小剂量氯胺酮复合芬太尼术后静脉镇痛

目的　比较小剂量氯胺酮联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者 12 0例 ,随机均分为三组 ,每组 4 0例 ,以一次性静脉镇痛泵 (2ml/h)分别行静脉术后镇痛。F组 :单纯芬太尼镇痛 ,0 4 μg·kg-1·h-1芬太尼 +5mg氟哌利多。KF1组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +40 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。KF2组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +80 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。各组镇痛泵中药物均用医用盐水稀释至 10 0ml。观察各组患者镇痛 4 8小时内的静息镇痛评分 (VAS方法 )、恶心呕吐、皮肤瘙痒、尿潴留和幻觉的发生情况。结果　三组患者的静息镇痛评分在 12小时内KF1组和KF2组明显低于F组 (P <0 0 5 ) ,而在 12小时后没有明显差别 (P >0 0 5 ) ;恶心呕吐、皮肤瘙痒和尿潴留发生率KF1组和KF2组显著低于F组 (P <0 0 1)。KF1组和KF2组之间在静息镇痛评分和并发症发生方面没有明显差别。三组中均无幻觉发生。结论　小剂量氯胺酮用于术后静脉镇痛可明显减少芬太尼的剂量 ,使恶心呕吐、皮肤瘙痒和尿潴留发生率降低 ,镇痛效果明显优于单纯芬太尼术后静脉镇痛     

吗啡、芬太尼、曲马多术后镇痛对病人白细胞介素-2的影响

目的 观察吗啡、芬太尼、曲马多用于术后病人静脉自控镇痛(PCIA)时对血清白细胞介素-2(IL-2)分泌的影响。方法 150例择期行上腹部手术的病人，随机分成三组：M组(吗啡组)；F组(芬太尼组)；T组(曲马多组)。分别于麻醉前、术后1、3、24h采血，应用酶联免疫吸附试验(ELISA)检测血清IL-2水平。结果 与麻醉前比较，M组病人术后各时点血清IL-2水平明显降低(P＜0．05)，F组在各时点明显升高(P＜0．05)，T组术后1h与麻醉前比较差异无显著性(P＞0．05)，术后3h明显升高(P＜0．05)，术后24h达到更高水平(P＜0．01)。结论 吗啡、芬太尼、曲马多均可有效减轻术后疼痛。与吗啡抑制IL-2分泌相反，芬太尼和曲马多可明显增强上腹部手术病人术后IL-2的分泌。     

曲马多用于术后静脉自控镇痛的效果评价

目的　将曲马多与传统的阿片类药物进行对比 ,对其镇痛效果进行评估。方法　 90例ASAⅠ～Ⅱ级的中下腹手术病人 ,随机分为三组 ,每组 30例 ,曲马多组 (T组 ) :负荷剂量 1 5mg/kg ,按压剂量 10mg ,背景输注量 10mg/h ,间隔时间 5min ;芬太尼组 (F组 ) :负荷剂量 1μg/kg ,按压剂量 10 μg ,背景输注量 10 μg/h ,间隔时间 5min ;吗啡组 (M组 ) :负荷剂量 0 15mg/kg ,按压剂量0 5mg ,背景输注量 1mg/h ,间隔时间 5min。观测患者 2 4h内心率、血压、呼吸频率、脉搏血氧饱和度、VAS、镇静评分、PrinceHenry评分 (PHS)以及不良反应的发生率 ,并记录患者 2 4h内用药量。结果　镇静评分 (SS)、VAS、PHS三组病人无显著性差异 ;恶心呕吐的发生率T、M组 >F组 (P <0 0 5 ) ;排气时间延长发生率F、M组 >T组 (P <0 0 5 )。结论　曲马多能够获得与吗啡、芬太尼相同的满意的镇痛效果 ,并且降低了术后排气时间延长的发生率 ,但恶心的发生率高于芬太尼组。     

吗啡、芬太尼和曲马多术后镇痛对病人血清β-内啡肽和白细胞介素-6水平的影响

目的比较吗啡、芬太尼和曲马多用于术后病人静脉自控镇痛(PCIA)时对血清β内啡肽(βEP)和白细胞介素6(IL6)水平的影响。方法150例择期行上腹部手术的病人,ASAⅠ～Ⅳ级,随机分成三组,吗啡组(M组)、芬太尼组(F组)和曲马多组(T组),每组50例。皮下缝合时给予负荷量开始术后镇痛,持续24h。分别于麻醉前、术后1、3、24h采血,应用放射免疫分析法检测血清βEP和IL6水平。结果三组病人麻醉前及术后1、3、24h血清IL6水平差异无显著意义。与麻醉前相比,M组βEP水平在术后各时点均明显下降(P<0.05);F组和T组则明显升高(P<0.05)。结论吗啡、芬太尼、曲马多均可有效抑制术后应激反应程度。与吗啡相比,芬太尼和曲马多可明显增加病人血清βEP的水平,有可能产生免疫增强作用,因此更适合用于术后镇痛。     

芬太尼、吗啡PCSA用于心外术后镇痛疗效的随机对照研究

目的　对皮下芬太尼或吗啡病人自控镇痛 (PCA)的疗效及安全性进行评价。方法　将 6 0例ASAⅠ～Ⅲ级心外术后病人随机分成芬太尼与吗啡病人皮下自控镇痛 (PCSA)组 ,其中芬太尼组 2 9例 ,吗啡组 31例。药物配方 :芬太尼组为 1ml药液中含芬太尼 2 5 μg、利多卡因 10mg ;吗啡组为 1ml药液中含吗啡 1mg、利多卡因 10mg ;PCA设置 :负荷量 2ml,单次剂量 1ml,小时限量 10ml,锁定时间 3分钟。于负荷量注射完毕后记录镇痛起效时间 ,并于放置PCSA泵后 2 4、48、和 72小时记录以下指标 :安静、咳嗽和运动时疼痛VAS评分 ,镇静程度 ,PCA需求按压和有效按压次数 ,MAP、HR、RR、SpO2 及副作用。结果　镇痛效果 :芬太尼组镇痛起效时间显著短于吗啡组 (P <0 0 5 ) ;芬太尼组PCA药物用量、需求按压和有效按压次数显著高于吗啡组 (P <0 0 5 ) ;吗啡组恶心、呕吐的发生率明显高于芬太尼组 (P <0 0 5 )。结论　芬太尼、吗啡PCSA操作简单、系统故障发生率低 ,适于较长时间留置     

曲马多与吗啡病人自控镇痛的临床效果比较

目的　比较曲马多和吗啡病人自控镇痛 (PCA)对经腹全子宫切除术病人的镇痛效果。方法　 4 0例病人进行随机、双盲研究。吗啡组 (M组 )PCA单次给药量吗啡 1mg ;曲马多组 (T组 )PCA单次给药量曲马多 2 0mg ;锁定时间均为 10min。术后 4、8、12、2 0、2 8、36h分别观察BP、HR、RR、疼痛评分 (VAS)、恶心、呕吐、镇静评分、眩晕、口干等不良反应。结果　曲马多组与吗啡组病人镇痛效果相似。术后 2 4h曲马多组恶心、呕吐发生率高于吗啡组 (分别为 2 9%vs 11% ,P <0 0 5 ;16 %vs 4 % ,P <0 0 5 ) ;吗啡组产生的镇静作用大于曲马多组 (第一个 2 4h为 34%vs 14 % ,P <0 0 5 )。结论　PCA曲马多对经腹全子宫切除病人可提供满意的镇痛效果 ,但恶心、呕吐的发生率较高     

小剂量吗啡和曲马多关节内注射用于膝关节镜术后镇痛的临床比较

目的　观察小剂量吗啡、曲马多关节内注射用于膝关节镜手术后的镇痛效果。方法　腰麻下行膝关节镜手术的病人 6 0例 ,双盲随机分为关节内注射吗啡组 (M组 ,n =2 0 )、曲马多组 (T组 ,n =2 0 )和生理盐水对照组 (C组 ,n =2 0 )。M组在术后关节内注射小剂量吗啡 (1mg) ,T组则在术后关节内注射小剂量曲马多 (10mg) ,C组则关节内注射等体积的生理盐水。给药后 8和 2 4小时 ,在病人双足站立膝关节伸展状态下进行视觉模拟评分。结果　M组评分平均为 1 7± 1 0和 1 5±1 1,T组评分为 2 0± 1 1和 1 7± 1 2 ,C组为 3 6± 1 5和 2 4± 1 3,M组与T组评分显著低于C组 (P <0 0 5 )。M组与T组评分有显著差异 (P <0 0 5 )。结论　小剂量的吗啡和曲马多关节内注射可以有效缓解膝关节镜手术的术后疼痛 ,尤以吗啡为佳     

雷米芬太尼复合曲马多用于术后病人自控静脉镇痛

目的比较不同浓度雷米芬太尼与曲马多联合用于上腹部手术后病人自控静脉镇痛（PCIA）的临床效果。方法45例30～70岁拟行上腹部手术病人随机分为三组：单独曲马多组（A组）,低浓度雷米芬太尼（0．0125μg·kg^-1·min^-1）与曲马多联合用药组（B组）、高浓度雷米芬太尼（0．025μg·kg^-1·min^-1）与曲马多联合用药组（C组）,每组15例。术毕拔管后使用PCIA,并分别记录术后15min（T0）、2h（T1）、5h（T2）、10h（T3）和24h（T4）共5个时点的疼痛程度（PI）、疼痛缓解程度（PAR）、生命体征的变化及各种不良反应。结果T0时PI值三组间差异无统计学意义;B组T1、T2和T4时及C组T1～T4时的PI值均明显低于A组（P〈0．05）,C组T1～T4时的PI值明显低于B组（P〈0．05）;C组T1～T4时的PAR值明显低于A组和B组（P〈0．05）。三组的呼吸抑制、头晕、恶心呕吐的发生率差异均无统计学意义。结论0．025pg·kg^-1·min^-1雷米芬太尼与曲马多联合用药术后镇痛效果满意,起效时间短,不良反应发生率与0．0125pg·kg^-1·min^-1雷米芬太尼与曲马多联合用药组及单独曲马多组差异无统计学意义。     

术中负荷剂量曲马多对术后吗啡PCA效果的影响

目的　研究术中负荷剂量曲马多的使用对术后吗啡病人自控镇痛 (PCA)效果的影响。方法　 6 0例腹部手术患者 ,采用随机、双盲、对照试验的方法于手术结束前静脉给予生理盐水 (对照组 )、1mg/kg曲马多或 2mg/kg曲马多。术后使用吗啡静脉PCA进行镇痛。观察术后镇痛效果及不良反应。结果　曲马多组与对照组比较 ,术后清醒时间、拔管时间、术后呼吸次数和血氧饱和度均无显著差异。 2mg/kg曲马多组在给药后 1小时和 8小时VAS评分分别为 (1 33± 1 4 6 )分和 (1 5 4±1 6 5 )分 ,对照组分别为 (2 78± 1 87)分和 (2 6 1± 2 0 6 )分 (P <0 0 1,P <0 0 5 )。结果还显示 ,术毕给予 2mg/kg曲马多可明显减少术后PCA的吗啡用量及补救吗啡用量。 结论　术中使用 2mg/kg负荷剂量的曲马多可有效改善术后吗啡PCA的镇痛效果 ,并可减少PCA吗啡和补救吗啡用量。同时 ,曲马多的使用对术毕的清醒时间和呼吸恢复没有明显影响     

氯胺酮对小儿术后镇痛中吗啡作用的影响

目的　研究氯胺酮在小儿术后硬膜外自控镇痛中对吗啡作用的影响。方法　全麻下择期腹部手术病儿 37例 ,病人随机分为三组。负荷量 :Ⅰ组 (n =13)吗啡 10 μg/kg +氯胺酮 0 1mg/kg ;Ⅱ组 (n =10 )吗啡 10 μg/kg ;Ⅲ组 (n =14)吗啡 2 0 μg/kg。维持量 :Ⅰ组吗啡 1μg·kg-1·h-1+氯胺酮 0 0 3mg·kg-1·h-1;Ⅱ组吗啡 1μg·kg-1·h-1;Ⅲ组吗啡 2 μg·kg-1·h-1。单次给药剂量 :同各组每小时持续量 ;锁定时间 10min。按预定 6个时点记录疼痛、镇静评分、维持期吗啡耗量及不良反应发生率。结果　疼痛评分 :Ⅰ、Ⅲ组均为 0 0 0± 0 0 0 ,明显优于Ⅱ组 0 12± 0 17(P <0 0 1)。吗啡维持量 :Ⅰ、Ⅱ、Ⅲ组分别为 :5 1 0± 3 3μg/kg、6 3 4± 18 0 μg/kg、117 6± 2 0 1μg/kg(P <0 0 1)。镇静评分及不良反应发生率均无显著性差异。结论　小儿术后硬膜外自控镇痛中 ,微量氯胺酮明显增强吗啡的镇痛作用 ,减少吗啡用量     

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.