一期解剖复位内固定结合负压封闭引流技术治疗开放性跖跗关节骨折脱位

目的 探讨负压封闭引流技术(VSD)在治疗开放性跖跗关节骨折脱位的作用.方法 自2008年1月～2009年1月共收治开放性跖跗关节骨折脱位96例,均急诊行清创缝合一期解剖复位内固定内术.26例术后常规换药治疗(换药组);70例行VSD治疗(VSD组).结果 术后随访1年3个月～2年2个月,平均1年7个月,伤口愈合情况:VSD组51例伤口浅表,拆除VSD敷料后换药1～2周伤口愈合.换药组:15例经3～5周换药后创面愈合,11例因创面面积大,换药4～7周后,行游离植皮术闭合伤口.换药组3例发生骨髓炎及关节化脓感染,骨折愈合时间较VSD组延长2～3周.治疗结果按美国足踝外科协会(AOFAS)中足部分的评分标准测定,VSD组:优32例,良26例,可8例,差4例,优良率为82.9%;换药组:优3例,良8例,可10例,差5例,优良率为42.3%.结论 负压封闭引流技术明显促进开放性跖跗关节骨折脱位伤口的愈合,提高AOFAS评分,是治疗开放性跖跗关节骨折脱位新的辅助方法.     

跨关节钢板内固定治疗跖跗关节损伤

目的 探讨跨关节钢板内固定治疗跖跗关节损伤的手术治疗方法和临床疗效. 方法 自2009年5月至2011年5月共收治31例跖骨基粉碎性跖跗关节损伤患者,男19例,女12例;年龄24 ～ 70岁,平均46.2岁;均为闭合性损伤,其中8例损伤累及跖跗关节复合体,2例合并骰骨压缩性骨折.所有患者待软组织条件改善后,择期行切开复位跨关节钢板内固定术.术后采用美国足踝外科协会(AOFAS)中足评分、简明健康调查量表(SF-36)评分和视觉模拟评分(VAS)评价治疗效果,并记录相关并发症. 结果 25例患者术后获12 ～36个月(平均24个月)随访,随访期间未见伤口感染、皮瓣坏死等软组织并发症.X线片示术后平均12周(10～15周)骨性愈合.末次随访时AOFAS中足评分为45 ～ 95分(平均78.0分),SF-36评分为45 ～96分(平均79.2分),VAS评分为0～8分(平均1.7分).1例跖跗关节复合体损伤患者术后9个月复查时发现螺钉断裂,但无不适主诉,予以取出内固定;2例跖跗关节复合体损伤患者分别于术后14、20个月发生创伤性关节炎,均予行跖跗关节融合术.结论 跨关节钢板内固定治疗跖跗关节损伤技术简单,可避免关节面软骨的再损伤,是治疗跖跗关节损伤安全、有效的方法.     

桥接固定治疗跖跗关节损伤

目的 探讨使用桥接钢板或外固定支架固定治疗跖跗关节损伤的临床疗效. 方法 对2008年8月至2011年2月收治的26例跖跗关节损伤患者的病例资料进行回顾性研究,男19例,女7例;年龄19 ～56岁,平均34岁.损伤按Myerson三柱损伤分型:单柱损伤2例,两柱损伤8例,三柱损伤16例.采用桥接钢板固定10例,外固定支架固定16例.术后定期放射学检查随访,采用美国足踝外科协会(AOFAS)中足评分进行功能评价.比较术后6个月和18个月AOFAS评分. 结果 所有患者术后获18～ 49个月(平均27个月)随访.伤口均愈合良好,未见感染征象,未发现钢板、螺钉松动、脱出、断裂及异物反应等与内置物相关的并发症.12例患者继发创伤性关节炎,2例因疼痛明显、行走受限二期行关节融合术.所有患者术后6个月和18个月的平均AOFAS中足评分分别为(59.6±15.4)分和(76.8±11.5)分,差异有统计学意义(t=12.620,P=0.000). 结论 对于低能量跖跗关节损伤患者使用桥接钢板,避免贯穿跖跗关节固定,可以减少关节软骨继发损伤.对于高能量跖跗关节损伤患者应重视柱的粉碎骨折造成的短缩问题,使用桥接外固定支架,恢复柱长度的解剖复位和可靠固定是获得良好疗效的关键.     

闭合复位经皮螺钉内固定治疗跖跗关节损伤

目的探讨应用闭合复位经皮螺钉内固定治疗跖跗关节损伤的临床疗效。方法自2003年1月～2005年6月应用闭合复位经皮螺钉内固定治疗跖跗关节损伤26例。按照Myerson分类:中间柱损伤13例,内侧、中间柱合并损伤7例,内侧、中间、外侧柱三柱损伤6例。结果本组切口均一期愈合,平均手术时间为40min(30～70min),切口长度平均为5mm;所有患者获平均11.4个月(6～17个月)随访,根据美国足踝骨科协会(AOFAS)评分平均为87分,患者术后平均5.3个月(3～11个月)恢复正常生活。结论闭合复位经皮螺钉内固定手术创伤小,软组织并发症低,能有效治疗跖跗关节复合体损伤;中间柱复位并沿Lisfranc韧带方向插入螺钉内固定是重建跖跗关节复合体稳定性的关键。     

跖跗关节复合体损伤的手术治疗

目的 评价跖跗关节复合体损伤的手术治疗效果.方法 2003年1月至2008年12月,共收治167例闭合性跖跗关节损伤患者,其中跖跗关节复合体损伤35例.通过X线及CT检查明确诊断,闭合或切开复位螺钉或钢板内固定,术后定期放射学检查随访,以美国足踝外科协会(AOFAS)中足评分系统进行功能评估.结果 本组有135例获得12～78个月随访,平均随访时间48个月.其中跖跗关节复合体损伤26例,术后AOFAS评分48～75分,平均67分;其中16例继发创伤性关节炎,12例因疼痛明显、行走受限二期行关节融合术;单纯跖跗关节损伤109例,术后AOFAS评分70～95分,平均82分,继发创伤性关节炎的17例中5例二期行关节融合术.单纯跖跗关节损伤闭合复位经皮螺钉内固定者术后AOFAS中足评分82～95分,平均87分,与跖跗关节复合体损伤者比较差异具有统计学意义(t=2.651,P<0.05).结论 跖跗关节复合体损伤的预后比单纯跖跗关节损伤的差,而准确诊断、实现复合体各个部分的解剖复位和可靠固定是取得良好治疗效果的关键.     

急诊修复伴有软组织缺损的跖跗关节损伤

目的报道以腓动脉终末穿支为血供的逆行转移皮瓣结合内固定技术,急诊修复治疗伴有软组织缺损的跖跗关节损伤的临床效果。方法2004年5月至2006年1月期间,对我院19例伴有足部软组织缺损的跖跗关节损伤病人急诊行清创复位内固定,同时设计以腓动脉终末穿支为血供的逆行转移皮瓣,对软组织缺损进行修复。结果术后随访14～20个月(平均18个月),所有病例皮瓣均存活,皮瓣质地优良,外观满意,足部功能恢复良好。结论腓动脉终末穿支皮瓣结合内固定是急诊修复治疗伴有足部软组织缺损的跖跗关节损伤的有效方法。     

切开复位内固定治疗跖跗关节损伤伴跖骨骨折

目的:探讨跖跗关节损伤伴跖骨骨折的治疗方法和注意点.方法:2006年1月至2008年6月收治跖跗关节损伤伴跖骨骨折19例,男13例,女6例;年龄21～56岁,平均38.1岁.跖跗关节损伤分型:单纯内侧柱损伤2例,内侧柱伴中间柱损伤5例,外侧柱伴中间柱损伤3例,三柱损伤9例.跖骨骨折:跖骨干骨折8例,颈部骨折7例,跖骨基底部骨折19例.均采用切开复位克氏针或螺钉内固定.结果:所有切口均I期愈合,未见皮肤坏死等情况.骨折平均愈合时间为11.2周.所有患者均得到随访,时间6～17个月,平均12.8个月.采用美国足踝外科协会(AOFAS)中前足评分标准进行临床评估,患者平均AOFAS评分为(84.500±8.553)分,其中优4例,良9例,一般3例,差3例.患者平均术后6.4个月恢复日常生活.3例患者存在轻度骨关节炎表现.结论:无论采用何种固定方式,尽量达到解剖复位重建足弓,恢复维持足部内外侧纵弓和横弓形态是治疗关键.从生物力学角度分析重建足弓,保证足受力点支架完整性,避免了因足底受力不均而引起的疼痛和破行.跖跗关节和跖骨的解剖复位对足部功能的恢复同样重要.     

一体化钢板系统结合克氏针内固定治疗Lisfranc损伤

目的探讨一体化钢板系统结合克氏针内固定治疗Lisfranc损伤临床疗效。方法回顾性分析2010年1月至2018年12月收治30例Lisfranc损伤患者资料,男22例,女8例;年龄22～58岁,平均44.5岁;均为闭合性损伤,其中8例合并跖跗基底部骨折,2例合并骰骨压缩性骨折。Lisfranc关节损伤分型:单纯内侧柱损伤6例,内侧柱与中间柱损伤10例,中间柱与外侧柱损伤4例,三柱损伤10例。致伤原因:交通伤12例,机器伤10例,坠落伤8例。所有患者待软组织条件改善后,择期手术采用切开复位一体化钢板系统结合克氏针内固定,受伤至手术时间为2～7 d,平均5 d。术后评价骨折复位及愈合情况,测量跖跗关节间隙,采用美国足踝外科协会(American Association of Foot and Ankle Surgery,AOFAS)中足评分评价治疗效果。结果术后6周,克氏针均取出。30例患者术后均获得随访,随访时间12～30个月,平均24个月,随访期间均未见伤口感染、皮肤坏死等软组织并发症。跖跗关节脱位及合并跖骨骨折和骰骨骨折均达到解剖复位,无一例出现复位丢失。合并骨折的Lisfranc损...     

开放性跖跗关节损伤的手术治疗

目的:探讨开放性跖跗关节损伤手术治疗方法及临床疗效。方法 :选择2011年3月至2015年1月手术治疗的21例开放性跖跗关节损伤患者,男14例,女7例;年龄20~75岁,平均45.6岁;左足13例,右足8例;交通伤5例,碾压伤6例,重物压伤10例。跖跗关节损伤根据Myerson分型:B2型5例,C1型9例,C2型7例。软组织损伤按照Gustilo分型:ⅡB型5例,ⅢA型10例,ⅢB型6例。采用分期手术治疗。术后观察骨折愈合及其并发症情况,并采用美国足踝外科协会(AOFAS)中足评分评价手术疗效。结果:21例患者术后均获随访,时间11~40个月,平均16.2个月。骨性愈合时间10~16周,平均12.3周。未并发深部感染、骨不连及骨髓炎等并发症。末次随访AOFAS中足评分为83.0±14.9;优9例,良8例,中2例,差2例。2例患者因并发严重创伤性关节炎再次行跖跗关节融合术。结论:对于开放性跖跗关节损伤的治疗,急诊合理清创,全面评估软组织损伤情况,正确把握内固定的手术指征及时机,可以降低深部感染及骨髓炎的发生率。     

切开复位内固定治疗多发跖骨基底部不稳定骨折合并跖跗关节损伤

[目的]探讨切开复位内固定治疗多发跖骨基底部不稳定骨折合并跖跗关节损伤的方法及临床疗效.[方法]2003年1月～2011年7月,收治35例多发跖骨基底部不稳定骨折合并跖跗关节损伤患者.男22例,女13例;年龄20 ～58岁,平均37.4岁.均采用切开复位内固定的方法治疗.共89处跖骨基底部骨折,其中第2、3跖骨骨折9例,第3、4跖骨骨折7例,第2、3、4跖骨骨折19例.跖跗关节损伤分型:单纯中间柱损伤2例,内侧柱伴中间柱损伤7例,外侧柱伴中间柱损伤10例,三柱损伤16例.针对第2、3跖骨基底部骨折应用微型钢板跨关节固定.[结果]所有患者均获随访,随访时间12 ～30个月,平均22.5个月.术后未发生切口感染、皮肤坏死、内固定断裂等并发症.骨折临床愈合时间为8～17周,平均13.9周.按照美国足踝外科协会(AOFAS)中足评分标准,优11例,良18例,一般4例,差2例,优良率82.9％.[结论]跖跗关节和跖骨基底部的解剖复位和可靠固定对足部功能的恢复同等重要,能减少中足骨性关节炎的发生率并取得良好疗效.固定方式的选择应根据损伤类型制定.     

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.     

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.     

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.