Anesthesia & Analgesia

August 2003

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

?阿斯匹林??血?蛋白在非心?手?中可以?少?血:多中心,?机,?照,?盲??

(殷文? ? 王祥瑞 )

Diaspirin-Crosslinked Hemoglobin Reduces Blood Transfusion in Noncardiac Surgery: A Multicenter, Randomized, Controlled, Double-Blinded Trial (Special Article)

Armin Schubert, Robert J. Przybelski, John F. Eidt, Larry C. Lasky, Kenneth E. Marks, Matthew Karafa, Andrew C. Novick, Jerome F. O’Hara, Jr., Michael E. Saunders, John W. Blue, John E. Tetzlaff, and Edward Mascha

Anesth Analg 2003 97: 323-332.

?离子通道在缺氧引起的血管舒?中的作用和大鼠????予利多卡因的??效?

(?敏翻? 薛??校)

The Role of K+ Channels in Vasorelaxation Induced by Hypoxia and the Modulator Effects of Lidocaine in the Rat Carotid Artery (Special Article)

Hiroyuki Kinoshita, Yoshiki Kimoto, Katsutoshi Nakahata, Hiroshi Iranami, Mayuko Dojo, and Yoshio Hatano

Anesth Analg 2003 97: 333-338.

PEDIATRIC ANESTHESIA:

高?血症和幽??窄

(王士雷 ? 庄心良 校)

Hyperkalemia and Pyloric Stenosis

Donald Schwartz, Neil Roy Connelly, P. Manikantan, and J. H. Nichols

Anesth Analg 2003 97: 355-357.

使用各种?格????管?Level 1与快速?液系?流速和升?能力的比?

(殷文? ? 王祥瑞 )

A Comparison of Flow Rates and Warming Capabilities of the Level 1 and Rapid Infusion System with Various-Size Intravenous Catheters

Sandra L. Barcelona, Fatima Vilich, and Charles J. Cote

Anesth Analg 2003 97: 358-363.

小?量芬太尼?七氟醚麻醉未行外科手?的小儿患者?醒?量的影?

(?敏翻? 薛??校)

The Effect of Small Dose Fentanyl on the Emergence Characteristics of Pediatric Patients After Sevoflurane Anesthesia Without Surgery

Joseph P. Cravero, Michael Beach, Brian Thyr, and Kate Whalen

Anesth Analg 2003 97: 364-367.

三种?度的左旋布比卡因用于小儿?管阻?的比?

(王士雷 ? 庄心良 校)

A Comparison of Three Different Concentrations of Levobupivacaine for Caudal Block in Children

Giorgio Ivani, Pasquale De Negri, Per-Arne Lonnqvist, Staffan Eksborg, Valeria Mossetti, Roberto Grossetti, Simona Italiano, Franca Rosso, Federica Tonetti, and Luigi Codipietro

Anesth Analg 2003 97: 368-371.

心???中各???T波??儿童麻醉???注射?上腺素?影?

(?羽霄 ? 王祥瑞 )

Choice of Electrocardiography Lead Does Not Affect the Usefulness of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose in Anesthetized Children

Kumiko Ogasawara, Makoto Tanaka, and Toshiaki Nishikawa

Anesth Analg 2003 97: 372-376.

小儿呼气末七氟醚?度和交感迷走?力?的?系

(?敏翻? 薛??校)

The Relationship Between Expired Concentration of Sevoflurane and Sympathovagal Tone in Children

Eric Wodey, Lotfi Senhadji, Patrick Pladys, Francois Carre, and Claude Ecoffey

Anesth Analg 2003 97: 377-382.

幼儿及儿童心肺?流后?精蛋白引起的副作用

(王立中 ? 庄心良 校)

Adverse Events After Protamine Administration Following Cardiopulmonary Bypass in Infants and Children

Harry A. Seifert, David R. Jobes, Thomas Ten Have, Stephen E. Kimmel, Lisa M. Montenegro, James M. Steven, Susan C. Nicolson, and Brian L. Strom

Anesth Analg 2003 97: 383-389.

AMBULATORY ANESTHESIA:

?丹司酮和多拉司酮在儿科非住院病人?后?防?吐使用中的??与效果的比?

(?羽霄 ? 王祥瑞 )

A Comparison of the Costs and Efficacy of Ondansetron and Dolasetron in the Prophylaxis of Postoperative Vomiting in Pediatric Patients Undergoing Ambulatory Surgery

Olutoyin Olutoye, Ellen C. Jantzen, Rhonda Alexis, Donna Rajchert, Mark S. Schreiner, and Mehernoor F. Watcha

Anesth Analg 2003 97: 390-396.

ANESTHETIC PHARMACOLOGY:

在????物中右旋布洛芬(S(+)-异构布洛芬)?少胃??增加止痛和抗炎效果

(?敏翻? 薛??校)

Dexibuprofen (S(+)-Isomer Ibuprofen) Reduces Gastric Damage and Improves Analgesic and Antiinflammatory Effects in Rodents

A. Bonabello, M. R. Galmozzi, R. Canaparo, G. C. Isaia, L. Serpe, E. Muntoni, and G. P. Zara

Anesth Analg 2003 97: 402-408.

01%??卡因和1 μg/mL?芬太尼体外抑制??假?胞菌生?但并不促?金?色葡萄菌的增殖

(王立中 ? 庄心良 校)

Ropivacaine 0.1% with Sufentanil 1 μg/mL Inhibits In Vitro Growth of Pseudomonas Aeruginosa and Does Not Promote Multiplication of Staphylococcus Aureus

Sandra Kampe, Carsten Poetter, Shariah Buzello, Hans-Martin Wenchel, Matthias Paul, Peter Kiencke, and Stefan-Mario Kasper

Anesth Analg 2003 97: 409-411.

健康志愿者使用左旋布比卡因和??卡因的中?神?系?和心血管系?反?

(?羽霄 ? 王祥瑞 )

The Central Nervous System and Cardiovascular Effects of Levobupivacaine and Ropivacaine in Healthy Volunteers

Jonathan Stewart, Norma Kellett, and Dan Castro

Anesth Analg 2003 97: 412-416.

既非脊髓γ-氨基丁酸-A也非番木??敏感的氨基乙酸受体系?是氟烷抑制脊髓后角感?神?元的唯一介?

(?敏翻? 薛??校)

Neither Spinal -Aminobutyric Acid-A nor Strychnine-Sensitive Glycine Receptor Systems Are the Sole Mediators of Halothane Depression of Spinal Dorsal Horn Sensory Neurons

Masanori Yamauchi, Steven G. Shimada, Hiroshi Sekiyama, and J. G. Collins

Anesth Analg 2003 97: 417-423.

GABA和??性氨基酸受体介?丙泊酚??的鼠麻醉

(?? ? 庄心良 校)

Propofol-Induced Anesthesia in Mice Is Mediated by -Aminobutyric Acid-A and Excitatory Amino Acid Receptors

Masahiro Irifune, Tohru Takarada, Yoshitaka Shimizu, Chie Endo, Sohtaro Katayama, Toshihiro Dohi, and Michio Kawahara

Anesth Analg 2003 97: 424-429.

??性麻醉?异氟醚抑制人初??皮?胞中由?胺?放的?离子?流

(梁雅芬翻? 薛??校)

吸入麻醉?物异氟醚抑制初?人?皮?胞?胺介?的?离子?流

(?羽霄 ? 王祥瑞 )

The Volatile Anesthetic Isoflurane Inhibits the Histamine-Induced Ca2+ Influx in Primary Human Endothelial Cells

Piet W. L. Tas, Christiane Stosel, and Norbert Roewer

Anesth Analg 2003 97: 430-435.

丙泊酚?大鼠肝?切片缺氧/复氧???保?作用

(?施? ?,庄心良 校)

Propofol Displays No Protective Effect Against Hypoxia/Reoxygenation Injury in Rat Liver Slices

Hiroo Shimono, Teruko Goromaru, Yoshitami Kadota, Takeshi Tsurumaru, and Yuichi Kanmura

Anesth Analg 2003 97: 442-448.

阿法沙?(Alphaxalone)?蟾蜍卵母?胞上M1M3毒蕈??受体的抑制作用

(忻?? ? 王祥瑞 )

The Inhibitory Effects of Alphaxalone on M1 and M3 Muscarinic Receptors Expressed in Xenopus Oocytes

Munehiro Shiraishi, Kouichiro Minami, Izumi Shibuya, Yasuhito Uezono, Junichi Ogata, Takashi Okamoto, Osamu Murasaki, Muneshige Kaibara, Yoichi Ueta, and Akio Shigematsu

Anesth Analg 2003 97: 449-455.

??注射前列腺素E1?似物前列地??防硫戊巴比妥-芬太尼??的人支气管收?

(梁雅芬翻? 薛??校)

Intravenous Alprostadil, an Analog of Prostaglandin E1, Prevents Thiamylal-Fentanyl-Induced Bronchoconstriction in Humans

Zen’ichiro Wajima, Toshiya Shiga, Tatsusuke Yoshikawa, Akira Ogura, Kazuyuki Imanaga, Tetsuo Inoue, and Ryo Ogawa

Anesth Analg 2003 97: 456-460.

丙泊酚混合利多卡因?丙泊酚麻醉??需要量的影?

(?施? ?,庄心良 校)

The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia

Li-Hoon Tan and Nian-Chih Hwang

Anesth Analg 2003 97: 461-464.

利多卡因?弱了?胞因子介?的?皮?胞和血管平滑肌?胞的??

(忻?? ? 王祥瑞 )

Lidocaine Attenuates Cytokine-Induced Cell Injury in Endothelial and Vascular Smooth Muscle Cells

Manuela J. M. de Klaver, Mary-Gordon Buckingham, and George F. Rich

Anesth Analg 2003 97: 465-70.

腹腔?手?不同麻醉方法(异丙酚全???麻醉与异氟醚吸入麻醉)?眼??的?化

(梁雅芬翻? 薛??校)

Intraocular Pressure Changes During Laparoscopy in Patients Anesthetized with Propofol Total Intravenous Anesthesia Versus Isoflurane Inhaled Anesthesia

Hany A. Mowafi, Abdulmohsin Al-Ghamdi, and Adel Rushood

Anesth Analg 2003 97: 471-474.

阻?5-HT2A受体可能介?吸入全麻?的制?作用

(王士雷 ? 庄心良 校)

Blockade of 5-HT2A Receptors May Mediate or Modulate Part of the Immobility Produced by Inhaled Anesthetics

Yi Zhang, Michael J. Laster, Edmond I Eger, II, Caroline R. Stabernack, and James M. Sonner

Anesth Analg 2003 97: 475-479.

麻?素不能促???溴胺神?肌肉阻?起效的??

(?波 ? 王祥瑞 )

Ephedrine Fails to Accelerate the Onset of Neuromuscular Block by Vecuronium

Ryu Komatsu, Osamu Nagata, Makoto Ozaki, and Daniel I. Sessler

Anesth Analg 2003 97: 480-483.

TECHNOLOGY, COMPUTING, AND SIMULATION:

完全清醒的志愿者神?肌肉阻?可使BIS值下降

(梁雅芬翻? 薛??校)

The Bispectral Index Declines During Neuromuscular Block in Fully Awake Persons

M. Messner, U. Beese, J. Romstock, M. Dinkel, and K. Tschaikowsky

Anesth Analg 2003 97: 488-491.

PAIN MEDICINE:

3-葡萄糖醛酸?-?啡(M3G)的神???作用通??接??N-甲基-D-天?冬氨酸(NMDA)受体介?:在培?的胚胎海?神?元?胞中?于其机制的研究

(梁雅芬翻? 薛??校)

Morphine-3-Glucuronide’s Neuro-Excitatory Effects Are Mediated via Indirect Activation of N-Methyl-D-Aspartic Acid Receptors: Mechanistic Studies in Embryonic Cultured Hippocampal Neurones

Kamondanai Hemstapat, Gregory R. Monteith, Deborah Smith, and Maree T. Smith

Anesth Analg 2003 97: 494-505.

神???因子可部分逆?甲?卡因和布比卡因引起的?育感?神?元的形??改?

(王士雷 ? 庄心良 校)

Neurotrophic Factors Can Partially Reverse Morphological Changes Induced by Mepivacaine and Bupivacaine in Developing Sensory Neurons

Inas A. M. Radwan, Shigeru Saito, and Fumio Goto

Anesth Analg 2003 97: 506-511.

兔子鞘?注射地卡因、利多卡因、布比卡因和??卡因?脊髓神?毒性作用的比?

(?波 ? 王祥瑞 )

A Comparison of the Neurotoxic Effects on the Spinal Cord of Tetracaine, Lidocaine, Bupivacaine, and Ropivacaine Administered Intrathecally in Rabbits Atsuo Yamashita, Mishiya Matsumoto, Satoshi Matsumoto, Makoto Itoh, Koji Kawai, and Takefumi Sakabe

Anesth Analg 2003 97: 512-519.

大鼠坐骨神?的慢性??性????其?福??林?向反?性:一?行?与荷?蒙的?价

(?越超翻? 薛??校)

A Chronic-Constriction Injury of the Sciatic Nerve Reduces Bilaterally the Responsiveness to Formalin in Rats: A Behavioral and Hormonal Evaluation

Kris Vissers, Hugo Adriaensen, Roland De Coster, Cathy De Deyne, and Theo F. Meert

Anesth Analg 2003 97: 520-525.

比?曲?多、 ?氯芬酸和二者复合?剖???后感?和疼痛的影?

(王士雷 ? 庄心良 校)

Postoperative Sensitization and Pain After Cesarean Delivery and the Effects of Single IM Doses of Tramadol and Diclofenac Alone and in Combination

Clive H. Wilder-Smith, Lauren Hill, Robert A. Dyer, Gregory Torr, and Ed Coetzee

Anesth Analg 2003 97: 526-533.

全?性?卷?查?示患者?后疼痛持?得不到充分?解

(朱? ? 王祥瑞 )

Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged

Jeffrey L. Apfelbaum, Connie Chen, Shilpa S. Mehta, and Tong J. Gan

Anesth Analg 2003 97: 534-540.

?拉明与西咪替丁?大鼠mRNA C-fos表?和?害性刺激防御行?的影?

(?越超翻? 薛??校)

The Effects of Pyrilamine and Cimetidine on mRNA C-Fos Expression and Nociceptive Flinching Behavior in Rats

Hazem Adel Ashmawi, Felipe S. Chambergo, Claudia C. Araujo Palmeira, and Irimar de Paula Posso

Anesth Analg 2003 97: 541-546.

effects.

CRITICAL CARE AND TRAUMA:

?毒素休克??中????血流的不均?性和代??化

(朱? ? 王祥瑞 )

Apparent Heterogeneity of Regional Blood Flow and Metabolic Changes Within Splanchnic Tissues During Experimental Endotoxin Shock

Jyrki J. Tenhunen, Ari Uusaro, Vesa Karja, Niku Oksala, Stephan M. Jakob, and Esko Ruokonen

Anesth Analg 2003 97: 555-563.

NEUROSURGICAL ANESTHESIA:

GABA受体介?异氟醚在器官型海?培?模型中的神?保?作用

(?? ? 庄心良 校)

-Aminobutyric Acid-A Receptors Contribute to Isoflurane Neuroprotection in Organotypic Hippocampal Cultures

Philip E. Bickler, David S. Warner, Greg Stratmann, and Jennifer A. Schuyler

Anesth Analg 2003 97: 564-571.

?外?病人中使用大?量异丙酚??血管?力自???的影?

(朱? ? 王祥瑞 )

The Effects of Large-Dose Propofol on Cerebrovascular Pressure Autoregulation in Head-Injured Patients

Luzius A. Steiner, Andrew J. Johnston, Doris A. Chatfield, Marek Czosnyka, Martin R. Coleman, Jonathan P. Coles, Arun K. Gupta, John D. Pickard, and David K. Menon

Anesth Analg 2003 97: 572-576.

REGIONAL ANESTHESIA:

外源性?上腺素?在斜角肌?臂?阻?麻醉下坐位肩部手??低血?/心????生率的影?

(王士雷 ? 庄心良 校)

The Effect of Exogenous Epinephrine on the Incidence of Hypotensive/Bradycardic Events During Shoulder Surgery in the Sitting Position During Interscalene Block

Salvatore Sia, Francesca Sarro, Antonella Lepri, and Maurizio Bartoli

Anesth Analg 2003 97: 583-588.

等比重和低比重布比卡因腰麻用于??位全???成形?的比?

(王士雷 ? 庄心良 校)

Isobaric Versus Hypobaric Spinal Bupivacaine for Total Hip Arthroplasty in the Lateral Position

Alexandre Faust, Roxane Fournier, Elisabeth Van Gessel, Anne Weber, Pierre Hoffmeyer, and Zdravko Gamulin

Anesth Analg 2003 97: 589-594.

GENERAL ARTICLE:

肥胖者比瘦者更多?困?气管插管

(?越超翻? 薛??校)

Difficult Tracheal Intubation Is More Common in Obese Than in Lean Patients

Philippe Juvin, Elisabeth Lavaut, Herve Dupont, Pascale Lefevre, Monique Demetriou, Jean-Louis Dumoulin, and Jean-Marie Desmonts

Anesth Analg 2003 97: 595-600.

高?血症和幽??窄

Hyperkalemia and Pyloric Stenosis

Donald Schwartz, MD*, Neil Roy Connelly, MD*, P. Manikantan, MD*, and J. H. Nichols, PhD

Departments of *Anesthesiology and Pathology, Baystate Medical Center, Springfield, Massachusetts

Anesth Analg 2003 97: 355-357.

以往??,幽??窄患儿一般?生低?或正常血?低氯代?性?中毒。我??幽??窄?儿的血?水平?行了??,??36%的病人血?水平升高。我?的??是,幽??窄患儿?生高血?的几率比原???的要常?得多。

(王士雷 ? 庄心良 校)

Children presenting with pyloric stenosis have hypochloremic metabolic alkalosis and their serum potassium levels are thought to be low or normal. We reviewed potassium levels in infants with pyloric stenosis. Thirty-six percent of patients with pyloric stenosis had increased serum potassium levels. We conclude that hyperkalemia may be more common in children with pyloric stenosis than previously thought.

 

三种?度的左旋布比卡因用于小儿?管阻?的比?

A Comparison of Three Different Concentrations of Levobupivacaine for Caudal Block in Children

Giorgio Ivani, MD*, Pasquale De Negri, MD, Per-Arne Lonnqvist, PhD, Staffan Eksborg, PhD, Valeria Mossetti, MD*, Roberto Grossetti, MD*, Simona Italiano, MD*, Franca Rosso, MD*, Federica Tonetti, MD*, and Luigi Codipietro, MD*

*Department of Anesthesiology and Intensive Care Unit, Regina Margherita Children’s Hospital, Turin; Department of Anesthesiology, Intensive Care Unit, and Pain Management, "CROB" Cancer Center, Rionero in Vulture, Italy; Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgrens Children’s Hospital, Karolinska Hospital; and Karolinska Pharmacy and Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden

Anesth Analg 2003 97: 368-371.

我?以前瞻、?机、?盲的方式比?了三种不同?度的左旋布比卡因(0.125%, 0.20%, and 0.25%)用于小儿(1–7 yr)?下手?的情?。?后?痛的??通??后第一次?用?痛?的??(小儿和?儿?后疼痛?分?4)?行估?,而?后即刻的阻?程度?用3分法?行?价。?果,?后?痛??的中位?(0.125%, 60 min; 0.20%, 118 min; 0.25%, 158 min)和?后早期出???阻?的病人?与左旋布比卡因的用量之?呈?量依?性?系。0.125%左旋布比卡因?后早期出???阻?的病人??少,但是?后?痛的??也?短(P < 0.05)。??:0.20%左旋布比卡因可能是小儿?管阻?最佳的?床?用?度。

(王士雷 ? 庄心良 校)

We investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%; n = 20 in each group) for caudal blockade in a prospective, randomized, observer-blinded fashion in children (1–7 yr) undergoing subumbilical surgery. The duration of postoperative analgesia was assessed as the time to first administration of supplemental analgesia (based on a Childrens and Infants Postoperative Pain Scale score of 4), and the degree of immediate postoperative motor blockade was determined by use of a 3-point scale. A dose-response relationship was observed both with regard to median duration of postoperative analgesia (0.125%, 60 min; 0.20%, 118 min; 0.25%, 158 min) and the number of patients with evidence of early postoperative motor blockade (0.125%, 0; 0.20%, 4; 0.25%, 8). The 0.125% concentration was associated with significantly less early motor blockade (P = 0.003) but was found to result in a significantly shorter duration of postoperative analgesia (P < 0.05). Based on these results, the use of 0.20% levobupivacaine might represent the best clinical option if a plain levobupivacaine solution is to be used for caudal blockade in children.


幼儿及儿童心肺?流后?精蛋白引起的副作用

Adverse Events After Protamine Administration Following Cardiopulmonary Bypass in Infants and Children

Harry A. Seifert, MD MSCE*,, David R. Jobes, MD, Thomas Ten Have, PhD MPH*, Stephen E. Kimmel, MD MSCE, FACC*, Lisa M. Montenegro, MD, James M. Steven, MD SM, FAAP, Susan C. Nicolson, MD, and Brian L. Strom, MD MPH, FACP, FACE

*Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Anesth Analg 2003 97: 383-389.

本研究目的是确定幼儿及儿童心肺?流后?精蛋白引起的副作用(AES)的?生率和危?因素。通?回?性?查三年的麻醉??以确定?精蛋白后AES。?后根据?格的?准?AES分?。在1249?麻醉??中,?有孤立或低血?相?的右心功能不全或急性肺功能不全。?精蛋白引起的低血??生率?1.76% (95%可信??11%–2.65%) 88% (95%可信??2.03%–3.97%)。?了确定危?因素,我??行了嵌套-?照??,即?照?机?同一?中按41的比例??。低血?更可能?生在女性(OR 6.47; 95% 可信??1.66-32.8)、大?量(OR, 1.88; 95%可信??1.03–3.63)或小?量肝素(OR, 0.49; 95%可信?? 0.17–0.67)

(王立中 ? 庄心良 校)

We performed this study to determine the incidence of and risk factors for adverse events (AEs) in infants and children after the IV administration of protamine after cardiopulmonary bypass. In a retrospective cohort study, all relevant anesthesia records from a 3-yr period were examined to identify AEs after protamine. The AEs were then grouped into three categories by applying increasingly strict criteria. Among 1249 anesthesia records, there were no documented episodes of isolated or hypotension-associated right-sided cardiac failure or acute pulmonary dysfunction. The incidence of systemic hypotension after protamine was between 1.76% (95% confidence interval [CI], 1.11%–2.65%) and 2.88% (95% CI, 2.03%–3.97%), depending on the strictness of case definition. To identify risk factors, we performed a nested case-control study in which unmatched controls were randomly selected from the parent cohort at a 4:1 ratio to cases. Cases of hypotension after protamine were more likely during operations on girls (odds ratio [OR], 6.47; 95% CI, 1.66–32.8), after larger doses of protamine (OR, 1.88; 95% CI, 1.03–3.63), or after smaller doses of heparin (OR, 0.49; 95% CI, 0.17–0.67).

01%??卡因和1 μg/mL?芬太尼体外抑制??假?胞菌生?但并不促?金?色葡萄菌的增殖

Ropivacaine 0.1% with Sufentanil 1 μg/mL Inhibits In Vitro Growth of Pseudomonas Aeruginosa and Does Not Promote Multiplication of Staphylococcus Aureus

Sandra Kampe, MD*, Carsten Poetter, MD, Shariah Buzello, MD*, Hans-Martin Wenchel, MD, Matthias Paul, MD*, Peter Kiencke, PhD, and Stefan-Mario Kasper, MD*

*Department of Anesthesiology, Infection Control Laboratory, Department of Hospital Infection Control, and Department of Medical Statistics, University of Cologne, Cologne, Germany

Anesth Analg 2003 97: 409-411.

我??查??卡因和?芬太尼复合?在室?下???假?胞菌和金色葡萄菌的生?的影?,?种复合?常在?后用于硬膜外?痛。??假?胞菌和金色葡萄菌在生理?水?浮液?移到含有0.1%??卡因和1 μg/mL?芬太尼(R+S)或生理?水(SA),后者作??照?。在接触上述液体0, 3, 6, 24h48h,取1ml溶液平?于?准的血?脂上。在220C下孵育48小?,?算菌落形成?位(cfu)?量。?菌株生?率??cfu ??(tn)/cfu 基?(t0)。初效率?量是根据生?率,曲?下面?(AUC) x??。R+S???假?胞菌AUC明?小于SA?(P = 0.028)SA??察到在接触后至少6小???假?胞菌的增殖(生?率>1)。接触后324小?R+S???假?胞菌的生?低于SA?。??金色葡萄菌AUC并?明?不同。R+SSA?均不能增加金色葡萄菌的生?。接触后48小?,R+S?金色葡萄菌生?明?低于SA?。??:R+S?与SA?相比能抑制??假?胞菌的生?但不能促?金色葡萄菌的生?。

(王立中 ? 庄心良 校)

We investigated the effect of ropivacaine combined with sufentanil, a mixture frequently used for postoperative epidural analgesia, on the growth of Staphylococcus aureus and Pseudomonas aeruginosa at room temperature. Aliquots of suspension of S. aureus and P. aeruginosa in saline were transferred into test tubes containing either a mixture of ropivacaine 0.1% and sufentanil 1 μg/mL (R+S) or saline (SA), with the latter serving as control. At 0, 3, 6, 24, and 48 h after inoculation, 1 mL of each solution was spread over standard blood agar. The plates were incubated at 22°C for 48 h, and the numbers of colony-forming units (cfu) were counted. The growth ratio for both bacterial strains was calculated as cfu time (tn)/cfu baseline (t0). The primary efficacy variable was the area under the curve (AUC) in (cfu tn/cfu t0) x time, based on the growth ratios. The AUC for P. aeruginosa was significantly less in R+S than in SA (P = 0.028). Multiplication of P. aeruginosa (growth ratio >1) was observed for at least 6 h after inoculation in SA. Growth of P. aeruginosa was significantly less in R+S than in SA at 3 h (P = 0.043) and 24 h (P = 0.012) after inoculation. The AUC for S. aureus did not differ significantly between R+S and SA (P = 0.74). Neither R+S nor SA promoted multiplication of S. aureus. Forty-eight hours after inoculation, growth of S. aureus was significantly less in R+S than in SA (P < 0.0001). We conclude that R+S inhibited growth of P. aeruginosa and did not promote multiplication of S. aureus when compared with SA.

 

GABA和??性氨基酸受体介?丙泊酚??的鼠麻醉

Propofol-Induced Anesthesia in Mice Is Mediated by -Aminobutyric Acid-A and Excitatory Amino Acid Receptors

Masahiro Irifune, DDS PhD*, Tohru Takarada, DDS PhD*, Yoshitaka Shimizu, DDS*, Chie Endo, DDS*, Sohtaro Katayama, DDS*, Toshihiro Dohi, PhD, and Michio Kawahara, MD PhD*

Departments of *Anesthesiology and Pharmacology, Hiroshima University School of Dentistry, Hiroshima, Japan

Anesth Analg 2003 97: 424-429.

??明GABAA受体和??性氨基酸(NMDA和非NMDA受体)在丙泊酚??的麻醉中的作用,作者研究了在丙泊酚麻醉中GABA能和谷氨酸能?物?小鼠行??的效?。所有?物均?腹腔?用。全麻??度用翻正反射?行?价。GABAA受体激???蕈醇增?丙泊酚(140 mg/kg; 50%翻正反射消失有效?量)??的麻醉。相似地,苯二氮卓受体激??安定和NMDA受体拮抗?MK-801增?丙泊酚麻醉,但非NMDA受体拮抗?CNQX??有?种作用。相比而言,GABAA受体拮抗?荷包牡丹?拮抗丙泊酚(200 mg/kg; 95%翻正反射消失有效?量)??的麻醉。然而,苯二氮卓受体拮抗?氟??尼, GABA合成抑制?L-allylglycine NMDA受体激??NMDA均不能逆?丙泊酚麻醉。相反,非NMDA受体激??使君子酸增?丙泊酚麻醉。?些?果提示丙泊酚??的麻醉至少部分是由GABAA和??性氨基酸受体介?的。

(?? ? 庄心良 校)

To elucidate the role of -aminobutyric acid (GABA)A receptor complex and excitatory amino acid receptors (N-methyl-D-aspartate [NMDA] and non-NMDA receptors) in propofol-induced anesthesia, we examined behaviorally the effects of GABAergic and glutamatergic drugs on propofol anesthesia in mice. All drugs were administered intraperitoneally. General anesthetic potencies were evaluated using a righting reflex assay. The GABAA receptor agonist muscimol potentiated propofol (140 mg/kg; 50% effective dose for loss of righting reflex) induced anesthesia. Similarly, the benzodiazepine receptor agonist diazepam and the NMDA receptor antagonist MK-801 augmented propofol anesthesia, but the non-NMDA receptor antagonist CNQX did not. In contrast, the GABAA receptor antagonist bicuculline antagonized propofol (200 mg/kg; 95% effective dose for loss of righting reflex) induced anesthesia. However, neither the benzodiazepine receptor antagonist flumazenil, the GABA synthesis inhibitor L-allylglycine, nor the NMDA receptor agonist NMDA reversed propofol anesthesia. Conversely, the non-NMDA receptor agonist kainate enhanced propofol anesthesia. These results suggest that propofol-induced anesthesia is mediated, at least in part, by both GABAA and excitatory amino acid receptors.


丙泊酚?大鼠肝?切片缺氧
/复氧???保?作用

Propofol Displays No Protective Effect Against Hypoxia/Reoxygenation Injury in Rat Liver Slices

Hiroo Shimono, MD, Teruko Goromaru, PhD, Yoshitami Kadota, MD, Takeshi Tsurumaru, MD, and Yuichi Kanmura, MD

Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine, Kagoshima, Japan

Anesth Analg 2003 97: 442-448.

采用雄性Wistar大鼠肝?精密切片(20-25mg?重),我?研究了?床相??度的丙泊酚是否?缺氧/复氧中的肝?具有保?作用或毒性作用。切片被置入?有Waymouth’s培?基的密封可??的小瓶??孵育2小?(37°C; 95% O2/5% CO2; 三片/瓶)。然后加入丙泊酚或脂肪乳?并形成四?(?照,脂肪乳?,低?度丙泊酚[0.5–1.5 μg/mL]以及高?度丙泊酚[2.0–6.0 μg/mL])。之后,每?孵育4h95% O2/5% CO2〔?缺氧〕或2h100%N22h95% O2/5% CO2(缺氧/复氧)。孵育?始后234h?定切片活性和缺氧/复氧??包括?胞?K+?度,能量??(ATP?度,?腺嘌呤核?酸含量以及能荷),肝??漏(天冬氨酸氨基?移?,丙氨酸?氨?和乳酸???)。和?照?相比,丙泊酚和脂肪乳?均?致明?的能荷恢复延?。?胞?K+?度和肝??漏在丙泊酚?和其它?????著差?。丙泊酚?大鼠肝切片?缺氧????毒性作用,同??缺氧/复氧引起的???保?作用。??:丙泊酚?大鼠肝切片?缺氧????毒性作用,同??缺氧/复氧引起的???保?作用。

(?施? ?,庄心良 校)

Using precision-cut liver slices (20–25 mg wet weight) from male Wistar rats, we examined whether clinically relevant propofol concentrations have hepatoprotective or -toxic effects during hypoxia/reoxygenation. Slices were preincubated for 2 h in sealed roller vials (three slices per vial) containing Waymouth’s medium (37°C; 95% oxygen/5% CO2). Then, propofol or Intralipid was added to create four different groups (control, Intralipid, small-concentration propofol [0.5–1.5 μg/mL], and large-concentration propofol [2.0–6.0 μg/mL]). Thereafter, each group was incubated for 4 h under 95% oxygen/5% CO2 (no hypoxia) or for 2 h under 100% nitrogen plus 2 h under 95% oxygen/5% CO2 (hypoxia/reoxygenation). Slice viability and hypoxia/reoxygenation injury were assessed at 2, 3, and 4 h after incubation began by using the slice intracellular K+ concentration, energy status (adenosine triphosphate content, total adenine nucleotides content, and energy charge), and liver enzyme leakage (aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase). Propofol and Intralipid caused a significant delay in energy charge recovery in comparison with the control. There were no significant differences between the propofol groups and the other two groups in intracellular K+ content or liver enzyme leakage. Propofol had no hepatotoxic effect under no-hypoxia conditions in rat liver slices, nor did it have a protective effect against hypoxia/reoxygenation-induced hepatic injury.

丙泊酚混合利多卡因?丙泊酚麻醉??需要量的影?

The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia

Li-Hoon Tan, Mmed (Anaesthesiology)*, and Nian-Chih Hwang, FFARCSI FAMS

Department of Anaesthesia and Surgical Intensive Care, *Changi General Hospital, and Singapore General Hospital, Singapore, Singapore

Anesth Analg 2003 97: 461-464.

利多卡因在混入丙泊酚或在丙泊酚注射前???用可??丙泊酚注射引起的疼痛。利多卡因可能?致丙泊酚乳?的不?定性,并降低其在大鼠和人的麻醉效价。我?在67例病人中?行了一??机?盲??去?估丙泊酚混合利多卡因?丙泊酚麻醉??需要量的影?。S?病人(n = 32)?注0.2 mg/kg利多卡因,然后予丙泊酚?注;M?病人(n = 35)??注生理?水(安慰?),然后予?注新?配制的混合液:1%丙泊酚/1%利多卡因按10:1体?比。?病人?失意??(采用手持?筒落地的方法)停止?注。??在病人?失意??所需丙泊酚的平均?量(95%可信限)在???上??著差异:S?2.0 (1.8–2.2) mg/kg versus M?1.9 (1.7–2.0) mg/kg(P = 0.206)200mg丙泊酚?加入20mg利多卡因似乎?丙泊酚麻醉??需要量?影?。??:丙泊酚?加入利多卡因可使丙泊酚乳?失?定。一??机?盲??:??是使用新?配制的混合液(1%丙泊酚/1%利多卡因按10:1体?比)或先??注射一定?量的利多卡因?所需麻醉???量在???上??著差异。

(?施? ?,庄心良 校)

Lidocaine is used to reduce pain associated with propofol injection, either mixed with propofol or preceding it as a separate injection. The addition of lidocaine to propofol causes destabilization of the emulsion and reduces anesthetic potency in rats and humans. We conducted a randomized double-blinded study on 67 patients to assess the effect of mixing lidocaine with propofol on the dose of propofol required for the induction of anesthesia. Patients in Group S (n = 32) received IV lidocaine 0.2 mg/kg followed by an infusion of propofol whereas those in Group M (n = 35) received IV normal saline (placebo) followed by an infusion of a freshly prepared mixture of propofol 1%/lidocaine 1% in 10:1 volume ratio. The infusion was stopped when the subjects lost consciousness, as detected by the syringe-drop method. There was no statistically significant difference between the two groups in the mean (95% confidence interval) doses of propofol required for loss of consciousness: 2.0 (1.8–2.2) mg/kg for Group S versus 1.9 (1.7–2.0) mg/kg for Group M (P = 0.206). Mixing 20 mg of lidocaine with 200 mg of propofol is unlikely to affect the dose of propofol required for the induction of anesthesia.

阻?5-HT2A受体可能介?吸入全麻?的制?作用

Blockade of 5-HT2A Receptors May Mediate or Modulate Part of the Immobil

ity Produced by Inhaled Anesthetics

Yi Zhang, MD, Michael J. Laster, DVM, Edmond I Eger, II, MD, Caroline R. Stabernack, MD, and James M. Sonner, MD

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

Anesth Analg 2003 97: 475-479.

很多吸入全麻?能阻???性神???5-?色胺?5-HT2A受体的作用,提示吸入全麻?可能通?此受体?生制?作用。本研究??,鞘?注射5-HT2A受体阻??酮色林能?降低异氟醚的MAC。此作用可能是通?阻?5-?色胺在脊髓中的信息??引起的,其最大作用可以?到20%–25%。??注射酮色林使MAC?一步降低(60%),?可能是通?脊髓上的作用引起的。降低大鼠异氟醚MAC的??用?量接近100 μg · kg-1 · min-1,而人?床?用的?量一般?1.25 μg · kg-1 · min-1。?些?果?明,1.25 μg · kg-1 · min-1 5-HT2A受体?在影?异氟醚MAC的神??路?。但是,由于?定异氟醚MAC部位主要在脊髓,因此, 5HT2A受体在介?异氟醚的制?方面可能?占很小的比例。

(王士雷 ? 庄心良 校)

Many inhaled anesthetics block the in vitro effect of the excitatory neurotransmitter serotonin on the 5-HT2A receptor, supporting the view that this receptor might mediate the capacity of inhaled anesthetics to produce immobility during noxious stimulation (i.e., would underlie MAC, the minimum alveolar concentration required to suppress movement in response to a noxious stimulus in 50% of subjects). In the present investigation in rats, we found that intrathecal administration of the 5HT-2A blocker, ketanserin, can decrease isoflurane MAC. This effect, presumably mediated by blockade of serotonin transmission in the spinal cord, reaches a maximum of 20%–25%. An additional decrease (to 60%) may be obtained by IV infusion of ketanserin, and presumably this decrease results from ketanserin’s actions on supraspinal centers. The IV doses of ketanserin that decreased MAC were approximately 100 μg · kg-1 · min-1 in rats, compared with usual clinical doses of 1.25 μg · kg-1 · min-1 in humans. These results indicate that 1.25 μg · kg-1 · min-1 receptors are in the neural circuitry influencing isoflurane MAC. These results, together with the blocking action of isoflurane on expressed 5HT2A receptors, strengthen the case for a role for 5HT2A receptors to isoflurane-induced immobility. However, because MAC for isoflurane is predominantly determined in the spinal cord, this result is consistent at most with a minor contribution of these receptors to the immobilizing action of isoflurane.

神???因子可部分逆?甲?卡因和布比卡因引起的?育感?神?元的形??改?

Neurotrophic Factors Can Partially Reverse Morphological Changes Induced by Mepivacaine and Bupivacaine in Developing Sensory Neurons

Inas A. M. Radwan, MD, Shigeru Saito, MD PhD, and Fumio Goto, MD PhD

Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Gunma, Japan

Anesth Analg 2003 97: 506-511.

布比卡因和甲?卡因均引起?育神?元的形??改?。我??某些神???因子在?些?物引起的?育神?元?害中的作用?行了探?。游离?胚的背根神??置于含布比卡因或甲?卡因的培?基,60min后更??含有?源性神???因子、???胞神???因子或神???因子-3而不含局麻?的新?培?基。48h后洗?并?查生?椎的萎陷情?。?果,?培?液中不含神???因子?,洗?甲?卡因20h以及洗?甲?卡因或布比卡因48h后生?椎萎?程度??照??著增大,而在?用神?生?因子的情?下,生?椎萎?体??著?小,与?照?之???著差异。??:神?生?因子促?暴露在局麻?中的神?元恢复,而且,其?甲?卡因所致生?椎萎?的作用?于布比卡因。

(王士雷 ? 庄心良 校)

Both bupivacaine and mepivacaine induce morphological changes in growing neurons. We designed this study to investigate the role of some neurotrophic factors (NTFs) in supporting developing neurons exposed to the deleterious effects of these drugs. Dorsal root ganglia were isolated from chick embryos and exposed to either bupivacaine or mepivacaine. After 60 min of exposure, the culture media were replaced with fresh culture media free from local anesthetics. NTFs—brain-derived NTF, glial-derived NTF, or neurotrophin-3—were added to the replacement media, and the cells were examined up to 48 h after the washout. The growth cone collapse assay was applied by a quantitative method of assessment. When the replacement media were not supported by any NTF, the growth cone collapse values were significantly larger than the control values at 20 h after the washout of mepivacaine and 48 h after the washout of either bupivacaine or mepivacaine (P < 0.05). However, when any of the NTFs were used, the collapsing activity was significantly attenuated, and growth cone collapse values showed no statistically significant differences in comparison with the control values at these time points (P > 0.05). We conclude that several NTFs support the recovery of neurons after exposure to local anesthetics. The supporting effects of NTFs on the reversibility of mepivacaine-induced collapse tended to be more obvious than those seen after the bupivacaine washout.

比?曲?多、 ?氯芬酸和二者复合?剖???后感?和疼痛的影?

Postoperative Sensitization and Pain After Cesarean Delivery and the Effects of Single IM Doses of Tramadol and Diclofenac Alone and in Combination

Clive H. Wilder-Smith, MD*, Lauren Hill, BSc (Med) Hons*, Robert A. Dyer, FCA (SA), Gregory Torr, FCA (SA), and Ed Coetzee, FRCOG FCOG (SA)

*Visceral Physiology Institute and Departments of Anaesthetics and Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, South Africa

Anesth Analg 2003 97: 526-533.

不同作用机制的?痛?复合?用可以控制?后疼痛。我?以120例剖??手?病人??象,以?盲、?机和安慰??照的方式??胺能和μ-阿片??物激??曲?多100 mg、?氯芬酸75 mg以及二者复合?用的?后?痛效果?行了?价,指?包括?后出?疼痛的??、 追加?痛?的?? 、曲?多的???以及?离切口部位的?感??。首次?予?痛?的??分??:曲?多复合?氯芬酸?197 min (70–1000 min)、曲?多复合安慰?48 min (25–90 min)、?氯芬酸复合安慰?113 min (35–270 min) 、安慰?复合安慰?55 min (30–100 min)。所有病人均????的延?出?疼痛??,而且??和?物作用之??著相?。所有各?均未?生?著的副作用。在切口周?以及?离切口部位的痛?增高?在曲?多复合?氯芬酸??生。曲?多和去甲曲?多的?代?力?不受?氯芬酸的影?。曲?多复合?氯芬酸的?痛效果优于??用?。只有复合用?才??防原?性和??性痛??敏。?前的感??值可以???后疼痛的敏感程度。

(王士雷 ? 庄心良 校)

Combining different analgesic mechanisms can reduce postoperative pain. We investigated postoperative pain and sensory sensitization in a double-blinded, placebo-controlled, randomized, single-dose comparison of the monoaminergic and μ-opioid agonist tramadol, 100 mg, and diclofenac 75 mg given IM in combination or alone in 120 patients who had elective cesarean delivery. The time to first postoperative demand for rescue analgesia, pain, tramadol pharmacokinetics, and electrical sensory thresholds at or distant from the incision were studied. The median time to first rescue (interquartile range) was 197 min (70–1000 min) with tramadol plus diclofenac, 48 min (25–90 min) with tramadol plus placebo, 113 min (35–270 min) with diclofenac plus placebo, and 55 min (30–100 min) with double placebo (tramadol plus diclofenac versus all other groups, P < 0.05). Pain intensity decreased markedly over time in all groups, and time and drug effects were significant (analysis of variance; P < 0.00001). Side effects were similarly minimal with all treatments. Pain thresholds at or distant from the incision increased significantly after surgery only with tramadol plus diclofenac. Preoperative sensory thresholds correlated with postoperative sensory changes (r > 0.53; P < 0.0001). The pharmacokinetics of tramadol and O-desmethyltramadol were unchanged by diclofenac. The combination of tramadol and diclofenac resulted in improved analgesia compared with monotherapy. Only the analgesic combination prevented both primary and secondary hyperalgesia. Preoperative sensory thresholds may allow prediction of postoperative sensitization.


GABA受体介?异氟醚在器官型海?培?模型中的神?保?作用

-Aminobutyric Acid-A Receptors Contribute to Isoflurane Neuroprotection in Organotypic Hippocampal Cultures

Philip E. Bickler, MD PhD*, David S. Warner, MD, Greg Stratmann, MD*, and Jennifer A. Schuyler, BS*

*Department of Anesthesia and Perioperative Care, University of California San Francisco; and Department of Anesthesiology, Duke University Medical Center, Durham, North

Anesth Analg 2003 97: 564-571.

 

麻醉?如异氟醚等?少????缺血模型中?胞死亡的机制仍不完全清楚。降低谷氨酸??毒性只能部分而非全部解?异氟醚的神?保?作用。因?异氟醚增?GABA受体介?的离子流,并且GABAA受体激??具有神?保?效?,因此我?推?是GABAA受体?致了异氟醚的神?保?作用。作者使用大鼠海??片作?大?缺血和恢复的模型。在37°C下,氧糖缺失(OGD)一小?后?察CA1CA3和??回神?元的存活率。?了确定GABAA受体在介?神?保?中的作用,?察了在OGD期?,存在GABAA受体拮抗?荷包牡丹??,1%异氟醚??胞存活的影?。?胞死亡用propidium iodide ?光法?定。异氟醚和??性的GABAA受体激???蕈醇(25 μM)?少OGD后的?胞死亡,与未暴露于OGD的?片?果相似,但?蕈醇不能?少OGD?天后CA3神?元的死亡。GABAA受体拮抗?荷包牡丹??少异氟醚?OGD23天海?神?元的保?作用。我?的??是GABAA受体是异氟醚?OGD23天海??片模型?生神?保?效?的原因。基于此以及其它研究,异氟醚?生的神?保?作用可能是多方面的,涉及GABAA和谷氨酸受体,可能?包括其它机制。

(?? ? 庄心良 校)

The mechanisms by which anesthetics such as isoflurane reduce cell death in rodent models of cerebral ischemia remain incompletely defined. Reduction in glutamate excitotoxicity explains some but not all of isoflurane’s neuroprotection. Because isoflurane potentiates -aminobutyric acid (GABA) receptor-mediated ion fluxes and GABAA receptor agonists have neuroprotective effects, we hypothesized that GABAA receptors contribute to isoflurane neuroprotection. As a model of cerebral ischemia and recovery, we used rat hippocampal slice cultures. Survival of CA1, CA3, and dentate neurons was examined 2 and 3 days after 1-h combined oxygen-glucose deprivation (OGD) at 37°C. To define the role of GABAA receptors in mediating protection, the effect of 1% isoflurane on cell survival was examined in the presence of the GABAA antagonist bicuculline during OGD. Cell death was measured with propidium iodide fluorescence. Isoflurane and the selective GABAA agonist muscimol (25 μM) reduced cell death after OGD to values similar to slices not exposed to OGD, with the exception that muscimol did not reduce cell death in CA3 neurons 2 days after OGD. The GABAA antagonist bicuculline reduced the neuroprotective effects of isoflurane on hippocampal neurons 2 and 3 days after OGD. We conclude that GABAA receptors contribute to neuroprotection against OGD produced by isoflurane in the hippocampal slice model. Based on this and other studies, it is likely that neuroprotection produced by isoflurane is multifactorial and includes actions at both GABAA and glutamate receptors and possibly other mechanisms.


外源性?上腺素?在斜角肌?臂?阻?麻醉下坐位肩部手??低血?/心????生率的影?

The Effect of Exogenous Epinephrine on the Incidence of Hypotensive/Bradycardic Events During Shoulder Surgery in the Sitting Position During Interscalene Block

Salvatore Sia, MD*, Francesca Sarro, MD, Antonella Lepri, MD*, and Maurizio Bartoli, MD*

*Department of Anesthesiology and Cardiology Unit, Centro Traumatologico Ortopedico, Azienda Ospedaliera Careggi, Firenze, Italia

Anesth Analg 2003 97: 583-588

据?道,在斜角肌?臂?神?阻?麻醉下坐位肩部手??突?性低血?/心???(hypotensive and/or bradycardic events HBE)的?生率??13%–28%。据??,Bezold-Jarisch反射是引起HBE的主要机制。?此,我???了本前瞻、?机研究?????假?。病人?机分?局麻?含?上腺素和不含?上腺素?(n = 55),不再?外?用?上腺素。必要?通????用?拉地?控制血?。含?上腺素?和不含?上腺素?HBE 的?生率分??11%29%。?上腺素??中心率增快和血?升高的?生率高。含?上腺素和不含?上腺素??用?拉地?的几率分??31% 13%(P = 0.018) 。?用?拉地后?上腺素?和不含?上腺素?病人HBE 的?生率分??5%4%。??:外源性?上腺素?著增加斜角肌臂?麻醉下坐位肩部手?的HBE?生率。

(王士雷 ? 庄心良 校)

Sudden hypotensive and/or bradycardic events (HBE) have been reported in 13%–28% of patients undergoing shoulder surgery in the sitting position during interscalene block. The Bezold-Jarisch reflex is the most likely mechanism for these events. It has been hypothesized that exogenous epinephrine might be a key component to the occurrence of HBE. We conducted this prospective, randomized study to verify this hypothesis. Patients received a local anesthetic solution with (Group E; n = 55) or without (Group P; n = 55) epinephrine for interscalene block; no further exogenous epinephrine was administered. Blood pressure control was achieved with IV urapidil, a peripheral vasodilator, as needed. The incidence of HBE was 11% in Group P versus 29% in Group E (P = 0.015). Increased intraoperative heart rate and arterial blood pressure were recorded in Group E (P = 0.000). Urapidil was administered to 13% of Group P and to 31% of Group E patients (P = 0.018). Urapidil administration induced a HBE in 4% of Group P and in 5% of Group E patients. We conclude that exogenous epinephrine is involved in the development of HBE in this setting.

 

等比重和低比重布比卡因腰麻用于??位全???成形?的比?

Isobaric Versus Hypobaric Spinal Bupivacaine for Total Hip Arthroplasty in the Lateral Position

Alexandre Faust, MD*, Roxane Fournier, MD*, Elisabeth Van Gessel, MD*, Anne Weber, MD*, Pierre Hoffmeyer, MD, and Zdravko Gamulin, MD*

*Division of Anesthesiology, Clinic of Orthopedic Surgery, University Hospital Geneva, Geneva, Switzerland

Anesth Analg 2003 97: 589-594.

全???成形?(THA)常在等比重或低比重局麻?腰麻下?行。然而,?未在相同的外科?件下?二者?行比?。?此,我???本???比?THA?等比重和低比重布比卡因腰麻的麻醉效?和?血流?力?的影?。40ASA I–II的病人?机分?等比重布比卡因和低比重布比卡因腰麻?,分?蛛网膜下腔注射3.5ml17.5mg)布比卡因-1.5ml生理?水和3.5ml17.5mg)布比卡因-1.5ml蒸?水。??手??和非手??感?平面至L2?的感?和??阻?情?、蛛网膜下腔注射?物后45min?的血流?力?指?以及第一次?用?痛?的??。?果,二?之?手??和非手??感?的最高平面以及??阻?的最大程度相似。与等比重布比卡因?相比,低比重布比卡因?手??感?平面消退至L2水平以及首次?用?痛?的??均延?(287 ± 51 versus 242 ± 36 min, P < 0.004287 ± 51 versus 242 ± 36 min, P < 0.004)。在外科手??束?二?之???阻?的程度?差异。?中血流?力?的?化二?之???著??。??:由于延?手??的?痛??以及延??后?痛?的?用??而不增加?血流?力?的干扰程度,??位THA?低比重布比卡因腰麻优于等比重布比卡因腰麻。

(王士雷 ? 庄心良 校)

Total hip arthroplasty (THA) is frequently performed under spinal anesthesia using either isobaric or hypobaric anesthetic solution. However, these two solutions have never been compared under similar surgical conditions. In the present study, we compared the anesthetic and hemodynamic effects of isobaric and hypobaric bupivacaine in 40 ASA physical status I–II patients undergoing THA in the lateral decubitus position under spinal anesthesia. With operative side up, patients randomly received, in a double-blinded manner, a spinal injection of 3.5 mL (17.5 mg) of plain bupivacaine mixed with either 1.5 mL of normal saline (isobaric group) or 1.5 mL of distilled water (hypobaric group). Sensory level and degree of motor block were evaluated on the nondependent and dependent sides until regression to L2 and total motor recovery. Hemodynamic changes during the first 45 min after spinal injection, and the time between spinal administration and first analgesic for a pain score >3 (on a 0–10 scale) were noted. Demographic characteristics of both groups were comparable. Upper sensory level and maximal degree of motor block were comparable between the operative and nonoperative sides in each group and between corresponding sides in both groups. Compared with the isobaric group, in the hypobaric group there was a prolonged time to sensory regression to L2 on the operative side (287 ± 51 versus 242 ± 36 min, P < 0.004) and a prolonged time to first analgesic (290 ± 46 versus 237 ± 39 min, P < 0.001). No difference in quality of motor block was noted at the end of surgery. Hemodynamic changes were comparable. We conclude that for THA in the lateral position, spinal hypobaric bupivacaine seems to be superior to isobaric in that it prolongs the sensory block on the operative side and delays the use of analgesics after surgery without further compromising hemodynamic stability.

?离子通道在缺氧引起的血管舒?中的作用和大鼠????予利多卡因的??效?

The Role of K+ Channels in Vasorelaxation Induced by Hypoxia and the Modulator Effects of Lidocaine in the Rat Carotid Artery

Hiroyuki Kinoshita, MD PhD*, Yoshiki Kimoto, MD, Katsutoshi Nakahata, MD*, Hiroshi Iranami, MD*, Mayuko Dojo, MD, and Yoshio Hatano, MD, PhD

*Department of Anesthesia, Japanese Red Cross Society, Wakayama Medical Center, and Department of Anesthesiology, Wakayama Medical University, Japan

Anesth Analg 2003 97: 333-338.

缺氧?致的血管舒?,部分是通?激活?离子通道而?生的。利多卡因可削弱因?离子通道??而引起的血管舒?作用,提示?种抗心律失常?有抑制缺氧?致的由?离子通道?控的血管舒?。我???了目前的研究?确定在???是否缺氧?致?离子通道??血管舒?以及是否利多卡因能??通?病理生理?和?理?刺激?离子通道?生的血管舒?作用。大鼠普通??????皮?胞能??等容?荷。在?苯?上腺素、缺氧?致的血管舒?的收?或?三磷酸腺?敏感的?离子通道??的?度反?的?程能用以改?控制气体到缺氧气体以及各自levcromakalim的累?增加。缺氧?致的血管舒?能由优降糖(5μM)?著下降,但不能由iberiotoxin0.1μM)、蜂毒明?(0.1μM)、BaCl2(10μM)4-氨基?啶(1mM)而降低。Levcromakalim?致的血管舒?能被优降糖完全消除。?度依?的利多卡因(10100μM)能抑制?种血管??,提示它不影?缺氧?致的血管舒?。?些??提示三磷酸腺?敏感的?离子通道在大鼠???因缺氧?致血管舒?中起?重要作用,利多卡因??地??通?病理生理?和?理?的刺激激活?些通道的血管舒?。

(?敏翻? 薛??校)

Hypoxia induces vasodilation, partly via the activation of K+ channels. Lidocaine impairs vasorelaxation mediated by a K+ channel opener, suggesting that this antiarrhythmic drug may inhibit hypoxia-induced vasodilation mediated by K+ channels. We designed the current study to determine whether, in the carotid artery, K+ channels contribute to vasorelaxation in response to hypoxia and whether lidocaine modulates vasorelaxation induced by K+ channels via pathophysiological and pharmacological stimuli. Rings of rat common carotid artery without endothelium were suspended for isometric force recording. During contraction to phenylephrine, hypoxia-induced vasorelaxation or concentration-response to an adenosine triphosphate-sensitive K+ channel opener was obtained changing control gas to hypoxic gas and the cumulative addition of levcromakalim, respectively. Hypoxia-induced vasorelaxation was significantly reduced by glibenclamide (5 μM) but not by iberiotoxin (0.1 μM), apamin (0.1 μM), BaCl2 (10 μM), or 4-aminopyridine (1 mM). Levcromakalim-induced vasorelaxation was completely abolished by glibenclamide. Lidocaine (10–100 μM) concentration-dependently inhibited this vasodilation, whereas it did not affect hypoxia-induced vasodilation. These results suggest that adenosine triphosphate-sensitive K+ channels play a role in hypoxia-induced vasodilation in the rat carotid artery and that lidocaine differentially modulates vasodilation via these channels activated by pathophysiological and pharmacological stimuli.

小?量芬太尼?七氟醚麻醉未行外科手?的小儿患者?醒?量的影?

The Effect of Small Dose Fentanyl on the Emergence Characteristics of Pediatric Patients After Sevoflurane Anesthesia Without Surgery

Joseph P. Cravero, MD, Michael Beach, MD, Brian Thyr, MD, and Kate Whalen, RN

Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Anesth Analg 2003 97: 364-367.

我???本????量小?量??注射芬太尼?七氟醚麻醉下未?外科手?干扰的小儿患者?醒?量的影?。32ASA?分I-II?接受七氟醚麻醉行MRI?查的患儿根据?机?盲的方式登?、入?,在?束麻醉之前10分?接受安慰?(?)1μg/kg??注射芬太尼。主要?果?量患儿?醒?量的百分比?。我?也?估躁?的持???和?到?院的???准。接受芬太尼的患儿?安慰??躁?的?生率降低(12%比56%)。到??院?理的???准??著差异。我?的??是?予小?量芬太尼能?少吸入麻醉?七氟醚引起的?立于疼痛控制效?的?醒躁?的?生。

(?敏翻? 薛??校)

We designed this study to measure the effect of a small dose of IV fentanyl on the emergence characteristics of pediatric patients undergoing sevoflurane anesthesia without any surgical intervention. Thirty-two ASA physical status I or II pediatric outpatients receiving sevoflurane anesthesia for magnetic resonance imaging scans were enrolled and assigned in a random and double-blinded manner to receive either placebo (saline) or 1 μg/kg IV fentanyl 10 min before discontinuation of their anesthetic. The primary outcome measure was the percentage of patients with emergence agitation. We also evaluated the duration of agitation and time to meet hospital discharge criteria. Patients who received fentanyl had a decreased incidence of agitation (12% versus 56%) when compared with placebo. There was no significant difference in time to meet hospital discharge criteria. We conclude that the addition of a small dose of fentanyl to inhaled sevoflurane anesthesia decreases the incidence of emergence agitation independent of pain control effects.

小儿呼气末七氟醚?度和交感迷走?力?的?系

The Relationship Between Expired Concentration of Sevoflurane and Sympathovagal Tone in Children

Eric Wodey, MD PhD*, Lotfi Senhadji, PhD, Patrick Pladys, MD PhD, Francois Carre, MD PhD, and Claude Ecoffey, MD*

*Department of Anesthesiology and Surgical Intensive Care, LTSI, Department of Pediatric and Neonatal Intensive Care, and Department of Physiology, Universite de Rennes 1, Paris, France

Anesth Analg 2003 97: 377-382.

在小儿,七氟醚在??期?降低副交感?力?氟烷明?。七氟醚?副交感活性的影?能解?在?儿和儿童?的心率不同改?。本??中,我?要研究在小儿呼气末七氟醚的?度和交感、副交感?力的相互?系通?光?分析的RR?期。?33ASA?分I?的小儿需要接受外科手??行研究。10名小儿(A?)在?始?床?醒?逐?降低吸入七氟醚的?度?8%起。另外23名小儿(B?)?醒?在?定的12的七氟醚最低肺泡麻醉?度。插入的RR序列???改?自?回?的模式,光?密度在低?(LF:0.04-0.15Hz)和高?(HF0.150.55Hz)的范?。A?心率?慢和呼出七氟醚?度的降低相平行。相反,呼出七氟醚的?度降低?致收??(SBP)、HFLFLF/HF升高。LF/HF的升高先于HF的升高。在B?,HF的基???和正常值Hfnu(Hfnu=HF/LF+HF)在大于三?的年?儿明?升高。七氟醚引起的心率?化与HF基?值和Hfnu呈副相?(R2=0.6;P<0.001)。?果示副交感?力降低是七氟醚?致心率?化的主要?定因素

(?敏翻? 薛??校)

In children, sevoflurane depresses parasympathetic tone during induction more than halothane. The effects of sevoflurane on parasympathetic activity could explain the difference in heart rate (HR) changes described between infants and children. In this study, we sought to determine the relationship between the end-tidal concentration of sevoflurane and sympathetic and parasympathetic tone in children by spectral analysis of RR intervals. Thirty-three children, ASA physical status I, who required elective surgery were studied. In 10 children (Group A), recordings were performed while gradually decreasing the inspired sevoflurane concentration from 8% to the beginning of clinical awakening. In 23 other children (Group B), recordings were performed while children were awake and at a steady-state of 1 and 2 minimum alveolar anesthetic concentration of sevoflurane. A time-varying autoregressive modeling of the interpolated RR sequences was performed, and spectral density in low-frequency (LF; 0.04–0.15 Hz) and high-frequency (HF; 0.15–0.55 Hz) bands was calculated. In Group A, HR slowing paralleled the decrease in expired sevoflurane concentration. Conversely, the decrease in expired concentration of sevoflurane led to an increase in systolic blood pressure (SBP), HF, LF, and LF/HF. The increase in LF/HF preceded the increase in HF. In Group B, the baseline HF power spectrum and normalized values HFnu (HFnu = HF/LF + HF) were significantly increased in children older than 3 yr. Changes in HR induced by sevoflurane were negatively correlated with baseline HF and HFnu (R2 = 0.6; P < 0.001). These results demonstrate that withdrawal of parasympathetic tone is the main determinant for the change in HR induced by sevoflurane

.

在????物中右旋布洛芬(S(+)-异构布洛芬)?少胃??增加止痛和抗炎效果

Dexibuprofen (S(+)-Isomer Ibuprofen) Reduces Gastric Damage and Improves Analgesic and Antiinflammatory Effects in Rodents

A. Bonabello, PhD*, M. R. Galmozzi, PhD*, R. Canaparo, PhD, G. C. Isaia, MD, L. Serpe, MD, E. Muntoni, MS, and G. P. Zara, MD

*Research Department, SPA-Societa’ Prodotti Antibiotici S.p.A., Milan, Italy; and Departments of Anatomy, Pharmacology and Forensic Medicine and Internal Medicine, University of Turin, Turin, Italy

Anesth Analg 2003 97: 402-408

.

我?研究在????物中活化S(+)-异构布洛芬(右旋布洛芬)的止痛和抗炎活性以及相?的急性胃粘膜??与?准的外消旋布洛芬比?。止痛效果在?小鼠IVPO??以及?大鼠PO??后用?板?和尾部拍打的方法?估。S(+)-布洛芬比外消旋型的布洛芬至少?二倍效能。化合物??抗炎效?用小鼠(IVPO)后腹部收???以及大鼠(IVPO)后后爪水????行?估,??在小鼠IV和大鼠PO?予布洛芬后?生更?著的效能。而且,在相同?量(大鼠50mg/kgPO)下化合物????准外消旋布洛芬能?著?少胃粘膜??的?生。??,S(+)-布洛芬异构体?外消旋者在止痛和抗炎??中有更多的效力而存在更少的胃毒性影?。基于本??的?果,我?提出化??构形式如R(-)-布洛芬?避免使用如果?于?期的治?活性?必要者。

(?敏翻? 薛??校)

We determined the analgesic and antiinflammatory actions and the related acute mucosal gastric damage from the active S(+)-isomer ibuprofen (dexibuprofen), in comparison with those of the standard racemic formulation of ibuprofen in rodents. The antinociception was evaluated by hot-plate and tail-flick methods after IV and oral (PO) administration in mice and after PO administration in rats. S(+)-Ibuprofen was at least twice more potent than the ibuprofen racemic formulation. The antiinflammatory action of the test compound, assessed with the abdominal constriction test in mice (IV and PO) and with hind paw edema in rats (IV and PO), was found to be significantly more potent than that of ibuprofen after IV treatment in mice and PO administration in rats. Moreover, the test compound caused significantly less mucosal gastric damage than the racemic formulation administered at identical doses (50 mg/kg PO in rats). In conclusion, the S(+)-ibuprofen isomer was found to be more potent than the racemic formulation in analgesic and antiinflammatory tests and presented fewer gastric toxic effects. On the basis of the results of this work, we suggest that the administration of chemical entities, such as R(-)-ibuprofen, should be avoided if they are not essential for the anticipated therapeutic activity.

既非脊髓γ-氨基丁酸-A也非番木??敏感的氨基乙酸受体系?是氟烷抑制脊髓后角感?神?元的唯一介?

Neither Spinal -Aminobutyric Acid-A nor Strychnine-Sensitive Glycine Receptor Systems Are the Sole Mediators of Halothane Depression of Spinal Dorsal Horn Sensory Neurons

Masanori Yamauchi, MD, Steven G. Shimada, PhD, Hiroshi Sekiyama, MD, and J. G. Collins, PhD

Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticu

Anesth Analg 2003 97: 417-423.

t

吸入麻醉?抑制脊髓后角低?值(LT)神?元?外周接受?刺激的反?。部分?种抑制能受麻醉?相互作用??通?γ-氨基丁酸AGABAA)和番木??敏感的氨基乙酸抑制神???系?。在此?生理??中,我???通??予荷包牡丹?(GABAA??性拮抗?)和/或番木??(氨基乙酸??性拮抗?)系?地??或?合??抗氟烷?LT神?元的抑制,?用于去大?、脊索??的大鼠。我?????荷包牡丹??是番木??,??或?合?用不?能部分逆?氟烷?接受?刺激的LT神?元的抑制。荷包牡丹?和番木????或?合不能完全逆?氟烷的抑制提示?然GABAA和氨基乙酸系?存在于氟烷的抑制中,但是其他作用机制在氟烷抑制LT脊髓感?神?元中也是必需的。

(?敏翻? 薛??校)

Inhaled anesthetics depress the response of spinal dorsal horn low-threshold (LT) neurons to peripheral receptive field stimulation. Part of that depression may be mediated by anesthetic interactions with -aminobutyric acid type A (GABAA) and strychnine-sensitive glycine inhibitory neurotransmitter systems. In this electrophysiological study, we attempted to antagonize halothane depression of LT neurons by administering bicuculline (a competitive GABAA antagonist) and/or strychnine (a competitive glycine antagonist) systemically, alone or in combination, to decerebrate, spinal cord-transected rats. We observed that both bicuculline and strychnine, alone or in combination, significantly but only partially reversed halothane depression of LT neuronal responses to receptive field stimulation. The inability of bicuculline and strychnine, alone or in combination, to completely reverse halothane depression suggests that although GABAA and glycine systems are involved in the observed halothane depression, additional mechanisms of action are also required for halothane depression of LT spinal sensory neurons.

腹腔?手?不同麻醉方法(异丙酚全???麻醉与异氟醚吸入麻醉)?眼??的?化

Intraocular Pressure Changes During Laparoscopy in Patients Anesthetized with Propofol Total Intravenous Anesthesia Versus Isoflurane Inhaled Anesthesia

Hany A. Mowafi, MB Bch, MSc, MD*, Abdulmohsin Al-Ghamdi, MD*, and Adel Rushood, MD

Departments of *Anesthesia and Ophthalmology, Faculty of Medicine, King Faisal University, Dammam, Saudi Arabia

Anesth Analg 2003 97: 471-474.

我??量了硫?妥?、异氟醚复合麻醉或异丙酚全???麻醉下行?科腹腔?手?患者眼??的?化。我?收?了40例?前?眼科疾病的行?科腹腔?手?成年女性患者。手?中?定的??段?定心率、平均???、气道峰?、平台?、呼气末二氧化碳值(ETCO2)及眼??(用Schioetz眼???定)。??患者麻醉??后眼?明?下降,并且异丙酚?患者?中一直保持此水平,但异氟醚??CO2气腹并取?低位?患者的眼??比??前水平?著升高。眼??与血?、气道?之??相?性。如果考?到控制????因素,异丙酚全???麻醉可能是腹腔?手?麻醉的更佳??。

(梁雅芬翻? 薛??校)

We examined intraocular pressure (IOP) changes during gynecologic laparoscopy performed under either thiopental-isoflurane anesthesia or total IV propofol anesthesia. Forty adult women with no preexisting eye disease scheduled for gynecologic CO2 insufflation laparoscopy were included in the study. Heart rate, mean arterial blood pressure, peak and plateau airway pressure, ETCO2, and IOP (using a Schioetz tonometer) were measured at defined intervals during the procedure. IOP decreased significantly after the induction of anesthesia in both groups, and remained so throughout the procedure in the propofol group. In the isoflurane group, however, IOP was increased significantly above the preinduction level after pneumoperitoneum with head-down position. There was no correlation between IOP and blood pressure or airway pressure. In conclusion, propofol total IV anesthesia may be a better choice for laparoscopic surgery should control of IOP be a concern

完全清醒的志愿者神?肌肉阻?可使BIS值下降

The Bispectral Index Declines During Neuromuscular Block in Fully Awake Persons

M. Messner, MD*, U. Beese, MD*, J. Romstock, MD, M. Dinkel, MD, and K. Tschaikowsky, MD*

Departments of *Anesthesiology and Neurosurgery, Friedrich-Alexander Universitat, Erlangen-Nuernberg, Germany; and Department of Anesthesiology, Frankenwaldklinik, Kronach, Germany

Anesth Analg 2003 97: 488-491

.

BIS(????指?)是用于??麻醉深度的?????,肌?活?可以影?表????及BIS值的?算.在??研究中我???察自?性肌?活??BIS的影?。我?用AspectA-100??了三名自愿者的BIS值,并同???肌?活?。在其中一名自愿者中重复了?一??,?予肌松?阿曲?胺和琥珀??,不使用其它任何?物。BIS值?肌肉松弛的反?表??与面肌自?性肌?活?下降平行的?低,最低值?33,其中一名自愿者中重复??中??到完全神?肌肉阻??BIS最低值?9。另外?名自愿者?有?到完全神?肌肉阻??他?的BIS分??6457。反之,BIS的恢复与自?性肌?活?相?。在整???中自愿者保持完全清醒,BIS值用Software3.31版本?算。??:BIS值与面肌自?性肌?活?相?,BIS在完全神?肌肉阻??象中不能??知?。因此,在完全神?肌肉阻??象中BIS??不能可靠地????深度的下降及?危急??的?知。

(梁雅芬翻? 薛??校)

Bispectral index (BIS) is an electroencephalographic variable promoted for measuring depth of anesthesia. Electromyographic activity influences surface electroencephalography and the calculation of BIS. In this study, we sought to determine the effect of spontaneous electromyographic activity on BIS. BIS was monitored in three volunteers by using an Aspect A-1000 monitor. The experiment was repeated in one volunteer. Electromyographic activity was recorded. Alcuronium and succinylcholine were administered. No other drugs were used. In parallel with spontaneous electromyographic activity of the facial muscles, BIS decreased in response to muscle relaxation to a minimum value of 33 and, in the repeated measurement, to a minimum value of 9 when total neuromuscular block was achieved. In two volunteers, no total block was achieved. BIS decreased to a minimal value of 64 and 57, respectively. In turn, recovery of BIS coincided with the reappearance of spontaneous electromyographic activity. During the entire experiment, the volunteers had full consciousness. BIS, assessed by software Version 3.31, correlates with spontaneous electromyographic activity of the facial muscles. BIS failed to detect awareness in completely paralyzed subjects. Thus, in paralyzed patients, BIS monitoring may not reliably indicate a decline in sedation and imminent awareness.

 

3-葡萄糖醛酸?-?啡(M3G)的神???作用通??接??N-甲基-D-天?冬氨酸(NMDA)受体介?:在培?的胚胎海?神?元?胞中?于其机制的研究

Morphine-3-Glucuronide’s Neuro-Excitatory Effects Are Mediated via Indirect Activation of N-Methyl-D-Aspartic Acid Receptors: Mechanistic Studies in Embryonic Cultured Hippocampal Neurones

Kamondanai Hemstapat, BPharm, Gregory R. Monteith, PhD, Deborah Smith, BPharm (Hons), and Maree T. Smith, PhD

School of Pharmacy, The University of Queensland, St Lucia Campus, Brisbane, Australia

Anesth Analg 2003 97: 494-505

?接?据表明了3-葡萄糖醛酸?-?啡(M3G)可能?致了大?量?啡全身???的神???副作用(肌??和痛??敏)。?了?一步探?M3G??性作用机制,我?采用了氟-3-?光?字?像技???了M3G5-50μm)?培?的胚胎海?神?元?胞?中Ca2+?度([Ca2+]CYT)的急性期影?。急性暴露3分???了?种典型的[Ca2+]CYT?流,其一表??[Ca2+]CYT持?增高,然后逐?降至基?水平;其二表??[Ca2+]CYT振幅急?增高并至少?持30秒的一?性振?反?。?洛酮??理??低10%-25%的神?元?M3G的反?,?提示M3G的神???作用主要通?非阿片?受体介?。?然?种由M3G??的??洛酮不敏感的[Ca2+]CYT增高可以被NMDA拮抗?和非NMDA拮抗?6-cyano-7-nitroquinoxaline-2,3-dione(CNQX)(alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainite antagonist)完全阻?,CNQX并?有?期地阻?NMDA??的[Ca2+]CYT增高,??明M3G?接地??了NMDA受体。另外,tetrodotoxinNa+通道阻??)、baclofen(GABA激??)MVIICP/QCa2+通道阻??),硝苯地平(L-Ca2+通道阻??)均阻?了M3G??的[Ca2+]CYT增高,提示了M3G可能通???神????放?生其神???作用,然而,?一???有待于更多事??明。

(梁雅芬翻? 薛??校)

Indirect evidence indicates that morphine-3-glucuronide (M3G) may contribute significantly to the neuro-excitatory side effects (myoclonus and allodynia) of large-dose systemic morphine. To gain insight into the mechanism underlying M3G’s excitatory behaviors, we used fluo-3 fluorescence digital imaging techniques to assess the acute effects of M3G (5–500 μM) on the cytosolic calcium concentration ([Ca2+]CYT) in cultured embryonic hippocampal neurones. Acute (3 min) exposure of neurones to M3G evoked [Ca2+]CYT transients that were typically either (a) transient oscillatory responses characterized by a rapid increase in [Ca2+]CYT oscillation amplitude that was sustained for at least 30 s or (b) a sustained increase in [Ca2+]CYT that slowly recovered to baseline. Naloxone-pretreatment decreased the proportion of M3G-responsive neurones by 10%–25%, implicating a predominantly non-opioidergic mechanism. Although the naloxone-insensitive M3G-induced increases in [Ca2+]CYT were completely blocked by N-methyl-D-aspartic acid (NMDA) antagonists and 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate antagonist), CNQX did not block the large increase in [Ca2+]CYT evoked by NMDA (as expected), confirming that M3G indirectly activates the NMDA receptor. Additionally, tetrodotoxin (Na+ channel blocker), baclofen (-aminobutyric acidB agonist), MVIIC (P/Q-type calcium channel blocker), and nifedipine (L-type calcium channel blocker) all abolished M3G-induced increases in [Ca2+]CYT, suggesting that M3G may produce its neuro-excitatory effects by modulating neurotransmitter release. However, additional characterization is required.

??注射前列腺素E1?似物前列地??防硫戊巴比妥-芬太尼??的人支气管收?

Intravenous Alprostadil, an Analog of Prostaglandin E1, Prevents Thiamylal-Fentanyl-Induced Bronchoconstriction in Humans

Zen’ichiro Wajima, MD PhD*, Toshiya Shiga, MD PhD||, Tatsusuke Yoshikawa, MD PhD,, Akira Ogura, MD PhD*, Kazuyuki Imanaga, MD*, Tetsuo Inoue, MD PhD*, and Ryo Ogawa, MD PhD

*Department of Anesthesia, Chiba Hokusoh Hospital, Chiba, Japan; Department of Anesthesia, Tama-Nagayama Hospital; Department of Anesthesiology, Nippon Medical School; Department of Anesthesiology, Tokyo Jikeikai Medical School, Tokyo, Japan; and ||Center for Anesthesiology Research, The Cleveland Clinic Foundation, Ohio

Anesth Analg 2003 97: 456-460

前列腺素E1PGE1)在?物??中可松弛气道平滑肌,然而,?床?于??注射其?似物前列地??支气管的松弛作用并???。我?曾??描述人体??中硫戊巴比妥-芬太尼可??支气管收?。?在我?就前列地??硫戊巴比妥-芬太尼??的支气管收?的作用作一?道。32例患者,?机分??照?和前列地??,各16例。麻醉??:硫戊巴比妥25mg/kg,??溴胺0.3 mg/kg。麻醉?持:??持??注硫戊巴比妥15mg/kg/h,机械通气笑气/氧气各50%吸入。麻醉??20分?,?照?病人???注前列地?生理?水20ml/h,前列地??病人??持??注前列地?0.2 mg/kg/min20ml/h),均?持60分?,然后???予芬太尼15μg/kg。麻醉前基?值?、芬太尼注射前(T30)、芬太尼注射后每隔6分?共三次(T36T42T48)及注射后30分?(T60)??病人收??、舒??、心率、平均气道阻力(Rawm)、呼气气道阻力(Rawe)和??肺??性(Cdyn)。??患者的RawmRaweCdyn基?值有可比性,?照?T36-60?RawmRaweCdyn基?值有可比性,?照?T36-60?RawmRaweCdyn与基?值比?著升高。T36-60?Cdyn?著降低,而前列地??T36-60?RawmRaweCdyn??化。??:??注射地??人可能有支气管??作用。

(梁雅芬翻? 薛??校)

Intravenous Alprostadil, an Analog of Prostaglandin E1, Prevents Thiamylal- Prostaglandin (PG) E1 relaxes airway smooth muscle in animals. However, no clinical data have been published on the bronchorelaxant effects of IV alprostadil, an analog of PGE1. We have described experimental thiamylal-fentanyl-induced bronchoconstriction in humans; we now report the effect of IV alprostadil on thiamylal-fentanyl-induced bronchoconstriction. Thirty-two patients were allocated randomly to a control group (n = 16) and alprostadil group (n = 16). Anesthesia was induced with thiamylal 5 mg/kg and vecuronium 0.3 mg/kg and maintained with a continuous infusion of thiamylal 15 mg · kg-1 · h-1. The lungs of the patients were ventilated with 50% nitrous oxide in oxygen. Twenty minutes after the induction of anesthesia, patients in the control group were given a continuous infusion of normal saline 20 mL/h, and those in the alprostadil group received a continuous infusion of alprostadil 0.2 μg · kg-1 · min-1 (20 mL/h), both for 60 min. Both groups were then given fentanyl 5 μg/kg. Systolic and diastolic arterial blood pressure, heart rate, mean airway resistance (Rawm), expiratory airway resistance (Rawe), and dynamic lung compliance (Cdyn) were measured at the baseline, just before the fentanyl injection (T30), at three consecutive 6-min intervals after fentanyl injection (T36, T42, and T48), and 30 min after fentanyl injection (T60). Baseline Rawm, Rawe, and Cdyn values were comparable between groups. In the control group, both Rawm and Rawe were significantly increased at T36–60, and Cdyn was significantly decreased at T36–60 compared with the baseline. Patients given alprostadil showed no change in Rawm, Rawe, or Cdyn at T36–60. Thus, IV alprostadil seems to have a bronchodilator effect in humans.

 

??性麻醉?异氟醚抑制人初??皮?胞中由?胺?放的?离子?流

The Volatile Anesthetic Isoflurane Inhibits the Histamine-Induced Ca2+ Influx in Primary Human Endothelial Cells

Piet W. L. Tas, PhD, Christiane Stosel, MD, and Norbert Roewer, MD

Department of Anesthesiology, University of Würzburg, Würzburg, Germany

Anesth Analg 2003 97: 430-435.

?然异氟醚是已知的血管???,但它的作用机制尚不清楚。在?一?程中最重要的系?之一是由NO介?的血管??。?一系?的作用并非通??源性?离子?放??,而是通?激活???的?离子?流??。曾有????性麻醉??猩猩?皮?胞??离子?度信???的作用作了研究,但在人体?皮?胞的?似研究尚缺乏。在本研究中我?研究了异氟醚是否影?初?培?的?皮?胞由?胺?放的?离子?流。采用同焦?激光?描?微?和??离子指士?-Fluo-3??的?胞。我?研究了异氟醚??胺??的?离子?向性?流平台期的影?,?一?流平台期被??是由?离子?能的?流引起,另外,由于Mn2+在?入?胞?可焠?-Fura-2-?光,我?直接用Mn2+?量了能通???离子通道的离子流。?果表明?种方法的?果吻合度很好,异氟醚??能的?离子?流的抑制作用呈?量依?性。??察到的抑制作用?有被下源的?皮?胞NO活?激活代??,异氟醚明?抑制了NO介?的血管??。

(梁雅芬翻? 薛??校)

Although isoflurane is a known vasodilator, the mechanism of isoflurane-induced vasodilation is not clear. One of the most important systems in this context is the nitric oxide (NO)-mediated vasodilation. The activity of this system is regulated by the agonist-induced Ca2+ influx rather than Ca2+ release from internal stores. A number of reports have studied the effect of volatile anesthetics on the cytoplasmic calcium concentration signaling in mammalian endothelial cells. However, similar studies using human endothelial cells are lacking. In this study, therefore, we investigated whether isoflurane affects the histamine-induced Ca2+ influx in primary cultures of human endothelial cells. Using confocal laser scanning microscopy and cells loaded with the Ca2+ indicator Fluo-3, we studied the effect of isoflurane on the plateau phase of the histamine-induced Ca2+ influx, which is considered to be due to capacitative Ca2+ entry. In addition, we measured the ion flux through capacitative Ca2+ channels directly by using Mn2+ ions, which, on entering the cell, quench the Fura-2 fluorescence. The results of these two methods were in close agreement and showed a dose-dependent inhibition of the capacitative Ca2+ entry by isoflurane. Isoflurane apparently depresses NO-mediated vasodilation when the observed inhibition is not compensated for downstream of the endothelial NO synthase activation.

?拉明与西咪替丁?大鼠mRNA C-fos表?和?害性刺激防御行?的影?

The effects of pyrilamine and cimetidine on mRNA C-fos expression and nociceptive flinching behavior in rats

Ashmawi HA, Chambergo FS, Araujo Palmeira CC, de Paula Posso I.

Anesthesiology Branch Department of Surgery, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. hazem@hcnet.usp.br

Anesth Analg. 2003 Aug;97(2):541-546

,

c-fosFos的表?,常作?神?感受?害性刺激的??,可被?多?物改?。?胺受体拮抗??c-fos信使(m)RNA表?的影?尚未明了。??局部和全身?用?拉明(H(1)受体拮抗?)与西咪替丁(H(2)受体拮抗?)?在大鼠后爪背部注射50mL1%福??林所引起的?害性刺激防御行?的影?。?察?害性刺激防御行?45分?,然后?死大鼠?取腰部脊髓?用?交技???c-fos mRNA的表?。全身?用?拉明与西咪替丁未能引起?害性刺激防御行?和c-fos mRNA的表?。局部?用?些?物?,它?以不同的方式影??害性刺激防御行?和c-fos mRNA的表?。?拉明在??中以?量依?的方式?少防御行?,然而西咪替丁不影??Ⅰ,?部分?少?Ⅱ的防御行?。520mM的?拉明?少c-fos mRNA的表?,但西咪替丁?在100mM??少c-fos mRNA的表?。全身?用?些?物?不影?c-fos mRNA的表?。??:?胺受体拮抗?局部?用?具有抗?害性刺激作用。在一??害性刺激防御行???和mRNA c-fos表?中可以??到?些作用。?拉明(H(1)受体拮抗?)比西咪替丁(H(2)受体拮抗?)具有更大的抗?害性刺激作用。

(?越超翻? 薛??校)

C-fos and Fos expression, frequently used as a neural nociceptive marker, is altered by many drugs. The effects of histamine receptor antagonists on c-fos messenger (m)RNA expression are unknown. We examined the effect of local and systemic administration of pyrilamine (H(1) receptor antagonist) and cimetidine (H(2) receptor antagonist) on the nociceptive flinching behavior elicited by injection of 50 micro L of 1% formalin into the dorsal region of the hind paw of rats. Nociceptive flinching behavior was observed for 45 min, and the rats were then killed and lumbar spinal cord obtained for c-fos mRNA expression, measured using the Northern blot hybridization technique. Systemic administration of pyrilamine and cimetidine did not elicit response in nociceptive behavior or in c-fos mRNA expression. When the drugs were locally administered, they affected behavior and c-fos mRNA expression in different patterns. Pyrilamine decreased the number of flinches in a dose dependent manner in both phases, whereas cimetidine did not affect Phase I and decreased the number of flinches in Phase II, but only partially. Pyrilamine 5 and 20 mM decreased c-fos mRNA expression, and cimetidine decreased the expression only at 100 mM. The systemic use of the drugs had no effect on c-fos mRNA expression. IMPLICATIONS: Histamine receptor antagonists present antinociceptive effects when administered peripherally. These effects are observed through a nociceptive flinching behavior test and mRNA c-fos expression. Pyrilamine (H(1) receptor antagonist) has a greater antinociceptive effect than cimetidine (H(2) receptor antagonist).

肥胖者比瘦者更多?困?气管插管

Difficult tracheal intubation is more common in obese than in lean patients

Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL, Desmonts JM.

Department of Anesthesia and Intensive Care, Bichat Claude-Bernard Hospital, Paris, Franc

Anesth Analg. 2003 Aug;97(2):595-600

肥胖者?行气管插管是否更困?尚有??。?用最近确定的客??准,插管困??准(IDS)?比?肥胖者与瘦者困?气管插管的?生率。研究了??的134名瘦者(体重指?<30Kg/m2)和129名肥胖者(体重指?>=35Kg/m2)。比?肥胖者与瘦者的IDS?分,分?困?插管(IDS>=5)和非困?插管(IDS<5),和患者?据,包括吸氧?的氧?和度(SpO2)。另外也确定了肥胖者困?插管的危?因子。3名瘦者和20名肥胖者的IDS?分>=5(p=0.0001)。肥胖者困?插管的唯一的?立危?因子是Mallampati?分Ⅲ-Ⅳ(OR=12.5195%CI 2.01-77.81,但是其特异性和?性??值?62%29%,有?著差异。瘦者与肥胖者的插管?SpO2?(平均值+/-?准差)99%+/-1%(范?:91%-100%)95%+/-8%(范?:50%-100%,有?著差异(p<0.0001)。由此??肥胖者比非肥胖者更多?困?气管插管。?肥胖者??,?有一??典的困?插管危?因子??意的。在肥胖者中,去?和高??的依据研究???新的困?插管??因子。??:肥胖者困?插管?生率?15.5%,瘦者困?气管插管?生率?2.2%。?有一?瘦者困?气管插管的危?因子?肥胖者??是?意的。?肥胖者??,去氧?和的高??可能伴?困?气管插管。

(?越超翻? 薛??校)

Whether tracheal intubation is more difficult in obese patients is debatable. We compared the incidence of difficult tracheal intubation in obese and lean patients by using a recently validated objective scale, the intubation difficulty scale (IDS). We studied 134 lean (body mass index, <30 kg/m2) and 129 obese (body mass index, >or=35 kg/m2) consecutive patients. The IDS scores, categorized as difficult intubation (IDS >or=>5) or not (IDS <5), and the patient data, including oxygen saturation (SpO2) while breathing oxygen, were compared between lean and obese patients. In addition, risk factors for difficult intubation were determined in obese patients. The IDS score was >or=5 in 3 lean and 20 obese patients (P = 0.0001). A Mallampati score of III-IV was the only independent risk factor for difficult intubation in obese patients (odds ratio, 12.51; 95% confidence interval, 2.01-77.81), but its specificity and positive predictive value were 62% and 29%, respectively. SpO2 values noted during intubation were (mean +/- SD) 99% +/- 1% (range, 91%-100%) and 95% +/- 8% (range, 50%-100%) in lean and obese patients, respectively (P < 0.0001). We conclude that difficult intubation is more common among obese than nonobese patients. None of the classic risk factors for difficult intubation was satisfactory in obese patients. The high risk of desaturation warrants studies to identify new predictors of difficult intubation in the obese. IMPLICATIONS: We report a difficult intubation rate of 15.5% in obese patients and 2.2% in lean patients. None of the risk factors for difficult intubation described in the lean population was satisfactory in the obese patients. We also report a high risk of desaturation in obese patients with difficult intubation.

)

大鼠坐骨神?的慢性??性????其?福??林?向反?性:一?行?与荷?蒙的?价

A chronic-constriction injury of the sciatic nerve reduces bilaterally the responsiveness to formalin in rats: a behavioral and hormonal evaluation.

Vissers K, Adriaensen H, De Coster R, De Deyne C, Meert TF.

Multidisciplinary Pain Unit, Ziekenhuis Oost-Limburg, Genk. R&D, PRD Johnson & Johnson, Beerse, Belgium.

Anesth Analg. 2003 Aug;97(2):520-5

?用四??子?大鼠坐骨神?造成?松的束?(慢性??性??CCI)介???害刺激和化?刺激明?的高敏性。然而,本研究中?大鼠后爪注射福??林, ??福??林???由CCI??的?神?痛?致同?退?功能、吃或咬功能的?退。?种作用与福??林的?度??。与假?注射或未注射的?物相比,?些行?的改?伴??血?低水平的促?上腺皮?激素和皮?酮。与假?注射或未注射的?照??物相比,在CCI大鼠??非?扎的后爪注射福??林同??少吃或咬的行?,但?在福??林???的第二?出?。因此,?于同?或??注射福??林,CCI??了疼痛反?和下丘?-垂体-?上腺?的活性。?一步的研究液?查了CCI??的疼痛反?降低是否也在外周、脊髓或脊髓上水平出?,或是?激反?改?的?果。??:?价了有害的化?刺激例如在?先?坐骨神?造成慢性??性??CCI的?物身上注射福??林所造成的行?反?和荷?蒙作用的改?。在?物同?和??的不同部位注射、假?注射、?照?都?行了比?。

(?越超翻? 薛??校)

Application of four loose ligatures to the sciatic nerve of a rat (chronic constriction injury [CCI]) induces clear hypersensitivity to non-noxious stimulation and chemical irritants. However, in this study, an injection of formalin in the hind paw of a rat with CCI-induced mononeuropathy resulted in an ipsilateral decreased flinching and licking or biting behavior in both phases of the formalin testing. The effect was independent of the formalin concentration used. This altered behavior was accompanied with smaller plasma levels of adrenocorticotrope hormone and corticosterone compared with sham and non-operated animals. Formalin injection in the contralateral nonligated hind paw of CCI rats also reduced the licking or biting behavior as compared with sham-operated and non-operated control animals only in the second phase of the formalin test. Thus, CCI reduces the pain reactivity and hypothalamic-pituitary-adrenal-axis activation to ipsilateral and contralateral formalin injection. Further research should investigate whether the decreased pain reactivity by CCI is situated at the peripheral, spinal, or supraspinal level or is result of changes in the stress reactivity and coping strategies. IMPLICATIONS: We evaluated the changes in the behavioral reactions and the hormonal effects of a noxious chemical stimulus, i.e., formalin injection in animals with previously induced chronic constriction injury to the sciatic nerve. The effect in animals injected at the ipsilateral and contralateral site, sham-operated and controls, were compared.

?阿斯匹林??血?蛋白在非心?手?中可以?少?血:多中心,?机,?照,?盲??

Diaspirin-Crosslinked Hemoglobin Reduces Blood Transfusion in Noncardiac Surgery: A Multicenter, Randomized, Controlled, Double-Blinded Trial

Armin Schubert, MD MBA*,||, Robert J. Przybelski, MD#, John F. Eidt, MD**, Larry C. Lasky, MD?, Kenneth E. Marks, MD, Matthew Karafa, MS, Andrew C. Novick, MD, Jerome F. O’Hara, Jr., MD*, Michael E. Saunders, MD, John W. Blue, Pharm D, John E. Tetzlaff, MD*, and Edward Mascha, MS and the Perioperative Avoidance or Reduction of Transfusion Trial (PARTT) Study Group,

Departments of *General Anesthesiology, Department of Orthopedic Surgery, Department of Urology, Department of Biostatistics & Epidemiology, The Cleveland Clinic Foundation; ||Cleveland Clinic Foundation Health Science Center of the Ohio State University; ?Department of Pathology, Ohio State University, Cleveland; #Department of Medicine, University of Wisconsin, Madison; **Division of Vascular Surgery, University of Arkansas for Medical Sciences, Little Rock; Baxter Hemoglobin Therapeutics, Boulder, Colorado; Pfizer Global Research and Development, New York City; and Richard Prielipp, MD, Bowman Gray School of Medicine; Gerald Fulda, MD, Christiana Health Care Services; Irwin Gratz, DO, Cooper Hospital/UMC; Michael Salem, MD, George Washington University Medical Center; Ronald Kline, MD, Harper Hospital; Benjamin Guslits, MD, Henry Ford Hospital; Michael Pasquale, MD, Lehigh Valley Hospital; Lauraine Stewart, MD, McGuire VA Medical Center; Larry Hollier, MD, Mt. Sinai Medical Center; Bhatar Desai, MD, St. Anthony Hospital; Marc J. Shapiro, MD, St. Louis University Hospital; Ronald Pearl, MD, Stanford University Medical Center; Michael J. Williams, MD, Thomas Jefferson University; Dennis Doblar, PhD, MD, University of Alabama-Birmingham; Marc Hudson, MD, University of Pittsburgh Medical Center; Michael P. Eaton, MD, University of Rochester Medical Center; Lewis Gottschalk, MB, University of Texas-Houston Health Sciences Center; Mali Mathru, MD, University of Texas Medical Branch; Daniel Herr, MD, Washington Hospital Center

Anesth Analg 2003;97:323-332


?机,前瞻性,?盲?床??研究?阿斯匹林??血?蛋白是否可以?少?中异体血的?注。?
1996年到1998年,?自19??床机构181名??性手?病人?加了此???。???准包括??注2-4?位血,大??修?和大??或腹部-盆腔手?。一旦?定?血,?予病人最多3250ml10%DCLHB?注液(n=92)或3??位的??胞?液(PRBCs(n=89)DCLHB36小?的?中窗?注。手??天,92名用DCLHB治?的患者中的58名?有再?注异体血(64%,可信??[CI]54%-74%)。?后第一天,???字?成了(48%,可信??CI37%-58%)到?后第7天,???值?一步下降。??92人中的44人(23%,可信??CI15%-33%)。在?后7天?段??里,DCLHB?病人每人使用21-4)?位的PRBC,相比?而言,?照??病人每人使用32-4)?位的PRBCP=0.002;中?值和第2575百分?)死亡率(分??4%3%)和至少一件不良事件的?生率(分??21%15%)在DCLHB?和PRBC?中相?似。DCLHB?病人?疸,泌尿系副作用和胰腺炎的?生???繁。由于安全因素此???提早?止。?管改良血?蛋白溶液的副作用方面有待改善,但我?的?据?示血?蛋白溶液在??性手?中可以有效?少异体血的使用。

( 殷文? ? 王祥瑞 )

In this randomized, prospective, double-blinded clinical trial, we sought to investigate whether diaspirin-crosslinked hemoglobin (DCLHb) can reduce the perioperative use of allogeneic blood transfusion. One-hundred-eighty-one elective surgical patients were enrolled at 19 clinical sites from 1996 to 1998. Selection criteria included anticipated transfusion of 2–4 blood units, aortic repair, and major joint or abdomino-pelvic surgery. Once a decision to transfuse had been made, patients received initially up to 3 250-mL infusions of 10% DCLHb (n = 92) or 3 U of packed red blood cells (PRBCs) (n = 89). DCLHb was infused during a 36-h perioperative window. On the day of surgery, 58 of 92 (64%; confidence interval [CI], 54%–74%) DCLHb-treated patients received no allogeneic PRBC transfusions. On Day 1, this number was 44 of 92 (48%; CI, 37%–58%) and decreased further until Day 7, when it was 21 of 92 (23%; CI, 15%–33%). During the 7-day period, 2 (1–4) units of PRBC per patient were used in the DCLHb group compared with 3 (2–4) units in the control patients (P = 0.002; medians and 25th and 75th percentiles). Mortality (4% and 3%, respectively) and incidence of suffering at least one serious adverse event (21% and 15%, respectively) were similar in DCLHb and PRBC groups. The incidence of jaundice, urinary side effects, and pancreatitis were more frequent in DCLHb patients. The study was terminated early because of safety concerns. Whereas the side-effect profile of modified hemoglobin solutions needs to be improved, our data show that hemoglobin solutions can be effective at reducing exposure to allogeneic blood for elective surgery.

 

使用各种?格????管?Level 1与快速?液系?流速和升?能力的比?

A Comparison of Flow Rates and Warming Capabilities of the Level 1 and Rapid Infusion System with Various-Size Intravenous Catheters

Sandra L. Barcelona, MD DABA*,, Fatima Vilich, MD DABA, and Charles J. Cote, MD DABA, FAAP

*Department of Anesthesiology, Northwestern University, The Feinberg School of Medicine; and Department of Pediatric Anesthesiology, Children’s Memorial Hospital, Chicago, Illinois *,

Anesth Analg 2003;97:358-363
大量?血的病人往往需要使用特殊的血液升??置,例如Level 1L-1)(Level 1 Technologies ,Inc.,Rockland,MA)或快速?液系?(RIS)(Haemonetics Corp.,Braintree,MA)。在??体外研究中,我?比?了使用儿童和成人尺寸???管?的液体?注和L-1(型?1000)RIS的升?能力。?量使用L-1RIS通?20-18-16-,和14-??管和4-5-6-7-,和8.5-法??管?注2L乳酸?林格氏溶液所需??和???度。?于18-20-??管?种系?的流速相近似;然而,??管尺寸>18??,使用RIS?的流速???快于L-1。在所有使用?16??管?,RIS的升?能力均优于L-1。我?的??是使用?18??管?,RIS的流速和升?能力均优于L-1,例如,?些可以用于大量失血的病例。在使用儿童尺寸?管?,在升?和流速方面RIS?有优?。

( 殷文? ? 王祥瑞 )

Cases involving massive blood transfusion may require the use of specialized blood warmers, such as the Level 1 (L-1) (Level 1 Technologies, Inc., Rockland, MA) or the Rapid Infusion System (RIS) (Haemonetics Corp., Braintree, MA). In this in vitro study, we compared the infusion and warming capabilities of the L-1 (model 1000) versus the RIS using pediatric- and adult-sized IV catheters. The time to infuse 2 L of lactated Ringer’s solution and the end temperature after infusion through 20-, 18-, 16-, and 14-gauge catheters, and 4-, 5-, 6-, 7-, and 8.5-French catheters using both the L-1 and RIS were measured. The flow rates of both systems were similar for 18- and 20-gauge catheters; however, the flow rates with the RIS were progressively faster than the L-1 as catheter size increased to >18 gauge. The heating capabilities of the RIS were superior to the L-1 for all catheters 16 gauge. We conclude that the RIS was superior to the L-1 for both flow rates and warming capacity for all IV catheters >18 gauge, i.e., those used for cases with massive blood loss. The RIS provided no advantage (with regard to heating and flow) when used with typical pediatric-sized catheters.

心???中各???T波??儿童麻醉???注射?上腺素?影?

Choice of Electrocardiography Lead Does Not Affect the Usefulness of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose in Anesthetized Children

Kumiko Ogasawara, MD, Makoto Tanaka, MD, and Toshiaki Nishikawa, MD

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

Anesth Analg 2003;97:372-376


儿童麻醉??注射?上腺素?偶于可?心???Ⅱ???示
T波振幅增大。本??目的了解心???中各??的???T波的影?。32例?期手?的?儿或儿童(年?6-49月),其ASA分??Ⅰ?,?中使用1.0MAC七氟醚和混有67%N2O的氧气。?血流?力?平?后,所有患儿?外周血管?注0.1ml/Kg生理?水,4分?后?注含1%利多卡因和1200000?上腺素的生理?水0.1ml/Kg(?上腺素量?0.5μg/Kg)。心率和收??每2060s??一次,心?????Ⅱ(n=32),V5(n=32),Ⅲ(n=17)或Ⅰ(n=15).??其中注?前T波振幅最大的??持???至注?后4分?。所有患儿在注?后均出?心率增快,收??增高和所有??T波振幅增大。而在?注生理?水后以上情?均未出?。在Ⅱ,Ⅰ,Ⅲ和V5??中T波最大振幅分?增加158%±69%175%±78%147%±89%170%±72%(平均±SDP>0.05)。四???中T波振幅改??有明???,其?敏度和特异度只与T波有?而与所?????。研究?果?示儿童手?接受七氟醚???注射?上腺素后Ⅱ,Ⅰ,Ⅲ和V5??的??作用相同。

(?羽霄 ? 王祥瑞 )

Accidental intravascular injection of an epinephrine-containing test dose increases T-wave amplitude of lead II electrocardiogram (EKG) in anesthetized children. We designed this study to test whether the choice of EKG lead would affect the usefulness of simulated intravascular test dose. We studied 32 ASA physical status I infants and children (aged 6–49 mo) undergoing elective surgeries during 1.0 minimum alveolar anesthetic concentration sevoflurane and 67% nitrous oxide in oxygen. When hemodynamic stability was obtained, all subjects received IV saline 0.1 mL/kg, followed 4 min later by an IV test dose (0.1 mL/kg) consisting of 1% lidocaine with 1:200,000 epinephrine (epinephrine 0.5 μg/kg) via a peripheral vein to simulate the intravascular injection of the test dose. Heart rate and systolic blood pressure were recorded every 20 and 60 s, respectively, and leads II (n = 32), V5 (n = 32) and either lead I (n = 15) or III (n = 17), choosing the one with greater preinjection T-wave amplitude, were continuously recorded for 4 min after the saline and the test dose injections. An IV test dose produced significant increases in heart rate, systolic blood pressure, and T-wave amplitude of all EKG leads studied in all subjects, whereas IV saline elicited no changes in these variables. Maximal increases in T-wave amplitude of leads II, I, III, and V5 were 158% ± 69%, 175% ± 78%, 147% ± 89%, and 170% ± 72%, respectively (mean ± SD, P > 0.05). There was no significant difference in temporal changes in T-wave amplitude among the 4 leads, and sensitivity and specificity were 100% on the basis of the T-wave criterion irrespective of the lead examined. Our results indicate that leads II, I, III, and V5 of EKG are equally effective for detecting intravascular injection of the epinephrine-containing test dose in sevoflurane-anesthetized children.

 

?丹司酮和多拉司酮在儿科非住院病人?后?防?吐使用中的??与效果的比?

A Comparison of the Costs and Efficacy of Ondansetron and Dolasetron in the Prophylaxis of Postoperative Vomiting in Pediatric Patients Undergoing Ambulatory Surgery

Olutoyin Olutoye, MD, Ellen C. Jantzen, MD, Rhonda Alexis, MD, Donna Rajchert, MD, Mark S. Schreiner, MD, and Mehernoor F. Watcha, MD

Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Anesth Analg 2003;97:390-396


?后?吐仍是一?未解?的??。我???了??研究,在?后?防?吐的治?中使用多少?量的多拉司酮其效果与?注
100μg/Kg?丹司酮相同。在???盲的??中,我???了204ASA分??Ⅰ-Ⅱ的健康儿童,年??2-12?,接受 手?。?他??行?机分?,一??注100μg/Kg?丹司酮,另一?在??期分??注45175350700μg/Kg多拉司酮。?极目?是POV的消失。?算出各?的住院?用及明??目。在使用45μg/Kg多拉司酮的患儿中其早期(0-6h)和24h的?吐?生率?350μg/Kg多拉司酮?,700μg/Kg多拉司酮?和?丹司酮?高。?多拉司酮的使用?量〈350μg/Kg?POV多次?生几率升高。??表明175350700μg/Kg多拉司酮?和100μg/Kg?丹司酮?的?吐?生率?有明???。??表明与100μg/Kg?丹司酮效果相同的多拉司酮最小?量是350μg/Kg。???表明使用350μg/Kg多拉司酮?的花?小于?丹司酮?。

(?羽霄 ? 王祥瑞 )

Postoperative vomiting (POV) after ambulatory surgery remains a major problem. We designed this study to determine the smallest dose of dolasetron equivalent to the Food and Drug Administration approved dose of ondansetron 100 μg/kg IV, for the prophylaxis of POV in children undergoing surgery. In this double-blinded controlled study, 204 healthy ASA I–II children aged 2–12 yr, undergoing superficial ambulatory (day-case) surgery, were randomized to receive either ondansetron 100 μg/kg IV, or dolasetron 45, 175, 350, or 700 μg/kg IV during a standardized perioperative regimen. The primary end-point was the incidence of complete response, defined as the absence of POV symptoms. Costs were calculated from the perspective of the hospital using a previously described model. The incidence of early (0–6 h) and 24-h emesis was more frequent in the dolasetron 45 μg/kg group compared with the dolasetron 350 and 700 μg/kg groups and with the ondansetron group. Repeated POV occurred more often when dolasetron was used in a dose <350 μg/kg. There were no significant differences in emesis rates between the dolasetron 175, 350, and 700 μg/kg groups or between these groups and the ondansetron 100 μg/kg group. The smallest dose of dolasetron with acceptable equivalent efficacy and patient satisfaction scores to ondansetron 100 μg/kg was 350 μg/kg. Institutional costs for managing POV were less with dolasetron 350 μg/kg than with ondansetron.

健康志愿者使用左旋布比卡因和??卡因的中?神?系?和心血管系?反?

The Central Nervous System and Cardiovascular Effects of Levobupivacaine and Ropivacaine in Healthy Volunteers

Jonathan Stewart, MBChB*, Norma Kellett, MBChB*, and Dan Castro, MD

*Inveresk Research, Edinburgh, Scotland, United Kingdom; and Abbott Laboratories, Abbott Park, Illinois

Anesth Analg 2003;97:412-416


我???了一??盲?机?照??研究,??男性健康的志愿者(
n=14)?注左旋布比卡因和??卡因,比?他?的中?神?系?和心血管系?反?。??中我?先?予利多卡因使受?者出?中?神?系?早期反?(如耳?,末梢感?异常,感??退),然后?予0.5%的左旋布比卡因或??卡因。?隔一分?后出???中?神?系?反?,研究?物的?予与第一?中?神?系?反?的?系。因此??症???隔的一分?起到消失。血流?力?改?的??通??胸?阻抗??完成,同?使用12??的心???。研究表明在以下方面左旋布比卡因和??卡因?有明???:第一?中?神?系?反?出?的平均??(p=0.870),第一?中?神?系?反?出??使用?物的平均容量(p=0.595),中?指?(p=0.678),心?指?(p=0.488),加速指?(p=0.697),PR?期(p=0.213),QRS?度(p=0.637),QT?期(p=0.724),QTc?期(p=0.737)和心率(p=0.267)。?之,研究表明左旋布比卡因要比??卡因出?更少的中?神?系?反?(218Vs277)。??研究???????予相同?度,?量和?注速度的左旋布比卡因和??卡因出?的中?神?系?和心血管系?反?基本相同。

(?羽霄 ? 王祥瑞 )

We compared the central nervous system (CNS) and cardiovascular effects of levobupivacaine and ropivacaine when given IV to healthy male volunteers (n = 14) in a double-blinded, randomized, crossover trial. Subjects received levobupivacaine 0.5% or ropivacaine 0.5% after a test infusion with lidocaine to become familiar with the early signs of CNS effects (e.g., tinnitus, circumoral paresthesia, hypesthesia). The development of CNS symptoms was assessed at 1-min intervals and study drug administration was terminated when the first CNS symptoms were recognized. Thereafter, symptoms were recorded at 1-min intervals until symptom resolution. Hemodynamic variables were assessed by transthoracic electrical bioimpedance. Continuous 12-lead electrocardiogram monitoring was also performed. There was no significant difference between levobupivacaine and ropivacaine for: the mean time to the first onset of CNS symptoms (P = 0.870), mean total volume of study drug administered at the onset of the first CNS symptom (P = 0.595), stroke index (P = 0.678), cardiac index (P = 0.488), acceleration index (P = 0.697), PR interval (P = 0.213), QRS duration (P = 0.637), QT interval (P = 0.724), QTc interval (P = 0.737), and heart rate (P = 0.267). Overall, fewer CNS symptoms were reported for levobupivacaine than ropivacaine (218 versus 277). This study found that levobupivacaine and ropivacaine produce similar CNS and cardiovascular effects when infused IV at equal concentrations, milligram doses, and infusion rates.

吸入麻醉?物异氟醚抑制初?人?皮?胞?胺介?的?离子?流

The Volatile Anesthetic Isoflurane Inhibits the Histamine-Induced Ca2+ Influx in Primary Human Endothelial Cells

Piet W. L. Tas, PhD, Christiane Stosel, MD, and Norbert Roewer, MD

Department of Anesthesiology, University of Würzburg, Wurzburg, Germany

Anesth Analg 2003;97:430-435


?所周知异氟醚是?血管?物,但异氟醚引起血管??的机制?不明确。其中比?重要的机制之一是
NO介?的血管??。??系?的激活主要是依靠收???机制引?的?离子?流而不是?存的?离子?放。?多研究?告表明吸入麻醉?物影?哺乳?物?皮?胞?胞?的?离子?度。但相同研究使用人?皮?胞的?少?。因此,我?研究吸入麻醉?物异氟醚是否能抑制初?人?皮?胞?胺介?的?离子?流。使用共焦的激光?微?和FLUO-3??Ca++的?胞,我?研究异氟醚??胺介?的?离子?流平台期的影?。另外我?使用FURA-2?光素??的Mn++?量Ca++通道?的离子流速。??种方法均表明异氟醚能域值依靠的抑制?离子?流。?抑制不能???源性NO合成?少?我?很明??察到异氟醚能抑制NO介?的血管舒?。

(?羽霄 ? 王祥瑞 )

Although isoflurane is a known vasodilator, the mechanism of isoflurane-induced vasodilation is not clear. One of the most important systems in this context is the nitric oxide (NO)-mediated vasodilation. The activity of this system is regulated by the agonist-induced Ca2+ influx rather than Ca2+ release from internal stores. A number of reports have studied the effect of volatile anesthetics on the cytoplasmic calcium concentration signaling in mammalian endothelial cells. However, similar studies using human endothelial cells are lacking. In this study, therefore, we investigated whether isoflurane affects the histamine-induced Ca2+ influx in primary cultures of human endothelial cells. Using confocal laser scanning microscopy and cells loaded with the Ca2+ indicator Fluo-3, we studied the effect of isoflurane on the plateau phase of the histamine-induced Ca2+ influx, which is considered to be due to capacitative Ca2+ entry. In addition, we measured the ion flux through capacitative Ca2+ channels directly by using Mn2+ ions, which, on entering the cell, quench the Fura-2 fluorescence. The results of these two methods were in close agreement and showed a dose-dependent inhibition of the capacitative Ca2+ entry by isoflurane. Isoflurane apparently depresses NO-mediated vasodilation when the observed inhibition is not compensated for downstream of the endothelial NO synthase activation.

阿法沙?(Alphaxalone)?蟾蜍卵母?胞上M1M3毒蕈??受体的抑制作用

The Inhibitory Effects of Alphaxalone on M1 and M3 Muscarinic Receptors Expressed in Xenopus Oocytes

Munehiro Shiraishi, MD*, Kouichiro Minami, MD PhD*, Izumi Shibuya, PhD, Yasuhito Uezono, MD PhD, Junichi Ogata, MD*, Takashi Okamoto, MD*, Osamu Murasaki, MD PhD, Muneshige Kaibara, MD PhD, Yoichi Ueta, MD PhD, and Akio Shigematsu, MD PhD*

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

Anesth Analg 2003;97:449-455


阿法沙?是一种神??固醇?麻醉?,其作用机理并不完全明确。毒蕈??受体涉及大?和??神?系?的各种神?功能,并作?麻醉?作用的靶受体而倍受?注。本研究主要研究阿法沙??卵母?胞上
M1M3毒蕈??受体的作用。在相??床?度?,阿法沙??卵母?胞表面M1受体的乙???受体通道?生抑制,同?也?M3受体的乙???受体通道?生抑制。M1M3受体通道的半?最大抑制?度分??1.8+/-0.6uM5.3+/-1.0μmGF109203CX是一种??性蛋白激?抑制?,?阿法沙?作用后卵母?胞上受体的乙???通道的抑制作用?影?。阿法沙?抑制了卵母?胞上M1M 3受体与[3H]quinuclidinyl benzilate的特意性?合。?些??提示:?床相??度的阿法沙?通?干扰受体[3H]quinuclidinyl benzilate?合位?,而非蛋白激?依?机制抑制M1M3受体的功能。

(忻?? ? 王祥瑞 )

Alphaxalone is a neurosteroid anesthetic, but its mechanisms of action are not completely understood. Muscarinic receptors are involved in a variety of neuronal functions in the brain and autonomic nervous system, and much attention has been paid to them as targets of anesthetics. In this study, we investigated the effects of alphaxalone on M1 and M3 muscarinic receptors using the Xenopus oocyte expression system. Alphaxalone inhibited acetylcholine-induced currents in oocytes expressing M1 receptors at clinically relevant concentrations. Alphaxalone also suppressed acetylcholine-induced currents in oocytes expressing M3 receptors. The half-maximal inhibitory concentration values for the inhibition of M1- and M3-mediated currents were 1.8 ± 0.6 μM and 5.3 ± 1.0 μM, respectively. GF109203X, a selective protein kinase C inhibitor, had little effect on the inhibition of acetylcholine-induced currents by alphaxalone in oocytes expressing these receptors. Alphaxalone inhibited the specific binding of [3H]quinuclidinyl benzilate to oocytes expressing M1 or M3 receptors. These findings suggest that alphaxalone at clinically relevant concentrations inhibits the function of M1 and M3 receptors through a protein kinase C-independent mechanism by interfering with the [3H]quinuclidinyl benzilate binding sites on the receptors.

Abstract 8 of 13

利多卡因?弱了?胞因子介?的?皮?胞和血管平滑肌?胞的??

Lidocaine Attenuates Cytokine-Induced Cell Injury in Endothelial and Vascular Smooth Muscle Cells

Manuela J. M. de Klaver, MD*, Mary-Gordon Buckingham*, and George F. Rich, MD PhD*,

Departments of *Anesthesiology and Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia

Anesth Analg 2003;97:465-70


已有?道局麻?可以??炎症反?和缺血
/再灌注??。所以我?假?以局麻??注可以保??皮?胞和血管平滑肌(VSM)?胞避免?胞因子介?的??。?人?微血管?皮?胞和小鼠VSM?胞在利多卡因或丁卡因(5-100μM)?注30分?后,暴露于α-?瘤坏死因子,γ-干扰素和白介素-1β中72小?。以?虫?排除和乳酸???的?放??价?胞存活和完整性。三磷酸腺??通道(KATP),蛋白激?C的作用,或者??者?局麻?介?的保?作用的??由?粒体KATP拮抗?5-hydroxydecanoate, ?胞表面KATP拮抗?HMR-1098和蛋白激?C抑制?星孢素(staurosporine)??估。利多卡因??胞因子介?的?胞??的保?作用呈?量依?性。5μM利多卡因可使?胞存活增加10%,而100μM利多卡因可使存活增加60%,并使?皮?胞和VSM?胞的乳酸????放?少3倍。相反,丁卡因不能???胞因子??胞的??。5-hydroxydecanoate可消除利多卡因的保?作用,而HMR-1098和星孢素?利多卡因的保?作用?影?。?研究指出利多卡因可???皮?胞和VSM?胞中?胞因子介?的?胞??而丁卡因不能。利多卡因可能的保?作用可能与??粒体KATP通道的??作用有?。

(忻?? ? 王祥瑞 )

Local anesthetics have been reported to attenuate the inflammatory response and ischemia/reperfusion injury. Therefore, we hypothesized that pretreatment with local anesthetics may protect endothelial and vascular smooth muscle (VSM) cells from cytokine-induced injury. Human microvascular endothelial cells and rat VSM cells were pretreated with lidocaine or tetracaine (5–100 μM for 30 min) and then exposed to the cytokines tumor necrosis factor-, interferon-, and interleukin-1s for 72 h. Cell survival and integrity were evaluated by trypan blue exclusion and lactate dehydrogenase release. The role of adenosine triphosphate-sensitive potassium (KATP) channels, protein kinase C, or both in modulating local anesthetic-induced protection was evaluated with the mitochondrial KATP antagonist 5-hydroxydecanoate, the cell-surfaceKATPantagonist1-[5-[2-(5-chloro-o-anisamido)ethyl]-2-methoxyphenyl]sulfonyl-3-methylthiourea (HMR-1098), and the protein kinase C inhibitor staurosporine. Lidocaine attenuated cytokine-induced cell injury in a dose-dependent manner. Lidocaine (5 μM) increased cell survival by approximately 10%, whereas lidocaine (100 μM) increased cell survival by approximately 60% and induced a threefold decrease in lactate dehydrogenase release in both cell types. In contrast, tetracaine did not attenuate cytokine-induced cell injury. 5-hydroxydecanoate abolished the protective effects of lidocaine, but staurosporine and HMR-1098 had no effect on the lidocaine-induced protection. This study showed that lidocaine, but not tetracaine, attenuates cytokine-induced injury in endothelial and VSM cells. Lidocaine-induced protection appears to be modulated by mitochondrial KATP channels.

 

麻?素不能促???溴胺神?肌肉阻?起效的??

Ephedrine Fails to Accelerate the Onset of Neuromuscular Block by Vecuronium

Ryu Komatsu, MD*, Osamu Nagata, MD*, Makoto Ozaki, MD*, and Daniel I. Sessler, MD

*Department of Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan; and Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology & Toxicology, University of Louisville, Louisville, Kentucky

Anesth Analg 2003;97:480-483


神?肌肉阻??物的起效??部分地受到循?因素的影?,包括肌肉血流和心?出量。因此可得出麻?素可以通?增加心?出量?促???溴胺神?肌肉阻?起效??的假?,本研究目的是????假?。?机??
53名?期手?的病人?行前瞻性研究。在麻醉??后,每10秒最大程度的刺激尺神?,并用加速度???拇?收肌的收?情?。病人在接受持?丙泊酚麻醉10分?后,?机?予麻?素210μg/Kg(n=27)或等量的生理?水(n=26)。然后?予??溴胺0.1mg/Kg。在本研究中?用阻抗心?描????心?出量。在研究中麻?素使病人的心指?增加(17%P0.003),而生理?水?有。但麻?素?病人(183±41S)和生理?水?病人(181±41S90%神?肌肉阻?起效????是相同的。因此心指?与神?肌肉阻?起效???相?性。我???????溴胺??的神?肌肉阻?主要与除心?出量以外的因素有?。复合?用麻?素和??溴胺并不能替代起效快的非去极化肌松?。

(?波 ? 王祥瑞 )

The onset time of neuromuscular blocking drugs is partially determined by circulatory factors, including muscle blood flow and cardiac output. We thus tested the hypothesis that a bolus of ephedrine accelerates the onset of vecuronium neuromuscular block by increasing cardiac output. A prospective, randomized study was conducted in 53 patients scheduled for elective surgery. After the induction of anesthesia, the ulnar nerve was stimulated supramaximally every 10 s, and the evoked twitch response of the adductor pollicis was recorded with accelerometry. Patients were maintained under anesthesia with continuous infusion of propofol for 10 min and then randomly assigned to ephedrine 210 μg/kg (n = 27) or an equivalent volume of saline (n = 26). The test solution was given 1 min before the administration of 0.1 mg/kg of vecuronium. Cardiac output was monitored with impedance cardiography. Ephedrine, but not saline, increased cardiac index (17%; P = 0.003). Nonetheless, the onset of 90% neuromuscular block was virtually identical in the patients given ephedrine (183 ± 41 s) and saline (181 ± 47 s). There was no correlation between cardiac index and onset of the blockade. We conclude that the onset of the vecuronium-induced neuromuscular block is primarily determined by factors other than cardiac output. The combination of ephedrine and vecuronium thus cannot be substituted for rapid-acting nondepolarizing muscle relaxants.

 

兔子鞘?注射地卡因、利多卡因、布比卡因和??卡因?脊髓神?毒性作用的比?

A Comparison of the Neurotoxic Effects on the Spinal Cord of Tetracaine, Lidocaine, Bupivacaine, and Ropivacaine Administered Intrathecally in Rabbits

Atsuo Yamashita, MD, Mishiya Matsumoto, MD, Satoshi Matsumoto, MD, Makoto Itoh, MD, Koji Kawai, MD, and Takefumi Sakabe, MD

Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Yamaguchi, Japan

Anesth Analg 2003;97:512-519


我?已??道了?脊液(
CSF)微透析液?谷氨酸??度的增加可以用?解?鞘?注射地卡因的神?毒性作用机理。然而,?种理?是否同?适用于其它局麻?尚?人知道。本研究主要比?不同局麻??CSF微透析液?谷氨酸??度的影?,以及?脊髓神?病?和??病理?的改?。?兔子分?5?,每?6只;?照?鞘?注射0.3mlNaCl溶液,其余各?分??予2%地卡因、10%利多卡因、2%布比卡因和2%??卡因。一周后?行神?病?和??病理?的?查。四种局麻?均?著增加了CSF微透析液?谷氨酸??度,但????著差异。利多卡因?兔子的感?和??功能明??其余各?差。特征性的??病理?改?是脊髓后索空泡形成和??神?染色?改?。脊髓后索空泡形成?重程度的?序?利多卡因=地卡因>布比卡因>??卡因。?然各局麻??之?研究?果的差异不能通?谷氨酸??度的改??解?,但?果表明利多卡因的安全范?是最小的。

(?波 ? 王祥瑞 )

We have reported that increased glutamate concentrations in microdialysate of the cerebrospinal fluid (CSF) may be clue phenomena to elucidate mechanisms of neurotoxicity of intrathecal tetracaine. However, little is known about whether this is true for other local anesthetics. In this study, we compared the effects of local anesthetics on glutamate concentrations in CSF microdialysate and neurologic and histopathologic outcome. Rabbits were assigned into 5 groups (n = 6 in each) and intrathecally received 0.3 mL of NaCl solution (control), 2% tetracaine, 10% lidocaine, 2% bupivacaine, or 2% ropivacaine. Neurologic and histopathologic assessments were performed 1 wk after the administration. Intrathecal local anesthetics significantly increased glutamate concentrations with no significant differences among the four local anesthetics. The sensory and motor functions in the lidocaine group were significantly worse than in the other groups. Characteristic histopathologic changes were vacuolation in the dorsal funiculus and chromatolytic damage of motor neurons. The extent of vacuolation of the dorsal funiculus was in the order of lidocaine = tetracaine > bupivacaine > ropivacaine. Although the differences among the local anesthetics cannot be explained by glutamate concentrations, the results suggest that the margin of safety may be smallest with lidocaine.

 

 

全?性?卷?查?示患者?后疼痛持?得不到充分?解

Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged

Jeffrey L. Apfelbaum, MD*, Connie Chen, PharmD, Shilpa S. Mehta, PharmD, and Tong J. Gan, MD

*Department of Anesthesia and Critical Care, The University Chicago Hospitals, Chicago, Illinois; Pharmacia Corp., Skokie, Illinois; and Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2003;97:534-540

?后疼痛能?重影?患者的恢复。理解患者的?度和?心?后的疼痛?健康?理者??相?重要的,且能?促??后的?理。??估患者?后疼痛的感受和急性疼痛的?理情?,我?通????卷?行了一?全?性?查。我?在美????机抽取了250名最近接受手?的患者?行?查。病人?被要求回答?后疼痛的程度,治?,?疼痛?物治?的?意度,病人的受教育程度,以及??后疼痛和?物治?的理解。大?80%的患者在手?后遭受了急性疼痛,其中86%的患者感到中度,?重或极度的疼痛。59%的病人???后疼痛是最普遍的事。接受疼痛治?的患者中?25%的患者?生?物副反?;但其中90%?疼痛治??意。?三分之二的病人述?他?曾与健康?理人????他?的疼痛??。?管增加了?疼痛治??划的?注并不?有新的疼痛治?方法的?世,?有?多患者在?后遭受持?的?重的疼痛。我??需要付出更多的努力以改善患者?后的疼痛。

(朱? ? 王祥瑞 )

Postoperative pain can have a significant effect on patient recovery. An understanding of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care. To assess patients’ postoperative pain experience and the status of acute pain management, we conducted a national study by using telephone questionnaires. A random sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion. Patients were asked about the severity of postsurgical pain, treatment, satisfaction with pain medication, patient education, and perceptions about postoperative pain and pain medications. Approximately 80% of patients experienced acute pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain, with more patients experiencing pain after discharge than before discharge. Experiencing postoperative pain was the most common concern (59%) of patients. Almost 25% of patients who received pain medications experienced adverse effects; however, almost 90% of them were satisfied with their pain medications. Approximately two thirds of patients reported that a health care professional talked with them about their pain. Despite an increased focus on pain management programs and the development of new standards for pain management, many patients continue to experience intense pain after surgery. Additional efforts are required to improve patients’ postoperative pain experience.

 

?毒素休克??中????血流的不均?性和代??化

Apparent Heterogeneity of Regional Blood Flow and Metabolic Changes Within Splanchnic Tissues During Experimental Endotoxin Shock

Jyrki J. Tenhunen, MD PhD*, Ari Uusaro, MD PhD, MHSc (Epid)*, Vesa Karja, MD PhD, Niku Oksala, MD, Stephan M. Jakob, MD PhD*, and Esko Ruokonen, MD PhD*

Departments of *Anesthesiology and Intensive Care, Clinical Pathology, and Surgery, Kuopio University Hospital, Kuopio, Finland

Anesth Analg 2003;97:555-563

在?毒素使?????于休克?机?照??,其研究目的?1)同??定不同部位?器的灌注以研究?器?血流?在的不均?性;2)研究?器?血流的?系,氧供,及不同的代?分?;3)分析灌注代???和?器?????的?系。??毒素最初的反?是在全身高?力?循?后的外周和??血流的下降。??循?的?化是血液再分布:即?系膜上??的血流得以?持,而腹腔干血流受影?。粘膜PCO2?力差?然不能反映?的??灌注?化,但它在休克低?力??段能反映局部血流情?。在高?力?循??期,胃?道?PCO2?力差升高不均一,而乳酸升高只在???。???分析揭示粘膜上皮??只?生在???。我?得出??,灌注和代?超?某一???域不能反映其他的??血管?域的灌注和代?。在?毒素性休克的12小????粘膜上皮?生??而空???有。高?力?性和低血?性休克可引起???乳酸?放但空???此种情?。粘膜上皮??和乳酸?放之?的?系或因果?系仍需?一步?明。

(朱? ? 王祥瑞 )

We conducted a randomized, controlled experiment of prolonged lethal endotoxin shock in pigs aiming at 1) simultaneously measuring perfusion at different parts of the gut to study the potential heterogeneity of blood flow within the splanchnic region; 2) studying the association among regional blood flows, oxygen supply, and different metabolic markers of perfusion; and 3) analyzing the association between histological gut injury and markers of perfusion and metabolism. The primary response to endotoxin was a decrease in systemic and splanchnic blood flow followed by hyperdynamic systemic circulation. Redistribution of blood flows occurred within the splanchnic circulation: superior mesenteric artery blood flow was maintained, whereas celiac trunk blood flow was compromised. Mucosal to arterial PCO2 gradients did not reflect changes in total splanchnic perfusion, but they were associated with regional blood flows during the hypodynamic phase of shock. During hyperdynamic systemic circulation, PCO2 gradients increased heterogeneously in the gastrointestinal tract, whereas luminal lactate increased only in the colon. Histological analysis revealed mucosal epithelial injury only in the colon. We conclude that markers of perfusion and metabolism over one visceral region do not reflect perfusion and metabolism in other splanchnic vascular areas. Intestinal mucosal epithelial injury occurs in the colon during 12 h of endotoxin shock while the epithelial injury is still absent in the jejunum. Hyperdynamic and hypotensive shock induces gut luminal lactate release in the colon but not in the jejunum. The association or causality between the mucosal epithelial injury and luminal lactate release remains to be elucidated.

 

 

?外?病人中使用大?量异丙酚??血管?力自???的影?

The Effects of Large-Dose Propofol on Cerebrovascular Pressure Autoregulation in Head-Injured Patients

Luzius A. Steiner, MD DEAA*,, Andrew J. Johnston, FRCA, Doris A. Chatfield, BA, Marek Czosnyka, PhD DSc*, Martin R. Coleman, PhD, Jonathan P. Coles, FRCA, Arun K. Gupta, FRCA, John D. Pickard, MChir FRCS, FMedSci*, and David K. Menon, MD PhD, FRCP, FRCA, FMedSci

*Academic Neurosurgery, University Department of Anaesthesia, and Wolfson Brain Imaging Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom

Anesth Analg 2003;97:572-576

?于健康人??,?血管?力自???受保?或在使用异丙酚?甚至加?。我??10名?外?的患者做??,?察增加血??异丙酚?度??血管?力自???的影?。我?通?靶控制异丙酚的滴注速率使血??异丙酚靶?度到?中?度(2.3±0.4μg/ml)和高?度(4.3±0.04μg/ml),?而?定自???的??速率。我?通??多普勒?量?中??血流,使用去甲?上腺素?控制?灌注?力,使每?异丙酚?度下的?灌注?都在7085mmHg之?。?果??使用高?度异丙酚的患者?中??血流速率明?低于使用中?度异丙酚的患者,且?伴?的????氧含量差的增加,即?有相?的血流代?的?化。?管如此,自???的??速率明??54%±36%降至28%±35%P=0.029)。我?的?据表明:?外?后的病人,异丙酚??血管的影?不同于那些健康人。我?建?,?外?的患者?慎重使用大?量异丙酚,因?它可能增加受????????害的敏感性。

(朱? ? 王祥瑞 )

In healthy individuals, cerebrovascular pressure autoregulation is preserved or even improved when propofol is infused. We examined the effect of an increase in propofol plasma concentration on pressure autoregulation in 10 head-injured patients. Using target-controlled infusions, the static rate of autoregulation was determined at a moderate (2.3 ± 0.4 μg/mL) and a large (4.3 ± 0.04 μg/mL) plasma target concentration of propofol. Using norepinephrine to control cerebral perfusion pressure, transcranial Doppler measurements from the middle cerebral artery were made at a cerebral perfusion pressure of 70 and 85 mm Hg at each propofol concentration. Middle cerebral artery flow velocities at the large propofol concentration were significantly lower than at the moderate concentration, without any concurrent increase in arterio-jugular difference in oxygen content, a finding compatible with maintained flow-metabolism coupling. Despite this, static rate of autoregulation decreased significantly from 54% ± 36% to 28% ± 35% (P = 0.029). Our data suggest that after head injury, the cerebrovascular effects of propofol are different from those observed in healthy individuals. We propose that large doses of propofol should be used cautiously in head-injured patients, because there is the potential to increase the injured brain’s vulnerability to secondary insults.