Anesthesia & Analgesia

July 2003

 

CARDIOVASCULAR ANESTHESIA:

蛛網膜下腔注射阿片類藥物和靜脈鎮痛兩者對腹主動脈術後心血管、呼吸及腎臟併發症發生率的影響的比較

(廖慶武 譯 薛張綱 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.

體外迴圈實驗中氯美噻唑對血漿內Il-6,Il-8,Il-1β,TNF-α濃度及中性粒細胞粘附因數表達的影響

(朱輝譯 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:

美國肝移植麻醉術中應用資源的調查

(王士雷 莊心良 校)

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

Roman Schumann

Anesth Analg 2003 97: 21-28.

普通氣道手法在兒童增殖腺切除術中對氣道壓力和流量的效應

(廖慶武 譯 薛張綱 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術後鎮痛效果和安全性的評估

(朱輝 譯  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在小兒意識和深度鎮靜監測中的價值

(王士雷   莊心良 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.

在嬰兒、兒童和成人使用靶控輸注羅庫溴銨:比較其藥物動力學和藥效學的關係

(廖慶武 譯 薛張綱 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:

小劑量布比卡因或利多卡因蛛網膜下腔麻醉用於宮頸環紮術的比較

(齊波 譯  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.

處理術後噁心嘔吐的指導原則

(王士雷 譯 莊心良 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:

異丙酚的藥物動力學與藥效學:以優化的環糊精形式和脂質形式——在豬模型中的腦電圖與血液動力學研究

(顧越超 薛張剛 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.

在順式阿曲庫胺誘導的神經肌肉阻滯恢復時強直刺激後計數與四個成串刺激反應的關係

(顧越超 薛張剛 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.

普魯卡因和鹽酸甲呱卡因毒性作用小於臨床其他局麻藥的離體研究

(齊波 譯  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.

大鼠快速輸注阿米替林布比卡因和左旋布比卡因的相對毒性

(王士雷譯  莊心良 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)鈣通道大鼠對異丙酚和氟烷的麻醉敏感性

(顧越超 薛張剛 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.

氯胺酮和戊巴比妥對爪蟾卵母細胞上P物質受體表達的抑制作用

(忻紀華 譯  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.

異氟醚濃度在0.8 1.2MAC時抑制彌散傷害性抑制控制

(王士雷    莊心良 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.

單一劑量鼻內鹽酸二氫嗎啡酮在健康志願者中的藥代動力學和生物利用度

(梁雅芬譯 薛張剛 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.

應用人類在體組織微透析模型評價布比卡因負荷微囊釋放的藥動學和藥代學改變

 (忻紀華 譯   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:

手術病人的內隱記憶隨不同的腦電圖鎮靜程度而出現差異

(王士雷    莊心良 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.

異丙酚和雷米芬太尼麻醉誘導中ARX源性的聽覺誘發電位指數和腦電雙頻指數的研究

(梁雅芬 譯 薛張剛 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.

測量壓力-容量關係時吸氣流量設置的指導

(殷文淵 譯  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.

在乾燥過程中CO2吸附劑的顏色變化:含水量的體外研究  

(王士雷 譯  莊心良 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:

不同制度間慢性疼痛管理對一年預後前瞻性研究:控制護理制度損害了它的有效性

(梁雅芬 譯 薛張剛 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.

氯胺酮和阿米替林對輕度熱損傷大鼠的外周抗痛覺過敏和鎮痛作用

(王士雷    莊心良 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.

經靜脈單劑量注射KRN5500(抗生素,司匹米星)可長期降低神經性疼痛的多發性感覺超敏

(梁雅芬 薛張剛 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:

多巴酚丁胺抑制人類單核細胞趨化蛋白-1的產生及趨化作用

(費敏 譯 薛張剛 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.

多巴胺調節人體單核細胞內脂多糖誘導巨噬細胞炎性蛋白-1α和白介素-8的產生

(殷文淵 譯  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.

新鮮冷凍血漿對中心粒細胞-內皮細胞相互作用的影響

(王士雷 譯  莊心良 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.

莫匹羅星抗經鼻氣管內插管相關細菌攜帶的保護效應

(費敏 譯 薛張剛 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.

尼非地平對豬後期心肺復蘇中室顫頻率的作用

(陳潔  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:

非人靈長類動物頸動脈輸入腺苷的急性腦血管反應

(王士雷   莊心良 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.

靜脈麻醉藥劑量褪黒激素的腦電圖效應:和硫噴妥鈉及丙泊酚比較研究

(費敏 譯 薛張剛 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:

小劑量布比卡因-芬太尼脊麻聯合嗎啡在分娩中的應用

(陳潔   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:

矯形外科手術後鞘內注射地塞米松、奧丹西隆以及二者複合液對鞘內注射嗎啡後嘔吐和瘙癢的預防作用

(王士雷   莊心良 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:

病態肥胖的病人行腹腔鏡術時潮氣量和呼吸頻率對氧合和呼吸力學的效應

(費敏 譯 薛張剛 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.

長期應用抗抑鬱藥可以降低術中體溫過低的發生率

(齊波 譯  王祥瑞  )

Chronic Treatment with Antidepressants Decreases Intraoperative Core Hypothermia

Akira Kudoh, Hajime Takase, and Tomoko Takazawa

Anesth Analg 2003 97: 275-279.

麻醉和肌松狀態下成年男性和女性病人ProSealTM喉罩型號的選擇

(王士雷 莊心良 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.

用引導器換口插管時氣管導管管頭設計的效應和導管厚度通過喉的能力

(費敏 譯 薛張剛 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.

體外迴圈實驗中氯美噻唑對血漿內Il-6,Il-8,Il-1β,TNF-α濃度及中性粒細胞粘附因數表達的影響

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)是一種神經保護藥,具有抗炎作用。本研究觀察了體外迴圈中CMZ對血漿內Il-6,Il-8,Il-1β,TNF-α濃度及中性粒細胞粘附因數表達的影響。研究中抽取了五個健康志願者的血液各500毫升,隨後分成等份(250毫升)的兩組,在CMZ組內加入CMZ使血漿內濃度達到40μmol/l,並在37℃下進行體外迴圈2小時。抽取不同時期的血樣標本:(1)獻血時,(2)剛加入CMZ時,(3)體外迴圈306090120分鐘後。CMZ組體外迴圈60分鐘後的血漿內Il-6,Il-8TNF-α濃度低於對照組(分別是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)。體外迴圈120分鐘後,CMZ組內中性粒細胞CD18的表達明顯低於對照組(237.5[97.4]280.5[111.5]P=0.03)。體外迴圈實驗中使用CMZ可抑制炎症反應。CMZ的此種作用應該可以在心肺體外迴圈中通過降低炎症介導的神經學損傷而具有一定的臨床意義。

(朱輝譯 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術後鎮痛效果和安全性的評估

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

 

本研究的目的是評估在小兒扁桃腺體切除術前使用Rofecoxib1mg/kg)的鎮痛效果和安全性。Rofecoxib是一種選擇性抑制環加氧酶-2途徑的非類固醇類抗炎藥。663-11歲需實施扁桃腺體切除的患者被隨機分成兩組,給予安慰劑或Rofecoxib,兩組患者在種群和血液丟失方面無顯著差異。我們發現使用Rofecoxib組的患者2小時(P<0.05)和24小時(P<0.006)的疼痛評分明顯低於對照組。對照組在家中噁心(P<0.03)和嘔吐(P<0.004)的發生頻率明顯多於Rofecoxib組。結論:小兒患者進行擇期扁桃腺體切除術時術前單純使用Rofecoxib可明顯減少嘔吐發生並降低24小時疼痛評分。

(朱輝   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.

 

小劑量布比卡因或利多卡因蛛網膜下腔麻醉用於宮頸環紮術的比較

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

 

宮頸環紮術通常在蛛網膜下腔麻醉下門診手術室內完成。因為手術時間短,局麻藥通常選用利多卡因,但因利多卡因具有短暫神經症狀(TNS)目前已不常用。本研究主要是觀察小劑量布比卡因是否可以替代利多卡因應用于宮頸環紮術。隨機選擇59名女性病人採用同等劑量的利多卡因30mg或布比卡因5.25mg實施蛛網膜下腔麻醉,兩種局麻藥中均加用20μg芬太尼,並用0.9%生理鹽水稀釋至3ml。在研究中記錄病人起始和最高的感覺阻滯的體表平面、麻醉效果、有無低血壓、T12平面消失的時間、下肢運動功能恢復的情況、能否自己移動以及排尿情況。並在術後24小時內通過電話詢問評估TNS的症狀。結果發現除了利多卡因組病人下肢運動恢復相對較慢外,兩組病人在術始或術畢恢復階段無任何顯著差異。利多卡因組有兩名病人發現有TNS症狀並在48小時內自行恢復,但布比卡因組沒有病人出現TNS症狀。因此,布比卡因蛛網膜下腔麻醉可以較好的替代利多卡因蛛網膜下腔麻醉用於宮頸環紮術。

(齊波   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.

 

普魯卡因和鹽酸甲呱卡因毒性作用小於臨床其他局麻藥的離體研究

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

 

通過觀察培養神經細胞胞體和軸突的塌陷可以證明局麻藥靜脈應用時的神經毒性作用。本研究應用椎實螺屬蝸牛的培養神經細胞比較普魯卡因、鹽酸甲呱卡因、羅呱卡因、布比卡因、利多卡因、地卡因和地布卡因的神經毒性。將局麻藥溶液加入神經細胞培養皿中,使最終濃度在1×10-62×10-2M之間。在實驗中觀察神經細胞胞體和軸突形態學改變並按照改變程度進行分級:1級(輕度)、2級(重度)。結果發現形態學改變為1級的局麻藥濃度分別為:普魯卡因為5×10-4M,鹽酸甲呱卡因為5×10-4M,羅呱卡因為2×10-4M,布比卡因為2×10-4M,利多卡因為1×10-4M,地卡因為5×10-5M,地布卡因為2×10-5M。統計學分析發現鹽酸甲呱卡因和羅呱卡因,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間有顯著差異(P0.05)。這幾種局麻藥神經毒性從小到大依次為普魯卡因=鹽酸甲呱卡因﹤羅呱卡因=布比卡因﹤利多卡因﹤地卡因﹤地布卡因。雖然利多卡因的毒性作用要大於與它具有相似藥理學效應的布比卡因、羅呱卡因和鹽酸甲呱卡因,但在臨床上常用的局麻藥中利多卡因對神經細胞胞體生長的毒性作用是最小的。

(齊波   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.

 

氯胺酮和戊巴比妥對爪蟾卵母細胞上P物質受體表達的抑制作用

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物質受體(SPR)調控著脊神經內傷害感受的傳遞。靜脈麻醉劑對SPR的作用尚不清楚。本研究中我們主要研究靜脈麻醉劑對爪蟾卵母細胞SPR表達的作用。通過全細胞電壓鉗測定SP介導的Ca2+啟動的Cl-電流來測驗氯胺酮、戊巴比妥、異丙酚和曲馬多對爪蟾卵母細胞SPR表達的作用。在藥理學相關濃度時氯胺酮和戊巴比妥可以抑制SPR介導的電流,但異丙酚和曲馬多幾乎無作用。本實驗還研究了氯胺酮和異丙酚對[3H]SP的作用。氯胺酮和異丙酚抑制爪蟾卵母細胞上[3H]SPSPR的特意性結合。[3H]SP結合的Scatchard分析顯示氯胺酮和戊巴比妥減低了受體結合和最大結合的表面分裂常數,且為非競爭性抑制。C蛋白激酶(PKC)抑制劑(bisindolylmalemide I)不能阻斷氯胺酮和戊巴比妥對SP介導的Ca2+啟動的Cl-通道電流的抑制作用。實驗結果提示氯胺酮和戊巴比妥可以抑制SPR的功能。其機制並不是通過PKC途徑,可能與SP非競爭性結合有關。

(忻紀華   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.

 

應用人類在體組織微透析模型評價布比卡因負荷微囊釋放的藥動學和藥代學改變

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

 

雙分級微囊可以帶來局麻藥的超長作用期。此作用可能是因為微囊對周圍組織的持續釋放造成的。先前的研究已試驗了布比卡因從微囊釋放和吸收入體循環的藥效學。微透析樣本可以判定任何藥物注射點的藥物動力學。本研究觀察志願者在注射後96小時內從微囊釋放的布比卡因和地塞米松的藥物動力學。將布比卡因的濃度與臨床局麻阻滯的濃度相比。本研究證實布比卡因以恒定的方式從微囊中釋放,其濃度在微囊注射後24-34小時上升,鎮痛效應與微透析法測得的布比卡因的濃度相關。單純水劑和微囊的布比卡因起效時間相同(P=0.23)。微囊注射部位在96小時後仍有78%的鎮痛作用,明顯較單純的布比卡因作用時間長(P<0.001)。輕度瘙癢是最常見的併發症,在微囊注射中發生率為56%。地塞米松布比卡因微囊耐受好並能延長皮膚的鎮痛作用。儘管微囊內的布比卡因濃度是布比卡因水劑的濃度的3倍,但布比卡因水劑的體循環吸收的血漿峰濃度較微囊注射的高。

(忻紀華    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.

 

測量壓力-容量關係時吸氣流量設置的指導

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

 

使用靜止的方法來獲得壓力-容量曲線以提高通氣策略十分費時。而低流量技術使用時間較少,但由於氣道和氣管導管對氣流的阻礙作用,順應性值會降低。在研究中,確定了三種氣流在麻醉中對氣道和氣管導管內氣流阻礙作用的影響(P-t)。研究了10 ASA P1/P2呼吸功能正常的患者。在使用61230L/min持續氣流進行容量—控制通氣時測量氣道和食道壓力。在移去氣管導管前後建立潮氣量為2505007501000ml時的壓力容量曲線圖,下彎曲點,呼吸系統和胸壁順應性。收集資料分析變化,比較61230L/min氣流時我們發現較低流量時下彎曲點較低。612L/min氣流之間沒有區別。移去(P-t)後僅僅在30L/min時有差異(P=0.004)。氣流越高,順應性越低。(P-t)順應性僅在30L/min時有所降低。胸壁順應性在使用三種氣流時沒有差異。結論是在術中獲得PV曲線時,控制流量<12L/min可以使(P-t)最小。順應性則提示6L/min為最合適的流量。

(殷文淵   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.

 

多巴胺調節人體單核細胞內脂多糖誘導巨噬細胞炎性蛋白-1α和白介素-8的產生

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介導白細胞向炎症部位的遷移。據報導,CC Chemokine 巨噬細胞炎症蛋白(MIP)-1α和CXC chemokine白介素(IL-8在炎症早期,傷口癒合,膿血症以及一些心血管疾病,包括急性冠狀動脈症狀和充血性心力衰竭中佔有重要地位。進行這個研究的目的是調查多巴胺對人體單核細胞THP-1細胞產生脂多糖誘導MIP -1α和白介素-8的影響。單核細胞和LPS37℃下在存在或缺少多巴胺的條件下在試管中孵育。多巴胺對MIP -1α和白介素-8的影響使用一種酶聯免疫吸附劑化驗,MIP -1α和白介素-8的信使RNAmRNA)使用逆轉錄酶聚合鏈反應檢驗。多巴胺對THP-1細胞產生脂多糖誘導MIP -1α和白介素-8有顯著的劑量依賴性抑制作用。,羥甲叔丁腎上腺素(Salbutamol)對LPS刺激MIP -1α和白介素-8的產生有相似的抑制作用。MIP -1αmRNA也被10µM的多巴胺所抑制,然而,在相同濃度下,多巴胺對IL-8mRNA水平沒有明顯抑制。此外,我們發現多巴胺能抑制THP-1分化巨噬細胞中MIP -1α引起的趨化作用。這些發現說明多巴胺可以抑制巨噬細胞的趨化作用,也就是單核細胞產生MIP -1α和白介素-8。生化調節部位對MIP -1α來說位於轉錄水平,而白介素-8則在轉錄後水平。

(殷文淵   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.

 

尼非地平對豬後期心肺復蘇中室顫頻率的作用

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

 

本研究評價一種鈣離子通道阻滯劑和安慰劑生理鹽水對後期心肺復蘇中室顫頻率和血流動力學變化的作用。在心臟驟停之前,10只豬隨機接受尼非地平(0.64mg/kg,n=5)或生理鹽水(n=5),注藥速度大於10分鐘.藥物攝入之後,立刻引導室顫。經過4分鐘的心臟驟停和18分鐘基本的心肺復蘇後,嘗試除顫。心跳驟停後90分鐘,尼非地平組室顫頻率明顯高於對照組(均數±標準差:12.4±2.1Hz8±0.7Hz),心跳驟停後218.5分鐘,兩組間室顫頻率無明顯差異。除顫之前,尼非地平組室顫頻率明顯高於對照組(均數±標準差:9.7±1.2Hz7.1±1.3Hz)。從室顫後11.5分鐘開始,尼非地平組冠狀動脈灌注壓明顯低於對照組。無一例室顫後自動恢復竇性心率。總結:尼非地平能防止心跳驟停後室顫頻率的快速下降並保持心肺後期復蘇中室顫頻率在10Hz,但是這與除顫成功無關。

                                                  (陳潔  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.

 

小劑量布比卡因-芬太尼脊麻聯合嗎啡在分娩中的應用

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

本研究使用小劑量布比卡因-芬太尼脊麻或聯合應用小劑量嗎啡對分娩的鎮痛作用。60例臨產婦參與了這次安慰劑對照、雙盲、隨機實驗。所有婦女脊管內注射12.5ug芬太尼和2mg布比卡因。嗎啡組同時接受125ug嗎啡,對照組接受生理鹽水。疼痛評分在注射後10分鐘內小於3分。組間的鎮痛持續時間相近(89分鐘比84分鐘,p無顯著差異),嗎啡組僅20%出現鎮痛時間延長。在脊麻之後,嗎啡組突破疼痛評分的發生率最低(0.15±0.140.26±0.18每小時)。同時,分娩後24小時內嗎啡組止痛藥物的需要量更少(3.3±3.74.7±3.5劑量,p=0.04)。椎管內注射這種小劑量布比卡因-芬太尼對分娩能產生快速鎮痛,加入小劑量嗎啡沒有明顯延長鎮痛時間,但進一步緩解了疼痛。這可能是臨床分娩中和分娩後緩解疼痛的有效方法。

                                     (陳潔   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.

 

長期應用抗抑鬱藥可以降低術中體溫過低的發生率

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

 

本研究主要觀察慢性抑鬱症病人長期應用抗抑鬱藥後麻醉過程中體溫調節和術後寒顫情況。選擇實行矯形外科手術的35名抑鬱症病人和35名對照組病人。研究中發現抑鬱症組病人麻醉誘導後607590分鐘的鼓膜溫度高於對照組病人(P0.05)。但兩組病人平均體表溫度無顯著差異。8名抑鬱症組病人和2名對照組病人出現了麻醉後寒顫。抑鬱症組病人的寒顫發生率明顯高於對照組病人(P=0.04)。在抑鬱症組病人中,應用氯丙嗪治療的病人的鼓膜溫度高於應用馬普替林治療的病人。本研究認為慢性抑鬱症病人術中體溫過低的發生率降低了,但術後寒顫發生率卻明顯增加。

(齊波   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.

美國肝移植麻醉術中應用資源的調查

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.

肝移植麻醉術中應用的資源,包括實驗室檢查、 配備的人員 、高流量輸入裝置、 高技術含量的監測儀和靜脈-靜脈轉流技術等在不同的機構之間是不同的。儘管大家對此感興趣,但是,有關這些資源在整個國家的應用情況仍知之甚少。為了瞭解美國各肝移植中心這些資源的應用情況,我們在20024月至7月期間進行了全國範圍的調查。共有99個中心通過郵件的方式接受了調查,有6666.6%)個中心給予了回復。統計結果顯示,小兒肝移植與成人以及混合年齡個案相比,在配備的人員 監測儀和靜脈-靜脈轉流技術等方面存在著顯著差異。在實驗室檢查方面,術中監測啟動凝血時間 、鎂和磷酸鹽濃度的次數越來越少。這些調查結果對於比較不同肝移植中心的的麻醉程式以及對肝移植麻醉的臨床發展是有利的。結論:在各個肝移植中心之間,術中應用資源的情況有顯著差異。這個調查結果與目前一些文獻中介紹的情況是不一致的。

(王士雷 莊心良 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在小兒意識和深度鎮靜監測中的價值

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.

本研究比較BIS和密西根大學鎮靜評分(UMSS)在小兒意識和深度鎮靜監測中的應用,探討BIS在小兒意識和深度鎮靜監測中的價值。在兒童醫院的4個部門,由非麻醉科醫生對86例小兒(小於12歲)進行意識和深睡眠的診斷和處理。對鎮靜藥物沒有嚴格控制,因此各個部門應用的鎮靜藥物是不一樣的。在小兒1小時的鎮靜期間,由一個獨立的觀察者每10分鐘進行UMSS評分。給小兒實施鎮靜者不知道UMSSBIS的評分情況。結果,BISUMSS之間有顯著相關性(r = -0.704, P < 0.0001),其中包含6例小於6歲的兒童(r = -0.761, P < 0.001)。當應用氯胺酮或氯胺酮複合水合氯醛、安泰樂和呱替啶鎮靜時,則二者的相關性較差。結論:BIS UMS之間有很好的相關性,可以作為評價兒童意識和深度鎮靜的有效手段。

(王士雷   莊心良 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.

 

處理術後噁心嘔吐的指導原則

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.

本文提供了由國際專家小組討論制訂的處理術後噁心嘔吐的指導原則。

(王士雷 莊心良 校)

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


大鼠快速輸注阿米替林布比卡因和左旋布比卡因的相對毒性

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.

血管內注入局麻藥導致心血管和中樞神經的毒性反應。阿米替林是三環類抗抑鬱藥,有較布比卡因更強的局麻效能。本研究比較布比卡因、左旋布比卡因和阿米替林的心血管和中樞神經毒性反應。選擇29SD大鼠為研究物件,在全麻下經頸外靜脈和頸動脈置管。在第二天,大鼠腹腔注射咪唑安定(0.375 mg/kg)鎮靜,並經頸外靜脈快速輸注: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)生理鹽水(400 µL · kg-1 · min-1)。監測心電圖和動脈血壓直至大鼠至瀕死狀態(心率50 bpm/心臟停搏或窒息時間 >30 s)。阿米替林引起窒息和瀕死狀態的劑量(分別為74.0 ± 21 mg/kg 74.5 ± 21 mg/kg)顯著大於左旋布比卡因(分別為32.2 ± 20 mg/kg 33.9 ± 22 mg/kg)和布比卡因(分別是21.5 ± 7 mg/kg 22.7 ± 7 mg/kg) (P < 0.05)。結論:急性輸注阿米替林引起心血管和中樞神經毒性反應的劑量顯著大於布比卡因和左旋布比卡因。

(王士雷譯  莊心良 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.

 

異氟醚濃度在0.8 1.2MAC時抑制彌散傷害性抑制控制

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.

傷害性刺激反應被遠端繼發性的傷害性刺激抑制的現象稱為彌散傷害性抑制控制(DNIC)。遠端繼發性傷害刺激不改變抑制體動的吸入麻醉藥的MAC。本研究的目的是觀察吸入麻醉藥在MAC附近的濃度時是否抑制DNIC。以異氟醚麻醉大鼠,並測定MAC。在伴有或不伴有尾或對側後肢傷害性刺激的情況下,測定脊髓背角對後肢溫度刺激的反應。在0.8MAC時,伴隨夾尾刺激與沒有夾尾刺激相比,後角神經元的反應減少70%(從1032 ± 178衝動/分減少到 301 ± 135; P < 0.05)。在1.2MAC時,夾尾對神經反應無顯著影響(879 ± 139衝動/分至 825 ± 191 衝動/; P > 0.05)1.2MAC異氟醚也顯著抑制後肢刺激引起的DNIC。在另一組大鼠,用冷的方式可逆性阻斷頸髓的傳遞以觀察這種調節方式是否由脊髓上部位進行調節的,結果顯示,在異氟醚0.8MAC時不能觀察到對側刺激引起的DNIC。結論:在異氟醚濃度低於1MAC時存在DNIC,而異氟醚超過1MAC時抑制DNICDNIC由脊髓上部位進行調節。

(王士雷    莊心良 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

 

手術病人的內隱記憶隨不同的腦電圖鎮靜程度而出現差異

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.

 

以前的研究觀察到內隱記憶和麻醉中特定的腦電圖有相關性。我們對以腦電圖監測的鎮靜深度和內隱記憶之間的相關性進行了檢驗。研究物件為32例腹腔鏡疝切開術和30例志願者。所有病人給予靜脈咪達唑侖2-3mg,隨後給予異丙酚和雷米芬太尼誘導。麻醉維持選用異丙酚-雷米芬太尼-順式阿曲庫銨。每例病人均聽4個故事中的2個,共聽6遍。第一個故事在腦電圖顯示輕至中度鎮靜水平時給予,第二個故事在深度鎮靜水平時給予。病人聽故事和鎮靜深度是均衡的。對照組在未接受麻醉的情況下開始聽故事。7小時後,通過電腦程式設計測定閱讀二個新故事和聽過的故事的速度。結果,所有病人均未出現麻醉不充分的情況,也無外顯記憶發生。閱讀深鎮靜時聽的故事時,閱讀速度無變化。相比較而言,閱讀在中淺鎮靜時聽的故事時,每個實義詞(如名詞 、動詞 、形容詞等)的閱讀速度增加20s,而功能詞(如連詞、 介詞等)的閱讀速度不增加。結論:在淺、中鎮靜狀態下病人能夠處理聽覺資訊,而在深鎮靜水平,則不能處理聽覺資訊。

(王士雷    莊心良 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.

 

在乾燥過程中CO2吸附劑的顏色變化:含水量的體外研究

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.

不含氫氧化堿的吸附劑在乾燥過程中發生顏色改變,而含氫氧化堿者則不發生改變。這種特性是否是由於氫氧化鈣比氫氧化堿有弱的易潮濕特性?我們對此進行了探討。不含氫氧化堿的吸附劑Amsorb® Superia®以及分別含1% 3% NaOH 3% KOH 的吸附劑在150°C 潮濕儀中乾燥,評價乾燥過程中的顏色變化(n5)。另外,我們分別用包含4% KOH 1% NaOH,Baralyme® Spherasorb®的散劑重複這個實驗。Amsorb® and Superia® 在乾燥以前很長一段時間已經開始發生顏色變化。在另外加入1% NaOH 後,象Spherasorb®    一樣,發生顏色變化的乾燥時間延長,顏色變化程度輕。這種作用在加入3% NaOH 時更明顯。加入KOH 以及Baralyme®在乾燥過程中不發生顏色改變。結論:不同含量的NaOH KOH吸附劑在乾燥過程中的顏色變化不是由於不同氫氧化堿吸附水的量不同引起的。

(王士雷   莊心良 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.

 

氯胺酮和阿米替林對輕度熱損傷大鼠的外周抗痛覺過敏和鎮痛作用

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.

本研究的目的是觀察局部給予氯胺酮和阿米替林對熱損傷大鼠的抗痛覺過敏和鎮痛作用。在麻醉狀態下大鼠後肢暴露在52°C 環境持續45s,導致明顯的持續至少2h的溫度性痛覺過敏。在後肢損傷前15min局部預先注射氯胺酮(100–1000 nmol)顯著抑制痛覺過敏,預先注射抗阿米替林則兼有抑制痛覺過敏(300 nmol)和鎮痛(1000 nmol)作用。在溫度損傷後再給予這些藥物,結果氯胺酮無作用,而阿米替林僅有鎮痛作用。阿米替林(300 1000 nmol)在注射到正常無損傷的後肢時產生鎮痛作用。二種藥物都引起爪腫脹,特別是在在大劑量時更明顯。但是,和氯胺酮不同,阿米替林的作用不涉及生物胺。結論:(1)在溫度損傷的局部注射氯胺酮產生抗痛覺過敏作用,但是不產生鎮痛作用;(2)阿米替林局部注射後既產生抗痛覺過敏作用,又產生鎮痛作用;(3)二種藥物引起爪腫脹的機制不同。

(王士雷    莊心良 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.

 

新鮮冷凍血漿對中心粒細胞-內皮細胞相互作用的影響

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.

在嚴重休克的情況下,白細胞粘附到內皮細胞而導致嚴重的微循環障礙。一些血漿擴容劑抑制白細胞的粘附,而某些情況下血漿蛋白的污染上調內皮細胞粘附分子。本研究目的是觀察新鮮冷凍血漿(FFP)對體外培養的中心粒細胞和臍靜脈內皮細胞(HUVEC)的相互作用的影響。HUVEC(n = 9)  20%FFP20%血漿中孵育6h。用TNF{alpha}(0.5 ng/mL for 4 h)誘導E-選擇蛋白、細胞間粘附因數-1和血管細胞粘附因數-1的產生並通過流式細胞儀測定其含量。中性粒細胞的粘附功能通過平行平板流量法測定。結果,與FFP共孵育使活化HUVEC產生E-選擇蛋白和細胞間粘附分子-1的量分別減少28%22%(P ≤ 0.01)。與FFP共孵育的HUVEC使中性粒細胞粘附降低20%-41%(n = 4; P ≤ 0.01)。結論:FFP減輕中性粒細胞和內皮細胞相互作用時內皮細胞的炎症反應。因為病人的血漿成分不僅受輸血的影響,而且受靜脈輸注液體的影響,因此,危重病人的血液稀釋是非常重要的。

(王士雷   莊心良 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

 

非人靈長類動物頸動脈輸入腺苷的急性腦血管反應

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.

 

本研究通過即時腦血流量(CBF)監測評價頸動脈輸入腺苷的急性腦血管反應。健康狒狒的頸內動脈經股穿刺置管。用溫度探極連續監測基礎和給予腺苷(6個劑量,從0.002 1.5 mg/min)後的CBF變化。每個劑量的腺苷輸注時間是15min。對於基礎和最大劑量腺苷劑量時的CBF,也通過靜脈內133Xe進行測定。溫度探極監測結果表明,腺苷以劑量依賴的方式增加CBF(從基礎的32 ± 6 mL · l00 g-1 · min-1 到最大劑量的90 ± 38 mL · l00 g-1 · min-1 )(n = 5; P < 0.0001)。應用133Xe 方式監測的CBF增加幅度和溫度探極監測結果相似。在腺苷輸注期間沒有明顯的顱內壓和全身心血管副作用的發生。輸注腺苷引起的CBF增加僅發生在腺苷輸注期間。結論:經頸動脈輸注腺苷非常適合動脈血管擴張治療和控制腦血管的阻力。

(王士雷   莊心良 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.

 

 

矯形外科手術後鞘內注射地塞米松、奧丹西隆以及二者複合液對鞘內注射嗎啡後嘔吐和瘙癢的預防作用

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.

本研究通過隨機雙盲的方式評價地塞米松8 mg、奧丹西隆8 mg或地塞米松8mg複合奧丹西隆4mg對預防瘙癢、噁心和嘔吐的作用。130例行擇期矯形外科手術的病人,應用重比重0.5%布比卡因和嗎啡腰麻。在腰麻後,病人隨機分為三組。單獨應用地塞米松預防術後噁心嘔吐失敗的幾率(29 of 40; 73%)遠遠高於單獨應用奧丹西隆組(23 of 47; 49%) (P = 0.02)和奧丹西隆複合地塞米松組(19 of 43; 44%)(P = 0.01)。術後24h預防瘙癢失敗的幾率無顯著差別(地塞米松8 mg、奧丹西隆8 mg和地塞米松8 mg 複合奧丹西隆4 mg 組分別是70% 72%、和70% (P > 0.1)。結論:地塞米松 8 mg 複合奧丹西隆與單純奧丹西隆 8 mg預防術後噁心嘔吐和瘙癢的效果無顯著差別。

(王士雷   莊心良 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.

 

麻醉和肌松狀態下成年男性和女性病人ProSealTM喉罩型號的選擇

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.

我們比較了男性用4號和5ProSealTM 喉罩以與女性用3號和4號以及4號和5號喉罩在喉罩插入、 口咽漏氣壓(OLP) 、通氣的情況(10 mL/kg 、氣體交換 、局部漏氣 、氣道和排泄管的解剖位置以及粘膜損傷的情況。以30例男性病人和60例女性病人(ASA I–II; 年齡18–80)為研究物件,在麻醉肌松情況下于三個水平上應用同一水平的交互研究。PLMATM 的插入通過手指由同一熟練技術操作者實施。應用5號喉罩的男性病人,其發生OLP  (P = 0.0002) 和局部漏氣(P = 0.03)的發生率高於4號。但是,二種型號喉罩的嘗試插入次數、 粘膜損傷 、解剖位置、 氣體交換和漏氣的位置是一樣的。在女性病人,5號喉罩OLP 的發生率高於4(P < 0.0001),但試圖插入的次數少(P = 0.02),插入的時間更快(P = 0.02),粘膜損傷的幾率也少(P = 0.01)。這二種型號喉罩的解剖位置 、氣體交換、漏氣的位置沒有差異。女性病人3號和4號喉罩相比,OLP發生率高(P = 0.0005),漏氣少(P = 0.03),嘗試插入的次數 、插入的時間、粘膜損傷、 解剖位置、 氣體交換和漏氣位置無顯著差別。沒有供氧失敗、通氣失敗和胃充氣等情況發生。結論:喉罩型號的選擇與性別有關,4號更適合女性,而5號更適合男性。

(王士雷 莊心良 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.

 蛛網膜下腔注射阿片類藥物和靜脈鎮痛兩者對腹主動脈術後心血管、呼吸及腎臟併發症發生率的影響的比較

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

 

大部分外科手術會引起應激反應從而導致有害結果,特別是這些併發症的高危人群。我們假設術後立即使用中樞阿片類藥物來提供強效鎮痛從而減少或消除一種應激源能夠減少大部分非手術併發症,並對此進行檢驗。217例預定接受腹主動脈手術的患者隨機分配到單純全身麻醉組(對照)和全身麻醉複合蛛網膜下腔注射阿片類藥物組(在L45注入1 µg/kg的蘇芬太尼和8 µg/kg無防腐劑的嗎啡)。兩組的術後護理是一樣的,包括患者自控鎮痛。每位元患者通過視覺類比評分表提供術後疼痛評估。術後併發症則根據先前建立的標準來記錄。手術後的第一個24小時內蛛網膜下腔給予阿片類藥物的患者比單用患者自控鎮痛的患者有更強效的鎮痛(P<0.05)。兩組間的主要心血管、呼吸和腎臟併發症的發生率(P<0.05)或死亡率(P<0.05)無差異。用肌鈣蛋白 I血漿濃度異常來定義心肌損傷或梗死,兩組的心肌損傷或梗死發生率亦無差別(P<0.05)。在接受大部分腹部血管手術的患者中,通過術中和術後早期給予中樞阿片類藥物以提供強效鎮痛來降低術後應激源之一,並不能改變主要心血管、呼吸和腎臟併發症的發生率。    

(廖慶武 薛張綱 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.

 

 

普通氣道手法在兒童增殖腺切除術中對氣道壓力和流量的效應

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

 

在麻醉狀態並保留自主呼吸的兒童特別是那些又有腺樣體增生的兒童經常發生上呼吸道梗阻。為了改善氣道開放程度,一些手法如抬頦(CL),推顎(JT)和持續正壓氣道壓力(CPAP)則常被使用。在此研究中,我們在預定接受增殖腺切除術的兒童中檢驗這些手法的比較功效。1629歲的兒童用七氟醚麻醉。在自主呼吸過程中同時測量面罩(ma),口咽部(op)和食道(es)內的流量和壓力,並計算出吸氣過程中的最大壓力差({Delta}P)。記錄好基線後,則使用CLJT手法並隨機給予或不給予CPAP(5 cm H2O)。使用所有氣道手法後,基線狀態下觀察到的12.3 ± 3.4 cm H2O Pma - Pes 有所降低(P<0.05)。除CL外所有的干預手法均導致{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,僅在使用JT手法(用和不用CPAP)時觀察到每分通氣量和最大吸氣峰流量有有意義的改善(P<0.05)。我們推斷CL也許能改善氣道開放和通氣,而JT同時使用或不用CPAP則是克服伴有腺樣體增生的兒童發生氣道梗阻最有效的手法。

(廖慶武 薛張綱 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.

 

在嬰兒、兒童和成人使用靶控輸注羅庫溴銨:比較其藥物動力學和藥效學的關係

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

 

靶控輸注(TCI)羅庫溴銨能夠維持一個穩定血藥濃度(Cp)。在穩態下,TCI補償了藥代動力(PK),並可觀察到穩定的效果。理論上的Cp表現為效應位置濃度(EC)。我們在嬰兒、兒童和成人用EC-效果來研究藥效學(PD)。在給予書面承諾後,14位嬰兒、23位兒童和21位成人預定接受選擇性手術操作,根據PD資料用TCI羅庫溴銨使其Cp3升到6。在每次增加TCI之前抽取靜脈血標本測定Cp。用加速肌動描記儀來評估神經肌肉阻滯。個體效果資料和測定的Cp值代入Hill方程。在TCI目標為1000, 1300 1600 ng/mL時,兒童的最大阻滯比嬰兒和成人的小。嬰兒50%藥效 (EC50)時的效應室濃度(平均值 [SD]) (652 [215] ng/mL)比成人的(954 [276] ng/mL)明顯低,而兒童的(1200 [295] ng/mL)則是最大的。計算平均EC90 值,嬰兒、兒童和成人分別是1705, 2230 2035 ng/mL。在不同的TCI目標下TCI羅庫溴銨建立的PK/PD穩態允許我們用標準化的方法來詳細說明PK/PD的關係。TCI羅庫溴銨建立的穩態顯示羅庫溴銨對嬰兒效果最強,對兒童最弱。

(廖慶武 薛張綱 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.

 

 

在順式阿曲庫胺誘導的神經肌肉阻滯恢復時強直刺激後計數與四個成串刺激反應的關係

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 

 

強直刺激後計數(PTC)用來評估非去極化神經肌肉阻滯的強度。本試驗的目標是搞清楚在吸入麻醉和靜脈麻醉時PTC是否與順式阿曲庫胺誘導的神經肌肉阻滯恢復程度有相關性。60位患者,麻醉誘導採用異丙酚2mg/Kg,芬太尼1.5ug/Kg,靜脈注射。分2組評估順式阿曲庫胺(0.15mg/Kg)誘導的神經肌肉阻滯恢復程度。組1n=30)麻醉維持採用異丙酚100-200ug/Kg/分鐘和60%的一氧化二氮,組2麻醉維持採用異氟醚(呼氣末濃度為0.8%)和60%的一氧化二氮與氧氣的混合氣體。應用肌動加速度儀進行神經肌肉功能監測。每6分鐘分別進行強直刺激後計數和四個成串刺激反應監測,包括強直刺激後四個成串刺激反應的T1時間,PTCT1的相關性。組1的平均PTC1T1反應時間為35.6 +/- 7.546.9 +/- 6.5分鐘,具有顯著性差異。組2的相應時間為39.5 +/- 6.856.7 +/- 5.4分鐘,也具有顯著性差異。兩組的PTCT1恢復有較好的時間相關性,PTC1異丙酚的r=0.919,組2異氟醚的r=0.779。當T1出現時,組1PTC8-9,而組2PTC8-14。與原先對其他神經肌肉阻滯藥物的觀察相一致,PTCT1在監測順式阿曲庫胺誘導的神經肌肉阻滯恢復程度上有一定的相關性,從而可以在異氟醚吸入麻醉和異丙酚靜脈麻醉時提供更好的神經肌肉阻滯程度的監測。結論:在監測神經肌肉阻滯程度時進行強制刺激後計數可以使臨床醫師估計神經肌肉阻滯程度和恢復時間。在吸入麻醉和靜脈麻醉時強直刺激後計數(PTC)與四個成串刺激反應在監測順式阿曲庫胺誘導的神經肌肉阻滯恢復程度上的關係已被證明。                                

(顧越超 薛張剛 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.

 

異丙酚的藥物動力學與藥效學:以優化的環糊精形式和脂質形式——在豬模型中的腦電圖與血液動力學研究
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

 

目前銷售的異丙酚有許多不受歡迎的特性,在一定程度上是其乳劑形式所產生的,包括注射時的疼痛、嚴重的變態反應、促進微生物的生長。以優化的環糊精(硫代丁醚β環糊精)為賦形劑的異丙酚已被開發出來,從而可以緩解賦形劑引起的問題。然而,採用新的賦形劑可能改變異丙酚的藥理特性。本研究的目的是比較目前銷售的乳劑形式的異丙酚和新的環糊精形式的異丙酚的藥代動力學與藥效學。假設環糊精形式的異丙酚的藥代動力學與藥效學和乳劑形式的異丙酚比較相似。32只異氟醚麻醉的動物進行肺動脈、動脈、靜脈置管,並隨機分組持續注射乳劑形式的異丙酚或環糊精形式的異丙酚。採集動脈血樣本進行異丙酚的分析測定。持續監測腦電圖、心率、平均動脈壓、心輸出量。應用獨立模型分析技術進行異丙酚形式的比較。複合的動力學模型也被建立以用於相仿的目的。這兩種異丙酚形式在藥代動力學與藥效學上無顯著差異。基於複合的藥代動力學/藥效學模型的相似性證明這兩種異丙酚形式較為相似。環糊精形式的異丙酚在藥代動力學與藥效學和乳劑形式的異丙酚比較相似的假設被證明。結論:以優化的環糊精為賦形劑的異丙酚已被開發出來,可以緩解乳劑形式的異丙酚所引起的一些問題。然而,改變異丙酚的賦形劑可能改變它的臨床特性。在豬模型中的研究顯示新的異丙酚賦形劑與乳劑形式的異丙酚比較相似。

(顧越超 薛張剛 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)鈣通道大鼠對異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

 

因為電壓依賴性鈣通道的抑制可能是全麻的一個機理,我們試驗了缺乏在神經元中廣泛表達的右旋(Ca(v)2.3)鈣通道大鼠對異丙酚和氟烷的麻醉敏感性。測定靜脈注射異丙酚(26mg/Kg)後的入睡時間,吸入氟烷的MACRR)和MAC50%失去正常反射和擠壓尾巴/收縮反應的有效濃度,有顯著意義)。觀測到Ca(v)2.3鈣通道敲除(Cav2.3(-/-))比一胎所生的野生型(Cav2.3(+/+))大鼠異丙酚誘導的入睡時間顯著的縮短(291.6 +/- 16.8vs 344.4 +/- 12.1秒),較大的氟烷MACRR)(1.11% +/- 0.04% vs 0.98% +/- 0.03%)。為了調查活體麻醉敏感性降低的原因,記錄了興奮性突觸後電位和總體的峰值(PSs)。異丙酚(10-30uM)抑制PSs ,通過加強對α-氨基丁酸的抑制。這種抑制在Cav2.3(-/-)大鼠明顯減小,由此引起活體對異丙酚敏感性的降低。在這兩種基因型的大鼠,氟烷(1.4%-2.2%)抑制興奮性突觸後電位的情況相似。而氟烷(1%-2%)在Cav2.3(-/-)大鼠更多地降低PSs,提示右旋鈣通道的突觸後電位在興奮性傳播的作用和其他機制引起Cav2.3(-/-)大鼠氟烷MACRR)的增加。結論:神經鈣通道的抑制可能是全麻機制之一,試驗了缺乏右旋(Ca(v)2.3)鈣通道大鼠的麻醉敏感性。大鼠麻醉敏感性的降低提示麻醉藥物阻滯了這個通道從而增加麻醉藥物的需求量的可能性。

(顧越超 薛張剛 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.

 

單一劑量鼻內鹽酸二氫嗎啡酮在健康志願者中的藥代動力學和生物利用度

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

我們評估在經鼻給予1.02.0mg以及經靜脈給予2.0mg鹽酸二氫嗎啡酮後單一劑量的鹽酸二氫嗎啡酮的藥代動力學和絕對生物利用度。在24名健康志願者(13男和11女)中進行公開標記、隨機、三路交叉研究。我們用0.1ml標記的噴霧劑經單個或雙個鼻孔給予1.02.0m鹽酸二氫嗎啡酮,每一個劑量後0-16小時內連續收集血標本,並用液相套色版塊、分光版塊光譜儀測定血漿氫化嗎啡酮濃度,非室性模型分析用來推測藥代動力學參數。結果:經鼻給予1.02.0m鹽酸二氫嗎啡酮分別觀察到的平均生物利用度和變異百分擬合度為52.4% (22.7)57.5% (18.6)。達到血漿最高濃度的時間中位數分別為20分鐘和50分鐘。除了各種給藥途徑均有的不良反應包括嗜睡和眩暈外,經鼻給藥還有怪味。還觀察到和劑量成比例的量效關係。結論:經鼻給予鹽酸二氫嗎啡酮A安全性高、吸收快、臨床相關生物利用度高。結果支持這一噴霧劑進一步發展。

(梁雅芬譯 薛張剛 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.

 

異丙酚和雷米芬太尼麻醉誘導中ARX源性的聽覺誘發電位指數和腦電雙頻指數的研究

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

一種新型的商業性的聽覺誘發電位監測儀(A- line AEP監測儀)可通過自動利用聽覺誘發電位的幅度和潛伏期計算出一個指數,稱為ARX源性的聽覺誘發電位指數(簡稱AAI)。在脊柱手術之前我們研究了患者在逐步全麻誘導時(異丙酚靶控濃度從1.0 µg/mL開始直至5.0 µg/mL,繼以0.3 µg · kg-1 · min-1的速度輸注雷米芬太尼)記錄AAI、腦電雙頻指數(BIS),{delta}, {theta}, {alpha}, ß相對百分比,邊緣頻率、中位數頻率、平均動脈壓、心率及氧飽和度。要求患者每分鐘握一次觀察者的手,預測可能性(PK),接受者的操作技能和logistic回歸分析用來計算預測清醒、非清醒狀態(第一次不能握手)及麻醉平穩狀態(5.0 µg/mL異丙酚靶, 0.3 µg · kg-1 · min-1的雷米芬太尼)的可能性。儘管AAIBIS、平均動脈壓、中位數頻率、波形百分比都顯示了不同狀態間的統計學顯著差異,只有AAIBIS對區分非清醒與清醒狀態、麻醉和清醒狀態的PK值大於0.9。現代的腦電圖變數指數AAIBIS在區分麻醉狀態上優於經典的腦電血流動力學參數。

(梁雅芬 薛張剛 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.

 

不同制度間慢性疼痛管理對一年預後前瞻性研究:控制護理制度損害了它的有效性

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

儘管不同策略的慢性疼痛管理不僅有效,而且效價比高,但由於控制護理制度的影響這種治療方式並未充分利用。我們通過這個前瞻性對照研究,對慢性疼痛患者進行一年的隨訪,表明不同策略的慢性疼痛管理的短期和長期有效性,並評介控制護理的物理治療-開拓性實踐對這些治療結果的影響。201例連續的慢性疼痛患者被收到此研究中,其中有些患者參加了這一治療程式的物理治療-開拓性實踐。結果表明成功完成這些不同策略的慢性疼痛治療是有效的,重要的是物理治療-開拓性實踐對短期及一年隨訪的長期轉歸都有負面的影響。因此,不同策略的慢性疼痛治療在處理慢性疼痛這一重大健康問題上是有效的,然而保險商們縮短開拓性實踐治療的政策顯著影響了這個以循證為基礎的醫療護理及最佳標準醫護治療效率,它提出了重要的醫療法律及倫理問題。

(梁雅芬 薛張剛 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.

 

經靜脈單劑量注射KRN5500(抗生素,司匹米星)可長期降低神經性疼痛的多發性感覺超敏

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

神經性疼痛是臨床上的一個顯著問題,當前沒有一種藥物能夠完全地改善這種疼痛。我們既往的研究表明抗生素司匹米星的衍生物KRN5500可長期(7天)顯著地減低神經性疼痛而非傷害性疼痛。我們通過在一群神經損傷後神經性疼痛的模型中經靜脈注射KRN5500觀察此藥對這類疼痛的改善情況,以更進一步證實此藥的療效。單劑量靜脈注射KRN55007天內均可增高強調性機械性刺激和冷刺激的痛閾,而靜脈注射此藥的載體(溶劑)並無效果。對側足痛閾無明顯影響,另外,在給藥後的1246星期均觀察到顯著的對機械刺激抗異常疼痛作用。此藥將成為治療癌性神經疼痛的一種選擇,而且它可成為尋找有效的抗神經性疼痛鎮痛藥的標誌物。

(梁雅芬 薛張剛 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.

 

多巴酚丁胺抑制人類單核細胞趨化蛋白-1的產生及趨化作用

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.

有報導稱,急性心肌梗死或充血性心衰的患者單核細胞趨化蛋白-1MCP-1)在其炎症反應進展中扮演重要作用,MCP-1   的水平與疾病的嚴重性相關。我們進行本研究以瞭解多巴酚丁胺和多巴胺對人類單核細胞THP-1細胞脂多糖(LPS)-誘導MCP-1產生的效應。在體外370C下用存在或不存在多巴酚丁胺或多巴胺的LPS孵育單核細胞16h。用酶連免疫吸附法檢測多巴酚丁胺對MCP-1合成的效應,MCP-1的信使RNA用逆轉錄聚合酶鏈反應法測定。多巴酚丁胺抑制LPS-誘導的MCP-1產生,與信使RNA表達的一樣,有劑量依賴關係,而多巴胺無此顯著效應。而且,我們證實對於單核細胞THP-1細胞,多巴酚丁胺能抑制MCP-1誘導的趨化作用和Ca離子的鋒濃度。這些發現提示在治療充血性心衰時多巴酚丁胺能調節單核細胞的活性,如趨化作用和Ca離子濃度,這些由MCP-1產生。

(費敏 薛張剛 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.

 

莫匹羅星抗經鼻氣管內插管相關細菌攜帶的保護效應

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.

 

經鼻氣管內插管在口腔和頜面外科經常應用。經鼻氣管內插管的併發症很多文獻報導過,但很少有系統地採取方法去預防。我們檢查了插管相關的細菌尤其是耐甲氧西林金黃色葡萄球菌(MRSA)帶入氣道,評估鼻腔局部應用莫匹羅星治療對插管相關細菌株的作用。38名患者未用莫匹羅星治療(非治療組),在插管前27(71.1%)名患者鼻腔內有普通細菌株。該組13.2%的患者分離到MRSA。但是,用莫匹羅星治療(治療組)在插管前22名患者中10名有普通細菌株而2名(9%)攜帶MRSA。在非治療組中經鼻插管後分別有66.2%和16.7%的患者氣管內導管頂部分離到普通細菌和MRSA。相反,經口插管後19.2%的患者氣管導管頂部分離到普通細菌,但未檢測到MRSA。然而在治療組中經鼻插管後在323.1%)名患者的氣管導管頂部分離到普通細菌,未檢測到MRSA,而口插氣管導管未分離到細菌。這些結果顯示經鼻氣管插管較經口插管有更高的幾率將細菌帶入氣道,莫匹羅星鼻腔治療能去除鼻腔帶有的金黃色葡萄球菌。在經鼻氣管插管前用莫匹羅星鼻腔局部治療能預防細菌帶入氣道。

(費敏 薛張剛 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.

 

 靜脈麻醉藥劑量褪黒激素的腦電圖效應:和硫噴妥鈉及丙泊酚比較研究

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

我們已經證實大劑量靜脈注射褪黒激素會發揮催眠效應,與硫噴妥鈉和丙泊酚產生的類似。在本研究中,我們比較褪黒激素與硫噴妥鈉和丙泊酚的腦電圖效應。SD大鼠給予相同負荷硫噴妥鈉(23.8mg/kg),丙泊酚(14.9mg/kg,或褪黒激素(312mg/kg)。腦電圖效應以間隔10分鐘的週期記錄。分析8個腦電圖變數,只有相關總電源頻率(rTP),相關光譜95%區間(rSE95),以及相關近似平均信息量(rAE) ,與它們的對照組比較都能被所用藥物改變。給予藥物減少了基線的相關價值,在10分鐘反應進程中向基線返回。硫噴妥鈉顯著增加rTP,而丙泊酚和褪黒激素不會。所有藥物都會明顯降低rSE95。但是,反應進程的鋒效應和持續時間各不相同,褪黒激素顯示較慢起效及較持續的EEG效應。所有藥物都會明顯降低rAE,硫噴妥鈉和丙泊酚具有相似的反應進程,而褪黒激素較慢起效作用較持久。褪黒激素對於EEG變數產生的效應與硫噴妥鈉和丙泊酚的相類似,尤其是對rSE95rAE的降低。

(費敏 薛張剛 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.

 

病態肥胖的病人行腹腔鏡術時潮氣量和呼吸頻率對氧合和呼吸力學的效應

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.

 

病態肥胖(MO)的病人行腹腔鏡術時PaO2較正常體重(NW)的病人低。我們假設增加潮氣量(V)或呼吸頻率(RR)能改善氧合。所有的測量方式如下:1)基線:VT600-700ml,RR10/;2)兩倍VT:VT1200-1400ml,RR10/分;3)兩倍頻率:VT600700ml,RR20/分。我們計算呼吸系統的順應性(Cst,rs)和氣道阻力(RI,rs.呼氣末CO2經質譜分析計測量,PaO2PaCO2用連續血氣監測。平臥位MO病人較NW病人低29Cst,rs(P<0.05)。在氣腹前定位病人頭高或頭低在兩組病人中對Cst,rs無顯著差異(P=0.8)。在兩倍VT而非兩倍RR時兩組的Cst,rs均增加。氣腹導致兩組Cst,rs大幅降低(兩組P<0.001)。在氣腹時改變體位,VT,RR在各組中都不再影響Cst,rsP>0.7)。在氣腹前,MO病人的RI,rsNW病人高,與體位無關(P0.01)。兩倍RRVT在氣腹前不改變任何一組的RIrs。氣腹後在頭低和頭高位RI,rs都增加(P<0.05),而仰臥位不變。不管研究條件如何,氧張力的肺泡-動脈差異不受體位元、氣腹或通氣模式的影響。腹腔鏡術時動脈血氧合只受體重影響,不能通過增加VTRR而改善。

(費敏 薛張剛 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.

 

用引導器換口插管時氣管導管管頭設計的效應和導管厚度通過喉的能力

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.

 

我們比較二種不同的導管和二種不同大小的氣管導管交換器在插管器引導下更容易經過聲門。一種是具有標準斜面洞的聚氯乙烯導管,另一種是新設計的半球狀斜面洞的導管。兩個氣管導管交換器的外徑分別為2.55.0mm。標準的麻醉誘導,維庫溴銨導致的麻痹後,在直接喉鏡導引下將氣管導管交換器置入氣管。用插管器作為導引,將氣管導管置入氣管。通過導管的不同由盲法的觀察員評定並用四點量表評分。使用外徑為2.5mm的氣管導管交換器,新設計的導管在置管時較通常的導管更順暢(P<0.01)在一些情況下比如單肺麻醉後,使用較厚的氣管導管交換器並不適用,新設計的管頭錐形的導管可作為經口氣管導管交換器的附加物,使用較薄的氣管導管交換器作為氣管插管的導引。

(費敏 薛張剛 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.