Anesthesia & Analgesia

July 2002

Table of Content

伴和不伴有术后认知障碍的CABG术病人中的血清肌酐变化
(周洁   王祥瑞校)
Serum Creatinine Patterns in Coronary Bypass Surgery Patients With and Without Postoperative Cognitive Dysfunction
Madhav Swaminathan, Brian J. McCreath, Barbara G. Phillips-Bute, Mark F. Newman, Joseph P.

Departments of *Anesthesiology, Surgery (Cardiothoracic Division), and Medicine and Psychiatry, Duke University Medical Center , Durham , North Carolina

Anesth & Analg July 2002 95:1-8.

 

心肌缺血和细胞因子与非心脏手术后的感染相关
 (周洁   王祥瑞校)

Myocardial Ischemia and Cytokine Response Are Associated with Subsequent Onset of Infections After Noncardiac Surgery

laudia D. Spies, MD*, Hartmut Kern, MD*, Torsten Schröder, MD*, Michael Sander, MD*, Henning Sepold, MD*, Philip Lang, MD*, Karl Stangl, MD, Steffen Behrens, MD, Pranav Sinha, MD, Walter Schaffartzik, MD||, Klaus-Dieter Wernecke, PhD¶, Wolfgang J. Kox, MD, PhD*, and Uday Jain, MSIT, PhD, MD#

Departments of *Anesthesiology and Intensive Care Medicine and Cardiology and Institute of Clinical Chemistry and Pathological Biochemistry, University Hospital

Anesth & Analg July 2002 95:9-18.

 

犬局部心肌功能障碍研究中多巴酚丁胺是否有改善心室功能的作用?
(李 懿译   薛张刚校) 

Does Dobutamine Improve Ventricular Function in Dogs with Regional Myocardial Dysfunction?

David P. Strum, MD, FRCP(C)*, and Michael R. Pinsky, MD, CM{dagger}

*Department of Anesthesiology and Critical Care Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada; and {dagger}Cardiopulmonary Research Laboratory, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:19-25

 

应用血浆改良激活凝血时间监测体外循环肝素化:一项指导性研究
(李 懿译   薛张刚校)

 The Plasma Supplemented Modified Activated Clotting Time for Monitoring of Heparinization During Cardiopulmonary Bypass: A Pilot Investigation

Andreas Koster, MD*, George Despotis, MD{ddagger}, Marcus Gruendel, MD*, Thomas Fischer, MD*, Michael Praus, MD{dagger}, Herman Kuppe, MD*, and Jerrold H. Levy, MD§

*Department of Anesthesia, Deutsches Herzzentrum, and {dagger}Institute of Pathobiochemistry and Clinical Chemistry, Charité, Campus Virchow, Berlin, Germany; {ddagger}Departments of Anesthesiology, Pathology, and Immunology, Washington University School of Medicine, St Louis, Missouri; and §Department of Cardiothoracic Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Anesth & Analg July 2002 95:26-30

 

七氟醚对健康和心肌病仓鼠交替性正性肌力作用

王士雷译  庄心良校)

The Paradoxical Positive Inotropic Effect of Sevoflurane in Healthy and Cardiomyopathic Hamsters

Benoît Vivien, MD*, Jean-Stéphane David, MD{dagger}, Jean-Luc Hanouz, MD, PhD{ddagger}, Julien Amour, MD*, Yves Lecarpentier, MD, PhD§, Pierre Coriat, MD*, and Bruno Riou, MD, PhD*||

 

*Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Centre Hospitalier Universitaire (CHU) Pitié-Salpêtrière, Université Paris VI, Paris, France; {dagger}Department of Anesthesiology, CHU Edouard Herriot, Lyon, France; {ddagger}Department of Anesthesiology, CHU Côte de Nacre, Caen, France; §Department of Physiology, CHU de Bicêtre, and Institut National de la Santé et de la Recherche Médicale, Palaiseau, France; and ||Department of Emergency Medicine, CHU Pitié-Salpêtrière, Université Paris VI, Paris, France

Anesth & Analg July 2002 95:31-38

 

Rapacuronium对麻醉儿童肺机械的影响:与美维松比较

(赵雪莲译  庄心良校)

The Effect on Lung Mechanics in Anesthetized Children with Rapacuronium: A Comparative Study with Mivacurium

Gavin F. Fine, MB, BCh*{ddagger}, Etsuro K. Motoyama, MD*{dagger}{ddagger}§, Barbara W. Brandom, MD*{ddagger}, Kathleen M. Fertal, BSN*, Rebecca Mutich, RRT{dagger}, and Peter J. Davis, MD*{ddagger}§

*Department of Anesthesiology and {dagger}Division of Pulmonology, Children’s Hospital of Pittsburgh; and the Departments of {ddagger}Anesthesiology and §Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:56-61                                

 

可弯曲支气管镜模拟器气道模拟器的的评估
 (周洁   王祥瑞校)

An Evaluation of a Virtual Reality Airway Simulator

Richard Rowe, MD, MPH*, and Ronald A. Cohen, MD

Departments of *Anesthesiology and Diagnostic Imaging, Children’s Hospital Oakland, Oakland; and Departments of Anesthesiology and Radiology, University of California, San Francisco School of Medicine, San Francisco, California

Anesth & Analg July 2002 95:62-66.

 

一种新的颞动脉温度监测器应用于成人和小儿病人效果不佳
(潘志浩译   薛张刚校) 

Insufficiency in a New Temporal-Artery Thermometer for Adult and Pediatric Patients

Mohammad-Irfan Suleman, MD*, Anthony G. Doufas, MD, PhD*, Ozan Akça, MD*, Michel Ducharme, PhD{dagger}, and Daniel I. Sessler, MD*{ddagger}

*Outcomes ResearchTM Institute and Department of Anesthesiology, University of Louisville, Kentucky; {dagger}Defence R&D Canada-Toronto, Canada; and {ddagger}Ludwig Boltzmann Institute, University of Vienna, Austria

Anesth & Analg July 2002 95:67-71

 

门诊病人麻醉的知晓和回忆

(王士雷译  庄心良校)

Awareness and Recall in Outpatient Anesthesia

Johanna Wennervirta, MD*, Seppo O.-V. Ranta, MD*, and Markku Hynynen, MD, PhD{dagger}

*Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Children’s Hospital, Helsinki, Finland; and {dagger}Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland

 Anesth & Analg July 2002 95:72-77

 

α-7烟碱型乙酰胆碱受体对异氟醚的敏感性有赖受体失活态

(杨保仲译   庄心良校)

Sensitivity of the α7 Nicotinic Acetylcholine Receptor to Isoflurane May Depend on Receptor Inactivation

Pamela Flood, MD, FACA, and Kristen M. Coates, BS

Department of Anesthesiology, Columbia University, New York

Anesth & Analg July 2002 95:83-87

 

地氟醚复合雷米芬太尼麻醉辅助小剂量氯胺酮可减少围术期阿片类镇痛药的用量
(潘志浩译   薛张刚校)

 Supplementing Desflurane-Remifentanil Anesthesia with Small-Dose Ketamine Reduces Perioperative Opioid Analgesic Requirements

Bruno Guignard, MD*, Carole Coste, MD*, Hélène Costes, MD*, Daniel I. Sessler, MD{dagger}, Claude Lebrault, MD*, William Morris, MD*, Guy Simonnet, MD{ddagger}, and Marcel Chauvin, MD*

*Department of Anesthesiology, Hôpital Ambroise Pare, Assistance Publique Hôpitaux de Paris, France; {dagger}Outcomes ResearchTM Institute and Department of Anesthesiology, University of Louisville, Kentucky and Ludwig Boltzmann Anesthesia Institute, University of Vienna, Austria; and {ddagger}Institut National de la Santé et de la Recherche Médicale (INSERM) U 259, Bordeaux, France

Anesth & Analg July 2002 95:103-108

 

重症肌无力(MG)血清反应阳性和血清反应阴性病人对维库溴胺敏感性差异的研究
(张俊峰译   薛张刚校)

 Sensitivity to Vecuronium in Seropositive and Seronegative Patients with Myasthenia Gravis

Hironori Itoh, MD*, Keizo Shibata, MD{dagger}, and Shunichi Nitta, MD{ddagger}

Departments of *Anesthesiology and Intensive Care Medicine and {dagger}Emergency and Critical Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan; and {ddagger}Division of Anesthesia, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

Anesth & Analg July 2002 95:109-113

小剂量氯胺酮可改善术后病人抑郁状态
(忻纪华译 王祥瑞校)

Small-Dose Ketamine Improves the Postoperative State of Depressed Patients

Akira Kudoh, MD*,Yoko Takahira, Hiroshi Katagai, MD, Tomoko Takazawa, MD

*Department of Anesthesiology, Hakodate Watanabe Hospital; and department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Aomori, Japan

Anesth & Analg July 2002 95:114-118.

 

琥珀胆碱能安全用于高钾血症的病人吗?

(颜涛译  庄心良校)

Can Succinylcholine Be Used Safely in Hyperkalemic Patients?

Adam J. Schow, MD*, David A. Lubarsky, MD, MBA{dagger}, Ronald P. Olson, MD*, and Tong J. Gan, MB*

 *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and {dagger}Department of Anesthesiology, University of Miami/Jackson Medical Center, Florida Anesth & Analg July 2002 95:119-122

 

压缩气筒动力的机械通气对麻醉管理和效率可能有不良影响
(张德林   薛张刚校 

E-Cylinder-Powered Mechanical Ventilation May Adversely Impact Anesthetic Management and Efficiency

Andreas H. Taenzer, MD*, Pete G. Kovatsis, MD{dagger}, and Kenneth L. Raessler, MD*

*Department of Anesthesiology, Maine Medical Center, Portland, Maine; and {dagger}Harvard Medical School and Children’s Hospital, Boston, Massachusetts

 Anesth & Analg July 2002 95:148-150

 

对妇科术前和术后疼痛评估的一种有效可靠的新方法
(忻纪华   王祥瑞校)

A New Highly Reliable Instrument for the Assessment of Pre- and Postoperative Gynecological Pain

Elisabet Stener-Victorin,RPT,PhD*, Jan Kowalski, BS, and Thomas Lundeberg,MD,PhD

瑞典歌德堡大学妇产科学系;斯德哥尔摩Karolinska学会生理学和药理学分会;瑞典斯德哥尔摩Karolinska医院药剂

Anesth & Analg July 20002 95:151-157.

 

腹式全子宫切除术后于腹膜内和切口应用布比卡因加肾上腺素的镇痛效应
 (齐波   王祥瑞校)

The Analgesic Effects of Intraperitoneal and Incisional Bupivacaine with Epinephrine After Total Abdominal Hysterectomy

A.Ng, FRCA*, A. Swami, FFARCSI*, G. Smith, MD, FRCA*, A.C. Davidson, FRCOG, and J. Emembolu, FRCOG

*University Department of Anaesthesia, Critical Care, and Pain Management, and Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom

Anesth & Analg July 2002 95:158-162

 

抗抑郁药的抗伤害效应与单胺受体有关的研究
(张俊峰译   薛张刚校) 

An Investigation of Monoamine Receptors Involved in Antinociceptive Effects of Antidepressants

Fumiko Yokogawa, MD*, Yuji Kiuchi, MD, PhD{dagger}, Yuji Ishikawa, MS{dagger}, Naoki Otsuka, MD, PhD*, Yutaka Masuda, MD, PhD*, Katsuji Oguchi, MD, PhD{ddagger}, and Akiyoshi Hosoyamada, MD, PhD*

*Department of Anesthesiology and {ddagger}First Department of Pharmacology, School of Medicine, and {dagger}Department of Pathophysiology, School of Pharmaceutical Sciences, Showa University, Tokyo, Japan

Anesth & Analg July 2002 95: 163-168

 

单极和双极气管内电极用于电刺激通气

(葛圣金译  庄心良校)

Electroventilation with Monopolar and Bipolar Intratracheal Electrodes

Zachary W. Sopcak, MSBME, L. A. Geddes, PhD, Kirk S. Foster, BSEE, William E. Schoenlein, BS, and Joe D. Bourland, PhD

Purdue University Department of Biomedical Engineering, West Lafayette, Indiana

 Anesth & Analg July 2002 95:189-191

 

建立压力-控制模式时气管导管逐渐阻塞时潮气量变化的模型

(赵雪莲译  庄心良校)

Modeling the Effect of Progressive Endotracheal Tube Occlusion on Tidal Volume in Pressure-Control Mode

Avery Tung, MD*, and Sherwin E. Morgan, RRT{dagger}

Departments of *Anesthesia and Critical Care and {dagger}Respiratory Therapy, University of Chicago, Chicago, Illinois

Anesth & Analg July 2002 95:192-197

 

腰麻能引起产妇听力丧失吗?
(嵇富海译   薛张刚校)

 Does Spinal Anesthesia Cause Hearing Loss in the Obstetric Population?

Helene Finegold, MD, Gordon Mandell, MD, Manuel Vallejo, MD, and Sivam Ramanathan, MD

Magee-Women’s Hospital, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:198-203

硬膜外应用布比卡因和罗哌卡因分娩镇痛的相对运动神经阻滞效能
(齐波   王祥瑞校)

The Relative Motor Blocking Potencies of Epidural Bupivacaine and Ropivacaine in Labor

Héctor J. Lacassie, MD*, Malachy O. Columb, FRCA, Héctor P. Lacassie, MD, and Rodrigo A. Lantadilla, MD*

*Anesthesiology Department, Pontificia Universidad Católica de Chile; and Anesthesiology Service, Clínica Alemana, Santiago, Chile; and South Manchester University Hospital, Withington, United Kingdom

Anesth & Analg July 2002 95:204-208.

 

坐骨神经阻滞前路法的新标志:影像学和临床研究

(焦志华译  庄心良校)

New Landmarks for the Anterior Approach to the Sciatic Nerve Block: Imaging and Clinical Study

Alain C. Van Elstraete, MD*, Claude Poey, MD{dagger}, Thierry Lebrun, MD*, and Frédéric Pastureau, MD*

Departments of *Anesthesiology and {dagger}Radiology, Saint-Paul Medical Center, Fort de France, Martinique, France

Anesth & Analg July 2002 95:214-218

 

小剂量地塞米松减少腹腔镜胆囊切除术后的恶心呕吐:同Tropisetron 比较
(嵇富海译   薛张刚校)

 Small-Dose Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy: A Comparison of Tropisetron with Saline

Jhi-Joung Wang, MD, DMS*, Shung-Tai Ho, MD, MS{dagger}, Yih-Huei Uen, MD{ddagger}, Mao-Tsun Lin, PhD*, Kuan-Ting Chen, MD*, Jeng-Chai Huang, PhD*, and Jann-Inn Tzeng, MD*

Departments of *Anesthesiology and {ddagger}Surgery, Chi-Mei Medical Center, Tainan, Taiwan; and {dagger}Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Anesth & Analg July 2002 95:229-232

 

降低吸入笑气浓度后对双腔管支气管套囊迅速放气的研究
(忻纪华   王祥瑞校)

Rapid Deflation of the Bronchial Cuff of the Double-Lumen Tube After Decreasing the Concentration of Inspired Nitrous Oxide

Fujio Karasawa, MD, Akira Takita, MD, Isao Takamatsu, MD, Tomohisa Mori, MD, Takashi Oshima, MD, and Yasushi Kawatani, MD

Department of Anesthesiology, National Defense Medical College, Saitama, Japan

Anesth & Analg July 2002 95:238-242.

 

N2O麻醉时气管套囊重复放气以稳定套囊内压力

(焦志华译  庄心良校)

Repeated Deflation of a Gas-Barrier Cuff to Stabilize Cuff Pressure During Nitrous Oxide Anesthesia

Fujio Karasawa, MD, Nobuhiro Matsuoka, MD, Mitsuyoshi Kodama, MD, Tomohiro Okuda, MD, Tomohisa Mori, MD, and Yasushi Kawatani, MD

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan

Anesth & Analg July 2002 95:243-248

Abstracts

 

伴和不伴有术后认知障碍的CABG术病人中的血清肌酐变化

Serum Creatinine Patterns in Coronary Bypass Surgery Patients With and Without Postoperative Cognitive Dysfunction

Madhav Swaminathan, Brian J. McCreath, Barbara G. Phillips-Bute, Mark F. Newman, Joseph P.

Departments of *Anesthesiology, Surgery (Cardiothoracic Division), and Medicine and Psychiatry, Duke University Medical Center , Durham , North Carolina

Anesth & Analg July 2002 95:1-8.

 

  目的 CABG术后肾功能障碍较为常见。我们早就发现CABG术中伴有脑卒中的病人其血清肌酐为未伴有脑卒中者的三倍。但是,术后肌酐变化是否合并认知障碍还未得知。因此,我们假设CABG术后的围术期急性肾功能损伤与术后认知障碍有关。方法 选择282例择期CABG术病人,于术前和术后6周进行心理测量试验并行资料统计。认知功能障碍定义为受两分变量认知缺陷[CD])和连续变量认知指数)。结果 40%的病人在术后6周有CD。但是,对术后肌酐和CD(相关性=-0.41P=0.91)或认知指数(相关性=-1.29P=0.46)之间的百分比峰变化的相关研究表明:两者无明显相关。结论 心脏术后的认知障碍与脑卒中不同,与术后肾功能障碍的增加无关。

                                                 (周洁   王祥瑞校)

Renal dysfunction is common after coronary artery bypass graft (CABG) surgery. We have previously shown that CABG procedures complicated by stroke have a threefold greater peak serum creatinine level relative to uncomplicated surgery. However, postoperative creatinine patterns for procedures complicated by cognitive dysfunction are unknown. Therefore, we tested the hypothesis that postoperative cognitive dysfunction is associated with acute perioperative renal injury after CABG surgery. Data were prospectively gathered for 282 elective CABG surgery patients. Psychometric tests were performed at baseline and 6 wk after surgery. Cognitive dysfunction was defined both as a dichotomous variable (cognitive deficit [CD]) and as a continuous variable (cognitive index). Forty percent of patients had CD at 6 wk. However, the association between peak percentage change in postoperative creatinine and CD (parameter estimate = -0.41; P = 0.91) or cognitive index (parameter estimate = -1.29; P = 0.46) was not significant. These data indicate that postcardiac surgery cognitive dysfunction, unlike stroke, is not associated with major increases in postoperative renal dysfunction.

                                                

心肌缺血和细胞因子与非心脏手术后的感染相关

Myocardial Ischemia and Cytokine Response Are Associated with Subsequent Onset of Infections After Noncardiac Surgery

laudia D. Spies, MD*, Hartmut Kern, MD*, Torsten Schröder, MD*, Michael Sander, MD*, Henning Sepold, MD*, Philip Lang, MD*, Karl Stangl, MD, Steffen Behrens, MD, Pranav Sinha, MD, Walter Schaffartzik, MD||, Klaus-Dieter Wernecke, PhD¶, Wolfgang J. Kox, MD, PhD*, and Uday Jain, MSIT, PhD, MD#

Departments of *Anesthesiology and Intensive Care Medicine and Cardiology and Institute of Clinical Chemistry and Pathological Biochemistry, University Hospital

Anesth & Analg July 2002 95:9-18.

 

目的 在多数非心脏手术术后普遍存在心肌缺血(POMI)。手术和POMI可能影响免疫力,使患者预后恶化。我们通过研究由POMI调节有关的白介素—6IL6)和IL10及其与术后感染率相关性。方法 选择的203例腹部,血管和整形外科手术病人。围术期处理方法一致。血流动力学改变维持在基础值的20%范围内。从麻醉诱导前8小时开始至术后96小时行Holter心动电流描记器来判断POMI。在入院,手术前,麻醉诱导前,手术后,入监护室,和术后612182436487296120144,和168小时检查12导联心电图,心肌酶谱和免疫指标测定。根据疾病控制中心所定规则诊断感染。结果 POMI发生率为27%,多数病例(76%)发生在术后24小时内。IL6IL10水平在手术中显著升高,但在POMI和非POMI组中无区别。术后出现严重感染或败血症(n=47)平均为3天(范围从18天),在此类病人中,POMI组病人术中IL6IL10较非POMI组升高3—10倍。在这些严重感染病人中用多因素分析法分析发现,外科创伤的类型与IL6的升高相关,而IL—10的升高与POMI有关。结论 这些发现提示由POMI引起的细胞因子的即刻反应和手术类型与严重感染和败血症的发生相关。

                                              (周洁   王祥瑞校)

Postoperative myocardial ischemia (POMI) is prevalent among patients after major noncardiac surgery. Surgery, as well as POMI, may modulate the immune system, potentially worsening patient outcome. We sought to investigate the modulation of soluble interleukin (IL)-6 and IL-10 by POMI and its association with increased postoperative infection rates. Two-hundred-three patients undergoing elective major abdominal, vascular, and orthopedic surgery participated in this prospective observational study. Perioperative management was standardized. Hemodynamic variables were kept within 20% of baseline. POMI was assessed by Holter electrocardiography starting at least 8 h before the induction of anesthesia and continued until 96 h after surgery. Twelve-lead electrocardiograms, cardiac enzymes, and immune variables were obtained at the time of admission to the hospital, before surgery, before the induction of anesthesia, after surgery, at the time of admission to the intensive care unit, and 6, 12, 18, 24, 36, 48, 72, 96, 120, 144, and 168 h after surgery. Infections were diagnosed according to the Centers for Disease Control criteria. The incidence of POMI was 27%, and the majority of cases (76%) occurred within the first 24 h after surgery. IL-6 and IL-10 levels significantly increased during surgery but did not differ between the POMI and Non-POMI groups. However, in the subset of patients who developed severe infections or sepsis (n = 47) a median of 3 days (range, 1–8 days) after surgery, the intraoperative increases of IL-6 and IL-10 in the POMI group were, respectively, 3 and 10 times higher compared with the increase in the Non-POMI group. By using a multifactorial analysis in these patients with severe infections, the type of surgical trauma was associated with an increased IL-6 response, whereas the increase in IL-10 was attributed to POMI. These findings suggest that immediate cytokine responses due to POMI and type of surgery might be relevant for the later onset of severe infections and sepsis.

                                                  

犬局部心肌功能障碍研究中多巴酚丁胺是否有改善心室功能的作用?

 Does Dobutamine Improve Ventricular Function in Dogs with Regional Myocardial Dysfunction?

David P. Strum, MD, FRCP(C)*, and Michael R. Pinsky, MD, CM{dagger}

*Department of Anesthesiology and Critical Care Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada; and {dagger}Cardiopulmonary Research Laboratory, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:19-25

 

目的:我们研究了8条麻醉状态下开胸的犬持续全身应用多巴酚丁胺(4 µg · kg-1 · min-1)对局部心室壁运动异常(regional wall motion abnormalities RWMAs)的作用。假设小剂量静脉推注多巴酚丁胺有利于缓解局部室壁运动异常并且改善整个心室功能。方法:犬局部冠状动脉中注射9毫克艾司洛尔诱发其心尖部室壁运动异常。试验分为三组即多巴酚丁胺组、艾司洛尔组和多巴酚丁胺-艾司洛尔组,分别比较左室心尖部、乳头肌、腱索和基底部这四部分室壁在局部相位角(Regional phase angles)、有效每搏心输出量、最大每搏心输出量、每搏作功和节段室壁收缩缩短率等方面的差别。将整个左室最小容积(收缩末期容积)设定为0º,而整个心动周期划分成360等份,用局部相位角评估局部心肌最小收缩容积与整个左室最小容积的差值(用度数表示)。结果:左室心尖部室壁运动异常引起血压下降(92 ± 2 mm Hg 下降至 84 ± 3 mm Hg)和左室舒张末期压力增高(1.8 ± 0.5 mm Hg 上升至 4.2 ± 0.8 mm Hg),也导致局部心肌收缩延迟(-2.9° ± 1.6° 增加至 52.3° ± 1.5°)和有效心搏量减少(2.3 ± 0.4 mL 减少至 1.6 ± 0.3 mL),但是并没有影响最大心搏量。心尖部心肌收缩同步性降低以及有效心搏量和每搏作功的变化均证明多巴酚丁胺能够恢复整个左室功能却不能消除局部室壁运动异常。结论:因此我们认为全身应用多巴酚丁胺能够恢复左室功能,但不能纠正局部室壁运动异常。

(李 懿译   薛张刚校)

We studied the effect of systemic dobutamine infusion (4 µg · kg-1 · min-1 IV) on regional wall motion abnormalities (RWMAs) in eight anesthetized open-chested dogs. We hypothesized that infusion of small doses of dobutamine would reduce RWMAs and improve global ventricular function. Apical RWMAs were induced by local intracoronary boluses of 9.0 mg esmolol. Phase angles, effective stroke volume (SV), maximum SV, stroke work, and segmental shortening were compared among four left ventricular (LV) regions (apical, papillary, chordal, and basal) during baseline, dobutamine, esmolol, and dobutamine-esmolol treatments. The minimal global LV volume was designated as 0°, and the cardiac cycle was divided into 360 intervals. Regional phase angles were defined as the distance (in degrees) that regional minimum volume differed from global minimal LV volume (end-systole). RWMA decreased blood pressure (92 ± 2 mm Hg to 84 ± 3 mm Hg) and increased LV end-diastolic pressure (1.8 ± 0.5 mm Hg to 4.2 ± 0.8 mm Hg). RWMA delayed regional contraction (-2.9° ± 1.6° to 52.3° ± 1.5°) and decreased effective SV (2.3 ± 0.4 mL to 1.6 ± 0.3 mL) in the affected apical region but did not decrease maximal SV. Systemic infusion of dobutamine restored global LV function but failed to eliminate RWMA, as evidenced by decreased apical synchrony, effective SV, and stroke work. We concluded that systemic dobutamine restored global LV function but failed to correct RWMA.

 

应用血浆改良激活凝血时间监测体外循环肝素化:一项指导性研究

 The Plasma Supplemented Modified Activated Clotting Time for Monitoring of Heparinization During Cardiopulmonary Bypass: A Pilot Investigation

Andreas Koster, MD*, George Despotis, MD{ddagger}, Marcus Gruendel, MD*, Thomas Fischer, MD*, Michael Praus, MD{dagger}, Herman Kuppe, MD*, and Jerrold H. Levy, MD§

*Department of Anesthesia, Deutsches Herzzentrum, and {dagger}Institute of Pathobiochemistry and Clinical Chemistry, Charité, Campus Virchow, Berlin, Germany; {ddagger}Departments of Anesthesiology, Pathology, and Immunology, Washington University School of Medicine, St Louis, Missouri; and §Department of Cardiothoracic Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Anesth * Analg July 2002 95:26-30

 

 目的:经典的硅藻土或白陶土激活凝血时间(ACT)与体外循环中肝素水平无明显的相关性。我们对添加了血浆的改良白陶土激活凝血时间和未经稀释的白陶土激活凝血时间在体外循环中监测肝素水平的情况进行比较研究。方法:15位进行常温体外循环的患者参与该项前瞻性调查研究。通过Hepcon HMS (Medtronic, Minneapolis, MN)监测肝素水平,使用ACT II device (Medtronic)测定激活凝血时间。在体外循环过程中每间隔30分钟就进行一次肝素水平测算以及经典白陶土凝血时间和血浆改良白陶土凝血时间测定,改良的方法是将患者的血样与人血浆(Behring, Marburg, Germany)1:1稀释后进行测定。所得数据均以血浆显色抗Xa因子激活法the plasma chromogenic anti-Xa activity作为测定肝素水平的参照方法,对全部64份血样均进行评估。结果:血浆显色抗Xa因子激活法测出的肝素范围为0.2–5.5 IU/mLHepcon HMS计算肝素范围为2.7–8.2 IU/mL,经典激活凝血时间测定范围是424秒直至大于999秒,而改良激活凝血时间范围在210秒和801秒之间。经典激活凝血时间与血浆显色抗Xa因子激活法测定的肝素水平相关性r = 0.43,改良激活凝血时间与血浆显色抗Xa因子激活法测定的肝素水平相关性r = 0.69结论:改良激活凝血时间与运用显色的方法测量抗Xa因子激活程度有更多相关性。这种相关性很有可能是由于血液稀释和体外促凝物质消耗导致凝血系统损害而引起的。

(李 懿译   薛张刚校)

 The standard celite or kaolin activated clotting time (ACT) correlates poorly with heparin levels during cardiopulmonary bypass (CPB). We compared a modified kaolin ACT, in which plasma was supplemented, to a standard undiluted kaolin ACT for monitoring heparin levels during CPB. Fifteen patients undergoing normothermic CPB were enrolled in this prospective study. Heparin management was performed according to the Hepcon HMS results (Medtronic, Minneapolis, MN). The ACTs were performed with the ACT II device (Medtronic). Hepcon HMS calculations, standard kaolin ACTs, and plasma supplemented modified ACTs (mACTs), prepared by diluting blood samples 1:1 with human plasma (Behring, Marburg, Germany), were measured every 30 min during CPB. The data obtained were correlated to the plasma chromogenic anti-Xa activity as a reference assay for heparin levels. A total of 64 samples were evaluated. The chromogenic anti-Xa activity ranged from 0.2 to 5.5 IU/mL. The Hepcon HMS calculations ranged from 2.7–8.2 IU/mL of heparin, the standard ACT ranged from 424 to >999 s, and the mACT ranged from 210 to 801 s. The correlation to the chromogenic anti-Xa method was r = 0.43 for the standard kaolin ACT and r = 0.69 for the plasma mACT. The plasma mACT provided an improved correlation to chromogenically measured levels of anti-Xa activity during CPB. The improved correlation most likely results from a correction of the effects of the impairment of the coagulation system caused by hemodilution and consumption of procoagulants on extracorporeal surfaces.

 

七氟醚对健康和心肌病仓鼠交替性正性肌力作用

The Paradoxical Positive Inotropic Effect of Sevoflurane in Healthy and Cardiomyopathic Hamsters

Benoît Vivien, MD*, Jean-Stéphane David, MD{dagger}, Jean-Luc Hanouz, MD, PhD{ddagger}, Julien Amour, MD*, Yves Lecarpentier, MD, PhD§, Pierre Coriat, MD*, and Bruno Riou, MD, PhD*||

 *Laboratory of Experimental Anesthesiology, Department of Anesthesiology, Centre Hospitalier Universitaire (CHU) Pitié-Salpêtrière, Université Paris VI, Paris, France; {dagger}Department of Anesthesiology, CHU Edouard Herriot, Lyon, France; {ddagger}Department of Anesthesiology, CHU Côte de Nacre, Caen, France; §Department of Physiology, CHU de Bicêtre, and Institut National de la Santé et de la Recherche Médicale, Palaiseau, France; and ||Department of Emergency Medicine, CHU Pitié-Salpêtrière, Université Paris VI, Paris, France

Anesth & Analg July 2002 95:31-38

 

目的  比较七氟醚(0.7~3.6vol%)对健康和基因诱发心肌病仓鼠左室乳头肌的变力作用。方法  在体外(29,pH7.40,Ca2+2.5mM,刺激频率3/)低负荷(等张)和高负荷(等容)条件下,研究七氟醚对健康和基因诱发心肌病仓鼠左室乳头肌的变力作用。结果 七氟醚对健康仓鼠和心肌病仓鼠均产生中度正性肌力作用(3.6vol%七氟醚对健康仓鼠心肌产生的等张和等容最大缩短速率分别为115%±12%128%±21%P<0.01;而对心肌病仓鼠心肌产生的等张和等容最大缩短速率分别为115%±20%124%±31%P<0.05 。七氟醚产生的正性肌力作用在健康和心肌病仓鼠之间无差异。在应用α-肾上腺受体阻滞剂和β-肾上腺受体阻滞剂的情况下,七氟醚产生的正性肌力作用在二类仓鼠之间也无不同。在应用钙通道阻滞剂的情况下,七氟醚产生的正性肌力作用在健康仓鼠消失,而在心肌病仓鼠增强。而在低负荷和高负荷情况下,七氟醚对二种仓鼠均产生中度负性舒张作用。结论 七氟醚对健康和心肌病仓鼠产生矛盾的正性肌力作用。

王士雷译  庄心良校)

We investigated the effects of sevoflurane (0.7 to 3.6 vol%) on inotropy and lusitropy in left ventricular papillary muscles of healthy hamsters and genetically induced cardiomyopathic (strain BIO 14.6) hamsters in vitro (29°C, pH 7.40, Ca2+ 2.5 mM, stimulation frequency three per minute) under low (isotony) and high (isometry) loads. Sevoflurane induced a moderate positive inotropic effect in healthy hamsters (maximum unloaded shortening velocity and isometric active force at 3.6 vol%: 115% ± 12% and 128% ± 21% of baseline values, respectively; P < 0.01) and in cardiomyopathic hamsters (maximum unloaded shortening velocity and isometric active force at 3.6 vol%: 115% ± 20% and 124% ± 31% of baseline values, respectively; P < 0.05). This positive inotropic effect did not differ between healthy and cardiomyopathic hamsters, even when sevoflurane concentrations were corrected for minimum alveolar anesthetic concentration values in each strain, and was unchanged after {alpha}- and ß-adrenoceptor blockade. After calcium-channel blockade, this positive inotropic effect was abolished in healthy hamsters but enhanced in cardiomyopathic hamsters. In both strains, sevoflurane induced a moderate negative lusitropic effect under low and high loads.

 

Rapacuronium对麻醉儿童肺机械的影响:与美维松比较

The Effect on Lung Mechanics in Anesthetized Children with Rapacuronium: A Comparative Study with Mivacurium

Gavin F. Fine, MB, BCh*{ddagger}, Etsuro K. Motoyama, MD*{dagger}{ddagger}§, Barbara W. Brandom, MD*{ddagger}, Kathleen M. Fertal, BSN*, Rebecca Mutich, RRT{dagger}, and Peter J. Davis, MD*{ddagger}§

*Department of Anesthesiology and {dagger}Division of Pulmonology, Children’s Hospital of Pittsburgh; and the Departments of {ddagger}Anesthesiology and §Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:56-61

 

目的  使用Rapacuronium可增加急性支气管痉挛发生的危险。本文通过测定肺功能来直接证明应用Rapacuronium的儿童是否会出现气道收缩。方法  本实验选取10ASA-Ⅱ患者(2-6岁),随机均分为两组,分别给予Rapacuronium和美维松。用七氟醚进行麻醉诱导,持续输入雷米芬太尼(0.2-0.3ug.kg-1.min-1)和异丙酚(200-250 ug.kg-1.min-1)维持麻醉。每组进行三个阶段的肺功能测试:肺功能基线数据测定;应用肌松药后和应用β2-激动剂后肺功能的测定。两组相较,静息状态呼吸顺应性没有发生变化。应用Rapacuronium使总呼吸系统阻力增加,但没有统计学上的意义(为基线数值的214.4%±122.65%P0.1)。相反10%用力肺活量的最大呼气流量(MEF10)和由用力通气技术测定的流量-容积曲线中的MEF功能余气量(MEFFRC)均明显降低(分别为53.4%±18.49%P0.0141.3%±27.42%P0.001〉。美维松组中呼吸系统阻力没有发生变化(109.5%±30.28%)。MEF10轻微降低(77.0%±9.03%P0.005〉但是MEFFRC没有发生明显改变(81.2%±29.85%,无统计学意义)。给予β2-激动剂后,所有的监测指标均回到基线水平。结论 与美维松相较,使用Rapacuronium可引起较轻的气道阻塞同时对静态呼吸顺应性没有影响。

                                (赵雪莲译  庄心良校)

The administration of rapacuronium increases the risk of severe bronchospasm. There have been no studies of pulmonary function directly demonstrating airway constriction with rapacuronium in children. In this study, 10 ASA physical status I or II patients (aged 2–6 yr) were randomly divided into 2 equal groups, receiving either rapacuronium or mivacurium. Anesthesia was induced with sevoflurane and maintained with remifentanil (0.2~0.3 µg·kg-1·min-1)and propofol (200~250 µg· kg-1·min-1)infusions. We performed three sets of pulmonary function tests: baseline, after the administration of muscle relaxant, and after the administration of a ß2 agonist. In both groups, there were no changes in static respiratory compliance. The increase in total respiratory system resistance after the administration of rapacuronium did not reach statistical significance (214.4% ± 122.65% of baseline, P {approx}0.1), whereas maximal expiratory flow at 10% of forced vital capacity (MEF)10 and MEFfunctional residual capacity on partial flow-volume curves by the forced deflation technique decreased markedly (53.4% ± 18.49%, P < 0.01 and 41.3% ± 27.42%, P < 0.001, respectively). With the administration of mivacurium, no changes were observed in respiratory system resistance (109.5% ± 30.28%). MEF10 decreased slightly (77.0% ± 9.03%, P < 0.005) whereas MEFFRC did not (81.2% ± 29.85%, not significant). After the administration of a ß2 agonist, all measurements returned to baseline. Thus, the administration of rapacuronium consistently results in lower airway obstruction with minimal changes in static respiratory compliance when compared with mivacurium.

 

可弯曲支气管镜模拟器气道模拟器的的评估

An Evaluation of a Virtual Reality Airway Simulator

Richard Rowe, MD, MPH*, and Ronald A. Cohen, MD

Departments of *Anesthesiology and Diagnostic Imaging, Children’s Hospital Oakland, Oakland; and Departments of Anesthesiology and Radiology, University of California, San Francisco School of Medicine, San Francisco, California

Anesth & Analg July 2002 95:62-66.

 

   目的 在本研究中,我们测试AccuTough®可弯曲支气管镜模拟器(模拟器)的使用对临床医生掌握小儿纤支镜气管插管是否有用。方法 选择以往未用过纤支镜的小儿科住院医生。住院医生在全麻下对小儿行纤支镜插管。对插管录象带做以下分析研究:看到气管隆突的时间,支气管镜头端触及黏膜的次数和时间。然后在模拟器对住院医生进行训练。与下一个小儿的纤支镜插管进行比较。在两次间仅接受模拟器的训练。结果 对照组在两次插管间不接受模拟器的训练。住院医生使用模拟器练习了平均17次,耗时39分钟。在使用模拟器后操作明显改善。由支气管镜成功完成插管的时间从5.15分钟减少至0.88分钟(P<0.001)。支气管镜头端触及黏膜的次数由21.4减至3.0P<0.001)。看见黏膜的时间由2.29降至0.19分钟(P<0.001)。看见气道的次数百分比从58.5%增加至80.4%P=0.004)。结论 支气管镜模拟器对住院医生掌握纤支镜插管是有效的。它可显著提高完成气管插管和其他操作性能指标。

                                                   (周洁   王祥瑞校)

In this research, we sought to test the hypothesis that the AccuTouch® Flexible Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument for intubating the trachea of a pediatric patient. Pediatric residents with no prior experience in fiberoptic bronchoscopy were studied. Residents performed fiberoptic intubation on children undergoing general anesthesia. Tapes of these intubations were analyzed for: time to visualization of the carina, and number and time that the bronchoscope tip hit the mucosa. Residents were then trained on the Simulator. Performance of fiberoptic intubation on a subsequent child was compared. Training on the Simulator was the only instruction that the residents received between the two cases. A control group of residents performed two consecutive intubations without training on the Simulator between cases. Residents studied an average of 17 cases, and spent 39 min on the Simulator. Performance was markedly improved after the Simulator. Time to completion of successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min (P < 0.001). The number of times that the tip of the bronchoscope hit the mucosa was reduced from 21.4 to 3.0 (P < 0.001). The amount of time that the resident spent viewing the mucosa decreased from 2.24 to 0.19 min (P < 0.001). The percent of time viewing the channel of the airway increased from 58.5% to 80.4% (P = 0.004). This bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic intubation. Significant improvement was seen in time to completion of endotracheal intubation, as well as other performance indicators.

 

一种新的颞动脉温度监测器应用于成人和小儿病人效果不佳

 Insufficiency in a New Temporal-Artery Thermometer for Adult and Pediatric Patients

Mohammad-Irfan Suleman, MD*, Anthony G. Doufas, MD, PhD*, Ozan Akça, MD*, Michel Ducharme, PhD{dagger}, and Daniel I. Sessler, MD*{ddagger}

*Outcomes ResearchTM Institute and Department of Anesthesiology, University of Louisville, Kentucky; {dagger}Defence R&D Canada-Toronto, Canada; and {ddagger}Ludwig Boltzmann Institute, University of Vienna, Austria

Anesth & Analg July 2002 95:67-71

 

 目的:SensorTouch(TM) 是一种新的无创温度监测仪,它有一个红外线扫描仪可以探测前额皮肤最高温度,该温度假定为颞动脉温度,该设备可估计中心体温。研究时我们假定SensorTouch(TM)应用于临床是准确有效的。方法:我们研究了体外循环后发生低热(中心体温不超过37. 8℃)的病人,其中15例成人和16例小儿。在整个苏醒期每间隔15分钟分别用SensorTouch(TM)和直接(成人测肺动脉温度,小儿测膀胱温度)监测并记录一次温度。结果:在成人患者中肺动脉温度(Tcore)和 SensorTouch(TM)温度(Tst)相关性较差:Tcore0.7 Tst+13,r(2)=0.3。红外线测得温度与肺动脉温度相差超过1.3+/-0.6,因此89%的成人二者温度差异超过0.5。小儿患者中膀胱温度和红外线测得温度的相关性略好于成人患者:Tcore0.9 Tst+12,r(2)0.6。膀胱温度和红外线测得温度相差只有0.3,但差异的标准差为0.5,因此在31%婴幼儿中二者温度差异超过0.5℃。结论:我们研究了无创红外线前额温度监测仪SensorTouch(TM)应用于成人和小儿心脏手术病人的效果,其准确性在成人较差,婴幼儿则略好于成人。

(潘志浩译   薛张刚校)

 SensorTouchTM is a new noninvasive temperature monitor and consists of an infrared scanner that detects the highest temperature on the skin of the forehead, presumably over the temporal artery. The device estimates core temperature (Tcore). We tested the hypothesis that the SensorTouchTM is sufficiently precise and accurate for routine clinical use. We studied adults (n = 15) and children (n = 16) who developed mild fever, a core temperature of at least 37.8°C, after cardiopulmonary bypass. Temperature was recorded at 15-min intervals throughout recovery with the SensorTouchTM thermometer and from the pulmonary artery (adults) or bladder (children). Pulmonary artery (Tcore) and SensorTouchTM (Tst) temperatures correlated poorly in adults: Tcore = 0.7 · Tst + 13, r2 = 0.3. Infrared and pulmonary artery temperatures differed by 1.3 ± 0.6°C; 89% of the adult temperatures thus differed by more than 0.5°C. Bladder and infrared temperatures correlated somewhat better in pediatric patients: Tcore = 0.9 · Tst + 12, r2 = 0.6. Infrared and bladder temperatures in children differed by only 0.3°C, but the SD of the difference was 0.5°C. Thus, 31% of the values in the infants and children differed by more than 0.5°C.

 

门诊病人麻醉的知晓和回忆

Awareness and Recall in Outpatient Anesthesia

Johanna Wennervirta, MD*, Seppo O.-V. Ranta, MD*, and Markku Hynynen, MD, PhD{dagger}

*Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Children’s Hospital, Helsinki, Finland; and {dagger}Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland

 Anesth & Analg July 2002 95:72-77

 

目的  研究门诊病人麻醉知晓和回忆的发生率,并与住院病人进行比较。方法  14.5个月期间,我们调查了1500例门诊病人和2343例住院病人麻醉知晓和回忆的发生情况。结果  5例门诊病人出现麻醉知晓和回忆,其中1例为清晰回忆,另外4例为模糊回忆。而在住院病人中有6例出现麻醉知晓和回忆,其中清晰回忆和模糊回忆各占3例。门诊病人和住院病人清晰回忆的发生率分别为0.07%0.13%,经统计学处理无显著性差异。出现麻醉知晓和回忆的门诊病人应用七氟醚的量较无知晓和回忆者少(p0.05〉。结论  麻醉知晓和回忆是全麻期间少见的并发症,而门诊病人和住院病人相比,出现麻醉知晓和回忆的危险性并无增加。

(王士雷译  庄心良校)

We studied the incidence of awareness and explicit recall during general anesthesia in outpatients versus inpatients undergoing surgery. During a 14.5-mo period, we structurally interviewed 1500 outpatients and 2343 inpatients. Among outpatients, there were five cases of awareness and recall (one with clear intraoperative recollections and four with doubtful intraoperative recollections). Of the inpatients, six reported awareness and recall (three with clear and three with doubtful intraoperative recollections). The incidence of clear intraoperative recollections was 0.07% in outpatients and 0.13% in inpatients. The difference in the incidence was not significant. Among outpatients, those with awareness and recall were given smaller doses of sevoflurane than those without awareness and recall (P < 0.05). In conclusion, awareness and recall are rare complications of general anesthesia, and outpatients are not at increased risk for this event compared with inpatients undergoing general anesthesia.

 

α-7烟碱型乙酰胆碱受体对异氟醚的敏感性有赖受体失活态

Sensitivity of the α-7 Nicotinic Acetylcholine Receptor to Isoflurane May Depend on Receptor Inactivation

Pamela Flood, MD, FACA, and Kristen M. Coates, BS

Department of Anesthesiology, Columbia University, New York

Anesth & Analg July 2002 95:83-87

 

目的  我们曾经证实,当异氟醚的浓度达到640μM2倍的MAC)时,将会影响α-7烟碱型乙酰胆碱受体(α-7 nAChR)功能,而α-7nAChR广泛分布于中枢和外周神经系统,通过突触前和突触后方式影响突触信号传递,这样,异氟醚对α-7 nAChR 活性的调制可能是其主要麻醉机制之一。本次实验中,我们进一步研究异氟醚对α-7 nAChR 的药理作用特征。方法   应用分子生物学技术,利用爪蛙卵母细胞表达系统表达鸡和人的α-7 nAChR,用双电极电压钳技术,研究了不同的异氟醚预灌注时间、不同的激动剂浓度和不同的膜电位水平下异氟醚对α-7 nAChR 的抑制作用。结果   在一定的电生理条件下,临床相关浓度的异氟醚可抑制α-7 nAChR 活性。当激动剂浓度增高以及异氟醚预灌注时间延长时,抑制作用增强。在用异氟醚预灌注,用100μM乙酰胆碱激动受体的条件下,异氟醚对鸡nAChR 的半数最大抑制浓度为938± 26μM,而用1 mM乙酰胆碱浓度时,异氟醚对鸡nAChR  的半数最大抑制浓度为408±51μM结论  激动剂浓度增高以及异氟醚预灌注时间延长时,异氟醚对之抑制增强,此现象提示,异氟醚主要作用于nAChR  的通道关闭态或关闭-脱敏态。

(杨保仲译   庄心良校)

In previous studies, we demonstrated that nicotinic acetylcholine receptors (nAChRs) composed of the {alpha}7 subunit are unaffected by the co-application of isoflurane with agonists at concentrations up to 640 µM (two times the minimum alveolar anesthetic concentration). Modulation of {alpha}7-nAChR activity by isoflurane might have important behavioral ramifications because these receptors are expressed diffusely in the central and peripheral nervous systems and play pre- and postsynaptic roles in synaptic transmission. Here we have demonstrated that under some potentially physiologically relevant circumstances, the activation of {alpha}7 nAChRs may be inhibited by clinically relevant concentrations of isoflurane. We evaluated isoflurane inhibition of {alpha}7 nAChRs from chicks and humans expressed in Xenopus oocytes using two-electrode voltage clamp methodology. We determined the influence of time of preperfusion of isoflurane, agonist concentration, and membrane potential on inhibition by isoflurane. Both activation by a large concentration of agonist and isoflurane preperfusion increased inhibition. The half-maximal inhibitory concentration for isoflurane inhibition of chick {alpha}7 nAChR with isoflurane preperfusion and activation by 100 µM of acetylcholine was 938 ± 26, and when activated by 1 mM of acetylcholine, it was 408 ± 51 µM. The increase in inhibition with isoflurane preexposure and large agonist concentration raises the possibility that isoflurane interacts preferentially with a closed or closed-desensitized state of the channel.

 

电针刺激足三里,阳陵泉,昆仑三穴位并不减少麻醉药用量

Electro-Acupuncture at the Zusanli, Yanglingquan, and Kunlun Points Does Not Reduce Anesthetic Requirement

Nobutada Morioka, MD*,Ozan Akca, MD*, Anthony  G. Doufas, MD, PhD*, Gregory Chernyak, MD*, and Daniel I. Sessler, MD#

*Department of Anesthesiology, University Louisville, Kentueky. #Ludwig Boltzmann Institute,University of Vienna, Austria.

Anesth & Analg July 2002 95:98-102

 

     目的  本文试图验证电针刺激足三里,阳陵泉,昆仑三穴位可以减少麻醉药得用量。方法14位年轻,健康的志愿者,在不同两天内分别使用地氟醚麻醉。针状电极置于腿上此三穴位处,试图获得全身性的镇静和镇痛效应。在试验期内,电针穿透皮肤刺入此三穴位,而在对照期内则拔出。在受试期中经电极给予电刺激, 2秒的间隙交替给予强度为2Hz100Hz的刺激。当呼气末地氟醚浓度达到5.5%并稳定15分钟时,在双腿上由25号针给予持续1070mA100Hz的刺激。如受试者有动作则将地氟醚浓度升高0.5%,如试验者不动则将地氟醚浓度减少0.5%。判定受试者是否移动的调查者对治疗情况并不知情。这一上下调节浓度的试验将持续直至受试者从动到不动反复轮回4次。结果 经回归分析,将在电刺激时50%有移动的地氟醚浓度确认为地氟醚麻醉最低肺泡浓度。在电刺激组(4.6%±0.6%)与对照组(4.6%±0.8%)间,最低地氟醚肺泡麻醉浓度无明显差异(P=0.8)。结论 这些数据提示可检出组间差别为0.35容积百分比的概率为80%

                                               (忻纪华   王祥瑞校)

We tested the hypothesis that electro-acupuncture at the Zusanli, Yanglingquan, and Kunlun acupuncture points on the legs decreases anesthetic requirement. Fourteen young, healthy volunteers were anesthetized with desflurane on two separate days. Needle electrodes were positioned at the three acupuncture points thought to produce a generalized sedative and analgesic effect. Needles were percutaneously placed on treatment days; on control days, they were insulated and taped near the insertion points. The electrodes were stimulated on the treatment day. Stimulation consisted of 2-Hz and 100-Hz currents alternated at 2-s intervals. When the end-tidal desflurane concentration of 5.5% was stable for 15 min, noxious electrical stimuli were administered via 25-gauge needles on both thighs (70 mA at 100 Hz for 10 s). Desflurane concentration was increased 0.5% when movement occurred and decreased 0.5% when it did not. An investigator, blinded to treatment, determined movement. These up-and-down sequences were continued until volunteers crossed from movement to no movement four times. A logistic regression determined the partial pressure of desflurane that produced a 50% likelihood of movement in response to noxious stimulation and consequently identified the minimum alveolar anesthetic concentration equivalent for desflurane. There was no significant difference in minimum alveolar anesthetic concentration equivalents between the electro-acupuncture (4.6% ± 0.6%, mean ± SD) and control (4.6% ± 0.8%) days (P = 0.8). These data provided an 80% power for detecting a difference of 0.35 volume-percent between the groups.

 

地氟醚复合雷米芬太尼麻醉辅助小剂量氯胺酮可减少围术期阿片类镇痛药的用量

 Supplementing Desflurane-Remifentanil Anesthesia with Small-Dose Ketamine Reduces Perioperative Opioid Analgesic Requirements

Bruno Guignard, MD*, Carole Coste, MD*, Hélène Costes, MD*, Daniel I. Sessler, MD{dagger}, Claude Lebrault, MD*, William Morris, MD*, Guy Simonnet, MD{ddagger}, and Marcel Chauvin, MD*

*Department of Anesthesiology, Hôpital Ambroise Pare, Assistance Publique Hôpitaux de Paris, France; {dagger}Outcomes ResearchTM Institute and Department of Anesthesiology, University of Louisville, Kentucky and Ludwig Boltzmann Anesthesia Institute, University of Vienna, Austria; and {ddagger}Institut National de la Santé et de la Recherche Médicale (INSERM) U 259, Bordeaux, France

Anesth & Analg July 2002 95:103-108

 

目的:术中相对大剂量应用雷米芬太尼可能导致术后需用较多的镇痛药。术中应用NMDA(N甲基D天门冬氨酸)受体拮抗剂如氯胺酮可减少术后阿片药的用量。因此该研究中我们假定采用以雷米芬太尼为主麻醉的腹部大手术的术中应用小剂量氯胺酮可改善术后镇痛效果。方法:50例采用以雷米芬太尼为主麻醉行腹部手术的病人随机分为术中辅助应用氯胺酮组和生理盐水对照组。氯胺酮首剂量为0.15mg/kg,随后的维持量为2mg/kg/min。两组病人中,地氟醚维持于0.5MAC不变(不用N2O, 雷米芬太尼的输注速度根据自主神经反应滴定调节。所有病人均于手术结束前30分钟给予0.15mg/kg的吗啡,术后4小时记录疼痛评分及吗啡用量。结果:雷米芬太尼的用量氯胺酮组比对照组少(P<0.01)。疼痛评分在术后前15分钟对照组明显大于氯胺酮组,但在随后的时间里二者则相似。与对照组相比,术后第一个24小时内氯胺酮组病人需用吗啡的时间较晚(P<0.01)且用量较少,前者用量为69mg(四分位数间距为4187P<0.01),后者为46 mg(四分位数间距为3458mg),两组病人均没有发生精神症状。总之,雷米芬太尼为主的麻醉辅助小剂量的氯胺酮可减少术中雷米芬太尼和术后吗啡的用量且不增加不良反应的发生,所以术中小剂量的氯胺酮是雷米芬太尼的一个有效的辅助药。结论:雷米芬太尼为主的麻醉辅助小剂量的氯胺酮可减少术中雷米芬太尼和术后吗啡的用量,该研究显示NMDA受体拮抗剂如氯胺酮是术中雷米芬太尼的一个有效的辅助药。

(潘志浩译   薛张刚校)

 Relative large-dose intraoperative remifentanil could lead to the need for more postoperative analgesics. Intraoperative N-methyl-D-aspartate receptor antagonists, such as ketamine, decrease postoperative opioid use. We therefore tested the hypothesis that intraoperative small-dose ketamine improves postoperative analgesia after major abdominal surgery with remifentanil-based anesthesia. Fifty patients undergoing abdominal surgery under remifentanil-based anesthesia were randomly assigned to intraoperative ketamine or saline (control) supplementation. The initial ketamine dose of 0.15 mg/kg was followed by 2 µg · kg-1 · min-1. In both groups, desflurane was kept constant at 0.5 minimum alveolar anesthetic concentration without N2O, and a remifentanil infusion was titrated to autonomic responses. All patients were given 0.15 mg/kg of morphine 30 min before the end of surgery. Pain scores and morphine consumption were recorded for 24 postoperative h. Less of the remifentanil was required in the Ketamine than in the Control group (P < 0.01). Pain scores were significantly larger in the Control group during the first 15 postoperative min but were subsequently similar in the two groups. The Ketamine patients required postoperative morphine later (P < 0.01) and received less morphine during the first 24 postoperative h: 46 mg (interquartile range, 34–58 mg) versus 69 mg (interquartile range, 41–87 mg, P < 0.01). No psychotomimetic symptoms were noted in either group. In conclusion, supplementing remifentanil-based anesthesia with small-dose ketamine decreases intraoperative remifentanil use and postoperative morphine consumption without increasing the incidence of side effects. Thus, intraoperative small-dose ketamine may be a useful adjuvant to intraoperative remifentanil.

 

重症肌无力(MG)血清反应阳性和血清反应阴性病人对维库溴胺敏感性差异的研究

 Sensitivity to Vecuronium in Seropositive and Seronegative Patients with Myasthenia Gravis

Hironori Itoh, MD*, Keizo Shibata, MD{dagger}, and Shunichi Nitta, MD{ddagger}

Departments of *Anesthesiology and Intensive Care Medicine and {dagger}Emergency and Critical Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan; and {ddagger}Division of Anesthesia, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

Anesth & Analg July 2002 95:109-113

 

目的:MG病人对非去极化肌松药高度敏感。尽管MG病人常常可以检测到乙酰胆碱受体(AchR)的抗体,但是有1030%的病人检测不到抗AchR抗体。该研究我们假定血清反应阳性和血清反应阴性病人对维库溴胺敏感性相同,方法:我们研究血清反应阳性和血清反应阴性MG病人及非MG病人对维库溴胺敏感性(每组8例病人)。麻醉维持为2.5%七氟醚+60N2OO2,测定超强刺激拇内收肌后的颤搐张力监测神经肌肉传导。基线测定后静注10mg/kg维库溴胺,随后按此剂量增加直到阻滞深度达到90%。第一次静注10mg/kg后评价阻滞深度及起效时间,记录阻滞深度超过90%的用量。此外,单纯从数据上计算其50%和95%有效量。结果:与非MG病人相比,两种MG病人对维库溴胺的敏感性均增加。结论:在假定血清反应阳性和血清反应阴性病人对维库溴胺敏感性相同的前提下,我们研究了血清反应阳性和血清反应阴性MG病人及非MG病人对维库溴胺敏感性,实际上二者确实对维库溴胺敏感性相同。

(张俊峰译   薛张刚校)

Patients with myasthenia gravis (MG) are hypersensitive to nondepolarizing neuromuscular blocking drugs. Although antibodies to the acetylcholine receptor (AChR) often are observed in MG patients, 10% to 30% of patients do not show an anti-AChR antibody. Little is known about differences in sensitivity to nondepolarizing neuromuscular blocking drugs between MG patients with and without anti-AChR antibody. Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative MG patients and in non-MG patients (n = 8 each). During anesthesia with sevoflurane (2.5%) and nitrous oxide (60%) in oxygen, neuromuscular transmission was monitored by measuring the twitch tension of the adductor pollicis muscle with supramaximal stimulation. After baseline measurements, 10 µg/kg IV dose increments of vecuronium were administered sequentially until blockade exceeded 90%. The degree of blockade and onset time after the initial 10 µg/kg of vecuronium were assessed, and doses required to exceed 90% blockade were recorded. In addition, effective doses of 50% and 95% for vecuronium were calculated from a single data point. Both types of MG patients showed increased sensitivity to vecuronium compared with non-MG patients.

 

小剂量氯胺酮可改善术后病人抑郁状态

Small-Dose Ketamine Improves the Postoperative State of Depressed Patients

Akira Kudoh, MD*,Yoko Takahira, Hiroshi Katagai, MD, Tomoko Takazawa, MD

*Department of Anesthesiology, Hakodate Watanabe Hospital; and department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Aomori, Japan

Anesth & Analg July 2002 95:114-118.

 

目的 本研究探讨氯胺酮是否适宜于有抑郁状态整形外科手术病人。方法70名有抑郁情绪的成年病人和25名对照组(C组)。抑郁病人随机分为2组,麻醉诱导A组(n=35)用异丙酚,芬太尼及氯胺酮,B组(n=35)用异丙酚及芬太尼。所有病人吸入1.5%-2.0%异氟醚及笑气维持麻醉。结果 术前2Hamilton Depressed Rating(HDR)平均评分在A组为12.7±5.4B组为12.3±6.0。术后1AHDR评分为9.9±4.1B组为14.4±3.8。术后1AHDR评分显著低于B组(P<0.05)。CHDR评分在术前2天为4.2±1.7,术后1天为4.8±1.6。与B组相比,A组病人的抑郁情绪,自杀倾向,焦虑不安等有明显降低。A组病人麻醉后8小时(26.6±8.7)和16小时(24.9±8.2)的疼痛评分要显著低于B组病人8小时(34.3±12.0)和16小时(31.1±8.8)的疼痛评分(P<0.05)。结论 小剂量氯胺酮可以改善抑郁病人术后的抑郁状态,并减轻其术后疼痛。

                                            (忻纪华译 王祥瑞校)

We investigated whether ketamine is suitable for depressed patients who had undergone orthopedic surgery. We studied 70 patients with major depression and 25 patients as the control (Group C). The depressed patients were divided randomly into two groups; patients in Group A (n = 35) were induced with propofol, fentanyl, and ketamine and patients in Group B (n = 35) were induced with propofol and fentanyl, and all patients were maintained with 1.5%–2.0% isoflurane plus nitrous oxide. The mean Hamilton Depression Rating (HDR) score was 12.7 ± 5.4 for Group A and 12.3 ± 6.0 for Group B 2 days before surgery and 9.9 ± 4.1 for Group A and 14.4 ± 3.8 for Group B 1 day after surgery. The HDR score in Group A 1 day after surgery was significantly (P < 0.05) lower than that in Group B. The HDR score in Group C was 4.2 ± 1.7 2 days before surgery and 4.8 ± 1.6 1 day after surgery. Depressed mood, suicidal tendencies, somatic anxiety, and hypochondriasis significantly decreased in Group A as compared with Group B. Postoperative pain scores in Group A at 8 and 16 h after the end of anesthesia were 26.6 ± 8.7 and 24.9 ± 8.2, respectively, which were significantly (P < 0.05) lower than 34.3 ± 12.0 and 31.1 ± 8.8 in Group B. In conclusion, small-dose ketamine improved the postoperative depressive state and relieved postoperative pain in depressed patients.

                                                     

琥珀胆碱能安全用于高钾血症的病人吗?

Can Succinylcholine Be Used Safely in Hyperkalemic Patients?

Adam J. Schow, MD*, David A. Lubarsky, MD, MBA{dagger}, Ronald P. Olson, MD*, and Tong J. Gan, MB*

 *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and {dagger}Department of Anesthesiology, University of Miami/Jackson Medical Center, Florida Anesth & Analg July 2002 95:119-122

 

背景 尽管现在还没有系统的资料确定血钾处于何种水平是安全的,高钾血症常被认为是琥珀胆碱的相对禁忌证。目的 研究在患有高钾血症的病人中应用琥珀胆碱是否安全。方法  回顾性地调查了超过四万例诱导时使用了琥珀胆碱的全麻病人,时间跨度超过70个月。结果  其中38人术前血清钾浓度超过5.6 mEq/L。这些病人的麻醉生存率是100%。通过人工调查以及检查术中自动生成的麻醉记录和术后病程记录均未发现有心律不齐或其它严重并发症的记载。经过统计处理,95%可信区间最大风险率是7.9%。当然这个比例是不容忽视的。但是这个数据几乎可以肯定高估了中等程度的高钾血症的危险。结论  欲通过前瞻性研究确定高钾血症的安全范围是困难的。所以现有的这些数据表明,在需要紧急插管又不能有长时间肌肉麻痹的情况下,对于中等高钾血症的病人,应用琥珀胆碱还是安全的。

                                       (颜涛译  庄心良校)

The use of succinylcholine in hyperkalemic patients (serum potassium >5.5 mEq/L) is often viewed as relatively contraindicated, although there are no systematic data to define what preoperative potassium level is safe. We retrospectively reviewed more than 40,000 general anesthetics administered over 70 mo in which succinylcholine was given at the induction. This search yielded 38 patients with a preoperative potassium of 5.6 mEq/L or greater. Survival of the anesthetic was 100%, and no dysrhythmias or other major morbidity were documented upon manual review of the intraoperative automated record keeper charts or the patient medical records. These data allow a 95% confidence interval assessment of maximal risk for an event of 7.9%, which is not negligible, but which almost certainly grossly overestimates the risk for patients with moderately increased potassium levels. A prospective trial to definitively assess the safety margin for succinylcholine use in hyperkalemic patients would be difficult. Therefore, these data, taken in the context of a compelling case for rapid intubating conditions without long-term paralysis, suggest safety in succinylcholine use in patients with modest hyperkalemia.

 

压缩气筒动力的机械通气对麻醉管理和效率可能有不良影响

 E-Cylinder-Powered Mechanical Ventilation May Adversely Impact Anesthetic Management and Efficiency

Andreas H. Taenzer, MD*, Pete G. Kovatsis, MD{dagger}, and Kenneth L. Raessler, MD*

*Department of Anesthesiology, Maine Medical Center, Portland, Maine; and {dagger}Harvard Medical School and Children’s Hospital, Boston, Massachusetts

 Anesth & Analg July 2002 95:148-150

 

目的:麻醉医师经常在手术室外处理病人,这些地方可能只有氧气筒而没有中心供氧,应用满的压缩气筒,我们确定两种情况的氧耗----这是经常用空气动力的麻醉通气器时要回答的三个问题:当中心供氧缺乏或管道故障时机械通气病人能维持多少时间?通气器需多少氧气来驱动皮囊?如何改变吸呼比和吸入流量来影响氧的应用?方法和结果:5L/min通气时,我们发现用E-筒来驱动通气器时如新鲜气流为1-10L/min可供氧气的浓度为59%-85%。出现低氧报警的时间为38-99min。改变吸入流量而不是吸呼比有显著的影响。结论:临床医师必须意识到用压缩气筒机械通气会迅速的消耗这唯一的氧源并且危及病人的安全。相反用低流量的新鲜气体手控或自主呼吸可以将氧耗减到最少。

(张德林   薛张刚校

 Anesthesiologists often administer care outside the operating room. These locations may depend on gas cylinders for their oxygen source more than the operating suites supplied by dedicated central pipelines. Using full E-cylinders, we determined the oxygen consumption of two often used, pneumatically driven anesthesia ventilators to answer three questions: How much time is available when mechanically ventilating patients in the setting of absent or malfunctioning central oxygen pipeline? How much oxygen is used by the ventilator to drive the bellows? How does changing the inspiratory to expiratory ratio and the inspiratory flow (Narkomed ventilator only) influence oxygen use? At a ventilation of 5 L/min, we found that mechanical ventilation consumes between 59% and 85% of the available oxygen in an E-cylinder to drive the ventilator at fresh gas flows ranging from 1 to 10 L/min. The time span until the low oxygen alarm sounded ranged from 38 to 99 min. Alteration of the inspiratory flow but not the inspiratory to expiratory ratio had a significant impact. Clinicians must recognize that mechanical ventilation using E-cylinders rapidly depletes this sole oxygen source and could jeopardize patient safety. Conversely, manual or spontaneous ventilation with low fresh gas flows minimizes oxygen depletion.

 

对妇科术前和术后疼痛评估的一种有效可靠的新方法

A New Highly Reliable Instrument for the Assessment of Pre- and Postoperative Gynecological Pain

Elisabet Stener-Victorin,RPT,PhD*, Jan Kowalski, BS, and Thomas Lundeberg,MD,PhD

瑞典歌德堡大学妇产科学系;斯德哥尔摩Karolinska学会生理学和药理学分会;瑞典斯德哥尔摩Karolinska医院药剂

Anesth & Analg July 20002 95:151-157.

    目的  在本文中我们在短小妇科手术中对一项新的疼痛评估方法的可靠性进行验证。方法这一方法建立在疼痛匹配对知觉匹配比较基础上。另外,对使用两种不同麻醉方法——电刺激或快速阿片类药物如阿芬太尼,两组同时合用宫颈旁阻滞,在术前和术后2小时使用疼痛匹配和VAS评分进行疼痛评估。有223名女病人(22-38岁)参与了这一测试。结果 疼痛匹配是一种可靠的疼痛评估方法。有个别病人不愿意参加此项测试,但这并不影响本文结果的统计学意义。扩大的阶梯程序(rank-order coefficient,ra)系数值十分理想(0.95-1.00)。当刻度用于探知疼痛状态的改变时,并没有明显的迹象显示有何反应。这可能主要是由于数据统计时无法顾及个别的情况。由于个别情况导致的差异在疼痛匹配测量时要小于VAS评分。总而言之,我们发现疼痛匹配是一种很好的测量疼痛的方法,其结果可靠,反复测量时差异比VAS评分小。结论 病人能很好地接受疼痛匹配测量,这在测量急性术前和术后疼痛时是非常有用的。

                                                   (忻纪华   王祥瑞校)

In this study, we evaluated the reliability of a newly developed method for pain assessment, which is based on perceptual matching by Pain Matcher®, Cefar Medical AB, Lund, Sweden, during minor gynecological surgery. In addition, the responsiveness to two different anesthetic methods—electro-acupuncture or a fast-acting opiate, alfentanil, both in combination with a paracervical block—was estimated by using Pain Matcher and visual analog scale (VAS) assessments before and 2 h after surgery. Two hundred-twenty-three women (aged 22–38 yr) participated. The results show that Pain Matcher is a reliable method for pain assessments, with lack of random individual disagreement and with no statistical evidence of systematic disagreement in position or in concentration. The augmented rank-order coefficient (ra) values were excellent (0.95–1.00). When scales were used to detect true changes over time, there was no clear indication of responsiveness, mostly because of statistically significant random individual changes. However, the individual changes were much smaller for magnitude matching than for VAS. In conclusion, we would recommend the use of perceptual matching by Pain Matcher for pain assessment, because in this study it was a reliable and powerful in test-retest situations and had smaller individual changes than VAS after intervention. The Pain Matcher procedure was well accepted by the patients, and the results suggest that it may be useful when evaluating acute pre- and postoperative pain.

 

腹式全子宫切除术后于腹膜内和切口应用布比卡因加肾上腺素的镇痛效应

The Analgesic Effects of Intraperitoneal and Incisional Bupivacaine with Epinephrine After Total Abdominal Hysterectomy

A.Ng, FRCA*, A. Swami, FFARCSI*, G. Smith, MD, FRCA*, A.C. Davidson, FRCOG, and J. Emembolu, FRCOG

*University Department of Anaesthesia, Critical Care, and Pain Management, and Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom

Anesth & Analg July 2002 95:158-162

 

目的 本研究观察腹式全子宫切除术后于腹膜内和切口应用布比卡因加肾上腺素产生的镇痛效应。方法 46ASAI-II级的病人接受常规麻醉,术毕行病人自控吗啡以及每6小时经直肠给予扑热息痛1g镇痛。病人被随机分为两组,一组给予50ml 0.25%布比卡因复合5ug/ml肾上腺素;另一组给予50ml生理盐水作为对照组。在关闭伤口前将其中30ml应用于腹膜内,另外20ml应用于切口。结果 安慰剂组的17例病人和布比卡因组的16例病人分别完成了本研究。部分病人没有完成本研究是因为PCA故障、PCA中止太早、恶心、胸部感染、放置了腹腔内引流管以及违反协议。两组病人在年龄、身高、体重或手术时间方面无明显差异。清醒状态下安慰剂组的病人活动后疼痛明显比布比卡因组病人强烈。安慰剂组病人24小时吗啡用量为62mg (53-85mg),而布比卡因组为44mg (33-56mg) (p<0.01)讨论 两组24h吗啡用量明显差异主要是因为安慰剂组病人在术后第一个4小时内的吗啡用量较大。结论 腹式全子宫切除术后于腹膜内和切口应用布比卡因加肾上腺素,在第一个4小时具有明显镇痛效果,可明显减少吗啡用量。

                                                         (齐波   王祥瑞校)

The objective of our study was to see if incisional and intraperitoneal bupivacaine with epinephrine produces analgesia after total abdominal hysterectomy. Forty-six ASA physical status I and II patients received a standardized anesthetic, patient-controlled analgesia (PCA) morphine, and rectal paracetamol 1 g every 6 h. Patients were randomized to receive 50 mL of bupivacaine 0.25% with epinephrine 5 µg/mL or 50 mL of normal saline. Thirty milliliters and 20 mL of treatment solution were administered into the peritoneum and incision, respectively, before wound closure. Seventeen and 16 patients in the Placebo and Bupivacaine groups, respectively, completed the study. The reasons for withdrawal were PCA malfunction, PCA discontinued too early, nausea, chest infection, intraabdominal drain insertion, and protocol violation. There were no significant differences between the Bupivacaine and Placebo groups in age, height, weight, or duration of surgery. Pain on movement was significantly more intense in the Placebo group than in the Bupivacaine group on awakening. Morphine consumption (interquartile range) over 24 h was 62 mg (53–85 mg) in the Placebo group compared with 44 mg (33–56 mg) in the Bupivacaine group (P < 0.01). This significant difference was attributable to the larger morphine consumption in the Placebo group in the first 4 postoperative h. We conclude that a combination of intraperitoneal and incisional bupivacaine with epinephrine provides significant morphine-sparing analgesia for 4 h after total abdominal hysterectomy.

 

抗抑郁药的抗伤害效应与单胺受体有关的研究 

An Investigation of Monoamine Receptors Involved in Antinociceptive Effects of Antidepressants

Fumiko Yokogawa, MD*, Yuji Kiuchi, MD, PhD{dagger}, Yuji Ishikawa, MS{dagger}, Naoki Otsuka, MD, PhD*, Yutaka Masuda, MD, PhD*, Katsuji Oguchi, MD, PhD{ddagger}, and Akiyoshi Hosoyamada, MD, PhD*

*Department of Anesthesiology and {ddagger}First Department of Pharmacology, School of Medicine, and {dagger}Department of Pathophysiology, School of Pharmaceutical Sciences, Showa University, Tokyo, Japan

Anesth & Analg July 2002 95: 163-168 

 

目的:在于确定那一单胺受体亚型与抗抑郁药诱导的抗伤害效应极为相关。方法:采用福尔马林试验评价其对大鼠的抗伤害效应。抗抑郁药通过作为norepinephrine的再摄取(nisoxetine,nortriptyline and maprotiline)的强效抑制剂或抑制norepinephrine 5HT(imipramine,milnacipran)的再摄取产生其剂量依赖性抗伤害效应。腹腔内同时注射抗抑郁药及哌唑嗪(α1受体拮抗剂)或ketanserin(5HT2受体拮抗剂)明显显著拮抗其抗伤害效应。Fluvoxamine(选择性5HT再摄取抑制剂)诱导的抗伤害效应比其它的抗抑郁药要弱,并且被ketanserin显著拮抗,不被哌唑嗪拮抗。恩胆西酮(5HT3受体拮抗剂)显著拮抗由10mg/kg imipramine诱导产生的抗伤害效应。与之相比,SDZ-205,5575HT4受体拮抗剂)显著增强由小剂量imipramine2.5mg/kg)诱导的抗伤害效应。imipramine诱导的抗伤害效应被脑室内注射哌唑嗪或ketanserin显著拮抗,但不被育亨宾碱(α2受体拮抗剂)或恩胆西酮所拮抗,而被脑室内注射SDZ-205,557所显著增强。结果:显示脑内的α1肾上腺能受体和5HT2受体与抗抑郁药诱导的抗伤害效应有关。此外,该结果表明抗抑郁药诱导的抗伤害效应的机制在于去甲肾上腺能神经元与5HT能神经元之间的功能相互作用。结论:应用抗抑郁药及单胺受体拮抗剂处理的大鼠福尔马林试验显示α1肾上腺能受体、5HT2受体及5HT3受体与抗抑郁药诱导的抗伤害效应有关,并且其可能机制在于去甲肾上腺能神经元与5HT能神经元之间的功能相互作用。

(张俊峰译   薛张刚校)

 We attempted to determine which monoamine re-ceptor subtypes are predominantly involved in antidepressant-induced antinociception. Antinociceptive effects were evaluated by using formalin tests with rats. Antidepressants acting as potent inhibitors of norepinephrine reuptake (nisoxetine, nortriptyline, and maprotiline) or inhibiting reuptake of both norepinephrine and serotonin (5-HT) (imipramine and milnacipran) induced dose-dependent antinociception. Simultaneous intraperitoneal administration of antidepressants and either prazosin ({alpha}1 antagonist) or ketanserin (5-HT2 antagonist) significantly antagonized antinociceptive effects. Fluvoxamine (selective serotonin reuptake inhibitor) induced antinociception less potently than other antidepressants and was significantly antagonized by ketanserin, but not prazosin. Ondansetron (5-HT3 antagonist) significantly antagonized antinociception by 10 mg/kg of imipramine. In contrast, SDZ-205,557 (5-HT4 antagonist) markedly enhanced antinociception by small-dose (2.5 mg/kg) imipramine. Imipramine-induced antinociception was significantly antagonized by intracerebroventricular administration of prazosin or ketanserin, but not by yohimbine ({alpha}2 antagonist) or ondansetron, and was significantly enhanced by intracerebroventricularly administered SDZ-205,557. These findings suggest that {alpha}1 adrenoceptors and 5-HT2 receptors in the brain are involved in antidepressant-induced antinociception. In addition, the results suggested functional interactions between noradrenergic and serotonergic neurons as mechanisms for antidepressant-induced antinociception.

 

单极和双极气管内电极用于电刺激通气

Electroventilation with Monopolar and Bipolar Intratracheal Electrodes

Zachary W. Sopcak, MSBME, L. A. Geddes, PhD, Kirk S. Foster, BSEE, William E. Schoenlein, BS, and Joe D. Bourland, PhD

Purdue University Department of Biomedical Engineering, West Lafayette, Indiana

 Anesth & Analg July 2002 95:189-191

 

目的 电刺激通气(electroventilation)是一种通过精心放置于体表或体内的电极给予吸气肌电刺激以产生吸气动作的技术。本研究分析使用单极和双极气管内电极进行电刺激通气的有效性。方法 选择7只狗为实验对象。置放单极和双极气管内电极进行电刺激通气,记录自发的潮气量和刺激所需电流及吸气量。结果 使用双极电极可以使所有7只狗的吸气量均大于自发的潮气量,但是使用单极电极仅能使其中3只吸气量增大。使用气管内电极产生单次潮气量所需电流比体表电极小,且电极置放比使用食道内电极方便。实验结果显示双极电极可以被用来进行电刺激通气。结论 本研究说明电刺激通气可以使用气管内电极,所需刺激电流比使用体表电极减小。气管内电极通气有两种方式:一种是单极式,其返回电极位于体表;另一种是双极式,其返回电极位于气管内。

(葛圣金译  庄心良校)

Electroventilation is the technique of producing inspiration with stimuli applied to inspiratory muscles by using strategically placed electrodes on or within the body. We conducted studies using the dog to determine the efficacy of monopolar and bipolar intratracheal electrodes for electroventilation. Bipolar electrodes were able to produce an inspired volume greater than a spontaneous tidal volume in all seven dogs, but monopolar electrodes were able to in only three of seven dogs. The intratracheal electrode has the advantage over body-surface electrodes that less current is required to produce a single tidal volume, and it has the advantage over intraesophageal electrodes that anatomical placement of the electrode is simplified. These experiments demonstrated that a bipolar electrode can be used for electroventilation.

 

建立压力-控制模式时气管导管逐渐阻塞时潮气量变化的模型

Modeling the Effect of Progressive Endotracheal Tube Occlusion on Tidal Volume in Pressure-Control Mode

Avery Tung, MD*, and Sherwin E. Morgan, RRT{dagger}

Departments of *Anesthesia and Critical Care and {dagger}Respiratory Therapy, University of Chicago, Chicago, Illinois

Anesth & Analg July 2002 95:192-197

 

目的  因气道分泌物可在气管导管(ETT)内的沉积,长期使用气管插管的主要的危险是气道逐渐阻塞。在使用容积-控制的呼吸机时,监测峰值和平台期的气道压差有助于查觉ETT阻塞的形成。然而在压力-控制的呼吸机,吸气时的气道压是预先设定的,因此不能作为报警指标,取而代之是以潮气量的变化帮助判断ETT的堵塞。本文采用数学方式模拟在逐渐增加气道阻力时压力-控制模式呼吸机的反应,进而验证监测潮气量是否能有效的发现进展中的气道阻塞。方法 为了确证作者的模型,作者采用实验肺和内径由9.0mm3.5mm的气管导管(模拟逐渐阻塞的气道)检测西门子 300型和Puritan-Bennett 7200型呼吸机。结果 作者发现当使用压力-控制模式时,直到气道几近完全阻塞,潮气量才降低。结论 作者认为长期使用压力-控制呼吸模式,会导致ETT发生明显阻塞而不能发觉,有发生气管完全阻塞的危险,同时用此通气模式使患者围术期的处理变复杂。

                                          (赵雪莲译  庄心良校)

A recognized hazard of prolonged endotracheal intubation is progressive airway occlusion resulting from deposition of secretions on the inner surface of the endotracheal tube (ETT). When volume-controlled ventilation is used, progressive ETT occlusion may be detected by monitoring the difference between peak and plateau airway pressures. In pressure-controlled modes, however, inspiratory airway pressures are preset and thus cannot act as a warning indicator. Instead, changes in delivered tidal volumes may aid the diagnosis of ETT occlusion. To determine whether tidal volume monitoring effectively de-tects progressive ETT occlusion, we mathematically modeled the response of a ventilator operating in pressure-controlled mode to increasing airway resistance. To corroborate our model, we then bench-tested the Siemens 300 and Puritan-Bennett 7200 ventilators by using a test lung and a series of ETTs ranging in size from 9.0 to 3.5 mm inner diameter to simulate progressive occlusion. We found that when pressure-controlled mode was used, progressive ETT occlusion did not reduce delivered tidal volumes until occlusion was nearly complete. We conclude that prolonged use of pressure-controlled mode may allow significant ETT obstruction to build up undetected, risking complete ETT occlusion and complicating the perioperative care of patients ventilated with this mode.

 

腰麻能引起产妇听力丧失吗?

 Does Spinal Anesthesia Cause Hearing Loss in the Obstetric Population?

Helene Finegold, MD, Gordon Mandell, MD, Manuel Vallejo, MD, and Sivam Ramanathan, MD

Magee-Women’s Hospital, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Anesth & Analg July 2002 95:198-203

 

目的:在老年病人中因腰穿使脑脊液漏出可引起听力减退。因此,我们假设蛛网下腔阻滞(SAB)可使听力丧失。我们估价SAB对择期行剖宫产的产妇的影响。方法:我们比较两种类型的穿刺针:铅笔尖穿刺针(24Sprotte针)和切割式的穿刺针(25Quincke针)。60个病人分成三组:20个产妇接受硬膜外阻滞进行分娩镇痛(控制组),20个产妇接受SAB24Sprotte针)和20个产妇接受SAB25Quincke针)行剖宫产术。在产妇接受125-, 250-, 500-, 1000-, 2000-, 4000-, 8000-Hz频率声音后应用音调听力计测定她们的分贝水平。在麻醉前、分娩后、手术后第一天、第二天分别进行听力测试。用方差的重复测量分析,P < 0.05为差异显著。结果:表明不管是在高频还是低频测定中三组都没有产妇听力丧失。结论:应用铅笔尖穿刺针(24Sprotte针)和切割式的穿刺针(25Quincke针)行腰麻不会引起明显听力丧失。

(嵇富海译   薛张刚校)

 Lumbar puncture is believed to cause hypoacousis by causing cerebrospinal fluid leakage in older individuals. We hypothesized that parturients undergoing subarachnoid block (SAB) may experience hearing loss. We evaluated the effects of SAB on hearing in parturients undergoing elective cesarean delivery. We also compared two types of spinal needles: a pencil-point needle (24-gauge Sprotte needle) and a cutting needle (25-gauge Quincke needle). Sixty patients were studied: 20 received lumbar epidural block for labor analgesia (controls), 20 received a SAB with a Sprotte needle, and 20 others received a SAB with a Quincke needle for cesarean delivery. A tone audiometer was used to test for that decibel level at which the patient heard 125-, 250-, 500-, 1000-, 2000-, 4000-, and 8000-Hz frequencies. The hearing test was performed before anesthesia, after delivery, and on the first and second postoperative days. The results were analyzed by using repeated-measures analysis of variance at P < 0.05. No patient from any of the three groups developed a hearing loss either at low or high frequencies. Spinal anesthesia does not lead to significant hearing loss when a pencil- or a cutting-point needle is used in the obstetric population.

 

硬膜外应用布比卡因和罗哌卡因分娩镇痛的相对运动神经阻滞效能

The Relative Motor Blocking Potencies of Epidural Bupivacaine and Ropivacaine in Labor

Héctor J. Lacassie, MD*, Malachy O. Columb, FRCA, Héctor P. Lacassie, MD, and Rodrigo A. Lantadilla, MD*

*Anesthesiology Department, Pontificia Universidad Católica de Chile; and Anesthesiology Service, Clínica Alemana, Santiago, Chile; and South Manchester University Hospital, Withington, United Kingdom

Anesth & Analg July 20002 95:204-208.

 

目的 最小局麻药浓度(MLAC)已用于评价硬膜外应用布比卡因和罗哌卡因的镇痛效能。目前尚无此类药物运动神经阻滞效能的报道。本研究主要观察两种药物在MLAC时的运动神经阻滞效能和两种药物的相对效能比。方法 60ASA I-II 级的产妇被随机分为两组,在第一产程分别给予两组产妇布比卡因或罗哌卡因20ml单次剂量。每一组第一个产妇所给药物的浓度为0.35%,其余产妇的药物浓度在0.35%的基础上依次递增或递减一个实验间隔剂量0.025%。在30分钟内Bromage评分<4则认为是有效的运动神经阻滞。结果 应用DixonMassey分析产妇药物浓度的上-下顺序,并用概率回归量化运动神经阻滞的最小局麻药浓度。两方面均于P<0.05时有明显差异。结果 布比卡因的运动神经阻滞的最小局麻药浓度为0.326%(95%可靠区间[CI]0.285-0.367),罗哌卡因为0.497%(95%CI0.431-0.563) (p=0.0008)。布比卡因/罗哌卡因效能比为0.66 (95%CI0.52-0.82)结论 本文首次评估布比卡因和罗哌卡因运动神经阻滞效能MLAC,罗哌卡因的运动神经阻滞效能较低,仅为布比卡因的66%

                                                 (齐波   王祥瑞校)

Minimal local analgesic concentrations (MLAC) have been used to determine the epidural analgesic potencies of bupivacaine and ropivacaine. There are no reports of the motor blocking potencies of these drugs. We sought to determine the motor block MLAC of both drugs and their relative potency ratio. Sixty ASA physical status I and II parturients were randomized to one of two groups, during the first stage of labor. Each received a 20-mL bolus of epidural bupivacaine or ropivacaine. The first woman in each group received 0.35%. Up-down sequential allocation was used to determine subsequent concentrations at a testing interval of 0.025%. Effective motor block was defined as a Bromage score <4 within 30 min. The up-down sequences were analyzed by using the Dixon and Massey method and probit regression to quantify the motor block minimal local analgesic concentration. Two-sided P < 0.05 defined significance. The motor block minimal local analgesic concentration for bupivacaine was 0.326% (95% confidence interval [CI], 0.285–0.367) and for ropivacaine was 0.497% (95% CI, 0.431–0.563) (P = 0.0008). The ropivacaine/bupivacaine potency ratio was 0.66 (95% CI, 0.52–0.82). This is the first MLAC study to estimate the motor blocking potencies of bupivacaine and ropivacaine. Ropivacaine was significantly less potent for motor block, at 66% that of bupivacaine.

                                                    

 

坐骨神经阻滞前路法的新标志:影像学和临床研究

New Landmarks for the Anterior Approach to the Sciatic Nerve Block: Imaging and Clinical Study

Alain C. Van Elstraete, MD*, Claude Poey, MD{dagger}, Thierry Lebrun, MD*, and Frédéric Pastureau, MD*

Departments of *Anesthesiology and {dagger}Radiology, Saint-Paul Medical Center, Fort de France, Martinique, France

Anesth & Analg July 2002 95:214-218

 

目的 评价腹股沟褶皱和股动脉作为前路坐骨神经阻滞解剖标志的可靠性并确定此路径时腿的理想位置。方法 临床研究前先进行一项影像学研究,以两种定位方法对20例行脚踝和足部手术的病人行坐骨神经阻滞:一为腿中间位,一为腿外旋位,病人均为仰卧位。使用一支连接神经刺激器的22150mm长斜角针从离腹股沟褶皱2.5cm远,距股动脉2.5cm远处向后侧方向与垂直面成10~15度角方向进针。结果 腿在中间位时,所有病人的坐骨神经阻滞点定位于10.6±1.8cm深度,而腿外旋位时则是10.4±1.5cm(无显著差别)。腿中间位和外旋位时,确定解剖标志的时间分别是28±15s26±14s(无显著差别)。确定坐骨神经阻滞的时间分别为79±53s46±25s (p<0.006)。我们确定腹股沟褶皱和股动脉是前路坐骨神经阻滞的可靠及有效的解剖标志,理想的体位是腿外旋位。结论 以腹股沟褶皱和股动脉作为进行坐骨神经阻滞的标志是一项简便和可靠的技术。

                                            (焦志华译  庄心良校)

In this study, we assessed the reliability of the inguinal crease and femoral artery as anatomic landmarks for the anterior approach to the sciatic nerve and determined the optimal position of the leg during this approach. An imaging study was conducted before the clinical study. The sciatic nerve was located twice in 20 patients undergoing ankle or foot surgery, once with the leg in the neutral position and once with the leg in the externally rotated position. The patient was lying supine. A 22-gauge, 150-mm insulated b-beveled needle connected to a nerve stimulator was inserted 2.5 cm distal to the inguinal crease and 2.5 cm medial to the femoral artery and was directed posteriorly and laterally with a 10°–15° angle relative to the vertical plane. The sciatic nerve was located in all patients at a depth of 10.6 ± 1.8 cm when the leg was in the neutral position and 10.4 ± 1.5 cm when the leg was in the externally rotated position (not significant). In the neutral position and in the externally rotated position, the time needed to identify anatomic landmarks was 28 ± 15 s and 26 ± 14 s, respectively (not significant), and the time needed to locate the sciatic nerve was 79 ± 53 s and 46 ± 25 s (P < 0.006), respectively. We conclude that the inguinal crease and femoral artery are reliable and effective anatomic landmarks for the anterior approach to the sciatic nerve and that the optimal position of the leg is the externally rotated position.

 

小剂量地塞米松减少腹腔镜胆囊切除术后的恶心呕吐:同Tropisetron 比较

 Small-Dose Dexamethasone Reduces Nausea and Vomiting After Laparoscopic Cholecystectomy: A Comparison of Tropisetron with Saline

Jhi-Joung Wang, MD, DMS*, Shung-Tai Ho, MD, MS{dagger}, Yih-Huei Uen, MD{ddagger}, Mao-Tsun Lin, PhD*, Kuan-Ting Chen, MD*, Jeng-Chai Huang, PhD*, and Jann-Inn Tzeng, MD*

Departments of *Anesthesiology and {ddagger}Surgery, Chi-Mei Medical Center, Tainan, Taiwan; and {dagger}Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Anesth & Analg July 2002 95:229-232

 

目的:地塞米松是一有效的抗恶心呕吐药,但小剂量地塞米松(5毫克)对腹腔镜胆囊切除术后的恶心呕吐(PONV)的预防效果尚未估价。因此,我们估价小剂量地塞米松(5毫克)对腹腔镜胆囊切除术后的恶心呕吐的预防效果。Tropisetron和生理盐水作为对照组。方法:120个择期行腹腔镜胆囊切除术的病人进行随机、双盲、安慰剂控制的研究。麻醉诱导后,地塞米松组静注地塞米松5mgTropisetron组静注Tropisetron2mg,安慰剂组接受静注生理盐水。结果:我们发现地塞米松和Tropisetron明显减少下面的参数:总的PONV发生率下降(P < 0.01),超过4次呕吐经历(P < 0.05),病人接受其他抗呕吐药的比例(P < 0.05)。地塞米松和Tropisetron组无明显差异。结论:我们认为预防性静注地塞米松5mg明显降低腹腔镜胆囊切除术后的恶心呕吐。地塞米松5mgTropisetron2mg一样有效,比安慰剂有效的多。

(嵇富海译   薛张刚校)

 Dexamethasone is an effective antiemetic drug, but the efficacy of small-dose dexamethasone 5 mg on the prophylaxis of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic chole-cystectomy has not been evaluated. We, therefore, evaluated the prophylactic effect of small-dose dexamethasone (5 mg) on PONV in patients undergoing laparoscopic cholecystectomy. Tropisetron and saline served as controls. One-hundred-twenty patients scheduled for laparoscopic cholecystectomy were enrolled in a randomized, double-blinded, placebo-controlled study. At the induction of anesthesia, the Dexamethasone group received IV dexamethasone 5 mg, the Tropisetron group received IV tropisetron 2 mg, and the Pla- cebo group received IV saline. We found that both dexamethasone and tropisetron significantly decreased the following variables: the total incidence of PONV (P < 0.01), more than four vomiting episodes (P < 0.05), and the proportions of patients requiring rescue antiemetics (P < 0.05). The differences between the Dexamethasone and Tropisetron groups were not significant. We conclude that prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing laparoscopic cholecystectomy. At this dose, dexamethasone is as effective as tropisetron 2 mg and is more effective than placebo.

 

降低吸入笑气浓度后对双腔管支气管套囊迅速放气的研究

Rapid Deflation of the Bronchial Cuff of the Double-Lumen Tube After Decreasing the Concentration of Inspired Nitrous Oxide

Fujio Karasawa, MD, Akira Takita, MD, Isao Takamatsu, MD, Tomohisa Mori, MD, Takashi Oshima, MD, and Yasushi Kawatani, MD

Department of Anesthesiology, National Defense Medical College, Saitama, Japan

Anesth & Analg July 2002 95:238-242.

 

目的 麻醉中吸入笑气(N2O)浓度减小后气管内套囊可发生放气现象,本文研究双腔管(DLT)套囊的放气现象。方法 随机挑选24例行胸外科手术的病人,并随机分为三组,采用Mallinckrodt双腔管(Athlone, Ireland),在双腔管的气管套囊和左支气管套囊内分别充满空气、40%N2O67%N2O(分别命名为空气组、N40组和N67)40分钟后,将N40组部分病人套囊内的N2O改为O2(命名为N40-c)。测定套囊内气体容积、N2O浓度和套囊顺应性。结果空气组病人的气管和支气管套囊的压力明显增大,而N67组减小。N40组无明显改变,但N40-c组病人在笑气麻醉结束后,气管和支气管套囊的压力均降低。支气管套囊压力减小一半所需时间(12.0+_5.5min)要短于气管套囊压力减小一半所需时间(31.2+_11.0min , P<0.01)N40-c组病人的气管套囊和支气管套囊的容积变化无显著差异,但气管套囊的顺应性明显高于支气管套囊。结论 在应用67%N2O进行麻醉时,如采用40%N2O充填DLT套囊可稳定套囊压力,在终止应用N2O后,因为支气管套囊的顺应性小,因此比气管套囊放气更加快。

                                              (忻纪华   王祥瑞校)

Deflationary phenomena of the endotracheal tube cuff may occur after inspired nitrous oxide (N2O) concentrations are reduced, but deflationary phenomena of the double-lumen tube (DLT) cuff have not been investigated. In this study, tracheal and bronchial cuffs of left-sided Mallinckrodt (Athlone, Ireland) DLTs were inflated with air, 40% N2O, or 67% N2O (Air, N40, or N67 groups, respectively) in 24 patients undergoing thoracic surgery; 40 min later, O2 was substituted for N2O in some of the patients in the N40 group (N40-c group). Intracuff gas volumes, N2O concentrations, and cuff compliance were also measured. Both tracheal and bronchial cuff pressures significantly increased in the Air group but decreased in the N67 group. Neither pressure significantly changed in the N40 group, but both decreased in the N40-c group after terminating N2O anesthesia; the time required for bronchial cuff pressures to decrease by half (12.0 ± 5.5 min) was less than that for tracheal cuff pressures (31.2 ± 11.0 min, P < 0.01). The volume change in the N40-c group was not significantly different between the tracheal and bronchial cuffs, but tracheal cuff compliance was significantly higher than bronchial compliance. Therefore, filling DLT cuffs with 40% N2O stabilizes cuff pressure during anesthesia with 67% N2O, but bronchial cuffs deflate more quickly than tracheal cuffs after cessation of N2O administration through smaller compliance.

                                                  

N2O麻醉时气管套囊重复放气以稳定套囊内压力

Repeated Deflation of a Gas-Barrier Cuff to Stabilize Cuff Pressure During Nitrous Oxide Anesthesia

Fujio Karasawa, MD, Nobuhiro Matsuoka, MD, Mitsuyoshi Kodama, MD, Tomohiro Okuda, MD, Tomohisa Mori, MD, and Yasushi Kawatani, MD

Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan

Anesth & Analg July 2002 95:243-248

 

目的 评价N2O麻醉中气管套囊重复放气时装有N2O阻挡器的气管导管套囊是否较标准的气管导管套囊能更有效地稳定套囊内压力。方法 分别测量67%N2O麻醉(每组8人)中充满气体的标准型气管套囊和装有N2O阻挡装置的软塞形气管内套囊(PSSC)压力。起初的3-4小时内,气囊每隔3060分钟放气一次。结果 吸气3小时后,两组中半数以上病人的气管套囊压力超过22mmHg。而两组中吸气4小时的气管套囊在放气间隔期的最大压力已经降低(p<0.01),气管套囊内N2O浓度增高(p<0.001)。重复放气4小时后,两组病人在接下来的3小时中气管套囊压力再也不超过22mmHg,套囊内N2O浓度也无明显变化。因此,N2O麻醉时4小时内重复放气可有效稳定两组气囊压力和平衡气囊内N2O浓度。但是PSSC没有减少放气时间去稳定压力。结论 N2O麻醉中气管套囊从2小时充气到4小时时,装有N2O阻挡器的软塞气囊中N2O浓度和压力逐渐稳定,且因为需要放气的次数较少,软塞形气管套囊将比标准气管套囊更方便应用于临床。

(焦志华译  庄心良校)

Although a nitrous oxide (N2O) gas-barrier cuff effectively limits the increase of cuff pressure during N2O anesthesia, there are few data assessing whether an N2O gas-barrier cuff is more beneficial for stabilizing intracuff pressure than standard endotracheal tubes when cuffs are repeatedly deflated to stabilize pressure during N2O anesthesia. In the present study, the pressure of air-filled standard-type cuffs (Trachelon; Terumo, Tokyo, Japan) and N2O gas-barrier type endotracheal tube cuffs (Profile Soft-Seal Cuff [PSSC]; Sims Portex, Kent, UK) was measured during 67% N2O anesthesia (n = 8 in each), during which the cuffs were repeatedly deflated every 30 min (Trachelon) or 60 min (PSSC) for the first 3 or 4 h. After aspirating the cuffs for 3 h, the cuff pressure exceeded 22 mm Hg in more than half of the patients in both groups. However, aspiration of the cuffs for 4 h decreased the maximal cuff pressure between deflation intervals in both groups (P < 0.01 for each), and increased the intracuff N2O concentration (P < 0.0001 for each). After deflating the cuffs over 4 h, the cuff pressure in both groups never exceeded 22 mm Hg during the subsequent 3 h, and intracuff N2O concentrations did not significantly change. Therefore, deflation of cuffs for 4 h during N2O anesthesia sufficiently stabilized cuff pressure and equilibrated the intracuff N2O concentrations in both groups. The use of the PSSC endotracheal tube might be more practical because of the smaller number of cuff deflations required, but the PSSC does not reduce the duration of cuff deflations to stabilize the pressure.