大鼠肝缺血／再灌注后肝组织一氧化氮和不同亚型一氧化氮合酶的变化

目的探讨一氧化氮（NO）和一氧化氮合成酶（NOS）在肝缺血／再灌注（I／R）过程中的变化和作用。方法健康雄性SD大鼠24只，随机分为3组（每组8只）：①正常对照组，术中只分离肝周围韧带，不做肝门阻断及再灌注。②I/R组，进行45min的部分肝门阻断及60min的再灌注。③L-精氨酸（L—Arg）组，缺血前20min经阴茎背静脉注射L—Arg（300mg／kg），余同②组。实验结束后，取下腔静脉血2ml，并迅速切取缺血肝组织。检测血清丙氨酸转氨酶（ALT）、门冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）；测定肝组织中超氧化物歧化酶（SOD）、丙二醛（MDA）、黄嘌呤氧化酶（XOD）、一氧化氮（NO）和一氧化氯合成酶（NOS）等指标；观察光镜和电镜下肝组织学变化。结果与正常对照组相比，I／R组iNOS升高，NO降低；L-Arg组NO、eNOS均高于I／R组。2、3组比1组大鼠的肝组织病理损害重、肝功能差，L—Arg组病理损害较I／R组明显减轻、肝功能改善。结论NO对大鼠肝I／R损伤具有保护作用．不同亚型NOS的变化参与其中。     

白藜芦醇对肝脏缺血再灌注损伤的保护作用

摘要：探讨白藜芦醇对肝脏缺血再灌注损伤的防护作用。将雄性SD大鼠随机分为空白对照组、缺血再灌注组（I/R组）、I/R加生理盐水处理组和I/R加白藜芦醇处理组。观察肝脏缺血40 min再灌注1，3，6，12h后血清谷丙转氨酶（ALT）、谷草转氨酶（AST）及肝组织丙二醛（MDA）含量的变化以及肝组织病理学改变。结果示肝脏I/R后血清ALT，AST及肝组织MDA含量均显著升高，肝脏缺血再灌注前用白藜芦醇15 mg/kg者，血清ALT，AST及肝组织MDA含量均明显降低，且肝组织病理学损害明显减轻。结果表明白藜芦醇对肝脏I/R损伤具有保护作用     

异丙酚对肝缺血再灌注损伤犬肝细胞线粒体的作用

目的探讨异丙酚对肝缺血再灌注损伤犬肝细胞线粒体的作用及其机制。方法20只杂种犬随机分为4组（n=5）：假手术组（S组）、缺血再灌注组（I／R组）、小剂量异丙酚组（P1组）及大剂量异丙酚组（P2组）。以10ml／min速率静脉输注6％羟乙基淀粉150～200ml，同时从股动脉缓慢放血100～150ml，使平均动脉压（MAP）不低于85mmHg。S、I／R组静脉注射3％戊巴比妥钠30mg／kg、维库溴铵0．3mg／kg麻醉诱导，P1、P2组依次静脉注射异丙酚6mg／kg、维库溴铵0．3mg／kg麻醉诱导，气管插管后控制呼吸。S、I／R组间断静脉注射戊巴比妥钠维持麻醉，P1、P2组以血浆靶浓度6、12μg／ml靶控输注异丙酚维持麻醉30min后麻醉维持同S组。缺血期间回输自体血，维持MAP不低于80mmHg。I／R、P1组、P2组气管插管后30min制备肝缺血（缺血30min）再灌注模型。分别于缺血前即刻、缺血30min、再灌注60min抽取静脉血，测定血浆谷丙转氨酶（ALT）、谷草转氨酶（AST）及肝细胞线粒体Na^＋-K^＋-ATP酶活性，并在透射电镜下观察肝细胞线粒体的超微结构。结果肝缺血再灌注可导致血浆ALT、AST活性升高，肝细胞线粒体Na^＋-K^＋-ATP酶活性降低，肝线粒体损伤，异丙酚可减弱肝缺血再灌注导致的上述改变，以大剂量效果较好。结论异丙酚可减轻肝缺血再灌注损伤犬肝细胞线粒体损伤，呈剂量依赖性。     

IH764—3对肝脏缺血再灌注损伤的保护作用

目的 探讨中药丹参提取的有效单体IH764－3对肝脏缺血再灌注（ischemia reperfusion,I/R）损伤的作用。方法 通过对预先对大鼠I／R模型腹腔注射IH764－3,经测定肝脏内ATP、AMP、ADP含量、肝细胞的能荷、血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（AKP）、谷胺酰转肽酶（γ－GT）等指标,并观察肝组织超微结构。结果 用药组较单纯I／R组肝组织内ATP含量高,肝脏功能损害轻,肝组织超微结构的损伤减轻。结论 IH764－3对肝脏I／R造成的损伤有明显的预防作用。     

乌司他汀对肝脏缺血再灌注损伤的防护作用

目的 探讨肝脏缺血再灌注(I/R)损伤的发生机制，观察乌司他汀(UTI)对肝脏I／R损伤的保护作用。方法 选择外伤性肝破裂手术中行肝门阻断术患者38例，随机分为I／R组和UTI组各19例。观察肝脏I／R后血清TNF、MDA、AST、ALT变化及再灌注肝组织多形核白细胞(PMN)浸润和肝组织形态学变化。结果 I／R组：血清TNF、MDA、AST、ALT显著升高，肝组织PMN浸润明显增加。电镜下可见肝窦内皮细胞破坏，肝细胞线粒体结构改变。UTI组：血清TNF、MDA、AST、ALT明显降低。肝组织PMN浸润明显减少，肝组织超微结构明显改善。结论肝脏I／R诱导TNF产生。UTI能明显减轻PMN依赖性肝脏I／R损伤。     

葛根素对肝硬化大鼠肝脏缺血再灌注损伤保护作用及其保护机制的研究

目的观察葛根素（Pue）对肝硬化大鼠肝脏缺血再灌注损伤是否具有保护作用，及其保护机制。方法首先建立大鼠肝硬化动物模型，在此模型基础上建立大鼠全肝缺血再灌注模型，比较用Pue预处理对缺血再灌注后，肝组织光镜下的形态学改变；血清中丙氨酸氨基转移酶（ALT）、天冬氮酸氨基转移酶（AST）和氧化亚氮（NO）、丙二醛（MDA）含量、超氧化物歧化酶（SOD）活性，及肝组织中NO、肿瘤坏死因子α（TNF-α）、MDA含量、SOD活性变化。结果Pue预处理可使大鼠血清NO含量、肝组织NO含量及SOD活性明显增高；而血清ALT、AST、MDA含量及肝组织TNF—α、MDA含量明显降低；肝组织形态损伤也有所减轻。结论葛根素对肝硬化大鼠肝缺血再灌注损伤有显著的保护作用，其主要机制是减少NO的降低、扩张血管、改善微循环；清除氧自由基、减轻脂质过氧化。     

缺血预处理对肝脏缺血再灌注损伤中MPO、TNF-α、ET、NO的影响

目的：探讨缺血预处理（IPC）对肝脏缺血再灌注（I/R）损伤中的中性粒细胞和某些细胞因子的影响。方法：采用大鼠部分肝脏原位缺血再灌注损伤模型,30只Wistar大鼠随机分成：①正常对照组;②缺血再灌注对照组;③预处理组。②、③组均在60min再灌注完成后取血及肝组织标本,检测血清AST、ALT、LDH、NO、ET-1、TNF-α、及肝组织中髓过氧化酶（MPO）活性和肝细胞病理改变。结果：预处理组与再灌注对照组比较,肝功明显改善,NO含量升高,ET-1、TNF-α浓度和MPO活性明显降低,两组比较差异具有显著性。结论：缺血预处理对肝脏缺血再灌注损伤有明显保护作用,可能与提高内源性NO水平、减轻中性粒细胞在肝脏中的渗出和聚集、抑制ET-1、TNF-α的合成有关。     

异丙酚联合白藜芦醇预先给药对大鼠肝脏缺血再灌注损伤的影响

目的 评价异丙酚联合白藜芦醇预先给药对大鼠肝脏缺血再灌注损伤的影响.方法 健康成年雄性SD大鼠108只,体重220 ～ 270 g,6～7周龄,采用随机数字表法,将其分为6组(n=18):假手术组(S组)、缺血再灌注组(I/R组)、溶剂组(TW-80组)、异丙酚组(P组)、白藜芦醇组(R组)和异丙酚+白藜芦醇组(P+R组).采用阻断第一肝门30 min后恢复灌注的方法制备大鼠肝脏缺血再灌注模型.于缺血前10 min经股静脉给药,P组静脉输注异丙酚10 mg·kg-1·h-1至术毕;R组静脉注射白藜芦醇10 mg/kg;P+R组静脉注射白藜芦醇10 mg/kg后输注异丙酚10 mg·kg1·h-1至术毕;S组和I/R组以等容量生理盐水替代,TW-80组静脉输注等容量TW-80.于再灌注3、6、12h时经上下腔静脉取血样2 ml,测定血清ALT、AST活性,取肝组织,测定SOD、髓过氧化物酶(MPO)活性、诱导型一氧化氮合酶(iNOS)表达、MDA和一氧化氮(N0)含量,观察肝组织病理学改变.结果 与S组比较,其余各组血清ALT、AST活性、肝组织MDA、NO含量、MPO活性和iNOS表达水平升高,SOD活性降低(P＜0.05).与I/R组比较,P组、R组及P+R组血清ALT、AST活性、肝组织MDA、NO含量、MPO活性和iNOS表达水平降低,SOD活性升高(P＜0.05),TW-80组上述各指标差异无统计学意义(P＞0.05).与P组和R组比较,P+R组肝组织SOD活性升高,其余指标均明显降低(P＜0.05).P组、R组及P+R组肝组织病理学损伤程度轻于I/R组.结论 异丙酚联合白藜芦醇预先给药可减轻大鼠肝脏缺血再灌注损伤,其效果优于两者单独应用;机制与提高机体抗氧化能力,抑制脂质过氧化反应,减少内源性NO生成有关.     

异氟烷预处理对大鼠肝窦内皮缺血再灌注损伤的影响

目的 研究异氟烷预处理对大鼠肝窦内皮常温缺血再灌注（I/R）损伤的影响,并探讨线粒体ATP敏感性钾通道（Mito-KATP）在其中的作用。方法 48只健康成年雄性SD大鼠,随机分为6组（n=8）。假手术组（S组）：进腹后仅分离韧带但不阻断血流;对照组（C组）：进腹后行部分肝脏缺血60min再灌注90min;异氟烷预处理组（Iso组）：吸入1．5%（1MAC）异氟烷30min,停止吸入10min后行I/R;5-HD＋Iso组：在吸入异氟烷前10min静脉注射5-羟葵酸（5-HD）10 mg/kg;二氮嗪组（Dia组）：I/R前10min静脉注射二氮嗪5mg/kg;5-HD＋Dia组：I/R前20min静脉注射5-HD 10mg/kg,10min后静脉注射二氮嗪5mg/kg。各组再灌注90min时测定血清谷丙转氨酶（ALT）的活性和透明质酸（HA）的浓度;以硝酸还原酶法检测肝组织一氧化氮（NO）含量,放免法检测内皮素（ET）含量;免疫组化法检测细胞间粘附分子-1（ICAM-1）的表达水平;光镜和电镜下观察肝组织病理学改变。结果 （1）与S组比较,C组血清ALT活性、HA浓度、肝组织ET含量和ICAM-1表达水平均升高,而肝组织NO含量降低（P＜0．05）。（2）异氟烷和二氮嗪预处理能抑制I/R引起的血清ALT活性及HA浓度、肝组织ET含量及ICAM-1表达水平的升高和肝组织NO含量的降低（P＜0．05）。（3）光镜和透射电镜检查提示Iso组和Dia组I/R所致的肝窦内皮细胞损伤减轻。（4）5-HD可完全阻断二氮嗪预处理对肝窦内皮的保护作用,但只能部分阻断异氟烷预处理对肝窦内皮的保护作用。结论 1．5%异氟烷预处理30min可减轻大鼠肝窦内皮缺血再灌注损伤,其部分机制通过开放Mito-KATP。     

牛磺酸对大鼠小肠缺血再灌注后肝、肾损伤的保护作用

摘要：目的:研究牛磺酸对大鼠小肠I/R后肝、肾损伤的保护作用。方法:雄性Wistar大鼠随机分为3组：假手术对照组（S组）、生理盐水对照组（I/R组）和牛磺酸保护组（T组）。T组术前30min经鼠阴茎背静脉注射2%的牛磺酸200mg/kg。采用肠系膜上动脉根部阻断1h后复流行再灌注的方法制作肠I/R模型。除S组外，其余2组分别于再灌注1.5,3,6,12h抽血测定ALT,AST,BUN及Cr值，评定肝、肾功能。肝、肾切片行HE染色，比较组织病理学差异。用原位末端标记（TUNEL）法测定肝、肾细胞凋亡百分率，评定平均光密度值。结果:I/R组与S组相比，血清ALT,AST,BUN及Cr值均明显升高（P<0.05 ），3h最高，以后开始下降，12h仍高于S组；肝、肾病理损伤I/R组也相应严重，肝、肾细胞TUNEL阳性表达率、平均光密度值明显增加 （P<0.05）。T组与I/R组相比，前者血清ALT,AST,BUN及Cr水平明显减低 (P<0.05)，病理损伤也相应较轻；肝、肾细胞TUNEL阳性表达率、平均光密度值明显减少(P<0.05)。结论:牛磺酸对大鼠小肠I/R后肝、肾损伤具有明显的保护作用。     

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.