血栓前状态预测老年冠心病非心脏手术患者围术期心脏事件的价值

目的 评价血栓前状态(PTS)预测老年冠心病非心脏手术患者围术期心脏事件的价值.方法 择期全麻下行腹部手术的冠心病老年患者128例,年龄65 ～ 75岁,性别不限,ASA分级Ⅰ或Ⅱ级,NYHA分级Ⅰ或Ⅱ级.采用全凭静脉麻醉.术前采集静脉血样,测定血浆D-二聚体、血栓前体蛋白及P-选择素的浓度,根据此3项指标判断是否存在PTS.根据术中和术后3d内是否发生心脏事件分为非心脏事件组和心脏事件组.记录患者一般资料及术中情况各指标,将组间差异有统计学意义的因素进行logistic回归分析,筛选心脏事件的危险因素.结果 29例患者发生心脏事件,与非心脏事件组比较,心脏事件组年龄、肥胖、糖尿病比率、手术时间和PTS比率差异有统计学意义(P＜ 0.05或0.01);logistic回归结果显示:高龄、糖尿病、手术时间长和PTS是心脏事件的独立危险因素(P＜O.O1).结论 PTS对老年冠心病非心脏手术围术期心脏事件的发生有一定的预测价值.     

心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析

目的探讨成人心肺转流(cardiopulmonary bypass,CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析1 349例心脏瓣膜手术患者的临床资料,采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4%,多因素Logistic回归分析显示,每增加1岁(OR=1.05,95%CI 1.03~1.06,P0.001)、糖尿病史(OR=2.11,95%CI 1.22~3.68,P=0.008)、贫血(OR=1.50,95%CI1.05~2.21,P=0.026)、术前血清肌酐(Scr)值每增加1mg/dl(OR=1.01,95%CI 1.01~1.02,P=0.001)、手术时间每增加1h(OR=1.28,95%CI 1.15~1.41,P0.001)、术中输注血浆(OR=1.50,95%CI 1.14~1.97,P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。     

椎管内阻滞对心脏事件高危患者行非心脏手术后心肌梗死影响的Meta分析

目的采用Meta分析比较椎管内阻滞[包括硬膜外阻滞(epidural anesthesia,EA)和蛛网膜下腔阻滞(spinal anesthesia,SA)]复合全身麻醉(general anesthesia,GA)对非心脏手术后心肌梗死的影响。方法检索中文数据库(中国生物医学文献服务系统、中国知网、万方、维普)和英文数据库(Medline、PubMed、EBSCO、Springer、Ovid、Cochrane Library、Google scholar);收集椎管内阻滞对非心脏手术患者术后心肌梗死及死亡率影响的随机对照试验(RCT),并采用RevMan 5.3软件进行统计分析。结果共纳入10篇RCT(n=21 859)。Meta分析结果显示:EA复合GA与单纯GA非心脏手术术后7d内(OR=0.44,95%CI 0.13~1.46,P=0.18)和30d内(OR=1.49,95%CI 0.89~2.49,P=0.13)内心肌梗死发生率差异无统计学意义;EA复合GA与单纯GA术后30d内(OR=1.26,95%CI 0.84~1.88,P=0.26)全因死亡率差异无统计学意义。SA与GA术后7d内心肌梗死发生率(OR=1.14,95%CI 0.31~4.17,P=0.84)和术后30d内全因死亡率(OR=0.88,95%CI 0.43~1.79,P=0.73)差异无统计学意义。结论椎管内阻滞并未降低心脏事件高危患者行中高危非心脏手术后心肌梗死发生率及死亡率。     

老年患者术前衰弱与术后并发症的相关性

目的 分析非心脏手术老年患者术后并发症的危险因素。方法 回顾性分析2021年3—8月行择期非心脏手术老年患者224例,男122例,女102例,年龄≥65岁,ASAⅠ—Ⅳ级。采用临床衰弱量表(CFS)评估患者术前衰弱状态。根据术后30 d是否发生并发症将患者分为两组：并发症组和非并发症组。采用单因素和多因素Logistic回归分析影响老年患者非心脏手术后并发症的危险因素。结果 共有64例(28.6%)患者发生术后并发症。与非并发症组比较,并发症组年龄、查尔森共病指数(CCI)明显增大,ASA分级明显增高,合并高血压、冠心病比例、衰弱比例、中性粒细胞浓度明显升高,白蛋白、Hb、淋巴细胞浓度明显降低,出血量明显增多,手术时间和麻醉时间明显延长(P<0.05)。多因素Logistic回归分析结果显示,年龄增大(每增大1岁,OR=1.142,95%CI 1.064～1.225,P<0.05)和术前衰弱(OR=12.028,95%CI 3.727～38.816,P<0.05)是术后并发症的独立危险因素。结论 年龄增大和术前衰弱是老年患者非心脏手术后并发症的独立危险因素。     

老年髋部骨折患者术后心血管并发症的危险因素分析

目的探讨老年髋部骨折患者住院期间术后新发心血管并发症的危险因素。方法回顾性分析本院骨科2005年1月至2015年12月收治的髋部骨折患者693例,男257例,女436例,年龄65~103岁,BMI 16.5~33.1 kg/m2,ASAⅡ~Ⅳ级,分别收集患者的人口学资料、术前合并症、卧床时间、手术方式、麻醉方法、手术时间和出血量,采用多因素Logistic回归模型分析老年髋部骨折患者住院期间术后新发心血管并发症的危险因素。结果 46例患者(6.64%)在住院期间发生术后心血管并发症,包括心绞痛25例(3.61%)、心律失常19例(2.74%)、心力衰竭5例(0.72%)、心肌梗死4例(0.58%)和心源性猝死2例(0.29%)。单因素分析显示,年龄、心脏疾病、脑血管疾病、高血压、糖尿病、肾功能不全和全麻方式是老年髋部骨折患者住院期间新发术后心血管并发症的相关危险因素(P0.05)。多因素Logistic回归分析显示年龄(OR=1.11,95%CI 1.06~1.17,P0.001)、心脏疾病(OR=1.98,95%CI 1.02~3.85,P=0.045)、脑血管疾病(OR=2.14,95%CI 1.06~4.32,P=0.033)、高血压(OR=2.61,95%CI 1.23~5.51,P=0.012)、糖尿病(OR=2.06,95%CI 1.04~4.09,P=0.039)和肾功能不全(OR=17.42,95%CI 3.69~82.80,P0.001)是髋部骨折患者住院期间术后新发心血管并发症的独立危险因素。结论年龄、心脏疾病、脑血管疾病、高血压、糖尿病和肾功能不全可作为老年髋部骨折患者住院期间新发心血管并发症的预警因素。     

非心脏手术后老年患者术后中性粒细胞与淋巴细胞比率升高增加术后谵妄风险:观察性研究

目的分析老年患者术后谵妄(postoperative delirium,POD)的危险因素,探究术后中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)的水平与老年患者POD的关系。方法选取2019年3月至2019年8月全身麻醉下接受非心脏手术后的老年患者531例,年龄≥65岁。使用混淆评估法(the Confusion Assessment Method,CAM)每天2次评估术后3 d内POD发生情况。根据患者是否发生POD分为术后谵妄组和非术后谵妄组。主要观察POD的发生率,并使用多因素Logistic回归分析评估POD的危险因素。同时使用倾向性评分匹配(Propensity Score Matching,PSM)进一步分析POD的危险因素。结果共125例(23.5%)患者发生POD。年龄[比值比(odds ratio,OR)=1.044,95%CI 1.006~1.048,P=0.025]、查尔森合并症指数(Charlson Comorbidity Index,CCI)(OR=1.189,95%CI 1.031~1.370,P=0.017)、Hb(OR=0.988,95%CI 0.977~0.999,P=0.039)、手术时间(OR=1.003,95%CI 1.000~1.005,P=0.043)、拔管时间(OR=1.028,95%CI 1.012~1.044,P=0.001)、术后入ICU(OR=2.222,95%CI 1.308~3.775,P=0.003)、术后NLR(OR=1.027,95%CI 1.000~1.054,P=0.048)是POD的独立危险因素。文化程度(P=0.061)、出血量(P=0.161)、日常生活活动能力量表(Activities of Daily Living,IADL)(P=0.368)两组间差异无统计学意义(P>0.05)。对术后NLR进行受试者工作特征(receiver operating characteristic curve,ROC)曲线分析,得出POD风险增加的术后NLR拐点值为11.85,将术后NLR转换为二分类变量并代入Logistic多因素回归模型,校正影响因素后,结果显示术后NLR拐点值>11.85者POD的风险明显增加[OR=2.019,95%CI 1.292~3.155,P=0.002],同时将混杂因素进行PSM后显示,术后NLR水平升高使POD的发生风险增高(OR=1.033,95%CI 1.007~1.060,P=0.012)。结论对于非心脏手术后的老年患者,术后NLR水平升高增加POD的发生风险。     

术后发生急性肺损伤的危险因素分析

目的探讨术后发生急性肺损伤(ALI)的危险因素。方法回顾性分析我院2009年2月至2013年12月的择期手术患者1 309例,其中术后发生ALI患者38例、未发生ALI患者1 271例,对两组临床资料进行单因素和多因素Logistic回归分析。结果单因素分析结果显示,与非ALI患者比较,ALI患者年龄60岁、高风险手术(心脏、主动脉、胸部)、糖尿病、慢性阻塞性肺疾病、限制性肺疾病、胃食管反流病、肝硬化、吸烟和酗酒的例数明显增加(P0.05)。多因素Logistic回归分析显示,术后发生ALI的危险因素为高风险心脏手术(OR=7.27,95%CI 3.73~11.52)、主动脉手术(OR=18.41,95%CI 8.91~32.77)、胸部手术(OR=5.55,95%CI 2.27~9.08)、糖尿病(OR=1.72,95%CI 1.26~3.31)、慢性阻塞性肺疾病(OR=2.85,95%CI 1.60~4.28)、胃食管反流病(OR=2.07,95%CI 1.37~2.89)和酗酒(OR=2.32,95%CI 1.48~3.31)(P0.05)。结论高风险手术(心脏、主动脉、胸部)、糖尿病、慢性阻塞性肺疾病、胃食管反流病和酗酒是术后发生ALI的危险因素。     

心包积液患儿围术期不良事件的危险因素分析

目的回顾性分析心包积液患儿围术期不良事件的影响因素。方法我院2009年1月至2014年7月手术治疗的心包积液患儿157例,麻醉期间不良事件定义为诱导后出现低氧、低血压或心律失常。应用单因素和多因素Logistic回归分析不良事件的危险因素。结果有38例(24.2%)患儿发生不良事件(A组),其中一般不良事件31例(81.6%),严重不良事件7例(18.4%)。A组术前合并胸腔积液、呼吸困难、奇脉、心房/心室压迫、较高ASA分级及入手术室时呼吸急促、心动过速、低氧、低血压明显多于无不良事件组(N组)(P0.05)。多因素Logistic回归分析显示,术前呼吸困难(OR=6.8,95%CI 1.4~12.4)、入手术室时低氧(OR=5.5,95%CI 1.1~15.9)、入手术室时低血压(OR=3.4,95%CI 1.2~9.1)及心房/心室压迫(OR=6.3,95%CI 1.8~22.1)是不良事件的独立危险因素。结论对存在危险因素的心包积液患儿应警惕其麻醉期间发生不良事件。     

心脏瓣膜置换患者术后急性肾损伤风险预测模型的建立与验证

目的建立心脏瓣膜置换术后急性肾损伤(acute kidney injury, AKI)的风险预测模型并进行验证。方法选择2016年1月1日至2021年12月31日在徐州市中心医院接受心脏瓣膜置换术的患者为研究对象, 采用Logistic回归模型筛选患者发生AKI的独立危险因素, 并建立列线图预测模型。采用受试者工作特征曲线(ROC曲线)、校准曲线及决策曲线分析法(DCA)对预测模型进行验证。结果共619例心脏瓣膜置换患者入选本研究, 其中术后发生AKI 74例(11.95%)。多因素Logistic回归分析结果显示, 高龄(OR=3.826, 95%CI 2.267～6.458)、合并高血压(OR=2.376, 95%CI 1.162～4.861)、体外循环时间延长(OR=1.049, 95%CI 1.024～1.074)、血白细胞计数升高(OR=1.066, 95%CI 1.027～1.106)、血小板计数降低(OR=0.994, 95%CI 0.990～0.997)及淋巴细胞比例降低(OR=0.873, 95%CI 0.774～0.985)是心脏瓣膜置换患者术后发生AKI的独立危险...     

监测P-选择素、血栓前体蛋白、D-二聚体对门脉高压脾切除术后门静脉血栓形成的早期预测价值

目的 探讨P-选择素(P-selectin,P-sel)、血栓前体蛋白(thrombus precursor protein,TpP)、D-二聚体(D-dimer,D-D)对门静脉高压症患者行脾脏切除(或联合血管断流)术后门静脉血栓形成(portal vein thrombosis,PVT)的早期预测价值.方法 2009-2011年入我院的48例行脾脏切除术的门静脉高压症患者根据血栓发生情况分为血栓组(26例)和非血栓组(22例).动态监测两组患者术前1d以及术后第1、3、5、7、14天P-sel、TpP及D-D含量,并进行统计学分析.结果 术前血栓组和非血栓组三项指标水平并无显著性差异(P＞0.05).术后第1天血栓组三项指标较非血栓组明显升高(P＜0.05).其中P-sel的受试者操作特征曲线下面积(area under curve,AUC)最大(0.893),其次为D-D、TpP;三者联合检测,其AUC高达0.977.结论 P-sel、TpP、D-D三者联合检测有助于PVT的早期预测.     

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.     

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.