腓肠神经移植重建海绵体神经保留勃起功能的实验研究

目的 :研究腓肠神经移植替代损伤的双侧海绵体神经恢复大鼠的勃起功能。　方法 :4 8只雄性SD大鼠 (3～ 4月龄和 30 0～ 4 0 0g)随机分为神经移植组、神经损伤组及假手术组 ,每组 16只。 2、4个月后 ,海绵体神经电刺激检测大鼠阴茎勃起功能 ,阴茎内注射神经逆行示踪剂荧光金 5d后检测盆神经节内被标记的神经元细胞。　结果 :2个月后神经移植组与神经损伤组大鼠对海绵体神经电刺激均无勃起反应 ,两组盆神经节内荧光金标记的神经元细胞数目差异有显著性 (P <0 .0 5 ) ;而 4个月后神经移植组大鼠勃起功能较神经损伤组差异有显著性 (P <0 .0 5 ) ,盆神经节内荧光金标记的神经元细胞数目也显著高于神经损伤组 (P <0 .0 5 ) ,与假手术组差异无显著性 (P >0 .0 5 )。　结论 :腓肠神经移植替代损伤的双侧海绵体神经可恢复大鼠的勃起功能。     

神经干细胞移植重建勃起功能的研究

目的 观察神经干细胞移植修复损伤的海绵体神经从而恢复勃起功能的可行性.方法 42只雄性SD大鼠(3～4个月龄和体质量300～400 g)随机分为假手术组、神经干细胞移植组和神经损伤组,每组14只.2、4个月后,海绵体神经电刺激检测大鼠阴茎勃起功能,免疫组织化学法检测海绵体内一氧化氮合酶(nNOS)阳性神经纤维.结果 2个月后3组大鼠对海绵体神经电刺激的勃起反应率分别为100%、0%和0%;3组海绵体内nNOS阳性神经纤维数目分别为98.5±9.2、22.5±3.5和25.7±5.1,后2组间差异无统计学意义(P>0.05).4个月后3组大鼠电刺激后勃起率分别为100%、57.14%和7.19%,后2组间差异有统计学意义(P<0.05);3组海绵体内nNOS阳性神经纤维数目分别为95.1±7.7、86.0±13.4、26.5±4.3,前2组间差异无统计学意义(P>0.05),后2组间差异有统计学意义(P<0.05).结论 神经干细胞移植是修复损伤的海绵体神经从而恢复勃起功能的一种有效方法.     

生长激素对大鼠海绵体神经移植后再生的影响

目的:研究腓肠神经移植替代损伤的双侧海绵体神经(CN)后,生长激素(GH)对大鼠勃起功能恢复的影响。方法:24只雄性SD大鼠(3~4个月,300~400 g)随机均分为2组:神经移植组(腓肠神经移植替代损伤的双侧CN);GH组(神经移植后皮下注射GH)。2个月及4个月后,CN电刺激检测大鼠阴茎勃起功能,免疫组化SP法检测阴茎海绵体内神经元型一氧化氮合酶(nNOS)神经纤维并图像分析计算阳性像素值。结果:2个月后GH组有31.25%CN对电刺激有勃起反应,较神经移植组0%差异有显著性(P<0.05),nNOS阳性神经纤维的像素值在GH组为38 971±7 692,而神经移植组为16 538±3 179,差异同样具有显著性(P<0.05);而4个月后GH组有75%的CN对电刺激有勃起反应,神经移植组43.75%的CN有反应,差异无显著性(P>0.05);nNOS阳性神经纤维的像素值分别为91 348±18 965,79 276±12 021,差异亦无显著性(P>0.05)。结论:GH能促进CN移植后的再生,有利于盆腔根治性手术后勃起功能的恢复。     

神经套管术重建勃起功能的动物实验研究

目的　探讨利用神经套管术加神经生长强化介质修复阴茎海绵体神经损伤 ,重建勃起功能的可行性。　方法　 5 4只SD雄性大鼠随机分成假手术对照组、双侧阴茎海绵体神经损伤组及神经套管加胰岛素生长因子 (IGF)组 ,术后 1、3、6个月用阿朴吗啡试验评估所建动物模型的勃起功能 ,随后取阴茎干、脚组织 ,利用NADPH d染色法证实nNOS阳性神经纤维的再生情况。　结果　术后 1个月 ,阿朴吗啡诱导阴茎勃起试验中 ,神经部分切断组和神经套管IGF组间勃起率没有显著差异 ;术后 3、6个月 ,神经套管组勃起率分别为 4 2 %和 5 0 % ,神经部分切断组勃起率均值为 0 % (P <0 .0 5 )。术后 3、6个月 ,神经套管组nNOS阳性神经纤维数显著增多 ,神经部分切断组的nNOS阳性神经纤维数同术后 1个月相比无增多 (P <0 .0 0 2 ) ,两两比较差异有显著性意义。　结论　利用神经套管加IGF促进神经再生 ,是双侧阴茎海绵体神经损伤后 ,重建勃起功能的一种有效方法。     

生殖股神经移植重建大鼠勃起神经通道

目的　探讨利用生殖股神经移植加神经生长强化介质修复损伤的阴茎海绵体神经,重建勃起神经通道的可行性。　方法　3月龄SD雄性大鼠54只,随机平均分成假手术对照组、双侧阴茎海绵体神经损伤组及神经移植加胰岛素样神经生长因子Ⅰ(IGF Ⅰ)组。术后1、3、6个月用阿朴吗啡试验评估各组动物勃起功能,并取阴茎干组织,采用NADPH d组化法了解nNOS阳性神经纤维的再生情况。　结果　术后1、3、6个月,假手术对照组均有正常阴茎勃起(勃起率100% ),神经切断组完全丧失勃起功能(勃起率0% );术后1个月神经移植组也丧失勃起功能(勃起率0% ),术后3、6个月勃起功能渐恢复(勃起率分别为50%和66. 7% ),两两比较差异有统计学意义(P<0. 05)。术后3、6个月,神经移植组nNOS 阳性神经纤维数显著增多,神经部分切断组的nNOS阳性神经纤维数和术后1个月相比无增多,两两比较差异有统计学意义(P<0. 002)。　结论　双侧阴茎海绵体神经损伤后,利用生殖股神经移植加IGF促进神经再生,是重建勃起神经通路,恢复大鼠勃起功能的一种有效方法。     

显微修复损伤的阴茎海绵体神经恢复大鼠勃起功能

目的　探讨利用显微外科技术修复外科损伤的阴茎海绵体神经 ,重建大鼠勃起通道的可行性。方法　 36只SD雄性大鼠随机平均分成 3组 ,即假手术对照组、双侧阴茎海绵体神经损伤组和显微修复组 ,术后 1、3个月后用阿朴吗啡 (APO)试验来评估所建动物模型 ,随后取阴茎干组织 ,利用NADPH d组化法证实nNOS阳性神经纤维的再生情况。结果　术后 1个月 ,神经部分切断组和显微修复组间差异无显著性 (P >0 .0 5 ) ;术后 3个月 ,APO所诱导的阴茎勃起试验中 ,显微修复组勃起率为 83 .3 % ;神经部分切断组勃起率一直为 0 % (P <0 .0 5 )。此外 ,神经套管组的nNOS阳性神经纤维数目在术后 3个月有显著增多 ,而神经部分切断组的nNOS阳性神经纤维数目同术后 1个月相比无增多 ,两两比较有差异有显著性 (P <0 .0 0 8)。结论　双侧阴茎海绵体损伤后 ,立即用显微外科技术吻合神经 ,是重建勃起通路 ,恢复勃起功能的一种有效方法。     

生长激素对髂内动脉结扎大鼠勃起功能和nNOS神经纤维的影响

目的 :研究生长激素 (GH)对髂内动脉结扎大鼠勃起功能和神经型一氧化氮合酶 (nNOS)神经纤维的影响。方法 :36只成年雄性Wistar大鼠随机均分为 3组 :假手术组、髂内动脉结扎组和GH干预组。于术后 4周末、8周末 ,分别取各组 1/ 2大鼠 ,观察大鼠勃起功能 ,并用免疫组化SP法检测阴茎组织中nNOS神经纤维的数目。　结果 :4周末 ,GH干预组和髂内动脉结扎组在勃起次数和nNOS神经纤维数目上与假手术组相比差异有显著性 (P<0 .0 5 ) ,前两组之间差异无显著性 (P >0 .0 5 ) ,而勃起率 3组之间差异不明显 (P >0 .0 5 )。 8周末 ,3组在勃起次数和勃起率上差异均不明显 ;而阴茎组织中nNOS神经纤维数目 ,GH干预组高于髂内动脉结扎组 (P <0 .0 0 1) ,而与假手术组比较差异无显著性 (P >0 .0 5 )。　结论 :GH可以改善髂内动脉结扎大鼠勃起功能 ,这种作用可能与其增加大鼠阴茎海绵体nNOS神经纤维数目有关     

盆神经节海绵体内移植对双侧海绵体神经损伤后大鼠阴茎勃起功能的影响

目的　研究双侧海绵体神经离断后 ,自体盆神经节海绵体内移植对大鼠阴茎勃起功能的影响。方法　将 2 6只雄性SD大鼠 (3～ 6个月 ,30 0～ 4 0 0g 只 )随机分为 2组 :(1)实验组 (n =16 )行双侧海绵体神经离断及左盆神经节移植入左侧阴茎脚内 ;(2 )对照组 (n =10 )仅离断双侧海绵体神经。1个月及 3个月后阿朴吗啡皮下注射检测勃起功能 ,电刺激左阴茎脚移植区域或右侧盆神经节比较海绵体内压的变化 ,NADPH染色检测海绵体内一氧化氮合酶 (NOS)阳性神经纤维 ,透射电镜观察盆神经节移植后的存活情况。结果　两组大鼠 1个月及 3个月后注射阿朴吗啡后均无勃起反应 ;电刺激左阴茎脚盆神经节移植区域后亦不能导致勃起。 1个月后电刺激两组左阴茎脚后的海绵体内压变化分别为 (9 4 1± 3 2 0 )、(4 16± 2 5 8)cmH2 O(t=4 76 9,P <0 0 5 ) ,3个月后分别为 (13 6 7± 4 18)、(5 0 9± 2 74 )cmH2 O(t=9 18,P <0 0 5 )。两组大鼠左阴茎脚区域的NOS阳性神经纤维数目 1个月后分别为 (2 18 7± 2 4 5 )、(18 0± 3 7) (t=14 77,P <0 0 5 ) ,3个月后分别为 (183 2± 19 7)、(19 0± 3 8) (t =12 18,P <0 0 5 ) ;透射电镜证实了神经节移植后的存活。结论　盆神经节海绵体内移植后可以存     

生殖股神经生殖支移位海绵体神经修复大鼠勃起功能的研究

目的：研究生殖股神经生殖支移位海绵体神经修复双侧海绵体神经损伤大鼠阴茎勃起功能的可行性。方法：将24只成年雄性SD大鼠随机分为3组：神经移位组（双侧生殖股神经生殖支近端与海绵体神经远端行端端吻合）、神经损伤组（双侧海绵体神经离断）和假手术组,每组8只。术后1、3个月行交配试验检测大鼠勃起功能恢复情况,术后3个月电刺激海绵体神经或生殖股神经生殖支,比较各组大鼠阴茎海绵体内压（ICP）的变化。结果：术后1个月交配试验观察到神经移位组与神经损伤组有插入行为的大鼠个数无明显差异,而3个月后神经移位组观察到75％（6／8）的大鼠有交配行为,明显高于神经损伤组（P〈0．05）。电刺激神经移位组大鼠生殖股神经生殖支时,可引起ICP明显升高,与神经损伤组相比差异有统计学意义（P〈0．05）。结论：生殖股神经生殖支移位海绵体神经可修复双侧海绵体神经损伤大鼠的勃起功能。     

小肠黏膜下层移植修复海绵体神经损伤的实验研究

目的:研究小肠黏膜下层(SIS)移植替代损伤的双侧海绵体神经(CN)恢复大鼠的勃起功能。方法:制备SIS,建立动物模型,分为CN损伤组、假手术组、SIS移植组,分别给予切断双侧的CN、仅游离CN以及SIS移植修复损伤的CN。术后3个月进行阿朴吗啡试验,了解阴茎勃起情况。取中、后段阴茎海绵体组织,进行nNOS免疫组化染色,记录nNOS阳性神经纤维的数目。结果:阿朴吗啡试验:30 min内SIS移植组72.73%(8/11)的大鼠出现阴茎勃起,平均勃起(1.07±0.89)次;CN损伤组勃起率和勃起次数均为0;假手术组则为90.91%(10/11)和(2.19±1.17)次。无论是勃起率还是勃起次数,SIS移植组均显著高于CN损伤组(P<0.01),但仍然比假手术组低(P<0.05)。nNOS神经纤维数目:SIS移植组为(70.36±10.09)条,CN损伤组为(22.09±4.76)条,差异有统计学意义(P<0.01),但二者均低于假手术组[(90.81±5.69)条,P<0.01]。结论:SIS作为移植物修复损伤的大鼠CN损伤,有利于恢复CN损伤所致的勃起功能障碍。     

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.