常温和低温心肺转流期间门静脉血流量及氧代谢的变化

目的：研究常温和低温心肺转流（CPB）期间门静脉血流量（PBF）和氧代谢的变化。方法：测定11号杂种犬在常温（N组）或低温（H组）CPB期间PBF和氧代谢指标。结果：CPB中低温组SpO2升高，PDO2、PVO2降低（P＜0．05或P＜0．01）；常温组PpO2、PDO2降低，而PERO2和PBF升高（P＜0．05或P＜0．01）。CPB后两组SaO2、PaO2、SpO2、PpO2、PBF、PDO2均有不同程度的降低（P＜0．05或P＜0．01），而PERO2明显升高（P＜0．01），常温组PVO2减少（P＜0．05）。两组相比，CPB中低温组PaO2、SaO2、SpO2高于常温组，PVO2、PERO2、PBF低于常温组（P＜0．05或P＜0．01）。CPB后低温组SaO2、PDO2、PVO2和PBF都高于常温组（P＜0．05）。结论：常温和低温CPB期间门脉系统都存在氧代谢障碍，但常温CPB期间PBF、门脉组织氧利用明显优于低温CPB，CPB后PBF、门脉组织氧代谢低温组优于常温组。     

不同程度肝功能损害患者原位肝移植术中机体氧代谢变化

目的观察不同程度肝功能损害患者在非转流原位肝移植手术过程中机体氧代谢变化。方法选择接受经典非转流肝移植术患者50例,按Pugh-Child评分法分为A组(A级12例)、B组(B级18例)、C组(C级20例)。左桡动脉置管后常规麻醉诱导,经右颈内静脉放置Swan-Ganz导管。分别在麻醉后手术前(T1),无肝期前10min(T2),无肝期30min(T3),新肝期30min(T4)及术毕(T5),采集桡动脉血和肺动脉的混合静脉血监测和计算以上各时点的动脉血氧饱和度(SaO2),动脉血氧分压(PaO2)、混合静脉血氧饱和度(S珔vO2)、心脏指数(CI)、氧供(DO2)、氧耗(VO2)及氧摄取率(ERO2)。结果三组患者在T3时VO2、S珔vO2和DO2均明显低于T1时(P<0.05或P<0.01)。三组VO2在T4时上升,明显高于T3时(P<0.05),T5时恢复至T1时水平。B、C组的ERO2在T3时均明显高于T1时(P<0.05)。T3时B、C组的S珔vO2和DO2低于A组(P<0.05),ERO2则明显高于A组(P<0.05)。结论不同程度肝功能损害患者肝移植术中机体氧代谢整体变化趋势一致,均以无肝期异常最为严重。Pugh-Child分级B级和C级患者DO2和ERO2变化较A级患者更为剧烈。     

1,6-二磷酸果糖对心肺转流期间氧代谢的影响

目的研究1,6-二磷酸果糖(FDP)对心肺转流(CPB)手术期间氧代谢的影响。方法随机将24例CPB手术病人均分成研究组(A组)和对照组(B组)。A组于转机前静滴FDP200mg/kg,B组于转机前滴入等量生理盐水,观察麻醉后(T1)、CPB前(T2)、升主动脉开放后10min(T3)、停CPB后10min(T4)、停CPB后60min(T5)的氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)及动脉血乳酸(ABL)的变化。结果两组T3时DO2明显降低(P<0.05),T3时A组ERO2和B组VO2、ERO2及两组T4、T5时VO2、ERO2明显增加(P<0.05或P<0.01),T3、T4和T5时ABL明显增加(P<0.01);B组T3、T4和T5时VO2、ERO2、ABL明显高于A组(P<0.05)。结论FDP对改善CPB手术期间氧供需平衡障碍有明显作用。     

以氧供为导向的血流动力学管理模式对非转流下原位肝移植术机体氧代谢的影响

目的观察以氧供(DO2)为导向的血流动力学管理模式在不同程度肝功能损害患者非转流经典原位肝移植手术过程中机体氧代谢变化。方法选择接受经典非转流肝移植术患者50例,按Pugh-Child评分法分为A级(A组,12例)、B级(B组,18例)、C级(C组,20例)。左桡动脉置管后常规麻醉诱导,经右颈内静脉放置Swan-Ganz导管。术中维持心排血指数(CI)>50ml/(s·m2),平均动脉压(MAP)≥60mm Hg(1mm Hg=0.133kPa)。分别在麻醉后手术前(T1),无肝期前10分钟(T2),无肝期30分钟(T3),新肝期30分钟(T4)及术毕(T5),采集桡动脉血和肺动脉的混合静脉血监测和计算以上各时点的动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、混合静脉血氧饱和度(SO2)、CI、DO2、氧耗(VO2)及氧摄取率(ERO2)。结果 3组患者在T3时VO2、SO2和DO2均明显低于T1时(P<0.05或P<0.01)。3组VO2在T4时上升,明显高于T3时(均P<0.05),T5时恢复至T1时水平。B、C组的ERO2在T3时均明显高于T1时(均P<0.05)。T3时B、C组的SO2和DO2低于A组(均P<0.05),ERO2则明显高于A组(均P<0.05)。术后住院天数A、B、C组依次递增。结论以DO2为导向的血流动力学管理模式,对不同程度肝功能损害患者肝移植术中机体氧代谢整体变化趋势一致,均以无肝期异常最为严重。Pugh-Child分级B级和C级患者DO2和ERO2变化较A级患者更为剧烈。     

去甲肾上腺素对重症瓣膜病瓣膜置换术的血流动力学影响

目的研究去甲肾上腺素(NA)对重症瓣膜病患者CPB下行心脏瓣膜置换术的血流动力学影响。方法择期CPB下行心脏瓣膜置换术患者27例,根据所使用的血管活性药物分为:NA+多巴酚丁胺(Dob)组(NA组,n=12);肾上腺素(AD)+Dob组(AD组,n=15)。术中监测脉搏指示剂连续心排血量(PiCCO)和动脉血气分析对两组血流动力学的影响。分别在术前(T0)、CPB结束时(T1)、术后6h(乳酸最高时,T2)、术后24h(T3)记录HR、MAP、CVP、连续心排血量(CCO)、心脏指数(CI)、每搏量指数(SVI)、外周血管阻力指数(SVRI)、血管外肺水指数(EVLWI)、肺毛细血管通透性(PVPI)、中心静脉氧饱和度(ScvO2),动脉氧分压(PaO2)、乳酸(Lac)及其清除率(LCR),并对供氧量(DO2)、耗氧量(VO2)、氧摄取率(ERO2)进行计算和比较。结果 T2、T3时两组CI持续升高,且AD组明显高于NA组(P<0.05),NA组SVRI明显高于AD组(P<0.05);HR慢于AD组(P<0.05)。T2,T3两组DO2差异无统计学意义。与AD组比较,T3时NA组的VO2、ERO2明显升高(P<0.05),而LCR和尿量差异无统计学意义。结论重症瓣膜患者术后循环衰竭应用去甲肾上腺素时无HR增快,减少心脏做功,提高CPB后组织氧利用能力,但需要PiCCO监测下调整其输注剂量及速度。     

原位肝移植患者术中氧代谢的变化

目的观察非静脉-静脉转流原位肝移植术患者术中全身氧代谢变化。方法23例接受非静脉-静脉转流原位肝移植的终末期肝病患者,全麻诱导用咪唑安定、依托咪酯、芬太尼和阿曲库铵,以异氟醚、丙泊酚、阿曲库铵、间断静注芬太尼维持麻醉,通过左侧桡动脉置动脉导管和右颈内静脉置Swan-Ganz导管。分别在麻醉后手术开始前(T1)、无肝期前10min(T2)、无肝期30min(T3)、新肝期30min(T4)及术毕(T5)采动脉血和混合静脉血,监测和计算以上各时点的SaO2、PaO2、SV-O2、心脏指数(CI)、氧供(DO2)、氧耗(VO2)和氧摄取率(ERO2)。结果与T1时相比,T2时S-VO2增加(P<0.05),DO2和VO2无明显变化,而ERO2下降。在T3时DO2和VO2下降明显(P<0.01),而ERO2则提高(P<0.05)。在T4时DO2、VO2和ERO2恢复至T1水平。至术毕时与无肝期无明显变化。结论非静脉-静脉转流下经典原位肝移植术患者术中氧代谢存在严重异常,以无肝期最为严重,氧供和氧耗明显下降,氧摄取率增加。     

高氧液急性等容性血液稀释对手术患者颈内静脉血氧分压的影响及应用

目的　通过高氧液急性等容性血液稀释患者的颈内静脉血氧分压的观察 ,探讨高氧液等容性血液稀释液用于失血量较大的手术患者的安全性和可行性。方法　选择髋关节和肝右叶切除术患者 6 0例 ,随机分成治疗组和对照组 ,每组 30例。两组均行急性等容性血液稀释。对照组输入复方乳酸钠和羟乙基淀粉 ;治疗组输入高氧液和羟乙基淀粉。两组同步记录混合静脉血氧分压(P vO2 )和混合静脉血氧饱和度 (S vO2 )、HR、MAP、CVP、肺毛细血管楔入压 (PCWP)。结果　治疗组P vO2 、S vO2 均较对照组高 (P <0 0 5 )。结论　高氧液用于急性等容性血液稀释的患者 ,可提高P vO2 、S vO2 以保证组织氧供需平衡 ,是安全可行的。     

心肺转流时间对氧代谢的影响

目的对心脏瓣膜手术病人麻醉与手术期间的氧代谢进行测定,探讨心肺转流(CPB)时间对其后氧代谢的影响。方法选择36例择期行心脏瓣膜手术病人,根据CPB时间,将病人分为S组(CPB≤150 min)和L组(CPB>150 min)。采用Swan-Ganz导管技术及反向Fick检测方法对麻醉手术期间的氧代谢进行测定。检测时点为麻醉前、CPB前、CPB停止10 min和60 min。结果麻醉前两组的pH、PaCO2、PaO2等血气参数维持在正常范围,但氧供(DO2)减少,氧摄取率(O2ER)增加。CPB前,两组病人DO2显著降低(P<0.05),S组的氧耗(VO2)显著降低(P<0.05)。CPB后10min到60 min期间,DO2、VO2显著增加(P<0.05),L组O2ER显著增加(P<0.05)。CPB后10 min和60 min,两组的pH、PaCO2及PaO2等虽与麻醉前比较有显著改变,但两组的变化是一致的。CPB后10 min两组的心指数(CI)较麻醉前和CPB前有极显著升高(P<0.01)。CPB后L组的VO2有增高趋势(P<0.05),O2ER明显大于S组。结论CPB对其后氧代谢有明显影响,随着CPB时间延长,CPB后氧代谢障碍更显著。     

常温与低温心肺转流心肌损伤的比较

目的比较常温和低温心肺转流（CPB）中的心肌损伤。方法成年健康杂种犬11只，随机分为低温组（H组，n=5）和常温组（N组，n=6）。H组采用4℃改良托马氏停搏液间断灌注，最低鼻咽温度28～30℃，N组采用氧合温血持续灌注，最低鼻咽温度35．3～37．1℃。主动脉阻断60min，CPB90min。分别测定CPB前、CPB30、90min、CPB后60min时静脉血心肌相关酶含量；CPB中心脏停跳时间和复跳时间；CPB后60min心肌含水量。结果两组天门冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、羟丁酸脱氢酶（HBDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）在CPB中和CPB后均较CPB前升高；且H组AST、HBDH、CK、CK-MB在CPB30、90min，CPB后60min均较N组升高；H组LDH在CPB90min、CPB后60min较N组高。主动脉夹闭后，H组的心脏停跳所需时间明显短于N组；主动脉开放后，H组的心脏复跳所需时间明显长于N组。CPB后60min心肌含水量H组高于N组。结论常温和低温CPB都可引起心肌组织损伤，尤以低温CPB为著。     

失血性休克时大鼠全身氧供给与氧消耗关系变化的研究

目的　研究失血性休克时大鼠全身氧供给 (DO2 )与氧消耗 (VO2 )关系变化。方法　按每次 4ml/kg ,每隔 0 5h分次从静脉放血 ,观察大鼠休克过程中DO2 ,VO2 ,氧摄取率 (ExtO2 )等变化。结果　失血 2 0h时平均动脉压开始明显下降 (P <0 0 1 )。在休克早期 ,DO2 呈进行性下降 ,ExtO2 出现代偿升高 ,VO2 维持相对不变 ,呈非氧供依赖关系 ;当DO2 降至2 7 64ml·min- 1 ·kg- 1 后 ,VO2 随DO2 线性降低 (P <0 0 1 ) ,即呈氧供依赖关系 ,并伴血乳酸浓度升高。结论　失血性休克时DO2 与VO2 间呈双相变化关系 ,氧供依赖关系的变化反映了全身组织缺氧的存在     

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.