颈前路椎间盘切除椎间融合器融合术加颈后路单开门术治疗脊髓型颈椎病

[目的]探讨颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术治疗脊髓型颈椎病在临床上的应用价值。[方法]应用Cervical Cage行颈椎前路椎间盘切除椎间融合术，同时，颈椎后路行单开门椎管扩大成形术11例，平均随访6个月。按40分法和JOA评分对手术前后脊髓功能进行评分，并测量颈椎术前术后前柱高度及椎管宽度和进行相关性分析．[结果]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，明显改善脊髓型颈椎病的脊髓功能。40分法平均37分，改善率83％；JOA评分16．5分，改善率91％；前柱高度平均增加1．28mm；椎管宽度平均增加2．22mm。[结论]颈椎前路椎间盘切除椎间融合器融合术加颈椎后路单开门椎管扩大成形术，有效恢复了颈椎前柱高度、增加椎管宽度，明显改善了脊髓型颈椎病的脊髓功能。     

单开门与一期前后路手术减压治疗前后受压脊髓型颈椎病的疗效比较

目的:总结后路单开门与一期前后路联合手术减压治疗前后受压脊髓型颈椎病的疗效,探讨一期前后路联合减压的手术适应证.方法:1996年2月至2007年12月,对67例前后方均受压的脊髓型颈椎病患者分别采用后路单开门神经根管扩大减压术(A组,36例)或一期前后路联合减压术(B组,31例)治疗.随访患者临床和影像学情况,手术前后按日本矫形外科学会(JOA)评分标准评定神经功能,计算改善率,比较两组l临床疗效.结果:A组手术时间1～1.5h,平均72min;术中出血量110～500ml,平均370ml;无明显术中并发症发生,术后1例出现肩部放射痛.B组手术时间3～5h,平均3.6h;术中出血量400～1300ml,平均710ml;术中出现脑脊液漏4例.随访6个月～8年,平均28个月,前路植骨及后路门轴全部骨性愈合.A组神经功能改善率为72.4%.优良率为80.1%;MRI检查显示34例脊髓明显后移、前后方软性压迫解除、脑脊液通畅,2例显示脊髓明显后移、前方仍存在骨化块轻度压迫、予以二期前路骨化块切除减压、内固定术,随访时21例显示前方椎间盘突出明显消失或缩小;CT显示椎管扩大充分,开门度数平均为63.2°.B组神经功能改善率为74.1%,优良率为80.6%;MRI显示31例脊髓前后方压迫均解除、脑脊液通畅;CT显示椎管扩大充分.开门度数平均为53.3°.两组神经功能改善率和优良率均无统计学差异.结论:后路单开门减压治疗前方软性压迫的前后受压脊髓型颈椎病可使脊髓充分后移躲避前方的压迫,术后脊髓前方的软性压迫缩小或消失,疗效肯定;但对椎管狭窄合并脊髓前方超过椎管50%的骨性压迫者疗效欠佳,应采用一期或二期前后路联合减压治疗.     

后路单开门与一期前后路手术减压治疗前后受压脊髓型颈椎病的疗效比较

目的:总结后路单开门与一期前后路联合手术减压治疗前后受压脊髓型颈椎病的疗效,探讨一期前后路联合减压的手术适应证。方法:1996年2月至2007年12月,对67例前后方均受压的脊髓型颈椎病患者分别采用后路单开门神经根管扩大减压术(A组,36例)或一期前后路联合减压术(B组,31例)治疗。随访患者临床和影像学情况,手术前后按日本矫形外科学会(JOA)评分标准评定神经功能,计算改善率,比较两组临床疗效。结果:A组手术时间1～1.5h,平均72min;术中出血量110～500ml,平均370ml;无明显术中并发症发生,术后1例出现肩部放射痛。B组手术时间3～5h,平均3.6h;术中出血量400～1300ml,平均710ml;术中出现脑脊液漏4例。随访6个月～8年,平均28个月,前路植骨及后路门轴全部骨性愈合。A组神经功能改善率为72.4%,优良率为80.1%;MRI检查显示34例脊髓明显后移、前后方软性压迫解除、脑脊液通畅,2例显示脊髓明显后移、前方仍存在骨化块轻度压迫,予以二期前路骨化块切除减压、内固定术,随访时21例显示前方椎间盘突出明显消失或缩小;CT显示椎管扩大充分,开门度数平均为63.2°。B组神经功能改善率为74.1%,优良率为80.6%;MRI显示31例脊髓前后方压迫均解除、脑脊液通畅;CT显示椎管扩大充分,开门度数平均为53.3°。两组神经功能改善率和优良率均无统计学差异。结论:后路单开门减压治疗前方软性压迫的前后受压脊髓型颈椎病可使脊髓充分后移躲避前方的压迫,术后脊髓前方的软性压迫缩小或消失,疗效肯定;但对椎管狭窄合并脊髓前方超过椎管50%的骨性压迫者疗效欠佳,应采用一期或二期前后路联合减压治疗。     

三种手术方法治疗相邻三节段脊髓型颈椎病的比较

目的 比较颈椎前路椎间盘切除植骨融合术、颈椎前路椎体次全切除联合椎间盘切除植骨融合术、颈椎后路单开门椎管扩大成形术治疗相邻三节段脊髓型颈椎病的临床疗效。方法 回顾性分析自2016-08—2021-08诊治的61例相邻三节段脊髓型颈椎病,16例采用颈椎前路椎间盘切除植骨融合术治疗（A组）,20例采用颈椎前路椎体次全切除减压联合椎间盘切除植骨融合术治疗（B组）,25例采用颈椎后路单开门椎管扩大成形术治疗（C组）。比较3组的手术时间、出血量、术后C-反应蛋白、肌酸激酶水平以及术后JOA评分。结果 61例均获得随访,随访时间平均21(12～32)个月。A组与B组手术时间差异无统计学意义（P>0.05）,而C组手术时间多于A组和B组（P<0.05）。A组出血量最少,B组出血量又少于C组,差异有统计学意义（P<0.05）。A组术后第1天的C-反应蛋白水平最低,而B组低于C组,差异有统计学意义（P<0.05）。A组与B组术后第1天的肌酸激酶水平差异无统计学意义（P>0.05）,而C组术后第1天的肌酸激酶水平高于A组和B组（P<0.05）。3组术后6、12个月JOA...     

重症脊髓型颈椎病前、后路联合手术治疗次序的选择

目的：探讨前、后路联合手术治疗重症脊髓型颈椎病手术次序选择的原则.方法：回顾性分析45例重症脊髓型颈椎病患者,男27例,女18例,先行颈椎前路减压再行后路椎管扩大成形手术19例（A组）,先行颈椎后路椎管扩大成形再行前路减压融合手术26例（B组）.术前、术后均采用JOA评分法进行评分,根据JOA评分改善率评价两组治疗效果的优良率.结果：术中A组1例因前路手术使椎管前方骨化组织进一步挤压脊髓组织致患者截瘫;2例因前路手术致压物切除不彻底,术后患者症状无明显改善.B组1例术后出现C5脊神经根麻痹,颈椎前路减压后逐渐恢复.术后随访9～38个月,平均20.4个月.两组优良率分别为69.23%（B组）、42.10%（A组）,B组患者手术治疗效果明显优于A组.结论：前后路联合手术治疗重症脊髓型颈椎病应先行后路椎管扩大成形再行前路减压融合,手术效果较好,并发症少,安全性高.     

多节段脊髓型颈椎病前后路手术疗效的临床观察

目的评估前路减压植骨内固定和后路椎管扩大成形术对多节段脊髓型颈椎病(CSM)的治疗效果。方法对67例多节段CSM分别采用前路手术(前路组)和后路手术(后路组)治疗。结果本组获随访12～24个月。前、后路组神经功能改善优良率分别为85.7%和84.4%,差异无统计学意义(P>0.05);两组间术后疗效(JOA评分、前凸Cobb角)差异无统计学意义(P>0.05),但同一入路术后较术前明显改善(P<0.05)。结论 CSM采用前路手术的疗效优于后路,可更大程度的恢复脊髓的受压,而对于来自脊髓后方的压迫,后纵韧带钙化、伴有颈椎椎管狭窄者,则以颈后路手术为主。     

脊柱结核前后路不同术式的选择及疗效分析

目的分析脊柱结核前后路不同术式的选择及疗效。方法选取2010年4月～2013年4月我院收治的成人腰骶段和胸腰椎结合患者188例,随机分成四组,每组47例。A组实施病灶前路清除手术、植骨融合术及前路内固定手术;B组实施椎弓根后路内固定手术、植骨融合术及病灶前路清除手术;C组实施病灶侧前方清除手术、植骨融合术及椎弓根后路内固定手术;D组实施病灶后路清除手术、椎弓根后路内固定手术及植骨融合术。对各组治疗效果进行观察。结果A组脊柱后凸畸形矫正率（47．5±11．8）%明显低于B、C、D组的（61．5±18．6）%、（58．7±15．9）%和（59．9±17．4）%（P〈0．05）;A组矫正角度丢失率（64．8±19．3）%明显高于B、C、D组的（53．6±15．6）％、（56．9±11．8）％和（54．9±5．4）％（P〈0．05）。结论治疗脊柱结核要依据正确的手术适应证选择不同的术式,从而将病灶清除、矫正脊柱后凸畸形;临床证明同前路固定手术方式相比,采用后路固定矫正脊柱后凸畸形能够取得更好的效果。     

3种手术方式治疗脊髓型颈椎病的疗效分析

目的 分析脊髓型颈椎病（CSM）前路3种手术方式的疗效。方法150例脊髓型颈椎病患者采用前路减压＋植骨融合术45例（A组）、前路减压＋cage融合术30例（B组）、前路减压＋钛网内植骨＋钢板内固定术75例（C组）。术后3d及6、12、24周摄颈椎正、侧位X线片。JOA评分系统评定不同手术方法的疗效。结果150例均获随访,时间6～60个月。除1例未融合外,余植骨均融合,时间为2—4个月。JOA评分均有改善,A组改善率为72．8％,B组为85．6％,C组为80．6％,B组与C组比较差异无显著性（P〉0．05）,B组和C组与A组比较差异有显著性（P〈0．05）。结论CSM的治疗关键在于充分减压及有效植骨融合,减压加椎间融合器植入术具有操作简单、出血少、减压充分、术后恢复好等优点,是治疗脊髓型颈椎病的较好方法。     

单开门术后前方残留压迫阻碍神经功能恢复的研究

[目的]研究后路单开门成形术后脊髓前方残留压迫对神经功能恢复的影响,并探讨残留压迫与术前椎管侵占率以及致压物最大径之间的关系.[方法] 2008年1月～2010年12月在本院行单开门手术的脊髓型颈椎病患者60例,所有患者均获得随访.平均随访时间34个月(12 ～52个月).将患者分为两组,A组:22例术后存在前方残留压迫;B组:38例术后不存在前方残留压迫.比较和分析两组术后疗效及影像学资料,如JOA总体评分及改善率,JOA各项评分及改善率,术前及术后颈椎曲度,前方压迫物最大径以及椎管侵占率.[结果]两组平均年龄、病程、随访时间、术前JOA评分以及术前术后的颈椎曲度比较均无统计学差异(P＞0.05).A组JOA改善率(52.7±19.2)％,B组改善率(69.8±9.8)％,两组间改善率比较有统计学差异(P＜0.05),A组vs B组上肢运动功能改善率(44.6％ vs76.3％),下肢运动功能改善率(43.2％ vs57.2％),两组间比较有统计学差异(P＜0.05).A组压迫物最大径及椎管侵占率分别为(7.2±1.4) mm和(58.2±10.7)％,B组分别为(5.9±1.3)mm和(49.5±10.6)％,两组间比较有统计学差异(P＜0.05).[结论]单开门术后脊髓受到前方残留压迫时会阻碍神经功能的恢复,特别是在四肢运动功能方面.单开门手术对伴有前方巨大占位的脊髓型颈椎病的治疗具有局限性.     

腰椎滑脱症手术治疗的临床分析

[目的]通过对82例腰椎滑脱症手术治疗病人的回顾性临床分析，探讨有关腰椎滑脱症的手术适应证、术式选择及治疗效果。[方法]依据病人情况分别采取以下4种术式：A组，后路单纯植骨融合术18例，均Ⅰ度滑脱；B组，椎弓根钉固定复位椎板间植骨融合术31例，Ⅰ度11例，Ⅱ度20例；C组，减压、椎弓根钉固定复位横突间植骨融合术19例，Ⅰ度2例，Ⅱ度13例，Ⅲ度4例，包括椎间盘突出3例，椎管狭窄3例；D组，减压、椎间融合、椎弓根钉固定复位横突间植骨融合术14例，Ⅰ度1例，Ⅱ度10例，Ⅲ度3例，包括椎管狭窄6例（Ⅰ度1例、Ⅱ度4例、Ⅲ度1例），椎间盘突出4例（Ⅱ度3例、Ⅲ度1例）。[结果]随访6个月～6a 6个月，平均3a8个月，单纯植骨融合组（A组）18例中15例融合，其融合率83％、滑脱复位率0．03％，根据下腰痛的FRS评分标准，其改善率52．69％。椎弓根钉固定复位椎板间植骨融合（B组）的31例中30例融合，其融合率96％，滑脱复位率83％，改善率56．20％。减压、椎弓根钉固定复位横突间植骨融合组（C组）融合率89％、滑脱复位率90％、改善率59．85％。减压、椎间融合、椎弓根钉固定复位横突间植骨融合组（D组）融合率100％、滑脱复位率92％、改善率61．08％。[结论]不同的手术方式针对不同的手术适应证。手术方式的不同因病人的病情不同而不同。     

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.