Anesthesia & Analgesia

February 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

离体模型中纤维蛋白原置换对逆转稀释性凝血障碍的作用

(范颖晖 陈杰 校)

The Effect of Fibrinogen Substitution on Reversal of Dilutional Coagulopathy: An In Vitro Model
Dietmar Fries, Petra Innerhofer, Christian Reif, Werner Streif, Anton Klingler, Wolfgang Schobersberger, Corinna Velik-Salchner, and Barbara Friesenecker Anesth Analg 2006 102: 347-351.

辅用小型转流系统的常温不停跳心脏手术:对术中血流动力学和炎症反应的影响

(黄施伟 马皓琳 李士通 校)

Normothermic Beating Heart Surgery with Assistance of Miniaturized Bypass Systems: The Effects on Intraoperative Hemodynamics and Inflammatory Response

Steffen Rex, Stefan Brose, Sebastian Metzelder, Lothar de Rossi, Sylvia Schroth, Rüdiger Autschbach, Rolf Rossaint, and Wolfgang Buhre

Anesth Analg 2006 102: 352-362.

PEDIATRIC ANESTHESIA:

BIS监测仪用于小儿镇静深度监测的有效性 

(孙敏莉译 薛张纲校)

Validation of the Bispectral Index Monitor for Measuring the Depth of Sedation in Children

Senthilkumar Sadhasivam, Arjunan Ganesh, Amy Robison, Robin Kaye, and Mehernoor F. Watcha

Anesth Analg 2006 102: 383-388

在出生至18岁儿童中区分镇静深度的观察性指标和客观测量方法的比较

(周志坚 马皓琳 李士通 校)

A Comparison of Observational and Objective Measures to Differentiate Depth of Sedation in Children from Birth to 18 Years of Age

Shobha Malviya, Terri Voepel-Lewis, and Alan R. Tait

Anesth Analg 2006 102: 389-394.

骶管麻醉,罗哌卡因浓度,术后镇痛与儿童

(金琳 薛张纲 校)

Caudal Regional Anesthesia, Ropivacaine Concentration, Postoperative Analgesia, and Infants

Samia Khalil, Hemanth Lingadevaru, Mariana Bolos, Mary Rabb, Maria Matuszczak, Douglas Maposa, and Alice Chuang

Anesth Analg 2006 102: 395-399.

行耳鼻喉小手术的儿童七氟醚吸入诱导后地氟醚维持麻醉比七氟醚诱导并维持麻醉苏醒期躁动少

(邱郁薇 马皓琳 李士通 校)

Desflurane Anesthesia After Sevoflurane Inhaled Induction Reduces Severity of Emergence Agitation in Children Undergoing Minor Ear-Nose-Throat Surgery Compared with Sevoflurane Induction and Maintenance

Jochen Mayer, Joachim Boldt, Kerstin D. Röhm, Klaus Scheuermann, and Stefan W. Suttner

Anesth Analg 2006 102: 400-404.

婴儿11/2ProSealTM喉罩的应用:与经典喉罩比较的随机、交叉实验研究

(赵延华 陈杰 校)

The Size 11/2 ProSealTM Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the ClassicTM Laryngeal Mask Airway

Kai Goldmann, Christine Roettger, and Hinnerk Wulf

Anesth Analg 2006 102: 405-410.

不带针头的注射系统与EMLA用于小儿静脉置管前镇痛效果的比较

(吴德华译 薛张纲校)

A Comparison of a Needle-Free Injection System for Local Anesthesia Versus EMLA® for Intravenous Catheter Insertion in the Pediatric Patient

Nathalia Jimenez, Heidi Bradford, Kristy D. Seidel, Manuela Sousa, and Anne M. Lynn

Anesth Analg 2006 102: 411-414

AMBULATORY ANESTHESIA:

隆乳术后甲基氢化泼尼松减轻疼痛、呕吐和疲劳:甲基氢化泼尼松125 mg,帕瑞考昔40mg和安慰剂单次剂量、随机、平行分组研究

(潘志英 陈杰 校)

Methylprednisolone Reduces Pain, Emesis, and Fatigue After Breast Augmentation Surgery: A Single-Dose, Randomized, Parallel-Group Study with Methylprednisolone 125 mg, Parecoxib 40 mg, and Placebo

Luis Romundstad, Harald Breivik, Helge Roald, Knut Skolleborg, Torleiv Haugen, Jon Narum, and Audun Stubhaug

Anesth Analg 2006 102: 418-425

ANESTHETIC PHARMACOLOGY:

联合应用瑞芬太尼的靶控输注异丙酚的性能:两种异丙酚输注公式的临床研究

(陈玮 马皓琳 李士通 校)

The Performance of a Target-Controlled Infusion of Propofol in Combination with Remifentanil: A Clinical Investigation with Two Propofol Formulations

J. K. Götz Wietasch, Martin Scholz, Jörg Zinserling, Nicholas Kiefer, Christian Frenkel, Pascal Knüfermann, Ute Brauer, and Andreas Hoeft

Anesth Analg 2006 102: 430-437

病态肥胖者中琥珀胆碱的剂量

(马皓琳 李士通 校)

The Dose of Succinylcholine in Morbid Obesity

Harry J. M. Lemmens and Jay B. Brodsky

Anesth Analg 2006 102: 438-442

大麻类激动剂WIN 55,212-2与酮洛酸间在抗伤害性刺激方面有相加作用

(田婕 陈杰 校)

The Additive Antinociceptive Interaction Between WIN 55,212-2, a Cannabinoid Agonist, and Ketorolac

Ahmet Ulugöl, Filiz Özyigit, Özgür Yesilyurt, and Ahmet Dogrul

Anesth Analg 2006 102: 443-447.

右美托咪定诱导所致大鼠Accumbal内多巴胺的减少部分是由兰斑核的调节所致

( 路译 薛张纲校)

Dexmedetomidine-Induced Decreases in Accumbal Dopamine in the Rat Are Partly Mediated via the Locus Coeruleus

Robert A. Whittington and László Virág

Anesth Analg 2006 102: 448-455.

右旋美托咪啶对围产期兴奋中毒性脑损伤的作用是通过α2A肾上腺受体亚型介导的

(王丽珺译 薛张纲校)

The Effects of Dexmedetomidine on Perinatal Excitotoxic Brain Injury are Mediated by the {alpha}2A-Adrenoceptor Subtype

Andrea Paris, Jean Mantz, Peter H. Tonner, Lutz Hein, Marc Brede, and Pierre Gressens

Anesth Analg 2006 102: 456-461.

局麻药通过抑制TrkA酪氨酸激酶活性抑制神经生长因子介导的神经突外生

(周雅春 马皓琳 李士通 校)

Local Anesthetics Suppress Nerve Growth Factor-Mediated Neurite Outgrowth by Inhibition of Tyrosine Kinase Activity of TrkA

Mayumi Takatori, Yoshihiro Kuroda, and Munetaka Hirose

Anesth Analg 2006 102: 462-467.

对易患恶性高热的猪肌肉注射氟烷和咖啡因后乳酸盐的剂量反应关系和局部分布

(张美荣 陈杰 校)

The Dose-Response Relationship and Regional Distribution of Lactate After Intramuscular Injection of Halothane and Caffeine in Malignant Hyperthermia-Susceptible Pigs

Frank Schuster, Hendrik Schöll, Martin Hager, Rainer Müller, Norbert Roewer, and Martin Anetseder

Anesth Analg 2006 102: 468-472.

局麻药对灌注大鼠肝脏的胆汁流量、钾平衡和痒耗的影响

(陆文清译 薛张纲校)

The Effects of Local Anesthetics on Bile Flow, Potassium Equilibrium and Oxygen Consumption in the Perfused Rat Liver

Peter Felleiter, Peter Lierz, and Jürg Graf

Anesth Analg 2006 102: 473-477.

TECHNOLOGY, COMPUTING, AND SIMULATION:

术中无线持续动脉压监测:一项试验性的研究

(黄佳佳 马皓琳 李士通 校)

Wireless Continuous Arterial Blood Pressure Monitoring During Surgery: A Pilot Study

Karl Øyri, Ilangko Balasingham, Eigil Samset, Jan Olav Høgetveit, and Erik Fosse

Anesth Analg 2006 102: 478-483

手术患者使用T-Line® Tensymeter (持续性无创血压监测设备)与常用的有创性桡动脉监测的精确性比较

(朱慧琛 陈杰 校)

An Accuracy Evaluation of the T-Line® Tensymeter (Continuous Noninvasive Blood Pressure Management Device) versus Conventional Invasive Radial Artery Monitoring in Surgical Patients

Gregory M. Janelle and Nikolaus Gravenstein

Anesth Analg 2006 102: 484-490.

氧气臂(OxyArm):一种辅助给氧设备

(周荻 薛张纲 校)

The OxyArmTM: A Supplemental Oxygen Delivery Device

James W. Futrell, Jr and Jack L. Moore

Anesth Analg 2006 102: 491-494

PAIN MEDICINE:

在掌挛缩行肌腱切除术后发生复杂区域疼痛综合征的发生率:对四个麻醉方法的前瞻性观察研究

(赵雪莲 马皓琳 李士通 校)

The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren’s Contracture: A Prospective Observational Study of Four Anesthetic Techniques

Scott S. Reuben, Rene Pristas, Duane Dixon, Shameema Faruqi, Lakshmi Madabhushi, and Steven Wenner

Anesth Analg 2006 102: 499-503.

围术期尼莫地平与术后镇痛

(郑丽 陈杰 校)

Perioperative Nimodipine and Postoperative Analgesia

Gerri Casey, Sally-Ann Nortcliffe, Paul Sharpe, and D. J. Buggy

Anesth Analg 2006 102: 504-508.

肉毒毒素A对人炎症疼痛模型无抗损伤和抗炎作用

(王慧琳译 薛张纲校)

A Lack of Antinociceptive or Antiinflammatory Effect of Botulinum Toxin A in an Inflammatory Human Pain Model

Thomas Sycha, Doris Samal, Boris Chizh, Stephan Lehr, Burkhard Gustorff, Peter Schnider, and Eduard Auff

Anesth Analg 2006 102: 509-516.

CRITICAL CARE AND TRAUMA:

在重症监护环境中的通讯:移动电话改善病人护理

(彭中美 马皓琳 李士通 校)

Communication in Critical Care Environments: Mobile Telephones Improve Patient Care

Roy G. Soto, Larry F. Chu, Julian M. Goldman, Ira J. Rampil, and Keith J. Ruskin

Anesth Analg 2006 102: 535-541

在体大鼠模型中肾上腺素增加窒息后短暂心跳停止的死亡率

(顾新宇 陈杰 校)

Epinephrine Increases Mortality after Brief Asphyxial Cardiac Arrest in an In Vivo Rat Model

Conán L. McCaul, Patrick J. McNamara, Doreen Engelberts, Gregory J. Wilson, Alex Romaschin, Andrew N. Redington, and Brian P. Kavanagh

Anesth Analg 2006 102: 542-548.

NEUROSURGICAL ANESTHESIA:

经光谱及转运功能分析评估七氟醚对动态脑血流自动调节的影响

(徐丽颖译 薛张纲校)

The Effect of Sevoflurane on Dynamic Cerebral Blood Flow Autoregulation Assessed by Spectral and Transfer Function Analysis

Yojiro Ogawa, Ken-ichi Iwasaki, Shigeki Shibata, Jitsu Kato, Setsuro Ogawa, and Yoshiyuki Oi

Anesth Analg 2006 102: 552-559.

七氟醚麻醉时前脑和后脑循环的自动调节及CO2反应性

(裘毅敏 马皓琳 李士通 校)

Cerebral Autoregulation and CO2 Reactivity in Anterior and Posterior Cerebral Circulation During Sevoflurane Anesthesia

Irene Rozet, Monica S. Vavilala, Andrew M. Lindley, Elizabeth Visco, Miriam Treggiari, and Arthur M. Lam

Anesth Analg 2006 102: 560-564

阶梯性缺氧性低氧血症期间大鼠纹状体血氧饱和度的测量

(忻纪华 陈杰 校)

Measuring Hemoglobin Oxygen Saturation During Graded Hypoxic Hypoxia in Rat Striatum

Cécile Julien, Adrian Bradu, Raphaël Sablong, Emmanuelle Grillon, Chantal Remy, Jacques Derouard, and Jean-François Payen

Anesth Analg 2006 102: 565-570

高血压和正常血压大鼠大脑微血管内向整流K+通道介导的血管舒张

(徐丽颖译 薛张纲校)

Vasodilation Mediated by Inward Rectifier K+ Channels in Cerebral Microvessels of Hypertensive and Normotensive Rats

Katsutoshi Nakahata, Hiroyuki Kinoshita, Yasuyuki Tokinaga, Yuko Ishida, Yoshiki Kimoto, Mayuko Dojo, Kazuhiro Mizumoto, Koji Ogawa, and Yoshio Hatano

Anesth Analg 2006 102: 571-576

OBSTETRIC ANESTHESIA:

在择期剖宫产病人中脊硬复合麻醉的阻滞平面高于等量单次脊麻

(颜涛 马皓琳 李士通 校)

Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients

Farida Ithnin, Yvonne Lim, Alex T. Sia, and Cecilia E. Ocampo

Anesth Analg 2006 102: 577-580

REGIONAL ANESTHESIA:

年龄对坐骨神经阻滞持续时间的影响

(曹榆 陈杰 校)

The Effect of Age on Sciatic Nerve Block Duration

R. Kyle Hanks, Ricardo Pietrobon, Karen C. Nielsen, Susan M. Steele, Marcy Tucker, David S. Warner, Kathryn P. King, and Stephen M. Klein

Anesth Analg 2006 102: 588-592.

坐骨神经阻滞的最小有效局麻剂量是多少——一项前瞻性、随机性的腘窝内与臀下注射法的比较。

(孙卓真译 薛张纲校)

What Is the Minimum Effective Volume of Local Anesthetic Required for Sciatic Nerve Blockade? A Prospective, Randomized Comparison Between a Popliteal and a Subgluteal Approach

Manuel Taboada, Jaime Rodríguez, Cristina Valiño, Javier Carceller, Begoña Bascuas, Juan Oliveira, Julian Alvarez, Francisco Gude, and Peter G. Atanassoff

Anesth Analg 2006 102: 593-597.

温度记录图体温测量法与针刺及冷觉在预测区域阻滞效果方面的比较

(黄丽娜 马皓琳 李士通 )

Thermographic Temperature Measurement Compared with Pinprick and Cold Sensation in Predicting the Effectiveness of Regional Blocks

Eilish M. Galvin, Sjoerd Niehof, Hector J. Medina, Freek J. Zijlstra, Jasper van Bommel, Jan Klein, and Serge J. C. Verbrugge

Anesth Analg 2006 102: 598-604.

地塞米松是否能加强静脉局部麻醉以及镇痛效果?一个随机对照临床研究

(丁希喆 陈杰 校)

Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized, Controlled Clinical Study

Zekiye Bigat, Neval Boztug, Necmiye Hadimioglu, Nihan Cete, Nesil Coskunfirat, and Ertugrul Ertok

Anesth Analg 2006 102: 605-609.

GENERAL ARTICLES:

术后鼻部填塞在睡眠呼吸紊乱和夜间低氧血症这两方面对睡眠呼吸暂停综合征病人的影响

(韩晓丹译 薛张纲校)

The Impact of Postoperative Nasal Packing on Sleep-Disordered Breathing and Nocturnal Oxygen Saturation in Patients with Obstructive Sleep Apnea Syndrome

Adrian Regli, Britta S. von Ungern-Sternberg, Werner M. Strobel, Hans Pargger, Antje Welge-Luessen, and Adrian Reber

Anesth Analg 2006 102: 615-620.

自发呼吸时对新型声门上气道装置King LT TM的插入和功能的评价

(张莹 马皓琳 李士通 校)

An Evaluation of the Insertion and Function of a New Supraglottic Airway Device, the King LT TM, During Spontaneous Ventilation

Carin Hagberg, Yefim Bogomolny, Clarence Gilmore, Valentine Gibson, Mark Kaitner, and Somya Khurana

Anesth Analg 2006 102: 621-625

可曲喉镜(FlexibladeTM)和Macintosh喉镜在成人全身麻醉时咽部显露情况的临床比较

(肖洁 陈杰 )

A Clinical Comparison of the FlexibladeTM and Macintosh Laryngoscopes for Laryngeal Exposure in Anesthetized Adults

Rochelle W. W. Cheung, Michael G. Irwin, Bassanio C. W. Law, and C. K. Chan
Anesth Analg 2006 102: 626-630.

眼镜蛇喉周导气管和喉罩在自主通气中的比较:一项随机的前瞻性研究:

( 静译 薛张纲校)

A Comparison Between the PLA CobraTM and the Laryngeal Mask Airway UniqueTM During Spontaneous Ventilation: A Randomized Prospective Study

Luis Gaitini, Boris Yanovski, Mustafa Somri, Sonia Vaida, Tome Riad, and David Alfery

Anesth Analg 2006 102: 631-636.

嗜铬细胞瘤腹腔镜手术路径:较低的腹内压是否有利?

( 马皓琳 李士通 校)

Laparoscopic Approach to Pheochromocytoma: Is a Lower Intraabdominal Pressure Helpful?

Jayashree Sood, Lakshmi Jayaraman, Ved P. Kumra, and Pradeep K. Chowbey

Anesth Analg 2006 102: 637-641.

BIS监测仪用于小儿镇静深度监测的有效性 
Validation of the bispectral index monitor for measuring the depth of sedation in children.

Sadhasivam S, Ganesh A, Robison A, Kaye R, Watcha MF.

Department of Anesthesiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Anesth Analg. 2006,102(2):383-8.

 

BIS(双频指数)是一个经验的校准数值,其起源于成人脑电图数据,该数据在成人与镇静深度相关。我们测试这样的假说,BIS分值在小儿镇静深度监测中是有效的测定,该研究设计避免以前已发表报道中的限制。BIS值来自96名健康的ASAI-II级的112岁的儿童,持续记录其镇静深度并自动传输至电脑中。两个不知情的观察者每隔3-5分钟使用OAA/S(the Observer's Assessment of Alertness /Se- dation)以及UMSS镇静评分表(the University of Michigan Sedation Scale)进行评估。通过Spearman's秩相关检测和预测概率(P < 0.001),在BISUMSS之间以及BISOAA/S之间有显著的相关性。在小于6岁的儿童,BIS与进行侵袭性和非侵袭性操作的亚组的临床镇静分值之间有着显著相关性(P < 0.001)。在进行临床镇静评分的两个独立的观察者之间也有着良好的一致性(к= 0.51, P < 0.001)。我们得出结论,在儿童,BIS监测仪是一个量化的、无创的,而且使用方便的镇静深度监测仪。

(孙敏莉译 薛张纲校)

The Bispectral Index (BIS) is an empirically calibrated number derived from adult electroencephalograph data that correlates with the depth of sedation in adults. We tested the hypothesis that the BIS score is a valid measure of the depth of pediatric sedation in a study designed to avoid limitations of a previously published report. BIS values from 96 healthy ASA physical status I-II children aged 1-12 yr undergoing sedation were continually recorded and electronically transferred to a computer. Two independent observers blinded as to BIS score evaluated sedation using the Observer's Assessment of Alertness/Sedation (OAA/S) and the University of Michigan Sedation Scale (UMSS) at 3-5 min intervals. There was a significant correlation between BIS and UMSS and between BIS and OAA/S by both the Spearman's rank correlation test and by prediction probability (P < 0.001). In children <6 yr, there was a significant correlation between BIS and the clinical sedation scores for subgroups undergoing invasive and noninvasive procedures (P < 0.001). There was also good agreement between the 2 independent observers who assessed clinical sedation scores (kappa = 0.51, P < 0.001). We conclude that the BIS monitor is a quantitative, nondisruptive and easy to use depth of sedation monitor in children.

 

骶管麻醉,罗哌卡因浓度,术后镇痛与儿童

Caudal Regional Anesthesia, Ropivacaine Concentration, Postoperative Analgesia, and Infants

Samia Khalil, MD, Hemanth Lingadevaru, MD, Mariana Bolos, MD, Mary Rabb, MD, Maria Matuszczak, MD, Douglas Maposa, MD, and Alice Chuang, PhD .

Department of Anesthesiology, Department of Ophthalmology, The University of Texas Medical School at Houston, Houston, Texas.

Anesth Analg 2006 102: 395-399.

 

为评价112月大的婴儿骶管阻滞后罗哌卡因镇痛及运动阻滞的效果及持续时间,我们进行了一项随机双盲临床试验,将患儿分为4组,分别使用0.1%(1)0.15%(2)0.175%(3)0.2%(4)的罗哌卡因,用量为1 mL/kg。术后各组需要进行药物镇痛的患儿数目不同(P<0.0005)。组1和组2需要镇痛的患儿比组4多,而组3和组4无明显差别。在PACU内,组1和组2比组4的患儿需要更多的镇痛药物(P0.0098)。在日间手术室,组间有显著的不同,组3和组4的患儿无需任何镇痛药物(P0.034. 各组镇痛时间长短也不相同(P0.034)。组1和组2的患儿镇痛时间较短,组3和组4没有明显差别。与组3相比,组4患儿需要更长的时间恢复运动功能(P0.0347)。我们认为,对于婴儿来说,0.175%的罗哌卡因与0.2%的罗哌卡因术后镇痛效果和时间相似,而0.1%0.15%的罗哌卡因较差;0.175%的罗哌卡因对运动功能的影响较少。

(金琳 薛张纲 校)

In this randomized, double-blind trial we evaluated the quality and duration of analgesia and motor effects after caudal block using 1 mL/kg of ropivacaine 0.1% (Group 1), 0.15% (Group 2), 0.175% (Group 3) compared to 0.2% (Group 4) in infants 1–12 mo old. Postoperatively, the number of infants who received pain medication differed among the groups (P < 0.0005). There were more infants in Groups 1 and 2 compared with Group 4 and there was no difference between Groups 3 and 4. In the postanesthesia care unit, infants in Groups 1 and 2 received more pain medication than did those in Group 4 (P = 0.0098). In the day surgery unit, there was a significant difference among the groups (P = 0.0326); infants in Groups 3 and 4 required no pain medication. The analgesia duration differed among the groups (P = 0.034). Infants in Groups 1 and 2 had a shorter duration, and there was no difference between Groups 3 and 4. Infants in Group 4 took longer to regain their motor power compared with those in Group 3 (P = 0.0347). We conclude that in infants, ropivacaine 0.175% provided postoperative analgesia and duration similar to that of ropivacaine 0.2%, whereas ropivacaine 0.1% and 0.15% did not, and it was associated with fewer motor effects.

 

不带针头的注射系统与EMLA用于小儿静脉置管前镇痛效果的比较

A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient.

Jimenez N. Bradford H. Seidel KD. Sousa M. Lynn AM.

Department of Anesthesiology and Pain Medicine, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA.

Anesth Analg 102(2):411-4, 2006 Feb.

 

静脉置管对小儿来说是一个疼痛和痛苦的过程。J-Tip是一种FDA认可的用于小儿静脉置管前局部麻醉的不带针头的注射系统。本研究我们比较了J-TipEMLA(局麻药可溶性混合物)用于小儿静脉置管前的镇痛效果。7-19岁的儿童(n = 116)随机分为两组:一组(n = 57)用装有1%丁卡因缓冲液0.25mLJ-Tip 注射系统在静脉置管前作局麻;另一组(n = 59)用2.5gEMLA 。记录置管成功次数和注射局麻药及静脉置管时的疼痛评分(0-10 视觉疼痛评分)。两组间疼痛的发生率有显著的差异(P = 0.0001):EMLA组中位数为3J-Tip 组中位数为0。局部敷料去除时,J-Tip 84%的儿童诉无痛而EMLA组为61%P = 0.004)。两组间在置管成功次数上没有差异。装有1%丁卡因缓冲液的J-Tip 注射系统用于静脉置管前局部麻醉可消除疼痛,与EMLA相比有更好的麻醉效果。

(吴德华译 薛张纲校)

Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7-19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip (n = 57) or 2.5 g of EMLA (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0-10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA (median = 3) and the J-Tip (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.

 

右美托咪定诱导所致大鼠Accumbal内多巴胺的减少部分是由兰斑核的调节所致

Dexmedetomidine-Induced Decreases in Accumbal Dopamine in the Rat Are Partly Mediated via the Locus Coeruleus

Robert A. Whittington, MD, and László Virág, MS

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York

Address correspondence and reprint requests to Robert A. Whittington, MD, Columbia University College of Physicians and Surgeons, Department of Anesthesiology, 622 West 168th Street, PH 5, New York, NY 10032.

Anesth Analg 2006 102: 448-455.

 

我们以前已经证实选择性2-肾上腺素能受体激动剂右美托咪定(Dex)降低大鼠NAcc细胞外多巴胺(DA)水平。由于兰斑核(LC)是和Dex多种药理作用相关联的去甲肾上腺素能中枢,我们在此研究兰斑核在Dex诱导下对accumbal DA的调制作用。将微透析探针植入Sprague-Dawley大鼠的NAccLC,并通过探针将Dex 5 mM (Dex-High, n = 6)Dex 0.5 mM (Dex-Mid, n = 5)Dex 5 µM (Dex-Low, n = 6),人工脑脊液(对照, n = 5)注入LC进行逆行标记微透析 45分钟。采用电化学探测仪高效液相色谱法连续测量NAcc透析液中细胞外液DA水平。Dex引起NAcc中细胞外液DA水平显著降低。在Dex-HighDex-Mid Dex-Low各组中,accumbal DA基线大幅度下降分别达68.9% ± 8.8%75.1% ± 6.5%77.04% ± 12.8%。对照组中细胞外液DA未观测到显著降低。伍用高选择性2-肾上腺素能受体拮抗剂(n = 6)RS 79948 20 mM可防止Dex诱导所致的accumbal DA减少。这些数据,表明LCDex诱导的中脑边缘系统DA调制中发挥作用,并支持这样的假设,去甲肾上腺素能系统能够调节中枢神经系统中较远处的多巴胺能部位。

(金 路译 薛张纲校)

We have demonstrated previously that the systemic administration of the selective 2-adrenoceptor agonist dexmedetomidine (Dex) decreases extracellular dopamine (DA) levels in the rat nucleus accumbens (NAcc). Because the locus ceruleus (LC) is a noradrenergic center linked to several of the pharmacological effects of Dex, we investigated the role of the LC in Dex-induced modulation of accumbal DA. Microdialysis probes were implanted in the NAcc and LC of Sprague-Dawley rats, and Dex 5 mM (Dex-High, n = 6), Dex 0.5 mM (Dex-Mid, n = 5), Dex 5 µM (Dex-Low, n = 6), or artificial cerebrospinal fluid (control, n = 5) was administered in the LC via retrograde microdialysis for 45 min. Extracellular DA levels were continuously measured in the NAcc dialysates using high-performance liquid chromatography coupled to electrochemical detection. Dex produced significant decreases in extracellular DA in the NAcc. Accumbal DA decreased maximally to 68.9% ± 8.8%, 75.1% ± 6.5%, and 77.04% ± 12.8% of baseline in the Dex-High, Dex-Mid, and Dex-Low groups, respectively. No significant decrease in extracellular DA was observed in the control group. The coadministration of the highly selective 2-adrenoceptor antagonist (n = 6) RS 79948 20 mM prevented the Dex-induced decrease in accumbal DA. These data suggest that the LC plays a role in Dex-induced modulation of mesolimbic DA and support the hypothesis that noradrenergic systems can regulate remote dopaminergic sites in the central nervous system.

 

右旋美托咪啶对围产期兴奋中毒性脑损伤的作用是通过α2A肾上腺受体亚型介导的

The Effects of Dexmedetomidine on Perinatal Excitotoxic Brain Injury are Mediated by the 2A-Adrenoceptor Subtype

Andrea Paris, Jean Mantz, Peter H. Tonner, Lutz Hein, Marc Brede, and Pierre Gressens

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.

Anesth Analg 2006 102: 456-461.

 

我们在α2肾上腺受体亚型缺陷的大鼠中进行这一试验,阐明在围产期兴奋中毒性脑损伤模型中,α2肾上腺受体亚型对右旋美托咪啶神经保护特性的作用。将出生后5天的野生型大鼠和缺乏α2A(α2A-KO)α2C(α2C-KO)肾上腺受体亚型的大鼠腹膜内随机注射右旋美托咪啶(3 μg/kg)或磷酸钠缓冲液。30分钟后,脑内注射10μg谷氨酸激动剂ibotenate,产生类似围产期缺氧性皮质坏死和白质损伤。出生后10天,对该损伤进行组织病理学定量检测。右旋美托咪啶使野生型大鼠和α2C-KO大鼠的皮质受损平均面积分别减少了44% 49%,右旋美托咪啶预处理使ibotenate导致的白质损伤减少了71%(野生型大鼠)75%(α2C-KO大鼠)。相反,在α2A-KO大鼠,右旋美托咪啶并未对皮质兴奋性损伤起到保护作用,反而使白质损伤更明显(受损平均面积达82%)。右旋美托咪啶对围产期兴奋性脑损伤具有神经保护作用,而其在α2A-KO大鼠上完全无效,提示了右旋美托咪啶的神经保护作用通过α2肾上腺受体亚型起效。

(王丽珺译 薛张纲校)

We performed the current study in mice lacking individual alpha2-adrenoceptor subtypes to elucidate the contribution of alpha(2)-adrenoceptor subtypes to the neuroprotective properties of dexmedetomidine in a model of perinatal excitotoxic brain injury. On postnatal Day 5, wild-type mice and mice lacking alpha2A-adrenoceptor (alpha2A-KO) or alpha2C-adrenoceptor subtypes (alpha2C-KO) were randomly assigned to receive dexmedetomidine (3 microg/kg) or phosphate-buffered saline intraperitoneally. Thirty minutes after the intraperitoneal injection, the glutamatergic agonist ibotenate (10 microg) was intracerebrally injected, producing transcortical necrosis and white matter lesions that mimic perinatal human hypoxic-like lesions. Quantification of the lesions was performed on postnatal Day 10 by histopathologic examination. Dexmedetomidine reduced mean lesion size in the cortex of wild-type mice and alpha2C-KO mice by 44% and 49%, respectively. Ibotenate-induced white matter lesions were reduced by 71% (wild-type mice) and 75% (alpha2C-KO mice) after pretreatment with dexmedetomidine. In contrast, in alpha2A-KO mice, dexmedetomidine did not protect against the cortical excitotoxic insult, and white matter lesions were even more pronounced (82% increase of mean lesion size). Dexmedetomidine provides potent neuroprotection in a model of perinatal excitotoxic brain damage. This effect was completely abolished in alpha2A-KO mice, suggesting that the neuroprotective effect is mediated via the alpha2A-adrenoceptor subtype.

 

局麻药对灌注大鼠肝脏的胆汁流量、钾平衡和痒耗的影响

The effects of local anesthetics on bile flow, potassium equilibrium and oxygen consumption in the perfused rat liver.
Felleiter P, Lierz P, Graf J.

Department of Intensive Care Medicine, Swiss Paraplegic-Centre Nottwil, Switzerland. Anesth Analg. 2006,102(2):473-7

 

酰胺类局麻药大部分通过肝脏代谢。只有在特殊的运用,如置管用于长时间的镇痛时,才会产生较高的血浆药物浓度。由于目前不知道局麻药是否影响肝功能,我们就检测利多卡因、布比卡因、罗派卡因分别在血药浓度1 10 microg/mL时对灌注大鼠肝脏代谢活性的影响。在高浓度的时候,三种局麻药都立即增加痒耗,布比卡因和罗派卡因也通过转运的方式减少钾离子的释放,三种药物都增加胆汁的流量,这种利胆的作用在布比卡因和利多卡因低浓度时就表现出来了。在低浓度时,只有利多卡因明显增加痒耗,肝静脉的PH值没有明显变化。结果显示,这三种局麻药的急性给药只造成肝脏功能性的改变。这些观察到的变化是由于线粒体的脱耦联、药物的吸收、代谢产物的胆道分泌及对钾离子通道的抑制造成的。数据并没有显示这些急性变化会引起持续的术后肝功能异常,例如胆汁瘀积或是黄疸。

(陆文清译 薛张纲校)

Amide local anesthetics mainly undergo hepatic metabolism. Specific applications, such as catheter application for long-term pain therapy, may result in large plasma concentrations. As it is unknown whether local anesthetics influence liver function, we examined the influence of lidocaine, bupivacaine, and ropivacaine in concentrations of 1 and 10 microg/mL on the metabolic activity of the perfused rat liver. At the large concentrations, all three local anesthetics caused an immediate increase of oxygen consumption. Bupivacaine and ropivacaine also transiently reduced potassium release. All drugs increased bile flow; this choleretic effect was also significant for bupivacaine and lidocaine in smaller concentrations. In the smaller concentration, only lidocaine significantly increased oxygen consumption. No significant changes in hepatic venous pH were observed. The results show that acute administration of all three local anesthetics results in significant changes of functional variables of the liver. The observed effects appear to result from mitochondrial uncoupling, uptake of the drugs, biliary secretion of their metabolites, and from inhibition of potassium channels. The data provide no evidence that these acute changes may result in enduring postoperative disturbances of liver function, such as cholestasis or jaundice.

 

氧气臂(OxyArm):一种辅助给氧设备

The OxyArm: a supplemental oxygen delivery device.
Futrell JW Jr, Moore JL.
Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Anesth Analg. 2006 Feb; 102(2):491-4.

 

面罩和鼻导管用于全麻术后病人的辅助给氧。这些设备有一些患者相关的并发症,包括吸气困难,高碳酸血症和机械损伤。一种新的设备,氧气臂(OxyArm)的设计以消除这些问题。这是一种开放给氧系统,不需要与患者面部直接接触。在本项临床研究中我们评估了氧气臂在术后即刻期间的应用。六十位病人在全麻气管拔管后的第一个八分钟内通过氧气臂接受辅助给氧。在3-4分钟内持续记录氧饱和度值:1)在气管拔管前通过气管内导管吸氧时,2)气管拔管后的4分钟以4L/min氧流量通过氧气臂给氧时,3)气管拔管后的8分钟以2L/min氧流量通过氧气臂给氧时。这三个时间段的氧饱和度无显著差异且没有病人的氧饱和度低于88%。病人和临床医生高度评价氧气臂,因为它舒适,使用简单,面部护理时无需打断氧疗。总而言之,氧气臂能提供大部分患者术后早期足够水平的氧。

(周荻 薛张纲 校)

Facemasks and nasal cannulae are used to provide supplemental oxygen to patients in the postoperative period after general anesthesia. These devices are associated with several patient complications, including aspiration, hypercarbia, and mechanical trauma. A new device, the OxyArm, is designed to eliminate these problems. It is an "open oxygen" system that does not require physical contact with the patient's face. In this clinical study we evaluated the OxyArm in the immediate postoperative period. Sixty patients received supplemental oxygen via the OxyArm for the first 8 min after tracheal extubation after general anesthesia. Oxygen saturation values were continuously recorded during 3 4-min time periods: 1) while breathing oxygen through an endotracheal tube before tracheal extubation, 2) while breathing oxygen delivered by the OxyArm at 4 L/min 4 min after tracheal extubation, and 3) while breathing oxygen delivered by the OxyArm at 2 L/min 8 min after tracheal extubation. There were no significant differences in oxygen saturation among the three time periods and no patient experienced an oxygen desaturation event less than 88%. Patients and clinicians praised the OxyArm for its comfort and ease of use, allowing nursing facial care without interrupting oxygen therapy. We conclude that the OxyArm delivers adequate levels of oxygen for most patients during the early postoperative period.

 

肉毒毒素A对人炎症疼痛模型无抗损伤和抗炎作用.

A lack of antinociceptive or antiinflammatory effect of botulinum toxin a in an inflammatory human pain model.
Sycha T, Samal D, Chizh B, Lehr S, Gustorff B, Schnider P, Auff E.
Department of Neurology, Medical University of Vienna, Vienna, Austria.

Anesth Analg 2006,102: 509-516.

 

几项体内和体外调查发现,肉毒毒素A(BoNT/A)可以抑制P物质和兴奋性氨基酸的释放。最近,在炎性致敏的动物疼痛模型中观察到,肉毒毒素A有明显的抗损伤作用和抑制谷氨酸盐的释放。在最新的研究中,我们测试了肉毒毒素A对于特征性的人炎症疼痛模型的抗炎和抗过敏作用。采用随机双盲配对的研究方法比较了100对老鼠模型(肉毒毒素A对照纯盐水)。记录了热损伤和机械损伤开始时,48小时(正常皮肤)和72小时(炎症皮肤)的表皮血流。紫外线B照射可导致局部严重的原发或继发的过敏性炎症。尽管肉毒毒素A有较强的泌汗功能,但对于正常皮肤和过敏皮肤的疼痛感觉无作用。原发的和继发的过敏性炎症不受肉毒毒素A的影响。因此,我们可以肯定,肉毒毒素A对急性的非炎性疼痛没有直接作用。尽管有大量来自动物的研究数据,我们仍未观察到肉毒毒素A对人的炎性疼痛有抗损伤和抗炎作用。

(王慧琳译 薛张纲校)

Several in vitro and in vivo investigations have shown that botulinum toxin A (BoNT/A) can inhibit the release of substance P and excitatory amino acids. Recently, a marked antinociceptive effect of BoNT/A and inhibition of glutamate release was observed in an animal pain model with inflammatory sensitization. In the present study, we tested the antiinflammatory and antihyperalgetic effect of BoNT/A in a well-characterized human inflammatory pain model. Using a randomized, double-blind, paired study design, we compared the effects of 100 mouse units of BoNT/A versus pure saline. Thermal and mechanical pain testings and superficial skin blood flow measurements were performed at baseline, at 48 h (in normal skin), and at 72 h (in inflamed skin) thereafter. Ultraviolet B irradiation resulted in a local inflammation with significant primary and secondary hyperalgesia. However, despite the evidence of efficacy on sudomotor function, BoNT/A had no effect on pain measures in either normal or inflamed skin. Signs of inflammation and primary and secondary hyperalgesia were found to be unaffected by BoNT. We have confirmed that BoNT/A has no direct effect on acute, noninflammatory pain. Furthermore, despite highly promising data from animal research, we have not observed antiinflammatory or antinociceptive effects of BoNT/A in human inflammatory pain.

 

经光谱及转运功能分析评估七氟醚对动态脑血流自动调节的影响

The effect of sevoflurane on dynamic cerebral blood flow autoregulation assessed by spectral and transfer function analysis

Ogawa Y, Iwasaki K, Shibata S, Kato J, Ogawa S, Oi Y.
Department of Dental Anesthesiology, Nihon University School of Dentistry, Nihon University School of Medicine, Tokyo, Japan.

Anesth Analg. 2006 Feb;102(2):552-9.

 

七氟醚降低自主神经系统调节,后者在脑自动调节中扮演重要角色。因此,我们假设七氟醚影响脑自动调节。我们采用血压变率和脑血流速率变率间光谱和转运功能分析来研究七氟醚对动态脑血流自动调节的影响。11名健康男性经面罩吸入0.5%, 1.0%, 1.5%七氟醚。通过转运功能增加,相位,和经颅多普勒测得的大脑中动脉的脑血流速率与桡动脉压的一致性来评估动态脑自动调节。给予0.5% 1.0%七氟醚期间,极低频率范围(0.02-0.07 Hz)一致性增加到0.5以上。0.5% 1.0%七氟醚使此频率范围(0.02-0.07 Hz)内转运功能增加作为一项动态脑自动调节指标显著增强。然而,给予七氟醚期间,转运功能增加和低、高频率范围内的一致性维持不变。这些结果表明,在极低频率范围内甚至低浓度的七氟醚就可削弱动态脑自动调节,而在低或高频率范围内动态脑自动调节维持不变。

(徐丽颖译 薛张纲校)

Sevoflurane reduces autonomic neural control, which plays a significant role in cerebral autoregulation. Therefore, we hypothesized that sevoflurane influences cerebral autoregulation. We investigated the effects of sevoflurane on dynamic cerebral blood flow (CBF) autoregulation by using spectral and transfer function analysis between blood pressure variability and CBF velocity variability. Eleven healthy male subjects received 0.5%, 1.0%, and 1.5% sevoflurane via facemask. Dynamic cerebral autoregulation was evaluated by transfer function gain, phase, and coherence between CBF velocity in the middle cerebral artery measured by transcranial Doppler, and blood pressure in the radial artery. Coherence in the very low-frequency range (0.02-0.07 Hz) increased above 0.5 during administration of 0.5% and 1.0% sevoflurane. Transfer function gain in this frequency range (0.02-0.07 Hz), as an index of dynamic cerebral autoregulation, increased significantly with 0.5% and 1.0% sevoflurane. Transfer function gain and coherence in the low- and high-frequency ranges, however, remained unchanged during administration of sevoflurane. These results suggest that sevoflurane impairs dynamic cerebral autoregulation in the very-low-frequency range even with small concentrations, whereas dynamic cerebral autoregulation in the low- and high-frequency ranges remained unchanged.

 

高血压和正常血压大鼠大脑微血管内向整流K+通道介导的血管舒张.

Vasodilation mediated by inward rectifier K+ channels in cerebral microvessels of hypertensive and normotensive rats.

Nakahata K, Kinoshita H, Tokinaga Y, Ishida Y, Kimoto Y, Dojo M, Mizumoto K, Ogawa K, Hatano Y.
Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan.

Anesth Analg. 2006 Feb;102(2):571-6.

 

尽管内向整流K+通道与脑循环调节相关,经这些通道介导的脑微血管系统扩张尚未在慢性高血压者中证实。我们设计了这项研究以调查在高血压和正常血压大鼠中,内向整流K+通道在脑实质细动脉细胞外K+水平升高导致的血管舒张中所起的作用。在前列腺素F2alpha (5 x 10(-7) M)所致的收缩期间,采用计算机辅助显微镜评估大脑切片的细动脉。氯化钾(KCl)致使血压正常(5-10 mM)和高血压(5-15 mM)大鼠的大脑细动脉扩张,而内向整流K+通道阻滞剂氯化钡(BaCl2; 10(-5) M)却完全消除了两组的血管舒张。高血压大鼠的细动脉对KCl的血管扩张反应比血压正常大鼠要显著。相反,两组中硝普钠(3 x 10(-8) to 3 x 10(-6) M)所致的血管扩张反应相似。这些结果表明,内向整流K+通道在大脑皮层实质微血管中,对细胞外K+引起的血管舒张起重要作用,且在慢性高血压者中经此通道导致的大脑细动脉扩张更甚。

(徐丽颖译 薛张纲校)

Although inward rectifier K+ channels contribute to the regulation of cerebral circulation, dilation of cerebral microvasculature mediated by these channels has not been demonstrated in chronic hypertension. We designed the present study to examine the roles of inward rectifier K+ channels in the vasodilation produced by increased levels of extracellular K+ in cerebral parenchymal arterioles from hypertensive and normotensive rats. During constriction to prostaglandin F2alpha (5 x 10(-7) M), the arterioles within brain slices were evaluated using computer-assisted microscopy. Potassium chloride (KCl) induced vasodilation in cerebral arterioles from normotensive (5-10 mM) and hypertensive (5-15 mM) rats, whereas an inward rectifier K+ channel antagonist barium chloride (BaCl2; 10(-5) M) completely abolished the vasodilation in both strains. In arterioles of hypertensive rats, vasodilator responses to KCl were augmented compared with those in normotensive rats. In contrast, the vasodilator responses induced by sodium nitroprusside (3 x 10(-8) to 3 x 10(-6) M) in these two strains were similar. These results suggest that in cerebral cortex parenchymal microvessels, inward rectifier K+ channels play a crucial role in vasodilation produced by extracellular K+ and that the dilation of cerebral arterioles via these channels is augmented in chronic hypertension.

 

坐骨神经阻滞的最小有效局麻剂量是多少——一项前瞻性、随机性的腘窝内与臀下注射法的比较。

What is the minimum effective volume of local anesthetic required for sciatic nerve blockade? A prospective, randomized comparison between a popliteal and a subgluteal approach.

Taboada M, Rodriguez J, Valino C, Carceller J, Bascuas B, Oliveira J, Alvarez J, Gude F, Atanassoff PG.
Department of Anesthesiology, University of Santiago de Compostela, Hospital Clinico Universitario de Santiago, Spain.

Anesth Analg. 2006 Feb;102(2):593-7.

 

对于坐骨神经阻滞而言,没有明确的研究表明最适用药量是多少。这项流行性、前瞻性、随机性的研究旨在发现用1.5%的甲哌卡因在腘窝内注射和臀下注射阻滞坐骨神经的最小用量。有56名将要进行足部手术的病人被随机的分配为臀下组(n = 28)与腘窝组(n = 28)。所有的神经阻滞都被神经刺激器(刺激频率, 2 Hz, 强度 1.5-0.5 mA)与外周神经刺激导管所检测。所有的病人都能在刺激<0.5 mA时被引发出跖屈反应并能维持一段时间。完整的局麻效果被定义为对针刺丧失痛觉并在阻滞后分钟又伴随的肌无力以至于不能跖屈或背屈。用臀下法阻滞坐骨神经的平均用量为12 +/- 3 mL而腘窝内注射法则为20 +/- 3 mL(P < 0.05)。臀下法充分阻滞坐骨神经的ED9517 mL而腘窝内注射法则为30 mL。作者得出的结论为局麻阻滞坐骨神经时,远距离的部位(腘窝)用药量要大于近距离部(臀下法)位阻滞时所用的药量。
(孙卓真译 薛张纲校)

For sciatic nerve blockade, no study has defined the optimal volume of local anesthetic required to block the nerve. The current, prospective, randomized investigation was designed to find a minimum volume of 1.5% mepivacaine required to block the sciatic nerve using the subgluteal and posterior popliteal approaches. A total of 56 patients undergoing foot surgery were randomly assigned to receive sciatic nerve block by means of a posterior subgluteal (group subgluteal, n = 28) or a posterior popliteal (group popliteal, n = 28) approaches. All blocks were performed with the use a nerve stimulator (stimulating frequency, 2 Hz, intensity 1.5-0.5 mA) and a perineural stimulating catheter. In all patients, plantar flexion of the foot was elicited at <0.5 mA, to maintain consistency among groups. The volume of local anesthetic used in each patient was based on the modified Dixon's up-and-down method. Complete anesthesia was defined as complete loss of pinprick sensation in the sciatic nerve distribution with concomitant inability to perform plantar or dorsal flexion of the foot 20 min after injection. The mean volume of local anesthetic required to block the sciatic nerve was 12 +/- 3 mL in the subgluteal group and 20 +/- 3 mL in the popliteal group (P < 0.05). The ED95 for adequate block of the sciatic nerve was 17 mL in the subgluteal group and 30 mL in the popliteal group. The authors conclude that a larger volume of local anesthetic is necessary to block the sciatic nerve at a more distal site (popliteal approach) as compared with a more proximal level (subgluteal approach).

 

术后鼻部填塞在睡眠呼吸紊乱和夜间低氧血症这两方面对睡眠呼吸暂停综合征病人的影响
The impact of postoperative nasal packing on sleep-disordered breathing and nocturnal oxygen saturation in patients with obstructive sleep apnea syndrome.
Regli A, von Ungern-Sternberg BS, Strobel WM, Pargger H, Welge-Luessen A, Reber A.
Department of Anesthesia and Operative Critical Care, University Hospital Basel, Basel, Switzerland.
Anesth Analg 2006 102: 615-620.

 

鼻中隔手术常常是为了建立一个功能性鼻道。在这些病人中阻塞性睡眠呼吸暂停综合症(OSAS)频繁发生。虽然患有阻塞性睡眠呼吸暂停综合症的病人发生低氧血症的危险性增加,但是术后鼻部填塞(PNP)对于患者的睡眠呼吸紊乱和氧的去饱和作用至今仍不清楚。我们连续调查了40位做内鼻手术的病人,他们术后都用了鼻部填塞。其中15位病人以前诊断为阻塞性睡眠呼吸暂停综合症(组2),另25位病人没有被诊断(组1)。在对照组,12位健康志愿者将进行耳部或颈部的手术而没有行鼻部填塞。在术前和术后的晚上,我们持续测量病人的口鼻流量、胸腹运动度和氧饱和度。我们计算了呼吸暂停-呼吸不全指数(AHI)和氧去饱和度指数(ODI)。将术前和术后的数值进行比较,对照组志愿者的AHIODI都没有改变。与此相反,第一组病人AHIODI值明显增加;而第二组病人,仅AHI明显增加,ODI没有明显改变。因为OSASPNP的病人ODI值不增加,所以术后的彻夜吸氧和重症监护就不必要作为一项常规来实行了。

(韩晓丹译 薛张纲校)


Nasal septum surgery is frequently performed to establish a functional nasal airway.
In these patients obstructive sleep apnea syndrome (OSAis frequently present. Although patients with OSAS are at increased risk for hypoxemia, the impact of postoperative nasal packing (PNP) on sleep-disordered breathing and oxygen desaturations in patients with OSAS is unknown. We consecutively investigated 40 patients undergoing endonasal surgery receiving PNP Fifteen of these patients had previously diagnosed OSAS (Group 2) and 25 did not (Group 1). In the control group, 12 healthy patients underwent elective ear or neck surgery without PNP. During the preoperative and postoperative nights, we continuously measured oronasal flow, thoracoabdominal movements, and oxygen saturation. We calculated the apnea-hypopnea index (AHI) and the oxygen-desaturation index (ODI). Compared with the preoperative valuafter the operation, neither AHI nor ODI changed in the control group. In contrast, in Group 1, AHI (from 11 [5-19] to 37 [22-49]) and ODI (from 4 [2-8] to 13 [6-21]) significantly increased (P < 0.05), whereas in Group 2, only AHI significantly increased (from 14 [10-21] to 39 [26-50]); ODI remained similar (13 [8-27] versus 11 [4-37]). Because ODI did not increase in patients with OSAS and PNP who received postoperative oxygen overnight, postoperative intensive care monitoring might not be necessary on a routine basis for all patients with PNP and OSAS.

 

眼镜蛇喉周导气管和喉罩在自主通气中的比较:一项随机的前瞻性研究:

A comparison between the PLA Cobra and the Laryngeal Mask Airway Unique during spontaneous ventilation: a randomized prospective study.
Gaitini L, Yanovski B, Somri M, Vaida S, Riad T, Alfery D.
Department of Anesthesiology, Bnai Zion Medical Center Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.

 

喉罩和眼镜蛇喉周导气管一次性使用的声门上通气器械。还没有研究比较两者在自主通气中的应用。我们比较两者在以下几方面:1)在自主通气中通气的可变2)有时间得到有效的气道。3)气道介入需求4)套囊封闭压力5)纤维光学镜6)围手术有害事件。80个成人ASA分级12级,病人全麻,病人被随机地分为使用喉罩或眼镜蛇喉周导气管。在吸入潮气量、呼出潮气量、呼气末CO2浓度、呼吸频率、次数和类型、纤维光学评分和围手术期有害时间上两组人没有明显差异。眼镜蛇喉周导气管地口咽漏气压力更高(27 +/- 7 versus 21 +/- 4 cm H2O; P < 0.001).喉罩组的氧饱和度更高(98.1% +/- 1% versus 97.3% +/- 2%; P = 0.02)喉罩的插入时间更短(23.7 +/- 2 s versus 26.6 +/- 7 s; P = 0.02)喉罩插入也更容易。但这些差异并没有临床意义。两种方式都可以为全麻提供充分的通气。

(钟 静译 薛张纲校)
The Laryngeal Mask (LMA) Unique and the Cobra Perilaryngeal Airway (PLA) are single-use supraglottic devices.
There are no published studies comparing these devices during spontaneous ventilation. We compared the LMA Unique and the Cobra PLA with respect to 1) ventilatory variables during spontaneous ventilation, 2) time to achieve an effective airway, 3) airway intervention requirements, 4) cuff seal pressures, 5) fiberoptic score, and 6) perioperative adverse events. Eighty adult ASA physical status I-II patients undergoing general anesthesia for minor routine surgery were randomly allocated to LMA Unique or PLA Cobra for airway management. No statistically significant differences were found between the devices with respect to inspiratory tidal volume, expiratory tidal volume, end-tidal CO2 concentration, respiratory rate, number and type of airway interventions required with placement, the fiberoptic score, and the incidence of perioperative adverse events. The oropharyngeal leak (seal) pressure was higher for the CobraPLA (27 +/- 7 versus 21 +/- 4 cm H2O; P < 0.001). The oxygen saturation was higher (98.1% +/- 1% versus 97.3% +/- 2%; P = 0.02) in the LMA group. Time of insertion was shorter for LMA (23.7 +/- 2 s versus 26.6 +/- 7 s; P = 0.02) and insertion difficulty was less for LMA (P = 0.03). As these differences were not judged to be clinically important, both devices appear to be effective in establishing an adequate airway in patients who are spontaneously breathing under general anesthesia.

离体模型中纤维蛋白原置换对逆转稀释性凝血障碍的作用

The Effect of Fibrinogen Substitution on Reversal of Dilutional Coagulopathy: An In Vitro Model

Dietmar Fries*, Petra Innerhofer*, Christian Reif{dagger}, Werner Streif{dagger}, Anton Klingler{ddagger}, Wolfgang Schobersberger§, Corinna Velik-Salchner*, and Barbara Friesenecker*

Departments of *Anaesthesiology and Critical Care Medicine and {dagger}Pediatrics and {ddagger}Division of Theoretical Surgery, Innsbruck Medical University; and §University for Health Science, Medical Informatics and Technology Tyrol (UMIT), Innsbruck, Austria

Anesth Analg 2006 102: 347-351.

 

胶体液和晶体液常用于处理重度创伤患者的低血压。但是伴随液体治疗时常出现凝血因子、血小板的稀释,及影响纤维蛋白原聚集导致出血加重,从而使患者的最终结果更差。作者用离体模型研究稀释血样中补充纤维蛋白原是否能逆转稀释性凝血功能障碍。取5位健康男性志愿者的血液用乳酸林格氏液、4%的明胶或6%羟乙基淀粉130\0.4,和乳酸林格氏液与这两种胶体液之一的混合物稀释60%。此后,三份稀释血样用3个不同浓度的纤维蛋白原(0.751.53 mg/mL)培养。用改良血栓弹性描记法(ROTEM®; Pentapharm, Munich, Germany)进行评估。稀释60%后,凝血时间延长,且血凝块强度和纤维蛋白聚合显著降低。在稀释血样中给予纤维蛋白原后,凝血时间缩短,血凝块强度和纤维聚合增加。离体纤维蛋白原置换对ROTEM®变量的作用取决于纤维蛋白原的剂量和用于稀释血样的液体种类。

(范颖晖 陈杰 校)

Colloids and crystalloids are usually administered as treatment for hypovolemia in severely injured patients. However, dilution of clotting factors and platelets together with impaired fibrinogen polymerization are associated with fluid therapy and may aggravate hemorrhage, thus worsening final outcome of these patients. We investigated, in an in vitro model, whether the addition of fibrinogen to diluted blood samples can reverse dilutional coagulopathy. Blood from 5 healthy male volunteers was diluted by 60% using lactated Ringer's solution, 4% modified gelatin solution, or 6% hydroxyethyl starch 130/0.4, as well as the combination of lactated Ringer's solution with either of the 2 colloid solutions. Thereafter, aliquots of diluted blood samples were incubated with 3 different concentrations of fibrinogen (0.75, 1.5, and 3.0 mg/mL). Measurements were performed by modified thrombelastography (ROTEM®; Pentapharm, Munich, Germany). After 60% dilution, clotting times increased, whereas clot firmness and fibrin polymerization decreased significantly. After administration of fibrinogen, clotting times decreased and clot firmness, as well as fibrin polymerization, increased in all diluted blood samples. The effect of in vitro fibrinogen substitution on ROTEM® variables was dependent on the fibrinogen dosage and the type of solution used to dilute the blood samples.

 

婴儿11/2ProSealTM喉罩的应用:与经典喉罩比较的随机、交叉实验研究

The Size 11/2 ProSealTM Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the ClassicTM Laryngeal Mask Airway

Kai Goldmann, MD, DEAA, Christine Roettger, FW, and Hinnerk Wulf, MD

Departmen t of Anaesthesia and Intensive Care Therapy, Philipps University Marburg, Germany

Anesth Analg 2006 102: 405-410.

 

经典喉罩(CLMA)用于小儿的许多问题,被认为与通气罩设计不足有关。CLMA的主要局限之一在于正压通气时通气罩密封不够。ProSeal喉罩(PLMA)是一种通气罩改良的新型喉罩,用于儿童时显示较CLMA有更有效的密封性。近来已经有了一种小儿尺寸(11/2)的PLMA。作者对30名年龄为15个月(2-30月)、体重9 kg (5-12 kg)的小儿进行非肌松的麻醉,随机应用CLMAPLMA。测定气道漏气压和最大潮气量,确定喉罩放置的难易度、最初气道的特性和用光导纤维定位的位置,并评估应用PLMA时放置胃管的情况。在头正中位时应用CLMAPLMA平均气道漏气压分别为26.718.9 cmH2O;最大屈曲状态时分别为35.6 28.2 cmH2O,平均最大潮气量分别为312260 mL,应用PLMA明显较大(P < 0.01)。有8名患者应用CLMA时空气进入胃内,应用PLMA者则没有。除一名病人外均成功放置了胃管。应用PLMA的患者中有3名出现了一定程度的喉压迫。与相同尺寸的CLMA 相比,11/2 PLMA用于小儿维持气道可能更合适。与应用CLMA相比,PLMA允许同时放置胃管,而且在气道压较高时才会出现漏气,用于小儿PPV时有重要意义。

(赵延华 陈杰 校)

Many problems with the ClassicTM laryngeal mask airway (CLMA) in infants are believed to be related to its inadequate cuff design. One of the main limitations of the CLMA is that the resulting low-pressure seal can be inadequate for positive pressure ventilation (PPV). The ProSealTM LMA (PLMA), a new laryngeal mask airway with a modified cuff, has been shown to form a more effective seal than the CLMA in children. The first infant size PLMA, size 11/2, became available recently. We studied 30 anesthetized, nonparalyzed infants aged 15 mo (2–30 mo) and weighing 9 kg (5–12 kg). The CLMA and PLMA were inserted in random order into each patient. Airway leak pressure and maximum tidal volume were measured. Ease of insertion, quality of initial airway, and fiberoptic position were also determined. Gastric tube placement was assessed for the PLMA. The mean airway leak pressure in neutral head position (26.7 versus 18.9 cm H2O), maximum flexion (35.6 versus 28.2 cm H2O), and the mean maximum tidal volume (312 versus 260 mL) were significantly higher for the PLMA (P < 0.01). Air entered the stomach in eight patients with the CLMA but did not with the PLMA. Gastric tube placement was possible in all but one patient. In three patients, the use of the PLMA led to some degree of clinically relevant compression of the larynx. The size 11/2 PLMA seems to be a more suitable device for airway maintenance in infants than the same size CLMA. The ability to insert a gastric tube at the same time, and a significantly higher airway leak pressure than with the CLMA, may have important implications for its use for PPV in infants.

 

隆乳术后甲基氢化泼尼松减轻疼痛、呕吐和疲劳:甲基氢化泼尼松125 mg,帕瑞考昔40mg和安慰剂单次剂量、随机、平行分组研究

Methylprednisolone Reduces Pain, Emesis, and Fatigue After Breast Augmentation Surgery: A Single-Dose, Randomized, Parallel-Group Study with Methylprednisolone 125 mg, Parecoxib 40 mg, and Placebo

Luis Romundstad, MD*, Harald Breivik, MD, DMSc*, Helge Roald, MD, DMSc{ddagger}, Knut Skolleborg, MD{ddagger}, Torleiv Haugen, MD{dagger}, Jon Narum, MD{dagger}, and Audun Stubhaug, MD, DMSc*

*Department Group of Clinical Medicine, University of Oslo; {dagger}Department of Anesthesiology, Rikshospitalet University Hospital; and {ddagger}Department of Plastic and ENT Surgery, Colosseum Clinic, Oslo, Norway

Anesth Analg 2006 102: 418-425.

 

作者用随机、双盲、平行分组的方法比较研究了隆乳术术前给予甲基氢化泼尼松125 mg IV (n = 68)和帕瑞考昔40 mg IV (n = 68)以及安慰剂IV (n = 68)的效果。以局麻辅助异丙酚/芬太尼麻醉下行手术。和安慰剂相比,甲基氢化泼尼松和帕瑞考昔在术后1-6h显著减少静息痛和活动痛(总平均疼痛强度:甲基氢化泼尼松组(17.25; 95% CI14.85-19.65)与安慰剂组(21.7; 95% CI, 19.3-24.1)相比P < 0.03; 帕瑞考昔组(15.25; 95% CI, 13.25-17.25)与安慰剂组相比 P < 0.001 总平均活动痛强度(1-6 h): 甲基氢化泼尼松(22.7; 95% CI, 20.1-23.3 安慰剂 28.4; 95% CI, 26.0-30.8)相比 P < 0.01 帕瑞考昔(20.9; 95% CI, 18.6-23.2 与安慰剂组相比 P < 0.001。甲基氢化泼尼松组与帕瑞考昔组间在第一个6h内所有追加药物用量和实际疼痛强度相似但均较安慰剂组减少,采用实际疼痛强度评分和追加镇痛药物量方法比较,有效药物组的疗效显著优于安慰剂组。在术后第一个24h恶心和呕吐发生率方面,与安慰剂组(60%)相比,甲基氢化泼尼松组(30%)明显降低(P < 0.001),但是帕瑞考昔组(37%)降低不明显。在术后疲劳感方面,与安慰剂(66%)相比甲基氢化泼尼松使用后疲劳感(44%)降低明显( P < 0.05),帕瑞考昔组(59%)降低不明显。结论:隆乳术术前甲基氢化泼尼松125mg静脉注射具有与帕瑞考昔40mg相当的良好的镇痛作用和节约其它镇痛药用量,甲基氢化泼尼松能减少恶心、呕吐和疲劳感,而帕瑞考昔无此作用。

(潘志英 陈杰 校)

We compared methylprednisolone 125 mg IV (n = 68) and parecoxib 40 mg IV (n = 68) with placebo (n = 68) given before breast augmentation surgery in a randomized, double-blind parallel group study. Surgery was performed under local anesthesia combined with propofol/fentanyl sedation. Methylprednisolone and parecoxib decreased pain at rest and dynamic pain intensity from 1 to 6 h after surgery compared with placebo (mean summed pain intensity1–6 h: methylprednisolone [17.25; 95% confidence interval [CI], 14.85–19.65] versus placebo [21.7; 95% CI, 19.3–24.1]; P < 0.03; parecoxib [15.25; 95% CI, 13.25–17.25] versus placebo; P < 0.001; mean summed dynamic pain intensity1–6 h: methylprednisolone [22.7; 95% CI, 20.1–23.3] versus placebo [28.4; 95% CI, 26.0–30.8]; P < 0.01; parecoxib [20.9; 95% CI, 18.6–23.2] versus placebo; P < 0.001). Both rescue drug consumption and actual pain (all observations before and after rescue) during the first 6 h were similar in the two active drug groups and significantly reduced compared with placebo. Using a composite score of actual pain intensity and rescue analgesic use, the active drugs were significantly superior to placebo (P < 0.001 for both active drugs). Postoperative nausea and vomiting was reduced after methylprednisolone administration (incidence, 30%), but not after parecoxib (incidence, 37%), during the first 24 h compared with placebo (incidence, 60%; P < 0.001). Fatigue was reduced by methylprednisolone (incidence, 44%), but not by parecoxib (incidence, 59%), compared with placebo (incidence, 66%; P < 0.05). In conclusion, methylprednisolone 125 mg IV given before breast augmentation surgery had analgesic and rescue analgesic-sparing effects comparable with those of parecoxib 40 mg IV. Methylprednisolone, but not parecoxib, reduced nausea, vomiting, and fatigue.

 

大麻类激动剂WIN 55,212-2酮洛酸间在抗伤害性刺激方面有相加作用

The Additive Antinociceptive Interaction Between WIN 55,212-2, a Cannabinoid Agonist, and Ketorolac

Ahmet Ulugöl*, Filiz Özyigit*, Özgür Yesilyurt{dagger}, and Ahmet Dogrul{dagger}

*Department of Pharmacology, Trakya University, Edirne, Turkey, and {dagger}Gülhane Academy of Medicine, Ankara, Turkey

Anesth Analg 2006 102: 443-447.

 

非甾体类抗炎药(NSAIDS)与阿片类药物的联合应用能够降低毒副作用,提高镇痛效果,因此广泛应用于疼痛治疗中。大麻类与阿片类有相似的药理特性,有望成为镇痛药物。然而,大麻类对精神系统的副作用一定程度上限制了其在疼痛治疗中的应用。本研究拟在小鼠中应用醋酸诱导扭体实验和甩尾实验,探讨大麻类和NSAIDS抗伤害性刺激的交互作用。应用等效坐标图分析法分析交互作用。单独或联合应用大麻类激动剂WIN 55,212-2NSAIDS酮洛酸均能在扭体实验中剂量依赖性产生镇痛作用。等效坐标图分析法显示,全身性同时应用WIN 55,212-2酮洛酸时,两者显示出协同作用。酮洛酸对热甩尾实验无明显镇痛作用,而WIN 55,212-2相反,酮洛酸对WIN 55,212-2的该种镇痛作用无明显影响。本研究提示,WIN 55,212-2酮洛酸在炎性内脏痛模型中有抗伤害性刺激相加作用。大麻类和NSAIDS联合应用有望成为疼痛药物治疗的新方法。

(田婕 陈杰 校)

Combinations of nonsteroidal antiinflammatory drugs (NSAIDs) and opioids are widespread in the management of pain, allowing better analgesia with reduced side effects. Cannabinoids are promising analgesic drugs that have pharmacological properties similar to those of opioids. However, the beneficial effects of cannabinoids for pain treatment are counterbalanced by their psychotomimetic side effects. We designed the present study to evaluate the antinociceptive interaction between cannabinoids and NSAIDs in mice, using the acetic acid-induced writhing test and tail-flick test. Interactions were analyzed using isobolographic analysis. WIN 55,212-2, a cannabinoid agonist, and the NSAID ketorolac, either alone or in combination, produced dose-dependent antinociception in the writhing test. Isobolographic analysis showed additive interactions between WIN 55,212-2 and ketorolac when they were coadministered systemically. Ketorolac is inactive in the radiant heat tail-flick test in which WIN 55,212-2 was active. Ketorolac did not influence WIN 55,212-2–induced antinociception in the tail-flick test. This study demonstrated an additive antinociceptive interaction between WIN 55,212-2 and ketorolac in an inflammatory visceral pain model. The combination of cannabinoids and NSAIDs may have utility in the pharmacotherapy of pain.

 

对易患恶性高热的猪肌肉注射氟烷和咖啡因后乳酸盐的剂量反应关系和局部分布

The Dose-Response Relationship and Regional Distribution of Lactate After Intramuscular Injection of Halothane and Caffeine in Malignant Hyperthermia-Susceptible Pigs

Frank Schuster, MD, Hendrik Schöll, MS, Martin Hager, MD, Rainer Müller, MD, Norbert Roewer, MD, and Martin Anetseder, MD

Department of Anesthesiology, University of Wuerzburg, Wuerzburg, Germany

Anesth Analg 2006 102: 468-472.

 

作者假设对易患恶性高热和不易患恶性高热的猪静脉注射亚胺培南,氟烷和咖啡因可以剂量依赖的增加乳酸盐的浓度,并且在限定的肌肉里乳酸盐和二氧化碳的局部分布的代谢亢进。把充满林格氏液的微量渗析探针扎进七个易患恶性高热和不易患恶性高热的猪的后肢,平衡后,逐渐提高剂量并一次性注射氟烷和咖啡因。第二个关于局部分布的假设,把微量渗析探针放在七个易患恶性高热和不易患恶性高热的猪的注射氟烷和咖啡因的部位和距离注射部位10mm25mm处,通过分光分度法测量渗析液中乳酸盐的浓度,另外,在氟烷的实验中测量二氧化碳分压。易患恶性高热比不易患恶性高热的猪在注射氟烷和咖啡因后明显增加乳酸盐的剂量依赖性。乳酸盐只在氟烷和咖啡因的注射部位增加而在距离注射部位10mm25mm处不增加。局部注射氟烷和咖啡因后恶性高热的易患性导致乳酸盐的剂量反应曲线向左侧移位。局部注射刺激恶性高热产生的药物,乳酸盐和二氧化碳的增加限定在探针附近的很小的区域。

(张美荣 陈杰 校)

We hypothesized that IM halothane and caffeine injection increases local lactate concentration dose-dependently in malignant hyperthermia-susceptible (MHS) and nonsusceptible (MHN) pigs and that the hypermetabolic reaction measured by regional distribution of lactate and carbon dioxide is limited to a small muscle volume. Microdialysis probes were placed in the hindlimbs of 7 MHS and 7 MHN pigs and perfused with Ringer's solution. After equilibration, boluses of increasing halothane and caffeine concentrations were injected. For the second hypothesis regarding regional distribution, microdialysis probes were positioned in 7 MHS and 6 MHN pigs at the injection site for halothane and caffeine and at a distance of 10 mm and 25 mm. Lactate was measured in the dialysate by spectrophotometry. In addition, Pco2 was measured in the halothane experiments. Halothane and caffeine increased IM lactate dose-dependently in MHS pigs significantly more than in MHN pigs. Lactate and Pco2 were increased only at the injection site but not at 10 mm and 25 mm distance. MH susceptibility leads to a leftward shift of the dose-response curve for IM lactate after local injection of halothane and caffeine. The increase of lactate and carbon dioxide levels after local MH trigger injection is limited to a small area around the probe.

 

手术患者使用T-Line® Tensymeter (持续性无创血压监测设备)与常用的有创性桡动脉监测的精确性比较

An Accuracy Evaluation of the T-Line® Tensymeter (Continuous Noninvasive Blood Pressure Management Device) versus Conventional Invasive Radial Artery Monitoring in Surgical Patients

Gregory M. Janelle, MD, and Nikolaus Gravenstein, MD

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Anesth Analg 2006 102: 484-490.

 

连续每次动脉血压监测并实时显示动脉波形通常通过有创动脉置管获得。本研究作者评估无创性装置T-Line® Tensymeter的性能,一种通过来自连续血压测定波形计算动脉压,并通过床旁监护仪或T-Line Tensymeter本身计算心率。25名全身麻醉患者,用T-Line® Tensymeter无创测定收缩压、平均血压和舒张压,并与对侧桡动脉测量值相比较。使用Bland Altman试验对数据进行了分析以确定两者间的一致性。两者的均数±标准差(mmHg)偏倚和精度分别为:收缩压1.77.05.74.4;舒张压2.36.95.74.5;平均血压1.75.34.04.8。在临床可接受的范围内,一定的手术患者中,收缩压41189mmHg范围内,T-Line® Tensymeter无创性测压测出的动脉波形与对侧有创性导管测得的血压一致。Tensymeter可使临床医生在一定情况下(低或中度风险的操作过程)避免动脉置管又希望实时监测血压时成为可能。

(朱慧琛 陈杰 校)

Continuous beat-to-beat arterial blood pressure (BP) monitoring with a simultaneous arterial waveform display is typically achieved with an invasive arterial catheter. We evaluated a noninvasive device, the T-Line® Tensymeter, that provides a calibrated arterial pressure waveform from which continuous BP measurements and heart rate may be computed by either a bedside host monitor or the tensymeter device itself. In 25 patients given general anesthesia, we measured systolic, mean, and diastolic BPs via the tensymeter and compared these measurements with those obtained from the contralateral radial artery catheter. Data were analyzed using the Bland Altman test to determine agreement between the two systems. The mean ± sd bias and precision (mm Hg) were as follows: 1.7 ± 7.0 and 5.7 ± 4.4 for systolic BP; 2.3 ± 6.9 and 5.7 ± 4.5 for diastolic BP; and 1.7 ± 5.3 and 4.0 ± 4.8 for mean BP. Noninvasive pressures from the tensymeter-produced arterial waveform agreed with simultaneous contralateral BPs measured from arterial catheters within an acceptable clinical range for a limited population of surgical patients studied over a systolic arterial BP range from 41 to 189 mm Hg without significant temporal performance degradation. The tensymeter may enable physicians to circumvent arterial cannulation in certain circumstances (such as with low- or intermediate-risk procedures) on patients when beat-to-beat BP measurement is desirable.

 

围术期尼莫地平与术后镇痛

Perioperative Nimodipine and Postoperative Analgesia

Gerri Casey, SRN*, Sally-Ann Nortcliffe, FRCA*, Paul Sharpe, FRCA*, and D. J. Buggy, MD, MSc, DME, FRCPI, FCA(Irel), FRCA{dagger}

*Departments of Anaesthesia, Critical Care and Pain Management, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK and {dagger}Mater Misericordiae University Hospital, Dublin 7, Ireland and Outcomes ResearchTM Institute, Louisville, Kentucky

Anesth Analg 2006 102: 504-508.

 

有实验证据显示:尼莫地平,一种L-型二氢吡啶类钙通道阻滞剂有着相对较高血脑屏障穿透力,可以增强吗啡的抗伤害作用。作者验证如下假设:手术期间48小时内每6小时口服尼莫地平可以降低VAS疼痛评分和术后急性疼痛处理的吗啡消耗量。40(年龄70 ± 7 , 男性28 )行膝关节置换术病人计算机随机分组,双盲接受尼莫地平胶囊30mg或安慰剂。所有的病人在麻醉前1-2小时前接受3个胶囊(尼莫地平90mg或安慰剂),之后在手术期间48小时内每6小时口服30mg尼莫地平或安慰剂。用高比重的0.5%的布比卡因进行脊麻并且根据麻醉医生的需要给予麻黄素。术后病人吗啡自控镇痛(PCA,单次 1mg, 锁定时间5 min)。主要监测患者休息和活动时VAS疼痛评分以及吗啡的消耗量。尼莫地平组患者吗啡消耗量显著增加,分别为12小时(39±18 29±15;P=0.04),24小时(62±23 45±24;P=0.02),和48小时(88±3461±27;P=0.01)。休息或活动时疼痛评分及吗啡首次使用时间组间无显著差异。结果显示手术期间给予尼莫地平的患者在12小时以后的吗啡消耗量增加。表明膝关节置换术的患者,尼莫地平不但无镇痛辅助作用,反而可能具有抑制吗啡的镇痛作用。

(郑丽 陈杰 校)

There is experimental evidence that nimodipine, an L-type dihydropiridine calcium channel blocker with relatively high blood-brain barrier penetration, enhances the antinociceptive properties of morphine. We tested the hypothesis that oral nimodipine taken preoperatively and 6 hourly for 48 h postoperatively would reduce visual analog scale pain scores and morphine consumption in morphine-naive patients with acute postoperative pain. Forty patients undergoing total knee replacement surgery (age 70 ± 7 yr, 28 male) were randomized by computer-generated numbers to receive capsules containing either nimodipine 30 mg or placebo in a double-blind study design. All patients received 3 capsules (nimodipine 90 mg or placebo) 1–2 h before induction of anesthesia followed by oral nimodipine 30 mg or placebo 6 hourly for 48 hours postoperatively. Spinal anesthesia was induced with hyperbaric bupivacaine 0.5% (2.4–3.0 mL) and fluids and ephedrine were given at the discretion of the anesthesiologist. Morphine patient-controlled analgesia (PCA, bolus 1 mg, lockout 5 min) was given for postoperative analgesia. Primary outcome measures were visual analog pain scores at rest and on moving (sitting forward) and PCA morphine consumption. Morphine consumption was significantly larger in nimodipine patients at 12 h (39 ± 18 versus 29 ± 15; P = 0.04), 24 h (62 ± 23 versus 45 ± 24; P = 0.02), and 48 h (88 ± 34 versus 61 ± 27; P = 0.01). There were no significant differences in pain scores at rest or moving or in time to first use of morphine analgesia. This study has demonstrated increased morphine consumption after 12 h in postoperative patients receiving nimodipine, suggesting that, in patients undergoing knee replacement surgery, it has no adjunctive analgesic effect and may actually inhibit the analgesic effect of morphine.

在体大鼠模型中肾上腺素增加窒息后短暂心跳停止的死亡率

Epinephrine Increases Mortality after Brief Asphyxial Cardiac Arrest in an In Vivo Rat Model

Conán L. McCaul, MD*{dagger}{ddagger}**, Patrick J. McNamara, MD*§, Doreen Engelberts*, Gregory J. Wilson, MD, Alex Romaschin, PhD, Andrew N. Redington, MD#, and Brian P. Kavanagh, MD*{dagger}{ddagger}**

*The Lung Biology Program, The Research Institute, and the Departments of {dagger}Critical Care Medicine, {ddagger}Anesthesia, Pediatrics (§Neonatology and #Cardiology) and ¶Pathology, The Hospital for Sick Children; and the **Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario

Anesth Analg 2006 102: 542-548.

 

肾上腺素在心跳停止中可能有害。本研究中,作者探究窒息后短暂心跳停止复苏后肾上腺素的作用和合并使用钙通道阻断剂对复苏后心肌的影响。麻醉大鼠脱离机械通气导致心跳停止。1分钟后用机械通气、吸氧、胸部按压、静脉给药等复苏。在研究1和2中,分别给予肾上腺素1030ug/kg0.9%生理盐水。研究3中给予肾上腺素30ug/kg,并且随机给予维拉帕米0.1mg/kg0.9%生理盐水。研究1和3中,用经胸超声心动图评估左心室功能。研究2监测左房压。肾上腺素导致死亡率增加(对照组为0/8[0%],肾上腺素10ug/kg组为4/12[33%],肾上腺素30ug/kg组的死亡率为16/22[72.8%]P<0.05),高血压(P < 0.001)、心动过速(P = 0.004)、早期短暂左房高压、剂量相关性左室舒张末期直径的减少。维拉帕米能阻止大剂量肾上腺素相关的死亡率增加,减轻心脏舒张早期功能障碍和复苏后高血压(P = 0.001)而无收缩期功能异常。肾上腺素对窒息后短暂心跳停止可能是有害的。

(顾新宇 陈杰 校)

Epinephrine may be detrimental in cardiac arrest. In this laboratory study we sought to characterize the effect of epinephrine and concomitant calcium channel blockade on postresuscitation myocardial performance after brief asphyxial cardiac arrest. Anesthesized rats were disconnected from mechanical ventilation, resulting in cardiac arrest. Resuscitation was attempted after 1 min with mechanical ventilation, oxygen, chest compressions, and IV medication. In experimental series 1 and 2, animals were allocated to 10 or 30 µg/kg epinephrine or 0.9% saline. In series 3, animals received 30 µg/kg of epinephrine and were randomized to 0.1 mg/kg of verapamil or to 0.9% saline. In series 1 and 3, left ventricular function was assessed using transthoracic echocardiography. In series 2, left atrial pressure was measured. Epinephrine was associated with increased mortality (0/8 [0%] in controls, 4/12 [33.3%] in 10 µg/kg animals, and 16/22 [72.8%] in 30 µg/kg animals; P < 0.05), hypertension (P < 0.001), tachycardia (P = 0.004), early transient left atrial hypertension, and dose-related reduction in left ventricular end diastolic diameter (P < 0.05). Verapamil prevented mortality associated with large-dose epinephrine (0% versus 100%) and attenuated early diastolic dysfunction and postresuscitation hypertension (P = 0.001) without systolic dysfunction. Epinephrine appears to be harmful in the setting of brief cardiac arrest after asphyxia.

 

阶梯性缺氧性低氧血症期间大鼠纹状体血氧饱和度的测量

Measuring Hemoglobin Oxygen Saturation During Graded Hypoxic Hypoxia in Rat Striatum

Cécile Julien, PhD*, Adrian Bradu, PhD{dagger}, Raphaël Sablong, PhD{dagger}, Emmanuelle Grillon, MSc*, Chantal Remy, PhD*, Jacques Derouard, PhD{dagger}, and Jean-François Payen, MD, PhD*{ddagger}

*INSERM UM 594, Neuroimagerie Fonctionelle et Métabolique, and Laboratoire de Spectrométrie Physique, Université Joseph Fourier, and Département d’Anesthésie-Réanimation, Hôpital Albert Michallon, Grenoble, France

Anesth Analg 2006 102: 565-570.

 

作者应用可见光的反射分光镜来评估大鼠纹状体组织的血氧饱和度(SstrO2)。7只大鼠在麻醉及机械通气下,吸入氧浓度(FiO2)逐级递减:0.350.250.150.1,其后进入复氧期(组1)。选取两侧的纹状体局部区域,分别应用反射分光镜和激光多普勒血流仪连续监测各个阶段的SstrO2和脑血流量(LCBF)。另一组大鼠(组2n6)则测量矢状窦的血氧饱和度(SssO2)。FiO20.35(对照值)时,纹状体SstrO238%±17%,其后随FiO2下降SstrO2递减,FiO2 0.12时为16 ±10%,FiO2 0.10时为13 ±7%(p<0.05),两侧半球之间无差异。这些变化伴随着LCBF的逐渐增加:分别为对照值的161%±26%和197%±34%(p<0.05)。所有的变化在复氧后完全恢复。组2中,SssO2FiO20.35时为38%±8%,当FiO20.1时则降低至10%±3%,与SstrO2的降低程度接近。本研究表明大鼠中应用可见光的反射分光镜连续测量SstrO2的方法可行。阶梯性缺氧性低氧血症时SssO2LCBF的测定说明SstrO2的变化可用于反应脑内静脉氧合的情况。

(忻纪华 陈杰 校)

We evaluated in vivo reflectance spectroscopy of visible light as a method to assess brain tissue hemoglobin oxygen saturation in rat striatum (SstrO2). Seven anesthetized and mechanically ventilated rats were subjected to incremental reduction in the fraction of inspired oxygen (Fio 2): 0.35, 0.25, 0.15, 0.12, and 0.10, followed by a reoxygenation period (Group 1). At each episode, local changes in SstrO2 and in cerebral blood flow (LCBF) were simultaneously determined in the two striatal regions, using reflectance spectroscopy and laser Doppler flowmetry, respectively. Another group of rats (Group 2, n = 6) was also studied to measure sagittal sinus blood hemoglobin saturation (SssO2) during graded hypoxic hypoxia. Corpus striatum exhibited a significant graded decrease in SstrO2, from 38% ± 17% at Fio2 of 0.35 (control) to 16% ± 10% at Fio2 of 0.12 and to 13% ± 7% at Fio2 of 0.10 (P < 0.05), with no difference between the two hemispheres. These local changes in SstrO2 were associated with a significant graded increase in LCBF: 161% ± 26% of control values and 197% ± 34% during these 2 hypoxic episodes, respectively (P < 0.05). All local changes were fully reversed during the reoxygenation period. In Group 2, SssO2 decreased from 38% ± 8% at Fio2 of 0.35 (control) to 10% ± 3% at Fio2 of 0.10, closely related to SstrO2 decreasing in hypoxia. This study shows that reflectance spectroscopy of the visible light in rat striatum could be a possible measure of continuous changes in SstrO2. SssO2 and LCBF measurements during graded hypoxic hypoxia indicate that changes in SstrO2 reflect primarily those in brain venous oxygenation.

 

年龄对坐骨神经阻滞持续时间的影响

The Effect of Age on Sciatic Nerve Block Duration

R. Kyle Hanks, BS*, Ricardo Pietrobon, MD, PhD{dagger}{ddagger}, Karen C. Nielsen, MD{dagger}, Susan M. Steele, MD{dagger}, Marcy Tucker, MD, PhD{dagger}, David S. Warner, MD{dagger}, Kathryn P. King, MD{dagger}, and Stephen M. Klein, MD{dagger}

*School of Medicine, and Departments of {dagger}Anesthesiology and {ddagger}Surgery, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2006 102: 588-592.

 

随着年龄增长的生理变化以及对外周神经阻滞持续时间的影响仍有待进一步明确。作者前瞻性地研究了年轻患者和年长患者使用甲哌卡因行坐骨神经阻滞的持续时间。80ASA I-III病人,年龄1835岁(n40),5580岁(n40),使用股神经和坐骨神经阻滞进行门诊膝关节镜检查。每组有37个病人完成了本实验。所有病人坐骨神经阻滞使用1%甲哌卡因20ml加入碳酸氢钠0.1 mEq/mL和肾上腺素14000002.5ug/ml),并行股神经阻滞。在手术侧肢体测量感觉阻滞(针刺觉、温度觉、震动觉)、运动阻滞(跖曲、背曲)持续时间以及坐骨神经分布区域感觉、运动完全阻滞持续时间。老年组感觉和运动完全恢复时间(329±47min)要比年轻组(306±46min)长(p0.04)。本研究中这种差异比较小,临床上不易觉察。年龄的增加使震动觉的恢复时间延长(年轻组295±58min,年老组257±50minp0.007原文有误)。其它的检测项目组间没有差异。结论是:年龄可能影响周围神经阻滞,其中的药理学、生理学和时间性因素需要进一步的研究。

(曹榆 陈杰 校)

The physiologic changes that occur with advancing age and their effect on the duration of peripheral nerve blocks have yet to be defined. We prospectively studied the duration of sciatic nerve block using mepivacaine in younger and older patients. Eighty ASA physical status I-III patients, aged 18–35 (n = 40) or 55–80 (n = 40) yr, having outpatient knee arthroscopy with a femoral block and a standardized sciatic nerve block were enrolled; 37 in each group completed the study. All patients received a Labat sciatic nerve block using 20 mL of 1.0% mepivacaine with 0.1 mEq/mL sodium bicarbonate and 1:400,000 (2.5 µg/mL) epinephrine and a femoral nerve block. The duration of sensory block (sensation of pinprick, temperature, and vibration), motor block (plantar and dorsi flexion), and complete sensory and motor block in the sciatic nerve distribution of the operative extremity were measured. The time for complete return of both sensory and motor function was longer in the older group, 329 ± 47 min compared with 306 ± 46 min (mean ± sd) in the younger group (P = 0.04). The difference was small under the conditions of this study and would not be perceived clinically. Age also increased the time to return of vibratory sensation (younger = 292 ± 58 min, older = 257 ± 50 min; P = 0.007). The other measurements did not differ between groups. We conclude that age may affect peripheral nerve blocks and that more investigation is needed to determine the pharmacologic, physiologic, and chronologic factors behind these findings.

 

地塞米松是否能加强静脉局部麻醉以及镇痛效果?一个随机对照临床研究

Does Dexamethasone Improve the Quality of Intravenous Regional Anesthesia and Analgesia? A Randomized, Controlled Clinical Study

Zekiye Bigat, Neval Boztug, Necmiye Hadimioglu, Nihan Cete, Nesil Coskunfirat, and Ertugrul Ertok

Department of Anesthesiology, Akdeniz University Medical Faculty, Antalya, Turkey

Anesth Analg 2006 102: 605-609.

 

本文作者研究了利多卡因静脉局部麻醉(IVRA)中加入地塞米松后的麻醉及镇痛效果。75名手外伤急诊患者随机分成3组:L组接受利多卡因(3mg/kg),LD组接受利多卡因(3mg/kg)+地塞米松(8mg),LDc组在局麻部位接受利多卡因(3mg/kg)注射,同时在无麻醉的非手术手臂接受地塞米松(8mg)静脉注射。局麻药均配成40ml溶液。分别在术中以及术后2小时记录VASvisual analog scale)和语言疼痛评分,当术后疼痛VAS评分大于3,给予对乙酰氨基酚500mg口服镇痛。记录术后至第一次需要镇痛药物的时间以及第一个24小时内的给药总量。达到完全感觉以及运动阻滞的时间在3组间无明显差异。LD组运动完全恢复时间[L组(85.91-10.08min, LD136.76-20.19min, LDc64.44-8.43min]以及感觉恢复时间[L75.21-10.30min, LD126.11-19.40min, LDc64.2-8.11]min]最长(P<0.05)。LD组的病人疼痛评分最低且术后第一个24小时内对乙酰氨基酚的需要量最少。结论:手外伤急诊病人的利多卡因静脉局部麻醉中加入地塞米松(8mg)可有效地增强术后第一天的镇痛效果。

(丁希喆 陈杰 校)

We investigated the anesthetic and analgesic effectiveness of adding dexamethasone to lidocaine for IV regional anesthesia (IVRA). Seventy-five patients undergoing ambulatory hand surgery were randomly assigned to one of three groups: group L received 3 mg/kg lidocaine, group LD received 3 mg/kg lidocaine + 8 mg dexamethasone, and group LDc received 3 mg/kg lidocaine for IVRA and 8 mg dexamethasone IV to the nonsurgical arm. IVRA was established using 40 mL of a solution. Visual analog scale and verbal pain scores were recorded intraoperatively and for 2 h postoperatively. Postoperative pain was treated with oral acetaminophen 500 mg every 4 h when visual analog scale score was more than 3. Time to request for the first analgesic and the total dose in the first 24 h were noted. Times to onset of complete sensory and motor block were similar in the 3 groups. The times to recovery of motor block (L = 8 [5.91–10.08] min, LD = 13 [6.76–20.19] min, LDc = 6 [4.44–8.43] min) and sensory block (L = 7 [5.21–10.30] min, LD = 12 [6.11–19.40] min and LDc = 6 [4.2–8.11] min) were longer in group LD (P < 0.05). Patients in group LD reported significantly lower pain scores and required less acetaminophen in the first 24 h after surgery. In conclusion, the addition of 8 mg dexamethasone to lidocaine for IVRA in patients undergoing hand surgery improves postoperative analgesia during the first postoperative day.

 

可曲喉镜(FlexibladeTM)和Macintosh喉镜在成人全身麻醉时咽部显露情况的临床比较

A Clinical Comparison of the FlexibladeTM and Macintosh Laryngoscopes for Laryngeal Exposure in Anesthetized Adults

Rochelle W. W. Cheung, MB, BS (Hong Kong), FANZCA, FHKCA, FHKAM*, Michael G. Irwin, MB, ChB, MD, DA, FRCA, FHKAM{dagger}, Bassanio C. W. Law, MB, BS (New South Wales), FANZCA, FHKCA, FHKAM{ddagger}, and C. K. Chan, MB, BS (Hong Kong), FHKCA, FHKAM{ddagger}

*Department of Anaesthesiology, Queen Elizabeth Hospital; {dagger}Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital; and {ddagger}Department of Anaesthesiology, Kwong Wah Hospital; and the University of Hong Kong, Hong Kong (SAR), China

Anesth Analg 2006 102: 626-630.

 

可曲喉镜(FlexibladeTM) 是带有可曲镜片的喉镜。为了评估和比较可曲喉镜和经典的喉镜(Macintosh)的有效性,作者选择了200名行选择性手术需全麻插管的病人作临床研究。分别用3Macintosh喉镜和可曲喉镜直接进行喉镜检查,用或不用可曲喉镜的可曲控制杆。在不进行任何操作的情况下,根据CormackLehane分类法,记录患者咽喉部的情况。用Macintosh喉镜的咽部暴露情况不差于未用可曲控制杆的可曲喉镜咽部显露情况。58.5%未使用可曲控制杆的可曲喉镜显露为非Ⅰ级的患者在使用Macintosh镜片后得到改善。而使用Macintosh镜片显露为非Ⅰ级的患者,在应用可曲喉镜并使用可曲控制杆后39.6%的患者得到改善。可曲喉镜暴露但未使用可曲控制杆咽部显露为非Ⅰ级患者在使用可曲控制杆后84.5%的患者咽部显露得到改善。使用可曲喉镜的可曲控制杆时不影响显露。仅有一例患者使用Macintosh镜片后的显露优于可曲喉镜并使用可曲控制杆时的显露。结论:全麻肌松下,使用可曲喉镜并使用可曲控制杆时,咽部的显露情况明显优于Macintosh喉镜(P<0.0001)。

(肖洁 陈杰 )

The FlexibladeTM is a laryngoscope with a flexible blade. To evaluate the efficacy of the FlexibladeTM compared with the classic Macintosh laryngoscope, we performed a clinical study in 200 paralyzed patients undergoing elective surgery requiring general anesthesia and endotracheal intubation. Direct laryngoscopy was performed with a size 3 Macintosh laryngoscope and the FlexibladeTM, with and without activation of the lever. The laryngeal views were recorded, without manipulation, according to the Cormack and Lehane classification. No laryngoscopic view obtained by the Macintosh blade was worse than that obtained by the FlexibladeTM without the lever activated. The Macintosh blade improved 58.5% of non-Grade I views obtained by the FlexibladeTM with its lever not activated. However, when the FlexibladeTM lever was activated, 39.6% of non-Grade I views obtained by the Macintosh blade were improved, whereas 84.5% of non-Grade I views obtained by the inactivated FlexibladeTM were improved. Activating the FlexibladeTM lever never caused a deterioration of view. In only one case was the view better with the Macintosh blade than that with the activated FlexibladeTM. We conclude that the FlexibladeTM, after lever activation, is significantly better than the Macintosh laryngoscope for laryngeal visualization in paralyzed adults (P < 0.0001).

 

辅用小型转流系统的常温不停跳心脏手术:对术中血流动力学和炎症反应的影响

Normothermic Beating Heart Surgery with Assistance of Miniaturized Bypass Systems: The Effects on Intraoperative Hemodynamics and Inflammatory Response

Steffen Rex, MD*, Stefan Brose, MD{ddagger}, Sebastian Metzelder*, Lothar de Rossi, MD§, Sylvia Schroth, MD*, Rüdiger Autschbach, MD{dagger}, Rolf Rossaint, MD*, and Wolfgang Buhre, MD#

Departments of *Anesthesiology and {dagger}Thoracic and Cardiovascular Surgery, Universitätsklinikum der RWTH, Aachen, Germany; {ddagger}Department of Cardiac Surgery, Heart Center Dresden, TU Dresden, Germany; §Boehringer Ingelheim Pharma, Clinical Research Department Immunology/Virology, Biberach, Germany; and #Division of Perioperative and Emergency Care, University Medical Center Utrecht, the Netherlands

Anesth Analg 2006;102:352-362

 

使用小型心肺转流(CPB)循环和避免心脏停搏的目的是试图减轻对心脏手术的炎症反应。我们对不停跳心脏手术(BHS)辅用简化的转流系统(SBS)对全身血流动力学、心肌功能以及对CPB的炎症反应的影响进行了研究。我们假设:与传统CPBcCPB)循环下进行手术相比,使用SBS可减少炎症反应从而使得CPB后的血流动力学更稳定。我们对45例行冠状动脉搭桥的病人进行了前瞻性的研究。15例病人随机纳入使用常规体外循环(cCPB)、冷晶体停搏液和中度低温。另两组各15例病人在两种不同的仅包括血泵和氧合器的SBS辅助下常温行BHS。用经肺热稀释法和经食道超声心动图评估血流动力学参数。对围术期血浆中促炎和抗炎介质的水平进行检测。在CPB后,全身血流动力学参数和心室收缩功能在各组间无差别。CPB后左室舒张功能受损在各组间相似(与转流前相比,P < 0.01)。在手术结束时,两个SBS组所需要的血管收缩药(去甲肾上腺素)较cCPB组更多(P < 0.01)。在CPB后,白介素(IL-6的释放在各组间无明显差别,但IL-10的血浆水平在cCPB组明显较高(与SBS组相比,P < 0.01)。心肌坏死的程度(肌钙蛋白T)在各组间相似。我们得出结论:在我们的实验中,小型转流系统和避免心脏停搏对改善CPB后的血流动力学和减轻促炎免疫反应并无作用。

(黄施伟 马皓琳 李士通 校)

The use of miniaturized cardiopulmonary bypass (CPB) circuits and avoidance of cardioplegic arrest are attempts to reduce the inflammatory response to cardiac surgery. We studied the effects of beating heart surgery (BHS) with assistance of simplified bypass systems (SBS) on global hemodynamics, myocardial function and the inflammatory response to CPB. We hypothesized that the use of SBS was associated with less hemodynamic instability after CPB resulting from attenuation of the inflammatory response when compared with surgery performed with a conventional CPB (cCPB) circuit. Forty-five patients undergoing coronary artery bypass grafting were prospectively studied. Fifteen patients were randomized to the use of a cCPB circuit, cold crystalloid cardioplegia, and moderate hypothermia. Two groups of 15 patients underwent BHS during normothermia with assistance of two different SBS consisting of only blood pump and oxygenator. Hemodynamic variables were assessed with transpulmonary thermodilution and transesophageal echocardiography. Plasma levels of proinflammatory and antiinflammatory mediators were measured perioperatively. After CPB, variables of global hemodynamics and systolic ventricular function did not differ among groups. Left ventricular diastolic function was impaired after CPB equally in all groups (P < 0.01 versus pre-CPB). At the end of surgery, there was more need for vasopressor (norepinephrine) support in both SBS groups than in the cCPB group (P < 0.01). After CPB, the release of interleukin (IL)-6 did not differ significantly among groups, whereas plasma levels of IL-10 were higher in the cCPB group (P < 0.01 versus SBS). The extent of myocardial necrosis (Troponin T) was comparable in all groups. We conclude that in our study, miniaturizing bypass systems and avoidance of cardioplegic arrest were not effective in improving hemodynamic performance and in attenuating the proinflammatory immune response after CPB.


在出生至18岁儿童中区分镇静深度的观察性指标和客观测量方法的比较

A Comparison of Observational and Objective Measures to Differentiate Depth of Sedation in Children from Birth to 18 Years of Age

Shobha Malviya, MD, Terri Voepel-Lewis, MSN, RN, and Alan R. Tait, PhD

Department of Anesthesiology, Section of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan Medical Center, Ann Arbor, Michigan

Anesth Analg 2006;102:389-394

 

可用以评价镇静深度的观察和客观方法有数种;然而,关于这些方法用以区分深度镇静的可靠性的数据目前尚缺。本研究中,我们在出生至18岁儿童中比较了3种镇静评价工具,观察它们检测镇静深度水平的相对价值。以双频指数监测(BIS®)、改良觉醒维持试验(MMWT)及密歇根州大学镇静量表(UMSS)来评价镇静。我们记录了39例儿童的327个观察值。在整个观察过程中,以镇静药适当改变镇静深度确保每个测量值有效。在UMSSBIS之间(rho = 0.73) UMSSMMWT之间(rho = 0.59; P < 0.01) 存在中度至高度的相关性。而BISMMWT之间的相关性有显著性但较低 (r = 0.36; P < 0.01)UMSSMMWT测量的一致性表明这两种方法在镇静连续过程中的可靠性。除了在UMSS评分23之间外,BISUMSS的镇静评分增高而显著降低。ROC曲线提示,BIS≤80MMWT≤14分钟是描绘深度镇静最为敏感的指标。我们的发现证实了这些观察性和客观测量方法在评价18岁以下儿童镇静深度时的总体有效性,但显示区分中度与深度镇静仍有局限性。

(周志坚 马皓琳 李士通 校)

Several observational and objective methods are available to assess sedation depth; however, data regarding their accuracy in differentiating deep sedation are limited. In this study we compared 3 sedation tools in children from birth to 18 yr of age and determined their relative value in detecting deep levels of sedation. Bispectral index monitoring (BIS®), Modified Maintenance of Wakefulness Tests (MMWT), and the University of Michigan Sedation Scale (UMSS) were used to assess sedation. Three-hundred-twenty-seven observations were recorded in 39 children. The overall validity of each measure was supported by appropriate changes after sedation administration through the observation period. There were moderate to high correlations between UMSS and BIS (rho = –0.73) and UMSS and MMWT (rho = –0.59; P < 0.01). The correlation between BIS and MMWT was significant but low (r = 0.36; P < 0.01). Measures of exact agreement supported the reliability of the UMSS and MMWT across the sedation continuum. There were significant decreases in BIS across UMSS scores except from scores 2–3. ROC curves suggested that BIS ≤80 and MMWT ≤14 min were most sensitive in delineating deep sedation. Our findings demonstrate the overall validity of these observational and objective measures of sedation depth in children <18 yr of age but show ongoing limitations distinguishing moderate from deep sedation.

 

行耳鼻喉小手术的儿童七氟醚吸入诱导后地氟醚维持麻醉比七氟醚诱导并维持麻醉苏醒期躁动少

Desflurane Anesthesia After Sevoflurane Inhaled Induction Reduces Severity of Emergence Agitation in Children Undergoing Minor Ear-Nose-Throat Surgery Compared with Sevoflurane Induction and Maintenance

Jochen Mayer, MD*, Joachim Boldt, MD*, Kerstin D. Röhm, MD*, Klaus Scheuermann, MD{dagger}, and Stefan W. Suttner, MD*

Department of *Anesthesia and Intensive Care Medicine and {dagger}ENT Department, Klinikum Ludwigshafen, Ludwigshafen, Germany

Anesth Analg 2006;102:400-404

 

儿童在吸入全麻苏醒期会发生躁动现象。我们设计本研究采用最近发表的儿科病人麻醉苏醒期谵妄(PAED)评分表来检查行耳鼻喉手术的儿童在七氟醚诱导地氟醚维持麻醉和七氟醚诱导并维持麻醉后苏醒期行为。38例给予术前用药的儿童,年龄为12个月-7岁,采用七氟醚面罩诱导后随机分为两组,一组用七氟醚维持麻醉(n=19),另一组用地氟醚维持麻醉(n=19)。评价气管拔管时间、改良Aldrete评分、苏醒期行为、复苏期并发症及疼痛评分。PAED评分显示地氟醚较七氟醚维持麻醉对苏醒期躁动有明显优点(6[015]12 [2–20], 严重躁动的最大总分为20)。地氟醚组气管拔管时间显著短于七氟醚(5.4 ± 1.4 13.4 ± 1.8分钟)。七氟醚维持麻醉的儿童到达麻醉后复苏室(PACU)时的改良Aldrete评分明显较低。出PACU回普通病房的时间及不良反应的发生率两组无明显差异。结论,在儿童七氟醚诱导后用地氟醚维持麻醉能降低苏醒期躁动程度,并且缩短复苏时间。

(邱郁薇 马皓琳 李士通 校)

Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or desflurane (n = 19) for maintenance of general anesthesia. Time to tracheal extubation, modified Aldrete score, emergence behavior, recovery complications, and pain scores were assessed. The PAED scale showed a significant advantage for desflurane (6 [0–15] versus 12 [2–20], maximum total score of 20 for severe agitation). Time to extubation was significantly shorter with desflurane than with sevoflurane (5.4 ± 1.4 versus 13.4 ± 1.8 min). The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.

 

联合应用瑞芬太尼的靶控输注异丙酚的性能:两种异丙酚输注公式的临床研究

The Performance of a Target-Controlled Infusion of Propofol in Combination with Remifentanil: A Clinical Investigation with Two Propofol Formulations

J. K. Götz Wietasch, MD*, Martin Scholz, MD{dagger}, Jörg Zinserling, MS{dagger}, Nicholas Kiefer, MD{dagger}, Christian Frenkel, MD, PhD§, Pascal Knüfermann, MD{dagger}, Ute Brauer, MD{ddagger}, and Andreas Hoeft, MD, PhD{dagger}

*Department of Anesthesiology, University Medical Center Groningen, The Netherlands; {dagger}Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany; {ddagger}Medical Department, Division Hospital Care, B. Braun Melsungen AG, Melsungen, Germany; §Department of Anesthesiology, Lüneburg, Germany

Anesth Analg 2006;102:430-437

 

靶控输注(TCI)结合了静脉用药物的药代动力学的各种变量以便于进行安全可靠的给药。本临床研究中,我们研究了联合应用瑞芬太尼的异丙酚TCI的性能。预期手术时间超过一小时的54名择期行普通外科手术的成年患者,联合应用异丙酚TCIMarsh参数组套,异丙酚随机溶于长链或中/长链甘油三酸酯中)和瑞芬太尼。在术前、术中和术后各个阶段测定动脉异丙酚的血浆浓度、血流动力学及来源于脑电图的参数。测定的异丙酚血浆浓度超过预计值的59%,而当应用Schnider参数组套重新计算时,则超过预计值的48%。药代动力学的总体分析表明异丙酚的中央分布容积很小(3.55 L),清除率很低(1.31 L/min)ASA分级和性别是仅有的对异丙酚药代动力学有明显影响的变量。在实验的第二阶段,从最初27名患者中确定出一套新的异丙酚药代动力学的参数。在此之后,对余下的27名患者进行的性能分析显示,应用新的参数设定改善精确性。我们的结果显示,当瑞芬太尼和异丙酚联合应用时,Marsh Schnider参数组套系统性地低估了异丙酚的血浆浓度。部分内容在荷兰阿姆斯特丹199961日欧洲麻醉医生协会的年会上和美国德克萨斯州达拉斯19991012日美国麻醉医师协会的年会上报道过。

(陈玮 马皓琳 李士通 校)

Target-controlled infusion (TCI) incorporates the pharmacokinetic variables of an IV drug to facilitate safe and reliable administration. In this clinical study we investigated the performance of propofol TCI in combination with remifentanil. Fifty-four adult patients scheduled for general surgery lasting longer than 1 h received a combined TCI of propofol (Marsh parameter set; propofol randomly either dissolved with long- or middle-/long-chain triglycerides) and remifentanil. Arterial propofol plasma concentrations and hemodynamic and derived electroencephalogram variables were determined at various stages before, during, and after surgery. Measured propofol plasma concentrations exceeded the predicted values by 59%, and 48% when recalculated with the Schnider parameter set. Pharmacokinetic population analysis showed a small central volume of distribution (3.55 L) and reduced clearance (1.31 L/min) for propofol. ASA status and sex were the only variables that had a significant influence on propofol pharmacokinetics. In a second step, a new pharmacokinetic variable set for propofol was determined in the first 27 patients. Post hoc performance analysis of the remaining 27 patients showed improved accuracy using the new variable set. Our results show that when remifentanil and propofol are combined, the Marsh and Schnider parameter sets systematically underestimate propofol plasma concentrations. Presented, in part, at the Annual Meeting of the European Society of Anesthesiologists, Amsterdam, The Netherlands, June 1, 1999, and the Annual Meeting of the American Society of Anesthesiologists, Dallas, Texas, October 12, 1999.


病态肥胖者中琥珀胆碱的剂量

The Dose of Succinylcholine in Morbid Obesity

Harry J. M. Lemmens, MD, PhD, and Jay B. Brodsky, MD

Department of Anesthesia, Stanford University School of Medicine, Stanford, California

Anesth Analg 2006;102:438-442

 

琥珀胆碱(SCH)在病态肥胖患者中的合适剂量尚未知晓。我们研究了45例拟行胃旁路手术的病态肥胖(体重指数>40 kg/m2)成人。用TOF-Watch SX®肌加速度仪记录拇内收肌对腕部尺神经刺激的反应。患者以随机双盲方式分入三个研究组中的一组。组I患者接受SCH 1 mg/kg理想体重,组II患者接受SCH 1 mg/kg去脂体重,组III患者接受SCH 1 mg/kg总体重。给予SCH后,对气管插管条件进行评分。记录20 min神经肌肉阻滞恢复过程。最大神经肌肉阻滞的起效时间组间比较无差异,但组I的最大阻滞程度显著较小。组I和组II的恢复时间显著较短。1/3的组I患者插管条件评为差,而组III中无患者插管条件评为差。我们的研究证实了为了达到完全的神经肌肉麻痹及预计的喉镜插管条件,推荐琥珀胆碱用总体重1 mg/kg

(马皓琳 李士通 校)

The appropriate dose of succinylcholine (SCH) in morbidly obese patients is unknown. We studied 45 morbidly obese (body mass index >40 kg/m2) adults scheduled for gastric bypass surgery. The response to ulnar nerve stimulation of the adductor pollicis muscle at the wrist was recorded using the TOF-Watch SX® acceleromyograph. In a randomized double-blind fashion, patients were assigned to one of three study groups. In Group I, patients received SCH 1 mg/kg ideal body weight, in Group II 1 mg/kg lean body weight, and in Group III 1 mg/kg total body weight. After SCH administration, endotracheal intubating conditions were scored. The recovery from neuromuscular block was recorded for 20 min. There was no difference in the onset time of maximum neuromuscular blockade among groups, but maximum block was significantly less in Group I. The recovery intervals were significantly shorter in Groups I and II. In one third of the patients in Group I, intubating conditions were rated poor, whereas no patient in Group III had poor intubating conditions. Our study demonstrates that for complete neuromuscular paralysis and predictable laryngoscopy conditions, SCH 1 mg/kg total body weight is recommended.


局麻药通过抑制TrkA酪氨酸激酶活性抑制神经生长因子介导的神经突外生

Local Anesthetics Suppress Nerve Growth Factor-Mediated Neurite Outgrowth by Inhibition of Tyrosine Kinase Activity of TrkA

Mayumi Takatori, MD*, Yoshihiro Kuroda, PhD{dagger}, and Munetaka Hirose, MD*

*Department of Anesthesiology, Kyoto Prefectural University of Medicine; and {dagger}Graduate School of Pharmaceutical Sciences, Kyoto University, Japan

Anesth Analg 2006;102:462-467

 

局麻药(LAs)可抑制与神经性疼痛相关的交感神经芽生。但是其确切机理至今未明。神经生长因子(NGF)可促进交感神经出芽, NGF刺激使NGF高亲和力受体TrkA自体磷酸化,启动NGF信号转导。PC12细胞是交感神经出芽的细胞模型,本研究通过观察利多卡因、布比卡因和普鲁卡因对NGF刺激后神经突外生的抑制作用探讨它们对NGF信号转导的影响。为了研究上述局麻药对NGF介导的PC12细胞神经突外生的影响,将细胞分别孵育于404004000µM浓度的每个局麻药中。用免疫沉淀和免疫印迹法检测局麻药对NGF刺激下TrkA的活性的影响来分析TrkA的自体磷酸化。通过乳酸脱氢酶释放试验和季铵乙啡啶碘染色评估局麻药对PC12细胞的毒性作用。利多卡因(400 µM)、布比卡因 (40 400 µM) 和普鲁卡因 4000 µM)显著抑制神经突外生或TrkA自体磷酸化而无细胞毒性作用。局麻药抑制NGF刺激后TrkA酪氨酸激酶活性可能涉及其抑制神经突外生的机制。

(周雅春 马皓琳 李士通 校)

Local anesthetics (LAs) suppress sympathetic sprouting, which correlates with neuropathic pain. However, the precise mechanism of the suppression is unknown. Nerve growth factor (NGF) contributes to the sympathetic sprouting, and NGF signaling starts with NGF-stimulated autophosphorylation of TrkA, which is a high affinity receptor of NGF. We examined the effects of lidocaine, bupivacaine, and procaine on NGF signaling under suppression of NGF-stimulated neurite outgrowth in PC12 cells, which is a cellular model of sympathetic sprouting. To investigate the effect of these LAs on NGF-mediated neurite outgrowth of PC12 cells, cells were incubated with 40, 400, and 4000 µM of each LA. The effect of LAs on NGF-stimulated TrkA activity was examined to analyze autophosphorylation of TrkA using immunoprecipitation and immunoblotting. Cytotoxic effects of LAs on PC12 cells were also assessed by lactate dehydrogenase release and by propidium iodide staining. Lidocaine (400 µM), bupivacaine (40 and 400 µM), or procaine (4000 µM) suppressed either neurite outgrowth or autophosphorylation significantly without cytotoxicity. The inhibition of NGF-stimulated tyrosine kinase activity of TrkA might be involved in the mechanisms of suppression of neurite outgrowth induced by LAs.


术中无线持续动脉压监测:一项试验性的研究

Wireless Continuous Arterial Blood Pressure Monitoring During Surgery: A Pilot Study

Karl Øyri, MSc*, Ilangko Balasingham, PhD*, Eigil Samset, PhD*, Jan Olav Høgetveit, MSc{dagger}, and Erik Fosse, MD, PhD*

*The Interventional Centre and {dagger}Department of Clinical Engineering, Rikshospitalet University Hospital, Oslo, Norway

Anesth Analg 2006;102:478-483

 

支持无线传输的病人监测设备可以帮助病人在医院内的转运和移动。必须证实无线传感器的精确性和抗干扰能力,以使其可以取代有线传感器。我们在临床环境中比较了无线动脉压生物医学传感器设计原型和标准的有线传感器。4位腹腔镜手术患者参与了该设备的测试。无线动脉压传感器和标准有线传感器的导线均连接于右侧桡动脉的同一动脉套管。记录从两个系统得到的数据进行后期的统计学比较。在实验过程中持续或间断应用了其余13 种电子设备。有线和无线数据间进行成组对照。统计学检验提示平均差异为0.71,标准差为0.14 可信区间为 1.28 1.56 ,提示在术中应用生物医学设备不会对有创动脉压监测产生显著的电磁干扰。无线压力生物医学传感器和蓝牙无线信号传送不会对手术室中或手术室外应用的生物医学设备产生影响。

(黄佳佳 马皓琳 李士通 校)

Patient monitoring devices supporting wireless transmission can facilitate transport and ambulation of patients in hospitals. To replace wired sensors with wireless sensors, the accuracy and resistance to interference of the wireless sensors have to be documented. We compared the performance of a wireless arterial blood pressure biomedical sensor prototype with standard wired sensors in a clinical setting. Four patients undergoing laparoscopic abdominal surgery were recruited for testing of the device. Lines to a wireless arterial blood pressure sensor and standard wired sensor were connected to the same arterial cannula inserted in the right radial artery. Data from both systems were logged for postprocedure statistical comparison. During the procedure, 13 other electric devices were used, either continuously or intermittently. A sample-by-sample comparison was performed for both wired and wireless data. Statistical tests showed mean difference of 0.71, standard deviation of 0.14, and confidence interval of –1.28 to 1.56), indicating no significant electromagnetic interference on invasive arterial blood pressure monitoring caused by biomedical devices used during surgery. The wireless pressure biomedical sensor with Bluetooth wireless transmission of signals did not interfere with biomedical devices used in the operating room or vice versa.


在掌挛缩行肌腱切除术后发生复杂区域疼痛综合征的发生率:对四个麻醉方法的前瞻性观察研究

The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren’s Contracture: A Prospective Observational Study of Four Anesthetic Techniques

Scott S. Reuben, MD, Rene Pristas, MD, Duane Dixon, MD, Shameema Faruqi, MD, Lakshmi Madabhushi, MD, and Steven Wenner, MD

Departments of Anesthesiology and Orthopedic Surgery, Baystate Medical Center, Springfield, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts

Anesth Analg 2006;102:499-503

 

复杂区域疼痛综合征(CRPS)的发生是掌挛缩术后常见的并发症。尽管研究兴趣逐渐提高,然而对于哪类病人发生CRPS的风险较高以及围术期怎么样的最佳处理策略可预防这个疾病的发生都知之甚少。我们对掌挛缩行肌腱切除术的患者前瞻性地评价了四个麻醉方法(全身麻醉、腋路臂丛阻滞、利多卡因静脉区域麻醉[IVRA]和加可乐定的利多卡因静脉区域麻醉)的应用。所有病人均在术后1312个月在疼痛管理中心由不知分组的医生随访来评判CRPS的存在。结果发现全身麻醉组(n = 25; 24%)和利多卡因IVRA(n = 12; 25%)的病人术后发生CRPS明显高于腋路臂丛阻滞组(n = 5; 5%)和加可乐定的IVRA(n = 3; 6%) (P < 0.01)。我们得出结论:与全身麻醉和单用利多卡因IVRA相比,腋路阻滞或加可乐定的IVRA能显著降低掌挛缩术后CRPS的发生。

(赵雪莲 马皓琳 李士通 校)

The development of complex regional pain syndrome (CRPS) is not an uncommon complication after Dupuytren’s surgery. Despite increasing research interest, little is known regarding which patients are at increased risk for developing CRPS and what is the optimal perioperative treatment strategy for preventing the occurrence of this disease after surgery. We prospectively evaluated the use of four anesthetic techniques (general anesthesia, axillary block, and IV regional anesthesia [IVRA] with lidocaine with or without clonidine) for patients undergoing fasciectomy for Dupuytren’s contracture. All patients were followed in the Pain Management Center at 1, 3, and 12 mo postoperatively by a blinded physician to evaluate the presence of CRPS. Significantly (P < 0.01) more patients developed postoperative CRPS in the general anesthesia group (n = 25; 24%) and the IVRA lidocaine group (n = 12; 25%) compared with either the axillary block group (n = 5; 5%) or the IVRA lidocaine and clonidine group (n = 3; 6%). We conclude that axillary block or IVRA with clonidine offers a significant advantage for decreasing the incidence of CRPS compared with either IVRA with lidocaine alone or general anesthesia for patients undergoing Dupuytren’s surgery.

 

在重症监护环境中的通讯:移动电话改善病人护理

Communication in Critical Care Environments: Mobile Telephones Improve Patient Care

Roy G. Soto, MD*, Larry F. Chu, MD, MS{ddagger}, Julian M. Goldman, MD§, Ira J. Rampil, MD{dagger}, and Keith J. Ruskin, MD

*Department of Anesthesiology and {dagger}Department of Anesthesiology and Neurological Surgery, University at Stony Brook, Stony Brook, New York; {ddagger}Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California; §Department of Anesthesia and Critical Care, Harvard Medical School, Boston, Massachusetts; ¶Departments of Anesthesiology and Neurosurgery, Yale University School of Medicine, New Haven, Connecticut

Anesth Analg 2006;102:535-541

 

大多数医院限制无线设备的政策均引用手机破坏医疗设备的报告。没有研究来确定手机是否可能对安全性有有益的影响。在2003年美国麻醉医师协会的会议上散发了7878个问卷给出席者。对麻醉医师民意调查的5个问题包括,用于手术室/ICU的通讯模式,以及通讯延迟和医疗差错的经历等。用测试-再测试分析和在17个麻醉医师小样本的比例一致性证实了调查的可靠性。收到4018份回卷。调查的测试-再测试可靠性是好的(Kappa0.75; 95%可信区间0.560.94)。65%调查的麻醉医师报告用拷机作为他们主要的通讯模式,而仅17%用手机。用拷机的回答者中有45%报告通讯延迟,而手机使用者中有31%。麻醉医师使用手机可减少因通讯延迟而导致的医疗错误或伤害的风险性(相对危险度= 0.78; 95%可信区间 0.62340.9649)。必须权衡移动电话对医疗设备电磁干扰的微小风险和改善通讯的潜在益处。

(彭中美 马皓琳 李士通 校)

Most hospital policies prohibiting the use of wireless devices cite reports of disruption of medical equipment by cellular telephones. There have been no studies to determine whether mobile telephones may have a beneficial impact on safety. At the 2003 meeting of the American Society of Anesthesiologists 7878 surveys were distributed to attendees. The five-question survey polled anesthesiologists regarding modes of communication used in the operating room/intensive care unit and experience with communications delays and medical errors. Survey reliability was verified using test-retest analysis and proportion agreement in a convenience sample of 17 anesthesiologists. Four-thousand-eighteen responses were received. The test-retest reliability of the survey instrument was excellent (Kappa = 0.75; 95% confidence interval, 0.56–0.94). Sixty-five percent of surveyed anesthesiologists reported using pagers as their primary mode of communications, whereas only 17% used cellular telephones. Forty-five percent of respondents who use pagers reported delays in communications compared with 31% of cellular telephone users. Cellular telephone use by anesthesiologists is associated with a reduction in the risk of medical error or injury resulting from communication delay (relative risk = 0.78; 95% confidence interval, 0.6234–0.9649). The small risks of electromagnetic interference between mobile telephones and medical devices should be weighed against the potential benefits of improved communication.


七氟醚麻醉时前脑和后脑循环的自动调节及CO2反应性

Cerebral Autoregulation and CO2 Reactivity in Anterior and Posterior Cerebral Circulation During Sevoflurane Anesthesia

Irene Rozet, MD*, Monica S. Vavilala, MD*{dagger}, Andrew M. Lindley, MD, FRCA*, Elizabeth Visco, CRNA*, Miriam Treggiari, MD, MPh*, and Arthur M. Lam, MD, FRCPC*{ddagger}

Departments of *Anesthesiology, {dagger}Pediatrics, and {ddagger}Neurological Surgery, University of Washington, Seattle, Washington

Anesth Analg 2006;102:560-564

 

本研究的目的是比较七氟醚麻醉下脑前后循环中的自动调节(CA)CO2反应性(CO2R)。我们研究了9ASA I级择期行矫形手术的成年病人(22–47 yr)。用经颅多普勒超声仪测定中脑动脉(Vmca)及基底动脉(Vba)中的血流速度。CA测试中使用苯肾上腺素升高动脉压。用自动调节指数(ARI)来对CA定量。在Paco230 ± 2.8 mm Hg39.4 ± 2.6 mm Hg48.7 ± 2.8 mm Hg时研究CO2RCO2R使用线性回归分析。我们发现ARI在两条动脉中都保持正常:ARImca(大脑中动脉)= 0.72 ± 0.2; ARIba(基底动脉)= 0.66 ± 0.2; P = 0.5。关于CO2RVmca1.7 cm/s/mm Hg Paco2的斜率增加,Vba1.5 cm/s/mm Hg Paco2的斜率增加;P = 0.83Vmca绝对值高于VbaP < 0.05。我们得出结论,在0.5 MAC七氟醚和小剂量瑞芬太尼麻醉下的健康个体:1BA的平均流速低于MCA; 2) 在基底动脉中的自动调节及CO2R保持恒定,并与MCA的相似。

(裘毅敏 马皓琳 李士通 校)

The purpose of the study was to compare cerebral autoregulation (CA) and CO2 reactivity (CO2R) between the anterior and posterior circulation under sevoflurane anesthesia. We studied 9 adult ASA physical status I patients (22–47 yr) scheduled for elective orthopedic surgery. Blood flow velocity in the middle cerebral artery (Vmca) and in the basilar artery (Vba) were measured using transcranial Doppler ultrasonography. For CA testing, arterial blood pressure was increased using phenylephrine infusion. CA was quantified with the autoregulatory index (ARI). CO2R was investigated at Paco2 of 30 ± 2.8 mm Hg, 39.4 ± 2.6 mm Hg, and 48.7 ± 2.8 mm Hg. Linear regression analysis was used for CO2R. We found ARI was preserved in both arteries: ARImca (middle cerebral artery) = 0.72 ± 0.2; ARIba (basilar artery) = 0.66 ± 0.2; P = 0.5. With regard to CO2R, Vmca increased with slope of 1.7 cm/s/mm Hg Paco2, Vba increased with slope of 1.5 cm/s/mm Hg Paco2; P = 0.83. Absolute Vmca was higher compared with Vba; P < 0.05. We conclude that in healthy individuals under 0.5 MAC of sevoflurane and small-dose remifentanil: 1) mean flow velocities of BA are less than those of MCA; 2) autoregulation and CO2R are preserved in the basilar artery and are similar to those of MCA.


在择期剖宫产病人中脊硬复合麻醉的阻滞平面高于等量单次脊麻

Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients

Farida Ithnin, MMed, Yvonne Lim, MMed, Alex T. Sia, MMed, and Cecilia E. Ocampo, MD

Department of Women’s Anesthesia, KK Women’s and Children’s Hospital, Singapore

Anesth Analg 2006;102:577-580

 

硬膜外联合脊麻(CSE)是一种确定的用于下段剖宫产的麻醉技术。在这项研究中,我们检验了关于CSE技术中的脊麻阻滞会导致局麻药在蛛网膜下腔的扩散范围比单次脊麻(SSS)方法广的假设。在这项随机、对照、双盲的研究中,我们征集了30ASAⅠ级入院择期行下段剖宫产的产妇。所有病人均在蛛网膜下腔注射0.5%布比卡因重比重溶液2ml。使用封口不透明信封的方法将病人随机分为两组。S组(n15)使用SSS技术。CS组使用2ml空气无阻力的CSE技术,但是蛛网膜下腔注射药物后不在硬膜外腔置管。CS组最大感觉阻滞平面在统计学上高于S组(中位数C6,四分位数间范围C5C8比中位数T3,范围T2T4P<0.001)。CS组达到最大阻滞平面所需时间显著较长。两组阻滞平面消退到T10所需时间、血流动力学情况和副作用均无差别。结论是,在蛛网膜下腔注入等量局麻药的情况下,不在硬膜外腔置管或注射药物的CSE方法产生的感觉阻滞平面明显高于SSS方法。

(颜涛 马皓琳 李士通 校)

Combined spinal epidural (CSE) is an established technique for lower segment cesarean delivery. In this study we tested the hypothesis that the spinal block from a CSE technique results in a more extensive spread of local anesthetic in the subarachnoid space than the single-shot spinal (SSS) technique. We recruited 30 ASA physical status I parturients admitted for elective lower segment cesarean delivery into our randomized, controlled, double-blind study. All patients intrathecally received 2 mL of 0.5% hyperbaric bupivacaine. The patients were randomized into one of the two groups using sealed opaque envelopes. Group S (n = 15) received a SSS technique. Group CS (n = 15) received a CSE technique using loss of resistance to 2 mL of air, but the epidural catheter was not inserted after the intrathecal drug administration. The maximal sensory block achieved in group CS was statistically higher than that in Group S (median C6 interquartile range, C5 to C8 versus median T3, T2 to T4, P < 0.001). Time taken to reach maximal sensory block was significantly longer in group CS. There were no differences in the time taken for the block to recede to T10, hemodynamic profile, or side effects. In conclusion, the CSE technique without placing an epidural catheter or administering epidural medication resulted in a significantly higher level of sensory block when compared with the SSS technique when the same dose of local anesthetic was given intrathecally.


温度记录图体温测量法与针刺及冷觉在预测区域阻滞效果方面的比较

Thermographic Temperature Measurement Compared with Pinprick and Cold Sensation in Predicting the Effectiveness of Regional Blocks

Eilish M. Galvin, MB, FCARCSI, Sjoerd Niehof, BSc, Hector J. Medina, MD, Freek J. Zijlstra, PhD, Jasper van Bommel, MD, PhD, Jan Klein, MD, PhD, and Serge J. C. Verbrugge, MD, PhD

Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands

Anesth Analg 2006;102:598-604

 

 

我们设计这项实验来评估用红外线摄影机进行温度记录图体温测量作为臂丛腋路阻滞成败评价方法的有效性,并与病人对针刺及冷觉的反应相比较。我们对25位行手或前臂手术的病人用1.5%甲哌卡因并用神经刺激器方法进行腋路阻滞。在30分钟内每隔5分钟对手术部位评价针刺及冷觉。在相同时间间隔内记录手术肢体的温度记录图影像。阻滞前和阻滞后30分钟时记录未阻滞肢体的温度记录图影像。手术部位和未阻滞肢体的温度值由温度记录图影像计算获得。结果显示,温度图法在所有时间间隔的敏感性、特异性、阳性和阴性预测值的综合值均较针刺和冷觉高,其中15分钟(温度图法与冷觉比较,P = 0.006;温度图法与针刺觉比较P = 0.026 )和30分钟(温度图法与冷觉比较,P = 0.038;温度图法与针刺觉比较P = 0.040)时有统计学上显著差异。用温度图法评估阻滞,甲哌卡因局部麻醉药注射后15分钟为理想时间,其预示阻滞成功的综合值最高(P = 0.004)。我们得出结论,温度图法是一种早期且客观评价腋路区域阻滞成败的方法。

(黄丽娜 马皓琳 李士通 )

We designed this study to evaluate the usefulness of thermographic temperature measurement with an infrared camera, compared with patient response to cold and pinprick, as a means of assessing the success or failure of axillary blockades. Axillary blocks were performed on 25 patients undergoing surgery on the hand or forearm using a nerve stimulator technique with mepivacaine 1.5%. Pinprick and cold sensation were assessed on the operative site at 5-min intervals for 30 min. A thermographic image of the operative limb was recorded at similar time intervals. Thermographic images of the unblocked limb were taken before block placement and at 30 min. Temperature values at the operative site and unblocked limb were calculated from the thermographic images. Results revealed that thermography had higher combined values for sensitivity, specificity, and positive and negative predictive values than both cold and pinprick at all time intervals, with statistically significant differences at 15 min (thermography versus cold, P = 0.006; thermography versus pinprick, P = 0.026) and 30 min (thermography versus cold, P = 0.038; thermography versus pinprick, P = 0.040). For thermography as a method of block assessment, an optimal time of 15 min after mepivacaine local anesthetic injection gives the highest combined values for predicting a successful block (P = 0.004). We conclude that thermography provides an early and objective assessment of the success and failure of axillary regional blockades.


自发呼吸时对新型声门上气道装置King LT TM的插入和功能的评价

An Evaluation of the Insertion and Function of a New Supraglottic Airway Device, the King LT TM, During Spontaneous Ventilation

Carin Hagberg, MD, Yefim Bogomolny, MD, Clarence Gilmore, MD, Valentine Gibson, MD, Mark Kaitner, MD, and Somya Khurana, MD

Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas

Anesth Analg 2006;102:621-625

 

King LT TMLT, King Systems, Noblesville, IN)肺控制通气试验已显示它是一种有效的声门上气道装置。我们设计这个研究评价在50ASA I-III级、气道Mallampati I-III级进行常规全麻的病人中,自发呼吸时King LT TM插入的难易程度、气道中的位置和解剖密闭性能。麻醉诱导使用最大2µg/kg芬太尼和1.5–2mg/kg丙泊酚,维持使用70%笑气/30%氧气和异氟醚。记录插入的时间、口咽部漏气压、光纤定位和呼吸流量、血流动力学资料。记录所有的并发症。研究确定插入该装置非常容易,所有病人都可建立通畅的气道。插入该装置一次成功率为86%,第二次为12%,第三次为2%90%的病例放置King LT TM所需的时间<5秒。发生漏气的最低压力为31±8.8cmH2O(17–50cmH2O)。并发症包括拔管时发生喉痉挛1例和咳嗽3例。术后1小时和24小时喉部疼痛的发生率分别为22%15%King LT TM 是一种自发呼吸时用于气道管理的简单而可靠的声门上气道装置。

(张莹 马皓琳 李士通 校)

Trials of the King LT TM (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT TM regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I–III, Mallampati I–III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 µg/kg fentanyl and 1.5–2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. Insertion time, oropharyngeal leak pressures, fiberoptic position, and spirometry and hemodynamic data were recorded. Any complications were noted. Insertion was determined to be easy and a patent airway was achieved in all patients. First, second, and third attempt insertion rates were 86%, 12%, and 2%, respectively. Time to place the King LT TM was <5 s in 90% of cases. Baseline leak pressures were 31 ± 8.8 cm H2O (17–50 cm H2O). Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT TM is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.


嗜铬细胞瘤腹腔镜手术路径:较低的腹内压是否有利?

Laparoscopic Approach to Pheochromocytoma: Is a Lower Intraabdominal Pressure Helpful?

Jayashree Sood, MD, FFARCS*, Lakshmi Jayaraman, MD, DA.*, Ved P. Kumra, MD, DA*, and Pradeep K. Chowbey, MS, MNAMS, FIMSA, FAIS, FICS{dagger}

Department of *Anaesthesiolgy, Pain & Perioperative Medicine; and {dagger}Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India

Anesth Analg 2006;102:637-641

 

腹腔镜下肾上腺切除术由于其公认的优点而得到普及。我们研究的目的是观察减少腹腔镜肾上腺切除手术中腹内压力对血流动力学参数和血清儿茶酚铵水平是否有影响。我们将9个病人随机分成2组,维持腹内压15 mm Hg (A) 或者8–10 mm Hg (B)。在术前、气管插管时、气腹时、结扎肾上腺静脉前即刻的肿瘤手术操作时及气管拔管时测量血液去甲肾上腺素和肾上腺素水平;记录血液动力学参数。建立CO2气腹导致心率和平均动脉压(MAP)的增加,尽管在统计学上没有差异。组A的去甲肾上腺素水平较组B有统计学上的显著增高(P = 0.0002)。组A肿瘤的手术操作导致MAP和去甲肾上腺素水平的显著增加(P 分别为0.0070.0001)。肾上腺素水平没有如此改变是由于肿瘤可能主要分泌去甲肾上腺素。甚至在拔管时,组A病人的去甲肾上腺素水平持续在高水平(P = 0.027)。我们的结论是,8–10 mm Hg的低腹内压减少儿茶酚铵的释放和血流动力学的波动。

(张 马皓琳 李士通 校)

Laparoscopic adrenalectomy is gaining popularity because of its well-documented benefits. The aim of our study was to see if a decreased intraoperative intraabdominal pressure during laparoscopic adrenalectomy would affect the hemodynamic variables and the serum levels of catecholamines. We randomly divided 9 patients into 2 groups, maintaining either an intraabdominal pressure of 15 mm Hg (group A) or 8–10 mm Hg (group B). Norepinephrine and epinephrine blood levels were measured preoperatively, during endotracheal intubation, carboperitoneum, surgical manipulation of tumor just before the ligation of the adrenal vein, and tracheal extubation; the hemodynamic variables were recorded. The introduction of carboperitoneum resulted in an increase in heart rate and mean arterial blood pressure (MAP), although it was statistically insignificant. The norepinephrine levels showed a statistically significant increase in group A as compared with group B (P = 0.0002). Surgical manipulation of the tumor resulted in a significant increase in MAP and norepinephrine levels in group A (P = 0.007 and P = 0.0001, respectively). The epinephrine levels did not change as much because the tumor was probably predominantly norepinephrine-secreting. Norepinephrine levels continued to be high even during tracheal extubation in group A patients (P = 0.027). We conclude that a low intraabdominal pressure of 8–10 mm Hg causes less catecholamine release and fewer hemodynamic fluctuations.