急性脊髓损伤后Fas、Caspase-3基因的表达及神经细胞凋亡的研究

急性脊髓损伤（ASCI）后，神经细胞死亡的方式不仅仅是坏死，同时细胞凋亡广泛存在。本研究旨在探讨Fas、Caspase-3基因与细胞凋亡的关系及在脊髓损伤发生发展中的作用。[第一段]     

异丙酚对脊髓缺血再灌注损伤大鼠脊髓细胞凋亡的影响

目的 探讨异丙酚对脊髓缺血再灌注损伤大鼠脊髓细胞凋亡的影响。方法成年雄性清洁级Wiser大鼠60只，体重200～250g，随机分为异丙酚组（A组）和缺血再灌注组（B组），每组30只，采用改进的Zivin等的方法制备脊髓缺血再灌注模型，缺血的同时A组腹腔注射异丙酚100mg/kg，B组注射等量生理盐水。每组分别于再灌注6h、1d、2d、3d、7d时处死6只大鼠。根据Tador评分评价大鼠后肢神经功能损伤情况，电镜下观察脊髓的病理学变化，用免疫组化法测定脊髓cyclinD1阳性细胞表达，原位末端标记法（TUNEL法）检测凋亡细胞，计算凋亡指数。结果A组脊髓损伤及后肢神经功能损伤均较B组轻，A组脊髓神经细胞凋亡指数及cyclinD1表达均低于B组（P〈0．05或0．01）。结论异丙酚对脊髓缺血再灌注损伤有一定的保护作用，其机制与下调脊髓cyclinD1表达，抑制神经细胞亡有关。     

大鼠脊髓损伤后细胞凋亡的光镜和电镜观察

目的：观察大白鼠脊髓损伤后细胞凋亡现象及超微结构特点，方法：48只SD大鼠为分两组，Allen's法致伤脊髓（轻度损伤和中度损伤），分别于术后4、8、24、48、72、168h处死，采集脊髓标本，应用HE、TUNEL当色进行光镜和电镜观察，结果：HE当色显示轻度损伤后 髓主要表现为多发性小出血灶，后期为胶细胞增生，中度损伤早期主要表现为大片出血灶，继之出现损伤部位细胞液化坏死，后期空腔形成。TUNEL染色显示，术后4h即出现细胞凋亡，术后8h达最高峰，包括神经元和胶质细胞凋亡。术后48h开始减少，术后72h和168h仍可见到凋亡的胶质细胞，术后4h和8h凋亡细胞主要分布在损伤节段内，结论：脊髓损伤后存在细胞凋亡现象，从形态上看包括神经元和胶质细胞和凋亡，细胞是脊髓继发性损害中细胞死亡的一种重要形式。     

淫羊藿苷在大鼠脊髓损伤中的神经保护作用

目的:研究淫羊藿苷在大鼠脊髓损伤中的神经保护作用。方法:108只SPF级雄性3月龄SD大鼠按随机数字表法分为实验组、对照组及假手术组3组,每组36只。对照组和实验组采用改良Allen法制作脊髓损伤模型,假手术组仅切开椎板不损伤脊髓。术后即刻实验组给予淫羊藿苷(100 mg/kg)灌胃,对照组和假手术组给予等量生理盐水灌胃,每日2次。术后1、2、3 d采用BBB评分法评定大鼠运动功能;术后72 h采用分光光度法检测髓过氧化物酶(myeloperoxidase,MPO)的活性,酶联免疫吸附测定(ELISA)法检测肿瘤坏死因子(tumor necrosis factor,TNF)-α、白介素(interleukin,IL)-1β的含量,免疫组化染色检测MPO、TNF-α、IL-1β的表达;采用硫代巴比妥酸法检测丙二醛(malondialdehyde,MDA)含量,黄嘌呤氧化酶法检测超氧化物歧化酶(superoxide dismutase,SOD)活性;采用TUNEL法检测细胞凋亡并计算细胞凋亡指数(apoptosis index,AI);光镜观察脊髓损伤后组织病理学的改变并行组织病理学评分。结果:术后各时间点对照组和实验组大鼠BBB评分均显著低于假手术组(P0.05);术后2、3 d实验组大鼠BBB评分均显著高于对照组(P0.05)。术后72 h,对照组和实验组MPO活性和TNF-α、IL-1β的含量显著高于假手术组(P0.05);实验组显著低于对照组(P0.05)。对照组和实验组MPO、TNF-α、IL-1β的表达显著高于假手术组(P0.05);实验组显著低于对照组(P0.05)。对照组和实验组MDA含量显著高于假手术组,实验组显著低于对照组(P0.05);对照组和实验组SOD活性显著低于假手术组,实验组显著高于对照组(P0.05)。对照组和实验组脊髓组织中AI显著高于假手术组,实验组显著低于对照组(P0.05)。对照组和实验组脊髓组织病理学评分均显著高于假手术组,实验组均显著低于对照组(P0.05)。结论:淫羊藿苷能够抑制脊髓损伤后的炎症、脂质过氧化和细胞凋亡,减轻脊髓组织病理学损伤,改善脊髓损伤大鼠的运动功能,有效保护脊髓组织,具有明显的神经保护作用。     

体外转基因成肌细胞移植对大鼠损伤脊髓细胞凋亡的影响

目的：探讨大鼠脊髓损伤后胚胎脊髓和腺病毒介导的脑源性神经生长因子（AxCA-BDNF)体外转基因成肌细胞移植对大鼠脊髓细胞凋亡的影响。方法：将动物分为：大鼠脊髓半切洞损伤明胶海绵填充组（A组）,大鼠脊髓半切洞损伤应用胚胎脊髓移植组（B组）,脊髓半切洞损伤损伤AxCA-BDNF基因转染的成肌细胞移植组（C组）大鼠脊髓半切洞损伤后应用胚胎脊髓和AxCA-BDNF基因转染的成肌细胞移植组（D组）。手术后1、3、7、14、28d应用行为学和电生理检查观察大鼠功能恢复情况,对脊髓损伤区进行细胞凋亡的检测（TUNEL）以及Bcl-2蛋白表达的测定（免疫组化法）。采用计算机图像分析技术,进行定量分析。结果：A、B、C、D四组中均发现凋亡细胞及Bcl-2蛋白阳性表达细胞,图像分析发现,各组凋亡细胞核为A＞B＞C＞D;Bcl-2免疫反应阳性细胞表达顺序为D＞C＞B＞A,Bcl-2免疫反应阳性细胞的表达与大鼠后肢功能恢复有同样的变化趋势。结论：大鼠胚胎脊髓和体外转基因成肌细胞移植能抑制脊髓损伤后的细胞凋亡。     

大鼠急性脊髓损伤后内质网应激相关蛋白CHOP的表达及其意义

目的:探讨内质网应激相关蛋白CHOP在急性脊髓损伤中的表达及其意义.方法:48只健康SD大鼠随机分为实验组与对照组(每组24只),实验组采用Allen法制作急性脊髓损伤模型,对照组只切开椎板不损伤脊髓.分别十伤后3h、1d、3d、7d时(每个时间点6只)应用改良Tarlov评分法评价其神经功能;然后处死动物,取受损节段脊髓行HE染色及免疫组化染色,观察形态学变化和CHOP在脊髓组织中的分布特点;并应用TUNEL方法检测神经细胞凋亡情况.其量的评定借助于IPP(Image-Pro Plus 6.0)软件,结果分别用累积光密度(integrated optical density,IOD)及平均光密度(mean density)表示.结果:对照组大鼠均末见明显瘫痪,实验组出现不同程度的下肢功能障碍,对照组各时间点的Tadov评分均高于实验组(P<0.01).对照组各时间点未见明显坏死细胞和细胞凋亡,实验组出现不同程度的细胞坏死和凋亡.实验组CHOP表达各时间点均明显高于对照组(P<0.01),实验组内CHOP表达1d增加,3d达到高峰,7d减少.实验组内细胞凋亡1d时增加,3d达到高峰,7d减少,且3h<1d<3d>7d(P<0.01).CHOP表达与细胞凋亡在时间上具有一致性,相关系数为0.644.结论:急性脊髓损伤能够诱导CHOP表达,CHOP表达的增高可能与内质网应激诱导的神经细胞凋亡有关.     

大鼠脊髓损伤中的细胞凋亡及甲基强的松龙的干预作用

目的：探讨脊髓损伤（SCI）继发损伤机制,研究损伤脊髓细胞的凋亡及其意义,观察甲基强的松龙（MP）对细胞凋亡的影响。方法：使用改良Allen法制作大鼠急性SCI模型,实验分3组,假损伤（脊髓未受打击）,损伤组及MP治疗组,采用HE,荧光Hoechst 33342,TUNEL(末端脱氧核苷转移酶介导的脱氧尿苷三磷酸生物素缺口末端标记技术）等技术观察SCI后4h,8h,3d,7d,14d,21d及28d时损伤中心及邻近节段脊髓细胞的凋亡,治疗组损伤后30min给予大剂量MP,比较MP治疗组与损伤组脊髓细胞凋亡的变化,同时平行观察大鼠神经学和组织学恢复情况及两组神经丝蛋白（NF）含量的变化。结果：假损伤组各检测方法未见脊髓细胞凋亡,损伤组大鼠急性SCI后1d开始出现脊髓细胞凋亡,3d达高峰,自损伤中心向头尾端递减分布,持续21d,MP治疗组在伤后3d及7d凋亡脊髓细胞较损伤组显著减少,神经学恢复及组织学评分较损伤组有显著性提高,结论：凋亡是SCI后脊髓神经元死亡的一种重要方式,在继发性损伤中起极为重要的作用。MP的治疗作用可能与其干预SCI后细胞凋亡有关。     

内皮素和脊髓损伤

脊髓损伤（SCI）的治疗是一个世界性医学难题，文献报道其发病率呈逐年上升趋势。按病理演变过程划分，SCI可分为原发性损伤和继发性损伤。继发性损伤的理论很多，如缺血缺氧机制、兴奋性氨基酸（EAA）毒性、钙超载、细胞因子及凋亡学说等。多数学者认为SCI后脊髓血流的改变是引起脊髓坏死和神经功能丧失的重要原因[1、2]。内皮素（ET）是目前已知缩血管作用最强的细胞因子，参与调节机体各种生理和病理生理过程。有关ET和SCI关系的报道逐渐增多，本文就ET在SCI中的作用及有关研究进展作一综述。1ET的结构、分布及其受体1.1结构…     

胶质细胞源神经生长因子对脊髓损伤后细胞凋亡保护作用的实验研究

目的探讨胶质细胞源神经生长因子(GDNF)对损伤脊髓的修复作用。方法用24只SD大鼠半横断法制作脊髓损伤动物模型；随后随机分为单纯脊髓损伤组(对照组)和脊髓损伤加GDNF组(实验组),应用Hochesst法检测脊髓损伤后细胞凋亡的动态变化并计算凋亡指数；手术后应用行为学(BBB评分)观察损伤脊髓功能恢复情况。结果伤后1、2周实验组凋亡指数(10．86±0．99、14．32±1．27)较对照组(13．85±1．54、16．4l±1．28)降低(P＜0．01)；伤后6周BBB评分实验组(5．30±0．52)明显高于对照组(3．6±0．4),差异有统计学意义(P＜0．01)；伤后6周BBB评分实验组(5．30±0．52)明显高于对照组(3．60±0．41),差异有统计学意义(P＜0．01)。结论GDNF能抑制脊髓损伤后细胞凋亡,对成年大鼠损伤脊髓功能恢复有促进作用。     

脊髓损伤后促红细胞生成素对bcl-2的影响

目的 探讨促红细胞生成素（EPO）对大鼠脊髓损伤后伤区脊髓细胞凋亡和神经功能恢复的影响。方法 Wistar大鼠210只，随机分为4组：假手术组、脊髓损伤组、脊髓损伤加重组人EPO治疗组、脊髓损伤加生理盐水治疗组。采用原位末端脱氧核糖核苷酸转移酶介导dUTP标记（TUNEL标记法）检测神经元和少突胶质细胞凋亡，Western blot免疫印迹法和免疫组化染色检测bcl-2表达，免疫组化染色和图像分析方法观察对白质内神经纤维（NF-200染色）的保护作用，通过感觉诱发电位（SSEP）、运动诱发电位（MEP）和大鼠BBB后肢运动功能评分，观察损伤脊髓传导功能的恢复。结果 EPO保护组bcl-2在各时相点的表达明显增高，8h和7d时神经元和少突胶质细胞的TUNEL阳性细胞数明显减少；在7d时白质中NF-200阳性神经纤维明显增多；SSEP和MEP的平均潜伏期和波幅以及BBB功能评分明显提高，与损伤组和生理盐水治疗相比，差异有统计学意义（P〈0．01）。结论 EPO通过上调bcl-2的表达，在抑制脊髓损伤后神经元和少突胶质细胞的凋亡中起到神经保护作用。     

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.     

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.