Anesthesia & Analgesia

November 2005

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

線粒體KATP通道在七氟烷預適應和後適應對大鼠在體心臟保護效應中的影響

(顏濤 馬皓琳,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.

異氟醚抑制血小板增強中性粒細胞介導的冠狀動脈內皮細胞動能紊亂作用
(陸文清譯 薛張綱校)

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.

正壓肺膨脹期間心肌收縮功能增強

(殷文淵 陳傑 )

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.

活性氧簇作為心臟損傷和保護的介質:與麻醉實踐的關聯

(張瑩 馬皓琳,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:

兒童心臟手術期間雙側腦血氧飽和度監測的評估

(齊波 陳傑 )

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

對於體重小於5公斤的嬰兒中心靜脈導管的最佳深度

(周荻譯 薛張綱校)

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.

關節內布比卡因-可樂定-嗎啡浸潤與股神經-坐骨神經阻滯在兒科病人前十字韌帶重建術的比較

(周志堅 馬皓琳,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

在新生小豬模型中大劑量甲強龍預處理不能減輕深低溫停迴圈後的神經元損傷

(範穎輝 陳傑 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:

活性氧簇在心肌損傷和保護的調節方面與麻醉實踐的相關性

門診採用神經周圍局麻藥注射行全肩關節成形術作為一項門診操作方案:一項初步可行性研究

(徐麗穎譯 薛張綱校)

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.

一項比較格蘭司瓊複合地塞米松與恩丹司瓊複合地塞米松預防腹式子宮切除術病人術後噁心嘔吐的隨機雙盲研究

(黃麗娜 馬皓琳,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.

奧坦西隆口服片劑與靜脈注射給藥用于預防青年男性病人鞘內嗎啡注射後引起的噁心嘔吐和瘙癢的療效比較

(肖潔 陳傑 )

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:

術後噁心、嘔吐很大程度上受到術後阿片類藥物劑量相關性應用的影響

(鍾靜譯 薛張綱校)

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.

給予新斯的明是否使術後噁心嘔吐有臨床意義的增多?

(馬皓琳 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.

羅庫溴胺和琥珀膽鹼用於快速順序麻醉誘導和氣管插管的比較:一項急診病人的前瞻性、隨機試驗

(忻紀華 陳傑 )

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.

氧化亞氮不是阻滯阿曲庫銨的介質

(孫卓真譯 薛張綱校)

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.

多沙普侖僅能輕微降低健康志願者的寒戰閾值

(黃佳佳 馬皓琳,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.

睡眠呼吸暫停綜合征患者麻醉前給予可樂定:一項隨機,雙盲,對照性研究

(田婕 陳傑 )

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.

麻醉劑和酒精對於異卵細胞G-蛋白偶聯鉀通道內部調節在α-2腎上腺素能受體亞型的作用

(王慧琳譯 薛張綱校)

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.

成年大鼠全麻後兩周的空間記憶能力

(邱鬱薇 馬皓琳,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:

現代無線電通訊技術及其與生命保障設備的電磁相容性

(潘志英譯 陳傑校)

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.

降低手術時著火的發生率:從麻醉機通過鼻導管提供低於100%O2混合氣體

(朱 馬皓琳, 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:

在大鼠甲醛試驗中鞘內注射腺苷受體亞型激動劑抵抗傷害性刺激

(孫敏莉譯,薛張綱校)

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噴丁的神經安全性:一項光學顯微鏡檢查

(黃施偉 馬皓琳,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.

應用加巴噴丁和局麻藥多模式鎮痛預防乳腺癌術後急性和慢性疼痛

(張美榮 陳傑 )

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.

骶髂關節疼痛:綜合解剖、診斷和治療的綜述

(金琳 薛張綱 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:

豬內毒素性休克時血清S-100B的微量增加可能表示血腦屏障的損傷

(顧新宇 陳傑 )

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.

行為疼痛評分在評估危重、鎮靜和機械通氣病人的有效性研究

(吳德華譯 薛張綱校)

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.

由急救醫療學技術員中比較喉管和氣囊-活瓣面罩通氣:一項在麻醉患者身上的可行性研究

(彭中美 馬皓琳,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.

鈍性胸部創傷所致的獨立的雙側肺挫傷的大鼠模型

(朱慧琛 陳傑 )

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:

術後口服恩丹司瓊裂解片劑對預防聽神經瘤術後噁心嘔吐的作用

(吳德華譯 薛張綱校)

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:

硬膜外導管置管前經穿刺針注入局部麻醉藥能改善麻醉質量並減少導管相關併發症

(趙延華譯 陳傑校)

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

脈搏氧飽和度波形振幅在成人硬膜外麻醉時含腎上腺素的試驗劑量注入血管時的指示作用

(金 路譯 薛張綱校)

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.

小劑量布比卡因-蘇芬太尼預防脊麻後的心輸出量改變

(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.

預防性靜注樞複甯和朵拉司瓊對於鞘內注射嗎啡所致瘙癢的影響:一項隨機、雙盲、對照研究

(蘇殿三 陳傑 )

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.

持續硬膜外麻醉和鎮痛對食管根治術病人應激反應和免疫功能的影響

(王麗珺譯 薛張綱校)

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:

抛物線飛行時微重力狀態下喉鏡引導氣管插管的可行性:兩種技術的比較

(陳瑋 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.

氣管導管套囊內應用鹼化利多卡因的效能和安全性評價

(鄭擁軍 陳傑 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.

身高甲狀頦距離比值的預測價值:對困難氣道的四項預測試驗

(王麗珺譯 薛張綱校)

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.

靜脈內補足晶體液不能減少外科傷口感染的危險

(張 馬皓琳,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

 

正壓肺膨脹期間心肌收縮功能增強

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.

氣道正壓肺膨脹可以對心肌收縮功能產生迅速而動態的影響。作者設計了本研究來評估臨床相應通氣壓力下單次正壓肺膨脹期間心肌功能變化的大小和時間。在840Kg的麻醉的豬中,直接測量左室壓力和容量。肺膨脹時給予15cmH2O的平臺期壓力,記錄兩點單次搏動時進行分析,一點是氣道壓為零的呼吸暫停期間,另一點是肺第一次最大膨脹時。分析氣道壓為零時和PPLI-15時的收縮功能變化。在氣道壓從零變化至PPLI15期間,從雙線時間變化彈性曲線上得出的彈性大約增加了15%。這個結果同左室收縮功能提高是相一致的。在持續氣道正壓和肺膨脹情況下應連續測量心肌功能。

(殷文淵 陳傑 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.

 

兒童心臟手術期間雙側腦血氧飽和度監測的評估

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.

 

腦血氧飽和度是一項心臟手術期間監測局部腦氧合情況的技術。本研究作者選擇了62名雙側心室修補而無主動脈弓重建手術的嬰兒,運用近紅外線光譜技術評估兩側大腦半球血氧飽和度的差異。麻醉誘導後持續記錄左側和右側局部腦氧飽和度指數(rSO2i),並在12個時間點對資料進行分析。rSO2i基礎值左側為65±13,右側為66±13(P=0.17)。不考慮深低溫停迴圈的應用,在體外迴圈前、中、後各階段,平均左、右rSO2i值無明顯差異(<2個百分點/絕對刻度值)。在這類病人中,還需進一步進行縱向神經學結果的研究來確定是否進行單側還是雙側大腦半球的氧監測。

(齊波 陳傑 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.

 

在新生小豬模型中大劑量甲強龍預處理不能減輕深低溫停迴圈後的神經元損傷

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.

 

有關甾體類藥對心肺轉流和深低溫停迴圈(DHCA)的神經元保護作用的報告結果不一致。作者評估了新生小豬深低溫停迴圈後神經元細胞損傷的型式和嚴重程度,以及大劑量甲強龍(MP)系統性預處理可能的神經保護作用。19只新生小豬(年齡,<10天,體重, 2.1±0.5kg)隨機分為2組:7只在術前24小時給予系統性大劑量MP30mg/kg),12只未予藥物預處理(生理鹽水)作為對照組。所有動物均連接全流量體外迴圈降溫至15℃並維持120分鐘的DHCACPB複溫至38.5℃後,停轉流,再存活6小時後處死,取腦組織用於光鏡、電鏡、免疫組化和TUNEL染色檢查。對海馬、皮質、小腦和尾核進行定量組織學研究。大劑量MP系統預處理導致了持續性高糖血症,但腦灌注無明顯改變。DHCA120分鐘後在所有分析的腦區均可見到神經元細胞死亡或凋亡。與對照組比較,系統性大劑量MP預處理導致神經元細胞壞死加速,並在海馬齒狀回誘發顯著神經元凋亡(P0.001)。結論:系統性大劑量MP預處理不能削弱延遲性DHCA後神經元細胞損傷,並會誘導齒狀回區域性神經元凋亡。

(範穎輝 陳傑 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.

 

奧坦西隆口服片劑與靜脈注射給藥用于預防青年男性病人鞘內嗎啡注射後引起的噁心嘔吐和瘙癢的療效比較

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.

 

本研究比較了奧坦西隆口服片劑(ODT)與靜脈注射(IV)給藥用于預防健康青年男性病人鞘內嗎啡注射後引起的皮膚瘙癢和術後噁心嘔吐(PONV)的療效。所有病人用嗎啡0.2mg含有的布比卡因行脊麻,隨機分為三組:ODT組(ODT奧坦西隆8mgn=50);IV組(奧坦西隆4mgn=50);空白對照組(n=50)。分別在術後026121824小時,使用3個不同的VAS量表評價病人瘙癢及術後噁心嘔吐的程度。記錄術後噁心嘔吐的發生頻率和止吐劑止癢劑的使用頻率。三組之間PONV的發生率和嚴重程度沒有顯著性差異,術後疼痛VAS評分也沒有顯著性差異。ODT組皮膚瘙癢的發生率為(56%),IV組為(66%),對照組為(86%);前兩組與對照組相比差異均有統計學意義(P<0.02)。ODT組的瘙癢, VAS評分在術後02612小時均較對照組明顯減低(P<0.023)。ODT組使用止癢劑的頻率明顯較對照組低(P=0.013)。口服奧坦西隆8mg和靜脈注射奧坦西隆4mg均較對照組有效地預防嗎啡脊麻後引起的瘙癢,但對嗎啡脊麻後引起的噁心嘔吐均無明顯療效。

(肖潔 陳傑 )

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.

 

羅庫溴胺和琥珀膽鹼用於快速順序麻醉誘導和氣管插管的比較:一項急診病人的前瞻性、隨機試驗

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

.

對於選擇性病人以丙泊酚行麻醉誘導時,在注射羅庫溴胺和琥珀膽鹼約60秒後行氣管內插管條件無差異。本研究調查在急診病人中,兩者之間是否仍無差異。選擇180例急診需氣管插管的病人,在丙泊酚誘導後,分別在注射羅庫溴胺(0.6mg/kg)60秒後或琥珀膽鹼(1mg/kg)行氣管內插管。從開始誘導至完成插管的時間,琥珀膽鹼組明顯短于羅庫溴胺組(平均為95秒和130秒;p<0.0001)。氣管內插管的條件以9分制記,琥珀膽鹼組明顯高於羅庫溴胺組(分別為8.6±1.18.5±1.5p<0.001)。兩組間插管困難的病例(分別為79例)或第一次插管失敗的病例(分別為45例)無顯著差異。作者認為在急診病人的順序麻醉誘導和氣管內插管時,琥珀膽鹼較羅庫溴胺所需時間更短,提供的插管條件更佳。

(忻紀華 陳傑 )

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.

 

睡眠呼吸暫停綜合征患者麻醉前給予可樂定:一項隨機,雙盲,對照性研究

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.

 

睡眠呼吸暫停綜合征患者常常伴有心臟疾病及呼吸困難,術後發生呼吸抑制的風險很高。作者對30位患有梗阻性睡眠呼吸暫停的擇期行耳--喉手術患者進行了一項隨機,雙盲,對照性研究。患者隨機分為對照組及實驗組,實驗組在術前一天晚上和當天清晨手術前2小時分別口服可樂定2 μg/kg。持續監測SpO2,心率,平均動脈壓(MAP),打鼾情況,及口鼻氣流量36小時。應用丙泊酚和瑞芬太尼麻醉。記錄患者的麻醉藥物用量,術後鎮痛藥物,和疼痛評分。可樂定組在麻醉誘導期,術中,及復蘇期MAP明顯較低。可樂定組麻醉誘導及維持期丙泊酚用量分別為190±32.2 mg6.3±1.3 mg·kg-1·h-1,對照組分別為218±32.4 mg7.7±1.5 mg·kg-1·h-1,前者明顯較低(P<0.05)。可樂定組呱腈米特用量(可樂定組,7.4±5.1 mg;對照組,14.2±8.5 mg)及疼痛評分也明顯較低。兩組間通氣不足情況和去氧飽和指數無明顯差異,但對照組手術當天術後最低氧飽和度明顯低於可樂定組(76.7%±8.0%82.4%±5.8%P<0.05)。作者認為麻醉前口服可樂定能夠穩定麻醉誘導,維持及復蘇期患者血流動力學,降低術中麻醉藥物及術後阿片類藥物用量,並對通氣無任何影響。

(田婕 陳傑 )

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.

 

現代無線電通訊技術及其與生命保障設備的電磁相容性

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.

 

在緊急狀態下,醫院依靠管理程式系統和普通的電話來聯繫工作人員。新型的通訊技術例如:通用無線業務(GPRS),第三代移動通信系統(UMTS),無線局域網 (WLAN),如果它們和醫療設備有良好的電磁相容的話或許能替代傳統的醫院管理程式系統。在本研究中作者探索GPRS, UMTS (寬帶分碼多工存取[WCDMA FDD]), WLAN (IEEE 802.11b)傳送的信號對ICU和手術室生命保障設備的干擾。在11個手術間和ICU進行臨床試驗,按照美國標準,ANSI C63.18-1997試驗設備用來檢測76台醫療設備。UMTS WLAN信號對設備有少許干擾。在ICU和手術室採用這些技術的設備可以安全使用。但是應當避免無線電通迅和醫療設備的直接接觸。在GPRS試驗中,50cm的距離會導致老式的輸注泵報警並停止運行,並不得不重新啟動,並且有10例干擾生命保障設備。GPRS可以在1m的距離安全使用。可以使用這些技術的終端設備或移動電話,因為其對生命保障設備的干擾風險微乎其微。

(潘志英譯  陳傑校)

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.

 

應用加巴噴丁和局麻藥多模式鎮痛預防乳腺癌術後急性和慢性疼痛

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.

 

作者評估了多模式鎮痛對乳腺癌術後急性和慢性疼痛的作用。50名擇期乳腺癌手術病人隨機盲法,接受加巴噴丁,低熔局部麻醉藥乳劑,傷口上應用羅呱卡因或三種安慰劑。記錄麻醉後監護室(PACU)3h6h9h和術後8天疼痛(VAS)評分和鎮痛藥用量。三個月和六個月之後,評定病人慢性疼痛情況。在PACU中,治療組較對照組相比,需要較少的撲熱息痛(分別是469毫克和991毫克,P<0.002)和較少的Lonalgal(分別是一片和四片,P=0.003),同時顯示PACU,手術後一天,三天和五天安靜時疼痛(VAS)評分更低(P=0.001,P=0.040,P=0.015,P=0.045) PACU中及手術後二天,四天和八天時運動後疼痛(VAS)評分也較低(P=0.001, P=0.028, P=0.007, P=0.032)。手術後三個月和六個月,對照組82%(18/22)57%(12/22)病人有慢性疼痛,而治療組只有45%(10/22)30%(6/20)(P=0.028P=0.424) 。同時對照組中5(22)4(21)病人要求用鎮痛藥,而治療組中沒有人要求用鎮痛藥(P=0.048; P=0.107)。多模式鎮痛可以減輕乳腺癌手術後急性和慢性疼痛。

(張美榮 陳傑 )

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.

 

豬內毒素性休克時血清S-100B的微量增加可能表示血腦屏障的損傷

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.

感染性休克是一種能影響許多器官的狀況,但對中樞神經系統的影響卻鮮為人知。S-100B,一種酸性低分子量蛋白,作為腦及血腦屏障破壞的標記物,已經引起極大的興趣。腦損傷後它從腦組織釋放到腦脊液和血液中。作者從與人類革蘭氏陰性感染性休克相似的豬的內毒素性休克實驗中來研究S-100B蛋白。10只小豬接受靜脈注射內毒素,收集注射前及注射後1-6小時內每小時血漿樣本,通過夾鏈酶免疫吸收劑來測定S-100B蛋白,結果顯示血漿中S-100B蛋白含量較低,但與注射前比較,1-5小時內S-100B有顯著意義的增加。作者認為是內毒素引起廣泛用於標記腦損傷的血清標記物S-100B的微量卻極重要的增加,然而,這還不能排除S-100B的增加是由大腦以外的器官釋放所致。

(顧新宇 陳傑 )

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.

 

鈍性胸部創傷所致的獨立的雙側肺挫傷的大鼠模型

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.

肺挫傷約占鈍性創傷患者的17-25%,同時肺挫傷還是鈍性胸部損傷患者的首要致死原因。獨立的雙側肺挫傷的小動物模型尚未建立。作者將0.3kg的重物壓于心前區放置防護罩的麻醉大鼠,從而避開心臟,直接作用於肺部造成肺挫傷。通過測量動脈氧合、支氣管肺泡灌洗(BAL)白蛋白和細胞學,壓力-容量力學和組織病理學,得知肺損傷特性主要受胸部衝擊能(1.8-2.7J)的影響。組織學證實雙側肺挫傷時不伴有實質性心肌損傷。承受2.7J胸部衝擊能的大鼠的死亡率達到33%,超過預期的亞致死損傷水平。接受最大亞致死量損傷的大鼠前24小時低氧的狀況與急性肺損傷的標準相符,而48h內逐步增加。<24hBAL白蛋白水平最高,48h時伴有BAL白細胞的持續增加和肺容量的減少。結論:2.45J的衝擊能可以導致獨立的、雙側肺挫傷,同時還建立了一個有效的模型利於將來的病理生理學研究。

(朱慧琛 陳傑 )

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.

 

硬膜外導管置管前經穿刺針注入局部麻醉藥能改善麻醉質量並減少導管相關併發症

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.

 

硬膜外阻滯時常在硬膜外置入可曲硬膜外導管但是,在硬膜外導管置入時可能產生諸如感覺異常,置入靜脈,蛛網膜下腔等併發症,並可影響麻醉質量作者前瞻性,隨機雙盲研究硬膜外置管前通過硬膜外穿次針單次給予局部麻醉藥(2%利多卡因20ml)的效果240名患者隨機分為兩組並評定麻醉效果和併發症在經針注藥組(經針組,n=100)硬膜外導管在經針注藥後置入。經導管注藥組(導管組,n=98)導管在穿刺針證實在硬膜外腔後即置入經導管注入局部麻醉藥記錄感覺異常,導管注入難易程度,或置入靜脈或蛛網膜下腔等情況注入局麻藥後20min測定感覺和運動阻滯情況證實感覺消失後手術置管中發生感覺異常者導管組占 31.6%,經針組為11%(P=0.00038) 置入靜脈病例導管組為8.2%,經針組為2%(P=0.048) 經針組較導管組手術條件優良率更高(分別為89.6%72.9%,P<0.003) 結論:硬膜外置管前經針一次性注入局麻藥能改善硬膜外麻醉質量並減少硬膜外導管相關併發症

(趙延華譯 陳傑校)

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.

 

預防性靜注樞複甯和朵拉司瓊對於鞘內注射嗎啡所致瘙癢的影響:一項隨機、雙盲、對照研究

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.

 

瘙癢是鞘內注射嗎啡進行術後鎮痛的常見副作用。其可能機制是啟動了中樞的5-羥色胺3受體(5-HT3)。但是5-HT3拮抗劑對嗎啡引起瘙癢的預防作用還沒有明確的結論。在本項前瞻性、隨機、雙盲、對照的臨床研究中,作者觀察了預防性靜注樞複甯和朵拉司瓊對於鞘內注射嗎啡所致瘙癢的預防效果。病人隨機分成3組,分別靜脈注射樞複寧4mgO組,n = 35)或者朵拉司瓊12.5mgD組,n = 35),或者安慰劑5mlP組,n = 35)。這些病人均進行泌尿外科、骨科或者血管外科手術,在脊髓麻醉0.5%重比重布比卡因17.5mg和嗎啡0.25mg)前靜脈注射上述藥物。在到達PACU時和術後24824小時觀察瘙癢的發病率和嚴重程度。研究結果表明,與安慰劑對照組相比,樞複寧組和朵拉司瓊組瘙癢的發生率和嚴重程度均明顯下降(分別為34%20%66%p<0.01)。接受5-HT3受體拮抗劑的病人在術後8小時內的瘙癢嚴重程度與安慰劑對照組相比明顯下降。嚴重的瘙癢僅發生在P組(P組:35名病人中發生4例;O或者D組:35名病人中無人發生嚴重瘙癢,P<0.05)。作者認為,預防性應用樞複甯和朵拉司瓊有助於減輕鞘內注射嗎啡引起瘙癢的發生率和嚴重程度。

(蘇殿三 陳傑 )

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.

 

氣管導管套囊內應用鹼化利多卡因的效能和安全性評價

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.

 

吸入笑氣行全身麻醉時,應用鹼化利多卡因代替空氣填充氣管導管套囊可明顯減少拔管時的咳嗽和嗆咳反射。然而一旦氣管導管套囊破裂導致碳酸氫鈉(用於將鹽酸利多卡因轉變為鹼性利多卡因)洩露,鹼性溶液則會刺激氣道粘膜。本文通過隨機對照研究,離體觀察低濃度的碳酸氫鈉(濃度為1.4%,與高濃度8.4%相比)是否能夠減少碳酸氫鈉向套囊外的彌散量,從而保護氣道。在確定不同溶液pH值後(2%鹽酸利多卡因2mL8.4%1.4%碳酸氫鈉26mL),通過體外實驗觀察利多卡因溶液通過氣管導管套囊的彌散速度(2%鹽酸利多卡因為2 mL8.4%或者1.4%碳酸氫鈉為3mL)。隨後選取甲狀腺手術患者(每組各20例),氣管導管套囊內分別充入空氣,高濃度碳酸氫鈉(2% 鹽酸利多卡因2 mL複合8.4%的碳酸氫鈉),低濃度碳酸氫鈉(2%鹽酸利多卡因2 mL複合1.4%的碳酸氫鈉),術畢拔除氣管導管後,通過視覺類比疼痛評分表評價咽喉疼痛發生率和程度,同時觀察聲音嘶啞、嗆咳、發聲困難、吞咽困難、咳嗽、煩躁不安以及術後噁心嘔吐情況。結果表明,低濃度的碳酸氫鈉(例如, 1.4%)彌散較慢。與空氣填充組相比,鹼化利多卡因在術後24小時內可明顯減少咽痛的發生,不同濃度碳酸氫鈉組之間無明顯統計學差異。本研究中未發生喉痙攣、氣管導管套囊破裂以及吞咽發射抑制。綜上所述應用小劑量鹼化利多卡因(鹼化利多卡因40 mg 1.4% 的碳酸氫鈉)填充氣管導管套囊,可明顯減少笑氣全麻患者圍手術期咽痛的發生。

(鄭擁軍 陳傑 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.

 

線粒體KATP通道在七氟烷預適應和後適應對大鼠在體心臟保護效應中的影響

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

 

揮發性麻醉藥可導致心肌預適應,在心臟再灌注開始時給予也保護心臟——這種做法近來被稱為“後適應”。我們研究了線粒體KATPmKATP通道在七氟烷單獨預適應和單獨後適應導致的心肌保護效應中的作用,並且研究兩者是否存在協同效應。大鼠的冠狀動脈被阻斷25分鐘,然後再灌注120分鐘。使用三苯基四唑鹽染色法確定梗死面積。採用如下試驗方案:1)預適應(S-Pre, n=10, 通過兩次每次用七氟烷5分鐘(1MAC),然後沖洗10分鐘;2)七氟烷後適應(S-postn=10,在再灌注開始時應用1 MAC七氟烷2分鐘);3)在缺血前後均使用(S-pre + S-postn=10)。在應用5-羥基癸酸鹽(5-HD)(一種特異性mKATP通道阻滯劑)後重複1-3方案(S-Pre + S-Post + 5HD, S-Pre + 5HD: n = 10; S-Post + 5HD: n = 9)9只大鼠作為未處理對照組(CON),另外10只僅應用了5-HD5HD, n = 10)。與對照組(CON)的梗死面積(危險區域的49% ± 11%,均數±標準差)相比,預適應組(S-Pre23% ± 13%)和後適應組(S-Post18% ± 5%)的梗死面積均減小(兩者均P< 0.05)。與僅在缺血前或者僅在缺血後應用相比,S-pre + S-post 使梗死面積減少更多(12% ± 5%,與S-Pre比較,P = 0.054 )。5-HD減少所有三個七氟烷處理組的保護效應(S-Pre + 5HD, 35% ± 12%; S-Post + 5HD, 44% ± 12%; S-Pre + S-Post + 5HD, 46% ± 14%)。但是單獨使用5-HD並不影響梗死面積(41% ± 13%)。七氟烷預適應和後適應能夠對心肌缺血-再灌注損傷產生保護作用,聯合使用預適應和後適應能夠產生更大的保護效應,這種效應至少部分是由mKATP通道介導的。

(顏濤 馬皓琳,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.

 

 

活性氧簇作為心臟損傷和保護的介質:與麻醉實踐的關聯

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)在心臟缺血和再灌注損傷中起到重要作用。它們促使心肌頓抑、梗塞和凋亡,並且可能促使心律失常的發生。多個實驗室研究和臨床試驗探討了使用ROS清除劑來保護心臟以防缺血和再灌注損傷的作用。動物模型實驗已普遍顯示了ROS這樣的作用。臨床試驗也已顯示清除劑具有保護作用,但是這種保護作用是否有意義深長的臨床效益仍不清楚。一些靜脈麻醉藥有ROS清除劑的作用。與此相反,近來有研究認為揮發性麻醉藥可使心臟產生ROS,其最大可能的原因是對心臟線粒體的抑制作用。ROS涉及短時間給予揮發性麻醉藥引起的心肌保護的信號級聯傳遞(術語稱為麻醉藥預適應)。因此,雖然大量ROS是有害的,但是少量ROS在心臟中有保護作用。在本綜述中,我們提供了與麻醉藥和輔助藥有關聯的(特別關於心臟的)有關ROS形成和消除的背景資訊。本綜述分別討論了ROS的來源、ROS引發心臟損害或刺激保護性信號通路的方式、評估ROS清除劑的臨床研究的結果以及麻醉藥對ROS的作用。

(張瑩 馬皓琳,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.


給予新斯的明是否使術後噁心嘔吐有臨床意義的增多?

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

 

新斯的明用來拮抗神經肌肉阻滯劑引起的殘餘神經肌肉麻痹。儘管以前有一個薈萃分析發現新斯的明影響術後噁心嘔吐,但是這種影響仍未確定。我們重新評價了新斯的明對術後噁心嘔吐的影響,同時考慮到不同的抗膽鹼能藥物是可能引起混淆的因素。我們用MEDLINEEmbaseCochrane庫、參考文獻列表和手工檢索進行了系統的無語言限制的文獻檢索,確定到200412月為止有10個評價新斯的明對術後噁心嘔吐影響的臨床隨機對照試驗。從933例患者採集到術後早期(0-6 h)、後期(6-24 h)和全期(0-24 h)有關噁心或嘔吐的資料,並用RevMan 4.2 Cochrane協作,牛津,英國)和多重邏輯回歸分析進行分析。新斯的明與阿托品或胃長寧合用並不顯著提高術後全期(0-24 h)嘔吐發生率(相對風險0.9195%可信區間0.70–1.18P = 0.48)和噁心發生率(相對風險1.2495%可信區間0.98–1.59P = 0.08)。多重邏輯回歸分析顯示大劑量新斯的明與小劑量比較,嘔吐風險未明顯增大。與以前的分析不同,我們得出結論:沒有足夠的證據來斷定新斯的明使術後噁心嘔吐的風險增大。

(馬皓琳 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.


多沙普侖僅能輕微降低健康志願者的寒戰閾值

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

 

我們測定多沙普侖對人體體溫自主調節主要反應的影響。我們對九位健康志願者進行了為期兩天的研究:對照組和多沙普侖組(在出汗、血管收縮和寒戰閾值時靜脈輸注至的血漿濃度分別為2.4 ± 0.82.5 ± 0.92.6 ± 1.1 μg/mL)。每天將皮膚和中心體溫提高至可引起出汗,然後降低至引起外周血管收縮及寒戰。我們通過對皮膚溫度變化的補償來測定出汗、血管收縮及寒戰閾值。用配對t檢驗分析資料,並且以平均值± 標準差來表示,P<0.05認為具有統計學意義。多沙普侖並不改變出汗 (對照組: 37.5° ± 0.4°C, 多沙普侖組: 37.3° ± 0.4°C; P = 0.290)和血管收縮的閾值(對照組36.8° ± 0.7°C多沙普侖組36.4° ± 0.5°C; P = 0.110)。然而,它可以將寒戰閾值從36.2° ± 0.5°C降低至35.7° ± 0.7°C (P = 0.012)。在兩天的研究時間內沒有發現任何鎮靜或焦慮症狀。觀察到的多沙普侖降低寒戰閾值的作用可以解釋這個藥在治療術後寒戰方面的功效,然而,作為單獨藥物應用時,僅僅0.5°C的下降不太可能顯著有利於治療性低溫的誘導。

(黃佳佳 馬皓琳,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噴丁的神經安全性:一項光學顯微鏡檢查

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

 

加巴噴丁主要作用於中樞神經系統。因此,我們假定硬膜外腔直接使用加巴噴丁與口服相比有所需劑量、副作用和效價這些多方面的好處。不過,在臨床上將加巴噴丁用到硬膜外腔之前,必須在動物身上對其神經毒性進行檢查。因此,我們通過觀察大鼠的行為學和感覺-運動的變化以及對脊髓和背根神經節進行組織病理學檢查來評估硬膜外腔使用加巴噴丁的神經毒性。27只大鼠被隨機分為3組:一組在硬膜外腔使用0.3ml30mg)的加巴噴丁(G組,n9);一組硬膜外腔使用同樣容積的酒精(A組,n9);另一組為生理鹽水(N組,n9)。3周觀察期內,在G組和N組沒有大鼠出現感覺-運動功能障礙、行為學改變或組織病理學異常,而A組的所有大鼠都有異常。我們得出結論:依據感覺-運動功能和行為學或顯微鏡下組織病理學評估,在大鼠硬膜外腔直接注射加巴噴丁未顯示有任何神經毒性的證據。本研究意味著通向硬膜外腔加巴噴丁在臨床上試驗道路上的充滿希望的第一步。

(黃施偉 馬皓琳,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.

 

靜脈內補足晶體液不能減少外科傷口感染的危險

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

 

創傷灌注和氧合是術後傷口感染發展的重要決定因素。應用液體補足顯著增加圍手術病人上臂皮下組織中切口的組織氧合。我們測試了下述假設,擇期結腸切除術手術時和手術後補足液體可減少術後傷口感染的發生率。進行開放的結腸切除手術的病人隨機分配到小容量(n = 124, 8 mL · kg–1 · h–1)或者大容量(n = 129, 16–18 mL · kg–1 · h–1)液體管理組。我們主要的結果是兩個清楚診斷外科傷口感染的標準:1)膿性滲出物結合致病菌培養陽性及2)疾病控制中心外科傷口感染的診斷標準。對在手術後15天裏由一個盲的觀察者用任一個標準診斷的所有傷口感染進行分析。用ASEPSIS評分系統評估傷口癒合。給予小容量液體治療的病人中有14例外科傷口感染;11例給予大容量液體治療的有感染,P = 0.46ASEPSIS傷口癒合評分在兩組相似:7 ± 16(小容量)對8 ± 14(大容量),P = 0.70。我們的結果提示在研究範圍內的補足水合不影響傷口感染率。

(張 馬皓琳,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.

 

關節內布比卡因-可樂定-嗎啡浸潤與股神經-坐骨神經阻滯在兒科病人前十字韌帶重建術的比較

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

 

我們假設,在兒科病人行前十字韌帶(ACL)重建術時以股神經-坐骨神經聯合阻滯(FSNB),與關節內浸潤(IA)麻醉相比,能提供更好的鎮痛效果,副作用更少。36例進行ACL重建術的兒童,隨機分入FSNB組或IA組。FSNB組病人以布比卡因(0.125%)-可樂定(2 µg/kg)進行FSNB,而IA組病人則給予布比卡因(0.25%)-可樂定(1 µg/kg)-嗎啡(5 mg)。以病人自控鎮痛方式提供術後的鎮痛,以嗎啡為補充方式。兩組病人的一般情況相似。FSNB組的病人術中所需芬太尼量較少(50 ± 40 µg 80 ± 50 µg; P = 0.04)FSNB組病人在恢復室內和術後24小時內的視覺類比量表疼痛評分要低於IA組的病人,分別為1.8 ± 3 5.4 ± 3( P = 0.0002)1.6 ± 12.9 ± 2( P = 0.01)。術後18小時內所用嗎啡量在FSNB組要更少(7 ± 13 mg21 ± 21 mg; P = 0.03)。嘔吐發生率在FSNB組更低(11%50%; P = 0.03)IA組的病人術後更早需要嗎啡病人自控鎮痛。在兒童ACL重建術後,以布比卡因-可樂定進行股神經-坐骨神經聯合阻滯,與布比卡因-可樂定-嗎啡進行關節內浸潤相比,可提供更好的鎮痛效果,而副作用更少。

(周志堅 馬皓琳,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.


一項比較格蘭司瓊複合地塞米松與恩丹司瓊複合地塞米松預防腹式子宮切除術病人術後噁心嘔吐的隨機雙盲研究

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

 

在這一隨機雙盲的研究中,我們評估了在需要全麻下進行腹式子宮切除術的病人中,小劑量的格蘭司瓊(0.1mg)複合地塞米松8mgG+D)在預防氣管拔管後2小時內的嘔吐方面是否與恩丹司瓊4mg複合地塞米松8mg (O+D)一樣有效。地塞米松(D)在麻醉誘導期給藥,格蘭司瓊(G)或恩丹司瓊(O)在拔管前約15分鐘給藥。採集術後02624小時噁心嘔吐的資料。在主要的有效性指標方面,兩組中絕大多數病人在術後2小時內沒有嘔吐(G+D 82/87[94%]O+D86/89[97%])。與O+D比較,G+D組的有效性得到證實。各治療組關於24小時內中度到重度噁心、完全有效、解救用藥及總控制是相似的。不良事件的描述性評估顯示兩種複合用藥均能很好耐受,不良事件罕見且兩組發病率相似。氣管拔管前給予小劑量G加上麻醉誘導期給予D在預防術後即刻至2小時內嘔吐上是除了O+D以外另一種有效的選擇。

(黃麗娜 馬皓琳,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.

成年大鼠全麻後兩周的空間記憶能力

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

 

我們以前已經證實,用1.2%的異氟醚複合70%的笑氣行全身麻醉,兩天後測試發現,年幼大鼠和老年大鼠的旋臂迷宮試驗能力會損害;兩周後測試,老年大鼠的旋臂迷宮試驗能力仍會損害。我們設計本研究擬觀察年幼大鼠麻醉後學習能力受損是否會持續存在。六月齡大鼠隨機分為三組,每組10例。一組採用1.2%的異氟醚複合70%的笑氣,一組1.8%異氟醚,對照組吸入30%的氧氣,麻醉時間為2小時。恢復兩周後大鼠每天檢測旋臂迷宮能力,共檢測14天。對照組和麻醉組大鼠在糾正第一次錯誤的選擇數和完成迷宮試驗的時間上無顯著性差異。錯誤的總數三組之間也沒有明顯差異(P > 0.05),但是試驗組大鼠每天表現的相互比較有顯著性差異,表現為後幾天測試時1.2%異氟醚70%笑氣複合麻醉組較對照能力進步快。因此,成年大鼠,以往的全身麻醉與其術後兩周的學習能力受損沒有明顯聯繫。事實上,早先的1.2%異氟醚70%笑氣複合麻醉能夠改善大鼠兩周後的迷宮表現。

(邱鬱薇 馬皓琳,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.


降低手術時著火的發生率:從麻醉機通過鼻導管提供低於100%O2混合氣體

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,健康保健組織鑒定聯合委員會(JCAHO)建議:“作為一個通用政策,用空氣或£30%的氧氣開放輸送(保證病人所需)”來預防手術時起火。能解釋JCAHO建議的一個原因為:100% O2不應濫用,麻醉者應有能力根據病人需要和臨床診斷,通過鼻導管給予低於100%濃度的O2。輔助的O2流量計有一個卡口連接器提供了連接鼻導管和麻醉機的簡便方法,常規用於100% O2的開放輸送。輔助的O2流量計只提供100% O2,這樣就不允許O2濃度根據病人需要調節,可能提高手術時起火的危險性。這個報告闡明了JCAHO的建議,並描述了主要基於使用麻醉機來混合低於100% O2的混合氣體並通過鼻導管輸送而選擇的不同方法。目前的選擇依賴於麻醉機的模型和製造商,允許通過鼻導管輸送濃度範圍是21%100%O2

(朱 馬皓琳, 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%.


由急救醫療學技術員中比較喉管和氣囊-活瓣面罩通氣:一項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

 

在急診處理中氣道管理是很重要。對於所有保健提供者的基礎技能是氣囊-活瓣面罩(BVM)通氣,它需要技能且可能較難使用。氣管內插管是保證氣道安全的進一步方法,它是一門要求高的技術,甚至當有經驗的醫務輔助人員操作時成功率也很低。因此已開始尋找其他可供選擇的氣道設備。已有研究,由有經驗的麻醉醫師在麻醉患者和在急救醫療訓練中的人體模型上應用喉管。我們決定評估沒有經驗的消防隊員-急救醫療技術的學生(fire-EMT)在麻醉患者身上插LT或使用BVM的能力。30fire-EMT隨機分為插LT(n = 15)和進行1分鐘通氣或者用BVM(n = 15)。我們發現所有學生都成功地(100%)插入LT。在第一次嘗試(73%)插入LT的學生需要48.2 ± 14.7秒。LTBVM都提供充足的氧氣和通氣。在本研究中,我們發現沒有經驗的fire-EMT學生在麻醉患者身上插入喉管和進行1分鐘通氣的成功率和耗時都較合理。

(彭中美 馬皓琳,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.




小劑量布比卡因-蘇芬太尼預防脊麻後的心輸出量改變

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

 

與大劑量布比卡因相比,在蛛網膜下腔注射小劑量布比卡因能減少低血壓的可能。我們假設小劑量的布比卡因可預防心輸出量的下降。在這項前瞻性的隨機研究中,我們選擇擇期行脊麻下泌尿科手術、下腹部手術或下肢手術的病人。蛛網膜下腔注射液分別為小劑量(7.5mg重比重布比卡因和葡萄糖·H2O80 mg/mLn=19)加5μg蘇芬太尼或大劑量(12.5 mg重比重布比卡因和葡萄糖·H2O80 mg/mLn=19)。在脊麻阻滯前1 min及鞘內注射後21030min監測CO(阻抗心動描記法)、動脈血壓及心率。在30min時測評感覺平面。與大劑量組相比,在脊麻後2min-30min,小劑量組的心輸出量較高。而且,與基礎值相比,小劑量組2min時心輸出量增加,而大劑量組的心輸出量在1030min時下降。結論:與大劑量布比卡因相比,小劑量布比卡因麻醉能提供成功的麻醉,且使心輸出量更好。

(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.


抛物線飛行時微重力狀態下喉鏡引導氣管插管的可行性:兩種技術的比較

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

 

我們測定在抛物線飛行時得到的微重力狀態下用喉鏡引導氣管插管(LG-TI)的可行性,並驗證這樣的一種假設:在患者的頭被夾在麻醉醫生的兩膝之間的自由浮體狀態和在軀幹被皮繩捆在平板的受限制狀態下進行LG-TI能同樣獲得成功。三名未經歷過氣道管理或微重力的人員參與本研究。每一位研究者在地面的基礎訓練之後,在這兩種狀態下在精密複雜標準尺寸的人體模型上各嘗試七次LG-TI 。太平洋上飛行的空中巴士300上發生的抛物線飛行,提供23秒的微重力時間。在這期間研究者打開裝有氣道裝備的盒子,進行LG-TI,連接上一個自動充氣的氣囊並握住。在水平飛行時通過擠壓氣囊和注意人體模型的感測器是否顯示潮氣量³300ml來評估通氣的有效性。通氣的成功率(41%33%)及成功插入氣管導管所需時間(均為18s)在自由浮體狀態和受限制狀態之間無差別。90%以上的失敗由在23s內不能插入氣管導管引起。各位研究者之間的表現無差別。我們得出結論,LG-TI在抛物線飛行器期間的微重力狀態下是可行的,但是由於嚴格的時間限制成功率很低。在把頭夾在兩膝之間的自由浮體狀態和軀幹被綁在平板的受限制狀態下的插管成功率無差別。

(陳瑋 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.


 

 

異氟醚抑制血小板增強中性粒細胞介導的冠狀動脈內皮細胞動能紊亂作用
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

我們首先評價血小板是否增強中性粒細胞介導的冠狀動脈內皮功能紊亂,當觀察到這些後,再評價異氟醚是否抑制這種效應。中性粒細胞、冠狀動脈片斷和血小板是從25條健康的狗身上獲得的。冠狀動脈環被暴露在被血小板啟動因數啟動的中性粒細胞下(1.0微莫爾),在洗脫及用U46619預先壓縮後,檢測其中對反應濃度相關的乙酰膽鹼,一種內皮依賴的血管舒張藥物。由啟動的中性粒細胞產生的過氧化物通過分光光度法被檢測到。啟動的中性粒細胞對冠狀動脈內皮細胞的黏附性通過螢光染色標記直接計數來評價。檢測在有和沒有異氟醚(1MAC)的情況下進行,兩者都有或者沒有血小板。血小板的存在增強中性粒細胞,使乙酰膽鹼濃度相關的血管舒張反應曲線右移。(引起50%最大舒張反應的乙酰膽鹼濃度(-logM)從6.78 +/- 0.7增加到5.26 +/- 0.6),它使過氧化物產物從45.0 +/- 4.2增加到54.3 +/- 4.2 nM O2-/5 x 10(6) 中性粒細胞,啟動的中性粒細胞的黏附性從204 +/- 10增加到268 +/- 5中性粒細胞/mm2。異氟醚可以抑制血小板的這些作用。總而言之,血小板增強中性粒細胞的功能來引起冠狀動脈內皮功能紊亂,這種效應可以被異氟醚抑制。這種作用可能歸結於對中性粒細胞過氧化物產物的抑制來減少內皮粘附分子的表達,從而減少中性粒細胞的粘附。

(陸文清譯 薛張綱校)

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.

 

 

對於體重小於5公斤的嬰兒中心靜脈導管的最佳深度

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

 

為了避免中心靜脈導管的致命併發症,如心臟填塞,中心靜脈導管(CVC)的頂端應該被放在心室外。為了對嬰兒的中心靜脈導管的合適深度提供一個指南,我們通過經食管超聲波心動描記術(TEE)測量了從皮膚穿刺點到上腔靜脈和右心房的連接點(SVC-RA連接點)的距離。五十名體重小於5kg,因為先天性心臟病正經歷手術的嬰兒入選本項預期的研究。全麻誘導後,中心靜脈導管(CVC)經過右鎖骨下靜脈被置入。在使用TEE引導下將中心靜脈導管的尖端放置到SVR-RA連接點後,測量中心靜脈導管置入皮下的長度。測量得的長度與病人的身高,體重和年齡有很高的相關性(分別為r = 0.88, 0.76 0.64)。在體重小於5kg的嬰兒中,以下的指南可以避免中心靜脈導管心房內的放置:2.0-3.0kg體重的嬰兒,深度在40-45mm之間,3.0-3.9kg的嬰兒,深度為45-50mm,而那些體重大於4.0kg的,深度為50-55mm。(周荻譯 薛張綱校)

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.

 

 

活性氧簇在心肌損傷和保護的調節方面與麻醉實踐的相關性

 

門診採用神經周圍局麻藥注射行全肩關節成形術作為一項門診操作方案:一項初步可行性研究

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

 

我們研究了在門診採用肌間溝神經周圍羅呱卡因注射使全肩關節成形術(TSA)轉變成一項門診操作方案的可行性。在第一階段被要求術後住院至少一個晚上的病人(n=8)中,5名在蘇醒室中達到出室標準。在後來第二階段的病人(n=6)中,術後都在蘇醒室中達到出室標準,其中5名直接離院回家。所有的病人術後鎮痛良好,口服阿片類藥物的需求和睡眠障礙都達最小程度,運動範圍持續達到或超過外科醫生的期望,且病人的滿意度很高。這些結果提示使用神經周圍局麻藥注射能使TSA在門診環境中得以實施。在其推廣使用前尚需進一步的研究來定義合適的病人群體和評估與之相關的併發症的發生率。

(徐麗穎譯 薛張綱校)

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.

 

 

術後噁心、嘔吐很大程度上受到術後阿片類藥物劑量相關性應用的影響

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.

 

我們觀察了193個沒有服用術後止吐預防藥的老年外科手術病人的術後噁心嘔吐的發生率。術後噁心嘔吐的危險因素以及對術後阿片類藥物的應用進行了記錄。術後嘔吐的發生率是23.8%,術後噁心是51.3%。阿片類藥物和女性是重要的影響的因素。術後阿片類藥物的應用和噁心和嘔吐成對數劑量反應的關係。病人自控鎮痛或硬膜外麻醉是大劑量阿片類藥物應用的標誌,和術後24小時內的噁心嘔吐的相關性分別是41%和31%,而不用PCA和硬外鎮痛的病人只有11%。進一步研究表明術後給予持續量的阿片類藥物比間斷給予術後發生嘔吐的危險性更高。

(鍾靜譯 薛張綱校)

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.

 

氧化亞氮不是阻滯阿曲庫銨的介質

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.

 

對於阿曲庫銨的阻滯是由於增加了誘導性氧化亞氮合酶活性和氧化亞氮在血漿中的水平從而使阿曲庫銨與1-酸糖化蛋白的結合增加的結果。我們研究是否抑制誘導性氧化亞氮合酶活性和氧化亞氮在血漿中的水平可以逆轉對於阿曲庫銨的阻滯。建立這樣一個1-酸糖化蛋白和氧化亞氮增加的模型,84Sprague-Dawley雄性鼠給予60 mg/kg的棒狀桿菌(CP)或鹽水靜脈注射。這兩組將進一步被分為以下幾組:通過飲水給予不同濃度的選擇性誘導性氧化亞氮合酶抑制劑,N型亞氨基賴氨酸。一天四次CP注射,阿曲庫銨的藥效學是確定的。氧化亞氮,阿曲庫銨,1-酸糖化蛋白和乙酰膽鹼受體的數量是確定的。在CP組,N型亞氨基賴氨酸抑制氧化亞氮是遵循計量依賴的方式。對於阿曲庫銨的阻滯是持續的。1-酸糖化蛋白的血漿水平在所有的CP組都保持增長並且與乙酰膽鹼受體的表達數量無關。我們的結論是1-酸糖化蛋白的表達和阿曲庫銨與其結合的持續增加不是由誘導性氧化亞氮合酶和氧化亞氮所介導

(孫卓真譯 薛張綱校)

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.

 

 

麻醉劑和酒精對於異卵細胞G-蛋白偶聯鉀通道內部調節在α-2腎上腺素能受體亞型的作用

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

 

許多生理反射都是由α-2腎上腺素能受體介導的通過其相關的G-蛋白偶聯鉀通道(GIRK)而形成.儘管α-2腎上腺素能受體已經分為3種亞型,但這3種亞型之間的藥理特性很難區別,因為缺乏具有選擇性的激動劑和拮抗劑;因此麻醉藥對α-2腎上腺素能受體亞型的作用知之甚少.我們在異卵細胞中表達每種亞型及GIRK1/ GIRK2亞單位並觀察給予臨床用量的酒精、氟烷和幾種靜脈麻醉藥後α-2腎上腺素能受體介導的GIRK1/ GIRK2反應.UK14304是一種選擇性的α-2腎上腺素能受體激動劑,在每個亞型都能啟動GIRK1/ GIRK2反應.沒有一種靜脈麻醉藥,包括戊巴比妥、異丙酚和氯胺酮能夠影響UK14304啟動的任何亞型受體的鉀通道反應.乙醇能增強UK14304誘發的鉀通道反應而氟烷則抑制.但哲學作用無太大差異,這提示乙醇和氟烷都並非直接作用於α-2腎上腺素能受體亞型.儘管測試表明沒有藥物作用於α-2腎上腺素能受體,但由α-2腎上腺素能受體介導的GIRK1/ GIRK2生理反應能被乙醇和氟烷所影響.

(王慧琳譯 薛張綱校)
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.

 

 

在大鼠甲醛試驗中鞘內注射腺苷受體亞型激動劑抵抗傷害性刺激

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.

 

通過脊髓腺苷受體,腺苷已經顯示了抵抗傷害刺激的作用。目前有四種腺苷受體類型:A1A2AA2BA3。根據控制脊髓水平的傷害性刺激,我們分化了腺苷受體的特性。為了產生刺激性疼痛,往斯普拉-道來大鼠的後足底注射甲醛溶液(5%50微升)。同時鞘內注射腺苷A1 (CPA)A2A (DPMA),和A3 (IB-MECA)受體激動劑的效果被檢測。甲醛試驗早期反應CPAIB-MECA效果有限或者無效,但是這兩種藥物可抑制晚期反應。DPMA則均可抑制上述兩期反應。在晚期,CPA是三種藥物中最有潛在作用的藥物。這些結果提示脊髓腺苷A1A2A受體在甲醛試驗中可能涉及了早期和後期反應的調節,而腺苷A3受體則可能涉及了晚期反應的調節。

(孫敏莉譯,薛張綱校)

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.

 

骶髂關節疼痛:綜合解剖、診斷和治療的綜述

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.

 

骶髂關節疼痛是一種具有挑戰性的情況,15%至25%的患者合併有軸性腰背痛,但卻沒有標準的長期治療手段。近期的研究表明病史、體格檢查和放射成像不足以診斷骶髂關節疼痛。診斷骶髂關節為疼痛的始發點最常用的方法是小劑量局部麻醉藥阻滯,雖然這一種診斷方法的可靠性尚未得到證實。在這篇綜述中,我對其解剖、功能和骶髂關節受傷的機制等方面做了綜合的綜述,同時對其診斷和治療進行了系統性評價。

(金琳 薛張綱 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.

 

 

行為疼痛評分在評估危重、鎮靜和機械通氣病人的有效性研究

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

 

評估危重病人的疼痛,特別是不能言語的病人具有很大的挑戰性。本研究,我們用行為疼痛評分(BPS)來評估危重、鎮靜和機械通氣病人的有效性。BPS3個專案組成:臉部表情、上肢運動和人機配合程度。每個項目分為1-4分。2個測試者同時用BPS觀察和記錄靜息和疼痛時的分數。研究表明BPS心理測試特徵是可靠、有效和敏感的。我們在30例病人中進行了360項觀察。BPS具有內在的可靠性(Cronbach = 0.72)。相關係數是高的(0.95)BPS分數值的不同證實了其可靠性,疼痛時分數明顯增高,平均3.9+/-1.1(靜息時)和6.8+/-1.9(疼痛時)(P < 0.001)。並通過多因數分析揭示首要因數為疼痛表達的多樣性,占65%BPS具有非常好的敏感性,有效分數範圍為2.2-3.4。本研究顯示了BPS在無法交流的ICU病人中是有效和可靠的。

(吳德華譯 薛張綱校)

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.

 

術後口服恩丹司瓊裂解片劑對預防聽神經瘤術後噁心嘔吐的作用

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

 

術後噁心嘔吐是穿顱術常見的併發症。作者採用前瞻性、隨機、安慰劑對照、雙盲實驗研究了術中靜脈注射恩丹司瓊及術後等效量口服恩丹司瓊裂解片劑對緩解術後噁心嘔吐的發生率及嚴重程度。選擇60例聽神經瘤手術患者,每例手術結束前30分鐘給恩丹司瓊靜注4mg,或者安慰劑。術後口服等效量恩丹司瓊或安慰劑,每天2次共3天。兩組中效果欠佳給胃複安補救。記錄噁心的程度(10-釐米可視法)、嘔吐次數和補救藥需要量。術後早期,恩丹司瓊組噁心程度低於安慰劑組(3.3 ± 4.1 versus 7.3 ± 4.2; P < 0.001),更少病人嘔吐(3 of 28 versus 11 of 32; x2 P < 0.01)。術後第一天安慰劑組中更多病人需要補救藥(26 of 32 versus 16 of 28; x2 P < 0.01)。我們的結論是靜注恩丹司瓊能預防聽神經瘤術後即刻的噁心嘔吐。術後口服恩丹司瓊對預防術後第一天的噁心嘔吐有效,能減少胃複安使用量。

(吳德華譯 薛張綱校)

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.

 

脈搏氧飽和度波形振幅在成人硬膜外麻醉時含腎上腺素的試驗劑量注入血管時的指示作用

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,我評價了脈搏氧飽和度波形幅度(PPWA)在檢測成人血管內注入一模擬硬膜外試驗劑量(含15µg腎上腺素)時的功效,並以傳統的心率(HR,增加10/分鐘以上為陽性結果)和收縮壓(SBP,升高15mmHg以上為陽性結果)標準為對照比較其可靠性。八十個病人被隨機分為兩組,分別接受1MAC的七氟烷和異氟烷吸入麻醉(每組病人數n40);每組麻醉病人再隨機分為靜脈注射3ml15 µg腎上腺素的1.5%利多卡因和3ml生理鹽水兩組(每組人數n20)。在注射後5分鐘內監測HRSBPPPWA。注射試驗劑量的病人出現PPWA波峰下降,七氟烷組在61 ± 12秒時下降61% ± 17%,異氟烷組在63 ± 13秒時下降58% ± 15%。由於注射生理鹽水組出現波峰升高,認為PPWA波峰下降≧10%PPWA陽性標準。使用此數值,在兩個麻醉組中PPWA的靈敏度、特異度、陽性預測值和陰性預測值都為100%。相反的,根據HR標準七氟烷組靈敏度為85%,異氟烷組靈敏度為95%;根據SBP標準,各麻醉組的靈敏度都為90%。結論是,PPWA是一種可靠的、可取代傳統的血流動力學標準的方法,用來監測是否硬膜外試驗劑量注入血管內。

(金 路譯 薛張綱校)

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.

 

 

 

持續硬膜外麻醉和鎮痛對食管根治術病人應激反應和免疫功能的影響

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

 

我們研究了術中廣泛的硬膜外阻滯(C3-L)是否影響食管根治術後病人的免疫反應。將食管根治術的病人隨機分為兩組,一組接受全麻複合硬膜外麻醉,術後持續硬膜外鎮痛(E組,n15),另一組術中實施全麻,術後靜脈嗎啡鎮痛(G組,n15)。術前及術後當天、第一天、第三天分別評價應激激素、細胞因數、C反應蛋白(CRP)的血漿濃度、白細胞計數及淋巴細胞分佈。和E組相比,G組術後當天的腎上腺素濃度、術後當天、第一天、第三天的去甲腎上腺素濃度均顯著升高(P < 0.01),術後當天的分化抗原簇(CD4/CD8)有顯著降低(P < 0.05)。而兩組間的其他變數無顯著性差異。兩組術後的血漿可的松、促腎上腺皮質激素、白介素(IL)-1ß, IL-6, IL-10C反應蛋白均升高(每組P < 0.01)。IL-1ß, IL-6, IL-10,CRP在術後第一天、第三天仍然升高(每種變化、每組P < 0.01)。白細胞計數在術後一、三天升高(前者P < 0.05,後者P < 0.01)。術後當天至第三天淋巴細胞比例下降(每組P < 0.01),術後第一天B細胞比例增加(每組P < 0.01),術後第一天及第三天自然殺傷細胞比例下降(每組P < 0.01)。我們推斷:組織損傷和炎症似乎比廣泛的硬膜外阻滯對食管根治術後的應激反應和免疫功能影響更顯著。

(王麗珺譯 薛張綱校)

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.

 

身高甲狀頦距離比值的預測價值:對困難氣道的四項預測試驗

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

 

術前對解剖學標誌和臨床因素的評價有助於發現潛在的困難氣道;然而預測的可靠性尚未明確。由於身高甲狀頦距離比值(RHTMD)較甲狀頦距離(TMD)具有更可靠的預測值,我們評價了RHTMD和張口度、TMD、轉頸度及口咽可視度(改良Mallampati法)的預測值和優勢比。我們選擇了550名需氣管插管行全麻的擇期手術病人,並在術前評價以上五項指標。由一位有經驗的麻醉師施行喉鏡操作及評分(Cormack Lehane分級)。69名病人出現困難氣道(34級)(12.5%)RHTMD比其他指標具有更高的靈敏度、陽性預測值,假陰性更少。在多元分析中,三項指標對困難氣道有獨立性(轉頸度≤80; Mallampati分級34級;RHTMD ≥23.5)。RHTMD, Mallampati分級和轉頸度的優勢比(95%可信區間)分別為6.72 (3.29–13.72), 2.96 (1.63–5.35) 2.73 (1.14–6.51)RHTMD的優勢比最大,因此也許是困難氣道的有效篩選試驗。

 

(王麗珺譯 薛張綱校)

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.