Anesthesia & Analgesia

July 2005

Table of Content

 

 

CARDIOVASCULAR ANESTHESIA:

应用米力农可改善合并二尖瓣返流病人在行非体外循环冠状动脉旁路吻合术时血流动力学改变

(金 路译 薛张纲校)

Hemodynamic Changes During Off-Pump Coronary Artery Bypass Anastomosis in Patients with Coexisting Mitral Regurgitation: Improvement with Milrinone

Takeshi Omae, Yasuyuki Kakihana, Akira Mastunaga, Isao Tsuneyoshi, Kouichi Kawasaki, Yuichi Kanmura, and Ryuzo Sakata

Anesth Analg 2005 101: 2-8.

米力农及考福新减弱兔腹主动脉阻断松夹后软脑膜小动脉的持续收缩

(裘毅敏 李士通 校)

Both Milrinone and Colforsin Daropate Attenuate the Sustained Pial Arteriolar Constriction Seen After Unclamping of an Abdominal Aortic Cross-Clamp in Rabbits

Masayoshi Uchida, Hiroki Iida, Mami Iida, Masahiko Kumazawa, Kazuyuki Sumi, Motoyasu Takenaka, and Shuji Dohi

Anesth Analg 2005 101: 9-16.

心脏手术/心肺转流后房颤与单核细胞激活有关

(朱辉 陈杰 )

Atrial Fibrillation After Cardiac Surgery/Cardiopulmonary Bypass Is Associated with Monocyte Activation

Manuel L. Fontes, Joseph P. Mathew, Henry M. Rinder, Daniel Zelterman, Brian R. Smith, Christine S. Rinder, and the Multicenter Study of Perioperative Ischemia (McSPI) Reasearch Group

Anesth Analg 2005 101: 17-23.

二尖瓣手术中伴随射频消融和手术方式(修补术对置换术)对心脏生物标志物释放的影响

(金 薛张纲 校)

The Effect of Concomitant Radiofrequency Ablation and Surgical Technique (Repair Versus Replacement) on Release of Cardiac Biomarkers During Mitral Valve Surgery

Alberto Zangrillo, Giuseppe Crescenzi, Giovanni Landoni, Stefano Benussi, Martina Crivellari, Federico Pappalardo, Enrica Dorigo, Carlo Pappone, and Ottavio Alfieri

Anesth Analg 2005 101: 24-29.

比较活体供肝和尸体供肝移植的输液需要量:与终末期肝病评分模型和基础凝血状态的关系

(马皓琳 李士通 校)

A Comparison of Transfusion Requirements Between Living Donation and Cadaveric Donation Liver Transplantation: Relationship to Model of End-Stage Liver Disease Score and Baseline Coagulation Status

Peter E. Frasco, Karl A. Poterack, Joseph G. Hentz, and David C. Mulligan

Anesth Analg 2005 101: 30-37.

PEDIATRIC ANESTHESIA:

小儿镇静状态下评估系统安全和潜在失误的方法

(朱辉 陈杰 校)

A Method for Measuring System Safety and Latent Errors Associated with Pediatric Procedural Sedation

George T. Blike, Klaus Christoffersen, Joseph P. Cravero, Steven K. Andeweg, and Jens Jensen
Anesth Analg 2005 101: 48-58.

昂丹司琼口服片:在接受增殖腺扁桃体切除术的患儿中的可行性及有效性

(王丽珺译 薛张纲校)

Ondansetron Oral Disintegrating Tablets: Acceptability and Efficacy in Children Undergoing Adenotonsillectomy

Ira Todd Cohen, Denise Joffe, Kelly Hummer, and Alice Soluri

Anesth Analg 2005 101: 59-63.

糖溶液的镇痛:葡萄糖对表达的阿片类μ受体的作用

(周志坚 李士通 校)

Sugar Solution Analgesia: The Effects of Glucose on Expressed Mu Opioid Receptors

George R. Kracke, Katherine A. Uthoff, and Joseph D. Tobias

Anesth Analg 2005 101: 64-68.

小儿骶管麻醉时咪唑安定、氯胺酮和新斯的明与布比卡因联合应用的比较

(赵延华 陈杰 校)

Caudal Additives in Pediatrics: A Comparison Among Midazolam, Ketamine, and Neostigmine Coadministered with Bupivacaine

P. Kumar, A. Rudra, A. K. Pan, and A. Acharya

Anesth Analg 2005 101: 69-73.

AMBULATORY ANESTHESIA:

高比重左布比卡因和罗哌卡因腰麻在门诊膝关节镜的应用:一项前瞻、随机、双盲试验

(王丽珺译 薛张纲校)

Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study

Gianluca Cappelleri, Giorgio Aldegheri, Giorgio Danelli, Chiara Marchetti, Massimiliano Nuzzi, Gabriella Iannandrea, and Andrea Casati

Anesth Analg 2005 101: 77-82.

围手术期罗非考西复合局麻药区域阻滞可减少门诊腹股沟疝修补术病人的疼痛及恢复时间

(黄佳佳 李士通 校)

Perioperative Rofecoxib Plus Local Anesthetic Field Block Diminishes Pain and Recovery Time After Outpatient Inguinal Hernia Repair

Dorothy J. Pavlin, Edward G. Pavlin, Karen D. Horvath, Laurie B. Amundsen, David R. Flum, and Kristine Roesen

Anesth Analg 2005 101: 83-89.

与药物前体丙帕他莫(propacetamol)相比,对乙酰氨基酚(扑热息痛)经静脉用于第三磨牙手术后疼痛有同样的镇痛效能,但安全性更好

(赵延华 陈杰 校)

Intravenous Acetaminophen (Paracetamol): Comparable Analgesic Efficacy, but Better Local Safety than Its Prodrug, Propacetamol, for Postoperative Pain After Third Molar Surgery

Philip Lange Moller, Gitte Irene Juhl, Catherine Payen-Champenois, and Lasse Ansgar Skoglund

Anesth Analg 2005 101: 90-96.

静脉注射异丙酚与咪达唑仑镇静对血流动力学及心率变异的不同影响

(金 琳译 薛张纲校)

The Different Effects of Intravenous Propofol and Midazolam Sedation on Hemodynamic and Heart Rate Variability

Ni Ni Win, Haruhisa Fukayama, Hikaru Kohase, and Masahiro Umino

Anesth Analg 2005 101: 97-102.

ANESTHETIC PHARMACOLOGY:

兔神经根进入区十分容易受鞘内丁卡因的损害

(黄施伟 李士通 校)

The Nerve Root Entry Zone Is Highly Vulnerable to Intrathecal Tetracaine in Rabbits

Shuichi Kaneko, Mishiya Matsumoto, Shunsuke Tsuruta, Takao Hirata, Toshikazu Gondo, and Takefumi Sakabe

Anesth Analg 2005 101: 107-114.

昔多芬(商品名:伟哥)对肺栓塞导致的氧化应激和肺高压的影响

(忻纪华 陈杰 校)

The Effect of Sildenafil on Pulmonary Embolism-Induced Oxidative Stress and Pulmonary Hypertension

Carlos A. Dias-Junior, Debora C. Souza-Costa, Talita Zerbini, Joao B. T. da Rocha, Raquel F. Gerlach, and Jose E. Tanus-Santos

Anesth Analg 2005 101: 115-120.

体外可乐定和新斯的明的抗菌活性

(孙敏莉译 薛张纲校)

Antibacterial Activity of Clonidine and Neostigmine In Vitro

Emmanuel Boselli, Marion Guillier, Jean Freney, Marie-Andrée Mazoyer, Emmanuelle Casoli, François R. N. Renaud, Thomas Rimmelé, Dominique Chassard, and Bernard Allaouchiche

Anesth Analg 2005 101: 121-124.

双频指数指导下的异丙酚麻醉中雷米芬太尼抑制气管插管和切皮时的心血管反应的效应部位浓度

(张曦 李士通 校)

The Effect-Site Concentration of Remifentanil Blunting Cardiovascular Responses to Tracheal Intubation and Skin Incision During Bispectral Index-Guided Propofol Anesthesia

Andrea Albertin, Andrea Casati, Lombardo Federica, Valeri Roberto, Vittorino Travaglini, Piercarlo Bergonzi, and Giorgio Torri

Anesth Analg 2005 101: 125-130.

右旋依托咪酯和光活性右旋Azietomidate在野生型鼠麻醉中的作用比较和降低γ-氨基丁酸受体β3亚单位上N265M位点突变体的比较

(忻纪华 陈杰 校)

R (+) Etomidate and the Photoactivable R (+) Azietomidate Have Comparable Anesthetic Activity in Wild-Type Mice and Comparably Decreased Activity in Mice with a N265M Point Mutation in the Gamma-Aminobutyric Acid Receptor ß3 Subunit

Mark Liao, James M. Sonner, S. Shaukat Husain, Keith W. Miller, Rachel Jurd, Uwe Rudolph, and Edmond I. Eger, II

Anesth Analg 2005 101: 131-135 receptors.

异氟醚对FisherLewis大鼠气道平滑肌连接桥动力的影响

(沈 洪译 薛张纲 校)

The Effects of Isoflurane on Airway Smooth Muscle Crossbridge Kinetics in Fisher and Lewis Rats

Caroline Duracher, François-Xavier Blanc, Pierre-Yves Gueugniaud, Jean Stéphane David, Bruno Riou, Yves Lecarpentier, and Catherine Coirault

Anesth Analg 2005 101: 136-142.

三种吸入麻醉药对GluR6(海人藻酸) 受体基因突变小鼠的作用

(周雅春 李士通 校)

The Effect of Three Inhaled Anesthetics in Mice Harboring Mutations in the GluR6 (Kainate) Receptor Gene

James M. Sonner, Bryce Vissel, Gordon Royle, Anya Maurer, Diane Gong, Nicole V. Baron, Neil Harrison, Michael Fanselow, and Edmond I. Eger, II

Anesth Analg 2005 101: 143-148.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Ohmeda 7810 呼吸机风箱漏气对室内空气污染、吸入氧浓度、气道压和潮气量的影响

(吴德华译 薛张纲校)

The Effect of a Bellows Leak in an Ohmeda 7810 Ventilator on Room Contamination, Inspired Oxygen, Airway Pressure, and Tidal Volume

Samsun Lampotang, Justin C. Sanchez, BaiXi Chen, and Nikolaus Gravenstein

Anesth Analg 2005 101: 151-154.

大鼠胸段蛛网膜下腔置管术的改良步骤

(黄丽娜    李士通  校)

An Improved Procedure for Catheterization of the Thoracic Spinal Subarachnoid Space in the Rat

Y. Y. Poon, Alice Y. W. Chang, S. F. Ko, and Samuel H. H. Chan

Anesth Analg 2005 101: 155-160.

先进的病人监测显示器:连续信息的工具

(殷文渊 陈杰 校)

Advanced Patient Monitoring Displays: Tools for Continuous Informing (Medical Intelligence)

Penelope M. Sanderson, Marcus O. Watson, and W. John Russell

Anesth Analg 2005 101: 161-168.

PAIN MEDICINE:

通过中线径路进行枕部神经电刺激和手术皮下置电极来治疗严重枕部神经痛:一项初步研究

(殷文渊 陈杰 校)

Occipital Nerve Electrical Stimulation via the Midline Approach and Subcutaneous Surgical Leads for Treatment of Severe Occipital Neuralgia: A Pilot Study

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

Anesth Analg 2005 101: 171-174.

大鼠神经损伤后不同时间镇痛药药效测试

(孙志荣译 薛张纲校)

The Effect of Antinociceptive Drugs Tested at Different Times After Nerve Injury in Rats

Aldric T. Hama and David Borsook

Anesth Analg 2005 101: 175-179.

曲马多代谢物O-去甲基曲马多在表达 M1 M3克隆受体的蟾蜍卵母细胞中对 毒蕈碱受体引起的反应的影响

(邱郁薇 李士通 校)

The Effects of the Tramadol Metabolite O-Desmethyl Tramadol on Muscarinic Receptor-Induced Responses in Xenopus Oocytes Expressing Cloned M1 or M3 Receptors

Motohiro Nakamura, Kouichiro Minami, Yasuhito Uezono, Takafumi Horishita, Junichi Ogata, Munehiro Shiraishi, Takashi Okamoto, Tadanori Terada, and Takeyoshi Sata

Anesth Analg 2005 101: 180-186.

CRITICAL CARE AND TRAUMA:

由单个职业医疗人员进行的头上方心肺复苏可改善基础生命支持的效果:一项模拟研究

(朱玫娟 陈杰 校)

Over-the-Head Cardiopulmonary Resuscitation Improves Efficacy in Basic Life Support Performed by Professional Medical Personnel with a Single Rescuer: A Simulation Study

Michael Hüpfl, Andreas Duma, Thomas Uray, Christina Maier, Nikolaus Fiegl, Norbert Bogner, and Peter Nagele

Anesth Analg 2005 101: 200-205.

床旁运用标准监测仪器估测功能残气量:吸入氧浓度小改变下的改良的氮气洗出洗入技术

(蔡美华译 薛张纲校)

Estimation of Functional Residual Capacity at the Bedside Using Standard Monitoring Equipment: A Modified Nitrogen Washout/Washin Technique Requiring a Small Change of the Inspired Oxygen Fraction

Cecilia Olegård, Sören Söndergaard, Erik Houltz, Stefan Lundin, and Ola Stenqvist

Anesth Analg 2005 101: 206-212.

丝氨酸蛋白酶抑制剂在酸误吸和高氧后维持固有超氧化物歧化酶水平,但不能减少肺损伤

(朱慧 李士通 校)

Serine Antiproteinase Administration Preserves Innate Superoxide Dismutase Levels After Acid Aspiration and Hyperoxia but Does Not Decrease Lung Injury

Nader D. Nader, Bruce A. Davidson, Alan R. Tait, Bruce A. Holm, and Paul R. Knight

Anesth Analg 2005 101: 213-219.

加巴喷丁与卡马西平对重症监护室格林-巴利(Guillain-Barre)综合征患者镇痛治疗的比较性评估

(朱玫娟 陈杰 校)

The Comparative Evaluation of Gabapentin and Carbamazepine for Pain Management in Guillain-Barré Syndrome Patients in the Intensive Care Unit

Chandra Kant Pandey, Mehdi Raza, Mukesh Tripathi, Deepa V. Navkar, Abhishek Kumar, and Uttam K. Singh

Anesth Analg 2005 101: 220-225.

儿茶酚胺加强诱导性的NO合酶的产生涉及到CAT-1CAT-2

(吴德华译 薛张纲校)

Catecholamines' Enhancement of Inducible Nitric Oxide Synthase-Induced Nitric Oxide Biosynthesis Involves CAT-1 and CAT-2A

Wen-Chou Lin, Pei-Shan Tsai, and Chun-Jen Huang

Anesth Analg 2005 101: 226-232. T-2A but not CAT-2 or CAT-2B.

NEUROSURGICAL ANESTHESIA:

在单侧脑半球功能抑制中的双侧双谱指数监测

(黄佳佳 李士通 校)

Bilateral Bispectral Index Monitoring During Suppression of Unilateral Hemispheric Function

Haren Heller, Raheleh Hatami, Paul Mullin, Robert R. Sciacca, Alexander G. Khandji, Marla Hamberger, Ronald Emerson, and Eric J. Heyer

Anesth Analg 2005 101: 235-341.

异氟醚麻醉期间静脉注射咪唑安定导致的脊髓血流改变

(顾漪闻 陈杰 校)

Spinal Cord Blood Flow Change by Intravenous Midazolam During Isoflurane Anesthesia

Tomoki Nishiyama

Anesth Analg 2005 101: 242-245.

OBSTETRIC ANESTHESIA:

麻醉中的过失与疏忽:一项使用试验性检查目录的实验性研究

(周晓敏 薛张纲 校)

Errors and Omissions in Anesthesia: A Pilot Study Using a Pilot’s Checklist

Elaine M. Hart and Harry Owen

Anesth Analg 2005 101: 246-250.

瑞芬太尼在腔镜手术中用于胎儿制动及母亲镇静的作用:与安定比较的随机、双盲实验

(张莹 李士通 校)

Remifentanil for Fetal Immobilization and Maternal Sedation During Fetoscopic Surgery: A Randomized, Double-Blind Comparison with Diazepam

Marc Van de Velde, Dominique Van Schoubroeck, Liesbeth E. Lewi, Marco A.E. Marcus, Jacques C. Jani, Carlo Missant, An Teunkens, and Jan A. Deprest

Anesth Analg 2005 101: 251-258.

REGIONAL ANESTHESIA:

采用新方法,排除旧方法?两种腰大肌阻滞方法的比较

(顾漪闻 陈杰 校)

In with the New, Out with the Old? Comparison of Two Approaches for Psoas Compartment Block

Stephen Mannion, Sheila O'Callaghan, Mary Walsh, Damian B. Murphy, and George D. Shorten

Anesth Analg 2005 101: 259-264 occurs more frequently after psoas compartment block than previously reported.

兔硬膜外止痛法预防内毒素诱导的肠粘膜损伤

(孙少潇译 薛张纲校)

Epidural Analgesia Prevents Endotoxin-Induced Gut Mucosal Injury in Rabbits
Shizuko Kosugi, Hiroshi Morisaki, Tomoyuki Satoh, Kimiaki Ai, Michiko Yamamoto, Junko Soejima, Ryohei Serita, Yoshifumi Kotake, Akitoshi Ishizaka, and Junzo Takeda

Anesth Analg 2005 101: 265-272.

垂直锁骨下臂丛神经阻滞:应用磁共振成像技术的模拟研究

(赵雪莲 庄心良 )

The Vertical Infraclavicular Brachial Plexus Block: A Simulation Study Using Magnetic Resonance Imaging

Øivind Klaastad, Örjan Smedby, Trygve Kjelstrup, and Hans-Jørgen Smith

Anesth Analg 2005 101: 273-278.

GENERAL ARTICLES:

Mallampti分级相比,上唇咬诊实验预测困难喉镜检查的可靠性和有效性:一个客观的前瞻性评估

(齐波 陈杰 校)

The Reliability and Validity of the Upper Lip Bite Test Compared with the Mallampati Classification to Predict Difficult Laryngoscopy: An External Prospective Evaluation

Leopold H. J. Eberhart, Christian Arndt, Thomas Cierpka, Judith Schwanekamp, Hinnerk Wulf, and Caroline Putzke

Anesth Analg 2005 101: 284-289.

磺酸甘葡环烃钠漱口减少气管插管引起的术后咽喉溃疡

(孙少潇译 薛张纲校)

Gargling with Sodium Azulene Sulfonate Reduces the Postoperative Sore Throat After Intubation of the Trachea

Junchi Ogata, Kouichiro Minami, Takafumi Horishita, Munehiro Shiraishi, Takashi Okamoto, Tadanori Terada, and Takeyoshi Sata

Anesth Analg 2005 101: 290-293.

心脏手术/心肺转流后房颤与单核细胞激活有关

Atrial Fibrillation After Cardiac Surgery/Cardiopulmonary Bypass Is Associated with Monocyte Activation

Manuel L. Fontes, MD{dagger}, Joseph P. Mathew, MD{dagger}, Henry M. Rinder, MD*, Daniel Zelterman, PhD{ddagger}, Brian R. Smith, MD*, Christine S. Rinder, MD*{dagger}, and the Multicenter Study of Perioperative Ischemia (McSPI) Reasearch Group

Department of *Laboratory Medicine, {dagger}Anesthesiology, and {ddagger}Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut

Anesth Analg 2005 101: 17-23.

心肺转流的心脏手术患者术后1/3患者发生房颤并引起相应的发病率和死亡率。最近的数据显示心肌的炎性浸润可能是造成房颤的原因。于是作者设计了这项研究以确定围术期心肺转流(CPB)引起的白细胞炎症反应是否与术后房颤有关。72名心脏手术/心肺转流的患者,术前均为窦性心律。围术期在单核细胞和中性粒细胞中测量白细胞激活情况(CD11b上调因子),术前测定反映炎症情况的C反应蛋白(CRP)和监测围术期中性粒细胞过氧化酶(MPO)以及测定反映心肌损伤的肌钙蛋白。评估术后发生房颤患者与术后正常窦性心律的患者之间各方面的差异。72名患者都完成了该研究,其中26名患者发生了房颤(36%)。发生房颤的患者围术期单核细胞CD11b上调因子显著增加(P0.01),但PMN CD11b的增加与房颤无明显相关(P=0.057)。主动脉夹闭钳开放后单核细胞和中性粒细胞两者计数增加与术后房颤显著相关(分别为P=0.007P=0.005)。相反,房颤和正常心律患者之间术前CRP和围术期MPO无差异。同样地,肌钙蛋白峰值在组间也无差异。在这项心脏手术/心肺转流患者的研究中,围术期单核细胞粘附受体CD11b上调以及循环中的单核细胞和中性粒细胞增加与术后房颤相关,显示心脏手术/心肺转流期间细胞炎症的介入可能促成这个病理生理学变化。

(朱辉 陈杰 )

Atrial fibrillation (AF) contributes significantly to morbidity and mortality in as many as one-third of patients after cardiac surgery that requires cardiopulmonary bypass (CPB). Recent data suggest that inflammatory infiltration of the myocardium may predispose to AF. We conducted an exploratory pilot study to determine if there was an association between the perioperative leukocyte inflammatory response to cardiac surgery/CPB and postoperative AF. We enrolled 72 patients undergoing cardiac surgery with CPB; all patients were in sinus rhythm before surgery. Leukocyte activation (CD11b upregulation) was perioperatively measured in monocytes and neutrophils (PMN). Preoperative C-reactive protein (CRP) and perioperative neutrophil myeloperoxidase (MPO) were also monitored for inflammation, and troponin I was assayed for perioperative cardiac muscle damage. All markers were evaluated for differences between the subset of patients who developed AF versus those who remained in normal sinus rhythm after surgery. All 72 patients completed the study. Postoperative AF developed in 26 (36%) patients. Perioperative monocyte CD11b upregulation was significantly increased in patients who developed AF (P = 0.01), but increases in PMN CD11b were not significantly associated with AF (P = 0.057). The increase in both monocyte and PMN counts after aortic cross-clamp release was significantly associated with postoperative AF (P = 0.007 and P = 0.005, respectively). By contrast, preoperative CRP and perioperative MPO did not differ between AF and normal rhythm patients. Similarly, the peak value of troponin I did not differ between groups. In this pilot study of cardiac surgery/CPB patients, perioperative upregulation of the monocyte adhesion receptor, CD11b, and higher circulating monocyte and PMN numbers were associated with postoperative AF, suggesting that the induction of cellular inflammation during cardiac surgery/CPB may contribute to this pathophysiology.

 

小儿镇静状态下评估系统安全和潜在失误的方法

A Method for Measuring System Safety and Latent Errors Associated with Pediatric Procedural Sedation

George T. Blike, MD, Klaus Christoffersen, PhD, Joseph P. Cravero, MD, Steven K. Andeweg, MD, and Jens Jensen, MS

Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Anesth Analg 2005 101: 48-58.

 

在医院内对于镇静患者的诊断和治疗过程中可能会发生危及生命的呼吸抑制。作者通过一模拟的实验发现潜在的系统错误。这个模拟事件可重复并有逼真的生理学过程且如果无干预措施将随时间消耗逐渐递减而给予适当治疗可改善。观察在理想场所,放射科,急诊科处理模拟事件的状况,并用摄像机录制下来。模拟的生理学数据每隔5秒被自动保存下来。通过录像标记的设置评估对模拟事件的发现,诊断,治疗与“最好实践”的偏差。模拟数据的保存文件被用来计算超出范围的紧急情况的时间。在放射科和急诊科低氧和低血压持续时间分别为4.55.5分钟,而在金标准场所为0分钟。许多潜在的失误可在录像回放中被发现。这项研究提示在实际的镇静护理场所利用人作为快速的试验模型能更客观地量化急救系统实施的可行性。这项试验说明尽管已对镇静护理要求作了相应的处理但对于患者本人和护理系统仍易受伤害。

(朱辉 陈杰 校)

The practice of sedating patients in the hospital for diagnostic and therapeutic procedures may be associated with life-threatening respiratory depression. We describe a method that uses a simulated event to identify latent system failures. A simulated scenario was developed that was reproducible with realistic physiology that degraded over time if no interventions occurred and improved when treated appropriately. Management of the scenario was observed in an ideal setting, a radiology department, and an emergency department. Event management was videotaped. The simulator’s physiological data were saved automatically at 5-s intervals. Deviations from "best practice" were measured by using a set of video markers for event detection, diagnosis, and treatment. The simulator data files were used to calculate time out of range for critical variables. Hypoxia and hypotension lasted 4.5 and 5.5 min in the radiology and emergency departments, respectively, compared with 0 min in the gold standard setting. Many latent failures were identified by reviewing the video. This study supports the feasibility of using available human simulation as a crash-test dummy to more objectively quantify rescue system performance in actual sedation care settings. This method revealed vulnerabilities in personnel and in care systems even though sedation care regulatory requirements were met.

 

小儿骶管麻醉时咪唑安定、氯胺酮和新斯的明与布比卡因联合应用的比较
Caudal Additives in Pediatrics: A Comparison Among Midazolam, Ketamine, and Neostigmine Coadministered with Bupivacaine

P. Kumar, MBBS, A. Rudra, MD, FAMS, A. K. Pan, DA, MD, and A. Acharya, DA, MD

Department of Anaesthesiology, Calcutta National Medical College, Kolkata, India

Anesth Analg 2005 101: 69-73.

 

小儿骶管麻醉时单次注射布比卡因的作用持续时间仅为4-8h,因此逐渐不再普遍应用。在一项前瞻性随机双盲临床试验中,比较并评价了氯胺酮、咪唑安定和新斯的明与布比卡因联合应用于骶管硬膜外腔后术中和术后镇痛效果。80名年龄为5-10岁需行腹股沟疝修补术病人(ASA I级),随机平均分为4组(每组n20),未用术前药,标准全麻诱导后行骶管注射,药液为0.25%布比卡因(1ml/kg),有或无氯胺酮(0.5mg/kg)、咪唑安定(50 µg /kg)和新斯的明(2 µg /kg)。对分组情况不清楚的麻醉医生负责监测疼痛、镇静、术后恶心/呕吐、头昏和瘙痒情况。在布比卡因-新斯的明组和布比卡因-咪唑安定组,首次给镇痛药(扑热息痛糖浆)的时间晚于其它组(P < 0.05)。不适反应如呕吐、瘙痒和头昏,在各组相似。但是,布比卡因-氯胺酮组的幻觉发生率高于其他组。该研究显示了单次骶管内注射布比卡因-新斯的明和布比卡因-咪唑安定与延长术后镇痛时间有关。

(赵延华 陈杰 校)

Single-shot "kiddie caudal" with bupivacaine alone is losing popularity because of its duration of 4–8 h. In a prospective randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief. Eighty children (ASA status I) aged 5–10 yr undergoing unilateral inguinal herniotomy were allocated randomly in equal numbers (n = 20) into 4 groups to receive a caudal injection of 0.25% bupivacaine (1 mL/kg) with or without ketamine (0.5 mg/kg), midazolam (50 µg/kg), and neostig-mine (2 µg/kg), after the induction of standardized general anesthesia without premedication. Monitoring for pain, sedation, postoperative nausea/vomiting, dizziness, and pruritus was performed by anesthesiologists blinded to the study allocation. The time to first analgesic administration (paracetamol syrup) was longer (P < 0.05) in the bupivacaine-neostigmine group and the bupivacaine-midazolam group than in the other groups. Undesirable effects, such as emesis, pruritus, and dizziness, were comparable in all groups. However, the incidence of hallucination was more frequent in the bupivacaine-ketamine group compared with the other groups. This study shows that single-shot caudal coadministration of bupivacaine-neostigmine and bupivacaine-midazolam was associated with an extended duration of postoperative pain relief.

与药物前体丙帕他莫(propacetamol)相比,对乙酰氨基酚(扑热息痛)经静脉用于第三磨牙手术后疼痛有同样的镇痛效能,但安全性更好
Intravenous Acetaminophen (Paracetamol): Comparable Analgesic Efficacy, but Better Local Safety than Its Prodrug, Propacetamol, for Postoperative Pain After Third Molar Surgery

Philip Lange Moller, MD, Gitte Irene Juhl, MD, Catherine Payen-Champenois, MD, and Lasse Ansgar Skoglund, DDS, DSci

Department of Anaesthesia, University Hospital of Aarhus, Aarhus, Denmark; Neurosciences Department, Bristol-Myers Squibb, France; and the Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Oslo, Norway

Address correspondence and reprint requests to Philip Lange Moller, MD, Department of Anesthesia, University Hospital of Aarhus, Norrebrogade 44, DK-8000 Aarhus, Denmark. .

Anesth Analg 2005 101: 90-96.

 

作者利用随机对照双盲平行分组研究,比较对乙酰氨基酚(扑热息痛)1gn51)和其前体丙帕他莫2gn51)以及安慰剂(n50)用于第三磨牙手术后中重度疼痛病人的效果。药物经静脉注射,时间为15min。注药开始后即在室内评价其治疗效果,时间为6h。根据100mm视觉模拟评分标尺和分类标尺评定疼痛强度,与安慰剂相比,两个治疗组有明显的疼痛缓解作用(p< 0.01,除了丙帕他莫6h时作用不明显)。除1h外,两个治疗组组间没有显著差别。6h的初步评价显示两个治疗组与安慰剂组相比有显著的治疗效果(P < 0.0001),而两个治疗组之间没有差别。治疗组疼痛开始出现缓解的平均时间是开始输注后6-8min,两个治疗组的效果相似,与安慰剂组相比镇痛时间更长和整体评价更好。病人主诉注射部位疼痛的情况,对乙酰氨基酚组或安慰剂组(0%)明显少于丙帕他莫组(49%)。结论:1g对乙酰氨基酚和2g丙帕他莫的镇痛效果强于安慰剂,丙帕他莫输注部位局部疼痛发生率更高。

(赵延华 陈杰 校)

We compared an acetaminophen (paracetamol) 1 g (n = 51) formulation for infusion with propacetamol 2 g (n = 51) and placebo (n = 50) in a randomized, controlled, double-blind, parallel group trial in patients with moderate-to-severe pain after third molar surgery. Treatment efficacy was assessed in house for 6 h after starting the 15-min infusion. Significant effects versus placebo (P < 0.01) were obtained with both active treatments on pain relief, pain intensity difference on a 100-mm visual analog scale, and on a categorical scale (except for propacetamol at 6 h). No significant differences were noted between active groups except at 1 h. Six-hour weighted sums of primary assessments showed significantly better efficacy than placebo (P < 0.0001) and no difference between active treatments. Median stopwatch time to onset of pain relief for active treatment was 6–8 min after infusion start. Active treatments showed comparable efficacy with a significantly longer duration of analgesia and better patients’ global evaluation compared with placebo. The incidence of patients reporting local pain at the infusion site was significantly less frequent after IV acetaminophen or placebo (0%) in comparison with propacetamol (49%). In conclusion, acetaminophen 1 g and propacetamol 2 g were superior to placebo regarding analgesic efficacy, with a more frequent incidence of local pain at the infusion site for propacetamol.

 

昔多芬(商品名:伟哥)对肺栓塞导致的氧化应激和肺高压的影响

The Effect of Sildenafil on Pulmonary Embolism-Induced Oxidative Stress and Pulmonary Hypertension

Carlos A. Dias-Junior, Pharm D, Debora C. Souza-Costa, Pharm D, MS, Talita Zerbini, Joao B. T. da Rocha, BS, PhD, Raquel F. Gerlach, DDS, PhD, and Jose E. Tanus-Santos, MD, PhD

Department of Pharmacology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil

Anesth Analg 2005 101: 115-120.

急性肺栓塞(APE)是肺高压和死亡的主要原因。作者测试了昔多芬对麻醉中的犬发生急性肺栓塞时的血流动力学影响。假手术的犬仅接受生理盐水(n3)。以静脉注射300um的微球逐步造成肺栓塞使肺动脉压升高20mmHg。在基础状态、APE诱导发生后和昔多芬0.25mg/kgn8),或昔多芬 1mg/kg0.3mg/kg/hn8)或生理盐水(n9)注射开始后测定血流动力学改变。相同的实验在小鼠单肺灌注准备时进行。血浆丙二酰磺尿酸相互作用也同时在两个研究中进行以测定氧化应激。两种剂量的昔多芬都可降低犬的肺动脉压8-16mmHgp<0.05),并减少APE后的氧化应激。两种剂量的昔多芬均未使动脉血压发生改变。昔多芬在单肺灌注肺的小鼠中产生同样的作用。这些发现指出静脉注射昔多芬可以选择性的减少APE后的肺平均动脉压,可能通过抗氧化机制。

(忻纪华 陈杰 校)

Acute pulmonary embolism (APE) is a major cause of pulmonary hypertension and death. We examined the effects of sildenafil on the hemodynamic changes caused by APE in anesthetized dogs. Sham-operated dogs (n = 3) received only saline. APE was induced by stepwise IV injections of 300 µm microspheres in amounts adjusted to increase mean pulmonary artery pressures by 20 mm Hg. Hemodynamic evaluation was performed at baseline, after APE was induced, and then after sildenafil 0.25 mg/kg (n = 8), or sildenafil 1 mg/kg + 0.3 mg · kg–1 · h–1 (n = 8) or saline (n = 9) infusions were started. Similar experiments were conducted to examine the effects of sildenafil in rat isolated perfused lung preparation. Plasma thiobarbituric acid reactive species were also determined in both studies to measure oxidative stress. Both doses of sildenafil reduced mean pulmonary artery pressures in dogs by approximately 8 to 16 mm Hg (both P < 0.05) and attenuated the increase in oxidative stress after APE. Mean arterial blood pressure remained unaltered after both doses of sildenafil. Sildenafil produced similar effects after APE in rat isolated perfused lung preparation. These findings indicate that IV sildenafil can selectively attenuate the increases in mean pulmonary artery pressures after APE, possibly through antioxidant mechanisms.

 

右旋依托咪酯和光活性右旋Azietomidate在野生型鼠麻醉中的作用比较和降低γ-氨基丁酸受体β3亚单位上N265M位点突变体的比较

R (+) Etomidate and the Photoactivable R (+) Azietomidate Have Comparable Anesthetic Activity in Wild-Type Mice and Comparably Decreased Activity in Mice with a N265M Point Mutation in the Gamma-Aminobutyric Acid Receptor ß3 Subunit

Mark Liao, BS, James M. Sonner, MD, S. Shaukat Husain, DPhil*, Keith W. Miller, DPhil*, Rachel Jurd, PhD{dagger}, Uwe Rudolph, MD{dagger}, and Edmond I. Eger, II, MD

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; *Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts; and {dagger}Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland

Anesth Analg 2005 101: 131-135.

 

衍生于依托米酯,Azietomidate光活化性的diazirine,具有很多依托米酯的作用,包括消除蝌蚪的正位反射和增加γ-氨基丁酸诱导的电流。应用Azietomidate来研究麻醉机制是基于它和依托米酯有共同作用位点的假设。在γ-氨基丁酸受体β3亚单位上具有N265M位点突变体的小鼠使用一定剂量的依托米酯可以显著降低正位反射缺失的敏感性。因此,本试验作者静脉注射一定剂量Azietomidate后测量了野生型鼠和突变鼠对正位反射的恢复时间。Azietomidate7.5mg/kg)的平均恢复时间分别为:野生型鼠10.0±0.9min,突变型鼠3.0±1.6min。依托米酯(7.5mg/kg)的平均恢复时间分别为:野生型鼠12.0±1.3min,突变型鼠4.0±0.7min。所以,此剂量下的γ-氨基丁酸受体β3亚单位上N265M单一位点突变体,几乎将依托米酯和Azietomidate的正位反射恢复时间分为两半(分别为7.6±1.5min7.2 ±1.8min),强烈显示上述两药的残余结构贡献于Azietomidate对行为的影响。

(忻纪华 陈杰 校)

A photoactivable diazirine derivative of etomidate, azietomidate, shares many actions of etomidate, including a capacity to abolish the righting reflexes in tadpoles and enhance gamma-aminobutyric acid (GABA)-induced currents. Azietomidate’s usefulness in studies of mechanisms of anesthesia depends on the assumption that it shares a site of action with etomidate. Mice bearing an N265M ß3 subunit point mutation in GABAA receptors have a markedly decreased sensitivity to loss of righting reflexes induced by etomidate over a range of doses. Accordingly, in the present study we measured the time to recovery of righting reflexes of wild type and mutant mice as a function of dose given as an IV bolus. Analysis of the data for azietomidate yielded mean times to recovery of righting reflexes at a dose of 7.5 mg/kg of 10.0 ± 0.9 min and 3.0 ± 1.6 min for wild type and mutant mice, respectively (mean ± sd). A similar analysis for etomidate yielded mean times to recovery of righting reflexes at a dose of 7.5 mg/kg of 12.0 ± 1.3 min and 4.0 ± 0.7 min for wild type and mutant mice respectively. Thus, at this dose a single mutation, N265M on the ß3 subunit of the GABAA receptor, approximately halved the time to recovery of righting reflexes for both etomidate and azietomidate (by 7.6 ± 1.5 min and 7.2 ± 1.8 min, respectively), emphasizing the contribution of this residue as a determinant of a behavioral response of azietomidate in mice.

 

先进的病人监测显示器:连续信息的工具

Advanced Patient Monitoring Displays: Tools for Continuous Informing

Penelope M. Sanderson, PhD, FASSA*, Marcus O. Watson, PhD*, and W. John Russell, MBBS, DPhil, DIC, FRCA, FANZCA{dagger}

*ARC Key Centre for Human Factors and Applied Cognitive Psychology, The University of Queensland, St Lucia; and {dagger}Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, Adelaide, Australia

Address correspondence to Penelope M. Sanderson, PhD, ARC Key Centre for Human Factors and Applied Cognitive Psychology, The University of Queensland, St Lucia, Australia 4072. .

Anesth Analg 2005 101: 161-168.

作者回顾了在麻醉监测中运用的先进显示技术情况。研究者调查了能整合各种信息,某些情况下可以提供给麻醉医师连续结果的显示器。整合后可视显示器提供了更高等级的病人状态和对事件的反应速度,但是这样精密的定时储存的信息的益处不得而知。悬挂式显示器似乎可以缩短对变化的反应时间,但它们对外围认知和注意的影响不得而知。持续音频显示器将血氧饱和度的功能扩展,看上去似乎可以缩短反应时间和改善其他定时监测任务的功能,但将它们整合入这个已经嘈杂的手术环境中效果仍需测试。作者回顾了这三种方法的利弊,吸取了其他方面的发明,例如航空学,提出在麻醉背景下获得的结果。证明先进的监测显示器提高病人的预后是有难度的,更实际的目标大概是证明这种显示器可以提高环境的认知,更早的反应,和更少的工作负担,所有这些都是有利于保证麻醉的安全。

(殷文渊 陈杰 校)

We reviewed the use of advanced display technologies for monitoring in anesthesia. Researchers are investigating displays that integrate information and that, in some cases, also deliver the results continuously to the anesthesiologist. Integrated visual displays reveal higher-order properties of patient state and speed in responding to events, but their benefits under an intensely timeshared load is unknown. Head-mounted displays seem to shorten the time to respond to changes, but their impact on peripheral awareness and attention is unknown. Continuous auditory displays extending pulse oximetry seem to shorten response times and improve the ability to timeshare other tasks, but their integration into the already noisy operative environment still needs to be tested. We reviewed the advantages and disadvantages of the three approaches, drawing on findings from other fields, such as aviation, to suggest outcomes where there are still no results for the anesthesia context. Proving that advanced patient monitoring displays improve patient outcomes is difficult, and a more realistic goal is probably to prove that such displays lead to better situational awareness, earlier responding, and less workload, all of which keep anesthesia practice away from the outer boundaries of safe operation.

 

通过中线径路进行枕部神经电刺激和手术皮下置电极来治疗严重枕部神经痛:一项初步研究

Occipital Nerve Electrical Stimulation via the Midline Approach and Subcutaneous Surgical Leads for Treatment of Severe Occipital Neuralgia: A Pilot Study

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

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

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

Anesth Analg 2005 101: 171-174.

 

持续枕部神经痛可以产生严重的头痛,不易通过保守或手术方法来控制。作者描述了一组6名平均具有4.9年慢性头痛史的病人,这些病人通过改良中间径路接受枕部神经电刺激导线的植入的枕部神经痛治疗效果。这些病人过去接受过保守和手术治疗,包括口服抗抑郁药,膜稳定剂,阿片类药物,枕部神经阻滞和射频消融术。在枕部刺激试验期间和植入后的三个月疼痛视觉模拟评分显著下降、功能显著改善。VAS平均评分从8.66±1.0下降至2.5±1.3;疼痛致残指数从49.8±15.9改善至14.0±7.4。中线径路与乳突下径路相比有几处优点。中线径路方法在颈部上方仅有一个小小的切口,仅当屈曲时拉紧导线,在侧曲和旋转时张力最小,从而使这个系统非常稳定。

(殷文渊 陈杰 校)

Persistent occipital neuralgia can produce severe headaches that may not be controllable by conservative or surgical approaches. We describe a case series of 6 patients who had chronic headaches over an average of 4.9 yr who underwent occipital nerve electrical stimulation lead implantation using a modified midline approach. The patients had received conservative and surgical therapies in the past including oral antidepressants, membrane stabilizers, opioids, occipital nerve blocks, and radiofrequency ablations. Significant decreases in pain visual analog scale (VAS) scores and drastic improvement in functional capacity were observed during the occipital stimulation trial and during the 3-mo follow-up after implantation. The mean VAS score changed from 8.66 ± 1.0 to 2.5 ± 1.3 whereas pain disability index improved from 49.8 ± 15.9 to 14.0 ± 7.4. Our midline approach has several advantages compared with the submastoid approach used elsewhere. There is only one small midline incision over the upper neck and the strain on the lead extension occurs only with flexion and is minimal with lateral flexion and rotation, which contributes to overall stability of this system.

由单个职业医疗人员进行的头上方心肺复苏可改善基础生命支持的效果:一项模拟研究

Over-the-Head Cardiopulmonary Resuscitation Improves Efficacy in Basic Life Support Performed by Professional Medical Personnel with a Single Rescuer: A Simulation Study

Michael Hüpfl, MD*{dagger}, Andreas Duma, MD*{dagger}, Thomas Uray, MD{dagger}, Christina Maier{dagger}, Nikolaus Fiegl{dagger}, Norbert Bogner{dagger}, and Peter Nagele, MD*{ddagger}

*Department of Anesthesia and General Intensive Care, Medical University; {dagger}St. John's Ambulance, Vienna, Austria; and {ddagger}Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri

Anesth Analg 2005 101: 200-205.

 

双人心肺复苏被认为是专业基础生命支持的最好办法。然而,对于许多院前心跳停止的情况来说,当别的救护员进行其他工作时,单个救护员必需要开始进行单人心肺复苏。理论上,在此情况时,头上方心肺复苏是一个合适的选择,此方法的附加优势是使单个救护员可以使用简易呼吸器进行通气。 在此试验中,作者对在人体模型上进行的标准单人心肺复苏和单人头上方心肺复苏进行了比较。此试验采用随机、交叉研究设计,每一个参与者都掌握这两种心肺复苏技术。由分析软件收集每个方法进行的2分钟心肺复苏试验中通气和胸部按压的数据。67个急救医学学生参与了此试验。与标准心肺复苏相比,头上方心肺复苏有更高的通气率(正确通气的数目为330/760279/779p0.002)。两组中胸部按压的质量没有区别(正确胸部按压:4293/63044313/6395,p=0.44)。总之,当单个职业医疗人员要进行单人心肺复苏时,头上方心肺复苏是一种有效的选择,与标准基本生命支持相比,头上方心肺复苏的通气率和胸部按压的质量更高。

(朱玫娟 陈杰 校)

Two-rescuer cardiopulmonary resuscitation (CPR) is considered the best method for professional basic life support (BLS). However, in many prehospital cardiac arrest situations, one rescuer has to begin CPR alone while the other performs additional tasks. In theory, over-the-head CPR is a suitable alternative in this situation, with the added benefit of allowing the single rescuer to use a self-inflating bag for ventilation. In this trial, we compared standard single-rescuer CPR with over-the-head CPR in manikins. We planned this study using a crossover study design where each participant administered both CPR techniques in a randomized order. Ventilation and chest compression data were collected with analysis software during a 2-min CPR test for each technique. Sixty-seven emergency medical technician students participated in this trial. Over-the-head CPR allowed for superior ventilation compared to standard CPR (number of correct ventilations: 330 of 760 versus 279 of 779; P = 0.002). The quality of delivered chest compressions did not differ between the two groups (correct chest compressions: 4293 of 6304 versus 4313 of 6395; P = 0.44). In conclusion, our study has shown that over-the-head CPR may be an effective alternative BLS technique when a single professional rescuer has to perform CPR, likely offering superior ventilation and comparable chest compression quality compared with standard BLS.

 

加巴喷丁与卡马西平对重症监护室格林-巴利(Guillain-Barre)综合征患者镇痛治疗的比较性评估

The Comparative Evaluation of Gabapentin and Carbamazepine for Pain Management in Guillain-Barré Syndrome Patients in the Intensive Care Unit

Chandra Kant Pandey, MD*, Mehdi Raza, MD*, Mukesh Tripathi, MD*, Deepa V. Navkar, MD*, Abhishek Kumar, MD*, and Uttam K. Singh, PhD{dagger}

*Departments of Anaesthesiology and {dagger}Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Anesth Analg 2005 101: 220-225.

 

作者比较了36Guillain-Barre综合症患者使用加巴喷丁与卡马西平后疼痛缓解的效果。患者随机分为加巴喷丁组(7天,每天3次,每次300mg)、卡马西平组(7天,每天3次,每次100mg)和安慰剂组(7天,每天3次)。当患者需要时,使用芬太尼2ug/kg作为辅助镇痛药。在用药以前和研究过程中每隔6小时,用010分疼痛评定量表对疼痛进行评分,用1-6Ramsay镇静评分对镇静进行评分。记录每个患者每天总芬太尼消耗量。研究结果显示与对照组(6.06.06.06.06.06.0)和卡马西平组(6.06.05.04.04.03.53.0)相比,加巴喷丁组的平均疼痛评分更低(p<0.05),分别为3.52.52.02.02.02.02.0)。加巴喷丁组和卡马西平组治疗第一天芬太尼消耗量没有明显差别(分别为340.1±34.3ug347.5±38.0ug),但与对照组(590.4±35.0ug)相比,这两组芬太尼消耗量有明显减少(p<0.05)。在研究的其余阶段,3组间芬太尼消耗量有明显差别,加巴喷丁组最少(p<0.05)。结论:在缓解疼痛和芬太尼消耗上,加巴喷丁比卡马西平更有效。

(朱玫娟 陈杰 校)

We evaluated the effects of gabapentin and carbamazepine for pain relief in 36 Guillain-Barré syndrome patients. Patients were randomly assigned to receive gabapentin 300 mg, carbamazepine 100 mg, or matching placebo 3 times a day for 7 days. Fentanyl 2 µg/kg was used as a supplementary analgesic on patient demand. The pain score was recorded by using a numeric pain rating scale of 0–10, and sedation was recorded with a Ramsay sedation scale of 1–6 before medications were given and then at 6-h intervals throughout the study period. Total daily fentanyl consumption was recorded each day for each patient. The results of the study demonstrated that patients in the gabapentin group had significantly lower (P < 0.05) median numeric pain rating scale scores (3.5, 2.5, 2.0, 2.0, 2.0, 2.0, and 2.0) compared with patients in the placebo group (6.0, 6.0, 6.0, 6.0, 6.0, 6.0, and 6.0) and the carbamazepine group (6.0, 6.0, 5.0, 4.0, 4.0, 3.5, and 3.0). There was no significant difference in fentanyl consumption between the gabapentin and carbamazepine groups on Day 1 (340.1 ± 34.3 µg and 347.5 ± 38.0 µg, respectively), but consumption was significantly less in these 2 groups compared with the placebo group (590.4 ± 35.0 µg) (P < 0.05). For the rest of the study period, there was a significant difference in fentanyl consumption among all treatment groups, and it was minimal in the gabapentin group (P < 0.05). We conclude that gabapentin is more effective than carbamazepine for decreasing pain and fentanyl consumption.

 

异氟醚麻醉期间静脉注射咪唑安定导致的脊髓血流改变

Spinal Cord Blood Flow Change by Intravenous Midazolam During Isoflurane Anesthesia

Tomoki Nishiyama, MD, PhD

Department of Anesthesiology, University of Tokyo, Japan

Anesth Analg 2005 101: 242-245.

作者研究了静脉注射咪唑安定对异氟醚麻醉下的猫脊髓血流改变的影响。猫行椎板切除,并暴露腰脊髓。在立体定位下,在L2水平的中线侧,将铂金电极插入脊髓12mm深度。在静脉注射负荷剂量的咪唑安定(将0124mg/kg的咪唑安定5ml;每组n8)后,分别记录515306090以及90min猫的动脉血压,心率,和脊髓血流(用氢清除法)。01mg/kg的咪唑安定组30min对动脉血压没有影响,但注射24mg/kg咪唑安定30min后动脉血压下降。心率没有改变。注射咪唑安定1mg/kg90min,和2mg/kg15min后脊髓血流增加,但是4mg/kg没有改变。结论:咪唑安定(1mg/kg)增加了猫的脊髓血流而不改变动脉血压。大剂量的咪唑安定(4mg/kg)不能改变脊髓的血流,但是可减低异氟醚麻醉下的猫的动脉血压。

(顾漪闻 陈杰 校)

We investigated the effects of IV midazolam on spinal cord blood flow in 32 cats anesthetized with isoflurane. Cats underwent laminectomy, and the lumbar spinal cord was exposed. A platinum electrode was inserted stereotaxically into the spinal cord to a depth of 1 mm—2 mm lateral to midline at L2. Arterial blood pressure, heart rate, and spinal cord blood flow (using the hydrogen clearance method) were measured before and at 5, 15, 30, 60, 90, and 120 min after an IV bolus of midazolam (0, 1, 2, or 4 mg/kg in saline 5 mL; n = 8 cats per dose). Arterial blood pressure was not affected by 0 or 1 mg/kg of midazolam but was decreased for 30 min by 2 or 4 mg/kg of midazolam. Heart rate did not change. Spinal cord blood flow was increased for 90 min by midazolam 1 mg/kg and for 15 min by midazolam 2 mg/kg but was not changed by midazolam 4 mg/kg. In conclusion, 1 mg/kg of midazolam increased feline spinal cord blood flow without changing arterial blood pressure. In contrast, a larger dose of midazolam (4 mg/kg) did not change spinal cord blood flow but substantially decreased arterial blood pressure during isoflurane anesthesia.

 

采用新方法,排除旧方法?两种腰大肌阻滞方法的比较

In with the New, Out with the Old? Comparison of Two Approaches for Psoas Compartment Block

Stephen Mannion, MRCPI, FCARCSI, Sheila O'Callaghan, FCARCSI, Mary Walsh, FCARCSI, Damian B. Murphy, FCARCSI, MD, and George D. Shorten, FCARCSI, PhD

Department of Anaesthesia and Intensive Care, Cork University Hospital; St. Mary's Orthopaedic Hospital; and University College, Cork, Ireland

Anesth Analg 2005 101: 259-264.

作者比较了WinnieCapdevila两种腰大肌阻滞方法(PCB)。操作均由一个医生完成,比较组间的对侧扩散,腰丛阻滞,和术后镇痛效果。前瞻性、双盲研究60名大关节成形术(髋或膝)患者,均行PCB0.5%左旋布比卡因0.4ml/kg,)随后行蛛网膜下腔阻滞。患者随机分为两组,一组采用Capdevila法(组Cn30),另一组采用改良Winnie法(组Wn30)。评估PCB153045min时向对侧扩散和腰丛阻滞效果。通过感觉测试来评价对侧扩散(双侧T4S5)和股和股外侧皮神经阻滞的情况,并评价闭孔肌运动阻滞情况。在组C10个患者发生双侧麻醉,组W则为12例(P0.8)。股神经,股外侧皮神经,和闭孔神经的阻滞情况:组C90%,93%,80%;组W分别为93%,97%,90%P>0.05)。因此,在PCB的过程中,疼痛评分,24h吗啡消耗,或第一次吗啡镇痛时间,两组没有差异。

(顾漪闻 陈杰 校)

We compared the approaches of Winnie and Capdevila for psoas compartment block (PCB) performed by a single operator in terms of contralateral spread, lumbar plexus blockade, and postoperative analgesic efficacy. Sixty patients underwent PCB (0.4 mL/kg levobupivacaine 0.5%) and subsequent spinal anesthesia for primary joint arthroplasty (hip or knee) in a prospective, double-blind study. Patients were randomly allocated to undergo PCB by using the Capdevila (group C; n = 30) or a modified Winnie (group W; n = 30) approach. Contralateral spread and lumbar plexus blockade were assessed 15, 30, and 45 min after PCB. Contralateral spread (bilateral from T4 to S5) and femoral and lateral cutaneous nerve block were evaluated by sensory testing, and obturator motor block was assessed. Bilateral anesthesia occurred in 10 patients in group C and 12 patients in group W (P = 0.8). Blockade of the femoral, lateral cutaneous, and obturator nerves was 90%, 93%, and 80%, respectively, for group C and 93%, 97%, and 90%, respectively, for group W (P > 0.05). No differences were found in PCB procedure time, pain scores, 24-h morphine consumption, or time to first morphine analgesia.

 

Mallampti分级相比,上唇咬诊实验预测困难喉镜检查的可靠性和有效性:一个客观的前瞻性评估

The Reliability and Validity of the Upper Lip Bite Test Compared with the Mallampati Classification to Predict Difficult Laryngoscopy: An External Prospective Evaluation

Leopold H. J. Eberhart, MD, Christian Arndt, MD, Thomas Cierpka, MD, Judith Schwanekamp, MD, Hinnerk Wulf, MD, and Caroline Putzke, MD

Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Germany

Anesth Analg 2005 101: 284-289.

 

最近,一项新的用于预测困难喉镜检查发生率的床旁筛查实验被应用,从而作为Mallampti分级的替代选择。上唇咬诊实验(ULBT)是测试病人能否用下切牙咬住上唇或能否完全咬住上唇。一般来讲,一个新的预测工具在应用于临床之前应进行客观性的评估。因此,本研究就这个预测方法,评估其可靠性,判别能力,并与Mallampti评分进行比较(应用SamsoonYoung氏校正)。结果发现有12%的病人不能应用ULBT(Mallampti评分法只有<1%)。用ULBT可靠性较好(к=0.79к=0.59)。对1425个连续的病人评估预测病人是否有困难喉镜检查。实验由两个经过特殊训练的完全独立的观察者在这些病人中同时进行评估。麻醉诱导后,由主治麻醉医生应用CormackLehane分级评估喉镜检查视野。I级或II级称为简单喉镜检查,III级或IV级为困难喉镜检查。两种预测方法的判别能力较低(ULBT0.60[95%可信区间,0.57-0.63]Mallampti评分为0.66[0.57-0.63]),表明了它们作为单一筛查工具应用时不能很好的进行预测。

(齐波 陈杰 校)

Recently, a new bedside screening test to predict the occurrence of a difficult laryngoscopy has been developed as a substitute for the Mallampati classification. The Upper-Lip-Bite test (ULBT) evaluated the patient’s ability to reach or completely cover the upper lip with the lower incisors. It is often accepted that new predictive tools should undergo an external evaluation before the tool is used in clinical practice. Thus, we evaluated this test with respect to applicability, interobserver reliability, and discriminating power and compared it with the Mallampati-score (using Samsoon and Young’s modification). The ULBT could not be applied in 12% of all patients (Mallampati score, <1%). However, the interobserver reliability was better for the ULBT ({kappa} = 0.79 versus {kappa}= 0.59). The discriminating power to predict a patient with difficult laryngoscopy was evaluated in 1425 consecutive patients. Both tests were assessed simultaneously in these patients by two specially trained independent observers. After the induction of anesthesia, the laryngoscopic view was assessed by the attending anesthesiologist using the classification of Cormack and Lehane. A grade I or II was called easy laryngoscopy and grade III and IV difficult laryngoscopy. The discriminating power for both tests was low (0.60 for the ULBT [95% confidence interval, 0.57–0.63] and 0.66 [0.63–0.69]) for the Mallampati score), indicating that both tests are poor predictors as single screening tests.

 

应用米力农可改善合并二尖瓣返流病人在行非体外循环冠状动脉旁路吻合术时血流动力学改变

Hemodynamic Changes During Off-Pump Coronary Artery Bypass Anastomosis in Patients with Coexisting Mitral Regurgitation: Improvement with Milrinone

Takeshi Omae, MD*, Yasuyuki Kakihana, MD*, Akira Mastunaga, MD*, Isao Tsuneyoshi, MD*, Kouichi Kawasaki, MD*, Yuichi Kanmura, MD*, and Ryuzo Sakata, MD.

*Department of Anesthesiology and Critical Care Medicine and {dagger}Second Department of Surgery, Faculty of Medicine, Kagoshima University, Japan.

Anesth Analg 2005 101: 2-8.

 

一般认为,合并二尖瓣返流病人在行非体外循环冠状动脉旁路(OPCAB)吻合术时,会有二尖瓣(MR)加重、心脏指数(CI)下降和平均肺动脉压(MPAP)增高,而米力农可以改善发生在OPCAB吻合术时的MF增加。本研究包括140名选择OPCAB的病人分成3组:无MR[MR-)组,n57]MR[MR+)组,n41]MR米力农治疗组[M+MR+)组,n42]。本研究只包含MR1+2+级病人,MR3+4+级病人不在研究之列。血流动力学参数在麻醉诱导之后以及吻合术术中测量。M+MR+)组在麻醉诱导后即给予米力农0.5 µg·kg–1·min–1静脉注射。在左冠状动脉吻合术中,MR+)组较MR-)组CI显著减小(P < 0.0001)MPAPMR显著增加(P < 0.001)。同样在左冠状动脉吻合术中,M+MR(+)组较MR+)组CI显著增大(P < 0.001)MPAPMR显著降低(P < 0.05)。合并MR的病人,左冠状动脉分支吻合术和CI减少及回流和MPAP增加相关。同样在这些病人中,采用米力农治疗有助于在吻合术中保持血流动力学稳定。

(金 路译 薛张纲校)

We hypothesized that mitral regurgitation (MR) would be exacerbated, cardiac index (CI) decreased, and mean pulmonary artery pressure (MPAP) increased in patients with coexisting MR during off-pump coronary artery bypass (OPCAB) anastomosis, and that milrinone could ameliorate increases in MR that occur during OPCAB anastomosis. Subjects comprised 140 patients scheduled for elective OPCAB divided into three groups: patients without MR (MR(-) group; n = 57), patients with MR (MR(+) group; n = 41), and patients with MR who received milrinone (M+MR(+) group; n = 42). Patients with grade 1+ or 2+ MR were included, whereas those with grade 3+ or 4+ MR were excluded. Hemodynamic variables were measured after the induction of anesthesia and during anastomosis. IV infusion of milrinone (0.5 µg · kg–1 · min–1) started immediately after the induction of anesthesia in the M+MR(+) group. CI was significantly decreased (P < 0.0001), and MPAP and MR were significantly increased (P < 0.001) during left coronary anastomosis in the MR(+) group compared with the MR(-) group. CI was significantly higher (P < 0.001), and neither MPAP nor MR were increased (P < 0.05) during left coronary artery anastomosis in the M+MR(+) group compared to the MR(+) group. In patients with MR, anastomosis of the left coronary artery branches was associated with decreased CI and increased regurgitation and MPAP. In such patients, treatment with milrinone helps to stabilize hemodynamics during anastomosis.

 

二尖瓣手术中伴随射频消融和手术方式(修补术对置换术)对心脏生物标志物释放的影响

The Effect of Concomitant Radiofrequency Ablation and Surgical Technique (Repair Versus Replacement) on Release of Cardiac Biomarkers During Mitral Valve Surgery

Alberto Zangrillo, MD*, Giuseppe Crescenzi, MD*, Giovanni Landoni, MD*, Stefano Benussi, MD{dagger}, Martina Crivellari, MD*, Federico Pappalardo, MD*, Enrica Dorigo, MD{dagger}, Carlo Pappone, MD, PhD{ddagger}, and Ottavio Alfieri, MD{dagger} .

*Departments of Cardiovascular Anesthesia, {dagger}Cardiac Surgery, and {ddagger}Cardiology, IRCCS San Raffaele Hospital, Milan, Italy .

Address correspondence and reprint requests to Giovanni Landoni, MD, Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy, Via Olgettina 60, 20132 Milano Italy.

Anesth Analg 2005 101: 24-29.

 

所有施行心脏手术的病人都会有一定程度的可通过心脏生物标志物释放的测定证实的非特异心肌损害,并伴随心输出量的减少。我们研究了在71例二尖瓣手术伴左房消融术病人中行房颤单极射频消融术对心脏生物标志物的释放的作用,并采用71例单纯二尖瓣手术病人作为病例对照。本研究可检测3 ng/mL的差别。两组间在心肌肌钙蛋白I10± 5.3 12 ± 10.4 ng/mL; P = 0.7)和CK-MB50 ± 21.8 57 ± 62.0 ng/mL; P = 0.5)的释放上没有差别。根据单变量分析,术后心肌肌钙蛋白I峰值水平与心肺转流(P = 0.002)及大动脉钳闭(P = 0.001)的持续时间呈线性相关,也和手术方式(二尖瓣置换术15 ± 12 ng/mL 二尖瓣修补术9 ± 4.8 ng/mL P = 0.0007)呈线性相关。在多变量分析中,二尖瓣置换术是术后心肌肌钙蛋白I峰值释放的唯一的独立预测因素(P = 0.005)。和单纯二尖瓣手术相比,房颤射频消融并不引起心脏生物标志物释放的显著增加;和二尖瓣置换术相比,二尖瓣修补术所致心脏生物标志物的释放相对较少。

(金 薛张纲 校)

All patients undergoing heart surgery experience a certain amount of nonspecific myocardial injury documented by the release of cardiac biomarkers and associated with poor outcome. We investigated the role of unipolar radiofrequency ablation of atrial fibrillation on the release of cardiac biomarkers in 71 patients undergoing mitral valve surgery and concomitant left atrial ablation case-matched with 71 patients undergoing isolated mitral surgery. The study was powered to detect a 3 ng/mL difference. There was no difference between the 2 groups in terms of cardiac troponin I (10 ± 5.3 versus 12 + 10.4 ng/mL; P = 0.7) or creatine kinase-MB (50 ± 21.8 versus 57 ± 62.0 ng/mL; P = 0.5) release. Postoperative peak cardiac troponin I levels had univariate associations with the duration of cardiopulmonary bypass (P = 0.002) and aortic cross-clamping (P = 0.001) and with the surgical technique (15 ± 12 ng/mL for mitral valve replacement versus 9 ± 4.8 for mitral valve repair; P = 0.0007) at univariate analysis. Mitral valve replacement was the only independent predictor of postoperative peak release of cardiac troponin I identified with multivariate analysis (P = 0.005). Radiofrequency ablation of atrial fibrillation does not significantly increase cardiac biomarker release compared with isolated mitral surgery; mitral valve repair is associated with less release of cardiac biomarkers compared with mitral valve replacement.

昂丹司琼口服片:在接受增殖腺扁桃体切除术的患儿中的可行性及有效性

Ondansetron Oral Disintegrating Tablets: Acceptability and Efficacy in Children Undergoing Adenotonsillectomy

Ira Todd Cohen, MD, Denise Joffe, MD, Kelly Hummer, BSN, and Alice Soluri, BSN

Department of Anesthesiology, Children's National Medical Center, and George Washington University School of Medicine, Washington, DC.

Anesth Analg 2005 101: 59-63.

术后恶心呕吐(PONV)是儿科手术的一大并发症,静注及口服昂丹司琼对之有效。由于这些方法不一定可行,我们研究了昂丹司琼口服片(ODT)的可行性和有效性。在该随机、双盲、安慰剂对照试验中,62511岁接受增殖腺扁桃体切除术的患儿术前口服ODT4mg)或安慰剂。患儿通过味觉或感觉评价药物。麻醉由七氟醚诱导、地氟醚维持,以及芬太尼2.5 µg/kg和地塞米松0.5 mg/kg(最大剂量 12mg)。由一位与治疗无关的观测者评价患儿的疼痛、躁动及术后恶心呕吐情况。术后处理包括芬太尼1 µg/kg治疗疼痛与躁动、胃复安0.15 mg/kg(最大剂量 10mg)治疗PONV。试验各组间的年龄、体重、恢复时间、躁动或疼痛没有显著差异。大约90%的受试对象觉得ODT味道不错。没有受试对象拒绝该试验药物,但我们发现,含昂丹司琼的药片没有安慰剂口感好。服用昂丹司琼组的呕吐发生率显著减少。

(王丽珺译 薛张纲校)

Postoperative nausea and vomiting (PONV), a major complication in children, is responsive to IV and oral ondansetron. Because these routes are not always available, we studied the acceptability and efficacy of ondansetron oral disintegrating tablets (ODT). In this double-blind, randomized, placebo-controlled study, 62 patients undergoing adenotonsillectomy, aged 5 to 11 years, preoperatively received ODT (4 mg) or placebo. Patients assessed the medication for taste and sensation. Anesthesia was induced with sevoflurane, maintained with desflurane, and supplemented with fentanyl 2.5 µg/kg and dexamethasone 0.5 mg/kg (maximum dose, 12 mg). An observer blinded to treat-ment evaluated patients for pain, agitation, and PONV. Postoperative treatment consisted of fentanyl 1 µg/kg for pain and agitation and metoclopramide 0.15 mg/kg (maximum dose, 10 mg) for PONV. There were no significant differences between study groups with regard to age, weight, recovery time, agitation, or pain. Approximately 90% of the subjects found the ODT to taste good. No subject rejected the study medication, but the ondansetron-containing tablets were found to be less palatable than the placebo. The incidence of vomiting was significantly less in the ondansetron-medicated group.

 

高比重左布比卡因和罗哌卡因腰麻在门诊膝关节镜的应用:一项前瞻、随机、双盲试验。

Spinal Anesthesia with Hyperbaric Levobupivacaine and Ropivacaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Study

Gianluca Cappelleri, MD*, Giorgio Aldegheri, MD*, Giorgio Danelli, MD{dagger}, Chiara Marchetti, MD*, Massimiliano Nuzzi, MD{dagger}, Gabriella Iannandrea, MD{dagger}, and Andrea Casati, MD{dagger} .

Department of Anesthesiology, Vita-Salute University of Milan, IRCCS H. San Raffaele, Milan, Italy; {dagger}Department of Anesthesiology, University of Parma, Azienda Ospedaliera di Parma, Parma, Italy.

Anesth Analg 2005 101: 77-82.

为比较用小剂量高比重罗哌卡因和2种剂量的高比重左布比卡因实施单侧脊髓阻滞,我们随机选取了91ASA I-II的门诊膝关节镜手术病人,分别接受0.5%高比重罗哌卡因7.5mg(罗哌卡因组-7.5,n=31)或0.5%高比重左布比卡因7.5mg(左布比卡因组-7.5n=30)5mg(左布比卡因组-5,n=31)。采用25Whitacre脊麻针在34腰椎间隙实施腰麻。患者在注射后15分钟内保持侧卧位。30分钟后,罗哌卡因组-7.5、左布比卡因组-7.5 及左布比卡因组-5分别有73%, 50%,61%的病人出现了绝对单侧感觉阻滞(P = 0.40)94%, 93%83%的病人出现了单侧运动阻滞(P = 0.31)。罗哌卡因组-7.5的一名病人需改全麻以完成手术,罗哌卡因组-7.5的一名病人(3%)及左布比卡因组-5的一名病人(3%)需用芬太尼补充给药法(P = 0.42)。罗哌卡因组-7.5的腰麻平均时间(时间范围)(135[126-154]分钟)短于左布比卡因组-7.5135[126-154]分钟),出院时间也是罗哌卡因组-7.5(197 [177–218] 分钟)和左布比卡因组-5(197 [187–251] 分钟)短于左布比卡因组-7.5(238 [219–277] 分钟)P分别为0.02 0.04)。我们推论:0.5%高比重罗哌卡7.5mg0.5%高比重左布比卡因5mg为门诊膝关节镜手术提供了良好的腰麻,较之0.5%高比重左布比卡因7.5mg,其出院时间更快。

(王丽珺译 薛张纲校)

To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine, we randomly allocated 91 ASA physical status I–II outpatients undergoing knee arthroscopy to receive unilateral spinal anesthesia with 7.5 mg of hyperbaric ropivacaine 0.5% (group Ropi-7.5, n = 31) or either 7.5 mg (group Levo-7.5, n = 30) or 5 mg (group Levo-5, n = 30) of hyperbaric levobupivacaine 0.5%. Spinal anesthesia was performed at the L3-4 interspace using a 25-gauge Whitacre spinal needle. The lateral decubitus position was maintained for 15 min after injection. Strictly unilateral sensory block was present in 73%, 50%, and 61% of cases in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively, 30 min after injection (P = 0.40), and unilateral motor block was observed in 94%, 93%, and 83% in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively (P = 0.31). One patient of group Ropi-7.5 required general anesthesia to complete surgery, and fentanyl supplementation was required in one patient of group Ropi-7.5 (3%) and one patient of group Levo-5 (3%) (P = 0.42). The median (range) time for spinal block resolution was shorter in group Ropi-7.5 (135 [126–154] min] than in group Levo-7.5 (162 [148–201] min) (P = 0.04); whereas home discharge was shorter in groups Ropi-7.5 (197 [177–218] min) and Levo-5 (197 [187–251] min) as compared with group Levo-7.5 (238 [219–277] min) (P = 0.02 and P = 0.04, respectively). We conclude that 7.5 mg of 0.5% hyperbaric ropivacaine and 5 mg of 0.5% hyperbaric levobupivacaine provide adequate spinal block for outpatient knee arthroscopy, with a faster home discharge as compared with 7.5 mg of 0.5% hyperbaric levobupivacaine.

 

静脉注射异丙酚与咪达唑仑镇静对血流动力学及心率变异的不同影响

The Different Effects of Intravenous Propofol and Midazolam Sedation on Hemodynamic and Heart Rate Variability

Ni Ni Win, Haruhisa Fukayama, Hikaru Kohase, Masahiro Umino.

Anesthesiology and Clinical Physiology, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, 1–5–45, Yushima, Bunkyou-ku, Tokyo, Japan, 113–8549.

Anesth Analg 2005 101: 97-102.

 

在使用异丙酚与咪达唑仑对患者进行镇静的过程中,有报道心率和血压会发生变化。一种可能的解释是二者通过影响心脏自主神经系统而影响心率和血压。通过心率变异性分析,有两种特别的假说得到检验:1)异丙酚使负交感神经活性占优势,引起心率和血压下降;2)咪达唑仑增加交感神经活性,引起心率增快,血压下降。一个前瞻性、随机试验研究了30位行牙科手术的患者,在清醒、镇静和恢复期监测他们的心率、血压、低频指数(LF)、高频指数(HF)及熵,并使用OAA/S评分(the Observer’s Assessment of Alertness/Sedation score)评估患者镇静水平。镇静期与基线相比,异丙酚使总强度及LF/HF比值明显下降(分别为503 ± 209 ms2/Hz 162 ± 92 ms2/Hz2.5 ± 1.2 1.0 ± 0.4),但心率并没有任何改变。咪达唑仑使镇静期正常的HF值降低(34 ± 10% 10 ± 4%),但却不会使LF/HF比值明显改变(2.3±1.1 2.2±1.4),心率则有所增加。在苏醒期,异丙酚使HF正常基线升高(34 ± 11%44 ± 12%),心率明显下降,而咪达唑仑则增加LF/HF比值(2.3 ± 1.13.7 ± 1.8),不改变心率。这些结果作用说明,在同一时期,异丙酚副交感作用占优势,而咪达唑仑的交感优势作用。在镇静麻醉中,特别是当非住院患者心血管并发症发生率高时,这些研究结果十分重要。

(金 琳译 薛张纲校)

Heart rate (HR) and arterial blood pressure (BP) changes have been reported during conscious sedation with propofol and midazolam. One potential mechanism to explain these changes is that propofol and midazolam affect HR and BP via changes in the cardiac autonomic nervous system. Two specific hypotheses were tested by HR variability analysis: 1) propofol induces predominance of parasympathetic activity, leading to decreased HR and BP, and 2) midazolam induces predominance of sympathetic activity, leading to increased HR and decreased BP. Thirty dental patients were included in a prospective, randomized study. HR, BP, low frequency (LF), high frequency (HF), and entropy were monitored during the awake, sedation, and recovery periods and depth of sedation was assessed using the Observer’s Assessment of Alertness/Sedation score. Propofol induced a significant decrease in total power (503 ± 209 ms2/Hz versus 162 ± 92 ms2/Hz) and LF/HF ratio (2.5 ± 1.2 versus 1.0 ± 0.4), despite the absence of any change in HR during the sedation period compared with baseline. Midazolam decreased normalized HF (34 ± 10% versus 10 ± 4%) but did not significantly change LF/HF ratio (2.3 ± 1.1 versus 2.2 ± 1.4) and increased HR in the sedation period. Compared with baseline, propofol was associated with a significant increase in normalized HF in the recovery period (34 ± 11% versus 44 ± 12%) and a significant decrease in HR, whereas midazolam was associated with an increase in LF/HF ratio (2.3 ± 1.1 versus 3.7 ± 1.8) with no change in HR. These results indicated a dominant parasympathetic effect of propofol and a dominant sympathetic effect of midazolam in both periods. These results should be considered during conscious sedation, especially in patients at risk of cardiovascular complications.

 

体外可乐定和新斯的明的抗菌活性

Antibacterial activity of clonidine and neostigmine in vitro.
Boselli E, Guillier M, Freney J, Mazoyer MA, Casoli E, Renaud FR, Rimmele T, Chassard D, Allaouchiche B.
Service d'Anesthesie-Reanimation, Department of Anesthesiology, Hopital Edouard Herriot, 5 place d'Arsonval, 69437 Lyon cedex 03, France.

Anesth Analg. 2005 Jul;101(1):121-4.

 

当区域麻醉后出现感染并发症,我们进行体外试验,研究可乐定和新斯的明对一般微生物的抗菌活性。37℃时,金黄葡萄球菌、表皮葡萄球菌及大肠埃希菌的悬液与浓度为37.575150mg/ml的可乐定及125250500mg/ml新斯的明在13624小时共同孵育。经3724小时孵育后,我们使用两因素方差分析来比较菌落计数。随着可乐定浓度的增高(P < 0.05),金葡菌平均菌落计数显著下降,在6小时最大浓度(150mg/ml)几乎100%灭菌,介于中间浓度(75mg/ml24小时几乎100%灭菌。对于表皮葡萄球菌,我们观察到了类似的结果,在6小时最大浓度(75150mg/ml)几乎100%灭菌。可乐定对大肠埃希菌无杀菌活性,新斯的明对所测试的任何菌属均无杀菌活性。在本次实验的环境下,在体外可乐定,而非新斯的明,表现出对区域麻醉后感染并发症最多见的微生物的抗菌活性呈现浓度和时间依赖性。

(孙敏莉译 薛张纲校)

We conducted an in vitro study to investigate the antibacterial activity of clonidine and neostigmine on common microorganisms encountered during infectious complications after regional anesthesia. Standardized suspensions of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli were incubated during 1, 3, 6, and 24 h at 37 degrees C with concentrations of 37.5, 75, and 150 microg/mL of clonidine and 125, 250, and 500 microg/mL of neostigmine. After 24 h incubation at 37 degrees C, the colony counts were compared by two-way analysis of variance. The mean colony counts for S. aureus decreased significantly from control as the exposure to clonidine increased (P < 0.05), with a approximately 100% kill at 6 h for the largest concentration (150 microg/mL) and at 24 h for the intermediate concentration (75 microg/mL). Similar results were observed for S. epidermidis, with a approximately 100% kill at 6 h for the largest concentrations (75 and 150 microg/mL). No bactericidal activity of clonidine was observed for E. coli and no bactericidal activity of neostigmine was observed for any of the tested strains. In the conditions of this experiment, clonidine, but not neostigmine, exhibited a concentration-dependent and time-dependent bactericidal activity in vitro on the microorganisms most frequently encountered in infectious complications after regional anesthesia.

 

异氟醚对FisherLewis大鼠气道平滑肌连接桥动力的影响

The effects of isoflurane on airway smooth muscle crossbridge kinetics in Fisher and Lewis rats.

Duracher C, Blanc FX, Gueugniaud PY, David JS, Riou B, Lecarpentier Y, Coirault C.

Laboratory of Pathophysiologie cellulaire et moleculaire de l'insuffisance cardiaque, Institut National de la Sante et de la Recherche Medicale INSERM U572 Centre Hospitalo-Universitaire Lariboisiere, Assistance Publique-Hopitaux de Paris, France.

Anesth Analg. 2005 Jul;101(1):136-42.

 

我们的目的是研究异氟醚如何改变连接桥的数目和其动力学以及比较其对Fisher Lewis 大鼠的不同作用,这两株大鼠的气道反应性不同。应用乙酰甲胆碱(10(-6) M)引起收缩后,观察异氟醚(2 MAC)对气管平滑肌带等张和等长收缩的作用。连接桥的力学和动力学用适合气道平滑肌的Huxley's方程分析。应用异氟醚后,在Lewis大鼠最大速度没有改变,而在Fisher大鼠(气道反应最强的株)显著减少,大约只有基础值的25%。异氟醚完全改变了乙酰甲胆碱引起的Lewis大鼠活性连接桥数目的增长(乙酰甲胆碱比异氟醚为2.4 +/- 0.5 1.8 +/- 0.4 10(9)/mm(2),而只是部分使Fisher大鼠发生了改变。(乙酰甲胆碱比异氟醚为2.7 +/- 0.4 versus 2.1 +/- 0.3 10(9)/mm(2)。异氟醚使两种大鼠收缩期的连接桥数目增加了40%,与基础值相比Lewis大鼠连接桥的数目在连接桥循环中几乎增加了两倍。在分离期异氟醚引起的连接桥的增加,Lewis大鼠要比Fisher大鼠要少(P < 0.05)。我们得出结论:异氟醚改变离体大鼠平滑肌连接桥的数目以及连接桥循环的程度的不同取决于气道反应水平。

(沈 洪译 薛张纲 校)

Our aim was to determine how isoflurane modified crossbridge (CB) number and kinetics in airway smooth muscle (ASM) and to compare its effects in Fisher and Lewis rats, two strains with differences in airway responsiveness. The effects of isoflurane (2 MAC) on isotonic and isometric contractility in tracheal ASM strips were investigated after methacholine (10(-6) M)-induced contraction. CB mechanics and kinetics were analyzed using the formalism of Huxley's equations adapted to ASM. After isoflurane, maximum velocity did not differ from baseline in Lewis rats, whereas it was significantly less than baseline in Fisher rats ( approximately 25%), the most reactive strain. Isoflurane totally reversed methacholine-induced increase in active CB number in Lewis rats (2.4 +/- 0.5 versus 1.8 +/- 0.4 10(9)/mm(2) after methacholine and isoflurane, respectively) whereas reversal was only partial in Fisher rats (2.7 +/- 0.4 versus 2.1 +/- 0.3 10(9)/mm(2) after methacholine and isoflurane, respectively). Isoflurane induced a 40% increase in attachment step duration in both strains and an almost twofold increase in the CB cycle duration compared with baseline in Lewis rats. The isoflurane-induced increase in detachment step duration was less in Lewis than in Fisher rats (P < 0.05). We concluded that isoflurane modulated CB number and CB cycling rates of isolated rat ASM differently depending on the level of airway responsiveness.

 

Ohmeda 7810 呼吸机风箱漏气对室内空气污染、吸入氧浓度、气道压和潮气量的影响
The effect of a bellows leak in an Ohmeda 7810 ventilator on room contamination, inspired oxygen, airway pressure, and tidal volume.

Lampotang S, Sanchez JC, Chen B, Gravenstein N.
Department of Anesthesiology, University of Florida, Gainesville, FL, USA.

Anesth Analg. 2005 Jul;101(1):151-4

 

作者利用氧驱动式麻醉呼吸机(Ohmeda 7810, Madison, WI)研究了呼吸机少量风箱漏气对吸入氧浓度(FiO2)、呼出气潮气量(Vt)、气道压和室内空气污染的影响。利用能产生CO2的模拟肺进行机械通气,分为有和没有风箱漏气两组,设置呼吸频率8bpm,吸/呼比12。测量呼吸阀CO2浓度、FiO2Vt和气道压力。设置潮气量分别为400600800ml。新鲜气体流量(FGF)分别为0.3L/min O2和(a5.0L/min 空气,(b2.0L/min 空气和(c0.2L/min 氮气。在有或没有风箱气体漏气组中以及所有FGFVt设置组中,FiO2VtPIP(吸气峰压)和PEEP(呼吸末正压)均无临床差别。而在漏气组中呼吸阀CO2浓度始终不能归零,表明载有CO2的循环气体通过风箱漏气污染风箱中的气体。Ohmeda 78104mm漏气口可使麻醉气体污染周围空气,但对FiO2VtPIP(吸气峰压)和PEEP(呼吸末正压)无明显影响。

(吴德华译 薛张纲校)

We investigated the effect of a small bellows leak (bellows full at end-expiration) on inspired oxygen fraction (Fio(2)), exhaled tidal volume (Vt), airway pressure, and room contamination in an oxygen-driven anesthesia ventilator (Ohmeda 7810, Madison, WI). CO(2) concentration at the ventilator exhalation valve, Fio(2), Vt, and airway pressure were measured (n = 3) while ventilating a CO(2)-producing test lung at 8 breaths/min and an inspiratory/expiratory ratio of 1:2, with and without a bellows leak (4-mm-long tear). Set Vt was 400, 600, 800, and 1000 mL. Fresh gas flow (FGF) was 0.3 L/min O(2) and (a) 5.0 L/min air, (b) 2.0 L/min air, and (c) 0.2 L/min nitrogen. There was no clinical difference in Fio(2), Vt, PIP (peak inspiratory pressure) and PEEP (positive end-expiratory pressure), with and without a 4-mm bellows tear, at all FGFs and Vt settings. CO(2) at the ventilator exhalation valve was always nonzero with a bellows leak, indicating that CO(2)-laden circuit gas was contaminating the drive gas via the bellows leak. A 4-mm bellows tear in an Ohmeda 7810 ventilator allows anesthetic gases to contaminate ambient air but does not cause clinically significant changes in Fio(2), exhaled Vt, PIP, or PEEP.

 

大鼠神经损伤后不同时间镇痛药药效测试

The effect of antinociceptive drugs tested at different times after nerve injury in rats

Hama AT, Borsook D.
Descartes Therapeutics, Inc., Waltham, Massachusetts, USA.

Anesth Analg 2005 101: 175-179.

 

假设涉及神经性头痛发展的神经系统解剖和功能发生改变,在神经性头痛患者药物疗效不一致时这在损伤后不同时间点是可能的。现在的研究,我们评估了两种神经性头痛临床治疗的一线药物在老鼠周围神经损伤后不同时间段行为效应,即抗惊厥药加巴喷丁 和抗抑郁药丙咪嗪。剩下神经已损伤的老鼠在受伤后2,4,8周时对无伤害的机械刺激下有反应(von Frey filament) 加巴喷丁在任何一个时间点呈 剂量依赖性抑止机械刺激敏感性,但是加巴喷丁 损伤后4周的药效是损伤后28周的3倍。相反的,丙咪嗪损伤后28周缺少重要的效应,但在损伤后4周稍微削弱机械高敏感性。结果表明药物效应在神经性状态下随时间改变,在评估药物在动物疼痛模型临床应用前期和作为暂时临床治疗方法时这应该被充分考虑。

(孙志荣译 薛张纲校)

Given the evolving nature of anatomical and functional changes in the nervous system that are involved in the development of neuropathic pain, it is possible that the differing time course after injury underlies the inconsistent efficacy of drugs in neuropathic pain patients. In the current study, we evaluated the behavioral effects of two standard drugs used clinically for neuropathic pain, the anticonvulsant gabapentin and antidepressant imipramine, in rats at different times after peripheral nerve injury. Rats that underwent the spared nerve injury procedure responded to an innocuous mechanical stimulus (von Frey filament) 2, 4, and 8 wk after injury. Gabapentin dose-dependently suppressed mechanical sensitivity at all time points tested but the potency of gabapentin was three-fold less 4 wk postinjury (135 mg/kg) compared with 2 and 8 wk postinjury (41 and 44 mg/kg, respectively). In contrast, imipramine lacked significant efficacy at 2 and 8 wk postinjury but slightly attenuated mechanical hypersensitivity at 4 wk postinjury. The results show that drug effects may change over time in the neuropathic state, which should be an important consideration in the evaluation of drugs in preclinical animal pain models and has implications for temporal approaches to therapy in the clinic.

 

床旁运用标准监测仪器估测功能残气量:吸入氧浓度小改变下的改良的氮气洗出洗入技术

Estimation of Functional Residual Capacity at the Bedside Using Standard Monitoring Equipment: A Modified Nitrogen Washout/Washin Technique Requiring a Small Change of the Inspired Oxygen Fraction

Cecilia Oleg?rd, MD*, S?ren S?ndergaard, MD, PhD*, Erik Houltz, MD, PhD, Stefan Lundin, MD, PhD*, and Ola Stenqvist, MD, PhD*.

*Department of Anesthesiology and Intensive Care and Department of Thoracic Anesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden .

Anesth Analg 2005 101: 206-212.

 

我们以吸入和呼气末气体浓度的标准监测为基础设计改良了氮气洗出洗进技术测量急性呼吸衰竭(ARF)的功能残气量(FRC)。我们用氧浓度在0.31.0的通气的氧消耗肺模型来验证这项设计。肺模型的呼吸商介于0.71.0。改变吸入氧浓度在0.10.20.3进行测量。28ARF的病人分别进行两次测量。在肺模型中,0.1的吸入氧浓度变化引起肺模型的参考FRC值有103 ± 5% 的数值变化,在吸入氧浓度达1.0时精度也一样好其值为103 ± 7%。在病人中,双次测量有-5mL的偏倚95%的可信区间为[38; 29 mL ]。吸入氧浓度分别为0.10.3表现出-9mL的偏倚,限制区间为[365; 347 mL]。这个实验显示了用常规监测仪吸入氧浓度只在0.1的变化下FRC的测量有良好的精度。在吸入氧浓度1.0的条件下测量方法也有一样好的精度。

(蔡美华译 薛张纲校)

We developed a modified nitrogen washin/washout technique based on standard monitors using inspiratory and end-tidal gas concentration values for functional residual capacity (FRC) measurements in patients with acute respiratory failure (ARF). For validation we used an oxygen-consuming lung model ventilated with an inspiratory oxygen fraction (Fio2) between 0.3 and 1.0. The respiratory quotient of the lung model was varied between 0.7 and 1.0. Measurements were performed changing Fio2 with fractions of 0.1, 0.2, and 0.3. In 28 patients with ARF, duplicate measurements were performed. In the lung model, an Fio2 change of 0.1 resulted in a value of 103 ± 5% of the reference FRC value of the lung model, and the precision was equally good up to an Fio2 of 1.0 with a value of 103 ± 7%. In the patients, duplicate measurements showed a bias of –5 mL with a 95% confidence interval [–38; 29 mL ]. A comparison of a change in Fio2 of 0.1 with 0.3 showed a bias of –9 mL and limits of agreement of [–365; 347 mL]. This study shows good precision of FRC measurements with standard monitors using a change in Fio2 of only 0.1. Measurements can be performed with equal precision up to an Fio2 of 1.0.

 

儿茶酚胺加强诱导性的NO合酶的产生涉及到CAT-1CAT-2

Catecholamines' enhancement of inducible nitric oxide synthase-induced nitric oxide biosynthesis involves CAT-1 and CAT-2A.

Lin WC, Tsai PS, Huang CJ.
Department of Urology, Mackay Memorial Hospital, 92 s. 2 Chung San N. Rd., Taipei 104, Taiwan, Republic of China.
Anesth Analg. 2005 Jul;101(1):226-32.

 

LPS刺激的巨噬细胞中,儿茶酚胺能增加诱导性一氧化氮合酶,使NO产生过量。由阳离子氨基酸运载体(包括CAT-1,CAT-2,CAT-2ACAT-2B)调节的L-精氨酸转运在iNOS合成中起关键性作用。我们在受刺激的巨噬细胞中研究了儿茶酚胺对L-精氨酸转运和CAT同工酶的表达。汇合RAW264.7细胞和LPS一起同儿茶酚氨或不给予儿茶酚胺(肾上腺素或去甲肾上腺素,5*10-6M)进行培养18小时。检测NO生成量,L-精氨酸转运和酶的表达。数据显示LPS同时诱导iNOSCAT-2CAT-2B的表达,而CAT-1CAT-2表达不受影响。受刺激的巨噬细胞中也发现NO产量和L-精氨酸转运也明显的增加(分别约为8倍和3倍)。儿茶酚胺明显地增加了受刺激巨噬细胞中NO合成和L-精氨酸的转运(分别几乎30%20%)。在LPS刺激的巨噬细胞中,儿茶酚胺也增加了iNOSCAT-1CAT-2A的表达,但不影响CAT-2CAT-2B的表达。此外,儿茶酚胺的这种作用能被地塞米松或心得安抑制。我们提供的首要证据表明在受刺激的巨噬细胞中,L-精氨酸转运能被儿茶酚胺加强。而且,这种作用可能涉及到CAT-1CAT-2A,但与CAT-2CAT-2B无关。

(吴德华译 薛张纲校)

Catecholamines enhance inducible nitric oxide synthase (iNOS) expression that results in nitric oxide (NO) overproduction in lipopolysaccharide (LPS)-stimulated macrophages. L-arginine transport mediated by cationic amino acid transporters (including CAT-1, CAT-2, CAT-2A, and CAT-2B) is crucial in regulating iNOS activity. We sought to assess the effects of catecholamines on L-arginine transport and CAT isozyme expression in stimulated macrophages. Confluent RAW264.7 cells were cultured with LPS with or without catecholamines (epinephrine or norepinephrine, 5 x 10(-6) M) for 18 h. NO production, L-arginine transport, and enzyme expression were determined. Our data revealed that LPS co-induced iNOS, CAT-2, and CAT-2B expression, whereas CAT-1 and CAT-2A expression remained unaffected. Significant increases in NO production and L-arginine transport (approximately eight-fold and three-fold increases, respectively) were found in activated macrophages. Catecholamines significantly enhanced NO production and L-arginine transport (approximately 30% and 20% increases, respectively) in activated macrophages. Catecholamines also enhanced the expression of iNOS, CAT-1, and CAT-2A but not CAT-2 or CAT-2B in LPS-stimulated macrophages. Furthermore, the enhancement effects of catecholamines were inhibited by either dexamethasone or propranolol. We provide the first evidence to indicate that L-arginine transport in activated macrophages could be enhanced by catecholamines. Furthermore, this catecholamine-enhanced L-arginine transport might involve CAT-1 and CAT-2A but not CAT-2 or CAT-2B.

 

麻醉中的过失与疏忽:一项使用试验性检查目录的实验性研究

Errors and omissions in anesthesia: a pilot study using a pilot's checklist.

Hart EM, Owen H.

Flinders Clinical Skills and Simulation Unit, Flinders University Department of Anesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, SA 5042, Australia.

Anesth Analg. 2005 Jul;101(1):246-50

 

近来麻醉医师在为剖腹产分娩实施全麻时变得更不熟练成为关注的焦点。我们考虑一项口头的检查目录是否有助于其准备工作。根据专家的建议,我们为剖腹产分娩实施全麻建立了一个需要检查的项目目录。这一目录被放入一个带有声音提醒的电子检查目录系统中, 20个麻醉医师通过一个高度灵敏的麻醉模拟器进行试验。在40个检查项目中,参与者忽视检查的项目平均达13个(范围为7-23个)。通常忽视的项目包括没有检查用于困难插管的推车是否备好及没有使病人的头处于最合适的位置。多数(95%)参与者感觉此检查目录是有用的,80%的参与者愿意在模拟试验中使用它;60%的参与者选择书面的检查目录而40%选择口头目录。准备为剖腹产分娩实施全麻时一些重要的检查可能会被遗忘,而使用一个检查目录可能会提高病人的安全性。

(周晓敏 薛张纲 校)

There are recent concerns that anesthesiologists are becoming less skilled in providing general anesthesia for Cesarean delivery. We considered whether a verbal checklist would help in the preparation for this event. We created a list of items to be checked when preparing to administer general anesthesia for a Cesarean delivery using expert opinion. This list was loaded onto an electronic checklist system with voice prompts and tested on 20 anesthesiologists using a high-fidelity anesthesia simulator. Participants omitted to check a median of 13 (range, 7-23) of 40 items. Common omissions included not checking that the difficult intubation trolley was available and not optimizing the patient's head position. Most (95%) participants felt that the checklist was useful and 80% would like to use it for practicing simulated scenarios; 60% preferred a written checklist and 40% preferred the verbal checklist. Important checks may be forgotten when preparing to give a general anesthetic for Cesarean delivery, and the use of a checklist could improve patient safety.

 

兔硬膜外止痛法预防内毒素诱导的肠粘膜损伤

Epidural analgesia prevents endotoxin-induced gut mucosal injury in rabbits.
Kosugi S, Morisaki H, Satoh T, Ai K, Yamamoto M, Soejima J, Serita R, Kotake Y, Ishizaka A, Takeda J.
Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Anesth Analg. 2005 Jul;101(1):265-72.


通过此研究,我们评价在兔身上实施硬膜外止痛法而改变肠道对内毒素屏障作用。放置硬膜外导管后,通过硬膜外导管,28只雄兔被随机注射0.5% 的利多卡因(E组)或生理盐水(C组)。总量为0.4 mL/kg ,以0.1 mL . kg(-1) . h(-1)持续输注。在以15 microg . kg(-1) . h(-1) 连续输注脂多糖时,测定平均动脉压、粘膜内PH值及血浆血栓调节素浓度。在4小时内,平均动脉压下降(P < 0.05), 粘膜内PH值增高(P < 0.01), E组与C组相比,血液被极大的稀释 (P < 0.05) ,而两组的血栓调节素水平上升程度相似。随着回肠湿干比的下降,E组的肠粘膜组织病理学损伤痕迹明显小于重C (P < 0.01)。在一系列独立的实验中(每组N>10E组的粘膜通透性明显小于重C (P < 0.05)。综上所述,虽然灌注压和动脉血氧含量显著下降,但硬膜外止痛法使内毒素诱导的肠粘膜组织和功能损伤降到最小,可能的机制为内皮独立机制。

(孙少潇译 薛张纲校)

In the present study, we evaluated the effect of epidural analgesia on the alterations of gut barrier function elicited by endotoxin in rabbits. After the placement of an epidural catheter, 28 male rabbits were randomized into either 0.5% lidocaine (group E) or saline (group C) group. The solutions (0.4 mL/kg) were epidurally injected, followed by continuous infusion (0.1 mL . kg(-1) . h(-1)) throughout the study period. Under a continuous infusion of lipopolysaccharide (15 microg . kg(-1) . h(-1)), mean arterial blood pressure, intramucosal pH, and plasma thrombomodulin concentrations were measured. At 4 h, mean arterial blood pressure was lower (P < 0.05), intramucosal pH was higher (P < 0.01), and the progression of hemodilution more profound (P < 0.05) in group E versus group C, whereas plasma thrombomodulin levels were increased to a similar extent between the groups. With less wet-to-dry weight ratio of ileum, histopathological injury scores of gut mucosa were significantly less in group E versus group C (P < 0.01). In a separate series of experiments (n = 10 each group), mucosal permeability in group E was significantly less compared with group C (P < 0.05). Collectively, these studies showed that despite a significant decrease of perfusion pressure and arterial oxygen content, epidural analgesia minimized endotoxin-induced functional and structural injury of gut mucosa possibly through endothelium-independent mechanisms.

 

磺酸甘葡环烃钠漱口减少气管插管引起的术后咽喉溃疡

Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.
Ogata J
, Minami K, Horishita T, Shiraishi M, Okamoto T, Terada T, Sata T.
Department of Anesthesiology, University of Occupational and Environmental Health School of Medicine, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, Fukuoka 807-8555, Japan.
Anesth Analg. 2005 Jul;101(1):290-3.

 

术后咽喉溃疡是一项仍未解决的气管插管术后并发症。在此试验中,我们研究了磺酸甘葡环烃钠对减少气管插管术后咽喉溃疡的作用。40个行全麻的择期术后病人被随机分配到甘葡环烃组和对照组。在甘葡环烃组,病人用40 microg/mL 的甘葡环烃稀释液100 mL漱口。在对照组,病人用自来水100 mL漱口。计数全麻后出现的术后咽喉溃疡,并用口述类比疼痛标尺法进行评价。两组的年龄、身高、体重、性别、麻醉和手术时间没有明显区别。在对照组,13个病人(65%) 主诉有术后咽喉溃疡,其中9(45%)持续24小时。在甘葡环烃组,5(25%) 主诉有术后咽喉溃疡,但都于24小时后消失。甘葡环烃组的术后咽喉溃疡发生率和口述类比疼痛标尺法评分明显低于对照组。我们证实甘葡环烃漱口是减轻术后咽喉溃疡病有效而无副作用的方法。

(孙少潇译 薛张纲校)

Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

米力农及考福新减弱兔腹主动脉阻断松夹后软脑膜小动脉的持续收缩

Both Milrinone and Colforsin Daropate Attenuate the Sustained Pial Arteriolar Constriction Seen After Unclamping of an Abdominal Aortic Cross-Clamp in Rabbits

Masayoshi Uchida, MD*, Hiroki Iida, MD{dagger}, Mami Iida, MD{ddagger}, Masahiko Kumazawa, MD{dagger}, Kazuyuki Sumi, MD{dagger}, Motoyasu Takenaka, MD{dagger}, and Shuji Dohi, MD{dagger}

* Department of Anesthesia, Chubu Rosai Hospital; {dagger}Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine; {ddagger}Department of Cardiology, Gifu University Graduate School of Medicine, and Department of Nutrition and Food Science, Faculty of Economics, Gifu Women’s University, Gifu, Japan

Anesth Analg 2005;101:9-16

 

以前我们曾报导了腹主动脉阻断钳松夹可引起软脑膜内动脉先扩张随后持续收缩。米力农及考福新均有血管扩张作用,并且都已用于如腹主动脉瘤切除术这些危重的情况。我们事先在兔的头颅上准备好一个封闭的颅骨窗,在静脉开始输注0.9%盐水(对照组)、米力农或考福新(0.050.5 µg · kg–1 · min–1)之前(基线)及输注开始后15 min(主动脉夹闭前)、主动脉夹闭后即刻、夹闭后20 min、及松夹后060 min的时候监测软脑膜小动脉的直径。在对照组,松夹后动脉直径明显变小,持续至少60min(与基础值相比,最大的变化,大动脉比基础值下降15%,小动脉下降26%)。这些数值在注入两个剂量的米力农及大剂量的考福新后明显减小(在 60 min时分别与基础值相比,–5% –8%, 10% 12%, –2% –5%)。在第二个实验中,颅内局部血流及组织氧分压的变化反映了血管参数的变化。因此,IV米力农及考福新可减弱由腹主动脉阻断松夹引起的软脑膜小动脉的持续性收缩

(裘毅敏 李士通 校)

We previously reported that unclamping of an abdominal aortic cross-clamp causes initial dilation of pial arteries followed by sustained constriction. Both milrinone and colforsin daropate have a vasodilator action, and both have been used in such critical conditions as abdominal aortic aneurysmectomy. We measured cerebral pial arteriolar diameters using a rabbit closed cranial window preparation before (baseline) and 15 min after the start of an IV infusion of 0.9% saline (control group), milrinone, or colforsin daropate (0.05 and 0.5 µg · /kg–1 · min–1) (pre-clamp), just after aortic clamping, 20 min after clamping, and at 0 to 60 min after unclamping. In the control group, a significant decrease in diameter persisted for at least 60 min after unclamping (maximum, –15% for large and –26% for small arterioles versus baseline). These values were significantly smaller after both doses of milrinone and the larger dose of colforsin daropate (–5% and –8%, 10% and 12%, and –2% and –5%, respectively vs baseline, at 60 min). In a second experiment, changes in regional cerebral blood flow and tissue oxygen tension reflected changes in vascular variables. Thus, sustained cerebral pial arteriolar constriction induced by aortic unclamping can be attenuated by IV milrinone or colforsin daropate.


比较活体供肝和尸体供肝移植的输液需要量:与终末期肝病评分模型和基础凝血状态的关系

A Comparison of Transfusion Requirements Between Living Donation and Cadaveric Donation Liver Transplantation: Relationship to Model of End-Stage Liver Disease Score and Baseline Coagulation Status

Peter E. Frasco, MD, Karl A. Poterack, MD, Joseph G. Hentz, MS, and David C. Mulligan, MD

Departments of Anesthesiology and Transplant Surgery, Mayo Clinic College of Medicine, Mayo Clinic Scottsdale, Arizona

Anesth Analg 2005;101:30-37

 

用活体供肝对需要肝移植的患者来说是一项重要的选择。我们回顾了3年的时间里(2001-200427例活的供肝移植和69例尸体供肝移植病人术前终末期肝病模型(MELD)评分、基础凝血实验室结果及术中红血球和血液成分治疗的输注。与接受尸体供肝移植的患者相比,接受活体供肝移植的患者的MELD评分显著较低,凝血功能好(P<0.001)。活供肝移植患者接受的红血球和血成分治疗的输注也显著少于尸体供肝移植患者(P<0.001)。合并尸体供肝移植和活供肝移植的所有患者进行分析发现,MELD评分和术前凝血试验(P<0.001)与术中红细胞和血液成分治疗的输注之间的相关性显著。认为MELD评分和术前纤维蛋白原浓度是需要输血的独立预计因素。结论,我们发现移植时的疾病严重程度、凝血功能受损程度和输红血球和血液成分治疗的需要量在接受活供肝移植的患者与接受尸体供肝移植的患者之间有显著差异。

(马皓琳 李士通 校)

The use of living donation is an important option for patients in need of liver transplant. We retrospectively reviewed the preoperative Model for End-Stage Liver Disease (MELD) score, baseline coagulation laboratory results, and intraoperative transfusion of red blood cells and component therapy for 27 living donation transplants and 69 cadaveric donation transplants during a 3-yr period (2001–2004). Patients undergoing living donation transplantation had significantly lower MELD scores and preserved coagulation function compared with cadaveric donation transplantation recipients (P < 0.001). The living donation transplant patients also received significantly fewer transfusions of red blood cells and component therapy compared with the cadaveric donation transplant patients (P < 0.001). For the combined population of both cadaveric donation transplant and living donation transplant patients, there were significant associations between MELD score and preoperative coagulation tests (P < 0.001) and intraoperative transfusion of blood and component therapy. MELD score and preoperative fibrinogen concentration were identified as independent predictors of transfusion exposure. In conclusion, we detected significant differences in severity of disease at time of transplantation, degree of impairment of coagulation function, and need for transfusion of red blood cells and component therapy between patients undergoing living donation transplantation compared with patients undergoing cadaveric donation transplantation.

 

 

糖溶液的镇痛:葡萄糖对表达的阿片类μ受体的作用

Sugar Solution Analgesia: The Effects of Glucose on Expressed Mu Opioid Receptors

George R. Kracke, PhD*, Katherine A. Uthoff, BS*, and Joseph D. Tobias, MD*{dagger}

Departments of *Anesthesiology and Perioperative Medicine and {dagger}Child Health, University of Missouri School of Medicine, Columbia

Anesth Analg 2005;101:64-68

 

口服葡萄糖或蔗糖溶液对新生儿手术疼痛提供有效的镇痛作用。鉴于阿片受体拮抗剂可削弱糖溶液的这一镇痛作用,我们检验了葡萄糖能直接激动阿片受体的假设。将μ受体(MOR-1)表达于蟾蜍卵母细胞这一公认的表达系统,然后检验葡萄糖对受体可能的激动、拮抗和调节作用。结果为对照实验中, 10 nM Tyr-D-Ala-Gly-Me-Phe-Gly-ol (DAMGO)(一种人工合成的脑啡肽,为μ受体特异性激动剂)可激动MOR-1;而20 mM的葡萄糖却并没有作用。并且,葡萄糖对DAMGO激动 MOR-1的效应无任何影响。最后,葡萄糖对DAMGO所致的急性受体脱敏感也不产生任何调节作用。我们得出结论,在体外表达系统中,葡萄糖对阿片类μ受体不产生直接作用;葡萄糖和阿片系统之间所表现的相互关系可能是涉及内源性阿片类释放的间接作用。

(周志坚 李士通 校)

Glucose or sucrose solutions administered orally provide effective analgesia for procedural pain in neonates. Because analgesia with sugar solutions can be decreased by opioid receptor antagonists, we tested the hypothesis that glucose directly activates opioid receptors. Mu opioid receptors (MOR-1) were expressed in Xenopus oocytes, a well recognized expression system, and glucose was tested for possible agonist, antagonist, and modulatory effects on the receptor. In control experiments, 10 nM of Tyr-D-Ala-Gly-Me-Phe-Gly-ol (DAMGO), a synthetic enkephalin and specific mu agonist, activated the MOR-1, whereas 20 mM of glucose had no effect. In addition, glucose had no effect on the activation of the mu receptor by DAMGO. Finally, glucose did not modulate acute receptor desensitization induced by DAMGO. We conclude that glucose does not directly interact with MOR-1 in an in vitro expression system and that the purported interaction between glucose and the opioid system may be an indirect one, involving release of endogenous opioids.

 

围手术期罗非考西复合局麻药区域阻滞可减少门诊腹股沟疝修补术病人的疼痛及恢复时间

Perioperative Rofecoxib Plus Local Anesthetic Field Block Diminishes Pain and Recovery Time After Outpatient Inguinal Hernia Repair

Dorothy J. Pavlin, MD, Edward G. Pavlin, MD, Karen D. Horvath, MD, Laurie B. Amundsen, MD, David R. Flum, MD, MPH, and Kristine Roesen, BA

Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington

Anesth Analg 2005;101:83-89

 

在这项研究中,我们比较了三组腹股沟疝修补术后病人的疼痛评分:实验组在切皮前行局麻药区域阻滞(PL)或PL复合围术期罗非考西;对照组接受常规标准化治疗。75例在全麻下行腹股沟疝修补术的病人随机分配至三组,第一组在术前及术后五天服用安慰剂药丸(CONT组),第二组在术前行布比卡因区域阻滞和围术期服用安慰剂(PL组),第三组在术前行区域阻滞加上术前及术后五天口服罗非考西50mgPLR组)。所有病人关腹时均在伤口处给予布比卡因局部浸润,并在术后静脉注射芬太尼和扑热息痛/羟考酮。用方差分析比较出院时间、疼痛评分(010),止痛剂的使用量及满意度评分(16)。和CONT组相比,PLR组病人在麻醉后监护病房里(3.75.3, P = 0.02)及术后24小时时(5.36.8, P = 0.03)的最高疼痛评分(最痛)都比较低,并且早38分钟出院(P = 0.01),出院后024小时期间羟考酮的用量也减少28%。PL组的疼痛30分钟内比CONT组要轻。手术24小时以后三组间无显著差异。我们可以得出结论:围手术期罗非考西复合PL可减少住院恢复时间,减少疼痛评分及阿片类药物的使用,并能提高术后24小时内的满意度评分。

(黄佳佳 李士通 校)

In this study, we compared pain scores after inguinal herniorrhaphy in patients treated by preincisional local anesthetic field block (PL), or PL combined with perioperative rofecoxib, with controls who received standard care. Seventy-five patients having herniorrhaphy under general anesthesia were randomly assigned to receive a placebo pill preoperatively, and for 5 days postoperatively (CONT); preoperative bupivacaine field block and perioperative placebo (PL); preoperative field block plus rofecoxib, 50 mg preoperatively and for 5 days postoperatively (PLR). Bupivacaine infiltration in the wound at closure, IV fentanyl and acetaminophen/oxycodone were administered postoperatively to all. Discharge time, pain scores (0–10), analgesic use, and satisfaction scores (1–6) were compared using analysis of variance. PLR patients had lower maximum pain scores (worst pain) in the postanesthesia care unit (3.7 versus 5.3, P = 0.02) and at 24 h (5.3 versus 6.8, P = 0.03), were discharged 38 min sooner (P = 0.01), required 28% less oxycodone 0–24 h after discharge (P = 0.04), and reported higher satisfaction scores compared with CONT. Pain in PL was less than CONT for 30 min. There were no differences among the 3 groups after 24 h postoperatively. We conclude that perioperative rofecoxib with PL reduces in-hospital recovery time, decreases pain scores and opioid use, and improves satisfaction scores in the first 24 h after surgery.

 

兔神经根进入区十分容易受鞘内丁卡因的损害

The Nerve Root Entry Zone Is Highly Vulnerable to Intrathecal Tetracaine in Rabbits

Shuichi Kaneko, MD, Mishiya Matsumoto, MD, Shunsuke Tsuruta, MD, Takao Hirata, MD, Toshikazu Gondo, MD, and Takefumi Sakabe, MD

Departments of Anesthesiology-Resuscitology and Surgical Pathology, Yamaguchi University School of Medicine, Yamaguchi, Japan

Anesth Analg 2005;101:107-114

 

据推测,脊髓的神经根进入区(也称为Obersteiner-Redlich区)可能对鞘内使用的高浓度局麻药更敏感。不过,尚无此方面形态学的依据。本研究中,我们在给兔鞘内使用丁卡因后检查了神经根进入区神经纤维的形态学变化。兔被分为4组(每组6只),分别接受鞘内注射0.3mL的生理盐水(对照)或1%、2%或4%的丁卡因。用药后1周时进行神经学和组织病理学的评估。1%丁卡因组尽管不能检测到神经学上的功能障碍,但选择性地损伤位于腹侧和背侧神经根的进入区由少突胶质细胞组成的髓鞘。应用2%和4%的丁卡因,组织病理的损伤延伸至背侧纤维、神经根的末梢部分及马尾;同时神经学的功能障碍变得明显。这些结果证实神经根进入区由少突胶质细胞组成的髓鞘十分容易受到鞘内使用的高浓度丁卡因的损害。

(黄施伟 李士通 校)

It has been speculated that the nerve root entry zone in the spinal cord, known as the Obersteiner-Redlich zone, may be more sensitive to large concentrations of local anesthetics administered intrathecally. However, there has been no morphological evidence for this. In the present study, we examined morphological changes of nerve fibers at the nerve root entry zone after administration of intrathecal tetracaine in rabbits. Rabbits were assigned to 4 groups (n = 6 in each) and received intrathecal 0.3 mL saline (control), or 1%, 2%, or 4% tetracaine. Neurological and histopathological assessments were performed 1 wk after the administration. Tetracaine 1% selectively injured the myelin sheaths made by oligodendrocytes at the nerve root entry zones of both ventral and dorsal roots, although neurological dysfunction could not be detected. With tetracaine 2% and 4%, histopathological damage extended to the dorsal funiculus, distal part of roots, and cauda equina and neurological dysfunction became apparent. These results demonstrate that the myelin sheaths made by oligodendrocytes at the nerve root entry zone are highly vulnerable to large concentrations of tetracaine given intrathecally.

 

双频指数指导下的异丙酚麻醉中雷米芬太尼抑制气管插管和切皮时的心血管反应的效应部位浓度

The Effect-Site Concentration of Remifentanil Blunting Cardiovascular Responses to Tracheal Intubation and Skin Incision During Bispectral Index-Guided Propofol Anesthesia

Andrea Albertin, MD, Andrea Casati, MD, Lombardo Federica, MD, Valeri Roberto, MD, Vittorino Travaglini, MD, Piercarlo Bergonzi, MD, and Giorgio Torri, MD

Department of Anesthesiology-IRCCS H. San Raffaele, Vita-Salute University of Milano, Milan, Italy

Anesth Analg 2005;101:125-130

 

我们在双频指数(BIS)指导下的异丙酚麻醉时,测定雷米芬太尼抑制气管插管和切皮时的交感神经反应的效应部位浓度。41例进行腹部大手术、ASA I-II级、年龄20-65岁的病人,随机分成两组:气管插管组(组TIn = 20)和切皮组(组 SI, n = 21)。所有的病人接受靶控输注异丙酚4 µg/mL,调节输注速度使BIS维持在40-50范围之间。用上下序贯试验法测定雷米芬太尼阻断50%病例对气管插管和切皮的交感神经反应的效应部位浓度(Ce50)TI组的雷米芬太尼Ce50平均值(95%可信区间[CI]) 5.0 ng/mL (95% CI, 4.7–5.4 ng/mL)SI 组是2.1 ng/mL(95% CI, 1.4–2.8 ng/mL)。此项研究显示,合并使用BIS指导下的靶控输注异丙酚时,5 ng/mL2 ng/mL的雷米芬太尼效应部位浓度能有效抑制50%病人对气管插管和切皮的交感神经反应。

(张曦 李士通 校)

We sought to determine the effect-site concentration of remifentanil blunting sympathetic responses to tracheal intubation and skin incision during bispectral index (BIS)-guided propofol anesthesia. Forty-one ASA physical status I–II patients, aged 20–65 yr and undergoing major abdominal surgery, were randomly assigned to one of two groups: tracheal intubation (group TI, n = 20) or skin incision (group SI, n = 21). All patients received a target-controlled infusion of propofol of 4 µg/mL, which was then adjusted to maintain a BIS value ranging between 40 and 50. The effect-site concentration of remifentanil blocking the sympathetic responses to tracheal intubation and skin incision in 50% of cases (Ce50) was determined using an up-and-down sequential allocation method. The mean (95% confidence interval [CI]) Ce50 of remifentanil was 5.0 ng/mL for TI (95% CI, 4.7–5.4 ng/mL) and 2.1 ng/mL for SI (95% CI, 1.4–2.8 ng/mL). This study shows that effect-site concentrations of remifentanil of 5 ng/mL and 2 ng/mL are effective in blunting sympathetic responses to tracheal intubation and skin incision in 50% of patients when combined with a BIS-guided target controlled infusion of propofol.


三种吸入麻醉药对GluR6(海人藻酸) 受体基因突变小鼠的作用

The Effect of Three Inhaled Anesthetics in Mice Harboring Mutations in the GluR6 (Kainate) Receptor Gene

James M. Sonner, MD, Bryce Vissel, PhD, Gordon Royle, PhD, Anya Maurer, BS, Diane Gong, BS, Nicole V. Baron, MD, Neil Harrison, PhD, Michael Fanselow, PhD, and Edmond I. Eger, II, MD

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; The Garvan Institute of Medical Research, Sydney, Australia; Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, La Jolla, California; Department of Anesthesiology, C.V Starr Laboratory for Molecular Neuropharmacology, Weill Medical College of Cornell University, New York, New York; and Psychology Department, University of California, Los Angeles, California

Anesth Analg 2005;101:143-148

 

GluR5-GluR7KA1 KA2亚单位共同组成海人藻酸受体——离子型兴奋性谷氨酸受体的一种亚型。 异氟醚可增强表达于卵母细胞上含GluR6亚单位的海人藻酸受体的作用。为验证GluR6亚单位基因改变是否会影响吸入麻醉药的在体作用,本实验选取敲除GluR6的小鼠(即缺乏海人藻酸受体亚单位GluR6的小鼠)和GluR6修饰突变株小鼠(此种小鼠在GluR6受体膜2区存在显性的谷氨酸/精氨酸阴性的修饰突变(O/R突变),此种突变增加含GluR6Q的海人藻酸受体钙离子的通透性),测定两组小鼠地氟醚、异氟醚和氟烷的最小肺泡浓度。同时测定异氟醚干扰对音调和伴存恐吓的巴甫洛夫条件反射的能力。缺乏GluR6亚单位不改变异氟醚、地氟醚或氟烷的最小肺泡浓度。这可能是由于构成海人藻酸受体的其他海人藻酸受体亚单位代偿了缺乏的GluR6的作用,故最小肺泡浓度仍正常。O/R突变明显影响含GluR6亚单位的海人藻酸受体,可增加小鼠异氟醚的最小肺泡浓度(增加12%;P < 0.01,减少地氟醚的最小肺泡浓度(减少18%;P < 0.001),但并不改变氟烷的最小肺泡浓度(P0.25)。这些数据可以表明含GluR6Q亚单位的海人藻酸受体直接或间接有差别地调节吸入麻醉药制动的机制。研究表明GluR6基因突变不影响异氟醚干扰惊恐条件反射的能力。

(周雅春 李士通 校)

Combinations of GluR5-GluR7, KA1, and KA2 subunits form kainate receptors, a subtype of excitatory ionotropic glutamate receptors. Isoflurane enhances the action of kainate receptors comprising GluR6 subunits expressed in oocytes. To test whether alterations of the GluR6 subunit gene affect the actions of inhaled anesthetics in vivo, we measured the minimum alveolar concentration of desflurane, isoflurane, and halothane in mice lacking the kainate receptor subunit GluR6 (GluR6 knockout mice) and mice with a dominant negative glutamine/arginine (Q/R) editing mutation in membrane domain 2 of the GluR6 receptor (GluR6 editing mutants), which increases the calcium permeability of kainate receptors containing GluR6Q. We also measured the capacity of isoflurane to interfere with Pavlovian fear conditioning to a tone and to context. Absence of the GluR6 subunit did not change the minimum alveolar concentration of isoflurane, desflurane, or halothane. Possibly, kainate receptors assembled from the remaining kainate receptor subunits compensate for the absent subunits and thereby produce a normal minimum alveolar concentration. A Q/R mutation that dominantly affects kainate receptors containing the GluR6 subunit in mice increased isoflurane minimum alveolar concentration (by 12%; P < 0.01), decreased desflurane minimum alveolar concentration (by 18%; P < 0.001), and did not change halothane minimum alveolar concentration (P = 0.25). These data may indicate that kainate receptors containing GluR6Q subunits differently modulate, directly or indirectly, the mechanism by which inhaled anesthetics cause immobility. The mutations of GluR6 that were studied did not affect the capacity of isoflurane to interfere with fear conditioning.


大鼠胸段蛛网膜下腔置管术的改良步骤

An Improved Procedure for Catheterization of the Thoracic Spinal Subarachnoid Space in the Rat

Y. Y. Poon, MD*{dagger}{ddagger}, Alice Y. W. Chang, PhD{dagger}, S. F. Ko, MD§, and Samuel H. H. Chan, PhD{dagger}

*Graduate Institute of Clinical Medicine and Science, Chang Gung University, Kaohsiung; {dagger}Center for Neuroscience, National Sun Yat-sen University, Kaohsiung; and Departments of {ddagger}Anesthesiology and §Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China

Anesth Analg 2005;101:155-160

 

蛛网膜下腔置管为动物实验中脊髓给药或是收集脑脊液提供了一个便利的途径,并且已经有助于我们理解为麻醉、镇痛以及心血管调节提供理论基础的脊髓机制。这些年得到的经验揭示了这项技术的几个缺点。我们报道的这种置管术包括了大鼠胸脊髓段直接蛛网膜下腔置管的益处,而摒弃了已知的缺陷。鞘内导管是一端有一个小硅珠子的PE10导管,与作为引导的4/0 缝线一起插入。用缝线引导器的L形钩作为固定物,进导管入蛛网膜下腔,直到硅珠嵌进T13椎骨椎板上的钻孔(2 x 2 mm)。我们改良过的大鼠胸段蛛网膜下腔置管术与以往报道过的方法相比较:手术创伤较少,导管放置得更精确且固定得更稳固,脑脊液漏较少,发病率或病死率最低。

(黄丽娜    李士通  校)

Catheterization of the subarachnoid space provides a convenient means to deliver drugs to, or collect cerebrospinal fluid from, the spinal cord in animal experiments, and has been instrumental to our understanding of spinal mechanisms that underlie anesthesia, analgesia, or cardiovascular regulation. Experience gained over the years has revealed several shortcomings of this technique. We report a procedure that encompasses the benefits of direct subarachnoid catheterization of the rat thoracic spinal cord but circumvents the known shortcomings. An intrathecal catheter was fabricated with a small silicon bead at one end of a PE-10 catheter, which was cannulated with a 4/0 suture that served as a guide. Using the L-shape hook of the suture guide as an anchorage, the catheter was advanced into the subarachnoid space until the silicon bead was lodged on a drilled hole (2 x 2 mm) over the lamina proper on the T13 vertebrae. With less surgical trauma, greater precision of placement and firmer anchorage of the catheter, less leakage of cerebrospinal fluid, and minimal mortality or morbidity, our modified procedure for catheterization of the thoracic spinal subarachnoid space in the rat compared favorably to previously reported methods.


曲马多代谢物O-去甲基曲马多在表达 M1 M3克隆受体的蟾蜍卵母细胞中对 毒蕈碱受体引起的反应的影响

The Effects of the Tramadol Metabolite O-Desmethyl Tramadol on Muscarinic Receptor-Induced Responses in Xenopus Oocytes Expressing Cloned M1 or M3 Receptors

Motohiro Nakamura, MD*, Kouichiro Minami, MD, PhD*, Yasuhito Uezono, MD, PhD{dagger}, Takafumi Horishita, MD, PhD*, Junichi Ogata, MD, PhD*, Munehiro Shiraishi, MD, PhD*, Takashi Okamoto, MD*, Tadanori Terada, MD*, and Takeyoshi Sata, MD, PhD*

*Department of Anesthesiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan; and {dagger}Department of Pharmacology, Nagasaki University Graduate School of Biomedical Sciences, Japan

Anesth Analg 2005;101:180-186

 

O-去甲基曲马多是曲马多的一种主要代谢物。它已广泛应用于临床,有镇痛效应。毒蕈碱受体参与脑和自主神经系统中的神经元功能,人们对这些受体作为镇痛药在中枢神经系统内的靶位给予了广泛关注。我们已报道曲马多抑制1型毒蕈碱(M1 受体和3型毒蕈碱(M3 受体的功能,提示毒蕈碱受体是曲马多的作用位点。可是O-去甲基曲马多对毒蕈碱受体功能的作用至今还没有详细研究。本研究使用蟾蜍卵母细胞表达系统观察了O-去甲基曲马多对M1 受体和M3 受体功能的影响。O-去甲基曲马多(0.1100  µM)抑制表达M1 受体的卵母细胞中乙酰胆碱(Ach)引起的电流(半量最大抑制浓度为[IC50] = 2 ± 0.6 µM),而它不抑制表达M3 受体的卵母细胞中Ach引起的电流。尽管蛋白激酶C抑制剂GF109203X能增加Ach引起的电流,但它对O-去甲基曲马多抑制表达M1 受体电流的卵母细胞中Ach引起的电流的作用几乎无影响。当Ach浓度增高时O-去甲基曲马多对M1 受体的抑制作用被克服(O-去甲基曲马多的KD= 0.3 µM)。O-去甲基曲马多抑制[3H] 二苯乙醇酸奎宁环酯([3H]QNB)与卵母细胞上表达的M1 受体的特异结合(IC50 = 10.1 ± 0.1 µM),而不抑制[3H]QNB与卵母细胞上表达的M3 受体的特异结合。根据上述结果,O-去甲基曲马多抑制M1 受体的功能,而对M3 受体的功能影响甚微。本研究显示了O-去甲基曲马多对受体分子水平的作用,这将有助于解释它的神经系统作用。

(邱郁薇 李士通 校)

 

O-desmethyl tramadol is one of the main metabolites of tramadol. It has been widely used clinically and has analgesic activity. Muscarinic receptors are involved in neuronal functions in the brain and autonomic nervous system, and much attention has been paid to these receptors as targets for analgesic drugs in the central nervous system. We have reported that tramadol inhibits the function of type-1 muscarinic (M1) receptors and type-3 muscarinic (M3) receptors, suggesting that muscarinic receptors are sites of action of tramadol. However, the effects of O-desmethyl tramadol on muscarinic receptor functions have not been studied in detail. In this study, we investigated the effects of O-desmethyl tramadol on M1 and M3 receptors, using the Xenopus oocyte expression system. O-desmethyl tramadol (0.1–100 µM) inhibited acetylcholine (ACh)-induced currents in oocytes expressing the M1 receptors (half-maximal inhibitory concentration [IC50] = 2 ± 0.6 µM), whereas it did not suppress ACh-induced currents in oocytes expressing the M3 receptor. Although GF109203X, a protein kinase C inhibitor, increased the ACh-induced current, it had little effect on the inhibition of ACh-induced currents by O-desmethyl tramadol in oocytes expressing M1 receptors. The inhibitory effect of O-desmethyl tramadol on M1 receptor was overcome when the concentration of ACh was increased (KD with O-desmethyl tramadol = 0.3 µM). O-desmethyl tramadol inhibited the specific binding of [3H]quinuclidinyl benzilate ([3H]QNB) to the oocytes expressed M1 receptors (IC50 = 10.1 ± 0.1 µM), whereas it did not suppress the specific binding of [3H]QNB to the oocytes expressed M3 receptors. Based on these results, O-desmethyl tramadol inhibits functions of M1 receptors but has little effect on those of M3 receptors. This study demonstrates the molecular action of O-desmethyl tramadol on the receptors and may help to explain its neural function.

 

 

丝氨酸蛋白酶抑制剂在酸误吸和高氧后维持固有超氧化物歧化酶水平,但不能减少肺损伤

Serine Antiproteinase Administration Preserves Innate Superoxide Dismutase Levels After Acid Aspiration and Hyperoxia but Does Not Decrease Lung Injury

 

Nader D. Nader, MD, PhD*, Bruce A. Davidson, BS*, Alan R. Tait, PhD§, Bruce A. Holm, PhD{ddagger}, and Paul R. Knight, MD, PhD*{dagger}

Departments of *Anesthesiology, {dagger}Microbiology, and {ddagger}Pharmacology, State University of New York at Buffalo; and §Department of Anesthesiology, University of Michigan, Ann Arbor

Anesth Analg 2005;101:213-219

 

酸误吸和周围环境氧过多后的急性肺损伤导致肺显著的氧化损害。肺的抗氧化剂水平也下降了。由于气道中丝氨酸蛋白酶水平急剧增加,我们猜测这些酶对肺抗氧化剂的分解起重要作用。在周围氧增多(氧过多)环境中大鼠肺误吸酸前注入丝氨酸蛋白酶抑制剂抑肽酶。测定肺Cu/Zn Mn 超氧化物歧化酶(SOD)活性(用比色测定)及Cu/Zn SOD免疫活性蛋白(酶联反应免疫吸收剂测定)。同时评定蛋白酶抑制剂处理对急性肺损伤的影响。总SODCu/Zn SOD Cu/Zn SOD 抗原蛋白水平在动物误吸酸和氧过多后均减少 。然而,Mn SOD活性没有改变。动物体内Cu/Zn SOD的下降由于丝氨酸蛋白酶活性被抑制而被削弱。但通过测定肺部渗入的放射性同位素白蛋白(渗透性指数)、动脉血气和急性炎症指标(肺髓过氧化物酶活性、替代的嗜中性细胞标记和炎性细胞因子)显示蛋白酶抑制剂处理并不减少急性肺损伤。我们得出结论丝氨酸蛋白酶的产生在减少Cu/Zn SOD中起主要作用,从而减少了肺抗氧化剂水平。但它在急性肺损伤的发病机理中的作用仍不清楚。

(朱慧 李士通 校)

Acute lung injury after acid aspiration and increased ambient oxygen result in significant oxidative damage to the lungs. Lung antioxidant levels are also reduced. Because levels of serine proteinases in the airspaces are also dramatically increased, we hypothesized that these enzymes play a role in degrading lung antioxidants. Rats were treated with a serine proteinase inhibitor, aprotinin, before pulmonary aspiration of acid in the presence of increased ambient oxygen (hyperoxia). Lung Cu/Zn and Mn superoxide dismutase (SOD) activity (by colorimetric assay) and Cu/Zn SOD immune reactive protein (enzyme-linked immunosorbent assay) were assayed. The effects of antiproteinase treatment on acute lung injury were also assessed. Total SOD, Cu/Zn SOD, and Cu/Zn SOD antigenic protein levels were decreased in animals after acid aspiration and hyperoxia. However, Mn SOD activity was unchanged. The decrease in Cu/Zn SOD was attenuated in animals, where serine proteinase activity was inhibited. However, antiproteinase treatment did not decrease acute pulmonary injury, as assessed by leakage of radiolabeled albumin into the lung (permeability index), arterial blood gases, and markers of acute inflammation (pulmonary myeloperoxidase activity, a surrogate neutrophilic marker, and inflammatory cytokine profiles). We conclude that production of serine proteinases play a major role in degrading Cu/Zn SOD, thereby decreasing pulmonary antioxidant capacity. However, the role this plays in the pathogenesis of the acute lung injury is not clear.


在单侧脑半球功能抑制中的双侧双谱指数监测

Bilateral Bispectral Index Monitoring During Suppression of Unilateral Hemispheric Function

Haren Heller, MD*, Raheleh Hatami, BA*, Paul Mullin, MD{dagger}, Robert R. Sciacca, EngScD{ddagger}, Alexander G. Khandji, MD§, Marla Hamberger, PhD{dagger}, Ronald Emerson, MD{dagger}, and Eric J. Heyer, MD, PhD*{dagger}

Departments of *Anesthesiology, {dagger}Neurology, {ddagger}Medicine, and §Radiology, The New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York

Anesth Analg 2005;101:235-341

 

双谱指数(BIS)已被用于监测基于脑电图(EEG)的“镇静”水平。筛选是否行癫痫手术时病人要进行Wada试验,即通过注射短效巴比妥类药物使一侧脑半球功能性失活。我们推测BIS指数能反映这些功能的变化。8名癫痫患者参与了此项研究。完整安置21EEG电极以及2BIS XPQuatro)条带电极置于双侧头皮的额叶区域。持续记录EEG。记录每分钟的双侧脑半球BIS值。通过双侧颈内动脉插入导管进行血管造影。一直注射异戊巴比妥或美索比妥直到病人出现轻偏瘫。EEG证实了巴比妥类对单侧大脑皮层的显著影响。用重复方差分析来分析从置于头部左侧和右侧的监测电极带得到的BIS 值(左BIS和右BIS)的差异以及在每次注射巴比妥类药物之前和之后左和 BIS 值间的差异。注射巴比妥类药物到左侧和右侧颈内动脉都会引起21导联EEG的显著变化。然而,双侧的BIS 值并无显著性差异(P=0.84)。重复注射巴比妥类药物,一些病人出现了镇静作用。这时,左右两侧的BIS 值在注射巴比妥后均出现了下降。除非病人在镇静状态下,否则BIS 监测仪无法区别显著的脑半球EEG和临床功能的改变。

(黄佳佳 李士通 校)

Bispectral Index (BIS) has been used to monitor level of "sedation" based on the electroencephalogram (EEG). Patients evaluated for surgery to control a seizure disorder undergo Wada testing, during which one hemisphere is rendered functionally inactive after injecting a short-acting barbiturate. We surmised that the BIS values would reflect these functional changes. Eight epileptic patients were enrolled. A full array of 21 EEG electrodes and 2 BIS XP (Quatro) strips over each frontal region of the scalp were applied. The EEG was continuously recorded. BIS values from each hemisphere were recorded every minute. Angiography was performed by advancing a catheter into each internal carotid artery. Amobarbital or methohexital was injected until the patient developed a hemiparesis. The EEG confirmed a significant lateralized cortical effect of the barbiturate. Repeated measures analysis of variance was used to analyze the differences between the BIS values from monitor electrode strips placed on the left (left BIS) and the right (right BIS) sides of the head as well as the differences in the left and right BIS values before and after each injection of the barbiturate. Injection of barbiturate into either the left or right internal carotid artery produced a significant change on the 21-electrode EEG. However, there was no difference between left BIS to right BIS values (P = 0.84). With repeated injections of barbiturates, some patients became sedated. At these times, both left BIS and right BIS values decreased together before and after injection of barbiturate. The BIS monitor was unable to distinguish significant hemispheric EEG and clinical functional changes except when the patient became sedated.


瑞芬太尼在腔镜手术中用于胎儿制动及母亲镇静的作用:与安定比较的随机、双盲实验

Remifentanil for Fetal Immobilization and Maternal Sedation During Fetoscopic Surgery: A Randomized, Double-Blind Comparison with Diazepam

Marc Van de Velde, MD, PhD, Dominique Van Schoubroeck, MD, Liesbeth E. Lewi, MD, Marco A.E. Marcus, MD, PhD, Jacques C. Jani, MD, Carlo Missant, MD, An Teunkens, MD, and Jan A. Deprest, MD, PhD

Departments of Anaesthesiology and Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium, and the Department of Anaesthesiology, University of Maastricht, The Netherlands

Anesth Analg 2005;101:251-258

 

我们医院常规使用产科内窥镜手术治疗单绒毛膜腔双胎胎儿的某些疾病。我们选择在脊硬联合麻醉加母亲镇静下实行手术。由于没有进行全麻,胎儿不会停止活动。我们假设瑞芬太尼可以使母亲达到足够的镇静,并使胎儿停止活动,此作用等同或优于安定。54例孕中期孕妇被列入这个随机双盲试验。实施脊硬联合麻醉后,开始用间断推注安定或持续输注瑞芬太尼使母亲镇静。分别于术前、术中和术后60分钟内评价母亲的镇静程度、血流动力学、不良反应以及胎儿的血流动力学和制动情况。瑞芬太尼使母亲产生足够的镇静效果,有轻微的、但并无临床意义的呼吸抑制作用(手术开始后40分钟时,母亲的呼吸频率为13 ± 4/分,Pco2 38.6 ± 4 mm Hg),而安定对母亲的镇静作用更明显,但没有呼吸抑制作用(手术开始后40分钟时,母亲的呼吸频率为18 ± 3/分,Pco2 32.7 ± 3 mm Hg)。与安定比较,瑞芬太尼使胎儿制动的作用出现早,且更加明显,从而改善了手术条件;手术开始40分钟内,胎儿总体和肢体活动次数,安定为12 ± 4,瑞芬太尼为2 ± 1。因此,使用瑞芬太尼麻醉的病人,其平均手术时间(范围)明显较安定组的病人短,瑞芬太尼麻醉组为60 (54–71)分钟,安定麻醉组为80 (60–90)分钟。 我们得出结论,瑞芬太尼可改善胎儿的制动,母亲产生足够的镇静,仅对母亲呼吸有轻微影响。

(张莹 李士通 校)

Obstetric endoscopy procedures are routinely performed at our institution to treat selected complications of monochorionic twin gestation. We perform these procedures under combined spinal epidural anesthesia plus maternal sedation. In the absence of general anesthesia, fetal immobilization is not achieved. We hypothesized that remifentanil would induce adequate maternal sedation and provide fetal immobilization, which is equal or superior to that induced by diazepam. Fifty-four second trimester pregnant women were included in this randomized, double-blind trial. After combined spinal epidural anesthesia, maternal sedation was initiated using either incremental doses of diazepam or a continuous infusion of remifentanil. Maternal sedation, hemodynamics, side effects, and fetal hemodynamics and immobilization were evaluated before, during, and for 60 min after surgery. Remifentanil produced adequate maternal sedation with mild but clinically irrelevant respiratory depression (respiratory rate 13 ± 4 breaths/min and Pco2 38.6 ± 4 mm Hg at 40 min of surgery), whereas diazepam resulted in a more pronounced maternal sedation but no respiratory depression (respiratory rate 18 ± 3 breaths/min and Pco2 32.7 ± 3 mm Hg at 40 min of surgery). Compared with diazepam, fetal immobilization with remifentanil occurred faster and was more pronounced, resulting in improved surgical conditions; the number of gross body and limb movements was 12 ± 4 (diazepam) versus 2 ± 1 (remifentanil) at 40 min of surgery. Because of this, the mean (range) duration of surgery was significantly shorter in the remifentanil-treated patients, 60 (54–71) min versus 80 (60–90) min in the diazepam group. We conclude that remifentanil produces improved fetal immobilization with good maternal sedation and only minimal effects on maternal respiration.

 

 

垂直锁骨下臂丛神经阻滞:应用磁共振成像技术的模拟研究

The Vertical Infraclavicular Brachial Plexus Block: A Simulation Study Using Magnetic Resonance Imaging

Øivind Klaastad, DMSc*, Örjan Smedby, DrMedSci{dagger}, Trygve Kjelstrup, MD{ddagger}, and Hans-Jørgen Smith, DMSc§

*Department of Anesthesiology and The Interventional Centre, {ddagger}Department of Anesthesiology, and §Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway; and {dagger}Department of Radiology, University Hospital Linköping, Linköping, Sweden

Anesth Analg 2005;101:273-278

 

推荐的垂直锁骨下臂丛神经阻滞进针轨迹是前后位,针尾朝向锁骨中点。作者采用磁共振成像技术研究在20例成年志愿者中气胸和穿破锁骨下血管的风险性和这种方法的精确性。进针指向肺的有6例,其中5人为女性。然而在所有研究对象中通过碰到锁骨下血管、神经丛或第一肋骨后停止进针就可避免刺破胸膜。3例进针轨迹碰到锁骨下静脉,5例遇到锁骨下动脉。进针轨迹与神经丛之间的距离(最靠近的方位)中位数为1 mm(范围0–9 mm9例碰到神经。总之,施行垂直锁骨下臂丛神经阻滞时,针穿破胸膜有很小的可能性,尤其在女性,但碰到锁骨下静脉和动脉的机会较大。尽管进针方向贴近神经丛,任何内侧偏斜在其它深度可导致刺破胸膜和锁骨下血管的危险。 临床上确定进针点的精确度是很关键的。

(赵雪莲 庄心良 )

The recommended needle trajectory for the vertical infraclavicular brachial plexus block is anteroposterior, caudad to the middle of the clavicle. We studied the risk of pneumothorax and subclavian vessel puncture and the precision of this method by using magnetic resonance imaging in 20 adult volunteers. The trajectory aimed at the lung in six subjects, five of whom were women. However, pleural contact could be avoided in all subjects by halting needle advancement after contact with the subclavian vessels, plexus, or first rib. The subclavian vein was reached by the trajectory in three and the subclavian artery in five subjects. The trajectory had a median distance to the plexus (closest aspect) of 1 mm (range, 0–9 mm) and contacted the nerves in 9 subjects. In conclusion, there is a small probability that the needle may reach the pleura when a vertical infraclavicular brachial plexus block is performed, particularly in women, and a high probability that it will contact the subclavian vein or artery. Although the trajectory is close to the plexus, any medial deviation carries the risk of pleural or subclavian vessel contact at other depths. Clinical accuracy in defining the insertion point is critical.