肩关节上部悬吊复合体双重损伤的治疗

目的：探讨肩关节上部悬吊复合体双重损伤手术治疗方法。方法：自2008年1月至2010年3月收治该类损伤11例,男9例,女2例;年龄20～47岁,平均38岁。分4类治疗：肩胛颈骨折合并同侧锁骨骨折4例,分别用重建钢板固定;喙突骨折或喙锁韧带断裂加锁骨肩峰端骨折或肩锁关节脱位2例,锁骨肩峰端骨折或肩锁关节脱位锁骨钩钢板固定,空心加压螺钉固定喙突骨折;肩峰基底部加肩胛盂加肩锁关节（锁骨外侧端骨折）损伤3例,肩峰基底部骨折切开复位重建钢板内固定,锁骨钩钢板固定肩锁关节（锁骨外侧端骨折）;肩峰加肩锁关节加锁骨外侧1/3骨折2例,肩峰用小斜＂T＂形钢板固定,肩锁关节、锁骨外侧1/3骨折用锁骨钩钢板固定。采用Constant-Murley评分评价肩关节功能。结果：本组11例中9例获随访,时间6～12个月,平均9.2个月。所有骨折愈合,无内固定失效和骨折不愈合。骨折平均愈合时间2.6个月,肩关节外形正常,双肩对称,无肩关节短缩、下垂、内收内旋等严重肩下垂畸形。根据Constant-Murley评分,本组评分为69～100分,平均89.7分,其中疼痛评分10～15分,日常活动评分14～20分,肌力评分15～25分,活动范围评分34～40分。结论：肩关节上部悬吊复合体双重损伤需手术分型治疗恢复其完整性和稳定性。     

锁骨钩钢板治疗新鲜 NeerⅡ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位

目的 总结锁骨钩钢板内固定治疗新鲜Neer Ⅱ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位的手术方法及临床疗效.方法 2004年8月～2008年10月,应用锁骨钩钢板治疗28 例Neer Ⅱ型锁骨远端骨折和21 例 Tossy Ⅲ型肩锁关节脱位,术中仅行锁骨钩钢板固定,未刻意修复喙锁韧带、喙肩韧带.术后X光片评估锁骨骨折愈合及肩锁关节脱位的复位,根据Constant-Murley 评分系统评价肩关节功能康复情况.结果 手术后复查X 线片示锁骨远端骨折及肩锁关节均完全复位.患者均获随访,随访12～48月,平均14.9月,均提示锁骨远端骨折愈合、无螺钉松动、钢板或钩部折断.术后8～18月内固定取出后,无肩锁关节再脱位.2例术后4个月患肩活动过大时明显感肩部酸痛不适,8月后取出钢板后症状消失.随访终末,所有患者Constant-Murley 评分平均为89.6分(83～92分).结论 采用锁骨钩钢板内固定治疗新鲜NeerⅡ型锁骨远端骨折及Tossy Ⅲ型肩锁关节脱位,具有复位简单、固定确切、肩关节可以早期活动、肩关节功能恢复好等优点.     

外踝解剖钢板治疗胸锁关节外锁骨近端骨折简

目的探讨外踝解剖钢板治疗胸锁关节外锁骨近端骨折的临床疗效。方法对6例胸锁关节外锁骨近端骨折均采用切开复位于骨折处安放4-6孔外踝解剖钢板。结果术后X线片提示骨折复位及内固定位置良好,均恢复解剖结构,外观及功能满意。6例均获随访,时间6～12个月,骨折均获得愈合,时间平均3个月。疗效评定：优5例,良1例。结论胸锁关节外锁骨近端骨折采用外踝解剖钢板固定稳定性好、安全可靠。患者能早期进行功能锻炼,可最大程度地恢复肩关节功能．是治疗锁骨近端骨折的有效方法。     

肩关节上方悬吊复合体损伤的手术治疗

目的探讨手术治疗肩关节上方悬吊复合体(SSSC)损伤的方法和疗效。方法收治SSSC损伤患者18例,其中肩胛颈骨折伴锁骨中远段粉碎性骨折6例,肩胛颈骨折伴肩峰骨折5例,锁骨远端粉碎性骨折伴肩峰及关节盂骨折2例,均行切开复位内固定术;肩锁关节完全脱位伴喙锁韧带完全断裂3例,行钩钢板固定及韧带修复;肩胛颈粉碎性骨折伴肩锁关节脱位1例,锁骨远端粉碎性骨折伴喙锁韧带断裂1例,均行切开复位内固定术及韧带修复。结果所有患者均获得随访,平均9个月(3~14个月),均解剖复位并愈合,骨折愈合时间平均8.6周(7~12周)。Constant-Murley评分为72~100分,平均91分,其中优11例,良4例,中3例,优良率为83.3%。结论 SSSC损伤解剖结构复杂,手术以内固定治疗为主,可恢复其稳定性,治疗效果良好。     

锁定钢板治疗胸锁关节脱位和锁骨近端骨折

目的 探讨锁定钢板内固定治疗胸锁关节脱位和锁骨近端骨折的疗效。方法 2006年1月至2009年10月收治9例胸锁关节脱位和锁骨近端骨折患者,男7例,女2例;年龄18～55岁,平均32岁。锁骨近端骨折3例,胸锁关节脱位5例（均为Allman分类Ⅲ级）,锁骨近端骨折伴胸锁关节脱位1例。脱位中前脱位5例,后脱位1例。均采用锁定钢板内固定治疗。结果 所有患者术后获8～24个月（平均12个月）随访,术后解剖结构恢复,外观及功能满意。根据Rockwood评分法评定疗效：优7例,良1例,可1例。结论 锁定钢板内固定治疗胸锁关节脱位和锁骨近端骨折,利用锁定钢板的优势,克服了传统固定方法的一些不足,疗效满意。     

重建锁定钢板联合锁定锁骨钩钢板内固定治疗锁骨中段骨折合并同侧肩锁关节脱位

目的 观察重建锁定钢板联合锁定锁骨钩钢板内固定治疗锁骨中段骨折合并同侧肩锁关节脱位的临床疗效。方法回顾性分析自2011-01—2021-01诊治的5例锁骨中段骨折合并同侧肩锁关节脱位,术中首先显露锁骨中段骨折,清除断端内淤血后用复位钳复位骨折,克氏针临时固定骨折断端。将重建锁定钢板置于锁骨前方合适位置,远近端各置入合适数量的螺钉进行固定,拆除临时固定的克氏针。对肩锁关节进行清理,清除破碎关节软骨盘及嵌压于脱位处的软组织,将锁骨钩钢板置入肩锁关节内,通过锁骨钩钢板复位并在锁骨上缘固定复位的肩锁关节。结果 5例均获得随访,随访时间平均16.3(12～25)个月。随访期间均未出现内固定失败,锁骨中段骨折愈合良好,取出内固定物后肩锁关节未再脱位。末次随访时肩关节功能Constant-Murley评分68～95分,平均83分。结论 锁骨中段骨折合并的同侧肩锁关节脱位具有一定的漏诊率,重建锁定钢板联合锁定锁骨钩钢板内固定是手术治疗此类损伤的理想选择。     

适度预弯锁骨锁定钢板治疗锁骨中段“折枝样”骨折合并喙突骨折、肩锁韧带损伤

目的 观察适度预弯锁骨锁定钢板治疗锁骨中段“折枝样”骨折合并喙突骨折、肩锁韧带损伤的临床疗效。方法回顾性分析自2017-01—2021-10采用适度预弯锁骨锁定钢板治疗的6例锁骨中段“折枝样”骨折合并喙突骨折、肩锁韧带损伤,骨折钳夹予以复位,适度下压锁骨,Nice结临时固定骨折断端,透视观察锁骨形态以及喙突骨折情况,用适度预弯的锁骨锁定钢板固定骨折断端,透视观察肩锁关节是否存在脱位以及喙突骨折断端位置。结果 手术时间35～50 min,平均40 min;术中出血量35～65 mL,平均50 mL。本组均获得随访,随访时间10～14个月,平均12个月。随访期间均无感染、切口不愈合、骨折不愈合或延迟愈合、血管神经损伤等并发症发生,骨折愈合时间8～12周,平均10周。术后1年所有患者肩关节功能均恢复满意,Rowe肩功能评分为95～100分,平均98.3分,Constant-Murley肩关节功能评分为96～100分,平均97.3分。结论 适度预弯锁骨锁定钢板治疗锁骨中段“折枝样”骨折合并喙突骨折、肩锁韧带损伤的疗效满意。     

锁骨钩钢板与三Endobutton钢板治疗新鲜肩锁关节脱位疗效比较

目的与锁骨钩钢板比较,探讨三Endobutton钢板治疗RockwoodⅢ～Ⅴ型新鲜肩锁关节脱位的临床疗效。方法 2008年2月-2010年10月,收治40例RockwoodⅢ～Ⅴ型新鲜肩锁关节脱位患者。其中22例采用锁骨钩钢板治疗(对照组),18例采用三Endobutton钢板治疗(试验组)。两组患者性别、年龄、病程、肩锁关节脱位分型、疼痛视觉模拟评分(VAS)及Constant-Murley评分等一般资料比较,差异均无统计学意义(P0.05),具有可比性。结果术后切口均Ⅰ期愈合,无血管、神经损伤及感染等早期并发症发生。患者均获随访,试验组随访时间12～20个月,平均15.8个月;对照组为13～24个月,平均17.2个月。末次随访时两组患肩VAS评分及Constant-Murley评分比较,差异均有统计学意义(P0.05)。X线片示患者均无内固定物松动,无肩锁关节再脱位。结论三Endobutton钢板治疗术后肩关节疼痛及活动受限发生率均低于锁骨钩钢板,是治疗RockwoodⅢ～Ⅴ型新鲜肩锁关节脱位的有效方法。     

上肩胛悬吊带复合体双重损伤的临床分型和手术治疗策略

目的 探讨上肩胛悬吊带复合体(superior shoulder suspensory complex,SSSC)双重损伤的临床分型和手术治疗策略.方法 回顾性分析2006年5月至2008年3月收治的SSSC双重损伤患者15例,男13例,女2例.年龄20～55岁,平均40.1岁.12例患者接受手术治疗,3例患者因严重合并伤接受保守治疗.根据Goss对SSSC的定义,将其双重损伤分为4型:Ⅰ型,肩胛颈骨折合并同侧锁骨中1/3骨折,共7例,5例接受锁骨骨折及肩胛颈骨折切开复位内固定术;Ⅱ型,喙突-喙锁韧带-锁骨连接体(C4连接)损伤,共1例,肩锁关节脱位行锁骨钩钢板固定,喙突骨折行空心拉力螺钉固定;Ⅲ型,喙突-肩胛盂上部分-肩峰联合部损伤,共6例,5例接受手术治疗,肩峰骨折行小"T"形钢板固定,喙突骨折行空心拉力螺钉固定;Ⅳ型,肩峰-肩锁关节-锁骨外1/3损伤,共1例,肩峰骨折行克氏针张力带固定,锁骨外1/3骨折行锁骨钩钢板固定.结果 15例患者均获得13.2(6～24)个月随访,骨折全部愈合,平均愈合时间10.2(8～12)周.手术组随访结果Constant-Murley评分平均91.3(70～100)分,Rowe评分平均92.9(80～100)分,Herscovici评分平均14.6(12～16)分.保守组Constant-Murley评分平均58.3(55～60)分,Rowe评分平均50(35～60)分,Herscovici评分平均6.7(4～9)分.结论 根据Goss对SSSC的定义对其双重损伤进行分型,并以此分型选择合适的手术方法治疗可获得满意疗效.手术治疗应以恢复SSSC的完整性和稳定性为目标来选择进行一处还是两处切开复位内固定,通常需行两处复位内固定.     

锁骨钩钢板联合带线铆钉治疗TossyⅢ型肩锁关节脱位

目的 探讨采用锁骨钩钢板联合带线铆钉治疗TossyⅢ型肩锁关节脱位的临床疗效.方法 应用锁骨钩钢板联合带线铆钉修复喙锁韧带治疗肩锁关节脱位21例.结果 患者获得随访15～32个月,于术后3～5个月取出钩钢板.患肩Constant评分平均96分(87～100分).术后3例出现肩峰下骨溶解,无螺钉松动、锁骨钩钢板断裂及锁骨钩钢板周围骨折等发生,取出钩钢板后无肩锁关节脱位复发.2例出现肩峰下撞击综合征,取出钩钢板后症状消失.结论 锁骨钩钢板联合带线铆钉治疗TossyⅢ型肩锁关节脱位能够有效维持肩锁关节复位稳定,喙锁韧带的生物力学模式重建效果良好.     

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.