Inhalační anestetika jsou nedílnou součástí technik celkové anestezie. Nejstarším a stále používaným inhalačním anestetikem je oxid dusný. Ostatní inhalační anestetika jsou halogenované deriváty aromatických uhlovodíků, které jsou do vdechované směsi dodávány pomocí odpařovačů. V současnosti používaná volatilní anestetika zahrnují izofluran, sevofluran a desfluran. Velmi zřídka je používán xenon. V přehledném článku je diskutována farmakokinetika a farmakodynamika jednotlivých volatilních anestetik, popsán je jejich efekt na jednotlivé orgánové systémy, především kardiovaskulární a respirační. Jsou zde rozebrány klinické indikace jednotlivých volatilních anestetik, jejich limitace a potenciální komplikace.

Volatile anesthetics are an integral part of total anethesia techniques. These are halogenated aromatic hydrocarbon derivatives which are supplied to the inhaled mixture by means of vaporizers. The oldest and still used inhalation anesthetic is nitrous oxide – laughing gas. The currently used volatile anesthetics include isoflurane, sevoflurane and desflurane. Very rarely xenon is used. This review article brings information about pharmocikinetcs, pfarmacodynamics of the currently used anesthetics, their physical and chemical properties, and mainly depicts their clinical use.

• Klíčová slova
• volatilní anestetika,
• MeSH
• anestetika inhalační * analýza   aplikace a dávkování   dějiny   farmakokinetika   farmakologie   MeSH
• desfluran farmakokinetika   MeSH
• fluorované uhlovodíky analýza   aplikace a dávkování   farmakokinetika   farmakologie   klasifikace   MeSH
• lidé MeSH
• oxid dusný analýza   dějiny   farmakologie   škodlivé účinky   MeSH
• pooperační období MeSH
• rozpustnost MeSH
• Check Tag
• lidé MeSH

OBJECTIVE: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. DESIGN: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. SETTING: Tertiary and University hospitals. INTERVENTIONS: Patients (n=10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. MEASUREMENTS AND MAIN RESULTS: The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. CONCLUSIONS: The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.

• MeSH
• analýza přežití MeSH
• anestetika inhalační * aplikace a dávkování   chemie   MeSH
• anestezie v kardiochirurgii * škodlivé účinky   metody   MeSH
• dospělí MeSH
• koronární bypass * škodlivé účinky   metody   mortalita   MeSH
• lidé MeSH
• nemoci koronárních tepen mortalita   chirurgie   MeSH
• pooperační komplikace * etiologie   prevence a kontrola   MeSH
• volatilizace MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS: A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS: Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).

• MeSH
• anestetika celková farmakologie   MeSH
• anestetika intravenózní MeSH
• aplikace inhalační MeSH
• celková anestezie MeSH
• elektivní chirurgické výkony MeSH
• intravenózní anestezie * MeSH
• jednoduchá slepá metoda MeSH
• Kaplanův-Meierův odhad MeSH
• koronární bypass * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita MeSH
• nemoci koronárních tepen mortalita   patofyziologie   chirurgie   MeSH
• senioři MeSH
• tepový objem MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• pragmatická klinická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

OBJECTIVES: Structural chromosomal aberrations in blood lymphocytes represent a biomarker for cellular damage caused by genotoxic carcinogens and are an indicator of increased cancer risk. We evaluated the association between frequencies of total chromosomal aberrations, chromatid- and chromosome-type aberrations, and occupational exposures to volatile anesthetics, antineoplastic agents, and formaldehyde among 601 medical professionals. METHODS: Chromosomal damage among exposed individuals and unexposed controls was determined by conventional cytogenetic analysis. We used binary logistic regression to evaluate the effects of workplace exposures and major confounders on chromosomal damage. RESULTS: Significantly higher frequencies of total chromosomal, chromatid-type and chromosome-type aberrations were observed among subjects occupationally exposed to volatile anesthetics, antineoplastic agents, and formaldehyde compared to age- and sex-matched controls (P<0.0001). The risk of an increased frequency of chromosomal aberrations was associated with exposure to anesthetics [odds ratio (OR) 3.9, 95% confidence interval (95% CI) 2.7-5.8], cytostatics (OR 2.7, 95% CI 1.9-3.9), and formaldehyde (OR 1.7, 95% CI 1.1-2.7). No other covariate contributed significantly to the model. Chromatid- and chromosome-type aberrations were associated with exposure to anesthetics and cytostatics without any contribution of other variables. Stratified data analysis showed the risk of increased chromosomal aberrations among non-smoking female nurses and physicians exposed to anesthetics, cytostatics and, partially, formaldehyde. Chromatid and chromosome exchanges were significantly higher in the exposed groups than among controls. CONCLUSION: Our findings indicate that the presence of genotoxic compounds in operating rooms, oncological units, and pathological departments results in a significant increase of chromosomal damage (impair of chromosomal integrity) among medical workers employed in these facilities.

• MeSH
• anestetika inhalační toxicita   MeSH
• chromozomální aberace * MeSH
• dospělí MeSH
• formaldehyd toxicita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutageny toxicita   MeSH
• pracovní expozice * MeSH
• protinádorové látky toxicita   MeSH
• studie případů a kontrol MeSH
• volatilizace MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Slovenská republika MeSH

Inhalační anestetika jsou používána k úvodu a vedení celkové doplňované anestezie. Volatilní anestetika (halotan, izofluran, desfluran a sevofluran) jsou za pokojové teploty a tlaku tekutiny, oxid dusný je v plynném skupenství. Použití inhalačních anestetik vede k amnézii a imobilitě, která je na dávce závislá. Výjimkou je oxid dusný, který má i analgetický účinek. V přehledném článku je diskutován efekt inhalačních anestetik na jednotlivé orgánové systémy a vysvětleny zásady klinického použití, výhod a limitací jednotlivých inhalačních anestetik.

Inhalational anesthetics are used for induction and maintenance of general anesthesia in the operating room. The volatile anesthetics (halothan, isoflurane, desflurane, and sevoflurane) are liquids and nitrous oxide is gas under normal temperature and pressure. All inhalational anesthetics provide dose-dependent amnesia and immobility, except for nitrous oxide, which also provides analgesia. This review article brings information about effects on organs, clinical use of the currently used anesthetics, their advantages and limitations.

• MeSH
• anestetika inhalační * farmakologie   terapeutické užití   MeSH
• lidé MeSH
• nežádoucí účinky léčiv MeSH
• oxid dusný * farmakologie   terapeutické užití   MeSH
• sevofluran * farmakologie   terapeutické užití   farmakologie   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. MEASUREMENTS AND MAIN RESULTS: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.

• MeSH
• anestetika inhalační * MeSH
• anestetika intravenózní MeSH
• infarkt myokardu * farmakoterapie   epidemiologie   MeSH
• koronární bypass metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace diagnóza   epidemiologie   prevence a kontrola   MeSH
• propofol * MeSH
• senioři MeSH
• sevofluran MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

V oblasti celkových inhalačných prchavých anestetík od použitia oxidu dusného, dietyléteru, chloroformu a cyklopropánu nastal vďaka zavedeniu fluórovaných anestetík a s nimi spojených chirálnych technológií pokrok, v dôsledku ktorého došlo pri anestézii k zníženiu úmrtnosti. Z fluórovaných chirálnych prchavých anestetík sa do oblasti anestézie dostali halotan (Fluotan®), izoflurán (Foran®), dezflurán (Supran®) a enflurán (Ehran®). Z nechirálnych sa používajú metoxyflurán (Penthrox®) a sevoflurán (Sevoran®). Chirálne anestetiká majú v svojej štruktúre stereogénne centrum a existujú vo forme dvoch enantiomérov (S)-(+) a (R)-(–). Hoci sa tieto chirálne anestetiká používajú vo forme racemátov, z hľadiska účinnosti a bezpečnosti je u nich dôležité študovať okrem biologickej aktivity racemátov i biologickú aktivitu ako i ďalšie vlastnosti jednotlivých enantiomérov. V predloženom prehľade je pozornosť venovaná skupine liečiv známych ako inhalačné anestetiká vo vzťahu k ich chirálnym aspektom. Boli u nich zistené významné rozdiely (R) a (S)-enantiomérov vo farmakodynamickej, farmakokinetickej aktivite, ako i v toxicite. Na rozdelenie jednotlivých racemátov na enantioméry sa využíva hlavne plynová chromatografia (GC). V prehľade sú uvedené jednotlivé chirálne fázy, resp. selektory využívané pri ich enantioseparácii, ako i pri farmakokinetických štúdiách. Príprava jednotlivých enantiomérov okrem preparatívnej GC je možná aj pomocou metód stereoselektívnej syntézy.

Since the advent of nitric oxide, diethyl ether, chloroform and cyclopropane, the greatest advancement in the area of general inhalational anesthetics has been achieved by the introduction of fluorinated anesthetics and the relevant chiral techniques. This progress led to marked decrease in mortality rates in anesthesia. In the group of chiral fluorinated compounds, halothane (Fluotan®), isoflurane (Foran®), desflurane (Supran®) and enflurane (Ehran®) are deployed as volatile anesthetics. Chiral anesthetics possess a stereogenic center in their molecules and thus exist as two enantiomers (S)-(+) and (R)-(–). Although these chiral anesthetics are used as racemates, it is crucial to study besides the bioactivities of the racemic compounds also the biological activity and other properties of the particular enantiomers. The present survey discusses the drug category known as inhalational anesthetics in regard to their chiral aspects. These compounds exhibit marked differences between the (R) and (S)-enantiomers in their pharmacodynamics, pharmacokinetics and toxicity. The main analytical technique employed in the enantioseparation of these compounds is gas chromatography (GC). This review lists the individual chiral phases (chiral selectors) used in the enantioseparation as well as in pharmacokinetic studies. The possibilities of preparation of these compounds in their enantiomerically pure form by means of stereoselective synthesis are also mentioned.

• MeSH
• anestetika celková * farmakokinetika   farmakologie   MeSH
• anestetika inhalační * farmakokinetika   farmakologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• anestetika inhalační MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• anesteziologie a intenzivní lékařství
• farmacie a farmakologie

• MeSH
• anestetika škodlivé účinky   MeSH
• chromozomální aberace chemicky indukované   MeSH
• dospělí MeSH
• hygiena práce MeSH
• látky znečišťující vzduch MeSH
• lidé MeSH
• operační sály MeSH
• podnebí MeSH
• služby preventivní péče MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH

There is increasing evidence that the microcirculation and its regulation are severely compromised during many pathological conditions, such as hemorrhage, sepsis, or trauma. The effects of anesthetic agents on macrohemodynamics were investigated intensively in the last several decades. Research regarding modern anesthetics and anesthesia techniques has increased knowledge regarding the nonanesthetic effects of anesthetic agents, including those on organ perfusion and the microcirculation. Alterations in microvascular reactivity, nitric oxide pathways, and cytokine release are presumably the main mechanisms of anesthetic-induced tissue perfusion changes. This review summarizes current methods of microcirculatory status assessment and current knowledge regarding the microcirculatory effects of intravenous and potent volatile anesthetics and anesthesia-related techniques under both normal and pathophysiological conditions.

• MeSH
• anestetika inhalační farmakologie   MeSH
• anestetika intravenózní farmakologie   MeSH
• anestezie metody   MeSH
• epidurální anestezie metody   MeSH
• kardiopulmonální bypass MeSH
• lidé MeSH
• mikrocirkulace účinky léků   MeSH
• peroperační monitorování metody   MeSH
• psi MeSH
• reperfuze MeSH
• tekutinová terapie MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• psi MeSH
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH