Anesthesia & Analgesia

August 2004

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

心臟手術期間正常血糖的維持

殷文淵 譯 陳傑 校

Maintenance of Normoglycemia During Cardiac Surgery

George Carvalho, Anne Moore, Baqir Qizilbash, Kevin Lachapelle, and Thomas Schricker

Anesth Analg 2004 99: 319-324.

糖尿病影響頸靜脈氧飽和度對苯腎上腺素的反應性和腦血管二氧化碳反應性之間關係

葛甯花譯 薛張綱校

The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity

Yuji Kadoi, Shigeru Saito, Fumio Goto, and Nao Fujita

Anesth Analg 2004 99: 325-331

用組織多普勒成象技術觀察負荷改變對收縮期二尖瓣管處流速的影響響

沈浩   李士通 

The Effects of Load on Systolic Mitral Annular Velocity by Tissue Doppler Imaging

Ruggero Amà, Patrick Segers, Carl Roosens, Tom Claessens, Pascal Verdonck, and Jan Poelaert
Anesth Analg 2004 99: 332-338.

 

原位肝移植手術中腦局部氧飽和度是腦低灌注的敏感指標

葛甯花譯 薛張綱校

Regional Cerebral Oxygen Saturation Is a Sensitive Marker of Cerebral Hypoperfusion During Orthotopic Liver Transplantation
Jens Plachky, Stefan Hofer, Martin Volkmann, Eike Martin, Hubert J. Bardenheuer, and Markus A. Weigand

Anesth Analg 2004 99: 344-349

PEDIATRIC ANESTHESIA:

氟烷真的比七氟醚更好保護心臟壓力反射?兒童麻醉中七氟醚和氟烷的自主性壓力反射的無創研究

張曦      李士通 

Does Halothane Really Preserve Cardiac Baroreflex Better Than Sevoflurane? A Noninvasive Study of Spontaneous Baroreflex in Children Anesthetized with Sevoflurane Versus Halothane

Isabelle Constant, Dominique Laude, Elizabeth Hentzgen, and Isabelle Murat

Anesth Analg 2004 99: 360-369.

AMBULATORY ANESTHESIA:

耳鼻喉手術監護麻醉中使用加巴噴丁的鎮痛效果

朱輝 譯 陳傑 校

The Analgesic Effects of Gabapentin in Monitored Anesthesia Care for Ear-Nose-Throat Surgery

Alparslan Turan, Dilek Memis, Beyhan Karamanlioglu, Recep Yagiz, Zafer Pamukçu, and Ebru Yavuz

Anesth Analg 2004 99: 375-378.

 

呼氣末二氧化碳監測能準確發現監護麻醉時無呼吸

葛甯花譯 薛張綱校

Capnography Accurately Detects Apnea During Monitored Anesthesia Care

Roy G. Soto, Eugene S. Fu, Hector Vila, Jr., and Rafael V. Miguel

Anesth Analg 2004 99: 379-382.

ANESTHETIC PHARMACOLOGY:

大面積燒傷病人中羅庫溴銨的神經肌肉阻滯藥效學

馬皓琳      李士通 

Neuromuscular Pharmacodynamics of Rocuronium in Patients with Major Burns

TaeHyung Han, HyeongSeok Kim, JiYoung Bae, KwangMin Kim, and J. A. Jeevendra Martyn

Anesth Analg 2004 99: 386-392.

 

丙泊酚可抑制人由脂類促炎症介質引起的血小板聚集

朱輝 譯 陳傑 校

Propofol Inhibits Human Platelet Aggregation Induced by Proinflammatory Lipid Mediators

Olivier Fourcade, Marie-Françoise Simon, Lawrence Litt, Kamran Samii, and Hugues Chap

Anesth Analg 2004 99: 393-398.

 

相同藥理作用下硫噴妥鈉和異丙酚作用於大腦的不同部位

(葛甯花譯 薛張綱校)

Thiopental and Propofol Affect Different Regions of the Brain at Similar Pharmacologic Effects

Robert A. Veselis, Vladimir A. Feshchenko, Ruth A. Reinsel, Ann M. Dnistrian, Bradley Beattie, and Timothy J. Akhurst

Anesth Analg 2004 99: 399-408.

 

氟烷和異丙酚調節γ—氨基丁酸A受體單通道電流

王立中      李士通 

Halothane and Propofol Modulation of {gamma}-Aminobutyric AcidA Receptor Single-Channel Currents

Akira Kitamura, Ryoichi Sato, William Marszalec, Jay Z. Yeh, Ryo Ogawa, and Toshio Narahashi

Anesth Analg 2004 99: 409-415

 

非洲爪蛙 Ca激動的Cl電流通過蛋白激酶C和蛋白磷酸酯酶調節:有關麻醉機制的研究

朱慧琛 譯 陳傑 校

Modulation of Xenopus laevis Ca-Activated Cl Currents by Protein Kinase C and Protein Phosphatases: Implications for Studies of Anesthetic Mechanisms

Klaus Hahnenkamp, Marcel E. Durieux, Hugo van Aken, Sascha Berning, Thomas J. Heyse, Christian W. Hönemann, and Bettina Linck

Anesth Analg 2004 99: 416-422.

 

七氟醚促進人離體網膜動脈和靜脈內皮細胞依賴的平滑肌鬆弛

葛甯花譯 薛張綱校

Sevoflurane Promotes Endothelium-Dependent Smooth Muscle Relaxation in Isolated Human Omental Arteries and Veins

Karin Thorlacius and Mikael Bodelsson

Anesth Analg 2004 99: 423-428.

 

雷米芬太尼導致的胃排空延遲不受體位的影響

吳儉      李士通 

The Delay of Gastric Emptying Induced by Remifentanil Is Not Influenced by Posture

Jakob Walldén, Sven-Egron Thörn, and Magnus Wattwil

Anesth Analg 2004 99: 429-434.

 

心臟斯里蘭卡肉桂堿受體缺陷患者中揮發性麻醉藥和琥珀膽鹼的應用

朱慧琛 譯 陳傑 校

Volatile Anesthetics and Succinylcholine in Cardiac Ryanodine Receptor Defects

Heikki Swan, Päivi J. Laitinen, and Lauri Toivonen

Anesth Analg 2004 99: 435-437.

TECHNOLOGY, COMPUTING, AND SIMULATION:

術後或麻醉後呼出氣中CO濃度增加

      李士通 

Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia

Masao Hayashi, Toru Takahashi, Hiroshi Morimatsu, Hiromi Fujii, Naoyuki Taga, Satoshi Mizobuchi, Masaki Matsumi, Hiroshi Katayama, Masataka Yokoyama, Masahiro Taniguchi, and Kiyoshi Morita

Anesth Analg 2004 99: 444-448.

PAIN MEDICINE:

兩種不同的神經性疼痛模型對止痛劑有不同敏感性

顧漪聞 譯 陳傑 校

Differential Analgesic Sensitivity of Two Distinct Neuropathic Pain Models

Isabelle Decosterd, Andrew Allchorne, and Clifford J. Woolf

Anesth Analg 2004 99: 457-463.

 

Ic 類抗心律失常藥對鼠感覺神經元中抗河豚毒素Na+電流的作用

葛甯花譯 薛張綱校

The Effects of Class Ic Antiarrhythmics on Tetrodotoxin-Resistant Na+ Currents in Rat Sensory Neurons

Yoko Osawa, Akiyoshi Oda, Hiroki Iida, Shigeaki Tanahashi, and Shuji Dohi

Anesth Analg 2004 99: 464-471.

 

椎間盤內纖維環熱成形術治療多節段椎間盤退行性病變所致的腰椎間盤源性疼痛

周雅春   李士通

Intradiscal Thermal Annuloplasty for the Treatment of Lumbar Discogenic Pain in Patients with Multilevel Degenerative Disc Disease

Leonardo Kapural, Nagy Mekhail, Zdenko Korunda, and Ayman Basali

Anesth Analg 2004 99: 472-476.

 

慢性和急性下腰痛時活動度和疼痛的關係分析

顧漪聞 譯 陳傑 校

An Analysis of the Relationship Between Activity and Pain in Chronic and Acute Low Back Pain

John J. Liszka-Hackzell and David P. Martin

Anesth Analg 2004 99: 477-481.

 

氯胺酮用作阿片類藥物的輔助鎮痛劑:定量和定性的系統總結

葛甯花譯 薛張綱校

Ketamine as Adjuvant Analgesic to Opioids: A Quantitative and Qualitative Systematic Review

Kathirvel Subramaniam, Balachundhar Subramaniam, and Richard A. Steinbrook

Anesth Analg 2004 99: 482-495.

 

局麻藥行腰部節段性神經阻滯的疼痛緩解和運動功能:一項利多卡因和羅呱卡因之間的前瞻性雙盲對比研究

黃施偉     李士通

Lumbar Segmental Nerve Blocks with Local Anesthetics, Pain Relief, and Motor Function: A Prospective Double-Blind Study Between Lidocaine and Ropivacaine

André P. Wolff, Oliver H. G. Wilder Smith, Ben J. P. Crul, Marc P. van de Heijden, and Gerbrand J. Groen

Anesth Analg 2004 99: 496-501.

 

圍術期硬膜外應用可樂定對結直腸手術後病人細胞因數,術後鎮痛和腸功能的影響

忻紀華 譯 陳傑 校

The Effect of Epidural Clonidine on Perioperative Cytokine Response, Postoperative Pain, and Bowel Function in Patients Undergoing Colorectal Surgery

Ching-Tang Wu, Shu-Wen Jao, Cecil O. Borel, Chun-Chang Yeh, Chi-Yuan Li, Chueng-He Lu, and Chih-Shung Wong

Anesth Analg 2004 99: 502-509.

CRITICAL CARE AND TRAUMA:

用以血紅蛋白為基礎的氧攜帶液進行深度血液稀釋能增加腦組織的氧張力

葛甯花譯 薛張綱校

Increased Cerebral Tissue Oxygen Tension After Extensive Hemodilution with a Hemoglobin-Based Oxygen Carrier

Gregory M. T. Hare, Kathryn M. Hum, Steve Y. Kim, Aiala Barr, Andrew J. Baker, and C. David Mazer

Anesth Analg 2004 99: 528-535.

 

 

比較高張生理鹽水及高張生理鹽水6%右旋糖酐-70用於狗出血性休克復蘇後的早期組織及胃腸氧合作用的研究

裘毅敏      李士通 

The Early Systemic and Gastrointestinal Oxygenation Effects of Hemorrhagic Shock Resuscitation with Hypertonic Saline and Hypertonic Saline 6% Dextran-70: A Comparative Study in Dogs

José Reinaldo Cerqueira Braz, Paulo do Nascimento, Jr., Odilar Paiva Filho, Leandro Gobbo Braz, Luiz Antonio Vane, Pedro Thadeu Galvão Vianna, and Geraldo Rolim Rodrigues, Jr.

Anesth Analg 2004 99: 536-546

 

N-乙酰甲基半胱氨酸阻止犬血液稀釋導致的缺氧性肺血管收縮的抑制作用

忻紀華 譯 陳傑 校

Prevention of Hemodilution-Induced Inhibition of Hypoxic Pulmonary Vasoconstriction by N-Acetylcysteine in Dogs

François Kerbaul, Philippe Van der Linden, Sébastien Pierre, Benoît Rondelet, Christian Melot, Serge Brimioulle, and Robert Naeije

Anesth Analg 2004 99: 547-551

 

病人自控芬太尼鎮痛用於燒傷換藥

葛甯花譯 薛張綱校

Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Smita Prakash, Tazeen Fatima, and Mridula Pawar

Anesth Analg 2004 99: 552-555.  

 

蛋白激酶CATP敏感性鉀通道激動劑對抗大鼠內皮細胞和血管平滑肌細胞炎症反應的保護作用:離體和在體研究

軒泓      李士通 

The Protective Effect of Protein Kinase C and Adenosine Triphosphate-Sensitive Potassium Channel Agonists Against Inflammation in Rat Endothelium and Vascular Smooth Muscle In Vitro and In Vivo

Roman V. Plachinta, Manuela J. M. de Klaver, John K. Hayes, and George F. Rich

NEUROSURGICAL ANESTHESIA:

異丙酚鎮靜對顱內占位患者顱內壓的影響

朱玫娟 譯 陳傑 校

The Effect of Propofol Sedation on the Intracranial Pressure of Patients with an Intracranial Space-Occupying Lesion

François Girard, Robert Moumdjian, Daniel Boudreault, Philippe Chouinard, Alain Bouthilier, Éric Sauvageau, Monique Ruel, and Dominique C. Girard Anesth Analg 2004 99: 573-577.

REGIONAL ANESTHESIA:

神經刺激器輔助誘發的運動反應能預計單次阻滯坐骨神經的潛伏期和成功率

葛甯花譯 薛張綱校

Nerve Stimulator-Assisted Evoked Motor Response Predicts the Latency and Success of a Single-Injection Sciatic Block

Radha Sukhani, Antoun Nader, Kenneth D. Candido, Robert Doty, Jr., Honorio T. Benzon, Edward Yaghmour, Mark Kendall, and Robert McCarthy Anesth Analg 2004 99: 584-588

 

肩關節腔鏡術後三種鎮痛方法之比較:關節腔內鎮痛,肩胛上神經阻滯和肌間溝臂叢神經阻滯

張俊傑      李士通 

Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block

François J. Singelyn, Laurence Lhotel, and Bertrand Fabre

Anesth Analg 2004 99: 589-592

GENERAL ARTICLES:

圍術期血糖控制的一種簡單的葡萄糖胰島素療法:Vellore療法

朱玫娟 譯 陳傑 校

A Simple Glucose Insulin Regimen for Perioperative Blood Glucose Control: The Vellore Regimen

Ann Miriam and Grace Korula

Anesth Analg 2004 99: 598-602.

 

判斷甲狀腺手術困難氣道插管

葛甯花譯 薛張綱校

Prediction of Difficult Tracheal Intubation in Thyroid Surgery

Abderrahmane Bouaggad, Sif Eddine Nejmi, Moulay Ahmed Bouderka, and Omar Abbassi

Anesth Analg 2004 99: 603-606.

 

 

相同藥理作用下硫噴妥鈉和異丙酚作用於大腦的不同部位

Thiopental and Propofol Affect Different Regions of the Brain at Similar Pharmacologic Effects

Robert A. Veselis, MD*,{ddagger}, Vladimir A. Feshchenko, PhD*, Ruth A. Reinsel, PhD*, Ann M. Dnistrian, PhD§, Bradley Beattie, BS||, and Timothy J. Akhurst, MBBS FRACP{dagger},{ddagger}

Departments of *Anesthesiology and Critical Care Medicine, {dagger}Radiology, Nuclear Medicine Service, §Clinical Laboratories, Clinical Chemistry Service, and ||Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York; and {ddagger}Weill Medical College of Cornell University, New York, New York

Anesth Analg 2004;99:399-408

 

異丙酚的遺忘作用比硫噴妥鈉強。在這一研究中,我們探討在相同強度的藥物作用下,異丙酚和硫噴妥鈉是否作用於大腦的不同部位。用15O標記液體,採用SPM99 方法分析通過正電子發射成像獲得的大腦局部血流變化圖像。十位右利手的志願者(年齡35 ± 10 歲,體重74.1 ± 7.5 kg)隨機分為硫噴妥鈉組(n = 4)或異丙酚組 (n = 6)。用BIS監測達到鎮靜和催眠的目標濃度。在清醒、鎮靜和睡眠狀態下,得到4個正電子發射成像圖。異丙酚組的2個志願者對鎮靜劑量無反應,因而不包括在最後的分析中。異丙酚鎮靜和催眠的血漿平均濃度分別是1.2µg/mL2.7µg/mL,而硫噴妥鈉則是4.8µg/mL10.6µg/mL。在兩組中BIS隨劑量下降。腦血流量變化的波形兩組明顯不同,異丙酚主要降低大腦前端的血流量(鎮靜時,在大腦的右側),而硫噴妥鈉主要降低小腦和大腦後端的血流量。在相同強度的藥物作用下,異丙酚和硫噴妥鈉作用於大腦的不同部位。這種不同,有助於解釋異丙酚非鎮靜如遺忘作用時的部位。

(葛甯花譯 薛張綱校)

Propofol has a greater amnesic effect than thiopental. In this study we tested whether different brain regions were affected by propofol and thiopental at similar drug effects. Changes in regional cerebral blood flow (rCBF) were identified by using SPM99 analysis of images obtained with positron emission tomography with 15O water. Ten right-handed male volunteers (age, 35 ± 10 yr; weight, 74.1 ± 7.5 kg; mean ± SD) were randomized to receive thiopental (n = 4) or propofol (n = 6) to target sedative and hypnotic concentrations with bispectral index (BIS) monitoring. Four positron emission tomography images  were obtained during various tasks at baseline and with sedative and hypnotic effects. Two participants receiving propofol were unresponsive at sedative concentrations and were not included in the final analyses. Median serum concentrations were 1.2 and 2.7 µg/mL for sedative and hypnotic propofol effects, respectively. Similarly, thiopental concentrations were 4.8 and 10.6 µg/mL. BIS decreased similarly in both groups. The pattern of rCBF change was markedly different for propofol and thiopental. Propofol decreased rCBF in the anterior (right-sided during sedation) brain regions, whereas thiopental decreased rCBF primarily in the cerebellar and posterior brain regions. At similar levels of drug effect, propofol and thiopental affect different regions of the brain. These differences may help to identify the loci of action for the nonsedative effects of propofol, such as amnesia.

 

七氟醚促進人離體網膜動脈和靜脈內皮細胞依賴的平滑肌鬆弛

Sevoflurane Promotes Endothelium-Dependent Smooth Muscle Relaxation in Isolated Human Omental Arteries and Veins

Karin Thorlacius, MD PhD, and Mikael Bodelsson, MD PhD

Department of Anesthesia and Intensive Care, Lund University Hospital, Sweden

Anesth Analg 2004;99:423-428

 

七氟醚麻醉伴有血管擴張。這主要由於七氟醚有內皮細胞依賴的平滑肌鬆弛作用。我們監測當吸入七氟醚不同濃度時(0%, 1%, 2%,4%),人離體網膜動脈和靜脈對P 物質或三硝酸甘油反應時的肌張力。用酶聯免疫吸附劑測量血管水平的鳥嘌呤35-環一磷酸。P物質引起內皮細胞和濃度依賴的網膜血管鬆弛作用不受七氟醚的影響。如合用L-N-硝基精氨酸甲基酯(氧化氮合成酶抑制劑),或合用氯化鉀(防止過極化),或兩者同時合用時,4%的七氟醚能增強動脈的鬆弛(P < 0.05)。在合用氯化鉀時,4%的七氟醚能增強靜脈的鬆弛作用,而同時合用L-N-硝基精氨酸甲基酯和氯化鉀時,2%4%的七氟醚均能增加靜脈的鬆弛作用(P < 0.05)4%的七氟醚能增強動脈和靜脈由三硝酸甘油誘導的內皮細胞非依賴的鬆弛作用(P < 0.05)。無論是否使用七氟醚,P物質能增加鳥嘌呤35-環一磷酸含量。這些結果顯示,七氟醚與它在動物體內的作用不同,通過增加平滑肌細胞對第二鬆弛信使的反應,能促進人體網膜動脈和靜脈的內皮細胞依賴的鬆弛作用。

(葛甯花譯 薛張綱校)

Anesthesia with sevoflurane is accompanied by vasodilatation. This could be due to the effects of sevoflurane on endothelium-dependent relaxation. We measured muscle tension of isolated human omental arteries and veins in response to substance P or glyceryl trinitrate in the presence of sevoflurane (0%, 1%, 2%, or 4%). Vascular levels of guanosine 3', 5'-cyclic monophosphate were measured with enzyme-linked immunosorbent assay. Substance P induced an endothelium- and concentration-dependent relaxation in omental vessels that was not affected by sevoflurane. In the presence of L-NG-nitroarginine methyl ester (nitric oxide synthase inhibitor), KCl (prevention of hyperpolarization), or both, sevoflurane at 4% enhanced the relaxation in the arteries (P < 0.05). In the vein segments, the relaxation was enhanced by sevoflurane at 4% in the presence of KCl and 2% and 4% in the presence of both L-NG-nitroarginine methyl ester and KCl (P < 0.05). The glyceryl trinitrate-induced endothelium-independent relaxation was enhanced by sevoflurane at 4% in both artery and vein segments (P < 0.05). Substance P increased the levels of guanosine 3', 5'-cyclic monophosphate similarly in the presence and absence of sevoflurane. These results show that sevoflurane, in contrast to its effect in animal models, promotes endothelium-dependent relaxation in human omental arteries and veins via an enhancement of the smooth muscle response to relaxing second messengers.

 

神經刺激器輔助誘發的運動反應能預計單次阻滯坐骨神經的潛伏期和成功率

Nerve Stimulator-Assisted Evoked Motor Response Predicts the Latency and Success of a Single-Injection Sciatic Block

Radha Sukhani, MD, Antoun Nader, MD, Kenneth D. Candido, MD, Robert Doty, Jr., MD, Honorio T. Benzon, MD, Edward Yaghmour, MD, Mark Kendall, MD, and Robert McCarthy, PharmD

Department of Anesthesiology, Northwestern University/Feinberg School of Medicine, Chicago, IL

Anesth Analg 2004;99:584-588
 

單次阻滯坐骨神經的起效時間各有差異,主要由於藥物未能足夠地積聚在所有神經纖維的周圍。假設這種差異是因為相對於神經組織的針尖位置所致,而後者能客觀地在注射局麻藥之前通過誘發運動反應(EMR)而決定。100ASA I–II行踝關節矯形術患者,在臀下和股二頭肌周圍阻滯坐骨神經,局麻藥為0.625%的左旋布比卡因,0.4 mL/kg(最大劑量35 mL)。最終注射點為最初出現EMR的點:刺激頻率為0.2-0.4 mA,內翻(I,蹠屈(PF),背曲(DF),或外翻(E)。出現不同EMR的頻率為:I 40%PF 43%, E 14%, DF 3%。如脛前神經和腓總神經均被阻滯,則認為坐骨神經阻滯完全;如觀察30分鐘或麻醉後60分鐘,仍然對針刺有痛覺,則坐骨神經阻滯失敗。出現IEMR至完全阻滯的平均時間(±95% 可信區間,CI)為8.5 min95% CI, 6.2–10.8 min),比出現PFEMR至完全阻滯的平均時間 27 min 95% CI, 20.6–33.4) 出現EEMR至完全阻滯的平均時間 30.4 min95% CI, 24.9–35.8 min)都快(P < 0.001)。在I組,不需要額外的阻滯,而在PEE組分別有24%71%需要。結論:在單次注射阻滯坐骨神經時,神經刺激器誘發的各類EMR,能預計神經完全阻滯的潛伏期和成功率。因為觀察到的各類EMR與注射針尖和脛前、腓總神經相關位置有關。

(葛甯花譯 薛張綱校)

Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I–II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.4 mL/kg (maximum 35 mL) of levobupivacaine 0.625%. The end-point for injection was the first elicited EMR: inversion (I), plantar flexion (PF), dorsiflexion (DF), or eversion (E) at 0.2–0.4 mA. The frequencies of the EMRs were: I 40%, PF 43%, E 14%, and DF 3%. SNB was considered complete if both tibial and common peroneal nerves were blocked and failed if either analgesia to pinprick was not observed at 30 min or anesthesia at 60 min. Patients with an EMR of I demonstrated shorter mean times (±95% confidence interval [CI]) to complete the block with 8.5 (95% CI, 6.2–10.8) min compared to 27.0 (95% CI, 20.6–33.4) min after PF (P < 0.001) and 30.4 (95% CI, 24.9–35.8) min after E (P < 0.001). No rescue blocks were required in group I compared with 24% (P = 0.001) and 71% (P < 0.001) of patients in groups PF and E, respectively. We conclude that EMR type during nerve stimulator-assisted single-injection SNB predicts latency and success of complete SNB because the observed EMR is related to the positioning of the needle tip relative to the tibial and common peroneal nerves.

 

氯胺酮用作阿片類藥物的輔助鎮痛劑:定量和定性的系統總結

Ketamine as Adjuvant Analgesic to Opioids: A Quantitative and Qualitative Systematic Review

Kathirvel Subramaniam, MD, Balachundhar Subramaniam, MD, and Richard A. Steinbrook, MD

From the Department of Anesthesiology, Critical Care & Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Anesth Analg 2004;99:482-495

 

氯胺酮和阿片類藥物的動物耐藥性研究結果喜人。但臨床系列研究與之矛盾。我們將氯胺酮和阿片類鎮痛藥物合用,進行隨機、雙盲的系統研究,包含51支研究隊、2385名患者參加的37個系列。研究分為5大組:單次氯胺酮靜脈注射組(n = 11),連續注射組(n = 11),患者自控鎮痛組(PCA) (n = 6),硬膜外氯胺酮和阿片類藥物合用組(n = 8),兒童中的研究(n = 4).觀察指標包括:疼痛評分,第一次需要鎮痛的時間,補充的鎮痛劑和副作用。觀察指標的統計學分析,評估鎮痛的療效,並且統計術後24小時鎮痛效果是否有顯著性的差異。與單獨使用嗎啡組比較,靜脈PCA 聯合使用氯胺酮和嗎啡並不能增加鎮痛的效果。在11系列的研究中,有6組研究顯示,靜脈連續輸注氯胺酮能減少靜脈和硬膜外嗎啡的需要量,7組研究顯示氯胺酮單次負荷量,能減少嗎啡的需要量。在8個系列的研究中,有5組研究顯示硬膜外注射氯胺酮有效。小劑量的氯胺酮不增加副作用。結論是用作標準阿片類鎮痛的輔助劑,小劑量的氯胺酮是安全的和有效的。

(葛甯花譯 薛張綱校)

Animal studies on ketamine and opioid tolerance have shown promising results. Clinical trials have been contradictory. We performed a systematic review of randomized, double-blind clinical trials of ketamine added to opioid analgesia. Thirty-seven trials with 51 treatment arms and 2385 patients were included. Studies were divided into 5 subgroups: IV ketamine as single dose (n = 11), continuous infusion (n = 11), patient-controlled analgesia (PCA) (n = 6), epidural ketamine with opioids (n = 8), and studies in children (n = 4). Outcome measures included pain scores, time to first request for analgesia, supplemental analgesics, and adverse events. Efficacy was estimated by statistical significance (P < 0.05) of outcome measures as reported in studies and also by calculation of weighted mean difference for pain scores during the first 24 h after surgery. As compared to morphine alone, IV PCA with ketamine and morphine did not improve analgesia. Intravenous infusion of ketamine decreased IV and epidural opioid requirements in 6 of 11 studies. A single bolus dose of ketamine decreased opioid requirements in 7 of 11 studies. Five of 8 trials with epidural ketamine showed beneficial effects. Adverse effects were not increased with small dose ketamine. We conclude that small dose ketamine is a safe and useful adjuvant to standard practice opioid-analgesia.

 

呼氣末二氧化碳監測能準確發現監護麻醉時無呼吸

Capnography Accurately Detects Apnea During Monitored Anesthesia Care

Roy G. Soto, MD*, Eugene S. Fu, MD*, Hector Vila, Jr., MD{dagger}, and Rafael V. Miguel, MD*

*Department of Anesthesiology and {dagger}Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida

Anesth Analg 2004;99:379-382

 

無呼吸和呼吸道梗阻是監護麻醉(MAC)時的常見現象。早期發現很重要,我們在MAC 時,通過比較不同的氧流量和胸阻抗,評估二氧化碳監測作為無呼吸

指標的可靠性。麻醉監護操作者採用標準美國麻醉醫生學會的監護方式,不知曉是否使用二氧化碳和胸阻抗監測。39位患者中有10位(26%),持續出現無呼吸20秒,無一例由麻醉操作者發現,均由二氧化碳和胸阻抗監測發現。兩種方法發現無呼吸的敏感率無差異。高氧流量降低二氧化碳波形的幅度,但並不影響無呼吸的發現率。這小樣本試驗顯示在MAC 麻醉時,每4個患者就有一個出現持續20秒的無呼吸。儘管麻醉操作者未能發現這些異常,但二氧化碳和呼吸體積描記儀能可靠地發現。因此鼻腔呼氣末CO2監測是提高MAC 麻醉安全性的重要途徑。

(葛甯花譯 薛張綱校)

Apnea and airway obstruction are common during monitored anesthesia care (MAC). Because their early detection is essential, we sought to measure the efficacy of capnography as an indicator of apnea during MAC at a variety of oxygen flow rates compared with thoracic impedance. Anesthesia care providers using standard American Society of Anesthesiologists monitors were blinded to capnography and thoracic impedance monitoring. Ten (26%) of the 39 patients studied developed 20 s of apnea; none was detected by the anesthesia provider, but all were detected by capnography and impedance monitoring. There was no difference in detection rates between the two methods. Higher oxygen flow rates decreased the amplitude of the capnograph but did not interfere with apnea detection. This pilot study revealed that apnea of at least 20 s in duration may occur in every fourth patient undergoing MAC. Although these episodes were undetected by the anesthesia provider, they were reliably detected by both capnography and respiratory plethysmography. Monitoring of nasal end-tidal CO2 is an important way to improve safety in patients undergoing MAC.


病人自控芬太尼鎮痛用於燒傷換藥

Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes

Smita Prakash, MD, Tazeen Fatima, MD, and Mridula Pawar, MD

Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India

Anesth Analg 2004;99:552-555

 

60ASA I II級、燒傷面積 20%的成年患者中進行隨機、雙盲研究,研究病人自控芬太尼鎮痛在燒傷換藥中應用的可行性,並決定其最佳芬太尼的劑量。最初的負荷劑量是靜脈注射芬太尼1 µg/kg。當視覺類比評分(VAS)〉2時,患者按組注入芬太尼(10, 20, 30, 40 µg)1020µg組的VAS平均值(分別為7.73 ± 1.33 7.20 ± 1.21 )顯著高於3040µg組的VAS平均值(分別為4.47 ± 0.833.90 ± 0.63) (所有的 P = 0.000)1020µg組的按壓次數/實際有效次數(分別為3.03 ± 1.06 2.54 ± 0.49)顯著大於3040µg組的按壓次數/實際有效次數(分別為1.36 ± 0.34 1.37 ± 0.36) (所有的 P = 0.000)3040µg組的VAS評分和按壓次數/實際有效次數均相似(P 分別為  0.260 0.977),意味著鎮痛效果相似。無循環系統不穩定和呼吸抑制。PCA芬太尼鎮痛的適宜劑量為30µg5 分鐘的鎖定時間),最初負荷劑量為1 µg/kg

(葛甯花譯 薛張綱校)

In this randomized, double-blinded study in 60 ASA I or II adults with >20% body-surface area thermal burns, we investigated the feasibility of patient-controlled analgesia (PCA) with fentanyl for pain management during dressing changes and determined the optimal PCA-fentanyl demand dose. An initial loading dose of IV fentanyl 1 µg/kg was administered. Patients received on-demand analgesia with fentanyl (10, 20, 30, and 40 µg) whenever their visual analog scale (VAS) score was >2. Mean VAS scores in the 10 and 20 µg groups (7.73 ± 1.33 and 7.20 ± 1.21, respectively) were significantly higher than those in the 30 and 40 µg groups (4.47 ± 0.83 and 3.90 ± 0.63, respectively) (all P = 0.000). Demand/delivery ratios were significantly larger in the 10 and 20 µg groups (3.03 ± 1.06 and 2.54 ± 0.49, respectively) than those in the 30 and 40 µg groups (1.36 ± 0.34 and 1.37 ± 0.36, respectively) (all P = 0.000). VAS scores and demand/delivery ratios were comparable in the 30 and 40 µg groups (P = 0.260 and P = 0.977, respectively), which suggests comparable analgesic efficacy. There was no hemodynamic instability or respiratory depression. The optimal demand dose of PCA-fentanyl was 30 µg (5-min lockout interval) after an initial loading dose of IV fentanyl 1 µg/kg.


原位肝移植手術中腦局部氧飽和度是腦低灌注的敏感指標

Regional Cerebral Oxygen Saturation Is a Sensitive Marker of Cerebral Hypoperfusion During Orthotopic Liver Transplantation

Jens Plachky, MD*, Stefan Hofer, MD*, Martin Volkmann, MD{dagger}, Eike Martin, MD*, Hubert J. Bardenheuer, MD*, and Markus A. Weigand, MD DEAA*

*Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany; and {dagger}Central Laboratory, Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany

Anesth Analg 2004;99:344-349

 

原位肝移植手術後,中樞神經系統的併發症是發病率和死亡率的重要因素。引起術後神經系統併發症的原因之一是手術過程中的腦缺血。在這研究中,我們探討術中局部腦氧飽和度(rSO2)的變化與術後神經元-特殊磷酸丙酮酸水合酶(NSE)和S-100的關係,後二者是缺氧/缺血引起腦異常的特殊指標。在16位原位肝移植手術的患者,以接近紅外線的光譜,連續監測rSO2。此外,在手術前和供肝再灌注後24小時,測定動脈血的NSES-100。有趣的是,有8位患者在切除受體病肝時,rSO2出現了顯著降低,其餘患者則能耐受,而rSO2沒有大的變化。這種在切除病肝後,rSO2的降低與術後NSE(r2 = 0.57)S-100 (r2 = 0.52)增加有顯著的相關性。但是,比較rSO2降低和rSO2正常的兩組患者,迴圈變化無顯著性差異。{Delta}rSO2 和心排血量(r2 = 0.20)之間、NSE和心排血量(r2 = 0.37)之間,或S-100 和心排血量 (r2 = 0.24)之間無顯著性相關性。在原位肝移植手術中,rSO2是無創監測手段,對估計神經系統的異常可能有效。
(葛甯花譯 薛張綱校)

Neurological complications contribute significantly to morbidity and mortality of patients after orthotopic liver transplantation (OLT). One possible cause of postoperative neurological complications is cerebral ischemia during the surgical procedure. In this study, we investigated the relationship between intraoperative changes in regional cerebral oxygen saturation (rSO2) and postoperative values of neuron-specific enolase (NSE) and S-100, which are specific variables that indicate cerebral disturbances due to hypoxia/ischemia. The rSO2 was monitored continuously by near-infrared spectroscopy in 16 patients undergoing OLT. In addition, NSE and S-100 were determined in arterial blood before surgery and 24 h after reperfusion of the donor liver. Interestingly, clamping of the recipient’s liver led to a significant decline in rSO2 in eight patients, whereas the others tolerated clamping without major changes in rSO2. The decrease in rSO2 after clamping correlated significantly with postoperative increases in NSE (r2 = 0.57) and S-100 (r2 = 0.52). However, there were no significant differences between patients with and without rSO2 decline concerning hemodynamic variables. There were no significant correlations between {Delta}rSO2 and cardiac output (r2 = 0.20), NSE and cardiac output (r2 = 0.37), or S-100 and cardiac output (r2 = 0.24). Monitoring of rSO2 may be a useful noninvasive tool to estimate disturbances in rSO2 during OLT.


Ic 類抗心律失常藥對鼠感覺神經元中抗河豚毒素Na+電流的作用

The Effects of Class Ic Antiarrhythmics on Tetrodotoxin-Resistant Na+ Currents in Rat Sensory Neurons

Yoko Osawa, MD, Akiyoshi Oda, MD, Hiroki Iida, MD, Shigeaki Tanahashi, MD, and Shuji Dohi, MD

Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Japan

Anesth Analg 2004;99:464-471


有報導靜脈或口服抗心律失常藥對緩解神經元性疼痛有效。最近研究認為抗河豚毒素(TTX-R) Na+通道在神經傳導傷害性衝動時起重要作用。本實驗中,我們用完整細胞膜片鉗的方法,研究在鼠背側節神經元中,氟卡尼、pilsicainideIc 類抗心律失常藥)和利多卡因(Ib 類藥)對TTX-R Na+電流的影響。氟卡尼、pilsicainide和利多卡因能可逆性阻斷TTX-R Na+電流的峰值,呈濃度依賴性。阻斷峰值一半時,三組的濃度分別為8.5 ± 6.6 µM (n = 7), 78 ± 6.9 µM (n = 7), 73 ± 6.8 µM (n = 7)。每個藥物使TTX-R Na+電流的失活曲線向超極化移動,並產生實用依賴性的阻滯。我們同樣研究這些作用於TTX-R Na+通道的抗心律失常藥物之間的相互作用。利多卡因與氟卡尼或pilsicainide 合用,導致阻滯強度增加和實用依賴性的阻滯。這些結果顯示,抗心律失常藥阻滯背側節神經元TTX-R Na+ 電流是因為或至少部分原因是它們阻滯神經傳導傷害性衝動。

(葛甯花譯 薛張綱校)

IV or oral administration of antiarrhythmics has been reported to be effective for relieving neuropathic pain. Recent reports have indicated that tetrodotoxin-resistant (TTX-R) Na+ channels play important roles in the nerve conduction of nociceptive sensation. In the present study, we investigated the effects of flecainide, pilsicainide (class Ic antiarrhythmics), and lidocaine (a class Ib drug) on TTX-R Na+ currents in rat dorsal root ganglion neurons using the whole-cell patch-clamp method. Flecainide, pilsicainide, and lidocaine reversibly blocked the peak amplitude of TTX-R Na+ currents in a concentration-dependent manner with half-maximum inhibitory concentration values of 8.5 ± 6.6 µM (n = 7), 78 ± 6.9 µM (n = 7), and 73 ± 6.8 µM (n = 7), respectively. Each drug shifted the inactivation curve for the TTX-R Na+ currents in the hyperpolarizing direction and caused a use-dependent block. We also studied an interaction between these antiarrhythmics on TTX-R Na+ channels. Additional application of flecainide or pilsicainide to lidocaine resulted in an additive increase of tonic and use-dependent block. These results suggest that the inhibition of TTX-R Na+ currents of dorsal root ganglion neurons by such antiarrhythmics is attributable, at least partly, to their antinociceptive effects.

 

糖尿病影響頸靜脈氧飽和度對苯腎上腺素的反應性和腦血管二氧化碳反應性之間關係

The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity

Yuji Kadoi, MD*, Shigeru Saito, MD{dagger}, Fumio Goto, MD{dagger}, and Nao Fujita, MD{ddagger}

Departments of *Intensive Care and {dagger}Anesthesiology, Gunma University, Graduate School of Medicine; and {ddagger}Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center and Keiyu Orthopedic Hospital, Japan

Anesth Analg 2004;99:325-331


在這一實驗中,我們研究糖尿病患者在體外迴圈時,腦血管CO2反應性是否與頸靜脈氧飽和度(SjvO2)對苯腎上腺素的反應性有關。40例行冠狀動脈搭橋術的糖尿病患者為研究組,另外40例非糖尿病患者,年齡匹配,同樣行冠狀動脈搭橋術,為對照組。經顱外Doppler連續監測腦血管CO2反應性,重複注射苯腎上腺素以增加平均動脈壓直至基礎值的100%。兩組之間,絕對CO2反應性有顯著性差異(對照組, 2.8 ± 0.7 cm • s–1 • mm Hg–1; 糖尿病組, 2.2 ± 1.1 cm • s–1 • mm Hg–1; P = 0.02)。糖尿病組中,絕對CO2反應值在胰島素依賴患者中比非胰島素依賴患者中低(飲食控制組,3.2 ± 0.7;優降糖組,2.6 ± 0.7,胰島素依賴組,1.0 ± 0.7; P < 0.01)。絕對CO2反應性與SjvO2的平均傾斜度/MAP有關(r = 0.54; P < 0.0001)。結論,SjvO2 對苯腎上腺素反應性和腦血管CO2 反應性之間的關係和腦血管自動調節功能受損一樣,與以往高血糖症有關。

(葛甯花譯 薛張綱校)

In this study, we examined whether cerebrovascular carbon dioxide (CO2) reactivity was related to the response of jugular venous oxygen saturation (SjvO2) to phenylephrine infusion in diabetic patients during cardiopulmonary bypass. Forty diabetic patients scheduled for coronary artery bypass graft surgery were studied, and 40 age-matched nondiabetic cardiopulmonary bypass patients served as controls. Cerebrovascular CO2 reactivity was measured continuously using transcranial Doppler. Mean arterial blood pressure (MAP) was increased by repeated phenylephrine infusion until reaching 100% of baseline values. There was a significant difference in absolute CO2 reactivity between the diabetic and control groups (controls, 2.8 ± 0.7 cm • s–1 • mm Hg–1; diabetics, 2.2 ± 1.1 cm • s–1 • mm Hg–1; P = 0.02). Among the diabetics, absolute CO2 reactivity in insulin-dependent patients was less than that in noninsulin-dependent patients (diet therapy group, 3.2 ± 0.7; glibenclamide group, 2.6 ± 0.7; insulin-dependent group, 1.0 ± 0.7; P < 0.01). There was a correlation between absolute CO2 reactivity and the mean slope of SjvO2 versus MAP for increasing MAP (r = 0.54; P < 0.0001). In conclusion, we found that the interrelationship between SjvO2 responsiveness to phenylephrine infusion and cerebrovascular CO2 reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.


用以血紅蛋白為基礎的氧攜帶液進行深度血液稀釋能增加腦組織的氧張力

Increased Cerebral Tissue Oxygen Tension After Extensive Hemodilution with a Hemoglobin-Based Oxygen Carrier

Gregory M. T. Hare, MD PhD, FRCPC*, Kathryn M. Hum*, Steve Y. Kim*, Aiala Barr, PhD{dagger}, Andrew J. Baker, MD FRCPC*, and C. David Mazer, MD FRCPC*

Departments of *Anesthesia and {dagger}Public Health, University of Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada

Anesth Analg 2004;99:603-606


對貧血患者輸注以血紅蛋白為基礎的氧攜帶液(HBOCs),能提高大腦氧供。但是,輸注HBOCs後,腦血管收縮,能使這一作用受限。我們假設,用HBOCs作血液稀釋,儘管出現大腦血管收縮,仍能維持腦組織的氧供。用異氟醚維持麻醉(吸入100%的氧)。用HBOCs (hemoglobin raffimer; HemolinkTM))或膠體液pentastarch (n = 6)稀釋血液。在血液稀釋之預計血容量的50%前後(30 mL/kg),監測直接動脈平均血壓,末梢組織氧張力(PBrO2)和局部大腦皮層血流量(rCBF)。用以血紅蛋白為基礎的氧攜帶液稀釋組,能使PBrO暫時升高,從24.9 ± 13.3 mm Hg 增加到32.2 ± 19.1 mm Hg (P < 0.05);動脈平均壓持續增加,rCBF無變化。儘管高鐵血紅蛋白增加和氧飽和度降低,但仍能維持動脈氧含量。用膠體液稀釋組,平均動脈壓暫時升高,PBrO2 無變化,rCBF的持續增加(P < 0.05),而血紅蛋白濃度和氧含量顯著降低。同樣程度的血液稀釋,以血紅蛋白為基礎的氧攜帶液組能增加PBrO2和防止rCBF增加。實驗資料提示,在嚴重貧血患者中,輸注以血紅蛋白為基礎的氧攜帶液能維持大腦的氧供。

(葛甯花譯 薛張綱校)

Transfusion of anemic patients with hemoglobin-based oxygen carriers (HBOCs) may improve cerebral oxygen delivery. Conversely, cerebral vasoconstriction, associated with HBOC transfusion, could limit optimal cerebral tissue oxygenation. We hypothesized that hemodilution with a HBOC would maintain cerebral tissue oxygenation, despite the occurrence of cerebral vasoconstriction. Isoflurane-anesthetized rats (100% oxygen) underwent direct measurement of mean arterial blood pressure (MAP), caudate tissue oxygen tension (PBrO2), and regional cortical cerebral blood flow (rCBF) before and after 50% of the estimated blood volume (30 mL/kg) was exchanged with either an HBOC (hemoglobin raffimer; HemolinkTM) or pentastarch (n = 6). Hemodilution with hemoglobin raffimer caused a transient increase in PBrO2 from 24.9 ± 13.3 mm Hg to 32.2 ± 19.1 mm Hg (P < 0.05), a sustained increase in MAP, and no change in rCBF. Arterial blood oxygen content was maintained despite an increase in methemoglobin and reduced oxygen saturation. Hemodilution with pentastarch caused a transient increase in MAP, no change in PBrO2, and a sustained increase in rCBF (P < 0.05), whereas the hemoglobin concentration and oxygen content were significantly reduced. Hemodilution with hemoglobin raffimer augmented PBrO2 and prevented the increase in rCBF observed after similar hemodilution with pentastarch. These data suggest that transfusion with hemoglobin raffimer may help to maintain cerebral oxygenation during severe anemia.

 

判斷甲狀腺手術困難氣道插管

Prediction of Difficult Tracheal Intubation in Thyroid Surgery

Abderrahmane Bouaggad, MD, Sif Eddine Nejmi, MD, Moulay Ahmed Bouderka, MD, and Omar Abbassi, MD

Department of Anesthesiology and Intensive Care, CHU Ibn Rochd Casablanca, Morocco

Anesth Analg 2004;99:603-606


很少報導甲狀腺切除術患者困難氣管內插管的發生率,評價困難氣管內插管因素的研究亦有限。我們為此進行前瞻性的研究,探討當甲狀腺腫大時,困難氣管內插管的發生率和評估與困難氣管內插管有關的因素。連續觀察320位行甲狀腺切除術患者。術前進行困難氣道評估。由麻醉醫生在沒有他人的幫助下進行氣管插管,並且再次評估是否存在插管困難。先進行單因素分析,在有其他預示困難氣道因素存在時,進行多因素分析。有17位患者中出現困難氣管內插管。插管無困難率是36.9%,輕度困難率是57.8%。在單因素分析中,性別(男性)、體重指數、Mallampati 分級、頜下距離、頸部活動度、Cormack 評級,癌性甲狀腺和氣管移位或受壓等預示是否存在潛在的困難氣管內插管。在多因素分析中,二個互不依賴的因素(如Cormack 評級 III IV和癌性甲狀腺腫大)都預示困難氣管內插管。我們的結論:腫大的甲狀腺並不增加困難氣道的發生率。但是,癌性甲狀腺是預示困難氣道的主要因素。

(葛甯花譯 薛張綱校)

The incidence of difficult endotracheal intubation (DEI) for patients undergoing thyroidectomy has rarely been studied, and evaluation of factors linked to DEI is limited to a few studies. We undertook this prospective study to investigate the incidence of DEI in the presence of goiter (an enlargement of the thyroid gland) and to evaluate factors linked to DEI. We studied 320 consecutive patients scheduled for thyroidectomy. DEI was evaluated by an intubation difficulty scale. The trachea was intubated by an unassisted anesthesiologist, and the intubation difficulty scale was calculated. A univariate analysis was performed to identify potential factors predicting DEI, followed by a multivariate analysis. DEI was reported in 17 patients. The rate of easy tracheal intubation was 36.9%; the rate for patients who had minor difficulty of intubation was 57.8%. Sex (male), body mass index, Mallampati class, thyromental distance, neck mobility, Cormack grade, cancerous goiter, and tracheal deviation or compression were identified in the univariate analysis as potential DEI risk factors. With multivariate analysis, two criteria were recognized as independent for DEI (Cormack Grade III or IV and cancerous goiter). We conclude that the large goiter is not associated with a more frequent DEI. However, the presence of a cancerous goiter is a major factor for predicting DEI.




用組織多普勒成象技術觀察負荷改變對收縮期二尖瓣管處流速的影

The Effects of Load on Systolic Mitral Annular Velocity by Tissue Doppler Imaging

Ruggero Amà, MD*, Patrick Segers, PhD*, Carl Roosens, MD{dagger}, Tom Claessens*, Pascal Verdonck, PhD*, and Jan Poelaert, MD PhD{dagger}

*Hydraulics Laboratory, Institute Biomedical Technology; and {dagger}Department of Intensive Care Unit, Ghent University Hospital and International Research Center, Ghent University, Belgium

Anesth Analg 2004;99:332-338

 

組織多普勒成像顯示技術(TDI) 通過測定收縮期二尖瓣環血流速率波型提供了豐富的關於收縮功能的資訊,它反映了心肌纖維縱向收縮功能的收縮速率峰值。在本研究中,我們評估負荷變化對於了收縮期二尖瓣環處血流速率波(Sm)的影響。連續選擇42例左心室射血分數>60%心臟手術病人,24個病人以靜脈推注了新福林或硝酸甘油改變後負荷;18個病人以快速輸注了500ml明膠溶液改變前負荷,組織多普勒成像顯示技術(TDI)通過食道中段心臟四腔室切面超聲進行記錄。結果:以新福林和硝酸甘油改變負荷的病人Sm沒有影響,而以快速輸注了500ml膠體溶液改變容量負荷的病人Sm有明顯增加(從基礎的8.4 ±2.6 cm/s增加到9.6 ±2.5 cm/s; P = 0.001)。我們推測,Sm依賴於容量補充導致的前負荷變化,而並不能反映那些有明顯心室充盈問題的重危病人的心室收縮功能。

(沈浩   李士通  校)

Tissue Doppler Imaging (TDI) provides information on systolic function through its systolic mitral annulus velocity wave (Sm), reflecting the peak velocity of shortening of the myocardial fibers oriented in the longitudinal direction. In this study, we evaluated the effect of load changes on Sm. Forty-two cardiac surgical patients with left ventricular ejection fraction >60% were consecutively evaluated. In 24 patients, load was changed with an IV bolus of phenylephrine (50–100 µg) or nitroglycerine (300–500 µg); in 18 patients, preload was changed with a rapid infusion of 500 mL of a gelatin solution. The sample volume of TDI was placed at the lateral side of the mitral annulus in the mid-esophageal 4-chamber view. Changing loading conditions with phenylephrine or nitroglycerine had no effect on Sm; the increase of preload in 18 patients resulted in a statistically significant increase of Sm (baseline, 8.4 ± 2.6 cm/s; after increase of preload, 9.6 ± 2.5 cm/s; P = 0.001). We conclude that Sm is dependent on changes in preload obtained by volume loading and cannot be recommended as an index of ventricular contractile performance in critically ill patients where significant changes in ventricular filling occur.

 

 

氟烷真的比七氟醚更好保護心臟壓力反射?兒童麻醉中七氟醚和氟烷的自主性壓力反射的無創研究

Does Halothane Really Preserve Cardiac Baroreflex Better Than Sevoflurane? A Noninvasive Study of Spontaneous Baroreflex in Children Anesthetized with Sevoflurane Versus Halothane

Isabelle Constant, MD PhD*, Dominique Laude, BSc{dagger}, Elizabeth Hentzgen, MD*, and Isabelle Murat, MD PhD*

*Service d’Anesthésie Réanimation Pédiatrique, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; and {dagger}Institut National de la Santé et de la Recherche Médicale E0107, Paris, France

Anesth Analg 2004;99:360-369

 

應用七氟醚和氟烷的麻醉誘導過程中心率的變化明顯不同。過去的研究顯示氟烷比七氟醚更多保護心臟的副交感活性。因為迷走神經調節竇房節是動脈壓力反射控制心率的主要效應器,所以氟烷可能比七氟醚更好保護心臟的壓力反射。為了調查兒童麻醉中心臟的壓力反射,我們使用兩種不同途徑的無創方法取得動脈血壓(BP)R-R間期(RRI)的關係:連續調查每搏BP變化和RRI(時域)間的變化和交叉光譜分析調查血壓波動和RRI(頻域)間的關係。兒童被隨機分配,面罩誘導用100%氧加七氟醚,50%氧氣50%笑氣加七氟醚,或者50%氧氣50%笑氣加氟烷。氣管插管以後,揮發性麻醉劑減少到一個MAC(最小肺泡有效濃度)。自主壓力反射(SBR)敏感性由連續記錄基礎值、誘導過程、和插管以後計算。心臟壓力反射也通過交叉光譜分析基礎值和1MAC時(固定情況)來估計。在三組中,麻醉誘導導致SBR敏感度明顯減少,七氟醚發生的比氟烷早。插管後5分鐘(1MAC),連續方法顯示三組中相似的SBR敏感度減少。相同地,交叉光譜分析收縮壓和RRI顯示了低頻帶計算的增益的減少,但是呼吸帶增益氟烷比七氟醚高。在兒童,氟烷和七氟醚麻醉誘導導致心臟壓力反射活性明顯下降。與有效的副交感壓力反射活性相比,氟烷的呼吸RRI波動的持續存在可能更能反映反射性呼吸不規律。

(張曦      李士通  校)

Heart rate profiles during the induction of anesthesia differ markedly between the administration of sevoflurane and halothane. Previous investigations have shown that halothane preserves cardiac parasympathetic activity more than sevoflurane. Because vagal drive to the sinus node is the main effector of arterial baroreflex control of heart rate, halothane may preserve cardiac baroreflex better than sevoflurane. To investigate cardiac baroreflex in anesthetized children, we used two noninvasive methods providing different approaches to the arterial blood pressure (BP) and R-R interval (RRI) relationship: the sequence methods investigating beat-to-beat changes in BP and RRI (time domain) and the cross-spectral analysis investigating relationships between oscillations of BP and RRI (frequency domain). Children were randomly assigned to mask induction with sevoflurane in 100% oxygen, sevoflurane in 50% nitrous oxide/50% oxygen, or halothane in 50% nitrous oxide/50% oxygen. After tracheal intubation, the inspired fraction of volatile anesthetic was reduced to 1 minimum alveolar anesthetic concentration (MAC). The spontaneous baroreflex (SBR) sensitivity was calculated with the sequence method at baseline, during induction, and after intubation. The cardiac baroreflex was also estimated with cross-spectral analysis at baseline and at 1 MAC (stationary conditions). In the three groups, the induction of anesthesia was associated with a marked decrease of SBR sensitivity, which occurred earlier with sevoflurane than with halothane. Five minutes after intubation (1 MAC), the sequence method showed a similar decrease of the SBR sensitivity in the three groups. Similarly, the cross-spectral analysis between systolic blood pressure and RRI showed a decrease of the gain calculated in the low-frequency band, but the gain in the respiratory band was higher with halothane compared with sevoflurane. In children, the induction of anesthesia with halothane and sevoflurane is associated with a marked decrease of cardiac baroreflex activity. The persistence of respiratory RRI fluctuations under halothane might reflect reflex respiratory arrhythmia rather than efficient parasympathetic baroreflex activity.

 

大面積燒傷病人中羅庫溴銨的神經肌肉阻滯藥效學

Neuromuscular Pharmacodynamics of Rocuronium in Patients with Major Burns

TaeHyung Han, MD PhD, FAAFP*, HyeongSeok Kim, MD*, JiYoung Bae, MD*, KwangMin Kim, MD PhD*, and J. A. Jeevendra Martyn, MD FRCA, FCCM{dagger}

*Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University, School of Medicine, Seoul, Korea; and {dagger}Department of Anesthesiology and Critical Care, Harvard Medical School, Massachusetts General Hospital, and Shriners Hospital for Children, Boston, Massachusetts

Anesth Analg 2004;99:386-392

 

羅庫溴銨起效時間短,無升血鉀作用,被認為可用于燒傷病人的麻醉快速誘導。在本研究中,我們評價了大面積燒傷病人中羅庫溴銨的神經肌肉藥效學。收入病人為年齡18-59歲的大面積燒傷成人(n56)和44例非燒傷病人的對照組。用羅庫溴銨3倍(0.9 mg/kg)或4倍(1.2 mg/kg)的95%有效量。麻醉包括異丙酚、芬太尼、笑氣和氧氣。用四個成串刺激的加速度儀監測神經肌肉阻滯。燒傷病人的神經肌肉阻滯95%的起效時間比非燒傷病人長(0.9 mg/kg 115 ± 58 s 68 ± 16 s 1.2 mg/kg 86 ± 20 s 57 ± 11 s )。增大劑量可縮短燒傷病人的起效時間,延長作用持續時間,並改善插管條件。燒傷組兩個劑量的所有恢復指標均比非燒傷組顯著較短。通過增大劑量可部分克服羅庫溴銨神經肌肉作用的耐藥性。在大面積燒傷後,大到1.2 mg/kg的一個劑量可提供良好的氣管插管條件。

(馬皓琳      李士通  校)

Rocuronium, which has a short onset time and is free of hyperkalemic effects, could be considered for rapid-sequence induction of anesthesia in patients with burns. In this study, we assessed the neuromuscular pharmacodynamics of rocuronium in patients with major burns. Adults aged 18–59 yr who had a major burn injury (n = 56) and a control group of 44 nonburned patients were included. Rocuronium was used at 3 times (0.9 mg/kg) or 4 times (1.2 mg/kg) the 95% effective dose. Anesthesia consisted of propofol and fentanyl with nitrous oxide and oxygen. Neuromuscular block was monitored with an acceleromyograph by using train-of-four stimulation. The onset time to 95% neuromuscular block was prolonged in burned compared with nonburned patients (115 ± 58 s versus 68 ± 16 s for 0.9 mg/kg; 86 ± 20 s versus 57 ± 11 s for 1.2 mg/kg). Dose escalation shortened the onset time, prolonged the duration of action, and improved intubating conditions in burned patients. All recovery profiles were significantly shorter in burned versus nonburned groups with both doses. Resistance to the neuromuscular effects of rocuronium was partially overcome by increasing the dose. A dose up to 1.2 mg/kg provides good tracheal intubating conditions after major burns.

 

氟烷和異丙酚調節γ—氨基丁酸A受體單通道電流

Halothane and Propofol Modulation of {gamma}-Aminobutyric AcidA Receptor Single-Channel Currents

Akira Kitamura, MD PhD*,{dagger}, Ryoichi Sato, MD PhD*, William Marszalec, PhD*, Jay Z. Yeh, PhD*, Ryo Ogawa, MD PhD{dagger}, and Toshio Narahashi, DVM PhD*

*Department of Molecular Pharmacology and Biological Chemistry, Northwestern University Medical School, Chicago, Illinois; and {dagger}Department of Anesthesiology, Nippon Medical School, Tokyo, Japan

Anesth Analg 2004;99:409-415

氟烷和異丙酚能增強麻醉機理中最重要系統γ—氨基丁酸(GABA)系統的活性。為確定氟烷和異丙酚是否以相同的機理增強GABA神經元反應,我們在原代培養的大鼠皮質神經元上行單通道膜片鉗實驗。用快和慢時間常數的總和表示每個GABAA受體單通道開放及關閉時間。氟烷和異丙酚均不能改變單通道電導。氟烷通過延長開放時間的緩慢相而增加通道開放概率,而異丙酚通過縮短關閉時間的緩慢相而增加通道開放概率。因此雖然氟烷和異丙酚均能通過增加通道開放概率而增加抑制性遞質作用過程中電遷移,但二者機制不同。

(王立中      李士通  校)

Halothane and propofol enhance the activity of the {gamma}-aminobutyric acid (GABA) system, which is one of the most important systems in the mechanism of anesthesia. To determine whether halothane and propofol enhance GABAergic responses by the same mechanism, we performed single-channel patch-clamp experiments with rat cortical neurons in primary culture. Each of the open-time and closed-time distributions of GABAA receptor single channels was expressed by a sum of fast and slow time constants. Neither halothane nor propofol changed the single-channel conductance. Halothane increased the probability of the channel being open via a prolongation of the slow phase of open time, whereas propofol increased the channel open probability via a shortening of the slow phase of closed time. Thus, although both halothane and propofol augmented the channel open probability, thereby causing an increase in charge transfer during inhibitory transmitter action, they acted by different mechanisms.

 

雷米芬太尼導致的胃排空延遲不受體位的影響

The Delay of Gastric Emptying Induced by Remifentanil Is Not Influenced by Posture

Jakob Walldén, MD*,{dagger}, Sven-Egron Thörn, MD PhD*, and Magnus Wattwil, MD PhD*,{dagger}

*Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; and {dagger}Department of Medicine and Care, Faculty of Health Sciences, Linköping, Sweden

Anesth Analg 2004;99:429-434

體位對胃排空有一定作用。在這項研究中,我們調查了體位是否對阿片類鎮痛藥引起的胃排空延遲有影響。10位健康男性用對乙酰氨基酚方法進行4項胃排空研究。兩項研究中受試者取20°頭高右側臥位或20°頭低左側臥位,給予持續雷米芬太尼輸注(0.2 µg • kg–1 min–1)。另兩項研究(對照),不輸注藥物,受試者取同樣兩種體位。給予雷米芬太尼後,兩種體位時的血清最大對乙酰氨基酚濃度(右側位34 µmol • L–1;左側位16 µmol • L–1)、達到峰濃度時間(94 109 min)以及對乙酰氨基酚濃度時間曲線下面積從060分鐘(962197 min • µmol • L–1)都無顯著差別。在對照組,兩種體位間的最大對乙酰氨基酚濃度(13894 µmol • L–1; P < 0.0001)和血清對乙酰氨基酚濃度時間曲線下面積從060分鐘(5092 3793 min • µmol • L–1; P < 0.0001)有差異,但達到峰濃度時間無明顯差異(25 47 min)。相比於對照組,兩種體位下雷米芬太尼都延遲胃排空。我們得出結論雷米芬太尼延遲胃排空,但這種作用不受體位影響。

(吳儉      李士通  校)

Posture has an effect on gastric emptying. In this study, we investigated whether posture influences the delay in gastric emptying induced by opioid analgesics. Ten healthy male subjects underwent 4 gastric emptying studies with the acetaminophen method. On two occasions the subjects were given a continuous infusion of remifentanil (0.2 µg • kg–1 min–1) while lying either on the right lateral side in a 20° head-up position or on the left lateral side in a 20° head-down position. On two other occasions no infusion was given, and the subjects were studied lying in the two positions. When remifentanil was given, there were no significant differences between the two postures in maximal acetaminophen concentration (right side, 34 µmol • L–1; versus left side, 16 µmol • L–1), time taken to reach the maximal concentration (94 versus 109 min), or area under the serum acetaminophen concentration time curve from 0 to 60 min (962 versus 197 min • µmol • L–1). In the control situation, there were differences between the postures in maximal acetaminophen concentration (138 versus 94 µmol • L–1; P < 0.0001) and area under the serum acetaminophen concentration time curves from 0 to 60 min (5092 versus 3793 min • µmol • L–1; P < 0.0001), but there was no significant difference in time taken to reach the maximal concentration (25 versus 47 min). Compared with the control situation, remifentanil delayed gastric emptying in both postures. We conclude that remifentanil delays gastric emptying and that this delay is not influenced by posture.

 

 

術後或麻醉後呼出氣中CO濃度增加

Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia

Masao Hayashi, MD*, Toru Takahashi, MD{dagger}, Hiroshi Morimatsu, MD{dagger}, Hiromi Fujii, MD{dagger}, Naoyuki Taga, MD{dagger}, Satoshi Mizobuchi, MD{dagger}, Masaki Matsumi, MD{dagger}, Hiroshi Katayama, MD{dagger}, Masataka Yokoyama, MD{dagger}, Masahiro Taniguchi, MD*, and Kiyoshi Morita, MD{dagger}

*Department of Anesthesiology, National Okayama Medical Center, Tamasu, Okayama, Japan; and {dagger}Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama, Japan

Anesth Analg 2004;99:444-448

 

血紅素加氧酶-1 (HO-1)是氧化應激中產生的,被認為有對抗組織氧化損傷的保護作用。HO-1催化亞鐵血紅素蛋白的亞鐵血紅素部分如血色素、肌球素及細胞色素P450轉化為膽綠素,在此過程中釋放一氧化碳(CO)。CO和血色素起反應生成碳氧血紅蛋白。本研究為探索麻醉和/或手術對於內源性CO生成的影響,測量在全麻或椎管內麻醉下手術患者的呼出CO量和動脈碳氧血紅蛋白濃度。結果發現,不管哪種麻醉,患者術後一日CO和碳氧血紅蛋白濃度都明顯比術前 (P < 0.05) 和恢復室(P < 0.05)中升高。全麻和椎管內麻醉並無明顯不同。這些結果顯示麻醉和/或手術引起的氧化應激會產生HO-1,促使亞鐵血紅素產生CO,增加呼出CO濃度。

(朱       李士通  校)

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin. In this study, to examine the effect of anesthesia and/or surgery on endogenous CO production, we measured the amount of exhaled CO and the arterial carboxyhemoglobin concentration of patients who underwent surgery under general or spinal anesthesia. Both CO and carboxyhemoglobin concentrations were significantly larger on the day after surgery than during the preoperative period (P < 0.05) and in the recovery room (P < 0.05), regardless of anesthesia. However, neither index differed between general and spinal anesthesia. These results suggest that oxidative stress caused by anesthesia and/or surgery may induce HO-1, which catalyzes heme to produce CO, leading to increased exhaled CO concentration.

 

 

椎間盤內纖維環熱成形術治療多節段椎間盤退行性病變所致的腰椎間盤源性疼痛

Intradiscal Thermal Annuloplasty for the Treatment of Lumbar Discogenic Pain in Patients with Multilevel Degenerative Disc Disease

Leonardo Kapural, MD PhD, Nagy Mekhail, MD PhD, Zdenko Korunda, MD, and Ayman Basali, MD MSci

Pain Management Department, The Cleveland Clinic Foundation, Ohio

Anesth Analg 2004;99:472-476

有症狀的椎間盤退行性病變(DDD)可顯著降低生活質量並導致功能障礙。椎間盤內纖維環熱成形術(IDTA)是一種治療疼痛性椎間盤退行性病變的微創療法。假設多節段DDD病人在IDTA術後疼痛評分和疼痛致殘指數(PDI)可能有所改善。本研究選擇的病例年齡在24-66歲之間,性別不限,將多節段DDDMDDD)與12節段DDD1,2DDD)病人進行配對研究。術後12個月內觀察記錄視覺類比疼痛評分(VAS) PDI1,2DDD病人組椎間盤內纖維環熱成形術後12個月的VAS評分為2.5 ± 2.4,較術前評分7.7 ± 2有所改善。MDDD組病人術後12個月VAS評分為4.9 ± 2.9較術前評分7.4 ± 1.8也有所改善。術後PDI也有類似的改善。1,2DDD組其疼痛緩解和PDI改善顯著優於MDDD組(P分別為0.00370.041)。可以推斷:IDTA是一種治療椎間盤源性疼痛的有效療法,且退行性病變所累及的椎間盤數目是IDTA療效的一個重要決定因數。

(周雅春   李士通 校)

Symptomatic degenerative disc disease (DDD) may lead to significant deterioration of quality of life and increased disability. Intradiscal thermal annuloplasty (IDTA) is a minimally invasive treatment for painful DDD. We hypothesized that there may be an improvement in pain scores and the pain disability index (PDI) of patients who have multilevel DDD after IDTA. Patients 24–66 yr old, male and female with multilevel DDD (MDDD) and matched 1 or 2 level DDD (1,2-DDD) patients were enrolled in the study. Visual analog pain scale (VAS) score and PDI were observed for 12 mo. The 1,2-DDD patient group had a 2.5 ± 2.4 VAS score at 12 mo after annuloplasty compared to 7.7 ± 2 before the procedure. The MDDD VAS score was 4.9 ± 2.9 at 12 mo compared to 7.4 ± 1.8 before the procedure. Similar improvements in PDI were found. The pain relief and PDI were significantly better in patients with 1,2-DDD than in the MDDD group (P = 0.0037 and P = 0.041, respectively). We concluded that IDTA is an effective treatment of discogenic pain and that the number of discs affected by degeneration is an important determinant of the procedure outcome.

 

 

局麻藥行腰部節段性神經阻滯的疼痛緩解和運動功能:一項利多卡因和羅呱卡因之間的前瞻性雙盲對比研究

Lumbar Segmental Nerve Blocks with Local Anesthetics, Pain Relief, and Motor Function: A Prospective Double-Blind Study Between Lidocaine and Ropivacaine

André P. Wolff, MD*,{dagger},{ddagger}, Oliver H. G. Wilder Smith, MD PhD{dagger}, Ben J. P. Crul, MD PhD{dagger}, Marc P. van de Heijden{dagger}, and Gerbrand J. Groen, MD PhD{ddagger}

*Pain Centre, Department of Anaesthesiology, Bernhoven Hospital, Oss, The Netherlands; {dagger}Pain Centre, Institute for Anaesthesiology, University Hospital Nijmegen, Nijmegen, The Netherlands; and {ddagger}Division of Perioperative Medicine, Anaesthesiology and Pain Treatment, University Medical Centre Utrecht, Utrecht, The Netherlands

Anesth Analg 2004;99:496-501

 

局麻藥行選擇性節段性神經阻滯被用於判斷慢性背痛病人的疼痛節段。我們進行本項研究試圖去明確使用利多卡因和羅呱卡因行L4脊神經阻滯後的肌肉運動減退效應及其與疼痛之間的關係。因此,20例有腰骶部神經根痛而無神經功能缺損的病人接受了利多卡因和羅呱卡因的L4段神經阻滯,其中19例完成了整個試驗。分別在疼痛側和對照側對疼痛強度評分(視覺數位評定量表;VNRS)和脛骨前肌和股四頭肌的最大主動肌力(MVMF;使用牛頓來表示的測力計)進行評估。VNRS中位數下降了4.0P < 0.00001Wilcoxon符號等級檢驗),但在羅呱卡因和利多卡因之間無顯著性差異(Mann-Whitney U-檢驗)。患側和對照側在MVME上有差異(P = 0.016Tukey檢驗)。多元回歸分析顯示VNRS評分變化和MVMF中位數變化之間呈顯著負相關(Spearman R = ?C0.48P = 0.00001)。本研究證實在單側下腰痛伴大腿放射的患者中,局麻藥行節段性(L4)神經阻滯所致的疼痛減輕與股四頭肌及脛骨前肌MVMF的增加相關,而利多卡因和羅呱卡因之間無差異。

(黃施偉     李士通 校)

Selective segmental nerve blocks with local anesthetics are applied for diagnostic purposes in patients with chronic back pain to determine the segmental level of the pain. We performed this study to establish myotomal motor effects after L4 spinal nerve blocks by lidocaine and ropivacaine and to evaluate the relationship with pain. Therefore, 20 patients, of which 19 finished the complete protocol, with chronic lumbosacral radicular pain without neurological deficits underwent segmental nerve blocks at L4 with both lidocaine and ropivacaine. Pain intensity scores (verbal numeric rating scale; VNRS) and the maximum voluntary muscle force (MVMF; using a dynamometer expressed in newtons) of the tibialis anterior and quadriceps femoris muscles were measured on the painful side and on the control side. The median VNRS decrease was 4.0 (P < 0.00001; Wilcoxon’s signed rank test), without significant differences between ropivacaine and lidocaine (Mann-Whitney U-test). A difference in effect on MVMF was found for affected versus control side (P = 0.016; Tukey test). Multiple regression revealed a significant negative correlation for change in VNRS score versus change in median MVMF (Spearman R = –0.48: P = 0.00001). This study demonstrates that in patients with unilateral chronic low back pain radiating to the leg, pain reduction induced by local anesthetic segmental nerve (L4) block is associated with increased quadriceps femoris and tibialis anterior MVMF, without differences for lidocaine and ropivacaine.

 

比較高張生理鹽水及高張生理鹽水6%右旋糖酐-70用於狗出血性休克復蘇後的早期組織及胃腸氧合作用的研究

The Early Systemic and Gastrointestinal Oxygenation Effects of Hemorrhagic Shock Resuscitation with Hypertonic Saline and Hypertonic Saline 6% Dextran-70: A Comparative Study in Dogs

José Reinaldo Cerqueira Braz, MD PhD, Paulo do Nascimento, Jr., MD PhD, Odilar Paiva Filho, MD, Leandro Gobbo Braz, MD, Luiz Antonio Vane, MD PhD, Pedro Thadeu Galvão Vianna, MD PhD, and Geraldo Rolim Rodrigues, Jr., MD PhD

Department of Anesthesiology, School of Medicine, University of São Paulo State, Botucatu, São Paulo, Brazil

Anesth Analg 2004;99:536-546

在處理出血性休克時用較小容量7.5%高張生理鹽水(HS)的方法與傳統的血漿擴充劑比較,全身氧輸送及組織的氧合較差。在狗的出血性休克模型中,我們分別使用HS或高張(6%)右旋糖酐-70HS的聯合 (HSD),與乳酸林格氏液(LR)6%羥乙基澱粉(HES)進行比較,比較它們對組織及胃腸的氧合效應。將48條雜種狗麻醉、機械通氣下行脾切除術。在其胃內放置一個胃氣體張力計以測量胃黏膜內的CO2(Pg CO2)及計算黏膜內的pH(pHi):

[pHi=pHa-log(Pg CO2/ PaCO2)]

半小時內控制狗的出血量為血容量的42%,維持平均動脈壓在40-50mmHg,然後復蘇,LR(n=12)輸入3倍於出血量;HS(n=12),6ml/kgHSD(n=12),6ml/kgHES(平均分子量200kDa、取代級0.5)(n=12)輸入量等同於出血量。在基礎、出血後30min、血管內輸入液體復蘇後560120 min時測量血流動力學、組織及胃氧合作用的變化。液體復蘇後,與輸入LRHES相比,輸入HS後,動脈血pH及混合靜脈PO2低,組織攝氧指數及組織攝氧率高(p<0.05)。而與輸入LRHES相比,輸入HSD後,動脈血pH低(p<0.05)。僅在輸入HSHSD兩組動脈pHpHi不能恢復到對照水平(p<0.05)。結論:所有液體都改善了狗出血性休克後組織及胃腸的氧合作用。然而,與LRHES相比,輸入HS後表現出的組織氧合作用最差,而輸入HSD後表現出的組織氧合作用居中。輸入HSHSD的方法不能使局部氧合作用恢復到對照值水平。

(裘毅敏      李士通  校)

The smaller volemic state from hypertonic (7.5%) saline (HS) solution administration in hemorrhagic shock can determine lesser systemic oxygen delivery and tissue oxygenation than conventional plasma expanders. In a model of hemorrhagic shock in dogs, we studied the systemic and gastrointestinal oxygenation effects of HS and hyperoncotic (6%) dextran-70 in combination with HS (HSD) solutions in comparison with lactated Ringer’s (LR) and (6%) hydroxyethyl starch (HES) solutions. Forty-eight mongrel dogs were anesthetized, mechanically ventilated, and subjected to splenectomy. A gastric air tonometer was placed in the stomach for intramucosal gastric CO2 (PgCO2) determination and for the calculation of intramucosal pH (pHi):

The dogs were hemorrhaged (42% of blood volume) to hold mean arterial blood pressure at 40–50 mm Hg over 30 min and were then resuscitated with LR (n = 12) in a 3:1 relation to removed blood volume; HS (n = 12), 6 mL/kg; HSD (n = 12), 6 mL/kg; and HES (mean molecular weight, 200 kDa; degree of substitution, 0.5) (n = 12) in a 1:1 relation to the removed blood volume. Hemodynamic, systemic, and gastric oxygenation variables were measured at baseline, after 30 min of hemorrhage, and 5, 60, and 120 min after intravascular fluid resuscitation. After fluid resuscitation, HS showed significantly lower arterial pH and mixed venous PO2 and higher systemic oxygen uptake index and systemic oxygenation extraction than LR and HES (P < 0.05), whereas HSD showed significantly lower arterial pH than LR and HES (P < 0.05). Only HS and HSD did not return arterial pH and pHi to control levels (P < 0.05). In conclusion, all solutions improved systemic and gastrointestinal oxygenation after hemorrhagic shock in dogs. However, the HS solution showed the worst response in comparison to LR and HES solutions in relation to systemic oxygenation, whereas HSD showed intermediate values. HS and HSD solutions did not return regional oxygenation to control values.

 

 

蛋白激酶CATP敏感性鉀通道激動劑對抗大鼠內皮細胞和血管平滑肌細胞炎症反應的保護作用:離體和在體研究

The Protective Effect of Protein Kinase C and Adenosine Triphosphate-Sensitive Potassium Channel Agonists Against Inflammation in Rat Endothelium and Vascular Smooth Muscle In Vitro and In Vivo

Roman V. Plachinta, MD*, Manuela J. M. de Klaver, MD*, John K. Hayes, PhD*, and George F. Rich, MD PhD*,{dagger}

Departments of *Anesthesiology and {dagger}Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia

Anesth Analg 2004;99:556-561

 

吸入性麻醉藥預處理通過啟動ATP敏感性鉀通道(KATP)和∕或蛋白激酶C(PKC),預防血管系統的炎症損傷。所以我們假設在體外和體內給予KATP PKC激動劑可模擬吸入性麻醉藥的保護作用。離體實驗:觀察KATP開放劑克羅卡林(CRK)PKC激動劑豆蔻酰佛波醇乙酯(PMA)預處理大鼠血管平滑肌細胞(VSM)和主動脈內皮細胞(AEC)能否減輕脂多糖(LPS)誘發的細胞損傷。6小時後用台盼藍染色評估細胞存活率。在體實驗:大鼠PMA CRK預處理組及未處理組,全身給予LPS或生理鹽水,6小時後測量平均動脈壓、對血管擴張藥(內皮依賴性擴管藥乙酰膽鹼,非內皮依賴性擴管藥硝普鈉)的反應及動脈血氣分析。離體實驗結果:對照組VSM AEC的生存率均超過90%,且不受PMA CRK影響。LPS組細胞生存率明顯下降;PMA (0.1–10 µM)使LPS的損傷作用減少28%–37% VSM 39%–53% AEC);CRK (1 mM)使細胞生存率增加 24% VSM )或 22% AEC)。在體試驗結果:對照組PMA CRK預處理對觀測指標無明顯影響。LPS組平均動脈壓下降,乙酰膽鹼和硝普鈉的擴管作用減弱,血糖降低;6小時後 PMA使乙酰膽鹼的擴管作用增加46%CRK無效;兩種激動機對LPS的其他損害均無作用。結論:離體實驗中KATP 開放劑和 PKC激動劑對VSMAEC的炎症損傷有一定保護作用;而我們的在體模型中,KATP 開放劑和 PKC激動劑全身給藥幾乎沒有保護作用。

(軒泓      李士通  校)

Volatile anesthetic pretreatment protects the vasculature from inflammation-induced injury via mechanisms involving the activation of adenosine triphosphate-sensitive potassium (KATP) channels and/or protein kinase C (PKC). Therefore, we hypothesized that KATP and PKC agonists may mimic the protective effects of volatile anesthetics in vitro and in vivo. In vitro, rat vascular smooth muscle cells (VSM) and aortic endothelial cells (AEC) were used to evaluate whether pretreatment with a KATP agonist, cromakalim (CRK), or a PKC agonist, phorbol 12-myristate 13-acetate (PMA), decreases lipopolysaccharide (LPS)-induced cell injury. Cell survival was determined by trypan blue staining after 6 h. In vivo, rats received systemic LPS or saline with or without pretreatment with PMA or CRK. Mean arterial blood pressure, the response to endothelium-dependent (acetylcholine; ACH) and -independent (sodium nitroprusside) vasodilators, and arterial blood gases were determined after 6 h. Cell survival in VSM and AEC control cultures was more than 90%, which was not altered in the presence of PMA or CRK, whereas LPS significantly decreased cell survival. PMA (0.1–10 µM) significantly attenuated the LPS-induced decrease in cell survival by 28%–37% in VSM and 39%–53% in AEC, and CRK (1 mM) increased cell survival by 24% in VSM and 22% in AEC. In vivo, PMA and CRK pretreatment had no significant effect on measured variables in control rats. LPS decreased mean arterial blood pressure and vasodilation to ACH and sodium nitroprusside and caused hypoglycemia. PMA, but not CRK, increased ACH-dependent vasodilation (46%) at 6 h, but neither agonist altered the other detrimental effects of LPS. In conclusion, PKC and KATP agonists appear to protect AEC and VSM cells against inflammation in vitro, but the systemic administration of PKC and KATP agonists appeared to exert minimal or no protection in our in vivo model.

 

肩關節腔鏡術後三種鎮痛方法之比較:關節腔內鎮痛,肩胛上神經阻滯和肌間溝臂叢神經阻滯

Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block

François J. Singelyn, MD PhD*, Laurence Lhotel, MD*, and Bertrand Fabre, MD{dagger}

*Department of Anesthesiology, Université Catholique de Louvain School of Medicine, St. Luc Hospital, Brussels, Belgium; and {dagger}Department of Anesthesiology, Clinique St. Léonard, Angers, France

Anesth Analg 2004;99:589-592

本實驗採用前瞻,隨機和盲法,評估關節鏡肩峰成形術後肌間溝臂叢神經阻滯(ISB)、肩胛上神經阻滯(SSB)和關節腔內局麻藥(IA)的鎮痛效能。120例患者平均分為4組。SSB組:0.25%布比卡因10ml阻滯肩胛上神經。IA組:手術結束時關節腔內注入0.25%布比卡因20mlISB組:0.25%布比卡因20ml肌間溝阻滯臂叢神經。對照組用於對比鎮痛作用。所有患者術中均採用全麻。24小時內觀察病人。分別在術後第4小時和第24小時記錄以下指標:疼痛評分、追加使用的鎮痛藥、滿意度評分和副作用。IA組和對照組之間各項指標沒有顯著差異。與它們相比,SSB組和ISB組疼痛評分明顯降低。術後第4小時,ISB組活動時的疼痛緩解好於SSB組。與對照組相比,只有ISB組嗎啡使用量明顯減少,滿意度評分明顯增高。我們認為在關節鏡下肩峰成形術後ISB是最有效的鎮痛技術。從臨床角度來說SSB也是一個不錯的選擇。

(張俊傑      李士通  校)

In this prospective, randomized, blinded study, we assessed the analgesic efficacy of interscalene brachial plexus block (ISB), suprascapular nerve block (SSB), and intraarticular local anesthetic (IA) after arthroscopic acromioplasty. One-hundred-twenty patients were divided into 4 groups of 30. In Group SSB, the block was performed with 10 mL of 0.25% bupivacaine. In Group IA, 20 mL of 0.25% bupivacaine was administered intraarticularly at the end of surgery. In Group ISB, the block was performed with 20 mL of 0.25% bupivacaine. A control group was included for comparison. General anesthesia was administered to all patients. Patients were observed during the first 24 h. Pain scores, supplemental analgesia, satisfaction scores, and side effects were recorded at 4 and 24 h. No significant difference was observed between the IA and control groups. When compared with these groups, Groups SSB and ISB had significantly lower pain scores. At 4-h follow-up, better pain relief on movement was noted in Group ISB than in Group SSB. When compared with controls, a significant reduction in morphine consumption and a better satisfaction score were noted only in Group ISB. We conclude that ISB is the most efficient analgesic technique after arthroscopic acromioplasty. SSN block would be a clinically appropriate alternative.

 

緊急氣管插管:與反復喉鏡嘗試相關的併發症

Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts

Thomas C. Mort, MD

Department of Anesthesiology, Hartford Hospital, University of Connecticut School of Medicine

Anesth Analg 2004;99:607-613

多次嘗試傳統的氣管插管可能會增加患者併發症的發病率。收集患有心血管疾病、肺部疾病、代謝疾病、神經性疾病及損傷相關的退行性疾病的危重病人(n=2833)行緊急插管的資料進行質量改進分析。該臨床分析依據一套確定的指標來評估氣道和血流動力學相關併發症,這些指標與手術室外成功的氣管插管所需的嘗試次數相關。當喉鏡嘗試次數增加( 2次以下比>2),氣道相關併發症的比率呈現有意義的增高:缺氧(11.8%70%),胃內容物返流(1.9%22%),胃內容物誤吸(0.8%13%),心動過緩(1.6%21%)及心臟停搏(0.7%11%P<0.001)。雖然這些結果是預期的,但是這項分析提供了資料證實喉鏡嘗試次數與氣道和血流動力學併發症的發生相關。這些資料也支援ASA困難氣道管理任務組提出的建議,限制喉鏡嘗試次數在三次以下以防可能發生的相當嚴重的損害。

(陳瑋      李士通  校)

Repeated conventional tracheal intubation attempts may contribute to patient morbidity. Critically-ill patients (n = 2833) suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration were entered into an emergency intubation quality improvement database. This practice analysis was evaluated for airway and hemodynamic-related complications based on a set of defined variables that were correlated to the number of attempts required to successfully intubate the trachea outside the operating room. There was a significant increase in the rate of airway-related complications as the number of laryngoscopic attempts increased (≤2 versus >2 attempts): hypoxemia (11.8% versus 70%), regurgitation of gastric contents (1.9% versus 22%), aspiration of gastric contents (0.8% versus 13%) bradycardia (1.6% versus 21%), and cardiac arrest (0.7% versus 11%; P < 0.001). Although predictable, this analysis provides data that confirm the number of laryngoscopic attempts is associated with the incidence of airway and hemodynamic adverse events. These data support the recommendation of the ASA Task Force on the Management of the Difficult Airway to limit laryngoscopic attempts to three in lieu of the considerable patient injury that may occur.

心臟手術期間正常血糖的維持

Maintenance of Normoglycemia During Cardiac Surgery

George Carvalho, MD*, Anne Moore, MD*, Baqir Qizilbash, MD*, Kevin Lachapelle, MD{dagger}, and Thomas Schricker, MD PhD*

Departments of *Anesthesia and {dagger}Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada

Anesth Analg 2004;99:319-324


作者使用高胰島素正常血糖穩定技術來保持選擇性心臟手術期間的血糖正常,即以一個恒定的速率輸注胰島素同時點滴葡萄糖從而使血糖位於一個特殊的水平。10名非糖尿病和7名糖尿病病人參加了此次試驗。同時評估接受傳統劑量胰島素輸注的19名非糖尿病和11名糖尿病病人(對照組)的術中血糖。實驗組的病人,在誘導前開始給予2U胰島素的初始負荷劑量,之後按5mU•kg•min-1輸注胰島素同時給予不同劑量的葡萄糖。實驗組每5分鐘測一次動脈血糖,對照組每20分鐘測一次。血糖控制正常定義為95%的血糖水平控制在4.0-6.0mmol/L內。記錄手術前,體外迴圈(CPB)前15分鐘,體外迴圈早期和晚期和關胸時的血糖濃度。對照組病人在手術期間有較頻繁的高血糖發生(CPB晚期; 非糖尿病病人, 9.0 ± 3.2 mmol/L; 糖尿病病人, 10.1 ± 3.6 mmol/L)。然而,實驗組病人則血糖正常(CPB晚期; 非糖尿病病人, 5.5 ± 0.7 mmol/L; 糖尿病病人, 4.9 ± 0.6 mmol/L;  P < 0.05 與對照組相比)。總之,使用高胰島素正常血糖穩定技術可以在非糖尿病和糖尿病病人的心臟手術中可靠地保持血糖正常。

(殷文淵 譯 陳傑 校)

We used the hyperinsulinemic normoglycemic clamp technique, i.e., infusion of insulin at a constant rate combined with dextrose titrated to clamp blood glucose at a specific level, to preserve normoglycemia during elective cardiac surgery. Ten nondiabetic and seven diabetic patients entered the clamp protocols. Perioperative glucose control was also assessed in 19 nondiabetic and 11 diabetic patients (control group) receiving a conventional insulin infusion sliding scale. In patients of the clamp group, a priming bolus of insulin (2 U) was started before the induction of anesthesia followed by infusions of insulin at 5 mU • kg–1 • min–1 and of variable amounts of dextrose. Arterial blood glucose was measured every 5 min in the clamp group and every 20 min in the control group. Control of normoglycemia was defined as ≥95% of the glucose levels within 4.0–6.0 mmol/L. Glucose concentration was recorded before surgery, 15 min before cardiopulmonary bypass (CPB), during early and late CPB, and at sternal closure. Patients of the control group became progressively hyperglycemic during surgery (late CPB; nondiabetics, 9.0 ± 3.2 mmol/L; diabetics, 10.1 ± 3.6 mmol/L), whereas normoglycemia was achieved in the study group (late CPB; nondiabetics, 5.5 ± 0.7 mmol/L; diabetics, 4.9 ± 0.6 mmol/L; P < 0.05 versus control group). In conclusion, it seems that normal blood glucose concentration during open heart surgery can be reliably maintained in nondiabetic and diabetic patients by using the hyperinsulinemic normoglycemic clamp technique.


 

咪唑安定:心臟手術後的有效止吐藥-一項臨床實驗

Midazolam: An Effective Antiemetic After Cardiac Surgery—A Clinical Trial

Orathy Patangi Sanjay, MD, and Deepak Ivan Tauro, MBBS

Department of Anesthesiology, St. John’s Medical College Hospital, Bangalore, Karnataka, India

Anesth Analg 2004;99:339-343


心臟手術後常伴有噁心、嘔吐(PONV) 。為了評價咪唑安定的止吐特性,作者在200名接受體外迴圈心臟手術的病人中進行了這項雙盲隨機實驗,將它預防術後噁心嘔吐的療效與樞複寧(ondansetron)相比較。在氣管插管後24小時內定期評價術後噁心嘔吐的發生,同時進行鎮靜和疼痛評分。結果顯示咪唑安定組6%的病人發生噁心,沒有病人發生嘔吐,樞複寧組有21%的病人發生了術後噁心嘔吐(P < 0.001)。樞複寧組的21名病人(18名女性和3名男性)需要追加止吐藥,而咪唑安定組的6名病人(全部是女性)則沒人需要追加(P < 0.001)。兩組患者的鎮靜和術後疼痛評分相似。結論:咪唑安定,開始以0.02 mg • kg–1 • h–1持續輸注,比每6小時靜注樞複寧0.02 mg • kg–1 • h–1, 對預防心臟手術後噁心嘔吐的發生更有效。

(殷文淵 譯 陳傑 校)

Cardiac surgery has been associated with a significant incidence of postoperative nausea and vomiting (PONV). To assess the antiemetic property of midazolam, we undertook this double-blinded, randomized trial in 200 patients undergoing cardiac surgery involving cardiopulmonary bypass, and we compared its efficacy with that of ondansetron in preventing PONV. Assessments on the occurrence of PONV were made at regular intervals for the first 24 h after tracheal extubation, along with sedation and pain scoring. We report a 6% incidence of nausea and no incidence of vomiting in the midazolam group, compared with a 21% incidence of PONV in the ondansetron group (P < 0.001). All 21 patients (18 women and 3 men) in the ondansetron group and none of the 6 patients (all women) in the midazolam group required a rescue antiemetic drug (P < 0.001). The sedation scores and postoperative pain scores were comparable in both groups. We conclude that midazolam, instituted as a continuous infusion in a dose of 0.02 mg • kg–1 • h–1, is a more effective antiemetic than ondansetron in a dose of 0.1 mg/kg IV every 6 h for the prevention of PONV after cardiac surgery.


耳鼻喉手術監護麻醉中使用加巴噴丁的鎮痛效果

The Analgesic Effects of Gabapentin in Monitored Anesthesia Care for Ear-Nose-Throat Surgery

Alparslan Turan, MD*, Dilek Memis, MD*, Beyhan Karamanlioglu, MD*, Recep Yagiz, MD{dagger}, Zafer Pamukçu, MD*, and Ebru Yavuz{ddagger}

Departments of *Anaesthesiology, {dagger}Ear-Nose-Throat Surgery, and {ddagger}Biostatistics, Trakya University Medical Faculty, Edirne, Turkey

Anesth Analg 2004;99:375-378


作者研究了鼻成形術或內窺鏡下鼻竇手術中使用加巴噴丁效果和安全性。患者在手術前1小時口服安慰劑或加巴噴丁1200mg。在標準的術前給藥後,每組25名患者術中使用丙泊酚,芬太尼並在手術部位使用局部麻醉藥。持續滴注丙泊酚並根據Ramsay評分調整劑量維持鎮靜。在手術開始後5153045,和60分鐘以及手術後30分鐘,2468121620,和24小時記錄鎮靜和疼痛評分。經肌肉注射二氯芬酸作為補救鎮痛藥。加巴噴丁組的患者術後和術中的4560分鐘疼痛評分明顯低於對照組,芬太尼(122±40µg148±42µgP<0.05)和二氯芬酸(33±53mg111±92mgP<0.001)的消耗較少,第一次需要鎮痛的時間更長(18±9h9±7hP<0.001)。加巴噴丁組頭暈的發生率高於對照組(24%對4%)。結論:對於不需臥床休息的鼻成形術或內窺鏡下的鼻竇手術患者,加巴噴丁有明顯減輕疼痛的作用;頭暈可能是其不需臥床患者的應用缺陷。

(朱輝 譯 陳傑 校)

We investigated the efficacy and safety of gabapentin in rhinoplasty or endoscopic sinus surgery patients. Patients received either oral placebo or gabapentin 1200 mg 1 h before surgery. After standard premedication, 25 patients in each group received propofol, fentanyl, and local anesthesia at the operative site. Sedation was maintained by a continuous infusion of propofol adjusted according to the Ramsay scale. Sedation and pain scores were obtained at 5, 15, 30, 45, and 60 min during surgery and 30 min and 2, 4, 6, 8, 12, 16, 20, and 24 h after the procedure. Diclofenac 75 mg IM was administered as a rescue analgesic. Postoperative pain scores and intraoperative pain scores at 45 and 60 min were significantly lower in the gabapentin group. Fentanyl (122 ± 40 µg versus 148 ± 42 µg; P < 0.05) and diclofenac (33 ± 53 mg versus 111 ± 92 mg; P < 0.001) consumption was smaller and the time to first analgesic request (18 ± 9 h versus 9 ± 7 h; P < 0.001) was longer in the gabapentin group. A more frequent incidence of dizziness was found in the gabapentin (versus placebo) group (24% versus 4%, respectively). We conclude that gabapentin provided a significant analgesic benefit for intraoperative and postoperative pain relief in patients undergoing ambulatory rhinoplasty or endoscopic sinus surgery; however, dizziness may be a handicap for ambulatory use.


丙泊酚可抑制人由脂類促炎症介質引起的血小板聚集

Propofol Inhibits Human Platelet Aggregation Induced by Proinflammatory Lipid Mediators

Olivier Fourcade, MD PhD*, Marie-Françoise Simon, PhD{dagger}, Lawrence Litt, MD PhD{ddagger}, Kamran Samii, MD*, and Hugues Chap, MD PhD{dagger}

Department of Anesthesia, Purpan Hospital, University of Toulouse, Toulouse, France; {dagger}Institut National de la Santé et de la Recherche Médicale, Unit 326, Purpan Hospital, Toulouse, France; and {ddagger}Department of Anesthesia, University of California, San Francisco, California

Anesth Analg 2004;99:393-398


溶血磷脂酸(LPA),血小板啟動因數(PAF),血栓素A2均為脂類炎症介質可啟動血小板表面受體使細胞內鈣增加,這是血小板聚集所必須的。作者研究丙泊酚對這三種激動劑引起的血小板聚集和細胞內鈣動員的影響。來自志願者的血小板放在含LPA1μM),U46619(血栓素A2類似體;1μM)或PAF10nM)的緩衝液內,然後加入丙泊酚乳劑或溶於酒精的26diisopropylphenol(無脂肪乳劑的丙泊酚)使其達到臨床使用的濃度5μg/ml10μg/ml2分鐘後,通過光學技術測試聚集作用或鈣的濃度。丙泊酚乳劑和溶於酒精的丙泊酚對LPA1μM),U46619PAF引起的血小板聚集有相似的劑量依賴的抑制作用。丙泊酚沒有緩解LPA1μM),U46619PAF引起的細胞內鈣的增加作用。由於丙泊酚不會顯著改變因受體啟動導致的細胞內鈣增加,所以抑制作用出現在血小板受體的遠端,如肌醇三磷酸和磷脂酶C。由於這三種脂類介質在炎症中起著關鍵作用,所以丙泊酚對它們的抑制作用可能在臨床上有重要意義。

(朱輝 譯 陳傑 校)

Lysophosphatidic acid (LPA), platelet-activating factor (PAF), and thromboxane A2 are proinflammatory lipid mediators that activate surface receptors on platelets, producing increased intracellular calcium, which is necessary for aggregation. We investigated propofol’s effect on platelet aggregation and intracellular calcium mobilization caused by these three agonists. Platelets from human volunteers were incubated in buffers containing LPA (1 µM), U46619 (thromboxane A2 analog; 1 µM), or PAF (10 nM). Propofol emulsion or 2,6-diisopropylphenol (propofol without fat emulsion) dissolved in ethanol was added to achieve concentrations of propofol used clinically: 5 or 10 µg/mL. After 2 min, aggregation or intracellular calcium concentrations were measured with optical techniques. Propofol emulsion and propofol in ethanol produced similar inhibition of platelet aggregation induced by LPA, PAF, and U46619 in a dose-dependent fashion. LPA, PAF, and U46619 each caused significant increases in intracellular calcium that were not modified by propofol. Because propofol does not significantly alter intracellular calcium increases caused by receptor activation, inhibition appears to act distal to platelet receptors, inositol phosphate 3, and phospholipase C. Because the three lipid mediators play a key role in inflammation, their inhibition by propofol might be clinically important.


非洲爪蛙 Ca激動的Cl電流通過蛋白激酶C和蛋白磷酸酯酶調節:有關麻醉機制的研究

Modulation of Xenopus laevis Ca-Activated Cl Currents by Protein Kinase C and Protein Phosphatases: Implications for Studies of Anesthetic Mechanisms

Klaus Hahnenkamp, MD*, Marcel E. Durieux, MD PhD*, Hugo van Aken, MD PhD*, Sascha Berning*, Thomas J. Heyse*, Christian W. Hönemann, MD*, and Bettina Linck, MD PhD{dagger}

*Department of Anesthesiology and Intensive Care, and {dagger}Institute of Pharmacology and Toxicology, University Hospital, Muenster, Germany

Anesth Analg 2004;99:416-422


Ca激動的Cl電流(IC1(Ca))通常是麻醉藥對非洲爪蛙卵母細胞G蛋白偶聯受體研究的標誌物。麻醉可影響蛋白激酶CPKC),如果電流受磷酸化調節則間接影響IC1(Ca)。作者在非洲爪蛙卵母細胞用電壓鉗制技術研究PKC或蛋白磷酸酯酶PP1αPP2A IC1(Ca)的調節作用。IC1(Ca) 激發是通過溶血磷脂(LPA)信號系統或微泵注射鈣。大鼠卵母細胞內的PP1αPP2A過分表達。將PP,IP3,PP抑制劑岡田酸能抑制磷脂酶A,PKC抑制劑白屈菜紅堿或CaCl2直接注入卵母細胞內,無論是否使用PP抑制劑斑蝥素或OA均測量在一控制電位-70mV時對激動劑的反應(LPA 10-6M, IP310-4M,CaCl2 0.5M)。PP1αPP2AIC1(Ca) 的抑制分別為7.6 ± 0.9μC2.5 ± 0.9μC 3.2 ± 1.4μCPP抑制劑提升了卵母細胞內IC1(Ca)並逆轉了對PP1αPP2A表達的抑制作用。白屈菜紅堿通過抑制PKC而增強LPA-CaCl2介導的IC1(Ca)。資料顯示非洲爪蛙IC1(Ca)是由磷酸化調節,它可通過對G蛋白偶聯受體的研究得以證實。

(朱慧琛 譯 陳傑 校)

Ca-activated Cl currents (ICl(Ca)) are used frequently as reporters in functional studies of anesthetic effects on G protein-coupled receptors using Xenopus laevis oocytes. However, because anesthetics affect protein kinase C (PKC), they could indirectly affect ICl(Ca) if this current is regulated by phosphorylation. We therefore studied the effect of modulation of either PKC or protein phosphatases PP1{alpha} and PP2A on ICl(Ca) stimulated either by lysophosphatidate (LPA) signaling or by microinjection of Ca. X. laevis oocytes were studied under voltage clamp. Rat PP1{alpha} and PP2A were overexpressed in oocytes. PP, inositoltrisphosphate (IP3), the PP inhibitor okadaic acid (OA), the PKC inhibitor chelerythrine, or CaCl2 were directly injected into the oocyte. Responses to agonists (LPA 10–6 M, IP3 10–4 M, CaCl2 0.5 M) were measured at a holding potential of –70 mV in the presence or absence of the PP inhibitors cantharidin or OA. PP1 {alpha}and PP2A inhibited ICl(Ca) from 7.6 ± 0.9 µC to 2.5 ± 0.9 µC and 3.2 ± 1.4 µC, respectively. PP inhibition enhanced ICl(Ca) in control oocytes and reversed the inhibitory effect in oocytes expressing PP1 {alpha}or PP2A. PKC inhibition by chelerythrine enhanced both LPA- and CaCl2-induced ICl(Ca). Our data indicate that the Xenopus ICl(Ca) is modulated by phosphorylation. This may complicate design and interpretation of studies of G protein-coupled receptors using this model.


心臟斯里蘭卡肉桂堿受體缺陷患者中揮發性麻醉藥和琥珀膽鹼的應用

Volatile Anesthetics and Succinylcholine in Cardiac Ryanodine Receptor Defects

Heikki Swan, MD*, Päivi J. Laitinen, MSc{dagger}, and Lauri Toivonen, MD*

Departments of *Cardiology and {dagger}Medicine, Helsinki University Central Hospital, Helsinki, Finland

Anesth Analg 2004;99:435-437


遺傳性多源性(兒茶酚胺能)室性心動過速是一種節律異常的心臟疾病,主要由於心肌等位斯里蘭卡肉桂堿受體基因突變所致(RyR2)。骨骼肌等位基因突變(RyR1)患者在接受揮發性麻醉藥和琥珀膽鹼時易產生惡性高熱,加重了遺傳性細胞內鈣離子釋放障礙。作者報導了一系列存在心臟斯里蘭卡肉桂鹹受體缺陷的患者接受全麻後卻並未出現併發症。RyR2缺陷患者在臨床上使用琥珀膽鹼和揮發性麻醉藥無明顯影響。

(朱慧琛 譯 陳傑 校)

Familial polymorphic (catecholaminergic) ventricular tachycardia is an arrhythmogenic cardiac disorder caused by mutations of the myocardial isoform of the ryanodine receptor gene (RyR2). Mutations of the corresponding gene in the skeletal muscle (RyR1) predispose its carriers to malignant hyperthermia upon use of volatile anesthetics or succinylcholine, which further deteriorate the inherited intracellular calcium release disorder. We report a series of patients with cardiac RyR defects who underwent general anesthesia without complications. Succinylcholine and volatile anesthetics did not have a clinically significant effect on RyR2 defects.


兩種不同的神經性疼痛模型對止痛劑有不同敏感性

Differential Analgesic Sensitivity of Two Distinct Neuropathic Pain Models

Isabelle Decosterd, MD*,{dagger}, Andrew Allchorne{ddagger}, and Clifford J. Woolf, MD PhD{ddagger}

*Anesthesiology Pain Research Group, Department of Anesthesiology, University Hospital Lausanne (CHUV), Lausanne, Switzerland; {dagger}Department of Cell Biology and Morphology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; and {ddagger}Neural Plasticity Research Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts

Anesth Analg 2004;99:457-463

對齧齒動物的坐骨神經擠壓所造成的漸進性的觸覺過敏(PTH)和不伴神經損傷的神經痛(SNI)是兩種不同的神經痛的試驗模型。PTH的概念是,在坐骨神經移植術後,對其所支配的皮膚給予間斷的重複的低閾值的機械刺激所造成的神經損傷,這種損傷數月後發生了PTH,它代表的是一種刺激誘導的疼痛模型。而SNI是指切開坐骨神經的其他兩個終末分支後,所造成的腓神經控制區域的皮膚,對於刺激喚起的疼痛早期、持續的敏感性的增加。作者對兩組實驗模型分別檢驗嗎啡(0.5–10 mg/kg)加巴噴丁(30–200 mg/kg)MK801(0.01–0.02 mg/kg)阿米替林(10–25 mg/kg)卡馬西平(5–7.5 mg/kg)的效果。結果發現:嗎啡,加巴噴丁卡馬西平都可以逆轉和防止刺激誘導的PTH,但是MK801阿米替林僅僅能夠減少而不能防止刺激誘導的PTH.。相反,這些藥物在SNI模型中刺激喚醒的行為性的高敏感性卻鮮有作用。這兩種各自獨立的神經痛的模型顯示了其對鎮痛藥物治療的不同的敏感性。作者認為,這是由於和神經痛相關行為的不同機制所造成。因此,為了研究神經痛的機制,並預測鎮痛藥物對於各種不同神經痛綜合症的效果,需要更多的動物模型。

(顧漪聞 譯 陳傑 校)

Progressive tactile hypersensitivity (PTH) manifesting after sciatic nerve crush and spared nerve injury (SNI) are two distinct rodent experimental models of neuropathic pain. PTH develops months after recovery from the nerve crush in response to repeated intermittent low-threshold mechanical stimulation of the reinnervated sciatic nerve skin territory and represents a model of stimulus-induced pain. SNI is characterized by an early and sustained increase in stimulus-evoked pain sensitivity in the intact skin territory of the spared sural nerve after sectioning of the two other terminal branches of the sciatic nerve. We examined the effects of morphine (0.5–10 mg/kg), gabapentin (30–200 mg/kg), MK801 (0.01–0.02 mg/kg), amitriptyline (10–25 mg/kg), and carbamazepine (5–7.5 mg/kg) in both models. Morphine, gabapentin, and carbamazepine both reversed and prevented stimulus-induced PTH, whereas MK801 and amitriptyline reduced but did not prevent stimulus-induced PTH. In contrast, the stimulus-evoked behavioral hypersensitivity in the SNI model was poorly modified by these drugs. Independent neuropathic pain models show differential sensitivity to analgesic drug treatment. We suggest that this is due to the different mechanisms responsible for the neuropathic pain-related behavior. Multiple models are required, therefore, to study the mechanisms that contribute to neuropathic pain and to predict analgesic efficacy for different components of the neuropathic pain syndrome.


慢性和急性下腰痛時活動度和疼痛的關係分析

An Analysis of the Relationship Between Activity and Pain in Chronic and Acute Low Back Pain

John J. Liszka-Hackzell, MD PhD*, and David P. Martin, MD PhD{dagger}

*Department of Anesthesiology, University of Arizona, Tucson; and {dagger}Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota

Anesth Analg 2004;99:477-481


作者研究了慢性和急性下腰痛患者的活動度和疼痛之間的關係。方法:觀察急性下腰痛和大於3周的慢性下腰痛病人各15例。用腕式加速儀來自動記錄活動度水平,每1分鐘記錄一次。而疼痛水平則用袖珍式電子日記記錄,至少每90分鐘記錄一次。每個病人的時間按順序排列,然後分為不同時間區域,用交叉相關函數來分析。結果:急性下腰痛病人的頭七天,活動度和疼痛之間有明顯的相關性(P<0.01)。通常活動後大約30分鐘產生疼痛。但是當這些病人症狀改善、疼痛減輕後,活動和疼痛之間的關係就消失了。而在慢性下腰痛的病人,則沒有發現這種相關性。

(顧漪聞 譯 陳傑 校)

We studied the temporal relationship between pain and activity in patients with acute or chronic low back pain. We studied 15 patients with acute low back pain and 15 patients with chronic low back pain over 3 wk. The activity levels were collected automatically using a wrist accelerometer and were sampled every minute. The pain levels were recorded at least every 90 min using a pocket-sized electronic diary. The time series from each patient were then analyzed using the cross-correlation function at various time offsets. We found that during the first 7 days of acute low back pain, there was a significant (P < 0.01) degree of cross-correlation between activity and pain. On average, pain followed activity by approximately 30 min. As these patients improved and reported less pain, the relationship between activity and pain disappeared. There was no such relationship at any point among the patients with chronic low back pain.

 

圍術期硬膜外應用可樂定對結直腸手術後病人細胞因數,術後鎮痛和腸功能的影響

The Effect of Epidural Clonidine on Perioperative Cytokine Response, Postoperative Pain, and Bowel Function in Patients Undergoing Colorectal Surgery

Ching-Tang Wu, MD*, Shu-Wen Jao, MD{dagger}, Cecil O. Borel, MD{ddagger}, Chun-Chang Yeh, MD*, Chi-Yuan Li, MD*, Chueng-He Lu, MD*, and Chih-Shung Wong, MD PhD*

Departments of *Anesthesiology and {dagger}Colon and Rectal Surgery, Tri-Service General Hospital and National Defense Medical Center, National Defense University, Taipei, Taiwan, Republic of China; and {ddagger}Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2004;99:502-509


術後細胞因數的生成增加使疼痛的敏感性增加。作者研究如下假設:硬膜外可樂定預處理和術後病人硬膜外自控鎮痛(PCEA)中應用可樂定可減少選擇性結直腸手術後病人炎性細胞因數(白介素(IL)-6, IL-1βIL-8和腫瘤壞死因數)和抗炎因數(IL-1受體拮抗劑)的釋放,並提供更佳的術後鎮痛。40例病人隨機分為2組,每組20人:對照組術前硬膜外用生理鹽水10ml,可樂定組硬膜外用可樂定150ug溶於9ml生理鹽水。誘導前,手術結束時,術後12-24小時取靜脈血做細胞因數水平檢測。可樂定組術後PCEA為:嗎啡(0.1mg/ml­)+可樂定(1.5ug /ml)+0.2%羅呱卡因100ml。對照組僅用嗎啡和羅呱卡因。術後72小時內與對照組相比可樂定組病人按壓PCEA的間隙時間長,靜息和咳嗽時的疼痛評分低,嗎啡的消耗量少,腸功能恢復快。可樂定組病人手術結束時,術後1224小時IL-1RA, IL-6, IL-8顯著減少。但是,IL-1ß  TNF-{alpha}的濃度無明顯增加。

(忻紀華 譯 陳傑 校)

The postoperative period is associated with an increased production of cytokines, which augment pain sensitivity. We investigated the hypothesis that epidural clonidine premedication and postoperative patient-controlled epidural analgesia (PCEA) including clonidine would decrease the release of proinflammatory (interleukin (IL)-6, IL-1ß, IL-8, and tumor necrosis factor (TNF)-{alpha}) and antiinflammatory (IL-1 receptor antagonist (RA)) cytokines in patients who underwent elective colorectal surgery and that they would provide better postoperative analgesia. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the control group received normal saline 10 mL, whereas the clonidine group received epidural clonidine 150 µg diluted with 9 mL of normal saline 30 min before surgery. Venous blood samples for cytokine levels were obtained before induction, at the end of surgery, and after surgery at 12 and 24 h. After surgery, the clonidine group patients received PCEA with morphine (0.1 mg/mL) and clonidine (1.5 µg/mL) in 0.2% ropivacaine 100 mL, whereas control group patients received only PCEA morphine and ropivacaine. Patients in the clonidine group exhibited longer PCEA trigger times, lower pain scores at rest and while coughing, less morphine consumption, and a faster return of bowel function throughout the 72-h postoperative observation period, compared with patients in the control group. For patients in the clonidine group, production of IL-1RA, IL-6, and IL-8 was significantly less increased at the end of the surgical procedure and at 12 and 24 h after surgery. However, the concentrations of IL-1ß and TNF-{alpha} were not significantly increased.


N-乙酰甲基半胱氨酸阻止犬血液稀釋導致的缺氧性肺血管收縮的抑制作用

Prevention of Hemodilution-Induced Inhibition of Hypoxic Pulmonary Vasoconstriction by N-Acetylcysteine in Dogs

François Kerbaul, MD*, Philippe Van der Linden, MD PhD{dagger}, Sébastien Pierre, MD{ddagger}, Benoît Rondelet, MD{ddagger}, Christian Melot, MD PhD§, Serge Brimioulle, MD PhD§, and Robert Naeije, MD PhD{ddagger}

*Department of Anesthesia and Intensive Care, Timone Hospital, Marseille, France; {dagger}Department of Anesthesia, Centre Hospitalo-Universitaire, Charleroi, Belgium; {ddagger}Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium; and §Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium

Anesth Analg 2004;99:547-551


作者研究了氧自由基和血液黏性的改變是否與犬血液稀釋所致的缺氧性肺血管收縮(HPV)的抑制作用有關。14只犬異氟醚麻醉誘導後隨機分為兩組:一組靜注N-乙酰甲基半胱氨酸(NAC200mg/kgn7),一組接受安慰劑(n7)。持續測量高氧(吸入氧指數,0.4)和低氧(吸入氧指數,0.1)時及血球壓積逐漸由40%降至20%時平均肺動脈壓(Ppa)和心排量。低氧時Ppa值減去高氧時Ppa值為HPV的抑制值。血液稀釋可使HPV7 ± 1 mm Hg 降至 3 ± 1 mm Hg (P < 0.01),而這種反應可被NAC抑制(HPV未改變, 8 ± 1 8 ± 1 mm Hg)。血液稀釋模型的HPV 8 ± 1 mm Hg 降至 6 ± 1 mm Hg (P < 0.05)。結論:血液稀釋導致的HPV抑制部分是由於血液粘性的改變所致,可被NAC抑制,後者作用可能由於NAC清除氧自由基所致。

(忻紀華 譯 陳傑 校)

We investigated the possible contributions of reactive oxygen species and of viscosity changes to hemodilution-induced inhibition of hypoxic pulmonary vasoconstriction (HPV) in dogs. Fourteen isoflurane-anesthetized dogs were randomly assigned to receive N-acetylcysteine (NAC) 200 mg/kg IV (n = 7) or placebo (n = 7). Mean pulmonary artery pressure (Ppa) was measured with cardiac output maintained constant by a manipulation of venous return in hyperoxia (fraction of inspired oxygen, 0.4) and in hypoxia (fraction of inspired oxygen, 0.1) at baseline and after stepwise reductions in hematocrit from 40% to 20%. Measured Ppa was compared with predicted Ppa by using a viscoelastic model. HPV was expressed as hypoxic Ppa minus hyperoxic Ppa. Hemodilution was associated with a decrease in HPV from 7 ± 1 mm Hg to 3 ± 1 mm Hg (P < 0.01), and this was completely prevented by NAC (HPV was unchanged, from 8 ± 1 to 8 ± 1 mm Hg; not significant). Hemodilution in the model decreased HPV from 8 ± 1 mm Hg to 6 ± 1 mm Hg (P < 0.05). We conclude that hemodilution-induced inhibition of HPV is in part explained by viscosity changes and can be prevented by the administration of NAC, which is possibly explained by the scavenging of reactive oxygen species.


異丙酚鎮靜對顱內占位患者顱內壓的影響

The Effect of Propofol Sedation on the Intracranial Pressure of Patients with an Intracranial Space-Occupying Lesion

François Girard, MD FRCPC*, Robert Moumdjian, MD FRCSC{dagger}, Daniel Boudreault, MD FRCPC*, Philippe Chouinard, MD FRCPC*, Alain Bouthilier, MD FRCSC{dagger}, Éric Sauvageau, MD{dagger}, Monique Ruel, RN*, and Dominique C. Girard*

Department of *Anesthesiology and {dagger}Neurosurgery Division, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Montréal, Canada

Anesth Analg 2004;99:573-577


因為擔心可能會產生CO2蓄積和繼發性顱內壓升高,有時會妨礙鎮靜劑在有自主呼吸的顱內占位患者中的使用。本研究作者評估了局麻下接受立體定位顱內腫瘤活檢患者術中用中等深度異丙酚鎮靜對顱內壓的影響。30名患者隨機分為兩組,鎮靜組:異丙酚滴注,清醒/鎮靜評分2級,另一組為非鎮靜組。通過活檢針來測定顱內壓。兩組患者術前顱內壓數值相似。鎮靜組術中有更高的PaCO248±8mmHg41±3mmHgP=0.005)(兩組95%可信區間分別為43-53mmHg39-43mmHg),更低的動脈血pH值。鎮靜組與非鎮靜組平均顱內壓相似,分別為13mmHg15mmHg,其95%可信區間分別為8.2-16.2mmHg8.3-21.7mmHg,(P=0.66)。鎮靜組顱內灌注壓更低(76±18mmHg89±18mmHgP=0.003)。對於立體定位顱內腫瘤活檢的患者來說,中等深度的異丙酚鎮靜並不會導致顱內壓增高。其他鎮靜藥物對顱內壓的影響還需進一步研究。

(朱玫娟 譯 陳傑 校)

The fear of producing CO2 retention and a secondary increase of intracranial pressure (ICP) sometimes precludes the use of sedation for the spontaneously breathing patient in the presence of an intracranial space-occupying lesion. In this study we assessed the effect of moderately deep propofol sedation on the ICP of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. Thirty patients were randomized into 2 groups to receive propofol titrated to a level of 2 on the Observer’s Assessment of Alertness/Sedation Scale or no sedation. ICP was measured via the biopsy needle. Preoperative data were similar in both groups. During surgery, patients receiving propofol had a higher arterial PCO2 (48 ± 8 mm Hg versus 41 ± 3 mm Hg; P = 0.005) (95% confidence interval, 43–53 mm Hg and 39–43 mm Hg, respectively), resulting in a lower arterial pH (P = 0.002) than patients in the no-sedation group. The median ICP (95% confidence interval) for both groups was similar—13 mm Hg (8.2–16.2 mm Hg) and 15 mm Hg (8.3–21.7 mm Hg)—for the propofol and no-sedation groups, respectively (P = 0.66). Cerebral perfusion pressure was lower in the propofol group (76 ± 18 mm Hg versus 89 ± 18 mm Hg; P = 0.003). Moderately deep propofol sedation does not result in a higher ICP than no sedation in patients undergoing stereotactic brain tumor biopsy. Further studies are needed to assess the effect on ICP of other sedative medications.


圍術期血糖控制的一種簡單的葡萄糖胰島素療法:Vellore療法

A Simple Glucose Insulin Regimen for Perioperative Blood Glucose Control: The Vellore Regimen

Ann Miriam, MD, and Grace Korula, MD

Department of Anaesthesia, Christian Medical College Hospital, Vellore, India

Anesth Analg 2004;99:598-602


在這項研究中,作者試圖在大型、多學科的教學醫院中尋找一種簡單易行的方法來控制糖尿病患者術中的血糖。作者評估了Vellore療法,後者優點在於將葡萄糖胰島素和輸液變化率相結合。方法:血糖超過100mg/dL後血糖濃度每超過1-50mg/dL5%葡萄糖溶液100mL中增加一個單位的胰島素,每小時測量血糖濃度。作者比較了這種血糖控制方法和在此醫院中所用的其他方法,隨機選取了204個患者,研究組98名,對照組106名。研究組的患者血糖為156±36mg/dL,對照組的患者血糖為189±63mg/dLP=0.003)。通過Vellore療法,血糖控制不良的患者(血糖在100-200 mg/dL範圍以外)從51%下降到28%(沒有患者血糖低於60 mg/dL),而對照組血糖控制不良的患者從49%上升到72%(有10個患者血糖低於60 mg/dL)(P=0.0013)。結論:Vellore療法是一種簡單、有效和安全的術中血糖控制的方法。

(朱玫娟 譯 陳傑 校)

In this study, we sought a simple, easily implemented method of intraoperative control of blood glucose in diabetic patients in a large multispecialty teaching hospital. The Vellore regimen, which offers the advantages of a combined glucose insulin and variable rate infusion was evaluated. For every 1 to 50-mg/dL increase in blood glucose concentration more than 100 mg/dL, 1 U of insulin was added to the injection port of a 100-mL measured volume set containing 5% dextrose in water. Hourly monitoring of blood glucose was performed. The blood glucose control was compared with the different existing techniques followed in the hospital in 204 randomized patients: 98 in the study and 106 in the control group. The study group had a mean ± SD blood glucose value of 156 ± 36 mg/dL, and the control group’s value was 189 ± 63 mg/dL (P = 0.003). The percentage of patients who were poorly controlled (outside 100 to 200-mg/dL range) decreased from 51% to 28% (no patient less than 60 mg/dL) with this regimen as compared with the control group in which it increased from 49% to 72% (10 patients less than 60 mg/dL) (P = 0.0013). We conclude that the Vellore regimen is simple, effective, and safe for intraoperative blood glucose control.