腹主动脉瘤腔内修复术后髂支闭塞的原因及治疗策略

目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)后髂支闭塞的原因及治疗策略。方法:回顾性收集2016年1月—2018年7月中南大学湘雅医院血管外科收治130例行EVAR的AAA患者临床资料,对其中并发髂支闭塞患者的临床资料进行分析。结果:130例成功接受EVAR的AAA患者中,6例(4.61%)发生术后髂支闭塞,均为单侧闭塞,发生闭塞的平均时间为(55±87)d。临床表现主要为间歇性跛行和静息痛。治疗方式包括:股动脉切开取栓+股-股动脉转流术2例,髂动脉支架植入术1例,股动脉切开取栓+髂动脉支架植入术3例。术后患肢缺血症状均消失。术后随访时间12个月,所有患者均未再次出现下肢缺血症状。结论:髂支闭塞是EVAR术后较为常见的并发症之一,其原因包括瘤颈条件差、髂动脉入路扭曲、髂支远端锚定区解剖异常等;股动脉切开取栓和(或)髂动脉支架植入是行之有效的治疗方法。     

多节段下肢动脉硬化闭塞症介入治疗及手术治疗体会

目的 总结一侧髂动脉闭塞合并下肢动脉长段闭塞患者治疗的临床效果.方法 对于一侧髂动脉同时合并下肢动脉长段闭塞的多节段下肢动脉硬化闭塞症患者,间歇跛行距离小于50m或有静息痛者采用髂动脉支架或联合血管旁路术治疗下肢动脉硬化闭塞症32例.结果 行髂动脉病变段球囊扩张及内置支架术29例36枚支架,3例髂动脉介入治疗失败,行股浅动脉病变段支架置入3例,行股-腘动脉膝上血管旁路术13例,行膝下血管旁路术2例,3例髂动脉支架治疗失败者2例行股-股动脉耻骨上旁路术,1例放弃治疗.介入治疗及手术治疗均取得成功.随访3～36个月,3例患者因肿瘤或急性心肌梗塞死亡,大部分患者临床症状消失.1例股浅动脉支架1个月后闭塞,后因肢体严重缺血截肢.3例股-腘旁路血管闭塞,1例接受取栓手术好转,1例截肢,1例无静息痛间歇跛行距离大于50m应用药物治疗.结论 支架置入或联合血管旁路术是治疗多节段下肢动脉硬化闭塞症的安全有效方法 .     

腹主动脉瘤腔内修复术后髂支闭塞的腔内处理

目的 探讨腹主动脉瘤腔内修复(endovascular aneurysm repair, EVAR)术后髂支闭塞的腔内再手术效果。方法 回顾性分析2018年3月～2023年3月6例EVAR术后髂支闭塞的资料。均行同侧股动脉切开Fogaty取栓、髂支球囊扩张,其中3例联合支架植入,1例联合Rotarex腘动脉取栓。结果 6例髂支闭塞再通率100%(6/6)。术后中位随访时间24个月(6～48个月)。5例术后下肢缺血症状消失(Rutherford 0级),1例膝下缺血、干性坏疽(RutherfordⅢ级)。结论对于EVAR术后髂支闭塞,需仔细分析原因,选择个体化腔内治疗方案。     

腹主动脉瘤腔内修复术后髂支闭塞治疗策略的单中心经验

目的 探讨腹主动脉瘤患者腹主动脉腔内修复术（endovascular aortic repair,EVAR）后髂支闭塞的原因和治疗策略。方法 回顾性分析佛山市第一人民医院2010年1月至2022年1月收治的15例EVAR术后髂支闭塞的病例资料。结果 14例患者采取手术治疗,技术成功率为100%;1例采取药物保守治疗,患者症状得到改善或消失。患者术后随访6～36个月,平均（20.3±6.8）个月,1例患者死于脑卒中,无再发髂支闭塞、截肢等严重不良事件发生。结论 EVAR术后发生髂支闭塞并不少见。如发生髂支闭塞,需仔细分析原因并及时处理,综合患者情况选择合适的治疗方案。     

腹主动脉瘤腔内修复术后髂支支架内闭塞的危险因素分析

目的:探讨腹主动脉瘤腔内修复术(EVAR)后髂支支架内闭塞的危险因素。方法:收集2011年1月—2015年12月行EVAR的腹主动脉瘤患者的临床资料,采用1:3配比病例对照方法,每个发生髂支支架内闭塞的病例随机选择3例同性别、年龄±3岁、使用同厂家的同种类型支架未发生髂支支架内闭塞的患者为对照,对EVAR后髂支支架内闭塞危险因素行单因素和多因素Logistic回归分析。结果:共495例腹主动脉瘤患者行EVAR,11例(2.2%)发生髂支支架内闭塞。术后发生髂支支架内闭塞的平均时间为2~20周。单因素分析显示,术前髂动脉扭曲成角≥60°(P=0.001),术前髂动脉狭窄≥50%(P=0.002),髂支支架远端口径放大率15%(P=0.004)等因素与EVAR后髂支支架内闭塞有关;Logistics回归分析显示,以上述因素均为EVAR后髂支支架内闭塞的独立危险因素(均P0.05)。结论:术前根据髂动脉解剖特性严格制定计划,选择合适的支架口径是减少术后髂支内闭塞的关键。应识别高危人群,针对可控因素采取预防措施,以避免及减少术后支架内闭塞的发生。     

主,髂动脉硬化性闭塞症的诊断及治疗

目的　总结42 例主髂动脉硬化性闭塞症的诊断和治疗经验。方法　回顾分析1993 ～1998 年我院收治本病患者的临床资料,下肢间歇性跛行22 例,静息痛、趾端坏疽14 例,“5P”症候群6 例。保守治疗21 例;主( 双) 股人造血管旁路术13 例; 主双股人造血管旁路 股腘自体大隐静脉旁路3 例;经皮腔内血管成形术( PTA)2 例,PTA 右髂动脉腔内支架 股股人造血管搭桥1 例;Ⅰ期膝上截肢2 例。结果　单纯间歇性跛行病人经系统保守治疗6 个月～1 年跛距延长100 ～200 m ,治疗前后踝肱指数及踝动脉压差别无显著性(P > 0 .05) 。手术治疗组术后2 d 及7 d 分别并发心肌梗塞1 例,ARDS1 例( 死亡) 。6 个月后膝上截肢1 例,其余病人术后3 个月踝肱指数及踝动脉压较术前有明显提高( P < 0 .05及0 .01) 。结论　主髂动脉硬化性闭塞的治疗应个体化。主股人造血管旁路术是治疗本病的基本术式,腔内支架的近期疗效好     

杂交技术在治疗TASC D型周围动脉闭塞性疾病中的应用

目的：总结杂交技术在治疗TASC D型周围动脉闭塞性疾病的治疗经验。 方法：回顾性分析2009年10月—2013年12月间采用杂交技术治疗的22例TASC D型周围动脉闭塞性疾病患者（24条肢体）的临床资料,其中采用髂动脉支架植入术+股总动脉内膜剥脱术（含股深动脉内膜剥脱术）+股深动脉成形术+股腘动脉人工血管旁路术治疗患者12例,采用股总动脉内膜剥脱术（含股深动脉内膜剥脱术）+股腘动脉人工血管旁路术+胫前动脉、胫后动脉球囊扩张术治疗患者4例,采用Fogarty导管取栓术+髂动脉支架植入术+股总动脉内膜剥脱术（含股深动脉内膜剥脱术）治疗患者6例。 结果：所有的患者均获得技术上的成功,围手术期无患者死亡,术后患肢疼痛改善,皮温升高,平均踝肱指数从术前的0.38升至术后的0.75。18例患者获随访3~28个月,2例患者术后发生人工血管旁路血栓形成,1例患者术后发生支架内再狭窄,其余患者未发生人工血管或支架相关并发症。 结论：杂交技术微创、安全、有效,是处理TASC D型周围动脉闭塞性疾病的合理选择,尤其适用于无法进行单纯腔内治疗的高危患者。     

血栓闭塞性脉管炎合并动脉硬化闭塞导致下肢缺血的手术治疗

目的 探讨下肢血栓闭塞性脉管炎(thmmboangiitis obliterans,TAO)合并动脉硬化闭塞症(arteriosclerosis obliterans,ASO)手术治疗效果.方法 回顾性分析2007年治疗的TAO合并ASO 6例患者的资料.2例行腹主动脉切开取栓+内膜剥脱+腹主动脉-股深动脉人工血管旁路移植-胭动脉人工血管-小腿动脉自体大隐静脉旁路移植术,1例行腹主动脉切开取栓+内膜剥脱+腹主动脉-右股深动脉人工血管旁路移植-膝下胭动脉人工血管旁路移植术;1例行左髂总动脉-左股深动脉人工血管旁路移植一胫前动脉自体大隐静脉原位移植术,1例行左侧人工血管切开取栓+左股深动脉成形-膝下腘动脉人工血管旁路移植术,1例行右股总动脉-左股总动脉人工血管旁路移植-胫后动脉自体大隐静脉旁路移植术.结果 5例患者术后恢复顺利,1例于术后当天出现股动脉-腘动脉人工血管和远段的大隐静脉桥血栓形成,立即再次手术行人工血管和大隐静脉切开取栓术,并同时行胫后动静脉吻合.6例患者均痊愈出院,无死亡病例.5例患者的下肢远端静息痛完全缓解,1例部分缓解.足部溃疡的2例创面明显缩小,无感染发生.所有患者得到随访,平均随访为6.5个月,3例足部溃疡愈合.1例术后3个月出现左股部切口感染,最终行膝上截肢处理,残端一期愈合.其他5例患者的移植血管通畅,症状缓解.结论 对TAO合并ASO患者如果手术治疗方式恰当,可以取得比较好的疗效.     

下肢动脉硬化闭塞症血管介入联合外科手术疗效观察

目的探讨下肢动脉硬化闭塞症的治疗方法及临床疗效。方法采用骼、股、腘动脉球囊扩张术+支架植入术结合动脉旁路术、股深动脉成形术治疗下肢动脉硬化闭塞症26例(30条患肢)。8条患肢行骼动脉球囊扩张+支架植入术,其中12条患肢加行股深动脉成形术,6条患肢加行股-腘动脉人工血管转流术,4条肢体行膝下球囊扩张术。结果手术均获得成功,未出现严重并发症。术后踝肱指数0.65±0.19与术前0.23±0.12相比有明显提高(P<0.05)。平均随访12个月(1～23个月)。与术前相比患者症状明显改善,仅4例残余有间歇性跛行(跛行距离300 m),其中1例术后3个月外院行干细胞移植术后症状明显好转,跛行距离>1 000 m。结论骼、股、腘动脉球囊扩张、膝下球囊扩张术+支架植入结合动脉旁路术、股深动脉成形术、股-腘动脉人工血管转流术是治疗下肢动脉硬化闭塞症的有效方法。手术创伤小,操作方便。手术方式灵活,尤适用于高危重症患者。     

腹主动脉瘤腔内修复术后髂支闭塞的治疗策略及其危险因素分析

背景与目的 腹主动脉瘤腔内修复术（EVAR）以其微创且术后恢复快的优势,已成为腹主动脉瘤（AAA）的首选治疗。髂支闭塞（ILO）是EVAR术后常见并发症,但其处理存在很多难点。因此,本文探讨EVAR术后ILO的治疗策略及其危险因素。方法 回顾性分析海南省人民医院血管外科2013年8月—2022年8月间14例EVAR术后发生ILO的病例资料。以同期435例无ILO的EVAR病例作为对照,分析EVAR术后发生ILO危险因素。结果 14例患者行腔内或杂交手术治疗的平均手术时间（183.9±32.6）min,术中出血量（187.1±70.2）mL。10例经杂交手术取栓恢复腔内血流,2例杂交手术失败后行双侧股动脉人造血管旁路术,2例采用吸栓导管行经皮机械血栓清除术恢复腔内血流。清除髂支内血栓后,对髂支及远端髂外动脉（EIA）残余狭窄性病变行球囊扩张及支架成形术。术后所有患者下肢缺血症状完全缓解。随访期,所有患者未再发下肢缺血症状。单因素分析显示,EIA起始端直径（P=0.045）、髂动脉扭曲≥60°（P=0.003）、髂动脉狭窄≥50%（P=0.007）、髂支远端锚定于EIA（P=0.015）、髂支远端放大率≥15%（P=0.028）等因素与EVAR术后ILO的发生有关。结论 腔内或杂交手术治疗是EVAR术后ILO的首选治疗。关注ILO的危险因素,并在EVAR方案设计和操作时积极预防。     

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.