Articles: anesthetics.
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Treatment with drugs and exposure to many environmental chemicals results in enzyme induction. However, the clinical significance of increased (or altered) metabolism of the inhaled anaesthetics appears to be trivial. Enzyme induction does not affect the conduct of inhalation anaesthesia. ⋯ Whether induction of halothane biotransformation and the production of reactive intermediates may lead to hepatoxicity is not yet settled. It is quite clear that induction, in the presence of hypoxia, leads to hepatic necrosis in rats. However, a similar relationship has not been established in surgical patients.
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Local anesthetics are in general not suitable for the treatment of patients with severe cancer pain. Local blocks are useful for diagnostic and prognostic purposes. ⋯ The use of local anesthetics may yield long-lasting relief in some specific pain syndromes, such as tumor-related reflex dystrophies, in painful muscle spasms, and trigger points due to tumor-affected vertebrae. In addition, local anesthetics may have a generally beneficial effect in the restless, cachectic, and aged patient.
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Biol Res Pregnancy Perinatol · Jan 1984
ReviewObstetric analgesia: pharmacokinetics and its relation to neonatal behavioral and adaptive functions.
The neonatal pharmacokinetic and neurobehavioral properties of certain agents used in obstetric analgesia are reviewed (local anesthetics, opiates, inhalation agents, benzodiazepines). Fetal and neonatal pharmacokinetic alterations partly explain the neurobehavioral differences observed between different drug groups and ways of drug administration. The most effective and safest method with fewest neonatal neurobehavioral effects appears to be regional epidural analgesia performed with plain bupivacaine. ⋯ Inhalation agents and parenteral pethidine (meperidine) are still clinically useful alternative compounds in circumstances where epidural analgesia is not possible. Pharmacokinetically and according to neurobehavioral assessments, inhalation agents appear to be more attractive than pethidine. Benzodiazepines, especially after high or repeated doses, may cause the so-called floppy-infant syndrome, at least partly, due to a slow neonatal drug elimination.