经皮椎体成形术的临床应用

目的探讨经皮椎体成形术治疗椎体良恶性病变及外伤性椎体骨折的临床应用价值。方法对21例共26个椎体在透视监视下行经皮椎体成形术(PVP),注射骨水泥剂量约2～6ml。所有患者均在术后2小时行CT扫描以评价骨水泥充填情况及有无渗漏,并应用形象类比评分(VAS)评价手术前后的疼痛程度,对其结果进行分析总结。结果CT显示骨水泥均在椎体中充填满意,5例5个椎体发生椎旁少量骨水泥渗漏,未出现神经损害症状。术前VAS为7～10分,平均为(8.69±0.82)分,术后24h的VAS为1.5～5分,平均(3.18±1.15)分。术后3天的VAS为0～4分,平均(3.01±1.06)分。术后24h和术后3天的VAS评分与术前相比较,均P<0.05,有显著性差异。结论经皮椎体成形术是一种治疗椎体良恶性病变及部分类型的外伤性椎体骨折的安全、有效的方法。     

经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的评价球囊扩张椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效和安全性。方法自2008年8月至2011年7月采用椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折30例42椎,患者均有腰背部疼痛。取俯卧位调节手术床使椎体骨折部位过伸,达到满意的闭合复位后,经皮双侧或单侧椎弓根穿刺球囊扩张,填充骨水泥。随访观察患者的疼痛、日常功能以及影像学改变情况。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,进行统计学分析。利用Oswestry评分、视觉模拟评分（visualanaloguescale,VAS）评定临床疗效。观察有无骨水泥渗漏等并发症。结果术后随访6～24个月,平均10个月。术后伤椎处疼痛均明显缓解,VAS评分从术前平均（8．45±0．48）分降至术后平均（2．45±0．52）分,椎体高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。未出现严重的骨水泥渗漏并发症。术后椎体高度及伤椎后凸角度与术前比较有统计学差异（P〈0．05）,术后VAS及Oswestry评分与术前比较有统计学差异（P〈0．01）。结论球囊扩张椎体后凸成形术治疗骨质疏松脊柱压缩性骨折,能有效恢复椎体高度和矫正后凸畸形,能迅速缓解疼痛,减少骨折并发症,提高患者生活质量。     

经皮球囊扩张椎体后凸成形术治疗 老年骨质疏松性椎体压缩性骨折

目的探讨经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折的临床 效果。方法对69例共叨个老年骨质疏松性椎体压缩性骨折的患者,均行经皮球囊扩张椎体后凸 成形术。观察指标为术前术后的疼痛视觉模拟评分（vasal analogue scale,VAS )、椎体高度的恢复及 并发症发生情况。结果 W个椎体均经皮行双侧椎弓根穿刺成功完成手术。所有患者疼痛缓解, VAS术前平均为（7. 52 10. 49)分,术后第3天平均为（2. 38 1 0. 22)分;术后1个月VAS平均为（1. 88 ±0. 12)分。术前骨折椎体前缘高度平均为（15.65 1 0. 68 ) mm,术后椎体前缘高度平均为（23.68 1 0.83) mm,术前术后差异有显著性（P < 0. 05 )。骨水泥注射量每个椎体3.5-7.5@1,平均5.5 ml。骨 水泥少量渗漏到椎间隙1个椎体,沿手术通道反流至椎弓根2个椎体,均无临床症状,渗漏率为 3.23%。结论经皮球囊扩张椎体后凸成形术（PKP)治疗老年骨质疏松性椎体压缩性骨折,能迅速 缓解疼痛,一定程度的恢复椎体高度,临床疗效确切。     

高黏度骨水泥治疗骨质疏松性椎体压缩骨折34例分析

目的分析临床应用高黏度骨水泥治疗骨质疏松性椎体压缩骨折的临床疗效和安全性。方法应用高黏度骨水泥及其椎体成形系统治疗骨质疏松性椎体压缩骨折34例,41个椎体。结果 34例获得随访1~12个月,平均5.3个月,患者术后腰背部疼痛明显缓解或消失。术前VAS评分为(8.1±1.6)分,术后第1天为(3.4±1.2)分,差异有统计学意义(P0.05)。高黏度骨水泥在椎体里弥散良好,出现1例骨水泥向椎间盘渗漏。结论应用高黏度骨水泥椎体成形术手术操作简便,骨水泥渗漏不易发生,手术安全性高,是治疗骨质疏松性椎体压缩骨折的有效方法。     

不同黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折

目的 比较采用高黏度骨水泥和低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效差异.方法 回顾性分析2013年9月至2014年11月我科治疗的83例骨质疏松性椎体压缩性骨折病人的病例资料.根据手术所用不同黏度骨水泥分组:采用低黏度骨水泥椎体成形术治疗的病人43例(低黏度组);采用高黏度骨水泥椎体成形术治疗的病人40例(高黏度组).记录单个椎体手术时间、骨水泥渗漏发生率,术后并发症发生率.采用疼痛视觉模拟量表(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)对两组进行术前及术后1 d、术后3个月疼痛及功能进行评价.通过X线检查对术前、术后椎体各部进行测量,统计椎体高度变化.结果 83例病人术后均得到3个月随访.两组术前VAS评分和骨折压缩率上无差异.高黏度组的手术时间较低黏度组明显缩短(t=22.32,P=0.000).术后1 d、术后3个月,两组组内VAS评分、ODI较术前明显降低(均P=0.000),但术后组间比较无明显差异(均P>0.05).高黏度组骨水泥渗漏率较低黏度组低,差异有统计学意义(P=0.0494).椎体成形术后高黏度组椎体高度恢复优于低黏度组,差异有统计学意义(P=0.000).结论 椎体成形术中使用不同类型的骨水泥均能有效地缓解病人疼痛,改善生活质量.与低黏度骨水泥相比,高黏度骨水泥有着较低的骨水泥渗漏率,同时缩短了手术时间和降低了术中放射性的暴露.     

体位复位结合高黏骨水泥椎体成形术治疗椎体压缩性骨折疗效观察

目的 探讨体位复位结合高黏骨水泥在椎体成形术中治疗椎体压缩性骨折的临床疗效。方法 回顾性分析2012年3月～2015年10月接受治疗的单椎体压缩骨折患者159例,其中经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗的56例患者纳入PVP组,经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的51例患者纳入PKP组,经体位复位结合高黏骨水泥椎体成形术治疗的52例患者纳入高黏骨水泥组,通过术前术后视觉模拟疼痛评分（VAS）、椎体后凸Cobb角的改变以及术后椎体高度恢复率、骨水泥渗漏率,比较3组临床疗效。结果 3组术后VAS评分较各组术前评分均有显著性改善（P<0.05）。椎体高度恢复率PVP组为36%,PKP组75%（χ2=30.792,P=0.021）,高黏骨水泥组79%（χ2=37.831,P=0.016）,PKP组及高黏骨水泥组较PVP组差异具有统计学意义（P<0.05）。椎体后凸Cobb角PVP组手术前后分别为23.6±1.3、23.0±2.7（t=1.498, P=0.182）,PKP组及高黏骨水泥组术前分别为25.7±1.7、26.2±2.3,术后分别为12.8±2.1（t=34.096, P=0.001）、13.3±1.6（t=33.201, P=0.001）。经X线证实PVP组发生骨水泥渗漏8例（14.3%）,PKP组发生渗漏3例（5.9%）,高黏骨水泥组渗漏3例（5.8%）,PKP组及高黏骨水泥组骨水泥渗漏率与PVP组比较具有显著性差异（t=3.886、3.996, P=0.012、0.008）。结论 体位复位结合高黏骨水泥椎体成形术治疗椎体压缩性骨折,可以取得与PKP相同的临床疗效,因其不需使用昂贵的球囊,因而有着良好的临床推广应用前景。     

膨胀式椎体成形术治疗椎体破坏31例

目的总结探讨膨胀式椎体成形术（Sky骨扩张器系统）治疗老年骨质疏松性椎体压缩性骨折和椎体肿瘤的临床效果及安全性。方法对31例共59个椎体压缩骨折和椎体肿瘤破坏的患者,应用Sky骨扩张器进行经皮穿刺椎体扩张成形术。观察指标为,术前术后的疼痛视觉模拟评分（vasual analoguescale,VAS）、椎体高度的恢复及并发症发生情况。结果59个椎体均单侧经椎弓根基底穿刺成功完成手术。所有患者疼痛均有明显缓解,VAS术前平均为（8．03±0．27）分,术后第3天平均为（3．0±0．32）分,术后1个月VAS平均为（2．8土0．22）分。术前病椎前缘的平均高度为（17．36±1．28）mm。术后椎体前缘的平均高度为（22．13±0．69）mm,术前术后有显著性差异（P〈0．05）。骨水泥注射量每个椎体3．0～5．0mL,平均4．6mL。骨水泥沿椎弓根针道反流2例,均无临床症状;渗漏到椎管内1例（1个椎体）．2d后出现下肢麻木、疼痛等临床症状,渗漏率为1．7％。结论Sky骨扩张器治疗老年骨质疏松椎体压缩性骨折及椎体转移瘤骨质破坏,可迅速缓解疼痛,能在一定程度上恢复椎体高度,手术操作简便,安全可行。     

经皮椎体后凸成形术中分步推注骨水泥治疗椎体后壁破损的骨质疏松性椎体骨折

目的 探讨经皮椎体后凸成形术（PKP）治疗椎体后壁破损的骨质疏松性椎体骨折中减少骨水泥渗漏的方法.方法 对27例老年骨质疏松性骨折患者在PKP术中采用分步推注骨水泥的方法治疗椎体后壁破损36椎,观察患者手术前后疼痛视觉模拟评分（VAS）变化、椎体高度恢复情况及骨水泥渗漏情况.结果 27例均获得随访,时间12~48（27.3±6.2）个月.术后3 d及末次随访时患者VAS、椎体高度均较术前明显改善（P〈0.05）,末次随访时与术后3 d比较差异无统计学意义（P〉0.05）.术后5个椎体（13.8%）发生骨水泥渗漏,其中椎旁渗漏2个,椎间盘渗漏2个,椎管内渗漏1个.无肺栓塞发生,未出现脊髓和神经根损伤.结论 PKP治疗椎体后壁破损老年骨质疏松性椎体压缩性骨折中,采用分步推注骨水泥的方法可有效减少骨水泥渗漏.     

高黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效

目的观察经皮椎体成形术(PVP)中使用高黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效及并发症。方法对60例骨质疏松性椎体压缩骨折患者(98个椎体)采用高黏度骨水泥PVP治疗。观察手术前后腰痛VAS评分、脊椎功能障碍指数(ODI)、骨水泥渗漏及邻近椎体骨折等并发症发生率。结果 60例均获得随访,时间3~6(4.2±1.4)年。VAS评分由术前6~10(8.4±1.2)分降低到末次随访时0~3(0.7±0.8)分(P0.001);ODI由术前45%~91%(63.7%±15.9%)降低到末次随访时2%~31%(8.4%±6.6%)(P0.001)。共8个椎体(8.2%)发生骨水泥静脉渗漏,6个椎体(6.1%)发生椎间盘渗漏,8个椎体(8.2%)发生椎旁渗漏,2例(3.3%)发生邻近椎体骨折。结论采用高黏度骨水泥行PVP治疗骨质疏松性椎体压缩骨折可获得满意的临床疗效,骨水泥渗漏率及邻近椎体骨折发生率均较低。     

单侧多穿刺通道注射骨水泥法在骨质疏松椎体压缩骨折经皮椎体成形术中的应用

目的：探讨经皮椎体成形术中采用单侧多通道穿刺注射骨水泥法的临床价值。方法：自2003年3月至2012年10月,采用单侧经椎弓根穿刺行椎体成形术（PVP）治疗骨质疏松椎体压缩骨折658例（885个椎体）,对术中注射骨水泥〈0．3ml即出现骨水泥渗漏的82例（99个椎体）采用单侧多穿刺通道灌注骨水泥,其中男38例（45个椎体）,女44例（54个椎体）;年龄69—92岁,平均75．4岁。记录手术时间,骨水泥注入量,并发症,术前及术后1h、1个月、3个月、6个月随访时的疼痛视觉模拟评分（VAS）及术前、术后1个月、3个月、6个月Oswestry功能障碍指数（ODI）以综合评估手术疗效;术后拍摄正侧位x线片,观察骨水泥在椎体内的分布,计算其分布优良率。结果：99个出现骨水泥渗漏的椎体均采用单侧多通道穿刺注射骨水泥法完成PVP操作。平均手术时间为33min,骨水泥分布优良率达98．8％（98／99）;术中无一例出现脊髓、神经根损伤及骨水泥血管内渗漏,无肺栓塞、气胸、穿刺部位出血伤口感染等并发症发生。VAS评分由术前（8．40±0．73）分改善至术后lh的（2．50±0．43）分,术后1个月的（2．00±0．33）分,术后3个月（1．80_＋0．28）分,术后6个月（2．10＋_0．17）分;ODI由术前（40．94±2．72）分改善至术后1个月（9．64±2．60）分,术后3个月（8．52±2．30）分,术后6个月（7．77±2．15）分。术后各时间点VAS评分、ODI与术前比较差异有统计学意义（P〈0．01）。结论：在经皮椎体成形术中发生骨水泥渗漏时,采用单侧多穿刺通道注射骨水泥法骨水泥分布满意、疼痛缓解率高、功能改善明显,无不良事件发生。     

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.