Best practice & research. Clinical anaesthesiology
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Toxicology has matured since it was defined as the 'science of poisons'. Modern toxicology is no longer anthropocentric but takes on different views at various biological systems, including ecosystems. Each will interact specifically when exposed to defined chemical agents, including drugs. ⋯ The key to understanding is in the host proteins that interact with the drug and mediate the cellular response. Hence, the proteom, i.e. the complete set of proteins of a cell, an individual or a species, determines how an exposed biological system may interact with the manifold of different xenobiotics. Structure-activity studies try to find out useful predictive parameters for risk and toxicity assessment.
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Studies on the toxic effects of muscle relaxants are difficult to design because of the need for mechanical ventilation and, consequently, concomitant administration of anaesthetic drugs which may influence the results. The following overview shows that muscle relaxants are weak toxic agents with regard to their teratogenicity, carcinogenicity and cytotoxic effects (including tissue- and organ-damaging effects). ⋯ Muscle relaxants and their metabolites may interact with muscarinic and nicotinic receptors in other organs and the ganglionic system, for example in the cardiovascular system. Direct stimulation of mast cells, with consequent release of histamine, after administration of muscle relaxants may clinically impose as toxic reactions.
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Best Pract Res Clin Anaesthesiol · Mar 2003
ReviewOccupational hazards of inhalational anaesthetics.
Occupational exposure to inhalational anaesthetics has often been associated with health hazards and reproductive toxicity, but the available evidence is weak and comes mostly from epidemiological studies that have been criticized. Studies based on registered data generally showed no association between occupational exposure to inhalational anaesthetics and reproductive effects. Animal studies also showed a lack of carcinogenicity, organ toxicity and reproductive effects with trace concentrations, as observed in operating rooms. ⋯ Occupational exposure has also been associated with impairment of psychological functions, but these effects do not occur with trace concentrations. All in all, the scientific evidence for hazards is weak. Nonetheless, it is good practice to limit levels of exposure.
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Best Pract Res Clin Anaesthesiol · Mar 2003
Interaction of inhalational anaesthetics with CO2 absorbents.
We review the currently available carbon dioxide absorbents: sodium hydroxide lime (=soda lime), barium hydroxide lime, potassium-hydroxide-free soda lime, calcium hydroxide lime and non-caustic lime. In general, all of these carbon dioxide absorbents are liable to react with inhalational anaesthetics. However, there is a decreasing reactivity of the different absorbents with inhalational anaesthetics: barium hydroxide lime > soda lime > potassium-hydroxide-free soda lime > calcium hydroxide lime and non-caustic lime. ⋯ Whether or not compound A, a gaseous compound formed by the reaction of sevoflurane with normally hydrated absorbents, is still a matter of concern is discussed. Even after very high loading with this compound, during long-lasting low-flow sevoflurane anaesthesias, no clinical or laboratory signs of renal impairment were observed in any of the surgical patients. Finally, guidelines for the judicious use of different absorbents are given.
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Unwanted side-effects of anaesthetic drugs that occur during anaesthesia or during the post-operative recovery period are what concern anaesthesiologists and anaesthetists. Occupational risks are of concern to all health-care professionals who administer anaesthetics or who are incidentally exposed to anaesthetic gases. After regulatory requirements for marketing drugs are met, the qualitative and quantitative nature of side-effects of the drugs in the target population and the risk of incidental exposure of health-care professionals are generally well defined. ⋯ Numerous scientific disciplines with specialized terminology contribute to the body of knowledge about anaesthetic toxicity. Scientific inquiry spanning a range of disciplines from molecular biology to global ecology provides information essential for predicting, assessing, avoiding and treating the untoward effects of anaesthetics. Contemporary concerns with respect to side-effects of anaesthetic drugs include delayed recovery of cognitive function, addiction and tolerance, local anaesthetic cardiotoxicity and tissue toxicity, relative toxicity of enantiomeric forms of drugs, and the role of biotransformation in unwanted responses to anaesthetic drug administration.