一期后路病灶清除植骨融合内固定治疗儿童胸腰段结核伴后凸畸形

目的探讨一期后路病灶清除植骨融合内固定治疗儿童胸腰段结核伴后凸畸形的效果。方法对12例胸腰段结核伴后凸畸形的患儿采用一期后路结核病灶清除、钛笼重建、后路钉棒系统内固定术。术后定期复查X线片了解后凸Cobb角变化和植骨融合情况,采用ASIA分级评定术后脊髓功能恢复情况,采用Bird—well分级评价术后植骨融合情况。结果术中无周围脏器、血管及脊髓损伤。12例均获随访,时间18—32（23±3．6）个月。患儿胸腰段疼痛均消失,结核症状消失无复发,无切口感染、窦道形成或内固定失败等并发症,复查血沉均正常。术后1年x线片提示植骨均获骨性融合,Birdwell分级：I级9例、Ⅱ级3例。内固定位置均正常。末次随访Cobb角：13°～28°（15．5°±1．8°）。末次随访ASIA分级：术前B级3例均恢复至C级,C级5例均恢复至D级,D级4例恢复至E级3例、1例无恢复。结论一期后路清除胸腰段结核病灶彻底,椎管减压可靠,矫形效果显著,钛笼重建、钉棒系统内固定可有效重建胸腰段脊柱的稳定性。     

一期后路有限减压及异体骨椎板重建治疗胸腰段脊柱结核

目的探讨在一期后路病灶清除、椎间植骨融合内固定的基础上,应用有限减压及异体骨椎板重建治疗胸腰段脊柱结核的临床疗效。方法对20例胸腰段(T11～L2)脊柱结核患者采用一期后路有限减压及异体骨椎板重建手术治疗。采用后凸Cobb角、神经功能、疼痛VAS评分和植骨融合情况评价疗效。结果患者均获得随访,时间36～60(47. 0±7. 6)个月。后凸Cobb角术前为18°～41°(31. 2°±6. 6°),末次随访为12°～26°(18. 2°±4. 3°),差异有统计学意义(P 0. 01)。疼痛VAS评分术前为6～9 (7. 6±0. 9)分,末次随访为0～2(0. 7±0. 7)分,差异有统计学意义(P 0. 01)。患者在术后9～15(11. 6±2. 2)个月显示植骨融合。末次随访时ASIA分级:1例由术前B级恢复至D级,4例由术前C级恢复至D级,5例由术前C级恢复至E级,8例由术前D级恢复至E级,2例术前E级仍为E级。结论应用一期后路有限减压及异体骨椎板重建、病灶清除、椎间植骨融合内固定治疗胸腰段脊柱结核安全有效。     

经皮穿刺引流联合后路病灶清除椎间植骨内固定治疗胸腰段脊柱结核伴巨大脓肿

目的探讨经皮穿刺引流联合后路病灶清除椎间植骨内固定治疗胸腰段脊柱结核伴巨大脓肿的安全性及临床疗效。方法回顾自2007-05—2012-04诊治胸腰段脊柱结核伴巨大脓肿9例。所有患者先行CT引导下穿刺,灌洗引流1~2周后再行后路开放减压、病灶清除、植骨融合内固定术。观察比较手术前后血沉(ESR)、后凸角度、神经功能及植骨融合情况。结果 9例均获得随访18~56个月,平均35个月。手术时间120~260 min,平均165 min;术中失血量300~1 600 ml,平均650 ml。患者术后切口均一期愈合,无窦道形成。术后3个月ESR恢复正常,平均21 mm/h。术后后凸角度3°~16°,平均7°。末次随访时Frankel分级:C级1例,D级4例,E级4例。植骨融合时间3~6个月,平均4个月。结论对于胸腰段脊柱结核伴巨大脓肿者采用经皮穿刺引流联合后路病灶清除椎间植骨内固定是一种安全有效的治疗方法。     

一期经椎间孔入路病灶清除融合固定联合灌注冲洗治疗胸腰椎结核

目的探讨一期经椎间孔入路病灶清除融合固定联合灌注冲洗治疗胸腰椎结核的近期临床疗效。方法采用一期经椎间孔入路病灶清除融合固定联合灌注冲洗治疗28例胸腰椎结核患者。记录手术时间和术中出血量,观察患者术后植骨融合以及相关并发症发生情况。结果 28例患者均顺利完成手术,手术时间90～160 min,术中出血量150～500 ml。术后随访1～3年。患者术后结核中毒症状均明显好转,营养状况也逐步改善。术后2周VAS评分与术前比较差异有统计学意义(P 0. 05),术后改善率93%。末次随访时患者ESR、CRP均恢复正常。除术前ASIA分级为E级的9例外,19例A～D级患者中,14例术后ASIA分级较术前改善1级,5例术后ASIA分级较术前改善2级。后凸Cobb角:术前为32. 5°±13. 2°,术后3个月为17. 5°±12. 3°,畸形角度明显减小(t=5. 624,P 0. 05)。患者均获得骨性融合。随访期内未出现内固定松动或断裂、假关节、骨不连等并发症,未发现结核复发者。结论一期经椎间孔入路病灶清除融合固定联合灌注冲洗是治疗胸腰椎结核有效且安全的手术方式。     

一期前后联合入路治疗胸腰段脊柱结核

目的回顾性分析一期后路椎弓根螺钉内固定和前路病灶清除植骨融合术治疗胸腰椎脊柱结核的临床疗效。方法 2004年12月～2010年8月,采用一期后路椎弓根螺钉系统内固定和前路病灶清除、神经减压、自体骨椎间植骨治疗胸腰段脊柱结核患者27例,2个椎体16例,3个椎体8例,4个椎体2例,5个椎体1例。分析术前与术后脊髓神经功能Frankel分级情况以及脊柱融合情况。结果所有患者术后随访9个月～3年,平均16.5个月。脊柱后凸畸形由术前平均46.3°改善到术后平均14.3°(P<0.05)。术后所有病例神经功能均获得改善。结论经后路椎弓根螺钉内固定和前路病灶清除植骨融合术治疗脊柱结核能彻底清除结核病灶,矫正脊柱后凸畸形,促进脊髓及神经功能恢复。     

一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核

[目的]探讨一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核的可行性及临床疗效。[方法]2007年1月~2014年1月收集23例胸腰段脊柱结核并有后突畸形的患者,伴有椎管及椎旁脓肿形成。其中男13例,女10例;年龄30~69岁,平均(46.48±12.01)岁。脊柱病变节段后凸Cobb角为17°~40°,平均(30.43±5.74)°。术前ASIA分级:B级2例,C级10例,D级7例,E级4例。均采用一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗。通过研究患者ASIA分级、脊柱病变节段后凸Cobb角、术后并发症、Oswestry功能障碍指数(ODI)、VAS疼痛评分、植骨融合时间评估手术疗效。[结果]术后随访21~41个月,平均(29.30±4.97)个月,无脊髓损伤加重及脑脊液漏,无窦道形成。1例术后伤口延迟愈合,1例出现皮下局部脓肿。术前有神经症状者均有不同程度恢复。至末次随访,根据ASIA分级,2例由B级恢复至D级,8例由C级恢复至E级,2例由C级恢复至D级,7例由D级恢复至E级。术后测量后凸Cobb角较术前显著改善(P0.001)。末次随访时ODI、VAS疼痛评分均较术前明显改善(P0.001)。本组无内固定失败及假关节形成,所有患者均在术后5~8个月达到植骨融合,疗效满意。[结论]对于有适应证的脊柱结核,一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核安全有效且手术创伤小。     

Ⅰ期手术经后路病灶清除内固定治疗儿童胸椎结核

目的:探讨Ⅰ期手术经后路结核病灶清除植骨融合内固定治疗儿童胸椎结核的效果.方法:2005年6月至2010年12月采用病灶清除植骨融合内固定治疗儿童胸椎结核9例,其中男7例,女2例;年龄3～12岁,平均7岁;病史3个月～1年,平均6个月.患儿均有不同程度胸背痛、肋间神经痛以及脊柱后凸畸形,同时伴有低热、盗汗、消瘦等全身症状.术前X线片、CT、MRI检查提示病变部位多发生于T4-T9节段.胸段后凸角35°～72°,平均48.2°.术前脊髓功能ASIA分级:B级2例,C级5例,D级2例.术后定期复查X线片了解后凸角变化和椎间植骨融合情况,采用ASIA分级评定术后脊髓功能恢复情况.结果:术中无大血管或脊髓损伤,术后随访16～38个月,平均24个月.所有患儿结核症状消失,无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉正常.术后4～8个月复查X线片提示椎间植骨均获骨性愈合,内固定位置正常.最后随访后凸角12°～30°,平均19.5°,脊髓功能ASIA分级:C级2例,D级2例,E级5例.脊髓功能均有不同程度改善.结论:Ⅰ期经后路清除胸椎结核病灶彻底,椎管减压可靠,矫形效果显著,行自体或同种异体骨植骨钉棒系统内固定可有效重建胸段脊柱的稳定性.     

一期后路病灶清除、植骨融合内固定治疗胸腰椎结核

目的分析一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核的临床效果。方法对60例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定术。采用ASIA分级评估手术前后脊髓神经功能,根据影像学资料评价术后畸形矫正情况和植骨融合情况。结果患者均手术顺利,未发生脊髓及神经根损伤情况,切口均一期愈合。患者均获得随访,时间12~48个月。术后脊髓神经功能ASIA分级明显改善:术前A级4例,B级6例,C级10例,D级22例,E级18例;术后A级1例,B级3例,C级8例,D级18例,E级30例。患者植骨均达到骨性融合。术后3个月后凸Cobb角从术前的32.5°±13.2°改善至17.5°±12.3°,差异有统计学意义(P0.05)。未出现内固定松动或断裂、假关节、骨不连等并发症。结论一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核能有效纠正后凸畸形,并促进神经功能恢复,临床治疗效果好。     

一期后路病灶清除植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的临床初步报告

[目的]探讨经后路一期病灶清除、植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的可行性及疗效.[方法]7例胸腰段脊柱结核患儿,均伴有后凸畸形.其中男5例,女2例;年龄9～12岁.术前脊柱后凸角为35°～45°,平均37.9°.Frankel分级:B级2例,C级3例,D级2例.采用经后路一期病灶清除、植骨融合加钉棒系统矫形固定治疗.[结果]术后随访27～42个月,平均34个月.切口均一期愈合,无1例结核复发.Frankel分级:4例恢复2级,3例恢复1级.术后后凸角为2°～9°,较术前明显改善,最后随访时后凸角为2°～12°,较术后无明显丢失.术后3个月血沉均恢复正常;所有患儿均获得满意的植骨融合.[结论]一期后路病灶清除、后方植骨内固定矫形手术治疗伴后凸畸形的儿童胸腰段脊柱结核是矫正后凸畸形和预防晚期后凸畸形发生的有效方法.     

侧前方病灶清除椎弓根内固定治疗胸椎结核后凸畸形

目的观察侧前方病灶清除椎间植骨经椎弓根内固定术治疗脊柱结核并后凸畸形的疗效。方法胸椎结核并后凸畸形患者17例,男11例,女6例;年龄23～56岁,平均36.4岁。结核病损位于下胸椎,累及两或三个椎体。后凸成角15°～34°,平均25°。5例患者合并脊髓损伤,Frankel分级为C级2例、D级3例。手术方法为一期侧前方病灶清除椎间植骨经椎弓根内固定,抗结核药物治疗9个月。结果术后随访2~4年,切口一期愈合,椎间植骨全部融合,脊柱结核全部治愈,脊髓功能损害患者术后1年内完全恢复。术后后凸成角平均为7°,平均矫正18°,随访期间畸形矫正无明显丢失。结论侧前方病灶清除椎弓根内固定术治疗脊柱结核并后凸畸形,能够一期完成病灶清除、脊髓减压、脊柱稳定性重建和后凸畸形矫正。坚强的内固定可促进病椎植骨融合,有助于缩短术后药物治疗时间和提高脊柱结核治愈率。     

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.