腔内支架植入治疗TASCⅡ C、D型股腘动脉慢性闭塞病变

目的 探讨泛大西洋协作组织(TransAtlantic InterSociety Consensus,TASC)ⅡC、D型股腘动脉慢性闭塞腔内支架治疗的临床疗效.方法 回顾性分析2008年1月至2011年6月46例(51条下肢)TASCⅡC型和D型股腘动脉闭塞患者腔内治疗的临床资料.46例中男27例,女19例,年龄52～88岁,平均(70 ±8)岁.术前Rutherford症状分级:3级重度间歇性跛行29条,4级静息痛12条,5级轻微组织缺损6条,6级组织溃疡、坏疽4条.总结分析技术成功率、患肢术后临床症状、踝肱指数(ankle brachial index,ABI)变化,并发症发生率和通畅率.结果 技术成功率90.2％ (42/51),治疗成功者共植入支架93枚.术后ABI 0.71 ±0.23,较术前0.42 ±0.13提高,两者差异有统计学意义(t=-7.281,P＜0.01).42例技术成功者均获随访,平均随访(14.6±1.2)个月.术后6个月的一期通畅率、辅助通畅率和累积通畅率分别为81.0％、88.1％、90.5％,术后12个月的一期通畅率、辅助通畅率和累积通畅率分别为66.7％、71.8％、79.5％.结论 TASCⅡC、D型股腘动脉慢性闭塞腔内治疗是一种安全有效的方法.     

TASCⅡ C、D型股腘动脉闭塞腔内治疗的操作技巧与疗效分析

目的观察TASCⅡ C、D型股腘动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧。方法 2009年1月～2010年6月,89例(113条患肢)TASCⅡ C、D型股腘动脉闭塞患者接受腔内治疗。对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析。结果成功开通病变肢体共106条,技术成功率93.8%。36条(34.0%)患肢出现并发症。75例患者(共92条下肢)获得随访,随访率为86.8%。平均随访时间12.5个月。术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P<0.01)。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%。结论 TASCⅡ C、D型股腘动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键。     

腘动脉局域超选技术用于股浅动脉内膜下顺行开通

目的 研究腘动脉局域超选法在完成股浅动脉顺向内膜下开通中的作用.方法 2009年1月至2011年12月对467例患者(550条肢体)行腔内治疗,病变均为泛大西洋协作组(Trans-Atlantic Inter-Society Consensus,TASC)定义的ⅡC/D级股腘动脉闭塞.统计其中直接应用腘动脉局域超选技术和传统真腔超选方法的62条肢体,观察其手术成功率、手术时间、症状改善和随访情况.结果 在550条肢体中,62条肢体直接应用了腘动脉局域超选技术,其中9条肢体未能顺向返回真腔操作.53条肢体(85.5％)完成手术,平均手术时间(69 ±24) min,平均支架应用数(1.8±0.6)枚,平均覆盖长度(33 ±6) cm.46条肢体(86.8％)术后早期症状有所改善,6条无明显变化,1条截肢.39条肢体术后随访1年,6个月通畅率为87.1％,12个月通畅率69.2％.另外488条肢体应用传统超选方法的肢体中,完成顺向开通378条(77.5％),平均手术时间(89±30)min,平均支架应用数(2.1±0.6)枚,平均覆盖长度(31 ±13) cm.79.4％( 300/378)的肢体术后早期症状得到改善,292条肢体进行了术后1年的随访,6个月通畅率为92.1(269/292),12个月通畅率61.0％(178/292).结论 股浅动脉长段闭塞患者的腔内治疗中,采用腘动脉局部超选法可以在不增加移植物基础上有效缩短手术时间.     

开放手术与腔内治疗对股腘动脉闭塞的疗效评价

目的：探讨TASC II C、D型股腘动脉闭塞的治疗效果。方法：将TASC II C、D型股腘动脉闭塞性病变178例患者回顾性分为观察组82例（开放手术组）和对照组96例（腔内治疗组）,对其疗效和并发症进行评估。结果：术后1周、3个月,观察组通畅率及踝肱指数（ABI）略高于对照组（P〉0.05）;术后6、12、24个月,观察组通畅率及ABI明显高于对照组（P〈0.05）;观察组心脑血管不良事发生率高于对照组（P〈0.01）。结论：TASC II C、D型股腘动脉慢性闭塞性病变,开放手术治疗后ABI改善情况及中远期通畅率高于腔内治疗组。     

TASCⅡC、D型股胭动脉闭塞腔内治疗的操作技巧与疗效分析

目的 观察TASCⅡC、D型股胭动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧.方法 2009年1月～20lO年6月,89例(113条患肢)TAsCⅡC、D型股胭动脉闭塞患者接受腔内治疗.对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析.结果 成功开通病变肢体共106条,技术成功率93.8%.36条(34.0%)患肢出现并发症.75例患者(共92条下肢)获得随访,随访率为86.8%.平均随访时间12.5个月.术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P＜0.01).术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%.结论 TASCⅡC、D型股腘动脉闭塞腔内治疗是一种安全有效的方法.熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键.     

SilverHawk斑块切除系统用于治疗股腘动脉硬化性闭塞症

目的 评价SilverHawk斑块切除系统治疗股腘动脉硬化性闭塞症的安全性及近期疗效. 方法 2011年4月至2012年5月采用SilverHawk斑块切除系统治疗股腘动脉硬化性闭塞症患者36例(40条动脉).男28例,女8例,年龄60 ～ 84岁,平均(72 ±6)岁.所有患者术前均行下肢动脉CTA检查及动脉造影明确诊断,其中股腘动脉原发性病变25条动脉,股腘动脉支架内再闭塞15条.按泛大西洋协作组(TransAtlantic Inter-Society Consensus,TASC)Ⅱ分型A、B、C、D型病变分别为6、6、9、4条;Rutherford分级3～5级,术前踝肱指数(ankle brachial index,ABI) 0.53±0.12.结果 本组技术成功率100％,治疗成功率87.5％ (35/40),无死亡病例.3例术中出现并发症:2例为血管损伤,其中1例采用覆膜支架处理,另1例因出血不严重,未予特殊处理;1例发生远侧肢体动脉栓塞,采用导管吸栓.所有患者术后症状较术前减轻,术后ABI 0.72±0.18.所有患者均获得随访,平均(6.4±1.2)个月.其中1例在术后6个月出现再狭窄,再次置入球囊扩支架;对3例出现并发症患者行彩超随访,患肢股腘动脉病变段及栓塞处动脉通畅.结论 SilverHawk斑块切除系统治疗股腘动脉硬化性闭塞症安全有效,近期效果满意.     

TASC II-C/D型股腘动脉闭塞症的腔内治疗

目的探讨腔内治疗TASC Ⅱ-C/D型股腘动脉闭塞症的可行性及有效性。方法回顾性分析2008年9月—2011年2月行腔内治疗的TASC Ⅱ-C/D型股腘动脉闭塞症74例患者资料,并随访观察手术效果。结果手术成功率92.6%,未出现严重围手术期并发症;术后踝肱指数(ABI)及趾肱指数(TBI)与术前相比均有明显升高(均P<0.01)。69例术后随访2～24个月,术后6,12,24个月患肢血管通畅率分别为81%,63%,51%,临床症状缓解率分别为92%,83%,76%。结论腔内治疗TASC Ⅱ-C/D型股腘动脉硬化闭塞症近期疗效满意,可作为高龄、手术耐受性差患者的首选治疗方法,远期疗效有待于进一步观察。     

股腘动脉闭塞腔内成形术与旁路转流术的临床疗效对比分析

目的探讨股腘动脉闭塞行腔内治疗和旁路转流术的临床疗效。方法回顾性分析2008年1月至2011年12月本院收治的60例(67条肢体)股腘动脉闭塞(TASCⅡC/D型)患者的临床资料,其中腔内治疗41例(47条肢体,腔内治疗组),旁路转流术19例(20条肢体,旁路转流术组),比较两组患者的手术时间、术中出血量、术后恢复行走时间、踝肱指数(ABI)及随访1~4年的通畅率及保肢率。结果腔内治疗组术中出血量、手术时间及术后恢复行走时间明显少于旁路转流术组(P0.01);两组术后ABI及技术成功率比较差异无统计学意义(P0.05)。术后6~12个月的随访,腔内治疗组一期通畅率与旁路转流术组的通畅率比较,差异无统计学意义(43.6%vs 50.0%,P0.05);术后18~48个月的随访,腔内治疗组二期通畅率及保肢率高于旁路转流术组,两组比较差异有统计学意义(79.5%vs 50.0%,P0.05)。结论腔内治疗与旁路转流术治疗TASCⅡC/D型股腘动脉闭塞患者在短期内均能取得满意临床疗效及较好通畅率;但腔内治疗有着微创、术后恢复快等优点,且具有可重复操作性,有助于提高患肢远期血管通畅率。     

老年人下肢动脉硬化闭塞症腔内治疗效果分析

目的 分析老年人下肢动脉硬化闭塞症腔内治疗的临床效果及影响预后的因素.方法 回顾性总结2006年1月至2008年11月收治的86例(98条肢体)下肢动脉硬化闭塞症老年患者的临床资料.本组患者男性56例,女性30例;年龄60～82岁,平均(70±6)岁.临床症状包括重度间歇性跛行54条肢体,静息痛28条肢体,肢体溃疡11条肢体,严重坏疽5条肢体.主髂动脉病变25条肢体,股腘动脉段病变33条肢体,胫腓动脉病变8条肢体,髂股腘动脉多节段病变32条肢体.全部患者接受下肢动脉腔内治疗,总结围手术期要点及影响预后的主要因素.结果 急诊手术8条肢体,择期手术90条肢体.单纯行球囊成形10条肢体,球囊成形+支架植入88条肢体.手术成功率95.9%,围手术期严重并发症5例(5.1%),其中心肌梗死2例,一期大腿截肢2例,不可逆造影剂肾病1例.无围手术期死亡.全组83例患者术后随访1～35个月,平均(18±10)个月,随访率96.5%.随访期内死亡2例,病死率2.3%.血管一期通畅率83.7%,二期通畅率94.9%.踝关节以上截肢4例,保肢率95.9%;另有6例行截趾或截足.因素分析显示,治疗效果与糖尿病史、缺血程度和病变范围相关.结论 下肢动脉腔内重建具有微创、安全以及可重复性等优点,应作为治疗老年下肢缺血首先考虑的治疗方法.糖尿病史、缺血程度和病变范围是影响下肢动脉腔内重建效果的主要因素.     

逆行开通技术治疗TASCⅡ C/D型股腘动脉硬化闭塞症

目的探讨逆行开通技术治疗TASCⅡ C/D型股腘动脉闭塞病变的价值。方法回顾性分析于我院接受逆行开通技术治疗的TASCⅡ C/D型股腘动脉硬化闭塞症患者36例。比较术前与术后踝肱指数(ABI)及间歇性跛行距离,分析术后血管通畅率及并发症。结果 36例均成功开通,术后7天及3、6、12个月间歇性跛行距离和ABI均较术前均明显增加(P均0.05)。术后3、6及12个月患肢血管通畅率分别为97.22%、91.67%及72.22%。随访期间无死亡或截肢,围手术期并发症发生率11.11%(4/36)。结论逆行开通技术可作为顺行开通TASCⅡ C/D型股腘动脉硬化闭塞症失败后的一种补救方法。     

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.