Anesthesia & Analgesia

October 2003

Table of Content

CARDIOVASCULAR ANESTHESIA:

?菌性中心???管污染的早期??

(???? 薛??校)

Early Identification of Bacteria Leading to Central Venous Catheter Contamination

Christian Jeske, Claus Raedler, Achim von Goedecke, Andreas Mayr, Guido Hinterberger, Ch. Aspoeck, Cornelia Lass-Floerl, and Arnulf Benzer

Anesth Analg 2003 97: 940-943.

心?手?后全身炎症反?和心肺并?症的增加与?瘤坏死因子多?性?象有?

(周洁 ? 王祥瑞 校)

Tumor Necrosis Factor Gene Polymorphism Is Associated with Enhanced Systemic Inflammatory Response and Increased Cardiopulmonary Morbidity After Cardiac Surgery

Hildur Tomasdottir, Hjortur Hjartarson, Anne Ricksten, Carina Wasslavik, Anders Bengtsson, and Sven-Erik Ricksten

Anesth Analg 2003 97: 944-949.

通?????管法的?力-容量??价??期左心室功能

(王士雷 ? 庄心良 校)

Sven A. F. Tulner, Robert J. M. Klautz, Gerda L. van Rijk-Zwikker, Frank H. M. Engbers, Jeroen J. Bax, Jan Baan, Ernst E. van der Wall, Robert A. Dion, and Paul Steendijk

Perioperative Assessment of Left Ventricular Function by Pressure-Volume Loops Using the Conductance Catheter Method

Anesth Analg 2003 97: 950-957.

冠???搭??的血液使用:CPBHct、性?、年?和体重等因素的影?

(王士雷 ? 庄心良 校)

Blood Use in Patients Undergoing Coronary Artery Bypass Surgery: Impact Of Cardiopulmonary Bypass Pump, Hematocrit, Gender, Age, and Body Weight

Bharathi H. Scott, Frank C. Seifert, Peter S. A. Glass, and Roger Grimson

Anesth Analg 2003 97: 958-963.

Jarvik 2000TM 左室支持系?植入?的麻醉管理

(方芳? 薛??校)

Anesthetic Management for Implantation of the Jarvik 2000TM Left Ventricular Assist System

Nancy A. Nussmeier, Charles B. Probert, Douglas Hirsch, John R. Cooper, Jr., Igor D. Gregoric, Timothy J. Myers, and O. H. Frazier

Anesth Analg 2003 97: 964-971.

急性等容血液稀??寒??血流?力?和代?影?

(忻?? ? 王祥瑞 校)

The Hemodynamic and Metabolic Effects of Shivering During Acute Normovolemic Hemodilution

Valeria Perez-de-Sa, Doris Cunha-Goncalves, Henning Schou, Christer Jonmarker, and Olof Werner

Anesth Analg 2003 97: 972-978.

冠???搭??后?生四肢??一例?道

(王士雷 ? 庄心良 校)

Tetraplegia After Coronary Artery Bypass Grafting (Case Report)

Susumu Fujioka, Yoshinari Niimi, Kazuo Hirata, Itaru Nakamura, and Shigeho Morita

Anesth Analg 2003 97: 979-980.

病?肥胖病人行腹主??瘤血管?修复?的麻醉技?

(???? 薛??校)

An Alternative Anesthetic Technique for the Morbidly Obese Patient Undergoing Endovascular Repair of an Abdominal Aortic Aneurysm (Case Report)

Maurice Lippmann, Sonny Rubin, Richard Ginsburg, Rodney A. White, Jason Lee, James Lee, and Ihab Aziz

Anesth Analg 2003 97: 981-983.

PEDIATRIC ANESTHESIA:

小儿麻醉中通?神?刺激器直接确定硬膜外?管的位置

(忻?? ? 王祥瑞 校)

Confirmation of Direct Epidural Catheter Placement Using Nerve Stimulation in Pediatric Anesthesia

Susan M. Goobie, Carolyne J. Montgomery, Rahul Basu, Jillian McFadzean, Gerald J. O’Connor, Kenneth Poskitt, and Ban C. H. Tsui

Anesth Analg 2003 97: 984-988.

吸入NO治?小儿和成人急性低氧性呼吸衰竭的Meta分析

(王士雷 ? 庄心良 校)

Inhaled Nitric Oxide for Acute Hypoxic Respiratory Failure in Children and Adults: A Meta-analysis (Review Article)

Jennifer Sokol, Susan Elizabeth Jacobs, and Desmond Bohn

Anesth Analg 2003 97: 989-998.

五天的???生儿分离?的麻醉管理

(?俊峰? 薛??校)

Anesthetic Management for a Five-Day Separation of Craniopagus Twins (Case Report)

Theodore G. Wong, Biauw-Chi Ong, Claire Ang, and Huei-Leng Chee

Anesth Analg 2003 97: 999-1002.

AMBULATORY ANESTHESIA:

??病人膝???手?使用腰肌?隙神?阻?、蛛网膜下腔麻醉及全身麻醉的比?

(朱? ? 王祥瑞 校)

A Comparison of Psoas Compartment Block and Spinal and General Anesthesia for Outpatient Knee Arthroscopy

Christopher J. Jankowski, James R. Hebl, Michael J. Stuart, Michael G. Rock, Mark W. Pagnano, Christopher M. Beighley, Darrell R. Schroeder, and Terese T. Horlocker

Anesth Analg 2003 97: 1003-1009.

外科病人的?充治?

(王士雷 ? 庄心良 校)

The Use of Complementary and Alternative Medicines by Surgical Patients: A Follow-Up Survey Study

Shu-Ming Wang, Alison A. Caldwell-Andrews, and Zeev N. Kain

Anesth Analg 2003 97: 1010-1015.

?前炎症反???????病人????予??昔康?痛功效的作用

(?俊峰? 薛??校)

The Effects of Preoperative Inflammation on the Analgesic Efficacy of Intraarticular Piroxicam for Outpatient Knee Arthroscopy

Seval Izdes, Sibel Orhun, Sacit Turanli, Ezgi Erkilic, and Orhan Kanbak

Anesth Analg 2003 97: 1016-1019.

ANESTHETIC PHARMACOLOGY:

?用?通道激活?利?唑???通道是否与异氟醚?定性有?

(朱? ? 王祥瑞 校)

The Use of the Potassium Channel Activator Riluzole to Test Whether Potassium Channels Mediate the Capacity of Isoflurane to Produce Immobility

Yilei Xing, Yi Zhang, Caroline R. Stabernack, Edmond I Eger, II, and Andrew T. Gray

Anesth Analg 2003 97: 1020-1024.

异氟醚??胞??粒体中三磷酸腺?致敏?通道的作用机制

(?羽霄 ? 王祥瑞 校)

Intracellular Mechanism of Mitochondrial Adenosine Triphosphate-Sensitive Potassium Channel Activation with Isoflurane

Yuri Nakae, Shinji Kohro, Quinn H. Hogan, and Zeljko J. Bosnjak

Anesth Analg 2003 97: 1025-1032.

吸入麻醉?的MAC是否可以作??价?物抗?害作用的工具?

(王士雷 ? 庄心良 校)

Can Determining the Minimum Alveolar Anesthetic Concentration of Volatile Anesthetic Be Used as an Objective Tool to Assess Antinociception in Animals?

Marie-Agnes Docquier, Patricia Lavand’homme, Christian Ledermann, Valerie Collet, and Marc De Kock

Anesth Analg 2003 97: 1033-1039.

丙泊酚或硫?妥?麻醉??爆?抑制相比反射消失:气管插管的儿茶酚胺和心血管反??化的差异

(?俊峰? 薛??校)

Electroencephalographic Burst Suppression Versus Loss of Reflexes Anesthesia with Propofol or Thiopental: Differences of Variance in the Catecholamine and Cardiovascular Response to Tracheal Intubation

Seppo T. Mustola, Gerhard A. Baer, Juhani K. Toivonen, Anne Salomaki, Mika Scheinin, Heini Huhtala, Pekka Laippala, and Ville Jantti

Anesth Analg 2003 97: 1040-1045.

氟?西尼?接受异氟醚或安定慢性治?后的大鼠耐?性的改?

(?羽霄 ? 王祥瑞 校)

Flumazenil Attenuates Development of Tolerance to Diazepam After Chronic Treatment of Mice with Either Isoflurane or Diazepam

Ron Flaishon, Avi A. Weinbroum, Leo Veenman, Svetlana Leschiner, Valerie Rudick, and Moshe Gavish

Anesth Analg 2003 97: 1046-1052.

左旋-、右旋和消旋布比卡因?LPS??的中性粒?胞?移的影?

(王士雷 ? 庄心良 校)

The Effects of S(-)-, R(+)-, and Racemic Bupivacaine on Lysophosphatidate-Induced Priming of Human Neutrophils

Markus W. Hollmann, Katrin Kurz, Susanne Herroeder, Danja Struemper, Klaus Hahnenkamp, Noud S. Berkelmans, Christel G. den Bakker, and Marcel E. Durieux

Anesth Analg 2003 97: 1053-1058.

氯化?喜?和新斯的明?鼠气道平滑肌作用的相互影?

(?波 ? 王祥瑞 校)

Interactions of Edrophonium with Neostigmine in the Rat Trachea

Osamu Shibata, Masataka Saito, Maki Yoshimura, Masakazu Yamaguchi, Tetsuji Makita, and Koji Sumikawa

Anesth Analg 2003 97: 1059-1063.

TECHNOLOGY, COMPUTING, AND SIMULATION:

二种液体?注系?(H1025FMS 2000)快速?注的??室?价

(王士雷 ? 庄心良 校)

A Laboratory Evaluation of the Level 1 Rapid Infuser (H1025) and the Belmont Instrument Fluid Management System (FMS 2000) for Rapid Transfusion

Mark E. Comunale

Anesth Analg 2003 97: 1064-1069.

手?室工作人?呼出气中七氟醚的含量

(??? 薛??校)

Sevoflurane in Exhaled Air of Operating Room Personnel

G. Summer, P. Lirk, K. Hoerauf, U. Riccabona, F. Bodrogi, H. Raifer, M. Deibl, J. Rieder, and W. Schobersberger

Anesth Analg 2003 97: 1070-1073.

Level 1和?距?加??液?置的相?性能

(?波 ? 王祥瑞 校)

Relative Performance of the Level 1 and Ranger Pressure Infusion Devices (Technical Communication)

Michael P. Eaton and Anahat K. Dhillon

Anesth Analg 2003 97: 1074-1077.

疼痛??后短???与健康有?的生活?量的影?

(王士雷 ? 庄心良 校)

The Effect of Pain on Health-Related Quality of Life in the Immediate Postoperative Period

Christopher L. Wu, Mohammad Naqibuddin, Andrew J. Rowlingson, Steven A. Lietman, Roland M. Jermyn, and Lee A. Fleisher

Anesth Analg 2003 97: 1078-1085.

PAIN MEDICINE:

持?的用??卡因浸??口可以?少肩部手?后?痛?的用量

(??? 薛??校)

Continuous Wound Infiltration with Ropivacaine Reduces Pain and Analgesic Requirement After Shoulder Surgery

Andre Gottschalk, Marc-Alexander Burmeister, Patricia Radtke, Markus Krieg, Faraneh Farokhzad, Sonja Kreissl, Matthias Strauss, and Thomas Standl

Anesth Analg 2003 97: 1086-1091.

?中??注射氯胺酮和硬膜外?痛:???后的?痛Intraoperative

(王士雷 ? 庄心良 校)

Intraoperative Intravenous Ketamine in Combination with Epidural Analgesia: Postoperative Analgesia After Renal Surgery

Alper Kararmaz, Sedat Kaya, Haktan Karaman, Selim Turhanoglu, and Mehmet Ali Ozyilmaz

Anesth Analg 2003 97: 1092-1096.

在?期接受阿片?治?的患者中?行行???和尿的毒理???

(??? 薛??校)

Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy

Nathaniel P. Katz, Summer Sherburne, Michael Beach, Robert J. Rose, Janet Vielguth, Joyce Bradley, and Gilbert J. Fanciullo

Anesth Analg 2003 97: 1097-1102.

鼠表面麻醉中?啡和氨苯丁酯?的?同?痛作用

(殷文? ? 王祥瑞 校)

Analgesic Synergy Between Topical Morphine and Butamben in Mice

Yuri A. Kolesnikov, Marcela Cristea, and Gavril W. Pasternak

Anesth Analg 2003 97: 1103-1107.

NMDA受体在疼痛中的作用(?述)

(王士雷 ? 庄心良 校)

The Role of N-Methyl-D-Aspartate (NMDA) Receptors in Pain: A Review (Review Article)

Andrei B. Petrenko, Tomohiro Yamakura, Hiroshi Baba, and Koki Shimoji

Anesth Analg 2003 97: 1108-1116.

???疹病毒引起的?重的急性??疼痛

(?俊峰? 薛??校)

Severe Acute Visceral Pain from Varicella Zoster Virus (Case Report)

Jacqueline M. Hyland and John Butterworth

Anesth Analg 2003 97: 1117-1118.

CRITICAL CARE AND TRAUMA:

膜表面溶?溶?交?在白蛋白降低人造半?透膜液体?透系?中的作用

(殷文? ? 王祥瑞 校)

The Contribution of Solute-Solvent Exchange at the Membrane Surface to the Reduction by Albumin of the Hydraulic Permeability Coefficient of an Artificial Semipermeable Membrane

Tsuneo Tatara

Anesth Analg 2003 97: 1137-1142.

用人工神?网??价机械通气?呼吸系?的??性

(王士雷 ? 庄心良 校)

Estimating Respiratory System Compliance During Mechanical Ventilation Using Artificial Neural Networks

Gaetano Perchiazzi, Rocco Giuliani, Loreta Ruggiero, Tommaso Fiore, and Goran Hedenstierna

Anesth Analg 2003 97: 1143-1148.

Cefepime Cefpirome:?肌酐清除率的影?的差?

(方芳? 薛??校)

Cefepime Versus Cefpirome: The Importance of Creatinine Clearance

Jeffrey Lipman, Steven C. Wallis, and Robert J. Boots

Anesth Analg 2003 97: 1149-1154. u

NEUROSURGICAL ANESTHESIA:

七氟醚和异丙酚??缺血大鼠??神????度的影?

(?洁 ? 王祥瑞 校)

The Effect of Sevoflurane and Propofol on Cerebral Neurotransmitter Concentrations During Cerebral Ischemia in Rats

Kristin Engelhard, Christian Werner, William E. Hoffman, Bianca Matthes, Manfred Blobner, and Eberhard Kochs

Anesth Analg 2003 97: 1155-1161.

急性和慢性脊髓??病人气管插管?的心血管反?

(王士雷 ? 庄心良 校)

Cardiovascular Responses to Endotracheal Intubation in Patients with Acute and Chronic Spinal Cord Injuries

Kyung Y. Yoo, Seong W. Jeong, Seok J. Kim, In H. Ha, and JongUn Lee

Anesth Analg 2003 97: 1162-1167.

REGIONAL ANESTHESIA:

0.5%和1% 利多卡因硬膜外复合七氟醚全麻中抑制?皮?刺激反?七氟醚需要量的研究

(方芳? 薛??校)

Sevoflurane Requirements to Suppress Responses to Transcutaneous Electrical Stimulation During Epidural Anesthesia with 0.5% and 1% Lidocaine

Atsuko Shono, Yoji Saito, Shinichi Sakura, Katsushi Doi, and Naomi Yokokawa

Anesth Analg 2003 97: 1168-1172.

布比卡因和??卡因用于持?外周神?阻?后的急性肌肉毒性作用

(?洁 ? 王祥瑞 校)

The Acute Myotoxic Effects of Bupivacaine and Ropivacaine After Continuous Peripheral Nerve Blockades

Wolfgang Zink, Christoph Seif, Jurgen R. E. Bohl, Nicola Hacke, Peter M. Braun, Barbara Sinner, Eike Martin, Rainer H. A. Fink, and Bernhard M. Graf

Anesth Analg 2003 97: 1173-1179.

持?腰?神?阻?后出?坐骨神?麻痹一例

(王士雷 ? 庄心良 校)

Sciatic Nerve Palsy After Total Hip Arthroplasty in a Patient Receiving Continuous Lumbar Plexus Block (Case Report)

Bruce Ben-David, Rama Joshi, and Jacques E. Chelly

Anesth Analg 2003 97: 1180-1182.

GENERAL ARTICLES:

直接?迫男性的?髓鞘尺神???比女性更易??

(方芳? 薛??校)

Men Are More Susceptible Than Women to Direct Pressure on Unmyelinated Ulnar Nerve Fibers

Robert C. Morell, Richard C. Prielipp, Timothy N. Harwood, Robert L. James, and John F. Butterworth

Anesth Analg 2003 97: 1183-1188.

常?清洗和高??菌不能清除可重复使用喉罩上的蛋白?沉淀物

(?波 ? 王祥瑞 校)

Routine Cleaning and Autoclaving Does Not Remove Protein Deposits from Reusable Laryngeal Mask Devices

Gay Clery, Joseph Brimacombe, Tisha Stone, Christian Keller, and Sandy Curtis

Anesth Analg 2003 97: 1189-1191.

?用ProSealTM喉面罩???于Foldover ?位的胃?容物?吸

(王士雷 ? 庄心良 校)

Aspiration of Gastric Contents During Use of a ProSealTM Laryngeal Mask Airway Secondary to Unidentified Foldover Malposition (Case Report)

Joseph Brimacombe and Christian Keller

Anesth Analg 2003 97: 1192-1194.

心?手?后全身炎症反?和心肺并?症的增加与?瘤坏死因子多?性?象有?

Tumor Necrosis Factor Gene Polymorphism Is Associated with Enhanced Systemic Inflammatory Response and Increased Cardiopulmonary Morbidity After Cardiac Surgery

Hildur Tomasdottir, MD PhD, Hjortur Hjartarson, MD, Anne Ricksten, PhD, Carina Wasslavik, BSc, Anders Bengtsson, MD PhD, and Sven-Erik Ricksten, MD PhD

Departments of Anesthesia and Intensive Care and Clinical Chemistry, Section of Molecular Biology, Sahlgrenska University Hospital, Goteborg, Sweden

Anesth Analg 2003;97:944-949


体外循?改?了心肺功能并?致了全身性的炎症反?。介?上述?化的?胞因子包括?瘤坏死因子(
TNF-α和白介素。由于TNF基因位?的多型?象,在一些?重的外?和?毒血症病人,可表??高TNF-α水平和高死亡率。我?假?在?行??性心?手?的病人中,TNF位??等位基因的多型?象与促炎介?的?放和心肺并?症的?生有?。?机??95名?行常?心?手?的病人???行TNF基因型,血?TNF-α?度,白介素-6和心肺并?症情?的??。TNF基因型通?排序方法?得。与TNFB1因子?合体和?合体的病人(n=53)相比,TNFB2因子?合体的病人(n=42)表?出?高的TNF-α?度峰值(11.3+1.37.8+0.7pg/mL;P=0.013)和白介素-6?值(153+2787+7pg/mL;P=0.010)。TNFB2因子?合体的病人左心室功能不良(31%9%P=0.029)和?后肺功能不良(24%6%P=0.016)的?生率?高,并易?生低氧合指?(29+1.936.1+1.8P=0.013)。所以?,TNFB2因子?合体的病人在心?手?后易于?生全身?重的炎症反?,?有?高的心肺并?症的?生率。

(周洁 ? 王祥瑞 校)

Cardiopulmonary bypass induces a systemic inflammatory response characterized by alterations in cardiopulmonary function. Mediators for this morbidity are the cytokines tumor necrosis factor (TNF)- and interleukins. A genomic polymorphism within the TNF locus is associated with increased TNF- levels and high mortality in severe trauma and sepsis. We assessed the relationship of biallelic polymorphisms of the TNF locus in patients undergoing elective cardiac surgery to release of proinflammatory cytokines and cardiopulmonary morbidity. TNF genotypes, plasma concentrations of TNF-, interleukin-6, and cardiopulmonary morbidity were studied in 95 unselected, consecutive patients undergoing routine cardiac surgery. TNF genotypes were determined by the solid-phase minisequencing method. Patients homozygous for the TNFB2 allele (n = 42) displayed larger peak concentrations of TNF- (11.3 ± 1.3 versus 7.8 ± 0.7 pg/mL; P = 0.013) and interleukin-6 (153 ± 27 versus 87 ± 7 pg/mL; P = 0.010) when compared with patients homozygous or heterozygous for TNFB1 (n = 53). The TNFB2 homozygotes had a higher incidence of left ventricular dysfunction (31% versus 9%; P = 0.029; odds ratio 3.84 [95% confidence interval, 1.40–24.3]), postoperative pulmonary dysfunction (24% versus 6%; P = 0.016; odds ratio 5.21 [95% confidence interval, 1.49–18.3]), and a lower pulmonary oxygenation index (29 ± 1.9 versus 36.1 ± 1.8; P = 0.013). Patients homozygous for the TNFB2 allele may develop an enhanced systemic inflammatory response with an increased risk of cardiopulmonary morbidity after cardiac surgery.

 

急性等容血液稀??寒??血流?力?和代?影?

The Hemodynamic and Metabolic Effects of Shivering During Acute Normovolemic Hemodilution

Valeria Perez-de-Sa, MD PhD, DEAA*, Doris Cunha-Goncalves, MD DEAA, Henning Schou, MD PhD, Christer Jonmarker, MD PhD, DEAA, and Olof Werner, MD PhD, DEAA*

*Children’s Hospital, the Heart Lung Division, and the Department of Anesthesia and Intensive Care at the University Hospital, Lund, Sweden, and from Children’s Hospital and Regional Medical Center, The University of Washington, Seattle, Washington

Anesth Analg 2003;97:972-978

?了?价极度血液等容稀?后寒??血?和代?的影?,我?以芬太尼-咪唑安定-潘?溴胺?16??行麻醉。通?体表降?行?度低?(36.5o+/-0.1℃),???机分??照?(血?蛋白118+/-3g/L)和血液稀??(血?蛋白52+/-2g/L)。后?中以等?的林格式液和右旋糖?70混合液置?。?少潘?溴胺的注入速度??寒?。??中寒?均使氧耗增加(p<0.001)。首先,?种反?可通?氧?出率(ER)?得到很好的??,但?氧耗?基?值的2.3+/-0.2倍?,?血??物的混合血??氧?和度(SvO2=18%+/-2%,PvO2=22.5+/-1.5mmHg)和ER82%+/-3%)?危?水平。?照?直至氧耗大最大?亦未出?危???(3.7+/-0.3倍的基?值)。?血?中的最大氧耗?小(2.9+/-0.1倍的基?值),在此水平???心肌?生乳酸,其中一?死于室?。?血?中的冠???灌注??著降低(p<0.01)。我?得出??在此??模型中,通?氧耗的????最大寒?受限于血液稀?的?物,并且通?乳酸的?取?少和?生??左室氧平衡?于????。

(忻?? ? 王祥瑞 校)

To assess the hemodynamic and metabolic effects of shivering during extreme normovolemic hemodilution, we anesthetized 16 pigs with fentanyl-midazolam-pancuronium. Mild hypothermia (36.5° ± 0.1°C) was induced by surface cooling, and the animals were randomized to either a control group (hemoglobin 118 ± 3 g/L) or a hemodilution group (hemoglobin 52 ± 2 g/L). In the latter group, blood was replaced with an isotonic Ringer’s acetate/dextran 70 solution. Shivering was allowed to occur by a controlled decrease in the infusion rate of pancuronium. Shivering increased oxygen consumption (O2) in both groups (P < 0.001). Initially, this was predominantly compensated for by an increased oxygen extraction ratio (ER), but when O2 was 2.3 ± 0.2 times baseline, critical levels of mixed venous oxygenation (SO2 = 18% ± 2%; PO2 = 22.5 ± 1.5 mm Hg) and ER (82% ± 3%) were recorded in anemic animals. Control animals did not reach critical levels until O2 was maximal (3.7 ± 0.3 times baseline). Maximal attained O2 was less (2.9 ± 0.1 times baseline) in the anemic animals (P = 0.01), and at this stage two of these pigs had myocardial lactate production, one of which died in ventricular fibrillation. Coronary perfusion pressure was significantly less (P < 0.001) in the anemic animals. We conclude that in this experimental model, maximal shivering as measured by O2 was limited in hemodiluted animals, and left ventricular oxygen balance was marginal, as evidenced by a decreased lactate uptake and extraction.

小儿麻醉中通?神?刺激器直接确定硬膜外?管的位置

Confirmation of Direct Epidural Catheter Placement Using Nerve Stimulation in Pediatric Anesthesia

Susan M. Goobie, MD FRCPC*, Carolyne J. Montgomery, MD FRCPC*, Rahul Basu, MD*, Jillian McFadzean, MD*, Gerald J. O’Connor, MD FRCPC*, Kenneth Poskitt, MD FRCPC, and Ban C. H. Tsui, MSC MD, FRCPC

Departments of *Anesthesiology and Pain Management, and Radiology, British Columbia’s Children’s Hospital and University of British Columbia, Vancouver, BC; Department of Anesthesiology & Pain Medicine, University of Alberta Hospitals, Edmonton, AB

Anesth Analg 2003;97:984-988

在小儿中我??估了以低?流刺激器(Tsui ??)?判?和直接肯定硬膜外?管放置的成功率。30例病人在Tsui ??中通?硬膜外?管的放置接受了?准麻醉和用?。比?硬膜外?管放置的想要?段和???段。除了一例病人外均?肌肉活?。肌肉活?的中值?位?5.3mA。通??片?查想要?段和???段平均差1.8??段。?床成功率?93.9%Tsui ??的?性?示率?82%;即28例病人中的23例,Tsui ??直接?硬膜外?管的位置肯定在??椎?隙?。?于盲探操作以皮???和???量?判??管位置而言,本??在放置硬膜外?管?直接定位并?多大优?。

(忻?? ? 王祥瑞 校)

We evaluated the success rate of using low current electrical stimulation (the Tsui test) to identify and confirm direct epidural catheter placement in a pediatric population. Thirty subjects received a standard anesthetic and administration of the Tsui test on epidural placement. The distribution of myotomal activity was recorded. The intended and actual level of the epidural catheter was compared. Myotomal activity was seen in all patients but one. The median current resulting in myotomal activity was 5.3 mA. The median difference between the intended and actual level as confirmed on radiograph was 1.8 levels. The clinical success rate was 93.9%. The positive predictive value of the Tsui test was 82%; i.e., in 23 of 28 cases, the Tsui test correctly identified the position of the epidural catheter tip within 2 vertebral levels. The test did not offer any added advantage when used in the setting of directly placed epidural catheters in our institution over "blind" methods already used to confirm catheter position when using cutaneous landmarks and test dosing.

??病人膝???手?使用腰肌?隙神?阻?、蛛网膜下腔麻醉及全身麻醉的比?

A Comparison of Psoas Compartment Block and Spinal and General Anesthesia for Outpatient Knee Arthroscopy

Christopher J. Jankowski, MD*, James R. Hebl, MD*, Michael J. Stuart, MD, Michael G. Rock, MD, Mark W. Pagnano, MD, Christopher M. Beighley, MS, Darrell R. Schroeder, MS, and Terese T. Horlocker, MD*

Departments of *Anesthesiology, Orthopedic Surgery, and Biostatistics, Mayo Clinic, Rochester, Minnesota

Anesth Analg 2003;97:1003-1009

??病人膝???手?使用哪种麻醉技?最?合理?有??。在??研究中,我??估?于腰肌?隙神?阻?、蛛网膜下腔麻醉及全身麻醉的手??件,病人?意度,恢复??以及?后?痛的需求等。我??机地?60名患者分成三?,第一?使用异丙酚/氧化?氮/芬太尼全身麻醉,第二?使用6mg布比卡因和15μg芬太尼,第三?使用1.5%甲?卡因40ml?行腰肌?隙神?阻?。所有的患者??注射酮咯酸并???注射布比卡因。?果全身麻醉的20名患者中有13名(65%)需要到麻醉后恢复室,21名蛛网膜下腔麻醉患者?有人?恢复室,而腰肌?隙神?阻?的19名患者有1名(5%)?恢复室(P0.001〉。三?麻醉的患者?手??束到符合出?院?准的平均??分??131129110分?。在?院?,全身麻醉?45%的患者需要阿片??痛?,而蛛网膜下腔麻醉?和腰肌?隙神?阻??分??14%21%P=0.087)。???于首次需要?痛的??或需要阿片??痛的患者?量?有差异。全身麻醉患者?后30分?(P=0.032)和6090120分?(P0.001〉的疼痛?分最高。病人?麻醉方法(P=0.025)和疼痛?理(P=0.009)的?意度在??有?著的差异;全身麻醉?所?得的?意度更低。我?得出??:?于膝???手?如果要考??源的利用,病人的?意程度和?后?痛?理的?,腰肌?隙神?阻?和蛛网膜下腔麻醉要优于全身麻醉。

(朱? ? 王祥瑞 校)

The optimal anesthetic technique for outpatient knee arthroscopy remains controversial. In this study, we evaluated surgical operating conditions, patient satisfaction, recovery times, and postoperative analgesic requirements associated with psoas compartment block, general anesthetic, or spinal anesthetic techniques. Sixty patients were randomized to receive a propofol/nitrous oxide/fentanyl general anesthetic, spinal anesthesia with 6 mg of bupivacaine and 15 μg of fentanyl, or psoas compartment block with 40 mL of 1.5% mepivacaine. All patients received IV ketorolac and intraarticular bupivacaine. The frequency of postanesthesia recovery room admission was 13 (65%) of 20 for patients receiving general anesthesia, compared with 0 of 21 for patients receiving spinal anesthesia and 1 (5%) of 19 for patients receiving psoas block (P < 0.001). The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups (131, 129, and 110 min for general, spinal, and psoas groups, respectively). In the hospital, 45% of general anesthesia patients received opioid analgesics, compared with 14% of spinal anesthesia and 21% of psoas block patients (P = 0.087). There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia. Pain scores were highest in patients receiving general anesthesia at 30 min (P = 0.032) and at 60, 90, and 120 min (P < 0.001). Patient satisfaction with anesthetic technique (P = 0.025) and pain management (P = 0.009) differed significantly across groups; patients receiving general anesthesia reported lower satisfaction ratings. We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering resource utilization, patient satisfaction, and postoperative analgesic management.

?用?通道激活?利?唑???通道是否与异氟醚?定性有?

The Use of the Potassium Channel Activator Riluzole to Test Whether Potassium Channels Mediate the Capacity of Isoflurane to Produce Immobility

Yilei Xing, MD, Yi Zhang, MD, Caroline R. Stabernack, MD, Edmond I Eger, II, MD, and Andrew T. Gray, MD PhD

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

Anesth Analg 2003;97:1020-1024

吸入麻醉?在有害刺激?期?生?定性最初?生于脊髓。在??研究中,我?研究?通道激活?KCNK?型是否能?改???性麻醉?的性能。我?4小???54SD大白鼠鞘?或??注射非特异性KCNK激活物利?唑?定最低肺泡有效?度。??或鞘?注射利?唑的量能同等地降低异氟醚的最低肺泡有效?度但不??致永久地??或死亡。我?得出??:?管利?唑有麻醉效?,但???或鞘?注射相同?量的效?提示全身的吸收和?大?的作用要比脊髓明?。

(朱? ? 王祥瑞 校)

Inhaled anesthetics produce immobility during noxious stimulation, primarily by actions on the spinal cord. In this study, we examined whether activation of potassium channels of the KCNK subfamily alters volatile anesthetic potency. We measured the change in isoflurane minimum alveolar anesthetic concentration (MAC) during 4-h intrathecal or IV infusions of the nonspecific KCNK activator riluzole in 54 Sprague-Dawley rats. IV or intrathecal infusions of riluzole doses that did not result in permanent injury or death equally decreased isoflurane MAC. We conclude that although riluzole exhibited anesthetic effects, the similar dose response from IV or intrathecal infusion suggests systemic absorption and actions in the brain rather than the spinal cord.

异氟醚??胞??粒体中三磷酸腺?致敏?通道的作用机制

Intracellular Mechanism of Mitochondrial Adenosine Triphosphate-Sensitive Potassium Channel Activation with Isoflurane

Yuri Nakae, MD PhD*, Shinji Kohro, MD PhD*, Quinn H. Hogan, MD*, and Zeljko J. Bosnjak, PhD*,

Departments of *Anesthesiology and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin

Anesth Analg 2003;97:1025-1032

异氟醚??胞??粒体中三磷酸腺?致敏?通道的明确作用机制仍?不清楚,?管?粒体中三磷酸腺?致敏?通道可能是异氟醚介??控的。我?研究了使用异氟醚后引起?粒体中三磷酸腺?致敏?通道改?的各种?胞?信?。在几???的心肌?胞中???粒体的?光?素蛋白与三磷酸腺?致敏?通道有?。?明确异氟醚是否介?MFF,我??行了????。??胞放在Tyrode’s液中,其中包含异氟醚(1.0±0.1mM)或二氮?或?者都有(每?n=10)。在另一???中在?予异氟醚的同?加用以下?物:腺?或腺?受体拮抗的SPTPKC的激??PMAPDBuPKC抑制?多黏菌素B ;烙胺酸激?抑制? ;有?分裂激活蛋白激?抑制?SB203580(每?n=10)。异氟醚可能通?二氮?介?MFF(100μM),二氮?也能增加异氟醚介?MFFMPA(0.2μM),PDBu(100μM)和腺?(100μM)介?MFF。然而SPT(100μM), 多黏菌素B(50μM), (200nM), A(0.5μM),SB203580(10μM)都不能抑制异氟醚的作用。我?的???示异氟醚,腺?和PKC能激活?粒体中三磷酸腺?致敏?通道。然而我?的?据不支持异氟醚的作用途?包括腺?,PKC,烙氨酸激?,有?分裂激活蛋白激?。?些?果提示异氟醚能直接激活??粒体中三磷酸腺?致敏?通道。

(?羽霄 ? 王祥瑞 校)

The precise mechanism of isoflurane and mitochondrial adenosine triphosphate-sensitive potassium channel (mitoKATP) interaction is still unclear, although the mitoKATP is involved in isoflurane-induced preconditioning. We examined the role of various intracellular signaling systems in mitoKATP activation with isoflurane. Mitochondrial flavoprotein fluorescence (MFF) was measured to quantify mitoKATP activity in guinea pig cardiomyocytes. To confirm isoflurane-induced MFF, cells were exposed to Tyrode’s solution containing either isoflurane (1.0 ± 0.1 mM) or diazoxide and then both drugs together (n = 10 each). In other studies, the following drugs were each added during isoflurane administration: adenosine or the adenosine receptor antagonist 8-(p-sulfophenyl)-theophylline (SPT); the protein kinase C (PKC) activators phorbol-12-myristate-13-acetate (PMA) and phorbol-12,13-dibutyrate (PDBu); the PKC inhibitors polymyxin B and staurosporine; the tyrosine kinase inhibitor lavendustin A; or the mitogen-activated protein kinase inhibitor SB203580 (n = 10 each). Isoflurane potentiated MFF induced by diazoxide (100 μM), and diazoxide also increased isoflurane-induced MFF. PMA (0.2 μM), PDBu (1 μM), and adenosine (100 μM) induced MFF. However, SPT (100 μM), polymyxin B (50 μM), staurosporine (200 nM), lavendustin A (0.5 μM), and SB203580 (10 μM) all failed to inhibit the effect of isoflurane. Our results show that isoflurane, adenosine, and PKC activate mitoKATP. However, our data do not support an action of isoflurane through pathways involving adenosine, PKC, tyrosine kinase, or mitogen-activated protein kinase. These results suggest that isoflurane may directly activate mitoKATP.

氟?西尼?接受异氟醚或安定慢性治?后的大鼠耐?性的改?

Flumazenil Attenuates Development of Tolerance to Diazepam After Chronic Treatment of Mice with Either Isoflurane or Diazepam

Ron Flaishon, MD*, Avi A. Weinbroum, MD*, Leo Veenman, PhD, Svetlana Leschiner, PhD, Valerie Rudick, MD*, and Moshe Gavish, PhD,

*Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, and The Sackler Faculty of Medicine, Tel Aviv, Israel; Department of Pharmacology, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; and Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel

Anesth Analg 2003;97:1046-1052


通?揭示异氟醚的作用机制,我?研究了氟?西尼?接受了异氟醚或安定慢性治?后的大鼠的影?。大鼠事先?予安定、异氟醚、?水、?予或不?予氟?西尼。?周后?估?异氟醚和安定的反?,以及中?苯二氮卓受体(
CBR)的?合能力。事先?予大?量异氟醚(0.5%)的大鼠在水平???中比事先?予?水(0.4%)的大鼠要差(p<0.05)。?事先加用氟?西尼后?些??就?有了。?予安定的???中,20%的安定?和11%的异氟醚?的大鼠?有通?水平???,事先加用氟?西尼后????字分?是50%44%p<0.02)。在加用或不加用氟?西尼的?水???中????字分?是80%100%。???予异氟醚或安定在加用氟?西尼后都?引起CBR的增加。??是异氟醚?是安定,氟?西尼都??了?期治?后的耐?性。氟?西尼的使用??少了CBR的?合。?些研究提示了异氟醚可能和安定的作用途?相同都是通??-氨基丁酸系??合CBR

(?羽霄 ? 王祥瑞 校)

In an effort to clarify the mechanism of action of isoflurane, we studied the effect of flumazenil on mice chronically treated with isoflurane or diazepam. Mice were pretreated with diazepam, isoflurane, or saline, with and without flumazenil. After 2 wk, responses to isoflurane and diazepam were assessed, and central benzodiazepine receptor (CBR) binding characteristics were assayed. Mice pretreated with isoflurane failed the horizontal wire test at a larger isoflurane concentration (0.5%) compared with saline-pretreated mice (0.4%) (P < 0.05). These differences did not occur when flumazenil was added to the pretreatment. After the administration of diazepam, 20% of diazepam- and 11% of isoflurane-pretreated mice failed the horizontal wire test, versus 50% and 44% when flumazenil was added to either drug (P < 0.002) and 80% and 100% in the saline and saline plus flumazenil-treated mice. The increased CBR density due to flumazenil was attenuated by the coadministration of isoflurane or diazepam. Flumazenil attenuated the development of tolerance to diazepam after chronic treatment with diazepam or isoflurane and attenuated the development of tolerance to isoflurane. Isoflurane, like diazepam, attenuated the effect of flumazenil on CBR ligand binding. These findings suggest that isoflurane shares a mechanism of action with diazepam, probably via the gamma-aminobutyric acid system, most probably the CBR.

氯化?喜?和新斯的明?鼠气道平滑肌作用的相互影?

Interactions of Edrophonium with Neostigmine in the Rat Trachea

Osamu Shibata, MD, Masataka Saito, MD, Maki Yoshimura, MD, Masakazu Yamaguchi, MD, Tetsuji Makita, MD, and Koji Sumikawa, MD

Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan

Anesth Analg 2003;97:1059-1063


气道平滑肌的毒蕈?M3受体具有垂直部位和?构部位???合部位。氯化?喜?可能是与?构部位相?合,?抑制垂直?合部位活性的。?了?一步??,我???了氯化?喜??新斯的明??的鼠气道平滑肌收?和磷脂?肌醇反?的影?。在??中增加新斯的明的?量使其???度?到100μM后,加入氯化?喜?,然后??气道平滑肌的?形?力。???束后??克-?氏溶液中氯化?喜?和新斯的明的含量?新?溶液增加了三倍。?气道平滑肌切片用肌醇溶液和含有或不含有氯化?喜?的新斯的明溶液?行培?。?量溶液中磷酸肌醇(IP3)的含量。???据用平均?±SE表?,并采用?异分析法?行???据分析,如P<0.05表示有???意?。新斯的明??的?力和IP1的增加被100μM或更高?度的氯化?喜?所?弱。如果用新?的克-?氏溶液?行?洗可?其逆?并超??照水平的80%。???果表明可以与鼠气道平滑肌毒蕈?M3受体的?构部位相?合,?而抑制M3受体垂直?合部位的活性。

(?波 ? 王祥瑞 校)

The muscarinic M3 receptor of airway smooth muscle has both an orthosteric binding site and an allosteric binding site. Edrophonium may bind to the allosteric site, resulting in the inhibition of the action of the orthosteric site. Therefore, we examined the effects of edrophonium on neostigmine-induced contractile and phosphatidylinositol responses of rat trachea. Neostigmine (100 μM in final concentration) was added, and ring tension was examined by the addition of edrophonium. After the completion of the experiment, Krebs-Henseleit (K-H) solution containing both edrophonium and neostigmine was changed three times with fresh K-H solution, and the tension was recorded. Tracheal slices were incubated with [3H]myo-inositol and 100 μM neostigmine in the presence or absence of edrophonium. The [3H]inositol monophosphate (IP1) was measured. Data were expressed as mean ± SE. Statistical significance (P < 0.05) was determined with analysis of variance. Neostigmine-induced tension and IP1 accumulation were attenuated by edrophonium at concentrations of 100 μM or more. This attenuation was reversed to more than 80% of control levels by washing with fresh K-H solution. The results suggest that edrophonium would bind to the allosteric site, resulting in the inhibition of the action of the orthosteric site of muscarinic M3 receptors of rat trachea.

Level 1和?距?加??液?置的相?性能

Relative Performance of the Level 1 and Ranger Pressure Infusion Devices

Michael P. Eaton, MD, and Anahat K. Dhillon, BA

Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York

Anesth Analg 2003;97:1074-1077


加??液?置在手?室病人?液??常被使用,但可能??致罕?的?重??气栓。本??的主要目的是在??室中??Level 1和?距?加??液?置的相?性能。相?于Level 1加??液?置,?距??生气栓机率小、?液速度快,但不能?液体或血?行加?。?然Ranger加??液?置在防止气栓形成方面具有?高安全性,但其加?性能差,?明最佳的加??液?置目前??有制造出?。

(?波 ? 王祥瑞 校)

Pressure infusion devices are often used to administer fluids in the operating room, but they may rarely be associated with serious venous air embolism. We studied the performance of the Level 1 and the Ranger Pressure Infusor in the laboratory. The Ranger delivered less air and delivered fluid faster than the Level 1 but did not warm fluid or blood as well. Although the Ranger device may be safer in terms of the risk of air embolism, its inferior warming performance shows that the optimal pressure infusion device has yet to be manufactured.

鼠表面麻醉中?啡和氨苯丁酯?的?同?痛作用

Analgesic Synergy Between Topical Morphine and Butamben in Mice

Yuri A. Kolesnikov, MD PhD*, Marcela Cristea, MD, and Gavril W. Pasternak, MD PhD

*Department of Anesthesiology and Laboratory of Molecular Neuropharmacology, Memorial-Sloan Kettering Cancer Center, New York, New York

Anesth Analg 2003;97:1103-1107


一系列研究表明在??射尾部????中?老鼠尾部施行表面麻醉?,利多卡因是一种有效的?痛?。此外,利多卡因和?啡混合施行表面麻醉????者之?有相互?同作用。在近期研究中,我??明了在??射尾部????中使用氨苯丁酯,苯坐卡因(Benzocaine),和布比卡因?行表面麻醉是有效的。在????中,利多卡因有一?效果的最高限度,?示?一???段曲?,大?量?著降低了?基?水平的反?。相比?而言,氨苯丁酯是一?S型的?量依?反?曲?,,?有象利多卡因的??段曲?,??明氨苯丁酯?行表面麻醉也?优于利多卡因。在??模型中苯坐卡因(Benzocaine)和布比卡因都?示了?量依?性的?痛作用。的确,?同作用在氨苯丁酯/?啡混合液中更??著。我?也?察了苯坐卡因(Benzocaine)和?啡的?同作用。?然等???射???分析提示有?同作用,但???上?有差异。?些研究提示一系列局麻?在??射尾部????中都可以?生表面麻醉作用,其中几?和?啡可以相互?生?同作用。在局麻???中,氨苯丁酯似乎有几?在有和?有?啡?的?理?特征,提示它也?优于其他局麻?。?之,?些?察提示?阿片?和局麻?混和?行表面麻醉可以??有?床价值。

(殷文? ? 王祥瑞 校)

Studies have revealed that lidocaine is an effective analgesic when applied topically to the tail of a mouse in the radiant heat tail-flick assay. In addition, the topical combination of lidocaine with morphine revealed synergistic interactions between the two drugs. In the current studies, we demonstrate that topical butamben, benzocaine, and bupivacaine are active in the radiant heat tail-flick assay. In this assay, topical lidocaine has a ceiling effect and displays a biphasic curve, with large doses markedly decreasing the responses almost to baseline levels. In contrast, butamben has an S-shape dose-dependent response in the assay and did not display a biphasic curve as seen with lidocaine, suggesting that topical butamben may have advantages over lidocaine. Both benzocaine and bupivacaine also showed dose-dependent analgesic activity in this model. Like lidocaine, butamben/morphine combinations displayed synergistic interactions. Indeed, the synergy appeared more prominent with a butamben/morphine combination. We also observed synergy between topical benzocaine and morphine. Although the bupivacaine/morphine combination was suggestive of synergy on isobolographic analysis, it did not achieve statistical significance. These studies indicate that a series of local anesthetics are all active topically in the radiant heat tail-flick assay in mice and that several interact synergistically with morphine. Of the local anesthetics tested, butamben seemed to have several pharmacological characteristics, alone and in combination with morphine, which suggest that it may be superior to the other local anesthetics. Together, these observations suggest that topical combinations of opioids and local anesthetics may prove clinically valuable.

膜表面溶?溶?交?在白蛋白降低人造半?透膜液体?透系?中的作用

The Contribution of Solute-Solvent Exchange at the Membrane Surface to the Reduction by Albumin of the Hydraulic Permeability Coefficient of an Artificial Semipermeable Membrane

Tsuneo Tatara, MD

Department of Anesthesiology, School of Medicine, Kyorin University, Tokyo, Japan

Anesth Analg 2003;97:1137-1142

在?急情?下由于??出血而?注人造?体?降低毛?血管膜的液体?透系?(Lp)。可是,?些?体微分子??毛?血管膜的液体?透系?(Lp)的分子机制?不清楚。在??研究中,我?查了白蛋白?人造半?透膜Lp的影?,?而确定是否膜表面溶?溶?交?在?体微分子降低人造半?透膜液体?透系?中起作用。使用?种人造膜是由于很明确的知道它的分子量限制大小,此外,?种膜和白蛋白之??有任何的相互作用。使用一种流体??差(P)?30cmH2O的?透量?胞?量有或?有白蛋白情?下P?030cmH2O?的超?膜(分子量?30000Lp值。在所有?度中,与?有白蛋白?相比,白蛋白在P?030cmH2O?都降低了Lp值(P<0.05)。?些降低差不多呈?度依?方式,?半?8 wt%白蛋白所引起。????也?可以大概解??白蛋白?度升高?膜表面溶?溶?交???。我?的??是?体微分子?致的毛?血管膜的液体?透系?(Lp)降低不??是毛?血管膜孔道阻塞所引起,也是膜表面溶?溶?交?所?致的。

(殷文? ? 王祥瑞 校)

Infusion of synthetic colloids for tissue edema in inflammatory conditions reduces the hydraulic permeability coefficient (Lp) of capillary membranes. However, the molecular mechanisms governing the modulation of Lp of capillary membranes by these colloidal macromolecules are not known. In this study, I examined the effect of albumin on the Lp of an artificial semipermeable membrane to determine whether solute-solvent exchange at the membrane surface may contribute to reduction of the Lp of capillary membranes by colloidal macromolecules. The artificial membrane was used because of its well known molecular weight cutoff size and the absence of any specific interaction of albumin with such membranes. Lp values of ultrafiltration membranes (molecular weight cutoff, 30,000) were measured by using an osmotic flow cell at a hydrostatic pressure difference (P) of 30 cm H2O in the absence of albumin or in the presence of albumin (2.4–8 wt%) at a P of 0 or 30 cm H2O. At all concentrations, albumin decreased Lp values at both P values of 0 and 30 cm H2O compared with those in the absence of albumin (P < 0.05). These reductions were almost in a concentration-dependent manner and by almost half at 8 wt% albumin. This finding may be appropriately explained by slowed solute-solvent exchange at the membrane surface as the albumin concentration is increased. It is concluded that the reduction in the Lp of capillary membranes by colloidal macromolecules is not caused solely by plugging of the capillary pores, but also by solute-solvent exchange at the capillary membrane surface.

七氟醚和异丙酚??缺血大鼠??神????度的影?

The Effect of Sevoflurane and Propofol on Cerebral Neurotransmitter Concentrations During Cerebral Ischemia in Rats

Kristin Engelhard, MD*, Christian Werner, MD*, William E. Hoffman, PhD, Bianca Matthes, BS, Manfred Blobner, MD*, and Eberhard Kochs, MD*

*Klinik fur Anaesthesiologie and Institut fur klinische Chemie und Pathobiochemie, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany; and Department of Anesthesiology, University of Illinois at Chicago

Anesth Analg 2003;97:1155-1161


七氟醚和异丙酚可能通??少中?和外周的儿茶酚胺具有神?保?作用。我?通??量体?儿茶酚胺和大?神???的?度??价麻醉?物的上述作用。40只雄性Sprague-Dawley大鼠?机分?:芬太尼和笑气/氧气(?照?),2.0%的七氟醚?,0.8-1.2mg/kg/min异丙酚?。通?一???????和控制性降?至平均???32±2mmHg??生?缺血模型(30分?)。持??量??、??血气、PH值,使用高?液相色???定大?儿茶酚胺和谷氨酸?度以及血?儿茶酚胺?度。在缺血?程中,循?儿茶酚胺几乎被异丙酚完全抑制,而七氟醚只能中度抑制。七氟醚和异丙酚分??少75%58%??去甲?上腺素,谷氨酸?度均?少60%。?些?果提出了一???:七氟醚和异丙酚是否通??少循?儿茶酚胺??生?保?。???儿茶酚胺介?的缺血??与我?的??相一致。

(?洁 ? 王祥瑞 校)

Sevoflurane and propofol are neuroprotective possibly by attenuating central or peripheral catecholamines. We evaluated the effect of these anesthetics on circulating catecholamines and brain neurotransmitters during ischemia in rats. Forty male Sprague-Dawley rats were randomly assigned to one of the following treatment groups: fentanyl and N2O/O2 (control), 2.0% sevoflurane, 0.8–1.2 mg · kg-1 · min-1 of propofol, and sham-operated rats with fentanyl and N2O/O2. Ischemia (30 min) was produced by unilateral common carotid artery occlusion plus hemorrhagic hypotension to a mean arterial blood pressure of 32 ± 2 mm Hg. Pericranial temperature, arterial blood gases, and pH value were maintained constant. Cerebral catecholamine and glutamate concentrations, sampled by microdialysis, and plasma catecholamine concentrations were analyzed using high-pressure liquid chromatography. During ischemia, circulating catecholamines were almost completely suppressed by propofol but only modestly decreased with sevoflurane. Sevoflurane and propofol suppressed brain norepinephrine concentration increases by 75% and 58%, respectively, compared with controls. Intra-ischemia cerebral glutamate concentration was decreased by 60% with both sevoflurane and propofol. These results question a role of circulating catecholamines as a common mechanism for cerebral protection during sevoflurane and propofol. A role of brain tissue catecholamines in mediating ischemic injury is consistent with our results.

布比卡因和??卡因用于持?外周神?阻?后的急性肌肉毒性作用

The Acute Myotoxic Effects of Bupivacaine and Ropivacaine After Continuous Peripheral Nerve Blockades

Wolfgang Zink, MD*,, Christoph Seif, MD, Jurgen R. E. Bohl, MD, Nicola Hacke*, Peter M. Braun, MD, Barbara Sinner, MD*,, Eike Martin, MD*, Rainer H. A. Fink, PhD, and Bernhard M. Graf, MD PhD*

*Department of Anesthesiology and Institute of Physiology & Pathophysiology, University of Heidelberg, Heidelberg, Germany; Department of Urology, University of Kiel, Kiel, Germany; and Department of Neuropathology, University of Mainz, Mainz, Germany

Anesth Analg 2003;97:1173-1179


布比卡因?引起肌肉??,而??卡因的?在肌肉毒性作用尚未?明。因此,我?比?等效量的布比卡因和??卡因?骨骼肌的作用。?股神?鞘置入麻醉小?上,?后注射20ml布比卡因(5mg/Ml)或??卡因(7.5 mg/Ml),接?持?注入2.5 mg/Ml布比卡因和3.75 mg/Ml的??卡因大于6小?,?照?接受等容量的生理?水,最后在注射部位取?肌肉?本,???理和染色后,通????方法?察到肌肉??,(0=?破坏,3=肌肉坏死)。注射?水???察到??水?,布比卡因????重的????(2.3±0.7分),??卡因?致的肌肉??范?小得多(1.3±0.8分)。另外,布比卡因?引起了肌??的凋亡。?之,?种?物均引起了肌肉???上的破坏。布比卡因?致坏死和凋亡,与之相比,??卡因引起的????要小得多。我?的??是:??卡因与布比卡因相比,肌肉毒性作用更低。

(?洁 ? 王祥瑞 校)

Bupivacaine causes muscle damage. However, the myotoxic potency of ropivacaine is still unexplored. Therefore, we performed this study to compare the effects of bupivacaine and ropivacaine on skeletal muscle tissue in equipotent concentrations. Femoral nerve catheters were inserted into anesthetized minipigs, and 20 mL of either bupivacaine (5 mg/mL) or ropivacaine (7.5 mg/mL) was injected. Subsequently, bupivacaine (2.5 mg/mL) and ropivacaine (3.75 mg/mL) were continuously infused over 6 h. Control animals were treated with corresponding volumes of normal saline. Finally, muscle samples were dissected at injection sites. After processing and staining, histological patterns of muscle damage were blindly examined, scored (0 = no damage to 3 = myonecrosis), and statistically analyzed. After normal saline, only interstitial edema was found. Bupivacaine treatment caused severe tissue damage (score, 2.3 ± 0.7), whereas ropivacaine induced fiber injury of a significantly smaller extent (score, 1.3 ± 0.8). Furthermore, bupivacaine, but not ropivacaine, induced apoptosis in muscle fibers. In summary, both drugs induce muscle damage with similar histological patterns. Compared with bupivacaine, which induces both necrosis and apoptosis, the tissue damage caused by ropivacaine is significantly less severe. We conclude that ropivacaine’s myotoxic potential is more moderate in comparison with that of bupivacaine.

常?清洗和高??菌不能清除可重复使用喉罩上的蛋白?沉淀物

Routine Cleaning and Autoclaving Does Not Remove Protein Deposits from Reusable Laryngeal Mask Devices

Gay Clery, MB ChB, FRCA, MD*, Joseph Brimacombe, MB ChB, FRCA, MD*,, Tisha Stone, MB BS*, Christian Keller, MD, and Sandy Curtis, RN

*Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia; James Cook University, Townsville, Queensland, Australia; Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria; and Central Sterile Supply Department, Cairns Base Hospital, Cairns, Australia

Anesth Analg 2003;97:1189-1191


本??的目的是??常?清洗和高??菌不能清除可重复使用喉罩(LMAS)上的蛋白?沉淀物?一假?。所??的?准和?曲喉罩均?自同一所?院。每一?喉罩均用含?的洗??手洗3分?,用消毒?在最高85℃?度下机洗14分?,然后在75℃?度下干燥30分?后,用多孔?水的薄膜包?并置于134℃高?下?菌4分?。??LMAS浸泡于1.2%的藻?B溶液中?可??沾染在其表面上的蛋白?沉淀物。在喉罩套囊和?管的?外表面均可??到沾染的蛋白?沉淀物。根据沾染面?的比例可?沾染的?重程度?行?分:?沾染、?度沾染(>0%20%)、中度沾染(>20%80%)和?重沾染(>80%100%)。本??共收集了59?喉罩,其中包括16??准式,43??曲式。???果??有15?(94%)?准式喉罩和39?(91%)?曲式喉罩被蛋白?沉淀物沾染。所有喉罩均??度沾染,且?种喉罩的?表面沾染程度均小于其外表面或??(P0.004=。另外????管的沾染程度比套囊任何部位都?(P0.02=。??作??照的未?使用的喉罩均?有被沾染。因此可得出??:常?清洗和高??菌不能清除可重复使用喉罩上的蛋白?沉淀物。

(?波 ? 王祥瑞 校)

We tested the hypothesis that routine cleaning and autoclaving does not remove protein deposits from reusable laryngeal mask airways (LMAs). All previously used classic and flexible LMAs from a single hospital were tested. Each LMA was hand-washed in an enzymatic solution for 3 min, machine-washed with a disinfectant for 14 min at up to 85°C; dried for 30 min at 75°C, packaged in porous film, and autoclaved for 4 min at 134°C. Protein deposits were detected by immersion in a 1.2% erythrosin B solution, which stains for proteins present on surfaces. The outer surface, inner surface, and edges of the cuff, and the outer and inner surface of the airway tube were examined for the uptake of stain. The severity of staining was scored according to the percentage of surface area stained: nil, mild (>0%–20%), moderate (>20%–80%), and severe (>80%–100%). Fifty-nine LMAs were collected (16 classic and 43 flexible). Staining was detected on 15 (94%) classic LMAs and 39 (91%) flexible LMAs. All staining was graded as mild. Staining was less common on the inner surface than the outer surface or edges for both devices (all P < 0.004). Staining was less common with the airway tube than any location on the cuff (all P < 0.02). Two unused LMAs used as controls were without staining. We conclude that routine cleaning and autoclaving does not remove protein material from reusable LMAs.

病?肥胖病人行腹主??瘤血管?修复?的麻醉技?

An Alternative Anesthetic Technique for the Morbidly Obese Patient Undergoing Endovascular Repair of an Abdominal Aortic Aneurysm

Maurice Lippmann, MD*, Sonny Rubin, MD*, Richard Ginsburg, MD*, Rodney A. White, MD, Jason Lee, MD, James Lee, MD, and Ihab Aziz, MD

Depatrments of *Anesthesiology and Surgery, Harbor-UCLA Medical Center, Torrance, California

Anesth Analg 2003 97: 981-983.

 

腹主??瘤行?放性修复?已有多年了。?病率与腹主??瘤的自然史及?放性外科修复有?。最近采用了一?手???更小的?放性修复。目前病例分析??了一??于病?肥胖病人的侵入??更小的麻醉技?。

(???? 薛??校)

Abdominal aortic aneurysms have been treated by open operative repair for many years. A frequent rate of morbidity is associated with the natural history of abdominal aortic aneurysms in combination with open surgical repair. Recently a new technique that is less surgically invasive has been developed as an alternative to open repair. The present case report outlines a less invasive anesthetic technique for the morbidly obese patient.

 

?菌性中心???管污染的早期??

Early Identification of Bacteria Leading to Central Venous Catheter Contamination

Christian Jeske, MD*, Claus Raedler, MD*, Achim von Goedecke, MD*, Andreas Mayr, MD*, Guido Hinterberger, Ch. Aspoeck, MD, Cornelia Lass-Floerl, MD, and Arnulf Benzer, MD*

*Department of Anaesthesia and Department of Hygiene, University Hospital Innsbruck, Innsbruck, and Department of Hygiene, General Hospital St. Poelten, St. Poelten, Austria

Anesth Analg 2003 97: 940-943

 

?管相?性血液感染(CRBSI)是中心??置管病人的常???。我??用DNA分析技?,?在由于CRBSI症?而取出的中心???管?端分离的?菌与穿刺?、?皮?、??上分离的?菌作比?。在由于CRBSI症?而取出的中心???管中七分之五在其?端分离的?菌与在穿刺??上分离的?菌基本相同,?明?些事件中的?管污染是由于?始穿刺?接触?菌所致。?些???于具有CRBSI危?病人?用抗菌素?防或治??是重要的。

(???? 薛??校)

Catheter-related bloodstream infections (CRBSI) are a common problem in patients after central venous catheterization. Using DNA analysis we compared bacteria found on the tip of central venous catheters removed because of clinical signs of CRBSI with bacteria found on needle, dilator, and guidewire used for insertion of these catheters. In five of seven central venous catheters removed because of clinical signs of CRBSI, bacteria on the catheter tip were genetically identical to bacteria found on the insertion device, proving that catheter contamination in these cases was caused by contacting bacteria during the initial puncture. These findings may be important for antibiotic prophylaxis or therapy in patients at risk for CRBSI.

Jarvik 2000TM 左室支持系?植入?的麻醉管理

Anesthetic Management for Implantation of the Jarvik 2000TM Left Ventricular Assist System

Nancy A. Nussmeier, MD*, Charles B. Probert, MD*, Douglas Hirsch, MD*, John R. Cooper, Jr., MD*, Igor D. Gregoric, MD, Timothy J. Myers, BS, and O. H. Frazier, MD

*Department of Cardiovascular Anesthesiology and The Cullen Cardiovascular Surgical Research Laboratories, Texas Heart Institute at St. Lukes Episcopal Hospital, Houston, Texas

Anesth Analg 2003 97: 964-971.

Jarvik 2000心?是通?一?旋?的篷式???生持??搏??流的左室支持系?。Jarvik 2000心??于麻醉及?手?期的考?不同于??的支持系?。Jarvik 2000心?是通?左胸切??并借助隔离左肺植入左心室的。短期的心肺?流及心室??有助于植入?。?食管心?超??于确???在心室?的确切位置及主???出量是必要的,它主要是通??察主??瓣在左室?到足?充盈量?的?放。由于持?灌流?置在系?及肺??阻力?低?功能最好,甲??酮常用作正性肌力?物。在最先?用Jarvik 2000心?的10?病人,泵提供了最高?8 L/min的心?出量(取?于前?荷、后?荷及泵速)。?些手??早期?手?期死亡。平均支持???81.2天(13214天)。?10?病人中的7?存活到?行心?移植手?,并且在泵支持期??到了完全?体康复。

(方芳? 薛??校)

The Jarvik 2000 HeartTM is a left ventricular assist device that produces continuous nonpulsatile axial flow by means of a single, rotating, vaned impeller. Anesthetic and perioperative considerations of the Jarvik 2000 HeartTM differ from those of conventional assist devices. The Jarvik 2000 is implanted within the left ventricle through a left thoracotomy, which is aided by left lung isolation. A brief period of cardiopulmonary bypass and induced ventricular fibrillation facilitate implantation. Transesophageal echocardiography is essential to assure proper intraventricular positioning of the device and aortic outflow, confirmed by observation of aortic valve opening in the presence of adequate left ventricular volume. Because continuous flow devices function best in the presence of lower systemic and pulmonary vascular resistance, milrinone was preferentially used as an inotropic drug. In the first group of 10 patients to receive the Jarvik 2000, the pump provided a cardiac output of up to 8 L/min, depending on preload, afterload, and pump speed. There were no early perioperative deaths. The average support duration was 81.2 days; the range was 13214 days. Seven of the 10 patients survived to transplantation. Survivors underwent complete physical rehabilitation during pump support.

Cefepime Cefpirome:?肌酐清除率的影?的差?

Cefepime vesus Cefpirome:The Importance of Creatinine Clearance

Jeffrey Lipman, FFA (Crit Care), FJFICM, Steven C. Wallis, PhD, and Robert J. Boots, FRACP FJFICM ;

Intensive Care Unit, Royal Brisbane Hospital; and Department of Anaesthesiology and Critical Care, University of Queensland, Queensland, Australia

Anesth Analg 2003;97:1149-1154

.

?准推荐?量的ß??胺抗菌素在??功能障?的外科??室(IC)病人??致?低的血??度。我?比???第四代?孢菌素(cefepime和cefpirome)的?代?力?差异并比?肌酐清除率(CLCR)与?物清除(CL)的?系。 ?种?物分?每天?次??。分?在初次和第二次??后抽取血?本,分??量和比?血???度及?代?力?分析。Cefepime和cefpirome的?代?力?在IC中?似。任何CL的差异明??定CLCR 的差异。?管在正常的血?肌酐?度下有54%病人在大于???隔20%的?段?抗菌素?度低于最低抑菌?度(MIC) (4 mg/L)。34%的病人CLCR >144 mL/min (比?期的最大值120 mL/min高20%)。只有 CLCR 是抗菌素CL的?立??因素。有些IC病人有很高的CLCR,?有很低的抗菌素血?度。?短???隔或持??注可阻止低血??度的?生并在?????保持血??度高于MIC。由于不能床?直接?量?孢菌素血??度,我?建???CLCR以???床低血??度的?生。 ??:有些??室病人有?高的肌酐清除率而致?低的四代?孢菌素血??度。?床必??持?些?物的血??度大于最低抑菌?度。因?不可能常??量?孢菌素血??度,我?建???CLCR以???床低血??度并以此?整???量。

(方芳? 薛??校)

Standard dosage recommendations for s-lactam antibiotics can result in very low drug levels in intensive care (IC) patients without renal dysfunction. We compared the pharmacokinetics of two fourth-generation cephalosporins, cefepime and cefpirome, and examined the relationship of drug clearance (CL) to creatinine clearance (CLCR). Two separate but similar pharmacokinetic studies (which used 2 g twice daily for each antibiotic) were conducted. Blood was sampled after an initial and a subsequent antibiotic dose. Drug plasma concentrations were measured, and pharmacokinetic analyses were conducted and compared. The pharmacokinetics of cefepime and cefpirome are similar in IC patients. Any differences in drug CL can largely be attributed to differences in CLCR. Despite normal plasma creatinine concentrations, 54% of patients婸 antibiotic concentrations were less than the minimum inhibitory concentration (MIC) (4 mg/L) for >20% of the dosing interval. Thirty-four percent of patients had CLCR >144 mL/min (20% higher than the expected maximum of 120 mL/min). Only CLCR was an independent predictor of antibiotic CL. Time above MIC was predicted only by CLCR. Some IC patients have a very large CLCR, which results in very low levels of studied antibiotics. Either shortening the dosage interval or using continuous infusions would prevent low levels and keep troughs above the MIC for longer periods. In view of the lack of bedside measurement of cephalosporin levels, we suggest that more frequent use be made of CLCR to allow prediction of small concentrations clinically.

0.5%和1% 利多卡因硬膜外复合七氟醚全麻中抑制?皮?刺激反?七氟醚需要量的研究

Sevoflurane Requirements to Suppress Responses to Transcutaneous Electrical Stimulation During Epidural Anesthesia with 0.5% and 1% Lidocaine

Atsuko Shono, MD, Yoji Saito, MD, Shinichi Sakura, MD, Katsushi Doi, MD, and Naomi Yokokawa, MD

Department of Anesthesiology, Shimane Medical University, Izumo City, Japan

Anesth Analg 2003;97:1168-1172

?研究在于明确硬膜外复全麻中抑制?皮?刺激(TES)引起的皮?血管收?反射(SVmR)及瞳孔??的反?(PD)全麻?的需要量。35例行下腹部手?病人?机分?0.5%? (Group 1) 和1% lidocaine ?(Group 2)。所有病人均复合七氟醚全麻。硬膜外注射?荷量的0.5,1%利多卡因后?定冷??失平面的中心(C),?后持??注相同?度的利多卡因。采用5%七氟醚和67%N2O全麻??后停用N2O并降低七氟醚的?度。在C和C的向??的上三?皮??(U)分?TES以确定抑制SVmR和 PD 的七氟醚的需要量。抑制SVmR和PD的呼末七氟醚?度,Group 1的?? 大于in Group 2的??,U 大于C。因此,我???硬膜外复合七氟醚全麻下,抑制SVmR和PD 所需的七氟醚量与利多卡因的?度及外科手?刺激的部位有?。??:我?研究了复合硬膜外麻醉下在手??域抑制?皮?刺激?皮?刺激(TES)引起的皮?血管收?反射(SVmR)及瞳孔??的反?(PD)七氟醚的需要量,?果?示硬膜外复合七氟醚全麻下,抑制SVmR和PD 所需的七氟醚量与利多卡因的?度及外科手?刺激的部位有?。

(方芳? 薛??校)

We sought to determine general anesthetic requirements to suppress skin vasomotor reflex (SVmR) and pupillary dilation (PD) in response to transcutaneous electrical stimulation (TES) during combined epidural-general anesthesia. Thirty-five patients undergoing lower abdominal surgery were randomly divided into 2 groups to epidurally receive 0.5% (Group 1) or 1% lidocaine (Group 2) with sevoflurane anesthesia. A bolus injection of either lidocaine was followed by the infusion of the same solution, and the central dermatomal level of loss of cold sensation (C) was determined. After the induction of general anesthesia with 5% sevoflurane and 67% nitrous oxide, nitrous oxide was discontinued, and sevoflurane concentration was decreased. TES was given at both site C and site three dermatomal segments (U) cephalad to C to determine the end-tidal sevoflurane concentration required to suppress SVmR and PD. End-tidal sevoflurane concentration that suppressed both responses was larger in Group 1 than in Group 2 at both sites and was larger at site U than at site C in both groups. We conclude that sevoflurane requirements to suppress SVmR and PD in response to TES during combined epidural-general anesthesia are different depending on the concentration of lidocaine and the site where surgical stimulation is applied

直接?迫男性的?髓鞘尺神???比女性更易??

Men Are More Susceptible Than Women to Direct Pressure on Unmyelinated Ulnar Nerve Fibers

Robert C. Morell, MD, Richard C. Prielipp, MD FCCM, Timothy N. Harwood, MD, Robert L. James, MStat, and John F. Butterworth, MD

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Anesth Analg 2003 97: 1183-1188.

 

尺神???是最常?的外周神???,并且其男女比例?3:1。 目前?不清楚??期尺神???的机制和男性易?的原因。我??3 ? 40例男性和40女性自愿者(?共240例),肘部屈曲,直接?迫尺神?和前臂缺血作?引起尺神????位(CPTs)不良?化的明?机制?行??模型研究。?A-s, A-,和?髓鞘C-fibers分?在2000-, 250-, 和5-Hz下重复?量CPT。在三种?率下缺血?生明?的CPT升高,男性和女性??明?的差异。肘??屈曲在三种?率下均不能?致?著的CPT升高,并且??著的性?差异。直接?迫在5和250 Hz是?引起CPT?著增高,?示其抑制?髓鞘的C-fibers和有髓鞘的 A- ??。C-fibers而非A-???示?直接?迫有性?差异, 在男性要高1.7倍(95%CI, 1.2- 2.4倍)。缺血?著抑制三种??的功能,可能充分?明性?差异。??:男性比女性直接?迫更易引起?髓鞘C-fibers的抑制,?可能有助于解?男性???期尺神?功能易?的原因。

(方芳? 薛??校)

Ulnar nerve injury, the most common form of perioperative peripheral nerve injury, has a 3:1 male/female predominance. Neither the mechanism of perioperative ulnar nerve injury nor the reasons for the increased male susceptibility are well understood. We used an experimental model with arm flexion at the elbow, direct pressure on the ulnar nerve, and arm ischemia as distinct stress mechanisms to induce adverse changes in ulnar current perception thresholds (CPTs) on 3 groups of 40 male and 40 female volunteers (a total of 240 volunteers). CPT measurements were repeated at 2000-, 250-, and 5-Hz stimulating frequencies, specific to A-s, A-, and unmyelinated C-fibers, respectively. Ischemia produced significant increases in CPT with all three stimulating frequencies, and there were no detectable differences between men and women. Flexion failed to produce significant CPT increases at any of the three stimulating frequencies, with no sex-based differences. Direct pressure produced significant CPT increases at 5 and 250 Hz, indicating inhibition of both unmyelinated C-fibers and myelinated A- fibers. C-fibers, but not A- fibers, demonstrated sex differences with direct pressure; there was a 1.7-fold (95% confidence interval, 1.2- to 2.4-fold) greater effect in men. Ischemia significantly inhibited the function of all three fiber types, perhaps sufficient to overwhelm gender differences

手?室工作人?呼出气中七氟醚的含量

Sevoflurane in Exhaled Air of Operating Room Personnel

G. Summer, MD*, P. Lirk, MD*, K. Hoerauf, MD, U. Riccabona, MD*, F. Bodrogi, MB*, H. Raifer, BSc*, M. Deibl, BSc, J. Rieder, MD*, and W. Schobersberger, MD*

*Department of Anesthesiology and Critical Care Medicine and Department of Medical Biostatistics, University of Innsbruck; and Department of Anesthesiology and General Intensive Care, University of Vienna, Austria

Anesth Analg 2003;97:1070-1073

?于暴露于??性吸入麻醉??健康??的危害至今尚有??。原?上可以通??外周空气或体?的途????暴露的程度。我?使用一种?子?移反??量分光?法??手?室的40名?工?行??。我???了?始工作前,?始工作,一小?,?小?,三小?,以及第二天?始工作前等六????,并?立?照?。他?的呼出气中七氟醚的含量?百万分之0.8明?高于百万分之0.26的基?值(P < 0.05)。??量通?反复?量的方法??整相互?系后?行分析??,他?有???意?的?效?系(P < 0.001)。我?得出????。一,?子?移反??量分光?法可以作?一种??,快捷的方法??定??性的暴露后呼出气中??性麻醉?量;二,每日暴露于七氟醚的人群中呼出气中持??著存在七氟醚。

(??? 薛??校)

Evidence on potential health hazards arising from exposure to volatile anesthetics remains controversial. Exposure may, in principle, be supervised by monitoring of ambient air or, alternatively, in vivo. We used the Proton Transfer Reaction-Mass Spectrometry to screen the breath of 40 operating room staff members before operating room duty, 0, 1, 2, and 3 h after duty, and before commencing duty on the consecutive day, and control persons. Staff members exhibited significantly increased sevoflurane levels in exhaled air after duty, with a mean of 0.80 parts per billion as compared with baseline values of 0.26 parts per billion (P < 0.05). Analysis of variance with adjustment for within correlation (repeated measurements) showed a statistically significant time-effect (P < 0.001). We conclude that (a) Proton Transfer Reaction-Mass Spectrometry biomonitoring of exhaled sevoflurane can serve as a simple and rapid method to determine volatile anesthetic excretion after occupational exposure, and (b) significant concentrations of sevoflurane may be continuously present in persons exposed to sevoflurane on a daily basis

持?的用??卡因浸??口可以?少肩部手?后?痛?的用量

Continuous Wound Infiltration with Ropivacaine Reduces Pain and Analgesic Requirement After Shoulder Surgery

Andre Gottschalk, MD*, Marc-Alexander Burmeister, MD*, Patricia Radtke, MD*, Markus Krieg*, Faraneh Farokhzad, MD*, Sonja Kreissl*, Matthias Strauss, MD, and Thomas Standl, MD*

*Department of Anesthesiology, University Hospital Eppendorf, and the Department of Orthopedics, University Hospital Eppendorf, Hamburg, Germany

Anesth Analg 2003;97:1086-1091


我???肩部手?后通??次??口?行??卡因浸?麻醉可以?解疼痛?十小?,于是通??照,?盲的方法?使用不同?度的??卡因?行?口持?浸?的?痛效果?行前瞻性的研究。45名肩部手?后的患者被?机分?三?。?皮后S?接受?次30毫升的生理?水治?;R2和R3.75?接受7.5 mg/mL??卡因的治?.手?后,S?接受48小?生理?水的持?浸?,R2??2 mg/mL??卡因,R3.75??3.75 mg/mL??卡因.使用阿片?piritramide???病人自控?痛?行?充.手?后1,2,3,4,24,48小?使用??模??分法(VAS)?piritramide的需要量及副作用?行?估.血???卡因的?度在手?前,手?后24,48小?分??行?量.48小?的R3.75?的VAS值(8 ± 9 mm)小于S?的(31 ± 14 mm)( P < 0.005),而且手?后4小?和48小?R3.75?的VAS值比R2?的更小(P < 0.05).?后piritramide的累?用量在R2和R3.75?比S?更少(1?24 小?, P < 0.005; 48 小?, P < 0.05). 血???卡因的?度始?控制在中毒?度以下.因此我?得出??一???肩部手?后使用持??口??卡因浸?与使用生理?水比?可以?小VAS值和阿片??的用量.

(??? 薛??校)

After achieving a reduction of pain scores for 10 h with a single dose wound infiltration after shoulder surgery, we examined in a prospective, placebo-controlled and double-blinded study the analgesic effects of continuous wound infiltration with different concentrations of ropivacaine. Forty-five patients undergoing shoulder surgery were randomly assigned into three groups to receive single dose wound infiltration with 30 mL saline (group S) or ropivacaine 7.5 mg/mL (groups R2 and R3.75) after skin closure. Postoperatively, patients received a continuous wound infiltration with saline (group S), ropivacaine 2 mg/mL (group R2) or ropivacaine 3.75 mg/mL (group R3.75) for 48 h. Supplemental pain relief was provided by IV patient-controlled analgesia with the opioid piritramide. At 1, 2, 3, 4, 24, and 48 h postoperatively visual analogue scale (VAS) values (0聸100 mm), piritramide requirements and side effects were registered. Plasma levels of ropivacaine were measured preoperatively and at 24 h and 48 h after surgery. Until 48 h VAS values were smaller in group R3.75 compared with group S (group R3.75, 8 ± 9 mm; group S, 31 ± 14 mm; P < 0.005), whereas 4 h and 48 h postoperatively VAS values were even smaller in group R3.75 compared with group R2 (P < 0.05). Cumulative piritramide consumption was always smaller in groups R2 and R3.75 compared with group S (1?24 h, P < 0.005; 48 h, P < 0.05). Plasma ropivacaine levels remained less than the toxic threshold. We conclude that continuous postoperative wound infiltration with ropivacaine, especially using 3.75 mg/mL, provides smaller VAS values and opioid requirement in comparison with saline after shoulder surgery

.

在?期接受阿片?治?的患者中?行行???和尿的毒理???

Behavioral Monitoring and Urine Toxicology Testing in Patients Receiving Long-Term Opioid Therapy

Nathaniel P. Katz, MD*, Summer Sherburne, BA*, Michael Beach, MD PhD,, Robert J. Rose, MD, Janet Vielguth, RN, Joyce Bradley, RN, and Gilbert J. Fanciullo, MD MS

*Pain Trials Center, Brigham and Women?s Hospital, Boston, Massachusetts; Departments of Anesthesiology and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and Pain Management Center, Brigham and Women?s Hospital, Boston, Massachusetts

Anesth Analg 2003;97:1097-1102

目前尚?研究??因?慢性疼痛而接受阿片??物治?的患者中在行???的基?上加用尿毒理???的意??行?价.??所大??痛中心的?位作者三年?所有接受慢性阿片??物治?的患者?行尿毒理???和行???,以次作???不恰?用?的方法.我?回?性的摘?了人口??料,异常的服?后行?和尿毒理????告.122位接受治?的患者中有43%(53)有??(或?性的尿??告,或一?以上的异常行?).在?有行???的患者中21%(26)尿?中出??禁?品或非?方控制?物?性.在尿??性的患者中14%(17)有一?以上的行?异常.同?使用????手段更能??不恰?的用?.?使用阿片??物的患者提供一?尿?和行???的?告使??系??得更?全面.

(??? 薛??校)

No study has examined the role of urine toxicology in addition to behavioral monitoring in patients receiving opioid therapy for chronic pain. All patients maintained on chronic opioid therapy by the two senior authors at two university pain management centers were monitored for 3 yr with urine toxicology testing and for behaviors suggestive of inappropriate medication use. We retrospectively extracted demographic information, aberrant drug-taking behaviors, and urine toxicology information from the medical record. For 122 patients maintained on chronic opioid therapy, 43% (n = 53) had a "problem" (either positive urine toxicology or one or more aberrant drug-taking behaviors). Of patients with no behavioral issues, 21% (n = 26) had a positive urine screen for either an illicit drug or a nonprescribed controlled medication. Of patients with a negative urine screen, 14% (n = 17) had one or more behavioral issues. Monitoring both urine toxicology and behavioral issues captured more patients with inappropriate drug-taking behavior than either alone. Requiring a report of behavioral issues and urine toxicology screens for patients receiving chronic opioids creates a more comprehensive monitoring system than either alone.

???疹病毒引起的?重的急性??疼痛

Severe Acute Visceral Pain from Varicella Zoster Virus

Jacqueline M. Hyland, MD, and John Butterworth, MD

From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Anesth Analg 2003;97:1117-1118

???疹病毒感染在接受骨髓移植的患者往往并不出?特征性?域的皮?水?表?.我?曾?理?一位51?的接受骨髓移植治?的非霍奇金淋巴瘤患者.他在接受治?后出??重的腹痛.直到他疼痛?天后出??散的血管性充血我?才意?到他患了???疹病毒感染.我??告??病例是?了?那些?相似的?瘤病人的疼痛提供建?的同行?引起警惕.

(?俊峰? 薛??校)

Varicella zoster virus infection often will not present in the characteristic dermatomal distribution of vesicles in patients who have undergone bone marrow transplantation. We cared for a 51-yr-old man with severe abdominal pain after bone marrow transplantation for non-Hodgkin?s lymphoma. The diagnosis of varicella zoster was not entertained until he developed a diffuse vesicular rash several days after the onset of pain. We report this case to alert others who may be consulted regarding pain management options for similiar oncology patients

五天的???生儿分离?的麻醉管理

Anesthetic Management for a Five-Day Separation of Craniopagus Twins

Wong, Theodore G. MD, FRCPC; Ong, Biauw-Chi MBBS, MMED; Ang, Claire MBBS, MMED;

Chee, Huei-Leng MBBS, MMED

Department of Anesthesia and Surgical Intensive Care, Singapore General Hospital

Anesth Analg 2003;97999-1002

???生是本已罕?的?体?生儿病例中更少?的形式。????科技和技?的?展,未???些日益复?病例?行外科分离的??有可能出?。?管如此,?于?些病例的麻醉管理的文?仍很稀少。如下?篇病例?道????一?11?月的???生儿?期五天的分离?的?划、?程和麻醉管理。??道?重于????合作、交流的重要性和?似病例所需要的?划。

(?俊峰? 薛??校)

Craniopagus twinning is a rare form of the already uncommon entity of conjointtwins. With advances in medical technology and expertise, future attempts at surgical separation of these increasingly complex cases are likely to occur.Despite this, medical literature on the anesthetic management of these cases is sparse. The following case report details the anesthetic management and planning leading to and including the 5-dy separation of 11-mo-old craniopagus twins. The report emphasizes the importance of teamwork, communication, and advanced planning required in cases such as this.

?前炎症反???????病人????予??昔康?痛功效的作用

The Effects of Preoperative Inflammation on the Analgesic Efficacy of IntraarticularPiroxicam for Outpatient Knee Arthroscopy

Izdes, Seval MD*; Orhun, Sibel MD+; Turanli, Sacit MD++; Erkilic, Ezgi MD*;

Kanbak, Orhan MD*

Departments of *Anesthesia,+Pathology, and++Orthopaedic Surgery, Emergency And Traumatology Hospital, Ankara, Turkey

Anesth Analg 2003;971016-1019

 我?在90位行??性膝?????手?的病人中?施了一??盲研究,以?定炎症反?在????予??昔康?痛中的作用。所有病人采用?准的全身麻醉技?。在手??束?,取完滑液活?,?病人均等地分成三??????。第一??予25mL生理?水,第二??予25mL0.25%布比卡因,第三??予25mL0.25%布比卡因和??昔康20mg。滑液成分??微??查后?病人分????,炎症反??性??(I+)和炎症反??性??(I-)。分????前和?后1246小?的疼痛分?、不痛??和?后?痛?的用量。第三?的I+??不痛??明??于I-??(P<0.05)。第三?的I+???后疼痛?分明?低于I躘??(P<0.05),然而在第一和第二?的??????著差异。我?得出??,?前炎症反?是????予??昔康?痛效果最重要的?定因素之一。

(?俊峰? 薛??校)

We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to determine whether there is a role of inflammation in the analgesic efficacy of intraarticular piroxicam. Standardized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxicam 20 mg. After microscopic examination of the synovial materials, the patients were divided into two subgroups, inflammation positive (I+) and inflammation negative (I-). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and postoperative analgesic consumption were recorded. Analgesic duration was significantly longer in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of intraarticular piroxicam.

丙泊酚或硫?妥?麻醉??爆?抑制相比反射消失:气管插管的儿茶酚胺和心血管反??化的差异

Electroencephalographic Burst Suppression Versus Loss of Reflexes Anesthesia

with Propofol or Thiopental: Differences of Variance in the Catecholamine and

Cardiovascular Response to Tracheal Intubation

Mustola, Seppo T. MD*; Baer, Gerhard A. MD, PhD+; Toivonen, Juhani K. MD, PhD*;

Salomaki, Anne Sc.lic.++; Scheinin, Mika PhD[S]; Huhtala, Heini MSc[//];

Laippala, Pekka PhD[P]; Jantti, Ville MD, PhD#

*Department of Anesthesia, South Carelia Central Hospital, Lappeenranta,Finland;+Department of Anesthesia, Tampere University Hospital, Tampere, Finland;++Department of Chemistry, Tampere University Hospital, Tampere, Finland;[S]Department of Pharmacology, University of Turku, Turku, Finland;[//]School of Public Health, University of Tampere, Tampere, Finland;[P]School of Public Health, Research Unit, Tampere University Hospital, Tampere,Finland; and#Ragnar Granit Institute, Tampere University of Technology, Tampere,Finland

Anesth Analg 2003;97 1040-1045

??爆?抑制模式(BSP)可能比?床征象更能准确地反映?效?部位的麻醉??度,因而用于采用不同???物?行气管插管反?的研究,?而排除?些研究中的偏倚。?了???假?,我?注射丙泊酚(30mg.kg-1.h,n=14)或硫?妥?(75mg.kg-1.h-1,n=14)以??BSP,或者通?反复集中???到反射消失(LR)的麻醉??,初始?量丙泊酚2.5mg/kg(n=15)或硫?妥?5mg/kg(n=15),?比?此?气管插管的儿茶酚胺和心血管反?以及?者的?化。BSP?的?准差要小于LR?,但?化差异的Levene’s test?果???著差异。在LR水平,丙泊酚能比硫?妥?更好的?弱儿茶酚胺、??血?和心率?插管的反?,但在BSP水平,只有去甲?上腺素反?被更好的?弱了。在BSP?始?丙泊酚和硫?妥?的Cp50?度分?是9.6531.60ug/mL

(?俊峰? 薛??校)

The electroencephalographic burst suppression pattern (BSP) might indicate the brain’s effect-site concentration of anesthetics more precisely than clinical signs and thus eliminate bias from studies on the reaction to tracheal intubation after different induction drugs. To test this hypothesis, we compared the catecholamine and cardiovascular responses and their variances to tracheal intubation when either BSP was induced by infusion of propofol (30 mg · kg-1 · h-1; n = 14) or thiopental (75 mg · kg-1 · h-1; n = 14) or anesthesia by repeated bolus doses until loss of reflexes (LR), initially of propofol 2.5 mg/kg (n = 15) or thiopental 5 mg/kg (n = 15). The standard deviations were more often smaller in the BSP than in the LR groups, but the results of Levene’s test for differences of variance were insignificant. At the LR level, propofol attenuated catecholamine, arterial blood pressure, and heart rate responses to intubation better than thiopental, but at the BSP level, only the norepinephrine response was better attenuated. Cp50 concentrations of propofol and thiopental at the onset of BSP were 9.65 and 31.60 μg/mL, respectively.

通?????管法的?力-容量??价??期左心室功能

Perioperative Assessment of Left Ventricular Function by Pressure-Volume Loops Using the Conductance Catheter Method

Sven A. F. Tulner, MD*,, Robert J. M. Klautz, MD PhD, Gerda L. van Rijk-Zwikker, MD PhD, Frank H. M. Engbers, MD, Jeroen J. Bax, MD PhD*, Jan Baan, PhD*, Ernst E. van der Wall, MD PhD*, Robert A. Dion, MD, and Paul Steendijk, PhD*

Departments of *Cardiology, Cardio-Thoracic Surgery, and Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands

Anesth Analg 2003 97: 950-957.

麻醉、心肺?流和外科手?操作等因素均引起心??荷的?化,使心?外科手?病人心?功能的?量?得非常复?。由于????管法的?力-容量?充分考?了?荷方面的因素,可能是?价左心室功能的好方法。因此,本文?8例冠???搭?手??????管技?的方法?和左心室功能?行了研究。?超?心??指引????管跨???弓,分?在平??和短?阻?下腔??的前?荷降低期???力-???。所有病人血流?力??定,?并?症?生。在CPB前后15min?得到了完整的?料。?果?示,病人的心?出量(5.2 ± 1.3 L/min to 6.0 ± 1.4 L/min)和左室射血分?(46% ± 17% to 48% ± 19%) CPB前后??化,但是舒?末?在CPB后?著升高(8 ± 2 mm Hg to 16 ± 7 mm Hg; P < 0.05)。心?收?倒?容(end-systolic elastance)?定不?(1.31 ± 1.20 mm Hg/mL 1.13 ± 0.59 mm Hg/mL)CPB后心室舒?功能?著?化,舒???常?? 64 ± 6 ms 下降到52 ± 5 ms ,腔硬度常??0.016 ± 0.014/mL 升高到 0.038 ± 0.016/mL (P < 0.05)。??:???管法提供了??期心?功能的???料,是?价手?操作和麻醉等?心?功能影?的有效方法。

(王士雷 ? 庄心良 校)

Interpretation of perioperative measurements of cardiac function during cardiac surgery is complicated by changes in loading conditions induced by anesthesia, cardiopulmonary bypass (CPB), and the surgical procedure itself. Quantification of left ventricular (LV) function by pressure-volume relations as obtained by the conductance catheter would be advantageous because load-independent indices can be determined. Accordingly, we evaluated methodological aspects of the conductance-catheter technique and documented LV function before and after CPB in eight patients undergoing coronary artery bypass grafting. LV pressure-volume loops by transesophageal echocardiography-guided transaortic application of the conductance catheter were obtained at steady-state and during preload reduction by temporary occlusion of the inferior cava. All patients remained hemodynamically stable, and no complications occurred. Complete data were acquired within 15 min before and after CPB. Cardiac output (5.2 ± 1.3 L/min to 6.0 ± 1.4 L/min) and LV ejection fraction (46% ± 17% to 48% ± 19%) did not change, but end-diastolic pressure increased significantly after CPB (8 ± 2 mm Hg to 16 ± 7 mm Hg; P < 0.05). Load-independent systolic indices remained constant (end-systolic elastance: 1.31 ± 1.20 mm Hg/mL to 1.13 ± 0.59 mm Hg/mL). Diastolic function changed significantly after CPB, as the relaxation time constant decreased from 64 ± 6 ms to 52 ± 5 ms (P < 0.05) and the chamber stiffness constant increased from 0.016 ± 0.014/mL to 0.038 ± 0.016/mL (P < 0.05). We conclude that the conductance catheter method provides detailed data on perioperative myocardial function and may be useful for evaluating the effects of new surgical and anesthetic procedures.

冠???搭??的血液使用:CPBHct、性?、年?和体重等因素的影?

Blood Use in Patients Undergoing Coronary Artery Bypass Surgery: Impact Of Cardiopulmonary Bypass Pump, Hematocrit, Gender, Age, and Body Weight

Bharathi H. Scott, MD*, Frank C. Seifert, MD, Peter S. A. Glass, MBChB*, and Roger Grimson, PhD*

Departments of *Anesthesiology and Surgery, State University of New York at Stony Brook, Stony Brook, New York

Anesth Analg 2003 97: 958-963.

我??一?大型大??院冠???搭?手?的血液使用影?因素-CPBHCT、年?、性?和体重等?行了研究。研究?象包括2年??行的1235例首次手?病人,其中681例在CPB下?行,554例在非CPB下?行。所有病人均?胸正中劈?胸骨。男性病人881例,女性病人354例。行CPB的病人?注聚集??胞血3.4 U ,而不行CPB的病人?注1.6 U CPB病人多次?入??胞的比率(72.5%)??大于非CPB病人45.7%。男女病人?注聚集??胞的量分?是2.2 U 3.6U 。男性病人?注的比率(52.6%)小于女性病人(79.4%)。?CPBHCT<35%、性?、年?65?和体重83 KG的中位?行logistic 回?,?果表明,CPBHCT、女性、高?、低体重???血液?注均有?助,其中,?前Hct<35%是???血的最?指征。

(王士雷 ? 庄心良 校)

We investigated the impact of cardiopulmonary bypass pump (CPB), hematocrit, gender, age, and body weight on blood use in patients undergoing coronary artery bypass graft surgery at a major university hospital. Participants were 1235 consecutive patients undergoing primary coronary artery surgery over a period of 2 yr (1999 and 2000); 681 patients underwent coronary surgery with use of CPB, and 554 patients underwent off-pump coronary artery bypass surgery using a median sternotomy incision. There were 881 males and 354 females. Average packed red blood cells (PRBC) transfusion for patients on CPB was 3.4 U compared with 1.6 U for the off-pump group (P = <0.001). Patients on CPB received more frequent PRBC transfusion (72.5%) compared with 45.7% of off-pump patients (P = <0.001). Average PRBC transfusion for males was 2.2 U compared with 3.6 U for females (P = <0.001). A lower percentage of males (52.6%) than females (79.4%) received transfusion (P = <0.001). T he impact of CPB, off-pump status, preoperative hematocrit <35%, gender, age 65 yr, and weight 83 kilograms using median values as cut points, on blood use was examined using logistic regression models. Use of CPB, preoperative hematocrit, (<35%) female gender, increasing age, and decreased body weight were significant predictors of transfusion (P = <0.001). Preoperative hematocrit <35% and use of CPB were the strongest predictors of PRBC transfusion.

冠???搭??后?生四肢??一例?道

Tetraplegia After Coronary Artery Bypass Grafting

Susumu Fujioka, MD*, Yoshinari Niimi, MD, Kazuo Hirata, MD*, Itaru Nakamura, MD*, and Shigeho Morita, MD

*Department of Anesthesia, Ageo Central General Hospital, Ageo, Saitama, Japan; and Department of Anesthesiology, School of Medicine, Teikyo University, Itabashi, Tokyo, Japan

Anesth Analg 2003 97: 979-980.

作者?道一例非复?冠???搭??后?髓功能障?。?前?查未??任何神?功能异常,然而,?后的磁共振?查???在?害水平存在?著的椎管?窄。?管不能肯定此病人?髓功能障?的病理生理基?,然而,外科手?中??部放在伸展位置加重了?先存在的椎管?窄,可能是造成脊髓??的重要因素。

(王士雷 ? 庄心良 校)

The authors present a rare case of a cervical cord dysfunction after uncomplicated coronary artery bypass grafting. The preoperative neurological examination did not reveal any abnormalities; however, the postoperative magnetic resonance image showed significant spinal canal stenosis at the same levels as high signal lesions. Although the pathophysiological basis of the case was impossible to determine retrospectively, it seems probable that placing the neck in an extended position during surgery might have aggravated a preexisting spinal canal stenosis to produce cervical injury.

吸入NO治?小儿和成人急性低氧性呼吸衰竭的Meta分析

Inhaled Nitric Oxide for Acute Hypoxic Respiratory Failure in Children and Adults: A Meta-analysis

Jennifer Sokol, FRACP FJFICM*,, Susan Elizabeth Jacobs, FRACP, and Desmond Bohn, FRCPC*

*Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Neonatology, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia; and Division of Neonatology, Royal Women’s Hospital, University of Melbourne, Melbourne, Australia

Anesth Analg 2003 97: 989-998.

我?系?复?了吸入NO?小儿和成人急性呼吸窘迫?合症或急性肺??的治?效果。根据Cochrane的方法????料?行meta分析。有5??床??符合本研究。研究??是,在NO吸入的最初4d病人氧合??得到明?改善,此后?未??其?效;在未用通气机的???,治??和空白?照?之??差?;?有?据表明一种NO?量?其他?量效果更好;吸入NO?死亡率??著影?。其他?床指?,如住院天?和重症????,?道??不一致。在?一步?行?方面的研究?,??根据病因以及可能??果造成影?的其他因素?行分?研究,以排除可能?NO治?效果造成影?的其他因素。

(王士雷 ? 庄心良 校)

We systematically reviewed randomized controlled trials examining inhaled nitric oxide (INO) for the treatment of acute respiratory distress syndrome or acute lung injury in children and adults. Qualitative assessments of identified trials were made, and metaanalyses were performed according to Cochrane methodology. Five randomized controlled trials (n = 535) met entry criteria. One study demonstrated significant improvement in oxygenation in the first 4 days of treatment, with no difference after this. There was no difference in ventilator-free days between treatment and placebo groups, and no specific dose of INO was more advantageous than any other. INO had no effect on mortality in trials without crossover of treatment failures to open-label INO (relative risk, 0.98; 95% confidence interval, 0.66–1.44). Other clinical indicators of effectiveness, such as duration of hospital and intensive care stay, were inconsistently reported. Lack of data prevented assessment of all outcomes. If further trials assessing INO in acute respiratory distress syndrome or acute lung injury are to proceed, they should be stratified for primary etiology, incorporate other modalities that may affect outcome, and evaluate clinically relevant outcomes before any benefit of INO can be excluded.

外科病人的?充治?

The Use of Complementary and Alternative Medicines by Surgical Patients: A Follow-Up Survey Study

Shu-Ming Wang, MD*, Alison A. Caldwell-Andrews, PhD, and Zeev N. Kain, MD*,,

Departments of *Anesthesiology, Pediatrics, and Child Psychiatry, Yale University

Anesth Analg 2003 97: 1010-1015.

我?在以往的研究中??,42%的外科??病人??灸用于?防和治?焦?感?趣。我??外科??和病房病人??些?充治?(complementary-alternative medical therapies CAM)的?度?行了研究。?果表明,大部分外科病人(57.4%)?用某种形式的CAM,包括?自己祈?(29%)、脊柱按摩(23%)、普通按摩(15%)、放松(14%) 草?、megavitamins (9%)和?灸(7%)。住院病人?用自我祈?的要比??病人多,但其它方式在住院和??病人之??差?。与外科??病人相比,更多的住院病人愿意向他?的?生坦白CAM的?用。大部分外科病人愿意接受CAM

(王士雷 ? 庄心良 校)

In a previous study, we indicated that 42% of surgical outpatients are interested in using acupuncture as a treatment modality for preoperative anxiety. We designed this follow-up survey to assess differences in attitude toward complementary-alternative medical therapies (CAM) between patients undergoing outpatient surgeries and those undergoing inpatient surgeries. The results indicate that most surgical patients (57.4%) use some form of CAM, including self-prayer (praying for their own health; 29%), chiropractic treatment (23%), massage therapy (15%), relaxation (14%), herbs (13%), megavitamins (9%), and acupuncture (7%). Inpatient surgical respondents reported using self-prayer more than outpatient surgical respondents, but no other differences in CAM use were found between inpatient and outpatient respondents. More inpatient respondents reported disclosing their usage of CAM to perioperative physicians than did outpatient respondents. Most surgical patients were willing to accept CAM as part of their perioperative management but were not willing to pay out-of-pocket for CAM treatment. The leading CAM therapies that fewer of the respondents were willing to pay for out-of-pocket included relaxation, massage, chiropractic medicine, herbs, and acupuncture.

吸入麻醉?的MAC是否可以作??价?物抗?害作用的工具?

Can Determining the Minimum Alveolar Anesthetic Concentration of Volatile Anesthetic Be Used as an Objective Tool to Assess Antinociception in Animals?

Marie-Agnes Docquier, MD*, Patricia Lavand’homme, MD PhD*, Christian Ledermann, MD, Valerie Collet, BS*, and Marc De Kock, MD PhD*

*Department of Anesthesiology, Laboratory of Anesthesia, University of Louvain, St. Luc Hospital, Brussels, Belgium; and Regional Clinic Hospital Conception, Chili

Anesth Analg 2003 97: 1033-1039.

我????价MAC作?麻醉?物效能指?的可靠性。?此,我???了不同??,并??果?行了分析。在第一套??中,我??在机械通气情?下七氟醚麻醉?行了研究。??尾的甩尾反?、?力增高?的撤退反?以及?些刺激后的心血管反??行了??。在第二套???在保留自主呼吸的情?下?行研究。??度和?力刺激以及在麻醉??和清醒??下?芬太尼和可?定?MAC的影?也?行了研究。?刺激?度?,抑制?尾反射的七氟醚?度比爪?力和放射性?度刺激的?度要大(1.81 ± 0.28 versus 1.45 ± 0.22 and 1.53 ± 0.26; P < 0.05)。?前二种刺激,抑制??和心血管反?的七氟醚?度?差?。除小?量的?芬太尼(0.005 μg · kg-1 · min-1) 明?增高机械通气?物的MACBAR以及自主通气?的MAC MACBAR外,其它?量的?芬太尼均?著降低七氟醚的MAC。理想?量的可?定(10 μg/kg)?著降低 MAC MACBAR。?清醒?物??射和?力刺激,可?定和?芬太尼??著影?。??:MAC??价不同麻醉?物的?痛作用??是有效的指?,然而,?察到的?果不??是?些?物抗?害作用的?果,而且体?了?些?物和?化物之?复?的相互作用。

(王士雷 ? 庄心良 校)

We intended to evaluate the reliability of the minimum anesthetic alveolar concentration (MAC)-sparing effect as an objective measure of the antinociceptive properties of a drug. For this purpose, we tested different variables and analyzed the significance of the results obtained. In a first set of experiments, we studied rats under mechanical ventilation and sevoflurane anesthesia. Outcome variables such as gross purposeful movements consecutive to tail clamping, paw withdrawal consecutive to increasing pressure, and cardio-circulatory reactivity (MACBAR) after these stimuli were recorded. In a second set of experiment, sevoflurane-anesthetized rats under spontaneous breathing conditions were used.Thermal stimuli were compared with pressure. The MAC-sparing effect of several doses of sufentanil and clonidine was evaluated in both anesthetized and awake rodents. When considering the stimulus applied, larger concentrations of sevoflurane were required to suppress reactivity after tail clamp than after paw pressure or radiant heat (1.81 ± 0.28 versus 1.45 ± 0.22 and 1.53 ± 0.26; P < 0.05). For the two first stimuli, no significant differences were noted between the concentrations that suppress motor or cardio-circulatory reactions. All doses of sufentanil tested significantly reduced (P < 0.05) the different MAC values except the smallest one (0.005 μg · kg-1 · min-1) that significantly increased MACBAR in ventilated animals and both MAC and MACBAR in spontaneously breathing rodents (P < 0.05). Clonidine, at its optimal dose (10 μg/kg), significantly reduced both MAC and MACBAR to the same degree. In awake animals submitted to radiant heat or pressure challenge, none of the clonidine doses nor sufentanil doses (0.005 and 0.07) were active. In conclusion, the MAC-sparing effect provides several reliable and quantifiable variables that allow comparison between different analgesic substances. However, the observations made are not simply the result of antinociceptive effects of the tested drugs but rather that of complex interactions between these drugs and a halogenated vapor.


左旋-、右旋和消旋布比卡因?LPS??的中性粒?胞?移的影?

The Effects of S(-)-, R(+)-, and Racemic Bupivacaine on Lysophosphatidate-Induced Priming of Human Neutrophils

Markus W. Hollmann, MD PhD*,,, Katrin Kurz, MS*,, Susanne Herroeder, MS*,, Danja Struemper, MD,, Klaus Hahnenkamp, MD, Noud S. Berkelmans, MS, Christel G. den Bakker, MS, and Marcel E. Durieux, MD PhD,

*Department of Anesthesiology, University of Heidelberg, Germany; Department of Anesthesiology, University Hospital Maastricht, The Netherlands; and Department of Anesthesiology, University Hospital Muenster, Germany

Anesth Analg 2003 97: 1053-1058.

局部麻醉???炎症反?,???外周炎症反?可能是有益的。左旋布比卡因??炎症反?的作用尚未被研究??。因此,本研究探?左旋、右旋和消旋布比卡因?中性粒?胞的功能以及信???的作用。通??胞色素c?原法研究lysophosphatidic acid [LPA]N-formylmethionine-leucyl-phenylalanine 刺激中性粒?胞?放?氧化物的量。用???探??物?卵母?胞上LPA受体信???的作用。所有三种局麻??激活作用?影?。左旋布比卡因?起?移作用的抑制大于消旋布比卡因,而右旋布比卡因?此?作用。在10-4 M?度?,左旋布比卡因抑制接近50%。在我?的重?模型上?行的?果表明左旋布比卡因能更有效抑制LPA信???。与右旋布比卡因和其它麻醉?相比,左旋布比卡因?抑制中性粒?胞?移特?有效,?而部分抑制?度的中性粒?胞反?。

(王士雷 ? 庄心良 校)

Local anesthetics modulate inflammatory responses and may therefore be potentially useful in mitigating perioperative inflammatory injury. The inflammatory modulating effects of S(-)-bupivacaine are not known. Therefore, we compared the effects of S(-)-bupivacaine, R(+)-bupivacaine, and racemic bupivacaine on neutrophil function and receptor signaling. Priming (by lysophosphatidic acid [LPA]) and activation (by N-formylmethionine-leucyl-phenylalanine) of superoxide release by isolated human neutrophils was studied by using a cytochrome c-reduction assay. LPA receptor signaling in Xenopus oocytes was studied by using voltage clamp. All three local anesthetics were without effect on activation. S(-)-Bupivacaine inhibited priming more than did racemic bupivacaine; R(+)-bupivacaine was without effect. At 10-4 M, S(-)-bupivacaine inhibited approximately 50%. Comparable results were obtained in our recombinant model, where S(-)-bupivacaine most effectively inhibited LPA signaling. Compared with racemic bupivacaine and other anesthetics, S(-)-bupivacaine appears particularly effective in suppressing neutrophil priming, a process responsible in part for the overactive neutrophil response.

二种液体?注系?(H1025FMS 2000)快速?注的??室?价

A Laboratory Evaluation of the Level 1 Rapid Infuser (H1025) and the Belmont Instrument Fluid Management System (FMS 2000) for Rapid Transfusion

Mark E. Comunale, MD

Department of Anesthesia and Critical Care, St. Louis University Medical Center, St. Louis University School of Medicine, St. Louis, Missouri

Anesth Analg 2003 97: 1064-1069.

本研究比?二种?注系?的加?能力、?注速率和空气排出能力。加?泵放置于???注袋的尖端以便与FMS 2000 系?的加?相匹配。在以250 500 mL/min?注凝集??胞(PRBC)?,自?注近端和?端?定?注?度。二?注系?的管道?度相同。在最大流速?,按上述方法?量?注?度。流速的?量以梯度?桶和秒表?行。空气排放的情?以在最大流速?自近端加入10ml空气到?交?系?的方式?行。空气??管道后?行收集和?量。在250mL/min?,二种?置的PRBC?度都37°C。?置1????而?注?度下降。 FMS 2000 的最大流速?500 mL/min H1025可以?到32°C 575 mL/min流速。空气?H1025的?端流出,FMS2000系??有空气自?端流出。??:FMS 2000 在以生理?度?注、 ??和排空气方面,?目前使用的?注系?均有优?。

(王士雷 ? 庄心良 校)

In this investigation I compared the heating capabilities, infusion rates, and air management system of the new FMS 2000 and the Level 1 infusion systems. A rollerhead pump was placed at the position of the IV bag spikes on the Level 1 disposable set and used to match the flow of the rollerhead pump of the FMS 2000. Infusate temperature was measured at 250 and 500 mL/min by using packed red blood cells (PRBC) at the infusate supply and distal end of the disposable tubing. Tubing lengths were equal for both systems. Devices were set at maximum flow while temperatures were measured as described previously. Flow was measured with a graduated cylinder and stopwatch. Air management was evaluated with a 10-mL air bolus injected proximal to the heat exchanger at maximum flow. Air passing through the system was collected and measured. At 250 mL/min, both devices provided infusate at 37°C. At 500 mL/min, only the FMS 2000 provided PRBC at 37°C. PRBC infusate temperature decreased over time with the Level 1 device. The FMS 2000 delivered PRBC at its maximum flow rate of 500 mL/min. The Level 1 attained a maximum flow of 575 mL/min of PRBC with a temperature of 32°C. Air (10 mL) was recovered from the distal tubing of the Level 1. No air was recovered from the tubing of the FMS 2000. In this laboratory investigation, the FMS 2000 performance was superior with respect to providing PRBC at physiologic temperatures (at 500 mL/min) and with respect to air detection and elimination compared with current widely used pressure-infuser technology.


疼痛??后短???与健康有?的生活?量的影?

The Effect of Pain on Health-Related Quality of Life in the Immediate Postoperative Period

Christopher L. Wu, MD*, Mohammad Naqibuddin, MBBS, MPH*, Andrew J. Rowlingson, BA, Steven A. Lietman, MD, Roland M. Jermyn, BA*, and Lee A. Fleisher, MD*,

*Department of Anesthesiology and Critical Care Medicine, Joint Appointment in Medicine (Cardiology), Biomedical Information Sciences and Health Policy and Management, and the Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland

Anesth Analg 2003 97: 1078-1085.

本研究的目的是???后疼痛是否?影??后短期?(?后2w?)病人与健康有?的生活?量。研究以前瞻 、非?机的方式在??院??中心?行。?象???性全???或膝??置??。在?准的全麻或硬膜外麻醉后,以病人自控??或硬膜外?痛方式行?后?痛。在?后1-5714d?价?息和活??的疼痛程度以及?性、瘙痒的情?。?果?示,病人与生理和精神有?的疼痛均降低,瘙痒的情???化。?心的精神部分程度降低,但生理部分不?。??:?后疼痛??降低病人的生活?量,然而,在?价?后生活?量?,?注意有几种方法?上的方式。

(王士雷 ? 庄心良 校)

The hypothesis of this study was to determine if the severity of postoperative pain would affect patients’ health-related quality of life (HRQL) in the immediate postoperative period (within 2 wk of surgery). We designed this study as a prospective, nonrandomized observational trial in a tertiary academic care center. Patients undergoing elective total hip or knee replacement surgery were eligible. Patients received a standardized intraoperative general or epidural anesthetic followed by IV patient-controlled analgesia or patient-controlled epidural analgesia. Short Form (SF)-12, visual analog scores for pain at rest and pain with activity, nausea, and itching were assessed on postoperative days 1–5, 7, and 14. The severity of pain correlated with a decrease in both the physical and mental component of the SF-12. The severity of nausea correlated with a decrease in the mental but not physical component of the SF-12. The severity of itching did not correlate with a change in the SF-12. Our findings suggest that an increase in postoperative pain will decrease a patient’s quality of life in the immediate postoperative period; however, several methodologic issues exist when assessing HRQL in the immediate postoperative period.

?中??注射氯胺酮和硬膜外?痛:???后的?痛Intraoperative Intravenous Ketamine in Combination with Epidural Analgesia: Postoperative Analgesia After Renal Surgery

Alper Kararmaz, MD, Sedat Kaya, MD, Haktan Karaman, MD, Selim Turhanoglu, MD, and Mehmet Ali Ozyilmaz, MD

Department of Anesthesiology, Dicle University Hospital, Diyarbakir, Turkey

Anesth Analg 2003 97: 1092-1096.

本研究以?盲、?机、?照的方式?价小?量??注射氯胺酮?合硬膜外注射?啡和布比卡因????后疼痛的影?。在外科手?前行硬膜外置管并?始自?管注入?啡和布比卡因。45例病人?机分?2?:氯胺酮?和?照?。氯胺酮??中?予氯胺酮?次注射后?始???注。在?后最初的6h?,?息??下的VAS?分的中位?在氯胺酮??著降低。咳嗽?的VAS分值也?著小于?照?。在?后12d,?痛?的消耗量?著少于?照?。?心和瘙痒的?生率也?著少于?照?。??:在脊髓和?敏感化被硬膜外?用?啡/布比卡因和??氯胺酮阻??,?后?痛效果?得更加理想。

(王士雷 ? 庄心良 校)

We designed this double-blinded, randomized, controlled study to evaluate the effect of small-dose ketamine IV in combination with epidural morphine and bupivacaine on postoperative pain after renal surgery. An epidural catheter was inserted, and the administration of morphine and bupivacaine was started before surgery. Forty patients were assigned to one of two groups (ketamine or control). The ketamine group was administered a ketamine bolus and infusion during surgery. The median visual analog pain scale (VAS) scores at rest were significantly lower in the ketamine group during the first 6 h (P < 0.01). VAS pain scores on coughing were also significantly lower in the ketamine group (P < 0.01). Cumulative postoperative total analgesic consumption was less in the ketamine group on Days 1 and 2 (P < 0.001). The first analgesic demand time was shorter in the control group (9.2 ± 11.5 min) than in the ketamine group (22.3 ± 17.1 min) (P < 0.0001). The incidence of nausea and pruritus was more frequent in the control group (P < 0.05). In conclusion, postoperative analgesia was more effective when spinal cord and brain sensitization were blocked by a combination of epidural morphine/bupivacaine and IV


NMDA受体在疼痛中的作用(?述)

The Role of N-Methyl-D-Aspartate (NMDA) Receptors in Pain: A Review

Andrei B. Petrenko, MD, Tomohiro Yamakura, MD PhD, Hiroshi Baba, MD PhD, and Koki Shimoji, MD PhD, FRCA

From the Department of Anesthesiology, Niigata University School of Medicine, Asahimachi 1–757, Niigata 951–8510, Japan

Anesth Analg 2003 97: 1108-1116

大量?据表明,NMDA受体?疼痛??下?中?敏感化的形成和?持有重要的作用。然而,NMDA受体也?与外周敏感化和??痛的形成。NMDA受体包含NR1NR2ABCD)和NR3AB)??位,?些??位?定了NMDA受体的功能特征。在NMDA受体的??位中,包含NR2B??位的受体??害性感受的作用特?重要,因此,NR2B阻??在治?慢性疼痛?可能??重要的价值。

(王士雷 ? 庄心良 校)

There is accumulating evidence to implicate the importance of N-methyl-D-aspartate (NMDA) receptors to the induction and maintenance of central sensitization during pain states. However, NMDA receptors may also mediate peripheral sensitization and visceral pain. NMDA receptors are composed of NR1, NR2 (A, B, C, and D), and NR3 (A and B) subunits, which determine the functional properties of native NMDA receptors. Among NMDA receptor subtypes, the NR2B subunit-containing receptors appear particularly important for nociception, thus leading to the possibility that NR2B-selective antagonists may be useful in the treatment of chronic pain.

用人工神?网??价机械通气?呼吸系?的??性

Estimating Respiratory System Compliance During Mechanical Ventilation Using Artificial Neural Networks

Gaetano Perchiazzi, MD*, Rocco Giuliani, MD, Loreta Ruggiero, MD, Tommaso Fiore, MD, and Goran Hedenstierna, MD PhD*

*Department of Clinical Physiology, Uppsala University Hospital, Sweden; and Department of Emergency and Transplantation, Bari University Hospital, Italy

Anesth Analg 2003 97: 1143-1148.

本研究?价一种人工神?网?(ANN)是否可以反?机械通气?呼吸系?的????性。?急性肺??模型被用?模?不同机械通气情?。每???包括容量控制呼吸中的10次或更多次呼吸,?后出?一次呼吸末?停以便通?阻?器(interrupter technique)?价??呼吸??性。容量-?力?立即?送到人工神?网?。?果?示,IT技?和ANN方法得出的肺??性?果基本一致,?差?-0.67 ± 1.52 mL/cm H2O (bias ± SD)。??:在容量控制呼吸的?候,ANN可以在不停止呼吸的情?下提取????性。

(王士雷 ? 庄心良 校)

In this study we evaluated whether a technology based on artificial neural networks (ANN) could estimate the static compliance (CRS) of the respiratory system, even in the absence of an end-inspiratory pause, during continuous mechanical ventilation. A porcine model of acute lung injury was used to provide recordings of different respiratory mechanics conditions. Each recording consisted of 10 or more consecutive breaths in volume-controlled mechanical ventilation, followed by a breath having an end-inspiratory pause used to calculate CRS according to the interrupter technique (IT). The volume-pressure loop of the breath immediately preceding the one with pause was given to the ANN for the training, together with the CRS separately calculated by the IT. The prospective phase consisted of giving only the loops to the trained ANN and comparing the results yielded by it to the compliance separately calculated by the investigators. Determination of measurement agreement between ANN and IT methods showed an error of -0.67 ± 1.52 mL/cm H2O (bias ± SD). We could conclude that ANN, during volume-controlled mechanical ventilation, can extract CRS without needing to stop inspiratory flow.

急性和慢性脊髓??病人气管插管?的心血管反?

Cardiovascular Responses to Endotracheal Intubation in Patients with Acute and Chronic Spinal Cord Injuries

Kyung Y. Yoo, MD PhD, Seong W. Jeong, MD PhD, Seok J. Kim, MD, In H. Ha, MD PhD, and JongUn Lee, MD PhD

Department of Anesthesiology and Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, South Korea

Anesth Analg 2003 97: 1162-1167

气管插管常引起短?的高血?和心??速。本研究目的是?价?种心血管反?在脊髓??的病人是否?????的消失而消退。??性完全脊髓??的106例病人根据??分?急性和慢性脊髓??,根据??的平面分?四肢??和下肢??。其中急性四肢??26例,慢性四肢??27例,急性下肢??27例,慢性下肢??29例。25例?四肢??的病人??照?。??血?、心率和血?儿茶酚胺?度。?果,气管插管不影?急性和慢性四肢??病人的血?,但是?著提高急性和慢性下肢??的血?。所有???病人的心率均出??著加快,然而,急性四肢??病人心率加快的幅度?著小于其它各?。除急性四肢???外,其余各?血?去甲?上腺素的?度均增高。慢性四肢???和?照?血?去甲?上腺素的?度增高幅度和?照?相同,均??,而急性下肢???的增高幅度?大。各??心律失常的?生率?差异。??:气管插管的心血管和儿茶酚胺反??脊髓??水平和??的?化而?化。

(王士雷 ? 庄心良 校)

Endotracheal intubation usually causes transient hypertension and tachycardia. We investigated whether the cardiovascular responses to intubation change as a function of the time elapsed in patients with spinal cord injury. One-hundred-six patients with traumatic complete spinal cord injury were grouped into acute and chronic groups according to the time elapsed (less than and more than 4 wk after injury) and into those with quadriplegia and paraplegia according to the level of injury (above C7 and below T5): acute quadriplegia, n = 26; chronic quadriplegia, n = 27; acute paraplegia, n = 24; and chronic paraplegia, n = 29. Twenty-five patients with no spinal cord injury served as controls. Systolic arterial blood pressure (SAP), heart rate, and plasma concentrations of catecholamines were measured. The intubation did not affect SAP in either the acute or chronic quadriplegics, but it significantly increased SAP in both acute and chronic paraplegics. Heart rate was significantly increased in all groups; however, the magnitude of change was less in acute quadriplegics than in the other groups. Plasma concentrations of norepinephrine increased in every group but the acute quadriplegics. The magnitude of increase was attenuated in chronic quadriplegics, accentuated in acute paraplegics, and similar in chronic paraplegics when compared with controls. The incidence of arrhythmias did not differ among groups. We conclude that the cardiovascular and catecholamine responses to endotracheal intubation may change as a function of the time elapsed and the level of spinal cord injury.

持?腰?神?阻?后出?坐骨神?麻痹一例

Sciatic Nerve Palsy After Total Hip Arthroplasty in a Patient Receiving Continuous Lumbar Plexus Block

Bruce Ben-David, MD, Rama Joshi, MD, and Jacques E. Chelly, MD PhD, MBA

Department of Anesthesiology, University of Pittsburgh Medical Centers, Shadyside Hospital, Pittsburgh, Pennsylvania

Anesth Analg 2003 97: 1180-1182.

我??告一例30?男性先天性??育不良行全?置?病人出?了?后坐骨神?麻痹。病人接受持?腰?神?阻?,在出?症?前3小??用了低分子量肝素。神?阻?和坐骨神?麻痹的解剖?上的差异使??和??血?的治?均非常迅速及?,病人神?功能恢复也很迅速。此例病人?明,???域阻?技?在急性疼痛中的重要作用,新?生的?后神?缺失必?由麻醉?生和外科?生共同??。及??放的交流是迅速采取措施和受?害神?功能恢复的重要保?。

(王士雷 ? 庄心良 校)

We report a case of late-onset postoperative sciatic palsy after total hip arthroplasty in a 30-yr-old man with congenital hip dysplasia. The patient was receiving continuous lumbar plexus blockade and had received low-molecular-weight heparin 3 h before the onset of symptoms. Anatomic distinction between the nerve block and the sciatic palsy facilitated rapid diagnosis and treatment of a periarticular hematoma, with resulting neurologic recovery. This case illustrates that, with the expanded role of regional anesthetic techniques in acute pain management, the finding of a new postoperative deficit must be jointly investigated by both anesthesiologists and surgeons. Timely and open communication between services is critical because rapid intervention may be essential to achieving full recovery of an affected nerve.

?用ProSealTM喉面罩???于Foldover ?位的胃?容物?吸

Aspiration of Gastric Contents During Use of a ProSealTM Laryngeal Mask Airway Secondary to Unidentified Foldover Malposition

Joseph Brimacombe, MB ChB, FRCA, MD*, and Christian Keller, MD

*Department of Anaesthesia and Intensive Care, James Cook University, Cairns Base Hospital, Australia; and Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria

Anesth Analg 2003 97: 1192-1194.

ProSealTM 排泄管的主要功能是防止胃?容物?吸。我??道一例?腹腔??囊切除??PLMA引起的?吸。病人?64?男性,胃?容物?吸??于foldover?位。提示,排泄管的位置和?放在所有的病人中都是非常重要的。

(王士雷 ? 庄心良 校)

The primary function of the drain tube of the ProSealTM laryngeal mask airway (PLMA) is to prevent aspiration of regurgitated stomach contents. We report a case of gastric aspiration with the PLMA during a laparoscopic cholecystectomy in a 64-yr-old healthy man secondary to an unidentified foldover malposition. It is imperative that the position and patency of the drain tube be verified in all patients with the PLMA.