异丙酚后处理联合缺血后处理对大鼠肝脏缺血再灌注损伤的影响

目的 探讨异丙酚后处理联合缺血后处理对大鼠肝脏缺血再灌注损伤的影响.方法 健康雄性sD大鼠30只,体重200～250 g,随机分为5组(n=6),假手术组(Ⅰ组)仅开腹;缺血再灌注组(11组)肝脏缺血1 h再灌注4 h;缺血后处理组(Ⅲ组)肝脏缺血1 h后,再灌注10 8,缺血10 8,重复6次进行缺血后处理;异丙酚后处理组(Ⅳ组)肝脏缺血1 h后经尾静脉注射异丙酚10 mg/kg,随后静脉输注异丙酚40 mg·kg~(-1)·h~(-1) h;异丙酚后处理+缺血后处理组(V组)肝脏缺血1 h后进行异丙酚后处理及缺血后处理.于再灌注4 h时测定血清ALT活性、肝组织MDA含量、SOD活性、Bcl-2及Bax的蛋白表达水平,电镜下观察肝细胞超微结构.结果 与Ⅰ组比较,Ⅱ组～Ⅴ组血清ALT活性及肝组织MDA含量升高,肝组织Bcl-2蛋白表达上调,Ⅲ组-Ⅴ组肝组织SOD活性升高,Ⅱ组、Ⅲ组及Ⅴ组肝组织Bax蛋白表达上调(P<0.05或0.01);与Ⅱ组比较,Ⅲ组-Ⅴ组血清ALT活性及肝组织MDA含量降低,肝组织SOD活性升高,Bcl-2蛋白表达上调,Bax蛋白表达下调(P<0.05或0.01);与Ⅲ组比较,Ⅳ组血清ALT活性及肝组织MDA含量降低(P<0.05或0.01).Ⅲ组-Ⅴ组肝组织病理学损伤较Ⅱ组明显减轻.结论 异丙酚后处理联合缺血后处理可减轻大鼠肝脏缺血再灌注损伤,与异丙酚后处理单独应用时效果相同,其机制可能与抑制肝组织脂质过氧化反应及细胞凋亡有关.     

丹参对大鼠供肝冷保存缺血再灌注损伤中肝细胞凋亡的影响

目的 探讨丹参对大鼠原位肝移植供肝冷保存缺血再灌注损伤中肝细胞凋亡的影响.方法 将40只SD大鼠分为对照组、实验组及假手术组,建立原位肝移植模型.供肝灌注冷保存以4℃乳酸林格氏液为基液,实验组加丹参注射液(60 ml/L),对照组不加丹参.保存5 h后植入受体.移植后6 h处死大鼠取样,检测血浆中ALT、AST水平;采用TUNEL法检测移植术后肝细胞凋亡情况;流式细胞仪检测凋亡相关基因Bcl-2、FasL蛋白的表达;光镜下观察移植肝脏病理形态学的改变.结果 再灌注后实验组ALT、AST显著低于对照组.与对照组比较,实验组肝细胞凋亡指数明显下降(F=133.802,P<0.05);肝组织中Bcl-2蛋白表达增加(F=91.063,P<0.01);FasL蛋白表达无明显变化(F=1.329,P>0.05);实验组与对照组比较肝组织形态学的再灌注损害程度明显减轻.结论 丹参可通过促进抑制凋亡基因Bcl-2蛋白的表达来抑制冷保存再灌注导致的肝细胞凋亡,对原位肝移植肝脏的缺血再灌注损伤有保护作用.     

瑞芬太尼对肝硬化大鼠肝脏缺血再灌注损伤的影响

目的 探讨瑞芬太尼对肝硬化大鼠肝脏缺血再灌注损伤的影响.方法 成年健康雄性SD大鼠30只,体重260～300 g,采用随机数字表法,将其随机分为3组(n=10):肝硬化组(C组)、肝硬化+肝缺血再灌注组(I/R组)和瑞芬太尼组(R组).C组、I/R组和R组采用四因素综合法制备大鼠肝硬化模型,I/R组和R组在肝硬化模型制备成功后1周制备大鼠70％肝脏缺血再灌注模型,R组于缺血前10 min开始静脉输注瑞芬太尼1μg·kg-1·min-至再灌注结束.于再灌注4h时取静脉血样和肝组织,测定血清ALT和AST活性、肝细胞Bcl-2和Bax表达及肝细胞凋亡情况,计算细胞凋亡指数,光镜下观察肝组织病理学结果.结果 与C组比较,I/R组血清ALT和AST的活性升高,肝细胞Bcl-2表达下调,Bax表达上调,细胞凋亡指数升高(P＜0.05);与I/R组比较,R组血清ALT和AST的活性降低,肝细胞Bcl-2表达上调,Bax表达下调,细胞凋亡指数降低(P＜0.05).R组肝组织病理学损伤轻于I/R组.结论 瑞芬太尼可减轻肝硬化大鼠肝脏缺血再灌注损伤,其机制与平衡肝细胞Bcl-2与Bax表达而抑制肝细胞凋亡有关.     

川芎嗪对大鼠移植肝的保护作用

目的探讨川芎嗪（TMP）对大鼠移植肝的保护作用。方法参照Delriviere和Kamada等方法建立大鼠肝移植模型，将大鼠随机分为3组：A组（假手术组）、B组（肝移植对照组）和c组（TMP干预组）。采用全自动生化分析仪检测术后血清肝功能（AST、ALT、LDH）水平；应用免疫组化SP法结合病理图像分析仪测定肝组织中Bcl-2、Bax的表达情况；HE染色观察其病理形态学变化。结果（1）C组AST、ALT、LDH明显低于B组（P〈0．01）。（2）C组Bcl-2或Bcl-2／Bax表达明显高于B组（P〈0．05），而Bax表达无明显变化（P〉0．05）。（3）A组无明显病理形态改变，B组术后肝组织出现明显的病理损害，C组病理变化明显减轻。结论TMP可能通过上调Bcl-2或Bcl-2／Bax表达而减轻肝移植体的低温保存再灌注损伤，对供肝有保护作用。     

银杏叶提取物预处理对大鼠移植肝的保护作用

目的探讨银杏叶提取物（EGb）预处理对大鼠移植肝的保护作用。方法采用Kamada’s袖套法建立大鼠原位肝移植模型。将大鼠随机分为银杏叶提取物预处理（EGb）组、生理盐水对照（NS）组和假手术组（SO）。分别于供肝再灌注后2，6，24h处死动物，检测血清ALT和AST；肝组织组织学检查，TUNEL法检测细胞凋亡；RT—PCR检测肝组织TNF—α mRNA及Bcl-2 mRNA的表达。结果供肝再灌注2，6，24h，EGb组血清ALT水平及细胞凋亡指数均明显低于生NS组（P〈0．01）。血清AST水平在供肝再灌注2，6h时明显低于NS组（P〈0．01）。供肝再灌注后2，6h时EGb组TNF—α mRNA的表达明显低NS组（P〈0．05）。供肝再灌注后2，6，24hEGb组Bcl-2 mRNA的表达明显高于NS组（P〈0．01）。结论经EGb预处理供可减轻大鼠肝移植供肝的缺血／再灌注损伤和细胞凋亡，影响TNF—α mRNA，Bcl-2 mRNA的表达，对供肝有保护作用。     

间断低氧预适应对大鼠肝切除缺血再灌注肝脏凋亡相关蛋白Bcl-2、Bax表达的影响

目的 观察术前间断低氧预适应对大鼠70％肝切术后缺血再灌注损伤肝脏凋亡相关蛋白Bcl-2和Bax表达的影响。方法 健康清洁级SD大鼠54只,用SPSS软件随机分为3组,每组18只：（1）肝切除组（PH组）,切除肝脏的左叶和中叶（约占总肝重的70％）;（2）缺血再灌注组（IR组）,即在肝门阻断下切除肝脏的左叶和中叶,肝门阻断20 min后开放血流,残余肝脏发生了缺血再灌注过程;（3）间断低氧预适应组（IHP组）,术前1周将大鼠置于氧气体积分数为10％的低氧环境中,每天1h。1周后在肝门阻断下行肝切除术（同IR组）。各组分别于术后12、24、48 h进行取材检测,用全自动生化分析仪检测血清谷丙转氨酶（ALT）、谷草转氨酶（AST）含量,采用免疫组化方法检测残余肝组织Bcl-2、Bax表达情况。结果 在术后各时间点,IR组和IHP组血清ALT和AST水平均显著高于PH组,但IHP组明显低于IR组。与IR组相比,IHP组术后各时间点肝脏Bcl-2蛋白表达显著升高,而Bax蛋白表达显著下降。差异均有统计学意义（P＜0.05）。结论 间断低氧预适应对残余肝脏缺血再灌注损伤具有保护作用,其途径可能是通过促进抗凋亡蛋白Bcl-2表达和抑制促凋亡蛋白Bax表达,来减少肝细胞凋亡。     

异丙酚对大鼠小肠缺血再灌注时粘膜上皮细胞凋亡的影响

目的 探讨异丙酚对大鼠小肠缺血再灌注时粘膜上皮细胞凋亡的影响及其机制.方法 健康Wistar大鼠24只,随机分为3组(n=8):假手术组(S组)、缺血再灌注组(I/R组)和异丙酚+缺血再灌注组(P+I/R组).夹闭肠系膜上动脉,缺血1 h,再灌注2 h,制备小肠缺血再灌注损伤模型.S组和I/R组缺血前10 min开始经股静脉持续输注生理盐水10 ml·kg-1·h-1,P+I/R组静脉注射异丙酚10 mg/kg,以后持续输注异丙酚10 mg·kg-1·h-1.取空肠组织3 cm,常规制备全层石蜡切片,行HE染色,光镜下观察小肠组织病理学;免疫组化法检测Bcl-2、Bax蛋白的表达;TUNEL法检测小肠粘膜上皮细胞凋亡,计数凋亡细胞及总细胞,计算小肠粘膜上皮细胞凋亡指数.结果 与S组比较,I/R组和P+I/R组Bcl-2和Bax蛋白表达上调,Bcl-2/Bax增加,小肠组织损伤程度增强,小肠粘膜上皮细胞凋亡指数增高(P＜0.01或0.05);与I/R组比较,P+I/R组Bcl-2蛋白表达上调,Bax蛋白表达下调,小肠组织损伤程度减轻,小肠粘膜上皮细胞凋亡指数降低(P＜0.01).结论 异丙酚可减轻大鼠小肠缺血再灌注损伤时粘膜上皮细胞凋亡,其机制与上调Bcl-2基因的表达和下调Bax基因的表达有关.     

三七总皂甙对大鼠移植肝缺血再灌注损伤的保护作用

摘要：目的:探讨三七总皂甙预处理对大鼠移植肝缺血再灌注损伤的保护作用。方法:建立大鼠原位肝移植模型，然后分为三七预处理组（P组）、对照组（N组）和假手术组（S组）3组，取血检查ALT，AST；用免疫组化法检测caspase-3和TNF-α的表达，TUNEL法检测肝细胞凋亡，行肝组织病理检查。结果:鼠肝移植模型N组的血ALT，AST数值、肝细胞中caspase-3和TNF-α的表达及肝细胞的凋亡均明显高于P组，差异均有显著意义（P<0.05）。结论:肝细胞凋亡加重移植肝缺血再灌注损伤，三七总皂甙预处理对大鼠肝移植缺血再灌注损伤有保护作用。     

银杏叶提取物预处理对大鼠移植肝的保护作用

目的: 探讨银杏叶提取物（EGb）预处理对大鼠移植肝的保护作用。方法:采用Kamada′s 袖套法建立大鼠原位肝移植模型。将大鼠随机分为银杏叶提取物预处理（EGb）组、生理盐水对照(NS)组和假手术组(SO)。分别于供肝再灌注后2，6，24h处死动物，检测血清ALT和AST；肝组织组织学检查，TUNEL法检测细胞凋亡；RT-PCR检测肝组织TNF-αmRNA及Bcl-2mRNA的表达。结果:供肝再灌注2，6，24h，EGb组血清ALT水平及细胞凋亡指数均明显低于生NS组（P<0.01）。血清AST水平在供肝再灌注2，6h时明显低于NS组（P<0.01）。供肝再灌注后2，6h时EGb组TNF-αmRNA的表达明显低NS组（P<0.05）。供肝再灌注后2，6，24hEGb组Bcl-2mRNA的表达明显高于NS组（P<0.01）。结论:经EGb预处理供可减轻大鼠肝移植供肝的缺血/再灌注损伤和细胞凋亡，影响TNF-αmRNA,Bcl-2mRNA的表达，对供肝有保护作用。     

三七总皂苷对大鼠肝移植物细胞凋亡及Bcl-2和Caspase-3 表达的影响

目的探讨三七总皂苷(PNS)预处理对大鼠供肝缺血一再灌注损伤的保护作用及其对供肝细胞凋亡和Bcl-2及Caspase-3 mRNA表达的影响。方法雄性SD大鼠分别用作供、受体．采用Kamada’s袖套法建立原位肝移植模型，根据供肝切取前1h是否静脉注射PNS(50mg／kg)将大鼠随机分为PNS预处理组(PNS组)和生理盐水对照组(NS组)；另设假手术作对照组(SO组)。分别于供肝再灌注后2h、6h及24h处死各组动物，检测血清ALT及AST，HE切片作病理组织学检查，TUNEL法检测肝细胞凋亡，RT-PCR法检测Bcl-2及Caspas-3m R-NA的表达。结果供肝再灌注后2h、6h及24h各时点，PNS组大鼠血清ALT和AST水平及肝细胞凋亡指数(A1)均明显低于NS组(P＜O．05．P＜O．01)；6h及24h，PNS组大鼠肝组织Bcl-2mRNA的表达水平明显高于NS组(P＜O．05)；2h及6h，PNS组大鼠肝组织Caspase-3mRNA的表达水平明显低于NS组(P＜O．05)。结论PNS预处理大鼠供肝，可以有效地减轻移植肝的缺血／再灌注损伤和细胞凋亡，影响细胞凋亡调控基因Bcl-2和Caspase-3的表达。这可能为PNS抗细胞凋亡的机理之一。     

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.