国产维库溴铵临床肌松效应和安全性的评价

目的：估价国产维库溴铵在临床使用中的肌松效应和安全性，方法：多中心试验，择期手术病人２００例，随机分为国产维库溴铵组（１００例）和进口维库溴铵组（１００例）肌松监测标完成后，给予维库溴铵０．１ｍｇ／ｋｇ＋硫喷妥钠４～５ｍｇ／ｋｇ，麻醉维持用药为，安氟醚，氧化亚氮，芬太尼和氧气，肌松监测仪的“四个成串”刺激第一肌颤搐反应强度（Ｔ１）恢复至７５％时，试验结束。结果：静脉注射国产维为溴铵０．１ｍｇ／ｋｇ     

肝硬化病人乌司他丁预处理对罗库溴铵肌松作用的影响

目的观察肝硬化病人乌司他丁预处理对罗库溴铵肌松作用的影响。方法选择30例患有肝硬化的成年手术病人,随机均分为两组:乌司他丁组(Ⅰ组),静注乌司他丁5000U/kg后1min,静脉给予罗库溴铵0.6mg/kg;生理盐水组(Ⅱ组),静脉给予生理盐水0.1ml/kg后1min,静脉给予罗库溴铵0.6mg/kg。另选15例无肝脏疾患的、ASAⅠ～Ⅱ级择期成年手术病人为对照组(Ⅲ组),处理同Ⅱ组。肌松监测仪检测四个成串刺激(TOF)的变化,记录三组注药后罗库溴铵的起效时间(注药到TOFr=0)、TOF无反应时间(T1=0持续时间)、T1最大抑制程度、临床时效(TOFr恢复至25%时间)、T1恢复至75%时间、恢复指数。结果与Ⅱ、Ⅲ组比较,Ⅰ组插管剂量罗库溴铵的起效时间明显延长(P<0.05)。Ⅱ、Ⅲ组罗库溴铵肌松的起效时间相似。与Ⅱ组比较,Ⅰ、Ⅲ组T1恢复25%时间和恢复指数明显缩短(P<0.05)。Ⅰ、Ⅲ组罗库溴铵肌松的恢复时间相似。结论肝硬化病人乌司他丁预处理延长罗库溴铵的起效时间,但缩短罗库溴铵肌松作用时间。     

低温体外循环对心血管手术病人罗库溴铵和维库溴铵肌松作用的影响

目的 采用肌松药自适应控制给药系统使病人的肌松水平稳定在恒定水平,研究低温体外循环（CPB）对心血管手术病人罗库溴铵和维库溴铵肌松作用的影响。方法 择期心血管手术病人20例,ASA分级Ⅱ或Ⅲ级,随机分为2组（n=10）：罗库溴铵组（R组）和维库溴铵组（V组）。用加速度仪监测神经肌肉传导功能,采用四个成串刺激,麻醉诱导时静脉注射依托咪酯0．3 mg/kg、芬太尼2～4μg/kg,并采用自适应控制给药系统给予肌松药负荷剂量：罗库溴铵0．3mg/kg（R组）或维库溴铵0．07mg/kg（V组）,T4消失时进行气管插管,当肌松水平恢复到T1=10%时,控制系统开始控制输注泵持续输注肌松药,2组术中肌松水平维持在T1=10%。间断静脉注射芬太尼和咪达唑仑维持麻醉。分别于CPB开始前T1=10%并且持续5min（T1）、CPB中达到设定的最低温度（T2）、CPB停止后5min （T1）采集动脉血,测定肌松药的血药浓度;记录CPB前（麻醉诱导开始至CPB开始前即刻）、CPB中（CPB开始即刻至CPB停止前即刻）和CPB后（CPB停止后即刻至术毕）肌松药的输注速率,记录达设定点时间（从T1=100%至T1=10%的时间）、达稳态时间（从T1=100%到T1稳定在10%的时间）、鼻咽温及拇内收肌皮温。并对本控制系统的性能进行评价。结果 与T1比较,R组和V组T2、T3时肌松药的血药浓度降低,CPB中及CPB后肌松药的输注速率均低于CPB前（P＜0．01）。两组平均超调和平均标准差均在5%以内,控制给药系统性能指标2组间比较差异无统计学意义（P＞0．05）。结论 心血管手术病人芬太尼复合咪达唑仑麻醉下,低温CPB强化了罗库溴铵、维库溴铵的肌松作用。     

高血压患者长期口服二氢吡啶类药物对维库溴铵肌松效应的影响

目的 观察高血压患者长期口服二氢吡啶类药物对维库溴铵的肌松效应的影响.方法 选择长期口服（超过3个月）珍菊降压片或二氢吡啶类药的高血压患者行中下腹部手术各30例,ASA Ⅰ或Ⅱ级,分为两组：长期口服二氢吡啶类药组（观察组）和长期口服珍菊降压片组（对照组）.用肌松监测仪观察并记录两组患者术中维库溴铵的起效时间（T1消失）、T1出现时间、TOF出现时间、T1恢复至25%的时间及恢复指数.结果 两组患者术中维库溴铵的起效时间、作用持续时间和恢复指数差异均无统计学意义.结论 高血压患者长期使用二氢吡啶类药物对维库溴铵肌松效应无显著影响.     

异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

罗库溴铵和维库溴铵在终末期肾衰竭病人临床药效的比较

目的　比较罗库溴铵和维库溴铵在终末期肾衰竭病人中的肌松效应。方法　 2 5例ASAⅢ级行肾移植术病人随机分为罗库溴铵组 (R组 ,15例 )和维库溴铵组 (V组 ,10例 )。麻醉诱导后分别给予 2×ED95剂量的罗库溴铵 (0 6mg/kg)或维库溴铵 (0 1mg/kg)。术中当T1恢复至 2 5 %时 ,追加 0 5×ED95剂量的罗库溴铵 (0 15mg/kg)或维库溴铵 (0 0 2 5mg/kg)。末次剂量后 ,使肌张力自然恢复或给予新斯的明拮抗。结果　初量罗库溴铵的起效时间为 (1 98± 0 4 7)min ,明显短于维库溴铵的 (3 2 5±0 82 )min。初量和追加量的罗库溴铵的肌松维持时间分别为 (4 6 87± 14 6 0 )min和 (34 86± 15 5 7)min,与维库溴铵相似。两组应用拮抗药后 ,恢复指数均显著缩短。结论　对于终末期肾衰竭病人 ,罗库溴铵的起效快于维库溴铵 ,肌松作用维持时间和恢复指数与维库溴铵相似。     

国产维库溴铵量-效关系的多中心研究

维库溴铵 (Ｖｅｃｕｒｏｎｉｕｍ ,简称Ｖｅｃ)是较为理想的非去极化类肌松药。国产维库溴铵由南京药科大学和浙江仙居制药有限公司共同研制并已在临床使用 ,其时 效、不良反应及安全性的方面已有研究资料[1] 。本试验旨在研究其量 效关系。资料和方法选择ＡＳＡⅠ～Ⅱ级择期手术全麻病人 30 0例。将病人分为国产维库溴铵组(15 0例 )和进口维库溴铵组 (15 0例 )。其中北京协和医院、浙江医科大学附属第一医院和邵逸夫医院各 10 0例。各家医院将病人随机分为国产组 5 0例 ,进口组 5 0例 ,各组再将病人随机分为 5个维库溴铵剂量组 ,即 10、2 …     

地氟醚、异氟醚对老年患者维库溴铵肌松效应的影响

目的：观察吸入等效浓度地氟溴、异氟醚对老年患者维库溴铵肌松效应的影响。方法：30例ASA I－Ⅱ级老年患者分为3组，均吸入N2O：O2（50％：50％），其中Des组和Iso组分别吸入等效浓度地氟醚（6％）和异氟醚（1．15％），对照组为无吸入组。麻醉诱导用咪达唑仑、异丙酚和芬太尼。所有患者经颈内静脉注入总量为40μg/kg的维库溴铵。用丹麦产TOF GUARD加速度仪进行肌松监测。维库溴铵40μg/kg分为4等份分次静注，记录每次注药（10μg/kg）后的起效时间及最大阻滞效应。用累积剂量法建立3组患者的剂量反应曲线。在最后一次注药后记录：T1恢复到25％、75％、90％的时间（T125％、T175％、T190％）；TOF比值恢复到70％的时间以及恢复指数。结果：与对照组（Con)相比，Des组和Iso组维库溴铵ED50和ED95值均明显缩小（P＜0．05），且Des组比Iso组的缩小更明显（P＜0．05）。3组的起效时间差异均无显著性（P＞0．05）。两个吸入麻醉药组的T125％、T175％和T190％明显长于对照组（P＜0．05），且Des组又明显高于Iso组（P＜0．05）。两个吸入麻醉药组的TOF比值恢复到70％的时间和恢复指数RI均明显高于对照组（P＜0．05），但在两个吸入麻醉药组之间差异无显著性（P＞0．05）。结论：地氟醚、异氟醚均能明显影响老年患者维库溴铵的肌松效应，地氟醚的影响大于异氟醚。     

罗库溴铵和阿曲库铵肌松作用的对比研究

目的 比较两种短效非去极化肌松药罗库铵在妇科腹腔镜手术全麻中的肌松作用。方法 选择妇科腹腔镜手术病人40例，术前检查无明显肝肾功能损害。随机分罗库溴铵组（Ⅰ组，n1=20例）和阿曲库铵组（Ⅱ组，n2=20例）。麻醉诱导；静注咪唑安定0.1mg/kg，芬太尼5μg/kg，琥珀胆碱1.5mg/kg，丙泊酚1.5mg/kg，经口明视插管，接Datex-OhmedaAS/3麻醉机，用TOF-guard肌松监测仪（丹麦），采用TOF刺激模式，当肌颤搐恢复至T125%时，静注罗库溴铵0.8mg/kg或阿曲库铵0.5mg/kg维持肌松；当T15%-10%时，分别追加罗库溴铵0.4mg/kg或阿曲库铵0.2mg/kg。麻醉维持丙泊酚80-120mg/h和苏太尼40-60μg/h速率用微量注射泵静脉注射，同时吸入氧化亚氮（N2O：O2为1：1）。结果 I组起效时间明显较Ⅱ组短，并且T125%时间，T190%时间以及恢复指数均较Ⅱ组短。Ⅱ组的循环变化主要表现在注药后1，3，5分钟的SBP较注射前呈明显下降，5分钟后呈回升趋势，结论 罗库溴铵比阿曲库铵肌松起效快，恢复较迅速，对循环影响小，是内腔镜手术麻醉时的良好肌松药选择。     

哌库溴铵前处理对琥珀胆碱的肌震颤及肌松效应的影响

目的：观察哌库溴铵前处理对琥珀胆碱肌震颤的预防作用及对其肌松效应的影响。方法：３６例择期手术病人随机分成三组，Ⅰ组静注琥珀胆碱１ｍｇ／ｋｇ（对照组）。Ⅱ、Ⅲ组静注哌库溴铵１５μｇ／ｋｇ后３．５分钟分别注入琥珀胆碱１ｍｇ／ｋｇ和１．５ｍｇ／ｋｇ。结果：哌库溴铵前处理能有效地消除琥珀胆碱引起的肌震颤，但使１ｍｇ／ｋｇ琥珀胆碱的起效时间延长、阻滞程度降低、气管插管条件变差、肌松恢复时间缩短。当琥珀胆碱的剂量增至１．５ｍｇ／ｋｇ时，肌松效应恢复满意。结论：哌库溴铵前处理使琥珀胆碱的肌松效应减弱，故琥珀胆碱的插管剂量应增至１．５ｍｇ／ｋｇ，以获得满意的肌松。     

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.     

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.     

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.