Anesthesia & Analgesia

 

August 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

兔异氟醚延迟性预处理的性别特异性:内皮一氧化氮合成酶的潜在作用

(孙敏莉译 薛张纲校)

Gender-Specificity of Delayed Preconditioning by Isoflurane in Rabbits: Potential Role of Endothelial Nitric Oxide Synthase

Chen Wang, Pascal C. Chiari, Dorothee Weihrauch, John G. Krolikowski, David C. Warltier, Judy R. Kersten, Phillip F. Pratt, Jr, and Paul S. Pagel

Anesth Analg 2006 103: 274-280

 

细胞外信号调的激酶触发异氟醚预处理伴随大鼠低氧可诱导因子-和血管内皮生长因子表达的调

(黄施伟 译,马皓琳 李士通 )

Extracellular Signal-Regulated Kinases Trigger Isoflurane Preconditioning Concomitant with Upregulation of Hypoxia-Inducible Factor-1{alpha} and Vascular Endothelial Growth Factor Expression in Rats

Chen Wang, Dorothee Weihrauch, David A. Schwabe, Martin Bienengraeber, David C. Warltier, Judy R. Kersten, Phillip F. Pratt, Jr, and Paul S. Pagel

Anesth Analg 2006 103: 281-288.

 

七氟醚对体外循环下主脉瓣置换手术病人的心肌保作用

(宋翠侠 陈杰 校)

Cardioprotective Properties of Sevoflurane in Patients Undergoing Aortic Valve Replacement with Cardiopulmonary Bypass

Stefanie Cromheecke, Veronik Pepermans, Ellen Hendrickx, Sur Lorsomradee, Pieter W. ten Broecke, Bernard A. Stockman, Inez E. Rodrigus, and Stefan G. De Hert

Anesth Analg 2006 103: 289-296

 

可乐定可降低局麻下行颈脉内膜剥脱术患者的应激反应:前瞻、随机、双盲、安慰剂对照临研究

(金琳 译 薛张纲 审校)

Clonidine Decreases Stress Response in Patients Undergoing Carotid Endarterectomy Under Regional Anesthesia: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study

Christine E. Schneemilch, Holger Bachmann, Anke Ulrich, Regine Elwert, Zuhir Halloul, and Thomas Hachenberg

Anesth Analg 2006 103: 297-302.

PEDIATRIC ANESTHESIA:

异丙酚/异氟烷麻醉下儿童的年龄对运激发电位的影响

(唐李隽 马皓琳  李士通 )

The Effect of Age on Motor Evoked Potentials in Children Under Propofol/Isoflurane Anesthesia

Jeremy A. Lieberman, Russ Lyon, John Feiner, Mohammad Diab, and George A. Gregory

Anesth Analg 2006 103: 316-321

 

儿童行Nuss术时硬膜外使用布比卡因-太尼和布比卡因-可乐定的比较

(曹瑜 陈杰 )

A Comparison of Epidural Bupivacaine-Fentanyl and Bupivacaine-Clonidine in Children Undergoing the Nuss Procedure

Giovanni Cucchiaro, Scott N. Adzick, John B. Rose, Lynne Maxwell, and Mehernoor Watcha

Anesth Analg 2006 103: 322-327

 

超声指导下神经刺激穿刺导管运用于小儿臀下肌坐骨神经阻滞:一项叙述性研究

(吴德华译 薛张纲校)

Ultrasound-Guided Subgluteal Sciatic Nerve Blocks with Stimulating Catheters in Children: A Descriptive Study

Geert Jan van Geffen and Mathieu Gielen

Anesth Analg 2006 103: 328-333.

ANESTHETIC PHARMACOLOGY:

大鼠术后疼痛模型中脑液和外周前列腺素E2水平调

(周雅春 马皓琳 李士通校)

Upregulation of Cerebrospinal Fluid and Peripheral Prostaglandin E2 in a Rat Postoperative Pain Model

Jeffrey S. Kroin, Asokumar Buvanendran, Daniel E. Watts, Chiranjeev Saha, and Kenneth J. Tuman

Anesth Analg 2006 103: 334-343.

 

健康志愿者应用新型经鼻咪达唑仑制剂的药代学和药效学

(肖洁 陈杰 )

Pharmacokinetics and Pharmacodynamics of a New Intranasal Midazolam Formulation in Healthy Volunteers

Daniel P. Wermeling, Kenneth A. Record, Thomas H. Kelly, Sanford M. Archer, Thomas Clinch, and Anita C. Rudy

Anesth Analg 2006 103: 344-349.

 

异氟烷制失血后补偿性血管内容量扩张

(金 路译 薛张纲校)

Isoflurane Inhibits Compensatory Intravascular Volume Expansion After Hemorrhage in Sheep

Robert G. Hahn, Lance Brauer, Peter Rodhe, Christer H. Svensén, and Donald S. Prough

Anesth Analg 2006 103: 350-358

 

机械通气的家兔对异丙酚镇静作用的耐受性

 (黄丽娜    马皓琳 李士通 )

Tolerance to Propofol’s Sedative Effect in Mechanically Ventilated Rabbits

Petros Ypsilantis, Dimitrios Mikroulis, Maria Politou, Heleni Tsoukali, Michail Pitiakoudis, Vasilios Didilis, Georgios Theodoridis, Georgios Bougioukas, and Constantinos Simopoulos

Anesth Analg 2006 103: 359-365

 

超临剂量的曲马多立体选择性弱离体大鼠主脉内皮细胞依赖性血管扩张

(赵延华 陈杰 校)

A Supraclinical Dose of Tramadol Stereoselectively Attenuates Endothelium-Dependent Relaxation in Isolated Rat Aorta

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

Anesth Analg 2006 103: 366-371.

TECHNOLOGY, COMPUTING, AND SIMULATION:

评价通气对脉搏氧饱和度仪影响的最佳位置是什么?

(王丽珺译,薛张纲校)

What Is the Best Site for Measuring the Effect of Ventilation on the Pulse Oximeter Waveform?

Kirk H. Shelley, Denis H. Jablonka, Aymen A. Awad, Robert G. Stout, Hoda Rezkanna, and David G. Silverman

Anesth Analg 2006 103: 372-377.

 

比较介入放射治疗中双谱指数(BIS)指导的和临指导的雷米太尼/异丙酚的镇痛/镇静水平:观察者单盲随机研究

(黄佳佳译,马皓琳 李士通 )

Bispectral-Index-Guided Versus Clinically Guided Remifentanil/Propofol Analgesia/Sedation for Interventional Radiological Procedures: An Observer-Blinded Randomized Study

Ashraf A. Dahaba, Ulrike Lischnig, Robert Kronthaler, Helmar Bornemann, Vassil Georgiev, Peter H. Rehak, and Helfried Metzler

Anesth Analg 2006 103: 378-384.

 

0.5%布比卡因硬膜外阻滞复合氧化亚氮镇静的麻醉中BIS指数与OAA/S评分没有明显的相关性

(刘哲 陈杰 校)

Bispectral Index Does Not Correlate with Observer Assessment of Alertness and Sedation Scores During 0.5% Bupivacaine Epidural Anesthesia with Nitrous Oxide Sedation

Kyung Soo Park, Eun Jin Hur, Kyung Woo Han, Ho Yeong Kil, and Tae Hyung Han

Anesth Analg 2006 103: 385-389.

CRITICAL CARE AND TRAUMA:

氯胺酮改善烧伤后脓毒血症的大鼠的生存率

(陆文清译 薛张纲校)

Ketamine Improves Survival in Burn Injury Followed by Sepsis in Rats

Reuven Gurfinkel, David Czeiger, Amos Douvdevani, Yoram Shapira, Alan A. Artru, Yuval Sufaro, Julia Mazar, and Gad Shaked

Anesth Analg 2006 103: 396-402.

 

在植入心内除颤复律器过程中重复短暂心脏停搏后的神经元损伤伴随认知能障碍

(颜涛 译, 马皓琳 李士通 )

Neuronal Injury After Repeated Brief Cardiac Arrests During Internal Cardioverter Defibrillator Implantation Is Associated With Deterioration of Cognitive Function

Manuela Weigl, Andrea Moritz, Barbara Steinlechner, Isabella Schmatzer, Bruno Mora, Richard Fakin, Daniel Zimpfer, Hendrik J. Ankersmit, Cesar Khazen, and Martin Dworschak

Anesth Analg 2006 103: 403-409

NEUROSURGICAL ANESTHESIA:

异氟醚对大鼠重度前脑缺血预后呈剂量依赖效应

(潘志英 陈杰 )

The Dose-Dependent Effects of Isoflurane on Outcome from Severe Forebrain Ischemia in the Rat

Ikuko Nasu, Noriko Yokoo, Seiji Takaoka, Kosuke Takata, Tamie Hoshikawa, Masayuki Okada, and Yoshihide Miura

Anesth Analg 2006 103: 413-418.

 

吸入麻醉药异氟醚在缺氧期间增强皮质神经元中Ca2+-依赖性存活信号表达并调MAP激酶,凋亡蛋白和转录因子

(徐丽颖译 薛张纲校)

The Inhaled Anesthetic, Isoflurane, Enhances Ca2+-Dependent Survival Signaling in Cortical Neurons and Modulates MAP Kinases, Apoptosis Proteins and Transcription Factors During Hypoxia

Philip E. Bickler and Christian S. Fahlman

Anesth Analg 2006 103: 419-429.

 

Sigma 1受体激剂通过制可诱导的一氧化氮合酶起神经保药物的作用

(姜旭晖译,马晧琳 李士通 )

Sigma 1 Receptor Agonists Act as Neuroprotective Drugs Through Inhibition of Inducible Nitric Oxide Synthase

Kamila Vagnerova, Patricia D. Hurn, Anish Bhardwaj, and Jeffrey R. Kirsch

Anesth Analg 2006 103: 430-434.

OBSTETRIC ANESTHESIA:

低氧性胎盘血管收缩:人胎盘对低氧反应是渐进性的

(苏殿三 陈杰 )

Hypoxemic Fetoplacental Vasoconstriction: A Graduated Response to Reduced Oxygen Conditions in the Human Placenta

Ramiah Ramasubramanian, Raymond F. Johnson, John W. Downing, Beth H. Minzter, and Ray L. Paschall

Anesth Analg 2006 103: 439-442.

 

挥发性麻醉药对离体的人怀孕子宫肌自发性收缩的作用:七氟烷,地氟烷,异氟烷和氟烷的比较

(周荻译 薛张纲校)

The Effects of Volatile Anesthetics on Spontaneous Contractility of Isolated Human Pregnant Uterine Muscle: A Comparison Among Sevoflurane, Desflurane, Isoflurane, and Halothane

Kyung Y. Yoo, Jun C. Lee, Myung H. Yoon, Min-HO Shin, Seok J. Kim, Yoon H. Kim, Tae B. Song, and JongUn Lee

Anesth Analg 2006 103: 443-447

GENERAL ARTICLES:

腹部大手术后国际标准化比值延长与血管内液体大平衡相关

(邱郁薇 马皓琳 李士通 )

Prolonged International Normalized Ratio Correlates with a Large Intravascular Fluid Balance After Major Abdominal Surgery

Michal Barak, Oded Jurim, Ronit Tal, and Yeshayahu Katz

Anesth Analg 2006 103: 448-452

 

喉罩在导丝扩张式气管造口术中的应用

(印杰敏译 陈杰 )

The Use of the Laryngeal Mask Airway During Guidewire Dilating Forceps Tracheostomy

Davide Cattano, Steven Abramson, Stefano Buzzigoli, Candido Zoppi, Ettore Melai, Francesco Giunta, and Carin Hagberg

Anesth Analg 2006 103: 453-457

 

对于只接受了基本训练的第一个月的麻醉住院医生,导引下放置喉罩优于传统的气管插管

(王慧琳译 薛张纲校)

Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

Matthias Hohlrieder, Joseph Brimacombe, Achim von Goedecke, and Christian Keller

Anesth Analg 2006 103: 458-462.

PAIN MEDICINE:

多虑平漱口:对癌症治疗导致口腔粘膜炎患者的镇痛作用和疼痛减轻持续时间

(张莹 译 马皓琳 李士通 校)

Oral Doxepin Rinse: The Analgesic Effect and Duration of Pain Reduction in Patients with Oral Mucositis Due to Cancer Therapy

Joel B. Epstein, Joshua D. Epstein, Matthew S. Epstein, Hal Oien, and Edmond L. Truelove

Anesth Analg 2006 103: 465-470.

 

{alpha}-1 {alpha}-2 肾腺素受体在周围咪唑啉和肾腺素受体激剂诱导的伤害感受中的发挥作用

(宋金超 陈杰 )

The Contribution of Alpha-1 and Alpha-2 Adrenoceptors in Peripheral Imidazoline and Adrenoceptor Agonist-Induced Nociception

Ahmet Dogrul, Ilke Coskun, and Tayfun Uzbay

Anesth Analg 2006 103: 471-477

 

异丙酚对γ氨基酸受体(A)β3亚单位突变的老鼠桥脑内注射福尔马林后感受受伤的行为以髓c-fos的表达的影响

(钟静译,薛张纲校)

Propofol’s Effects on Nociceptive Behavior and Spinal C-Fos Expression After Intraplantar Formalin Injection in Mice with a Mutation in the Gamma-Aminobutyric Acid-TypeA Receptor ß3 Subunit

Austin W. Merrill, Linda S. Barter, Uwe Rudolph, Edmond I. Eger, II, Joseph F. Antognini, Mirela Iodi Carstens, and E. Carstens

Anesth Analg 2006 103: 478-483

兔异氟醚延迟性预处理的性别特异性:内皮一氧化氮合成酶的潜在作用Gender-Specificity of Delayed Preconditioning by Isoflurane in Rabbits: Potential Role of Endothelial Nitric Oxide Synthase

Chen Wang, Pascal C. Chiari, Dorothee Weihrauch, John G. Krolikowski, David C. Warltier, Judy R. Kersten, Phillip F. Pratt, Jr, and Paul S. Pagel .

The Departments of Anesthesiology, Medicine (Division of Cardiovascular Diseases), and Pharmacology and Toxicology, the Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, and the Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.

Anesth Analg 2006 103: 274-280.

 

参照于心脏保,雌性物缺血再灌注损伤,部分是由于雌激素通过内皮一氧化氮合成酶(eNOS)增一氧化氮产物。是否在雌性物发生缺血预处理依然存在争论。在雄性家兔,异氟醚的延迟性心肌预适应通过eNOS来调,但在雌性物,异氟醚是否有相似的保作用还不清楚。我们已试验了这样的假说,在雌性家兔心肌梗死面积为性别特异性减少,但是这种内在的心脏保作用破坏进一步异氟醚诱导延迟性预处理的有效应。方法:家兔(n=115)经历30分钟的冠脉闭塞和3小时再灌注,在试验前一天有或无的吸入异氟醚1.0最低肺泡有效浓度2小时。家兔接受生理盐水或非选择性、选择性诱导,或选择性接受二乙基溴乙酰胺NOS制剂[N-硝基-L-精氨酸甲酯(L-NAME, 10mg/kg),氨基胍(AG, 300mg/kg),或7-硝基吲唑(7-NI, 50mg/kg),分别地]。结果:相对生理盐水(45 ± 2%),在雄性物异氟醚减少梗塞面积(平均值 ± sd,左心室区域危险度的26 ± 5%)。在雄性家兔L-NAME,但不是AG7-NI,破坏异氟醚诱导的保作用(分别为41 ± 9, 24 ± 4 22 ± 2%)。雌性家兔与雄性相比,梗塞面积减少而且eNOS蛋白表达增多。有或无异氟醚预处理,梗塞面积在雌性家兔无改变(分别为27 ± 9 27 ± 10%)。在雌性家兔有或无异氟醚预处理,L-NAME,但不是AG7-NI,增梗塞面积。结论:雌性性别诱导减少梗塞面积通过eNOS介导,但是在活体,在缺血和再灌注之前暴露于异氟醚(1.0MAC)不能产生额外的心脏保作用。

(孙敏莉译 薛张纲校)

INTRODUCTION: Female gender confers cardioprotection against ischemia-reperfusion injury, in part because estrogen enhances nitric oxide production by endothelial nitric oxide synthase (eNOS). Whether ischemic preconditioning occurs in females remains controversial. Delayed myocardial preconditioning by isoflurane is mediated by eNOS in male rabbits, but whether females are similarly protected by isoflurane is unknown. We tested the hypothesis that gender-specific reductions in myocardial infarct size occur in female rabbits, but that this inherent cardioprotection abrogates further beneficial effects of isoflurane-induced delayed preconditioning.

METHODS: Rabbits (n = 115) underwent a 30 min coronary artery occlusion and 3 h reperfusion with or without a 2 h administration of 1.0 minimum alveolar concentration isoflurane one day before experimentation. Rabbits received saline or a nonselective, selective inducible, or selective neuronal NOS inhibitor [N-nitro-L-arginine methyl ester (L-NAME, 10 mg/kg), aminoguanidine (AG, 300 mg/kg), or 7-nitroindazole (7-NI, 50 mg/kg), respectively].

RESULTS: Isoflurane reduced infarct size in males (mean± sd, 26 ± 5% of the left ventricular area at risk) versus saline (45 ± 2%). L-NAME, but not AG or 7-NI, abolished isoflurane-induced protection in males (41 ± 9, 24 ± 4 and 22 ± 2%, respectively). Infarct size was reduced, and eNOS protein expression was greater, in female versus male rabbits. Infarct size was unchanged in female rabbits with, versus without, isoflurane pretreatment (27 ± 9 and 27 ± 10%, respectively). L-NAME, but not AG or 7-NI, increased infarct size with or without isoflurane pretreatment in females.

CONCLUSIONS: Female gender-induced reductions in infarct size are mediated by eNOS, but remote isoflurane exposure (1.0 MAC) before ischemia and reperfusion does not produce additional cardioprotection in vivo.

 

可乐定可降低局麻下行颈脉内膜剥脱术患者的应激反应:前瞻、随机、双盲、安慰剂对照临研究

Clonidine Decreases Stress Response in Patients Undergoing Carotid Endarterectomy Under Regional Anesthesia: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study

Christine E. Schneemilch, Holger Bachmann, Anke Ulrich, Regine Elwert, Zuhir Halloul, and Thomas Hachenberg

From the *Department of Anesthesiology and Intensive Care Medicine and {dagger}Department of Surgery, Otto-von-Guericke-University, Magdeburg, Germany.

Anesth Analg 2006 103: 297-302.

 

不充分的镇痛或焦虑会增局麻(RA)下行颈脉内膜剥脱术(CEA)患者的应激反应。中枢α2肾腺素受体激剂有显著的镇静和镇痛作用,可能可以减弱CEA过程中交感肾腺活性,而提高RA的质量。我们研究了80位患者,随机分为2组,每组40人。一组RA安慰剂;另一组RA可乐定,初始剂量为1 µg/kg,维持剂量为1 µg ·kg–1 ·h–1RA均采用颈深丛复合颈浅丛阻滞。测量CEA前、中、后血流学和神经系统变量。在特定的时间点采脉血样测量血浆肾腺素、去甲肾腺素、皮质醇、肌酸酶和CKMB浓度。在这项研究中,所有的患者均配合进行神经系统评估。两组间钳夹前和钳夹过程中的平均脉压和心率无明显差异。但是可乐定组患者缝皮和术后ICU中平均脉压明显较低(P < 0.01)。安慰剂组患者皮质醇、肾腺素、去甲肾腺素的血浆浓度明显升高(P < 0.05),并且有更多的患者需要使用高血压治疗(P < 0.01)。可乐定组患者术后高血压的发生率(P < 0.01)和神经系统缺陷的发生率(P < 0.05)明显减少。我们认为,1 µg ·kg–1 ·h–1可乐定在CEA手术中可制高肾腺素反应,而不增血流学和临神经系统监测的副作用。

(金琳 译 薛张纲 审校)

Inadequate analgesia or anxiety may induce an increased stress response in patients undergoing carotid endarterectomy (CEA) under regional anesthesia (RA). Central {alpha}2 adrenoceptor agonists have significant sedative and analgesic properties, which may attenuate sympathoadrenal activation during CEA and improve the quality of RA. We randomly assigned 80 patients to 2 groups receiving either RA plus placebo (n = 40) or RA plus clonidine 1 µg/kg as the initial loading dose followed by 1 µg ·kg–1 ·h–1 (n = 40). RA was performed as combined deep and superficial cervical plexus blockade. Hemodynamic and neurological variables were assessed before, during, and after CEA. Arterial blood samples were collected at defined time points for the determination of plasma concentrations of epinephrine, norepinephrine, cortisol, and creatinine kinase and creatinine kinase-MB. Throughout the study, all patients responded easily to neurological evaluations. Before and during clamping mean arterial blood pressure and heart rate were not different between the groups, but mean arterial blood pressure was lower in the clonidine group (P < 0.01) at skin closure and postoperatively in the intensive care unit. In the placebo group, cortisol, epinephrine, and norepinephrine plasma concentrations were increased significantly (P < 0.05) and more patients required antihypertensive treatment (P < 0.01). Postoperatively the incidence of hypertension (P < 0.001) and development of neurological deficits (P < 0.05) was significantly decreased in the clonidine group. We conclude that 1 µg ·kg–1 ·h–1 clonidine suppresses the hyperadrenergic response to CEA without adverse effects on hemodynamics or clinical neurological monitoring.

 

 

超声指导下神经刺激穿刺导管运用于小儿臀下肌坐骨神经阻滞:一项叙述性研究

Ultrasound-guided subgluteal sciatic nerve blocks with stimulating catheters in children: a descriptive study.

van Geffen GJ, Gielen M.

Institute for Anesthesiology, Medical Centre, Radboud University, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

Anesth Analg. 2006 Aug;103(2):328-33, table of contents

 

我们描述了在小儿联合运用超声和神经刺激指导臀下肌坐骨神经穿刺放置导管的临经验。选择10例准备行下肢手术的患儿,为了术中麻醉和术后镇痛行全身麻醉和臀下肌坐骨神经穿刺放置导管。在超声指导下,通过17G50mm的连续外周神经阻滞针和19G的刺激导管放置坐骨神经导管。在患儿中,用于刺激穿刺针和导管获得肌肉收缩的最小电流有很大的不同。在注射局麻药进入导管期间,通过可视的局麻药阻滞范围,来预测坐骨神经阻滞的成。所有的导管都被成的放置,并且提供了完善的术后镇痛,未见并发症。

(吴德华译 薛张纲校)

We describe our clinical experience of combining ultrasound guidance and nerve stimulation for the insertion of subgluteal sciatic catheters in children. Ten children scheduled for lower limb surgery with a combined general anesthetic and a subgluteal sciatic catheter placement for both operative anesthesia and postoperative pain relief were studied. Under ultrasonographic guidance the sciatic catheter was placed using an 17-gauge 50-mm Arrow continuous peripheral nerve block needle and a 19-gauge stimulating catheter (Stimucath). The minimal electrical current required for muscle contraction on the stimulating needle and catheter differed widely among patients. Based on the visualization of the spread of local anesthetic during injection through the catheter, a successful prediction for the sciatic block was made in all patients. All catheters were successfully placed and provided excellent postoperative pain relief without complications.

 

 

异氟烷制失血后补偿性血管内容量扩张

Isoflurane Inhibits Compensatory Intravascular Volume Expansion After Hemorrhage in Sheep

Robert G. Hahn, MD, PhD*, Lance Brauer, MD{dagger}, Peter Rodhe*, Christer H. Svensén, MD, PhD{ddagger}, and Donald S. Prough, MD

From the *Karolinska Institute, Stockholm, Sweden; {dagger}Anesthesia Investigational Intensive Care Unit, {ddagger}Department of Anesthesiology, Professor and Rebecca Terry White Distinguished Chair of Anesthesiology, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas.

Address correspondence to Robert G. Hahn, MD, PhD, Department of Anesthesiology, Karolinska Institute at Soder Hospital, 118 83 Stockholm, Sweden.

Anesth Analg 2006 103: 350-358.

 

在失血后,通过跨毛细血管壁再充盈,血容量可以得到部分的恢复,我们认为这一自发性补偿性血管内容量扩张过程会被麻醉所制。六只模型在清醒或异氟烷麻醉态下进行四个随机安排的实验。用靛青绿测定血容量后,将15%45%的血容量出。假定跨毛细管壁再充盈会稀血红蛋白浓度,用质量平衡和态计算反复测量血红蛋白浓度来量化跨毛细管壁再充盈程度。在失血15%的情况下,清醒和异氟烷麻醉下的的平均脉压都保持平稳(正常血压出血),但在出血45%的情况下,平均脉压都降低(低血压出血)。在正常血压出血和低血压出血后前40分钟内的跨毛细血管再充盈远较其后的140分钟内迅速(P < 0.001)。在清醒的,出血后180分钟时,正常血压出血的57%容量恢复,低血压出血的42%容量恢复,相应的异氟烷麻醉下的分别只有13%27%血容量的恢复(P < 0.001)。这一新的态模型提示血流学因素导致早期快速跨毛细血管壁再充盈,而随后的血浆渗透压降低使得再充盈减慢。我们得出结论,异氟烷麻醉制正常血压出血和低血压出血后的跨毛细血管壁再充盈。

(金 路译 薛张纲校)

After hemorrhage, blood volume is partially restored by transcapillary refill, a process of spontaneous compensatory intravascular volume expansion that we hypothesized would be inhibited by anesthesia. Six chronically instrumented sheep were subjected to four randomly ordered experiments while conscious or during anesthesia with isoflurane. After plasma volume measurement (indocyanine green), 15% or 45% of the blood volume was withdrawn. To quantify transcapillary refill, mass balance and kinetic calculations utilized repeated measurements of hemoglobin concentration, assuming that transcapillary refill would dilute hemoglobin concentration. After 15% hemorrhage, mean arterial blood pressure remained stable in both conscious and isoflurane-anesthetized sheep (normotensive hemorrhage) but decreased after 45% hemorrhage (hypotensive hemorrhage). After either normotensive or hypotensive hemorrhage, transcapillary refill occurred more rapidly during the first 40 min than during the next 140 min (P < 0.001). In conscious sheep, at 180 min, 57% and 42% of the bled volume had been restored after normotensive and hypotensive hemorrhage, respectively, in contrast to only 13% and 27% (P < 0.001) in isoflurane-anesthetized sheep. A novel kinetic model implicated hemodynamic factors in rapid, early transcapillary refill and decreased plasma oncotic pressure in subsequent slower filling. We conclude that isoflurane inhibits transcapillary refill after both normotensive and hypotensive hemorrhage in sheep.

 

评价通气对脉搏氧饱和度仪影响的最佳位置是什么?

What Is the Best Site for Measuring the Effect of Ventilation on the Pulse Oximeter Waveform?

Kirk H. Shelley, Denis H. Jablonka, Aymen A. Awad, Robert G. Stout, Hoda Rezkanna, and David G. Silverman

Department of Anesthesiology, Yale University, New Haven, Connecticut, USA.

Anesth Analg 2006 103: 372-377.

 

心搏是脉搏氧饱和度仪波形的主要特征。通气对于波形的影响尚不明确。已有学者研究了通气对波形的影响以确定呼吸频率、潮气量和血容量。该试验选择三个不同位置:手指、耳垂和前额,测定了通气对反射性体积描计波形影响的相对强度。体积描计波形来自18名术中接受正压通气的病人和10名肾脏透析时自主呼吸的病人。光谱分析显示,呼吸信号和波形是独立的。前额和手指相比,前者脉搏氧饱和度波形中呼吸信号的强度是后者的10倍以。在正压通气和自主呼吸的病人中均是如此。耳垂测得的体积描计数据证实了术中估计失血量和通气的影响具有显著的相关性(r(s) = 0.624, P = 0.006)

(王丽珺译,薛张纲校)

The cardiac pulse is the predominant feature of the pulse oximeter (plethysmographic) waveform. Less obvious is the effect of ventilation on the waveform. There have been efforts to measure the effect of ventilation on the waveform to determine respiratory rate, tidal volume, and blood volume. We measured the relative strength of the effect of ventilation on the reflective plethysmographic waveform at three different sites: the finger, ear, and forehead. The plethysmographic waveforms from 18 patients undergoing positive pressure ventilation during surgery and 10 patients spontaneously breathing during renal dialysis were collected. The respiratory signal was isolated from the waveform using spectral analysis. It was found that the respiratory signal in the pulse oximeter waveform was more than 10 times stronger in the region of the head when compared with the finger. This was true with both controlled positive pressure ventilation and spontaneous breathing. A significant correlation was demonstrated between the estimated blood loss from surgical procedures and the impact of ventilation on ear plethysmographic data (r(s) = 0.624, P = 0.006).

 

 

氯胺酮改善烧伤后脓毒血症的大鼠的生存率

Ketamine improves survival in burn injury followed by sepsis in rats

Gurfinkel R, Czeiger D, Douvdevani A, Shapira Y, Artru AA, Sufaro Y, Mazar J, Shaked G

Department of Plastic Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel.

Anesth Analg. 2006 Aug;103(2):396-402

 

曾经有道,氯氨酮可以减少细胞因子的产物和改善大肠杆菌引起的脓毒血症的生存率。我们检验是否氯氨酮减少白介素(IL)6以是否改善1)烧伤或2)烧伤合并脓毒血症24小时的生存率。氯氨酮(10 mg/kg)或生理盐水在烧伤后1小时给予(1, 2, 5, 6),在烧伤后24小时给予( 3, 4)或在大肠杆菌接种时给予(7, 8)。记录7天的死亡率,检测血清中的IL-6在烧伤后6小时( 1-2),烧伤后30小时(3-4),或是在脓毒血症后6小时( 5-8)。单纯烧伤:氯氨酮在烧伤后1小时马给予的而不是24小时给予的,减少烧伤引起的IL-6但不增生存率。烧伤+脓毒血症:氯氨酮在烧伤后马给予的并不改善生存率和明显减少脓毒血症诱导的IL-6的增。相对的,氯氨酮在脓毒血症后马给予明显改善生存率(46.1% vs 13.3%, P = 0.008)和减少IL-6 (72,640 +/- 40,990 vs 332,300 +/- 32,300 pg/mL, P = 0.008)。我们认为氯氨酮治疗可以改善烧伤伴脓毒血症的生存率。这种有的作用可能是通过干扰了炎症反应链,因为有证据表明促炎标记IL-6的减少。

(陆文清译 薛张纲校)

Ketamine was reported to decrease cytokine production and improve survival after Escherichia coli-induced sepsis. We examined whether ketamine decreased interleukin (IL)-6 production and improved survival after 1) burn injury or 2) burn injury combined with sepsis (E. coli) at 24 h. Ketamine (10 mg/kg) or saline was given at 1 h after burn injury (G 1, 2, 5, 6), 24 h after burn injury (G 3, 4), or at E. coli inoculation (G 7, 8). Mortality was recorded for 7 days and IL-6 was measured in serum at 6 h after burn (G 1-2), 30 h after burn (G 3-4), or 6 h after sepsis (30 h after burn) (G 5-8).Burn injury only: Ketamine given immediately (1 h) after burn injury but not 24 h after, decreased the burn-induced increase of IL-6 but did not improve survival. Burn injury + sepsis: Ketamine given immediately after burn injury did not significantly decrease the sepsis-induced increase of IL-6 or improve survival. In contrast, ketamine given immediately after sepsis significantly improved survival (46.1% versus 13.3%, P = 0.008) and decreased IL-6 production (72,640 +/- 40,990 vs 332,300 +/- 32,300 pg/mL, P = 0.008). We conclude that ketamine therapy improves survival in burn injury followed by sepsis. This beneficial effect is probably achieved through interference with the inflammatory cascade, as evidenced by attenuation of the proinflammatory marker IL-6.

 

 

吸入麻醉药异氟醚在缺氧期间增强皮质神经元中Ca2+-依赖性存活信号表达并调MAP激酶,凋亡蛋白和转录因子

The inhaled anesthetic, isoflurane, enhances Ca2+-dependent survival signaling in cortical neurons and modulates MAP kinases, apoptosis proteins and transcription factors during hypoxia

Bickler PE, Fahlman CS.

Severinghaus-Radiometer Research Laboratories, Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, California 94143-0542, USA. bicklerp@anesthesia.ucsf.edu

Anesth Analg. 2006 Aug;103(2):419-29, table of contents

 

我们检验了吸入麻醉药异氟醚对缺氧神经元的保是否与MAP激酶和凋亡制因子的Ca2+依赖性磷酸化相关。在鼠皮质神经元培养中我们测定了缺氧或缺氧联合异氟醚(1%气相)后Ca2+依赖性和非Ca2+依赖性MAP激酶,转录因子和凋亡因子的磷酸化的改变。在缺氧神经元中,异氟醚减少>80%的细胞死亡和TUNEL着色。异氟醚放细胞内储存的Ca2+,在氧化神经元中增[Ca2+]i20%。神经元保与缺氧神经元中[Ca2+]i的轻度增相关,且需要IP3受体和磷脂酶C。在缺氧神经元中,异氟醚增了Ca2+依赖性MAP激酶Pyk2 p42/44 (ERK)的磷酸化。非Ca2+依赖性MAP激酶p38途径显示了异氟醚而不是Ca2+载体ionomycin的磷酸化作用。异氟醚存在下缺氧神经元中JNK被磷酸化,转录因子c-Jun亦然;SP600125所致的JNK制可阻止c-Jun的磷酸化和神经元保。异氟醚减少促凋亡因子Bad p90RSK的磷酸化并增Akt磷酸化。然而,除了c-Jun,转录因子(Elk-1, GSK-3, Forkhead, p90RSK)减少或保持不变。可以推断,异氟醚对缺氧皮质神经元的保涉的信号包括细胞内Ca2+调,多种MAP激酶途径和凋亡因子的调的改变。

(徐丽颖译 薛张纲校)

We tested whether the protection of hypoxic neurons by the inhaled anesthetic isoflurane is related to the Ca2+-dependent phosphorylation of MAP kinases and anti-apoptotic co-factors. In cultures of mouse cortical neurons we measured changes in the phosphorylation of Ca2+-dependent and Ca2+-independent MAP kinases, transcription factors, and apoptosis regulators after hypoxia or hypoxia combined with isoflurane (1% in gas phase). In hypoxic neurons, isoflurane reduced cell death and TUNEL staining by >80%. Isoflurane released Ca2+ from intracellular stores, increasing [Ca2+]i in oxygenated neurons by approximately 20%. Neuroprotection was associated with a smaller increase in [Ca2+]i in hypoxic neurons and required IP3 receptors and phospholipase C. In hypoxic neurons, isoflurane increased the phosphorylation of the Ca2+-dependent MAP kinases Pyk2 and p42/44 (ERK). The Ca2+-independent MAP kinase p38 pathway showed increased phosphorylation with isoflurane but not with ionomycin, a Ca2+ ionophore. JNK was phosphorylated in hypoxic neurons in the presence of isoflurane, as was the transcription factor c-Jun; JNK inhibition with SP600125 prevented both phosphorylation of c-Jun and neuroprotection. Isoflurane decreased phosphorylation of the pro-apoptotic cofactors Bad and p90RSK and increased Akt phosphorylation. However, with the exception of c-Jun, transcription factors (Elk-1, GSK-3, Forkhead, p90RSK) decreased or remained unchanged. We conclude that isoflurane's protection of hypoxic cortical neurons involves signaling that includes changes in intracellular Ca2+ regulation, several MAP kinase pathways and modulation of apoptosis regulators.

 

 

挥发性麻醉药对离体的人怀孕子宫肌自发性收缩的作用:七氟烷,地氟烷,异氟烷和氟烷的比较

The Effects of Volatile Anesthetics on Spontaneous Contractility of Isolated Human Pregnant Uterine Muscle: A Comparison Among Sevoflurane, Desflurane, Isoflurane, and Halothane

Kyung Y. Yoo, Jun C. Lee, Myung H. Yoon, Min-HO Shin, Seok J. Kim, Yoon H. Kim, Tae B. Song, and JongUn Lee

Department of Anesthesiology, Chonnam National University Medical School, 5 Hak-dong, Gwangju 501-746, Korea.

Anesth Analg 2006 103: 443-447.

 

我们检测了等效浓度七氟烷,地氟烷,异氟烷和氟烷对离体人类子宫肌自发性收缩的作用。我们也探讨了是否他们的作用与钾通道有关。子宫样本取自正常足月的行择期下腹部剖腹产的怀孕妇女。纵行肌束垂直包埋在组织腔内。记录它们暴露于0.5-3MAC挥发性麻醉药下,在没有或有高电导的钙激活的钾通道阻滞剂,四乙铵,或三磷酸腺苷敏感的钾通道(K(ATP))阻滞剂,格列本脲情况下的等长张。麻醉药产生了剂量依赖性的收缩制。七氟烷和地氟烷的制效能是相似的,异氟烷较弱,氟烷最弱。产生制50%收缩幅度的浓度(ED(50))分别是1.72, 1.44, 2.351.66 MAC (P < 0.05)四乙铵和格列本脲不影响子宫对麻醉药的反应,除了格列本脲会消除对异氟烷的反应。这些结果显示挥发性麻醉药对人类子宫收缩有制作用。异氟烷的制作用可能有一部分是通过激活K(ATP) 通道产生的。

(周荻译 薛张纲校)

We examined the effects of equianesthetic concentrations of sevoflurane, desflurane, isoflurane, and halothane on the spontaneous contractility of isolated human pregnant uterine muscles. We also determined if their action was related to potassium channels. Uterine specimens were obtained from normal full-term pregnant women undergoing elective lower-segment cesarean delivery. Longitudinal muscle strips were mounted vertically in tissue chambers. Their isometric tension was recorded while they were exposed to 0.5-3 minimum alveolar concentration (MAC) of volatile anesthetics in the absence and presence of the high conductance calcium-activated potassium channel blocker, tetraethylammonium, or the adenosine triphosphate-sensitive potassium channel (K(ATP))-blocker, glibenclamide. The anesthetics examined produced a dose-dependent depression of contractility. The inhibitory potency of sevoflurane and desflurane was comparable to, whereas that of isoflurane was smaller than, that of halothane: concentrations causing 50% inhibition of the contractile amplitude (ED(50)) were 1.72, 1.44, 2.35, and 1.66 MAC (P < 0.05), respectively. Tetraethylammonium and glibenclamide did not affect the uterine response to the anesthetics, except for glibenclamide, which attenuated the response to isoflurane. These results indicate that the volatile anesthetics have inhibitory effects on the contractility of the human uterus. The inhibitory effect of isoflurane may in part be mediated through activation of K(ATP) channels.

 

 

对于只接受了基本训练的第一个月的麻醉住院医生,导引下放置喉罩优于传统的气管插管

Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

Matthias Hohlrieder, Joseph Brimacombe, Achim von Goedecke, and Christian Keller

Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Austria.

Anesth Analg 2006 103: 458-462.

 

在以下的研究中,我们通过只接受了基本训练的第一个月的麻醉住院医生来比较两种插管方式,即传统的喉镜暴露下气管插管和喉镜暴露、弹性橡胶探条导引下喉罩放置。五名无气道管理经验的第一个月的麻醉住院医生,但要用述方法完成200ASA12级的成人患者的插管和喉罩的放置。每位医生要完成40例病人,每种方式20例,按随机化原则分配。记录下插管尝试次数、有效气道时间、压控制在12cm水柱时的通气量、气道损伤和巧的获得。数据经非盲观察者采集。探条导引喉罩放置组在插管成率(100%65%)和有效气道时间(41+/-24秒比89+/62)要优于喉镜插管组(两组P<0.0001)。在控制压通气下探条导引喉罩放置组的呼气量较大(730+/-170ml560+/-140ml),呼末CO2较低(33+/-4mmHg37+/-5mmHg)(两组P<0.0001)。喉镜插管组中喉镜更易沾血(24%2%,P,0.0001)。有证据表明两组在术均有收获。我们得出结论:对于只接受过基本训练的第一个月的麻醉住院医生,喉镜暴露、橡胶弹性探条导引下放置喉罩的方法在插管成率、呼气量和气道损伤方面要优于传统的喉镜暴露下气管插管法。心肺复苏时,非专业人员在传统插管失败后可采用探条导引下放置喉罩。

王慧琳译 薛张纲校)

In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 +/- 170 mL versus 560 +/- 140 mL) and end-tidal CO(2) lower (33 +/- 4 mm Hg versus 37 +/- 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

 

 

异丙酚对γ氨基酸受体(A)β3亚单位突变的老鼠桥脑内注射福尔马林后感受受伤的行为以髓c-fos的表达的影响

Propofol's effects on nociceptive behavior and spinal c-fos expression after intraplantar formalin injection in mice with a mutation in the gamma-aminobutyric acid-type(A) receptor beta3 subunit.

Austin W. Merrill, Linda S. Barter, Uwe Rudolph, Edmond I. Eger, II, Joseph F. Antognini, Mirela Iodi Carstens, and E. Carstens

Section of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, California 95616, USA.

Anesth Analg 2006 103: 478-483

 

我们研究了异丙酚是否影响野生型老鼠和突变型老鼠(γ氨基酸受体(A)点突变,使得这些老鼠对异丙酚耐药)在桥脑内注射福尔马林后腰骶部髓感受受伤行为fos样免疫反应(FLI)。和桥脑内注射脂类药物联合福尔马林的野生型老鼠相比,单注射异丙酚(30mg/kg IV)减少了福尔马林引发的一期行为的最初2-3分钟但不能改变2其行为或者髓FLI(64 +/- 19 细胞/)。对于桥脑内福尔马林注射,大部分FLI被限制在同侧髓浅表背角。接受60分钟的异丙酚注射的野生型老鼠被麻醉了且不显示出感受受伤的行为但FLI (58 +/- 11 细胞/)和其他野生型老鼠并没有多大区别。接受30mg/kg异丙酚注射和桥脑内注射福尔马林的突变型的老鼠没有被麻醉且表现出感受受伤的行为。总的髓中的FLI47 +/- 29 细胞/段。这些数据表明尽管异丙酚能产生麻醉作用,它不能制FLI(和感受受伤性行为相关),这和异丙酚没有镇痛作用这一特性相一致。

(钟静译,薛张纲校)

We investigated whether propofol affected nociceptive behavior and fos-like immunoreactivity (FLI) in the lumbo-sacral spinal cord after intraplantar formalin injection in wild-type (WT) mice and in mutant mice harboring a point mutation of the gamma-aminobutyric acid type(A) receptor, which renders them resistant to propofol. Bolus injection of propofol (30 mg/kg IV) in WT mice reduced phase 1 formalin-evoked behavior over the initial 2-3 min but did not alter phase 2 behavior or spinal FLI (64 +/- 19 cells/section) compared with WT mice receiving intralipid vehicle plus intraplantar formalin (57 +/- 19 cells/section). Most FLI was restricted to superficial dorsal horn laminae ipsilateral to the formalin injection. WT mice receiving a 60-min propofol infusion were anesthetized throughout and did not display nociceptive behavior but had FLI (58 +/- 11 cells/section) that did not differ significantly from the other WT groups. Mutant mice receiving bolus injection of propofol (30 mg/kg) and intraplantar formalin were not anesthetized and exhibited nociceptive behavior. The total FLI in the spinal cord was 47 +/- 29 cells/section. These data indicate that although propofol produces anesthesia, it does not prevent the FLI that is associated with nociception, a finding consistent with propofol lacking analgesic properties.

 

七氟醚对体外循环下主脉瓣置换手术病人的心肌保作用

Cardioprotective Properties of Sevoflurane in Patients Undergoing Aortic Valve Replacement with Cardiopulmonary Bypass

Stefanie Cromheecke, MD*, Veronik Pepermans, MD*, Ellen Hendrickx, MD*, Sur Lorsomradee, MD*, Pieter W. ten Broecke, MD*, Bernard A. Stockman, MD{dagger}, Inez E. Rodrigus, MD, PhD{dagger}, and Stefan G. De Hert, MD, PhD*

From the Departments of *Anesthesiology and {dagger}Cardiac Surgery, University Hospital Antwerp, Belgium.

Anesth Analg 2006 103: 289-296.

冠脉手术患者吸入挥发性麻醉药七氟醚有利于术后心肌能的恢复,并减少肌钙蛋白的放。作者研究七氟醚在主脉狭窄患者行换瓣术(AVR)中是否有相同的心肌保作用。30AVR手术病人随机分成2组,一组靶控输入异丙酚,另一组吸入七氟醚。围术期通过肺脉导管评估心脏能。在左心室放置一个高度精密的压导管,用于连续48小时监测心脏的肌钙蛋白浓度。七氟醚组体外循环后病人的每搏量和左室内压升最大速率显著增。在体外循环前后,七氟醚组增心脏负荷对左室内压升最大速率的影响相似(体外循环前为1.3% ±8.6%,体外循环后1.0% ±5.4%);但是在异丙酚组,增心脏负荷对左室内压升最大速率有明显的制(体外循环前为0.1% ±4.9%,体外循环后为-8.2%+-4.4%)。异丙酚组,体外循环后心室舒张速率也明显减慢,七氟醚组术后肌钙蛋白水平较低。结果表明在AVR手术中吸入麻醉具有较好的心肌保能并减少肌钙蛋白的放。

(宋翠侠 陈杰 校)

In coronary surgery patients the use of a volatile anesthetic regimen with sevoflurane was associated with a better recovery of myocardial function and less postoperative release of troponin I. In the present study we investigated whether these cardioprotective properties were also apparent in the cardiac surgical setting of aortic valve replacement (AVR) surgery for the correction of aortic stenosis. Thirty AVR surgery patients were randomly assigned to receive either target-controlled infusion of propofol or inhaled anesthesia with sevoflurane. Cardiac function was assessed perioperatively using a pulmonary artery catheter. Perioperatively, a high-fidelity pressure catheter was positioned in the left ventricle. Postoperative concentrations of cardiac troponin I were followed for 48 h. After cardiopulmonary bypass (CPB), stroke volume and dP/dtmax were significantly higher in the patients with sevoflurane. Post-CPB, the effects of an increase in cardiac load on dP/dtmax were similar to pre-CPB in the sevoflurane group (1.0 % ± 5.4% post-CPB versus 1.3% ± 8.6% pre-CPB) but more depressed in the propofol group (–8.2% ± 4.4% post-CPB versus 0.1% ± 4.9% pre-CPB). The rate of relaxation was significantly slower post-CPB in the propofol group. Postoperative levels of troponin I were significantly lower in the sevoflurane group. Our data indicate that the use of a volatile anesthetic regimen in AVR surgery was associated with better preservation of myocardial function and a reduced postoperative release of troponin I.

 

儿童行Nuss术时硬膜外使用布比卡因-太尼和布比卡因-可乐定的比较

A Comparison of Epidural Bupivacaine-Fentanyl and Bupivacaine-Clonidine in Children Undergoing the Nuss Procedure

Giovanni Cucchiaro, MD, Scott N. Adzick, MD, John B. Rose, MD, Lynne Maxwell, MD, and Mehernoor Watcha, MD From the Department of Anesthesiology and Critical Care Medicine and Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Anesth Analg 2006 103: 322-327.

 

硬膜外注入阿片类药物虽然能产生有效的镇痛,但多数患者有严重的副反应。目前可乐定是否能取代阿片类药物并产生较少的副作用仍不清楚。在这项随机试验中,作者比较了硬膜外注入三种不同组合的布比卡因、太尼和可乐定(布比卡因+太尼,布比卡因+可乐定,布比卡因+太尼+可乐定)在行Nuss术的过程中,呕吐和瘙痒的发生率以镇痛效果的差异。与布比卡因+太尼组(92%)和布比卡因+太尼+可乐定组(74%)相比,布比卡因+可乐定组副反应的发生率明显较低(33%)(P0.004)。三组的术后镇痛质量相似。没有观察到严重的并发症。结论:可乐定是一种有效而安全的硬膜外阿片类药物的替代品。

(曹瑜 陈杰 校)

The administration of epidural opioids, though effective for producing analgesia, has severe side effects in most patients. It is unknown whether clonidine can effectively replace opioids and cause fewer side effects. We compared, in this randomized trial, the incidence of vomiting and pruritus as well as the analgesic profile of three different combinations of bupivacaine, fentanyl, and clonidine administered epidurally in patients undergoing the Nuss procedure: bupivacaine + fentanyl, bupivacaine + clonidine, bupivacaine + fentanyl + clonidine. The incidence of side effects was significantly less in the bupivacaine + clonidine group (33%) compared with the bupivacaine + fentanyl (92%) and bupivacaine + fentanyl + clonidine (73%) groups (P = 0.004). Quality of postoperative analgesia was similar in the three groups. No significant complications were observed. In conclusion, clonidine is an effective and safe alternative to epidural opioids.

 

健康志愿者应用新型经鼻咪达唑仑制剂的药代学和药效学

Pharmacokinetics and Pharmacodynamics of a New Intranasal Midazolam Formulation in Healthy Volunteers

Daniel P. Wermeling, PharmD, FASHP*, Kenneth A. Record, PharmD*, Thomas H. Kelly, PhD{dagger}, Sanford M. Archer, MD{ddagger}, Thomas Clinch, and Anita C. Rudy, PhD

From the *University of Kentucky College of Pharmacy; {dagger}University of Kentucky College of Medicine; {ddagger}Division of Otolaryngology – Head & Neck Surgery, University of Kentucky A. B. Chandler Medical Center; Intranasal Therapeutics, Inc., Lexington, Kentucky.

Anesth Analg 2006 103: 344-349.

本文作者对12名健康志愿者进行标签开放、随机、三元交叉研究,评估单一剂量5mg的咪达唑仑在三种不同给药方式下,即新式经鼻内给药(IN)、肌注(IM)和静脉内注射(IV)时药代学和药效学。IN给药以喷雾方式用0.1mL单位剂量将药物喷入两侧鼻孔。在每次给药后的0-12小时内连续采血。使用高效液相术和质谱法术检测咪达唑仑的血浆浓度。用无房室法分析药代学参数。INIM咪达唑仑的平均生物利用度和百分比变异系数分别为72.512)和93.412)。IN时血药浓度达到峰值的平均时间为10分钟。不同给药方式的不良事件很少,但是经鼻喷雾给药有鼻咽部刺激,眼睛流泪和味道较差等不良。结果显示咪达唑仑经鼻喷雾剂需进一步的研制。

(肖洁 陈杰 校)

We evaluated the pharmacokinetics and pharmacodynamics of single 5-mg doses of midazolam after administration of a novel intranasal (IN) formula, IM, and IV midazolam in an open-label, randomized, 3-way cross-over study in 12 healthy volunteers. IN doses were delivered as 0.1-mL unit-dose sprays of a novel formulation into both naris. Blood samples were taken serially from 0 to 12 h after each dose. Plasma midazolam concentrations were determined by liquid chromatography/mass spectrometry/mass spectrometry. Noncompartmental analysis was used to estimate pharmacokinetic parameters. The mean midazolam bioavailabilities and % coefficient of variation were 72.5 (12) and 93.4 (12) after the IN and IM doses, respectively. Median time to maximum concentration was 10 min for IN doses. Adverse events were minimal with all routes of administration, but nasopharyngeal irritation, eyes watering, and a bad taste were reported after IN doses. Our results support further development of this novel midazolam nasal spray.

 

超临剂量的曲马多立体选择性弱离体大鼠主脉内皮细胞依赖性血管扩张

A Supraclinical Dose of Tramadol Stereoselectively Attenuates Endothelium-Dependent Relaxation in Isolated Rat Aorta

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

From the *Department of Anesthesia and Pain Medicine, Gyeongsang National University College of Medicine; {dagger}Institutes of Health Sciences, Gyeongsang National University; and {ddagger}Department of Pharmacology, Gyeongsang National University College of Medicine, Gyeongnam, Republic of Korea

Anesth Analg 2006 103: 366-371.

曲马多是R(-)S(+)对映体的化合物,可制乙酰胆碱介导的毒蕈碱受体反应和毒蕈碱引起的环鸟苷酸聚积。作者在离体实验中利用大鼠主脉研究曲马多对乙酰胆碱引起的内皮细胞依赖性血管扩张的效应,并确定曲马多的这种效应是否具有立体选择性,阐明其相关的细胞机制。在有或无纳洛酮的情况下,用苯肾腺素对内皮细胞完整的血管环进行预处理。然后在有或无曲马多(外消旋、R(-)S(+))的情况下,绘制乙酰胆碱、组胺和钙离子载体A23187的剂量反应曲线。在有或无外消旋曲马多的情况下,绘制硝普钠的剂量反应曲线。不管有或无纳洛酮,外消旋曲马多(5×10–5 10–4 M)弱乙酰胆碱引起的血管环扩张。R(-)曲马多5 x 10–5 M弱乙酰胆碱引起的血管环扩张,但S(+)曲马多5 x 10–5 M没有这种作用。外消旋曲马多对钙离子载体A23187或硝普钠的剂量反应曲线没有影响。述结果显示超临剂量(5 x 10–5 M)的曲马多,通过在涉非特异性内皮细胞活化的一个通路接近于一氧化氮合酶激活水平的制作用,可立体特异性地弱内皮细胞依赖性血管扩张。

(赵延华 陈杰 校)

Tramadol, a combination of R(–) and S(+) enantiomers, inhibits both the acetylcholine-mediated response of muscarinic receptors and the muscarine-induced accumulation of cyclic guanosine monophosphate. Our goals in this in vitro study were to investigate the effects of tramadol on endothelium-dependent relaxation induced by acetylcholine, to determine whether this effect of tramadol is stereoselective, and to elucidate the associated cellular mechanism in rat aorta. In endothelium-intact rings precontracted with phenylephrine with or without naloxone, dose-response curves for acetylcholine, histamine, and calcium ionophore A23187 were generated in the presence and absence of tramadol (racemic, R(–) and S(+)). Sodium nitroprusside dose-response curves were generated in the presence and absence of racemic tramadol. Racemic tramadol (5 x 10–5 10–4 M) attenuated acetylcholine-induced relaxation in the rings with or without naloxone. R(–) tramadol, 5 x 10–5 M, attenuated acetylcholine-induced relaxation, whereas S(+) tramadol, 5 x 10–5 M, did not. Racemic tramadol (10–4 M) had no effect on dose-response curves for calcium ionophore A23187 or sodium nitroprusside. Taken together, these results indicate that tramadol, at a supraclinical dose (5 x 10–5 M), stereoselectively attenuates endothelium-dependent relaxation via an inhibitory effect at levels proximal to nitric oxide synthase activation on a pathway involving nonspecific endothelial receptor activation.

 

0.5%布比卡因硬膜外阻滞复合氧化亚氮镇静的麻醉中BIS指数与OAA/S评分没有明显的相关性

Bispectral Index Does Not Correlate with Observer Assessment of Alertness and Sedation Scores During 0.5% Bupivacaine Epidural Anesthesia with Nitrous Oxide Sedation

Kyung Soo Park, PhD, MD*, Eun Jin Hur, BS*, Kyung Woo Han{dagger}, Ho Yeong Kil, MD, PhD{dagger}, and Tae Hyung Han, MD, PhD, FAAFP{dagger}

From the Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea; {dagger}Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Anesth Analg 2006 103: 385-389.

BIS指数被用作监测静脉镇静催眠药、强效挥发性麻醉剂的镇静程度和催眠水平。作者在实施区域阻滞的患者中,评价提高氧化亚氮的浓度对BIS的影响,并将它与OAA/S比较。随机选择48ASA-Ⅱ级,在腰部硬膜外麻醉下行下肢手术的成人患者。氧化亚氮与氧气同时给予,通过紧扣的面罩使氧化亚氮潮气末浓度逐渐增至33%50%67% ,且每种浓度维持20分钟。在每次增氧化亚氮前获取BIS指数和OAA/S的数据。48名患者中40人完成了实验。增氧化亚氮的浓度,BIS值没有变化,但是氧化亚氮浓度在50%67%OAA/S评分明显下降。用Somer dx.y计算的预测BISOAA/S的概率分别是0.600.84。麻醉医师应该警惕,在单独利用氧化亚氮镇静时BIS监测并不能敏感地测量镇静和催眠的深度。利用临监测镇静方法(如OAA/S评分)可能更好地确定麻醉药需要的剂量和足够的镇静和催眠的深度。

(刘哲 陈杰 校)

The bispectral index (BIS) has been used as a measure of the degree of sedation and level of hypnosis for IV hypnotics and sedatives, potent volatile anesthetics. We evaluated the effect of increasing concentrations of nitrous oxide (N2O) on BIS and compared it with the Observer's Assessment of Alertness and Sedation (OAA/S) scale in patients undergoing regional anesthesia. We studied 48 unpremedicated, ASA physical status I–II adult patients scheduled for lower extremity surgery under lumbar epidural anesthesia. N2O was given in oxygen to achieve measured end-tidal concentrations of 33%, 50%, and 67% N2O by a tight-fitting facemask, and each N2O concentration was maintained for 20 min. Paired measurements of BIS and OAA/S scores were obtained just before each increase in N2O concentration. Forty of the 48 subjects completed the study. Increasing N2O concentrations produced no changes in BIS despite a significant decrease in OAA/S scores at 50% and 67% N2O concentrations. The prediction probability for BIS and OAA/S calculated by Somers' dx · y were 0.60 and 0.84, respectively. Anesthesiologists should be aware that the BIS monitor may not be sensitive enough to provide an adequate measure of the depth of sedation and hypnosis when using N2O alone for sedation. It may be better to monitor sedation clinically (e.g., with the OAA/S scale) to determine the dose requirement and the adequacy of depth of sedation and hypnosis.

 

异氟醚对大鼠重度前脑缺血预后呈剂量依赖效应

The Dose-Dependent Effects of Isoflurane on Outcome from Severe Forebrain Ischemia in the Rat

Ikuko Nasu, MD*, Noriko Yokoo, MD, PhD*, Seiji Takaoka, MD, PhD*, Kosuke Takata, MD*, Tamie Hoshikawa, MD*, Masayuki Okada, MD*, and Yoshihide Miura, MD, PhD{dagger}

From the *Department of Anesthesiology, Yamagata University School of Medicine, Yamagata, Japan; and the {dagger}Department of Dental Anesthesiology, Health Sciences University of Hokkaido, Japan.

Anesth Analg 2006 103: 413-418.

异氟醚改善大鼠脑缺血预后,但其最佳的脑保浓度尚未阐明。作者研究了大鼠重度前脑缺血模型中不同浓度异氟醚对预后的影响。禁食大鼠在进行双侧颈脉闭塞全身低血压时分别吸入0.5, 1.0, 1.5, 2.0, 2.5 MAC的异氟醚。脉血压无须药物处理。缺血后,麻醉以太尼/NO2维持2h。在实验期间颅骨膜的温度维持正常。缺血5天后评估神经运评分,海马CA1神经元死亡百分比,皮层的损伤。在缺血前,脉血压随着MAC的增而降低。吸入>1.0 MAC异氟醚的物在缺血后频发癫痫并且有较高的死亡率。CA1神经元死亡百分比没有显著差异(93 ~95%)。吸入0.5 MAC 1.0 MAC异氟醚的皮层神经元的坏死显著低于>1.0 MAC的组。在1.0 MAC异氟醚的组,神经肌肉评分优于2.5 MAC组。在重度前脑缺血模型中,缺血前异氟醚预处理呈现显著的组织学和行为学剂量依赖效应。小于1.5MAC剂量的异氟醚脑保作用优于大剂量异氟醚。

(潘志英 陈杰 校)

Isoflurane improves outcome against cerebral ischemia in the rat. However, the optimal neuroprotective concentration has not been defined. We examined the effects of different isoflurane concentrations on outcome from severe forebrain ischemia in the rat. Fasted rats were subjected to 0.5, 1.0, 1.5, 2.0, or 2.5 minimum alveolar concentration (MAC) isoflurane during 10 min bilateral carotid occlusion plus systemic hypotension. Each isoflurane concentration was administered only before ischemia. Arterial blood pressure was not pharmacologically manipulated. After ischemia, the anesthetic regimen was changed to fentanyl/nitrous oxide and maintained for 2 h. Pericranial temperature was maintained normothermic during the experiment. Neuromotor score, % dead hippocampal CA1 neurons, and cortical injury were measured 5 days postischemia. Preischemic arterial blood pressure decreased as MAC was increased. Animals administered >1.0 MAC frequently exhibited postischemic seizures resulting in increased mortality. There was no difference among MAC conditions for % dead CA1 neurons (93 ~95%). In the cortex, neuronal necrosis was less severe with 0.5 MAC and 1.0 MAC isoflurane relative to >1.0 MAC values. The neuromotor score in the 1.0 MAC isoflurane group was superior to the 2.5 MAC group. Dose-dependent effects of preischemic administration of isoflurane on histologic and behavioral outcome after severe forebrain ischemia were observed. Isoflurane MAC values <1.5 provided superior overall outcome relative to larger isoflurane concentrations.

 

低氧性胎盘血管收缩:人胎盘对低氧反应是渐进性的

Hypoxemic Fetoplacental Vasoconstriction: A Graduated Response to Reduced Oxygen Conditions in the Human Placenta

Ramiah Ramasubramanian, MD, Raymond F. Johnson, BS, John W. Downing, MD, Beth H. Minzter, MD, and Ray L. Paschall, MD

From the *Department of Anesthesiology, Providence Milwaukie Hospital, Milwaukie, Oregon; {dagger}Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; and {ddagger}Department of Anesthesiology, Columbia University, New York, New York.

Anesth Analg 2006 103: 439-442.

本文作者研究离体、双重灌注的人胚胎绒毛的低氧性胎盘血管收缩(HFPV)的特性。将四个胎盘母面绒毛小叶应用21%O25%CO2N2(对照组)进行平衡,然后用含有5% CO2N2平衡30min,在此过程中监测其血压的变化。结果发现血压从69.8 (±6.4) mm Hg 升高至 105 (±3.0) mm Hg (P < 0.05),这肯定了HFPV在人胎盘中的作用。另外8个胎盘母面绒毛小叶分别依次应用对照气体和混合气体平衡15min,混合气体包括15%, 12%, 5%0% O2,含有5% CO2N2 。结果发现胎盘血压在15% O2平衡时从68.7 (± 3.7) mm Hg 升高到 70.5 (±3.3) mm Hg,在12% O2平衡时从69.3 (±3.8) mm Hg 升高到72.4 (±4.3) mm Hg,在0% O2平衡时从69.7 (± 3.4) mm Hg升高到77.9 (± 5.9) mm Hg。这说明,HFPV在人胎盘对低氧反应为渐进性。

(苏殿三 陈杰 校)

We investigated the characteristics of hypoxemic fetoplacental vasoconstriction (HFPV) in the dual perfused, single isolated human placental cotyledon. Fetal arterial blood pressures (FAP) were measured in four cotyledons (Group 1) equilibrated with 21% oxygen (O2), 5% carbon dioxide (CO2), and nitrogen (N2) [control] followed by 5% CO2 in N2 for 30 min. FAP (mean ± sd) increased from 69.8 (± 6.4) to 105 (± 3.0) mm Hg (P < 0.05), confirming the utility of HFPV in the human placenta. Eight more cotyledons (Group 2) were exposed sequentially and alternately at 15-min intervals to the control gases and to gas blends containing 15%, 12%, 5%, and 0% O2 with 5% CO2 and N2. FAP increased significantly (P < 0.05) in a stepwise fashion from 68.7 (± 3.7) to 70.5 (± 3.3) mm Hg with 15% O2; from 69.3 (± 3.8) to 72.4 (± 4.3) mm Hg with 12% O2; from 67.8 (± 3.2) to 74.5 (± 3.4) mm Hg with 5% O2; and from 69.7 (± 3.4) to 77.9 (± 5.9) mm Hg with 0% O2, suggesting that HFPV is a graduated response to reduced O2 conditions in the human placenta.

 

喉罩在导丝扩张式气管造口术中的应用

The Use of the Laryngeal Mask Airway During Guidewire Dilating Forceps Tracheostomy

Davide Cattano, MD*{dagger}, Steven Abramson, MD{ddagger}, Stefano Buzzigoli, MD{dagger}, Candido Zoppi, MD{dagger}, Ettore Melai, MD*, Francesco Giunta, MD*, and Carin Hagberg, MD{ddagger}

From the *Department of Surgery, Division of Anesthesiology and Intensive Care, University of Pisa, Pisa, Italy; {dagger}Department of Intensive Care, Anaesthesia and Analgesia, Versilia Hospital, Lidodi Camaiore, Italy; and {ddagger}Department of Anesthesiology, The University of Texas Medical School, Houston, Texas.

Anesth Analg 2006 103: 453-457.

 

经皮气管造口因使用便捷,耗费较低,并能降低气管造口术后并发症的发生率,已来多地替代了经典的开放式气管造口。作者回顾了ICU中采用气管内插管下行导丝扩张式经皮气管造口术,并与使用经典的喉罩下进行操作的病例作比较。1998年至2004年间,有274名病人施行过气管造口,其中254人(92.7%)使用了导丝扩张式气管造口术,20人(7.3%)行外科开放式气管造口。在使用导丝扩张式气管造口的一组中,188人(74%)应用了经喉罩支气管内镜术,66人(26%)则行气管内插管下完成操作。作者认为经喉罩内窥镜术的视野优于气管导管。气管导管所引起的急性并发症较喉罩常见(6/66对比4/188P=0.022 Fisher’s精确测验,优比=4.6)。两者在急性并发症(10/2546/20P<0.001,优比=10.5)和长期合并症(0/254对比4/20P<0.001)的发生率亦有显著差异。无换气能障碍和胃内容物误吸的。因此选择性病人行导丝扩张式气管造口,喉罩较气管导管提供了更为安全和有效的气道管理。

(印杰敏译 陈杰 校)

Percutaneous tracheostomy has become a common alternative to the classical open tracheostomy because of its convenience, cost effectiveness, and decreased complication rates. We retrospectively reviewed our intensive care practice using a guidewire dilatating forceps percutaneous tracheostomy technique with an endotracheal tube, as compared with the Classic Laryngeal Mask Airway (LMA) for these procedures. From 1998 to 2004, 274 patients underwent a tracheostomy procedure. Two-hundred-fifty-four (92.7%) of these patients underwent a guidewire dilatating forceps tracheostomy and 20 (7.3%) underwent a surgical tracheostomy. In the guidewire dilatating forceps group, 188 (74%) were performed by endoscopy via LMA-guided bronchoscopy, and 66 (26%) were performed through an endotracheal tube. Endoscopic views obtained via the LMA were subjectively better than those obtained with the endotracheal tube. Acute complications were significantly more frequent when using an endotracheal tube as compared with the LMA (6 of 66 versus 4 of 188; P = 0.022 Fisher's exact test, odds ratio = 4.6). There was a significant difference in terms of acute (10 of 254 versus 6 of 20; P < 0.001, odds ratio = 10.5) and chronic (0 of 254 versus 4 of 20; P < 0.001) complications between the 2 groups. There were no ventilatory complications or reports of gastric aspiration. The LMA provides a safe and effective alternative to an endotracheal tube for airway management during guidewire dilatating forceps tracheostomies in selected patients.

 

{alpha}-1 {alpha}-2 肾腺素受体在周围咪唑啉和肾腺素受体激剂诱导的伤害感受中的发挥作用

The Contribution of Alpha-1 and Alpha-2 Adrenoceptors in Peripheral Imidazoline and Adrenoceptor Agonist-Induced Nociception

Ahmet Dogrul, MD, Ilke Coskun, and Tayfun Uzbay

From the Gülhane Military Medical Academy, Faculty of Medicine, Department of Medical Pharmacology, Psychopharmacology Research Unit, Ankara, Turkey.

Anesth Analg 2006 103: 471-477

作者用轻弹鼠尾试验研究了大鼠外周肾腺素受体和咪唑啉受体对伤害性感受激活的影响以{alpha}-1 {alpha}-2 肾腺素受体在激剂诱导的伤害感受中的作用。在鼠尾皮内注射10 µL的可乐定({alpha}-2肾腺素受体激剂), 胍丁胺(咪唑啉受体和{alpha}-2肾腺素受体激剂),去甲肾腺素({alpha}-1{alpha}-2肾腺素受体激剂),苯肾腺素({alpha}-1肾腺素受体激剂), 0.9%生理盐水。皮内注射可乐定(1, 3, 10 µg) 或胍丁胺(3, 30, 50 µg) 可产生剂量依赖性的-伤害感受, 而皮内注射去甲肾腺素(1, 10, and 30 µg)或苯肾腺素(1, 10 30 µg) 可产生剂量依赖性的热痛觉过敏。可乐定(10 µg)和胍丁胺(50 µg)导致的外周性的-伤害感受作用被预给育亨宾(一种选择性的{alpha}-2肾腺素拮剂)(2.5 mg/kg IP) ,而不能被哌唑唪(一种选择性的{alpha}-1肾腺素拮剂)(1 mg/kg IP) 拮。去甲肾腺素(30 µg) 和苯肾腺素 (30 µg)引起的热的痛觉过敏可以被哌唑唪(1 mg/kg IP)拮,而不能被育亨宾(2.5 mg/kg IP) 拮。结果表明去甲肾腺素和苯肾腺素对局部的热痛觉过敏的影响与{alpha}-1 肾腺素受体有关,可乐定和胍丁胺的外周性-伤害感受作用与{alpha}-2 肾腺素受体有关。

(宋金超 陈杰 校)

We evaluated the effects of activation of peripheral adrenoceptors (AR) and imidazoline receptors on nociception and the contribution of {alpha}-1 and {alpha}-2 AR receptors in agonist-induced nociception by using the tail-flick test in mice. Clonidine ({alpha}-2 AR agonist), agmatine (imidazoline receptor and {alpha}-2 AR agonist), noradrenaline (mixed {alpha}-1 and {alpha}-2 AR agonist), phenylephrine ({alpha}-1 AR agonist), or 0.9% saline was given by intradermal injection (10 µL) into the tail. The intradermal injection of clonidine (1, 3, and 10 µg) and agmatine (3, 30, and 50 µg) produced dose-dependent antinociception, whereas noradrenaline (1, 10, and 30 µg) and phenylephrine (1, 10 and 30 µg) produced dose-dependent thermal hyperalgesia. Clonidine (10 µg) and agmatine (50 µg)-induced peripheral antinociception were antagonized by pretreatment with yohimbine (2.5 mg/kg IP), a selective {alpha}-2 AR antagonist, but not by prazosin (1 mg/kg IP), a selective {alpha}-1 AR antagonist. Noradrenaline (30 µg) and phenylephrine (30 µg)-induced thermal hyperalgesia were antagonized by prazosin (1 mg/kg IP) but not by yohimbine (2.5 mg/kg IP). Our results suggest that local thermal hyperalgesic effects of noradrenaline and phenylephrine are linked to {alpha}-1 AR and the peripheral antinociceptive action of clonidine and agmatine are linked to {alpha}-2 AR.

 

细胞外信号调的激酶触发异氟醚预处理伴随大鼠低氧可诱导因子-和血管内皮生长因子表达的调

Extracellular Signal-Regulated Kinases Trigger Isoflurane Preconditioning Concomitant with Upregulation of Hypoxia-Inducible Factor-1{alpha} and Vascular Endothelial Growth Factor Expression in Rats

Chen Wang, MD, Dorothee Weihrauch, DVM, PhD, David A. Schwabe, BSEE, Martin Bienengraeber, PhD, David C. Warltier, MD, PhD, Judy R. Kersten, MD, Phillip F. Pratt, Jr, PhD, and Paul S. Pagel, MD, PhD

From the Departments of Anesthesiology, Medicine (Division of Cardiovascular Diseases), and Pharmacology and Toxicology, the Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center; Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.

Anesth Analg 2006;103:281-288

 

引言:细胞外信号相关激酶12Erk1/2)是与麻醉药预处理相关的线粒体激活的蛋白激酶;不过Erk1/2究竟是触发还是介导了此有效应以其产生心肌保的机制尚属未知。我们验证了以下假设:大鼠接受冠脉阻断30min再灌注2h,通过血流学测定提示异氟醚预处理是由Erk1/2触发并伴有低氧可诱导因子HIF)血管内皮生长因子(VEGF)表达调。

方法:大鼠随机接受静注生理盐水(对照)或异氟醚(冠脉阻断之前吸入1MAC 30min,停止15min〔记忆期〕),并分别给予或不给予选择性Erk1/2制剂PD 0980591mg/kg溶于二甲基亚砜,分别于吸入异氟醚〔触发剂〕前3min或停止药物〔介导剂〕后3min)。另外有兔单用二甲基亚砜预处理。从额外的各组大鼠按选定时点分别采集左心室组织标本用来对磷酸化-Erk1/2HIFVEGF的蛋白表达进行Western免疫印迹分析。

结果:和对照组相比,异氟醚明显减少了梗死面积(左室危险部位面积的41±8vs 59% ± 4%P < 0.05,氯三苯四唑染色)。在异氟醚使用之前而不是之后使用PD 098059取消了心肌保作用(分别为61% ± 5% 42% ± 9%)。异氟醚引起的磷酸化-Erk1/2HIFVEGF的表达增也被PD 098059预处理所制。

结论:结果提示体内Erk1/2触发了异氟醚预处理伴随HIFVEGF的调。

(黄施伟 译,马皓琳 李士通 校)

INTRODUCTION: Extracellular signal-related kinases 1 and 2 (Erk1/2) are mitogen-activated protein kinases that have been implicated in anesthetic preconditioning; but whether Erk1/2 triggers or mediates this beneficial effect and the mechanisms by which Erk1/2 produces cardioprotection are unknown. We tested the hypothesis that isoflurane preconditioning is triggered by Erk1/2 concomitant with upregulation of hypoxia-inducible factor 1{alpha} (HIF-1{alpha}) and vascular endothelial growth factor (VEGF) expression in rats instrumented for hemodynamic measurement and subjected to a 30-min coronary artery occlusion and 2-h reperfusion.

METHODS: Rats randomly received IV 0.9% saline (control) or isoflurane (1.0 minimum alveolar concentration administered for 30 min and discontinued 15 min [memory period] before coronary occlusion) in the absence or presence of the selective Erk1/2 inhibitor PD 098059 (1 mg/kg in dimethylsulfoxide administered IV either 3 min before exposure to isoflurane [trigger] or 3 min after discontinuation of the drug [mediator]). Additional rabbits were pretreated with dimethylsulfoxide alone. Left ventricular tissue samples were obtained at selected intervals from additional groups of rats for Western immunoblot analysis of phospho-Erk1/2, HIF-1{alpha}, and VEGF protein expression.

RESULTS: Isoflurane significantly (P < 0.05) reduced infarct size (41% ± 8% of the left ventricular area at risk; triphenyltetrazolium chloride staining) as compared with control (59% ± 4%). PD 098059 administered before, but not after, isoflurane abolished this cardioprotection (61% ± 5% and 42% ± 9%, respectively). Isoflurane-induced increases in phospho-Erk1/2, HIF-1{alpha}, and VEGF expression were also inhibited by PD 098059 pretreatment.

CONCLUSIONS: The results indicate that Erk1/2 triggers isoflurane preconditioning concomitant with HIF-1{alpha} and VEGF upregulation in vivo.

 

 

异丙酚/异氟烷麻醉下儿童的年龄对运激发电位的影响

The Effect of Age on Motor Evoked Potentials in Children Under Propofol/Isoflurane Anesthesia

Jeremy A. Lieberman, MD*, Russ Lyon, MS, DABNM{ddagger}, John Feiner, MD*, Mohammad Diab, MD{dagger}, and George A. Gregory, MD*

From the *Department of Anesthesia and Perioperative Care, {dagger}Department of Orthopedic Surgery, {ddagger}Division of Perioperative Services, University of California, San Francisco, San Francisco, California.

Anesth Analg 2006;103:316-321

 

术中经颅运激发电位(MEP)监测有于预防柱手术期间的神经损伤。对于儿科群体来说,在常规麻醉条件下,此种监测可能有困难。我们回顾性地研究了56个年龄在218岁,欲在MEP监测下 行先天性柱侧凸矫正手术的儿童的数据。在异氟烷-异丙酚复合全身麻醉下,我们在切皮前检测出达到50微伏或更大MEP反应幅度所需的最小刺激阈电压。年龄小,引起足够MEP反应所需的阈电压大。此外,年龄较小者的刺激脉冲系列较长并且更需要调整头皮刺激电极。体表面积、身高、体重、体重指数亦是重要的因素,但经年龄标化后,并不能成为独立的评估指标。给予年龄较小的儿童接受的异氟烷水平低于年龄较大的儿童,异丙酚的剂量相近。年幼患者需要更强的刺激方能产生MEP反应,可能是因为其中枢神经系统,尤其是下行皮质髓运束的传导欠成熟在最优化生理变异、限制麻醉镇静药和选择最适用于儿童(尤其是年龄<10岁)的刺激条件这些方面尚需强关注。

唐李隽 马皓琳  李士通 校)

Intraoperative transcranial motor evoked potential (MEP) monitoring may help prevent neurologic injury during spine surgery. This type of monitoring may be difficult in the pediatric population under general anesthesia. We retrospectively reviewed data from 56 children, aged 2 to 18 yr, who were to undergo surgical correction of idiopathic scoliosis with MEP monitoring. Under combined isoflurane-propofol general anesthesia, before incision, we examined the minimum stimulating threshold voltage required to achieve a 50-microvolt or greater MEP response amplitude. Younger age was associated with an increase in the threshold voltage needed to elicit a sufficient MEP response. In addition, younger age was associated with longer stimulating pulse trains and greater need to adjust stimulating scalp electrodes. Body surface area, height, weight, and body mass index were also significant factors, but they were not independent predictors, after adjusting for age. Younger children received significantly lower levels of isoflurane and comparable doses of propofol, compared with older patients. Stronger stimulation needed to produce MEP responses in younger patients may reflect immaturity of their central nervous system, specifically conduction by the descending corticospinal motor tracts. Greater attention must be given to optimizing physiologic variables, limiting depressant anesthetics, and selecting the most favorable stimulating conditions in children, especially those <10 yr old.

 

 

大鼠术后疼痛模型中脑液和外周前列腺素E2水平调

Upregulation of Cerebrospinal Fluid and Peripheral Prostaglandin E2 in a Rat Postoperative Pain Model

Jeffrey S. Kroin, PhD, Asokumar Buvanendran, MD, Daniel E. Watts, BS, Chiranjeev Saha, MD, and Kenneth J. Tuman, MD

From the Department of Anesthesiology, Rush Medical College, Chicago, Illinois.

Anesth Analg 2006;103:334-343

 

胸外科手术术后疼痛治疗一直以来是临的一个难题。在本研究中,我们采用胸肌切口模型显示疼痛相关的行为特点和胸段脑液(CSF)切口部位组织前列腺素E2 (PGE2)水平的变化。 用异氟醚、丙酚或蛛网膜下腔内注射布比卡因麻醉的大鼠左胸部行一深部肌肉切口。用微透析环路导管监测6小时内胸段脑液和切口部位组织的PGE2浓度。通过记录探索性运作评估术后疼痛相关行为学改变。胸部肌肉手术使大鼠术后后腿直立作和行走作减少。口服酮咯酸或罗非考昔3mg/kg可使大鼠恢复正常的后腿直立作和行走作。接受麻的大鼠术后CSFPGE2浓度升高幅度最高(3倍),而接受丙酚麻醉的大鼠CSFPGE2浓度没有变化。对于接受异氟醚麻醉或蛛网膜下腔注射布比卡因麻醉的大鼠,术前口服酮咯酸或罗非考昔3mg/kg可降低这些大鼠术后CSF和切口组织PGE2水平。鞘内注射酮咯酸(4 µg)可降低术后CSFPGE2水平而对切口组织PGE2水平没有影响。但是鞘内注射L-745,337 (80 µg)不能降低CSFPGE2水平。胸外科手术伤口增疼痛相关的行为学改变和脑液切口组织PGE2水平,口服环氧合酶制剂可弱此种变化。

(周雅春 马皓琳 李士通校)

Analgesic management of postoperative pain associated with thoracic surgery remains a difficult clinical challenge. In the present study we used a thoracic muscle incision model to characterize pain-related behavior and changes in prostaglandin E2 (PGE2) in both thoracic cerebrospinal fluid (CSF) and incision site tissues. A deep muscle incision was made in the left thoracic region of rats anesthetized with isoflurane, propofol, or spinal bupivacaine. Thoracic CSF and incision site tissue concentrations of PGE2 were monitored for 6 h using microdialysis loop catheters. Postoperative pain-related behavior was assessed by recording exploratory locomotive activity. Thoracic muscle surgery decreased rearing and ambulation. Oral ketorolac or rofecoxib 3 mg/kg restored normal rearing and ambulation. Postoperative CSF PGE2 concentration increased most (threefold) with spinal anesthesia, and not at all with propofol. With surgery under isoflurane or spinal bupivacaine, presurgical oral administration of ketorolac or rofecoxib 3 mg/kg reduced postsurgical CSF PGE2 levels and tissue PGE2 levels. Intrathecal ketorolac (4 µg) reduced CSF PGE2 after surgery without affecting tissue PGE2 levels, whereas intrathecal L-745,337 (80 µg) did not reduce CSF PGE2. Thoracic surgical wounds increase pain-related behavior and CSF and tissue PGE2 levels, all of which can be attenuated by oral cyclooxygenase inhibitors.

 

 

机械通气的家兔对异丙酚镇静作用的耐受性

Tolerance to Propofol’s Sedative Effect in Mechanically Ventilated Rabbits

Petros Ypsilantis, DVM, PhD*, Dimitrios Mikroulis, MD, PhD{dagger}, Maria Politou, MD*, Heleni Tsoukali, PhD{ddagger}, Michail Pitiakoudis, MD, PhD*, Vasilios Didilis, MD, PhD{dagger}, Georgios Theodoridis, PhD, Georgios Bougioukas, MD, PhD{dagger}, and Constantinos Simopoulos, MD, PhD*

From the *Laboratory of Experimental Surgery and Surgical Research and {dagger}Thoracic and Cardiac Surgery Clinic, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece; {ddagger}Laboratory of Forensic Medicine and Toxicology, Medical School, and Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Anesth Analg 2006;103:359-365

 

异丙酚常用于对机械通气的危重病人的镇静。在长期输注过程中,这些病人可能会产生耐受。这里,我们描述了长期机械通气的家兔对异丙酚镇静效应耐药的发展过程。六只健康的雄性新西兰大白兔进行了气管内插管,持续静脉输注异丙酚48小时以维持镇静。调异丙酚输注速率(IR)以维持想达到的镇静水平。每30分钟或者如果有清醒的体征可以更早些,评定一次镇静深度。每次调整输注速率后,假设镇静水平足够,均取一次脉血,用高效液相色谱分析测定异丙酚浓度,并且计算出全身清除率。死亡率是100%,生存期30.8 ± 6.0 小时(均数±标准差)。输注速率的调整过程遵循一个5相模式:1)稳定的输注速率(持续时间的均数±标准差,1.2 ± 0.6 小时)2)增输注速率(9.4 ± 5.5 小时)3)稳定的高输注速率(9.4 ± 5.5 小时)4)降低输注速率(13.7 ± 1.9 小时)5)稳定的低输注速率(5.0 ± 2.7 小时)。试验中与异丙酚输注速率相关的异丙酚浓度的变化过程遵循3相模式:1)随着输注速率的增维持稳定的浓度(6.0 ± 2.7 小时),2)随着输注速率增浓度增(5.8 ± 2.5 小时),3)随着输注速率降低浓度增(18.8 ± 3.3 小时)。异丙酚全身清除率在6.0 ± 2.7 小时里逐渐增,接着在24.6 ± 4.7小时里逐渐下降。总而言之,所有家兔在异丙酚最初的输注中对其镇静效应均发生了耐药,与该种药物的代谢清除率的变化有关。

 (黄丽娜    马皓琳 李士通 )

Propofol is commonly used for the sedation of critically ill patients undergoing mechanical ventilation. These patients may develop tolerance during long-term administration. Here, we describe the development of tolerance to propofol’s sedative effect in rabbits during prolonged mechanical ventilation. Six healthy male New Zealand White rabbits were endotracheally intubated and received propofol by continuous IV infusion to maintain sedation for 48 h. The propofol infusion rate (IR) was adjusted to maintain the desired level of sedation. Assessments of the sedation level were made every 30 min or earlier if there were signs of awakening. Propofol concentrations were measured in arterial plasma after every other IR adjustment, provided there was an adequate level of sedation, using high performance liquid chromatography, and calculations of systemic clearance rates were made. The mortality rate was 100% with a survival period of 30.8 ± 6.0 h (mean ± sd). The course of IR adjustments followed a 5-phase pattern: 1) steady IR (mean ± sd duration; 1.2 ± 0.6 h), 2) increasing IR (9.4 ± 5.5 h), 3) steady high-IR (2.3 ± 1.2 h), 4) decreasing IR (13.7 ± 1.9 h), and 5) steady low-IR (5.0 ± 2.7 h). The course of propofol concentrations during the experiment in relation to propofol IR followed a 3-phase pattern: 1) steady concentration with increasing IRs (6.0 ± 2.7 h), 2) increasing concentrations with increasing IR (5.8 ± 2.5 h), and 3) increasing concentrations with decreasing IR (18.8 ± 3.3 h). Propofol systemic clearance rates were progressively increased for 6.0 ± 2.7 h and then gradually decreased for 24.6 ± 4.7 h. In conclusion, all rabbits developed tolerance to propofol’s sedative effect within the first hours of administration related to changes to the drug’s metabolic clearance.

 

 

比较介入放射治疗中双谱指数(BIS)指导的和临指导的雷米太尼/异丙酚的镇痛/镇静水平:观察者单盲随机研究

Bispectral-Index-Guided Versus Clinically Guided Remifentanil/Propofol Analgesia/Sedation for Interventional Radiological Procedures: An Observer-Blinded Randomized Study

Ashraf A. Dahaba, MD, MSc, PhD*, Ulrike Lischnig, MD*, Robert Kronthaler, MD*, Helmar Bornemann, MD*, Vassil Georgiev, MD*, Peter H. Rehak, PhD{dagger}, and Helfried Metzler, MD*

From the *Department of Anaesthesiology and Intensive Care Medicine, and {dagger}Biomedical Engineering and Computing Unit of the Department of Surgery, Graz Medical University, Graz, Austria.

Anesth Analg 2006;103:378-384

 

接受潜在疼痛的放射介入治疗的病人一般需要复合镇痛和镇静。这种镇痛/镇静应该使病人在保持平静的态下具有交流能。双谱指数(BIS)监测在这方面是非常有用的。我们研究的主要目的是在54位随机的病人中比较BIS指导的雷米太尼/异丙酚麻醉方法和临指导的麻醉方法最佳镇静(定义为镇静兴奋分级〔SAS 4级)的时间百分比。BIS组最佳镇静的时间百分比均数±标准差, (76.6% ± 14.7%)SAS(63.8% ± 16.4%)显著延长(P = 0.004)BIS组雷米太尼(P = 0.0067)和异丙酚(P = 0.0075)的每公斤体重平均注速度(0.066 ± 0.027 μg · kg–1 · min–1 1.59 ± 0.44 mg · kg–1 · h–1)SAS(0.091 ± 0.036 μg · kg–1 · min–1 1.92 ± 0.43 mg · kg–1 · h–1)间均有显著差异。BIS值和SAS分数 间存在着一个短期的相关性(r2 = 0.72)。结论,由BIS指导的比SAS指导的方法更有效。BIS的应用可以减少雷米太尼和异丙酚的用量。BIS靶范围在8085可以提供足够的镇静能性水平。

(黄佳佳译,马皓琳 李士通

Patients undergoing potentially painful interventional radiological procedures generally require a combination of analgesia and sedation. This sedation/analgesia should allow the patient to communicate while also remaining calm. Bispectral index (BIS) monitoring could be useful in achieving this. The primary end-point of our study was to compare the percentage time with optimal sedation, defined as Sedation Agitation Scale (SAS) grade 4, between a BIS-guided remifentanil/propofol regimen and a clinically guided regimen in 54 randomly allocated patients. The mean ± sd percentage time with optimal sedation was significantly longer (P = 0.004) in the BIS group (76.6% ± 14.7%) than in the SAS group (63.8% ± 16.4%). There was a significant difference in the weighted mean infusion rates of remifentanil (P = 0.0067) and propofol (P = 0.0075) in the BIS group (0.066 ± 0.027 µg · kg–1 · min–1 1.59 ± 0.44 mg · kg–1 · h–1) compared with the SAS group (0.091 ± 0.036 µg · kg–1 · min–1 1.92 ± 0.43 mg · kg–1 · h–1), respectively. BIS values exhibited a temporal correlation to SAS scores (r2 = 0.72). In conclusion, a BIS-guided regimen was more effective than a SAS-guided regimen. The use of BIS resulted in fewer remifentanil and propofol doses. The targeted BIS range of 80–85 provided a sufficient functional level of sedation.

 

 

在植入心内除颤复律器过程中重复短暂心脏停搏后的神经元损伤伴随认知能障碍

Neuronal Injury After Repeated Brief Cardiac Arrests During Internal Cardioverter Defibrillator Implantation Is Associated With Deterioration of Cognitive Function

Manuela Weigl, MD*, Andrea Moritz, MD*, Barbara Steinlechner, MD*, Isabella Schmatzer, cand. med.*, Bruno Mora, MD*, Richard Fakin, cand. med.*, Daniel Zimpfer, MD{dagger}, Hendrik J. Ankersmit, MD{dagger}, Cesar Khazen, MD{dagger}, and Martin Dworschak, MD*

From the *Department of Anesthesiology and General Intensive Care, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; {dagger}Department of Surgery, Division of Cardiothoracic Surgery, University Hospital Vienna, Austria.

Anesth Analg 2006;103:403-409

 

为了确定在植入心内除颤复律器(ICD)后神经认知能障碍的程度其与神经元损伤范围的关系,我们研究了42位施行ICDn=21)或起搏器(PM)(对照病人,n=21)植入术的病人。在术前和术后进行简易智能量表、追踪试验ATrailmaking A test)、向前向后数字距离测验和P300潜伏期测定。在术前、手术结束时以术后2624小时测定血浆神经元特异性烯醇酶(NSE)。在术前,PM组病人的向后数字距离测验评分和追踪试验得分较差,P300潜伏期延长。在术后,只有ICD植入病人的向后数字距离评分下降,NSE水平升高(P 0.05)。术前和术后向后数字距离测验评分的差值与血浆NSE水平的升高相关(r2 = 0.3, P ≤0.05)。此外,在17ICD植入病人中13P300潜伏期延长,但是在10PM植入病人中7P300潜伏期缩短(P 0.05)。PM植入病人的追踪试验得分甚至得到改善(P 0.05)。看来即使短暂大脑缺血导致的神经元损伤也伴随神经认知能损害。

(颜涛 译, 马皓琳 李士通 校)

To determine the degree of neurocognitive dysfunction after placement of internal cardioverter defibrillators (ICD) and its relationship to the extent of neuronal injury, we studied 42 patients undergoing ICD (n = 21) or pacemaker (PM) insertion (control patients, n = 21). The Mini Mental State Examination, the Trailmaking A test and the forward and backward Digit Span tests were used and P300 latencies were determined preoperatively and postoperatively. Serum neuron-specific enolase (NSE) was determined before and at the end of, as well as 2, 6, and 24 h after surgery. Preoperatively, PM patients scored worse in the Digit Span backward and the Trailmaking tests and showed prolonged P300 latencies. Postoperatively, the Digit Span backward scores declined and NSE levels increased only in the ICD group (P 0.05). The difference between preoperative and postoperative Digit Span backward scores correlated with the increase in serum NSE levels (r2 = 0.3, P 0.05). Moreover, P300 latencies increased in 13 of 17 ICD patients, but decreased in 7 of 10 PM patients (P ≤0.05). PM patients even improved in the Trailmaking test (P 0.05). Neuronal injury from even brief periods of global brain ischemia seems to be associated with deteriorating neurocognitive function.

 

 

Sigma 1受体激剂通过制可诱导的一氧化氮合酶起神经保药物的作用

Sigma 1 Receptor Agonists Act as Neuroprotective Drugs Through Inhibition of Inducible Nitric Oxide Synthase

Kamila Vagnerova, MD, Patricia D. Hurn, PhD, Anish Bhardwaj, MD, and Jeffrey R. Kirsch, MD

From the Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Science University, Portland, Oregon.

Anesth Analg 2006;103:430-434

 

缺血后给予sigma-1受体激剂可以减少缺血性脑损伤,但是其中的机制还不清楚。我们假设sigma-1受体激剂喷他左辛的右旋构体(P(+))可以通过部分改善可诱导的一氧化氮合酶(iNOS)介导的细胞死亡,从而减少损伤,其左旋构体(P(-))则缺少这种能。我们比较了喷他左辛的右旋构体合用或不合用iNOS制剂氨基胍(AG)的治疗效果以喷他左辛的右旋构体对缺乏iNOSiNOSKO)的小鼠的效果。神经保的一个可能机制是制iNOS的表达。雄性C57/Bl6小鼠被短暂夹闭中脑脉(90 min),再灌注时给予药物:1)喷他左辛的右旋构体+氨基胍,2)喷他左辛的右旋构体,3)喷他左辛的左旋构体,4)氨基胍,或5)安慰剂。可诱导一氧化氮合酶缺乏的小鼠用喷他左辛的右旋构体或安慰剂治疗。用喷他左辛的右旋构体治疗后梗死(氯化三苯四唑组织学,72 h)和安慰剂相比在纹体方面减少44%,在新大脑皮质方面减少23%(P<0.05),其减少与氨基胍作用相近。喷他左辛的左旋构体并不减少脑损伤。同时给予喷他左辛的右旋构体+氨基胍和单独给予喷他左辛的右旋构体在神经保水平方面没有区别。喷他左辛的右旋构体在缺乏可诱导的一氧化氮合酶小鼠身没有进一步的神经保作用。我们总结得出缺血后给予喷他左辛的右旋构体可以减少小鼠的梗死面积。由于氨基胍没有促进喷他左辛的右旋构体的保作用,且喷他左辛的右旋构体对可诱导的一氧化氮合酶缺乏小鼠不起作用,所以我们推测喷他左辛的右旋构体通过制iNOS毒性作用导致的细胞死亡起作用。

(姜旭晖译,马晧琳 李士通 校)

Postischemic administration of the sigma-1 agonists reduces ischemic brain injury; however, the mechanism is unclear. We hypothesized that the sigma-1 agonist (+)isoform of pentazocine (P(+)) reduces damage in part by ameliorating cell death mediated via inducible nitric oxide synthase (iNOS) and that the (–)isoform (P(–)) lacks this effect. We compared treatment with P(+) with or without the iNOS inhibitor aminoguanidine (AG) and also the effects of P(+) in iNOS deficient (iNOSKO) mice. A possible mechanism of neuroprotection is inhibition of iNOS expression. Male C57/Bl6 mice were subjected to transient middle cerebral artery occlusion (90 min) and drugs were administered with reperfusion: 1) P(+) with AG (P+/AG), 2) P(+), 3) P(–), 4) AG, or 5) placebo. iNOSKOs were treated with either P(+) or placebo. Infarction (triphenyltetrazolium chloride histology, 72 h) was reduced by P(+) treatment in striatum by 44% and in neocortex by 23% versus placebo (P < 0.05), a reduction comparable to AG effect. P(–) did not attenuate brain injury. There was no difference in P(+)/AG treatment compared with showed the same level of neuroprotection as P(+) alone. P(+) also did not provide further neuroprotection for iNOSKOs. We conclude that postischemic administration of P(+) reduces infarct volume in mice. Because AG provides no additional benefit to P(+) treatment and iNOSKOs do not benefit from P(+), we speculate that P(+) acts by suppressing cell death resulting from iNOS toxicity.

 

 

腹部大手术后国际标准化比值延长与血管内液体大平衡相关

Prolonged International Normalized Ratio Correlates with a Large Intravascular Fluid Balance After Major Abdominal Surgery

Michal Barak, MD, Oded Jurim, MD{ddagger}, Ronit Tal, MD{dagger}, and Yeshayahu Katz, MD, DSc

From the Departments of *Anesthesiology and {dagger}Surgery B, Rambam Medical Center; {ddagger}Department of Surgery A, Carmel Medical Center; ¶Laboratory for Anesthesia, Pain and Neural Research, Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa; Department of Anesthesiology, Haemek Medical Center, Afula, Israel.

Anesth Analg 2006;103:448-452

 

我们对32例已行胰十二指肠切除术且术中和术后未输血的病人进行前瞻性随机研究。根据病人术后早期液体平衡情况将其前瞻性地分为2组,组114例)维持血管内正液体平衡0-1000ml;组218例)维持血管内正液体平衡1000-2000ml。取3个时间点比较全血细胞计数、凝血试验(国际标准化比值)和部分活化凝血酶原时间(aPTT):术前一天、到麻醉后恢复室即刻离开麻醉后恢复室即刻(16h后)。两组在麻醉后恢复室时国际标准化比值变差,组间有显著性差异,但aPTT值之间无显著性差异。液体正平衡的量与国际标准化比值延长之间存在正相关,与aPTT无相关性。结果显示,限制性血管内液体平衡有于保病人腹部大手术后的凝血能。

(邱郁薇 马皓琳 李士通 校)

We performed a prospective randomized study of 32 patients who had undergone pancreaticoduodenectomy and did not receive blood during and after surgery. The patients were prospectively assigned to two groups related to fluid balance in the immediate postoperative period. Group 1 (14 patients) were maintained at a positive intravascular fluid balance of 0–1000 mL; Group 2 (18 patients) were maintained at a positive balance of 1000–2000 mL. Complete blood counts and coagulation tests (International Normalized Ratio) and activated partial thromboplastin time (aPTT) were performed at three time points: the day before surgery, on arrival at the postanesthesia care unit, and on leaving the postanesthesia care unit (16 h later). There were significant differences in International Normalized Ratio values between the groups with deterioration during the time they were in the postanesthesia care unit but not in aPTT values. Positive correlation was found between the amount of positive fluid balance and International Normalized Ratio prolongation, but not with aPTT, suggesting that restricted intravascular fluid balance is beneficial for preservation of coagulation after major abdominal surgery.

 

 

多虑平漱口:对癌症治疗导致口腔粘膜炎患者的镇痛作用和疼痛减轻持续时间

Oral Doxepin Rinse: The Analgesic Effect and Duration of Pain Reduction in Patients with Oral Mucositis Due to Cancer Therapy

 

Joel B. Epstein, DMD, MSD*, Joshua D. Epstein, MA{dagger}, Matthew S. Epstein, BS{ddagger}, Hal Oien, DDS, and Edmond L. Truelove, DDS, MSD

From the *Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, and Chicago Cancer Center, College of Medicine, University of Illinois, Chicago, Illinois; {dagger}Department of Pharmaceutical Economics and Policy, University of Southern California, Los Angeles, California; {ddagger}Fred Hutchinson Cancer Research Center, Seattle; Private General Dental Practice, Beaverton, Oregon; and ¶Department of Oral Medicine, University of Washington, Seattle, Washington.

Anesth Analg 2006;103:465-470

 

在以往的研究中,我们评估了癌症和癌症治疗导致口腔粘膜炎患者局部多虑平漱口后减轻疼痛的作用,这个研究就是我们以往研究的延伸。我们的研究对象继续仍限于仅仅因为癌症治疗导致疼痛性口腔粘膜炎的病人,我们进一步分析了疼痛减轻的持续时间。共有51例口腔粘膜炎病人参与到实验中。在多虑平(5mg/mL)漱口前和漱口后的4小时里定期间隔时间,我们对口腔粘膜炎进行评分,对口腔疼痛用视觉模拟评分进行评估。那些疼痛减轻的病人中,有95%在多虑平漱口后15分钟内疼痛减轻。在总的样本中,一般的病人认为疼痛最大减轻70%(P<0.0001)。疼痛再次出现较缓慢,研究结束时有19例病人(37%)仍疼痛较基础值轻。我们使用Cox风险比例分析检验了这些资料,来判断是哪些变量对疼痛减轻持续时间延长最有影响。我们最后的模型分析可以得出这样的结论,基础疼痛严重,粘膜红斑分数差,或者相对疼痛最大减轻明显,与漱口后疼痛再次出现慢相关(P<0.01)

(张莹 译 马皓琳 李士通 校)

This research expands on our prior study, in which we assessed pain reduction after topical doxepin rinse in patients with oral mucositis resulting from cancer and cancer therapy. We continued to enroll patients with painful oral mucositis attributable solely to cancer therapy and performed further analysis on the duration of pain reduction. Fifty-one patients with oral mucositis were enrolled. Mucositis was scored and oral pain was assessed with a visual analog scale before doxepin oral rinse (5 mg/mL) and at regular intervals up to 4 h after rinsing. Of those who reported pain reduction, 95% did so within 15 min of rinsing with doxepin. In the total sample, the average patient reported a 70% maximum decrease in pain (P < 0.0001). Recurrence of pain was slow and at the conclusion of the study 19 patients (37%) still reported a reduction from baseline pain. With this censored data we used Cox-proportional hazards to determine what variables best explained longer duration of pain reduction. Our final model determined that more severe baseline pain, worse mucosal erythema score, or a larger relative maximum reduction in pain were all associated with a slower rate of pain recurrence after oral rinsing (all P < 0.01).