Ceriana P, Maurelli M
Servizio di Anestesia e Rianimazione I, IRCCS Policlinico San Matteo, Pavia.
Minerva Anestesiol. 1995 May;61(5):219-28.
To collect data in the current literature dealing with the diffusion, the reliability and the effectiveness of the rectal administration of anaesthetic drugs. To evaluate differences with parenteral administration.
Pharmacokinetics and clinical studies published in recent years in indexed journals.
Based on the study methodology, drugs employed and pharmacokinetic parameters evaluated.
Factors involved in absorption of drugs from the rectal mucosa, clinical effect and pharmacokinetic data of the following drugs: diazepam, flunitrazepam, midazolam, ketamin and methohexital, then a brief evaluation of other drugs: thiopental, etomidate, morphine and chloral hydrate.
The most widely used drugs are benzodiazepines: they are safe, easy to manage and highly effective; among them midazolam has the best kinetic and dynamic pattern. Ketamin is useful during painful diagnostic procedures; with the use of barbiturates there is a greater risk of respiratory depression and more caution must be employed.
Wide intervariability of rate of absorption, achievement of plasma levels and clinical effect is a relevant drawback of this technique, such to make it not preferable to the parenteral route, when both are feasible. It deserves, anyway, more consideration, and maintains its validity for the preparation of the paediatric patient to general anaesthesia.
收集当前文献中有关麻醉药物直肠给药的扩散、可靠性和有效性的数据。评估与胃肠外给药的差异。
近年来在索引期刊上发表的药代动力学和临床研究。
基于研究方法、所使用的药物和评估的药代动力学参数。
涉及药物从直肠黏膜吸收的因素、以下药物的临床效果和药代动力学数据：地西泮、氟硝西泮、咪达唑仑、氯胺酮和美索比妥，然后简要评估其他药物：硫喷妥钠、依托咪酯、吗啡和水合氯醛。
使用最广泛的药物是苯二氮䓬类：它们安全、易于管理且高效；其中咪达唑仑具有最佳的动力学和动态模式。氯胺酮在痛苦的诊断过程中有用；使用巴比妥类药物时呼吸抑制的风险更大，必须更加谨慎。
吸收速率、血浆水平的达到和临床效果的广泛变异性是该技术的一个相关缺点，以至于在两种方法都可行时，它不如胃肠外途径可取。无论如何，它值得更多考虑，并在小儿患者全身麻醉的准备中保持其有效性。
