重组血管生成抑制剂Ad-METH-1对兔耳增生性瘢痕的抑制

目的将已经成功构建、携带有METH-1基因的腺病毒表达载体pAdEasy-meth1,转染增生性瘢痕动物模型,研究血管靶向基因治疗对增生性瘢痕的抑制作用.方法复制兔耳增生性瘢痕模型,于创面上皮化后10天,兔耳瘢痕局部注射携带有目的基因METH-1的重组腺病毒颗粒,30天后,用激光多普勒血流仪观察兔耳瘢痕微循环的变化,标本取材,行HE染色、CD34染色、核仁区嗜银颗粒染色,研究分析血管靶向基因治疗对兔耳瘢痕组织血管生成、微循环血流灌注及成纤维细胞增殖的影响.结果与对照组相比,血管靶向治疗30天后,兔耳瘢痕微血管生成、微循环血流灌注及成纤维细胞增殖受到明显抑制.结论在瘢痕形成早期,应用Ad-METH-1进行血管靶向治疗,对兔耳增生性瘢痕的形成,有明显的抑制作用.     

血管抑制因子METH1基因转染对兔耳瘢痕组织增生的影响

目的 研究血管抑制因子METH1基因转染对兔耳瘢痕成纤维细胞增殖、胶原合成的影响.方法 复制兔耳增生性瘢痕模型,用微循环显微镜检、瘢痕组织AgNOR染色、苦味酸一天狼星红染色等方法,观察基因重组血管抑制剂Ad-METH1对增生性瘢痕组织血管生成、成纤维细胞增殖、胶原分布的影响.结果 Ad-METH1注射后30 d瘢痕组织血管生成明显减少,成纤维细胞增殖减弱、Ⅰ/Ⅲ型胶原比明显降低.结论 上皮化后早期血管抑制基因治疗可有效抑制增生性瘢痕的形成.     

血管抑制基因治疗对增生性瘢痕的病理学影响

目的:研究血管抑制基因治疗对兔耳增生性瘢痕的病理学影响。方法:复制兔耳增生性瘢痕,待创面上皮化后10天瘢痕组织局部多点注射基因重组血管抑制剂Ad-METH1(血管生成抑制因子-1,extracellular protein with metalloprotease and thrombospondin1 domains),30天后观察兔耳瘢痕组织形态、超微结构的变化。结果:Ad-METH1注射后30天,兔耳瘢痕组织学染色显示微血管分布明显减少,超微结构显示内皮细胞肿胀、变性,部分血管丧失功能,成纤维细胞增殖及分泌活性明显降低。结论:Ad-METH1对增生性瘢痕的形成有明确的抑制作用,血管抑制基因治疗有望为增生性瘢痕的防治提供新的方法。     

兔耳增生性瘢痕血管生成及腺病毒转染基因重组血管生成抑制因子1

目的 研究不同时期兔耳增生性瘢痕组织血管生成,探索新的增生性瘢痕防治方法. 方法 19 只日本大耳白兔,体重2.0～2.5 kg,制备兔耳增生性瘢痕模型.其中8只于创面上皮化后10、30、60及90 d行微血管计数、微循环监测及HE染色观察.另11只选择每只兔的左、右侧耳为实验组及对照组,于上皮化后10 d,实验组兔耳瘢痕局部多点注射基因重组血管生成抑制因子1 (adenovirus extracellular protein with metalloprotease and thrombospondin 1domains,Ad-METH1) 重组腺病毒40 μL,对照组注射等量空载腺病毒.取 1 只兔于注射后3 d,采用 RT-PCR 和 Westernblot 方法检测基因转染后瘢痕组织中 METH1 mRNA 和蛋白的表达.余 10 只兔注射后30 d,行两组大体观察、微血管计数及 HE 染色. 结果 上皮化后10、30、60 及 90 d 瘢痕组织微血管计数分别为(42.37±3.89)、(49.46±4.13)、(33.12±4.34) 及 (13.24±2.31) 支;瘢痕组织微循环灌注分别为(37.75±2.11)、(59.87±6.46)、(44.53±6.14) 及 (29.21±1.84) PU;上皮化后10～60 d微血管计数及血流灌注值明显高于上皮化后90 d,差异均有统计学意义(P<0.05).兔耳创面上皮化后10～30 d组织学为瘢痕增生早期和增生期表现;60 d时仍为增生期表现,但已出现成熟迹象;90 d时大部分瘢痕软化,为成熟期表现.Ad-METH1 注射后 3 d,实验组 METH1 mRNA 及蛋白有较高水平的表达,对照组未检测到靶基因表达;注射 Ad-METH1 后 30 d,大体观察:实验组瘢痕颜色接近正常兔耳肤色,质地接近正常;对照组瘢痕明显高出兔耳腹侧皮面,质地坚硬;瘢痕组织微血管计数实验组为(12.38±2.56)支,对照组为(48.12±6.46)支,组间比较差异有统计学意义(P<0.01).组织学染色显示实验组瘢痕微血管分布较少,成纤维细胞散在,胶原排列有序;对照组见大量成纤维细胞,血管分布丰富,胶原纤维粗大、排列紊乱. 结论 血管生成与增生性瘢痕的形成有密切关系,血管抑制基因治疗有望成为一种有效的增生性瘢痕防治方法.     

重组血管生成抑制因子-1对增生性瘢痕组织血管及其相关因子的影响

目的 研究基因转染血管生成抑制对兔耳增生性瘢痕组织血管及其相关因子表达的影响.方法 将基因重组血管抑制剂Ad-METH-1作用于兔耳增生性瘢痕,用微循环显微镜检、组织学染色、免疫组织化学染色等方法,研究Ad-METH-1对兔耳瘢痕组织增生、血管生成及血管内皮细胞生长因子(vascular endothelial cell growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)表达的影响,探讨基因转染血管生成抑制对增生性瘢痕的影响.结果 Ad-METH-1注射后30 d,实验组瘢痕组织微血管计数为12.38±2.56,VEGF阳性细胞百分比为17.64%,bFGF阳性细胞为18.24%;对照组微血管计数为48.12±6.46,VEGF阳性细胞百分比为31.34%,bFGF阳性细胞为28.26%.结果 显示,实验组瘢痕组织微血管计数低于对照组,两组间差异有统计学意义(P＜0.01);实验组瘢痕组织VEGF及bFGF的阳性细胞百分比均低于对照组,两组间差异有统计学意义(P＜0.05).结论 Ad-METH-1对兔耳瘢痕组织增生、血管生成及VEGF、bFGF表达产生了明确的抑制作用,早期行血管抑制治疗可抑制增生性瘢痕的形成.基因转染血管抑制治疗有望成为一种有效的增生性瘢痕防治方法.     

鲜地龙液外敷对兔耳增生性瘢痕组织形态学的影响

目的：观察鲜地龙液外敷对兔耳增生性瘢痕组织的影响.方法：选用成年新西兰大耳白兔,建立兔耳增生性瘢痕动物模型,造模术后随机分为空白组、模型组和地龙治疗组和积雪草甙组.各组进行相应的处理50天后,观察鲜地龙液对瘢痕形态及瘢痕增生指数的影响.结果：地龙治疗组与空白组、模型组及积雪草甙组之间相比较,瘢痕增生指数差异有显著性意义（P＜0.05）;光镜显示,明显抑制成纤维细胞增殖以及降低胶原纤维的含量.结论：鲜地龙液外敷可以对兔耳增生性瘢痕组织增生有抑制作用.     

血管抑制基因对瘢痕组织中VEGF表达的影响

目的 研究血管抑制剂Ad-METH1对兔耳增生性瘢痕组织及其VEGF表达的影响,探讨其作用机制.方法 选取10只健康的日本大耳白兔,将兔耳制作成增生性瘢痕模型后,随机将兔的左右耳分为实验组和对照组,每组10只兔耳.实验组行多点注射重组腺病毒质粒(pAdEasy-meth1),对照组注射空载腺病毒,30d后行成纤维细胞核仁区嗜银颗粒染色(AgNOR)、组织羟脯氨酸含量分析及WesternBlotting分析.结果 AgNOR颗粒计数:实验组为1.86±0.34,对照组为2.53±0.48,两组比较差异有统计学意义(P＜0.05);羟脯氨酸含量:实验组为(4.335±0.156)mg/g,对照组为(5.259±0.169)mg/g,两组比较差异有统计学意义(P＜0.05);VEGF表达的WesternBlotting分析:实验组为0.56±0.15,对照组为0.84±0.23,两组比较差异有统计学意义(P＜0.05).结论 Ad-METH1对兔耳瘢痕组织增生及VEGF的表达有抑制作用,而对早期增生性瘢痕组织中VEGF表达的抑制是其抑制瘢痕增生的可能机制之一.     

黑布药膏对兔耳增生性瘢痕成纤维细胞增殖的影响

目的：探讨黑布药膏对兔耳增生性瘢痕成纤维细胞增殖的影响。方法：成年大耳白兔24只,建立兔耳腹侧面增生性瘢痕模型,21天后,将瘢痕动物模型随机分为黑布药膏治疗组和瘢痕模型组,在黑布药膏治疗组瘢痕局部涂抹黑布药膏,每3天一次。在用药后第2、4、6、8周分别切取两组瘢痕组织,对比研究在瘢痕形成过程中黑布药膏对兔耳瘢痕成纤维细胞的影响。采用HE染色法观察瘢痕形态,计算瘢痕增生指数和成纤维细胞密度;采用免疫组化方法检测增殖细胞核抗原（PCNA）蛋白表达。结果：黑布药膏治疗组和模型对照组比较,PCNA蛋白表达明显减弱（P〈0.05）,光镜下见黑布药膏能明显抑制成纤维细胞增殖;黑布药膏能降低瘢痕增生指数和成纤维细胞密度,与模型对照组比较,差异有显著性意义（P〈0.05）。结论：黑布药膏可抑制兔耳增生性瘢痕成纤维细胞增殖。     

中草药单体松萝酸抑制兔耳增生性瘢痕的作用研究

目的探讨中草药单体松萝酸对兔耳增生性瘢痕的抑制作用。方法建立兔耳增生性瘢痕模型,于兔左右侧耳形成4孔创面,23 d后给药;将24只大耳白兔随机分为4组(1 mg松萝酸和2 mg松萝酸的实验组、DMSO和曲安奈德的对照组),每组6只;实验组每孔创面注射含不同浓度松萝酸的DMSO 50μl;DMSO组注射等体积的DMSO溶剂;曲安奈德对照组注射曲安奈德50μl。每周给药1次,共4次,于给药35 d后取材。通过HE染色观察组织学变化,并检测瘢痕的增生指数;通过Masson染色检测胶原排列情况;应用CD31免疫组织化学染色检测瘢痕内血管的变化。结果 2 mg松萝酸实验组可以显著抑制兔耳增生性瘢痕的形成,明显改善瘢痕的颜色和厚度,且瘢痕增生指数也明显减少,胶原组织排列有明显改善。CD31染色结果表明,2 mg松萝酸实验组可显著抑制瘢痕内的血管新生。结论 2 mg松萝酸具有抑制兔耳增生性瘢痕内血管新生的作用,从而抑制增生性瘢痕的形成。     

反义结缔组织生长因子对增生性瘢痕动物模型的抑制作用

目的:研究结缔组织生长因子(CTGF)反义寡核苷酸(ASODN)对兔耳增生性瘢痕模型的作用,探讨增生性瘢痕的基因治疗。方法:建立兔耳增生性瘢痕动物模型,分别将生理盐水、转化生长因子β(1TGF-β1)、TGF-β1 CTGF、CTGF、ASODN作用于动物模型。7、14、20天后观察瘢痕体积的变化,采用WesternBlot方法检测CTGF蛋白表达情况,应用免疫组织化学染色方法检测增生性瘢痕组织中增殖细胞核抗原(PCNA)表达、原位末端标记法(TUNEL)观察细胞凋亡。结果:注射TGF-β1、CTGF后瘢痕体积、CTGF蛋白表达、PCNA阳性表达均增高,TUNEL阳性细胞减少,其中以联合注射TGF-β1 CTGF最为显著;ASODN作用后瘢痕体积、CTGF蛋白表达、PCNA阳性表达降低,TUNEL阳性细胞增加。结论:CTGFASODN能够有效抑制CTGF蛋白的表达和细胞增殖,并且加快了细胞的凋亡,从而抑制瘢痕增生。     

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.     

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.