对乙酰氨基酚、非甾体抗炎药和类固醇药物的药理学：对麻醉的影响或独特的相关风险。

Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks.

作者信息

Candido Kenneth D, Perozo Oscar J, Knezevic Nebojsa Nick

机构信息

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor Street, Chicago, IL 60612, USA; Department of Surgery, University of Illinois, 840 S. Wood Street, Chicago, IL 60612, USA.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA.

出版信息

Anesthesiol Clin. 2017 Jun;35(2):e145-e162. doi: 10.1016/j.anclin.2017.01.020. Epub 2017 Mar 14.

DOI:10.1016/j.anclin.2017.01.020

PMID:28526157

Abstract

Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. The primary mechanism of action of corticosteroids involves regulation of nuclear expression of genes involved in inflammatory pathways and other systemic effects. Metaanalyses have added purposeful perioperative indications, clarified misconceptions, and established protocols for administering these drugs. Some indications, doses, clinical considerations, and adverse effects need to be further studied.

摘要

对乙酰氨基酚、非甾体抗炎药（NSAIDs）和皮质类固醇，过去常用于围手术期管理，是强效镇痛药。它们主要抑制环氧化酶（COX），减少前列腺素的合成，并调节疼痛和体温。对乙酰氨基酚在炎症部位不抑制这种合成。皮质类固醇的主要作用机制涉及调节炎症途径相关基因的核表达及其他全身效应。荟萃分析增加了围手术期的特定适应证，澄清了误解，并制定了这些药物的给药方案。一些适应证、剂量、临床注意事项和不良反应需要进一步研究。