Anesthesia & Analgesia

February 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

離體模型中纖維蛋白原置換對逆轉稀釋性凝血障礙的作用

(範穎暉 陳傑 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.

輔用小型轉流系統的常溫不停跳心臟手術:對術中血流動力學和炎症反應的影響

(黃施偉 馬皓琳 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監測儀用於小兒鎮靜深度監測的有效性 

(孫敏莉譯 薛張綱校)

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歲兒童中區分鎮靜深度的觀察性指標和客觀測量方法的比較

(周志堅 馬皓琳 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,羅呱卡因濃度,術後鎮痛與兒童

(金琳 薛張綱 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.

行耳鼻喉小手術的兒童七氟醚吸入誘導後地氟醚維持麻醉比七氟醚誘導並維持麻醉蘇醒期躁動少

(邱鬱薇 馬皓琳 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.

嬰兒11/2ProSealTM喉罩的應用:與經典喉罩比較的隨機、交叉實驗研究

(趙延華 陳傑 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.

不帶針頭的注射系統與EMLA用於小兒靜脈置管前鎮痛效果的比較

(吳德華譯 薛張綱校)

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:

隆乳術後甲基氫化潑尼松減輕疼痛、嘔吐和疲勞:甲基氫化潑尼松125 mg,帕瑞考昔40mg和安慰劑單次劑量、隨機、平行分組研究

(潘志英 陳傑 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:

聯合應用瑞芬太尼的靶控輸注異丙酚的性能:兩種異丙酚輸注公式的臨床研究

(陳瑋 馬皓琳 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

病態肥胖者中琥珀膽鹼的劑量

(馬皓琳 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

大麻類激動劑WIN 55,212-2與酮洛酸間在抗傷害性刺激方面有相加作用

(田婕 陳傑 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.

右美托咪定誘導所致大鼠Accumbal內多巴胺的減少部分是由蘭斑核的調節所致

( 路譯 薛張綱校)

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.

右旋美托咪啶對圍產期興奮中毒性腦損傷的作用是通過α2A腎上腺受體亞型介導的

(王麗珺譯 薛張綱校)

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.

局麻藥通過抑制TrkA酪氨酸激酶活性抑制神經生長因數介導的神經突外生

(周雅春 馬皓琳 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.

對易患惡性高熱的豬肌肉注射氟烷和咖啡因後乳酸鹽的劑量反應關係和局部分佈

(張美榮 陳傑 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.

局麻藥對灌注大鼠肝臟的膽汁流量、鉀平衡和癢耗的影響

(陸文清譯 薛張綱校)

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:

術中無線持續動脈壓監測:一項試驗性的研究

(黃佳佳 馬皓琳 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

手術患者使用T-Line® Tensymeter (持續性無創血壓監測設備)與常用的有創性橈動脈監測的精確性比較

(朱慧琛 陳傑 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.

氧氣臂(OxyArm):一種輔助給氧設備

(周荻 薛張綱 校)

The OxyArmTM: A Supplemental Oxygen Delivery Device

James W. Futrell, Jr and Jack L. Moore

Anesth Analg 2006 102: 491-494

PAIN MEDICINE:

在掌攣縮行肌腱切除術後發生複雜區域疼痛綜合征的發生率:對四個麻醉方法的前瞻性觀察研究

(趙雪蓮 馬皓琳 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.

圍術期尼莫地平與術後鎮痛

(鄭麗 陳傑 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對人炎症疼痛模型無抗損傷和抗炎作用

(王慧琳譯 薛張綱校)

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:

在重症監護環境中的通訊:移動電話改善病人護理

(彭中美 馬皓琳 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

在體大鼠模型中腎上腺素增加窒息後短暫心跳停止的死亡率

(顧新宇 陳傑 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:

經光譜及轉運功能分析評估七氟醚對動態腦血流自動調節的影響

(徐麗穎譯 薛張綱校)

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.

七氟醚麻醉時前腦和後腦迴圈的自動調節及CO2反應性

(裘毅敏 馬皓琳 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

階梯性缺氧性低氧血症期間大鼠紋狀體血氧飽和度的測量

(忻紀華 陳傑 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

高血壓和正常血壓大鼠大腦微血管內向整流K+通道介導的血管舒張

(徐麗穎譯 薛張綱校)

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:

在擇期剖宮產病人中脊硬複合麻醉的阻滯平面高於等量單次脊麻

(顏濤 馬皓琳 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:

年齡對坐骨神經阻滯持續時間的影響

(曹榆 陳傑 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.

坐骨神經阻滯的最小有效局麻劑量是多少——一項前瞻性、隨機性的膕窩內與臀下注射法的比較。

(孫卓真譯 薛張綱校)

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.

溫度記錄圖體溫測量法與針刺及冷覺在預測區域阻滯效果方面的比較

(黃麗娜 馬皓琳 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.

地塞米松是否能加強靜脈局部麻醉以及鎮痛效果?一個隨機對照臨床研究

(丁希喆 陳傑 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:

術後鼻部填塞在睡眠呼吸紊亂和夜間低氧血症這兩方面對睡眠呼吸暫停綜合征病人的影響

(韓曉丹譯 薛張綱校)

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.

自發呼吸時對新型聲門上氣道裝置King LT TM的插入和功能的評價

(張瑩 馬皓琳 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

可曲喉鏡(FlexibladeTM)和Macintosh喉鏡在成人全身麻醉時咽部顯露情況的臨床比較

(肖潔 陳傑 )

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.

眼鏡蛇喉周導氣管和喉罩在自主通氣中的比較:一項隨機的前瞻性研究:

( 靜譯 薛張綱校)

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.

嗜鉻細胞瘤腹腔鏡手術路徑:較低的腹內壓是否有利?

( 馬皓琳 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監測儀用於小兒鎮靜深度監測的有效性 
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(雙頻指數)是一個經驗的校準數值,其起源于成人腦電圖資料,該資料在成人與鎮靜深度相關。我們測試這樣的假說,BIS分值在小兒鎮靜深度監測中是有效的測定,該研究設計避免以前已發表報導中的限制。BIS值來自96名健康的ASAI-II級的112歲的兒童,持續記錄其鎮靜深度並自動傳輸至電腦中。兩個不知情的觀察者每隔3-5分鐘使用OAA/S(the Observer's Assessment of Alertness /Se- dation)以及UMSS鎮靜評分表(the University of Michigan Sedation Scale)進行評估。通過Spearman's秩相關檢測和預測概率(P < 0.001),在BISUMSS之間以及BISOAA/S之間有顯著的相關性。在小於6歲的兒童,BIS與進行侵襲性和非侵襲性操作的亞組的臨床鎮靜分值之間有著顯著相關性(P < 0.001)。在進行臨床鎮靜評分的兩個獨立的觀察者之間也有著良好的一致性(к= 0.51, P < 0.001)。我們得出結論,在兒童,BIS監測儀是一個量化的、無創的,而且使用方便的鎮靜深度監測儀。

(孫敏莉譯 薛張綱校)

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,羅呱卡因濃度,術後鎮痛與兒童

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.

 

為評價112月大的嬰兒骶管阻滯後羅呱卡因鎮痛及運動阻滯的效果及持續時間,我們進行了一項隨機雙盲臨床試驗,將患兒分為4組,分別使用0.1%(1)0.15%(2)0.175%(3)0.2%(4)的羅呱卡因,用量為1 mL/kg。術後各組需要進行藥物鎮痛的患兒數目不同(P<0.0005)。組1和組2需要鎮痛的患兒比組4多,而組3和組4無明顯差別。在PACU內,組1和組2比組4的患兒需要更多的鎮痛藥物(P0.0098)。在日間手術室,組間有顯著的不同,組3和組4的患兒無需任何鎮痛藥物(P0.034. 各組鎮痛時間長短也不相同(P0.034)。組1和組2的患兒鎮痛時間較短,組3和組4沒有明顯差別。與組3相比,組4患兒需要更長的時間恢復運動功能(P0.0347)。我們認為,對於嬰兒來說,0.175%的羅呱卡因與0.2%的羅呱卡因術後鎮痛效果和時間相似,而0.1%0.15%的羅呱卡因較差;0.175%的羅呱卡因對運動功能的影響較少。

(金琳 薛張綱 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.

 

不帶針頭的注射系統與EMLA用於小兒靜脈置管前鎮痛效果的比較

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.

 

靜脈置管對小兒來說是一個疼痛和痛苦的過程。J-Tip是一種FDA認可的用於小兒靜脈置管前局部麻醉的不帶針頭的注射系統。本研究我們比較了J-TipEMLA(局麻藥可溶性混合物)用於小兒靜脈置管前的鎮痛效果。7-19歲的兒童(n = 116)隨機分為兩組:一組(n = 57)用裝有1%丁卡因緩衝液0.25mLJ-Tip 注射系統在靜脈置管前作局麻;另一組(n = 59)用2.5gEMLA 。記錄置管成功次數和注射局麻藥及靜脈置管時的疼痛評分(0-10 視覺疼痛評分)。兩組間疼痛的發生率有顯著的差異(P = 0.0001):EMLA組中位數為3J-Tip 組中位數為0。局部敷料去除時,J-Tip 84%的兒童訴無痛而EMLA組為61%P = 0.004)。兩組間在置管成功次數上沒有差異。裝有1%丁卡因緩衝液的J-Tip 注射系統用於靜脈置管前局部麻醉可消除疼痛,與EMLA相比有更好的麻醉效果。

(吳德華譯 薛張綱校)

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.

 

右美托咪定誘導所致大鼠Accumbal內多巴胺的減少部分是由蘭斑核的調節所致

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.

 

我們以前已經證實選擇性2-腎上腺素能受體激動劑右美托咪定(Dex)降低大鼠NAcc細胞外多巴胺(DA)水平。由於蘭斑核(LC)是和Dex多種藥理作用相關聯的去甲腎上腺素能中樞,我們在此研究蘭斑核在Dex誘導下對accumbal DA的調製作用。將微透析探針植入Sprague-Dawley大鼠的NAccLC,並通過探針將Dex 5 mM (Dex-High, n = 6)Dex 0.5 mM (Dex-Mid, n = 5)Dex 5 µM (Dex-Low, n = 6),人工腦脊液(對照, n = 5)注入LC進行逆行標記微透析 45分鐘。採用電化學探測儀高效液相色譜法連續測量NAcc透析液中細胞外液DA水平。Dex引起NAcc中細胞外液DA水平顯著降低。在Dex-HighDex-Mid Dex-Low各組中,accumbal DA基線大幅度下降分別達68.9% ± 8.8%75.1% ± 6.5%77.04% ± 12.8%。對照組中細胞外液DA未觀測到顯著降低。伍用高選擇性2-腎上腺素能受體拮抗劑(n = 6)RS 79948 20 mM可防止Dex誘導所致的accumbal DA減少。這些資料,表明LCDex誘導的中腦邊緣系統DA調製中發揮作用,並支援這樣的假設,去甲腎上腺素能系統能夠調節中樞神經系統中較遠處的多巴胺能部位。

(金 路譯 薛張綱校)

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.

 

右旋美托咪啶對圍產期興奮中毒性腦損傷的作用是通過α2A腎上腺受體亞型介導的

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.

 

我們在α2腎上腺受體亞型缺陷的大鼠中進行這一試驗,闡明在圍產期興奮中毒性腦損傷模型中,α2腎上腺受體亞型對右旋美托咪啶神經保護特性的作用。將出生後5天的野生型大鼠和缺乏α2A(α2A-KO)α2C(α2C-KO)腎上腺受體亞型的大鼠腹膜內隨機注射右旋美托咪啶(3 μg/kg)或磷酸鈉緩衝液。30分鐘後,腦內注射10μg谷氨酸激動劑ibotenate,產生類似圍產期缺氧性皮質壞死和白質損傷。出生後10天,對該損傷進行組織病理學定量檢測。右旋美托咪啶使野生型大鼠和α2C-KO大鼠的皮質受損平均面積分別減少了44% 49%,右旋美托咪啶預處理使ibotenate導致的白質損傷減少了71%(野生型大鼠)75%(α2C-KO大鼠)。相反,在α2A-KO大鼠,右旋美托咪啶並未對皮質興奮性損傷起到保護作用,反而使白質損傷更明顯(受損平均面積達82%)。右旋美托咪啶對圍產期興奮性腦損傷具有神經保護作用,而其在α2A-KO大鼠上完全無效,提示了右旋美托咪啶的神經保護作用通過α2腎上腺受體亞型起效。

(王麗珺譯 薛張綱校)

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.

 

局麻藥對灌注大鼠肝臟的膽汁流量、鉀平衡和癢耗的影響

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

 

酰胺類局麻藥大部分通過肝臟代謝。只有在特殊的運用,如置管用於長時間的鎮痛時,才會產生較高的血漿藥物濃度。由於目前不知道局麻藥是否影響肝功能,我們就檢測利多卡因、布比卡因、羅派卡因分別在血藥濃度1 10 microg/mL時對灌注大鼠肝臟代謝活性的影響。在高濃度的時候,三種局麻藥都立即增加癢耗,布比卡因和羅派卡因也通過轉運的方式減少鉀離子的釋放,三種藥物都增加膽汁的流量,這種利膽的作用在布比卡因和利多卡因低濃度時就表現出來了。在低濃度時,只有利多卡因明顯增加癢耗,肝靜脈的PH值沒有明顯變化。結果顯示,這三種局麻藥的急性給藥只造成肝臟功能性的改變。這些觀察到的變化是由於線粒體的脫耦聯、藥物的吸收、代謝產物的膽道分泌及對鉀離子通道的抑制造成的。資料並沒有顯示這些急性變化會引起持續的術後肝功能異常,例如膽汁瘀積或是黃疸。

(陸文清譯 薛張綱校)

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.

 

氧氣臂(OxyArm):一種輔助給氧設備

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.

 

面罩和鼻導管用於全麻術後病人的輔助給氧。這些設備有一些患者相關的併發症,包括吸氣困難,高碳酸血症和機械損傷。一種新的設備,氧氣臂(OxyArm)的設計以消除這些問題。這是一種開放給氧系統,不需要與患者面部直接接觸。在本項臨床研究中我們評估了氧氣臂在術後即刻期間的應用。六十位病人在全麻氣管拔管後的第一個八分鐘內通過氧氣臂接受輔助給氧。在3-4分鐘內持續記錄氧飽和度值:1)在氣管拔管前通過氣管內導管吸氧時,2)氣管拔管後的4分鐘以4L/min氧流量通過氧氣臂給氧時,3)氣管拔管後的8分鐘以2L/min氧流量通過氧氣臂給氧時。這三個時間段的氧飽和度無顯著差異且沒有病人的氧飽和度低於88%。病人和臨床醫生高度評價氧氣臂,因為它舒適,使用簡單,面部護理時無需打斷氧療。總而言之,氧氣臂能提供大部分患者術後早期足夠水平的氧。

(周荻 薛張綱 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對人炎症疼痛模型無抗損傷和抗炎作用.

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.

 

幾項體內和體外調查發現,肉毒毒素A(BoNT/A)可以抑制P物質和興奮性氨基酸的釋放。最近,在炎性致敏的動物疼痛模型中觀察到,肉毒毒素A有明顯的抗損傷作用和抑制谷氨酸鹽的釋放。在最新的研究中,我們測試了肉毒毒素A對於特徵性的人炎症疼痛模型的抗炎和抗過敏作用。採用隨機雙盲配對的研究方法比較了100對老鼠模型(肉毒毒素A對照純鹽水)。記錄了熱損傷和機械損傷開始時,48小時(正常皮膚)和72小時(炎症皮膚)的表皮血流。紫外線B照射可導致局部嚴重的原發或繼發的過敏性炎症。儘管肉毒毒素A有較強的泌汗功能,但對於正常皮膚和過敏皮膚的疼痛感覺無作用。原發的和繼發的過敏性炎症不受肉毒毒素A的影響。因此,我們可以肯定,肉毒毒素A對急性的非炎性疼痛沒有直接作用。儘管有大量來自動物的研究資料,我們仍未觀察到肉毒毒素A對人的炎性疼痛有抗損傷和抗炎作用。

(王慧琳譯 薛張綱校)

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.

 

經光譜及轉運功能分析評估七氟醚對動態腦血流自動調節的影響

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.

 

七氟醚降低自主神經系統調節,後者在腦自動調節中扮演重要角色。因此,我們假設七氟醚影響腦自動調節。我們採用血壓變率和腦血流速率變率間光譜和轉運功能分析來研究七氟醚對動態腦血流自動調節的影響。11名健康男性經面罩吸入0.5%, 1.0%, 1.5%七氟醚。通過轉運功能增加,相位,和經顱多普勒測得的大腦中動脈的腦血流速率與橈動脈壓的一致性來評估動態腦自動調節。給予0.5% 1.0%七氟醚期間,極低頻率範圍(0.02-0.07 Hz)一致性增加到0.5以上。0.5% 1.0%七氟醚使此頻率範圍(0.02-0.07 Hz)內轉運功能增加作為一項動態腦自動調節指標顯著增強。然而,給予七氟醚期間,轉運功能增加和低、高頻率範圍內的一致性維持不變。這些結果表明,在極低頻率範圍內甚至低濃度的七氟醚就可削弱動態腦自動調節,而在低或高頻率範圍內動態腦自動調節維持不變。

(徐麗穎譯 薛張綱校)

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.

 

高血壓和正常血壓大鼠大腦微血管內向整流K+通道介導的血管舒張.

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.

 

儘管內向整流K+通道與腦迴圈調節相關,經這些通道介導的腦微血管系統擴張尚未在慢性高血壓者中證實。我們設計了這項研究以調查在高血壓和正常血壓大鼠中,內向整流K+通道在腦實質細動脈細胞外K+水平升高導致的血管舒張中所起的作用。在前列腺素F2alpha (5 x 10(-7) M)所致的收縮期間,採用電腦輔助顯微鏡評估大腦切片的細動脈。氯化鉀(KCl)致使血壓正常(5-10 mM)和高血壓(5-15 mM)大鼠的大腦細動脈擴張,而內向整流K+通道阻滯劑氯化鋇(BaCl2; 10(-5) M)卻完全消除了兩組的血管舒張。高血壓大鼠的細動脈對KCl的血管擴張反應比血壓正常大鼠要顯著。相反,兩組中硝普鈉(3 x 10(-8) to 3 x 10(-6) M)所致的血管擴張反應相似。這些結果表明,內向整流K+通道在大腦皮層實質微血管中,對細胞外K+引起的血管舒張起重要作用,且在慢性高血壓者中經此通道導致的大腦細動脈擴張更甚。

(徐麗穎譯 薛張綱校)

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.

 

坐骨神經阻滯的最小有效局麻劑量是多少——一項前瞻性、隨機性的膕窩內與臀下注射法的比較。

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.

 

對於坐骨神經阻滯而言,沒有明確的研究表明最適用藥量是多少。這項流行性、前瞻性、隨機性的研究旨在發現用1.5%的甲呱卡因在膕窩內注射和臀下注射阻滯坐骨神經的最小用量。有56名將要進行足部手術的病人被隨機的分配為臀下組(n = 28)與膕窩組(n = 28)。所有的神經阻滯都被神經刺激器(刺激頻率, 2 Hz, 強度 1.5-0.5 mA)與外周神經刺激導管所檢測。所有的病人都能在刺激<0.5 mA時被引發出蹠屈反應並能維持一段時間。完整的局麻效果被定義為對針刺喪失痛覺並在阻滯後分鐘又伴隨的肌無力以至於不能蹠屈或背屈。用臀下法阻滯坐骨神經的平均用量為12 +/- 3 mL而膕窩內注射法則為20 +/- 3 mL(P < 0.05)。臀下法充分阻滯坐骨神經的ED9517 mL而膕窩內注射法則為30 mL。作者得出的結論為局麻阻滯坐骨神經時,遠距離的部位(膕窩)用藥量要大於近距離部(臀下法)位阻滯時所用的藥量。
(孫卓真譯 薛張綱校)

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).

 

術後鼻部填塞在睡眠呼吸紊亂和夜間低氧血症這兩方面對睡眠呼吸暫停綜合征病人的影響
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.

 

鼻中隔手術常常是為了建立一個功能性鼻道。在這些病人中阻塞性睡眠呼吸暫停綜合症(OSAS)頻繁發生。雖然患有阻塞性睡眠呼吸暫停綜合症的病人發生低氧血症的危險性增加,但是術後鼻部填塞(PNP)對於患者的睡眠呼吸紊亂和氧的去飽和作用至今仍不清楚。我們連續調查了40位做內鼻手術的病人,他們術後都用了鼻部填塞。其中15位病人以前診斷為阻塞性睡眠呼吸暫停綜合症(組2),另25位病人沒有被診斷(組1)。在對照組,12位健康志願者將進行耳部或頸部的手術而沒有行鼻部填塞。在術前和術後的晚上,我們持續測量病人的口鼻流量、胸腹運動度和氧飽和度。我們計算了呼吸暫停-呼吸不全指數(AHI)和氧去飽和度指數(ODI)。將術前和術後的數值進行比較,對照組志願者的AHIODI都沒有改變。與此相反,第一組病人AHIODI值明顯增加;而第二組病人,僅AHI明顯增加,ODI沒有明顯改變。因為OSASPNP的病人ODI值不增加,所以術後的徹夜吸氧和重症監護就不必要作為一項常規來實行了。

(韓曉丹譯 薛張綱校)


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.

 

眼鏡蛇喉周導氣管和喉罩在自主通氣中的比較:一項隨機的前瞻性研究:

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.

 

喉罩和眼鏡蛇喉周導氣管一次性使用的聲門上通氣器械。還沒有研究比較兩者在自主通氣中的應用。我們比較兩者在以下幾方面:1)在自主通氣中通氣的可變2)有時間得到有效的氣道。3)氣道介入需求4)套囊封閉壓力5)纖維光學鏡6)圍手術有害事件。80個成人ASA分級12級,病人全麻,病人被隨機地分為使用喉罩或眼鏡蛇喉周導氣管。在吸入潮氣量、呼出潮氣量、呼氣末CO2濃度、呼吸頻率、次數和類型、纖維光學評分和圍手術期有害時間上兩組人沒有明顯差異。眼鏡蛇喉周導氣管地口咽漏氣壓力更高(27 +/- 7 versus 21 +/- 4 cm H2O; P < 0.001).喉罩組的氧飽和度更高(98.1% +/- 1% versus 97.3% +/- 2%; P = 0.02)喉罩的插入時間更短(23.7 +/- 2 s versus 26.6 +/- 7 s; P = 0.02)喉罩插入也更容易。但這些差異並沒有臨床意義。兩種方式都可以為全麻提供充分的通氣。

(鍾 靜譯 薛張綱校)
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.

離體模型中纖維蛋白原置換對逆轉稀釋性凝血障礙的作用

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.

 

膠體液和晶體液常用於處理重度創傷患者的低血壓。但是伴隨液體治療時常出現凝血因數、血小板的稀釋,及影響纖維蛋白原聚集導致出血加重,從而使患者的最終結果更差。作者用離體模型研究稀釋血樣中補充纖維蛋白原是否能逆轉稀釋性凝血功能障礙。取5位健康男性志願者的血液用乳酸林格氏液、4%的明膠或6%羥乙基澱粉130\0.4,和乳酸林格氏液與這兩種膠體液之一的混合物稀釋60%。此後,三份稀釋血樣用3個不同濃度的纖維蛋白原(0.751.53 mg/mL)培養。用改良血栓彈性描記法(ROTEM®; Pentapharm, Munich, Germany)進行評估。稀釋60%後,凝血時間延長,且血凝塊強度和纖維蛋白聚合顯著降低。在稀釋血樣中給予纖維蛋白原後,凝血時間縮短,血凝塊強度和纖維聚合增加。離體纖維蛋白原置換對ROTEM®變數的作用取決於纖維蛋白原的劑量和用於稀釋血樣的液體種類。

(範穎暉 陳傑 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.

 

嬰兒11/2ProSealTM喉罩的應用:與經典喉罩比較的隨機、交叉實驗研究

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.

 

經典喉罩(CLMA)用於小兒的許多問題,被認為與通氣罩設計不足有關。CLMA的主要局限之一在於正壓通氣時通氣罩密封不夠。ProSeal喉罩(PLMA)是一種通氣罩改良的新型喉罩,用於兒童時顯示較CLMA有更有效的密封性。近來已經有了一種小兒尺寸(11/2)的PLMA。作者對30名年齡為15個月(2-30月)、體重9 kg (5-12 kg)的小兒進行非肌松的麻醉,隨機應用CLMAPLMA。測定氣道漏氣壓和最大潮氣量,確定喉罩放置的難易度、最初氣道的特性和用光導纖維定位的位置,並評估應用PLMA時放置胃管的情況。在頭正中位元時應用CLMAPLMA平均氣道漏氣壓分別為26.718.9 cmH2O;最大屈曲狀態時分別為35.6 28.2 cmH2O,平均最大潮氣量分別為312260 mL,應用PLMA明顯較大(P < 0.01)。有8名患者應用CLMA時空氣進入胃內,應用PLMA者則沒有。除一名病人外均成功放置了胃管。應用PLMA的患者中有3名出現了一定程度的喉壓迫。與相同尺寸的CLMA 相比,11/2 PLMA用於小兒維持氣道可能更合適。與應用CLMA相比,PLMA允許同時放置胃管,而且在氣道壓較高時才會出現漏氣,用於小兒PPV時有重要意義。

(趙延華 陳傑 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.

 

隆乳術後甲基氫化潑尼松減輕疼痛、嘔吐和疲勞:甲基氫化潑尼松125 mg,帕瑞考昔40mg和安慰劑單次劑量、隨機、平行分組研究

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.

 

作者用隨機、雙盲、平行分組的方法比較研究了隆乳術術前給予甲基氫化潑尼松125 mg IV (n = 68)和帕瑞考昔40 mg IV (n = 68)以及安慰劑IV (n = 68)的效果。以局麻輔助異丙酚/芬太尼麻醉下行手術。和安慰劑相比,甲基氫化潑尼松和帕瑞考昔在術後1-6h顯著減少靜息痛和活動痛(總平均疼痛強度:甲基氫化潑尼松組(17.25; 95% CI14.85-19.65)與安慰劑組(21.7; 95% CI, 19.3-24.1)相比P < 0.03; 帕瑞考昔組(15.25; 95% CI, 13.25-17.25)與安慰劑組相比 P < 0.001 總平均活動痛強度(1-6 h): 甲基氫化潑尼松(22.7; 95% CI, 20.1-23.3 安慰劑 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 與安慰劑組相比 P < 0.001。甲基氫化潑尼松組與帕瑞考昔組間在第一個6h內所有追加藥物用量和實際疼痛強度相似但均較安慰劑組減少,採用實際疼痛強度評分和追加鎮痛藥物量方法比較,有效藥物組的療效顯著優於安慰劑組。在術後第一個24h噁心和嘔吐發生率方面,與安慰劑組(60%)相比,甲基氫化潑尼松組(30%)明顯降低(P < 0.001),但是帕瑞考昔組(37%)降低不明顯。在術後疲勞感方面,與安慰劑(66%)相比甲基氫化潑尼松使用後疲勞感(44%)降低明顯( P < 0.05),帕瑞考昔組(59%)降低不明顯。結論:隆乳術術前甲基氫化潑尼松125mg靜脈注射具有與帕瑞考昔40mg相當的良好的鎮痛作用和節約其他鎮痛藥用量,甲基氫化潑尼松能減少噁心、嘔吐和疲勞感,而帕瑞考昔無此作用。

(潘志英 陳傑 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.

 

大麻類激動劑WIN 55,212-2酮洛酸間在抗傷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.

 

非甾體類抗炎藥(NSAIDS)與阿片類藥物的聯合應用能夠降低毒副作用,提高鎮痛效果,因此廣泛應用於疼痛治療中。大麻類與阿片類有相似的藥理特性,有望成為鎮痛藥物。然而,大麻類對精神系統的副作用一定程度上限制了其在疼痛治療中的應用。本研究擬在小鼠中應用醋酸誘導扭體實驗和甩尾實驗,探討大麻類和NSAIDS抗傷害性刺激的交互作用。應用等效座標圖分析法分析交互作用。單獨或聯合應用大麻類激動劑WIN 55,212-2NSAIDS酮洛酸均能在扭體實驗中劑量依賴性產生鎮痛作用。等效座標圖分析法顯示,全身性同時應用WIN 55,212-2酮洛酸時,兩者顯示出協同作用。酮洛酸對熱甩尾實驗無明顯鎮痛作用,而WIN 55,212-2相反,酮洛酸對WIN 55,212-2的該種鎮痛作用無明顯影響。本研究提示,WIN 55,212-2酮洛酸在炎性內臟痛模型中有抗傷害性刺激相加作用。大麻類和NSAIDS聯合應用有望成為疼痛藥物治療的新方法。

(田婕 陳傑 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.

 

對易患惡性高熱的豬肌肉注射氟烷和咖啡因後乳酸鹽的劑量反應關係和局部分佈

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.

 

作者假設對易患惡性高熱和不易患惡性高熱的豬靜脈注射亞胺培南,氟烷和咖啡因可以劑量依賴的增加乳酸鹽的濃度,並且在限定的肌肉裏乳酸鹽和二氧化碳的局部分佈的代謝亢進。把充滿林格氏液的微量滲析探針紮進七個易患惡性高熱和不易患惡性高熱的豬的後肢,平衡後,逐漸提高劑量並一次性注射氟烷和咖啡因。第二個關於局部分佈的假設,把微量滲析探針放在七個易患惡性高熱和不易患惡性高熱的豬的注射氟烷和咖啡因的部位和距離注射部位10mm25mm處,通過分光分度法測量滲析液中乳酸鹽的濃度,另外,在氟烷的實驗中測量二氧化碳分壓。易患惡性高熱比不易患惡性高熱的豬在注射氟烷和咖啡因後明顯增加乳酸鹽的劑量依賴性。乳酸鹽只在氟烷和咖啡因的注射部位增加而在距離注射部位10mm25mm處不增加。局部注射氟烷和咖啡因後惡性高熱的易患性導致乳酸鹽的劑量反應曲線向左側移位元。局部注射刺激惡性高熱產生的藥物,乳酸鹽和二氧化碳的增加限定在探針附近的很小的區域。

(張美榮 陳傑 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.

 

手術患者使用T-Line® Tensymeter (持續性無創血壓監測設備)與常用的有創性橈動脈監測的精確性比較

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.

 

連續每次動脈血壓監測並即時顯示動脈波形通常通過有創動脈置管獲得。本研究作者評估無創性裝置T-Line® Tensymeter的性能,一種通過來自連續血壓測定波形計算動脈壓,並通過床旁監護儀或T-Line Tensymeter本身計算心率。25名全身麻醉患者,用T-Line® Tensymeter無創測定收縮壓、平均血壓和舒張壓,並與對側橈動脈測量值相比較。使用Bland Altman試驗對資料進行了分析以確定兩者間的一致性。兩者的均數±標準差(mmHg)偏倚和精度分別為:收縮壓1.77.05.74.4;舒張壓2.36.95.74.5;平均血壓1.75.34.04.8。在臨床可接受的範圍內,一定的手術患者中,收縮壓41189mmHg範圍內,T-Line® Tensymeter無創性測壓測出的動脈波形與對側有創性導管測得的血壓一致。Tensymeter可使臨床醫生在一定情況下(低或中度風險的操作過程)避免動脈置管又希望即時監測血壓時成為可能。

(朱慧琛 陳傑 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.

 

圍術期尼莫地平與術後鎮痛

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.

 

有實驗證據顯示:尼莫地平,一種L-型二氫吡啶類鈣通道阻滯劑有著相對較高血腦屏障穿透力,可以增強嗎啡的抗傷害作用。作者驗證如下假設:手術期間48小時內每6小時口服尼莫地平可以降低VAS疼痛評分和術後急性疼痛處理的嗎啡消耗量。40(年齡70 ± 7 , 男性28 )行膝關節置換術病人電腦隨機分組,雙盲接受尼莫地平膠囊30mg或安慰劑。所有的病人在麻醉前1-2小時前接受3個膠囊(尼莫地平90mg或安慰劑),之後在手術期間48小時內每6小時口服30mg尼莫地平或安慰劑。用高比重的0.5%的布比卡因進行脊麻並且根據麻醉醫生的需要給予麻黃素。術後病人嗎啡自控鎮痛(PCA,單次 1mg, 鎖定時間5 min)。主要監測患者休息和活動時VAS疼痛評分以及嗎啡的消耗量。尼莫地平組患者嗎啡消耗量顯著增加,分別為12小時(39±18 29±15;P=0.04),24小時(62±23 45±24;P=0.02),和48小時(88±3461±27;P=0.01)。休息或活動時疼痛評分及嗎啡首次使用時間組間無顯著差異。結果顯示手術期間給予尼莫地平的患者在12小時以後的嗎啡消耗量增加。表明膝關節置換術的患者,尼莫地平不但無鎮痛輔助作用,反而可能具有抑制嗎啡的鎮痛作用。

(鄭麗 陳傑 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.

在體大鼠模型中腎上腺素增加窒息後短暫心跳停止的死亡率

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.

 

腎上腺素在心跳停止中可能有害。本研究中,作者探究窒息後短暫心跳停止復蘇後腎上腺素的作用和合併使用鈣通道阻斷劑對復蘇後心肌的影響。麻醉大鼠脫離機械通氣導致心跳停止。1分鐘後用機械通氣、吸氧、胸部按壓、靜脈給藥等復蘇。在研究1和2中,分別給予腎上腺素1030ug/kg0.9%生理鹽水。研究3中給予腎上腺素30ug/kg,並且隨機給予維拉帕米0.1mg/kg0.9%生理鹽水。研究1和3中,用經胸超聲心動圖評估左心室功能。研究2監測左房壓。腎上腺素導致死亡率增加(對照組為0/8[0%],腎上腺素10ug/kg組為4/12[33%],腎上腺素30ug/kg組的死亡率為16/22[72.8%]P<0.05),高血壓(P < 0.001)、心動過速(P = 0.004)、早期短暫左房高壓、劑量相關性左室舒張末期直徑的減少。維拉帕米能阻止大劑量腎上腺素相關的死亡率增加,減輕心臟舒張早期功能障礙和復蘇後高血壓(P = 0.001)而無收縮期功能異常。腎上腺素對窒息後短暫心跳停止可能是有害的。

(顧新宇 陳傑 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.

 

階梯性缺氧性低氧血症期間大鼠紋狀體血氧飽和度的測量

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.

 

作者應用可見光的反射分光鏡來評估大鼠紋狀體組織的血氧飽和度(SstrO2)。7只大鼠在麻醉及機械通氣下,吸入氧濃度(FiO2)逐級遞減:0.350.250.150.1,其後進入複氧期(組1)。選取兩側的紋狀體局部區域,分別應用反射分光鏡和鐳射多普勒血流儀連續監測各個階段的SstrO2和腦血流量(LCBF)。另一組大鼠(組2n6)則測量矢狀竇的血氧飽和度(SssO2)。FiO20.35(對照值)時,紋狀體SstrO238%±17%,其後隨FiO2下降SstrO2遞減,FiO2 0.12時為16 ±10%,FiO2 0.10時為13 ±7%(p<0.05),兩側半球之間無差異。這些變化伴隨著LCBF的逐漸增加:分別為對照值的161%±26%和197%±34%(p<0.05)。所有的變化在複氧後完全恢復。組2中,SssO2FiO20.35時為38%±8%,當FiO20.1時則降低至10%±3%,與SstrO2的降低程度接近。本研究表明大鼠中應用可見光的反射分光鏡連續測量SstrO2的方法可行。階梯性缺氧性低氧血症時SssO2LCBF的測定說明SstrO2的變化可用於反應腦內靜脈氧合的情況。

(忻紀華 陳傑 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.

 

年齡對坐骨神經阻滯持續時間的影響

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.

 

隨著年齡增長的生理變化以及對外周神經阻滯持續時間的影響仍有待進一步明確。作者前瞻性地研究了年輕患者和年長患者使用甲呱卡因行坐骨神經阻滯的持續時間。80ASA I-III病人,年齡1835歲(n40),5580歲(n40),使用股神經和坐骨神經阻滯進行門診膝關節鏡檢查。每組有37個病人完成了本實驗。所有病人坐骨神經阻滯使用1%甲呱卡因20ml加入碳酸氫鈉0.1 mEq/mL和腎上腺素14000002.5ug/ml),並行股神經阻滯。在手術側肢體測量感覺阻滯(針刺覺、溫度覺、震動覺)、運動阻滯(蹠曲、背曲)持續時間以及坐骨神經分佈區域感覺、運動完全阻滯持續時間。老年組感覺和運動完全恢復時間(329±47min)要比年輕組(306±46min)長(p0.04)。本研究中這種差異比較小,臨床上不易覺察。年齡的增加使震動覺的恢復時間延長(年輕組295±58min,年老組257±50minp0.007原文有誤)。其他的檢測項目組間沒有差異。結論是:年齡可能影響周圍神經阻滯,其中的藥理學、生理學和時間性因素需要進一步的研究。

(曹榆 陳傑 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.

 

地塞米松是否能加強靜脈局部麻醉以及鎮痛效果?一個隨機對照臨床研究

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靜脈局部麻醉(IVRA)中加入地塞米松後的麻醉及鎮痛效果。75名手外傷急診患者隨機分成3組:L組接受利多卡因(3mg/kg),LD組接受利多卡因(3mg/kg)+地塞米松(8mg),LDc組在局麻部位接受利多卡因(3mg/kg)注射,同時在無麻醉的非手術手臂接受地塞米松(8mg)靜脈注射。局麻藥均配成40ml溶液。分別在術中以及術後2小時記錄VASvisual analog scale)和語言疼痛評分,當術後疼痛VAS評分大於3,給予對乙酰氨基酚500mg口服鎮痛。記錄術後至第一次需要鎮痛藥物的時間以及第一個24小時內的給藥總量。達到完全感覺以及運動阻滯的時間在3組間無明顯差異。LD組運動完全恢復時間[L組(85.91-10.08min, LD136.76-20.19min, LDc64.44-8.43min]以及感覺恢復時間[L75.21-10.30min, LD126.11-19.40min, LDc64.2-8.11]min]最長(P<0.05)。LD組的病人疼痛評分最低且術後第一個24小時內對乙酰氨基酚的需要量最少。結論:手外傷急診病人的利多卡因靜脈局部麻醉中加入地塞米松(8mg)可有效地增強術後第一天的鎮痛效果。

(丁希喆 陳傑 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.

 

可曲喉鏡(FlexibladeTM)和Macintosh喉鏡在成人全身麻醉時咽部顯露情況的臨床比較

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.

 

可曲喉鏡(FlexibladeTM) 是帶有可曲鏡片的喉鏡。為了評估和比較可曲喉鏡和經典的喉鏡(Macintosh)的有效性,作者選擇了200名行選擇性手術需全麻插管的病人作臨床研究。分別用3Macintosh喉鏡和可曲喉鏡直接進行喉鏡檢查,用或不用可曲喉鏡的可曲控制杆。在不進行任何操作的情況下,根據CormackLehane分類法,記錄患者咽喉部的情況。用Macintosh喉鏡的咽部暴露情況不差於未用可曲控制杆的可曲喉鏡咽部顯露情況。58.5%未使用可曲控制杆的可曲喉鏡顯露為非Ⅰ級的患者在使用Macintosh鏡片後得到改善。而使用Macintosh鏡片顯露為非Ⅰ級的患者,在應用可曲喉鏡並使用可曲控制杆後39.6%的患者得到改善。可曲喉鏡暴露但未使用可曲控制杆咽部顯露為非Ⅰ級患者在使用可曲控制杆後84.5%的患者咽部顯露得到改善。使用可曲喉鏡的可曲控制杆時不影響顯露。僅有一例患者使用Macintosh鏡片後的顯露優於可曲喉鏡並使用可曲控制杆時的顯露。結論:全麻肌松下,使用可曲喉鏡並使用可曲控制杆時,咽部的顯露情況明顯優於Macintosh喉鏡(P<0.0001)。

(肖潔 陳傑 )

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).

 

輔用小型轉流系統的常溫不停跳心臟手術:對術中血流動力學和炎症反應的影響

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

 

使用小型心肺轉流(CPB)迴圈和避免心臟停搏的目的是試圖減輕對心臟手術的炎症反應。我們對不停跳心臟手術(BHS)輔用簡化的轉流系統(SBS)對全身血流動力學、心肌功能以及對CPB的炎症反應的影響進行了研究。我們假設:與傳統CPBcCPB)迴圈下進行手術相比,使用SBS可減少炎症反應從而使得CPB後的血流動力學更穩定。我們對45例行冠狀動脈搭橋的病人進行了前瞻性的研究。15例病人隨機納入使用常規體外迴圈(cCPB)、冷晶體停搏液和中度低溫。另兩組各15例病人在兩種不同的僅包括血泵和氧合器的SBS輔助下常溫行BHS。用經肺熱稀釋法和經食道超聲心動圖評估血流動力學參數。對圍術期血漿中促炎和抗炎介質的水平進行檢測。在CPB後,全身血流動力學參數和心室收縮功能在各組間無差別。CPB後左室舒張功能受損在各組間相似(與轉流前相比,P < 0.01)。在手術結束時,兩個SBS組所需要的血管收縮藥(去甲腎上腺素)較cCPB組更多(P < 0.01)。在CPB後,白介素(IL-6的釋放在各組間無明顯差別,但IL-10的血漿水平在cCPB組明顯較高(與SBS組相比,P < 0.01)。心肌壞死的程度(肌鈣蛋白T)在各組間相似。我們得出結論:在我們的實驗中,小型轉流系統和避免心臟停搏對改善CPB後的血流動力學和減輕促炎免疫反應並無作用。

(黃施偉 馬皓琳 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歲兒童中區分鎮靜深度的觀察性指標和客觀測量方法的比較

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

 

可用以評價鎮靜深度的觀察和客觀方法有數種;然而,關於這些方法用以區分深度鎮靜的可靠性的資料目前尚缺。本研究中,我們在出生至18歲兒童中比較了3種鎮靜評價工具,觀察它們檢測鎮靜深度水平的相對價值。以雙頻指數監測(BIS®)、改良覺醒維持試驗(MMWT)及密歇根州大學鎮靜量表(UMSS)來評價鎮靜。我們記錄了39例兒童的327個觀察值。在整個觀察過程中,以鎮靜藥適當改變鎮靜深度確保每個測量值有效。在UMSSBIS之間(rho = 0.73) UMSSMMWT之間(rho = 0.59; P < 0.01) 存在中度至高度的相關性。而BISMMWT之間的相關性有顯著性但較低 (r = 0.36; P < 0.01)UMSSMMWT測量的一致性表明這兩種方法在鎮靜連續過程中的可靠性。除了在UMSS評分23之間外,BISUMSS的鎮靜評分增高而顯著降低。ROC曲線提示,BIS80MMWT14分鐘是描繪深度鎮靜最為敏感的指標。我們的發現證實了這些觀察性和客觀測量方法在評價18歲以下兒童鎮靜深度時的總體有效性,但顯示區分中度與深度鎮靜仍有局限性。

(周志堅 馬皓琳 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.

 

行耳鼻喉小手術的兒童七氟醚吸入誘導後地氟醚維持麻醉比七氟醚誘導並維持麻醉蘇醒期躁動少

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

 

兒童在吸入全麻蘇醒期會發生躁動現象。我們設計本研究採用最近發表的兒科病人麻醉蘇醒期譫妄(PAED)評分表來檢查行耳鼻喉手術的兒童在七氟醚誘導地氟醚維持麻醉和七氟醚誘導並維持麻醉後蘇醒期行為。38例給予術前用藥的兒童,年齡為12個月-7歲,採用七氟醚面罩誘導後隨機分為兩組,一組用七氟醚維持麻醉(n=19),另一組用地氟醚維持麻醉(n=19)。評價氣管拔管時間、改良Aldrete評分、蘇醒期行為、復蘇期併發症及疼痛評分。PAED評分顯示地氟醚較七氟醚維持麻醉對蘇醒期躁動有明顯優點(6[015]12 [2–20], 嚴重躁動的最大總分為20)。地氟醚組氣管拔管時間顯著短於七氟醚(5.4 ± 1.4 13.4 ± 1.8分鐘)。七氟醚維持麻醉的兒童到達麻醉後復蘇室(PACU)時的改良Aldrete評分明顯較低。出PACU回普通病房的時間及不良反應的發生率兩組無明顯差異。結論,在兒童七氟醚誘導後用地氟醚維持麻醉能降低蘇醒期躁動程度,並且縮短復蘇時間。

(邱鬱薇 馬皓琳 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.

 

聯合應用瑞芬太尼的靶控輸注異丙酚的性能:兩種異丙酚輸注公式的臨床研究

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

 

靶控輸注(TCI)結合了靜脈用藥物的藥代動力學的各種變數以便於進行安全可靠的給藥。本臨床研究中,我們研究了聯合應用瑞芬太尼的異丙酚TCI的性能。預期手術時間超過一小時的54名擇期行普通外科手術的成年患者,聯合應用異丙酚TCIMarsh參數組套,異丙酚隨機溶於長鏈或中/長鏈甘油三酸酯中)和瑞芬太尼。在術前、術中和術後各個階段測定動脈異丙酚的血漿濃度、血流動力學及來源於腦電圖的參數。測定的異丙酚血漿濃度超過預計值的59%,而當應用Schnider參數組套重新計算時,則超過預計值的48%。藥代動力學的總體分析表明異丙酚的中央分佈容積很小(3.55 L),清除率很低(1.31 L/min)ASA分級和性別是僅有的對異丙酚藥代動力學有明顯影響的變數。在實驗的第二階段,從最初27名患者中確定出一套新的異丙酚藥代動力學的參數。在此之後,對餘下的27名患者進行的性能分析顯示,應用新的參數設定改善精確性。我們的結果顯示,當瑞芬太尼和異丙酚聯合應用時,Marsh Schnider參數組套系統性地低估了異丙酚的血漿濃度。部分內容在荷蘭阿姆斯特丹199961日歐洲麻醉醫生協會的年會上和美國德克薩斯州達拉斯19991012日美國麻醉醫師協會的年會上報導過。

(陳瑋 馬皓琳 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.


病態肥胖者中琥珀膽鹼的劑量

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

 

琥珀膽鹼(SCH)在病態肥胖患者中的合適劑量尚未知曉。我們研究了45例擬行胃旁路手術的病態肥胖(體重指數>40 kg/m2)成人。用TOF-Watch SX®肌加速度儀記錄拇內收肌對腕部尺神經刺激的反應。患者以隨機雙盲方式分入三個研究組中的一組。組I患者接受SCH 1 mg/kg理想體重,組II患者接受SCH 1 mg/kg去脂體重,組III患者接受SCH 1 mg/kg總體重。給予SCH後,對氣管插管條件進行評分。記錄20 min神經肌肉阻滯恢復過程。最大神經肌肉阻滯的起效時間組間比較無差異,但組I的最大阻滯程度顯著較小。組I和組II的恢復時間顯著較短。1/3的組I患者插管條件評為差,而組III中無患者插管條件評為差。我們的研究證實了為了達到完全的神經肌肉麻痹及預計的喉鏡插管條件,推薦琥珀膽鹼用總體重1 mg/kg

(馬皓琳 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.


局麻藥通過抑制TrkA酪氨酸激酶活性抑制神經生長因數介導的神經突外生

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

 

局麻藥(LAs)可抑制與神經性疼痛相關的交感神經芽生。但是其確切機理至今未明。神經生長因數(NGF)可促進交感神經出芽, NGF刺激使NGF高親和力受體TrkA自體磷酸化,啟動NGF信號轉導。PC12細胞是交感神經出芽的細胞模型,本研究通過觀察利多卡因、布比卡因和普魯卡因對NGF刺激後神經突外生的抑制作用探討它們對NGF信號轉導的影響。為了研究上述局麻藥對NGF介導的PC12細胞神經突外生的影響,將細胞分別孵育於404004000µM濃度的每個局麻藥中。用免疫沉澱和免疫印跡法檢測局麻藥對NGF刺激下TrkA的活性的影響來分析TrkA的自體磷酸化。通過乳酸脫氫酶釋放試驗和季銨乙啡啶碘染色評估局麻藥對PC12細胞的毒性作用。利多卡因(400 µM)、布比卡因 (40 400 µM) 和普魯卡因 4000 µM)顯著抑制神經突外生或TrkA自體磷酸化而無細胞毒性作用。局麻藥抑制NGF刺激後TrkA酪氨酸激酶活性可能涉及其抑制神經突外生的機制。

(周雅春 馬皓琳 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.


術中無線持續動脈壓監測:一項試驗性的研究

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

 

支援無線傳輸的病人監測設備可以幫助病人在醫院內的轉運和移動。必須證實無線感測器的精確性和抗干擾能力,以使其可以取代有線感測器。我們在臨床環境中比較了無線動脈壓生物醫學感測器設計原型和標準的有線感測器。4位元腹腔鏡手術患者參與了該設備的測試。無線動脈壓感測器和標準有線感測器的導線均連接於右側橈動脈的同一動脈套管。記錄從兩個系統得到的資料進行後期的統計學比較。在實驗過程中持續或間斷應用了其餘13 種電子設備。有線和無線資料間進行成組對照。統計學檢驗提示平均差異為0.71,標準差為0.14 可信區間為 1.28 1.56 ,提示在術中應用生物醫學設備不會對有創動脈壓監測產生顯著的電磁干擾。無線壓力生物醫學感測器和藍牙無線信號傳送不會對手術室中或手術室外應用的生物醫學設備產生影響。

(黃佳佳 馬皓琳 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.


在掌攣縮行肌腱切除術後發生複雜區域疼痛綜合征的發生率:對四個麻醉方法的前瞻性觀察研究

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

 

複雜區域疼痛綜合征(CRPS)的發生是掌攣縮術後常見的併發症。儘管研究興趣逐漸提高,然而對於哪類病人發生CRPS的風險較高以及圍術期怎麼樣的最佳處理策略可預防這個疾病的發生都知之甚少。我們對掌攣縮行肌腱切除術的患者前瞻性地評價了四個麻醉方法(全身麻醉、腋路臂叢阻滯、利多卡因靜脈區域麻醉[IVRA]和加可樂定的利多卡因靜脈區域麻醉)的應用。所有病人均在術後1312個月在疼痛管理中心由不知分組的醫生隨訪來評判CRPS的存在。結果發現全身麻醉組(n = 25; 24%)和利多卡因IVRA(n = 12; 25%)的病人術後發生CRPS明顯高於腋路臂叢阻滯組(n = 5; 5%)和加可樂定的IVRA(n = 3; 6%) (P < 0.01)。我們得出結論:與全身麻醉和單用利多卡因IVRA相比,腋路阻滯或加可樂定的IVRA能顯著降低掌攣縮術後CRPS的發生。

(趙雪蓮 馬皓琳 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.

 

在重症監護環境中的通訊:移動電話改善病人護理

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

 

大多數醫院限制無線設備的政策均引用手機破壞醫療設備的報告。沒有研究來確定手機是否可能對安全性有有益的影響。在2003年美國麻醉醫師協會的會議上散發了7878個問卷給出席者。對麻醉醫師民意調查的5個問題包括,用於手術室/ICU的通訊模式,以及通訊延遲和醫療差錯的經歷等。用測試-再測試分析和在17個麻醉醫師小樣本的比例一致性證實了調查的可靠性。收到4018份回卷。調查的測試-再測試可靠性是好的(Kappa0.75; 95%可信區間0.560.94)。65%調查的麻醉醫師報告用拷機作為他們主要的通訊模式,而僅17%用手機。用拷機的回答者中有45%報告通訊延遲,而手機使用者中有31%。麻醉醫師使用手機可減少因通訊延遲而導致的醫療錯誤或傷害的風險性(相對危險度= 0.78; 95%可信區間 0.62340.9649)。必須權衡移動電話對醫療設備電磁干擾的微小風險和改善通訊的潛在益處。

(彭中美 馬皓琳 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.


七氟醚麻醉時前腦和後腦迴圈的自動調節及CO2反應性

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

 

本研究的目的是比較七氟醚麻醉下腦前後迴圈中的自動調節(CA)CO2反應性(CO2R)。我們研究了9ASA I級擇期行矯形手術的成年病人(22–47 yr)。用經顱多普勒超聲儀測定中腦動脈(Vmca)及基底動脈(Vba)中的血流速度。CA測試中使用苯腎上腺素升高動脈壓。用自動調節指數(ARI)來對CA定量。在Paco230 ± 2.8 mm Hg39.4 ± 2.6 mm Hg48.7 ± 2.8 mm Hg時研究CO2RCO2R使用線性回歸分析。我們發現ARI在兩條動脈中都保持正常:ARImca(大腦中動脈)= 0.72 ± 0.2; ARIba(基底動脈)= 0.66 ± 0.2; P = 0.5。關於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絕對值高於VbaP < 0.05。我們得出結論,在0.5 MAC七氟醚和小劑量瑞芬太尼麻醉下的健康個體:1BA的平均流速低於MCA; 2) 在基底動脈中的自動調節及CO2R保持恒定,並與MCA的相似。

(裘毅敏 馬皓琳 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.


在擇期剖宮產病人中脊硬複合麻醉的阻滯平面高於等量單次脊麻

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

 

硬膜外聯合脊麻(CSE)是一種確定的用於下段剖宮產的麻醉技術。在這項研究中,我們檢驗了關於CSE技術中的脊麻阻滯會導致局麻藥在蛛網膜下腔的擴散範圍比單次脊麻(SSS)方法廣的假設。在這項隨機、對照、雙盲的研究中,我們徵集了30ASAⅠ級入院擇期行下段剖宮產的產婦。所有病人均在蛛網膜下腔注射0.5%布比卡因重比重溶液2ml。使用封口不透明信封的方法將病人隨機分為兩組。S組(n15)使用SSS技術。CS組使用2ml空氣無阻力的CSE技術,但是蛛網膜下腔注射藥物後不在硬膜外腔置管。CS組最大感覺阻滯平面在統計學上高於S組(中位數C6,四分位數間範圍C5C8比中位數T3,範圍T2T4P<0.001)。CS組達到最大阻滯平面所需時間顯著較長。兩組阻滯平面消退到T10所需時間、血流動力學情況和副作用均無差別。結論是,在蛛網膜下腔注入等量局麻藥的情況下,不在硬膜外腔置管或注射藥物的CSE方法產生的感覺阻滯平面明顯高於SSS方法。

(顏濤 馬皓琳 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.


溫度記錄圖體溫測量法與針刺及冷覺在預測區域阻滯效果方面的比較

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

 

 

我們設計這項實驗來評估用紅外線攝影機進行溫度記錄圖體溫測量作為臂叢腋路阻滯成敗評價方法的有效性,並與病人對針刺及冷覺的反應相比較。我們對25位行手或前臂手術的病人用1.5%甲呱卡因並用神經刺激器方法進行腋路阻滯。在30分鐘內每隔5分鐘對手術部位評價針刺及冷覺。在相同時間間隔內記錄手術肢體的溫度記錄圖影像。阻滯前和阻滯後30分鐘時記錄未阻滯肢體的溫度記錄圖影像。手術部位和未阻滯肢體的溫度值由溫度記錄圖影像計算獲得。結果顯示,溫度圖法在所有時間間隔的敏感性、特異性、陽性和陰性預測值的綜合值均較針刺和冷覺高,其中15分鐘(溫度圖法與冷覺比較,P = 0.006;溫度圖法與針刺覺比較P = 0.026 )和30分鐘(溫度圖法與冷覺比較,P = 0.038;溫度圖法與針刺覺比較P = 0.040)時有統計學上顯著差異。用溫度圖法評估阻滯,甲呱卡因局部麻醉藥注射後15分鐘為理想時間,其預示阻滯成功的綜合值最高(P = 0.004)。我們得出結論,溫度圖法是一種早期且客觀評價腋路區域阻滯成敗的方法。

(黃麗娜 馬皓琳 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.


自發呼吸時對新型聲門上氣道裝置King LT TM的插入和功能的評價

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)肺控制通氣試驗已顯示它是一種有效的聲門上氣道裝置。我們設計這個研究評價在50ASA I-III級、氣道Mallampati I-III級進行常規全麻的病人中,自發呼吸時King LT TM插入的難易程度、氣道中的位置和解剖密閉性能。麻醉誘導使用最大2µg/kg芬太尼和1.5–2mg/kg丙泊酚,維持使用70%笑氣/30%氧氣和異氟醚。記錄插入的時間、口咽部漏氣壓、光纖定位和呼吸流量、血流動力學資料。記錄所有的併發症。研究確定插入該裝置非常容易,所有病人都可建立通暢的氣道。插入該裝置一次成功率為86%,第二次為12%,第三次為2%90%的病例放置King LT TM所需的時間<5秒。發生漏氣的最低壓力為31±8.8cmH2O(17–50cmH2O)。併發症包括拔管時發生喉痙攣1例和咳嗽3例。術後1小時和24小時喉部疼痛的發生率分別為22%15%King LT TM 是一種自發呼吸時用於氣道管理的簡單而可靠的聲門上氣道裝置。

(張瑩 馬皓琳 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.


嗜鉻細胞瘤腹腔鏡手術路徑:較低的腹內壓是否有利?

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

 

腹腔鏡下腎上腺切除術由於其公認的優點而得到普及。我們研究的目的是觀察減少腹腔鏡腎上腺切除手術中腹內壓力對血流動力學參數和血清兒茶酚銨水平是否有影響。我們將9個病人隨機分成2組,維持腹內壓15 mm Hg (A) 或者8–10 mm Hg (B)。在術前、氣管插管時、氣腹時、結紮腎上腺靜脈前即刻的腫瘤手術操作時及氣管拔管時測量血液去甲腎上腺素和腎上腺素水平;記錄血液動力學參數。建立CO2氣腹導致心率和平均動脈壓(MAP)的增加,儘管在統計學上沒有差異。組A的去甲腎上腺素水平較組B有統計學上的顯著增高(P = 0.0002)。組A腫瘤的手術操作導致MAP和去甲腎上腺素水平的顯著增加(P 分別為0.0070.0001)。腎上腺素水平沒有如此改變是由於腫瘤可能主要分泌去甲腎上腺素。甚至在拔管時,組A病人的去甲腎上腺素水平持續在高水準(P = 0.027)。我們的結論是,8–10 mm Hg的低腹內壓減少兒茶酚銨的釋放和血流動力學的波動。

(張 馬皓琳 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.