腹腔镜Roux-en-Y胃旁路手术治疗肥胖症和2型糖尿病

目的 探讨腹腔镜Roux-en-Y胃旁路手术（LRYGB）治疗肥胖症和（或）2型糖尿病的可行性及疗效.方法 对21例单纯性肥胖症及9例2型糖尿病患者施行LRYGB,观察肥胖症患者体质量、BMI、超重体质量减少率（EWL%）改善情况;观察糖尿病患者术后的空腹血糖和口服葡萄糖耐量试验（OGTT）变化情况;观察全组患者手术时间、术中出血量、术后恢复、术后并发症情况.结果 本组30例皆成功完成手术,无中转开放手术者,手术时间110～270（平均168）min.术中出血量10～75（平均24.0）ml.本组21例单纯性肥胖症患者术前体质量及BMI分别为（97.2±15.0）kg和35.3±3.5;术后随访2个月至5年,术后1个月体质量及BMI即显著下降[（85.1±10.1）kg和31.2±2.2,均P〈0.01],至术后2～3年降至最低水平[（66.8±9.2）kg和24.3±1.1],之后维持在此水平;EWL%则相应增高（均P〈0.05）.9例2型糖尿病患者术前空腹血糖及OGTT 2 h血糖分别为（12.6±2.6）mmol/L和（17.8±4.1）mmol/L;术后随访3～8个月,空腹血糖及OGTT2 h血糖均显著下降[（5.9±1.4）mmol/L和（7.8±1.4）mmol/L,均P〈0.05];其中合并肥胖症的4例患者BMI明显降低（P〈0.05）,而5例未合并肥胖症者BMI无明显变化（P〉0.05）.本组30例患者中5例（16.7%）术后出现并发症,其中1例因急性暴发性胰腺炎死亡外,1例因肠系膜裂孔疝致肠梗阻行再次手术治愈,余3例均经保守治疗治愈.结论 LRYGB治疗肥胖症和（或）2型糖尿病手术安全可行,术后近期减重和（或）降糖效果显著.     

Ⅱ型糖尿病影响骨折愈合的治疗体会

目的:针对Ⅱ型糖尿病患者发生骨折后,糖尿病对骨折不愈合或愈合不良的影响进行分析,并探讨治疗方法和体会.方法:自2008年1月至2012年1月我们收治26例,股骨骨折9例,足骨骨折1例,桡骨骨折3例,胫骨骨折13例.患者均知道自己患有Ⅱ型糖尿病,患糖尿病时间2～12年,大部分在持续治疗中.首次术前空腹血糖值6.8～16.6mmol/L;糖化血红蛋白6.8～11.6％.初次手术至再次就诊时间为3～18个月,平均8.3个月;二次入院时分别进行血糖测定:空腹血糖值9.8～23.6mmol/L;糖化血红蛋8.9～13.8％.入院后就每一位患者的具体情况,制定缜密相关治疗方案以控制血糖:分别用静点胰岛素、皮下注射胰岛素,1～3周时间血糖控制在正常范围内(血糖均≤7.0mmol/L、餐后2小时血糖≤10mmol/L、糖化血红蛋白≤8 5％).并且在血糖在正常范围内后再持续治疗、监测、控制2周后,行二次手术治疗.结果:本组26例患者术后经9-36个月(平均21.5个月)随访.骨折愈合23例,部分愈合3例.结论:患有糖尿病的病人发生骨折在临床上比较多见,其骨折的发生率与其本身的糖尿病有一定的关系.而且骨折后骨折愈合的快慢及愈合的程度亦因其患有糖尿病有密切关系.     

3C方案用于脆性糖尿病患者血糖监测

目的 提高糖尿病患者治疗的安全性.方法 对20例脆性糖尿病患者采用3C方案监测和治疗,实施针对性护理.结果 20例患者于入院第6天开始空腹血糖逐渐控制在6.5～8.6 mmol/L,餐后2h血糖控制在9.5～12.8 mmol/L;尿酮均转阴;住院15～25 d好转出院.随访6个月,空腹血糖控制在5.8～10.4 mmol/L,餐后2h血糖控制在9.5～13.7 mmol/L,未发生酮症酸中毒和低血糖现象.结论 3C方案可安全用于脆性糖尿病患者的监测和治疗,有利于提高疗效.     

瑞格列奈对2型糖尿病肾病患者的疗效观察

目的:探讨瑞格列奈治疗合并肾衰竭代偿期的2型糖尿病肾病患者的疗效.方法:选择2型糖尿病合并肾衰竭代偿期的患者43例,随机分为2组,分别给予诺和灵M30R和瑞格列奈控制血糖,共12周.检测其生化指标.结果:瑞格列奈组治疗前后空腹血糖下降(1.89±1.05)mmol/L,餐后2 h血糖下降(2.31±1.27)mmol/L,糖化血红蛋白Alc下降(1.17±0.35)%;诺和灵M30R组治疗前后空腹血糖下降(1.95±1.12)mmol/L,餐后2 h血糖下降(2.37±1.34)mmol/L,糖化血红蛋白Alc下降(1.21±0.41)%.两组治疗前后比较均有统计学差异(P＜0.05),组间比较无差异(P＞0.05).结论:瑞格列奈能有效控制空腹和餐后血糖,降低HbAlc,而且安全性和依从性较强.     

骨疾病并存糖尿病患者的围手术期处理

目的: 探讨糖尿病患者骨科手术围手术期血糖的控制和对手术的影响。方法: 回顾性分析35例骨疾病并存糖尿病的患者接受骨科手术治疗围手术期的血糖调控情况。结果: 35例患者入院时空腹血糖(13 0±1 5) mmol/L, 经术前用胰岛素控制血糖至(7 .0±2 .3) mmol/L后, 分别接受全髋关节置换、股骨头置换、腰椎滑脱协和钢板脊柱内固定系统复位固定等复杂骨科手术治疗, 术中及术后继续用胰岛素控制血糖至基本正常水平, 本组术后血糖为(8. 0±1 .8) mmol/L。35例中, 仅1例(2. 9% ) 术后内固定松动, 未发生感染和其他并发症。术后患者症状体征均明显改善, 肢体功能恢复良好。结论: 糖尿病患者经正确的围手术期处理, 将血糖控制至基本正常水平, 可耐受复杂的骨科手术。     

合并糖尿病的腹部手术病人89例治疗分析

目的　探讨合并糖尿病的腹部手术病人的外科治疗措施。方法　对我院普外科 1 991年～ 2 0 0 2年治疗的 89例合并糖尿病的腹部手术病人作回顾性分析。结果　 89例中 ,择期手术 6 8例 ,限期手术 1 3例 ,术前空腹血糖控制在 6 .7～ 1 0 .0mmol/L ;急诊手术 8例 ,术前空腹血糖 8.3～ 1 3.9mmol/L。术中血糖控制在 8.3～ 1 3.9mmol/L ,术后血糖控制在 7.8mmol/L以下。术后并发症发生率 :切口感染 3例 ,肺部感染 2例 ,泌尿系感染 1例 ,左下肢深静脉血栓形成 2例。无酮症酸中毒 ,无死亡病例。结论　合并糖尿病病人的腹部手术只要围手术期严格控制血糖、作好必要的肠道准备、选择合理的手术时间及麻醉方式完全可以达到理想的外科治疗效果     

袖状胃切除间置回肠的十二指肠空肠旁路手术治疗非肥胖型2型糖尿病

目的 评价袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖型2型糖尿病的治疗效果.方法 对符合纳入标准的非肥胖型2型糖尿病患者41例实施袖状胃切除间置回肠的十二指肠空肠旁路手术.观察术前及术后1、3、6个月患者的空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、胰岛素抵抗指数(Homa-IR)、甘油三酯、高密度脂蛋白、低密度脂蛋白的变化及糖尿病并发症的缓解情况.结果 对本组41例患者平均随访时间9.6个月(6～21个月).95％的患者术后糖化血红蛋白＜7％,不需任何降糖药物.78％的患者糖化血红蛋白＜6％.空腹血糖从术前的(9.7±0.4) mmol/L降至术后的(6.2±0.3)mmol/L(P＜0.01);糖化血红蛋白从术前的8.1％±1.4％降至术后的5.8％±0.6％(P＜0.01);餐后2h血糖从术前的(13.6±0.7) mmol/L降至术后的(10.6±0.2) mmol/L(P＜0.01);Homa-IR从术前的4.8±1.3降至术后的1.2±0.4(P＜0.01);空腹C肽从术前的(3.3±1.7) ng/ml升至术后的(4.9±0.2) ng/ml(P ＜0.01);空腹胰岛素从术前的(10.2±1.4) mlu/L升至术后的(15.6±0.7) mlu/L(P ＜0.01)L;甘油三酯从术前的(3.1±0.5) mmol/L降至术后的(1.9±0.4) mmol/L(P ＜0.01);高密度脂蛋白从术前的(1.2±0.2) mmol/L升至术后的(1.9±0.8) mmol/L(P ＜0.01);低密度脂蛋白从术前的(3.5±0.3)mmol/L降至术后的(2.4±0.6)mmol/L(P＜0.01).7例合并高血压患者中3例的血压得到控制.78％(21/27例)患者的尿微量白蛋白得到缓解.53％(8/15例)患者的糖尿病视网膜病变得到改善.结论 袖状胃切除间置回肠的十二指肠空肠旁路手术治疗非肥胖型2型糖尿病短期效果良好.     

非重度肥胖2型糖尿病的外科治疗（附200例报告）

目的 探讨全腹腔镜胃旁路术（laparoscopic gastric bypass surgery,LGBP）治疗非重度肥胖2型糖尿病（type 2 diabetes mellitus,T2DM）的临床疗效.方法 2009年7月至2012年5月实施LGBP的200例非重度肥胖T2DM[25 kg/m2≤术前体重指数（BMI）＜35 kg/m2]患者,监测其术前、术后的空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹C肽,并进行统计学分析.结果 LGBP术后1年空腹血糖由术前的（8.95±0.52） mmol/L降为（6.01±0.31） mmol/L,餐后2 h血糖由术前的（15.55±1.30） mmol/L降为（9.02±0.61） mmol/L,糖化血红蛋白由术前的（8.23±0.37）%降为（5.35±0.45）%,三者均有不同程度的下降,差异均有统计学意义（P值均＜0.05）.而餐后血糖下降比空腹血糖快、显著,空腹C肽水平变化不明显.结论 LGBP治疗非重度肥胖T2DM近期疗效明显,术后餐后血糖、空腹血糖的改善不同步,预示其机制可能不完全相同.LGBP是一种微创、安全、有效的外科治疗糖尿病的方法,其远期疗效有待于进一步随访.     

腹腔镜可调节胃束带术治疗肥胖病伴2型糖尿病21例疗效分析

目的 观察评价腹腔镜可调节胃束带术（LAGB）治疗肥胖病伴2型糖尿病的临床效果。方法 回顾分析2005-2007年天津市南开医院微创外科中心对21例肥胖病伴2型糖尿病病人施行LAGB的临床资料,观察分析手术前后病人体重、体重指数（BMI）及空腹血糖等指标变化。 结果 21例手术均获成功,未发生围手术期严重并发症。术后随访1年,体重从平均106.7（±13.8）kg降至93.8（±10.6）kg;体重指数从平均37.2（±3.6）降至32.4（±2.1）, 空腹血糖从平均8.60（±2.1）mmol/L降至7.80（±2.2）mmol/L,体重下降明显,但糖尿病缓解不明显。随访2年,平均体重降至85.2（±11.8）kg;平均体重指数降至 29.4（±2.8）, 平均空腹血糖降至5.86（±1.7）mmol/L,体重下降及糖尿病缓解均明显。结论 LAGB术后2年疗效可靠,平均体重下降20.1%, 糖尿病缓解率76%,是治疗肥胖病伴2型糖尿病的有效方法。     

良性梗阻性黄疸合并糖尿病310例分析

目的 探讨良性梗阻性黄疸合并糖尿病围手术期治疗措施.方法 对2006年1月至2010年12月收治的310例良性梗阻性黄疸合并糖尿病择期手术病例进行回顾性分析.结果 手术前日空腹血糖控制在4.5～7.8 mmol/L182例,术后发生并发症47例(25.8%);控制_在7.8～10.0 mmol/L128例,术后发生并发症40例(31.2%).两相比较差异没有统计学意义.术中血糖控制在6.3～11.1mmol/L.术后血糖控制在5.6～7.8 mmol/L132例,发生并发症20例(15.1%);控制在7.8～11.1mmol/L178例.发牛并发症67例(37.6%).两相比较差异有统计学意义(P<0.05).黄疸程度与血糖交互作用归因比(AIP):0.25,95%可信区间在0.14～1.02,表明两者在并发症中存在交互作用.结论 强化围手术期治疗,并将术后血糖控制在7.8 mmol/L以下可显着降低术后并发症发生率.黄疸程度在术后并发症方面与血糖存在交互作用.     

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.