PACS系统在改良等腰三角形截骨治疗肘内翻中的辅助应用

[目的]探讨PACS系统在改良肱骨髁上等腰三角形截骨矫形联合锁定钢板内固定治疗肘内翻畸形中的辅助应用效果。[方法]回顾性分析本院2012年1月~2015年12月应用PACS系统在改良肱骨髁上等腰三角形截骨矫形联合锁定钢板内固定治疗27例肘内翻畸形的临床资料,术前使用PACS系统辅助对肘内翻患者进行改良肱骨髁上等腰三角形截骨设计,依据截骨角度计算等腰三角形截骨底边的长度,测量出截骨角度及长度,术中均行外侧切开改良等腰三角形截骨矫形联合锁定钢板内固定术。[结果]患者截骨处均获骨性愈合,愈合时间7~12周,平均9周。本组获随访12~36个月,平均15个月,末次随访时提携角8°~15°,平均11°。术后1年均采用Mayo肘关节功能评分标准(MEPS)评估手术疗效:优19例,良7例,中1例,优良率96.3%。[结论]术前辅助应用PACS系统对肘内翻患者进行改良肱骨髁上等腰三角形截骨设计,可以精确指导术中截骨角度及长度,能取得良好治疗效果。     

设计并应用改良肱骨髁上等腰三角形截骨矫形治疗肘内翻畸形北大核心CSCD

目的探讨辅助应用医学影像存档和传输系统（PACS）设计改良肱骨髁上等腰三角形截骨矫形并联合锁定钢板内固定治疗肘内翻畸形的效果。方法回顾性分析2012年1月至2016年7月期间收治的31例肘内翻畸形患者资料。男12例,女19例;年龄为17～24岁,平均20．6岁;肘内翻角为14°～35°,平均22．4°。术前使用PACS辅助对肘内翻畸形患者进行改良肱骨髁上等腰三角形截骨设计,根据截骨角度计算等腰三角形截骨长度,测量出截骨角度及长度,术中均行外侧切开改良等腰三角形截骨矫形联合锁定钢板内固定。结果31例患者术后获12～40个月（平均16个月）随访。31例患者截骨处均获骨性愈合,愈合时间为7—12周,平均9周。末次随访时提携角为8°～15°,平均11o;患侧肘关节屈伸活动范围为126°～150°,平均139°;旋转范围为134°～160°,平均144°。术后1年采用Mayo肘关节功能评分标准评定疗效：优23例,良7例,中1例,优良率为96．8％。随访期间未见提携角丢失、神经损伤、骨折畸形愈合及延迟愈合、肘关节骨化性肌炎等并发症发生。结论术前辅助应用PACS对肘内翻畸形患者进行改良肱骨髁上等腰三角形设计,可以精确指导术中截骨长度并确保矫正角度,获得良好疗效。     

"L"形钢板固定治疗儿童肘内翻

[目的]探讨比较儿童肘内翻矫形手术不同内固定的优缺点.[方法]临床25例肘内翻儿童,肘内翻截骨后应用＂L＂形解剖钢板固定,观察术后骨愈合、肘部提携角改善、肘关节功能和并发症情况.[结果]本组术后随诊1～2年,术后骨折线消失、骨愈合的时间为5～8周,平均6.4周.未发生骨不连,肘部提携角未发生丢失,肘关节伸屈功能良好,无神经损伤并发症.[结论]肘内翻肱骨髁上截骨后＂L＂形钢板内固定稳定,肘关节可早期活动、关节功能恢复良好,比常规克氏针、普通钢板或钢丝固定更安全、可靠.     

成人创伤后肘内翻畸形的矫形及双柱固定

目的探讨肱骨髁上截骨双钢板固定治疗成人创伤后肘内翻的方法及疗效。方法回顾性分析2007年6月-2010年12月手术治疗22例成人创伤后肘内翻畸形患者的临床资料。其中男16例,女6例;年龄18～29岁,平均21岁。既往均有肱骨髁上骨折病史;初次骨折后3个月～1年,平均6个月出现肘内翻畸形;出现畸形后4～17年,平均8年入院手术。术前患侧肘关节提携角为肘内翻16～25°,平均20.6°。肘关节功能采用Flynn评分均为差。术中行肱骨外侧闭合楔形截骨,以2块重建钢板塑形后分别置于肱骨内外侧柱以固定截骨断端。术后无需外固定,早期行功能锻炼。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间6～24个月,平均13个月。末次随访时患侧肘关节提携角为肘外翻0～10°,平均7.5°。患者截骨处均骨性愈合,愈合时间8～13周,平均10周。术后无感染,神经、血管损伤,内固定物松动、断裂等并发症发生,无肘内翻复发。末次随访时Flynn评分优17例,良3例,中2例,优良率91%。结论采用肱骨髁上截骨加双钢板固定治疗成人创伤后肘内翻畸形,固定坚强,骨折愈合率高,术后能早期功能锻炼,肘关节功能恢复满意。     

PACS系统在肘内翻肱骨髁上楔形截骨矫形术中的应用

目的探讨PACS系统在肘内翻肱骨髁上楔形截骨矫形术中的应用效果。方法采用外侧肱骨髁上楔形截骨内固定治疗58例肘内翻畸形患者,肘内翻角度15°~29°。术前患者均在PACS图像工作站上进行截骨设计,测量出截骨角度及截骨长度。截骨后39例采用钢板内固定,19例采用交叉克氏针内固定。结果患者术后畸形矫正均良好,获得5°~16°提携角。58例均获随访,时间12~29个月。截骨处骨愈合时间为6~12周。1例术后出现尺神经麻痹,经对症治疗后症状消失;1例出现克氏针部分退出。无血管损伤、感染、骨化性肌炎等并发症发生,按Aitken和Rorabeek标准进行肘关节功能评定:优49例,良8例,可1例,优良率为98.3%。结论在PACS图像工作站上进行肱骨髁上楔形截骨设计,可以精确地测量出截骨角度及截骨长度,指导术中正确操作。     

PACS和Photoshop辅助下等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻

目的：应用影像归档和通信系统（picture archiving and communication system,PACS）和Photoshop系统辅助等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻的疗效分析。方法：回顾性分析自2014年10月至2019年10月采用肱骨远端等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻20例的临床资料,男13例,女7例;年龄3.2～13.5岁,中位数6.65岁;左侧12例,右侧8例。均为肱骨远端骨折畸形愈合后的远期并发症。术前用PACS系统设计截骨,模拟测量顶角位置及底边长度。再将图片导入Photoshop系统,画出术后模拟效果图,指导模拟截骨。结果：20例患儿均获得随访,时间20～24个月,中位数22.5个月。最后一次复查时患肢提携角5°～13°,中位数8.3°。疗效根据Flynn肘关节功能评分标准评价：优16例,良2例,可2例。结论：PACS和Photoshop系统辅助下等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻取得良好的临床疗效。     

肱骨髁上楔形截骨钢板内固定治疗儿童肘内翻畸形

目的 探讨并总结运用重建钢板治疗儿童肘内翻畸形的临床疗效.方法 回顾分析南方医科大学附属小榄医院2005年6月至2011年7月采用外侧肱骨髁上楔形截骨重建钢板内固定治疗的肘内翻畸形患儿31例,男18例,女13例;年龄6～14岁,平均8.39岁.肘内翻角度25.4°(17°～31°).结果 所有患儿术后畸形矫正良好,获得平均6.2°(3°～20°)提携角.术前与术后提携角比较,有统计学差异(t=1.925,P＜0.05).术后关节活动范围平均125°(90°～135°),与术前相比无明显改变.术后随访时间1～3年(平均2.6年),无一例复发,无骨化性肌炎发生.所有病例均无血管损伤、感染等并发症发生,术后肌力正常,1例并发尺神经损伤,经保守治疗2个月后改善,2例旋转轻度障碍,14例肱骨外髁处出现隆起.肱骨截骨处平均骨性愈合时间为3.4个月(3～4个月),所有病例均未出现内固定松动现象,拆除内固定时间为15个月(8～l8个月).结论 尽管侧方肱骨髁上楔形截骨重建钢板内固定治疗儿童肘内翻畸形可能发生肱骨远端外侧突起、肘关节外侧瘢痕等并发症,但是术后总体疗效满意,是一种可以广泛应用的术式.     

测定肱骨远端解剖轴成角旋转中心辅助中性楔形截骨术治疗儿童肘内翻畸形的疗效分析

目的探讨解剖轴成角旋转中心(CORA)测定和中性楔形截骨术在儿童肘内翻畸形中的应用效果。方法回顾性分析2016年1月至2019年12月苏州市吴江区儿童医院骨科收治的20例肱骨髁上骨折后的肘内翻畸形儿童患者资料。男8例, 女12例;年龄4～12岁, 平均7.0岁。术前拍摄双侧肱骨标准正位X线片, 测量双侧肱骨Baumann角、近端解剖轴(PAA)及远端解剖轴(DAA), 确定成角旋转中心CORA点和内翻畸形角度。术中围绕CORA点行外侧闭合中性楔形截骨术矫正内翻畸形。术后患儿均采用屈肘石膏固定, 记录肘关节屈伸功能、术后瘢痕、体表携带角, 同时采集肘关节X线片测量携带角及Baumann角, 术后24个月按照改良Flynn肘关节评分标准评估肘关节功能。结果所有患者术后获24～36个月(平均29.3个月)随访。18例肘关节过伸接近正常, 2例存在过伸5°。15例患者屈曲> 130°, 平均133.1°(130°～138°);5例患者屈曲为110°～130°。术前Baumann角为99.0°±1.0°, 术后为76.0°±1.0°;术前提携角为-14.0°±1.0°, 术后为13.6°±...     

小切口后外侧入路外侧闭合楔形截骨锁定钢板治疗成人肘内翻畸形

目的探讨小切口后外侧入路外侧闭合楔形截骨锁定钢板治疗成人肘内翻畸形的疗效。方法回顾性分析2013年7月至2017年9月期间武汉市第四医院手外一科收治的19例成人肘内翻畸形患者资料。男3例,女16例;年龄17~27岁,平均20.3岁;左侧13例,右侧6例;肘内翻角为20.7°±2.8°。所有患者术前在医学影像存档和传输系统(PACS)上精确测量健侧提携角及患侧的内翻角,并测算出截骨角度,术中采用小切口后外侧入路,外侧闭合楔形截骨矫形锁定钢板固定。末次随访时测量患肘提携角并采用Mayo肘关节功能评分标准(MEPS)评定肘关节功能,采用Bellemore方法评定肘矫形手术疗效。结果19例患者术后获9~32个月(平均14个月)随访,所有患者截骨处均愈合良好。末次随访时患肘提携角为11.4°±1.6°,患者手术瘢痕平均4 cm(3~5 cm),术后患肢肘内翻畸形与术前对比明显改善,肘关节功能良好。术后采用MEPS评定肘关节功能:优10例,良7例,中2例;采用Bellemore方法评定肘矫形手术疗效:优13例,良6例。2例患者术后出现尺神经部分损伤,1例患者术后出现轻度肘关节僵硬。所有患者随访期间未出现内固定物松动、断裂等失效情况,无一例出现骨折延迟愈合及不愈合。结论术前应用PACS系统精确测量截骨角度,术中应用小切口后外侧入路进行外侧闭合楔形截骨矫形,既确保了矫形角度和术后肘关节功能恢复,又未留下明显手术瘢痕,外形美观,疗效良好。     

肘内翻肱骨髁上楔形截骨角度设计的探讨

肘内翻是肘部损伤的常见合并症,治疗主要采用肱骨髁上截骨。截骨方法主要有楔形截骨、“V”形截骨、“L”形截骨,但临床上最常用的是肱骨髁上楔形截骨。至于截骨角度的设计,《骨科手术学》(以下简称《骨》)方法为:“摄患侧肘关节伸直位X线片,测量出肘内翻畸形的角度,其法为沿肱骨干纵轴画一直线,另沿尺桡骨干之间画一直线,此二线在肱骨髁上部相交处所形成的角度,即为肘内翻角。截骨矫正此角度时须加上正常肘提携角,它一般为10°。”《手术学全集·矫形外科卷》 (以下简称《矫》)方法为:“摄肘关节伸直位X线片,沿肱骨干与尺骨干纵轴各绘一直线,测量二线在肱骨髁上部相交处所形成的角度,此角度即为内翻角。正常肘提携角一般约为10°,楔形截骨矫正肘内翻角时,必须加上正常提携角。”肱骨髁上截骨角度的设计各家报道不一。笔者认为这两种测量方法根本区别在于前臂轴线的选择,《骨》认为前臂轴线系尺桡骨干之间连线,而《矫》认为尺骨纵轴线才是前臂轴线。根据是携角的定义,笔者认为《骨》的测量方法是错误的,理由如下:     

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.     

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.