Anesthesia & Analgesia

July 2003

CARDIOVASCULAR ANESTHESIA:

蛛网膜下腔注射阿片类药物和静脉镇痛两者对腹主动脉术后心血管、呼吸及肾脏并发症发生率的影响的比较

(廖庆武 译 薛张纲 校)

A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular, Respiratory, and Renal Complications After Abdominal Aortic Surgery

Marie-Hélène Fléron, Richard B. Weiskopf, Michèle Bertrand, Stéphane Mouren, Daniel Eyraud, Gilles Godet, Bruno Riou, Edouard Kieffer, and Pierre Coriat

Anesth Analg 2003 97: 2-12.

体外循环实验中氯美噻唑对血浆内Il-6,Il-8,Il-1β,TNF-α浓度及中性粒细胞粘附因子表达的影响

(朱辉译 王祥瑞 )

The Effect of Clomethiazole on Plasma Concentrations of Interleukin-6, -8, -1ß, Tumor Necrosis Factor-{alpha}, and Neutrophil Adhesion Molecule Expression During Experimental Extracorporeal Circulation

D. Harmon, E. Coleman, C. Marshall, W. Lan, and G. Shorten

Anesth Analg 2003 97: 13-18.

PEDIATRIC ANESTHESIA:

美国肝移植麻醉术中应用资源的调查

(王士雷 庄心良 校)

Intraoperative Resource Utilization in Anesthesia for Liver Transplantation in the United States: A Survey

Roman Schumann

Anesth Analg 2003 97: 21-28.

普通气道手法在儿童增殖腺切除术中对气道压力和流量的效应

(廖庆武 译 薛张纲 校)

The Effects of Common Airway Maneuvers on Airway Pressure and Flow in Children Undergoing Adenoidectomies

Heinz Bruppacher, Adrian Reber, Jürg P. Keller, Jeremy Geiduschek, Thomas O. Erb, and Franz J. Frei

Anesth Analg 2003 97: 29-34.

Rofecoxib术后镇痛效果和安全性的评估

(朱辉 译  王祥瑞  )

An Evaluation of the Safety and Efficacy of Administering Rofecoxib for Postoperative Pain Management

Wandana Joshi, Neil Roy Connelly, Scott S. Reuben, Marten Wolckenhaar, and Nikhil Thakkar

Anesth Analg 2003 97: 35-38.

BIS在小儿意识和深度镇静监测中的价值

(王士雷   庄心良 校)

Validation of the Bispectral Index Monitor During Conscious and Deep Sedation in Children

Nicole Brown McDermott, Tamitha VanSickle, Dominika Motas, and Robert H. Friesen

Anesth Analg 2003 97: 39-43.

在婴儿、儿童和成人使用靶控输注罗库溴铵:比较其药物动力学和药效学的关系

(廖庆武 译 薛张纲 校)

Target-Controlled Infusion of Rocuronium in Infants, Children, and Adults: A Comparison of the Pharmacokinetic and Pharmacodynamic Relationship

V. Saldien, K. M. Vermeyen, and F. L. Wuyts

Anesth Analg 2003 97: 44-49.

AMBULATORY ANESTHESIA:

小剂量布比卡因或利多卡因蛛网膜下腔麻醉用于宫颈环扎术的比较

(齐波 译  王祥瑞 校)

Subarachnoid Small-Dose Bupivacaine Versus Lidocaine for Cervical Cerclage

Yaakov Beilin, Jeffrey Zahn, Sharon Abramovitz, Howard H. Bernstein, Sabera Hossain, and Carol Bodian

Anesth Analg 2003 97: 56-61.

处理术后恶心呕吐的指导原则

(王士雷 译 庄心良 校)

Consensus Guidelines for Managing Postoperative Nausea and Vomiting (Special Article)

Tong J. Gan, Tricia Meyer, Christian C. Apfel, Frances Chung, Peter J. Davis, Steve Eubanks, Anthony Kovac, Beverly K. Philip, Daniel I. Sessler, James Temo, Martin R. Tramèr, and Mehernoor Watcha

Anesth Analg 2003 97: 62-71

ANESTHETIC PHARMACOLOGY:

异丙酚的药物动力学与药效学:以优化的环糊精形式和脂质形式——在猪模型中的脑电图与血液动力学研究

(顾越超 薛张刚 校)

The Pharmacokinetics and Pharmacodynamics of Propofol in a Modified Cyclodextrin Formulation (Captisol®) Versus Propofol in a Lipid Formulation (Diprivan®): An Electroencephalographic and Hemodynamic Study in a Porcine Model

Talmage D. Egan, Steven E. Kern, Kenward B. Johnson, and Nathan L. Pace

Anesth Analg 2003 97: 72-79.

在顺式阿曲库胺诱导的神经肌肉阻滞恢复时强直刺激后计数与四个成串刺激反应的关系

(顾越超 薛张刚 校)

The Relationship of Posttetanic Count and Train-of-Four Responses During Recovery from Intense Cisatracurium-Induced Neuromuscular Blockade

Mohammad I. El-Orbany, Ninos J. Joseph, and M. Ramez Salem

Anesth Analg 2003 97: 80-84.

普鲁卡因和盐酸甲哌卡因毒性作用小于临床其它局麻药的离体研究

(齐波 译  王祥瑞 校)

Procaine and Mepivacaine Have Less Toxicity In Vitro Than Other Clinically Used Local Anesthetics

Toshiharu Kasaba, Shin Onizuka, and Mayumi Takasaki

Anesth Analg 2003 97: 85-90.

大鼠快速输注阿米替林布比卡因和左旋布比卡因的相对毒性

(王士雷译  庄心良 校)

The Relative Toxicity of Amitriptyline, Bupivacaine, and Levobupivacaine Administered as Rapid Infusions in Rats

Venkatesh Srinivasa, Peter Gerner, Anna Haderer, Salahadin Abdi, Petr Jarolim, and Ging Kuo Wang

Anesth Analg 2003 97: 91-95.

缺乏右旋(Cav2.3)钙通道大鼠对异丙酚和氟烷的麻醉敏感性

(顾越超 薛张刚 校)

Anesthetic Sensitivities to Propofol and Halothane in Mice Lacking the R-Type (Cav2.3) Ca2+ Channel

Tetsuhiro Takei, Hironao Saegusa, Shuqin Zong, Takayuki Murakoshi, Koshi Makita, and Tsutomu Tanabe

Anesth Analg 2003 97: 96-103.

氯胺酮和戊巴比妥对爪蟾卵母细胞上P物质受体表达的抑制作用

(忻纪华 译  王祥瑞 校)

The Inhibitory Effects of Ketamine and Pentobarbital on Substance P Receptors Expressed in Xenopus Oocytes

Takashi Okamoto, Kouichiro Minami, Yasuhito Uezono, Junichi Ogata, Munehiro Shiraishi, Akio Shigematsu, and Yoichi Ueta

Anesth Analg 2003 97: 104-110.

异氟醚浓度在0.8 1.2MAC时抑制弥散伤害性抑制控制

(王士雷    庄心良 校)

Isoflurane Depresses Diffuse Noxious Inhibitory Controls in Rats Between 0.8 and 1.2 Minimum Alveolar Anesthetic Concentration

Steven L. Jinks, Joseph F. Antognini, and Earl Carstens

Anesth Analg 2003 97: 111-116.

单一剂量鼻内盐酸二氢吗啡酮在健康志愿者中的药代动力学和生物利用度

(梁雅芬译 薛张刚 校)

Pharmacokinetics and Bioavailability of Single-Dose Intranasal Hydromorphone Hydrochloride in Healthy Volunteers

Barbara A. Coda, Anita C. Rudy, Sanford M. Archer, and Daniel P. Wermeling

Anesth Analg 2003 97: 117-123.

应用人类在体组织微透析模型评价布比卡因负荷微囊释放的药动学和药代学改变

 (忻纪华 译   王祥瑞 校)

A Model to Evaluate the Pharmacokinetic and Pharmacodynamic Variables of Extended-Release Products Using In Vivo Tissue Microdialysis in Humans: Bupivacaine-Loaded Microcapsules

Dan J. Kopacz, Christopher M. Bernards, Hugh W. Allen, Craig Landau, Partha Nandy, Danlin Wu, and Peter G. Lacouture

Anesth Analg 2003 97: 124-131.

TECHNOLOGY, COMPUTING, AND SIMULATION:

手术病人的内隐记忆随不同的脑电图镇静程度而出现差异

(王士雷    庄心良 校)

Implicit Memory Varies as a Function of Hypnotic Electroencephalogram Stage in Surgical Patients

Sinikka Münte, Thomas F. Münte, Jörg Grotkamp, Gertrud Haeseler, Konstantinos Raymondos, Siegfried Piepenbrock, and Gabriele Kraus

Anesth Analg 2003 97: 132-138.

异丙酚和雷米芬太尼麻醉诱导中ARX源性的听觉诱发电位指数和脑电双频指数的研究

(梁雅芬 译 薛张刚 校)

ARX-Derived Auditory Evoked Potential Index and Bispectral Index During the Induction of Anesthesia with Propofol and Remifentanil

Gunter N. Schmidt, Petra Bischoff, Thomas Standl, Malte Issleib, Moritz Voigt, and Jochen Schulte am Esch

Anesth Analg 2003 97: 139-144.

测量压力-容量关系时吸气流量设置的指导

(殷文渊 译  王祥瑞  )

Guidelines for Inspiratory Flow Setting When Measuring the Pressure-Volume Relationship

Fábio E. Bensenor, Joaquim E. Vieira, and Jose Otávio C. Auler, Jr.

Anesth Analg 2003 97: 145-150.

在干燥过程中CO2吸附剂的颜色变化:含水量的体外研究  

(王士雷 译  庄心良 校)

The Color Change in CO2 Absorbents On Drying: An In Vitro Study Using Moisture Analysis

Erich Knolle, Wolfgang Linert, and Hermann Gilly

Anesth Analg 2003 97: 151-155.

PAIN MEDICINE:

不同制度间慢性疼痛管理对一年预后前瞻性研究:控制护理制度损害了它的有效性

(梁雅芬 译 薛张刚 校)

A Prospective One-Year Outcome Study of Interdisciplinary Chronic Pain Management: Compromising Its Efficacy by Managed Care Policies

Heather Robbins, Robert J. Gatchel, Carl Noe, Noor Gajraj, Peter Polatin, Martin Deschner, Akshay Vakharia, and Laura Adams

Anesth Analg 2003 97: 156-162.

氯胺酮和阿米替林对轻度热损伤大鼠的外周抗痛觉过敏和镇痛作用

(王士雷    庄心良 校)

Peripheral Antihyperalgesic and Analgesic Actions of Ketamine and Amitriptyline in a Model of Mild Thermal Injury in the Rat

Mark Oatway, Allison Reid, and Jana Sawynok

Anesth Analg 2003 97: 168-173.

经静脉单剂量注射KRN5500(抗生素,司匹米星)可长期降低神经性疼痛的多发性感觉超敏

(梁雅芬 译 薛张刚 校)

A Single Intravenous Injection of KRN5500 (Antibiotic Spicamycin) Produces Long-Term Decreases in Multiple Sensory Hypersensitivities in Neuropathic Pain

L. A. Kobierski, S. Abdi, L. DiLorenzo, N. Feroz, and D. Borsook

Anesth Analg 2003 97: 174-182.

CRITICAL CARE AND TRAUMA:

多巴酚丁胺抑制人类单核细胞趋化蛋白-1的产生及趋化作用

(费敏 译 薛张刚 校)

Dobutamine Inhibits Monocyte Chemoattractant Protein-1 Production and Chemotaxis in Human Monocytes

Chi-Yuan Li, Chien-Sung Tsai, Sheau-Huei Chueh, Ping-Ching Hsu, Jia-Yi Wang, Chih-Shung Wong, and Shung-Tai Ho

Anesth Analg 2003 97: 205-209.

多巴胺调节人体单核细胞内脂多糖诱导巨噬细胞炎性蛋白-1α和白介素-8的产生

(殷文渊 译  王祥瑞  )

Dobutamine Modulates Lipopolysaccharide-Induced Macrophage Inflammatory Protein-1{alpha} and Interleukin-8 Production in Human Monocytes

Chi-Yuan Li, Chien-Sung Tsai, Ping-Ching Hsu, Ching-Tang Wu, Chih-Shung Wong, and Shung-Tai Ho

Anesth Analg 2003 97: 210-215.

新鲜冷冻血浆对中心粒细胞-内皮细胞相互作用的影响

(王士雷 译  庄心良 校)

The Effects of Fresh Frozen Plasma on Neutrophil-Endothelial Interactions

Boris Nohé, Ralph Thomas Kiefer, Annette Ploppa, Helene A. Haeberle, Torsten H. Schroeder, and Hans-Juergen Dieterich

Anesth Analg 2003 97: 216-221.

莫匹罗星抗经鼻气管内插管相关细菌携带的保护效应

(费敏 译 薛张刚 校)

The Preventive Effects of Mupirocin Against Nasotracheal Intubation-Related Bacterial Carriage

Satoshi Takahashi, Kouichiro Minami, Midori Ogawa, Hiroshi Miyamoto, Kunio Ikemura, Akio Shigematsu, and Hatsumi Taniguchi

Anesth Analg 2003 97: 222-225.

尼非地平对猪后期心肺复苏中室颤频率的作用

(陈洁  王祥瑞 )

The Effects of Nifedipine on Ventricular Fibrillation Mean Frequency in a Porcine Model of Prolonged Cardiopulmonary Resuscitation

Karl H. Stadlbauer, Klaus Rheinberger, Volker Wenzel, Claus Raedler, Anette C. Krismer, Hans-Ulrich Strohmenger, Sven Augenstein, Horst G. Wagner-Berger, Wolfgang G. Voelckel, Karl H. Lindner, and Anton Amann

Anesth Analg 2003 97: 226-230.

NEUROSURGICAL ANESTHESIA:

非人灵长类动物颈动脉输入腺苷的急性脑血管反应

(王士雷   庄心良 校)

The Acute Cerebrovascular Effects of Intracarotid Adenosine in Nonhuman Primates

Shailendra Joshi, Roger Hartl, Mei Wang, Lei Feng, Daniel Hoh, Robert R. Sciacca, and Sundeep Mangla

Anesth Analg 2003 97: 231-237.

静脉麻醉药剂量褪黒激素的脑电图效应:和硫喷妥钠及丙泊酚比较研究

(费敏 译 薛张刚 校)

The Electroencephalographic Effects of IV Anesthetic Doses of Melatonin: Comparative Studies with Thiopental and Propofol

Mohamed Naguib, Phillip G. Schmid, III, and Max T. Baker

Anesth Analg 2003 97: 238-243.

OBSTETRIC ANESTHESIA:

小剂量布比卡因-芬太尼脊麻联合吗啡在分娩中的应用

(陈洁   王祥瑞  )

Small Dose Bupivacaine-Fentanyl Spinal Analgesia Combined with Morphine for Labor

Philip E. Hess, Anasuya Vasudevan, Caroline Snowman, and Stephen D. Pratt

Anesth Analg 2003 97: 247-252.

REGIONAL ANESTHESIA:

矫形外科手术后鞘内注射地塞米松、奥丹西隆以及二者复合液对鞘内注射吗啡后呕吐和瘙痒的预防作用

(王士雷   庄心良 校)

A Comparison of Dexamethasone, Ondansetron, and Dexamethasone plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Major Orthopedic Surgery

Szilvia Szarvas, Ramesh S. Chellapuri, Dominic C. Harmon, John Owens, Damian Murphy, and George D. Shorten

Anesth Analg 2003 97: 259-263.

GENERAL ARTICLES:

病态肥胖的病人行腹腔镜术时潮气量和呼吸频率对氧合和呼吸力学的效应

(费敏 译 薛张刚 校

The Effects of Tidal Volume and Respiratory Rate on Oxygenation and Respiratory Mechanics During Laparoscopy in Morbidly Obese Patients

Juraj Sprung, David G. Whalley, Tommaso Falcone, William Wilks, James E. Navratil, and Denis L. Bourke

Anesth Analg 2003 97: 268-274.

长期应用抗抑郁药可以降低术中体温过低的发生率

(齐波 译  王祥瑞  )

Chronic Treatment with Antidepressants Decreases Intraoperative Core Hypothermia

Akira Kudoh, Hajime Takase, and Tomoko Takazawa

Anesth Analg 2003 97: 275-279.

麻醉和肌松状态下成年男性和女性病人ProSealTM喉罩型号的选择

(王士雷 庄心良 校)

Sex-Based ProSealTM Laryngeal Mask Airway Size Selection: A Randomized Crossover Study of Anesthetized, Paralyzed Male and Female Adult Patients

Shinichi Kihara and Joseph Brimacombe

Anesth Analg 2003 97: 280-284.

用引导器换口插管时气管导管管头设计的效应和导管厚度通过喉的能力

(费敏 译 薛张刚 校)

The Effects of Tracheal Tube Tip Design and Tube Thickness on Laryngeal Pass Ability During Oral Tube Exchange with an Introducer

Hiroshi Makino, Takasumi Katoh, Syunji Kobayashi, Hiromichi Bito, and Shigehito Sato

Anesth Analg 2003 97: 285-288.

体外循环实验中氯美噻唑对血浆内Il-6,Il-8,Il-1β,TNF-α浓度及中性粒细胞粘附因子表达的影响

The Effect of Clomethiazole on Plasma Concentrations of Interleukin-6, -8, -1ß, Tumor Necrosis Factor-{alpha}, and Neutrophil Adhesion Molecule Expression During Experimental Extracorporeal Circulation

D. Harmon, MMedsci FCARCSI*, E. Coleman, Dip Lab Med, FCCP{dagger}, C. Marshall, BSc ACP{dagger}, W. Lan, MB*, and G. Shorten, MD PhD*

*Department of Anaesthesia & Intensive Care Medicine, Cork University Hospital, University College Cork; and {dagger}Department of Clinical Perfusion, Cork University Hospital, Cork, Ireland

Anesth Analg 2003;97:13-18

 

氯美噻唑CMZ)是一种神经保护药,具有抗炎作用。本研究观察了体外循环中CMZ对血浆内Il-6,Il-8,Il-1β,TNF-α浓度及中性粒细胞粘附因子表达的影响。研究中抽取了五个健康志愿者的血液各500毫升,随后分成等份(250毫升)的两组,在CMZ组内加入CMZ使血浆内浓度达到40μmol/l,并在37℃下进行体外循环2小时。抽取不同时期的血样标本:(1)献血时,(2)刚加入CMZ时,(3)体外循环306090120分钟后。CMZ组体外循环60分钟后的血浆内Il-6,Il-8TNF-α浓度低于对照组(分别是2.2[0.3]3.2[0.4]14.9[4.8]21.9[18.4]63.3[43.5]132.2[118.9]pg/ml,P<0.05)。体外循环120分钟后,CMZ组内中性粒细胞CD18的表达明显低于对照组(237.5[97.4]280.5[111.5]P=0.03)。体外循环实验中使用CMZ可抑制炎症反应。CMZ的此种作用应该可以在心肺体外循环中通过降低炎症介导的神经学损伤而具有一定的临床意义。

(朱辉译 王祥瑞 )

Clomethiazole (CMZ), a neuroprotective drug, has antiinflammatory actions. We investigated the effects of CMZ administration on plasma concentrations of interleukin (IL)-6, IL-8, IL-1ß, tumor necrosis factor-{alpha}, and neutrophil adhesion molecule expression during experimental extracorporeal circulation. Five healthy volunteers each donated 500 mL of blood, which was subsequently divided into equal portions. Identical extracorporeal circuits were simultaneously primed with donated blood (250 mL) and circulated for 2 h at 37°C. CMZ was added to 1 of the circuits of each pair to achieve a total plasma concentration of 40 µmol/L. Blood samples were withdrawn at (i) donation, (ii) immediately after addition of CMZ, and at (iii) 30, 60, 90, and 120 min after commencing circulation. Plasma concentrations of IL-6, IL-8, and tumor necrosis factor-{alpha} were less in the CMZ group compared with control after 60 min of circulation (2.2 [0.3] versus 3.2 [0.4], 14.9 [4.8] versus 21.9 [18.4], 63.3 [43.5] versus 132.2 [118.9] pg/mL, respectively, P < 0.05). After 120 min of circulation, neutrophils from CMZ-treated circuits showed significantly less CD18 expression compared with control (237.5 [97.4] versus 280.5 [111.5], P = 0.03). The addition of CMZ to experimental extracorporeal circuits decreases the inflammatory response. This effect may be of clinical benefit by decreasing inflammatory-mediated neurological injury during cardiopulmonary bypass.

 

Rofecoxib术后镇痛效果和安全性的评估

An Evaluation of the Safety and Efficacy of Administering Rofecoxib for Postoperative Pain Management

Wandana Joshi, DO, Neil Roy Connelly, MD, Scott S. Reuben, MD, Marten Wolckenhaar, MD, and Nikhil Thakkar, MD

Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts

Anesth Analg 2003;97:35-38

 

本研究的目的是评估在小儿扁桃腺体切除术前使用Rofecoxib1mg/kg)的镇痛效果和安全性。Rofecoxib是一种选择性抑制环加氧酶-2途径的非类固醇类抗炎药。663-11岁需实施扁桃腺体切除的患者被随机分成两组,给予安慰剂或Rofecoxib,两组患者在种群和血液丢失方面无显著差异。我们发现使用Rofecoxib组的患者2小时(P<0.05)和24小时(P<0.006)的疼痛评分明显低于对照组。对照组在家中恶心(P<0.03)和呕吐(P<0.004)的发生频率明显多于Rofecoxib组。结论:小儿患者进行择期扁桃腺体切除术时术前单纯使用Rofecoxib可明显减少呕吐发生并降低24小时疼痛评分。

(朱辉   王祥瑞  )

The goal of our study was to evaluate the analgesic efficacy and safety of administering rofecoxib (1 mg/kg), a cyclo-oxygenase (COX)-2 selective nonsteroidal antiinflammatory drug, before pediatric tonsillectomy. Sixty-six patients, aged 3–11 yr, scheduled to undergo tonsillectomy received either placebo or rofecoxib (1 mg/kg). There were no significant differences between the two study groups with respect to demographics and blood loss. We found that the pain scores were significantly lower in the rofecoxib group compared with the control group at 2 h (P < 0.05) and 24 h (P < 0.006). The incidence of nausea (P < 0.03) and vomiting (P < 0.004) at home was more frequent in the control group than in the rofecoxib group. We conclude that a single preoperative dose of rofecoxib resulted in less vomiting and lower 24-h pain scores in pediatric patients undergoing an elective tonsillectomy.

 

小剂量布比卡因或利多卡因蛛网膜下腔麻醉用于宫颈环扎术的比较

Subarachnoid Small-Dose Bupivacaine Versus Lidocaine for Cervical Cerclage

Yaakov Beilin, MD*,{dagger}, Jeffrey Zahn, MD*, Sharon Abramovitz, MD{ddagger}, Howard H. Bernstein, MD*,{dagger}, Sabera Hossain, MS§, and Carol Bodian, DrPH§

Departments of *Anesthesiology, {dagger}Obstetrics, Gynecology, and Reproductive Sciences, and §Biomathematical Sciences, Mount Sinai School of Medicine, New York University, New York, New York; and {ddagger}Department of Anesthesiology, Weill Medical College of Cornell University, New York, New York

Anesth Analg 2003;97:56-61

 

宫颈环扎术通常在蛛网膜下腔麻醉下门诊手术室内完成。因为手术时间短,局麻药通常选用利多卡因,但因利多卡因具有短暂神经症状(TNS)目前已不常用。本研究主要是观察小剂量布比卡因是否可以替代利多卡因应用于宫颈环扎术。随机选择59名女性病人采用同等剂量的利多卡因30mg或布比卡因5.25mg实施蛛网膜下腔麻醉,两种局麻药中均加用20μg芬太尼,并用0.9%生理盐水稀释至3ml。在研究中记录病人起始和最高的感觉阻滞的体表平面、麻醉效果、有无低血压、T12平面消失的时间、下肢运动功能恢复的情况、能否自己移动以及排尿情况。并在术后24小时内通过电话询问评估TNS的症状。结果发现除了利多卡因组病人下肢运动恢复相对较慢外,两组病人在术始或术毕恢复阶段无任何显著差异。利多卡因组有两名病人发现有TNS症状并在48小时内自行恢复,但布比卡因组没有病人出现TNS症状。因此,布比卡因蛛网膜下腔麻醉可以较好的替代利多卡因蛛网膜下腔麻醉用于宫颈环扎术。

(齐波   王祥瑞 )

Cervical cerclage is often performed as an outpatient procedure under subarachnoid anesthesia. Lidocaine was historically the drug of choice for short procedures but has fallen out of favor because of concerns of transient neurologic symptoms (TNS). We performed this study to determine whether small-dose bupivacaine is an acceptable alternative to lidocaine for cervical cerclage. We randomized 59 women to receive either subarachnoid isobaric lidocaine 30 mg or hyperbaric bupivacaine 5.25 mg. Fentanyl 20 µg was added to both local anesthetics, and the total volume was diluted to 3 mL with 0.9% saline. Onset and highest dermatomal level of sensory block; quality of anesthesia; hypotension; and times until T12 regression, return of lower extremity motor function, ambulation, and micturition were recorded. Symptoms of TNS were evaluated by telephone interview 24 h after surgery. We did not find any significant difference in onset or recovery times between the groups, with the exception of a longer duration until return of lower extremity motor strength in the lidocaine group. Symptoms consistent with TNS that resolved spontaneously within 48 h were reported by two women in the lidocaine group but by none in the bupivacaine group. We conclude that subarachnoid bupivacaine offers a satisfactory alternative to subarachnoid lidocaine for cervical cerclage.

 

普鲁卡因和盐酸甲哌卡因毒性作用小于临床其它局麻药的离体研究

Procaine and Mepivacaine Have Less Toxicity In Vitro Than Other Clinically Used Local Anesthetics

Toshiharu Kasaba, MD, Shin Onizuka, MD, and Mayumi Takasaki, MD

Department of Anesthesiology, Miyazaki Medical College, Kiyotake-Cho, Miyazaki, Japan

Anesth Analg 2003;97:85-90

 

通过观察培养神经细胞胞体和轴突的塌陷可以证明局麻药静脉应用时的神经毒性作用。本研究应用椎实螺属蜗牛的培养神经细胞比较普鲁卡因、盐酸甲哌卡因、罗哌卡因、布比卡因、利多卡因、地卡因和地布卡因的神经毒性。将局麻药溶液加入神经细胞培养皿中,使最终浓度在1×10-62×10-2M之间。在实验中观察神经细胞胞体和轴突形态学改变并按照改变程度进行分级:1级(轻度)、2级(重度)。结果发现形态学改变为1级的局麻药浓度分别为:普鲁卡因为5×10-4M,盐酸甲哌卡因为5×10-4M,罗哌卡因为2×10-4M,布比卡因为2×10-4M,利多卡因为1×10-4M,地卡因为5×10-5M,地布卡因为2×10-5M。统计学分析发现盐酸甲哌卡因和罗哌卡因,布比卡因和利多卡因,利多卡因和地卡因,地卡因和地布卡因之间有显著差异(P0.05)。这几种局麻药神经毒性从小到大依次为普鲁卡因=盐酸甲哌卡因﹤罗哌卡因=布比卡因﹤利多卡因﹤地卡因﹤地布卡因。虽然利多卡因的毒性作用要大于与它具有相似药理学效应的布比卡因、罗哌卡因和盐酸甲哌卡因,但在临床上常用的局麻药中利多卡因对神经细胞胞体生长的毒性作用是最小的。

(齐波   王祥瑞 )

The neurotoxicity of local anesthetics can be demonstrated in vitro by the collapse of growth cones and neurites in cultured neurons. We compared the neurotoxicity of procaine, mepivacaine, ropivacaine, bupivacaine, lidocaine, tetracaine, and dibucaine by using cultured neurons from the freshwater snail Lymnaea stagnalis. A solution of local anesthetics was added to the culture dish to make final concentrations ranging from 1 x 10-6 to 2 x 10-2 M. Morphological changes in the growth cones and neurites were observed and graded 1 (moderate) or 2 (severe). The median concentrations yielding a score of 1 were 5 x 10-4 M for procaine, 5 x 10-4 M for mepivacaine, 2 x 10-4 M for ropivacaine, 2 x 10-4 M for bupivacaine, 1 x 10-4 M for lidocaine, 5 x 10-5 M for tetracaine, and 2 x 10-5 M for dibucaine. Statistically significant differences (P < 0.05) were observed between mepivacaine and ropivacaine, bupivacaine and lidocaine, lidocaine and tetracaine, and tetracaine and dibucaine. The order of neurotoxicity was procaine = mepivacaine < ropivacaine = bupivacaine < lidocaine < tetracaine < dibucaine. Although lidocaine is more toxic than bupivacaine and ropivacaine, mepivacaine, which has a similar pharmacological effect to lidocaine, has the least-adverse effects on cone growth among clinically used local anesthetics.

 

氯胺酮和戊巴比妥对爪蟾卵母细胞上P物质受体表达的抑制作用

The Inhibitory Effects of Ketamine and Pentobarbital on Substance P Receptors Expressed in Xenopus Oocytes

Takashi Okamoto, MD*, Kouichiro Minami, MD PhD*, Yasuhito Uezono, MD PhD{ddagger}, Junichi Ogata, MD*, Munehiro Shiraishi, MD*, Akio Shigematsu, MD PhD*, and Yoichi Ueta, MD PhD{dagger}

Departments of *Anesthesiology and {dagger}Physiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu; {ddagger}Department of Pharmacology, Nagasaki University, Graduate School of Biomedical Sciences, Japan

Anesth Analg 2003;97:104-110

 

P物质受体(SPR)调控着脊神经内伤害感受的传递。静脉麻醉剂对SPR的作用尚不清楚。本研究中我们主要研究静脉麻醉剂对爪蟾卵母细胞SPR表达的作用。通过全细胞电压钳测定SP介导的Ca2+激活的Cl-电流来测验氯胺酮、戊巴比妥、异丙酚和曲马多对爪蟾卵母细胞SPR表达的作用。在药理学相关浓度时氯胺酮和戊巴比妥可以抑制SPR介导的电流,但异丙酚和曲马多几乎无作用。本实验还研究了氯胺酮和异丙酚对[3H]SP的作用。氯胺酮和异丙酚抑制爪蟾卵母细胞上[3H]SPSPR的特意性结合。[3H]SP结合的Scatchard分析显示氯胺酮和戊巴比妥减低了受体结合和最大结合的表面分裂常数,且为非竞争性抑制。C蛋白激酶(PKC)抑制剂(bisindolylmalemide I)不能阻断氯胺酮和戊巴比妥对SP介导的Ca2+激活的Cl-通道电流的抑制作用。实验结果提示氯胺酮和戊巴比妥可以抑制SPR的功能。其机制并不是通过PKC途径,可能与SP非竞争性结合有关。

(忻纪华   王祥瑞 )

Substance P receptors (SPR) modulate nociceptive transmission within the spinal cord. The effects of IV anesthetics on SPR are not clear. In this study, we investigated the effects of IV anesthetics on SPR expressed in Xenopus oocytes. We examined the effects of ketamine, pentobarbital, propofol, and tramadol on SP-induced Ca2+-activated Cl- currents mediated by SPR expressed in Xenopus oocytes using a whole-cell voltage clamp. Ketamine and pentobarbital inhibited the SPR-induced currents at pharmacologically relevant concentrations, but propofol and tramadol had little effect on the currents. We also studied the effects of ketamine and pentobarbital on [3H]-SP to SPR. Ketamine and pentobarbital inhibited the specific binding of [3H]-SP to SPR expressed in Xenopus oocytes. Scatchard analysis of [3H]-SP binding revealed that ketamine and pentobarbital decreased the apparent dissociation constant for binding and maximal binding, indicating noncompetitive inhibition. The protein kinase C (PKC) inhibitor bisindolylmaleimide I did not abolish the inhibitory effects of ketamine and pentobarbital on SP-induced Ca2+-activated Cl- currents. The results suggest that ketamine and pentobarbital inhibit SPR function. The mechanism of their inhibition on SPR function could not be through activation of the PKC pathway and may be due to noncompetitive displacing the SP binding.

 

应用人类在体组织微透析模型评价布比卡因负荷微囊释放的药动学和药代学改变

A Model to Evaluate the Pharmacokinetic and Pharmacodynamic Variables of Extended-Release Products Using In Vivo Tissue Microdialysis in Humans: Bupivacaine-Loaded Microcapsules

Dan J. Kopacz, MD*, Christopher M. Bernards, MD{dagger}, Hugh W. Allen, MD*, Craig Landau, MD{ddagger}, Partha Nandy, PhD§, Danlin Wu, PhD§, and Peter G. Lacouture, PhD||,¶

Department of Anesthesiology, *Virginia Mason Clinic and {dagger}University of Washington, Seattle, Washington; {ddagger}Medical Research and §Clinical Pharmacokinetics, Purdue Pharma L. P., Stamford; ||Magidom Discovery, LLC, Westport, Connecticut; and ¶Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania

Anesth Analg 2003;97:124-131

 

双分级微囊可以带来局麻药的超长作用期。此作用可能是因为微囊对周围组织的持续释放造成的。先前的研究已试验了布比卡因从微囊释放和吸收入体循环的药效学。微透析样本可以判定任何药物注射点的药物动力学。本研究观察志愿者在注射后96小时内从微囊释放的布比卡因和地塞米松的药物动力学。将布比卡因的浓度与临床局麻阻滞的浓度相比。本研究证实布比卡因以恒定的方式从微囊中释放,其浓度在微囊注射后24-34小时上升,镇痛效应与微透析法测得的布比卡因的浓度相关。单纯水剂和微囊的布比卡因起效时间相同(P=0.23)。微囊注射部位在96小时后仍有78%的镇痛作用,明显较单纯的布比卡因作用时间长(P<0.001)。轻度瘙痒是最常见的并发症,在微囊注射中发生率为56%。地塞米松布比卡因微囊耐受好并能延长皮肤的镇痛作用。尽管微囊内的布比卡因浓度是布比卡因水剂的浓度的3倍,但布比卡因水剂的体循环吸收的血浆峰浓度较微囊注射的高。

(忻纪华    王祥瑞 )

Biodegradable microcapsules produce an ultra-long duration of local anesthesia. We hypothesized that this duration is caused by the sustained-release of bupivacaine from the microcapsules into the surrounding tissue. Previous studies investigated the pharmacokinetics (PKs) of bupivacaine after release from microcapsules and absorption into the systemic circulation. Microdialysis sampling can determine the PKs of any drug at its site of injection. This study was performed to characterize the PKs of bupivacaine and dexamethasone released from microcapsules at a subcutaneous injection site over a 96-h period in volunteers. Bupivacaine concentrations were compared with clinical variables of local anesthetic blockade. This study demonstrates that bupivacaine is released in a sustained manner from microcapsules, that bupivacaine concentrations increase for 24–34 h after microcapsule injection, and that analgesia parallels the tissue bupivacaine concentration obtained by microdialysis. Analgesia was equally rapid in onset with aqueous and microcapsule bupivacaine (P = 0.23). Analgesia was still present at 78% of microcapsule-injected sites after 96 h, significantly longer than for aqueous bupivacaine (P < 0.001). Mild pruritus was the most common side effect, occurring with 56% of the microcapsule injections. Dexamethasone-containing bupivacaine microcapsules are well tolerated and produce a prolonged duration of skin analgesia. Systemic absorption of bupivacaine produces higher peak plasma levels after aqueous injection than after microcapsule injection, despite the injection of a threefold larger load of bupivacaine in the latter.

 

测量压力-容量关系时吸气流量设置的指导

Guidelines for Inspiratory Flow Setting When Measuring the Pressure-Volume Relationship

Fábio E. Bensenor, MD PhD, Joaquim E. Vieira, MD PhD, and Jose Otávio C. Auler, Jr., MD PhD

Anesthesia Department, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Anesth Analg 2003;97:145-150

 

使用静止的方法来获得压力-容量曲线以提高通气策略十分费时。而低流量技术使用时间较少,但由于气道和气管导管对气流的阻碍作用,顺应性值会降低。在研究中,确定了三种气流在麻醉中对气道和气管导管内气流阻碍作用的影响(P-t)。研究了10 ASA P1/P2呼吸功能正常的患者。在使用61230L/min持续气流进行容量—控制通气时测量气道和食道压力。在移去气管导管前后建立潮气量为2505007501000ml时的压力容量曲线图,下弯曲点,呼吸系统和胸壁顺应性。收集数据分析变化,比较61230L/min气流时我们发现较低流量时下弯曲点较低。612L/min气流之间没有区别。移去(P-t)后仅仅在30L/min时有差异(P=0.004)。气流越高,顺应性越低。(P-t)顺应性仅在30L/min时有所降低。胸壁顺应性在使用三种气流时没有差异。结论是在术中获得PV曲线时,控制流量<12L/min可以使(P-t)最小。顺应性则提示6L/min为最合适的流量。

(殷文渊   王祥瑞  )

Acquisition of pressure-volume (PV) curves to improve ventilation strategy is time consuming when using static methods. Low-flow techniques use less time, but compliance values can be decreased by the resistance to flow in airways and tracheal tube (P-t). In this study, we determined the impact of three flows on the resistive component of airway pressure during anesthesia. We studied 10 ASA status P1/P2 patients with normal respiratory function. Airway and esophageal pressures were measured while volume-control ventilated with 6, 12, and 30 L/min continuous flows. PV curves, lower inflection point, respiratory system, and chest wall compliances at 250, 500, 750, and 1000 mL tidal volume were established before and after removing P-t. Data were submitted to analysis of variance. The inflection point was lower for the lower flow when comparing 6 and 12 with 30 L/min (P < 0.001). No difference was found between 6 and 12 L/min. Removal of P-t showed a difference only for 30 L/min (P = 0.004). Higher flows generated lower compliances. P-t subtraction reduced compliances only for 30 L/min. Chest wall compliances showed no difference between flows. We concluded that flows ≤12 L/min minimize P-t during intraoperative PV curves acquisition. Compliances suggest 6 L/min as the most adequate flow.

 

多巴胺调节人体单核细胞内脂多糖诱导巨噬细胞炎性蛋白-1α和白介素-8的产生

Dobutamine Modulates Lipopolysaccharide-Induced Macrophage Inflammatory Protein-1{alpha} and Interleukin-8 Production in Human Monocytes

Chi-Yuan Li, MD MS*, Chien-Sung Tsai, MD{dagger}, Ping-Ching Hsu, MS{dagger}, Ching-Tang Wu, MD*, Chih-Shung Wong, MD PhD*, and Shung-Tai Ho, MD MS*

Departments of *Anesthesiology and {dagger}Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan, Republic of China

Anesth Analg 2003;97:210-215

 

Chemokine介导白细胞向炎症部位的迁移。据报道,CC Chemokine 巨噬细胞炎症蛋白(MIP)-1α和CXC chemokine白介素(IL-8在炎症早期,伤口愈合,脓血症以及一些心血管疾病,包括急性冠状动脉症状和充血性心力衰竭中占有重要地位。进行这个研究的目的是调查多巴胺对人体单核细胞THP-1细胞产生脂多糖诱导MIP -1α和白介素-8的影响。单核细胞和LPS37℃下在存在或缺少多巴胺的条件下在试管中孵育。多巴胺对MIP -1α和白介素-8的影响使用一种酶联免疫吸附剂化验,MIP -1α和白介素-8的信使RNAmRNA)使用逆转录酶聚合链反应检验。多巴胺对THP-1细胞产生脂多糖诱导MIP -1α和白介素-8有显著的剂量依赖性抑制作用。,羟甲叔丁肾上腺素(Salbutamol)对LPS刺激MIP -1α和白介素-8的产生有相似的抑制作用。MIP -1αmRNA也被10µM的多巴胺所抑制,然而,在相同浓度下,多巴胺对IL-8mRNA水平没有明显抑制。此外,我们发现多巴胺能抑制THP-1分化巨噬细胞中MIP -1α引起的趋化作用。这些发现说明多巴胺可以抑制巨噬细胞的趋化作用,也就是单核细胞产生MIP -1α和白介素-8。生化调节部位对MIP -1α来说位于转录水平,而白介素-8则在转录后水平。

(殷文渊   王祥瑞  )

Chemokines mediate the migration of leukocytes to sites of inflammation. The CC chemokine macrophage inflammatory protein (MIP)-1{alpha} and the CXC chemokine interleukin (IL)-8 are reported to play an important role in early inflammatory stages, wound healing, sepsis, and some cardiovascular diseases, including acute coronary syndromes and congestive heart failure. We conducted this study to investigate the effect of dobutamine on lipopolysaccharide (LPS)-induced MIP-1{alpha} and IL-8 production by human monocytic THP-1 cells. Monocytes were incubated in vitro with LPS for 4 or 16 h at 37°C in the presence or absence of dobutamine. The effect of dobutamine on MIP-1{alpha} and IL-8 synthesis was examined by using an enzyme-linked immunosorbent assay, and MIP-1{alpha} and IL-8 messenger RNA (mRNA) were examined by using reverse transcriptase-polymerase chain reaction. Dobutamine significantly inhibited LPS-induced MIP-1{alpha} and IL-8 production by THP-1 cells in a dose-dependent manner. Salbutamol had a similar suppressive effect on LPS-stimulated MIP-1{alpha} and IL-8 production. MIP-1{alpha} mRNA was also suppressed by 10 µM dobutamine, whereas, at the same concentration, dobutamine had no significant effect on the IL-8 mRNA level. Moreover, we found that dobutamine suppressed the MIP-1{alpha}-induced chemotaxis in THP-1 differentiated macrophages. These findings suggest that dobutamine may inhibit macrophage chemotaxis, as well as MIP-1{alpha} and IL-8 production by monocytes. The site of chemokine regulation is at the transcriptional level for MIP-1{alpha} and might be at the posttranscriptional level for IL-8.

 

尼非地平对猪后期心肺复苏中室颤频率的作用

The Effects of Nifedipine on Ventricular Fibrillation Mean Frequency in a Porcine Model of Prolonged Cardiopulmonary Resuscitation

Karl H. Stadlbauer, MD, Klaus Rheinberger, MSc, Volker Wenzel, MD, Claus Raedler, MD, Anette C. Krismer, MD, Hans-Ulrich Strohmenger, MD, Sven Augenstein, MD, Horst G. Wagner-Berger, MD, Wolfgang G. Voelckel, MD, Karl H. Lindner, MD, and Anton Amann, PhD

Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

Anesth Analg 2003;97:226-230

 

本研究评价一种钙离子通道阻滞剂和安慰剂生理盐水对后期心肺复苏中室颤频率和血流动力学变化的作用。在心脏骤停之前,10只猪随机接受尼非地平(0.64mg/kg,n=5)或生理盐水(n=5),注药速度大于10分钟.药物摄入之后,立刻引导室颤。经过4分钟的心脏骤停和18分钟基本的心肺复苏后,尝试除颤。心跳骤停后90分钟,尼非地平组室颤频率明显高于对照组(均数±标准差:12.4±2.1Hz8±0.7Hz),心跳骤停后218.5分钟,两组间室颤频率无明显差异。除颤之前,尼非地平组室颤频率明显高于对照组(均数±标准差:9.7±1.2Hz7.1±1.3Hz)。从室颤后11.5分钟开始,尼非地平组冠状动脉灌注压明显低于对照组。无一例室颤后自动恢复窦性心率。总结:尼非地平能防止心跳骤停后室颤频率的快速下降并保持心肺后期复苏中室颤频率在10Hz,但是这与除颤成功无关。

                                                  (陈洁  王祥瑞 )

We assessed the effects of a calcium channel blocker versus saline placebo on ventricular fibrillation mean frequency and hemodynamic variables during prolonged cardiopulmonary resuscitation (CPR). Before cardiac arrest, 10 animals were randomly assigned to receive either nifedipine (0.64 mg/kg; n = 5) or saline placebo (n = 5) over 10 min. Immediately after drug administration, ventricular fibrillation was induced. After 4 min of cardiac arrest and 18 min of basic life support CPR, defibrillation was attempted. Ninety seconds after the induction of cardiac arrest, ventricular fibrillation mean frequency was significantly (P < 0.01) increased in nifedipine versus placebo pigs (mean ± SD: 12.4 ± 2.1 Hz versus 8 ± 0.7 Hz). From 2 to 18.5 min after the induction of cardiac arrest, no differences in ventricular fibrillation mean frequency were detected between groups. Before defibrillation, ventricular fibrillation mean frequency was significantly (P < 0.05) increased in nifedipine versus placebo animals (9.7 ± 1.2 Hz versus 7.1 ± 1.3 Hz). Coronary perfusion pressure was significantly lower in the nifedipine than in the placebo group from the induction of ventricular fibrillation to 11.5 min of cardiac arrest; no animal had a return of spontaneous circulation after defibrillation. In conclusion, nifedipine, but not saline placebo, prevented a rapid decrease of ventricular fibrillation mean frequency after the induction of cardiac arrest and maintained ventricular fibrillation mean frequency at ~10 Hz during prolonged CPR; this was nevertheless associated with no defibrillation success.

 

小剂量布比卡因-芬太尼脊麻联合吗啡在分娩中的应用

Small Dose Bupivacaine-Fentanyl Spinal Analgesia Combined with Morphine for Labor

Philip E. Hess, MD, Anasuya Vasudevan, FRCA, Caroline Snowman, BSN, and Stephen D. Pratt, MD

Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA

Anesth Analg 2003;97:247-252

本研究使用小剂量布比卡因-芬太尼脊麻或联合应用小剂量吗啡对分娩的镇痛作用。60例临产妇参与了这次安慰剂对照、双盲、随机实验。所有妇女脊管内注射12.5ug芬太尼和2mg布比卡因。吗啡组同时接受125ug吗啡,对照组接受生理盐水。疼痛评分在注射后10分钟内小于3分。组间的镇痛持续时间相近(89分钟比84分钟,p无显著差异),吗啡组仅20%出现镇痛时间延长。在脊麻之后,吗啡组突破疼痛评分的发生率最低(0.15±0.140.26±0.18每小时)。同时,分娩后24小时内吗啡组止痛药物的需要量更少(3.3±3.74.7±3.5剂量,p=0.04)。椎管内注射这种小剂量布比卡因-芬太尼对分娩能产生快速镇痛,加入小剂量吗啡没有明显延长镇痛时间,但进一步缓解了疼痛。这可能是临床分娩中和分娩后缓解疼痛的有效方法。

                                     (陈洁   王祥瑞  )

 

We investigated the duration of labor analgesia produced by a small dose of spinal bupivacaine/fentanyl alone or in combination with a small dose of morphine. Sixty parturients were enrolled in this placebo-controlled, double-blinded, randomized trial. All women received a spinal injection of 12.5 µg of fentanyl with 2 mg of bupivacaine. The morphine group (MBF) also received 125 µg of morphine; the placebo group (BF) received saline. Pain scores were <3 of 10 within 10 min of injection. The median duration of analgesia was similar between groups (89 min versus 84 min; P = not significant), and only 20% of the MBF group experienced prolonged analgesia. During subsequent epidural analgesia, the MBF group had a significantly lesser rate of breakthrough pain (0.15 ± 0.14 episodes per hour versus 0.26 ± 0.18 episodes per hour; P = 0.02). Also, during the first 24 h postpartum, the MBF group required significantly fewer medications (3.3 ± 3.7 doses versus 4.7 ± 3.5 doses; P = 0.04). Intrathecal injection of this small dose of bupivacaine/fentanyl produced a rapid onset of labor analgesia; the addition of a small dose of morphine did not significantly prolong analgesia, but it improved subsequent pain relief, as measured by the rate of breakthrough pain and postpartum medication requirements. This may provide a clinically useful means of improving intra- and postpartum pain relief.

 

长期应用抗抑郁药可以降低术中体温过低的发生率

Chronic Treatment with Antidepressants Decreases Intraoperative Core Hypothermia

Akira Kudoh, MD, Hajime Takase, MD, and Tomoko Takazawa, MD

Department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Japan

Anesth Analg 2003;97:275-279

 

本研究主要观察慢性抑郁症病人长期应用抗抑郁药后麻醉过程中体温调节和术后寒颤情况。选择实行矫形外科手术的35名抑郁症病人和35名对照组病人。研究中发现抑郁症组病人麻醉诱导后607590分钟的鼓膜温度高于对照组病人(P0.05)。但两组病人平均体表温度无显著差异。8名抑郁症组病人和2名对照组病人出现了麻醉后寒颤。抑郁症组病人的寒颤发生率明显高于对照组病人(P=0.04)。在抑郁症组病人中,应用氯丙嗪治疗的病人的鼓膜温度高于应用马普替林治疗的病人。本研究认为慢性抑郁症病人术中体温过低的发生率降低了,但术后寒颤发生率却明显增加。

(齐波   王祥瑞  )

We investigated temperature regulation during anesthesia and postoperative shivering in chronically depressed patients given antidepressant drugs. We studied 35 depressed patients and 35 control patients who underwent orthopedic surgery. Tympanic membrane temperatures 60, 75, and 90 min after induction in the depression group were significantly (P < 0.05) higher than those of the control group. There were no significant differences in mean skin temperature between the depression and the control groups. Eight of 35 patients in the depression group and 2 of 35 patients in the control group developed postanesthetic shivering. The incidence of shivering in the depression group was significantly more frequent than that in the control group (P = 0.04). The tympanic membrane temperature of the patients treated with clomipramine tended to be higher than that of the patients treated with maprotiline. In conclusion, intraoperative core hypothermia in chronically depressed patients was decreased. However, the incidence of shivering in depressed patients was significantly more frequent.

美国肝移植麻醉术中应用资源的调查

Intraoperative Resource Utilization in Anesthesia for Liver Transplantation in the United States: A Survey

Roman Schumann, MD

Department of Anesthesiology, Division of Liver Transplant Anesthesia, Tufts–New England Medical Center, Boston, Massachusetts

Anesth Analg 2003 97: 21-28.

肝移植麻醉术中应用的资源,包括实验室检查、 配备的人员 、高流量输入装置、 高技术含量的监测仪和静脉-静脉转流技术等在不同的机构之间是不同的。尽管大家对此感兴趣,但是,有关这些资源在整个国家的应用情况仍知之甚少。为了了解美国各肝移植中心这些资源的应用情况,我们在20024月至7月期间进行了全国范围的调查。共有99个中心通过邮件的方式接受了调查,有6666.6%)个中心给予了回复。统计结果显示,小儿肝移植与成人以及混合年龄个案相比,在配备的人员 监测仪和静脉-静脉转流技术等方面存在着显著差异。在实验室检查方面,术中监测激活凝血时间 、镁和磷酸盐浓度的次数越来越少。这些调查结果对于比较不同肝移植中心的的麻醉程序以及对肝移植麻醉的临床发展是有利的。结论:在各个肝移植中心之间,术中应用资源的情况有显著差异。这个调查结果与目前一些文献中介绍的情况是不一致的。

(王士雷 庄心良 校)

Among the intraoperative resources expended for liver transplantation, laboratory tests, personnel, high-flow infusion devices, high-tech monitoring equipment, and veno-venous bypass vary from institution to institution. Although of obvious interest to the anesthesia liver transplantation community and others, little is known regarding current utilization of these resources on a national level. To determine the resource utilization among liver transplantation centers in the United States, we conducted a national survey between April and July 2002. Results were stratified according to pediatric versus adult recipient populations and transplantation case volume. Of 99 centers that received the survey by mail, 66 (66.6%) responded. Pediatric liver transplantation programs were distinctly different in personnel, equipment, monitoring, and veno-venous bypass utilization when compared with adult or mixed-age programs. Among laboratory studies, statistically significant trends emerged for fewer intraoperative determinations of the activated clotting time, magnesium, and phosphate with increasing transplantation volume. The results describe national practice patterns and may be useful for programs to compare their approaches and develop clinical pathways. There is wide variation of resource use between centers. The survey results do not consistently correlate with the few recommendations found in the current literature.

 

BIS在小儿意识和深度镇静监测中的价值

Validation of the Bispectral Index Monitor During Conscious and Deep Sedation in Children

Nicole Brown McDermott, MD, Tamitha VanSickle, MD, Dominika Motas, MD, and Robert H. Friesen, MD

Department of Anesthesiology, The Children’s Hospital and the University of Colorado School of Medicine, Denver, Colorado

Anesth Analg 2003 97: 39-43.

本研究比较BIS和密西根大学镇静评分(UMSS)在小儿意识和深度镇静监测中的应用,探讨BIS在小儿意识和深度镇静监测中的价值。在儿童医院的4个部门,由非麻醉科医生对86例小儿(小于12岁)进行意识和深睡眠的诊断和处理。对镇静药物没有严格控制,因此各个部门应用的镇静药物是不一样的。在小儿1小时的镇静期间,由一个独立的观察者每10分钟进行UMSS评分。给小儿实施镇静者不知道UMSSBIS的评分情况。结果,BISUMSS之间有显著相关性(r = -0.704, P < 0.0001),其中包含6例小于6岁的儿童(r = -0.761, P < 0.001)。当应用氯胺酮或氯胺酮复合水合氯醛、安泰乐和哌替啶镇静时,则二者的相关性较差。结论:BIS UMS之间有很好的相关性,可以作为评价儿童意识和深度镇静的有效手段。

(王士雷   庄心良 校)

 In this study, we tested the validity of the bispectral index (BIS) monitor during conscious and deep sedation of children by comparing it with the University of Michigan Sedation Scale (UMSS), a validated observational pediatric sedation scale. Eighty-six children <12 yr of age were enrolled in this observational study. The subjects underwent conscious or deep sedation administered by non-anesthesiologists for diagnostic or therapeutic procedures in four departments in a children’s hospital. Sedation medications varied among departments and were not controlled by the study protocol. An independent observer derived a UMSS score at 10-min intervals for 1 h during sedation; personnel administering sedation medications and performing the procedures were blinded to the BIS and UMSS scores. Significant correlation between BIS scores and UMSS scores was found (r = -0.704, P < 0.0001), including in subjects <6 mo of age (n = 6) (r = -0.761, P < 0.001). Poor correlation was found when ketamine or an oral combination of chloral hydrate, hydroxyzine, and meperidine were used for sedation. We conclude that BIS correlates well with UMSS scores and may be a valid measure of conscious and deep sedation in children.

 

处理术后恶心呕吐的指导原则

Consensus Guidelines for Managing Postoperative Nausea and Vomiting

Tong J. Gan, MD*, Tricia Meyer, MS FASHP{dagger}, Christian C. Apfel, MD{ddagger}, Frances Chung, FRCPC§, Peter J. Davis, MD||, Steve Eubanks, MD, Anthony Kovac, MD#, Beverly K. Philip, MD**, Daniel I. Sessler, MD{dagger}{dagger}, James Temo, CRNA MSN, MBA{ddagger}{ddagger}, Martin R. Tramèr, MD DPhil§§, and Mehernoor Watcha, MD||||

Departments of *Anesthesiology and ¶Surgery, Duke University Medical Center, Durham, North Carolina; {dagger}Departments of Pharmacy and Anesthesiology, Scott and White Memorial Hospital, Texas A&M University System HSC College of Medicine, Temple, Texas; {ddagger}Outcomes ResearchTM Group and Department of Anesthesiology, University of Wuerzburg, Wuerzburg, Germany; §Department of Anesthesia, University of Toronto, Toronto, Canada; ||Departments of Anesthesiology and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; #Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; **Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts; {dagger}{dagger}Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky; {ddagger}{ddagger}Duke University Nurse Anesthetist Program, Durham, North Carolina; §§Division of Anaesthesiology, Geneva University Hospital, Geneva, Switzerland; and ||||Department of Anesthesia, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Anesth Analg 2003 97: 62-71.

本文提供了由国际专家小组讨论制订的处理术后恶心呕吐的指导原则。

(王士雷 庄心良 校)

IMPLICATIONS: We present evidence-based guidelines developed by an international panel of experts for the management of postoperative nausea and vomiting.


大鼠快速输注阿米替林布比卡因和左旋布比卡因的相对毒性

The Relative Toxicity of Amitriptyline, Bupivacaine, and Levobupivacaine Administered as Rapid Infusions in Rats

Venkatesh Srinivasa, MD*, Peter Gerner, MD*, Anna Haderer, MD*, Salahadin Abdi, MD PhD{dagger}, Petr Jarolim, MD PhD{ddagger}, and Ging Kuo Wang, PhD*

Departments of *Anesthesiology, Perioperative and Pain Medicine and {ddagger}Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and {dagger}Department of Anesthesia and Intensive Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Anesth Analg 2003 97: 91-95.

血管内注入局麻药导致心血管和中枢神经的毒性反应。阿米替林是三环类抗抑郁药,有较布比卡因更强的局麻效能。本研究比较布比卡因、左旋布比卡因和阿米替林的心血管和中枢神经毒性反应。选择29SD大鼠为研究对象,在全麻下经颈外静脉和颈动脉置管。在第二天,大鼠腹腔注射咪唑安定(0.375 mg/kg)镇静,并经颈外静脉快速输注:1)布比卡因左旋布比卡因或阿米替林2 mg · kg-1 · min-1 (5 mg/mL)2)生理盐水(400 µL · kg-1 · min-1)。监测心电图和动脉血压直至大鼠至濒死状态(心率50 bpm/心脏停搏或窒息时间 >30 s)。阿米替林引起窒息和濒死状态的剂量(分别为74.0 ± 21 mg/kg 74.5 ± 21 mg/kg)显著大于左旋布比卡因(分别为32.2 ± 20 mg/kg 33.9 ± 22 mg/kg)和布比卡因(分别是21.5 ± 7 mg/kg 22.7 ± 7 mg/kg) (P < 0.05)。结论:急性输注阿米替林引起心血管和中枢神经毒性反应的剂量显著大于布比卡因和左旋布比卡因。

(王士雷译  庄心良 校)

Intravascular injection of local anesthetics carries the risk of cardiovascular (CV) and central nervous system (CNS) toxicity. Amitriptyline, a tricyclic antidepressant, has local anesthetic potency that is more than that of bupivacaine. In this study, we compared the CV and CNS toxicity of the local anesthetics bupivacaine and levobupivacaine with that of amitriptyline. Twenty-nine Sprague-Dawley rats had their right external jugular vein and carotid artery cannulated under general anesthesia. On Day 2, rats were sedated with midazolam (0.375 mg/kg intraperitoneally) and received rapid infusions of either 1) bupivacaine, levobupivacaine, or amitriptyline at 2 mg · kg-1 · min-1 (5 mg/mL concentration) or 2) normal saline (400 µL · kg-1 · min-1) through an external jugular vein cannula. Electrocardiogram and arterial blood pressure were measured until the dose to cause impending death was reached (heart rate 50 bpm/asystole or apnea for >30 s). The mean dose required to cause apnea and impending death was significantly larger for amitriptyline (74.0 ± 21 mg/kg and 74.5 ± 21 mg/kg, respectively) than for levobupivacaine (32.2 ± 20 mg/kg and 33.9 ± 22 mg/kg, respectively) or bupivacaine (21.5 ± 7 mg/kg and 22.7 ± 7 mg/kg, respectively) (P < 0.05). A significantly larger dose of amitriptyline, given by rapid infusion, is required to cause CV and CNS toxicity in rats, when compared with bupivacaine and levobupivacaine.

 

异氟醚浓度在0.8 1.2MAC时抑制弥散伤害性抑制控制

Isoflurane Depresses Diffuse Noxious Inhibitory Controls in Rats Between 0.8 and 1.2 Minimum Alveolar Anesthetic Concentration

Steven L. Jinks, PhD*, Joseph F. Antognini, MD*,{dagger}, and Earl Carstens, PhD{dagger}

*Department of Anesthesiology and Pain Medicine and {dagger}Section of Neurobiology, Physiology and Behavior, University of California, Davis

Anesth Analg 2003 97: 111-116.

伤害性刺激反应被远端继发性的伤害性刺激抑制的现象称为弥散伤害性抑制控制(DNIC)。远端继发性伤害刺激不改变抑制体动的吸入麻醉药的MAC。本研究的目的是观察吸入麻醉药在MAC附近的浓度时是否抑制DNIC。以异氟醚麻醉大鼠,并测定MAC。在伴有或不伴有尾或对侧后肢伤害性刺激的情况下,测定脊髓背角对后肢温度刺激的反应。在0.8MAC时,伴随夹尾刺激与没有夹尾刺激相比,后角神经元的反应减少70%(从1032 ± 178冲动/分减少到 301 ± 135; P < 0.05)。在1.2MAC时,夹尾对神经反应无显著影响(879 ± 139冲动/分至 825 ± 191 冲动/; P > 0.05)1.2MAC异氟醚也显著抑制后肢刺激引起的DNIC。在另一组大鼠,用冷的方式可逆性阻断颈髓的传递以观察这种调节方式是否由脊髓上部位进行调节的,结果显示,在异氟醚0.8MAC时不能观察到对侧刺激引起的DNIC。结论:在异氟醚浓度低于1MAC时存在DNIC,而异氟醚超过1MAC时抑制DNICDNIC由脊髓上部位进行调节。

(王士雷    庄心良 校)

Diffuse noxious inhibitory control (DNIC) occurs when the response to a noxious stimulus is inhibited by a second, spatially remote noxious stimulus. The minimum alveolar anesthetic concentration (MAC) to suppress movement is not altered by a second remote noxious stimulus. We hypothesized that DNIC would be depressed in the peri-MAC range. Rats were anesthetized with isoflurane, and MAC was measured. We recorded dorsal horn neuronal responses to noxious thermal stimulation of the hindpaw, with or without concomitant supramaximal noxious mechanical stimulation of the tail or contralateral hindpaw. At 0.8 MAC, the tail clamp decreased neuronal responses 70% compared with control heat-evoked responses (from 1032 ± 178 impulses per minute to 301 ± 135 impulses per minute; P < 0.05). The tail clamp had no significant effect on neuronal responses at 1.2 MAC (from 879 ± 139 impulses per minute to 825 ± 191 impulses per minute; P > 0.05). Similarly, 1.2 MAC isoflurane significantly depressed DNIC elicited by hindpaw clamping. In another group, the cervical spinal cord was reversibly blocked by cooling to determine whether the inhibition was mediated supraspinally. With spinal cord cooling, the counterstimulus-evoked inhibition was not observed at 0.8 MAC. These results suggest that DNIC involves supraspinal structures and is present

 

手术病人的内隐记忆随不同的脑电图镇静程度而出现差异

Implicit Memory Varies as a Function of Hypnotic Electroencephalogram Stage in Surgical Patients

Sinikka Münte, MD*, Thomas F. Münte, MD{dagger}, Jörg Grotkamp, MD{ddagger}, Gertrud Haeseler, MD*, Konstantinos Raymondos, MD*, Siegfried Piepenbrock, MD*, and Gabriele Kraus, MD§

*Department of Anaesthesiology, Medical School of Hannover, Germany; {dagger}Department of Neuropsychology, Otto-von-Guericke University Magdeburg, Germany; and Departments of {ddagger}Internal Medicine and §Anaesthesiology, Siloah Hospital, Hannover, Germany

Anesth Analg 2003 97: 132-138.

 

以前的研究观察到内隐记忆和麻醉中特定的脑电图有相关性。我们对以脑电图监测的镇静深度和内隐记忆之间的相关性进行了检验。研究对象为32例腹腔镜疝切开术和30例志愿者。所有病人给予静脉咪达唑仑2-3mg,随后给予异丙酚和雷米芬太尼诱导。麻醉维持选用异丙酚-雷米芬太尼-顺式阿曲库铵。每例病人均听4个故事中的2个,共听6遍。第一个故事在脑电图显示轻至中度镇静水平时给予,第二个故事在深度镇静水平时给予。病人听故事和镇静深度是均衡的。对照组在未接受麻醉的情况下开始听故事。7小时后,通过计算机程序设计测定阅读二个新故事和听过的故事的速度。结果,所有病人均未出现麻醉不充分的情况,也无外显记忆发生。阅读深镇静时听的故事时,阅读速度无变化。相比较而言,阅读在中浅镇静时听的故事时,每个实义词(如名词 、动词 、形容词等)的阅读速度增加20s,而功能词(如连词、 介词等)的阅读速度不增加。结论:在浅、中镇静状态下病人能够处理听觉信息,而在深镇静水平,则不能处理听觉信息。

(王士雷    庄心良 校)

Previous studies have observed a correlation of implicit memory with certain electroencephalogram (EEG) measures during anesthesia. Here, we tested the relationship between hypnotic depth determined by computer system (NarcotrendTM) and implicit memory in anesthetized patients, assessed by a postoperative reading speed test. Thirty-two patients undergoing laparoscopic herniotomy and 30 age-matched volunteer controls were included the study. All patients received IV midazolam 2–3 mg followed by an induction dose of propofol and remifentanil. The anesthesia was maintained with propofol and remifentanil infusions and cisatracurium. Each patient was exposed to 2 of 4 stories, repeated 6 times. The first story was presented during light to moderate hypnotic EEG stages, and the second story was presented during deep hypnosis. Presentation of stories was balanced between patients and hypnotic stages. The controls listened to the two stories without receiving anesthesia. The reading speed for the previously presented stories and two new stories was measured approximately 7 h later with a computer program. No signs of inadequate anesthesia were observed, and no explicit memories of intraoperative events were revealed by a structured interview. No change of reading speed was observed for words presented during deep hypnotic stages. In contrast, an increased reading speed of 20 ms per word was found for content words (i.e., nouns, verbs, and adjectives), but not for function words (conjunctions, prepositions, and so on), presented during light to moderate hypnotic stages. Increased reading speed for semantically rich content words indicates that anesthetized patients are able to process acoustic information during light and moderate, but not deep, hypnosis.

 

在干燥过程中CO2吸附剂的颜色变化:含水量的体外研究

The Color Change in CO2 Absorbents On Drying: An In Vitro Study Using Moisture Analysis

Erich Knolle, MD*, Wolfgang Linert, PhD{dagger}, and Hermann Gilly, PhD*,{ddagger}

*Department of Anesthesiology and General Intensive Care (B), University of Vienna; {dagger}Institute of Applied Synthetic Chemistry, Technical University of Vienna; and {ddagger}L. Boltzmann Institute for Anesthesiology and Intensive Care, Vienna, Austria

Anesth Analg 2003 97: 151-155.

不含氢氧化碱的吸附剂在干燥过程中发生颜色改变,而含氢氧化碱者则不发生改变。这种特性是否是由于氢氧化钙比氢氧化碱有弱的易潮湿特性?我们对此进行了探讨。不含氢氧化碱的吸附剂Amsorb® Superia®以及分别含1% 3% NaOH 3% KOH 的吸附剂在150°C 潮湿仪中干燥,评价干燥过程中的颜色变化(n5)。另外,我们分别用包含4% KOH 1% NaOH,Baralyme® Spherasorb®的散剂重复这个实验。Amsorb® and Superia® 在干燥以前很长一段时间已经开始发生颜色变化。在另外加入1% NaOH 后,象Spherasorb®    一样,发生颜色变化的干燥时间延长,颜色变化程度轻。这种作用在加入3% NaOH 时更明显。加入KOH 以及Baralyme®在干燥过程中不发生颜色改变。结论:不同含量的NaOH KOH吸附剂在干燥过程中的颜色变化不是由于不同氢氧化碱吸附水的量不同引起的。

(王士雷   庄心良 校)

Alkali hydroxide-free absorbents change color markedly when they dry, whereas absorbents containing alkali hydroxides do not. We investigated whether this observation can be explained by the weaker hygroscopic properties of pure calcium hydroxide compared with alkali hydroxides. Samples of the alkali hydroxide-free absorbents Amsorb® or Superia® and samples of these two absorbents with 1% or 3% NaOH or 3% KOH added were dried in a moisture analyzer at 105°C to determine their moisture content and to assess the color of the samples during drying (each group, n = 5). Additionally, we repeated the experiments with pulverized samples of Baralyme® and Spherasorb®, which contain approximately 4% KOH and 1% NaOH, respectively. Amsorb® and Superia® changed color long before they were dry. After the addition of 1% NaOH, and as with the Spherasorb® samples, the drying time required for a color change was longer, and the intensity of the resulting violet was less. This effect was even stronger when 3% NaOH was added. The samples with added KOH and the Baralyme® did not change color at all on drying. We conclude that the differences in color change on drying in absorbents with varying NaOH or KOH content cannot be explained by larger water retention because of the hygroscopic properties of the alkali hydroxides.

 

氯胺酮和阿米替林对轻度热损伤大鼠的外周抗痛觉过敏和镇痛作用

Peripheral Antihyperalgesic and Analgesic Actions of Ketamine and Amitriptyline in a Model of Mild Thermal Injury in the Rat

Mark Oatway, BSc, Allison Reid, BSc, and Jana Sawynok, PhD

Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada

Anesth Analg 2003 97: 168-173.

本研究的目的是观察局部给予氯胺酮和阿米替林对热损伤大鼠的抗痛觉过敏和镇痛作用。在麻醉状态下大鼠后肢暴露在52°C 环境持续45s,导致明显的持续至少2h的温度性痛觉过敏。在后肢损伤前15min局部预先注射氯胺酮(100–1000 nmol)显著抑制痛觉过敏,预先注射抗阿米替林则兼有抑制痛觉过敏(300 nmol)和镇痛(1000 nmol)作用。在温度损伤后再给予这些药物,结果氯胺酮无作用,而阿米替林仅有镇痛作用。阿米替林(300 1000 nmol)在注射到正常无损伤的后肢时产生镇痛作用。二种药物都引起爪肿胀,特别是在在大剂量时更明显。但是,和氯胺酮不同,阿米替林的作用不涉及生物胺。结论:(1)在温度损伤的局部注射氯胺酮产生抗痛觉过敏作用,但是不产生镇痛作用;(2)阿米替林局部注射后既产生抗痛觉过敏作用,又产生镇痛作用;(3)二种药物引起爪肿胀的机制不同。

(王士雷    庄心良 校)

In this study, we examined antihyperalgesic and analgesic actions after local peripheral administration of ketamine and amitriptyline in a rat model of mild thermal injury. Exposure of the hindpaw to 52°C for 45 s under anesthesia produced a subsequent thermal hyperalgesia lasting at least 2 h. The local peripheral administration of ketamine (100–1000 nmol) 15 min before the thermal injury produced an antihyperalgesic effect when injected into the ipsilateral paw, whereas amitriptyline produced both antihyperalgesic (300 nmol) and analgesic (1000 nmol) effects. Administered after the thermal injury, ketamine had no effect, whereas amitriptyline retained its analgesic but not its antihyperalgesic effect. Amitriptyline (300 and 1000 nmol) produced an analgesic action when administered into the normal nonsensitized hindpaw. Both drugs increase paw volume, particularly at larger doses; biogenic amines are not involved in the action of amitriptyline, as was shown previously for ketamine. These results indicate that (a) ketamine produces antihyperalgesia, but not analgesia, when administered locally with a mild thermal injury model; (b) amitriptyline produces both antihyperalgesia and analgesia when administered locally; and (c) the increase in paw volume produced by these drugs occurs by different mechanisms.

 

新鲜冷冻血浆对中心粒细胞-内皮细胞相互作用的影响

The Effects of Fresh Frozen Plasma on Neutrophil-Endothelial Interactions

Boris Nohé, MD, Ralph Thomas Kiefer, MD, Annette Ploppa, MD, Helene A. Haeberle, MD, Torsten H. Schroeder, MD, and Hans-Juergen Dieterich, MD

Department of Anaesthesiology and Critical Care, University Hospital Tuebingen, Tuebingen, Germany

Anesth Analg 2003 97: 216-221.

在严重休克的情况下,白细胞粘附到内皮细胞而导致严重的微循环障碍。一些血浆扩容剂抑制白细胞的粘附,而某些情况下血浆蛋白的污染上调内皮细胞粘附分子。本研究目的是观察新鲜冷冻血浆(FFP)对体外培养的中心粒细胞和脐静脉内皮细胞(HUVEC)的相互作用的影响。HUVEC(n = 9)  20%FFP20%血浆中孵育6h。用TNF{alpha}(0.5 ng/mL for 4 h)诱导E-选择蛋白、细胞间粘附因子-1和血管细胞粘附因子-1的产生并通过流式细胞仪测定其含量。中性粒细胞的粘附功能通过平行平板流量法测定。结果,与FFP共孵育使活化HUVEC产生E-选择蛋白和细胞间粘附分子-1的量分别减少28%22%(P ≤ 0.01)。与FFP共孵育的HUVEC使中性粒细胞粘附降低20%-41%(n = 4; P ≤ 0.01)。结论:FFP减轻中性粒细胞和内皮细胞相互作用时内皮细胞的炎症反应。因为病人的血浆成分不仅受输血的影响,而且受静脉输注液体的影响,因此,危重病人的血液稀释是非常重要的。

(王士雷   庄心良 校)

Leukocyte adhesion to endothelial cells contributes to microcirculatory disturbances during severe shock syndromes. Whereas certain plasma expanders inhibit leukocyte adhesion, contaminants of plasma protein solutions upregulate endothelial cell adhesion molecules in certain cases. We performed this study to determine whether fresh frozen plasma (FFP) affects neutrophil-endothelial interactions in cocultures of neutrophils and human umbilical vein endothelial cells (HUVEC) in vitro. HUVEC (n = 9) were incubated with either 20% FFP or 20% serum in medium for 6 h. Expression of E-selectin, intercellular adhesion molecule 1, and vascular cell adhesion molecule-1 was induced by tumor necrosis factor {alpha}(0.5 ng/mL for 4 h) and measured by flow cytometry. Neutrophil adhesion was examined in a parallel plate flow chamber in which isolated neutrophils were perfused over pretreated HUVEC under postcapillary flow conditions. Incubation with FFP decreased E-selectin and intercellular adhesion molecule 1 on activated HUVEC by 28% and 22%, respectively (P ≤ 0.01; analysis of covariance). Consequently, neutrophil adhesion decreased by 20%–41% in FFP-treated cocultures (n = 4; P ≤ 0.01; paired Student’s t-test). We conclude that FFP attenuates the inflammatory response of endothelial cells with regard to neutrophil-endothelial interactions. Because the composition of patients’ plasma is affected not only by transfusion, but more frequently by shock treatment with IV fluids, plasma

 

非人灵长类动物颈动脉输入腺苷的急性脑血管反应

The Acute Cerebrovascular Effects of Intracarotid Adenosine in Nonhuman Primates

Shailendra Joshi, MD*, Roger Hartl, MD{dagger}, Mei Wang, MS*, Lei Feng, MD{ddagger}, Daniel Hoh, BA§, Robert R. Sciacca, EngScD||, and Sundeep Mangla, MD{ddagger}

Departments of *Anesthesiology, {ddagger}Radiology, §Neurological Surgery, and ||Medicine, College of Physicians and Surgeons of Columbia University, New York, New York; and {dagger}Department of Neurosurgery, Weill Medical College, Cornell University, New York, New York

Anesth Analg 2003 97: 231-237.

 

本研究通过实时脑血流量(CBF)监测评价颈动脉输入腺苷的急性脑血管反应。健康狒狒的颈内动脉经股穿刺置管。用温度探极连续监测基础和给予腺苷(6个剂量,从0.002 1.5 mg/min)后的CBF变化。每个剂量的腺苷输注时间是15min。对于基础和最大剂量腺苷剂量时的CBF,也通过静脉内133Xe进行测定。温度探极监测结果表明,腺苷以剂量依赖的方式增加CBF(从基础的32 ± 6 mL · l00 g-1 · min-1 到最大剂量的90 ± 38 mL · l00 g-1 · min-1 )(n = 5; P < 0.0001)。应用133Xe 方式监测的CBF增加幅度和温度探极监测结果相似。在腺苷输注期间没有明显的颅内压和全身心血管副作用的发生。输注腺苷引起的CBF增加仅发生在腺苷输注期间。结论:经颈动脉输注腺苷非常适合动脉血管扩张治疗和控制脑血管的阻力。

(王士雷   庄心良 校)

In this study we sought to determine the acute cerebrovascular effects of intracarotid adenosine by using real-time cerebral blood flow (CBF) measurements in nonhuman primates. The internal carotid arteries of healthy anesthetized baboons were transfemorally cannulated. Changes in CBF were continuously measured at baseline and with 6 increasing doses of adenosine (0.002 to 1.5 mg/min) by use of an intraparenchymal thermal diffusion (TD) probe. Each infusion lasted 5 min. At baseline and at the largest dose of adenosine, CBF was also determined by the intraarterial 133Xe technique. TD measurements revealed a dose-dependent increase in CBF from 32 ± 6 mL · l00 g-1 · min-1 at baseline to 90 ± 38 mL · l00 g-1 · min-1 with the largest dose of adenosine (n = 5; P < 0.0001). A similar magnitude of increase in CBF was also observed with 133Xe CBF measurements. No significant increases in intracranial pressure or adverse systemic hemodynamic side effects were observed during adenosine infusion. The increase in CBF after adenosine lasted only for the duration of drug infusion. In conclusion, the transient cerebrovascular effects of intracarotid adenosine make it suitable for a trial of intraarterial vasodilator therapy and for controlled manipulation of cerebrovascular resistance.

 

 

矫形外科手术后鞘内注射地塞米松、奥丹西隆以及二者复合液对鞘内注射吗啡后呕吐和瘙痒的预防作用

A Comparison of Dexamethasone, Ondansetron, and Dexamethasone plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Major Orthopedic Surgery

Szilvia Szarvas, MB*, Ramesh S. Chellapuri, MBBS{dagger}, Dominic C. Harmon, MMedSci FCARCSI*, John Owens, FFARCSI{dagger}, Damian Murphy, MD FFARCSI*, and George D. Shorten, MD PhD*

*Department of Anesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork; and {dagger}Department of Anesthesia, Bon Secours Hospital, Cork, Ireland

Anesth Analg 2003 97: 259-263.

本研究通过随机双盲的方式评价地塞米松8 mg、奥丹西隆8 mg或地塞米松8mg复合奥丹西隆4mg对预防瘙痒、恶心和呕吐的作用。130例行择期矫形外科手术的病人,应用重比重0.5%布比卡因和吗啡腰麻。在腰麻后,病人随机分为三组。单独应用地塞米松预防术后恶心呕吐失败的几率(29 of 40; 73%)远远高于单独应用奥丹西隆组(23 of 47; 49%) (P = 0.02)和奥丹西隆复合地塞米松组(19 of 43; 44%)(P = 0.01)。术后24h预防瘙痒失败的几率无显著差别(地塞米松8 mg、奥丹西隆8 mg和地塞米松8 mg 复合奥丹西隆4 mg 组分别是70% 72%、和70% (P > 0.1)。结论:地塞米松 8 mg 复合奥丹西隆与单纯奥丹西隆 8 mg预防术后恶心呕吐和瘙痒的效果无显著差别。

(王士雷   庄心良 校)

In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) ondansetron 8 mg, and (c) dexamethasone 8 mg plus ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, ondansetron 8 mg, and dexamethasone 8 mg plus ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with ondansetron 4 mg has no added benefit compared with ondansetron 8 mg alone in the prophylaxis of PONV and pruritus.

 

麻醉和肌松状态下成年男性和女性病人ProSealTM喉罩型号的选择

Sex-Based ProSealTM Laryngeal Mask Airway Size Selection: A Randomized Crossover Study of Anesthetized, Paralyzed Male and Female Adult Patients

Shinichi Kihara, MD*, and Joseph Brimacombe, FRCA MD{dagger}

*Department of Anaesthesia, Pain Clinic, and Clinical Toxicology, Mito Saiseikai General Hospital, Ibaraki, Japan; and {dagger}University of Queensland, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia

Anesth Analg 2003 97: 280-284.

我们比较了男性用4号和5ProSealTM 喉罩以与女性用3号和4号以及4号和5号喉罩在喉罩插入、 口咽漏气压(OLP) 、通气的情况(10 mL/kg 、气体交换 、局部漏气 、气道和排泄管的解剖位置以及粘膜损伤的情况。以30例男性病人和60例女性病人(ASA I–II; 年龄18–80)为研究对象,在麻醉肌松情况下于三个水平上应用同一水平的交互研究。PLMATM 的插入通过手指由同一熟练技术操作者实施。应用5号喉罩的男性病人,其发生OLP  (P = 0.0002) 和局部漏气(P = 0.03)的发生率高于4号。但是,二种型号喉罩的尝试插入次数、 粘膜损伤 、解剖位置、 气体交换和漏气的位置是一样的。在女性病人,5号喉罩OLP 的发生率高于4(P < 0.0001),但试图插入的次数少(P = 0.02),插入的时间更快(P = 0.02),粘膜损伤的几率也少(P = 0.01)。这二种型号喉罩的解剖位置 、气体交换、漏气的位置没有差异。女性病人3号和4号喉罩相比,OLP发生率高(P = 0.0005),漏气少(P = 0.03),尝试插入的次数 、插入的时间、粘膜损伤、 解剖位置、 气体交换和漏气位置无显著差别。没有供氧失败、通气失败和胃充气等情况发生。结论:喉罩型号的选择与性别有关,4号更适合女性,而5号更适合男性。

(王士雷 庄心良 校)

 We compared the Size 4 and 5 ProSealTM laryngeal mask airway (PLMATM) in men and the Size 3 and 4, and 4 and 5 PLMATM in women in terms of 1) ease of insertion, 2) oropharyngeal leak pressure (OLP), 3) ease of ventilation at a tidal volume of 10 mL/kg, 4) gas exchange, 5) location of gas leak, 6) anatomic position of the airway and drain tube, and 7) mucosal injury. Thirty male and 60 female (ASA physical status I–II; 18–80 yr old) anesthetized, paralyzed patients were studied in a crossover fashion in three equal-sized groups. PLMATM insertion was performed by a single experienced operator by using digital manipulation. In male patients comparing the Size 4 and 5, OLP was higher (P = 0.0002) and leak fraction lower (P = 0.03) for the Size 5, but the number of insertion attempts, insertion time, mucosal injury, anatomic position, gas exchange, and location of gas leak were similar. In female patients comparing the Size 4 and 5 PLMATM, OLP was higher for the Size 5 (P < 0.0001), but the number of insertion attempts was fewer (P = 0.02), insertion time was quicker (P = 0.02), and there was less mucosal injury (P = 0.01) with the Size 4. There were no differences in anatomic position, gas exchange, or location of gas leak. In female patients comparing the Size 3 and 4 PLMATM, OLP was higher (P = 0.0005) and leak fraction was lower (P = 0.03) for the Size 4, but the number of insertion attempts, insertion time, mucosal injury, anatomic position, gas exchange, and location of gas leak were similar. There were no episodes of failed oxygenation, failed ventilation, or gastric insufflation. We conclude that if size is selected by sex, the Size 4 PLMATM is preferable for women and the Size 5 PLMATM for men.

 蛛网膜下腔注射阿片类药物和静脉镇痛两者对腹主动脉术后心血管、呼吸及肾脏并发症发生率的影响的比较

A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular, Respiratory, and Renal Complications After Abdominal Aortic Surgery

Marie-Hélène Fléron, MD, Richard B. Weiskopf, MD, Michèle Bertrand, MD, Stéphane Mouren, MD PhD, Daniel Eyraud, MD, Gilles Godet, MD, Bruno Riou, MD PhD, Edouard Kieffer, MD, and Pierre Coriat, MD

 Departments of Anesthesiology and Critical Care, and Vascular Surgery, CHU Pitié-Salpêtrière; Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France; and Department of Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California

 Anesth Analg 2003;97:2-12

 

大部分外科手术会引起应激反应从而导致有害结果,特别是这些并发症的高危人群。我们假设术后立即使用中枢阿片类药物来提供强效镇痛从而减少或消除一种应激源能够减少大部分非手术并发症,并对此进行检验。217例预定接受腹主动脉手术的患者随机分配到单纯全身麻醉组(对照)和全身麻醉复合蛛网膜下腔注射阿片类药物组(在L45注入1 µg/kg的苏芬太尼和8 µg/kg无防腐剂的吗啡)。两组的术后护理是一样的,包括患者自控镇痛。每位患者通过视觉模拟评分表提供术后疼痛评估。术后并发症则根据先前建立的标准来记录。手术后的第一个24小时内蛛网膜下腔给予阿片类药物的患者比单用患者自控镇痛的患者有更强效的镇痛(P<0.05)。两组间的主要心血管、呼吸和肾脏并发症的发生率(P<0.05)或死亡率(P<0.05)无差异。用肌钙蛋白 I血浆浓度异常来定义心肌损伤或梗死,两组的心肌损伤或梗死发生率亦无差别(P<0.05)。在接受大部分腹部血管手术的患者中,通过术中和术后早期给予中枢阿片类药物以提供强效镇痛来降低术后应激源之一,并不能改变主要心血管、呼吸和肾脏并发症的发生率。    

(廖庆武 薛张纲 校)

 

Major surgery evokes a stress response that can produce deleterious consequences, especially in a population at high risk for those complications. We tested the hypothesis that decreasing or eliminating one of the sources of stress by providing intense analgesia in the immediate postoperative period via application of neuraxial opioids would decrease major nonsurgical complications. Two-hundred-seventeen patients scheduled to undergo abdominal aortic surgery were randomly allocated to receive either general anesthesia alone (control) or general anesthesia combined with intrathecal opioid (1 µg/kg sufentanil with 8 µg/kg preservative-free morphine injected at the L4–5 interspace). Postoperative care was identical in the two groups, including patient-controlled analgesia. Each patient provided an assessment of postoperative pain using a visual analog scale. Postoperative complications were recorded according to criteria established a priori. The administration of intrathecal opioid provided more intense analgesia than patient-controlled analgesia during the first 24 h postoperatively (P < 0.05). There was no difference between groups for the incidence of combined major cardiovascular, respiratory, and renal complications (P > 0.05) or mortality (P > 0.05). The incidence of myocardial damage or infarction, as defined by abnormal plasma concentration of troponin I, did not differ between the two groups (P > 0.05). In patients undergoing major abdominal vascular surgery, decrease of one contributor to postoperative stress, by provision of intense analgesia for the intraoperative and initial postoperative period, via application of neuraxial opioid, does not alter the combined major cardiovascular, respiratory, and renal complication rate.

 

 

普通气道手法在儿童增殖腺切除术中对气道压力和流量的效应

The Effects of Common Airway Maneuvers on Airway Pressure and Flow in Children Undergoing Adenoidectomies

Heinz Bruppacher, MD, Adrian Reber, MD PhD, Jürg P. Keller, PhD, Jeremy Geiduschek, MD, Thomas O. Erb, MD MHS, and Franz J. Frei, MD

 Division of Pediatric Anesthesia, University Children’s Hospital Beider Basel, Basel, Switzerland; {dagger}Fachtechnische Hochschule, Oensingen, Switzerland; and Department of Anesthesiology, University of Washington School of Medicine and Children’s Hospital and Regional Medical Center, Seattle, Washington

 Anesth Analg 2003;97:29-34

 

在麻醉状态并保留自主呼吸的儿童特别是那些又有腺样体增生的儿童经常发生上呼吸道梗阻。为了改善气道开放程度,一些手法如抬颏(CL),推颚(JT)和持续正压气道压力(CPAP)则常被使用。在此研究中,我们在预定接受增殖腺切除术的儿童中检验这些手法的比较功效。1629岁的儿童用七氟醚麻醉。在自主呼吸过程中同时测量面罩(ma),口咽部(op)和食道(es)内的流量和压力,并计算出吸气过程中的最大压力差({Delta}P)。记录好基线后,则使用CLJT手法并随机给予或不给予CPAP(5 cm H2O)。使用所有气道手法后,基线状态下观察到的12.3 ± 3.4 cm H2O Pma - Pes 有所降低(P<0.05)。除CL外所有的干预手法均导致{Delta}Pma - Pop (P < 0.05) {Delta}Pop - Pes (P < 0.05)的降低,使用CL{Delta}Pma - Pop 仍然是相似的。相反,仅在使用JT手法(用和不用CPAP)时观察到每分通气量和最大吸气峰流量有有意义的改善(P<0.05)。我们推断CL也许能改善气道开放和通气,而JT同时使用或不用CPAP则是克服伴有腺样体增生的儿童发生气道梗阻最有效的手法。

(廖庆武 薛张纲 校)

Obstruction of the upper airway occurs frequently in anesthetized, spontaneously breathing children, especially in those with adenoidal hyperplasia. To improve airway patency, maneuvers such as chin lift (CL), jaw thrust (JT), and continuous positive airway pressure (CPAP) are often used. In this study, we examined the comparative efficacy of these maneuvers in children scheduled to undergo adenoidectomy. Sixteen children aged 2–9 yr were anesthetized with sevoflurane. During spontaneous breathing, the flows and pressures in the mask (ma), oropharynx (op), and esophagus (es) were measured simultaneously, and maximal pressure differences during inspiration ({Delta}P) were calculated. After baseline recording, CL and JT maneuvers were performed in random order without and with CPAP (5 cm H2O). The observed {Delta}Pma - Pes of 12.3 ± 3.4 cm H2O at baseline decreased with all airway maneuvers (P < 0.05). This resulted from decreases of {Delta}Pma - Pop (P < 0.05) and {Delta}Pop - Pes (P < 0.05) in all interventions except CL, in which {Delta}Pma - Pop remained similar. In contrast, significant improvements of minute ventilation and maximal inspiratory peak flow (P > 0.05) were observed only with JT (with and without CPAP). We conclude that CL may improve airway patency and ventilation, whereas JT with or without CPAP was the most effective maneuver to overcome airway obstruction in children with adenoidal hyperplasia.

 

在婴儿、儿童和成人使用靶控输注罗库溴铵:比较其药物动力学和药效学的关系

Target-Controlled Infusion of Rocuronium in Infants, Children, and Adults: A Comparison of the Pharmacokinetic and Pharmacodynamic Relationship

V. Saldien, MD, K. M. Vermeyen, MD PhD, and F. L. Wuyts, PhD

Departments of Anesthesiology and Otorhinolaryngology, University Hospital Antwerp, Edegem, Belgium

 Anesth Analg 2003;97:44-49

 

靶控输注(TCI)罗库溴铵能够维持一个稳定血药浓度(Cp)。在稳态下,TCI补偿了药代动力(PK),并可观察到稳定的效果。理论上的Cp表现为效应位置浓度(EC)。我们在婴儿、儿童和成人用EC-效果来研究药效学(PD)。在给予书面承诺后,14位婴儿、23位儿童和21位成人预定接受选择性手术操作,根据PD数据用TCI罗库溴铵使其Cp3升到6。在每次增加TCI之前抽取静脉血标本测定Cp。用加速肌动描记仪来评估神经肌肉阻滞。个体效果数据和测定的Cp值代入Hill方程。在TCI目标为1000, 1300 1600 ng/mL时,儿童的最大阻滞比婴儿和成人的小。婴儿50%药效 (EC50)时的效应室浓度(平均值 [SD]) (652 [215] ng/mL)比成人的(954 [276] ng/mL)明显低,而儿童的(1200 [295] ng/mL)则是最大的。计算平均EC90 值,婴儿、儿童和成人分别是1705, 2230 2035 ng/mL。在不同的TCI目标下TCI罗库溴铵建立的PK/PD稳态允许我们用标准化的方法来详细说明PK/PD的关系。TCI罗库溴铵建立的稳态显示罗库溴铵对婴儿效果最强,对儿童最弱。

(廖庆武 薛张纲 校)

Target-controlled infusion (TCI) of rocuronium can be used to maintain a stable blood concentration (Cp). At steady-state, the pharmacokinetics (PK) are compensated for by TCI, and a stable effect can be observed. The theoretical Cp may represent effect-site concentration (EC). We used the EC-effect relationship to study pharmacodynamics (PD) in infants, children, and adults. After giving their written, informed consent, 14 infants, 23 children, and 21 adults scheduled for elective surgical procedures received 3 to 6 ascending Cp targets of TCI rocuronium according to PD data. Just before each increase of TCI, venous blood samples were taken to measure Cp. Neuromuscular block was evaluated acceleromyographically. Individual effect data and measured Cp were fitted to the Hill equation. Maximum block during TCI targets—1000, 1300, and 1600 ng/mL—was smaller in children in comparison with infants and adults. The concentration in the effect compartment associated with a 50% drug effect (EC50) was significantly smaller in infants (mean [SD]) (652 [215] ng/mL) than in adults (954 [276] ng/mL) and was the largest in children (1200 [295] ng/mL). Calculated mean EC90 values were 1705, 2230, and 2035 ng/mL, respectively, in infants, children, and adults. TCI rocuronium established steady-state PK/PD at different TCI targets and allowed us to define PK/PD relationships in a standardized way. Steady-state TCI rocuronium revealed the most potency of rocuronium in infants and the least in children.

 

 

在顺式阿曲库胺诱导的神经肌肉阻滞恢复时强直刺激后计数与四个成串刺激反应的关系

The relationship of posttetanic count and train-of-four responses during recovery from intense cisatracurium-induced neuromuscular blockade.

El-Orbany MI, Joseph NJ, Salem MR.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago 60657, USA. mohammad.el-orbany-md@advocatehealth.com

Anesth Analg. 2003 Jul;97(1):80-4 

 

强直刺激后计数(PTC)用来评估非去极化神经肌肉阻滞的强度。本试验的目标是搞清楚在吸入麻醉和静脉麻醉时PTC是否与顺式阿曲库胺诱导的神经肌肉阻滞恢复程度有相关性。60位患者,麻醉诱导采用异丙酚2mg/Kg,芬太尼1.5ug/Kg,静脉注射。分2组评估顺式阿曲库胺(0.15mg/Kg)诱导的神经肌肉阻滞恢复程度。组1n=30)麻醉维持采用异丙酚100-200ug/Kg/分钟和60%的一氧化二氮,组2麻醉维持采用异氟醚(呼气末浓度为0.8%)和60%的一氧化二氮与氧气的混合气体。应用肌动加速度仪进行神经肌肉功能监测。每6分钟分别进行强直刺激后计数和四个成串刺激反应监测,包括强直刺激后四个成串刺激反应的T1时间,PTCT1的相关性。组1的平均PTC1T1反应时间为35.6 +/- 7.546.9 +/- 6.5分钟,具有显著性差异。组2的相应时间为39.5 +/- 6.856.7 +/- 5.4分钟,也具有显著性差异。两组的PTCT1恢复有较好的时间相关性,PTC1异丙酚的r=0.919,组2异氟醚的r=0.779。当T1出现时,组1PTC8-9,而组2PTC8-14。与原先对其它神经肌肉阻滞药物的观察相一致,PTCT1在监测顺式阿曲库胺诱导的神经肌肉阻滞恢复程度上有一定的相关性,从而可以在异氟醚吸入麻醉和异丙酚静脉麻醉时提供更好的神经肌肉阻滞程度的监测。结论:在监测神经肌肉阻滞程度时进行强制刺激后计数可以使临床医师估计神经肌肉阻滞程度和恢复时间。在吸入麻醉和静脉麻醉时强直刺激后计数(PTC)与四个成串刺激反应在监测顺式阿曲库胺诱导的神经肌肉阻滞恢复程度上的关系已被证明。                                

(顾越超 薛张刚 校)

 

Posttetanic count (PTC) has been used to quantify intense degrees of nondepolarizing neuromuscular blockade. Our objective in the present investigation was to discern whether PTC correlates with recovery from intense cisatracurium-induced neuromuscular blockade under both inhaled and IV anesthesia. In 60 patients, anesthesia was induced with propofol 2 mg/kg and fentanyl 1.5 micro g/kg IV. Recovery from intense neuromuscular blockade induced by cisatracurium (0.15 mg/kg) was studied in 2 groups. Group 1 (n = 30) had anesthesia maintained with propofol 100-200 micro g x kg(-1) x min(-1) and 60% N(2)O in O(2), whereas Group 2 (n = 30) had anesthesia maintained with isoflurane (end-tidal concentration 0.8%) and 60% N(2)O in O(2). Neuromuscular functions were monitored using acceleromyography. Cycles of posttetanic stimulation were repeated every 6 min with train-of-four (TOF) stimulation in between. Measurement included times to posttetanic responses and to the first response to TOF stimulation (T(1)), as well as the correlation between PTC and T(1). In Group 1, the mean times to PTC(1) and T(1) were 35.6 +/- 7.5 and 46.9 +/- 6.5 min, respectively. Corresponding times in Group 2 were 39.5 +/- 6.8 and 56.7 +/- 5.4 min, respectively. There was a good time correlation, r = 0.919 for propofol (Group 1) and r = 0.779 for isoflurane (Group 2), between PTC and T(1) recovery in both groups. The PTC when T(1) appeared ranged between 8 and 9 in Group 1 and 8 and 14 in Group 2. Conforming to original observations with other neuromuscular blocking drugs, there is a correlation between PTC and TOF recovery from intense cisatracurium-induced neuromuscular blockade allowing better monitoring of this intense degree of blockade during both IV (propofol) and isoflurane anesthesia. IMPLICATIONS: Monitoring posttetanic count during intense neuromuscular blockade allows the clinician to estimate the intensity of the blockade and estimate recovery time. The relationship between posttetanic count and train-of-four recovery from intense cisatracurium-induced neuromuscular blockade was documented under both IV and inhaled anesthesia.

 

异丙酚的药物动力学与药效学:以优化的环糊精形式和脂质形式——在猪模型中的脑电图与血液动力学研究
The pharmacokinetics and pharmacodynamics of propofol in a modified cyclodextrin formulation (Captisol) versus propofol in a lipid formulation (Diprivan): an electroencephalographic and hemodynamic study in a porcine model.

Egan TD, Kern SE, Johnson KB, Pace NL.
Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA.

Anesth Analg. 2003 Jul;97(1):72-9

 

目前销售的异丙酚有许多不受欢迎的特性,在一定程度上是其乳剂形式所产生的,包括注射时的疼痛、严重的变态反应、促进微生物的生长。以优化的环糊精(硫代丁醚β环糊精)为赋形剂的异丙酚已被开发出来,从而可以缓解赋形剂引起的问题。然而,采用新的赋形剂可能改变异丙酚的药理特性。本研究的目的是比较目前销售的乳剂形式的异丙酚和新的环糊精形式的异丙酚的药代动力学与药效学。假设环糊精形式的异丙酚的药代动力学与药效学和乳剂形式的异丙酚比较相似。32只异氟醚麻醉的动物进行肺动脉、动脉、静脉置管,并随机分组持续注射乳剂形式的异丙酚或环糊精形式的异丙酚。采集动脉血样本进行异丙酚的分析测定。持续监测脑电图、心率、平均动脉压、心输出量。应用独立模型分析技术进行异丙酚形式的比较。复合的动力学模型也被建立以用于相仿的目的。这两种异丙酚形式在药代动力学与药效学上无显著差异。基于复合的药代动力学/药效学模型的相似性证明这两种异丙酚形式较为相似。环糊精形式的异丙酚在药代动力学与药效学和乳剂形式的异丙酚比较相似的假设被证明。结论:以优化的环糊精为赋形剂的异丙酚已被开发出来,可以缓解乳剂形式的异丙酚所引起的一些问题。然而,改变异丙酚的赋形剂可能改变它的临床特性。在猪模型中的研究显示新的异丙酚赋形剂与乳剂形式的异丙酚比较相似。

(顾越超 薛张刚 校)

The currently marketed propofol formulation has a number of undesirable properties that are in part a function of the lipid emulsion formulation, including pain on injection, serious allergic reactions, and the support of microbial growth. A modified cyclodextrin-based formulation of propofol (sulfobutyl ether-beta-cyclodextrin) has been developed that may mitigate some of these formulation-dependent problems. However, reformulation may alter propofol's pharmacologic behavior. Our aim in this study was to compare the pharmacokinetics and pharmacodynamics of propofol in the currently marketed lipid-based formulation with those of the novel cyclodextrin formulation. We hypothesized that the pharmacokinetics and pharmacodynamics of the propofol in cyclodextrin would be substantially similar to those of the propofol in lipid. Thirty-two isoflurane-anesthetized animals were instrumented with pulmonary artery, arterial, and IV catheters and were randomly assigned to receive either propofol in lipid or propofol in cyclodextrin by continuous infusion. Arterial blood samples for propofol assay were collected. The processed electroencephalogram, heart rate, mean arterial blood pressure, and cardiac output were measured continuously. The propofol formulations were compared by using model-independent analysis techniques. Combined kinetic/dynamic models were also constructed for simulation purposes. There were no significant differences in the pharmacokinetics or pharmacodynamics of the two propofol formulations. The simulations based on the combined pharmacokinetic/pharmacodynamic models confirmed the substantial similarity of the two formulations. The hypothesis that the propofol-in-cyclodextrin formulation would exhibit pharmacokinetic and pharmacodynamic behavior that was substantially similar to the propofol-in-lipid formulation was confirmed. IMPLICATIONS: A modified cyclodextrin-based formulation of propofol has been developed that may mitigate some of the problems associated with propofol in lipid emulsion. However, reformulation of propofol may change its clinical characteristics. This study in a pig model showed that the novel propofol formulation was substantially similar to the lipid emulsion propofol formulation.

 

缺乏右旋(Cav2.3)钙通道大鼠对异丙酚和氟烷的麻醉敏感性

Anesthetic sensitivities to propofol and halothane in mice lacking the R-type (Cav2.3) Ca2+ channel.

Takei T, Saegusa H, Zong S, Murakoshi T, Makita K, Tanabe T.
Department of Anesthesiology, Graduate School of Medicine, Tokyo Medical and Dental University, Japan.

Anesth Analg. 2003 Jul;97(1):96-103

 

因为电压依赖性钙通道的抑制可能是全麻的一个机理,我们试验了缺乏在神经元中广泛表达的右旋(Ca(v)2.3)钙通道大鼠对异丙酚和氟烷的麻醉敏感性。测定静脉注射异丙酚(26mg/Kg)后的入睡时间,吸入氟烷的MACRR)和MAC50%失去正常反射和挤压尾巴/收缩反应的有效浓度,有显著意义)。观测到Ca(v)2.3钙通道敲除(Cav2.3(-/-))比一胎所生的野生型(Cav2.3(+/+))大鼠异丙酚诱导的入睡时间显著的缩短(291.6 +/- 16.8vs 344.4 +/- 12.1秒),较大的氟烷MACRR)(1.11% +/- 0.04% vs 0.98% +/- 0.03%)。为了调查活体麻醉敏感性降低的原因,记录了兴奋性突触后电位和总体的峰值(PSs)。异丙酚(10-30uM)抑制PSs ,通过加强对α-氨基丁酸的抑制。这种抑制在Cav2.3(-/-)大鼠明显减小,由此引起活体对异丙酚敏感性的降低。在这两种基因型的大鼠,氟烷(1.4%-2.2%)抑制兴奋性突触后电位的情况相似。而氟烷(1%-2%)在Cav2.3(-/-)大鼠更多地降低PSs,提示右旋钙通道的突触后电位在兴奋性传播的作用和其它机制引起Cav2.3(-/-)大鼠氟烷MACRR)的增加。结论:神经钙通道的抑制可能是全麻机制之一,试验了缺乏右旋(Ca(v)2.3)钙通道大鼠的麻醉敏感性。大鼠麻醉敏感性的降低提示麻醉药物阻滞了这个通道从而增加麻醉药物的需求量的可能性。

(顾越超 薛张刚 校)

Because inhibition of voltage-dependent Ca(2+) channels can be a mechanism underlying general anesthesia, we examined sensitivities to propofol and halothane in mice lacking the R-type (Ca(v)2.3) channel widely expressed in neurons. Sleep time after propofol injection (26 mg/kg IV) and halothane MAC(RR) and MAC (50% effective concentrations for the loss of the righting reflex and for the tail pinch/withdrawal response, respectively) were determined. Significantly shorter propofol-induced sleep time (291.6 +/- 16.8 s versus 344.4 +/- 12.1 s) and larger halothane MAC(RR) (1.11% +/- 0.04% versus 0.98% +/- 0.03%) were observed in Ca(v)2.3 channel knockouts (Ca(v)2.3(-/-)) than in wild-type (Ca(v)2.3(+/+)) litter mates. To investigate the basis of the decreased anesthetic sensitivities in vivo, field excitatory postsynaptic potentials and population spikes (PSs) were recorded from Schaffer collateral CA1 synapses in hippocampal slices. Propofol (10-30 micro M) inhibited PSs by potentiating gamma-aminobutyric acid-ergic inhibition, and this potentiation was markedly smaller at 30 micro M in Ca(v)2.3(-/-) mice, possibly accounting for the decreased propofol sensitivity in vivo. Halothane (1.4%-2.2%) inhibited field excitatory postsynaptic potentials similarly in both genotypes, whereas 1%-2% halothane depressed PSs more in Ca(v)2.3(-/-) mice, suggesting the postsynaptic role of the R-type channel in the propagation of excitation and other mechanisms underlying the increased halothane MAC(RR) in Ca(v)2.3(-/-) mice. IMPLICATIONS: Because inhibition of neuronal Ca(2+) currents can be a mechanism underlying general anesthesia, we examined anesthetic sensitivities in mice lacking the R-type (Ca(v)2.3) Ca(2+) channels both in vivo and in hippocampal slices. Decreased sensitivities in mutant mice imply a possibility that agents blocking this channel may increase the requirements of anesthetics/hypnotics.

 

单一剂量鼻内盐酸二氢吗啡酮在健康志愿者中的药代动力学和生物利用度

Pharmacokinetics and Bioavailability of Single-Dose Intranasal Hydromorphone Hydrochloride in Healthy Volunteers

Barbara A. Coda, MD*,{dagger}, Anita C. Rudy, PhD{ddagger}, Sanford M. Archer, MD§, and Daniel P. Wermeling, PharmD{ddagger},||

*Department of Anesthesiology, University of Washington, Seattle; {dagger}McKenzie Anesthesia Group, Springfield, Oregon; {ddagger}Intranasal Technology, Inc; §Division of Otolaryngology-Head & Neck Surgery, University of Kentucky, A.B. Chandler Medical Center; and ||University of Kentucky College of Pharmacy, Lexington, Kentucky Anesth Analg 2003 97: 117-123

我们评估在经鼻给予1.02.0mg以及经静脉给予2.0mg盐酸二氢吗啡酮后单一剂量的盐酸二氢吗啡酮的药代动力学和绝对生物利用度。在24名健康志愿者(13男和11女)中进行公开标记、随机、三路交叉研究。我们用0.1ml标记的喷雾剂经单个或双个鼻孔给予1.02.0m盐酸二氢吗啡酮,每一个剂量后0-16小时内连续收集血标本,并用液相套色版块、分光版块光谱仪测定血浆氢化吗啡酮浓度,非室性模型分析用来推测药代动力学参数。结果:经鼻给予1.02.0m盐酸二氢吗啡酮分别观察到的平均生物利用度和变异百分拟合度为52.4% (22.7)57.5% (18.6)。达到血浆最高浓度的时间中位数分别为20分钟和50分钟。除了各种给药途径均有的不良反应包括嗜睡和眩晕外,经鼻给药还有怪味。还观察到和剂量成比例的量效关系。结论:经鼻给予盐酸二氢吗啡酮A安全性高、吸收快、临床相关生物利用度高。结果支持这一喷雾剂进一步发展。

(梁雅芬译 薛张刚 校)

We evaluated pharmacokinetics and absolute bioavailability of single doses of hydromorphone hydrochloride after administration of 1.0 and 2.0 mg of intranasal (IN) and 2.0 mg of IV hydromorphone hydrochloride. An open-label, randomized, three-way crossover study was conducted in 24 healthy volunteers (13 men and 11 women). IN doses were delivered as 0.1-mL metered-dose sprays into one or both nostrils for 1.0- and 2.0-mg doses, respectively. Blood samples were taken serially from 0 to 16 h after each dose. Plasma hydromorphone concentrations were determined by liquid chromatography-mass spectrometry-mass spectrometry. Noncompartmental analysis was used to estimate pharmacokinetic varia-bles. Mean hydromorphone bioavailabilities and percent coefficient of variation of 52.4% (22.7) and 57.5% (18.6) were seen after the 1.0- and 2.0-mg IN doses, respectively. Median times to maximum concentration were 20 and 25 min for IN doses. Adverse events included somnolence and dizziness with all routes of administration and a bad taste after IN doses. Dose proportionality for the 1.0- and 2.0-mg IN doses was observed. IN hydromorphone hydrochloride met the minimum requirements for safety and demonstrated rapid nasal drug absorption and clinically relevant bioavailability. Results support further development of this novel hydromorphone hydrochloride nasal spray.

 

异丙酚和雷米芬太尼麻醉诱导中ARX源性的听觉诱发电位指数和脑电双频指数的研究

ARX-Derived Auditory Evoked Potential Index and Bispectral Index During the Induction of Anesthesia with Propofol and Remifentanil

Gunter N. Schmidt, MD, Petra Bischoff, MD, Thomas Standl, MD, Malte Issleib, Moritz Voigt, and Jochen Schulte am Esch, MD

Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany Anesth Analg 2003;97:139-144

一种新型的商业性的听觉诱发电位监测仪(A- line AEP监测仪)可通过自动利用听觉诱发电位的幅度和潜伏期计算出一个指数,称为ARX源性的听觉诱发电位指数(简称AAI)。在脊柱手术之前我们研究了患者在逐步全麻诱导时(异丙酚靶控浓度从1.0 µg/mL开始直至5.0 µg/mL,继以0.3 µg · kg-1 · min-1的速度输注雷米芬太尼)记录AAI、脑电双频指数(BIS),{delta}, {theta}, {alpha}, ß相对百分比,边缘频率、中位数频率、平均动脉压、心率及氧饱和度。要求患者每分钟握一次观察者的手,预测可能性(PK),接受者的操作技能和logistic回归分析用来计算预测清醒、非清醒状态(第一次不能握手)及麻醉平稳状态(5.0 µg/mL异丙酚靶, 0.3 µg · kg-1 · min-1的雷米芬太尼)的可能性。尽管AAIBIS、平均动脉压、中位数频率、波形百分比都显示了不同状态间的统计学显著差异,只有AAIBIS对区分非清醒与清醒状态、麻醉和清醒状态的PK值大于0.9。现代的脑电图变量指数AAIBIS在区分麻醉状态上优于经典的脑电血流动力学参数。

(梁雅芬 译 薛张刚 校)

A new commercial auditory evoked potential (AEP) monitor (A-line AEP monitor) was developed to calculate an index (ARX AEP index; AAI) by automatically using the amplitudes and latencies of the AEP. We investigated 30 patients before spine surgery. AAI; bispectral index (BIS); relative (%), {theta}, {alpha}, and ß; spectral edge frequency; median frequency; mean arterial blood pressure; heart rate; and oxygen saturation were obtained simultaneously during stepwise (1.0 µg/mL) induction of target-controlled propofol concentration until 5.0 µg/mL, followed by an infusion of 0.3 µg · kg-1 · min-1 of remifentanil. Every minute, the patients were asked to squeeze the observer’s hand. Prediction probability (Pk), receiver operating characteristic, and logistic regression were used to calculate the probability to predict the conditions AWAKE, UNCONSCIOUSNESS (first loss of hand squeeze), and steady-state ANESTHESIA (5.0 µg/mL of propofol and 0.3 µg · kg-1 · min-1 of remifentanil). Although a statistically significant difference among the conditions was observed for AAI, BIS, mean arterial blood pressure, median frequency, and %{alpha}, only AAI and BIS were able to distinguish UNCONSCIOUSNESS versus AWAKE and ANESTHESIA versus AWAKE with better than Pk = 0.90. The modern electroencephalographic variables AAI and BIS were superior to the classic electroencephalographic and hemodynamic variables to distinguish the observed anesthetic conditions.

 

不同制度间慢性疼痛管理对一年预后前瞻性研究:控制护理制度损害了它的有效性

A Prospective One-Year Outcome Study of Interdisciplinary Chronic Pain Management: Compromising Its Efficacy by Managed Care Policies

Heather Robbins, PhD, Robert J. Gatchel, PhD, Carl Noe, MD, Noor Gajraj, MD, Peter Polatin, MD, Martin Deschner, PhD, Akshay Vakharia, MD, and Laura Adams, PhD

The Eugene McDermott Center for Pain Management, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2003;97:156-162

尽管不同策略的慢性疼痛管理不仅有效,而且效价比高,但由于控制护理制度的影响这种治疗方式并未充分利用。我们通过这个前瞻性对照研究,对慢性疼痛患者进行一年的随访,表明不同策略的慢性疼痛管理的短期和长期有效性,并评介控制护理的物理治疗-开拓性实践对这些治疗结果的影响。201例连续的慢性疼痛患者被收到此研究中,其中有些患者参加了这一治疗程序的物理治疗-开拓性实践。结果表明成功完成这些不同策略的慢性疼痛治疗是有效的,重要的是物理治疗-开拓性实践对短期及一年随访的长期转归都有负面的影响。因此,不同策略的慢性疼痛治疗在处理慢性疼痛这一重大健康问题上是有效的,然而保险商们缩短开拓性实践治疗的政策显著影响了这个以循证为基础的医疗护理及最佳标准医护治疗效率,它提出了重要的医疗法律及伦理问题。

(梁雅芬 译 薛张刚 校)

Although interdisciplinary pain management programs are both therapeutically effective as well as cost-effective, they are currently being underutilized because of managed care policies. We used this prospective comparison trial, with 1-yr follow-up of chronic pain patients, to demonstrate the short- and long-term efficacy of an interdisciplinary pain management program, and evaluate the impact of managed care’s physical therapy "carve out" practices on these treatment outcomes. Consecutive chronic pain patients (n = 201) were evaluated, some of whom had their physical therapy "carved out" from this integrated program. Results revealed that successful completion of interdisciplinary pain management was therapeutically effective. Most importantly, physical therapy "carved out" practices had a negative impact on both the short-term and 1-yr follow-up outcome measures. Thus, interdisciplinary pain management is effective in treating the major health problem of chronic pain. However, insurance carrier policies of contracting treatment "carve outs" significantly compromise the efficacy of this evidence-based, best standard of medical care treatment. This raises important medico-legal and ethical issues.

 

经静脉单剂量注射KRN5500(抗生素,司匹米星)可长期降低神经性疼痛的多发性感觉超敏

A Single Intravenous Injection of (Antibiotic Spicamycin) Produces Long-Term Decreases in Multiple Sensory Hypersensitivities in Neuropathic Pain

L. A. Kobierski, MD PhD*, S. Abdi, MD PhD{dagger}, L. DiLorenzo, MD*, N. Feroz, MD*, and D. Borsook, MD PhD*,{ddagger}

Departments of *Radiology, {dagger}Anesthesia and Critical Care, and {ddagger}Neurology, Center for Functional Pain Neuroimaging and Therapy Research, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts

Anesth Analg 2003;97:174-182

神经性疼痛是临床上的一个显著问题,当前没有一种药物能够完全地改善这种疼痛。我们既往的研究表明抗生素司匹米星的衍生物KRN5500可长期(7天)显著地减低神经性疼痛而非伤害性疼痛。我们通过在一群神经损伤后神经性疼痛的模型中经静脉注射KRN5500观察此药对这类疼痛的改善情况,以更进一步证实此药的疗效。单剂量静脉注射KRN55007天内均可增高强调性机械性刺激和冷刺激的痛阈,而静脉注射此药的载体(溶剂)并无效果。对侧足痛阈无明显影响,另外,在给药后的1246星期均观察到显著的对机械刺激抗异常疼痛作用。此药将成为治疗癌性神经疼痛的一种选择,而且它可成为寻找有效的抗神经性疼痛镇痛药的标志物。

(梁雅芬 译 薛张刚 校)

Neuropathic pain is a significant clinical problem. Currently, there are no drugs that produce complete amelioration of this type of pain. We have previously shown that KRN5500, a derivative of the antibiotic spicamycin, produces a prolonged (7-day), and significant reduction in neuropathic pain, but not nociceptive pain. Herein, we provide further evidence for the efficacy of this drug in inhibiting pain after IV injection in a spared nerve injury model of neuropathic pain. A single IV dose of the drug produces an increase in pain thresholds to punctuate mechanical stimuli and to cold stimuli over a period of 7 days, whereas IV injection of the vehicle is without any effect. No change in pain threshold was observed in the contralateral foot. In addition, a significant antiallodynic effect to mechanical stimuli was observed at 1, 2, 4, and 6 wk. The drug may be a potential candidate for cancer-related neuropathic pain as well as a marker for discovery of effective analgesics for neuropathic pain.

 

多巴酚丁胺抑制人类单核细胞趋化蛋白-1的产生及趋化作用

Dobutamine Inhibits Monocyte Chemoattractant Protein-1 Production and Chemotaxis in Human Monocytes

Chi-Yuan Li, MD MS*, Chien-Sung Tsai, MD{dagger}, Sheau-Huei Chueh, PhD{ddagger}, Ping-Ching Hsu, MS{dagger}, Jia-Yi Wang, PhD§, Chih-Shung Wong, MD PhD*, and Shung-Tai Ho, MD MS*

Departments of *Anesthesiology and {dagger}Surgery, Tri-Service General Hospital; and Departments of {ddagger}Biochemistry and §Physiology, National Defense Medical Center, Taipei, Taiwan, Republic of China

Anesth Analg 2003 97: 205-209.

有报道称,急性心肌梗死或充血性心衰的患者单核细胞趋化蛋白-1MCP-1)在其炎症反应进展中扮演重要作用,MCP-1   的水平与疾病的严重性相关。我们进行本研究以了解多巴酚丁胺和多巴胺对人类单核细胞THP-1细胞脂多糖(LPS)-诱导MCP-1产生的效应。在体外370C下用存在或不存在多巴酚丁胺或多巴胺的LPS孵育单核细胞16h。用酶连免疫吸附法检测多巴酚丁胺对MCP-1合成的效应,MCP-1的信使RNA用逆转录聚合酶链反应法测定。多巴酚丁胺抑制LPS-诱导的MCP-1产生,与信使RNA表达的一样,有剂量依赖关系,而多巴胺无此显著效应。而且,我们证实对于单核细胞THP-1细胞,多巴酚丁胺能抑制MCP-1诱导的趋化作用和Ca离子的锋浓度。这些发现提示在治疗充血性心衰时多巴酚丁胺能调节单核细胞的活性,如趋化作用和Ca离子浓度,这些由MCP-1产生。

(费敏 译 薛张刚 校)

It has been reported that, in patients with acute myocardial infarction or congestive heart failure, monocyte chemoattractant protein-1 (MCP-1) plays an important role in the development of inflammatory responses and that the level of MCP-1 is correlated with the severity of the disease. We conducted this study to investigate the effects of dobutamine and dopamine on lipopolysaccharide (LPS)-induced MCP-1 production in human monocytic THP-1 cells. Monocytes were incubated in vitro with LPS for 16 h at 37°C in the presence or absence of dobutamine or dopamine. Enzyme-linked immunosorbent assay was used to examine the effect of dobutamine on MCP-1 synthesis, with the MCP-1 messenger RNA expression examined by reverse transcriptase-polymerase chain reaction. Dobutamine inhibited LPS-induced production of MCP-1, as well as messenger RNA expression, in a dose-dependent manner, whereas dopamine had no significant effect. Furthermore, we demonstrated that dobutamine suppressed MCP-1-induced chemotaxis and peak [Ca2+]i in monocytic THP-1 cells. These findings suggest that dobutamine may modulate monocyte activation, such as chemotaxis and [Ca2+]i, as well as MCP-1 production, during therapy for congestive heart failure.

 

莫匹罗星抗经鼻气管内插管相关细菌携带的保护效应

The Preventive Effects of Mupirocin Against Nasotracheal Intubation-Related Bacterial Carriage

Satoshi Takahashi*, Kouichiro Minami{dagger}, Midori Ogawa{ddagger}, Hiroshi Miyamoto{ddagger}, Kunio Ikemura*, Akio Shigematsu{dagger}, and Hatsumi Taniguchi{ddagger}

Department of *Oral and Maxillofacial Surgery, {dagger}Anesthesiology, and {ddagger}Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

Anesth Analg 2003 97: 222-225.

 

经鼻气管内插管在口腔和颌面外科经常应用。经鼻气管内插管的并发症很多文献报道过,但很少有系统地采取方法去预防。我们检查了插管相关的细菌尤其是耐甲氧西林金黄色葡萄球菌(MRSA)带入气道,评估鼻腔局部应用莫匹罗星治疗对插管相关细菌株的作用。38名患者未用莫匹罗星治疗(非治疗组),在插管前27(71.1%)名患者鼻腔内有普通细菌株。该组13.2%的患者分离到MRSA。但是,用莫匹罗星治疗(治疗组)在插管前22名患者中10名有普通细菌株而2名(9%)携带MRSA。在非治疗组中经鼻插管后分别有66.2%和16.7%的患者气管内导管顶部分离到普通细菌和MRSA。相反,经口插管后19.2%的患者气管导管顶部分离到普通细菌,但未检测到MRSA。然而在治疗组中经鼻插管后在323.1%)名患者的气管导管顶部分离到普通细菌,未检测到MRSA,而口插气管导管未分离到细菌。这些结果显示经鼻气管插管较经口插管有更高的几率将细菌带入气道,莫匹罗星鼻腔治疗能去除鼻腔带有的金黄色葡萄球菌。在经鼻气管插管前用莫匹罗星鼻腔局部治疗能预防细菌带入气道。

(费敏 译 薛张刚 校)

Nasotracheal intubation is often required during dental and maxillofacial surgery. The complications of nasotracheal intubation are well documented, but there have been few systematic attempts to find methods for their prevention. We examined intubation-related carriage of bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA), into the trachea and evaluated the effects of topical nasal treatment with mupirocin on intubation-related bacterial colonization. Of 38 patients without mupirocin treatment (nontreatment group), 27 (71.1%) showed general bacterial colonization in the nasal cavities before intubation. MRSA was isolated from 13.2% of the patients in this group. However, 10 of 22 patients (45%) treated with mupirocin (treatment group) showed colonization by general bacteria, and 2 (9%) were MRSA carriers before intubation. After nasal intubation, general bacteria and MRSA were isolated from the endotracheal tube tip in 66.2% and 16.7% of these patients in the nontreatment group, respectively. In contrast, general bacteria were isolated from the endotracheal tube tip in 19.2% of these patients after oral intubation, but no MRSA was detected. However, after nasal intubation, general bacteria were isolated from the endotracheal tube tip in 3 of the patients in the treatment group (23.1%), and no MRSA was detected, whereas no bacteria were isolated from oral intubation tubes. These results indicate that bacteria were carried into the trachea at a more frequent rate by nasal intubation as compared with oral intubation, and nasal treatment with mupirocin eliminated the nasal carriage of S. aureus. Topical nasal treatment with mupirocin before nasal intubation is thus suggested to be effective for preventing carriage of bacteria into the trachea.

 

 静脉麻醉药剂量褪黒激素的脑电图效应:和硫喷妥钠及丙泊酚比较研究

The Electroencephalographic Effects of IV Anesthetic Doses of Melatonin: Comparative Studies with Thiopental and Propofol

Mohamed Naguib, MB BCh, MSc, FFARCSI, MD, Phillip G. Schmid, III, MD, and Max T. Baker, PhD

Department of Anesthesia, University of Iowa College of Medicine, Iowa City, Iowa

Anesth Analg 2003 97: 238-243

我们已经证实大剂量静脉注射褪黒激素会发挥催眠效应,与硫喷妥钠和丙泊酚产生的类似。在本研究中,我们比较褪黒激素与硫喷妥钠和丙泊酚的脑电图效应。SD大鼠给予相同负荷硫喷妥钠(23.8mg/kg),丙泊酚(14.9mg/kg,或褪黒激素(312mg/kg)。脑电图效应以间隔10分钟的周期记录。分析8个脑电图变量,只有相关总电源频率(rTP),相关光谱95%区间(rSE95),以及相关近似平均信息量(rAE) ,与它们的对照组比较都能被所用药物改变。给予药物减少了基线的相关价值,在10分钟反应进程中向基线返回。硫喷妥钠显著增加rTP,而丙泊酚和褪黒激素不会。所有药物都会明显降低rSE95。但是,反应进程的锋效应和持续时间各不相同,褪黒激素显示较慢起效及较持续的EEG效应。所有药物都会明显降低rAE,硫喷妥钠和丙泊酚具有相似的反应进程,而褪黒激素较慢起效作用较持久。褪黒激素对于EEG变量产生的效应与硫喷妥钠和丙泊酚的相类似,尤其是对rSE95rAE的降低。

(费敏 译 薛张刚 校)

We have demonstrated that large-dose IV melatonin can exert hypnotic effects similar to those caused by thiopental and propofol. In this study, we compared the electroencephalographic (EEG) effects of melatonin with those of thiopental and propofol. Sprague-Dawley rats were assigned to receive equipotent bolus doses of thiopental (23.8 mg/kg), propofol (14.9 mg/kg), or melatonin (312 mg/kg). EEG effects were recorded at periodic intervals over 10 minutes. Of eight processed EEG variables analyzed, only relative total power (rTP), relative spectral edge 95% (rSE95), and relative approximate entropy (rAE) were altered by all drugs compared with their control vehicles. Drug administration decreased the values relative to baseline, with subsequent return toward baseline during the 10-min time course. Thiopental significantly increased rTP, whereas propofol and melatonin did not. All drugs significantly decreased rSE95. However, the time course of peak effect and duration differed for each, with melatonin exhibiting a slower onset and a more sustained EEG effect. All drugs significantly decreased rAE, with similar time courses for thiopental and propofol and a slower onset/longer duration for melatonin. Melatonin produced effects on processed EEG variables similar to those of thiopental and propofol, specifically a decrease in the rSE95 and a decrease in the rAE.

 

病态肥胖的病人行腹腔镜术时潮气量和呼吸频率对氧合和呼吸力学的效应

The Effects of Tidal Volume and Respiratory Rate on Oxygenation and Respiratory Mechanics During Laparoscopy in Morbidly Obese Patients

Juraj Sprung, MD PhD*, David G. Whalley, MB ChB{dagger}, Tommaso Falcone, MD{ddagger},§, William Wilks, RT§, James E. Navratil, MD, and Denis L. Bourke, MD||

*Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; {dagger}Department of Anesthesiology, The Cleveland Clinic Foundation, Naples, Florida; {ddagger}Department of Obstetrics and Gynecology, Minimally Invasive Surgery, §The Cleveland Clinic Foundation, Cleveland, Ohio; and ||Department of Anesthesiology, University of Maryland, and Veterans Administration Medical Center, Baltimore, Maryland

Anesth Analg 2003 97: 268-274.

 

病态肥胖(MO)的病人行腹腔镜术时PaO2较正常体重(NW)的病人低。我们假设增加潮气量(V)或呼吸频率(RR)能改善氧合。所有的测量方式如下:1)基线:VT600-700ml,RR10/;2)两倍VT:VT1200-1400ml,RR10/分;3)两倍频率:VT600700ml,RR20/分。我们计算呼吸系统的顺应性(Cst,rs)和气道阻力(RI,rs.呼气末CO2经质谱分析计测量,PaO2PaCO2用连续血气监测。平卧位MO病人较NW病人低29Cst,rs(P<0.05)。在气腹前定位病人头高或头低在两组病人中对Cst,rs无显著差异(P=0.8)。在两倍VT而非两倍RR时两组的Cst,rs均增加。气腹导致两组Cst,rs大幅降低(两组P<0.001)。在气腹时改变体位,VT,RR在各组中都不再影响Cst,rsP>0.7)。在气腹前,MO病人的RI,rsNW病人高,与体位无关(P0.01)。两倍RRVT在气腹前不改变任何一组的RIrs。气腹后在头低和头高位RI,rs都增加(P<0.05),而仰卧位不变。不管研究条件如何,氧张力的肺泡-动脉差异不受体位、气腹或通气模式的影响。腹腔镜术时动脉血氧合只受体重影响,不能通过增加VTRR而改善。

(费敏 译 薛张刚 校)

Morbidly obese (MO) patients undergoing laparoscopy have lower PaO2 compared with normal-weight (NW) patients. We hypothesized that increases in tidal volume (VT) or respiratory rate (RR) would improve oxygenation. All measurements were performed at: 1) baseline: VT 600–700 mL and 10 breaths/min, 2) double VT: VT 1200–1400 mL and 10 breaths/min, and 3) double rate: VT 600–700 mL and 20 breaths/min. We calculated static respiratory system compliance (Cst,rs) and inspiratory resistance (RI,rs). End-tidal CO2 was measured with a mass spectrometer, and PaO2 and PaCO2 with a continuous blood gas monitor. Supine anesthetized MO patients had 29% lower Cst,rs than the NW patients (P < 0.05). Positioning patients head-up or head-down before pneumoperitoneum did not significantly affect Cst,rs in either group (P = 0.8). Doubling the VT, but not RR, increased Cst,rs in both groups. Pneumoperitoneum caused large decreases in Cst,rs in both groups (both P < 0.001). During pneumoperitoneum, changing the body position, VT, or RR did not further affect Cst,rs in either group (P > 0.7). Before pneumoperitoneum, RI,rs was higher in the MO patients compared with the NW patients regardless of body position (P = 0.01). Doubling either RR or VT before pneumoperitoneum did not change RI,rs in either group. After pneumoperitoneum, RI,rs increased in both the head-down and head-up positions (P < 0.05), but not in the supine position. Regardless of the conditions studied, alveolar-arterial difference in oxygen tension was always significantly higher in MO patients (P < 0.05). The alveolar-arterial difference in oxygen tension was not affected by body position, pneumoperitoneum, or the mode of ventilation. Arterial oxygenation during laparoscopy was affected only by body weight and could not be improved by increasing either the VT or RR.

 

用引导器换口插管时气管导管管头设计的效应和导管厚度通过喉的能力

The Effects of Tracheal Tube Tip Design and Tube Thickness on Laryngeal Pass Ability During Oral Tube Exchange with an Introducer

Hiroshi Makino, MD, Takasumi Katoh, MD, Syunji Kobayashi, MD, Hiromichi Bito, MD, and Shigehito Sato, MD

Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan

Anesth Analg 2003 97: 285-288.

 

我们比较二种不同的导管和二种不同大小的气管导管交换器在插管器引导下更容易经过声门。一种是具有标准斜面洞的聚氯乙烯导管,另一种是新设计的半球状斜面洞的导管。两个气管导管交换器的外径分别为2.55.0mm。标准的麻醉诱导,维库溴铵导致的麻痹后,在直接喉镜导引下将气管导管交换器置入气管。用插管器作为导引,将气管导管置入气管。通过导管的不同由盲法的观察员评定并用四点量表评分。使用外径为2.5mm的气管导管交换器,新设计的导管在置管时较通常的导管更顺畅(P<0.01)在一些情况下比如单肺麻醉后,使用较厚的气管导管交换器并不适用,新设计的管头锥形的导管可作为经口气管导管交换器的附加物,使用较薄的气管导管交换器作为气管插管的导引。

(费敏 译 薛张刚 校)

We compared the ease of passage through the glottis of two different tubes and two different sizes of tracheal tube exchanger (TE) during introducer-guided tracheal intubation. One tube was a polyvinyl chloride tube with a standard bevel, and the other was a newly designed tube with a hemispherical bevel. The outer diameters (OD) of the two TEs were 2.5 and 5.0 mm. After the standard induction of anesthesia, followed by vecuronium-induced paralysis, a TE was inserted into the trachea with a direct laryngoscope. By using the introducer as a guide, the tracheal tube was inserted into the trachea. The difficulty in passing the tube was assessed by a blinded observer and graded with a four-point scale. The newly designed tube was inserted more smoothly than was the conventional tube when the 2.5-mm-OD TE was used (P < 0.01). In situations such as those occurring after one-lung anesthesia, when use of a thicker TE is not applicable, this newly designed taper-tipped tube may be considered as an adjunct to oral tracheal tube exchange, using a thinner (smaller-OD) TE as the guide for tracheal intubation.