缺血再灌注损伤皮瓣组织中金属硫蛋白的免疫组化研究

目的：观察缺血再灌注损伤皮瓣组织中金属硫蛋白(Metallothionein MT)的表达部位及表达量的变化规律。方法：16只大鼠随机分为对照组(n=8)和缺血再灌注组(n=8)。在大鼠以腹壁浅血管为蒂的岛状皮瓣缺血再灌注模型上，用硫代巴比妥法和比色法分别测定皮瓣组织中丙二醛(MDA)含量和髓过氧化物酶(MPO)活性。观察免疫组化切片中MT的表达部位，并对切片进行图像分析，以积分光密度代表MT的含量。结果：缺血再灌注组再灌注1h和24h，皮瓣组织中MDA含量分别较对照组高46.5％、147.8％，MPO活性分别较对照组高1169．5％、408．6％，MT含量分别较对照组高119．9％、234．6％。在发生缺血再灌注损伤的皮瓣中MT表达在表皮基底层细胞、皮下组织及肉膜下组织血管壁细胞、成纤维细胞，毛囊、皮脂腺、汗腺和肌细胞的细胞浆中。结论：皮瓣发生缺血再灌注损伤后，MT表达在皮瓣组织的多种细胞内，MT含量增加可能和皮瓣在发生缺血再灌注损伤时的某些代谢产物有关。     

白藜芦醇促进任意皮瓣成活的实验研究

目的：观察白藜芦醇（Resveratrol）对超长任意皮瓣成活的影响并探讨其机制。方法：69只SD大鼠随机分为对照组（n=23）、灌胃组（n=23）和外用药处理组（n=23）。在大鼠背部设计蒂在尾部的3cm×9cm大小任意皮瓣,皮瓣掀起后原位缝合。分别测定皮瓣组织中丙二醛（Malondialdehyde,MDA）含量、髓过氧化物酶（Myeloperoxidase,MPO）活性。组织切片HE染色观察各组毛细血管生成情况。术后7天观察皮瓣成活面积。结果：两个处理组术后12h、24h皮瓣组织中MDA含量与对照组相比有统计学差异（P〈0．05）,MPO活性与对照组相比有统计学差异（P〈0．05）。术后7天皮瓣成活面积处理组明显高于较对照组。结论：白藜芦醇对超长任意皮瓣具有保护作用,可提高皮瓣的成活面积。     

外源性锌对缺血再灌注损伤皮瓣超微结构的影响

目的:观察外源性锌对缺血再灌注(ischemia-reperfusionIR)损伤皮瓣的保护作用。方法:48只大鼠随机分为对照组(n=16)、缺血再灌注组即IR组(n=16)和补锌缺血再灌注组即补锌-IR组(n=16)。在大鼠以腹壁浅血管为蒂的岛状皮瓣缺血再灌注模型上,用硫代巴比妥法和比色法分别测定皮瓣组织中丙二醛(MDA)含量和髓过氧化物酶(MPO)活性。应用透射电镜观察皮瓣缺血再灌注损伤后超微结构的改变,并观察皮瓣成活率。结果:补锌-IR组在再灌注1h和24h,皮瓣组织中MDA含量分别较IR组降低11.3%、33.2%,MPO活性分别较IR组降低17.9%、21.4%。补锌-IR组皮瓣的超微结构改变较IR组明显减轻,皮瓣成活率较IR组升高27.2%。结论:外源性锌能显著减轻缺血再灌注损伤皮瓣中组织细胞超微结构的病理改变,对皮瓣缺血再灌注损伤产生一定的保护作用。     

缺血再灌注损伤皮瓣组织中金属硫蛋白含量变化

目的　观察缺血再灌注损伤皮瓣组织中金属硫蛋白 (metallothionein ,MT)的含量变化。方法　 16只大鼠随机分为对照组 (n =8)和缺血再灌注损伤组 (n =8)。在大鼠腹壁浅血管为蒂的岛状皮瓣缺血再灌注损伤模型上 ,用10 9Cd血红蛋白饱和法和硫代巴比妥酸法测定皮瓣组织中MT及丙二醛(MDA)含量 ,比色法测定皮瓣组织过氧化物酶 (MPO )活性。结果　缺血再灌注损伤组在缺血 8h、再灌注 12h、2 4h时皮瓣组织中MDA水平分别较对照组高 41.7%、111.4%、13 5.7% ,MPO水平分别较对照组高 72 .1%、2 18.9%、2 96.0 % ,MT含量分别较对照组高 42 .6%、52 .8%、10 2 .3 % (P <0 .0 5或P<0 .0 1)。结论　皮瓣组织中MT含量增多 ,可能与皮瓣缺血再灌注损伤有关     

硫酸锌对皮瓣缺血再灌注损伤保护作用的研究

目的 观察外源性锌对皮瓣缺血再灌注（ischemia—reperfusion，IR）损伤的保护作用，并探讨其机制。方法 48只大鼠随机分为非-IR组、IR组和补锌-IR组。在大鼠以腹壁浅血管为蒂的岛状皮瓣缺血再灌注模型上，分别测定皮瓣组织中丙二醛（MDA）含量和髓过氧化物酶（MPO）活性。观察免疫组化切片中金属硫蛋白（metallothionein，MT）的表达，并对切片进行图像分析。应用透射电镜观察皮瓣缺血再灌注损伤后超微结构的改变，观察皮瓣成活率。结果 补锌-IR组在再灌注1h和24h，皮瓣组织中MDA含量分别较IR组降低11．3％、33．2％（P〈0．05），MPO活性分别较IR组降低14．2％、22．7％（P〈0．05），MT含量分别较IR组高41．5％、44％（P〈0．01）。在补锌-IR组掀起皮瓣即刻的标本中有一定量的MT表达。MT表达在皮瓣组织多种细胞的细胞浆中。补锌-IR组皮瓣的超微结构改变较IR组减轻，皮瓣成活率较IR组升高27．2％（P〈0．05）。结论 外源性锌能诱导皮瓣内MT产生，MT通过细胞保护作用对皮瓣缺血再灌注损伤产生一定的保护作用。     

一氧化氮对任意型皮瓣成活影响的实验研究

目的　观察任意型皮瓣掀起后皮瓣远端组织内一氧化氮 (NO)含量的变化和外源性L 精氨酸 (L arginine ,L arg)对任意型皮瓣成活的影响。方法　采用Wistar大白鼠为实验动物 ,在其背部形成 7cm× 2cm任意型皮瓣 ,通过图像分析技术和不同时间远端皮瓣组织匀浆中NO-2 NO-3含量测定 ,观察皮瓣掀起后皮瓣组织内NO含量变化 ,和NO前体L arg对皮瓣成活的影响。结果　实验组皮瓣成活率明显高于对照 2组 (P <0 0 1) ,组织学检查发现实验组皮瓣组织炎症细胞浸润较对照 2组少 ,组织匀浆NO含量结果发现 :术后即刻各组NO含量差异无显著性意义 (P >0 0 5 ) ,术后 8、12、2 4和 72h各组存在差异有显著性意义 (分别为P <0 0 1,P <0 0 1,P <0 0 5和P <0 0 1) ,实验组明显高于对照 2组。结论　皮瓣掀起后 ,组织NO含量早期有所升高而后降低 ;应用外源性L arg可以提高皮瓣组织中NO含量和皮瓣成活率。     

脂质体携载金属硫蛋白对皮瓣继发静脉缺血再灌注损伤的作用

目的 观察脂质体包裹金属硫蛋白(MT)对岛状皮瓣继发静脉缺血再灌注损伤的保护作用。方法 在大鼠下腹部岛状皮瓣继发静脉缺血再灌注损伤模型上测定皮瓣即刻、继发缺血再灌注30min、7d后的丙二醛(MDA)含量、髓过氧化物酶(MPO)活性，继发缺血再灌注30min时血浆内皮素(ET)、乳酸脱氢酶(LDH)水平，7d后皮瓣MT的含量。结果 脂质体携载MT组明显降低皮瓣MDA、MPO、血浆ET、LDH含量，增加7d后皮瓣组织MT含量，提高皮瓣成活率。结论 脂质体包裹MT对皮瓣继发静脉缺血再灌注损伤具有良好的保护作用。     

锰苯甲酸卟啉干预活性氧在小肝移植物缺血再灌注损伤中的作用及其意义

目的 观察锰苯甲酸卟啉(MnTBAP)对SD大鼠小肝移植物模型缺血再灌注损伤的治疗及保护作用.方法 采用二袖套法建立供肝/标准肝体积比(GV/SV)≤30%的小肝移植物大鼠模型,将大鼠随机分为A:假手术组(n=24),B:对照组(n=24),C:MnTBAP治疗组(n=24),于复流后3、6、12、24 h各取6只处死取材,检测各组大鼠肝组织中肿瘤坏死因子(TNF)-α mRNA表达、髓过氧化物酶(MPO)、丙二醛(MDA)、肝功能指标和肝细胞凋亡间的状态.结果 与假手术组比较,对照组肝组织TNF-α mRNA及MDA、MPO含量显著升高(P<0.01),肝丙氨酸转氨酶(ALT)活性显著升高(P<0.01),肝细胞凋亡明显增多(P<0.01);而MnTBAP治疗组的肝组织MDA、MPO含量较对照组显著降低(P<0.05),肝细胞凋亡减少,且在术后6、12、24 h,肝TNF-α mRNA表达均下降(P<0.05),血清ALT水平也明显降低(P<0.01).结论 MnTBAP可以抑制中性粒细胞的呼吸爆发,降低肝组织TNF-α mRNA表达、减轻细胞膜损伤程度,对缺血肝损伤有良好的保护作用.     

血肿中的铁对任意皮瓣毒性作用的研究

目的：探讨血肿中的铁对皮瓣的毒性作用。方法：8头4～8月龄白色小型猪,在每头猪脊柱两侧各设计6个任意皮瓣,共96个。将皮瓣随机分配进入对照组、生理盐水组、血肿组、去铁胺组,每组24个皮瓣。对照组：皮瓣形成后无其他处理;生理盐水组：在皮瓣形成后向皮瓣下注入15ml生理盐水;血肿组：在皮瓣形成后向皮瓣下注入15ml自体血液;去铁胺组：在皮瓣形成后向皮瓣下注入15ml自体血液和270mg甲磺酸去铁胺。各组分别在术后24h、72h、120h取材,检测各组术后2h皮瓣的血流情况,检测皮瓣铁含量、丙二醛（MDA）含量、髓过氧化物酶（MPO）活性。结果：①四个组术后2h皮瓣血流灌注量无显著差别（P〉0.05）;②生理盐水组各项指标与对照组无显著差异（P〉0.05）;③血肿组术后皮瓣铁含量、MDA含量和MPO活性均高于对照组（P〈0.01）;④去铁胺组皮瓣铁含量和MDA含量低于血肿组（P〈0.01）,MPO活性与血肿组无显著差异（P〉0.05）。结论：血肿中的铁能增强皮瓣内的脂质过氧化反应。     

锌对皮瓣缺血再灌注损伤细胞保护作用的研究

目的观察外源性锌在皮瓣缺血再灌注(ischem ia-reperfus ion,IR)损伤中的细胞保护作用,并探讨其机制。方法48只健康雄性W istar大鼠,制备以腹壁浅动脉为蒂的轴型皮瓣IR模型。大鼠随机分为对照组、IR组和补锌-IR实验组,每组16只。各组分别取8只大鼠,IR组和实验组于掀起皮瓣即刻、再灌注后1 h和24 h分别于皮瓣中段边缘取全层皮瓣组织1.0 cm×0.5 cm,对照组于掀起皮瓣即刻、9 h和32 h同法取材,分别行免疫组织化学检测金属硫蛋白(m eta lloth ione in,M T)的表达部位,并对切片进行图像分析;透射电镜观察IR后超微结构的改变和皮瓣成活率;生物化学检测皮瓣组织中丙二醛(m a lond ia ldehyde,M DA)含量和髓过氧化物酶(m ye loperox idase,M PO)活性。结果掀起皮瓣即刻对照组、IR组和实验组皮瓣M DA、M PO水平相近,差异无统计学意义(P>0.05)。缺血再灌注后1、24 h,IR组M DA含量分别高于对照组62.2%和136.4%(P<0.01),高于实验组11.3%和33.2%(P<0.05);M PO活性分别高于对照组238.4%和503.4%(P<0.01),高于实验组17.9%、24.1%(P<0.05)。掀起皮瓣即刻对照组和IR组M T含量极低,无法定量分析,实验组为45.30±7.60。缺血再灌注后1、24 h,实验组M T含量分别较IR组高41.5%和44.9%(P<0.01),IR组M T含量分别较对照组高119.9%和234.6%(P<0.01)。对照组皮瓣成活率为100%,IR组皮瓣成活率为19.65%±4.38%,实验组皮瓣成活率为24.99%±5.12%,较IR组提高27.2%(P<0.05)。结论外源性锌能对皮瓣内多种细胞的IR损伤产生保护作用,可明显提高皮瓣成活率。     

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.