Anesthesia & Analgesia

 

June 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

心脏外科手术前妇女的预成认知损害以及它与C-反应蛋白浓度之间的关系

(孙敏莉译 薛张纲校)

Preexisting Cognitive Impairment in Women Before Cardiac Surgery and Its Relationship with C-Reactive Protein Concentrations

Charles W. Hogue, Jr, Tamara Hershey, David Dixon, Robert Fucetola, Abdullah Nassief, Kenneth E. Freedland, Betsy Thomas, and Kenneth Schechtman

Anesth Analg 2006 102: 1602-1608.

心脏手术后早期活动时混合静脉血氧饱和度显著下降:体位或锻炼的影响?

(赵延华 译 陈杰 校)

The Marked Reduction in Mixed Venous Oxygen Saturation During Early Mobilization After Cardiac Surgery: The Effect of Posture or Exercise?

Idar Kirkeby-Garstad, Ulrik Wisløff, Eirik Skogvoll, Tomas Stølen, Arnt-Erik Tjønna, Roar Stenseth, and Olav FM Sellevold

Anesth Analg 2006 102: 1609-1616.

体外循环期间人体空肠粘膜灌注的自身调节

(彭中美 译 马皓琳 李士通 校)

Autoregulation of Human Jejunal Mucosal Perfusion During Cardiopulmonary Bypass

Andreas Nygren, Anders Thorén, Erik Houltz, and Sven-Erik Ricksten

Anesth Analg 2006 102: 1617-1622.

心脏手术后白介素-6升高预示感染的发生

(金琳 译 薛张纲 审校)

Increased Interleukin-6 After Cardiac Surgery Predicts Infection

Michael Sander, Christian von Heymann, Vera von Dossow, Corinna Spaethe, Wolfgang F. Konertz, Uday Jain, and Claudia D. Spies

Anesth Analg 2006 102: 1623-1629.

体外循环冠状动脉手术病人术后血清改变内皮Ca2+的信号转导

(殷文渊 译 陈杰 校)

Endothelial Ca2+ Signal Transduction Is Altered by Postoperative Serum from Patients Undergoing Coronary Surgery with Cardiopulmonary Bypass

Crispin Schneider and Thomas Volk

Anesth Analg 2006 102: 1630-1637.

N-乙酰半胱氨酸对腹主动脉手术中肾功能受损的预防作用:一个随机、双盲、安慰剂对照试验

(裘毅敏 马皓琳 李士通 校)

N-Acetylcysteine for the Prevention of Kidney Injury in Abdominal Aortic Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Marja S. Hynninen, Tomi T. Niemi, Reino Pöyhiä, Elina I. Raininko, Markku T. Salmenperä, Mauri J. Lepäntalo, Mikael J. Railo, and Minna K. Tallgren

Anesth Analg 2006 102: 1638-1645.

比较三种磷酸二酯酶III抑制剂对豚鼠离体心脏机械和代谢功能的影响

(吴德华译 薛张纲校)

A Comparison of Three Phosphodiesterase Type III Inhibitors on Mechanical and Metabolic Function in Guinea Pig Isolated Hearts

York A. Zausig, David F. Stowe, Wolfgang Zink, Christoph Grube, Eike Martin, and Bernhard M. Graf

Anesth Analg 2006 102: 1646-1652.

经食管超声心动图在非心脏手术心脏停搏并入中的应用

(刘哲 译 陈杰 校 )

The Usefulness of Transesophageal Echocardiography During Intraoperative Cardiac Arrest in Noncardiac Surgery

Stavros G. Memtsoudis, Peter Rosenberger, Michaela Loffler, Holger K. Eltzschig, Annette Mizuguchi, Stanton K. Shernan, and John A. Fox

Anesth Analg 2006 102: 1653-1657.

PEDIATRIC ANESTHESIA:

儿科脊柱侧突手术中瑞芬太尼输注过程中急性阿片类药物耐受的发生

(姜旭晖 马皓琳 李士通 校)

Development of Acute Opioid Tolerance During Infusion of Remifentanil for Pediatric Scoliosis Surgery

Mark W. Crawford, Chantal Hickey, Christian Zaarour, Andrew Howard, and Basem Naser

Anesth Analg 2006 102: 1662-1667.

与吗啡相比术中使用曲马多对儿童心脏手术后采用护士控制镇痛可以较早苏醒和较少使用镇静剂

(金 路译 薛张纲校)

Intraoperative Administration of Tramadol for Postoperative Nurse-Controlled Analgesia Resulted in Earlier Awakening and Less Sedation than Morphine in Children After Cardiac Surgery

Ya-Chun Chu, Su-Man Lin, Ying-Chou Hsieh, Kwok-Hon Chan, and Mei-Yung Tsou

Anesth Analg 2006 102: 1668-1673.

脑部MRI扫描能升高镇静小儿的中心体温

(苏殿三 译 陈杰 校)

Brain Magnetic Resonance Imaging Increases Core Body Temperature in Sedated Children

Yvon F. Bryan, Thomas W. Templeton, Todd G. Nick, Martin Szafran, and Avery Tung

Anesth Analg 2006 102: 1674-1679.

在儿科麻醉中超声波引导下的髂腹股沟/髂腹下神经阻滞:最佳容量是多少?

(姜旭晖译,马皓琳 李士通校)

Ultrasonographic-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Anesthesia: What is the Optimal Volume?

H. Willschke, A. Bösenberg, P. Marhofer, S. Johnston, S. Kettner, U. Eichenberger, O. Wanzel, and S. Kapral

Anesth Analg 2006 102: 1680-1684

儿科病人通过喉周导气管对声门上气道的可视定位

(王丽珺译 薛张纲校)

Video Assessment of Supraglottic Airway Orientation Through the Perilaryngeal Airway in Pediatric Patients

David M. Polaner, Dheeraj Ahuja, Jeannie Zuk, and Zhaoxing Pan

Anesth Analg 2006 102: 1685-1688

ANESTHETIC PHARMACOLOGY:

全麻药抑制培养的海马切片的缝隙连接间的信息传递

(李启芳 译 陈杰 校)

General Anesthetics Inhibit Gap Junction Communication in Cultured Organotypic Hippocampal Slices

Kirsten Wentlandt, Marina Samoilova, Peter L. Carlen, and Hossam El Beheiry

Anesth Analg 2006 102: 1692-1698

年龄增长延长成年人七氟醚/笑气诱导的起效时间

(张 曦 译,马皓琳 李士通 校)

Onset Time for Sevoflurane/Nitrous Oxide Induction in Adults Is Prolonged with Increasing Age

Michael C. Lewis, Ricardo I. Gerenstein, and Gilbert Chidiac

Anesth Analg 2006 102: 1699-1702.

七氟烷对大鼠气管上皮细胞纤毛活动的作用:与异氟烷和氟烷比较

(周荻 译 薛张纲 校)

The Effect of Sevoflurane on Ciliary Motility in Rat Cultured Tracheal Epithelial Cells: A Comparison with Isoflurane and Halothane

Shogo Matsuura, Gotaro Shirakami, Hiroko Iida, Keiji Tanimoto, and Kazuhiko Fukuda

Anesth Analg 2006 102: 1703-1708.

氟烷、异氟烷对微电流刺激网状细胞时引起脑电反应的效应差异

(顾新宇 译 陈杰 校)

The Differential Effects of Halothane and Isoflurane on Electroencephalographic Responses to Electrical Microstimulation of the Reticular Formation

Mashawn Orth, Emigdio Bravo, Linda Barter, Earl Carstens, and Joseph F. Antognini

Anesth Analg 2006 102: 1709-1714.

氙气对兔肌原性动作诱发电位的作用:与丙泊酚和异氟醚的比较

(周雅春 译 马皓琳 李士通 校)

The Effects of Xenon on Myogenic Motor Evoked Potentials in Rabbits: A Comparison with Propofol and Isoflurane

Yuri Yamamoto, Masahiko Kawaguchi, Meiko Kakimoto, Masahiro Takahashi, Satoki Inoue, Takahisa Goto, and Hitoshi Furuya

Anesth Analg 2006 102: 1715-1721.

环孢霉素和胰岛素对大鼠缺血性脊髓损伤的的作用

(陆文清译 薛张纲校)

The Effects of Cyclosporin A and Insulin on Ischemic Spinal Cord Injury in Rabbits

Shunsuke Tsuruta, Mishiya Matsumoto, Shiro Fukuda, Atsuo Yamashita, Ying Jun Cui, Hiroya Wakamatsu, and Takefumi Sakabe

Anesth Analg 2006 102: 1722-1727.

阿米替林的神经毒性由细胞凋亡介导并被Caspase抑制剂阻断

(王震虹 译 陈杰 校)

The Neurotoxic Effects of Amitriptyline Are Mediated by Apoptosis and are Effectively Blocked by Inhibition of Caspase Activity

Philipp Lirk, Ingrid Haller, Barbara Hausott, Shota Ingorokva, Martina Deibl, Peter Gerner, and Lars Klimaschewski

Anesth Analg 2006 102: 1728-1733.

使离体鳌虾巨轴突传导阻滞的利多卡因和布比卡因的细胞内浓度的比较

(颜涛 译, 马皓琳 李士通校)

A Comparison of Intracellular Lidocaine and Bupivacaine Concentrations Producing Nerve Conduction Block in the Giant Axon of Crayfish In Vitro

Takeshi Yano, Shoichiro Ibusuki, and Mayumi Takasaki

Anesth Analg 2006 102: 1734-1738.

利多卡因抑制诱生型一氧化氮合酶和阳离子氨基酸转运蛋白2在有活性的鼠类巨噬细胞中的转录可能与电压敏感性钠通道有关

(韩晓丹译 薛张纲校)

Lidocaine Inhibition of Inducible Nitric Oxide Synthase and Cationic Amino Acid Transporter-2 Transcription in Activated Murine Macrophages May Involve Voltage-Sensitive Na+ Channel

Yun-Fang Kai, Chen-Hsien Yang, and Chun-Jen Huang

Anesth Analg 2006 102: 1739-1744.

TECHNOLOGY, COMPUTING, AND SIMULATION:

脑电图衰退和针灸

(钟静译 薛张纲校)

Electroencephalogram-Entropy and Acupuncture

Gerhard Litscher

Anesth Analg 2006 102: 1745-1751.

一种优化充气止血带压力测量动脉阻断压的新方法

(宋金超 译 陈杰 校)

New Method for Estimating Arterial Occlusion Pressure in Optimizing Pneumatic Tourniquet Inflation Pressure

Bahattin Tuncali, Ayse Karci, Binnur Erdalkiran Tuncali, Omur Mavioglu, Mustafa Ozkan, Abdul Kadir Bacakoglu, Hakan Baydur, Ahmet Ekin, and Zahide Elar

A Anesth Analg 2006 102: 1752-1757.

传统动脉血气分析研究动脉氧分压波动的含义

(张莹 译 马皓琳 李士通 校)

The Implications of Arterial Po2 Oscillations for Conventional Arterial Blood Gas Analysis

Birgit Pfeiffer, Rebecca S. Syring, Klaus Markstaller, Cynthia M. Otto, and James E. Baumgardner

Anesth Analg 2006 102: 1758-1764.

PAIN MEDICINE:

吗啡、可待因和美沙酮及其对映体在不同的大鼠疼痛模型的作用

(王慧琳译 薛张纲校)

Morphine, Oxycodone, Methadone and Its Enantiomers in Different Models of Nociception in the Rat

Kim Lemberg, Vesa K. Kontinen, Kaarin Viljakka, Irene Kylänlahti, Jari Yli-Kauhaluoma, and Eija Kalso

Anesth Analg 2006 102: 1768-1774.

颅脊神经媒介大鼠经颅电刺激法中的抗伤害作用

(张美荣 译 陈杰 校)

The Role of the Craniospinal Nerves in Mediating the Antinociceptive Effect of Transcranial Electrostimulation in the Rat

Vladimir Nekhendzy, M. Frances Davies, Hendrikus J. M. Lemmens, and Mervyn Maze

Anesth Analg 2006 102: 1775-1780.

吗啡-6-葡萄糖醛酸:用于术后镇痛的吗啡代替品

(黄佳佳译 马皓琳 李士通校)

Morphine-6-Glucuronide: Morphine's Successor for Postoperative Pain Relief? (Review Article)

Eveline L. A. van Dorp, Raymonda Romberg, Elise Sarton, James G. Bovill, and Albert Dahan

Anesth Analg 2006 102: 1789-1797.

CRITICAL CARE AND TRAUMA:

志愿受试者急性疼痛期间乙琥红霉素促进胃排空

(潘志英 译 陈杰 校)

Erythromycin Promotes Gastric Emptying During Acute Pain in Volunteers

Lionel Bouvet, Frédéric Duflo, Nathalie Bleyzac, François Mion, Emmanuel Boselli, Bernard Allaouchiche, and Dominique Chassard

Anesth Analg 2006 102: 1803-1808.

血浆N端-脑型利钠肽原水平作为危重病人预后的一个标记

(黄施伟 译,马皓琳 李士通 校)

Plasma Level of N Terminal Pro-Brain Natriuretic Peptide as a Prognostic Marker in Critically Ill Patients

Yaniv Almog, Victor Novack, Rinat Megralishvili, Sergio Kobal, Leonid Barski, Daniel King, and Doron Zahger

Anesth Analg 2006 102: 1809-1815.

NEUROSURGICAL ANESTHESIA:

用脑电图监测麻醉深度的实验中证实:通过颈内静脉单剂量多次注射法会影响维持麻醉深度的异丙酚的用量

(孙卓真译 薛张纲校)

Bolus Configuration Affects Dose Requirements of Intracarotid Propofol for Electroencephalographic Silence

Shailendra Joshi, Mei Wang, Joshua J. Etu, and John Pile-Spellman

Anesth Analg 2006 102: 1816-1822.

吲哚美辛对有颅内高压的绵羊接受异丙酚或异氟醚麻醉中对颅内压和脑血流动力学的影响

(郑丽 译 陈杰 校)

The Effects of Indomethacin on Intracranial Pressure and Cerebral Hemodynamics During Isoflurane or Propofol Anesthesia in Sheep with Intracranial Hypertension

Mads Rasmussen, Richard N. Upton, Cliff Grant, Allison M. Martinez, Georg E. Cold, and Guy Ludbrook

Anesth Analg 2006 102: 1823-1829.

地氟醚和七氟醚在稳态条件下对脑氧测定的影响

(邱郁薇 译 马皓琳 李士通 校)

The Effect of Desflurane and Sevoflurane on Cerebral Oximetry Under Steady-State Conditions

Argyro Fassoulaki, Helen Kaliontzi, George Petropoulos, and Athanassia Tsaroucha

Anesth Analg 2006 102: 1830-1835.

高渗盐水在治疗由外伤性脑损伤引起的颅内高压中的作用

(孙卓真译 薛张纲校)

The Use of Hypertonic Saline for Treating Intracranial Hypertension After Traumatic Brain Injury (Review Article)

Hayden White, David Cook, and Bala Venkatesh

Anesth Analg 2006 102: 1836-1846.

REGIONAL ANESTHESIA:

年龄对罗哌卡因硬膜外麻醉后运动阻滞中位有效浓度的影响

(曹瑜 译 陈杰 校)

The Effects of Age on the Median Effective Concentration of Ropivacaine for Motor Blockade After Epidural Anesthesia with Ropivacaine

Yuhong Li, Shengmei Zhu, Fangping Bao, Jianhong Xu, Xiang Yan, and Xudong Jin

Anesth Analg 2006 102: 1847-1850.

对比1%纯利多卡因和由等量生理盐水稀释2%利多卡因后的1%利多卡因所产生的硬膜外阻滞

(赵雪莲 马皓琳 李士通 校)

A Comparison of Epidural Blockade Produced by Plain 1% Lidocaine and 1% Lidocaine Prepared by Dilution of 2% Lidocaine with the Same Volume of Saline

Akifumi Kanai and Sumio Hoka

Anesth Analg 2006 102: 1851-1855.

GENERAL ARTICLES:

Mallampati试验预测困难气道准确性的系统回顾 (meta分析)

(徐丽颖译 薛张纲校)

A Systematic Review (Meta-Analysis) of the Accuracy of the Mallampati Tests to Predict the Difficult Airway

Anna Lee, Lawrence T. Y. Fan, Tony Gin, Manoj K. Karmakar, and Warwick D. Ngan Kee

Anesth Analg 2006 102: 1867-1878.

体位影响手灵巧度

肖洁 译 陈杰 校)

Body Position Affects Manual Dexterity

Charles W. Buffington, Stanley D. MacMurdo, and Christopher M. Ryan

Anesth Analg 2006 102: 1879-1883.

术后恶心呕吐的危险因子

(黄丽娜     马皓琳 李士通  )

Risk Factors for Postoperative Nausea and Vomiting (Review Article)

Tong J. Gan

Anesth Analg 2006 102: 1884-1898.

 

 

心脏外科手术前妇女的预成认知损害以及它与C-反应蛋白浓度之间的关系

Preexisting cognitive impairment in women before cardiac surgery and its relationship with C-reactive protein concentrations.
Hogue CW Jr, Hershey T, Dixon D, Fucetola R, Nassief A, Freedland KE, Thomas B, Schechtman K.
Department of Anesthesiology and Critical Care Med Johns Hopkins Hospital, 600 N. Wolfe St, Tower 711 Baltimore, MD 21287-8711, USA.

Anesth Analg 2006 102: 1602-1608.

当调查心脏外科手术对认知的影响时,发现术前认知状态很少被重视。 在这项研究中,我们寻求明确择期行心脏外科手术妇女认知损害的患病率,以非住院的志愿者作为参照组,同时检测C-反应蛋白水平与认知损害之间的关系。108名择期行心脏外科手术绝经后的妇女和58名非住院作为对照的妇女进行了心理测试。在外科手术患者中,检测到高灵敏度C-反应蛋白含量。与对照组相比,术前认知损害被定义为>2sd较低分值≥2个测试。108名患者中49位表现认知损害(45%)。与没有出现认知损害的患者相比,认知损害患者的C-反应蛋白水平较高(中位数,8.1 mg/L 4.7 mg/L; P = 0.04)。基于多变量逻辑回归分析,患者年龄、较低教育水平、2型糖尿病,以及心肌梗塞可作为认知损害的危险因素(P < 0.05),但是C-反应蛋白水平却不是(P = 0.09)。结论是,在心脏外科手术之前妇女的认知损害是普遍的,处于这种状态的妇女C-反应蛋白水平是增高的,但是这种炎性标记物和预成认知损害之间的关系可能是续发的急性期反应物,作为其他易发因素的标记物。

(孙敏莉译 薛张纲校)

Preoperative cognitive state is seldom considered when investigating the effects of cardiac surgery on cognition. In this study we sought to determine the prevalence of cognitive impairment in women scheduled for cardiac surgery using nonhospitalized volunteers as a reference group and to examine the relationship between C-reactive protein levels and cognitive impairment. Psychometric testing was performed in 108 postmenopausal women scheduled for cardiac surgery and in 58 nonhospitalized control women. High sensitivity C-reactive protein levels were measured in the surgical patients. Preoperative cognitive impairment was defined as >2 sd lower scores on > or =2 tests compared with the controls. Cognitive impairment was present in 49 of 108 (45%) patients. C-reactive protein levels were higher for patients with compared with those without cognitive impairment (median, 8.1 mg/L versus 4.7 mg/L; P = 0.04). Based on multivariate logistic regression analysis, patient age, lower attained level of education, type 2 diabetes mellitus, and prior myocardial infarction identified risk for cognitive impairment (P < 0.05) but C-reactive protein levels did not (P = 0.09). In conclusion, cognitive impairment is prevalent in women before cardiac surgery. C-reactive protein levels are increased in women with this condition but the relationship between this inflammatory marker and preexisting cognitive impairment is likely secondary to the acute phase reactant serving as a marker for other predisposing conditions

 

 

 

心脏手术后白介素-6升高预示感染的发生

Increased Interleukin-6 After Cardiac Surgery Predicts Infection

Michael Sander, MD, Christian von Heymann, MD, Vera von Dossow, MD, Corinna Spaethe, MD, Wolfgang F. Konertz, MD, Uday Jain, MSIT, MD, PhD, and Claudia D. Spies, MD.

Departments of Anesthesiology and Intensive Care Medicine, and Cardiovascular Surgery, University Hospital Charité, Campus Charité Mitte/Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany; Department of Anesthesiology, St. Marys Medical Center, San Francisco, California

Anesth Analg 2006 102: 1623-1629.

 

使用体外循环(CPB)的心脏手术后感染的早期诊断和治疗有利于改善预后。传统的实验室检查如C反应蛋白、白细胞计数等不能分辨患者是感染的早期还是不伴有感染的全身炎症反应综合症。CPB之后,机体释放促炎和抗炎反应因子,包括肿瘤坏死因子α、白介素(IL)-6和IL-10。我们研究了这项因子对心脏手术术后感染的预示能力。46位因左室射血分数受损(<60%)准备行心脏手术的患者进入研究。在术前1天、术前即刻、入ICU时、术后1天、3天、7天采血标本。感染的定义依照疾病预防和控制中心的标准。手术后有13位患者发生感染。发生感染的患者平均在术后4天被证实,术后3天所有感染患者的IL-6、IL-10均明显升高,而肿瘤坏死因子α、白细胞、C反应蛋白并未升高。感染患者术后即刻的血糖明显升高。CPBIL-6升高可以预示左心功能不全患者心脏手术后感染的发生。

(金琳 译 薛张纲 审校)

Early diagnosis and treatment of infection after cardiac surgery with cardiopulmonary bypass (CPB) improves outcome. Conventional laboratory tests, such as C-reactive protein and white blood cell count can not distinguish patients with early infection from those with systemic inflammatory response syndrome but without infection. After CPB, there is a systemic release of proinflammatory and antiinflammatory cytokines, including tumor necrosis factor-{alpha}, interleukin (IL)-6, and IL-10. We investigated the predictive ability of these variables for infection after cardiac surgery. Forty-six patients with impaired left ventricular ejection fraction (<60%), scheduled for cardiac surgery, were included. Plasma samples were drawn 1 day before and immediately before surgery, on admission to the intensive care unit, and on days 1, 3, and 7 after surgery. Infection was identified according to the criteria of the Centers for Disease Control and Prevention. After surgery 13 patients developed an infection. In patients with infection, confirmed a median of 4 days after surgery, all measurements of IL-6, and IL-10 on postoperative day 3 were significantly increased. Tumor necrosis factor-{alpha}, leukocytes, and C-reactive protein were not increased in these patients. Immediately after surgery blood glucose was significantly increased in patients with infection. Increased IL-6 after CPB is predictive of infection after cardiac surgery in patients with impaired left ventricular function.

 

 

比较三种磷酸二酯酶III抑制剂对豚鼠离体心脏机械和代谢功能的影响

A comparison of three phosphodiesterase type III inhibitors on mechanical and metabolic function in guinea pig isolated hearts.

Zausig YA. Stowe DF. Zink W. Grube C. Martin E. Graf BM.

University of Goettingen, Dept. of Anaesthesia, ZARI, Robert-Koch-Strasse 40, Goettingen, 37075, Germany.

Anesth Anal. 102(6):1646-52, 2006 Jun.

 

对外周循环无影响的磷酸二酯酶III抑制剂是否对心脏舒张和冠脉血管有影响仍知之甚少。我们假设磷酸二酯酶III抑制剂对心脏功能和代谢有不同的作用,以及其冠脉舒张作用仅仅依靠正性肌力作用后的自主调节。本研究目的是比较Langendorff灌注的豚鼠离体心脏中三种临床常用磷酸二酯酶III抑制剂对电生理、机械、血管舒张和代谢的剂量反应性影响。我们发现,超过10-710-4M的范围,安力农、铱诺昔酮和米力农都产生最大的浓度依赖性正性变时效应(12%,18%,26%)、变力效应(16%,26%,26%)和松弛效应(14%,21%,19%)。临床浓度下,所有的三种药都增加心率,但是只有米力农明显增加心肌收缩性和舒张性(11%)。最高浓度下,每种磷酸二酯酶III抑制剂相似地增加心肌收缩力,同时氧耗增加,相应增加冠脉血流和氧输送。每种药物浓度达最高时,冠脉血流仍能保持,表明是由于代谢率增加导致冠脉血流增加。我们的结论,三种磷酸二酯酶III抑制剂不直接促进冠脉舒张,米力农在临床浓度时有最强的心肌收缩性和舒张性。

(吴德华译 薛张纲校)

Little is known about of the comparative cardiac lusitropic and coronary vasoactive effects of type III phosphodiesterase inhibitors independent of their systemic circulatory effects. We hypothesized that phosphodiesterase inhibitors have dissimilar concentration-dependent effects on cardiac function and metabolism and that their coronary vasodilatory effects are solely dependent on flow autoregulation secondary to positive inotropic effects. Our aim was to compare the dose-response electrophysiologic, mechanical, vasodilatory, and metabolic properties of three clinically available phosphodiesterase inhibitors in isolated Langendorff perfused guinea pig hearts. We found that, over a range from 10(-7) to 10(-4) M, amrinone, enoximone, and milrinone each produced maximal concentration-dependent positive chronotropic (12%, 18%, 26%), inotropic (16%, 26%, 26%), and lusitropic (14%, 21%, 19%) effects. At clinical concentrations, all phosphodiesterase inhibitors increased heart rate, but only milrinone significantly enhanced contractility and relaxation (11%). Each phosphodiesterase inhibitor similarly increased contractility at its highest concentration; this was accompanied by an increase in oxygen consumption, which was matched by comparable increases in coronary flow and oxygen delivery. Coronary flow reserve was preserved at the highest concentration of each drug, indicating that an increased metabolic rate was responsible for the increase in coronary flow by each drug at each concentration. Over the concentrations examined, we conclude that each of the phosphodiesterase inhibitors does not directly promote coronary vasodilation and that milrinone has the most prominent effects on contractility and relaxation at clinically relevant concentrations.

 

与吗啡相比术中使用曲马多对儿童心脏手术后采用护士控制镇痛可以较早苏醒和较少使用镇静剂

Intraoperative Administration of Tramadol for Postoperative Nurse-Controlled Analgesia Resulted in Earlier Awakening and Less Sedation than Morphine in Children After Cardiac Surgery

Ya-Chun Chu, MD, PhD, Su-Man Lin, MD, Ying-Chou Hsieh, MD, Kwok-Hon Chan, MD, and Mei-Yung Tsou, MD, PhD

Department of Anesthesiology Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan

Address correspondence and reprint requests to Mei-Yung Tsou, MD, PhD, Department of Anesthesiology, Taipei-Veterans General Hospital, 112, Taiwan.

Anesth Analg 2006 102: 1668-1673.

 

在成人,术中使用曲马多与吗啡相比可以较早苏醒,较少使用镇静剂。在本随机、对照、双盲研究中,我们研究了术中初始剂量曲马多是否可以获得比吗啡在全麻后更迅速的苏醒、较少使用镇静剂和在小儿术后较早拔除气管内导管。四十名16岁行房或室间隔缺损修补术后在儿科加强监护病房拔除气管内导管的儿童,在胸骨关闭后随机给予吗啡(初始剂量0.2 mg/kg)或曲马多(初始剂量2 mg/kg)后,再分别行单剂吗啡0.02 mg/kg或曲马多0.2 mg/kg、背景剂量吗啡0.015 mg/kg·hr或曲马多0.15mg/kg·hr的护士控制镇痛。术后使用曲马多的儿童从全麻中苏醒较早(P = 0.02),术后第12小时较少使用镇静剂(分别为 P=0.03 P=0.01)。曲马多组气管内导管拔除较早(P = 0.01)。两组之间在滞留在儿科加强监护病房内的时长方面无差别。同时两组间护士控制镇痛第一次剂量给予时间和48小时观察期内客观疼痛评分相当。脉搏氧饱和度降低和呕吐发生率两组间相似。所有患儿在术后第12天进食良好,且两组间无差别。

(金 路译 薛张纲校)

In adults, intraoperative administration of tramadol could result in earlier recovery and less sedation than morphine. In this controlled, randomized, double-blind study, we investigated whether an intraoperative initial dose of tramadol could cause more rapid awakening from general anesthesia, less sedation, and earlier tracheal extubation than morphine in children during the immediate postoperative period. Forty children aged 16 yr, scheduled for atrial or ventricular septal defect repair and tracheal extubation in the pediatric intensive care unit, were randomly allocated to receive morphine, initial dose 0.2 mg/kg, or tramadol 2 mg/kg given at the end of sternal closure, followed by nurse-controlled analgesia (bolus 0.02 mg/kg of morphine and 0.2 mg/kg of tramadol) with background infusions (0.015 mg · kg1 · h1 for morphine and 0.15 mg · kg1 · h1 for tramadol). Postoperatively, children receiving tramadol had earlier awakening from general anesthesia (P = 0.02) and were less sedated at 1 and 2 h postoperatively (P = 0.03 and P = 0.01, respectively). Tracheal extubation was earlier in the tramadol group (P = 0.01). Lengths of pediatric intensive care unit stay did not differ between groups. Times to first trigger of nurse-controlled analgesia bolus and objective pain scores during the 48 h observation period were comparable between groups. The incidence of desaturation and emesis were similar between groups. The patients ate well and did not differ on Day 1 or Day 2.

 

儿科病人通过喉周导气管对声门上气道的可视定位

Video Assessment of Supraglottic Airway Orientation Through the Perilaryngeal Airway in Pediatric Patients

David M. Polaner, Dheeraj Ahuja, Jeannie Zuk, and Zhaoxing Pan

The Children's Hospital Department of Anesthesia, 1056 East 19th Avenue, B090, Denver, CO 80218, USA.

Anesth Analg 2006 102: 1685-1688.

 

COBRA喉周导气管(PLA)是一种应用于儿童的新型声门上的导气管装置。我们研究了45名婴儿和儿童,通过纤支镜定位,采用PLA来确定喉的位置。对喉的可视程度进行评分,并评价PLA和会厌的位置。所有受试对象都选用合适的导气管,但在10kg及以下的病人中,76.9%的儿童喉头部分或完全阻塞,在声门开放时会厌盖于声门上。这在较大的儿童中是不常见的。几乎在所有的受试对象中,PLA的装置与会厌和声门上结构相近。我们推测:1)PLA为婴儿和儿童提供了一种可接受的气道,但会厌的折叠及声门开放时的阻塞在婴儿中是常见的。2)在这一年龄组,格外警惕气道的梗阻是必要的。3)PLA和声门上结构的相近提示了较深的麻醉可能减少对喉头的刺激。

(王丽珺译 薛张纲校)

The COBRA perilaryngeal airway (PLA) is a new supraglottic airway device available for use in children. We studied the orientation of the larynx as viewed through the PLA using video obtained with a fiberoptic bronchoscope in 45 infants and children. Laryngeal view was scored, and position of the grill bars of the PLA and the epiglottis was assessed. An acceptable airway was obtained in all subjects, but the laryngeal view was nearly or completely obstructed in 76.9% of the patients 10 kg and less, with the epiglottis folded over the glottic opening. This was uncommon in larger children. The grill bars of the PLA were closely opposed to the epiglottis and supraglottic structures in nearly all subjects. We conclude that 1) the PLA provides an acceptable airway in infants and children, but infolding of the epiglottis with obstruction of the view of the glottic opening is common in infants, 2) extra vigilance for airway obstruction in this age group is necessary, and 3) the PLA's close opposition to the supraglottic structures suggests that removal in a deeper plane of anesthesia might minimize laryngeal stimulation.

 

七氟烷对大鼠气管上皮细胞纤毛活动的作用:与异氟烷和氟烷比较

The Effect of Sevoflurane on Ciliary Motility in Rat Cultured Tracheal Epithelial Cells: A Comparison with Isoflurane and Halothane

Shogo Matsuura, Gotaro Shirakami, Hiroko Iida, Keiji Tanimoto, and Kazuhiko Fukuda

Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan

Address correspondence and reprint requests to Gotaro Shirakami, MD, Department of Anesthesia, Kyoto University Hospital, Kyoto 606-8507, Japan.

Anesth Analg 2006 102: 1703-1708.

 

氟烷和异氟烷有力地抑制了气道纤毛活动度。我们用纯化培养的大鼠气管上皮细胞比较了七氟烷与氟烷和异氟烷对纤毛活动频率(CBF)的影响。大鼠气管上皮细胞从成年雄性SD大鼠中分离出来,建立气液交界面。细胞的顶端表面暴露于含有潮湿和温暖(25°C)空气(媒介)的新鲜气体中,含有或没有七氟烷(0%4%),氟烷(0%2%),或异氟烷(0%2%)。纤毛活动的图像被记录下来,用计算机分析CBFCBF基线(= 100%),计算暴露后30分钟的CBF。暴露于媒介后30分钟的CBF101% ± 4% (mean ± sd)。暴露于0.25%2%七氟烷,CBF没有显著的改变,而暴露于0.25%2%的氟烷和异氟烷中,CBF呈剂量依赖性降低。暴露于2%的七氟烷,氟烷和异氟烷30分钟后的CBF分别是97% ± 9%, 56% ± 14%, and 47% ± 6%n=5)。这些结果说明在离体大鼠气管上皮细胞中,七氟烷有直接的纤毛抑制作用但是作用要远弱于氟烷和异氟烷。

(周荻 译 薛张纲 校)

Halothane and isoflurane potently depress airway ciliary motility. We compared the effect of sevoflurane on ciliary beat frequency (CBF) with that of halothane and isoflurane using purified and cultured rat tracheal epithelial cells. Rat tracheal epithelial cells were isolated from adult male Sprague-Dawley rats to establish an air-liquid interface culture. Apical surfaces of the cells were exposed to a fresh gas containing humidified and warmed (25°C) air (vehicle) with or without sevoflurane (0%4%), halothane (0%2%), or isoflurane (0%2%). The images of motile cilia were videotaped and CBF was analyzed using a computer. Baseline CBF (= 100%) and CBF 30 min after the exposure were measured. CBF 30 min after vehicle exposure was 101% ± 4% (mean ± sd). Exposures to 0.25%2% sevoflurane did not change CBF significantly, although exposures to 0.25%2% halothane or isoflurane decreased CBF dose-dependently. CBFs 30 min after exposures to 2% of sevoflurane, halothane, and isoflurane were 97% ± 9%, 56% ± 14%, and 47% ± 6%, respectively (n = 5 each). Sevoflurane 4% reduced CBF significantly but slightly (84% ± 2%, n = 5). These results show that sevoflurane has a direct cilioinhibitory action but its action is much weaker than that of halothane and isoflurane in isolated rat tracheal epithelial cells.

 

环孢霉素和胰岛素对大鼠缺血性脊髓损伤的的作用

The effects of cyclosporin a and insulin on ischemic spinal cord injury in rabbits.

Tsuruta S, Matsumoto M, Fukuda S, Yamashita A, Cui YJ, Wakamatsu H, Sakabe T.
Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.

Anesth Analg. 2006 Jun;102(6):1722-7

通过这个研究,我们检测环孢霉素(一种抑制线粒体渗透转运的药物)和胰岛素对大鼠脊髓缺血性损伤的作用。我们将大鼠分为5(每组6),正常屏障组(sham BO),屏障开放组(BO),屏障开放环孢霉素组(BO-CsA),屏障开放胰岛素组(BO-I),屏障开放环孢霉素胰岛素组(BO-CsA-I)。第一天的时候打开血—脊髓屏障以便药物更好的渗透。环孢霉素(10 mg/kg.d, IV)在第35天给药(共30 mg/kg)。胰岛素在缺血前30分钟给药。对于所有的组,缺血是在第5天阻断腹主动脉13分钟。
神经学和组织病理学的评价在缺血后4天进行。在BO-CsA组,血糖水平明显高于其他组,并且没有观察到保护作用。作为对照,BO-I 组和Bo-CsA-I组的下肢活动功能和BO-CsA-I组的组织病理学明显好于sham BO, BO, and BO-CsA组。结果显示,胰岛素可以保护缺血性的脊髓损伤,而环孢霉素的作用是很小的。

(陆文清译 薛张纲校)

We examined the effects of cyclosporin A (CsA), a drug that inhibits mitochondrial permeability transition pore, and insulin on ischemic spinal cord damage in rabbits. We assigned rabbits to 5 groups (n = 6 in each); sham barrier-opened group (sham BO), barrier-opened group (BO), barrier-opened-CsA group (BO-CsA), barrier-opened-insulin group (BO-I), and barrier-opened-CsA-insulin group (BO-CsA-I). The blood-spinal cord barrier was opened to facilitate drug penetration by a mild injury to the lumber spinal cord on day 1. CsA (10 mg/kg per day IV) was administered on day 3 to day 5 (total 30 mg/kg). Insulin was administered 30 min before ischemia. In all groups, spinal cord ischemia was produced on day 5 by occluding the abdominal aorta for 13 min.Neurological and histopathological evaluations were performed 4 days after ischemia. In group BO-CsA, blood glucose concentrations were significantly larger compared with the other four groups, and no protection was observed. In contrast, hindlimb motor function in groups BO-I and Bo-CsA-I and histopathology in group BO-CsA-I were significantly better than in groups sham BO, BO, and BO-CsA. The results indicate that insulin protects against ischemic spinal cord injury, whereas the effect of CsA is, at best, minimal.

 

利多卡因抑制诱生型一氧化氮合酶和阳离子氨基酸转运蛋白2在有活性的鼠类巨噬细胞中的转录可能与电压敏感性钠通道有关

Lidocaine inhibition of inducible nitric oxide synthase and cationic amino Acid transporter-2 transcription in activated murine macrophages may involve voltage-sensitive na+ channel.

Huang YH, Tsai PS, Kai YF, Yang CH, Huang CJ.

Ya-Hsien Huang, Pei-Shan Tsai, Yun-Fang Kai, Chen-Hsien Yang, and Chun-Jen Huang

Departments of Anesthesiology and Medical Research, Mackay Memorial Hospital; Mackay Medicine, Nursing and Management College; College of Nursing and Graduate Institute of Medical Science, Taipei Medical University, Taipei, Taiwan

Anesth Analg 2006 102: 1739-1744.


有报道在有活性的鼠类巨噬细胞中利多卡因对NO的生成有抑制作用,但是诱生型一氧化氮合酶(iNOS)在其中的作用仍没有探明。另外,2型阳离子氨基酸转运蛋白(CAT-2)和鸟苷三磷酸环水解酶I (GTPCH)对于iNOS有调节作用。目前利多卡因对CAT-2 GTPCH的作用仍未知。为了研究它们之间的作用,连生的鼠类巨噬细胞(RAW264.7 细胞)将在收获前18小时与脂多糖(LPS)或利多卡因(5, 50, or 500 muM)联合孵化。我们也用了TTX和无定形藜芦碱来阐明电压敏感性钠通道的可能作用。我们的数据表明在受刺激的巨噬细胞中LPS对于iNOS CAT-2的转录是正调节作用而GTPCH没有此作用。在剂量依赖性的方法中,利多卡因可减弱LPS对于iNOS CAT-2的正调节作用。相反的,利多卡因可明显增强LPS激活的巨噬细胞中GTPCH的转录作用。TTX对于iNOS, CAT-2GTPCH的作用与利多卡因相似。另外,无定形藜芦碱明显减弱利多卡因和TTX的作用。我们得出结论:在LPS激活的巨噬细胞中利多卡因明显抑制iNOS CAT-2的转录,而增强GTPCH的转录,这可能与电压敏感性钠通道有关。

(韩晓丹译 薛张纲校)
Lidocaine has been reported to inhibit nitric oxide (NO) production in activated murine macrophages, but the role of inducible NO synthase (iNOS) in lidocaine-induced inhibition of NO has not been explored. In addition, type-2 cationic amino acid transporter (CAT-2) and guanosine triphosphate cyclohydrolase I (GTPCH) also regulate iNOS activity. The effects of lidocaine on CAT-2 and GTPCH are unknown. To explore further these effects, confluent immortalized murine macrophages (RAW264.7 cells) were incubated with lipopolysaccharide (LPS) or in combination with lidocaine (5, 50, or 500 muM) for 18 h before harvesting. We also used tetrodotoxin (TTX) and veratridine to elucidate the possible role of voltage-sensitive Na(+) channel. Our data demonstrated that LPS significantly upregulated transcription of iNOS and CAT-2 but not GTPCH in stimulated macrophages. In a dose-dependent manner, lidocaine significantly attenuated the LPS-induced upregulation of iNOS and CAT-2. Conversely, lidocaine significantly increased GTPCH transcription in LPS-stimulated macrophages. The effects of TTX on iNOS, CAT-2, and GTPCH expression were comparable to those of lidocaine. In addition, veratridine significantly attenuated the effects of lidocaine and TTX. We therefore concluded that lidocaine significantly inhibits iNOS and CAT-2 and, in turn, enhances GTPCH transcription in LPS-stimulated macrophages via a mechanism that possibly involves the voltage-sensitive Na(+) channel.

 

脑电图衰退和针灸

Electroencephalogram-entropy and acupuncture.
Litscher G.
MDsc, Research Unit of Biomedical Engineering, in Anesthesia and Intensive Care Medicine, Medical University Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. gerhard.

Anesth Analg 2006 102: 1745-1751.


用计算机来评价镇静和催眠的深度是困难的。脑电图被认为可能是一种方法。反应减退(RE)和状态减退(SE)是多因素的脑电图检测新技术,我们用针灸来研究。这两个参数都被用来反应镇静状态的改变。在一项随机交叉试验中用两种针灸方法对9名健康患者进行研究。在镇静穴位用针刺或用雷射针进行针灸能显著降低RESE。相反,在"Qi-energy"点针灸不能降低这两个参数。不同的针灸方法能产生不同的可重复的脑电图的改变。因此,针灸的衰退测量的研究可能是有价值的。

(钟静译 薛张纲校)

Computer-based measuring of the level of sedation and hypnosis is difficult and has proven to be challenging. The electroencephalogram (EEG) has been proposed as a potential method. Response entropy (RE) and state entropy (SE) are multifactor, dimensionless parameters of a new technology of EEG monitoring, and we investigated them for the first time in acupuncture research within this study. Both parameters have been alleged to reflect changes in the clinical state of sedation. Two different acupuncture schemes were tested in a randomized crossover trial with nine healthy volunteers (mean age +/- sd, 28.8 +/- 3.6 yr; 25-36 yr). Applying and stimulating acupuncture needles or performing laserneedle acupuncture at special sedation points decreased RE and SE significantly (P </= 0.01; paired t-test) compared with the reference interval before acupuncture. In contrast, acupuncture of points for increasing "Qi-energy" did not decrease parameters of entropy. Specific acupuncture schemes produce specific, reproducible, and quantifiable effects on entropy parameters in the EEG. Therefore, entropy measurements during acupuncture seem to be worthy of further evaluation with a larger series of subjects.

 

吗啡、可待因和美沙酮及其对映体在不同的大鼠疼痛模型的作用

Morphine, Oxycodone, Methadone and Its Enantiomers in Different Models of Nociception in the Rat

Kim Lemberg, Vesa K. Kontinen, Kaarin Viljakka, Irene Kylänlahti, Jari Yli-Kauhaluoma, and Eija Kalso

Pain Clinic, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital,

Anesth Analg 2006 102: 1768-1774.

 

我们研究常用的μ-阿片受体激动剂吗啡、可待因和美沙酮及其对映体对于大鼠急性疼痛的热和机械模型以及脊神经结扎的神经性疼痛模型的作用。蛛网膜下腔给予吗啡、可待因和美沙酮及其对映体对于弹尾巴、烫板和压爪试验的抗疼痛成剂量依赖性。左旋美沙酮、外消旋美沙酮和可待因的剂量依赖性抗疼痛效果相似,而吗啡的量效曲线较浅。在脊神经结扎的神经性疼痛模型中,蛛网膜下腔给予吗啡、可待因、美沙酮和左旋美沙酮对于大鼠的机械性和冷疼痛模型有抗疼痛作用。并证实了左旋美沙酮的抗异常性疼痛作用最强。D-美沙酮在所有试验中无活性。给予吗啡5.0 mg/kg,可待因2.5 mg/kg和左旋美沙酮1.25 mg/kg30分钟后可降低自主运动。结论:对于急性损伤,所有μ-受体激动剂都有抗损伤作用,其中吗啡的作用最弱。对于神经损伤性疼痛,左旋美沙酮对于机械和冷所至的异常性疼痛的抗疼痛效果最好。阿片类药物在不同的疼痛模型中的效果不同。应当研究左旋美沙酮在人的神经病性疼痛中的作用。

(王慧琳译 薛张纲校)

We studied the effects of the commonly used mu-opioid receptor agonists morphine, oxycodone, methadone and the enantiomers of methadone in thermal and mechanical models of acute pain and in the spinal nerve ligation model of neuropathic pain in rats. Subcutaneous administration of morphine, oxycodone, and methadone produced a dose-dependent antinociceptive effect in the tail flick, hotplate, and paw pressure tests. l-methadone, racemic methadone, and oxycodone had a similar dose-dependent antinociceptive effect, whereas the dose-response curve of morphine was shallower. In the spinal nerve ligation model of neuropathic pain, subcutaneous administration of morphine, oxycodone, methadone and l-methadone had antiallodynic effects in tests of mechanical and cold allodynia. l-methadone showed the strongest antiallodynic effect of the tested drugs. d-methadone was inactive in all tests. Morphine 5.0 mg/kg, oxycodone 2.5 mg/kg, and l-methadone 1.25 mg/kg decreased spontaneous locomotion 30 min after drug administration. In conclusion, in acute nociception all mu-opioid receptor agonists produced antinociception, with morphine showing the weakest effect. In nerve injury pain, l-methadone showed the greatest antiallodynic potency in both mechanical and cold allodynia compared with the other opioids. Opioids seem to have different profiles in different pain models. l-methadone should be studied for neuropathic pain in humans.

 

高渗盐水在治疗由外伤性脑损伤引起的颅内高压中的作用

The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury.

White H, Cook D, Venkatesh B.
QE II Hospital, Kessels Rd., Coopers Plains 33, Queensland 4108, Australia.

Anesth Analg. 2006 Jun;102(6):1836-46

 

过去的十年中我们见证了高渗盐水在外伤性低容量复苏治疗中再次启用。最初研究表明髙渗盐水在外伤病人中对脑损伤有益,然而在最近的研究中这点并未得到证实。在动物与人的实验中已证明了高渗盐水在神经损伤病人的脑血流、颅内压和炎症应答方面有临床所希望的生理效应。由于脑外伤病人存活率低,因此在这方面的临床研究很少。在本综述中我将一起回顾与调查实验与临床中的有关髙渗盐水在神经外伤中作为渗透疗法药物的知识。

(孙卓真译 薛张纲校)

The past decade has witnessed a resurgence of interest in the use of hypertonic saline for low-volume resuscitation after trauma. Preliminary studies suggested that benefits are limited to a subgroup of trauma patients with brain injury, but a recent study of prehospital administration of hypertonic saline to patients with traumatic brain injury failed to confirm a benefit. Animal and human studies have demonstrated that hypertonic saline has clinically desirable physiological effects on cerebral blood flow, intracranial pressure, and inflammatory responses in models of neurotrauma. There are few clinical studies in traumatic brain injury with patient survival as an end point. In this review, we examined the experimental and clinical knowledge of hypertonic saline as an osmotherapeutic agent in neurotrauma.

 

用脑电图监测麻醉深度的实验中证实:通过颈内静脉单剂量多次注射法会影响维持麻醉深度的异丙酚的用量

Bolus configuration affects dose requirements of intracarotid propofol for electroencephalographic silence.

Joshi S, Wang M, Etu JJ, Pile-Spellman J.

Irving Assistant Department of Anesthesiology, P&S P Box 46, College of Physicians and Surgeons of Columbia University

Anesth Analg. 2006 Jun;102(6):1816-22.

 

我们假设通过颈内静脉单剂量多次注射异丙酚来维持脑电图稳定时所需要的用量比持续输注法所需的用量小。并且保证每次异丙酚的单剂量都是一个有效剂量。我们以大鼠为实验来比较了单剂量多次法与持续输注法的异丙酚的用量。然后我们又比较了四组不同设定的单剂量(浓度或剂量)的异丙酚(0.33% x 0.1 mL, 0.33% x 0.3 mL, 1% x 0.1 mL, and 1% x 0.3 mL)在维持脑电图稳定时的用量。我们发现同样在维持脑电图稳定的情况下持续输注法所需异丙酚的用量是单剂量多次法的三倍,分别是22.8 +/- 11.9 vs 6.2 +/- 2.9 mL/h(n = 7, P < 0.004) 此外,在单剂量多次法中每次异丙酚的用量与浓度会影响其最终的整体作用,总剂量=3.6 + 29 x mg/, n = 32, r = 0.85。因此为了达到最大的效果我们应该调整好每次异丙酚的用量与浓度。

(孙卓真译 薛张纲校)

We hypothesized that an intracarotid bolus injection of propofol to produce electroencephalographic (EEG) silence would require a smaller dose of the drug compared with the continuous infusion of the drug. Furthermore, the bolus propofol dose will be a function of the bolus characteristics in each bolus (mass/volume). We compared the dose requirements of intracarotid propofol needed to maintain EEG silence when delivered as bolus injections to continuous infusions in rabbits. Subsequently, we compared whether four different bolus characteristics (concentration and volume) of propofol (0.33% x 0.1 mL, 0.33% x 0.3 mL, 1% x 0.1 mL, and 1% x 0.3 mL) affected the dose required to produce EEG silence. We found that the infusion rate of propofol required to sustain EEG silence was three-fold larger than the dose required by bolus injections, 22.8 +/- 11.9 vs 6.2 +/- 2.9 mL/h for infusion versus bolus, respectively (n = 7, P < 0.004). Furthermore, during bolus injection, the doses of propofol required to produce EEG silence were a direct function of the bolus volume and the mass of drug in each bolus, total dose = 3.6 + 29 x mg/bolus, n = 32, r = 0.85. For maximum regional effects of the bolus intracarotid drug injection, the bolus characteristics (volume and drug concentration) have to be optimized.

 

Mallampati试验预测困难气道准确性的系统回顾 (meta分析)

A systematic review (meta-analysis) of the accuracy of the mallampati tests to predict the difficult airway.

Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD.

MPH, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.

Anesth Analg. 2006 Jun;102(6):1867-78

 

最初的和改良的Mallampati试验常常用以预测困难气道,但关于其准确性存在争议。我们在MEDLINE和其它的一些数据库搜索了对全麻病人术前Mallampati 试验结果与随后的困难气道发生率(困难喉镜检查,困难插管,或困难通气作为参照试验)进行比较的前瞻性研究。包括了42项研究34,513个病人。参照试验的定义差异很大。预测困难喉镜检查,两种Mallampati试验准确性都很好(sROC曲线下面积分别为0.89 0.05 0.78 0.05)。预测困难插管,改良Mallampati试验准确性较好(sROC曲线下面积=0.83 0.03),而最初的Mallampati试验较差(sROC曲线下面积=0.58 0.12)Mallampati试验对识别困难面罩通气较差。未发现发表偏倚。单独使用Mallampati试验对预测困难气道准确性有限,因而不是实用的筛选试验。

(徐丽颖译 薛张纲校)

The original and modified Mallampati tests are commonly used to predict the difficult airway, but there is controversy regarding their accuracy. We searched MEDLINE and other databases for prospective studies of patients undergoing general anesthesia in which the results of a preoperative Mallampati test were compared with the subsequent rate of difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation as reference tests). Forty-two studies enrolling 34,513 patients were included. The definitions of the reference tests varied widely. For predicting difficult laryngoscopy, both versions of the Mallampati test had good accuracy (area under the summary receiver operating characteristic (sROC) curve = 0.89 0.05 and 0.78 0.05, respectively). For predicting difficult intubation, the modified Mallampati test had good accuracy (area under the sROC curve = 0.83 0.03) whereas the original Mallampati test was poor (area under the sROC curve = 0.58 0.12). The Mallampati tests were poor at identifying difficult mask ventilation. Publication bias was not detected. Used alone, the Mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests.

 

心脏手术后早期活动时混合静脉血氧饱和度显著下降:体位或锻炼的影响?
The Marked Reduction in Mixed Venous Oxygen Saturation During Early Mobilization After Cardiac Surgery: The Effect of Posture or Exercise?

Idar Kirkeby-Garstad, MD, Ulrik Wisløff, PhD, Eirik Skogvoll, MD, PhD, Tomas Stølen, Arnt-Erik Tjønna, Roar Stenseth, MD, PhD, and Olav FM Sellevold, MD, PhD

Department of Cardiothoracic Anesthesia and Intensive Care, St Olav University Hospital, Department of Circulation and Medical Imaging, and Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Anesth Analg 2006 102: 1609-1616.

心脏手术后早期活动可引起混合静脉血氧饱和度(SvO2)的显著下降。通过肺动脉导管和间接测热法,作者研究了锻炼和体位改变对冠状动脉搭桥术前和术后首日上午心指数(CI)和SvO2的影响。16名射血分数>0.50的患者,在静息状态、仰卧脚踏车锻炼和被动站立时接受研究。术前进行30W的仰卧蹬车可使CI增加1.5 ± 0.8 L·min-1·m-2,术后则使CI增加0.9 ± 0.7 L·min-1·m-2 (P < 0.05);但术前SvO2从静息状态的80%± 4%降低至63 ± 6% (P < 0.05),术后SvO2从静息状态的71% ± 5% 降低至46% ± 11% (P < 0.05)。术前被动站立时CI 降低0.8 ± 0.5 L·min-1·m-2,术后被动站立时CI降低0.3± 0.4 L·min-1·m-2(P < 0.05);术前SvO279% ± 5%降至64%± 7% (P < 0.05),术后从72% ± 6%降至60%± 6% (P < 0.05)。这种锻炼显示术后心血管反应发生改变,同样的工作负荷可引起SvO2显著降低。手术前后被动站立均可显著降低SvO2,但是这种影响在术后相对较不明显。术后对体位改变和锻炼的反应发生改变,可能都引起了术后活动中SvO2的降低。

(赵延华 译 陈杰 校)

Early mobilization after cardiac surgery induces a marked reduction in mixed venous oxygen saturation (Svo2). Using pulmonary artery catheters and indirect calorimetry, we investigated the effects of exercise and postural change on cardiac index (CI) and Svo2 before and on the first morning after coronary artery bypass surgery. Sixteen patients with an ejection fraction >0.50 were studied at rest, during supine bicycle exercise, and during passive standing. Supine cycling at 30 W increased CI by 1.5 ± 0.8 L · min1 · m2 before and 0.9 ± 0.7 L · min1 · m2 after surgery (P < 0.05), whereas Svo2 was reduced from 80% ± 4% at rest to 63 ± 6% preoperatively (P < 0.05) and from 71% ± 5% to 46% ± 11% postoperatively (P < 0.05). Passive standing reduced CI by 0.8 ± 0.5 L · min1 · m2 before and 0.3 ± 0.4 L · min1 · m2 after surgery (P < 0.05). Svo2 was reduced from 79% ± 5% to 64% ± 7% preoperatively (P < 0.05) and from 72% ± 6% to 60% ± 6% postoperatively (P < 0.05). The exercise challenge revealed an altered cardiovascular response after surgery, causing a larger reduction in Svo2 for the same workload. Passive standing significantly reduced Svo2 both days, but this effect was less pronounced after surgery. The response to postural change and exercise was altered after surgery and may both contribute to the reduction in Svo2 during postoperative mobilization.

 

体外循环冠状动脉手术病人术后血清改变内皮Ca2+的信号转导

Endothelial Ca2+ Signal Transduction Is Altered by Postoperative Serum from Patients Undergoing Coronary Surgery with Cardiopulmonary Bypass
Crispin Schneider, Cand. med., and Thomas Volk, MD

Department of Anesthesiology and Intensive Care Medicine, Charitè-Universitätsmedizin Berlin, Berlin, Germany

Anesth Analg 2006 102: 1630-1637.

术后内皮失功可能为内皮细胞内信号转导性质改变所致。一般认为这种功能改变是全身性的,且和创伤大小有关。这促使作者假设血中存在某种介质所致。因此,作者研究了高侵袭性手术(体外循环冠状动脉手术[CS])和较小侵袭手术(关节融合手术[TJA])病人围术期血清对内皮信号细胞Ca2+反应的影响。采集26名接受CS病人和15名接受TJA病人术前和术后的血清,将主动脉内皮细胞放在其中培养。用ATP100 µM)诱发的FURA-2荧光改变方法测量细胞内的Ca2+。在CS样本中,诱发[Ca2+]i信号被术后血清增强(高峰水平: 96 ± 41 FU 116 ± 45 FU; P < 0.05)TJA病人血清则无这种术后增强。使用硝苯地平对CS样本进行预孵化阻断电压门控Ca2+通道不会改变这种效应,但缺乏细胞外Ca2+会终止暴露于CS血清所导致的反应性增高。利用Mn2+抑制可探测到Ca2+的内流,暴露于CS血浆的内皮细胞Ca2+内流增加,而Ca2+内流与术后循环内白介素-6水平相关(P < 0.007)。体外循环冠状动脉手术病人术后内皮功能改变部分由存在于血浆内的全身因素导致,血浆可导致特异内皮Ca2+信号转导增强。在离体情况下这一增强作用在接受未存在Ca2+内流增强的TJA病人的血清时消失。

(殷文渊 译 陈杰 校)

Endothelial dysfunction after surgery may be caused by alterations in the intracellular signaling properties of endothelial cells. Functional alterations are believed to be systemic and dependent on the amount of invasiveness. This led us to assume that there would be a mediator in the blood. Therefore, we investigated the influence of perioperative serum obtained from patients undergoing highly invasive surgical interventions (cardiac surgery [CS] with cardiopulmonary bypass) and less invasiveness (total joint arthroplasty [TJA]) on endothelial single cell Ca2+ responses. Aortic endothelial cells were incubated with preoperative and postoperative serum samples from 26 patients undergoing CS and from 15 patients undergoing TJA. Adenosine triphosphate (100 µM)-induced alterations in FURA-2 fluorescence was used to measure intracellular Ca2+ in single cells. In CS samples the induced [Ca2+]i signals were enhanced by postoperative serum (peak levels: 96 ± 41 FU versus 116 ± 45 FU; P < 0.05). These postoperative enhancements were absent in TJA patients serum. Preincubation of CS samples with nifedipine to block voltage gated Ca2+ channels did not alter this effect, but the absence of extracellular Ca2+ abolished the increased response from postoperative CS serum exposure. Ca2+ entry probed with Mn2+ quenching was increased in endothelial cells exposed with postoperative CS serum and Ca2+ entry correlated with postoperative circulating interleukin-6 levels (P < 0.007). Endothelial functional alterations after CS with cardiopulmonary bypass are attributable, in part, to systemic factors present in serum that lead to specific endothelial enhanced Ca2+-signaling. This enhancement can be separated in vitro as an increased Ca2+ entry not present in serum from patients recovering from TJA.

 

经食管超声心动图在非心脏手术心脏停搏并入中的应用

The Usefulness of Transesophageal Echocardiography During Intraoperative Cardiac Arrest in Noncardiac Surgery

Stavros G. Memtsoudis, MD, PhD, Peter Rosenberger, MD, Michaela Loffler, Holger K. Eltzschig, MD, Annette Mizuguchi, MD, PhD, Stanton K. Shernan, MD, and John A. Fox, MD

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany

Anesth Analg 2006 102: 1653-1657.

根据美国麻醉协会和心血管麻醉协会指南,威胁生命的血流动力学紊乱是术中应用经食道超声心动图(TEE)Ⅰ类适应证。然而,TEE对术中心脏停搏诊断的用途以及它对病人处理的影响尚无严密的观察。作者利用本科TEE数据库,选取22例行非心脏手术且在全麻诱导与手术结束期间有意外的严重血流动力学衰竭需要加强心脏生命支持的病人。回顾TEE检查结果、病程录、具体的操作记录、心输出量等,来分析TEE在诊断血流动力学的效用,并评估其对其后处理的影响。在22例行TEE检查的患者中,初步诊断19人存在潜在的病理学过程,包括9例有血栓栓子,6例急性心肌缺血,2例血容量减少,2例心包填塞。3例患者不能利用TEE确诊。18例患者接受TEE指导下高级心脏生命支持方案以外的特殊处理,包括12例病人接受了外科处理。14例病人安全离开手术室,其中7例病人康复出院。因此,TEE可为术中心脏停搏病人提供另外的诊断信息,并可以直接指导特殊的生命支持治疗。

(刘哲 译 陈杰 校 )

According to guidelines established by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists, life-threatening hemodynamic disturbances are classified as a category I indication for the intraoperative use of transesophageal echocardiography (TEE). However, the usefulness of TEE during intraoperative cardiac arrest and its impact on patient management have not been rigorously investigated. Using our departmental TEE database, we identified a population of 22 patients who underwent noncardiac surgical procedures and experienced unexpected intraoperative hemodynamic collapse requiring the initiation of Advanced Cardiac Life Support procedures between the time of induction of general anesthesia and the termination of the surgical procedure. Results of TEE examinations, patient records, detailed operative records, and outcome of patients were reviewed for the utility of TEE to diagnose the etiology of the hemodynamic collapse. Furthermore, the impact on subsequent patient management was evaluated. A primary suspected diagnosis of the underlying pathological process was established in 19 of 22 patients with TEE, including 9 with thromboembolic events, 6 with acute myocardial ischemia, 2 with hypovolemia, and 2 patients with pericardial tamponade. A definitive diagnosis could not be made in 3 patients with TEE. In 18 patients, TEE guided specific management beyond implementation of Advanced Cardiac Life Support protocols, including the addition of surgical procedures in 12 patients. Fourteen patients survived to leave the operating room, and 7 of these patients were eventually discharged from the hospital. Thus, TEE may provide additional diagnostic information in patients with intraoperative cardiac arrest and may directly guide specific, potentially life-saving therapy.

 

脑部MRI扫描能升高镇静小儿的中心体温

Brain Magnetic Resonance Imaging Increases Core Body Temperature in Sedated Children

Yvon F. Bryan, MD*, Thomas W. Templeton, MD{ddagger}, Todd G. Nick, PhD{dagger}, Martin Szafran, BS§, and Avery Tung, MD

*Department of Clinical Anesthesia and Clinical Pediatrics, {dagger}Department of Pediatrics, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, College of Medicine, Cincinnati, Ohio; {ddagger}Department of Pediatric Anesthesia and Critical Care, Wake Forest University School of Medicine, Winston-Salem, North Carolina; §Pritzker School of Medicine, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois

Anesth Analg 2006 102: 1674-1679.

 

目前,越来越多的儿童在麻醉镇静的状态下接受核磁共振(MRI)检查。MRI需要一个温度较低的环境。由于儿童的体表面积/体重比较成人大,大多数保温设备与MRI不兼容,因此存在着由于热量散失造成体温下降的风险。但是由于患儿吸收扫描过程产生的辐射可以对抗这种热量损失。为了研究辐射吸收对患儿体温的影响,作者在MRI之前和之后测量了30名行MRI检查的小儿的鼓膜温度。这些患儿均在水合氯醛镇静下行MRI检查,均穿医院的服装并盖一条毯子。研究结果显示,患儿的平均年龄为14.9±8.6月,体重为9.8±2.8kg。平均扫描时间为42±13min,在这期间鼓膜温度升高了0.5摄氏度,从36.9±0.4℃升高到37.4±0.3℃(95%CI,0.3-0.7℃,p<0.001)。研究结果表明,尽管没有应用防止热量散失和保暖措施,但是应用水合氯醛镇静的小儿行脑部MRI检查时体温非但没有下降反而升高了。这一结果表明,在MRI检查过程中积极进行保暖并不适合于所有病人。

(苏殿三 译 陈杰 校)

An increasing number of children now undergo magnetic resonance imaging (MRI) under sedation. MRI requires a cool environment. Because children have a larger surface area to body weight ratio than adults and because active warming devices are not MRI compatible, hypothermia as a result of passive heat loss is a risk. Absorption of radiofrequency radiation generated by the scanning process, however, may partially offset this heat loss. To determine the effect of absorbed radiofrequency radiation on body temperature during MRI, we measured pre-MRI and post-MRI tympanic temperatures in 30 children who underwent brain MRI while sedated with chloral hydrate and covered with a hospital gown and blanket. The mean (± sd) age was 14.9 ± 8.6 mo, and weight was 9.8 ± 2.8 kg. During an average scan duration of 42 ± 13 min, mean tympanic temperatures increased 0.5°C from 36.9°C ± 0.4°C to 37.4°C ± 0.3°C; (95% CI difference, 0.3°C to 0.7°C; P < 0.001). Our findings suggest that children sedated with chloral hydrate for brain MRI did not become hypothermic but rather had increased body temperature despite minimal barriers to heat loss and no active warming. These results imply that aggressive measures to prevent passive heat loss during MRI studies may not be needed in all patients.

 

全麻药抑制培养的海马切片的缝隙连接间的信息传递

General Anesthetics Inhibit Gap Junction Communication in Cultured Organotypic Hippocampal Slices

Kirsten Wentlandt, PhD, Marina Samoilova, PhD, Peter L. Carlen, MD, FRCPC, and Hossam El Beheiry, MBBCh, PhD, FRCPC

Division of Cellular and Molecular Biology, Toronto Western Research Institute, Departments of Anesthesia & Pain Management, Physiology and Medicine (Neurology), University of Toronto, University Health Network, Toronto, Ontario, Canada

Anesth Analg 2006 102: 1692-1698.

 

缝隙连接是连接相邻细胞的通道蛋白,形成电突触,促进神经元活动的同步活动。由此神经元活动引发和传播形成的脑电波产生认知和意识。本实验探讨异丙酚,硫喷妥钠,氟烷在培养的海马切片中对缝隙连接间的信息传递的影响。采用照相漂白后荧光恢复技术(FRAP)和心电生理检测技术。FRAP 发现15m的异丙酚和10m硫喷妥钠分别减低缝隙连接间的信息传递达46.7±4.5%和48.8±5.5%。低剂量(5m异丙酚,2m硫酚妥钠)则不影响缝隙连接耦联。电生理检测发现连续4次电刺激(50Hz2″)时,15m的异丙酚和10m硫喷妥钠可减低海马切片的自发放电及放电后第一次收缩。且0.64mM的氟烷(约2MAC)对缝隙连接间的信息传递无影响。但2.8mM的氟烷阻断FRAP70%。本研究表明麻醉剂量的异丙酚,硫喷妥钠(除氟烷)可抑制培养海马切片的缝隙连接间的信息传递。缝隙连接间的信息传递的抑制可能在麻醉机理中发挥一定的作用。

(李启芳 译 陈杰 校)

Gap junctions are protein channels that directly connect the cytosol of neighboring cells, thus forming electrical synapses and promoting synchronous neuronal activities. Such activities lead to the initiation and propagation of electroencephalogram oscillations implicated in cognition and consciousness. In this study, we investigated the effects of propofol, thiopental, and halothane on gap junction communication in cultured organotypic hippocampal slices by recovery of fluorescence after photo bleaching (FRAP) technique and electrophysiological recordings. Propofol 15 µM and thiopental 10 µM attenuated gap junction communication in slice cultures by 46.7% ± 4.5% and 48.8% ± 5.5%, respectively, as measured by FRAP. Smaller concentrations of propofol 5 µM and thiopental 2 µM did not change gap junction coupling. Accompanying the decreased gap junction communication, hippocampus slice cultures exposed to propofol 15 µM and thiopental 10 µM were found to have reduced electrophysiologic spontaneous discharges and primary after discharges evoked by a tetanic train of 50 Hz for 2 s. On the other hand, halothane 0.64 mM, a concentration slightly larger than twice its minimum alveolar concentration had no effect on gap junction coupling while halothane 2.8 mM blocked FRAP by 70%. The current study illustrates that anesthetic concentrations of propofol and thiopental, but not halothane, attenuate gap junction communication in cultured hippocampal slices. Suppression of gap junction function could compound the mechanisms of anesthetic actions.

 

氟烷、异氟烷对微电流刺激网状细胞时引起脑电反应的效应差异

The Differential Effects of Halothane and Isoflurane on Electroencephalographic Responses to Electrical Microstimulation of the Reticular Formation

Mashawn Orth, BS, Emigdio Bravo, BS, Linda Barter, MVSc, Earl Carstens, PhD, and Joseph F. Antognini, MD

Department of Anesthesiology and Pain Medicine, Section of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, California

Anesth Analg 2006 102: 1709-1714.

异氟烷和氟烷在网状细胞结构(决定意识状态的关键之处)能产生脑电抑制和神经细胞抑制。作者假定异氟烷对微电流刺激网状细胞结构引出的脑电活动的抑制要强于氟烷。用异氟烷、氟烷麻醉大鼠,并将刺激电极置于网状细胞结构。在交叉实验中,调整氟烷或异氟烷的浓度为0.8 1.2最小肺泡浓度(MAC),运用微电流刺激并记录EEG反应。在0.8MAC氟烷-异氟烷和1.2MAC氟烷时,微刺激能增加边缘频谱和频率中值范围2-2.5HZ。在1.2MAC异氟烷时能产生爆发抑制,微刺激缩短等电位时限(24%±19%8%±7%;P<0.05),而并不 改变边缘频谱和频率中值范围。在需要制动的麻醉药浓度下,从0.8MAC1.2MAC,虽然EEG反应被抑制,皮层对网状细胞结构的微刺激仍然有反应。这些数据显示皮层神经元在异氟烷和氟烷麻醉时对突触输入仍有反应。

(顾新宇 译 陈杰 校)

Isoflurane and halothane cause electroencephalographic (EEG) depression and neuronal depression in the reticular formation, a site critical to consciousness. We hypothesized that isoflurane, more than halothane, would depress EEG activation elicited by electrical microstimulation of the reticular formation. Rats were anesthetized with either halothane or isoflurane and stimulating electrodes were positioned in the reticular formation. In a crossover design, anesthetic concentration was adjusted to 0.8 and 1.2 minimum alveolar concentration (MAC) of halothane or isoflurane and electrical microstimulation was performed and the EEG responses were recorded. Microstimulation increased the spectral edge and median edge frequencies 22.5 Hz at 0.8 MAC for halothane and isoflurane and 1.2 MAC halothane. At 1.2 MAC isoflurane, burst suppression occurred and microstimulation decreased the period of isoelectricity (24% ± 19% to 8% ± 7%; P < 0.05), whereas the spectral edge and median edge frequencies were unchanged. At anesthetic concentrations required to produce immobility, the cortex remains responsive to electrical microstimulation of the reticular formation, although the EEG response is depressed in the transition from 0.8 to 1.2 MAC. These data indicate that cortical neurons remain responsive to synaptic input during isoflurane and halothane anesthesia.

 

阿米替林的神经毒性由细胞凋亡介导并被Caspase抑制剂阻断

The Neurotoxic Effects of Amitriptyline Are Mediated by Apoptosis and are Effectively Blocked by Inhibition of Caspase Activity

Philipp Lirk, MD*, Ingrid Haller, MD*, Barbara Hausott, PhD#, Shota Ingorokva, MD#, Martina Deibl, MSc&, Peter Gerner, MD%, and Lars Klimaschewski, MD#

*Department of Anesthesiology and Critical Care Medicine, #Division of Neuroanatomy, and &Institute of Biostatistics, Computer Sciences, and Health Management, Innsbruck Medical University, Austria; %Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womens Hospital/Harvard Medical School, Boston, USA

Anesth Analg 2006 102: 1728-1733.

 

口服三环抗抑郁药被广泛的应用于慢性疼痛的治疗,在体外用于阻断钠通道,在体内用于阻滞神经传导。但是,已经发现在神经系统使用阿米替林后出现了毒性反应。因此作者研究了阿米替林的神经毒性的产生机制以及防止此毒性的可能方法。为了评估剂量依赖性的阿米替林的神经毒性作者用阿米替林培养了成年大鼠背根神经节的细胞,定量测定了神经存活数。此外,还研究了细胞凋亡的指标(线粒体膜电位,细胞质细胞色素C,和活化的caspase-3),阿米替林和caspase活性抑制剂z-vad-fmk共同培养细胞并对细胞的存活进行测定。作者发现阿米替林引起剂量依赖性毒性。用阿米替林培养的神经元线粒体膜电位的降低,细胞色素C的释放至细胞质和caspase-3激活。和z-vad-fmk一起进行孵育细胞可以显著的改善细胞存活。总之,阿米替林引起的神经毒性是由细胞凋亡介导的, caspase活性抑制剂可以减轻毒性,这显示了抑制凋亡途径可能会减轻局麻药的神经毒性。在体内试验需要证实抗细胞凋亡药和局麻药联合应用是否能够减轻神经毒性的副作用。

(王震虹 译 陈杰 校)

Oral tricyclic antidepressants, widely used as adjuncts in the treatment of chronic pain, block sodium channels in vitro and nerve conduction in vivo. However, toxicity of amitriptyline has been observed after neural application. We therefore investigated the mechanism and possible prevention of amitriptyline neurotoxicity. To assess dose-dependent neurotoxicity of amitriptyline, we incubated neuron cultures from adult rat dorsal root ganglia with amitriptyline and quantified neuronal survival. Additionally, we investigated accepted markers of apoptosis (mitochondrial membrane potential, cytosolic cytochrome c, and activated caspase-3) and co-incubated amitriptyline with an inhibitor of caspase activity, z-vad-fmk, to assess the effect on cell survival. We found a dose-dependent neurotoxic effect of amitriptyline. Neurons incubated with amitriptyline exhibited loss of mitochondrial membrane potential, release of cytochrome c into the cytoplasm, and activation of caspase-3. Co-incubation with z-vad-fmk substantially improved neuronal survival in culture. In conclusion, amitriptyline-induced neurotoxicity is mediated by apoptosis and is attenuated by inhibition of caspase activity, suggesting that inhibition of apoptotic pathways may be efficient at alleviating local anestheticinduced neurotoxicity. In vivo studies will have to corroborate whether the co-injection of anti-apoptotic drugs with local anesthetics decreases neurotoxic side effects.

 

一种优化充气止血带压力测量动脉阻断压的新方法

A New Method for Estimating Arterial Occlusion Pressure in Optimizing Pneumatic Tourniquet Inflation Pressure

Bahattin Tuncali, MD, Ayse Karci, MD, Binnur Erdalkiran Tuncali, MD, Omur Mavioglu, MD, Mustafa Ozkan, Abdul Kadir Bacakoglu, Hakan Baydur, MD, Ahmet Ekin, and Zahide Elar

Department of Anesthesiology and Reanimation, Department of Orthopedics and Traumatology-Division of Hand Surgery, Department of Public Health, Dokuz Eylul University, Izmir, Turkey

Anesth Analg 2006 102: 1752-1757.

为了减轻在使用充气止血带过程中与压力相关的损伤,常推荐使用最低有效的充气压。动脉阻断压(AOP)是一种测定用于维持无血术野的袖带压力。但是时间的控制是关键,它需要操作者的技巧,所以很少被广泛使用。动脉阻断压的测量要通过皮下软组织的压力转换才能实现。作者测量了30例麻醉状态的成年病人的止血带充气压力为100,200,300mmHg时的止血带下最上层和最下层的组织压力。所有病人均接受肌松全麻。Stryker压力监测仪测量止血带下组织压力。所有病人的软组织的压力始终低于应用(设定)的止血带充气压力。结果表明组织填料系数是20-75 cm。一种新的AOP的测量方法 [AOP=(systolic blood pressure+10)/Tissue padding coefficient] 这种新的AOP测量方法可能是一种简单快速可供临床选用的AOP测量方法。

(宋金超 译 陈杰 校)

To reduce pressure-related injuries resulting from pneumatic tourniquet use, the lowest possible inflation pressure is recommended. Arterial occlusion pressure (AOP) is a measure of the cuff pressure required to maintain a bloodless surgical field. However, its determination method is time consuming, requires operator skill, and is therefore seldom used in current practice. An AOP estimation can be made by knowing the pressure transmitted to the underlying soft tissues. We measured upper and lower extremity tissue pressures under the tourniquet cuff at 100, 200, and 300 mm Hg of tourniquet inflation pressures in 30 anesthetized living adult patients. All patients received general anesthesia with neuromuscular relaxation. A Stryker intra-compartmental pressure monitor was used to measure tissue pressures under the tourniquet cuff. In all patients, the soft tissue pressures were consistently lower than the applied tourniquet inflation pressures. Our results revealed tissue padding coefficients for extremities 20 to 75 cm in circumferences. An estimation method of AOP was developed [AOP = (systolic blood pressure + 10)/Tissue padding coefficient]. The new AOP estimation method may be a simple, rapid, and clinically practical alternative to the AOP determination method.


颅脊神经媒介大鼠经颅电刺激法中的抗伤害作用

The Role of the Craniospinal Nerves in Mediating the Antinociceptive Effect of Transcranial Electrostimulation in the Rat

Vladimir Nekhendzy, MD, M. Frances Davies, PhD, Hendrikus J. M. Lemmens, MD, PhD, and Mervyn Maze, MB, ChB, FRCP, FRCA

Department of Anesthesiology, Stanford University School of Medicine, Stanford, California; Department of Anaesthetics and Intensive Care, Imperial College, London and Chelsea and Westminster NHS Hospital Trust, London, UK

Anesth Analg 2006 102: 1775-1780.

 

已有报道显示经颅电刺激疗法(TES)具有显著的镇痛作用,但它的作用机制尚未阐明。从最近临床上关于TES的鼠模型介绍中作者已验证TES的抗伤害作用,提示鼠的头皮感觉神经起间接作用。在这个研究中,作者试图通过在TES的电极下行局部浸润麻醉以阻断TES的抗伤害作用来研究颅脊神经的作用。通过TES电极应用各种不同的经皮电神经刺激方式来比较TES的抗伤害作用的差异。用清醒的未限制活动的雄鼠进行实验,在清醒状态下用甩尾的潜伏期来测量伤害性疼痛的阈值以评估TES的抗伤害作用。数据用Bonferroni t-检验单变量检验分析。TES的抗伤害作用在局麻后明显减少,给予100赫兹的经皮电神经刺激后能长时间产生相同深度的抗伤害作用。结论:颅脊神经在TES的间接抗伤害作用中起了重要的作用,也提供了这种作用的潜在机制的假设。

(张美荣 译 陈杰 校)

Transcranial electrostimulation (TES) has been reported to elicit significant analgesia, but its mechanism of action has not been elucidated. In a recently introduced clinically relevant rat model of TES we have validated and characterized the TES antinociceptive effect, suggesting involvement of the sensory nerves of the rat's scalp in mediating that effect. In this study, we have further investigated the role of the craniospinal nerves by attempting to block the TES antinociceptive effect with local anesthetic injected under the TES electrodes. We also applied different transcutaneous electrical nerve stimulation modalities through the TES electrodes and compared the elicited antinociceptive effect to that of TES. The antinociceptive effect was assessed by measuring nociceptive thresholds in the tail-flick latency test in awake, unrestrained male rats. Data were analyzed by one-way analysis of variance followed by the Bonferroni t-test. The TES antinociceptive effect was significantly reduced after local anesthetic injection, and administration of 100 Hz transcutaneous electrical nerve stimulation was, over time, capable of eliciting the same degree of antinociceptive effect as TES. We conclude that sensory craniospinal nerves play a critical role in mediating the TES antinociceptive action and offer a hypothesis on the underlying mechanism(s) responsible for this action.

 

志愿受试者急性疼痛期间乙琥红霉素促进胃排空

Erythromycin Promotes Gastric Emptying During Acute Pain in Volunteers

Lionel Bouvet, MD, Frédéric Duflo, MD, Nathalie Bleyzac, PharmD, François Mion, MD, PhD, Emmanuel Boselli, MD, Bernard Allaouchiche, MD, PhD, and Dominique Chassard, MD, PhD

Department of Anesthesiology and Intensive Care, and Laboratory of Pathophysiology in Anesthesiology and Intensive Care (EA 18/96), Hôpital de l'Hôtel-Dieu; Department of Pharmacy, Hôpital Debrousse; Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France

Anesth Analg 2006 102: 1803-1808. [

 

在本双盲交叉研究中,作者假设使用乙琥红霉素能作为一种促进胃动力药来防治急性疼痛引起的胃轻瘫。7名标准化急性疼痛的志愿者来评估乙琥红霉素对于胃排空(GE)的效应。辛酸呼吸实验来测定固体的胃排空率。对乙酰氨基酚吸收试验测定液体的胃排空率。摄入13C-标记的食物5min后,受试者随机成为实验组(安慰剂和乙琥红霉素组)和对照刺激(对照组)包括每分钟重复将手浸入4°C (实验) or 37°C (对照) 水中,两次间隔15S。当实验开始,输注250mL生理盐水(对照组和安慰剂组)250mg乙琥红霉素(乙琥红霉素组)。以视觉评分来评估疼痛和应激状态,实验自始至终记录标准的血液动力学参数。结果显示急性应激降低固体的胃排空,但是和安慰剂组相比乙琥红霉素可以显著促进胃排空。液体的胃排空率3组相似。作者推断乙琥红霉素可以作为一种有效的促进胃运动的药物来用于急性疼痛。

(潘志英 译 陈杰 校)

In this double-blind cross-over study, we assessed whether erythromycin infusion is effective as a prokinetic drug against gastroparesis from acute pain. The effect of erythromycin on gastric emptying (GE) was measured in seven volunteers subjected to a standardized acute painful stimulus. The GE rate for solids was measured using the octanoic acid breath test. An acetaminophen absorption test measured the GE rate for liquids. Five minutes after ingestion of a 13C-labeled meal, the subjects received in randomized order either a test (placebo and erythromycin groups) or a control (control group) stimulus consisting of repeated 1-min immersion of a hand into 4°C (test) or 37°C (control) water, with 15 s for recovery between immersions, for a total of 20 min. While the stimulus was applied, 250 mL saline (control and placebo groups) or 250 mg erythromycin (erythromycin group) was infused. Pain and stress were evaluated using visual analog scales, and standard hemodynamic values were recorded throughout the study. Our results show that acute stress decreased GE for solids, which was significantly accelerated in the erythromycin group in comparison with the placebo group. GE for liquids was similar in the three groups. We conclude that erythromycin is effective as a prokinetic drug for solids in acute painful situations.


吲哚美辛对有颅内高压的绵羊接受异丙酚或异氟醚麻醉中对颅内压和脑血流动力学的影响

The Effects of Indomethacin on Intracranial Pressure and Cerebral Hemodynamics During Isoflurane or Propofol Anesthesia in Sheep with Intracranial Hypertension

Mads Rasmussen, MD, PhD*{dagger}, Richard N. Upton, BSc, PhD*, Cliff Grant, MMedSc*, Allison M. Martinez*, Georg E. Cold, MD, PhD{dagger}, and Guy Ludbrook, MD, FANZCA, PhD*

*Department of Anesthesia and Intensive Care, Royal Adelaide Hospital/University of Adelaide, North Terrace, Australia; and {dagger}Department of Neuroanesthesia, Århus University Hospital, Denmark

Anesth Analg 2006 102: 1823-1829.

吲哚美辛降低颅内压的作用或许取决于麻醉用药。作者在有颅内高压的绵羊在接受异丙酚或异氟醚麻醉时,吲哚美辛对颅内压和脑血流的影响。六只随机接受异氟醚或异丙酚麻醉的绵羊用交叉设计方法进行研究。麻醉深度通过动物反应和状态熵来测定。在静脉注射吲哚美辛前后的特定的时间测定CBFICP,平均动脉压,动静脉氧分压差,PaCO2。两种麻醉中动物反应和状态熵相似。在两组麻醉中,异氟醚和异丙酚组CBF降低分别为11%34%。吲哚美辛在两组麻醉用药之后的15秒产生了ICP的下降作用,ICP的降低异氟醚组更为显著(P = 0.009)。在两组麻醉中,吲哚美辛导致平均动脉压增加和CBF较用药前降低17%(异氟醚组)和14%(异丙酚组)。异氟醚组在CBF上的降低作用要明显大于异丙酚组。对ICP的影响,异氟醚更为明显。作者认为吲哚美辛的作用部分通过自身调节反应产生的。

(郑丽 译 陈杰 校)

The effect of indomethacin in reducing intracranial pressure (ICP) may be dependent on the choice of anesthetic regimen. We studied the effects of indomethacin on ICP and cerebral blood flow (CBF) during isoflurane or propofol anesthesia in a sheep model of intracranial hypertension. A crossover design was applied in which six sheep were anesthetized with isoflurane and propofol in a random order. Anesthetic depth was measured with response and state entropy. Changes in CBF, ICP, mean arterial blood pressure, arterio-venous oxygen difference, and Paco2 were measured at specific times before and after an IV indomethacin bolus (0.2 mg/kg). Response and state entropy values during anesthesia were similar in both groups. Isoflurane and propofol reduced CBF by 11% and 34%, respectively. Indomethacin caused a reduction in ICP within 15 s during both anesthetic regimens, with the decrease in ICP being significantly more pronounced during isoflurane (P = 0.009). In both anesthetic groups, indomethacin caused a simultaneous increase in mean arterial blood pressure and a further 17% versus 14% decrease in CBF from predrug values for isoflurane and propofol, respectively. The reduction in CBF was significantly more pronounced for propofol (P = 0.02). The effect on ICP, however, was most pronounced during isoflurane anesthesia. We suggest that the effect of indomethacin is partly mediated by an autoregulatory response.


年龄对罗哌卡因硬膜外麻醉后运动阻滞中位有效浓度的影响

The Effects of Age on the Median Effective Concentration of Ropivacaine for Motor Blockade After Epidural Anesthesia with Ropivacaine

Yuhong Li, PhD, Shengmei Zhu, PhD, Fangping Bao, MS, Jianhong Xu, MS, Xiang Yan, MS, and Xudong Jin, MS

Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Peoples Republic of China

Anesth Analg 2006 102: 1847-1850.

局麻药最小镇痛浓度定义为中位有效浓度(EC50)。在这项研究中,泌尿科或下肢小手术的病人中,作者致力于研究年龄对运动阻滞的影响并确定老年病人硬膜外注入罗哌卡因后运动阻滞的EC50。将ASA I-II级的病人分入两个年龄组(组I:≥70岁;组II<70岁)。每一组硬膜外注入15ml罗哌卡因,不加肾上腺素。每组的第一个病人使用0.425%的浓度。使用上下顺序分配来决定后一个的使用浓度。试验浓度间隔是0.025%。有效运动阻滞的标准是30分钟内Bromage评分>0。罗哌卡因运动阻滞的EC50第一组是0.383%(95%可信区间,0.385%-0.409%),第二组是0.536%(95%可信区间,0.512%-0.556%)(p<0.01)。结论:年龄是罗哌卡因硬膜外麻醉运动阻滞EC50的一项决定因素。

(曹瑜 译 陈杰 校)

Minimal local analgesic concentrations have been defined as the median effective concentration (EC50). In this study, we sought to examine the effect of age on motor blockade and determine the motor block EC50 of elderly patients after epidural administration of ropivacaine in patients undergoing urological or minor lower limb surgery. ASA physical status III patients were enrolled in 1 of 2 age groups (Group 1: ≥70 yr; Group 2: <70 yr). Each received a 15-mL bolus of epidural ropivacaine without epinephrine. The first patient in each group received 0.425%. Up-down sequential allocation was used to determine subsequent concentrations at a testing interval of 0.025%. Effective motor blockade was defined as a modified Bromage score >0 within 30 min. The motor blockade EC50 of ropivacaine was 0.383% (95% confidence interval, 0.358%0. 409%) in group 1 and 0.536% (95% confidence interval, 0.512%0.556%) in group 2 (P < 0.01). We conclude that age is a determinant of motor blockade EC50 of ropivacaine with epidural administration.

 

体位影响手灵巧度
Body Position Affects Manual Dexterity

Charles W. Buffington, MD*, Stanley D. MacMurdo, MD*, and Christopher M. Ryan, PhD{dagger}

Departments of *Anesthesiology and {dagger}Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

Anesth Analg 2006 102: 1879-1883.

 

为评估姿势和精神运动功效两者之间的关系,20例麻醉医生参加了这项实验。检测每位医生分别在坐着、跪着和站着腰部向前弯曲这三个体位时,体位对手灵巧度和眼-手协调性的影响。受试者在坐位时较其它体位的工作效率(用Grooved Pegboard Test评价)改善6-10%(P<0.005)。除了坐位外,其它体位都会使受试者感到疼痛和不适。坐位改善手灵巧度在低分操作者较高分操作者更显著。本研究表明受试者处于一个较为舒适的坐位时,可改善其手灵巧度。
(肖洁 译 陈杰 校)

To evaluate the relationship between posture and psychomotor efficiency, 20 anesthesia providers performed a test requiring manual dexterity and eye-hand coordination while seated, kneeling, and standing bent forward at the waist. Performance on the Grooved Pegboard Test improved 6%10% (P < 0.005) when subjects were seated compared to kneeling and standing bent at the waist, positions that the subjects rated as more painful and less comfortable than sitting. Sitting improved manual dexterity more in subjects with poor scores than it did in subjects with good performance. This study demonstrates improved manual dexterity in subjects seated in a comfortable position.

 

体外循环期间人体空肠粘膜灌注的自身调节

Autoregulation of Human Jejunal Mucosal Perfusion During Cardiopulmonary Bypass

Andreas Nygren, MD, Anders Thorén, MD, PhD, Erik Houltz, MD, PhD, and Sven-Erik Ricksten, MD, PhD

Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg Sweden

Anesth Analg 2006;102:1617-1622

 

动物研究已提示小肠血流的自身调节在体外循环(CPB)期间遭到严重的损害。我们研究了10例行择期心脏手术的患者非搏动血流CPB (34°C)期间空肠粘膜对灌注的自身调节功能。随机改变CPB流速从2.4 L/min/m2 1.8或者 3.0 L/min/m2持续3分钟,引起平均动脉压(MAP)变化。用激光多普勒血流仪持续记录空肠粘膜灌注(JMP)。在CPB期间所有患者都记录到典型的流量变化(血管舒缩运动)模式。在平均动脉压在50 ± 15 ~74 ± 16 mm Hg 范围内,CPB流速的变化没有引起平均JMP、空肠粘膜红细胞压积及红细胞流速的显著变化。血管运动频率和幅度与CPB流速呈正相关。静脉输注环前列腺素(10 µg, Flolan®),尽管MAP 59 ± 12降至 45 ± 10 mm Hg (P < 0.05),但能抑制血管运动,并增加JMP192 ± 53 277 ± 70 (P < 0.05) 灌注单位。环前列腺素诱导的血管舒张导致粘膜自身调节(压力依赖性灌注)减弱。我们得出结论,在人体CPB期间小肠粘膜灌注的自身调节能够维持。

(彭中美 译 马皓琳 李士通 校)

Animal studies have suggested that autoregulation of intestinal blood flow is severely impaired during cardiopulmonary bypass (CPB). We investigated the jejunal mucosal capacity to autoregulate perfusion during nonpulsatile CPB (34°C) in 10 patients undergoing elective cardiac surgery. Changes in mean arterial blood pressure (MAP) were induced by altering the CPB flow rate randomly for periods of 3 min from 2.4 L/min/m2 to either 1.8 or 3.0 L/min/m2. Jejunal mucosal perfusion (JMP) was continuously recorded by laser Doppler flowmetry. A typical pattern of flow motion (vasomotion) was recorded in all patients during CPB. Variations in CPB flow rates caused no significant changes in mean JMP, jejunal mucosal hematocrit, or red blood cell velocity within a range of MAP from 50 ± 15 to 74 ± 16 mm Hg. The vasomotion frequency and amplitude was positively correlated with CPB flow rate. IV injections of prostacyclin (10 µg, Flolan®) blunted vasomotion and increased JMP from 192 ± 53 to 277 ± 70 (P < 0.05) perfusion units despite a reduction in MAP from 59 ± 12 to 45 ± 10 mm Hg (P < 0.05). Prostacyclin-induced vasodilation resulted in loss of mucosal autoregulation (pressure-dependent perfusion). We conclude that autoregulation of intestinal mucosal perfusion is maintained during CPB in humans.

 

 

N-乙酰半胱氨酸对腹主动脉手术中肾功能受损的预防作用:一个随机、双盲、安慰剂对照试验

N-Acetylcysteine for the Prevention of Kidney Injury in Abdominal Aortic Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Marja S. Hynninen, MD, PhD, Tomi T. Niemi, MD, PhD, Reino Pöyhiä, MD, PhD, Elina I. Raininko, MD, Markku T. Salmenperä, MD, PhD, Mauri J. Lepäntalo, MD, PhD, Mikael J. Railo, MD, PhD, and Minna K. Tallgren, MD, PhD

Department of Anesthesia and Intensive Care Medicine, Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland

Anesth Analg 2006;102:1638-1645

 

在这项前瞻性的、随机、双盲、安慰组对照的试验中,我们研究了静脉注射N-乙酰半胱氨酸对腹主动脉手术病人肾功能损伤的预防作用。70个无肾功能受损既往史的病人随机分配接受N-乙酰半胱氨酸(150 mg/kg混合在250 mL 5%的葡萄糖中注射20 min,随后150 mg/kg混合在250 mL 5%的葡萄糖中输注24 h)或安慰剂。麻醉诱导后开始输注。主要检测结果为肾功能的损伤,通过测得的尿N-乙酰-ß-d-氨基葡糖苷酶 (NAG)/肌酐比(肾小管损伤的标志)增加及尿白蛋白/肌酐比(肾小球损伤的标志)增加来反映。通过测定血浆肌酐及血清半胱氨酸蛋白酶抑制剂Ccystatin C)浓度来评估肾功能。两组病人从基础值到腹主动脉夹闭前,尿NAG/肌酐比显著增加,并持续升高至术后第5天。N-乙酰半胱氨酸组从基础值到松夹后6 h尿白蛋白/肌酐比显著增加。然而,两组间NAG/肌酐比及白蛋白/肌酐比无明显差别。在研究阶段两组的血浆肌酐及血清cystatin C值保持不变。结论,对于术前肾功能正常的病人,在择期行大动脉手术期间N-乙酰半胱氨酸未能对肾功能提供任何明显的保护作用,肾小管的某些程度损伤看来发生于大动脉夹闭前。

(裘毅敏 马皓琳 李士通 校)

In this prospective, randomized, placebo-controlled, double-blind trial we studied the effects of IV N-acetylcysteine for prevention of renal injury in patients undergoing abdominal aortic surgery. Seventy patients without previously documented renal dysfunction were randomly allocated to receive either N-acetylcysteine (150 mg/kg mixed in 250 mL of 5% dextrose infused in 20 min, followed by an infusion of 150 mg/kg in 250 mL of 5% dextrose over 24 h) or placebo. The infusion was started after the induction of anesthesia. The primary outcome measure was renal injury as measured by the increases in urinary N-acetyl-ß-d-glucosaminidase (NAG)/creatinine ratio (indicator of renal tubular injury) and urinary albumin/creatinine ratio (indicator of glomerular injury). Renal function was assessed by measuring plasma creatinine and serum cystatin C concentrations. The urinary NAG/creatinine ratio increased significantly from baseline to before crossclamp and remained increased on day 5 in both groups. The urinary albumin/creatinine ratio increased significantly from baseline to 6 h after declamping in the N-acetylcysteine group. However, the changes in the NAG/creatinine ratio and the albumin/creatinine ratio were not significantly different between the two groups. Plasma creatinine and serum cystatin C values remained unchanged during the study period in both groups. In conclusion, N-acetylcysteine did not offer any significant protection from renal injury during elective aortic operation in patients with normal preoperative renal function, and some degree of tubular injury seems to occur before aortic crossclamp.

 

 

儿科脊柱侧突手术中瑞芬太尼输注过程中急性阿片类药物耐受的发生

Development of Acute Opioid Tolerance During Infusion of Remifentanil for Pediatric Scoliosis Surgery

Mark W. Crawford, MBBS, FRCPC, Chantal Hickey, MD, FRCPC, Christian Zaarour, MD, Andrew Howard, MD, FRCSC, and Basem Naser, MBBS, FRCPC

Department of Anesthesia, Division of Orthopedic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Anesth Analg 2006;102:1662-1667

 

我们检验了在进行脊柱侧突手术的青少年中连续术中输注瑞芬太尼会造成临床上相关的急性阿片类药物耐受的假设。我们将三十个青少年病人随机分成两组接受不同的术中镇痛方案,一组连续输注瑞芬太尼,另一组只间断给予吗啡。用病人可以自己给予吗啡的病人自控镇痛装置来评估术后镇痛药的消耗量。术后吗啡的消耗累积总量、疼痛评分和镇静评分由一位不知情的研究者记录,术后最初四小时每小时记录一次,以后的二十小时每四小时记录一次。在术后24小时的每个时间点瑞芬太尼组的吗啡累积消耗量均显著超过吗啡组(P<0.001)。术后24小时吗啡的累积消耗量在瑞芬太尼组(1.65 ± 0.41 mg/kg)比吗啡组(1.27 ± 0.32 mg/kg)30%(差异的95%可信区间为0.11~0.65 mg/kg)。两组之间的疼痛评分和镇静评分的差异没有统计学意义。这些数据提示了青少年在脊柱侧突手术中连续输注瑞芬太尼会造成临床上相关的急性阿片类药物耐受的发展。

(姜旭晖 马皓琳 李士通 校)

We tested the hypothesis that continuous intraoperative infusion of remifentanil is associated with the development of clinically relevant acute opioid tolerance in adolescents undergoing scoliosis surgery. Thirty adolescents were randomly assigned to receive an intraoperative analgesic regimen consisting of continuous remifentanil infusion or intermittent morphine alone. Postoperative analgesic consumption was assessed with a patient-controlled analgesia device that was used to self-administer morphine. Cumulative postoperative morphine consumption, pain scores, and sedation scores were recorded by a blinded investigator every hour for the first 4 h postoperatively and then every 4 h for a total of 24 h. Cumulative morphine consumption in the remifentanil group was significantly more than that in the morphine group at each time point in the initial 24 h after surgery (P < 0.0001). At 24 h after surgery, cumulative morphine consumption was 30% greater in the remifentanil group (1.65 ± 0.41 mg/kg) than in the morphine group (1.27 ± 0.32 mg/kg) (95% confidence interval for the difference, 0.11 to 0.65 mg/kg). Differences in pain and sedation scores were not statistically significant. These data suggest that intraoperative infusion of remifentanil is associated with the development of clinically relevant acute opioid tolerance in adolescents undergoing scoliosis surgery.

 

 

在儿科麻醉中超声波引导下的髂腹股沟/髂腹下神经阻滞:最佳容量是多少?

Ultrasonographic-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Anesthesia: What is the Optimal Volume?

H. Willschke, MD*, A. Bösenberg, MBChB, FFA(SA){ddagger}, P. Marhofer, MD*, S. Johnston, MBChB, FCA(SA){ddagger}, S. Kettner, MD*, U. Eichenberger, MD§, O. Wanzel, MD{dagger}, and S. Kapral, MD*

*Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna; {dagger}Division of Anesthesia and Intensive Care Medicine, Orthopedic Hospital Gersthof, Vienna, Austria; {ddagger}Department of Anesthesia, Red Cross Children's War Memorial Hospital, University Cape Town, South Africa; and §Department of Anaesthesia, Inselspital Bern, Switzerland

Anesth Analg 2006;102:1680-1684

 

最近我们的研究组已经证实了在小儿髂腹股沟/髂腹下神经阻滞中超声波引导的有效性。因此我们设计了一个后续研究来评定用于这个区域麻醉技术的局麻药最佳用量。每个研究组有十个小儿,在超声波引导下进行髂腹股沟/髂腹下神经阻滞,用修正的上调下调方法,给予的开始剂量为0.25%左旋布比卡因0.2 mL/kg。在每组的10例后分析结果,如果所有的阻滞都满意的话,我们就再增加10个小儿进行研究并将局麻药用量减少50%。如果一组没有达到100%的成功率,我们就将下一组的用量增加一半。用0.25%左旋布比卡因0.2 0.1 mL/kg时,成功率为100%。用量为 0.25%左旋布比卡因0.05mL/kg时,10个小儿中有4个因为阻滞不全需要追加镇痛。因此,依据方案将用量增大到0.25%左旋布比卡因0.075mL/kg,这一次成功率又达到了100%。我们得出结论,用于小儿髂腹股沟/髂腹下神经阻滞的超声波引导使局麻药用量减少到0.075mL/kg

(姜旭晖译,马皓琳 李士通校)

Recently, our study group demonstrated the usefulness of ultrasonographic guidance in ilioinguinal/iliohypogastric nerve blocks in children. As a consequence, we designed a follow-up study to evaluate the optimal volume of local anesthetic for this regional anesthetic technique. Using a modified step-up-step-down approach, with 10 children in each study group, a starting dose of 0.2 mL/kg of 0.25% levobupivacaine was administered to perform an ilioinguinal/iliohypogastric nerve block under ultrasonographic guidance. After each group of 10 patients, the results were analyzed, and if all blocks were successful, the volume of local anesthetic was decreased by 50%, and a further 10 patients were enrolled into the study. Failure to achieve a 100% success rate within a group subjected patients to an automatic increase of half the previous volume reduction to be used in the subsequent group. Using 0.2 and 0.1 mL/kg of 0.25% levobupivacaine, the success rate was 100%. With a volume of 0.05 mL/kg of 0.25% levobupivacaine, 4 of 10 children received additional analgesia because of an inadequate block. Therefore, according to the protocol, the amount was increased to 0.075 mL/kg of 0.25% levobupivacaine, where the success rate was again 100%. We conclude that ultrasonographic guidance for ilioinguinal/iliohypogastric nerve blocks in children allowed a reduction of the volume of local anesthetic to 0.075 mL/kg.

 

 

年龄增长延长成年人七氟醚/笑气诱导的起效时间

Onset Time for Sevoflurane/Nitrous Oxide Induction in Adults Is Prolonged with Increasing Age

Michael C. Lewis, MD, Ricardo I. Gerenstein, MD, and Gilbert Chidiac, MD

Department of Anesthesiology, University of Miami, Miami, Florida; Division of Anesthesiology, Cleveland Clinic Florida, Weston Florida

Anesth Analg 2006;102:1699-1702

 

吸入诱导麻醉偶尔应用于成人。我们用改良肺活量法七氟醚/笑气吸入诱导,评估年龄增长对麻醉起效时间的影响。20个病人,年龄26-65岁,从预充有8%七氟醚/N2O/O2的麻醉环路中进行一个肺活量呼吸后,再行常规潮气量呼吸。记录以下参数:睫毛反射消失时间(LOER);双频指数60时间(BIS60);诱导时、LOER时和BIS60时七氟醚呼出浓度。LOER BIS60平均时间和95%可信区间分别为54 s(37-70 s)175 s(143-207 s),并显著随年龄增长而延长(r = 0.65; P = 0.002)。从回归曲线可以预测60岁病人的LOERBIS60的时间比30岁的病人分别延长3.9倍和2倍。LOERBIS60时七氟醚呼出浓度随着年龄增加而减少。我们得出结论,年龄增长显著延长七氟醚/笑气吸入诱导。

(张 曦 译,马皓琳 李士通 校)

Inhaled induction of anesthesia is occasionally used in adults. Using a modified vital capacity sevoflurane/nitrous oxide (N2O) inhaled induction, we evaluated the effect of increasing age on the onset time of anesthesia. Twenty patients, aged 26-65 yr, performed a vital capacity breath followed by regular tidal breathing from an anesthesia circuit primed with sevoflurane 8%/N2O/O2. The following values were recorded: time to loss of eyelash reflex (LOER); time to bispectral index ≤60 (BIS ≤60); expired fraction of sevoflurane at the time of induction, LOER and BIS ≤60. The mean times and 95% confidence intervals to LOER and BIS ≤60 were 54 s (37-70 s) and 175 s (143-207 s), respectively, and were significantly prolonged by aging (r = 0.65; P = 0.002). Times to LOER and BIS ≤60, predicted from the regression line, were 3.9 and 2 times longer in a 60-yr-old than in a 30-yr-old patient. The expired fraction of sevoflurane measured at time to LOER and BIS ≤60 decreases with increase in age. We conclude that inhaled induction with sevoflurane/N2O is dramatically prolonged with increased age.

 

 

氙气对兔肌原性动作诱发电位的作用:与丙泊酚和异氟醚的比较

The Effects of Xenon on Myogenic Motor Evoked Potentials in Rabbits: A Comparison with Propofol and Isoflurane

Yuri Yamamoto, MD, Masahiko Kawaguchi, MD, Meiko Kakimoto, MD, Masahiro Takahashi, MD, Satoki Inoue, MD, Takahisa Goto, MD, and Hitoshi Furuya, MD

Department of Anesthesiology, Nara Medical University, Nara, Japan; Department of Anesthesia, Teikyo University, School of Medicine, Tokyo, Japan

Anesth Analg 2006;102:1715-1721

 

本研究比较了氙气、丙泊酚和异氟醚对氯胺酮/芬太尼麻醉下兔肌原性动作诱发电位(MEPs)的不同作用。30只实验动物随机分为3组(每组10只)。丙泊酚组动物给予丙泊酚0.4 mg·kg1·min1(小剂量组)和0.8 mg·kg1·min1 (大剂量组)。异氟醚组动物给予异氟醚0.8%(小剂量组)和1.6%(大剂量组)。氙气组给予氙气35%(小剂量组)和70%(大剂量组)。在每种麻醉给药之前、给药过程中(小剂量组和大剂量组)和给药之后记录单脉冲和5个成串脉冲刺激比目鱼肌引起的肌原性MEPs。单脉冲刺激下,氙气小剂量组和大剂量组分别有90%和50%动物的MEPs可被记录到,且氙气组和异氟醚组MEP振幅显著低于丙泊酚组。在成串脉冲刺激下,氙气小剂量组和大剂量组分别有100%和90%动物的MEPs可被记录到,且氙气组MEP振幅减小程度比丙泊酚组显著,但小于异氟醚大剂量组。上述结果提示尽管氙气对于肌原性MEPs具有抑制作用,氙气麻醉时采用多脉冲刺激进行MEP记录还是可行的。

(周雅春 译 马皓琳 李士通 校)

We compared the effects of xenon on myogenic motor evoked potentials (MEPs) with those of propofol and isoflurane in rabbits under ketamine/fentanyl anesthesia. Thirty animals were randomly allocated to one of 3 groups (n = 10 in each group). In the propofol group, propofol was administered at a rate of 0.4 mg · kg1 · min1 (small) and 0.8 mg · kg1 · min1 (large). In the isoflurane group, isoflurane was administered at 0.8% (small) and 1.6% (large). In the xenon group, xenon was administered at 35% (small) and 70% (large). Myogenic MEPs in response to stimulation with single pulse and a train of 5 pulses were recorded from the soleus muscle before, during (at small and large doses), and after the administration of each anesthetic. With single-pulse stimulation, MEPs were recorded in 90% and 50% of animals at small and large doses of xenon, respectively, and MEP amplitudes in the xenon and isoflurane groups were significantly lower compared with those in the propofol group. With train pulse stimulation, MEPs were recorded in 100% and 90% of animals at small and large doses of xenon, respectively, and a reduction in MEP amplitudes by xenon was more prominent than by propofol but less than isoflurane at large doses. These results suggest that MEP recording may be feasible under xenon anesthesia if multipulse stimulation is used, although xenon has suppressive effects on myogenic MEPs.

 

 

使离体鳌虾巨轴突传导阻滞的利多卡因和布比卡因的细胞内浓度的比较

A Comparison of Intracellular Lidocaine and Bupivacaine Concentrations Producing Nerve Conduction Block in the Giant Axon of Crayfish In Vitro

Takeshi Yano, MD, Shoichiro Ibusuki, MD, and Mayumi Takasaki, MD

Department of Anesthesiology, Faculty of Medicine, University of Miyazaki, Kiyotake-Cho, Japan

Anesth Analg 2006;102:1734-1738

 

临床上,利多卡因需要比布比卡因高的浓度才能阻滞神经。布比卡因比利多卡因的脂溶性高、组织穿透性好、对钠通道的结合力更强,导致其麻醉强度更高。局麻药需要从细胞内环境接近钠通道。在本研究中,我们目的是确定利多可因和布比卡因在鳌虾巨轴突产生神经阻滞时的细胞内浓度。使用利多卡因或者布比卡因溶液灌流,通过对强直或相位电刺激不产生诱发动作电位来确定神经阻滞。用利多卡因或者布比卡因敏感性玻璃微电极来测定细胞内利多卡因或布比卡因浓度。与利多卡因相比,较小浓度布比卡因产生相位阻滞更有效、更快。在神经传导已经阻滞时,利多卡因的细胞内浓度和细胞内/胞外浓度比显著高于布比卡因。这些发现说明布比卡因比利多卡因强度高,至少在离体鳌虾巨轴突上如此。现有结果提示与利多卡因相比,布比卡因是更强的神经阻滞剂,且在较低浓度即可产生效用依赖性的(相位性)阻滞。

(颜涛 译, 马皓琳 李士通校)

Clinically, lidocaine requires a larger concentration than bupivacaine to block nerves. Bupivacaine has a higher lipid solubility, tissue permeability, and affinity for sodium channels than lidocaine, resulting in greater anesthetic potency. Local anesthetics require access to the sodium channel from the intracellular milieu. In this study, we sought to determine the intracellular concentration of lidocaine and bupivacaine when a nerve was blocked in the giant axon of a crayfish. A solution of lidocaine or bupivacaine was perfused, and a nerve block was determined as the absence of an evoked action potential after tonic or phasic electrical stimulation. The intracellular lidocaine or bupivacaine concentration was measured using a lidocaine- or bupivacaine-sensitive glass micro-electrode. A phasic block was more effectively and rapidly achieved with a smaller concentration of bupivacaine than with lidocaine. The intracellular concentration and intra- to extracellular ratios were significantly larger with lidocaine than with bupivacaine when nerve conduction was blocked. These findings suggest that bupivacaine has a higher potency than lidocaine, at least in the giant axon of a crayfish in vitro. The implications of the present results are that bupivacaine is a more potent nerve block and produces a use-dependent (phasic) block at smaller concentrations than lidocaine.

 

 

传统动脉血气分析研究动脉氧分压波动的含义

The Implications of Arterial Po2 Oscillations for Conventional Arterial Blood Gas Analysis

Birgit Pfeiffer, MD, Rebecca S. Syring, DVM, Klaus Markstaller, MD, Cynthia M. Otto, DVM, PhD, and James E. Baumgardner, MD, PhD

Department of Anesthesia, Section of Critical Care, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology, Johannes Gutenberg University, Mainz, Germany; SpectruMedix LLC, State College, Pennsylvania; Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany

Anesth Analg 2006;102:1758-1764

 

在一个没有肺泡表面活性物质的肺损伤模型,潮气性的肺不张范围波动和分流率变化可以导致动脉氧分压(PaO2)产生很大的波动。我们以人工通气的兔子为模型,采用不同采样技术研究这种波动对传统动脉血气(ABG)分析结果的影响。每只兔子均给予了5种不同的通气设置,2种是在盐水灌洗肺损伤之前,3种是在盐水灌洗之后。在一种头臂动脉内快速反应探头的指导下,根据要达到的PaO2幅度和平均值波动的5种不同目标,改变通气机设置。在PaO2波动的峰顶和谷底,或者几个呼吸周期定时采集血样进行动脉血气分析。在肺损伤之前,PaO2波动很小,采样时间的选择并不影响PaO2。在盐水肺灌洗之后,动脉内氧探头测得的氧分压波动确认有肺不张潮气性改善存在时,传统动脉血气的PaO2在改善峰顶(295 ± 130 mm Hg)明显较谷底(74 ± 15 mm Hg)和平均值要高(125 ± 75 mm Hg)。盐水灌洗后,早期轻微肺损伤,在呼吸周期的不同时间氧分压变化即很大。在每次呼吸使肺不张膨胀时,由传统血气得出的分流率,在解释其变化时应该考虑到呼吸因素对动脉氧分压潜在的巨大的影响。

(张莹 译 马皓琳 李士通 校)

In a surfactant-depletion model of lung injury, tidal recruitment of atelectasis and changes in shunt fraction lead to large Pao2 oscillations. We investigated the effect of these oscillations on conventional arterial blood gas (ABG) results using different sampling techniques in ventilated rabbits. In each rabbit, 5 different ventilator settings were studied, 2 before saline lavage injury and 3 after lavage injury. Ventilator settings were altered according to 5 different goals for the amplitude and mean value of brachiocephalic Pao2 oscillations, as guided by a fast responding intraarterial probe. ABG collection was timed to obtain the sample at the peak or trough of the Pao2 oscillations, or over several respiratory cycles. Before lung injury, oscillations were small and sample timing did not influence Pao2. After saline lavage, when Po2 fluctuations measured by the indwelling arterial Po2 probe confirmed tidal recruitment, Pao2 by ABG was significantly higher at peak (295 ± 130 mm Hg) compared with trough (74 ± 15 mm Hg) or mean (125 ± 75 mm Hg). In early, mild lung injury after saline lavage, Pao2 can vary markedly during the respiratory cycle. When atelectasis is recruited with each breath, interpretation of changes in shunt fraction, based on conventional ABG analysis, should account for potentially large respiratory variations in arterial Po2.

 

 

吗啡-6-葡萄糖醛酸:用于术后镇痛的吗啡代替品

Morphine-6-Glucuronide: Morphine's Successor for Postoperative Pain Relief?

Eveline L. A. van Dorp, MSc, Raymonda Romberg, MD, PhD, Elise Sarton, MD, PhD, James G. Bovill, MD, PhD, and Albert Dahan, MD, PhD

Department of Anesthesiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands

Anesth Analg 2006;102:1789-1797

 

在探索比吗啡副作用少的镇痛药时,对吗啡的活性代谢产物吗啡-6-葡萄糖醛酸(M6G)的检查显示其可能就是这样一个药物。和吗啡相反,M6G不经过代谢,但通过肾脏排泄,并且显示出肠肝循环,因为它是存在于肝和肠中的多药耐受传递蛋白的底物。M6G显示出延迟性镇痛效应(血-效应部位平衡半衰期48h),这部分与其通过血脑屏障及在脑室间分布速度较慢有关。在人体,M6G的效价只有吗啡的一半。在临床研究中,M6G能被很好耐受并且可产生足够且长效的术后镇痛。在镇痛剂量范围内,M6G和等效镇痛剂量吗啡相比,可产生相似程度的二氧化碳通气反应降低,但是对低氧通气反应的抑制显著较小。初步数据提示,M6G恶心呕吐的发生率低于吗啡,在术后及实验环境中分别可减少50%和75%。尽管文献资料的数据很有说服力,我们相信仍需要更多的研究以证明M6G在术后镇痛方面优于吗啡。

(黄佳佳译 马皓琳 李士通校)

In searching for an analgesic with fewer side effects than morphine, examination of morphine's active metabolite, morphine-6-glucuronide (M6G), suggests that M6G is possibly such a drug. In contrast to morphine, M6G is not metabolized but excreted via the kidneys and exhibits enterohepatic cycling, as it is a substrate for multidrug resistance transporter proteins in the liver and intestines. M6G exhibits a delay in its analgesic effect (blood-effect site equilibration half-life 48 h), which is partly related to slow passage through the blood-brain barrier and distribution within the brain compartment. In humans, M6G's potency is just half of that of morphine. In clinical studies, M6G is well tolerated and produces adequate and long lasting postoperative analgesia. At analgesic doses, M6G causes similar reduction of the ventilatory response to CO2 as an equianalgesic dose of morphine but significantly less depression of the hypoxic ventilatory response. Preliminary data indicate that M6G is associated less than morphine with nausea and vomiting, causing 50% and 75% less nausea in postoperative and experimental settings, respectively. Although the data from the literature are very promising, we believe that more studies are necessary before we may conclude that M6G is superior to morphine for postoperative analgesia.

 

 

血浆N端-脑型利钠肽原水平作为危重病人预后的一个标记

Plasma Level of N Terminal Pro-Brain Natriuretic Peptide as a Prognostic Marker in Critically Ill Patients

Yaniv Almog, MD*, Victor Novack, MD{dagger}, Rinat Megralishvili, RN,CCRN*, Sergio Kobal, MD{ddagger}, Leonid Barski, MD{dagger}, Daniel King, MD{dagger}, and Doron Zahger, MD{ddagger}

*Medical Intensive Care Unit and the Departments of {dagger}Medicine and {ddagger}Cardiology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel

Anesth Analg 2006;102:1809-1815

 

我们对入住重症监护室时检测的N端-脑型利钠肽原(NT-pro BNP)是否能作为危重病人死亡率的独立预测指标进行了研究。我们实施了一项前瞻性的观察性群组研究,包括78APACHE II 评分大于12的患者。准入时对血清NT-pro BNP和心肌肌钙蛋白T进行检测,24h内行超声心动图检查。主要观察终点是30天死亡率。22例(28.2%)死亡患者的NT-pro BNP水平的中位数明显高于存活者(83281016 pg/mL; P = 0.001)。NT-pro BNP水平大于1900 pg/mL的患者死亡率明显增高(47.2%11.9%; P = 0.03),该组中到重度左室功能障碍的发生率(30.6%9.5%; P = 0.02)和心肌肌钙蛋白T水平异常的发生率也较高(33.3%14.3%; P = 0.05)APACHE-II校正后的多变量分析显示:NT-pro BNP水平高于1900 pg/mL是死亡率的一个独立预测指标。

(黄施伟 译,马皓琳 李士通 校)

We studied whether N-terminal pro brain natriuretic peptide (NT-pro BNP) measured at intensive care unit admission is an independent predictor of mortality in critically ill patients. We conducted a prospective observational cohort study enrolling 78 patients with APACHE II scores more than 12. Serum NT-pro BNP and cardiac troponin T were measured at admission, and echocardiography was performed within 24 h. The primary end-point was 30-day mortality. The median NT-pro BNP levels of the 22 (28.2%) patients who died were significantly more frequent than that of those who survived (8328 versus 1016 pg/mL; P = 0.001). Patients with NT-pro BNP levels more than 1900 pg/mL had significantly more frequent mortality (47.2% versus 11.9%; P = 0.03). This group also had more frequent moderate to severe left ventricular dysfunction (30.6% versus 9.5%; P = 0.02) and abnormal cardiac troponin T levels (33.3% versus 14.3%; P = 0.05). Multivariate analyses adjusted for APACHE-II revealed that a NT-pro BNP level more than 1900 pg/mL is an independent predictor of mortality.

 

 

地氟醚和七氟醚在稳态条件下对脑氧测定的影响

The Effect of Desflurane and Sevoflurane on Cerebral Oximetry Under Steady-State Conditions

Argyro Fassoulaki, MD, PhD, DEAA, Helen Kaliontzi, MD, George Petropoulos, MD, and Athanassia Tsaroucha, MD

Department of Anesthesiology, Aretaieion Hospital, Athens, Greece

Anesth Analg 2006;102:1830-1835

 

我们研究了七氟醚和地氟醚对局域脑氧合(rSO2)的影响。22例行腹式子宫切除术的病人在稳态条件下以随机交叉的方式间隔30 min吸入七氟醚和地氟醚各15min,以维持脑电双频指数(BIS)为4050。其余22例进行相同麻醉和手术的病人,BIS维持在2030。在稳态状态下吸入每个麻醉剂的15min内,每3min记录rSO2 BIS、吸入和呼气末麻醉剂浓度、呼气末二氧化碳分压、Spo2收缩压和舒张压及心率。当BIS值维持在40502030时,rSO2七氟醚与地氟醚之间无差异。维持BIS值在40502030所需的地氟醚和七氟醚MACBIS值分别为1.01.2 (P = 0.004)1.6 1.8 (P < 0.001)。吸入1.6MAC地氟醚比1MAC地氟醚rSO2较高,分别为71 ± 1366 ± 10P < 0.001);吸入1.8MAC七氟醚比1.2MAC七氟醚rSO2较高,分别为72 ± 1166 ± 13P < 0.001)。结论,在BIS方面等效浓度的地氟醚和七氟醚具有相似的rSO2值,而两个麻醉药的较大麻醉剂浓度能提高rSO2值。

(邱郁薇 译 马皓琳 李士通 校)

We studied the effect of sevoflurane and desflurane on regional cerebral oxygenation (rSO2). Twenty-two patients undergoing abdominal hysterectomy received sevoflurane and desflurane for 15 min each and 30 min apart under steady-state conditions in a randomized, crossover manner to maintain a bispectral index (BIS) of 4050. In another 22 patients undergoing the same anesthesia and surgery BIS was maintained at 2030. During the 15-min administration of each anesthetic at steady-state conditions rSO2, BIS, inspired and end-tidal anesthetic concentrations, end-tidal CO2, Spo2, systolic and diastolic blood pressures, and heart rate were recorded every 3 min. The rSO2 did not differ between sevoflurane and desflurane when BIS values were maintained between 4050 or 2030. The MACBIS values required to maintain BIS at 4050 and at 2030 were 1.0 versus 1.2 (P = 0.004) and 1.6 versus 1.8 (P < 0.001) for desflurane and sevoflurane respectively. Higher rSO2 values were obtained by 1.6 MAC (71 ± 13) than by 1 MAC of desflurane (66 ± 10; P < 0.001) and by 1.8 MAC (72 ± 11) than by 1.2 MAC of sevoflurane (66 ± 13; P < 0.001). In conclusion, equipotent concentrations of desflurane or sevoflurane in terms of BIS are associated with similar rSO2 values, but larger anesthetic concentrations of both anesthetics increased the rSO2 values.

 

 

对比1%纯利多卡因和由等量生理盐水稀释2%利多卡因后的1%利多卡因所产生的硬膜外阻滞

A Comparison of Epidural Blockade Produced by Plain 1% Lidocaine and 1% Lidocaine Prepared by Dilution of 2% Lidocaine with the Same Volume of Saline

Akifumi Kanai, MD, PhD, and Sumio Hoka, MD, PhD

Department of Anesthesiology, Kitasato University School of Medicine, Kitasato, Japan

Anesth Analg 2006;102:1851-1855

 

局部麻醉药经常由生理盐水稀释,但是稀释对硬膜外阻滞的影响还不清楚。作者选取40名行妇科腹部手术的患者,随机分为两组;应用商业上配备的纯1%利多卡因组(P组)和用由等量生理盐水稀释2%利多卡因得到的1%利多卡因组(D组),都通过在L12的硬膜外导管硬膜外输注。测定溶液pH值、钠和氯离子的浓度。在硬膜外输注后51015分钟,监测感觉和运动阻滞、足部皮肤温度、动脉血压和心率。相较于D组,P组各评价时点的感觉阻滞平面扩散均显著较广。P组的足部温度升高和平均动脉压降低显著快于D组。尽管两溶液的平均pH值相似,稀释溶液的钠离子和氯离子浓度明显高于纯溶液。作者认为以等量生理盐水稀释2%利多卡因产生的硬膜外阻滞效能低于商业上配备的纯1%利多卡因。

(赵雪莲 译 马皓琳 李士通 校)

Local anesthetics are commonly diluted with saline, but the influence of the dilution on the epidural anesthesia remains unclear. We randomized 40 patients scheduled for gynecological abdominal surgery under epidural anesthesia to one of two groups; those in group P received plain commercially prepared 1% lidocaine and those in group D received 1% lidocaine derived from 2% lidocaine and the same volume of saline was infused epidurally with an epidural catheter at L1-2. The pH and sodium and chloride ion concentrations of the solutions were measured. Sensory and motor blockade, foot skin temperature, arterial blood pressure, and heart rate were assessed at 5, 10, and 15 min after the epidural infusion. The spread of sensory blockade was significantly wider in group P at all assessment times than in group D. The increase of foot temperature and decrease of mean arterial blood pressure were significantly faster in group P than in group D. Although the mean pH values of the two solutions were similar, sodium and chloride ion concentrations of the diluted solution were significantly larger than those of the plain solution. We conclude that 2% lidocaine diluted with the same volume of saline produces less potent epidural blockade than commercially prepared plain 1% lidocaine.

 

 

术后恶心呕吐的危险因子

Risk Factors for Postoperative Nausea and Vomiting

Tong J. Gan, MB, FRCA, FFARCSI

Department of Anesthesiology, Duke University Medical Center, Durham, NC

Anesth Analg 2006;102:1884-1898

 

对于术后恶心呕吐(PONV)风险因素的认识可以帮助麻醉医生完善使用预防性疗法。现代PONV风险性研究始于20世纪90年代应用对数回归分析来同时判别多重独立的PONV预测因素的研究,以及荟萃分析及系统综述的发表文献。这些文献认为,少壮期女性、非抽烟人群、有PONV或运动病的病史、婴儿期后的儿童期和成年期早期、手术持续时间延长以及应用挥发性麻醉剂、笑气、大剂量新斯的明或者术中或术后应用阿片类药物,是已经确定的PONV危险因子。可能的危险因子包括,偏头痛的病史、儿童的父母或同胞有PONV或运动病的病史、较好的ASA体格状态、严重的术前焦虑某些种族或者手术类型、术期补液、给予的晶胶比值、较长的麻醉时间,全麻还是区域麻醉或镇静、平衡麻醉或全凭静脉麻醉、以及长效还是短效阿片类药的应用。月经早期、肥胖以及缺乏辅助供氧等证明不是危险因素。当前的风险评分系统对于预测哪些病人群体将遭受PONV55%~80%的准确性。对于分析遗传性或调查不足的临床病人特征作为潜在的危险因子以及涉及门诊病人及儿童的进一步研究,必将改善对PONV的预测系统。

 (黄丽娜     马皓琳 李士通  )

Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. This literature shows that female gender post-puberty, nonsmoking status, history of PONV or motion sickness, childhood after infancy and younger adulthood, increasing duration of surgery, and use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids are well established PONV risk factors. Possible risk factors include history of migraine, history of PONV or motion sickness in a childs parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration, increasing duration of anesthesia, general versus regional anesthesia or sedation, balanced versus total IV anesthesia, and use of longer-acting versus shorter-acting opioids. Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Current risk scoring systems have ~55%80% accuracy in predicting which patient groups will suffer PONV. Further research examining genetic and under-investigated clinical patient characteristics as potential risk factors, and involving outpatients and children, should improve predictive systems.