Anesthesia & Analgesia

March 2004

Table of Content

CARDIOVASCULAR ANESTHESIA:

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The Incidence and Prediction of Automatically Detected Intraoperative Cardiovascular Events in Noncardiac Surgery

Rainer Röhrig, Axel Junger, Bernd Hartmann, Joachim Klasen, Lorenzo Quinzio, Andreas Jost, Matthias Benson, and Gunter Hempelmann

Anesth Analg 2004 98: 569-577.

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Prophylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery

Hilde Pleym, Roar Stenseth, Alexander Wahba, Lise Bjella, Arve Tromsdal, Asbjørn Karevold, and Ola Dale

Anesth Analg 2004 98: 578-584.

 

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The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

George Djaiani, Barbara Phillips-Bute, Mihai Podgoreanu, Robert H. Messier, Joseph P. Mathew, Fiona Clements, and Mark F. Newman

Anesth Analg 2004 98: 585-589.

 

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Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine

Nicolas Dalibon, Marc Moutafis, Ngai Liu, Jean-Dominique Law-Koune, Stéphanie Monsel, and Marc Fischler

Anesth Analg 2004 98: 590-594.

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Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol

Alexandre Ouattara, Gilles Boccara, Patrick Lecomte, Rachid Souktani, Philippe Le Cosquer, Stéphane Mouren, Pierre Coriat, and Bruno Riou

Anesth Analg 2004 98: 595-603.

 

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The Effects of a Polymerized Bovine-Derived Hemoglobin Solution in a Rabbit Model of Arterial Thrombosis and Bleeding

Emmanuel Marret, Philippe Bonnin, Elisabeth Mazoyer, Bruno Riou, Ted Jacobs, Pierre Coriat, and Charles-Marc Samama

Anesth Analg 2004 98: 604-610.

PEDIATRIC ANESTHESIA:

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Clinical Evaluation of the Effects of Signal Integrity and Saturation on Data Availability and Accuracy of Masimo SET® and Nellcor N-395 Oximeters in Children

Frederick A. Robertson and George M. Hoffman

Anesth Analg 2004 98: 617-622.

 

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Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies

C. Dadure, O. Raux, P. Gaudard, M. Sagintaah, R. Troncin, A. Rochette, and X. Capdevila

Anesth Analg 2004 98: 623-628.

AMBULATORY ANESTHESIA:

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Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review

Anil Gupta, Tracey Stierer, Rhonda Zuckerman, Neal Sakima, Stephen D. Parker, and Lee A. Fleisher

Anesth Analg 2004 98: 632-641.

 

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The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia

Martti Silvanto, Pekka Tarkkila, Marja-Leena Mäkelä, and Per H. Rosenberg

Anesth Analg 2004 98: 642-646.

ANESTHETIC PHARMACOLOGY:

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Attenuation of Gap-Junction-Mediated Signaling Facilitated Anesthetic Effect of Sevoflurane in the Central Nervous System of Rats

Eiji Masaki, Masahito Kawamura, and Fusao Kato

Anesth Analg 2004 98: 647-652.

 

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Functional Inhibition by Methadone of N-Methyl-D-Aspartate Receptors Expressed in Xenopus Oocytes: Stereospecific and Subunit Effects

Robert J. Callahan, John D. Au, Matthias Paul, Canhui Liu, and C. Spencer Yost

Anesth Analg 2004 98: 653-659.

 

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The Effects of Hexanol on G{alpha}i Subunits of Heterotrimeric G Proteins

John Streiff, David O. Warner, Elena Klimtchuk, William J. Perkins, Kristofer Jones, and Keith A. Jones

Anesth Analg 2004 98: 660-7.

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Peroxynitrite Decreases Rabbit Tissue Factor Activity In Vitro

Vance G. Nielsen and John P. Crow

Anesth Analg 2004 98: 668-671.

 

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Local Anesthetic Properties of a Novel Derivative, N-Methyl Doxepin, Versus Doxepin and Bupivacaine

Yukari Sudoh, Elaine Elliott Cahoon, Umberto De Girolami, and Ging Kuo Wang

Anesth Analg 2004 98: 672-676.

 

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Vasodilation Increases the Threshold for Bupivacaine-Induced Convulsions in Rats

Yutaka Oda, Tomoharu Funao, Katsuaki Tanaka, and Akira Asada

Anesth Analg 2004 98: 677-682.

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Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection

Anil Agarwal, Mohammad F. Ansari, Devendra Gupta, Ravindra Pandey, Mehdi Raza, Prabhat K. Singh, Shiopriye, Sanjay Dhiraj, and Uttam Singh

Anesth Analg 2004 98: 683-686.

 

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The Pharmacodynamic Effects of a Lower-Lipid Emulsion of Propofol: A Comparison with the Standard Propofol Emulsion

Dajun Song, Mohamed Hamza, Paul F. White, Kevin Klein, Alejandro Recart, and Omeed Khodaparast

Anesth Analg 2004 98: 687-691.

TECHNOLOGY, COMPUTING, AND SIMULATION:

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Narcotrend Index Versus Bispectral Index as Electroencephalogram Measures of Anesthetic Drug Effect During Propofol Anesthesia

Sascha Kreuer, Wolfram Wilhelm, Ulrich Grundmann, Reinhard Larsen, and Jörgen Bruhn

Anesth Analg 2004 98: 692-697.

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Spectral Analysis of Movement Patterns During Anesthesia (Technical Communication)

Steven L. Jinks, Joseph F. Antognini, and Earl Carstens

Anesth Analg 2004 98: 698-702.

PAIN MEDICINE:

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Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery

Martin Schuster, André Gottschalk, Marc Freitag, and Thomas Standl

Anesth Analg 2004 98: 708-713.

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Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study

Avi A. Weinbroum, Benjamin Bender, Alexander Nirkin, Shoshana Chazan, Isaac Meller, and Yehuda Kollender

Anesth Analg 2004 98: 714-722.

 

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Reduction of ß-Endorphin-Containing Immune Cells in Inflamed Paw Tissue Corresponds with a Reduction in Immune-Derived Antinociception: Reversible by Donor Activated Lymphocytes

Siobhan Hermanussen, MyHong Do, and Peter John Cabot

Anesth Analg 2004 98: 723-729.

 

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The Antinociceptive Effect of Transcranial Electrostimulation with Combined Direct and Alternating Current in Freely Moving Rats

 

Vladimir Nekhendzy, Christo P. Fender, M. Frances Davies, Hendrikus J. M. Lemmens, Michael S. Kim, Donna M. Bouley, and Mervyn Maze

Anesth Analg 2004 98: 730-737.

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Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study

I. Dobrydnjov, K. Axelsson, L. Berggren, J. Samarütel, and B. Holmström

Anesth Analg 2004 98: 738-744.

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Decreased Insulin Requirements with Spinal Cord Stimulation in a Patient with Diabetes (Case Report)

Leonardo Kapural, Salim M. Hayek, Michael Stanton-Hicks, and Nagy Mekhail

Anesth Analg 2004 98: 745-746.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

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Is Physician Anesthesia Cost-Effective?

J. P. Abenstein, Kirsten Hall Long, Brian P. McGlinch, and Niki M. Dietz

Anesth Analg 2004 98: 750-757.

NEUROSURGICAL ANESTHESIA:

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Effect of Isoflurane on Neuronal Apoptosis in Rats Subjected to Focal Cerebral Ischemia

Masahiko Kawaguchi, John C. Drummond, Daniel J. Cole, Paul J. Kelly, Mark P. Spurlock, and Piyush M. Patel

Anesth Analg 2004 98: 798-805.

OBSTETRIC ANESTHESIA:

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Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Eileen Lew, Seow-Woon Yeo, and Easaw Thomas

Anesth Analg 2004 98: 810-814.

 

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Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

Warwick D. Ngan Kee, Kim S. Khaw, Floria F. Ng, and Bee B. Lee

Anesth Analg 2004 98: 815-821.

REGIONAL ANESTHESIA:

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Continuous Parasacral Sciatic Block: A Radiographic Study

Elisabeth Gaertner, Pablo Lascurain, Cyrille Venet, Xavier Maschino, Alina Zamfir, Radu Lupescu, and Admir Hadzic

Anesth Analg 2004 98: 831-834.

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Adding Dexmedetomidine to Lidocaine for Intravenous Regional Anesthesia

Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Zafer Pamukçu, and Imran Kurt

Anesth Analg 2004 98: 835-840.

 

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Intracellular Calcium Increases in Growth Cones Exposed to Tetracaine

Shigeru Saito, Inas A. M. Radwan, Koichi Nishikawa, Hideaki Obata, Tomonori Okamoto, Toshio Kanno, and Fumio Goto

Anesth Analg 2004 98: 841-845.

 

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The Effect of Short-Term Epidural Local Anesthetic Blockade on Urinary Levels of Substance P in Interstitial Cystitis

Andrew Sukiennik, Daniel B. Carr, Iwona Bonney, James E. Marchand, Heinrich Wurm, and Grannum R. Sant

Anesth Analg 2004 98: 846-850.

GENERAL ARTICLES:

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Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients

Christophe Baillard, Sylvie Bourdiau, Philippe Le Toumelin, Farid Ait Kaci, Bruno Riou, Michel Cupa, and C. Marc Samama

Anesth Analg 2004 98: 854-7.

 

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The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

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

Anesth Analg 2004 98: 858-861.

 

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Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients

Christophe Baillard, MD PhD*, Sylvie Bourdiau, MD*, Philippe Le Toumelin, MD*, Farid Ait Kaci, MD*, Bruno Riou, MD PhD{dagger}, Michel Cupa, MD*, and C. Marc Samama, MD PhD*

*Department of Anesthesiology and Intensive Care, Avicenne Hospital, Bobigny; and {dagger}Department of Emergency Medicine and Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France

Anesth Analg 2004;98:854-7

 

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Postoperative awake patients may have significant residual neuromuscular block. In awake patients, the results of accelerometry are affected by extra movements to which the thumb may be subject. In this study, we evaluated the repeatability of train-of-four (TOF) ratio using acceleromyography in 253 patients recovering from anesthesia. Immediately after arrival in the postanesthesia care unit, the ulnar nerve was stimulated with TOF stimulation. The evoked response at the thumb was measured by the TOF-Watch apparatus. The current intensity was 30 mA. Two TOF stimulations were applied and recorded at 30-s intervals. A Bland-Altman test was used. The Kappa ({kappa}) test for clinical agreement between the two measurements was also calculated according to the presence or absence of a residual neuromuscular blockade, defined as a TOF ratio <0.9. According to the presence of a residual neuromuscular blockade, the paired TOF ratios were discordant in 61 patients (24%; 95% confidence interval, 21%V27%). The {kappa}test indicated a moderate agreement (k = 0.47). We demonstrated that accelerometry as used in this study is not always accurate. Two isolated acceleromyograph TOF ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

 

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Spectral Analysis of Movement Patterns During Anesthesia

Steven L. Jinks, PhD, Joseph F. Antognini, MD, and Earl Carstens, PhD Department of Anesthesiology and Pain Medicine and the Section of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, California

Anesth Analg 2004;98:698-702

 

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It remains unclear how anesthetics produce immobility, an end-point used in determining anesthetic potency. Understanding how movement (in response to noxious stimulation) is ablated by anesthetics could be aided by using spectral analysis of the high and low frequency components of complex movement patterns. We therefore applied a spectral analysis to previously published movement data from rats anesthetized with isoflurane and halothane at 0.6, 0.9, and 1.1 minimum alveolar concentration (MAC). We recorded isometric forces of hindlimb movement elicited by noxious mechanical stimulation of the hindpaw. The movement patterns were subjected to spectral analysis to determine force amplitude for each frequency component. When halothane was increased from 0.6 to 0.9 MAC, force amplitude decreased only for the lowest-frequency (<1 Hz) components, in part related to the generally lower high-frequency forces at 0.6 MAC. Between 0.6 and 0.9 MAC isoflurane amplitude was reduced for most frequencies in the 0V10 Hz range. For both halothane and isoflurane at 1.1 MAC, as expected, force amplitude substantially decreased at all frequencies. We conclude that spectral analysis is useful to describe and quantify the effects of anesthetics on complex movement patterns resulting from noxious stimuli applied during anesthesia.

 

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Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies

C. Dadure, MD*, O. Raux, MD*, P. Gaudard, MD*, M. Sagintaah, MD , R. Troncin, MD*, A. Rochette, MD*, and X. Capdevila, MD PhD*

Departments of *Anesthesia and Critical Care Medicine and@ Pediatric Radiology, Lapeyronie University Hospital, Montpellier, France

Address correspondence and reprint requests to Christophe Dadure, MD, Département dAnesthésie Réanimation A, H&ocirc;pital Lapeyronie, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France.

Anesth Analg 2004 98: 623-628.

 

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Femoral shaft or hip surgeries are very painful for children. We conducted both computed tomographic (CT) and clinical prospective studies to define new landmarks in children and to evaluate the effectiveness of continuous psoas compartment blocks (CPCBs) using disposable elastomeric pumps. In a preliminary CT scan study of 20 patients, the plexus depth was correlated to patient age and the optimal point of puncture for CPCB was three-quarters of the distance from the spinous process of L4 to a line parallel to the spinal column passing through the posterior superior iliac spine. In a subsequent prospective series, a CPCB was administered before surgery to 15 children for pain relief after femoral and hip osteotomies. After general anesthesia, a 0.5 mL/kg bolus of a mixture of 1% lidocaine with epinephrine (1/200.000) and 0.5% ropivacaine was injected through the CPCB catheter. After contrast media assessment of the catheter location, a disposable pump (Infusor LV&reg;; Baxter, Paris, France) with 0.2% ropivacaine was connected and pump flow was adjusted to the patients weight (0.2 mg /kg/ h). Postoperative pain was evaluated using a visual analog scale or the Children and Infants Postoperative Pain Score at hour H1, H6, H12, H18, H24, H36, and H48, and in terms of rescue analgesia, adverse events, and motor blocks. All blocks were effective during surgery. Postoperative analgesia was excellent. The median pain scores were 1 for H1 and 0 beginning H6. The motor blockade was minimal before 24 h and absent thereafter. No major adverse event was noted. Parents of 93% of the children were satisfied. We conclude that postoperative analgesia with CPCB is a very effective technique in children after major proximal lower limb orthopedic surgery. The CT scan landmarks described in this study were more medial than the conventional landmarks used in the literature .

 

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Attenuation of Gap-Junction-Mediated Signaling Facilitated Anesthetic Effect of Sevoflurane in the Central Nervous System of Rats

Eiji Masaki, MD PhD*, Masahito Kawamura, MD{dagger}, and Fusao Kato, PhD{ddagger} Section Editor

Departments of *Anesthesiology, {dagger}Pharmacology, and {ddagger}Neuroscience, Jikei University School of Medicine, Tokyo, Japan

Address correspondence and reprint requests to Eiji Masaki, Department of Anesthesiology, Jikei University School of Medicine, 3V25V8, Nishishinbashi Minato-ku, Tokyo 105V8461, Japan.

Anesth Analg 2004;98:647-652

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Accumulating evidence suggests that reduction of intrinsic excitability or synaptic excitation and/or an enhancement of synaptic inhibition underlie the general anesthetic condition. Besides chemical synapse, neurons could communicate with each other by electrical coupling via gap-junctions. We hypothesized that inhibition of cell-to-cell signaling through gap-junction in the central nervous system (CNS) is involved in the anesthetic mechanism of volatile anesthetics. The minimum alveolar concentration (MAC) of sevoflurane was measured after the intracerebroventricular (ICV) or intrathecal (IT) administration of carbenoxolone (CBX), a gap-junction inhibitor, in vivo. The spontaneous oscillation in membrane currents of locus coeruleus neurons that results from electrical coupling between neurons was also recorded from young rat pontine slices by the patch clamp method, and the effect of sevoflurane on this oscillation was examined in vitro. The ICV administration of CBX (125 and 250 µg/rat)

significantly reduced the MAC of sevoflurane dose-dependently, whereas IT injection failed to inhibit the MAC. Sevoflurane at clinically relevant concentrations (0.1V0.5 mM) suppressed the spontaneous oscillation in membrane current concentration-dependently. These suppressions were significant at 0.5 mM with both amplitude and frequency. We suggest that suppression of gap-junction-mediated signaling in the CNS is involved in the anesthetic-induced immobilization by sevoflurane.

 

 

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Reduction of ß-Endorphin-Containing Immune Cells in Inflamed Paw Tissue Corresponds with a Reduction in Immune-Derived Antinociception: Reversible by Donor Activated Lymphocytes

Siobhan Hermanussen, BSc Hons, MyHong Do, BPharm Hons, and Peter John Cabot, PhD

The School of Pharmacy, The University of Queensland, Queensland, Australia

Address correspondence and reprint requests to Peter J. Cabot, PhD, The School of Pharmacy, The University of Queensland, 4072, Queensland, Australia.

Anesth Analg 2004;98:723-729

K̨t统\৹O产ͥ~P伤`P@Ϊn条CHesK细Mibg组织发强Ī伤`@ΡCb过环UA]CsA^产ͧĶ动AP肾W质E释]l诱导伤`@Ψ显C们项s检验F单剂qCsA对g伤`P@ΡCCsAj较没产ͧĶj伤`ʧ@Ω显W[AP时`环M组织O细M减֡C~ACsAjP肾W质E释]l诱导K̷ʧ伤`@ΡA静脉`g~经MAEO细M]1.07.0x106细M/0.1@ɡ^if转应AB㦳剂q赖ʡC结论G该发现进@B证u证tK细MO~P镇hn条C这发现还ʯkhܤj赖_\}nK̨t统C

]PK 译@ hq ա^

The functional integrity of the immune system is essential for peripheral antinociception. Previous studies have demonstrated that immune cells elicit potent antinociception in inflamed tissues and that corticotropin-releasing factor-induced antinociception is significantly inhibited in animals that have undergone cyclosporin A (CsA)-induced immunosuppression. In this study, we examined the effect of a single bolus of CsA on inflammatory nociception. CsA-treated rats had substantially increased nociception compared with nonimmunosuppressed rats, consistent with a reduction in circulating and infiltrating lymphocytes. Furthermore, CsA-treated rats had inhibition of corticotropin-releasing factor-induced immune-derived antinociception, which was dose-dependently reversed by IV injection of concanavalin A-activated donor lymphocytes (1.0V7.0 x 106 cells/0.1 mL). In conclusion, our findings provided further evidence that opioid-containing immune cells are essential for peripheral analgesia. It is evident from these findings that control of inflammatory pain relies heavily on a functioning immune system.

 

εw~eq扩Rеw联X¾K择宫产Z运动`较֡G@项e¤ʡB随B双s

Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Eileen Lew, MBBS MMed, Seow-Woon Yeo, MBBS MMed, FAMS, and Easaw Thomas, MBBS FANZCA, FAMS Section Editor

From the Department of Anaesthesia (Obstetrics and Gynaecology), KK Womens and Childrens Hospital, Singapore

Anesth Analg 2004;98:810-814

 

b¡еw~滞联X¾K]CSE^时Aεw~eq扩R]EVE^术Oq过w~Ī`gͲz盐Ϥp剂qT内滞W强kCb项e¤ʡB随B双sA们较FEVEkO单`gªP觉M运动滞SʤΦy动O学稳wʡC62进择宫产临产妇]U组n31^给0.5%d]9mgϪӥ10 µg¡FCESY0.5%d]5mgϪӥ10 µg¦Z5 minq过w~导ު`g0.9%6.0 mlCCj2.5 min记录U组̧C缩压]SBP^B针无hP觉滞M}Bromage评C较两组视觉拟kh评]VAS^B̰P觉滞B̰}Bromage运动评BP觉滞h10ݬq区]T10^һݪ时间M运动滞`C两组fH@资ơBVAS评B̰P觉滞BP觉滞hT10һݪ时间记录̧CSBPۦCEVE组fH显运动`}Bromage 0时间显较(73 33 min vs. 136 32 min, P < 0.05)CܡGO传统单`g¬ۤAp剂qժ滞w~eq扩Ru55%d]剂qNണ满N宫产¾KABU运动`较֡C

]马qY 译@ hq ա^

 

Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique is the enhancement of a small-dose intrathecal block by epidural saline boluses. In this prospective, randomized, double-blind study, we compared the EVE technique with single-shot spinal anesthesia with respect to its sensory and motor block profile and hemodynamic stability. Sixty-two parturients (n = 31 in each group) undergoing elective cesarean deliveries were administered either spinal anesthesia with hyperbaric 0.5% bupivacaine 9 mg and fentanyl 10 µg or CSE comprising intrathecal hyperbaric 0.5% bupivacaine 5 mg with fentanyl 10 µg, followed by 0.9% saline 6.0 mL through the epidural catheter 5 min thereafter. In each group, the lowest systolic blood pressure (SBP), sensory block level to loss of pain from pinprick, and modified Bromage scores were recorded at 2.5-min intervals. The visual analog pain score (VAS), peak sensory block height, highest modified Bromage motor score, time for sensory regression to the tenth thoracic dermatome (T10), and motor block recovery were compared between groups. Both groups were comparable in demographic data, VAS scores, peak sensory block height, time for sensory regression to T10, and lowest SBP recorded. Patients in the EVE group demonstrated significantly faster motor recovery to modified Bromage 0 (73 33 min versus 136 32 min, P < 0.05).

 

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Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol

Alexandre Ouattara, MD*,{dagger}, Gilles Boccara, MD PhD*,{dagger}, Patrick Lecomte, MD*,{dagger}, Rachid Souktani, PhD*,{dagger}, Philippe Le Cosquer, MD*,{dagger}, Stéphane Mouren, MD PhD*,{dagger}, Pierre Coriat, MD*,{dagger}, and Bruno Riou, MD PhD*,{ddagger}

*Laboratory of Anesthesiology, Université Pierre et Marie Curie, Paris; {dagger}Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris; {ddagger}Department of Emergency Medicine and Surgery, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France

Anesth Analg 2004;98:595-603

 

们b^B红细M`ߤ߼ҫ检验F这样@个设Gb无(PaO2 = 137 16 mm Hg, n = 12)M(PaO2 = 541 138 mm Hg, n = 12)况UAݤ(10V300 µM)对^a状动脉Mߦ٧@显ۤPC诱导a状动脉显ۦ缩(-13% 7%)C时ݤ张a状动脉@μW强C]为w报D压q过关闭ATPӷP钾qDϫa状动脉缩A们sFb无M况UήC脲]glibenclamide ^0.6 µMMcromakalim 0.5 µM预处zt~两组]U组n=6^脏ݤ@ΡCC脲预处zϫa状动脉缩(-16% 7%)Av响ݤa状动脉张@ΡCCromakalim预处zhF时ݤa状动脉张@ΪW强Cb无M况UAݤ浓>100 µM显ۭCߦ٩ʯC们oX结论GW强ݤ张a状动脉@ΡC现HήC脲ް_a状动脉缩现H释COACromakalim脏预处zhF时ݤa状动脉张@ΪW强C񤣼v响ݤߦ٧@ΡC

]马qY 译@ hq ա^

@We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10V300 µM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO2 = 137 16 mm Hg, n = 12) or in the presence (PaO2 = 541 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 µM) and cromakalim (0.5 µM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 µM both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia.

 

 

术eAΪǪLfH预应Υh[压}ण减֫a脉术ZXqProphylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery

Hilde Pleym, MD*, Roar Stenseth, MD PhD*, Alexander Wahba, MD PhD{dagger}, Lise Bjella, MD*, Arve Tromsdal, MD{dagger}, Asbjørn Karevold, MD{dagger}, and Ola Dale, MD PhD*,{ddagger}

Departments of *Anesthesiology and {dagger}Cardiothoracic Surgery, St. Olav University Hospital; and {ddagger}Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Anesth Analg 2004;98:578-584

 

HuXޥ[压Хh[压㦳SʡAi减֫a状动脉f桥术]CABG^ZXqC@项关_AΪǪLb脏术对pO\v响s显ܡA术e2内AΪǪL对pO\঳较j损`C们bAΪǪL75160 mg术e@ѦӦCABG术fH评h[压对术ZXqv响Cs为e¤ʡB随B双Bw剂对ӡB组试验C100үfHG组C@组b鱼JիܨxZ给h[压0.3 µg/kgAt@组则给w剂]0.9%Ͳz盐^C记录术Z16p时内XqCh[压组Xq]标t^为606]237^mLA对组为601 (301) mL(P = 0.93)A无显tݡ]95%iH区间为107X117 mL^C结论Gh[压}减֪AΪǪL术e@ѯfHCABG术ZXqC

]ߤ译@ hqա^

The synthetic vasopressin analog desmopressin has hemostatic properties and may reduce postoperative bleeding after coronary artery bypass grafting (CABG). A study on the effects of recent aspirin ingestion on platelet function in cardiac surgery showed a greater impairment of platelet function in patients treated with aspirin <2 days before the operation. We evaluated the effects of desmopressin on postoperative bleeding in CABG patients who were treated with aspirin 75 or 160 mg until the day before surgery. The study was a prospective, randomized, double-blinded, placebo-controlled, parallel group trial. One-hundred patients were included and divided into two groups. One group received desmopressin 0.3 µg/kg and the other received placebo (0.9% NaCl) after the neutralization of heparin with protamine sulfate. Postoperative blood loss was recorded for 16 h. The mean (SD) bleeding was 606 (237) mL in the desmopressin group and 601 (301) mL in the placebo group (P = 0.93), representing no significant difference (95% confidence interval, -107 to 117 mL). We conclude that desmopressin does not reduce postoperative bleeding in CABG patients treated with aspirin until the day before surgery.

 

过亚v盐C^组织]l

Peroxynitrite Decreases Rabbit Tissue Factor Activity In Vitro

Vance G,Nielsen,MD,*and John P.Crow,PhD*.

Department of *Anesthesiology . Pharmacology/Toxicology, Biochemistry and Molecular Genetics,The Center for Free Radical Biology, The University of Alabama at Birmingham

Anesth Analg 2004;98:668-671.

 

组织]lO^内ް_Ͳzʾ应@n质C过亚v盐]OONO-^l产ͮƴ(NO)MWƪ(O2-)AiHb^~CH组织]lʡCbxp肠ʦA`导PfA]AΨ过亚v盐ΦCӥBAߨxp肠ʦA`Z`环组织]l显ۭCC们测组织]lSb过亚v盐ZiϨ䬡ʭCC过亚v盐iHSIN1]3-morpholinosydnonimine^产͡A SIN1iHΦƴMWƪC脑组织]l别bUCGH37J|90(C组n=8 )G0mM SIN-1, 5mM SIN-1, 5mM SIN-1 M 2000 U/mLH组Wƪ[酶]hSOD1^A2000 U/mLH组Wƪ[酶]hSOD1^CMZ将这组织]l样[JH浆AΦ弹ʴy记图测w微块Φ动O学A评w组织]lʡC组织]lSbSIN1䬡ʭCF48HCOLT组较显۩ʮt(P<0.01)CLL组间结G无显۩ʮtݡC们结论OA组织]lQ过亚v盐ҧA过亚v盐bx脏p肠ʦA`导PfҰ_쪺@Τ继续sC

]H E 译 Ahq ա^

Tissue factor (TF) is a primary initiator of physiological coagulation in vivo.Peroxynitrite (OONO-),a molecule formed nitric oxide (NO) and superoxide (O2-),decreases human TF activity in vitro. Coagulopathy has been associated with hepatoenteric ischemia-reperfusion@ known to involve formation of OONO-. Further , circulating TF activity decreases in rabbits after hepatoenteric ischemia-reperfusion.We hypothesized that exposure of rabbit TF to OONO- would result in a decrease in activity. OONO- generation was performed with 3-morpholinosydnonimine(SIN-1),a molecule that produces both nitric oxide and superoxide .Rabbit brain TF was incubated at 37C for 90 min with 1)0mM SIN-1, 2)5mM SIN-1, 3) 5mM SIN-1 and 2000 U/mL recombinant human superoxide@ dismutase (hSOD1),or 4)2000 U/mL hSOD1(n=8 per condition ) .TF activity was assessed by addition of TF samples to human plasma and measuring clot formation kinetics with a thrombelastograph. TF exposure to SIN-1 resulted in a 48%decrease in activity that was significantly different from the other three conditions (P<0.01). There were no significantly differences between the other conditions .We conclude that rabbit TF is inhibited by OONO-,and further investigation to determine the role of OONO- in coagulopathies associated with hepatoenteric ischemia-reperfusion is warranted.

 

预`喷钠y`gh

Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection

Anil Agarwal, MD, Mohammad F. Ansari, MD, Devendra Gupta, MD, Ravindra Pandey, MD, Mehdi Raza, MD, Prabhat K. Singh, MD, Shiopriye, MBBS, Sanjay Dhiraj, MD, and Uttam Singh, PhD*

Departments of Anesthesia and *Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Anesth Analg 2004;98:683-686

 

y`gh发Ͳv约为28%V90%A为减֯kh试ΪkܦhAĪGUݡC们较F断静脉ZA预`g喷钠0.25 mg/kgA0.5 mg/kgΧQhd]40 mg预y`ghĪGC124Ҧ~w̡AASA IVII级A择术A随为|组AC组31HC组I预`Ͳz盐A组II 2%Qhd]40 mgA组III喷钠0.25 mg/kgA组IV喷钠0.5 mg/kgCU预`药}释2 mLAP时k断静脉^y1钟C静脉开Z`gyCkh评Υ|kA`g时无h为0A轻Lh为1A׵h为2A׵h为3CͲz盐组 24ұw̡]77%^D诉`ghA组IIB组IIIB组IV别为12 ҡ]39%^B10 ]32%^M 1 ҡ]3%^]P < 0.05^C喷钠0.5 mg/kg预y`gh̦ġC们`规预`喷钠0.5 mg/kgAP时k断静脉^y1钟A来预y`ghC

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Propofol causes pain on IV injection in 28%V90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status IVII, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P < 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection.

 

Qhd]静脉¾K[Jdexmedetomidine

Adding Dexmedetomidine to Lidocaine for Intravenous Regional Anesthesia

Dilek Memis, MD*, Alparslan Turan, MD*, Beyhan Karamanlioglu, MD*, Zafer Pamukçu, MD*, and Imran Kurt, MD{dagger}

Departments of *Anaesthesiology and {dagger}Biostatistics, Trakya University Medical Faculty, Edirne, Turkey

Anesth Analg 2004;98:835-840

 

Dexmedetomidine{alpha}-2肾W^选择ʬOi乐w8hC㦳镇h应}减达90%¾K药ζqC实验评Qhd]静脉¾K[JDexmedetomidineįC实验观运动MP觉滞_ĩM维时间A¾K质qA术M术Zy动O学参数H术M术ZkhM镇静况C30Ҥⳡ术w随为2组静脉¾KC对组为0.5%Qhd]40 mL[1 mL 张盐 ( L, n = 15). 实验组为 0.5%Qhd]40 mL[0.5 µg/kg dexmedetomidine (LD, n = 15)C记录P觉M运动滞_ĩM`时间γ¾K质qC应Τ带eM应ΦZ@ 5, 10, 15, 20, M40 min记录y动O学参数B带khB镇静M镇h药ϥα况CQ带Z30 min, M2, 4, 6, 12, 24 h记录y动O学参数BkhM镇静数ȡBnDĤ@镇h药时间B镇h药ϥα况Τ}应CbLD组P觉M运动滞_时间缩uAP觉M运动`时间长A对带@时间长A¾K质qC术MQ带Z30 min, M 2, 4, and 6 hALDVAS评显ۧC_L组CLD组术M术Z镇h药nDq显C_L组CĤ@nD镇h药时间LD组显۩迟C结论GIVRA时bQhd][Jdexmedetomidineണ¾K质qM术镇hĪG却会ް_}应

]赵莲@ 译hq ^

@Dexmedetomidine is approximately 8 times more selective toward the {alpha}-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 µg/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 µg/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects.

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Decreased Insulin Requirements with Spinal Cord Stimulation in a Patient with Diabetes

Leonardo Kapural, MD PhD, Salim M. Hayek, MD PhD, Michael Stanton-Hicks, MB BS, and Nagy Mekhail, MD PhD

Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, Ohio

Address correspondence and reprint requests to Leonardo Kapural, MD, PhD, Pain Management Center, The Cleveland Clinic Foundation, 9500 Euclid Ave. Desk C25, Cleveland, OH 44195.

Anesth Analg 2004;98:745-746

 

们绍@II}fw̦bEZ}o显ۧﵽM显C岛ݭnqC们۫HE󦳯q_长kh}fHC

]赵莲@ @@@ hq@ ա^

We describe a case of type-2 diabetes mellitus with significant improvement in blood glucose control and significant decrease in insulin requirements after initiation of spinal cord stimulation. We believe that spinal cord stimulation may provide additional beneficial effects in patients with chronic pain and diabetes.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ ]

 

 

CABG术ZZ圆ե闭Mߩ颤动关

The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery

Bypass Graft Surgery

George Djaiani, MD DEAA, FRCA*, Barbara Phillips-Bute, PhD*, Mihai Podgoreanu, MD*, Robert H. Messier, MD{dagger}, Joseph P. Mathew, MD*, Fiona Clements, MD*, and Mark F. Newman, MD*

Departments of *Anesthesiology and {dagger}Cardiac Surgery, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2004;98:585-589


CABG术Z颤(AF)发fvAW[F医疗资ӡCsFCABGfHZ圆ե闭(PFO)M间j动脉FO术ZAF发fv关tC1008CABG术fHA术q过经DW声动图̬O_间j损A监测术结X|间AF发ͱ况C结G显ܡG术Z124(12.3%)}发AFCAFfHh为~ѪfHA术e`񦳥RʤߤOIܥvA术夹闭时间长A术Z|时间长CPFO72 (7.1%)A间j动脉F23(2.3%)C 术ZAFfH }发PFO 14(19.4%)A}发间j动脉F8(34.8%)CLogistic^归R显PFO (Lv[OR], 1.95; 1.007V3.778; P = 0.047), ~龄(OR, 1.03; 1.015V1.053; P = 0.0004)ΥRʤ߰Iv(OR, 2.55; 1.671V3.900; P < 0.0001)O术Z发AFC

]齐i@译@@@ա^

Atrial fibrillation (AF) is associated with considerable morbidity and increased resource utilization after coronary artery bypass graft surgery. In this study, we sought to determine whether patent foramen ovale (PFO) and atrial septal aneurysm are associated with an increased risk of postoperative AF in this patient population. We performed a database study on 1008 patients undergoing primary coronary artery bypass graft surgery. All patients were assessed for the development of postoperative AF from the day of surgery to hospital discharge. Atrial septal defects were identified during comprehensive intraoperative transesophageal echocardiographic examination. Postoperative AF was present in 124 (12.3%) patients. Patients with AF were significantly older and had a more frequent incidence of preoperative congestive heart failure, longer cross-clamp time, and prolonged hospital length of stay. PFO was present in 72 (7.1%) and atrial septal aneurysm in 23 (2.3%) patients. In these patients, postoperative AF was present in 14 (19.4%) patients with PFO and 8 (34.8%) patients with atrial septal aneurysm. Multivariate logistic regression analysis identified that PFO (odds ratio [OR], 1.95; 1.007V3.778; P = 0.047), age (OR, 1.03; 1.015V1.053; P = 0.0004), and history of congestive heart failure (OR, 2.55; 1.671V3.900; P < 0.0001) were predictive of postoperative AF.

 

a应ΤʻEX红J对动脉ΦMX媺@

The Effects of a Polymerized Bovine-Derived Hemoglobin Solution in a Rabbit Model of Arterial Thrombosis and Bleeding

Emmanuel Marret, MD*, Philippe Bonnin, MD PhD{dagger}, Elisabeth Mazoyer, MD{ddagger}, Bruno Riou, MD PhD*,, Ted Jacobs, MD||, Pierre Coriat, MD*, and Charles-Marc Samama, MD PhD

Departments of *Anesthesiology and Critical Care and Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, Paris, France; {dagger}Department of Functional Investigations and {ddagger}Laboratory of Hematology, Hôpital Lariboisière, Paris, France; ||Biopure Corporation, Cambridge, Massachusetts; and ¶Department of Anesthesiology, Hôpital Avicenne, Bobigny, France

Anesth Analg 2004;98:604-610

H红J为础载^(HBOCs)㦳X\`Τ_术创伤Z红细MNΫ~AMӨ对譱v响`JsCs较EX红J(HBOC-201)A胶GMͲz盐对动脉ΦMX媺v响C¦ZA30uFoltsҫaߡAS颈总动脉}备60%狭A}إ动脉挤压损伤AZD发PʦΦ]Pʦy减 [CFRs])Ab计数CFRs础ȦZA动随T组AC组10u(n = 10)GͲz盐(对组)A胶AMHBOC-201组Cq过HU标来ϬM药@ΡGP时CFRs数MզX时间C结G显ܡG胶MHBOC-201@άۦACFRs减C时 (别从71A61)X时间显۩长(8898sM81102sF P < 0.05)CͲz盐对CFRsΥX时间无显ۼv响C结论GHBOC-201M胶@άۦAi减动脉Φv}长X时间C

]齐i@译@@ա^

Hemoglobin-based oxygen carriers (HBOCs) have been developed primarily for their oxygenating function and possible use as an alternative to red blood cells during surgery or after major trauma. However, their effect on hemostasis has not been studied extensively. We compared the effects on hemostasis of bovine-derived hemoglobin solution (HBOC-201) with gelatin solution and saline infusion in an experimental model of arterial thrombosis and bleeding. After anesthesia, the Folts model was constructed in 30 rabbits. The common carotid artery was exposed, and a 60% stenosis was induced. A compression injury of the artery was then produced, which triggered a series of cyclic episodes of thrombosis (cyclic flow reductions [CFRs]). After the number of baseline CFRs was counted, animals were assigned randomly to one of three groups (n = 10 each): saline (control), gelatin, or HBOC-201 solution. The effect of studied solutions was observed by recording the number of CFRs during another period and was compared with that of saline. Ear immersion bleeding time was recorded after each CFR period. Gelatin and HBOC-201 had similar effects, manifested by significantly decreased CFRs (from median of 7 to 1 and 6 to 1, respectively) and significantly lengthened bleeding time (from 88 to 98 s and 81 to 102 s, respectively; P < 0.05). Saline infusion had no significant effect on CFRs or bleeding time. HBOC-201 and gelatin had similar effects marked by a reduction in the arterial thrombosis rate and increased bleeding time in rabbits.

yBݬtšBCtũMatūD|¾KZ`苏况较G@项t统ʦ^顾s

Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review

Anil Gupta, MD FRCA, PhD*,{dagger}, Tracey Stierer, MD*, Rhonda Zuckerman, MD*, Neal Sakima, MD*, Stephen D. Parker, MD*, and Lee A. Fleisher, MD* Section Editor

*Department of Anesthesiology and Critical Care, and the Division of Ambulatory Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland and the {dagger}Division for Ambulatory Surgery, Department of Anesthesiology, University Hospital, Örebro, Sweden

Anesth Analg 2004;98:632-641


t统ʦ^顾s|¾K术术Z`苏M}发gCϥηj词anesthesiaMup术A}B_H]>19岁^随对实验A语为^语Aq过PubMed]19662002~6^检MEDLINEW数u库CĤGB检ϥ yBatBCtMatN两个词C筛选Z@58g论进̦ZRC结G显ܡGb`苏AyMݬt没tݡFatŪ`苏n֤_yMݬtšAӤCtŤS֤_ݬtšCݬtũMCtŤ间5钟wVOLptݡAӨ䥦¾K剂间没tݡCb恶ߡB呕RB头hMX|Z恶ߡB呕R发Ͳv譱yɬ_ݬtš]P<0.05^C许hlJ¾K剂组fHOy组ۤݭnR药C结论GP¾K剂间`苏时间tݤjAӧlJʳ¾K剂eɬCƤ应发Ͳv譱y较֡AרOX|Z恶ߩM呕RC

]渊@译@@ա^

In this systematic review we focused on postoperative recovery and complications using four different anesthetic techniques. The database MEDLINE was searched via PubMed (1966 to June 2002) using the search words "anesthesia" and with ambulatory surgical procedures limited to randomized controlled trials in adults (>19 yr), in the English language, and in humans. A second search strategy was used combining two of the words "propofol," "isoflurane," "sevoflurane," or "desflurane". Screening and data extraction produced 58 articles that were included in the final meta-analysis. No differences were found between propofol and isoflurane in early recovery. However, early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane. A minor difference was found in home readiness between sevoflurane and isoflurane (5 min) but not among the other anesthetics. Nausea, vomiting, headache, and postdischarge nausea and vomiting incidence were in favor of propofol compared with isoflurane (P < 0.05). A larger number of patients in the inhaled anesthesia groups required antiemetics compared with the propofol group. We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics. The incidence of side effects, specifically postoperative nausea and vomiting, was less frequent with propofol.

 

Fଥ\ʧNХҰDФѥVĨ^bZ细M达G^^M亚单쪺应

Functional Inhibition by Methadone of N-Methyl-D-Aspartate Receptors Expressed in Xenopus Oocytes: Stereospecific and Subunit Effects

Robert J. Callahan, BS*, John D. Au, BS*, Matthias Paul, MD DEAA{dagger}, Canhui Liu, PhD*, and C. Spencer Yost, MD*

*Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; and {dagger}Department of Anesthesiology and Intensive Care, University of Cologne, Cologne, Germany

Anesth Analg 2004;98:653-659


Fଡ]Methadone^O@bCʯkhv疗ϥζV来Vh强Ī类镇h药C@̦b@项电Ͳz试验]ƧZ细M^证㦳NХҰDФѥVĨ^达C~۬FଦbL尔浓׭S围ҦNMDA^亚C这浓O药动O学s报D临ɦ浓׬ۤ@PCۤ较ӨA吗ا这ǥ\älqDһ浓׬O临ɨϥ浓8-16CNR1/2AMNR1/2B亚`X^对F଩M吗ت@较NR1/2CMNR1/2D亚`X^为ӷPCb~۬Fଦsb况UA̤jNMDAE电y显ۼWjA产50%̤j动NMDA浓ק变jA这说Fଳq过D竞争C虽MFପ^^b许h亚显ܤF̤p^选择ʡAR(-)F对NR1/2A`X^选择ʡC这结GѤFFଧNMDA^动进@B数uA药z@άOq过类^MNMDA^@P_@ΡC

]渊@译@@ա^

Methadone is a strong opioid analgesic that is finding increasing use in chronic pain therapeutics. We explored its reported efficacy for inhibiting N-methyl-D-aspartate (NMDA) receptors in a functional electrophysiologic assay (Xenopus laevis oocyte expression). Racemic methadone inhibited all subtypes of rat NMDA receptors with derived 50% inhibitory concentrations in the low micromolar range. These concentrations overlap with clinically achievable concentrations reported in pharmacokinetic studies. In contrast, morphine inhibited these functional ion channels only at 8V16 times larger concentrations. The NR1/2A and NR1/2B subtype combinations were in general significantly more sensitive to inhibition by methadone and morphine compared with the NR1/2C and NR1/2D subtypes. In the presence of racemic methadone, the maximum NMDA-stimulated currents were markedly decreased, but the NMDA concentration producing 50% of maximal activation was altered only slightly, indicating that methadone blocks by a noncompetitive mechanism. Although stereoisomers of methadone showed minimal stereoselectivity in most subtypes, R(-) methadone was highly selective in its inhibition of the NR1/2A combination. These results provide further functional data describing the NMDA receptor inhibitory actions of methadone and support the hypothesis that methadone acts through both opioid and NMDA receptor mechanisms.

 

slͪN-Ұh虑Oh虑Md]@为¾K药Sʪ较

Local Anesthetic Properties of a Novel Derivative, N-Methyl Doxepin, Versus Doxepin and Bupivacaine

Yukari Sudoh, MD*, Elaine Elliott Cahoon, BS*, Umberto De Girolami, MD{dagger}, and Ging Kuo Wang, PhD*

*Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womens Hospital; and {dagger}Department of Pathology, Brigham and Womens Hospital and Childrens Hospital and Harvard Medical School, Boston, Massachusetts

Anesth Analg 2004;98:672-676


bUT环类ܧ药Ah虑M̴L]O长Ī药C@̦XF@sƦXN-Ұh虑}s䧽¾K@ίSʡCj经A测试2.5A5.0A10mM N-Ұh虑Mh虑对^P觉A运动Hεh觉滞ĪG}O0.5%d]@对Fq过电压钳术U测试养^F细M来评N-Ұh虑Mh虑对NaälqD滞况C结G显ܡGN-Ұh虑ް_经滞时间长_h虑]ҦpAb10mM时别O7.4p时M5.3p时^C@发现bU浓ױ况U\৹`时间显ۮtݡAF2.5mM浓ץ~滞时间]显ۮtݡC0.5%d]]15.4mM^滞时间]约1.5p时^֤_N-Ұh虑Mh虑CN-Ұh虑Mh虑O潜bNaälqD滞剂AN-Ұh虑MvC_h虑C结论GN-Ұh虑O@潜bNaälqD滞剂BO@长ħ¾K剂C

]辉@译@@ա^

Among various tricyclic antidepressants, doxepin and amitriptyline are also long-acting local anesthetics. We synthesized a new compound, N-methyl doxepin, and investigated whether this derivative possesses local anesthetic properties. N-methyl doxepin and doxepin were tested in a rat sciatic nerve model at 2.5, 5.0, and 10 mM. Proprioceptive, motor, and nociceptive blockade were evaluated and compared with those induced by 0.5% bupivacaine. Block of Na+ channels by N-methyl doxepin and doxepin was assessed in cultured pituitary tumor cells under voltage clamp conditions. N-methyl doxepin elicited complete nociceptive blockade that generally lasted longer than that caused by doxepin (e.g., approximately 7.4 h versus 5.3 h at 10 mM). Significant differences were observed for full recovery of function at all concentrations and for the duration of complete blockade except at 2.5 mM. Bupivacaine at 0.5% (15.4 mM) was less effective in producing complete blockade (approximately 1.5 h) than N-methyl doxepin and doxepin. Both doxepin and N-methyl doxepin were potent Na+ channel blockers, although N-methyl doxepin displayed a slower wash-in rate. No morphological alterations were detected in cross-sectioned sciatic nerve specimens with these three drugs. We conclude that N-methyl doxepin is a potent Na+ channel blocker and a long-acting local anesthetic for rat sciatic nerve blockade.

 

Cݤ剂O标㪺ݤ剂药Ĥ较

The Pharmacodynamic Effects of a Lower-Lipid Emulsion of Propofol: A Comparison with the Standard Propofol Emulsion

Dajun Song, MD PhD, Mohamed Hamza, MD, Paul F. White, PhD MD, Kevin Klein, MD, Alejandro Recart, MD, and Omeed Khodaparast, MS

From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2004;98:687-691


s药XXCݤ剂]Ampofol^At1%ݤA5%oH0.6%ZCסC@随B双s63Wd门诊fH¾K时应ΧCݤ剂ݤ剂(Diprivan)较_时间B诱导M维时@ήĪGC静脉`gΪӥ0.1gg/kg]Ϊӥ1gg/kg^Mݤ2mg/kgAϥΤ@i调节ݤtv`静脉维Atvb120-200ggEkg-1Emin-1C记录UϮg时间M`g时间A}B评`g时kh{סA诱导tסA术y动O学变ƥH双频数A睁时间Mw`时间C结G显AmpofolMDiprivanb_时间A诱导tסA¾Kһݪ剂qA双频数Ay动O学标A`标Hαw̪满N׳没显tݡC`g时kh发ͲvAmpofol组_Diprivan组]26%M6%APq0.05rC结论GAmpofolb¾KʯODiprivanۦPA`gkh发Ͳv_Z̡C

]辉@译@@ա^

Using a randomized, double-blind protocol design, we compared a new lower-lipid emulsion of propofol (Ampofol®) containing propofol 1%, soybean oil 5%, and egg lecithin 0.6% with the most commonly used formulation of propofol (Diprivan®) with respect to onset of action and recovery profiles, as well as intraoperative efficacy, when administered for induction and maintenance of general anesthesia as part of a "balanced" anesthetic technique in 63 healthy outpatients. Anesthesia was induced with sufentanil 0.1 µg/kg (or fentanyl 1 µg/kg) and propofol 2 mg/kg IV and maintained with a variable-rate propofol infusion, 120V200 µg E kg-1 E min-1. Onset times to loss of the eyelash reflex and dropping a syringe were recorded. Severity of pain on injection, speed of induction, intraoperative hemodynamic variables, and electroencephalographic bispectral index values were assessed. Recovery times to opening eyes and orientation were noted. The results demonstrated that there were no significant differences between Ampofol® and Diprivan® with respect to onset times, speed of induction, anesthetic dose requirements, bispectral index values, hemodynamic variables, recovery variables, or patient satisfaction. However, the incidence of pain on injection was more frequent in the Ampofol® group (26% versus 6%, P < 0.05). We conclude that Ampofol® is equipotent to Diprivan® with respect to its anesthetic properties but was associated with a more frequent incidence of mild pain on injection.

j术ZfHw~۱镇h]PCEA^v疗术Zkh费Τ较

Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery

Martin Schuster, MD, MA, André Gottschalk, MD, Marc Freitag, MD, and Thomas Standl, MD Section Editor

Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Anesth Analg 2004;98:708-713


@̦^顾ʬsF350Ҥj术Z应PCEAv疗术Zkh]]ABݳB术B妇产MΥ~术fH^疗ġB疗{MkC术ZĤ@ѩMĤTѪkh评别为1623M916]视觉拟评S围A0-100^C¯fH疗{为4.92.2ѡA妇产fH为5.23.1ѡAΥ~fH为4.52.8ѡCw~Ī`g药M类药VXG总qb¯fH为707507mlA妇产fH为770576mlAΥ~fH为593456mlPCEAv疗过{总费为447218/ҡ]1个单约为1^C䤤51%为医务H员费A20%为药费A15%PCEAM费A13%为导޸mJ费ΡCu这费ΩM减费ΪiʡA议ϥPCEAZ计费ΡCѤ_ϥPCEA费ΥDnO药费M医务H员XAҥH应该虑PCEAZ监测}预̩w䥦~径C

]纪华@译@@ա^

In this retrospective study, we determined efficiency, treatment length, and resource use for postoperative pain management with patient-controlled epidural analgesia (PCEA) in 350 consecutive patients undergoing major abdominal, thoracic, gynecological, or orthopedic surgery. Average pain scores on a visual analog scale were 16 23 and 9 16 (visual analog scale range, 0 to 100) on postoperative Days 1 and 3, respectively, and were similar among groups. The treatment length was 4.9 2.2 days in general surgical, 5.2 3.1 days in gynecological, and 4.5 2.8 days in orthopedic patients. The total volumes of the mixture of local anesthetic and opioid received epidurally were 707 507 mL, 770 576 mL, and 593 456 mL in the general surgical, gynecological, and orthopedic groups, respectively. The average total costs for all groups for the full treatment course with PCEA were 447 218 per case (1 equals approximately US$1). Fifty-one percent of these costs were staff costs, 20% were costs for the applied drugs, 15% were costs for PCEA pumps and pump material, and 13% were costs for the initial catheter insertion. In the light of these costs and the availability of less costly alternatives, measurements for cost containment by using PCEA are recommended. Because treatment length is the main cost driver both for drug and staff costs, close monitoring of treatment length and a predefined migration path to alternative techniques after PCEA should be considered.

 

ۥѬ动j联X应ΪyMy电进经颅电E伤`@

The Antinociceptive Effect of Transcranial Electrostimulation with Combined Direct and Alternating Current in Freely Moving Rats

Vladimir Nekhendzy, MD*, Christo P. Fender, BA*, M. Frances Davies, PhD*, Hendrikus J. M. Lemmens, MD, PhD*, Michael S. Kim, MD*, Donna M. Bouley, DVM, PhD{dagger}, and Mervyn Maze, MBChB, FRCP, FRCA{ddagger}

Departments of *Anesthesiology and {dagger}Comparative Medicine, Stanford University School of Medicine, Stanford, California, and the {ddagger}Department of Anaesthetics and Intensive Care, Imperial College, London and Chelsea and Westminster NHS Hospital Trust, London, UK

Anesth Analg 2004;98:730-737


u报D经颅电E]TES^iH诱发显镇h@ΡA术e类药ζq减֡CѤ_ʤ临对实验MTES镇h@Ϊ动实验ATES临应ΨC这ǫD决wʪ数uiH释为TES电m_肤时AbH类应ΪUE无kΤ_pC实验A@̪ΨEΦO临ɬۦs动ҫA证实TES伤`@ΡC伤`@γq过测qMBۥѬ动对夹B热O试验伤`E阈来评C应2.25mATES产ֳͧtB续B频v赖ʡ]40-60Hz^伤`@,i达̤j50%C结论Gj经TES㦳伤`@ΡC这@ΪS点ܤj头֤P觉经b经TES导伤`@Τ_n@ΡC

]纪华@译@@ա^

Transcranial electrostimulation (TES) has been reported to elicit significant analgesia, allowing a substantial reduction of intraoperative opioids. Acceptance of TES into clinical practice is hampered by lack of controlled clinical trials and inconclusive animal data regarding the TES antinociceptive action. This inconclusive data may be explained, in part, by failure in rat experiments to simulate the variables used in humans when TES electrodes are positioned on the skin. In this study we validated the TES antinociceptive effect in a novel animal model of cutaneously administered TES, when the stimulating conditions mimic the ones used in clinical practice. The antinociceptive effect was assessed by measuring nociceptive thresholds in the tail-flick and hot-plate latency tests in awake, unrestrained male rats. Data were analyzed by analysis of variance and mixed-effects population modeling. The administration of TES at 2.25 mA produced an almost immediate, sustained, frequency-dependent (40V60 Hz) antinociceptive effect, reaching approximately 50% of the maximal possible value. We conclude that an antinociceptive effect of cutaneously administered TES can be demonstrated in the rat. Some characteristics of the effect suggest an important role of the sensory nerves of the rats scalp in mediating the TES antinociceptive response.

 

医师¾Kįq问题

Is Physician Anesthesia Cost-Effective?

J. P. Abenstein, MSEE MD*, Kirsten Hall Long, PhD{dagger}, Brian P. McGlinch, MD*, and Niki M. Dietz, MD* Section Editor

*Department of Anesthesiology and {dagger}Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota

Anesth Analg 2004;98:750-757


¾K@个̦争议问题OGb¾Ku@O_D医学专业¾K师医师¾K㦳įqH@调d国¾KI费来评䦨CQΤI¾K费Ϊ调d数uMs结GAإ߰_@SwҦ来较医师¾KOD医师¾K@经济Cįqvw义为G¾K医师W这Ҧ带来预寿RW[]Y费/寿RW[[$/YLS]^C结G医师¾KiHCA[JO险C~w̦įqv为-$2,601/YLSA[JO险Ѧ~w预įqv为-$4,410/YLSC@ΦhӷPRįqvS围b-$4,410 $38,778/YLS间C结G对ϬMwIt别Mw`vD`̡C这R为医师¾KҦѤF经济学证uC

]z`@译@@ա^

One of the most controversial issues in anesthesia is whether nonmedically directed nurse anesthetists are relatively more cost-effective than anesthesiologists in the provision of anesthesia care. We electronically surveyed anesthesia practices throughout the United States to estimate the range in anesthesia professional costs from the payer perspective. Using this survey data on anesthesia reimbursement and published outcomes studies, we developed an ad hoc model to estimate the cost-effectiveness of physician-directed anesthesia relative to a nonmedically directed nurse anesthetist model of care from the payer perspective. Cost-effectiveness ratios were defined as the ratio of incremental costs associated with physician anesthesia relative to the estimated incremental life expectancy gains with this model of care (i.e., dollars per year of life saved [$/YLS]). Reference case results suggest that physician anesthesia is cost saving with an estimated incremental cost-effectiveness ratio of -$2,601/YLS for a younger privately insured patient and an estimated cost-effectiveness ratio of -$4,410/YLS for an elderly Medicare insured patient. Cost-effectiveness ratios ranged from -$4,410 to $38,778/YLS in univariate and multivariate sensitivity analyses across payer types. Results were most sensitive to assumed differences in reimbursement (commercial conversion factors) and to mortality rate assumptions by provider type. This analysis offers economic evidence in support of the physician anesthesia model of care.

 

预ʨϥέf肾Wi帡产术]¤ް_C压

Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

Warwick D. Ngan Kee, MBChB MD, FANZCA, Kim S. Khaw, MBBS FRCA, Floria F. Ng, RN BASc, and Bee B. Lee, MBBS FANZCA

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China

Anesth Analg 2004;98:815-821


b@随对实验A@̬sF帡产术预ʨϥέf肾W对קK¾Kް_C压@ΡCbT内`药Z随Yϥέf肾W100gg/min]n=26^续3钟CbLIXeC钟测q@压AY动脉缩压]SAP^C_`K给f肾W100gg/minC对组]n=24^bSAPp_`80%时给f肾W100ggCO对组ۤ续`gf肾W减֧C压发Ͳv]6/26]23%^F对组为21/24]88%^FP<0.0001^AP时]减轻压U{ס]̧CSAP106mmHg,i动T为95X111mmHg;对组为80mmHg,73X93mmHgFP<0.0001^C߲v]较对组C]P<0.0001^C实验组f肾W剂q]1260gg; 1010--1640gg^j_对组]450ggA300--750ggFP<0.0001^A脐带aMApgar评ۦCC组@个LI脐带PH<7.2C结论G¾KU帡产fH预ʨϥέf肾Wi简单BwBĦa术压C

]z`@译@@ա^

In a randomized, double-blinded, controlled trial, we investigated the prophylactic infusion of IV phenylephrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Immediately after intrathecal injection, phenylephrine was infused at 100 µg/min (n = 26) for 3 min. From that point until delivery, phenylephrine was infused at 100 µg/min whenever systolic arterial blood pressure (SAP), measured each minute, was less than baseline. A control group (n = 24) received IV bolus phenylephrine 100 µg after each measurement of SAP <80% of baseline. Phenylephrine infusion decreased the incidence (6 [23%] of 26 versus 21 [88%] of 24; P < 0.0001), frequency, and magnitude (median minimum SAP, 106 mm Hg; interquartile range, 95V111 mm Hg; versus median, 80 mm Hg; range, 73V93 mm Hg; P < 0.0001) of hypotension compared with control. Heart rate was significantly slower over time in the infusion group compared with the control group (P < 0.0001). Despite a large total dose of phenylephrine administered to the infusion group compared with the control group (median, 1260 µg; interquartile range, 1010V1640 µg; versus median, 450 µg; interquartile range, 300V750 µg; P < 0.0001), umbilical cord blood gases and Apgar scores were similar. One patient in each group had umbilical arterial pH <7.2. Prophylactic phenylephrine infusion is a simple, safe, and effective method of maintaining arterial blood pressure during spinal anesthesia for cesarean delivery.

 

ad]W[经长锥细M内钙äl

Intracellular Calcium Increases in Growth Cones Exposed to Tetracaine

Shigeru Saito, MD, Inas A. M. Radwan, MD, Koichi Nishikawa, MD, Hideaki Obata, MD, Tomonori Okamoto, MD, Toshio Kanno, MD, and Fumio Goto, MD

From the Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan

Anesth Analg 2004;98:841-845


药对Mb长经rʧ@Χw报DC实验@̬sad]b长锥Ih过{O_ް_Ca2+浓פɰC长锥S_ad]ZAq过fura2/AM测wCa2+浓סA发现ad]]12mM^ް_长锥细M内Ca2+浓פɰ]P<0.01^. Ca2+热点从~PV细M^ܯ经Cb无Ca2+养򤤡Aad]@Τ_长锥ACa2+浓תW[ܤpA导PF长锥IhCNi2+(100Um;@Ca2+滞剂)MBAPTA-AM(5Um; 细M内Ca2+gX剂)12mMad]导P长锥IhC结论Gad]]>1Mm^ P时ް_长锥IhMCa2+浓׼W[A这两现HiO独发ͪC

]陈ϡ@译@@ա^

Neurotoxicity of local anesthetics has been reported for both matured and growing neurons. In the present study, we examined if tetracaine increases Ca2+ concentration during growth cone collapse. Intracellular Ca2+ concentration was measured by fura 2/AM after exposure to tetracaine. Tetracaine (1V2 mM) induced increases in intra-growth cone Ca2+ concentration (P < 0.01). The Ca2+ hot spot was expanded into the neurite from the periphery towards the cell body. When tetracaine was applied to growth cones in Ca2+ free media, the increase was minor. However, tetracaine induced growth cone collapse even in the culture media, which did not contain Ca2+. Ni2+ (100 µM; a general Ca2+ channel inhibitor) and BAPTA-AM (5 µM; intracellular Ca2+ chelator) could not inhibit growth cone collapse induced by 1V2 mM tetracaine. Tetracaine (>1 mM) induces collapse and Ca2+ increase at growth cones simultaneously; however, these two

phenomena might be provoked independently.

nU_侧卧a޴

The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

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

*Department of Anesthesiology, Tokyo Womens Medical University, Tokyo, Japan, and the {dagger}Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky

Anesth Analg 2004;98:858-861


虽M侧卧a޴ުx难{没经过t统评ɲA侧卧术时aD显ܧx难会ް_M险结GC@调dnmJ]ILMA^O_帮UaDѭ奿`w̪a޴ޡA侧卧时Mallampati3A头Z5cmCq过\vM时间来评ɲ这术O_@为术侧卧w̧x难时补ϱIC选择为50Aұy间盘X术]侧卧^M50ҨL术]卧^A¾K诱导药为ݤMӥCyդ术w̳¾K诱导e侧Υk侧卧Aޤ]ΦP样^A对组诱导MާΥ卧C两组ϥLIMAA记录ު时间Mݭn调㴡ި数M覡CϥMann-Whitney U , Fishers exact test,X2ΫD对Students t 统计RC结GG两组fH@뱡况MaD测q况ۦF侧卧组张f{׵yj]5.1G4.6cm^F两组a޴时间۪]25s^Aަ\v]@样]96H^C结论GYϦb侧卧AILMAѤF满Nަ\vM时间]<1min^C

]陈ϡ@译@@ա^

Although the difficulty of tracheal intubation in the lateral position has not been systematically evaluated, airway loss during surgery in a laterally positioned patient may have hazardous consequences. We explored whether the intubating laryngeal mask airway (ILMA) facilitates tracheal intubation in patients with normal airway anatomy, i.e., Mallampati grade <=3 and thyromental distance >=5 cm, positioned in the lateral position. We evaluated whether this technique can be used as a rescue when the airway is lost during the middle of surgery in laterally positioned patients with respect to success rate and intubation time. Anesthesia was induced with propofol, fentanyl, and vecuronium in 50 patients undergoing spine surgery for lumbar disk herniation (Lateral) and 50 undergoing other surgical procedures (Supine). Patients having disk surgery (Lateral) were positioned on their right or left sides before induction of general anesthesia, and intubation was performed in that position. Patients in the control group (Supine) were anesthetized in supine position, and intubation was performed in that position. Intubation was performed blindly via an ILMA in both groups. The time required for intubation and number and types of adjusting maneuvers used were recorded. Data were compared by the Mann-Whitney U test, Fishers exact test, {chi}2 test, or unpaired Students t-test, as appropriate. Data presented as mean (SD). Demographic and airway measures were similar in the two groups, except for mouth opening, which was slightly wider in patients in the lateral position: 5.1 (0.9) versus 4.6 (0.7) cm. The time required for intubation was similar in each group ({approx}25 s), as was intubation success (96%). We conclude that blind intubation via an ILMA offers a frequent success rate and a clinically acceptable intubation time (<1 min) even in the lateral position.

D脏术术ߦިƥ发ͲvΦ动检Xv

The Incidence and Prediction of Automatically Detected Intraoperative Cardiovascular Events in Noncardiac Surgery

Rainer Röhrig, Dr. med., Axel Junger, PD Dr. med., MBA (FIT), Bernd Hartmann, Dr. med., Joachim Klasen, Dr. med., Lorenzo Quinzio, Dr. med., Andreas Jost, Matthias Benson, Dr. med. habil., and Gunter Hempelmann, Prof. Dr. med. Dr. h.c. Section Editor

Anesth Analg 2004;98:569-577
@

sOX_质qO证ت来评ɲ术动检Xߦިƥ(CVE)58A458W进D脏术w̪预ZҫC们ϥέ订Z脏M险数(RCRI)HASA级来评¾KM险CH们إߤF两sҫCq过电l¾K续记录t统来发现CVEsCϥ逻辑^归来إߤ@个`杂M@个简单ҫCϥήխM别R来评ɲ预Zҫ̩ʡCb评(n = 29,437)5249Ww(17.8%)M证实(n = 29,021) 5031Ww(17.3%)ܤ֦@项CVECCVEM医|fv显۬关(2.1% 1.0%; P < 0.01)Csҫ显ܤFܦn别OA试̤u@S线(AUC)U积别为0.709 M 0.707CASA(AUC 0.647)M RCRI (AUC 0.620)vt@ǡCO两sҫMASA ARCRI别v还够C单纯ASA级M RCRIXΤ_预见术CVE发͡C

] 译 张纲 ա^

The objective of this study was to evaluate prognostic models for quality assurance purposes in predicting automatically detected intraoperative cardiovascular events (CVE) in 58,458 patients undergoing noncardiac surgery. To this end, we assessed the performance of two established models for risk assessment in anesthesia, the Revised Cardiac Risk Index (RCRI) and the ASA physical status classification. We then developed two new models. CVEs were detected from the database of an electronic anesthesia record-keeping system. Logistic regression was used to build a complex and a simple predictive model. Performance of the prognostic models was assessed using analysis of discrimination and calibration. In 5249 patients (17.8%) of the evaluation (n = 29,437) and 5031 patients (17.3%) of the validation cohorts (n = 29,021), a minimum of one CVE was detected. CVEs were associated with significantly more frequent hospital mortality (2.1% versus 1.0%; P < 0.01). The new models demonstrated good discriminative power, with an area under the receiver operating characteristic curve (AUC) of 0.709 and 0.707 respectively. Discrimination of the ASA classification (AUC 0.647) and the RCRI (AUC 0.620) were less. Neither the two new models nor ASA classification nor the RCRI showed acceptable calibration. ASA classification and the RCRI alone both proved unsuitable for the prediction of intraoperative CVEs.

 

静脉ϥβm哌T嗪v疗单ͳqaCg

Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine

Nicolas Dalibon, MD, Marc Moutafis, MD, Ngai Liu, MD, Jean-Dominique Law-Koune, MD, Stéphanie Monsel, MD, and Marc Fischler, MD

From the Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France

Anesth Analg 2004;98:590-594

们ϥ这个随双e¤ʬs来评ɲ静脉ϥβm哌T嗪来v疗单ͳqa(OLV) 时CgĪGC28Ww̨ϥݤAΪӥA库wAϥ双ĺ进͹j术CϥέDW声头来评ɲ脏数COLV SpO2@ _Τp_95%]lJ0.6^w̳Q纳JsCϥΦw剂Am哌T嗪 (12 µg E kg-1 E min-1 10 min 4 µg E kg-1 E min-1) SpO2 90%ΧC_90%]ưbs~^C28Ww̤18HQ纳JsS围A䤤9Hm哌T嗪A8Hw剂v疗Cm哌T嗪组@个Aw剂组6H终v疗(P < 0.05)Cm哌T嗪组8HAw剂组1Hv疗(SpO2 O >=95% b OLV) (P < 0.01)Cs߲vA动脉压A脏数没显变CO们ub@bw̤发现够D动脉yCm哌T嗪iH来v疗单ͳqa时CgC

] 译 张纲 ա^

We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-

eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO2 was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almit- rine (12 µg E kg-1 E min-1 for 10 min followed by 4 µg E kg-1 E min-1) infusion until SpO2 reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO2 remaining >=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV.


pIϥMasimo SET® and Nellcor N-395计H号XM饱Mת数u̩ʩMĩʪ临评ɲ

Clinical Evaluation of the Effects of Signal Integrity and Saturation on Data Availability and Accuracy of Masimo SET® and Nellcor N-395 Oximeters in Children

Frederick A. Robertson, MD, and George M. Hoffman, MD Section Editor

From the Department of Pediatric Anesthesiology, Childrens Hospital of Wisconsin, and the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin

Anesth Analg 2004;98:617-622
@

脉i计yӤ绍F术A声称iHC检XvCѤ_H号处zM数uk对终数uP@ΡA们较FbPH号XM饱MפUNellcor N-395, Masimo SET®, and GE Solar 8000计数u报iAH号启发M协议Cb27w̤@对@进术较AR时间M数u关tA检测协议MH号启发Aq过H号XM SpO2来进报ĵ层CSolar 8000L两个s󾹧֦数uk脱CMasimos LoSIQ]H号质q^启发Nellcors MOT/PS]运动/脉i检测^应F֪数uC当没H号启发Q显ܪ时ԡA两̤间b̩ʩMt譱没t别CMӡA两仪间协议bSIQ, MOT, ΧCg况U会恶ơC两仪iHI减问题H号AOL们PkyFP结GC]AbCSIQMCUNellcor N-395 M Masimo仪b临ɤWOPAMѪGE Solar 8000计]PC

] 译 张纲 ա^

Pulse oximetry manufacturers have introduced technologies that claim improved detection of hypoxemic events. Because improvements in signal processing and data rejection algorithms may differentially affect data reporting, we compared the data reporting and signal heuristic performance and agreement among the Nellcor N-395, Masimo SET®, and GE Solar 8000 oximeters under a spectrum of conditions of signal integrity and arterial oxygen saturations. A blinded side-by-side comparison of technologies was performed in 27 patients, and data were analyzed for time of data availability, measures of agreement and signal heuristics, and warnings stratified by signal integrity and SpO2. The Solar 8000 had less total data dropout than either of the new technologies. Masimos LoSIQ (signal quality) heuristic rejected less data than Nellcors MOT/PS (motion/pulse search) flag. When no signal heuristic was displayed, there was little difference in precision and bias between the two newer technologies; however, agreement between devices deteriorated in the presence of SIQ, MOT, or hypoxemia. Both newer devices flagged questionable data, but their use of different rejection algorithms resulted in different probabilities of presenting data. Therefore, with poor SIQ or during hypoxemia, the Nellcor N-395 and Masimo oximeters are not clinically equivalent to each other or to the older Solar 8000 oximeter

 

樫时间对Qhd]¦Z@过ʯ经g状发ͪv响

The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia

Martti Silvanto, MD*, Pekka Tarkkila, MD, PhD{ddagger}, Marja-Leena Mäkelä, MD{dagger}, and Per H. Rosenberg, MD, PhD

Research Institute of Military Medicine and {dagger}Department of Anaesthesia, Central Military Hospital, Helsinki; {ddagger}Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital

Anesth Analg 2004;98:642-646

 

Qhd]¦Z@过ʯ经综Xg]TNS^|MCw设认为¦Z樫i导PTNS发iC们设2H񭫪Qhd]50mgΤ_关节镜术ZA樫时间TNS发͡C120潥关节镜术]ASA1~2^fHQ随3组Ap樫组]GroupE^A6p时Z樫组]Group6h^Mߴ樫组]GroupL^CbGroupEAfHQ许b«`Z尽樫]229+/-21钟AS围135247钟^CbGroup6hAfHb¦Z卧ɤj约6AӦbGroupLfH卧ɦܲĤGѦWCҦfHb统计学B¾KM~学标类C总TNS发Ͳv为16HC䤤GroupE3ҡ]7.5H^AGroup6h11ҡ]28H^AGroupL5ҡ]13H^Cb无TNSfH间发现显tݡC2HQhd]50mg¦Z樫}DTNSM险]C

]钟鸣 译 张纲 ա^

The cause of transient neurologic symptoms (TNSs) after lidocaine spinal anesthesia remains unclear. It has been proposed that early ambulation after spinal anesthesia contributes to the development of TNSs. We evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with 50 mg of 2% plain lidocaine for knee arthroscopy. One-hundred-twenty patients undergoing knee arthroscopy (ASA physical status 1V2) were randomized into 3 groups, i.e., early (Group E), 6-h (Group 6-h), or late ambulation (Group L) groups. In Group E, ambulation was allowed as early as possible after regression of spinal block (on average 229 21 min; range, 135V247 min). In Group 6-h, the patients remained in bed for approximately 6 h after the block and in Group L until the next morning. The patient groups were comparable with respect to demographic, anesthetic, and surgical variables. The overall incidence of TNSs was 16%. TNSs occurred in 3 patients of Group E (7.5%), in 11 patients of Group 6-h (28%), and in 5 patients of Group L (13%). No significant differences were detected between the patients with and without TNSs. Early ambulation was not found to be a risk factor for TNSs after spinal anesthesia with 50 mg of 2% lidocaine.

 

vJ对ݤTE^GJ质 G{alpha}i亚򪺼v响

The Effects of Hexanol on G{alpha}i Subunits of Heterotrimeric G Proteins

John Streiff, PhD*, David O. Warner, MD*, Elena Klimtchuk, PhD{dagger}, William J. Perkins, MD*, Kristofer Jones, BS{ddagger}, and Keith A. Jones, MD*

Departments of *Anesthesiology and {dagger}Physiology and Biophysics, {ddagger}Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Anesth Analg 2004;98:660-7

 

AJML¾K药zѤTC鸟I]GTP^结XJա]GJա^调节@tCt统\C们检验FvJ对ݤTE^GJ质 G{alpha}i亚򬡩ʪ@ΡCGTPѦA结XG{alpha}IʬO0.029*Pi/G{alpha}I*minAQvJbj_10mMB为22mM浓שҧC圆ΤGʥ谱kܤFvJ将G{alpha}I变温从47.2oC42.5oCAӦb10oC变G级结ۡCq过ؤoбưM⪩k检验oXvJ]30mM^୰CGG{alpha}I单E^数qA这ܤFvJ导PFJժEXCMӡAGTP结X从aDƦٽK̨IӱoG{alpha}Itצ}QvJ]30mM^Ҽv响C~ѻEX诱导H产ͪA结XG{alpha}I显A们}没发现b㪺aDƦ١AѤ_内[35S]GTP{gamma}S结XG{alpha}Itת导PvJ诱导^EG{alpha}I联~径C

]钟鸣 译 张纲 ա^

Alcohols and other anesthetics interfere with the function of a variety of systems regulated by guanosine triphosphate (GTP)-binding proteins (G proteins). We examined the effect of hexanol on the activity of the {alpha}subunit (G{alpha}i1) of heterotrimeric G proteins. The GTP hydrolysis activity of recombinant G{alpha}i1 was 0.029 mole Pi E mole G{alpha}i1-1 E min-1 and was inhibited by hexanol at concentrations larger than 10 mM, with a 50% inhibitory concentration of 22 mM. Circular dichroism spectroscopy revealed that hexanol decreased the denaturation temperature of G{alpha}i1 from 47.2XC to 42.5XC without altering its secondary structure at 10XC. Hexanol (30 mM) reduced the amount of monomeric G{alpha}i1 in solution measured by size-exclusion chromatography, indicating that hexanol caused protein aggregation. However, the rate of GTP{gamma}S binding to G{alpha}i immunoprecipitated from airway smooth muscle membranes was not affected by 30 mM hexanol. Excluding the apparent inhibition of recombinant G{alpha}i1 resulting from aggregation-induced artifact, we found no evidence that the hexanol-induced inhibition of receptor-activated G{alpha}i-coupled pathways in intact airway smooth muscle resulted from direct inhibition of the intrinsic rate of [35S]GTP{gamma}S binding to G{alpha}i.

 

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Vasodilation Increases the Threshold for Bupivacaine-Induced Convulsions in Rats

Yutaka Oda, MD PhD, Tomoharu Funao, MD, Katsuaki Tanaka, MD, and Akira Asada, MD PhD

From the Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan

Anesth Analg 2004 98: 677-682

 

d]q过~PM枢经t统v响FުOC]为ަ缩药W[F静脉`gd]枢经t统rʡAG扩张药i୰C这rʡC们检验F该设AY扩张药CFMBۥDIlѹd]枢rʡCSprague-DawleyѹQ随对组]C^Bda组]N^Mԩ组]P^]C组12ҡ^CH1mg/kg/mint给ۥd]ܥX现紧张/阵挛a֡C3组随d]P时别给Ͳz盐Bda]0.4ug/min^Mԩ]̪510ug/minA随Z50ug/min^CC组`gd]Z动脉压显ɰN组BP组ba发@e维b线CC组d]a剂q为5.8+/-1.5mg/kgAӦbN组MP组显ۤɰ]别为7.6+/-1.5mg/kg,p=0.02M8.1+/-1.1mg/kg^CMӡAb3组发@a时浆总ΫDJ结Xd]浓ש脑内d]浓没tݡC们oX结论AdaMԩFd]积剂qA}v响ѥd]诱导a֩һݪ浆脑内浓סC

]钟鸣 译 张纲 ա^

Bupivacaine affects the vascular resistance by peripheral and central nervous system (CNS) mechanisms. As vasoconstrictors increase the CNS toxicity of IV bupivacaine, vasodilators may decrease its CNS toxicity. We examined the hypothesis that vasodilators decrease the CNS toxicity of bupivacaine in awake, spontaneously breathing rats. Male Sprague-Dawley rats were randomly divided into control (C), nicardipine (N), and phentolamine (P) groups (n = 12 in each group). Racemic bupivacaine was administered IV at 1 mg/kg/min until tonic/clonic convulsions occurred. Saline, nicardipine (0.4 µg/min), and phentolamine (10 µg/min within 5 min, 50 µg/min thereafter) were simultaneously administered with bupivacaine in groups C, N, and P, respectively. Mean arterial blood pressure was significantly increased by infusion of bupivacaine in group C and was maintained at baseline levels before the onset of convulsions in groups N and P. The convulsive dose of bupivacaine in group C was 5.8 1.5 mg/kg, but was significantly larger in groups N and P (7.6 1.5 and 8.1 1.1 mg/kg, P = 0.02 and 0.001, respectively). However, there were no differences in total or protein-unbound plasma concentration of bupivacaine or in concentration of bupivacaine in the brain at the onset of convulsions among the 3 groups. We conclude that nicardipine and phentolamine increase the cumulative dose but do not affect the threshold plasma or brain concentrations required for bupivacaine-induced convulsions.

 

y¾K应脑电图监测¾K药@ΪNarcotrend数O双频数较

Narcotrend Index Versus Bispectral Index as Electroencephalogram Measures of Anesthetic Drug Effect During Propofol Anesthesia

Sascha Kreuer, MD*, Wolfram Wilhelm, MD DEAA*, Ulrich Grundmann, MD*, Reinhard Larsen, MD*, and Jörgen Bruhn, MD{dagger} Section Editor

*Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Germany, and the {dagger}Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany

Anesth Analg 2004 98: 692-697

 

Narcotrend监测仪(MonitorTechnik, Bad Bramstedt, Germany)_lEEG视觉评对¾K间EEG进动RC̷s软4.0]Adimensionless数]类_BIS数^AS围从100]苏^0C们较by¾K应NarcotrendBIS监测¾K药@ΡC选18择ڪvʫeC术fHC术e_y间ةmw~导ޡA}产ӪmmBIS(version XP; Aspect Medical Systems, Natick, MA)Narcotrend电CC5s记录@Narcotrend数BBISȡBy⪺浆浓פή应浓סCHӥΤy诱导Aa޴ަZw~0.5%d]15mlA45minZy剂q̦W[B减2Cb剂q调㤤Ay应浓צb2.0 0.4 µg/mL (̧C) 6.3 1.3 µg/mL (̰)间i动CNarcotrendBIS来预测y应浓ס]HPKܡ^A两̤别为0.880.03, 0.850.04CNarcotrendBIS监测药@ΡAke0别为0.200.05 min-1 ]Narcotrend数^B0.160.07 min-1]BIS^.by⪺i动S围内ANarcotrendBIS检测EEG动态变ơC

]P晓译 张纲 ա^

The Narcotrend monitor (MonitorTechnik, Bad Bramstedt, Germany) performs an automatic analysis of the electroencephalogram (EEG) during anesthesia based on a visual assessment of the raw EEG. Its newest software version 4.0 includes a dimensionless index that, similar to the bispectral index (BIS), ranges from 100 (awake) to 0. We compared the performance of Narcotrend index and BIS as EEG measures of anesthetic drug effect during propofol anesthesia. Eighteen adult patients scheduled for radical prostatectomy were investigated. An epidural catheter was placed in the lumbar space and electrodes for BIS (version XP; Aspect Medical Systems, Natick, MA) and Narcotrend were positioned as recommended by the manufacturers. Narcotrend index, BIS values, and propofol plasma and effect site concentrations as parallelly simulated by Rugloop software (Department of Anesthesia, Ghent University, Belgium) were automatically recorded in intervals of 5 s. Induction of anesthesia consisted of a fentanyl bolus and a propofol infusion. After endotracheal intubation, patients received 15 mL bupivacaine 0.5% epidurally, and 45 min later propofol dosages were subsequently increased and decreased twice. Simulated propofol effect site concentrations ranged from 2.0 0.4 µg/mL (smallest) to 6.3 1.3 µg/mL (largest) during these subsequent increases and decreases of propofol. In terms of prediction probability (PK) the performance of the Narcotrend index (PK = 0.88 0.03) to predict propofol effect site concentrations was comparable to the BIS (PK = 0.85 0.04). Using the respective EEG index as a measure of drug effect the mean ke0 was calculated as 0.20 0.05 min-1 for Narcotrend index and 0.16 0.07 min-1 for BIS. In the observed propofol concentration range Narcotrend index detected differences in EEG dynamics as well as BIS.

 

恶ʰ肿F术fH应Dextromethorphan联Xw~PCA较联X静脉PCAѧn镇hĪGXX@项随B双Bw剂对Ӭs

Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study

Avi A. Weinbroum, MD*,{ddagger}, Benjamin Bender, MD{dagger}, Alexander Nirkin, MD{dagger}, Shoshana Chazan, RN{ddagger}, Isaac Meller, MD{dagger}, and Yehuda Kollender, MD{dagger}

*Postanesthesia Care Unit, the {ddagger}Acute Pain Service, and the {dagger}National Orthopedic Oncology Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty Medicine, Tel Aviv University, Tel Aviv, Israel

Anesth Analg 2004 98: 714-722.

 

恶ʰ肿F~术Zkh剧PAݥΤj剂q¾K药CDextromethorphan]DM^AN-ҰD-ѥVĨ^剂AwQ证㦳强j镇hĪGC恶ʰ肿FfHb标`Xw~¾KU]应ΩΤDM^~术ZA们对应εw~PCA(PCEA)静脉PCA(IV-PCA)来评@ΡC随l120fHA术Z应PCEA(罗d]3.2mgϪӥ8ug/单剂)IV-PCA(mg/单剂)AbD观视觉kh评>=4时开l应Ϊ术Z96hCC组U30fHw剂DM 90mgfA]术e应Ϊ术Z2ѡ^@为双对ӡCkh剧P时Diclofenac75mg IM@为补ϡC应DMfHPCAϥΤίkh评较P组w剂对ӯfH减50HAS别O术Z2内]P<0.01^CPCEA组Cp时总kh强ק较IV-PCA组减p50H(P<0.01)CPCA-DMfHDiclofenacζq较P组w剂对ӯfH减42H(P<0.01)CPCEA-DM7HBIV-PCA-DM11H报iƧ@ΡAPCEA-w剂组IV-PCA-w剂组@44H报iƧ@(P<0.01)C应两P镇h术fH̦Uɬ动时间۪A应DMfH较w剂组U时间u(1.5+-0.8 VS 2.1+-1.1dAP=0.02)C]ADM঳Ħakh}减ֳ¾K药ζqAW强@ΦbPCEA组较IV-PCA组显C~应DMfHUɬ动时间较w剂应Ϊ̦C

]P晓 译 张纲 ա^

Pain after bone malignancy surgery is intense and requires large amounts of analgesics. The augmented antinociceptive effects of dextromethorphan (DM), a N-methyl-D-aspartate receptor antagonist, were demonstrated previously. We assessed the use of postoperative patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) in patients undergoing surgery for bone malignancy under standardized combined general and epidural anesthesia with or without DM. Patients (n = 120) were randomly allocated to receive PCEA (ropivacaine 3.2 mg plus fentanyl 8 µg/dose) or IV-PCA (morphine 2 mg/dose) postoperatively, starting at subjective visual analog scale pain intensity >=4 of 10 for up to 96 h. Placebo or DM 90 mg orally (30 patients/group/set) was given in a double-blinded manner before surgery and for 2 days afterwards. Diclofenac 75 mg IM was available as a rescue drug. DM patients used PCA and rated their pain >50% less than their placebo counterparts in each set, especially during the first 2 postoperative days (P < 0.01). Hourly and overall maximal pain intensity among PCEA patients was ~50% less than in the IV-PCA set (P < 0.01). Diclofenac was used 42% less (P < 0.01) by the PCA-DM patients compared with their placebo counterparts. Seven PCEA-DM and 11 IV-PCA-DM individuals reported having side effects compared with 44 in the PCEA-placebo and the IV-PCA-placebo groups (P < 0.01). Time to first ambulation was similar with both analgesia techniques but shorter among the DM-treated patients compared with the placebo recipients (1.5 0.8 versus 2.1 1.1 days, P = 0.02). Thus, DM afforded better pain control and reduced the demand for analgesics, augmented the PCEA effect versus IV-PCA, and was associated with minimal untoward effects in each analgesia set. DM patients ambulated earlier than placebo recipients.

 

T内ΤfAi乐w预术Zs断综XXX@项随B双对Ӭs

Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study

I. Dobrydnjov, MD*, K. Axelsson, MD PhD*, L. Berggren, MD PhD*, J. Samarütel, MD PhD{dagger}, and B. Holmström, MD PhD*

*Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; and {dagger}Tartu University Hospital, Tartu, Estonia Anesth Analg 2004 98: 738-744

 

b项sA们评ɲFb术Z发Ͱs断综Xg(AWS)M险¯fH补RT内应ΩΤfAi乐wĪGC们wi乐w对术ZAWS预@ΡC45s赖fH(AJ摄J>60g/d)A择经DeC术(TURP)A随双为3组CҦfHQhd]100mg񭫲GIUĪ`gCa组(DiazG)术ea10mgfAAT内i乐w组(Cloni/tG)fAw剂}T内应Υi乐w150ugAfAi乐w组(Clonp/oG)i乐w150ugfACs断临评e员会w评标诊断AWSfHCDiazG12fHX现断g状ACloni/tG2BClonp/oG1fHX现g状Cs断临评e员会w评标进评ADiazG12ӥi乐w组1CDiazG2fHX现严谵kCClonp/oG组fH¦Z612h动脉压轻פU(P<0.05), DiazG组fH术Z2472hX现动Oʴ`环应C总A术eT内应ΩΤfAi乐w150ugi预s赖fH发严术ZAWSC

]P晓译 张纲 ա^

@In this study, we evaluated the effect of intrathecal and oral clonidine as supplements to spinal anesthesia with lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric lidocaine 100 mg intrathecally. The diazepam group (DiazG) was premedicated with diazepam 10 mg orally; the intrathecal clonidine group (Cloni/tG) received a placebo (saline) tablet and clonidine 150 µg intrathecally; and the oral clonidine group (Clonp/oG) received clonidine 150 µg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Cloni/tG and one in the Clonp/oG. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the clonidine-treated groups. Two patients in the DiazG had severe delirium. Patients receiving oral clonidine had a slightly decreased mean arterial blood pressure 6V12 h after spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24V72 h after surgery. In conclusion, preoperative clonidine 150 µg, intrathecally or orally, prevented significant postoperative AWS in ethanol-dependent patients.

Anesth Analg 2004 98: 738-744

 

ݬt对_脑ʦj经`v响

Effect of isoflurane on neuronal apoptosis in rats subjected to focal cerebral ischemia.

Kawaguchi M, Drummond JC, Cole DJ, Kelly PJ, Spurlock MP, Patel PM.

Department of Anesthesiology, VA Medical Center and University of California, San Diego, California, USA.

Anesth Analg 2004 98G 798-805

 

虽MݬtťiH减ֵu暂ʦZ`ʦʯ经损伤AO这@脑O护ĤO}DO续变C经`i归]_ʦZ뭱积vB扩jC这尽ݬtťi减֦经`Ai无kʦް_经`C们sFݬt对_ʯʦj标记细M`v响Cϥݬtų¾KWistar-Kyotoj}随为M组(n = 40)Mݬt组(n = 40)A两组jq过结j脑动脉70钟来Φ_ʯʦC实验过{头温ױb37+/- 0.2JCbM组ݬtŰϥΡAji苏;bݬt组Aݬtų¾K维b1.5 MACCjbA`Z7p时B1B4β7处]n=10//时点^C脑뭱积q过苏红V图R来进计CbT个邻Aq过TUNELVMK̬Vk证实F`细Mʪcaspase-9Mcaspase-3CA`Z7p时B1ѩM4ݬt组뭱积p_M组(P < 0.05)AMӦA`Z7两组}无t别Cʦ1ѦZM组`细M(TUNEL, caspase-3, M caspase-9 )数q显h_ݬt组A经过4ѩ7Ѫ`Aݬt组`细Mh_M组C7ѦZAcaspase-3 M -9阳ʪ经数qbݬt组较h(P < 0.05)C这数uݬtŬO迟ӤOFʦ导P脑몺发iCݬt减֤FʦZ`发iAO}没ʦZ`Z`发iC结论G们sFݬt对_脑ʦj经`v响Cbݬtų¾KjAʦް_`发ͤ_ʦZ`ߴ阶qAݬtŦ}ʦZ经`C

]陆伟 译 张纲 ա^

Although isoflurane can reduce ischemic neuronal injury after short postischemic recovery intervals, this neuroprotective efficacy is not sustained. Neuronal apoptosis can contribute to the gradual increase in infarct size after ischemia. This suggests that isoflurane, although capable of reducing early neuronal death, may not inhibit ischemia-induced apoptosis. We investigated the effects of isoflurane on markers of apoptosis in rats subjected to focal ischemia. Fasted Wistar-Kyoto rats were anesthetized with isoflurane and randomly allocated to awake (n = 40) or isoflurane (n = 40) groups. Animals in both groups were subjected to focal ischemia by filament occlusion of the middle cerebral artery for 70 min. Pericranial temperature was servo-controlled at 37 degrees C +/- 0.2 degrees C throughout the experiment. In the awake group, isoflurane was discontinued and the animals were allowed to awaken. In the isoflurane group, isoflurane anesthesia was maintained at 1.5 MAC (minimum alveolar anesthetic concentration). Animals were killed 7 h, 1 day, 4 days, or 7 days after reperfusion (n = 10/group/time point). The area of cerebral infarction was measured by image analysis in a hematoxylin and eosin stained section. In three adjacent sections, apoptotic neurons were identified by TUNEL staining and immunostaining for active caspase-9 and caspase-3. Infarct size was smaller in the isoflurane group than the awake group 7 h, 1 day, and 4 days after reperfusion (P < 0.05). However, this difference was absent 7 days after reperfusion. The number of apoptotic (TUNEL, caspase-3, and caspase-9 positive) cells 1 day after ischemia was significantly more in the awake versus isoflurane group. After a recovery period of 4 or 7 days, the number of apoptotic cells in the isoflurane group was more than in the awake group. After 7 days, the number of caspase-3 and -9 positive neurons was more in the isoflurane group (P < 0.05). The data indicate that isoflurane delays but does not prevent the development of cerebral infarction caused by ischemia. Isoflurane reduced the development of apoptosis early after ischemia but did not prevent it at later stages of postischemic recovery. IMPLICATIONS: The effect of isoflurane on neuronal apoptosis was investigated in rats subjected to focal cerebral ischemia. In isoflurane-anesthetized animals, ischemia-induced apoptosis occurred during the later stages of postischemic recovery. Isoflurane did not inhibit postischemic neuronal apoptosis.

 

续骶PM经滞G@项X线s

Continuous parasacral sciatic block: a radiographic study.

Gaertner E, Lascurain P, Venet C, Maschino X, Zamfir A, Lupescu R, Hadzic A.

*Service dAnesthésie Réanimation Chirurgicale Hôpital de Hautepierre, Strasbourg, France; {dagger}Service dAnesthésie, Clinique des Eaux Claires, Grenoble, France; and {ddagger}Department of Anesthesiology, St. Lukes-Roosevelt Hospital, New York, New York

Anesth Analg 2004 98: 831-834.

 

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]陆伟 译 张纲 ա^

Parasacral sciatic blockade results in anesthesia of the entire sacral plexus. In this study we sought to determine the spread of the local anesthetic injected through a parasacral catheter, the anatomical location of the inserted catheters, and the extent and reliability of the blockade. In this study, 87 consecutive patients undergoing major lower limb surgery were enrolled. After placement of the catheter and injection of 8 mL of radio-opaque contrast dye, radiographic images were evaluated for dispersion of the injectate. Sensory and motor evaluations were also performed. Radiographic analysis of the injectates revealed that nearly all catheters (86 catheters, 99%) were in the correct anatomical position. The mean volume of local anesthetic injection was 21 +/- 3 mL. All patients developed a full sensory block of all three major components of the sciatic plexus (tibial, common peroneal, and posterior cutaneous nerve of the thigh). We conclude that the parasacral sciatic block results in frequent success of blockade of all three major components of the sciatic plexus and it has a small risk of complications. Contrast radiography can be used to document the catheter placement.

 

uw~滞对间质ʻH֪GP质v响

The effect of short-term epidural local anesthetic blockade on urinary levels of substance P in interstitial cystitis.

Sukiennik A, Carr DB, Bonney I, Marchand JE, Wurm H, Sant GR.

Departments of Anesthesia and Urology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.

Anesth Analg 2004 98: 846-850.

 

们sFw~滞对个发ʯkh间质ʻH֪fHGP质v响Cw~ϥ0.25%d]AMZ0.05%d]维A24p时GAϥΩgK̪k测qP质tqCbw~`药开lZAҦfHGP质ɰMZUCҦfHDzkh{减轻C们虑b3Ѫw~给药间HַP觉经骺P质释M损导PG肽u暂ɰMkh强ת减轻C结论Gb5个ϥεw~给药达镇h发@间质ʻH֪fHAGP质ɰMZUC

]陆伟 译 张纲 ա^

We investigated the effect of epidural local anesthetic blockade on urinary substance P levels in five patients suffering from painful flare-ups of interstitial cystitis. Urine was collected in 24-h intervals commencing at the onset of an epidural bolus of 0.25% bupivacaine followed by maintenance epidural infusions of 0.05% bupivacaine. Substance P was measured by radioimmunoassay. After initiation of the epidural infusion, urinary substance P levels increased and then declined in all patients. All patients reported a decrease in pain intensity. We hypothesize that acute release, followed by depletion, of substance P from bladder sensory nerve endings accounts for the transient increase of peptide levels in urine and may contribute to the decrease in pain intensity during a 3-day epidural infusion.