金属硫蛋白与皮瓣缺血预处理延迟保护作用的实验研究

目的：探讨金属硫蛋白（MT）参与皮瓣缺血预处理（PC）延迟保护作用（DP）的可能性。方法：在猪背阔肌岛状皮瓣PC和培养肌细胞PC的模型上，检测PC后即刻，12h和24h MT含量变化，观察PC后24h对再次长时间缺血再灌注（I／R）或缺氧复氧（A／R）损伤的保护作用以及用丝裂素蛋白激酶抑制剂（PD098059）抑制PC后MT含量增高对PC和DP的影响。结果：MT含量在PC后12h（肌细胞）和24h（肌细胞和皮瓣组织）显著增高，与未PC的皮瓣组织或肌细胞遭受I／R或A／R的损伤相比较，PC后24h其皮瓣坏死范围缩小（P＜0．05），血浆乳酸脱氢酶（LDH）活性降低（P＜0．05），肌细胞存活率增高，细胞丙二醛（MDA）含量和LDH释放均降低（P＜0．01）。用PD098059抑制后则消除了PC后的DP作用，上述皮瓣损伤指标接近单纯I／R组或A／R组（P＞0．05）。结论：①PC后24h对皮瓣或肌细胞的再次I／R或A／R损伤具有保护作用；②MT参与了皮瓣或肌细胞PC后的DP作用。     

脂质体携载金属硫蛋白对皮瓣继发静脉缺血再灌注损伤的作用

目的 观察脂质体包裹金属硫蛋白(MT)对岛状皮瓣继发静脉缺血再灌注损伤的保护作用。方法 在大鼠下腹部岛状皮瓣继发静脉缺血再灌注损伤模型上测定皮瓣即刻、继发缺血再灌注30min、7d后的丙二醛(MDA)含量、髓过氧化物酶(MPO)活性，继发缺血再灌注30min时血浆内皮素(ET)、乳酸脱氢酶(LDH)水平，7d后皮瓣MT的含量。结果 脂质体携载MT组明显降低皮瓣MDA、MPO、血浆ET、LDH含量，增加7d后皮瓣组织MT含量，提高皮瓣成活率。结论 脂质体包裹MT对皮瓣继发静脉缺血再灌注损伤具有良好的保护作用。     

缺血再灌注损伤皮瓣组织中金属硫蛋白含量变化

目的　观察缺血再灌注损伤皮瓣组织中金属硫蛋白 (metallothionein ,MT)的含量变化。方法　 16只大鼠随机分为对照组 (n =8)和缺血再灌注损伤组 (n =8)。在大鼠腹壁浅血管为蒂的岛状皮瓣缺血再灌注损伤模型上 ,用10 9Cd血红蛋白饱和法和硫代巴比妥酸法测定皮瓣组织中MT及丙二醛(MDA)含量 ,比色法测定皮瓣组织过氧化物酶 (MPO )活性。结果　缺血再灌注损伤组在缺血 8h、再灌注 12h、2 4h时皮瓣组织中MDA水平分别较对照组高 41.7%、111.4%、13 5.7% ,MPO水平分别较对照组高 72 .1%、2 18.9%、2 96.0 % ,MT含量分别较对照组高 42 .6%、52 .8%、10 2 .3 % (P <0 .0 5或P<0 .0 1)。结论　皮瓣组织中MT含量增多 ,可能与皮瓣缺血再灌注损伤有关     

一氧化氮对岛状肌皮瓣缺血再灌注损伤的影响

目的　观察NO对岛状肌皮瓣I/R损伤的影响并探讨其作用机制。方法　选用白色小家猪 15只 ,随机分为I/R组、I/R +NO供体L -arg组及对照组。制作猪腹直肌岛状肌皮瓣I/R模型 ,于再灌注前后给予L -arg ,检测I/R不同时相皮瓣静脉血中NO的间接含量、皮瓣NTR渗出 ,计算再灌注完毕后肌肉存活比例。结果　①I/R +L -arg组再灌注 0 .5小时、1小时NO间接含量 ( 75 .0 7± 12 .5 4 ) μmol/L、( 86.86± 2 0 .15 ) μmol/L ,明显高于I/R组 ( 4 6.75± 11.77) μmol/L、( 4 0 .3 8± 10 .78) μmol/L(P <0 .0 1)。②再灌注 1小时、4小时I/R +L -arg组皮瓣NTR计数 ( 66.5 0± 17.3 3～ 15 3 .80± 3 8.5 3 ) / 2 0个高倍视野明显低于I/R组 ( 171.5 0± 4 4 .5 0 ,3 16.80± 5 2 .85 ) / 2 0个高倍视野 (P <0 .0 1)。③再灌注完毕后 ,I/R +L -arg组皮瓣肌肉的存活比例 ( 83 .70± 15 .60 ) %明显高于I/R组 ( 2 4 .0 7± 12 .3 5 ) % (P <0 .0 1)。结论　于缺血后再灌注前及再灌注早期给予L -arg ,适当增加内源性NO的产生 ,能有效减轻肌皮瓣缺血再灌注损伤。     

重组人sCR1蛋白对大鼠肢体缺血再灌注损伤的保护作用

[目的]探讨重组人可溶性补体受体1型(Soluble complement receptor type 1,sCR1)对大鼠肢体缺血再灌注(I/R)损伤的保护作用。[方法]采用无创血管夹夹闭左侧股动脉制作大鼠肢体缺血再灌注(Ischemiareperfusion,I/R)损伤模型,观察0、4、8 h时间点sCR1蛋白干预组(B组)与生理盐水(NS)对照组(A组)I/R损伤肌组织细胞形态学变化、测定肌肉湿干重比(W/D)、髓过氧化物酶(MPO)、丙二醛(MDA)、乳酸脱氢酶(LDH)的表达水平。[结果]sCR1蛋白干预后的B组各时间点腓肠肌组织的W/D均低于NS对照A组,以I/R 4 h组最为显著(P<0.01);B组的MDA、MPO、LDH表达水平明显低于A组,以I/R 4 h组最为显著(P<0.01)。[结论]重组人sCR1蛋白对大鼠模型进行sCR1蛋白早期干预后,可明显减轻大鼠后肢骨骼肌I/R的损伤。     

肠缺血/再灌注对肝脏自由基的影响及亚甲蓝的抗损伤作用

目的 研究肠缺血/再灌注(I/R)后氧自由基(ROS)对远隔器官肝脏的损伤作用,探讨亚甲蓝(MB)抗肝脏损伤的作用机制。方法 新西兰白兔32只,体重2.3～2.9 kg,随机分为4组,(1)正常组:本组仅做假手术处理。(2)I/R组:本组通过夹闭兔肠系膜前动脉1h复制肠I/R模型。(3)治疗A组:本组于松夹后静脉内给予MB 3 mg·kg-1。(4)治疗B组:本组于松夹后静脉内给予MB 15 mg·kg-1。颈总动脉置管,连续监测血压。于夹闭前、松夹即刻、松夹后30 min、1h和2h取血测定血中MDA浓度。实验结束后取一小块肝组织用于测定超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、黄嘌呤氧化酶(XO)及MDA。结果与I/R前基础值比较,I/R组血中MDA水平I/R后显著增加,同时血压显著下降;而治疗A组及B组血中MDA水平于I/R后均未显著增加。与正常组比较,I/R组肝组织MDA水平显著增高,而正常组与两个治疗组间肝组织中MDA无显著差异。结论 MB能减少肠I/R后ROS的生成并能对抗ROS对肝脏的损伤作用。     

缺血再灌注损伤皮瓣组织中金属硫蛋白的免疫组化研究

目的：观察缺血再灌注损伤皮瓣组织中金属硫蛋白(Metallothionein MT)的表达部位及表达量的变化规律。方法：16只大鼠随机分为对照组(n=8)和缺血再灌注组(n=8)。在大鼠以腹壁浅血管为蒂的岛状皮瓣缺血再灌注模型上，用硫代巴比妥法和比色法分别测定皮瓣组织中丙二醛(MDA)含量和髓过氧化物酶(MPO)活性。观察免疫组化切片中MT的表达部位，并对切片进行图像分析，以积分光密度代表MT的含量。结果：缺血再灌注组再灌注1h和24h，皮瓣组织中MDA含量分别较对照组高46.5％、147.8％，MPO活性分别较对照组高1169．5％、408．6％，MT含量分别较对照组高119．9％、234．6％。在发生缺血再灌注损伤的皮瓣中MT表达在表皮基底层细胞、皮下组织及肉膜下组织血管壁细胞、成纤维细胞，毛囊、皮脂腺、汗腺和肌细胞的细胞浆中。结论：皮瓣发生缺血再灌注损伤后，MT表达在皮瓣组织的多种细胞内，MT含量增加可能和皮瓣在发生缺血再灌注损伤时的某些代谢产物有关。     

前列地尔乳剂对缺血再灌注心肌的保护作用

目的　研究前列地尔脂肪乳剂 (Lipo PGE1)对大鼠心肌缺血再灌注损伤 (MIRI)的影响。方法　应用Langendorff鼠心脏灌注模型 ,将 3 0只SD大鼠随机分成空白对照组 (A组 )、再灌注时K H液加Lipo PGE1组 (B组 )、停跳液中加Lipo PGE1组 (C组 ) ,各组分别平衡灌注 2 0min后灌注冷晶体停搏液 ,2 5℃缺血 5 0min ,再灌注 60min ,观察比较各组心肌I/R前后心率 (HR )、左室发展压 (LVDP)、左室压力变化速率 (△dp/dt)、冠脉流量 (CF)、冠脉流出液中磷酸肌酸激酶 (CPK)、乳酸脱氢酶 (LDH)含量及再灌注后心肌超氧化物歧化酶 (SOD)活性、丙二醛 (MDA)和ATP含量的变化、心肌细胞超微结构的变化。结果　Lipo PGE1改善心肌I/R后的收缩功能、增加冠脉流量和心肌ATP含量 ,促进SOD活性恢复 ,减少心肌细胞CPK和LDH的漏出及MDA的生成 ,减轻了心肌细胞超微结构的损伤。结论　Lipo PGE1通过其抗氧化和扩张冠脉作用可减轻MIRI。     

硫酸锌对皮瓣缺血再灌注损伤保护作用的研究

目的 观察外源性锌对皮瓣缺血再灌注（ischemia—reperfusion，IR）损伤的保护作用，并探讨其机制。方法 48只大鼠随机分为非-IR组、IR组和补锌-IR组。在大鼠以腹壁浅血管为蒂的岛状皮瓣缺血再灌注模型上，分别测定皮瓣组织中丙二醛（MDA）含量和髓过氧化物酶（MPO）活性。观察免疫组化切片中金属硫蛋白（metallothionein，MT）的表达，并对切片进行图像分析。应用透射电镜观察皮瓣缺血再灌注损伤后超微结构的改变，观察皮瓣成活率。结果 补锌-IR组在再灌注1h和24h，皮瓣组织中MDA含量分别较IR组降低11．3％、33．2％（P〈0．05），MPO活性分别较IR组降低14．2％、22．7％（P〈0．05），MT含量分别较IR组高41．5％、44％（P〈0．01）。在补锌-IR组掀起皮瓣即刻的标本中有一定量的MT表达。MT表达在皮瓣组织多种细胞的细胞浆中。补锌-IR组皮瓣的超微结构改变较IR组减轻，皮瓣成活率较IR组升高27．2％（P〈0．05）。结论 外源性锌能诱导皮瓣内MT产生，MT通过细胞保护作用对皮瓣缺血再灌注损伤产生一定的保护作用。     

内源性一氧化碳在大鼠肢体缺血再灌注致远隔多脏器氧化性损伤中的作用

目的　探讨内源性一氧化碳 (CO)在大鼠肢体缺血再灌注 (I/ R)致远隔多器官氧化性损伤中的作用机制。方法　将 6 4只大鼠随机分为 4组 :假手术 (Sham )组 ;Sham 特异性血红素氧化酶阻断剂—锌原卟啉 (Zn PP)组 ;肢体缺血 2小时和再灌注 4小时 (I/ R)组 ;I/ R Zn PP组。测定各组心、肺、肝和肾组织匀浆中丙二醛 (MDA )含量、超氧化物歧化酶 (SOD)活性及血液内碳氧血红蛋白 (COHb)的变化 ,观察动物 2 4小时存活率。结果　与 Sham组相比 ,I/ R组各脏器 MDA含量及血液内 COHb水平均显著增高 ,组织中 SOD活性和动物 2 4小时存活率显著降低 ,有统计学意义(P<0 .0 5 ) ;I/ R Zn PP组与 I/ R组相比各脏器 MDA含量进一步增高 ,血液内 COHb水平、组织中 SOD活性和动物的2 4小时存活率显著降低 ,也有统计学意义 (P<0 .0 5 )。结论　肢体缺血再灌注可导致多器官的氧化性损伤 ,并使 CO产生增多 ,后者在大鼠抗缺血再灌注所致的远隔多器官损伤中具有重要作用。     

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.