Anesthesia & Analgesia

August 2002

Table of Content

CARDIOVASCULAR ANESTHESIA

正常体温和浅低温心肺转流使肝和内脏氧合受损以及血浆透明质增加

(颜涛 译  庄心良校)

Impairment of Hepatosplanchnic Oxygenation and Increase of Serum Hyaluronate During Normothermic and Mild Hypothermic Cardiopulmonary Bypass

Nobuhiro Okano, MD*, Sotaro Miyoshi, MD*, Ryoichi Owada, MD*, Nao Fujita, MD*, Yuji Kadoi, MD, Shigeru Saito, MD, Fumio Goto, MD, and Toshihiro Morita, MD*

*Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Saitama, Japan; and Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Gunma, Japan

Anesth Analg 2002;95:278-286

骨科大手术中抑肽酶对安慰剂:一项随机,双盲,剂量范围研究

(张俊峰译 薛张刚校)

Aprotinin Versus Placebo in Major Orthopedic Surgery: A Randomized, Double-Blinded, Dose-Ranging Study

Charles Marc Samama, MD PhD*, Olivier Langeron, MD, Nadia Rosencher, MD, Xavier Capdevila, MD PhD, Patricia Rouche, MD||, Michel Pegoix, MD, Josée Bernière, MD#, and Pierre Coriat, MD for the Hémorragies et Aprotinine en Chirurgie Orthopédique Lourde Study Group

常温体外循环时平均动脉压增加不影响胰岛素依赖病人的颈静脉氧饱和度

(张俊峰译 薛张刚校)

Increasing Mean Arterial Blood Pressure Has No Effect on Jugular Venous Oxygen Saturation in Insulin-Dependent Patients During Tepid Cardiopulmonary Bypass

Yuji Kadoi, MD*, Shigeru Saito, MD*, Daisuke Yoshikawa, MD*, Fumio Goto, MD*, Nao Fujita, MD, and Fumio Kunimoto, MD

术中心动过速和高血压与非心脏手术后的长期预后独立影响因素

(忻纪华 译    王祥瑞 校)

Intraoperative Tachycardia and Hypertension Are Independently Associated with Adverse Outcome in Noncardiac Surgery of Long Duration

David L. Reich, MD, Elliott Bennett-Guerrero, MD, Carol A. Bodian, DrPH, Sabera Hossain, MSc, Wanda Winfree, RN, and Marina Krol, PhD

Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York

Anesth Analg 2002;95:273-277

成人脊柱手术中,乳酸林格氏液大量静脉内灌注后的术后早期呼吸性酸中毒

(忻纪华 译    王祥瑞 校)

Early Postoperative Respiratory Acidosis After Large Intravascular Volume Infusion of Lactated Ringers Solution During Major Spine Surgery

Arzu Takil, MD, Zeynep Eti, MD, Pinar Irmak, MD, and F. Yilmaz Göü, MD

Department of Anesthesiology, Medical Faculty of Marmara University, Istanbul, Turkey

Anesth Analg 2002;95:294-298

PEDIATRIC ANESTHESIA:

心电图指导下婴幼儿经尾入路胸部硬膜外置管

(王士雷 摘  庄心良校)

Thoracic Epidural Catheter Placement Via the Caudal Approach in Infants by Using Electrocardiographic Guidance

Ban C. H. Tsui, MSC MD, FRCP(C), R. Seal, MD FRCP(C), and J. Koller, MD FRCP(C)

Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada

Anesth & Analg August 2002 95:326-330

 

AMBULATORY ANESTHESIA:

腕部神经阻滞可增加门诊腕管手术病人术中心血管稳定性并提早出院时间

(潘志浩译薛张刚校)

Distal Nerve Blocks at the Wrist for Outpatient Carpal Tunnel Surgery Offer Intraoperative Cardiovascular Stability and Reduce Discharge Time

Ralf E. Gebhard, MD, Tameem Al-Samsam, MD, Jennifer Greger, MD, Ahmad Khan, MD, and Jacques E. Chelly, MD PhD, MBA

ANESTHETIC PHARMACOLOGY:

吸入麻醉药和非去极化类肌肉松弛药在神经肌肉接头部位的相互作用特征

(杨保仲 译  庄心良校)

Characterization of the Interactions Between Volatile Anesthetics and Neuromuscular Blockers at the Muscle Nicotinic Acetylcholine Receptor

Matthias Paul, MD DEAA*, Ralf M. Fokt*, Christoph H. Kindler, MD DEAA, Natalie C. J. Dipp, and C. Spencer Yost, MD*

*Department of Anesthesia and Perioperative Care, University of California, San Francisco; Department of Anesthesia, Kantonsspital, Basel, Switzerland; and University of Cologne, Germany

Anesth Analg 2002;95:362-367

 

高血压患者应用美维松的心血管效应

(赵雪莲    庄心良校)

The Cardiovascular Effects of Mivacurium in Hypertensive Patients

Benoît Plaud, MD*, Jean Marty, MD, Bertrand Debaene, MD, Claude Meistelman, MD, Daniel Pellissier, MD||, Jean-Yves LePage, MD, Pierre Feiss, MD#, Philippe Scherpereel, MD**, Marie-Noëlle Bouverne, MSc, and Sandrine Fosse, MSc

*Department of Anesthesiology and Intensive Care, Fondation Adolphe de Rothschild, Paris, France; Department of Anesthesiology and Intensive Care, Hôpital Beaujon, Université Paris VII, Clichy, France; Department of Anesthesiology and Intensive Care, Centre Hospitalier Regional Universitaire de Poitiers, Poitiers, France; Department of Anesthesiology and Intensive Care, Hôpitaux de Brabois, Centre Hospitalo-Universitaire de Nancy, Nancy, France; ||Department of Anesthesiology and Intensive Care, Hôpital La Timone, Marseille, France; Department of Anesthesiology and Intensive Care, CHRU de Nantes, Nantes, France; #Department of Anesthesiology and Intensive Care, CHRU de Limoges, Limoges, France; **Department of Anesthesiology and Intensive Care, CHRU de Lille, Lille, France; and GlaxoSmithKline Laboratories, Marly-le-Roi, France

Anesth Analg 2002;95:379-384

口服α2受体激动剂Tizannidine降低成人七氟醚的最小肺泡浓度

(张军 译  庄心良 校)

Oral Tizanidine, an 2-Adrenoceptor Agonist, Reduces the Minimum Alveolar Concentration of Sevoflurane in Human Adults

Zenichiro Wajima, MD PhD, Tatsusuke Yoshikawa, MD PhD, Akira Ogura, MD PhD, Kazuyuki Imanaga, MD, Toshiya Shiga, MD PhD, Tetsuo Inoue, MD PhD, and Ryo Ogawa

Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; Department of Anesthesia, Hakujikai Memorial Hospital, Tokyo, Japan; Department of Anesthesiology, Tokyo Jikeikai Medical School, Tokyo, Japan; Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and ||Department of Anesthesiology, Nippon Medical School, Tokyo, Japan

Anesth Analg 2002;95:393-396

第二代血液替代品Perflubron Emulsion增加体外试验中现代吸入麻醉药的血溶性

(潘志浩译薛张刚校)

A Second-Generation Blood Substitute (Perflubron Emulsion) Increases the Blood Solubility of Modern Volatile Anesthetics In Vitro

Olivier Y. Cuignet, MD*, Philippe M. Baele, MD, and Luc J. Van Obbergh, MD PhD

确定乳腺癌前哨淋巴结时的Isosulfan Blue Dye反应

(嵇富海译  薛张刚校)

Isosulfan Blue Dye Reactions During Sentinel Lymph Node Mapping for Breast Cancer

Leslie L. Montgomery, MD*, Alisa C. Thorne, MD, Kimberly J. Van Zee, MS MD*, Jane Fey, MPH*, Alexandra S. Heerdt, MD MPH*, Mary Gemignani, MD*, Elisa Port, MD*, Jeanne Petrek, MD*, Hiram S. Cody, III, MD*, and Patrick I. Borgen, MD*

*Breast Service, Department of Surgery, and Department of Anesthesia, Memorial Sloan-Kettering Cancer Center, New York, New York

Anesth Analg 2002;95:385-388

氟化物和低温对体内咪库溴胺代谢影响

嵇富海译  薛张刚校)

The Effect of Fluoride and Hypothermia on the In Vitro Metabolism of Mivacurium

Michael Gruber, PhD, Regina Lindner, Christopher Prasser, MD, and Gunther Wiesner, MD

Department of Anesthesiology, University of Regensburg, Regensburg, Germany

Anesth Analg 2002;95:397-399

麻醉药的静电相互作用对N-乙酰胆碱受体的影响

(朱辉       王祥瑞 校)

The Role of Electrostatic Interactions in Governing Anesthetic Action on the Torpedo Nicotinic Acetylcholine Receptor

Douglas E. Raines, MD*, and Robert J. Claycomb, BS

*Department of Anesthesia, Harvard Medical School; and Massachusetts General Hospital, Boston, Massachusetts

Anesth Analg 2002;95:356-361

咪唑安定的非γ-氨基丁酸介导的促使c-FosEGR-1的表达

(朱辉       王祥瑞 校)

Midazolam Induces Expression of c-Fos and EGR-1 by a Non-GABAergic Mechanism

Kazuhiko Fukuda, MD, Takehiro Shoda, MD, Hiroyuki Mima, MD, and Hisatoshi Uga, MD

Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan

Anesth Analg 2002;95:373-378

 

在异丙酚麻醉中使用阿托品对心率的影响

(周洁       王祥瑞 校)

Heart Rate Response to Intravenous Atropine During Propofol Anesthesia

Takashi Horiguchi, MD, and Toshiaki Nishikawa, MD

Department of Anesthesia, Akita University School of Medicine, Akita, Japan

Anesth Analg 2002;95:389-392

PAIN MEDICINE:

硬膜外类固醇药物的注入技术:一项全国性问卷调查

(周洁       王祥瑞 校)

The Technical Aspects of Epidural Steroid Injections: A National Survey

Robert Cluff, MD, Abdel-Kader Mehio, MD, Steven P. Cohen, MD, Yuchiao Chang, PhD, Christine N. Sang, MD MPH*, and Milan P. Stojanovic, MD

*Clinical Trials Program and Interventional Pain Program, MGH Pain Center; and Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Anesth Analg 2002;95:403-408

CRITICAL CARE AND TRAUMA:

咪哒唑仑对模拟急救医疗运输服务过程中应激水平的影响:安慰剂对照的、剂量效应研究

(焦志华译 庄心良校)

The Effect of Midazolam on Stress Levels During Simulated Emergency Medical Service Transport: A Placebo-Controlled, Dose-Response Study

Volker Dörges, MD*, Volker Wenzel, MD, Susanne Dix, BS, Alexander Kühl, BSThomas Schumann, BS, Michael Hüppe, PhD,Heiko Iven, PhD,  and Klaus Gerlach, MD

*Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel; Departments of Anesthesiology, and Pharmacology, Medical University of Lübeck, Germany; and Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

Anesth Analg 2002;95:417-422

比较0.1%0.2%罗比卡因和布比卡因加吗啡用于大的腹部手术后的术后镇痛。

(张德林译 薛张刚校)

A Comparison of 0.1% and 0.2% Ropivacaine and Bupivacaine Combined with Morphine for Postoperative Patient-Controlled Epidural Analgesia After Major Abdominal Surgery

Marc Senard, MD, Jean L. Joris, MD PhD, Didier Ledoux, MD, Pierre J. Toussaint, MD, Benoît Lahaye-Goffart, MD, and Maurice L. Lamy, MD

Department of Anesthesia and Intensive Care Medicine, CHU de Liège, D Anesth Analg 2002;95

omaine du Sart-Tilman, Belgium

 

比较异丙酚和右美托咪定在术中镇静中的作用、副作用和恢复特性

(李懿 译  薛张刚校)

The Efficacy, Side Effects, and Recovery Characteristics of Dexmedetomidine Versus Propofol When Used for Intraoperative Sedation

Shahbaz R. Arain, MD, and Thomas J. Ebert, MD PhD

Department of Anesthesiology, Medical College of Wisconsin and VA Medical Center, Milwaukee, Wisconsin

Anesth Analg 2002;95:461-466

NEUROSURGICAL ANESTHESIA:

硬膜外穿刺后鼠模型观察硬膜外注射血液和其他药液时颅内血流调节机制

(张德林译 薛张刚校)

The Mechanisms of Intracranial Pressure Modulation by Epidural Blood and Other Injectates in a Postdural Puncture Rat Model

Jeffrey S. Kroin, PhD, Subhash K.S. Nagalla, MD, Asokumar Buvanendran, MD

Department of Anesthesiology, Rush Medical College at Rush-Presbyterian-St. Lukes Medical Center, Chicago, Illinois

Anesth Analg 2002;95

 

三种麻醉技术应用于幕上颅内手术病人的比较

(齐波 译   王祥瑞 校)

A Comparison of Three Anesthetic Techniques in Patients Undergoing Craniotomy for Supratentorial Intracranial Surgery

Pekka Talke, MD, James E. Caldwell, MBChB, Ronald Brown, BS, Barbara Dodson, MD, Joan Howley, MD, and Charles A. Richardson, PhD

Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California

Anesth Analg 2002;95:430-435

OBSTETRIC ANESTHESIA:

鞘内和硬膜外注射吗啡用于择期剖宫产术后镇痛的对比研究

(王士雷 摘  庄心良 校)

A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

J. Sarvela, MD PhD, P. Halonen, MD, A. Soikkeli, MD, and K. Korttila, MD PhD, FRCA

Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland

Anesth & Analg August 2002 95: 436-440

REGIONAL ANESTHESIA:

应用前臂或上臂止血带实施利多卡因-酮咯酸静脉局部麻醉镇痛效能的对比研究

(葛圣金译  庄心良校)

An Evaluation of the Analgesic Efficacy of Intravenous Regional Anesthesia with Lidocaine and Ketorolac Using a Forearm Versus Upper Arm Tourniquet

Scott S. Reuben, MD*, Robert B. Steinberg, MD PhD*, Holly Maciolek, RN*, and Poornachandran Manikantan, MD*

 

Department of Anesthesiology, *Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts

Anesth & Analg August 2002 95: 457-460

腹腔镜胆囊切除术后通过导管向胆囊窝内间断注射0.5%布比卡因的镇痛研究

(齐波 译   王祥瑞 校)

Postoperative Pain Relief Using Intermittent Injections of 0.5% Ropivacaine Through a Catheter After Laparoscopic Cholecystectomy

Anil Gupta, MD FRCA, PhD*, Sven E. Thörn, MD PhD*, Kjell Axelsson, MD PhD*, Lars G. Larsson, MD, Göran Ågren, MD, Björn Holmström, MD PhD*, and Narinder Rawal, MD PhD*

Departments of *Anesthesiology and Intensive Care, Surgery, and Division for Ambulatory Surgery, University Hospital, Örebro, Sweden

Anesth Analg 2002;95:450-456

硬膜外/全麻复合麻醉和硬膜外术后镇痛对腹腔镜或开腹结直肠手术病人的肠道功能恢复和体温调节的影响

(殷文渊 译   王祥瑞 校)

Temperature Control and Recovery of Bowel Function After Laparoscopic or Laparotomic Colorectal Surgery in Patients Receiving Combined Epidural/General Anesthesia and Postoperative Epidural Analgesia

Giorgio Danelli, MD*, Marco Berti, MD*, Valeria Perotti, MD*, Andrea Albertin, MD*, Paolo Baccari, MD, Francesco Deni, MD*, Guido Fanelli, MD*, and Andrea Casati, MD*

*Department of Anesthesiology and Emergency Surgery, Vita-Salute University of Milano, IRCCS H.S. Raffaele, Milano, Italy

Anesth Analg 2002;95:467-471

GENERAL ARTICLES:

围术期胃排空不能预测经腹腔镜胆囊切除术后早期恶心呕吐的发生

(颜涛 译  庄心良 校)

Perioperative Gastric Emptying Is Not a Predictor of Early Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

M. Wattwil, MD PhD*, S.-E. Thörn, MD PhD*, A Lövqvist*, L. Wattwil*, H. Klockhoff, MD, L.-G. Larsson, MD, and I. Näslund, MD PhD

Departments of *Anesthesiology and Intensive Care and Surgery, Örebro University Hospital, Örebro; and Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden

Anesth Analg 2002;95:476-479

比较应用喉镜和Lightwand气管插管装置 (Trachlight®)两者行成人正常气道气管内插管的血流动力学反应

(李懿 译 薛张刚校)

Hemodynamic Responses to Tracheal Intubation with Laryngoscope Versus Lightwand Intubating Device (Trachlight®) in Adults with Normal Airway

Shinji Takahashi, MD*, Taro Mizutani, MD, Masayuki Miyabe, MD*, and Hidenori Toyooka, MD*

Departments of *Anesthesiology and Critical Care Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan

Anesth Analg 2002;95:480-484

Abstracts

 

正常体温和浅低温心肺转流使肝和内脏氧合受损以及血浆透明质增加

Impairment of Hepatosplanchnic Oxygenation and Increase of Serum Hyaluronate During Normothermic and Mild Hypothermic Cardiopulmonary Bypass

Nobuhiro Okano, MD*, Sotaro Miyoshi, MD*, Ryoichi Owada, MD*, Nao Fujita, MD*, Yuji Kadoi, MD, Shigeru Saito, MD, Fumio Goto, MD, and Toshihiro Morita, MD*

*Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Saitama, Japan; and Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Gunma, Japan

Anesth Analg 2002;95:278-286

目的  研究心肺转流期间和转流后内源性透明质酸(一种敏感的反映SEC功能的指示剂)的血浆动力学以及肝-内脏的氧合情况。方法  在心肺转流下行择期冠状动脉搭桥手术的25病人,其中15位为正常体温心肺转流(>35℃),10位为浅低温心肺转流(32)。每例病人都放置肝静脉导管以监测肝-内脏氧合情况及血浆透明质酸浓度。结果  正常体温或浅低温体外循环下肝静脉血氧饱和度的下降程度相似。在正常体温心肺转流期间肝-内脏氧耗和氧的提取量都增加(P<0.05),但是在浅低温心肺转流期间则没有变化。两组病人的动脉和肝静脉血透明质酸浓度在心肺转流中和转流后都升高了3倍。结论  在心肺转流期间,动脉血透明质酸浓度和肝-内脏氧耗量之间存在正相关,提示肝-内脏氧代谢在血浆透明质酸浓度升高的机制中起作用。肝脏丧失了提高对透明质酸的提取能力强烈提示肝血窦内皮细胞功能损害可能是血浆透明质酸浓度升高的原因                  

                                       (颜涛 译  庄心良 校)

Hepatic sinusoidal endothelial cells (SECs) are more vulnerable to hypoxia or hypothermia than hepatocytes. To test the hypothesis that hepatic venous desaturation during cardiopulmonary bypass (CPB) leads to impairment of SEC function, we studied the plasma kinetics of endogenous hyaluronate (HA), a sensitive indicator of SEC function, and hepatosplanchnic oxygenation during and after CPB. Twenty-five consecutive patients scheduled for elective coronary artery bypass graft surgery, who underwent normothermic (>35°C; n = 15) or mild hypothermic (32°C; n = 10) CPB participated in this study. A hepatic venous catheter was inserted into each patient to monitor hepatosplanchnic oxygenation and serum levels of HA concentration. Hepatic venous oxygen saturation decreased essentially to a similar degree during normothermic and mild hypothermic CPB. Hepatosplanchnic oxygen consumption and extraction increased during normothermic (P < 0.05), but not mild hypothermic, CPB. Both arterial and hepatic venous HA concentrations showed threefold increases during and after CPB in both groups. A positive correlation was found between hepatosplanchnic oxygen consumption and arterial HA concentrations during CPB, suggesting a role of changes in hepatosplanchnic oxygen metabolism in the mechanisms of increases in serum HA concentrations. The failure of the liver to increase HA extraction to a great degree suggests that a functional impairment of the SEC may contribute to the observed increase of serum HA.

 

骨科大手术中抑肽酶对安慰剂:一项随机,双盲,剂量范围研究

Aprotinin Versus Placebo in Major Orthopedic Surgery: A Randomized, Double-Blinded, Dose-Ranging Study

Charles Marc Samama, MD PhD*, Olivier Langeron, MD, Nadia Rosencher, MD, Xavier Capdevila, MD PhD, Patricia Rouche, MD||, Michel Pegoix, MD, Josée Bernière, MD#, and Pierre Coriat, MD for the Hémorragies et Aprotinine en Chirurgie Orthopédique Lourde Study Group

    我们进行的前瞻性,多中心,双盲,剂量范围研究比较了骨科大手术后大剂量和小剂量抑肽酶以及安慰剂的风险/效益比。58例病人随机分为三组: 大剂量抑肽酶组(术前4 百万KIU负荷剂量随后持续输注1百万KIU/小时直到手术结束),小剂量组(2百万 KIU 负荷 加0.5 百万 KIU/小时),以及安慰剂组。测量和计算出血量。双侧顺行静脉造影在术后第三天系统地进行。大剂量抑肽酶组测定和计算的血液丧失减少(计算出血量,全血量, 压积 30%, 均数 [范围], 2,023 mL [6334,113];安慰剂组, 3,577 mL [1,67021,758 mL])。异体和自体输血的总量在大剂量抑肽酶组也显著减少 (2 U [05 U]; 安慰剂组, 4 U [042 U]) 抑肽酶组观察到的深静脉血栓和肺栓塞没有增加。大剂量抑肽酶在骨科大手术后安全、有效地显著减少了测定和计算的出血量和输用的红细胞单位。结论:大剂量抑肽酶在骨科大手术后减少了失血和输血量。(张俊峰译 薛张刚校)

We conducted a prospective, multicenter, double-blinded, dose-ranging study to compare the risk/benefit ratio of large- and small-dose aprotinin with placebo after major orthopedic surgery. Fifty-eight patients were randomized into three groups: Large-Dose Aprotinin (4 M kallikrein inactivator unit [KIU] bolus before surgery followed by a continuous infusion of 1 M KIU/h until the end of surgery), Small-Dose Aprotinin (2 M KIU bolus plus 0.5 M KIU/h), and Placebo. Bleeding was measured and calculated. Bilateral ascending venography was systematically performed on the third postoperative day. Measured and calculated blood loss decreased in the Large-Dose Aprotinin group (calculated bleeding, whole blood, hematocrit 30%, median [range], 2,023 mL [6334,113] as compared with placebo, 3,577 mL [1,67021,758 mL]). The total number of homologous and autologous units was also significantly decreased in the Large-Dose Aprotinin group (2 U [05 U] as compared with placebo, 4 U [042 U]). No increase in deep vein thrombosis or pulmonary embolism was observed in the aprotinin groups. Large-dose aprotinin was safe and effective in dramatically reducing the measured and calculated bleeding and the amount of transfused red blood cell units after major orthopedic surgery.

IMPLICATIONS: Large doses of aprotinin decrease blood loss and transfusion amount in major orthopedic surgery.

 

常温体外循环时平均动脉压增加不影响胰岛素依赖病人的颈静脉氧饱和度

Increasing Mean Arterial Blood Pressure Has No Effect on Jugular Venous Oxygen Saturation in Insulin-Dependent Patients During Tepid Cardiopulmonary Bypass

Yuji Kadoi, MD*, Shigeru Saito, MD*, Daisuke Yoshikawa, MD*, Fumio Goto, MD*, Nao Fujita, MD, and Fumio Kunimoto, MD

    术前存在的糖尿病是一个与心脏手术后不良神经功能紊乱相关的重要因素。在以前的报告中,我们发现在常温体外循环时糖尿病病人与非糖尿病病人相比脑去饱和更多见。本研究的目的在于检测在糖尿病病人常温体外循环时应用新福林提高平均动脉压对颈静脉氧饱和度的影响。我们研究了20例择期冠脉搭桥手术的糖尿病病人,20例年龄相当的非糖尿病病人作为对照。在麻醉诱导后,光纤氧饱和度导管置入右颈静脉球监测SjvO2。在测定动脉和颈静脉血气分压和心血管血流动力学参数的基础值后,重复应用10-µg冲击剂量的新福林增加平均动脉压直到基础值的100%。在应用新福林后糖尿病组和对照组SjvO2 值有显著差异 (糖尿病组, 56% ± 6%; 对照组: 60% ± 4%) (P < 0.05)。在应用新福林后糖尿病组和对照组 的动脉-颈静脉氧含量差值也有显著差异 (糖尿病组, 4.9% ± 0.6%;对照组, 4.5% ± 0.4%) (P < 0.05)。我们将糖尿病组又分为三个小组 (饮食治疗组 [n = 4], 优降糖组 [n = 10],和胰岛素依赖组 [n = 6])。胰岛素依赖组和其他组之间SjvO2对脑灌注压的平均斜率也有显著差异 (Dunnett 检验: P = 0.04)。胰岛素依赖病人在常温体外循环平均动脉压增加对SjvO2 值无影响。结论: 我们检测了糖尿病病人常温体外循环时应用新福林增加平均动脉压对颈内静脉氧饱和度的效应,发现胰岛素依赖病人平均动脉压的增加对SjvO2 值无影响。(张俊峰译 薛张刚校)

Preexisting diabetes mellitus is one of the major factors related to adverse postoperative neurological disorders after cardiac surgery. In previous reports, we found that diabetic patients more often experienced cerebral desaturation than nondiabetic patients during normothermic cardiopulmonary bypass (CPB). The purpose of this study was to examine the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen hemoglobin saturation (SjvO2) during tepid CPB in diabetic patients. We studied 20 diabetic patients scheduled for elective coronary artery bypass graft surgery and, as a control, 20 age-matched nondiabetic patients. After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO2. After measuring the baseline partial pressure of the arterial and jugular venous blood gases and cardiovascular hemodynamic values, MAP was increased by the repeated administration of a 10-µg bolus of phenylephrine until it reached 100% of baseline values. There was a significant difference in SjvO2 value between the Diabetic and Control groups after the administration of phenylephrine (Diabetic group, 56% ± 6%; Control group: 60% ± 4%) (P < 0.05). There was a significant difference in the arterial-jugular oxygen content difference value between the Diabetic and Control groups after the administration of phenylephrine (diabetic group, 4.9% ± 0.6%; Control group, 4.5% ± 0.4%) (P < 0.05). We subdivided the Diabetic group into three groups (Diet Therapy group [n = 4], Glibenclamide group [n = 10], and Insulin-Dependent group [n = 6]). There was a significant difference in the mean slopes of SjvO2 versus cerebral perfusion pressure for increasing cerebral perfusion pressure between the Insulin-Dependent group and the other groups (Dunnett test: P = 0.04). Increasing MAP had no effects on the SjvO2 value in insulin-dependent patients during tepid CPB.

IMPLICATIONS: We examined the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen saturation (SjvO2) during tepid cardiopulmonary bypass in diabetic patients and found that increasing MAP had no effect on the SjvO2 value in insulin-dependent patients

 

术中心动过速和高血压与非心脏手术后的长期预后独立影响因素

Intraoperative Tachycardia and Hypertension Are Independently Associated with Adverse Outcome in Noncardiac Surgery of Long Duration

David L. Reich, MD, Elliott Bennett-Guerrero, MD, Carol A. Bodian, DrPH, Sabera Hossain, MSc, Wanda Winfree, RN, and Marina Krol, PhD

Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York

Anesth Analg 2002;95:273-277

已知术中血流动力学改变对外科预后的影响几乎无关。我们从一项非心脏手术病人的研究中取样(n=797)。以生理学的POSSUM(生理学和手术的标准误分数计算死亡率)作为手术危险分级指数,并且从计算机的麻醉记录中取得术中的测量值,包括心率(HR)、平均动脉压、收缩压(SAP)。术中每5分钟记录一次,HR、平均动脉压、SAP各自被分为低、正常和高组。手术预后不良(NSO)指住院天数大于10天且病情不好转,或于住院期间死亡。统计学分析包括Mantel Haenszel检验和多项逻辑回归分析。对于短小手术,血流动力学改变和NSO无明显相关。在133例手术时间长于平均手术时间(220分钟)的病人中,NSO的发生率为15.6%。对照POSSUM评分和手术时间大于220分钟,心率加快(差率,2.704p=0.001)和SAP升高(差率,2.095p=0.009)和长时间手术后的NSO有关。因此,术中心动过速和高血压与多数非心脏手术后的长期预后不良有关。

                              (忻纪华 译    王祥瑞 校)

Relatively little is known about the influence of intraoperative hemodynamic variables on surgical outcomes. We drew subjects (n = 797) from a study of patients undergoing major noncardiac surgery. The physiological component of the POSSUM (Physiological and Operative Se- verity Score for the enUmeration of Mortality) operative risk stratification index was determined, and intraoperative measurements of heart rate (HR), mean arterial blood pressure, and systolic arterial blood pressure (SAP) were retrieved from computerized anesthesia records. For every 5-min epoch during the surgery, HR, mean arterial blood pressure, and SAP were each classified as low, normal, or high. Negative surgical outcome (NSO) was defined as a hospital stay of >10 days with a morbid condition or death during the hospital stay. Statistical analyses included Mantel-Haenszel tests and multiple logistic regression. There was no significant association between hemodynamic variables and NSO with short operations. In 388 patients with operations longer than the median time of 220 min, NSO occurred in 15.6%. Controlling for POSSUM score and operation time beyond 220 min, both high HR (odds ratio, 2.704; P = 0.01) and high SAP (odds ratio, 2.095; P = 0.009) were associated with NSO in longer operations. Thus, intraoperative tachycardia and hypertension were associated independently with adverse outcomes after major noncardiac surgery of long duration, over and above the risk imparted by underlying medical conditions.

成人脊柱手术中,乳酸林格氏液大量静脉内灌注后的术后早期呼吸性酸中毒

Early Postoperative Respiratory Acidosis After Large Intravascular Volume Infusion of Lactated Ringers Solution During Major Spine Surgery

Arzu Takil, MD, Zeynep Eti, MD, Pinar Irmak, MD, and F. Yilmaz Göü, MD

Anesth Analg 2002;95:294-298

Department of Anesthesiology, Medical Faculty of Marmara University, Istanbul, Turkey

本研究在30(年龄为1870)成人脊柱手术病人比较0.9%盐溶液(NS)或乳酸林格氏液(LR)大量静脉输注对术中电解质和酸碱平衡的影响,同时估价其术后作用。全麻诱导5mg/kg硫贲妥和0.1mg/kg维库溴胺。麻醉维持吸入70%笑气和1.52%的七氟醚。I组输注NS溶液,II组输注LR溶液,术中以20ml/kg/hr ,术后以2.5ml/kg/hr 滴注。于术前,术中每隔一小时,术后第1246小时测量电解质(Na+,K+,Cl-)和动脉血气。NS组,pHa,HCO3-和碱剩余(BE)下降,Cl-浓度在术中第2小时,Na+浓度在术中第4小时明显增高(p<0.001,术后12小时,浓度降至正常。LR组,血气分析和电解质浓度在术中无明显改变,但在术后1小时PaCO2明显升高,血清Na+pHa降低。尽管术中20ml/kg/hrLR输注没有象NS组引起高氯性代谢性酸中毒,但LR可导致术后呼吸性酸中毒和轻度低钠血症。                 (忻纪华 译    王祥瑞 校)

In this study, we compared the effects of large intravascular volume infusion of 0.9% saline (NS) or lactated Ringers (LR) solution on electrolytes and acid base balance during major spine surgery and evaluated the postoperative effects. Thirty patients aged 1870 yr were included in the study. General anesthesia was induced with 5 mg/kg thiopental and 0.1 mg/kg vecuronium IV. Anesthesia was maintained with oxygen in 70% nitrous oxide and 1.5%2% sevoflurane. In Group I, the NS solution, and in Group II, the LR solution were infused 20 mL · kg-1 · h-1 during the operation and 2.5 mL · kg-1 · h-1, postoperatively. Electrolytes (Na+, K+, Cl-) and arterial blood gases were measured preoperatively, every hour intraoperatively and at the 1st, 2nd, 4th, 6th, and 12th hours postoperatively. In the NS group, pHa, HCO3 and base excess decreased, and Cl- values increased significantly at the 2nd hour and Na+ values increased at the 4th hour intraoperatively (P < 0.001). The values returned to normal ranges at the 12th hour postoperatively. In the LR group, blood gas analysis and electrolyte values did not show any significant difference intraoperatively, but the increase in PaCO2 and the decrease in pHa and serum Na+ was significant at the 1st hour postoperatively. Although intraoperative 20 mL · kg-1 · h-1 LR infusion does not cause hyperchloremic metabolic acidosis as does NS infusion, it leads to postoperative respiratory acidosis and mild hyponatremia.

心电图指导下婴幼儿经尾入路胸部硬膜外置管

Thoracic Epidural Catheter Placement Via the Caudal Approach in Infants by Using Electrocardiographic Guidance

Ban C. H. Tsui, MSC MD, FRCP(C), R. Seal, MD FRCP(C), and J. Koller, MD FRCP(C)

Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada

Anesth & Analg August 2002 95:326-330

目的 探讨在心电图监测指导下婴幼儿经尾入路胸部硬膜外置管的成功率。方法 在病人(20例)全麻诱导后,用18号穿刺针经尾穿刺,置入20号硬膜外导管。同时记录经硬膜外导管5导联心电图和仰卧位体表5导联心电图,二者波形相同时,停止置入导管。通过术后X线检查确认导管尖端的位置。结果 所有患儿均获得满意的硬膜外麻醉效果,硬膜外导管尖端位于目的平面2个椎间隙内。结论 经硬膜外导管监测心电图可以指导婴幼儿经尾入路胸部硬膜外置管。

                                     (王士雷 摘  庄心良 校)

We examined the success of inserting epidural catheters via the caudal route in infants by using electrocardiographic guidance. A case series of 20 patients with thoracic epidural analgesia was studied. After the induction of general anesthesia, an 18-gauge IV catheter was inserted into the caudal space to allow threading of a 20-gauge epidural catheter. The electrocardiogram (ECG) tracings via the epidural catheter, as well as the surface ECG at the target spine level, were recorded simultaneously with a modified two-channel five-lead ECG system. The epidural catheter was advanced from the caudal space until the tip reached the target level as demonstrated by a match in the configuration of the epidural ECG tracing to that of the surface ECG tracing at the target level. The catheter tip location was verified by postoperative radiographs. All catheter tips were located within two vertebrae of the target level, and satisfactory intraoperative epidural anesthesia was achieved in all subjects.

 

腕部神经阻滞可增加门诊腕管手术病人术中心血管稳定性并提早出院时间Distal Nerve Blocks at the Wrist for Outpatient Carpal Tunnel Surgery Offer Intraoperative Cardiovascular Stability and Reduce Discharge Time

Ralf E. Gebhard, MD, Tameem Al-Samsam, MD, Jennifer Greger, MD, Ahmad Khan, MD, and Jacques E. Chelly, MD PhD, MBA

    腕管松解术是一个常在门诊施行的手术。我们设计该回顾性研究以评价不同麻醉方法对术中心血管稳定性和出院时间的影响。根据所使用的麻醉方法不同,62例病人依次分为静脉局部麻醉组BIER (IV regional anesthesia)、神经阻滞组BLOCK (distal nerve blocks)和全身麻醉组GENERAL (general anesthesia),研究其术中心动过缓、心动过速、高血压及低血压的发生率,上止血带时间,手术时间,手术室停留时间及出院时间。BLOCK组的心血管稳定性较佳,与 BIER组相比其高血压的发生率较低(5%对25%),与GENERAL组相比其低血压的发生率也较低(14%42)。术后医院停留时间明显短于BIER组(6588分钟)和GENERAL组(65133分钟)。因此,我们认为,对于门诊行腕管松解术的病人,神经阻滞麻醉可提供比全身麻醉更佳的术中心血管稳定性。在术后,BLOCK组的病人比BIER组或GENERAL组的病人较早出院,可能与神经阻滞具有卓越的术后镇痛效应有关。结论:该项关于门诊腕管松解术三种麻醉方法的回顾性研究显示腕部神经阻滞麻醉可提供较佳的术中心血管稳定性并可提早出院时间。(潘志浩译薛张刚校)

 

Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.

 

吸入麻醉药和非去极化类肌肉松弛药在神经肌肉接头部位的相互作用特征

Characterization of the Interactions Between Volatile Anesthetics and Neuromuscular Blockers at the Muscle Nicotinic Acetylcholine Receptor

Matthias Paul, MD DEAA*, Ralf M. Fokt*, Christoph H. Kindler, MD DEAA, Natalie C. J. Dipp, and C. Spencer Yost, MD*

*Department of Anesthesia and Perioperative Care, University of California, San Francisco; Department of Anesthesia, Kantonsspital, Basel, Switzerland; and University of Cologne, Germany

Anesth Analg 2002;95:362-367

目的  吸入麻醉药可以强化非去极化类肌肉松弛药(NDMRs)的肌松效应。这两种药物相互影响的作用位点被认为是在神经肌肉接头部位,即两种药物共同作用于神经肌肉接头部位的乙酰胆碱受体(m-nAChRs)之结果。本试验拟对此假说作验证。方法  应用异种组织表达系统爪蟾卵母细胞表达大鼠肌肉成年型乙酰胆碱受体m-nAChRs2α、β、δ、ε),首先建立维库溴铵、筒箭毒碱、异氟醚和七氟醚对该受体由乙酰胆碱所激发的电流之抑制效应的浓度—效应曲线,求得单独应用维库溴铵、筒箭毒碱、异氟醚和七氟醚时对该受体的半数(或半效)抑制剂量(ID50)。接着研究了在同时给予ID50的异氟醚或七氟醚时NDMRsm-nAChRs的抑制效应。结果  四种药物均产生可逆的浓度依赖性的抑制效应,维库溴铵、筒箭毒碱、异氟醚和七氟醚的ID50值分别为9.9nM(95%可信区间为8.4-11.4nM)43.4nM(95%可信区间为33.6-53.3nM)897μM(95%可信区间为699-1150μM)818μM(95%可信区间为685-1001μM)。同时应用异氟醚或七氟醚可大大加强维库溴铵或筒箭毒碱对m-nAChRs之抑制效应,尤以使用低浓度的NDMRs时为最。结论  吸入麻醉药可以强化非去极化类肌肉松弛药的效能,此现象的可能机制是吸入麻醉药增加拮抗剂和受体的亲和力。

                                    (杨保仲 译  庄心良 校)

Volatile anesthetics enhance the neuromuscular blockade produced by nondepolarizing muscle relaxants (NDMRs). The neuromuscular junction is a postulated site of this interaction. We tested the hypothesis that volatile anesthetic enhancement of muscle relaxation is the result of combined drug effects on the nicotinic acetylcholine receptor. The adult mouse muscle nicotinic acetylcholine receptor (2, ß, , ) was heterologously expressed in Xenopus laevis oocytes. Concentration-effect curves for the inhibition of acetylcholine-induced currents were established for vecuronium, d-tubocurarine, isoflurane, and sevoflurane. Subsequently, inhibitory effects of NDMRs were studied in the presence of the volatile anesthetics at a concentration equivalent to half the concentration producing a 50% inhibition alone. All individually tested compounds produced rapid and readily reversible concentration-dependent inhibition. The calculated 50% inhibitory concentration values were 9.9 nM (95% confidence interval [CI], 8.411.4 nM), 43.4 nM (95% CI, 33.653.3 nM), 897 µM (95% CI, 6991150 µM), and 818 µM (95% CI, 6851001 µM) for vecuronium, d-tubocurarine, isoflurane, and sevoflurane, respectively. Coapplication of either isoflurane or sevoflurane significantly enhanced the inhibitory effects of vecuronium and d-tubocurarine, especially so at small concentrations of NDMRs. Volatile anesthetics increase the potency of NDMRs, possibly by enhancing antagonist affinity at the receptor site. This effect may contribute to the clinically observable enhancement of neuromuscular blockade by volatile anesthetics.

 

高血压患者应用美维松的心血管效应

The Cardiovascular Effects of Mivacurium in Hypertensive Patients

Benoît Plaud, MD*, Jean Marty, MD, Bertrand Debaene, MD, Claude Meistelman, MD, Daniel Pellissier, MD||, Jean-Yves LePage, MD, Pierre Feiss, MD#, Philippe Scherpereel, MD**, Marie-Noëlle Bouverne, MSc, and Sandrine Fosse, MSc

*Department of Anesthesiology and Intensive Care, Fondation Adolphe de Rothschild, Paris, France; Department of Anesthesiology and Intensive Care, Hôpital Beaujon, Université Paris VII, Clichy, France; {ddagger}Department of Anesthesiology and Intensive Care, Centre Hospitalier Regional Universitaire de Poitiers, Poitiers, France; Department of Anesthesiology and Intensive Care, Hôpitaux de Brabois, Centre Hospitalo-Universitaire de Nancy, Nancy, France; ||Department of Anesthesiology and Intensive Care, Hôpital La Timone, Marseille, France; Department of Anesthesiology and Intensive Care, CHRU de Nantes, Nantes, France; #Department of Anesthesiology and Intensive Care, CHRU de Limoges, Limoges, France; **Department of Anesthesiology and Intensive Care, CHRU de Lille, Lille, France; and GlaxoSmithKline Laboratories, Marly-le-Roi, France

AAnesth Analg 2002;95:379-384

目的:健康患者应用美维松通常会出现低血压。本文研究高血压患者应用美维松后的血流动力学变化。方法:本文为采用开放式、多中心研究。以芬太尼和依托米酯进行麻醉诱导后,血压正常组(n=149)和高血压组(n=57)患者分别在10秒或30秒静注0.2mgKg-1的美维松。用电子血压计记录HRMAP结果:血压正常组和高血压组患者10秒静注组低血压(血压低于给美维松前对照MAP20%为低血压)的发生率分别为21%36% 30秒静注组低血压的发生率分别为11%10%。在高血压组30秒静注组MAP的降低幅度明显高于10秒静注组(20%10% p=0.002),而在血压正常组未见这种差异。结论:高血压患者与正常血压患者相比,快速静注美维松(10秒注射完)后低血压的发生率更多,降低幅度更大。

 

                  (赵雪莲      庄心良校)

Hypotension is common after mivacurium injection in healthy patients. This hemodynamic event had not been investigated in hypertensive patients characterized by more intense hemodynamic instability. In this open-label, multicenter, randomized, and controlled study, we sought to determine whether mean arterial blood pressure (MAP) and heart rate variations were larger in hypertensive versus normotensive patients after a bolus dose of mivacurium injected over 10 or 30 s. After the induction of anesthesia with fentanyl and etomidate, normotensive (n = 149) and hypertensive (n = 57) patients received a single dose of mivacurium 0.2 mg/kg injected over 10 or 30 s by random allocation. Heart rate and MAP were recorded electronically. The incidence of hypotension (defined as a 20% MAP decrease from the control value before mivacurium injection) was 21% and 36% (10-s injection) or 11% and 10% (30-s injection) in the Normotensive and Hypertensive groups, respectively. In Hypertensive patients, the maximum decrease in MAP was significantly greater when mivacurium was injected over 10 s compared with 30 s: 20% vs 11%, respectively (P = 0.002). This difference was not observed in Normotensive patients. Hypotension after rapid (e.g., 10 s) mivacurium injection was more frequent and more pronounced in Hypertensive than in Normotensive patients.

 

口服α2受体激动剂Tizannidine降低成人七氟醚的最小肺泡浓度

Oral Tizanidine, an 2-Adrenoceptor Agonist, Reduces the Minimum Alveolar Concentration of Sevoflurane in Human Adults

Zenichiro Wajima, MD PhD, Tatsusuke Yoshikawa, MD PhD, Akira Ogura, MD PhD, Kazuyuki Imanaga, MD, Toshiya Shiga, MD PhD, Tetsuo Inoue, MD PhD, and Ryo Ogawa

 

Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; Department of Anesthesia, Hakujikai Memorial Hospital, Tokyo, Japan; Department of Anesthesiology, Tokyo Jikeikai Medical School, Tokyo, Japan; Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and ||Department of Anesthesiology, Nippon Medical School, Tokyo, Japan

Anesth Analg 2002;95:393-396

 

目的  α2受体激动剂Tizannidine对动物具有抗伤害作用。术前口服Tizannidine,可减轻与放置咽喉镜及插管相关的血压升高,令意识消失所需的咪唑安定剂量显著减少。我们推测口服Tizannidine可能降低七氟醚的最小肺泡麻醉浓度(MAC)方法  52ASAⅠ~Ⅱ级的病人,年龄2456岁,随机分成两组:对照组(n=26)和Tizannidine组(n=26),分别在手术切皮前90分钟口服安慰剂和Tizannidin 4毫克。所有病人使用肺活量吸入七氟醚(5%)进行诱导。意识消失定义为眼睑反射消失及对语言命令反应的丧失。采用传统的上~下(up-down)法进行可数性反应来测定。结果  对照组七氟醚的MAC2.2%±0.2%,Tizannidine组为1.8%±0.2%p=0.0004)。意识消失的时间Tizannidine组(60.2±22.5秒)显著短于对照组(73.7±26.3秒)(p=0.03)。结论  口服4毫克Tizannidine可以降低成人七氟醚18%的最小肺泡浓度。               (张军 译  庄心良 校)

 

Tizanidine, an 2-adrenoceptor agonist, has an antinociceptive effect in animals. In humans premedicated with oral tizanidine, the increase in blood pressure associated with laryngoscopy and intubation was attenuated, and the amount of midazolam required for loss of consciousness was significantly reduced. We speculated that the oral administration of tizanidine might reduce the minimum alveolar anesthetic concentration (MAC) of sevoflurane. Fifty-two ASA physical status III patients, aged 2456 yr, were randomly allocated into two groups: a Control group (n = 26) and a Tizanidine group (n = 26). As premedication, the Control group received a placebo, and the Tizanidine group received 4 mg of oral tizanidine 90 min before surgical skin incision. Anesthesia was induced in all patients by using vital capacity rapid inhaled induction with sevoflurane (5%). Loss of consciousness was defined as both the loss of the eyelid reflex and the lack of a response to a verbal command. MAC was determined by a technique adapted from the conventional up-down method for quantal responses. The MAC of sevoflurane was 2.2% ± 0.2% in the Control group and 1.8% ± 0.2% in the Tizanidine group (P = 0.0004). The time to loss of consciousness in the Tizanidine group (60.2 ± 22.5 s) was significantly shorter than that in the Control group (73.7 ± 26.3 s) (P = 0.03). The oral administration of tizanidine 4 mg successfully reduced the MAC of sevoflurane by 18% in human adults.

 

第二代血液替代品Perflubron Emulsion增加体外试验中现代吸入麻醉药的血溶性

A Second-Generation Blood Substitute (Perflubron Emulsion) Increases the Blood Solubility of Modern Volatile Anesthetics In Vitro

Olivier Y. Cuignet, MD*, Philippe M. Baele, MD, and Luc J. Van Obbergh, MD PhD

    全氟碳乳剂可增加异氟醚、氨氟醚、氟烷的血溶性,据报道对溶解性较低的异氟醚具有最大的效应。目前的吸入麻醉药的血溶性都较低并且较易受此现象影响。Perflubron (OxygentTM)是一种正接受后期临床试验的全氟碳类乳剂,它用于外科病人作为暂时的氧载体。该研究事先假设perflubron可增加异氟醚、七氟醚、地氟醚的溶解性,其溶解度以其血气分配系数Bl:g作为反映。从8位志愿者中采集新鲜全血标本并与perflubron混合使其容积百分比浓度分别达到1.2%1.8%3.6%,相当于体内1.8-5.4g/kg的剂量,该剂量是临床期望剂量的两倍。采用双重提取技术我们证实异氟醚、七氟醚、地氟醚的Bl:g增加了,但是其血溶性没有真正变化,因为实际上吸入麻醉药部分溶入到perflubron中,增加血液中乳胶的容量自然就增加了气体的携带量,并反映在三种吸入麻醉药的Bl:g值和perflubron剂量线性相关性上。 尽管增加量是正常值的0.9(地氟醚)到2.6倍(七氟醚),目前的许多perflubron试验缺乏明显的临床意义,这还有待于进一步的体外实验研究。结论:血液中临床浓度水平的perflubron可增加吸入麻醉药的溶解度。实际上吸入麻醉药部分溶入到perflubron,但其血中溶解度并无变化。有待进一步研究明确perflubron是否影响体内吸入麻醉药的药代动力学。(潘志浩译薛张刚校)

 Perfluorocarbon-based emulsions increase the blood solubility of isoflurane, enflurane, and halothane, with a maximal effect Bl:g reported for the less soluble isoflurane. Current volatile anesthetics are less soluble and may be more affected by this phenomenon. Perflubron (OxygentTM) is a perfluorocarbon-based emulsion in late-stage clinical testing in surgical patients for use as a temporary oxygen carrier. We tested the hypothesis that perflubron increases the solubility of isoflurane, sevoflurane, and desflurane, as reflected by their blood/gas partition coefficient (Bl:g). Fresh whole-blood samples were drawn from eight volunteers and mixed with perflubron to obtain concentrations of 1.2%, 1.8%, and 3.6% by volume (equivalent to in vivo doses of 1.8 to 5.4 g/kg, which represent up to twice the intended clinical dose range). By using the double-extraction method, we demonstrated increased Bl:g for isoflurane, sevoflurane, and desflurane. However, the solubility in blood does not really change, because volatile anesthetics are actually partitioning into perflubron. Increasing the amount of emulsion in the blood consequently increases the amount of gas carried, as reflected by the measured linear correlation between the Bl:g values of all three volatile anesthetics and perflubron doses. Even though the increase ranges from 0.9 (desflurane) to 2.6 (sevoflurane) times the normal value, the apparent lack of clinical implications in current trials with perflubron may trigger further in vivo experiments. IMPLICATIONS: Perflubron increases the in vitro solubility of volatile anesthetics when present in the blood at clinically relevant concentrations. Volatile anesthetics actually partition into the emulsion, but the solubility in the blood does not change. Further studies are needed to assess whether perflubron will affect the pharmacokinetics of volatile anesthetics in vivo.

 

确定乳腺癌前哨淋巴结时的Isosulfan Blue Dye反应

Isosulfan Blue Dye Reactions During Sentinel Lymph Node Mapping for Breast Cancer

Leslie L. Montgomery, MD*, Alisa C. Thorne, MD, Kimberly J. Van Zee, MS MD*, Jane Fey, MPH*, Alexandra S. Heerdt, MD MPH*, Mary Gemignani, MD*, Elisa Port, MD*, Jeanne Petrek, MD*, Hiram S. Cody, III, MD*, and Patrick I. Borgen, MD*

*Breast Service, Department of Surgery, and Department of Anesthesia, Memorial Sloan-Kettering Cancer Center, New York, New York

Anesth Analg 2002;95:385-388

     在美国,确定前哨淋巴结(SLN)需要99mTc标志的胶体,1% isosulfan blue dye,或者示踪一个新生物的淋巴通路。我们报道在确定乳腺癌前哨淋巴结时的Isosulfan Blue Dye副反应的临床经验。我们总结回顾了1996912-2000816日在Memorial Sloan-Kettering癌症中心乳腺癌SLN的病史,有2392个病人用isosulfan blue dye行组织检查。2392病人中有39个有过敏反应(1.6%,大多数反应(69%)产生荨麻疹,蓝色荨麻疹,形成一片,搔痒。低血压的发生率0.5%。尽管在注射isosulfan blue dye后发生过敏反应很少,但本文强调在注射sosulfan blue dye后血流动力学不稳定,应怀疑是过敏反应。我们的经验表明发生支气管痉挛、呼吸不好并不常见,大多数病人不需要紧急气管插管,而只需短期的压力支持。而且我们的数据也表明对磺胺药过敏的病人对isosulfan blue dye无交叉过敏反应。(嵇富海译  薛张刚校)

 

In the United States, identification of the sentinel lymph node (SLN) requires the use of 99mTc-labeled colloid, 1% isosulfan blue dye, or both to trace the lymphatic drainage of a given neoplasm. We report our experience with adverse reactions to isosulfan blue dye during SLN mapping in breast cancer. A chart review of the breast cancer SLN database was performed; it included 2392 sequential patients who underwent SLN biopsy involving isosulfan blue dye at Memorial Sloan-Kettering Cancer Center from September 12, 1996, to August 17, 2000. Thirty-nine of 2392 patients (1.6%) had a documented allergic reaction during the mapping procedure. Most reactions (69%) produced urticaria, blue hives, a generalized rash, or pruritus. The incidence of hypotensive reactions was 0.5%. Although anaphylaxis after the injection of isosulfan blue dye is rare, this article highlights the need to suspect anaphylaxis when hemodynamic instability occurs after the injection of this compound. Our experience indicates that bronchospasm and respiratory compromise are unusual and that most patients do not require emergent intubation and can be managed with short-term pressor support. In addition, our data indicate that patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye.

IMPLICATIONS: We report the largest single-institution review of adverse reactions to injection of isosulfan blue dye during sentinel lymph node mapping in breast cancer. Bronchospasm and respiratory compromise are unusual, and most patients can be treated with short-term pressor support. Patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye.

 

氟化物和低温对体内咪库溴胺代谢影响

The Effect of Fluoride and Hypothermia on the In Vitro Metabolism of Mivacurium

Michael Gruber, PhD, Regina Lindner, Christopher Prasser, MD, and Gunther Wiesner, MD

Department of Anesthesiology, University of Regensburg, Regensburg, Germany

Anesth Analg 2002;95:397-399

                                                嵇富海译  薛张刚校)

 

IMPLICATIONS: The fluoride inhibition of mivacurium hydrolysis by pseudocholinesterase increases in hypothermia, but it will very rarely occur in clinical practice because it requires rather large fluoride concentrations (>50 µmol/L) and very low temperatures (<28°C).

 

麻醉药的静电相互作用对N-乙酰胆碱受体的影响

The Role of Electrostatic Interactions in Governing Anesthetic Action on the Torpedo Nicotinic Acetylcholine Receptor

Douglas E. Raines, MD*, and Robert J. Claycomb, BS

*Department of Anesthesia, Harvard Medical School; and Massachusetts General Hospital, Boston, Massachusetts

Anesth Analg 2002;95:356-361

临床使用浓度的异氟醚和正链烷醇能降低N-乙酰胆碱受体表面兴奋剂的离解常数,而环丙烷和丁烷无此作用。这就提示本受体模型系统中麻醉剂的静电相互作用(氢键和/偶极)调节麻醉强度,进一步明确这些相互作用的特性,将不同全身麻醉剂降低N-乙酰胆碱受体表面兴奋剂离解常数的强度量化,以评估麻醉剂分子容量、提供酸性氢键或接受碱性氢键的能力及偶极距的重要性。结果发现麻醉剂的水容性随分子量增加而增强,随碱性氢键减少而降低,但不受偶极矩和酸性氢键的影响。这就提示麻醉剂像水分子一样,通过偶极和结合氢键来降低N-乙酰胆碱受体表面兴奋剂的离解常数,但提供氢键的能力弱于水分子。

                                (朱辉  译     王祥瑞 校)

Isoflurane and normal alkanols reduce the apparent agonist dissociation constant (Kd) of the nicotinic acetylcholine receptor (nAChR) at clinically relevant concentrations, whereas cyclopropane and butane do not. This suggests that electrostatic (hydrogen bonding and/or dipolar) interactions modulate anesthetic potency in this model receptor system. To further define the nature of these interactions, we quantified the potencies with which a heterologous group of general anesthetics reduces the nAChRs apparent Kd for acetylcholine. We assessed the importance that an anesthetics molecular volume, ability to donate a hydrogen bond (hydrogen bond acidity), ability to accept a hydrogen bond (hydrogen bond basicity), and dipole moment play in determining aqueous potency. We found that aqueous anesthetic potency increases with molecular volume and decreases with hydrogen bond basicity but is unaffected by dipole moment and hydrogen bond acidity. These results suggest that anesthetics reduce the apparent agonist Kd of the nAChR by binding to a site that has a dipolarity and ability to accept hydrogen bonds that are similar to those of water, but a hydrogen bond-donating capacity that is less.

 

咪唑安定的非γ-氨基丁酸介导的促使c-FosEGR-1的表达

Midazolam Induces Expression of c-Fos and EGR-1 by a Non-GABAergic Mechanism

Kazuhiko Fukuda, MD, Takehiro Shoda, MD, Hiroyuki Mima, MD, and Hisatoshi Uga, MD

Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan

Anesth Analg 2002;95:373-378

由全身麻醉药诱发的基因表达的变化还没有被广泛研究。本研究在含有嗜铬细胞瘤PC12细胞的老鼠体内注射静脉麻醉药,通过免疫印迹分析法以评估早期基因产物c-FosEGR-1的表达。戊硫代巴比妥,氯氨酮,异丙酚及安定没有使c-FosEGR-1的量显著变化,与此相反,咪唑安定促进c-FosEGR-1的表达且受时间-剂量依赖的影响,但不受苯二氮受体拮抗剂flumazenilPK11195的影响。咪唑安定促发的c-FosEGR-1的表达可被促细胞分裂活化蛋白酶/细胞外信号调控酶(ERKs)抑制剂PD98059终止。免疫印迹分析法证明咪唑安定促使ERKs磷酸化并激活。结果表明咪唑安定促使PC12细胞内c-FosEGR-1的表达并非依赖γ-氨基丁酸受体介导的机制而是通过激活ERKs,这就说明咪唑安定可以通过改变基因表达来长时间的改变神经中枢功能。

                                (朱辉       王祥瑞 校)

Gene expression changes induced by general anesthetics have not been extensively examined. In this investigation, we treated rat pheochromocytoma PC12 cells with IV anesthetics, and assessed expression of immediate early gene products, c-Fos and EGR-1, by immunoblot analysis. Thiopental, ketamine, propofol, and diazepam did not significantly change the expression level of c-Fos and EGR-1. In contrast, midazolam dose- and time-dependently induced expression of c-Fos and EGR-1, which was not affected by antagonists of the benzodiazepine receptors, flumazenil and PK11195. The midazolam-induced c-Fos and EGR-1 expression was abolished by PD98059, an inhibitor for mitogen- activated protein kinase/extracellular signal-regulated kinase kinase, suggesting the involvement of extracellular signal-regulated kinases (ERKs). Immunoblot analysis demonstrated that midazolam induces phosphorylation and activation of ERKs. These results indicate that midazolam induces the expression of c-Fos and EGR-1, by activation of ERKs through a mechanism independent from -aminobutyric acidA receptors, in PC12 cells, and suggest the possibility that midazolam can induce long-term changes of neural functions by changing gene expression.

 

在异丙酚麻醉中使用阿托品对心率的影响

Heart Rate Response to Intravenous Atropine During Propofol Anesthesia

Takashi Horiguchi, MD, and Toshiaki Nishikawa, MD

Department of Anesthesia, Akita University School of Medicine, Akita, Japan

Anesth Analg 2002;95:389-392

61例异丙酚麻醉的病人中研究静注阿托品与心率改变的剂量—反应关系。对照组(n=15)不用异丙酚。P-5组(n=22)在1分钟内静注异丙酚1.25mg/kg后使用异丙酚5mg/kg/h维持。插管后,麻醉维持异丙酚5mg/kg/h和吸入67%笑气。P-10组(n=24)先静注异丙酚2.5 mg/kg后使用异丙酚10mg/kg/h维持,其余用药均相等。所有病人每2分钟以5秒的速度静注阿托品5μg/kg剂量递增直至心率增加超过基础心率20bpm。静注阿托品10μg/kg后,P-5组心率增加12±7 bpmP-10组心率增加9±6 bpm,而对照组心率增加28±13 bpm,与前两组相比,差异有显著意义(P<0.05)。静注异丙酚剂量达到20μg/kg时,对照组所有病人的心率均增加>20bpm,而在P-5组和P-10组心率均增加>20bpm的病人仅为43%13%P<0.05)。上述结果显示,在使用异丙酚的病人中,阿托品对心率的影响明显减少,即使加大阿托品的剂量也无法克服异丙酚对其的影响,可能与异丙酚引起交感神经系统的抑制有关。

                                       (周洁       王祥瑞 校)

We studied the dose-response relationships for atropine-induced heart rate (HR) changes in 61 patients during propofol anesthesia. The control group (n = 15) received no propofol. Group P-5 (n = 22) received IV propofol 1.25 mg/kg over 1 min followed by propofol at 5 mg · kg-1 · h-1. After tracheal intubation, anesthesia was maintained with propofol 5 mg · kg-1 · h-1 and 67% nitrous oxide in oxygen. Group P-10 (n = 24) received IV propofol 2.5 mg/kg over 1 min followed by propofol at 10 mg · kg-1 · h-1. The P-10 protocol was otherwise identical. All patients received incremental doses of IV atropine 5 µg/kg over 5 s at 2-min intervals until HR increased >20 bpm from baseline values. Heart rate response to atropine 10 µg/kg was attenuated in Groups P-5 (12 ± 7 bpm) and P-10 (9 ± 6 bpm) compared with the control group (28 ± 13 bpm, P<0.05). When atropine 20 µg/kg was administered, HR increased >20 bpm in all patients of the control group, but in only 43% and 13% of patients in Groups P-5 and P-10, respectively (P<0.05). These results indicate the decreased HR responsiveness to IV atropine in patients receiving propofol, which cannot be effectively overcome by a large dose of atropine, is possibly attributable to propofol-induced suppression of the sympathetic nervous system.

 

硬膜外类固醇药物的注入技术:一项全国性问卷调查

The Technical Aspects of Epidural Steroid Injections: A National Survey

Robert Cluff, MD, Abdel-Kader Mehio, MD, Steven P. Cohen, MD, Yuchiao Chang, PhD, Christine N. Sang, MD MPH*, and Milan P. Stojanovic, MD*

*Clinical Trials Program and Interventional Pain Program, MGH Pain Center; and Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Anesth Analg 2002;95:403-408

尽管在慢性疼痛治疗中硬膜外类固醇药物注射(ESI)是一项常用的治疗方法,但临床操作医生的操作方法是否正确一致尚无定论。近来的文献报道显示,操作技术的不同将明显影响ESI的效果。本研究的目的在于提供制定ESI标准方法的参考。对美国68所医学院和28所私立诊所的麻醉科问卷进行分析调查。结果发现目前临床上并无一致可靠的ESI实施方法。被调查者ESI操作方法的个体差异非常大。私立诊所与医学院麻醉科相比,更多地使用了X线透视的技术。最明显的差别是在子宫颈阻滞的病人中,依靠X线透视的引导进行ESI的病人比例在私立诊所为73%而在学院附属医院则为39%P=0.005)。类似的差异也发生在椎板切除术后的病人中,在私立诊所有61%的病人使用微孔针进行ESI,而在学院附属医院这一比例仅为15%。上述结果表明,目前并无一致有效的方法用于ESI,临床上的操作差异非常大。                     (周洁       王祥瑞 校)

Although epidural steroid injections (ESIs) are a common treatment for chronic pain conditions, it is not clear whether there is consensus on their technical aspects. The current literature suggests that variations in technical aspects may affect ESI outcomes. The goal of the survey was to help establish a standard frame of reference for the performance of ESIs. We analyzed survey results from 68 academic anesthesia programs and 28 private practices in the United States. The main finding in this survey is that there is no clear-cut consensus as to the ideal method to perform ESI. There is a wide variation among individual practices in almost every technical aspect of ESI. Private practices use significantly more fluoroscopy than academic centers. The large difference was found in the cervical region where 73% of private practices and only 39% of academic institutions polled perform the ESIs with fluoroscopic guidance (P = 0.005). A similar discrepancy was found in approaches to the epidural space after laminectomy where 61% of private practices, but only 15% of academic centers, use the transforaminal approach. The study results indicate that there is no consensus, and that there is a wide variation in current practices.

 

咪哒唑仑对模拟急救医疗运输服务过程中应激水平的影响:安慰剂对照的、剂量效应研究

The Effect of Midazolam on Stress Levels During Simulated Emergency Medical Service Transport: A Placebo-Controlled, Dose-Response Study

Volker Dörges, MD*, Volker Wenzel, MD, Susanne Dix, BS, Alexander Kühl, BSThomas Schumann, BS, Michael Hüppe, PhD,Heiko Iven, PhD,  and Klaus Gerlach, MD

*Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel; Departments of Anesthesiology, and Pharmacology, Medical University of Lübeck, Germany; and Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

Anesth Analg 2002;95:417-422

 

目的 比较几组进行急救医疗服务(EMS)的病人血清儿茶酚胺含量,探讨预先给予镇静剂的作用。方法 在模拟EMS的求救的场景中,72名健康男性志愿者中的一半被护理人员通过楼梯从三层楼上抬下来,然后送上带有警报的急救服务车中(3个应激组,每组n=12,总数n=36)。另一半则坐在椅子上5分钟或躺在担架上15分钟(3个对照组n=12,总n=36)。测量各基础血清儿茶酚胺含量以及给予IV组安慰剂(n=12)、25µg/kg(n=12)50µg/kgn=12)的咪哒唑仑后的血清儿茶酚胺值,IV组安慰剂应用于全部的实验过程。统计学处理采用方差分析,p<0.05认为差别有显著意义。结果 经过楼梯运输以后,安慰剂应激组和对照组相比明显增加血清肾上腺素(73±5pg/ml VS 45±5pg/ml; p<0.001)和去甲肾上腺素含量(398±34pg/ml VS 278±23pg/mlp<0.01),而50µg/kg咪哒唑仑组血清肾上腺素和去甲肾上腺素含量无明显增加。经过急救车运输后,安慰剂应激组和对照阻相比,肾上腺素含量明显增加(51±4pg/ml VS 37±4pg/mlp<0.05),而去甲肾上腺素含量无明显变化(216±24pg/ml VS 237±18pg/ml);而在2550µg/kg咪哒唑仑组血清儿茶酚胺含量与对照阻相比无明显差别。结论 模拟EMS的病人在楼梯运输过程中的应激水平高于救护车运输的过程。加入咪哒唑仑能明显降低内源性儿茶酚胺的水平,对心率无明显影响。

(焦志华译 庄心良校)

Patients in the emergency medical service (EMS) may have increased endogenous catecholamines because of pain or fear and may benefit from sedation similar to premedication in the hospital. During a simulated EMS scene call, 72 healthy male volunteers were either transported by paramedics from a third-floor apartment through a staircase with subsequent EMS transport with sirens (three stress groups of n = 12; total, n = 36) or asked to sit on a chair for 5 min and lie down on a stretcher for 15 min (three control groups of n = 12; total, n = 36). Catecholamine plasma samples were measured in the respective stress and control groups at baseline and after placebo IV (n = 12) or 25 (n = 12) or 50 (n = 12) µg/kg of midazolam IV throughout the experiment, respectively. Statistical analysis was performed with analysis of variance; P < 0.05 was considered significant. The Placebo Stress versus Control group, but not the 50 µg/kg Stress Midazolam group, had both significantly increased epinephrine (73 ± 5 pg/mL versus 45 ± 5 pg/mL; P < 0.001) and norepinephrine (398 ± 34 pg/mL versus 278 ± 23 pg/mL; P < 0.01) plasma levels after staircase transport. After EMS transport, the Placebo Stress versus Control group had significantly increased epinephrine (51 ± 4 pg/mL versus 37 ± 4 pg/mL; P < 0.05) but not norepinephrine (216 ± 24 pg/mL versus 237 ± 18 pg/mL) plasma levels, whereas no significant differences in catecholamine plasma levels occurred between groups after either 25 or 50 µg/kg of midazolam. In conclusion, simulated EMS patients may be subject to more stress during staircase transport than during transport in an EMS vehicle. Titrating sedation with 25 µg/kg of midazolam significantly reduced endogenous catecholamines but not heart rate.

 

比较0.1%0.2%罗比卡因和布比卡因加吗啡用于大的腹部手术后的术后镇痛。

A Comparison of 0.1% and 0.2% Ropivacaine and Bupivacaine Combined with Morphine for Postoperative Patient-Controlled Epidural Analgesia After Major Abdominal Surgery

Anesth Analg 2002;95

Marc Senard, MD, Jean L. Joris, MD PhD, Didier Ledoux, MD, Pierre J. Toussaint, MD, Benoît Lahaye-Goffart, MD, and Maurice L. Lamy, MD

Department of Anesthesia and Intensive Care Medicine, CHU de Liège, Domaine du Sart-Tilman, Belgium

罗比卡因与布比卡因相比由于用于硬膜外镇痛时具有较少的毒性和较小的运动阻滞而似乎更具有吸引力。关于罗比卡因加吗啡用于硬膜外镇痛时的剂量的文章很少。本研究中,我们比较罗比卡因和布比卡因加小剂量吗啡用于大的腹部手术后的术后镇痛的剂量和副作用,60个病人随机分为4组:0.1%0.2%罗比卡因和布比卡因加0.1mg/kg吗啡用于术后病人自控镇痛。观察60小时的疼痛评分、副作用、运动阻滞和局麻药用量。组间的疼痛评分和副作用无差别。两0.1%组的罗比卡因和布比卡因用量相似。剂量加倍后可减少布比卡因用量(P>0.05)但罗比卡因用量无减少。因此,用0.%罗比卡因与0.1%罗比卡因用量相比用量显著增加(ROPI 0.1% = 314 ± 151 mg ROPI 0.2% = 573 ± 304 mg at Hour 48; P < 0.05. 0.1%0.2%罗比卡因和布比卡因加吗啡用于术后病人自控镇痛效果相似。与0.1%罗比卡因相比,0.2%罗比卡因用量增加但没有改善镇压痛效果。(张德林译 薛张刚校)

Ropivacaine (ROPI), which is less toxic and produces less motor block than bupivacaine (BUPI), seems attractive for epidural analgesia. Few data are available concerning dose requirements of epidural ROPI when combined with morphine. In this study, we compared the dose requirements and side effects of ROPI and BUPI combined with small-dose morphine after major abdominal surgery. Postoperatively, 60 patients were randomly allocated (double-blinded manner) to four groups: patient-controlled epidural analgesia with the same settings using 0.1% or 0.2% solution of ROPI or BUPI combined with an epidural infusion of 0.1 mg/h of morphine. Pain scores, side effects, motor block, and local anesthetic consumption were measured for 60 h. Pain scores and the incidence of side effects did not differ among the groups. Consumption of ROPI and BUPI were similar in both 0.1% groups. Doubling the concentration significantly reduced the consumption (milliliters) of BUPI (P < 0.05) but not of ROPI. Consequently, using ROPI 0.2% significantly increased the dose administered as compared with ROPI 0.1% (ROPI 0.1% = 314 ± 151 mg and ROPI 0.2% = 573 ± 304 mg at Hour 48; P < 0.05). Patient-controlled epidural analgesia with the 0.1% or 0.2% solution of ROPI or BUPI combined with epidural morphine resulted in comparable analgesia. As compared with ROPI 0.1%, the use of ROPI 0.2% increased consumption of local anesthetic without improving analgesia.

 

比较异丙酚和右美托咪定在术中镇静中的作用、副作用和恢复特性

The Efficacy, Side Effects, and Recovery Characteristics of Dexmedetomidine Versus Propofol When Used for Intraoperative Sedation

Shahbaz R. Arain, MD, and Thomas J. Ebert, MD PhD

Department of Anesthesiology, Medical College of Wisconsin and VA Medical Center, Milwaukee, Wisconsin

Anesth Analg 2002;95:461-466

目的 我们评价在术中镇静中异丙酚和右美托咪定达到相同镇静效果的剂量对心肺功能的影响。其次,比较两者达到镇静和从镇静中恢复的时间以及术后镇痛和精神运动方面的表现。方法 40例择期手术的病人在知情同意的情况下被随机分为两组,术中分别给予右美托咪定(初始10分钟,1 µg/kg; 维持,0.40.7 µg · kg-1 · h-1)异丙酚(初始10分钟,75 µg · kg-1 · min-1;维持,12.575 µg · kg-1 · min-1)。术中及术后95分钟内监测血流动力学指标(心率和平均动脉压)、镇静的程度(visual analog scale和观察者对患者觉醒或镇静的评估)、脑电双频谱指数、通气指标(呼吸频率、O2 sat ETCO2)、精神运动表现(digital symbol substitution test)和疼痛程度(visual analog scale)。术中镇静的程度要求达到脑电双频谱指数评分70-80。两组病人的人口统计学指标、ASA评分等级、手术操作过程和基础心肺功能都相似。结果 使用异丙酚组出现镇静较迅速,但是在注射初始剂量后25分钟两组间镇静程度无差别。右美托咪定平均注射速度为0.7 µg · kg-1 · h-1,异丙酚平均注射速度为38 µg · kg-1 · min-1。在恢复阶段,两组精神运动表现和呼吸频率没有差别。右美托咪定组在恢复期间遗留较强的镇静作用,导致低血压和协助镇痛作用(减少吗啡用量)。结论 右美托咪定适用于围手术期镇静,相对于异丙酚其达到镇静和从镇静恢复都延缓。并且右美托咪定在术后有促进镇痛的作用,减少吗啡的用量。

                                               (李懿 译  薛张刚校)

We evaluated the cardio-respiratory effects of equi-sedative doses of dexmedetomidine and propofol for intraoperative sedation. Secondary comparison end points were time to achieve and terminate sedation and postoperative analgesia and psychomotor performance. Forty patients scheduled for elective surgery provided informed consent and were randomized equally to receive either dexmedetomidine (1 µg/kg initial loading dose for 10 min; maintenance, 0.40.7 µg · kg-1 · h-1) or propofol (75 µg · kg-1 · min-1 x 10 min; maintenance, 12.575 µg · kg-1 · min-1). Hemodynamic variables (heart rate and mean arterial blood pressure), sedation (visual analog scale and Observer Assessment of Alertness/Sedation), bispectral index score of sedation, ventilation (respiratory rate, O2 sat, and ETCO2), psychomotor performance (digital symbol substitution test), and pain (visual analog scale) were determined during surgery and up to 95 min after surgery. Intraoperative sedation levels were targeted to achieve a bispectral index score of 7080. Patient demographics, ASA class, surgical procedure, and baseline cardio-respiratory variables were similar between groups. Sedation was achieved more rapidly with propofol but was similar between groups 25 min after initiating infusions. The average infusion rate for dexmedetomidine was 0.7 µg · kg-1 · h-1 and 38 µg · kg-1 · min-1 for propofol. There were no differences between groups in psychomotor performance and respiratory rate during recovery. The previous use of dexmedetomidine resulted in more sedation, lower blood pressure, and improved analgesia (less morphine use) in recovery. Dexmedetomidine may be useful for perioperative sedation. It has a slower onset and offset of sedation compared with propofol. Dexmedetomidine was associated with improved analgesia and less morphine use in the postoperative period.

 

硬膜外穿刺后鼠模型观察硬膜外注射血液和其他药液时颅内血流调节机制

The Mechanisms of Intracranial Pressure Modulation by Epidural Blood and Other Injectates in a Postdural Puncture Rat Model

Jeffrey S. Kroin, PhD, Subhash K.S. Nagalla, MD, Asokumar Buvanendran, MD

epartment of Anesthesiology, Rush Medical College at Rush-Presbyterian-St. Lukes Medical Center, Chicago, Illinois

Anesth Analg 2002;95

硬膜外血液填补被认为是治疗硬膜外穿刺后头痛的有效的方法。我们硬膜外穿刺后鼠模型来定量评价硬膜外注射血液和其他药液时颅内血流(CSF)变化的程度和时间。这种模型用来比较硬膜外注射不同药物恢复和维持CSF压力达240分钟。腰部硬膜外穿刺后CSF压力下降3.6 ± 0.2 mm Hg,在硬膜外穿刺点注射盐水100 µL,最初压力增加7.2 ± 0.7 mm Hg,但迅速7.8 ± 0.6 min下降到基线。注射其他药物可观察到类似最初压力增加的变化,但持续时间有很大的不同,贺斯和低佑40结果与盐水相似。仅全血和纤维凝胶持续增加CSF压力达240分钟,距穿刺点向头端20mm注射全血加凝剂不能维持压力。在椎板切开后在硬膜外直用或粘合剂不能维持压力。注射初量后持续输注盐水能维持压力增加达180分钟,但停止输注后压力回到基线。这结果证明硬膜外注射全血和纤维凝胶纠正硬膜外穿刺后CSF低压是有效的,且提供了解颅内压的调节机制。除非硬膜外填塞是持续的,否则对纠正CSF压力无效。(张德林译 薛张刚校)

The epidural blood patch is considered effective in treating postdural puncture headache. We have developed a postdural puncture model in rats for quantitative evaluation of the magnitude and duration of changes in cerebrospinal fluid (CSF) pressure in the cisterna magna in response to the administration of epidural blood or other moieties. This model was used to compare the efficacy of various methods of epidural injection for restoring and maintaining CSF pressure for up to 240 min. After lumbar dural puncture, CSF pressure declined 3.6 ± 0.2 mm Hg. Epidural saline (100 µL) injected at the puncture site initially increased pressure by 7.2 ± 0.7 mm Hg, but it rapidly (7.8 ± 0.6 min) returned to postdural puncture baseline. A similar initial increase of CSF pressure was observed with equal volumes of all other epidural injectates, but the duration of pressure increase varied greatly. Hetastarch and dextran 40 produced results similar to saline. Only whole blood or fibrin glue consistently increased CSF pressure for the entire 240-min observation period. Whole blood mixed with anticoagulant or injected 20-mm cephalad to the puncture site did not sustain pressure. After laminectomy, direct application of blood or adhesive to the dural defect caused no pressure increase. Continuous infusion of saline after bolus could maintain pressure increase for 180 min, but within 60 min of stopping infusion, pressure returned to baseline. These results confirm the efficacy of the epidural administration of blood or fibrin glue to correct CSF hypotension after dural puncture and also provide insight into the mechanisms of intracranial pressure modulation. Sealing the dural defect does not effectively correct CSF pressure unless an epidural tamponade effect is also maintained.

 

.三种麻醉技术应用于幕上颅内手术病人的比较

A Comparison of Three Anesthetic Techniques in Patients Undergoing Craniotomy for Supratentorial Intracranial Surgery

Pekka Talke, MD, James E. Caldwell, MBChB, Ronald Brown, BS, Barbara Dodson, MD, Joan Howley, MD, and Charles A. Richardson, PhD

Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California

Anesth Analg 2002;95:430-435

 

几种麻醉技术已成功用于颅内幕上肿块切除手术的麻醉,其中之一为在关颅时将吸入麻醉更改为异丙酚麻醉促进病人尽快恢复的方法。然而,目前尚无临床资料证明该种方法对颅脑手术病人术后恢复的临床优点。在本研究中选择60例择期行颅内幕上肿块切除手术的病人,对三种麻醉技术进行了评估。将病人随机分为三组:异丙酚麻醉组、异氟醚麻醉组以及异丙酚和异氟醚复合麻醉组。在复合麻醉组,当硬脑膜关闭后停止吸入异氟醚,同时改用异丙酚麻醉。观察术中和术后病人的血流动力学参数以及麻醉后2小时内的几个神志恢复变量。各组病人术中的基础血压、平均压及心率无明显差异。各组病人的心率和血压在气管插管、探针放置及术后恢复阶段均有同样幅度的升高。各恢复事件的时间(如睁眼、拔管、指令动作、方向识别和Aldrete评分)或精神运动测试均无明显差异。因此我们认为与单独应用异氟醚麻醉相比,术中按次序复合应用异氟醚和异丙酚并不能促进病人意识和认识能力的早期恢复。

                                                (齐波 译   王祥瑞 校)

Several anesthetic techniques have been used successfully to provide anesthesia for resection of intracranial supratentorial mass lesions. One technique used to enhance recovery involves changing anesthesia from vapor-based to propofol-based for cranial closure. However, there are no data to support a beneficial effect of this approach in the immediate postoperative period after craniotomy. We evaluated 3 anesthetic techniques in 60 patients undergoing elective surgery for supratentorial mass lesions. Patients were randomly assigned to three anesthesia study groups: propofol infusion, isoflurane inhalation, and these two techniques combined. In the combination group, once the dura was closed, isoflurane was discontinued and propofol infusion simultaneously started. We studied intra- and postoperative hemodynamics and several recovery variables for 2 h after the end of anesthesia. Baseline and average intraoperative blood pressure and heart rate values did not differ among the groups. Heart rate and blood pressure increased similarly in all groups in response to intubation and pin placement and postoperatively. None of the recovery event times (open eyes, extubation, follow commands, oriented, Aldrete score) or psychomotor test performance differed significantly. We conclude that the sequential administration of isoflurane and propofol did not provide earlier recovery and cognition than the intraoperative use of isoflurane alone.

 

鞘内和硬膜外注射吗啡用于择期剖宫产术后镇痛的对比研究

A Double-Blinded, Randomized Comparison of Intrathecal and Epidural Morphine for Elective Cesarean Delivery

J. Sarvela, MD PhD, P. Halonen, MD, A. Soikkeli, MD, and K. Korttila, MD PhD, FRCA

Department of Anaesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland

Anesth & Analg August 2002 95: 436-440

目的 比较鞘内和硬膜外注射吗啡的镇痛效果和副作用的发生率。方法 在腰-硬联合麻醉下行剖宫产手术的病人共150例,按术后镇痛方式随机分为鞘内吗啡100ug组、鞘内吗啡 200 ug组和硬膜外吗啡3mg组。另外,病人每天服用酮洛酚300mg。术后24h内每3h记录术后疼痛程度和副作用发生率。结果 各组病人的术后疼痛得到了有效控制(优良率90%),但鞘内吗啡100ug组与另外二组比较,产妇需要更多的额外镇痛药物。瘙痒是三组病人术后镇痛最常见的并发症,硬膜外吗啡3mg组、鞘内吗啡 100 ug组和鞘内吗啡 200 ug组的发生率分别为74% 65% 91%,其中需药物治疗的病人比例分别为44% 24%45%。各组病人术后恶心呕吐的发生率无差别。结论 由于鞘内吗啡100ug组瘙痒发生率低,需治疗者少,因此,术后镇痛推荐鞘内注射吗啡100ug配合应用酮洛酚,但仍应按需辅助其它镇痛药物。

 

                                     (王士雷 摘  庄心良 校)

 

We randomized 150 parturients into a double-blinded trial to receive intrathecal (IT) 100 µg (IT 100 group) or 200 µg (IT 200 group) or epidural 3 mg (Epidural group) of morphine for elective cesarean delivery with a combined spinal/epidural technique. The patients additionally received ketoprofen 300 mg/d. Postoperative pain relief and side effects were registered every 3 h up to 24 h, and all patients were interviewed on the first postoperative day. Pain control was equally good, but the parturients in the IT 100 group requested rescue analgesics more often compared with the other groups (P < 0.05). Itching was a common complaint and was reported by 74% of the parturients in the Epidural group and 65% and 91% in the IT 100 and IT 200 groups, respectively (P < 0.01). Medication for itching was requested by 44%, 24%, and 45% of the patients, respectively (P < 0.05). There was no difference in postoperative nausea or vomiting. The pain relief was perceived as good by >90% of the patients in all groups. In conclusion, because of the decreased incidence of and lesser requirements of medication for itching, IT morphine 100 µg with ketoprofen is recommended in cesarean deliveries. Rescue analgesics nevertheless need to be prescribed.

 

应用前臂或上臂止血带实施利多卡因-酮咯酸静脉局部麻醉镇痛效能的对比研究

An Evaluation of the Analgesic Efficacy of Intravenous Regional Anesthesia with Lidocaine and Ketorolac Using a Forearm Versus Upper Arm Tourniquet

 

Scott S. Reuben, MD*, Robert B. Steinberg, MD PhD*, Holly Maciolek, RN*, and Poornachandran Manikantan, MD*

 

Department of Anesthesiology, *Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts

Anesth & Analg August 2002 95: 457-460

 

目的 评估门诊手部手术时应用前臂以及上臂止血带实施利多卡因-酮咯酸经静脉局部麻醉(IVRA)的镇痛效能。方法 将所选的在IVRA下行门诊手部手术的病人随机分为上臂IVRA组和前臂IVRA上臂IVRA组的药物配方是利多卡因200 mg酮咯酸20 mg (0.5 mg/mL) 稀释至40 mL。前臂IVRA组的药物配方是利多卡因100 mg酮咯酸10 mg (0.5 mg/mL) 稀释至20 mL。记录感觉阻滞的起效和持续时间以及术后镇痛和使用镇痛药的情况。结果 前臂IVRA组的病人无需镇痛药镇痛的时间 (701 ± 133 min) 显著长于上臂IVRA (624 ± 80 min) (P = 0.032)。两组感觉阻滞起效时间相似,但前臂IVRA组感觉恢复时间 (22 ± 5 min) 显著长于上臂IVRA (13 ± 3 min) (P < 0.05)。两组之间术后镇痛药的使用和镇痛评分无差异。由此可见,门诊手部手术时实施利多卡因-酮咯酸前臂IVRA能提供安全有效的围术期镇痛,其与上臂IVRA相比感觉阻滞和术后镇痛时间延长,且利多卡因和酮咯酸用量减少一半。结论 使用上臂IVRA所需利多卡因和酮咯酸的50%剂量实施前臂IVRA能提供更长时间感觉阻滞和术后镇痛。

 

(葛圣金译  庄心良校)

 

Intravenous regional anesthesia (IVRA) using a forearm tourniquet may be a potentially safer technique compared with using an upper arm tourniquet. Ketorolac is a useful adjuvant to lidocaine for IVRA. In this study, we assessed the analgesic efficacy of administering IVRA lidocaine and ketorolac with either a forearm or upper arm tourniquet for outpatient hand surgery. Upper arm IVRA was established using 40 mL of a solution containing 200 mg of lidocaine and ketorolac 20 mg (0.5 mg/mL). Forearm IVRA was established using 20 mL of a solution containing 100 mg of lidocaine and ketorolac 10 mg (0.5 mg/mL). Onset and duration of sensory block as well as postoperative pain and analgesic use were recorded. The patients who received forearm IVRA had a significantly longer period during which they required no analgesics (701 ± 133 min) compared with 624 ± 80 min for the upper arm IVRA ketorolac patients (P = 0.032). Onset of sensory block was similar between the two groups; however, recovery of sensation was significantly longer in the Forearm IVRA (22 ± 5 min) group compared with the Upper Arm IVRA (13 ± 3 min) group (P < 0.05). There were no differences in postoperative analgesic use or pain scores between the two groups. We conclude that forearm IVRA with lidocaine and ketorolac provides safe and effective perioperative analgesia for patients undergoing ambulatory hand surgery. This technique results in a longer duration of sensory block and prolonged postoperative analgesia compared with upper arm IVRA while using one-half the doses of both lidocaine and ketorolac.

 

腹腔镜胆囊切除术后通过导管向胆囊窝内间断注射0.5%布比卡因的镇痛研究

Postoperative Pain Relief Using Intermittent Injections of 0.5% Ropivacaine Through a Catheter After Laparoscopic Cholecystectomy

Anil Gupta, MD FRCA, PhD*, Sven E. Thörn, MD PhD*, Kjell Axelsson, MD PhD*, Lars G. Larsson, MD, Göran Ågren, MD, Björn Holmström, MD PhD*, and Narinder Rawal, MD PhD*

Departments of *Anesthesiology and Intensive Care, Surgery, and Division for Ambulatory Surgery, University Hospital, Örebro, Sweden

Anesth Analg 2002;95:450-456

 

术后疼痛是限制日间腹腔镜胆囊切除开展的一个重要因素。选择40ASA I-II的病人,采用异丙酚诱导,七氟醚、空氧混合气维持麻醉。在麻醉结束时,将病人随机分为两组:P(安慰剂组)R(0.5罗哌卡因)。术毕通过放置于胆囊窝内的一个导管将20ml生理盐水或布比卡因分别注射入腹腔内。术后当病人感到疼痛时,间断注射10ml的研究药物,并静脉注射1-2mg 凯托米酮。在术后12348121620小时,以及术后第一周内每隔一天应用视觉模拟疼痛评分评估病人休息时(深疼痛)、肩部和切口以及咳嗽时的疼痛程度。在病人从第一阶段到第二阶段期间,评估病人行走、喝水、进食以及排泄的能力。并测定了8例病人的血浆罗哌卡因浓度。有关病人恢复行走、排便、驾车以及正常日常活动能力的时间,我们通过调查问卷的形式进行调查。在术后第一个4小时,R组病人深疼痛和咳嗽后疼痛的评分比P组病人低(P<0.05)。两组病人术后Ketobemidone 的用量无明显差异。两组病人在家中恢复的中位时间是相似的。在术后第七天时93%的病人恢复了正常的日常生活能力。因此我们认为于胆囊窝内间断0.5%罗哌卡因可缓解行走腹腔镜胆囊切除病人术后早期疼痛。

                                             (齐波 译   王祥瑞 校)

Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status III patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were randomized into one of two groups: Group P (Placebo) and Group R (0.5% Ropivacaine). Twenty milliliters of normal saline or ropivacaine, respectively, were injected intraperitoneally at the end of surgery via a catheter placed in the bed of the gall bladder. Postoperatively, intermittent injections (10 mL) of the study solution were given when required for pain. Ketobemidone 12 mg was given IV as rescue medication. Pain was assessed using a visual analog scale at 1, 2, 3, 4, 8, 12, 16, and 20 h after surgery and once each day for 1 wk at rest (deep pain), shoulder and incision sites, and pain during coughing. Recovery was assessed by the time to transfer from Phase 1 to 2, the ability to walk, drink, and eat, and the ability to void. Plasma concentrations of ropivacaine were measured in eight patients. Time to ability to walk, defecation, driving a car, and return to normal activities were also recorded through a questionnaire sent home with the patient. During the first 4 postoperative h, patients in Group R had lower scores for deep pain and during coughing compared with Group P (P < 0.05). No differences were found in the postoperative consumption of ketobemidone. Median times to recovery at home were similar between the groups. By the seventh day, 93% of the patients had returned to normal activities of daily living. We conclude that the early postoperative pain after ambulatory laparoscopic cholecystectomy could be relieved using intermittent injections of ropivacaine 0.5% into the bed of the gall bladder.

 

硬膜外/全麻复合麻醉和硬膜外术后镇痛对腹腔镜或开腹结直肠手术病人的肠道功能恢复和体温调节的影响

Temperature Control and Recovery of Bowel Function After Laparoscopic or Laparotomic Colorectal Surgery in Patients Receiving Combined Epidural/General Anesthesia and Postoperative Epidural Analgesia

Giorgio Danelli, MD*, Marco Berti, MD*, Valeria Perotti, MD*, Andrea Albertin, MD*, Paolo Baccari, MD, Francesco Deni, MD*, Guido Fanelli, MD*, and Andrea Casati, MD*

*Department of Anesthesiology and Emergency Surgery, Vita-Salute University of Milano, IRCCS H.S. Raffaele, Milano, Italy

Anesth Analg 2002;95:467-471

 

比较44名硬膜外/全麻复合麻醉下开腹(n=21)和腹腔镜(n=23)成人结直肠手术病人体温调节的影响。胸段硬膜外阻滞,给予0.75%罗哌卡因6-10ml,麻醉平面最高到T4, 全麻诱导静注硫喷妥钠,芬太尼,和卡肌宁;异氟醚吸入维持麻醉。通过膀胱探针测量中心体温,诱导后每15分钟记录一次。手术结束后两组病人的中心体温都下降到35.2℃(范围,34-36℃)。手术后,腹腔镜组病人在75分钟后(60-120分钟)体温恢复正常;开腹组病人在60分钟后(45-180分钟)体温恢复正常(P = 0.56)。术后24h72h内腹腔镜手术病人咳嗽引起疼痛的程度要小于开腹组病人(P < 0.01)。开腹组病人术后镇痛吗啡用量为 22 mg2-65mg),腹腔镜组病人吗啡用量为5 mg0-45mg)(P = 0.02)。腹腔镜组病人第一次排气的时间(24h[16-72h])短于开腹组病人(72h[26-96h])(P =0.0005),腹腔镜组病人在术后48h24-72h)首次进食无渣流质;开腹组病人在术后96h90-96h)首次进食无渣流质(P = 0.0005)。虽然腹腔镜手术对术后疼痛程度和肠道功能恢复有积极的影响,但腹腔镜手术中最少地暴露肠管所减少的热量损失并不能补偿麻醉等相关因素的对体温调节的影响,因此腹腔镜手术时也必须积极地对病人进行保温。

                                    (殷文渊 译   王祥瑞 校)

We compared the effects of a laparoscopic (n = 23) versus laparotomic (n = 21) technique for major abdominal surgery on temperature control in 44 patients undergoing colorectal surgery during a combined epidural/general anesthesia. A thoracic epidural block up to T4 was induced with 610 mL of 0.75% ropivacaine; general anesthesia was induced with thiopental, fentanyl, and atracurium IV and maintained with isoflurane. Core temperature was measured with a bladder probe and recorded every 15 min after the induction. In both groups, core temperature decreased to 35.2°C (range, 34°C36°C) at the end of surgery. After surgery, normothermia returned after 75 min (60120 min) in the Laparoscopy group and 60 min (45180 min) in the Laparotomy group (P = 0.56). No differences in postanesthesia care unit discharge time were reported between the two groups. The degree of pain during coughing was smaller after laparoscopy than laparotomy from the 24th to the 72nd observation times (P < 0.01). Morphine consumption was 22 mg (265 mg) in the Laparotomy group and 5 mg (045 mg) in the Laparoscopy group (P = 0.02). The time to first flatus was shorter after laparoscopy (24 h [1672 h]) than laparotomy (72 h [2696 h]) (P = 0.0005), and the first intake of clear liquid occurred after 48 h (2472 h) in the Laparoscopy group and after 96 h (9096 h) in the Laparotomy group (P = 0.0005). Although laparoscopic surgery provides positive effects on the degree of postoperative pain and recovery of bowel function, the reduction in heat loss produced by minimizing bowel exposure with laparoscopic surgery does not compensate for the anesthesia-related effects on temperature control, and active patient warming must also be used with laparoscopic techniques.

 

围术期胃排空不能预测经腹腔镜胆囊切除术后早期恶心呕吐的发生

Perioperative Gastric Emptying Is Not a Predictor of Early Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

M. Wattwil, MD PhD*, S.-E. Thörn, MD PhD*, A Lövqvist*, L. Wattwil*, H. Klockhoff, MD, L.-G. Larsson, MD, and I. Näslund, MD PhD

Departments of *Anesthesiology and Intensive Care and Surgery, Örebro University Hospital, Örebro; and Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden

 

Anesth Analg 2002;95:476-479

 

目的  比较在镜腹腔下胆囊切除术术后即刻发生术后恶心呕吐与未发生恶心呕吐的病人的胃排空率。 方法  采用对乙酰氨基酚法研究胃的排空率。40ASA-Ⅱ级的病人,在麻醉诱导后放置胃管,从中注入用200ml水稀释的对乙酰氨基酚1.5克。在注入前和注入后180分钟内每15分钟抽静脉血测定血浆对乙酰氨基酚浓度。结果  26例病人在术后4小时内发生恶心,而其它14例病人没有恶心。二者血浆对乙酰氨基酚峰浓度、达峰时间、在用药后0-60分钟、0-120分钟、0-180分钟内血浆药物浓度曲线下面积无统计学显著差异。结论 术后胃排空速度和恶心呕吐间存在任何联系,故胃排空速率不是术后恶心呕吐的预测因素。

                      (颜涛 译  庄心良 校)

It is not known whether patients with postoperative nausea and vomiting (PONV) have delayed gastric emptying compared with patients without PONV. We compared the perioperative rate of gastric emptying in patients experiencing PONV with the rate in those without PONV immediately after laparoscopic cholecystectomy. Gastric emptying was studied by the acetaminophen method. Acetaminophen is not absorbed from the stomach but is rapidly absorbed from the small intestine, and the rate of gastric emptying therefore determines the rate of absorption of acetaminophen administered into the stomach. Forty patients (ASA physical status I and II) were included in the study. After the induction of anesthesia, a gastric tube was positioned in the stomach and 1.5 g of acetaminophen dissolved in 200 mL of water was administered. Venous blood samples for the determination of serum acetaminophen concentrations were taken before and at 15-min intervals during a period of 180 min after the administration of acetaminophen. Twenty-six patients experienced nausea during the first 4 h postoperatively. The other 14 patients had no nausea. There were no statistically significant differences in the maximal acetaminophen concentration, the time taken to reach the maximal concentration, or the area under the serum acetaminophen concentration time curves from 0 to 60, 0120, and 0180 min between the groups of patients with or without PONV. We did not find any relationship between postoperative gastric emptying and PONV, and therefore gastric emptying is not a predictor of PONV.

 

比较应用喉镜和Lightwand气管插管装置 (Trachlight®)两者行成人正常气道气管内插管的血流动力学反应

Hemodynamic Responses to Tracheal Intubation with Laryngoscope Versus Lightwand Intubating Device (Trachlight®) in Adults with Normal Airway

Shinji Takahashi, MD*, Taro Mizutani, MD, Masayuki Miyabe, MD*, and Hidenori Toyooka, MD*

Departments of *Anesthesiology and Critical Care Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan

Anesth Analg 2002;95:480-484

目的 使用Lightwand 辅助进行气管插管是一种有效而且安全的措施。理论上,避免行直视下喉镜气管插管相对于传统的用喉镜气管插管法能够减少气管插管引起的刺激。我们设计了一个前瞻性随机化研究来评价正常成人在七氟醚麻醉下行Lightwand或直接喉镜气管插管后心血管系统的变化。方法60例健康、正常气道的成人根据插管方式的不同随机分为三组,三组均使用七氟醚混合笑气麻醉(吸入氧浓度为0.33)(每组20例)。Lightwand 组使用Trachlight®装置完成气管内插管,喉镜气管插管组使用直视喉镜(Macintosh 喉镜片)进行气管插管,而第三组仅行喉镜检查。在从容地行气管内插管后或喉镜检查5分钟内持续记录心率和收缩压。所有的操作均一次成功。结果 使用Trachlight®装置行气管内插管组出现的最快心率和最高收缩压(分别是114 ± 20 bpm 143 ± 30 mm Hg)与使用Macintosh喉镜插管组(分别是114 ± 20 bpm 138 ± 23 mm Hg)没有差别,但是两组的最快心率和最高收缩压都显著大于仅行喉镜检查组(分别是94 ± 19 bpm 112 ± 21 mm Hg)(P < 0.05)。结论 气管插管术中对气管的直接刺激是引起血流动力学改变的一个主要因素。

                                                  (李懿 译 薛张刚校)

Lightwand devices are effective and safe as an aid to tracheal intubation. Theoretically, avoiding direct-vision laryngoscopy could allow for less stimulation by intubation than the conventional laryngoscopic procedure. We designed this prospective randomized study to assess the cardiovascular changes after either lightwand or direct laryngoscopic tracheal intubation in adult patients anesthetized with sevoflurane. Sixty healthy adult patients with normal airways were randomly assigned to one of three groups according to intubating procedure under sevoflurane/nitrous oxide anesthesia (fraction of inspired oxygen = 0.33) (n = 20 each). The lightwand group received tracheal intubation with Trachlight®, the laryngoscope-intubation group received tracheal intubation with a direct-vision laryngoscope (Macintosh blade), and the laryngoscopy-alone group received the laryngoscope alone. Heart rate and systolic blood pressure were recorded continuously for 5 min after tracheal intubation or laryngoscopy with enough time to intubate. All procedures were successful on the first attempt. The maximum heart rate and systolic blood pressure values obtained after intubation with Trachlight (114 ± 20 bpm and 143 ± 30 mm Hg, respectively) did not differ from those with the Macintosh laryngoscope (114 ± 20 bpm and 138 ± 23 mm Hg), but they were significantly larger than those in the laryngoscopy-alone group (94 ± 19 bpm and 112 ± 21 mm Hg) (P < 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation..