#1
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Èíãàëÿöèîííûå àíåñòåòèêè è ýïèëåïñèÿ.
Èçó÷àòü ôàðìàêîëîãèþ ïî "èíñòðóêöèÿì ê ïðåïàðàòàì" íå î÷åíü ðåêîìåíäóåòñÿ è òåì áîëåå äåëàòü íà îñíîâàíèè ýòîãî êàêèå-ëèáî êàòåãîðè÷íûå âûâîäû. Ñóäîðîãè ïðè èñïîëüçîâàíèè ñåâîôëþðàíà - ÿâëÿåíèå êàçóèñòè÷åñêè ðåäêîå. Íàñòîëüêî ðåäêîå, ÷òî ïðàêòè÷åñêè íå âñòð÷àåòñÿ â ðóòèííîé ïðàêòèêå. Ýòî ïîäòâåðäèò ëþáîé, êòî èñïîëüçîâàë ïðåïàðàò.
Âîçìîæíî àíåñòåçèîëîã çà ñóäîðîãè ïðèíÿë ðåàêöèþ äâèãàòåëüíîãî âîçáóæäåíèÿ íà ýòàïå èíäóêöèè íàðêîçà. Òàêîå íåðåäêî ñëó÷àåòñÿ, äàæå ïðè èñïîëüçîâàíèè ñåâîðàíà, îñîáåííî åñëè ðåáåíîê èçíà÷àëüíî íå î÷åíü äðóæåëþáíî íàñòðîåí ïî îòíîøåíèþ ê ìåä. ðàáîòíèêàì. |
#2
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È òåì íå ìåíåå, ýòî íàäî çíàòü.
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#3
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èç îïèñàíèÿ ïðåïàðàòà: "...Ó äåòåé, ïîëó÷àâøèõ Ñåâîðàí äëÿ ââîäíîãî íàðêîçà, íàáëþäàëèñü ñëó÷àè ñàìîñòîÿòåëüíî ïðîõîäÿùèõ äèñòîíè÷åñêèõ äâèæåíèé, ñâÿçü êîòîðûõ ñ ïðåïàðàòîì íå óñòàíîâëåíà.  åäèíè÷íûõ ñëó÷àÿõ ïîñëå ïðèìåíåíèÿ Ñåâîðàíà îòìå÷àëèñü êðàòêîâðåìåííûå ñóäîðîãè..."
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ýòî íå ãîâîðèò, ÷òî ó ðåáåíêà äîëæíà áûòü ýïèëåïñèÿ. (õîòÿ îáñëåäîâàòüñÿ íà íåå íå ìåøàåò òîëüêî ïîòîìó, ÷òî îíà ÿâëÿåòñÿ ïðîòèâîïîêàçàíèåì (àáñîëþòíûì èëè îòíîñèòåëüíûì?) ê ïðåäïîëàãàåìîìó îïåðàòèâíîìó âìåøàòåëüñòâó. Ïî ïîâîäó íàðêîçîâ â äàëüíåéøåì - àðñåíàë ïðåïàðàòîâ íå îãðàíè÷èâàåòñÿ ñåâîôëþðàíîì, è â êàæäîì êîíêðåòíîì ñëó÷àå ðåøàåòñÿ êîíêðåòíûì àíåñòåçèîëîãîì ïðèìåíèòåëüíî ê êîíêðåòíîìó áîëüíîìó. |
#4
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Öèòàòà:
"Sevoflurane and epileptiform EEG changes. ISABELLE CONSTANT MD, PhD, ROBERT SEEMAN MD AND ISABELLE MURAT MD, PhD Service d'Anesthésie-Réanimation, Hopital d'enfants Armand Trousseau, Assistance-Publique, Hôpitaux de Paris, Paris VI University, Paris, France Summary Sevoflurane has become the volatile agent of choice for inhalation induction of anesthesia. Hemodynamic stability and lack of respiratory irritation have justified its rapid extension to pediatric inhalation induction. The epileptogenic potential of sevoflurane has been suspected since the first case reports of abnormal movements in children without a history of epilepsy. The objectives of this short review are to: (i) analyze clinical and electroencephalographic (EEG) features supporting epileptogenic activity of sevoflurane, (ii) identify factors which may modulate that activity, and (iii) suggest guidelines of clinical practice to limit expression of this epileptiform phenomenon, which has thus far unknown morbidity. The use of sevoflurane may be associated with cortical epileptiform EEG signs, usually without clinical manifestation. No lasting neurological or EEG sequelae have been described thus far, and the potential morbidity of this epileptogenic effect is unknown. The use of sevoflurane in children, with its remarkable cardiovascular profile, should include a number of precautions. Among them, the limitation of the depth of anesthesia is essential. The wide use of cerebral function monitoring (the most simple being the EEG), may permit optimization of sevoflurane dose and avoidance of burst suppression and major epileptiform signs in fragile subjects, notably the very young and the very old." [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] P.S. (åñëè èíòåðåñóåò, ïîëíûé òåêñò ìîæíî â áèáëèîòåêå ïîïðîñèòü) |
#5
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Âûäåëèë â îòäåëüíûé òîïèê ýòó âåòêó äèñêóññèè (â òîì ÷èñëå è ïîòîìó, ÷òî â êîíñóëüòàòèâíûõ òåìàõ ïðàâèëàìè ôîðóìà íå ðàçðåøàåòñÿ äàâàòü öèòàòû èç àíãëîÿçû÷íûõ ñòàòåé áåç ïåðåâîäà).
Öèòàòà, ïðèâåäåííàÿ Âàìè Äìèòðèé äîâîëüíî èíòåðåñíàÿ. Ìû ðàáîòàåì ó ñåáÿ â êëèíèêå ïðàêòè÷åñêè èñêëþ÷èòåëüíî ñåâîôëþðàíîì, â ò.÷. èñïîëüçóåì äëÿ ìàñî÷íîé èíäóêöèè ó äåòåé. Ó íàñ çíà÷èòåëüíàÿ ÷àñòü ïàöèåíòîâ èìååò èñõîäíóþ ñóäîðîæíóþ ïðåäðàñïîëîæåííîñòü (ïðîôèëü - íåéðîõèðóðãèÿ, ïëàíîâàÿ è ýêñòðåííàÿ), íåðåäêî âî âðåìÿ îïåðàöèè èñïîëüçóåòñÿ ÝÝà ìîíèòîðèíã. È â îáùåì ñóäîðîã íà ôîíå èñïîëüçîâàíèÿ ñåâîôëþðàíà èëè ïàòîëîãè÷åñêîé àêòèâíîñòè íà ÝÝà íè ÿ íè êîëëåãè (íàñêîëüêî ìíå èçâåñòíî) íå íàáëþäàëè. Íàïðîòèâ, èñïîëüçîâàíèå èíãàëÿöèîííûõ àíåñòåòèêîâ ïðèíÿòî ñ÷èòàòü áåçîïàñíûì ìåòîäîì àíåñòåçèè ó áîëüíûõ ñ ýïèëåïñèåé, íàïðèìåð ïî ñðàâíåíèþ ñ ïðîïîôîëîì. |
#6
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïðîêîíâóëüñèâíûé ýôôåêò åñòü è ó àíòèêîíâóëüñàíòîâ (êëàññè÷åñêèé ïðèìåð - êàðáàìàçåïèí è ìèîêëîíè÷åñêèå ïðèñòóïû), òóò âîçìîæíû êàêèå-òî ïàðàëëåëè. Äëÿ êàðáàìàçåïèíà åñòü êëèíè÷åñêèå è ÝÝà îðèåíòèðû, óêàçûâàþùèå íà âåðîÿòíîñòü àããðàâàöèè, äëÿ àíåñòåòèêîâ èõ íå âèäíî.  ñòàòüå Voss ðåêîìåíäàöèè êàñàþòñÿ ïàöèåíòîâ ñ ýïèëåïñèåé, îäíîêðàòíûå ñïðîâîöèðîâàííûå ñóäîðîãè îöåíèòü ñëîæíî, äîëãîñðî÷íûõ íàáëþäåíèé ÿ íå íàøåë è âðÿä ëè òàêèå ïðèñòóïû ÷åì-òî îòëè÷àþòñÿ îò ñïðîâîöèðîâàííûõ äðóãèìè ôàêòîðàìè. |
#7
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Àëåêñàíäð, ñïàñèáî çà êîððåêòèðîâêó òåìû, ïðîñòî â èíåòå ïîïàëîñü, âîò è âûëîæèë "â òåìó", ïîñêîëüêó íå çíàë, çàèíòåðåñóåò ëè êîãî-íèáóäü ýòî ÿâëåíèå.
Êñòàòè, ôèíñêèå êîëåãè òîæå èññëåäîâàëè â ñâîå âðåìÿ ýòó òåìó: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] îíè æå - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] À âîò åùå èíòåðåñíàÿ ñòàòåéêà "Inhalation induction with sevoflurane for electroconvulsive therapy: a case series" Êñòàòè âîò äèññåð ôèíñêîãî ä-ðà Anne Vakkuri (äîñòóïåí ïî àäðåñó [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] äî 2010-03-12, password: passw). èç ÿïîíñêàÿ ñòàòåéêè "The epileptogenic properties of the volatile anesthetics sevoflurane and isoflurane in patients with epilepsy" ([Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ): "...Sevoflurane has a stronger epileptogenic property than isoflurane, but nitrous oxide or hyperventilation counteracts this specific epileptogenic property..." Ò.å. ïîäâîäÿ èòîã - â àííîòàöèè íå çðÿ íàïèñíî ïðîèçâîäèòåëåì |
#8
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Êñòàòè, â ÿïîíñêîé ðàáîòå åñòü èíòåðåñíàÿ ôðàçà, êàñàåìàÿ ïàöèåíòîâ íå ñòðàäàþùèõ ýïèëåïñèåé:
Öèòàòà:
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#9
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È ó ïðîïîôîëà, òàêîå áûâàåò: "[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]":
"Two non-epileptic patients developed convulsions immediately after induction of anesthesia with propofol. Their vital signs were stable during operation and they recovered from convulsion promptly. Case 1: A 25-year-old man was scheduled for lumbar herniectomy. Anesthesia was induced with propofol 200 mg (2 mg.kg-1). On termination of propofol administration, he developed generalized shivering like movements. Although tracheal intubation was performed with suxamethonium 100 mg, he showed no fasciculations. Vital signs and Spo2 were stable except increase of pulse rate from 70 to 116.min-1 for a few minutes. Case 2: A 75-year-old female was scheduled for cholecystectomy for cholelithiasis. Immediately after induction with propofol 60 mg (1.5 mg.kg-1), she developed generalized tonic-clonic convulsion, and she had her trachea intubated with aid of vecuronium 6 mg. Propofol-related convulsion may occur in non-epileptic patients." |