右美托咪定复合艾司氯胺酮治疗顽固性失眠伴抑郁症患者的有效性

目的 评价右美托咪定复合艾司氯胺酮在顽固性失眠伴抑郁症中的临床疗效。方法选择顽固性失眠伴抑郁症患者68例,男26例,女42例,年龄18～64岁,BMI 18～28 kg/m²,ASAⅠ或Ⅱ级。将患者随机分为两组：右美托咪定复合艾司氯胺酮组(DE组)和右美托咪定复合生理盐水组(DS组),每组34例。两组分别用麻醉诱导睡眠平衡术治疗3个疗程,分别给予微泵注射右美托咪定1μg/kg持续10 min以诱导睡眠,继以右美托咪定0.2～1.5μg·kg^-1·h^-1维持睡眠。DE组同时泵注艾司氯胺酮0.5 mg/kg, DS组同时泵注生理盐水。分别在首次治疗前(T₀)、第1疗程治疗后(T₁)、第2疗程治疗后(T₂)和第3疗程治疗后(T₃)采取匹兹堡睡眠质量指数(PSQI)和失眠严重程度指数(ISI)评估睡眠状况,采取汉密尔顿抑郁量表(HAMD)和视觉模拟抑郁量表(VAS-D)评估抑郁状况,分析汉密尔顿焦虑量表(HAMA)和血清皮质醇浓度的变化。记录...     

右美托咪定腰硬联合麻醉在老年经尿道前列腺电切术中的应用效果

目的 评价右美托咪定腰硬联合麻醉用于老年经尿道前列腺电切术(TURP)的效果。方法 择期拟在腰硬联合麻醉下行TURP术的老年良性前列腺增生症(BPH)患者70例,年龄≥60周岁,ASA分级Ⅰ～Ⅱ级。采用随机数字表法分为观察组(36例)和对照组(34例)。2组均于L_3～4间隙穿刺注入0.25%布比卡因注射液2.0 mL和脑脊液1.0 mL混合液,并向头端置入硬膜外导管。控制感觉阻滞平面不超过T₁₀。术中根据平均动脉压(MAP)和心率(HR)情况应用麻黄碱或阿托品。观察组在10 min内泵入0.5μg/kg右美托咪定,再以0.2μg·kg^-1·h^-1的速度维持;对照组在10 min内泵入0.04 mg/kg咪达唑仑,以0.04 mg·kg^-1·h^-1的速度维持;手术结束前10 min停止给药。分别于麻醉前(T₀)和手术开始后10 min(T₁)、30 min(T₂)、60 min(T_3...     

去阿片化麻醉在泌尿外科短小手术中的应用

目的 探讨去阿片化麻醉在泌尿外科短小手术中的应用效果。方法 选择2021年8—12月行泌尿外科短小手术患者60例,男40例,女20例,年龄18～64岁,BMI 18～28 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组：去阿片化麻醉组(F组)和瑞芬太尼麻醉组(R组),每组30例。F组使用艾司氯胺酮复合右美托咪定进行麻醉维持,R组使用瑞芬太尼复合丙泊酚进行麻醉维持。记录麻醉诱导前(T₀)、麻醉诱导后即刻(T₁)、喉罩置入后(T₂)、麻醉诱导后10 min(T₃)、喉罩移除前(T₄)、喉罩移除后(T₅)的HR、SBP、DBP和BIS。记录麻醉苏醒时间、术后30 min、24 h VAS疼痛评分分级和术后不良反应的发生情况。结果 与T₀时比较,R组T₁—T₄时HR明显减慢,T₁—T₅时SBP、DBP明显降低(P<0...     

右美托咪定对全身麻醉下行腹腔镜胆囊切除术治疗胆囊疾病的老年患者的应激反应的影响

目的 探讨右美托咪定对全身麻醉下行腹腔镜胆囊切除术老年患者的应激反应的影响。方法 回顾性分析2021年1月至2022年2月南京医科大学附属江宁医院收治的全身麻醉下行腹腔镜胆囊切除术的老年患者70例的临床资料,根据麻醉干预方式不同分为对照组和研究组各35例,对照组患者采用丙泊酚干预,研究组患者采用盐酸右美托咪定注射液干预。比较两组患者麻醉诱导前(T₀)、气管插管时(T₁)、建立气腹时(T₂)、气管导管拔管时(T₃)、拔管5min后(T₄)血流动力学指标、应激指标以及手术情况。结果 研究组T₀～T₃时心率、平均动脉压均低于对照组(P <0.05),且两组T₄时血流动力学指标无显著差异(P> 0.05)。研究组T₀～T₃时血浆皮质醇水平均低于对照组(P <0.05),研究组T₄时,血管紧张素Ⅱ水平低于对照组(P <0.05),且两...     

预注右美托咪定的镇静效应及其对全麻患者气管插管反应的影响

目的观察预注右美托咪定对镇静及气管插管反应的影响。方法择期全凭静脉麻醉下行甲状腺次全切除术患者42例,ASAⅠ或Ⅱ级,年龄18～60岁,体重指数18～30kg/m²,随机均分为两组:右美托咪定组（D组）和对照组（C组）。D组患者于麻醉诱导前15min静脉泵注右美托咪定0.6μg/kg（10min内泵注完毕）,C组患者以同样方式泵注等量生理盐水;观察5min后开始麻醉诱导,两组患者麻醉诱导方法相同,当BIS≤45时行气管插管。记录给药前（T₀）、给药完毕即刻（T₁）、给药后5min（T₂）、插管前即刻（T₃）、插管成功后即刻（T₄）、插管成功后1min（T₅）、3min（T₆）、5min（T₇）患者的MAP、HR、SpO₂、BIS、Ramsay镇静评分;记录患者意识消失时间和BIS降至45的时间;观察并记录麻醉诱导期间的不良反应。结果与C组比较,D组患者意识消失时间和BIS降至45的时间缩短（P<0.05）;与T₀时比较,T₁～T₇时D组患者MAP、BIS均降低,HR减慢,Ramsay镇静评分升高（P<0.05）;T₃～T₇时C组MAP、BIS均降低,Ramsay镇静评分升高;T₃、T₆和T₇时C组HR减慢（P<0.05）;与T₃时比较,T₆时D组MAP降低,T₄、T₅时C组MAP均升高,HR增快（P<0.05）。结论右美托咪定0.6μg/kg预注可产生明显的镇静作用,缩短麻醉诱导时间,有效抑制气管插管所引起的心血管反应。     

右美托咪定预处理对心脏瓣膜置换术患者心肌肌钙蛋白Ⅰ和心肌酶学的影响

【摘要】〓目的〓观察右美托咪定预处理对脏瓣膜置换术患者心肌肌钙蛋白Ⅰ和心肌酶学的影响,探讨其对缺血再灌注损伤心肌的保护作用。方法〓拟择期行瓣膜置换术患者50例随机分为右美托咪定组(D组,n=25)和对照组(C组,n=25)。D组在麻醉诱导前经15 min静脉泵注右美托咪定0.5 μg/kg,随后以0.5 μg·kg^-1·h^-1速率泵注至阻断主动脉。C组泵注等容量生理盐水。所有患者手术前(T₀),主动脉阻断30 min(T₁)、主动脉开放1 h(T₂),术毕(T₃)和术后24小时(T₄)抽血测定磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)的活性及心肌肌钙蛋白I(cTnI)的浓度。观察自动复跳率、心律失常发生率、左室射血分数(LVEF)以及血管活性药物使用情况。结果〓与C组相比,D组的cTnI浓度、CK和CK-MB的活性、多巴胺和肾上腺素用量低于C组;两组自动复跳率和心律失常发生率无统计学差异;D组术后LVEF值高于C组。结论〓右美托咪定预处理可减轻瓣膜置换患者的心肌损伤。     

右美托咪定用于气管异物患儿气管拔管的镇静效果

目的 观察术前给予右美托咪定对气管异物取出术患儿气管拔管的镇静效果.方法 气管异物取出术患儿60例,随机均分为两组,分别在全麻诱导前10 min内静脉输注右美托咪定0.5 μg/kg(D组)或生理盐水(C组).术中丙泊酚2mg·kg-1·h-1、瑞芬太尼0.1μg·kg-1·h-1维持麻醉.记录拔管前1 min、拔管时、拔管后1、5min时的HR、MAP、RR、Ramsay镇静评分的变化,以及拔管期间呛咳和躁动情况.结果 D组HR、RR、MAP、呛咳评分和躁动评分低于C组(P＜0.05),Ramsay镇静评分高于C组(P＜0.05).结论 术前给予右美托咪定可为气管异物患儿苏醒期提供较好的镇静,减少拔管期间躁动和呛咳.     

右美托咪定在胸外科手术患者中的应用

目的 分析右美托咪定在普胸手术患者中应用的安全性和可能获益.方法 从麻醉信息系统获取普胸术中使用右美托咪定的患者117例作为右美组;同时获取同期、同类型、未用右美托咪定的患者117例作为非右美组.右美托咪定的给药方法分为:麻醉诱导前、诱导同步及诱导后10 min内输注1μg/kg.两组麻醉诱导及维持方法相同.观察两组的麻醉效果、麻醉维持期丙泊酚TCI的靶浓度、拔管时间及麻醉恢复室(PACU)中用药情况及其他不良反应.结果 右美组在麻醉维持期丙泊酚TCI靶浓度≤2.5μg/ml的病例数明显多于非右美组(P＜0.01).PACU中右美组应用曲马多的病例数明显低于非右美组,两组的拔管时间差异无统计学意义.右美组在诱导同步或诱导后用药一过性血压升高的发生率低于麻醉诱导前用药(P＜0.01);右美组严重心动过缓( HR＜40次/分)的发生率为4.2％.结论 普胸术中,以1μg/kg的右美托咪定10 min内输注,在麻醉诱导前、诱导同步或诱导后给药均是安全的.给予右美托咪定的主要获益在于可降低麻醉维持期丙泊酚TCI的靶浓度,减少苏醒过程中其他药物的使用.个别患者应用右美托咪定后可产生严重的心动过缓应予以注意.     

右美托咪定和瑞芬太尼持续静脉输注在纤维支气管镜清醒插管中的应用

目的比较右美托咪定和瑞芬太尼在纤维支气管镜（FOB）清醒插管中应用的效果。方法选择困难气道FOB清醒插管患者60例,ASAⅠ或Ⅱ级,年龄18～59岁,体重46～80 kg,随机均分为右美托咪定组（D组）和瑞芬太尼组（R组）。气管内表面麻醉后,D组给予右美托咪定1μg/kg后以0.5μg·kg^-1·h^-1持续静脉输注;R组给予瑞芬太尼1μg/kg后以0.1μg·kg^-1·min^-1持续静脉输注。记录入室后（基础值,T₀）、插管前即刻（T₁）、气管导管进入声门即刻（T₂）、插管后2min（T₃）、5 min（T₄）、10 min（T₅）时的HR、SBP、DBP,并于各时点采静脉血检测肾上腺素（E）、去甲肾上腺素（NE）浓度。结果与T₀时比较,T₂～T₄时两组SBP、DBP明显增高,HR明显增快,且R组显著高于、快于D组（P<0.05）;T₃～T₅时,两组NE均明显升高,且R组明显高于D组,R组E明显升高,且高于D组（P<0.05）。结论气管表面麻醉后持续静注右美托咪定较瑞芬太尼能更好地完成困难气道FOB清醒气管插管,血流动力学变化更小,不良反应少。     

右美托咪定对妇科腹腔镜手术患者全麻苏醒期的影响

目的评价右美托咪定用于妇科腹腔镜手术患者全麻苏醒期的有效性和安全性。方法择期行妇科腹腔镜手术患者60例,ASAⅠ或Ⅱ级,采用随机数字表法,随机均分为:右美托咪定组(D组)和对照组(C组)。两组均采用全凭静脉麻醉,手术结束前30 min D组患者单次静脉泵注右美托咪定0.5μg/kg,10 min内注药完毕。C组以同样方式输注生理盐水。手术结束缝皮前停用静脉麻醉药,手控诱导呼吸。记录患者自主呼吸恢复时间、苏醒时间、拔管时间、Ramsay镇静评分及拔管时患者出现呛咳、躁动等全麻苏醒期不良反应的情况。结果两组呼吸恢复时间、苏醒时间、拔管时间差异均无统计学意义;D组Ramsay镇静评分明显高于C组(P0.05)。D组呛咳、躁动发生率明显低于C组(P0.05)。两组在拔管后均未发生呼吸抑制。结论妇科腹腔镜手术患者手术结束前30 min单次静脉泵注右美托咪定未发生呼吸抑制及气道不良反应,未延长拔管时间,提高了全麻苏醒期的质量。     

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.