Anesthesia & Analgesia

January 2004

Table of Content

CARDIOVASCULAR ANESTHESIA:

心臟手術術前預防性使用抗血小板藥和/或抗凝藥對術後出血的影響

( 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.

心臟手術中的A- B-型利尿鈉肽

(方芳翻譯 薛張綱校)

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.

體外迴圈冠脈搭橋術中使用16FDP的心肌保護作用:隨機對照臨床實驗

(陳潔 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.

 

鈣敏化劑MCI-154和異氟醚的相互作用--對慢性置管狗的體循環和冠脈血流動力學研究

( 泓譯 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.

原發性多汗症病人中內鏡下胸交感神經切除術可以抑制壓力反射對心率的控制

(方芳翻譯 薛張綱校)

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.

體位元性低血壓通常發生在麻醉後第一個小時

(陳潔 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:

幼兒心臟手術時呼吸機械力學的改變

(王立中譯 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.

 

可樂定延長新生兒脊麻時間:一項前瞻性劑量範圍研究

(方芳翻譯 薛張綱校)

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.

 

右旋美托咪啶單次量可減少小兒七氟醚麻醉中的躁動

(肖潔 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:

脊髓中氯普魯卡因溶液:37° C的密度和 pH滴定。

(方芳翻譯 薛張綱校)

脊麻氯普魯卡因溶液:37攝氏度時的比重和pH滴定

(黃施偉 譯,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.

 

在志願者身上進行2-氯普魯卡因與利多卡因的比較研究

(肖潔 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-氯普魯卡因:一項系列劑量研究以及添加腎上腺素的效果

(黃施偉 譯,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-氯普魯卡因脊麻:添加右旋糖的作用

(陸緒偉翻譯 薛張綱校)

Spinal 2-Chloroprocaine: The Effect of Added Dextrose

Daniel T. Warren and Dan J. Kopacz

Anesth Analg 2004 98: 95-101.

ANESTHETIC PHARMACOLOGY:

在四個成串刺激的第2個刺激恢復後對順式阿曲庫胺和羅庫溴銨進行拮抗時:是否必須對神經肌肉功能進行定量評估?

(殷文淵 譯 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.

 

順式阿曲庫銨和羅庫溴銨的藥效學相互作用

( 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.

長期應用抗精神病藥物增加術中低體溫的發生

(陸緒偉翻譯 薛張綱校)

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 監護儀的“敲擊聲檢測”無助於判別麻醉中耳機的不慎脫開

(黃施偉 譯,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:

術前口服Rofecoxib作為下腹部手術後鎮痛的輔助手段:對疼痛強度和肺功能的影響

(殷文淵 譯 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.

 

針刺能減低傷害性刺激對麻醉狀態下志願者所引起的體感誘發電位振幅
(王立中譯  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.

 

大鼠長期鞘內注射Ketorolac Tromethamine的抗傷害感受反應及神經毒性篩選

(陸緒偉翻譯 薛張綱校)

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.

 

成年病人住院手術後使用右旋美托咪啶與嗎啡鎮痛療效的比較

(朱輝 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

.

丙帕他莫單次和重複給藥治療術後疼痛鎮痛效果評估:牙科手術後應用丙帕他莫和嗎啡鎮痛的比較

(周雅春譯,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.

 

脊柱融合術後切口持續滴注羅吡卡因的藥動學及效力

(陸緒偉翻譯 薛張綱校)

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小時以上的初級和次級痛覺過敏穩定性的比較

(忻紀華 譯 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.

 

胺碘酮減少大鼠神經痛模型對熱、冷和機械刺激的痛覺過敏

(周雅春譯,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]腦啡肽誘導的外周抗疼痛作用的減弱:L-精氨酸/一氧化氮/環一磷酸鳥嘌呤途徑的作用

(鍾鳴翻譯 薛張綱校)

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:

整形手術患者隨機應用潘庫溴胺或羅庫溴胺的麻醉後蘇醒時間研究

(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:

術中血細胞回收經濟學分析

(周雅春譯,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:

二氧化碳描記術在非氣管內插管急診病人的院前呼吸監測中作為脈搏血氧飽和度監測的附加工具

(鍾鳴翻譯 薛張綱校)

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.

 

在肺損傷實驗中通氣-血流分佈與不同的吸入流量模式相關

(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

.

韓國手部指壓法用於治療創傷病人院前轉運中的暈動病:一項在老年人群中進行的前瞻性隨機雙盲研究:

(顏濤譯,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:

硬膜外鎮痛的走動延長對分娩的作用

(鍾鳴翻譯 薛張綱校)

延長走動時間對硬膜外鎮痛分娩產程的影響

(顏濤譯,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.

 

鞘內注射呱替啶可減少脊麻下剖腹產病人寒顫的發生率

(齊波 王祥瑞 )

椎管內呱替啶減少脊麻下行剖宮產手術中寒戰的發生率

(顏濤譯,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%羅呱卡因以三種不同途徑行坐骨神經阻滯起效時間的比較

(齊波 譯 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%氧不影響麻醉後動脈血氧分壓

周曉敏翻譯 薛張綱校

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.

比較麻醉誘導時經面罩機械通氣和手控呼吸的不同:前瞻性、隨機化、交叉性研究

(周曉敏翻譯 薛張綱校)

 

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.

體外迴圈冠脈搭橋術中使用16FDP的心肌保護作用:隨機對照臨床實驗

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


體內和體外實驗提示16FDPFDP,一種葡萄糖代謝的中間產物,能通過提高高能磷酸水平來改善缺血組織的損傷,因此可能對體外迴圈冠脈搭橋術的患者有心肌保護作用。

通過隨機,雙盲,對照,安全劑量內的實驗,以研究5種劑量的FDPCABG患者的作用。(n12060FDP60例對照)。5種濃度的FDP,3種無效,1種改善了心功能,1種因為產生代謝性酸中毒而需要調整劑量。患者在術前靜脈注射250mgkg, 術中追加2.5Mm(n15),這些患者再灌注後246小時,血漿肌酐濃度低(p<0.05),很少發生術後心梗(p<0.05),術後心功能得到改善,表現為再灌注61216小時後(p<0.01)更高的左心室收縮指數(LVSWI),以及1216小時後的CIp<0.05)。這些資料一致說明:FDPCABG手術患者有心肌保護作用,並且支持以往的實驗室和臨床關於FDP對缺血性心臟病作用的研究結果。

(陳潔 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.

 

體位元性低血壓通常發生在麻醉後第一個小時

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


體位性不耐受是全麻後的常見症狀,與術後死亡率的增長存在著相關性。直立位低血壓(OH)的誘因尚不明確。我們將較小全麻手術後的患者採用頭高斜位,以評價直立位低血壓(OH)的發生率和危險因素。共召集了104位患者,預先分為4組:老年女性,老年男性,青年女性,青年男性。OH的發生率分別為76.0%,72.0%,45.5%和62.5%,並與年齡的增長呈相關性(p<0.05)。血壓正常組與OH組在健康指數,術前血壓,ASA評分,麻醉過程,靜脈補液和鎮痛藥物以及麻醉後抗嘔吐藥物的使用方面沒有差異。全麻後OH患者的心率和舒張壓沒有升高,可能是麻醉對心血管反射的持續作用或者是因為臥床引起的心血管反射調節紊亂。我們的結論是:OH常見於全麻術後,可能是術後體位性不耐受的主要原因。

(陳潔 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.

 

右旋美托咪啶單次量可減少小兒七氟醚麻醉中的躁動

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


急性躁動是小兒七氟醚麻醉過程中常見的副反應。右旋美托咪啶, 具有鎮靜和止痛作用,可能改善此種副反應。我們觀察了90個進行下腹部手術和生殖器手術的兒童(年齡從1歲到10歲),在恢復期時使用右旋美托咪啶的療效。麻醉誘導時吸入七氟醚,病人隨機分組,一組病人注射生理鹽水(組1, n = 30), 一組病人注射右旋美托咪啶0.15 µg/kg (2, n = 30),還有一組病人注射右旋美托咪啶0.30 µg/kg(3, n = 30). 然後面罩通氣,行骶管阻滯。麻醉維持使用1%七氟醚和50%氧化亞氮,維持其自主通氣。手術過程中,每隔5分鐘記錄病人血液動力學和呼吸的改變。並麻醉結束時記錄睜眼的時間(TEO)和其他的緊急事件。三組病人的手術過程基本相似。組1TEO7.5±5.0分鐘,組2的為8.2±5.0 min,組3的為9.8±4.0min(NS)。第一組病人躁動的發生率為37% (20%–54%),第二組病人的發生率為17% (4%–30%),第三組病人的發生率為10% (0%–21%)(P < 0.05)。第一組和第三組配對比較有明顯的差異(P < 0.05, 95%可信間隙: 7%–47%)。三組病人的出院時間也基本相似。總結,我們認為七氟醚全麻誘導後使用0.3 µg/kg右旋美托咪啶可以減少躁動的發生,而且沒有什麼不良反應。

(肖潔 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.

 

在志願者身上進行2-氯普魯卡因與利多卡因的比較研究

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

需要脊麻的門診病人一般選擇利多卡因行蛛網膜下腔麻醉。但是,常發生短暫的神經症狀(TNS)2-氯普魯卡因具有獨特的化學結構,不含防腐劑,在脊麻過程中與利多卡因進行了比較。在這個雙盲的,隨機的,對照研究中,我們在8位自願者身上比較了氯普魯卡因和利多卡因,每一位自願者接受了兩次脊麻,一次為40mg 2% 的利多卡因,另一次為40 mg 2% 2-氯普魯卡因。通過針刺覺,對經皮電刺激的耐受程度以及止血帶,運動能力和模擬放電軌跡等方面進行評價。氯普魯卡因的藥效與利多卡因相似,包括阻滯峰值分別為(T8 [T5–11]T8 [T6–12], P = 0.8183),止血帶耐受時間(46 ± 6 min 38 ± 24 min, P = 0.4897)。氯普魯卡因麻醉感覺消失的較早(103 ± 13 min126 ± 16 min, P = 0.0045),更迅速的達到模擬放電的標準(104 ± 12 min 134 ± 14 min, P = 0.0007)8個自願者中有7位在使用利多卡因後有中度的TNS反應,而使用氯普魯卡因後無TNS的發生(P = 0.0004)。總結,通過氯普魯卡因與利多卡因的比較,氯普魯卡因具有可信的感覺和運動阻滯區間,並且副反應少,是在門診手術中值得選用的脊麻藥物。

(肖潔 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.

 

在四個成串刺激的第2個刺激恢復後對順式阿曲庫胺和羅庫溴銨進行拮抗時:是否必須對神經肌肉功能進行定量評估?

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


隨著四個成串刺激(TOF)比值>0.70作為肌松恢復的標準,麻醉後監護室(PACUs)中經常發生術後肌松殘餘麻痹。可是,有關麻醉前管理的詳細資訊很少提供。我們研究了使用短效肌松藥順式阿曲庫銨和羅庫溴銨以及隨後使用新斯的明後術後肌肉無力的發生情況。在使用0.15mg/kg順式阿曲庫銨或0.60mg/kg羅庫溴銨後使用地氟醚,N2O,阿片類鎮痛藥插管。拇指對刺激尺神經所產生的反應通過觸動來估計。補加肌松藥使TOF計數維持在12。在手術結束時,TOF計數為2,使用新斯的明0.05mg/kg10μg/kg。機械TOF反應在逆轉後5分鐘通過壓力轉換器測量。病人都觀察到TOF比值恢復到0.90。順式阿曲庫銨和羅庫溴銨相比在恢復上沒有顯著差別。TOF比值在逆轉後10分鐘分別為0.72±0.100.76±0.11。在逆轉後15分鐘,每組只有一個病例TOF比值<0.70。結果提示如果使用順式阿曲庫銨或羅庫溴銨時通過TOF計數來作為指導的必要性不大.

(殷文淵 譯 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.

術前口服Rofecoxib作為下腹部手術後鎮痛的輔助手段:對疼痛強度和肺功能的影響

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是一種選擇性環氧化酶-2抑制劑,它能減輕疼痛和炎症反應而不抑制血小板功能。我們在48名開腹手術病人中檢測了它對疼痛強度,術後嗎啡的需求量,和肺功能的影響。術前進行被動呼氣量和被動潮氣量的測量來評估肺功能。在隨機雙盲情況下,全麻插管前一小時給予口服安慰劑(A組)或口服Rofecoxib25mg[]50mg[C])。在麻醉後監護室中靜脈注射嗎啡,在病房中病人自控鎮痛靜脈使用嗎啡控制疼痛。嗎啡劑量,平靜時疼痛程度和用力呼吸後疼痛(術後肺活量)分別在研究藥物使用1224小時候記錄。B組和C組與A組相比病人自控鎮痛嗎啡劑量在24小時分別減少44%30.3±17.5mg)和59%22.1±16.5mg)。在12小時,B組和C組平靜時和呼吸後疼痛評分均低於A組(P<0.05)。在24小時C組的平靜時疼痛評分是最低的(P<0.05)。C12小時FVC是保持最好的(P<0.03)。不利影響和術中出血各組間沒有差異。口服Rofecoxib可以提供一種嗎啡起始效應,也就是改善了疼痛控制和開腹手術病人的12小時FVC

(殷文淵 譯 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.

 

成年病人住院手術後使用右旋美托咪啶與嗎啡鎮痛療效的比較

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名成年選擇性手術患者被隨機地等分成兩組,一組使用右旋美托咪啶(首次負荷劑量為1μg/kg,10分鐘後給予0.4μg/kg/h維持4小時),另一組在手術結束前30分鐘使用硫酸嗎啡(0.08mg/kg)。我們測定心率(HR,平均動脈壓(MAP),呼吸頻率(RR),鎮靜和鎮痛效果(視覺疼痛評分),記錄在麻醉後蘇醒室(PACU)額外使用嗎啡的量直至手術結束後24小時。兩組患者的人口統計學,ASA分級,手術過程,基礎血流動力學以及術中用藥輸液情況都相似。使用右旋美托咪啶的患者在PACU時心率要慢於後一組(平均為16bpm),然而MAP,RR以及鎮靜程度兩組相似。在復蘇的第一階段,右旋美托咪啶組的患者使用嗎啡的量顯著低於後組而達到相同的鎮痛效果(右旋美托咪啶組,4.5±6.8mg;嗎啡組,9.2±5.2mg)。60分鐘內蘇醒的患者中,右旋美托咪啶組17名病人中僅有6名再需要嗎啡,而嗎啡組有15名再需要嗎啡。由此,我們得出結論,在成年患者住院手術結束前使用右旋美托咪啶可減少(約66%)術後早期嗎啡的需求量並可降低在PACU時的心率。

(朱輝 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小時以上的初級和次級痛覺過敏穩定性的比較

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


我們的目的是研究10小時以上經UVB照射導致的初級和次級痛覺過敏在當天的穩定性和隔天的重複性。8名志願者大腿部經UVB照射20小時後,對該照射點(r=2.5cm)的針刺覺,熱痛閾(HPTT)和電刺激(5250Hz的電痛閾[EPTT])進行評估。在兩個時段裏,分別測量10小時(每隔2小時測量一次)。觀察到針刺覺的次級痛覺過敏區域擴大(5995mm 2; SD 1645.與正常的皮膚相比,照射點初級痛覺過敏的HPTT明顯下降(平均差,6.5℃;95%可信區間,6.1-6.8 ; p<0.001),250HzEPTT也下降( 平均差,0.45mA95%可信區間,0.13-0.75p<0.005)。在同一時段內的初級痛覺過敏(p=0.14, HPTT)或次級痛覺過敏(p=0.95)無不同趨勢,兩個時段內的初級痛覺過敏(p=0.28)和次級痛覺過敏(p=0.07)無差異。日灼模型提供了長期穩定的痛覺過敏,在當天高度穩定,而隔天的初級和次級痛覺過敏的重複心病感高。

(忻紀華 譯 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

整形手術患者隨機應用潘庫溴胺或羅庫溴胺的麻醉後蘇醒時間研究

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


在這次實驗中我們主要研究整形外科手術患者在選用了神經肌肉阻滯藥(潘庫溴胺和羅庫溴胺)後,其術後恢復時間和相關副反應的不同。70名患者被隨機分為羅庫溴胺組和潘庫溴胺組,在到達麻醉後恢復室(PACU)時及30分鐘後運用肌松監測儀測試TOF比率,並評估麻醉恢復程度。在PACU期間記錄下低氧血症、噁心、嘔吐的發生情況以及離開PACU的標準時間和實際離開的時間。潘庫溴胺組中40%的患者在到達PACUTOF比率<0.7,而羅庫溴胺組僅5.9%P<0.001)。在PACU期間潘庫溴胺組的患者更容易出現肌力減退症狀(視力模糊和全身乏力P<0.001),低氧血症的發生率潘庫溴胺組為21名患者而羅庫溴胺組為10名患者,潘庫溴胺組離開PACU的標準時間為50分鐘(45—60分鐘),實際離開時間為70分鐘(60—90分鐘);羅庫溴胺組離開PACU的標準時間為30分鐘(25—40分鐘),實際離開時間為57.5分鐘(45—61分鐘)(P<0.001)。綜上所述,對於使用長效肌松藥的手術患者在PACU中的恢復時間應盡可能延長。

(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.

 

在肺損傷實驗中通氣-血流分佈與不同的吸入流量模式相關

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


在急性肺損傷(ALI)時,減速流量(Vdec)與恒定流量(Vcon)的控制性機械通氣相比可提高氧合,這主要是由於改善了通氣-血流(VA/VQ)分佈。我們利用ALI的動物模型以測試這一理論,同時也評估Vdeco的效用。在此實驗中,18ALI的豬被隨機分為VconVdecVdeco組,每組均以相同的潮氣量及PEEP行機械通氣6小時,期間檢測各組的血流動力學、氣體交換和VA/VQ分佈,結果顯示各組因減少了肺內分流,因此氧合均增加(P<0.05),然而僅Vcon通氣組在正常的VA/VQ分佈時增加肺內血流(P<0.05)。VconPaO2VdecVdeco更高(P<0.05)。我們得出結論:Vcon可提供更好的VA/VQ分佈並進一步提高氧合。

(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.

 

鞘內注射呱替啶可減少脊麻下剖腹產病人寒顫的發生率

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


由脊麻引起的術中寒顫可使病人感到不舒適,並影響麻醉監測。因此,我們進行了這項前瞻性、隨機雙盲試驗來研究通過鞘內注射呱替啶(0.2mg/Kg)是否可以減少脊麻下剖腹產病人寒顫的發生率和強度。40名行非急診剖腹產手術的臨產婦被分為兩組。脊麻藥物採用重比重布比卡因(0.7510.5mg)和嗎啡0.15mg,另外,實驗組病人加用呱替啶(0.2mg/Kg,對照組加用生理鹽水。實驗中需觀察的資料包括感覺阻滯平面、血壓、中心溫度和寒顫強度。在實驗過程中首先每一分鐘記錄這些資料共記錄10分鐘,然後每3分鐘一次記錄33分鐘,再每5分鐘一次直到感覺平面消退至L4。結果發現到達最高感覺平面的時間、最大阻斷節斷數、感覺和運動阻滯平面的消退情況和病人收縮壓在兩組病人均無明顯差異。而呱替啶組病人的寒顫發生率(P0.02)和寒顫強度(P0.003)均減小。因此鞘內注射呱替啶0.2mg/kg可減少脊麻下剖腹產病人寒顫的發生率和寒顫強度

(齊波 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%羅呱卡因以三種不同途徑行坐骨神經阻滯起效時間的比較

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


我們研究0.75%羅呱卡因以三種不同途徑行坐骨神經阻滯的起效時間和效果。全部75例病人均行足部手術,隨機分為三組行坐骨神經阻滯:經典後徑路(經典組;n=25),改良的臀筋膜下後徑路(臀筋膜下組;n=25),或側膕窩徑路(膕窩組;n=25)。所有操作均應用神經刺激器(刺激頻率,2Hz;刺激強度,0.5-2mA)和30ml 0.75%羅呱卡因。神經阻滯的起效時間以坐骨神經支配區域的針刺覺完全消失和足部不能背曲和蹠曲為標準。在這三組中,有一例在<0.5mA時誘發出刺激。三組的失敗率相似(膕窩組:4%,經典組:4%,臀筋膜下組:8%)。膕窩組的起效時間(25+/-5min)長於經典組(16+/-4min)和臀筋膜下組(17+/-4min,p<0.001)。經典組和臀筋膜下組的起效時間無明顯差異。在術後第一次給予鎮痛藥之前三組的疼痛程度評分無差異。我們總結到:在坐骨神經支配區域三種方法都可為臨床接受,臀筋膜下組和經典徑路組的麻醉起效時間早於側膕窩組。

(齊波 譯 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.

 

心臟手術中的A- B-型利尿鈉肽

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

 

這個研究是關於進行心臟手術的病人中A-(ANP) B-(BNP) 利尿鈉肽的分泌機制和預後評價。我們分別在接受冠脈搭橋(CABG)和換瓣的病人中測量ANP BNP的值。將CABG再分為有心室功能不全組(n = 28)和無心室功能不全組(n = 32);換瓣組分為二尖瓣(n = 21)和主動脈瓣組(n = 24)。術後死亡率隨訪到術後730天。ANP的濃度比BNP與主動脈夾閉後心臟的再灌注容量相關性更大。手術中BNP的分泌機制更加不一致。BNP的濃度在體外迴圈的病人中于主動脈夾閉的時間(r2 = 0.32; P = 0.006)和術後肌鈣蛋白I的濃度(r2 = 0.22; P = 0.0009)相關,在這些病人中術前 BNP的濃度增高和術後(兩年)的死亡率有關。在二尖瓣替換(增高3倍)和主動脈瓣替換(增高14倍)的患者中術前顯著增高的BNP在術後不再繼續增高。這些資料表明ANP主要和主動脈夾閉後心臟的再灌注容量相關,而BNP和其他因素,如長期左室內壓和/或血管內容量超負荷有關。BNP而不是ANP,在CABG病人中顯示為一種預測死亡率的因素。

(方芳翻譯 薛張綱校)

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

.

原發性多汗症病人中內鏡下胸交感神經切除術可以抑制壓力反射對心率的控制

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

 

內鏡下胸交感神經(T2-3 T3-4)切除術(ETS)是手掌多汗症的一個非常有效的治療方法。由於T2-3 T3-4的交感神經節和心臟的交感神經直接相關,交感神經切除會改變心率的壓力反射。我們這項研究的目的就是觀察小劑量地氟醚麻醉下,ETS對由升壓或降壓刺激引起的壓力反射的影響。我們觀察了40位因為手心或腋下多汗而接受 ETS的患者。在手術中,我們使用內鏡來確認並切除胸交感神經節。術前或術後在小劑量全麻下我們通過靜脈使用新福林和硝酸甘油來進行升壓和降壓實驗。壓力反射的敏感性通過R-R間期和收縮壓來反映。ETS並不改變靜息狀態下的心率和系統血壓;但是顯著改變了所有病人的在升壓和降壓實驗中的壓力反射。19個接受升壓實驗的患者中一人的壓力反射被完全抑制住了,而在21個接受降壓實驗的患者中,有9個。我們認為在接受ETS的病人中壓力反射被抑制了。

(方芳翻譯 薛張綱校)

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.

 

可樂定延長新生兒脊麻時間:一項前瞻性劑量範圍研究

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

在新生兒和早產兒中脊麻可以減少全麻後的死亡率。但是單用布比卡因對40%的病人來說作用時間太短而難以完成手術。可樂定延長了成人的脊麻和兒童的骶麻的時間而不帶來顯著的副作用。我們用75例在脊麻下接受臍疝修補術的新生兒,其中50%為早產兒,來進行可樂定前瞻性,對照的劑量範圍研究。患兒分別接受0.5%的等比重布比卡因(1 mg/kg),或加入0.25, 0.5, 1, 2 µg/kg可樂定的布比卡因。主要記錄平均動脈壓,心率,SpO2 ,感覺阻滯的平面和持續時間的資料。平均動脈壓,心率,SpO2 ,感覺阻滯的平面在五組患兒中都相似。在對照組中持續時間為67 (58–82)分鐘,而加入1µg/kg可樂定的組中為111 (93–125) 分鐘(P < 0.003)。使用2µg/kg可樂定組中, 一過性的低血壓發生率更高(P < 0.05),咖啡因的使用更頻繁。我們認為在新生兒中1µg/kg可樂定能顯著提高脊麻的效果並且不發生嚴重的副反應。

(方芳翻譯 薛張綱校)

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.

 

脊髓中氯普魯卡因溶液: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

當作為鞘內用藥時,局麻藥的密度和PH值是重要的參數。不含防腐劑和抗氧化劑配方的 氯普魯卡因可用於短時間的脊麻。在此項研究中,我們評價了這些新配方的氯普魯卡因的PH和密度( 37.0°C時以g/mL表示,保留小數點後五位)。我們評價了單純2% 3% 氯普魯卡因 和2%利多卡因,加入腎上腺素或碳酸氫鹽的2%的氯普魯卡因。我們也通過使用水稀釋或加入不同量的葡萄糖來改變密度。2%3%的氯普魯卡因(密度分別為1.00123 g/mL 1.00257 g/mL)在加入葡萄糖之前對腦脊液(CSF)來說是重比重溶液。當用水稀釋後都為低比重溶液(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)。不含亞硫酸氫鹽的2-氯普魯卡因仍偏酸(pH <4.0),但通過加入小劑量的碳酸氫鹽(0.25–0.33 mL/10 mL)可提高PH值到7.0以上。提高氯普魯卡因的密度,即使不加入葡萄糖,也能使他成為一種有用的重比重脊麻藥。

(方芳翻譯 薛張綱校)

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-氯普魯卡因脊麻: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-氯普魯卡因常作為門診病人手術中利多卡因的替代品。加入右旋糖後增加了溶液的鹼度並改變了脊麻的特徵。在此項研究中我們比較了2-氯普魯卡因脊麻中加或不加右旋糖(1.1%)的區別。八位志願者分別參與了此二項脊麻,一組為2-氯普魯卡因40mg2ml2   %)加0.25ml鹽溶液,另一組為2-氯普魯卡因40mg0.25ml 10%右旋糖,並採取雙盲、隨機、交叉平衡化處理。分別進行以下項目評估:針刺麻醉、對皮膚電刺激及驅血帶的耐受度、運動張力測試、恢復步行時間及完全消退時間。消退後應用超聲測膀胱殘餘尿量。所有受試者脊麻均成功並在11080-110min內消退。兩組在以下方面無顯著區別如麻醉最高平面均為T4(T7C6)、達最高平面的時間(14±6min)、消退達2個節段的時間(44±9min)、消退至L1水平的時間(66±12min)、耐受驅血帶的時間(43±9min)、運動功能恢復時間(81±14min)。麻醉消退後殘餘尿量均值右旋糖組較大(74±67ml16±35mlP=0.02)。無受試者發生短暫性神經症狀(TNS)。總之,2-氯普魯卡因脊麻效果完善,消退完全,無TNS發生。加入右旋糖並不能顯著改變脊麻阻滯特徵卻增加膀胱殘餘功能不全發生率。因此2-氯普魯卡因脊麻中不必加糖

(陸緒偉翻譯 薛張綱校)

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.

 

長期應用抗精神病藥物增加術中低體溫的發生

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.

 

抗精神病藥物能減少低體溫發生,但服用抗精神病藥物的精神分裂症病人的術中體溫調節尚不明確。我們調查了服用抗精神病藥物的精神分裂症病人的術中體溫管理及術後寒戰發生率。共觀察了行矯形外科手術的30位精神分裂症病人及30位對照病人。精神分裂症病人誘導後15min30min45min60min75min90min鼓膜溫度分別為(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)顯著低於對照組(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。精神分裂症病人誘導後60min75min90min平均皮膚溫度分別為(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])顯著低於對照組(31.5°C ± 0.3°C, 31.5°C ± 0.3°C, and 31.5°C ± 0.3°C)30位元精分病人中4人發生術後寒戰,30位對照組病人中7人發生術後寒戰。拔管後1h寒戰病人及無寒戰病人的鼓膜溫度無顯著差別。總之,慢性精分病人術中更易發生低體溫。但並不增加術後寒戰發生率。

(陸緒偉翻譯 薛張綱校)

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.

 

大鼠長期鞘內注射Ketorolac Tromethamine的抗傷害感受反應及神經毒性篩選

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

 

許多藥物行鞘內注射來觀察對阿片類藥物的替代效果。我們擬對老鼠行長期鞘內注射ketorolac tromethamine來探討其麻醉作用及可能的神經毒性作用。28Witar大鼠腹腔內注射30mg/kg硫噴妥鈉麻醉下經寰樞間隙放置導管。大鼠隨機分為4組每5天行4次重複鞘內注射。控制組給予10ml鹽水,其他組分別給予ketorolac tromethamine50ug150ug400ug。而後分別對各組大鼠行福馬林試驗、行為測試、脊髓組織病理學測試。行為測試及組織病理學試驗均未發現提示神經毒性的異常。福馬林試驗提示ketorolac tromethamine組的大鼠I相、II相反應均顯著低於控制組。雖然I相反應在ketorolac tromethamine三組中無顯著差別,但II相反應在接受150ug400ug ketorolac tromethamine組中有顯著減少。鞘內注射ketorolac tromethamine可減少傷害感受反射並且即便大劑量應用時亦未見不良神經作用。不過仍應繼續探索其他替代藥物鞘內注射治療慢性疼痛。

(陸緒偉翻譯 薛張綱校)

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

.

脊柱融合術後切口持續滴注羅吡卡因的藥動學及效力

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.

 

由於尚未對脊柱融合術後切口持續滴注的局麻方法進行評估,我們設計了此項研究來判定這種技術是否能增強麻醉效果並提高腰椎後路融合術後病人的轉歸。將38位進行脊柱穩定術的病人隨機分為2組。M組術後予靜脈嗎啡及ketorolac基線注射24hR組予靜脈注射鹽水。兩組病人均于皮下埋植16G多孔導管,R組切口予0.5%羅吡卡因200mg/40ml浸潤,並以0.2%羅吡卡因5ml/h維持注射;M組以同樣的速度注射鹽水。由對病人麻醉處理並不瞭解的護士對病人休息時及被動運動時進行疼痛評分。並測量病人血漿羅吡卡因濃度。R組的疼痛評分及應急醫療要求(diclofenac 及曲馬多)顯著少於M組。並且R組病人術後失血減少,住院天數縮短。羅吡卡因輸注後24h血漿濃度達峰,並處安全閾內,亦未發現毒副作用。這些結果提示脊柱穩定術後切口浸潤複合0.2%羅吡卡因持續輸注能有效治療疼痛。

(陸緒偉翻譯 薛張綱校)

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]腦啡肽誘導的外周抗疼痛作用的減弱:L-精氨酸/一氧化氮/環一磷酸鳥嘌呤途徑的作用

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

 

我們假設在糖尿病大鼠中阿片µ受體激動劑異常的低藥效可能是因為L-精氨酸/一氧化氮/環一磷酸鳥嘌呤途徑的功能性改變,為了證實該假設,我們評價了鏈脲黴素(STZ)糖尿病和非糖尿病大鼠中,N--L-鳥氨酸,亞甲基藍和3-嗎啉-斯得酮亞胺對[D-Ala2, NMePhe4, Gly-ol5]腦啡肽(DAMGO)誘導的外周抗疼痛中的作用。動物通過注射STZ(60mg/kg腹膜內注射)產生糖尿病。抗疼痛作用通過福馬林試驗來評估。阿片µ受體激動劑DAMGO(1ug每爪)抑制了第二階段的刺激反應。在STZ糖尿病大鼠中DAMGO的抗疼痛作用明顯低於非糖尿病大鼠。N--L-鳥氨酸(100ug每爪),一種NO合成酶抑制劑,或亞甲基藍(500ug每爪),一種鳥苷環化酶抑制劑,無論在糖尿病或非糖尿病大鼠中,均明顯降低了DAMGO誘導的抗疼痛作用。而且,3-嗎啉-斯得酮亞胺(200ug每爪),一種NO原料,在非糖尿病大鼠中增強了DAMGO的抗疼痛作用,但在糖尿病大鼠中卻無改變。這些結果提示,DAMGO的外周抗疼痛作用可能在於L-精氨酸/NO/cGMP途徑的啟動和這一途徑的功能紊亂;而且,隨著cGMP的啟動可能導致如所見的阿片µ受體激動劑對糖尿病大鼠效果不佳的抗疼痛作用。

(鍾鳴翻譯 薛張綱校)

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.

 

二氧化碳描記術在非氣管內插管急診病人的院前呼吸監測中作為脈搏血氧飽和度監測的附加工具

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

 

由醫護人員為基礎的救護系統轉運的較小創傷的受難者通常監測脈搏血氧飽和度。在院前惡劣的創傷監護條件下,脈搏血氧飽和度監測常常發生故障。我們假設二氧化碳描記術對非插管的創傷受難者而言是種效果不錯且便於使用的監測工具,並證實該假設。本研究中共收入70位未插管的創傷病人。分別對血氧飽和度和二氧化碳描記的生命變數和故障的數量和發生時間的記錄進行採樣。總報警數量(63vs10),每一病人報警數(3.3[1.9]vs0.3[0.9])(均數[標準差],總故障時間(191.5[216.7]vs11.8[40.2]秒),每一報警的故障時間(58.3[71.4]vs5.5[14.6]),轉運過程中故障時間百分比(13.2%[15.3%]vs0.8%[2.8%]),血氧飽和度組和二氧化碳描記組間明顯不同(P<0.01)。雖然脈搏血氧飽和度監測是急診監護監測中的標準方法,但我們發現二氧化碳描記術是種有幫助的監測設備。因此我們建議在轉運過程中使用二氧化碳描記術作為一種附加的監測工具以減少缺乏生命指標監測的時間段。

(鍾鳴翻譯 薛張綱校)

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.

 

硬膜外鎮痛的走動延長對分娩的作用

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

 

分娩時走動正變得越來越流行了,雖然其對分娩過程和疼痛強度的影響還不清楚。我們想知道有硬膜外鎮痛的走動延長是否對分娩和疼痛的持續有影響的可能。在本前瞻的、隨機試驗中,61位無併發症的臨產婦被分為斜躺組(n30)和走動組(n=30)。間斷給予0.08%布比卡因-腎上腺素加1ug/mL蘇芬太尼來提供硬膜外鎮痛。走動組的30位婦女中,25位真正走動了。她們走動的時間是64 ± 34分鐘(平均±標準差),如,占第一階段的29% ± 16%。兩組間分娩時程和疼痛的可視模擬比例評分間無顯著差異。然而,走動組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),後葉催產素的用量也少(6.4 ± 2.2 mg/h vs 8.4 ± 3.6 mg/h; P = 0.01)。而且我們發現,走動組有更好的排泄能力(P < 0.01)。雖然分娩和疼痛緩解的持續時間沒有改變,但這些發現支持分娩時走動更加有利。

(鍾鳴翻譯 薛張綱校)

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%氧不影響麻醉後動脈血氧分壓

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

在使用氣管內導管的情況下,全麻結束時吸入100%的氧氣已經顯示可損害肺氣體交換。相對措施如高呼氣末正壓通氣或肺活量手法,可能減輕其損害。但是這些策略在使用喉罩(LMA)時可能是不可行甚至是禁忌的。LMA和氣管導管在設計上有很大的差異,我們檢查了經LMA吸氧麻醉後病人的血氣。64ASAⅠ-Ⅱ級,使用LMA實施60分鐘全麻的病人,隨機分為兩組,在麻醉開始到拔除LMA期間分別吸入100%和30%的氧氣。拔除LMA3060分鐘檢測血氣,結果吸入100%氧氣組病人的動脈氧分壓和30%氧氣組基本相同(60分鐘時的檢測結果:83 +/- 885 +/- 7 mm Hg [均數+/-標準差]P = 0.14)。我們的結論是:使用LMA在全麻結束時吸入100%氧氣不會損害術後肺氣體交換。

結論:在麻醉病人的肺通氣中使用氣管導管和LMA作為人工氣道有相當大的差別。拔除氣管導管前吸入100%可導致肺功能損害,而此研究表明拔除LMA前吸入純氧不影響肺功能。(周曉敏翻譯 薛張綱校)

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.

 

比較麻醉誘導時經面罩機械通氣和手控呼吸的不同:前瞻性、隨機化、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.

 

使無保護的氣道通氣安全的一個方法是限制潮氣量,另一個可能是限制氣道峰壓,儘管不知道這樣是否能提供充分的潮氣量。因此,本研究的目的是評估無保護氣道在自動壓力控制通氣和週期性手控面罩通氣下通氣參數的質量,是一個前瞻性、隨機化、交叉性研究,物件是41個成人(ASA評分Ⅰ-Ⅱ級),在麻醉誘導時使用這兩套設備。使用一台肺監測儀(CP-100)測量呼吸參數。壓力控制面罩通氣和週期性系統通氣測量結果(均數+/-標準差)比較如下:低氣道峰壓(10.6 +/- 1.5 cm H(2)O 14.4 +/- 2.4 cm H(2)O; P < 0.001),氣道壓力差(8.5 +/- 1.5 cm H(2)O 11.9 +/- 2.3 cm H(2)O; P < 0.001),呼氣量(650 +/- 100 mL 680 +/- 100 mL; P = 0.001),分鐘通氣量(10.4 +/- 1.8 L/min 11.6 +/- 1.8 L/min; P < 0.001),最大吸氣流速(0.81 +/- 0.06 L/s 1.06 +/- 0.26 L/s; P < 0.001),吸氣平臺時間比例(48% +/- 0.8% 33% +/- 7.7%; P < 0.001)和呼氣末二氧化碳(34 +/- 3 mm Hg 33 +/- 4 mm Hg; 無意義).我們的結論是:在病人氣道無保護、無呼吸的情況下,壓力控制通氣相比週期性系統通氣可減少最大吸氣流速和氣道峰壓,因此,可在面罩通氣時使病人更安全。

結論:在病人氣道無保護、無呼吸的情況下,壓力控制通氣相比週期性系統通氣可減少最大吸氣流速和氣道峰壓,因此,可在面罩通氣時使病人更安全。

(周曉敏翻譯 薛張綱校)

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.

 

韓國手部指壓法用於治療創傷病人院前轉運中的暈動病:一項在老年人群中進行的前瞻性隨機雙盲研究:

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

 

創傷或者患病的病人在用急救車轉送的過程中經常發生暈動病。由於在奧地利禁止在急救車內使用藥物,非創傷性的韓國手部K-K9穴位指壓法可能成為對抗噁心和嘔吐的替代性方法。我們的研究納入了100例輕微創傷的老年病人,隨機分為KK9組和假指壓組。記錄了病人的噁心視覺類比評分數(VAS)和病人對於處理的總滿意數、血流動力學參數和外周血管收縮。在K-K9組,所有病人都記錄到噁心的明顯增加(P<0.01):VAS0mm25±6mm。假指壓組也記錄到了相似的顯著增加:從0mm83±8mmP<0.01)。但是在抵達醫院時K-K9組和假指壓組噁心評分有顯著不同(P<0.01);儘管所有病人在急診室治療前都有血管收縮,但是在醫院內血管收縮的病人數在兩組之間有顯著不同(P<0.01):K-K9組血管收縮與擴張病人分別為446人;假指壓組血管收縮和舒張病人分別為482人。在抵達醫院時,K-K9組和假指壓組病人的心率有顯著差別(P<0.01):65±6 bpm98±8bpmK-K9組病人對提供的照顧的總的滿意度(類比視覺評分19±9mm)顯著高於假指壓組(類比視覺評分48±12mm)。兩組血壓均無明顯變化。K-K9穴刺激是一種簡單有效的處理急診中的噁心的方法,能明顯提高病人的滿意度。

(顏濤譯,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.

 

 

延長走動時間對硬膜外鎮痛分娩產程的影響

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

在分娩過程中走動已經越來越普遍,但是它對於產程和疼痛強度的影響仍不清楚。我們懷疑在硬膜外鎮痛時增加走動時間可能對產程和疼痛強度產生影響。在這項前瞻性隨機研究中,61例無併發症的足月臨產婦被分為不活動組(n=31)和走動組(n=30)。由硬膜外間斷注射含有1 µg/mL 蘇芬太尼的0.08%布比卡因-腎上腺素提供鎮痛。在分配到走動組的30人中,實際走動的為25人。其走動時間是64 ± 34 min (均數 ±標準差), 即第一產程的29% ± 16%。兩組在產程時間和疼痛視覺類比評分上沒有差別。但是走動組使用的布比卡因(6.4 ± 2.2 mg/h vs 8.4 ± 3.6 mg/h; P = 0.01)和催產素(6.0 ± 3.7 mUI/min vs 10.2 ± 8.8 mUI/min; P < 0.05)的量小於不活動組。還發現走動組排尿能力更強(P<0.01)。儘管產程和疼痛減輕的程度沒有改變,上述發現還是支持在產程中走動有益的觀點。

(顏濤譯,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.

 

 


椎管內呱替啶減少脊麻下行剖宮產手術中寒戰的發生率

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

與脊髓麻醉有關的寒戰是不舒服的,並且可能干擾監測。我們開展這項前瞻性隨機雙盲研究的目的是確定鞘內應用呱替啶是否可以減少剖宮產手術時脊髓麻醉後寒戰的發生率和強度。40例擇期行非急診剖宮產的臨產婦被分為兩組。脊髓麻醉用藥為重比重布比卡因(0.75%,10.5mg)、嗎啡0.15mg和呱替啶0.2mg/kg(試驗組)或生理鹽水(對照組)。在開始10分鐘內每分鐘收集資料,隨後33分鐘內每3分鐘收集資料,然後每5分鐘收集資料直至感覺平面消退至L4。收集的資料包括感覺阻滯平面、血壓、中心溫度和寒戰強度。兩組間達到最高感覺阻滯平面的時間、最大阻滯平面數、感覺和運動阻滯的消退以及收縮壓都沒有差別。呱替啶組寒戰的發生率(P < 0.02)和強度(P < 0.003)均小於對照組。椎管內呱替啶(0.2mg/kg)能有效減少與脊髓麻醉有關的剖宮產手術中寒戰的發生率和寒戰的強度。

(顏濤譯,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.

 

丙帕他莫單次和重複給藥治療術後疼痛鎮痛效果評估:牙科手術後應用丙帕他莫和嗎啡鎮痛的比較

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.

 

丙帕他莫為對乙酰胺基酚的前體形式,可注射給藥。該雙盲、隨機試驗評估丙帕他莫重複給藥的鎮痛效果,並與嗎啡的鎮痛效果進行比較。擇期全麻下行骨性阻生第三磨牙拔除術,術後疼痛度為中到重度的患者,隨機分為三組:丙帕他莫組,靜脈注射丙帕他莫2gn31);嗎啡組,肌肉注射嗎啡10mgn30),或安慰劑組(n34)。五小時以後,各組重複給予初始劑量的一半。10小時內重複進行鎮痛標準評分。首次給藥後5小時及10小時(首次給藥和追加給藥),丙帕他莫和嗎啡比安慰劑鎮痛更有效,且差異有顯著性。首次劑量後安慰劑組34個病人中有21人需要追加其他鎮痛藥,而丙帕他莫組31個病人中僅有6人需要追加其他鎮痛藥(P<0.0009),嗎啡組30個病人中僅4人需要追加其他鎮痛藥(P<0.0001)。丙帕他莫組和嗎啡組的鎮痛評分總和及最高值,組間無統計學或臨床顯著差異。未發現嚴重併發症;副反應的發生率,丙帕他莫組顯著小於嗎啡組(P<0.027)。牙科手術後重複靜脈注射丙帕他莫(2g後再給1g)與重複肌肉注射嗎啡(10mg後再給予5mg)相比,其鎮痛效果無明顯差別,且耐受性更好。提示:中等疼痛度的手術操作後,以丙帕他莫的形式靜脈注射對乙酰胺基酚,可有助於控制術後急性疼痛。

(周雅春譯,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.

 

胺碘酮減少大鼠神經痛模型對熱、冷和機械刺激的痛覺過敏

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.

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利多卡因可有效控制室性心律失常和神經痛。胺碘酮和利多卡因一樣具有鈉通道阻滯特性。我們的研究旨在探討胺碘酮與利多卡因治療大鼠神經痛模型中對熱、冷和機械刺激痛覺過敏的療效是否相似。10S-D大鼠,麻醉後在其右後爪的坐骨神經放置四條鬆散的結紮線。在對側的後爪實行假手術(對照)。通過比較每個爪子對熱刺激(輻射熱源,50°C)回縮反射的潛伏期判斷熱刺激痛覺過敏;給予丙酮以評估冷刺激痛覺過敏;運用標準von Frey絲比較結紮的後爪和對照的後爪的機械閾值判斷機械刺激痛覺過敏。建立痛覺過敏後腹腔注射胺碘酮15102050100mg/kg。給予單次劑量之前和之後1324小時測定大鼠痛覺過敏程度。另有5只大鼠植入鞘內導管,鞘內注射胺碘酮5mg/kg。在胺碘酮鞘內給藥組進行相似的熱、機械和冷刺激痛覺過敏測定。腹腔內注射胺碘酮後熱、冷和機械刺激所致的痛覺過敏顯著減少,且有統計學意義。結果具有統計學意義的有腹腔注射10mg/kg熱刺激痛覺過敏減少,20mg/kg機械刺激痛覺過敏減少,100mg/kg冷刺激痛覺過敏減少。單次劑量後24小時痛覺過敏恢復。鞘內給予胺碘酮對減少痛覺過敏的差異無顯著性。在大鼠神經痛模型中觀察到胺碘酮可能與利多卡因有相似的作用。由於在人體胺碘酮的半衰期顯著長於利多卡因(胺碘酮平均53天而利多卡因90分鐘),胺碘酮對於神經性疼痛可能有潛力提供更長時程(或許更有效)的療效。提示:腹腔注射胺碘酮可減少大鼠神經痛模型對熱、冷和機械刺激的痛覺過敏,且有統計學意義。考慮到其在人體的半衰期很長,胺碘酮有望長時間緩解神經性疼痛。

(周雅春譯,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.

 


術中血細胞回收經濟學分析

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.

 

美國紅細胞輸血的費用每年超過13億美元。由於擔心輸血傳染病毒性疾病,普遍採用術中血細胞回收以減少庫血用量。儘管曾有人質疑該項技術的經濟性,尚無術中自體輸血的經濟學參數分析。我們設計了數學模型以醫院年自體輸血例數為基礎確定成本-效益最佳的策略。用表格程式預計術中自體輸血的成本對四種模型進行分析:完全使用外來人員,部分使用外來人員,雇傭全職技術員操作,或由接受過交叉培訓的雇員操作。當醫院年自體輸血例數超過185例時,部分使用外來人員較完全使用外來人員更經濟。當醫院年自體輸血例數超過110例時新雇員模型比完全外來人員模型更經濟。當醫院年自體輸血例數超過55例時,交叉訓練模型最經濟。提示:如果醫院年自體輸血例數超過55例,交叉培訓一名雇員作為血細胞回收的技術員比使用外來人員更經濟。

(周雅春譯,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 監護儀的“敲擊聲檢測”無助於判別麻醉中耳機的不慎脫開

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

 

聽覺誘發電位(AEP)可被麻醉藥劑量依賴性地抑制,但因為缺少合適的聽覺刺激而不能被註冊。Alaris AEP 監護儀包含“敲擊聲檢測”(CD)(產生“無AEP”或“低AEP”的資訊)來判別聲音刺激的缺失。我們研究了17名病人清醒(AWAKE)和麻醉中(ANESTHESIA)正確放置頭戴耳機(HP)以及HP脫離(No HP)後5分鐘各自CD的準確性。每隔一分鐘記錄Alaris AEP ARX 指數、CD和雙頻指數。變化用Friedman Wilcoxon 檢驗來評估。敏感性(SEN)、特異性(SPE)以及受者工作特徵曲線被用來分析CD的準確性。在清醒期間HP脫離後,Alaris AEP ARX 指數顯著降低(P < 0.05)。在HP脫離後2分鐘,CD可以判別,其敏感性為88%,特異性為97%。在麻醉期間,HP脫離後未發現變化。CD判別HP脫離的敏感性為100%,而特異性為20%。 Alaris AEP監護儀含有的CD不能判別出麻醉期間HP的不慎脫離。結論:聽覺誘發電位的信號傳遞可以被麻醉藥抑制,但抑制也可能為頭戴耳機脫離引起。在本實驗中,我們證明即使擁有最新“敲擊聲檢測”特性的Alaris AEP監護儀仍不能判別出異丙酚和雷米芬太尼全麻時頭戴耳機的脫離。

(黃施偉 譯,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-氯普魯卡因:一項系列劑量研究以及添加腎上腺素的效果

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.

 

隨著不含保存劑和抗氧化劑的2-氯普魯卡因(2CP)的出現,可成為一種合適的短效藥物來代替利多卡因進行腰麻。我們研究了2CP的安全性、劑量-反應特性以及添加腎上腺素的效果。每組6名志願者隨機接受椎管內應用3045、或60mg加或不加腎上腺素的2CP。對感覺和運動阻滯的作用強度和作用時間進行評估。18名志願者中的11位稱有模糊的、非特異性的感冒樣症狀,揭盲提示所有和感冒樣症狀有關的藥物內都加了腎上腺素。那些使用未加腎上腺素的2CP的志願者中沒有稱有感冒樣症狀,所以隨後沒有進一步使用含腎上腺素的椎管內藥物,結果為29人藥物使用(11次含腎上腺素,18次不含腎上腺素)。結果顯示阻滯平面廣度和作用時間均呈2CP劑量依賴性,而2個節段消退時間和消退至T10時間除外。使用2CP不同劑量後感覺完全恢復時間分別為98+/- 20, 116 +/- 15, 132 +/- 23 min2CP加腎上腺素後感覺完全恢復時間分別為153 +/- 25, 162 +/- 33, 148+/- 29 min。不含保存劑和抗氧化劑的2CP在劑量為3060mg時可有效地用於椎管內麻醉。不建議添加腎上腺素,因為副作用發生率較高。結論:椎管內使用高比重的2-氯普魯卡因是有效的,而3060mg劑量範圍時適合來用於門診手術病人,無一過性神經症狀體征。不建議添加腎上腺素,因為副作用發生率較高。

(黃施偉 譯,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.

 

脊麻氯普魯卡因溶液:37攝氏度時的比重和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.

 

局麻藥的比重和pH在其作為椎管內用藥時是重要的特性。不含保存劑和抗氧化劑的氯普魯卡因配方已出現,並正被研究用於短效的脊麻。本研究中,我們評估了這些新型氯普魯卡因配方的pH和比重(至5位有效數字,g/mL37攝氏度)。除了2%和3%氯普魯卡因以及2%利多卡因外,添加腎上腺素或碳酸氫鹽的2%氯普魯卡因也被評估。還在用水稀釋和添加葡萄糖之後測定了密度。氯普魯卡因,2%或3%,在添加葡萄糖之前相對於腦脊液是重比重的(密度分別為1.00123g/mL1.00257g/mL)。當用水稀釋時,所有的溶液相對於腦脊液是低比重的(密度小於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)。不含亞硫酸氫鹽的2-氯普魯卡因非常酸(pH<4.0),但加入少量的碳酸氫鹽(0.25-0.33 mL/10mLpH可增加至7.0以上。氯普魯卡因密度的增加使其在不加葡萄糖的情況下成為有效的重比重脊麻藥物。結論:不含葡萄糖的2-氯普魯卡因在37攝氏度時相對於腦脊液是重比重的,因此用於脊麻時可不加葡萄糖。不含亞硫酸氫鹽的2-氯普魯卡因保持酸性(pH<4.0)。加入少量的碳酸氫鹽(0.25-0.33 mL/10mLpH可增加至7.0以上。

(黃施偉 譯,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.

 
針刺能減低傷害性刺激對麻醉狀態下志願者所引起的體感誘發電位振幅
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 
 
針刺對疼痛感覺的影響尚無定論。因為傷害性刺激引出的體感誘發電位(SEPs)晚期振幅被認為與疼痛強度的主觀感受有關,所以我們以雙盲原則設計了本研究,觀察針刺前後SEPs變化。16個健康志願者以異丙酚麻醉及右食指給予傷害性電刺激,隨後分二組,針刺組(n = 8)在腿部鎮痛點給予電針刺激15 min,而對照組未給予處理(觀察人員不知情),之後重複刺激。在每次刺激時記錄SEPs的最高值Cz並分析N150  P260潛伏期和振幅的變異。P260振幅從針刺前的4.40 +/- 2.76 mV (mean +/- SD)下降至針刺後的1.67 +/- 1.21 mV(P < 0.05),而對照組則未變(針刺前2.64 +/- 0.94 mV,針刺後2.54 +/- 1.54 mV)。總之本觀察顯示電針針刺能明顯減少麻醉狀態下傷害性電刺激誘發的SEP晚期振幅,提示針刺具有特殊的鎮痛作用。
(王立中譯  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.
 
幼兒心臟手術時呼吸機械力學的改變
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  
 

先天性心臟病伴有肺血流(PBF)增加的兒童常有呼吸力學的異常。低溫CPB對肺功能也產生不良影響。本研究觀察106例年齡低於1歲行心臟手術的幼兒呼吸力學改變。切皮前和關胸後在手術室及在進入ICU時分別測定動態呼吸順應性(Cdyn)及總的呼吸阻力(Rrs)。同時記錄下列資料:年齡,體重,術前肺浸潤,術前機械通氣及PBF增加的表現,CPB時間,主動脈阻斷時間,深低溫停迴圈時間,類固醇使用和超濾液容量。協方差分析變異以確定三個時間點各個因素對Cdyn Rrs的影響。在糾正高PBF的心臟手術後Rrs改善,且在嬰兒最明顯。在PBF正常或降低的幼兒中,CPB導致Cdyn下降。我們認為手術對過度肺血流糾正的有益作用超過CPB對幼兒呼吸力學的不良影響。

(王立中譯 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. 

 

心臟手術術前預防性使用抗血小板藥和/或抗凝藥對術後出血的影響

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:瞭解術前預防性使用抗血小板藥和/或抗凝藥對冠脈搭橋術後失血量的影響。儘管有必要預防性用藥以防止心肌缺血,這種療法往往持續進行,除非有跡象表明有增加出血的危險性,如術前五到七天內用藥。經患者同意後,隨機抽取93例成人患者的治療前血樣。患者分為三組:組Ⅰ,術前不用藥;組Ⅱ,用血小板二磷酸腺苷(ADP)受體拮抗劑;組Ⅲ,ADP受體拮抗劑聯合靜脈注射肝素。術後24小時內的胸腔引流液組Ⅱ最高(P<0.05),三組分別為:組Ⅰ,503 +/- 56; 組Ⅱ,633 +/- 55; 組Ⅲ,439 +/- 29 mL (平均值+/-標準誤)。單用ADP受體拮抗劑,出血量增加,而聯合使用ADP受體拮抗劑和肝素可以減少出血量。治療前和術後血漿纖維蛋白原濃度最高的是組Ⅲ(P<0.05),分別為:治療前,組Ⅰ,311 +/- 17, 組Ⅱ,366 +/- 16, 組Ⅲ,423 +/- 18 mg/dL;術後,組Ⅰ,229 +/- 16, 組Ⅱ,267 +/- 13, 組Ⅲ,312 +/- 16 mg/dL(平均值+/-標準誤)。三組的術後血漿纖維蛋白原濃度與術前值顯著相關(相關係數從0.576 0.825; P 值從0.0110(-6))。結論:聯合用藥組失血量減少可能與對凝血因數的保護有關,該組血漿纖維蛋白原濃度最高可以證明。

(軒 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.

 

鈣敏化劑MCI-154和異氟醚的相互作用--對慢性置管狗的體循環和冠脈血流動力學研究

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.

研究藥物阻斷慢性置管狗的自主神經系統後,鈣敏化劑—

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

和異氟醚對心肌收縮力、體循環和冠脈血流動力學的影響及其相互作用。犬清醒狀態下,MCI-154增加心率和左室功能,不改變心率收縮壓乘積(RPP)、壓力功指數和冠脈血流量,減小冠脈阻力(CVR)。異氟醚減慢心率,降低左室功能、RPP、壓力功指數和CVR,但不影響冠脈血流量。異氟醚麻醉下MCI-154對心血管功能的影響與清醒狀態下的相似。MCI-154可以逆轉異氟醚降低心輸出量和每搏功(與前負荷有關)的作用,但影響不明顯。

結論:MCI-154在清醒和異氟醚麻醉狀態下均能增強心肌收縮力,降低CVR,不改變心肌氧耗量。

(軒 泓譯 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.


 

順式阿曲庫銨和羅庫溴銨的藥效學相互作用

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.

神經肌肉阻斷劑維持劑量的起效和持續時間可能受到初始肌松藥的影響。觀察甾體類和苄異喹啉類肌松藥的相互作用對維持劑量順式阿曲庫銨臨床持續作用時間的影響。方法:60例成人患者接受異氟醚、笑氣和氧氣麻醉,隨機分為三組:組Ⅰ,羅庫溴銨0.6 mg/kg TOF的第一次顫搐恢復25%時給順式阿曲庫銨0.03 mg/kg ;組Ⅱ,順式阿曲庫銨0.15 mg/kg ,繼以順式阿曲庫銨0.03 mg/kg;組Ⅲ,羅庫溴銨0.6 mg/kg ,繼以羅庫溴銨0.15 mg/kg 。用肌肉加速度儀(TOF-Guard, Boxtel, The Netherlands)測量神經肌肉阻滯程度。前兩次維持劑量的臨床持續作用時間(分鐘,平均值+/-標準差)分別為:第一次,組Ⅰ,41 +/- 10, 組Ⅱ,31 +/- 7++,組Ⅲ,25 +/- 8++ ;第二次,組Ⅰ,39 +/- 11,組Ⅱ,30 +/- 6+, 組Ⅲ,29 +/- 9*(*P < 0.05, +P < 0.01, ++P < 0.001; I II、組III相比)結論:預先使用羅庫溴銨可以延長順式阿曲庫銨的前兩次維持劑量的臨床持續作用時間。

(軒 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.