Utjecaj anestetika na funkciju jetre u djece

master's thesis

• Title (english): Effects of anesthetics on liver function in children
• Author: Dina Muratović
• Mentor: Ljiljana Popović (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Ljiljana Popović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2014-09-22, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Jetra je najveći neparni parenhimni organ i najveća žlijezda u tijelu koja prosječno čini oko 5% tjelesne mase u novorođenčeta. Razvija se iz primitivnog crijeva, a njezina se osnova pojavljuje sredinom 3. tjedna kao izbočenje endodermalnog epitela na distalnom kraju prednjeg crijeva. Riječ je o organu koji obavlja brojne funkcije u organizmu, koje međutim nisu u potpunosti razvijene u novorođenačkoj i dječjoj dobi. Jedna od njih je i metabolizam lijekova koji se poglavito odvija preko dviju vrsta biokemijskih reakcija (reakcije faze I. i II.). Naime, djeca različite dobi različito metaboliziraju lijekove. Lijekovi koji se primjenjuju u djece za postizanje anestezije istovrsni su onima u odraslih. Razvitkom farmakološke industrije anesteziološki lijekovi s većim brojem neželjenih nuspojava nadomještaju se novim, sigurnijim sredstvima za bolesnika. Npr. prijašnji najčešće korišteni inhalacijski anestetik halotan, zbog svog hepatotoksičnog učinka, danas je potisnut primjenom sevoflurana, koji se smatra najboljim inhalacijskim anestetikom za primjenu u djece. Ipak, ni jedan anestetik nije u potpunosti siguran, pa tako ni sevofluran, što potvrđuju i brojna istraživanja u kojima je dokazan štetan učinak navedenog lijeka na jetru, uglavnom u obliku blagog porasta aminotrasferaza. Također su zabilježeni i slučajevi u kojima je sevofluran doveo do izraženije jetrene disfunkcije, ali i fulminantnog hepatitisa te jetrene nekroze. U današnje vrijeme cilj je anestezirati malog bolesnika tehnikom i lijekovima u potrebnom i zadanom vremenskom trajanju sa što manje neželjenih učinaka.

Abstract (english)

The liver is the largest odd parenchymal organ and the largest gland in the body, which on average accounts for about 5% of body weight in the newborn. It develops from the primitive gut, and her foundation appears mid third week as the projection of the endodermal epithelium at the distal end of the anterior intestine. It is the organ that performs many functions in the body, which, however, are not fully developed in the neonatal and childhood. One of them is the metabolism of drugs that are mainly carried out through two kinds of biochemical reactions (reaction phase I and II.). Specifically, children of different ages metabolize drugs differently. Drugs used in children to achieve anesthesia are the same as those that apply to adults. With development of pharmacological industry, anesthetic drugs with a number of unwanted side effects are replaced by new, more secure means for patients. For example, previously the most commonly used inhaled anesthetics halothane, because of its hepatotoxic effect, today is suppressed by using sevoflurane, which is considered the best inhaled anesthetics for use in children. However, there is no completely safe anesthetic. Even sevoflurane has been confirmed by numerous studies as a drug with detrimental effect to the liver, mainly in the form of a slight increase of aminotransferases. As well, there have been cases in which sevoflurane led to pronounced liver dysfunction and fulminant hepatic necrosis and hepatitis. At the present time, the target is to anesthetize small patient with technique and drugs that in the necessary and given time duration have less side effects.

• Keywords: jetra; metabolizam lijekova; dječja dob; anestetici; sevofluran
• Keywords (english): liver; drug metabolism; childhood; anesthetics; sevoflurane
• Language: croatian
• URN:NBN: urn:nbn:hr:105:911023
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-11-25 13:37:56