雷米芬太尼复合丙泊酚麻醉在电视胸腔镜手术病人的应用

目的评价雷米芬太尼复合丙泊酚全凭静脉麻醉在电视胸腔镜手术(VATS)中的麻醉效果。方法ASAⅠ～Ⅱ级于电视胸腔镜下行自发性肺大泡缝扎术病人40例,随机分为雷米芬太尼复合丙泊酚组(R组)和芬太尼复合丙泊酚组(F组),每组20例。观察麻醉诱导及气管插管时BP、HR;记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间及拔管时间;记录拔管后即刻、30min和24h疼痛视觉模拟评分(VAS);随访记录术中知晓发生率和术后恶心呕吐等副作用。结果R组插管期心血管副作用显著低于F组(P<0.05)。R组术后自主呼吸恢复时间、呼之睁眼时间及拔管时间明显短于F组(P<0.05)。R组拔管后即刻、30min的VAS高于F组(P<0.05)。两组病人均未出现术中知晓,术后的恶心呕吐发生率差异无显著意义。结论雷米芬太尼复合丙泊酚全凭静脉麻醉可安全、有效地应用于电视胸腔镜下自发性肺大泡缝扎术。雷米芬太尼半衰期短,需提前实施术后镇痛。     

全凭静脉麻醉与静吸复合麻醉恢复质量及用药相关费用的比较

目的 比较相同麻醉深度下异氟醚-芬太尼静吸复合麻醉与丙泊酚复合芬太尼或雷米芬太尼全凭静脉麻醉的恢复质量和用药相关费用.方法 ASA Ⅰ或Ⅱ级,择期行下腹部手术患者60例,随机均分为静吸复合组(B组)、芬太尼组(F组)及雷米芬太尼组(R组),分别以异氟醚-芬太尼、丙泊酚-芬太尼和丙泊酚-雷米芬太尼辅以维库溴铵维持麻醉.麻醉深度维持在Narcotrend D0～D2水平,记录术毕停药后患者自主呼吸恢复时间、呼名睁眼时间、拔管时间、定向力恢复时间;观察拔管后即刻、拔管后20 min患者意识状态(OAA/S)、疼痛程度(VAS)及主诉需要镇痛药的例次;术后24 h访视患者,记录有无术中知晓及恶心、呕吐等不良反应;比较三种麻醉方式的用药相关费用.结果 三种麻醉方式术毕自主呼吸恢复时间、呼名睁眼时间、拔管时间的差异无统计学意义,但R组定向力恢复早于B组,其拔管后20 min患者OAA/S评分也高于B组(P＜0.01).R组在拔管后即刻及拔管后20 min VAS明显高于其他两组,主诉需要镇痛药者也多于其他两组(P＜0.01).三组患者术后恶心、呕吐等不良反应发生率的差异无统计学意义.B组麻醉用药相关费用明显低于其他两组(P＜0.01).结论 三种麻醉方式麻醉苏醒速度相近,丙泊酚-雷米芬太尼苏醒质量较好,但麻醉恢复期疼痛明显.全凭静脉麻醉特别是丙泊酚-雷米芬太尼用药相关费用高于异氟醚-芬太尼静吸复合麻醉.     

不同靶浓度雷米芬太尼对全麻苏醒拔管期心血管反应的影响

目的观察全麻苏醒拔管期不同靶浓度雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行胆囊手术患者40例,ASAⅠ或Ⅱ级,随机均分为四组:雷米芬太尼血浆靶浓度0.6μg/L组(Ⅰ组)、0.8μg/L(Ⅱ组)、1.0μg/L(Ⅲ组)和生理盐水对照组(Ⅳ组)。四组患者均接受丙泊酚、阿曲库铵、芬太尼、1%~2.5%异氟醚复合50%氧化亚氮的全身麻醉。术毕,Ⅰ、Ⅱ、Ⅲ组患者均TCI输注雷米芬太尼,血浆浓度分别为0.6、0.8、1.0μg/L,Ⅳ组TCI输注生理盐水作对照。观察TCI开始前、吸氮时、拔管时、拔管后5、10min的MAP和HR;观察TCI开始后的患者呼吸恢复时间、睁眼时间、拔管时间。结果Ⅰ、Ⅳ组的MAP和HR在吸痰、拔管时较TCI开始前明显升高(P<0.05),Ⅱ、Ⅲ组无明显升高;四组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义。结论雷米芬太尼用于抑制全麻苏醒拔管期心血管反应的合适血浆浓度可能在0.8~1.0μg/L之间。     

全麻苏醒拔管期雷米芬太尼靶控输注对心血管反应的影响

目的观察全麻苏醒拔管期雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行妇科手术患者60例,ASAⅠ~Ⅱ级,随机均分为雷米芬太尼组(A组)和生理盐水对照组(B组)。两组患者均接受丙泊酚、维库溴铵、芬太尼、0·8%~1·0%异氟醚复合50%氧化亚氮的全身麻醉。术毕时送至麻醉复苏室(PACU),A组患者TCI输注雷米芬太尼,血浆浓度为1μg/L,B组TCI输注生理盐水作对照。观察苏醒期患者的平均动脉压(MAP)、HR、呼吸恢复时间、睁眼时间和拔管时间。结果A组患者在吸痰、拔管时MAP、HR无明显变化,B组则明显升高(P<0·05);两组患者呼吸恢复、睁眼、拔管时间差异无显著意义。结论TCI雷米芬太尼可抑制全麻苏醒拔管期的心血管反应,平稳苏醒。     

老年腹部手术患者应用芬太尼与瑞芬太尼麻醉临床分析

目的分析瑞芬太尼与芬太尼在老年腹部手术患者麻醉中的应用价值。方法将68例老年腹部手术患者随机分成2组,每组34例。观察组患者给予瑞芬太尼麻醉,对照组患者给予芬太尼麻醉,观察2组患者手术期间心率(HR)、收缩压(SBP)、舒张压(DBP)和术后患者自主呼吸恢复时间、睁眼时间以及定向力恢复时间等情况。结果 2组患者诱导后HR、SPB、DPB均显著低于诱导前,差异均有统计学意义(P0.05)。观察组插管后及拔管后HR、SPB、DPB、术后自主呼吸恢复时间、睁眼时间以及定向力恢复时间均低于对照组,差异均有统计学意义(P0.05)。结论老年腹部手术患者实施瑞芬太尼麻醉,术中血流动力学稳定,术后苏醒时间短。     

雷米芬太尼和芬太尼用于老年患者全凭静脉麻醉的临床比较

目的比较雷米芬太尼及芬太尼用于老年患者全凭静脉麻醉(TIVA)诱导、维持及苏醒的效果。方法40例择期行胆囊手术及胃部手术的患者,随机均分为雷米芬太尼组(RF组)及芬太尼组(F组),分别以雷米芬太尼和芬太尼为TIVA的麻醉性镇痛药,观察两组诱导前(T0)、插管前即刻(T1)、插管后1min(T2)、5min(T3)、切皮后5min(T4)、30min(T5)的BP及HR的变化以及苏醒时的咽喉反射恢复时间、睁眼时间和拔管时间。结果与T0时相比,T1、T2和T4时RF组的SBP、DBP下降均比F组显著(P<0.05或P<0.01);在麻醉恢复期,RF组患者咽喉反射恢复时间、睁眼时间和拔管时间均显著短于F组(P<0.01)。结论与芬太尼相比,雷米芬太尼是更理想的全麻镇痛药。     

雷米芬太尼用于胆囊腹腔镜手术麻醉

目的评价雷米芬太尼靶控输注（TCI）全凭静脉麻醉（TIVA）的诱导和术后苏醒过程。方法ASAⅠ～Ⅱ级择期行胆囊腹腔镜切除手术病人40例,随机分为芬太尼（F组）和雷米芬太尼（RF组）两组,每组20例。观察麻醉诱导气管插管及拔管期的SBP、DBP、HR、术中血液动力学变化;术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、离开恢复室时间及疼痛状况、恶心呕吐等不良反应。结果在插管后即刻、插管后5minRF组SBP、DBP、HR的变化均明显小于F组（JP〈0．01）;在切皮、麻醉维持期间两组病人血液动力学变化基本相似。两组病人从手术结束到呼之睁眼和拔除气管导管的时间及血管活性药物的用量基本相似。RF组术后疼痛的例数明显多于F组（P〈0．05）。结论依托咪酯和雷米芬太尼TCI TIVA的诱导更加平稳,苏醒质量高。但由于雷米芬太尼消除半衰期短,术后镇痛应及时建立。     

氯胺酮复合雷米芬太尼用于腹部手术的麻醉

目的 观察小剂量氯胺酮复合雷米芬太尼用于腹部手术的麻醉效果。方法 ASAⅠ或Ⅱ级择期手术病人60例,随机均分为芬太尼组（F组）、雷米芬太尼组（R组）和雷米芬太尼复合氯胺酮组（RK组）。依据病人对手术刺激的反应强度调节用药量。观察术中循环功能、麻醉苏醒及停药后的不良反应。结果 R组在气管插管、切皮、麻醉维持期间平均动脉压及心率显著低于F组与RK组。RK组在麻醉维持期间平均动脉压及心率低于F组。RK组病人术毕呼吸恢复时间（7．2±3．6）min、呼唤睁眼时间（10．1±3．4）rain、拔管时间（12．9±7．1）min、定向力恢复时间（14．9±4．6）min,均比F组明显缩短,与R组差异无统计学意义。RK组苏醒期质量优于R组和F组。结论 小剂量氯胺酮复合雷米芬太尼用于腹部手术麻醉时,术中循环稳定,术后苏醒迅速,小剂量氯胺酮可提高雷米芬太尼术后恢复质量。     

七氟醚复合雷米芬太尼快通道麻醉在鼻内窥镜手术中的应用

目的观察七氟醚复合雷米芬太尼快通道麻醉在鼻内窥镜手术中的应用效果。方法 60例择期行鼻内窥镜手术患者,年龄21～55岁,随机分为三组,每组20例。Ⅰ组全凭吸入七氟醚麻醉,Ⅱ组丙泊酚复合雷米芬太尼,Ⅲ组七氟醚复合雷米芬太尼。观察三组患者术中、术后血流动力学变化,记录术后拔管时间、清醒时间、术后躁动评分(RS)、意识状态评分(OAA/S)等。结果三组术中血压控制均较满意。术后Ⅱ、Ⅲ组拔管时间及清醒时间较Ⅰ组短,躁动发生率稍低(P0.05)。结论七氟醚复合雷米芬太尼静吸复合麻醉与丙泊酚复合雷米芬太尼全凭静脉麻醉均为鼻内窥镜手术提供安全、快捷、苏醒彻底的快通道麻醉方法。     

异丙酚复合芬太尼或瑞芬太尼靶控静脉麻醉与静吸复合麻醉的比较

目的 评价异丙酚和瑞芬太尼靶控静脉麻醉的诱导和术后苏醒过程。方法 ASA Ⅰ-Ⅱ级择期行腹腔镜胆囊切除手术的病人60例,年龄<65岁,随机分为静吸复合麻醉(C)组、异丙酚瑞芬太尼靶控(R)组及异丙酚芬太尼靶控(F)组,每组20例。观察麻醉诱导及气管插管时的血压、心率;记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间;观察病人拔管后即刻、离开恢复室、拔管后1、3和24h的意识状态(OAAS),认知功能测试(MMSE),疼痛评分(VRS)及主诉需要阿片药镇痛的时间;观察恶心呕吐等副反应,记录术中知晓的发生率和病人满意度等。结果 ①C组诱导时的舒张压低于R组和F组,低血压者多于R组,插管反应发生率高于R组。F组的插管反应发生率高于R组。②三组病人术后自主呼吸恢复时间、呼之睁眼时间、拔管时间差异无显著性,但F组的定向力恢复时间和离开术后恢复室(PACU)的时间早于C组。F组病人在拔管后即刻、离开PACU时、拔管后1h和3h的OAAS评分高于C组,R组病人离开PACU时的OAAS评分高于C组。F组病人拔管后1h的MMSE评分高于C组。R组病人在拔管后即刻、离开PACU时、拔管后1h和术后24h的VBS评分高于C组和F组,需要阿片药镇痛者R组多于其他两组。三组病人术后的恶心呕吐发生率差异无显著性。结     

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.