肝硬变门静脉高压症患者血红素氧化酶-1的表达

目的　探讨肝硬变门静脉高压症患者脾脏及脾血管血红素氧化酶 (HO ) 1mRNA的表达。方法　应用原位杂交方法检测 2 0例肝硬变门静脉高压症患者脾脏、脾动脉、脾静脉组织HO 1mRNA的表达 ,以 12例脾破裂患者作对照。结果　对照组仅有 4例脾组织可见弱阳性表达 ,平均阳性染色指数为 0 .0 5± 0 .0 1,其脾动、静脉组织未见HO 1mRNA表达。肝硬变门静脉高压症组 18例脾脏HO 1mRNA阳性表达 ,平均阳性染色指数为 0 .68± 0 .12 ,显著高于对照组 (P <0 .0 0 1)。脾动、静脉HO 1mRNA全部表达者 15例 ,脾动、静脉阳性染色指数分别为 0 .5± 0 .1与 0 .5 6± 0 .1,两者差异无显著性 ,(P >0 .0 5 )。结论　肝硬变门静脉高压症合并多种应激原刺激患者HO 1mRNA表达增强 ,HO 1及其代谢产物可能参与门静脉高压症多种病理过程。     

核因子-κB的活化与肿瘤坏死因子-αmRNA的表达在门静脉高压症性血管病变中的作用

目的探讨脾脏动、静脉组织核因子-κB(NF-κB)的活化与肿瘤坏死因子-α(TNF-α)mRNA的表达在门静脉高压症(PHT)性血管病变中的意义.方法采用化学发光凝胶电泳迁移率实验(EMSA)方法检测肝硬化PHT患者脾脏动、静脉和正常血管NF-κB的活性,用逆转录-聚合酶链反应(RT-PCR)方法检测TNF-α mRNA的表达情况.结果对照组内脾脏动、静脉组织TNF-α mRNA分别为(0.24±0.12)、(0.21±0.10),显著低于肝硬化PHT组脾动脉、脾静脉TNF-α mR-NA的表达(0.38±0.21)、(0.36±0.16),(P＜0.05);对照组脾动、静脉NF-κB未被检测到明显的活性,而于肝硬化PHT组检测到显著具有活性的NF-κB表达(P＜0.05),且PHT组脾脏动、静脉TNF-α mRNA表达与NF-κB的活性呈显著的正相关.结论肝硬化PHT血管组织NF-κB的活化、TNF-α表达增强,可能是肝硬化PHT时内脏血管病变形成和发展的原因之一.     

血管紧张素转换酶抑制剂对肝硬化门静脉高压症患者门静脉血流动力学的影响

目的：观察血管紧张素转换酶抑制对肝硬化门静脉高压症门静脉血流动力学的影响，探讨血管紧张素转换酶抑制剂治疗肝硬化门静脉高压症的有效性及机制。方法：肝硬化门静脉高压症患者80例，在服用血管紧张素转换酶抑制剂后不同时期，用彩色多普勒超声测量门静脉最大血流速度和门静脉血流量。用放射免疫法测定血浆肾素活性和醛固酮浓度。结果：脾切除加断流术的肝硬化患者16例，应用血管紧张素转换酶抑制剂后30分钟、60分钟、1周时，门静脉压力分别下降0．45±0．34kPa(P<0.05)、0.52±0.32kPa(P<0.05)、0．43±0.24kPa(P<0.05)，门静脉血流量、最大血流速度较用药前略有增加，但无统计学意义。因浆肾素活性从4±2mg/ml·h升高到14±6mg/ml·h(P<0.05)，血浆醛固酮浓度从125±5ng/L下降到45±4ng/L(P<0.05)，未见明显副作用。结论：血管紧张素转换酶抑制剂能快速降低门静脉压，不减少门静脉血流量，长期应用降低门静脉压力效果明显。     

核因子-κB的活化与基质Gla蛋白mRNA的表达在门静脉高压症血管病变中的意义

目的 探讨脾脏动、静脉组织内核因子-kappaB（NF-κB）的活化与基质Gla蛋白（matrix Glaprotein，MGP）mRNA的表达在门静脉高压症性血管病变中的意义。方法 实验组为肝炎后肝硬化门静脉高压症（portal hypertension，PHT）患者28例，住院期间行择期脾切除加贲门周围血管离断术；对照组选取同期因外伤性脾破裂急诊入院行脾切除术患者12例。采用化学发光凝胶电泳迁移率（eleetrophoretic mobility shift assay，EMSA）方法检测脾脏动、静脉血管NF-κB的活性；采用逆转录-聚合酶链反应（RT-PCR）方法检测血管组织的MGPmRNA表达。结果 对照组内脾脏动、静脉组织MGPmRNA分别为0．23±0．10、0．26±0．13，显著低于PHT组脾动脉、脾静脉的0．58±0．19、0．55±0．15，差异有统计学意义（P〈0．05）；于PHT组脾动、静脉内检测到NF-κB活性表达1．44±0．23、1．38±0．18，显著高于对照组脾动、静脉的0．19±0．12、0．25±0．16，差异有统计学意义（P〈0．05），且PHT组脾脏动、静脉MGPmRNA表达与NF-KB的活性呈显著正相关（r=0．692，P〈0．05；r=0．703，P〈0．05）。结论 肝硬化时PHT血管组织内NF-κB的活化，MGPmRNA的表达增强，调节血管平滑肌细胞（vascular smooth muscle cell，VSMC）的增殖和迁移，并参与了内脏血管病变形成和发展。     

血管内皮生长因子在门静脉高压脾血管病变中的表达及意义

目的:探讨血管内皮生长因子(VEGF)在肝硬化门静脉高压症患者脾脏及脾血管病变中的表达及意义。方法:2017年6月至2019年3月,手术治疗的肝硬化门静脉高压症脾肿大患者(门静脉高压组)及同期行脾切除的外伤脾破裂患者(对照组)手术切除的脾静脉及脾脏标本,比较免疫组化方法染色脾静脉及脾脏组织中VEGF的表达情况。结果:门静脉高压组脾静脉壁VEGF染色更深,阳性细胞数更多,染色指数显著高于对照组(3.68±1.45 vs 1.56±0.73,P0.01),门静脉高压组脾脏组织VEGF染色更深,阳性细胞数更多,染色指数显著高于对照组(5.11±1.56 vs 2.19±0.83,P0.01)。结论:肝硬化门静脉高压症患者脾静脉壁及脾脏组织中VEGF高表达,可能是导致肝硬化门静脉高压、脾肿大及脾血管病变的原因之一。     

PDGF mRNA及TGF-β在门静脉高压症病人内脏血管重构中的表达及意义

目的　研究门静脉高压症病人脾动脉血小板源性生长因子 (PDGF)mRNA及转化生长因子 β(TGF β)的表达并探讨与门静脉高压血管病变的关系。方法　肝硬化门静脉高压病人 37例及外伤性脾破裂病人 17例 ,取脾门处脾动脉。原位杂交法检测PDGFmRNA的表达 ,免疫组化法检测TGF β的表达 ,经计算机图像处理后行统计学分析。 结果　对照组PDGFmRNA及TGF β表达为阴性或弱阳性 ,门静脉高压组PDGFmRNA及TGF β表达均明显增强 ,为中到强阳性 ,平滑肌层有明显表达。图像光密度值有显著性差异 (PDGFmRNA :73 2 6± 12 35vs 18 2 7± 5 86 ,P <0 0 5 ;TGF β:6 5 36± 9 74vs 12 17± 6 5 5 ,P <0 0 5 )。结论　门静脉高压内脏血管PDGFmRNA及TGF β的表达增加可能为高动力循环、毒血症等引起的血管损伤所诱导 ,并可加重平滑肌细胞过度增生及纤维化 ,在门静脉高压血管病变及细胞表型转化过程中有一定意义。     

门静脉高压症患者脾动脉局部血红素氧合酶表达异常及意义

目的研究血红素氧合酶(HO)在门静脉高压症患者脾动脉的表达,探讨血红素氧合酶-内源性一氧化碳系统(HO-CO)在门静脉高压症发病机制中的作用。方法应用半定量逆转录- 聚合酶链反应(RT—PCR)检测HO-1、HO-2 mRNA表达,Western blot进一步检测其蛋白表达。试验组为门脉高压症并行择期脾切除加贲门周围血管离断术患者,同期外伤性脾破裂行脾切除术患者为对照。结果 HO-1mRNA及蛋白仅在门静脉高压症患者组的脾动脉表达,在非门脉高压症患者组不表达,吸光度比值半定量分析结果相比差异都有统计学意义(mRNA 0．81±0．12 vs 0．03± 0．00,P<0．01,蛋白1．56±0．25 vs 0．04±0．01,P<0．01);而HO-2 mRNA及蛋白在门静脉高压症患者组与非门脉高压症患者组都有表达,且吸光度比值半定量分析相比差异均无统计学意义 (mRNA 0．58±0．09 vs 0．64±0．12,P>0．05,蛋白0．92±0．12 vs 0．84±0．14,P>0．05)。结论 HO-CO系统,尤其是HO—1在门静脉高压症发生发展中起重要作用。     

肝硬化大鼠肝脏内皮素受体基因的表达与门静脉压力的关系

目的　研究四氯化碳诱导的肝硬化大鼠肝脏内皮素(endothelin, ET)受体基因的表达,并探讨其与门静脉压力的关系。方法　采用逆转录多聚酶链反应(RT PCR)测定大鼠肝组织 ETA受体和ETB受体mRNA的表达水平, 并测量门静脉压力。结果　肝硬化大鼠肝组织 ETA受体(0 4245±0 0612 vs 0 2792±0 1115,P<0 05) 和 ETB受体(0 5984±0 1047 vs 0 2938±0 1399,P< 0 05) mRNA 的表达均较对照组均显著升高;肝硬化大鼠门静脉压力较正常大鼠明显升高(16 08±2 19 vs8 25±2 56 cmH2O,P<0 05),并且ETA受体mRNA的表达与门静脉压力显著正相关(r=0 8074,P<0 05)。结论　四氯化碳诱导的肝硬化大鼠肝组织ET受体 mRNA的表达显著升高,并且 ETA受体 mRNA的表达与门静脉压力显著正相关, 表明 ET受体的高表达在门静脉高压症的发病机制中起重要作用。     

门静脉高压症病人肝内血管内皮细胞凋亡的研究

目的　研究门静脉高压症病人肝组织内血管及肝窦壁内皮细胞的凋亡及其对肝微循环的影响。方法　对 37例门静脉高压症病人、10例正常人肝组织 ,用TUNEL法检测血管内皮细胞及肝窦壁内皮细胞凋亡 ,免疫组化法检测Bax和Bcl 2基因的蛋白表达。结果　肝硬化门静脉高压症病人 ,门管区血管内膜破坏、断裂 ,内皮细胞脱落。管腔内血栓形成。血管壁和肝窦壁内皮细胞TUNEL 阳性细胞数为 (2 9 2 9± 4 15 ) % ,与对照组仅 (0 5± 0 2 ) % ,有显著性差异 (P <0 0 0 1) ;门管区血管内皮细胞和肝窦壁内皮细胞Bax和Bcl 2强阳性表达率分别为 (33 5 1± 5 6 9) %和 (2 4 6 4± 5 87) % ,对照组均为阴性 (P <0 0 0 1)。结论　肝硬化门静脉高压症病人门管区内皮细胞和肝窦壁内皮细胞凋亡和坏死明显增加 ,内皮细胞的凋亡和坏死激活凝血系统 ,促使血栓形成 ,从而破坏了肝脏微循环。     

肝阻抗血流图评价门静脉高压症患者贲门周围血管离断术前后肝血流灌注的改变

目的利用肝阻抗血流图探讨肝硬化门静脉高压症患者的肝脏血流灌注改变和贲门周围血管离断术对肝血流灌注的影响.方法选取22例肝硬化门静脉高压症患者,分别在术前1周、术后2周检测其肝血流阻抗的改变,同时用Doppler彩超检测门静脉血流动力学的变化.结果肝阻抗血流图测定结果表明,门静脉高压症患者的肝动脉、门静脉向肝血流灌注明显下降,总肝灌注血流降低[(0.053±0.011)比(0.031±0.009)、(0.033±0.011)比(0.018±0.008)、(7.7±3.0)比(3.5±1.7),P<0.05];断流术后门静脉高压症患者的门静脉向肝灌注增加[(0.018±0.008)比(0.026±0.006),P<0.05],肝动脉向肝灌注无显著改变.结论肝硬化患者肝动脉、门静脉向肝有效血流灌注都降低,肝脏总血流量下降;贲门周围血管离断术能增加大部分患者的门静脉向肝血流灌注,但对肝动脉的向肝灌注无显著影响;肝阻抗血流图对于评价肝硬化患者的肝脏血流及手术对肝脏血流动力学的影响有一定的价值.     

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.