Anesthesia & Analgesia

January 2004

Table of Content

CARDIOVASCULAR ANESTHESIA:

心脏手术术前预防性使用抗血小板药和/或抗凝药对术后出血的影响

( 李士通 校)

The Effect of Preoperative Antiplatelet/Anticoagulant Prophylaxis on Postoperative Blood Loss in Cardiac Surgery

Suryanarayana Pothula, Vajubhai T. Sanchala, Basavaraj Nagappala, and Mario A. Inchiosa, Jr.

Anesth Analg 2004 98: 4-10.

心脏手术中的A- B-型利尿钠肽

(方芳翻译 薛张纲校)

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures

Elmar Berendes, Christoph Schmidt, Hugo Van Aken, Maike Grosse Hartlage, Markus Rothenburger, Stefan Wirtz, Hans Heinrich Scheld, Gerhard Brodner, and Michael Walter

Anesth Analg 2004 98: 11-19.

体外循环冠脉搭桥术中使用16FDP的心肌保护作用:随机对照临床实验

(陈洁 王祥瑞 校)

Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial

Bernhard J. Riedel, Janos Gal, Gillian Ellis, Paul J. Marangos, Anthony W. Fox, and David Royston

Anesth Analg 2004 98: 20-29.

 

钙敏化剂MCI-154和异氟醚的相互作用--对慢性置管狗的体循环和冠脉血流动力学研究

( 泓译 李士通 校)

The Interaction of MCI-154, a Calcium Sensitizer, and Isoflurane on Systemic and Coronary Hemodynamics in Chronically Instrumented Dogs

Shunji Takahashi, Sungsam Cho, Tetsuya Hara, Hiroyuki Ureshino, Shiro Tomiyasu, and Koji Sumikawa

Anesth Analg 2004 98: 30-36.

原发性多汗症病人中内镜下胸交感神经切除术可以抑制压力反射对心率的控制

(方芳翻译 薛张纲校)

Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis

Yurie T. Kawamata, Tomoyuki Kawamata, Keiichi Omote, Eiji Homma, Tatsuo Hanzawa, Toshifumi Kaneko, and Akiyoshi Namiki

Anesth Analg 2004 98: 37-39.

体位性低血压通常发生在麻醉后第一个小时

(陈洁 王祥瑞 校)

Orthostatic Hypotension Occurs Frequently in the First Hour After Anesthesia

Dean A. Cowie, J. Kevin Shoemaker, and Adrian W. Gelb

Anesth Analg 2004 98: 40-45.

PEDIATRIC ANESTHESIA:

幼儿心脏手术时呼吸机械力学的改变

(王立中译 李士通校)

Changes in Respiratory Mechanics Among Infants Undergoing Heart Surgery

Stephen A. Stayer, Laura K. Diaz, Debora L. East, Jill N. Gouvion, Tracie L. Vencill, E. Dean McKenzie, Charles D. Fraser, and Dean B. Andropoulos

Anesth Analg 2004 98: 49-55.

 

可乐定延长新生儿脊麻时间:一项前瞻性剂量范围研究

(方芳翻译 薛张纲校)

Clonidine Prolongs Spinal Anesthesia in Newborns: A Prospective Dose-Ranging Study

Alain Rochette, Olivier Raux, Rachel Troncin, Christophe Dadure, Régis Verdier, and Xavier Capdevila

Anesth Analg 2004 98: 56-59.

 

右旋美托咪啶单次量可减少小儿七氟醚麻醉中的躁动

(肖洁 王祥瑞 校)

Single-Dose Dexmedetomidine Reduces Agitation After Sevoflurane Anesthesia in Children

Mauricio E. Ibacache, Hernán R. Muñoz, Verena Brandes, and Anita L. Morales

Anesth Analg 2004 98: 60-63.

AMBULATORY ANESTHESIA:

脊髓中氯普鲁卡因溶液:37° C的密度和 pH滴定。

(方芳翻译 薛张纲校)

脊麻氯普鲁卡因溶液:37摄氏度时的比重和pH滴定

(黄施伟 译,李士通 校)

Spinal Chloroprocaine Solutions: Density at 37° C and pH Titration

Kimberly B. Na and Dan J. Kopacz

Anesth Analg 2004 98: 70-74.

 

在志愿者身上进行2-氯普鲁卡因与利多卡因的比较研究

(肖洁 王祥瑞 校)

Spinal 2-Chloroprocaine: A Comparison with Lidocaine in Volunteers

Mary E. Kouri and Dan J. Kopacz

Anesth Analg 2004 98: 75-80.

脊麻用2-氯普鲁卡因:一项系列剂量研究以及添加肾上腺素的效果

(黄施伟 译,李士通 校)

Spinal 2-Chloroprocaine: A Dose-Ranging Study and the Effect of Added Epinephrine

Kristin N. Smith, Dan J. Kopacz, and Susan B. McDonald

Anesth Analg 2004 98: 81-88.

 

2-氯普鲁卡因脊麻:添加右旋糖的作用

(陆绪伟翻译 薛张纲校)

Spinal 2-Chloroprocaine: The Effect of Added Dextrose

Daniel T. Warren and Dan J. Kopacz

Anesth Analg 2004 98: 95-101.

ANESTHETIC PHARMACOLOGY:

在四个成串刺激的第2个刺激恢复后对顺式阿曲库胺和罗库溴铵进行拮抗时:是否必须对神经肌肉功能进行定量评估?

(殷文渊 译 王祥瑞 校)

Antagonism of Cisatracurium and Rocuronium Block at a Tactile Train-of-Four Count of 2: Should Quantitative Assessment of Neuromuscular Function Be Mandatory?

Aaron F. Kopman, Lee M. Zank, Jennifer Ng, and George G. Neuman

Anesth Analg 2004 98: 102-106.

 

顺式阿曲库铵和罗库溴铵的药效学相互作用

( 李士通 校)

Pharmacodynamic Interactions Between Cisatracurium and Rocuronium

Dara S. Breslin, Kuiran Jiao, Ashraf S. Habib, John Schultz, and Tong J. Gan

Anesth Analg 2004 98: 107-110.

长期应用抗精神病药物增加术中低体温的发生

(陆绪伟翻译 薛张纲校)

Chronic Treatment with Antipsychotics Enhances Intraoperative Core Hypothermia

Akira Kudoh, Hajime Takase, and Tomoko Takazawa

Anesth Analg 2004 98: 111-115.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Alaris AEP 监护仪的“敲击声检测”无助于判别麻醉中耳机的不慎脱开

(黄施伟 译,李士通 校)

Alaris AEPTM Monitor’s "Click Detection" Does Not Help to Detect Inadvertent Disconnection of Headphones During Anesthesia

Gunter N. Schmidt, Petra Bischoff, Thomas Standl, Andreas Gerhardt, Gunnar Lankenau, and Jochen Schulte am Esch

Anesth Analg 2004 98: 123-127.

PAIN MEDICINE:

术前口服Rofecoxib作为下腹部手术后镇痛的辅助手段:对疼痛强度和肺功能的影响

(殷文渊 译 王祥瑞 校)

Preoperative Rofecoxib Oral Suspension as an Analgesic Adjunct After Lower Abdominal Surgery: The Effects on Effort-Dependent Pain and Pulmonary Function

Raymond S. Sinatra, Qiheng J. Shen, Thomas Halaszynski, Martha A. Luther, and Yasser Shaheen

Anesth Analg 2004 98: 135-140.

 

针刺能减低伤害性刺激对麻醉状态下志愿者所引起的体感诱发电位振幅
(王立中译  李士通校)

Acupuncture Decreases Somatosensory Evoked Potential Amplitudes to Noxious Stimuli in Anesthetized Volunteers

Winfried Meissner, Thomas Weiss, Ralf H. Trippe, Holger Hecht, Clemens Krapp, and Wolfgang H. Miltner

Anesth Analg 2004 98: 141-147.

 

大鼠长期鞘内注射Ketorolac Tromethamine的抗伤害感受反应及神经毒性筛选

(陆绪伟翻译 薛张纲校)

Antinociceptive and Neurotoxicologic Screening of Chronic Intrathecal Administration of Ketorolac Tromethamine in the Rat

H. Ayben Korkmaz, Fikret Maltepe, Serhat Erbayraktar, Osman Yilmaz, Merih Güray, M. Serefettin Canda, Ali Günerli, and Necati Gökmen

Anesth Analg 2004 98: 148-152.

 

成年病人住院手术后使用右旋美托咪啶与吗啡镇痛疗效的比较

(朱辉 王祥瑞 校)

The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery

Shahbaz R. Arain, Renée M. Ruehlow, Toni D. Uhrich, and Thomas J. Ebert

Anesth Analg 2004 98: 153-158

.

丙帕他莫单次和重复给药治疗术后疼痛镇痛效果评估:牙科手术后应用丙帕他莫和吗啡镇痛的比较

(周雅春译,李士通校)

Assessing Analgesia in Single and Repeated Administrations of Propacetamol for Post

Hugo Van Aken, L. Thys, Luc Veekman, and Hartmut Buerkle

Anesth Analg 2004 98: 159-165.

 

脊柱融合术后切口持续滴注罗吡卡因的药动学及效力

(陆绪伟翻译 薛张纲校)

The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery

Margherita Bianconi, Luca Ferraro, Riccardo Ricci, Gustavo Zanoli, Tiziana Antonelli, Bighetti Giulia, Aurelia Guberti, and Leo Massari

Anesth Analg 2004 98: 166-172.

日灼性疼痛模型:交叉安置10小时以上的初级和次级痛觉过敏稳定性的比较

(忻纪华 译 王祥瑞 校)

The Sunburn Pain Model: The Stability of Primary and Secondary Hyperalgesia Over 10 Hours in a Crossover Setting

Burkhard Gustorff, Sebastian Anzenhofer, Thomas Sycha, Stephan Lehr, and Hans G. Kress

Anesth Analg 2004 98: 173-177.

 

胺碘酮减少大鼠神经痛模型对热、冷和机械刺激的痛觉过敏

(周雅春译,李士通校)

Amiodarone Decreases Heat, Cold, and Mechanical Hyperalgesia in a Rat Model of Neuropathic Pain

Sukdeb Datta, Taruna Waghray, Maria Torres, and Silvio Glusman

Anesth Analg 2004 98: 178-184.

 

糖尿病大鼠中[D-Ala2, NMePhe4, Gly-ol5]脑啡肽诱导的外周抗疼痛作用的减弱:L-精氨酸/一氧化氮/环一磷酸鸟嘌呤途径的作用

(钟鸣翻译 薛张纲校)

Reduction in [D-Ala2, NMePhe4, Gly-ol5]Enkephalin-Induced Peripheral Antinociception in Diabetic Rats: The Role of the L-Arginine/Nitric Oxide/Cyclic Guanosine Monophosphate Pathway

Arda Tasatargil and Gulay Sadan

Anesth Analg 2004 98: 185-192.

 

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

整形手术患者随机应用潘库溴胺或罗库溴胺的麻醉后苏醒时间研究

(朱慧琛 王祥瑞 校)

Postanesthesia Care Unit Recovery Times and Neuromuscular Blocking Drugs: A Prospective Study of Orthopedic Surgical Patients Randomized to Receive Pancuronium or Rocuronium

Glenn S. Murphy, Joseph W. Szokol, Mark Franklin, Jesse H. Marymont, Michael J. Avram, and Jeffery S. Vender

Anesth Analg 2004 98: 193-200.

TECHNICAL COMMUNICATIONS:

术中血细胞回收经济学分析

(周雅春译,李士通校)

Economic Analysis of an Intraoperative Cell Salvage Service

Dale F. Szpisjak, Paul S. Potter, and Bruce P. Capehart

Anesth Analg 2004 98: 201-205.

CRITICAL CARE AND TRAUMA:

二氧化碳描记术在非气管内插管急诊病人的院前呼吸监测中作为脉搏血氧饱和度监测的附加工具

(钟鸣翻译 薛张纲校)

Capnography in Non-Tracheally Intubated Emergency Patients as an Additional Tool in Pulse Oximetry for Prehospital Monitoring of Respiration

Alexander Kober, Barbara Schubert, Petra Bertalanffy, Laszlo Gorove, Tivadar Puskas, Burkhard Gustorff, Alma Joldzo, and Klaus Hoerauf

Anesth Analg 2004 98: 206-210.

 

在肺损伤实验中通气-血流分布与不同的吸入流量模式相关

(朱慧琛 王祥瑞 校)

Ventilation-Perfusion Distribution Related to Different Inspiratory Flow Patterns in Experimental Lung Injury

Rolf Dembinski, Dietrich Henzler, Ralf Bensberg, Berit Prüsse, Rolf Rossaint, and Ralf Kuhlen

Anesth Analg 2004 98: 211-219

.

韩国手部指压法用于治疗创伤病人院前转运中的晕动病:一项在老年人群中进行的前瞻性随机双盲研究:

(颜涛译,李士通校)

Korean Hand Acupressure for Motion Sickness in Prehospital Trauma Care: A Prospective, Randomized, Double-Blinded Trial in a Geriatric Population

Petra Bertalanffy, Klaus Hoerauf, Roman Fleischhackl, Helmut Strasser, Franziska Wicke, Manfred Greher, Burkhard Gustorff, and Alexander Kober

Anesth Analg 2004 98: 220-223.

OBSTETRIC ANESTHESIA:

硬膜外镇痛的走动延长对分娩的作用

(钟鸣翻译 薛张纲校)

延长走动时间对硬膜外镇痛分娩产程的影响

(颜涛译,李士通校)

The Effects of Prolonged Ambulation on Labor with Epidural Analgesia

Stéphane Frenea, Christine Chirossel, Raphaël Rodriguez, Jean-Philippe Baguet, Claude Racinet, and Jean-Francois Payen

Anesth Analg 2004 98: 224-229.

 

鞘内注射哌替啶可减少脊麻下剖腹产病人寒颤的发生率

(齐波 王祥瑞 )

椎管内哌替啶减少脊麻下行剖宫产手术中寒战的发生率

(颜涛译,李士通校)

Intrathecal Meperidine Decreases Shivering During Cesarean Delivery Under Spinal Anesthesia

Jean-Denis Roy, Michel Girard, and Pierre Drolet

Anesth Analg 2004 98: 230-234.

REGIONAL ANESTHESIA:

0.75%罗哌卡因以三种不同途径行坐骨神经阻滞起效时间的比较

(齐波 译 王祥瑞 校)

The Effects of Three Different Approaches on the Onset Time of Sciatic Nerve Blocks with 0.75% Ropivacaine

Manuel Taboada, Julián Álvarez, Joaquín Cortés, Jaime Rodríguez, Susana Rabanal, Francisco Gude, Alexander Atanassoff, and Peter G. Atanassoff

Anesth Analg 2004 98: 242-247.

GENERAL ARTICLES:

拔除喉罩前吸入100%氧不影响麻醉后动脉血氧分压

周晓敏翻译 薛张纲校

Administration of 100% Oxygen Before Removal of the Laryngeal Mask Airway Does Not Affect Postanesthetic Arterial Partial Pressure of Oxygen

Markus Renner, Matthias Hohlrieder, Thomas Wölk, Friedrich Pühringer, Axel T. Kleinsasser, Christian Keller, and Arnulf Benzer

Anesth Analg 2004 98: 257-259.

比较麻醉诱导时经面罩机械通气和手控呼吸的不同:前瞻性、随机化、交叉性研究

(周晓敏翻译 薛张纲校)

 

Mechanical Versus Manual Ventilation via a Face Mask During the Induction of Anesthesia: A Prospective, Randomized, Crossover Study

 

Achim von Goedecke, Wolfgang G. Voelckel, Volker Wenzel, Christoph Hörmann, Horst G. Wagner-Berger, Volker Dörges, Karl H. Lindner, and Christian Keller

Anesth Analg 2004 98: 260-263. ventilation.

体外循环冠脉搭桥术中使用16FDP的心肌保护作用:随机对照临床实验

Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial

Bernhard J. Riedel, MBChB, MMed, FCA, FAHA*, Janos Gal, MD, PhD*, Gillian Ellis, PhD{dagger}, Paul J. Marangos, PhD{dagger}, Anthony W. Fox, MD, FFPM, FIBiol{dagger}, and David Royston, MBBS, FRCA*

*Department of Anesthesiology, Royal Brompton & Harefield NHS Trust, London, UK and {dagger}Cypros Pharmaceutical Corporation, Carlsbad, California (now incorporated into Questcor Pharmaceuticals, Inc., Hayward, California)

Anesth Analg 2004;98:20-29


体内和体外实验提示16FDPFDP,一种葡萄糖代谢的中间产物,能通过提高高能磷酸水平来改善缺血组织的损伤,因此可能对体外循环冠脉搭桥术的患者有心肌保护作用。

通过随机,双盲,对照,安全剂量内的实验,以研究5种剂量的FDPCABG患者的作用。(n12060FDP60例对照)。5种浓度的FDP,3种无效,1种改善了心功能,1种因为产生代谢性酸中毒而需要调整剂量。患者在术前静脉注射250mgkg, 术中追加2.5Mm(n15),这些患者再灌注后246小时,血浆肌酐浓度低(p<0.05),很少发生术后心梗(p<0.05),术后心功能得到改善,表现为再灌注61216小时后(p<0.01)更高的左心室收缩指数(LVSWI),以及1216小时后的CIp<0.05)。这些数据一致说明:FDPCABG手术患者有心肌保护作用,并且支持以往的实验室和临床关于FDP对缺血性心脏病作用的研究结果。

(陈洁 王祥瑞 校)

In vitro and in vivo studies suggest that fructose-1,6-diphosphate (FDP), an intermediary glycolytic pathway metabolite, ameliorates ischemic tissue injury through increased high-energy phosphate levels and may therefore have cardioprotective properties in patients undergoing coronary artery bypass graft (CABG) surgery. We designed a randomized, placebo-controlled, double-blinded, sequential-cohort, dose-ranging safety study to test 5 FDP dosage regimens in patients (n = 120; 60 FDP, 60 control) undergoing CABG surgery. Of these dosage regimens, 3 produced no benefit, 1 produced improved cardiac function, and 1 required adjustment as a result of metabolic acidosis. This suggests that we achieved the intended effect of a dose-ranging study. The expected response was observed in patients treated with 250 mg/kg FDP IV before surgery and 2.5 mM FDP as a cardioplegic additive (n = 15). These patients had lower serum creatine kinase-MB levels 2, 4, and 6 h after reper fusion (P < 0.05), fewer perioperative myocardial infarctions (P < 0.05), and improved postoperative cardiac function, as evidenced by higher left ventricular stroke work index (LVSWI) 6, 12, and 16 h (P < 0.01) and cardiac index (CI) at 12 and 16 h (P < 0.05) after reperfusion. Overall efficacy of FDP was tested across all regimens that included IV FDP (n = 88; 44 FDP, 44 control) using 2 (FDP versus placebo) x 3 (dose size) factorial analyses. Area-under-curve (AUC) analysis demonstrated a significant increase in CI (AUC-16h, P = 0.013) and LVSWI (AUC-16h, P = 0.003) and reduction in CK-MB levels (AUC-16h, P < 0.05) in FDP-treated patients. The internal consistency of this dataset suggests that FDP may provide myocardial protection in CABG surgery and supports previous laboratory and clinical studies of FDP in ischemic heart disease.

 

体位性低血压通常发生在麻醉后第一个小时

Orthostatic Hypotension Occurs Frequently in the First Hour After Anesthesia

Dean A. Cowie, FANZCA*, J. Kevin Shoemaker, PhD{dagger}, and Adrian W. Gelb, FRCP*,{dagger}

*Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, and The University of Western Ontario; and {dagger}School of Kinesiology, The University of Western Ontario, London, Ontario, Canada

Anesth Analg 2004;98:40-45


体位性不耐受是全麻后的常见症状,与术后死亡率的增长存在着相关性。直立位低血压(OH)的诱因尚不明确。我们将较小全麻手术后的患者采用头高斜位,以评价直立位低血压(OH)的发生率和危险因素。共召集了104位患者,预先分为4组:老年女性,老年男性,青年女性,青年男性。OH的发生率分别为76.0%,72.0%,45.5%和62.5%,并与年龄的增长呈相关性(p<0.05)。血压正常组与OH组在健康指数,术前血压,ASA评分,麻醉过程,静脉补液和镇痛药物以及麻醉后抗呕吐药物的使用方面没有差异。全麻后OH患者的心率和舒张压没有升高,可能是麻醉对心血管反射的持续作用或者是因为卧床引起的心血管反射调节紊乱。我们的结论是:OH常见于全麻术后,可能是术后体位性不耐受的主要原因。

(陈洁 王祥瑞 校)

Symptoms of orthostatic intolerance are common after general anesthesia and are associated with an increased risk of postoperative morbidity. The contribution of orthostatic hypotension (OH) has not been well defined. We conducted a head-up tilt test on patients after general anesthesia for minor surgery to assess the incidence of and risk factors for OH after general anesthesia. One-hundred-four patients were enrolled and were prospectively divided into four groups: older female, older male, young female, and young male. The incidence of OH was 76.0%, 72.0%, 45.5%, and 62.5% respectively and was associated with increasing age (P < 0.05) and posttest dizziness (P < 0.05). Body mass index, preoperative blood pressure, ASA class, anesthetic duration, IV fluid administration, and use of analgesics and antiemetics in the postanesthetic care unit were not different in subjects who demonstrated OH compared with those with a normotensive response. Subjects with OH after general anesthesia did not increase their heart rate and diastolic blood pressure with a head-up tilt which may have been caused by persistent effects of anesthetics on reflex cardiovascular control and/or bedrest-induced dysregulation of reflex cardiovascular control. We conclude that OH is common after general anesthesia for minor surgery and may be the major cause of postoperative orthostatic intolerance.

 

右旋美托咪啶单次量可减少小儿七氟醚麻醉中的躁动

Single-Dose Dexmedetomidine Reduces Agitation After Sevoflurane Anesthesia in Children

Mauricio E. Ibacache, MD, Hernán R. Muñoz, MD, Verena Brandes, MD, and Anita L. Morales, RN

From the Departamento de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Anesth Analg 2004;98:60-63


急性躁动是小儿七氟醚麻醉过程中常见的副反应。右旋美托咪啶, 具有镇静和止痛作用,可能改善此种副反应。我们观察了90个进行下腹部手术和生殖器手术的儿童(年龄从1岁到10岁),在恢复期时使用右旋美托咪啶的疗效。麻醉诱导时吸入七氟醚,病人随机分组,一组病人注射生理盐水(组1, n = 30), 一组病人注射右旋美托咪啶0.15 µg/kg (2, n = 30),还有一组病人注射右旋美托咪啶0.30 µg/kg(3, n = 30). 然后面罩通气,行骶管阻滞。麻醉维持使用1%七氟醚和50%氧化亚氮,维持其自主通气。手术过程中,每隔5分钟记录病人血液动力学和呼吸的改变。并麻醉结束时记录睁眼的时间(TEO)和其他的紧急事件。三组病人的手术过程基本相似。组1TEO7.5±5.0分钟,组2的为8.2±5.0 min,组3的为9.8±4.0min(NS)。第一组病人躁动的发生率为37% (20%–54%),第二组病人的发生率为17% (4%–30%),第三组病人的发生率为10% (0%–21%)(P < 0.05)。第一组和第三组配对比较有明显的差异(P < 0.05, 95%可信间隙: 7%–47%)。三组病人的出院时间也基本相似。总结,我们认为七氟醚全麻诱导后使用0.3 µg/kg右旋美托咪啶可以减少躁动的发生,而且没有什么不良反应。

(肖洁 王祥瑞 校)

Emergence agitation is a common side effect of sevoflurane anesthesia in children. Dexmedetomidine, because of its sedative and analgesic properties, might be useful for the management of this adverse effect. We studied the effect of dexmedetomidine on recovery characteristics in 90 children aged 1 to 10 yr scheduled to undergo superficial lower abdominal and genital surgery. After inhaled induction with sevoflurane, patients were randomly assigned to receive saline (Group 1, n = 30), dexmedetomidine 0.15 µg/kg (Group 2, n = 30), or dexmedetomidine 0.30 µg/kg (Group 3, n = 30). After a laryngeal mask airway insertion a caudal block was performed in all patients. Maintenance of anesthesia was with 1% end-tidal sevoflurane and 50% nitrous oxide and spontaneous ventilation. Intraoperative hemodynamic and respiratory variables were recorded every 5 min. At the end of anesthesia time to eyes opening (TEO) and characteristics of emergence were recorded. General and intraoperative variables were similar in the 3 groups. The TEO was 7.5 ± 5.0 min in Group 1, 8.2 ± 5.0 min in Group 2, and 9.8 ± 4.0 min in Group 3 (NS). The incidence (95% confidence interval) of agitation was 37% (20%–54%) in Group 1, 17% (4%–30%) in Group 2, and 10% (0%–21%) in Group 3 (P < 0.05). Paired comparisons showed a significant difference for Group 1 versus Group 3 (P < 0.05, 95% confidence interval of the difference: 7%–47%). The time to discharge from the postanesthesia care unit was similar for the 3 groups. We conclude that a dose of dexmedetomidine 0.3 µg/kg administered after induction of anesthesia reduces the postsevoflurane agitation in children and with no adverse effects.

 

在志愿者身上进行2-氯普鲁卡因与利多卡因的比较研究

Spinal 2-Chloroprocaine: A Comparison with Lidocaine in Volunteers

Mary E. Kouri, MD, and Dan J. Kopacz, MD

From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington

Anesth Analg 2004;98:75-80

需要脊麻的门诊病人一般选择利多卡因行蛛网膜下腔麻醉。但是,常发生短暂的神经症状(TNS)2-氯普鲁卡因具有独特的化学结构,不含防腐剂,在脊麻过程中与利多卡因进行了比较。在这个双盲的,随机的,对照研究中,我们在8位自愿者身上比较了氯普鲁卡因和利多卡因,每一位自愿者接受了两次脊麻,一次为40mg 2% 的利多卡因,另一次为40 mg 2% 2-氯普鲁卡因。通过针刺觉,对经皮电刺激的耐受程度以及止血带,运动能力和模拟放电轨迹等方面进行评价。氯普鲁卡因的药效与利多卡因相似,包括阻滞峰值分别为(T8 [T5–11]T8 [T6–12], P = 0.8183),止血带耐受时间(46 ± 6 min 38 ± 24 min, P = 0.4897)。氯普鲁卡因麻醉感觉消失的较早(103 ± 13 min126 ± 16 min, P = 0.0045),更迅速的达到模拟放电的标准(104 ± 12 min 134 ± 14 min, P = 0.0007)8个自愿者中有7位在使用利多卡因后有中度的TNS反应,而使用氯普鲁卡因后无TNS的发生(P = 0.0004)。总结,通过氯普鲁卡因与利多卡因的比较,氯普鲁卡因具有可信的感觉和运动阻滞区间,并且副反应少,是在门诊手术中值得选用的脊麻药物。

(肖洁 王祥瑞 校)

Subarachnoid lidocaine has been the anesthetic of choice for outpatient spinal anesthesia. However, its use is associated with transient neurologic symptoms (TNS). Preservative-free formulations of 2-chloroprocaine are now available and may compare favorably with lidocaine for spinal anesthesia. In this double-blinded, randomized, crossover study, we compared spinal chloroprocaine and lidocaine in 8 volunteers, each receiving 2 spinal anesthetics: 1 with 40 mg 2% lidocaine and the other with 40 mg 2% preservative-free 2-chloroprocaine. Pinprick anesthesia, tolerance to transcutaneous electrical stimulation and thigh tourniquet, motor strength, and a simulated discharge pathway were assessed. Chloroprocaine produced anesthetic efficacy similar to lidocaine, including peak block height (T8 [T5–11] versus T8 [T6–12], P = 0.8183) and tourniquet tolerance (46 ± 6 min versus 38 ± 24 min, P = 0.4897). Chloroprocaine anesthesia resulted in faster resolution of sensory (103 ± 13 min versus 126 ± 16 min, P = 0.0045) and more rapid attainment of simulated discharge criteria (104 ± 12 min versus 134 ± 14 min, P = 0.0007). Lidocaine was associated with mild to moderate TNS in 7 of 8 subjects; no subject complained of TNS with chloroprocaine (P = 0.0004). We conclude that the anesthetic profile of chloroprocaine compares favorably with lidocaine. Reliable sensory and motor blockade with predictable duration and minimal side effects make chloroprocaine an attractive choice for outpatient spinal anesthesia.

 

在四个成串刺激的第2个刺激恢复后对顺式阿曲库胺和罗库溴铵进行拮抗时:是否必须对神经肌肉功能进行定量评估?

Antagonism of Cisatracurium and Rocuronium Block at a Tactile Train-of-Four Count of 2: Should Quantitative Assessment of Neuromuscular Function Be Mandatory?

Aaron F. Kopman, MD, Lee M. Zank, MD, Jennifer Ng, MD, and George G. Neuman, MD Section Editor

Department of Anesthesiology, New York Medical College, Valhalla, New York

Anesth Analg 2004;98:102-106


随着四个成串刺激(TOF)比值>0.70作为肌松恢复的标准,麻醉后监护室(PACUs)中经常发生术后肌松残余麻痹。可是,有关麻醉前管理的详细信息很少提供。我们研究了使用短效肌松药顺式阿曲库铵和罗库溴铵以及随后使用新斯的明后术后肌肉无力的发生情况。在使用0.15mg/kg顺式阿曲库铵或0.60mg/kg罗库溴铵后使用地氟醚,N2O,阿片类镇痛药插管。拇指对刺激尺神经所产生的反应通过触动来估计。补加肌松药使TOF计数维持在12。在手术结束时,TOF计数为2,使用新斯的明0.05mg/kg10μg/kg。机械TOF反应在逆转后5分钟通过压力转换器测量。病人都观察到TOF比值恢复到0.90。顺式阿曲库铵和罗库溴铵相比在恢复上没有显著差别。TOF比值在逆转后10分钟分别为0.72±0.100.76±0.11。在逆转后15分钟,每组只有一个病例TOF比值<0.70。结果提示如果使用顺式阿曲库铵或罗库溴铵时通过TOF计数来作为指导的必要性不大.

(殷文渊 译 王祥瑞 校)

With a train-of-four (TOF) ratio >0.70 as the standard of acceptable recovery, postoperative residual paralysis is a frequent occurrence in postanesthesia care units (PACUs). However, detailed information regarding prior anesthetic management is rarely provided. We examined the incidence of postoperative weakness after the administration of cisatracurium and rocuronium when using a rigid protocol for muscle relaxant and subsequent neostigmine administration. Under desflurane, N2O, and opioid anesthesia, tracheal intubation was accomplished after either cisatracurium 0.15 mg/kg or rocuronium 0.60 mg/kg. The response of the thumb to ulnar nerve stimulation was estimated by palpation. Additional increments of muscle relaxant were given as needed to maintain the TOF count at 1 or 2. At the conclusion of surgery, at a TOF count of 2, neostigmine 0.05 mg/kg plus glycopyrrolate 10 µg/kg was administered. The mechanical TOF response was then measured with a force transducer starting 5 min postreversal. Patients were observed until a TOF ratio of 0.90 was achieved. There were no significant differences in the recovery profiles of cisatracurium versus rocuronium. TOF ratios at 10 min postreversal were 0.72 ± 0.10 and 0.76 ± 0.11, respectively. At 15 min postreversal, only one subject in each group had a TOF ratio of <0.70. No patient in either group arrived in the PACU with a TOF ratio <0.70. Our results suggest that if cisatracurium or rocuronium is administered by using the TOF count as a guide, critical episodes of postoperative weakness in the PACU should be an infrequent occurrence.

术前口服Rofecoxib作为下腹部手术后镇痛的辅助手段:对疼痛强度和肺功能的影响

Preoperative Rofecoxib Oral Suspension as an Analgesic Adjunct After Lower Abdominal Surgery: The Effects on Effort-Dependent Pain and Pulmonary Function

Raymond S. Sinatra, MD, PhD, Qiheng J. Shen, MD, Thomas Halaszynski, MD, Martha A. Luther, MPH, and Yasser Shaheen, MD Section Editor

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

Anesth Analg 2004;98:135-140

Rofecoxib是一种选择性环氧化酶-2抑制剂,它能减轻疼痛和炎症反应而不抑制血小板功能。我们在48名开腹手术病人中检测了它对疼痛强度,术后吗啡的需求量,和肺功能的影响。术前进行被动呼气量和被动潮气量的测量来评估肺功能。在随机双盲情况下,全麻插管前一小时给予口服安慰剂(A组)或口服Rofecoxib25mg[]50mg[C])。在麻醉后监护室中静脉注射吗啡,在病房中病人自控镇痛静脉使用吗啡控制疼痛。吗啡剂量,平静时疼痛程度和用力呼吸后疼痛(术后肺活量)分别在研究药物使用1224小时候记录。B组和C组与A组相比病人自控镇痛吗啡剂量在24小时分别减少44%30.3±17.5mg)和59%22.1±16.5mg)。在12小时,B组和C组平静时和呼吸后疼痛评分均低于A组(P<0.05)。在24小时C组的平静时疼痛评分是最低的(P<0.05)。C12小时FVC是保持最好的(P<0.03)。不利影响和术中出血各组间没有差异。口服Rofecoxib可以提供一种吗啡起始效应,也就是改善了疼痛控制和开腹手术病人的12小时FVC

(殷文渊 译 王祥瑞 校)

Rofecoxib is a selective cyclooxygenase-2 inhibitor that reduces pain and inflammation without inhibiting platelet function. We examined its effects on effort-dependent pain, postoperative morphine requirements, and pulmonary function in 48 patients recovering from open abdominal surgery. Spirometric measurement of forced expiratory volume1 and vital capacity (FVC) were assessed preoperatively. One hour before the induction of a standardized general anesthetic, patients were given either placebo oral suspension (Group A), or rofecoxib oral suspension (25 mg [Group B] or 50 mg [Group C]) in a double-blinded manner. Postoperative pain control was provided with IV morphine in the postanesthesia care unit and IV-patient-controlled analgesia morphine on the patient care unit. Morphine dose, pain intensity at rest, and pain after respiratory effort (postoperative spirometry) were assessed at 12 and 24 h after study drug administration. The patient-controlled analgesia morphine dose at 24 h was reduced 44% in Group B (30.3 ± 17.5 mg) and 59% in Group C (22.1 ± 16.5 mg) versus Group A (53.7 ± 31.1 mg); P < 0.01 (A versus B). At 12 h, pain scores at rest and after spirometry were lower in Groups B and C than in A (P < 0.05). At 24 h, resting pain scores were lowest in Group C (P < 0.05). Twelve-hour FVC was best preserved in Group C (P < 0.03). There were no inter-group differences in adverse effects or perioperative blood loss. Rofecoxib oral suspension provided a morphine-sparing effect, as well as improvements in pain control and 12-h FVC in patients recovering from open abdominal surgery.

 

成年病人住院手术后使用右旋美托咪啶与吗啡镇痛疗效的比较

The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery

Shahbaz R. Arain, MD, Renée M. Ruehlow, BS, Toni D. Uhrich, MS, and Thomas J. Ebert, MD, PhD

From the Department of Anesthesiology, Medical College of Wisconsin and VA Medical Center, Milwaukee, WI

Anesth Analg 2004;98:153-158


34名成年选择性手术患者被随机地等分成两组,一组使用右旋美托咪啶(首次负荷剂量为1μg/kg,10分钟后给予0.4μg/kg/h维持4小时),另一组在手术结束前30分钟使用硫酸吗啡(0.08mg/kg)。我们测定心率(HR,平均动脉压(MAP),呼吸频率(RR),镇静和镇痛效果(视觉疼痛评分),记录在麻醉后苏醒室(PACU)额外使用吗啡的量直至手术结束后24小时。两组患者的人口统计学,ASA分级,手术过程,基础血流动力学以及术中用药输液情况都相似。使用右旋美托咪啶的患者在PACU时心率要慢于后一组(平均为16bpm),然而MAP,RR以及镇静程度两组相似。在复苏的第一阶段,右旋美托咪啶组的患者使用吗啡的量显著低于后组而达到相同的镇痛效果(右旋美托咪啶组,4.5±6.8mg;吗啡组,9.2±5.2mg)。60分钟内苏醒的患者中,右旋美托咪啶组17名病人中仅有6名再需要吗啡,而吗啡组有15名再需要吗啡。由此,我们得出结论,在成年患者住院手术结束前使用右旋美托咪啶可减少(约66%)术后早期吗啡的需求量并可降低在PACU时的心率。

(朱辉 王祥瑞 校)

Thirty-four patients scheduled for elective inpatient surgery were randomized equally to receive either dexmedetomidine (initial loading dose of 1-µg/kg over 10 min followed by 0.4 µg • kg-1 • h-1 for 4 h) or morphine sulfate (0.08 mg/kg) 30 min before the end of surgery. We determined heart rate (HR), mean arterial blood pressure (MAP), respiratory rate (RR), sedation and analgesia (visual analog scale), and use of additional morphine in the postanesthesia care unit (PACU) and up to 24 h after surgery. Groups were similar for patient demographics, ASA physical status, surgical procedure, baseline hemodynamics, and intraoperative use of drugs and fluids. Dexmedetomidine-treated patients had slower HR in the PACU (by an average of 16 bpm), whereas MAP, RR, and level of sedation were similar between groups. During Phase I recovery, dexmedetomidine-treated patients required significantly less morphine to achieve equivalent analgesia (PACU dexmedetomidine group, 4.5 ± 6.8 mg; morphine group, 9.2 ± 5.2 mg). Sixty minutes into recovery only 6 of 17 dexmedetomidine patients required morphine in contrast to 15 of 17 in the morphine group. The administration of dexmedetomidine before the completion of major inpatient surgical procedures significantly reduced, by 66%, the early postoperative need for morphine and was associated with a slower HR in the PACU.

 

日灼性疼痛模型:交叉安置10小时以上的初级和次级痛觉过敏稳定性的比较

The Sunburn Pain Model: The Stability of Primary and Secondary Hyperalgesia Over 10 Hours in a Crossover Setting

Burkhard Gustorff, MD, DEAA, Sebastian Anzenhofer, MD, Thomas Sycha, MD, Stephan Lehr, MSc, and Hans G. Kress, MD, PhD

From the Department of Anesthesia and General Intensive Care Medicine (B), University of Vienna, Vienna, Austria

Anesth Analg 2004;98:173-177


我们的目的是研究10小时以上经UVB照射导致的初级和次级痛觉过敏在当天的稳定性和隔天的重复性。8名志愿者大腿部经UVB照射20小时后,对该照射点(r=2.5cm)的针刺觉,热痛阈(HPTT)和电刺激(5250Hz的电痛阈[EPTT])进行评估。在两个时段里,分别测量10小时(每隔2小时测量一次)。观察到针刺觉的次级痛觉过敏区域扩大(5995mm 2; SD 1645.与正常的皮肤相比,照射点初级痛觉过敏的HPTT明显下降(平均差,6.5℃95%可信区间,6.1-6.8 ; p<0.001),250HzEPTT也下降( 平均差,0.45mA95%可信区间,0.13-0.75p<0.005)。在同一时段内的初级痛觉过敏(p=0.14, HPTT)或次级痛觉过敏(p=0.95)无不同趋势,两个时段内的初级痛觉过敏(p=0.28)和次级痛觉过敏(p=0.07)无差异。日灼模型提供了长期稳定的痛觉过敏,在当天高度稳定,而隔天的初级和次级痛觉过敏的重复心病感高。

(忻纪华 译 王祥瑞 校)

It was our aim to study the within-day stability and between-day repeatability of ultraviolet B (UVB) light-induced primary and secondary hyperalgesia over 10 h. Twenty hours after UVB irradiation of a skin spot (r = 2.5 cm) on the upper leg of 8 healthy volunteers the areas of secondary hyperalgesia to pinprick and pain tolerance thresholds to heat (HPTT) and electrical stimuli (5 and 250 Hz, electrical pain tolerance thresholds [EPTT]) were assessed. Measurements were repeated for 10 h at 2-h intervals and in 2 different sessions. Large areas of secondary hyperalgesia to pin prick were observed (5995 mm2; SD, 1645). Primary hyperalgesia was evidenced by significant decreases of HPTT (mean difference, 6.5°C; 95% confidence interval, 6.1–6.8; P < 0.001) and EPTT at 250 Hz (mean difference, 0.45 mA; 95% confidence interval, 0.13–0.78; P < 0.05) compared to normal skin. There was no trend within one session of either primary (P = 0.14 for HPTT) or secondary hyperalgesia (P = 0.95) and no difference between the two sessions (primary hyperalgesia, P = 0.28; secondary hyperalgesia, P = 0.07). The sunburn pain model provides a long time course of stable hyperalgesia with a high within-day stability and between-day repeatability for primary and secondary hyperalgesia

整形手术患者随机应用潘库溴胺或罗库溴胺的麻醉后苏醒时间研究

Postanesthesia Care Unit Recovery Times and Neuromuscular Blocking Drugs: A Prospective Study of Orthopedic Surgical Patients Randomized to Receive Pancuronium or Rocuronium

Glenn S. Murphy, MD*, Joseph W. Szokol, MD*, Mark Franklin, MD*, Jesse H. Marymont, MD*, Michael J. Avram, PhD{dagger}, and Jeffery S. Vender, MD* Section Editor

*Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, Illinois; and {dagger}Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Anesth Analg 2004;98:193-200


在这次实验中我们主要研究整形外科手术患者在选用了神经肌肉阻滞药(潘库溴胺和罗库溴胺)后,其术后恢复时间和相关副反应的不同。70名患者被随机分为罗库溴胺组和潘库溴胺组,在到达麻醉后恢复室(PACU)时及30分钟后运用肌松监测仪测试TOF比率,并评估麻醉恢复程度。在PACU期间记录下低氧血症、恶心、呕吐的发生情况以及离开PACU的标准时间和实际离开的时间。潘库溴胺组中40%的患者在到达PACUTOF比率<0.7,而罗库溴胺组仅5.9%P<0.001)。在PACU期间潘库溴胺组的患者更容易出现肌力减退症状(视力模糊和全身乏力P<0.001),低氧血症的发生率潘库溴胺组为21名患者而罗库溴胺组为10名患者,潘库溴胺组离开PACU的标准时间为50分钟(45—60分钟),实际离开时间为70分钟(60—90分钟);罗库溴胺组离开PACU的标准时间为30分钟(25—40分钟),实际离开时间为57.5分钟(45—61分钟)(P<0.001)。综上所述,对于使用长效肌松药的手术患者在PACU中的恢复时间应尽可能延长。

(朱慧琛 王祥瑞 校)

In this study, we examined the effect of choice of neuromuscular blocking drug (NMBD) (pancuronium versus rocuronium) on postoperative recovery times and associated adverse outcomes in patients undergoing orthopedic surgical procedures. Seventy patients were randomly allocated to a pancuronium or rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30 min later, train-of-four ratios were quantified by using acceleromyography. Immediately after acceleromyographic measurements, patients were assessed for signs and symptoms of residual paresis. During the PACU admission, episodes of hypoxemia, nausea, and vomiting were recorded. The time required for patients to meet discharge criteria and the time of actual PACU discharge were noted. Forty percent of patients in the pancuronium group had train-of-four ratios <0.7 on arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group (P < 0.001). Patients in the pancuronium group were more likely to experience symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001) and hypoxemia (10 patients in the rocuronium group versus 21 patients in the pancuronium group; P = 0.015) during the PACU admission. Significant delays in meeting PACU discharge criteria (50 min [45–60 min] versus 30 min [25–40 min]) and achieving actual discharge (70 min [60–90 min] versus 57.5 min [45–61 min]) were observed when the pancuronium group was compared with the rocuronium group (P < 0.001). In conclusion, our study indicates that PACU recovery times may be prolonged when long-acting NMBDs are used in surgical patients.

 

在肺损伤实验中通气-血流分布与不同的吸入流量模式相关

Ventilation-Perfusion Distribution Related to Different Inspiratory Flow Patterns in Experimental Lung Injury

Rolf Dembinski, MD, Dietrich Henzler, MD, Ralf Bensberg, Berit Prüsse, Rolf Rossaint, MD, and Ralf Kuhlen, MD

From the Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

Anesth Analg 2004;98:211-219


在急性肺损伤(ALI)时,减速流量(Vdec)与恒定流量(Vcon)的控制性机械通气相比可提高氧合,这主要是由于改善了通气-血流(VA/VQ)分布。我们利用ALI的动物模型以测试这一理论,同时也评估Vdeco的效用。在此实验中,18ALI的猪被随机分为VconVdecVdeco组,每组均以相同的潮气量及PEEP行机械通气6小时,期间检测各组的血流动力学、气体交换和VA/VQ分布,结果显示各组因减少了肺内分流,因此氧合均增加(P<0.05),然而仅Vcon通气组在正常的VA/VQ分布时增加肺内血流(P<0.05)。VconPaO2VdecVdeco更高(P<0.05)。我们得出结论:Vcon可提供更好的VA/VQ分布并进一步提高氧合。

(朱慧琛 王祥瑞 校)

In acute lung injury (ALI), controlled mechanical ventilation with decelerating inspiratory flow (Vdec) has been suggested to improve oxygenation when compared with constant flow (Vcon) by improving the distribution of ventilation and perfusion (VA/Q). We performed the present study to test this hypothesis in an animal model of ALI. Furthermore, the effects of combined decelerating and constant flow (Vdeco) were evaluated. Thus, 18 pigs with experimental ALI were randomized to receive mechanical ventilation with either Vcon, Vdec or a fixed combination of both flow wave forms (Vdeco) at the same tidal volume and positive end-expiratory pressure level for 6 h. Hemodynamics, gas exchange, and VA/Q distribution were determined. The results revealed an improvement of oxygenation resulting from a decrease of pulmonary shunt within each group (P < 0.05). However, blood flow to lung areas with a normal VA/Q distribution increased only during ventilation with Vcon (P < 0.05). Accordingly, PaO2 was higher with Vcon than with Vdec and Vdeco (P < 0.05). We conclude that contrary to the hypothesis, Vcon provides a more favorable VA/Q distribution, and hence better oxygenation, when compared with Vdec and Vdeco in this model of ALI.

 

鞘内注射哌替啶可减少脊麻下剖腹产病人寒颤的发生率

Intrathecal Meperidine Decreases Shivering During Cesarean Delivery Under Spinal Anesthesia

Jean-Denis Roy, MD, Michel Girard, MD, MHPE, FRCP(C), and Pierre Drolet, MD, FRCP(C)

Département d’Anesthésiologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada

Anesth Analg 2004;98:230-234


由脊麻引起的术中寒颤可使病人感到不舒适,并影响麻醉监测。因此,我们进行了这项前瞻性、随机双盲试验来研究通过鞘内注射哌替啶(0.2mg/Kg)是否可以减少脊麻下剖腹产病人寒颤的发生率和强度。40名行非急诊剖腹产手术的临产妇被分为两组。脊麻药物采用重比重布比卡因(0.7510.5mg)和吗啡0.15mg,另外,实验组病人加用哌替啶(0.2mg/Kg,对照组加用生理盐水。实验中需观察的数据包括感觉阻滞平面、血压、中心温度和寒颤强度。在实验过程中首先每一分钟记录这些数据共记录10分钟,然后每3分钟一次记录33分钟,再每5分钟一次直到感觉平面消退至L4。结果发现到达最高感觉平面的时间、最大阻断节断数、感觉和运动阻滞平面的消退情况和病人收缩压在两组病人均无明显差异。而哌替啶组病人的寒颤发生率(P0.02)和寒颤强度(P0.003)均减小。因此鞘内注射哌替啶0.2mg/kg可减少脊麻下剖腹产病人寒颤的发生率和寒颤强度

(齐波 王祥瑞 )

Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. We performed this prospective, double-blinded, and randomized study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for cesarean delivery. Forty parturients scheduled for nonemergent cesarean delivery were enrolled in two groups. Spinal anesthesia consisted of hyperbaric bupivacaine (0.75%; 10.5 mg), morphine 0.15 mg, and, in the experimental group, meperidine (0.2 mg/kg) or, in the control group, normal saline. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was performed every minute for 10 min, every 3 min for 33 min, and then every 5 min until the sensory level receded to L4. Time to highest sensory level, maximum number of blocked segments, sensory and motor blockade regression, and systolic blood pressure showed no difference between groups. The incidence of shivering was less (P < 0.02) in the meperidine group, as was its intensity (P < 0.003). Intrathecal meperidine (0.2 mg/kg) is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery.

 

0.75%罗哌卡因以三种不同途径行坐骨神经阻滞起效时间的比较

The Effects of Three Different Approaches on the Onset Time of Sciatic Nerve Blocks with 0.75% Ropivacaine

Manuel Taboada, MD*, Julián Álvarez, MD, PhD*, Joaquín Cortés, MD, PhD*, Jaime Rodríguez, MD, PhD*, Susana Rabanal, MD*, Francisco Gude, MD{dagger}, Alexander Atanassoff{ddagger}, and Peter G. Atanassoff, MD§ Section Editor

*Department of Anesthesiology and {dagger}Clinical Epidemiology Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; {ddagger}Department of Anesthesiology, Universidad de Santiago de Compostela, Spain; and §Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut

Anesth Analg 2004;98:242-247


我们研究0.75%罗哌卡因以三种不同途径行坐骨神经阻滞的起效时间和效果。全部75例病人均行足部手术,随机分为三组行坐骨神经阻滞:经典后径路(经典组;n=25),改良的臀筋膜下后径路(臀筋膜下组;n=25),或侧腘窝径路(腘窝组;n=25)。所有操作均应用神经刺激器(刺激频率,2Hz;刺激强度,0.5-2mA)和30ml 0.75%罗哌卡因。神经阻滞的起效时间以坐骨神经支配区域的针刺觉完全消失和足部不能背曲和跖曲为标准。在这三组中,有一例在<0.5mA时诱发出刺激。三组的失败率相似(腘窝组:4%,经典组:4%,臀筋膜下组:8%)。腘窝组的起效时间(25+/-5min)长于经典组(16+/-4min)和臀筋膜下组(17+/-4min,p<0.001)。经典组和臀筋膜下组的起效时间无明显差异。在术后第一次给予镇痛药之前三组的疼痛程度评分无差异。我们总结到:在坐骨神经支配区域三种方法都可为临床接受,臀筋膜下组和经典径路组的麻醉起效时间早于侧腘窝组。

(齐波 译 王祥瑞 校)

We studied three different injection techniques of sciatic nerve block in terms of block onset time and efficacy with 0.75% ropivacaine. A total of 75 patients undergoing foot surgery were randomly allocated to receive sciatic nerve blockade by means of the classic posterior approach (group classic; n = 25), a modified subgluteus posterior approach (group subgluteus; n = 25), or a lateral popliteal approach (group popliteal; n = 25). All blocks were performed with the use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 2–0.5 mA) and 30 mL of 0.75% ropivacaine. Onset of nerve block was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot. In the three groups, an appropriate sciatic stimulation was elicited at <0.5 mA. The failure rate was similar in the three groups (group popliteal: 4% versus group classic: 4% versus group subgluteus: 8%). The onset of nerve block was slower in group popliteal (25 ± 5 min) compared with group classic (16 ± 4 min) and group subgluteus (17 ± 4 min; P < 0.001). There was no significant difference in the onset of nerve block between group classic and group subgluteus. No differences in the degree of pain measured at the first postoperative administration of pain medication were observed among the three groups. We conclude that the three approaches resulted in clinically acceptable anesthesia in the distribution of the sciatic nerve. The subgluteus and classic posterior approaches generated a significantly faster onset of anesthesia than the lateral popliteal approach.

 

心脏手术中的A- B-型利尿钠肽

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures

Elmar Berendes, MD*, Christoph Schmidt, MD*, Hugo Van Aken, MD, PhD, FRCA, FANZCA*, Maike Grosse Hartlage, MD*, Markus Rothenburger, MD{dagger}, Stefan Wirtz, MD*, Hans Heinrich Scheld, MD{dagger}, Gerhard Brodner, MD*, and Michael Walter, MD{ddagger}

Klinik und Poliklinik für *Anästhesiologie und Operative Intensivmedizin and {dagger}Herz–, Thorax- und Gefäßchirurgie, University of Münster, Münster, Germany; and {ddagger}Department of Biochemistry, Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2004;98:11-19

 

这个研究是关于进行心脏手术的病人中A-(ANP) B-(BNP) 利尿钠肽的分泌机制和预后评价。我们分别在接受冠脉搭桥(CABG)和换瓣的病人中测量ANP BNP的值。将CABG再分为有心室功能不全组(n = 28)和无心室功能不全组(n = 32);换瓣组分为二尖瓣(n = 21)和主动脉瓣组(n = 24)。术后死亡率随访到术后730天。ANP的浓度比BNP与主动脉夹闭后心脏的再灌注容量相关性更大。手术中BNP的分泌机制更加不一致。BNP的浓度在体外循环的病人中于主动脉夹闭的时间(r2 = 0.32; P = 0.006)和术后肌钙蛋白I的浓度(r2 = 0.22; P = 0.0009)相关,在这些病人中术前 BNP的浓度增高和术后(两年)的死亡率有关。在二尖瓣替换(增高3倍)和主动脉瓣替换(增高14倍)的患者中术前显著增高的BNP在术后不再继续增高。这些数据表明ANP主要和主动脉夹闭后心脏的再灌注容量相关,而BNP和其他因素,如长期左室内压和/或血管内容量超负荷有关。BNP而不是ANP,在CABG病人中显示为一种预测死亡率的因素。

(方芳翻译 薛张纲校)

This study was performed to determine the secretion pattern and prognostic value of A-type (ANP) and B-type (BNP) natriuretic peptide in patients undergoing cardiac surgical procedures. We measured ANP and BNP in patients undergoing coronary artery bypass grafting (CABG) with (n = 28) or without (n = 32) ventricular dysfunction and in patients undergoing mitral (n = 21) or aortic (n = 24) valve replacement, respectively. Postoperative mortality was recorded up to 730 days after operation. ANP, but not BNP, concentrations were closely associated with volume reloading of the heart after aortic cross-clamp in all patients. The secretion pattern of BNP during surgery was much less uniform. BNP, but not ANP, concentrations correlated with aortic cross-clamp time (r2 = 0.32; P = 0.006) and postoperative troponin I concentrations (r2 = 0.22; P = 0.0009) in bypass patients, and preoperative BNP increases were associated with a more frequent postoperative (2-yr) mortality in these patients. Markedly increased preoperative BNP concentrations in mitral (3-fold) and aortic (14-fold) valve disease patients did not further increase during cardiopulmonary surgery. The data suggest that ANP is primarily influenced by intravascular volume reloading of the heart after cross-clamp, whereas the secretion of BNP is related to other factors, such as duration of ischemia and long-term left ventricular pressure and/or excessive intravascular volume. BNP, but not ANP, was shown to be a mortality risk predictor in patients undergoing CABG

.

原发性多汗症病人中内镜下胸交感神经切除术可以抑制压力反射对心率的控制

Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis

Yurie T. Kawamata, MD*, Tomoyuki Kawamata, MD{dagger}, Keiichi Omote, MD{dagger}, Eiji Homma, MD*, Tatsuo Hanzawa, MD*, Toshifumi Kaneko, MD{ddagger}, and Akiyoshi Namiki, MD{dagger}

Departments of *Anesthesiology and {ddagger}Surgery, Nippon Telegraph and Telephone East Japan Sapporo Hospital, Sapporo, Japan; and {dagger}Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan

Anesth Analg 2004;98:37-39

 

内镜下胸交感神经(T2-3 T3-4)切除术(ETS)是手掌多汗症的一个非常有效的治疗方法。由于T2-3 T3-4的交感神经节和心脏的交感神经直接相关,交感神经切除会改变心率的压力反射。我们这项研究的目的就是观察小剂量地氟醚麻醉下,ETS对由升压或降压刺激引起的压力反射的影响。我们观察了40位因为手心或腋下多汗而接受 ETS的患者。在手术中,我们使用内镜来确认并切除胸交感神经节。术前或术后在小剂量全麻下我们通过静脉使用新福林和硝酸甘油来进行升压和降压实验。压力反射的敏感性通过R-R间期和收缩压来反映。ETS并不改变静息状态下的心率和系统血压;但是显著改变了所有病人的在升压和降压实验中的压力反射。19个接受升压实验的患者中一人的压力反射被完全抑制住了,而在21个接受降压实验的患者中,有9个。我们认为在接受ETS的病人中压力反射被抑制了。

(方芳翻译 薛张纲校)

Endoscopic thoracic (T2-3 or T3-4) sympathectomy (ETS) is a highly effective treatment for palmar hyperhidrosis. Because the T2-3 or T3-4 sympathetic ganglia are involved in direct sympathetic innervation of the heart, sympathectomy at this level may alter baroreflex control of heart rate. The purpose of our study was to examine the influence of ETS on baroreflex responses to pressor and depressor stimuli under small-dose sevoflurane anesthesia. We studied 40 patients with palmar or axillary hyperhidrosis who were scheduled to receive ETS. In the ETS procedure, the sympathetic trunk was identified by using thoracic endoscopy and was transected. Before and after ETS, the pressor or depressor test was performed by using an IV infusion of phenylephrine or nitroglycerin, respectively, under small-dose general anesthesia. Baroreflex sensitivity was calculated from R-R intervals and systolic blood pressure. ETS did not change heart rate and systemic blood pressure at rest, although ETS significantly altered baroreflex in both pressor and depressor tests in all patients. Baroreflex was completely suppressed in 1 of 19 patients in the pressor test and in 9 of 21 patients in the depressor test. We conclude that baroreflex responses are suppressed in patients who receive ETS.

 

可乐定延长新生儿脊麻时间:一项前瞻性剂量范围研究

Clonidine Prolongs Spinal Anesthesia in Newborns: A Prospective Dose-Ranging Study

Alain Rochette, MD*, Olivier Raux, MD*, Rachel Troncin, MD*, Christophe Dadure, MD*, Régis Verdier, MD{dagger}, and Xavier Capdevila, MD, PhD*

Departments of *Anesthesia and Intensive Care "A" and {dagger}Medical Statistics, Hôpital Lapeyronie, CHU de Montpellier, France

Anesth Analg 2004;98:56-59

在新生儿和早产儿中脊麻可以减少全麻后的死亡率。但是单用布比卡因对40%的病人来说作用时间太短而难以完成手术。可乐定延长了成人的脊麻和儿童的骶麻的时间而不带来显著的副作用。我们用75例在脊麻下接受脐疝修补术的新生儿,其中50%为早产儿,来进行可乐定前瞻性,对照的剂量范围研究。患儿分别接受0.5%的等比重布比卡因(1 mg/kg),或加入0.25, 0.5, 1, 2 µg/kg可乐定的布比卡因。主要记录平均动脉压,心率,SpO2 ,感觉阻滞的平面和持续时间的数据。平均动脉压,心率,SpO2 ,感觉阻滞的平面在五组患儿中都相似。在对照组中持续时间为67 (58–82)分钟,而加入1µg/kg可乐定的组中为111 (93–125) 分钟(P < 0.003)。使用2µg/kg可乐定组中, 一过性的低血压发生率更高(P < 0.05),咖啡因的使用更频繁。我们认为在新生儿中1µg/kg可乐定能显著提高脊麻的效果并且不发生严重的副反应。

(方芳翻译 薛张纲校)

Spinal anesthesia may reduce the incidence of morbidity that follows general anesthesia in neonates and in former preterm infants. However, bupivacaine alone provides a block too short for complete surgery in up to 40% of the patients. Clonidine lengthens spinal anesthesia in adults and caudal block in children without significant side effects. We conducted a controlled, prospective, dose-ranging study of clonidine in spinal anesthesia in 75 neonates, including 50% of former preterm infants, undergoing elective inguinal herniorrhaphy. Patients were given a spinal anesthetic with either 0.5% plain isobaric bupivacaine (1 mg/kg), or bupivacaine plus 0.25, 0.5, 1, or 2 µg/kg clonidine. Mean arterial blood pressure, heart rate, SpO2, sensory block extension and duration were the main data recorded. Mean arterial blood pressure, heart rate, SpO2, and block extension were similar in the five groups. Duration of spinal block increased from 67 (58–82) min in the control group up to 111 (93–125) min in the group receiving 1 µg/kg clonidine (P < 0.003). Transient hypotension occurred more often (P < 0.05), and caffeine was given more often, when 2 µg/kg clonidine was given. We conclude that 1 µg/kg clonidine provides a significant improvement in spinal anesthesia duration in newborns without significant side effects.

 

脊髓中氯普鲁卡因溶液:37° C的密度和 pH滴定。

Spinal Chloroprocaine Solutions: Density at 37° C and pH Titration

Kimberly B. Na, MD, and Dan J. Kopacz, MD Section Editor

From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington

Anesth Analg 2004;98:70-74

当作为鞘内用药时,局麻药的密度和PH值是重要的参数。不含防腐剂和抗氧化剂配方的 氯普鲁卡因可用于短时间的脊麻。在此项研究中,我们评价了这些新配方的氯普鲁卡因的PH和密度( 37.0°C时以g/mL表示,保留小数点后五位)。我们评价了单纯2% 3% 氯普鲁卡因 和2%利多卡因,加入肾上腺素或碳酸氢盐的2%的氯普鲁卡因。我们也通过使用水稀释或加入不同量的葡萄糖来改变密度。2%3%的氯普鲁卡因(密度分别为1.00123 g/mL 1.00257 g/mL)在加入葡萄糖之前对脑脊液(CSF)来说是重比重溶液。当用水稀释后都为低比重溶液(密度 <1.00028 g/mL)2%的利多卡因是唯一的不含葡萄糖的低比重溶液(1.00004 g/mL)。不含亚硫酸氢盐的2-氯普鲁卡因仍偏酸(pH <4.0),但通过加入小剂量的碳酸氢盐(0.25–0.33 mL/10 mL)可提高PH值到7.0以上。提高氯普鲁卡因的密度,即使不加入葡萄糖,也能使他成为一种有用的重比重脊麻药。

(方芳翻译 薛张纲校)

The density and pH of a local anesthetic are important characteristics in its use as an intrathecal drug. Preservative- and antioxidant-free formulations of chloroprocaine are available and are being investigated for short-duration spinal anesthesia. In this study, we evaluated the pH and density (to 5 significant digits in g/mL, at 37.0°C) of these new chloroprocaine formulations. In addition to plain 2% and 3% chloroprocaine and 2% lidocaine, mixed solutions of 2% chloroprocaine with epinephrine or with bicarbonate were evaluated. Density was also measured after water dilution and after increasing amounts of added dextrose. Chloroprocaine, 2% or 3%, is hyperbaric relative to cerebrospinal fluid (CSF) before any addition of dextrose (density 1.00123 g/mL and 1.00257 g/mL, respectively). When diluted with water, all the solutions are hypobaric relative to CSF (density <1.00028 g/mL). Plain 2% lidocaine is the only dextrose-free solution measured to be hypobaric (density 1.00004 g/mL). Bisulfite-free 2-chloroprocaine remains very acidic (pH <4.0), but the pH can be increased to more than 7.0 with a small amount of bicarbonate (0.25–0.33 mL/10 mL). The increased density of plain chloroprocaine makes it a useful hyperbaric spinal drug without the addition of dextrose.

 

2-氯普鲁卡因脊麻:添加右旋糖的作用

Spinal 2-Chloroprocaine: The Effect of Added Dextrose

Daniel T. Warren, MD, and Dan J. Kopacz, MD

From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington

Anesth Analg 2004 98: 95-101.

脊麻用2-氯普鲁卡因常作为门诊病人手术中利多卡因的替代品。加入右旋糖后增加了溶液的碱度并改变了脊麻的特征。在此项研究中我们比较了2-氯普鲁卡因脊麻中加或不加右旋糖(1.1%)的区别。八位志愿者分别参与了此二项脊麻,一组为2-氯普鲁卡因40mg2ml2   %)加0.25ml盐溶液,另一组为2-氯普鲁卡因40mg0.25ml 10%右旋糖,并采取双盲、随机、交叉平衡化处理。分别进行以下项目评估:针刺麻醉、对皮肤电刺激及驱血带的耐受度、运动张力测试、恢复步行时间及完全消退时间。消退后应用超声测膀胱残余尿量。所有受试者脊麻均成功并在11080-110min内消退。两组在以下方面无显著区别如麻醉最高平面均为T4(T7C6)、达最高平面的时间(14±6min)、消退达2个节段的时间(44±9min)、消退至L1水平的时间(66±12min)、耐受驱血带的时间(43±9min)、运动功能恢复时间(81±14min)。麻醉消退后残余尿量均值右旋糖组较大(74±67ml16±35mlP=0.02)。无受试者发生短暂性神经症状(TNS)。总之,2-氯普鲁卡因脊麻效果完善,消退完全,无TNS发生。加入右旋糖并不能显著改变脊麻阻滞特征却增加膀胱残余功能不全发生率。因此2-氯普鲁卡因脊麻中不必加糖

(陆绪伟翻译 薛张纲校)

Spinal 2-chloroprocaine is being investigated as an alternative short-acting spinal anesthetic to replace lidocaine for outpatient surgery. Adding dextrose increases the baricity of solutions and alters the characteristics of spinal anesthesia. In this study, we compared 2-chloroprocaine spinal anesthesia performed with or without the addition of dextrose (1.1%). Eight volunteers underwent 2 spinal anesthetics, receiving 40 mg 2-chloroprocaine (2 mL, 2%) with 0.25 mL saline with one and 0.25 mL 10% dextrose with the other in a double-blinded, randomized, balanced crossover manner. Pinprick anesthesia, tolerance to transcutaneous electrical stimulation, and tourniquet, motor strength measurements, and time to ambulation and void were assessed. Postvoid residual bladder volume was measured via ultrasound. Spinal anesthesia was successful in all subjects and regressed within 110 (80–110) min. There was no significant difference in peak height T4 (T7-C6), time to achieve peak block height (14 ± 6 min), time for 2-segment regression (44 ± 9 min), regression to L1 (66 ± 12 min), tolerance of tourniquet (43 ± 9 min), or return of motor function (81 ± 14 min) Mean postvoid residual volume was larger with dextrose (74 ± 67 mL versus 16 ± 35 mL; P = 0.02). No subject reported signs of transient neurologic symptoms (TNS). In conclusion, spinal 2-chloroprocaine provides adequate potency with reliable regression, seemingly without TNS. Adding dextrose does not significantly alter spinal block characteristics but increases residual bladder dysfunction. Therefore, the addition of glucose to 2-chloroprocaine for spinal anesthesia is not necessary.

 

长期应用抗精神病药物增加术中低体温的发生

CHronic Treatment with Antipsychotics Enhances Intraoperative Core Hypothermia

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

Department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Japan

Anesth Analg 2004 98: 111-115.

 

抗精神病药物能减少低体温发生,但服用抗精神病药物的精神分裂症病人的术中体温调节尚不明确。我们调查了服用抗精神病药物的精神分裂症病人的术中体温管理及术后寒战发生率。共观察了行矫形外科手术的30位精神分裂症病人及30位对照病人。精神分裂症病人诱导后15min30min45min60min75min90min鼓膜温度分别为(35.7°C ± 0.5°C, 35.6°C ± 0.5°C, 35.6°C ± 0.4°C, 35.5°C ± 0.4°C, 35.4°C ± 0.5°C, and 35.4°C ± 0.3°C)显著低于对照组(36.5°C ± 0.5°C, 36.4°C ± 0.5°C, 36.3°C ± 0.4°C, 36.2°C ± 0.5°C, 36.2°C ± 0.4°C, and 36.1°C ± 0.4°C)P<0.001。精神分裂症病人诱导后60min75min90min平均皮肤温度分别为(31.1°C ± 0.4°C [P = 0.008], 31.1°C ± 0.3°C [P = 0.007], and 31.1°C ± 0.2°C [P = 0.006])显著低于对照组(31.5°C ± 0.3°C, 31.5°C ± 0.3°C, and 31.5°C ± 0.3°C)30位精分病人中4人发生术后寒战,30位对照组病人中7人发生术后寒战。拔管后1h寒战病人及无寒战病人的鼓膜温度无显著差别。总之,慢性精分病人术中更易发生低体温。但并不增加术后寒战发生率。

(陆绪伟翻译 薛张纲校)

Antipsychotics can induce hypothermia, but intraoperative temperature regulation in schizophrenic patients taking antipsychotics remains unclear. We investigated intraoperative temperature regulation and postoperative shivering in chronic schizophrenic patients receiving antipsychotics. We studied 30 schizophrenic patients and 30 control patients who underwent orthopedic surgery. Tympanic membrane temperatures (35.7°C ± 0.5°C, 35.6°C ± 0.5°C, 35.6°C ± 0.4°C, 35.5°C ± 0.4°C, 35.4°C ± 0.5°C, and 35.4°C ± 0.3°C) 15, 30, 45, 60, 75, and 90 min, respectively, after induction in schizophrenic patients were significantly (P < 0.001) lower than those (36.5°C ± 0.5°C, 36.4°C ± 0.5°C, 36.3°C ± 0.4°C, 36.2°C ± 0.5°C, 36.2°C ± 0.4°C, and 36.1°C ± 0.4°C) in control patients. Mean skin temperatures (31.1°C ± 0.4°C [P = 0.008], 31.1°C ± 0.3°C [P = 0.007], and 31.1°C ± 0.2°C [P = 0.006]) 60, 75, and 90 min, respectively, after induction in schizophrenic patients were significantly lower than those (31.5°C ± 0.3°C, 31.5°C ± 0.3°C, and 31.5°C ± 0.3°C) in control patients. Four of 30 schizophrenic patients and 7 of 30 control patients developed postanesthesia shivering. There were no significant differences within 1 h after tracheal extubation in tympanic membrane temperatures between patients who shivered and those who did not shiver. In conclusion, chronic schizophrenic patients were more hypothermic during anesthesia. The incidence of postanesthesia shivering was not significantly increased.

 

大鼠长期鞘内注射Ketorolac Tromethamine的抗伤害感受反应及神经毒性筛选

Antinociceptive and Neurotoxicologic Screening of Chronic Intrathecal Administration of Ketorolac Tromethamine in the Rat

H. Ayben Korkmaz, MD*, Fikret Maltepe, MD*, Serhat Erbayraktar, MD{dagger}, Osman Yilmaz{ddagger}, Merih Güray, MD§, M. Serefettin Canda, MD§, Ali Günerli, MD*, and Necati Gökmen, MD*

Departments of *Anesthesiology and Reanimation, {dagger}Neurosurgery,the {ddagger}Animal Research Center, and the §Department of Pathology, Dokuz Eylül University, School of Medicine, Izmir, Turkey

Anesth Analg 2004 98: 148-152

 

许多药物行鞘内注射来观察对阿片类药物的替代效果。我们拟对老鼠行长期鞘内注射ketorolac tromethamine来探讨其麻醉作用及可能的神经毒性作用。28Witar大鼠腹腔内注射30mg/kg硫喷妥钠麻醉下经寰枢间隙放置导管。大鼠随机分为4组每5天行4次重复鞘内注射。控制组给予10ml盐水,其他组分别给予ketorolac tromethamine50ug150ug400ug。而后分别对各组大鼠行福尔马林试验、行为测试、脊髓组织病理学测试。行为测试及组织病理学试验均未发现提示神经毒性的异常。福尔马林试验提示ketorolac tromethamine组的大鼠I相、II相反应均显著低于控制组。虽然I相反应在ketorolac tromethamine三组中无显著差别,但II相反应在接受150ug400ug ketorolac tromethamine组中有显著减少。鞘内注射ketorolac tromethamine可减少伤害感受反射并且即便大剂量应用时亦未见不良神经作用。不过仍应继续探索其他替代药物鞘内注射治疗慢性疼痛。

(陆绪伟翻译 薛张纲校)

Many drugs are tested intrathecally to investigate alternatives to opioids. We aimed to explore the analgesic and possible neurotoxic effects of chronic intrathecally-administered ketorolac tromethamine in rats. Catheters were placed via atlantoaxial interval in 28 Wistar rats under anesthesia of intraperitoneally-injected thiopental 30 mg/kg. Rats were randomized into 4 groups and administered 4 repeated intrathecal doses of therapy with 5-day intervals. The control group received 10 µL of saline, and the other groups received 50, 150, and 400 µg of ketorolac tromethamine respectively. The formalin test, behavioral test, and histopathological examination of four different spinal cord levels were performed. Neither behavioral testing nor histopathological examination revealed abnormalities that would suggest neurotoxicity. Formalin tests showed that both phase I and phase II responses of ketorolac tromethamine groups were significantly less than those of the control group. Although phase I responses did not differ during comparisons among ketorolac tromethamine-administered groups, phase II responses decreased significantly in groups that received 150 and 400 µg of ketorolac tromethamine. Intrathecally administered ketorolac tromethamine reduced nociceptive responses and exhibited no untoward neurological effect even at large doses. However, its intrathecal use as a safe alternative drug for chronic pain remains to be investigated in other species

.

脊柱融合术后切口持续滴注罗吡卡因的药动学及效力

The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery

Margherita Bianconi, MD*, Luca Ferraro, PharmD{dagger}, Riccardo Ricci, MD*, Gustavo Zanoli, MD{ddagger}, Tiziana Antonelli, MD{dagger},§, Bighetti Giulia, MD{ddagger}, Aurelia Guberti, MD*, and Leo Massari, MD{ddagger}

Departments of *Anesthesiology and Intensive Care and §Clinical Pharmacology, St. Anna Hospital, Ferrara, Italy; and Departments of {dagger}Clinical and Experimental Medicine, Section of Pharmacology, and {ddagger}Biomedical Sciences and Advanced Therapies, Section of Orthopaedics and Traumatology, University of Ferrara, Ferrara, Italy

Anesth Analg 2004 98: 166-172.

 

由于尚未对脊柱融合术后切口持续滴注的局麻方法进行评估,我们设计了此项研究来判定这种技术是否能增强麻醉效果并提高腰椎后路融合术后病人的转归。将38位进行脊柱稳定术的病人随机分为2组。M组术后予静脉吗啡及ketorolac基线注射24hR组予静脉注射盐水。两组病人均于皮下埋植16G多孔导管,R组切口予0.5%罗吡卡因200mg/40ml浸润,并以0.2%罗吡卡因5ml/h维持注射;M组以同样的速度注射盐水。由对病人麻醉处理并不了解的护士对病人休息时及被动运动时进行疼痛评分。并测量病人血浆罗吡卡因浓度。R组的疼痛评分及应急医疗要求(diclofenac 及曲马多)显著少于M组。并且R组病人术后失血减少,住院天数缩短。罗吡卡因输注后24h血浆浓度达峰,并处安全阈内,亦未发现毒副作用。这些结果提示脊柱稳定术后切口浸润复合0.2%罗吡卡因持续输注能有效治疗疼痛。

(陆绪伟翻译 薛张纲校)

Because local anesthetic continuous wound instillation has not been evaluated after spine fusion surgery, we designed this study to determine whether this technique could enhance analgesia and improve patient outcome after posterior lumbar arthrodesis. Thirty-eight patients undergoing spine stabilization were randomly divided into two groups. The M group received a postoperative baseline IV infusion of morphine plus ketorolac for 24 h, and the R group received IV saline. In both groups, a multihole 16-gauge catheter was placed subcutaneously; in the R group, the wound was infiltrated with a solution of ropivacaine 0.5% 200 mg/40 mL, and infusion of ropivacaine 0.2% 5 mL/h was maintained for 55 h. In the M group, saline infusion was given at the same rate. Pain scores were taken at rest and on passive mobilization by nurses blinded to patient analgesic treatment. The total plasma ropivacaine concentration was evaluated. Pain scores and rescue medication requirements (diclofenac and tramadol) were significantly less in the R group than in the M group. Postoperative blood loss was less and the length of hospital stay was shorter in the R group. The ropivacaine peak total plasma concentration occurred at 24 h during infusion and was within safe limits; no toxic local anesthetic side effects were observed. These results suggest that wound infiltration and continuous instillation of ropivacaine 0.2% is effective for pain management after spine stabilization surgery.

 

糖尿病大鼠中[D-Ala2, NMePhe4, Gly-ol5]脑啡肽诱导的外周抗疼痛作用的减弱:L-精氨酸/一氧化氮/环一磷酸鸟嘌呤途径的作用

Reduction in [D-Ala2, NMePhe4, Gly-ol5]Enkephalin-Induced Peripheral Antinociception in Diabetic Rats: The Role of the L-Arginine/Nitric Oxide/Cyclic Guanosine Monophosphate Pathway

Arda Tasatargil, MD, and Gulay Sadan, MD

Department of Pharmacology, Faculty of Medicine, Akdeniz University, Antalya, Turkey

Anesth Analg 2004 98: 185-192

 

我们假设在糖尿病大鼠中阿片µ受体激动剂异常的低药效可能是因为L-精氨酸/一氧化氮/环一磷酸鸟嘌呤途径的功能性改变,为了证实该假设,我们评价了链脲霉素(STZ)糖尿病和非糖尿病大鼠中,N--L-鸟氨酸,亚甲基蓝和3-吗啉-斯得酮亚胺对[D-Ala2, NMePhe4, Gly-ol5]脑啡肽(DAMGO)诱导的外周抗疼痛中的作用。动物通过注射STZ(60mg/kg腹膜内注射)产生糖尿病。抗疼痛作用通过福尔马林试验来评估。阿片µ受体激动剂DAMGO(1ug每爪)抑制了第二阶段的刺激反应。在STZ糖尿病大鼠中DAMGO的抗疼痛作用明显低于非糖尿病大鼠。N--L-鸟氨酸(100ug每爪),一种NO合成酶抑制剂,或亚甲基蓝(500ug每爪),一种鸟苷环化酶抑制剂,无论在糖尿病或非糖尿病大鼠中,均明显降低了DAMGO诱导的抗疼痛作用。而且,3-吗啉-斯得酮亚胺(200ug每爪),一种NO原料,在非糖尿病大鼠中增强了DAMGO的抗疼痛作用,但在糖尿病大鼠中却无改变。这些结果提示,DAMGO的外周抗疼痛作用可能在于L-精氨酸/NO/cGMP途径的激活和这一途径的功能紊乱;而且,随着cGMP的激活可能导致如所见的阿片µ受体激动剂对糖尿病大鼠效果不佳的抗疼痛作用。

(钟鸣翻译 薛张纲校)

To test our hypothesis that the abnormally small efficacy of µ-opioid agonists in diabetic rats may be due to functional changes in the L-arginine/nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway, we evaluated the effects of N-iminoethyl-L-ornithine, methylene blue, and 3-morpholino-sydnonimine on [D-Ala2, NMePhe4, Gly-ol5]enkephalin (DAMGO)-induced antinociception in both streptozotocin (STZ)-diabetic and nondiabetic rats. Animals were rendered diabetic by an injection of STZ (60 mg/kg intraperitoneally). Antinociception was evaluated by the formalin test. The µ-opioid receptor agonist DAMGO (1 µg per paw) suppressed the agitation response in the second phase. The antinociceptive effect of DAMGO in STZ-diabetic rats was significantly less than in nondiabetic rats. N-Iminoethyl-L-ornithine (100 µg per paw), an NO synthase inhibitor, or methylene blue (500 µg per paw), a guanylyl cyclase inhibitor, significantly decreased DAMGO-induced antinociception in both diabetic and nondiabetic rats. Furthermore, 3-morpholino-sydnonimine (200 µg per paw), an NO donor, enhanced the antinociceptive effect of DAMGO in nondiabetic rats but did not change in diabetic rats. These results suggest that the peripheral antinociceptive effect of DAMGO may result from activation of the L-arginine/NO/cGMP pathway and dysfunction of this pathway; also, events that are followed by cGMP activation may have contributed to the demonstrated poor antinociceptive response of diabetic rats to µ-opioid agonists.

 

二氧化碳描记术在非气管内插管急诊病人的院前呼吸监测中作为脉搏血氧饱和度监测的附加工具

Capnography in Non-Tracheally Intubated Emergency Patients as an Additional Tool in Pulse Oximetry for Prehospital Monitoring of Respiration

Alexander Kober, MD*,{ddagger}, Barbara Schubert, BS*, Petra Bertalanffy, MD*,{ddagger}, Laszlo Gorove, MD{dagger}, Tivadar Puskas, MD{dagger}, Burkhard Gustorff, MD{ddagger}, Alma Joldzo, BS{ddagger}, and Klaus Hoerauf, MD, PhD{ddagger} Section Editor

Vienna Red Cross, Van Swieten and the Research Institute of the Vienna Red Cross, Vienna, Austria; {dagger}Hungarian National Emergency Service, Hungary; and the {ddagger}Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria

Anesth Analg 2004;98:206-210

 

由医护人员为基础的救护系统转运的较小创伤的受难者通常监测脉搏血氧饱和度。在院前恶劣的创伤监护条件下,脉搏血氧饱和度监测常常发生故障。我们假设二氧化碳描记术对非插管的创伤受难者而言是种效果不错且便于使用的监测工具,并证实该假设。本研究中共收入70位未插管的创伤病人。分别对血氧饱和度和二氧化碳描记的生命变量和故障的数量和发生时间的记录进行采样。总报警数量(63vs10),每一病人报警数(3.3[1.9]vs0.3[0.9])(均数[标准差],总故障时间(191.5[216.7]vs11.8[40.2]秒),每一报警的故障时间(58.3[71.4]vs5.5[14.6]),转运过程中故障时间百分比(13.2%[15.3%]vs0.8%[2.8%]),血氧饱和度组和二氧化碳描记组间明显不同(P<0.01)。虽然脉搏血氧饱和度监测是急诊监护监测中的标准方法,但我们发现二氧化碳描记术是种有帮助的监测设备。因此我们建议在转运过程中使用二氧化碳描记术作为一种附加的监测工具以减少缺乏生命指标监测的时间段。

(钟鸣翻译 薛张纲校)

Victims of minor trauma transported by paramedic-based rescue systems are usually monitored with pulse oximetry. Under the difficult surroundings of prehospital trauma care, pulse oximeters show considerable periods of malfunction. We tested the hypothesis that capnography is a good, easy to use tool for monitoring in nonintubated trauma victims. Seventy nonintubated trauma victims were included in this study. Vital variables and number and time of malfunctions were sampled for oximeter and capnometer recordings. Total number of alerts (63 versus 10), number of alerts per patient (3.3 [1.9] versus 0.3 [0.9]) (mean [SD]), total time of malfunction (191.5 [216.7] s versus 11.8 [40.2] s), time of malfunction per alarm (58.3 [71.4] s versus 5.5 [14.6] s), and the percentage of malfunction time during transport (13.2% [15.3%] versus 0.8% [2.8%]) differed significantly (P < 0.01) between oximetry and capnography. Although pulse oximetry is a standard method of monitoring in emergency care, we found capnography to be helpful as a monitoring device. We consequently recommend the use of capnography on transport as an additional monitoring tool to reduce periods lacking supervision of the vital variables.

 

硬膜外镇痛的走动延长对分娩的作用

The Effects of Prolonged Ambulation on Labor with Epidural Analgesia

Stéphane Frenea, MD*, Christine Chirossel, MD*, Raphaël Rodriguez{dagger}, Jean-Philippe Baguet, MD, PhD{ddagger}, Claude Racinet, MD{dagger}, and Jean-Francois Payen, MD, PhD* Section Editor

Department of Anesthesiology, {dagger}Department of Obstetrics, and {ddagger}Department of Cardiology and Hypertension, Albert Michallon Hospital, Grenoble, France

Anesth Analg 2004;98:224-229

 

分娩时走动正变得越来越流行了,虽然其对分娩过程和疼痛强度的影响还不清楚。我们想知道有硬膜外镇痛的走动延长是否对分娩和疼痛的持续有影响的可能。在本前瞻的、随机试验中,61位无并发症的临产妇被分为斜躺组(n30)和走动组(n=30)。间断给予0.08%布比卡因-肾上腺素加1ug/mL苏芬太尼来提供硬膜外镇痛。走动组的30位妇女中,25位真正走动了。她们走动的时间是64 ± 34分钟(平均±标准差),如,占第一阶段的29% ± 16%。两组间分娩时程和疼痛的可视模拟比例评分间无显著差异。然而,走动组布比卡因的用量更少(6.4 ± 2.2 mg/h vs 8.4 ± 3.6 mg/h; P = 0.01),后叶催产素的用量也少(6.4 ± 2.2 mg/h vs 8.4 ± 3.6 mg/h; P = 0.01)。而且我们发现,走动组有更好的排泄能力(P < 0.01)。虽然分娩和疼痛缓解的持续时间没有改变,但这些发现支持分娩时走动更加有利。

(钟鸣翻译 薛张纲校)

Ambulation during labor is becoming more popular, although its impact on the progress of labor and on pain intensity remains unclear. We wondered whether prolonged ambulation with epidural analgesia had a possible effect on duration of labor and pain. In this prospective, randomized trial, 61 parturients with uncomplicated term pregnancies were allocated to be recumbent (n = 31) or to ambulate (n = 30). Epidural analgesia was provided with intermittent administrations of 0.08% bupivacaine-epinephrine plus 1 µg/mL of sufentanil. Of the 30 women assigned to the ambulatory group, 25 actually walked. Their ambulating time was 64 ± 34 min (mean ± SD), i.e., 29% ± 16% of the first stage. There were no differences between the two groups in the length of labor and in pain visual analog scale scores. However, the ambulatory group received smaller doses of bupivacaine (6.4 ± 2.2 mg/h versus 8.4 ± 3.6 mg/h; P = 0.01) and of oxytocin (6.0 ± 3.7 mUI/min versus 10.2 ± 8.8 mUI/min; P < 0.05). A greater ability to void was also found in the ambulatory group (P < 0.01). Although the duration of labor and pain relief was unchanged, these findings support that ambulation during labor may be advantageous.

 

拔除喉罩前吸入100%氧不影响麻醉后动脉血氧分压

Administration of 100% oxygen before removal of the laryngeal mask airway does not affect postanesthetic arterial partial pressure of oxygen

Renner M, Hohlrieder M, Wolk T, Puhringer F, Kleinsasser AT, Keller C, Benzer A.

Department of Anesthesiology and Critical Care Medicine, Klinikum am Steinenberg, Reutlingen, Germany.

Anesth Analg 2004 98: 257-259

在使用气管内导管的情况下,全麻结束时吸入100%的氧气已经显示可损害肺气体交换。相对措施如高呼气末正压通气或肺活量手法,可能减轻其损害。但是这些策略在使用喉罩(LMA)时可能是不可行甚至是禁忌的。LMA和气管导管在设计上有很大的差异,我们检查了经LMA吸氧麻醉后病人的血气。64ASAⅠ-Ⅱ级,使用LMA实施60分钟全麻的病人,随机分为两组,在麻醉开始到拔除LMA期间分别吸入100%和30%的氧气。拔除LMA3060分钟检测血气,结果吸入100%氧气组病人的动脉氧分压和30%氧气组基本相同(60分钟时的检测结果:83 +/- 885 +/- 7 mm Hg [均数+/-标准差]P = 0.14)。我们的结论是:使用LMA在全麻结束时吸入100%氧气不会损害术后肺气体交换。

结论:在麻醉病人的肺通气中使用气管导管和LMA作为人工气道有相当大的差别。拔除气管导管前吸入100%可导致肺功能损害,而此研究表明拔除LMA前吸入纯氧不影响肺功能。(周晓敏翻译 薛张纲校)

Breathing 100% oxygen at the end of general anesthesia has been shown to worsen postoperative pulmonary gas exchange when an endotracheal tube is used. Counter measures, such as high positive end-expiratory pressure or the vital-capacity maneuver, may limit this effect. Such strategies, however, may be impracticable, or even contraindicated, when the laryngeal mask airway (LMA) is used. Because of the vast differences in design between the LMA and endotracheal tube, we examined postanesthetic blood gas tensions in patients after emergence from anesthesia breathing oxygen via LMA. Sixty-four ASA physical status I-II patients undergoing general anesthesia for 60 min with LMA were randomly assigned to receive either 100% or 30% oxygen during emergence from anesthesia and removal of LMA. Postoperative blood gas measurements were taken at 30 and 60 min after removal of the LMA. At either measurement, patients treated with 100% oxygen essentially had the same arterial partial pressure of oxygen (60-min measurement: 83 +/- 8 versus 85 +/- 7 mm Hg [mean +/- SD], P = 0.14) as those treated with 30% oxygen. We conclude that breathing 100% oxygen at the end of general anesthesia does not worsen postoperative pulmonary gas exchange when an LMA is used. IMPLICATIONS: The endotracheal tube and laryngeal mask airway are substantially different artificial airways used to ventilate the lungs of anesthetized patients. Breathing 100% oxygen before removing the endotracheal tube results in lung function defects. This study shows that oxygen breathing before removing the laryngeal mask airway has no effect on pulmonary function.

 

比较麻醉诱导时经面罩机械通气和手控呼吸的不同:前瞻性、随机化、交叉性研究

Mechanical versus manual ventilation via a face mask during the induction of anesthesia: a prospective, randomized, crossover study.

von Goedecke A, Voelckel WG, Wenzel V, Hormann C, Wagner-Berger HG, Dorges V, Lindner KH, Keller C.

Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, 6020 Innsbruck, Austria.

Anesth Analg 2004 98: 260-263.

 

使无保护的气道通气安全的一个方法是限制潮气量,另一个可能是限制气道峰压,尽管不知道这样是否能提供充分的潮气量。因此,本研究的目的是评估无保护气道在自动压力控制通气和周期性手控面罩通气下通气参数的质量,是一个前瞻性、随机化、交叉性研究,对象是41个成人(ASA评分Ⅰ-Ⅱ级),在麻醉诱导时使用这两套设备。使用一台肺监测仪(CP-100)测量呼吸参数。压力控制面罩通气和周期性系统通气测量结果(均数+/-标准差)比较如下:低气道峰压(10.6 +/- 1.5 cm H(2)O 14.4 +/- 2.4 cm H(2)O; P < 0.001),气道压力差(8.5 +/- 1.5 cm H(2)O 11.9 +/- 2.3 cm H(2)O; P < 0.001),呼气量(650 +/- 100 mL 680 +/- 100 mL; P = 0.001),分钟通气量(10.4 +/- 1.8 L/min 11.6 +/- 1.8 L/min; P < 0.001),最大吸气流速(0.81 +/- 0.06 L/s 1.06 +/- 0.26 L/s; P < 0.001),吸气平台时间比例(48% +/- 0.8% 33% +/- 7.7%; P < 0.001)和呼气末二氧化碳(34 +/- 3 mm Hg 33 +/- 4 mm Hg; 无意义).我们的结论是:在病人气道无保护、无呼吸的情况下,压力控制通气相比周期性系统通气可减少最大吸气流速和气道峰压,因此,可在面罩通气时使病人更安全。

结论:在病人气道无保护、无呼吸的情况下,压力控制通气相比周期性系统通气可减少最大吸气流速和气道峰压,因此,可在面罩通气时使病人更安全。

(周晓敏翻译 薛张纲校)

One approach to make ventilation safer in an unprotected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be delivered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ventilation regarding ventilatory variables in an unprotected airway. We studied 41 adults (ASA status I-II) in a prospective, randomized, crossover design with both devices during the induction of anesthesia. Respiratory variables were measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation versus circle system ventilation resulted in lower (mean +/- SD) peak airway pressures (10.6 +/- 1.5 cm H(2)O versus 14.4 +/- 2.4 cm H(2)O; P < 0.001), delta airway pressures (8.5 +/- 1.5 cm H(2)O versus 11.9 +/- 2.3 cm H(2)O; P < 0.001), expiratory tidal volume (650 +/- 100 mL versus 680 +/- 100 mL; P = 0.001), minute ventilation (10.4 +/- 1.8 L/min versus 11.6 +/- 1.8 L/min; P < 0.001), and peak inspiratory flow rates (0.81 +/- 0.06 L/s versus 1.06 +/- 0.26 L/s; P < 0.001) but higher inspiratory time fraction (48% +/- 0.8% versus 33% +/- 7.7%; P < 0.001) and end-tidal carbon dioxide (34 +/- 3 mm Hg versus 33 +/- 4 mm Hg; not significant). We conclude that in this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during mask ventilation.

 

韩国手部指压法用于治疗创伤病人院前转运中的晕动病:一项在老年人群中进行的前瞻性随机双盲研究:

Korean Hand Acupressure for Motion Sickness in Prehospital Trauma Care: A Prospective, Randomized, Double-Blinded Trial in a Geriatric Population

Petra Bertalanffy, MD*, Klaus Hoerauf, MD*, Roman Fleischhackl, MD{dagger}, Helmut Strasser, BS{dagger}, Franziska Wicke, MD*, Manfred Greher, MD*, Burkhard Gustorff, MD, DEAA*, and Alexander Kober, MD*,{dagger} Section Editor

*Department of Anaesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria; and {dagger}Vienna Red Cross, Van Swieten and the Research Institute of the Vienna Red Cross, Vienna, Austria

Anesth Analg 2004;98:220-223

 

创伤或者患病的病人在用急救车转送的过程中经常发生晕动病。由于在奥地利禁止在急救车内使用药物,非创伤性的韩国手部K-K9穴位指压法可能成为对抗恶心和呕吐的替代性方法。我们的研究纳入了100例轻微创伤的老年病人,随机分为KK9组和假指压组。记录了病人的恶心视觉模拟评分数(VAS)和病人对于处理的总满意数、血流动力学参数和外周血管收缩。在K-K9组,所有病人都记录到恶心的明显增加(P<0.01):VAS0mm25±6mm。假指压组也记录到了相似的显著增加:从0mm83±8mmP<0.01)。但是在抵达医院时K-K9组和假指压组恶心评分有显著不同(P<0.01);尽管所有病人在急诊室治疗前都有血管收缩,但是在医院内血管收缩的病人数在两组之间有显著不同(P<0.01):K-K9组血管收缩与扩张病人分别为446人;假指压组血管收缩和舒张病人分别为482人。在抵达医院时,K-K9组和假指压组病人的心率有显著差别(P<0.01):65±6 bpm98±8bpmK-K9组病人对提供的照顾的总的满意度(模拟视觉评分19±9mm)显著高于假指压组(模拟视觉评分48±12mm)。两组血压均无明显变化。K-K9穴刺激是一种简单有效的处理急诊中的恶心的方法,能明显提高病人的满意度。

(颜涛译,李士通校)

Patients with trauma or medical illnesses transported to the hospital by ambulance have a frequent incidence of motion sickness. Because the administration of drugs in the ambulance is prohibited by law in Austria, the noninvasive Korean hand acupressure point at K-K9 may be an alternative against nausea and vomiting. We enrolled 100 geriatric patients with minor trauma, randomizing them into a K-K9 group and a sham acupressure group. We recorded visual analog scores (VAS) for nausea and for the patient’s overall satisfaction with the treatment, hemodynamic variables, and peripheral vasoconstriction. In the K-K9 group, a significant (P < 0.01) increase in nausea was recorded in all cases: from VAS of 0 mm to 25 ± 6 mm. A similarly significant (P < 0.01) increase was registered in the sham group: from VAS of 0 mm to 83 ± 8 mm. However, at the time of arrival in the hospital, nausea scores were significantly different between the K-K9 group and the sham group (P < 0.01). Although all patients had been vasoconstricted at the emergency site before treatment, there was a significant difference (P < 0.01) between groups with regard to the number of vasoconstricted patients at the hospital (4 and 46 constricted and dilated, respectively, in the K-K9 group versus 48 and 2 constricted and dilated, respectively, in the sham group). On arrival in the hospital, a significant difference (P < 0.01) in heart rate was noted between the K-K9 group and the sham group (65 ± 6 bpm versus 98 ± 8 bpm). The patients’ overall satisfaction with the provided care was significantly higher (P < 0.01) in the K-K9 group (19 ± 9 mm VAS) than in the sham group (48 ± 12 mm VAS). Neither group experienced a significant change in blood pressure. K-K9 stimulation was an effective and simple treatment for nausea during emergency care and significantly improved patient satisfaction.

 

 

延长走动时间对硬膜外镇痛分娩产程的影响

The Effects of Prolonged Ambulation on Labor with Epidural Analgesia

Stéphane Frenea, MD*, Christine Chirossel, MD*, Raphaël Rodriguez{dagger}, Jean-Philippe Baguet, MD, PhD Claude Racinet, MD{dagger}, and Jean-Francois Payen, MD, PhD* Section Editor

*Department of Anesthesiology, {dagger}Department of Obstetrics, and {ddagger}Department of Cardiology and Hypertension, Albert Michallon Hospital, Grenoble, France

Anesth Analg 2004;98:224-229

在分娩过程中走动已经越来越普遍,但是它对于产程和疼痛强度的影响仍不清楚。我们怀疑在硬膜外镇痛时增加走动时间可能对产程和疼痛强度产生影响。在这项前瞻性随机研究中,61例无并发症的足月临产妇被分为不活动组(n=31)和走动组(n=30)。由硬膜外间断注射含有1 µg/mL 苏芬太尼的0.08%布比卡因-肾上腺素提供镇痛。在分配到走动组的30人中,实际走动的为25人。其走动时间是64 ± 34 min (均数 ±标准差), 即第一产程的29% ± 16%。两组在产程时间和疼痛视觉模拟评分上没有差别。但是走动组使用的布比卡因(6.4 ± 2.2 mg/h vs 8.4 ± 3.6 mg/h; P = 0.01)和催产素(6.0 ± 3.7 mUI/min vs 10.2 ± 8.8 mUI/min; P < 0.05)的量小于不活动组。还发现走动组排尿能力更强(P<0.01)。尽管产程和疼痛减轻的程度没有改变,上述发现还是支持在产程中走动有益的观点。

(颜涛译,李士通校)

Ambulation during labor is becoming more popular, although its impact on the progress of labor and on pain intensity remains unclear. We wondered whether prolonged ambulation with epidural analgesia had a possible effect on duration of labor and pain. In this prospective, randomized trial, 61 parturients with uncomplicated term pregnancies were allocated to be recumbent (n = 31) or to ambulate (n = 30). Epidural analgesia was provided with intermittent administrations of 0.08% bupivacaine-epinephrine plus 1 µg/mL of sufentanil. Of the 30 women assigned to the ambulatory group, 25 actually walked. Their ambulating time was 64 ± 34 min (mean ± SD), i.e., 29% ± 16% of the first stage. There were no differences between the two groups in the length of labor and in pain visual analog scale scores. However, the ambulatory group received smaller doses of bupivacaine (6.4 ± 2.2 mg/h versus 8.4 ± 3.6 mg/h; P = 0.01) and of oxytocin (6.0 ± 3.7 mUI/min versus 10.2 ± 8.8 mUI/min; P < 0.05). A greater ability to void was also found in the ambulatory group (P < 0.01). Although the duration of labor and pain relief was unchanged, these findings support that ambulation during labor may be advantageous.

 

 


椎管内哌替啶减少脊麻下行剖宫产手术中寒战的发生率

Intrathecal Meperidine Decreases Shivering During Cesarean Delivery Under Spinal Anesthesia

Jean-Denis Roy, MD, Michel Girard, MD, MHPE, FRCP(C), and Pierre Drolet, MD, FRCP(C)

Département d’Anesthésiologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada

Anesth Analg 2004;98:230-234

与脊髓麻醉有关的寒战是不舒服的,并且可能干扰监测。我们开展这项前瞻性随机双盲研究的目的是确定鞘内应用哌替啶是否可以减少剖宫产手术时脊髓麻醉后寒战的发生率和强度。40例择期行非急诊剖宫产的临产妇被分为两组。脊髓麻醉用药为重比重布比卡因(0.75%,10.5mg)、吗啡0.15mg和哌替啶0.2mg/kg(试验组)或生理盐水(对照组)。在开始10分钟内每分钟收集数据,随后33分钟内每3分钟收集数据,然后每5分钟收集数据直至感觉平面消退至L4。收集的数据包括感觉阻滞平面、血压、中心温度和寒战强度。两组间达到最高感觉阻滞平面的时间、最大阻滞平面数、感觉和运动阻滞的消退以及收缩压都没有差别。哌替啶组寒战的发生率(P < 0.02)和强度(P < 0.003)均小于对照组。椎管内哌替啶(0.2mg/kg)能有效减少与脊髓麻醉有关的剖宫产手术中寒战的发生率和寒战的强度。

(颜涛译,李士通校)

Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. We performed this prospective, double-blinded, and randomized study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for cesarean delivery. Forty parturients scheduled for nonemergent cesarean delivery were enrolled in two groups. Spinal anesthesia consisted of hyperbaric bupivacaine (0.75%; 10.5 mg), morphine 0.15 mg, and, in the experimental group, meperidine (0.2 mg/kg) or, in the control group, normal saline. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was performed every minute for 10 min, every 3 min for 33 min, and then every 5 min until the sensory level receded to L4. Time to highest sensory level, maximum number of blocked segments, sensory and motor blockade regression, and systolic blood pressure showed no difference between groups. The incidence of shivering was less (P < 0.02) in the meperidine group, as was its intensity (P < 0.003). Intrathecal meperidine (0.2 mg/kg) is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery.

 

丙帕他莫单次和重复给药治疗术后疼痛镇痛效果评估:牙科手术后应用丙帕他莫和吗啡镇痛的比较

Assessing Analgesia in Single and Repeated Administrations of Propacetamol for Postoperative Pain: Comparison with Morphine After Dental Surgery

Hugo Van Aken, MD*, L. Thys, MD, Luc Veekman, MD, and Hartmut Buerkle, MD*

*Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Münster, Germany; University Medical Center, Acadmish Ziekenhuis, Medical Intensive Care Unit, Amsterdam, the Netherlands; and Department of Anesthesiology, University Hospital, Leuven, Belgium

Anesth Analg 2004 98: 159-165.

 

丙帕他莫为对乙酰胺基酚的前体形式,可注射给药。该双盲、随机试验评估丙帕他莫重复给药的镇痛效果,并与吗啡的镇痛效果进行比较。择期全麻下行骨性阻生第三磨牙拔除术,术后疼痛度为中到重度的患者,随机分为三组:丙帕他莫组,静脉注射丙帕他莫2gn31);吗啡组,肌肉注射吗啡10mgn30),或安慰剂组(n34)。五小时以后,各组重复给予初始剂量的一半。10小时内重复进行镇痛标准评分。首次给药后5小时及10小时(首次给药和追加给药),丙帕他莫和吗啡比安慰剂镇痛更有效,且差异有显著性。首次剂量后安慰剂组34个病人中有21人需要追加其他镇痛药,而丙帕他莫组31个病人中仅有6人需要追加其他镇痛药(P<0.0009),吗啡组30个病人中仅4人需要追加其他镇痛药(P<0.0001)。丙帕他莫组和吗啡组的镇痛评分总和及最高值,组间无统计学或临床显著差异。未发现严重并发症;副反应的发生率,丙帕他莫组显著小于吗啡组(P<0.027)。牙科手术后重复静脉注射丙帕他莫(2g后再给1g)与重复肌肉注射吗啡(10mg后再给予5mg)相比,其镇痛效果无明显差别,且耐受性更好。提示:中等疼痛度的手术操作后,以丙帕他莫的形式静脉注射对乙酰胺基酚,可有助于控制术后急性疼痛。

(周雅春译,李士通校)

We conducted this double-blinded, randomized study to assess the analgesic effect of repeated administrations of paracetamol, administered as propacetamol, an injectable prodrug formulation of paracetamol, and to compare this with the analgesic effects of morphine. Patients experiencing moderate to severe pain after elective surgical removal of bone-impacted third-molar teeth under general anesthesia were randomly assigned to receive IV propacetamol 2 g (n = 31), IM morphine 10 mg (n = 30), or placebo (n = 34). Five hours later, the treatments were readministered at half of the previous dosages. Standard measures of analgesia were collected repeatedly for 10 h. Propacetamol and morphine were significantly more effective than placebo in all primary measures of analgesia over 5 h after the first administration and globally over 10 h (first and second administrations). After the first dose, 21 of the 34 patients in the placebo group required rescue medication, compared with 6 of the 31 in the propacetamol group (P < 0.0009) and 4 of the 30 in the morphine group (P < 0.0001). No statistically or clinically significant differences were found between propacetamol and morphine for any sum or peak measures of analgesia. No serious adverse events were reported; adverse events were significantly less frequent in the propacetamol group than in the morphine group (P < 0.027). Propacetamol administered IV in repeated doses (2 g followed by 1 g) has a significant analgesic effect that is indistinguishable from that of morphine administered IM (10 mg followed by 5 mg) after dental surgery, with better tolerability.

 

胺碘酮减少大鼠神经痛模型对热、冷和机械刺激的痛觉过敏

Amiodarone Decreases Heat, Cold, and Mechanical Hyperalgesia in a Rat Model of Neuropathic Pain

Sukdeb Datta, MD, DABPM, Taruna Waghray, MD, Maria Torres, MD, and Silvio Glusman, MD, PhD

From the Department of Anesthesiology and Pain Management, Cook County Hospital, Chicago, Illinois

Anesth Analg 2004 98: 178-184.

[

利多卡因可有效控制室性心律失常和神经痛。胺碘酮和利多卡因一样具有钠通道阻滞特性。我们的研究旨在探讨胺碘酮与利多卡因治疗大鼠神经痛模型中对热、冷和机械刺激痛觉过敏的疗效是否相似。10S-D大鼠,麻醉后在其右后爪的坐骨神经放置四条松散的结扎线。在对侧的后爪实行假手术(对照)。通过比较每个爪子对热刺激(辐射热源,50°C)回缩反射的潜伏期判断热刺激痛觉过敏;给予丙酮以评估冷刺激痛觉过敏;运用标准von Frey丝比较结扎的后爪和对照的后爪的机械阈值判断机械刺激痛觉过敏。建立痛觉过敏后腹腔注射胺碘酮15102050100mg/kg。给予单次剂量之前和之后1324小时测定大鼠痛觉过敏程度。另有5只大鼠植入鞘内导管,鞘内注射胺碘酮5mg/kg。在胺碘酮鞘内给药组进行相似的热、机械和冷刺激痛觉过敏测定。腹腔内注射胺碘酮后热、冷和机械刺激所致的痛觉过敏显著减少,且有统计学意义。结果具有统计学意义的有腹腔注射10mg/kg热刺激痛觉过敏减少,20mg/kg机械刺激痛觉过敏减少,100mg/kg冷刺激痛觉过敏减少。单次剂量后24小时痛觉过敏恢复。鞘内给予胺碘酮对减少痛觉过敏的差异无显著性。在大鼠神经痛模型中观察到胺碘酮可能与利多卡因有相似的作用。由于在人体胺碘酮的半衰期显著长于利多卡因(胺碘酮平均53天而利多卡因90分钟),胺碘酮对于神经性疼痛可能有潜力提供更长时程(或许更有效)的疗效。提示:腹腔注射胺碘酮可减少大鼠神经痛模型对热、冷和机械刺激的痛觉过敏,且有统计学意义。考虑到其在人体的半衰期很长,胺碘酮有望长时间缓解神经性疼痛。

(周雅春译,李士通校)

Lidocaine is effective in controlling ventricular dysrhythmia and neuropathic pain. Amiodarone, like lidocaine, has sodium channel blocking properties. In the present study we explore whether amiodarone has a similar effect as lidocaine on the heat, cold, and mechanical hyperalgesia seen in the rat model of neuropathic pain. Ten male Sprague-Dawley rats were anesthetized. Four loose ligatures were placed on the sciatic nerve of the right hindpaw. A sham operation was performed on the contralateral hindpaw (control). Heat hyperalgesia was determined by comparing each paw withdrawal latency to heat stimulation (radiant heat source, 50°C). Cold hyperalgesia was assessed with acetone application. Mechanical hyperalgesia was determined by comparing the mechanical threshold in the ligated and control hind paws using calibrated von Frey filaments. Amiodarone was intraperitoneally administered at doses of 1, 5, 10, 20, 50, and 100 mg/kg after the development of hyperalgesia. The animals were tested for hyperalgesia before and 1, 3, and 24 h after the administration of a single dose of amiodarone. Intrathecal catheters were implanted in 5 new rats, and amiodarone 5 mg/kg was injected. Testing for heat, mechanical, and cold hyperalgesia was performed similarly in the intrathecal amiodarone administration group. Amiodarone produces statistically significant decreases of heat, cold, and mechanical hyperalgesia after intraperitoneal administration. Results are statistically significant at 10 mg/kg (heat hyperalgesia), 20 mg/kg (mechanical hyperalgesia), and 100 mg/kg (cold hyperalgesia) intraperitoneally. Hyperalgesia returns 24 h after a dose. The intrathecal administration of amiodarone produces a nonstatistically significant reduction of hyperalgesia. Amiodarone seems to have a similar effect as lidocaine on the hyperalgesia seen in the rat model of neuropathic pain. As the half-life of amiodarone is significantly longer that that of lidocaine (mean, 53 days versus 90 min) in humans, it may have the potential to provide a longer lasting (and perhaps more effective) effect than lidocaine on neuropathic pain states.

 


术中血细胞回收经济学分析

Economic Analysis of an Intraoperative Cell Salvage Service

Dale F. Szpisjak, MD*,, Paul S. Potter, MD, and Bruce P. Capehart, MD, MBA

*Anesthesia Department, Naval Hospital Rota, Spain; Department of Anesthesiology, Uniform Services University of the Health Sciences, Bethesda, Maryland; Department of Anesthesiology, Dunlap Memorial Hospital, Orrville, Ohio; and Federal Medical Center, Butner, North Carolina

Address correspondence and reprint requests to Dale F. Szpisjak, MD,

Anesth Analg 2004 98: 201-205.

 

美国红细胞输血的费用每年超过13亿美元。由于担心输血传染病毒性疾病,普遍采用术中血细胞回收以减少库血用量。尽管曾有人质疑该项技术的经济性,尚无术中自体输血的经济学参数分析。我们设计了数学模型以医院年自体输血例数为基础确定成本-效益最佳的策略。用表格程序预计术中自体输血的成本对四种模型进行分析:完全使用外来人员,部分使用外来人员,雇佣全职技术员操作,或由接受过交叉培训的雇员操作。当医院年自体输血例数超过185例时,部分使用外来人员较完全使用外来人员更经济。当医院年自体输血例数超过110例时新雇员模型比完全外来人员模型更经济。当医院年自体输血例数超过55例时,交叉训练模型最经济。提示:如果医院年自体输血例数超过55例,交叉培训一名雇员作为血细胞回收的技术员比使用外来人员更经济。

(周雅春译,李士通校)

In the United States, the cost of erythrocyte transfusion exceeds 1.3 billion dollars annually. The fear of viral disease transmission popularized intraoperative salvage to reduce the use of banked blood. Although the economics of this technique have been questioned, the financial variables in providing an intraoperative autotransfusion service have not been analyzed. We designed mathematical models to determine the most cost-effective strategy based on hospital caseload. Four models were analyzed with a spreadsheet to project costs of an intraoperative autotransfusion service when fully or partially outsourced, performed by a full-time technician employee, or performed by a cross-trained employee. The Partially Outsourced model was more economical than the Fully Outsourced model when the annual caseload exceeded 185 cases. The New Employee model became more economical than the Fully Outsourced model when the annual caseload exceeded 110 cases. The Cross-Trained model was the most economical when annual caseload exceeded 55 cases.

 

Alaris AEP 监护仪的“敲击声检测”无助于判别麻醉中耳机的不慎脱开

Alaris AEP monitor's "Click Detection" does not help to detect inadvertent disconnection of headphones during anesthesia.

Schmidt GN, Bischoff P, Standl T, Gerhardt A, Lankenau G, Schulte em Esch J.

Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany

Anesth Analg. 2004;98(1):123-7

 

听觉诱发电位(AEP)可被麻醉药剂量依赖性地抑制,但因为缺少合适的听觉刺激而不能被注册。Alaris AEP 监护仪包含“敲击声检测”(CD)(产生“无AEP”或“低AEP”的信息)来判别声音刺激的缺失。我们研究了17名病人清醒(AWAKE)和麻醉中(ANESTHESIA)正确放置头戴耳机(HP)以及HP脱离(No HP)后5分钟各自CD的准确性。每隔一分钟记录Alaris AEP ARX 指数、CD和双频指数。变化用Friedman Wilcoxon 检验来评估。敏感性(SEN)、特异性(SPE)以及受者工作特征曲线被用来分析CD的准确性。在清醒期间HP脱离后,Alaris AEP ARX 指数显著降低(P < 0.05)。在HP脱离后2分钟,CD可以判别,其敏感性为88%,特异性为97%。在麻醉期间,HP脱离后未发现变化。CD判别HP脱离的敏感性为100%,而特异性为20%。 Alaris AEP监护仪含有的CD不能判别出麻醉期间HP的不慎脱离。结论:听觉诱发电位的信号传递可以被麻醉药抑制,但抑制也可能为头戴耳机脱离引起。在本实验中,我们证明即使拥有最新“敲击声检测”特性的Alaris AEP监护仪仍不能判别出异丙酚和雷米芬太尼全麻时头戴耳机的脱离。

(黄施伟 译,李士通 校)

Auditory evoked potentials (AEP) can be suppressed by anesthetics dose dependently, but may fail to be registered because of the absence of adequate auditory stimuli. The Alaris AEP monitor includes the "Click Detection" (CD)(generating the message "NO AEP" or "LOW AEP") to detect the loss of auditory stimuli. We investigated the accuracy of the CD in 17 patients awake (AWAKE) and during anesthesia (ANESTHESIA) with accurately placed headphones (HP) and after disconnected HP (No HP) over 5 min each, respectively. Alaris AEP ARX index, CD,and Bispectral Index were recorded each minute. Changes were evaluated with the Friedman and Wilcoxon test. Sensitivity (SEN) and specificity (SPE) and receiver operating characteristic curve were analyzed for the accuracy of the CD. During AWAKE after disconnection of the HP, Alaris AEP ARX index decreased significantly (P < 0.05). The CD was able to detect No HP after 2 min with a SEN of 88% and a SPE of 97%. During ANESTHESIA, no changes were found after HP disconnection. CD detected No HP with a SEN of 100% and a SPE of 20%. The CD of the Alaris AEP monitor is not able to detect unnoticed disconnection of HP during anesthesia

 

脊麻用2-氯普鲁卡因:一项系列剂量研究以及添加肾上腺素的效果

Spinal 2-chloroprocaine: a dose-ranging study and the effect of added epinephrine.

Smith KN, Kopacz DJ, McDonald SB.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98111, USA.

Anesth Analg. 2004 Jan;98(1):81-8.

 

随着不含保存剂和抗氧化剂的2-氯普鲁卡因(2CP)的出现,可成为一种合适的短效药物来代替利多卡因进行腰麻。我们研究了2CP的安全性、剂量-反应特性以及添加肾上腺素的效果。每组6名志愿者随机接受椎管内应用3045、或60mg加或不加肾上腺素的2CP。对感觉和运动阻滞的作用强度和作用时间进行评估。18名志愿者中的11位称有模糊的、非特异性的感冒样症状,揭盲提示所有和感冒样症状有关的药物内都加了肾上腺素。那些使用未加肾上腺素的2CP的志愿者中没有称有感冒样症状,所以随后没有进一步使用含肾上腺素的椎管内药物,结果为29人药物使用(11次含肾上腺素,18次不含肾上腺素)。结果显示阻滞平面广度和作用时间均呈2CP剂量依赖性,而2个节段消退时间和消退至T10时间除外。使用2CP不同剂量后感觉完全恢复时间分别为98+/- 20, 116 +/- 15, 132 +/- 23 min2CP加肾上腺素后感觉完全恢复时间分别为153 +/- 25, 162 +/- 33, 148+/- 29 min。不含保存剂和抗氧化剂的2CP在剂量为3060mg时可有效地用于椎管内麻醉。不建议添加肾上腺素,因为副作用发生率较高。结论:椎管内使用高比重的2-氯普鲁卡因是有效的,而3060mg剂量范围时适合来用于门诊手术病人,无一过性神经症状体征。不建议添加肾上腺素,因为副作用发生率较高。

(黄施伟 译,李士通 校)

With the availability of preservative- and antioxidant-free 2-chloroprocaine (2-CP), there may be an acceptable short-acting alternative to lidocaine for spinal anesthesia. We examined the safety, dose-response characteristics, and effects of epinephrine with spinal 2-CP. Six volunteers per group were randomized to receive 30, 45, or 60 mg of spinal 2-CP with and without epinephrine. Intensity and duration of sensory and motor blockade were assessed. When 11 of the 18 volunteers complained of vague, nonspecific flu-like symptoms, breaking of the blind revealed that all spinal anesthetics associated with the flu-like symptoms contained epinephrine. There were no complaints of flu-like symptoms in the volunteers who received 2-CP without epinephrine. No further spinal anesthetics containing epinephrine were administered, resulting in 29anesthetics (11 with epinephrine, 18 without epinephrine.) Plain 2-CP demonstrated a dose-dependent increase in peak block height and duration of effect at all variables except time to 2-segment regression and time to regression to T10. Time to complete sensory regression with plain 2-CP was 98 +/- 20, 116 +/- 15, and 132 +/- 23 min, respectively. 2-CP with epinephrine produced times to complete sensory regression of 153 +/- 25, 162 +/- 33, and 148+/- 29 min, respectively. Preservative and antioxidant free 2-CP can be used effectively for spinal anesthesia in doses of 30-60 mg. Epinephrine is not recommended as an adjunct because of the frequent incidence of side effects.

 

脊麻氯普鲁卡因溶液:37摄氏度时的比重和pH滴定

Spinal chloroprocaine solutions: density at 37 degrees C and pH titration.

Na KB, Kopacz DJ.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, B2-AN, Seattle, WA 98111, USA.

Anesth Analg. 2004 Jan;98(1):70-4.

 

局麻药的比重和pH在其作为椎管内用药时是重要的特性。不含保存剂和抗氧化剂的氯普鲁卡因配方已出现,并正被研究用于短效的脊麻。本研究中,我们评估了这些新型氯普鲁卡因配方的pH和比重(至5位有效数字,g/mL37摄氏度)。除了2%和3%氯普鲁卡因以及2%利多卡因外,添加肾上腺素或碳酸氢盐的2%氯普鲁卡因也被评估。还在用水稀释和添加葡萄糖之后测定了密度。氯普鲁卡因,2%或3%,在添加葡萄糖之前相对于脑脊液是重比重的(密度分别为1.00123g/mL1.00257g/mL)。当用水稀释时,所有的溶液相对于脑脊液是低比重的(密度小于1.00028g/mL)。2%的利多卡因是唯一不含葡萄糖的低密度溶液(密度1.00004g/mL)。不含亚硫酸氢盐的2-氯普鲁卡因非常酸(pH<4.0),但加入少量的碳酸氢盐(0.25-0.33 mL/10mLpH可增加至7.0以上。氯普鲁卡因密度的增加使其在不加葡萄糖的情况下成为有效的重比重脊麻药物。结论:不含葡萄糖的2-氯普鲁卡因在37摄氏度时相对于脑脊液是重比重的,因此用于脊麻时可不加葡萄糖。不含亚硫酸氢盐的2-氯普鲁卡因保持酸性(pH<4.0)。加入少量的碳酸氢盐(0.25-0.33 mL/10mLpH可增加至7.0以上。

(黄施伟 译,李士通 校)

The density and pH of a local anesthetic are important characteristics in its use as an intrathecal drug. Preservative- and antioxidant-free formulations of chloroprocaine are available and are being investigated for short-duration spinal anesthesia. In this study, we evaluated the pH and density (to 5 significant digits in g/mL, at 37.0 degrees C) of these new chloroprocaine formulations. In addition to plain 2% and 3% chloroprocaine and 2% lidocaine, mixed solutions of 2% chloroprocaine with epinephrine or with bicarbonate were evaluated. Density was also measured after water dilution and after increasing amounts of added dextrose. Chloroprocaine, 2% or 3%, is hyperbaric relative to cerebrospinal fluid (CSF) before any addition of dextrose (density 1.00123 g/mL and 1.00257 g/mL, respectively). When diluted with water, all the solutions are hypobaric relative to CSF (density <1.00028 g/mL). Plain 2% lidocaine is the only dextrose-free solution measured to be hypobaric (density 1.00004 g/mL). Bisulfite-free 2-chloroprocaine remains very acidic (pH <4.0), but the pH can be increased to more than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10 mL). The increased density of plain chloroprocaine makes it a useful hyperbaric spinal drug without the addition of dextrose.

 
针刺能减低伤害性刺激对麻醉状态下志愿者所引起的体感诱发电位振幅
Acupuncture decreases somatosensory evoked potential amplitudes to noxious stimuli in anesthetized volunteers.
Meissner W, Weiss T, Trippe RH, Hecht H, Krapp C, Miltner WH.
Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University
Anesth Analg. 2004 Jan;98(1):141-7 
 
针刺对疼痛感觉的影响尚无定论。因为伤害性刺激引出的体感诱发电位(SEPs)晚期振幅被认为与疼痛强度的主观感受有关,所以我们以双盲原则设计了本研究,观察针刺前后SEPs变化。16个健康志愿者以异丙酚麻醉及右食指给予伤害性电刺激,随后分二组,针刺组(n = 8)在腿部镇痛点给予电针刺激15 min,而对照组未给予处理(观察人员不知情),之后重复刺激。在每次刺激时记录SEPs的最高值Cz并分析N150  P260潜伏期和振幅的变异。P260振幅从针刺前的4.40 +/- 2.76 mV (mean +/- SD)下降至针刺后的1.67 +/- 1.21 mV(P < 0.05),而对照组则未变(针刺前2.64 +/- 0.94 mV,针刺后2.54 +/- 1.54 mV)。总之本观察显示电针针刺能明显减少麻醉状态下伤害性电刺激诱发的SEP晚期振幅,提示针刺具有特殊的镇痛作用。
(王立中译  李士通校)
The effect of acupuncture on pain perception is controversial. Because late amplitudes of somatosensory evoked potentials (SEPs) to noxious stimuli are thought to correlate with the subjective experience of pain intensity, we designed this study to detect changes of these SEPs before and after acupuncture in a double-blinded fashion. Sixteen volunteers were anesthetized by propofol and exposed to painful electric stimuli to the right forefinger. Then, blinded to the research team, the acupuncture group (n = 8) was treated with electric needle acupuncture over 15 min at analgesic points of the leg, whereas the sham group (n = 8) received no treatment. Thereafter, nociceptive stimulation was repeated. SEPs were recorded during each noxious stimulation from the vertex Cz, and latencies and amplitudes of the N150 and P260 components were analyzed by analysis of variance. P260 amplitudes decreased from 4.40 +/- 2.76 microV (mean +/- SD) before treatment to 1.67 +/- 1.21 microV after treatment (P < 0.05), whereas amplitudes of the sham group remained unchanged (2.64 +/- 0.94 microV before versus 2.54 +/- 1.54 microV after treatment). In conclusion, this double-blinded study demonstrated that electric needle acupuncture, as compared with sham treatment, significantly decreased the magnitudes of late SEP amplitudes with electrical noxious stimulation in anesthetized subjects, suggesting a specific analgesic effect of acupuncture.
 
幼儿心脏手术时呼吸机械力学的改变
Changes in respiratory mechanics among infants undergoing heart surgery.
Stayer SA, Diaz LK, East DL, Gouvion JN, Vencill TL, McKenzie ED, Fraser CD,Andropoulos DB.
Department of Anesthesiology, Division of Pediatric Cardiovascular
Anesthesiology, Baylor College of Medicine, Texas Children's Hospital 
Anesth Analg. 2004 Jan;98(1):49-55  
 

先天性心脏病伴有肺血流(PBF)增加的儿童常有呼吸力学的异常。低温CPB对肺功能也产生不良影响。本研究观察106例年龄低于1岁行心脏手术的幼儿呼吸力学改变。切皮前和关胸后在手术室及在进入ICU时分别测定动态呼吸顺应性(Cdyn)及总的呼吸阻力(Rrs)。同时记录下列数据:年龄,体重,术前肺浸润,术前机械通气及PBF增加的表现,CPB时间,主动脉阻断时间,深低温停循环时间,类固醇使用和超滤液容量。协方差分析变异以确定三个时间点各个因素对Cdyn Rrs的影响。在纠正高PBF的心脏手术后Rrs改善,且在婴儿最明显。在PBF正常或降低的幼儿中,CPB导致Cdyn下降。我们认为手术对过度肺血流纠正的有益作用超过CPB对幼儿呼吸力学的不良影响。

(王立中译 李士通校)

Children with excessive pulmonary blood flow (PBF) from congenital heart disease have abnormal respiratory mechanics. Exposure to hypothermic cardiopulmonary bypass (CPB) adversely affects lung function. We designed this study of 106 patients to determine the changes in respiratory mechanics in infants younger than 1 yr undergoing heart surgery. Dynamic respiratory compliance (Cdyn) and total respiratory resistance (Rrs) were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded: age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Repeated-measures analysis of variance with covariate analysis was used to determine the effect of each covariate on Cdyn and Rrs at the three time periods. Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. We consider that the benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of CPB on respiratory mechanics. 

 

心脏手术术前预防性使用抗血小板药和/或抗凝药对术后出血的影响

The effect of preoperative antiplatelet/anticoagulant prophylaxis on postoperative blood loss in cardiac surgery.
Pothula S, Sanchala VT, Nagappala B, Inchiosa MA Jr.
Department of Anesthesiology, New York Medical College, Valhalla, NY 10595, USA.

Anesth Analg. 2004 Jan;98(1):4-10.

目的:了解术前预防性使用抗血小板药和/或抗凝药对冠脉搭桥术后失血量的影响。尽管有必要预防性用药以防止心肌缺血,这种疗法往往持续进行,除非有迹象表明有增加出血的危险性,如术前五到七天内用药。经患者同意后,随机抽取93例成人患者的治疗前血样。患者分为三组:组Ⅰ,术前不用药;组Ⅱ,用血小板二磷酸腺苷(ADP)受体拮抗剂;组Ⅲ,ADP受体拮抗剂联合静脉注射肝素。术后24小时内的胸腔引流液组Ⅱ最高(P<0.05),三组分别为:组Ⅰ,503 +/- 56; 组Ⅱ,633 +/- 55; 组Ⅲ,439 +/- 29 mL (平均值+/-标准误)。单用ADP受体拮抗剂,出血量增加,而联合使用ADP受体拮抗剂和肝素可以减少出血量。治疗前和术后血浆纤维蛋白原浓度最高的是组Ⅲ(P<0.05),分别为:治疗前,组Ⅰ,311 +/- 17, 组Ⅱ,366 +/- 16, 组Ⅲ,423 +/- 18 mg/dL;术后,组Ⅰ,229 +/- 16, 组Ⅱ,267 +/- 13, 组Ⅲ,312 +/- 16 mg/dL(平均值+/-标准误)。三组的术后血浆纤维蛋白原浓度与术前值显著相关(相关系数从0.576 0.825; P 值从0.0110(-6))。结论:联合用药组失血量减少可能与对凝血因子的保护有关,该组血浆纤维蛋白原浓度最高可以证明。

(轩 李士通 校)

In this study we sought to determine whether preoperative treatment with antiplatelet and/or anticoagulant drugs influences postoperative blood loss after coronary artery bypass graft surgery. Although prophylactic treatment to prevent ischemic events preoperatively is often necessary, the treatment frequently continues until there may be a risk of increased bleeding (i.e., within 5-7 days before surgery). With patient consent, a preincision blood sample was collected prospectively from 93 adult subjects who presented randomly. They consisted of 3 groups regarding their primary preoperative regimen: 1) no preoperative treatment within the week before surgery; 2) platelet adenosine diphosphate (ADP) receptor antagonist; 3) ADP receptor antagonist plus IV heparin. Postoperative chest tube drainage (24 h) in the group that received ADP antagonist alone was more (P < 0.05) than either of the other groups: 503 +/- 56; 633 +/- 55; 439 +/- 29 mL (mean +/- SEM) for Groups 1, 2, and 3, respectively. Combined treatment with ADP antagonist plus heparin infusion appeared to prevent the increased blood loss with the ADP antagonist alone. Preincision and postoperative plasma fibrinogen concentrations were largest (P < 0.05) in the group that received the combination treatment; mean +/- SEM for groups 1, 2, and 3 preincision, 311 +/- 17, 366 +/- 16, and 423 +/- 18 mg/dL, and postoperatively, 229 +/- 16, 267 +/- 13, and 312 +/- 16 mg/dL. Postoperative fibrinogen showed strong dependence on preoperative fibrinogen in all groups (r = 0.576 to 0.825; P = 0.01 to 10(-6)). Prevention of the increased blood loss in the ADP receptor antagonist group by the addition of a heparin infusion may have been attributable to a conservation of coagulation factors, as evidenced by the increased plasma fibrinogen concentrations with combined prophylactic treatment.

 

钙敏化剂MCI-154和异氟醚的相互作用--对慢性置管狗的体循环和冠脉血流动力学研究

The interaction of MCI-154, a calcium sensitizer, and isoflurane on systemic and coronary hemodynamics in chronically instrumented dogs.
Takahashi S, Cho S, Hara T, Ureshino H, Tomiyasu S, Sumikawa K.
Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

Anesth Analg. 2004 Jan;98(1):30-6.

研究药物阻断慢性置管狗的自主神经系统后,钙敏化剂—

6-[4-(4'-pyridylamino)phenyl]-4,5-dihydro-3(2H)-pyridazinone hydrochloride(MCI-154)

和异氟醚对心肌收缩力、体循环和冠脉血流动力学的影响及其相互作用。犬清醒状态下,MCI-154增加心率和左室功能,不改变心率收缩压乘积(RPP)、压力功指数和冠脉血流量,减小冠脉阻力(CVR)。异氟醚减慢心率,降低左室功能、RPP、压力功指数和CVR,但不影响冠脉血流量。异氟醚麻醉下MCI-154对心血管功能的影响与清醒状态下的相似。MCI-154可以逆转异氟醚降低心输出量和每搏功(与前负荷有关)的作用,但影响不明显。

结论:MCI-154在清醒和异氟醚麻醉状态下均能增强心肌收缩力,降低CVR,不改变心肌氧耗量。

(轩 泓译 李士通 校)

We conducted this study to determine the interaction of MCI-154, 6-[4-(4'-pyridylamino)phenyl]-4,5-dihydro-3(2H)-pyridazinone hydrochloride, a calcium sensitizer, and isoflurane on myocardial contractility as well as systemic and coronary hemodynamics in chronically instrumented dogs after pharmacological autonomic nervous system activity blockade. MCI-154 increased heart rate and left ventricular function with no change in rate pressure product, pressure work index, and coronary blood flow, with a decrease in coronary vascular resistance (CVR) in the conscious state. Isoflurane decreased heart rate and left ventricular function, with a decrease in rate pressure product and pressure work index. Isoflurane also decreased CVR, but not coronary blood flow. The cardiovascular actions of MCI-154 during isoflurane anesthesia were qualitatively similar to those observed in the conscious state. In contrast to the finding in the conscious state, MCI-154 reversed the decrease in cardiac output and preload recruitable stroke work caused by isoflurane, but these are not significantly d different from the effects of isoflurane alone. These results indicate that MCI-154 increases myocardial contractility and decreases CVR without changing calculated myocardial oxygen consumption during both the conscious state and isoflurane anesthesia. IMPLICATIONS: MCI-154, a calcium sensitizer, restores the myocardial contractility depressed by isoflurane and enhances the coronary vasodilating effect of isoflurane in chronically instrumented dogs.


 

顺式阿曲库铵和罗库溴铵的药效学相互作用

Pharmacodynamic interactions between cisatracurium and rocuronium.
Breslin DS, Jiao K, Habib AS, Schultz J, Gan TJ.
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.

Anesth Analg. 2004 Jan;98(1):107-10.

神经肌肉阻断剂维持剂量的起效和持续时间可能受到初始肌松药的影响。观察甾体类和苄异喹啉类肌松药的相互作用对维持剂量顺式阿曲库铵临床持续作用时间的影响。方法:60例成人患者接受异氟醚、笑气和氧气麻醉,随机分为三组:组Ⅰ,罗库溴铵0.6 mg/kg TOF的第一次颤搐恢复25%时给顺式阿曲库铵0.03 mg/kg ;组Ⅱ,顺式阿曲库铵0.15 mg/kg ,继以顺式阿曲库铵0.03 mg/kg;组Ⅲ,罗库溴铵0.6 mg/kg ,继以罗库溴铵0.15 mg/kg 。用肌肉加速度仪(TOF-Guard, Boxtel, The Netherlands)测量神经肌肉阻滞程度。前两次维持剂量的临床持续作用时间(分钟,平均值+/-标准差)分别为:第一次,组Ⅰ,41 +/- 10, 组Ⅱ,31 +/- 7++,组Ⅲ,25 +/- 8++ ;第二次,组Ⅰ,39 +/- 11,组Ⅱ,30 +/- 6+, 组Ⅲ,29 +/- 9*(*P < 0.05, +P < 0.01, ++P < 0.001; I II、组III相比)结论:预先使用罗库溴铵可以延长顺式阿曲库铵的前两次维持剂量的临床持续作用时间。

(轩 李士通 校)

The onset and duration of maintenance doses of neuromuscular blocking drugs may be influenced by the original neuromuscular blocking drug used. We assessed the effect of the interaction between steroidal and benzo-isoquinolinium compounds on the clinical duration of maintenance doses of cisatracurium. Sixty adult patients undergoing anesthesia with isoflurane, nitrous oxide, and oxygen were randomized to receive the following: Group I = rocuronium 0.6 mg/kg followed by cisatracurium 0.03 mg/kg when the first twitch in the train-of-four (TOF) recovered to 25%, Group II = cisatracurium 0.15 mg/kg followed by cisatracurium 0.03 mg/kg, and Group III = rocuronium 0.6 mg/kg followed by rocuronium 0.15 mg/kg. Neuromuscular blockade was monitored using acceleromyography (TOF-Guard, Boxtel, The Netherlands). The clinical duration (mean +/- SD) of the first 2 maintenance doses was 41 +/- 10, 31 +/- 7++, and 25 +/- 8++ min, and 39 +/- 11, 30 +/- 6+, 29 +/- 9* min in Groups I-III, respectively (*P < 0.05, +P < 0.01, ++P < 0.001; Group I versus II and III). Thus, the clinical duration of the first two maintenance doses of cisatracurium was prolonged when administered after rocuronium. IMPLICATIONS: We assessed the clinical effect of administering cisatracurium after an intubating dose of rocuronium in 60 patients undergoing isoflurane/nitrous oxide and oxygen anesthesia. The clinical duration of the first two maintenance doses of cisatracurium administered after rocuronium was significantly prolonged. This supports the contention that combinations of structurally dissimilar neuromuscular blocking drugs result in a synergistic effect.