后方韧带复合体损伤对腰椎后路椎间融合术后邻近节段影响的有限元分析

目的 利用三维有限元分析方法量化评价后方韧带复合体损伤(posterior ligament complex, PLC)对腰椎后路椎间融合术后邻近节段椎间盘和小关节的生物力学影响。方法 建立正常的腰骶椎(L₁-S₁)三维有限元模型(normal model, Nm),分别建立单纯融合模型(fusion model, Fm)、腰椎后路椎间融合模型(posterior lumbar interbody fusion model, PLIFm)、切除上邻近节段PLC的腰椎后路椎间融合模型(PLC resection and posterior lumbar interbody fusion model, PR&PLIFm),在相同的预载荷和力矩加载下进行前屈、后伸、侧弯和扭转运动,分析比较4组模型手术及邻近节段的活动度(range of motion, ROM)、椎间盘应力和小关节接触力变化。结果 成功建立了正常有效的腰骶椎有限元模型及3种融合模型。3种融合模型均出现邻近节段ROM和椎间盘应力的不同程度增加,PLIFm和PR&PLI...     

后路枕骨髁螺钉内固定系统的生物力学研究

目的 :通过对后路枕骨髁螺钉内固定系统治疗枕颈部不稳的生物力学研究,为其临床应用提供理论依据。方法:选取6具年龄32~55岁,身高155~180cm的颈椎尸体标本,不做手术处理建立正常模型,切断标本的寰椎横韧带、齿状突尖韧带、翼状韧带,制作枕颈不稳模型,枕骨髁螺钉的置钉固定建立枕骨髁螺钉内固定模型,分别给予三个模型枕骨1.5N·m的屈伸、侧弯、旋转力矩,测量标本C0~C1与C0~C2的前屈后伸、侧弯、旋转的运动范围(range of motion,ROM),分析比较正常模型、失稳模型及内固定模型的运动范围改变,评价枕骨髁螺钉内固定系统的生物力学有效性。结果:在C0~C1节段上,正常模型的前屈、后伸、侧弯、旋转活动度分别为:14.13°±0.71°、7.60°±0.43°、3.77°±0.27°、5.42°±0.44°,失稳模型的活动度分别为23.57°±2.26°、11.96°±1.44°、5.21°±0.29°、7.13°±0.67°,枕骨髁螺钉内固定模型的活动度分别为7.53°±0.77°、3.79°±0.64°、2.56°±0.34°、0.89°±0.31°;而在C0~C2节段上,正常模型的前屈、后伸、侧弯、旋转活动度分别为:19.72°±0.71°、17.62°±0.97°、7.55°±0.51°、51.46°±3.11°,失稳模型的活动度分别为30.57°±2.32°、23.85°±0.91°、9.37°±0.55°、68.91°±6.25°,枕骨髁螺钉内固定模型的活动度分别为11.30°±0.66°、9.19°±0.63°、5.12°±0.59°、7.39°±0.76°。失稳模型的活动度大于正常模型,正常模型的活动度大于固定模型。结论:枕骨髁螺钉内固定系统能有效减少枕颈部的前屈、后伸、侧弯、旋转的运动范围,充分证明了该固定技术具有可靠的生物力学稳定性。     

腰椎峡部裂对上位脊椎稳定性影响的生物力学研究

目的:通过生物力学方法测量腰椎峡部裂模型上位脊椎三维活动范围,分析峡部裂上位脊椎稳定性,为腰椎峡部裂外科治疗提供新的理论依据.方法:9具成人新鲜腰椎标本,切断L5双侧椎弓峡部制成实验模型,通过脊柱三维运动试验机对造模前(正常组)及造模后(峡部裂组)标本施加前屈、后伸、左右侧弯和左右旋转10N·m力矩,由脊柱三维运动测量系统分析比较峡部裂组及正常组上位及同序脊椎节段的运动范围.结果:9具标本峡部裂组上位脊椎(L4)在前屈、后伸及旋转活动范围均值分别是12.71°、4.79°、3.71°,正常组均值分别为10.41°、3.70°、2.78°,两组比较有显著性差异(P值均＜0.01),峡部裂组分别增加了22.1%、29.4%、33.8%,而侧屈活动范围峡部裂组均值为7.74°,正常组为7.67°,两组比较无显著性差异(P＞0.05).峡部裂同序脊椎(L5)在前屈、后伸及旋转活动范围均值分别为12.69°、6.29°、4.10°,正常组均值分别为10.12°、5.19°、3.01°,两组比较有显著性差异(P值均＜0.01),峡部裂组分别增加25.4%、44.1%、36.4%,而侧屈活动范围峡部裂组为6.12°,正常组为6.06°,两组比较无显著性差异(P＞0.05).结论:腰椎峡部裂对上位脊椎稳定也有重要影响,可导致上位脊椎在前屈、后伸和旋转方向失稳.     

老年膝骨关节炎患者膝关节肌力与骨密度相关性分析

目的探讨老年膝骨关节炎(knee osteoarthritis,KOA)患者膝关节肌力与骨密度(bone mineral density,BMD)的相关关系。方法采用多关节等速力量测试与训练系统测试老年KOA患者膝关节肌力;采用双能X线骨密度仪检测老年KOA患者BMD,并分析两者之间的关系。结果 (1)老年KOA患者主患侧伸膝肌群峰力矩、相对峰力矩均显著低于对侧。(2)老年KOA患者双侧膝关节肌力部分指标与BMD相关,在等长等速模式下,伸膝肌群峰力矩与髋关节以及L1-L4 BMD呈正相关;屈膝肌群峰力矩与股骨颈、髋关节以及L1-L4 BMD呈正相关。(3)老年KOA患者主患侧膝关节肌力部分指标与BMD有一定相关性,在等速模式下,屈膝肌群峰力矩以及相对峰力矩与主患侧髋关节以及股骨颈BMD呈正相关;在等长等速模式下,伸膝以及屈膝肌群峰力矩与L1-L4 BMD呈正相关。结论老年KOA患者膝关节肌力与骨密度之间存在相关性。加强膝关节肌力锻炼,特别要加强主患侧屈膝肌群肌力锻炼,可能会提高髋关节、股骨颈以及腰椎BMD,从而预防骨质疏松。     

骶骨倾斜角与腰椎峡部应力相关性有限元分析

目的基于有限元分析研究不同骶骨倾斜角(SS)在不同运动状态下对腰椎峡部存在的力学机制的影响。方法研究于2021年11月3日于新疆军区总医院完成CT数据扫描, 利用Mimics、3-matic构建不同SS的腰骶模型, 将其分为SS=30°组、SS=35°组、SS=40°组、SS=45°组、SS=50°组, 利用Solidworks进行椎间盘, 软骨重建, 在Ansys有限元软件中模拟直立、前屈、后伸、侧弯, 轴向旋转、前屈+侧弯、前屈+轴向旋转、后伸+侧弯、后伸+轴向旋转运动状态。多组间均数比较采用One-way ANOVA分析。结果第五腰椎-第一骶骨(L5-S1)活动度随SS增加呈上升趋势:SS=50°组高于SS=45°组[(2.81±1.33)°比(2.35±1.36)°, F=101.72, P<0.01], SS=45°组高于SS=40°组[(2.35±1.36)°比(1.86±0.92)°, F=52.35, P<0.01], SS=40°组高于SS=35°组[(1.86±0.92)°比(1.52±0.86)°, F=16.42, P<0.05], SS=35...     

脊柱失稳节段经椎弓根螺钉内固定器固定后对邻近节段三维运动的影响

目的研究经椎弓根螺钉内固定器固定脊柱失稳节段后对邻近节段三维运动范围的影响.方法在7例新鲜成人尸体T10～L4脊柱标本上,模拟L1骨折后安放经椎弓根螺钉内固定器,在10.0N@m载荷下进行三维运动测试.分析脊柱固定阶段(T12～L2)、邻近节段(T11～T12、L2～L3)和总节段(T11～L3)的前屈、后伸、轴向旋转和侧弯运动范围.结果经椎弓根螺钉内固定器固定后能使固定节段屈伸、侧弯运动方向上运动范围减少,轴线旋转运动恢复至正常完整节段运动范围.但同时邻近节段屈伸、侧弯运动运动范围增加,轴向旋转运动范围无明显变化.固定后总节段比正常完整总节段屈伸、侧弯运动运动范围增加,轴向旋转运动范围无明显变化.结论经椎弓根螺钉内固定器固定使邻近节段屈伸和侧弯运动范围代偿性增加,但不能代偿丢失的运动范围,对邻近节段的轴向旋转无明显影响.     

椎体成形术治疗老年骨质疏松椎体压缩骨折对邻近节段生物力学的影响

目的:应用三维有限元模型探讨椎体成形术治疗老年骨质疏松椎体压缩性骨折对邻近节段生物力学的影响.方法:选取1例老年骨质疏松椎体(T12)压缩性骨折女性患者的术前、球囊扩张后凸成形术(KP)术后CT片,范围为T11～L1(包括病椎、邻近椎体和邻近椎间盘),分别建立术前、术后的三维脊柱功能单元的有限元模型.对T11上终板垂直向下加载300N的力矩和10N·m的旋转力矩,分析在垂直载倚、前屈、后伸、侧屈及旋转的情况下,手术前后病变椎体的变化以及椎体皮质骨、松质骨、相邻椎间蕊、终板的应力改变情况.结果:成功建立术前、术后脊柱功能单元的三维有限元模型,术前T12椎体前、中缘高度分别为13.1mm和10.9mm,术后分别为15.2mm和12.6mm,明显增高(P<0.05).在垂直载荷应力下,邻近椎体上下终板(T11下终板和L1上终板)所受应力无显著变化,但在前屈、后伸、侧屈、轴向旋转时T11/12椎间盘所受压力分别增加0.66、0.88、2.25、0.85MPa;T12/L1椎间盘所受压力分别增加1.56、1.60、0.50、2.35MPa,与术前比较均有显著性差异(P<0.05).结论:球囊扩张后凸成形术有效改善了脊柱功能单位的生物力学性能,并未对邻近椎体产生较大的影响,但可能会加速邻近椎间盘的退变.     

腰椎髓核摘除后小关节应力分析

[目的]研究L4、5正常腰椎节段、髓核摘除术后腰椎节段小关节的应力大小和分布情况.[方法]利用有限元软件Ansys,建立L4、5正常节段和髓核摘除术后三维有限元模型.固定模型L5椎体下终板,在L4椎体上终板施加400 N的轴向压缩载荷,并在L4椎体上终板分别向模型施加前屈、后伸和右旋转力,力矩大小均为6 Nm.分析各个状态下腰椎小关节的应力分布情况.[结果]建立了L4、5腰椎节段正常、髓核摘除术后的三维有限元模型.小关节处理为三维接触模型,线性、面接触单元,无摩擦,由上下关节突关节面及韧带结构组成.正常模型两侧小关节在右旋转时均产生较大应力,而以左侧小关节产生应力更大.髓核摘除模型在前屈、后伸、旋转时小关节的应力均增加.[结论]在腰椎不同的运动状态下,两侧小关节面各个部位的接触情况是不同的,应力大小和分布也是变化的.髓核摘除后腰椎前柱的承载功能减弱,小关节等后柱结构分担载荷增大.     

马尾神经内多发性神经鞘瘤1例报告

<正>1资料与方法罗某,男,24岁,因腰骶部及右下肢酸痛1年入院。专科查体示:脊柱生理弯曲腰段平直,无台阶感,屈颈试验(-),仰卧挺腹试验(+),腰椎后伸活动受限,前屈65°、后伸15°、左侧弯25°、右侧弯20°、旋转25°,L4~5、S1棘间隙及椎板压痛不明显、叩击痛(+),以L4~5椎间隙为甚,双髂腰肌肌力基本正常,双侧下肢直腿抬高试验及加强试验阳性:右侧     

微创经椎间孔入路腰椎椎体间融合术对腰椎多裂肌影响的MRI评估

目的应用MRI技术探讨微创经椎间孔入路腰椎椎体间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)对腰椎多裂肌的影响及其临床意义。方法选取2016年9月至2019年7月青岛大学附属医院因单节段(L3,4、L4,5、L5S1)单侧症状椎间盘突出症接受MIS-TLIF手术者23例,均于手术前1周内和手术后3、6个月行腰椎MR检查,在轴位T2加权像测量术前及术后椎间盘不同层面对应轴切面的多裂肌截面积(axial section of multifidus muscle cross section area,AxCSA)、长短径线比值(ratio of long and short lines,RLS)、多裂肌脂肪浸润截面积(axial section of muscle fat infiltration cross section area,FLSA)与AxCSA比值记为FLSA/AxCSA。比较患者手术前后腰椎患侧和健侧、病变与非病变节段多裂肌各项指标的变化,观察MIS-TLIF术式...     

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.