下腰椎间盘退变与两侧髂骨连线高度的相关性研究报告

目的研究髂嵴联线高度与腰椎间盘损伤和退变的关系。方法根据两侧髂嵴最高点连线与腰椎正中线交点,将两侧髂嵴最高点连线与腰椎的关系分成四组,即连线在L4椎下缘以上者为A组、连线在L4-5椎间隙为B组、连线在L5椎体上缘以下至L5椎中1/2部分为C组、连线和L5椎中1/2以下者为D组。结果A组L3-4椎间盘突出最多,L5-S1则最少;D组L3-4椎间盘突出最少,L5-S1则最多,二组相比均有显著差异。结论两侧髂嵴联线高度是L3-4、L5-S1椎间盘损伤和退变的重要影响因素。     

后路螺纹式Cage植骨治疗退变性腰椎间盘病变

目的 通过后路螺纹式Ca8e植骨治疗退变性腰椎问盘病变，探讨其治疗机制与手术效果。方法后路螺纹式Ca8e植骨治疗22例退变性腰椎间盘病变患者。L4、5椎间盘病变13例，其中L4、5椎间行TFC植骨，同时伴有L5S1椎间盘突出，又行L5S1椎间盘摘除术者4例；L5S1椎间盘病变9例，其中L5S1椎间行TFC植骨，同时伴有L4-5椎间盘突出，又行L4，5椎间盘摘除术者2例。有8例病人有I度椎体滑脱，同时行后路椎弓根钉内固定术。结果 本组病例随访2—21个月，平均11．5个月。按Nakai标准评定疗效：优20例，占90．9％；良2例，占9．1％。所有病人术后半年均已见植骨融合，Cage无移位，椎间隙无塌陷。结论 后路螺纹式Cage植骨能有效地撑开或保持受累椎间隙、扩大椎间孔、提供术后即刻稳定性，并可固定移植骨，骨融合可靠，是治疗退变性腰椎间盘病变最为有效的方法之一。     

腰椎间盘突出症骨性椎间孔的测量分析

目的研究腰椎间盘突出症骨性椎间孔的病理变化规律,探讨腰椎间孔狭窄的发病机制。方法对100例无下腰痛病史及腰椎畸形的人群(正常组)和59例L4～5椎间盘突出症患者(L4～5突出组)拍摄标准腰椎X线侧位片。在侧位片上分别测量L3～4及L4～5椎间隙高度、椎间孔高度、椎间孔上部宽度;采用"同身法"处理后进行统计分析。结果 L4～5突出组病变椎间隙高度、椎间孔高度和椎间孔上部宽度均较正常组明显变小(P<0.001);椎间孔高度与椎间隙高度变化正相关;椎间孔上部宽度与椎间孔高度变化正相关。结论 L4～5椎间盘突出症患者的病变节段骨性椎间孔高度和上部宽度明显变小,腰椎间孔有效空间明显减少;椎间孔的高度随腰椎间盘退变的加重而减小;腰椎间盘退变对腰椎间孔上部宽度无直接影响;腰椎间孔高度和上部宽度的变化有关联性。     

后路螺纹式Cage植骨治疗退变性腰椎间盘病变

目的　通过后路螺纹式Cage植骨治疗退变性腰椎间盘病变 ,探讨其治疗机制与手术效果。 方法　后路螺纹式Cage植骨治疗 2 2例退变性腰椎间盘病变患者。L4、5椎间盘病变 13例 ,其中L4、5椎间行TFC植骨 ,同时伴有L5S1椎间盘突出 ,又行L5S1椎间盘摘除术者 4例 ;L5S1椎间盘病变 9例 ,其中L5S1椎间行TFC植骨 ,同时伴有L4、5椎间盘突出 ,又行L4、5椎间盘摘除术者 2例。有 8例病人有Ⅰ度椎体滑脱 ,同时行后路椎弓根钉内固定术。结果　本组病例随访 2～ 2 1个月 ,平均 11 5个月。按Nakai标准评定疗效 :优 2 0例 ,占 90 9% ;良 2例 ,占 9 1%。所有病人术后半年均已见植骨融合 ,Cage无移位 ,椎间隙无塌陷。结论　后路螺纹式Cage植骨能有效地撑开或保持受累椎间隙、扩大椎间孔、提供术后即刻稳定性 ,并可固定移植骨 ,骨融合可靠 ,是治疗退变性腰椎间盘病变最为有效的方法之一。     

骶骨倾斜角和髂嵴连线对下腰椎间盘突出症发病的影响

目的 探讨骶骨倾斜角和髂嵴高度对下腰椎间盘突出症发病的影响.方法 对本院骨科2016年1月～2019年12月收治的100例单纯L4-5或L5-S1腰椎间盘突出症患者进行回顾性分析.分别测量并比较两组患者的骶骨倾斜角和髂嵴连线高度.骶骨倾斜角在腰椎CT正中矢状位上测量,两侧髂嵴连线高度于腰椎正位X线片上测量,将L4-5椎间隙平均分为3等份,L4和L5椎体各自平均分为4等份,L4-5椎间隙中1/3赋值0,上方为正值1～5,下方为负值-1～-5.结果 两组骶骨倾斜角和髂嵴高度比较有显著差异,L4-5组骶骨倾斜角和髂嵴高度显著高于L5-S1组(P<0.05).结论 高髂嵴、骶骨倾斜角度大的人群易发生L4-5椎间盘突出;反之,易发生L5-S1椎间盘突出.     

插入型椎问融合器在腰椎不稳症中的应用

目的探讨应用插入型椎间融合器治疗腰椎不稳症的临床疗效。方法采用插入型椎间融合器治疗腰椎不稳43例，52个节段。椎间盘突出症13例，椎管狭窄症19例，退变性椎体滑脱7例，椎弓崩裂性滑脱4例。使用两种插入式融合器：高分子聚醚醚酮融合器31例，表面钛涂层融合器12例。均行后路椎间融合术(PLIF)。测量术前、术后3个月及末次随访的椎间隙及椎间孔高度，椎体间活动域，采用Oswestry功能障碍指数进行疗效评定。结果全部病例均得到随访，平均随访时间21个月。融合率90．7％。椎间隙及椎间孔高度得到满意恢复。疗效评定结果术后3个月及末次随访优良率分别为86．1％及93．1％。结论插入型椎间融合器应用于腰椎不稳的治疗是安全、有效的方法。     

两种棘突间动态稳定系统置入后对腰椎结构的影响变化及对比分析

[目的]对比分析两种棘突间动态稳定系统(X-Stop和Wallis)置入后对腰椎结构的影响变化。[方法]2009年11月²011年8月收治的61例L4/5节段腰椎间盘退变性疾病患者,按入院时间和自身对手术的选择随机分为X-Stop组(A组,33例)和Wallis组(B组,28例)。两组患者性别、年龄、病变节段、病程等一般资料比较差异无统计学意义(P>0.05),具有可比性。分别于X线片上测量L4/5节段手术前后的Cobb角度变化、椎间孔横径及纵径/L5椎体后缘高度、椎间隙高度/L5椎体后缘高度。[结果]A组术后Cobb角、椎间隙后高度/L5椎体高度、椎间孔横径/L5椎体高度、椎间孔纵径/L5椎体高度均较术前有显著变化,成增大趋势(P值分别为:0.016、0.000、0.001和0.001);B组术后Cobb角、椎间隙后高度/L5椎体高度、椎间孔横径/L5椎体高度、椎间孔纵径/L5椎体高度均较术前有显著变化,成增大趋势(P值分别为:0.000、0.000、0.001和0.000)。组间比较术前、术后变化,Cobb角(P=0.168>0.05)、椎间孔横径/L5椎体高度(P=0.884>0.05)、椎间孔横径/L5椎体高度(P=0.566>0.05)的变化差异,A、B两组无统计学意义,椎间隙后高度/L5椎体高度存在组间差别(P=0.002<0.05),椎间隙后高度在两种不同动态稳定系统置入后变化的趋势不同,其中A组椎间隙后高度增加趋势更大。[结论]X-Stop系统与Wallis系统均可恢复腰椎生理曲度,有效增大椎间孔面积和椎间隙高度,是治疗腰椎间盘退变性疾病的一种安全、有效的外科方法,但X-Stop系统在增加椎间隙高度方面较Wallis系统有优势,且具有操作方便,不损伤相邻节段棘间韧带等优势。     

经皮激光腰椎间盘减压术后腰椎关节突关节和椎间高度的变化

目的：观察经皮激光椎间盘减压术（percutaneous laser disc decompression，PLDD）治疗腰椎间盘突出症术后腰椎关节突关节和椎间高度的变化。方法：应用半导体激光系统对32例腰椎间盘突出症患者进行PLDD治疗。29例患者为单节段突出，其中L3/4 3例，L4／5 18例，L5/S1 8例；3例患者同时合并IA／5和L5/S1节段突出。利用Macnab标准评价随访患者的疗效，并观察术前、术后椎间盘突出节段关节突关节角的形态，测量L3，4、L4/5和L5／S1椎间高度指数和椎间盘突出节段关节突关节角的角度。结果：所有患者无术中和术后并发症。随访14～22个月，平均17个月，按Macnab标准评价：优14例（43．75％），良13例（40．63％）；可3例（9．37％），差2例（6．25％），优良率84．38％。术后L5/S1椎间高度指数与术前相比显著性下降（P〈0．05），但L3/4和L4／5椎间高度指数无显著性改变；关节突关节无明显退变；L4／5和L5／S1椎间盘突出侧的关节突关节角角度显著性下降（P〈0．05），但L3/4椎间盘突出侧的关节突关节角度无显著性改变。结论：经皮激光腰椎间盘减压术后患者的L5／S1椎间高度和腰椎间盘突出侧关节突关节角角度下降．有可能增加腰椎滑脱的风险。     

后路椎体间植骨融合术治疗老年腰椎间盘突出症

目的　探讨后路椎体间植骨融合术治疗老年椎间盘突出症的手术技术并评价其应用价值。方法　对明确诊断为老年椎间盘突出症的 36例患者进行后正中入路下的椎间盘切除 ,椎管狭窄减压 ,椎弓根螺钉植入并行椎间隙撑开 ,保留侧方以及前方的纤维环 ,刮除终板的软骨层 ,植入足量的松质骨以及椎板关节突切除物 ,最后植入双条三面皮质骨的髂骨块 ,椎弓根螺钉系统加压固定。结果　平均手术时间为 110 m in,平均失血量较常规手术多 10 0 m L。33例获得手术后的 3个月随访 ,原有的神经压迫症状大部分恢复 ,行走距离增加明显 ,下腰痛缓解最为明显。椎间高度术前 2 .6～ 6 .8m m,平均高度 4 .1mm,术后椎间高度 11.6～ 14 .2 m m,平均 12 .6 mm。在 3个月随访时平均高度为 10 .9～ 13.3mm,平均为 11.8mm。椎间孔 3个月后较术前增加 6 mm。 31例显示椎间隙的活动度小于 2°,椎体与植骨块交界处无透亮区。 2例植骨块有部分吸收 ,但症状改善。最常见的并发症为脑脊液漏和神经根牵拉刺激 ,最终缓解。结论　后路椎体间植骨融合结合椎弓根螺钉系统固定治疗老年腰椎间盘突出症满足充分减压 ,椎间隙高度恢复和稳定性重建以及长期可靠融合治疗的基本要素。     

经Quadrant通道单侧椎弓根置钉联合TLIF治疗下腰椎退行性疾病

目的探讨经Quadrant微创通道单边椎弓根置钉联合单枚Cage经椎间孔椎体间融合术治疗下腰椎退行性疾病中的疗效及手术并发症的预防。方法自2011年12月至2013年7月,应用Quadrant可扩张微创通道全层切开法对32例患者实行单侧椎弓根置钉,单枚Cage经椎间孔椎体间融合术。其中男23例,女9例;年龄22~57岁,平均37.3岁。椎间盘突出31例,单节段L3~42例,L4~515例,L5S113例;双节段L4~5~L5S11例。退行性下腰椎不稳1例。所有患者术前均有不同程度的下腰部疼痛,伴或不伴有单侧下肢放射性疼痛或感觉异常。观察手术时间,出血量,切口长度,住院时间,术后并发症情况。应用疼痛视觉模拟评分(visual analogue scale,VAS)进行术前和末次随访时疼痛评定,Nakai评定临床疗效,正侧位X线片观察植骨融合、椎间隙高度恢复情况。结果手术时间82~180 min,平均100 min;术中出血90~200 mL,平均120 mL;切口长度3~6 cm,平均4.5 cm;住院时间5~14 d,平均7 d。术后未出现切口区明显皮缘坏死、伤口感染等并发症。所有患者均获得随访,平均随访时间为8个月(3~16个月)。随访期间未见椎弓根钉棒松动、断裂,末次随访VAS评分由术前的(7.1±1.3)分降至(2.3±1.6)分。临床疗效评定:优15例,良11例,可6例,优良率81.25%。末次随访椎间融合率93.3%,椎间隙高度前缘由术前(1.31±0.33)cm升高到术后(1.54±0.21)cm;后缘由术前(0.55±0.11)cm升高到术后(0.65±0.1)cm。结论微创单侧椎弓根置钉联合椎间孔椎体间融合术手术时间短,出血少,对人体正常组织结构破坏小,治疗费用低,全层切开法对于预防皮缘坏死、脂肪液化具有良好的临床效果。     

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.