Anesthesia & Analgesia

August 2003

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

雙阿斯匹林關聯血紅蛋白在非心臟手術中可以減少輸血:多中心,隨機,對照,雙盲試驗

(殷文淵 譯 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.

鉀離子通道在缺氧引起的血管舒張中的作用和大鼠頸動脈給予利多卡因的調節效應

(費敏翻譯 薛張綱校)

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:

高鉀血症和幽門狹窄

(王士雷 莊心良 校)

Hyperkalemia and Pyloric Stenosis

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

Anesth Analg 2003 97: 355-357.

使用各種規格靜脈內導管時Level 1與快速輸液系統流速和升溫能力的比較

(殷文淵 譯 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.

小劑量芬太尼對七氟醚麻醉未行外科手術的小兒患者蘇醒質量的影響

(費敏翻譯 薛張綱校)

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.

三種濃度的左旋布比卡因用於小兒?管阻滯的比較

(王士雷 莊心良 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.

心電監護中各導聯對T波監測兒童麻醉時靜脈注射腎上腺素無影響

(鄧羽霄 譯 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.

小兒呼氣末七氟醚濃度和交感迷走張力間的關係

(費敏翻譯 薛張綱校)

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.

幼兒及兒童心肺轉流後魚精蛋白引起的副作用

(王立中 莊心良 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:

奧丹司酮和朵拉司酮在兒科非住院病人術後預防嘔吐使用中的經濟與效果的比較

(鄧羽霄 譯 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:

在齧齒類動物中右旋布洛芬(S(+)-異構布洛芬)減少胃損傷增加止痛和抗炎效果

(費敏翻譯 薛張綱校)

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%羅呱卡因和1 μg/mL蘇芬太尼體外抑制銅綠假單胞菌生長但並不促進金黃色葡萄菌的增殖

(王立中 莊心良 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.

健康志願者使用左旋布比卡因和羅呱卡因的中樞神經系統和心血管系統反應

(鄧羽霄 譯 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?堿敏感的氨基乙酸受體系統是氟烷抑制脊髓後角感覺神經元的唯一介質

(費敏翻譯 薛張綱校)

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和興奮性氨基酸受體介導丙泊酚誘導的鼠麻醉

(張軍 莊心良 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.

揮發性麻醉藥異氟醚抑制人初級內皮細胞中由組胺釋放的鈣離子內流

(梁雅芬翻譯 薛張綱校)

吸入麻醉藥物異氟醚抑制初級人內皮細胞組胺介導的鈣離子內流

(鄧羽霄 譯 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.

丙泊酚對大鼠肝臟切片缺氧/複氧損傷無保護作用

(黃施偉 譯,莊心良 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.

阿法沙龍(Alphaxalone)對蟾蜍卵母細胞上M1M3毒蕈堿樣受體的抑制作用

(忻紀華 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.

靜脈注射前列腺素E1類似物前列地爾預防硫戊巴比妥-芬太尼誘導的人支氣管收縮

(梁雅芬翻譯 薛張綱校)

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對丙泊酚麻醉誘導需要量的影響

(黃施偉 譯,莊心良 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.

利多卡因減弱了細胞因數介導的內皮細胞和血管平滑肌細胞的損傷

(忻紀華 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.

腹腔鏡手術不同麻醉方法(異丙酚全憑靜脈麻醉與異氟醚吸入麻醉)對眼內壓的變化

(梁雅芬翻譯 薛張綱校)

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.

阻滯5-HT2A受體可能介導吸入全麻藥的制動作用

(王士雷 莊心良 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.

麻黃素不能促進維庫溴胺神經肌肉阻滯起效的時間

(齊波 譯 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:

完全清醒的志願者神經肌肉阻滯可使BIS值下降

(梁雅芬翻譯 薛張綱校)

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?-嗎啡(M3G)的神經興奮作用通過間接興奮N-甲基-D-天門冬氨酸(NMDA)受體介導:在培養的胚胎海馬神經元細胞中關於其機制的研究

(梁雅芬翻譯 薛張綱校)

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.

神經營養因數可部分逆轉甲呱卡因和布比卡因引起的發育感覺神經元的形態學改變

(王士雷 莊心良 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.

兔子鞘內注射地卡因、利多卡因、布比卡因和羅呱卡因對脊髓神經毒性作用的比較

(齊波 譯 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.

大鼠坐骨神經的慢性壓縮性損傷減輕其對福馬林雙向反應性:一項行為與荷爾蒙的評價

(顧越超翻譯 薛張綱校)

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.

比較曲嗎多、 雙氯芬酸和二者複合對剖宮產術後感覺和疼痛的影響

(王士雷 莊心良 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.

全國性問卷調查顯示患者術後疼痛持續得不到充分緩解

(朱輝 譯 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.

?拉明與西咪替丁對大鼠mRNA C-fos表達和傷害性刺激防禦行為的影響

(顧越超翻譯 薛張綱校)

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:

內毒素休克試驗中內臟組織血流的不均勻性和代謝變化

(朱輝 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受體介導異氟醚在器官型海馬培養模型中的神經保護作用

(張軍 莊心良 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.

腦外傷病人中使用大劑量異丙酚對腦血管壓力自動調節的影響

(朱輝 譯 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:

外源性腎上腺素對在斜角肌間臂叢阻滯麻醉下坐位肩部手術時低血壓/心動過緩發生率的影響

(王士雷 莊心良 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於側臥位全髖關節成形術的比較

(王士雷 莊心良 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:

肥胖者比瘦者更多見困難氣管插管

(顧越超翻譯 薛張綱校)

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.

高鉀血症和幽門狹窄

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.

以往認為,幽門狹窄患兒一般發生低鉀或正常血鉀低氯代謝性堿中毒。我們對幽門狹窄嬰兒的血鉀水平進行了總結,發現36%的病人血鉀水平升高。我們的結論是,幽門狹窄患兒發生高血鉀的幾率比原來認為的要常見得多。

(王士雷 莊心良 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.

 

三種濃度的左旋布比卡因用於小兒?管阻滯的比較

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.

我們以前瞻、隨機、雙盲的方式比較了三種不同濃度的左旋布比卡因(0.125%, 0.20%, and 0.25%)用於小兒(1–7 yr)臍下手術的情況。術後鎮痛的時間通過術後第一次應用鎮痛藥的時間(小兒和嬰兒術後疼痛評分?4)進行估計,而術後即刻的阻滯程度應用3分法進行評價。結果,術後鎮痛時間的中位數(0.125%, 60 min; 0.20%, 118 min; 0.25%, 158 min)和術後早期出現運動阻滯的病人數與左旋布比卡因的用量之間呈劑量依賴性關係。0.125%左旋布比卡因術後早期出現運動阻滯的病人數較少,但是術後鎮痛的時間也較短(P < 0.05)。結論:0.20%左旋布比卡因可能是小兒?管阻滯最佳的臨床應用濃度。

(王士雷 莊心良 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.


幼兒及兒童心肺轉流後魚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.

本研究目的是確定幼兒及兒童心肺轉流後魚精蛋白引起的副作用(AES)的發生率和危險因素。通過回顧性檢查三年的麻醉記錄以確定魚精蛋白後AES。隨後根據嚴格的標準將AES分組。在1249個麻醉記錄中,沒有孤立或低血壓相關的右心功能不全或急性肺功能不全。魚精蛋白引起的低血壓發生率約1.76% (95%可信區間11%–2.65%) 88% (95%可信區間2.03%–3.97%)。為了確定危險因素,我們進行了嵌套-對照試驗,即對照隨機從同一組中按41的比例選擇。低血壓更可能發生在女性(OR 6.47; 95% 可信區間1.66-32.8)、大劑量(OR, 1.88; 95%可信區間1.03–3.63)或小劑量肝素(OR, 0.49; 95%可信區間 0.17–0.67)

(王立中 莊心良 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%羅呱卡因和1 μg/mL蘇芬太尼體外抑制銅綠假單胞菌生長但並不促進金黃色葡萄菌的增殖

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.

我們調查羅呱卡因和蘇芬太尼複合劑在室溫下對銅綠假單胞菌和金色葡萄菌的生長的影響,這種複合劑常在術後用於硬膜外鎮痛。銅綠假單胞菌和金色葡萄菌在生理鹽水懸浮液轉移到含有0.1%羅呱卡因和1 μg/mL蘇芬太尼(R+S)或生理鹽水(SA),後者作為對照組。在接觸上述液體0, 3, 6, 24h48h,取1ml溶液平輔於標準的血瓊脂上。在220C下孵育48小時,計算菌落形成單位(cfu)數量。細菌株生長率計為cfu 時間(tn)/cfu 基礎(t0)。初效率變數是根據生長率,曲線下面積(AUC) x時間。R+S組銅綠假單胞菌AUC明顯小於SA(P = 0.028)SA組觀察到在接觸後至少6小時銅綠假單胞菌的增殖(生長率>1)。接觸後324小時R+S組銅綠假單胞菌的生長低於SA組。兩組金色葡萄菌AUC並無明顯不同。R+SSA組均不能增加金色葡萄菌的生長。接觸後48小時,R+S組金色葡萄菌生長明顯低於SA組。結論:R+S組與SA組相比能抑制銅綠假單胞菌的生長但不能促進金色葡萄菌的生長。

(王立中 莊心良 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和興奮性氨基酸受體介導丙泊酚誘導的鼠麻醉

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.

為闡明GABAA受體和興奮性氨基酸(NMDA和非NMDA受體)在丙泊酚誘導的麻醉中的作用,作者研究了在丙泊酚麻醉中GABA能和谷氨酸能藥物對小鼠行為學的效應。所有藥物均經腹腔應用。全麻藥強度用翻正反射進行評價。GABAA受體激動劑蠅蕈醇增強丙泊酚(140 mg/kg; 50%翻正反射消失有效劑量)誘導的麻醉。相似地,苯二氮卓受體激動劑安定和NMDA受體拮抗劑MK-801增強丙泊酚麻醉,但非NMDA受體拮抗劑CNQX則沒有這種作用。相比而言,GABAA受體拮抗劑荷包牡丹堿拮抗丙泊酚(200 mg/kg; 95%翻正反射消失有效劑量)誘導的麻醉。然而,苯二氮卓受體拮抗劑氟馬澤尼, GABA合成抑制劑L-allylglycine NMDA受體激動劑NMDA均不能逆轉丙泊酚麻醉。相反,非NMDA受體激動劑使君子酸增強丙泊酚麻醉。這些結果提示丙泊酚誘導的麻醉至少部分是由GABAA和興奮性氨基酸受體介導的。

(張軍 莊心良 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.


丙泊酚對大鼠肝臟切片缺氧
/複氧損傷無保護作用

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.

採用雄性Wistar大鼠肝臟精密切片(20-25mg濕重),我們研究了臨床相關濃度的丙泊酚是否對缺氧/複氧中的肝臟具有保護作用或毒性作用。切片被置入裝有Waymouth’s培養基的密封可滾動的小瓶內預孵育2小時(37°C; 95% O2/5% CO2; 三片/瓶)。然後加入丙泊酚或脂肪乳劑並形成四組(對照,脂肪乳劑,低濃度丙泊酚[0.5–1.5 μg/mL]以及高濃度丙泊酚[2.0–6.0 μg/mL])。之後,每組孵育4h95% O2/5% CO2〔無缺氧〕或2h100%N22h95% O2/5% CO2(缺氧/複氧)。孵育開始後234h測定切片活性和缺氧/複氧損傷包括細胞內K+濃度,能量狀態(ATP濃度,總腺嘌呤核?酸含量以及能荷),肝?滲漏(天冬氨酸氨基轉移?,丙氨酸轉氨?和乳酸脫氫?)。和對照組相比,丙泊酚和脂肪乳劑均導致明顯的能荷恢復延遲。細胞內K+濃度和肝?滲漏在丙泊酚組和其他兩組間無顯著差別。丙泊酚對大鼠肝切片無缺氧狀態時無毒性作用,同樣對缺氧/複氧引起的損傷無保護作用。結論:丙泊酚對大鼠肝切片無缺氧狀態時無毒性作用,同樣對缺氧/複氧引起的損傷無保護作用。

(黃施偉 譯,莊心良 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對丙泊酚麻醉誘導需要量的影響

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單獨應用可減輕丙泊酚注射引起的疼痛。利多卡因可能導致丙泊酚乳劑的不穩定性,並降低其在大鼠和人的麻醉效價。我們在67例病人中進行了一項隨機雙盲試驗去評估丙泊酚混合利多卡因對丙泊酚麻醉誘導需要量的影響。S組病人(n = 32)靜注0.2 mg/kg利多卡因,然後予丙泊酚輸注;M組病人(n = 35)則靜注生理鹽水(安慰劑),然後予輸注新鮮配製的混合液:1%丙泊酚/1%利多卡因按10:1體積比。當病人喪失意識時(採用手持針筒落地的方法)停止輸注。兩組在病人喪失意識時所需丙泊酚的平均劑量(95%可信限)在統計學上無顯著差異:S2.0 (1.8–2.2) mg/kg versus M1.9 (1.7–2.0) mg/kg(P = 0.206)200mg丙泊酚內加入20mg利多卡因似乎對丙泊酚麻醉誘導需要量無影響。結論:丙泊酚內加入利多卡因可使丙泊酚乳劑失穩定。一項隨機雙盲發現:無論是使用新鮮配製的混合液(1%丙泊酚/1%利多卡因按10:1體積比)或先單獨注射一定劑量的利多卡因時所需麻醉誘導劑量在統計學上無顯著差異。

(黃施偉 譯,莊心良 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.

阻滯5-HT2A受體可能介導吸入全麻藥的制動作用

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.

很多吸入全麻藥能阻斷興奮性神經遞質5-羥色胺對5-HT2A受體的作用,提示吸入全麻藥可能通過此受體產生制動作用。本研究發現,鞘內注射5-HT2A受體阻滯劑酮色林能夠降低異氟醚的MAC。此作用可能是通過阻斷5-羥色胺在脊髓中的資訊傳遞引起的,其最大作用可以達到20%–25%。靜脈注射酮色林使MAC進一步降低(60%),這可能是通過脊髓上的作用引起的。降低大鼠異氟醚MAC的靜脈用藥量接近100 μg · kg-1 · min-1,而人臨床應用的劑量一般為1.25 μg · kg-1 · min-1。這些結果說明,1.25 μg · kg-1 · min-1 5-HT2A受體處在影響異氟醚MAC的神經環路內。但是,由於決定異氟醚MAC部位主要在脊髓,因此, 5HT2A受體在介導異氟醚的制動方面可能僅占很小的比例。

(王士雷 莊心良 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.

神經營養因數可部分逆轉甲呱卡因和布比卡因引起的發育感覺神經元的形態學改變

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.

布比卡因和甲呱卡因均引起發育神經元的形態學改變。我們對某些神經營養因數在這些藥物引起的發育神經元損害中的作用進行了探討。游離雞胚的背根神經節置於含布比卡因或甲呱卡因的培養基,60min後更換為含有腦源性神經營養因數、膠質細胞神經營養因數或神經營養因數-3而不含局麻藥的新鮮培養基。48h後洗脫並檢查生長椎的萎陷情況。結果,當培養液中不含神經營養因數時,洗脫甲呱卡因20h以及洗脫甲呱卡因或布比卡因48h後生長椎萎縮程度較對照組顯著增大,而在應用神經生長因數的情況下,生長椎萎縮體積顯著減小,與對照組之間無顯著差異。結論:神經生長因數促進暴露在局麻藥中的神經元恢復,而且,其對甲呱卡因所致生長椎萎縮的作用強於布比卡因。

(王士雷 莊心良 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.

比較曲嗎多、 雙氯芬酸和二者複合對剖宮產術後感覺和疼痛的影響

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.

不同作用機制的鎮痛藥複合應用可以控制術後疼痛。我們以120例剖宮產手術病人為物件,以雙盲、隨機和安慰劑對照的方式對單胺能和μ-阿片類藥物激動劑曲嗎多100 mg、雙氯芬酸75 mg以及二者複合應用的術後鎮痛效果進行了評價,指標包括術後出現疼痛的時間、 追加鎮痛藥的時間 、曲嗎多的藥動學以及遠離切口部位的電感覺閾。首次給予鎮痛藥的時間分別為:曲嗎多複合雙氯芬酸組197 min (70–1000 min)、曲嗎多複合安慰劑48 min (25–90 min)、雙氯芬酸複合安慰劑113 min (35–270 min) 、安慰劑複合安慰劑55 min (30–100 min)。所有病人均隨著時間的延遲出現疼痛減輕,而且時間和藥物作用之間顯著相關。所有各組均未發生顯著的副作用。在切口周圍以及遠離切口部位的痛閾增高僅在曲嗎多複合雙氯芬酸組發生。曲嗎多和去甲曲嗎多的藥代動力學不受雙氯芬酸的影響。曲嗎多複合雙氯芬酸的鎮痛效果優於單獨用藥。只有複合用藥才會預防原發性和繼發性痛覺過敏。術前的感覺閾值可以預測術後疼痛的敏感程度。

(王士雷 莊心良 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受體介導異氟醚在器官型海馬培養模型中的神經保護作用

-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.

 

麻醉藥如異氟醚等減少齧齒類腦缺血模型中細胞死亡的機制仍不完全清楚。降低谷氨酸興奮毒性只能部分而非全部解釋異氟醚的神經保護作用。因為異氟醚增強GABA受體介導的離子流,並且GABAA受體激動劑具有神經保護效應,因此我們推測是GABAA受體導致了異氟醚的神經保護作用。作者使用大鼠海馬腦片作為大腦缺血和恢復的模型。在37°C下,氧糖缺失(OGD)一小時後觀察CA1CA3和齒狀回神經元的存活率。為了確定GABAA受體在介導神經保護中的作用,觀察了在OGD期間,存在GABAA受體拮抗劑荷包牡丹堿時,1%異氟醚對細胞存活的影響。細胞死亡用propidium iodide 螢光法測定。異氟醚和選擇性的GABAA受體激動劑蠅蕈醇(25 μM)減少OGD後的細胞死亡,與未暴露於OGD的腦片結果相似,但蠅蕈醇不能減少OGD兩天後CA3神經元的死亡。GABAA受體拮抗劑荷包牡丹堿減少異氟醚對OGD23天海馬神經元的保護作用。我們的結論是GABAA受體是異氟醚對OGD23天海馬腦片模型產生神經保護效應的原因。基於此以及其他研究,異氟醚產生的神經保護作用可能是多方面的,涉及GABAA和谷氨酸受體,可能還包括其他機制。

(張軍 莊心良 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.


外源性腎上腺素對在斜角肌間臂叢阻滯麻醉下坐位肩部手術時低血壓/心動過緩發生率的影響

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

據報導,在斜角肌間臂叢神經阻滯麻醉下坐位肩部手術時突發性低血壓/心動過緩(hypotensive and/or bradycardic events HBE)的發生率約為13%–28%。據認為,Bezold-Jarisch反射是引起HBE的主要機制。為此,我們設計了本前瞻、隨機研究來證實這個假說。病人隨機分為局麻藥含腎上腺素和不含腎上腺素組(n = 55),不再額外應用腎上腺素。必要時通過靜脈應用烏拉地爾控制血壓。含腎上腺素組和不含腎上腺素組HBE 的發生率分別為11%29%。腎上腺素組術中心率增快和血壓升高的發生率高。含腎上腺素和不含腎上腺素組應用烏拉地爾的幾率分別為31% 13%(P = 0.018) 。應用烏拉地後腎上腺素組和不含腎上腺素組病人HBE 的發生率分別為5%4%。結論:外源性腎上腺素顯著增加斜角肌臂叢麻醉下坐位肩部手術的HBE發生率。

(王士雷 莊心良 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於側臥位全髖關節成形術的比較

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.

全髖關節成形術(THA)常在等比重或低比重局麻藥腰麻下進行。然而,從未在相同的外科條件下對二者進行比較。為此,我們設計本實驗來比較THA時等比重和低比重布比卡因腰麻的麻醉效應和對血流動力學的影響。40ASA I–II的病人隨機分為等比重布比卡因和低比重布比卡因腰麻組,分別蛛網膜下腔注射3.5ml17.5mg)布比卡因-1.5ml生理鹽水和3.5ml17.5mg)布比卡因-1.5ml蒸餾水。記錄手術側和非手術側感覺平面至L2時的感覺和運動阻滯情況、蛛網膜下腔注射藥物後45min時的血流動力學指標以及第一次應用鎮痛藥的時間。結果,二組之間手術側和非手術側感覺的最高平面以及運動阻滯的最大程度相似。與等比重布比卡因組相比,低比重布比卡因組手術側感覺平面消退至L2水平以及首次應用鎮痛藥的時間均延長(287 ± 51 versus 242 ± 36 min, P < 0.004287 ± 51 versus 242 ± 36 min, P < 0.004)。在外科手術結束時二組之間運動阻滯的程度無差異。術中血流動力學的變化二組之間無顯著區別。結論:由於延長手術側的鎮痛時間以及延遲術後鎮痛藥的應用時間而不增加對血流動力學的干擾程度,側臥位THA時低比重布比卡因腰麻優於等比重布比卡因腰麻。

(王士雷 莊心良 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.

鉀離子通道在缺氧引起的血管舒張中的作用和大鼠頸動脈給予利多卡因的調節效應

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.

缺氧導致的血管舒張,部分是通過啟動鉀離子通道而產生的。利多卡因可削弱因鉀離子通道開啟而引起的血管舒張作用,提示這種抗心律失常藥有抑制缺氧導致的由鉀離子通道調控的血管舒張。我們設計了目前的研究來確定在頸動脈是否缺氧導致鉀離子通道調節血管舒張以及是否利多卡因能調節通過病理生理學和藥理學刺激鉀離子通道產生的血管舒張作用。大鼠普通頸動脈環無內皮細胞能緩衝等容負荷。在對苯腎上腺素、缺氧導致的血管舒張的收縮或對三磷酸腺?敏感的鉀離子通道開啟的濃度反應的過程能用以改變控制氣體到缺氧氣體以及各自levcromakalim的累積增加。缺氧導致的血管舒張能由優降糖(5μM)顯著下降,但不能由iberiotoxin0.1μM)、蜂毒明?(0.1μM)、BaCl2(10μM)4-氨基?啶(1mM)而降低。Levcromakalim導致的血管舒張能被優降糖完全消除。濃度依賴的利多卡因(10100μM)能抑制這種血管擴張,提示它不影響缺氧導致的血管舒張。這些結論提示三磷酸腺?敏感的鉀離子通道在大鼠頸動脈因缺氧導致血管舒張中起著重要作用,利多卡因區別地調節通過病理生理學和藥理學的刺激啟動這些通道的血管舒張。

(費敏翻譯 薛張綱校)

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.

小劑量芬太尼對七氟醚麻醉未行外科手術的小兒患者蘇醒質量的影響

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.

我們設計本試驗來測量小劑量靜脈注射芬太尼對七氟醚麻醉下未經外科手術干擾的小兒患者蘇醒質量的影響。32ASA評分I-II級接受七氟醚麻醉行MRI檢查的患兒根據隨機雙盲的方式登記、入組,在結束麻醉之前10分鐘接受安慰劑()1μg/kg靜脈注射芬太尼。主要結果測量患兒蘇醒質量的百分比數。我們也評估躁動的持續時間和達到醫院的時間標準。接受芬太尼的患兒較安慰劑組躁動的發生率降低(12%比56%)。到達醫院處理的時間標準無顯著差異。我們的結論是給予小劑量芬太尼能減少吸入麻醉藥七氟醚引起的獨立於疼痛控制效應的蘇醒躁動的發生。

(費敏翻譯 薛張綱校)

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.

小兒呼氣末七氟醚濃度和交感迷走張力間的關係

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.

在小兒,七氟醚在誘導期間降低副交感張力較氟烷明顯。七氟醚對副交感活性的影響能解釋在嬰兒和兒童間的心率不同改變。本試驗中,我們要研究在小兒呼氣末七氟醚的濃度和交感、副交感張力的相互關係通過光譜分析的RR間期。對33ASA評分I級的小兒需要接受外科手術進行研究。10名小兒(A組)在開始臨床蘇醒時逐漸降低吸入七氟醚的濃度從8%起。另外23名小兒(B組)蘇醒時在穩定的12的七氟醚最低肺泡麻醉濃度。插入的RR序列隨時間改變自動回歸的模式,光譜密度在低頻(LF:0.04-0.15Hz)和高頻(HF0.150.55Hz)的範圍。A組心率減慢和呼出七氟醚濃度的降低相平行。相反,呼出七氟醚的濃度降低導致收縮壓(SBP)、HFLFLF/HF升高。LF/HF的升高先于HF的升高。在B組,HF的基礎頻譜和正常值Hfnu(Hfnu=HF/LF+HF)在大於三歲的年長兒明顯升高。七氟醚引起的心率變化與HF基礎值和Hfnu呈副相關(R2=0.6;P<0.001)。結果示副交感張力降低是七氟醚導致心率變化的主要決定因素

(費敏翻譯 薛張綱校)

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

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在齧齒類動物中右旋布洛芬(S(+)-異構布洛芬)減少胃損傷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

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我們研究在齧齒類動物中活化S(+)-異構布洛芬(右旋布洛芬)的止痛和抗炎活性以及相關的急性胃粘膜損傷與標準的外消旋布洛芬比較。止痛效果在給小鼠IVPO給藥以及給大鼠PO給藥後用熱板燙和尾部拍打的方法評估。S(+)-布洛芬比外消旋型的布洛芬至少強二倍效能。化合物試驗抗炎效應用小鼠(IVPO)後腹部收縮試驗以及大鼠(IVPO)後後爪水腫試驗進行評估,發現在小鼠IV和大鼠PO給予布洛芬後產生更顯著的效能。而且,在相同劑量(大鼠50mg/kgPO)下化合物試驗較標準外消旋布洛芬能顯著減少胃粘膜損傷的發生。結論,S(+)-布洛芬異構體較外消旋者在止痛和抗炎試驗中有更多的效力而存在更少的胃毒性影響。基於本試驗的結果,我們提出化學結構形式如R(-)-布洛芬應避免使用如果對於預期的治療活性無必要者。

(費敏翻譯 薛張綱校)

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?堿敏感的氨基乙酸受體系統是氟烷抑制脊髓後角感覺神經元的唯一介質

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

吸入麻醉藥抑制脊髓後角低閾值(LT)神經元對外周接受場刺激的反應。部分這種抑制能受麻醉藥相互作用調節通過γ-氨基丁酸AGABAA)和番木?堿敏感的氨基乙酸抑制神經遞質系統。在此電生理試驗中,我們試圖通過給予荷包牡丹堿(GABAA競爭性拮抗劑)和/或番木?堿(氨基乙酸競爭性拮抗劑)系統地單獨或聯合來對抗氟烷對LT神經元的抑制,應用於去大腦、脊索橫斷的大鼠。我們發現無論荷包牡丹堿還是番木?堿,單獨或聯合應用不僅能部分逆轉氟烷對接受場刺激的LT神經元的抑制。荷包牡丹堿和番木?堿單獨或聯合不能完全逆轉氟烷的抑制提示雖然GABAA和氨基乙酸系統存在於氟烷的抑制中,但是其他作用機制在氟烷抑制LT脊髓感覺神經元中也是必需的。

(費敏翻譯 薛張綱校)

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.

腹腔鏡手術不同麻醉方法(異丙酚全憑靜脈麻醉與異氟醚吸入麻醉)對眼內壓的變化

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.

我們測量了硫噴妥鈉、異氟醚複合麻醉或異丙酚全憑靜脈麻醉下行婦科腹腔鏡手術患者眼內壓的變化。我們收錄了40例術前無眼科疾病的行婦科腹腔鏡手術成年女性患者。手術中預定的時間段測定心率、平均動脈壓、氣道峰壓、平臺壓、呼氣末二氧化碳值(ETCO2)及眼內壓(用Schioetz眼壓計測定)。兩組患者麻醉誘導後眼壓明顯下降,並且異丙酚組患者術中一直保持此水平,但異氟醚組當CO2氣腹並取頭低位時患者的眼內壓比誘導前水平顯著升高。眼內壓與血壓、氣道壓之間無相關性。如果考慮到控制煙壓這個因素,異丙酚全憑靜脈麻醉可能是腹腔鏡手術麻醉的更佳選擇。

(梁雅芬翻譯 薛張綱校)

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

完全清醒的志願者神經肌肉阻滯可使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(腦電雙頻指數)是用於監測麻醉深度的腦電圖參數,肌電活動可以影響表層腦電圖及BIS值的計算.在這個研究中我們將觀察自發性肌電活動對BIS的影響。我們用AspectA-100監測了三名自願者的BIS值,並同時記錄肌電活動。在其中一名自願者中重複了這一實驗,給予肌松藥阿曲庫胺和琥珀膽鹼,不使用其他任何藥物。BIS值對肌肉鬆弛的反應表現為與面肌自發性肌電活動下降平行的減低,最低值為33,其中一名自願者中重複實驗中當達到完全神經肌肉阻滯時BIS最低值為9。另外兩名自願者沒有達到完全神經肌肉阻滯時他們的BIS分別為6457。反之,BIS的恢復與自發性肌電活動相關。在整個實驗中自願者保持完全清醒,BIS值用Software3.31版本計算。結論:BIS值與面肌自發性肌電活動相關,BIS在完全神經肌肉阻滯物件中不能監測知曉。因此,在完全神經肌肉阻滯物件中BIS監測不能可靠地預測鎮靜深度的下降及對危急狀態的預知。

(梁雅芬翻譯 薛張綱校)

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?-嗎啡(M3G)的神經興奮作用通過間接興奮N-甲基-D-天門冬氨酸(NMDA)受體介導:在培養的胚胎海馬神經元細胞中關於其機制的研究

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

間接證據表明了3-葡萄糖醛酸?-嗎啡(M3G)可能導致了大劑量嗎啡全身給藥時的神經興奮副作用(肌陣攣和痛覺過敏)。為了進一步探討M3G興奮性作用機制,我們採用了氟-3-螢光數位圖像技術監測了M3G5-50μm)對培養的胚胎海馬神經元細胞質中Ca2+濃度([Ca2+]CYT)的急性期影響。急性暴露3分鐘誘發了兩種典型的[Ca2+]CYT電流,其一表現為[Ca2+]CYT持續增高,然後逐漸降至基礎水平;其二表現為[Ca2+]CYT振幅急劇增高並至少維持30秒的一過性振盪反應。納洛酮預處理僅減低10%-25%的神經元對M3G的反應,這提示M3G的神經興奮作用主要通過非阿片類受體介導。雖然這種由M3G誘導的對納洛酮不敏感的[Ca2+]CYT增高可以被NMDA拮抗劑和非NMDA拮抗劑6-cyano-7-nitroquinoxaline-2,3-dione(CNQX)(alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainite antagonist)完全阻滯,CNQX並沒有預期地阻滯NMDA誘導的[Ca2+]CYT增高,這證明M3G間接地興奮了NMDA受體。另外,tetrodotoxinNa+通道阻斷劑)、baclofen(GABA激動劑)MVIICP/QCa2+通道阻斷劑),硝苯地平(L-Ca2+通道阻斷劑)均阻滯了M3G誘導的[Ca2+]CYT增高,提示了M3G可能通過調節神經遞質釋放產生其神經興奮作用,然而,這一結論還有待於更多事實證明。

(梁雅芬翻譯 薛張綱校)

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.

靜脈注射前列腺素E1類似物前列地爾預防硫戊巴比妥-芬太尼誘導的人支氣管收縮

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)在動物實驗中可鬆弛氣道平滑肌,然而,臨床關於靜脈注射其類似物前列地爾對支氣管的鬆弛作用並無報導。我們曾報導描述人體實驗中硫戊巴比妥-芬太尼可誘發支氣管收縮。現在我們就前列地爾對硫戊巴比妥-芬太尼誘導的支氣管收縮的作用作一報導。32例患者,隨機分為對照組和前列地爾組,各16例。麻醉誘導:硫戊巴比妥25mg/kg,維庫溴胺0.3 mg/kg。麻醉維持:靜脈持續輸注硫戊巴比妥15mg/kg/h,機械通氣笑氣/氧氣各50%吸入。麻醉誘導20分鐘,對照組病人靜脈輸注前列地爾生理鹽水20ml/h,前列地爾組病人靜脈持續靜注前列地爾0.2 mg/kg/min20ml/h),均維持60分鐘,然後靜脈給予芬太尼15μg/kg。麻醉前基礎值時、芬太尼注射前(T30)、芬太尼注射後每隔6分鐘共三次(T36T42T48)及注射後30分鐘(T60)監測病人收縮壓、舒張壓、心率、平均氣道阻力(Rawm)、呼氣氣道阻力(Rawe)和動態肺順應性(Cdyn)。兩組患者的RawmRaweCdyn基礎值有可比性,對照組T36-60RawmRaweCdyn基礎值有可比性,對照組T36-60RawmRaweCdyn與基礎值比顯著升高。T36-60Cdyn顯著降低,而前列地爾組T36-60RawmRaweCdyn無變化。結論:靜脈注射地爾對人可能有支氣管擴張作用。

(梁雅芬翻譯 薛張綱校)

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.

 

揮發性麻醉藥異氟醚抑制人初級內皮細胞中由組胺釋放的鈣離子內流

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.

雖然異氟醚是已知的血管擴張劑,但它的作用機制尚不清楚。在這一過程中最重要的系統之一是由NO介導的血管擴張。這一系統的作用並非通過內源性鈣離子釋放調節,而是通過啟動劑誘導的鈣離子內流調節。曾有報導揮發性麻醉藥對猩猩內皮細胞質鈣離子濃度信號傳遞的作用作了研究,但在人體內皮細胞的類似研究尚缺乏。在本研究中我們研究了異氟醚是否影響初級培養的內皮細胞由組胺釋放的鈣離子內流。採用同焦點鐳射掃描顯微鏡和經鈣離子指士劑-Fluo-3標記的細胞。我們研究了異氟醚對組胺誘導的鈣離子內向性電流平臺期的影響,這一電流平臺期被認為是由鈣離子獲能的內流引起,另外,由於Mn2+在進入細胞時可焠滅-Fura-2-螢光,我們直接用Mn2+測量了能通過獲鈣離子通道的離子流。結果表明兩種方法的結果吻合度很好,異氟醚對獲能的鈣離子內流的抑制作用呈劑量依賴性。當觀察到的抑制作用沒有被下源的內皮細胞NO活?啟動代償時,異氟醚明顯抑制了NO介導的血管擴張。

(梁雅芬翻譯 薛張綱校)

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.

?拉明與西咪替丁對大鼠mRNA C-fos表達和傷害性刺激防禦行為的影響

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的表達,常作為神經感受傷害性刺激的標記,可被許多藥物改變。組胺受體拮抗劑對c-fos信使(m)RNA表達的影響尚未明瞭。檢驗局部和全身應用?拉明(H(1)受體拮抗劑)與西咪替丁(H(2)受體拮抗劑)對在大鼠後爪背部注射50mL1%福馬林所引起的傷害性刺激防禦行為的影響。觀察傷害性刺激防禦行為45分鐘,然後處死大鼠獲取腰部脊髓應用雜交技術檢測c-fos mRNA的表達。全身應用?拉明與西咪替丁未能引起傷害性刺激防禦行為和c-fos mRNA的表達。局部應用這些藥物時,它們以不同的方式影響傷害性刺激防禦行為和c-fos mRNA的表達。?拉明在兩組中以劑量依賴的方式減少防禦行為,然而西咪替丁不影響組Ⅰ,僅部分減少組Ⅱ的防禦行為。520mM的?拉明減少c-fos mRNA的表達,但西咪替丁僅在100mM時減少c-fos mRNA的表達。全身應用這些藥物時不影響c-fos mRNA的表達。結論:組胺受體拮抗劑局部應用時具有抗傷害性刺激作用。在一項傷害性刺激防禦行為測試和mRNA c-fos表達中可以觀測到這些作用。?拉明(H(1)受體拮抗劑)比西咪替丁(H(2)受體拮抗劑)具有更大的抗傷害性刺激作用。

(顧越超翻譯 薛張綱校)

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).

肥胖者比瘦者更多見困難氣管插管

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

肥胖者進行氣管插管是否更困難尚有爭論。應用最近確定的客觀標準,插管困難標準(IDS)來比較肥胖者與瘦者困難氣管插管的發生率。研究了連續的134名瘦者(體重指數<30Kg/m2)和129名肥胖者(體重指數>=35Kg/m2)。比較肥胖者與瘦者的IDS評分,分為困難插管(IDS>=5)和非困難插管(IDS<5),和患者資料,包括吸氧時的氧飽和度(SpO2)。另外也確定了肥胖者困難插管的危險因數。3名瘦者和20名肥胖者的IDS評分>=5(p=0.0001)。肥胖者困難插管的唯一的獨立危險因數是Mallampati評分Ⅲ-Ⅳ(OR=12.5195%CI 2.01-77.81,但是其特異性和陽性預測值為62%29%,有顯著差異。瘦者與肥胖者的插管時SpO2為(平均值+/-標準差)99%+/-1%(範圍:91%-100%)95%+/-8%(範圍:50%-100%,有顯著差異(p<0.0001)。由此認為肥胖者比非肥胖者更多見困難氣管插管。對肥胖者來講,沒有一個經典的困難插管危險因數時滿意的。在肥胖者中,去飽和高風險的依據研究來識別新的困難插管預測因數。結論:肥胖者困難插管發生率為15.5%,瘦者困難氣管插管發生率為2.2%。沒有一個瘦者困難氣管插管的危險因數對肥胖者來講是滿意的。對肥胖者來講,去氧飽和的高風險可能伴隨困難氣管插管。

(顧越超翻譯 薛張綱校)

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.

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大鼠坐骨神經的慢性壓縮性損傷減輕其對福馬林雙向反應性:一項行為與荷爾蒙的評價

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

應用四條帶子對大鼠坐骨神經造成較松的束壓(慢性壓縮性損傷CCI)介導對無害刺激和化學刺激明顯的高敏性。然而,本研究中對大鼠後爪注射福馬林, 兩組福馬林試驗組由CCI誘導的單神經痛導致同側退縮功能、吃或咬功能的減退。這種作用與福馬林的濃度無關。與假裝注射或未注射的動物相比,這些行為的改變伴隨著血漿低水平的促腎上腺皮質激素和皮質酮。與假裝注射或未注射的對照組動物相比,在CCI大鼠對側非結紮的後爪注射福馬林同樣減少吃或咬的行為,但僅在福馬林試驗組的第二組出現。因此,對於同側或對側注射福馬林,CCI減輕了疼痛反應和下丘腦-垂體-腎上腺軸的活性。進一步的研究液調查了CCI誘導的疼痛反應降低是否也在外周、脊髓或脊髓上水平出現,或是應激反應改變的結果。結論:評價了有害的化學刺激例如在預先對坐骨神經造成慢性壓縮性損傷CCI的動物身上注射福馬林所造成的行為反應和荷爾蒙作用的改變。在動物同側和對側的不同部位注射、假裝注射、對照組都進行了比較。

(顧越超翻譯 薛張綱校)

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.

雙阿斯匹林關聯血紅蛋白在非心臟手術中可以減少輸血:多中心,隨機,對照,雙盲試驗

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


隨機,前瞻性,雙盲臨床試驗研究雙阿斯匹林關聯血紅蛋白是否可以減少術中異體血的輸注。從
1996年到1998年,來自19個臨床機構181名選擇性手術病人參加了此項試驗。選擇標準包括預輸注2-4單位血,大動脈修補和大關節或腹部-盆腔手術。一旦決定輸血,給予病人最多3250ml10%DCLHB輸注液(n=92)或3個單位的紅細胞懸液(PRBCs(n=89)DCLHB36小時的術中窗輸注。手術當天,92名用DCLHB治療的患者中的58名沒有再輸注異體血(64%,可信區間[CI]54%-74%)。術後第一天,這個數字變成了(48%,可信區間CI37%-58%)到術後第7天,這個數值進一步下降。變為92人中的44人(23%,可信區間CI15%-33%)。在術後7天這段時間堙ADCLHB組病人每人使用21-4)單位的PRBC,相比較而言,對照組組病人每人使用32-4)單位的PRBCP=0.002;中間值和第2575百分點)死亡率(分別為4%3%)和至少一件不良事件的發生率(分別為21%15%)在DCLHB組和PRBC組中相類似。DCLHB組病人黃疸,泌尿系副作用和胰腺炎的發生較為頻繁。由於安全因素此項實驗提早終止。儘管改良血紅蛋白溶液的副作用方面有待改善,但我們的資料顯示血紅蛋白溶液在選擇性手術中可以有效減少異體血的使用。

( 殷文淵 譯 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.

 

使用各種規格靜脈內導管時Level 1與快速輸液系統流速和升溫能力的比較

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
大量輸血的病人往往需要使用特殊的血液升溫裝置,例如Level 1L-1)(Level 1 Technologies ,Inc.,Rockland,MA)或快速輸液系統(RIS)(Haemonetics Corp.,Braintree,MA)。在這個體外研究中,我們比較了使用兒童和成人尺寸靜脈導管時的液體輸注和L-1(型號1000)RIS的升溫能力。測量使用L-1RIS通過20-18-16-,和14-號導管和4-5-6-7-,和8.5-法國導管輸注2L乳酸鹽林格氏溶液所需時間和終點溫度。對於18-20-號導管兩種系統的流速相近似;然而,當導管尺寸>18號時,使用RIS時的流速會漸漸快於L-1。在所有使用?16號導管時,RIS的升溫能力均優於L-1。我們的結論是使用?18號導管時,RIS的流速和升溫能力均優於L-1,例如,這些可以用於大量失血的病例。在使用兒童尺寸導管時,在升溫和流速方面RIS沒有優勢。

( 殷文淵 譯 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.

心電監護中各導聯對T波監測兒童麻醉時靜脈注射腎上腺素無影響

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


兒童麻醉靜脈注射腎上腺素時偶於可見心電監護Ⅱ導聯顯示
T波振幅增大。本實驗目的瞭解心電監護中各導聯的選擇對T波的影響。32例擇期手術的嬰兒或兒童(年齡6-49月),其ASA分級為Ⅰ級,術中使用1.0MAC七氟醚和混有67%N2O的氧氣。當血流動力學平穩後,所有患兒經外周血管靜注0.1ml/Kg生理鹽水,4分鐘後靜注含1%利多卡因和1200000腎上腺素的生理鹽水0.1ml/Kg(腎上腺素量為0.5μg/Kg)。心率和收縮壓每2060s記錄一次,心電監護選擇Ⅱ(n=32),V5(n=32),Ⅲ(n=17)或Ⅰ(n=15).選擇其中注藥前T波振幅最大的導聯持續監測至注藥後4分鐘。所有患兒在注藥後均出現心率增快,收縮壓增高和所有導聯T波振幅增大。而在輸注生理鹽水後以上情況均未出現。在Ⅱ,Ⅰ,Ⅲ和V5導聯中T波最大振幅分別增加158%±69%175%±78%147%±89%170%±72%(平均±SDP>0.05)。四個導聯中T波振幅改變沒有明顯區別,其靈敏度和特異度只與T波有關而與所選導聯無關。研究結果顯示兒童手術接受七氟醚時靜脈注射腎上腺素後Ⅱ,Ⅰ,Ⅲ和V5導聯的監測作用相同。

(鄧羽霄 譯 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.

 

奧丹司酮和朵拉司酮在兒科非住院病人術後預防嘔吐使用中的經濟與效果的比較

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


術後嘔吐仍是一個未解決的問題。我們設計了這個研究,在術後預防嘔吐的治療中使用多少劑量的朵拉司酮其效果與靜注
100μg/Kg奧丹司酮相同。在這個雙盲的實驗中,我們選擇了204ASA分級為Ⅰ-Ⅱ的健康兒童,年齡為2-12歲,接受 手術。對他們進行隨機分組,一組靜注100μg/Kg奧丹司酮,另一組在圍術期分別靜注45175350700μg/Kg朵拉司酮。終極目標是POV的消失。計算出各組的住院費用及明細帳目。在使用45μg/Kg朵拉司酮的患兒中其早期(0-6h)和24h的嘔吐發生率較350μg/Kg朵拉司酮組,700μg/Kg朵拉司酮組和奧丹司酮組高。當朵拉司酮的使用劑量〈350μg/KgPOV多次發生幾率升高。實驗表明175350700μg/Kg朵拉司酮組和100μg/Kg奧丹司酮組的嘔吐發生率沒有明顯區別。實驗表明與100μg/Kg奧丹司酮效果相同的朵拉司酮最小劑量是350μg/Kg。實驗還表明使用350μg/Kg朵拉司酮組的花費小於奧丹司酮組。

(鄧羽霄 譯 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.

健康志願者使用左旋布比卡因和羅呱卡因的中樞神經系統和心血管系統反應

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


我們設計了一個雙盲隨機對照實驗研究,選擇男性健康的志願者(
n=14)靜注左旋布比卡因和羅呱卡因,比較他們的中樞神經系統和心血管系統反應。實驗中我們先給予利多卡因使受試者出現中樞神經系統早期反應(如耳鳴,末梢感覺異常,感覺減退),然後給予0.5%的左旋布比卡因或羅呱卡因。間隔一分鐘後出現繼發中樞神經系統反應,研究藥物的給予與第一個中樞神經系統反應的關係。因此記錄症狀從間隔的一分鐘起到消失。血流動力學改變的記錄通過經胸電阻抗監測完成,同時使用12導聯的心電監護。研究表明在以下方面左旋布比卡因和羅呱卡因沒有明顯區別:第一個中樞神經系統反應出現的平均時間(p=0.870),第一個中樞神經系統反應出現時使用藥物的平均容量(p=0.595),中風指數(p=0.678),心臟指數(p=0.488),加速指數(p=0.697),PR間期(p=0.213),QRS寬度(p=0.637),QT間期(p=0.724),QTc間期(p=0.737)和心率(p=0.267)。總之,研究表明左旋布比卡因要比羅呱卡因出現更少的中樞神經系統反應(218Vs277)。這項研究還發現當靜脈給予相同濃度,劑量和輸注速度的左旋布比卡因和羅呱卡因出現的中樞神經系統和心血管系統反應基本相同。

(鄧羽霄 譯 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.

吸入麻醉藥物異氟醚抑制初級人內皮細胞組胺介導的鈣離子內流

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


眾所周知異氟醚是擴血管藥物,但異氟醚引起血管擴張的機制還不明確。其中比較重要的機制之一是
NO介導的血管擴張。這個系統的啟動主要是依靠收縮調節機制引導的鈣離子內流而不是儲存的鈣離子釋放。許多研究報告表明吸入麻醉藥物影響哺乳動物內皮細胞細胞質的鈣離子濃度。但相同研究使用人內皮細胞的較少見。因此,我們研究吸入麻醉藥物異氟醚是否能抑制初級人內皮細胞組胺介導的鈣離子內流。使用共焦的鐳射顯微鏡和FLUO-3標記Ca++的細胞,我們研究異氟醚對組胺介導的鈣離子內流平臺期的影響。另外我們使用FURA-2螢光素標記的Mn++測量Ca++通道內的離子流速。這兩種方法均表明異氟醚能域值依靠的抑制鈣離子內流。當抑制不能補償內源性NO合成減少時我們很明顯觀察到異氟醚能抑制NO介導的血管舒張。

(鄧羽霄 譯 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.

阿法沙龍(Alphaxalone)對蟾蜍卵母細胞上M1M3毒蕈堿樣受體的抑制作用

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


阿法沙龍是一種神經類固醇類麻醉藥,其作用機理並不完全明確。毒蕈堿樣受體涉及大腦和運動神經系統的各種神經功能,並作為麻醉藥作用的靶受體而倍受關注。本研究主要研究阿法沙龍對卵母細胞上
M1M3毒蕈堿樣受體的作用。在相應臨床濃度時,阿法沙龍對卵母細胞表面M1受體的乙?膽鹼受體通道產生抑制,同樣也對M3受體的乙?膽鹼受體通道產生抑制。M1M3受體通道的半數最大抑制濃度分別為1.8+/-0.6uM5.3+/-1.0μmGF109203CX是一種選擇性蛋白激?抑制劑,對阿法沙龍作用後卵母細胞上受體的乙?膽鹼通道的抑制作用無影響。阿法沙龍抑制了卵母細胞上M1M 3受體與[3H]quinuclidinyl benzilate的特意性結合。這些發現提示:臨床相應濃度的阿法沙龍通過干擾受體[3H]quinuclidinyl benzilate結合位點,而非蛋白激?依賴機制抑制M1M3受體的功能。

(忻紀華 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

利多卡因減弱了細胞因數介導的內皮細胞和血管平滑肌細胞的損傷

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


已有報導局麻藥可以減輕炎症反應和缺血
/再灌注損傷。所以我們假設以局麻藥預注可以保護內皮細胞和血管平滑肌(VSM)細胞避免細胞因數介導的損傷。將人類微血管內皮細胞和小鼠VSM細胞在利多卡因或丁卡因(5-100μM)預注30分鐘後,暴露於α-腫瘤壞死因數,γ-干擾素和白介素-1β中72小時。以錐蟲蘭排除和乳酸脫氫?的釋放來評價細胞存活和完整性。三磷酸腺?鉀通道(KATP),蛋白激?C的作用,或者說兩者對局麻藥介導的保護作用的調節由線粒體KATP拮抗劑5-hydroxydecanoate, 細胞表面KATP拮抗劑HMR-1098和蛋白激?C抑制劑星孢素(staurosporine)來評估。利多卡因對細胞因數介導的細胞損傷的保護作用呈劑量依賴性。5μM利多卡因可使細胞存活增加10%,而100μM利多卡因可使存活增加60%,並使內皮細胞和VSM細胞的乳酸脫氫?釋放減少3倍。相反,丁卡因不能減輕細胞因數對細胞的損傷。5-hydroxydecanoate可消除利多卡因的保護作用,而HMR-1098和星孢素對利多卡因的保護作用無影響。該研究指出利多卡因可減輕內皮細胞和VSM細胞中細胞因數介導的細胞損傷而丁卡因不能。利多卡因可能的保護作用可能與對線粒體KATP通道的調節作用有關。

(忻紀華 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.

 

麻黃素不能促進維庫溴胺神經肌肉阻滯起效的時間

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


神經肌肉阻滯藥物的起效時間部分地受到迴圈因素的影響,包括肌肉血流和心輸出量。因此可得出麻黃素可以通過增加心輸出量來促進維庫溴胺神經肌肉阻滯起效時間的假說,本研究目的是檢驗這個假說。隨機選擇
53名擇期手術的病人進行前瞻性研究。在麻醉誘導後,每10秒最大程度的刺激尺神經,並用加速度儀記錄拇內收肌的收縮情況。病人在接受持續丙泊酚麻醉10分鐘後,隨機給予麻黃素210μg/Kg(n=27)或等量的生理鹽水(n=26)。然後給予維庫溴胺0.1mg/Kg。在本研究中應用阻抗心動描記術監測心輸出量。在研究中麻黃素使病人的心指數增加(17%P0.003),而生理鹽水沒有。但麻黃素組病人(183±41S)和生理鹽水組病人(181±41S90%神經肌肉阻滯起效時間實際是相同的。因此心指數與神經肌肉阻滯起效時間無相關性。我們總結認為維庫溴胺誘導的神經肌肉阻滯主要與除心輸出量以外的因素有關。複合應用麻黃素和維庫溴胺並不能替代起效快的非去極化肌松藥。

(齊波 譯 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.

 

兔子鞘內注射地卡因、利多卡因、布比卡因和羅呱卡因對脊髓神經毒性作用的比較

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


我們已經報導了腦脊液(
CSF)微透析液內谷氨酸鹽濃度的增加可以用來解釋鞘內注射地卡因的神經毒性作用機理。然而,這種理論是否同樣適用於其他局麻藥尚無人知道。本研究主要比較不同局麻藥對CSF微透析液內谷氨酸鹽濃度的影響,以及對脊髓神經病學和組織病理學的改變。將兔子分為5組,每組6只;對照組鞘內注射0.3mlNaCl溶液,其餘各組分別給予2%地卡因、10%利多卡因、2%布比卡因和2%羅呱卡因。一周後進行神經病學和組織病理學的檢查。四種局麻藥均顯著增加了CSF微透析液內谷氨酸鹽濃度,但組間無顯著差異。利多卡因組兔子的感覺和運動功能明顯較其餘各組差。特徵性的組織病理學改變是脊髓後索空泡形成和運動神經染色質改變。脊髓後索空泡形成嚴重程度的順序為利多卡因=地卡因>布比卡因>羅呱卡因。雖然各局麻藥組之間研究結果的差異不能通過谷氨酸鹽濃度的改變來解釋,但結果表明利多卡因的安全範圍是最小的。

(齊波 譯 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.

 

 

全國性問卷調查顯示患者術後疼痛持續得不到充分緩解

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

術後疼痛能嚴重影響患者的恢復。理解患者的態度和關心術後的疼痛對健康護理者來說相當重要的,且能夠促進術後的護理。為評估患者術後疼痛的感受和急性疼痛的處理情況,我們通過電話問捲進行了一項全國性調查。我們在美國國內隨機抽取了250名最近接受手術的患者進行調查。病人們被要求回答術後疼痛的程度,治療,對疼痛藥物治療的滿意度,病人的受教育程度,以及對術後疼痛和藥物治療的理解。大約80%的患者在手術後遭受了急性疼痛,其中86%的患者感到中度,嚴重或極度的疼痛。59%的病人認為術後疼痛是最普遍的事。接受疼痛治療的患者中約25%的患者發生藥物副反應;但其中90%對疼痛治療滿意。約三分之二的病人述說他們曾與健康護理人員討論過他們的疼痛問題。儘管增加了對疼痛治療計畫的關注並不斷有新的疼痛治療方法的問世,還有許多患者在術後遭受持續的嚴重的疼痛。我們將需要付出更多的努力以改善患者術後的疼痛。

(朱輝 譯 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.

 

內毒素休克試驗中內臟組織血流的不均勻性和代謝變化

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

在內毒素使豬長時間處於休克隨機對照試驗,其研究目的為1)同時測定不同部位臟器的灌注以研究臟器間血流潛在的不均勻性;2)研究臟器間血流的關係,氧供,及不同的代謝分數;3)分析灌注代謝狀況和臟器組織損傷間的聯繫。對內毒素最初的反應是在全身高動力學迴圈後的外周和內臟血流的下降。內臟迴圈的變化是血液再分佈:即腸系膜上動脈的血流得以維持,而腹腔幹血流受影響。粘膜PCO2壓力差雖然不能反映總的內臟灌注變化,但它在休克低動力學階段能反映局部血流情況。在高動力學迴圈時期,胃腸道內PCO2壓力差升高不均一,而乳酸升高只在結腸內。組織學分析揭示粘膜上皮損傷只發生在結腸內。我們得出結論,灌注和代謝超過某一內臟區域不能反映其他的內臟血管區域的灌注和代謝。在內毒素性休克的12小時內結腸粘膜上皮發生損傷而空腸還沒有。高動力學性和低血壓性休克可引起結腸內乳酸釋放但空腸內無此種情況。粘膜上皮損傷和乳酸釋放之間的聯繫或因果關係仍需進一步闡明。

(朱輝 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.

 

 

腦外傷病人中使用大劑量異丙酚對腦血管壓力自動調節的影響

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

對於健康人來說,腦血管壓力自動調節受保護或在使用異丙酚時甚至加強。我們對10名腦外傷的患者做試驗,觀察增加血漿內異丙酚濃度對腦血管壓力自動調節的影響。我們通過靶控制異丙酚的滴注速率使血漿內異丙酚靶濃度到達中濃度(2.3±0.4μg/ml)和高濃度(4.3±0.04μg/ml),從而測定自動調節的靜態速率。我們通過腦多普勒測量腦中動脈血流,使用去甲腎上腺素來控制腦灌注壓力,使每個異丙酚濃度下的腦灌注壓都在7085mmHg之間。結果發現使用高濃度異丙酚的患者腦中動脈血流速率明顯低於使用中濃度異丙酚的患者,且無伴隨的頸動靜脈氧含量差的增加,即沒有相應的血流代謝的變化。儘管如此,自動調節的靜態速率明顯從54%±36%降至28%±35%P=0.029)。我們的資料表明:腦外傷後的病人,異丙酚對腦血管的影響不同于那些健康人。我們建議,腦外傷的患者應慎重使用大劑量異丙酚,因為它可能增加受損腦組織對繼發損害的敏感性。

(朱輝 譯 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.