Anesthesia & Analgesia

November 2005

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

线粒体KATP通道在七氟烷预适应和后适应对大鼠在体心脏保护效应中的影响

(颜涛 马皓琳,李士通 校)

The Influence of Mitochondrial KATP-Channels in the Cardioprotection of Preconditioning and Postconditioning by Sevoflurane in the Rat In Vivo

Detlef Obal, Saskia Dettwiler, Christian Favoccia, Horst Scharbatke, Benedikt Preckel, and Wolfgang Schlack

Anesth Analg 2005 101: 1252-1260.

异氟醚抑制血小板增强中性粒细胞介导的冠状动脉内皮细胞动能紊乱作用
(陆文清译 薛张纲校)

Isoflurane Prevents Platelets from Enhancing Neutrophil-Induced Coronary Endothelial Dysfunction

Guochang Hu, M. Ramez Salem, and George J. Crystal

Anesth Analg 2005 101: 1261-1268.

正压肺膨胀期间心肌收缩功能增强

(殷文渊 陈杰 )

Myocardial Systolic Function Increases During Positive Pressure Lung Inflation

Michael F. Haney, Göran Johansson, Sören Häggmark, Björn Biber, Michael F. Haney, Göran Johansson, Sören Häggmark, and Björn Biber

Anesth Analg 2005 101: 1269-1274.

活性氧簇作为心脏损伤和保护的介质:与麻醉实践的关联

(张莹 马皓琳,李士通 校)

Reactive Oxygen Species as Mediators of Cardiac Injury and Protection: The Relevance to Anesthesia Practice (Review Article)
Leo G. Kevin, Enis Novalija, and David F. Stowe

Anesth Analg 2005 101: 1275-1287.

PEDIATRIC ANESTHESIA:

儿童心脏手术期间双侧脑血氧饱和度监测的评估

(齐波 陈杰 )

An Evaluation of Bilateral Monitoring of Cerebral Oxygen Saturation During Pediatric Cardiac Surgery

Barry D. Kussman, David Wypij, James A. DiNardo, Jane Newburger, Richard A. Jonas, Jodi Bartlett, Ellen McGrath, and Peter C. Laussen

Anesth Analg 2005 101: 1294-1300

对于体重小于5公斤的婴儿中心静脉导管的最佳深度

(周荻译 薛张纲校)

The Optimal Depth of Central Venous Catheter for Infants Less Than 5 kg
Jin-Hee Kim, Chong-Sung Kim, Jae-Hyun Bahk, Kyung Joon Cha, Young-Sun Park, Young-Tae Jeon, and Sung-Hee Han

Anesth Analg 2005 101: 1301-1303.

关节内布比卡因-可乐定-吗啡浸润与股神经-坐骨神经阻滞在儿科病人前十字韧带重建术的比较

(周志坚 马皓琳,李士通 校)

Intraarticular Bupivacaine-Clonidine-Morphine Versus Femoral-Sciatic Nerve Block in Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction

Kha M. Tran, Theodore J. Ganley, Lawrence Wells, Arjunan Ganesh, Kimberly I. Minger, and Giovanni Cucchiaro

Anesth Analg 2005 101: 1304-1310

在新生小猪模型中大剂量甲强龙预处理不能减轻深低温停循环后的神经元损伤

(范颖辉 陈杰 校)

Large-Dose Pretreatment with Methylprednisolone Fails to Attenuate Neuronal Injury After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model

Stephan Schubert, Gisela Stoltenburg-Didinger, Anke Wehsack, Dirk Troitzsch, Wolfgang Boettcher, Michael Huebler, Matthias Redlin, Majid Kanaan, Michael Meissler, Peter E. Lange, and Hashim Abdul-Khaliq

Anesth Analg 2005 101: 1311-1318.

AMBULATORY ANESTHESIA:

活性氧簇在心肌损伤和保护的调节方面与麻醉实践的相关性

门诊采用神经周围局麻药注射行全肩关节成形术作为一项门诊操作方案:一项初步可行性研究

(徐丽颖译 薛张纲校)

Total Shoulder Arthroplasty as an Outpatient Procedure Using Ambulatory Perineural Local Anesthetic Infusion: A Pilot Feasibility Study

Brian M. Ilfeld, Thomas W. Wright, F. Kayser Enneking, Jennie A. Mace, Jonathan J. Shuster, Eugene H. Spadoni, Terese L. Chmielewski, and Krista Vandenborne

Anesth Analg 2005 101: 1319-1322.

一项比较格兰司琼复合地塞米松与恩丹司琼复合地塞米松预防腹式子宫切除术病人术后恶心呕吐的随机双盲研究

(黄丽娜 马皓琳,李士通 )

A Randomized, Double-Blind Study of Granisetron Plus Dexamethasone Versus Ondansetron Plus Dexamethasone to Prevent Postoperative Nausea and Vomiting in Patients Undergoing Abdominal Hysterectomy

Tong J. Gan, Andrew Coop, Beverly K. Philip, and the Kytril Study Group

Anesth Analg 2005 101: 1323-1329.

奥坦西隆口服片剂与静脉注射给药用于预防青年男性病人鞘内吗啡注射后引起的恶心呕吐和瘙痒的疗效比较

(肖洁 陈杰 )

Ondansetron, Orally Disintegrating Tablets Versus Intravenous Injection for Prevention of Intrathecal Morphine-Induced Nausea, Vomiting, and Pruritus in Young Males

Arash Pirat, Senay F. Tuncay, Adnan Torgay, Selim Candan, and Gulnaz Arslan

Anesth Analg 2005 101: 1330-1336.

ANESTHETIC PHARMACOLOGY:

术后恶心、呕吐很大程度上受到术后阿片类药物剂量相关性应用的影响

(钟静译 薛张纲校)

Postoperative Nausea and Vomiting Are Strongly Influenced by Postoperative Opioid Use in a Dose-Related Manner
Gregory W. Roberts, Tenna B. Bekker, Helle H. Carlsen, Christine H. Moffatt, Peter J. Slattery, and Anna F. McClure

Anesth Analg 2005 101: 1343-1348.

给予新斯的明是否使术后恶心呕吐有临床意义的增多?

(马皓琳 李士通 校)

Does Neostigmine Administration Produce a Clinically Important Increase in Postoperative Nausea and Vomiting?

Ching-Rong Cheng, Daniel I. Sessler, and Christian C. Apfel

Anesth Analg 2005 101: 1349-1355.

罗库溴胺和琥珀胆碱用于快速顺序麻醉诱导和气管插管的比较:一项急诊病人的前瞻性、随机试验

(忻纪华 陈杰 )

Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation: A Prospective, Randomized Trial in Emergent Cases
Mathias Sluga, Wolfgang Ummenhofer, Wolfgang Studer, Martin Siegemund, and Stephan C. Marsch

Anesth Analg 2005 101: 1356-1361.

氧化亚氮不是阻滞阿曲库铵的介质

(孙卓真译 薛张纲校)

Nitric Oxide Is Not a Mediator of Inflammation-Induced Resistance to Atracurium

Heidrun Fink, Ralph Bogdanski, Peter Luppa, J. A. Jeevendra Martyn, and Manfred Blobner

Anesth Analg 2005 101: 1362-1367.

多沙普仑仅能轻微降低健康志愿者的寒战阈值

(黄佳佳 马皓琳,李士通 校)

Doxapram Only Slightly Reduces the Shivering Threshold in Healthy Volunteers

Ryu Komatsu, Papiya Sengupta, Grigory Cherynak, Anupama Wadhwa, Daniel I. Sessler, Jin Liu, Harrell E. Hurst, and Rainer Lenhardt \Anesth Analg 2005 101: 1368-1373.

睡眠呼吸暂停综合征患者麻醉前给予可乐定:一项随机,双盲,对照性研究

(田婕 陈杰 )

Clonidine Premedication in Patients with Sleep Apnea Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study
Michael T. Pawlik, Ernil Hansen, Daniela Waldhauser, Christoph Selig, and Thomas S. Kuehnel

Anesth Analg 2005 101: 1374-1380.

麻醉剂和酒精对于异卵细胞G-蛋白偶联钾通道内部调节在α-2肾上腺素能受体亚型的作用

(王慧琳译 薛张纲校)

The Effects of Anesthetics and Ethanol on {alpha}2 Adrenoceptor Subtypes Expressed with G Protein-Coupled Inwardly Rectifying Potassium Channels in Xenopus Oocytes
Koji Hara, Tomohiro Yamakura, Takeyoshi Sata, and R. Adron Harris

Anesth Analg 2005 101: 1381-1388.

成年大鼠全麻后两周的空间记忆能力

(邱郁薇 马皓琳,李士通 校)

Spatial Memory Performance 2 Weeks After General Anesthesia in Adult Rats

Catherine Crosby, Deborah J. Culley, Mark G. Baxter, Rustam Yukhananov, and Gregory Crosby

Anesth Analg 2005 101: 1389-1392

TECHNOLOGY, COMPUTING, AND SIMULATION:

现代无线电通讯技术及其与生命保障设备的电磁相容性

(潘志英译 陈杰校)

Modern Wireless Telecommunication Technologies and Their Electromagnetic Compatibility with Life-Supporting Equipment

Mats K. E. B. Wallin, Therese Marve, and Peter K. Hakansson

Anesth Analg 2005 101: 1393-1400.

降低手术时着火的发生率:从麻醉机通过鼻导管提供低于100%O2混合气体

(朱 马皓琳, 李士通 校)

Reducing the Incidence of Surgical Fires: Supplying Nasal Cannulae with sub-100% O2 Gas Mixtures from Anesthesia Machines (Medical Intelligence)

Samsun Lampotang, Nikolaus Gravenstein, David A. Paulus, and Dietrich Gravenstein

Anesth Analg 2005 101: 1407-1412

PAIN MEDICINE:

在大鼠甲醛试验中鞘内注射腺苷受体亚型激动剂抵抗伤害性刺激

(孙敏莉译,薛张纲校)

Antinociception of Intrathecal Adenosine Receptor Subtype Agonists in Rat Formalin Test
Myung Ha Yoon, Hong Beom Bae, and Jeong Il Choi

Anesth Analg 2005 101: 1417-1421.

大鼠硬膜外腔使用加巴喷丁的神经安全性:一项光学显微镜检查

(黄施伟 马皓琳,李士通 校)

The Neurological Safety of Epidural Gabapentin in Rats: A Light Microscopic Examination

Sang-Sik Choi, Yong-Chul Kim, Young Jin Lim, Chul-Joong Lee, Pyung-Bok Lee, Sang-Chul Lee, Woo-Seok Sim, and Yoon-La Choi

Anesth Analg 2005 101: 1422-1426.

应用加巴喷丁和局麻药多模式镇痛预防乳腺癌术后急性和慢性疼痛

(张美荣 陈杰 )

Multimodal Analgesia with Gabapentin and Local Anesthetics Prevents Acute and Chronic Pain After Breast Surgery for Cancer
Argyro Fassoulaki, Argyro Triga, Aikaterini Melemeni, and Constantine Sarantopoulos

Anesth Analg 2005 101: 1427-1432.

骶髂关节疼痛:综合解剖、诊断和治疗的综述

(金琳 薛张纲 校)

Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment (Review Article)
Steven P. Cohen

Anesth Analg 2005 101: 1440-1453.

CRITICAL CARE AND TRAUMA:

猪内毒素性休克时血清S-100B的微量增加可能表示血脑屏障的损伤

(顾新宇 陈杰 )

Slight Increase of Serum S-100B During Porcine Endotoxemic Shock May Indicate Blood-Brain Barrier Damage
Anders Larsson, Miklós Lipcsey, Jan Sjölin, Lars-Olof Hansson, and Mats B. Eriksson

Anesth Analg 2005 101: 1465-1469.

行为疼痛评分在评估危重、镇静和机械通气病人的有效性研究

(吴德华译 薛张纲校)

Validation of a Behavioral Pain Scale in Critically Ill, Sedated, and Mechanically Ventilated Patients

Younès Aïssaoui, Amine Ali Zeggwagh, Aïcha Zekraoui, Khalid Abidi, and Redouane Abouqal

Anesth Analg 2005 101: 1470-1476.

由急救医疗学技术员中比较喉管和气囊-活瓣面罩通气:一项在麻醉患者身上的可行性研究

(彭中美 马皓琳,李士通 校)

A Comparison of the Laryngeal Tube and Bag-Valve Mask Ventilation by Emergency Medical Technicians: A Feasibility Study in Anesthetized Patients

Jouni O. Kurola, Matti J. Turunen, Juha-Pekka Laakso, Jouko T. Gorski, Heikki J. Paakkonen, and Tom O. Silfvast

Anesth Analg 2005 101: 1477-1481.

钝性胸部创伤所致的独立的双侧肺挫伤的大鼠模型

(朱慧琛 陈杰 )

A Rat Model for Isolated Bilateral Lung Contusion from Blunt Chest Trauma
Krishnan Raghavendran, Bruce A. Davidson, Jadwiga D. Helinski, Cristi J. Marschke, Patricia Manderscheid, James A. Woytash, Robert H. Notter, and Paul R. Knight

Anesth Analg 2005 101: 1482-1489

NEUROSURGICAL ANESTHESIA:

术后口服恩丹司琼裂解片剂对预防听神经瘤术后恶心呕吐的作用

(吴德华译 薛张纲校)

The Efficacy of Postoperative Ondansetron (Zofran®) Orally Disintegrating Tablets for Preventing Nausea and Vomiting After Acoustic Neuroma Surgery

Theresa Hartsell, Donlin Long, and Jeffrey R. Kirsch
Anesth Analg 2005 101: 1492-1496.

REGIONAL ANESTHESIA:

硬膜外导管置管前经穿刺针注入局部麻醉药能改善麻醉质量并减少导管相关并发症

(赵延华译 陈杰校)

Administration of Local Anesthetic Through the Epidural Needle Before Catheter Insertion Improves the Quality of Anesthesia and Reduces Catheter-Related Complications

Mehmet Cesur, Haci A. Alici, Ali F. Erdem, Fikret Silbir, and Mustafa S. Yuksek

脉搏氧饱和度波形振幅在成人硬膜外麻醉时含肾上腺素的试验剂量注入血管时的指示作用

(金 路译 薛张纲校)

The Efficacy of Plethysmographic Pulse Wave Amplitude as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Anesthetized Adults

Hany A. Mowafi

Anesth Analg 2005 101: 1506-1511.

小剂量布比卡因-苏芬太尼预防脊麻后的心输出量改变

(裘毅敏 李士通 校)

Small-Dose Bupivacaine-Sufentanil Prevents Cardiac Output Modifications After Spinal Anesthesia

Karim Asehnoune, Eric Larousse, Jean Marc Tadié, Vincent Minville, Stephane Droupy, and Dan Benhamou

Anesth Analg 2005 101: 1512-1515.

预防性静注枢复宁和多拉司琼对于鞘内注射吗啡所致瘙痒的影响:一项随机、双盲、对照研究

(苏殿三 陈杰 )

Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study
Christos A. Iatrou, Christos K. Dragoumanis, Theodosia D. Vogiatzaki, George I. Vretzakis, Constantinos E. Simopoulos, and Vasilios K. Dimitriou

Anesth Analg 2005 101: 1516-1520.

持续硬膜外麻醉和镇痛对食管根治术病人应激反应和免疫功能的影响

(王丽珺译 薛张纲校)

The Effects of Continuous Epidural Anesthesia and Analgesia on Stress Response and Immune Function in Patients Undergoing Radical Esophagectomy

Masataka Yokoyama, Yoshitaro Itano, Hiroshi Katayama, Hiroshi Morimatsu, Yoshimasa Takeda, Toru Takahashi, Osamu Nagano, and Kiyoshi Morita

Anesth Analg 2005 101: 1521-1527.

GENERAL ARTICLES:

抛物线飞行时微重力状态下喉镜引导气管插管的可行性:两种技术的比较

(陈玮 李士通 校)

The Feasibility of Laryngoscope-Guided Tracheal Intubation in Microgravity During Parabolic Flight: A Comparison of Two Techniques

Gernot E. Groemer, Joseph Brimacombe, Thorsten Haas, Cristina de Negueruela, Alexander Soucek, Michael Thomsen, and Christian Keller Anesth Analg 2005 101: 1533-1535.

气管导管套囊内应用碱化利多卡因的效能和安全性评价

(郑拥军 陈杰 校)

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Jean-Pierre Estebe, Marc Gentili, Pascal Le Corre, Gilles Dollo, François Chevanne, and Claude Ecoffey

Anesth Analg 2005 101: 1536-1541.

身高甲状颏距离比值的预测价值:对困难气道的四项预测试验

(王丽珺译 薛张纲校)

The Predictive Value of the Height Ratio and Thyromental Distance: Four Predictive Tests for Difficult Laryngoscopy
Banjong Krobbuaban, Siriwan Diregpoke, Sujarit Kumkeaw, and Malin Tanomsat

Anesth Analg 2005 101: 1542-1545.

静脉内补足晶体液不能减少外科伤口感染的危险

(张 马皓琳,李士通 校)

Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection

Barbara Kabon, Ozan Akça, Akiko Taguchi, Angelika Nagele, Ratnaraj Jebadurai, Cem F. Arkilic, Neeru Sharma, Arundhathi Ahluwalia, Susan Galandiuk, James Fleshman, Daniel I. Sessler, and Andrea Kurz

Anesth Analg 2005 101: 1546-1553

 

正压肺膨胀期间心肌收缩功能增强

Myocardial Systolic Function Increases During Positive Pressure Lung Inflation

Michael F. Haney, Göran Johansson, Sören Häggmark, Björn Biber, Michael F. Haney, MD, PhD, Göran Johansson, MS, Sören Häggmark, MS, and Björn Biber, MD, PhD

Anesthesiology and Intensive Care Medicine, Umeå University Hospital, Umeå, Sweden

Anesth Analg 2005 101: 1269-1274.

气道正压肺膨胀可以对心肌收缩功能产生迅速而动态的影响。作者设计了本研究来评估临床相应通气压力下单次正压肺膨胀期间心肌功能变化的大小和时间。在840Kg的麻醉的猪中,直接测量左室压力和容量。肺膨胀时给予15cmH2O的平台期压力,记录两点单次搏动时进行分析,一点是气道压为零的呼吸暂停期间,另一点是肺第一次最大膨胀时。分析气道压为零时和PPLI-15时的收缩功能变化。在气道压从零变化至PPLI15期间,从双线时间变化弹性曲线上得出的弹性大约增加了15%。这个结果同左室收缩功能提高是相一致的。在持续气道正压和肺膨胀情况下应连续测量心肌功能。

(殷文渊 陈杰 校)

Lung inflation with positive airway pressure may have rapid and dynamic effects on myocardial contractile function. We designed this study to assess the magnitude and time to onset of myocardial function changes during the initiation of single positive pressure lung inflation at clinically relevant inflation pressures. In 8 anesthetized 40-kg pigs, left ventricular pressures and volumes were measured directly (conductance volumetry). A 15 cm H2O airway pressure plateau with lung inflation (PPLI-15) was performed, and 2 single beats from that sequence, one from resting apnea at zero airway pressure and the second from the point when the lungs were first maximally inflated, were selected for analysis. Systolic function variables for zero airway pressure and PPLI-15 were analyzed. Systolic elastance, derived from bilinear time-varying elastance curves, increased approximately 15% during PPLI-15 from zero airway pressure. This agreed with other systolic function variables that identified an increase in left ventricular contractile function for the lung inflation beat. Serial measurements of myocardial function should be conducted with constant airway pressure and lung inflation conditions.

 

儿童心脏手术期间双侧脑血氧饱和度监测的评估

An Evaluation of Bilateral Monitoring of Cerebral Oxygen Saturation During Pediatric Cardiac Surgery

Barry D. Kussman, MBBCh*||, David Wypij, PhD{dagger}{ddagger}#{dagger}{dagger}, James A. DiNardo, MD*||, Jane Newburger, MD, MPH{ddagger}¶#, Richard A. Jonas, MD§**, Jodi Bartlett, RN{ddagger}, Ellen McGrath, RN{ddagger}, and Peter C. Laussen, MBBS*{ddagger}||¶

Departments of *Anesthesiology, Perioperative, and Pain Medicine, {dagger}Clinical Research Program, {ddagger}Cardiology and §Cardiovascular Surgery, Children’s Hospital Boston; Departments of Anesth

||Anesthesia, ¶Cardiology, #Pediatrics, and **Surgery, Harvard Medical School; and {dagger}{dagger}Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Anesth Analg 2005 101: 1294-1300.

 

脑血氧饱和度是一项心脏手术期间监测局部脑氧合情况的技术。本研究作者选择了62名双侧心室修补而无主动脉弓重建手术的婴儿,运用近红外线光谱技术评估两侧大脑半球血氧饱和度的差异。麻醉诱导后持续记录左侧和右侧局部脑氧饱和度指数(rSO2i),并在12个时间点对数据进行分析。rSO2i基础值左侧为65±13,右侧为66±13(P=0.17)。不考虑深低温停循环的应用,在体外循环前、中、后各阶段,平均左、右rSO2i值无明显差异(<2个百分点/绝对刻度值)。在这类病人中,还需进一步进行纵向神经学结果的研究来确定是否进行单侧还是双侧大脑半球的氧监测。

(齐波 陈杰 校)

Cerebral oximetry is a technique that enables monitoring of regional cerebral oxygenation during cardiac surgery. In this study, we evaluated differences in bi-hemispheric measurement of cerebral oxygen saturation using near-infrared spectroscopy in 62 infants undergoing biventricular repair without aortic arch reconstruction. Left and right regional cerebral oxygen saturation index (rSO2i) were recorded continuously after the induction of anesthesia, and data were analyzed at 12 time points. Baseline rSO2i measurements were left 65 ± 13 and right 66 ± 13 (P = 0.17). Mean left and right rSO2i measurements were similar (≤2 percentage points/absolute scale units) before, during, and after cardiopulmonary bypass, irrespective of the use of deep hypothermic circulatory arrest. Further longitudinal neurological outcome studies are required to determine whether uni- or bi-hemispheric monitoring is required in this patient population.

 

在新生小猪模型中大剂量甲强龙预处理不能减轻深低温停循环后的神经元损伤

Large-Dose Pretreatment with Methylprednisolone Fails to Attenuate Neuronal Injury After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model

Stephan Schubert, MD*, Gisela Stoltenburg-Didinger, MD, PhD§, Anke Wehsack, MD*, Dirk Troitzsch, MD*, Wolfgang Boettcher, ECCP{ddagger}, Michael Huebler, MD{ddagger}, Matthias Redlin, MD{dagger}, Majid Kanaan, MD*, Michael Meissler, MD||, Peter E. Lange, MD, PhD*, and Hashim Abdul-Khaliq, MD, PhD*

Departments of *Paediatric Cardiology and Congenital Heart Disease, {dagger}Anesthesiology, and {ddagger}Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin; §Department of Neuropathology, University Clinic Benjamin Franklin, Free University of Berlin; and ||Animal Experimental Laboratory, Charité, Humboldt University, Berlin, Germany

Anesth Analg 2005 101: 1311-1318.

 

有关甾体类药对心肺转流和深低温停循环(DHCA)的神经元保护作用的报告结果不一致。作者评估了新生小猪深低温停循环后神经元细胞损伤的型式和严重程度,以及大剂量甲强龙(MP)系统性预处理可能的神经保护作用。19只新生小猪(年龄,<10天,体重, 2.1±0.5kg)随机分为2组:7只在术前24小时给予系统性大剂量MP30mg/kg),12只未予药物预处理(生理盐水)作为对照组。所有动物均连接全流量体外循环降温至15℃并维持120分钟的DHCACPB复温至38.5℃后,停转流,再存活6小时后处死,取脑组织用于光镜、电镜、免疫组化和TUNEL染色检查。对海马、皮质、小脑和尾核进行定量组织学研究。大剂量MP系统预处理导致了持续性高糖血症,但脑灌注无明显改变。DHCA120分钟后在所有分析的脑区均可见到神经元细胞死亡或凋亡。与对照组比较,系统性大剂量MP预处理导致神经元细胞坏死加速,并在海马齿状回诱发显著神经元凋亡(P0.001)。结论:系统性大剂量MP预处理不能削弱延迟性DHCA后神经元细胞损伤,并会诱导齿状回区域性神经元凋亡。

(范颖辉 陈杰 校)

Conflicting results have been reported with regard to the neuroprotective effects of steroidtreatment with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). We evaluated the mode and severity of neuronal cell injury in neonatal piglets after prolonged DHCA and the possible neuroprotective effect of systemic pretreatment (>6 h before surgery) with large-dose methylprednisolone (MP). Nineteen neonatal piglets (age, <10 days; weight, 2.1 ± 0.5 kg) were randomly assigned to 2 groups: 7 animals were pretreated with large-dose systemic MP (30 mg/kg) 24 h before surgery, and 12 animals without pharmacological pretreatment (saline) served as control groups. All animals were connected to full-flow CPB with cooling to 15°C and 120 min of DHCA. After rewarming to 38.5°C with CPB, animals were weaned from CPB and survived 6 h before they were killed, and the brain was prepared for light and electron microscopy, immunohistochemistry, and TUNEL-staining. Quantitative histological studies were performed in hippocampus, cortex, cerebellum, and caudate nucleus. Systemic pretreatment with large-dose MP lead to persistent hyperglycemia but no significant changes of cerebral perfusion. Necrotic and apoptotic neuronal cell death were detected in all analyzed brain regions after 120 min of DHCA. In comparison to the control group, large-dose pretreatment with systemic MP lead to an increase of necrotic neuronal cell death and induced significant neuronal apoptosis in the dentate gyrus of the hippocampus (P = 0.001). In conclusion, systemic pretreatment with large-dose MP fails to attenuate neuronal cell injury after prolonged DHCA and induces regional neuronal apoptosis in the dentate gyrus.

 

奥坦西隆口服片剂与静脉注射给药用于预防青年男性病人鞘内吗啡注射后引起的恶心呕吐和瘙痒的疗效比较

Ondansetron, Orally Disintegrating Tablets Versus Intravenous Injection for Prevention of Intrathecal Morphine-Induced Nausea, Vomiting, and Pruritus in Young Males

Arash Pirat, MD, Senay F. Tuncay, MD, Adnan Torgay, MD, Selim Candan, MD, and Gulnaz Arslan, MD

Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey and Department of Anesthesiology, Air Force Hospital, Etimesgut, Ankara, Turkey

Anesth Analg 2005 101: 1330-1336.

 

本研究比较了奥坦西隆口服片剂(ODT)与静脉注射(IV)给药用于预防健康青年男性病人鞘内吗啡注射后引起的皮肤瘙痒和术后恶心呕吐(PONV)的疗效。所有病人用吗啡0.2mg含有的布比卡因行脊麻,随机分为三组:ODT组(ODT奥坦西隆8mgn=50);IV组(奥坦西隆4mgn=50);空白对照组(n=50)。分别在术后026121824小时,使用3个不同的VAS量表评价病人瘙痒及术后恶心呕吐的程度。记录术后恶心呕吐的发生频率和止吐剂止痒剂的使用频率。三组之间PONV的发生率和严重程度没有显著性差异,术后疼痛VAS评分也没有显著性差异。ODT组皮肤瘙痒的发生率为(56%),IV组为(66%),对照组为(86%);前两组与对照组相比差异均有统计学意义(P<0.02)。ODT组的瘙痒, VAS评分在术后02612小时均较对照组明显减低(P<0.023)。ODT组使用止痒剂的频率明显较对照组低(P=0.013)。口服奥坦西隆8mg和静脉注射奥坦西隆4mg均较对照组有效地预防吗啡脊麻后引起的瘙痒,但对吗啡脊麻后引起的恶心呕吐均无明显疗效。

(肖洁 陈杰 )

In this study we compared the efficacy of orally disintegrating tablets (ODT) and IV ondansetron for preventing spinal morphine-induced pruritus and postoperative nausea and vomiting (PONV) in healthy young male patients. Patients who received bupivacaine with 0.20 mg morphine for spinal anesthesia were randomly assigned to the ODT group (ODT ondansetron 8 mg, n = 50), the IV group (4 mg ondansetron IV, n = 50), or the placebo group (n = 50). Each individual was assessed for pruritus, postoperative nausea and vomiting, and pain at 0, 2, 6, 12, 18, and 24 h after surgery using three distinct visual analog scales. The frequencies of postoperative nausea and vomiting and frequencies of requirement for rescue antiemetic and antipruritic were recorded. There were no significant differences among the three groups with respect to incidence or severity of PONV or postoperative pain visual analog scale scores. The incidences of pruritus in the ODT (56%) and IV (66%) groups were significantly different from that in the placebo group (86%) (P < 0.02 for both). Only the ODT group had significantly lower mean pruritus visual analog scale scores at 0, 2, 6, and 12 h postsurgery than the placebo group (P < 0.023 for all). The frequency of requirement for rescue antipruritic was significantly less in the ODT group than the placebo group (P = 0.013). Both ODT ondansetron 8 mg and IV ondansetron 4 mg are more effective than placebo for preventing spinal morphine-induced pruritus, but neither form of this agent reduces spinal morphine-induced postoperative nausea and vomiting in this patient group.

 

罗库溴胺和琥珀胆碱用于快速顺序麻醉诱导和气管插管的比较:一项急诊病人的前瞻性、随机试验

Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation: A Prospective, Randomized Trial in Emergent Cases

Mathias Sluga, MD, Wolfgang Ummenhofer, MD, Wolfgang Studer, MD, Martin Siegemund, MD, and Stephan C. Marsch, MD, DPhil

Department of Anesthesia, Krankenhaus Thusis, Switzerland

Anesth Analg 2005 101: 1356-1361

.

对于选择性病人以丙泊酚行麻醉诱导时,在注射罗库溴胺和琥珀胆碱约60秒后行气管内插管条件无差异。本研究调查在急诊病人中,两者之间是否仍无差异。选择180例急诊需气管插管的病人,在丙泊酚诱导后,分别在注射罗库溴胺(0.6mg/kg)60秒后或琥珀胆碱(1mg/kg)行气管内插管。从开始诱导至完成插管的时间,琥珀胆碱组明显短于罗库溴胺组(平均为95秒和130秒;p<0.0001)。气管内插管的条件以9分制记,琥珀胆碱组明显高于罗库溴胺组(分别为8.6±1.18.5±1.5p<0.001)。两组间插管困难的病例(分别为79例)或第一次插管失败的病例(分别为45例)无显著差异。作者认为在急诊病人的顺序麻醉诱导和气管内插管时,琥珀胆碱较罗库溴胺所需时间更短,提供的插管条件更佳。

(忻纪华 陈杰 )

When anesthesia is induced with propofol in elective cases, endotracheal intubation conditions are not different between succinylcholine and rocuronium approximately 60 s after the injection of the neuromuscular relaxant. In the present study, we investigated whether, in emergent cases, endotracheal intubation conditions obtained at the actual moment of intubation under succinylcholine differ from those obtained 60 s after the injection of rocuronium. One-hundred-eighty adult patients requiring rapid sequence induction of anesthesia for emergent surgery received propofol (1.5 mg/kg) and either rocuronium (0.6 mg/kg; endotracheal intubation 60 s after injection) or succinylcholine (1 mg/kg; endotracheal intubation as soon as possible). The time from beginning of the induction until completion of the intubation was shorter after the administration of succinylcholine than after rocuronium (median time 95 s versus 130 s; P < 0.0001). Endotracheal intubation conditions, rated with a 9-point scale, were better after succinylcholine administration than after rocuronium (8.6 ± 1.1 versus 8.0 ± 1.5; P < 0.001). There was no significant difference in patients with poor intubation conditions (7 versus 12) or in patients with failed first intubation attempt (4 versus 5) between the groups. We conclude that during rapid sequence induction of anesthesia in emergent cases, succinylcholine allows for a more rapid endotracheal intubation sequence and creates superior intubation conditions compared with rocuronium.

 

睡眠呼吸暂停综合征患者麻醉前给予可乐定:一项随机,双盲,对照性研究

Clonidine Premedication in Patients with Sleep Apnea Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study

Michael T. Pawlik, MD, DEAA*, Ernil Hansen, MD, PhD*, Daniela Waldhauser*, Christoph Selig, MD{ddagger}, and Thomas S. Kuehnel, MD{dagger}

Departments of *Anesthesiology and {dagger}Otorhinolaryngology, Universitätsklinik Regensburg; and {ddagger}Department of Anesthesiology, Universitätsklinik Ulm, Germany

Anesth Analg 2005 101: 1374-1380.

 

睡眠呼吸暂停综合征患者常常伴有心脏疾病及呼吸困难,术后发生呼吸抑制的风险很高。作者对30位患有梗阻性睡眠呼吸暂停的择期行耳--喉手术患者进行了一项随机,双盲,对照性研究。患者随机分为对照组及实验组,实验组在术前一天晚上和当天清晨手术前2小时分别口服可乐定2 μg/kg。持续监测SpO2,心率,平均动脉压(MAP),打鼾情况,及口鼻气流量36小时。应用丙泊酚和瑞芬太尼麻醉。记录患者的麻醉药物用量,术后镇痛药物,和疼痛评分。可乐定组在麻醉诱导期,术中,及复苏期MAP明显较低。可乐定组麻醉诱导及维持期丙泊酚用量分别为190±32.2 mg6.3±1.3 mg·kg-1·h-1,对照组分别为218±32.4 mg7.7±1.5 mg·kg-1·h-1,前者明显较低(P<0.05)。可乐定组哌腈米特用量(可乐定组,7.4±5.1 mg;对照组,14.2±8.5 mg)及疼痛评分也明显较低。两组间通气不足情况和去氧饱和指数无明显差异,但对照组手术当天术后最低氧饱和度明显低于可乐定组(76.7%±8.0%82.4%±5.8%P<0.05)。作者认为麻醉前口服可乐定能够稳定麻醉诱导,维持及复苏期患者血流动力学,降低术中麻醉药物及术后阿片类药物用量,并对通气无任何影响。

(田婕 陈杰 )

Patients with sleep apnea often present with cardiac diseases and breathing difficulties, with a high risk of postoperative respiratory depression. We conducted a randomized, double-blind, prospective study in 30 adult patients with obstructive sleep apnea, undergoing elective ear-nose-throat surgery. The patients were randomly assigned to receive placebo or clonidine (2 µg/kg oral) the night before and the next morning 2 h before surgery. Spo2, heart rate, mean arterial blood pressure, snoring, and oronasal airflow were monitored for 36 h. A standard anesthesia was used consisting of propofol and remifentanil. Anesthetic drug consumption, postoperative analgesics, and pain score were recorded. In the clonidine group, mean arterial blood pressures were significantly lower during induction, operation, and emergence from anesthesia. Both propofol dose required for induction (190 ± 32.2 mg) and anesthesia (6.3 ± 1.3 mg · kg–1 · h–1) during surgery were significantly reduced in the clonidine group compared with the placebo group (induction 218 ± 32.4, anesthesia 7.70 ± 1.5; P < 0.05). Piritramide consumption (7.4 ± 5.1 versus 14.2 ± 8.5 mg; P < 0.05) and analgesia scores were significantly reduced in the clonidine group. Apnea and desaturation index were not different between the groups, whereas the minimal postoperative oxygen saturation on the day of surgery was significantly lower in the placebo than in the clonidine group (76.7% ± 8.0% versus 82.4% ± 5.8%; P < 0.05). We conclude that oral clonidine premedication stabilizes hemodynamic variables during induction, maintenance, and emergence from anesthesia and reduces the amount of intraoperative anesthetics and postoperative opioids without deterioration of ventilation.

 

现代无线电通讯技术及其与生命保障设备的电磁相容性

Modern Wireless Telecommunication Technologies and Their Electromagnetic Compatibility with Life-Supporting Equipment
Mats K. E. B. Wallin, Therese Marve, and Peter K. Hakansson

Department of Anesthesiology and Intensive Care, Karolinska Hospital, S-171 76 Stockholm, Sweden.

Anesth Analg 2005 101: 1393-1400.

 

在紧急状态下,医院依靠管理程序系统和普通的电话来联系工作人员。新型的通讯技术例如:通用无线业务(GPRS),第三代移动通信系统(UMTS),无线局域网 (WLAN),如果它们和医疗设备有良好的电磁兼容的话或许能替代传统的医院管理程序系统。在本研究中作者探索GPRS, UMTS (宽带分码多工存取[WCDMA FDD]), WLAN (IEEE 802.11b)传送的信号对ICU和手术室生命保障设备的干扰。在11个手术间和ICU进行临床试验,按照美国标准,ANSI C63.18-1997试验设备用来检测76台医疗设备。UMTS WLAN信号对设备有少许干扰。在ICU和手术室采用这些技术的设备可以安全使用。但是应当避免无线电通迅和医疗设备的直接接触。在GPRS试验中,50cm的距离会导致老式的输注泵报警并停止运行,并不得不重新启动,并且有10例干扰生命保障设备。GPRS可以在1m的距离安全使用。可以使用这些技术的终端设备或移动电话,因为其对生命保障设备的干扰风险微乎其微。

(潘志英译  陈杰校)

Hospitals rely on pagers and ordinary telephones to reach staff members in emergency situations. New telecommunication technologies such as General Packet Radio Service (GPRS), the third generation mobile phone system Universal Mobile Telecommunications System (UMTS), and Wireless Local Area Network (WLAN) might be able to replace hospital pagers if they are electromagnetically compatible with medical devices. In this study, we sought to determine if GPRS, UMTS (Wideband Code Division Multiple Access-Frequency Division Duplex [WCDMA FDD]), and WLAN (IEEE 802.11b) transmitted signals interfere with life-supporting equipment in the intensive care and operating room environment. According to United States standard, ANSI C63.18–1997, laboratory tests were performed on 76 medical devices. In addition, clinical tests during 11 operations and 100 h of intensive care were performed. UMTS and WLAN signals caused little interference. Devices using these technologies can be used safely in critical care areas and during operations, but direct contact between medical devices and wireless communication devices ought to be avoided. In the case of GPRS, at a distance of 50 cm, it caused an older infusion pump to alarm and stop infusing; the pump had to be reset. Also, 10 cases of interference with device displays occurred. GPRS can be used safely at a distance of 1 m. Terminals/cellular phones using these technologies should be allowed without restriction in public areas because the risk of interference is minimal.

 

应用加巴喷丁和局麻药多模式镇痛预防乳腺癌术后急性和慢性疼痛

Multimodal Analgesia with Gabapentin and Local Anesthetics Prevents Acute and Chronic Pain After Breast Surgery for Cancer

Argyro Fassoulaki, MD, PhD, DEAA*, Argyro Triga, MD{dagger}, Aikaterini Melemeni, MD*, and Constantine Sarantopoulos, MD, PhD, DEAA{ddagger}

*Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens; {dagger}Department of Anesthesiology, St. Savas Hospital, Athens, Greece; and {ddagger}Department of Anesthesiology, Medical College of Wisconsin, Milwaukee

Anesth Analg 2005 101: 1427-1432.

 

作者评估了多模式镇痛对乳腺癌术后急性和慢性疼痛的作用。50名择期乳腺癌手术病人随机盲法,接受加巴喷丁,低熔局部麻醉药乳剂,伤口上应用罗哌卡因或三种安慰剂。记录麻醉后监护室(PACU)3h6h9h和术后8天疼痛(VAS)评分和镇痛药用量。三个月和六个月之后,评定病人慢性疼痛情况。在PACU中,治疗组较对照组相比,需要较少的扑热息痛(分别是469毫克和991毫克,P<0.002)和较少的Lonalgal(分别是一片和四片,P=0.003),同时显示PACU,手术后一天,三天和五天安静时疼痛(VAS)评分更低(P=0.001,P=0.040,P=0.015,P=0.045) PACU中及手术后二天,四天和八天时运动后疼痛(VAS)评分也较低(P=0.001, P=0.028, P=0.007, P=0.032)。手术后三个月和六个月,对照组82%(18/22)57%(12/22)病人有慢性疼痛,而治疗组只有45%(10/22)30%(6/20)(P=0.028P=0.424) 。同时对照组中5(22)4(21)病人要求用镇痛药,而治疗组中没有人要求用镇痛药(P=0.048; P=0.107)。多模式镇痛可以减轻乳腺癌手术后急性和慢性疼痛。

(张美荣 陈杰 )

We evaluated the effect of multimodal analgesia on acute and chronic pain after breast surgery for cancer. Fifty patients scheduled for breast cancer surgery were blindly randomized to receive gabapentin, eutectic mixture of local anesthetics cream, and ropivacaine in the wound or three placebos. Pain (visual analog scale) and analgesics were recorded in the postanesthesia care unit (PACU) 3, 6, and 9 h and 8 days after surgery. Three and 6 mo later, patients were assessed for chronic pain. The treatment group consumed less paracetamol in the PACU (469 versus 991 mg; P < 0.002) and less Lonalgal® (1.0 versus 4.4 tablets; P = 0.003) than the controls, exhibited lower visual analog scale scores at rest in the PACU (P = 0.001) and on postoperative Days 1, 3, and 5 ((P = 0.040, P = 0.015, and P = 0.045, respectively), and after movement in the PACU (P = 0.001) and on postoperative Days 2, 4, and 8 (P = 0.028, P = 0.007, and P = 0.032, respectively). Three and 6 mo after surgery, 18 of 22 (82%) and 12 of 21 (57%) of the controls reported chronic pain versus 10 of 22 (45%) and 6 of 20 (30%) in the treatment group (P = 0.028 and P = 0.424, respectively); 5 of 22 and 4 of 21 of the controls required analgesics versus 0 of 22 and 0 of 20 of those treated (P = 0.048 and P = 0.107, respectively). Multimodal analgesia reduced acute and chronic pain after breast surgery for cancer.

 

猪内毒素性休克时血清S-100B的微量增加可能表示血脑屏障的损伤

Slight Increase of Serum S-100B During Porcine Endotoxemic Shock May Indicate Blood-Brain Barrier Damage

Anders Larsson, MD, PhD*, Miklós Lipcsey, MD{dagger}, Jan Sjölin, MD, PhD*, Lars-Olof Hansson, MD, PhD*, and Mats B. Eriksson, MD, PhD{dagger}

Departments of *Medical Sciences and {dagger}Surgical Sciences, Uppsala University Hospital, Sweden

Anesth Analg 2005 101: 1465-1469.

感染性休克是一种能影响许多器官的状况,但对中枢神经系统的影响却鲜为人知。S-100B,一种酸性低分子量蛋白,作为脑及血脑屏障破坏的标记物,已经引起极大的兴趣。脑损伤后它从脑组织释放到脑脊液和血液中。作者从与人类革兰氏阴性感染性休克相似的猪的内毒素性休克实验中来研究S-100B蛋白。10只小猪接受静脉注射内毒素,收集注射前及注射后1-6小时内每小时血浆样本,通过夹链酶免疫吸收剂来测定S-100B蛋白,结果显示血浆中S-100B蛋白含量较低,但与注射前比较,1-5小时内S-100B有显著意义的增加。作者认为是内毒素引起广泛用于标记脑损伤的血清标记物S-100B的微量却极重要的增加,然而,这还不能排除S-100B的增加是由大脑以外的器官释放所致。

(顾新宇 陈杰 )

Septic shock is a condition that affects many organs, but little is known about the effects on the central nervous system. S-100B, an acidic low molecular weight protein, has attracted considerable interest as a marker for brain damage and disintegration of the blood-brain barrier. It is released into the cerebrospinal fluid and blood from brain tissue after brain damage. We studied S-100B in a porcine model of endotoxemic shock that resembles human Gram-negative septic shock. Ten piglets received IV endotoxin, and plasma samples were collected before the endotoxin infusion and each hour (1–6 h) during the endotoxin infusion. S-100B was measured by sandwich enzyme-linked immunosorbent assay. Low levels of plasma S-100B were detected, but there was a significant increase in S-100B during Hours 1–5 in comparison with the 0 values. We determined that endotoxemia causes a very small but significant increase in the levels of the widely used brain damage marker serum S-100B. However, it cannot be excluded that the increase in S-100B could be caused by release from organs other than the brain.

 

钝性胸部创伤所致的独立的双侧肺挫伤的大鼠模型

A Rat Model for Isolated Bilateral Lung Contusion from Blunt Chest Trauma

Krishnan Raghavendran, MD*{dagger}, Bruce A. Davidson, BS{dagger}, Jadwiga D. Helinski, BS{dagger}, Cristi J. Marschke{dagger}, Patricia Manderscheid, PhD{dagger}, James A. Woytash, MD{ddagger}, Robert H. Notter, MD, PhD§, and Paul R. Knight, MD, PhD{dagger}

Departments of *Surgery, {dagger}Anesthesiology, and {ddagger}Pathology, State University of New York (SUNY) at Buffalo, Buffalo; and §Department of Pediatrics, University of Rochester, Rochester, New York

Anesth Analg 2005 101: 1482-1489.

肺挫伤约占钝性创伤患者的17-25%,同时肺挫伤还是钝性胸部损伤患者的首要致死原因。独立的双侧肺挫伤的小动物模型尚未建立。作者将0.3kg的重物压于心前区放置防护罩的麻醉大鼠,从而避开心脏,直接作用于肺部造成肺挫伤。通过测量动脉氧合、支气管肺泡灌洗(BAL)白蛋白和细胞学,压力-容量力学和组织病理学,得知肺损伤特性主要受胸部冲击能(1.8-2.7J)的影响。组织学证实双侧肺挫伤时不伴有实质性心肌损伤。承受2.7J胸部冲击能的大鼠的死亡率达到33%,超过预期的亚致死损伤水平。接受最大亚致死量损伤的大鼠前24小时低氧的状况与急性肺损伤的标准相符,而48h内逐步增加。<24hBAL白蛋白水平最高,48h时伴有BAL白细胞的持续增加和肺容量的减少。结论:2.45J的冲击能可以导致独立的、双侧肺挫伤,同时还建立了一个有效的模型利于将来的病理生理学研究。

(朱慧琛 陈杰 )

Lung contusion affects 17%–25% of adult blunt trauma patients, and is the leading cause of death from blunt thoracic injury. A small animal model for isolated bilateral lung contusion has not been developed. We induced lung contusion in anesthetized rats by dropping a 0.3-kg weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs. Lung injury was characterized as a function of chest impact energy (1.8–2.7 J) by measurements of arterial oxygenation, bronchoalveolar lavage (BAL) albumin and cytology, pressure-volume mechanics, and histopathology. Histology confirmed bilateral lung contusion without substantial cardiac muscle trauma. Rats receiving 2.7 J of chest impact energy had 33% mortality that exceeded prospectively defined limits for sublethal injury. Hypoxemia in rats with maximal sublethal injury (2.45 J) met criteria for acute lung injury at ≤24 h, improving by 48 h. BAL albumin levels were highest at ≤24 h, and remained elevated along with increased BAL leukocytes and decreased lung volumes at 48 h. We concluded that an impact energy of 2.45 J induces isolated, bilateral lung contusion and provides a useful model for future mechanistic pathophysiological assessments.

 

硬膜外导管置管前经穿刺针注入局部麻醉药能改善麻醉质量并减少导管相关并发症

Administration of Local Anesthetic Through the Epidural Needle Before Catheter Insertion Improves the Quality of Anesthesia and Reduces Catheter-Related Complications

Mehmet Cesur, Haci A. Alici, Ali F. Erdem, Fikret Silbir, and Mustafa S. Yuksek

Department of Anesthesiology and Reanimation, Atatürk University, Erzurum, Turkey

Anesth Analg 2005 101: 1501-1505.

 

硬膜外阻滞时常在硬膜外置入可曲硬膜外导管但是,在硬膜外导管置入时可能产生诸如感觉异常,置入静脉,蛛网膜下腔等并发症,并可影响麻醉质量作者前瞻性,随机双盲研究硬膜外置管前通过硬膜外穿次针单次给予局部麻醉药(2%利多卡因20ml)的效果240名患者随机分为两组并评定麻醉效果和并发症在经针注药组(经针组,n=100)硬膜外导管在经针注药后置入。经导管注药组(导管组,n=98)导管在穿刺针证实在硬膜外腔后即置入经导管注入局部麻醉药记录感觉异常,导管注入难易程度,或置入静脉或蛛网膜下腔等情况注入局麻药后20min测定感觉和运动阻滞情况证实感觉消失后手术置管中发生感觉异常者导管组占 31.6%,经针组为11%(P=0.00038) 置入静脉病例导管组为8.2%,经针组为2%(P=0.048) 经针组较导管组手术条件优良率更高(分别为89.6%72.9%,P<0.003) 结论:硬膜外置管前经针一次性注入局麻药能改善硬膜外麻醉质量并减少硬膜外导管相关并发症

(赵延华译 陈杰校)

Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesia and venous and subarachnoid cannulation may occur, and suboptimal catheter placement can affect the quality of anesthesia. We performed this prospective, randomized, double-blind study to assess the effect of a single-injection dose of local anesthetic (20 mL of 2% lidocaine) through the epidural needle as a priming solution into the epidural space before catheter insertion. We randomized 240 patients into 2 equal groups and measured the quality of anesthesia and the incidence of complications. In the needle group (n = 100), catheters were inserted after injection of a full dose of local anesthetic through the needle. In the catheter group (n = 98), the catheters were inserted immediately after identification of the epidural space. Local anesthetic was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement. Sensory and motor block were assessed 20 min after the injection of local anesthetic. Surgery was initiated when adequate sensory loss was confirmed. In the catheter group, the incidence of paresthesia during catheter placement was 31.6% compared with 11% in the needle group (P = 0.00038). IV catheterization occurred in 8.2% versus 2% of patients in the catheter and needle groups, respectively (P = 0.048). More patients in the needle group had excellent surgical conditions than the catheter group (89.6% versus 72.9; P < 0.003). We conclude that giving a single-injection dose via the epidural needle before catheter placement improves the quality of epidural anesthesia and reduces catheter-related complications.

 

预防性静注枢复宁和多拉司琼对于鞘内注射吗啡所致瘙痒的影响:一项随机、双盲、对照研究

Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study

Christos A. Iatrou, MD, PhD, Christos K. Dragoumanis, MD, Theodosia D. Vogiatzaki, MD, PhD, George I. Vretzakis, MD, PhD, Constantinos E. Simopoulos, MD, PhD, and Vasilios K. Dimitriou, MD, PhD

Departments of Anesthesia and Surgery, Democritus University of Thrace, Alexandroupolis, Greece, and the Department of Anesthesia, "G. Gennimatas" Hospital, Athens, Greece

Anesth Analg 2005 101: 1516-1520.

 

瘙痒是鞘内注射吗啡进行术后镇痛的常见副作用。其可能机制是激活了中枢的5-羟色胺3受体(5-HT3)。但是5-HT3拮抗剂对吗啡引起瘙痒的预防作用还没有明确的结论。在本项前瞻性、随机、双盲、对照的临床研究中,作者观察了预防性静注枢复宁和多拉司琼对于鞘内注射吗啡所致瘙痒的预防效果。病人随机分成3组,分别静脉注射枢复宁4mgO组,n = 35)或者多拉司琼12.5mgD组,n = 35),或者安慰剂5mlP组,n = 35)。这些病人均进行泌尿外科、骨科或者血管外科手术,在脊髓麻醉0.5%重比重布比卡因17.5mg和吗啡0.25mg)前静脉注射上述药物。在到达PACU时和术后24824小时观察瘙痒的发病率和严重程度。研究结果表明,与安慰剂对照组相比,枢复宁组和多拉司琼组瘙痒的发生率和严重程度均明显下降(分别为34%20%66%p<0.01)。接受5-HT3受体拮抗剂的病人在术后8小时内的瘙痒严重程度与安慰剂对照组相比明显下降。严重的瘙痒仅发生在P组(P组:35名病人中发生4例;O或者D组:35名病人中无人发生严重瘙痒,P<0.05)。作者认为,预防性应用枢复宁和多拉司琼有助于减轻鞘内注射吗啡引起瘙痒的发生率和严重程度。

(苏殿三 陈杰 )

The most common side effect of intrathecal morphine for postoperative pain relief. Activation of central 5-hydroxytryptamine subtype 3 (5-HT3) receptors is one of its possible mechanisms. The role of 5-HT3 antagonists in the prevention of pruritus has not been clearly established. In a prospective, randomized, double-blind, placebo-controlled study, we evaluated the efficacy of prophylactic administration of ondansetron and dolasetron for the prevention of intrathecal morphine-induced pruritus. The patients were randomized into 3 groups to receive either 4 mg ondansetron IV (group O, n = 35), 12.5 mg dolasetron IV (group D, n = 35) or 5 mL placebo (group P, n = 35) 30 min before administration of spinal anesthesia with 10 to 17.5 mg of 0.5% hyperbaric bupivacaine and 0.25 mg of morphine for urologic, orthopedic, or vascular surgery. Patients were evaluated for incidence and severity of pruritus at arrival to the postanesthesia care unit and at 2, 4, 8, and 24 h postoperatively. The incidence and severity of pruritus was significantly less frequent in the ondansetron and dolasetron groups compared with placebo (34%, 20%, and 66% respectively, P < 0.01). Patients who received 5-HT3 antagonist reported significantly less total severity of pruritus compared with placebo during the first 8 h and the severe pruritus was observed only in patients within P group (P group: 4 of 35; 11%, O or D group: 0 of 35; 0%, P < 0.05). We conclude that the prophylactic use of ondansetron and dolasetron helps to reduce the incidence and severity of intrathecal morphine-induced pruritus.

 

气管导管套囊内应用碱化利多卡因的效能和安全性评价

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Jean-Pierre Estebe, MD, PhD*{ddagger}, Marc Gentili, MD, PhD*§, Pascal Le Corre, PharmD, PhD{dagger}{ddagger}, Gilles Dollo, PharmD, PhD{dagger}{ddagger}, François Chevanne, BSc{dagger}{ddagger}, and Claude Ecoffey, MD*{ddagger}

*Service d’Anesthésie Réanimation Chirurgicale 2; {dagger}Laboratoire de Biopharmacie, {ddagger}UPRES EA 3892, Université Rennes 1, §Polyclinique Saint Vincent, Rennes, France

Anesth Analg 2005 101: 1536-1541.

 

吸入笑气行全身麻醉时,应用碱化利多卡因代替空气填充气管导管套囊可明显减少拔管时的咳嗽和呛咳反射。然而一旦气管导管套囊破裂导致碳酸氢钠(用于将盐酸利多卡因转变为碱性利多卡因)泄露,碱性溶液则会刺激气道粘膜。本文通过随机对照研究,离体观察低浓度的碳酸氢钠(浓度为1.4%,与高浓度8.4%相比)是否能够减少碳酸氢钠向套囊外的弥散量,从而保护气道。在确定不同溶液pH值后(2%盐酸利多卡因2mL8.4%1.4%碳酸氢钠26mL),通过体外实验观察利多卡因溶液通过气管导管套囊的弥散速度(2%盐酸利多卡因为2 mL8.4%或者1.4%碳酸氢钠为3mL)。随后选取甲状腺手术患者(每组各20例),气管导管套囊内分别充入空气,高浓度碳酸氢钠(2% 盐酸利多卡因2 mL复合8.4%的碳酸氢钠),低浓度碳酸氢钠(2%盐酸利多卡因2 mL复合1.4%的碳酸氢钠),术毕拔除气管导管后,通过视觉模拟疼痛评分表评价咽喉疼痛发生率和程度,同时观察声音嘶哑、呛咳、发声困难、吞咽困难、咳嗽、烦躁不安以及术后恶心呕吐情况。结果表明,低浓度的碳酸氢钠(例如, 1.4%)弥散较慢。与空气填充组相比,碱化利多卡因在术后24小时内可明显减少咽痛的发生,不同浓度碳酸氢钠组之间无明显统计学差异。本研究中未发生喉痉挛、气管导管套囊破裂以及吞咽发射抑制。综上所述应用小剂量碱化利多卡因(碱化利多卡因40 mg 1.4% 的碳酸氢钠)填充气管导管套囊,可明显减少笑气全麻患者围手术期咽痛的发生。

(郑拥军 陈杰 校)

When alkalinized lidocaine instead of air is used to fill the endotracheal tube (ETT) cuff, coughing, and bucking are decreased during extubation when ventilation is controlled with N2O. However, sodium bicarbonate (NaHCO3) used to transform lidocaine hydrochloride (L-HCl) to lidocaine base induces a pH increase that could be irritating for mucosa in the case of cuff rupture. Therefore, we determined, in a randomized controlled study with controlled patient ventilation without N2O, whether the smallest concentrations of NaHCO3 (1.4% versus 8.4%) reduced diffusion (in vitro evaluation) and other secondary clinical benefits. After pH determination of different solutions (2 mL of 2% L-HCl and 2 to 6 mL of 8.4%, or 1.4% NaHCO3), an in vitro lidocaine diffusion through the ETT cuffs was evaluated (2 mL of 2% L-HCl and 3 mL of 8.4% or 1.4% NaHCO3). Then, adult patients scheduled for total thyroidectomy surgery were consecutively enrolled (n = 20 for each group). The ETT cuff was filled with air (group air) or with alkalinized lidocaine (2 mL of 2% L-HCl) using 8.4% (group large dose) or 1.4% (group small dose) of NaHCO3. After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. Hoarseness, bucking, dysphonia, dysphagia, cough, restlessness, and postoperative nausea and vomiting were also evaluated. There was a slight tendency toward a slower release when a small concentration of NaHCO3 was used (i.e., 1.4%). Compared with group air, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.0001). The difference was not significant between the two alkalinized lidocaine groups. This increase in ETT tolerance was confirmed by the analysis of secondary end-points. No laryngospasm, rupture of ETT cuff, or depression of the swallowing reflex were recorded. A decrease in sore throat during the postoperative period was recorded when the cuff was inflated with a small dose of alkalinized lidocaine (i.e., 40 mg of L-HCl and 1.4% of NaHCO3) rather than with air when ventilation was controlled without N2O.

 

线粒体KATP通道在七氟烷预适应和后适应对大鼠在体心脏保护效应中的影响

The Influence of Mitochondrial KATP-Channels in the Cardioprotection of Preconditioning and Postconditioning by Sevoflurane in the Rat In Vivo

Detlef Obal, MD, DEAA, Saskia Dettwiler, cand. MD, Christian Favoccia, MD, DEAA, Horst Scharbatke, MD, Benedikt Preckel, MD, DEAA, and Wolfgang Schlack, MD, PhD, DEAA

Klinik für Anaesthesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

Anesth Analg 2005;101:1252-1260

 

挥发性麻醉药可导致心肌预适应,在心脏再灌注开始时给予也保护心脏——这种做法近来被称为“后适应”。我们研究了线粒体KATPmKATP通道在七氟烷单独预适应和单独后适应导致的心肌保护效应中的作用,并且研究两者是否存在协同效应。大鼠的冠状动脉被阻断25分钟,然后再灌注120分钟。使用三苯基四唑盐染色法确定梗死面积。采用如下试验方案:1)预适应(S-Pre, n=10, 通过两次每次用七氟烷5分钟(1MAC),然后冲洗10分钟;2)七氟烷后适应(S-postn=10,在再灌注开始时应用1 MAC七氟烷2分钟);3)在缺血前后均使用(S-pre + S-postn=10)。在应用5-羟基癸酸盐(5-HD)(一种特异性mKATP通道阻滞剂)后重复1-3方案(S-Pre + S-Post + 5HD, S-Pre + 5HD: n = 10; S-Post + 5HD: n = 9)9只大鼠作为未处理对照组(CON),另外10只仅应用了5-HD5HD, n = 10)。与对照组(CON)的梗死面积(危险区域的49% ± 11%,均数±标准差)相比,预适应组(S-Pre23% ± 13%)和后适应组(S-Post18% ± 5%)的梗死面积均减小(两者均P< 0.05)。与仅在缺血前或者仅在缺血后应用相比,S-pre + S-post 使梗死面积减少更多(12% ± 5%,与S-Pre比较,P = 0.054 )。5-HD减少所有三个七氟烷处理组的保护效应(S-Pre + 5HD, 35% ± 12%; S-Post + 5HD, 44% ± 12%; S-Pre + S-Post + 5HD, 46% ± 14%)。但是单独使用5-HD并不影响梗死面积(41% ± 13%)。七氟烷预适应和后适应能够对心肌缺血-再灌注损伤产生保护作用,联合使用预适应和后适应能够产生更大的保护效应,这种效应至少部分是由mKATP通道介导的。

(颜涛 马皓琳,李士通 校)

Volatile anesthetics induce myocardial preconditioning and can also protect the heart when given at the onset of reperfusion—a practice recently termed "postconditioning." We investigated the role of mitochondrial KATP (mKATP)-channels in sevoflurane-induced cardioprotection for both preconditioning and postconditioning alone and whether there is a synergistic effect of both. Rats were subjected to 25 min of coronary artery occlusion followed by 120 min of reperfusion. Infarct size was determined by triphenyltetrazolium staining. The following protocols were used: 1) preconditioning (S-Pre, n = 10, achieved by 2 periods of 5 min sevoflurane administration (1 MAC) followed by 10 min of washout); 2) sevoflurane postconditioning (1 MAC of sevoflurane given for 2 min at the beginning of reperfusion; S-Post, n = 10); 3) administration before and after ischemia (S-Pre + S-Post, n = 10). Protocols 1–3 were repeated in the presence of 5-hydroxydecanoate (5HD), a specific mKATP-channel-blocker (S-Pre + S-Post + 5HD, S-Pre + 5HD: n = 10; S-Post + 5HD: n = 9). Nine rats served as untreated controls (CON) or received 5HD alone (5HD, n = 10). Both S-Pre (23% ± 13% of the area at risk, mean ± sd) and S-Post (18% ± 5%) reduced infarct size compared with CON (49% ± 11%, both P < 0.05). S-Pre + S-Post resulted in a larger reduction of infarct size (12% ± 5%, P = 0.054 versus S-Pre) compared with administration before or after ischemia alone. 5HD diminished the protection in all three sevoflurane treated groups (S-Pre + 5HD, 35% ± 12%; S-Post + 5HD, 44% ± 12%; S-Pre + S-Post + 5HD, 46% ± 14%;) but given alone had no effect on infarct size (41% ± 13%). Sevoflurane preconditioning and postconditioning protects against myocardial ischemia-reperfusion injury. The combination of preconditioning and postconditioning provides additive cardioprotection and is mediated, at least in part, by mKATP-channels.

 

 

活性氧簇作为心脏损伤和保护的介质:与麻醉实践的关联

Reactive Oxygen Species as Mediators of Cardiac Injury and Protection: The Relevance to Anesthesia Practice

Leo G. Kevin, MD, FCARCSI, Enis Novalija, MD, and David F. Stowe, MD, PhD

Anesthesiology Research Laboratories, Departments of Anesthesiology and Physiology, Cardiovascular Research Center, The Medical College of Wisconsin, VA Medical Center Research Service, and Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin

Anesth Analg 2005;101:1275-1287

 

活性氧簇(ROS)在心脏缺血和再灌注损伤中起到重要作用。它们促使心肌顿抑、梗塞和凋亡,并且可能促使心律失常的发生。多个实验室研究和临床试验探讨了使用ROS清除剂来保护心脏以防缺血和再灌注损伤的作用。动物模型实验已普遍显示了ROS这样的作用。临床试验也已显示清除剂具有保护作用,但是这种保护作用是否有意义深长的临床效益仍不清楚。一些静脉麻醉药有ROS清除剂的作用。与此相反,近来有研究认为挥发性麻醉药可使心脏产生ROS,其最大可能的原因是对心脏线粒体的抑制作用。ROS涉及短时间给予挥发性麻醉药引起的心肌保护的信号级联传递(术语称为麻醉药预适应)。因此,虽然大量ROS是有害的,但是少量ROS在心脏中有保护作用。在本综述中,我们提供了与麻醉药和辅助药有关联的(特别关于心脏的)有关ROS形成和消除的背景信息。本综述分别讨论了ROS的来源、ROS引发心脏损害或刺激保护性信号通路的方式、评估ROS清除剂的临床研究的结果以及麻醉药对ROS的作用。

(张莹 马皓琳,李士通 校)

Reactive oxygen species (ROS) are central to cardiac ischemic and reperfusion injury. They contribute to myocardial stunning, infarction and apoptosis, and possibly to the genesis of arrhythmias. Multiple laboratory studies and clinical trials have evaluated the use of scavengers of ROS to protect the heart from the effects of ischemia and reperfusion. Generally, studies in animal models have shown such effects. Clinical trials have also shown protective effects of scavengers, but whether this protection confers meaningful clinical benefits is uncertain. Several IV anesthetic drugs act as ROS scavengers. In contrast, volatile anesthetics have recently been demonstrated to generate ROS in the heart, most likely because of inhibitory effects on cardiac mitochondria. ROS are involved in the signaling cascade for cardioprotection induced by brief exposure to a volatile anesthetic (termed "anesthetic preconditioning"). ROS, therefore, although injurious in large quantities, can have a paradoxical protective effect within the heart. In this review we provide background information on ROS formation and elimination relevant to anesthetic and adjuvant drugs with particular reference to the heart. The sources of ROS, the means by which they induce cardiac injury or activate protective signaling pathways, the results of clinical studies evaluating ROS scavengers, and the effects of anesthetic drugs on ROS are each discussed.


给予新斯的明是否使术后恶心呕吐有临床意义的增多?

Does Neostigmine Administration Produce a Clinically Important Increase in Postoperative Nausea and Vomiting?

Ching-Rong Cheng, MD, Daniel I. Sessler, MD, and Christian C. Apfel, MD

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

Anesth Analg 2005;101:1349-1355

 

新斯的明用来拮抗神经肌肉阻滞剂引起的残余神经肌肉麻痹。尽管以前有一个荟萃分析发现新斯的明影响术后恶心呕吐,但是这种影响仍未确定。我们重新评价了新斯的明对术后恶心呕吐的影响,同时考虑到不同的抗胆碱能药物是可能引起混淆的因素。我们用MEDLINEEmbaseCochrane库、参考文献列表和手工检索进行了系统的无语言限制的文献检索,确定到200412月为止有10个评价新斯的明对术后恶心呕吐影响的临床随机对照试验。从933例患者采集到术后早期(0-6 h)、后期(6-24 h)和全期(0-24 h)有关恶心或呕吐的数据,并用RevMan 4.2 Cochrane协作,牛津,英国)和多重逻辑回归分析进行分析。新斯的明与阿托品或胃长宁合用并不显著提高术后全期(0-24 h)呕吐发生率(相对风险0.9195%可信区间0.70–1.18P = 0.48)和恶心发生率(相对风险1.2495%可信区间0.98–1.59P = 0.08)。多重逻辑回归分析显示大剂量新斯的明与小剂量比较,呕吐风险未明显增大。与以前的分析不同,我们得出结论:没有足够的证据来断定新斯的明使术后恶心呕吐的风险增大。

(马皓琳 李士通 校)

Neostigmine is used to antagonize neuromuscular blocker-induced residual neuromuscular paralysis. Despite the findings of a previous meta-analysis, the effect of neostigmine on postoperative nausea and vomiting remains unresolved. We reevaluated the effect of neostigmine on postoperative nausea and vomiting while considering the different anticholinergics as potentially confounding factors. We performed a systematic literature search using MEDLINE, Embase, Cochrane library, reference listings, and hand searching with no language restriction through December 2004 and identified 10 clinical, randomized, controlled trials evaluating neostigmine’s effect on postoperative nausea and vomiting. Data on nausea or vomiting from 933 patients were extracted for the early (0–6 h), delayed (6–24 h), and overall (0–24 h) postoperative periods and analyzed with RevMan 4.2 (Cochrane Collaboration, Oxford, UK) and multiple logistic regression analysis. The combination of neostigmine with either atropine or glycopyrrolate did not significantly increase the incidence of overall (0–24 h) vomiting (relative risk, 0.91; 95% confidence interval, 0.70–1.18; P = 0.48) or nausea (relative risk, 1.24; 95% confidence interval, 0.98–1.59; P = 0.08). Multiple logistic regression analysis indicated that there was not a significant increase in the risk of vomiting with large compared with small doses of neostigmine. Contrasting a previous analysis, we conclude that there is insufficient evidence to conclude that neostigmine increases the risk of postoperative nausea and vomiting.


多沙普仑仅能轻微降低健康志愿者的寒战阈值

Doxapram Only Slightly Reduces the Shivering Threshold in Healthy Volunteers

Ryu Komatsu, MD*, Papiya Sengupta, MD*, Grigory Cherynak, MD{dagger}, Anupama Wadhwa, MD*{dagger}, Daniel I. Sessler, MD*{dagger}, Jin Liu, MD§, Harrell E. Hurst, PhD§, and Rainer Lenhardt, MD*{dagger}

*Outcomes ResearchTM Institute, University of Louisville; and Departments of {dagger}Anesthesiology & Perioperative Medicine, and §Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky

Anesth Analg 2005;101:1368-1373

 

我们测定多沙普仑对人体体温自主调节主要反应的影响。我们对九位健康志愿者进行了为期两天的研究:对照组和多沙普仑组(在出汗、血管收缩和寒战阈值时静脉输注至的血浆浓度分别为2.4 ± 0.82.5 ± 0.92.6 ± 1.1 μg/mL)。每天将皮肤和中心体温提高至可引起出汗,然后降低至引起外周血管收缩及寒战。我们通过对皮肤温度变化的补偿来测定出汗、血管收缩及寒战阈值。用配对t检验分析数据,并且以平均值± 标准差来表示,P<0.05认为具有统计学意义。多沙普仑并不改变出汗 (对照组: 37.5° ± 0.4°C, 多沙普仑组: 37.3° ± 0.4°C; P = 0.290)和血管收缩的阈值(对照组36.8° ± 0.7°C多沙普仑组36.4° ± 0.5°C; P = 0.110)。然而,它可以将寒战阈值从36.2° ± 0.5°C降低至35.7° ± 0.7°C (P = 0.012)。在两天的研究时间内没有发现任何镇静或焦虑症状。观察到的多沙普仑降低寒战阈值的作用可以解释这个药在治疗术后寒战方面的功效,然而,作为单独药物应用时,仅仅0.5°C的下降不太可能显著有利于治疗性低温的诱导。

(黄佳佳 马皓琳,李士通 校)

We determined the effects of doxapram on the major autonomic thermoregulatory responses in humans. Nine healthy volunteers were studied on 2 days: control and doxapram (IV infusion to a plasma concentration of 2.4 ± 0.8, 2.5 ± 0.9, and 2.6 ± 1.1 µg/mL at the sweating, vasoconstriction, and shivering thresholds, respectively). Each day, skin and core temperatures were increased to provoke sweating, then reduced to elicit peripheral vasoconstriction and shivering. We determined the sweating, vasoconstriction, and shivering thresholds with compensation for changes in skin temperature. Data were analyzed with paired t-tests and presented as mean ± sd; P < 0.05 was considered statistically significant. Doxapram did not change the sweating (control: 37.5° ± 0.4°C, doxapram: 37.3° ± 0.4°C; P = 0.290) or the vasoconstriction threshold (36.8° ± 0.7°C versus 36.4° ± 0.5°C; P = 0.110). However, it significantly reduced the shivering threshold from 36.2° ± 0.5°C to 35.7° ± 0.7°C (P = 0.012). No sedation or symptoms of panic were observed on either study day. The observed reduction in the shivering threshold explains the drug’s efficacy for treatment of postoperative shivering; however, a reduction of only 0.5°C is unlikely to markedly facilitate induction of therapeutic hypothermia as a sole drug.

 

大鼠硬膜外腔使用加巴喷丁的神经安全性:一项光学显微镜检查

The Neurological Safety of Epidural Gabapentin in Rats: A Light Microscopic Examination

Sang-Sik Choi, MD*, Yong-Chul Kim, MD*, Young Jin Lim, MD*, Chul-Joong Lee, MD*, Pyung-Bok Lee, MD*, Sang-Chul Lee, MD*, Woo-Seok Sim, MD{dagger}, and Yoon-La Choi, MD{ddagger}

*Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine; and Departments of {dagger}Anesthesiology and Pain Medicine and {ddagger}Diagnostic Pathology, SungKyunKwan University College of Medicine, Seoul, Korea

Anesth Analg 2005;101:1422-1426

 

加巴喷丁主要作用于中枢神经系统。因此,我们假定硬膜外腔直接使用加巴喷丁与口服相比有所需剂量、副作用和效价这些多方面的好处。不过,在临床上将加巴喷丁用到硬膜外腔之前,必须在动物身上对其神经毒性进行检查。因此,我们通过观察大鼠的行为学和感觉-运动的变化以及对脊髓和背根神经节进行组织病理学检查来评估硬膜外腔使用加巴喷丁的神经毒性。27只大鼠被随机分为3组:一组在硬膜外腔使用0.3ml30mg)的加巴喷丁(G组,n9);一组硬膜外腔使用同样容积的酒精(A组,n9);另一组为生理盐水(N组,n9)。3周观察期内,在G组和N组没有大鼠出现感觉-运动功能障碍、行为学改变或组织病理学异常,而A组的所有大鼠都有异常。我们得出结论:依据感觉-运动功能和行为学或显微镜下组织病理学评估,在大鼠硬膜外腔直接注射加巴喷丁未显示有任何神经毒性的证据。本研究意味着通向硬膜外腔加巴喷丁在临床上试验道路上的充满希望的第一步。

(黄施伟 马皓琳,李士通 校)

Gabapentin acts primarily on the central nervous system. Therefore, we hypothesized that the direct epidural administration of gabapentin could have various advantages over its oral administration with respect to required dose, side effects, and efficacy. However, before administering gabapentin into the epidural space in a clinical setting, its neurotoxicity must be examined in animals. Thus, we evaluated neurotoxicity of epidural gabapentin by observing behavioral and sensory-motor changes, and by histopathological examinations of spinal cords and dorsal root ganglia in the rat. Twenty-seven rats were randomly divided into 3 groups, which were administered 0.3 mL (30 mg) of epidural gabapentin (group G, n = 9) and the same volume of epidural alcohol (group A, n = 9) or normal saline (group N, n = 9). No rats in groups G and N showed sensory-motor dysfunction, behavioral change, or histopathological abnormalities over a 3-wk observation period, whereas all rats in group A showed abnormalities. We conclude that the direct epidural injection of gabapentin in rats did not show any neurotoxic evidence in terms of sensory-motor functions and behavior, or by a microscopic histopathological evaluation. This study represents a first promising step toward the trial of epidural gabapentin in a clinical setting.

 

静脉内补足晶体液不能减少外科伤口感染的危险

Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection

Barbara Kabon, MD, Ozan Akça, MD{ddagger}§, Akiko Taguchi, MD*, Angelika Nagele, RN*, Ratnaraj Jebadurai, MD*, Cem F. Arkilic, MD*, Neeru Sharma, MD*, Arundhathi Ahluwalia, MD*, Susan Galandiuk, MD||, James Fleshman, MD{dagger}, Daniel I. Sessler, MD{ddagger}§, and Andrea Kurz, MD{ddagger}#

Departments of *Anesthesiology and {dagger}Surgery, Washington University, St. Louis, Missouri; {ddagger}Outcomes Research Institute and Departments of §Anesthesiology & Perioperative Medicine and ||Surgery, University of Louisville, Louisville, Kentucky; ¶Department of Anesthesiology and General Intensive Care, Vienna General Hospital, University of Vienna, Vienna, Austria; and #Department of Anesthesiology, University of Bern, Bern, Switzerland

Anesth Analg 2005;101:1546-1553

 

创伤灌注和氧合是术后伤口感染发展的重要决定因素。应用液体补足显著增加围手术病人上臂皮下组织中切口的组织氧合。我们测试了下述假设,择期结肠切除术手术时和手术后补足液体可减少术后伤口感染的发生率。进行开放的结肠切除手术的病人随机分配到小容量(n = 124, 8 mL · kg–1 · h–1)或者大容量(n = 129, 16–18 mL · kg–1 · h–1)液体管理组。我们主要的结果是两个清楚诊断外科伤口感染的标准:1)脓性渗出物结合致病菌培养阳性及2)疾病控制中心外科伤口感染的诊断标准。对在手术后15天里由一个盲的观察者用任一个标准诊断的所有伤口感染进行分析。用ASEPSIS评分系统评估伤口愈合。给予小容量液体治疗的病人中有14例外科伤口感染;11例给予大容量液体治疗的有感染,P = 0.46ASEPSIS伤口愈合评分在两组相似:7 ± 16(小容量)对8 ± 14(大容量),P = 0.70。我们的结果提示在研究范围内的补足水合不影响伤口感染率。

(张 马皓琳,李士通 校)

Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small-volume (n = 124, 8 mL · kg–1 · h–1) or large-volume (n = 129, 16–18 mL · kg–1 · h–1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria, and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days after surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P = 0.46. ASEPSIS wound-healing scores were similar in both groups: 7 ± 16 (small volume) versus 8 ± 14 (large volume), P = 0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate.

 

关节内布比卡因-可乐定-吗啡浸润与股神经-坐骨神经阻滞在儿科病人前十字韧带重建术的比较

Intraarticular Bupivacaine-Clonidine-Morphine Versus Femoral-Sciatic Nerve Block in Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction

Kha M. Tran, MD*, Theodore J. Ganley, MD{dagger}, Lawrence Wells, MD{dagger}, Arjunan Ganesh, MBBS*, Kimberly I. Minger, BSN{ddagger}, and Giovanni Cucchiaro, MD*

Departments of *Anesthesiology and Critical Care Medicine, {dagger}Orthopaedic Surgery, and {ddagger}Clinical Research, Children’s Hospital of Philadelphia, Pennsylvania

Anesth Analg 2005;101:1304-1310

 

我们假设,在儿科病人行前十字韧带(ACL)重建术时以股神经-坐骨神经联合阻滞(FSNB),与关节内浸润(IA)麻醉相比,能提供更好的镇痛效果,副作用更少。36例进行ACL重建术的儿童,随机分入FSNB组或IA组。FSNB组病人以布比卡因(0.125%)-可乐定(2 µg/kg)进行FSNB,而IA组病人则给予布比卡因(0.25%)-可乐定(1 µg/kg)-吗啡(5 mg)。以病人自控镇痛方式提供术后的镇痛,以吗啡为补充方式。两组病人的一般情况相似。FSNB组的病人术中所需芬太尼量较少(50 ± 40 µg 80 ± 50 µg; P = 0.04)FSNB组病人在恢复室内和术后24小时内的视觉模拟量表疼痛评分要低于IA组的病人,分别为1.8 ± 3 5.4 ± 3( P = 0.0002)1.6 ± 12.9 ± 2( P = 0.01)。术后18小时内所用吗啡量在FSNB组要更少(7 ± 13 mg21 ± 21 mg; P = 0.03)。呕吐发生率在FSNB组更低(11%50%; P = 0.03)IA组的病人术后更早需要吗啡病人自控镇痛。在儿童ACL重建术后,以布比卡因-可乐定进行股神经-坐骨神经联合阻滞,与布比卡因-可乐定-吗啡进行关节内浸润相比,可提供更好的镇痛效果,而副作用更少。

(周志坚 马皓琳,李士通 校)

We hypothesized that combined femoral-sciatic nerve block (FSNB) offers better analgesia with fewer side effects than intraarticular infiltration (IA) in children undergoing anterior cruciate ligament (ACL) reconstruction. Thirty-six children undergoing ACL reconstruction were randomized to FSNB or IA. FSNB patients had FSNB with bupivacaine (0.125%)-clonidine (2 µg/kg), whereas IA patients received bupivacaine (0.25%)-clonidine (1 µg/kg)-morphine (5 mg). Postoperatively, analgesia was provided with patient-controlled analgesia and rescue morphine. Patient demographics were similar. FSNB patients required less intraoperative fentanyl (50 ± 40 µg versus 80 ± 50 µg; P = 0.04). Visual analog scale score for FSNB was smaller than IA in the recovery room (1.8 ± 3 versus 5.4 ± 3; P = 0.0002) and during the first 24 h (1.6 ± 1 versus 2.9 ± 2; P = 0.01)). FSNB morphine use in the first 18 h was less (7 ± 13 mg versus 21 ± 21 mg; P = 0.03). Fewer FSNB patients vomited (11% versus 50%; P = 0.03). IA patients required morphine patient-controlled analgesia sooner. After ACL reconstruction in children, FSNB with bupivacaine-clonidine provides better analgesia with fewer side effects than IA with bupivacaine-clonidine-morphine.


一项比较格兰司琼复合地塞米松与恩丹司琼复合地塞米松预防腹式子宫切除术病人术后恶心呕吐的随机双盲研究

A Randomized, Double-Blind Study of Granisetron Plus Dexamethasone Versus Ondansetron Plus Dexamethasone to Prevent Postoperative Nausea and Vomiting in Patients Undergoing Abdominal Hysterectomy

Tong J. Gan, MD*, Andrew Coop, MBChB{dagger}, Beverly K. Philip, MD{ddagger}, and the Kytril Study Group§

*Duke University Medical Center, Durham, North Carolina; {dagger}Roche Laboratories Inc., Nutley, New Jersey; {ddagger}Brigham & Women’s Hospital, Boston, Massachusetts; §See Appendix

Anesth Analg 2005;101:1323-1329

 

在这一随机双盲的研究中,我们评估了在需要全麻下进行腹式子宫切除术的病人中,小剂量的格兰司琼(0.1mg)复合地塞米松8mgG+D)在预防气管拔管后2小时内的呕吐方面是否与恩丹司琼4mg复合地塞米松8mg (O+D)一样有效。地塞米松(D)在麻醉诱导期给药,格兰司琼(G)或恩丹司琼(O)在拔管前约15分钟给药。采集术后02624小时恶心呕吐的数据。在主要的有效性指标方面,两组中绝大多数病人在术后2小时内没有呕吐(G+D 82/87[94%]O+D86/89[97%])。与O+D比较,G+D组的有效性得到证实。各治疗组关于24小时内中度到重度恶心、完全有效、解救用药及总控制是相似的。不良事件的描述性评估显示两种复合用药均能很好耐受,不良事件罕见且两组发病率相似。气管拔管前给予小剂量G加上麻醉诱导期给予D在预防术后即刻至2小时内呕吐上是除了O+D以外另一种有效的选择。

(黄丽娜 马皓琳,李士通 )

In this randomized, double-blind study, we evaluated whether small-dose granisetron (0.1 mg) plus dexamethasone 8 mg (G+D) was as effective as ondansetron 4 mg plus dexamethasone 8 mg (O+D) for preventing vomiting during the 0 to 2 h after tracheal extubation in patients undergoing abdominal hysterectomy requiring general anesthesia. Dexamethasone (D) was administered at induction of anesthesia, and granisetron (G) or ondansetron (O) was given approximately 15 min before tracheal extubation. Data on postoperative nausea and vomiting were collected at 0, 2, 6, and 24 h. For the primary efficacy endpoint, most patients in each group had no vomiting in the 0- to 2-h interval (82/87 [94%] for G+D versus 86/89 [97%] for O+D). Effectiveness of G+D was demonstrated versus O+D. Treatment groups were similar with regard to moderate or severe nausea, complete response, rescue medication use, and total control over 24 h. A descriptive assessment of adverse events showed that both combinations were well tolerated with infrequent and similar incidences of adverse events. The combination of small-dose G administered just before tracheal extubation plus D given at induction of anesthesia is an effective alternative to O+D in preventing vomiting during the 0- to 2-h interval after tracheal extubation.

成年大鼠全麻后两周的空间记忆能力

Spatial Memory Performance 2 Weeks After General Anesthesia in Adult Rats

Catherine Crosby*, Deborah J. Culley, MD{dagger}, Mark G. Baxter, PhD{ddagger}, Rustam Yukhananov, MD, PhD{dagger}, and Gregory Crosby, MD{dagger}

*Department of Psychology, Harvard University, Cambridge, Massachusetts; {ddagger}Department of Experimental Psychology, Oxford, UK; {dagger}Department of Anesthesia, Harvard Medical School, Brigham & Women’s Hospital, Boston, Massachusetts

Anesth Analg 2005;101:1389-1392

 

我们以前已经证实,用1.2%的异氟醚复合70%的笑气行全身麻醉,两天后测试发现,年幼大鼠和老年大鼠的旋臂迷宫试验能力会损害;两周后测试,老年大鼠的旋臂迷宫试验能力仍会损害。我们设计本研究拟观察年幼大鼠麻醉后学习能力受损是否会持续存在。六月龄大鼠随机分为三组,每组10例。一组采用1.2%的异氟醚复合70%的笑气,一组1.8%异氟醚,对照组吸入30%的氧气,麻醉时间为2小时。恢复两周后大鼠每天检测旋臂迷宫能力,共检测14天。对照组和麻醉组大鼠在纠正第一次错误的选择数和完成迷宫试验的时间上无显著性差异。错误的总数三组之间也没有明显差异(P > 0.05),但是试验组大鼠每天表现的相互比较有显著性差异,表现为后几天测试时1.2%异氟醚70%笑气复合麻醉组较对照能力进步快。因此,成年大鼠,以往的全身麻醉与其术后两周的学习能力受损没有明显联系。事实上,早先的1.2%异氟醚70%笑气复合麻醉能够改善大鼠两周后的迷宫表现。

(邱郁薇 马皓琳,李士通 校)

We have previously demonstrated that general anesthesia with 1.2% isoflurane-70% nitrous oxide impairs acquisition of a radial arm maze task in both young and aged rats when testing begins 2 days after anesthesia and in aged rats when testing begins 2 wk later. We designed this study to examine whether postanesthesia learning impairment is persistent in young rats. Six-month-old rats were randomized to anesthesia for 2 h with 1.2% isoflurane-70% nitrous oxide, 1.8% isoflurane, or a control group that received 30% oxygen (n = 10 per group). Rats recovered for 2 wk and were then tested daily on a radial arm maze for 14 days. There were no differences between the controls and anesthesia groups in number of correct choices to first error or time to complete the maze. There was no main effect of group in terms of total number of errors (P > 0.05) but the group by day interaction was significant (P < 0.05), reflecting improved performance in the 1.2% isoflurane-70% nitrous oxide group relative to controls during the later days of testing (P < 0.005). Hence, in adult rats, previous general anesthesia is not associated with impaired learning 2 wk later. In fact, previous 1.2% isoflurane-70% nitrous oxide improves maze performance 2 wk later.


降低手术时着火的发生率:从麻醉机通过鼻导管提供低于100%O2混合气体

Reducing the Incidence of Surgical Fires: Supplying Nasal Cannulae with sub-100% O2 Gas Mixtures from Anesthesia Machines

 

Samsun Lampotang, PhD*{ddagger}§, Nikolaus Gravenstein, MD*{dagger}, David A. Paulus, MD*{ddagger}, and Dietrich Gravenstein, MD*

Departments of *Anesthesiology and {dagger}Neurosurgery, University of Florida College of Medicine; and Departments of {ddagger}Mechanical and Aerospace Engineering and §Electrical and Computer Engineering, University of Florida College of Engineering, Gainesville, Florida

Anesth Analg 2005;101:1407-1412

 

20036月,健康保健组织鉴定联合委员会(JCAHO)建议:“作为一个通用政策,用空气或£30%的氧气开放输送(保证病人所需)”来预防手术时起火。能解释JCAHO建议的一个原因为:100% O2不应滥用,麻醉者应有能力根据病人需要和临床诊断,通过鼻导管给予低于100%浓度的O2。辅助的O2流量计有一个卡口连接器提供了连接鼻导管和麻醉机的简便方法,常规用于100% O2的开放输送。辅助的O2流量计只提供100% O2,这样就不允许O2浓度根据病人需要调节,可能提高手术时起火的危险性。这个报告阐明了JCAHO的建议,并描述了主要基于使用麻醉机来混合低于100% O2的混合气体并通过鼻导管输送而选择的不同方法。目前的选择依赖于麻醉机的模型和制造商,允许通过鼻导管输送浓度范围是21%100%O2

(朱 马皓琳, 李士通 校)

In June 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended: "As a general policy, use air or Fio2 at ≤30% for open delivery (consistent with patient needs)" to prevent surgical fires. One way to interpret JCAHO's recommendation is that 100% O2 should not be indiscriminately used, and anesthesia providers should have the ability, consistent with patient needs and their clinical judgment, to deliver sub-100% O2 with nasal cannulae. An auxiliary O2 flowmeter has a barbed outlet connector that offers a convenient means to connect a cannula to an anesthesia machine and is routinely used for open delivery of 100% O2. The auxiliary O2 flowmeter provides only 100% O2 and thus does not allow titration of the O2 concentration to patient needs and may increase the risk of surgical fires. This report clarifies the JCAHO recommendation and describes different means of addressing it that are based primarily on using the anesthesia machine to blend a sub-100% O2 gas mixture and delivering it via a nasal cannula. The options presented depend on the model and manufacturer of the anesthesia machine and allow delivery via nasal cannula of O2 concentrations that range from 21% to 100%.


由急救医疗学技术员中比较喉管和气囊-活瓣面罩通气:一项在麻醉患者身上的可行性研究

A Comparison of the Laryngeal Tube and Bag-Valve Mask Ventilation by Emergency Medical Technicians: A Feasibility Study in Anesthetized Patients

Jouni O. Kurola, MD*, Matti J. Turunen, MD*, Juha-Pekka Laakso, RN{dagger}, Jouko T. Gorski, RN, MSc{dagger}, Heikki J. Paakkonen, RN, MSc{dagger}, and Tom O. Silfvast, MD{ddagger}

*Department of Anaesthesia and Intensive Care, Kuopio University Hospital; {dagger}Emergency Services College, Kuopio; and {ddagger}Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Finland

Anesth Analg 2005;101:1477-1481

 

在急诊处理中气道管理是很重要。对于所有保健提供者的基础技能是气囊-活瓣面罩(BVM)通气,它需要技能且可能较难使用。气管内插管是保证气道安全的进一步方法,它是一门要求高的技术,甚至当有经验的医务辅助人员操作时成功率也很低。因此已开始寻找其他可供选择的气道设备。已有研究,由有经验的麻醉医师在麻醉患者和在急救医疗训练中的人体模型上应用喉管。我们决定评估没有经验的消防队员-急救医疗技术的学生(fire-EMT)在麻醉患者身上插LT或使用BVM的能力。30fire-EMT随机分为插LT(n = 15)和进行1分钟通气或者用BVM(n = 15)。我们发现所有学生都成功地(100%)插入LT。在第一次尝试(73%)插入LT的学生需要48.2 ± 14.7秒。LTBVM都提供充足的氧气和通气。在本研究中,我们发现没有经验的fire-EMT学生在麻醉患者身上插入喉管和进行1分钟通气的成功率和耗时都较合理。

(彭中美 马皓琳,李士通 校)

Airway management is of major importance in emergency care. The basic technique for all health care providers is bag-valve mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding technique that has been shown to be associated with infrequent success, even when used by experienced paramedical personnel. Therefore, alternative airway devices have been sought. The use of the laryngeal tube (LT) by experienced anesthesia personnel had been studied in anesthetized patients and manikins in emergency medical training. We decided to evaluate the ability of inexperienced firefighter-emergency medical technician students (fire-EMT) to insert the LT or perform BVM in anesthetized patients. Thirty fire-EMTs randomly inserted the LT (n = 15) and performed 1 min of ventilation or used the BVM (n = 15). We found that all students successfully (100%) inserted the LT. Those who inserted the LT on the first attempt (73%) required 48.2 ± 14.7 s for the insertion. Both the LT and BVM provided adequate oxygenation and ventilation. In this study, we found that inexperienced fire-EMT students inserted LT and performed 1-min ventilation with a reasonable success rate and insertion time in anesthetized patients.




小剂量布比卡因-苏芬太尼预防脊麻后的心输出量改变

Small-Dose Bupivacaine-Sufentanil Prevents Cardiac Output Modifications After Spinal Anesthesia

Karim Asehnoune, MD*, Eric Larousse, MD*, Jean Marc Tadié, MD*, Vincent Minville, MD*, Stephane Droupy, MD{dagger}, and Dan Benhamou, MD*

*Service d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur-Equipe d'Accueil (UPRES-EA 3540) and {dagger}Service d'Urologie, Centre Hospitalo-Universitaire de Bicêtre, AP-HP, Le Kremlin Bicêtre, France

Anesth Analg 2005;101:1512-1515

 

与大剂量布比卡因相比,在蛛网膜下腔注射小剂量布比卡因能减少低血压的可能。我们假设小剂量的布比卡因可预防心输出量的下降。在这项前瞻性的随机研究中,我们选择择期行脊麻下泌尿科手术、下腹部手术或下肢手术的病人。蛛网膜下腔注射液分别为小剂量(7.5mg重比重布比卡因和葡萄糖·H2O80 mg/mLn=19)加5μg苏芬太尼或大剂量(12.5 mg重比重布比卡因和葡萄糖·H2O80 mg/mLn=19)。在脊麻阻滞前1 min及鞘内注射后21030min监测CO(阻抗心动描记法)、动脉血压及心率。在30min时测评感觉平面。与大剂量组相比,在脊麻后2min-30min,小剂量组的心输出量较高。而且,与基础值相比,小剂量组2min时心输出量增加,而大剂量组的心输出量在1030min时下降。结论:与大剂量布比卡因相比,小剂量布比卡因麻醉能提供成功的麻醉,且使心输出量更好。

(裘毅敏 李士通 校)

Spinal injection of small-dose (SD) bupivacaine decreases the likelihood of hypotension compared with large-dose (LD) bupivacaine. We assumed that a SD of bupivacaine could also prevent the decrease in cardiac output (CO). Patients undergoing elective urologic, lower abdominal, or lower limb surgery under spinal anesthesia were included in this prospective randomized study. Spinal injection consisted of 5 µg of sufentanil and either SD (7.5 mg of hyperbaric bupivacaine with glucosemonohydrate80 mg/mL; n = 19 patients) or LD (12.5 mg of hyperbaric bupivacaine with glucosemonohydrate80 mg/mL; n = 19 patients). CO (impedance cardiography), arterial blood pressure, and heart rate) were measured at 1 min before performance of spinal block and 2, 10, and 30 min after the intrathecal injection. Sensory level was also assessed at 30 min. CO was higher in the SD group as compared with the LD group from 2 min to 30 min after spinal anesthesia. Moreover, CO increased at 2 min in the SD group and decreased at 10 and 30 min in the LD group compared with baseline value. In conclusion, SD bupivacaine provides successful anesthesia and gives better CO stability than LD.


抛物线飞行时微重力状态下喉镜引导气管插管的可行性:两种技术的比较

The Feasibility of Laryngoscope-Guided Tracheal Intubation in Microgravity During Parabolic Flight: A Comparison of Two Techniques

Gernot E. Groemer*, Joseph Brimacombe{ddagger}, Thorsten Haas{dagger}, Cristina de Negueruela§, Alexander Soucek||, Michael Thomsen, and Christian Keller{dagger}

*Institute of Astrophysics and {dagger}Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria; {ddagger}Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Australia; §Space Mission European Space Agency, European Space Research and Technology Centre, Noordwijk, The Netherlands; ||European Space Agency, European Space Research Institute, Frascati, Italy; and ¶Technical University of Denmark, Denmark

Anesth Analg 2005;101:1533-1535

 

我们测定在抛物线飞行时得到的微重力状态下用喉镜引导气管插管(LG-TI)的可行性,并验证这样的一种假设:在患者的头被夹在麻醉医生的两膝之间的自由浮体状态和在躯干被皮绳捆在平板的受限制状态下进行LG-TI能同样获得成功。三名未经历过气道管理或微重力的人员参与本研究。每一位研究者在地面的基础训练之后,在这两种状态下在精密复杂标准尺寸的人体模型上各尝试七次LG-TI 。太平洋上飞行的空中巴士300上发生的抛物线飞行,提供23秒的微重力时间。在这期间研究者打开装有气道装备的盒子,进行LG-TI,连接上一个自动充气的气囊并握住。在水平飞行时通过挤压气囊和注意人体模型的传感器是否显示潮气量³300ml来评估通气的有效性。通气的成功率(41%33%)及成功插入气管导管所需时间(均为18s)在自由浮体状态和受限制状态之间无差别。90%以上的失败由在23s内不能插入气管导管引起。各位研究者之间的表现无差别。我们得出结论,LG-TI在抛物线飞行器期间的微重力状态下是可行的,但是由于严格的时间限制成功率很低。在把头夹在两膝之间的自由浮体状态和躯干被绑在平板的受限制状态下的插管成功率无差别。

(陈玮 李士通 校)

We determined the feasibility of laryngoscope-guided tracheal intubation (LG-TI) in microgravity obtained during parabolic flight and tested the hypothesis that LG-TI is similarly successful in the free-floating condition, with the patient’s head gripped between the anesthesiologist’s knees, as in the restrained condition, with the torso strapped to the surface. Three personnel with no experience in airway management or microgravity participated in the study. LG-TI of a sophisticated full-size manikin was attempted on seven occasions in each condition by each investigator after ground-based training. The parabolic flights, which took place in an Airbus 300 over the Atlantic Ocean, provided 23 s of microgravity. During this time, the investigator opened a box with airway equipment, performed LG-TI, and attached and held onto a self-inflating bag. The efficacy of ventilation was assessed during level flight by squeezing the bag and noting whether the manikin sensors indicated a tidal volume ≥300 mL. There were no differences in ventilation success (41% versus 33%) or time to successful insertion (both 18 s) between the free-floating and the restrained conditions. More than 90% of failures were caused by the inability to insert the tracheal tube within 23 s. There were no differences in performance among investigators. We conclude that LG-TI is feasible in microgravity obtained during parabolic flight, but the success rate is infrequent because of severe time restrictions. There were no differences in success rate between the free-floating condition, with the head gripped between the knees, and the restrained condition, with the torso strapped to the surface.


 

 

异氟醚抑制血小板增强中性粒细胞介导的冠状动脉内皮细胞动能紊乱作用
Isoflurane prevents platelets from enhancing neutrophil-induced coronary endothelial dysfunction.
Hu G,Salem MR ,Crystal GJ
Department of Anesthesiology, Advocate IL Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657-5193, USA.
Anesth Analg. 2005 Nov;101(5):1261-8

我们首先评价血小板是否增强中性粒细胞介导的冠状动脉内皮功能紊乱,当观察到这些后,再评价异氟醚是否抑制这种效应。中性粒细胞、冠状动脉片断和血小板是从25条健康的狗身上获得的。冠状动脉环被暴露在被血小板激活因子激活的中性粒细胞下(1.0微莫尔),在洗脱及用U46619预先压缩后,检测其中对反应浓度相关的乙酰胆碱,一种内皮依赖的血管舒张药物。由激活的中性粒细胞产生的过氧化物通过分光光度法被检测到。激活的中性粒细胞对冠状动脉内皮细胞的黏附性通过萤光染色标记直接计数来评价。检测在有和没有异氟醚(1MAC)的情况下进行,两者都有或者没有血小板。血小板的存在增强中性粒细胞,使乙酰胆碱浓度相关的血管舒张反应曲线右移。(引起50%最大舒张反应的乙酰胆碱浓度(-logM)从6.78 +/- 0.7增加到5.26 +/- 0.6),它使过氧化物产物从45.0 +/- 4.2增加到54.3 +/- 4.2 nM O2-/5 x 10(6) 中性粒细胞,激活的中性粒细胞的黏附性从204 +/- 10增加到268 +/- 5中性粒细胞/mm2。异氟醚可以抑制血小板的这些作用。总而言之,血小板增强中性粒细胞的功能来引起冠状动脉内皮功能紊乱,这种效应可以被异氟醚抑制。这种作用可能归结于对中性粒细胞过氧化物产物的抑制来减少内皮粘附分子的表达,从而减少中性粒细胞的粘附。

(陆文清译 薛张纲校)

We evaluated whether platelets can enhance polymorphonuclear neutrophil-induced coronary endothelial dysfunction, and, after observing this, whether isoflurane can prevent the effect. Neutrophils, coronary artery segments, and platelets were obtained from 25 healthy dogs. Coronary artery rings were exposed to neutrophils activated with platelet-activating factor (1.0 microM), and after washing and preconstriction with U46619, were evaluated for concentration-related responses to acetylcholine, an endothelium-dependent vasorelaxing drug. Superoxide production by activated neutrophils was measured spectrophotometrically. Adherence of the activated neutrophils to the endothelium of coronary segments was assessed by direct counting of neutrophils labeled with fluorescent dye. Measurements were performed in absence and presence of isoflurane (1 minimum alveolar concentration) both with and without platelets.

The presence of platelets enhanced the neutrophil-induced rightward shift in the concentration-vasorelaxation response curve to acetylcholine (the concentration of acetylcholine required to elicit 50% of maximal relaxation (-log M) was increased from 6.78 +/- 0.7 to 5.26 +/- 0.6), and it increased superoxide oxide production from 45.0 +/- 4.2 to 54.3 +/- 4.2 nM O2-/5 x 10(6) neutrophils and adherence of activated neutrophils from 204 +/- 10 to 268 +/- 5 neutrophils/mm2. Isoflurane abolished these effects of platelets. In conclusion, platelets enhanced the ability of neutrophils to cause coronary endothelial dysfunction. This effect was prevented by isoflurane. This may be attributable to an inhibitory action on superoxide production by the neutrophils leading to reduced expression of endothelial adhesion molecules and, in turn, reduced neutrophil adherence.

 

 

对于体重小于5公斤的婴儿中心静脉导管的最佳深度

The Optimal Depth of Central Venous Catheter for Infants Less Than 5 kg

Jin-Hee Kim, MD*, Chong-Sung Kim, MD{dagger}, Jae-Hyun Bahk, MD{dagger}, Kyung Joon Cha, PhD{ddagger}, Young-Sun Park, PhD{ddagger}, Young-Tae Jeon, MD{dagger}, and Sung-Hee Han, MD{dagger}

*Department of Anesthesiology, Seoul National University Bundang Hospital; {dagger}Department of Anesthesiology, Seoul National University Hospital; {ddagger}Laboratory of Statistical Information Analysis, Hanyang University, College of Natural Sciences, Seoul, Korea

Address correspondence and reprint requests to Sung- Hee Han, MD, Department of Anesthesiology and Pain Medicine, 300 Gumi-Dong, Bundang-Gu, Seongnam–Si, Gyoenggi-Do, 463–707, Korea. Address e-mail to noninvasive@snubh.org or noninvasive@hanmail.net

Anesth Analg 2005;101:1301-1303

 

为了避免中心静脉导管的致命并发症,如心脏填塞,中心静脉导管(CVC)的顶端应该被放在心室外。为了对婴儿的中心静脉导管的合适深度提供一个指南,我们通过经食管超声波心动描记术(TEE)测量了从皮肤穿刺点到上腔静脉和右心房的连接点(SVC-RA连接点)的距离。五十名体重小于5kg,因为先天性心脏病正经历手术的婴儿入选本项预期的研究。全麻诱导后,中心静脉导管(CVC)经过右锁骨下静脉被置入。在使用TEE引导下将中心静脉导管的尖端放置到SVR-RA连接点后,测量中心静脉导管置入皮下的长度。测量得的长度与病人的身高,体重和年龄有很高的相关性(分别为r = 0.88, 0.76 0.64)。在体重小于5kg的婴儿中,以下的指南可以避免中心静脉导管心房内的放置:2.0-3.0kg体重的婴儿,深度在40-45mm之间,3.0-3.9kg的婴儿,深度为45-50mm,而那些体重大于4.0kg的,深度为50-55mm。(周荻译 薛张纲校)

To avoid fatal complications of central venous catheterization such as cardiac tamponade, the tip of the central venous catheter (CVC) should be placed outside of the cardiac chamber. To suggest a guideline for a proper depth of CVC in infants, we measured the distance from the skin puncture site to the junction between superior vena cava and right atrium (SVC-RA junction) by using transesophageal echocardiography (TEE). Fifty infants less than 5 kg undergoing surgery for congenital heart disease were enrolled in this prospective study. After the induction of general anesthesia, CVC was inserted via the right subclavian vein. After the tip of the CVC was placed at the SVC-RA junction using TEE guidance, the length of the CVC inserted beneath the skin was measured. The measured distance had a high correlation with the patient’s height, weight, and age (r = 0.88, 0.76, and 0.64, respectively). In infants smaller than 5 kg, the following guideline can avoid intraatrial placement of the CVC: a depth between 40 and 45 mm for infants 2.0–3.0 kg in weight, 45–50 mm for those 3.0–3.9 kg, and 50–55 mm for those more than 4.0 kg.

 

 

活性氧簇在心肌损伤和保护的调节方面与麻醉实践的相关性

 

门诊采用神经周围局麻药注射行全肩关节成形术作为一项门诊操作方案:一项初步可行性研究

Total shoulder arthroplasty as an outpatient procedure using ambulatory perineural local anesthetic infusion: a pilot feasibility study

 

Ilfeld BM, Wright TW, Enneking FK, Mace JA, Shuster JJ, Spadoni EH, Chmielewski TL, Vandenborne K.
Department of Anesthesiology, P.O. Box 100254, 1600 SW Archer Rd., Gainesville, FL 32610-0254, USA. bilfeld@ufl.edu

Anesth Analg. 2005 Nov;101(5):1319-22

 

我们研究了在门诊采用肌间沟神经周围罗哌卡因注射使全肩关节成形术(TSA)转变成一项门诊操作方案的可行性。在第一阶段被要求术后住院至少一个晚上的病人(n=8)中,5名在苏醒室中达到出室标准。在后来第二阶段的病人(n=6)中,术后都在苏醒室中达到出室标准,其中5名直接离院回家。所有的病人术后镇痛良好,口服阿片类药物的需求和睡眠障碍都达最小程度,运动范围持续达到或超过外科医生的期望,且病人的满意度很高。这些结果提示使用神经周围局麻药注射能使TSA在门诊环境中得以实施。在其推广使用前尚需进一步的研究来定义合适的病人群体和评估与之相关的并发症的发生率。

(徐丽颖译 薛张纲校)

We investigated the feasibility of converting total shoulder arthroplasty (TSA) into an outpatient procedure using ambulatory interscalene perineural ropivacaine infusion. Of the patients of the first phase (n = 8) who were required to remain hospitalized for at least 1 postoperative night, 5 met discharge criteria in the recovery room. Of the subsequent patients of the second phase (n = 6), all met discharge criteria in the recovery room after surgery, and 5 were discharged directly home. For all patients, postoperative pain was well controlled, oral opioid requirements and sleep disturbances were minimal, range-of-motion consistently reached or exceeded the surgeon's expectations, and patient satisfaction was high. These results suggest that TSA may be performed on an outpatient basis using perineural local anesthetic infusion. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with this practice before its mainstream use.

 

 

术后恶心、呕吐很大程度上受到术后阿片类药物剂量相关性应用的影响

Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner.
Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF.
Pharmacy Department, Repatriation General Hospital, Daws Rd., Daw Park SA 5041, Australia.

Anesth Analg 2005 1011345-1348.

 

我们观察了193个没有服用术后止吐预防药的老年外科手术病人的术后恶心呕吐的发生率。术后恶心呕吐的危险因素以及对术后阿片类药物的应用进行了记录。术后呕吐的发生率是23.8%,术后恶心是51.3%。阿片类药物和女性是重要的影响的因素。术后阿片类药物的应用和恶心和呕吐成对数剂量反应的关系。病人自控镇痛或硬膜外麻醉是大剂量阿片类药物应用的标志,和术后24小时内的恶心呕吐的相关性分别是41%和31%,而不用PCA和硬外镇痛的病人只有11%。进一步研究表明术后给予持续量的阿片类药物比间断给予术后发生呕吐的危险性更高。

(钟静译 薛张纲校)

We prospectively examined the incidence of postoperative nausea and vomiting (PONV) in a group of 193 elderly surgical inpatients receiving no postoperative antiemetic prophylaxis. Risk factors for PONV and detailed data on postoperative opioid use were recorded. The overall postoperative vomiting (POV) rate was 23.8%, whereas postoperative nausea (PON) was 51.3%. Opioid use (P = 0.025), and female gender (P = 0.038) were identified as significantly influencing POV in this relatively small population. There was a strong logarithmic dose-response relationship between postoperative opioid dose and POV (r2= 0.98, P < 0.01), as well as PON (r2= 0.98, P = 0.01). Use of patient-controlled analgesia or epidural analgesia was a marker for large-dose opioid use (P < 0.001) and was associated with POV in the 24-h postoperative period of 41% and 31% respectively, compared with 11% for other patients (P < 0.001). Future studies defining risk factors for POV should treat postoperative opioid use as a continuous variable, rather than treat it as a dichotomous variable.

 

氧化亚氮不是阻滞阿曲库铵的介质

Nitric Oxide Is Not a Mediator of Inflammation-Induced Resistance to Atracurium

Heidrun Fink, Ralph Bogdanski, Peter Luppa, J. A. Jeevendra Martyn, and Manfred Blobner

Klinik für Anaesthesiologie der Technischen Universität München and #Institut für Klinische Chemie und Pathobiochemie der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany; and Department of Anesthesiology and Critical Care, Harvard Medical School and Anesthesia Services, Massachusetts General Hospital, and Shriners Hospital for Children, Boston, MA

Anesth Analg. 2005 Oct;101(4):1362-1367.

 

对于阿曲库铵的阻滞是由于增加了诱导性氧化亚氮合酶活性和氧化亚氮在血浆中的水平从而使阿曲库铵与1-酸糖化蛋白的结合增加的结果。我们研究是否抑制诱导性氧化亚氮合酶活性和氧化亚氮在血浆中的水平可以逆转对于阿曲库铵的阻滞。建立这样一个1-酸糖化蛋白和氧化亚氮增加的模型,84Sprague-Dawley雄性鼠给予60 mg/kg的棒状杆菌(CP)或盐水静脉注射。这两组将进一步被分为以下几组:通过饮水给予不同浓度的选择性诱导性氧化亚氮合酶抑制剂,N型亚氨基赖氨酸。一天四次CP注射,阿曲库铵的药效学是确定的。氧化亚氮,阿曲库铵,1-酸糖化蛋白和乙酰胆碱受体的数量是确定的。在CP组,N型亚氨基赖氨酸抑制氧化亚氮是遵循计量依赖的方式。对于阿曲库铵的阻滞是持续的。1-酸糖化蛋白的血浆水平在所有的CP组都保持增长并且与乙酰胆碱受体的表达数量无关。我们的结论是1-酸糖化蛋白的表达和阿曲库铵与其结合的持续增加不是由诱导性氧化亚氮合酶和氧化亚氮所介导

(孙卓真译 薛张纲校)

Resistance to atracurium as a result of increased drug binding to 1-acid glycoprotein is associated with increased inducible nitric oxide synthase activity and increased nitric oxide levels in plasma. We investigated if the inhibition of inducible nitric oxide synthase and suppression of nitric oxide can reverse the resistance to atracurium. As a model of 1-acid glycoprotein and nitric oxide increase, 84 male Sprague-Dawley rats received an IV injection of either 60 mg/kg Corynebacterium parvum (CP) or saline (control). The 2 groups (CP/Control) were further divided into subgroups, receiving the selective inducible nitric oxide synthase inhibitor, N-Iminolysine, via drinking water at different concentrations. On day 4 post-CP injection, the pharmacodynamics of atracurium were determined. Plasma concentrations of nitric oxide, atracurium, and 1-acid glycoprotein were measured and acetylcholine receptor numbers were quantified. In the CP groups, N-Iminolysine suppressed nitric oxide levels in a dose-dependent manner. Resistance to atracurium persisted. 1-acid glycoprotein serum levels remained increased in all CP groups with no differences in acetylcholine receptor expression. Our results suggest that the mechanism leading to increased expression of 1-acid glycoprotein and consecutive increased protein binding of atracurium is not mediated by inducible nitric oxide synthase induction and nitric oxide expression.

 

 

麻醉剂和酒精对于异卵细胞G-蛋白偶联钾通道内部调节在α-2肾上腺素能受体亚型的作用

The effects of anesthetics and ethanol on alpha2 adrenoceptor subtypes expressed with G protein-coupled inwardly rectifying potassium channels in Xenopus oocytes.
Hara K, Yamakura T, Sata T, Harris RA.
Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan.
Anesth Analg 2005 101:1381-1388

 

许多生理反射都是由α-2肾上腺素能受体介导的通过其相关的G-蛋白偶联钾通道(GIRK)而形成.尽管α-2肾上腺素能受体已经分为3种亚型,但这3种亚型之间的药理特性很难区别,因为缺乏具有选择性的激动剂和拮抗剂;因此麻醉药对α-2肾上腺素能受体亚型的作用知之甚少.我们在异卵细胞中表达每种亚型及GIRK1/ GIRK2亚单位并观察给予临床用量的酒精、氟烷和几种静脉麻醉药后α-2肾上腺素能受体介导的GIRK1/ GIRK2反应.UK14304是一种选择性的α-2肾上腺素能受体激动剂,在每个亚型都能激活GIRK1/ GIRK2反应.没有一种静脉麻醉药,包括戊巴比妥、异丙酚和氯胺酮能够影响UK14304激活的任何亚型受体的钾通道反应.乙醇能增强UK14304诱发的钾通道反应而氟烷则抑制.但哲学作用无太大差异,这提示乙醇和氟烷都并非直接作用于α-2肾上腺素能受体亚型.尽管测试表明没有药物作用于α-2肾上腺素能受体,但由α-2肾上腺素能受体介导的GIRK1/ GIRK2生理反应能被乙醇和氟烷所影响.

(王慧琳译 薛张纲校)
A wide range of physiological effects are mediated by alpha2-adrenoceptors (ARs) through their association with G protein-coupled inwardly rectifying potassium (GIRK) channels. Although alpha2-ARs are divided into three subtypes (alpha2A-C), a pharmacological distinction among the subtypes is difficult to establish because of the lack of a selective agonist and antagonist; therefore, little is known about the effects of anesthetics on the alpha2-AR subtypes. We expressed each subtype together with GIRK1/GIRK2 subunits in Xenopus oocytes and observed alpha2-AR-mediated GIRK1/GIRK2 currents to test the effects of ethanol, halothane, and several IV anesthetics at clinical concentrations. UK 14,304, a selective alpha2-AR agonist, evoked GIRK1/GIRK2 currents in every subtype. None of the IV anesthetics, which included pentobarbital, propofol, ketamine, and alphaxalone, influenced UK 14,304-evoked potassium currents in any of the receptor subtypes. Ethanol enhanced the UK 14,304-evoked potassium currents, whereas halothane inhibited the currents. However, these effects were not significantly different from those on the baseline-GIRK1/GIRK2 current, suggesting that neither ethanol nor halothane acts directly on the alpha2-AR subtypes. Although none of the drugs examined had any effect on the alpha2-ARs, the physiological actions of the alpha2-ARs mediated by the GIRK1/GIRK2 channels may be affected by ethanol and halothane.

 

 

在大鼠甲醛试验中鞘内注射腺苷受体亚型激动剂抵抗伤害性刺激

Antinociception of intrathecal adenosine receptor subtype agonists in rat formalin test.
Yoon MH, Bae HB, Choi JI

Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, 8 Hakdong, Dongku, Gwangju 501-757, Korea.

Anesth Analg. 2005 Nov;101(5):1417-21.

 

通过脊髓腺苷受体,腺苷已经显示了抵抗伤害刺激的作用。目前有四种腺苷受体类型:A1A2AA2BA3。根据控制脊髓水平的伤害性刺激,我们分化了腺苷受体的特性。为了产生刺激性疼痛,往斯普拉-道来大鼠的后足底注射甲醛溶液(5%50微升)。同时鞘内注射腺苷A1 (CPA)A2A (DPMA),和A3 (IB-MECA)受体激动剂的效果被检测。甲醛试验早期反应CPAIB-MECA效果有限或者无效,但是这两种药物可抑制晚期反应。DPMA则均可抑制上述两期反应。在晚期,CPA是三种药物中最有潜在作用的药物。这些结果提示脊髓腺苷A1A2A受体在甲醛试验中可能涉及了早期和后期反应的调节,而腺苷A3受体则可能涉及了晚期反应的调节。

(孙敏莉译,薛张纲校)

Adenosine has shown antinociceptive action via spinal adenosine receptors. There are four types of adenosine receptors: A1, A2A, A2B, and A3. We characterized the nature of types of adenosine receptors for the control of nociception at the spinal level. For nociception, formalin solution (5%, 50 microL) was injected into the hindpaw of male Sprague-Dawley rats. The effects of intrathecal adenosine A1 (CPA), A2A (DPMA), and A3 (IB-MECA) receptor agonists were examined. CPA and IB-MECA produced limited or no effect on the early phase response of the formalin test, respectively, but the two drugs depressed the late phase response. DPMA suppressed both phase responses. CPA was the most potent drug among the three in the late phase. These results suggest that spinal adenosine A1 and A2A receptors may be involved in the modulation of the early and the late phase responses of the formalin test, whereas adenosine A3 receptor may be involved in the regulation of the late phase response.

 

骶髂关节疼痛:综合解剖、诊断和治疗的综述

Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment

Steven P. Cohen, MD

Pain Management Divisions, Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD and Walter Reed Army Medical Center, Washington, DC

Anesth Analg 2005;1011440-1453.

 

骶髂关节疼痛是一种具有挑战性的情况,15%至25%的患者合并有轴性腰背痛,但却没有标准的长期治疗手段。近期的研究表明病史、体格检查和放射成像不足以诊断骶髂关节疼痛。诊断骶髂关节为疼痛的始发点最常用的方法是小剂量局部麻醉药阻滞,虽然这一种诊断方法的可靠性尚未得到证实。在这篇综述中,我对其解剖、功能和骶髂关节受伤的机制等方面做了综合的综述,同时对其诊断和治疗进行了系统性评价。

(金琳 薛张纲 校)

Sacroiliac (SI) joint pain is a challenging condition affecting 15% to 25% of patients with axial low back pain, for which there is no standard long-term treatment. Recent studies have demonstrated that historical and physical examination findings and radiological imaging are insufficient to diagnose SI joint pain. The most commonly used method to diagnose the SI joint as a pain generator is with small-volume local anesthetic blocks, although the validity of this practice remains unproven. In the present review I provide a comprehensive review of the anatomy, function, and mechanisms of injury of the SI joint, along with a systematic assessment of its diagnosis and treatment.

 

 

行为疼痛评分在评估危重、镇静和机械通气病人的有效性研究

Validation of a Behavioral Pain Scale in Critically Ill, Sedated, and Mechanically Ventilated Patients

Younès Aïssaoui, MD*, Amine Ali Zeggwagh, MD, PhD*, Aïcha Zekraoui, MD*, Khalid Abidi, MD*, and Redouane Abouqal, MD, PhD*

Service de Réanimation Médicale et de Toxicologie Clinique, Hôpital Ibn Sina; and Laboratoire de Biostatistiques, de Recherche Clinique et Epidémiologique, Faculté de Médecine et de Pharmacie, Rabat, Morocco

Anesth Analg 2005;101:1470-1476

 

评估危重病人的疼痛,特别是不能言语的病人具有很大的挑战性。本研究,我们用行为疼痛评分(BPS)来评估危重、镇静和机械通气病人的有效性。BPS3个项目组成:脸部表情、上肢运动和人机配合程度。每个项目分为1-4分。2个测试者同时用BPS观察和记录静息和疼痛时的分数。研究表明BPS心理测试特征是可靠、有效和敏感的。我们在30例病人中进行了360项观察。BPS具有内在的可靠性(Cronbach = 0.72)。相关系数是高的(0.95)BPS分数值的不同证实了其可靠性,疼痛时分数明显增高,平均3.9+/-1.1(静息时)和6.8+/-1.9(疼痛时)(P < 0.001)。并通过多因数分析揭示首要因数为疼痛表达的多样性,占65%BPS具有非常好的敏感性,有效分数范围为2.2-3.4。本研究显示了BPS在无法交流的ICU病人中是有效和可靠的。

(吴德华译 薛张纲校)

Assessing pain in critically ill patients, particularly in nonverbal patients, is a great challenge. In this study, we validated a behavioral pain scale (BPS) in critically ill, sedated, and mechanically ventilated patients. The BPS score was the sum of 3 subscales that have a range score of 1–4: facial expression, upper limb movements, and compliance with mechanical ventilation. Two assessors observed and scored pain simultaneously with the BPS at rest and during painful procedures. The psychometric properties of the BPS that were studied were reliability, validity, and responsiveness. We achieved 360 observations in 30 patients. The BPS was internally reliable (Cronbach = 0.72). The intraclass correlation coefficient to evaluate inter-rater reliability was high (0.95). Validity was demonstrated by the change in BPS scores, which were significantly higher during painful procedures, with averages of 3.9 ± 1.1 at rest and 6.8 ± 1.9 during procedures (P < 0.001), and by the principal components factor analysis, which revealed a large first-factor accounting for 65% of the variance in pain expression. The BPS exhibited excellent responsiveness, with an effect size ranging from 2.2 to 3.4. This study demonstrated that the BPS can be valid and reliable for measuring pain in noncommunicative intensive care unit patients.

 

术后口服恩丹司琼裂解片剂对预防听神经瘤术后恶心呕吐的作用

The Efficacy of Postoperative Ondansetron (Zofran®) Orally Disintegrating Tablets for Preventing Nausea and Vomiting After Acoustic Neuroma Surgery

Theresa Hartsell, MD, PhD*, Donlin Long, MD, PhD, and Jeffrey R. Kirsch, MD*

Departments of Anesthesiology and Critical Care Medicine and Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Anesth Analg 2005;101:1492-1496

 

术后恶心呕吐是穿颅术常见的并发症。作者采用前瞻性、随机、安慰剂对照、双盲实验研究了术中静脉注射恩丹司琼及术后等效量口服恩丹司琼裂解片剂对缓解术后恶心呕吐的发生率及严重程度。选择60例听神经瘤手术患者,每例手术结束前30分钟给恩丹司琼静注4mg,或者安慰剂。术后口服等效量恩丹司琼或安慰剂,每天2次共3天。两组中效果欠佳给胃复安补救。记录恶心的程度(10-厘米可视法)、呕吐次数和补救药需要量。术后早期,恩丹司琼组恶心程度低于安慰剂组(3.3 ± 4.1 versus 7.3 ± 4.2; P < 0.001),更少病人呕吐(3 of 28 versus 11 of 32; x2 P < 0.01)。术后第一天安慰剂组中更多病人需要补救药(26 of 32 versus 16 of 28; x2 P < 0.01)。我们的结论是静注恩丹司琼能预防听神经瘤术后即刻的恶心呕吐。术后口服恩丹司琼对预防术后第一天的恶心呕吐有效,能减少胃复安使用量。

(吴德华译 薛张纲校)

Postoperative nausea and vomiting is a frequent complication of craniotomy. We evaluated the ability of intraoperative IV ondansetron followed by postoperative ondansetron in an orally disintegrating tablet formulation to reduce the frequency and severity of postoperative nausea and vomiting in a prospective, randomized, placebo-controlled double-blind trial of 60 patients undergoing acoustic neuroma resection. Each patient received intraoperative ondansetron (4 mg IV) or placebo 30 min before case end. Postoperatively, patients received ondansetron in an orally disintegrating tablet formulation (8 mg BID) or placebo twice a day for up to 72 h. Metoclopramide was available as rescue therapy for both groups. Severity of nausea (as measured on a 10-cm visual scale), number of emetic episodes, and requirement for rescue therapy were recorded. In the immediate postoperative period, nausea severity was less in patients treated with ondansetron than placebo (3.3 ± 4.1 versus 7.3 ± 4.2; P < 0.001) and fewer patients experienced vomiting (3 of 28 versus 11 of 32; 2 P < 0.01). More patients required some form of rescue treatment in the placebo group on the first postoperative day (26 of 32 versus 16 of 28; 2 P < 0.01). We conclude that after acoustic neuroma surgery IV ondansetron treatment prevents immediate postoperative nausea and vomiting. Postoperative treatment with ondansetron in an orally disintegrating tablet formulation was associated with less frequent rescue therapy as compared with placebo on the first postoperative day.

 

脉搏氧饱和度波形振幅在成人硬膜外麻醉时含肾上腺素的试验剂量注入血管时的指示作用

The Efficacy of Plethysmographic Pulse Wave Amplitude as an Indicator for Intravascular Injection of Epinephrine-Containing Epidural Test Dose in Anesthetized Adults

Hany A. Mowafi, MB, Bch, MSc, MD

Department of Anesthesia, Faculty of Medicine, King Faisal University, Saudi Arabia

Address correspondence and reprint requests to Hany A. Mowafi, Department of Anesthesia, King Fahd University Hospital,

Anesth Analg 2005;101 1506-1511.

 

在本研究中,我评价了脉搏氧饱和度波形幅度(PPWA)在检测成人血管内注入一模拟硬膜外试验剂量(含15µg肾上腺素)时的功效,并以传统的心率(HR,增加10/分钟以上为阳性结果)和收缩压(SBP,升高15mmHg以上为阳性结果)标准为对照比较其可靠性。八十个病人被随机分为两组,分别接受1MAC的七氟烷和异氟烷吸入麻醉(每组病人数n40);每组麻醉病人再随机分为静脉注射3ml15 µg肾上腺素的1.5%利多卡因和3ml生理盐水两组(每组人数n20)。在注射后5分钟内监测HRSBPPPWA。注射试验剂量的病人出现PPWA波峰下降,七氟烷组在61 ± 12秒时下降61% ± 17%,异氟烷组在63 ± 13秒时下降58% ± 15%。由于注射生理盐水组出现波峰升高,认为PPWA波峰下降≧10%PPWA阳性标准。使用此数值,在两个麻醉组中PPWA的灵敏度、特异度、阳性预测值和阴性预测值都为100%。相反的,根据HR标准七氟烷组灵敏度为85%,异氟烷组灵敏度为95%;根据SBP标准,各麻醉组的灵敏度都为90%。结论是,PPWA是一种可靠的、可取代传统的血流动力学标准的方法,用来监测是否硬膜外试验剂量注入血管内。

(金 路译 薛张纲校)

In this study, I evaluated the efficacy of plethysmographic pulse wave amplitude (PPWA) in detecting intravascular injection of a simulated epidural test dose containing 15 µg of epinephrine in adults during either sevoflurane or isoflurane inhaled anesthesia and compared its reliability to the classical heart rate (HR; positive if ≥10 bpm) and systolic blood pressure (SBP; positive if ≥15 mm Hg) criteria. Eighty patients were randomized to receive either 1 mean alveolar anesthetic concentration of sevoflurane or 1 mean alveolar anesthetic concentration of isoflurane (n = 40 for each anesthesia group). Patients in each anesthesia group were further randomized to receive either 3 mL of 1.5% lidocaine containing 15 µg of epinephrine IV or 3 mL of saline IV (n = 20 each). HR, SBP, and PPWA were monitored for 5 min after injection. Injection of the test dose resulted in peak PPWA decrease by 61% ± 17% and 58% ± 15% at 61 ± 12 s and 63 ± 13 s in the sevoflurane and isoflurane groups, respectively. Positive PPWA criterion, as determined from peak increases during saline administration, was a decrease in PPWA ≥10%. Using this value, the sensitivity, specificity, positive predictive, and negative predictive values of PPWA were 100% in both anesthetic groups. On the contrary, sensitivities of 85% and 95% were obtained based on HR criterion in the sevoflurane and isoflurane patients, respectively, and a sensitivity of 90% was obtained in both anesthesia groups on the basis of SBP criterion. In conclusion, PPWA is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.

 

 

 

持续硬膜外麻醉和镇痛对食管根治术病人应激反应和免疫功能的影响

The Effects of Continuous Epidural Anesthesia and Analgesia on Stress Response and Immune Function in Patients Undergoing Radical Esophagectomy

Masataka Yokoyama, MD, Yoshitaro Itano, PhD, Hiroshi Katayama, MD, Hiroshi Morimatsu, MD, Yoshimasa Takeda, MD, Toru Takahashi, MD, Osamu Nagano, MD, and Kiyoshi Morita, MD

Department of Anesthesiology and Resuscitology Okayama University Medical School 2–5–1, Shikata-cho, Okayama City, Okayama 700–8558, Japan

Anesth Analg 2005;101:1521-1527

 

我们研究了术中广泛的硬膜外阻滞(C3-L)是否影响食管根治术后病人的免疫反应。将食管根治术的病人随机分为两组,一组接受全麻复合硬膜外麻醉,术后持续硬膜外镇痛(E组,n15),另一组术中实施全麻,术后静脉吗啡镇痛(G组,n15)。术前及术后当天、第一天、第三天分别评价应激激素、细胞因子、C反应蛋白(CRP)的血浆浓度、白细胞计数及淋巴细胞分布。和E组相比,G组术后当天的肾上腺素浓度、术后当天、第一天、第三天的去甲肾上腺素浓度均显著升高(P < 0.01),术后当天的分化抗原簇(CD4/CD8)有显著降低(P < 0.05)。而两组间的其它变量无显著性差异。两组术后的血浆可的松、促肾上腺皮质激素、白介素(IL)-1ß, IL-6, IL-10C反应蛋白均升高(每组P < 0.01)。IL-1ß, IL-6, IL-10,CRP在术后第一天、第三天仍然升高(每种变化、每组P < 0.01)。白细胞计数在术后一、三天升高(前者P < 0.05,后者P < 0.01)。术后当天至第三天淋巴细胞比例下降(每组P < 0.01),术后第一天B细胞比例增加(每组P < 0.01),术后第一天及第三天自然杀伤细胞比例下降(每组P < 0.01)。我们推断:组织损伤和炎症似乎比广泛的硬膜外阻滞对食管根治术后的应激反应和免疫功能影响更显著。

(王丽珺译 薛张纲校)

We investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on POD1 (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at POD1 and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.

 

身高甲状颏距离比值的预测价值:对困难气道的四项预测试验

The Predictive Value of the Height Ratio and Thyromental Distance: Four Predictive Tests for Difficult Laryngoscopy

Banjong Krobbuaban, MD, Siriwan Diregpoke, BN, Sujarit Kumkeaw, BN, and Malin Tanomsat, BN

Department of Anesthesiology, Chaiyaphum Hospital, Thailand

Anesth Analg 2005;101:1542-1545

 

术前对解剖学标志和临床因素的评价有助于发现潜在的困难气道;然而预测的可靠性尚未明确。由于身高甲状颏距离比值(RHTMD)较甲状颏距离(TMD)具有更可靠的预测值,我们评价了RHTMD和张口度、TMD、转颈度及口咽可视度(改良Mallampati法)的预测值和优势比。我们选择了550名需气管插管行全麻的择期手术病人,并在术前评价以上五项指标。由一位有经验的麻醉师施行喉镜操作及评分(Cormack Lehane分级)。69名病人出现困难气道(34级)(12.5%)RHTMD比其他指标具有更高的灵敏度、阳性预测值,假阴性更少。在多元分析中,三项指标对困难气道有独立性(转颈度≤80; Mallampati分级34级;RHTMD ≥23.5)。RHTMD, Mallampati分级和转颈度的优势比(95%可信区间)分别为6.72 (3.29–13.72), 2.96 (1.63–5.35) 2.73 (1.14–6.51)RHTMD的优势比最大,因此也许是困难气道的有效筛选试验。

 

(王丽珺译 薛张纲校)

Preoperative evaluation of anatomical landmarks and clinical factors help identify potentially difficult laryngoscopies; however, predictive reliability is unclear. Because the ratio of height to thyromental distance (RHTMD) has a demonstrably better predictive value than the thyromental distance (TMD), we evaluated the predictive value and odds ratios of RHTMD versus mouth opening, TMD, neck movement, and oropharyngeal view (modified Mallampati). We collected data on 550 consecutive patients scheduled for elective-surgery general anesthesia requiring endotracheal intubation and then assessed all five factors before surgery. An experienced anesthesiologist, not apprised of the recorded preoperative airway assessment, performed the laryngoscopy and grading (as per Cormack and Lehane’s classification). Difficult laryngoscopy (Grade 3 or 4) occurred in 69 patients (12.5%). RHTMD had a higher sensitivity, positive predictive value, and fewer false negatives than the other variables tested. In the multivariate analysis, three criteria were found independent for difficult laryngoscopy (neck movement ≤80 degrees; Mallampati Class 3 or 4, and RHTMD ≥23.5). The odds ratio (95% confidence interval) of the RHTMD, Mallampati class, and neck movement were 6.72 (3.29–13.72), 2.96 (1.63–5.35), and 2.73 (1.14–6.51), respectively. The odds ratio for RHTMD was the largest and thus may prove a useful screening test for difficult laryngoscopy.