尿动力学评价子宫切除术后尿潴留及Credé手法治疗1年疗效分析

目的:探讨因子宫颈癌行广泛子宫切除术后尿潴留患者下尿路尿动力学特点,评价Crede手法治疗子宫切除术后尿潴留患者的疗效。方法:回顺性分析因子宫颈癌行广泛性子宫切除术后尿潴留患者47例,年龄(40.5±11.7)岁,所有患者术前及术后3个月均行尿动力学检查。术后3个月开始行Crede手法辅助排尿,治疗1年后行尿动力学检查随访。比较手术前后和行Crede手法排尿1年后尿动力学指标的变化。结果:术后最大尿流率(MFR)、平均尿流率(AFR)、排尿量(VV)、最大逼尿肌收缩压(MDP)和膀胱顺应性(BC)明显低于手术前[MFR(10.9±5.3)ml/s vs.(23.4±6.3)ml/s;AFR(4.6±2.1)ml/s vs.(12.4±5.7)ml/s;VV(161.2±127.2)ml vs.(350±135)ml;MDP(1.65±2.34)kPa vs.(3.82±1.72)kPa;BC(33.3±48.2)ml/cmH_2Ovs.(98±57.5)ml/cmH_2O];剩余尿量(PVR)和尿流时间(VT)较术前明显增多或延长[PVR(147±158)ml vs.(8.7±4.9)ml;VT(42.3±23.4)s vs.(28.5±14.7)s]。Crede手法辅助排尿1年后,患者总漏尿次数、下尿路功能症状评分较治疗前显著降低[TLT(5±3)次vs.(13±4)次;LUTS(16±5)分vs.(29±3)分]。患者最大尿流率[(14.0±7.8)ml/s,平均尿流率(6.7±4.3)ml/s]和膀胱顺应性[(56.9±29.4)ml/cmH_2O]较治疗前明显改善(P0.05),剩余尿量(20.0±13.8)ml较治疗前明显减少。结论:广泛子宫切除术后长期尿潴留患者下尿路的尿动力学特点主要表现为逼尿肌收缩乏力或者无收缩,部分术后逼尿肌无收缩的患者术后1年出现逼尿肌收缩,提示重新获得神经支配。Crede手法辅助排尿对治疗子宫颈癌手术后逼尿肌收缩乏力致尿潴留的患者切实有效。     

症状性BPH剩余尿及最大尿流率的临床价值再探讨

目的：探讨症状性BPH剩余尿（PVR）、最大尿流率（Qmax）在临床诊疗中的作用。方法：对173例BPH症患者进行IPSS、并测定Qmax、PVR及前列腺体积。应用相关分析评价各检变量间的相关性及其不同组间各指标的比较。结果：PVR与IPSS、前列腺移行带体积均呈正相关,与Qmax呈负相关。与年龄、前列总腺体积（P〉0．05）之间均无相关。PVR〈10ml组与10-30ml组在年龄、IPSS、前列腺移行带体积和Qmax比较差异均无统计学意义。PVR10-30ml组与≥30ml组在年龄、前列腺移行带体积比较差别均无统计学意义,而IPSS、Qmax比较差别有统计学意义。在Qmax〈10mL／s组,Qmax与年龄、IPSS、PVR、前列腺总体积和前列腺移行带体积均呈负相关;在Qmax〉10ml／s组,Qmax与上述指标均呈无相关（P〉0．05）;除年龄外,两组间上述指标均差异有统计学意义（P〈0．01）。结论：症状性BPH患者PVR≥30ml,Qmax〈10ml／s时,在排除其他因素引起逼尿肌损害所致的PVR增加及Qmax降低后,应及早解除膀胱出口梗阻。     

经尿道等离子体双极汽化电切术治疗高危前列腺增生症(附69例报告)

目的:探讨治疗高龄并高危BPH的有效治疗方法.方法:采用经尿道等离子体前列腺双极汽化电切术(TUPKVP)治疗高危前列腺增生(BPH)患者69例.结果:69例平均手术时间38 min,平均失血58 ml,切割获取前列腺组织平均重量51 g,无水中毒及尿失禁发生,治疗前国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、剩余尿(PVR)分别为( 27.4± 5.8)分、( 5.0± 0.4)分、( 7.6± 2.1)ml/s、( 133.0± 41.8)ml,治疗后1个月分别为( 17.3± 4.7)分、( 2.9± 0.5)分、( 14.4± 3.2)ml/s、( 16.0± 8.6)ml,治疗前后IPSS、QOL、Qmax、PVR差异有统计学意义.结论:TUPKVP是治疗高龄并高危BPH的安全有效的方法.     

福施乐治疗良性前列腺增生的临床研究

目的:观察福施乐治疗BPH的有效性和安全性。方法:采用多中心、开放性、自身前后对照的临床研究方法,对60例BPH患者采用福施乐治疗12周。以国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、膀胱残余尿(PVR)和前列腺体积为主要疗效指标,以生活质量评分(QOL)和平均尿流率(Qave)为次要疗效指标,来评价福施乐治疗BPH的效果。结果:治疗12周后,患者IPSS评分、Qmax、PVR、QOL评分、Qave均比治疗前明显改善(P<0.01),而前列腺体积治疗前后无显著性差异(P>0.05)。结论:福施乐可明显改善BPH患者的排尿症状,增加尿流率,减少残余尿,无明显不良反应,治疗BPH安全、有效。     

症状性前列腺增生剩余尿及最大尿流率的临床价值再探讨

目的：探讨症状性前列腺增生剩余尿（PVR）、最大尿流率（Qmax）在临床诊疗中的作用。方法：对173例BPH患者进行IPSS评分、并测定Qmax、PVR及前列腺体积。应用相关分析评价各检变量间的相关性及其不同组问各指标的比较。结果：PVR与IPSS、前列腺移行带体积均呈正相关，与Qmax呈负相关。与年龄、前列总腺体积之问均无相关（P〉O．05）。PVR＜10ml组与10～30ml组在年龄、IPSS、前列腺移行带体积和Qmax比较差异均无统计学意义。PVR 10～30ml组与≥30ml组在年龄、前列腺移行带体积比较差异均无统计学意义,而IPSS、Qmax比较差异有统计学意义。在Qmax〈10ml／s组，Qmax与年龄、IPSS、PVR、前列腺总体积和前列腺移行带体积均呈负相关；在Qmax〉10ml／s组，Qmax与上述指标均呈无相关（P〉0.05）；除年龄外，两组问上述指标均有显著的统计学意义（P＜0．001）。结论：症状性BPH患者PVR≥30ml，Qmax〈10ml／s时，在排除其他因素引起逼尿肌损害所致的PVR增加及Qmax降低后,应及早解除畴胱出口梗阻。     

萘哌地尔治疗良性前列腺增生伴膀胱过度活动症的临床观察

目的:探讨α1A、α1D肾上腺素能受体阻滞剂萘哌地尔治疗良性前列腺增生(BPH)伴膀胱过度活动症(OAB)的有效性及安全性。方法:采用自身对照的临床试验方法,萘哌地尔25mg,每日1次口服,对50例BPH伴OAB患者进行了为期6周的治疗。于治疗前后,以国际前列腺症状评分(IPSS)、生活质量评估(QOL)及最大尿流率(Qmax)、平均尿流率(Qave)、尿量(VV),以及血压和心率为评估指标,观察其有效性及安全性。结果:服药6周后,可评价病例46例。IPSS平均降低9.75分(P<0.01),其中,排尿症状评分平均降低3.97分(P<0.01),储尿症状评分平均降低5.78分(P<0.01);QOL平均降低1.95分(P<0.01),Qmax平均增加4.29ml/s(P<0.01),Qave平均增加3.75ml/s(P<0.01),VV平均增加55.12ml(P<0.05)。血压及心律无明显变化(P>0.05)。治疗过程中不良事件发生率4.35%(1例患者出现头晕)。结论:萘哌地尔治疗BPH伴OAB有效,安全。     

黄莪胶囊治疗气虚血瘀、湿热阻滞型BPH的单臂、开放、多中心Ⅳ期临床研究

目的:评价在广泛使用条件下黄莪胶囊治疗气虚血瘀、湿热阻滞型良性前列腺增生(BPH)的有效性。方法:605例BPH受试者口服黄莪胶囊治疗,3次/d,4粒/次,疗程为42 d。观察受试者治疗前后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、平均尿流率(Qave)、生活质量(QOL)评分、前列腺体积变化。结果:共503例受试者完成了整个临床试验,治疗后受试者IPSS下降了(7. 54±4. 61)分,Qmax增加了(2. 05±5. 85) ml/s、Qave增加了(1. 04±3. 17) ml/s、QOL评分下降了(1. 69±1. 00)分、前列腺体积减小了(2. 80±12. 02) ml,变化均有统计学意义(P 0. 05)。结论:黄莪胶囊治疗气虚血瘀、湿热阻滞型BPH标本兼顾,有良好的疗效。     

前列腺增生症患者压力-流率测定的诊断价值评估

目的评估压力-流率测定在前列腺增生症(BPH)患者诊断中的价值。方法对280名伴有下尿路症状的BPH患者进行尿动力学检查和IPSS评分。结果根据膀胱出口梗阻指数(BOOI)将患者分为3组,分别为BOO组156例,轻度BOO组61例,无BOO组63例,其最大尿流率(Qmax)分别为(6．44±1．44)ml／s,(7．49±1．76) ml／s,(8．11±1．97)ml／s,BOO组与另二组统计学分析有显著性差异;最大尿流率时的逼尿肌压力(Pdet-Qmax)分别为(73．49±15．91)cmH2O,(49．90±6．82)cmH2O,(30．70±6．04)cmH2O,3组之间统计学分析有显著性差异;术前IPSS评分分别为(20．55±5．09),(17．51±4．46),(17．54±4．96),BOO组与另两组之间统计学分析有显著性差异;术前剩余尿量(PVR)分别为(104．53±37．14)ml,(106．66±41．70)ml,(104．29±40．75)ml, 3组之间差异无显著性意义。结论压力-流率测定可了解BPH患者BOO严重程度,对BPH治疗的选择和判断预后具有指导意义。     

压力-流率测定中尿道内置测压导管对尿流率的影响

目的　探讨尿道内置测压管在压力 流率测定中对尿流率的影响。　方法　对 4 4例良性前列腺增生 (BPH)患者进行自由尿流率和压力 流率测定。压力 流率测定中尿道内放置 7F测压导管。统计学分析比较自由尿流率和置管后尿流率的变化。　结果　 4 4例患者自由尿流率和带管尿流率的排尿量分别为 (174 .72± 74 .6 2 )ml和 (186 .4 8± 6 9.71)ml(P >0 .0 5 )。最大自由尿流率(9 .5 5± 4 .10 )ml/s ,最大带管尿流率 (7.32± 3.2 8)ml/s(P =0 .0 0 0 )。最大尿流率下降值为 (2 .2 2± 3.0 7)ml/s。膀胱出口梗阻 (BOO) 0～Ⅰ级、Ⅲ级和Ⅳ级时自由尿流率和带管尿流率两者差异有显著性意义 (P <0 .0 5 ) ,BOOⅡ级、Ⅴ～Ⅵ级时自由尿流率和带管尿流率差异无显著性意义 (P >0 .0 5 )。　结论　尿道内置 7F测压导管可影响最大尿流率测定值。     

剩余分数在评价BPH所致膀胱出口梗阻中的临床意义

目的:探讨剩余分数(RF)在评价BPH致膀胱出口梗阻(BOO)程度及逼尿肌功能的应用价值。方法:69例BPH患者行尿动力学各项指标测定,分析剩余尿量(PVR)和RF与排尿前尿量、Qmax、逼尿肌收缩强度的相关性。结果:PVR与排尿前尿量呈显著正相关(r=0.6154,P<0.01),RF与排尿前尿量则无明显相关性(r=0.2419,P=0.07)。PVR与Qmax呈显著负相关(r=-0.3212,P<0.01),RF与Qmax呈极显著负相关(r=-0.4356,P<0.01)。逼尿肌收缩强度为极弱、弱与正常和强的患者的PVR、RF的差异均有统计学意义(分别为P=0.0172,P=0.0021)。结论:RF不受排尿前尿量的影响,是一项较PVR能更好的评价BPH所致BOO及其程度和逼尿肌收缩功能的静态指标。     

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.