三种国产抗纤溶药物在体外循环手术中对血小板保护效应的观察

目的：在体外循环(CPB)手术中,分别应用三种国产抗纤溶药物,观察其对血小板的保护作用及对术后出血的影响。方法：选择30例CPB病人,随机分为三组,即止血环酸组、抑肽酶组和止血芳酸组。测定血浆纤溶酶活性、D-二聚体浓度;测定和记录术后12h及24h的血小板计数和胸腔纵隔引流量。结果：术后血小板计数在止血环酸组和抑肽酶组接近,在止血芳酸组则明显下降;血浆纤溶酶(PLm)活性在止血环酸组和抑肽酶组明显高于基础值,但已有所降低;止血芳酸组PLm活性明显高于前二组。三组同D-二聚体含量无显著性差异。结论：止血环酸和抑肽酶可部分抑制CPB手术中的纤溶亢进,两组的药物作用无显著性差异．     

心脏手术中凝血及血小板功能的变化

目的应用Sonoclot凝血及血小板功能分析仪(SCT)检测风心病和冠心病患者心脏手术中凝血与血小板功能的变化.方法ASAⅡ～Ⅲ级心脏手术患者30例,其中瓣膜置换术15例(瓣膜组),冠脉搭桥术15例(CABG组).采用静吸复合全身麻醉.分别于麻醉前(T1)、诱导后(T2)、肝素化后(3mg/kg)(T3)、CPB结束鱼精蛋白拮抗后5min(T4)抽血,检测激活全血凝固时间(sonACT)、凝血速率和血小板功能,并在T1和T4行血小板计数.结果与T1相比,T2的凝血速率明显升高(P＜0.05);T3的sonACT明显延长(P＜0.01),凝结率和血小板功能显著下降(P＜0.01);T4的sonACT明显延长、血小板功能明显升高(P＜0.01),血小板计数显著降低(P＜0.01).另外,瓣膜组T3的sonACT明显长于CABG组(P＜0.05);CABG组T1的凝血速率(30.32±3.07凝血信号/min)明显高于瓣膜组(24.15±4.13凝血信号/min)(P＜0.05).CABG组T4的血小板功能(2.83±0.90)明显高于瓣膜组(2.00±0.81)(P＜0.05).结论心脏手术中监测凝血及血小板功能具有一定价值,尤其在CPB结束后.瓣膜组患者的凝血及血小板功能虽在正常范围内但均低于冠心病患者.     

甲基强的松龙预先给药对体外循环诱发心脏手术患者肠粘膜屏障损伤的影响

目的 评价甲基强的松龙预先给药对体外循环(CPB)诱发心脏手术患者肠粘膜屏障损伤的影响.方法 择期心脏手术患者90例,年龄30-50岁,性别不限,体重50-75 kg,心功能分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为3组(n=30):非CPB对照组(Ⅰ组)、CPB对照组(Ⅱ组)和CPB甲基强的松龙组(Ⅲ组).Ⅲ组于手术开始前和CPB开始前分别静脉注射甲基强的松龙10mg/kg,Ⅰ组和Ⅱ组静脉注射等量生理盐水.于麻醉诱导前(T1)、CPB开始前(T2)、CPB 30 min(T3)、CPB结束后30min(T4)、术后120 min(T5)时采集中心静脉血样测定血浆内毒素浓度；记录术后7d内感染发生情况.结果 3组Tl时血浆内毒素浓度比较差异无统计学意义,且均在正常范围；与Ⅰ组比较,Ⅲ组T3、T4和T5时血浆内毒素浓度升高,术后感染发生率升高(P＜0.05)；与Ⅱ组比较,Ⅲ组T3、T4和T5时血浆内毒素浓度降低,术后感染发生率降低(P＜0.05).结论 甲基强的松龙预先给药可减轻心脏手术患者CPB所致的肠粘膜屏障功能损害.     

急性血小板分离回输对体外循环心脏直视手术患者的血液保护效果

目的 评价急性血小板(Plt)分离回输对体外循环(CPB)心脏直视手术患者的血液保护效果.方法 择期拟在CPB下行心脏直视手术患者30例,ASA分级Ⅱ或Ⅲ级,年龄41～63岁,体重52～72 kg.采用随机数字表法,将患者随机分为2组(n=15):对照组(C组)和急性Plt分离组(APP组).APP组在麻醉诱导后行APP,提取富Plt血浆,于CPB结束鱼精蛋白中和肝索后回输,C组不行APP.于麻醉诱导前、术后1、24和48h时记录Hb、Plt、PT、APTT及Fib.记录CPB时间、主动脉阻断时间、术后引流量和输血情况.结果 APP组急性Plt分离处理的全血容量为(1285±185) ml,采集富Plt血浆(192±38) ml,其中Plt计数(817±282)×10/L,占全身血容量Plt总数(21±3)％,Plt分离时间(35±10) min.与C组比较,APP组术后1h时Plt升高,术后24h内引流量、异体红细胞、Plt输注量和异体Ph输注率降低(P＜0.05或0.01),其余指标差异无统计学意义(P＞0.05).结论 急性Plt分离回输对CPB心脏直视手术患者具有血液保护作用.     

氨甲环酸对心肺转流病人纤溶系统的影响

目的　比较氨甲环酸 (血速宁 )与抑肽酶对心肺转流 (CPB)术中纤溶系统、血小板及术后出血量的作用 ;探讨两种给药方法的效果。方法　 80例行心脏直视术患者随机分为抑肽酶 (A)组、氨甲环酸 1(TA 1)组和氨甲环酸 2 (TA 2 )组。A组将抑肽酶 30 0万KIU于CPB前一次加入预冲液中 ;TA 1组诱导后即静注负荷量氨甲环酸 2 0mg/kg ,然后以 2mg·kg-1·h-1持续静注达 10小时 ;TA 2组诱导后先静注负荷量氨甲环酸 2 0mg/kg ,停CPB时追加 2 0mg/kg ,术毕再补充 10mg/kg。分别于诱导后、CPB 30分钟、停CPB鱼精蛋白中和后 10分钟及CPB后 2小时测定血小板计数、血栓素B2 (TXB2 )、血小板α膜蛋白 14 0 (GMP 14 0 )、纤溶酶活性 (Plm)、纤维蛋白降解产物 (FDP)。并记录术后 12小时、2 4小时胸液引流量和出血量。结果　氨甲环酸组与抑肽酶组相比 ,在血小板计数、纤溶酶活性、FDP浓度及术后引流量及输血量均无显著差别 (P >0 0 5 )。氨甲环酸组CPB开始后TXB2浓度高于抑肽酶组 (P <0 0 1) ,且CPB后GMP 14 0浓度恢复较抑肽酶组缓慢 (P <0 0 5 )。两种不同给药方式在术中出血量、术后引流量方面也无显著性差异。结论　小剂量持续给药和负荷 追加 补充给药法应用氨甲环酸在抑制纤溶、减少心脏手术后出血量方面与抑肽酶常规     

氯胺酮对小儿术后镇痛中吗啡作用的影响

目的　研究氯胺酮在小儿术后硬膜外自控镇痛中对吗啡作用的影响。方法　全麻下择期腹部手术病儿 37例 ,病人随机分为三组。负荷量 :Ⅰ组 (n =13)吗啡 10 μg/kg +氯胺酮 0 1mg/kg ;Ⅱ组 (n =10 )吗啡 10 μg/kg ;Ⅲ组 (n =14)吗啡 2 0 μg/kg。维持量 :Ⅰ组吗啡 1μg·kg-1·h-1+氯胺酮 0 0 3mg·kg-1·h-1;Ⅱ组吗啡 1μg·kg-1·h-1;Ⅲ组吗啡 2 μg·kg-1·h-1。单次给药剂量 :同各组每小时持续量 ;锁定时间 10min。按预定 6个时点记录疼痛、镇静评分、维持期吗啡耗量及不良反应发生率。结果　疼痛评分 :Ⅰ、Ⅲ组均为 0 0 0± 0 0 0 ,明显优于Ⅱ组 0 12± 0 17(P <0 0 1)。吗啡维持量 :Ⅰ、Ⅱ、Ⅲ组分别为 :5 1 0± 3 3μg/kg、6 3 4± 18 0 μg/kg、117 6± 2 0 1μg/kg(P <0 0 1)。镇静评分及不良反应发生率均无显著性差异。结论　小儿术后硬膜外自控镇痛中 ,微量氯胺酮明显增强吗啡的镇痛作用 ,减少吗啡用量     

体外循环中小剂量抑肽酶对白细胞介素-6的影响

目的　研究体外循环 (CPB)中小剂量抑肽酶 (4 0 0万单位 )对炎症反应的影响。　方法　 2 0例择期心瓣膜置换术患者 ,随机分为抑肽酶组 (n=10 )和对照组 (n=10 )。分别观察各时点白细胞介素 - 6 (IL - 6 )的活性 ,于术前、主动脉阻断前、主动脉阻断后 30分钟、主动脉开放 15分钟、6 0分钟从桡动脉采血 5 ml,测血清中各时点 IL- 6。　结果　各时点 IL - 6与术前相比 ,对照组在主动脉开放 6 0分钟明显升高 (P<0 .0 5 ) ,而抑肽酶组在主动脉阻断 30分钟、开放 15分钟、6 0分钟明显升高 (P<0 .0 5 ) ,同一时点两组间比较差别无显著性意义。　结论　小剂量抑肽酶用于 CPB时 ,不能有效抑制 CPB诱发促炎因子 IL- 6的反应。     

使用凝血酸减少二次换瓣和再次冠脉搭桥手术的用血量

体外循环(CPB)心脏手术后出血是一个多因素问题,它包括获得性血小板功能障碍,纤维蛋白溶解和手术止血不细等。凝血酸(TA,止血环酸)是一种能抑制纤溶酶的赖氨酸同型物,其作用是防止纤维蛋白裂解和保护CPB中的血小板功能。TA能减少失血并已用于CPB手术病人。本文的目的是调查TA在减少二次换瓣或再次冠脉搭桥手术(CABG)中用血的效果。     

抑肽酶与止血芳酸对风湿性心脏病换瓣病人凝血及血小板功能的影响

目的 比较抑肽酶与止血芳酸用于风湿性心脏病换瓣病人对凝血及血小极的影响。方法 30例择期换瓣手术病人随机分为抑肽酶(AP)组和止血芳酸(TA)组(n=15)。两组药物分别于肝素化前静脉输注和体外循环液预充,AP组抑肽酶2.5×106KIU,TA组止血芳酸10 mg/Kg。测激活凝血时间(ACT)、激活全血凝固时间(SonACT)、血凝斜率、峰值时间、峰值最大血凝信号(MCS)并计算血小板斜率。测定血细胞压积(Hct)、术后血红蛋白(Hb)及血小板计数(Plt)。随访术后胸液量和全血及新鲜冻血浆(FFP)的用量。结果 与基础值比较,给药后AP使ACT、SonACT及峰值时间明显延长(分别P<0.05、P<0.01及P<0.01),使血凝斜率和血小板斜率明显减小(P<0.05和P<0.01)。而TA对ACT及各项声凝指标无明显影响。与TA组比较,AP对凝血及血小板功能抑制明显大于TA(P<0.01)。术后胸液量AP组[(260±65)ml]明显小于TA组[(365±135)ml](P<0.05)。新鲜冻血浆输用率AP组(6.7％)明显小于TA组(33％)(P<0.01)。结论 AP抑制凝血及血小板的激活,对风湿性心脏病换瓣病人,AP的血液保护作用可能优于TA。     

异氟醚与咪唑安定或丙泊酚联合应用对心肌缺血-再灌注期心肌肌钙蛋白Ⅰ的影响

目的　观察异氟醚与咪唑安定或丙泊酚联合应用对心肺转流 (CPB)心内直视手术心肌缺血 /再灌注期血清心肌肌钙蛋白Ⅰ (cTnⅠ )的影响。方法　 5 0例先心、房或室间隔缺损择期行心内直视手术患者 ,随机分为五组 ,每组 10例。Ⅰ组泵注咪唑安定 2 0～ 4 0mg·kg-1·h-1维持麻醉 ;Ⅱ组丙泊酚 0 2～ 0 4mg·kg-1·h-1;Ⅲ组转流前、主动脉开放后持续吸入 0 8～ 1 3MAC异氟醚 ;Ⅳ组转流前吸入异氟醚同Ⅲ组 ,主动脉阻断后泵注咪唑安定同Ⅰ组 ;Ⅴ组转流前同Ⅲ组 ,主动脉阻断后微泵静注丙泊酚同Ⅱ组。分别在术前、停CPB后 30分钟、2小时和术后 2 4小时取中心静脉血 ,测定血清cTnⅠ水平 ,并观察开放主动脉后心脏复跳情况。结果　与术前比较 ,五组患者停CPB后各时点cTnⅠ明显升高 (P <0 0 1)。各组术后 2 4小时值与停CPB 2小时值比较已显著下降 (P <0 0 1) ,Ⅰ组与其他各组比较升高更为显著 (P <0 0 1)。异氟醚与咪唑安定或丙泊酚联合应用 ,与异氟醚组各时点值比较 ,血清cTnⅠ未见明显降低。Ⅳ组与Ⅴ组间相比也无显著差异。各组心脏自动复跳率无差异。结论　丙泊酚减轻心肌缺血再灌注损伤的作用明显强于等效剂量的咪唑安定 ;异氟醚具有明显的心肌保护作用 ;异氟醚和丙泊酚或咪唑安定合用 ,cTnⅠ水平接近异氟     

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.