髂股静脉狭窄伴血栓形成介入治疗53例临床分析

目的探讨髂股静脉狭窄伴下肢深静脉血栓形成 (deepvenousthrombosis,DVT)介入治疗的临床疗效。方法将 5 3例髂股静脉狭窄伴DVT随机分为 5组。A组 :11例 ,置入下腔静脉滤器后采用血栓消融器 (AmplatzThrombectomyDevice,ATD)浸软溶栓或流变溶栓导管 (OASIS)溶栓加静脉药物溶栓 ;B组 :9例 ,置入下腔静脉滤器后用导引导管抽吸血栓加静脉药物溶栓 ;C组 :13例 ,单纯经股动脉药物溶栓 ;D组 :8例 ,单纯经静脉药物溶栓 ;E组 :12例 ,单纯经足背静脉药物溶栓。其中 17例髂股静脉狭窄采用球囊扩张或置入支架治疗。结果 5 3例中治愈 2 6例 (49 0 % ) ,显效 2 1例 (39 6 % ) ,改善 3例 (5 7% ) ,无效 3例 (5 7% )。 17例髂股静脉狭窄术后造影示复通率80 %以上。溶栓过程中出现并发症 3例 (5 7% ) ,经处理后均恢复正常。结论髂股静脉狭窄伴DVT采用机械除栓及导管药物溶栓结合腔内血管成形治疗疗效直接肯定 ,安全性高 ,下腔静脉滤器可有效地预防致死性肺动脉栓塞。     

大隐静脉高位结扎剥脱术后深静脉血栓形成12例分析

目的 探讨大隐静脉高位结扎剥脱术后深静脉血栓形成(deep venous thrombosis,DVT)的临床特点、病因及预防措施.方法 回顾性分析收治的12例行大隐静脉高位结扎剥脱术后合并DVT患者的临床特点及诊疗方法,并讨论病因及预防措施.结果 12例DVT患者中7例为中央型,2例为周围型,3例为混合型.DVT合并肺栓塞2例.10例中央型和混合型DVT的肢体增粗症状严重,肢围差距均＞5 cm.9例行下腔静脉滤器(inferior vena cava filter,(IV)CF)保护下的腘静脉置管溶栓术( catheter-directed thrombolysis,CDT)治疗,其中l例介入造影过程中发现左股静脉突然中断,中转手术行股静脉探查修复术、CDT及髂静脉支架植入术;8例发现左髂静脉压迫综合征的影像学表现,其中6例在CDT治疗后行髂静脉支架植入术.1例结合术前彩超及造影所见考虑为右大隐静脉残端血栓蔓延至股静脉,行股静脉切开取栓治疗.2例周围型DVT行抗凝为主的综合性药物治疗.本组12例DVT患者均取得较好的近期疗效.结论 手术损伤股静脉、大隐静脉残端过长、左髂静脉压迫综合征是大隐静脉高位结扎剥脱术后DVT的临床常见原因.术前明确下肢慢性静脉功能不全的病变类型、术中仔细操作、术后早期下床活动至关重要.     

下肢深静脉血栓形成CDT治疗的疗效和安全性分析

目的探讨下肢深静脉血栓形成(DVT)行导管溶栓(CDT)治疗的疗效和安全性。方法收集自2014年6月至2017年6月就诊于本院血管外科诊断为DVT行CDT治疗的患者共124例,观察CDT治疗的效果和有无出血等相关并发症的发生。结果 124例下肢DVT患者行CDT治疗后下肢肿胀等症状均较前有所好转,其中13例存在髂静脉受压综合征,行髂静脉支架植入后症状明显改善;共发生并发症9例(7.2%),其中牙龈出血等相关出血并发症3例(2.4%),与CDT直接相关的并发症6例(4.8%)。应用尿激酶治疗后,118(95.2%)例患者谷丙转氨酶、谷草转氨酶等指标出现一过性升高,停止应用尿激酶或者加用保肝药物后上述指标恢复正常。结论 CDT是治疗下肢动静脉血栓形成的一种可行方法,疗效确切,安全性较高。     

经皮机械性血栓清除术治疗急性髂股静脉血栓

目的观察经皮机械性血栓清除术(PMT)治疗急性髂股静脉血栓的有效性和安全性。方法对21例急性髂股静脉血栓形成患者置入下腔静脉滤器,之后应用Aspirex导管行PMT,并造影评估血栓清除效果,发现血栓残留时行经导管接触性溶栓治疗;如清除血栓发现髂静脉严重狭窄或闭塞,则行球囊扩张及支架植入术。最后取出下腔静脉滤器。观察治疗并发症、血栓清除效果及症状改善情况。术后1、3、6个月随访评估静脉通畅情况,并以Villalta评分判断血栓后综合征发生与否及其等级。结果 21例均顺利完成PMT。8例血栓完全清除;13例血栓部分清除,经置管溶栓后残留血栓均获清除。13例因左髂静脉重度狭窄或闭塞而接受球囊扩张及支架植入术。治疗后21例静脉血流均恢复,下肢肿胀、疼痛症状均缓解,无手术相关严重并发症及死亡。术后随访未见血栓复发,髂静脉支架均通畅;1例术后6个月Villalta评分5分,为轻度血栓后综合征。结论 PMT治疗急性髂股静脉血栓安全有效。     

置管溶栓结合髂静脉支架治疗Cockett综合征伴下肢深静脉血栓的近远期疗效

目的:探讨置管溶栓(CDT)结合髂静脉支架对Cokett综合征伴下肢深静脉血栓(DVT)患者近远期疗效。方法:将2013年1月—2015年1月收治的90例Cockett综合征伴DVT患者用随机数字表法分为观察组和对照组,每组各45例,观察组采用CDT联合支架治疗,对照组采用单独的CDT治疗,对比两组近远期疗效、血管损伤程度及炎症因子变化。结果:两组患者术后疗效差异无统计学意义(H=0.518,P=0.604)。所有患者随访36～40个月,无支架断裂、移位、塌陷、解体或穿破血管现象。观察组再阻塞率低于对照组(11.1%vs. 37.8%,P0.05)、一次通畅率高于对照组(88.9%vs. 62.2%,P0.05)。观察组末次随访Villalta评分、VCSS评分低于对照组,CIVIQ评分高于对照组(P0.05)。两组患者术后血管损伤程度评分、血清TNF-α、IL-10水平较术前明显升高,观察组升高程度明显大于对照组(均P0.05);观察组再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平明显高于无再阻塞患者(P0.05),对照组再阻塞与无再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平差异无统计学意义(P0.05)。两组不良反应率差异无统计学意义(P0.05)。结论:CDT联合髂静脉支架植入治疗Cockett综合征伴DVT近期疗效与单独的CDT相似,但远期疗效优于单独的CDT。CDT联合支架植入治疗后发生再阻塞,可能与支架植入刺激炎症因子释放和导致血管损伤有关。     

机械性血栓清除术与单纯经皮导管接触性溶栓术治疗急性下肢深静脉血栓合并髂静脉压迫综合征的临床疗效

目的探讨机械性血栓清除术(PMT)与单纯经皮导管接触性溶栓术(CDT)治疗急性下肢深静脉血栓(DVT)合并髂静脉压迫综合征(IVCS)的临床疗效。方法收集2019年3月至2020年8月西南医科大学附属医院收治的80例急性下肢DVT合并IVCS患者的临床资料,根据治疗方法的不同将患者分为PMT组(n=42,给予机械性血栓清除术)和CDT组(n=38,给予单纯经皮导管接触性溶栓术)。比较两组患者血栓清除率,手术前后大、小腿周径差,D-二聚体水平、Villalta评分。结果PMT组患者尿激酶用量少于CDT组患者,溶栓治疗时间、住院时间均短于CDT组患者,差异均有统计学意义(P<0.05)。PMT组患者血栓清除率高于CDT组患者,Villalta评分低于CDT组患者,差异均有统计学意义(P<0.05)。术后,两组患者大、小腿周径差均小于本组术前,差异均有统计学意义(P<0.05);两组患者大、小腿周径差比较,差异均无统计学意义(P>0.05)。PMT组患者D-二聚体高峰持续时间短,下降时间早于CDT组,且下降趋势快。结论PMT治疗急性下肢DVT合并IVCS患者的血栓清除率较高,尿激酶用量少,溶栓治疗时间及住院时间均较短,可减少大、小腿周径差,短中期疗效确切,值得临床进一步推广应用。     

经腘静脉置管溶栓治疗下肢深静脉血栓形成

目的初步探讨经腘静脉置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法67例下肢深静脉血栓形成患者,在B超引导下行经腘静脉置入溶栓导管,以输液泵经溶栓导管持续泵入溶栓药物10~14d,同时行抗凝治疗。结果所有病人均置管成功,其中3例未能通过髂静脉;治疗后临床表现均有不同程度的好转,出院前均行影像学检查,治愈11例,其中8例病程≤10d,显效42例,有效16例,有效率100%;其中5例接受髂静脉球囊扩张术,3例行髂静脉支架置入术,1例行耻骨上静脉转流术。结论经腘静脉置管溶栓术治疗下肢深静脉血栓可以延长尿激酶溶栓时间窗,减少尿激酶用量,减少出血并发症,并为后续治疗提供机会。     

Cleaner血栓清除系统联合导管接触性溶栓治疗急性下肢深静脉血栓的近期疗效观察

目的 探讨Cleaner血栓清除系统联合导管接触性溶栓(catheter directed thrombolysis,CDT)治疗急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的近期疗效。方法回顾性分析2021年6月至2021年12月空军军医大学西京医院收治的48例急性下肢DVT患者的临床资料,其中24例行Cleaner血栓清除系统联合CDT治疗,24例行单纯CDT治疗。比较两组患者治疗期间尿激酶总量、溶栓时间、住院时间、术后静脉通畅率及并发症发生情况。结果 两组患者手术均获成功。联合治疗组手术时间、术中出血量高于单纯CDT组,溶栓时间、住院时间、溶栓药物剂量明显低于单纯CDT组,血栓清除率、术后24 h大腿及小腿消肿率高于单纯CDT组,差异均有统计学意义(P<0.05)。术后随访6个月,两组患者血栓形成后综合征发生率的比较差异无统计学意义(P>0.05)。结论 Cleaner血栓清除系统联合CDT治疗急性下肢DVT近期疗效显著,有助于减少溶栓时间、住院时间、尿激酶用量,降低出血风险。     

下肢深静脉血栓形成导管溶栓术后髂静脉病变支架治疗的前瞻性对照性研究

目的观察下肢深静脉血栓形成(DVT)导管接触性溶栓(CDT)术后髂静脉支架治疗髂静脉病变的疗效。方法本研究为单中心前瞻性随机对照研究。155例下肢DVT患者经CDT治疗后,髂静脉远端主干静脉完全通畅,髂静脉残留狭窄大于50%者中的74例患者随机分为对照组和实验组:实验组45例行髂静脉支架置入,对照组29例髂静脉未置入支架。观察指标:深静脉通畅率,CEAP分类法中临床分级(C)变化,静脉临床严重程度计分(VCSS)变化及生活质量调查表(CIVIQ)评分。结果术后患者均获得随访,随访时间6～24个月。行静脉造影或彩超检查,实验组40例,对照组27例,实验组与对照组的终点通畅率比较差异有统计学意义[87.5%(35/40)vs29.6%(8/27),P<0.05];实验组与对照组的1年累积通畅率比较差异有显著统计学意义(86.0%vs54.8%,P<0.01)。实验组及对照组的CEAP分类法中临床分级(C)术前术后差值比较差异有统计学意义(1.61±0.21vs0.69±0.23,P<0.01)。随访终点实验组及对照组VCSS术后两组差值比较差异有统计学意义(7.57±0.27vs6.56±0.23,P<0.01)。实验组及对照组CIVIQ调查表终点评分比较差异均有统计学意义(22.67±3.01vs39.34±6.66,P<0.01)。结论髂静脉支架对下肢DVT导管溶栓术后治疗髂静脉病变能够提高深静脉的通畅率,提高疗效,提高生活质量。     

改良取栓术联合骼静脉支架植入治疗Cockett综合征合并急性DVT效果分析

目的 研究分析不同联合方法治疗Cockett综合征合并DVT伴的临床疗效。方法 回顾性分析2016年1月至2021年2月本院收治的48例Cockett综合征合并DVT病人相关资料，研究人员按照手术方法不同，将48例患者分为两组，观察组26例，行改良取栓联合髂静脉支架植入治疗，本对照组22例，行CDT联合髂静脉支架植入术治疗。结果 观察组术后血栓Ⅱ～Ⅲ级清除率(96.15%)明显大于对照组血栓Ⅱ～Ⅲ级清除率(81.82%)，差异具有统计学意义(χ²=8.6411,P<0.05)；术后1周，观察组临床疗效有效率(92.31%)明显大于对照组(81.82%)，差异具有统计学意义(χ²=6.5892,P<0.05)；观察组术后并发症发生率(3.85%)明显小于对照组(13.64%)，差异具有统计学意义(χ²=5.6028,P<0.05)。结论 综上所述，采用改良取栓术、髂股静脉支架植入联合方法治疗DVT伴Cockett综合征，术后患者的血栓清除率更高，临床疗效更好，适合临床选择应用。     

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.