患者静脉输注羟乙基淀粉130/0.4或羟乙基淀粉200/0.5的药代动力学

目的 比较患者静脉输注6%羟乙基淀粉(HES)130/0.4和HES 200/0.5的药代动力学.方法 择期手术患者20例,ASA Ⅰ级,随机分为2组,HES 130/0.4组和HES 20010.5组,每组10例.分别在30min内静脉输注500 ml HES 130/0.4或HES 200/0.5,蒽酮比色法测定输注后各时点血清中胶体浓度,采用3P97软件计算其药代动力学参数.结果 二室模型权重为1时计算药代动力学参数最符合HES 130/0.4和HES 200/0.5的体内特点,HES 130/0.4主要的药代动力学参数如下:t1/2α=1.7 h、t1/2β=10 h、K10:0.13 h-1、K12=0.133 h-1、K21=0.210 h-1、CL(s)=10.77 L/h、AUC=46 mg·h·ml-1.HES200/0.5主要药代动力学参数如下:t1/2α=3.2 h、t1/2β=164 h、K10=0.09 h-1、K12=0.120 h-1、K21=0.010h-1、CL(s)=0.19 L/h、AUC=53 mg·h·ml-1.结论 HIES 130/0.4和HES 200/0.5在血管内停留时间均较长,HES 130/0.4较HES 200/0.5具有更好的药代动力学特点,其消除半衰期短、在血液内无蓄积.     

两种舒芬太尼靶控输注系统的准确性

目的 评价两种舒芬太尼靶控输注系统的准确性.方法 择期手术患者18例,年龄21～64岁,ASA Ⅰ或Ⅱ级,均采用舒芬太尼、异丙酚及维库溴铵行麻醉诱导和维持.随机选择6例患者行体重修正舒芬太尼Gepts药代动力学参数研究,靶控输注舒芬太尼(血浆靶浓度0.8 ng/ml)10 min,输注异丙酚(血浆靶浓度3～4 mg/L),意识消失后静脉注射维库溴铵0.1 mg/kg,靶控输注舒芬太尼(血浆靶浓度0.2～0.8 ng/ml),术毕前30 min停止输注.分别于靶控输注舒芬太尼前、输注舒芬太尼1、3、5、10、20、40、60、90、120和150 min时取桡动脉血3 ml/次,采用ELISA法测定舒芬太尼血药浓度.计算偏离度、准确度,中央室容积(V1)与体重(m)作直线回归分析,并修正药代动力学参数.余12例患者选用上述体重修正后药代动力学参数行临床麻醉,计算舒芬太尼靶控输注系统的偏离度、准确度、分散度、摆动度.结果 采用舒芬太尼Gepts药代动力学参数靶控输注舒芬太尼时,偏离度为16.7%、准确度为42.0%;体重修正后参数为:V1(L)=0.147 m+2.82,K10=0.064 5 min-1、K12=0.108 6 min-1、K21=0.024 5 min-1、K13=0.022 9 min-1、K31=0.001 3 min-1;采用体重修正后药代动力学参数靶控输注舒芬太尼时,偏离度、准确度分别为4.0%、22.3%,较Gepts药代动力学参数靶控输注舒芬太尼时小(P＜0.05),分散度、摆动度分别为-4.4%/h、20.4%.结论 舒芬太尼Gepts药代动力学参数的中央室容积偏大,体重修正后嵌入靶控输注系统,可提高靶控输注的精确度及稳定性,可维持较准确的血药浓度.     

羟乙基淀粉对内毒素血症大鼠肠系膜细静脉白细胞活化和血管通透性的影响

目的 探讨羟乙基淀粉(HES 130/0.4)对内毒素血症早期大鼠肠系膜细静脉白细胞活化及血管通透性的影响.方法 雄性Wistar大鼠36只,体重200～250 g,随机分为3组(n=12):对照组(C组)静脉注射生理盐水0.5 ml后,静脉输注生理盐水16 ml·kg-1·h-1;内毒素组(LPS组)静脉注射LPS 2 mg/ks(溶于生理盐水0.5 ml)后,静脉输注生理盐水16 ml·kg-1·h-1;HES组静脉注射LPS 2ms/kg(溶于生理盐水0.5 ml)后,静脉输注HES 16 ml·kg-1·h-1.各组补液时间60 min.观察给药前及补液期间和补液后30 min内肠系膜细静脉白细胞滚动数、粘附数、游出数、肥大细胞脱颗粒情况及细静脉血管通透性情况,检测外周血白细胞粘附分子CD11b和CD18的表达.结果 与C组比较,LPS组沿肠系膜细静脉内滚动、粘附和游出的白细胞增加,肥大细胞脱颗粒率增加,LPS组和HES组CD11b、CD18表达上调,细静脉血管通透性增加(P＜0.05).与LPS组比较,HES组上述指标均降低(P＜0.05).结论 HES 130/0.4可抑制内毒素血症早期大鼠肠系膜细静脉白细胞沿血管壁滚动、粘附和游出,抑制肥大细胞脱颗粒及血管通透性的增加,从而改善微循环障碍.     

全麻下儿童丙泊酚的药代动力学特征

目的 研究全麻下儿童丙泊酚的药代动力学特征.方法 选择拟在全麻下行择期手术的患儿19例,ASA Ⅰ或Ⅱ级.丙泊酚3 mg/kg在上肢静脉约30 S左右注射完毕,注药后1、2、4、6、10、15、30、60、90、150、210、300、420 min从右颈内静脉抽取1.5 ml全血.血浆药物浓度的测定方法采用反相高效液相色谱技术,应用3p87软件包拟合总的药代动力学参数.结果 最终药代动力学参数：清除速率常数（k10）0.1616/min,1室向2室转运速率常数（k12）0.0640/min,2室向1室转运速率常数（k21）0.0062/min,分布半衰期（T1/2α）4.1176 min,清除半衰期（T1/2β）123.9559 min,清除率（CL）0.0745 L·min^-1·kg^-1,中央室分布容积（Vc）0.9505 L/kg,表观分布容积（Va）27.4100 L/kg.未发现体重等变量和各个药代动力学参数间有线性方程可建立.结论 丙泊酚在儿童的药代学模型呈二室模型,符合线性药代动力学特点.儿童丙泊酚的药代动力学特征明显不同于成人.     

羟乙基淀粉130/0.4和羟乙基淀粉200/0.5对患者肾小球和肾小管功能影响的比较

羟乙基淀粉(HES)可迅速恢复机体有效循环血容量、维持心脏功能、减轻组织水肿,广泛用于临床创伤及失血性休克患者的早期液体复苏.羟乙基淀粉200/0.5(HES 200/0.5)的体内降解速度和经肾脏排泄速度较慢,因此每日推荐用量不超过33 ml/kg[1].HES 130/0.4分子量和取代级较HES 200/0.5低,具有较好的药代动力学特性.     

等容量血液稀释对犬异丙酚药代动力学的影响

目的观察等容量血液稀释对犬异丙酚药代动力学的影响。方法13只雄性犬随机分为对照组(n=7)与等容量血液稀释组(n=6)。静脉注射地西泮0.5 mg/kg、氯胺酮5mg/kg麻醉后, 股静脉与股动脉穿刺,乳酸钠林格氏液5—7 ml·kg-1·h-1持续静脉滴注。麻醉后0.5 h等容量血液稀释组由股动脉放血,同时经股静脉1:1快速输入6%羟乙基淀粉,直至红细胞压积达25%。两组持续恒速静脉输注异丙酚10mg·kg-1·h-130 min,分别于输注2、5、10、15、20、30、31、32、35、40、50、70、90、120、150、180、240、300min采动脉血,测定异丙酚血浆浓度并计算药代动力学参数。一周后两组均根据各自药代动力学参数靶控输注异丙酚60 min,分别于靶控输注5、15、30、45、60 min测定两组异丙酚血浆浓度、游离浓度、脑脊液浓度及脑组织含量。结果与对照组比较,恒速给药时等容量血液稀释组异丙酚血浆浓度降低,中央室分布容积、稳态分布容积与全身清除率均升高(P<0.05或0.01);靶控输注时两组异丙酚血浆浓度与血浆靶浓度一致,但等容量血液稀释组异丙酚游离药物浓度、脑脊液浓度、脑组织含量及脑/血浆分配系数升高(P<0.05),脑/血浆分配系数与游离药物百分比[异丙酚游离浓度/(异丙酚游离浓度 异丙酚血浆浓度)]呈正相关(r=0.87,P<0.05)。结论等容血液稀释提高了异丙酚中央室分布容积、稳态分布容积和全身清除率,降低了分布项系数和浓度-时间曲线下面积,中枢药物浓度升高,可能导致药效增强。     

左旋布比卡因臂丛神经阻滞的药代动力学

目的研究左旋布比卡因用于臂丛神经阻滞的临床药代动力学特性。方法10例择期上肢手术患者,0.375%左旋布比卡因0.4ml/kg行肌间沟入路臂丛神经阻滞。于注药前及注药后10、20、30、45、60、90、120、180、240、360、480和720min采血2ml,分离血浆,高效液相色谱法测定左旋布比卡因血药浓度。所得数据经3P97药代动力学软件处理,选择最佳房室模型,绘出血药浓度-时间曲线,求得药代动力学参数。结果左旋布比卡因血药浓度-时间数据符合二房室开放模型,主要药代动力学参数:分布半衰期(t1/2α)(0.46±0.21)h、消除半衰期(t1/2β)(4.58±0.66)h、达峰时间(Tmax)(0.31±0.19)h、峰值浓度(Cmax)(0.95±0.31)mg/L、曲线下面积(AUC)(3.76±0.52)mg.h-1.L-1、清除率(CL)(0.42±0.07)L/h和表观分布容积(Vd)(1.34±0.44)L/kg。结论0.375%左旋布比卡因可安全用于臂丛神经阻滞,其临床药代动力学符合二房室开放模型。     

国人靶控输注异丙酚的群体药代动力学

目的 运用非线性混合效应模型(NONMEM)软件计算国人异丙酚靶控输注(TCI)群体药代动力学参数并分析药代动力学特点。方法 61例行择期手术患者,ASAⅠ～Ⅱ级,男26例,女35例,年龄18～64岁,体重41～83kg。采用Tackley药代动力学参数,恒定靶血浆药物浓度(3μg·ml~(-1))变速输注60min,间断采血90min,共976个血标本,用气相色谱-质谱法测定异丙酚的血浆药物浓度。运用NONMEM软件估算异丙酚TCI群体药代动力学参数并分析药代动力学变化特点。结果 国人异丙酚TCI可用二室开放型药代动力学模型进行描述。最终药代动力学参数:K_(10)、K_(12)、K_(21)分别为0.111、0.064、0.023min~(-1);V_1、V_2分别为0.205、0.404L·kg~(-1);CL_1、CL_2分别为22.76、13.24ml·min~(-1)·kg~(-1)。最终回归模型中异丙酚血药浓度估算值与实测浓度间线性关系良好。在固定效应参数中,体重影响V_1、CL_1,年龄影响K_(21),性别对参数无影响。结论 国人异丙酚TCI的药代动力学特点为可用二室指数开放模型进行描述,中央室分布容积明显小于欧美人群,药物从中央室向外周室转运和消除速率较快。     

持续输注丙泊酚药代动力学模型的选择

目的　将四种文献报道的药代动力学模型用于计算机模拟以预测持续输注丙泊酚的 血浆浓度,籍以选择适合中国人的药代动力学模型。方法　选择ASAⅠ～Ⅱ级的择期手术病人16 例,≥65岁(Ⅰ组)病人静脉输注丙泊酚速度60ml/h,<65岁(Ⅱ组)者输注速度75ml/h,抽取动脉血 分析药物血浆浓度,用四种药代动力学模型预测丙泊酚血浆浓度,计算样本加权残差(WR)、绝对值 加权残差(absWR)。结果　Schuttler模型在Ⅰ组病人,中位数加权残差(MDWR)显著小于其他三种 参数(P<0.01),对所有病人输注期间预测浓度 实测浓度的拟合程度最好(P<0.01)。结论　仅 Schuttler药代动力学模型适合用于持续静脉输注丙泊酚期间和停止输注后的药物浓度预测。     

不同分子量和取代级的羟乙基淀粉溶液对兔凝血功能的影响

目的观察家兔输注羟乙基淀粉(贺斯,HES)HES 450/0.7、HES 200/0.62、HES 200/0.5和HES130/0.4后的凝血功能变化。方法 家兔40只,随机分为5组(n=8):组I:HES 450/0.7;组Ⅱ:HES200/0.62;组Ⅲ:HES 200/0.5;组Ⅳ:HES 130/0.4;组Ⅴ:0.9％NaCl。按10 ml·kg-1·h-1输注胶体,共3 h,于输注前、输注1 h、2 h、3 h测定凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIb)及血栓弹性描记图TEG(R、K、α角及MA)。结果 (1)输注30 ml·kg-1后,组I:R(16.1±1.9)min、K(6.0±2.1)min,α(35±9)deg,MA(45±5)mm(P<0.01);组Ⅱ:R(15.4±1.0)min,K(7.0±2.1)min,α(34±5)deg,MA(38±9)mm(P<0.01)。(2)输注20 m1·kg-1后五组PT均延长(P<0.05)。(3)组I、组Ⅱ输注30ml·kg-1后APTT显著延长(P<0.05)。(4)组I输注30ml·kg-1后FIb显著降低(P<0.05)。结论HES 450/0.7与HES 200/0.62大剂量输注对凝血功能有显著影响,HES 200/0.5与HES 130/0.4则无明显损害。     

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.