胃十二指肠手术后呼吸系统并发症的危险因素探讨

目的探讨胃、十二指肠手术患者术后发生呼吸系统并发症(postoperativepulmonarycomplications,PPC)的危险因素。方法对1999年12月至2003年12月接受胃十二指肠手术的连续病例共508例患者的临床资料进行回顾性分析。采用单因素、多因素Logistic回归分析的方法筛选与发生PPC相关的危险因素。结果508例患者有131例(25.8%)发生PPC。多因素Logistic回归分析筛选出与PPC有关的危险因素为:年龄(OR=1.052)、术前伴存呼吸疾病(OR=2.915)、血清白蛋白水平(OR=0.995)、术中气管插管时间(OR=1.005)、保留鼻胃管时间(OR=1.059)、术后机械通气时间(OR=1.367)。得出Logistic回归预测方程为:P(1)=1/犤1+e-(-3.780+0.051×Y+1.086×Rd-0.005×Alb+0.005×Dtc+0.057×Dnt+0.312×Dmv)犦。结论高龄、有基础呼吸疾病、血清白蛋白水平低于正常、术中和术后留置胃管、气管插管、机械通气时间长者,易于发生PPC。     

胰十二指肠切除术后早期呼吸系统并发症的危险因素分析

目的 探讨胰十二指肠切除术病人术后早期呼吸系统并发症(pulmonary complica-tions,PC)的危险因素.方法 回顾性分析165例胰十二指肠切除术病人的临床资料,采用单因素和多因素Logistic回归分析筛选与发生术后PC相关的危险因素.结果 165例病人有32例(19.4%)术后发生PC.多因素Logistic回归分析筛选出与PC有关的危险因素为:手术方式(OR=2.859)、血管重建(OR=4.803)、术后抑酸剂使用时间(OR=1.063)、术后气管插管时间(OR=1.087).得出Logistic回归预测方程为:P(1)=1/[1+e<'-(-4.987)+1.051X1+1.569X2+0.061X3+0.083X4>].结论 PPPD、联合血管重建、术后使用抑酸剂和气管插管时间长的胰十二指肠切除术病人,易发生PC.     

月经周期不同阶段对妇科腹腔镜手术后恶心呕吐的影响

目的观察月经周期不同阶段对妇科腹腔镜手术后恶心呕吐(PONV)的影响。方法选择2016年3月至2017年2月在北京大学第一医院接受全身麻醉下妇科腹腔镜手术的患者228例。根据患者在手术日处于月经周期的不同阶段分为卵泡期(n=98)、排卵期(n=79)和黄体期(n=51)。收集围术期资料,记录术后0~2h、0~24h内恶心呕吐的发生情况。采用Logistic回归模型分析月经周期不同阶段对PONV发生率的影响。结果术后0~2h有53例(23.2%)患者发生PONV,0~24h有125例(54.8%)PONV。单因素分析显示:月经周期不同阶段PONV发生率差异无统计学意义。多因素Logistic回归分析显示:手术时间1h(OR=3.176,95%CI 1.567~6.436,P=0.001)、PONV史(OR=5.711,95%CI 1.710~19.080,P=0.005)是术后0~2h恶心呕吐的独立危险因素;手术时间1h(OR=2.577,95%CI 1.460~4.549,P=0.001)、术后使用PCA泵(OR=2.671,95%CI 1.224~5.831,P=0.014)、术后应用甲硝唑(OR=2.728,95%CI 1.413~5.267,P=0.003)是术后0~24h恶心呕吐的独立危险因素。结论月经周期不同阶段对妇科腹腔镜手术后恶心呕吐的发生率无明显影响。     

经皮肾镜碎石术后全身炎症反应综合征的危险因素分析

目的 探讨经皮肾镜碎石术(PCNL)后全身炎症反应综合征(SIRS)的相关危险因素,以评估PCNL手术的安全性.方法 回顾性分析2005年1月至2006年8月收治的147例连续PCNL手术患者资料.应用X2.检验、t检验、Logistic回归等多种统计学方法评估手术时间、通道数目、输血、年龄、性别、尿pH、尿培养加药敏、预防性抗生素、地塞米松、呋塞米、结石是否清除干净等11个因素对PCNL术后发生SIRS的影响.结果 单因素Logistic回归结果显示,手术时间＞180min组发生SIRS风险是≤30 min组的52倍(OR=52.00,P=0.017).多因素Logistic回归结果显示,PCNL术后发生SIRS的危险因素有手术时间(OR=1.01,P=0.017),通道数目(OR=5.19,P=0.063),输血(OR=5.87,P=0.015).结论 手术时间、通道数目和输血是PCNL术后发生SIRS的危险因素.手术时间尽量不要超过3 h,单次PCNL手术选择多通道要慎重,术中应小心碎石,避免输血并发症.     

自发性气胸微小单孔胸腔镜术后肺部并发症的危险因素分析

目的分析自发性气胸患者行微小单孔电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗的术后肺部并发症(postoperative pulmonary complications,PPC)发生情况及其危险因素。方法回顾性纳入2017年4月—2019年12月在东莞市松山湖中心医院接受微小单孔VATS手术治疗的自发性气胸患者158例,其中男99例、女59例,平均年龄(40.53±9.97)岁。根据术后是否发生PPC分为PPC组(21例)、非PPC组(137例),分析影响PPC发生的因素。结果158例患者均顺利完成微小单孔VATS术,无术中死亡病例;患者术后胸闷、胸痛、呼吸困难等症状均基本消失。术后住院期间发生肺部感染3例,肺不张7例,肺漏气4例,胸腔积液6例,肺不张+胸腔积液1例,PPC发生率13.29%(21/158)。多因素logistic回归分析显示:伴肺部疾病[OR=32.404,95%CI(2.717,386.452),P=0.006]、术前白蛋白水平≤35 g/L[OR=14.912,95%CI(1.719,129.353),P=0.014]、胸膜粘连严重[OR=26.023,95%CI(3.294,205.557),P=0.002]、术后24 h疼痛分级Ⅱ~Ⅲ级[OR=64.024,95%CI(3.606,1136.677),P=0.005]、年龄[OR=1.195,95%CI(1.065,1.342),P=0.002]、术中出血量[OR=1.087,95%CI(1.018,1.162),P=0.013]是自发性气胸微小单孔VATS术后发生PPC的危险因素。结论自发性气胸微小单孔VATS术后PPC与围术期指标关系密切,临床可根据年龄、伴肺部疾病情况、术前白蛋白水平、术中出血量、胸膜粘连程度、术后24 h疼痛分级等情况实施针对性防治。     

腰椎退行性疾病手术患者腰椎术后综合征发生情况及危险因素分析

目的研究腰椎退行性疾病手术患者的腰椎术后综合征(failed back surgery syndrome,FBSS)发生情况,并分析其危险因素。方法纳入2015年1月～2017年6月手术治疗的176例腰椎退行性疾病患者,术后随访1年以上,依据FBSS发生情况,设为FBSS组与非FBSS组。收集两组患者病历资料,组间经单因素分析和多因素Logistic回归分析调查术后发生FBSS的独立危险因素。结果 176例患者发生FBSS 40例,发生率为22.73%;两组瘢痕体质、术后关节突关节间隙增大、合并骨质疏松、手术术式、首次锻炼时间、合并糖尿病、性别、年龄、术中出血量、病程的差异均有统计学意义(P0.05);多因素Logistic回归分析显示,瘢痕体质(OR=3.213)、术后关节突关节间隙增大(OR=3.032)、合并骨质疏松(OR=2.764)、开放性手术(OR=2.486)、首次锻炼时间3 d(OR=3.331)、合并糖尿病(OR=2.343),均是术后并发FBSS的独立危险因素。结论腰椎退行性疾病手术患者FBSS的发生率较高,瘢痕体质、术后关节突关节间隙增大、合并骨质疏松、开放性手术、首次锻炼时间3 d、合并糖尿病均会增加其发生风险。     

心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析

目的探讨成人心肺转流(cardiopulmonary bypass,CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析1 349例心脏瓣膜手术患者的临床资料,采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4%,多因素Logistic回归分析显示,每增加1岁(OR=1.05,95%CI 1.03~1.06,P0.001)、糖尿病史(OR=2.11,95%CI 1.22~3.68,P=0.008)、贫血(OR=1.50,95%CI1.05~2.21,P=0.026)、术前血清肌酐(Scr)值每增加1mg/dl(OR=1.01,95%CI 1.01~1.02,P=0.001)、手术时间每增加1h(OR=1.28,95%CI 1.15~1.41,P0.001)、术中输注血浆(OR=1.50,95%CI 1.14~1.97,P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。     

关节镜下肩袖修补术后感染的危险因素分析

目的:探讨关节镜下肩袖修补术后感染的危险因素,为降低感染发生提供依据。方法:对2019年1月至2022年1月采用关节镜下肩袖修补治疗的2 591例肩关节镜下肩袖修补术后患者的临床资料进行回顾性分析,其中男1 265例,女1 326例;年龄25～82(51.5±15.6)岁。按照术后是否发生感染分为感染组(n=18)和未感染组(n=2 573),记录两组患者性别、年龄、是否吸烟、有无糖尿病、身体质量指数、术前1个月内是否进行局部封闭、手术时间、是否预防性使用抗生素、是否有内固定置入等,应用单因素Logistic回归分析筛选出术后感染的危险因素,再将有统计学意义的危险因素纳入多因素Logistic回归分析,筛选出关节镜下肩袖修补术后感染的独立危险因素。结果:本组2 591例患者中,术后发生感染18例,感染率为0.69%,单因素分析结果显示性别、年龄、手术时间、预防性使用抗生素、内固定置入是关节镜下肩袖修补术后患者发生感染的危险因素。多因素Logistic分析显示男性(OR=14.227)、年龄≥65岁(OR=34.313)、手术时间≥2h(OR=15.616)、未预防性使用抗生素(OR=4...     

老年髋部骨折术后肺部并发症的危险因素分析

目的探讨引起老年髋部骨折患者术后肺部并发症(PPC)的危险因素。方法回顾性分析广东省江门市五邑中医院骨伤科二区在2012年6月至2015年6月收治的符合纳入标准的老年髋部骨折患者418例,其中男性182例(43.5%),女性236例(56.5%),年龄75~99岁,平均(82±6)岁,根据是否出现PPC进行分组,记录并比较两组患者的年龄、性别、手术方式、麻醉方式、术前并存病、待术时间、血气分析和肺通气功能情况,采用多因素logistic回归分析老年髋部骨折术后并发症的相关危险因素。结果单因素分析示组间年龄x^2=12.473,P=0.001)、麻醉方式x^2=36.721,P<0.001)、术前并存病x^2=16.724,P<0.001)、待术时间(t=4.872,P=0.041)、血气分析x^2=26.341,P<0.001)、肺通气功能x^2=35.431,P<0.001)差异有统计学意义。多因素Logistic回归分析示年龄>85岁组PPC发生率高于年龄<85岁组,OR值为3.673(95%CI:1.684,7.615);待术3~4 d组和5~7 d组和PPC发生率高于1~2 d组(OR:13.349,95%CI:5.391~23.819;OR:16.579,95%CI:6.324~37.324);术前并存病≥3组PPC的发生率高于≤2组(OR:4.069,95%CI:2.024~8.182);全麻组PPC发生率高于椎管内麻醉组(OR:3.579,95%CI:1.848~8.608);血气分析异常组PPC发生率高于血气分析正常组(OR:9.842,95%CI:2.338~7.421);肺通气功能异常组PPC发生率高于肺通气功能正常组(OR:11.384,95%CI:3.652~9.352)。结论高龄、术前并存病≥3种、待术时间长、全身麻醉以及血气分析异常和肺通气功能异常是老年髋部骨折患者发生PPC的危险因素。     

急性外伤性颅内血肿开颅血肿清除术后迟发血肿相关因素的Logistic回归分析

目的研究急性外伤性颅内血肿开颅血肿清除术后迟发血肿的相关因素。方法收集记录271例急性外伤性颅内血肿开颅手术治疗患者的临床资料．对相关因素进行二分类单因素及多因素Logistic回归分析。结果52例患者术后迟发血肿。单因素回归分析得到持续昏迷、Babinski征阳性、颅骨骨折等12个变量有统计学意义（P〈0．05）．多因素回归分析得到血浆凝血酶时间（P=0．027,OR=1．154）、Babinski征阳性（P=0．000,OR=4．107）、颅骨骨折（P=0．000,OR=4．980）为术后迟发血肿的危险因素,手术时机（P=0．016,OR=0．91）为保护因素。结论对入院时Babinski征阳性、血浆凝血酶时间明显延长、合并颅骨骨折且早期急诊手术治疗的重型颅脑损伤患者在术后早期需警惕迟发血肺的发生。     

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.