POSSUM和P-POSSUM评分系统对老年股骨颈骨折手术风险的预测研究

目的 探讨生理学和手术严重度评分系统,即POSSUM和P-POSSOM评分系统,对老年股骨颈骨折手术的手术风险预测价值.方法 首都医科大学附属北京友谊医院骨科于2010年1月-2012年5月收治因股骨颈骨折行人工关节置换手术治疗的老年患者108例,应用POSSUM和P-POSSUM评分系统预测患者手术病死率和并发症发病率,分析人工髋关节置换手术风险预测值和观察值之间的差异.同时对病例资料进行分组比较,分析不同组别间的预测情况是否存在差异.结果 根据POSSUM评分系统预测,47例患者术后发生并发症,平均并发症发病率为43.52％,而实际发生并发症37例,实际并发症发病率为34.26％,预测值与实际值差异无统计学意义(P=0.238);预测11例死亡,平均病死率为10.19％,实际死亡2例,实际病死率为1.85％,预测值明显高于实际值.根据P-POSSUM评分系统预测的病死率(预测死亡4例,平均病死率为3.70％,实际死亡2例,实际病死率为1.85％),预测值与实际值差异无统计学意义(P=0.625).以POSSUM评分得分40分为界分组,两组并发症发病率及病死率的预测值与实际值分组比较差异无统计学意义(P =0.527,P =0.285).结论 POSSUM评分系统能较好地预测老年股骨颈骨折手术患者并发症发病率,但过高估计手术病死率;P-POSSUM评分系统能准确地预测手术病死率,对于高危组患者的预测结果尤为满意.     

脑卒中患者医院-家庭过渡期用药偏差风险 预测模型的构建及验证

目的 构建并验证脑卒中患者医院-家庭过渡期用药偏差风险预测模型,并编制简易风险评分量表,为规范用药偏差管理以确保患者用药安全性、连续性提供参考。方法 选取蚌埠市某三甲医院脑血管病大数据平台中出院2周的脑卒中患者400例为建模组,采用单因素分析和logistic回归进行影响因素分析,构建用药偏差风险预测模型,使用Hosmer-Lemeshow（H-L）和受试者工作特征曲线（ROC曲线）检验模型的拟合优度及预测效果。同法抽取基本资料匹配的210例患者进行模型外部验证,并编制用药偏差简易风险评分量表。结果 建模组有245例（61.25%）发生用药偏差。logistic回归分析结果显示,有无照护者、用药史是否完整、半年内门急诊或住院经历、长期使用药物数量、服用高风险药品、服药依从性是患者发生用药偏差的独立影响因素（均P＜0.05）。H-L检验拟合效果P=0.814,ROC曲线下面积（AUC）为 0.929,灵敏度为0.873,特异度为0.826;验证组的AUC为0.925,预测正确率为88.57%;最终编制了总分值为10分、截断值为4分、AUC为0.913的简易风险评分量表,评分量表的预测正确率为85.24%。结论 构建的脑卒中患者医院-家庭过渡期用药偏差风险预测模型灵敏度及特异度较高,可以有效预测用药偏差的发生;简易评分量表可供临床医护人员测评用药偏差高风险患者,以采取预防性措施避免发生用药偏差。     

急诊留观患者病情变化风险预测模型的构建

目的 构建急诊留观患者病情变化风险预测模型,并检验其预测效能.方法 回顾性收集急诊留观室收治的568例患者资料,采用随机数字表法抽取400例作为建模组,168例作为验证组.建模组将是否发生病情变化作为因变量构建Logistic回归模型,采用Hosmer-Lemeshow判断模型的拟合优度,根据β系数建立风险预测评分系统.验证组采用ROC曲线下面积检验评分的预测效能,对预测结局与实际临床结局采用一致性检验.结果 纳入预测模型的因子有年龄(OR=2.192)、校正改良早期预警评分(OR =3.081)、低蛋白血症(OR=26.712)、高乳酸血症(OR=13.929)、呼吸兴奋剂(OR=14.415)和抗心律失常药物(OR=4.488),模型Hosmer-Lemeshow检验P=0.220.预测评分系统ROC曲线下面积为0.985,灵敏度0.972,特异度0.919,识别患者病情变化的最佳截断值为9分,预测结局与实际临床结局的Kappa值为0.935.结论 构建的病情变化风险预测模型预测效能较好,可为急诊留观室筛查潜在危重患者提供评估工具.     

EuroSCORE和STS-PROM对成人主动脉瓣置换死亡风险的预测

目的 评价EuroSCORE和STS-PROM模型对成人主动脉瓣患者手术死亡风险预测的价值.方法 回顾性收集1999年1月至2008年12月521例行主动脉瓣置换术的患者临床资料,包括同期行冠状动脉旁路(CABG)手术患者,排除同期其他瓣膜置换、主动脉手术、先天性心脏病矫治及房颤外科手术治疗患者,年龄＜18岁患儿.以患者住院死亡作为终点事件.利用网页在线计算EuroSCORE和STS-PROM预测的住院病死率,并根据additive EuroSCORE评分结果把患者分为低、中、高3个风险组.通过实际、预测病死率间的比较以及模型符合度、鉴别度的验证来评价各风险模型对患者住院病死率的预测能力.结果 521例主动脉瓣置换患者的实际住院病死率为4％(21/521例).Additive、logistic EuroSCORE和STS-PROM预测住院病死率分别为3.36％、2.82％和1.25％,实际观察值/预测值(O/E)分别为1.20、1.43和3.23.STS-PROM对全部患者和中、高风险组的预测准确性较差,明显低估患者住院病死率(P＜0.01).Logistic EuroSCORE明显低估中风险组患者住院病死率(P＜0.05).Additive和logisticEuroSCORE有低估高风险组患者住院病死率的趋势,实际观察值/预测值分别为1.84和1.46.EuroSCORE在各风险组以及STS-PROM在中、高风险组中均显示出较差的预测鉴别度(ROC ＜0.7).结论 STS-PROM和EuroSCORE对521例主动脉瓣置换患者个体手术死亡风险的预测均较差,不适合被用于筛选主动脉瓣置换术高危患者人群.有必要建立适合我国瓣膜患者特征的手术风险预测模型.     

Caprini血栓评估量表在ICU非手术患者高危血栓风险预测中的应用

目的探讨Caprini风险评估量表在ICU非手术患者中高危血栓风险的最佳界值。方法采用回顾性病例对照研究,选取154例ICU非手术深静脉血栓形成(DVT)患者作为病例组,选择同时期入住ICU的154例非手术非DVT患者作为对照组。运用受试者工作特性曲线(ROC)分析Caprini风险评估量表的准确度及高危血栓风险最佳临界值。结果 Caprini风险评估量表的ROC曲线下面积为0. 709,95%CI为0. 655～0. 759,当临界值为7分时,约登指数为0. 331,灵敏度为70. 78%,特异度为62. 30%,阳性预测值为65. 27%,阴性预测值为68. 09%。结论 Caprini风险评估量表在ICU非手术患者高危血栓风险预测中的最佳界值为7分,其可用于血栓风险评估。     

ICU患者连续性肾脏替代治疗24 h内低体温研究

目的 了解ICU患者连续性肾脏替代治疗24 h内低体温发生率及体温变化趋势,为优化连续性肾脏替代治疗体外加温方案提供参考.方法 通过医院电子病历系统、重症监护护理系统、连续性肾脏替代治疗护理记录单回顾性收集2019年行连续性肾脏替代治疗的ICU患者一般资料,连续性肾脏替代治疗相关资料,连续性肾脏替代治疗启动后0～h、4～h、8～h、12～24 h最低体温.结果 共纳入213例ICU患者的784例次数据.84例患者(39.4％)发生低体温(核心体温＜36℃);低体温患者的APACHEⅡ评分和序贯器官衰竭估计评分、病死率显著高于非低体温患者(均P＜0.01).122例次(15.6％)连续性肾脏替代治疗运行过程出现低体温,其中运行4 h内体温下降显著(P＜0.05),随后20 h内体温无明显回升;低体温组机械通气率更高,治疗前体温更低(均P＜0.01).结论 ICU患者连续性肾脏替代治疗低体温发生率较高,且24 h内体温复温效果不理想,常规的保温/复温方案有待进一步优化.     

评估非肿瘤性肝功能衰竭患者肝移植标准的数学模型

目的 建立评估非肿瘤性肝功能衰竭患者肝移植标准(LTS)的数学模型.方法 分析200例非肿瘤性肝功能衰竭患者的临床资料,初步筛选出28项可能与肝功能衰竭预后有关的因素,应用单因素和多因素Cox风险比例回归模型分析出独立危险因素,建立LTS数学模型.另选择51例非肿瘤性肝功能衰竭患者验证LTS数学模型的预测能力,并与终末期肝病评分标准(MELD)进行比较.结果 影响肝功能衰竭预后的独立危险因素有4项:凝血酶原时间的国际标准化比值(INR)、血清肌酐(Cr)、肝性脑病(HE)和消化道出血(ATH),由此建立非肿瘤性肝功能衰竭患者LTS的数学模型,LTS评分=[4.96 x LnINR+7.16×LnCr(μmol/L)+9.62×HE+6.82×ATH].经51例独立样本的验证,LTS评分的ROC曲线下的面积(AUC)为0.804,敏感度为78.26%,特异度为92.85%,阳性预测值为90%,阴性预测值为83.87%,Youden指数为71.11%;LTS评分的AUC和Youden指数均优于MELD评分(AUC和Youden指数分别为0.750和43.48%).所有251例患者的LTS评分最小为30分,最大为87分,平均(48±11)分;在90 d观察期内,存活96例,死亡155例,存活患者与死亡患者的LTS评分分别为(40±5)分和(53±11)分,两者比较,差异有统计学意义(P＜0.01).将LTS评分分别为＜40、40～45、46～53和＞53分的患者分为4组,4组间死亡率和存活时间的比较,差异均有统计学意义(P＜0.01).结论 LTS的数学模型能准确预测肝功能衰竭患者的近期预后,可为非肿瘤性肝功能衰竭患者肝移植时机的选择提供依据.     

护理干预对急诊科低钾血症患者焦虑的影响

目的 探讨减轻低钾血症患者焦虑水平的护理干预方法.方法 将79例急诊低钾血症患者随机分为观察组(40例)和对照组(39例),对照组行常规治疗及护理,观察组在此基础上行针对性的心理干预、认知干预、行为干预.分别于患者刚进急诊科、护理3 h后采用状态-特质焦虑问卷(STAI)及分量表SAI进行问卷调查.结果 两组患者刚进急诊科时SAI及TAI评分比较,差异无显著性意义(均P＞0.05);但SAI评分显著高于TAI(均P＜0.01).护理3 h后观察组SAI评分显著低于对照组(P＜0.01).结论 急诊低钾血症患者就诊初期呈高焦虑水平,针对性的心理干预、认知干预、行为干预可有效缓解其焦虑情绪.     

外科住院患者创伤后应激障碍相关因素及护理需求研究

目的调查外科住院患者创伤后应激障碍(post-traumatic stress disorder,PTSD)的相关因素及护理需求,为护理干预提供依据.方法对93例创伤事件后外科住院患者于伤后1个月进行PTSD诊断,并采用精神卫生症状自评量表(SCL-90)、艾森克个性问卷(EPQ)和自制创伤事件后护理需求调查量表进行评估.结果确诊PTSD 31例(33.33%),PTSD组性别、受教育年限、外伤情况与非PTSD组(62例)比较,差异有显著性意义(P＜0.05,P＜0.01).PTSD患者各项SCL-90因子分及总分均显著高于非PTSD组(P＜0.05,P＜0.01).PTSD患者的精神病性(P)、神经质或情绪(N)和人格稳定性(L)评分显著高于非PTSD组,而内外向性(E)评分显著低于非PTSD组(P＜0.05,P＜0.01).PTSD患者的心理需求、精神需求和护理需求总分均显著高于非PTSD组(P＜0.05,P＜0.01).结论遭遇创伤事件的外科住院患者并发PTSD概率较高,且PTSD患者护理需求高,需及早采取能满足其需求的针对性护理干预措施,以提高患者的应对能力,降低PTSD发生率.     

基于决策树构建胸痛患者院内心脏骤停早期预警模型

目的 构建并验证基于决策树的胸痛患者院内心脏骤停早期预警模型.方法 收集以急性非创伤性胸痛为主诉就诊并进入抢救室治疗的患者3 146例,以其中发生心脏骤停的71例患者为病例组,选取同期未发生心脏骤停的142例患者为对照组,利用决策树构建心脏骤停早期预警模型,采用十折交叉进行验证,并与GRACE评分、TIMI评分和HEART评分比较模型的预测效能.结果 决策树共有3层,5个节点,舒张压、Killip分级、肌钙蛋白、胸痛持续时间和肌酸激酶是心脏骤停的预测指标.基于决策树构建的模型受试者工作特征曲线下面积为0.893,显著高于TIMI评分(0.817)、HEART评分(0.801),差异有统计学意义(均P＜0.05);高于GRACE评分(0.857),但差异无统计学意义(P＞0.05).结论 基于决策树构建的胸痛患者院内心脏骤停早期预警模型对心脏骤停的预测准确性高、结果直观、逻辑清晰,可作为医护人员对胸痛患者风险管理的决策依据.     

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.     

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.