Anesthesia & Analgesia

February 2005

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

开胸或内镜技术行微创冠状动脉旁路移植术时心肌壁节段性运动

(王 薛张纲 校)

Segmental Myocardial Wall Motion During Minimally Invasive Coronary Artery Bypass Grafting Using Open and Endoscopic Surgical Techniques

S. Mierdl, C. Byhahn, V. Lischke, T. Aybek, G. Wimmer-Greinecker, S. Dogan, S. Viehmeyer, P. Kessler, and Klaus Westphal

Anesth Analg 2005 100: 306-314

心脏手术期间伤口干燥能防止吗? 一项实验性研究

(朱慧琛 译 陈杰 校)

Can Wound Desiccation Be Averted During Cardiac Surgery? An Experimental Study

Mikael Persson and Jan van der Linden

Anesth Analg 2005 100: 315-320

持续胃减压治疗冠脉搭桥术后的恶心呕吐

(彭中美 李士通 校)

Continuous Gastric Decompression for Postoperative Nausea and Vomiting After Coronary Revascularization Surgery

Crina L. Burlacu, David Healy, Donal J. Buggy, Ciaran Twomey, David Veerasingam, Andrew Tierney, and Denis C. Moriarty

Anesth Analg 2005 100: 321-326.

氙或笑气麻醉对猪单肺通气的全身氧合和肺灌注的影响

(朱慧琛 译 陈杰 校)

The Effects of Xenon or Nitrous Oxide Supplementation on Systemic Oxygenation and Pulmonary Perfusion During One-Lung Ventilation in Pigs

Konrad Schwarzkopf, Torsten Schreiber, Elke Gaser, Niels-Peter Preussler, Lars Hueter, Harald Schubert, Helga Rek, and Waheedullah Karzai

Anesth Analg 2005 100: 335-339.

经食道超声心动图评估腹腔镜手术中二氧化碳气腹对肝血流的影响

(张俊杰 李士通 校)

The Effects of Intraabdominally Insufflated Carbon Dioxide on Hepatic Blood Flow During Laparoscopic Surgery Assessed by Transesophageal Echocardiography

Rainer Meierhenrich, Albrecht Gauss, Peter Vandenesch, Michael Georgieff, Bertram Poch, and Wolfram Schütz

Anesth Analg 2005 100: 340-347.

非损伤性脊髓缺血后使用吗啡所致脊髓运动神经元变性可能来源于脊髓N-甲基天冬氨酸受体的激活

(王 薛张纲 校)

The Effect of Volatile Anesthetics on Respiratory System Resistance in Patients with Chronic Obstructive Pulmonary Disease

挥发性麻醉药对慢性阻塞性肺患者呼吸道阻力的影响

(王 薛张纲 校)

C. A. Volta, V. Alvisi, S. Petrini, S. Zardi, E. Marangoni, R. Ragazzi, M. Capuzzo, and R. Alvisi

Anesth Analg 2005 100: 348-353.

PEDIATRIC ANESTHESIA:

ProSealTM喉罩时压力支持通气与持续气道正压通气的比较:小儿麻醉时的随机交叉研究

(赵延华 译 陈杰 校)

Pressure Support Ventilation Versus Continuous Positive Airway Pressure Ventilation with the ProSealTM Laryngeal Mask Airway: A Randomized Crossover Study of Anesthetized Pediatric Patients

A. von Goedecke, J. Brimacombe, C. Hörmann, H. -C. Jeske, A. Kleinsasser, and C. Keller

Anesth Analg 2005 100: 357-360.

AMBULATORY ANESTHESIA:

最佳时机针刺刺激辅助枢复宁预防整形手术病人的呕吐

(裘毅敏 李士通 校)

Optimal Timing of Acustimulation for Antiemetic Prophylaxis as an Adjunct to Ondansetron in Patients Undergoing Plastic Surgery

Paul F. White, Mohamed A. Hamza, Alejandro Recart, Jayne E. Coleman, Amy R. Macaluso, Lyndsey Cox, Omar Jaffer, Dajun Song, and Rod Rohrich

Anesth Analg 2005 100: 367-372.

道拉西酮和枢复宁治疗术后恶心呕吐的比较

(金 薛张刚 校)

Dolasetron Versus Ondansetron for the Treatment of Postoperative Nausea and Vomiting

Tricia A. Meyer, Charles R. Roberson, Mohammed H. Rajab, Jad Davis, and Charles H. McLeskey

Anesth Analg 2005 100: 373-377

ANESTHETIC PHARMACOLOGY:

急性大剂量接触有机磷时的保护性药物:小鼠中应用甲氧氯普胺、泰必利与解磷定的比较

(忻纪华 陈杰 校)

Protective Drugs in Acute Large-Dose Exposure to Organophosphates: A Comparison of Metoclopramide and Tiapride with Pralidoxime in Rats
Georg A. Petroianu, Mohammed Y. Hasan, Syed M. Nurulain, Kholoud Arafat, Rajan Sheen, Ayman Saleh, and Andrea Schmitt

Anesth Analg 2005 100: 382-386.

针刺刺激的时间并不影响麻醉药的需要量

(沈浩译,李士通校)

The Timing of Acupuncture Stimulation Does Not Influence Anesthetic Requirement

Grigory Chernyak, Papiya Sengupta, Rainer Lenhardt, Edwin Liem, Anthony G. Doufas, Daniel I. Sessler, and Ozan Akça

Anesth Analg 2005 100: 387-392.

顺式阿曲库铵在眼咽肌营养不良患者的药效动力学

(金 薛张刚 校)

Cisatracurium Pharmacodynamics in Patients with Oculopharyngeal Muscular Dystrophy

Marie-Josée Caron, François Girard, Dominique C. Girard, Daniel Boudreault, Bernard Brais, Edgard Nassif, Philippe Chouinard, Monique Ruel, and André Duranceau

Anesth Analg 2005 100: 393-397.

异氟醚麻醉期间CO2通过中枢而非外周途径抑制F

(殷文渊 译 陈杰 校)

Carbon Dioxide Depresses the F Wave by a Central, Not Peripheral, Mechanism During Isoflurane Anesthesia

Carmen Dominguez, Earl Carstens, and Joseph F. Antognini

Anesth Analg 2005 100: 398-403.

高浓度笑气能减弱大鼠由吗啡产生的异氟醚最小肺泡浓度的节省效应

(张曦 李士通 校)

Large Concentrations of Nitrous Oxide Decrease the Isoflurane Minimum Alveolar Concentration Sparing Effect of Morphine in the Rat

Martín Santos, Viviana Kuncar, Fernando Martínez-Taboada, and Francisco J. Tendillo

Anesth Analg 2005 100: 404-408.

利多卡因使活性内皮IL-1betaIL-6IL-8浓度降低及ICAM-1表达的削弱

(金 薛张刚 校)

Activated Endothelial Interleukin-1ß, -6, and -8 Concentrations and Intercellular Adhesion Molecule-1 Expression Are Attenuated by Lidocaine

Wei Lan, Dominic C. Harmon, Jiang H. Wang, George D. Shorten, and Paul H. Redmond

Anesth Analg 2005 100: 409-412.

离体脊髓的吸入麻醉药洗出过程中高反应性与乙醇清除的比较

(赵延华 译 陈杰 校)

Hyperresponsiveness on Washout of Volatile Anesthetics from Isolated Spinal Cord Compared to Withdrawal from Ethanol

Shirley M.E. Wong, Sarah M. Sweitzer, Michael C. Peters, and Joan J. Kendig

Anesth Analg 2005 100: 413-436.

ATP敏感钾通道参与培养的人主动脉内皮细胞膜电位对髙渗的反应

(黄施伟 李士通 校)

Involvement of Adenosine Triphosphate-Sensitive Potassium Channels in the Response of Membrane Potential to Hyperosmolality in Cultured Human Aorta Endothelial Cells

Mikiyo Yamaguchi, Yoshinobu Tomiyama, Toshiko Katayama, Hiroshi Kitahata, and Shuzo Oshita

Anesth Analg 2005 100: 419-426.

TECHNOLOGY, COMPUTING, AND SIMULATION:

挥发性和气体麻醉药在体外输入系统中吸附性丢失的研究

(吴德华 薛张刚 校)

Sorptive Loss of Volatile and Gaseous Anesthetics from In Vitro Drug Application Systems

Takahiro Suzuki, Ichiro Uchida, and Takashi Mashimo

Anesth Analg 2005 100: 427-430

血红蛋白氧载体(Oxyglobin®Hemopure®HemolinkTM)对乳酸测定的干扰

(朱辉 译 陈杰 校)

Lactate Measurement Interference by Hemoglobin-Based Oxygen Carriers (Oxyglobin®, Hemopure®, and HemolinkTM)

Jonathan S. Jahr, Stephen Osgood, Stephen J. Rothenberg, Qiao-Ling Li, Anthony W. Butch, Robert Gunther, Anthony Cheung, and Bernd Driessen

Anesth Analg 2005 100: 431-436.

氧化血红蛋白为基质的携氧分子(血红蛋白 Glutamer-200)产生的高铁血红蛋白干扰乳酸测定 (YSI 2700 SELECTTM生化分析仪)吗?

(轩泓 李士通 校)

Does Methemoglobin from Oxidized Hemoglobin-Based Oxygen Carrier (Hemoglobin Glutamer-200) Interfere with Lactate Measurement (YSI 2700 SELECTTM Biochemistry Analyzer)?

Stephen L. Osgood, Jonathan S. Jahr, Poonam Desai, Jessica Tsukamoto, and Bernd Driessen

Anesth Analg 2005 100: 437-439.

刺激模式和异丙酚血浆浓度对运动诱发电位的修饰效应

(廖庆武 薛张纲 校)

The Modifying Effects of Stimulation Pattern and Propofol Plasma Concentration on Motor-Evoked Potentials

Kai M. Scheufler, Peter C. Reinacher, Winfried Blumrich, Josef Zentner, and Hans-Joachim Priebe

Anesth Analg 2005 100: 440-447.

PAIN MEDICINE:

围术期联合使用右美沙芬和静脉利多卡因对腹腔镜胆囊手术后疼痛的缓解和肠功能恢复的影响

(朱辉 译 陈杰 校)

The Interaction Effect of Perioperative Cotreatment with Dextromethorphan and Intravenous Lidocaine on Pain Relief and Recovery of Bowel Function After Laparoscopic Cholecystectomy

Ching-Tang Wu, Cecil O Borel, Meei-Shyuan Lee, Jyh-Cherng Yu, Hang-Seng Liou, Haun-De Yi, and Chih-Ping Yang

Anesth Analg 2005 100: 448-453.

环加氧酶-2抑制剂帕瑞考昔钠治疗妇产科剖腹手术后疼痛与肌注吗啡12 mg一样有效

(赵雪莲 李士通 校)

The Cyclooxygenase-2-Specific Inhibitor Parecoxib Sodium Is as Effective as 12 mg of Morphine Administered Intramuscularly for Treating Pain After Gynecologic Laparotomy Surgery

T. Philip Malan, Jr, Stephen Gordon, Richard Hubbard, and Michael Snabes

Anesth Analg 2005 100: 454-460

吗啡能加强神经结扎损伤大鼠模型椎管内注射N(6)-2-苯基-腺苷-右异构体(R-PIA)的镇痛效果

(沈 薛张刚 校)

Morphine Can Enhance the Antiallodynic Effect of Intrathecal R-PIA in Rats with Nerve Ligation Injury

Jai-Hyun Hwang, Gyu-Sam Hwang, Sung-Kang Cho, and Sung-Min Han

Anesth Analg 2005 100: 461-468.

术后患者使用曲马多和吗啡的半数有效量:一项相互作用的研究

(朱玫娟 译 陈杰 校)

The Median Effective Dose of Tramadol and Morphine for Postoperative Patients: A Study of Interactions

Thi Aurore Marcou, Sophie Marque, Jean-Xavier Mazoit, and Dan Benhamou

Anesth Analg 2005 100: 469-474.

注射小剂量氯胺酮可改善全膝关节成形术后镇痛及康复

(周雅春 李士通 校)

Small-Dose Ketamine Infusion Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty

Frédéric Adam, Marcel Chauvin, Bertrand Du Manoir, Mathieu Langlois, Daniel I. Sessler, and Dominique Fletcher

Anesth Analg 2005 100: 475-480.

异丙酚对热痛觉的影响

(孙志荣 薛张纲 )

The Effect of Propofol on Thermal Pain Perception

Michael A. Frölich, Donald D. Price, Michael E. Robinson, Jonathan J. Shuster, Douglas W. Theriaque, and Marc W. Heft

Anesth Analg 2005 100: 481-486.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

一个作为数据收集平台面向多中心研究的网站

(朱玫娟 译 陈杰 校)

An Internet Web Site as a Data Collection Platform for Multicenter Research

Alexander Avidan, Charles Weissman, and Charles L. Sprung

Anesth Analg 2005 100: 506-511.

CRITICAL CARE AND TRAUMA:

环周性调整超声探头位置以确定穿刺颈内静脉的最佳径路:对成人无创性几何研究

(王立中 李士通 校)

Circumferential Adjustment of Ultrasound Probe Position to Determine the Optimal Approach to the Internal Jugular Vein: A Noninvasive Geometric Study in Adults

James M. Riopelle, Darren P. Ruiz, John P. Hunt, Mark R. Mitchell, J. Carlos Mena, Jason A. Rigol, Bruno C. Jubelin, Arthur J. Riopelle, Valeriy V. Kozmenko, and Matthew K. Miller

Anesth Analg 2005 100: 512-519.

肾上腺素加强全血中血小板与白细胞粘着力的体外实验

许文妍 薛张纲 )

Epinephrine Enhances Platelet-Neutrophil Adhesion in Whole Blood In Vitro

Nicola A. Horn, Denisa M. Anastase, Klaus E. Hecker, Jan H. Baumert, Tilo Robitzsch, and Rolf Rossaint

Anesth Analg 2005 100: 520-526.

危重病中指导营养支持实验的实际方法学质量的回顾:有待提高

殷文渊 陈杰 校)

A Review of the True Methodological Quality of Nutritional Support Trials Conducted in the Critically Ill: Time for Improvement

Gordon S. Doig, Fiona Simpson, and Anthony Delaney

Anesth Analg 2005 100: 527-533.

NEUROSURGICAL ANESTHESIA:

神经外科手术患者长期应用苯妥英或卡马西平治疗影响顺式阿曲库铵引起的神经肌肉阻滞作用

(陈玮    李士通 校)

Cisatracurium-Induced Neuromuscular Blockade Is Affected by Chronic Phenytoin or Carbamazepine Treatment in Neurosurgical Patients

Anouk Richard, François Girard, Dominique C. Girard, Daniel Boudreault, Philippe Chouinard, Robert Moumdjian, Alain Bouthilier, Monique Ruel, Johanne Couture, and France Varin

Anesth Analg 2005 100: 538-544.

REGIONAL ANESTHESIA:

脊麻手术中应用2-氯普鲁卡因初始十个月的经验

(蔡美华 薛张刚 校)

Spinal 2-Chloroprocaine for Surgery: An Initial 10-Month Experience

Jessica R. Yoos and Dan J. Kopacz

Anesth Analg 2005 100: 553-558.

\2-氯普鲁卡因脊髓麻醉:复合可乐定的效果

(齐波 译 陈杰 校)

Spinal 2-Chloroprocaine: The Effect of Added Clonidine

Brad R. Davis and Dan J. Kopacz

Anesth Analg 2005 100: 559-565.

2-氯普鲁卡因脊麻:在志愿者中与小剂量布比卡因比较

(周志坚 李士通 )

Spinal 2-Chloroprocaine: A Comparison with Small-Dose Bupivacaine in Volunteers

Jessica R. Yoos and Dan J. Kopacz

Anesth Analg 2005 100: 566-572.

脊麻2-氯普鲁卡因:志愿者中与普鲁卡因比较

(费 薛张刚 校)

Spinal 2-Chloroprocaine: A Comparison with Procaine in Volunteers

Aaron F. Gonter and Dan J. Kopacz

Anesth Analg 2005 100: 573-579.

GENERAL ARTICLES:

全麻诱导期间应用呼吸末正压通气可增加病态肥胖病人呼吸暂停而无低氧的持续时间

(齐波 译 陈杰 校)

Positive End-Expiratory Pressure During Induction of General Anesthesia Increases Duration of Nonhypoxic Apnea in Morbidly Obese Patients
Sylvain Gander, Philippe Frascarolo, Michel Suter, Donat R. Spahn, and Lennart Magnusson

Anesth Analg 2005 100: 580-584

成人颈深部感染的气道管理:病例系列和文献回顾

(张莹 李士通 校)

Airway Management in Adult Patients with Deep Neck Infections: A Case Series and Review of the Literature

Andranik Ovassapian, Meltem Tuncbilek, Erik K. Weitzel, and Chandrashekhar W. Joshi

Anesth Analg 2005 100: 585-589.

与经典喉罩比较Proseal喉罩寿命较短

(孙敏莉 薛张纲 校)

The ProSealTM Has a Shorter Life-Span than the ClassicTM Laryngeal Mask Airway

Sarah Doneley, Joseph Brimacombe, Christian Keller, and Achim von Goedecke

Anesth Analg 2005 100: 590-593.

 

心脏手术期间伤口干燥能防止吗? 一项实验性研究

Can Wound Desiccation Be Averted During Cardiac Surgery? An Experimental Study

Mikael Persson, PhD, and Jan van der Linden, MD PhD

Division of Medical Engineering, Department of Laboratory Medicine, and Department of Cardiothoracic Surgery & Anesthesiology; Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

Anesth Analg 2005 100: 315-320.

 

心脏手术中伤口暴露而干燥,尤其是手术室使用空气流通装置及吹入干燥的CO2时。本文作者比较了心胸伤口体外模型中在上述情况和吹入潮湿CO2的情况下的气体湿度和干燥率。为评价流速的影响,CO210l/min的流速经过一个标准末端开口的管子或一个低流量的气体雾化器。并与没有吸入的对照组相比较。当通过末端开口的管子时,无论吸入干燥或湿化的CO2,两组的湿度基本相同。然而,总的干燥率比对照组高(P<0.001),尤其是在暴露处与气体喷射的地方,这些地方的干燥率要比对照组高3倍(P<0.001)。使用气体雾化器时,干燥CO2导致零湿度,与对照组的干燥率相同。CO2湿化的吸入组与对照组相比增加了湿度(P<0.001),降低干燥率90%P<0.001)。湿化的CO2可被用来防止心胸外科伤口的干燥。潮湿的气体只有经过低流量的出口装置时才有效。

(朱慧琛 译 陈杰 校)

During cardiac surgery the wound is exposed to desiccation, especially as a result of operating room ventilation and the insufflation of dry carbon dioxide (CO2) for de-airing. We compared the gas humidity and desiccation rates in an in vitro model of a cardiothoracic wound during these conditions and during insufflation of humidified CO2. To assess the influence of flow velocity, CO2 was insufflated at 10 L/min via two devices, a standard open-ended tube and a low-velocity gas diffuser. The treatment arms were compared with a control without insufflation. When insufflated via the open-ended tube the humidity in the model was almost equal to the control, both with dry and humidified CO2. However, the total desiccation rate was more rapid than the control (P < 0.001), especially in the area exposed to the gas jet where the desiccation rate was three times more rapid (P < 0.001). With the gas diffuser, dry CO2 caused almost zero humidity and a desiccation rate that was almost equal to the control. Humidified CO2 increased humidity in comparison with the control (P < 0.001) and decreased the desiccation rate by >90% (P < 0.001). Humidified CO2 may be used to avert desiccation of the cardiothoracic wound. The humidified gas is effective only when delivered via a low-velocity outlet device.

 

氙或笑气麻醉对猪单肺通气的全身氧合和肺灌注的影响

The Effects of Xenon or Nitrous Oxide Supplementation on Systemic Oxygenation and Pulmonary Perfusion During One-Lung Ventilation in Pigs

Konrad Schwarzkopf, MD*, Torsten Schreiber, MD*, Elke Gaser, MD*, Niels-Peter Preussler, MD*, Lars Hueter, MD*, Harald Schubert, DVM{dagger}, Helga Rek*, and Waheedullah Karzai, MD{ddagger}

*Department of Anesthesiology and Intensive Care Medicine and {dagger}Institute for Experimental Animals, University of Jena; and {ddagger}Department of Anesthesiology and Intensive Care Medicine, Zentralklinik Bad Berka, Germany

Anesth Analg 2005 100: 335-339.

 

在单肺通气(OLV)过程中,不同的麻醉方式可影响全身血流动力学状态、肺灌注和氧合。本文作者研究了猪单肺通气模型中异丙酚复合氙气(Xe)或笑气麻醉时对氧合、肺灌注和全身及肺血流动力学的影响。九只猪施行麻醉、气管插管和机械通气。在置入动脉导管和肺动脉导管后,通过气管切开处置入左双腔气管导管。异丙酚静脉持续滴注并随机复合N2O/O26040)或Xe/ O26040)或N2/O26040)。所有检测均在吸入浓度稳定后进行。使用染色微滴法监测肺灌注的微小差别。单肺通气时氧合(N2/O2, N2O/O2, Xe/ O2Pa O2分别为90+1795+2094+20mmHg)、左肺灌注(N2/O2, N2O/O2, Xe/ O2组分别为16%+5%14%+6%18.8%)组间无明显差别。但N2O/O2组平均动脉压(N2/O2, N2O/O2, Xe/ O2组分别为78+2562+2366+23mmHg)和混合静脉饱和度(N2/O2, N2O/O2, Xe/ O2组分别为55%+12%48%+12%50%+12%)低于对照组(N2/O2)。因此,在实验性单肺通气时静脉麻醉复合XeN2O不会影响氧合及肺灌注。

(朱慧琛 译 陈杰 校)

During experimental one-lung ventilation (OLV), the type of anesthesia may alter systemic hemodynamics, lung perfusion, and oxygenation. We studied whether xenon (Xe) or nitrous oxide (N2O) added to propofol anesthesia would affect oxygenation, lung perfusion, and systemic and pulmonary hemodynamics during OLV in a pig model. Nine pigs were anesthetized, tracheally intubated, and mechanically ventilated. After placement of arterial and pulmonary artery catheters, a left-sided double-lumen tube was placed via tracheotomy. IV anesthesia with propofol was supplemented in random order with N2O/O2 60:40 or Xe/O2 60:40 or N2/O2 60:40. All measurements were made after stabilization at each concentration. Differential lung perfusion was measured with colored microspheres. Oxygenation (Pao2: 90 ± 17, 95 ± 20, and 94 ± 20 mm Hg for N2/O2, N2O/O2, and Xe/O2) and left lung perfusion (16% ± 5%, 14% ± 6%, and 18.8% for N2/O2, N2O/O2, and Xe/O2) during OLV did not differ among the 3 groups. However, mean arterial blood pressure (78 ± 25, 62 ± 23, and 66 ± 23 mm Hg for N2/O2, N2O/O2, and Xe/O2) and mixed venous saturation (55% ± 12%, 48% ± 12%, and 50% ± 12% for N2/O2, N2O/O2, and Xe/O2) were reduced during N2O/O2 as compared with the control group (N2/O2). Supplementation of IV anesthesia with Xe or N2O does not impair oxygenation nor alter lung perfusion during experimental OLV.

 

ProSealTM喉罩时压力支持通气与持续气道正压通气的比较:小儿麻醉时的随机交叉研究

Pressure Support Ventilation Versus Continuous Positive Airway Pressure Ventilation with the ProSealTM Laryngeal Mask Airway: A Randomized Crossover Study of Anesthetized Pediatric Patients

A. von Goedecke, MD*, J. Brimacombe, MB, ChB, FRCA, MD{dagger}, C. Hörmann, MD*, H. -C. Jeske, MD*, A. Kleinsasser, MD*, and C. Keller, MD*

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

Anesth Analg 2005 100: 357-360.

 

对成人的研究发现,持续气道正压通气(CPAP)和压力支持通气(PSV)可改善气体交换,但是关于儿童的研究很少。作者比较了儿童麻醉下利用ProSealTM喉罩通气时PSVCPAP的有效性。病人随机分为两组,术前获得相关数据。在第一组,病人按顺序进行CPAPPSVCPAP。在第二组,病人按顺序进行PSVCPAPPSVPSV时呼气末正压(PEEP3cmH2O、压力支持设定为高于PEEP水平10cmH2OCPAP设定为3cmH2O。每一种通气模式维持5min,在此过程中记录以下数据,包括呼气末CO2(PETCO2)SpO2、潮气量、气道峰压、呼吸功(WOB)、 食道压的变化、压力时间乘积、呼吸驱动力、吸入时间分数、呼吸频率、无创平均动脉压和心率。在第一组,PSV前后进行CPAP,测定值相同。在第二组,CPAP前后进行PSV,测定值相同。CPAPPETCO2、呼吸频率、WOB、压力时间乘积、食道压的变化、吸入时间分数分别为52±7mmHg30±6/min0.95 ±0.72 JL150 ±90cmH2O·s-1·min-114.1±8.9 cmH2O34% ±5%PSV的相应指标分别为46±6mmHg24±6/min0.54±0.54JL94±88 cmH2O·s-1·min-110.6±7.4cmH2O29%±3%,均小于CPAPP < 0.0010.05)。PSV的潮气量为179 ±50mL,高于CPAP129 ±44 mLP < 0.001)。SpO2、呼吸驱动力、平均动脉压和心率在两种通气模式没有区别。结论:对ASA I级的1-7岁儿童利用ProSealTM喉罩进行麻醉时,与CPAP相比PSV能改善气体交换并减少呼吸功(WOB)。

(赵延华 译 陈杰 校)

Continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) improve gas exchange in adults, but there are little published data regarding children. We compared the efficacy of PSV with CPAP in anesthetized children managed with the ProSealTM laryngeal mask airway. Patients were randomized into two equal-sized crossover groups and data were collected before surgery. In Group 1, patients underwent CPAP, PSV, and CPAP in sequence. In Group 2, patients underwent PSV, CPAP, and PSV in sequence. PSV comprised positive end-expiratory pressure set at 3 cm H2O and inspiratory pressure support set at 10 cm H2O above positive end-expiratory pressure. CPAP was set at 3 cm H2O. Each ventilatory mode was maintained for 5 min. The following data were recorded at each ventilatory mode: ETco2, Spo2, expired tidal volume, peak airway pressure, work of breathing patient (WOB), {delta}esophageal pressure, pressure time product, respiratory drive, inspiratory time fraction, respiratory rate, noninvasive mean arterial blood pressure, and heart rate. In Group 1, measurements for CPAP were similar before and after PSV. In Group 2, measurements for PSV were similar before and after CPAP. When compared with CPAP, PSV had lower ETco2 (46 ± 6 versus 52 ± 7 mm Hg; P < 0.001), slower respiratory rate (24 ± 6 versus 30 ± 6 min–1; P < 0.001), lower WOB (0.54 ± 0.54 versus 0.95 ± 0.72 JL–1; P < 0.05), lower pressure time product (94 ± 88 versus 150 ± 90 cm H2O s–1min–1; P < 0.001), lower {delta}esophageal pressure (10.6 ± 7.4 versus 14.1 ± 8.9 cm H2O; P < 0.05), lower inspiratory time fraction (29% ± 3% versus 34% ± 5%; P < 0.001), and higher expired tidal volume (179 ± 50 versus 129 ± 44 mL; P < 0.001). There were no differences in Spo2, respiratory drive, mean arterial blood pressure, and heart rate. We conclude that PSV improves gas exchange and reduces WOB during ProSealTM laryngeal mask airway anesthesia compared with CPAP in ASA physical status I children aged 1–7 yr.

 

急性大剂量接触有机磷时的保护性药物:小鼠中应用甲氧氯普胺、泰必利与解磷定的比较

Protective Drugs in Acute Large-Dose Exposure to Organophosphates: A Comparison of Metoclopramide and Tiapride with Pralidoxime in Rats

Georg A. Petroianu, MD, PhD, FCP*, Mohammed Y. Hasan, PhD, DABT*, Syed M. Nurulain, Mphil*, Kholoud Arafat, MSc*, Rajan Sheen, MSc*, Ayman Saleh, PhD{dagger}, and Andrea Schmitt, MD{ddagger}

Departments of *Pharmacology and {dagger}Biochemistry, Faculty of Medicine & Health Sciences, UAE University, Al-Ain, United Arab Emirates; and {ddagger}Central Institute of Mental Health, Mannheim, Germany

Anesth Analg 2005 100: 382-386.

 

作用微弱的可逆性胆碱酯酶抑制剂与作用强烈的抑制剂如有机磷酸盐合用时,可以产生保护性作用。慢性小剂量接触有机磷后,体内和体外实验研究显示苯甲酰胺化合物、甲氧氯普胺在胆碱酯酶拮抗对氧磷时可产生保护作用(假定通过该机制)。泰必利是相关的苯甲酰胺类药物。本研究中作者用治疗金标准”——解磷定比较了甲氧氯普胺和泰必利对急性大剂量接触有机磷类药对氧磷的保护作用。组1接受1umol的对氧磷(约为75%的致死剂量),组2 接受50umol的甲氧氯普胺,组3 接受50umol的泰必利,组4 接受50umol的解磷定,组5 接受1umol的对氧磷和50umol的甲氧氯普胺,组6 接受1umol的对氧磷和50umol的泰必利,组7 接受1umol的对氧磷和50umol的解磷定。所有药物均以外周静脉用药。所有动物均观察48小时,记录30分钟,12342448小时的死亡率。分别于基础状态,30分钟,24小时和48小时抽血测红细胞乙酰胆碱酯酶。除了第7组死亡出现较晚,其余组死亡主要集中在对氧磷用药后30分钟,而此后变化甚小。甲氧氯普胺,泰必利和解磷定组30分钟时的死亡率几乎为0,对氧磷组为73±20,对氧磷和甲氧氯普胺组为65±15,对氧磷和泰必利组为38±14,对氧磷和解磷定组为13±1948小时时,死亡率在对氧磷组为75±18,对氧磷和甲氧氯普胺组为67±17,对氧磷和泰必利组为42±16,对氧磷和解磷定组为27±24。在急性大剂量对氧磷中毒后,甲氧氯普胺对死亡率无明显影响。泰必利与解磷定均能明显降低死亡率。30分钟时泰必利的保护作用较解磷定弱,但在48小时时两者无显著差异。

(忻纪华 陈杰 校)

Weak and reversible inhibitors of cholinesterase(s), when coadministered in excess with a more potent inhibitor such as organophosphates, can act in a protective manner. The benzamide compound, metoclopramide, confers some protection (putatively via this mechanism) for cholinesterases against inhibition by paraoxon both in vitro and in vivo, after chronic small-dose exposure. Tiapride is a related benzamide. In this study, we compared the protection by metoclopramide and tiapride in rats acutely exposed to large doses of paraoxon with the therapeutic "gold standard," pralidoxime. Group 1 received 1 µmol paraoxon (approximately 75% lethal dose), Group 2 received 50 µmol metoclopramide, Group 3 received 50 µmol tiapride, Group 4 received 50 µmol pralidoxime, Group 5 received 1 µmol paraoxon + 50 µmol metoclopramide, Group 6 1 µmol paraoxon + 50 µmol tiapride, and Group 7 1 µmol paraoxon + 50 µmol pralidoxime. All substances were administered intraperitoneally. The animals were monitored for 48 h and mortality was recorded at 30 min, 1, 2, 3, 4, 24, and 48 h. Blood was taken for red blood cell acetylcholinesterase measurements at baseline, 30 min, 24, and 48 h. With the exception of Group 7, in which some late mortality was observed, mortality occurred mainly in the first 30 min after paraoxon administration with minimal changes occurring thereafter. Mortality at 30 min was 0% in the metoclopramide, tiapride, and pralidoxime groups and 73 ± 20 (paraoxon), 65 ± 15 (paraoxon + metoclopramide), 38 ± 14 (paraoxon + tiapride), and 13 ± 19 (paraoxon + pralidoxime). Mortality at 48 h was 75 ± 18 (paraoxon), 67 ± 17 (paraoxon + metoclopramide), 42 ± 16 (paraoxon + tiapride), and 27 ± 24 (paraoxon + pralidoxime). Metoclopramide does not significantly influence mortality after acute large-dose paraoxon exposure. Both tiapride and pralidoxime significantly decreased mortality in our model. The protection conferred by tiapride was significantly less than that conferred by pralidoxime at 30 min, but was not significantly different at 24 and 48 h.

 

异氟醚麻醉期间CO2通过中枢而非外周途径抑制F

Carbon Dioxide Depresses the F Wave by a Central, Not Peripheral, Mechanism During Isoflurane Anesthesia

Carmen Dominguez, MD*, Earl Carstens, PhD{dagger}, and Joseph F. Antognini, MD*{dagger}

*Department of Anesthesiology and Pain Medicine and {dagger}Section of Neurobiology, Physiology and Behavior, University of California, Davis

Anesth Analg 2005 100: 398-403.

 

二氧化碳(CO2)具有麻醉特性并有报道称抑制诱发肌电图的F波,F波被认为代表运动神经元的兴奋性。麻醉药如异氟醚也会抑制F波。因为CO2能抑制肌肉收缩功能和脊髓神经元,现在还不清楚CO2抑制F波是通过中枢途径还是外周途径。作者使用异氟醚(1.4%)麻醉兔子,准备后肢转流(使用膜性氧合器),籍此获得后肢肌肉和躯干的CO2分压可以单独调整。记录后肢和躯干的CO2均正常时,下肢或躯干CO2升高({approx}90 mm Hg)时,下肢和躯干CO2都升高时({approx}90 mm Hg)脚底肌肉的F波。结果显示只有后肢CO2的升高时对F波的振幅没有显著影响,而躯干CO2的升高会使F波降低52%±32%。当躯干低碳酸血症时增加后肢的CO2并不会导致额外的F波降低。因此,CO2抑制F波是通过中枢而非外周途径,但确切机制仍不清楚。

(殷文渊 译 陈杰 校)

Carbon dioxide (CO2) has anesthetic properties and has been reported to depress the F wave of the evoked electromyogram; the F wave is thought to reflect motoneuron excitability. Anesthetics such as isoflurane also depress the F wave. Because CO2 can depress muscle contractile function, as well as spinal cord neurons, it is unclear whether CO2 depresses the F wave via a central or peripheral mechanism. We anesthetized rabbits with isoflurane (1.4%) and prepared for hindlimb bypass (with a membrane oxygenator) whereby the partial pressures of CO2 in the hindlimb muscle and torso could be independently adjusted. The F wave was recorded from the hindlimb plantar muscles when the CO2 was normal to the hindlimb and torso, and when it was increased (to {approx}90 mm Hg) in the hindlimb, the torso, or both. Increasing the CO2 to just the hindlimb had no significant effect on the F-wave amplitude, but increasing the CO2 to the torso depressed the F wave to 52% ± 32% of control; adding CO2 to the hindlimb during torso hypercarbia did not result in any additional depression of the F wave. CO2 depressed the F wave via a central, not peripheral, mechanism, although the precise mechanism is unknown.

 

离体脊髓的吸入麻醉药洗出过程中高反应性与乙醇清除的比较

Hyperresponsiveness on Washout of Volatile Anesthetics from Isolated Spinal Cord Compared to Withdrawal from Ethanol

Shirley M.E. Wong, MSc, Sarah M. Sweitzer, PhD{dagger}, Michael C. Peters, BS, and Joan J. Kendig, PhD

Department of Anesthesia, Stanford University School of Medicine, Stanford, California.

Anesth Analg 2005 100: 413-436.

 

作者用新生鼠游离的脊髓进行实验,研究吸入麻醉药氟烷和异氟烷(1MAC)的清除过程中观察到的群集兴奋性诱发电位(pEPSP)与麻醉浓度的乙醇相比反应性较高的机制。暴露于每一种麻醉药30min并洗出,pEPSP面积增加,显著高于对照水平(P < 0.01-0.001)。相同时间内持续暴露于极小浓度(0.025MAC)的异氟烷,pEPSP增大程度相似 (P < 0.05)。提示这种现象是洗出过程中低浓度麻醉药引起的直接兴奋效应,不同于乙醇的真正清除过程。异氟烷而不是氟烷能显著增加钾刺激引起的兴奋性神经递质谷氨酸、天冬氨酸和P物质的释放,提示对该药物的高反应性是突触前介导的递质释放增加的结果。一种广谱的特殊蛋白激酶C抑制剂GF109203X阻断乙醇清除过程中的高反应性,但不能阻断氟烷洗出过程的高反应性。如果麻醉后行为症状的出现是以类似于脊髓观察到的兴奋性为基础,这些结果就显示它们反映直接兴奋作用,而不是清除过程。是由于对离子通道或受体的直接作用,而不是蛋白激酶C介导的间接效应。

(赵延华 译 陈杰 校)

We performed experiments in spinal cords isolated from neonatal rats to probe the mechanisms responsible for hyperresponsiveness of the population excitatory evoked potential (pEPSP) observed on washout of the volatile anesthetics halothane and isoflurane (1 minimal alveolar anesthetic concentration equivalent, MAC) compared with that observed after an anesthetic concentration of ethanol. After 30 min exposure to each anesthetic and washout, pEPSP area increased to levels significantly more than control (P < 0.01–0.001). Exposure to a very small (0.025 MAC) concentration of isoflurane over the same period itself produced a similarly exaggerated pEPSP (P < 0.05) in the continued presence of the drug, suggesting that the phenomenon is a direct excitatory effect of the small concentrations of anesthetic on washout, unlike the true withdrawal observed with ethanol. Isoflurane, but not halothane, significantly increased the amount of potassium-stimulated release of the excitatory neurotransmitters glutamate, aspartate, and substance P, suggesting the hyperresponsiveness for that drug is the result of a presynaptically mediated increase in transmitter release. A broad spectrum specific protein kinase C inhibitor, GF109203X, blocked ethanol withdrawal hyperresponsiveness but not hyperresponsiveness after halothane. If the behavioral symptoms of emergence from anesthesia are based on excitatory actions similar to those observed in the spinal cord, the results show that they represent direct excitatory actions rather than withdrawal and are attributable to direct actions on ion channels or receptors, rather than indirect effects mediated by protein kinase C.

 

血红蛋白氧载体(Oxyglobin®Hemopure®HemolinkTM)对乳酸测定的干扰

Lactate Measurement Interference by Hemoglobin-Based Oxygen Carriers (Oxyglobin®, Hemopure®, and HemolinkTM)

Jonathan S. Jahr, MD, Stephen Osgood, MD, Stephen J. Rothenberg, PhD, Qiao-Ling Li, MD, PhD, Anthony W. Butch, PhD, Robert Gunther, PhD, Anthony Cheung, PhD, and Bernd Driessen, DVM, PhD

Departments of Anesthesiology and Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and Department of Anesthesiology, Charles R. Drew University of Medicine and Science, Martin Luther King, Jr./Drew Medical Center, Los Angeles, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; National Institute of Public Health, Cuernavaca, Mexico; Departments of Surgery and Medical Pathology, UC Davis School of Medicine; and Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Anesth Analg 2005 100: 431-436

 

作者研究血红蛋白氧载体(HBOCs)、小牛血红蛋白-200(HBOC-200Oxyglobin®)、小牛血红蛋白-250HBOC-201, Hemopure®)和hemolinktTM是否干扰乳酸盐测定的准确性。浓缩的左旋乳酸盐溶液、HBOC 和全血或是加了PlasmaLYte-ATM 血浆的混合物加到样管里做成浓度线性而持续增加的连续乳酸盐浓缩液样品。乳酸盐样品浓度范围在5~110mg/dl(0.6-12mm)〔生理参考范围:5-20mg/ml0.56-2.2mm) ]。将乳酸盐浓度的仪器测量值与计算值做比较。小牛血红蛋白-250乳酸盐浓度的测量值与计算值之间平均相差-5.1mg/dl(-0.51mm)(LX-20),乳酸盐浓度越高的时候两个值相差越大。hemolinktTM组测量值与计算值之间平均相差-2.2mg/dl(-0.24mm)(LX-20)。兽医产品,小牛血红蛋白-200在三台分析仪(LX-20YSI 1500YSI 2300)上检测。YSI1500测得的值减去计算值的差值平均是+1.3mg/dl,相对于YSI2300 (差值为-2.6mg/dl)LX-20l(差值为-8.4mg/d)来说最精确。这项研究的临床意义在于随着血浆中HBOC水平的增加,乳酸盐浓度的判断将变得不准确,尤其是在乳酸盐浓度较高的时候,这将导致低估乳酸盐测量价值和对病人的处理不足。因此,当血浆中混有HBOC时解释乳酸盐浓度测量值时需慎重。

(朱辉 译 陈杰 校)

We sought to determine whether hemoglobin-based oxygen carriers (HBOCs), hemoglobin glutamer-200 [bovine] (HBOC-200, Oxyglobin®), hemoglobin glutamer-250 [bovine] (HBOC-201, Hemopure®), and hemoglobin raffimer (HemolinkTM) interfere with the accuracy of lactate measurements. Combinations of concentrated L-lactate solution, HBOC, and blood or plasma with added PlasmaLyte-ATM were added to sample tubes to make a linear and constant increase in lactate concentration in consecutive samples. Sample lactate concentrations ranged from 5–110 mg/dL (0.6–12 mm) (physiological reference range: 5–20 mg/dL [0.56–2.2 mm]). Comparisons were made between machine measured lactate concentrations and calculated lactate concentrations. For Hb glutamer-250, the average difference between measured and calculated lactate concentrations was –5.1 mg/dL (–0.57 mm) (LX-20®), with greater underestimation at larger lactate concentrations. For Hb raffimer, the average difference was –2.2 mg/dL (–0.24 mm) (LX-20®). The veterinary product, Hb glutamer-200, was tested on 3 analyzers (LX-20®, YSI 1500, and YSI 2300). The YSI 1500 was the most accurate instrument with the mean difference between measured minus calculated lactate being +1.3 mg/dL versus –2.6 mg/dL (YSI 2300) and –8.4 mg/dL (LX-20®). The clinical implications of this study are that with increasing levels of an HBOC in plasma, lactate interpretation may become inaccurate, especially at larger lactate concentrations, causing underestimation of measured lactate values and possible under-treatment of the patient. Therefore, caution must be exercised when interpreting lactate results when a HBOC is present in plasma.

 

围术期联合使用右美沙芬和静脉利多卡因对腹腔镜胆囊手术后疼痛的缓解和肠功能恢复的影响

The Interaction Effect of Perioperative Cotreatment with Dextromethorphan and Intravenous Lidocaine on Pain Relief and Recovery of Bowel Function After Laparoscopic Cholecystectomy

Ching-Tang Wu, MD*, Cecil O Borel, MD, Meei-Shyuan Lee, MPH{ddagger}, Jyh-Cherng Yu, MD{dagger}, Hang-Seng Liou, MD§, Haun-De Yi, MD||, and Chih-Ping Yang, MD||

Department of *Anesthesiology and {dagger}General Surgery, Tri-Service General Hospital; {ddagger}Department of Public Health, National Defense Medical Center, National Defense University, Taipei; Division of §Obstetrics and Gynecology and ||Anesthesiology, Armed Forces Taoyuan General Hospital, Taiwan, Republic of China; and ¶Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2005 100: 448-453.

 

右美沙芬(DM)和利多卡因都可改善术后疼痛。在这项研究中,作者评估了腹腔镜胆囊手术(LC)后使用右美沙芬和静注利多卡因镇痛的相互作用。100ASAⅠ级择期行LC的患者随机分成四组:(a)肌注马来酸扑尔敏(CPM20mg和静注正常生理盐水(C组);(b) 肌注DM40mg和静注正常生理盐水(DM)(c) 肌注CPM20mg和静注利多卡因3mg·kg-1·h-1L组)(d) 肌注DM40mg和静注利多卡因(DM+L组)。所有的注药都在切皮前30分钟进行。根据休息和咳嗽时视觉疼痛评分,使用度冷丁的次数和剂量以及术后第一次排气的时间等指标评估镇痛效果。结果DM+L组的患者镇痛效果最好,肠功能恢复最快。DML组的患者缓解疼痛的效果明显好于C组的患者。结果表明腹腔镜胆囊手术后联合使用DM和静注利多卡因可增强镇痛效果并对肠功能恢复有协同作用。

(朱辉 译 陈杰 校)

Both dextromethorphan (DM) and IV lidocaine improve postoperative pain relief. In the present study, we evaluated the interaction of DM and IV lidocaine on pain management after laparoscopic cholecystectomy (LC). One-hundred ASA physical status I or II patients scheduled for LC were randomized into four equal groups to receive either: (a) chlorpheniramine maleate (CPM) intramuscular injection (IM) 20 mg and IV normal saline (N/S) (group C); (b) DM 40 mg IM and IV N/S (group DM); (c) CPM 20 mg IM and IV lidocaine 3 mg · kg–1 · h–1 (group L); or (d) DM 40 mg IM and IV lidocaine (group DM+L). All treatments were administered 30 min before skin incision. Analgesic effects were evaluated using visual analog scale pain scores at rest and during coughing, time to meperidine request, total meperidine consumption, and the time to first passage of flatus after surgery. Patients of the DM+L group exhibited the best pain relief and fastest recovery of bowel function among groups. Patients in the DM and L groups had significantly better pain relief than those in the C group. The results showed an additional effect on pain relief and a synergistic effect on recovery of bowel function when DM was combined with IV lidocaine after LC.

 

术后患者使用曲马多和吗啡的半数有效量:一项相互作用的研究

The Median Effective Dose of Tramadol and Morphine for Postoperative Patients: A Study of Interactions

Thi Aurore Marcou, MD, Sophie Marque, MD, Jean-Xavier Mazoit, MD, PhD, and Dan Benhamou, MD

Department of Anesthesiology, Hôpital Bicętre, Assistance Publique-Hôpitaux de Paris, F-94275 Le Kremlin-Bicętre and Anesthesia Laboratory UPRES EA 3540, Faculté de Médecine du Kremlin-Bicętre, Université de Paris-Sud, F-94276 Le Kremlin-Bicętre, France

Anesth Analg 2005 100: 469-474.

 

曲马多是一中枢性止痛剂。在一项采用含小量吗啡的有效平衡镇痛技术的研究中,作者使用等辐射分析法研究曲马多、吗啡和联合使用的半数有效量(ED50 ),以此来判定其交互作用。这项双盲、随机、两阶段的前瞻性研究中,90个术后患者分为3组。每一个患者使用的曲马多和吗啡的剂量由上下分配技术决定。在曲马多组和吗啡组的起始剂量分别为100mg5mg,每次增加的剂量分别为10mg1mg。在第二阶段,曲马多和吗啡的使用剂量的比例为403。疼痛评分(010)小于或等于3为有效镇痛的阈值。然后使用等辐射分析法。曲马多和吗啡的ED50分别为86 mg 5.7 mg95%的可信区间分别为57–115 mg4.2–7.2 mg 。联合使用时曲马多的ED5072 mg95%的可信区间为6282mg,吗啡的ED505.4 mg95%的可信区间为46.2mg。联合使用曲马多和吗啡的效果弱于其相加作用,因此不建议用于术后镇痛。

(朱玫娟 译 陈杰 校)

Tramadol is a centrally-acting analgesic drug. In a search of an effective balanced analgesia technique with a morphine-sparing component, we studied the median effective analgesic doses (ED50) of tramadol, morphine, and their combination to determine the nature of their interaction using an isobolographic analysis. In this double-blind, randomized, two-stage prospective study, 90 postoperative patients were enrolled in one of three groups. The dose of tramadol and morphine received by a particular patient was determined using an up-down allocation technique. Initial doses and increments were, respectively, 100 mg and 10 mg in the tramadol group and 5 mg and 1 mg in the morphine group. In the second part, a 40:3 tramadol:morphine dosing ratio was used. The threshold of effective analgesia was defined as 3 or less on a numerical pain score (0–10). Isobolographic analysis was subsequently applied. The ED50 values (95% confidence interval) of tramadol and morphine were, respectively, 86 mg (57–115 mg) and 5.7 mg (4.2–7.2 mg). The ED50 of the combination was 72 mg (62–82 mg) for tramadol and 5.4 mg (4–6.6.2 mg) for morphine. The combination of tramadol and morphine was infra-additive and thus not recommended for postoperative analgesia.

 

一个作为数据收集平台面向多中心研究的网站

An Internet Web Site as a Data Collection Platform for Multicenter Research

Alexander Avidan, MD, Charles Weissman, MD, and Charles L. Sprung, MD

Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Ein Karem, POB 12000, Jerusalem, 91120, Israel

Anesth Analg 2005 100: 506-511.

对于多中心的研究来说,互联网是一个有效的数据收集的选择。相比传统的诸如使用纸张或传统信件的方式来说,具有很大的优势。作者创建了一个网站,为多中心的有关伦理决策研究收集数据。这个网站采用Microsoft FrontPage做为编辑工具。采用Microsoft Access处理数据库。在网站设计上,安全性问题是最受到关心的。欧洲37个中心近一年半中4248个患者使用这个网站。利用网站收集数据是非常高效的,调查者不需要接受训练就可以使用。使用者的总体满意率较高。除了安全性问题以外,可交互性与用户友善的设计是这个系统获得成功的基石。

(朱玫娟 译 陈杰 校)

The Internet can be an effective alternative for data collection for multicenter studies. It has major advantages over the "classical" method of using paper and traditional ("snail") mail. We developed an Internet site and implemented collection of data for a multicenter study of ethical decision-making. The Web site was built with Microsoft FrontPage as the authoring tool. Database management was performed with Microsoft Access. Security issues were the major concerns for the web design. Thirty-seven European centers enrolled 4248 patients during 1.5 yr using the Internet site. The use of this Internet site for data acquisition was highly effective, and the investigators were able to use the system without training. Overall satisfaction of the investigators was high. After security issues, interactivity and user-friendly design are the main cornerstones for the success of such a system.

 

危重病中指导营养支持实验的实际方法学质量的回顾:有待提高

A Review of the True Methodological Quality of Nutritional Support Trials Conducted in the Critically Ill: Time for Improvement

Gordon S. Doig, PhD, Fiona Simpson, MSc, and Anthony Delaney, MBBS

From the Northern Clinical School, University of Sydney, Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia, the Department of Nutrition, Royal North Shore Hospital, Sydney, Australia and Foothills Medical Centre, Calgary, Alberta, Canada

Anesth Analg 2005 100: 527-533.

 

在这个综述中,作者试图评价危重症病人中进行的营养支持实验的实际方法的质量,并将这些结果同脓毒血症试验的方法相比较。大范围的文献检索显示有111篇危重病人中进行营养支持干预对临床预后影响的随机、对照实验文献。与脓毒血症试验相比较,营养支持试验似乎较少使用盲法(营养支持实验35 /111;脓毒血症试验32 / 40, P < 0.001)或缺少意向治疗分析((营养支持实验64 /111;脓毒血症试验37 / 40, P < 0.001)。较少使用随机方法(营养支持实验19 / 111;脓毒血症试验12 / 40 versus, P = 0.010),而众所周知这可以保持分配的隐密性。虽然1996年公布配对声明后营养支持研究中使用盲法有所增加(公布前9 /47 ;公布后 26 / 64, P = 0.023),但在其他关键领域中并没有改善。先前的声明中描述所有的脓毒血症试验的方法质量为。但营养支持研究在方法质量上所有方面都显著差于脓毒血症试验,且随着时间的推移鲜有改善。 如果试图在危重病医学发现具有富有意义的临床预后的差异,未来研究的方法质量必须改进。

殷文渊 陈杰 校)

In this review we sought to appraise the true methodological quality of nutritional support studies conducted in critically ill patients and to compare these findings to the methodological quality of sepsis trials. An extensive literature search revealed 111 randomized controlled trials conducted in critically ill patients evaluating the impact of nutritional support interventions on clinically meaningful outcomes. Compared with sepsis trials, nutritional support studies were significantly less likely to use blinding (32 of 40 versus 35 of 111, P < 0.001) or present an intention-to-treat analysis (37 of 40 versus 64 of 111, P < 0.001). There was a trend toward the less frequent use of randomization methods that are known to maintain allocation concealment (12 of 40 versus 19 of 111, P = 0.10). Although nutritional support studies demonstrated a significant increase in the use of blinding after the publication of the CONSORT statement in 1996 (9 of 47 versus 26 of 64 post-CONSORT, P = 0.023), there were no improvements in other key areas. Previous publications have described the overall methodological quality of sepsis trials as "poor." Nutritional support studies were significantly worse than sepsis trials in all aspects of methodological quality, and there were few improvements noted over time. To detect important differences in clinically meaningful outcomes in critical care, the methodological quality of future studies must be improved.

\2-氯普鲁卡因脊髓麻醉:复合可乐定的效果

Spinal 2-Chloroprocaine: The Effect of Added Clonidine

Brad R. Davis, MD, and Dan J. Kopacz, MD

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

Anesth Analg 2005 100: 559-565

 

2-氯普鲁卡因(2CP)是一种短效的脊髓麻醉药。可乐定能够增加布比卡因和罗哌卡因的麻醉效果,但在常规剂量(12ug/Kg)下可产生全身副反应。目前,还没有关于2-氯普鲁卡因复合可乐定的试验研究。在这个随机双盲交叉试验研究中,作者选择8个志愿者,比较2-氯普鲁卡因(30mg)复合可乐定(15ug)和单独应用2-氯普鲁卡因(30mg)的麻醉效果。在研究中对志愿者进行针刺疼痛,运动力量,对电刺激和大腿止血带耐受性以及行走恢复时间的评估。2CP组和2CP复合可乐定组的最高阻滞平面相似,分别为T8(阻滞范围为T6L2)和T8(阻滞范围为T4T11)(P0.57)。复合可乐定组L1感觉阻滞时间延长(51 ± 23 分钟比 76 ± 11 分钟;P = 0.002),感觉阻滞完全衰退时间延长(99 ± 18 分钟比131 ± 15 分钟;P = 0.001)。复合可乐定组下肢运动阻滞时间增加(恢复至Bromage评分基线水平的时间:65 ± 13 min 79 ± 19 min, P = 0.004;腓肠肌力量恢复 90% P = 0.003)。可乐定增加志愿者对止血带耐受时间从33分钟增加至45分钟(P = 0.06),志愿者恢复行走的时间,自主排泄和出院的时间也相应延长(均为99 ± 18 分钟比 131 ± 15 分钟; P = 0.001),两组志愿者在血流动力学改变上无明显差异,且均无暂时的局部神经主诉症状出现。本研究认为小剂量可乐定可增加2CP脊髓麻醉阻滞时间和麻醉效果且无全身副反应。

(齐波 译 陈杰 校)

Preservative-free 2-chloroprocaine (2-CP) is being investigated for short-acting spinal anesthesia. Clonidine improves the quality of spinal bupivacaine and ropivacaine, but in traditional doses (1–2 µg/kg) it produces systemic side effects. It has not been studied in combination with 2-CP. In this double-blind, randomized crossover study, we compared spinal 2-CP (30 mg) with and without clonidine (15 µg) in eight volunteers. Pinprick anesthesia, motor strength, tolerance to electrical stimulation and thigh tourniquet, and time to ambulation were assessed. Peak block height was similar between 2-CP (T8 [range, T6 to L2]) and 2-CP with clonidine (T8 [range, T4 to T11]) (P = 0.57). Sensory anesthesia was prolonged with clonidine at L1 (51 ± 23 min versus 76 ± 11 min; P = 0.002), as was complete block regression (99 ± 18 min versus 131 ± 15 min; P = 0.001). Lower extremity motor blockade was increased with clonidine (return to baseline Bromage score: 65 ± 13 min versus 79 ± 19 min, P = 0.004; return to 90% gastrocnemius strength: P = 0.003). Clonidine increased tourniquet tolerance from 33 to 45 min (P = 0.06) and increased time to ambulation, spontaneous voiding, and discharge (99 ± 18 min versus 131 ± 15 min for all; P = 0.001). There were no differences in hemodynamic measurements, and no subject reported transient neurologic symptoms. We conclude that small-dose clonidine increases the duration and improves the quality of 2-CP spinal anesthesia without systemic side effects.

 

全麻诱导期间应用呼吸末正压通气可增加病态肥胖病人呼吸暂停而无低氧的持续时间

Positive End-Expiratory Pressure During Induction of General Anesthesia Increases Duration of Nonhypoxic Apnea in Morbidly Obese Patients

Sylvain Gander, MD*, Philippe Frascarolo, PhD*, Michel Suter, MD{dagger}, Donat R. Spahn, MD*, and Lennart Magnusson, MD, PhD*

Departments of *Anesthesiology and {dagger}Surgery, University Hospital, Lausanne, Switzerland Anesth Analg 2005 100: 580-584.

 

在全麻诱导期间应用呼吸末正压通气(PEEP)可以防止肺不张形成,并增加非肥胖病人呼吸暂停而无低氧的持续时间。PEEP也可以防止病态肥胖病人的肺不张。因为病态肥胖病人发生困难气道处理的机会更多,且动脉血去氧饱和发展更迅速。本研究的目的是研究麻醉诱导过程中应用PEEP的临床优点。三十名病态肥胖病人随机分为两组。PEEP组,病人先通过一个持续正压气道压力装置(10cmH­2O)吸入100%纯氧,注入麻醉诱导药物后,通过呼吸机给予PEEP10cmH­2O5分钟至气管插管。对照组诱导顺序相同,但在诱导过程中不给予持续气道正压或PEEP。研究中测定病人SpO2下降到90%时的呼吸暂停持续时间,并在呼吸暂停前和Spo292%时进行动脉血气分析。结果发现PEEP组病人无低氧情况的呼吸暂停时间较对照组延长(188 ± 46 127 ± 43 s P = 0.002)。PEEP组病人呼吸暂停前的PaO2较高(P = 0.038)。研究表明在全麻醉诱导过程中应用正压通气可将病态肥胖病人呼吸暂停而无低氧的持续时间增加50%

(齐波 译 陈杰 校)

Positive end-expiratory pressure (PEEP) applied during induction of anesthesia prevents atelectasis formation and increases the duration of nonhypoxic apnea in nonobese patients. PEEP also prevents atelectasis formation in morbidly obese patients. Because morbidly obese patients have difficult airway management more often and because arterial desaturation develops rapidly, we studied the clinical benefit of PEEP applied during anesthesia induction. Thirty morbidly obese patients were randomly allocated to one of two groups. In the PEEP group, patients breathed 100% O2 through a continuous positive airway pressure device (10 cm H2O) for 5 min. After induction of anesthesia, they were mechanically ventilated with PEEP (10 cm H2O) for another 5 min until tracheal intubation. In the control group, the sequence was the same but without any continuous positive airway pressure or PEEP. We measured apnea duration until Spo2 reached 90% and we performed arterial blood gases analyses just before apnea and at 92% Spo2. Nonhypoxic apnea duration was longer in the PEEP group compared with the control group (188 ± 46 versus 127 ± 43 s; P = 0.002). Pao2 was higher before apnea in the PEEP group (P = 0.038). Application of positive airway pressure during induction of general anesthesia in morbidly obese patients increases nonhypoxic apnea duration by 50%.

开胸或内镜技术行微创冠状动脉旁路移植术时心肌壁节段性运动

Segmental Myocardial Wall Motion During Minimally Invasive Coronary Artery Bypass Grafting Using Open and Endoscopic Surgical Techniques

S. Mierdl, MD, C. Byhahn, MD, V. Lischke, MD, T. Aybek, MD, G. Wimmer-Greinecker, MD, S. Dogan, MD{dagger}, S. Viehmeyer, P. Kessler, MD, and Klaus Westphal, MD

Department of Anesthesiology, Intensive Care Medicine and Pain Control, Department of Thoracic and Cardiovascular Surgery, J.W. Goethe-University Hospital, Frankfurt, Germany

Anesth Analg 2005 Feb 100(2): 306-314.

 

目前对于单支冠状动脉病变行微创外科治疗的方法包括保持心跳、不用心肺转流的微创开胸手术(MIDCAB)和使用心肺转流、完全内镜下机器人辅助的手术(TECAB)。在血运重建之前,这两类手术中都可能存在潜在的引起心肌应激的因素,比如单肺通气、暂时的冠脉阻断、心脏脱位、胸内吹入CO2、长时间的心肺转流和手术。在本次超声心动图的研究中我们通过评价节段性心肌运动的异常程度来分析微创开胸手术和内镜下机器人辅助手术中的影响因素。我们研究了46个患有单支冠脉病变的病人,其中16位患者接受了微创开胸手术而其余30位则行内镜下机器人辅助手术。对这2组患者整个手术过程中间我们进行了持续的经食道超声心动图的监测,同时获得了血流动力学和氧合的数据。在这2组病人手术中我们都可以观察到轻微但是明显的异常的节段性心肌壁运动,这种异常变化在内镜下机器人辅助手术组尤为明显。与手术的时间无关的是这些变化在血运重建后均完全消失,没有观察到明显的血流动力学损害。因此我们认为微创开胸手术和内镜下机器人辅助手术和围手术期显著的节段性异常心肌壁运动有关。与开胸组不同,内镜下机器人辅助手术组病人出现了更加有意义的异常心肌壁运动,因为2组都使用了单肺通气技术,所以这可能是胸内吹入CO2所致。2组患者都未出现永久性的异常心肌壁运动或心肺转流后的异常心肌壁运动。内镜下机器人辅助手术组出现了更加广泛的异常心室壁运动,这一现象提示我们使用这种方法时可能存在更大的右心功能不全的风险。

(王 薛张纲 校)

Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO2 insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures.

 

非损伤性脊髓缺血后使用吗啡所致脊髓运动神经元变性可能来源于脊髓N-甲基天冬氨酸受体的激活

The Effect of Volatile Anesthetics on Respiratory System Resistance in Patients with Chronic Obstructive Pulmonary Disease

Manabu Kakinohana, MD, PhD*, Osamu Kakinohana, PhD{dagger}, Jong Hun Jun, MD, PhD{ddagger}, Martin Marsala, MD{dagger}, Kenneth J. Davison, MD§, and Kazuhiro Sugahara, MD, PhD*

*Department of Anesthesiology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan; {dagger}Department of Anesthesiology, University of California, San Diego, California; {ddagger}Department of Anesthesiology, Hanyang University College of Medicine, Seoul, Korea; and §Department of Anesthesiology, Massachusetts General Hospital, Boston, Massachusetts

Anesth Analg 2005 Feb 1002: 327-334.

 

我们研究了阻断大鼠主动脉后神经轴索使用吗啡引起的脊髓运动神经元变性和N-甲基天冬氨酸受体(NMDA)的激活的关系。我们使用带气囊的导管阻断主动脉6分钟造成脊髓缺血。在微透析研究中,再灌注后30分钟我们鞘内注射生理盐水10µL(c组;n=8)和吗啡30µg(M组;n=8),在假手术后30分钟吗啡30µg(SM组;n=8)和生理盐水10µL(SC组;n=8)同样被注射入鞘内。我们在缺血前、鞘内注射前和再灌注后2、4、8、24和48小时(鞘内注射后)收集了微透析样本。第二,我们研究了吗啡引起的痉挛性下肢瘫痪后鞘内注射MK-80130 µg)后的脊髓组织病理学改变。M组鞘内注射吗啡后与基线和C组相比脑脊液中的谷氨酸盐浓度升高(P<0.05),这一浓度升高持续了8小时。吗啡引起的痉挛性下肢瘫痪后鞘内注射MK-801与注射生理盐水相比减少了暗染的{alpha}-运动神经元的数量。这些数据表明鞘内注射吗啡可导致痉挛性下肢瘫痪同时伴有脑脊液中谷氨酸盐的浓度升高,后者参与了NMDA受体的激活。因此我们认为在脊髓缺血的情况下吗啡可以通过激活NMDA受体产生神经毒性。

(王 薛张纲 校)

We investigated the relationship between the degeneration of spinal motor neurons and activation of N-methyl-d-aspartate (NMDA) receptors after neuraxial morphine following a noninjurious interval of aortic occlusion in rats. Spinal cord ischemia was induced by aortic occlusion for 6 min with a balloon catheter. In a microdialysis study, 10 µL of saline (group C; n = 8) or 30 µg of morphine (group M; n = 8) was injected intrathecally (IT) 0.5 h after reflow, and 30 µg of morphine (group SM; n = 8) or 10 µL of saline (group SC; n = 8) was injected IT 0.5 h after sham operation. Microdialysis samples were collected preischemia, before IT injection, and at 2, 4, 8, 24, and 48 h of reperfusion (after IT injection). Second, we investigated the effect of IT MK-801 (30 µg) on the histopathologic changes in the spinal cord after morphine-induced spastic paraparesis. After IT morphine, the cerebrospinal fluid (CSF) glutamate concentration was increased in group M relative to both baseline and group C (P < 0.05). This increase persisted for 8 hrs. IT MK-801 significantly reduced the number of dark-stained {alpha}-motoneurons after morphine-induced spastic paraparesis compared with the saline group. These data indicate that IT morphine induces spastic paraparesis with a concomitant increase in CSF glutamate, which is involved in NMDA receptor activation. We suggest that opioids may be neurotoxic in the setting of spinal cord ischemia via NMDA receptor activation.

 

挥发性麻醉药对慢性阻塞性肺患者呼吸道阻力的影响

The Effect of Volatile Anesthetics on Respiratory System Resistance in Patients with Chronic Obstructive Pulmonary Disease

C. A. Volta, MD, V. Alvisi, MD, S. Petrini, MD, S. Zardi, MD, E. Marangoni, MD, R. Ragazzi, MD, M. Capuzzo, MD, and R. Alvisi, MD

Department of Surgical, Anesthesiological and Radiological Science, Section of Anesthesia and Intensive Care, S. Anna Hospital, University of Ferrara, Ferrara, Italy

Address correspondence and reprint requests to Carlo Alberto Volta, MD, Department of Surgical, Anesthesiological and Radiological Science, Section of Anesthesia and Intensive Care, S. Anna Hospital, University of Ferrara, Corso Giovecca 203, 44100

Anesth Analg 2005 Feb 1002: 348-353.

 

我们研究了异氟烷和七氟醚对于慢性阻塞性肺病(COPD)患者呼吸道阻力(Rmin,rs)的影响,COPD的诊断依靠呼吸道存在阻塞,这种阻塞在使用支气管扩张药物治疗后仅是部分可逆的。我们连续选择接受胸外科手术的周围型肺癌的96位患者。这些患者被分成2组:术前第一秒用力肺活量/用力肺活量<70%>70%。在麻醉维持5分钟和10分钟后,我们使用持续气流/快速阻断的方法来测量呼吸道的阻力。麻醉维持随机使用硫贲妥钠0.30 mg.kg–1.min–1或者呼气末1.1MAC的异氟烷或七氟醚。11位患者被排除在研究之外:其中2位误用异丙酚诱导,9位患者因为气管导管位置不当。使用挥发性麻醉药维持麻醉的病例能够降低COPD患者的气道阻力而硫贲妥钠却不能。COPD患者中对于挥发性麻醉药无反应的百分比也较正常人要大。因此我们的结论是:异氟烷或七氟醚能够对COPD患者产生支气管扩张作用。

(王 薛张纲 校)

We examined the effect of isoflurane and sevoflurane on respiratory system resistance (Rmin,rs) in patients with chronic obstructive pulmonary disease (COPD). The diagnosis of COPD rests on the presence of airway obstruction, which is only partially reversible after bronchodilator treatment. Ninety-six consecutive patients undergoing thoracic surgery for peripheral lung cancer were enrolled. They were divided into two groups: preoperative forced expiratory volume in 1 s/forced vital capacity ratio <70% or >70%. Rmin,rs was measured after 5 and 10 min of maintenance anesthesia by using the constant flow/rapid occlusion method. Maintenance of anesthesia was randomized to thiopental 0.30 mg · kg–1 · min–1 or 1.1 minimum alveolar anesthetic concentration end-tidal isoflurane or sevoflurane. Eleven patients were excluded: two because anesthesia was erroneously induced with propofol and nine because of an incorrect tube position. Maintenance with thiopental failed to decrease Rmin,rs, whereas both volatile anesthetics were able to decrease Rmin,rs in patients with COPD. The percentage of patients who did not respond to volatile anesthetics was larger in those with COPD as well. In conclusion, we have demonstrated that isoflurane and sevoflurane produce bronchodilation in patients with COPD.

 

道拉西酮和枢复宁治疗术后恶心呕吐的比较

Dolasetron versus ondansetron for the treatment of postoperative nausea and vomiting.

Meyer TA, Roberson CR, Rajab MH, Davis J, McLeskey CH.
Department of Pharmacy, Scott & White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508, USA.

Anesth Analg. 2005 Feb;100(2):373-7

 

术后恶心呕吐(PONV)仍是难以处理的问题。尽管预防性给予止吐药,(术后)剧烈的恶心呕吐仍然经常发生。目前,还没有有关道拉西酮和枢复宁治疗术后恶心呕吐的疗效比较的研究公开发表。这是一个对成年门诊手术病人进行的前瞻性的随机双盲的对照研究。我们从连续559名成年手术病人中筛选92名,随机给予道拉西酮和枢复宁。本研究的目的:1) 探明对于白天手术的病人,给予枢复宁4 mg或道拉西酮12.5 mg静脉注射,哪一种治疗PONV的疗效更好;2)比较两种药物治疗PONV的成本。使用枢复宁的47名病人中,有33人(70%)需要追加药物,而使用道拉西酮的45名病人中,只有18人(40%)需要追加药物(P<0.004)。使用道拉西酮比使用枢复宁要便宜近40%,而且,在追加使用止吐药产生的费用中,使用道拉西酮的病人要比使用枢复宁的病人节约30%。由于较少需要追加用药,可认为道拉西酮具有更好的止吐治疗效果。因为在本医院追加用药的较少和药物较便宜,使用道拉西酮组的病人所需费用比使用枢复宁组的病人要少。

(金 薛张刚 校)

The management of postoperative nausea and vomiting (PONV) remains a persistent problem. Despite the use of prophylactic antiemetics, breakthrough nausea and vomiting still frequently occur. There have been no published studies comparing dolasetron and ondansetron for the treatment of PONV. This was a prospective, randomized, double-blind, active-controlled study in adult outpatient surgery patients. We screened 559 consecutive adult surgery patients, with 92 patients randomized to either ondansetron or dolasetron. The objectives of the study were 1) to determine whether treatment of PONV with ondansetron 4 mg IV or dolasetron 12.5 mg IV would result in better outcomes in patients undergoing day surgery and 2) to compare the cost of drugs used for treating PONV. Thirty-three (70%) of 47 patients given ondansetron required rescue medication, compared with 18 (40%) of 45 patients given dolasetron (P < 0.004). Dolasetron was approximately 40% less expensive than ondansetron, and the costs of the study drug plus rescue antiemetics were 30% less in the dolasetron group than in the ondansetron group. Dolasetron provided greater efficacy for antiemetic treatment because of the need for less rescue therapy. Because of the decreased use of rescue antiemetics and acquisition cost at our hospital, costs in the dolasetron group were less than costs in the ondansetron group.

 

顺式阿曲库铵在眼咽肌营养不良患者的药效动力学

Cisatracurium pharmacodynamics in patients with oculopharyngeal muscular dystrophy.

Caron MJ, Girard F, Girard DC, Boudreault D, Brais B, Nassif E, Chouinard P, Ruel M, Duranceau A.
Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, 1560 Sherbrooke E., Montreal, Quebec, Canada H2L 4M1.
Anesth Analg. 2005 Feb;100(2):393-7.

 

肌松药在眼咽型肌营养不良症(OPMD)患者体内的药效动力学尚未有专门研究。我们设计了本研究,比较顺式阿曲库铵在OPMD患者和对照组中的药效动力学。选取40名病人:20名需在全麻下行咽肌环形切开术的病人和20名手术时间和失血量相仿、年龄相近的对照病人。麻醉方式标准化,每组病人都推注0.1mg/kg的顺式阿曲库铵。每组病人记录起效时间、至T1恢复10%时间以及T1恢复10%-25%25%-75%的间隔时间。对OPMD患者按疾病不同严重程度进一步作分析,统计结果和手术过程中的数据都相似。和对照组相比,OPMD患者用药后的起效时间明显延长(4.6+/-1.5 min3.4 +/- 1.0 minP = 0.001)。在不同组别之间,尽管疾病的严重程度不同,恢复时间或指数没有差异。结论,在OPMD患者和对照组中,顺式阿曲库铵产生的神经肌肉阻滞过程没有差别,在OPMD患者中药物起效延迟可能存在。

(金 薛张刚 校)

The pharmacodynamics of muscle relaxants in patients with oculopharyngeal muscular dystrophy (OPMD) have never been studied. We designed this study to compare the pharmacodynamics of cisatracurium in OPMD patients versus a control group. Forty patients were enrolled: 20 OPMD patients requiring general anesthesia for cricopharyngeal myotomy and 20 age-matched controls undergoing an operation of similar duration and expected blood loss. Anesthesia was standardized, and both groups received a bolus of cisatracurium 0.1 mg/kg. Onset time, time to 10% T1 recovery, and the intervals 10%-25% and 25%-75% were calculated for both groups. A subgroup analysis was performed in patients with a more severe form of OPMD. Demographic and intraoperative data were similar. Onset time was significantly longer in OPMD patients compared with the control group (4.6 +/- 1.5 min versus 3.4 +/- 1.0 min; P = 0.001). There was no difference in recovery times or indices between groups, regardless of the severity of the disease. In conclusion, there was no difference in the duration of a cisatracurium-induced neuromuscular block between OPMD patients and a control group. A delayed onset of action of the drug may occur.

 

利多卡因使活性内皮IL-1betaIL-6IL-8浓度降低及ICAM-1表达的削弱

Activated endothelial interleukin-1beta, -6, and -8 concentrations and intercellular adhesion molecule-1 expression are attenuated by lidocaine.

Lan W, Harmon DC, Wang JH, Shorten GD, Redmond PH.
Academic Department of Surgery, Cork University Hospital, University College, Cork, Ireland.

Anesth Analg. 2005 Feb;100(2):409-12

 

内皮细胞在缺血再灌注损伤中起了重要的作用。我们研究了利多卡因对活性脐血管内皮细胞(HUVEC)白介素(IL)-1betaIL-6IL-8浓度以及细胞间粘附分子-1ICAM-1)表达的影响。HUVECs用不同浓度的利多卡因(0 to 0.5 mg/ml)预处理60分钟后,再加入2.5 ng/ml浓度的肿瘤坏死因子- alpha,经4小时孵化后提取上清液,用酶联免疫吸附试验测定细胞因子浓度。内皮性ICAM-1表达用流式血细胞计数方法测定。根据不同资料采用卡方检验或post hoc不配对资料t-检验进行分析。0.5mg/ml利多卡因使HUVECs内白介素(IL)浓度降低,和临床治疗量血浆浓度近似的利多卡因(0.005 mg/ml)处理后的HUVECs相比,IL-1beta1.89+/-0.11pg/ml4.16 +/- 1.27pg/ml; P = 0.009),IL-6 65.5 +/- 5.14 pg/ml162 +/- 11.5pg/ml; P < 0.001),IL-83869 +/- 785pg/ml14,961 +/- 406pg/ml ; P < 0.001)。用0.05 mg/ml利多卡因处理过的HUVECs,其ICAM-1的表达要低于对照组(198 +/- 52.7 298 +/- 50.3; Mean Channel Fluorescence; P < 0.001)。高于临床治疗浓度的高浓度利多卡因使活性内皮性IL-1betaIL-6IL-8浓度降低,使ICAM-1表达削弱。

(金 薛张刚 校)

Endothelial cells play a key role in ischemia reperfusion injury. We investigated the effects of lidocaine on activated human umbilical vein endothelial cell (HUVEC) interleukin (IL)-1beta, IL-6, and IL-8 concentrations and intercellular adhesion molecule-1 (ICAM-1) expression. HUVECs were pretreated with different concentrations of lidocaine (0 to 0.5 mg/mL) for 60 min, thereafter tumor necrosis factor-alpha was added at a concentration of 2.5 ng/mL and the cells incubated for 4 h. Supernatants were harvested, and cytokine concentrations were analyzed by enzyme-linked immunosorbent assay. Endothelial ICAM-1 expression was analyzed by using flow cytometry. Differences were assessed using analysis of variance and post hoc unpaired Student's t-test where appropriate. Lidocaine (0.5 mg/mL) decreased IL-1beta (1.89 +/- 0.11 versus 4.16 +/- 1.27 pg/mL; P = 0.009), IL-6 (65.5 +/- 5.14 versus 162 +/- 11.5 pg/mL; P < 0.001), and IL-8 (3869 +/- 785 versus 14,961 +/- 406 pg/mL; P < 0.001) concentrations compared with the control. IL-1beta, IL-6, and IL-8 concentrations in HUVECs treated with clinically relevant plasma concentrations of lidocaine (0.005 mg/mL) were similar to control. ICAM-1 expression on lidocaine-treated (0.05 mg/mL) HUVECs was less than on controls (198 +/- 52.7 versus 298 +/- 50.3; Mean Channel Fluorescence; P < 0.001). Activated endothelial IL-1beta, IL-6, and IL-8 concentrations and ICAM-1 expression are attenuated only by lidocaine at concentrations larger than clinically relevant concentrations.

 

挥发性和气体麻醉药在体外输入系统中吸附性丢失的研究

Sorptive loss of volatile and gaseous anesthetics from in vitro drug application systems.

Suzuki T, Uchida I, Mashimo T.

Department of Anesthesiology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, Japan 565-0871.

Anesth Analg. 2005 Feb;100(2):427-30.

 

在体外药理学实验中,各种麻醉药的效应浓度值的确定取决于生理状态下浓解的药物确切浓度。由于麻醉药在输入过程中,特别在管道系统中,存在吸附、吸收和其它的丢失,实际麻醉药浓度可能不同于预期浓度。作者检测了这种假设:当麻醉药溶液通过实验管道时,其递送浓度将降低,并通过检测两种挥发性麻醉药(七氟醚和异氟醚)以及两种气体麻醉药(N2O和疝气)来研究其丢失的量。作者分别测定了由5种不同物质[玻璃、聚四氟乙烯、聚乙烯(PE)、聚氯乙烯(PVC)和硅胶]组成的管道(1m*2mm*ID*4mmOD)中的溶液。当麻醉药分别通过PVC和硅胶管时,其输出浓度显著减少,分别为>33%和>43%。而当麻醉药分别通过玻璃管、聚四氟乙烯或硅胶管时其输出麻醉药浓度没有降低,当七氟醚溶液流经PVC和硅胶管时,从溶液流动开始到麻醉药丢失忽略不计时所需时间分别为2030分钟。研究结果表明尽管PVC和硅胶管柔软易使,但在吸入麻醉药药理学实验中频繁使用PVC和硅胶管显示出很大不足。

(吴德华 薛张刚 校)

In in vitro pharmacological experiments, determination of effective concentration values for various anesthetics depends on understanding the exact concentration of the drugs dissolved in physiological solutions. Actual anesthetic concentration may differ from expectations because of drug adsorption, absorption or other loss, especially in tubing. We tested the hypothesis that delivered concentrations of anesthetics decrease when solutions pass through laboratory tubing and investigated such loss by measuring the entering and exiting dissolved concentrations of two volatile (sevoflurane and isoflurane) and two gaseous (nitrous oxide and xenon) anesthetics. We tested solutions passed through tubes (1 m x 2 mm ID x 4 mm OD) made of five different materials (glass, Teflon, polyethylene (PE), polyvinyl chloride (PVC), and silicon rubber). Exiting concentrations of anesthetics were significantly reduced when they were passed through PVC (>33%) and silicon (>43%) tubes. There were no decreases in anesthetic concentrations with glass, Teflon, or PE tubes. When sevoflurane solution flowed through PVC and silicon tubes, it took 20 and 30 min, respectively, after start of flow until the anesthetic loss became negligible. These results indicate that frequently used PVC and silicon tubes, whereas flexible and easy to handle, have serious drawbacks when used in inhaled anesthetic pharmacology experiments.

 

 

刺激模式和异丙酚血浆浓度对运动诱发电位的修饰效应

The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials.

Scheufler KM, Reinacher PC, Blumrich W, Zentner J, Priebe HJ.

Abt. Allgemeine Neurochirurgie, Universitatsklinikum Freiburg, Breisacher Strasse 64, D-79106 Freiburg, Germany.

Anesth Analg. 2005 Feb;100(2):440-7

 

手术中运动诱发电位(MEPs)的特性极大的依赖于刺激模式和麻醉技术。术中MEP记录进一步的改善需要有每个这些因素修饰效应的精确知识。因此,我们设计的这项研究为了描述不同异丙酚靶血浆浓度时不同刺激模式的修饰效应的特征,在手术期经颅记录电MEPs12名患者进行了开颅术,刺激模式(300-500v100-1000Hz 1-5刺激)在不同的PTPCs24,和6mg/ml)随机不同。瑞芬太尼予0.2mg/kgmin保持不变。MEPs被记录从大鱼际肌到小鱼际肌。分析MEPs不考虑PTPC。三向方差分析揭示了增加刺激强度、频率及刺激的数目显著影响MEP波幅(P<0.05)。MEP最大的波幅和记录成功的频率在1000Hz,≤150V3或更多刺激下被观测到。PTPC2 4 6mg/ml)对MEP波幅的显著地主要影响仅在大鱼际肌记录点观测到。波幅率是由两倍或四倍刺激诱发相应的MEPs计算而得来的,其证明MEPsPTPC改变不敏感。因此,在刺激模式变化时,MEP特征表现为显著不同,而在PTPC变化时,则较少改变。

(廖庆武 薛张纲 校)

The quality of intraoperative motor-evoked potentials (MEPs) largely depends on the stimulation pattern and anesthetic technique. Further improvement in intraoperative MEP recording requires exact knowledge of the modifying effects of each of these factors. Accordingly, we designed this study to characterize the modifying effect of different stimulation patterns during different propofol target plasma concentrations (PTPCs) on intraoperatively recorded transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V; 100-1000 Hz; 1-5 stimuli) were varied randomly at different PTPCs (2, 4, and 6 microg/mL). Remifentanil was administered unchanged at 0.2 microg . kg(-1) . min(-1). MEPs were recorded from the thenar and hypothenar muscles. Analysis of MEPs was blinded to the PTPC. Three-way analysis of variance revealed significant main effects of increasing stimulation intensity, frequency, and number of stimuli on MEP amplitude (P < 0.05). Maximum MEP amplitudes and recording success rates were observed with three or more stimuli delivered at 1000 Hz and > or =150 V. A significant main effect of PTPC (2 vs 4 and 6 microg/mL) on MEP amplitude was observed at the thenar recording site only (P < 0.05). An amplitude ratio calculated from corresponding MEPs evoked by double and quadruple stimulation proved to be insensitive to changes in PTPC. In conclusion, MEP characteristics varied significantly in response to changes in stimulation pattern and less to changes in PTPC.

 

吗啡能加强神经结扎损伤大鼠模型椎管内注射N(6)-2-苯基-腺苷-右异构体(R-PIA)的镇痛效果

Morphine can enhance the antiallodynic effect of intrathecal R-PIA in rats with nerve ligation injury

Hwang JH, Hwang GS, Cho SK, Han SM

Department of Anesthesia and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-Gu, Seoul 138-736Korea.

Anesth Analg. 2005 Feb;100(2):461-8.

 

神经结扎损伤可以产生可触知的异常疼痛。椎管内注射腺苷受体激动剂或吗啡具有镇痛效应。在这项研究中,我们观察了神经结扎损伤老鼠模型由腺苷A1受体激动剂N(6)-2-苯基-腺苷-右异构体(R-PIA)所致镇痛背景下椎管内注射吗啡的效应。大鼠模型为左侧L5-6脊神经结扎并在椎管内置管。应用足底纤维测试方法(von Frey filaments)对受损的后腿进行疼痛监测。将退缩反应作为阈值。给予吗啡和R-PIA以获得剂量-反应曲线和半数有效量(ED50)。ED50的部分同时建立联合用药的ED50。应用等幅射分析方法来分析药物的相互作用。椎管内注射8-环戊基-13二丙基黄嘌呤(DPCPX一种A1受体拮抗剂)以及纳洛酮以观测镇痛效应的逆转。同时观察副作用。结果:椎管内注射吗啡和R-PIA以及它们的混合物都能够产生剂量依赖性的镇痛效果而没有严重的副作用。当联合用药时椎管内注射吗啡能够加强R-PIA的镇痛作用并且DPCPX能够逆转其最大效应。结果表明可触知的异常疼痛在脊髓水平μ-阿片以及A1受体的激活是相互促进的。

(沈 薛张刚 校)

Nerve ligation injury may produce a tactile allodynia. Intrathecal adenosine receptor agonists or morphine have an antiallodynic effect. In this study, we examined the effect of intrathecal morphine on the antiallodynic state induced by the adenosine A1 receptor agonist, N(6)-(2-phenylisopropyl)-adenosine R-(-)isomer (R-PIA), in a rat model of nerve ligation injury. Rats were prepared with ligation of left L5-6 spinal nerves and intrathecal catheter implantation. Tactile allodynia was measured by applying von Frey filaments to the lesioned hindpaw. Thresholds for withdrawal response were assessed. Morphine and R-PIA were administered to obtain the dose-response curve and the 50% effective dose (ED(50)). Fractions of ED(50)s were administered concurrently to establish the ED(50) of the drug combination. The drug interaction was analyzed using the isobolographic method. Intrathecal 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), an A1 receptor antagonist, and naloxone were administered to examine the reversal of the antiallodynic effect. Side effects were also observed. Intrathecal morphine and R-PIA and their combination produced a dose-dependent antagonism without severe side effects. Intrathecal morphine synergistically enhanced the antiallodynic effect of R-PIA when coadministered. Intrathecal naloxone and DPCPX reversed the maximal antiallodynic effect in the combination group. These results suggest that activation of mu-opioid and A1 receptors at the spinal level is required for the synergistic interaction on tactile allodynia.

 

异丙酚对热痛觉的影响

The Effect of Propofol on Thermal Pain Perception

Michael A. Froplich, MD, MS, Donald D. Price, PhD, Michael E. Robinson, PhD, Jonathan J. Shuster, PhD, Douglas W. Theriaque, MS, and Marc W. Heft, DMD, PhD

Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, Birmingham, AL 35249-6810, USA.

Anesth Analg 2005 Feb;1002: 481-486.

 

研究广泛使用的镇静催眠药propofol对疼痛感知的影响。18个病例平衡而随机的分成两组,propofol两个不同镇静浓度组。推荐疼痛刺激温度(45摄氏度,47摄氏度,49摄氏度)任意顺序,31摄氏度无疼痛刺激交替试验。使用目标靶控注射,效应室浓度0.5mug/ml为温和镇静,1.0mug/ml为适度镇静。应用视觉模拟评分,分为疼痛强度和更不愉快的痛苦。平均疼痛强度于安慰时为28/100,温和镇静时35/100,适度镇静40/100。更不愉快痛苦安慰时23/100,温和镇静时29/100,适度镇静时33/100。这种影响对于不同疼痛经历和镇痛感知水平的患者有所差别。propofol镇静的患者需给予适当镇痛。

(孙志荣 薛张纲 )

We studied the effect of propofol, a widely used sedative-hypnotic drug, on pain perception. Eighteen subjects received propofol in two sedative concentrations that were balanced and randomized in order. Painful (45 degrees C, 47 degrees C, and 49 degrees C) stimulation temperatures were presented in random order, and nonpainful 31 degrees C stimuli were presented on alternate trials. We used a target-controlled infusion and chose effect site concentrations of 0.5 mug/mL for mild sedation and 1.0 mug/mL for moderate sedation. Using a visual analog scale, subjects rated both pain intensity and unpleasantness higher when sedated with propofol. The average pain intensity was 28/100 for placebo, 35/100 for mild, and 40/100 for moderate sedation. Pain unpleasantness was 23/100 for placebo, 29/100 for mild, and 33/100 for moderate sedation. This effect was unexpected and may be explained by a difference of subjective pain experience by a patient and the perceived level of analgesia by a health care provider in sedated patients. This finding calls further attention to the need for adequate analgesia in patients sedated with propofol.

 

肾上腺素加强全血中血小板与白细胞粘着力的体外实验

Epinephrine Enhances Platelet-Neutrophil Adhesion in Whole Blood In Vitro

Horn, Nicola A. MD *; Anastase, Denisa M. MD +; Hecker, Klaus E. MD *;

Baumert, Jan H. MD *; Robitzsch, Tilo MD ++; Rossaint, Rolf MD, PhD *

*Department of Anesthesiology, Rheinisch-Westfalische Technische Hochschule,

Aachen, Germany; +Department of Anesthesiology, Spitalul Clinic de Ortopedie

Foisor, Bucuresti, Romania; and ++Institute of Transfusion Medicine,

Rheinisch-Westfalische Technische Hochschule, Aachen, Germany

Anesth Analg 2005 Feb;1002: 520-526.

 

先前的研究表明:儿茶酚胺对α或β肾上腺素能受体的激活可以影响中性粒细胞的功能、细胞因子的释放以及血小板的聚集能力。由此我们来研究是否通过肾上腺素对肾上腺素能受体的激活也能改变血小板与中性粒细胞的粘着力。这项研究对某些严重的疾病可能带来特别的价值,因为血小板和中性粒细胞间联系的增强是炎症和血栓形成的关键。基于这个意图,不同肾上腺素浓度的全血(10纳摩尔、100纳摩尔以及1微摩尔)被用来作为培养基。为了区别受体特异性的反应,我们取样本的一部分在用肾上腺素培养前先加入普萘洛尔(10微摩尔)或酚妥拉明(10微摩尔)培养。之后,另外一部分样本由100纳摩尔末端甲酰-甲硫氨酰-亮氨酰-苯丙氨酸激活。所有的样本均染色,且血小板和中性粒细胞的黏着和CD45以及L-选择蛋白、CD11bP-选择蛋白糖蛋白配位基、糖蛋白IIb/IIIa、和P-选择蛋白的表达由双色的流式细胞计量数来测量。肾上腺素主要加强血小板与中性粒细胞的聚集以及P-选择蛋白与糖蛋白IIb/IIIa在血小板上的表达。CD11bL-选择蛋白在未受激活的中性粒细胞上表达不变,而在末端甲酰-甲硫氨酰-亮氨酰-苯丙氨酸激活的培养基里,C

D11b的表达上调并且L-选择蛋白受肾上腺素抑止而表达下调。在用肾上腺素培养前使用β肾上腺素能受体阻断剂增强了血小板与中性粒细胞的聚集并进一步地促进了黏附因子(CD11bP-选择蛋白和糖蛋白IIb/IIIa)的表达。这些结果表示肾上腺素加强了血小板和中性粒细胞的粘着力。由α肾上腺素能受体介导的P-选择蛋白和糖蛋白IIb/IIIa的表达增加从本质上有助于这一反应。我们的研究显示:收缩性的因素加强了血小板和中性粒细胞的粘着力--对某些严重疾病的患者而言可这能是决定性的因素。

(许文妍 薛张纲 )

Previous studies showed that [alpha]- or [beta]-adrenoceptor stimulation by catecholamines influenced neutrophil function, cytokine liberation, and platelet aggregability. We investigated whether adrenergic stimulation with epinephrine also alters platelet-neutrophil adhesion. This might be of specific interest in the critically ill, because the increased association of platelets and neutrophils has been shown to be of key importance in inflammation and thrombosis. For this purpose, whole blood was incubated with increasing concentrations of epinephrine (10 nM, 100 nM, and 1 [mu]M). To distinguish receptor-specific effects, a subset of samples was incubated with propranolol (10 [mu]M) or phentolamine (10 [mu]M) before exposure to epinephrine. After incubation, another subset of samples was also stimulated with 100 nM of N-formyl-methionyl-leucyl-phenylalanine. All samples were stained, and platelet-neutrophil adhesion and CD45, L-selectin, CD11b, P-selectin glycoprotein ligand-1, glycoprotein IIb/IIIa, and P-selectin expression were measured by two-color flow cytometry. Epinephrine significantly enhanced platelet-neutrophil adhesion and P-selectin and glycoprotein IIb/IIIa expression on platelets. CD11b and L-selectin expression on unstimulated neutrophils remained unchanged, whereas N-formyl-methionyl-leucyl-phenylalanine-induced upregulation of CD11b and downregulation of L-selectin were suppressed by epinephrine. [beta]-Adrenergic blockade before incubation with epinephrine increased platelet-neutrophil aggregates and adhesion molecule expression (CD11b, P-selectin, and glycoprotein IIb/IIIa) even further. These results demonstrate that epinephrine enhances platelet-neutrophil adhesion. The [alpha]-adrenergic receptor-mediated increase in P-selectin and glycoprotein IIb/IIIa expression on platelets may contribute substantially to this effect. Our study shows that inotropic support enhances the platelet-neutrophil interaction, which might be crucial for critically ill patients.

 

脊麻手术中应用2-氯普鲁卡因初始十个月的经验

Spinal 2-Chloroprocaine for Surgery: An Initial 10-Month Experience

Jessica R. Yoos, MD, and Dan J. Kopacz, MD

Department of Anesthesiology, Virginia Mason Clinic, Seattle, Washington

Anesth Analg 2005 Feb;1002: 553-558.

 

由于利多卡因经常在外科患者中引起短暂神经病变综合征(TNS),目前开始了2-氯普鲁卡因(2-CP)作为短效局麻药利多卡因的替代药物的研究。在志愿者中应用剂量30-60mg2-CP能够提供理想的麻醉平面而且未有TNS事件发生的报道。我们回顾研究了本机构初次在外科病人脊麻中应用2-CP的十个月临床经验。多数应用在急诊手术中,其中39例为整形外科,30例普外科,18例妇产科,34例泌尿外科。常同剂量为2-CP 30-40mg92%的病例中再添加10-20ug的芬太尼。中位阻滞最高平面在T6-T8。手术时间为32.3±18.4分钟。麻醉开始到手术结束时间为53.1± 20.7分钟。入院至开始手术时间和入院至出院时间分别为155.1 ± 34.7分钟和207.9 ± 69.4 分钟。2-CP可预测阻滞范围消退时间,所以在历时一小时的外科手术中可以安全有效地作为利多卡因和普鲁卡因的替代药物。手术之后未有TNS报导。

(蔡美华 薛张刚 校)

Spinal 2-chloroprocaine (2-CP) is currently being investigated as a short-acting alternative to lidocaine, which frequently causes transient neurologic symptoms (TNS) in surgical patients. TNS has not been reported with 2-CP in volunteers in doses ranging from 30 to 60 mg and appears to provide an excellent level of surgical anesthesia. In this retrospective study, we describe the experience with spinal 2-CP in surgical patients during its first 10 mo of clinical use at our institution. Most patients had ambulatory surgery, including 39 orthopedic, 30 general surgical, 18 gynecologic, and 34 genitourinary procedures. Chloroprocaine 30 or 40 mg, with or without fentanyl (10–20 &micro;g), was the most common (92%) dose combination used. Mean peak block height averaged T6 to T8. The surgical procedure time was 32.3 ± 18.4 min. Time from placement of the block to the end of the surgical procedure was 53.1 ± 20.7 min. Times to ambulation and discharge were 155.1 ± 34.7 min and 207.9 ± 69.4 min, respectively. 2-CP spinal anesthesia has proven to be a safe and effective alternative to lidocaine and procaine for ambulatory surgical procedures of 1 h, with a predictable regression of block height. No patients reported TNS after surgery.

 

脊麻2-氯普鲁卡因:志愿者中与普鲁卡因比较

Spinal 2-Chloroprocaine: A Comparison with Procaine in Volunteers

Aaron F. Gonter, MD, and Dan J. Kopacz, MD

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

Anesth Analg 2005 Feb;1002: 573-579.

 

近期将不含防腐剂的2-氯普鲁卡因(2CP)用于脊麻的研究显示它是一种能提供与利多卡因相似麻醉效应的可靠短效药。在这个随机双盲交叉研究中,我们在8名志愿者中比较脊麻2CP30mg)和普鲁卡因(80mg)的效应以决定哪种药物产生的脊麻效应对于门诊手术的患者是理想的。通过针刺感觉、经皮电刺激、对腿部止血带的耐受性以及运动阻代替手术效应,2CP与普鲁卡因是相似的。峰阻滞高度(T9[范围,T6T12]T6[T4T8];P=0.0796),消退2个节段的时间(51 ± 17 分钟 53 ± 10 分钟; P = 0.7434),止血带耐受时间(37 ± 16 分钟 49 ± 17分钟; P = 0.1755),肌力恢复时间(Bromage分期: 54 ± 23 分钟较 55 ± 44 分钟, P = 0.9366; 四头肌恢复 90 %: 78 ± 9分钟 versus 98 ± 30 分钟; P = 0.0721),都是相似的。普鲁卡因作用维持较长的感觉阻滞 (P = 0.0011)和运动阻滞在腓肠肌(P = 0.0004)和四头肌(P = 0.0146);感觉阻滞结束时间(103 ± 12 分钟较151 ± 26 分钟; P = 0.0003),移动时间(103 ± 12 分钟 151 ± 26 分钟; P = 0.0003),排尿时间(103 ± 12 分钟 156 ± 23 分钟; P < 0.0001),用普鲁卡因者均延长。结论,剂量试验,脊麻2CP (30 mg)可能是短小门诊手术的更佳选择,因为它能提供与普鲁卡因(80mg)类似的麻醉效应,而达到消退标准更快。

(费 薛张刚 校)

Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting drug that provides similar anesthesia to lidocaine. In this randomized, double-blind, crossover study, we compared the characteristics of spinal 2-CP (30 mg) with those of procaine (80 mg) in eight volunteers to determine whether either drug produces spinal anesthetic characteristics ideal for outpatient surgery. By using sensation to pinprick, transcutaneous electrical stimulation, tolerance to thigh tourniquet, and motor blockade as surrogates for surgical efficacy, 2-CP compared similarly to procaine. Peak block height (T9 [range, T6 to T12] versus T6 [T4 to T8]; P = 0.0796), time to two-segment regression (51 ± 17 min versus 53 ± 10 min; P = 0.7434), tourniquet time tolerance (37 ± 16 versus 49 min ± 17 min; P = 0.1755), and time to return of motor strength (Bromage scale: 54 ± 23 min versus 55 ± 44 min, P = 0.9366; return of 90% quadriceps strength: 78 ± 9 min versus 98 ± 30 min; P = 0.0721) were all similar. Procaine did produce overall longer sensory blockade (P = 0.0011) and motor blockade at the gastrocnemius (P = 0.0004) and quadriceps (P = 0.0146) muscles. Times until the resolution of sensory blockade (103 ± 12 min versus 151 ± 26 min; P = 0.0003), ambulation (103 ± 12 min versus 151 ± 26 min; P = 0.0003), and micturition (103 ± 12 min versus 156 ± 23 min; P < 0.0001) were all prolonged after procaine. In conclusion, at the doses tested, spinal 2-CP (30 mg) may be a better choice for short outpatient procedures because it provides anesthesia with similar efficacy as procaine (80 mg) but with more rapid fulfillment of discharge criteria.

与经典喉罩比较Proseal喉罩寿命较短

The ProSeal has a shorter life-span than the Classic laryngeal mask airway.

Doneley S, Brimacombe J, Keller C, von Goedecke A.
Department of Anaesthesia, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia.

Anesth Analg. 2005 Feb;100(2):590-3

 

我们测试了这样的假设:ProSeal喉罩(LMA)比经典喉罩的寿命短。我们也比较了使用时残留气囊的容量、弹性的改变以及其通透性。六个新的4ProSeal喉罩和六个新的4号经典喉罩被测试。每个喉罩都经历模拟的临床使用周期,直到该喉罩不能通过使用前检查,而停止使用。模拟的临床使用周期包括:1)使气囊膨胀至推荐的最大容量一小时;2)浸入含酶溶液中3分钟;3)清洗内、外表面;4)自动清洗14分钟(≤85℃);5)干燥30分钟(≤75℃);6)在134℃,206kPa下高压灭菌4分钟。在第一个周期和后来的每10个周期之前,气囊内充进40ml的空气,分别立刻及3小时后测气囊内压力。最初气囊内压测得通过弹性或阻力使其变形的方法,气囊内压改变的测量是利用通透性的方法而测得。残留气囊容量的测量是由10个经典和10ProSeal4号喉罩用气体稀释技术测得。经典喉罩和ProSeal喉罩的寿命分别为(均值±标准差,范围)82±2345-109)及133±3576-176)。ProSeal喉罩与经典喉罩相比寿命较短(P=0.01)。对于ProSeal喉罩,使用时不存在弹性及通透性的改变。对于经典喉罩,有弹性的减退(P<0.0001)和通透性的增加(P<0.0001)。经典喉罩残留气囊容量较ProSeal喉罩高(2.6±1.3ml1.5±0.9mlP=0.04)。我们推断ProSeal喉罩寿命较经典喉罩短,但是使用次数都超过了商家推荐的40次。我们推荐重复使用喉罩,直到其不能通过使用前检测再丢弃该喉罩,而不是在使用了特定的次数后。

(孙敏莉 薛张纲 校)

We tested the hypothesis that the life-span of the ProSeal laryngeal mask airway (LMA) is shorter than the Classic LMA. We also compared residual cuff volumes and changes in elastance and permeability with use. Six new size 4 ProSeal LMAs and 6 new size 4 Classic LMAs were tested. Each LMA underwent a simulated clinical use cycle until it failed the pre-use check tests. The simulated clinical use cycle comprised: i) inflating the cuff to the maximum recommended volume for 1 h; ii) immersion in an enzymatic solution for 3 min; iii) washing the external and internal surfaces; iv) automatic washing for 14 min (< or =85 degrees C); v) drying for 30 min (< or =75 degrees C); and vi) autoclaving at 134 degrees C for 4 min at 206 kPa. Before the first cycle and every 10 subsequent cycles, the cuff was inflated with 40 mL air and the intracuff pressure was measured immediately and 3 h later. The initial intracuff pressure was taken to be an inverse measure of the elastance or resistance to deformation, and the intracuff pressure change were taken as a measure of the permeability. The residual cuff volume was determined for 10 Classic and 10 ProSeal size 4 LMAs using a gas dilution technique. The mean +/- sd (range) longevity for the ProSeal LMA and Classic LMA was 82 +/- 23 (45-109) uses and 133 +/- 35 (76-176) uses, respectively. The ProSeal LMA has a shorter life-span than the Classic LMA (P = 0.01). For the ProSeal LMA, there was no change in elastance or permeability with use. For the Classic LMA, there was a decrease in elastance (P < 0.0001) and an increase in permeability (P < 0.0001) with use. The residual cuff volume was higher for the ProSeal LMA (2.6 +/- 1.3 mL versus 1.5 +/- 0.9, P = 0.04). We conclude that the life-span of the ProSeal LMA is shorter than the Classic LMA, but both exceed the manufacturer's recommendations of 40 uses. We recommend that reusable LMA devices be discarded when they fail the pre-use check tests, rather than after a specific number of uses.

持续胃减压治疗冠脉搭桥术后的恶心呕吐

Continuous Gastric Decompression for Postoperative Nausea and Vomiting After Coronary Revascularization Surgery

Crina L. Burlacu, FCAI*, David Healy, MRCSI{dagger}, Donal J. Buggy, MD, MSc, DME, FRCPI, FCAI, FRCA*{ddagger}, Ciaran Twomey, FCAI*, David Veerasingam, FRCSI{dagger}, Andrew Tierney, FCAI*, and Denis C. Moriarty, FCAI, FRCA*

* Department of Anaesthesia and Intensive Care Medicine, and {dagger}Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, and {ddagger}Outcomes Research InstituteTM, University of Louisville, Louisville, Kentucky

Anesth Analg 2005;100:321-326

 

心脏手术后常见恶心、呕吐,并可能导致严重的并发症发病率。而麻醉期间胃减压对预防较短时间的非心脏手术后的恶心、呕吐,有相矛盾的结果。我们检验了这样一个假设,即对在体外循环下行择期冠脉血管搭桥术中进行胃减压,持续到术后气管导管拔除后,可降低呕吐或干呕和恶心的发生率。在这一前瞻的、随机的群组研究中, 104例术后恶心和呕吐的Apfel风险因素至少2级的病人分为2组,一组在麻醉诱导后插入靠重力自然引流的胃管(n = 52),另一组为对照组(n = 52)。在术后气管导管拔除时同时拔除胃管。主要监测呕吐或干呕的发生率。次要的监测结果包括用视觉模拟评分法评估恶心的发生率和严重程度。有胃减压的病人呕吐或干呕的发生率为13.4%,对照组为11.5% (P = 0.7)。相同地,两组之间在恶心的发生率 (32.7%25.0%, P = 0.6),在12小时时用视觉模拟评分法评估的恶心严重程度中位值 (25; 范围0–55 mm30; 范围 0–60 mm, P = 0.4), 及止吐药应用(38.5%28.8%, P = 0.3) 上没有明显统计学差异。在冠脉血管搭桥术中和术后直到拔除气管导管期间持续胃减压不能降低这些病人呕吐或干呕的发生率及恶心的发生率和严重程度。

(彭中美 李士通 校)

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel’s risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0–55 mm versus 30; range, 0–60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

 

经食道超声心动图评估腹腔镜手术中二氧化碳气腹对肝血流的影响

The Effects of Intraabdominally Insufflated Carbon Dioxide on Hepatic Blood Flow During Laparoscopic Surgery Assessed by Transesophageal Echocardiography

Rainer Meierhenrich, MD, Albrecht Gauss, MD, Peter Vandenesch, MD, Michael Georgieff, MD, Bertram Poch, MD*, and Wolfram Schütz, MD

Departments of Anesthesiology and *General Surgery, University of Ulm, Germany

Anesth Analg 2005;100:340-347

 

二氧化碳(CO2)气腹对内脏和肝脏灌注的影响以往有不同的结果报导。一些实验室研究认为气腹可以引起与腹内压相关的肝血流量减少,而其它的研究者则认为当腹内压(IAP)低于16 mm Hg时肝血流量是增加的。本实验的目的是为了观察在健康成人行腹腔镜手术时充入CO2对肝血流量的影响。我们采用经食道多普勒超声心动图的方法,测定了24例行腹腔镜手术患者的肝中和肝右静脉血流量。分别在气腹前、气腹后第5102030 40分钟以及放气第15分钟测定肝静脉血流量。12例行常规疝修补术的患者作为对照组。在气腹形成过程中,肝中和右肝静脉血流明显增加。在充入CO25分钟后右肝平均血流指数从196 mL/min/m2 (95% 可信区间(CI), 140–261 mL/min/m2) 增加至392 mL/min/m2 (CI, 263–551 mL/min/m2) (P < 0.05),并在整个气腹过程中一直维持。肝中静脉血流指数在充气20分钟后从105 mL/min/m2 (CI, 71–136 mL/min/m2) 增加至159 mL/min/m2 (CI, 103–236 mL/min/m2)。放气后两条肝静脉血流量都回复到基础值。相反的是对照组肝血流量在整个研究过程中未发生改变。我们作出结论健康成人在CO2气腹形成IAP 12 mm Hg时肝脏灌注增加。

(张俊杰 李士通 校)

Conflicting results have been published about the effects of carbon dioxide (CO2) pneumoperitoneum on splanchnic and liver perfusion. Several experimental studies described a pressure-related reduction in hepatic blood flow, whereas other investigators reported an increase as long as the intraabdominal pressure (IAP) remained less than 16 mm Hg. Our goal in the present study was to investigate the effects of insufflated CO2 on hepatic blood flow during laparoscopic surgery in healthy adults. Blood flow in the right and middle hepatic veins was assessed in 24 patients undergoing laparoscopic surgery by use of transesophageal Doppler echocardiography. Hepatic venous blood flow was recorded before and after 5, 10, 20, 30, and 40 min of pneumoperitoneum, as well as 1 and 5 min after deflation. Twelve patients undergoing conventional hernia repair served as the control group. The induction of pneumoperitoneum produced a significant increase in blood flow of the right and middle hepatic veins. Five minutes after insufflation of CO2 the median right hepatic blood flow index increased from 196 mL/min/m2 (95% confidence interval (CI), 140–261 mL/min/m2) to 392 mL/min/m2 (CI, 263–551 mL/min/m2) (P < 0.05) and persisted during maintenance of pneumoperitoneum. In the middle hepatic vein the blood flow index increased from 105 mL/min/m2 (CI, 71–136 mL/min/m2) to 159 mL/min/m2 (CI, 103–236 mL/min/m2) 20 min after insufflation of CO2. After deflation blood flow returned to baseline values in both hepatic veins. Conversely, in the control group hepatic blood flow remained unchanged over the entire study period. We conclude that induction of CO2 pneumoperitoneum with an IAP of 12 mm Hg is associated with an increase in hepatic perfusion in healthy adults.

 

最佳时机针刺刺激辅助枢复宁预防整形手术病人的呕吐

Optimal Timing of Acustimulation for Antiemetic Prophylaxis as an Adjunct to Ondansetron in Patients Undergoing Plastic Surgery

 

Paul F. White, MD, PhD*, Mohamed A. Hamza, MD*, Alejandro Recart, MD*, Jayne E. Coleman, MD*, Amy R. Macaluso, MD*, Lyndsey Cox, MS*, Omar Jaffer, MS*, Dajun Song, MD, PhD*, and Rod Rohrich, MD{dagger}

Departments of *Anesthesiology & Pain Management and {dagger}Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2005;100:367-372

 

我们设计这项研究,以评估在整形手术前、后、或前后都使用经皮电针穴位刺激,同时合并使用枢复宁止吐疗效。使用随机、双盲、假性装置对照的研究设计比较三种预防性针刺刺激的治疗方案:术前组术前使用有活性的装置30 min,术后使用假性装置72 h;术后组术前使用假性装置30 min,术后使用有活性的装置72 h;围术期组术前使用有活性的装置30 min,术后使用有活性的装置72 h(每组n = 35)。所有的病人均接受标准化全麻,术毕静脉注射4 mg枢复宁。在术后72 h里的特定时间间隔测定呕吐/干呕的发生率及对额外止吐药的需求。用11点的口头等级评定量表来记录恶心评分。评定的其他结果参数包括:出院时间(对于门诊病人)、正常日常生活活动的恢复、完全的止吐反应率及病人对止吐治疗及恢复质量的满意度。围术期使用ReliefBand®的完全有效率(68%)比只在术前使用该装置(43%)明显增加。在围术期及术后治疗组(与术前组相比)术后恶心的评分中位值明显降低。最终,在一个从0 ( 最坏) 100( 最好)的任意标度上,围术期或术后接受针刺刺激组(相对术前组)的病人对恢复质量的满意度(83 ± 16 85 ± 13 72 ± 18)及对止吐处理的满意度(96 ± 994 ± 10 86 ± 13)明显较高。对手术当日出院的病人,围术期给予针刺刺激(相对术前而言),可以回家的时间明显提前(114 ± 41 min164 ± 50 min; P < 0.05)。结论,在术后使用ReliefBand®给予针刺刺激进行止吐治疗能最有效地减少术后恶心呕吐及改善病人的满意度。

(裘毅敏 李士通 校)

We designed this study to evaluate the antiemetic efficacy of transcutaneous electrical acupoint stimulation in combination with ondansetron when applied before, after, or both before and after plastic surgery. A randomized, double-blind, sham-controlled study design was used to compare three prophylactic acustimulation treatment schedules: preoperative—an active device was applied for 30 min before and a sham device for 72 h after surgery; postoperative—a sham device was applied for 30 min before and an active device for 72 h after surgery; and perioperative—an active device was applied for 30 min before and 72 h after surgery (n = 35 per group). All patients received a standardized general anesthetic, and ondansetron 4 mg IV was administered at the end of surgery. The incidence of vomiting/retching and the need for rescue antiemetics were determined at specific time intervals for up to 72 h after surgery. Nausea scores were recorded with an 11-point verbal rating scale. Other outcome variables assessed included discharge times (for outpatients), resumption of normal activities of daily living, complete antiemetic response rate, and patient satisfaction with antiemetic therapy and quality of recovery. Perioperative use of the ReliefBand® significantly increased complete responses (68%) compared with use of the device before surgery only (43%). Median postoperative nausea scores were significantly reduced in the peri- and postoperative (versus preoperative) treatment groups. Finally, patient satisfaction with the quality of recovery (83 ± 16 and 85 ± 13 vs 72 ± 18) and antiemetic management (96 ± 9 and 94 ± 10 vs 86 ± 13) on an arbitrary scale from 0 = worst to 100 = best was significantly higher in the groups receiving peri- or postoperative (versus preoperative) acustimulation therapy. For patients discharged on the day of surgery, the time to home readiness was significantly reduced (114 ± 41 min versus 164 ± 50 min; P < 0.05) when acustimulation was administered perioperatively (versus preoperatively). In conclusion, acustimulation with the ReliefBand® was most effective in reducing postoperative nausea and vomiting and improving patients’ satisfaction with their antiemetic therapy when it was administered after surgery.

 

针刺刺激的时间并不影响麻醉药的需要量

The Timing of Acupuncture Stimulation Does Not Influence Anesthetic Requirement

Grigory Chernyak, MD*, Papiya Sengupta, MD, Rainer Lenhardt, MD*, Edwin Liem, MD*, Anthony G. Doufas, MD, PhD*, Daniel I. Sessler, MD*, and Ozan Akça, MD*

*Department of Anesthesiology and Perioperative Medicine and Outcomes ResearchTM Institute, University of Louisville, Kentucky

Anesth Analg 2005;100:387-392

 

有研究提示在麻醉诱导前进行针刺比在其后进行更有效果。我们通过实验希望证明,在诱导前30min开始给予电针刺激比在诱导后开始,能更明显地减少麻醉药用量。7名志愿者在3天中以地氟醚进行麻醉实验。首先选择四个可以产生上腹部区域镇痛效果、同时也产生一定的非特异性的镇静和镇痛效果穴位针刺,分别为:足三里 (St36),三阴交 (Sp6), 列缺 (Sp34), 合谷 (LI4)。分别用2Hz10Hz电刺激以2秒的时程交替进行针刺。三天实验第一天内容为针刺在诱导前(诱导前组),志愿者以麻醉诱导前进行30min的电针刺激,并维持到整个过程中。第二天实验内容为针刺在诱导中(诱导组),针头在诱导前安置在皮肤上,但是电刺激直到诱导后才给予。第三天实验中(实验组),电极被放置到针刺点邻近,但是并不在皮肤上放置针灸针。测痛用的伤害性电刺激通过25G的针在上腹部给予(70 mA; 100 Hz; 10 s)。在病人因为疼痛发生体动时地氟醚的浓度增加0.5%,在不发生体动时减少0.5%。这种连续上下调节,使志愿者从体动到无体动的变化连续反复四次,以LOGISTIC回归P50分析方法来分析地氟醚的需要量。在三组实验组中地氟醚的需求量基本相近,分别为实验组(mean ± sd; 5.2% ± 0.6%), 诱导前组 (5.0% ± 0.8%), 和诱导组 (4.7% ± 0.3%; P = 0.125) 。我们认为这种形式的针刺并不能影响全麻效能或减少全麻药物的需求量。

(沈浩译,李士通校)

Studies suggest that acupuncture is more effective when induced before the induction of general anesthesia than afterwards. We tested the hypothesis that electro-acupuncture initiated 30 min before the induction reduces anesthetic requirement more than acupuncture initiated after the induction. Seven volunteers were each anesthetized with desflurane on 3 study days. Needles were inserted percutaneously at four acupuncture points thought to produce analgesia in the upper abdominal area and provide generalized sedative and analgesic effects: Zusanli (St36), Sanyinjiao (Sp6), Liangqiu (Sp34), and Hegu (LI4). Needles were stimulated at 2 Hz and 10 Hz, with frequencies alternating at 2-s intervals. On Preinduction day, electro-acupuncture was started 30 min before the induction of anesthesia and maintained throughout the study. On At-induction day, needles were positioned before the induction of anesthesia, but electro-acupuncture stimulation was not initiated until after the induction. On Control day, electrodes were positioned near the acupoints, but needles were not inserted. Noxious electrical stimulation was administered via 25-gauge needles on the upper abdomen (70 mA; 100 Hz; 10 s). The desflurane concentration was increased 0.5% when movement occurred and decreased 0.5% when it did not. These up-and-down sequences continued until volunteers crossed from movement to no movement four times. The P50 of logistic regression identified desflurane requirement. Desflurane requirement was similar on the Control (mean ± sd; 5.2% ± 0.6%), Preinduction (5.0% ± 0.8%), and At-induction (4.7% ± 0.3%; P = 0.125) days. This type of acupuncture is thus unlikely to facilitate general anesthesia or decrease the requirement for anesthetic drugs.

 

高浓度笑气能减弱大鼠由吗啡产生的异氟醚最小肺泡浓度的节省效应

Large Concentrations of Nitrous Oxide Decrease the Isoflurane Minimum Alveolar Concentration Sparing Effect of Morphine in the Rat

Martín Santos, DVM, PhD*{dagger}, Viviana Kuncar, DVM*, Fernando Martínez-Taboada, DVM*, and Francisco J. Tendillo, DVM, PhD, DipECVA*{dagger}

*Department of Experimental Surgery, University Hospital Puerta de Hierro; and {dagger}Department of Anesthesiology, Complutense University Veterinary School, Madrid, Spain

Anesth Analg 2005;100:404-408

 

当与挥发性麻醉剂复合应用时,已证实许多辅助药有节省挥发性麻醉剂的特性 。笑气复合应用挥发性麻醉剂,减少了挥发性麻醉剂产生麻醉作用所需的浓度。阿片类麻醉剂的镇痛剂量明显减少人和实验动物的吸入麻醉剂需要量。我们实施此研究来确定,复合应用笑气和吗啡能否进一步减少鼠异氟醚最小肺泡有效浓度(MAC)58只母鼠被分在8组:在4个可能的笑气浓度下(0%30%50%70%)给于异氟醚和生理盐水或者吗啡(1 mg/kg)。然后在夹尾时从肺泡气体样本测定异氟醚的MAC (MACISO)。在不同笑气浓度下异氟醚的MAC明显不同,增加笑气浓度减少异氟醚的需求。在0%30%笑气浓度时应用吗啡减少MACISO。吗啡减少MACISO的作用在50%笑气浓度时减少,在70%笑气浓度时不存在。无论如何,有吗啡存在时,MACISO30%–70%的笑气浓度范围不依赖于笑气浓度。

(张曦 李士通 校)

Many adjuvant drugs have demonstrated anesthetic-sparing properties when combined with volatile anesthetics. Nitrous oxide is combined with volatile anesthetics to reduce the concentrations of volatile anesthetics required to produce anesthesia. Analgesic doses of opioids clearly reduce the requirement for inhaled anesthetics in both human patients and experimental animals. We performed this study to determine whether the combination of nitrous oxide and morphine decreased isoflurane minimum alveolar anesthetic concentration (MAC) even further in the rat. Fifty-eight female rats were used. The rats were divided into 8 groups: isoflurane in 4 possible nitrous oxide concentrations (0%, 30%, 50%, or 70%) with saline or morphine (1 mg/kg). Then the MAC of isoflurane (MACISO)was determined from alveolar gas samples at the time of tail clamp. The MAC of isoflurane was significantly different at each nitrous oxide concentration, and increasing nitrous oxide concentrations reduced anesthetic requirements for isoflurane. The administration of morphine reduced the MACISO when used with 0% or 30% nitrous oxide. This MACISO by morphine reduction was less with 50% nitrous oxide and nonexistent at 70% nitrous oxide. However, with morphine present the MACISO was independent of the nitrous oxide concentration in the 30%–70% range.

 

ATP敏感钾通道参与培养的人主动脉内皮细胞膜电位对髙渗的反应

Involvement of Adenosine Triphosphate-Sensitive Potassium Channels in the Response of Membrane Potential to Hyperosmolality in Cultured Human Aorta Endothelial Cells

Mikiyo Yamaguchi, MD, Yoshinobu Tomiyama, MD, Toshiko Katayama, MD, Hiroshi Kitahata, MD, and Shuzo Oshita, MD

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

Anesth Analg 2005;100:419-426

 

内皮细胞的膜电位是内皮功能包括血管张力调节的一项重要决定因素。我们研究了ATP敏感钾通道(KATP)是否参与培养的人主动脉内皮细胞膜电位对髙渗的反应。用电压敏感的荧光染料bis-(1,3-diethylthiobarbiturate)trimethine oxonol来对膜电位的相对变化进行半定量评估。为了探讨甘露醇、蔗糖和NaCl引起的髙渗对膜电位的影响,细胞用含200 nM bis-(1,3-diethylthiobarbiturate)trimethine oxonolEarle’s平衡盐溶液(285 mOsm/kg H2O)持续灌流,并在有或无1 µM格列苯脲(一种公认的KATP通道阻滞剂)的情况下接触315345 mOsm/kg H2O的髙渗媒介。髙渗的甘露醇明显地引起内皮细胞的超极化,1 µM的格列苯脲可以预防(n6)。估计的膜电位变化在315345 mOsm/kg H2O时分别为13 ± 8 21 ± 8 mV。髙张的蔗糖引起相似的变化。然而,尽管髙张的盐水也可以显著地引起内皮细胞的超极化(n6),这一变化却并不为1 µM 格列苯脲所预防。结论,在培养的人主动脉内皮细胞上,KATP通道可能参与了由髙渗甘露醇和蔗糖引起的超极化,其并未参与由髙张盐水引起的超极化。

(黄施伟 李士通 校)

The membrane potential of endothelial cells is an important determinant of endothelial functions, including regulation of vascular tone. We investigated whether adenosine triphosphate-sensitive potassium (KATP) channels were involved in the response of membrane potential to hyperosmolality in cultured human aorta endothelial cells. The voltage-sensitive fluorescent dye, bis-(1,3-diethylthiobarbiturate)trimethine oxonol, was used to assess relative changes in membrane potential semiquantitatively. To investigate the effect of mannitol-, sucrose-, and NaCl-induced hyperosmolality on membrane potential, cells were continuously perfused with Earle’s balanced salt solution (285 mOsm/kg H2O) containing 200 nM bis-(1,3-diethylthiobarbiturate)trimethine oxonol and exposed to 315 and 345 mOsm/kg H2O hyperosmotic medium sequentially in the presence and absence of 1 µM glibenclamide, a well-known KATP channel blocker. Hyperosmotic mannitol significantly induced hyperpolarization of the endothelial cells, which was prevented by 1 µM glibenclamide (n = 6). Estimated changes of membrane potential at 315 and 345 mOsm/kg H2O were 13 ± 8 and 21 ± 8 mV, respectively. Hypertonic sucrose induced similar changes. However, although hypertonic saline also significantly induced hyperpolarization of the endothelial cells (n = 6), the hyperpolarization was not prevented by 1 µM glibenclamide. In conclusion, KATP channels may participate in hyperosmotic mannitol- and sucrose-induced hyperpolarization, but not in hypertonic saline-induced hyperpolarization in cultured human aorta endothelial cells.

 

氧化血红蛋白为基质的携氧分子(血红蛋白 Glutamer-200)产生的高铁血红蛋白干扰乳酸测定 (YSI 2700 SELECTTM生化分析仪)吗?

Does Methemoglobin from Oxidized Hemoglobin-Based Oxygen Carrier (Hemoglobin Glutamer-200) Interfere with Lactate Measurement (YSI 2700 SELECTTM Biochemistry Analyzer)?

Stephen L. Osgood, MD*, Jonathan S. Jahr, MD*{dagger}, Poonam Desai*, Jessica Tsukamoto*, and Bernd Driessen, DVM, PhD*{ddagger}

*Department of Anesthesiology, David Geffen School of Medicine at University of California Los Angeles; {dagger}Charles R. Drew University of Medicine and Science, Martin Luther King Jr./Drew Medical Center, Los Angeles, California; and {ddagger}Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia

Anesth Analg 2005;100:437-439

 

在本研究中,我们验证了当氧化血红蛋白源性的携氧物质――血红蛋白 Glutamer-200Oxyglobin®Biopure 公司)产生的高铁血红蛋白(Met-HBOC)存在时, YSI 2700 SELECTTM 葡萄糖/乳酸分析仪测定乳酸的准确性。不同浓度组合的浓缩左旋乳酸溶液、库存狗血浆和Plasmalyte ATM 加入四种样本组(1%10%20%40% Met-HBOC [1.3 g/dL])中,使连贯样本中的乳酸浓度线性增加。乳酸浓度测量值和计算值之间的平均差异分别是–5.1 mg/dL (1% Met-HBOC)–5.8 mg/dL (10% Met-HBOC)–4.6 mg (20% Met-HBOC)–8.5 mg/dL (40% Met-HBOC)。均方根误差分别是6.5 mg/dL7.4 mg/dL6.8 mg/dL10.3 mg/dLBland-Altman 相关系数(r)分别是 r = –0.94 (P = 0.01) r = –0.91 (P < 0.001) r = –0.90 (P < 0.001)r = –0.94 (P < 0.001)(当测量值和计算值完全一致时 r = 0 )。结果提示当Met-HBOC存在时,用YSI 2700分析仪测量的乳酸浓度偏低,其偏差与Met-HBOC的含量无关。当患者血浆中存在HBOC时,所测乳酸浓度会偏低,其偏差与高铁血红蛋白的浓度无关。

(轩泓 李士通 校)

In this study, we validated the accuracy of lactate measurements (YSI 2700 SELECTTM glucose/lactate analyzer) in the presence of methemoglobin from an oxidized bag of hemoglobin-based oxygen carrier (Met-HBOC), hemoglobin glutamer-200 (Oxyglobin®; Biopure Corp). Different combinations of concentrated l-lactate solution, pooled canine plasma, and Plasmalyte ATM were added to 4 sample groups (1%, 10%, 20%, and 40% Met-HBOC [1.3 g/dL]) to yield linear increases in lactate concentration in consecutive samples. The mean difference between measured and calculated lactate was –5.1 mg/dL (1% Met-HBOC), –5.8 mg/dL (10% Met-HBOC), –4.6 mg (20% Met-HBOC), and –8.5 mg/dL (40% Met-HBOC). The root mean square error was 6.5 mg/dL, 7.4 mg/dL, 6.8 mg/dL, and 10.3 mg/dL, respectively. The Bland-Altman correlation (r) was r = –0.94 (P = 0.01), r = –0.91 (P < 0.001), r = –0.90 (P < 0.001), and r = –0.94 (P < 0.001), respectively, where r = 0 for perfect agreement between measured and calculated values. Results indicate that true lactate levels in the presence of Met-HBOC are underestimated when measured by an YSI 2700 analyzer independent of the amount of Met-HBOC present. When interpreting lactate concentrations from a patient with a HBOC present in plasma, underestimation of true lactate levels may occur unrelated to methemoglobin concentrations.

 

环加氧酶-2抑制剂帕瑞考昔钠治疗妇产科剖腹手术后疼痛与肌注吗啡12 mg一样有效

The Cyclooxygenase-2-Specific Inhibitor Parecoxib Sodium Is as Effective as 12 mg of Morphine Administered Intramuscularly for Treating Pain After Gynecologic Laparotomy Surgery

T. Philip Malan, Jr, MD, PhD*, Stephen Gordon, MD{dagger}, Richard Hubbard, MD{ddagger}, and Michael Snabes, MD{ddagger}

*Department of Anesthesiology, The University of Arizona, Tucson, Arizona; {dagger}Comprehensive NeuroScience Inc., Atlanta, Georgia; and {ddagger}Pfizer Global Pharmaceuticals, Skokie, Illinois

Anesth Analg 2005;100:454-460

 

帕瑞考昔钠为选择性环加氧酶-2抑制剂,也是伐地昔布可注射的前驱药物,它能有效的缓解术后疼痛。在此随机、双盲、安慰剂对照的研究中,我们对单次肌注40 mg帕瑞考昔钠和单次肌注6 mg12 mg吗啡控制妇产科剖腹手术后疼痛的效果进行了对比。根据几乎所有的功效测定值(包括总体疼痛缓解度和患者对此研究性治疗的总体评估),肌注40 mg帕瑞考昔钠能缓解疼痛并降低疼痛的强度,其效果与肌注12 mg吗啡相比无统计学差异,并明显优于肌注6 mg吗啡。相较于两种剂量的吗啡,肌注40 mg帕瑞考昔钠处理的病人追加镇痛药物的时间较晚,且此剂量能持续缓解疼痛达12小时。各治疗组的不良反应发生率同安慰剂组相同。上述结果显示40 mg帕瑞考昔钠同临床上有关剂量的吗啡在控制妇产科剖腹手术术后疼痛上同样有效。

(赵雪莲 李士通 校)

Parecoxib sodium, the injectable prodrug of valdecoxib, is a cyclooxygenase-2-specific inhibitor that is effective in the treatment of postoperative pain. In this randomized, double-blind, placebo-controlled study, we compared the efficacy of a single dose of parecoxib sodium 40 mg IM with single doses of morphine 6 and 12 mg IM in treating postoperative pain after gynecologic surgery requiring a laparotomy incision. By nearly all efficacy measures (including total pain relief and patient's global evaluation of study medication), parecoxib sodium 40 mg IM demonstrated pain relief and a decrease in pain intensity that was statistically similar to that with morphine 12 mg IM and superior to that with morphine 6 mg IM. Parecoxib sodium 40 mg IM-treated patients also demonstrated a longer time to use of rescue medication than patients treated with both morphine doses, and this dose provided sustained pain relief over the 12-h study period. The incidence of adverse events in the active treatment groups was similar to that observed with placebo. Parecoxib sodium, 40 mg IM, has been shown to be as effective as clinically relevant doses of morphine in patients after gynecologic laparotomy surgery.


注射小剂量氯胺酮可改善全膝关节成形术后镇痛及康复

Small-Dose Ketamine Infusion Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty

 

Frédéric Adam, MD, Marcel Chauvin, MD, Bertrand Du Manoir, MD, Mathieu Langlois, MD, Daniel I. Sessler, MD, and Dominique Fletcher, MD

Departments of Anesthesia and INSERM E 332, Hôpital Ambroise Pare, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne, France; Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 92428 Garches, France; and the Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky

Anesth Analg 2005;100:475-480

 

我们设计该试验以评估静脉注射小剂量氯胺酮复合持续股神经阻滞对于全膝关节成形术后疼痛和康复的作用。术前以0.3 mL/kg 0.75%罗哌卡因行股神经阻滞,术后在外科病房继以0.2%罗哌卡因以0.1 mL · kg–1 · h–1速度行持续股神经阻滞48小时。病人随机分为两组,一组在术中静脉注射0.5 mg/kg初始剂量的氯胺酮后继以3 µg · kg–1 · min–1速度静脉持续输注氯胺酮,术后以1.5 µg · kg–1 · min–1速度持续输注氯胺酮48小时(氯胺酮组);另一组给予同样容量的生理盐水(对照组)。术后病人自控静脉输注吗啡以提供附加的术后镇痛。记录48小时里的疼痛评分和吗啡用量。每天记录病人膝关节主动屈曲可忍受的最大幅度直至病人出院。手术后6周和3个月对病人进行随访。氯胺酮组吗啡需求量少于对照组(45 ± 20 mg69 ± 30mgP < 0.02)。氯胺酮组病人比对照组更快达到膝关节可主动屈曲90°(两组中位数7天对12天;25--75%可信限5—11天对8—15; P < 0.03)。术后6周和3个月的预后两组相似。以上结果证实氯胺酮是围手术期多方式镇痛中的有效辅助镇痛用药,且对于膝盖早期活动有积极作用。两组病人均未报告出现镇静、幻觉、噩梦或复视,且两组间恶心和呕吐的发生率也无显著差异。

(周雅春 李士通 校)

We designed this study to evaluate the effect of small-dose IV ketamine in combination with continuous femoral nerve block on postoperative pain and rehabilitation after total knee arthroplasty. Continuous femoral nerve block was started with 0.3 mL/kg of 0.75% ropivacaine before surgery and continued in the surgical ward for 48 h with 0.2% ropivacaine at a rate of 0.1 mL · kg–1 · h–1. Patients were randomly assigned to receive an initial bolus of 0.5 mg/kg ketamine followed by a continuous infusion of 3 µg · kg–1 · min–1 during surgery and 1.5 µg · kg–1 · min–1 for 48 h (ketamine group) or an equal volume of saline (control group). Additional postoperative analgesia was provided by patient-controlled IV morphine. Pain scores and morphine consumption were recorded over 48 h. The maximal degree of active knee flexion tolerated was recorded daily until hospital discharge. Follow-up was performed 6 wk and 3 mo after surgery. The ketamine group required significantly less morphine than the control group (45 ± 20 mg versus 69 ± 30 mg; P < 0.02). Patients in the ketamine group reached 90° of active knee flexion more rapidly than those in the control group (at 7 [5–11] versus 12 [8–45] days, median [25%–75% interquartile range]; P < 0.03). Outcomes at 6 wk and 3 mo were similar in each group. These results confirm that ketamine is a useful analgesic adjuvant in perioperative multimodal analgesia with a positive impact on early knee mobilization. No patient in either group reported sedation, hallucinations, nightmares, or diplopia, and no differences were noted in the incidence of nausea and vomiting between the two groups.

 

环周性调整超声探头位置以确定穿刺颈内静脉的最佳径路:对成人无创性几何研究

Circumferential Adjustment of Ultrasound Probe Position to Determine the Optimal Approach to the Internal Jugular Vein: A Noninvasive Geometric Study in Adults

 

James M. Riopelle, MD*, Darren P. Ruiz, MD*, John P. Hunt, MD{dagger}, Mark R. Mitchell, MD*, J. Carlos Mena, MD, Jason A. Rigol, MD*, Bruno C. Jubelin, PhD{ddagger}, Arthur J. Riopelle, PhD§, Valeriy V. Kozmenko, MD*, and Matthew K. Miller, MD*

Departments of *Anesthesiology, {dagger}Surgery, ¶Radiology, and {ddagger}Medicine, Louisiana State University Health Sciences Center at New Orleans, New Orleans, Louisiana; and §Department of Psychology, Louisiana State University, Baton Rouge, Louisiana

Anesth Analg 2005;100:512-519

 

 环颈部调整二维超声(US)探头位置常被推荐作为一种在颈内静脉(IJV)置管时减少误穿颈总动脉机率的方法。我们获得并分析了107个成人的双侧颈部高分辨US多重图像,以确定利用该方法来辨认从皮肤至IJV的径路,使颈部动静脉重叠最少而静脉目标(角的)宽度最大。该方法在确定穿刺IJV径路方面始终优于四种常用的利用表面解剖标志确定穿刺径路方法(“盲法”),并且在用US指导的下列情况更有效:1)调整头部转动程度,2)在高和低的途径之间选择及3)在左与右IJV间选择。利用高分辨率超声图像仪也有助于辩认可能与选择最佳穿刺IJV通路有关的其它颈部解剖结构(非目标的静脉、淋巴结和甲状腺)的精确边界。

(王立中 李士通 校)

Circumferential adjustment of the position of a two-dimensional ultrasound (US) probe around the neck has been recommended as a strategy for reducing the potential for unintentional common carotid artery puncture during internal jugular venous (IJV) cannulation. We obtained multiple high-resolution US images bilaterally from the necks of 107 adult subjects and analyzed these to determine the degree to which this strategy permits identification of a pathway from the skin to the IJV that minimizes venoarterial overlap while maximizing venous target (angular) width. The method consistently permitted identification of an approach to the IJV superior to that obtainable with any one of four popular surface anatomy-based ("blind") approaches and was even more powerful if used in concert with a US-guided 1) adjustment of the degree of head rotation, 2) choice between a high and low approach, and 3) choice between the right and left IJV. Use of a high-resolution US imaging device also permitted identification of the precise boundaries of additional cervical anatomic structures (nontarget vessels, lymph nodes, and the thyroid gland) potentially relevant to selection of an optimal approach to the IJV.


神经外科手术患者长期应用苯妥英或卡马西平治疗影响顺式阿曲库铵引起的神经肌肉阻滞作用

Cisatracurium-Induced Neuromuscular Blockade Is Affected by Chronic Phenytoin or Carbamazepine Treatment in Neurosurgical Patients

Anouk Richard, MD, FRCPC*, François Girard, MD, FRCPC*, Dominique C. Girard, MD, FRCPC*, Daniel Boudreault, MD, FRCPC*, Philippe Chouinard, MD, FRCPC*, Robert Moumdjian, MD, FRCS{dagger}, Alain Bouthilier, MD, FRCS{dagger}, Monique Ruel, RN, CCRP*, Johanne Couture, RT{ddagger}, and France Varin, Bpharm, PhD{ddagger}

*Department of Anesthesiology and {dagger}Neurosurgery Division, CHUM, Hôpital Notre-Dame; and {ddagger}Faculty of Pharmacy, Université de Montréal, Montréal, Canada

Anesth Analg 2005;100:538-544

 

慢性抗惊厥治疗(CAT)对顺式阿曲库铵的神经肌肉阻滞作用的维持和恢复的影响还未被充分地研究。在本研究中,我们比较应用或不应用CAT的患者长时间输注顺式阿曲库铵的药代动力学和药效动力学。30位进行颅内手术的患者入选本研究:15位患者应用CAT(卡马西平和苯妥英,A组)和15位患者作为对照不进行抗惊厥治疗(C组)。麻醉标准化,两组均给予一个剂量的顺式阿曲库铵然后持续输注保持肌颤搐抑制95%。获得稳态后再持续输注两小时。然后使神经肌肉阻滞自然恢复。测量顺式阿曲库铵血浆浓度的血样在稳态期间(Cp ss 95)和恢复的不同时间采集。两组人口统计学资料和术中情况相似。CAT使第一个肌颤搐恢复到25%75%更快。保持肌颤搐抑制95%的稳态所需的顺式阿曲库铵的输注速率在A组要快44% P < 0.001)。与C组相比A组顺式阿曲库铵的清除明显要快(7.12 ± 1.87 vs 5.72 ± 0.70 L · kg –1 · min –1P = 0.01)。Cpss95A组也明显要高(191 ± 45 vs 159 ± 36 ng/mLP = 0.04)。另外,应用CAT的患者顺式阿曲库铵的清除增加20%,从而使肌松药输注后神经肌肉阻滞的恢复更快。同样,应用CAT的患者Cpss95增加20%,表明对顺式阿曲库铵作用的耐药性增加。

(陈玮    李士通 校)

The effect of chronic anticonvulsant therapy (CAT) on the maintenance and recovery profiles of cisatracurium-induced neuromuscular blockade has not been adequately studied. In this study, we compared the pharmacokinetics and pharmacodynamics of cisatracurium after a prolonged infusion in patients with or without CAT. Thirty patients undergoing intracranial surgery were enrolled in the study: 15 patients under CAT (carbamazepine and phenytoin, Group A) and 15 controls receiving no anticonvulsant therapy (Group C). Anesthesia was standardized and both groups received a bolus of cisatracurium followed by an infusion to maintain a 95% twitch depression. A steady-state was obtained and the infusion was kept constant for 2 additional hours. Neuromuscular blockade was then allowed to spontaneously recover. Blood samples were taken for measurement of cisatracurium plasma concentration during the steady-state period (Cpss95) and at various times during recovery. Demographic and intraoperative data were similar. CAT resulted in faster 25% and 75% recovery of the first twitch. The rate of infusion of cisatracurium needed to maintain a 95% twitch depression at steady-state was 44% faster in Group A (P < 0.001). The clearance of cisatracurium was significantly faster in Group A when compared with Group C (7.12 ± 1.87 versus 5.72 ± 0.70 L · kg–1 · min–1, P = 0.01). The Cpss95 was also significantly larger in Group A (191 ± 45 versus 159 ± 36 ng/mL, P = 0.04). In addition, patients receiving CAT had a 20% increase in the clearance of cisatracurium that, in turn, resulted in a faster recovery of neuromuscular blockade after an infusion of the drug. Also, patients under CAT had a 20% increase in their Cpss95, indicating an increased resistance to the effect of cisatracurium.

 

2-氯普鲁卡因脊麻:在志愿者中与小剂量布比卡因比较

Spinal 2-Chloroprocaine: A Comparison with Small-Dose Bupivacaine in Volunteers

Jessica R. Yoos, MD, and Dan J. Kopacz, MD

Department of Anesthesiology, Virginia Mason Clinic, Seattle, Washington

Anesth Analg 2005;100:566-572

 

在全国范围内,门诊手术量呈持续上升 。由于利多卡因脊麻存在与之相关的一过性神经症状,因此许多临床医师在门诊手术时转而选用小剂量布比卡因进行脊麻。然而,布比卡因常常不能提供充分的手术麻醉效果,时效也很难预料。所以,不含防腐剂的2-氯普鲁卡因(2-CP)又再度成为门诊脊麻的选择之一。我们设计了这个双盲、随机、交叉、志愿者试验来比较2-CP 40mg和小剂量布比卡因7.5mg的脊麻效果。观察指标为针刺麻醉水平、运动肌力、对止血带和电刺激的耐受性以及模拟出院标准。两组之间,阻滞的峰平面(2-CP平均到T7 [范围T3–10]; 布比卡因平均到T9 [范围T4–L1])、消退到L1的时间 (2-CP 64 ± 10 min对布比卡因 87 ± 41 min)及止血带耐受时间(2-CP 52 ± 11 min对布比卡因60 ± 27 min)没有显著差异(P 值分别为 0.150.120.40)。然而,布比卡因组的模拟出院时间(包括阻滞完全消退时间、下床活动时间和自然排便时间)显著较长(2-CP113 ± 14min, 布比卡因191 ± 30 min, P = 0.0009)。受试者中未见一过性神经症状表现和其他副反应。我们得出结论,与7.5mg布比卡因相比,使用2-CP进行门诊手术脊麻可以提供充分的麻醉时效和阻滞深度,而且阻滞消退及恢复到离床活动显著加快。

(周志坚 李士通 )

Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3–10]; bupivacaine average T9 [range T4–L1]), regression to L1 (2-CP 64 ± 10 versus bupivacaine 87 ± 41 min), and tourniquet tolerance (2-CP 52 ± 11 versus bupivacaine 60 ± 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 ± 14, bupivacaine 191 ± 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.

 

成人颈深部感染的气道管理:病例系列和文献回顾

Airway Management in Adult Patients with Deep Neck Infections: A Case Series and Review of the Literature

Andranik Ovassapian, MD*, Meltem Tuncbilek, MD{dagger}, Erik K. Weitzel, MD{ddagger}, and Chandrashekhar W. Joshi, MD{dagger}

*Department of Anesthesia and Critical Care, the University of Chicago, Chicago Illinois; {dagger}Department of Anesthesiology, Northwestern University, Chicago, Illinois, and {ddagger}Department of Otolaryngology and Communication Sciences, Baylor College of Medicine, Houston, Texas

Anesth Analg 2005;100:585-589

 

患有颈深部感染的病人,尤其是那些有路德维格咽痛的病人,很可能死于气道管理失误。这些病人非常需要熟练的气道管理,但是现在仍未建立一种安全的控制气道的方法。我们对患颈深部感染的病人通过表面麻醉行纤维支气管镜引导气管插管,以提供全身麻醉用于手术干预。用专门的资料收集表格记录病人的特点和插管方法。26例病人中,17例患路德维格咽痛,其余9例患其它类型颈深部感染。3例病人在坐位,2例在福勒氏体位,21例在仰卧头抬高10°–15°行气管插管。25例病人气管插管成功:19例经鼻,6例经口。手术后7例病人保留气管导管,5例病人实施气管切开。并发症限于3例轻微鼻衄、4例镇静过度伴短暂低氧血症。12例病人知晓部分手术情况,其中2例认为是不愉快的。表面麻醉后纤维支气管镜引导气管插管用于患颈深部感染的成年病人是非常成功的。如果不能使用纤维支气管镜、临床医生没有熟练掌握清醒纤维支气管镜引导气管插管、或者插管失败,建议局麻下行气管切开术。

(张莹 李士通 校)

Patients with deep neck infections, especially those with Ludwig’s angina, may die as a result of airway management mishaps. Skillful airway management is critical, but a safe method of airway control in these patients is yet to be established. We subjected patients with deep neck infections to fiberoptic tracheal intubation by using topical anesthesia to provide general anesthesia for surgical interventions. Patient characteristics and techniques for intubations were recorded on a special data-collection form. Of the 26 patients, 17 had Ludwig’s angina, and 9 had other types of deep neck infections. Three patients were tracheally intubated while in the sitting position, 2 in Fowler’s position, and 21 in the supine position with the head up 10°–15°. Tracheal intubations were successful in 25 patients: 19 nasally and 6 orally. After surgery, seven patients were kept tracheally intubated, and five patients had tracheostomies. Complications were limited to three cases of mild epistaxis and four oversedations with transient hypoxemia. Twelve patients remembered part of the procedure, and two considered it unpleasant. Tracheal intubation with a flexible bronchoscope by using topical anesthesia is highly successful in adult patients with deep neck infections. Tracheostomy using local anesthesia is recommended if fiberoptic intubation is not feasible, if the clinician is not skillful in the use of awake fiberoptic intubation, or if intubation attempts have failed.