异丙酚抑制福尔马林致痛诱导c-fos基因在大鼠脊髓内的表达

目的研究异丙酚在脊髓水平是否有镇痛作用.方法SD大鼠15只,随机分为三组对照组、芬太尼组、异丙酚组,分别腹腔注射0.9%生理盐水,0.1mg/kg芬太尼或100mg/kg异丙酚,2min后,向大鼠右侧后肢跖部皮下注射福尔马林,1h后,用Fos免疫组织化学方法观察脊髓内c-fos基因的表达.结果福尔马林仅诱导Fos在同侧脊髓表达,预注芬太尼或异丙酚明显抑制Fos的表达,Fos免疫反应阳性神经元(FLIN)数量分别降低了57.8%、36.3%(P＜0.01),且芬太尼的抑制作用强于异丙酚(P＜0.01).结论睡眠剂量的异丙酚在脊髓水平有镇痛作用,但作用比芬太尼弱.     

鞘内新斯的明对福尔马林致痛大鼠的抗伤害作用

目的 探讨鞘内注射新斯的明对福尔马林致痛大鼠的抗伤害作用的可能机制。方法 雄性SD大鼠24只，随机分为三组：生理盐水对照组(NS组)、福尔马林(F组)和新斯的明福尔马林组(NeF组)。F组给予5％福尔马林100μl，足底注射，NeF组在同F组处理前鞘内给予新斯的明(Neo)。在福尔马林处理后观察大鼠的行为学表现并检测大鼠脊髓Fos的表达。结果 NeF、组的缩腿舔爪时间、脊髓的Fos表达显著短于或弱于F组。结论 新斯的明能抑制大鼠脊髓背角Fos的释放，可能是其产生抗伤害作用的机制之一。     

鞘内注射吗啡对福尔马林炎性疼痛大鼠脊髓背角环氧化酶-2表达的影响

目的评价鞘内注射吗啡对福尔马林炎性疼痛大鼠脊髓背角环氧化酶-2（COX-2）表达的影响。方法32只鞘内置管成功的雄性SD大鼠，随机分为4组（n=8）：对照组（C组）、模型组（F组）、生理盐水组（NS组）及吗啡组（M组）。鞘内置管后5d，F组、NS组及M组大鼠于左后足掌部皮下注射5％福尔马林50μl，注射福尔马林前30min，NS组鞘内注射20μl生理盐水，M组鞘内注射10μl（10μg）吗啡和10出生理盐水，C组不给任何处理，采用疼痛加权评分评价疼痛行为学。F组、NS组及M组于注射福尔马林后24h，C组于鞘内置管后6d处死大鼠，取L5脊髓，采用免疫组织化学方法观察脊髓背角COX-2表达。结果吗啡可减轻福尔马林炎性疼痛；与C组比较，F组、NS组脊髓背角COX-2表达增加（P〈0．01）；与F组、NS组比较，M组脊髓背角COX-2表达降低（P〈0．01）。结论鞘内注射吗啡可抑制福尔马林炎性疼痛引起的脊髓中COX-2表达增加，可能与吗啡的抗伤害和镇痛作用有关．     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

目的 观察鞘内注射(intrathecal injection,IT)吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A(protein kinaseA,PKA)催化亚单位表达的影响.方法 选择鞘内置管成功的雄性SD大鼠80只,随机分为5组,每组16只,分别为假手术组、对照组、吗啡2.5μg组、可乐定5 μg组和吗啡2.5 μg+可乐定5μg组.按Yaksh法鞘内置管,按Brennan法制作大鼠足底切口疼痛模型,用机械缩爪反射阈值(mechanical withdrawal threshold.MWT)和热缩爪潜伏期(thermal withdrawal latency,TWL)观察疼痛行为学变化,应用免疫组织化学法和免疫印迹法测定大鼠脊髓背角PKA催化亚单位表达的变化.结果 与假手术组比较,术后2h对照组大鼠的MWT明显降低,TWL明显缩短(P<0.01),脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化亚单位表达明显增加(P<0.01);与对照组比较,吗啡2.5μg+可乐定5μg组大鼠的MWT明显增加,TWL明显延长(P<0.01),脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化哑单位表达明显减少(P<0.01);而吗啡2.5μg组和可乐定5μg组大鼠的MWT、TWL、脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化亚单位表达与对照组比较均无统计学意义.结论 在大鼠切口痛模型中,IT可乐定能增强吗啡的抗伤害作用,其机制可能与其抑制切口痛引起的脊髓背角PKA催化亚单位的表达增加有关.     

脊髓谷氨酸转运体、孤啡肽和脑源性神经营养因子在炎性痛大鼠吗啡耐受形成中的作用

目的 探讨脊髓谷氨酸转运体(GT)、孤啡肽(OFQ)和脑源性神经营养因子(BDNF)在炎性痛大鼠吗啡耐受形成中的作用.方法 健康雄性SD大鼠,8～ 10周龄,体重300 ～ 350 g,取鞘内置管成功的雄性SD大鼠20只,采用随机数字表法,将其随机分为4组(n=5):生理盐水组(NS组)、炎性痛组(IP组)、吗啡组(M组)和GT激动剂riluzole组(R组).NS组于左后足踝关节腔注射生理盐水50μl,其余3组注射完全弗氏佐剂50 μl.3d后,NS组和IP组鞘内注射生理盐水10 μl;M组鞘内注射吗啡10 μg;R组鞘内注射riluzole 10 μg,30 min后注射吗啡10 μg.注射药物容量均为10μl,2次/d,连续7d.于鞘内给药前、鞘内给药2、4、6d和鞘内给药结束后1 d(T0-4)时测定机械痛阈.于T4时痛阈测定后取左侧脊髓背角,采用RT-PCR法测定OFQ mRNA和BDNF mRNA的表达.结果 与NS组比较,IP组机械痛阈降低,脊髓背角OFQ mRNA及BDNF mRNA表达上调(P＜0.05或0.01);与IP组比较,M组T1,2时机械痛阈升高,脊髓背角OFQ mRNA及BDNF mRNA表达上调(P＜0.05或0.01),T3,4时机械痛阈差异无统计学意义(P＞0.05);与M组比较,R组机械痛阈升高,脊髓背角OFQ mRNA及BDNF mRNA表达下调(P＜0.05或0.01).结论 炎性痛大鼠长期注射吗啡时脊髓GT功能降低,导致谷氨酸水平升高和OFQ、BDNF表达上调之间的失衡,可能在吗啡耐受形成中起到一定作用.     

脊髓糖皮质激素受体在吗啡耐受大鼠PI3K/Akt信号通路中的作用

目的 探讨脊髓糖皮质激素受体(GR)在吗啡耐受大鼠磷脂酰肌醇-3激酶/蛋白激酶B(PI3K/Akt)信号通路中的作用.方法 健康雄性SD大鼠,8～ 10周龄,体重300 ～ 350 g,取鞘内置管成功的大鼠40只,采用随机数字表法,将大鼠随机分为4组(n=10):对照组(C组)鞘内注射生理盐水10μl;吗啡耐受组(M组)鞘内注射吗啡10 μg;地塞米松组(GR激动剂,DEX组)鞘内注射地塞米松4μg,30 min后注射吗啡10 μg; RU38486组(GR阻断剂,R组)鞘内注射RU38486 2 μg,30 min后注射吗啡10 μg.注射药物容量均为10μl,2次/d,连续7d.于每天第1次鞘内给药前和鞘内给药结束后1d测定甩尾潜伏期,计算最大抗伤害效应百分比( MPAE),最后一次甩尾潜伏期测定结束后,取脊髓背角组织,测定PI3K、Caspase-3的表达水平和Akt活性.结果 M组、DEX组和R组发生了吗啡耐受,C组未发生吗啡耐受.与C组比较,M组脊髓背角Akt活性降低,PI3K表达下调,Caspase-3表达上调(P＜0.01);与M组比较,DEX组MPAE和Akt活性降低,PI3K表达下调,Caspase-3表达上调,R组MPAE和Akt活性升高,PI3K表达上调,Caspase-3表达下调(P＜0.05).结论 脊髓GR可通过抑制PI3K/Akt信号通路参与吗啡耐受的形成.     

异丙酚超前镇痛作用的实验研究

目的：研究亚睡眠剂量异丙酚在脊髓的超前镇痛作用。方法：SD大鼠15只,随机分为对照组(F S)、异丙酚预注组(P F)、异丙酚后注组(F P)三组。动物右侧后肢跖部皮下注射4％福尔马林100μl。P F、F P组分别在注射福尔马林前和后1min静脉注射异丙酚5mg／L,观察动物疼痛反应。1h后用Fos免疫组织化学方法观察脊髓内c—fos基因的表达。结果：预注或后注异丙酚对福尔马林所致疼痛反应和脊髓内c—fos表达有明显的抑制作用,且预注异丙酚的作用明显强于后注异丙酚。结论：亚睡眠剂量异丙酚在脊髓有镇痛作用,而预注异丙酚可发挥超前镇痛作用。     

异丙酚对福尔马林致痛大鼠脊髓Fos表达的影响

目的：研究脊髓结构对福尔马林痛刺激的反应及异丙酚对其的影响。方法：采用福尔马林致痛模型及c-fos基因免疫组织化学方法（ABC法）。SD大鼠30只,随机分为6组：2．5％福尔马林注射于大鼠一侧前爪掌心皮下组、福尔马林痛刺激后腹腔注射异丙酚组、福尔马林痛刺激后腹腔注射同等容量生理盐水组、腹腔注射异丙酚后再行福尔马林痛刺激组、腹腔注射同等剂量异丙酚组、腹腔注射等容量生理盐水6组,取脊髓切片。结果：（1）予福尔马林痛刺激后,刺激侧脊髓背角出现大量Fos免疫样阳性神经元,I层及Ⅱ层外带的内侧部最为密集;（2）痛刺激之前或之后给予异丙酚,脊髓背角各层Fos免疫样阳性神经元的数量均减少（P＜0．01）,痛刺激之前给药效果优于痛后给药（P＜0．05）;（3）单纯腹腔注射异丙酚或生理盐水,脊髓未见或偶见Fos免疫样阳性神经元。结论：同侧相应脊髓节段的某些神经元参与了化学性致痛信息的传导和调控,异丙酚可抑制这些神经元的活动,从而产生一定的抗伤害作用。     

丙泊酚诱导Fos蛋白与脑啡肽在大鼠脊髓共同表达

目的;研究丙泊酚在脊髓的镇痛机制。方法：SD大鼠12只,随机分为对照组,丙泊酚I组（20mg/kg),丙泊酚II组（100mg/kg),药物经腹腔注射,运用免疫组织化学双标法观察丙泊酚诱导大鼠脊髓内Fos蛋白与脑啡肽（ENK）的表达。结果：对照组脊髓中可见较多ENK染色阳性神经元（ELIN）,偶见Fos染色阳性神经元（FLIN）散在分布,无Fos,ENK双标记神经元（ELI／ELIN）;丙泊酚组可见较多ELIN,FLIN分布,而且可见FLI／ELIN,主要分布于脊髓后角,三种染色阳性神经元数量明显大于对照组（P＜0．05）,而且丙泊酚两组音差异显著（P＜0．05）,结论：丙泊酚可增加脊髓内ENK含量,诱导Fos蛋白与脑啡肽共同表达,诱导c-fos基因表达调节前脑啡肽基因,增加ENK含量可能是丙泊酚在脊髓重要的镇痛机制。     

布托啡诺对福尔马林致痛大鼠脊髓Fos蛋白表达的影响

目的 探讨布托啡诺对福尔马林致痛大鼠脊髓Fos蛋白表达的影响.方法 SD大鼠25只,随机分为5组(n=5):生理盐水组(NS组)、福尔马林组(F组)、芬太尼-福尔马林组(FF组)、布托啡诺-福尔马林Ⅰ组(BF1,组)和布托啡诺-福尔马林Ⅱ组(BF2组).NS组和F组腹腔注射0.9%生理盐水500μl,FF组、BF1组和BF2组分别腹腔注射0.1 ms/kg芬太尼、1 mg/kg布托啡诺和2mg/kg布托啡诺,药物均用生理盐水稀释至500μl,5 min后NS组右侧后肢跖部皮下注射生理盐水150μl,其余各组均注射4%福尔马林15μl.于注射福尔马林后5、lO、20、30、45、60、90、120 min时记录痛行为学评分;注射布托啡诺后2 h时处死大鼠,取L3～L5段脊髓,采用免疫组化法测定脊髓Fos蛋白表达水平.结果 与NS组比较,其余各组痛行为学评分升高,脊髓Fos蛋白表达上调(P<0.05);与F组比较,FF组、BF1组和BF2组痛行为学评分降低,脊髓Fos蛋白表达下调(P<0.05);与FF组比较,BF1组痛行为学评分升高,脊髓Fos蛋白表达上调(P<0.05),BF2组差异无统计学意义(P>0.05);与BF1组比较,BF2组痛行为学评分降低,脊髓Fos蛋白表达下调(P<0.05).结论 布托啡诺可减轻大鼠福尔马林致痛程度,其机制与抑制脊髓Fos蛋白表达上调有关,其效应呈剂量依赖性.     

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.