Anesthesia & Analgesia

October 2005

Table of Content

CARDIOVASCULAR ANESTHESIA:

吗啡诱导在体大鼠心脏的晚期心肌保护作用与阿片受体和核转录因子KappaB有关

(苏殿三译 陈杰 )

Morphine Induces Late Cardioprotection in Rat Hearts In Vivo: The Involvement of Opioid Receptors and Nuclear Transcription Factor B

Jan Frässdorf, Nina C. Weber, Detlef Obal, Octavian Toma, Jost Müllenheim, Georg Kojda, Benedikt Preckel, and Wolfgang Schlack

Anesth Analg 2005 101: 934-941

 

吗啡增强异氟醚诱导的对抗心肌坏死的后效应:3磷酸肌醇和阿片类受体对兔子所起的作用。

(孙卓真译 薛张纲校)

Morphine Enhances Isoflurane-Induced Postconditioning Against Myocardial Infarction: The Role of Phosphatidylinositol-3-Kinase and Opioid Receptors in Rabbits

Dorothee Weihrauch, John G. Krolikowski, Martin Bienengraeber, Judy R. Kersten, David C. Warltier, and Paul S. Pagel

Anesth Analg 2005 101: 942-949.

 

磷酸二酯酶-3抑制剂在离体人胃网膜动脉、乳内动脉及桡动脉之间不同的药理学敏感性

(黄施伟 马皓琳,李士通 )

Differential Pharmacologic Sensitivities of Phosphodiesterase-3 Inhibitors Among Human Isolated Gastroepiploic, Internal Mammary, and Radial Arteries

Masanori Onomoto, Isao Tsuneyoshi, Arata Yonetani, Shoich Suehiro, Kazuhisa Matsumoto, Ryuzo Sakata, and Yuichi Kanmura

Anesth Analg 2005 101: 950-956.

 

机械通气对行胸部手术的患者肺免疫功能的影响

(彭中美 马皓琳,李士通 )

The Pulmonary Immune Effects of Mechanical Ventilation in Patients Undergoing Thoracic Surgery

Thomas Schilling, Alf Kozian, Christof Huth, Frank Bühling, Moritz Kretzschmar, Tobias Welte, and Thomas Hachenberg

Anesth Analg 2005 101: 957-965.

 

无痛超声吸出法肝切除(CUSA)增加了静脉空气栓塞(VAE)的发生率和危险性.

(孙卓真译 薛张纲校)

Hepatic Resection by the Cavitron Ultrasonic Surgical Aspirator® Increases the Incidence and Severity of Venous Air Embolism

Bon N. Koo, Hae K. Kil, Jin-S Choi, Ji Y. Kim, Duk H. Chun, and Yong W. Hong

Anesth Analg 2005 101: 966-970.

 

麻醉恢复期西罗莫司涂抹冠脉支架内的血栓形成

(郑拥军译 陈杰校)

Thrombosis of Sirolimus-Eluting Coronary Stent in the Postanesthesia Care Unit (Case Report)

J. Thomas Murphy and Brenda G. Fahy

Anesth Analg 2005 101: 971-973.

PEDIATRIC ANESTHESIA:

儿童颈部伸展时气管长度伸长对气管内导管安全的意义

(郑拥军译 陈杰校)

Elongation of the Trachea During Neck Extension in Children: Implications of the Safety of Endotracheal Tubes

Kim Jin-Hee, Young-Jin Ro, Min Seong-Won, Kim Chong-Soo, Kim Seong-Deok, Jun Ho Lee, and Bahk Jae-Hyon

Anesth Analg 2005 101: 974-977

 

比较Vasotrac血压仪和有创动脉血压监测在行脊柱侧突手术的青春期病人的桡动脉血压测定

(王慧琳译 薛张纲校)

A Comparison of Radial Artery Blood Pressure Determination Between the Vasotrac Device and Invasive Arterial Blood Pressure Monitoring in Adolescents Undergoing Scoliosis Surgery

Mary E. McCann, David Hill, Kristin C. Thomas, David Zurakowski, and Peter C. Laussen

Anesth Analg 2005 101: 978-985

 

糖尿病患儿外科围手术期管理

(周志坚 马皓琳,李士通 )

Perioperative Management of Pediatric Surgical Patients with Diabetes Mellitus (Medical Intelligence)

Erinn T. Rhodes, Lynne R. Ferrari, and Joseph I. Wolfsdorf

Anesth Analg 2005 101: 986-999.

AMBULATORY ANESTHESIA:

月经黄体期增加的黄体酮可减少麻醉药物的需要量

(赵延华译 陈杰校)

Increased Progesterone Production During the Luteal Phase of Menstruation May Decrease Anesthetic Requirement

Veysel Erden, Zehra Yangin, Kerem Erkalp, Hamdi Delatioglu, Feyza Bahçeci, and Ayse Seyhan

Anesth Analg 2005 101: 1007-1011

 

白内障手术的球下麻醉:需要多少剂量?

(王慧琳译 薛张纲校)
Sub-Tenon’s Anesthetic Administration for Cataract Surgery: How Much Stays In?

Niall Patton, Tahira Y. Malik, and Tariq M. Aslam

Anesth Analg 2005 101: 1012-1014

ANESTHETIC PHARMACOLOGY:

七氟醚增强大鼠主动脉对硝酸甘油的耐药:提示可能通过在血管平滑肌内附加产生超氧阴离子和/或氢氧根使可溶性鸟苷酸环化酶脱敏感化

(周雅春 马皓琳,李士通 )

Sevoflurane Enhances Nitroglycerin Tolerance in Rat Aorta: Implications for the Desensitization of Soluble Guanylate Cyclase Possibly Through the Additive Generation of Su

Tetsuya Kakutani, Koji Ogawa, Shizue Iwahashi, Kazuhiro Mizumoto, and Yoshio Hatano

Anesth Analg 2005 101: 1015-1022.

 

不同效应部位半数平衡时间参数对预测效应部位七氟醚浓度的影响:一项模拟研究

(田婕 陈杰 )

The Effect of Using Different Values for the Effect-Site Equilibrium Half-Time on the Prediction of Effect-Site Sevoflurane Concentration: A Simulation Study

R. Ross Kennedy

Anesth Analg 2005 101: 1023-1028.

 

给予吗啡的雪貂预注昂丹司琼会减弱血浆抗利尿激素增加

(钟静译,薛张纲校)

Pretreatment with Ondansetron Blunts Plasma Vasopressin Increases Associated with Morphine Administration in Ferrets

Eric P. Wilkens and Bill J. Yates

Anesth Analg 2005 101: 1029-1033.

 

在麻醉成人中用于拔除喉罩通气道的最佳的七氟醚呼气末浓度

(马皓琳 李士通 )

Optimal End-Tidal Sevoflurane Concentration for the Removal of the Laryngeal Mask Airway in Anesthetized Adults

Yon Hee Shim, Cheung Soo Shin, Chul Ho Chang, and Yang-Sik Shin

Anesth Analg 2005 101: 1034-1037

 

长期使用氢离子拮抗剂治疗的病人麻醉前使用质子泵抑制剂的有效性

(肖洁 陈杰 )

The Efficacy of Preanesthetic Proton Pump Inhibitor Treatment for Patients on Long-Term H2 Antagonist Therapy

Kazuyoshi Hirota, Mihoko Kudo, Hiroshi Hashimoto, and Tetsuya Kushikata

Anesth Analg 2005 101: 1038-1041

 

K2P通道――TRESK对麻药和其他调节器反应存在种特异性差异

(钟静译,薛张纲校)

Species-Specific Differences in Response to Anesthetics and Other Modulators by the K2P Channel TRESK

Bharat Keshavaprasad, Canhui Liu, John D. Au, Christoph H. Kindler, Joseph F. Cotten, and C. Spencer Yost

Anesth Analg 2005 101: 1042-1049.

 

选择性磷酸二酯酶5抑制不减少健康志愿者丙泊酚镇静需要量但影响恢复速度和血浆环鸟苷酸3',5'-单磷酸浓度

(颜涛 马皓琳,李士通 )

Selective Phosphodiesterase 5 Inhibition Does Not Reduce Propofol Sedation Requirements but Affects Speed of Recovery and Plasma Cyclic Guanosine 3',5'-Monophosphate Concentrations in Healthy Volunteers

Thomas Engelhardt, Jamie MacDonald, Helen F. Galley, and Nigel R. Webster

Anesth Analg 2005 101: 1050-1053

 

静脉麻醉剂对肥大细胞功能的抑制作用

(朱辉 陈杰 )

Inhibitory Effects of Intravenous Anesthetics on Mast Cell Function

Takahiro Fujimoto, Tomoki Nishiyama, and Kazuo Hanaoka

Anesth Analg 2005 101: 1054-1059

 

一项非脂化丙泊酚和含中链甘油三脂的丙泊酚乳剂所引起注射疼痛的比较研究

(齐波 陈杰 )

Pain on Injection of Lipid-Free Propofol and Propofol Emulsion Containing Medium-Chain Triglyceride: A Comparative Study (Brief Report)

Prakash K. Dubey and Arun Kumar

Anesth Analg 2005 101: 1060-1062.

 

乙醚或异氟醚麻醉对大鼠肝脏中细胞色素酶P450 2E1P450还原酶活性的影响

(陆文清译 薛张纲校)

The Effect of Anesthesia by Diethyl Ether or Isoflurane on Activity of Cytochrome P450 2E1 and P450 Reductases in Rat Liver (Brief Report)

Andrea Y. A. Plate, Daune L. Crankshaw, and Daniel D. Gallaher

Anesth Analg 2005 101: 1063-1064

 

托特罗定预防导尿管相关膀胱不适的药效:一项前瞻性、随机、安慰剂-对照、双盲研究

(黄佳佳 马皓琳,李士通 )

The Efficacy of Tolterodine for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study (Brief Report)

Anil Agarwal, Mehdi Raza, Vinay Singhal, Sanjay Dhiraaj, Rakesh Kapoor, Aneesh Srivastava, Devendra Gupta, Prabhat K. Singh, Chandra Kant Pandey, and Uttam Singh

Anesth Analg 2005 101: 1065-1067

TECHNOLOGY, COMPUTING, AND SIMULATION:

 

麻醉学中以模拟为基础的评估演示的可行性

(忻纪华 陈杰 )

The Feasibility of Sharing Simulation-Based Evaluation Scenarios in Anesthesiology

Haim Berkenstadt, Gareth S. Kantor, Yakov Yusim, Naomi Gafni, Azriel Perel, Tiberiu Ezri, and Amitai Ziv

Anesth Analg 2005 101: 1068-1074

 

在手术前对病人完成书面和电子调查的比较

(陆文清译 薛张纲校)

A Comparison of Paper with Electronic Patient-Completed Questionnaires in a Preoperative Clinic

Elizabeth G. VanDenKerkhof, David H. Goldstein, William C. Blaine, and Michael J. Rimmer

Anesth Analg 2005 101: 1075-1080

 

通过持续上呼吸道二氧化碳监测来优化气管内导管的套囊填充

(周荻译 薛张纲校)

Optimization of Endotracheal Tube Cuff Filling by Continuous Upper Airway Carbon Dioxide Monitoring

Shai Efrati, Yuval Leonov, Amir Oron, Yariv Siman-Tov, Michael Averbukh, Alex Lavrushevich, and Ahuva Golik

Anesth Analg 2005 101: 1081-1088

 

评估葡萄糖初始分布积以评价液冲击中血浆容积

(黄丽娜 马皓琳,李士通 )

An Evaluation of the Initial Distribution Volume of Glucose to Assess Plasma Volume During a Fluid Challenge (Technical Communication)

Laurence van Tulder, Burkhardt Michaeli, René Chioléro, Mette M. Berger, and Jean-Pierre Revelly

Anesth Analg 2005 101: 1089-1093

PAIN MEDICINE:

 

伊拉克战争中士兵受伤的表现,诊断,损伤机制和治疗:在两所军事疼痛治疗中心进行的一项流行病学研究

(殷文渊译 陈杰 )

Presentation, Diagnoses, Mechanisms of Injury, and Treatment of Soldiers Injured in Operation Iraqi Freedom: An Epidemiological Study Conducted at Two Military Pain Management Centers

Steven P. Cohen, Scott Griffith, Thomas M. Larkin, Felipe Villena, and Ralph Larkin

Anesth Analg 2005 101: 1098-1103.

 

Etoricoxib对全膝或全髋替换术后病人的镇痛效能:随机,双盲,安慰剂控制的研究

(周荻译 薛张纲校)
Etoricoxib Provides Analgesic Efficacy to Patients After Knee or Hip Replacement Surgery: A Randomized, Double-Blind, Placebo-Controlled Study

G. Lynn Rasmussen, Kerstin Malmstrom, Michael H. Bourne, Maurice Jove, Steven M. Rhondeau, Paul Kotey, Jennifer Ang, Michelle Aversano, Alise S. Reicin for the Etoricoxib Postorthopedic Study Group

Anesth Analg 2005 101: 1104-1111

 

围手术期疼痛管理技术对大鼠剖腹手术后食物消耗量和体重的影响

(张曦 马皓琳,李士通 )

The Effects of Perioperative Pain Management Techniques on Food Consumption and Body Weight After Laparotomy in Rats

Yehuda Shavit, Gila Fish, Gilly Wolf, Eduard Mayburd, Ylia Meerson, Raz Yirmiya, and Benzion Beilin

Anesth Analg 2005 101: 1112-1116

 

吗啡能够诱导免疫抑制性淋巴细胞凋亡:真的吗?

(潘志英 陈杰 )

Immunosuppression by Morphine-Induced Lymphocyte Apoptosis: Is It a Real Issue?

Takeshi Ohara, Tsunetoshi Itoh, and Masahiko Takahashi

Anesth Analg 2005 101: 1117-1122.

CRITICAL CARE AND TRAUMA:

 

生物和化学紧急事件的准备-------美国麻醉住院医生培训的调查

(顾新宇译 陈杰校)

Emergency Preparedness for Biological and Chemical Incidents: A Survey of Anesthesiology Residency Programs in the United States

Keith A. Candiotti, Aimee Kamat, Paul Barach, Fani Nhuch, David Lubarsky, and David J. Birnbach

Anesth Analg 2005 101: 1135-1140.

 

危重病人能否运用脑电图分析法来确定镇静的水平?

(韩晓丹译 薛张纲校)

Can Electroencephalographic Analysis Be Used to Determine Sedation Levels in Critically Ill Patients?

Jean-Paul Roustan, Sarah Valette, Pierre Aubas, Gérard Rondouin, and Xavier Capdevila

Anesth Analg 2005 101: 1141-1151.

 

七氟醚预处理可抑制大鼠内毒素诱发的休克

(赵雪莲 马皓琳,李士通 )

Sevoflurane Pretreatment Inhibits Endotoxin-Induced Shock in Rats

Yoko Kidani, Takumi Taniguchi, Hiroko Kanakura, Yasuhiro Takemoto, Kazunobu Tsuda, and Ken Yamamoto

Anesth Analg 2005 101: 1152-1156

NEUROSURGICAL ANESTHESIA:

 

损伤前或后应用利多卡因或硫贲妥钠来减弱无氧-糖的大鼠海马切片培养的细胞死亡

(范颖晖 陈杰 )

Pre- or Postinsult Administration of Lidocaine or Thiopental Attenuates Cell Death in Rat Hippocampal Slice Cultures Caused by Oxygen-Glucose Deprivation

Hong Cao, Ira S. Kass, James E. Cottrell, and Peter J. Bergold

Anesth Analg 2005 101: 1163-1169

 

经蝶骨的垂体手术病人在手术期间的管理

(韩晓丹译,薛张纲校)

Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery (Review Article)

Edward C. Nemergut, Aaron S. Dumont, Usha T. Barry, and Edward R. Laws

Anesth Analg 2005 101: 1170-1181  

OBSTETRIC ANESTHESIA:

 

剖腹产病人优选的麻醉结果

( 马皓琳,李士通 )

Patient Preferences for Anesthesia Outcomes Associated with Cesarean Delivery

Brendan Carvalho, Sheila E. Cohen, Steven S. Lipman, Andrea Fuller, Anbu D. Mathusamy, and Alex Macario

Anesth Analg 2005 101: 1182-1187.

REGIONAL ANESTHESIA:

单侧坐骨神经阻滞时选择大转子旁不同距离的部位注射是否有差异?

(朱慧琛译 陈杰校)

Does the Site of Injection Distal to the Greater Trochanter Make a Difference in Lateral Sciatic Nerve Blockade?

Manuel Taboada, Jaime Rodríguez, Sabela Del Rio, Juan Lagunilla, Javier Carceller, Julián Álvarez, and Peter G. Atanassoff

Anesth Analg 2005 101: 1188-1191

 

使用刺激性导管持续坐骨神经阻滞较之传统的非刺激性导管缩短达到手术所需阻滞要求的起始时间并使拇趾外翻修复后的镇痛药物使用量减至最小

(徐丽颖译 薛张纲校)

Using Stimulating Catheters for Continuous Sciatic Nerve Block Shortens Onset Time of Surgical Block and Minimizes Postoperative Consumption of Pain Medication After Halux Valgus Repair as Compared with Conventional Nonstimulating Catheters

Andrea Casati, Guido Fanelli, Zbigniew Koscielniak-Nielsen, Gianluca Cappelleri, Giorgio Aldegheri, Giorgio Danelli, Régis Fuzier, and François Singelyn

Anesth Analg 2005 101: 1192-1197.

 

锁骨臂丛神经阻滞与肱骨入路麻醉时间与效果的比较

(邱郁薇 马皓琳,李士通 )

Infraclavicular Brachial Plexus Block Versus Humeral Approach: Comparison of Anesthetic Time and Efficacy

Vincent Minville, Roland Amathieu, N’Guyen Luc, Claude Gris, Olivier Fourcade, Kamran Samii, and Dan Benhamou

Anesth Analg 2005 101: 1198-1201

 

髋部术后神经阻滞的抗分解代谢作用

(范颖晖 陈杰 )

The Anticatabolic Effect of Neuraxial Blockade After Hip Surgery

Ralph Lattermann, Geesche Belohlavek, Sigrid Wittmann, Bernd Füchtmeier, and Michael Gruber

Anesth Analg 2005 101: 1202-1208

GENERAL ARTICLES:

 

髋部骨折修复术后苏醒室中谵妄预示术后谵妄

(徐丽颖译 薛张纲校)

Recovery Room Delirium Predicts Postoperative Delirium After Hip-Fracture Repair

Punita T. Sharma, Frederick E. Sieber, Khwaja J. Zakriya, Ronald W. Pauldine, Kevin B. Gerold, Jian Hang, and Timothy H. Smith

Anesth Analg 2005 101: 1215-1220.

 

侧卧位的气道管理:一项随机对照实验

(陈玮 马皓琳,李士通 审校)

Airway Management in the Lateral Position: A Randomized Controlled Trial

Conan L. McCaul, Donal Harney, Margaret Ryan, Ciaran Moran, Brian P. Kavanagh, and John F. Boylan

Anesth Analg 2005 101: 1221-1225

 

.经鼻腔气管插管时导管尖端设计对鼻腔损伤的影响:Magill尖与Murphy尖之比较

(田婕 陈杰 )

The Influence of Endotracheal Tube Tip Design on Nasal Trauma During Nasotracheal Intubation: Magill-Tip Versus Murphy-Tip

Jong-Hwan Lee, Chang-Hee Kim, Jae-Hyon Bahk, and Kum-Suk Park

Anesth Analg 2005 101: 1226-1229.

 

评价valsalva动作在静脉穿刺疼痛的作用:一项随机前瞻研究。

(王丽珺译,薛张纲校)

Evaluating the Efficacy of the Valsalva Maneuver on Venous Cannulation Pain: A Prospective, Randomized Study

Anil Agarwal, P. K. Sinha, Manish Tandon, Sanjay Dhiraaj, and Uttam Singh

Anesth Analg 2005 101: 1230-1232

 

中重度气管插管困难病人McCoy气囊喉镜检查的评估

(张莹 马皓琳,李士通 )

An Evaluation of McCoy Balloon Laryngoscopy in Patients With Moderate-to-Major Endotracheal Intubation Difficulty

Spyros D. Mentzelopoulos, Maria Tzoufi, Kostas Rellos, Argyris S. Michalopoulos, Elissavet Stamataki, Charris Roussos, and Spyros G. Zakynthinos

Anesth Analg 2005 101: 1233-1237.

 

吗啡增强异氟醚诱导的对抗心肌坏死的后效应:3磷酸肌醇和阿片类受体对兔子所起的作用。

Morphine enhances isoflurane-induced postconditioning against myocardial infarction: the role of phosphatidylinositol-3-kinase and opioid receptors in rabbits.

Weihrauch D, Krolikowski JG, Bienengraeber M, Kersten JR, Warltier DC, Pagel PS.

Department of Anesthesiology, Medical College of Wisconsin and Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin 53226, USA.

Anesth Analg. 2005 Oct;101(4):942-9.

 

异氟醚能激活3磷酸肌醇(PI3K)信号从而减少早期再灌注时心急损伤的面积。我们测试了这样一个假说:吗啡能增强心肌对再灌注损伤的自我保护作用同时减少了脱噬作用从而保护了心机的活性。将兔子(n = 108)的冠状动脉阻断30分钟后给于3小时生理盐水的再灌注,在阻断冠状动脉前3分钟和再灌注后2分钟时用或不用异氟醚(0.5 or 1.0 MAC)、吗啡(0.05 or 0.1 mg/kg)或两者联合诱导,然后给与选择性抑制剂(PI3K)渥曼青霉素(0.6 mg/kg)或非选择性阿片类拮抗剂纳洛酮(6 mg/kg)后测试兔子的血流动力学。心急损伤的面积和脱噬作用的评估则分别采用三苯四唑着色和细胞色素c易位和TUNEL对左室心肌细胞着色的方法。1.0 MAC的异氟醚和0.1 mg/kg的吗啡能减少心肌的损伤面积(P < 0.05)0.5 MAC的异氟醚和0.05 mg/kg的吗啡联合应用也能减少心肌的损伤。渥曼青霉素和纳洛酮的单独使用并不影响损伤面积但阻断了由异氟醚、吗啡或两者联合应用所产生的心肌保护作用。异氟醚和吗啡减少了细胞色素c易位和TUNEL的着色。研究的结果表明了在体外吗啡通过激活PI3K和阿片类受体增强了异氟醚诱导的后效应。异氟醚的后效应能减少死亡细胞的脱噬作用从而保护了心机的完整性。意义:研究的结果表明了在体外吗啡通过激活PI3K和阿片类受体增强了异氟醚诱导的后效应。异氟醚和吗啡的后效应能减少死亡细胞的脱噬作用从而保护了心机的完整性。

(孙卓真译 薛张纲校)

Isoflurane reduces myocardial infarct size during early reperfusion by activating phosphatidylinositol-3-kinase (PI3K) signaling. We tested the hypothesis that this cardioprotection against reperfusion injury is enhanced by morphine and that a decrease in apoptosis plays a role in preservation of myocardial viability. Rabbits (n = 108) instrumented for hemodynamic measurement and subjected to a 30-min coronary occlusion followed by 3 h reperfusion received 0.9% saline, the selective PI3K inhibitor wortmannin (0.6 mg/kg), or the nonselective opioid antagonist naloxone (6 mg/kg) before coronary occlusion in the presence or absence of isoflurane (0.5 or 1.0 MAC), morphine (0.05 or 0.1 mg/kg), or their combination administered for 3 min before and 2 min after reperfusion. Infarct size was determined using triphenyltetrazolium staining and apoptosis assessed using cytochrome c translocation and Terminal Deoxynucleotidyl Transferase-Mediated dUTP Nick End Labeling (TUNEL) staining of left ventricular myocardium in situ. Isoflurane (1.0 but not 0.5 MAC) and morphine (0.1 but not 0.05 mg/kg) reduced (P < 0.05) infarct size (mean +/- sd 21% +/- 4%, 44% +/- 6%, 19% +/- 4%, and 41% +/- 6% of left ventricular area at risk, respectively) as compared with control (41% +/- 4%). The combination of 0.5 MAC isoflurane and 0.05 mg/kg morphine also decreased infarct size (18% +/- 9%). Wortmannin and naloxone alone did not affect infarct size but blocked the protection produced by isoflurane, morphine, and their combination. Isoflurane and morphine reduced cytochrome c translocation and TUNEL staining. The results indicate that morphine enhances isoflurane-induced postconditioning by activating PI3K and opioid receptors in vivo. A reduction in apoptotic cell death contributes to preservation of myocardial integrity during postconditioning by isoflurane. IMPLICATIONS: The results of this study indicate that morphine enhances isoflurane-induced postconditioning by activating phosphatidylinositol-3-kinase and opioid receptors in vivo. A reduction in apoptotic cell death contributes to preservation of myocardial integrity during postconditioning by isoflurane and morphine.

 

 

 

无痛超声吸出法肝切除(CUSA)增加了静脉空气栓塞(VAE)的发生率和危险性.

Hepatic resection by the Cavitron Ultrasonic Surgical Aspirator increases the incidence and severity of venous air embolism.

Koo BN, Kil HK, Choi JS, Kim JY, Chun DH, Hong YW.

Department of Anesthesia and Pain Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, C.P.O. Box 8044, Seoul 120-752, Korea.

Anesth Analg. 2005 Oct;101(4):966-70

 

CUSA 是一种切除肝实质的无创技术,可以减少术中及围手术期出血发病率。本研究通过比较用钳夹破碎法(CC)和CUSA两种方法在肝切除过程中经食道超声心动图(TEE)测定VAE的发生率与严重程度。在麻醉诱导后,TEE探头被插入患者的食管,一位独立的麻醉医生将通过TEE的四室视野对VAE作出评分。CUSA组中所有的病人都发生了VAE44%的病人的VAE半径超过右心半径。而在CC组中有68%的病人发生了VAE 且其半径小于右心半径。两组之间无明显的血液动力学或呼气末二氧化碳分压的差别。总之,用CUSA 进行肝切除会增加VAE的发生率和危险性。意义:本研究论证了用CUSA 方法进行肝切除更常发生VAE且更严重。虽然我们没有发现血流动力学方面的证明,但VAE会增加肝硬化病人的反常栓子的危险性。

(孙卓真译 薛张纲校)

The Cavitron Ultrasonic Surgical Aspirator (CUSA) is an innovative tool for resecting hepatic parenchyma, which reduces intraoperative blood loss and perioperative morbidity. We designed this study to compare the incidence and severity of venous air embolism (VAE) detected via transesophageal echocardiography (TEE) during hepatic resection by using either the clamp-crushing method or the CUSA method. Fifty patients scheduled for hepatic resection were randomly assigned to receive hepatic resection by the clamp-crushing method (CC group) or by CUSA (CUSA group). After the induction of anesthesia, the TEE probe was inserted into the patient's esophagus. An independent anesthesiologist graded VAE shown in the 4-chamber view of TEE. All patients in the CUSA group showed VAE during hepatic resection and 44% of the patients had air embolism filling more than half the right heart diameter. In CC group, 68% of the patients showed VAE, which filled less than half the right heart diameter. There were no significant differences in hemodynamics and end-tidal CO2 partial pressure between the two groups. In conclusion, hepatic resection by CUSA increases the incidence and severity of VAE. IMPLICATIONS: This study demonstrated that venous air embolism during hepatic resection was more frequent and severe when using the Cavitron Ultrasonic Surgical Aspirator. Although we found no evidence of hemodynamic compromise, increased venous air embolism may increase the risk of paradoxical embolism in patients with liver cirrhosis.

 

 

比较Vasotrac血压仪和有创动脉血压监测在行脊柱侧突手术的青春期病人的桡动脉血压测定

A comparison of radial artery blood pressure determination between the vasotrac device and invasive arterial blood pressure monitoring in adolescents undergoing scoliosis surgery

 

McCann ME,Hill D,Thomas KC,Zurakowski D,Laussen PC.

Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Harvard Medical School, USA.

Anesth Analg 2005 101: 978-985.

 

Vasotrac血压仪可以在无创情况下进行动脉血压和动脉波形的测定.我们在心监对实行了心脏手术后循环尚稳定的儿童进行了Vasotrac血压仪监测和持续动脉内血压监测,结果证实了这一点.为了在不同的生理情况下评估此仪器,我们对行脊柱侧突手术的麻醉状态下的青春期儿童在俯卧位,控制性降压或非控制性降压情况下对此仪器进行研究.11个因特发性脊柱侧突而行手术的儿童参与了此次的研究.麻醉方法为氧化亚氮和静脉注射拉贝洛尔控制性降温.得到的数据通过相关性,均数误差和Bland-Altman图表进行分析.无创的Vasotrac监测结果与动脉内血压监测很接近.两种系统所显示出来的波形也十分相似.两钟方法所测得的收缩压,舒张压及平均动脉压的相关系数分别为0.82,0.830.90.我们因此总结出, 在俯卧位和药物导致的低血压麻醉状态下用Vasotrac进行无创血压监测的效果和持续动脉血压监测很接近并且是可靠的.(因此说明: Vasotrac这种无创的动脉血压监测仪,对于俯卧位和轻中度控制性降压状态下行脊柱侧突手术的青春期患者的血压监测是很有效的.)

(王慧琳译 薛张纲校)

 

The Vasotrac device (Medwave, Arden Hills, MN) allows noninvasive measurement of arterial blood pressure (BP) and arterial waveform. We have previously demonstrated agreement between the Vasotrac and continuous intraarterial BP monitoring in children with a stable circulation after cardiac surgery in the cardiac intensive care unit. To assess this monitor during different physiologic conditions, we studied the Vasotrac in anesthetized adolescent children undergoing scoliosis surgery in the prone position, with or without controlled hypotension. Eleven children undergoing surgery for idiopathic scoliosis were enrolled in this study. The anesthetic consisted of primarily a nitrous oxide and narcotic technique with controlled hypotension obtained using IV labetalol. Data were analyzed using correlations, mean error, and Bland-Altman plots. Noninvasive BP measured by the Vasotrac correlated closely with intraarterial BP. Waveforms displayed by the two systems were qualitatively similar. Correlation between the two methods for systolic, diastolic and mean BP was r = 0.82, r = 0.83, and r = 0.90, respectively. We conclude that noninvasive BP measurement using the Vasotrac monitor enables near-continuous and reliable monitoring of BP during anesthesia in the prone position and pharmacologic-induced hypotension. IMPLICATIONS: The Vasotrac, a noninvasive arterial blood pressure monitor, performs well in the prone position in adolescent patients undergoing scoliosis surgery using a technique of mild-to-moderate induced hypotension.

 

 

白内障手术的球下麻醉:需要多少剂量?

Sub-Tenon’s Anesthetic Administration for Cataract Surgery:How Much Stays In?

Patton N,Malik TY,Aslam TM

Department of Ophthalmology, Princess Margaret Hospital, Dunfermline, Fife, United Kingdom.

Anesth analg 2005 101:1012-1014.

 

我们采用了前瞻性随机实验的方法对予球下注射3ml5ml麻药后剩余的溶解量进行评估.剩余容量与运动阻滞相关(r = 0.72; P < 0.001).两组经切口所丢失的容量占注射总容量的百分比是相似的,这便提示球下空间不限于5ml,并且可以注射更大量麻醉药来增加运动阻滞.说明:麻醉药在球下空间的溶解量同运动阻滞是相关联的.丢失量占注射给药的百分比与注射量无关,提示球下空间不限于5ml,并且可以注射更大量麻醉药来增加运动阻滞.

(王慧琳译 薛张纲校)

We performed a prospective, randomized trial assessing the "remaining" volume of anesthetic solution that stays within the sub-Tenon's space after administration of 2 different volumes: 3 mL and 5 mL. The remaining volume correlated with motor block (r = 0.72; P < 0.001). The volume lost through the incision as a percentage of total volume injected was similar in both groups, suggesting sub-Tenon's space is not limited to a finite injected volume less than 5 mL and may be capable of receiving larger volumes of anesthetic to improve motor block.

给予吗啡的雪貂预注昂丹司琼会减弱血浆抗利尿激素增加

Pretreatment with ondansetron blunts plasma vasopressin increases associated with morphine administration in ferrets.
Wilkens EP, Yates BJ.
Department of Anesthesia-6413 JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, Iowa 52242, USA.

Anesth Analg. 2005 Oct;101(4):1029-33, table of contents.

 

术后恶心和呕吐是一个很重要的问题。可以用血浆标记物的方法来测量麻醉的呕吐域值,例如用精氨酸加压素(AVP)。我们可以测量单独使用吗啡以及联合使用吗啡及昂丹司琼两种情况下AVP浓度的变化。数据是由植入导管的雪貂而来的。雪貂苏醒后,给予单独静注吗啡后者先注昂丹司琼再注吗啡。在注入吗啡前先采集基线血标本,然后分别在吗啡注入5, 10, 15, 30, 45, 60, 90分钟后收集血标本。血标本中AVP的浓度用放射免疫学方法测得。单独应用吗啡,血浆AVP的浓度在注射吗啡456090分钟时与基线水平有显著差别。单独应用昂丹司琼,血浆AVP浓度在注射20分钟后无改变。在注射吗啡前先预注昂丹司琼血浆AVP浓度无显著变化。双向变量分析法证实:昂丹司琼能显著降低在注射吗啡后6090分钟血浆中AVP的增加。这些数据表明:血浆AVP浓度可能是恶心的精确标志,并可能对指导治疗有效。提示:止吐药昂丹司琼不仅对有临床表现的呕吐有效,对血浆AVP水平的调控也有效。

(钟静译,薛张纲校)

Postoperative nausea and vomiting are significant problems. A method for measuring vomiting thresholds for anesthetics using plasma markers, such as arginine vasopressin (AVP), would be useful. We measured the change in AVP concentrations associated with morphine alone or in combination with ondansetron pretreatment. Data were collected from ferrets implanted with IV catheters. After recovery, the ferrets were administered IV morphine alone or with ondansetron pretreatment. Baseline blood samples were taken before morphine injection, and at 5, 10, 15, 30, 45, 60, and 90 min after morphine injection. Plasma AVP levels were measured using radioimmunoassay. Morphine alone was associated with a significant increase in plasma AVP concentrations from baseline at 45, 60, and 90 min (P < 0.05). Ondansetron alone did not change the plasma AVP concentration after 20 min (P > 0.46). There was no significant increase (P > 0.46) in AVP concentration in animals that were pretreated with ondansetron before administration of morphine. Two-way analysis of variance confirmed that ondansetron significantly decreased the increase in AVP by morphine at 60 and 90 min (P < 0.05). These data suggest that plasma AVP concentration may be an accurate marker for nausea, and may be useful to guide treatment for this condition. IMPLICATIONS: The antiemetic, ondansetron, has an effect not only on clinically perceived vomiting, but also on plasma vasopressin level.

K2P通道――TRESK对麻药和其他调节器反应存在种特异性差异

Species-specific differences in response to anesthetics and other modulators by the K2P channel TRESK.
Keshavaprasad B, Liu C, Au JD, Kindler CH, Cotten JF, Yost CS.
Department of Anesthesia and Perioperative Care, University of California San Francisco, 513 Parnassus Ave., Room S-261, Box 0542, San Francisco, California 94143, USA.

Anesth Analg. 2005 Oct;101(4):1042-9, table of contents.

 

TRESKTWIK相关的脊柱钾通道)是新近发现的钾通道(K2P)家族中的一员。人类的TRESK被氟烷,异氟醚,七氟醚和地氟醚激活,使其成为最敏感的被挥发性麻药激活的K2P通道。我们比较了啮齿类动物和人类TRESK对麻药敏感性和药理学调节的差异。我们给小鼠和老鼠通电流,TRESK被临床浓度的异氟醚激活,但其效能明显低于人类的TRESK。和人类的TRESK不同,啮齿类动物的TRESK在生理范围内被酸性的细胞外液所抑制。微克分子的锌就能抑制啮齿类动物的TRESK传导的电流,但对人类的TRESK无效。在活体具有立体选择性麻药效能的异氟醚的异构体对于离体的啮齿类动物的TRESKs有立体特异性的增强作用。抑制啮齿类动物TRESKs酰胺类局麻药的浓度比抑制人类TRESKs的浓度低了10倍。这表明了TRESKs种间差异和药理学的相似性。要进一步了解TRESK的表达模式就要理解TRESK在麻药作用机制中的地位。提示:小鼠和老鼠的TRESKTWIK相关的脊柱钾通道)和人类的TRESK相比有不同的药效学反应机制。特别是我们发现啮齿类动物的TRESK对异氟醚有立体特异性差异,但人类却没有。TRESK可能是挥发性麻醉气体发挥作用的靶位。

(钟静译,薛张纲校)

TRESK (TWIK-related spinal cord K+ channel) is the most recently characterized member of the tandem-pore domain potassium channel (K2P) family. Human TRESK is potently activated by halothane, isoflurane, sevoflurane, and desflurane, making it the most sensitive volatile anesthetic-activated K2P channel yet described. Herein, we compare the anesthetic sensitivity and pharmacologic modulation of rodent versions of TRESK to their human orthologue. Currents passed by mouse and rat TRESK were enhanced by isoflurane at clinical concentrations but with significantly lower efficacy than human TRESK. Unlike human TRESK, the rodent TRESKs are strongly inhibited by acidic extracellular pH in the physiologic range. Zinc inhibited currents passed by both rodent TRESK in the low micromolar range but was without effect on human TRESK. Enantiomers of isoflurane that have stereoselective anesthetic potency in vivo produced stereospecific enhancement of the rodent TRESKs in vitro. Amide local anesthetics inhibited the rodent TRESKs at almost 10-fold smaller concentrations than that which inhibit human TRESK. These results identified interspecies differences and similarities in the pharmacology of TRESK. Further characterization of TRESK expression patterns is needed to understand their role in anesthetic mechanisms. IMPLICATIONS: Mouse and rat TRESK (TWIK-related spinal cord K+ channel) have different pharmacologic responses compared with human TRESK. In particular, we found stereospecific differences in response to isoflurane by the rodent TRESKs but not by human TRESK. TRESK may be a target site for the mechanism of action of volatile anesthetics.

乙醚或异氟醚麻醉对大鼠肝脏中细胞色素酶P450 2E1P450还原酶活性的影响

The Effect of Anesthesia by Diethyl Ether or Isoflurane on Activity of Cytochrome P450 2E1 and P450 Reductases in Rat Liver

Andrea Y. A. Plate, MSc, Daune L. Crankshaw, PhD, and Daniel D. Gallaher, PhD

Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota

Anesth Analg 2005;101:1063-1064.

 

通过这项研究,我们试图去确定用乙醚或异氟醚麻醉是否影响肝脏细胞色素酶P450 2E1P450还原酶的活性。大鼠在用纯净的饲料喂养6周后,分别用二氧化碳、乙醚、异氟醚麻醉。然后检测肝细胞微粒体中细胞色素酶P450 2E1P450还原酶的活性。在这三组中,酶的活性没有明显的差别。结果显示致死剂量的乙醚和异氟醚也不会影响P450酶的活性。

(陆文清译 薛张纲校)

In this study we sought to determine whether exposure to the anesthetics diethyl ether and isoflurane influences the activity of hepatic cytochrome P450 2E1 and P450 reductases in the rat. Rats were fed a purified diet for 6 wk before anesthesia with 1 of 3 anesthetics: carbon dioxide, diethyl ether, or isoflurane. Cytochrome P450 2E1 and P450 reductases were measured in liver microsomes. No significant differences in enzyme activities were found among the groups. These results indicate that diethyl ether and isoflurane can be used to kill rats without inducing P450 enzymes.

 

 

在手术前对病人完成书面和电子调查的比较

A Comparison of Paper with Electronic Patient-Completed Questionnaires in a Preoperative Clinic

Elizabeth G. VanDenKerkhof, RN, DrPH, David H. Goldstein, MB, BcH, MSc, FRCPC, William C. Blaine, MSc, and Michael J. Rimmer

Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada

Anesth Analg 2005;101:1075-1080.

 

在这个随机非盲法的试验中,我们比较电子自助与纸笔完成成人麻醉签字前调查表(PAAQ)的不同,电子自助法使用触摸屏技术。选择的病人为在预评价门诊中完成PAAQ的人。病人被随机的分为四组来完成PAAQ,分别是纸、掌上电脑(PDA)、触摸屏电脑(kiosk)和写字板。病人同时也完成一个偏爱度和满意度的调查。主要的结果指标是之前完成与现在完成PAAQ两者一致性的百分比和完成时间。只有366个病人中的1/6拒绝参加。完成PAAQ时间的中间数,最短的为kiosk2.3min,最长的为PDA3.2min({chi}2 = 14.5; P = 0.002)。全部病人平均两者的一致性大约是94%。参与者在完成PAAQ前后的满意度,用电子组的从10%增加到了97%,而用纸张的从60%增加到了64 。触摸屏技术对病人完成PAAQ是一种精确和有效的平台。对于将来的调查,病人更希望使用电子技术而不是普通的纸张

(陆文清译 薛张纲校)

In this unblinded randomized control trial we compared electronic self-administered Pre-Admission Adult Anesthetic Questionnaires (PAAQ) using touchscreen technology with pen and paper. Patients were recruited in the Preassessment Clinic if they had completed a PAAQ in the surgeon’s office. Patients were randomized to study PAAQ using paper, hand-held computer (PDA), touchscreen desktop computer (kiosk), or tablet. Patients also completed a preference and satisfaction survey. The main outcome measures were percent agreement between the prestudy and study PAAQ and time to completion. Only six of the 366 patients approached refused to participate. The median time to completion of the PAAQ was shortest on the kiosk (2.3 min) and longest on the PDA (3.2 min) ({chi}2 = 14.5; P = 0.002). The mean agreement between the prestudy and the study PAAQ was approximately 94% across all study arms. The proportion of participants expressing comfort before and after completing the PAAQ increased from 10% to 97% on the computerized arms and from 60% to 64% on the paper arm. Touchscreen computer technology is an accurate, efficient platform for patient-administered PAAQ. Patients expressed comfort using the technology and preference for computerized versus paper for future questionnaires.

 

通过持续上呼吸道二氧化碳监测来优化气管内导管的套囊填充

Optimization of endotracheal tube cuff filling by continuous upper airway carbon dioxide monitoring

Efrati S, Leonov Y, Oron A, Siman-Tov Y, Averbukh M, Lavrushevich A, Golik A

Department of Medicine A, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.

Anesth Analg.

2005 Oct;101(4):1081-8, table of contents.

 

不适当的管口套囊填充与使用气管内导管(ETT)造成的不同的并发症有关。在本次研究中,我们评价一种客观的,非创伤性的方法通过监测上呼吸道内的二氧化碳分压PCO2)来持续评估ETT管口周围的泄漏。PCO2)水平通过同时测量ETT管口和声带之间,喉部和鼻孔内的二氧化碳描记图。管口套囊填充用电子控制器来调整产生最小的压力防止CO2泄漏。这种方式的可行性在人类模拟器和小猪模型中评估。临床功能在60个正在经历手术的病人中评估,与标准的麻醉评估方法比较。在ETT管口压力和人类模拟器(R2=0.954,P<0.0001)以及小猪模型(R2>0.98P<0.0001)的PCO2)水平中观察到线型相关性。ETT管口的碘泄漏,在小猪模型中,仅发生在当PCO2)水平〉2mmHg时。在手术病人中,平均ETT管口压力由麻醉师根据临床决定,明显高于由PCO2)评估的最佳管口压力(分别为,25.2+/-3.6 18.2+/-7.8mmHg,P<0.001)。根据这些发现,最佳ETT管口套囊填充压可以通过监测鼻孔或喉部的PCO2)来确定。意义:一种新的,客观的,无创的,基于在上呼吸道监测二氧化碳水平的优化气管内导管套囊填充的方法能用来确定最低的管口压力消除泄漏和防止窒息。

(周荻译 薛张纲校)

Inappropriate cuff filling is responsible for various complications related to the use of an endotracheal tube (ETT). In this study, we evaluated an objective, noninvasive method for continuous assessment of leak around the ETT cuff by monitoring carbon dioxide pressure (P(CO2) in the upper airway. P(CO2) levels were measured by capnography simultaneously between the ETT cuff and the vocal cords, at the oropharynx, and in the nares of the nose. Cuff filling was regulated by an electronic controller to achieve the minimal pressure needed to prevent CO2 leak. Feasibility of the method was assessed in a human simulator and in a porcine model. Clinical function was evaluated in 60 patients undergoing surgery, comparing the method to the standard anesthesiologist evaluation. Linear correlations were observed between the ETT cuff pressure and P(CO2) level in the human simulator (R2 = 0.954, P < 0.0001) and in the porcine model (R2 > 0.98, P < 0.0001). Iodine leak around the ETT cuff, in the porcine model, occurred only when P(CO2) levels were >2 mm Hg. In the surgery patients, the mean ETT cuff pressure determined clinically by the anesthesiologist was significantly higher than the optimal cuff pressure assessed by P(CO2) (25.2 +/- 3.6 versus 18.2 +/- 7.8 mm Hg, respectively; P < 0.001). According to these findings, optimal ETT cuff filling pressure can be identified by monitoring P(CO2) at the nares or the oropharynx. IMPLICATIONS: A new, objective, noninvasive method for optimizing endotracheal tube cuff filling based on monitoring carbon dioxide levels in the upper airways can be used to identify the minimal cuff pressure necessary to eliminate leak and prevent aspiration.

 

 

Etoricoxib对全膝或全髋替换术后病人的镇痛效能:随机,双盲,安慰剂控制的研究

Etoricoxib provides analgesic efficacy to patients after knee or hip replacement surgery: a randomized, double-blind, placebo-controlled study.
Rasmussen GL, Malmstrom K, Bourne MH, Jove M, Rhondeau SM, Kotey P, Ang J, Aversano M, Reicin AS; Etoricoxib Postorthopedic Study Group.
Orthopedic Specialty Hospital, Murray, Utah, USA.

Anesth Analg 2005 101: 1104-1111.


在这个随机,双盲,安慰剂对照,多中心的研究中,我们评估etoricoxib(一种新的环氧酶-2抑制剂)在全膝或全髋术后病人的镇痛效果。总共228名中至重度疼痛的病人在术后72小时内被随机分配接受120mg etoricoxib,对照给于甲氧萘丙酸钠1100mg,或安慰剂(111)第一天,接着etoricoxib和安慰剂(12)第二天到第七天。病人报告疼痛分数,减少(阿片类-结合)药物的使用,和研究药物的反应。第一天,etoricoxib提供的镇痛效果优于安慰剂,与控制给予的甲氧萘丙酸钠相似,证明全部疼痛缓解分数超过8小时,原始终点;最低平均分数分别为为11.011.5,和5.6P<0.001比安慰剂)。相似地,比那些接受安慰剂治疗的病人,更大百分数的病人接受etoricoxib和甲氧萘丙酸钠对研究药物报告效果好到很好:分别为53%60%26%。第2-7天,etoricoxib证明明显减少了药物的使用,35%P<0.001比安慰剂)。减少的临床相关性由全球病人评估确定(P<0.05比安慰剂)。接受etoricoxib的病人也经历了更少的“严重的”和“中度的”疼痛,和那些使用安慰剂的病人相比。Etoricoxib在本试验中有很好的耐受性;副反应的发生不常见,在治疗组中相似。总的来说,etoricoxib提供镇痛与对照给予的甲氧萘丙酸钠在第一天相似,而且优于安慰剂,减少了超过7天的补充的阿片类使用。意义:在术后组中(膝和髋置换术),etoricoxib120mg 提供镇痛优于安慰剂而且与对照给予的甲氧萘丙酸钠1100mg相似。接受etoricoxib的病人与安慰剂病人相比经历更少的疼痛,减少阿片类的药物使用。

(周荻译 薛张纲校)
In this randomized, double-blind, placebo-controlled, multicenter study we assessed the analgesic effect of etoricoxib (a new cyclooxygenase-2 inhibitor) in patients having had knee or hip replacement surgery. A total of 228 patients with moderate or severe pain were randomly allocated within 72 h after surgery to receive etoricoxib 120 mg, controlled-release naproxen sodium 1100 mg, or placebo (1:1:1) on day 1 followed by etoricoxib and placebo (1:2) on days 2 to 7. Patients reported pain scores, rescue (opioid-combination) medication use, and the response to study drug. On day 1, etoricoxib provided an analgesic effect superior to placebo and similar to controlled-release naproxen sodium as demonstrated by the total pain relief score over 8 h, the primary end-point; least-squares mean scores were 11.0, 11.5, and 5.6, respectively (P < 0.001 versus placebo). Similarly, a larger percentage of patients receiving etoricoxib and naproxen sodium than those receiving placebo reported good to excellent responses to study drug: 53%, 60%, and 26% respectively. On days 2-7, etoricoxib demonstrated a significant reduction of rescue medication use, 35% (P < 0.001 versus placebo). The clinical relevance of the decrease was confirmed by Patient's Global Evaluation (P < 0.05 versus placebo). Patients receiving etoricoxib also experienced significantly less "worst" and "average" pain than did those on placebo. Etoricoxib was generally well tolerated in this study; the incidence of adverse experiences was infrequent and similar across treatment groups. In summary, etoricoxib provided analgesia that was similar to controlled-release naproxen sodium on day 1 and superior to placebo with reduced supplemental opioid use over 7 days. IMPLICATIONS: In a postsurgery setting (knee and hip replacements), etoricoxib 120 mg provided analgesia superior to placebo and similar to controlled-release naproxen sodium 1100 mg. Patients receiving etoricoxib suffered less pain and took less opioid rescue medication compared with patients on placebo.

 

危重病人能否运用脑电图分析法来确定镇静的水平?

Can electroencephalographic analysis be used to determine sedation levels in critically ill patients?
Roustan JP, Valette S, Aubas P, Rondouin G, Capdevila X.
Department of Anesthesiology and Intensive Care Medicine, Neurological Explorations Laboratory, Lapeyronie University Hospital, 295 Avenue du Doyen G Giraud, 34000 Montpellier, France.
Anesth Analg 2005 101: 1141-1151.


长时间地使用镇静药物可频繁地导致重症监护病人的过度镇静。在深度镇静的病人临床评估的尺度是不可靠的。从脑电图记录的光谱和双频光谱分析中得来的参数已经组合起来产生了一个监测麻醉深度的指标(BIS)。对于ICU的病人这些参数在监测镇静深度方面的作用仍不确定。对于从脑电图原有的记录中得到的光谱和双频光谱的参数,我们设计了这个前瞻性的研究来重新定义和计算并且评估它们在ICU病人镇静不足或者过度镇静诊断方面的临床相关性。连续服用咪达唑仑和吗啡来镇静的四十岁以上病人也包括在内。我们获取了167位病人镇静水平的临床评估,运用了RamsayComfort标准,同时脑电图记录了300秒。我们计算了四个频带(beta, alpha, Theta, and delta)的六个光谱相关参数、SEF95SEF50、四个双频光谱参数、有效的三联产物、双频光谱、双结合因子和比率10,同时评估了这些参数的相关性以及它们在预测镇静不足(Ramsay 12)和镇静过度(Ramsay 56)水平时的组合。这些计算在完成前后除外了激动的病人(此时COMFORT4的分值在2以上)。在预测过度镇静(Ramsay 56) 和镇静不足(Ramsay 12)的水平时相关性最大的参数是比率10SEF95。它们的线性组合相关性在预测镇静水平时作了合适地改进。在除外了激动病人后结果是相似的。我们得出结论:不同的脑电图描述性参数呈现出巨大的个体差异性。脑电图的光谱和双频光谱参数之间有着很强的关联性。双频光谱分析在区别ICU病人镇静不足或镇静过度水平的预测能力方面相对于单纯光谱分析有了略微的改善。

结论:SEF95和比率10 是脑电图在监测ICU病人镇静水平时相关性最大的指标,但是脑电图的计算值呈现出巨大的个体差异性。脑电图的双频光谱分析相对于单纯光谱分析有了略微的改善。

(韩晓丹译 薛张纲校)

Prolonged use of sedative drugs frequently leads to oversedation of intensive care patients. Clinical assessment scales are not reliable in deeply sedated patients. Parameters obtained from spectral and bispectral analysis of electroencephalogram (EEG) records have been combined to create an index (BIS) to monitor anesthesia depth. The role of such parameters in monitoring the depth of the sedation in intensive care unit (ICU) patients has yet to be determined. We designed the present prospective study to redefine and calculate available spectral and bispectral parameters from raw EEG records and estimate their clinical relevance for the diagnosis of under- or oversedation levels in ICU patients. Forty adult patients receiving continuous midazolam and morphine sedation were included. We obtained 167 clinical evaluations of sedation level using Ramsay and COMFORT scales along with an EEG record of 300 s. Six spectral parameters-relative power of 4 frequency bands (beta, alpha, Theta, and delta), 95th percentile of the power spectrum (SEF95), and 50th percentile of the power spectrum (SEF50) and four bispectral parameters, real triple product, bispectrum (Bispectrum), bicoherence, and ratio 10-were calculated. The relevance of each of these parameters and combinations in predicting too light (Ramsay 1 and 2) or deep (Ramsay 5 and 6) sedation levels was assessed. These calculations were performed before and after exclusion of the agitated patients, whose COMFORT 4 score was above 2. The most relevant parameters for predicting levels of deep sedation (Ramsay 5 and 6) were ratio 10 (area under the curve = 0.763; 95% confidence interval, 0.679-0.833) and SEF95 (area under the curve = 0.687; 95% confidence interval, 0.597-0.767). The most relevant parameters for predicting light levels of sedation (Ramsay 1 and 2) were also ratio 10 (area under the curve = 0.829; 95% confidence interval, 0.695-0.917) and SEF95 (area under the curve = 0.798; 95% confidence interval, 0.650-0.898). There is a modest improvement in relevance of their linear combination in predicting sedation level. Results were similar after exclusion of agitated patients. We conclude that various calculated EEG descriptive parameters exhibited large interindividual variability. There was a strong correlation between EEG spectral and bispectral parameters. Bispectral analysis slightly improves the predictive power of simple spectral analysis in distinguishing too light or deep sedation levels in ICU patients. IMPLICATIONS: Spectral edge frequency 95 and Ratio 10 are the most relevant electroencephalogram (EEG) indexes for monitoring the level of sedation in intensive care unit patients but calculated EEG values exhibited large interindividual variability. Bispectral analysis of EEG provides a slight improvement over simple spectral analysis.

 

经蝶骨的垂体手术病人在手术期间的管理

Perioperative management of patients undergoing transsphenoidal pituitary surgery.
Nemergut EC, Dumont AS, Barry UT, Laws ER.
Department of Anesthesiology, University of Virginia Health System, P.O. Box 800710, Charlottesville, Virginia 22908-0710, USA.

Anesth Analg 2005 101: 1170-1181.

 

垂体腺瘤通常表现为激素分泌过多,虽然药物治疗对于大多数机能亢进的腺瘤是有效的,但是却不能治愈。所以,经蝶骨的垂体手术已经成为神经外科的一种普遍的治疗方法,但是却将独特的挑战留给了麻醉科医生,因为不同的腺瘤有不一样的并发症存在。任何类型的垂体瘤都可能引起垂体功能减退和局部质量效应,这些是蝶鞍内逐渐扩大的肿块引起的。这里我们回顾一下外科摘除腺瘤和蝶鞍内减压所涉及的手术期间的厉害关系。对于库兴综合症(肾上腺皮质激素分泌型腺瘤引起的皮质醇增多症)、肢端肥大症(生长激素分泌型腺瘤引起的)和促甲状腺腺瘤引起的甲状腺机能亢进我们要给于特别地注意。我们会详细地表述手术中的危险包括出血、尿崩症、不适当抗利尿激素综合症和垂体机能减退症。了解术前评估、术中管理、潜在并发症以及它们的处理和避免策略是手术期间成功的病人保健和减少发病率、死亡率的基础。

(韩晓丹译,薛张纲校)

Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing's disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

 

使用刺激性导管持续坐骨神经阻滞较之传统的非刺激性导管缩短达到手术所需阻滞要求的起始时间并使拇趾外翻修复后的镇痛药物使用量减至最小

Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters

Casati A, Fanelli G, Koscielniak-Nielsen Z, Cappelleri G, Aldegheri G, Danelli G, Fuzier R, Singelyn F.
Department of Anesthesiology and Pain Therapy, Azienda Ospedaliera di Parma, Via Gramsci 14-43100 Parma, Italy. acasati@ao.pr.it

Anesth Analg. 2005 Oct;101(4):1192-7

 

我们在随机的110例择期整形脚外科手术病人中前瞻性地检验了应用刺激性导管增强持续腘窝部坐骨神经阻滞功效的假设。在引发一个坐骨神经介导的< = 0.5 mA的神经刺激输出的肌颤后,通过盲测(C; n = 50)或是经由导管刺激(S; n = 50),这种围神经导管超过导引器尖端2-4 cm。一次大剂量25 mL 1.5%甲哌卡因,术后病人自控输注0.2%罗哌卡因(背景输注:3 mL/h,增补剂量:5 mL,锁定时间:30 min)。每8小时丙帕他莫2 g IV,如需要可用阿片类药物补救性镇痛。导管置管在S组需要7 +/- 2分钟,在C组需要5 +/- 2分钟 (P = 0.056)。可以发现S组中感觉和运动阻滞的起始时间显著缩短。组间静息和运动期间疼痛缓解质量未发现有差异。术后48小时局麻药消耗中值(范围)在SC组分别为239 mL (175-519 mL)322 mL (184-508 mL) (P = 0.002)SC组分别有12 (25%)28 (58%)的病人需要阿片类药补救性镇痛(P = 0.002)。我们推断使用刺激性导管能达到更短的腘窝部坐骨神经阻滞起始时间,减少术后局麻药液消耗而达到类似的疼痛缓解和使用较少的阿片类药补救性镇痛。推论:此项前瞻性随机盲法调查证明了与盲法导管置入相比,使用刺激性导管持续腘窝部坐骨神经阻滞能达到更短的感觉和运动阻滞起始时间,在择期整形脚外科手术后具有较少的局麻药消耗和补救性药物镇痛的需要。

(徐丽颖译 薛张纲校)

We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at < or = 0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 +/- 2 min in Group S and 5 +/- 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184-508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption. IMPLICATIONS: This prospective, randomized, blind investigation demonstrated that the use of a stimulating catheter for continuous posterior popliteal sciatic nerve block resulted in shorter onset time of sensory and motor blocks and less local anesthetic consumption and need for rescue pain medication after elective orthopedic foot surgery compared with blind catheter advancement.

 

髋部骨折修复术后苏醒室中谵妄预示术后谵妄

Recovery room delirium predicts postoperative delirium after hip-fracture repair

Sharma PT, Sieber FE, Zakriya KJ, Pauldine RW, Gerold KB, Hang J, Smith TH
Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, Maryland 21224, USA. Anesth Analg. 2005 Oct;101(4):1215-20

 

在这项研究中,我们试图确定全麻下行髋部骨折修复术的老年病人苏醒室中谵妄的发生率,并探索苏醒室中谵妄是否与持续的术后谵妄相关。在这项前瞻性研究中,病人在标准化的麻醉方案下接受髋部骨折修复。另外,在术后麻醉监护室和病房中的术后疼痛管理也是标准化的。谵妄的存在通过精神紊乱评估方法(CAM)评分来确定。苏醒室中谵妄通过终止异氟醚吸入后60分钟获取一个CAM评分来评估。术后谵妄通过术后住院恢复期间获取每日CAM评分来评估。50例病人同意加入研究,47例进入分析(诱导后手术取消n=1;未遵从方案n=2)。病人平均年龄为77 +/- 1 (mean +/- SE) (range, 56-98 )。研究中77%病人ASA评分III级或III级以上。苏醒室中谵妄的发生率为45%。术后谵妄的发生率为36%。苏醒室中谵妄预示术后谵妄(P < 0.001, Fisher的精确试验)的敏感性为100%,特异性为85%。术后麻醉监护室和病房中镇痛药给药剂量在有和无术后谵妄的病人中是相似的。此项研究结果表明,苏醒室谵妄是术后谵妄的强烈预测因素。推论:在行髋部骨折修复术的病人中,在使用标准化全麻方案和术后疼痛管理下,苏醒室中谵妄是术后谵妄的一个强烈预测因素。

(徐丽颖译 薛张纲校)

In this study, we sought to determine the incidence of recovery room delirium in elderly patients having hip-fracture repair under general anesthesia and to discover whether recovery room delirium is associated with continuing postoperative delirium. In this prospective study, patients undergoing hip-fracture repair were anesthetized using a standardized protocol. In addition, postoperative pain management was standardized in both the postoperative anesthesia care unit and in the hospital ward. The presence of delirium was determined using the confusion assessment method (CAM) score. Recovery room delirium was assessed by obtaining a CAM score at 60 min after discontinuation of isoflurane. Postoperative delirium was assessed by obtaining a daily CAM score during the postoperative in-hospital recovery period. Fifty patients consented to the study and 47 patients were included in the analysis (surgery cancelled postinduction n = 1; nonadherence to protocol n = 2). Average patient age was 77 +/- 1 (mean +/- SE) yr (range, 56-98 yr). Seventy-seven percent of the study patients were ASA class III or more. The prevalence of recovery room delirium was 45%. The prevalence of postoperative delirium was 36%. Recovery room delirium predicted postoperative delirium (P < 0.001, Fisher's exact test) with a sensitivity of 100% and a specificity of 85%. Analgesic doses administered in the postoperative anesthesia care unit and ward were similar in patients with or without postoperative delirium. Results of this study show that recovery room delirium is a strong predictor of postoperative delirium. IMPLICATIONS: In patients undergoing hip-fracture repair, recovery room delirium is a strong predictor of postoperative delirium when using a standardized protocol for general anesthesia and postoperative pain management.

 

评价valsalva动作在静脉穿刺疼痛的作用:一项随机前瞻研究。

Evaluating the efficacy of the valsalva maneuver on venous cannulation pain: a prospective, randomized study.

Agarwal A, Sinha PK, Tandon M, Dhiraaj S, Singh U.

Department of Anesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Anesth Analg. 2005 Oct;101(4):1230-2

 

静脉穿刺引起的疼痛是一种不适的症状。我们评价了valsalva动作在静脉穿刺引起的疼痛上的作用。研究对象为择期手术的75名成人、 ASA III,性别不限。 病人随机分成3组,每组25人。组IC):对照组;组IIV):病人向血压计管道吹气,使水银柱上升至30 mm Hg,持续20秒;IIIB):病人挤压橡皮球。20秒后进行外周静脉穿刺。静脉穿刺引起的疼痛采用4点评分:030=无疼痛,1=轻度疼痛,2=中度疼痛,3=重度疼痛,以及视觉模拟评分:0-10,0=无疼痛,10=最重度无法忍受的疼痛。Valsalva组观察到疼痛发生率的显著下降:25名病人中18名(72%),而另外两组疼痛发生率均为100(P< 0.001)。同样,Valsalva组病人疼痛的程度、需要穿刺前显露静脉的人数及穿刺时间均显著降低(P< 0.001)。结论:静脉穿刺是安全实施麻醉必不可少的步骤;然而由此引起的疼痛有时非常不适。我们观察到静脉穿刺同时采用valsalva动作能大大减少这种疼痛。

(王丽珺译,薛张纲校)

Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001). IMPLICATIONS: Venous cannulation is a necessary step for safe anesthesia administration; however, the pain associated with it is sometimes very distressing. We observed that the Valsalva maneuver performed at the time of venous cannulation greatly decreases this pain.

磷酸二酯酶-3抑制剂在离体人胃网膜动脉、乳内动脉及桡动脉之间不同的药理学敏感性

Differential Pharmacologic Sensitivities of Phosphodiesterase-3 Inhibitors Among Human Isolated Gastroepiploic, Internal Mammary, and Radial Arteries

Masanori Onomoto, MD*, Isao Tsuneyoshi, MD*, Arata Yonetani, MD*, Shoich Suehiro, MD{dagger}, Kazuhisa Matsumoto, MD{dagger}, Ryuzo Sakata, MD{dagger}, and Yuichi Kanmura, MD*

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

Anesth Analg 2005;101:950-956

 

目前尚无针对磷酸二酯酶(PDE)-3抑制剂对不同部位的人血管组织作用的系统研究 。我们在总共134例行冠脉搭桥手术患者身上采集了人胃网膜动脉(n = 70)、乳内动脉(n = 72)和挠动脉(n = 70),并探讨了特异性PDE3抑制剂(奥普力农、米力农和氨力农)对这些血管收缩的影响。所有的这些PDE3抑制剂都剂量依赖性地减轻了血管对10–6 mol/L去甲肾上腺素以及10–9 10–8 mol/L凝血烷A2相似体U46619的收缩反应。在介导血管舒张时,这些抑制剂在去甲肾上腺素收缩的血管环中的作用比U46619中更有效。此外,在与最大治疗血浆浓度相近似的浓度中(10–7 mol/L的奥普力农、10–6 mol/L的米力农、10–5 mol/L的氨力农)时,奥普力农和米力农对胃网膜和挠动脉的舒张作用比氨力农强;而对乳内动脉,米力农的舒张作用比其它两者更强。这些结果提示这三种PDE-3抑制剂对人体不同部位动脉存在不同活性,并对它们在血管重建中预防不同动脉移植物痉挛的有效性具有借鉴作用。

(黄施伟 马皓琳,李士通 校)

Systematic investigations of the actions of phosphodiesterase (PDE)-3 inhibitors on different human vascular tissues have not been performed. We investigated the effects of specific PDE-3 inhibitors (olprinone, milrinone, and amrinone) on contracted human gastroepiploic arteries (n = 70), internal mammary arteries (n = 72), and radial arteries (n = 70) harvested from a total of 134 patients, all of whom were undergoing coronary artery bypass surgery. Each of these PDE-3 inhibitors dose-dependently diminished the contractile responses to 10–6 mol/L norepinephrine and to either 10–9 or 10–8 mol/L of the thromboxane A2 analog U46619. In inducing vasorelaxations, these inhibitors were significantly more potent in norepinephrine-contracted rings than in those contracted with U46619. Further, at concentrations similar to the maximum therapeutic plasma concentrations (10–7 mol/L olprinone; 10–6 mol/L milrinone; 10–5 mol/L amrinone) olprinone and milrinone were more potent at inducing relaxations than amrinone in gastroepiploic arteries and radial arteries, whereas in internal mammary arteries milrinone was more potent than the others. These results suggest different activities for the three PDE-3 inhibitors among human arteries located in different regions and may be informative about the effectiveness of these inhibitors in preventing spasms in the various arterial grafts used in revascularization.


机械通气对行胸部手术的患者肺免疫功能的影响

The Pulmonary Immune Effects of Mechanical Ventilation in Patients Undergoing Thoracic Surgery

 

Thomas Schilling, MD, DEAA*, Alf Kozian, MD*, Christof Huth, MD{dagger}, Frank Bühling, MD{ddagger}, Moritz Kretzschmar, cand med*, Tobias Welte, MD§, and Thomas Hachenberg, MD, PhD*

*Department of Anesthesiology and Intensive Care Medicine, {dagger}Department of Cardiovascular and Thoracic Surgery, {ddagger}Institute of Immunology, and §Department of Cardiology, Angiology, and Pneumology, Otto-von-Guericke-University, Magdeburg, Germany

Anesth Analg 2005;101:957-965

 

机械通气(MV)可诱发肺泡的炎性反应。有建议单肺通气(OLV)仍用双肺通气时的潮气量(Vt),但有可能增加单肺的机械压力,并可能加重肺泡介质释放。我们研究了用不同的潮气量通气是否改变肺免疫功能、血流动力学和气体交换。选择32例行开胸手术的患者,随机分成两组,一组Vt 10 mL/kg (n = 16) ,另一组Vt 5 mL/kg (n = 16),调整MV使单肺通气时和单肺通气后Paco2正常。通气肺行纤维光学支气管肺泡灌洗,灌洗液中测定细胞、蛋白质、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-8、可溶性细胞间黏附分子(sICAM)-1IL-10和弹性蛋白酶。根据需要用参数或非参数检验分析资料。在所有患者中,都发现促进炎性的变量增加。单肺通气后和术后肺泡内细胞、蛋白质、球蛋白、IL-8 弹性蛋白酶和 IL-10的时间过程在两组间没有差异。TNF-α(8.45.0 µg/mL)sICAM-1浓度(52.727.5 µg/mL)在用Vt = 5 mL/kg单肺通气后明显减小。这些结果表明MV可诱发上皮损伤及通气肺的促炎反应。OLV时减小潮气量可减低肺泡TNF-αsICAM-1浓度。

(彭中美 马皓琳,李士通 校)

Mechanical ventilation (MV) may induce an inflammatory alveolar response. One-lung ventilation (OLV) with tidal volumes (Vt) as used during two-lung ventilation is a suggested algorithm but may impose mechanical stress of the dependent lung and potentially aggravate alveolar mediator release. We studied whether ventilation with different Vt modifies pulmonary immune function, hemodynamics, and gas exchange. Thirty-two patients undergoing open thoracic surgery were randomized to receive either MV with Vt = 10 mL/kg (n = 16) or Vt = 5 mL/kg (n = 16) adjusted to normal Paco2 during and after OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed, and cells, protein, tumor necrosis factor (TNF)-{alpha}, interleukin (IL)-8, soluble intercellular adhesion molecule (sICAM)-1, IL-10, and elastase were determined in the bronchoalveolar lavage. Data were analyzed by parametric or nonparametric tests, as indicated. In all patients, an increase of proinflammatory variables was found. The time courses of intra-alveolar cells, protein, albumin, IL-8, elastase, and IL-10 did not differ between the groups after OLV and postoperatively. TNF-{alpha} (8.4 versus 5.0 µg/mL) and sICAM-1 (52.7 versus 27.5 µg/mL) concentrations were significantly smaller after OLV with Vt = 5 mL/kg. These results indicate that MV may induce epithelial damage and a proinflammatory response in the ventilated lung. Reduction of tidal volume during OLV may reduce alveolar concentrations of TNF-{alpha} and of sICAM-1.

 

 

糖尿病患儿外科围手术期管理

Perioperative Management of Pediatric Surgical Patients with Diabetes Mellitus

Erinn T. Rhodes, MD, MPH*{ddagger}, Lynne R. Ferrari, MD{dagger}§, and Joseph I. Wolfsdorf, MB, BCh*{ddagger}

*Division of Endocrinology and {dagger}Department of Anesthesiology, Perioperative, and Pain Medicine, Children’s Hospital Boston; {ddagger}Departments of Pediatrics and §Anesthesia, Harvard Medical School, Boston, Massachusetts

Anesth Analg 2005;101:986-999

 

目前对糖尿病患儿的管理策略日益复杂。为了优化这类病人的围术期管理,儿科麻醉医师必须认真考虑疾病的病理生理学、针对性的治疗方法、血糖控制状态和计划手术的类型。儿科方面包括身体大小、青春期发育及耐受禁食的能力都是必须考虑的重要问题。为保持糖尿病治疗的连贯性,围术期的计划应在参考儿童内分泌医师的意见下制定。我们给出了波士顿儿童医院对拟行计划手术麻醉的1型或2型糖尿病患儿在手术和全麻的管理策略。这一儿科麻醉和内分泌治疗之间的合作性成果,代表了必须促进医疗和改善管理的此类病人的标准化方法实例。文章突出了与之前发表的建议的不同之处,这些都是儿童糖尿病治疗的持续发展所带来的预期改变。

(周志坚 马皓琳,李士通 校)

Pediatric patients with diabetes are managed with increasingly complex regimens. To optimally manage these patients during the perioperative period, pediatric anesthesiologists must carefully consider the pathophysiology of the disease, patient-specific methods of treatment, status of glycemic control, and the type of surgery proposed. Important pediatric issues, including body size, pubertal development, and ability to tolerate nil per os status, must be considered. To keep pace with the array of options for treating diabetes in children, the perioperative plan should be developed in consultation with a pediatric endocrinologist. We present an algorithm that was developed at Children’s Hospital Boston for the management of pediatric patients with either type 1 or type 2 diabetes mellitus presenting for surgery and general anesthesia. This collaborative effort between the pediatric anesthesia and endocrine services represents one example of a standardized approach to these patients that should facilitate care and improve management. Differences from previously published recommendations are highlighted, as are expected changes caused by the continued evolution of pediatric diabetes care.

 

 

七氟醚增强大鼠主动脉对硝酸甘油的耐药:提示可能通过在血管平滑肌内附加产生超氧阴离子和/或氢氧根使可溶性鸟苷酸环化酶脱敏感化

Sevoflurane Enhances Nitroglycerin Tolerance in Rat Aorta: Implications for the Desensitization of Soluble Guanylate Cyclase Possibly Through the Additive Generation of Superoxide Anions and/or Hydroxyl Radicals Within Vascular Smooth Muscle

Tetsuya Kakutani, MD, Koji Ogawa, MD, Shizue Iwahashi, MD, Kazuhiro Mizumoto, MD, and Yoshio Hatano, MD

Department of Anesthesiology, Wakayama, Medical University, Wakayama, Japan.

Anesth Analg 2005;101:1015-1022

 

近来有证据表明: 硝酸甘油(TNG)耐药,即硝酸甘油的血管舒张作用减弱,和活性基团的产生增加有关。我们设计本研究以探究介导TNG耐药的机制并比较七氟醚和异氟醚对TNG耐药形成的影响。记录大鼠去内皮主动脉环张力的变化。评估由去氧肾上腺素引起收缩的动脉环对TNG (10–8–10–5 M)的累积舒张效应。然后在每种麻醉药(1 to 3 MAC)存在或不存在的情况下将动脉环在含TNG (10–5 M)的浴液中孵育30min以诱导产生TNG耐药。洗脱TNG和麻醉药后获得动脉环第二次对TNG的反应。一些动脉环预先给予氧基清除剂或巯基补充剂。比较前后两次动脉环对TNG的舒张反应。3MAC七氟醚,而不是更小浓度的七氟醚或异氟醚,在同时给予TNG时促进TNG耐药。单独给予七氟醚对TNG耐药没有影响。氧基清除剂或低氧浓度(25%)可抑制共同给予七氟醚和TNG增强的TNG耐药。3MAC七氟醚在高氧环境下可能通过在血管平滑肌内附加产生超氧阴离子或氢氧根来增强TNG耐药形成。

(周雅春 马皓琳,李士通 校)

Nitroglycerin (TNG) tolerance, defined as an impaired vasodilation response to TNG, has been recently demonstrated to be associated with increased production of reactive species. We designed this study to investigate the mechanisms that mediate TNG tolerance and to compare the effects of sevoflurane and isoflurane on the development of TNG tolerance. Tension changes in rat aortic rings without endothelium were recorded. The cumulative relaxant responses to TNG (10–8–10–5 M) were assessed in phenylephrine-contracted rings. To induce TNG tolerance, the rings were then incubated in the bathing solution containing TNG (10–5 M) for 30 min in the presence or absence of each anesthetic (1 to 3 MAC). After washout of TNG and anesthetic, the second response to TNG was obtained. Some rings were pretreated with oxygen radical scavengers or sulfhydryl supplements. The first and the second responses to TNG were compared. Sevoflurane at 3 MAC, but not sevoflurane at smaller concentrations or isoflurane, enhanced TNG tolerance when administered in combination with TNG. Sevoflurane alone had no effect on TNG tolerance. The enhancement of TNG tolerance in the case of a combined sevoflurane and TNG treatment was inhibited in the presence of oxygen radical scavengers or at a smaller oxygen concentration (25%). Sevoflurane at a concentration of 3 MAC in hyperoxic condition enhances the development of TNG tolerance, possibly by additive generation of superoxide anions or hydroxyl radicals within vascular smooth muscle.


在麻醉成人中用于拔除喉罩通气道的最佳的七氟醚呼气末浓度

Optimal End-Tidal Sevoflurane Concentration for the Removal of the Laryngeal Mask Airway in Anesthetized Adults

Yon Hee Shim, MD, Cheung Soo Shin, MD, Chul Ho Chang, MD, and Yang-Sik Shin, MD

Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

Anesth Analg 2005;101:1034-1037

 

七氟醚提供平稳且快速的麻醉,在麻醉成人中拔除喉罩通气道(LMA)时可用七氟醚。我们试图确定在麻醉成人中用于拔除LMA所需的最佳七氟醚呼气末浓度。我们研究了3522-64岁、ASA III级、进行会阴手术的成年患者。全身麻醉诱导用硫喷妥钠,然后插入LMA。用七氟醚、氧气和空气维持麻醉。手术后维持靶浓度至少10 min,然后拔除LMA。用Dixon上下序贯方法(每步增减0.1%)预先确定拔除时的每个靶浓度,开始用1.7%的七氟醚呼气末浓度。当拔除过程中或拔除后1 min内无咳嗽、牙关紧闭或有目的的大体动,且如果拔除后无屏气、喉痉挛或氧饱和度下降,则认为LMA拔除成功。在50%的成人中达到成功拔除LMA的七氟醚呼气末浓度为0.99% ± 0.09%(平均值±标准差),在95%的成人中为1.18%95%可信限1.07%–1.79%)。结论,我们已经确定七氟醚浓度为0.99%1.18%时,在50%95%的麻醉成人中可达到安全的LMA拔除,且无咳嗽、体动或任何其它气道并发症。

(马皓琳 李士通 校)

Sevoflurane provides smooth and rapid emergence from anesthesia and can be used when the removal of a laryngeal mask airway (LMA) is required in anesthetized patients. We sought to determine the optimal end-tidal concentrations of sevoflurane required for the removal of LMA in anesthetized adults. We studied 35 adults, aged 22–64 years old with an ASA physical status I or II, who were undergoing perineal surgery. General anesthesia was induced with thiopental, and the LMA was then inserted. Anesthesia was maintained with sevoflurane, oxygen, and air. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration at the time of removal was predetermined by the Dixon up-down method (with 0.1% as a step size) starting at 1.7% end-tidal concentra-tion of sevoflurane. The LMA removal was considered successful when there was no coughing, clenching of teeth, or gross purposeful movements during or within 1 min after removal and also if there was no breath holding, laryngospasm, or desaturation after removal. The end-tidal concentration of sevoflurane to achieve successful LMA removal in 50% of adults was 0.99% ± 0.09% (mean ± sd) and in 95% of adults was 1.18% (95% confidence limits, 1.07%–1.79%). In conclusion, we have determined that LMA removal in 50% and 95% of anesthetized adults can be safely accomplished without coughing, moving, or any other airway complications at 0.99% and 1.18% end-tidal concentrations of sevoflurane.


选择性磷酸二酯酶5抑制不减少健康志愿者丙泊酚镇静需要量但影响恢复速度和血浆环鸟苷酸3',5'-单磷酸浓度

Selective Phosphodiesterase 5 Inhibition Does Not Reduce Propofol Sedation Requirements but Affects Speed of Recovery and Plasma Cyclic Guanosine 3',5'-Monophosphate Concentrations in Healthy Volunteers

Thomas Engelhardt, MD, PhD, FRCA, Jamie MacDonald, FRCA MBChB, Helen F. Galley, PhD FIMLS, and Nigel R. Webster, PhD, FRCA, FRCP

Academic Unit of Anaesthesia and Intensive Care, Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom

Anesth Analg 2005;101:1050-1053

 

麻醉效应的调节涉及环鸟苷-3',5'单磷酸(cGMP)。我们假设通过选择性抑制磷酸二酯酶限制cGMP的分解会影响丙泊酚的镇静需要量和血浆cGMP浓度。在这项安慰剂对照、双盲、随机交叉的预试验中,10名志愿者口服西地那非(sildenafil100mg或者安慰剂。通过使用丙泊酚靶控输注系统直至达到无法语言交流(LVC)的镇静效果。测定血浆cGMP的基础值、达到LVC时和达到LVC30分钟后的浓度。与安慰剂处理者相比,口服西地那非的志愿者的丙泊酚用量、预测的血浆浓度和镇静时间均无差异。服用西地那非后,恢复自发性语言交流的时间较短(4 [3–5] min vs 6 [3–8] min, 中位数[范围], P = 0.019)。在安慰剂组,在丙泊酚镇静期间的cGMP浓度较基础值降低(P < 0.004)。与安慰剂组相比,西地那非组在达到LVC时的血浆cGMP浓度较高(P = 0.004)。我们已证明,选择性抑制磷酸二酯酶5能缩短丙泊酚镇静的恢复时间但不影响用量。在安慰剂组丙泊酚镇静期间血浆cGMP浓度的降低提示cGMP在丙泊酚对人类的麻醉中具有潜在的作用。

(颜涛 马皓琳,李士通 校)

Cyclic guanosine 3',5'-monophosphate (cyclic GMP) has been implicated in modulating the effects of anesthesia. We hypothesized that limiting the breakdown of cyclic GMP through selective phosphodiesterase inhibition would influence propofol sedation requirements and plasma cyclic GMP concentrations. Ten volunteers received 100 mg of sildenafil or placebo orally in this placebo-controlled, double-blind, randomized crossover pilot study. Propofol sedation was achieved using a target-controlled infusion system until loss of verbal contact (LVC). Plasma cyclic GMP concentrations were determined at baseline, LVC, and 30 min after LVC. There was no difference in the amount of propofol used, predicted plasma concentration, or duration of sedation in volunteers after sildenafil compared with placebo treatment. Return of spontaneous verbal contact was faster after sildenafil (4 [3–8] min versus 6 [3–5] min, median [range], P = 0.019). Cyclic GMP concentrations were reduced during propofol sedation in the placebo group compared with baseline (P < 0.004). The plasma cyclic GMP concentrations were larger (P = 0.004) at LVC in the sildenafil group compared with placebo. We have shown that selective phosphodiesterase 5 inhibition decreases recovery time from propofol sedation without affecting propofol requirements. The decrease of plasma cyclic GMP concentrations during propofol sedation in the placebo group indicates a potential role of cyclic GMP in propofol anesthesia in humans.


托特罗定预防导尿管相关膀胱不适的药效:一项前瞻性、随机、安慰剂-对照、双盲研究

The Efficacy of Tolterodine for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Anil Agarwal, MD*, Mehdi Raza, MD*, Vinay Singhal, MD*, Sanjay Dhiraaj, MD*, Rakesh Kapoor, MS, McH{dagger}, Aneesh Srivastava, MS, McH{dagger}, Devendra Gupta, MD*, Prabhat K. Singh, MD*, Chandra Kant Pandey, MD*, and Uttam Singh, PhD{ddagger}

Departments of *Anesthesia, {dagger}Surgical Urology, and {ddagger}Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Anesth Analg 2005;101:1065-1067

 

留置导尿管继发的膀胱不适是非常难受的,尤其对于麻醉苏醒的病人。我们希望研究术中插入导尿管病人膀胱不适的发生率和严重程度,并衡量托特罗定――一种纯胆碱能受体拮抗剂在预防此不适方面的药效。连续250ASAIII级、性别不限、接受需要插入导尿管的泌尿外科手术的成年病人参与了此项研究。C组(对照组n=165)接受安慰剂,T组(托特罗定组 n=50)接受托特罗定2mg。药物在术前一小时口服。麻醉诱导以后,病人插上16F的气囊导尿管,并用10mL生理盐水充气囊。在麻醉后复苏室评估到达时(0)、到达后126小时的膀胱不适感及其严重程度,后者分为“轻,中和重”三个等级。在对照组观察到的膀胱不适发生率为55%(165个病人中出现91个)。托特罗定组的膀胱不适发生率降低到36%(50个病人中出现18个),严重程度也比对照组有所减轻(P<0.05)。

(黄佳佳 马皓琳,李士通 校)

Bladder discomfort secondary to an indwelling urinary catheter is distressing, particularly for patients awakening from anesthesia. We sought to discover the incidence and severity of bladder discomfort in patients who were catheterized intraoperatively and to evaluate the efficacy of tolterodine, a pure muscarinic receptor antagonist, in preventing this. Two-hundred-fifteen consecutive adult patients, ASA physical status I and II, either sex, undergoing urologic surgery requiring bladder catheterization were enrolled. Group C (control, n = 165) received placebo and group T (tolterodine, n = 50) received tolterodine 2 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL of normal saline. In the postanesthesia care unit, bladder discomfort was assessed on arrival (0), 1, 2 and 6 h. Severity of bladder discomfort was graded as mild, moderate, and severe. Bladder discomfort observed in group C was 55% (91 of 165). Tolterodine reduced both the incidence 36% (18 of 50) and severity of bladder discomfort (P < 0.05).


评估葡萄糖初始分布容积以评价液体冲击中血浆容积

An Evaluation of the Initial Distribution Volume of Glucose to Assess Plasma Volume During a Fluid Challenge

Laurence van Tulder, MD, Burkhardt Michaeli, MD, René Chioléro, MD, Mette M. Berger, MD, PhD, and Jean-Pierre Revelly, MD

Surgical Intensive Care Unit, University Hospital, 1011 Lausanne, Switzerland

Anesth Analg 2005;101:1089-1093

 

循环血容量可以用葡萄糖初始分布体积(IDVG)的方法来估计。在一个前瞻性观察实验中,我们评价了液体冲击在个体病人中对IDVG的影响。在13个心脏手术后的病人中,分别在输注羟乙基淀粉前和输注7 mL/kg 30分钟后测定IDVG11名不需要液体冲击的病人作为对照组。运用单室指数模型,用5g葡萄糖静注前和静注后34567分钟的血浆葡萄糖浓度,计算出IDVG。对照组的IDVG重复测定三次。IDVG在液体冲击后并没有变化(85±14 mL/kg93±14 mL/kgP = 0.08)。当P=0.05时可比度是0.25。葡萄糖指数幂对时间的回归系数在淀粉输注前是0.96±0.03,之后是0.95±0.04(没有显著性差异)。在对照组,IDVG90 ± 18 mL/kg,平均个体变异系数是0.15 ± 0.08IDVG看起来似乎不足以评价液体疗法的个体反应。这个局限性可能与IDVG的可重复性差有关。

 (黄丽娜 马皓琳,李士通 )

Circulation blood volume can be estimated with the initial distribution volume of glucose (IDVG) method. In a prospective, observational study, we evaluated the effect of a fluid challenge on IDVG in individual patients. In 13 patients after cardiac surgery, IDVG was determined before and after the infusion of 7 mL/kg hydroxyethyl starch over 30 min. Eleven patients not requiring a fluid challenge served as control. IDVG was computed with a one-compartment exponential model, using plasma glucose concentrations at baseline and 3, 4, 5, 6, and 7 min after 5 g of glucose IV bolus. IDVG was repeated 3 times in the control group. IDVG did not change after a fluid challenge (85 ± 14 versus 93 ± 14 mL/kg, P = 0.08), and the power of the comparison was 0.25 for a P value of 0.05. The regression coefficient of the exponential fit of glucose versus time was 0.96 ± 0.03 before, and 0.95 ± 0.04 after starch infusion (not significant). In the control group, IDVG was 90 ± 18 mL/kg, and the average individual coefficient of variation was 0.15 ± 0.08. IDVG seems inadequate to assess individual response to fluid therapy. This limitation may be related to the weak reproducibility of IDVG.


围手术期疼痛管理技术对大鼠剖腹手术后食物消耗量和体重的影响

The Effects of Perioperative Pain Management Techniques on Food Consumption and Body Weight After Laparotomy in Rats

Yehuda Shavit, PhD*, Gila Fish, MSc*, Gilly Wolf, PhD C*, Eduard Mayburd, MD{dagger}, Ylia Meerson, MD{dagger}, Raz Yirmiya, PhD*, and Benzion Beilin, MD{dagger}

*Department of Psychology, Hebrew University, Jerusalem; and {dagger}Department of Anesthesiology, Rabin Medical Center, Golda–Hasharon Campus, Petah Tiqva, affiliated with the Sackler School of Medicine, Tel-Aviv University, Israel

Anesth Analg 2005;101:1112-1116

 

我们通过评估体重(BW)和食物消耗量(FC)来检验两个围手术期疼痛管理技术对剖腹手术后恢复的效应。所有大鼠术前鞘内给予吗啡和布比卡因混合液,并且给予下列两者之一:(a)术毕注射缓释吗啡或者(b)一种抗炎药白介素-1受体拮抗剂(IL-1ra)联合术前混合液。剖腹手术显著减少FCBW。两个镇痛方法导致FCBW恢复较快。这种有益的作用在术前镇痛联合IL-1ra的组中更明显。

(张曦 马皓琳,李士通 校)

We examined the effects of two perioperative pain management techniques on recovery after laparotomy, as assessed by body weight (BW) and food consumption (FC). All rats received a preoperative intrathecal mixture of morphine plus bupivacaine combined with one of two treatments: (a) injection of slow-release morphine at the end of the surgery or (b) an antiinflammatory drug, interleukin-1 receptor antagonist (IL-1ra), combined with the preoperative mixture. Laparotomy significantly decreased FC and BW. Both analgesic treatments resulted in a faster recovery of FC and BW. This beneficial effect was more pronounced in the group receiving preoperative analgesics combined with IL-1ra.

 

 

七氟醚预处理可抑制大鼠内毒素诱发的休克

Sevoflurane Pretreatment Inhibits Endotoxin-Induced Shock in Rats

Yoko Kidani, MD*, Takumi Taniguchi, MD{dagger}, Hiroko Kanakura, MD*, Yasuhiro Takemoto, MD*, Kazunobu Tsuda, MD*, and Ken Yamamoto, MD*

Departments of *Anesthesiology and Intensive Care Medicine and {dagger}Emergency and Critical Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan

Anesth Analg 2005;101:1152-1156

 

作者观察七氟醚预处理对内毒素致休克时死亡率和炎性反应的作用。将大鼠随机分为4组(每组12只):内毒素组(静脉注射大肠杆菌内毒素15 mg/kg 注射时间2 min);生理盐水对照组(注射0.9%盐水1.0 mL/kg);单用七氟醚组(在注射生理盐水前吸入2.4%七氟醚30 min);七氟醚预处理组(在注射内毒素前吸入2.4%七氟醚30 min)。测定血流动力学参数、动脉血气、血浆肿瘤坏死因子-a和白介素-6的浓度。观察8小时死亡率。在注射内毒素前七氟醚预处理组,收缩压和酸碱平衡得到改善。内毒素血症组、生理盐水对照组、单用七氟醚组和七氟醚预处理组在注射内毒素后8小时的死亡率分别为83%8%0%25%。内毒素组的血浆细胞因子浓度明显高于其它组。大鼠注射内毒素时七氟醚预处理可以抑制炎症反应和降低死亡率。

(赵雪莲 马皓琳,李士通 )

We examined the effects of sevoflurane pretreatment on mortality and inflammatory responses during endotoxin-induced shock. Rats were allocated randomly to 1 of 4 groups (n = 12 per group): an endotoxemia group, receiving IV Escherichia coli endotoxin (15 mg/kg over 2 min); a saline control group, receiving 0.9% saline (1.0 mL/kg); a sevoflurane-only group, receiving 2.4% sevoflurane for 30 min immediately before injection of 0.9% saline; and a sevoflurane pretreatment group, receiving 2.4% sevoflurane for 30 min immediately before injection of endotoxin. Hemodynamic variables, arterial blood gases, and plasma concentrations of tumor necrosis factor-{alpha} and interleukin-6 were measured. The 8-h mortality rate was determined. Systolic arterial blood pressure and acid-base balance improved with sevoflurane pretreatment before induction of endotoxemia. Mortality rates 8 h after endotoxin injection were 83%, 8%, 0%, and 25% for the endotoxemia, saline control, sevoflurane-only, and sevoflurane pretreatment groups, respectively. Plasma cytokine concentrations were significantly larger in the endotoxemia group than in the other groups. Sevoflurane pretreatment inhibited inflammatory responses and decreased mortality in rats exposed to endotoxin.


剖腹产病人优选的麻醉结果

Patient Preferences for Anesthesia Outcomes Associated with Cesarean Delivery

Brendan Carvalho, MBBCh, FRCA*, Sheila E. Cohen, MB, ChB, FRCA*, Steven S. Lipman, MD*, Andrea Fuller, MD*, Anbu D. Mathusamy, MD{dagger}, and Alex Macario, MD*

*Department of Anesthesia, Stanford University School of Medicine, Stanford, California; and {dagger}Bronx-Lebanon Hospital, Bronx, New York

Anesth Analg 2005;101:1182-1187

 

当决定在区域麻醉下剖腹产(CS)使用椎管内给药(如蛛网膜下腔阿片类药物)时,麻醉医生需要权衡减轻疼痛和副作用风险增加可能性来做出处理决定。以前没有人研究产科病人的麻醉喜好。研究者向参加我们机构的准父母班的怀孕妇女进行了100份书面调查。我们用优先顺序等级和相对值评分测定了特殊的术中和术后麻醉重要后果的病人喜好,同时研究病人对剖腹产及镇痛药的恐惧、关注和耐受度。100份调查中返回了82份进行分析。剖腹产过程中和其后的疼痛是最受关注的,其次是呕吐、恶心、抽筋、瘙痒和颤抖。优先顺序等级和相对值评分高度相关(R2 = 0.7)。病人在她们接受的镇痛药可能对她们的婴儿有作用前能忍受视觉模拟疼痛评分(0–100 mm56 ± 22的疼痛。与早先一般的外科手术群体恶心和呕吐是最受关注的调查不同,我们发现剖腹产术中术后的疼痛是产妇最关心的。一般的副作用如瘙痒和颤抖只引起中度关注。这个信息应该被用来指导麻醉选择,如包括蛛网膜下腔阿片类药物的足量应用。

(朱 马皓琳,李士通 校)

When deciding on neuraxial medication (e.g., spinal opioids) for cesarean delivery (CS) under regional anesthesia, anesthesiologists make treatment decisions that "trade off" relieving pain with the potential for increased risk of side effects. No previous studies have examined obstetric patients’ anesthesia preferences. Researchers administered 100 written surveys to pregnant women attending our institutions’ expectant parent class. We determined patients’ preferences for importance of specific intraoperative and postoperative anesthesia outcomes using priority ranking and relative value scales. We also explored patients’ fears, concerns, and tolerance regarding CS and analgesics. Eighty-two of 100 surveys were returned and analyzed. Pain during and after CS was the greatest concern followed by vomiting, nausea, cramping, pruritus, and shivering. Ranking and relative value scores were closely correlated (R2 = 0.7). Patients would tolerate a visual analog pain score (0–100 mm) of 56 ± 22 before exposing their baby to the potential effects of analgesics they receive. In contrast to previous general surgical population surveys that found nausea and vomiting as primary concerns, we found pain during and after CS as parturients’ most important concern. Common side effects such as pruritus and shivering caused only moderate concern. This information should be used to guide anesthetic choices, e.g., inclusion of spinal opioids given in adequate doses.


锁骨臂丛神经阻滞与肱骨入路麻醉时间与效果的比较

Infraclavicular Brachial Plexus Block Versus Humeral Approach: Comparison of Anesthetic Time and Efficacy

Vincent Minville, MD*, Roland Amathieu, MD*, N’Guyen Luc, MD*, Claude Gris, MD*, Olivier Fourcade, MD, PhD*, Kamran Samii, MD*, and Dan Benhamou, MD{dagger}

*Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Paul Sabatier University, Toulouse, France; {dagger}Department of Anesthesiology and Intensive Care, Bicêtre University Hospital, Le Kremlin-Bicêtre, France

Anesth Analg 2005;101:1198-1201

 

大多数上臂的区域麻醉技术都是很成功的,其效力的区别并不能指导麻醉技术的选择。本研究拟比较肱骨入路阻滞(HB)与锁骨下臂丛神经阻滞(ICB),用麻醉时间(如操作时间+起效时间)作为主要的效果评估手段。手臂的四个主要神经达到完全感觉阻滞即说明此项阻滞是成功的。记录下达到完全阻滞的时间。行上肢整形外科手术的病人入选此项前瞻随机研究,分为ICB (In = 60例病人) HB (Hn = 60例病人)ICB组总的麻醉需要时间为19.5min(95%可信区间[CI], 17.4—21.6 min)HB组为20.8 min (95% CI, 18.7--22.9 min)。(无显著性差异)。实施阻滞的时间,ICB组为4.5 min (95% CI, 4-5 min)HB 组为9.8 min (95% CI, 8.9-10.7 min) (P < 0.05)。起效时间,ICB组为15 min (95% CI, 13-17 min)HB 组为11 min (95% CI, 9--13 min) (P < 0.05)。成功率,ICB组为92%HB组为95%(无显著性差异)。每组都有1例自限血管穿破。HB组起效时间更快,但是使用双刺激的ICB组操作时间更快。两组麻醉维持时间相似。

(邱郁薇 马皓琳,李士通 校)

Most upper arm regional anesthesia techniques are successful and differences in efficacy should not dictate the choice of technique. In the present study, we compared humeral block (HB) and infraclavicular brachial plexus block (ICB) using anesthetic time (i.e., duration of the procedure + onset time) as the primary outcome measure. The block was successful when a complete sensory block was obtained in the four major nerves of the arm, and the time to complete block was recorded. Patients undergoing orthopedic surgery of the upper limb were included in a prospective randomized study and received ICB (group I, n = 60 patients) or HB (group H, n = 60 patients). Total anesthetic time was 19.5 min (95% confidence interval [CI], 17.4—21.6 min) for ICB and 20.8 min (95% CI, 18.7--22.9 min) for HB (not significant). Time to perform the block was 4.5 min (95% CI, 4-5 min) for ICB and 9.8 min (95% CI, 8.9--10.7 min) for HB (P < 0.05). The onset time was 15 min (95% CI, 13-17 min) for ICB and 11 min (95% CI, 9--13 min) for HB (P < 0.05). The success rate was 92% for ICB and 95% for HB (not significant). One self-limited vascular puncture was made in each group. HB had a faster onset time but ICB using a double-stimulation technique was faster to perform. Anesthetic time was similar with the two techniques.


侧卧位的气道管理:一项随机对照实验

Airway Management in the Lateral Position: A Randomized Controlled Trial

Conan L. McCaul, FFARCSI*, Donal Harney, FCARCSI*, Margaret Ryan, FFARCSI*, Ciaran Moran, FFARCSI{dagger}, Brian P. Kavanagh, FRCPC{ddagger}, and John F. Boylan, FRCPC*

*Department of Anaesthesia and Intensive Care Medicine, St. Vincent’s University Hospital, Dublin, Ireland; {dagger}The Robert Jones Agnes Hunt Orthopedic Hospital, Oswestry, United Kingdom; and {ddagger}Division of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada

Anesth Analg 2005;101:1221-1225

 

在一些情况下可能需要确保侧卧位时气道通畅。我们进行了一项前瞻性随机临床研究,研究左侧卧位对气道解剖和随后的气道管理的影响。对麻醉患者在仰卧位和左侧卧位、环状软骨加压或不加压时用喉镜检查气道。患者随机分成气管内插管和喉罩通气道(LMA)气道管理两组。左侧卧位使35%的患者喉镜观察到的气道情况变差而无一例有改善。在侧卧位时,气管内插管与LMA相比,气道管理失败发生更多(8/391/30; P = 0.03),成功完成气道管理的平均时间更长(39 ± 19 s26 ± 12 s; P = 0.002)。侧卧位时应用LMA进行气道控制比气管内插管更可靠。在该体位开始进行气道管理时应把LMA作为首选的通气道装备。

(陈玮 马皓琳,李士通 审校)

It may be required to ensure patency of the airway in the lateral position in certain circumstances. We performed a prospective randomized clinical trial investigating the effects of left lateral patient positioning on airway anatomy and subsequent airway management. Laryngoscopic airway examination was performed in anesthetized patients, in the supine and left lateral positions, and in the presence and absence of cricoid pressure. Patients were randomized to airway management via an endotracheal tube or laryngeal mask airway (LMA). The left lateral position resulted in a deterioration of laryngoscopic view in 35% of patients and improvement in none. In the lateral position, failure of airway management occurred in more patients with the endotracheal tube versus LMA (8 of 39 versus 1 of 30; P = 0.03), and the mean time to successful completion of airway management was longer with tracheal intubation compared with the LMA (39 ± 19 s versus 26 ± 12 s; P = 0.002). LMA use results in more reliable airway control compared to tracheal intubation in the lateral position. The LMA should be considered as the primary airway device when instituting airway management in this position.


中重度气管插管困难病人McCoy气囊喉镜检查的评估

An Evaluation of McCoy Balloon Laryngoscopy in Patients With Moderate-to-Major Endotracheal Intubation Difficulty

Spyros D. Mentzelopoulos, MD, PhD, DEAA, Maria Tzoufi, MD, DEAA, Kostas Rellos, MD, PhD, Argyris S. Michalopoulos, MD, FCCM, FCCP, Elissavet Stamataki, MD, PhD, DEAA, Charris Roussos, MD, PhD, and Spyros G. Zakynthinos, MD, PhD

Departments of Intensive Care Medicine Henry Dunant General Hospital and Evaggelismos General Hospital, Athens, Greece.

Anesth Analg 2005;101:1233-1237

 

我们假设McCoy-气囊复合喉镜检查较单独的McCoy或气囊喉镜检查使气道管理更为便捷。10例实施了麻醉和肌松,先前插管困难评分大于5分的病人,McCoy复合气囊喉镜检查较传统/气囊/McCoy喉镜检查使喉部的暴露面积更大(2.3 ± 0.60.6 ± 0.2/1.4 ± 0.4/1.5 ± 0.6 cm2),插管困难评分更低 (0.00 (0.00–0.00)6.00 (6.00–8.25)/1.50(0.00–4.00)/2.00(0.75–5.00),插管确认的时间要短9%–74% (所有的P < 0.05–0.001)。气囊和McCoy喉镜检查较传统的喉镜检查暴露和插管的条件均有提高。在中重度传统气道管理困难的病人中,McCoy复合气囊喉镜检查进一步提高了喉镜检查暴露和插管的条件。

(张莹 马皓琳,李士通 校)

We hypothesized that combined McCoy-balloon laryngoscopy may facilitate airway management relative to McCoy or balloon laryngoscopy. In 10 anesthetized/paralyzed patients with prior intubation difficulty scale scores of >5, McCoy-balloon laryngoscopy versus conventional/balloon/McCoy laryngoscopies resulted in greater laryngeal aperture exposure (2.3 ± 0.6 versus 0.6 ± 0.2/1.4 ± 0.4/1.5 ± 0.6 cm2, respectively), lower intubation difficulty scale score (0.00 (0.00–0.00) versus 6.00 (6.00–8.25)/1.50(0.00–4.00)/2.00(0.75–5.00), respectively, median [interquartile range]), and 9%–74% shorter time to intubation confirmation (P < 0.05–0.001 for all). Balloon and McCoy laryngoscopies improved laryngoscopic/intubating conditions relative to conventional laryngoscopy. In patients with moderate-to-major conventional airway management difficulty, McCoy-balloon laryngoscopy further improves laryngoscopic/intubating conditions.

 

吗啡诱导在体大鼠心脏的晚期心肌保护作用与阿片受体和核转录因子KappaB有关

Morphine Induces Late Cardioprotection in Rat Hearts In Vivo: The Involvement of Opioid Receptors and Nuclear Transcription Factor {kappa}B

Jan Frässdorf, MD, Nina C. Weber, PhD, Detlef Obal, MD, Octavian Toma, MD, Jost Müllenheim, MD, DEAA, Georg Kojda, MD, PharmD, Benedikt Preckel, MD, DEAA, and Wolfgang Schlack, MD, DEAA

Department of Anesthesiology, University Hospital of Düsseldorf, Düsseldorf, Germany

Anesth Analg 2005 101: 934-941.

 

Delta1阿片受体激动剂早期或者晚期预处理可以诱导明显的心肌保护作用。在急性冠脉综合症时吗啡是最常用的镇痛药,因此在本研究中,作者研究了吗啡晚期预处理是否能够诱导心肌保护作用,同时观察了这种作用是否与核转录因子KappaBNF-kappaB)的信号转导有关。研究者分别用生理盐水(NaCl0.9%5ml)、大肠杆菌脂多糖(LPS; 1 mg/kg)和吗啡(MO,3 mg/kg)预处理,然后心肌局部缺血25min再灌注2小时。脂多糖是晚期预处理的触发物,作为阳性对照组。纳洛酮(NAL)用来观察晚期预处理中阿片受体的作用,在生理盐水,脂多糖或者吗啡应用之前或者缺血再灌注前给药。研究结果表明,在NaCl, NAL-NaCl,NaCl-NAL组梗死灶范围分别为59% ± 9%, 51% ± 6%, 53%± 10%。吗啡预处理后24h梗死灶范围减少到20%± 6%MO-24H,并且这一作用可以被纳洛酮取消(NAL-MO, 53% ± 14%MO-NAL, 60% ± 8%)。LPS预处理后梗死灶范围缩至23% ± 8%。纳洛酮在LPS应用前给药不能拮抗LPS的作用(NAL-LPS 30% ± 16%),但是在缺血再灌注前给药则能够拮抗LPS的作用(LPS-NAL 54% ± 8%)。本研究同时应用Western blot电泳迁移率变动分析观察了NF-kappaB在这其中的作用。结果发现吗啡和LPS均可以提高抑制性蛋白kappaB的磷酸化,从而提高NF-kappaB的活性。总之,吗啡诱导的晚期预处理与LPS相似,其心肌保护作用至少一部分是激活了NK-kappaB。阿片受体在吗啡和LPS诱导的晚期预处理中都有作用,但是只有在吗啡诱导的晚期预处理中具有触发的作用。

苏殿三译 陈杰 校)

{delta}1-opioid receptor agonists can induce cardioprotection by early and late preconditioning (LPC). Morphine (MO) is commonly used for pain treatment during acute coronary syndromes. We investigated whether MO can induce myocardial protection by LPC and whether a nuclear transcription factor {kappa}B (NF-{kappa}B)-dependent intracellular signaling pathway is involved. Rats were subjected to 25 min of regional ischemia and 2 h of reperfusion 24 h after treatment with saline (NaCl; 0.9% 5 mL), lipopolysaccharide of Escherichia coli (LPS; 1 mg/kg), or MO (3 mg/kg). LPS is a trigger of LPC and served as positive control. Naloxone (NAL) was used to investigate the role of opioid receptors in LPC and was given before NaCl, LPS, or MO application (trigger phase) or before ischemia-reperfusion (mediator phase). Infarct size (percentage area at risk) was 59% ± 9%, 51% ± 6%, or 53% ± 10% in the NaCl, NAL-NaCl, and NaCl-NAL groups, respectively. Pretreatment with MO reduced infarct size to 20% ± 6% after 24 h (MO-24h), and this effect was abolished by NAL in the trigger (NAL-MO, 53% ± 14%) and in the mediator (MO-NAL, 60% ± 8%) phases. Pretreatment with LPS reduced infarct size to 23% ± 8%. NAL administration in the trigger phase had no effect on infarct size (NAL-LPS 30% ± 16%), whereas NAL during the mediator phase of LPC abolished the LPS-induced cardioprotection (LPS-NAL 54% ± 8%). The role of NF-{kappa}B in morphine-induced LPC was investigated by Western blot and electrophoretic mobility shift assay. Morphine and LPS treatment increased phosphorylation of the inhibitory protein {kappa}B, leading to an increased activity of NF-{kappa}B. Thus, MO induces LPC similarly to LPS and it is likely that this cardioprotection is mediated at least in part by activation of NF-{kappa}B. Opioid receptors are involved as mediators in both MO- and LPS-induced LPC but as triggers only in MO-induced LPC.

 

麻醉恢复期西罗莫司涂抹冠脉支架内的血栓形成

Thrombosis of Sirolimus-Eluting Coronary Stent in the Postanesthesia Care Unit

J. Thomas Murphy, MD, FRCPC, and Brenda G. Fahy, MD

Department of Anesthesiology, University of Kentucky College of Medicine Lexington, Kentucky

Anesth Analg 2005 101: 971-973.

一名44岁的妇女在放置药物涂抹冠脉支架后两周行子宫切除术,结果在麻醉复苏阶段突发生心肌梗死,最终不治身亡。她在术前仅仅停服了一次阿司匹林和氯吡格雷。如能早期发现亚急性冠脉支架血栓并紧急行经皮冠脉处理,也许能避免她的死亡。在本例报道中,作者主要强调围术期冠脉支架应用中的问题及其可能造成的影响。

(郑拥军译 陈杰校)

A 44-yr-old woman with a drug-eluting coronary stent placement two weeks before surgery suffered a myocardial infarction in the postanesthesia care unit immediately after hysterectomy. She had missed only one dose of aspirin and clopidogrel preoperatively. Early recognition of subacute stent thrombosis and urgent percutaneous coronary intervention probably prevented her death. In this case report, we highlight perioperative coronary stent issues and discuss their implications.

 

儿童颈部伸展时气管长度伸长对气管内导管安全的意义

Elongation of the Trachea During Neck Extension in Children: Implications of the Safety of Endotracheal Tubes

Kim Jin-Hee, MD*, Young-Jin Ro, MD{dagger}, Min Seong-Won, MD{dagger}, Kim Chong-Soo, MD{dagger}, Kim Seong-Deok, MD*, Jun Ho Lee, MD{ddagger}, and Bahk Jae-Hyon, MD*

*Department of Anesthesiology, Seoul National University Medical College; {dagger}Departments of Anesthesiology and {ddagger}Otolaryngology, Seoul City Boramae Hospital, Korea

Anesth Analg 2005 101: 974-977.

 

儿童颈部伸展时,因为气管的延长,气管导管头部(ETT)与气管隆突之间距离的变化不等同于ETT与声带之间距离的变化。上述距离的变化与气管导管脱出的危险性之间具有密切关系。本研究以25名儿童(年龄在2-8岁)为研究对象,全麻期间保持其头位于中位,颈部充分伸展,应用纤维支气管镜测量ETT头部与声带之间的距离。纤维支气管镜分别测量儿童头部位于中位和颈部充分伸展两种状态下气管导管长度变化。气管长度减去ETT头部和隆突之间的距离得到声带和ETT头部之间的距离。颈部充分伸展后,气管的平均长度为(7.97 ± 0.85 cm),平均增加0.95 ± 0.43 cm,声带和ETT头部之间的距离变化为–1.08 ± 0.47 cm,然而ETT头部和隆突之间的距离变化为2.02 ± 0.58 cm。上述结果表明颈部的充分伸展确实可改变ETT尖端与声带之间的相对位置,从而增加较年长儿童气管导管脱出的危险性,但ETT尖端到声带实际移位由于气管的延长而减少。

(郑拥军译 陈杰校)

During neck extension, the changes in distance between endotracheal tube (ETT) tip and carina may not be equal to the changes in distance between vocal cords and ETT tip because of tracheal elongation. These distances are directly related to extubation risk. Using a fiberoptic bronchoscope, the distance between ETT tip and carina was measured in the neutral position after full extension of the neck in 25 children (2–8 yr old) scheduled for elective surgery under general anesthesia. The tracheal length was then measured in the neutral position and after full extension. The distance between vocal cords and ETT tip was calculated as the tracheal length minus the distance between ETT tip and carina. After full extension, the tracheal length (7.97 ± 0.85 cm) was increased by 0.95 ± 0.43 cm, and the change in distance between vocal cords and ETT tip was –1.08 ± 0.47 cm, whereas the change in distance between ETT tip and carina was 2.02 ± 0.58 cm. These results suggest that neck extension actually displaces the ETT tip to the vocal cords, increasing the risk of tracheal extubation in older children, although the actual displacement of ETT tip to vocal cords is reduced by tracheal lengthening.

 

月经黄体期增加的黄体酮可减少麻醉药物的需要量

Increased Progesterone Production During the Luteal Phase of Menstruation May Decrease Anesthetic Requirement

Veysel Erden, MD*, Zehra Yangin, MD*, Kerem Erkalp, MD*, Hamdi Delatioglu, MD*, Feyza Bahçeci, MD*, and Ayse Seyhan, MD{dagger}

*Departments of Anesthesiology and {dagger}Obstetrics/Gynecology, SSK Vakif Gureba Hospital, Istanbul, Turkey

Anesth Analg 2005 101: 1007-1011

..

黄体酮除了具有重要的激素作用,对大脑还具有镇静和催眠效应。在该研究中,作者就黄体酮水平较低的卵泡期的妇女和黄体酮水平较高的黄体期的妇女对麻醉药物的需要量进行了比较。该研究包括处于月经周期第1-10天(卵泡期)和第18-24天(黄体期)的病人各20名。麻醉诱导用芬太尼和硫喷妥,罗库溴铵保证肌松,NO2 2L/minO2 2L/min和七氟醚维持麻醉,调节七氟醚浓度使两组病人的脑电双频指数平均数值均维持在46。术前所有病人均抽取血液以测定黄体酮水平。作者发现卵泡组和黄体组的黄体酮水平分别为0.86 ± 0.30 ng/mL7.48 ±3.86 ng/mL。七氟醚的最低肺泡浓度(MAC-h在卵泡组(1.55 ± 0.18 MAC-h)显著大于黄体组(1.3 ± 0.13 MAC-h) (P < 0.0001)。卵泡组的麻醉维持期七氟醚需要量较大。结论:黄体期较高的黄体酮水平可能是麻醉药用量较少的原因。

(赵延华译 陈杰校)

Besides having important hormonal effects, progesterone has depressant and hypnotic effects on the brain. In this study, we compared women in the follicular phase with low progesterone levels and in the luteal phase with high progesterone levels regarding their anesthetic requirements. Twenty patients with menstrual cycle days from 1 to 10 (follicular group) and 20 patients with menstrual cycle days from 18 to 24 (luteal group) were included in the study. Anesthesia was induced with fentanyl and thiopental; relaxation was secured with rocuronium, and anesthesia was maintained with a mixture of nitrous oxide 2 L/min and oxygen 2 L/min plus sevoflurane. The delivered sevoflurane concentration was adjusted to sustain a constant bispectral index value that averaged 46 in both groups. To determine the progesterone levels, blood samples were taken from all patients before surgery. We found that progesterone levels were 0.86 ± 0.30 ng/mL in the follicular group and 7.48 ± 3.86 ng/mL in the luteal group. The minimum alveolar anesthetic concentration (MAC)-hour (MAC-h) value of sevoflurane in the follicular group (1.55 ± 0.18 MAC-h) was significantly larger than in the luteal group (1.3 ± 0.13 MAC-h) (P < 0.0001). The sevoflurane requirements were larger in the follicular group during the maintenance phase of anesthesia. In conclusion, high progesterone levels during the luteal phase might be the cause of decreased anesthetic requirement.



不同效应部位半数平衡时间参数对预测效应部位七氟醚浓度的影响:一项模拟研究

The Effect of Using Different Values for the Effect-Site Equilibrium Half-Time on the Prediction of Effect-Site Sevoflurane Concentration: A Simulation Study

R. Ross Kennedy, MB, ChB, PhD FANZCA

Department of Anaesthesia, Christchurch Hospital & Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand

Anesth Analg 2005 101: 1023-1028.

 

作者实验室的一项预测性研究中曾将吸入麻醉药的效应部位浓度(Ceff)作为吸入治疗的靶目标。Ceff是由血浆效应部位半数平衡时间[t1/21/2ke0]决定的。在该项预测性研究中,t1/2ke0)是固定的,与患者的实际值有偏差。本研究的目的旨在探讨这种偏差对Ceff预期值的影响。应用计算机模拟模型,调整新鲜气流量及挥发罐设置,使t1/2ke0)分别为2.53.55分钟,以达到数个不同预期的Ceff值。应用每次模拟的呼气末参数和t1/2ke0),重新计算Ceff值。分别计算预测点的最大偏离度,总体吻合度,及复苏延迟时间。当预测性研究中t1/2ke0)为3.5分钟时,Ceff的最大偏离度为0.18vol%,发生在洗入阶段,并在2-3分钟内消失。Ceff1.0降至0.7vol%的时间差异为1.3分钟。当显示出的t1/2ke0)为2.5分钟,模拟出的患者t1/2ke0)为5分钟,或前者为5分钟,后者为2.5分钟时,Ceff结果近似相差两倍。这些结果提示,Cefft1/2ke0)的较大偏离(50%-100%)时相对不敏感。

(田婕 陈杰 校)

We have developed a predictive display that allows effect-site concentration (Ceff) to be used as a target for administration of inhaled anesthesia. Ceff is dependent on the half-time for plasma effect-site equilibrium [t1/21/2(ke0)]. The t1/2(ke0) used in the predictive display is fixed and may differ from that in the patient. We wished to explore the effect of this difference on predictions of Ceff. In a computer simulation, fresh gas flow and vaporizer settings required to achieve a predefined time profile for Ceff were determined for t1/2(ke0) of 2.5, 3.5, and 5 min. The end-tidal values for each simulation were used to recalculate Ceff with each t1/2(ke0). The maximal deviation at predetermined points, measures of global fit, and the delay in "recovery" were calculated. With a predictive display t1/2(ke0) of 3.5 min, the maximal error in Ceff was 0.18 vol%, occurring during the wash-in phase and disappearing within 2–3 min. The difference in time for Ceff to decrease from 1.0 to 0.7 vol% was 1.3 min. Results with a display t1/2(ke0) of 2.5 min or 5 min and simulated patient t1/2(ke0) of 5 min or 2.5 min were approximately twice as large. These results suggest that Ceff is relatively insensitive to large (50%–100%) variations in t1/2(ke0).

 

长期使用氢离子拮抗剂治疗的病人麻醉前使用质子泵抑制剂的有效性

The Efficacy of Preanesthetic Proton Pump Inhibitor Treatment for Patients on Long-Term H2 Antagonist Therapy

Kazuyoshi Hirota, MD, Mihoko Kudo, MD, Hiroshi Hashimoto, MD, and Tetsuya Kushikata, MD

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

Anesth Analg 2005 101: 1038-1041

.

作者曾报道了长期使用氢离子拮抗剂(疗程大于4周)的病人,麻醉前使用氢离子拮抗剂耐受。本次研究,作者评价了长期规则使用氢离子拮抗剂(口服法莫替丁,疗程大于4周)治疗的病人,麻醉前使用质子泵抑制剂(PPI;口服雷贝拉唑)的有效性。48位择期手术的病人假设能够完全耐受氢离子拮抗剂,随机分为两组,一组接受PPI(口服雷贝拉唑20mgn24),另一组接受质子泵抑制剂(口服罗沙替丁75mgn24),服药时间分别为,术前一天晚上9点和麻醉诱导前2小时。于麻醉诱导后,分别测量胃内容量和PH值。PPI组的胃内PH值为(5.38±2.42)较氢离子拮抗剂组(3.27±1.98P<0.01)明显增高。PPI组的胃内容量为(8.6±1.5mL)较氢离子拮抗剂组(15.4±2.8mLP<0.05cf.PPI)明显少。氢离子拮抗剂组有14位病人有产生酸性吸入性肺炎的危险(胃内PH<2.5或容量>25mL),而PPI组仅有4位病人存在此风险(P<0.05)。这些数据表明长期使用氢离子拮抗剂(疗程大于4周)的病人,预防酸性吸入性肺炎应包括麻醉前使用PPI

(肖洁 陈杰 校)

We previously reported that H2-antagonist medication given for longer than 4 wk may produce complete tolerance to preanesthetic H2 antagonist therapy. In this study, we evaluated the efficacy of preanesthetic proton pump inhibitor (PPI; oral rabeprazol) use in patients receiving regular H2-antagonist (oral famotidine) therapy for more than 4 wk. Forty-eight patients with assumed complete tolerance to H2 antagonists undergoing elective surgery were recruited and randomly assigned to receive either a preanesthetic PPI (rabeprazol 20 mg; n = 24) or H2-antagonist (H2 group; roxatidine 75 mg; n = 24) at 9:00 pm on the day before surgery and 2 h before the induction of anesthesia. Volume of gastric contents and pH values were measured after the induction of anesthesia. Gastric pH value in the PPI group (5.38 ± 2.42) was significantly higher than in the H2 group (3.27 ± 1.98; P < 0.01). Gastric volume in the PPI group (8.6 ± 1.5 mL) was significantly smaller than in the H2 group (15.4 ± 2.8 mL; P < 0.05; cf. PPI). Fourteen patients in the H2 group were at risk of acid aspiration pneumonia (gastric pH <2.5 or volume >25 mL), whereas only four patients in the PPI group (P < 0.05) were at risk. These data suggest that in patients receiving H2-antagonist therapy for longer than 4 wk, prophylaxis for acid aspiration pneumonia should include preanesthetic PPI medication.

 

静脉麻醉剂对肥大细胞功能的抑制作用

Inhibitory Effects of Intravenous Anesthetics on Mast Cell Function

Takahiro Fujimoto, MD, PhD, Tomoki Nishiyama, MD, PhD, and Kazuo Hanaoka, MD, PhD

Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Anesth Analg 2005 101: 1054-1059.

 

肥大细胞在炎症和自身组织损伤中起保护作用。肥大细胞功能受损可能会影响机体对感染的防御机制。本文研究四种静脉麻醉剂(硫喷妥钠,咪唑安定,氯胺酮,异丙酚)对肥大细胞趋化性和胞吐作用的影响。利用P物质100μg/ml作为刺激物,通过博伊登技术测定犬肥大细胞的趋化性。利用P物质或伽玛单体的IgG介导的交联作为刺激物通过测定肥大细胞释放的组胺评估肥大细胞的胞吐作用。硫喷妥钠,咪唑安定和异丙酚对肥大细胞的趋化性产生剂量依赖的抑制作用。氯胺酮,咪唑安定和异丙酚对肥大细胞的胞吐作用产生剂量依赖的抑制作用。总之,咪唑安定和异丙酚对肥大细胞的趋化性和胞吐作用都有抑制作用,而硫喷妥钠仅抑制肥大细胞的趋化性,氯胺酮仅抑制肥大细胞的胞吐作用。

(朱辉 陈杰 校)

Mast cells play a protective role in the inflammation and auto-tissue injury. The impairment of mast cell function may influence defense against infection. We investigated the effect of four IV anesthetics (thiopental, midazolam, ketamine, and propofol) on the chemotaxis and exocytosis of mast cells. Canine mast cell chemotaxis was measured by the Boyden's blindwell chamber technique using 100 µg/mL of substance P as a stimulator. We measured mast cell exocytosis by measuring released histamine from mast cells using substance P or gamma-monomeric IgG-mediated crosslinking as a stimulator. Thiopental, midazolam, and propofol exerted a dose-dependent inhibitory effect on mast cell chemotaxis. Ketamine, midazolam, and propofol had a dose-dependent inhibitory effect on mast cell exocytosis. In conclusion, midazolam and propofol inhibited both chemotaxis and exocytosis of mast cells, while thiopental only inhibited chemotaxis, and ketamine only inhibited exocytosis.

 

一项非脂化丙泊酚和含中链甘油三脂的丙泊酚乳剂所引起注射疼痛的比较研究

Pain on Injection of Lipid-Free Propofol and Propofol Emulsion Containing Medium-Chain Triglyceride: A Comparative Study

Prakash K. Dubey, MD, and Arun Kumar, MD

Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, India

Anesth Analg 2005 101: 1060-1062.

丙泊酚引起的注射疼痛一直是麻醉医生关注的问题。目前,在印度市场上,非脂化丙泊酚和含中链甘油三脂的丙泊酚乳剂均可供选择。本研究的目的是对含中链甘油三脂的丙泊酚乳剂和非脂化丙泊酚所引起的注射疼痛进行评估。130名成年病人被随机分为两组:组I病人给予含中链甘油三脂的丙泊酚乳剂;组II病人给予非脂化丙泊酚。计算所得的总的诱导剂量的四分之一经病人手背最大的静脉注射完成,注射时间超过5s。注射疼痛的评估主要是根据病人的言语反应和行为特征。结果两种制剂的丙泊酚均可引起注射疼痛。然而,与含中链甘油三脂的丙泊酚乳剂(40%)相比,非脂化丙泊酚所引起的注射疼痛更常见(89%)、更严重。

(齐波 陈杰 校)

Pain on injection of propofol continues to be a problem for anesthesiologists. A lipid-free formulation of propofol and a propofol emulsion containing medium-chain triglyceride have become available in the Indian market. We performed this study to assess the pain on injection of propofol emulsion containing medium-chain triglyceride as the lipid carrier and lipid-free propofol formulation. One-hundred-thirty adult patients were randomly assigned to one of two groups: Group I received propofol emulsion containing medium-chain triglyceride and Group II received lipid-free propofol. One fourth of the total calculated induction dose was injected over 5 s in the largest vein on the dorsum of a hand. Pain was assessed using verbal response and behavioral signs. Both formulations caused pain on injection. However, the lipid-free propofol solution produced frequent (89%) and severe pain on injection compared with the emulsion containing medium-chain triglyceride (40%).

 

麻醉学中以模拟为基础的评估演示的可行性

The Feasibility of Sharing Simulation-Based Evaluation Scenarios in Anesthesiology

Haim Berkenstadt, MD*{dagger}, Gareth S. Kantor, MD{ddagger}, Yakov Yusim, MD{dagger}, Naomi Gafni, PhD§, Azriel Perel, MD{dagger}, Tiberiu Ezri, MD||¶, and Amitai Ziv, MD

*The Israel Center for Medical Simulation (M.S.R.,1); {dagger}Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Israel; {ddagger}Department of Anesthesiology, University Hospitals of Cleveland, Cleveland, Ohio; §The National Institution for Testing and Evaluation, Jerusalem, Israel; ||Department of Anesthesiology, Edith Wolfson Medical Center, Holon, Israel; and ¶Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel

Anesth Analg 2005 101: 1068-1074.

 

尽管存在语言、教育和麻醉实践背景的不同,作者在以色列,应用美国多学会联合组织验证体系,前瞻性评估以模拟实验为基础的评估方法在全球应用的可行性。31名以色列的低年资住院医生进行了4次模拟演示。培训期被录像,并且以两名独立的等级评定人运用两个有效的评分系统对他们的表现进行评估。长表格的得分范围从379570±12),总分为108,短表格的得分从18 35( 28±4.5),总分为4061%的参与者评分大于总分的70%,而原先US 的研究仅为5%80%的参与者认为演练的等级评定是符合实际的(1-4 级中为4 级)。通过长表格0.66的可信区间和短表格0.75的可信区间原先评价手段的可信度被证实。先前研究的值在长表格为0.72-0.76 ,短表格为0.71-0.75。当修订的以色列的翻译版本被应用时,结果仍是可信的。Pearson 集合的相互作用的可信度分析在长表格为0.91,短表格为0.96p<0.01)。对演示的高分解释和与先前评估方法的相似性都说明在美国和以色列得到改进的以模拟为基础的评估方法的可行性。以色列住院医生的高分可能与以色列住院医生多为先前受过麻醉培训的移民有关。

(忻纪华 陈杰 校)

We prospectively assessed the feasibility of international sharing of simulation-based evaluation tools despite differences in language, education, and anesthesia practice, in an Israeli study, using validated scenarios from a multi-institutional United States (US) study. Thirty-one Israeli junior anesthesia residents performed four simulation scenarios. Training sessions were videotaped and performance was assessed using two validated scoring systems (Long and Short Forms) by two independent raters. Subjects scored from 37 to 95 (70 ± 12) of 108 possible points with the "Long Form" and "Short Form" scores ranging from 18 to 35 (28.2 ± 4.5) of 40 possible points. Scores >70% of the maximal score were achieved by 61% of participants in comparison to only 5% in the original US study. The scenarios were rated as very realistic by 80% of the participants (grade 4 on a 1–4 scale). Reliability of the original assessment tools was demonstrated by internal consistencies of 0.66 for the Long and 0.75 for the Short Form (Cronbach {alpha}statistic). Values in the original study were 0.72–0.76 for the Long and 0.71–0.75 for the Short Form. The reliability did not change when a revised Israeli version of the scoring was used. Interrater reliability measured by Pearson correlation was 0.91 for the Long and 0.96 for the Short Form (P < 0.01). The high scores for plausibility given to the scenarios and the similar reliability of the original assessment tool support the feasibility of using simulation-based evaluation tools, developed in the US, in Israel. The higher scores achieved by Israeli residents may be related to the fact that most Israeli residents are immigrants with previous training in anesthesia.

 

伊拉克战争中士兵受伤的表现,诊断,损伤机制和治疗:在两所军事疼痛治疗中心进行的一项流行病学研究

Presentation, Diagnoses, Mechanisms of Injury, and Treatment of Soldiers Injured in Operation Iraqi Freedom: An Epidemiological Study Conducted at Two Military Pain Management Centers

LTC Steven P. Cohen, MD*{ddagger}, MAJ Scott Griffith, MD{dagger}{ddagger}, LTC Thomas M. Larkin, MD{dagger}{ddagger},, MAJ Felipe Villena, DO§, and Ralph Larkin, PhD

*Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore; {dagger}Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; {ddagger}Department of Anesthesiology, Walter Reed Army Medical Center, Washington, DC; §Pain Management Center, Landstuhl Regional Army Medical Center, Landstuhl, Germany; and ¶John Jay College of Criminal Justice of the City University of New York

Anesth Analg 2005 101: 1098-1103.

在近期的军事冲突中,士兵减员的主要原因不是战斗损伤,大多数常见的原因却与发生在国内生活中的相类似。为了解战时影响士兵的疼痛原因,作者对162名士兵进行了观察性研究,这些人都是由于身体原因而从伊拉克战场上撤离的,在远离战争威胁的两大军事疼痛治疗中心进行治疗。53%的士兵存在根性的(n=49)或轴性的(n=37)下背部疼痛,腰椎间盘突出是最常见的原因(24%)。两种最多见的发病原因是以前手术治疗后病情恶化 (15%)和摩托车事故(12%)。仅有17%的病人是在战斗中受伤的。72%的士兵至少接受了一次神经阻滞/注射,最多的是腰硬膜外类固醇激素治疗(22%)。56%的病人服用非甾体类抗炎药,49%的病人服用阿片类药物,17%的病人接受了其他形式的治疗。在49名可获得数据的病人中,仅有2%回到了伊拉克服役。排除战争相关损伤,现代战争期间疼痛原因与发生在国内的相类似。为了提高好转后返回服役的比例,建议前线部署的医疗机构进行更好的预防和更积极的治疗。

(殷文渊译 陈杰 校)

In recent military conflicts the major source of soldier attrition has not been battle injuries but more mundane causes similar to those encountered in civilian life. In an effort to determine the pain conditions affecting soldiers during wartime, we conducted an observational study among 162 soldiers medically evacuated from Operation Iraqi Freedom who were referred to 2 large pain treatment centers located outside the theaters of combat. Fifty-three percent of soldiers presented with either radicular (n = 49) or axial (n = 37) low back pain, with lumbar herniated disk being the most frequently diagnosed condition (24%). The two most implicated etiologies were exacerbation of a previous pain condition treated with surgery (15%) and motor vehicle accidents(12%). Only 17% of patients were injured during battle. Seventy-two percent of soldiers received at least one nerve block/injection, the most common of which was lumbar epidural steroid administration (22%). Nonsteroidal antiinflammatory drugs were prescribed to 56% of patients, opioids to 49%, and some form of alternative therapy to 17%. Among the 49 patients in whom data were available, only 2% returned to combat duty in Iraq. With the exception of battle-related injuries, the pain conditions suffered during modern warfare seem to be similar to those encountered in civilian pain clinics. To improve the return-to-duty rate, better preventive measures and more aggressive treatment conducted in forward-deployed medical units are recommended.

 

吗啡能够诱导免疫抑制性淋巴细胞凋亡:真的吗?

Immunosuppression by Morphine-Induced Lymphocyte Apoptosis: Is It a Real Issue?

Takeshi Ohara, MD*, Tsunetoshi Itoh, MD{dagger}, and Masahiko Takahashi, MD{ddagger}

*Division of Pain Control, Department of Anesthesiology and Emergency Medicine, and {dagger}Division of Immunology and Embryology, Department of Cell Biology, Tohoku University Graduate School of Medicine, and {ddagger}Division of Dento-oral Anesthesiology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan

Anesth Analg 2005 101: 1117-1122.

 

吗啡是治疗癌痛的良好药物,然而最近不少文献报导吗啡会引起外周血淋巴细胞(PBLs)的凋亡,引起广泛的关注。在本研究中作者评估吗啡是否会引起体外培养的PBLs凋亡。通过流式细胞检测分析表面磷脂酰丝氨酸和核碎片来检测凋亡,并在流式细胞仪器的光散射基础上分析Fas, Bcl-2, Caspase-3 活性。从健康机体分离出外周血单核细胞并且以鬼臼乙叉甙、吗啡或培养基培养48小时。在和鬼臼乙叉甙共同培养过程中,PBLs中显著诱导出凋亡过程,细胞存活没有超过48小时。与之相比,在整个培育期间吗啡没有对凋亡过程产生显著影响。此外,在吗啡和Fas-特异抗体共同培养没有增加凋亡细胞率。实验结果未证明吗啡引起免疫抑制导致淋巴细胞凋亡。在没有更多的研究证明之前,作者认为吗啡仍然是一种理想的止痛剂。

(潘志英 陈杰 校)

Morphine has been an optimal choice for cancer pain management. However, several recent studies suggested that morphine induces apoptosis in human peripheral blood lymphocytes (PBLs), raising a serious concern about the use of opioid-based analgesic strategies. In this study, therefore, we aimed to evaluate whether morphine induced apoptosis in cultured human PBLs. Apoptotic events were assessed by flow-cytometrical detection of surface phosphatidylserine and nuclear fragmentation, as well as Fas, Bcl-2, and Caspase-3 activity in PBLs gated on a light-scatter basis. Peripheral blood mononuclear cells isolated from healthy subjects were cultured with etoposide, morphine, or vehicle (medium) for 48 h. During co-culture with etoposide, apo-ptosis was significantly induced in PBLs, and the cells did not survive for 48 h. In comparison, morphine had no effect on the expression rate of any of the detected molecules, suggesting that no apparent apoptotic processes were induced during the incubation. Furthermore, co-incubation with a Fas-specific antibody did not increase apoptotic cell rates in the morphine cultures. These results do not support the hypothesis that morphine directly modulates PBL apoptosis resulting in immunosuppression. We believe that the choice of opioids for optimal pain relief should not be discouraged until further studies clarify this issue.

 

 

生物和化学紧急事件的准备-------美国麻醉住院医生培训的调查

Emergency Preparedness for Biological and Chemical Incidents: A Survey of Anesthesiology Residency Programs in the United States

Keith A. Candiotti, MD, Aimee Kamat, MD, Paul Barach, MD, MPH, Fani Nhuch, MD, David Lubarsky, MD, MBA, and David J. Birnbach, MD

Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami School of Medicine, Miami, Florida

Anesth Analg 2005 101: 1135-1140.

作者调查了专业医务人员处理病人暴露于危险物品时临床处理问题,包括大规模毁灭性武器(WMD)。对WMD的训练被认为是公共健康政策和准备状态的一个重要部分。尽管这些情况罕见,但一旦发生,将造成大规模伤亡。在许多大规模伤亡处理的例子中,麻醉医生有责任在病人到达医院后立即处理。作者调查了美国麻醉住院医生培训规划提供的麻醉医生对WMD的保护性调整及病人处理的训练程度。信息是通过所有培训点的主管及主席的联机在线调查获得的。调查135家麻醉培训所,其中90家(67%)作出回答。其中只有37%有一些培训形式,而且其中最初的培训之后不再重复训练。密西西比河以东地区28%的培训点有一些训练形式,以西地区则只有17%提供培训。根据调查显示大多数美国麻醉住院医生培训中提供处理WMD下病人的训练很少甚至没有。

(顾新宇译 陈杰校)

We surveyed health care professionals about their preparations to manage the clinical problems associated with patients exposed to hazardous substances, including weapons of mass destruction (WMD). Training for WMD is considered a key part of public health policy and preparedness. Although such events are rare, when they do occur, they can cause mass casualties. In many models of mass casualty management, anesthesiology personnel are responsible for treating patients immediately on arrival at the hospital. We studied the extent of training offered to anesthesiology personnel in the use of WMD protective gear and patient management in United States (US) anesthesiology residency programs. Information was obtained via an online survey to all program directors and chairpersons of anesthesiology programs. We polled all of the 135 US anesthesiology programs of which 90 (67%) responded. Only 37% had any form of training, and many of them did not repeat training after initial sessions. Twenty-eight percent of programs east of the Mississippi River reported some form of training whereas only 17% of programs west of it reported training available. The majority of anesthesia residency programs in the US that responded to our survey provided little or no training in the management of patients exposed to WMD.

 

损伤前或后应用利多卡因或硫贲妥钠来减弱无氧-糖的大鼠海马切片培养的细胞死亡

Pre- or Postinsult Administration of Lidocaine or Thiopental Attenuates Cell Death in Rat Hippocampal Slice Cultures Caused by Oxygen-Glucose Deprivation

Hong Cao, MD*{ddagger}§, Ira S. Kass, PhD*{dagger}{ddagger}, James E. Cottrell, MD*, and Peter J. Bergold, PhD{dagger}

Departments of *Anesthesiology and {dagger}Physiology & Pharmacology, State University of New York Downstate Medical Center, Brooklyn, New York; {ddagger}Department of Anesthesiology, Xuzhou Medical College, Jiangsu Province; and §Anesthesiology Department, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province, People’s Republic of China

Anesth Analg 2005 101: 1163-1169.

在低氧和缺血期间应用利多卡因或硫贲妥钠能改善恢复;但损伤前或后的治疗效应尚不得而知。作者在20天龄的大鼠无氧-糖(OGD)损伤前或后10分钟的海马培养切片中给予利多卡因或硫贲妥钠。用PI荧光作为OGD7天内神经元死亡的观测指标。在海马CA1区和齿状回区OGD诱导的神经元死亡,均在缺血后一天达到高峰。损伤前给利多卡因(10100µM)或硫贲妥钠(250, 600µM)显著减弱OGD12天的损伤;这两个药物同样显著降低两侧大脑OGD后每日的 PI。损伤后给药显著降低OGD后一天的PI,同样也减弱了总计日常OGDPI。这些数据提示,OGD之前或之后给予利多卡因或硫贲妥钠,能在这种脑缺血离体模型减弱神经元的损伤。缺血后给药往往是治疗的第一先机。

(范颖晖 陈杰 校)

Lidocaine and thiopental improve recovery when administrated during hypoxia and ischemia; however, the effect of pre- or postinsult treatment alone is unknown. We applied either lidocaine or thiopental to hippocampal slice cultures from 20-day-old rats either before or after 10 min of oxygen-glucose deprivation (OGD). Propidium iodide (PI) fluorescence was used as an indicator of neuronal death for 7 days after OGD. OGD-induced neuronal death, in both the Cornus Ammonis 1 (CA1) and the dentate gyrus regions, peaked the first day after ischemia. Preinsult administration of either lidocaine (10, 100 µM) or thiopental (250, 600 µM) significantly reduced the damage measured on the first and second days after OGD; these drugs also significantly decreased the summed daily post-OGD PI fluorescence in both regions. Postinsult administration of lidocaine (10, 100 µM) or thiopental (250, 600 µM) significantly decreased the PI fluorescence on the first day after OGD; postinsult administration of these drugs also attenuated the summed daily post-OGD PI. These data indicate that the administration of lidocaine or thiopental either before or directly after OGD reduced neuronal damage in this in vitro model of cerebral ischemia. Postischemic administration is frequently the first opportunity for treatment.

 

单侧坐骨神经阻滞时选择大转子旁不同距离的部位注射是否有差异?

Does the Site of Injection Distal to the Greater Trochanter Make a Difference in Lateral Sciatic Nerve Blockade?

Manuel Taboada, MD*, Jaime Rodríguez, MD, PhD*, Sabela Del Rio, MD*, Juan Lagunilla, MD*, Javier Carceller, MD*, Julián Álvarez, MD, PhD*, and Peter G. Atanassoff, MD{dagger}

*Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Spain; and {dagger}Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut

Anesth Analg 2005 101: 1188-1191

 

坐骨神经的两个不同分支在下肢的走行路线相距甚远,如果使用单次注射技术进行小容量局部阻滞麻醉时可能产生临床差异。在这次前瞻性、随机、双盲实验中,作者比较了两种不同的注射部位(距大转子20cm30cm)分别单次注入1.5%甲哌卡因20mL后,坐骨神经阻滞的起效时间及成功率的差别。50个接受足部手术的患者随机分配至任一组中进行单侧坐骨神经阻滞:距大转子20cm(近侧端组;n=25),距大转子30cm(远侧端组;n=25)。在弯曲的足部对<0.5mA的刺激有反应后注入1.5%甲哌卡因20mL,记录足部感觉和运动阻滞的起效时间。成功率是指坐骨神经所有分布区的感觉和运动阻滞完全,达到无痛手术。近侧端组感觉和运动完全阻滞的时间(12+7min15+8min)比远侧端组(19+9min23+9minP<0.05)快,而且近侧端组较远侧端组成功率更高(分别为88%56%P<0.05)。结论:进行单次小容量的单侧坐骨神经阻滞时,选择坐骨神经近侧端作为注射部位可使起效时间缩短,同时提高阻滞成功率。

(朱慧琛译 陈杰校)

The two components of the sciatic nerve become more distant from one another in their course down the lower limb. This may have clinical implications if a small volume of local anesthetic is used with a single injection technique. In this prospective, randomized, double-blind study, we compared two different injection sites, 20 cm and 30 cm distal to the greater trochanter, in terms of onset time and success rate of sciatic nerve blockade after a single injection of 20 mL of 1.5% mepivacaine. Fifty patients undergoing foot surgery were randomly allocated to receive a lateral sciatic nerve blockade using one of 2 levels: 20 cm distal to the greater trochanter (group proximal; n = 25) and 30 cm distal to the greater trochanter (group distal; n = 25). Twenty milliliters of 1.5% mepivacaine was injected after a flexion plantar response was obtained at <0.5 mA. Time required for onset of sensory and motor blockade of the foot was recorded. Success rate was defined as complete sensory and motor blockade in all sciatic nerve distributions associated with a pain-free surgery. Onset of complete sensory and motor blockade was faster in group proximal (12 ± 7 min and 15 ± 8 min, respectively) compared with group distal (19 ± 9 min and 23 ± 9 min; P < 0.05). Group proximal also had a more frequent success rate compared with group distal (88% versus 56%, respectively; P < 0.05). It is concluded that in lateral sciatic nerve blockade, a more proximal approach to the sciatic nerve predicts a shorter onset time and more frequent success than a more distal injection site when a single injection and a small volume of local anesthetic is used.

 

髋部术后神经阻滞的抗分解代谢作用

The Anticatabolic Effect of Neuraxial Blockade After Hip Surgery

Ralph Lattermann, MD, MSc*, Geesche Belohlavek, MD*, Sigrid Wittmann, MD*, Bernd Füchtmeier, MD{dagger}, and Michael Gruber, PhD*

Departments of *Anesthesia and {dagger}Trauma Surgery, University of Regensburg, Germany

Anesth Analg 2005 101: 1202-1208.

 

尽管已成功建立腹部手术后神经阻滞的蛋白质损耗减少效应,但神经阻滞后对下肢手术后的代谢影响仍不清楚。本研究作者对硬脊联合阻滞(CSE)抑制髋部术后氨基酸氧化这一假说进行了验证。16位将行全髋置换手术的病人进行全身麻醉继以用氰苯双哌酰胺行静脉内病人自控镇痛(对照组;n8),或用0.5%布比卡因行腰麻、用0.2%罗哌卡因和0.5ug/ml舒芬太尼行术后硬膜外镇痛(CSEn8)。术前一天和术后一天的糖和蛋白代谢通过稳定同位素示踪技术(66-2H2糖,L-1-13C 亮氨酸)测定。同时测定糖、乳酸、自由脂肪酸、皮质醇、高血糖素和胰岛素的血浆浓度。CSE阻断了术中和术后当时血糖浓度的升高(切皮后60分钟:CSE4.9±0.7与对照组6.2±0.7mmol/LP<0.05)。CSE组术中皮质醇血浆浓度稍低于对照组。术后一天两组间的血糖浓度、糖代谢产物、和糖清除率相当。CSE抑制了术后亮氨酸氧化率的升高(CSE 30 ± 12 对照组 43 ± 8 µmol·kg–1·h–1; P < 0.05)。两组间蛋白分解、蛋白合成、和血浆乳酸、自由脂肪酸、胰岛素、胰高血糖素无显著差别。结论:CSE能预防髋部手术期间的高血糖,并抑制随后蛋白分解代谢。

(范颖晖 陈杰 校)

Although the protein-sparing effect of neuraxial blockade after abdominal surgery is well established, its metabolic effect after operations on the lower extremities remains unclear. In this study, we tested the hypothesis that combined spinal and epidural blockade (CSE) inhibits amino acid oxidation after hip surgery. Sixteen patients undergoing hip replacement surgery received either general anesthesia followed by IV patient-controlled analgesia with piritramide (control; n = 8) or CSE using bupivacaine 0.5% for spinal anesthesia and ropivacaine 0.2% with 0.5 µg/mL of sufentanil for postoperative epidural analgesia (CSE; n = 8). Glucose and protein kinetics were assessed by stable isotope tracer technique ([6,6-2H2]glucose, L-[1-13C]leucine) on the day before and one day after surgery. Plasma concentrations of glucose, lactate, free fatty acids, cortisol, glucagon, and insulin were also determined. CSE prevented the increase in plasma glucose concentration during and immediately after the operation (60 min after skin incision: CSE 4.9 ± 0.7 versus control 6.2 ± 0.7 mmol/L; P < 0.05; postanesthesia care unit: CSE 5.0 ± 0.9 versus control 7.3 ± 1.1 mmol/L; P < 0.05). Intraoperative cortisol plasma concentrations were smaller in the CSE group than in the control group. One day after the operation, however, glucose plasma concentration, glucose production, and glucose clearance were comparable in both groups. CSE inhibited the postoperative increase in leucine oxidation rate (CSE 30 ± 12 versus control 43 ± 8 µmol·kg–1·h–1; P < 0.05). There were no differences between the groups in protein breakdown, whole body protein synthesis, and plasma concentrations of lactate, free fatty acids, insulin, and glucagon. In conclusion, CSE prevents hyperglycemia during hip surgery and inhibits protein catabolism thereafter.

 

.经鼻腔气管插管时导管尖端设计对鼻腔损伤的影响:Magill尖与Murphy尖之比较

The Influence of Endotracheal Tube Tip Design on Nasal Trauma During Nasotracheal Intubation: Magill-Tip Versus Murphy-Tip

Jong-Hwan Lee, MD*, Chang-Hee Kim, MD{dagger}, Jae-Hyon Bahk, MD*, and Kum-Suk Park, MD*

Departments of *Anesthesiology and {dagger}Otolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Korea

Anesth Analg 2005 101: 1226-1229.

 

本研究应用传统氯化多聚乙烯气管导管(ETT),旨在探讨经鼻腔气管插管时不同尖端设计的ETTMagill尖与Murphy尖)对鼻腔损伤的影响。患者随机分为四组(每组25人):经加热软化处理的Magill尖和Murphy尖,以及未经处理的Magill尖和Murphy尖。ETT在盲探下插入鼻咽部,在直接喉镜暴露下插入气管。通过吸痰管中血液的容积来评估鼻衄的严重程度。未经加热软化处理时,MurphyETTMagillETT鼻衄损伤更严重(P<0.05)。加热软化处理在两种尖端设计ETT中均明显降低鼻衄严重程度(P<0.05)。然而,未经加热软化处理的MagillETT与加热软化处理的MurphyETT相比,鼻衄严重程度,鼻腔损伤和疼痛的发生率无明显差异。加热软化处理能够降低经鼻腔气管插管时损伤发生率,是值得推荐使用的措施。在使用正常导管的情况下,MagillETTMurphyETT损伤更小。

(田婕 陈杰 校)

We performed this study to assess the influence of endotracheal tube (ETT) tip design (Murphy-tip versus Magill-tip) on nasal trauma during nasotracheal intubation with a conventional polyvinyl chloride ETT. Patients were randomly allocated to one of four groups (n = 25 each): Magill-tipped ETT and Murphy-tipped ETT with or without thermosoftening. After preparation with a vasoconstrictor, the selected, well-lubricated ETT was advanced blindly into the nasopharynx, and intubation was completed under direct laryngoscopy. The severity of epistaxis was estimated based on the distance that blood had traveled up the suction catheter and tubing. Without thermosoftening, the Murphy-tipped ETT produced more severe epistaxis than the Magill-tipped ETT (P < 0.05). Thermosoftening effectively reduced the severity of epistaxis for both conventional types of ETT (P < 0.05). However, there was no difference in the severity of epistaxis and the incidence of nasal injury and pain between the Magill-tipped, nonthermosoftened ETT and Murphy-tipped, thermosoftened ETT. Thermosoftening is recommended because it decreases the trauma during nasotracheal intubation. However, if one chooses to use a normal ETT, the Magill-tipped ETT will cause fewer traumas than the Murphy-tipped ETT.