Anesthesia & Analgesia

March 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

行冠脉搭桥手术的老年病人的纤维蛋白溶解和血小板活性增加

(彭中美 马皓琳 李士通 校)

Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery

Hilde Pleym, Alexander Wahba, Vibeke Videm, Arne Åsberg, Stian Lydersen, Lise Bjella, Ola Dale, and Roar Stenseth

Anesth Analg 2006 102: 660-667.

区域麻醉下行颈动脉内膜切除术中使用右美托咪定(dexmedetomidine)镇静和血流动力学控制与传统治疗方法的比较

(殷文渊 陈杰 )

A Comparison of Dexmedetomidine Versus Conventional Therapy for Sedation and Hemodynamic Control During Carotid Endarterectomy Performed Under Regional Anesthesia

Craig A. McCutcheon, Ruari M. Orme, David A. Scott, Michael J. Davies, and Desmond P. McGlade

Anesth Analg 2006 102: 668-675.

地西泮提高鼠心室肌对多巴胺的收缩反应

(孙敏莉译 薛张纲校)

Diazepam Enhances Inotropic Responses to Dopamine in Rat Ventricular Myocardium

María Jesús Juan-Fita, María Luisa Vargas, and Jesús Hernández

Anesth Analg 2006 102: 676-681.

地西泮减弱新福林引起的鼠主动脉收缩作用

(金 琳译 薛张纲校)

Diazepam Attenuates Phenylephrine-Induced Contractions in Rat Aorta

Soon-Eun Park, Ju-Tae Sohn, Cheol Kim, Ki Churl Chang, Il-Woo Shin, Kyeong-Eon Park, Heon-Keun Lee, and Young-Kyun Chung

Anesth Analg 2006 102: 682-689.

PEDIATRIC ANESTHESIA:

心脏手术的儿童避免输血:对抑肽酶随机试验的荟萃分析

(裘毅敏 马皓琳 李士通 校)

Avoiding Transfusions in Children Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Trials of Aprotinin

Donald M. Arnold, Dean A. Fergusson, Anthony K.C. Chan, Richard J. Cook, Graeme A. Fraser, Wendy Lim, Morris A. Blajchman, and Deborah J. Cook

Anesth Analg 2006 102: 731-737.

儿童在N2O/O2/丙泊酚麻醉期间使用0.1mg/kg剂量的顺式阿曲库铵的药代和药效动力学

(朱辉 陈杰 )

Pharmacokinetics and Pharmacodynamics of a 0.1 mg/kg Dose of Cisatracurium Besylate in Children During N2O/O2/Propofol Anesthesia

Karynn Imbeault, Davina E. Withington, and France Varin

Anesth Analg 2006 102: 738-743

连续硬膜外和连续腘神经阻滞用于小儿足部手术术后镇痛:前瞻、对比、随机性研究

(吴德华译 薛张纲校)

Continuous Epidural Block Versus Continuous Popliteal Nerve Block for Postoperative Pain Relief After Major Podiatric Surgery in Children: A Prospective, Comparative Randomized Study

Christophe Dadure, Sophie Bringuier, Florence Nicolas, Luke Bromilow, Olivier Raux, Alain Rochette, and Xavier Capdevila

Anesth Analg 2006 102: 744-749.

麻醉儿童的上呼吸道塌陷

(张莹 译,马皓琳 李士通 校)

Upper Airway Collapsibility in Anesthetized Children

Ronald S. Litman, Joseph M. McDonough, Carole L. Marcus, Alan R. Schwartz, and Denham S. Ward

Anesth Analg 2006 102: 750-754.

AMBULATORY ANESTHESIA:

舌下含服吡罗昔康进行术后镇痛:术前和术后用药的随机、双盲研究

(张美荣 陈杰 )

Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study

Hans-F Gramke, Jurgen J. J. Petry, Marcel E. Durieux, Jean-P Mustaki, Marcel Vercauteren, Georges Verheecke, and Marco A. E. Marcus

Anesth Analg 2006 102: 755-758

ANESTHETIC PHARMACOLOGY:

挥发性吸入麻醉药效能的决定因素:卤化麻醉剂的三维药效团基础

(金 路译 薛张纲校)

Determinants of Volatile General Anesthetic Potency: A Preliminary Three-Dimensional Pharmacophore for Halogenated Anesthetics

Jason C. Sewell and John W. Sear

Anesth Analg 2006 102: 764-771.

静脉麻醉药对大鼠海马CA1区抑制性通路的作用强于吸入麻醉药

(周雅春 马皓琳 李士通 校)

Intravenous Anesthetics Are More Effective than Volatile Anesthetics on Inhibitory Pathways in Rat Hippocampal CA1

Takehisa Asahi, Koki Hirota, Rika Sasaki, Yamazaki Mitsuaki, and Sheldon H. Roth

Anesth Analg 2006 102: 772-778.

呼吸兴奋剂多沙普仑抑制TASK相关钾通道功能,但不影响最低肺泡有效麻醉浓度

(郑丽 陈杰 校)

The Ventilatory Stimulant Doxapram Inhibits TASK Tandem Pore (K2P) Potassium Channel Function but Does Not Affect Minimum Alveolar Anesthetic Concentration

Joseph F. Cotten, Bharat Keshavaprasad, Michael J. Laster, Edmond I. Eger, II, and C. Spencer Yost

Anesth Analg 2006 102: 779-785.

氟哌利多对大鼠主动脉三磷酸腺苷敏感性钾通道的强化作用

(王丽珺译 薛张纲校)

Augmented Activity of Adenosine Triphosphate-Sensitive K+ Channels Induced by Droperidol in the Rat Aorta

Hiroyuki Kinoshita, Mayuko Dojo, Katsutoshi Nakahata, Yoshiki Kimoto, Tetsuya Kakutani, Kazuhiro Mizumoto, and Yoshio Hatano

Anesth Analg 2006 102: 786-791.

布比卡因异构体对Wistar大鼠心肌细胞内钙的调节

(黄施伟 译,马皓琳 李士通 校)

Regulation of Intracellular Calcium by Bupivacaine Isomers in Cardiac Myocytes from Wistar Rats

Núbia G. B. Chedid, Roberto T. Sudo, Marli I. S. Aguiar, Margarete M. Trachez, Masako O. Masuda, and Gisele Zapata-Sudo

Anesth Analg 2006 102: 792-798.

染色体置换依赖性的戊巴比妥钠心血管反应的差异

(颜涛 马皓琳 李士通 校)

Chromosomal Substitution-Dependent Differences in Cardiovascular Responses to Sodium Pentobarbital

Thomas A. Stekiel, Stephen J. Contney, Zeljko J. Bosnjak, John P. Kampine, Richard J. Roman, and William J. Stekiel

Anesth Analg 2006 102: 799-805.

氯胺酮削弱离体新生鼠的脊髓交感活性并非通过N-甲基-d-天门冬氨酸受体介导

(顾新宇 陈杰 校)

Ketamine Attenuates Sympathetic Activity Through Mechanisms not Mediated by N-Methyl-d-Aspartate Receptors in the Isolated Spinal Cord of Neonatal Rats

Chiu-Ming Ho and Chun-Kuei Su

Anesth Analg 2006 102: 806-810.

TECHNOLOGY, COMPUTING, AND SIMULATION:

一个双盲对照的实验评价三个多元的困难气道模型的预期作用
(陆文清译 薛张纲校)

Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Controlled Study

Mohamed Naguib, Franklin L. Scamman, Cormac O'Sullivan, John Aker, Alan F. Ross, Steven Kosmach, and Joe E. Ensor

Anesth Analg 2006 102: 818-824.

脑电描计法定位在常规临床实践中的应用:气管插管时皮层觉醒?

(邱郁薇 马皓琳 李士通 校)

Electroencephalographic Mapping During Routine Clinical Practice: Cortical Arousal During Tracheal Intubation?

Wolfgang J. Kox, Christian von Heymann, Judith Heinze, Leslie S. Prichep, E. Roy John, and Ingrid Rundshagen

Anesth Analg 2006 102: 825-831.

PAIN MEDICINE:

福尔马林实验中大鼠的超声发声:一种测量疼痛引起情感变化程度的方法?

(苏殿三 陈杰 校)

Ultrasonic Rat Vocalizations During the Formalin Test: A Measure of the Affective Dimension of Pain?
Alexandre R. Oliveira and Helena M. T. Barros

Anesth Analg 2006 102: 832-839.

硫酸金刚烷胺减轻慢性后背痛病人的实验敏感性和疼痛

(周荻 薛张纲校)

Amantadine Sulfate Reduces Experimental Sensitization and Pain in Chronic Back Pain Patients

Dieter Kleinböhl, Roman Görtelmeyer, Hans-Joachim Bender, and Rupert Hölzl

Anesth Analg 2006 102: 840-847.

巴氯芬注射相关的鞘内导管肉芽肿

(潘志英 陈杰 校)

Intrathecal Catheter Granuloma Associated with Isolated Baclofen Infusion

Paul M. Murphy, Danielle E. Skouvaklis, Ryan J.J. Amadeo, Craig Haberman, David H. Brazier, and Michael J. Cousins

Anesth Analg 2006 102: 848-852.

CRITICAL CARE AND TRAUMA:

持续脉搏氧监测对手术后入ICU的影响

(王慧琳译 薛张纲校)

The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor

E. Andrew Ochroch, Michael W. Russell, William C. Hanson, III, Gayle A. Devine, Andrew J. Cucchiara, Mark G. Weiner, and Sanford J. Schwartz

Anesth Analg 2006 102: 868-875.

曲马多和芬太尼对脓毒症大鼠胃肠蠕动的影响

(黄丽娜   马皓琳 李士通  校)

The Effects of Tramadol and Fentanyl on Gastrointestinal Motility in Septic Rats

Ismet Topcu, N. Zeynep Ekici, Rusen Isik, and Melek Sakarya

Anesth Analg 2006 102: 876-881. it.

NEUROSURGICAL ANESTHESIA:

癫痫清醒开颅术的麻醉并发症

(丁希喆 陈杰 校)

Anesthetic Complications of Awake Craniotomies for Epilepsy Surgery

Andrius P. Skucas and Alan A. Artru

Anesth Analg 2006 102: 882-887.

刺激模式和七氟醚浓度对术中运动诱发电位的影响

(徐丽颖译 薛张纲校)

The Effects of Stimulation Pattern and Sevoflurane Concentration on Intraoperative Motor-Evoked Potentials

Peter C. Reinacher, Hans-Joachi

m Priebe, Winfried Blumrich, Josef Zentner, and Kai M. Scheufler

Anesth Analg 2006 102: 888-895.

OBSTETRIC ANESTHESIA:

内关穴针压法不能预防剖宫产脊麻中的呕吐

(黄佳佳 马皓琳 李士通 校)

P6 Acupressure Does Not Prevent Emesis During Spinal Anesthesia for Cesarean Delivery

Chiu-Ming Ho, Hsin-Jung Tsai, Kwok-Hon Chan, and Shen-Kou Tsai

Anesth Analg 2006 102: 900-903.

程序化硬膜外间断给药和连续给药用于分娩镇痛的随机比较

(赵延华 陈杰 校)

A Randomized Comparison of Programmed Intermittent Epidural Bolus with Continuous Epidural Infusion for Labor Analgesia

Cynthia A. Wong, John T. Ratliff, John T. Sullivan, Barbara M. Scavone, Paloma Toledo, and Robert J. McCarthy

Anesth Analg 2006 102: 904-909

REGIONAL ANESTHESIA:

锁骨下与肱骨臂丛神经阻滞在外伤病人中舒适度的比较

(孙卓真译 薛张纲校)

Infraclavicular Brachial Plexus Block Versus Humeral Block in Trauma Patients: A Comparison of Patient Comfort

Vincent Minville, Olivier Fourcade, Lamia Idabouk, Jonathan Claassen, Clément Chassery, Luc Nguyen, Jean-Claude Pourrut, and Dan Benhamou

Anesth Analg 2006 102: 912-915.

利多卡因中加硝酸甘油对局部静脉麻醉的镇痛作用

(赵雪莲 马皓琳 李士通 校)

The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia

Selda Sen, Bakiye Ugur, Osman N. Aydin, Mustafa Ogurlu, Feray Gursoy, and Oner Savk

Anesth Analg 2006 102: 916-920.

综述:硬膜外试验剂量

(肖洁 陈杰 校)

The Epidural Test Dose: A Review

Joanne Guay

Anesth Analg 2006 102: 921-929.

 

α-氨基羟甲基恶唑丙酸受体拮抗剂对于丁卡因鞘内给药所引起的神经毒性的效应

(韩晓丹译 薛张纲校)

The Effects of an AMPA Receptor Antagonist on the Neurotoxicity of Tetracaine Intrathecally Administered in Rabbits

Yumika Koizumi, Mishiya Matsumoto, Atsuo Yamashita, Shunsuke Tsuruta, Takanao Ohtake, and Takefumi Sakabe

Anesth Analg 2006 102: 930-936.

GENERAL ARTICLES:

用拇内收肌TOF 比判断肌松恢复后的术后上呼吸道阻塞

(马皓琳 李士通 校)

Postoperative Upper Airway Obstruction After Recovery of the Train of Four Ratio of the Adductor Pollicis Muscle from Neuromuscular Blockade

Matthias Eikermann, Manfred Blobner, Harald Groeben, Christopher Rex, Thomas Grote, Markus Neuhäuser, Martin Beiderlinden, and Jürgen Peters

Anesth Analg 2006 102: 937-942.

罗库溴铵在快速诱导插管中不比琥珀酰胆碱有更多的声带损伤:一项随机、前瞻性对照研究

(郑拥军 陈杰 校)

Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial

Thomas Mencke, Heike Knoll, Jan-Uwe Schreiber, Matthias Echternach, Sarah Klein, Gabriele Noeldge-Schomburg, and Malte Silomon

Anesth Analg 2006 102: 943-949.

膝关节成形术中止血带使用时间延长后麻醉,病人和手术风险因素对神经系统并发症的影响

(钟静译 薛张纲校)

Anesthetic, Patient, and Surgical Risk Factors for Neurologic Complications After Prolonged Total Tourniquet Time During Total Knee Arthroplasty

Terese T. Horlocker, James R. Hebl, Bhargavi Gali, Christopher J. Jankowski, Christopher M. Burkle, Daniel J. Berry, Fernando A. Zepeda, Susanna R. Stevens, and Darrell R. Schroeder

Anesth Analg 2006 102: 950-955

全身麻醉不缩短老年大鼠的平均寿命

(陈玮 马皓琳 李士通 校)

General Anesthesia Does Not Reduce Life Expectancy in Aged Rats

Deborah J. Culley, Alexander Loguinov, Rustam Yukhananov, and Gregory Crosby

Anesth Analg 2006 102: 956-959.

 

区域麻醉下行颈动脉内膜切除术中使用右美托咪定(dexmedetomidine)镇静和血流动力学控制与传统治疗方法的比较

A Comparison of Dexmedetomidine Versus Conventional Therapy for Sedation and Hemodynamic Control During Carotid Endarterectomy Performed Under Regional Anesthesia

Craig A. McCutcheon, MBBS, FANZCA, Ruari M. Orme, MBBS, FANZCA, David A. Scott, MBBS, PhD, FANZCA, Michael J. Davies, MBBS, MD, FANZCA, and Desmond P. McGlade, MBBS, FANZCA

Anesth Analg 2006 102: 668-675.

 

右美托咪定(DEX)的可滴定镇静和交感神经调节的特性提示它也许适合在区域麻醉下颈动脉内膜切除术(CEA)中使用。作者在56名区域麻醉下行颈动脉内膜切除术的病人中进行了一个随机双盲的研究,比较使用DEX和传统的使用咪唑安定和芬太尼(STD)的标准镇静技术下的血流动力学。两组均滴定至Ramsay镇静评分2-4分。主要的结果是处理动脉血压和心率偏移出预定范围所需的用药次数。同时也比较血流动力学恢复情况,病人满意度和不良心血管和神经事件。所有的血流动力学干涉次数没有差别(DEX 80% STD 79%; P = 1.0)。可是,两组中干涉的内容不同:DEX组病人由于高血压和/或心动过速所需干涉的次数少于STD(DEX 40% STD 72%; P = 0.03)DEX组中每名病人由于高血压和/或心动过速所需干涉的次数也较少。在动脉分流期间由于高血压和/或心动过速所需治疗的病人数没有差异。在麻醉后恢复室,较多的DEX组病人需要血管活性药物干预(DEX 11, 44%, STD4, 14%; P = 0.03)。主要为了低血压(DEX 7, 28% STD 3, 11%; P = 0.16)。在麻醉恢复室中,不需额外镇痛的病人数DEX组明显多于STD (DEX 18, 72% STD 11, 38%; P = 0.027)DEX组提供了一种可供选择的清醒CEA中镇静的方法,但其并不优于标准镇静技术。

(殷文渊 陈杰 校)

The properties of dexmedetomidine (DEX) that result in titratable sedation and sympathetic modulation suggest that it would be suitable for use during carotid endarterectomy (CEA) performed under regional anesthesia. We performed a randomized, double-blind study in 56 patients having CEA under regional anesthesia and compared hemodynamic control using DEX versus a conventional sedation technique using midazolam and fentanyl standard (STD). Sedation was titrated to a Ramsay Sedation Score of 2–4 in both groups. The primary outcome was the number of pharmacological interventions required to treat deviations of arterial blood pressure and heart rate outside of predetermined limits. We also compared recovery hemodynamic profiles, patient satisfaction, and adverse cardiac and neurological events. There was no difference in the overall rate of hemodynamic interventions (DEX 80% versus STD 79%; P = 1.0). However, the nature of interventions differed in that patients in the DEX group were less likely to require treatment for hypertension and/or tachycardia (DEX 40% versus STD 72%; P = 0.03). The number of interventions per patient for hypertension and/or tachycardia was also lesser in the DEX group (P = 0.02). There were no significant differences in the numbers of patients needing intraoperative treatment for hypotension or bradycardia or in the need for intraarterial shunting. In the postanesthesia care unit, more patients in the DEX group required hemodynamic drug interventions (DEX 11, 44%, versus STD 4, 14%; P = 0.03). These were primarily for hypotension (DEX 7, 28% versus STD 3, 11%; P = 0.16). The number of patients requiring no additional pain relief in the postanesthesia care unit was significantly larger for patients in the DEX group (DEX 18, 72% versus STD 11, 38%; P = 0.027). DEX provides an acceptable alternative, without superiority to standard techniques for sedation during awake CEA.

 

儿童在N2O/O2/丙泊酚麻醉期间使用0.1mg/kg剂量的顺式阿曲库铵的药代和药效动力学

Pharmacokinetics and Pharmacodynamics of a 0.1 mg/kg Dose of Cisatracurium Besylate in Children During N2O/O2/Propofol Anesthesia

Karynn Imbeault, B Pharm, Davina E. Withington, FRCA, MRCP(UK), and France Varin, B Pharm, PhD

Faculté de Pharmacie, Université de Montréal, Department of Anesthesia, Montreal Children’s Hospital/McGill University, Montreal, Quebec, Canada

Anesth Analg 2006 102: 738-743.

 

此文研究91-6岁儿童(平均年龄3.75岁,平均体重,17.1kg)在丙泊酚-氧化亚氮麻醉期间使用阿曲库铵的药代和药效动力学。实施神经肌肉监测。在静脉注射0.1mg/kg阿曲库铵前及注射后2510306090120分钟分别抽取血样本,通过高性能的液相色谱法来计算血浆内阿曲库铵浓度。起效时间为2.5±0.8分钟,肌颤搐25%恢复时间为37.6±10.2分钟,25%-75%的恢复指数为10.9±3.分钟。药物分布和清除半衰期分别为3.5±0.9分钟和22.9±4.5分钟。达稳态分布容积(0.207±0.031L/kg)和总体内清除率(6.8±0.7ml/min/kg)都明显高于成人。结果显示除了肌颤搐25%恢复时间较长外,阿曲库铵的药效动力学与小儿氟烷或阿片类药物麻醉时结果相似。尽管血浆有效室平衡速度常数(0.115±0.025min-12倍于成人,但50%阻滞的有效室浓度是相同的(129±27ng/ml)。

(朱辉 陈杰 校)

We studied the pharmacokinetics and pharmacodynamics of cisatracurium in 9 children (mean weight, 17.1 kg) aged 1–6 yr (mean, 3.75 yr) during propofol-nitrous oxide anesthesia. Neuromuscular monitoring was performed. Venous samples were taken before injection of a 0.1 mg/kg dose of cisatracurium and then at 2, 5, 10, 30, 60, 90, and 120 min. Cisatracurium plasma concentrations were determined by high performance liquid chromatography. Onset time was 2.5 ± 0.8 min, recovery to 25% of baseline twitch height was 37.6 ± 10.2 min, and the 25%–75% recovery index was 10.9 ± 3.7 min. Distribution and elimination half-lives were 3.5 ± 0.9 min and 22.9 ± 4.5 min, respectively. Steady-state volume of distribution (0.207 ± 0.031 L/kg) and total body clearance (6.8 ± 0.7 mL/min/kg) were significantly larger than those published for adults. Pharmacodynamic results were comparable to those obtained in pediatric studies during halothane or opioid anesthesia with the exception of a longer recovery to 25% baseline. Although the plasma-effect compartment equilibration rate constant was twofold faster (0.115 ± 0.025 min–1) than that published for cisatracurium in adults, the effect compartment concentration corresponding to 50% block was similar (129 ± 27 ng/mL).

 

舌下含服吡罗昔康进行术后镇痛:术前和术后用药的随机、双盲研究

Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study

Hans-F Gramke, MD, Jurgen J. J. Petry, MD, Marcel E. Durieux, MD, PhD, Jean-P Mustaki, MD, Marcel Vercauteren, MD, PhD, Georges Verheecke, MD, and Marco A. E. Marcus, MD, PhD

University Hospital Maastricht, Department of Anesthesiology and Pain Treatment, Maastricht, The Netherlands; Hopital de Zone Morges, Service d’ Anesthesiologie, Morges, Switzerland; Universitair Ziekenhuis Antwerpen, Dienst Anesthesiologie, Edegem, Belgium; Klinieken Noord Antwerpen, Dienst Anesthesiologie, Brasschaat, Belgium

Anesth Analg 2006 102: 755-758.

 

非甾体抗炎药物已经被用于超前镇痛。在这个随机的双盲研究中,作者研究术前舌下含服吡罗昔康是否比术后应用更有效。选择52个择期全麻下行腹腔镜下双侧腹股沟疝修补术手术病人。术前组(n25)病人术前2小时舌下含服吡罗昔康40mg,术后10min给予一片安慰剂。术后组(n27)病人术前2小时给予一片安慰剂,术后10min舌下含服吡罗昔康40mg。在静注曲马多100mg初始剂量后,病人开始应用曲马多自控镇痛并记录整个过程。在恢复期和术后62030小时进行疼痛评分。结果显示术前组病人术后6小时和20小时的疼痛评分较低,术后30小时的曲马多累积消耗较少。研究结果表明术前舌下含服吡罗昔康比术后应用更有效。因为两组的疼痛评分都较低,从这个研究得到的结果和临床的关联性还不明确。

(张美荣 陈杰 校)

Nonsteroidal antiinflammatory drugs have been used to obtain preemptive analgesia. We investigated, in this randomized, double-blind study, whether sublingual (s.l.) piroxicam given before was more effective than that given after surgery. Fifty-two patients scheduled for laparoscopic bilateral inguinal hernia repair under general anesthesia were enrolled. Group PRE (25 patients) received 40 mg of piroxicam s.l. 2 h before surgery and a placebo 10 min after surgery. Group POST (27 patients) were treated with a placebo 2 h before surgery and received 40 mg of piroxicam s.l. 10 min after surgery. After an initial dose of 100 mg tramadol IV, patient-controlled analgesia with tramadol was started and recorded. Visual analog scores were assessed in the recovery and at 6, 20, and 30 h postoperatively. Significantly lower visual analog scores were found in group PRE at 6 and 20 h. Significantly smaller cumulative tramadol consumption was observed after 30 h in group PRE. In summary, our findings suggest that preoperative s.l. piroxicam is more effective than the postoperative administration. Because of the low pain scores in both groups, the clinical relevance of these findings is not clear from this study.

 

呼吸兴奋剂多沙普仑抑制TASK相关钾通道功能,但不影响最低肺泡有效麻醉浓度

The Ventilatory Stimulant Doxapram Inhibits TASK Tandem Pore (K2P) Potassium Channel Function but Does Not Affect Minimum Alveolar Anesthetic Concentration

Joseph F. Cotten, MD, PhD, Bharat Keshavaprasad, MD, Michael J. Laster, DVM, Edmond I. Eger, II, MD, and C. Spencer Yost, MD

Department of Anesthesia and Perioperative Care, University of California San Francisco

Anesth Analg 2006 102: 779-785.

 

TASK-1KCNK3(TWIK相关酸敏感钾离子通道1)TASK-3(KCNK9)是串联的钾通道亚单位,常在颈动脉体和脑干表达。酸PH值和缺氧抑制TASK-1TASK-3功能,而氟烷增强其功能。因此推测这些通道作用与通气调节和挥发性麻醉药的作用机制相关。.多沙普仑兴奋呼吸作用是通过颈动脉体起效,作者假设这种兴奋作用可能通过抑制TASK-1TASK-3发挥作用。作者在爪蟾卵表达TASK-1TASK-3TASK-1/TASK-3异二聚体,嵌合体K通道,并研究多沙普仑对它们作用。多沙普仑抑制了TASK-1(半数有效浓度[EC50],410nM),TASK-3(EC50,37uM)TASK-1/TASK[-3异二聚体通道的功能(EC50, 9 µM)。嵌合体研究显示TASK-1的末端羟基对于多沙普仑抑制效应具有重要作用。其它K2p通道的出现抑制效应时需要更高的浓度。为了检测TASK-1TASK-3在氟烷产生不动性效应中的作用,作者给大鼠静脉注射多沙普仑,结果氟烷的最低肺泡有效浓度并没有发生变化。结果显示:虽然TASK-1TASK-3在氟烷产生的不动效应中未起到作用,但其似乎是多沙普仑的呼吸效应中的分子水平作用位点。

(郑丽 陈杰 校)

TWIK-related acid-sensitive K+-1 (TASK-1 [KCNK3]) and TASK-3 (KCNK9) are tandem pore (K2P) potassium (K) channel subunits expressed in carotid bodies and the brainstem. Acidic pH values and hypoxia inhibit TASK-1 and TASK-3 channel function, and halothane enhances this function. These channels have putative roles in ventilatory regulation and volatile anesthetic mechanisms. Doxapram stimulates ventilation through an effect on carotid bodies, and we hypothesized that stimulation might result from inhibition of TASK-1 or TASK-3 K channel function. To address this, we expressed TASK-1, TASK-3, TASK-1/TASK-3 heterodimeric, and TASK-1/TASK-3 chimeric K channels in Xenopus oocytes and studied the effects of doxapram on their function. Doxapram inhibited TASK-1 (half-maximal effective concentration [EC50], 410 nM), TASK-3 (EC50, 37 µM), and TASK-1/TASK-3 heterodimeric channel function (EC50, 9 µM). Chimera studies suggested that the carboxy terminus of TASK-1 is important for doxapram inhibition. Other K2P channels required significantly larger concentrations for inhibition. To test the role of TASK-1 and TASK-3 in halothane-induced immobility, the minimum alveolar anesthetic concentration for halothane was determined and found unchanged in rats receiving doxapram by IV infusion. Our data indicate that TASK-1 and TASK-3 do not play a role in mediating the immobility produced by halothane, although they are plausible molecular targets for the ventilatory effects of doxapram.

 

氯胺酮削弱离体新生鼠的脊髓交感活性并非通过N-甲基-d-天门冬氨酸受体介导

Ketamine Attenuates Sympathetic Activity Through Mechanisms not Mediated by N-Methyl-d-Aspartate Receptors in the Isolated Spinal Cord of Neonatal Rats

Chiu-Ming Ho, MD, PhD*, and Chun-Kuei Su, PhD{dagger}

*Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University; {dagger}Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

Anesth Analg 2006 102: 806-810.

 

尽管氯胺酮的中枢机制还不明确,但还是被认为具有拟交感活性。在新生鼠的离体内脏脊髓神经标本上,作者先前的研究表明交感活性的增强是胸部脊髓自发产生的。本研究作者设计一项实验来观察对脊髓应用氯胺酮是否增加交感活性,这一作用是否依赖于N-甲基-d-天门冬氨酸受体(NMDA)。应用氯胺酮后产生浓度依赖的交感活性降低。应用浓度分别为10204080120uM氯胺酮,降低交感活性分别到82.6%+4.4%(P<0.05)61.7%+5.1%42.8%+4.2%24.9%+4.4%9.2%+2.7%(P<0.01,每组n=8)。氯胺酮抑制50%交感活性的浓度为32uM。预先给予DL-2-氨基-5-phosphonovaleric acid,一种选择性竞争N-甲基-d-天门冬氨酸受体拮抗剂,并不改变氯胺酮产生交感活性的抑制作用。上述结果显示氯胺酮产生的交感活性的降低并非通过NMDA的机制。

(顾新宇 陈杰 校)

Ketamine is believed to have sympathomimetic effects, although the central mechanism remains unclear. Using an in vitro splanchnic nerve-spinal cord preparation from neonatal rats, our previous investigations have demonstrated that tonic sympathetic activity is spontaneously generated from the thoracic spinal cord. We designed this study to investigate whether applications of ketamine to the cord would augment sympathetic activity and whether this action was dependent on N-methyl-d-aspartate receptors. Bath application of ketamine significantly reduced sympathetic activity in a concentration-dependent manner. Ketamine in 10, 20, 40, 80, and 120 µM reduced the sympathetic activity to 82.6% ± 4.4% (P < 0.05), 61.7% ± 5.1%, 42.8% ± 4.2%, 24.9% ± 4.4%, and 9.2% ± 2.7% of the control value, respectively (P < 0.01, n = 8 for each test). The 50% inhibitory concentration of ketamine on sympathetic activity was 32 µM. Pretreatment with DL-2-amino-5-phosphonovaleric acid, a selective competitive N-methyl-d-aspartate receptor antagonist, did not alter ketamine-induced depression of sympathetic activity. These results suggest that ketamine reduces sympathetic activity by mechanisms that are independent of N-methyl-d-aspartate receptor activity.

 

福尔马林实验中大鼠的超声发声:一种测量疼痛引起情感变化程度的方法?

Ultrasonic Rat Vocalizations During the Formalin Test: A Measure of the Affective Dimension of Pain?

Alexandre R. Oliveira, MD, and Helena M. T. Barros, MD, PhD*

Pharmacology Division, Fundação Faculdade Federal de Ciências Medicas de Porto Alegre

福尔马林实验中大鼠超声发声(USV)散布情况还没有得到证实。作者进行了两项试验来确定能诱导产生USV的福尔马林浓度、福尔马林实验中USV的散布与运动行为间的关系以及吗啡和纳洛酮对USV的影响。在实验1中,三组不同的大鼠的前爪皮下注射5%、10%或12.5%的福尔马林。实验2是为了明确在12.5%组的福尔马林实验中注射吗啡12.55mg/kgUSV的影响。而另外两组的大鼠每个吗啡剂量接受纳洛酮2mg/kg来明确阿片类药物的作用特点。每5分钟测量USV和运动行为,共测量了40分钟。并且将实验分为早期(05min),中期(520min),晚期(2040min)。试验中,主要在福尔马林注射间期,尤其在注入12.5%福尔马林后检测发声。在可逆性纳洛酮使用模式中,吗啡能抑制USV。这证明了福尔马林实验中USV的情况,获得了另一种非反射性行为的测量方法来帮助临床上明确这种大鼠疼痛模型中相关的完整的行为模式的特征。

(苏殿三 陈杰 校)

The emission of ultrasonic vocalization (USV) by rats submitted to the formalin test has not yet been demonstrated. We performed two experiments to establish the formalin concentration to induce USV and the relationship of USV emission with motor behaviors and the effects of morphine and naloxone on USV during the formalin test. Male Wistar rats were used. In Experiment 1, 3 different groups of rats were subcutaneously injected with 5%, 10%, or 12.5% formalin in 1 of the anterior paws. Experiment 2 was intended to verify the effect of morphine 1, 2.5, or 5 mg/kg on USV during the 12.5% formalin test, whereas other groups of rats received naloxone 2 mg/kg with each one of the morphine doses to verify the specificity of opioid action. USV and motor behaviors were simultaneously measured in 5-min windows for 40 min, and early (0–5 min), interphase (5–20 min), and late (20–40 min) phases of the test were characterized. Vocalization was detected mostly during the interphase of the formalin test, mainly after formalin 12.5%. Morphine suppressed USV in a naloxone-reversible manner. This is a demonstration of USV during the formalin test, allowing the inclusion of an additional nonreflex behavioral measure to help characterize more clinically relevant integrated behavioral patterns in this rat model of pain.

 

.巴氯芬注射相关的鞘内导管肉芽肿

Intrathecal Catheter Granuloma Associated with Isolated Baclofen Infusion

Paul M. Murphy, MB, MRCPI, FCARCSI*, Danielle E. Skouvaklis, MD*, Ryan J.J. Amadeo, MD*, Craig Haberman, MD*, David H. Brazier, MD{dagger}, and Michael J. Cousins, AM, MD, FFPMANZCA*

*University of Sydney Pain Management and Research Institute and {dagger}Department of Radiology, Royal North Shore Hospital, St. Leonards, Australia

Anesth Analg 2006 102: 848-852.

 

当口服巴氯芬效果不佳时,鞘内注射(IT)巴氯芬是一种有效的控制痉挛状态的方法。作者提供以下病例:一例57岁妇女,C6节段水平以下瘫痪。尽管逐步加大口服巴氯芬剂量达到80 mg/d仍然无法控制严重的痉挛。鞘内注射(IT)巴氯芬反应良好,经植入的泵进行鞘内注射,初始剂量200µg/d2周后由于导管移位,重新调整导管位置。鞘内注射巴氯芬的剂量逐渐加大到400 µg/d达到较好的控制水平。经过一段持续输注后,尽管加大剂量,她的下肢开始发生严重的进行行肌肉痉挛。脊髓CT (X线)造影照片以排除机械性因素,导管没有移位或破裂,但是显示导管尖端有块状物质。先前使用单独使用巴氯芬鞘内注射并未见有导管尖端肉芽肿的报道。这表明尽管少见,但是使用鞘内注射巴氯芬的病人如果神经系统功能改变或药量需求显著增加,其发生导管相关肉芽肿的可能性仍要考虑。

(潘志英 陈杰 校)

Intrathecal (IT) baclofen is an effective management strategy for controlling spasticity in patients unresponsive to maximal oral therapy. We present the case of a 57-yr-old woman who was rendered quadriplegic after a complete spinal cord transection at the C6 level. Her course was complicated by severe spasms, which were uncontrolled despite titrating orally administered baclofen to 80 mg/d. IT baclofen testing was performed with good response, and administration was commenced via an implanted intrathecal pump 6 mo after the injury at an initial dose of 200µg/d. Catheter revision was required 2 wk later as a result of catheter displacement. The initial IT baclofen dose was gradually increased to achieve good control at a level of 400 µg/d. After a period of stability lasting 38 mo, her lower limb spasms dramatically increased in severity and remained poorly controlled despite repeated dose increases. Contrast pumpogram and computed tomography myelogram were performed to exclude a mechanical cause for this apparent increase in baclofen requirement. These investigations revealed neither catheter displacement nor fracture as suspected but, rather, displayed the presence of a catheter tip-associated mass. Catheter tip granuloma has not previously been described in a patient receiving IT baclofen alone. This suggests that although uncommon, the possibility of catheter-associated granuloma must be considered in all patients receiving IT baclofen presenting with altered neurological function or significant increase in drug requirement.

 

癫痫清醒开颅术的麻醉并发症

Anesthetic Complications of Awake Craniotomies for Epilepsy Surgery

Andrius P. Skucas, MD, and Alan A. Artru, MD

Department of Anesthesiology, University of Washington, School of Medicine, Seattle, Washington

Anesth Analg 2006 102: 882-887.

 

清醒开颅手术经常用于切除靠近脑部重要功能区的癫痫放电灶。在作者医院内清醒开颅手术中,常在局部麻醉和开颅时使用异丙酚,保持病人的自主通气,而不置入气管导管或者喉罩。在需要病人说话、动作、以及感觉定位和脑电图定位时暂停使用异丙酚。当切除以及关颅时再继续使用异丙酚镇静。作者对332名基于应用异丙酚的“沉睡-清醒-沉睡(asleep-awake-asleep,AAA)”技术而不插管的病人以及129个气管插管全麻后进行癫痫开颅术的病人进行了回顾性比较研究。作者比较了术中呼吸以及血流动力学并发症以及痉挛、恶心、脑水肿、病人活动、出血、误吸、空气栓塞、死亡的发生率。AAA病人中很少出现呼吸问题,但与气管插管全麻的病人相比高血压、低血压、心动过速的发生率较高,这些在术中都得到了适当的处理。只有一例使用AAA技术的病人出现了不良临床后果。

(丁希喆 陈杰 校)

Awake craniotomies are often performed for resection of epileptogenic foci close to vital areas of the brain. For awake craniotomies at our institution, propofol is infused during local anesthetic injection and craniotomy, spontaneous ventilation is preserved, and no endotracheal tube or laryngeal mask airway is used. Propofol is discontinued for language, motor, and/or sensory mapping and for electrocorticography. Patients are re-sedated with propofol for resection and closure. We performed a retrospective chart review of 332 propofol-based "asleep-awake-asleep" (AAA) techniques with unsecured airways and 129 general anesthesia with endotracheal intubation craniotomies for epilepsy surgery. We compared the incidence of intraoperative respiratory and hemodynamic complications and incidence of seizures, nausea, brain swelling, patient movement, bleeding, aspiration, air embolism, and death. Airway compromise was uncommon in AAA cases and although incidences of hypertension, hypotension, and tachycardia were statistically increased in AAA versus general anesthesia craniotomy, these were treated appropriately. In only one patient the use of our AAA technique may have contributed to a poor clinical outcome.

 

程序化硬膜外间断给药和连续给药用于分娩镇痛的随机比较

A Randomized Comparison of Programmed Intermittent Epidural Bolus with Continuous Epidural Infusion for Labor Analgesia

Cynthia A. Wong, MD, John T. Ratliff, MD, John T. Sullivan, MD, Barbara M. Scavone, MD, Paloma Toledo, MD, and Robert J. McCarthy, PharmD

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Ilinois

Address correspondence to Cynthia A. Wong, MD, Department of Anesthesiology, 251 E. Huron Street, F5-704, Chicago, IL 60611.

Anesth Analg 2006 102: 904-909.

 

通过硬膜外导管给予麻醉药液时,间断给药与持续给药相比前者可能使药液在硬膜外间隙的分布更好。在该随机双盲的研究中,作者比较了接受程序化硬膜外间断给药(PIEB)和连续给药(CEI)分娩镇痛的布比卡因用量、硬膜外追加镇痛的需要、镇痛效果和满意情况。主要的结果是用于镇痛的布比卡因每小时用量。宫颈扩张2-5cm将分娩的经产妇,行鞘内和硬膜外联合镇痛。病人随机分为PIEB组(鞘内给药45min后开始每30min注射6ml麻醉药液)或者CEI组(鞘内给药15min后开始按12ml/h连续给药)。硬膜外镇痛药液是布比卡因0.625 mg/mL和芬太尼2 µg/mL。突发性疼痛时两组病人均通过自控硬膜外镇痛(PCEA),手动给予0.125%布比卡因来缓解。布比卡因每小时用量的中位数在PIEB(n = 63)CEI(n = 63)分别为10.5 mg/h95%可信区间为9.5–11.8 mg/h)、12.3 mg/h95%可信区间为10.5–14.0 mg/h) PIEB组较少(P < 0.01)PIEB组需要手动加药来缓解疼痛的几率较低(两组的率差为22%,其95%可信区间为5%-38%)。PIEB组的满意评分更高。分娩痛、PCEA            需求以及PCEA用量在两组间没有区别。PIEBCEI分别与PECA联合用于硬膜外分娩镇痛的维持时,镇痛效果相同,但前者的布比卡因用量更少且病人满意度更好。(赵延华 陈杰 校)

 

Bolus injection through an epidural catheter may result in better distribution of anesthetic solution in the epidural space compared with continuous infusion of the same anesthetic solution. In this randomized, double-blind study we compared total bupivacaine consumption, need for supplemental epidural analgesia, quality of analgesia, and patient satisfaction in women who received programmed intermittent epidural boluses (PIEB) compared with continuous epidural infusion (CEI) for maintenance of labor analgesia. The primary outcome variable was bupivacaine consumption per hour of analgesia. Combined spinal epidural analgesia was initiated in multiparas scheduled for induction of labor with cervical dilation between 2 and 5 cm. Subjects were randomized to PIEB (6-mL bolus every 30 min beginning 45 min after the intrathecal injection) or CEI (12-mL/h infusion beginning 15 min the after the intrathecal injection). The epidural analgesia solution was bupivacaine 0.625 mg/mL and fentanyl 2 µg/mL. Breakthrough pain in both groups was treated initially with patient-controlled epidural analgesia (PCEA) followed by manual bolus rescue analgesia using bupivacaine 0.125%. The median total bupivacaine dose per hour of analgesia was less in the PIEB (n = 63) (10.5 mg/h; 95% confidence interval, 9.5–11.8 mg/h) compared with the CEI group (n = 63) (12.3 mg/h; 95% confidence interval, 10.5–14.0 mg/h) (P < 0.01), fewer manual rescue boluses were required (rate difference 22%, 95% confidence interval of difference 5% to 38%), and satisfaction scores were higher. Labor pain, PCEA requests, and delivered PCEA doses did not differ. PIEB combined with PCEA provided similar analgesia, but with a smaller bupivacaine dose and better patient satisfaction compared with CEI with PCEA for maintenance of epidural labor analgesia.

 

综述:硬膜外试验剂量

The Epidural Test Dose: A Review

Joanne Guay, MD, FRCPC

Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Canada

Anesth Analg 2006 102: 921-929.

 

本综述系统地调查了有关传统的硬膜外试验剂量的作用和其它测试方法及时发现硬膜外穿刺针或导管误入血管内、鞘内、硬膜下腔的有关情况。为了测试误入血管方法,至少有来自不同的研究中心的两项随机对照试验,用灵敏度(S)和阳性预测值(PPV≥80)方法检测不同的人群中方法的可靠性。成年非孕患者,用肾上腺素(1015µg)注射方法:以收缩压增高≥15mmHg为标准时S80-10093-100PPV=80-10083-100。以收缩压增高≥15mmHg或心率增快≥10bpm为标准,注射肾上腺素10µgS = 100 PPV = 83–100。注射肾上腺素15µgS = 100 PPV = 83–100。怀孕患者用注射芬太尼(100µg)方法,以5分钟内发生镇静,困倦,或头晕为标准,该方法的S=92-100PPV=91-95。小儿患者用注射肾上腺素(0.5µg/kg)方法,以注射后收缩压增高15mmHg为标准,该方法S=81-100PPV=100。相反,以上三类人群中寻找更好的测试方法及时发现硬膜外穿刺针或导管误入鞘内或硬膜下腔还需进行大量的研究。

 

(肖洁 陈杰 校)

This review systematically examines the literature on the ability of the classical epidural test dose and other strategies to detect intravascular, intrathecal, or subdural epidural needle/catheter misplacement. For detection of simulated intravascular misplacements, a sensitivity (S) and a positive predictive value (PPV) ≥80 demonstrated by at least two randomized controlled trials coming from two different centers were determined for the following tests and patient populations: Nonpregnant adult patients = increase in systolic blood pressure (SBP) ≥15 mm Hg (S = 80–100 and 93–100; PPV = 80–100 and 83–100) or either an increase in SBP ≥15 mm Hg or an increase in heart rate ≥10 bpm after the injection of 10 (S = 100; PPV = 83–100) or 15 µg of epinephrine (S = 100; PPV = 83–100); pregnant patients = sedation, drowsiness, or dizziness within 5 min after the injection of 100 µg of fentanyl (S = 92–100; PPV = 91–95); and children = increase in SBP ≥15 mm Hg after the injection of 0.5 µg/kg of epinephrine (S = 81–100; PPV = 100). Conversely, more studies are required to determine the best strategies to detect intrathecal and subdural epidural needle/catheter misplacements in these three patient populations.

 

罗库溴铵在快速诱导插管中不比琥珀酰胆碱有更多的声带损伤:一项随机、前瞻性对照研究

Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial

Thomas Mencke, MD*, Heike Knoll, MD{dagger}, Jan-Uwe Schreiber, MD{dagger}, Matthias Echternach, MD{ddagger}, Sarah Klein, MD{dagger}, Gabriele Noeldge-Schomburg, MD*, and Malte Silomon, MD||

*Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, {dagger}Department of Anaesthesia and Intensive Care Medicine, {ddagger}Department of Otorhinolaryngology, University of the Saarland, Homburg/Saar, ||Department of Anaesthesia and Intensive Care Medicine, Catholic Hospital, Koblenz, Germany

Anesth Analg 2006 102: 943-949.

 

术后声嘶(PH)、咽喉痛(ST)及声带损伤(VCI)是全身麻醉后的常见并发症。插管暴露条件越好则喉部损伤的几率越小。本研究选取160例病人随机分为两组,进行罗库溴铵与琥珀酰胆碱在快速诱导插管中对声带损伤的比较。琥珀酰胆碱组(S组)诱导用药为:琥珀酰胆碱1.0 mg/kg,硫喷妥钠5.0 mg/kg以及芬太尼3.0 µg/kg;罗库溴铵组(V组)为:罗库溴铵1.0 mg/kg,其余用药相同。术后244872小时进行声嘶、咽喉痛损伤评估,声嘶超过三天的患者行镜检观察声带损伤情况。研究结果表明:与罗库溴铵相比,琥珀酰胆碱能提供更佳的插管条件。最佳插管条件两组分别为57% 21% ;临床可接受的插管条件为89%59% (P < 0.001)。声嘶、咽喉痛及声带损伤在两组无显著差别。琥珀酰胆碱组与罗库溴铵组相比:PH分别为50%51%(P = 0.99)VCI3%1% (P = 0.98); ST39%28% (P = 0.22)。两组患者术后肌痛也没有显著差别,琥珀酰胆碱组为39% ,罗库溴铵组为 29% (P = 0.25)。综上所述:琥珀酰胆碱和罗库溴铵在术后声嘶、声带损伤、咽喉痛和肌痛的发生率方面相似,但琥珀酰胆碱能提供更好的插管条件。

(郑拥军 陈杰 校)

Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. In this prospective trial, 160 patients were randomized in 2 groups to receive thiopental 5.0 mg/kg, fentanyl 3.0 µg/kg, succinylcholine 1.0 mg/kg, or rocuronium 0.6 mg/kg during RSI. PH and ST were assessed at 24, 48, and 72 h after surgery, VCI were examined by stroboscopy in those patients who had PH >3 days. Excellent and clinically acceptable intubating conditions were significantly increased in the succinylcholine group compared with the rocuronium group: 57% versus 21% and 89% versus 59%, respectively (P < 0.001). The incidence and severity of PH, and VCI between the succinylcholine and the rocuronium groups did not differ significantly: PH: 50% versus 51% (P = 0.99) and VCI: 3% versus 1% (P = 0.98), respectively. Similar findings were found for ST, 39% versus 28% (P = 0.22), and postoperative myalgia, 39% versus 29% (P = 0.25), respectively. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.

 

地西泮提高鼠心室肌对多巴胺的收缩反应

Diazepam enhances inotropic responses to dopamine in rat ventricular myocardium.
Juan-Fita MJ, Vargas ML, Hernandez J.

Departmento de Farmacologia, Facultad de Medicina, Murcia, Spain.
Anesth Analg.
2006 Mar;102(3):676-81


地西泮抑制4型磷酸二酯酶,并且提高某些3',5'环磷酸腺苷(cAMP)-依赖的正性肌力药的反应。我们寻求明确是否地西泮和选择性4型磷酸二酯酶抑制剂咯利普(rolipram)可以提高收缩反应以及提高鼠心肌经多巴胺诱导产生的cAMP水平。多巴胺(3-100 mic - roM)产生浓度依赖性的正性肌力效应(-log EC50 = 5.21 +/- 0.2, n = 5),地西泮10 microM(-log EC50 = 5.40 +/- 0.08, n = 6, P < 0.05)rolipram(-log EC50 = 5.41 +/- 0.1, n = 6, P < 0.05)1microM时,这种效应被扩大。地西泮的这种效应既不能被微摩尔伽玛氨基丁酸(GABA)所模拟,也不能被浓度为5 microM的外周及中枢的苯二氮卓类受体拮抗剂,氟马西尼和PK 11195所拮抗。在组织中,由于地西泮(1073 +/- 97.7, n = 6, P < 0.05)rolipram (1034.0 +/- 245.2, n = 5, P < 0.05)的存在,由多巴胺(744.4 +/- 111.8, n = 5)产生的cAMP水平(pmol/g)被增强。因此,地西泮,像rolipram,在鼠心肌增强多巴胺的收缩力和生物化学效应。这种效应不能经苯二氮卓类受体来调节,但这大概是地西泮4型磷酸二酯酶抑制的结果。

(孙敏莉译 薛张纲校)

Diazepam inhibits phosphodiesterase type 4 and enhances the effect of some 3',5'-cyclic adenosine monophosphate (cAMP)-dependent positive inotropic drugs. We sought to determine whether diazepam and the selective phosphodiesterase type 4 inhibitor rolipram enhances the contractile response and cAMP levels induced by dopamine in rat myocardium. Dopamine (3-100 microM) produced concentration-dependent positive inotropic effects (-log EC50 = 5.21 +/- 0.2, n = 5), which were augmented in the presence of 10 microM diazepam (-log EC50 = 5.40 +/- 0.08, n = 6, P < 0.05) or 1 microM rolipram (-log EC50 = 5.41 +/- 0.1, n = 6, P < 0.05). The effect of diazepam was not mimicked by 100 microM gamma-aminobutyric acid nor it was antagonized by a 5 microM concentration of the blockers of central and peripheral type benzodiazepine receptors, flumazenil and PK 11195. cAMP levels (pmol/g) produced by dopamine (744.4 +/- 111.8, n = 5) in this tissue were enhanced by the presence of diazepam (1073 +/- 97.7, n = 6, P < 0.05) or rolipram (1034.0 +/- 245.2, n = 5, P < 0.05). Therefore, diazepam, like rolipram, augments the inotropic and biochemical effects of dopamine in rat myocardium. This effect is not mediated by benzodiazepine receptors but is probably the consequence of the phosphodiesterase type 4 inhibitory activity of diazepam.

 

地西泮减弱新福林引起的鼠主动脉收缩作用

Diazepam Attenuates Phenylephrine-Induced Contractions in Rat Aorta

Soon-Eun Park, MD*, Ju-Tae Sohn, MD{dagger}§, Cheol Kim, MD{dagger}, Ki Churl Chang, PhD{ddagger}§, Il-Woo Shin, MD{dagger}, Kyeong-Eon Park, MD{dagger}, Heon-Keun Lee, MD{dagger}, and Young-Kyun Chung, MD{dagger}

Anesth Analg 2006 102: 682-689.

 

在这项体外试验中,我们研究了地西泮对新福林引起的鼠主动脉收缩作用的影响,并且证实其相关的细胞结构——内皮源性血管松弛因子。我们做了有或无地西泮时新福林和氯化钾的浓度-反应曲线。在有或无地西泮时,分别用NW-硝基-L-精氨酸甲酯、PK 11195、四乙铵及吲哚美辛预处理完整的环形血管内皮得到新福林浓度-反应曲线。新福林可使完整的环形血管内皮收缩,而地西泮(7 x 10–7 M)可减弱这种作用,无论是否有内皮细胞存在,大剂量(5 x 10–6 M)地西泮可减弱新福林引起的主动脉环收缩。若使用NW-硝基-L-精氨酸甲酯进行预处理,可以完全避免地西泮对新福林浓度反应曲线的上述作用。使用地西泮(5 x 10–6 M)预处理可增强NW-硝基-L-精氨酸甲酯(10–4 M)对血管环的收缩作用。这些结果表明,超临床浓度的地西泮可增加内皮细胞氧化亚氮的活性,直接影响血管平滑肌,从而减弱新福林引起的血管收缩作用。

(金 琳译 薛张纲校)

In this in vitro study we examined the effects of diazepam on a phenylephrine-induced contraction in rat aorta and determined the associated cellular mechanism focusing on the endothelium-derived vasodilators. The concentration-response curves for phenylephrine and potassium chloride were generated in the presence or absence of diazepam. Phenylephrine concentration-response curves were generated from the endothelium-intact rings pretreated independently with NW-nitro-l-arginine methyl ester, PK 11195, tetraethylammonium, and indomethacin in the presence or absence of diazepam. Diazepam (7 x 10–7 M) attenuated the phenylephrine-induced contraction in the endothelium-intact rings, whereas a large dose (5 x 10–6 M) of diazepam attenuated the phenylephrine-induced contraction in the aortic rings with or without the endothelium. A pretreatment with the NW-nitro-l-arginine methyl ester completely abolished the diazepam (7 x 10–7 M)-induced attenuation of the phenylephrine concentration-response curve, as well as the diazepam (5 x 10–6 M)-induced attenuation of the maximal contractile response to phenylephrine. The NW-nitro-l-arginine methyl ester (10–4 M)-induced contraction was enhanced in the rings pretreated with diazepam (5 x 10–6 M). These results indicate that a supra clinical concentration of diazepam attenuates phenylephrine-induced contraction by increasing endothelial nitric oxide activity and directly affecting vascular smooth muscle.

 

连续硬膜外和连续腘神经阻滞用于小儿足部手术术后镇痛:前瞻、对比、随机性研究

Continuous epidural block versus continuous popliteal nerve block for postoperative pain relief after major podiatric surgery in children: a prospective, comparative randomized study.

Dadure C. Bringuier S. Nicolas F. Bromilow L. Raux O. Rochette A. Capdevila X.

Department of Anesthesia, Lapeyronie University Hospital, Montpellier, France.

Anesthesia & Analgesia. 102(3):744-9, 2006 Mar.

 

小儿足部和踝部手术术后是非常疼痛的,吗啡和连续硬膜外阻滞(CEB)的副作用又限制了其在小儿中的应用。连续腘神经阻滞(CPNB)在这方面的应用未见报道。本研究我们评价了CPNBCEB用于小儿足部手术术后镇痛的效果及其副作用。52例足部手术小儿患者按年龄和镇痛方法分为四组。全麻后,0.5-1.0ml/kg 0.25%布比卡因和1.0%利多卡因含1200000的肾上腺素的混合液注入硬膜外或腘神经周围。术后0.1ml/kg.hCPNB)或0.2ml/kg.hCEB)的0.2%罗派卡因用于术后镇痛48h。常规给予尼氟灭酸(Niflumic acid )。记录每组的副作用。评估活动后161218243648h的疼痛情况,补救用药量(一线药丙岶他莫30mg/kg 4/日或二线药0.2mg/kg纳布啡 iv)和运动阻滞情况。记录48h父母的满意情况。CEB27例,CPNB25例。16岁患者32例(CPNB15例;CEB17例),712岁患者20例(CPNB10;CEB10)。两组镇痛方法和两组年龄组中术后镇痛都满意,术后运动阻滞程度两组镇痛方法中相同。副作用(16岁组中术后恶心、呕吐、尿潴溜和局麻药无法连续输注)在CEB组中发生更频繁(p< 0.05)。CEB86%和CPNB100%的父母满意。我们的结论:虽然两组镇痛方法都可产生满意的术后镇痛,但是CPNB有更少的尿潴留、恶心、呕吐等副作用。因此,我们认为CPNB112岁的患儿行足部手术理想的术后镇痛方法。

(吴德华译 薛张纲校)

Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. In this prospective, randomized study we evaluated the effectiveness and adverse events of CPNB or CEB in children after podiatric surgery. Fifty-two children scheduled for foot surgery were separated into four groups by age and analgesia technique. After general anesthesia, 0.5 to 1 mL/kg of an equal-volume mixture of 0.25% bupivacaine and 1% lidocaine with 1:200000 epinephrine was injected via epidural or popliteal catheters. In the postoperative period, 0.1 mL x kg(-1) x h(-1) (group CPNB) or 0.2 mL x kg(-1) x h(-1) (group CEB) of 0.2% ropivacaine was administered for 48 h. Niflumic acid was routinely used. Adverse events were noted in each treatment group. Postoperative pain during motion was evaluated at 1, 6, 12, 18, 24, 36, and 48 h. Requirement for rescue analgesia (first-line propacetamol 30 mg/kg 4 times daily or second-line 0.2 mg/kg IV nalbuphine), and motor blockade were recorded. Parental satisfaction was noted at 48 h. Twenty-seven patients were included in the CEB groups and 25 in CPNB groups. There were 32 children 1 to 6 yr of age (CPNB = 15; CEB = 17) and 20 children 7 to 12 yr of age (CPNB = 10; CEB = 10). The demographic data were comparable among groups. Postoperative analgesia was excellent for the two continuous block techniques and in the two age groups. Motor block intensity was equal between techniques. Adverse events (postoperative nausea or vomiting, urinary retention, and premature discontinuation of local anesthetic infusion in the 1- to 6-yr-old group) were significantly more frequent in the CEB group (P < 0.05). Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent postoperative analgesia in this study, CPNB was associated with less urinary retention and nausea and vomiting. Therefore, we recommend CPNB as the ideal form of postoperative analgesia after major podiatric surgery in 1- to 12-yr-old children.

 

挥发性吸入麻醉药效能的决定因素:卤化麻醉剂的三维药效团基础

Determinants of Volatile General Anesthetic Potency: A Preliminary Three-Dimensional Pharmacophore for Halogenated Anesthetics

Jason C. Sewell, PhD, and John W. Sear, PhD, FFARCS

Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK

Address correspondence to John W. Sear, PhD, FFARCS, Nuffield Department of Anaesthetics, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.

Anesth Analg 2006 102: 764-771.

 

我们采用比较分子力场分析方法研究了卤化麻醉剂固定活性的分子基础。从文献中获得69种不同结构的麻醉剂的体外效能资料(用最小肺泡气浓度表示,MAC)。这些药物被随机分配到由活性模型决定的训练组(n52)和独立的评估模型的预测效能的测试组(n17)。这些麻醉剂结构上的排列特点使之该组中效能最强的药物 CF2H-(CF2)3-CH2OH 的分子结构和静息电位非常相似。这些麻醉剂中形状和排列与之相似度最差的(根据碳指数计算)被保留下来用作为比较分子力场分析方法模型。最终的模型说明了训练组化合物中观测活性的94.2%的变异。此模型显示了对训练组(cross –vali dated, r2 = 0.705)和随机排除的测试组麻醉剂(r2 = 0.837)的良好的预测能力。三维药效团图来自对关键区域的空间分布的鉴别,该区原子空间排列和静电相互作用在决定卤化药物的固定活性非常重要,并且可用来和早先发表的从非卤化挥发性麻醉剂得来的图形相比较。

(金 路译 薛张纲校)

We investigated the molecular basis for the immobilizing activity of halogenated volatile anesthetics using comparative molecular field analysis. In vivo potency data (expressed as minimum alveolar concentrations) for 69 structurally diverse anesthetics were obtained from the literature. The drugs were randomly divided into a training set (n = 52) used to derive the activity model and a test set (n = 17) used to independently assess the model's predictive power. The anesthetic structures were aligned so as to maximize their similarity in molecular shape and electrostatic potential to the most potent drug in the group, CF2H-(CF2)3-CH2OH. The conformers and alignments of the anesthetics with maximum similarity (calculated as Carbo indices) were retained and used to derive the comparative molecular field analysis models. The final model explained 94.2% of the variance in the observed activities of the training set compounds. The model showed good predictive capability for both the training set (cross-validated r2 = 0.705) and randomly excluded test set anesthetics (r2 = 0.837). Three-dimensional pharmacophoric maps were derived to identify the spatial distribution of key areas where steric and electrostatic interactions are important in determining immobilizing activity of the halogenated drugs and were compared with our previously published maps obtained for nonhalogenated volatile anesthetics.

 

氟哌利多对大鼠主动脉三磷酸腺苷敏感性钾通道的强化作用

Augmented Activity of Adenosine Triphosphate-Sensitive K+ Channels Induced by Droperidol in the Rat Aorta

Hiroyuki Kinoshita, Mayuko Dojo, Katsutoshi Nakahata, Yoshiki Kimoto, Tetsuya Kakutani, Kazuhiro Mizumoto, and Yoshio Hatano

Department of Anesthesiology, Wakayama Medical University, Wakayama, Wakayama, Japan

Anesth Analg 2006 102: 786-791

 

氟哌利多能引起心肌细胞钾通道的抑制.然而,其对血管钾通道的作用尚不明确。因此,我们进行该试验来研究是否氟哌利多影响了血管平滑肌细三磷酸腺苷(ATP)敏感性钾通道的活性。分别记录无内皮的大鼠主动脉环的膜电位。 左克罗卡林(10-8 10-5 M 10-5 M)引起的血管舒张和超级化被格列本脲(10-5 M)完全拮抗,后者是ATP敏感性钾通道抑制剂。氟派利多(10-7 M)和α肾上腺受体拮抗剂酚妥拉明(3 × 10-9 M)引起类似的血管扩张(大约是罂粟碱3 × 10-4 M引起的最大血管舒张程度的20%),而格列本脲不能改变由氟哌利多引起的血管舒张。氟哌利多(3 × 10-8M 10-7M)强化了左克罗卡林引起的血管扩张和超级化,而酚妥拉明(3 × 10-9 M)不能改变这种血管舒张. 格列本脲(10-5 M)拮抗了由左克罗卡林和氟派利多(10-7 M)引起的血管舒张和超级化。这些结果提示,氟派利多通过ATP敏感性钾通道增加了血管舒张作用。然而,这种强化作用未必是抑制了血管平滑肌细胞的α肾上腺受体而起效的。

(王丽珺译 薛张纲校)

Droperidol produces the inhibition of K+ channels in cardiac myocytes. However, the effects of droperidol on K+ channels have not been studied in blood vessels. Therefore, we designed the present study to determine whether droperidol modulates the activity of adenosine triphosphate (ATP)-sensitive K+ channels in vascular smooth muscle cells. Rat aortic rings without endothelium were suspended or used for isometric force and membrane potential recordings, respectively. Vasorelaxation and hyperpolarization induced by levcromakalim (10-8 to 10-5 M or 10-5 M, respectively) were completely abolished by the ATP-sensitive K+ channel antagonist glibenclamide (10-5 M). Droperidol (10-7 M) and an [alpha]-adrenergic receptor antagonist phentolamine (3 × 10-9 M) caused a similar vasodilator effect (approximately 20% of vasorelaxation compared with maximal vasorelaxation induced by papaverine [3 × 10-4 M]), whereas glibenclamide did not alter vasorelaxation induced by droperidol. Droperidol (3 × 10-8M to 10-7M) augmented vasorelaxation and hyperpolarization produced by levcromakalim, whereas phentolamine (3 × 10-9 M) did not alter this vasorelaxation. Glibenclamide (10-5 M) abolished the vasodilating and hyperpolarizing effects of levcromakalim in the aorta treated with droperidol (10-7 M). These results suggest that droperidol augments vasodilator activity via ATP-sensitive K+ channels. However, it is unlikely that this augmentation is mediated by the inhibition of [alpha]-adrenergic receptors in vascular smooth muscles.

 

一个双盲对照的实验评价三个多元的困难气道模型的预期作用
Predictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study.

Naguib M, Scamman FL, O'Sullivan C, Aker J, Ross AF, Kosmach S, Ensor JE.
Department of Anesthesiology and Pain Medicine, Unit 409, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

Anesth Analg. 2006 Mar;102(3):818-24

 

我们用一个双盲对照的实验来评价三个多元的临床模型(Wilson, Arne, and Naguib模型)在预测意外的困难插管的作用。实验组包括97例已经发生的意外困难插管的病人。每一个插管困难的病人都有一个容易插管的病人作为对照。术后,一个调查者去评价这两个病人。临床评价包括病人的体重、身高、年龄、Mallampat评分、甲颏距离、胸甲距离、颈周长、Wilson危险积分、困难插管史及与喉镜暴露困难和插管困难相关的疾病。Naguib模型在灵敏度(81.4%)上明显比Arne(54.6%)模型和 Wilson (40.2%)模型高(P < 0.0001)。Naguib (76.8%) Arne (74.7%)模型比Wilson 模型 (66.5%)区分出更准确的插管率。ArneWilsonNaguib模型的特异性分别为94.9%92.8% 72.2%ROC曲线下面积分别为0.870.79 0.82。我们新的用来预测困难插管的模型通过logistic回归和甲颏距离、Mallampati 评分、和身高已经改进了。这个模型的灵敏度为82.5%,特异度为85.6%,ROC曲线下面积为0.90

(陆文清译 薛张纲校)

We performed a case-controlled, double-blind study to examine the performance of three multivariate clinical models (Wilson, Arne, and Naguib models) in the prediction of unanticipated difficult intubation. The study group consisted of 97 patients in whom an unanticipated difficult intubation had occurred. For each difficult intubation patient, a matched control patient was selected in whom tracheal intubation had been easily accomplished. Postoperatively, a blinded investigator evaluated both patients. The clinical assessment included the patient's weight, height, age, Mallampati score, interincisor gap, thyromental distance, thyrosternal distance, neck circumference, Wilson risk sum score, history of previous difficult intubation, and diseases associated with difficult laryngoscopy or intubation. The Naguib model was significantly more sensitive (81.4%; P < 0.0001) than the Arne (54.6%) or Wilson (40.2%) models. Both the Naguib (76.8%) and Arne (74.7%) model classified more intubations correctly (P = 0.01) than the Wilson model (66.5%). The specificity of Arne, Wilson, and Naguib model was 94.9%, 92.8%, and 72.2%, respectively (P < 0.0001). The corresponding area under the receiver operating characteristic curve was 0.87, 0.79, and 0.82, respectively. Our new model for prediction of difficult intubation was developed using logistic regression and includes thyromental distance, Mallampati score, interincisor gap, and height. This model is 82.5% sensitive and 85.6% specific with an area under the receiver operating characteristic curve of 0.90.

 

硫酸金刚烷胺减轻慢性后背痛病人的实验敏感性和疼痛

Amantadine Sulfate Reduces Experimental Sensitization and Pain in Chronic Back Pain Patients
Dieter Kleinböhl, PhD*, Roman Görtelmeyer, PhD{dagger}, Hans-Joachim Bender, MD{ddagger}, and Rupert Hölzl, PhD*

*Laboratory for Clinical Psychophysiology, Otto-Selz-Institute, University of Mannheim; {dagger}Medical Biometrics and Data Management, Merz Pharmaceuticals GmbH, Frankfurt; and {ddagger}Institute of Anesthesiology and Intensive Care, University Hospital Mannheim, University of Heidelberg, Germany

Anesth Analg 2006 102: 840-847.

 

我们研究了在慢性肌肉骨骼痛的病人中已确定增强的实验敏感性的生理心理量是否能用N-甲基-d-门冬氨酸受体拮抗剂,金刚烷胺来减轻。并且这种敏感性的减轻是否伴有临床疼痛的协同改善。敏感性是通过短期敏感性的实验紧张热模型与协同的主观和行为心理比例来评估的。二十六例慢性背痛病人加入这一项随机,双盲,安慰剂对照的研究,一周的治疗期间每天接受安慰剂或100mg的硫酸金刚烷胺。参与者在治疗前和治疗后完成定量的疼痛阈值感觉和实验敏感性测试,在治疗前,中,后完成临床疼痛分级。实验敏感性增强和临床疼痛在接受实验药的病人中减轻。最终,试验敏感性在那些无痛苦强度水平接触热的早期敏感性增加病人和在有痛苦强度水平敏感性增强的病人中增强,正如先前所示。经过一周的治疗,试验敏感性在使用硫酸金刚烷胺的病人中减轻但安慰剂则没有。我们总结得出,如果与增强的敏感性有关,N-甲基-d-门冬氨酸受体拮抗剂辅助治疗慢性疼痛可能对慢性疼痛有益,当时的定量感觉测试总结可以用来验证这一点。

(周荻 薛张纲校)

We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this.

 

持续脉搏氧监测对手术后入ICU的影响

The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor

E. Andrew Ochroch, Michael W. Russell, William C. Hanson, III, Gayle A. Devine, Andrew J. Cucchiara, Mark G. Weiner, and Sanford J. Schwartz

Anesthesia and Cardiopulmonary Services, University Health Systems East, Philadelphia, Pennsylvania, USA.

Anesth Analg 2006 102: 868-875.

 

持续脉搏氧监测(CPOX)能够增加警醒,减少肺部并发症,因而有效降低了入ICU的几率.在一项1219例随机非盲的研究中(通过一个拥有33个床位的心胸手术术后监护病房),我们比较了CPOX和标准监测对于术后入ICU的概率.结果表明,两种监测对于再入ICU的概率无差别.除了年龄偏大和体质差,需要入ICU的病人中,有监测的要比没有监测的在监护上花费的时间短(平均预算花费要相差28195美元;P=0.04).进行CPOX改变了病人入ICU的原因但并不改变入ICU的几率.CPOX,ICU的时间及花费要大大降低.CPOX对于肺部并发症的早期干预或是预防的作用尚需确证. CPOX不能降低入ICU的几率和死亡率以及整个住院的花费,目前尚不清楚此监测对于心胸手术术后恢复的好处.

(王慧琳译 薛张纲校)

Continuous pulse oximetry (CPOX) has the potential to increase vigilance and decrease pulmonary complications and thus decrease intensive care unit (ICU) admissions. In a randomized nonblinded study of 1219 subjects we compared the effects of CPOX and standard monitoring on the rate of transfer to an ICU from a 33-bed postcardiothoracic surgery care floor. There was no difference in the rate of ICU readmission between the CPOX and standard monitor groups. Despite older age and comorbidity, estimated cost to time of censoring (enrollment to completion of the study) was less in the monitored patients who required ICU transfer than in the unmonitored patients who required ICU transfer (mean estimated cost difference of 28,195 dollars; P = 0.04). Use of CPOX altered the reasons that patients were transferred to an ICU but did not affect the rate of transfer. The duration, and thus estimated cost, of ICU stay was significantly less in the CPOX-monitored group. The potential for CPOX to allow for early intervention, or perhaps prevention of pulmonary complications, needs to be explored. Routine CPOX monitoring did not reduce transfer to ICU, mortality, or overall estimated cost of hospitalization, and it is unclear if there is any real benefit from the application of this technology in patients on a general care floor who are recovering from cardiothoracic surgery.

 

刺激模式和七氟醚浓度对术中运动诱发电位的影响

The Effects of Stimulation Pattern and Sevoflurane Concentration on Intraoperative Motor-Evoked Potentials

Reinacher PC, Priebe HJ, Blumrich W, Zentner J, Scheufler KM.

Department of Neurosurgery, University Hospital, Aachen, Germany

Anesth Analg. 2006 Mar;102(3):888-95

 

术中运动诱发电位(MEPs)监测在吸入麻醉期间的有效性由于挥发性麻醉药对MEP信号的抑制作用而受到限制。我们研究了不同刺激模式和呼末七氟醚浓度对术中脑电MEP的影响。在12名行颅骨切开术的病人中,随机给予不同的刺激模式(300-500 V, 100-1000 Hz, 1-5 个刺激)和不同的(0.5, 0.75, 1.0)七氟醚最低肺泡有效浓度(MAC),同时持续输注瑞芬太尼0.2 microg x kg(-1) x min(-1)。经鱼际肌和小鱼际肌记录MEPs,并在不知各自MAC的情况下进行分析。三因素方差分析显示了刺激强度,频率和刺激个数渐增对MEP振幅的重要影响(P < 0.05)。在1000 Hz 300 V传递的4个刺激下观察到最大MEP振幅和成功记录比率。只在鱼际肌记录点观察到七氟醚浓度(0.5 相对0.75 1 MAC)MEP振幅的重要影响(P < 0.05)。得出结论,刺激模式的变化可导致MEP特征的显著改变,而七氟醚浓度的改变产生的影响较小。结果表明在1 MAC的七氟醚和0.2 microg x kg(-1) x min(-1)瑞芬太尼持续输注下,高频重复刺激使得MEP监测得以在术中适用。

(徐丽颖译 薛张纲校)

 

The usefulness of intraoperative monitoring of motor-evoked potentials (MEPs) during inhaled anesthesia is limited by the suppressive effects of volatile anesthetics on MEP signals. We investigated the effects of different stimulation patterns and end-tidal concentrations of sevoflurane on intraoperative transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V, 100-1000 Hz, 1-5 stimuli) and multiples (0.5, 0.75, and 1.0) of minimum alveolar concentration (MAC) of sevoflurane were varied randomly while remifentanil was administered at a constant rate of 0.2 microg x kg(-1) x min(-1). MEPs were recorded from thenar and hypothenar muscles and analyzed without knowledge of the respective MAC. Three-way analysis of variance revealed significant main effects for increasing stimulation intensity, frequency, and number of stimuli on MEP amplitude (P < 0.05). Maximum MEP amplitudes and recording success rates were observed during 4 stimuli delivered at 1000 Hz and 300 V. A significant main effect of sevoflurane concentration (0.5 versus 0.75 and 1 MAC multiple) on MEP amplitude was observed at the thenar recording site only (P < 0.05). In conclusion, MEP characteristics varied significantly with changes in stimulation pattern and less so with changes in sevoflurane concentration. The results suggest that high frequency repetitive stimulation allows intraoperative use of MEP monitoring during up to 1 MAC multiple of sevoflurane and constant infusion of remifentanil up to 0.2 microg x kg(-1) x min(-1).

 

锁骨下与肱骨臂丛神经阻滞在外伤病人中舒适度的比较

Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort.

Minville V, Fourcade O, Idabouk L, Claassen J, Chassery C, Nguyen L, Pourrut JC, Benhamou D

Department of anesthesiology and intensive care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France.

Anesth Analg 2006 102: 912-915.

 

在这项前瞻性、随机性的研究中,我们比较了由肱骨阻滞(HB)与锁骨下臂丛阻滞(HB)引起的疼痛的程度,假设ICB引起的疼痛比HB小。研究对象是急诊行上臂外科手术的病人,他们随机接受ICB( I, n = 52 )HB( H, n = 52 )。病人被要求在被阻滞过程中对疼痛的程度进行量化,使用的方法是通过从0100mm的评分表来对以下4种在操作过程中会产生不愉快的事件进行评分以便找出其中最令人不愉快的事件,包括皮肤穿刺、用针头对神经定位、局麻药的注射和电刺激。从阻滞完全后30分钟内每5分钟测量一次。通过观察评分表发现组 H的疼痛评分为35 +/- 27而组 I的为19 +/- 18(P < 0.0011)。电刺激是所有不愉快事件中最令人不愉快的( H的疼痛评分为29 +/- 15 mm而组 I的为15 +/- 10 mm) (P < 0.019)。组 I所用的操作时间大大短于组 H(ICB, 6 +/- 4 分钟而HB, 10 +/- 4 分钟; P < 0.0001)。两者的起效时间分别为ICB 13 +/- 7分钟,HB 9 +/- 3 分钟(P < 0.05)。期间没有观察到严重的并发症。总之,在同样的穿刺成功率下ICBHB相较引起的疼痛更少。

(孙卓真译 薛张纲校)

In this prospective randomized study, we compared humeral block (HB) and infraclavicular brachial plexus block (ICB) with pain caused by the block as a primary outcome, assuming that ICB would cause less pain than HB. Patients undergoing emergency upper limb surgery were included in this study and received either ICB (group I, n = 52 patients) or HB (group H, n = 52 patients). Patients were asked to quantify the severity of the pain during the procedure using a visual analog scale from 0 to 100 mm and to identify which of the 4 components of the procedure was most unpleasant (skin transfixion, needle redirection in search of the nerves, local anesthetic injections, or electrical stimulation). The block was assessed every 5 min for 30 min after completion of the block. Overall visual analog scale scores for the block were 35 +/- 27 mm in group H versus 19 +/- 18 mm in group I (P < 0.0011). Electrical stimulation was the most unpleasant part of the block (group H, 29 +/- 15 mm versus group I, 15 +/- 10 mm) (P < 0.019). Time to perform the block was significantly shorter in group I (ICB, 6 +/- 4 min versus HB, 10 +/- 4 min; P < 0.0001). The onset time was 13 +/- 7 min for ICB and 9 +/- 3 min for HB (P < 0.05). No serious complications were observed. In summary, ICB is less painful, compared with HB, with a similar success rate.

 

α-氨基羟甲基恶唑丙酸受体拮抗剂对于丁卡因鞘内给药所引起的神经毒性的效应

The effects of an AMPA receptor antagonist on the neurotoxicity of tetracaine intrathecally administered in rabbits.

Koizumi Y, Matsumoto M, Yamashita A, Tsuruta S, Ohtake T, Sakabe T.

Department of Anesthesiology-Resuscitology Yamaguchi University School of Medicine, Yamaguchi, Japan.

Anesth Analg 2006 102: 930-936.

 

我们已经报道了在大鼠鞘内给予大剂量的局麻药将会导致脑脊液中谷氨酸浓度上升和造成神经毒性。在新近的研究中我们发现AMPA受体拮抗剂和YM872的鞘内给药将会降低丁卡因的神经毒性。我们首先研究了在大鼠鞘内分别给予YM872 1030100300mug时的效应。YM872会产生可逆性的剂量依赖性的运动和神经阻滞。然后我们评估了YM872300mug时)对于丁卡因引起的谷氨酸释放和神经毒性的调节作用。YM872的预处理不会减低1% 2%丁卡因所引起的脑脊液中谷氨酸的浓度。为了评估神经毒性,我们将大鼠分成四组(每组六只),鞘内分别给予1%丁卡因和盐水(1T);1%丁卡因和YM8721TY;2%丁卡因和盐水(2T);2%丁卡因和YM8722TY)。盐水、YM872和丁卡因都是0.3ml。盐水和YM872在丁卡因给药前30分钟给药。神经学和组织病理学的评估将在给药后一周进行。用了1T后分别有两只和一只动物出现运动和感觉功能异常,而用了2T后有五只动物出现运动和感觉功能异常。YM872对于2%丁卡因引起的运动功能障碍和神经损害有改善作用。在2TY组,三只大鼠运动功能正常,而另三只有轻微的异常(能跳跃,但不正常);在2T组,有四只大鼠表现为轻微的功能异常(不能跳跃)。在2TY组只有两只大鼠表现为神经元染色质溶解,而在2%T组有五只大鼠表现为416神经元染色质溶解。结果显示AMPA受体拮抗剂与丁卡因在脊髓引起的神经毒性有关,至少是部分相关。

(韩晓丹译 薛张纲校)

We have reported that large concentrations of intrathecal local anesthetics increase glutamate concentrations in the cerebrospinal fluid (CSF) and cause neuronal injury in rabbits. In the current study we determined whether an alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor antagonist, YM872, administered intrathecally, reduces neuronal injury caused by tetracaine. We first examined the effects of intrathecal YM872 10, 30, 100, or 300 mug in rabbits (n = 3 in each). YM872 produced reversible motor and sensory block in a dose-dependent manner. Then, we evaluated modulatory effects of YM872 (300 mug) on tetracaine-induced glutamate release and neuronal injury. Pretreatment of YM872 did not attenuate 1% or 2% tetracaine-induced increases in cerebrospinal fluid glutamate concentrations (n = 3 in each). For evaluation of neuronal injury, rabbits were assigned to 4 groups (n = 6 in each) and intrathecally received 1% tetracaine and saline (1%T), 1% tetracaine and YM872 (1%TY), 2% tetracaine and saline (2%T), or 2% tetracaine and YM872 (2%TY). The volume of saline, YM872, and tetracaine was 0.3 mL. Saline or YM872 was administered 30 min before tetracaine administration. Neurological and histopathological assessments were performed 1 wk after the administration. Two and 1 animals respectively, showed motor and sensory dysfunction in 1%T, whereas 5 animals showed both motor and sensory dysfunction in 2%T. YM872 improved 2% tetracaine-induced motor dysfunction and neuronal damage (chromatolytic neurons, identified by round-shaped cytoplasm with loss of Nissl substance from the central part of the cell and eccentric nuclei). In 2%TY, 3 animals showed normal motor function and 3 showed mild dysfunction (ability to hop, but not normally), whereas 4 animals showed moderate dysfunction (inability to hop) in 2%T (P = 0.042). Only 2 animals showed one chromatolytic neuron in 2%TY, whereas 5 animals showed 4-16 chromatolytic neurons in 2%T (P = 0.020). These results suggest that AMPA receptor activation is involved, at least in part, in the tetracaine-induced neurotoxicity in the spinal cord.

 

膝关节成形术中止血带使用时间延长后麻醉,病人和手术风险因素对神经系统并发症的影响

Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty.
Horlocker TT, Hebl JR, Gali B, Jankowski CJ, Burkle CM, Berry DJ, Zepeda FA, Stevens SR, Schroeder DR.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Anesth Analg 2006 102: 950-955.

 

止血带长时间充气的神经损伤缘自缺血和机械创伤的综合效果。止血带放气1030分钟给予组织再灌注的时间,然后再充气,这已作为止血带使用的推荐方法。然而,这一指南在临床上并没有被很好的执行。我们回顾一下五年间1001个行膝关节置换术的病人,手术期间止血带的使用时间超过了120分钟。他们平均止血带的使用时间为145/—25分钟(120308)。其中759个病人,止血带在手术中未间断。371个病人在术中在两次充气中有一次放气,23个病人在三次充气中有两次放气。在90个病人中有129种神经系统并发症(胫、腓神经并发症),发生率为77%。85例腓神经损伤和44例胫神经损伤。在39例中,胫、腓神经都有损伤。有76例腓神经损伤(89%)和44例胫神经损伤(100%)得到了恢复。年龄越小(P < 0.001; 优势比 = 0.7/每十岁)、止血带时间越长(P < 0.001; 优势比 = 2.8 /30分钟)、术前屈曲挛缩>20(P = 0.002; 优势比= 3.9)术后神经系统损伤就越大。在一项116例病人的研究中,其止血带时间>=180分钟,放气时间的延长和神经系统并发症发生率下降有关。我们的结论是:神经系统的损伤和总的止血带时间有关,而再灌注间隔能降低神经损伤的发生。

(钟静译 薛张纲校)

Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10-30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. We retrospectively reviewed the medical records of 1001 patients undergoing 1166 primary or revision knee replacements with tourniquet time more than 120 min during a 5-yr interval. Mean total tourniquet time was 145 +/- 25 min (range, 120-308 min). In 759 patients, the tourniquet inflation was uninterrupted. Two tourniquet inflations, interrupted by a single deflation, were noted in 371 patients, and 3 tourniquet inflations interrupted by 2 deflation intervals were noted in 23 patients. A total of 129 neurologic complications (peroneal and/or tibial nerve palsies) were noted in 90 patients for an overall incidence of 7.7%. Eighty-five cases involved the peroneal nerve and 44 cases involved the tibial nerve. In 39 cases, both peroneal and tibial deficits were noted. Complete neurologic recovery occurred in 76 (89%) peroneal and 44 (100%) tibial palsies. Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20 degrees (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times > or =180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.

 

行冠脉搭桥手术的老年病人的纤维蛋白溶解和血小板活性增加

Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery

Hilde Pleym, MD*, Alexander Wahba, MD, PhD{dagger}, Vibeke Videm, MD, PhD{ddagger}#, Arne Åsberg, MD, PhD§, Stian Lydersen, PhD||, Lise Bjella, MD, Ola Dale, MD, PhD*, and Roar Stenseth, MD, PhD

*Department of Cardiothoracic Anesthesia and Intensive Care, {dagger}Department of Cardiothoracic Surgery, {ddagger}Department of Immunology and Transfusion Medicine, and §Department of Medical Biochemistry, St. Olav University Hospital, and ||Unit for Applied Clinical Research, ¶Department of Circulation and Medical Imaging, and #Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway

Anesth Analg 2006;102:660-667

 

心脏手术后出血再探查使并发症发生率和死亡率增高。老年心脏手术病人的过度出血和再探查的危险性增加。在本研究中我们比较了行冠脉搭桥术的老年病人与较年轻病人围手术期的凝血功能。本研究中包括25个老年病人(≥75岁)和25个较年轻病人(<60岁)。分别在术前、术后30分钟、3小时和约20小时采血样分析血小板计数、国际标准化比值、活化部分凝血活酶时间、纤维蛋白原含量、D-二聚体、抗凝血酶、凝血酶原片段1 + 2、凝血酶-抗凝血酶复合物、纤溶酶抑制物、中性粒细胞激活肽2血小板-单核细胞凝集物。老年病人的凝血系统活性较高。特别的是,老年病人与较年轻病人相比,术后纤维蛋白溶解和血小板活性显著增加。

(彭中美 马皓琳 李士通 校)

Reexploration for hemorrhage after cardiac surgery is associated with increased morbidity and mortality. Elderly cardiac surgical patients have an increased risk of excessive bleeding and reexploration. In the present study we investigated the perioperative hemostatic function in elderly patients compared with younger patients undergoing coronary artery bypass grafting. Twenty-five elderly (75 yr and older) and 25 younger (younger than 60 yr) patients were included in the study. Blood samples for the analysis of platelet counts, international normalized ratio, activated partial thromboplastin time, fibrinogen, d-dimer, antithrombin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, plasmin inhibitor, neutrophil-activating peptide 2, and platelet-monocyte complexes were drawn preoperatively, 30 min, and 3 h postoperatively and approximately 20 h postoperatively. Elderly patients had an increased activation of the hemostatic system. In particular, elderly patients showed a more pronounced increase in fibrinolysis and platelet activation postoperatively compared with younger patients.


心脏手术的儿童避免输血:对抑肽酶随机试验的荟萃分析

Avoiding Transfusions in Children Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Trials of Aprotinin

 

Donald M. Arnold, MD, FRCP(C)*{dagger}, Dean A. Fergusson, PhD, Anthony K.C. Chan, MD, FRCP(C){ddagger}, Richard J. Cook, PhD**, Graeme A. Fraser, MD, FRCP(C){dagger}***, Wendy Lim, MD, FRCP(C){dagger},, Morris A. Blajchman, MD FRCPC(C)*{dagger}§, and Deborah J. Cook, MSc, MD, FRCP(C){dagger}#

*Canadian Blood Services; Departments of {dagger}Medicine, {ddagger}Pediatrics, §Pathology and Molecular Medicine, and #Medicine & Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; ¶Centre for Transfusion Research, University of Ottawa, Ottawa, Ontario; **Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario; and ***Juravinski Cancer Centre, Hamilton, Ontario, Canada

Anesth Analg 2006;102:731-737

 

尽管抑肽酶(一种强效的抗纤溶药)在儿童中的疗效尚不明确,它能减少在心脏手术中接受输血的成年病人比例。我们对所有体外循环下行矫正或姑息心脏手术的患儿中进行抑肽酶的随机对照试验的英语文献进行了系统性回顾。对所有的研究都评定了方法质量,并检查证实系不同来源。我们测定了抑肽酶对输血患儿比例、输血量及胸导管引流量的影响。有包括626名合格患儿的12个试验达到入选标准。抑肽酶能减少在心脏手术中接受红细胞或全血输注的患儿比例33%(相对风险=0.67; 95%可信区间,0.51 to 0.89)。抑肽酶对输血量或术后胸导管引流量并没有明显作用。大部分研究的方法质量较差,并很少用预先确定的输血适应证。总之,抑肽酶能减少在体外循环的心脏手术中接受输血的患儿比例。常规建议在这个人群中使用抑肽酶前,尚需高质量试验证明有重要临床结果。

(裘毅敏 马皓琳 李士通 校)

Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving children undergoing corrective or palliative cardiac surgery with cardiopulmonary bypass. All studies were assessed for methodological quality, and sources of heterogeneity were examined. We measured the effect of aprotinin on the proportion of children transfused, the volume of blood transfused, and the volume of chest tube drainage. Twelve trials enrolling 626 eligible children met the inclusion criteria. Aprotinin reduced the proportion of children who received red blood cell or whole blood transfusions during cardiac surgery by 33% (relative risk = 0.67; 95% confidence interval, 0.51 to 0.89). Aprotinin did not have a significant effect on the volume of blood transfused or on the amount of postoperative chest tube drainage. Most of the studies were of poor methodological quality and predefined transfusion triggers were infrequently used. Overall, aprotinin reduced the proportion of children who received blood transfusion during cardiac surgery with cardiopulmonary bypass. Further high-quality trials with clinically important outcomes may be warranted before aprotinin can be routinely recommended in this population.

 

麻醉儿童的上呼吸道塌陷

Upper Airway Collapsibility in Anesthetized Children

Ronald S. Litman, DO, Joseph M. McDonough, MS, Carole L. Marcus, MBBCh, Alan R. Schwartz, MD, and Denham S. Ward, MD, PhD

Department of Anesthesiology, University of Rochester, Rochester, New York; Department of Anesthesiology and Critical Care, Division of Pulmonary Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland

Anesth Analg 2006;102:750-754

 

我们拟使用气道负压动力学装置,建立可行的方法测定麻醉后保留自发呼吸儿童上呼吸道的狭窄程度。第二个目的是比较给予七氟醚或氟烷后上呼吸道梗阻的差异。病人随机用七氟醚或氟烷进行吸入麻醉诱导。每个病人调整浓度到1MAC(氟烷0.9%,七氟醚 2.5%),由一位不知用药情况的麻醉者托面罩,除了口咽通气道,不用任何人为气道开放手法。由插入麻醉环路的产生可调节负压的真空机使上呼吸道部分梗阻时测定吸气流速。标记面罩中不同负压时相对应的吸气峰流速,并用直线相关分析推测到流速为零时的压力,即咽部闭合的临界压(Pcrit)。有14例儿童参加实验,每组7人。即使负压达到–9 cm H2O,氟烷组中仍有2例患儿没有出现限制流量的气道梗阻。七氟醚的Pcrit范围为–6.7–11.6 (平均值±标准差–9.8 ± 1.9) cm H2O。氟烷的Pcrit范围为–8.1–33 (平均值±标准差–19.4 ± 9.3) cm H2O (七氟醚与氟烷相比,P=0.048)。我们得出结论,当使用气道负压动力学装置时,等效浓度的氟烷较七氟醚更少导致上呼吸道梗阻。

(张莹 译,马皓琳 李士通 校)

We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. Each was adjusted to their 1 MAC value (0.9% for halothane and 2.5% for sevoflurane) and a blinded anesthesia provider held the facemask without performing manual airway opening maneuvers but with inclusion of an oral airway device. Inspiratory flows were measured during partial upper airway obstruction created by an adjustable negative pressure-generating vacuum motor inserted into the anesthesia circuit. Critical closing pressure of the pharynx (Pcrit) was obtained by plotting the peak inspiratory flow of the obstructed breaths against the corresponding negative pressure in the facemask and extrapolating to zero airflow using linear correlation. Fourteen children were enrolled, seven in each anesthetic group. Two children in the halothane group did not develop flow-limited airway obstruction despite negative pressures as low as –9 cm H2O. Pcrit for sevoflurane ranged from –6.7 to –11.6 (mean ± sd, –9.8 ± 1.9) cm H2O. Pcrit for halothane ranged from –8.1 to –33 (mean ± sd, –19.4 ± 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.

 

静脉麻醉药对大鼠海马CA1区抑制性通路的作用强于吸入麻醉药

Intravenous Anesthetics Are More Effective than Volatile Anesthetics on Inhibitory Pathways in Rat Hippocampal CA1

Takehisa Asahi, MD*, Koki Hirota, MD, PhD*, Rika Sasaki, MD, PhD*, Yamazaki Mitsuaki, MD, PhD*, and Sheldon H. Roth, PhD{dagger}

*Department of Anesthesiology, University of Toyama, Japan; and {dagger}Departments of Pharmacology & Therapeutics and Anaesthesia, Faculty of Medicine, University of Calgary, Alberta, Canada

Anesth Analg 2006;102:772-778

 

在本研究中,我们通过观察吸入麻醉药和静脉全麻药对有或无返回抑制时的兴奋性突触传递的作用,以阐明兴奋性突触与抑制性突触何者为全麻药作用的主要靶位点。记录大鼠海马脑片CA1区锥体神经细胞场群峰电位(fPSs)。顺行刺激Schaffer侧支连合纤维(Sch),测量CA1区诱发场群峰电位(PS[Sch])。此外,在逆向刺激海马白质(Alv)以产生返回抑制后,记录刺激Sch所产生的fPSsPS[Alv+Sch])。观察到七氟醚(0.5%-5%)和异氟醚(0.5%-5%)主要抑制PS[Sch],且对PS[Alv+Sch]也有附加的浓度依赖性的抑制作用。计算所得七氟醚和异氟醚抑制PS[Sch] PS[Alv+Sch] 50%有效浓度(EC50)分别为5.3 vol% 3.9 vol% (七氟醚) 1.7 vol% 1.1 vol% (异氟醚)。与之相比,硫喷妥钠 2.0 x 10–5–5.0 x 10–4 mol/L)都呈浓度依赖性地减小PS[Sch] PS[Alv+Sch] 。计算所得硫喷妥钠抑制 PS[Sch] PS[Alv+Sch] EC50值分别为 3.4 x 10–4 5.7 x 10–5 mol/L。丙泊酚 (2.0 x 10–5–3.5 x 10–4 mol/L) PS[Sch] 几乎没有作用,但是却抑制 PS[Alv+Sch] ,其计算所得 EC50 值为 5.1 x 10–4 mol/L。有返回抑制时静脉麻醉药的作用可被γ-氨基丁酸-A受体拮抗剂甲碘荷包牡丹碱所拮抗。此外所有麻醉药均延长返回抑制,其延长时限从100ms(七氟醚和异氟醚)至400ms(丙泊酚)不等。结果提示七氟醚和异氟醚主要抑制谷氨酸介导的顺行通路,而硫喷妥钠和丙泊酚增强{gamma}γ-氨基丁酸-A介导的CA1区神经元返回抑制通路,因此对全麻药机理具有药物特异性和通路特异性提供了进一步的证据。

(周雅春 马皓琳 李士通 校)

In this study, we have examined the effects of both volatile and IV general anesthetics on excitatory synaptic transmission, with and without recurrent inhibition, to clarify whether excitatory or inhibitory synapses are the major targets of action. Field population spike amplitudes (fPSs) of CA1 pyramidal neurons were recorded in rat hippocampal slices. Schaffer-collateral-commissural fibers (Sch) were stimulated orthodromically, and the evoked fPSs (PS[Sch]) in CA1 area were measured. In addition, the fPSs (PS[Alv+Sch]) elicited by stimulation of the Sch after antidromic stimulation of the alveus hippocampi (Alv) to produce recurrent inhibition were determined. It was observed that sevoflurane (0.5%–5%) and isoflurane (0.5%–5%) primarily inhibited PS[Sch] and also produced additive inhibition on the PS[Alv+Sch] in a concentration-dependent manner. The calculated 50% effective concentration (EC50) values for PS[Sch] and PS[Alv+Sch] were 5.3 vol% and 3.9 vol% (sevoflurane) and 1.7 vol% and 1.1 vol% (isoflurane), respectively. In comparison, thiopental (2.0 x 10–5–5.0 x 10–4 mol/L) reduced both the PS[Sch] and PS[Alv+Sch] in a concentration-dependent manner. The calculated EC50 values for thiopental on PS[Sch] and PS[Alv+Sch] were 3.4 x 10–4 and 5.7 x 10–5 mol/L, respectively. Propofol (2.0 x 10–5–3.5 x 10–4 mol/L) had little effect on the PS[Sch] but reduced PS[Alv+Sch] with a calculated EC50 value of 5.1 x 10–4 mol/L. The effects of the IV anesthetics with recurrent inhibition were antagonized in the presence of the {gamma}-aminobutyric acid-A-receptor antagonist bicuculline methiodide. In addition, all anesthetics prolonged recurrent inhibition from 100 ms (sevoflurane and isoflurane) to 400 ms (propofol). The results suggest that sevoflurane and isoflurane inhibit mainly on glutamate-mediated orthodromic pathways, whereas thiopental and propofol enhance {gamma}-aminobutyric acid-A-mediated recurrent inhibitory pathways in CA1 neurons, thus providing further evidence that the mechanisms of general anesthetics are drug- and pathway-specific.


布比卡因异构体对Wistar大鼠心肌细胞内钙的调节

Regulation of Intracellular Calcium by Bupivacaine Isomers in Cardiac Myocytes from Wistar Rats

Núbia G. B. Chedid, PhD, Roberto T. Sudo, MD, PhD, Marli I. S. Aguiar, Margarete M. Trachez, MD, PhD, Masako O. Masuda, PhD, and Gisele Zapata-Sudo, MD, PhD

Departamento de Farmacologia Básica e Clínica, ICB, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Serviço de Anestesiologia, Universidade Federal Fluminense, Rio de Janeiro, Brazil

Anesth Analg 2006;102:792-798

 

本研究中我们探讨了布比卡因消旋混合体(RS(±)布比卡因)和其异构体(S(-)布比卡因和R(+)布比卡因)对Wistar大鼠心室肌细胞内钙转运的影响。酶解分离制备单个心室肌细胞,并用Ca2+ 荧光指示剂fura 2-am标记来评估收缩期和舒张期细胞内的Ca2+ 浓度。S(-)布比卡因(10 µM)明显提高了Ca2+瞬态的振幅峰值和增长速率,分别为对照组的155% ± 54% (P < 0.05) 194% ± 94% (P < 0.01)。然而,试验的任何浓度的R(+)布比卡因都对这二项参数无影响。皂角苷包被的心室肌纤维被用来研究布比卡因通过光面内质网(SR)对细胞内Ca2+ 调节的影响以及其对收缩系统Ca2+敏感性的影响。S(-)R(+)RS(±)布比卡因促使Ca2+SR内释放(P < 0.01)。在SR断裂的心室肌细胞内,布比卡因和其异构体(5 mM)增强了收缩系统对Ca2+的敏感性。S(-)RS(+)R(±)布比卡因使得pCa505.8 ± 0.15.8 ± 0.15.8 ± 0.1明显增至6.1 ± 0.1 (P < 0.05)6.0 ± 0.1 (P < 0.05)6.1 ± 0.1 (P < 0.05)。通过激活RyR2引起Ca2+SR释放可以用来解释心肌细胞内Ca2+瞬态的增加。心肌细胞内Ca2+的增加体现了S(-)布比卡因的立体选择性。

(黄施伟 译,马皓琳 李士通 校)

In this study we investigated the effects of a racemic mixture of bupivacaine (RS(±)bupivacaine) and its isomers (S(-)bupivacaine and R(+)bupivacaine) on the Ca2+ handling by ventricular myocytes from Wistar rats. Single ventricular myocytes were enzymatically isolated and loaded with the fluorescent Ca2+ indicator fura 2-am to estimate intracellular Ca2+ concentration during contraction and relaxation cycles. S(-)bupivacaine (10 µM) significantly increased peak amplitude and the rate of increase of Ca2+ transients in 155% ± 54% (P < 0.05) and 194% ± 94% (P < 0.01) of control. However, exposure to R(+)bupivacaine had no effect on either peak amplitude or rate of increase at any concentration tested. Saponin-skinned ventricular fibers were used to investigate the effect of bupivacaine on the intracellular Ca2+ regulation by sarcoplasmic reticulum (SR) and on the Ca2+ sensitivity of contractile system. S(-), R(+), and RS(±)bupivacaine induced Ca2+ release from SR (P < 0.01). In SR-disrupted skinned ventricular cells, bupivacaine and its isomers (5 mM) increased the sensitivity of contractile system to Ca2+. S(-), RS(±), and R(+)bupivacaine significantly increased pCa50 from 5.8 ± 0.1, 5.8 ± 0.1, and 5.8 ± 0.1, to 6.1 ± 0.1 (P < 0.05), 6.0 ± 0.1 (P < 0.05), and 6.1 ± 0.1 (P < 0.05). Ca2+ release from SR through RyR2 activation could explain the increase of Ca2+ transients in cardiac cells. Increased intracellular Ca2+ in cardiac myocytes display a stereoselectivity to S(-)bupivacaine.

 

 

染色体置换依赖性的戊巴比妥钠心血管反应的差异

Chromosomal Substitution-Dependent Differences in Cardiovascular Responses to Sodium Pentobarbital

Thomas A. Stekiel, MD, Stephen J. Contney, MS, Zeljko J. Bosnjak, PhD, John P. Kampine, MD, PhD, Richard J. Roman, PhD, and William J. Stekiel, PhD

Departments of Anesthesiology and Physiology, Medical College of Wisconsin, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin

Anesth Analg 2006;102:799-805

 

在本研究中,我们提出了关于正常血压的Dahl盐敏感性大鼠(SS)较Brown NorwayBN)大鼠对戊巴比妥钠(PTB)心血管敏感性增强的原创性实验室观察。我们还使用了独特的染色体取代株动物来确认我们的初步观察结果,即这种差异与第13染色体有关。对SSBN和具有BN染色体取代物的SS动物连续给予浓度逐渐增高的PTB,直至产生心血管虚脱。对自主呼吸和控制通气的情况均作了研究。也测定了局部交感神经支配完整或者被消除的这些动物中大浓度(450µg/mL)和小浓度(35µg/mLPTB对肠系膜上动脉血管平滑肌(VSM)细胞原位跨膜电位的影响。用变量分析以鉴别组间的显著性差异。尽管PTB的血浆清除率事实上相同,在自主呼吸和控制通气的情况下,SS和其他株动物达到循环虚脱时给予的PTB累积剂量均比BNSS.13BNBN动物第13染色体渗入到SS)约少35%–45%。在神经系统完整的制备中,大剂量PTB引起的VSM超极化比SSSS.16BN而非BNSS.13BN株中的小剂量大4-5倍。去神经支配可以消除这种株间差异。这些结果表明,SS大鼠对PTB的心血管敏感性增高与阻力血管VSM跨膜电位超极化增加有关,这个作用与第13染色体有关。

(颜涛 马皓琳 李士通 校)

In this study we addressed initial laboratory observations of enhanced cardiovascular sensitivity to sodium pentobarbital (PTB) in normotensive Dahl Salt Sensitive rats (SS) compared to Brown Norway (BN) rats. We also used unique consomic (chromosomal substitution) strains to confirm preliminary observations that such differences were related to chromosome 13. Increasing concentrations of PTB were administered sequentially to SS, BN, and SS strains with BN chromosomal substitutions until the point of cardiovascular collapse. Both spontaneous and controlled ventilation were studied. The effect of large (450 µg/mL) and small (35 µg/mL) concentrations of PTB on in situ transmembrane potential of mesenteric arterial vascular smooth muscle (VSM) cells was also measured in these animals with local sympathetic innervation both intact and eliminated. An analysis of variance was used to identify significant differences among groups. Despite virtually identical plasma clearance of PTB, cardiovascular collapse occurred at approximately 35%–45% smaller cumulative doses of administered PTB in SS and other strains compared with BN and SS.13BN (introgression of BN chromosome 13 into an SS) in both spontaneous and controlled ventilation. In neurally intact preparations, large dose PTB-induced VSM hyperpolarization was 4–5 times greater than the small dose in SS and SS.16BN but not in BN and SS.13BN strains. Denervation eliminated this strain difference. These results suggest that enhanced cardiovascular sensitivity to PTB in SS rats is related to greater hyperpolarization of VSM transmembrane potential in resistance vessels and this effect is associated with chromosome 13.

 

 

脑电描计法定位在常规临床实践中的应用:气管插管时皮层觉醒?

Electroencephalographic Mapping During Routine Clinical Practice: Cortical Arousal During Tracheal Intubation?

Wolfgang J. Kox, MD*, Christian von Heymann, MD{dagger}, Judith Heinze{dagger}, Leslie S. Prichep, PhD{ddagger}§, E. Roy John, PhD{ddagger}§, and Ingrid Rundshagen, MD{dagger}

*University Hospital of Muenster, Muenster, Germany; {dagger}Department of Anesthesiology, University Hospital Charité, Humboldt University of Berlin, Campus Charité Mitte, Berlin, Germany; {ddagger}Brain Research Laboratories, NYU School of Medicine, New York, NY; §Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY

Anesth Analg 2006;102:825-831

 

我们对42例病人的脑电图(EEG)采用定量分析来评估标准临床实践中用依托咪酯和舒芬太尼诱导后气管插管的影响。EEG记录来源于八个双极电极,并根据年龄预计的δ,θ,α和β频段相对功率的标准化数据行Z转换。气管插管会导致典型的皮层觉醒,这一点从EEG频率加速可以看出。各频率段均见显著影响,以α频段最为显著,额颞区双侧均增加最多。(F值:δ-9.592P<0.001; θ-1.691, P<0.001; α-18.439, P<0.001; β-4.504, P<0.001)。麻醉诱导时α和δ功率的改变与依托咪酯的剂量相关(P<0.05)。气管插管后脑部顶枕区α功率的改变与舒芬太尼的剂量相关(P<0.05)。在常规临床实践中,舒芬太尼和依托咪酯的剂量个体化滴定并不足以阻断气管插管的强伤害性刺激,从而导致皮层觉醒。这种皮层觉醒现象的临床影响尚未确定。

(邱郁薇 马皓琳 李士通 校)

We used quantitative analysis of the electroencephalogram (EEG) in 42 patients to assess the effect of tracheal intubation after induction of anesthesia with etomidate and sufentanil using standard clinical practice. The EEG was recorded from eight bipolar electrode derivations and Z-transformed relative to age expected normative data for relative power in the delta, theta, alpha, and beta frequency bands. Tracheal intubation resulted in classical cortical arousal, as indicated by acceleration of the EEG frequencies. Significant effects were seen in all frequency bands, most pronounced in the alpha frequency band, with the largest increase bilaterally in the fronto-temporal regions (F-values: Delta – 9.592, P < 0.001; theta – 1.691, P < 0.001; alpha – 18.439, P < 0.001; beta – 4.504, P < 0.001). Changes in alpha and delta power during induction of anesthesia were correlated with the dose of etomidate (P < 0.05). Changes in alpha after tracheal intubation were correlated at the parietooccipital brain regions to the dose of sufentanil (P < 0.05). Individual titration of the dose of etomidate and sufentanil, as during routine clinical practice, is not sufficient to block the strong noxious stimulation of tracheal intubation and results in cortical arousal. The clinical impact of this cortical wake-up phenomenon is undetermined.


曲马多和芬太尼对脓毒症大鼠胃肠蠕动的影响

The Effects of Tramadol and Fentanyl on Gastrointestinal Motility in Septic Rats

Ismet Topcu, N. Zeynep Ekici, Rusen Isik, and Melek Sakarya

Department of Anesthesiology and Intensive Care, Celal Bayar University, Manisa, Turkey

Anesth Analg 2006;102:876-881

 

在此研究中,我们研究了曲马多和芬太尼对盲肠结扎和穿孔(GLP)这一实验模型中急性全身性炎症期胃肠道运输(GIT)的影响。120只瑞士-白化体雄性大鼠随机分为6组:第一组为假手术加盐水,第二组为假手术加芬太尼,第三组为假手术加曲马多,第四组为GLP组加盐水,第五组为GLP组加芬太尼,第六组为GLP组加曲马多。给予木炭混悬液作为胃内进食以衡量GIT水平。第一到六组的GIT%(均数±标准差)分别为46.1% ± 9.8%43.2% ± 9.8%45.9% ± 10.2%33.2% ± 9.2%24.9% ± 4.1%31.8% ± 8.4%。第五组的GIT%明显低于第一、二、三及四组(P < 0.05)。第六组的平均数明显低于第一、二及三组(P < 0.05),但与第四和五组没有差异(P > 0.05)。芬太尼的抗通过作用在脓毒症的实验模型中显示增强,但是曲马多的GIT并没有降低。这被认为是脓毒症中伴随的内源性阿片系统激活以及受体增量调节的结果。

(黄丽娜   马皓琳 李士通  校)

In this study, we investigated the effects of tramadol and fentanyl on gastrointestinal transit (GIT) during acute systemic inflammation in an experimental model of cecal ligation and perforation (CLP). One-hundred-twenty male Swiss-Albino rats were divided randomly into 6 groups: Group I = sham-operated + saline; Group II = sham-operated + fentanyl; Group III = sham-operated + tramadol; Group IV = CLP + saline; Group V = CLP + fentanyl; Group VI = CLP + tramadol. Suspension of charcoal was administered as an intragastric meal to measure the GIT. GIT% (mean ± sd) were 46.1% ± 9.8%, 43.2% ± 9.8%, 45.9% ± 10.2%, 33.2% ± 9.2%, 24.9% ± 4.1%, and 31.8% ± 8.4% in Groups I, II, III, IV, V, and VI, respectively. GIT% was significantly less in Group V than in Groups I, II, III, and IV (P < 0.05). The Group VI mean value was significantly lower than those of Groups I, II, and III (P < 0.05) but not different from those of Groups IV and V (P > 0.05). The antitransit effect of fentanyl was shown to have increased in the experimental sepsis model, but no decrease in GIT was obtained with tramadol. This was thought to be the result of an associated endogenic opioid system activation and receptor upregulation in sepsis.

 

 

内关穴针压法不能预防剖宫产脊麻中的呕吐

P6 Acupressure Does Not Prevent Emesis During Spinal Anesthesia for Cesarean Delivery

Chiu-Ming Ho, MD, PhD*, Hsin-Jung Tsai, MD{dagger}, Kwok-Hon Chan, MD*, and Shen-Kou Tsai, MD, PhD*

*Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University; {dagger}Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan

Anesth Analg 2006;102:900-903

 

恶心呕吐是剖宫产脊麻中的主要不良作用。刺激内关穴是一种用于有效抗呕吐的中国传统针灸技术。在这项研究中,我们评估了内关穴针压在剖宫产脊麻产妇中的抗呕吐作用。110名预定择期剖宫产的孕妇参与了此项随机双盲对照研究。在脊麻开始前半小时,产妇随机分至在双侧内关穴的针压组和安慰剂组,并观察研究期中其恶心呕吐的发生情况。母体特征两组间没有显著的统计学差异。术中恶心的发生率为64% (针压组) 71% (对照组) (P = 0.416),术中呕吐的发生率为22% (针压组) 27% (对照组) (P = 0.506)。这一结果显示,预防性应用双侧内关穴针压不能防止剖宫产脊麻中恶心呕吐的发生。

(黄佳佳 马皓琳 李士通 校)

Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery. Stimulation of the P6 (Neiguan) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purposes. In this study, we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery. In a randomized, double-blind, controlled trial, 110 parturients scheduled for elective cesarean delivery were enrolled in the study. Thirty minutes before initiation of spinal anesthesia, parturients were randomized to acupressure bands or placebo bands bilaterally on the P6 acupoint and nausea and vomiting were observed over the study period. There were no statistically significant differences in maternal characteristics. Incidence rates for intraoperative nausea were 64% (acupressure group) and 71% (control group) (P = 0.416), with an incidence of intraoperative vomiting of 22% (acupressure group) and 27% (control group) (P = 0.506). The results suggest that prophylactic use of acupressure bands bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery.


利多卡因中加硝酸甘油对局部静脉麻醉的镇痛作用

The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia

Selda Sen, MD, Bakiye Ugur, MD, Osman N. Aydin, MD, Mustafa Ogurlu, MD, Feray Gursoy, MD, and Oner Savk, MD

Department of Anesthesiology and Reanimation, Department of Orthopedics, and Traumatology Adnan Menderes University, Medical Faculty, Aydin, Turkey

Anesth Analg 2006;102:916-920

 

我们评价了在局部静脉麻醉中当硝酸甘油加入利多卡因时的镇痛作用。行手部手术的30例病人随机分为2组。对照组(C组,n15)应用 3 mg/kg利多卡因并用生理盐水稀释总容量为40ml;硝酸甘油组(NTG组,n=15)在同上溶液中加入200µg NTG。在术中记录血流动力学参数、止血带充气前及充气后15102030 min时测得的止血带疼痛值和镇痛药需要量。记录止血带放气后130min24 h时的视觉模拟评分(VAS)分值、第一次需要镇痛药的时间、术后第一个24小时内总的镇痛药消耗量及不良反应。发现NTG组的感觉和运动阻滞起效时间较短(NTG组和C组分别为3.2 ± 1.14.5 ± 1.2 min; P = 0.01 3.3 ± 1.65.2 ± 1.8; P = 0.009),感觉和运动阻滞的恢复时间较长(NTG组和C组分别为6.8 ± 1.63.1 ± 1.2 minP < 0.0001 7.3 ± 1.33.6 ± 0.8P < 0.0001),止血带疼痛的VAS评分较低(P = 0.023)以及麻醉质量得以改善(P < 0.05)。止血带放松后和术后阶段中NTG组的VAS评分也较低(P = 0.001)NTG组对第一次需要镇痛药的时间较C组更晚一些(225 ± 74 min39 ± 33 min P < 0.0001)NTG组对术后镇痛的要求明显较少(P < 0.0001),但是两组的不良反应发生没有差别。我们得出结论在利多卡因中加入硝酸甘油用于局部静脉麻醉可以改善感觉和运动的阻滞、止血带疼痛和术后镇痛而没有不良反应。

(赵雪莲 马皓琳 李士通 校)

We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 µg NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 ± 1.1 versus 4.5 ± 1.2 min; P = 0.01 and 3.3 ± 1.6 versus 5.2 ± 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 ± 1.6 versus 3.1 ± 1.2 min P < 0.0001 and 7.3 ± 1.3 versus 3.6 ± 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 ± 74 min versus 39 ± 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.


用拇内收肌TOF 比判断肌松恢复后的术后上呼吸道阻塞

Postoperative Upper Airway Obstruction After Recovery of the Train of Four Ratio of the Adductor Pollicis Muscle from Neuromuscular Blockade

Matthias Eikermann, MD*, Manfred Blobner, MD{dagger}, Harald Groeben, MD*, Christopher Rex, MD{ddagger}, Thomas Grote*, Markus Neuhäuser, PhD§, Martin Beiderlinden, MD*, and Jürgen Peters, MD*

*Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen; {dagger}Klinik für Anästhesiologie, Technische Universität München; {ddagger}Klinik für Anästhesiologie und Operative Intensivmedizin, Kreiskliniken Reutlingen; and §Institut für Medizinische Informatik, Biometrie und Epidemiologie, Germany

Anesth Analg 2006;102:937-942

 

麻醉药以及即使最小量的神经肌肉阻滞可导致上呼吸道阻塞(UAO)。在本研究中我们用肺活量测定法对四个成串刺激比率>0.9的患者评估UAO的发生率(即50%肺活量时最大呼气流速与最大吸气流速的比〔MEF50/MIF50>1)并确定UAO是否由神经肌肉阻滞引起(定义为用力肺活量〔FVC〕衰减,即在连续肺活量测定操作时从第一个FVC值到第二个值降低≥10%)。患者接受丙泊酚和阿片类作为麻醉。用一系列的3次重复肺活量测定操作进行肺活量测定:第一次诱导前(术前用药咪唑安定),第二次气管导管拔除后(TOF比:0.9或更大)及第三次30 min后。气管导管拔除后即刻和30 min后,130例患者中分别有48例和6例由于镇静不能进行适当的肺活量测定。UAO的发生率从诱导前基线的82/13063%)显著增高到拔管后的70/8283%)(P < 0.01),随后在30 min内降低到在基线观察到的值(80/12465%)。气管导管拔除后50%肺活量时的平均最大呼气流速与最大吸气流速比比基线显著增大(增加20%1.39 ± 1.011.73 ± 1.02P < 0.01),随后显著减小到在基线值(1.49 ± 0.93)。拔管后没有统计学上有意义的FVC衰减,且只在2例患者中观察到≥10%FVC衰减。因此,TOF比率恢复到0.9预计了无神经肌肉阻滞剂引起UAO的高度可能性,但仍有极端的情况发生,即TOF比尽管已恢复,神经肌肉阻滞作用对上呼吸道通畅性仍可能持续影响。

(马皓琳 李士通 校)

Anesthetics, and even minimal residual neuromuscular blockade, may lead to upper airway obstruction (UAO). In this study we assessed by spirometry in patients with a train-of-four (TOF) ratio >0.9 the incidence of UAO (i.e., the ratio of maximal expiratory flow and maximal inspiratory flow at 50% of vital capacity [MEF50/MIF50] >1) and determined if UAO is induced by neuromuscular blockade (defined by a forced vital capacity [FVC] fade, i.e., a decrease in values of FVC from the first to the second consecutive spirometric maneuver of ≥10%). Patients received propofol and opioids for anesthesia. Spirometry was performed by a series of 3 repetitive spirometric maneuvers: the first before induction (under midazolam premedication), the second after tracheal extubation (TOF ratio: 0.9 or more), and the third 30 min later. Immediately after tracheal extubation and 30 min later, 48 and 6 of 130 patients, respectively, were not able to perform spirometry appropriately because of sedation. The incidence of UAO increased significantly (P < 0.01) from 82 of 130 patients (63%) at preinduction baseline to 70 of 82 patients (85%) after extubation, and subsequently decreased within 30 min to values observed at baseline (80 of 124 patients, 65%). The mean maximal expiratory flow and maximal inspiratory flow at 50% of vital capacity ratio after tracheal extubation was significantly increased from baseline (by 20%; 1.39 ± 1.01 versus 1.73 ± 1.02; P < 0.01), and subsequently decreased significantly to values observed at baseline (1.49 ± 0.93). A statistically significant FVC fade was not present, and a FVC fade of ≥10% was observed in only 2 patients after extubation. Thus, recovery of the TOF ratio to 0.9 predicts with high probability an absence of neuromuscular blocking drug-induced UAO, but outliers, i.e., persistent effects of neuromuscular blockade on upper airway integrity despite recovery of the TOF ratio, may still occur.

 

全身麻醉不缩短老年大鼠的平均寿命

General Anesthesia Does Not Reduce Life Expectancy in Aged Rats

Deborah J. Culley, MD, Alexander Loguinov, PhD, Rustam Yukhananov, MD, PhD, and Gregory Crosby, MD

Department of Anesthesia, Division on Aging, Harvard Medical School, Brigham & Women’s Hospital, Boston, Massachusetts; Logstat, Pasadena, California

Anesth Analg 2006;102:956-959

 

一项新近的临床研究证明在用双谱指数监测测得的深麻醉使中年和老年手术患者的一年死亡率增加。我们在之前已经证明老年大鼠在应用1.2%异氟醚-70%笑气-30%氧气的全身麻醉后会产生几个星期的认知功能损害。然而,2小时1.2%异氟醚-70%笑气-30%氧气的全身麻醉对啮齿类动物的平均寿命的作用仍是未知的,而且可能已混淆我们的结果。因此,我们设计了本研究来确定全身麻醉是否会改变老年大鼠的平均寿命。1622个月大的Fischer 344大鼠随机分为两组,麻醉组接受2小时1.2%异氟醚-70%笑气-30%氧气的全身麻醉,对照组接受30%氧气(每组各8只)。大鼠在富氧的环境中恢复,然后把它们放在它们原来的常规条件下的笼子里。记录给予麻醉至死亡的天数,产生Kaplan-Meier生存曲线,应用对数等级检验和引导方法进行统计学上的比较。长期生存在对照组和麻醉组之间没有差别。因此,1.2%异氟醚-70%笑气-30%氧气的全身麻醉不缩短老年Fischer 344大鼠的平均寿命。

(陈玮 马皓琳 李士通 校)

A recent clinical study demonstrated that deep anesthesia, as measured by Bispectral index monitoring, was associated with increased 1-yr mortality among middle-aged and elderly surgical patients. We have previously demonstrated impaired cognitive performance in aged rats for weeks after general anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen. However, the effects of 2 h of anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen on rodent life expectancy are unknown and may have confounded our results. Accordingly, we designed this study to determine if general anesthesia alters life expectancy in aged rats. Sixteen 22-mo-old Fischer 344 rats were randomized to anesthesia for 2 h with 1.2% isoflurane-70% nitrous oxide-30% oxygen or a control group that received 30% oxygen (n = 8 per group). Rats recovered in an enriched oxygen environment and then were placed in their home cage under routine conditions. The number of days between anesthesia administration and death were recorded and Kaplan-Meier survival curves generated and compared statistically using the log-rank test and bootstrap method. There was no difference in long-term survival between the control and anesthesia groups. Hence, general anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen does not reduce life expectancy in aged Fischer 344 rats.