不保留胆囊管的腹腔镜胆囊切除术

目的探讨不保留胆囊管的腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性、可行性及临床效果。方法回顾性分析2013年3月~2016年1月321例LC的临床资料。采取三孔或四孔法LC,首先解剖出胆总管、胆囊管、肝总管及胆囊动脉"四管"结构;充分游离胆囊管近肝总管汇入部;确认无胆囊管结石后,于近肝总管处夹闭胆囊管并切除胆囊。结果 312例(97.2%)顺利完成不保留胆囊管LC;9例(2.8%)保留0.5 cm~全长胆囊管,包括肝管变异1例(中转开腹),胆囊管汇入点异常4例,萎缩性胆囊炎三角区解剖困难3例,急性坏疽性胆囊炎1例。均无术中胆管损伤、术后胆漏及腹腔大出血等严重并发症。术后随访1~40个月,(23.3±11.0)月,312例不保留胆囊管LC术后无胆管狭窄、胆道残余结石、腹痛、黄疸等表现;9例保留胆囊管病例中,2例术后反复上腹部隐痛症状,未发现结石残留或结石复发。结论不保留胆囊管LC安全、可行,可防止残余小胆囊,避免胆囊管残余结石。     

腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发情况及术后结石复发的相关危险因素分析

目的探究腹腔镜胆囊切除(LC)联合胆总管切开取石T管引流术(LCHTD)后结石复发及复发相关危险因素。 方法回顾性分析2014年1月至2016年6月行LC联合LCHTD治疗的89例胆结石合并胆总管结石患者的临床资料,采用SPSS21.0统计软件分析,术后结石复发率、1～3年累计复发率和单因素分析采用χ²检验,多因素分析采用logistic回归分析,计算OR和95%可信区间,P<0.05为差异有统计学意义。 结果术后18例患者出现结石复发情况,复发率为20.22%,累计复发率分别为：1年2.25%(2/89),2年5.62%(5/89),3年12.36%(11/89)。单因素分析显示：年龄、胆总管直径、结石数量、碎石术、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症与联合术后结石复发有关(P<0.05);多因素分析显示：胆总管直径≥1.5 cm、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症是联合术后结石复发的独立危险因素。 结论胆囊结石合并胆总管结石行LC联合LCHTD治疗后结石复发的影响因素较多,且部分因素会合并出现,有必要采取有针对性的措施以期降低术后结石复发率。     

腹腔镜胆囊切除术前逆行胆管造影的临床价值

目的探讨在腹腔镜胆囊切除术 (LC)前 ,行内镜逆行胆管造影 (ERC)对判断胆总管并存病变的价值。方法对 43例病史中有黄疸、胰腺炎 ,肝功能异常 ,B超怀疑或证实胆管结石的患者 ,经ERC排除或取石后 ,再行LC。结果 43例ERC造影均获成功 ,ERC成功取出胆管结石 34例 ,LC成功 39例 (91 % )。术前有黄疸史 (P <0 0 1 ) ,胆总管扩张≥ 1cm(P <0 0 0 1 ) ,肝功能异常 (P <0 0 0 1 ) ,有胰腺炎史 (P <0 0 5) ,提示存在胆管结石。发生并发症 1例 (3 % ) ,无死亡。随访 1～ 3个月 ,未发现胆管残余结石。结论LC与ERC联合应用可有效治疗胆囊疾病合并总胆管结石     

腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石

目的 总结运用腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石的临床经验.方法 完成腹腔镜胆囊切除后,经胆囊管残端扩张、经胆囊管胆总管汇合部切开或经胆总管前壁切口入路,采用胆管镜取石网取石、液电碎石、经胆囊管残端输尿管导管胆管引流、T管引流或胆总管切口即时缝合等,有选择地对205例胆总管内径≤0.8 cm的正常直径胆总管结石患者进行治疗.结果 腹腔镜胆总管探查取石术205例中,腹腔镜联合术中胆管镜取尽结石162例,中转为术中十二指肠镜下乳头切开取石43例,无中转开腹.胆管镜组162例患者平均手术时间112 min,术后并发症率5.5% (9/162),无残余结石;十二指肠镜组43例患者平均手术时间95 min.术后并发症率9.3%(4/43),术后残余结石1例.无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡.结论 只要选择合适的病例,腹腔镜、胆管镜同期联合手术治疗胆囊结石合并正常直径胆总管结石是可行、有效和安全的.     

腹腔镜胆道镜治疗胆囊结石合并胆总管结石两种术式的疗效比较

目的对比腹腔镜胆囊切除+经胆囊管胆道探查术(LC+LTCBDE)与腹腔镜胆囊切除术+胆总管切开探查+T管引流术(LC+LCHTD)两组微创手术方式治疗胆囊结石合并胆总管结石的临床疗效。方法 130例胆囊结石合并胆总管结石患者,其中70例行LC+LTCBDE,60例行LC+LCHTD。比较两组患者手术时间、术后住院时间、住院费用、术后恢复正常生活时间和并发症情况(胆漏、出血、胆管狭窄,胆管残余结石等)。结果 LC+LTCBDE组的手术时间、术后住院时间、住院费用、术后恢复正常生活时间均低于LC+LCHTD组,差异有统计学意义(P0.05)。两组术后并发症比较,差异无统计学意义(P0.05)。结论 LC+LTCBDE可作为胆囊结石合并胆总管结石的首选治疗,难以经胆囊管胆道探查时,LC+LCHTD仍为明智选择。     

腹腔镜胆囊切除术联合胆总管切开取石T管引流术的复发多因素分析

目的探讨胆囊结石合并胆总管结石患者采用腹腔镜胆囊切除术(LC)联合胆总管切开取石T管引流术(LCHTD)治疗后结石复发的发生率及其影响因素。方法回顾性分析2011年6月至2014年1月采用LC+LCHTD治疗的319例胆囊结石合并胆总管结石患者的临床资料,观察术后2~5年内患者胆囊结石复发情况,并探讨影响结石复发的危险因素。采用SAS 10.0软件进行统计学分析,性别、饮酒率、吸烟率、糖尿病患病率、胆囊管扩张率、高血压患病率、≥15 mm胆总管直径患者所占百分比、多发结石患者所占百分比、≥10 mm结石患者所占百分比、胆总管扩张率采用百分比(%)进行统计描述,组间比较采用χ~2检验;多因素分析方法采用非条件Logistic回归分析法;P值0.05表示差异具有统计学意义。结果术后1年累积复发14例(4.4%)、3年累积复发30例(9.4%)、5年复发累积47例(14.7%);采用非条件Logistic回归进行分析,结果显示结石数目多发、采用碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素(OR=1.721,OR=1.582,OR=1.404,OR=1.381,P0.05)。结论碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素。     

腹腔镜胆囊切除术中隐匿性胆总管结石的微创治疗

目的：探讨对腹腔镜胆囊切除术（ laparoscopic cholecystectomy ,LC）中隐匿性胆总管结石行微创治疗的可行性。方法2007年7月-2012年5月对27例LC术中发现的隐匿性胆总管结石采用微创治疗。胆囊管内径＞5 mm者经胆囊管胆道镜取石;胆总管内径＞6 mm者行胆囊管汇入胆总管处微切开后胆道镜取石,一期缝合或留置造影管;胆囊管内径≤5 mm、胆总管内径≤6 mm者直接留置造影管,术后再次造影,必要时行十二指肠镜乳头括约肌切开（ endoscopic sphincterotomy ,EST）取石。结果手术均获成功。8例直接经胆囊管胆道镜取石;11例行胆囊管汇入胆总管处微切开后胆道镜取石,一期缝合7例,留置造影管4例,1周后造影均阴性;8例直接留置造影管,1例术后36 h滑出,1周后ERCP造影胆囊管残端无渗漏,EST取石,术后1周再次造影3例结石消失,4例仍有结石,均经EST取出。无出血、胆漏、腹腔感染等并发症。24例随访6-24个月,平均16个月,无结石残留、胆管狭窄及胆管炎发生。结论熟练运用腹腔镜、胆道镜、十二指肠镜技术,对LC术中发现的隐匿性胆总管结石实施微创治疗是安全、可行的。     

胆囊结石合并胆总管结石患者行腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发危险因素分析

目的探讨胆囊结石合并胆总管结石患者行腹腔镜胆囊切除(LC)联合胆总管切开取石T管引流术(LCHTD)治疗后结石复发的影响因素。方法回顾性分析247例胆囊结石合并胆总管结石患者的临床资料和随访资料,均行LC联合LCHTD治疗。对可能影响术后结石复发的相关因素进行Logistic分析。结果 247例患者中,术后1年累积复发率为2.43%,3年累积复发率为8.10%,5年累积复发率为14.98%。单因素分析显示,年龄、结石数量、胆总管直径、是否行碎石术、胆总管扩张、胆囊管扩张、合并炎症与术后结石复发有关(P0.05);性别、病程、胆总管结石类型、结石直径与术后复发无相关性(P0.05)。Logistic多因素回归分析显示,胆总管直径≥1.5 cm、胆总管扩张、胆囊管扩张、合并炎症是术后结石复发的独立危险因素(P0.05),而结石数量、胆总管扩张、胆囊管扩张与术后结石复发无关(P0.05)。结论胆囊结石合并胆总管结石患者行LC联合LCHTD治疗后结石复发是多种因素共同作用的结果,应认真评估患者术后复发的风险,并积极采取干预措施以降低术后结石复发率。     

腹腔镜胆总管探查取石术治疗细径胆总管结石148例

目的 总结运用腹腔镜胆总管探查取石术治疗细径胆总管结石的治疗经验.方法 完成腹腔镜胆囊切除后,经胆囊管残端扩张、胆囊管胆总管汇合部切开或经胆总管前壁切口入路,采用胆管镜取石网取石、液电碎石、经胆囊管残端输尿管导管胆管引流、T管引流或胆总管切口即时缝合等,有选择地对148例胆总管内径≤0.8 cm的细径胆总管结石病人进行治疗.结果 腹腔镜胆总管探查取石术148例中,腹腔镜手术成功116例,中转为术中十二指肠镜下乳头切开取石术32例,无中转开腹.术中胆管镜下取净结石116例,十二指肠镜下取出结石29例,乳头切开术后排出结石3例.无残余结石.术后胆漏7例,均经术中常规放置的胆管引流和腹腔引流管引流治愈.术后轻症胰腺炎3例.术后经输尿管导管胆管造影有2例呈现胆总管切口即时缝合区狭窄影像,未予处理.术后其他并发症均经非手术综合疗法治愈.无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡.结论 只要选择合适的病例,腹腔镜胆总管探查取石术治疗细径胆总管结石,对于有较高腹腔镜和内镜技术者是可行、有效和安全的.     

腹腔镜胆总管探查取石术治疗细径胆总管结石148例

目的 总结运用腹腔镜胆总管探查取石术治疗细径胆总管结石的治疗经验.方法 完成腹腔镜胆囊切除后,经胆囊管残端扩张、胆囊管胆总管汇合部切开或经胆总管前壁切口入路,采用胆管镜取石网取石、液电碎石、经胆囊管残端输尿管导管胆管引流、T管引流或胆总管切口即时缝合等,有选择地对148例胆总管内径≤0.8 cm的细径胆总管结石病人进行治疗.结果 腹腔镜胆总管探查取石术148例中,腹腔镜手术成功116例,中转为术中十二指肠镜下乳头切开取石术32例,无中转开腹.术中胆管镜下取净结石116例,十二指肠镜下取出结石29例,乳头切开术后排出结石3例.无残余结石.术后胆漏7例,均经术中常规放置的胆管引流和腹腔引流管引流治愈.术后轻症胰腺炎3例.术后经输尿管导管胆管造影有2例呈现胆总管切口即时缝合区狭窄影像,未予处理.术后其他并发症均经非手术综合疗法治愈.无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡.结论 只要选择合适的病例,腹腔镜胆总管探查取石术治疗细径胆总管结石,对于有较高腹腔镜和内镜技术者是可行、有效和安全的.     

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.