岛状皮瓣静脉淤血再通后对大鼠全身情况的影响

目的：探讨岛状皮瓣静脉淤血再通后对全身多脏器的影响。方法：按静脉淤血时间的不同将大鼠分为4组。观察耳部微循环的改变，测量术后肿瘤坏死因子α(TNFα），白细胞介素10（IL－10）的动态变化，观察心，肺，肝，肾，小肠及耳部血管等组织结构及中性粒细胞浸润数目。结果：皮瓣原位缝合组及静脉淤血2h组，耳部微循环、TNFα、IL-10浓度基本保持不变，各脏器结构改变较轻，中性粒细胞浸润数目少。静脉淤血6、10h组，微循环，肺，小肠，血管则有明显组织学改变，大量中性粒细胞浸润其中，但心，肝，肾组织学改变较轻。TNFα浓度再灌注1h达到高峰，其后逐渐下降，IL－10浓度3h达到最低，然后逐渐上升。结论：皮瓣静脉淤血再通后可造成肺、小肠及血管器官损伤，静脉淤血时间越长，再通后则损伤程度越重。全身微循环的改变，中性粒细胞在肺、小肠中的浸润，与血管内皮细胞的粘附及细胞因子TNFα与IL－10的浓度失衡是重要的操作原因。     

地塞米松防治皮瓣缺血-再灌注损伤及其机制

目的研究地塞米松对中性粒细胞凋亡与坏死的调控,阐明地塞米松防治皮瓣缺血-再灌注损伤的机制. 方法 30只Wistar大鼠腹部制备3 cm×6 cm 岛状皮瓣,分成3组(n＝10).A组正常皮瓣组;B组阻断静脉8 h,腹腔注射生理盐水作为对照组;C组阻断静脉8 h,腹腔注射地塞米松5 mg/kg,作为治疗组.术后7 d观察皮瓣成活面积;以Annexin V及Propidium双标记,流式细胞仪检测全血中性粒细胞凋亡、坏死水平;电镜观察凋亡、坏死中性粒细胞的形态.并于术后1 d,从各组大鼠皮瓣中央取材,电镜观察吞噬细胞吞噬凋亡中性粒细胞形态.阻断血管前,再灌注损伤后0、 3、6、12 及 24 h,以双夹心ELISA法测量血浆肿瘤坏死因子α(tumor necrosis factor α,TNF-α)及白细胞介素10(interleukin 10,IL-10)浓度. 结果皮瓣成活面积A、C组大于B组(P<0.05),A、C组差异无统计学意义(P＞0.05).术后1、3 d,B组全血中性粒细胞凋亡含量明显低于A、C组, 6 d高于A、C组.术后1、3、6 d,中性粒细胞坏死水平B组高于A、C组.术后1 d,皮瓣中吞噬细胞吞噬凋亡中性粒细胞的数量C组明显高于B组(P<0.05).B组血浆TNF-α于再灌注1 h达到高峰,IL-10于再灌注3 h达到最低.C组TNF-α峰值明显低于B组,6 h即明显下降;IL-10再灌注1h达最低,3 h时明显上升,其浓度明显高于B组. 结论地塞米松防治皮瓣缺血再灌注损伤的机制在于调理了中性粒细胞的凋亡水平,减少了中性粒细胞的坏死数量,平衡了中性粒细胞分泌细胞因子.     

中性粒细胞活化在缺血-再灌注损伤皮瓣微循环改变中的作用及地塞米松的调理

目的：研究皮瓣微循环超微结构的改变及活化中性粒细胞在其中的作用，阐明地塞米松保护皮瓣的作用机理。方法：Wistar大鼠分成4组，形成岛状皮瓣后，Ⅰ组：原位缝合；Ⅱ组：阻断静脉回流6h；Ⅲ组：阻断静脉回流10h；Ⅳ组：阻断静脉回流10h，去除血管夹时腹腔注射地塞米松5mg／kg。取材进行电镜和髓过氧化物酶(MPO)的检测。结果：Ⅰ组皮瓣微循环内皮细胞结构完整，无中性粒细胞粘附。术后MPO值一直为0。Ⅱ组内皮细胞肿胀，部分脱落，有一定数量活化中性粒细胞粘附于管壁。术后l、3天MPO值明显上升。Ⅲ组：内皮细胞坏死脱落。术后l天MPO值几乎是Ⅱ组的2倍。Ⅳ组内皮细胞结构基本完整，管壁少见活化中性粒细胞粘附。结论：缺血一再灌注损伤皮瓣微循环有显著的组织学改变，MPO值术后显著增加，且随阻断静脉回流时间延长而增加。中性粒细胞的活化在这一组织学改变过程中起重要作用。地塞米松保护皮瓣的机理与减轻了中性粒细胞的活化水平有关。     

岛状皮瓣缺血-再灌注损伤后组织结构的变化及地塞米松的保护性作用

目的：研究岛状皮瓣缺血-再灌注损伤后组织学，阐明中性粒细胞在这一过程中的作用及地塞米松的保护作用。方法：wistar大鼠等分为地塞米松治疗组与生理盐水对照组。观察组织学改变。结果：治疗组皮瓣成活面积明显增加。光镜显示：皮瓣组织学改变轻。透射电镜发现中性粒细胞坏死数量较小，凋亡数量较多，皮瓣毛细血管结构较完整。扫描电镜显示：血管通畅，中性粒细胞活化程度轻，与血管壁粘附现象少见。对照组皮瓣组织学改变重；光镜显示：术后1天即可见皮瓣内血管有大量血栓形成，皮瓣中性粒细胞浸润数量多；透射电镜显示皮瓣毛细血管结构不完整，内皮细胞坏死，脱落，皮瓣中有较多数量的坏死中性粒细胞，少见凋亡的中性粒细胞，3天时中性粒细胞数量明显减少，但皮瓣中有大量溶酶体分布。扫描电镜显示血管附壁血栓形成多，血管内中性粒细胞活化程度重，与血管壁粘附现象多见。结论：地塞米松保护皮瓣与其减少中性粒细胞坏死数量，增加其凋亡水平有关。     

岛状皮瓣缺血再灌注损伤的血液流变学改变及地塞米松的调理研究

目的 探讨岛状皮瓣缺血再灌注损伤中血液流变学的变化及地塞米松的调理作用机制。方法 采用Wister大鼠60只，等分为缺血再灌注损伤模型。对照组（Ⅰ组）腹腔注射生理盐水2ml/kg，实验组（Ⅱ组）腹腔注射地塞米松5mg/kg。术后7天观察皮瓣成活面积；电镜观察皮瓣超微结构，计数中性粒细胞的坏死数量；以血液流变检测仪检测红细胞流变学，以微循环检测仪及扫描电镜检测中性粒细胞的流变学。结果 皮瓣成活面积Ⅱ组显著大于Ⅰ组；术后1、2天时，中性粒细胞的坏死数量Ⅱ组显著少于Ⅰ组（P＜0.05）；全血低切黏度、红细胞聚集指数、Casson屈服应力及中性粒细胞的黏附性Ⅰ组明显高于Ⅱ组（P＜0.05）；中性粒细胞的变形性Ⅰ组则比Ⅱ组低。结论 皮瓣缺血再灌注损伤可引起红细胞聚集性增强，中性粒细胞黏附性增加、变形性能力下降和坏死数量增多；地塞米松可有效调理上述指标，减少中性粒细胞的坏死数量，改善皮瓣血运。     

大鼠岛状皮瓣缺血-再灌注损伤的中性粒细胞动态变化

目的　探讨大鼠岛状皮瓣缺血 再灌注损伤中性粒细胞数量的动态变化 ,阐明中性粒细胞黏附血管壁及组织浸润是这一变化的重要原因。方法　 36只大鼠等分为 3组。皮瓣原位缝合组 (Ⅰ组 ) ;实验组 (Ⅱ组 ) :再灌注时腹腔注射地塞米松 5mg/kg ;对照组 (Ⅲ组 ) :再灌注时腹腔注射生理盐水2ml/kg。 0、1、3、5、7d时分析皮瓣蒂部血液及皮瓣中性粒细胞变化规律 ,检测皮瓣蒂部及耳部中性粒细胞黏附功能变化。结果　蒂部血液中性粒细胞变化规律 :Ⅰ组比较恒定 ,Ⅱ、Ⅲ组缺血 8h时上升 ,再灌注1d时II组明显大于Ⅲ组 ,3d时Ⅱ组呈明显下降趋势 ,5d时恢复正常 ,Ⅲ组 5d后中性粒细胞呈现上升趋势。皮瓣中性粒细胞浸润数目 :1、3d时Ⅲ组明显大于Ⅱ、Ⅰ组 ;蒂部粒细胞黏附数量 :再灌注开始时Ⅲ、Ⅱ组 >Ⅰ组 ,1、3、5、7d时Ⅲ组 >Ⅱ、Ⅰ组。耳部中性粒细胞黏附数量与蒂部呈现相同的变化规律。结论　中性粒细胞黏附血管壁及组织浸润是岛状皮瓣缺血 再灌注损伤的重要原因 ,也是 3组间中性粒细胞呈现不同变化特点的重要原因。     

地塞米松对中性粒细胞死亡过程的调控

目的　研究地塞米松对中性粒细胞死亡的调控 ,阐明地塞米松防治皮瓣缺血再灌注损伤的机理。方法　 5 0只大鼠等分成 5组。Ⅰ组 :正常皮瓣组 ;Ⅱ组 :阻断动脉 8h ,生理盐水对照组 ;Ⅲ组 :阻断静脉 8h ,生理盐水对照组 ;Ⅳ组阻断动脉 8h ,地塞米松 5mg kg组 ;Ⅴ组 :阻断静脉 8h ,地塞米松 5mg kg组。术后观测皮瓣成活面积 ,检测全血中中性粒细胞凋亡、坏死水平。光镜观察中性粒细胞凋亡及坏死形态 ,电镜观察吞噬细胞吞噬凋亡中性粒细胞形态。结果　Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组的皮瓣成活面积分别是 ( 99 8± 2 5 ) %、( 18 8± 1 8) %、( 9 0± 0 8) %、( 98 2± 2 4) %、( 96 2± 2 2 ) %。中性粒细胞凋亡含量术后早期Ⅱ、Ⅲ组明显低于另外 3组 ,但第 6天则高于另外 3组。坏死水平术后Ⅱ、Ⅲ组高于另外 3组。皮瓣中吞噬细胞吞噬凋亡粒细胞的数量Ⅳ、Ⅴ组明显高于Ⅱ、Ⅲ组。结论　地塞米松防治皮瓣缺血再灌注损伤的原因在于调理了中性粒细胞凋亡水平 ,减少了其坏死数量 ,增加吞噬细胞吞噬凋亡中性粒细胞的水平。     

地塞米松对皮瓣缺血再灌注后TNFα与IL-10的调节作用

目的研究皮瓣缺血再灌注后TNFα与IL-10的浓度变化,阐明地塞米松保护皮瓣的作用机理以及地塞米松对TNFα与IL-10的调节作用.方法将大鼠分为地塞米松治疗Ⅰ组和生理盐水对照Ⅱ组,观察皮瓣成活面积,测量未缺血时及再灌注0、1、3、6、12、24h血浆中TNFα与IL-10的浓度.结果皮瓣成活面积Ⅰ组为(96.2±3.5)%;Ⅱ组为(9.8±2.4)% .TNFα于再灌注后,Ⅰ组3h达到峰值,Ⅱ组1h达到高峰,Ⅰ组明显低于Ⅱ组.IL-10于再灌注后,Ⅰ组6h达到最高峰值,Ⅱ组3h达到最低值,两组间呈现出不同的变化趋势.24h内两组TNFα与IL-10的浓度均有显著差别.结论 TNFα在皮瓣缺血再灌注过程中对皮瓣起明显的损害作用,而IL-10则起保护作用.地塞米松保护皮瓣的作用机理与减少血浆中TNFα的浓度、增加IL-10浓度有关.     

断肢再植肌组织缺血再灌注损伤的细胞凋亡表达

目的研究断肢再植过程中缺血性损伤和缺血再灌注损伤的发生情况和病理改变，探讨细胞凋亡表达规律。方法建立大鼠后肢断肢实验模型，以光镜观察缺血和缺血再灌注早期的骨骼肌组织病理变化，以TUNEL（POD法）检测缺血和缺血再灌注过程中细胞凋亡现象的发生。结果缺血5h的大鼠断肢再植全部存活，而缺血9h者未存活。大鼠断肢再植过程中，缺血性和缺血再灌注性损伤引起骨骼肌细胞水肿、坏死和细胞凋亡，并于再灌注过程观察到微循环障碍和中性粒细胞趋化浸润现象，缺血7h凋亡率最高。结论骨骼肌存在缺血性和缺血再灌注性损伤，细胞凋亡是缺血和缺血再灌注损伤的重要病理改变。骨骼肌缺血再灌注过程存在微循环障碍和中性粒细胞趋化浸润，它们是缺血再灌注损伤的重要原因之一。     

阻断动脉与静脉缺血-再灌注损伤皮瓣中性粒细胞凋亡及坏死率的对比研究

目的:检测中性粒细胞凋亡及坏死率在两种类型皮瓣缺血-再灌注损伤中的水平,说明阻断动脉血供较阻断静脉回流皮瓣对缺血耐受要强的原因。方法:24只大鼠对等分成两组,形成皮瓣缺血-再灌注损伤模型(Ⅰ组:阻断动脉8h;Ⅱ组:阻断静脉回流8h)。术后7天观察皮瓣成活面积;1,3,6天从蒂部抽静脉血3.5ml,分离中性粒细胞,以Annexin-Ⅴ及PI双标记,流式细胞仪分析粒细胞凋亡及坏死率。结果:Ⅰ组,Ⅱ组皮瓣成活面积分别为25.1％±5.1％;9.8％±2.4％。术后1,3,6天,粒细胞凋亡率Ⅰ组分别为0.2％±0.1％,4.1％±1.1％,34.1％±4.4％;而坏死率为10.8％±3.5％,8.5％±1.2％,0.1％±0.9％;Ⅱ组凋亡率为0.1％±0.1％,3.8％±1.0％,26.1％±3.6％,坏死率为18.7％±0.8％,13.7％±0.2％,5.8％±0.9％。统计分析显示:两组粒细胞凋亡数量无统计学差别,而死亡率1,3,6天Ⅰ组明显低于Ⅱ组。结论:中性粒细胞坏死率与皮瓣面积呈负相关,Ⅰ组皮瓣较Ⅱ组对缺血耐受要强的原因在于术后Ⅰ组中性粒细胞坏死率较低。     

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.