梗阻性黄疸术后早期肠内营养对全身炎症反应综合征的影响

目的观察早期肠内营养对梗阻性黄疸术后全身炎症反应综合征（SIRS）的影响。方法60例梗阻性黄疸患者,随机分为肠内营养（EN）组、肠外营养（PN）组和对照组,术后第1天开始分别接受肠内、肠外营养及普通输液治疗,测定3组患者术前和术后1、3、5、7、9d血清C反应蛋白（CRP）、白细胞介素6（IL-6）和肿瘤坏死因子仪（TNF-α）含量变化,观察术后全身炎症反应综合征（SIRS）及多器官功能不全综合征（MODS）的发生率,以及其他各种并发症发生率。结果EN组术后第3、5、7、9天的CRP、IL-6、TNF-α血清水平较PN组和对照组下降显著（P〈0．05）,PN组与对照组比较无显著性差异;EN组SIRS持续时问（3．26±1．27）d明显短于PN组的（5．314-1．47）d和对照组的（5．69±1．58）d（P〈0．05）;EN组MODS发病率为9．52％,明显低于PN组（23．81％）和对照组（27．78％）（P〈0．05）;EN组术后并发症发生率为19．0％,明显低于PN组（38．1％）和对照组（55．6％）（P〈0．05）,而PN组又低于对照组（P〈0．05）;在感染性并发症方面,EN组明显低于PN组和对照组（P〈0．05）。结论梗阻性黄疸术后早期肠内营养能有效地减轻SIRS,降低MODS发病率,减少术后并发症的发生,促进患者康复。     

全胃切除术后不同营养支持方式对患者免疫功能的影响

目的探讨全胃切除术后不同营养支持方式对患者免疫功能的影响。方法选择行全胃切除术患者33例，随机分为肠内营养组（17例，EN组）和肠外营养组（16例，PN组），分别于手术前后检测外周血补体和免疫球蛋白水平及各种淋巴细胞百分率的变化，并观察感染性并发症发生率及胃肠功能恢复时间。结果术后第1天．两组患者补体、免疫球蛋白及淋巴细胞百分率均较术前明显下降（P〈0．05）；而术后第8天，EN组补体及免疫球蛋白水平较术后第1天有所恢复（P〈0．01），且改变量与PN组比较差异有统计学意义（P〈0．05）。术后第8天，两组患者淋巴细胞百分率及EN组的CD4^＋／CD8^＋较术后第1天有所恢复（P〈0．01）；EN组淋巴细胞百分率的改变量与PN组比较差异有统计学意义（P〈0．01）。PN组术后感染性并发症的发生率（31.3％）高于EN组（5．9％）（P〈0．05）。结论全胃切除术后患者EN支持较PN支持能更好地促进免疫功能的恢复，降低肺内感染的发生率。     

脾肾静脉分流联合贲门周围血管离断术后早期肠内营养疗效观察

目的观察脾肾静脉分流联合贲门周围血管离断术（后简称联合术）后病人早期肠内营养的疗效和安全性。方法回顾性分析我院2004年2月至2009年2月行联合术病人共76例,其中接受肠内营养（EN）23例,肠外营养（PN）33例,非营养治疗20例,观察肝功能、营养代谢、感染情况,记录肠道通气时间、营养治疗费用以及住院时问。结果（1）三组术后肝功能均有损害,组间无明显差异;（2）三组术后血浆前白蛋白均明显下降,非营养组血浆前自蛋白水平明显低于EN组和PN组（P〈0．05）;（3）EN组术后第8天内毒素水平明显低于非营养组和PN组（P〈0．05）;（4）EN组血培养阳性率明显低于非营养组和PN组（P〈0．05）。结论术后早期EN简单安全,有效改善病人营养状况,促进肝功能恢复,减少并发症,降低感染,促进胃肠功能早期恢复,节省住院费用。     

胃癌术后早期炎症与肠道黏膜通透性的关系

目的探讨肠道黏膜通透性（D-乳酸含量）与外周血中内毒素含量和WBC计数之间的关系。方法胃癌行手术病人62例,检测术前和术后第1、3、7天的外周血中D-乳酸、内毒素、WBC计数水平并进行比较。结果术后第1天、第3天D-乳酸、内毒素及WBC计数均高于术前及第7天（P〈0．05）;术后第1、3、7天血清D-乳酸水平与内毒素之间均呈正相关。结论胃癌手术后第1天开始肠黏膜通透性增加,炎性反应明显,术后第3天达到高峰。肠道菌群易位与炎症反应有关。     

选择性消化道去污染对体外循环患者内毒素血症及炎症介质的影响

目的探讨术前选择性消化道去污染（SDD）对体外循环（CPB）心内直视术患者肠源性内毒素血症、炎症介质和临床结果的影响。方法选择风湿性心脏病瓣膜置换术CPB患者30例，随机分为对照组与SDD组各15例。对照组行常规术前肠道准备，即饮食准备和清洁灌肠；SDD组在常规准备的基础上口服肠道不吸收抗生素等药物进行术前SDD干预。检测两组患者在诱导麻醉、CPB结束、CPB后2h、24h共4个时相点循环血D-乳酸、内毒素、TNF-α、补体C3值，临床生化指标和ICU停留时间、住院时间、术后机械通气时间、抗生素使用天数等临床指标。结果SDD组患者循环血D-乳酸水平在诱导麻醉和CPB后2h显著低于对照组（均P〈0．05）。两组患者CPB后体内内毒素水平皆显著增高（P〈0．05，P〈0．01），而SDD组在CPB结束及CPB结束24h内毒素水平皆显著低于对照组（P〈0．01，P〈0．05）。两组患者TNF-α水平比较，差异无显著性意义（均P〉0．05）；补体C3水平在CPB结束24h SDD组显著高于对照组（P〈0．05）；两组临床生化指标及结果比较，差异无显著性意义（均P〉0．05）。结论SDD干预是预防内毒素血症的有效肠道准备方法。     

益生菌对大肠癌术后肠屏障功能及全身炎症反应的影响

目的研究益生菌对大肠癌术后患者肠屏障功能及炎症反应的影响。方法60例择期大肠癌手术患者分为益生菌组和对照组，每组各30例。分别于术后第3～7d给予等氮量、等热卡营养支持。从术后第1d起，益生菌组口服优菌多2g／d，共7d。于术后每天观察2组患者体温及心率情况；术前，术后第1、5、8d分别进行白细胞计数；术前，术后第1、8d检测全血细菌DNA、血浆D-乳酸水平及尿乳果糖／甘露醇（L／M）比值；观察2组患者全身炎症反应综合征（SIRS）和感染并发症发生情况。结果益生菌组术后发热持续时间、术后5d平均心率及白细胞计数恢复正常时间均明显短于或低于对照组（P〈0．01）。术后第1d2组患者外周血细菌DNA检测阳性率差异无统计学意义；第8d对照组仍有7例（23．3％）PCR检测呈阳性，而益生菌组为1例（3．3％），2组间差异有统计学意义（P〈0．05）。对照组血浆D-乳酸水平由术后第1d的（6．63±1．29）ng／ml下降至第8d的（0．95土0．83）ng／ml，而益生菌组则由（6．90±1．41）ng／ml下降至（0．56±0．18）ng／ml，第8d时2组间差异有统计学意义（P〈0．05）。对照组L／M比值由术后第1d的0．053±0．019升高至第8d的0．063±0．016，益生菌组则由0．047±0．012降至0．031±0．008，第8d时2组间差异有统计学意义（P〈0．01）。术后SIRS发生率及感染并发症的发生率2组间差异无统计学意义（P〉0．05）。结论益生菌能降低大肠癌患者术后肠道通透性，减少细菌易位，有利于大肠癌患者术后早期炎症反应的恢复。     

微生态制剂对老年结肠癌术后肠道屏障功能的影响

目的观察微生态制剂对老年结肠癌术后患者肠道屏障功能的影响。方法72例老年结肠癌手术患者根据随机数字表法分为两组,对照组按常规术前、术后处理,试验组术前及术后使用微生态制剂,每组各36例。比较两组患者术后一般情况及血浆D-乳酸水平与尿乳果糖／甘露醇（L/M）。结果试验组的首次肛门排气时间[（3．1±1．2）d]、腹泻发生率（11．1％,4／36）、腹泻总时间[（6．2±3．1）d]、发热持续时间[（5．1±1．3）d]均较对照组明显改善,差异有统计学意义（P〈0．05）。两组术后第1天D哥L酸水平与尿L／M均较术前明显增高,两组术后第8天D-乳酸水平较术后第1天明显改善（P〈0．05）,且试验组改善更明显。试验组术后第8天尿L／M明显低于对照组及术后第1天,差异有统计学意义（P〈0．05）。结论微生态制剂能改善结肠癌患者术后肠道屏障功能,从而减少细菌易位的发生,有利于术后恢复。     

老年胃癌术后早期营养支持方式临床研究

目的探讨老年胃癌术后合理的早期营养支持方式。方法前瞻性入组2010年1月至2013年3月间厦门大学附属第一医院收治的120例老年胃癌术后患者,按随机数字表法分为完全肠外营养组（TPN）、完全肠内营养组（TEN）及部分肠内加肠外营养组（EN加PN）,每组40例。比较3组患者营养支持治疗耐受性、术后7d营养指标和免疫指标、术后肛门排气时间及感染并发症发生率。结果在营养支持过程中,EN加PN组耐受性（97．5％,39／40）明显高于TPN组（82．5％,33／40）和TEN组（80．0％,32／40）（P〈0．05）。术后7d,3组患者体质量指数、血浆白蛋白、前白蛋白及转铁蛋白水平等营养指标的差异均无统计学意义（P〉0．05）;但EN加PN组和TEN组CD3、CD4、CD4／CD8等免疫指标明显高于TPN组（均P〈0．05）。EN加PN组和TEN组感染发生率明显低于TPN组[5．13％（2／39）和6．25％（2／32）比12．12％（4／33）,P〈0．05],肛门排气时间明显快于TPN组f（49．5±22．1）h和（48．2±17．6）h比（68．2±16．7）h,P〈0．05]。结论老年胃癌术后早期行肠内营养安全可行．EN加PN为最佳的早期营养支持方式。     

食管癌术后早期肠内肠外营养的对比研究

目的 探讨食管癌术后早期肠内营养（EN）与肠外营养（PN）对息者营养状况的改善及并发症发生率的影响。方法将106例食管癌根治手术的患者随机分为早期EN组和PN组，手术后第1天开始分别给予营养支持1周，于术前1d、术后8d检测体重、血常规、肝功能，并观察并发症的发生率。结果EN组体重、红细胞数、血红蛋白、白蛋白及转氨酶下降幅度少于PN组，两组比较P〈0．01，差异有统计学意义。EN组息者无吻合口瘘发生，肺部感染发生率为5．7％，胸腔积液发生率为3．8％，无切口愈合不良者；PN组患者吻合口瘘发生率5．7％，肺部感染发生率28．3％，胸腔积液发生率15．1％，切口愈合不良发生率7．6％；丽组比较P〈0．05，差异有统计学意义。结论术后早期EN比PN对食管癌营养状况的改善更好，并发症发生率更低。     

术后早期肠内营养支持对胃肠癌病人的机体营养状况和细胞免疫功能的影响

目的：研究术后早期肠内营养支持对肋肠部病人的机体营养状况和细胞免疫功能的影响。方法 将20例胃肠癌的病人随机分为两组，PN组和EN组。PN组术后行TPN支持，EN组术后第1天起经鼻饲管输注能全力，量由500ml/d递增至1500ml/d，速度由21ml/h递增至63ml/h，分别于术前及术后2，4，8d抽取外周血测定T细胞亚群，NK细胞，血清IL－2浓度，血清PA浓度，血清RBP浓度。结果 （1）术后患者血清PA、RBP浓度较术前有明显下降（P＜0．05，P＜0．01），经一段时期的EN和PN支持后基本恢复到术前水平。（2）术后经EN和PN支持后T细胞亚群恢复到术前水平，NK细胞明显增高（P＜0．05）。EN组IL－2明显增高（P＜0．05）且与PN组术后IL－2比亦有显著差异（P＜0．05）。结论 术后早期肠内营养支持可以改善胃肠癌病人的营养状况，其增强细胞免疫功能的作用优于肠外营养。     

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.