经皮肝穿刺联合上下腔静脉途径介入治疗肝静脉闭塞型布加综合征

目的:评价肝静脉闭塞型布加综合征(BCS)介入治疗效果。方法:回顾性分析2010年1月—2016年1月于海南省人民医院血管外科接受介入治疗的14例肝静脉闭塞型BCS患者的临床资料。结果:14例患者手术方式均采用经皮肝穿刺造影结合上下腔静脉会师造影与球囊扩张术,14例患者均成功开通。患者均行逐步扩大直径的多次球囊扩张,其中9例患者半年内行2次手术,5例患者行3次手术。与术前比较术后患者平均肝静脉内压力明显降低(54 cm H2O vs.25 cm H2O);14例患者均未植入支架,所有患者症状均得到明显改善。随访时间为12~48个月,无死亡患者,无1例复发及严重并发症。结论:经皮肝穿刺造影结合上下腔静脉会师造影与球囊扩张术治疗肝静脉闭塞型BCS安全而有效,并发症发生率低,疗效满意。     

节段性狭窄闭塞Budd-Chiari综合征的介入治疗

目的　研究Budd Chiari综合征 (BCS)下腔静脉节段性狭窄闭塞合并肝静脉阻塞及血栓形成的介入治疗。方法　本组 13例下腔静脉节段性狭窄闭塞长 2～ 5cm ,其中 8例肝静脉闭塞 ,5例下腔静脉血栓形成。下腔静脉开通术应用房间隔穿刺针。闭塞肝静脉开通术应用RUPS 10 0肝穿装置。用 0 5～ 1 0cm球囊扩张 ,下腔静脉开通后用 1 0～ 2 0cm球囊扩张后放入金属内支架。术后抗凝治疗 3个月。结果　 13例患者成功的进行了经皮穿刺球囊扩张术 (PTA)和血管内支架植入治疗。术后患者肝脾缩小 ,腹水吸收。随访 3～ 2 6个月未见复发及消化道出血。结论　下腔静脉闭塞有血栓形成 ,必须在下腔静脉开通前用药物溶栓治疗。下腔静脉开通后放内支架要避开副肝静脉开口。肝静脉开通成形术应放在BCS介入治疗的首要位置。     

青少年布加综合征临床特点及介入治疗

目的 探讨青少年布加综合征(Budd-Chiari syndrome,BCS)临床特点并评估介入治疗的疗效.方法 徐州医学院附属医院自1990年1月至2012年4月收治227例年龄在29岁以下的BCS患者,均经彩超及血管造影证实,其中下腔静脉型87例、肝静脉型105例、混合型35例.通过经皮血管腔内血管成形术(percutaneous transluminal angioplasty,PTA)、血管内支架置入术及置管溶栓术开通闭塞血管.术后给予抗凝治疗、定期随访.结果 227例患者均以门脉高压的症状和体征为最初临床表现.210例患者初次介入手术取得成功,其中下腔静脉阻塞型成功率100％,肝静脉阻塞型85.7％,混合型94.3％.介入治疗成功后的下腔静脉平均压力由术前的(26.52±8.16) cm H2O下降至术后(14.28 ±4.08) cm H2O(P＜0.05).肝静脉平均压力由术前(35.70±13.26) cm H2O下降至术后(18.36±8.16) cm H2O(P＜0.05).术后随访1个月至15年,平均(46±37)个月.再狭窄发生率为21.4％(45/210),其中下腔静脉型狭窄率为13.8％(12/87),肝静脉阻塞型31.1％ (28/90),混合型15.2％ (5/33),肝静脉型患者再狭窄发生率明显高于其他两型.再狭窄患者介入治疗方法同初次治疗,44例再狭窄患者再次介入治疗取得成功.结论 青少年布加综合征患者以肝静脉阻塞型最多见,门脉高压症状和体征为主要临床表现特点,肝静脉型介入治疗后复发率高于其他两型.     

肝静脉阻塞型布加综合征介入治疗的临床疗效

目的 探讨肝静脉阻塞型布加综合征（BCS）介入治疗的临床疗效.方法 回顾性分析2010年12月至2012年12月安徽省立医院和徐州医学院附属医院收治的69例肝静脉阻塞型BCS行介入治疗患者的临床资料,采用经颈静脉、股静脉或经皮经肝联合下腔静脉途径开通肝静脉,行球囊扩张术或支架置入术,若肝静脉无法介入则行经颈静脉肝内门体分流术,观察肝静脉压力及患者临床症状的变化,评估治疗后无症状生存率.采用电话和门诊随访,随访时间截至2013年7月.计量资料用（x-）±s表示,采用t检验.等级资料采用Wilcoxon W秩和检验.采用Kaplan-Meier法绘制生存曲线,生存率比较采用Log-rank检验.结果 66例患者成功行介入治疗,经颈静脉43例,股静脉14例,经皮经肝穿刺9例;单纯球囊扩张术41例,球囊扩张术＋溶栓治疗14例,球囊扩张术＋支架置入术6例,球囊扩张术＋溶栓术＋支架置入术5例.61例患者术后症状完全缓解,其他5例症状部分缓解.BCS患者介入治疗前后肝静脉压力分别为（47±9）cmH2O（1 cmH2O =0.098 kPa）和（23±7）cmH2O,两者比较,差异有统计学意义（t=9.73,P＜0.05）.入院时腹腔积液有66例,治疗后减少至13例,两者比较,差异有统计学意义（Z=10.38,P＜0.05）.66例成功行介入治疗的患者均获随访,中位随访时间为15个月（6～ 24个月）.随访期间10例患者再次出现BCS相关症状,7例再次介入治疗成功,其余3例治疗失败.BCS患者首次介入治疗术后6、12、24个月无症状生存率分别为97.0％、92.2％、76.4％;再次介入治疗后无症状生存率分别为98.4％、98.4％、92.3％.单纯行球囊扩张术患者首次介入后无症状生存率为90.2％;球囊扩张术＋溶栓术患者为71.4％;球囊扩张术＋支架置入术患者为83.3％;球囊扩张术＋溶栓术＋支架置入术患者为80.0％.BCS患者行不同介入治疗后无症状生存率比较,差异无统计学意义（x2=3.08,P     

肝静脉阻塞型布加综合征的腔内治疗

目的 总结肝静脉阻塞型布加综合征(Budd-Chiari syndrome,BCS)的腔内治疗经验.方法 回顾性分析32例肝静脉阻塞型BCS的临床资料.分别行下腔静脉球囊扩张成形或支架植入术+脾肾静脉分流术;经股静脉或颈静脉入路肝静脉成形术和经皮肝穿刺肝静脉联合颈静脉和/或股静脉入路肝静脉成形术或支架植入术.结果 2例行经皮肝穿刺肝静脉造影时未发现主肝静脉而放弃治疗,其余病例均成功行肝静脉成形和下腔静脉成形术.肝静脉扩张成形前后测肝静脉压力由术前(43±8)cm H_2O降至术后(16±4)cm H_2O(t=21.23,P<0.01).术后1周原有症状明显缓解,腹水消失,腹胀减轻,胸腹壁曲张静脉塌陷.围手术期发生2例穿刺针道出血,经剖腹止血后痊愈.本组随访25例,随访率78.1%.随访时间5～65个月,平均(26.0±2.0)个月.无支架移位及肝静脉再狭窄或闭塞,胸腹擘曲张静脉消失,食道造影见食道静脉曲张明显减轻.本组无肺栓塞及死亡病例.结论 腔内治疗肝静脉阻塞型BCS方法简便、微创、有效,远期疗效尚有待于进一步观察研究.     

多支架治疗血栓性膜型阻塞性布-加综合征

目的探讨血栓性膜型阻塞性布-加氏综合征(BCS)的介入治疗方法.方法对17例血栓性膜型阻塞性BCS患者实施多支架压栓并球囊扩张成形支架置入术.结果下腔静脉压力由术前的平均(9.40±3.13)cmH2 O 下降至术后的平均(13.45±3.32)cm H2 O.无肺栓塞等严重并发症发生.随访3～40个月,效果良好.结论对血栓性膜型阻塞性BCS,可施行多支架压栓的介入治疗.     

肝静脉球囊扩张、支架置入术治疗下腔静脉长段闭塞型布加综合征

目的 探讨肝静脉球囊扩张支架置入术治疗下腔静脉长段闭塞型布加综合征( Budd-Chiari syndrome,BCS)的意义.方法 对40例下腔静脉长段闭塞型BCS经彩超、CT、MR对肝静脉情况进行评估后,先经颈静脉行膈上段下腔静脉造影,观察有无肝静脉开口,再用椎动脉导管结合超滑导丝寻找肝静脉;显示肝静脉后,行肝静脉球扩、支架术.结果 40例BCS中,29例为肝静脉开口处隔膜或主干的短段闭塞,其中隔膜5例、主干短段闭塞24例,成功地对28例进行了肝静脉的介入治疗,其中单纯球扩5例,球扩加支架23例,1例穿刺失败.另11例为肝静脉的广泛阻塞无法行肝静脉的介入治疗.随访26例,平均随访(24.0±1.3)个月,症状复发5例(19.2％),彩超见肝静脉再狭窄或闭塞6例(23％).结论 下腔静脉长段闭塞,多数肝静脉病变仅是开口处隔膜或主干的短段闭塞,采用颈静脉入路行肝静脉球扩支架的方法,可以解除肝静脉梗阻、缓解门静脉高压.     

Budd-Chiari 综合征根治术后复发的介入治疗：附15例报告

目的：探讨布加综合征（BCS）根治术后复发患者介入治疗的可行性及疗效。 方法：回顾性分析2007年3月—2013年9月15例BCS根治术后复发行介入治疗患者的临床资料。 结果：15例患者,年龄30~68岁,平均46.4岁;共行18例次介入治疗（1例3次,1例2次）,其中下腔静脉球囊扩张成形术10例次,置管溶栓后下腔静脉球囊扩张成形术5例次,下腔静脉、肝静脉及副肝静脉球囊扩张成形术2例次,下腔静脉球囊扩张成形术并下腔静脉支架植入1例次。围手术期未出现肺动脉栓塞、心包填塞等并发症 。15例患者随访12~106个月,平均41.9个月,13例未出现复发症状及体征,1例肝静脉闭塞在外院行球囊扩张支架成形术,1例下腔静脉再次闭塞保守治疗。 结论：对于BCS根治术后复发患者,选择及时介入治疗安全有效,可以改善累积通畅率及预后。     

恶性肿瘤所致上腔静脉压迫综合征的介入治疗

目的 探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征的疗效及临床意义.方法 13例恶性肿瘤所致上腔静脉阻塞综合征患者中,肺癌伴纵隔淋巴结转移8例,食管癌纵隔淋巴结转移2例,纵隔恶性肿瘤2例,乳腺癌纵隔淋巴结转移1例,均经原发灶病理证实为恶性.经右侧股静脉入路,以猪尾巴导管于狭窄段近端或远端造影,明确狭窄部位、长度、程度,无局部血栓形成者直接置入Wallstent支架(Boston Scientific,USA),1例同时置入Z形支架(COOK,USA),合并血栓病例留置溶栓导管局部溶栓后再置入支架.结果 13例全部开通成功,手术成功率100%,狭窄段平均长度4.3 cm(3～6 cm).1例置入2枚支架,其余患者均置入1枚支架.6例在支架置入前行溶栓治疗.开通前后梗阻远侧卧位测静脉压,术前(26.2±1.6) cm H2O,术后降至(4.3±0.8) cm H2O,置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退.8例术后4～10个月内死于肿瘤多处转移造成脏器功能衰竭,其余5例(包括后续治疗的3例)存活,随访8～26个月,中位数13个月,所有病例上腔静脉阻塞症状未再复发.结论 上腔静脉支架置入部分联合导管局部溶栓治疗是恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法.     

介入治疗肝移植术后门静脉狭窄38例疗效分析

目的 探讨介入治疗肝移植术后门静脉狭窄的价值.方法 回顾性分析2005年1月至2013年3月于本院行肝脏移植术后发生门静脉狭窄并接受介入治疗的38例患者资料.所有患者均采用介入手段治疗.介入治疗后再次造影如发现胃冠状静脉仍明显扩张且影响门静脉血流,则以弹簧圈栓塞.总结临床资料、影像随访资料、介入治疗的并发症和预后等情况.结果 38例患者介入治疗的技术成功率为100％.共置入自膨式支架7枚、球囊扩张式支架29枚,覆膜支架1枚.对2例小儿肝移植患者单纯采用球囊扩张成形术治疗.共有2例患者介入治疗后胃冠状静脉明显扩张且影响门静脉血流,予以栓塞治疗.随访3～90个月.介入治疗后发生肝内血肿1例,发生率为2.63％.1例因同时合并肝动脉闭塞、缺血性胆道损伤于术后3个月死于多脏器功能衰竭.因胆道并发症接受三次肝移植1例;因门静脉主干内癌栓形成再次置入覆膜支架1例;发生支架内再狭窄1例.其余34例患者影像随访显示门静脉通畅.结论 肝移植术后门静脉狭窄采用介入治疗安全、有效,远期疗效良好.     

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.