甲状腺乳头状癌淋巴结转移规律的临床研究

目的探讨甲状腺乳头状癌颈部淋巴结的转移规律及合理的手术方式。方法回顾性分析我院2004年9月至2009年9月期间收治的221例甲状腺乳头状癌患者的临床资料。结果本组行甲状腺全切除术32例,次全切除术189例。术后病理学诊断单侧甲状腺癌202例(91.40%),双侧甲状腺癌19例(8.60%)。甲状腺的原发肿瘤直径0.2~8.0 cm,平均3.5 cm。有包膜侵犯50例;多灶性33例。每侧颈清扫淋巴结数目10~24个,平均14.3个。颈部淋巴结转移总发生率为37.56%(83/221),中央组(Ⅵ区)淋巴结转移发生率为33.94%(75/221),颈深组(Ⅱ+Ⅲ+Ⅳ区)淋巴结转移发生率为18.10%(40/221)。当肿瘤直径>1.0 cm、肿瘤突破甲状腺包膜、多发灶或年龄>45岁时Ⅵ区及Ⅱ+Ⅲ+Ⅳ区的同侧淋巴结转移发生率明显增加(P<0.05)。结论甲状腺乳头状癌最常见的淋巴结转移为Ⅵ区淋巴结,其次为Ⅱ+Ⅲ+Ⅳ区淋巴结,初次手术应常规清扫Ⅵ区淋巴结,当肿块直径>1.0 cm、癌肿突破甲状腺包膜时或B超、CT等影像学检查有颈部淋巴结转移时,应清扫Ⅱ+Ⅲ+Ⅳ区淋巴结。     

乳头状甲状腺癌的颈部淋巴结转移规律与手术方式

目的探讨甲状腺乳头状癌颈部淋巴结的转移规律以及清扫范围的合理选择。方法同顾性分析近4年多米收治的457例乳头状甲状腺癌患者的临床资料。结果全组患者均接受常规甲状腺双侧全切加颈深（Ⅲ＋Ⅳ区）组技巾央（Ⅵ区）组颈部淋巴结清扫术。颈部淋巴结总转移发生率为63．67％（291／457），中央组淋巴结转移发生率为59．08％（270／457），颈深组淋巴结转移发生率为29．76％（136／457）。当癌肿直径〉1cm或癌肿突破甲状腺包膜、侵犯肌肉时各区淋巴结转移的发生率明显增加（P〈0．05）。全组无手术或住院期间死亡。结论乳头状甲状腺癌最常见的淋巴结转移为巾央组淋巴结，其次为颈深组（Ⅲ＋Ⅳ区）的淋巴结，初次手术应常规清扫双侧中央组淋巴结，当肿块直径〉1cm或癌肿突破甲状腺包膜和／或侵犯肌肉时宜同时，清扫同侧的颈深组淋巴结。     

甲状腺癌诊断及复发因素分析

目的探讨甲状腺癌的诊断及与术后复发有关的因素。方法回顾性分析1999年3月至2006年2月期间上海市第一人民医院宝山分院收治的256例经手术及病理检查证实的甲状腺癌患者的临床资料。结果甲状腺乳头状癌235例(91.8%),滤泡状癌11例(4.3%),髓样癌7例(2.7%),未分化癌3例(1.2%)。所有病例均行手术治疗,手术方式包括:患侧腺叶+峡部+对侧甲状腺腺叶大部切除+病变侧中央区颈淋巴结清扫术;明确颈淋巴结转移或肿块明显外侵者,则行功能性颈淋巴结清扫术;对多灶癌或双腺叶癌者则施行双侧甲状腺全或近全切除,单或双侧Ⅵ区颈淋巴结清扫或一侧功能性颈淋巴结清扫+对侧Ⅵ区颈淋巴结清扫术。228例患者有完整的术后随访资料,随访3～9年,平均随访(6.5±1.3)年。随访期间14例发生复发或转移,其中6例死亡,死亡原因均为术后复发或远处转移。结论影像学检查是诊断甲状腺癌最主要的检查方法,肿块细针穿刺细胞学检查对肿块性质的判断准确率高,可靠性强。淋巴结转移率与原发病灶直径有关,肿瘤病理类型、分期、肿瘤外侵程度、淋巴结转移度、年龄及初次手术方式的选择与术后复发有关。     

甲状腺乳头状癌前上纵隔淋巴结转移与临床病理因素相关性分析

目的：为探讨临床病理学因素与前上纵隔淋巴结转移的相关性,从而进一步探讨甲状腺癌颈淋巴结清扫手术中同期前上纵隔淋巴结清扫的临床意义。 方法：纳入54例甲状腺乳头状癌患者,在做颈淋巴结清扫的过程中,同时行前上纵隔淋巴结清扫取样进行临床研究,比较其与性别、年龄、肿瘤的大小、多灶性、有无甲状腺外侵犯、有无淋巴血管侵犯,第6区淋巴结转移情况等临床病理因素的相关性。 结果：甲状腺乳头状癌患者的甲状腺肿瘤直径>4 cm、肿瘤有血管淋巴侵犯、6区淋巴结转移>3个,与前上纵隔淋巴结转移有关（P<0.05）,而与性别、年龄、多灶性、有无甲状腺外侵犯无关（P>0.05）。 结论：临床病理学因素与前上纵隔淋巴结转移具有关,甲状腺癌颈淋巴结清扫手术中同期前上纵隔淋巴结清扫对治疗甲状腺乳头状癌具有一定的临床意义。     

乳头状甲状腺癌淋巴结转移特点与中央组淋巴结清扫的临床意义

目的 探讨乳头状甲状腺癌进行颈部中央组淋巴结清扫的必要性.方法 回顾性分析2003年6月至2007年9月457例常规接受甲状腺双侧全切除和选择性颈部淋巴结清扫术的乳头状甲状腺癌患者的临床资料.本组男性86例,女性371例,年龄17～73岁.结果 全组无手术及住院期间死亡.中央组(Ⅵ区)淋巴结转移的总发生率为59.1%(270/457),其中双侧转移的占42.2%(114/270).颈深组(m+Ⅳ区)淋巴结转移的总发生率为29.8%(136/457).单侧甲状腺癌时,癌肿直径>1 cm和癌肿突破甲状腺包膜时的中央组淋巴结转移的发生率分别为64.5%(178/276)和81.6%(120/147),癌肿直径≤1 cm和癌肿未突破甲状腺包膜时此比例分别为23.4%(11/47)和39.2%(69/176).5例患者淋巴结呈跳跃性转移.术后随访7～59个月,1例死于肺转移;4例局部复发,3例远处转移.所有患者术后行甲状腺素替代治疗,无甲状腺功能减退发生.结论 乳头状甲状腺癌最常发生中央组淋巴结转移,初次手术应常规清扫双侧中央组淋巴结.     

甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈部淋巴结的转移规律及其影响因素,为PTC颈部淋巴结清扫手术方式的选择提供依据。方法收集贵阳医学院附属医院甲状腺外科2009年1月至2011年12月期间收治的98例PTC患者的临床资料,对其淋巴结转移特点、规律及其影响因素进行回顾性分析。结果 98例患者中,共行颈部淋巴结清扫114侧。总颈淋巴结转移率为77.55%（76/98）,其中Ⅵ区淋巴结转移率为74.49%（73/98）,颈侧Ⅱ＋Ⅲ＋Ⅳ区为42.86%（42/98）,Ⅴ区为5.10%（5/98）。单因素分析结果显示：当肿瘤直径大于1 cm、侵犯甲状腺包膜、呈多灶性或年龄大于45岁时,Ⅵ区和Ⅱ＋Ⅲ＋Ⅳ区的淋巴结转移率较高（P〈0.05）。多因素分析结果显示：患者年龄、肿瘤直径、包膜侵犯及多灶性是颈部淋巴结转移的影响因素（P〈0.05）;包膜侵犯、多灶性、合并Ⅵ区淋巴结转移及合并颈侧Ⅱ＋Ⅲ＋Ⅳ区淋巴结转移是喉前淋巴结转移的影响因素（P〈0.05）;包膜侵犯和多灶性是跳跃性淋巴结转移的影响因素（P〈0.05）。结论 PTC易发生Ⅵ、Ⅲ及Ⅳ区淋巴结转移,应常规清扫Ⅵ区淋巴结。对颈部淋巴结转移规律的研究可为临床选择合理的颈部淋巴结清扫手术方式提供依据。     

同期双侧颈淋巴结清扫治疗高分化及髓样甲状腺癌

目的 探讨同期双侧颈淋巴结清扫治疗高分化及髓样甲状腺癌的适应证、原发灶的根治范围和颈淋巴结清扫术式的选择。方法 回顾我院收治的22例双侧颈淋巴结转移的甲状腺乳头状、滤泡状及髓样癌的病例资料,10例行一侧叶切除加对侧叶近全切除根治原发癌,同时行一侧传统颈清扫加对侧改良清扫（下称传统清扫组）;12例行全甲状腺切除根治并行同期双侧颈淋巴结改良清扫（下称改良清扫组）。结果 单侧癌9例,双侧癌13例,20例原发癌为多中心性。双侧改良清扫组颜面水肿率显著低于传统清扫组（16．7％vs100％,P〈0．01）,渗出量[（300．4±40．65）ml vs（406．8±39．85）ml]、术后住院时间[（8．3±1．16）d vs（12．5±1．58）d]也低于传统清扫组（P〈0．01）。结论 发生双侧颈淋巴结转移的高分化甲状腺癌及髓样癌,应行全甲状腺切除及双侧颈淋巴结清扫,同期双侧的改良颈淋巴结清扫不但术后恢复快、生活质量高,而且远期疗效肯定,值得推广和应用。     

甲状腺癌颈部淋巴结清扫术

近年来,大部分分化型甲状腺癌伴颈部淋巴结癌转移的患者实施保留副神经、颈内静脉和胸锁乳突肌的功能性颈淋巴结清扫术,因为分化型甲状腺癌较少侵犯上述组织,术后生存时间长,改善生活质量就显得十分重要。我们中心大部分患者术前已行细针穿刺诊断右甲状腺乳头状癌,所以术中先将单侧腺叶切除,送术中冰冻,等待期间清扫中央区淋巴结。病理证实为甲状腺癌后,进一步实施功能性的侧颈区淋巴结清扫术。     

cN0甲状腺乳头状癌行中央区颈淋巴结清扫术的临床研究

目的探讨中央区颈淋巴结清扫术对cN0甲状腺乳头状癌患者的意义。方法对解放军总医院2010年12月至2012年7月期间128例行中央区颈淋巴结清扫术的cN0甲状腺乳头状癌患者的临床资料进行回顾性分析。结果cN0甲状腺乳头状癌患者中央区颈淋巴结转移率为35．94％（46／128）。年龄〈45岁、原发病灶直径〉1cm、包膜或腺外侵犯的cN0甲状腺乳头状癌患者中央区颈淋巴结转移率均明显高于年龄≥45岁、原发病灶直径≤1cm、无包膜或腺外侵犯者（P〈0．05）。术后22例（17．19％）患者出现暂时性甲状旁腺功能低下,3例（2．34％）患者出现暂时性喉返神经损伤,无永久性喉返神经损伤及永久性甲状旁腺功能低下发生。术后随访14～32个月（平均23．4个月）,2例患者出现颈侧区淋巴结转移。结论中央区颈淋巴结清扫术对cN0甲状腺乳头状癌患者是一种必要、安全且有效的术式,且应由经验丰富的专科医生来实施。     

微小乳头状癌淋巴结转移及预防性淋巴结清扫的价值

目的探讨微小乳头状癌颈侧区淋巴结转移的危险因素及预防性清扫的价值。方法选取2010年2月至2016年2月收治的172例甲状腺微小乳头状癌患者进行回顾性分析,根据颈淋巴结分区有92例淋巴结转移阴性患者,其中50例采取了预防性单侧或双侧淋巴结清扫(预防组),42例未行预防性淋巴结清扫(未预防组),比较两组预后。应用SPSS 19.0进行分析,住院时间等计量资料用均数±标准差(x珋±s)表示,比较采用独立样本t检验;性别、年龄、肿瘤大小、包膜浸润、侧别、肿瘤位置、肿瘤数目、中央区转移、并发症发生率、肿瘤局部复发或远处转移率、病死率等计数资料计算构成比(%),采用χ2检验;危险因素的预测采用多因素Logical回归,P0.05为差异有统计学意义。结果颈侧区淋巴结转移阳性患者中年龄≤45岁、肿瘤0.5~1.0 cm、包膜浸润、肿瘤位于甲状腺上极、中央区转移者占67.5%、72.5%、45.0%、87.5%、67.5%,均高于阴性患者(P0.05)。中央区转移、肿瘤位于甲状腺上极为颈侧区淋巴结转移的危险因素。预防组患者随访期间未见肿瘤局部复发、远处转移与死亡情况,未预防组病死率2.4%(P0.05),肿瘤局部复发或远处转移率为9.5%(P0.05)。结论肿瘤位于甲状腺上极、存在中央区转移的微小乳头状癌患者更易出现颈侧区淋巴结转移。颈侧区淋巴结转移阴性患者行预防性淋巴结清扫术可有效改善远期预后,且术后并发症未明显增加。     

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.