脊髓前动脉损伤后脊髓病理演变的实验研究

目的：观察脊髓前动脉损伤后脊髓组织形态学演变过程，研究病理机制。方法：以家犬为实验模型，损伤脊髓前动脉后进行肉眼、光镜和电镜动态观察，定量测定坏死神经元。结果：脊髓前动脉损伤2h运动神经元变性，轴索病变，6h神经元坏死，24h脊髓水肿达到高峰，7d髓内出血最明显。在脊髓前动脉损伤节段，24h 30％一40％的运动神经元坏死，3d达80％，7d以后95％以上。病变均位于脊髓2／3。脊髓前动脉损伤节段变性坏死最严重，相邻节段其次，尾侧脊髓坏死量逐渐减少。结论：脊髓前动脉损伤后脊髓缺血性病变是渐进和不可逆的，可引起广泛节段脊髓病变。     

甲泼尼龙对急性脊髓爆震伤后脊髓继发性损伤的影响

目的探讨甲泼尼龙（MP）对脊髓爆震性损伤早期救治的效果及其机制。方法家兔36只，随机分为三组：对照组、损伤组和MP组，每组12只。除对照组外，其他两组建立局限性脊髓爆震性损伤模型，损伤组仅给予生理盐水注射，MP组致伤后立即给予MP治疗。于伤后6、12、24h取血液标本和损伤段脊髓标本，测定血液和脊髓组织中SOD、MDA和Ca^＋的含量变化情况，同时观察损伤段脊髓组织的病理变化。结果损伤组血液标本和脊髓组织中MDA、Ca^＋升高，SOD浓度下降，与对照组比较差异有统计学意义（P〈0．01）。与损伤组比较，MP组能明显降低脊髓爆震伤后血液标本和损伤脊髓中MDA、Ca^＋含量，防止SOD损失，差异有统计学意义（P〈0．01）。组织学观察可见损伤组伤后6h脊髓组织出现轻微坏死，24h出现不可逆性损伤，MP组脊髓组织坏死性改变较轻。结论急性脊髓爆震伤后立即应用MP冲击治疗，能够明显降低血清和脊髓组织中MDA、Ca^＋含量，提高SOD浓度，在一定程度上阻止继发性损伤的进一步发展。     

红花注射液对脊髓损伤早期自由基影响的实验研究

目的:通过观察对大鼠脊髓损伤模型早期使用红花注射液后自由基的变化探讨红花注射液防止脊髓继发性损伤的作用机制。方法:选择成年雄性SD大鼠48只,分为正常对照组、损伤组、红花治疗组,每组大鼠16只。采用Allen’s撞击法建立脊髓损伤模型,其中红花治疗组分别于打击后30 min、2、4 h腹腔注射红花注射液。术后6 h测定脊髓组织和血液中丙二醛(MDA)和超氧化物歧化酶(SOD)的含量,并在光镜下观察组织形态的变化。结果:损伤组血液标本和脊髓标本中MDA升高、SOD降低,红花组血液和脊髓标本所测定的各个指标与损伤组比较有显著性差别(P<0.01),红花组与对照组各指标无明显差别(P>0.05)。组织学形态上,红花治疗组脊髓损伤程度小,神经元细胞破坏少。结论:脊髓损伤后血液和脊髓组织中自由基含量升高,红花注射液能有效清除自由基,在一定程度上能防止脊髓继发性损伤。注射红花注射液后,MDA降低,SOD升高。     

脊髓损伤后自由基变化及丹参对自由基影响的实验研究

目的　了解实验性脊髓损伤后血液和脊髓组织中自由基的变化及丹参对自由基的清除作用。方法　选用家兔 3 5只 ,分为正常组、损伤组、生理盐水对照组、丹参治疗组 A和 B等 5组 ,后 4组按 Allen氏法致伤造成脊髓损伤模型 ,后 3组术后分别立即静脉注射生理盐水 ,不同浓度丹参注射液。 2小时后取血液和脊髓组织测丙二醛 ( MDA)和超氧化物歧化酶 ( SOD) ,并观察脊髓病理变化。结果　脊髓损伤后血液和脊髓组织中 MDA升高 ,SOD下降 ,使用丹参后可使 MDA降低 ,SOD升高。结论　脊髓损伤后血液和脊髓组织中自由基含量升高 ,丹参能够有效清除自由基 ,两个丹参治疗组之间的抗自由基作用无显著性差异。     

富甲烷生理盐水对大鼠急性脊髓损伤的治疗作用及剂量效应研究

目的研究富甲烷生理盐水(MS)腹腔注射对大鼠脊髓损伤的治疗作用及剂量效应关系。方法 50只雌性SD大鼠,随机取40只采用改良Allen法制作大鼠脊髓损伤模型,其余10只纳入假手术组。40只脊髓损伤大鼠随机分为脊髓损伤组、0.5 ml/kg MS组、5 ml/kg MS组、20 ml/kg MS组,每组10只。0.5 ml/kg MS组、5 ml/kg MS组、20 ml/kg MS组大鼠每12 h腹腔内注射相应剂量的MS。造模72 h后处死大鼠,迅速取出以脊髓损伤部位为中心、周围6 mm内组织,检测超氧化物歧化酶(SOD)、丙二醛(MDA)、TNF-α、IL-1β和IL-6含量。结果与假手术组比较,脊髓损伤组大鼠脊髓组织中MDA含量显著升高,而SOD活性显著降低,IL-1β、TNF-α、IL-6含量显著升高,差异有统计学意义(P 0.05)。与脊髓损伤组比较,0.5 ml/kg MS组、5 ml/kg MS组、20 ml/kg MS组MDA含量逐渐降低,SOD活性逐渐升高,IL-1β、TNF-α、IL-6含量逐渐降低,差异有统计学意义(P 0.05)。结论大鼠腹腔注射MS可以通过抑制脊髓受损节段的炎症反应、氧化应激,起到治疗脊髓损伤的作用,剂量与效应呈正相关。     

氯胺酮对大鼠脊髓背角星形胶质细胞的保护机制

目的 探讨氯胺酮对N-甲基-D天冬氨酸（NMDA）诱导的大鼠脊髓背角星形胶质细胞损伤的保护机制。方法 取新生2～3dWistar大鼠40只T12～L5脊髓背角星形胶质细胞,原代纯化培养3周。将细胞随机分六组：NMDA组（N组）,氯胺酮组（K组）、NMDA加不同浓度氯胺酮组（标记为NK1～NK3组）,对照组（C组）。加药后培养30min或24h取各组细胞检测超氧化物岐化酶（SOD）活性和丙二醛（MDA）含量,免疫细胞化学观察Bcl-2／Bax表达,流式细胞仪检测星形胶质细胞凋亡率和胞内游离钙浓度（[Ca^2＋]i）。结果 与C组比较,N组细胞发生大量凋亡（P〈0．01）,Bax强阳性表达,Bcl-2阴性表达,SOD活性显著降低（P〈0．01）,MDA含量明显增加（P〈0．01）,[Ca^2＋]i显著升高（P〈0．01）。与N组比较,NK2、NK3组细胞凋亡明显减少（P〈0．05或P〈0．01）,Bcl-2阳性表达,Bax阴性表达,[Ca^2＋]i低（P〈0．05或P〈0．01）,SOD活性增加（P〈0．01）,MDA含量低（P〈0．01）。结论 氯胺酮抑制激活的背角星形胶质细胞内Ca^2＋超载,增强Bcl-2蛋白表达,抑制NMDA诱导的细胞凋亡,并增强抗氧化酶活性,抑制脂质过氧化反应引起的细胞损伤。     

急性脊髓损伤后诱生型一氧化氮合酶的表达、分布及作用

目的：研究大鼠急性脊髓损伤（spinal cord injury,SCI)后不同时间脊髓内诱生型一氧化氮合酶（inducble nitric oxide synthase,iNOS)的表达及其在不同类型细胞中的分布、血清中一氧化氮（nitric oxide,NO)含量的变化及iNOS特异性抑制剂氨基胍（aminoguanidine,AG)对大鼠后肢功能的影响。方法：Allen′s模型致伤后，分别于损伤后1、2、3、5、7d取伤段脊髓，作蛋白质印迹分析。在SCI后3d，用免疫荧光和免疫组化顺序标记方法分析iNOS在脊髓神经元、小胶质细胞和星形细胞中的表达与分布。应用比色法测定SCI后血清硝酸盐和亚硝酸盐的含量。观察腹腔注射20mg/kg、200mg/kg AG后SCI大鼠后肢功能的变化。结果：SCI后1d可见iNOS表达，3d达高峰，7d明显降低。在SCI后，神经元、星形细胞和小胶质细胞中均可iNOS表达，其中以神经元表达为主。SCI后血清硝酸盐和亚硝酸盐的含量于伤后1h和3-7d时出现两个高峰。损伤后腹腔注射20mg/kg、200mg/kg AG均能显著抑制血清硝酸盐和亚硝酸盐含量的升高，同时大鼠后肢功能显著恢复。结论：SCI后脊髓内iNOS表达增高，并分布在以神经元为主的多种细胞中。iNOS产生的NO加重了继发性脊髓损伤，对iNOS的抑制可能有助于脊髓损伤后神经功能的恢复。     

红花注射液对大鼠脊髓损伤后继发性损伤的影响

目的探讨脊髓损伤（spinal cord injury,SCI）后红花注射液对脊髓的保护效果。方法将18只SD大鼠随机分为假手术组（A组）,脊髓打击损伤组（B组）、红花溶液组（C组）,每组6只。观察3组大鼠SCI后1 h、24 h、48 h的脊髓组织病理学变化,检测这3个时间点乳酸（lactic acid,LD）含量、乳酸脱氢酶（lactate dehydrogenase,LDH）活性、超氧化物歧化酶（superoxide dismutase,SOD）活性、丙二醛（malondialdehyde,MDA）含量。结果术后C组LD含量、LDH活性比B组低,差异有统计学意义（P〈0.05）,特别是在术后48 h（P〈0.01）;与B组相比较,C组术后24 hMDA含量明显较低,SOD活性明显升高,差异具有统计学意义（P〈0.05）。结论红花注射液能减轻脊髓继发性损伤,对SCI后的脊髓神经功能具有一定的保护作用。     

胚胎脊髓移植加神经生长因子和尼莫地平对成年大鼠脊髓继发性损伤的影响

目的：用神经生长因子（NGF）和尼莫地平（ND）增强胚胎脊髓移植修复成年大鼠损伤脊髓的效果,缓解脊髓继发性损伤。方法：采用脊髓半切洞损伤模型,分为单纯胚胎脊髓移植组,移植加NGF组,移植加NGF和ND组,术后移植部位脊髓细胞内游离钙离子浓度,超氧化物歧化酶（SOD）,丙二醛（MDA）的变化,并比较各组死亡率,结果：移植加NGF组较单纯移植组,MDA明显下降,SOD显著升高,有统计学意义（P＜0．05）,但两组间细胞内游离钙离子浓度差别不显著（P＞0．05）,移植加NGF和ND组更有效地升高SOD浓度,降低钙离子浓度和MDA含量,与其它两组比较有显著性差异（P＜0．05）,移植加NGF和ND组的死亡率明显低于其它两组,有非常显著性差异（P＜0．01）,结论：NGF和ND能较好地改善继发性脊髓损伤,明显降低经胚胎脊髓移植术皇的成年大鼠死亡率,。。     

中性粒细胞在急性脊髓损伤中作用的实验研究

目的：观察中性粒细胞在脊髓压迫伤中的局部聚集情况及其可能的作用。方法：采用压迫法致大鼠脊髓中度损伤，实验动物分正常大鼠损伤组、低白细胞血症大鼠损伤组和假手术组。观察伤后1、3、6、12、24h伤段脊髓髓过氧化物酶(MPO)活性，记录双下肢运动诱发电位(MEP)，应用斜板试验评价大鼠的运动功能。结果：脊髓压迫伤后1h MPO活性开始升高，3h达到高峰。低白细胞血症组伤后3hMPO活性较对照组明显降低，脊髓运动功能的改善较对照组明显。结论：脊髓损伤后局部中性粒细胞聚集增加，可能参与脊髓继发性损伤。     

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.