,12-EET长时间保存未成熟离体兔心的初步研究

目的探讨11，12-EET(11，12-epoxyeicosatrienoic acid)对未成熟兔离体心脏缺血再灌注损伤的保护作用及机制。方法利用非循环式Langendorff灌注装置将16只未成熟离体兔心制成缺血再灌注模型，随机分成对照组(st．Thomas No．2液为停搏液及保存液)和实验组(st．Thomas No．2液加ll，12-EET为停搏液及保存液)。测定心脏保存(4^。C)8h、再灌注(37^。C)30min的心功能指标：左心室变化压、舒张末压、最大压力变化速率、冠状动脉流量以及心肌含水量、心律失常评分和心肌酶CK、LDH、心肌超微结构改变等。结果(1)实验组的心功能恢复率、心肌水肿程度、心肌超微结构和心肌酶及心律失常评分改变均优于对照组。(2)与保存前相比，实验组的心功能无显著性改变，心功能恢复基本接近保存前水平。结论St．Thomas No．2液中加人11，12-EET可增强对未成熟兔离体心脏的保存效果。     

HOE-642联合尼可地尔对无心跳猪供心的保护作用

目的 探讨无心跳供者(NHBD)的心脏进行移植的可行性,以及HOE-642联合尼可地尔对这种供心的保护效果.方法 将健康雄性家猪随机分为实验组和对照组,实验组供者采取主动脉快速完全放血法制成NHBD模型,取其心脏,冷保存4 h后进行移植;对照组供者经主动脉适量放血(仍有心跳),造成热缺血,然后取其心脏,冷保存4 h后进行移植.实验组于供心热缺血前5 min静脉给予HOE-642(2 mg/kg);以含HOE-642和尼可地尔的4 ℃ Stanford液灌洗和保存供心;供心吻合前经主动脉根部以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(高钾)灌注1次;供心吻合期间以含HOE-642和尼可地尔的4 ℃ 4:1血心停搏液(低钾)间断灌注;心脏吻合完毕主动脉开放后初始5 min时段内,静脉给予HOE-642(2 mg/kg).对照组的供心处理除不用HOE-642和尼可地尔外,其余同实验组.采集供心主动脉根部放血前、移植心脏吻合完毕主动脉开放后1 h(停机)以及主动脉开放后2 h(实验结束)3个时点的心脏血流动力学指标,测定移植心脏的心肌含水量,观察心肌的组织学变化.结果 两组在主动脉开放后心肌红润,心脏搏动有力,均成功脱机.两组各检测时点的左心室舒张末压、左心室峰发展压及左心室压力变化速率的差异均无统计学意义(P＞0.05);实验组和对照组心肌组织含水量分别为(78.6±5.7)%和(76.4±4.2)%,其差异无统计学意义(P＞0.05);光镜下见两组的心肌纤维结构清楚,排列紧密,间质未见炎症细胞浸润,也未见变性、坏死,无排斥反应征象,电镜下见心肌细胞超微结构完整.结论 NHBD的供心可用于移植,其效果与有心跳者相近;HOE-642和尼可地尔联用可能对该类供心具有一定的保护作用.     

UW和St.Thomas液对冠状动脉张力的影响

目的 比较University of Wisconsin液(UW液)和St．Thomas液(STH)对猪冠状动脉张力的影响。方法 取新鲜猪心外膜下冠状动脉前降支切成3段，长3mm，共42条血管环，按单纯随机抽样法分为6组，每组7条。(1)在37℃有氧的器官槽中保存4小时，对照组：浸入重碳酸盐缓冲液(KH液)；UW液组：浸入UW液；STH液组：浸入STH液。(2)在4℃无氧的冰箱中保存4小时，对照组：浸入KH液；UW液组：浸入UW液；STH液组：浸入STH液。采用器官槽法，持续监测在37℃保存过程中血管环张力的变化，及在环加氧酶阻断剂消炎痛(7μmol/L)和一氧化氮合成酶阻断剂L—N—硝基精氨酸(300μmol／L)作用下，前列腺素F2α(30nmol／L)及非受体介导钙离子载体引发的收缩舒张反应。结果常温下，与对照组相比，UW液组、STH液组血管末张力明显降低(P＜0．01)，UW液组预收缩强度明显降低(P＜0．05)。与对照组相比，非受体介导钙离子载体引发的内皮源性舒张反应，UW液组明显下降(P＝0．004，0．009)，STH液组变化不明显(P＝0．477，0．331)。结论 在37℃条件下UW液和STH液均有舒张冠状动脉的作用，低温有利于UW液对冠状动脉收缩功能的保护；UW液保存冠状动脉4小时后，对内皮源性超极化因子介导血管舒张功能有损伤作用。     

对四种心肌保存液保存效果的评价

本文评价了4种心肌保存液的保存效果。结论是HTK液和UW液是良好的心肌保存液，尤其是HTK液保存效果优于UW液，Celsior液仅可用于心脏保存,对其它器官的保存效果还有待于进一步观察，Euro-Collins液中含有葡萄糖，使用复杂，现在几乎不再用保存心肌，低温对器官保存十分重要。UW液在0－4度条件下保存效果最好，HTK液在4度和8度时的保存效果无明显差别。     

11,12-EET对未成熟离体兔心的长时间保存作用

目的 观察11，12-EET(11，12-epoxyeicosatrienoic acid)液对未成熟兔离体心脏的保护作用。方法 将48只未成熟离体兔心按随机分配原则分成对照组(24只)和EET组(24只)，对照组保存心脏采用St.Thomas No.2液为停搏液及保存液，EET组采用St.Thomas No.2液 11，12-EET为停搏液及保存液，分别保存心脏8h、16h、24h。利用非循环式Langendorff灌注装置测定各组心脏保存前及保存后再灌注30min(37℃)的左心室变化压(LVDP)、舒张末期压(LVEDP)、最大压力变化速率( dp/ptmax)和冠状动脉流量(CBE)，并测定心律失常评分、心肌肌酸激酶(CK)、乳酸脱氢酶(LDH)含量及观察心肌超微结构的改变等指标。结果 (1)EET组各保存时间的心功能恢复率、心肌水肿程度、心律失常评分均好于相应对照组；CK、LDH及心肌超微结构的改变亦明显优于对照组。(2)心脏保存16h后，EET组的心功能恢复率、心律失常评分基本接近心脏保存之前的测定值，而对照组则明显减低。(3)心脏保存24h，EET组心脏全部复跳，对照组5只心脏不能复跳。结论 St.Thomas No.2液中加入11，12-EET可延长对未成熟兔离体心脏的保存时间并增强其保存效果。     

热休克预适应诱导HSP72提高兔心长期保存效果的实验研究

目的：通过热休克预适应模型，观察其是否可以改善心脏后心功能的恢复，提高心脏的保存质量，探讨此模型中心肌保护作用的分子基础。方法：健康成年新西兰白兔20只，随机分为两组，每组10只，I组为对照组；Ⅱ组为热休克组，将兔体温升高到42℃，保持15min，自然环境下恢复24h后处理；两组实验方法相同，心肌保存前用K－H液灌注35min，然后用4℃STS液使心脏停搏并4℃保存6h，保存后用K－H复灌30min。保存前、复灌后工作心期末测定心率（HR），冠脉流量（CF）、左室收缩末期压（LVESP）和左室舒张末期压（LVEDP），心功能恢复率以保存前的百分率表示，再灌注期末取心肌组织进行热休克蛋白72（HSP72）的定量和定位检测，测定心肌内NO、肌酸激酶同功酶（CK－MB）、乳酸脱氢酶（LDH）的含量，测定超氧化物歧化酶（SOD）和脂质过氧化物（LPO)的含量，测定心肌含水量。结果：热休克组功能恢复明显好于对照组，且与心肌内HSP72含量相关（r＝0．95），其心肌内NO含量亦明显高于对照组。结论：热休克预适应可明显改善心脏保存6h后心功能的恢复，减轻心肌酶的漏出，减轻缺血－再灌注损伤。且其分子基础是HSP72，其保护机制可能与内皮细胞保护有关。     

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.     

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.     

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.