全胸腔镜下房间隔缺损修补手术单中心临床研究

目的总结全胸腔镜下房间隔缺损修补手术临床经验。方法 2008年5月至2018年12月442例房间隔缺损患者在我院行全胸腔镜下心脏手术,其中男149例、女293例,年龄3～74(29.1±14.3)岁。采用右侧胸壁3孔入路,在全胸腔镜下完成心脏手术。结果本组442例患者均治愈出院,无中转正中开胸,全组患者手术时间1.5～4.6(2.2±0.3)h,体外循环时间28～118(55.9±13.3)min,升主动脉阻断时间8～78(21.5±10.2)min,术后呼吸机辅助时间3.5～122.0(8.1±7.4)h,术后住重症监护室时间13～141(20.7±10.2)h,术后胸腔引流量70～1 280(251.8±131.5)mL,术后住院时间4～16(7.1±1.4)d。全组有15例(3.3%)患者出现并发症。术后随访1～128(67.6±33.3)个月,出现持续性心房颤动25例,轻中度三尖瓣关闭不全25例,中度三尖瓣关闭不全1例,无再次手术及残余分流发生,心功能明显好转。结论完全胸腔镜下房间隔缺损修补手术安全可行,手术创伤小、并发症少,具有较好的近中期疗效。     

改良机器人手术方式行房间隔缺损修补术22例

目的 总结使用“达芬奇”（da Vinci S）机器人手术系统行体外循环下房间隔缺损修补或房间隔缺损修补＋三尖瓣成形术的经验体会.方法 2013年7月至2013年10月回顾性研究,使用da Vinic S机器人系统,体外循环下完成继发孔型房间隔缺损修补或房间隔缺损修补＋三尖瓣成形术22例.患者女16例,男6例;年龄平均（36.5±5.8）岁.房间隔缺损直径为2.5～4.1 cm,平均（3.8±1.3）cm,左向右分流,2例伴有三尖瓣中度关闭不全,2例伴有右侧胸膜腔部分粘连.手术经股动、静脉插管,于右侧胸壁打3个孔,采用我院成熟全腔镜心脏手术技术建立体外循环,阻断升主动脉,切开右心房后,再连接机器人手术系统,术者于操作台前遥控机器臂进行房间隔缺损修补,三尖瓣中度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损20例,补片修补房间隔缺损2例,同期三尖瓣成形及胸膜粘连松解各2例.结果 22例均成功接受机器人房间隔缺损修补术或房间隔缺损修补＋三尖瓣成形术,手术时间1.5 ～ 3.5 h,平均（2.3±0.6）h;后10例手术时间体外循环（58.6±18.3） min,升主动脉阻断（26.8±8.6） min,术后呼吸机辅助（5.8±1.6）h.胸液引流量50 ～ 300 ml,平均（150±32） ml,平均1～2d拔除胸腔闭式引流管.术后住院时间（5.6±1.4）d.均无中转开胸、院内死亡及术后并发症发生.全组术后3～5d超声心动图示手术效果满意,患者均顺利出院.随访1个月～3个月,无残余分流,下肢静脉血栓形成,心功能均为Ⅰ级,超声心动图检查结果满意.结论 改良达芬奇S机器人手术方式体外循环下房缺修补术安全可靠,疗效满意,且进一步缩短手术时间,创伤小、恢复快,具有良好的发展前景.     

房间隔缺损合并三尖瓣反流行房间隔缺损封堵术的疗效分析

目的分析房间隔缺损合并三尖瓣反流行房间隔缺损封堵术的治疗效果。方法自2006年7月至2012年1月上海交通大学医学院附属新华医院共对98例房间隔缺损合并三尖瓣反流患者施行房间隔缺损封堵术治疗,其中男36例、女62例,手术年龄2个月至80岁。所有房间隔缺损均为继发孔型,房间隔缺损直径3～23 mm。其中合并轻度三尖瓣关闭不全60例,中度三尖瓣关闭不全28例,重度三尖瓣关闭不全10例。所有患者均行房间隔缺损封堵术,其中数字减影血管造影（DSA）下封堵51例,经胸小切口封堵46例,经胸超声心动图引导下封堵1例。术后对患者进行超声心动图随访,观察封堵术后三尖瓣反流的变化情况。结果围术期无死亡,1例手术失败,术后第3 d出现房间隔缺损残余分流;1例于术后第3 d异常出血,再次开胸止血;其余患者恢复顺利。随访84例,随访时间1～64（26.56±21.35）个月。随访期间术后第3 d出现房间隔缺损残余分流患者随访至术后6个月时无明显好转,转为开胸手术。73例（86.90%）三尖瓣反流均有不同程度的减轻,其中10例三尖瓣重度反流改善为轻度反流8例,中度反流1例,1例无改善;26例三尖瓣中度反流改善为无反流6例、轻度反流18例、2例无改善;48例三尖瓣轻度反流改善为无反流40例,8例无明显改善。结论房间隔缺损合并三尖瓣反流的患者,对三尖瓣的处理可持保守治疗态度,单纯房间隔缺损封堵即可获得良好的效果,同时也避免体外循环造成的心肌损伤、肺损伤等并发症的发生。     

胸腔镜辅助超声引导房间隔缺损经胸封堵术的临床疗效

目的分析胸腔镜辅助超声引导下房间隔缺损经胸封堵术的安全性和有效性。方法前瞻性分析2017年1～9月我院行胸腔镜辅助超声引导下经胸房间隔缺损封堵术12例患者的临床资料,其中男4例、女8例,年龄29(24.5～39.5)岁。研究其房间隔缺损病变特征、术中操作特点、手术安全性和有效性、术后并发症及随访结果。结果 12例患者中有10例成功行胸腔镜辅助超声引导下房间隔缺损封堵术,2例中转胸腔镜辅助体外循环下房间隔缺损修补术。成功行经胸封堵的患者缺损大小17～40(27.22±8.97)mm,使用的封堵器大小36(30～42)mm,术后平均住院时间6 d,术后无明显心率失常、出血、心包积液等并发症。术后平均随访6(3～10)个月。随访期间未见Ⅲ度传导阻滞,无封堵器脱落、无残余分流、无心包积液。结论胸腔镜辅助超声引导下房间隔缺损经胸封堵术是一种微创、安全、有效的治疗方法。为缺损直径较大、缺损边缘条件差的患者提供了一种全新微创的手术选择。     

中老年继发孔型房间隔缺损的外科治疗

目的总结中老年（年龄≥40岁）继发孔型房间隔缺损的外科治疗经验。方法回顾性分析昆明市延安医院2000年1月至2007年9月手术治疗89例年龄大于40岁继发孔型房间隔缺损患者的临床资料,年龄40～68岁（平均年龄47．8岁）,其中上腔型房间隔缺损23例、下腔型房间隔缺损31例,中央型房间隔缺损29例,混合型6例。全组均在全身麻醉低温体外循环下施行手术,均予涤纶补片修补房间隔缺损,合并三尖瓣关闭不全者同期行三尖瓣成形术。结果全组无死亡及严重并发症发生,术后平均住院时间13d（9～37d）,术后Ⅰ周复查右房室内径较术前明显缩小,随访3个月-8年,心功能及健康状况良好。结论中老年继发孔型房间隔缺损手术治疗效果良好;如无介入封堵术指征或伴中度以上三尖瓣关闭不全者均应手术治疗,补片修补及术中积极处理合并的三尖瓣关闭不全有利于术后恢复。     

全胸腔镜下房间隔缺损封堵术186例报告

目的探讨全胸腔镜非体外循环下房间隔缺损微创封堵术治疗先天性继发孔房间隔缺损(atrial septal defect,ASD)的疗效。方法 2008年5月~2016年5月186例先天性继发孔ASD行全胸腔镜非体外循环下房间隔缺损微创封堵术。全麻,右侧第7肋间腋中线1.0 cm小孔置入胸腔镜,右侧锁骨中线微切口2.0 cm,第4肋间进胸,作为操作孔。术中经食道超声(TEE)引导下经输送器置入封堵器闭合ASD。结果 178例成功封堵,7例中转胸腔镜辅助体外循环下修补术(2例上腔型、3例下腔型、2例中央型由于房间隔缺损过大,封堵器影响二尖瓣结构),1例次日心脏彩超发现封堵器脱落立即送手术室行开胸体外循环下直视修补术。无死亡,术中出现室上性心动过速6例,Ⅲ度房室传导阻滞3例,经治疗均转为窦性心律;胸腔积液5例,经引流等治疗痊愈。术后3~7 d出院。178例随访0.5~8年,(3.2±1.9)年,彩超示封堵器无残余漏、移位,心功能Ⅰ级70例,Ⅱ级83例,Ⅲ级25例。结论全胸腔镜下房间隔缺损封堵术采用微切口入路,符合美容要求,无须体外循环,费用低,术后恢复快,临床效果确切,若封堵不成功,可同期直接改体外循环下直视修补术。     

成人房间隔缺损64例手术治疗体会

目的总结成人继发孔房间隔缺损的手术治疗经验。方法对64例成人继发孔房间隔缺损患者均在体外循环下行房缺修补术,采用直接缝合15例,补片修补49例。三尖瓣中度以上关闭不全者9例中行Kay,s二瓣化成形术3例,Devega三尖瓣环成形术6例。结果 61例患者术后恢复顺利,疗效满意。围术期死亡3例,死亡原因为低心排综合征2例、肺动脉高压危象1例。结论手术治疗是有效控制成人继发孔房间隔缺损患者病情进一步发展的重要手段,一经确诊应尽早手术,围术期肺动脉高压及合并症的正确处理是手术成功的关键。     

经胸小切口非体外循环封堵术对房间隔缺损患者住院时间及并发症发生率的影响

目的探讨经胸小切口非体外循环封堵术对房间隔缺损患者住院时间及并发症发生率的影响。方法回顾性分析2016-01—2019-06间郑州市第七人民医院心外科收治的106例房间隔缺损患者的临床资料,按手术方案不同分为2组,各53例。直视组采用传统体外循环心脏直视修补术,微创组采用经胸小切口非体外循环封堵术。比较2组的手术时间、住院时间、并发症发生率。结果与直视组比较,微创组手术时间、住院时间短,并发症发生率低,差异均有统计学意义(P0.05)。结论经胸小切口非体外循环封堵术治疗房间隔缺损,可显著缩短手术时间及住院时间,而且并发症发生率低。     

双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究

目的分析双心房射频消融术与单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动（房颤）的效果。方法回顾性分析2007年1月至2012年12月47例房间隔缺损合并心房颤动接受房间隔缺损修补联合射频消融术治疗患者的临床资料,其中男20例,女27例;年龄35～76岁;房颤病程3个月至15年;持续性房颤18例,长程持续性房颤29例。合并二尖瓣轻度至中度以上关闭不全10例,三尖瓣轻度至中度以上关闭不全28例。根据手术方式不同将47例患者分为两组,单纯右心房消融组（n=19）：行房间隔缺损修补术＋单纯右心房射频消融术;双心房消融组（n=28）：行房间隔缺损修补术＋双心房射频消融术。对于二尖瓣、三尖瓣存在轻一中度以上反流者,术中同期行二尖瓣、三尖瓣成形术。所有患者术后3个月、6个月、12个月均接受24h动态心电图检查,1年后间断门诊随访。结果双心房消融组的体外循环时间、主动脉阻断时间及术后住院时间较单纯右心房消融组略长,但两组术后早期并发症及恢复情况无明显差异。心脏复跳时,双心房消融组25例（89．3％）直接恢复窦性心律,3例为交界心律,无房颤心律。单纯右心房消融组14例（73．7％）直接恢复窦性心律,2例为交界心律,3例为房颤心律。出院时,双心房消融组28例（100％）均维持窦性心律;单纯右心房消融组15例（78．9％）维持窦性心律,4例房颤复发（P=0．045）。所有患者均得到随访,随访时间3～75个月,全组无死亡病例;房间隔无残余分流;2例出现二尖瓣轻一中度以上关闭不全,4例出现三尖瓣轻．中度以上关闭不全;双心房消融组术后2年累积窦性心律维持率为87．7％±6．7％,明显高于单纯右心房消融组的47．4％±11．5％（P=0．003）。结论对于成人房间隔缺损合并房颤,双心房射频消融术较单纯右心房射频消融术有更好的治疗效果,而且不会增加手术的风险。     

经胸微创封堵治疗房间隔缺损和室间隔缺损临床分析

目的探讨经胸微创封堵治疗房间隔缺损和室间隔缺损的效果和安全性。方法根据不同手术方式将163例房间隔缺损和室间隔缺损患者分为2组。观察组(96例)采用经胸微创封堵术,对照组(67例)采用传统开胸手术。比较2组的疗效。结果 2组手术成功率差异无统计学意义(P0.05)。观察组的手术时间、术中出血量和输血量及术后引流量、并发症发生率及住院时间均优于对照组,差异均有统计学意义(P0.05)。结论经胸微创封堵术治疗房间隔缺损和室间隔缺损,安全、有效。但应严格掌握手术指征、规范操作和把握好中转开胸手术的时机。     

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.