Anesthesia & Analgesia

January 2006

Table of Content

CARDIOVASCULAR ANESTHESIA:

透析持续时间是透析依赖患者心脏手术术后机械通气时间延长的显著预见指标

彭中美 马皓琳 李士通

Duration of Dialysis Is a Significant Predictor of Prolonged Postoperative Mechanical Ventilation in Dialysis-Dependent Patients Undergoing Cardiac Surgery

Masato Nakasuji, Shinichi Nishi, Kae Nakasuji, Naoya Hamaoka, Kazutoshi Ikeshita, and Akira Asada

Anesth Analg 2006 102: 2-7.

术前压力超声心动图和核素闪烁描记图的荟萃分析比较

周荻 薛张纲

A Meta-Analytic Comparison of Preoperative Stress Echocardiography and Nuclear Scintigraphy Imaging

W. Scott Beattie, Esam Abdelnaem, Duminda N. Wijeysundera, and D. Norman Buckley

Anesth Analg 2006 102: 8-16.

常温体外转流(CPB)中应用小剂量的E-前列醇能降低全身氧耗和内脏的氧摄取

忻纪华 译 陈杰 校

Small-Dose Epoprostenol Decreases Systemic Oxygen Consumption and Splanchnic Oxygen Extraction During Normothermic Cardiopulmonary Bypass

Jan-Peter Braun, Torsten Schroeder, Sabine Buehner, Uday Jain, Ulrich Döpfmer, Josephine Schuster, Selcuk Bas, Ingolf Schimke, Pascal M. Dohmen, Herbert Lochs, Wolfgang Konertz, and Claudia Spies

Anesth Analg 2006 102: 17-24.

SymmetryTM主动脉连接装置和急性肾损害:比较三种不同主动脉-冠脉旁路手术技术后的肾功能不全

裘毅敏 李士通校

SymmetryTM Aortic Connector Devices and Acute Renal Injury: A Comparison of Renal Dysfunction After Three Different Aortocoronary Bypass Surgery Techniques

Stephanie S. F. Fischer, Barbara Phillips-Bute, Madhav Swaminathan, Carmelo Milano, and Mark Stafford-Smith

Anesth Analg 2006 102: 25-31.

人心衰机械支持过程中心肌病病因学和SERCA2a逆向重构

周荻 译 薛张纲 校

Cardiomyopathic Etiology and SERCA2a Reverse Remodeling During Mechanical Support of the Failing Human Heart

Paul M. Heerdt, Stefan Klotz, and Daniel Burkhoff

Anesth Analg 2006 102: 32-37.

鞘内和硬膜外麻醉与镇痛技术在心脏手术中的应用

齐波 译 陈杰 校

Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery (Review Article)

Mark A. Chaney

Anesth Analg 2006 102: 45-64.

PEDIATRIC ANESTHESIA:

脊麻用于婴儿外科手术的安全性和有效性:佛蒙特州婴儿脊椎麻醉登记处的研究

周志坚 马皓琳 李士通

The Safety and Efficacy of Spinal Anesthesia for Surgery in Infants: The Vermont Infant Spinal Registry

Robert K. Williams, David C. Adams, Eva V. Aladjem, Joseph M. Kreutz, Kennith H. Sartorelli, Dennis W. Vane, and J. Christian Abajian

Anesth Analg 2006 102: 67-71.

异氟烷在新生鼠的生理学效应

韩晓丹译 薛张纲校

The Physiologic Effects of Isoflurane Anesthesia in Neonatal Mice

Andreas W. Loepke, John C. McCann, C. Dean Kurth, and John J. McAuliffe

Anesth Analg 2006 102: 75-80.

ANESTHETIC PHARMACOLOGY:

利用脑电图熵指数建立七氟醚催眠效果的药代动力学-药效学模型

黄佳佳 马皓琳 李士通

Pharmacokinetic-Pharmacodynamic Modeling the Hypnotic Effect of Sevoflurane Using the Spectral Entropy of the Electroencephalogram

Ian D. H. McKay, Logan J. Voss, James W. Sleigh, John P. Barnard, and Ewa K. Johannsen

Anesth Analg 2006 102: 91-97.

七氟醚和丙泊酚对爪蟾卵QT间期及HERG通道电流的影响

苏殿三 译 陈杰 校

The Effects of Sevoflurane and Propofol on QT Interval and Heterologously Expressed Human Ether-A-Go-Go Related Gene Currents in Xenopus Oocytes

Masana Yamada, Noboru Hatakeyama, Anna P. Malykhina, Mitsuaki Yamazaki, Yasunori Momose, and Hamid I. Akbarali

Anesth Analg 2006 102: 98-103

一种新的分子在外周用阿片类药物时的特性:在稳态下与吗啡和安慰剂比较对于心肌肥大和低氧通气的效应

韩晓丹译 薛张纲校

A Novel Molecule with Peripheral Opioid Properties: The Effects on Hypercarbic and Hypoxic Ventilation at Steady-State Compared with Morphine and Placebo

Åsa Österlund Modalen, Hans Quiding, Joana Frey, Lars Westman, and Sten Lindahl

Anesth Analg 2006 102: 104-109.

腹部大手术丙泊酚麻醉期间奈福泮对瑞芬太尼引起的吗啡消耗量增加的影响
郑丽 译 陈杰 校

The Effect of Nefopam on Morphine Overconsumption Induced by Large-Dose Remifentanil During Propofol Anesthesia for Major Abdominal Surgery

Myriam Tirault, Nicolas Derrode, David Clevenot, Delphine Rolland, Dominique Fletcher, and Bertrand Debaene

Anesth Analg 2006 102: 110-117.

雷米芬太尼在猫肺血管床中的一项分析

颜涛 译, 马皓琳 李士通 校)

An Analysis of Remifentanil in the Pulmonary Vascular Bed of the Cat

Alan D. Kaye, Amir Baluch, James Phelps, Syed R. Baber, Ikhlass N. Ibrahim, Jason M. Hoover, Cuihua Zhang, and Aaron Fields

Anesth Analg 2006 102: 118-123.

去甲肾上腺素和异氟醚在成年大鼠脊髓胶质神经元抑制性突触转移中的作用

(陆文清译 薛张纲校)

Actions of Norepinephrine and Isoflurane on Inhibitory Synaptic Transmission in Adult Rat Spinal Cord Substantia Gelatinosa Neurons

Stefan K. Georgiev, Ayako Wakai, Tatsuro Kohno, Tomohiro Yamakura, and Hiroshi Baba

Anesth Analg 2006 102: 124-128.

大鼠静脉内应用乳化异氟醚的有效性和安全性

曹瑜 译 陈杰 校

The Efficacy and Safety of Intravenous Emulsified Isoflurane in Rats

Jian-Xin Zhou, Nan-Fu Luo, Xiao-Min Liang, and Jin Liu

Anesth Analg 2006 102: 129-134

环氧化酶-1抑制能缩短地西泮导致的小鼠翻正反射消失时程

颜涛 译, 马皓琳 李士通

Cyclooxygenase-1 Inhibition Shortens the Duration of Diazepam-Induced Loss of Righting Reflex in Mice

Xuejing Liu, Tat Leang Lee, and Peter T.-H. Wong

Anesth Analg 2006 102: 135-140.

局麻药氨苯丁酯对低电压诱发的T型电流在小的感觉神经元的作用

王慧琳译 薛张纲校

The Local Anesthetic Butamben Inhibits and Accelerates Low-Voltage Activated T-Type Currents in Small Sensory Neurons

Jeroen P. Beekwilder, Gertrudis Th.H. van Kempen, Rutgeris J. van den Berg, and Dirk L. Ypey

Anesth Analg 2006 102: 141-145.

健康志愿者曲马多静脉注射后的麻醉效应与CYP2D6的关系

田婕 译 陈杰 校

The Analgesic Effect of Tramadol After Intravenous Injection in Healthy Volunteers in Relation to CYP2D6

Thomas P. Enggaard, Lars Poulsen, Lars Arendt-Nielsen, Kim Brøsen, Joachim Ossig, and Søren H. Sindrup

Anesth Analg 2006 102: 146-150.

提供优良气管插管条件所需的司可林剂量

邱郁薇 马皓琳 李士通

The Dose of Succinylcholine Required for Excellent Endotracheal Intubating Conditions

Mohamed Naguib, Abdulhamid H. Samarkandi, Mansour Emad El-Din, Khaled Abdullah, Mazen Khaled, and Saleh W. Alharby

Anesth Analg 2006 102: 151-155.

TECHNOLOGY, COMPUTING, AND SIMULATION:

利多卡因不能预防气管内插管时的双频指数上升反应

王慧琳译 薛张纲校

Lidocaine Does Not Prevent Bispectral Index Increases in Response to Endotracheal Intubation

Woon-Young Kim, Yoon-Sook Lee, Se-Jin Ok, Moon-Seok Chang, Jae-Hwan Kim, Young-Cheol Park, and Hye-Ja Lim

Anesth Analg 2006 102: 156-159.

围术期状态熵、反应熵与双频指数的比较

赵延华 译 陈杰 校

A Comparison of State and Response Entropy Versus Bispectral Index Values During the Perioperative Period (Technical Communication)

Paul F. White, Jun Tang, Gladys F. Romero, Ronald H. Wender, Robert Naruse, Alexander Sloninsky, and Robert Kariger

Anesth Analg 2006 102: 160-167.

一种可听呼气指示器在皮囊阀门面罩通气时增加病人模拟器的输出潮气量

徐丽颖译 薛张纲校

An Audible Indication of Exhalation Increases Delivered Tidal Volume During Bag Valve Mask Ventilation of a Patient Simulator

Samsun Lampotang, D. E. Lizdas, N. Gravenstein, and S. Robicsek

Anesth Analg 2006 102: 168-171.

PAIN MEDICINE:

加巴喷丁:围术期镇痛治疗药环氧化酶2(COX-2)抑制剂的替代药物

范颖晖 译 陈杰 校

Gabapentin: An Alternative to the Cyclooxygenase-2 Inhibitors for Perioperative Pain Management

A. Turan, P. F. White, B. Karamanlioglu, D. Memis, M. Tasdogan, Z. Pamukçu, and E. Yavuz

Anesth Analg 2006 102: 175-181

椎管内使用加巴喷丁的抗痛敏作用靶位:Ca2+通道、KATP通道还是N-甲基-D-天门冬氨酸受体?

黄施伟 译,马皓琳 李士通

The Antiallodynic Action Target of Intrathecal Gabapentin: Ca2+ Channels, KATP Channels or N-Methyl-d-Aspartic Acid Receptors?

Jen-Kun Cheng, Chien-Chuan Chen, Jia-Rung Yang, and Lih-Chu Chiou

Anesth Analg 2006 102: 182-187.

芬太尼电离子渗入疗法递药系统在术后镇痛的作用:随机、双盲、安慰剂对照试验

孙卓真 译 薛张纲 校

An Iontophoretic Fentanyl Patient-Activated Analgesic Delivery System for Postoperative Pain: A Double-Blind, Placebo-Controlled Trial

Eugene R. Viscusi, Lowell Reynolds, Stacy Tait, Timothy Melson, and Linda E. Atkinson

Anesth Analg 2006 102: 188-194.

非甾体类抗炎镇痛药(NSAIDs)抑制小鼠行为相关性疼痛但不涉及内脏痛的痛觉增

顾新宇 译 陈杰 校

Nonsteroidal Antiinflammatory Drugs Suppress Pain-Related Behaviors, but Not Referred Hyperalgesia of Visceral Pain in Mice

Jin-Woo Shin, Kyu-Sam Hwang, Yoo-Kyung Kim, Jeong-Gill Leem, and Cheong Lee

Anesth Analg 2006 102: 195-200.

开胸术后硬膜外输注新斯的明的作用

黄丽娜    马皓琳 李士通 

The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy

Yuan-Yi Chia, Ting-Hang Chang, Kang Liu, Huang-Chou Chang, Nai-Hua Ko, and Ying-Ming Wang

Anesth Analg 2006 102: 201-208.

CRITICAL CARE AND TRAUMA:

行冠脉造影包括经皮冠脉介入治疗病人心肺复苏的结果和生存期望值

钟静 译 薛张纲 校

Outcomes of Cardiopulmonary Resuscitation and Predictors of Survival in Patients Undergoing Coronary Angiography Including Percutaneous Coronary Interventions

Juraj Sprung, Matthew J. Ritter, Charanjit S. Rihal, Mary E. Warner, Gregory A. Wilson, Brent A. Williams, Susanna R. Stevens, Darrell R. Schroeder, Denis L. Bourke, and David O. Warner

Anesth Analg 2006 102: 217-224.

SimvastatinHMG辅酶A还原酶抑制剂)预处理可减轻大鼠肠缺血-再灌 注后相关性肺损伤

肖洁 译 陈杰 校

Pretreatment with Simvastatin Reduces Lung Injury Related to Intestinal Ischemia-Reperfusion in Rats

Arash Pirat, Pinar Zeyneloglu, Derya Aldemir, Muammer Yücel, Özlem Özen, Selim Candan, and Gülnaz Arslan

Anesth Analg 2006 102: 225-232.

NEUROSURGICAL ANESTHESIA:

比较瑞芬太尼和芬太尼复合异丙酚在清醒开颅肿瘤切除术中患者的满意度

陈玮 马皓琳 李士通 审校

Patient Satisfaction with Awake Craniotomy for Tumor Surgery: A Comparison of Remifentanil and Fentanyl in Conjunction with Propofol

Pirjo H. Manninen, Mrinalini Balki, Karolinah Lukitto, and Mark Bernstein

Anesth Analg 2006 102: 237-242.

OBSTETRIC ANESTHESIA:

剖宫产腰硬联合麻醉时采用坐位和右侧卧位阻滞特点及低血压严重程度的比较

王丽珺 译 薛张纲 校

The Sitting Versus Right Lateral Position During Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension

Hilde C. Coppejans, Ellen Hendrickx, Joris Goossens, and Marcel P. Vercauteren

Anesth Analg 2006 102: 243-247.

REGIONAL ANESTHESIA:

术后连续外周神经阻滞的镇痛效果优于阿片类药物吗? 一项荟萃分析研究

郑拥军 译 陈杰 校

Does Continuous Peripheral Nerve Block Provide Superior Pain Control to Opioids? A Meta-Analysis

Jeffrey M. Richman, Spencer S. Liu, Genevieve Courpas, Robert Wong, Andrew J. Rowlingson, John McGready, Seth R. Cohen, and Christopher L. Wu

Anesth Analg 2006 102: 248-257.

腘部刺激导管在拇(足)外翻手术后镇痛中的应用

张莹 马皓琳 李士通

Stimulating Popliteal Catheters for Postoperative Analgesia After Hallux Valgus Repair

Jaime Rodríguez, Manuel Taboada, Javier Carceller, Juan Lagunilla, Maria Bárcena, and Julián Álvarez

Anesth Analg 2006 102: 258-262.

利多卡因内添加地塞米松可延长腋路臂丛神经阻滞时间

金路 译 薛张纲 校

Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade

Ali Movafegh, Mehran Razazian, Fatemeh Hajimaohamadi, and Alipasha Meysamie

Anesth Analg 2006 102: 263-267.

持续气道正压通气增强低位胸段硬膜外注射利多卡因后感觉阻滞的扩散

张美荣 译 陈杰 校

Continuous Positive Airway Pressure Breathing Increases the Spread of Sensory Blockade After Low-Thoracic Epidural Injection of Lidocaine

W. Anton Visser, Mathieu J. M. Gielen, and Janneke L. P. Giele

Anesth Analg 2006 102: 268-271.     

脊髓麻醉中温度对高比重布比卡因扩散的影响

译,马皓琳 李士通

The Influence of Hyperbaric Bupivacaine Temperature on the Spread of Spinal Anesthesia
Young-Chang P. Arai, Wasa Ueda, Eri Takimoto, and Masanobu Manabe

Anesth Analg 2006 102: 272-275.

年龄对硬膜外使用罗哌卡因全身吸收和分布的影响

金琳 译 薛张纲 校

The Effect of Age on the Systemic Absorption and Systemic Disposition of Ropivacaine after Epidural Administration

Mischa J. G. Simon, Bernadette T. Veering, Arie A. Vletter, Rudolf Stienstra, Jack W. van Kleef, and Anton G. L. Burm

Anesth Analg 2006 102: 276-282.

鼠外用和鞘内应用多虑平的研究

潘志英 译 陈杰 校

Doxepin by Topical Application and Intrathecal Route in Rats

Peter Gerner, Venkatesh Srinivasa, Anthony M. Zizza, Zhi-Ye Zhuang, ShiHua Luo, David Zurakowski, Sunil Eappen, and GingKuo Wang

Anesth Analg 2006 102: 283-287.

GENERAL ARTICLES:

性别与全麻联用肌松药的恢复

马皓琳 李士通

Gender and Recovery After General Anesthesia Combined with Neuromuscular Blocking Drugs

Frank F. Buchanan, Paul S. Myles, Kate Leslie, Andrew Forbes, and Flavia Cicuttini

Anesth Analg 2006 102: 291-297.

腹腔镜减肥术中肺泡扩张术和呼气末正压通气对动脉氧合的影响 

孙敏莉 译 薛张纲 校

The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric Surgery

Francis X. Whalen, Ognjen Gajic, Geoffrey B. Thompson, Michael L. Kendrick, Florencia L. Que, Brent A. Williams, Michael J. Joyner, Rolf D. Hubmayr, David O. Warner, and Juraj Sprung

Anesth Analg 2006 102: 298-305.

通过神经肌肉监测选择插管时间能减少喉部损伤吗?一项随机前瞻性对照试验

朱辉 译 陈杰 校

Does the Timing of Tracheal Intubation Based on Neuromuscular Monitoring Decrease Laryngeal Injury? A Randomized, Prospective, Controlled Trial

Thomas Mencke, Matthias Echternach, Peter K. Plinkert, Ulrich Johann, Nazan Afan, Hauke Rensing, Gabriele Noeldge-Schomburg, Heike Knoll, and Reinhard Larsen

Anesth Analg 2006 102: 306-312.

红发女性报告出现瘀斑的比率稍高但凝血功能测试结果正常

周雅春 马皓琳 李士通

Women with Red Hair Report a Slightly Increased Rate of Bruising but Have Normal Coagulation Tests
Edwin B. Liem, Sandra C. Hollensead, Teresa V. Joiner, and Daniel I. Sessler

Anesth Analg 2006 102: 313-318.

不同气道设备中有或没有笑气全麻对中耳压力影响的研究

吴德华 译 薛张纲 校

Middle Ear Pressure Changes During Anesthesia With or Without Nitrous Oxide are Similar Among Airway Devices

Mathias Hohlrieder, Christian Keller, Joseph Brimacombe, Stephan Eschertzhuber, Günter Luckner, Irene Abraham, and Achim von Goedecke

Anesth Analg 2006 102: 319-321.

常温体外转流(CPB)中应用小剂量的E-前列醇能降低全身氧耗和内脏的氧摄取
Small-Dose Epoprostenol Decreases Systemic Oxygen Consumption and Splanchnic Oxygen Extraction During Normothermic Cardiopulmonary Bypass Jan-Peter Braun, MD*, Torsten Schroeder, MD*, Sabine Buehner, Dr (Biology) , Uday Jain, MD, PhD, FACC, FAHA||, Ulrich Döpfmer, MD, FRCA*, Josephine Schuster, MD*, Selcuk Bas, MD*, Ingolf Schimke, MD , Pascal M. Dohmen, MD , Herbert Lochs, MD , Wolfgang Konertz, MD , and Claudia Spies, MD*

*Departments of Anesthesiology and Intensive Care,  Gastroenterology,  Cardiac Surgery, and  Cardiology, Campus Charité Mitte, Charité University Hospital, CharitéUniversity Medicine Berlin, Germany; and ||St. Marys Medical Center, San Francisco, California

Anesth Analg 2006 102: 17-24.


常温下非搏动性体外转流(CPB)可损害全身和内脏的氧运输,并且增加胃肠道粘膜的 通透性。CPB期间的一个重要目标是如何避免低氧血症。在败血症病人中小剂量的前列 腺素可以改善内脏氧运输和微循环。本研究为了检验心脏手术中,前列腺素的类似药物 E-前列醇是否改善全身和内脏的氧输送平衡。18例接受心脏瓣膜置换术病人随机分为E -前列醇(3ng•kg-1•min)组和安慰剂组,分别在术中和术后1小时给 药。于CPB前、CPB期间和CPB后监测全身和内脏的氧摄取,消耗和输出以及动脉血、混 合静脉血和肝静脉血的乳酸浓度。应用三连糖(triple sugar)通透性实验来测定术前 1日和术后1日的胃肠道粘膜的通透性。CPBE-前列醇组全身氧耗和内脏氧摄取减少(P 0.024)。但这些作用在E-前列醇停药后1小时消失。本研究没有充分的数据说明E- 前列醇是否有增加乳酸代谢和术后胃肠道粘膜通透性的趋向,也不能证明两组的临床结 果不同。结论:在CPB期间应用小剂量的E-前列醇可以降低全身氧耗和内脏的氧摄取。
(忻纪华 译 陈杰 校)
Normothermic, nonpulsatile cardiopulmonary bypass (CPB) impairs systemic and splanchnic oxygen transport and increases gastrointestinal permeability. It is an important therapeutic goal to avoid splanchnic dysoxia during CPB. Small-dose prostacyclin therapy improves splanchnic oxygen transport and microcirculation in septic patients. In this study, we sought to determine if during cardiac surgery, the prostacyclin analog epoprostenol improves the balance of systemic and splanchnic oxygen transport. Eighteen patients undergoing cardiac valve replacement were randomized to receive either epoprostenol (3 ng •kg1 •min1) or placebo during, and for 1 hour after, surgery. Systemic and splanchnic oxygen delivery, consumption, and extraction and arterial, mixed venous, and hepato-venous lactate concentrations were measured before, during, and after CPB. Gastrointestinal permeability was measured 1 day before and 1 day after surgery using the triple sugar permeability test. During CPB, the epoprostenol group had decreased systemic oxygen consumption and splanchnic oxygen extraction (P = 0.024). These effects were not present 1 hour after the end of epoprostenol infusion. The study was not adequately powered to determine whether epoprostenol altered the trend towards increased lactate metabolism and increased postoperative gastrointestinal permeability, nor could we demonstrate any differences between groups in clinically relevant end-points. In conclusion, these findings suggest that during normothermic CPB, small-dose epoprostenol therapy may reduce systemic oxygen consumption and splanchnic oxygen extraction.

鞘内和硬膜外麻醉与镇痛技术在心脏手术中的应用
Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery

Mark A. Chaney, MD

Department of Anesthesia and Critical Care, University of Chicago, Illinois
Anesth Analg 2006 102: 45-64.

足够的术后镇痛可以防止病人的术后不适,也可以减少病人死亡率、术后住院时间,以 及住院费用。然而,心脏手术后病人往往难以获得满意的镇痛。虽然很多临床技术均可 提供镇痛,但各有优缺点。在心脏手术中应用鞘内和硬膜外技术可获得满意的镇痛效果 ,另外潜在的优势包括减少应激反应和胸心去交感反应。胸部硬膜外麻醉技术所获得的 镇痛效果非常满意,可以满足病人在不实施气管插管全麻清醒下进行心脏手术。然而, 应用区域麻醉技术实施心脏手术并非没有风险。包括局麻药的副反应(低血压)和阿片类 药物的副反应(搔痒、恶心呕吐、尿潴留和呼吸抑制等),当应用这种麻醉技术时,可能 使围术期管理复杂化。由于在这种情况下病人发生硬膜外血肿的风险增加,从而导致有 关应用区域麻醉技术实施心脏手术的可接受的风险-收益比仍有许多的争论。
(齐波 译 陈杰 校)
Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.

 

七氟醚和丙泊酚对爪蟾卵QT间期及HERG通道电流的影响
The Effects of Sevoflurane and Propofol on QT Interval and Heterologously Expressed Human Ether-A-Go-Go Related Gene Currents in Xenopus Oocytes Masana Yamada, MD*, Noboru Hatakeyama, MD, PhD*, Anna P. Malykhina, PhD , Mitsuaki Yamazaki, MD, PhD*, Yasunori Momose, PhD , and Hamid I. Akbarali, PhD 

*Department of Anesthesiology, University of Toyama, Toyama, Japan,  Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;  Department of Clinical Pharmacy, Toho University, Chiba, Japan

Anesth Analg 2006 102: 98-103.

七氟醚能够抑制动作电位复极化过程,导致心脏QT间期延长。这一效应可能是由于抑制 了人ether-a-go-go related gene(HERG)通道造成的。为了证明麻醉药对于HERG通道的 作用机制,研究者观察了豚鼠在七氟醚和丙泊酚麻醉下心电图QT间期的变化。结果发现 ,七氟醚(1%-4%)可以剂量依赖性的延长QT间期(7.5%-21.2%),但是丙泊酚却无此 作用。另外,HERG通道在爪蟾卵有表达,该通道从-70mV去极化时可以记录到HERG外向 电流。再复极到-70mV时也可以记录到一个较强的外向尾电流。七氟醚(1%-4%)可以剂 量依赖性的抑制HERG外向尾电流(9.7%-26.6%),但是只有在高浓度的情况下才能抑制 其稳态电流。汇聚电流的时间常数在七氟醚存在的情况下减小了,但是其失活和激活曲 线没有变化。丙泊酚在临床相当浓度下对于这些电生理参数没有影响。总之,研究者认 为,与稳态电流相比,七氟醚抑制外向尾电流的作用更强,说明七氟醚对HERG通道的影 响可能发生在失活期。
(苏殿三 译 陈杰 校)
Sevoflurane can induce prolongation of the cardiac QT interval by inhibiting the repolarization phase of the action potential. This may occur as a result of inhibition of the human ether-a-go-go related gene (HERG) channel. To clarify the mechanisms of anesthetics on HERG channels, we monitored the electrocardiogram and measured QT intervals in the guinea pig in the presence of sevoflurane and propofol. Sevoflurane (1%4%) prolonged QTc dose-dependently (7.5%21.2%), but propofol did not affect it. Furthermore, HERG channels were expressed in Xenopus oocytes and outward HERG currents were obtained on step depolarization from a holding potential of 70 mV. Repolarization to 70 mV from positive test potentials resulted in large outward tail currents. Sevoflurane (1%4%), in a dose-dependent manner, inhibited the HERG outward tail currents (9.7%
26.6%), whereas steady-state currents were inhibited only at large concentrations. The time constant of the converging current was decreased in the presence of sevoflurane, but the inactivation and activation curves were not shifted. Propofol did not affect these currents within the clinically relevant concentration. In conclusion, compared with steady-state currents, sevoflurane was more potent in inhibiting the outward tail currents, suggesting that sevoflurane may modulate the HERG channel kinetics in its inactivated state.

腹部大手术丙泊酚麻醉期间奈福泮对瑞芬太尼引起的吗啡消耗量增加的影响
The Effect of Nefopam on Morphine Overconsumption Induced by Large-Dose Remifentanil During Propofol Anesthesia for Major Abdominal Surgery

Myriam Tirault, MD*, Nicolas Derrode, MD*, David Clevenot, MD*, Delphine Rolland, MD*, Dominique Fletcher, MD , and Bertrand Debaene, MD*

*Department of Anesthesiology and Intensive Care, Hôpital J. Bernard, Poitiers, France;  Department of Anesthesiology and Intensive Care, Hôpital R. Poincaré, Garches, France

Anesth Analg 2006 102: 110-117.

阿片类药物可以激活镇痛作用相反的疼痛易化系统。作者研究在全凭静脉麻醉中大剂量 瑞芬太尼是否导致术后吗啡消耗过量,并研究奈福泮是否减轻此作用。研究中包括60名 择期腹部手术病人并随机分组。第一组30个病人丙泊酚静脉麻醉期间靶控输注大剂量( L: 8ng/ml)或小剂量(S: 3ng/ml)的瑞芬太尼。在缝皮前给病人0.15mg/kg的吗 啡。另外一组给与奈福泮20mg。术后用静滴吗啡控制疼痛随后病人自控镇痛(PCA)。L 组需要吗啡早于S[10(1-63min )versus 375-90minP<0.002 ]L组的吗啡需要 量大于S[0.28(0.04-0.38 versus 0.16 0.03-0.41 mg/kgP<0.05 ]。两组间痛 觉消失时吗啡消耗量和疼痛程度相似。应用奈福泮后患者术后首次需要吗啡及术后持续 滴定吗啡量组无间差异。在大剂量瑞芬太尼和丙泊酚麻醉术后早期发生的术后吗啡消耗 量增加。预先给予奈福泮能阻止阿片类药物产生的痛觉敏感。
(郑丽 译 陈杰 校)
Opioids may activate pain facilitatory systems opposing analgesia. We investigated whether large-dose remifentanil given during IV anesthesia caused postoperative morphine overconsumption and whether nefopam (a centrally acting analgesic) could reduce this. Sixty patients scheduled for abdominal surgery were included in this prospective, randomized study. The first 30 patients received either small-dose (Group S: 3 ng/mL) or large-dose (Group L: 8 ng/mL) remifentanil administrated by a target-controlled infusion during propofol anesthesia. Before skin closure, patients received morphine 0.15 mg/kg. Another 30 patients also received nefopam 20 mg intraoperatively. Postoperative pain was controlled by titration of morphine, followed by patient-controlled morphine analgesia (PCA). Morphine was requested earlier in Group L than in Group S (10 [1 63] min versus 37 [590] min, median [range]; P < 0.002). The dose of morphine by titration was larger in Group L than in Group S (0.28 [0.04 0.38] mg/kg versus 0.16 [0.030.41] mg/kg; P < 0.05). PCA morphine consumption and pain scores were similar. There were no differences between the nefopam groups in the time to first morphine request or in the dose of morphine by titration. Postoperative morphine overconsumption occurred after large-dose remifentanil and propofol anesthesia during the early postoperative period. Pretreatment with nefopam could be useful to prevent pain sensitization induced by opioids.

大鼠静脉内应用乳化异氟醚的有效性和安全性
The Efficacy and Safety of Intravenous Emulsified Isoflurane in Rats

Jian-Xin Zhou, MD*, Nan-Fu Luo, MB , Xiao-Min Liang, MD , and Jin Liu, MD  * Intensive Care Unit, Bejing Tiantan Hospital, Capital University of Medical Sciences, Bejing, and  Department of Anesthesiology and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Anesth Analg 2006 102: 129-134.
虽然静脉内应用液态可挥发性麻醉药通常是致命的,但在动物身上已能安全使用乳化氟 烷、异氟醚进行麻醉诱导而无副作用。作者在大鼠身上确立乳化挥发性麻醉药制剂的安 全浓度及静脉注射乳化异氟醚和丙泊酚的剂量-反应关系。作者测量了地氟醚、七氟 醚、异氟醚、恩氟醚和氟烷在20%和30%英脱利匹特的液/气分配系数并计算它们的饱 和浓度。不饱和的乳化异氟醚是用液态异氟醚加入到30%英脱利匹特中置配而成的。前 足翻正反射的消失作为麻醉诱导的标志,心电图的消失则作为死亡的标志。乳化异氟醚 的半数有效诱导剂量(ED50)和半数致死剂量(LD50)分别是0.0720.216ml/kg。异 丙酚的半数有效诱导剂量(ED50)和半数致死剂量(LD50)分别是5.8918.19mg/kg。 乳化异氟醚诱导后前足翻正反射恢复时间(38±18s)要比异丙酚(101±62sp<0.05
)明显缩短。在大鼠中静脉使用乳化异氟醚能成功实现麻醉诱导,其安全系数与安全因 子与异丙酚相当。静脉内使用乳化异氟醚的麻醉复苏要比异丙酚快。
(曹瑜 译 陈杰 校)
Although direct IV injection of liquid volatile anesthetics is usually lethal, anesthesia using emulsified halothane and isoflurane without adverse effects has been safely induced in animals. We identified the safe concentration of emulsified volatile anesthetic preparations and determined the dose-response relationship of IV emulsified isoflurane and propofol in rats. Liquid/gas partition coefficients of desflurane, sevoflurane, isoflurane, enflurane, and halothane in 20% and 30% Intralipid were measured and used to calculate their saturated concentrations. Unsaturated emulsified isoflurane was prepared by adding liquid isoflurane to 30% Intralipid. The loss of forepaw righting reflex was taken as induction of anesthesia, and disappearance of electrocardiogram was taken as death. The median effective induction dose (ED50) and median lethal dose (LD50) of emulsified isoflurane were 0.072 and 0.216 mL/kg liquid isoflurane, respectively. The ED50 and LD50 of propofol were 5.89 mg/kg and 18.19 mg/kg, respectively. Time to return of forepaw righting reflex after injection of emulsified isoflurane (38 ± 18 s) was significantly shorter than with propofol (101 ± 62 s; P < 0.05). Anesthesia was successfully induced in rats by IV emulsified isoflurane with a comparable safety index and certain safety factor as propofol. Recovery of anesthesia after IV emulsified isoflurane was faster than with propofol.

健康志愿者曲马多静脉注射后的麻醉效应与CYP2D6的关系
The Analgesic Effect of Tramadol After Intravenous Injection in Healthy Volunteers in Relation to CYP2D6

Thomas P. Enggaard, MD* , Lars Poulsen, MD*, Lars Arendt-Nielsen, PhD , Kim Br&oslash;sen, MD*, Joachim Ossig, PhD||, and S&oslash;ren H. Sindrup, MD  * Clinical Pharmacology, University of Southern Denmark,  Department of Anaesthesiology and Intensive Care,  Department of Neurology, Odense University Hospital, Odense, Denmark.  Center of Sensory-Motor Interaction Aalborg University, Denmark; ||Department of Pharmacokinetics Grünenthal GmbH, Aachen, Germany Anesth Analg 2006 102: 146-150.

曲马多的麻醉效应源自于其本身的单胺能作用及CYP2D6存在下其O型去甲基化的主要代 谢物(+)-M1产生的阿片样作用。本实验中,作者用实验性疼痛模型来研究M1对曲马多麻 醉效应的影响。将健康志愿者随机分为两组,每组10人,分别为有CYP2D6存在,产生丰 富代谢物组,和无CYP2D6存在,代谢产物贫乏组。在静脉注射100 mg曲马多1590 min 后,研究其对两组志愿者实验性疼痛的影响。疼痛测试包括腓神经的单次电刺激的感应 和耐受阈值,腓神经重复性电刺激的疼痛累计阈值(暂时累计)和冷压测试。在丰富代 谢产物组中,曲马多能够降低冷压测试中的不适感(P=0.002)。腓神经刺激的疼痛忍 受阈值在贫乏代谢产物组的志愿者中较高(P0.04)。在丰富代谢产物组中,除一人 外,其余志愿者的血清样品中均能检测到(+)-M1,而在贫乏代谢产物组中,(+)-M1均低 于测量下限。实验表明,(+)-M1的阿片样作用有助于曲马多的麻醉效应,但该效应的产 生似乎主要源于曲马多本身的单胺能作用。
(田婕 译 陈杰 校)
Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an IV injection of 100 mg tramadol on experimental pain was studied 1590 min after dosing in volunteers, 10 extensive metabolizers with CYP2D6 and 10 poor metabolizers without CYP2D6 in 2 placebo-controlled trials. The pain tests included detection and tolerance threshold to single electrical sural nerve stimulation, pain summation threshold to repetitive electrical sural nerve stimulation (temporal summation), and the cold pressor test. In extensive metabolizers, tramadol reduced discomfort experienced during the cold pressor test (P = 0.002). In poor metabolizers, the pain tolerance thresholds to sural nerve stimulation were increased (P = 0.04). (+)-M1 could be detected in the serum samples from all extensive metabolizers except one, but (+)-M1 was below the limit of determination in all poor metabolizers. The opioid effect of (+)-M1 appears to contribute to the analgesic effect of tramadol, but the monoaminergic effect of tramadol itself seems to create an analgesic effect.

围术期状态熵、反应熵与双频指数的比较
A Comparison of State and Response Entropy Versus Bispectral Index Values During the Perioperative Period

Paul F. White, PhD, MD*, Jun Tang, MD , Gladys F. Romero, MD*, Ronald H. Wender, MD , Robert Naruse, MD , Alexander Sloninsky, MD , and Robert Kariger, MD 

*Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas, Texas; and  Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California

Anesth Analg 2006 102: 160-167.

脑电监测指数在很大程度上受病人间变异和手术时电信号的干扰。作者设计了该项临床 研究,以验证异丙酚和地氟醚全麻时频谱熵(Entropy)模块受干扰的程度低于双频指数 (BIS)监测仪。该前瞻性研究包括30名拟行腹腔镜手术的病人,同意接受试验。对病 人实施常规全麻,记录获取基础指数的时间(elapsed time)、以及在麻醉诱导、维持 以及苏醒期特定时间的状态熵(SE)、反应熵(RE)和BIS数值。在维持期给予负荷剂 量的异丙酚(20mg iv)和增加或减少吸入地氟醚浓度2%后测定这些指数的变化。正如 预期的那样,SE基础值(88 ±2)低于RE96± 3)和BIS96 ± 4)。但SERE值与BIS 值相关,诱导期相关系数(r)分别为 0.770.78;苏醒期r 分别为0.860.91。受试 者操作特征曲线(Receiver Operating Characteristic Curve, ROC曲线)可反映意识 状态,其曲线下面积也提示 SE (0.93 ±0.04)RE(0.98 ± 0.04)BIS (0.97± 0.04)相关。在维持期,这三个指数对异丙酚和地氟醚浓度改变的反应相同。熵指数受 术中电刀的干扰较少(与BIS监测仪相比分别为12%和62%)。由于监测熵指数和BIS的 一次性电极的平均售价相似(分别为$14.25 $14.95),作者认为熵模块的费用与BIS 监测仪相当,可以替代后者。
(赵延华 译 陈杰 校)
Cerebral monitoring indices are associated with a large degree of inter-patient variability and electrical signal interference during surgery. We designed this clinical study to test the hypothesis that use of the spectral entropy (Entropy) module is associated with less frequent intraoperative interference with the displayed indices than the bispectral index (BIS) monitor when used during general anesthesia with propofol and desflurane. Thirty consenting patients scheduled for major laparoscopic surgery procedures were enrolled in this prospective study. The elapsed time to obtain a baseline index value was recorded, as well as the simultaneous state entropy (SE), response entropy (RE), and BIS values at specific time intervals during the induction, maintenance, and emergence periods in patients administered a standardized general anesthetic technique. During the maintenance period, the changes in these indices were evaluated after a bolus dose of propofol (20 mg IV) and a 2% increase or decrease in the inspired concentration of desflurane. As expected, the baseline SE values were less than the RE and BIS values (88 ± 2 versus 96 ± 3 and 96 ± 4, respectively). However, the SE and RE values correlated with the BIS value during the induction (r = 0.77 and 0.78, respectively) and emergence (r = 0.86 and 0.91, respectively) periods. The area under the receiver operating characteristic curve for detection of consciousness also indicated a similar performance of the SE (0.93 ± 0.04) relative to the RE (0.98 ± 0.04) and BIS (0.97 ± 0.04). During the maintenance period, the responses to changes in propofol and desflurane concentrations were consistent with all three indices. Finally, the entropy indices were less interfered with by the electrocautery unit during the operation (12% versus 62% for the BIS monitor). Because the average selling prices of the Entropy and BIS disposable electrode strips ($14.25 versus $14.95 USD, respectively) are comparable, we conclude that the Entropy module is a cost-equivalent alternative to the BIS monitor.

加巴喷丁:围术期镇痛治疗药环氧化酶2(COX-2)抑制剂的替代药物
Gabapentin: An Alternative to the Cyclooxygenase-2 Inhibitors for Perioperative Pain Management

. Turan, A MD*, White, P. F. PhD, MD , Karamanlio lu, B. MD*, Memis, D.MD*, M. Ta do an, MD*,Pamuk&ccedil;u, Z. MD*, and Yavuz, E. MD 

*Department of Anaesthesiology and  Biostatistics, Trakya University, Edirne, Turkey; and  Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2006 102: 175-181.

环氧化酶2(COX-2)抑制剂罗非昔布是常用的围术期镇痛药。在这项安慰剂对照的临床研 究中,研究者证明加巴喷丁同样能够减轻围术期的疼痛,减少阿片类药物的用量,改善 术后恢复过程。100名行经腹子宫切除术的患者随机分配到4组:1)安慰剂对照组(组1 ):在术前和术后2天口服安慰剂;2)罗非昔布组(组2),病人术前和术后口服罗非昔 布50mg/d3)加巴喷丁组(组3),病人术前和术后口服加巴喷丁1.2g/d4)联合用药 组(4),病人在术前和术后口服罗非昔布50mg/d,加巴喷丁1.2g/d。各组均采用标准 的麻醉方法处理,术后评估包括疼痛和镇静评分,静脉吗啡的用量,恢复质量的评估, 肠道功能恢复时间,正常活动的开始时间和病人对术后镇痛的满意度。研究结果发现, 在三个处理组术后疼痛评分均明显下降,与对照组相比三个处理组病人自控镇痛(PCA )吗啡用量在术后18,2430h明显减少。与对照组相比,组2, 3,组4 PCA吗啡用 量分别减低43%, 24%50%。与对照组相比,组2和组4口服镇痛药的消耗量也明显减 少。罗非昔布和加巴喷丁减少麻醉性镇痛药的需要并可以加速肠道功能的恢复。与对照 组相比,组2和组4术后24h出院合格评分明显改善。三个处理组术后镇痛的满意度明显 提高。对照组,组2和组3 72小时随访对术后镇痛的满意度分别为32%, 64%,72%,而 组4的满意度为100%。总之,研究者认为术后短期口服加巴喷丁1.2 g/d可以替代罗非昔 布(50mg/d,口服)用于下腹部手术后镇痛时阿片类镇痛药的辅助用药。
(范颖晖 译 陈杰 校)
The cyclooxygenase-2 inhibitor, rofecoxib, was a popular analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could produce similar reductions in postoperative pain and opioid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups: 1) control group received placebo capsules and pills before and for 2 days after surgery, 2) rofecoxib group received 50 mg/d PO and placebo capsules before and after surgery and, 3) gabapentin group received 1.2 g/d PO and placebo pills before and after surgery, and 4) combination group received rofecoxib 50 mg/d and gabapentin 1.2 g/d PO before and after surgery. The anesthetic technique was standardized and the postoperative assessments included verbal rating scales for pain and sedation, IV morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Postoperative pain scores were significantly reduced in all three analgesic treatment groups (versus control group). Compared with the control group, patient-controlled analgesia morphine usage was also significantly reduced in the 3 analgesic treatment groups at 1, 8, 24, and 30 h after surgery. Total PCA morphine usage was decreased by 43%, 24%, and 50% in groups 2, 3, and 4, respectively, compared with group 1. Oral analgesic consumption was also smaller in groups 2 and 4 when compared with the control group. The opioid-sparing effects of rofecoxib and gabapentin lead to a faster recovery of bowel function. Discharge eligibility scores in groups 2 and 4 were improved at 24 h when compared with group 1, and patient satisfaction with postoperative pain management was significantly higher at 24 h in all 3 analgesic treatment groups. At the 72 h follow-up, all of the patients in group 4 were completely satisfied with their pain management compared with only 32%, 64%, and 72% in groups 1, 2, and 3, respectively. Gabapentin (1.2 g/d PO) appears to be an acceptable alternative to rofecoxib (50 mg/d PO) for short-term use as an adjuvant to opioid analgesics in patients undergoing lower abdominal surgery.

非甾体类抗炎镇痛药(NSAIDs)抑制小鼠行为相关性疼痛但不涉及内脏痛的痛觉增 敏
Nonsteroidal Antiinflammatory Drugs Suppress Pain-Related Behaviors, but Not Referred Hyperalgesia of Visceral Pain in Mice

Jin-Woo Shin, MD, PhD, Kyu-Sam Hwang, MD, PhD, Yoo-Kyung Kim, MD, PhD, Jeong-Gill Leem, MD, PhD, and Cheong Lee, MD, PhD

Department of Anesthesiology and Pain Medicine, Ulsan University College of Medicine, Seoul, Korea

Anesth Analg 2006 102: 195-200.

内脏痛是以自发性疼痛和痛觉增敏为特征。用芥子油结肠内给药使老鼠产生内脏痛之后 ,通过行为相关性疼痛和外渗物的伊文斯蓝染色来检测不同NSAIDs的效果。给予动物以 下药物中的一种:盐、乙醇、二甲基亚砜、吗啡、酮基布洛芬、痛力克或双脱氧氟尿苷 DFU(一种环氧化酶-2抑制剂)。通过药物处理后,在小鼠结肠内给予1.5%芥子油 50&micro;l,并评估20min内的自发性相关疼痛反应。检测对腹部、脚、尾巴应用von Frey毛的停药反应的频率。完成行为测试后,经动物尾上的静脉注射伊文斯蓝。2小时 后作结肠解剖并测定伊文斯蓝含量。动物在吗啡3-10mg/kg、痛力克50mg/kg、酮基布洛 芬100mg/kgDFU20mg/kg处理后,其自发性行为疼痛明显减少(p<0.05)。但应用吗啡 10mg/kg后小鼠的反应频率更低且不受痛力克、酮基布洛芬或DFU处理的影响(p<0.05
)。结肠内伊文斯蓝含量在给予酮基布洛芬100mg/kgDFU20mg/kg的小鼠中更低( p<0.05)。结论:NSAIDs能减轻行为疼痛和炎症但对痛觉增敏的影响很小。
(顾新宇 译 陈杰 校)
Visceral pain is characterized by spontaneous pain and referred hyperalgesia. After inducing visceral pain in mice using intracolonic mustard oil administration, we examined the effects of various nonsteroidal antiinflammatory drugs (NSAIDs) on pain-related behavior and on Evans blue dye extravasation. Animals were given one of the following: saline, ethanol, dimethylsulfoxide (DMSO), morphine, ketoprofen, ketorolac, or DFU (a cyclooxygenase-2 inhibitor). After drug treatment, mice underwent intracolonic administration of 50 &micro;L 1.5% mustard oil. Spontaneous pain-related responses were assessed for the next 20 min. The frequency of withdrawal responses to the application of von Frey hairs to the abdomen, foot, and tail was determined. After completion of the behavioral tests, Evans blue was injected into the animals via the tail vein. Two hours later, the colon was removed postmortem and Evans blue content was measured. Spontaneous pain behaviors were significantly less in animals administered 3 and 10 mg/kg morphine, 50 mg/kg ketorolac, 100 mg/kg ketoprofen, and 20 mg/kg DFU (P < 0.05). Response frequencies to the application of von Frey hairs were lower in mice administered 3 and 10 mg/kg morphine (P < 0.05) but were not affected by ketorolac, ketoprofen, or DFU treatment. Colonic Evans blue content was smaller in mice given 100 mg/kg ketoprofen and 20 mg/kg DFU (P < 0.05). We concluded that NSAIDs reduced pain behavior and inflammation but had little effect on referred hyperalgesia.

SimvastatinHMG辅酶A还原酶抑制剂)预处理可减轻大鼠肠缺血-再灌 注后相关性肺损伤
Pretreatment with Simvastatin Reduces Lung Injury Related to Intestinal Ischemia-Reperfusion in Rats

Arash Pirat, MD*, Pinar Zeyneloglu, MD*, Derya Aldemir, MD , Muammer Yü
cel, MD , &Ouml;zlem &Ouml;zen , Selim Candan, MD*, and Gülnaz Arslan, MD*
Departments of *Anesthesiology,  Biochemistry, and  Pathology, Baskent University Faculty of Medicine, Ankara, Turkey

Anesth Analg 2006 102: 225-232.

以大鼠为实验模型,研究评价使用Simvastatin预处理是否可以影响肠缺血-再灌注( I/R)导致急性肺损伤的严重程度。24个实验动物随机分为3组(shamcontrol
Simvastatin),Simvastatin组预先使用Simvastatin10mg&#8226;kg-1&#8226;-1 ,连续3天,其它两组使用对照剂。三组实验动物,均阻断肠系膜上动脉60min,而后再 灌注90min。与Simvastatin组相比,对照组产生相对更为严重的肠缺血-再灌注性肺损 伤,这是因为氧分压低和血氧饱和度低(分别为:P=0.01P=0.005)而肺内中性粒细 胞渗透压平均值增高导致的(P=0.003),总的肺组织病理损伤评分(P=0.003),肺干 -湿比重比(P=0.009),肺组织丙二醛水平(P=0.016)。所有检测中,除了对照组支 气管肺泡灌洗液中的P选择蛋白较高(P=0.006)外,对照组和Simvastatin组的血清、 支气管肺泡灌洗液中细胞因子水平(白介素-1,白介素-6,α-肿瘤坏死因子)P选择蛋 白水平都是相似的。本大鼠模型研究证明Simvastatin预处理可以减轻肠缺血-再灌注性 肺损伤。
(肖洁 译 陈杰 校)
In this rat model study we evaluated whether pretreatment with simvastatin affects the severity of acute lung injury caused by intestinal ischemia-reperfusion (I/R). Twenty-four animals were randomly allocated to three equal groups (sham, control, simvastatin). The simvastatin group was pretreated with simvastatin 10 mg &#8226; kg1 &#8226; day1 for 3 days, whereas the other groups received placebo. The simvastatin and control groups underwent 60 min of superior mesenteric artery occlusion and 90 min of reperfusion. Compared with the simvastatin group, the control group exhibited significantly more severe intestinal I/R-induced acute lung injury, as indicated by lower Pao2 and oxygen saturation (P = 0.01 and P = 0.005, respectively) and higher mean values for neutrophil infiltration of the lungs (P = 0.003), total lung histopathologic injury score (P = 0.003), lung wet-to-dry weight ratio (P = 0.009), and lung-tissue malondialdehyde levels (P = 0.016). The control and simvastatin groups had similar serum levels and similar bronchoalveolar lavage fluid levels of cytokines (interleukin-1, interleukin-6, and tumor necrosis factor- ) and P-selectin at all measurements, except for a significantly higher level of bronchoalveolar lavage fluid P-selectin in the control group (P = 0.006). Pretreatment with simvastatin reduces the severity of acute lung injury induced by intestinal I/R in rats.

 

术后连续外周神经阻滞的镇痛效果优于阿片类药物吗? 一项荟萃分析研究
Does Continuous Peripheral Nerve Block Provide Superior Pain Control to Opioids? A Meta-Analysis

Jeffrey M. Richman, MD*, Spencer S. Liu, MD , Genevieve Courpas, BA*, Robert Wong, MD*, Andrew J. Rowlingson, BA*, John McGready, MS , Seth R. Cohen, BS , and Christopher L. Wu, MD*

*Department of Anesthesiology and Critical Care Medicine,  School of Public Health, The Johns Hopkins University; Baltimore, Maryland;  Department of Anesthesiology; Virginia Mason Medical Center University of Washington; Seattle, Washington;  Philadelphia College of Osteopathic Medicine; Philadelphia, Pennsylvania

Anesth Analg 2006 102: 248-257.

尽管大多数随机临床研究表明:与阿片类药物相比,连续外周神经阻滞(CPNB)可减轻 术后疼痛,减少阿片类药物的副作用。但由于这些研究包含的样本数较少,因而很难从 统计学角度得到明确的结论。本文主要通过对1966-2004OVID数据库有关CPNB和阿片 类药物用于术后镇痛的相关研究进行分析,数据来自于每一篇文章中的图表和相关信 息。19篇文章中包含的603位病人符合入选标准,入选标准包括:麻醉方式明确(包括 全麻复合区域阻滞,单纯全麻或单纯外周神经阻滞);随机试验;成年患者(年龄大于 或者等于18岁);术后应用CPNB(但不包括胸膜内导管)或麻醉性镇痛药;应用阿片类 药物的患者不能接受外周神经阻滞。研究结果表明:术后外周神经阻滞镇痛效果优于阿
片类药物(P < 0.001),上述结论通过术后24h(P < 0.001)48 h (P < 0.001)平均视
觉模拟评分和最大视觉模拟评分,以及术后 72 h 平均视觉模拟评分 (P < 0.001)得 到。不论镇痛部位,也不论镇痛持续时间,神经阻滞效果均优于阿片类药物。CPNB引发 恶心/呕吐,嗜睡以及瘙痒等症状(P < 0.001)的发生率也明显减少,且神经阻滞可减少 阿片类药物的用量(P < 0.001)。综上所述,与阿片类药物相比,外周神经阻滞(不管 其阻滞部位如何)镇痛效果好,副作用少。
(郑拥军 译 陈杰 校)
Although most randomized clinical trials conclude that the addition of continuous peripheral nerve blockade (CPNB) decreases postoperative pain and opioid-related side effects when compared with opioids, studies have included relatively small numbers of patients and the majority failed to show statistical significance during all time periods for reduced pain or side effects. We identified studies primarily by searching Ovid Medline (1966 May 21, 2004) for terms related to postoperative analgesia with CPNB and opioids. Each article from the final search was reviewed and data were extracted from tables, text, or extrapolated from figures as needed. Nineteen articles, enrolling 603 patients, met all inclusion criteria. Inclusion criteria were a clearly defined anesthetic technique (combined general/regional anesthesia, general anesthesia alone, peripheral nerve block), randomized trial, adult patient population ( 18 yr old), CPNB (or analgesia) used postoperatively (intrapleural catheters were deemed not to be classified as a peripheral nerve catheter), and opioids administered for postoperative analgesia in groups not receiving peripheral nerve block. Perineural analgesia provided better postoperative analgesia compared with opioids (P < 0.001). This effect was seen for all time periods measured for both mean visual analog scale and maximum visual analog scale at 24 h (P < 0.001), 48 h (P < 0.001), and 72 h (mean visual analog scale only) (P < 0.001) postoperatively. Perineural catheters provided superior analgesia to opioids for all catheter locations and time periods (P < 0.05). Nausea/vomiting, sedation, and pruritus all occurred more commonly with opioid analgesia (P < 0.001). A reduction in opioid use was noted with perineural analgesia (P < 0.001). CPNB analgesia, regardless of catheter location, provided superior postoperative analgesia and fewer opioid-related side effects when compared with opioid analgesia.

持续气道正压通气增强低位胸段硬膜外注射利多卡因后感觉阻滞的扩散
Continuous Positive Airway Pressure Breathing Increases the Spread of Sensory Blockade After Low-Thoracic Epidural Injection of Lidocaine

W. Anton Visser, MD*, Mathieu J. M. Gielen, MD, PhD , and Janneke L. P. Giele, MSci 

*Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, Breda, The Netherlands;  Department of Anesthesiology, University Medical Center Nijmegen, Nijmegen, The Netherlands; and  Department of Anesthesiology, University Medical Center Nijmegen, HB Nijmegen, The Netherlands

Anesth Analg 2006 102: 268-271.

硬膜外注射局部麻醉药后感觉阻滞扩散的影响因素尚未完全阐明。为了评价胸内压的增 加对胸段硬膜外麻醉扩散的影响,作者选择20T7-8T8-9椎间隙硬膜外置管的病人, 随机分成2组,对照组为自主呼吸时硬膜外注射2%利多卡因4mL作为试验量,持续气道正 压通气组为自主呼吸加7.5cmH2O持续气道正压通气并接受同样的硬膜外试验量。组间人 口统计学变异值相当。硬膜外注射15分钟后,对照组的感觉阻滞节段为T4T11,而持 续气道正压通气组是为T5L2。对照组的阻滞节段数为7个节段而持续气道正压通气组 为11个节段。对照组的注射部位尾向阻滞节段数为3个节段而持续气道正压通气组为6
节段。结论:持续气道正压通气可以增强胸段硬膜外麻醉感觉阻滞的扩散,主要为增强 尾向感觉阻滞的扩散。
(张美荣 译 陈杰 校)
Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the T7-8 or T8-9 intervertebral space into 2 groups. The control group (n = 10) received an epidural test dose of 4 mL lidocaine 2% during spontaneous breathing at ambient pressure. The continuous positive airway pressure (n = 10) group received the same epidural test dose but during spontaneous respiration with 7.5 cm H2O continuous positive airway pressure. The groups were comparable with respect to demographic variables. Fifteen minutes after the conclusion of the epidural injection, the sensory block ranged from from T4 [median, interquartile range 2.75 segments] to T11 (interquartile range 3.5 segments) in the control group and from T5 (interquartile range 2.25 segments) to L2 (IQR 2.25 segments) in the continuous positive airway pressure group (P = 0.005 for the caudal border). The total number of segments blocked was 7 (median, interquartile range 2.25) in the control group and 11 (interquartile range 3.5) in the continuous positive airway pressure group (P = 0.004). The number of segments blocked caudad to the injection site was 3 (median, interquartile range 3.5) in the control group and 6 (interquartile range 2.25) in the continuous positive airway pressure group (P = 0.005). We conclude that continuous positive airway pressure increases the spread of sensory blockade in thoracic epidural anesthesia, primarily by a more caudad extension of sensory blockade.

 

鼠外用和鞘内应用多虑平的研究
Doxepin by Topical Application and Intrathecal Route in Rats

Peter Gerner, MD*, Venkatesh Srinivasa, MD*, Anthony M. Zizza, BA*, Zhi-Ye Zhuang, PhD*, ShiHua Luo, BS*, David Zurakowski, PhD , Sunil Eappen, MD*, and GingKuo Wang, PhD*

*Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womens Hospital and Harvard Medical School; and  Department of Biostatistics, Department of Orthopaedic Surgery, Childrens Hospital and Harvard Medical School, Boston, Massachusetts

Anesth Analg 2006 102: 283-287.

已有报道称三环抗抑郁剂多虑平在鼠坐股神经阻滞中有潜在的局部麻醉功效。作者假设 与对照药及布比卡因鞘内注射相比外用多虑平有显著的长效抗伤害性刺激作用。5075 100mM的多虑平溶液0.3mL和对照组(仅用溶剂)片状涂于鼠的背部剃毛皮肤。每过2h 将药液清除,用36针的刺激器来测试,对疼痛的撤退抑制和躯干表面的肌肉反射进行 评级。在第二项研究中:10, 20 50 mM的多虑平60 uL分别在鼠的腰部进行鞘内注射 ,并评估运动功能,本体感受以及伤害感受性。75 mM 100 mM浓度的多虑平外用比 对照组有显著疗效(P < 0.05)。尽管应用100mM浓度多虑平5只鼠中有2只出现红斑并形 成疤痕,但是60h后恢复。对于运动和本体感受功能,20mM多虑平鞘内注射与23 mM (0.75%)布比卡因相比无显著差异。然而50 mM多虑平鞘内注射开始出现神经毒性(定义 为持续的神经损伤)
(潘志英 译 陈杰 校)
The tricyclic antidepressant, doxepin, has been reported to be a potent local anesthetic in rat sciatic nerve blockade. We hypothesized that topical doxepin has significantly longer antinociception compared with control and intrathecally compared with bupivacaine. Solutions of 0.3 mL of doxepin at 50, 75, and 100 mM and control (only the vehicle solution) were applied as a patch to the shaved dorsal skin of rats. After a 2-h contact interval, the patch was removed, and the rats were tested by three sets of six pinpricks. Inhibition of withdrawal to pain and cutaneous trunci muscle reflex were graded. In the second investigation, 60 &micro;L of doxepin at 10, 20, and 50 mM was injected through intrathecal catheters implanted in the lumbar region of rats, which were evaluated for motor function, proprioception, and nociception. Topical doxepin at concentrations of 75 mM and 100 mM was significantly more effective than control (P < 0.05). Complete recovery for the 100-mM concentration occurred at 60 h, although two of five rats demonstrated erythema and scarring. Intrathecally, 20 mM of doxepin was not significantly different for motor and proprioceptive function from 23 mM (0.75%) bupivacaine; however, neurotoxicity (defined as persistent neurological deficit) commenced at 50 mM.

通过神经肌肉监测选择插管时间能减少喉部损伤吗?一项随机前瞻性对照试验
Does the Timing of Tracheal Intubation Based on Neuromuscular Monitoring Decrease Laryngeal Injury? A Randomized, Prospective, Controlled Trial

Thomas Mencke, MD*, Matthias Echternach, MD , Peter K. Plinkert, MD , Ulrich Johann, MD , Nazan Afan, MD , Hauke Rensing, MD , Gabriele Noeldge-Schomburg, MD*, Heike Knoll, MD , and Reinhard Larsen, MD 

*Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany;  Department of Otorhinolaryngology,  Department of Anaesthesia and Intensive Care Medicine, University of the Saarland, Homburg/Saar, Germany

Anesth Analg 2006 102: 306-312.

声带损伤和术后声嘶是全身麻醉后常见的并发症。插管时肌松不完全可能会导致声带损 伤。使用神经肌肉阻滞药物后神经肌肉抑制程度个体间差异很大。因此,通过神经肌肉 监测选择理想的个体化的插管时间或许可减少声带损伤。在这项前瞻性的研究中60名患 者被随机分成两组:监测组:给予阿曲库铵(0.5mg/kg)后通过神经肌肉监测使肌肉阻 滞达最完全时插管;2-分钟组:静脉注射阿曲库铵(0.5mg/kg2分钟后插管。利用 Copenhagen评分来评估插管条件。术前、术后24小时、术后72小时通过动态镜检查声带 损伤程度。术后244872小时通过一访谈标准来评估声嘶情况。监测组极好插管的人 数明显高于2-分钟组,分别为8名和2名(P=0.036)。发生声嘶的人数监测组和2-分 钟组分别为7名和8名(P=0.860),而声带损伤分别为9名和5名(P=0.268);声带损伤 的类型:声带肥厚患者监测组和2-分钟组分别为8名和5名(P=0.423);声带血肿各2 个(无差异)。本研究显示神经肌肉监测可改善插管条件。但即使神经肌肉阻滞达最完 全时插管也不能降低声带的损伤。
(朱辉 译 陈杰 校)
Vocal cord injuries (VCI) and postoperative hoarseness (PH) are common complications after general anesthesia. Poor muscle relaxation at the moment of tracheal intubation may result in VCI. There is a large interindividual variation in neuromuscular depression after administration of neuromuscular blocking drugs. Therefore, the optimal individual timing of tracheal intubation based on neuromuscular monitoring (monitoring) may decrease VCI. In this prospective trial, 60 patients were randomized into 2 groups: Monitoring group: tracheal intubation at maximum block based on monitoring after atracurium 0.5 mg/kg and 2-min group: tracheal intubation 2 min after injection of atracurium 0.5 mg/kg. Intubating conditions were evaluated with the Copenhagen score. VCI were examined by stroboscopy before and 24 and 72 h after surgery. PH was assessed at 24, 48, and 72 h after surgery by a standardized interview. Excellent intubating conditions were significantly increased in the monitoring group compared with the 2-min group: 8 versus 2 patients, respectively (P = 0.036). The incidence of PH between the study groups was comparable: 7 (monitoring) versus 8 patients (2-min) (P = 0.860). Similar findings were observed for VCI: 9 versus 5 patients; respectively (P = 0.268); type of VCI: thickening of the vocal cords: 8 (monitoring) versus 5 (2-min) patients (P = 0.423), hematomas: 2 patients in each group (not significant). The present study demonstrated that neuromuscular monitoring improved endotracheal intubating conditions. However, tracheal intubation at maximum intensity of neuromuscular block was not associated with a decrease in vocal cord injuries.

术前压力超声心动图和核素闪烁描记图的荟萃分析比较

A Meta-Analytic Comparison of Preoperative Stress Echocardiography and Nuclear Scintigraphy Imaging

W. Scott Beattie, Esam Abdelnaem, Duminda N. Wijeysundera, and D. Norman Buckley

Department of Anesthesia and Pain Management University Health Network (Toronto General Hospital), University of Toronto, Toronto, Ontario.
Anesth Analg 2006 102: 8-16.

 

在本荟萃分析中,我们比较有心肌梗塞(MI)风险的病人行非心脏手术前的铊成像检查(TI)和压力超声心动图检查(SE)。两项对已出版文章的研究用来确定相关的文章。我们包括了所有陈述阳性实验标准的研究并详述了术后心肌梗死和医院内死亡的发生率。数据由两位作者摘得并记录了术前病人的特征,研究设计,盲法和研究结果。我们定义阳性实验为有可逆缺点的实验,可能的话定量每项研究中的缺点。心肌梗塞和/或死亡是唯一有意义的术后结果。我们计算每项研究的敏感性,特异性和可能率(LR),可能的话还有患者心脏事件的手术特征曲线(ROC)。LR和ROC通过使用随机效应模型的荟萃分析结合起来。不同之处通过I2实验评估。分析包括了68项研究,10049名病人。其中有25个SE研究和50个TI研究。有七个研究直接比较了这两种方法学。研究的质量各不相同;心肌梗塞的常规筛选在SE研究中较常使用(47.8% 比21.2%,P=0.008)而筛选导致的治疗在TI(72.1%)检查后比SE(46.3%)多(P=0.027)。SE的LR比TI更能预测术后心脏事件的发生(LR, 4.09; 95% CI, 3.21-6.56比 1.83; 1.59-2.10; P = 0.001)。这个差别是由于SE比较少的假阴性。在定性研究中的累积ROC并没有差别(SE, 0.80; 95% CI, 0.76-.84 versus TI, 0.75; 95% CI, 0.70-081)。此外,阴性SE的LR较少(0.23; 95% CI, 0.17-0.32 versus 0.44; 95% CI, 0.36-0.54)。在14%的病例中可见中-大的缺点,包括预测术后心脏事件的方法(LR, 8.35; 95% CI, 5.6-12.45)。本荟萃分析有统计能力证明SE在阴性预计方面比TI强。SE和TI在预计术后心肌梗塞和死亡的能力都有中-大的普遍缺点。我们的结论是:SE在预计术后心脏事件方面优于TI。

(周荻 译 薛张纲 校)

In this meta-analysis we compared thallium imaging (TI) and stress echocardiography (SE) in patients at risk for myocardial infarction (MI) scheduled for elective noncardiac surgery. Two searches of published articles were used to identify relevant articles. We included all studies that stated the criteria for a positive test and detailed the frequency of postoperative MI and in-hospital death. Data were abstracted by two authors and captured preoperative patient characteristics, study design, blinding, and outcome adjudication. We defined a positive test as a test with a reversible defect and, where possible, quantified the size of the defects in each study. MI and/or death were the only postoperative outcomes of interest. We calculated the sensitivity, specificity, and likelihood ratio (LR) and, where possible, the Receiver Operating Characteristic (ROC) curve of a cardiac event in each study. The LR and ROC were combined by meta-analyses using the random effects model. Heterogeneity was assessed using the I2 test. The search revealed 68 studies of 10,049 patients. There were 25 SE studies and 50 TI studies. There were 7 studies with a direct comparison of the two methodologies. The quality of studies differed; routine screening for MI was used more frequently in SE studies (47.8% versus 21.2%; P = 0.008) and screening dictated treatment more often after TI (72.1%) than after SE (46.3%) (P = 0.027). The LR for SE was more indicative of a postoperative cardiac event than TI (LR, 4.09; 95% CI, 3.21-6.56 versus 1.83; 1.59-2.10; P = 0.001). This difference was attributable to fewer false-negative SEs. There was no difference in the cumulative ROC curves from qualitative studies (SE, 0.80; 95% CI, 0.76-.84 versus TI, 0.75; 95% CI, 0.70-081). Again, the LR for a negative SE was less (0.23; 95% CI, 0.17-0.32 versus 0.44; 95% CI, 0.36-0.54). A moderate-to-large defect, seen in 14% of patients, by either method predicts a postoperative cardiac event (LR, 8.35; 95% CI, 5.6-12.45). This meta-analysis possesses the statistical power to demonstrate that SE has better negative predicative characteristics than TI. A moderate-to-large perfusion defect by either SE or TI predicts postoperative MI and death. We conclude the SE is superior to TI in predicting postoperative cardiac events.

人心衰机械支持过程中心肌病病因学和SERCA2a逆向重构
Cardiomyopathic Etiology and SERCA2a Reverse Remodeling During Mechanical Support of the Failing Human Heart

Paul M. Heerdt, Stefan Klotz, and Daniel Burkhoff

Department of Anesthesiology, Weill Medical College of Cornell University and Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Anesth Analg 2006 102: 32-37.

 

许多心脏在终末期,慢性衰竭(CHF)时当用左心室辅助装置(LVAD)支持时仍保持着逆转调控心肌细胞钙通路基因的异常表达的能力。在本项研究中,我们确定了是否LVAD上调了基因编码关键钙通道蛋白,肌浆网钙三磷酸腺苷亚型2a(SERCA2a)是受潜在疾病的自然影响如广泛意义上的缺血(ICM)或先天性扩张性心肌病(DCM)。由用Northern印记法对84例心脏病例(50 例CHF[23 DCM和27 ICM]和34例CHF+LVAD[18 DCM和16ICM]的SERCA2a的信使(m)RNA分析获得数据来特征化基因表达。此外,用力-频率关系(FFR)的测量,体内SERCA2a功能的反射,由75例心脏(51 CHF [29 DCM 和 22 ICM] 和 24 CHF+LVAD [10 DCM 和 14 ICM])分离的心肌小梁中获得。SERCA2a mRNA证明了LVAD之后的上调并不受ICM或DCM的影响。然而,只有在DCM心脏中有部分小梁在LVAD后显示出正常的FFR增加。因此,尽管LVAD支持后的SERCA2a基因表达上调是独立于肌原因的,但心肌FFR的正常化,SERCA2a功能指数则不是的。这些数据提供了心脏逆向分子重构过程中的新视角,并强调了疾病过程对转录后事件影响的可能区别。

(周荻 译 薛张纲 校)

Many hearts in end-stage, chronic failure (CHF) retain the capacity to reverse abnormal expression of genes regulating myocyte calcium cycling when supported with a left ventricular assist device (LVAD). In the present study, we determined whether LVAD-induced upregulation of the gene encoding for the key calcium cycling protein sarcoplasmic endoreticular calcium adenosine triphosphatase subtype 2a (SERCA2a) is influenced by the nature of underlying disease broadly characterized as ischemic (ICM) or idiopathic dilated (DCM) cardiomyopathy. Data from Northern blot analysis of SERCA2a messenger (m)RNA within 84 heart samples (50 CHF [23 DCM and 27 ICM] and 34 CHF+LVAD [18 DCM and 16 ICM]) were used for characterizing gene expression. In addition, measurements of the force-frequency relationship (FFR), a reflection of in vivo SERCA2a function, were obtained in myocardial trabeculae isolated from 75 hearts (51 CHF [29 DCM and 22 ICM] and 24 CHF+LVAD [10 DCM and 14 ICM]). SERCA2a mRNA demonstrated upregulation after LVAD that was not influenced by ICM or DCM. However, only in DCM hearts was the proportion of trabeculae exhibiting a normal FFR increased after LVAD. Thus, although upregulated SERCA2a gene expression after LVAD support is independent of myopathic origin, normalization of myocardial FFR, an index of SERCA2a function, is not. These data provide new insight into the process of cardiac "reverse molecular remodeling," and underscore potential differences in the impact of disease processes on posttranscriptional events.

 

 

异氟烷在新生鼠的生理学效应

The physiologic effects of isoflurane anesthesia in neonatal mice.
Loepke AW, McCann JC, Kurth CD, McAuliffe JJ.
Department of Anesthesia, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.

Anesth Analg 2006 102: 75-80.


新生的啮齿类在迁延照射后,异氟烷对于局部缺氧缺血和沉淀物造成的神经退行性病变有神经保护作用。神经保护或神经毒性作用是因为异氟烷直接作用于脑的结果还是因为脑部血流或代谢改变而导致的间接效应现在还不清楚。我们记录了出生10天小鼠用异氟烷麻醉保留自主呼吸或机械通气60分钟的动脉血压,心率,血气和血糖;同时也记录了60分钟用异氟烷麻醉且伴有缺氧缺血症状和不用麻醉时的情况。在用异氟烷麻醉时低血糖和代谢性酸中毒在自主呼吸或机械通气都会发生。在有缺氧缺血症状且用异氟烷麻醉,保留自主呼吸的小鼠是致死的,但是用机械通气的小鼠可以存活,两者的动脉血压和心率与未上麻醉的小鼠相似。出生10天小鼠异氟烷的MAC值是2.3%。总的来说,新生鼠用异氟烷麻醉时由于沉淀而造成的低血糖可能是神经变性的原因。实验中异氟烷是用0.8MAC,当有缺氧缺血时给予机械通气和补充葡萄糖。

(韩晓丹译 薛张纲校)
In neonatal rodents, isoflurane has been shown to confer neurological protection during hypoxia-ischemia and to precipitate neurodegeneration after prolonged exposure.
Whether neuroprotection or neurotoxicity result from a direct effect of isoflurane on the brain or an indirect effect through hemodynamic or metabolic changes remains unknown. We recorded arterial blood pressure, heart rate, blood gases, and glucose in 10-day-old mice during 60 min of isoflurane anesthesia with spontaneous or mechanical ventilation, as well as during 60 min of hypoxia-ischemia with isoflurane anesthesia or without anesthesia. During isoflurane anesthesia, hypoglycemia and metabolic acidosis occurred with spontaneous and mechanical ventilation. During hypoxia-ischemia, isoflurane was fatal with spontaneous breathing but survivable with mechanical ventilation, with arterial blood pressure and heart rate being similar to that observed in unanesthetized animals. Minimum alveolar concentration (MAC) was 2.3% in 10-day-old mice. In summary, isoflurane anesthesia precipitated hypoglycemia, which may have contributed to the neurodegeneration observed in neonatal rodents. Use of 0.8 MAC isoflurane for evaluation of neuroprotection during hypoxia-ischemia requires mechanical ventilation and glucose supplementation in this model.

一种新的分子在外周用阿片类药物时的特性:在稳态下与吗啡和安慰剂比较对于心肌肥大和低氧通气的效应

A novel molecule with peripheral opioid properties: the effects on hypercarbic and hypoxic ventilation at steady-state compared with morphine and placebo.

Åsa Österlund Modalen, MD, PhD*, Hans Quiding, PhD{dagger}, Joana Frey, MD*, Lars Westman, MD, PhD*, and Sten Lindahl, MD, PhD*

*Department of Anesthesiology and Intensive Care, Danderyds Hospital and Karolinska Institute, Stockholm; and {dagger}Experimental Medicine, AstraZeneca R&D, Södertälje, Sweden

Anesth Analg 2006 102: 104-109.


氟雷法胺
(FF)是一种新型的外周阿片类受体激动剂。此次双盲、随机、双安慰剂、四种方法的交叉试验是为了证实FF输注了六小时后对于心肌肥大和低氧通气的效应。对照组是两个剂量的吗啡(最大值和最小值)和安慰剂在12个健康男性中的效应。FF的剂量是1.22 mg/kg,吗啡的最大值剂量是0.44 mg/kg,最小值剂量是0.11 mg/kg。安慰剂氯化钠的剂量是9 mg/mL。通气用呼吸速度描计和流线二氧化碳图来描述。FF和安慰剂对于通气没有作用。和预期估计的一样,最大剂量的吗啡对于心肌肥大和低氧通气都有影响。我们认为输注六小时的FF没有中枢呼吸的抑制作用。然而,吗啡对于心肌肥大和低氧通气时的中枢抑制作用是剂量依赖性的。

(韩晓丹译 薛张纲校)
Frakefamide (FF), is a new peripherally acting mu-opioid receptor agonist. The aim of this double-blind, randomized, double-dummy, four-way, crossover study was to investigate FF effects on hypercarbic and hypoxic ventilation at steady-state after a 6-h infusion.
We compared the effect with 2 clinical doses of morphine (M-small and M-large) and placebo in 12 healthy men. The subjects received 1.22 mg/kg of FF, 0.44 mg/kg of M-large, and 0.11 mg/kg of M-small. Sodium chloride 9 mg/mL was used as placebo. Ventilation was studied by pneumotachography and in-line capnography. There were no ventilatory effects caused by FF or placebo. As expected, large doses of morphine influenced both hypercarbic and hypoxic ventilatory responses. We conclude that there were no signs of central respiratory depression caused by FF after 6 h of constant infusion, which supports a peripheral action of the compound. However, morphine caused a dose-dependent central depression during the hypercarbic ventilatory response and a mild depression of hypoxic ventilatory response.

 

去甲肾上腺素和异氟醚在成年大鼠脊髓胶质神经元抑制性突触转移中的作用

Actions of norepinephrine and isoflurane on inhibitory synaptic transmission in adult rat spinal cord substantia gelatinosa neurons.
Georgiev SK, Wakai A, Kohno T, Yamakura T, Baba H.
Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.

Anesth Analg. 2006 Jan;102(1):124-8.

挥发性吸入麻醉药和笑气(N2O)常常被同时用于临床麻醉。因为笑气的麻醉作用至少部分被脊髓释放的去甲肾上腺素(NE)所中和了。我们通过中枢对疼痛的反应来检测异氟醚和NE在成年大鼠脊髓的相互作用。我们使用全细胞膜片钳技术来检测临床浓度的异氟醚(1 MAC)和NE (20 microM)对胶质神经元自发的抑制性转移的作用。ISO延长自发的抑制性突触后电流的衰减,增加它的总电荷转移。NE增加它的频率和平均电流,也增加它的总电荷转移。两者同时使用起到一个相加的作用。我们最终觉得ISO和NE都增强大鼠胶质神经元抑制性的突出转移,它们的相互作用是相加的,这表现在在脊髓背段水平,ISO可以增强笑气的麻醉作用。

(陆文清译 薛张纲校)

Volatile inhaled anesthetics and nitrous oxide (N2O) are often used together in clinical practice to produce analgesia. Because the analgesic effect of N2O is, at least in part, mediated by norepinephrine (NE) release in the spinal cord, we examined the interaction between isoflurane (ISO) and NE in the adult rat spinal cord with respect to central nociceptive information processing. The effects of clinically relevant concentrations of ISO (1 MAC) and NE (20 microM) on spontaneous inhibitory transmission in substantia gelatinosa (SG) neurons were examined using the blind whole-cell patch-clamp method. ISO prolonged the decay time and increased the total charge transfer of spontaneous inhibitory postsynaptic currents. NE increased the frequency and mean amplitude of inhibitory postsynaptic currents and the charge transfer as well. Coapplication of both drugs led to an additive increase of the charge transfer and frequent temporal summation of inhibitory postsynaptic currents. We conclude that both ISO and NE enhance the inhibitory synaptic transmission in the rat SG neurons and their interaction is additive, suggesting that ISO may add to the analgesic action of N2O at the spinal cord dorsal horn level.

 

局麻药氨苯丁酯对低电压诱发的T型电流在小的感觉神经元的作用

The local anesthetic butamben inhibits and accelerates low-voltage activated T-type currents in small sensory neurons.
Beekwilder JP, van Kempen GT, van den Berg RJ, Ypey DL.
Department of Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.
Anesth Analg. 2006 Jan;102(1):141-5.

 

氨苯丁酯(BAB)是一种局麻药,可以用于长时间硬膜外选择性地阻滞背根疼痛传导,也用于外用药膏治疗皮肤疼痛。之前已有报道,氨苯丁酯对高电压诱发的N型钙通道有抑制作用。现今研究发现,氨苯丁酯对低电压诱发的或是T型钙通道同样有作用。 T型钡通道,是一种选择性的被低电压(-40毫伏)所诱发的来自于新生小鼠的背根神经节,可以被大约200毫摩的氨苯丁酯所抑制。与之前的N型钙通道相比,200毫摩的氨苯丁酯可以加速T型钡通道的激活,减活和失活。尽管200毫摩的氨苯丁酯在失活曲线上引起大约3毫伏的超极化,但它不影响倾斜因素,所以它对于失活曲线的中点电位和倾斜因素没有作用。我们得出以下结论:氨苯丁酯通过运动加速通道机制来抑制T型钙通道。

(王慧琳译 薛张纲校)

Butamben (BAB) is a local anesthetic that can be used in epidural suspensions for long-term selective suppression of dorsal root pain signal transmission and in ointments for the treatment of skin pain. Previously, high-voltage activated N-type calcium channel inhibition has been implicated in the analgesic effect of BAB. In the present study we show that low-voltage activated or T-type calcium channels may also contribute to this effect. Typical transient T-type barium currents, selectively evoked by low-voltage (-40 mV) clamp stimulation of small (approximately 20 microm diameter) dorsal root ganglion neurons from newborn mice, were inhibited by BAB with an IC50 value of approximately 200 microM. Furthermore, 200 microM BAB accelerated T-type current activation, deactivation, and inactivation kinetics, comparable to earlier observations for N-type calcium channels. Finally, 200 microM BAB had no effect on the midpoint potential and slope factor of the activation curve, although it caused a approximately 3 mV hyperpolarizing shift of the inactivation curve, without affecting the slope factor. We conclude that BAB inhibits T-type calcium channels with a mechanism associated with channel kinetics acceleration.

 

利多卡因不能预防气管内插管时的双频指数上升反应

Lidocaine does not prevent bispectral index increases in response to endotracheal intubation.
Kim WY, Lee YS, Ok SJ, Chang MS, Kim JH, Park YC, Lim HJ.
Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea.

Anesth Analg. 2006 Jan;102(1):156-9

 

我们研究了在全麻诱导和气管内插管时静脉注射利多卡因对于血流动力学和双频指数(BIS)的作用。40个ASAI级的病人随机分为两组(每组20人),在诱导后30秒分别给予普通盐水和利多卡因1.5毫克每公斤体重。90秒后行气管内插管。测量诱导时,诱导后一分钟,插管前,插管后5分钟的每一分钟的收缩压,心率和BIS。BIS在诱导后一分钟和插管前有差别,利多卡因组比对照组要低得多(P<0.05)。在对照组里插管后一分钟和两分钟的收缩压要比诱导前的收缩压高很多,但在利多卡因组里没有明显增高。插管后一至三分钟内的心率在两组都有增加(P<0.05),但两组之间没有显著差别。对照组中有一位病人脱落。我们因此总结出:静脉注射利多卡因(1.5毫克每公斤体重)不能抑制气管内插管时的催眠反应。

(王慧琳译 薛张纲校)

We investigated the effect of IV lidocaine on the hemodynamic and bispectral index responses to induction of general anesthesia and endotracheal intubation. Forty patients (ASA I) were randomly allocated into 2 groups of 20 to receive normal saline or lidocaine 1.5 mg/kg IV 30 s after induction. Ninety seconds later, endotracheal intubation was performed. Systolic blood pressure, heart rate, and bispectral index were measured at baseline, 1 min after induction, at preintubation, and every minute until 5 min after endotracheal intubation. Bispectral index at 1 min after induction and preintubation in the lidocaine group were significantly lower compared with the control group (P < 0.05). Systolic blood pressure increased significantly at 1 and 2 min after intubation in the control group compared with the baseline value (P < 0.05) but did not increase significantly in the lidocaine group. Heart rate increased at 1 to 3 min in both groups (P < 0.05), but there was no significant difference between the two groups. One patient in the control group had recall of the procedure. We conclude that the administration of IV lidocaine (1.5 mg/kg) does not suppress the hypnotic response to endotracheal intubation.

 

一种可听呼气指示器在皮囊阀门面罩通气时增加病人模拟器的输出潮气量

An audible indication of exhalation increases delivered tidal volume during bag valve mask ventilation of a patient simulator

Lampotang S, Lizdas DE, Gravenstein N, Robicsek S.
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA. slampotang@anest.ufl.edu

Anesth Analg. 2006 Jan;102(1):168-71

 

由于皮囊不同于Mapleson型设备,自动膨胀式手控人工呼吸机(SIMRs)即使在病人没有呼气时也会再膨胀,因而会误导看护人员。我们在SIMR的呼气端口加了一个蜂鸣器作为一个可听指示器。各参与者按随机顺序用SIMR经面罩通气向一个记录肺容量变化的改良病人模拟器提供两组呼吸,一组有可听反馈,另一组没有。每组的最后三次呼吸用来比较两种情况下的平均潮气量(Vt)。征募了87位二期心脏生命支持的受训者(54位男性,33位女性),平均有6.4 +/- 9.4 年的临床经验。采用标准SIMR的平均输出潮气量为486 +/- 166 mL,而采用改良SIMR为624 +/- 96 mL。在标准SIMR后采用改良SIMR,平均输出潮气量显著增加40%,而先采用改良SIMR则增加19%。采用装有可听呼气指示器的SIMR显著(P < 0.001)增加了病人模拟器的面罩通气量,表明用SIMR的病人,其面罩通气也能受客观、实时的呼出潮气量的反馈而增加。

(徐丽颖译 薛张纲校)

Self-inflating manual resuscitators (SIMRs) can mislead caregivers because the bag, unlike a Mapleson-type device, reinflates even without patient exhalation. We added a whistle as an audible indicator to the exhalation port of a SIMR. In randomized order, each participant provided two sets of breaths via mask ventilation with a SIMR, one with and one without audible feedback, to a Human Patient Simulator modified to log lung volume changes. The last three breaths in each set were used to compare average tidal volume (Vt) under both conditions. Eighty-seven advanced cardiac life support trainees (54 males, 33 females) with clinical experience averaging 6.4 +/- 9.4 yr were recruited. Average Vt delivered with the standard SIMR was 486 +/- 166 mL and 624 +/- 96 mL with the modified SIMR. Average Vt delivered by a modified SIMR was significantly larger by 40% when it followed standard SIMR use and 19% when using the modified SIMR first. Use of a SIMR with an audible indicator of exhalation significantly (P < 0.001) increased mask ventilation of a patient simulator, suggesting that mask ventilation of a patient with a SIMR may also be increased by objective, real-time feedback of exhaled Vt.

 

芬太尼电离子渗入疗法递药系统在术后镇痛的作用:随机、双盲、安慰剂对照试验

An iontophoretic fentanyl patient-activated analgesic delivery system for postoperative pain: a double-blind, placebo-controlled trial

Viscusi ER, Reynolds L, Tait S, Melson T, Atkinson LE.
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Anesth Analg. 2006 Jan;102(1):188-94

 

芬太尼氯化氢电离子渗入 疗法经皮激活病人系统(PATS)是建立在术后急性疼痛治疗手段发展的基础之上的。芬太尼氯化氢PATS是一种不用注射、由标卡测定的、预先有计划的一套系统。它被应用于病人的上外侧臂或胸壁。芬太尼氯化氢PATS在先前的试验中被证实优于安慰剂。然而过去的试验由于计划随意,缺乏对于疼痛入选标准的控制从而得不到坚实有力的结论。本次芬太尼氯化氢PATS与安慰剂在术后急性疼痛治疗中作用的比较与过去的试验相比有了各种明确的限制。成年病人在大外科手术后入苏醒室后24小时内以1:1比例随机使用芬太尼氯化氢PATS40微克或安慰剂后滴定阿片类药物直至感觉舒适。在入组后前3小时静脉中追加的芬太尼在两组病人中都是有效的。终点被定义为病人由于得不到充分的镇痛而放弃。疼痛程度评分则是由病人整体评价PGA 和研究者整体评价IGA来收集。共有484名病人,244位PGA和240位IGA入组。与安慰剂组相比芬太尼氯化氢PATS组由于得到了充分的镇痛而放弃的病人数较少。芬太尼氯化氢PATS组与安慰剂组的疼痛程度的平均分分别是3.5和5.4。73.4%的病人和72.1% 的研究者认为芬太尼氯化氢PATS是一种良好而有效的控制疼痛的方法。与试验相关的不良事件发生率两组也是相同的。本研究证明了芬太尼氯化氢PATS在术后急性疼痛治疗中由于安慰剂。

(孙卓真 译 薛张纲 校)

An iontophoretic fentanyl HCl patient-activated transdermal system (fentanyl HCl PATS) is under development for the treatment of acute postoperative pain. The fentanyl HCl PATS is a needle-free, credit card-sized, preprogrammed system that is applied to the patient's upper outer arm or chest. The fentanyl HCl PATS was demonstrated to be superior to placebo in a previous trial; however, the randomization scheme used and the lack of control of entry pain level may have contributed to the lack of robust findings. We compared the fentanyl HCl PATS with placebo for acute postoperative pain management in a larger trial that addressed the limitations of the previous study. Adult patients admitted to the postanesthesia care unit after major surgery were titrated to comfort with opioids and randomized 1:1 to receive the fentanyl HCl PATS 40 microg or placebo for 24 hours. Supplemental IV fentanyl was available to patients upon request in both treatment groups for the first 3 hours after enrollment. The primary efficacy end-point was the percentage of patients who discontinued participation in the study because of inadequate analgesia. Pain intensity scores, patient global assessments (PGA), and investigator global assessments (IGA) were collected. Four-hundred-eighty-four patients (PATS, n = 244; placebo, n = 240) were enrolled. Fewer patients receiving the fentanyl HCl PATS discontinued because of inadequate analgesia compared with placebo (28.7% versus 60.0%; P < 0.0001). Mean last pain intensity scores were 3.5 and 5.4 for the fentanyl HCl PATS and placebo groups, respectively. Patients (73.4%, PGA) and investigators (72.1%, IGA) considered the fentanyl HCl PATS a good or excellent method of pain control. Treatment-related adverse events were similar between groups. This study demonstrated the superiority of the iontophoretic fentanyl HCl PATS over placebo for acute postoperative pain management.

 

行冠脉造影包括经皮冠脉介入治疗病人心肺复苏的结果和生存期望值

Outcomes of cardiopulmonary resuscitation and predictors of survival in patients undergoing coronary angiography including percutaneous coronary interventions.
Sprung J, Ritter MJ, Rihal CS, Warner ME, Wilson GA, Williams BA, Stevens SR, Schroeder DR, Bourke DL, Warner DO.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Anesth Analg 2006;102:217-224

 

我们研究乐行冠脉造影病人或行PCI病人的心肺复苏的结果。在1990年1月1号到2000年12月31号间51985个行CA和PCI的病人需要CPR。我们对病人的个体差异,不同程序,和短期存活率进行乐研究。长期存活率是通过比较一群在导管介入时出现停搏的病人和名尼苏达州的人群。在11年间,CPR的发生率是10000人中21.9个。这个比率从1995年前的33.9/10000下降到1995年后13.1/10000。CPR后的出院后总生存率是56.1%。存活下的人很少有充血性心衰、冠脉搭桥术及血流动力学不稳定史,有延期的或紧急的导管介入。无脉电活动(心室纤维颤动)预示着低生存率。有趣的是,短期生存和冠脉疾病的程度无关。导管介入中出现停搏的病人和未出现停搏的病人的长期生存率是一样的。结论是:在诊断和介入治疗冠脉疾病时CPR的发生率在1995年后降低了。在导管介入时接受CPR的病人出院后有很高的生存率。这些病人的远期生存期的减少并不明显。

(钟静 译 薛张纲 校)
We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI).
Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary artery bypass graft surgery, hemodynamic instability during the procedure, and with prolonged or emergent catheterizations. Pulseless electrical activity (versus asystole or ventricular fibrillation) indicated very poor short-term survival. Interestingly, short-term survival was not related to the extent of coronary artery disease. Long-term survival of patients who survived cardiac arrest was comparable to that of those who did not have arrest during catheterization. In conclusion, the incidence of periprocedural CPR during diagnostic or interventional coronary procedures decreased after 1995. Patients who received CPR in the cardiac catheterization lab have a remarkably frequent survival to hospital discharge rate. Long-term survival of these patients is only minimally reduced.

剖宫产腰硬联合麻醉时采用坐位和右侧卧位阻滞特点及低血压严重程度的比较

The Sitting Versus Right Lateral Position During Combined Spinal-Epidural Anesthesia for Cesarean Delivery: Block Characteristics and Severity of Hypotension

Hilde C. Coppejans, MD, Ellen Hendrickx, MD, Joris Goossens, MD, and Marcel P. Vercauteren, MD, PhD

Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium

Anesth Analg 2006;102:243-247


在过去的研究中,我们评价了施行小剂量腰硬联合麻醉(CSE)时,坐位是否比侧卧位更少地引起低血压。60名择期行剖宫产的妇女随机分成侧卧位组和坐位组,均以重比重布比卡因和舒芬太尼3.3 g进行腰麻。当硬膜外导管放好后,病人放成左侧15仰卧位。麻黄素5 mg IV用于防治恶心/呕吐和(或)低血压(收缩压小于95 mm Hg或低于基础值的25%)。尽管麻黄素的追加剂量没有差别,坐位组的妇女需要的麻黄素较少(P = 0.012),且更容易识别硬膜外腔(P = 0.01)。然而,该组中更多的病人需要追加硬膜外剂量(35% vs 3%; P = 0.007)。侧卧位组,平面更易向头侧扩散(P = 0.014)。Apgar评分并无差别,但坐位组的脐动脉血pH值较侧卧位组显著增高(7.31 0.04 vs 7.26 0.03; P = 0.02)。我们推断:剖宫产病人行CSE麻醉时,采用坐位,技术上更简单,且引起低血压的程度更轻。

(王丽珺 译 薛张纲 校)

In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 g in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15 left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 0.04 versus 7.26 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension.

 

利多卡因内添加地塞米松可延长腋路臂丛神经阻滞时间

Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade

Ali Movafegh, MD*, Mehran Razazian, MD*, Fatemeh Hajimaohamadi, MD*, and Alipasha Meysamie, MD

*Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital; and Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran

Anesth Analg 2006 102: 263-267.

 

局部神经阻滞时局麻药中常添加不同药物用来延长阻滞时间。本研究采用前瞻随机双盲研究方法来评价在利多卡因中添加地塞米松用于腋路臂丛神经阻滞的诱导和维持时延长作用时间的效果。六十个手或前臂手术采用臂丛神经阻滞的病人随机分为两组,一组采用34mL 1.5%的利多卡因添加2mL生理盐水(对照组,n = 30),另一组采用34mL 1.5%的利多卡因添加2mL地塞米松(8 mg)(地塞米松组,n = 30)。两组中都不添加肾上腺素和碳酸氢盐。在所有病人身上采用神经刺激器和多种刺激方法。在实施神经阻滞后,5、15、30分钟时记录桡神经、正中神经、肌皮神经和尺神经的运动和感觉阻滞效果。感觉和运动阻滞的起效时间定义为从最后一个剂量注入到针刺反应完全消除和完全麻痹之间的时间。感觉和运动阻滞的维持时间定义为实施局部麻醉到第一次术后疼痛和运动功能完全恢复之间的时间。十六个病人因为不成功的神经阻滞被排除在实验之外。手术时间和感觉和运动阻滞的起效时间两组间相似。地塞米松组较之对照组在感觉阻滞时间(242 ± 76 对 98 ± 33 分钟)和运动阻滞时间(310 ± 81 对 130 ± 31 分钟)都明显延长(P < 0.01)。我们的结论是1.5%利多卡因添加地塞米松用于腋路臂丛神经阻滞时可延长感觉和运动阻滞时间。

(金路 译 薛张纲 校)

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 ± 76 versus 98 ± 33 min) and motor (310 ± 81 versus 130 ± 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

 

年龄对硬膜外使用罗哌卡因全身吸收和分布的影响

The Effect of Age on the Systemic Absorption and Systemic Disposition of Ropivacaine after Epidural Administration

Mischa J. G. Simon, MD, Bernadette T. Veering, MD, PhD, Arie A. Vletter, BSc, Rudolf Stienstra, MD, PhD, Jack W. van Kleef, MD, PhD, and Anton G. L. Burm, MSc, PhD

Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.

Anesth Analg 2006 102: 276-282.

 

硬膜外使用罗哌卡因后全身吸收和分布的问题是很重要的,因为这与其临床使用及全身毒性危险性相关。我们使用稳定同位素法观察了年龄对硬膜外使用1.0%罗哌卡因药代动力学的影响。估计年龄将24位患者分为3组(组1:18-40岁;组2:41-60岁;组3:≥61岁)。每位患者硬膜外注入150mg盐酸罗哌卡因。25min后,再静脉注射50mL 0.44mg/mL 氘标记的罗哌卡因(D3罗哌卡因)。硬膜外用药后24h以内收集动脉血标本。高龄的患者组与最小年龄患者组相比,罗哌卡因的清除半衰期明显延长(几何均数比为0.60;95%可信区间为0.37-0.99),清除率明显降低(均差为194mL/min;95%可信区间为18-370mL/min)。全身吸收情况为双向分布。罗哌卡因的吸收动力学(在快吸收和慢吸收进程中,吸收分数:(F1,F2)为0.27 ± 0.08 与 0.77 ± 0.12;半衰期:(t,a1, t,a2)为10.7 ± 5.2 min 与 248 ± 64 min)和其他长效局部麻醉药范围相当。最年轻组患者F1的平均值是0.11(95%可信区间为0.002-0.22),较中年组稍高一些。我们还观察到,老年患者硬膜外使用单一剂量的罗哌卡因,年龄相关性药代动力学差异似乎不影响与药物全身毒性危险。

(金琳 译 薛张纲 校)

Knowledge about the systemic absorption and disposition of ropivacaine after epidural administration is important in regard to its clinical profile and the risk of systemic toxicity. We investigated the influence of age on the pharmacokinetics of ropivacaine 1.0% after epidural administration, using a stable-isotope method. Twenty-four patients were enrolled in 1 of 3 groups according to age (group 1: 1840 yr; group 2: 4160 yr; group 3: 61 yr). Patients received 150 mg ropivacaine hydrochloride epidurally. After 25 min, patients received 50 mL 0.44 mg/mL deuterium-labeled ropivacaine (D3-ropivacaine) IV. Arterial blood samples were collected up to 24 h after epidural administration. Total plasma concentrations of ropivacaine and D3-ropivacaine were determined using liquid chromatography mass spectrometry. In the oldest patients, elimination half-life was significantly longer (ratio of the geometric means 0.60; 95% confidence interval, 0.370.99) and clearance was significantly decreased (mean difference, 194 mL/min; 95% confidence interval, 18-370 mL/min) compared with the youngest patients. The systemic absorption was biphasic. Absorption kinetics for ropivacaine (fractions absorbed: (F1, F2) and half-lives: (t,a1, t,a2) during the fast and slow absorption process: 0.27 ± 0.08 and 0.77 ± 0.12, respectively; 10.7 ± 5.2 min and 248 ± 64 min, respectively) were in the same range as for other long-acting local anesthetics. F1 was on average 0.11 (95% confidence interval, 0.002-0.22) higher in the youngest compared with the middle age group. Observed age-dependent pharmacokinetic differences do not likely influence the risk of systemic toxicity in the elderly after a single epidural dose of ropivacaine.

 

腹腔镜减肥术中肺泡扩张术和呼气末正压通气对动脉氧合的影响 
The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery.
Whalen FX, Gajic O, Thompson GB, Kendrick ML, Que FL, Williams BA, Joyner MJ, Hubmayr RD, Warner DO, Sprung J.
Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Anesth Analg. 2006 Jan;102(1):298-305

 

麻醉期间,不正常气体交换的发生多数是由肺萎陷所致,而且这些变化对于病态肥胖患者的影响比正常体重患者更为显著。在正常体重的健康患者,持续肺内充气可以恢复肺内塌陷区域而且改善氧合。我们测试这种通气策略对于进行腹腔镜减肥手术患者的动脉氧合(PaO2)的影响。在气腹建立后,充气组接受4cmH2O持续肺内充气,吸气峰压到50cmH2O,同时用12cmH2O的呼气末正压(PEEP)通气模式。对照组患者的肺给予标准模式PEEP为4cmH2O的通气。在充气组和对照组之间比较气体交换、呼吸动力学,以及血流动力学相关变量。我们发现肺泡充气有效地增加了术中PaO 2和暂时增加了呼吸系统动态顺应性(两者均P< 0.01)。只要气管插管后,肺泡充气对氧合的影响便存在,肺脏给予高PEEP的通气,但气管拔管后不久,所有对氧合有利的影响便消失了。在外科手术期间,与对照组相比较,充气组血管加压治疗使用均数较大(3.0 对 0.8; P = 0.04)。结论是,我们的数据建议在病态肥胖患者使用肺泡充气可以是改善术中氧合的有效模式。我们的结果显示影响效果变得短效而且与术中较频繁使用血管加压药物相关。

(孙敏莉 译 薛张纲 校)

Abnormalities in gas exchange that occur during anesthesia are mostly caused by atelectasis, and these alterations are more pronounced in morbidly obese than in normal weight subjects. Sustained lung insufflation is capable of recruiting the collapsed areas and improving oxygenation in healthy patients of normal weight. We tested the effect of this ventilatory strategy on arterial oxygenation (Pao2) in patients undergoing laparoscopic bariatric surgery. After pneumoperitoneum was accomplished, the recruitment group received up to 4 sustained lung inflations with peak inspiratory pressures up to 50 cm H2O, which was followed by ventilation with 12 cm H2O positive end-expiratory pressure (PEEP). The patient's lungs in the control group were ventilated in a standard fashion with PEEP of 4 cm H2O. Variables related to gas exchange, respiratory mechanics, and hemodynamics were compared between recruitment and control groups. We found that alveolar recruitment effectively increased intraoperative Pao2 and temporarily increased respiratory system dynamic compliance (both P < 0.01). The effects of alveolar recruitment on oxygenation lasted as long as the trachea was intubated, and lungs were ventilated with high PEEP, but soon after tracheal extubation, all the beneficial effects on oxygenation disappeared. The mean number of vasopressor treatments given during surgery was larger in the recruitment group compared with the control group (3.0 versus 0.8; P = 0.04). In conclusion, our data suggest that the use of alveolar recruitment may be an effective mode of improving intraoperative oxygenation in morbidly obese patients. Our results showed the effect to be short lived and associated with more frequent intraoperative use of vasopressors.

 

不同气道设备中有或没有笑气全麻对中耳压力影响的研究

Middle Ear Pressure Changes During Anesthesia With or Without Nitrous Oxide are Similar Among Airway Devices

 

Mathias Hohlrieder, MD*, Christian Keller, MD, MSc*, Joseph Brimacombe, MB, ChB, FRCA, MD, Stephan Eschertzhuber, MD*, Günter Luckner, MD*, Irene Abraham, MD, and Achim von Goedecke, MD*

*Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria; James Cook University, Cairns Base Hospital, Australia; Department of Ear, Nose and Throat Surgery, Leopold-Franzens University, Innsbruck, Austria

Anesth Analg 2006;102:319-321

 

我们研究了通过不同的气道设备在混和气体中带有或不带有笑气(N2O)全麻对中耳气道压力(MEP)的影响。80例行全麻的患者(ASA physical status III, 1865 yr)随机分成口插气管导管组,经典喉罩组,ProSeal 喉罩组,或喉插管吸引组。分别给予带有或不带有66%笑气的混合气体麻醉。从诱导前到诱导后每10分钟至70分钟,由另一位观察者随机顺序测量他们双耳的MEP。N2O组中,40分钟后N2O改为空气。N2O组和空气组中,不同的气道设备组MEP没有变化。MEP在空气组中也没有变化,但在笑气组中MEP增加(P < 0.0001),空气组中MEP降低(P < 0.02)。MEP在不同组基础值相同,但在笑气组一直处于较高水平(P < 0.001)。我们得出结论,气道设备的选择(气管导管,经典喉罩,ProSeal 喉罩或喉插管吸引)在有或没有笑气混合气体麻醉中不影响MEP。

(吴德华 译 薛张纲 校)

We tested the hypothesis that middle ear pressure (MEP) is influenced by the choice of airway device during anesthesia with or without nitrous oxide (N2O) in the gas mixture. Eighty consecutive anesthetized, paralyzed ventilated patients (ASA physical status III, 1865 yr) were randomly allocated for airway management with the orally inserted tracheal tube, classic laryngeal mask airway, ProSeal laryngeal mask airway, or laryngeal tube suction with or without N2O 66% in the gas mixture. MEP was measured from both ears in random order by a blinded observer before induction of anesthesia and every 10 min for 70 min. In the N2O groups, N2O was changed to air after 40 min. There were no differences in MEP among the airway devices in the N2O or air groups. MEP was unchanged in the air groups but increased in the N2O groups with N2O (P < 0.0001) and decreased with air (P < 0.02). Baseline values for MEP were similar, but MEP was always higher for the N2O groups (P < 0.001). We conclude that the choice of airway device does not influence MEP among orally inserted tracheal tube, classic laryngeal mask airway, ProSeal laryngeal mask airway, and laryngeal tube suction during anesthesia with or without N2O in the gas mixture.

 

透析持续时间是透析依赖患者心脏手术术后机械通气时间延长的显著预见指标

Duration of Dialysis Is a Significant Predictor of Prolonged Postoperative Mechanical Ventilation in Dialysis-Dependent Patients Undergoing Cardiac Surgery

Masato Nakasuji, MD, Shinichi Nishi, MD, PhD, Kae Nakasuji, MD, Naoya Hamaoka, MD, PhD, Kazutoshi Ikeshita, MD, and Akira Asada, MD, PhD

Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan

Anesth Analg 2006;102:2-7

 

有报道机械通气时间延长与心脏手术后死亡率增高有相关性。我们设计本研究以确定可能预见体外循环下冠脉搭桥的透析依赖患者术后机械通气延长的术前和术中风险因素。44个透析依赖患者分为2组;E(n = 19)为进入术后ICU24小时内拔除气管导管,L(n = 25)为需要超过24小时的机械通气。所有患者在体外循环期间接受血液过滤和术后持续静脉-静脉血液透析。多元逻辑回归分析显示透析持续时间(>10 yr)和手术持续时间(>24 h)是机械通气延长(>24 h)的独立风险因素。进入ICU时,L组的Pao2/Fio2明显低于E(294 ± 135415 ± 99 mm Hg)L组的循环状态比E组差。E组的ICU逗留时间的中值(四分位极差范围)为33.00)天,明显短于L(5 [2.75] )。这可能是较长的手术时间使有长期透析史的患者心脏功能不全和低氧合的可能性增加。

(彭中美 马皓琳 李士通 校)

Prolonged mechanical ventilation is reported to correlate with increased risk of mortality after cardiac surgery. We designed the present study to determine the preoperative and intraoperative risk factors that could predict postoperative prolonged mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery with cardiopulmonary bypass. Forty-four dialysis-dependent patients were divided into two groups; patients of group E were tracheally extubated within 24 h after admission to the intensive care unit postoperatively (n = 19) and patients of group L (n = 25) required more than 24 h of mechanical ventilation. All patients received hemofiltration during cardiopulmonary bypass and continuous veno-venous hemodialysis postoperatively. A multiple logistic regression analysis showed that duration of dialysis (>10 yr) and duration of surgery (>8 h) were independent risk factors of prolonged mechanical ventilation (>24 h). On admission to the intensive care unit, Pao2/Fio2 of group L was significantly lower than that of group E (294 ± 135 versus 415 ± 99 mm Hg) and the circulatory status of group L was worse than that of group E. The median (interquartile range) duration of intensive care unit stay in group E was 3 (3.00) days, which was significantly shorter than that of group L (5 [2.75] days). It is possible that longer surgery increases the likelihood of cardiac dysfunction and poor oxygenation in patients with a long history of dialysis.

 

 

SymmetryTM主动脉连接装置和急性肾损害:比较三种不同主动脉-冠脉旁路手术技术后的肾功能不全

SymmetryTM Aortic Connector Devices and Acute Renal Injury: A Comparison of Renal Dysfunction After Three Different Aortocoronary Bypass Surgery Techniques

 

Stephanie S. F. Fischer, FCA (SA), Barbara Phillips-Bute, PhD, Madhav Swaminathan, MD, Carmelo Milano, MD, and Mark Stafford-Smith, MD, FRCPC

Cardiothoracic Division, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2006;102:25-31

 

虽然心脏手术后的急性肾损害发生机制是多因素的,但降主动脉的粥样硬化和栓塞是强烈的独立预测因素。使用SymmetryTM 主动脉连接装置 (ACD)吻合冠脉移植物近端可能减轻降主动脉动脉粥样硬化栓塞。所以我们假设使用ACD行非体外循环冠脉搭桥术(OPCAB),与常规的OPCAB 或体外循环冠脉搭桥术比较,术后肾功能不全更少。3300例连续的非急诊主动脉-冠脉搭桥术病人依手术方式回顾性分为三组:A组用ACDOPCAB124例,B组标准OPCAB313例,C组体外循环CABG2863例。术后肌酐与基础值比较的最大变化值用来评判肾脏后果。虽然已知的数个肾脏危险因素和术后肌酐改变峰值之间的关系得到证实,但多因素分析未发现ACD使用可作为术后肌酐改变峰值的独立预测因素(P = 0.71)。我们未发现与标准OPCAB和体外循环CABG相比用ACDOPCAB能减少急性肾损害。

(裘毅敏 李士通校)

Although the pathogenesis of acute renal injury after cardiac surgery is multifactorial, atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the SymmetryTM aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic atheroembolism. Therefore, we tested the hypothesis that off-pump coronary artery bypass (OPCAB) surgery performed using an ACD is associated with less postoperative renal dysfunction compared with conventional OPCAB or on-pump coronary artery bypass graft (CABG) surgery. Three-thousand-three-hundred consecutive patients undergoing non-emergent aortocoronary bypass surgery were retrospectively divided into three groups by surgical procedure; Group A: OPCAB with ACD (n = 124), Group B: standard OPCAB (n = 313), Group C: on-pump CABG (n = 2863). Postoperative peak fractional change in creatinine compared with baseline was used as a measure of renal outcome. Multivariable analysis did not identify ACD use as an independent predictor of postoperative peak fractional change in creatinine (P = 0.71), although the relationships of several known renal risk factors with postoperative peak fractional change in creatinine were confirmed. We could not find evidence that OPCAB surgery using ACDs reduces acute renal injury compared with standard OPCAB or CABG surgery.

 

 

脊麻用于婴儿外科手术的安全性和有效性:佛蒙特州婴儿脊椎麻醉登记处的研究

The Safety and Efficacy of Spinal Anesthesia for Surgery in Infants: The Vermont Infant Spinal Registry

Robert K. Williams, MD*{dagger}, David C. Adams, MD*, Eva V. Aladjem, MD*, Joseph M. Kreutz, MD*, Kennith H. Sartorelli, MD{ddagger}, Dennis W. Vane, MD{ddagger}, and J. Christian Abajian, MD*

Departments of *Anesthesia, {dagger}Pediatrics, and {ddagger}Surgery, University of Vermont, College of Medicine and Vermont Children’s Hospital, Burlington, Vermont

Anesth Analg 2006;102:67-71

 

在数量适中的病人中的研究提示,与婴儿脊麻相关的并发症发生率非常低,如低氧血症、心动过缓及术后呼吸暂停。尽管对于许多外科手术,脊麻似可合理替代全麻,然而这一技术仍未得到充分应用。自1978年以来,关于在佛蒙特州大学进行脊麻的所有婴儿的临床资料均已被前瞻性地记录下来。共有1554例病人被列入研究。由麻醉科住院医师和主治医师施行麻醉。穿刺成功率为97.4%。获得足够脊麻平面的病人占95.4%。脊麻获得效果所需时间平均为10 min。有10例病人观察到氧合血红蛋白饱和度下降到<90%24(1.6%)病人出现心动过缓(心率<100bpm)。本研究证实,婴儿脊麻并发症发生率很低。施行脊麻安全、有效,且预期的成功率较高。当婴儿进行下腹部或下肢手术时,应重点考虑脊麻作为全麻以外的另一选择。

(周志坚 马皓琳 李士通 )

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.

 

 

利用脑电图熵指数建立七氟醚催眠效果的药代动力学-药效学模型

Pharmacokinetic-Pharmacodynamic Modeling the Hypnotic Effect of Sevoflurane Using the Spectral Entropy of the Electroencephalogram

Ian D. H. McKay, MBChB*, Logan J. Voss, PhD{dagger}, James W. Sleigh, MD, MBChB, FANZCA*, John P. Barnard, MBChB, FANZCA*, and Ewa K. Johannsen, MBBCh*

*Department of Anaesthesia, Waikato Hospital, New Zealand; {dagger}Department of Anaesthesiology, University of Auckland, New Zealand

Anesth Analg 2006;102:91-97

 

熵指数是一种从脑电图衍生出来的新参数,可以用于建立全身麻醉药的药代动力学-药效学(PKPD)模型。这项研究中,我们试图推导出七氟醚浓度和脑电图熵之间关系的PKPD模型。我们在加深和减弱七氟醚麻醉过程中收集了20位病人的熵数据。第一轮周期由无任何辅助用药的麻醉诱导和减浅期组成。用效应室和抑制性Emax模型描述了七氟醚浓度和熵之间的关系。PKPD参数从完整的周期以及加深和减弱七氟醚麻醉各阶段中得出。第二轮麻醉周期仅由一个重新加深阶段组成,同时包括气道管理和常规辅助药物的应用。用从第一轮中得到的PKPD数据以预测第二轮的熵变化。七氟醚效应位点浓度与熵之间存在着一致的关系(绝对加权剩余中位数= 11.6%)。对于完整的第一轮周期的效应熵(平均值±标准差):T1/2 Keo = 2.4 ± 1.5 min, γ= 5.9 ± 2.3, EC50 = 1.7 ± 0.3我们发现在周期中的七氟醚浓度上升部分与下降部分的γ值之间存在显著差别(61.1 ± 55.25.7 ± 2.8)。当效应位点浓度大于3%时,EEG熵就不能随着七氟醚浓度的进一步增加而变化了。效应室抑制性Emax模型精确地描述了七氟醚浓度和EEG熵间的关系。在七氟醚浓度上升到3%的过程中,熵逐渐减小。量-效曲线的斜率在麻醉药浓度的上升期和下降期不同。

(黄佳佳 马皓琳 李士通 校)

Spectral entropy is a new electroencephalogram (EEG)-derived parameter that may be used to model the pharmacokinetic-pharmacodynamic (PKPD) effects of general anesthetics. In the present study we sought to derive a PKPD model of the relationship between sevoflurane concentration and spectral entropy of the EEG. We collected spectral entropy data during increasing and decreasing sevoflurane anesthesia from 20 patients. The first cycle consisted of induction and lightening phases with no supplemental medications. An effect-site compartment and inhibitory Emax model described the relation between sevoflurane concentration and spectral entropy. PKPD parameters were derived from the full cycle and separately from the increasing and decreasing stages. The second anesthetic cycle consisted of a redeepening phase only and included airway manipulation and routinely administered adjunctives. PKPD data obtained from the first cycle were used to predict second cycle entropy changes. There was a consistent relationship between effect-site sevoflurane concentration and spectral entropy (median absolute weighted residual = 11.6%). For complete first-cycle response entropy (mean ± sd): T1/2 Keo = 2.4 ± 1.5 min, {gamma}= 5.9 ± 2.3, EC50 = 1.7 ± 0.3. We found significant differences between {gamma}values when the sevoflurane concentration was increasing (61.1 ± 55.2) compared with the decreasing part of the cycle (5.7 ± 2.8). Above an effect-site concentration of 3%, spectral entropy of the EEG is unresponsive to further increases in sevoflurane concentration. The effect-compartment inhibitory Emax model accurately describes the relation between sevoflurane concentration and spectral entropy of the EEG. Spectral entropy decreases with increasing sevoflurane concentrations up to 3%. The steepness of the dose-response curve varies between phases of increasing and decreasing anesthetic concentrations.

 

 

雷米芬太尼在猫肺血管床中的一项分析

An Analysis of Remifentanil in the Pulmonary Vascular Bed of the Cat

Alan D. Kaye, MD, PhD*{dagger}, Amir Baluch, BS{ddagger}, James Phelps, MPT{ddagger}, Syed R. Baber, BS§, Ikhlass N. Ibrahim, DVM*, Jason M. Hoover, BS{ddagger}, Cuihua Zhang, MD, PhD*, and Aaron Fields, MD||

Departments of *Anesthesiology and {dagger}Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana; {ddagger}Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas and El Paso, Texas; §Tulane University, New Orleans, Louisiana; and ||Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut

Anesth Analg 2006;102:118-123

 

在这项研究中,我们试图鉴定雷米芬太尼在猫科动物肺血管床的作用。在对成年杂种猫进行的离体实验中,研究了格列本脲(腺苷三磷酸敏感性K+通道阻滞剂)、苯海拉明(组胺H1受体拮抗剂)、L-N51-胍)盐酸鸟氨酸(一氧化氮合酶抑制剂)和纳洛酮(阿片受体拮抗剂)在肺动脉对雷米芬太尼(阿片激动剂)、吡那地尔(pinacidil,腺苷三磷酸敏感性K+通道激动剂)和缓激肽(一氧化氮合酶诱导剂)的反应中的作用。在分离的猫左下肺叶血管床张力增加的情况下,雷米芬太尼导致剂量依赖性的血管减压反应,在应用格列本脲和L-N51-胍)盐酸鸟氨酸后这种反应无显著变化。应用苯海拉明和纳洛酮后肺血管床对雷米芬太尼的反应明显减弱。本结果提示雷米芬太尼对猫肺血管床具有较强的血管减压作用,这种作用是由组胺和阿片受体敏感通路介导的。

(颜涛 译, 马皓琳 李士通 校)

In this investigation we sought to identify the role of remifentanil in the feline pulmonary vascular bed. Using adult mongrel cats in separate experiments, the effects of glibenclamide (adenosine triphosphate-sensitive K+ channel blocker), diphenhydramine (histamine H1-receptor antagonist), L-N5-(1-Iminoethyl) ornithine hydrochloride (nitric oxide synthase inhibitor), and naloxone (opioid receptor antagonist) were investigated in pulmonary arterial responses to remifentanil (opioid agonist), pinacidil (adenosine triphosphate-sensitive K+ channel activator), and bradykinin (nitric oxide synthase inducer). Under increased tone conditions in the isolated left lower lobe vascular bed of the cat, remifentanil induced a dose-dependent vasodepressor response that was not significantly altered after administration of glibenclamide and L-N5-(1-Iminoethyl) ornithine hydrochloride. Responses to remifentanil were significantly attenuated after administration of diphenhydramine and naloxone. The results suggest that remifentanil has potent vasodepressor activity in the feline pulmonary vascular bed and that these responses are mediated by histamine and opioid receptor sensitive pathways.

 

 

环氧化酶-1抑制能缩短地西泮导致的小鼠翻正反射消失时程

Cyclooxygenase-1 Inhibition Shortens the Duration of Diazepam-Induced Loss of Righting Reflex in Mice

Xuejing Liu, BSc*, Tat Leang Lee, MBBS, MMed, FANZCA{dagger}, and Peter T.-H. Wong, PhD*

Departments of *Pharmacology and {dagger}Anesthesia, Faculty of Medicine, National University of Singapore, 18 Medical Drive, Kent Ridge, Singapore

Anesth Analg 2006;102:135-140

 

选择性的环氧合酶-1COX-1)抑制剂戊酰水杨酸盐或者非选择性抑制剂10 mg/kg(包括阿司匹林、布洛芬、消炎痛和picroxicam)的COX-1抑制作用,使地西泮(20 mg/kg)导致的小鼠翻正反射消失时程缩短29%-46%。另一方面,花生四烯酸(20 mg/kg)使地西泮导致的翻正反射消失的时程延长48%。阿司匹林能够取消花生四烯酸的这种效应。但是,10 mg/kg阿司匹林并不改变5 mg/kg地西泮对自主活动能力和翻转能力的效应。这些发现强烈提示,一种或者更多的环氧合酶产物,最可能是前列腺素,在调节地西泮的催眠作用机制中扮演重要角色。阐释相关机制能有助于增加我们对苯二氮卓类药物的药理学的认识。

(颜涛 译, 马皓琳 李士通 校)

 

Cyclooxygenase-1 (COX-1) inhibition by a selective inhibitor valeryl salicylate, or nonselective inhibitors at 10 mg/kg, including aspirin, ibuprofen, indomethacin, and picroxicam, attenuated by 29%-46% the duration of loss of righting reflex induced by diazepam (20 mg/kg) in mice. On the other hand, arachidonic acid (20 mg/kg) increased the duration of diazepam-induced loss of righting reflex by 48%. This effect of arachidonic acid was abolished by aspirin. However, aspirin at 10 mg/kg also did not alter the effects of diazepam (5 mg/kg) on spontaneous activity and rotarod performance. These findings strongly suggest that one or more COX products, most likely prostaglandins, play a significant role in modulating the hypnotic effect of diazepam. Elucidating the mechanism involved may further our understanding of the pharmacology of benzodiazepines.

 

 

提供优良气管插管条件所需的司可林剂量

The Dose of Succinylcholine Required for Excellent Endotracheal Intubating Conditions

Mohamed Naguib, MB, BCh, MSc, MD, Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI, Mansour Emad El-Din, MD, Khaled Abdullah, MB, BCh, MSc, AB, MD, Mazen Khaled, MD, and Saleh W. Alharby, MB, BS, FRCS (Glas)

Department of Anesthesiology and Pain Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Departments of Anesthesia and Surgery, King Saud University, Riyadh, Saudi Arabia

Anesth Analg 2006;102:151-155

 

在这个前瞻、随机、双盲、安慰剂对照的研究中,我们试图确定模拟快速麻醉诱导时,在60s内提供优级插管条件的司可林剂量范围。180例病人麻醉诱导采用芬太尼2 µg/kg和异丙酚 2 mg/kg。病人意识消失后,随机静注司可林 0.30.51.01.52.0 mg/kg或盐水(对照组)。在60 s后行气管插管。由一名对本试验分组不知情的研究者行所有的喉镜检查并评估插管条件。结果显示,插管条件优级的发生率 在司可林 0.00.30.51.01.52.0 mg/kg组分别0.0%43.3%60.0%63.3%80.0%86.7%。司可林各组气管插管条件优级的发生率比对照组高(P < 0.001);而司可林2.0 mg/kg 组气管插管条件优级的发生率较 司可林0.3 mg/kg组高(P < 0.05)。使50%和80%的病人在60s内达到优级气管插管条件所需的司可林计算剂量(以及其95%可信区间)分别为0.390.290.51mg/kg1.61.22.0mg/kg。看来司可林剂量超过1.5mg/kg时并无优点。

(邱郁薇 马皓琳 李士通 校)

In this prospective, randomized, double-blind, placebo-controlled study, we attempted to define the dose of succinylcholine that provides excellent intubation conditions in patients within 60 s during simulated rapid-sequence induction of anesthesia. Anesthesia was induced in 180 patients with 2 µg/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.3, 0.5, 1.0, 1.5, or 2.0 mg/kg succinylcholine or saline solution (control group). Tracheal intubation was performed 60 s later. A blinded investigator performed all laryngoscopies and graded intubating conditions. Intubating conditions were excellent in 0.0%, 43.3%, 60.0%, 63.3%, 80.0%, and 86.7% of patients after 0.0, 0.3, 0.5, 1.0, 1.5, and 2.0 mg/kg succinylcholine, respectively. The incidence of excellent intubating conditions was significantly more frequent (P < 0.001) in patients receiving succinylcholine than in the controls and in patients who received 2.0 mg/kg succinylcholine (P < 0.05) than in those who received 0.3 mg/kg succinylcholine. The calculated doses of succinylcholine (and their 95% confidence intervals) that are required to achieve excellent intubating conditions in 50% and 80% of patients at 60 s are 0.39 (0.29–0.51) mg/kg and 1.6 (1.2–2.0) mg/kg, respectively. It appears that there are no advantages to using doses of succinylcholine larger than 1.5 mg/kg.

 

 

 

椎管内使用加巴喷丁的抗痛敏作用靶位:Ca2+通道、KATP通道还是N-甲基-D-天门冬氨酸受体?

The Antiallodynic Action Target of Intrathecal Gabapentin: Ca2+ Channels, KATP Channels or N-Methyl-d-Aspartic Acid Receptors?

Jen-Kun Cheng, MD*{dagger}{ddagger}, Chien-Chuan Chen, MD*, Jia-Rung Yang, BS*, and Lih-Chu Chiou, PhD{dagger}§

*Department of Anesthesiology, Mackay Memorial Hospital; {dagger}Institute and §Department of Pharmacology, College of Medicine, National Taiwan University; {ddagger}Department of Anesthesiology, Taipei Medical University, Taipei, Taiwan

Anesth Analg 2006;102:182-187

 

加巴喷丁是一种新镇痛药,其作用机制尚不明了。我们 在一个术后疼痛的模型上对到底是ATP敏感性钾通道(KATP)、N甲基D天门冬氨酸(NMDA)受体还是Ca2+通道参与了椎管内使用加巴喷丁的抗痛敏作用进行了研究。异氟醚麻醉的大鼠通过切割脚掌诱发出机械性痛超敏。在切割前后及椎管内使用药物后分别测定近切口处对von Frey 细丝刺激的回缩阈值。加巴喷丁(100 µg)的抗痛敏作用并不受KATP通道、NMDA受体或γ氨基丁酸(GABAA受体拮抗剂椎管内预处理的影响。KATP通道和γ氨基丁酸(GABAA受体激动剂本身对切割后的痛敏几乎没有作用。NCa2+通道阻断剂({omega}-芋螺毒素 GVIA, 0.1–3 µg)而不是P/Q({omega}-agatoxin IVA)L型(维拉帕米、地尔硫卓或尼莫地平)或T型(米贝拉地尔)阻断剂可以象加巴喷丁那样缓解由切割诱导的痛敏。加巴喷丁和{omega}-芋螺毒素的抗痛敏作用都可被Bay K 8644(一种LCa2+通道激动剂)所抵消。这些结果提供了相关证据支持以下观点:是NCa2+通道而不是KATP通道、NMDA受体或GABAA受体可能参与了椎管内应用加巴喷丁的抗痛敏作用。

(黄施伟 译,马皓琳 李士通 校)

Gabapentin is a novel analgesic whose mechanism of action is not known. We investigated in a postoperative pain model whether adenosine triphosphate (ATP)-sensitive K+ (KATP) channels, N-methyl-d-aspartic acid (NMDA) receptors, and Ca2+ channels are involved in the antiallodynic effect of intrathecal gabapentin. Mechanical allodynia was induced by a paw incision in isoflurane-anesthetized rats. Withdrawal thresholds to von Frey filament stimulation near the incision site were measured before and after incision and after intrathecal drug administration. The antiallodynic effect of gabapentin (100 µg) was not affected by intrathecal pretreatment with antagonists of KATP channels, NMDA receptors or gamma-aminobutyric acid (GABA)A receptors. KATP channel openers and GABAA receptor agonist, per se, had little effect on the postincision allodynic response. The Ca2+ channel blocker of N-type ({omega}-conotoxin GVIA, 0.1–3 µg), but not of P/Q-type ({omega}-agatoxin IVA), L-type (verapamil, diltiazem or nimodipine), or T-type (mibefradil), attenuated the incision-induced allodynia, as did gabapentin. Both the antiallodynic effects of gabapentin and {omega}-conotoxin GVIA were attenuated by Bay K 8644, an L-type Ca2+ channel activator. These results provide correlative evidence to support the contention that N-type Ca2+ channels, but not KATP channels or NMDA or GABAA receptors, might be involved in the antiallodynic effect of intrathecal gabapentin.

 

 

开胸术后硬膜外输注新斯的明的作用

The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy

Yuan-Yi Chia, MD*{ddagger}, Ting-Hang Chang, MD*, Kang Liu, MD*, Huang-Chou Chang, MD{dagger}, Nai-Hua Ko, RN*, and Ying-Ming Wang, MD*

Departments of *Anesthesiology and {dagger}Chest Surgery, Kaohsiung Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan; {ddagger}Institution of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan

Anesth Analg 2006;102:201-208

 

很少有麻醉方面的研究探讨过手术期间的连续硬膜外注入新斯的明的作用。我们在开胸术的病人中进行这一研究。这是一个双盲试验,九十例病人按随机法分为3组。麻醉诱导前在局麻下于T5-8水平置入硬膜外导管。Pre-neo组于麻醉诱导前硬膜外推注500µg新斯的明,之后以125 µg/h连续输注直至手术结束。Post-neo组在相同的时间段内硬膜外给予盐水,并且在手术结束时硬膜外给予500µg新斯的明。对照组在三个时间段内均硬膜外给予盐水。新斯的明组病人术后用吗啡0.02 mg/mL, 布比卡因0.08 mg/mL, 新斯的明7 µg/mL进行硬膜外自控镇痛。对照组术后硬膜外自控镇痛不用新斯的明。数据采集至术后6天。Pre-neo组病人每日硬膜外自控镇痛消耗量在术后 1–6天明显小于post-neo组及对照组(分别至少减少10%16% P < 0.05)。Pre-neo组在术后3–6天疼痛强度较其他组明显减轻(P <0.05)。这些结果提示胸段硬膜外连续给予新斯的明麻醉前可以提供超前镇痛,并且有节省镇痛药的效果,可以在不增加不良反应发生率的前提下改善手术后的镇痛。

(黄丽娜    马皓琳 李士通  校)

Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-µg epidural neostigmine before anesthesia induction followed by infusion of 125 µg/h until the end of surgery. Post-neo patients received epidural saline during the same time periods plus bolus 500-µg epidural neostigmine at end of surgery. Patients in the control group received saline placebo during all three periods. Patients in the neostigmine groups postoperatively received patient-controlled epidural analgesia with morphine 0.02 mg/mL, bupivacaine 0.08 mg/mL, and neostigmine 7 µg/mL. Control patient-controlled epidural analgesia excluded neostigmine. Data were recorded for 6 postoperative days. Daily patient-controlled epidural analgesia consumption (mL) for Pre-neo patients was significantly less than that of post-neo and control group patients for postoperative days 1–6 (at least 10% and 16% less, respectively; P < 0.05). There was a modest decrease in pain intensity on postoperative days 3–6 for pre-neo patients versus other groups (P < 0.05). These results suggest that continuous thoracic epidural neostigmine started before anesthesia provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia for these patients without increasing the incidence of adverse effects.

 

 

比较瑞芬太尼和芬太尼复合异丙酚在清醒开颅肿瘤切除术中患者的满意度

Patient Satisfaction with Awake Craniotomy for Tumor Surgery: A Comparison of Remifentanil and Fentanyl in Conjunction with Propofol

Pirjo H. Manninen, MD*, Mrinalini Balki, MD*, Karolinah Lukitto, MD*, and Mark Bernstein, MD{dagger}

Departments of *Anesthesia and {dagger}Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario

Anesth Analg 2006;102:237-242

 

本研究比较瑞芬太尼和芬太尼复合应用异丙酚在为清醒开颅肿瘤切除术患者提供有意识的镇静中的效力, 并评估患者对这两种技术的满意度。50名患者随机分为瑞芬太尼组和芬太尼组,评估是否能维持适当水平的镇静、足够的镇痛和血流动力学的稳定。记录所有的并发症。术后1小时、4小时、24小时随访患者术中知晓和疼痛以及所有方面的满意度。在镇静和疼痛评分或血流动力学和呼吸变量方面两组没有差别,术中并发症的发生率也无差别(芬太尼,14;瑞芬太尼16)。有9名(18%)患者发生呼吸方面的并发症(芬太尼6;瑞芬太尼3)。知晓和满意度评分也没差别,93%的患者在几次的随访中都表示十分满意。瑞芬太尼持续输注复合应用异丙酚可以替代芬太尼和异丙酚复合应用于清醒开颅术镇静,这两种技术都能很好地被患者接受。

(陈玮 马皓琳 李士通 审校)

In this study we compared the effectiveness of the use of remifentanil to fentanyl in conjunction with propofol in providing conscious sedation for awake craniotomy for tumor surgery and to assess patient satisfaction with both techniques. The ability to maintain appropriate levels of sedation, adequate analgesia, and hemodynamic stability was assessed in 50 patients randomized to receive either fentanyl or remifentanil. All complications were documented. Patients were interviewed at 1 h, 4 h, and 24 h after surgery to note their recall of procedure and pain and their overall satisfaction. There were no differences in sedation and pain scores or in hemodynamic and respiratory variables between the two groups. The incidence of intraoperative complications was not different (fentanyl, 14; remifentanil, 16). Respiratory complications occurred in 9 (18%) patients (fentanyl 6, remifentanil 3). The recall and satisfaction scores were not different; 93% of all patients were completely satisfied at all interview times. The use of remifentanil infusion in conjunction with propofol is a good alternative to fentanyl and propofol for conscious sedation for the awake craniotomy and these techniques are both well accepted by the patient.

 

 

腘部刺激导管在拇(足)外翻手术后镇痛中的应用

Stimulating Popliteal Catheters for Postoperative Analgesia After Hallux Valgus Repair

Jaime Rodríguez, MD, PhD, Manuel Taboada, MD, Javier Carceller, MD, Juan Lagunilla, MD{dagger}, Maria Bárcena, MD, and Julián Álvarez, MD, PhD

Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain

Anesth Analg 2006;102:258-262

 

刺激导管最近已在临床上应用。我们对48例拇外翻手术后留置导管行腘部坐骨神经阻滞镇痛的病人行随机、对照、双盲研究,观察使用刺激导管或非刺激导管镇痛的有效性和局麻药的用量。S-125S-0625组病人放置了刺激导管,NS-125组病人放置同样的导管,但不给予刺激。S-125NS-125组病人给予0.125%的左旋布比卡因,S-0625组病人给予0.0625%的左旋布比卡因。所有病人每小时给予3ml持续输注,同时有每小时3ml的可能单次追加量。术后6–8小时和19–23小时,对病人进行VAS疼痛评分。S-125 S-0625组病人,放置导管需要多次尝试。术后6–8小时,与S-0625 NS-125组病人相比,S-125组病人中位VAS疼痛评分较低〔5(0–17.5)60(15–80)70(25–80) (P<0.05)〕。术后19–23小时,S-125组病人中位VAS疼痛评分较NS-125组病人低〔0(0–0)7.5(0–10)(P<0.05)〕。S-125组与S-0625NS-125组病人相比,需要静脉注射阿片类药物镇痛的较少〔057例病人,(P<0.05)〕。我们认为使用刺激导管可以提高镇痛的有效性。

(张莹 马皓琳 李士通 校)

Stimulating catheters have been recently introduced in clinical practice. We assessed the efficacy of stimulating and nonstimulating catheter placement for pain control and local anesthetic requirements after hallux valgus repair with continuous sciatic popliteal nerve block in this comparative, randomized, blinded-to-observer study of 48 patients. A stimulating catheter was placed in groups S-125 and S-0625. The same catheter was inserted without stimulation in group NS-125. An infusion of 0.125% levobupivacaine was given in groups S-125 and NS-125, whereas 0.0625% levobupivacaine was used in group S-0625. All patients received an infusion of the test drug at a basal rate of 3 mL/h, with the possibility of an additional bolus of 3 mL every hour. Verbal analog scale (VAS) scores for pain were assessed between 6–8 h and between 19–23 h postoperatively. Multiple attempts were required for catheter insertion in all patients in groups S-125 and S-0625. Lower median (range) VAS scores for pain (0–100 points) were found in group S-125 at 6–8 h postoperatively when compared with groups S-0625 and NS-125: 5 (0–17.5) versus 60 (15–80) and 70 (25–80), respectively (P < 0.05); and lower VAS scores for pain were also found in group S-125 at 19–23 h when compared with group NS-125: 0 (0–0) and 7.5 (0–10), respectively (P < 0.05). Fewer patients required IV opioid analgesia in group S-125 than in groups S-0625 and NS-125: 0, 5, and 7 patients, respectively (P < 0.05). We conclude that efficacy in pain control was increased with stimulating catheter placement.

 

 

脊髓麻醉中温度对高比重布比卡因扩散的影响

The Influence of Hyperbaric Bupivacaine Temperature on the Spread of Spinal Anesthesia

Young-Chang P. Arai, MD*, Wasa Ueda, MD{dagger}{ddagger}§, Eri Takimoto, MD*, and Masanobu Manabe, MD{dagger}

*Department of Anesthesiology, Kochi Municipal Hospital, Marunouchi; and Departments of {dagger}Anesthesiology, {ddagger}Clinical Physiology, and §Pharmacology, School of Nursing, Kochi Medical School, Japan

Anesth Analg 2006;102:272-275

 

脊髓麻醉的分布受局部麻醉剂溶液的密度和粘滞度的影响,可能受注射剂温度的影响。我们这一试验中的假设是注射剂的温度影响它在蛛网膜下腔的分布。我们测量高比重0.5%布比卡因在25°C37°C时的密度和粘滞度,在36个病人中检验这些溶液在脊髓麻醉中的起效和范围。两个溶液的密度相似(均数 [标准差]): 25°C, 1.028 [0.000], 相对37°C, 1.028 [0.000] (g/mL),但是粘滞度在25°C时比37°C时更明显(0.01116 [0.00003] 相对0.00843 [0.00002] g · cm–1 · s–1; P < 0.001)。用失去针刺感评判向头侧的最大扩散范围,37°C溶液更高(37°C T225°CT5; P < 0.001),但是达到最大阻滞高度的时间是一样的。结论,我们发现通过加热高比重0.5%布比卡因从25°C37°C,产生一定程度的脊髓麻醉向头侧扩散的一致增加。粘滞度在温暖的溶液中减小,但是不清楚是这个原因或者别的因素造成脊髓麻醉中阻滞平面的不同。

(张 译,马皓琳 李士通 校)

The distribution of spinal anesthesia is affected by the density and viscosity of the local anesthetic solution that, in turn, may be influenced by the temperature of the injectate. Our hypothesis in the present study was that the temperature of the injectate influences its distribution into the subarachnoid space. We measured the density and viscosity of hyperbaric 0.5% bupivacaine at 25°C and 37°C and tested the onset and extent of spinal anesthesia achieved by these solutions in 36 patients. The densities of the two solutions were similar (mean [sd]): 25°C, 1.028 [0.000], versus 37°C, 1.028 [0.000] (g/mL), but the viscosity was more at 25°C than at 37°C (0.01116 [0.00003] versus 0.00843 [0.00002] g · cm–1 · s–1; P < 0.001). The maximum cephalad extent of loss of pinprick sensation was significantly higher with 37°C (T2 with 37°C versus T5 with 25°C; P < 0.001), but the time to achieve peak block height was similar. In conclusion, we showed a consistent, but modest, increase in the cephalad level of spinal anesthesia by warming hyperbaric bupivacaine 0.5% from 25°C to 37°C. Viscosity was reduced in the warmed solution, but it is unclear if this or other factors led to the difference in spinal anesthetic level.

 

 

性别与全麻联用肌松药的恢复

Gender and Recovery After General Anesthesia Combined with Neuromuscular Blocking Drugs

Frank F. Buchanan, BSc(Hons), MB BS, FANZCA, Paul S. Myles, MBBS, MD, MPH, FFARCSI, FANZCA, Kate Leslie, MBBS, MD, FANZCA, Andrew Forbes, BSc, PhD, and Flavia Cicuttini, MBBS, PhD, FRACP

Department of Anesthesia and Pain Management, Alfred Hospital, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Anesthesia, Monash University, Melbourne, Australia; Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Australia; Department of Pharmacology, University of Melbourne, Australia

Anesth Analg 2006;102:291-297

 

以前的研究提示全麻后女性恢复比男性快,但是尚不清楚其原因是性别的影响还是给药模式或手术类型的差别。我们冒着术中知晓的风险进行了一个子集分析,比较了入组到一个测试双谱指数(BIS)监测有效性的大试验的联用肌松药的全麻女性和男性患者的恢复特点。我们在1079例患者(584例男性,495例女性)中用多元统计方法来调整基线特点、手术持续时间和范围以及给麻醉药的差异。尽管给予的麻醉药量相近,然而女性患者的BIS值高于男性患者(时间-平均值[标准差]BIS:男性44.6 [7.1]比女性46.4 [6.6]P = 0.005)。女性麻醉后到睁眼的时间和到能够离开麻醉后监护室的时间均较男性短(分别为:男性13.9 [13.2] min比女性10.6 [11.6] min P < 0.001;男性 133 [209] min比女性78 [106] minP < 0.001)。多元调整后这些差异持续存在(两者的P ≤0.001)。对于接受联用神经肌肉阻滞剂的全麻患者的恢复时间,性别有独立的影响作用,女性恢复较男性快。尽管给予的麻醉药量相近,然而女性在麻醉维持期间的BIS值较高,这提示女性对麻醉药的催眠作用不如男性敏感,且可能有助于解释女性恢复时间较快。

(马皓琳 李士通 校)

Previous studies suggest that women recover faster from general anesthesia than men, but it is unclear whether this is a result of a gender effect or differences in the pattern of drug administration or type of surgery. We performed a subset analysis comparing recovery characteristics from general anesthesia combined with neuromuscular blocking drugs of female and male patients, at risk of awareness, enrolled in a large trial testing the effectiveness of bispectral index (BIS) monitoring. We used multivariate statistical methods to adjust for differences in baseline characteristics, duration and extent of surgery, and anesthetic drug administration in 1079 patients (584 male, 495 female). Female patients had higher BIS values than male patients despite similar amounts of anesthetic drug administration (time-averaged mean [sd] BIS: male 44.6 [7.1] versus female 46.4 [6.6]; P = 0.005). Time to eye opening after anesthesia and time to eligibility to discharge from the postanesthesia care unit were less in women than men (male 13.9 [13.2] min versus female 10.6 [11.6] min; P < 0.001; male 133 [209] min versus female 78 [106] min; P < 0.001, respectively). These differences persisted after multivariate adjustment (both P ≤0.001). Gender has an independent effect on recovery times in patients undergoing general anesthesia combined with neuromuscular blocking drugs, with women recovering faster than men. Higher BIS values during maintenance of anesthesia in women, despite similar amounts of anesthetic drug administration, suggests that women are less sensitive to the hypnotic effect of anesthetic drugs than men and may help explain faster recovery times in women.

 

 

红发女性报告出现瘀斑的比率稍高但凝血功能测试结果正常

Women with Red Hair Report a Slightly Increased Rate of Bruising but Have Normal Coagulation Tests

Edwin B. Liem, MD, Sandra C. Hollensead, MD, Teresa V. Joiner, BSN, and Daniel I. Sessler, MD

Outcomes Research Institute and the Departments of Anesthesiology & Perioperative Medicine and Pathology & Laboratory Medicine, University of Louisville, Louisville, Kentucky

Anesth Analg 2006;102:313-318

 

有一种未经检验的印象认为红发的病人较其他发色的病人更易在围术期出现出血等并发症。本研究检验了下述假设:可通过 常用的凝血功能测试发现可被感知的凝血问题。参加研究的健康高加索人种女性志愿者年龄在1840岁,天然红发的志愿者(n25)和天然黑发和深棕发色的志愿者(n26)在身高、体重和年龄方面均有可比性。询问志愿者既往出血史并进行如下测试:全血细胞计数、凝血酶原时间/国际标准比率、部分凝血活酶时间、血小板功能分析、标准浊度法测血小板聚集反应。促血小板聚集剂为二磷酸腺苷、花生四烯酸、胶原、肾上腺素和2个单位浓度的瑞斯西丁菌素。红发组志愿者报告出现瘀斑的比率明显高于黑发组,但是两组间血红蛋白浓度、血小板计数、凝血酶原时间/国际标准比率和部分凝血活酶时间无显著差异。且进一步的血小板功能分析和血小板聚集反应测定也未发现两组间血小板功能有明显差异。由此得出结论:即使红发的人有凝血功能异常,此种异常也非常轻微。

(周雅春 马皓琳 李士通 校)

There is an anecdotal impression that redheads experience more perioperative bleeding complications than do people with other hair colors. We, therefore, tested the hypothesis that perceived problems with hemostasis could be detected with commonly used coagulation tests. We studied healthy female Caucasian volunteers, 18 to 40 yr of age, comparable in terms of height, weight, and age, with natural bright red (n = 25) or black or dark brown (n = 26) hair. Volunteers were questioned about their bleeding history and the following tests were performed: complete blood count, prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet function analysis, and platelet aggregation using standard turbidimetric methodology. Agonists for aggregation were adenosine diphosphate, arachidonic acid, collagen, epinephrine, and two concentrations of ristocetin. The red-haired volunteers reported significantly more bruising, but there were no significant differences between the red-haired and dark-haired groups in hemoglobin concentration, platelet numbers, prothrombin time/international normalized ratio, or activated partial thromboplastin time. Furthermore, no significant differences in platelet function, as measured by platelet function analysis or platelet aggregometry, were observed. We conclude that if redheads have hemostasis abnormalities, they are subtle.