Anesthesia & Analgesia

January 2006

Table of Content

CARDIOVASCULAR ANESTHESIA:

透析持續時間是透析依賴患者心臟手術術後機械通氣時間延長的顯著預見指標

彭中美 馬皓琳 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.

術前壓力超聲心動圖和核素閃爍描記圖的薈萃分析比較

周荻 薛張綱

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.

常溫體外轉流(CPB)中應用小劑量的E-前列醇能降低全身氧耗和內臟的氧攝取

忻紀華 陳傑

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主動脈連接裝置和急性腎損害:比較三種不同主動脈-冠脈旁路手術技術後的腎功能不全

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.

人心衰機械支持過程中心肌病病因學和SERCA2a逆向重構

周荻 薛張綱

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.

鞘內和硬膜外麻醉與鎮痛技術在心臟手術中的應用

齊波 陳傑

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

Mark A. Chaney

Anesth Analg 2006 102: 45-64.

PEDIATRIC ANESTHESIA:

脊麻用於嬰兒外科手術的安全性和有效性:佛蒙特州嬰兒脊椎麻醉登記處的研究

周志堅 馬皓琳 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.

異氟烷在新生鼠的生理學效應

韓曉丹譯 薛張綱校

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:

利用腦電圖熵指數建立七氟醚催眠效果的藥代動力學-藥效學模型

黃佳佳 馬皓琳 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.

七氟醚和丙泊酚對爪蟾卵QT間期及HERG通道電流的影響

蘇殿三 陳傑

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

一種新的分子在外周用阿片類藥物時的特性:在穩態下與嗎啡和安慰劑比較對於心肌肥大和低氧通氣的效應

韓曉丹譯 薛張綱校

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.

腹部大手術丙泊酚麻醉期間奈福泮對瑞芬太尼引起的嗎啡消耗量增加的影響
鄭麗 陳傑

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.

雷米芬太尼在貓肺血管床中的一項分析

顏濤 譯, 馬皓琳 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.

去甲腎上腺素和異氟醚在成年大鼠脊髓膠質神經元抑制性突觸轉移中的作用

(陸文清譯 薛張綱校)

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.

大鼠靜脈內應用乳化異氟醚的有效性和安全性

曹瑜 陳傑

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

環氧化酶-1抑制能縮短地西泮導致的小鼠翻正反射消失時程

顏濤 譯, 馬皓琳 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.

局麻藥氨苯丁酯對低電壓誘發的T型電流在小的感覺神經元的作用

王慧琳譯 薛張綱校

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.

健康志願者曲馬多靜脈注射後的麻醉效應與CYP2D6的關係

田婕 陳傑

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.

提供優良氣管插管條件所需的司可林劑量

邱郁薇 馬皓琳 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:

利多卡因不能預防氣管內插管時的雙頻指數上升反應

王慧琳譯 薛張綱校

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.

圍術期狀態熵、反應熵與雙頻指數的比較

趙延華 陳傑

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.

一種可聽呼氣指示器在皮囊閥門面罩通氣時增加病人模擬器的輸出潮氣量

徐麗穎譯 薛張綱校

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:

加巴噴丁:圍術期鎮痛治療藥環氧化酶2(COX-2)抑制劑的替代藥物

范穎暉 陳傑

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

椎管內使用加巴噴丁的抗痛敏作用靶位:Ca2+通道、KATP通道還是N-甲基-D-天門冬氨酸受體?

黃施偉 譯,馬皓琳 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.

芬太尼電離子滲入療法遞藥系統在術後鎮痛的作用:隨機、雙盲、安慰劑對照試驗

孫卓真 薛張綱

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.

非甾體類抗炎鎮痛藥(NSAIDs)抑制小鼠行為相關性疼痛但不涉及內臟痛的痛覺增

顧新宇 陳傑

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.

開胸術後硬膜外輸注新斯的明的作用

黃麗娜    馬皓琳 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:

行冠脈造影包括經皮冠脈介入治療病人心肺復蘇的結果和生存期望值

鍾靜 薛張綱

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輔酶A還原酶抑制劑)預處理可減輕大鼠腸缺血-再灌 注後相關性肺損傷

肖潔 陳傑

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:

比較瑞芬太尼和芬太尼複合異丙酚在清醒開顱腫瘤切除術中患者的滿意度

陳瑋 馬皓琳 李士通 審校

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:

剖宮產腰硬聯合麻醉時採用坐位和右側臥位阻滯特點及低血壓嚴重程度的比較

王麗珺 薛張綱

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:

術後連續外周神經阻滯的鎮痛效果優於阿片類藥物嗎? 一項薈萃分析研究

鄭擁軍 陳傑

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.

膕部刺激導管在拇(足)外翻手術後鎮痛中的應用

張瑩 馬皓琳 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.

利多卡因內添加地塞米松可延長腋路臂叢神經阻滯時間

金路 薛張綱

Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade

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

Anesth Analg 2006 102: 263-267.

持續氣道正壓通氣增強低位胸段硬膜外注射利多卡因後感覺阻滯的擴散

張美榮 陳傑

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.     

脊髓麻醉中溫度對高比重布比卡因擴散的影響

譯,馬皓琳 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.

年齡對硬膜外使用羅呱卡因全身吸收和分佈的影響

金琳 薛張綱

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.

鼠外用和鞘內應用多慮平的研究

潘志英 陳傑

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:

性別與全麻聯用肌松藥的恢復

馬皓琳 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.

腹腔鏡減肥術中肺泡擴張術和呼氣末正壓通氣對動脈氧合的影響 

孫敏莉 薛張綱

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.

通過神經肌肉監測選擇插管時間能減少喉部損傷嗎?一項隨機前瞻性對照試驗

朱輝 陳傑

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.

紅發女性報告出現瘀斑的比率稍高但凝血功能測試結果正常

周雅春 馬皓琳 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.

不同氣道設備中有或沒有笑氣全麻對中耳壓力影響的研究

吳德華 薛張綱

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.

常溫體外轉流(CPB)中應用小劑量的E-前列醇能降低全身氧耗和內臟的氧攝取
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.


常溫下非搏動性體外轉流(CPB)可損害全身和內臟的氧運輸,並且增加胃腸道粘膜的 通透性。CPB期間的一個重要目標是如何避免低氧血症。在敗血症病人中小劑量的前列 腺素可以改善內臟氧運輸和微循環。本研究為了檢驗心臟手術中,前列腺素的類似藥物 E-前列醇是否改善全身和內臟的氧輸送平衡。18例接受心臟瓣膜置換術病人隨機分為E -前列醇(3ng•kg-1•min)組和安慰劑組,分別在術中和術後1小時給 藥。於CPB前、CPB期間和CPB後監測全身和內臟的氧攝取,消耗和輸出以及動脈血、混 合靜脈血和肝靜脈血的乳酸濃度。應用三連糖(triple sugar)通透性實驗來測定術前 1日和術後1日的胃腸道粘膜的通透性。CPBE-前列醇組全身氧耗和內臟氧攝取減少(P 0.024)。但這些作用在E-前列醇停藥後1小時消失。本研究沒有充分的資料說明E 前列醇是否有增加乳酸代謝和術後胃腸道粘膜通透性的趨向,也不能證明兩組的臨床結 果不同。結論:在CPB期間應用小劑量的E-前列醇可以降低全身氧耗和內臟的氧攝取。
(忻紀華 陳傑 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.

鞘內和硬膜外麻醉與鎮痛技術在心臟手術中的應用
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.

足夠的術後鎮痛可以防止病人的術後不適,也可以減少病人死亡率、術後住院時間,以 及住院費用。然而,心臟手術後病人往往難以獲得滿意的鎮痛。雖然很多臨床技術均可 提供鎮痛,但各有優缺點。在心臟手術中應用鞘內和硬膜外技術可獲得滿意的鎮痛效果 ,另外潛在的優勢包括減少應激反應和胸心去交感反應。胸部硬膜外麻醉技術所獲得的 鎮痛效果非常滿意,可以滿足病人在不實施氣管插管全麻清醒下進行心臟手術。然而, 應用區域麻醉技術實施心臟手術並非沒有風險。包括局麻藥的副反應(低血壓)和阿片類 藥物的副反應(搔癢、噁心嘔吐、尿瀦留和呼吸抑制等),當應用這種麻醉技術時,可能 使圍術期管理複雜化。由於在這種情況下病人發生硬膜外血腫的風險增加,從而導致有 關應用區域麻醉技術實施心臟手術的可接受的風險-收益比仍有許多的爭論。
(齊波 陳傑 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.

 

七氟醚和丙泊酚對爪蟾卵QT間期及HERG通道電流的影響
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.

七氟醚能夠抑制動作電位複極化過程,導致心臟QT間期延長。這一效應可能是由於抑制 了人ether-a-go-go related gene(HERG)通道造成的。為了證明麻醉藥對於HERG通道的 作用機制,研究者觀察了豚鼠在七氟醚和丙泊酚麻醉下心電圖QT間期的變化。結果發現 ,七氟醚(1%-4%)可以劑量依賴性的延長QT間期(7.5%-21.2%),但是丙泊酚卻無此 作用。另外,HERG通道在爪蟾卵有表達,該通道從-70mV去極化時可以記錄到HERG外向 電流。再複極到-70mV時也可以記錄到一個較強的外向尾電流。七氟醚(1%-4%)可以劑 量依賴性的抑制HERG外向尾電流(9.7%-26.6%),但是只有在高濃度的情況下才能抑制 其穩態電流。彙聚電流的時間常數在七氟醚存在的情況下減小了,但是其失活和啟動曲 線沒有變化。丙泊酚在臨床相當濃度下對於這些電生理參數沒有影響。總之,研究者認 為,與穩態電流相比,七氟醚抑制外向尾電流的作用更強,說明七氟醚對HERG通道的影 響可能發生在失活期。
(蘇殿三 陳傑 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.

腹部大手術丙泊酚麻醉期間奈福泮對瑞芬太尼引起的嗎啡消耗量增加的影響
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.

阿片類藥物可以啟動鎮痛作用相反的疼痛易化系統。作者研究在全憑靜脈麻醉中大劑量 瑞芬太尼是否導致術後嗎啡消耗過量,並研究奈福泮是否減輕此作用。研究中包括60 擇期腹部手術病人並隨機分組。第一組30個病人丙泊酚靜脈麻醉期間靶控輸注大劑量( L: 8ng/ml)或小劑量(S: 3ng/ml)的瑞芬太尼。在縫皮前給病人0.15mg/kg的嗎 啡。另外一組給與奈福泮20mg。術後用靜滴嗎啡控制疼痛隨後病人自控鎮痛(PCA)。L 組需要嗎啡早於S[10(1-63min )versus 375-90minP<0.002 ]L組的嗎啡需要 量大於S[0.28(0.04-0.38 versus 0.16 0.03-0.41 mg/kgP<0.05 ]。兩組間痛 覺消失時嗎啡消耗量和疼痛程度相似。應用奈福泮後患者術後首次需要嗎啡及術後持續 滴定嗎啡量組無間差異。在大劑量瑞芬太尼和丙泊酚麻醉術後早期發生的術後嗎啡消耗 量增加。預先給予奈福泮能阻止阿片類藥物產生的痛覺敏感。
(鄭麗 陳傑 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.

大鼠靜脈內應用乳化異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.
雖然靜脈內應用液態可揮發性麻醉藥通常是致命的,但在動物身上已能安全使用乳化氟 烷、異氟醚進行麻醉誘導而無副作用。作者在大鼠身上確立乳化揮發性麻醉藥製劑的安 全濃度及靜脈注射乳化異氟醚和丙泊酚的劑量-反應關係。作者測量了地氟醚、七氟 醚、異氟醚、恩氟醚和氟烷在20%和30%英脫利匹特的液/氣分配係數並計算它們的飽 和濃度。不飽和的乳化異氟醚是用液態異氟醚加入到30%英脫利匹特中置配而成的。前 足翻正反射的消失作為麻醉誘導的標誌,心電圖的消失則作為死亡的標誌。乳化異氟醚 的半數有效誘導劑量(ED50)和半數致死劑量(LD50)分別是0.0720.216ml/kg。異 丙酚的半數有效誘導劑量(ED50)和半數致死劑量(LD50)分別是5.8918.19mg/kg 乳化異氟醚誘導後前足翻正反射恢復時間(38±18s)要比異丙酚(101±62sp<0.05
)明顯縮短。在大鼠中靜脈使用乳化異氟醚能成功實現麻醉誘導,其安全係數與安全因 子與異丙酚相當。靜脈內使用乳化異氟醚的麻醉復蘇要比異丙酚快。
(曹瑜 陳傑 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.

健康志願者曲馬多靜脈注射後的麻醉效應與CYP2D6的關係
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.

曲馬多的麻醉效應源自於其本身的單胺能作用及CYP2D6存在下其O型去甲基化的主要代 謝物(+)-M1產生的阿片樣作用。本實驗中,作者用實驗性疼痛模型來研究M1對曲馬多麻 醉效應的影響。將健康志願者隨機分為兩組,每組10人,分別為有CYP2D6存在,產生豐 富代謝物組,和無CYP2D6存在,代謝產物貧乏組。在靜脈注射100 mg曲馬多1590 min 後,研究其對兩組志願者實驗性疼痛的影響。疼痛測試包括腓神經的單次電刺激的感應 和耐受閾值,腓神經重複性電刺激的疼痛累計閾值(暫時累計)和冷壓測試。在豐富代 謝產物組中,曲馬多能夠降低冷壓測試中的不適感(P=0.002)。腓神經刺激的疼痛忍 受閾值在貧乏代謝產物組的志願者中較高(P0.04)。在豐富代謝產物組中,除一人 外,其餘志願者的血清樣品中均能檢測到(+)-M1,而在貧乏代謝產物組中,(+)-M1均低 於測量下限。實驗表明,(+)-M1的阿片樣作用有助於曲馬多的麻醉效應,但該效應的產 生似乎主要源于曲馬多本身的單胺能作用。
(田婕 陳傑 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.

圍術期狀態熵、反應熵與雙頻指數的比較
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.

腦電監測指數在很大程度上受病人間變異和手術時電信號的干擾。作者設計了該項臨床 研究,以驗證異丙酚和地氟醚全麻時頻譜熵(Entropy)模組受干擾的程度低於雙頻指數 BIS)監測儀。該前瞻性研究包括30名擬行腹腔鏡手術的病人,同意接受試驗。對病 人實施常規全麻,記錄獲取基礎指數的時間(elapsed time)、以及在麻醉誘導、維持 以及蘇醒期特定時間的狀態熵(SE)、反應熵(RE)和BIS數值。在維持期給予負荷劑 量的異丙酚(20mg iv)和增加或減少吸入地氟醚濃度2%後測定這些指數的變化。正如 預期的那樣,SE基礎值(88 ±2)低於RE96± 3)和BIS96 ± 4)。但SERE值與BIS 值相關,誘導期相關係數(r)分別為 0.770.78;蘇醒期r 分別為0.860.91。受試 者操作特徵曲線(Receiver Operating Characteristic Curve, ROC曲線)可反映意識 狀態,其曲線下面積也提示 SE (0.93 ±0.04)RE(0.98 ± 0.04)BIS (0.97± 0.04)相關。在維持期,這三個指數對異丙酚和地氟醚濃度改變的反應相同。熵指數受 術中電刀的干擾較少(與BIS監測儀相比分別為12%和62%)。由於監測熵指數和BIS 一次性電極的平均售價相似(分別為$14.25 $14.95),作者認為熵模組的費用與BIS 監測儀相當,可以替代後者。
(趙延華 陳傑 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.

加巴噴丁:圍術期鎮痛治療藥環氧化酶2(COX-2)抑制劑的替代藥物
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.

環氧化酶2(COX-2)抑制劑羅非昔布是常用的圍術期鎮痛藥。在這項安慰劑對照的臨床研 究中,研究者證明加巴噴丁同樣能夠減輕圍術期的疼痛,減少阿片類藥物的用量,改善 術後恢復過程。100名行經腹子宮切除術的患者隨機分配到4組:1)安慰劑對照組(組1 ):在術前和術後2天口服安慰劑;2)羅非昔布組(組2),病人術前和術後口服羅非昔 50mg/d3)加巴噴丁組(組3),病人術前和術後口服加巴噴丁1.2g/d4)聯合用藥 (4),病人在術前和術後口服羅非昔布50mg/d,加巴噴丁1.2g/d。各組均採用標準 的麻醉方法處理,術後評估包括疼痛和鎮靜評分,靜脈嗎啡的用量,恢復質量的評估, 腸道功能恢復時間,正常活動的開始時間和病人對術後鎮痛的滿意度。研究結果發現, 在三個處理組術後疼痛評分均明顯下降,與對照組相比三個處理組病人自控鎮痛(PCA )嗎啡用量在術後18,2430h明顯減少。與對照組相比,組2, 3,組4 PCA嗎啡用 量分別減低43%, 24%50%。與對照組相比,組2和組4口服鎮痛藥的消耗量也明顯減 少。羅非昔布和加巴噴丁減少麻醉性鎮痛藥的需要並可以加速腸道功能的恢復。與對照 組相比,組2和組4術後24h出院合格評分明顯改善。三個處理組術後鎮痛的滿意度明顯 提高。對照組,組2和組3 72小時隨訪對術後鎮痛的滿意度分別為32%, 64%,72%,而 4的滿意度為100%。總之,研究者認為術後短期口服加巴噴丁1.2 g/d可以替代羅非昔 布(50mg/d,口服)用於下腹部手術後鎮痛時阿片類鎮痛藥的輔助用藥。
(範穎暉 陳傑 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.

非甾體類抗炎鎮痛藥(NSAIDs)抑制小鼠行為相關性疼痛但不涉及內臟痛的痛覺增
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.

內臟痛是以自發性疼痛和痛覺增敏為特徵。用芥子油結腸內給藥使老鼠產生內臟痛之後 ,通過行為相關性疼痛和外滲物的伊文斯藍染色來檢測不同NSAIDs的效果。給予動物以 下藥物中的一種:鹽、乙醇、二甲基亞碸、嗎啡、酮基布洛芬、痛力克或雙去氧氟尿苷 DFU(一種環氧化酶-2抑制劑)。通過藥物處理後,在小鼠結腸內給予1.5%芥子油 50&micro;l,並評估20min內的自發性相關疼痛反應。檢測對腹部、腳、尾巴應用von Frey毛的停藥反應的頻率。完成行為測試後,經動物尾上的靜脈注射伊文斯藍。2小時 後作結腸解剖並測定伊文斯藍含量。動物在嗎啡3-10mg/kg、痛力克50mg/kg、酮基布洛 100mg/kgDFU20mg/kg處理後,其自發性行為疼痛明顯減少(p<0.05)。但應用嗎啡 10mg/kg後小鼠的反應頻率更低且不受痛力克、酮基布洛芬或DFU處理的影響(p<0.05
)。結腸內伊文斯藍含量在給予酮基布洛芬100mg/kgDFU20mg/kg的小鼠中更低( p<0.05)。結論:NSAIDs能減輕行為疼痛和炎症但對痛覺增敏的影響很小。
(顧新宇 陳傑 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輔酶A還原酶抑制劑)預處理可減輕大鼠腸缺血-再灌 注後相關性肺損傷
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.

以大鼠為實驗模型,研究評價使用Simvastatin預處理是否可以影響腸缺血-再灌注( I/R)導致急性肺損傷的嚴重程度。24個實驗動物隨機分為3組(shamcontrol
Simvastatin),Simvastatin組預先使用Simvastatin10mg&#8226;kg-1&#8226;-1 ,連續3天,其他兩組使用對照劑。三組實驗動物,均阻斷腸系膜上動脈60min,而後再 灌注90min。與Simvastatin組相比,對照組產生相對更為嚴重的腸缺血-再灌注性肺損 傷,這是因為氧分壓低和血氧飽和度低(分別為:P=0.01P=0.005)而肺內中性粒細 胞滲透壓平均值增高導致的(P=0.003),總的肺組織病理損傷評分(P=0.003),肺幹 -濕比重比(P=0.009),肺組織丙二醛水平(P=0.016)。所有檢測中,除了對照組支 氣管肺泡灌洗液中的P選擇蛋白較高(P=0.006)外,對照組和Simvastatin組的血清、 支氣管肺泡灌洗液中細胞因數水平(白介素-1,白介素-6,α-腫瘤壞死因數)P選擇蛋 白水平都是相似的。本大鼠模型研究證明Simvastatin預處理可以減輕腸缺血-再灌注性 肺損傷。
(肖潔 陳傑 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.

 

術後連續外周神經阻滯的鎮痛效果優於阿片類藥物嗎? 一項薈萃分析研究
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.

儘管大多數隨機臨床研究表明:與阿片類藥物相比,連續外周神經阻滯(CPNB)可減輕 術後疼痛,減少阿片類藥物的副作用。但由於這些研究包含的樣本數較少,因而很難從 統計學角度得到明確的結論。本文主要通過對1966-2004OVID資料庫有關CPNB和阿片 類藥物用於術後鎮痛的相關研究進行分析,資料來自於每一篇文章中的圖表和相關信 息。19篇文章中包含的603位病人符合入選標準,入選標準包括:麻醉方式明確(包括 全麻複合區域阻滯,單純全麻或單純外周神經阻滯);隨機試驗;成年患者(年齡大於 或者等於18歲);術後應用CPNB(但不包括胸膜內導管)或麻醉性鎮痛藥;應用阿片類 藥物的患者不能接受外周神經阻滯。研究結果表明:術後外周神經阻滯鎮痛效果優於阿
片類藥物(P < 0.001),上述結論通過術後24h(P < 0.001)48 h (P < 0.001)平均視
覺類比評分和最大視覺類比評分,以及術後 72 h 平均視覺類比評分 (P < 0.001) 到。不論鎮痛部位,也不論鎮痛持續時間,神經阻滯效果均優於阿片類藥物。CPNB引發 噁心/嘔吐,嗜睡以及瘙癢等症狀(P < 0.001)的發生率也明顯減少,且神經阻滯可減少 阿片類藥物的用量(P < 0.001)。綜上所述,與阿片類藥物相比,外周神經阻滯(不管 其阻滯部位如何)鎮痛效果好,副作用少。
(鄭擁軍 陳傑 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.

持續氣道正壓通氣增強低位胸段硬膜外注射利多卡因後感覺阻滯的擴散
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藥後感覺阻滯擴散的影響因素尚未完全闡明。為了評價胸內壓的增 加對胸段硬膜外麻醉擴散的影響,作者選擇20T7-8T8-9椎間隙硬膜外置管的病人, 隨機分成2組,對照組為自主呼吸時硬膜外注射2%利多卡因4mL作為試驗量,持續氣道正 壓通氣組為自主呼吸加7.5cmH2O持續氣道正壓通氣並接受同樣的硬膜外試驗量。組間人 口統計學變異值相當。硬膜外注射15分鐘後,對照組的感覺阻滯節段為T4T11,而持 續氣道正壓通氣組是為T5L2。對照組的阻滯節段數為7個節段而持續氣道正壓通氣組 11個節段。對照組的注射部位尾向阻滯節段數為3個節段而持續氣道正壓通氣組為6
節段。結論:持續氣道正壓通氣可以增強胸段硬膜外麻醉感覺阻滯的擴散,主要為增強 尾向感覺阻滯的擴散。
(張美榮 陳傑 )
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.

 

鼠外用和鞘內應用多慮平的研究
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.

已有報導稱三環抗抑鬱劑多慮平在鼠坐股神經阻滯中有潛在的局部麻醉功效。作者假設 與對照藥及布比卡因鞘內注射相比外用多慮平有顯著的長效抗傷害性刺激作用。5075 100mM的多慮平溶液0.3mL和對照組(僅用溶劑)片狀塗於鼠的背部剃毛皮膚。每過2h 將藥液清除,用36針的刺激器來測試,對疼痛的撤退抑制和軀幹表面的肌肉反射進行 評級。在第二項研究中:10, 20 50 mM的多慮平60 uL分別在鼠的腰部進行鞘內注射 ,並評估運動功能,本體感受以及傷害感受性。75 mM 100 mM濃度的多慮平外用比 對照組有顯著療效(P < 0.05)。儘管應用100mM濃度多慮平5只鼠中有2只出現紅斑並形 成疤痕,但是60h後恢復。對於運動和本體感受功能,20mM多慮平鞘內注射與23 mM (0.75%)布比卡因相比無顯著差異。然而50 mM多慮平鞘內注射開始出現神經毒性(定義 為持續的神經損傷)
(潘志英 陳傑 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.

通過神經肌肉監測選擇插管時間能減少喉部損傷嗎?一項隨機前瞻性對照試驗
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.

聲帶損傷和術後聲嘶是全身麻醉後常見的併發症。插管時肌松不完全可能會導致聲帶損 傷。使用神經肌肉阻滯藥物後神經肌肉抑制程度個體間差異很大。因此,通過神經肌肉 監測選擇理想的個體化的插管時間或許可減少聲帶損傷。在這項前瞻性的研究中60名患 者被隨機分成兩組:監測組:給予阿曲庫銨(0.5mg/kg)後通過神經肌肉監測使肌肉阻 滯達最完全時插管;2-分鐘組:靜脈注射阿曲庫銨(0.5mg/kg2分鐘後插管。利用 Copenhagen評分來評估插管條件。術前、術後24小時、術後72小時通過動態鏡檢查聲帶 損傷程度。術後244872小時通過一訪談標準來評估聲嘶情況。監測組極好插管的人 數明顯高於2-分鐘組,分別為8名和2名(P=0.036)。發生聲嘶的人數監測組和2-分 鍾組分別為7名和8名(P=0.860),而聲帶損傷分別為9名和5名(P=0.268);聲帶損傷 的類型:聲帶肥厚患者監測組和2-分鐘組分別為8名和5名(P=0.423);聲帶血腫各2 個(無差異)。本研究顯示神經肌肉監測可改善插管條件。但即使神經肌肉阻滯達最完 全時插管也不能降低聲帶的損傷。
(朱輝 陳傑 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.

術前壓力超聲心動圖和核素閃爍描記圖的薈萃分析比較

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.

 

在本薈萃分析中,我們比較有心肌梗塞(MI)風險的病人行非心臟手術前的鉈成像檢查(TI)和壓力超聲心動圖檢查(SE)。兩項對已出版文章的研究用來確定相關的文章。我們包括了所有陳述陽性實驗標準的研究並詳述了術後心肌梗死和醫院內死亡的發生率。資料由兩位元作者摘得並記錄了術前病人的特徵,研究設計,盲法和研究結果。我們定義陽性實驗為有可逆缺點的實驗,可能的話定量每項研究中的缺點。心肌梗塞和/或死亡是唯一有意義的術後結果。我們計算每項研究的敏感性,特異性和可能率(LR),可能的話還有患者心臟事件的手術特徵曲線(ROC)。LRROC通過使用隨機效應模型的薈萃分析結合起來。不同之處通過I2實驗評估。分析包括了68項研究,10049名病人。其中有25SE研究和50TI研究。有七個研究直接比較了這兩種方法學。研究的質量各不相同;心肌梗塞的常規篩選在SE研究中較常使用(47.8% 21.2%P=0.008)而篩選導致的治療在TI72.1%)檢查後比SE46.3%)多(P=0.027)。SELRTI更能預測術後心臟事件的發生(LR, 4.09; 95% CI, 3.21-6.56 1.83; 1.59-2.10; P = 0.001)。這個差別是由於SE比較少的假陰性。在定性研究中的累積ROC並沒有差別(SE, 0.80; 95% CI, 0.76-.84 versus TI, 0.75; 95% CI, 0.70-081)。此外,陰性SELR較少(0.23; 95% CI, 0.17-0.32 versus 0.44; 95% CI, 0.36-0.54)。在14%的病例中可見中-大的缺點,包括預測術後心臟事件的方法(LR, 8.35; 95% CI, 5.6-12.45)。本薈萃分析有統計能力證明SE在陰性預計方面比TI強。SETI在預計術後心肌梗塞和死亡的能力都有中-大的普遍缺點。我們的結論是:SE在預計術後心臟事件方面優於TI

(周荻 薛張綱 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.

人心衰機械支持過程中心肌病病因學和SERCA2a逆向重構
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.

 

許多心臟在終末期,慢性衰竭(CHF)時當用左心室輔助裝置(LVAD)支援時仍保持著逆轉調控心肌細胞鈣通路基因的異常表達的能力。在本項研究中,我們確定了是否LVAD上調了基因編碼關鍵鈣通道蛋白,肌漿網鈣三磷酸腺苷亞型2aSERCA2a)是受潛在疾病的自然影響如廣泛意義上的缺血(ICM)或先天性擴張性心肌病(DCM)。由用Northern印記法對84例心臟病例(50 CHF[23 DCM27 ICM]34CHF+LVAD[18 DCM16ICM]SERCA2a的信使(mRNA分析獲得資料來特徵化基因表達。此外,用力-頻率關係(FFR)的測量,體內SERCA2a功能的反射,由75例心臟(51 CHF [29 DCM 22 ICM] 24 CHF+LVAD [10 DCM 14 ICM])分離的心肌小梁中獲得。SERCA2a mRNA證明了LVAD之後的上調並不受ICMDCM的影響。然而,只有在DCM心臟中有部分小梁在LVAD後顯示出正常的FFR增加。因此,儘管LVAD支持後的SERCA2a基因表達上調是獨立於肌原因的,但心肌FFR的正常化,SERCA2a功能指數則不是的。這些資料提供了心臟逆向分子重構過程中的新視角,並強調了疾病過程對轉錄後事件影響的可能區別。

(周荻 薛張綱 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.

 

 

異氟烷在新生鼠的生理學效應

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.


新生的齧齒類在遷延照射後,異氟烷對於局部缺氧缺血和沉澱物造成的神經退行性病變有神經保護作用。神經保護或神經毒性作用是因為異氟烷直接作用於腦的結果還是因為腦部血流或代謝改變而導致的間接效應現在還不清楚。我們記錄了出生10天小鼠用異氟烷麻醉保留自主呼吸或機械通氣60分鐘的動脈血壓,心率,血氣和血糖;同時也記錄了60分鐘用異氟烷麻醉且伴有缺氧缺血症狀和不用麻醉時的情況。在用異氟烷麻醉時低血糖和代謝性酸中毒在自主呼吸或機械通氣都會發生。在有缺氧缺血症狀且用異氟烷麻醉,保留自主呼吸的小鼠是致死的,但是用機械通氣的小鼠可以存活,兩者的動脈血壓和心率與未上麻醉的小鼠相似。出生10天小鼠異氟烷的MAC值是2.3%。總的來說,新生鼠用異氟烷麻醉時由於沉澱而造成的低血糖可能是神經變性的原因。實驗中異氟烷是用0.8MAC,當有缺氧缺血時給予機械通氣和補充葡萄糖。

(韓曉丹譯 薛張綱校)
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.

一種新的分子在外周用阿片類藥物時的特性:在穩態下與嗎啡和安慰劑比較對於心肌肥大和低氧通氣的效應

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)是一種新型的外周阿片類受體激動劑。此次雙盲、隨機、雙安慰劑、四種方法的交叉試驗是為了證實FF輸注了六小時後對於心肌肥大和低氧通氣的效應。對照組是兩個劑量的嗎啡(最大值和最小值)和安慰劑在12個健康男性中的效應。FF的劑量是1.22 mg/kg,嗎啡的最大值劑量是0.44 mg/kg,最小值劑量是0.11 mg/kg。安慰劑氯化鈉的劑量是9 mg/mL。通氣用呼吸速度描計和流線二氧化碳圖來描述。FF和安慰劑對於通氣沒有作用。和預期估計的一樣,最大劑量的嗎啡對於心肌肥大和低氧通氣都有影響。我們認為輸注六小時的FF沒有中樞呼吸的抑制作用。然而,嗎啡對於心肌肥大和低氧通氣時的中樞抑制作用是劑量依賴性的。

(韓曉丹譯 薛張綱校)
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.

 

去甲腎上腺素和異氟醚在成年大鼠脊髓膠質神經元抑制性突觸轉移中的作用

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.

揮發性吸入麻醉藥和笑氣(N2O)常常被同時用於臨床麻醉。因為笑氣的麻醉作用至少部分被脊髓釋放的去甲腎上腺素(NE)所中和了。我們通過中樞對疼痛的反應來檢測異氟醚和NE在成年大鼠脊髓的相互作用。我們使用全細胞膜片鉗技術來檢測臨床濃度的異氟醚(1 MAC)NE (20 microM)對膠質神經元自發的抑制性轉移的作用。ISO延長自發的抑制性突觸後電流的衰減,增加它的總電荷轉移。NE增加它的頻率和平均電流,也增加它的總電荷轉移。兩者同時使用起到一個相加的作用。我們最終覺得ISONE都增強大鼠膠質神經元抑制性的突出轉移,它們的相互作用是相加的,這表現在在脊髓背段水平,ISO可以增強笑氣的麻醉作用。

(陸文清譯 薛張綱校)

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.

 

局麻藥氨苯丁酯對低電壓誘發的T型電流在小的感覺神經元的作用

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)是一種局麻藥,可以用於長時間硬膜外選擇性地阻滯背根疼痛傳導,也用於外用藥膏治療皮膚疼痛。之前已有報導,氨苯丁酯對高電壓誘發的N型鈣通道有抑制作用。現今研究發現,氨苯丁酯對低電壓誘發的或是T型鈣通道同樣有作用。 T型鋇通道,是一種選擇性的被低電壓(-40毫伏)所誘發的來自于新生小鼠的背根神經節,可以被大約200毫摩的氨苯丁酯所抑制。與之前的N型鈣通道相比,200毫摩的氨苯丁酯可以加速T型鋇通道的啟動,減活和失活。儘管200毫摩的氨苯丁酯在失活曲線上引起大約3毫伏的超極化,但它不影響傾斜因素,所以它對於失活曲線的中點電位和傾斜因素沒有作用。我們得出以下結論:氨苯丁酯通過運動加速通道機制來抑制T型鈣通道。

(王慧琳譯 薛張綱校)

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.

 

利多卡因不能預防氣管內插管時的雙頻指數上升反應

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

 

我們研究了在全麻誘導和氣管內插管時靜脈注射利多卡因對於血流動力學和雙頻指數(BIS)的作用。40ASAI級的病人隨機分為兩組(每組20人),在誘導後30秒分別給予普通鹽水和利多卡因1.5毫克每公斤體重。90秒後行氣管內插管。測量誘導時,誘導後一分鐘,插管前,插管後5分鐘的每一分鐘的收縮壓,心率和BISBIS在誘導後一分鐘和插管前有差別,利多卡因組比對照組要低得多(P<0.05)。在對照組裏插管後一分鐘和兩分鐘的收縮壓要比誘導前的收縮壓高很多,但在利多卡因組裏沒有明顯增高。插管後一至三分鐘內的心率在兩組都有增加(P<0.05),但兩組之間沒有顯著差別。對照組中有一位病人脫落。我們因此總結出:靜脈注射利多卡因(1.5毫克每公斤體重)不能抑制氣管內插管時的催眠反應。

(王慧琳譯 薛張綱校)

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.

 

一種可聽呼氣指示器在皮囊閥門面罩通氣時增加病人模擬器的輸出潮氣量

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

 

由於皮囊不同於Mapleson型設備,自動膨脹式手控人工呼吸機(SIMRs)即使在病人沒有呼氣時也會再膨脹,因而會誤導看護人員。我們在SIMR的呼氣埠加了一個蜂鳴器作為一個可聽指示器。各參與者按隨機順序用SIMR經面罩通氣向一個記錄肺容量變化的改良病人模擬器提供兩組呼吸,一組有可聽反饋,另一組沒有。每組的最後三次呼吸用來比較兩種情況下的平均潮氣量(Vt)。徵募了87位二期心臟生命支援的受訓者(54位男性,33位女性),平均有6.4 +/- 9.4 年的臨床經驗。採用標準SIMR的平均輸出潮氣量為486 +/- 166 mL,而採用改良SIMR624 +/- 96 mL。在標準SIMR後採用改良SIMR,平均輸出潮氣量顯著增加40%,而先採用改良SIMR則增加19%。採用裝有可聽呼氣指示器的SIMR顯著(P < 0.001)增加了病人模擬器的面罩通氣量,表明用SIMR的病人,其面罩通氣也能受客觀、即時的呼出潮氣量的反饋而增加。

(徐麗穎譯 薛張綱校)

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.

 

芬太尼電離子滲入療法遞藥系統在術後鎮痛的作用:隨機、雙盲、安慰劑對照試驗

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

 

芬太尼氯化氫電離子滲入 療法經皮啟動病人系統(PATS)是建立在術後急性疼痛治療手段發展的基礎之上的。芬太尼氯化氫PATS是一種不用注射、由標卡測定的、預先有計劃的一套系統。它被應用于病人的上外側臂或胸壁。芬太尼氯化氫PATS在先前的試驗中被證實優於安慰劑。然而過去的試驗由於計畫隨意,缺乏對於疼痛入選標準的控制從而得不到堅實有力的結論。本次芬太尼氯化氫PATS與安慰劑在術後急性疼痛治療中作用的比較與過去的試驗相比有了各種明確的限制。成年病人在大外科手術後入蘇醒室後24小時內以11比例隨機使用芬太尼氯化氫PATS40微克或安慰劑後滴定阿片類藥物直至感覺舒適。在入組後前3小時靜脈中追加的芬太尼在兩組病人中都是有效的。終點被定義為病人由於得不到充分的鎮痛而放棄。疼痛程度評分則是由病人整體評價PGA 和研究者整體評價IGA來收集。共有484名病人,244PGA240IGA入組。與安慰劑組相比芬太尼氯化氫PATS組由於得到了充分的鎮痛而放棄的病人數較少。芬太尼氯化氫PATS組與安慰劑組的疼痛程度的平均分分別是3.55.473.4%的病人和72.1% 的研究者認為芬太尼氯化氫PATS是一種良好而有效的控制疼痛的方法。與試驗相關的不良事件發生率兩組也是相同的。本研究證明了芬太尼氯化氫PATS在術後急性疼痛治療中由於安慰劑。

(孫卓真 薛張綱 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.

 

行冠脈造影包括經皮冠脈介入治療病人心肺復蘇的結果和生存期望值

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

 

我們研究樂行冠脈造影病人或行PCI病人的心肺復蘇的結果。在199011號到20001231號間51985個行CAPCI的病人需要CPR。我們對病人的個體差異,不同程式,和短期存活率進行樂研究。長期存活率是通過比較一群在導管介入時出現停搏的病人和名尼蘇達州的人群。在11年間,CPR的發生率是10000人中21.9個。這個比率從1995年前的33.9/10000下降到1995年後13.1/10000CPR後的出院後總生存率是56.1%。存活下的人很少有充血性心衰、冠脈搭橋術及血流動力學不穩定史,有延期的或緊急的導管介入。無脈電活動(心室纖維顫動)預示著低生存率。有趣的是,短期生存和冠脈疾病的程度無關。導管介入中出現停搏的病人和未出現停搏的病人的長期生存率是一樣的。結論是:在診斷和介入治療冠脈疾病時CPR的發生率在1995年後降低了。在導管介入時接受CPR的病人出院後有很高的生存率。這些病人的遠期生存期的減少並不明顯。

(鍾靜 薛張綱 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.

剖宮產腰硬聯合麻醉時採用坐位和右側臥位阻滯特點及低血壓嚴重程度的比較

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


在過去的研究中,我們評價了施行小劑量腰硬聯合麻醉(CSE)時,坐位是否比側臥位更少地引起低血壓。60名擇期行剖宮產的婦女隨機分成側臥位組和坐位組,均以重比重布比卡因和舒芬太尼3.3 g進行腰麻。當硬膜外導管放好後,病人放成左側15仰臥位。麻黃素5 mg IV用於防治噁心/嘔吐和(或)低血壓(收縮壓小於95 mm Hg或低於基礎值的25%)。儘管麻黃素的追加劑量沒有差別,坐位組的婦女需要的麻黃素較少(P = 0.012),且更容易識別硬膜外腔(P = 0.01)。然而,該組中更多的病人需要追加硬膜外劑量(35% vs 3%; P = 0.007)。側臥位組,平面更易向頭側擴散(P = 0.014)Apgar評分並無差別,但坐位組的臍動脈血pH值較側臥位組顯著增高(7.31 0.04 vs 7.26 0.03; P = 0.02)。我們推斷:剖宮產病人行CSE麻醉時,採用坐位,技術上更簡單,且引起低血壓的程度更輕。

(王麗珺 薛張綱 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.

 

利多卡因內添加地塞米松可延長腋路臂叢神經阻滯時間

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.

 

局部神經阻滯時局麻藥中常添加不同藥物用來延長阻滯時間。本研究採用前瞻隨機雙盲研究方法來評價在利多卡因中添加地塞米松用於腋路臂叢神經阻滯的誘導和維持時延長作用時間的效果。六十個手或前臂手術採用臂叢神經阻滯的病人隨機分為兩組,一組採用34mL 1.5%的利多卡因添加2mL生理鹽水(對照組,n = 30),另一組採用34mL 1.5%的利多卡因添加2mL地塞米松(8 mg)(地塞米松組,n = 30)。兩組中都不添加腎上腺素和碳酸氫鹽。在所有病人身上採用神經刺激器和多種刺激方法。在實施神經阻滯後,51530分鐘時記錄橈神經、正中神經、肌皮神經和尺神經的運動和感覺阻滯效果。感覺和運動阻滯的起效時間定義為從最後一個劑量注入到針刺反應完全消除和完全麻痹之間的時間。感覺和運動阻滯的維持時間定義為實施局部麻醉到第一次術後疼痛和運動功能完全恢復之間的時間。十六個病人因為不成功的神經阻滯被排除在實驗之外。手術時間和感覺和運動阻滯的起效時間兩組間相似。地塞米松組較之對照組在感覺阻滯時間(242 ± 76 98 ± 33 分鐘)和運動阻滯時間(310 ± 81 130 ± 31 分鐘)都明顯延長(P < 0.01)。我們的結論是1.5%利多卡因添加地塞米松用於腋路臂叢神經阻滯時可延長感覺和運動阻滯時間。

(金路 薛張綱 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.

 

年齡對硬膜外使用羅呱卡因全身吸收和分佈的影響

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.

 

硬膜外使用羅呱卡因後全身吸收和分佈的問題是很重要的,因為這與其臨床使用及全身毒性危險性相關。我們使用穩定同位素法觀察了年齡對硬膜外使用1.0%羅呱卡因藥代動力學的影響。估計年齡將24位患者分為3組(組118-40歲;組241-60歲;組361歲)。每位患者硬膜外注入150mg鹽酸羅呱卡因。25min後,再靜脈注射50mL 0.44mg/mL 氘標記的羅呱卡因(D3羅呱卡因)。硬膜外用藥後24h以內收集動脈血標本。高齡的患者組與最小年齡患者組相比,羅呱卡因的清除半衰期明顯延長(幾何均數比為0.6095%可信區間為0.37-0.99),清除率明顯降低(均差為194mL/min95%可信區間為18-370mL/min)。全身吸收情況為雙向分佈。羅呱卡因的吸收動力學(在快吸收和慢吸收進程中,吸收分數:(F1F2)為0.27 ± 0.08 0.77 ± 0.12;半衰期:(t,a1, t,a2)為10.7 ± 5.2 min 248 ± 64 min)和其他長效局部麻醉藥範圍相當。最年輕組患者F1的平均值是0.1195%可信區間為0.002-0.22),較中年組稍高一些。我們還觀察到,老年患者硬膜外使用單一劑量的羅呱卡因,年齡相關性藥代動力學差異似乎不影響與藥物全身毒性危險。

(金琳 薛張綱 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.

 

腹腔鏡減肥術中肺泡擴張術和呼氣末正壓通氣對動脈氧合的影響 
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

 

麻醉期間,不正常氣體交換的發生多數是由肺萎陷所致,而且這些變化對於病態肥胖患者的影響比正常體重患者更為顯著。在正常體重的健康患者,持續肺內充氣可以恢復肺內塌陷區域而且改善氧合。我們測試這種通氣策略對於進行腹腔鏡減肥手術患者的動脈氧合(PaO2)的影響。在氣腹建立後,充氣組接受4cmH2O持續肺內充氣,吸氣峰壓到50cmH2O,同時用12cmH2O的呼氣末正壓(PEEP)通氣模式。對照組患者的肺給予標準模式PEEP4cmH2O的通氣。在充氣組和對照組之間比較氣體交換、呼吸動力學,以及血流動力學相關變數。我們發現肺泡充氣有效地增加了術中PaO 2和暫時增加了呼吸系統動態順應性(兩者均P< 0.01)。只要氣管插管後,肺泡充氣對氧合的影響便存在,肺臟給予高PEEP的通氣,但氣管拔管後不久,所有對氧合有利的影響便消失了。在外科手術期間,與對照組相比較,充氣組血管加壓治療使用均數較大(3.0 0.8; P = 0.04)。結論是,我們的資料建議在病態肥胖患者使用肺泡充氣可以是改善術中氧合的有效模式。我們的結果顯示影響效果變得短效而且與術中較頻繁使用血管加壓藥物相關。

(孫敏莉 薛張綱 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.

 

不同氣道設備中有或沒有笑氣全麻對中耳壓力影響的研究

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

 

我們研究了通過不同的氣道設備在混和氣體中帶有或不帶有笑氣(N2O)全麻對中耳氣道壓力(MEP)的影響。80例行全麻的患者(ASA physical status III, 1865 yr)隨機分成口插氣管導管組,經典喉罩組,ProSeal 喉罩組,或喉插管吸引組。分別給予帶有或不帶有66%笑氣的混合氣體麻醉。從誘導前到誘導後每10分鐘至70分鐘,由另一位元觀察者隨機順序測量他們雙耳的MEPN2O組中,40分鐘後N2O改為空氣。N2O組和空氣組中,不同的氣道設備組MEP沒有變化。MEP在空氣組中也沒有變化,但在笑氣組中MEP增加(P < 0.0001),空氣組中MEP降低(P < 0.02)MEP在不同組基礎值相同,但在笑氣組一直處於較高水準(P < 0.001)。我們得出結論,氣道設備的選擇(氣管導管,經典喉罩,ProSeal 喉罩或喉插管吸引)在有或沒有笑氣混合氣體麻醉中不影響MEP

(吳德華 薛張綱 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.

 

透析持續時間是透析依賴患者心臟手術術後機械通氣時間延長的顯著預見指標

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

 

有報導機械通氣時間延長與心臟手術後死亡率增高有相關性。我們設計本研究以確定可能預見體外迴圈下冠脈搭橋的透析依賴患者術後機械通氣延長的術前和術中風險因素。44個透析依賴患者分為2組;E(n = 19)為進入術後ICU24小時內拔除氣管導管,L(n = 25)為需要超過24小時的機械通氣。所有患者在體外迴圈期間接受血液過濾和術後持續靜脈-靜脈血液透析。多元邏輯回歸分析顯示透析持續時間(>10 yr)和手術持續時間(>24 h)是機械通氣延長(>24 h)的獨立風險因素。進入ICU時,L組的Pao2/Fio2明顯低於E(294 ± 135415 ± 99 mm Hg)L組的迴圈狀態比E組差。E組的ICU逗留時間的中值(四分位極差範圍)為33.00)天,明顯短於L(5 [2.75] )。這可能是較長的手術時間使有長期透析史的患者心臟功能不全和低氧合的可能性增加。

(彭中美 馬皓琳 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主動脈連接裝置和急性腎損害:比較三種不同主動脈-冠脈旁路手術技術後的腎功能不全

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

 

雖然心臟手術後的急性腎損害發生機制是多因素的,但降主動脈的粥樣硬化和栓塞是強烈的獨立預測因素。使用SymmetryTM 主動脈連接裝置 (ACD)吻合冠脈移植物近端可能減輕降主動脈動脈粥樣硬化栓塞。所以我們假設使用ACD行非體外迴圈冠脈搭橋術(OPCAB),與常規的OPCAB 或體外迴圈冠脈搭橋術比較,術後腎功能不全更少。3300例連續的非急診主動脈-冠脈搭橋術病人依手術方式回顧性分為三組:A組用ACDOPCAB124例,B組標準OPCAB313例,C組體外迴圈CABG2863例。術後肌酐與基礎值比較的最大變化值用來評判腎臟後果。雖然已知的數個腎臟危險因素和術後肌酐改變峰值之間的關係得到證實,但多因素分析未發現ACD使用可作為術後肌酐改變峰值的獨立預測因素(P = 0.71)。我們未發現與標準OPCAB和體外迴圈CABG相比用ACDOPCAB能減少急性腎損害。

(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.

 

 

脊麻用於嬰兒外科手術的安全性和有效性:佛蒙特州嬰兒脊椎麻醉登記處的研究

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

 

在數量適中的病人中的研究提示,與嬰兒脊麻相關的併發症發生率非常低,如低氧血症、心動過緩及術後呼吸暫停。儘管對於許多外科手術,脊麻似可合理替代全麻,然而這一技術仍未得到充分應用。自1978年以來,關於在佛蒙特州大學進行脊麻的所有嬰兒的臨床資料均已被前瞻性地記錄下來。共有1554例病人被列入研究。由麻醉科住院醫師和主治醫師施行麻醉。穿刺成功率為97.4%。獲得足夠脊麻平面的病人占95.4%。脊麻獲得效果所需時間平均為10 min。有10例病人觀察到氧合血紅蛋白飽和度下降到<90%24(1.6%)病人出現心動過緩(心率<100bpm)。本研究證實,嬰兒脊麻併發症發生率很低。施行脊麻安全、有效,且預期的成功率較高。當嬰兒進行下腹部或下肢手術時,應重點考慮脊麻作為全麻以外的另一選擇。

(周志堅 馬皓琳 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.

 

 

利用腦電圖熵指數建立七氟醚催眠效果的藥代動力學-藥效學模型

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

 

熵指數是一種從腦電圖衍生出來的新參數,可以用於建立全身麻醉藥的藥代動力學-藥效學(PKPD)模型。這項研究中,我們試圖推導出七氟醚濃度和腦電圖熵之間關係的PKPD模型。我們在加深和減弱七氟醚麻醉過程中收集了20位元病人的熵資料。第一輪週期由無任何輔助用藥的麻醉誘導和減淺期組成。用效應室和抑制性Emax模型描述了七氟醚濃度和熵之間的關係。PKPD參數從完整的週期以及加深和減弱七氟醚麻醉各階段中得出。第二輪麻醉週期僅由一個重新加深階段組成,同時包括氣道管理和常規輔助藥物的應用。用從第一輪中得到的PKPD資料以預測第二輪的熵變化。七氟醚效應位點濃度與熵之間存在著一致的關係(絕對加權剩餘中位數= 11.6%)。對於完整的第一輪週期的效應熵(平均值±標準差):T1/2 Keo = 2.4 ± 1.5 min, γ= 5.9 ± 2.3, EC50 = 1.7 ± 0.3我們發現在週期中的七氟醚濃度上升部分與下降部分的γ值之間存在顯著差別(61.1 ± 55.25.7 ± 2.8)。當效應位點濃度大於3%時,EEG熵就不能隨著七氟醚濃度的進一步增加而變化了。效應室抑制性Emax模型精確地描述了七氟醚濃度和EEG熵間的關係。在七氟醚濃度上升到3%的過程中,熵逐漸減小。量-效曲線的斜率在麻醉藥濃度的上升期和下降期不同。

(黃佳佳 馬皓琳 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.

 

 

雷米芬太尼在貓肺血管床中的一項分析

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

 

在這項研究中,我們試圖鑒定雷米芬太尼在貓科動物肺血管床的作用。在對成年雜種貓進行的離體實驗中,研究了格列本脲(腺苷三磷酸敏感性K+通道阻滯劑)、苯海拉明(組胺H1受體拮抗劑)、L-N51-胍)鹽酸鳥氨酸(一氧化氮合酶抑制劑)和納洛酮(阿片受體拮抗劑)在肺動脈對雷米芬太尼(阿片激動劑)、吡那地爾(pinacidil,腺苷三磷酸敏感性K+通道激動劑)和緩激肽(一氧化氮合酶誘導劑)的反應中的作用。在分離的貓左下肺葉血管床張力增加的情況下,雷米芬太尼導致劑量依賴性的血管減壓反應,在應用格列本脲和L-N51-胍)鹽酸鳥氨酸後這種反應無顯著變化。應用苯海拉明和納洛酮後肺血管床對雷米芬太尼的反應明顯減弱。本結果提示雷米芬太尼對貓肺血管床具有較強的血管減壓作用,這種作用是由組胺和阿片受體敏感通路介導的。

(顏濤 譯, 馬皓琳 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.

 

 

環氧化酶-1抑制能縮短地西泮導致的小鼠翻正反射消失時程

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

 

選擇性的環氧合酶-1COX-1)抑制劑戊酰水楊酸鹽或者非選擇性抑制劑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)導致的小鼠翻正反射消失時程縮短29%-46%。另一方面,花生四烯酸(20 mg/kg)使地西泮導致的翻正反射消失的時程延長48%。阿司匹林能夠取消花生四烯酸的這種效應。但是,10 mg/kg阿司匹林並不改變5 mg/kg地西泮對自主活動能力和翻轉能力的效應。這些發現強烈提示,一種或者更多的環氧合酶產物,最可能是前列腺素,在調節地西泮的催眠作用機制中扮演重要角色。闡釋相關機制能有助於增加我們對苯二氮卓類藥物的藥理學的認識。

(顏濤 譯, 馬皓琳 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.

 

 

提供優良氣管插管條件所需的司可林劑量

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

 

在這個前瞻、隨機、雙盲、安慰劑對照的研究中,我們試圖確定模擬快速麻醉誘導時,在60s內提供優級插管條件的司可林劑量範圍。180例病人麻醉誘導採用芬太尼2 µg/kg和異丙酚 2 mg/kg。病人意識消失後,隨機靜注司可林 0.30.51.01.52.0 mg/kg或鹽水(對照組)。在60 s後行氣管插管。由一名對本試驗分組不知情的研究者行所有的喉鏡檢查並評估插管條件。結果顯示,插管條件優級的發生率 在司可林 0.00.30.51.01.52.0 mg/kg組分別0.0%43.3%60.0%63.3%80.0%86.7%。司可林各組氣管插管條件優級的發生率比對照組高(P < 0.001);而司可林2.0 mg/kg 組氣管插管條件優級的發生率較 司可林0.3 mg/kg組高(P < 0.05)。使50%和80%的病人在60s內達到優級氣管插管條件所需的司可林計算劑量(以及其95%可信區間)分別為0.390.290.51mg/kg1.61.22.0mg/kg。看來司可林劑量超過1.5mg/kg時並無優點。

(邱鬱薇 馬皓琳 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.

 

 

 

椎管內使用加巴噴丁的抗痛敏作用靶位:Ca2+通道、KATP通道還是N-甲基-D-天門冬氨酸受體?

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

 

加巴噴丁是一種新鎮痛藥,其作用機制尚不明了。我們 在一個術後疼痛的模型上對到底是ATP敏感性鉀通道(KATP)、N甲基D天門冬氨酸(NMDA)受體還是Ca2+通道參與了椎管內使用加巴噴丁的抗痛敏作用進行了研究。異氟醚麻醉的大鼠通過切割腳掌誘發出機械性痛超敏。在切割前後及椎管內使用藥物後分別測定近切口處對von Frey 細絲刺激的回縮閾值。加巴噴丁(100 µg)的抗痛敏作用並不受KATP通道、NMDA受體或γ氨基丁酸(GABAA受體拮抗劑椎管內預處理的影響。KATP通道和γ氨基丁酸(GABAA受體激動劑本身對切割後的痛敏幾乎沒有作用。NCa2+通道阻斷劑({omega}-芋螺毒素 GVIA, 0.1–3 µg)而不是P/Q({omega}-agatoxin IVA)L型(維拉帕米、地爾硫卓或尼莫地平)或T型(米貝拉地爾)阻斷劑可以象加巴噴丁那樣緩解由切割誘導的痛敏。加巴噴丁和{omega}-芋螺毒素的抗痛敏作用都可被Bay K 8644(一種LCa2+通道激動劑)所抵消。這些結果提供了相關證據支援以下觀點:是NCa2+通道而不是KATP通道、NMDA受體或GABAA受體可能參與了椎管內應用加巴噴丁的抗痛敏作用。

(黃施偉 譯,馬皓琳 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.

 

 

開胸術後硬膜外輸注新斯的明的作用

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討過手術期間的連續硬膜外注入新斯的明的作用。我們在開胸術的病人中進行這一研究。這是一個雙盲試驗,九十例病人按隨機法分為3組。麻醉誘導前在局麻下於T5-8水平置入硬膜外導管。Pre-neo組於麻醉誘導前硬膜外推注500µg新斯的明,之後以125 µg/h連續輸注直至手術結束。Post-neo組在相同的時間段內硬膜外給予鹽水,並且在手術結束時硬膜外給予500µg新斯的明。對照組在三個時間段內均硬膜外給予鹽水。新斯的明組病人術後用嗎啡0.02 mg/mL, 布比卡因0.08 mg/mL, 新斯的明7 µg/mL進行硬膜外自控鎮痛。對照組術後硬膜外自控鎮痛不用新斯的明。資料獲取至術後6天。Pre-neo組病人每日硬膜外自控鎮痛消耗量在術後 1–6天明顯小於post-neo組及對照組(分別至少減少10%16% P < 0.05)。Pre-neo組在術後3–6天疼痛強度較其他組明顯減輕(P <0.05)。這些結果提示胸段硬膜外連續給予新斯的明麻醉前可以提供超前鎮痛,並且有節省鎮痛藥的效果,可以在不增加不良反應發生率的前提下改善手術後的鎮痛。

(黃麗娜    馬皓琳 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.

 

 

比較瑞芬太尼和芬太尼複合異丙酚在清醒開顱腫瘤切除術中患者的滿意度

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

 

本研究比較瑞芬太尼和芬太尼複合應用異丙酚在為清醒開顱腫瘤切除術患者提供有意識的鎮靜中的效力, 並評估患者對這兩種技術的滿意度。50名患者隨機分為瑞芬太尼組和芬太尼組,評估是否能維持適當水平的鎮靜、足夠的鎮痛和血流動力學的穩定。記錄所有的併發症。術後1小時、4小時、24小時隨訪患者術中知曉和疼痛以及所有方面的滿意度。在鎮靜和疼痛評分或血流動力學和呼吸變數方面兩組沒有差別,術中併發症的發生率也無差別(芬太尼,14;瑞芬太尼16)。有9名(18%)患者發生呼吸方面的併發症(芬太尼6;瑞芬太尼3)。知曉和滿意度評分也沒差別,93%的患者在幾次的隨訪中都表示十分滿意。瑞芬太尼持續輸注複合應用異丙酚可以替代芬太尼和異丙酚複合應用於清醒開顱術鎮靜,這兩種技術都能很好地被患者接受。

(陳瑋 馬皓琳 李士通 審校)

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.

 

 

膕部刺激導管在拇(足)外翻手術後鎮痛中的應用

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

 

刺激導管最近已在臨床上應用。我們對48例拇外翻手術後留置導管行膕部坐骨神經阻滯鎮痛的病人行隨機、對照、雙盲研究,觀察使用刺激導管或非刺激導管鎮痛的有效性和局麻藥的用量。S-125S-0625組病人放置了刺激導管,NS-125組病人放置同樣的導管,但不給予刺激。S-125NS-125組病人給予0.125%的左旋布比卡因,S-0625組病人給予0.0625%的左旋布比卡因。所有病人每小時給予3ml持續輸注,同時有每小時3ml的可能單次追加量。術後6–8小時和19–23小時,對病人進行VAS疼痛評分。S-125 S-0625組病人,放置導管需要多次嘗試。術後6–8小時,與S-0625 NS-125組病人相比,S-125組病人中位VAS疼痛評分較低〔5(0–17.5)60(15–80)70(25–80) (P<0.05)〕。術後19–23小時,S-125組病人中位VAS疼痛評分較NS-125組病人低〔0(0–0)7.5(0–10)(P<0.05)〕。S-125組與S-0625NS-125組病人相比,需要靜脈注射阿片類藥物鎮痛的較少〔057例病人,(P<0.05)〕。我們認為使用刺激導管可以提高鎮痛的有效性。

(張瑩 馬皓琳 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.

 

 

脊髓麻醉中溫度對高比重布比卡因擴散的影響

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

 

脊髓麻醉的分佈受局部麻醉劑溶液的密度和粘滯度的影響,可能受注射劑溫度的影響。我們這一試驗中的假設是注射劑的溫度影響它在蛛網膜下腔的分佈。我們測量高比重0.5%布比卡因在25°C37°C時的密度和粘滯度,在36個病人中檢驗這些溶液在脊髓麻醉中的起效和範圍。兩個溶液的密度相似(均數 [標準差]): 25°C, 1.028 [0.000], 相對37°C, 1.028 [0.000] (g/mL),但是粘滯度在25°C時比37°C時更明顯(0.01116 [0.00003] 相對0.00843 [0.00002] g · cm–1 · s–1; P < 0.001)。用失去針刺感評判向頭側的最大擴散範圍,37°C溶液更高(37°C T225°CT5; P < 0.001),但是達到最大阻滯高度的時間是一樣的。結論,我們發現通過加熱高比重0.5%布比卡因從25°C37°C,產生一定程度的脊髓麻醉向頭側擴散的一致增加。粘滯度在溫暖的溶液中減小,但是不清楚是這個原因或者別的因素造成脊髓麻醉中阻滯平面的不同。

(張 譯,馬皓琳 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.

 

 

性別與全麻聯用肌松藥的恢復

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後女性恢復比男性快,但是尚不清楚其原因是性別的影響還是給藥模式或手術類型的差別。我們冒著術中知曉的風險進行了一個子集分析,比較了入組到一個測試雙譜指數(BIS)監測有效性的大試驗的聯用肌松藥的全麻女性和男性患者的恢復特點。我們在1079例患者(584例男性,495例女性)中用多元統計方法來調整基線特點、手術持續時間和範圍以及給麻醉藥的差異。儘管給予的麻醉藥量相近,然而女性患者的BIS值高於男性患者(時間-平均值[標準差]BIS:男性44.6 [7.1]比女性46.4 [6.6]P = 0.005)。女性麻醉後到睜眼的時間和到能夠離開麻醉後監護室的時間均較男性短(分別為: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)。多元調整後這些差異持續存在(兩者的P ≤0.001)。對於接受聯用神經肌肉阻滯劑的全麻患者的恢復時間,性別有獨立的影響作用,女性恢復較男性快。儘管給予的麻醉藥量相近,然而女性在麻醉維持期間的BIS值較高,這提示女性對麻醉藥的催眠作用不如男性敏感,且可能有助於解釋女性恢復時間較快。

(馬皓琳 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.

 

 

紅發女性報告出現瘀斑的比率稍高但凝血功能測試結果正常

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

 

有一種未經檢驗的印象認為紅發的病人較其他發色的病人更易在圍術期出現出血等併發症。本研究檢驗了下述假設:可通過 常用的凝血功能測試發現可被感知的凝血問題。參加研究的健康高加索人種女性志願者年齡在1840歲,天然紅發的志願者(n25)和天然黑髮和深棕發色的志願者(n26)在身高、體重和年齡方面均有可比性。詢問志願者既往出血史並進行如下測試:全血細胞計數、凝血酶原時間/國際標準比率、部分凝血活酶時間、血小板功能分析、標準濁度法測血小板聚集反應。促血小板聚集劑為二磷酸腺苷、花生四烯酸、膠原、腎上腺素和2個單位濃度的瑞斯西丁菌素。紅發組志願者報告出現瘀斑的比率明顯高於黑髮組,但是兩組間血紅蛋白濃度、血小板計數、凝血酶原時間/國際標準比率和部分凝血活酶時間無顯著差異。且進一步的血小板功能分析和血小板聚集反應測定也未發現兩組間血小板功能有明顯差異。由此得出結論:即使紅發的人有凝血功能異常,此種異常也非常輕微。

(周雅春 馬皓琳 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.