A Comparative Review of the Newer Inhalational Anaesthetics
A Comparative Review of the Newer Inhalational Anaesthetics
复制标题
新型吸入麻醉药的比较综述
DOI：
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
J. Apfelbaum
中科院分区：
文献类型：
--
作者：
C. Young;J. Apfelbaum
本文综述了七氟醚和地氟醚的物理生理特性、有效性和不良反应。这两种药物较低的血气溶解度提供了更大程度的麻醉水平控制和更快的立即从麻醉中恢复比旧的吸入剂。然而，这种快速恢复可能导致两种药物的紧急躁动，可能与术后疼痛的快速觉醒有关。这两种药物的成本效益将取决于他们的能力，以减少人员和时间成本的手术，通过这种快速出现，这方面需要进一步研究。七氟烷目前在日本和欧洲和美洲的部分地区广泛的临床使用。与地氟烷相比，它具有对气道无刺激性的额外优势;使用七氟烷吸入诱导麻醉快速且容易实现。七氟烷与二氧化碳吸收剂的不稳定性及其体内生物转化产生潜在毒性副产物。已对这些副产物（包括化合物A [五氟异丙烯基氟甲基醚（PIFE）]和氟化物）进行了广泛研究，尽管七氟烷可能会导致医源性后遗症，但长期毒性的可能性似乎相当低。IV期研究旨在确定七氟烷给药的安全性：（i）肾功能受损患者，和（ii）使用新鲜气体流量<2 L/min时的任何患者。七氟烷在其他方面耐受性良好，似乎具有快速平稳诱导和从全身麻醉中苏醒的优势，具有优异的血液动力学特征。地氟烷目前在美国广泛使用，除了干燥二氧化碳吸收剂产生一氧化碳外，不具有七氟烷的体外和体内稳定性问题。由于地氟烷具有明显的刺激性，因此未批准用于吸入诱导。此外，它对交感神经系统的短暂激活可能是由于刺激气道受体而产生高血压和心动过速。地氟烷在其他方面耐受性良好，可非常迅速地从全身麻醉中苏醒。
The physical and physiological characteristics and efficacy and adverse effects of sevoflurane and desflurane are reviewed. A lower blood-gas solubility of both drugs affords a greater degree of control of anaesthetic levels and a more rapid immediate recovery from anaesthesia than is achieved with older inhaled agents. However, this rapid recovery may result in emergence agitation for both agents, probably related to rapid awakening to postoperative pain. The cost efficacy of both agents will depend upon their ability to reduce the personnel and time costs of surgery through this rapid emergence, and this aspect needs to be studied further.Sevoflurane is currently in widespread clinical use in Japan and parts of Europe and the Americas. Compared with desflurane, it has the additional advantage of being nonirritating to the airway; inhalational induction of anaesthesia with sevoflurane is achieved rapidly and easily. The instability of sevoflurane with carbon dioxide absorbents and its in vivo biotransformation produce potentially toxic by-products. These by-products, including Compound A [pentafluoroisopropenyl fluoromethyl ether (PIFE)] and fluoride, have been extensively studied, and although there is a possibility of iatrogenic sequelae from sevoflurane, the likelihood of long term toxicity appears to be quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane: (i) to renally impaired patients, and (ii) to any patient when fresh gas flows of <2 L/min are used. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anaesthesia, with excellent haemodynamic characteristics.Desflurane is currently in widespread use in the US and does not possess the in vitro and in vivo stability concerns of sevoflurane, with the exception of carbon monoxide production from dry carbon dioxide absorbents. Because of its significant pungency, desflurane is not approved for use in inhalational inductions. In addition, its transient activation of the sympathetic nervous system produces hypertension and tachycardia, probably from stimulation of airway receptors. Desflurane is also otherwise well tolerated and provides very rapid emergence from general anaesthesia.
影响因子：
8.8
作者：
Rampil,IJ;Lockhart,SH;Eger2nd,EI;Yasuda,N;Weiskopf,RB;Cahalan,MK
通讯作者：
Cahalan,MK
大鼠新生肝切片对七氟醚的生物转化。
DOI：
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发表时间：
1995
期刊：
Drug metabolism and disposition: the biological fate of chemicals
影响因子：
--
作者：
Payne,AK;Morgan,SE;Gandolfi,AJ;Brendel,K
通讯作者：
Brendel,K
DOI：
--
发表时间：
1996
期刊：
Acta anaesthesiologica Belgica.
影响因子：
--
作者：
Kharasch,ED
通讯作者：
Kharasch,ED