Anesthesia & Analgesia

 

September 2006

Table of Content

CARDIOVASCULAR ANESTHESIA:

与异氟醚相比,体外循环过程中使用大剂量异丙酚可减少冠脉手术患者心肌损伤的生化标志物

(  琳译  薛张纲 校)

Large-Dose Propofol During Cardiopulmonary Bypass Decreases Biochemical Markers of Myocardial Injury in Coronary Surgery Patients: A Comparison with Isoflurane

Zhengyuan Xia, Zhiyong Huang, and David M. Ansley

Anesth Analg 2006 103: 527-532.

颈脉内膜剥离术中颈深浅丛复合神经阻滞后心血管自主调能的变化

(杨卫红 陈杰 )

Altered Autonomic Cardiovascular Regulation After Combined Deep and Superficial Cervical Plexus Blockade for Carotid Endarterectomy

Young-Kug Kim, Gyu-Sam Hwang, In-Young Huh, Jai-Hyun Hwang, Jong-Yeon Park, Sung-Lyang Chung, Tae-Won Kwon, and Sung-Min Han

Anesth Analg 2006 103: 533-539

比伐卢定在不停跳冠脉再造术中提供快速、有效且可靠的凝作用:"EVOLUTION OFF"试验的结果

(裘毅敏 译,马皓琳 李士通 校)

Bivalirudin Provides Rapid, Effective, and Reliable Anticoagulation During Off-Pump Coronary Revascularization: Results of the "EVOLUTION OFF" Trial

Andreas Koster, Bruce Spiess, Michael Jurmann, Cornelius M. Dyke, Nicholas G. Smedira, Sol Aronson, and Michael A. Lincoff

Anesth Analg 2006 103: 540-544

糖尿病弱离子通道阻断剂的心律失常作用

(孙敏莉译 薛张纲校)

Diabetes Mellitus Reduces the Antiarrhythmic Effect of Ion Channel Blockers

Isao Ito, Yukio Hayashi, Yusuke Kawai, Mitsuo Iwasaki, Koji Takada, Takahiko Kamibayashi, Atsushi Yamatodani, and Takashi Mashimo

Anesth Analg 2006 103: 545-550.

模拟麻醉危象中认知辅方法的应用

(詹琼慧 陈杰 校)

Use of Cognitive Aids in a Simulated Anesthetic Crisis

T. Kyle Harrison, Tanja Manser, Steven K. Howard, and David M. Gaba
Anesth Analg 2006 103: 551-556.

慢性心衰的围手术期处理

(彭中美 马皓琳 李士通校)

Perioperative Management of Chronic Heart Failure (Review Article)

Leanne Groban and John Butterworth

Anesth Analg 2006 103: 557-575.

PEDIATRIC ANESTHESIA:

小儿肝移植术中低钾血症:发生率与风险因素

(吴德华译 薛张纲校)

Intraoperative Hypokalemia in Pediatric Liver Transplantation: Incidence and Risk Factors

Victor W. Xia, Bin Du, Albert Tran, Luke Liu, Ke-Qin Hu, Jonathan R. Hiatt, Ronald W. Busuttil, and Randolph H. Steadman

Anesth Analg 2006 103: 587-593.

ANESTHETIC PHARMACOLOGY:

异丙酚减弱致敏大鼠气管卵清蛋白诱导的支气管平滑肌收缩:制5-羟色胺和乙酰胆碱信号转导

(丁震敏 陈杰 校)

Propofol Attenuates Ovalbumin-Induced Smooth Muscle Contraction of the Sensitized Rat Trachea: Inhibition of Serotonergic and Cholinergic Signaling

Masakazu Yamaguchi, Osamu Shibata, Kenji Nishioka, Tetsuji Makita, and Koji Sumikawa

Anesth Analg 2006 103: 594-600.

大鼠气管内注射维库溴铵与静脉给药和肌注的效能比较

(黄丽娜 马皓琳 李士通 较)

The Efficacy of Intratracheal Administration of Vecuronium in Rats, Compared with Intravenous and Intramuscular Administration

Hiroshi Sunaga, Masahisa Kaneko, and Yoshikiyo Amaki

Anesth Analg 2006 103: 601-607.

低浓度的地卡因延缓神经生长,并不损害神经突和生长锥

(吴德华译 薛张纲校)

Tetracaine at a Small Concentration Delayed Nerve Growth Without Destroying Neurites and Growth Cones

Kenichi Sekimoto, Shigeru Saito, and Fumio Goto

Anesth Analg 2006 103: 608-614.

局部麻醉对家兔眼睛初级感觉神经和副交感神经的制作用

(李惟一 陈杰 校)

The Inhibitory Effects of Local Anesthetics on Primary Sensory Nerve and Parasympathetic Nerve in Rabbit Eye

Ko Takakura, Maki Mizogami, Shigeru Morishima, and Ikunobu Muramatsu

Anesth Analg 2006 103: 615-619.

经皮血气二氧化碳监测小鼠诱导性通气制

(邱郁薇 马皓琳 李士通 校)

Transcutaneous Blood Gas CO2 Monitoring of Induced Ventilatory Depression in Mice

Peyman Sahbaie, Shohreh Madanlou, Parham Gharagozlou, J. David Clark, Jelveh Lameh, and Timothy M. Delorey

Anesth Analg 2006 103: 620-625.

TECHNOLOGY, COMPUTING, AND SIMULATION:

 海豚的单侧大脑球的BIS 监测

(孙卓真译 薛张纲校)

Bispectral Index Monitoring of Unihemispheric Effects in Dolphins

Red S. Howard, James J. Finneran, and Sam H. Ridgway

Anesth Analg 2006 103: 626-632.

用双频指数评估麻醉深度与术后认知能障碍和恢复有关吗?

(肖洁 陈杰 校)

Is Depth of Anesthesia, as Assessed by the Bispectral Index, Related to Postoperative Cognitive Dysfunction and Recovery?

Ehab Farag, Gordon J. Chelune, Armin Schubert, and Edward J. Mascha

Anesth Analg 2006 103: 633-640.

七氟醚复合静脉太尼麻醉时脑电图 Bicoherence的变化

(张曦   马皓琳 李士通  校)

Changes in Electroencephalographic Bicoherence During Sevoflurane Anesthesia Combined with Intravenous Fentanyl

Yasuhiro Morimoto, Satoshi Hagihira, Satoshi Yamashita, Yasuhiko Iida, Mishiya Matsumoto, Syunsuke Tsuruta, and Takefumi Sakabe

Anesth Analg 2006 103: 641-645

CRITICAL CARE AND TRAUMA:

 压控制通气模式中气管内插管部分梗阻的呼气流量改变检测

(  荻译 薛张纲校)

Change in Expiratory Flow Detects Partial Endotracheal Tube Obstruction in Pressure-Controlled Ventilation

Rafael Kawati, Laszlo Vimlati, Josef Guttmann, Göran Hedenstierna, Ulf Sjöstrand, Stefan Schumann, and Michael Lichtwarck-Aschoff

Anesth Analg 2006 103: 650-657.

NEUROSURGICAL ANESTHESIA:

β-受体阻滞剂减轻大鼠大脑暂时性局部缺血后损伤

(周懿之 陈杰 校)

ß-Adrenoreceptor Antagonists Attenuate Brain Injury After Transient Focal Ischemia in Rats

Toru Goyagi, Tetsu Kimura, Toshiaki Nishikawa, Yoshitsugu Tobe, and Yoko Masaki

Anesth Analg 2006 103: 658-663.

OBSTETRIC ANESTHESIA:

伐地考昔用于剖宫产术后镇痛:一个随机、双盲、安慰剂对照研究

(黄佳佳译,李士通 马皓琳校)

Valdecoxib for Postoperative Pain Management After Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Study

Brendan Carvalho, Larry Chu, Andrea Fuller, Sheila E. Cohen, and Edward T. Riley

Anesth Analg 2006 103: 664-670.

GENERAL ARTICLES:

开腹手术期间的血管内补液管理与血流学的变化

(胡湘 马皓琳 李士通 校)

Intravascular Fluid Administration and Hemodynamic Performance During Open Abdominal Surgery

Christer H. Svensén, Joel Olsson, and Robert G. Hahn

Anesth Analg 2006 103: 671-676.

高碳酸血症可以改善病态肥胖手术病人的组织氧供

(陆文清译 薛张纲校)

Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

Helmut Hager, Dayakar Reddy, Goutham Mandadi, Debra Pulley, J. Chris Eagon, Daniel I. Sessler, and Andrea Kurz

Anesth Analg 2006 103: 677-681.

腹膜内局麻在腹腔镜下胆切除术中的作用:系统回顾与荟萃分析

(印杰敏 陈杰 校)

The Effect of Intraperitoneal Local Anesthesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Alexander P. Boddy, Samir Mehta, and Michael Rhodes

Anesth Analg 2006 103: 682-688.

ANALGESIA:

鞘内注射环氧化酶-1制剂而非环氧化酶-2制剂能够逆转剖腹手术对大鼠探索行为的影响

(颜涛 马皓琳 李士通 校)

Intrathecal Administration of a Cylcooxygenase-1, but Not a Cyclooxygenase-2 Inhibitor, Reverses the Effects of Laparotomy on Exploratory Activity in Rats

Thomas J. Martin, Nancy L. Buechler, and James C. Eisenach

Anesth Analg 2006 103: 690-695.

 静脉应用酮洛来克对辣椒素诱发的深部组织痛觉过敏的作用

(徐丽颖译 薛张纲校)

The Effect of Intravenous Ketorolac on Capsaicin-Induced Deep Tissue Hyperalgesia

Keeran Kumar, Greg R. Polston, and Mark S. Wallace

Anesth Analg 2006 103: 696-702.

乳腺手术前行椎旁神经阻滞(PVB)可减少术后慢性疼痛的发生

(赵延华 陈杰 校)

Preincisional Paravertebral Block Reduces the Prevalence of Chronic Pain After Breast Surgery

Pekka M. Kairaluoma, Martina S. Bachmann, Per H. Rosenberg, and Pertti J. Pere

Anesth Analg 2006 103: 703-708.

腹式全子宫切除术后足三里穴应用辣椒素贴剂的镇痛作用

(周雅春 马皓琳 李士通 校)

The Analgesic Effects of Capsicum Plaster at the Zusanli Point After Abdominal Hysterectomy

Kyo S. Kim and Yu M. Nam

Anesth Analg 2006 103: 709-713.  

给大鼠间歇性腰穿:一种新的实验方法用于研究阿片类药物的耐受性

(王慧琳译 薛张纲校)

Intermittent Lumbar Puncture in Rats: A Novel Method for the Experimental Study of Opioid Tolerance (Technical Communication)

Jijun J. Xu, Brittan C. Walla, Miguel F. Diaz, Gregory N. Fuller, and Howard B. Gutstein

Anesth Analg 2006 103: 714-720.

疼痛记忆:外周神经树脂毒素的作用

(宋翠侠 陈杰 校)

Memory of Pain: The Effect of Perineural Resiniferatoxin

Igor Kissin, Cristina F. Freitas, and Edwin L. Bradley, Jr

Anesth Analg 2006 103: 721-728.

通过亚麻醉剂量的右旋氯胺酮来调疼痛成像

(姜旭晖 马皓琳 李士通校)

Imaging Pain Modulation by Subanesthetic S-(+)-Ketamine

Till Sprenger, Michael Valet, Ralph Woltmann, Claus Zimmer, Rainer Freynhagen, Eberhard F. Kochs, Thomas R. Tölle, and Klaus J. Wagner

Anesth Analg 2006 103: 729-737.

 痛敏肽受体在笑气的痛敏反应中的作用

(钟静译 薛张纲校)

The Involvement of the Nociceptin Receptor in the Antinociceptive Action of Nitrous Oxide

Shugaku Himukashi, Hiroshi Takeshima, Sahoko Koyanagi, Tsutomu Shichino, and Kazuhiko Fukuda

Anesth Analg 2006 103: 738-741.

 

枢复宁在P-糖蛋白制作用过程中的伤害性疼痛效应

(宋金超 陈杰 校)

The Pronociceptive Effect of Ondansetron in the Setting of P-Glycoprotein Inhibition

Jason A. Scott, Margaret Wood, and Pamela Flood

Anesth Analg 2006 103: 742-746.

吗啡对人类5-HT 3A受体的影响

(张莹 马皓琳 李士通校)

The Effects of Morphine on Human 5-HT3A Receptors

Maria Wittmann, I. Peters, T. Schaaf, H. C. Wartenberg, S. Wirz, J. Nadstawek, B. W. Urban, and M. Barann

Anesth Analg 2006 103: 747-752.

 氟烷和异氟醚对非麻醉下去大脑大鼠背角神经元的不同作用

(王丽珺译 薛张纲校)

The Differential Effects of Halothane and Isoflurane on Windup of Dorsal Horn Neurons Selected in Unanesthetized Decerebrated Rats

Toshihiko Mitsuyo, Robert C. Dutton, Joseph F. Antognini, and Earl Carstens

Anesth Analg 2006 103: 753-760.

肌间沟臂丛阻滞的神经定位术:机械异感法和神经刺激法的一项前瞻性、随机比较研究

(曹瑜 陈杰 校)

Nerve Localization Techniques for Interscalene Brachial Plexus Blockade: A Prospective, Randomized Comparison of Mechanical Paresthesia Versus Electrical Stimulation

Gregory A. Liguori, Victor M. Zayas, Jacques T. YaDeau, Richard L. Kahn, Leonardo Paroli, Valeria Buschiazzo, and Anita Wu

Anesth Analg 2006 103: 761-767.

坐骨神经和股神经联合阻滞下全膝关成形术中的罗哌卡因和布比卡因的药效学

(唐李隽   马皓琳 李士通 校)

The Pharmacodynamics of Ropivacaine and Bupivacaine in Combined Sciatic and Femoral Nerve Blocks for Total Knee Arthroplasty

Pierre Beaulieu, Denis Babin, and Thomas Hemmerling

Anesth Analg 2006 103: 768-774.

 

颈脉内膜剥离术中颈深浅丛复合神经阻滞后心血管自主调能的变化

Altered Autonomic Cardiovascular Regulation After Combined Deep and Superficial Cervical Plexus Blockade for Carotid Endarterectomy

Young-Kug Kim, MD*, Gyu-Sam Hwang, MD*, In-Young Huh, MD*, Jai-Hyun Hwang, MD*, Jong-Yeon Park, MD*, Sung-Lyang Chung, MD*, Tae-Won Kwon, MD{dagger}, and Sung-Min Han, MD*

From the *Department of Anesthesiology and Pain Medicine and {dagger}Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Anesth Analg 2006 103: 533-539.

失调的心脏自主调会导致心血管能乱。作者研究了颈脉内膜剥离术(CEA)中颈深浅丛复合神经阻滞(CP)是否对心血管自主调能产生影响。为评估颈深浅丛复合神经阻滞前后心血管自主调作用,22例行CEA的病人参与了此项研究。作者对其心率(HR)变异性,收缩期血压(SBP)变异性,以压反射灵敏度等指标进行了监测和分析。结果显示在行颈深浅丛复合神经阻滞(CP)后,SBP (157±28mmHg vs 191±38mmHg)和HR (68±10bpm vs 84±9bpm)均有所增。心率变异性的高频率(3.7±0.9 vs 2.2±1.2In/ms²)下降(副交感降低);而收缩期血压变异性的低频率(5.5±4.7mmHg vs 8.6±9.4mmHg²)增(交感增强);压反射灵敏度降低,而且这种减少与SBP的增呈负相关的(r=-0.455)。目前的研究结果提示颈深浅丛复合神经阻滞(CP)破坏了心血管自主调系统的态平衡。因此,在行CEA的高危心脏病人中,颈深浅丛复合神经阻滞(CP)与术中和术后的不利的心血管事件是否有一定的相关,有待进一步研究证实。

(杨卫红 陈杰 校)

Compromised cardiac autonomic modulation can produce cardiovascular disturbances. We investigated whether combined deep and superficial cervical plexus (CP) blockade for carotid endarterectomy (CEA) produces changes in autonomic cardiovascular regulation. To estimate alterations in cardiovascular autonomic control before and after combined CP blockade in 22 patients undergoing CEA, the heart rate (HR) variability, systolic blood pressure (SBP) variability, and baroreflex sensitivity were analyzed. We found that SBP (157 ± 28 mm Hg versus 191 ± 38 mm Hg before and after combined CP blockade, respectively) and HR (68 ± 10 bpm versus 84 ± 9 bpm) increased after combined CP blockade. The high frequency power of HR variability (3.7 ± 0.9 versus 2.2 ± 1.2 ln/ms2) decreased (decrease in parasympathetic drive), whereas the low frequency power of SBP variability (5.5 ± 4.7 versus 8.6 ± 9.4 mm Hg2) increased (increase in vascular sympathetic outflow). Baroreflex sensitivity decreased, and this decrease was negatively correlated with a SBP increase (r = –0.455). The present results suggest that combined CP blockade impairs autonomic cardiovascular homeostasis and suggests an association between combined CP blockade and intraoperative or postoperative adverse cardiovascular events in high-risk cardiac patients undergoing CEA that merits further studies.

 

模拟麻醉危象中认知辅方法的应用

Use of Cognitive Aids in a Simulated Anesthetic Crisis

T. Kyle Harrison, MD, Tanja Manser, PhD, Steven K. Howard, MD, and David M. Gaba, MD

From the Patient Simulation Center of Innovation at VA Palo Alto Health Care System and the Department of Anesthesia, Stanford University School of Medicine, Stanford, California.

Anesth Analg 2006 103: 551-556.

 

作者凭经验地评估了在高保真模拟恶性高热事件中,使用认知辅方法是否促进恶性高热的准确、时地治疗。48例模拟恶心高热的成人病例,其中24例为CA1组,24例为CA2组。在CA1组中,24个病例中有19例使用了认知辅方法(79%),19例中8例是经常或广泛使用认知辅方法。而在CA2组中,23例中有18例使用了认知辅方法(78%),18个病例中仅6例经常或广泛地使用认知辅方法。在CA1CA2组中,认知辅方法使用频率与恶性高热治疗的有效性显著相关,CA 1 r0.59P<0.01),CA 2 r0.68P<0.001)。治疗恶性高热最佳的团队经常使用认知辅方法。尽管这种现象在CA2的队列中并不十分显著,但是认知辅方法的使用与恶性高热的治疗仍有显著相关性。作者认为认知辅方法与恶性高热正确治疗之间存在显著相关。

(詹琼慧 陈杰 校)

We evaluated empirically the extent to which the use of a cognitive aid during a high-fidelity simulation of a malignant hyperthermia (MH) event facilitated the correct and prompt treatment of MH. We reviewed the management of 48 simulated adult MH scenarios; 24 involving CA 1 and 24 involving CA 2 residents. In the CA 1 group, 19 of the 24 teams (79%) used a cognitive aid, but only 8 of the 19 teams used it frequently or extensively. In the CA 2 group, 18 of the 23 teams (78%) used a cognitive aid but only 6 of them used it frequently or extensively. The frequency of cognitive aid use correlated significantly with the MH treatment score for the CA 1 group (Spearman r = 0.59, P < 0.01) and CA 2 group (Spearman r = 0.68, P < 0.001). The teams that performed the best in treating MH used a cognitive aid extensively throughout the simulation. Although the effect was less pronounced in the more experienced CA 2 cohort, there was still a strong correlation between performance and cognitive aid use. We were able to show a strong correlation between the use of a cognitive aid and the correct treatment of MH.

 

异丙酚减弱致敏大鼠气管卵清蛋白诱导的支气管平滑肌收缩:制5-羟色胺和乙酰胆碱信号转导

Propofol Attenuates Ovalbumin-Induced Smooth Muscle Contraction of the Sensitized Rat Trachea: Inhibition of Serotonergic and Cholinergic Signaling

Masakazu Yamaguchi, MD, Osamu Shibata, MD, Kenji Nishioka, MD, Tetsuji Makita, MD, and Koji Sumikawa, MD

From the Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.

Anesth Analg 2006 103: 594-600.

异丙酚被认为适合于支气管哮喘病人的麻醉诱导。然而,它作用于支气管的机制尚未完全阐明。作者研究了异丙酚对卵清蛋白(OA)诱导的致敏鼠支气管收缩作用的效应。雄性Wistar鼠,用卵清蛋白10ug混合铝氢氧化合物10mg单次腹腔内注射以致敏。14天后,用支气管环作试验研究。观察凯坦生(5-HT2受体拮剂)和阿托品对卵清蛋白诱导的收缩作用的影响。然后观察异丙酚对卵清蛋白,5羟色胺,乙酰胆碱电刺激诱发的收缩效应的影响。凯坦生和阿托品混合剂减弱卵清蛋白诱发的收缩效应90%。异丙酚剂量依赖性减弱卵清蛋白诱发的收缩作用。异丙酚可消除5羟色胺诱发的收缩效应,减弱乙酰胆碱的收缩作用,几乎完全减弱由电刺激区域5羟色胺引起收缩增强作用。这些结果提示异丙酚减弱卵清蛋白诱导的收缩作用的机制是制5羟色胺。异丙酚在免疫球蛋白E相关的哮喘病人应是一个有用的麻醉药。

(丁震敏 陈杰 校)

Propofol is considered suitable for induction of anesthesia in patients with bronchial asthma. However, the mechanisms of its action on bronchi are not fully understood. We examined the effects of propofol on ovalbumin (OA)-induced contraction of OA-sensitized rat trachea. Male Wistar rats were sensitized by a single intraperitoneal injection of OA 10 µg mixed with aluminum hydroxide, 10 mg, as adjuvant. Fourteen days later, the experiment was performed using the tracheal rings. We observed the effects of ketanserin, a 5-HT2 receptor antagonist, and atropine on OA-induced contraction. Next, the effects of propofol on OA-, serotonin (5-HT)-, acetylcholine-, or electrical field stimulation-induced contractions were observed. OA-induced contraction was 90% attenuated by the combination of ketanserin and atropine. Propofol significantly attenuated OA-induced contraction in a dose-dependent manner. Propofol abolished 5-HT-induced contraction, attenuated acetylcholine-induced contraction, and also almost completely attenuated the enhancement by 5-HT of electrical field stimulation-induced contraction. These results suggest that the mechanism involved in the attenuation by propofol of OA-induced contraction is inhibition of the actions of 5-HT. Propofol should be a useful anesthetic in patients with immunoglobulin E-related asthma.

 

局部麻醉对家兔眼睛初级感觉神经和副交感神经的制作用

The Inhibitory Effects of Local Anesthetics on Primary Sensory Nerve and Parasympathetic Nerve in Rabbit Eye

Ko Takakura, MD, PhD*, Maki Mizogami, MD, PhD*, Shigeru Morishima, MD, PhD{dagger}, and Ikunobu Muramatsu, PhD{dagger}

From the *Department of Anesthesiology, Asahi University School of Dentistry, Hozumi, Mizuho, Gifu; and {dagger}Division of Pharmacology, Department of Biochemistry and Bioinformative Sciences, School of Medicine, University of Fukui, Matsuoka, Japan.

Anesth Analg 2006 103: 615-619.

初级感觉神经同时向外周神经系统和中枢神经系统传递信息,并且通过在外周放诸如速激肽之类的神经递质来调神经源性炎症。因为局部麻醉在神经源性炎症中的作用仍有争议,作者通过对比局部麻醉在家兔的虹膜括约肌中对于速激肽类神经递质和胆碱类神经递质的直接作用进行相关的研究。家兔虹膜括约肌受三叉神经速激肽类和副交感胆碱类神经的支配,经粘膜电刺激可以产生速激肽类和胆碱类神经支配引发的收缩。可卡因和利多卡因(1-300uM)以浓度和刺激频率依赖性的方式消弱由电刺激所引发的速激肽类和胆碱类收缩。然而,局部麻醉对于速激肽类神经作用的敏感度要比在胆碱类中的更高,这种差异轻微但有显著意义。外源性神经激肽A和氯化氨甲酰胆碱所产生的收缩不受100uM的可卡因和利多卡因影响。述研究结果显示局部麻醉对三叉神经感觉支中的速激肽类神经递质有直接的制作用,而且这种作用较之在同一神经的副交感支的作用更为显著。提示局部麻醉可能由外周感觉神经传导的制而产生神经炎症的作用。

(李惟一 陈杰 校)

Primary sensory nerves transmit information to both the periphery and central nervous systems, and they mediate neurogenic inflammation by release of neurotransmitters, such as tachykinins, in the periphery. Because the effect of local anesthetics on neurogenic inflammation is a subject of controversy, we investigated the direct effect of local anesthetics on tachykininergic neurotransmission, comparing it with cholinergic neurotransmission in the rabbit iris sphincter muscle. Rabbit iris sphincter muscle is innervated by trigeminal tachykininergic and parasympathetic cholinergic nerves, and the electrical transmural stimulation produces tachykininergic and cholinergic contractions. Cocaine and lidocaine (1–300 µM) attenuated tachykininergic and cholinergic contractions induced by electrical transmural stimulation in concentration- and stimulus frequency-dependent manner. However, the sensitivity to both local anesthetics was slightly, but significantly, higher in tachykininergic than in cholinergic responses. Exogenous neurokinin A and carbachol produced contractions that were not inhibited by 100 µM of cocaine and lidocaine. These results show that local anesthetics have a direct inhibitory effect on tachykininergic neurotransmission of the trigeminal sensory nerve, and the effect on this nerve is more potent than on the parasympathetic nerve and suggests that local anesthetics may have antineurogenic inflammatory effects via the inhibitory effects on the peripheral transmission of primary sensory nerve.

 

用双频指数评估麻醉深度与术后认知能障碍和恢复有关吗?

Is Depth of Anesthesia, as Assessed by the Bispectral Index, Related to Postoperative Cognitive Dysfunction and Recovery?

Ehab Farag, MD, FRCA*, Gordon J. Chelune, PhD{dagger}, Armin Schubert, MD, MBA*, and Edward J. Mascha, PhD

From the *Department of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio; {dagger}Department of Neurology, Center for Alzheimer’s Care, Imaging, and Research, University of Utah, Salt Lake City, Utah; and {ddagger}Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.

Anesth Analg 2006 103: 633-640.

[

作者将74位手术患者随机分成手术过程中低BIS组(平均BIS值,38.9)和高BIS组(平均BIS值,50.7)。分别在术前和术后4-6周,用认知的一套试验包括运算速度指数(processing speed index)、工作记忆指数(working memory index)和语言记忆指数(verbal memory index)对患者的认知态进行评估。低BIS组运算速度指数为113.7±1.5,高BIS组为107.9±1.4P0.006)。在另外两项试验中无差异。因此,较深的麻醉深度与术后4-6周认知能较好有一定的相关性,特别表现在信息运算能等方面。

(肖洁 陈杰 校)

We randomized 74 patients to either a lower Bispectral Index (BIS) regimen (median BIS, 38.9) or a higher BIS regimen (mean BIS, 50.7) during the surgical procedure. Preoperatively and 4–6 wk after surgery, the patients’ cognitive status was assessed with a cognitive test battery consisting of processing speed index, working memory index, and verbal memory index. Processing speed index was 113.7 ± 1.5 (mean ± se) in the lower BIS group versus 107.9 ± 1.4 in the higher BIS group (P = 0.006). No difference was observed in the other two test battery components. Somewhat deeper levels of anesthesia were therefore associated with better cognitive function 4–6 wk postoperatively, particularly with respect to the ability to process information.

 

β-受体阻滞剂减轻大鼠大脑暂时性局部缺血后损伤

ß-Adrenoreceptor Antagonists Attenuate Brain Injury After Transient Focal Ischemia in Rats

Toru Goyagi, MD, Tetsu Kimura, MD, Toshiaki Nishikawa, MD, Yoshitsugu Tobe, and Yoko Masaki, PhD

From the Department of Anesthesia and Intensive Care Medicine, Akita University School of Medicine, Akita, Japan.

Anesth Analg 2006 103: 658-663.

 

实验发现β-受体阻滞剂可以减轻心脏和肾脏缺血后的损伤,用于临治疗心梗和严重烧伤。此外,在实验条件下β-受体阻滞剂对大脑暂时性局部缺血后起到神经能保作用。作者设计了这个实验来比较几种不同的β-受体阻滞剂对大鼠大脑暂时性局部缺血后的神经保作用。氟烷麻醉下体温正常的成年雄性SpragueDawley大鼠大脑中脉阻断2小时(管腔内的缝合线借并用激光多普勒血流测量仪验证)。一部分大鼠接受静脉输注(IV)生理盐水0.5mL/h,普萘洛尔100ug·kg1·min1,卡维地洛4 ug·kg1·min1,艾司洛尔200 ug·kg1·min1或者兰地洛尔50 ug·kg1·min1(每组n6),大脑中脉阻断前30分钟开始静脉注射并持续24小时。按照同样的实验设计,另一部分大鼠接受鞘内(IT)枕大池注射艾司洛尔50 ug·kg1·min1或者兰地洛尔10 ug·kg1·min1n5每组)。再灌注22小时后进行神经病学的损伤评估,取出脑组织用氯化三苯四唑固定后测定梗塞灶体积。另一部分大鼠接受静脉注射saline,艾司洛尔和兰地洛尔(n6每组),存活七天后测定梗塞灶的大小。神经病学的评估发现给予普萘洛尔(IV),卡维地洛(IV),艾司洛尔(IV),兰地洛尔(IV),艾司洛尔(IT),兰地洛尔(IT)的大鼠较给予saline的大鼠损伤轻(P<0.05)。接受静脉内或鞘内注射β-受体阻滞剂的大鼠大脑皮质和纹体的梗塞灶体积较给予生理盐水的大鼠小(P<0.05)。作者推断β-受体阻滞剂可以改善大鼠大脑暂时性局部缺血后的神经学和组织学结果,并且与给药途径无关。

(周懿之 陈杰 校)

ß-adrenoreceptor antagonists experimentally reduce cardiac and renal injury after ischemia and are also clinically useful for myocardial infarction and severe burns. In addition, ß-adrenoreceptor antagonists provide neuroprotective effects after focal cerebral ischemia in experimental settings. We conducted the present study to compare the neuroprotective effects of several ß-adrenoreceptor antagonists in rat transient focal cerebral ischemia. Halothane-anesthetized normothermic adult male Sprague-Dawley rats were subjected to 2 h of middle cerebral artery occlusion using the intraluminal suture technique confirmed by laser Doppler flowmetry. Rats received an IV infusion of saline 0.5 mL/h, propranolol 100 µg · kg–1 · min–1, carvedilol 4 µg · kg–1 · min–1, esmolol 200 µg · kg–1 · min–1, or landiolol 50 µg · kg–1 · min–1 (n = 6 in each group). Infusion was initiated 30 min before middle cerebral artery occlusion and continued for 24 h. Additional rats received esmolol 50 µg · kg–1 · min–1 or landiolol 10 µg · kg–1 · min–1 intrathecally (IT) via the cisterna magna (n = 5 in each group), according to the same experimental protocol. The neurological deficit score was evaluated at 22 h after reperfusion, and the brains were removed and stained with triphenyltetrazolium chloride for evaluation of infarct volume. Additional rats that received saline, esmolol, and landiolol IV (n = 6 in each group) were allowed to survive for 7 days followed by measurement of infarct size. Neurological deficit scores were smaller in rats treated with propranolol-IV, carvedilol-IV, esmolol-IV, landiolol-IV, esmolol-IT, and landiolol-IT compared with saline-treated rats (P < 0.05). Cortical and striatum infarct volumes were less in the rats receiving ß-adrenoreceptor antagonists via either IV or IT than in saline-treated rats (P < 0.05). We conclude that ß-adrenoreceptor antagonists improve neurological and histological outcomes after transient focal cerebral ischemia in rats independent of administration route.

 

腹膜内局麻在腹腔镜下胆切除术中的作用:系统回顾与荟萃分析

The Effect of Intraperitoneal Local Anesthesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Alexander P. Boddy, BM, BCh, Samir Mehta, BM, BCh, and Michael Rhodes, MD

From the Department of General Surgery, Norfolk and Norwich University Hospital, United Kingdom.

Anesth Analg 2006 103: 682-688.

 

腹膜内给药局部麻醉常被用于强腹腔镜下胆切除术后镇痛效果。作者进行了一系列综合性分析从而确立这一术在减轻术后腹部疼痛的效能。系统文献检索显示了24个随机对比实验评估腹膜内局麻在符合实验标准的腹腔镜下胆切除术中的应用效果。其中,16个研究道了充分的数据从而可以进行组合定量分析。手术后4小时视觉模拟评分权平均数(WMD)使用随机的效应模型以混合。总体说,腹膜内局麻可以显著降低术后4小时的痛觉评分(WMD,-9mm95%CI〕,-13至-5)。亚组分析提示这种局部麻醉在手术开始时即进行与在手术结束时注药相比(WMD,-6mm95(CI),-10至-2)其效果会更强(WMD,-13mm95(CI),-19至-7)。没有发现关于发生局麻药毒性反应的负面事例的道。结论:腹膜内局麻是安全的,并显著减轻了术后早期的腹部疼痛。

(印杰敏 陈杰 校)

Intraperitoneal administration of local anesthesia is often used to improve pain relief after laparoscopic cholecystectomy. We have conducted a meta-analysis to establish the efficacy of this technique in reducing early postoperative abdominal pain. A systematic literature search revealed 24 randomized, controlled trials assessing intraperitoneal local anesthetic use in laparoscopic cholecystectomy that met inclusion criteria. Of these, 16 studies reported sufficient data to allow pooled quantitative analysis. The weighted mean differences (WMD) in visual analog pain score at 4 h after surgery were pooled using a random effects model. Overall, the use of intraperitoneal local anesthesia resulted in a significantly reduced pain score at 4 h (WMD, –9 mm; 95% confidence interval [CI], –13 to –5). Subgroup analysis suggested that the effect was greater when the local anesthetic was given at the start of the operation (WMD, –13 mm; 95% CI, –19 to –7) compared with instillation at the end (WMD, –6 mm; 95% CI, –10 to –2). No adverse events related to local anesthetic toxicity were reported. We conclude that the use of intraperitoneal local anesthesia is safe, and it results in a statistically significant reduction in early postoperative abdominal pain.

 

乳腺手术前行椎旁神经阻滞(PVB)可减少术后慢性疼痛的发生

Preincisional Paravertebral Block Reduces the Prevalence of Chronic Pain After Breast Surgery

Pekka M. Kairaluoma, MD, Martina S. Bachmann, MD, PhD, Per H. Rosenberg, MD, PhD, and Pertti J. Pere, MD, PhD

From the Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Finland.

Anesth Analg 2006 103: 703-708.

作者早先曾道过,乳腺肿瘤手术前行椎旁神经阻滞(PVB)可提供明显而迅速的术后镇痛。作者对这些病人(n60)又进行了为期一年的随访,以观察PVB是否也能减少术后慢性疼痛的发生。该随访包括14天的症记录和术后1个月、6个月、12个月时通过电话询问病人情况。30PVB患者和30名对照者的14天镇痛药用量是相同的。但是,术后1个月后运相关性疼痛的强度在PVB组较低(P = 0.005)。术后6个月后,任何疼痛症的发生情况在PVB组均较低(P = 0.029)。最后,术后12个月后,除了疼痛症的发生率较低(P = 0.003)和运相关性疼痛程度较轻(P = 0.003)外,PVB组静息性疼痛的强度也较轻(P = 0.011)。这些结果与术中有无切开臂丛神经无关。神经病理性疼痛的发生率低(PVB组和对照组分别为2例和3例)。乳腺肿瘤手术前PVB除了能缓解术后急性疼痛,也能减轻术后1年时间内慢性疼痛的发生。

(赵延华 陈杰 校)

We reported earlier that preincisional paravertebral block (PVB) provides significant immediate postoperative analgesia after breast cancer surgery. In the same patients (n = 60), a 1-yr follow-up was performed to find out whether PVB could also reduce the prevalence of postoperative chronic pain. The follow-up consisted of a 14-day symptom diary and telephone interviews 1, 6, and 12 mo after surgery. The 14-day consumption of analgesics was similar in the 30 PVB and the 30 control patients. However, 1 mo after surgery, the intensity of motion-related pain was lower (P = 0.005) in the PVB group. Six months after surgery, the prevalence of any pain symptoms (P = 0.029) was lower in the PVB group. Finally, at 12 mo after surgery, in addition to the prevalence of pain symptoms (P = 0.003) and the intensity of motion-related pain (P = 0.003), the intensity of pain at rest (P = 0.011) was lower in the PVB group. These findings were independent of whether or not axillary dissection had been performed. The incidence of neuropathic pain was low (two and three patients in the PVB and control groups, respectively). In addition to providing acute postoperative pain relief, preoperative PVB seems to reduce the prevalence of chronic pain 1 yr after breast cancer surgery.


疼痛记忆:外周神经树脂毒素的作用

Memory of Pain: The Effect of Perineural Resiniferatoxin

Igor Kissin, MD, PhD*, Cristina F. Freitas, BA*, and Edwin L. Bradley, Jr, PhD{dagger}

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and {dagger}Department of Biostatistics, University of Alabama at Birmingham.

Anesth Analg 2006 103: 721-728.

中枢神经系统对于急性疼痛的持久记忆可能导致向慢性疼痛转化。据道,长时增强于中枢敏感性均可作为突触可塑性的形式,并且可以通过刺激C类神经纤维所诱发。目前的研究中,作者通过在角叉藻聚糖反复的诱发炎症反应中测定远端的痛觉增敏情况来评估对伤害性疼痛的记忆,这种方法用于判断是否选择性阻断C类神经纤维可以制持久的疼痛记忆的发生。在大鼠实验中,于坐骨神经和隐神经处经皮给予树脂毒素,然后分别在后爪通过交叉的2只置入器注射角叉藻聚糖,观察2周,在这2次炎症反应中,于各个不同的时间间隔测定指标:对伤害性压的反应,后爪的温度以体积的变化。试验表明:初次炎症反应诱发的痛觉增敏恢复后,反复的炎症反应可以导致远端的痛觉增敏,而在初次炎症反应是不出现的。第二次注射角叉藻聚糖后,远端痛觉增敏的最大值(对侧的后爪伤害性压的阈值从141±23g下降为96±19gp< 0.0001)达到24h。在反复的炎症反应中初次注射角叉藻聚糖之前给予外周神经树脂毒素(0.001%)后远端的痛觉增敏可以完全制(p<0.0002)。述结果显示伤害性神经纤维的选择性阻滞能预防中枢神经系统长时程痛觉高敏相关的印迹的形成。因此,疼痛记忆能通过选择性、长时C-纤维预制。

(宋翠侠 陈杰 校)

The long-lasting imprint of acute pain in the central nervous system may contribute to the transition of acute pain to chronicity. The long-term potentiation (which is proposed as a mechanism of memory) and central sensitization were each reported as a form of synaptic plasticity, and both can be initiated by stimulation of C fibers. In the current study, we assessed nociceptive memory regarding hyperalgesia by measuring distant hyperalgesia after repeated carrageenan-induced inflammation. This approach was used to determine whether selective blockade of C fibers can prevent the development of a long-lasting imprint of hyperalgesia. In rat experiments, resiniferatoxin was administered percutaneously at the sciatic and saphenous nerves, and two crossover intraplantar injections of carrageenan into the hindpaws were performed 2 wk apart. Responses to noxious pressure and heat and changes in paw volumes were measured at various intervals during two carrageenan-induced inflammations. The experiments demonstrated that after recovery of hyperalgesia induced by the initial inflammation, repeated inflammation led to the development of a distant hyperalgesia that was absent during the initial inflammation. The maximum of distant hyperalgesia (decrease of noxious pressure threshold in the contralateral hindpaw from 141 ± 23 g to 96 ± 19 g; P < 0.0001) was reached 24 h after the second injection of carrageenan. The development of distant hyperalgesia during the repeated inflammation was completely prevented (P < 0.0002) by perineural resiniferatoxin (0.001%) administered before the initial injection of carrageenan. These results indicate that selective blockade of nociceptive fibers prevents formation of long-term hyperalgesia-related imprint in the central nervous system. Thus, pain memory can be preempted by selective and prolonged blockade of C-fibers.


枢复宁在P-糖蛋白制作用过程中的伤害性疼痛效应

The Pronociceptive Effect of Ondansetron in the Setting of P-Glycoprotein Inhibition

Jason A. Scott, MD, Margaret Wood, MD, and Pamela Flood, MD

From the Department of Anesthesiology, Columbia University, New York, New York.

Anesth Analg 2006 103: 742-746

.

枢复宁是一种强效的止吐药,它通过制5HT3受体起效。异氟醚的肺泡最低有效浓度 (MAC)不受外周血里枢复宁的影响;然而,枢复宁是P-糖蛋白(一种表达在血脑屏障的转运泵)的酶作用底物。因此作者假设中枢神经系统的枢复宁的浓度可能被P-糖蛋白所消减。作为一直强的P-糖蛋白制剂,在临试验中用来促进化疗药或菌()素进入中枢神经系统,作者研究了P-糖蛋白缺如时枢复宁的影响。给予正常大鼠腰部鞘内注射枢复宁赋型剂。P-糖蛋白敲除的大鼠野生型对照大鼠无论是否临使用P-糖蛋白制物都给予外周枢复宁处理。伤害感受性用热刺激退缩等待时间来评估,无体时的异氟醚浓度作为异氟醚的MAC。在大鼠鞘内注射枢复宁 (20 g )增热疼痛敏感性20.0% ± 5.8% (P < 0.01)。在P-糖蛋白敲除的大鼠中外周枢复宁 (2 mg/kg) 增了热疼痛敏感性,但是在野生型对照大鼠中没有作用 (P < 0.01)。外周 枢复宁对经P-糖蛋白制物奎尼丁处理以后的野生型大鼠有小的但有统计意义的伤害感受性的影响,但是对经环孢霉素 A或维拉帕米处理的野生型大鼠无影响。在P-糖蛋白敲除的大鼠中异氟醚的MAC没有因鞘内注射枢复宁或外周给予枢复宁而改变。鞘内注射枢复宁可以提高热疼痛敏感性。在P-糖蛋白缺如时, 枢复宁可以达到足够的浓度以增疼痛敏感。即使直接髓给药, 枢复宁也没有改变异氟醚的MAC值,结果支持了5HT3 对全身麻醉药制作用不起作用的观点。

(宋金超 陈杰 校)

Ondansetron is a potent antiemetic drug that acts through inhibition of the 5HT3 receptors for serotonin. Minimum alveolar concentration (MAC) for isoflurane is not affected by systemic ondansetron; however ondansetron is a substrate of P-glycoprotein, a transport pump expressed in the blood-brain barrier. Thus, we hypothesized that central nervous system concentrations of ondansetron might be reduced by the P-gp protein. As potent inhibitors of P-gp are in clinical trials to improve access of desirable chemotherapeutic and antibiotic drugs to the central nervous system, we studied the effect of ondansetron in the absence of extrusion by P-gp. Normal rats were given lumbar intrathecal ondansetron or vehicle. P-gp knockout mice and wild-type controls were treated with systemic ondansetron in the presence and absence of clinically used P-gp inhibitors. Nociception was assessed as thermal hindpaw withdrawal latency and immobility was assessed as isoflurane MAC. In rats, intrathecal ondansetron (20 g) increased thermal pain sensitivity by 20.0% ± 5.8% (P < 0.01). Systemic ondansetron (2 mg/kg) increased pain sensitivity in P-gp knockout mice but had no effect in wild-type mice (P < 0.01). Systemic ondansetron had a small but statistically significant pronociceptive effect after treatment of wild-type mice with the P-gp inhibitor quinidine but not with cyclosporine or verapamil. Isoflurane MAC was not changed by intrathecal ondansetron in rats or systemically administered ondansetron in P-gp knockout mice. Intrathecal ondansetron can enhance thermal pain sensitivity. In the absence of P-gp protein, ondansetron can reach concentrations sufficient to increase pain sensitivity. Even with direct spinal application, ondansetron does not alter isoflurane MAC, supporting the idea that 5HT3 modulation does not play a role in general anesthetic immobility.


肌间沟臂丛阻滞的神经定位术:机械异感法和神经刺激法的一项前瞻性、随机比较研究

Nerve Localization Techniques for Interscalene Brachial Plexus Blockade: A Prospective, Randomized Comparison of Mechanical Paresthesia Versus Electrical Stimulation

Gregory A. Liguori, MD, Victor M. Zayas, MD, Jacques T. YaDeau, MD, PhD, Richard L. Kahn, MD, Leonardo Paroli, MD, PhD, Valeria Buschiazzo, and Anita Wu, MD

From the Hospital for Special Surgery, Department of Anesthesiology Weill Medical College of Cornell University, New York, New York.

Anesth Analg 2006 103: 761-767.

术后神经症(PONS)在行外周神经阻滞的肢整形手术后是比较常见的。在这项研究中,作者前瞻性地比较了肩部手术使用电刺激法(ES)和机械异感法(MP)进行神经定位的肌间沟阻滞后PONS的发生率。在随机选入MP组的中,一根1英寸长,23号的长斜面针置入肌间沟来诱导肩、手臂、肘、腕或手的麻痹感。ES组的病人,一根5cm22号的短斜面绝缘针置入肌间沟来诱导运反应,包括肘、腕或手指的屈曲或伸展,或是三角肌的刺激反应,刺激强度0.2-0.5mA之间。每个肌间沟阻滞都使用1.5%甲哌卡因(另130万肾腺素,0.1meq/L碳酸氢纳)5060ml 218个病人随机分入两组。一个病人脱落。ES25个病人(23%)在针刺入时产生麻痹感。ESPONS的发生率是10.1%(11/109),而MP组的发生率是9.3%(10/108)(两组差异不显著)。PONS平均持续两个月,所有患者的症在12个月内完全消失。成率、起效时间和病人满意率两组相同。结论:选择神经定位的方法可以基于患者和麻醉医师的舒适度和喜好,而不必考虑PONS的发生。

(曹瑜 陈杰 校)

Postoperative neurologic symptoms (PONS) are relatively common after upper extremity orthopedic surgery performed under peripheral neural blockade. In this study, we prospectively compared the incidence of PONS after shoulder surgery under interscalene (IS) block using the electrical stimulation (ES) or mechanical paresthesia (MP) techniques of nerve localization. For patients randomized to the MP group, a 1-in, 23-g long-beveled needle was placed into the IS groove to elicit a paresthesia to the shoulder, arm, elbow, wrist, or hand. For patients randomized to the ES group, a 5-cm, 22-g short-beveled insulated needle was placed into the IS groove to elicit a motor response including flexion or extension of the elbow, wrist, or fingers or deltoid muscle stimulation at a current between 0.2 and 0.5 mA. Each IS block was performed with 50–60 mL of 1.5% mepivacaine containing 1:300,000 epinephrine and 0.1meq/L sodium bicarbonate. Two-hundred-eighteen patients were randomized between the two groups. One patient was lost to follow-up. Twenty-five patients (23%) in the ES group experienced paresthesia during needle insertion. The incidence of PONS using the ES technique was 10.1% (11/109), whereas the incidence with the MP technique was 9.3% (10/108) (not significant). The PONS lasted a median duration of 2 mo, and symptoms in all patients resolved within 12 mo. The success rate, onset time, and patient satisfaction were also comparable between groups. We conclude that the choice of nerve localization technique can be made based on the patient’s and anesthesiologist’s comfort and preferences and not on concern for the development of PONS.


比伐卢定在不停跳冠脉再造术中提供快速、有效且可靠的凝作用:"EVOLUTION OFF"试验的结果

Bivalirudin Provides Rapid, Effective, and Reliable Anticoagulation During Off-Pump Coronary Revascularization: Results of the "EVOLUTION OFF" Trial

Andreas Koster, MD*, Bruce Spiess, MD{ddagger}, Michael Jurmann, MD{dagger}, Cornelius M. Dyke, MD, Nicholas G. Smedira, MD, Sol Aronson, MD#, and Michael A. Lincoff, MD||

From the Departments of *Anesthesia and {dagger}Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany; {ddagger}Department of Cardiothoracic Anesthesia, Virginia Commonwealth University, Richmond; Departments of Cardiothoracic Surgery and ||Cardiovascular Medicine, The Cleveland Clinic Foundation, Ohio; ¶Gaston Memorial Hospital, Gastonia; and #Department of Anesthesiology, Duke University, Durham, North Carolina.

Anesth Analg 2006;103:540-544

 

EVOLUTION OFF试验中,我们评估了比伐卢定在不停跳冠脉搭桥术中与肝素-鱼精蛋白相比的安全性效。在这项用比伐卢定处理的患者的EVOLUTION OFF数据分析中,我们评估了比伐卢定的药代学(PK)其凝的有效性,即达到活化凝血时间(ACT)目标值。分析的数据来自于101位病人。在搭桥手术过程中,在推注0.75 mg/kg比伐卢定后,以1.75 mg · kg–1 · h–1的速率持续输注。目标是ACT+>300 s。在4位患者身获得了比伐卢定的PK数据。仅在例外情况中需要重复推注部分的药量或增输注速率。PK数据的分析显示了初量推注后的比伐卢定的平均浓度为11.0 ± 0.53 µg/mL,输注中的平均浓度为11.2 ± 2.32 µg/mL。比伐卢定浓度与ACT+值之间的Pearson相关度为0.92。比伐卢定的PK数据始终都超过6.5 µg/mL,该值已证实是经皮冠脉手术的有效浓度。比伐卢定浓度与ACT+值之间的相关度是好的,且目标ACT+值几乎都能达到。这些结果提示:倘若按照目前的方案,比伐卢定在不停跳冠脉搭桥术中可提供可靠有效的凝作用。

(裘毅敏 译,马皓琳 李士通 校)

In the EVOLUTION OFF trial, we evaluated the safety and efficacy of bivalirudin during off-pump coronary artery bypass grafting as compared with heparin-protamine. In this subanalysis of EVOLUTION OFF data of bivalirudin-treated patients, we assessed the pharmacokinetics (PK) and effectiveness of bivalirudin anticoagulation to achieve target activated clotting time (ACT)+ values. Data from 101 patients were assessed. A bolus of 0.75 mg/kg of bivalirudin was followed by a continuous infusion of 1.75 mg · kg–1 · h–1 during the grafting procedure. An ACT+ value of >300 s was the target. In four patients, PK data for bivalirudin were obtained. Only in exceptional cases were repeat fractional boluses or an increase of the infusion rate required. Assessment of the PK data showed a mean concentration of bivalirudin after the initial bolus of 11.0 ± 0.53 µg/mL and a mean concentration during infusion of 11.2 ± 2.32 µg/mL. Pearson’s correlation between bivalirudin concentrations and ACT+ values was 0.92. Bivalirudin PK data consistently exceeded concentrations of 6.5 µg/mL, which have been evaluated as effective during percutaneous coronary intervention. The correlation between bivalirudin levels and ACT+ values was good, and the target ACT+ values were almost always achieved. These results suggest that bivalirudin, given according to the current protocol, provides reliable and effective anticoagulation during off-pump coronary artery bypass graft surgery.

 

慢性心衰的围手术期处理

Perioperative Management of Chronic Heart Failure

Leanne Groban, MD*, and John Butterworth, MD{dagger}

From the *Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; {dagger}Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.

Anesth Analg 2006;103:557-575

 

心衰是正在增多的一些心脏情况之一。尽管对激素和其他信号系统的病理生理基础有较好的了解,尽管通过药物治疗改善预后,许多心衰病人还是没有接受有效的治疗。心衰病人通常在手术室和ICU里需要医学断和处理;那么,麻醉医师应掌握最新的门病人(慢性)的医学治疗进展和住院病人的急性心衰病情恶化的处理。因此,我们回顾了血管紧张素转换酶制剂、血管紧张素受体阻滞剂、ß-肾腺素受体阻滞剂和醛固酮拮剂,因为这些药物延长生命,也在当前的慢性心衰临实践指导中经常应用。我们还回顾了慢性心衰病人行手术和麻醉的并发症,并讨论了对急性症恶化(例如由血管内容量过多、不恰当的药物“假期”或者潜在的心脏疾病的恶化引起)如何最好地提供强治疗。

(彭中美 马皓琳 李士通校)

Heart failure (HF) is one of the few cardiac conditions that is increasing. Despite a better understanding of how hormones and other signaling systems underlie the pathophysiology, and despite improved outcomes from pharmacologic therapy, many HF patients receive no effective treatment. Patients with HF commonly require medical diagnosis and management in operating rooms and critical care units; thus anesthesiologists are obliged to remain up-to-date both with advances in outpatient (chronic) medical management and with inpatient treatments for acute exacerbations of HF. Accordingly, we reviewed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ß-adrenergic receptor blockers, and aldosterone antagonists because these drugs prolong life and are included in current clinical practice guidelines for treating patients with chronic HF. We also reviewed the implications of chronic HF for patients undergoing surgery and anesthesia and discuss how best to provide intensive treatment for acute exacerbations of symptoms, such as might be caused by excessive intravascular volume, inappropriate drug "holidays," or worsening of the underlying cardiac disease.

 

大鼠气管内注射维库溴铵与静脉给药和肌注的效能比较

The Efficacy of Intratracheal Administration of Vecuronium in Rats, Compared with Intravenous and Intramuscular Administration

Hiroshi Sunaga, MD*, Masahisa Kaneko, PhD{dagger}, and Yoshikiyo Amaki, MD*

From the *Department of Anesthesiology, Jikei University School of Medicine Tokyo, Japan; and {dagger}Medical Museum, Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan.

Anesth Analg 2006;103:601-607

 

气管内给药将成为注射维库溴铵的一个可选择的途径,为了研究其适当与否,我们比较了三组大鼠分别经气管内、肌肉和静脉注射维库溴铵的药效学参数。同时也研究了三组中维库溴铵的药代学。经气管内、静脉和肌注的剂量分别设在1.500.302.25mg/kg。气管内给药组起效(127 ± 17s)明显早于肌注组(267 ± 62s),明显晚于静脉组(18 ± 7s(经方差分析和Tukey-Kramer 分析P < 0.05)。气管内给药组的作用时间(794 ± 162 s)明显长于静脉给药组(93 ± 30 s),但与肌注组(743 ± 131 s)没有明显差异。气管内给药组的恢复指数(134 ± 30 s)明显短于肌注组(222 ± 47 s),明显长于静脉给药组(32 ± 12 s)。尽管气管内给予维库溴铵仍慢于静脉注射,但倘若其较肌注组吸收快、起效快,看来仍较有优。

(黄丽娜 马皓琳 李士通 较)

To investigate the suitability of the intratracheal (IT) route as an alternative route for the administration of vecuronium, we compared the pharmacodynamic parameters for neuromuscular block in three groups of rats given vecuronium via the IT, IM, and IV routes. We also examined the pharmacokinetics of vecuronium in the three groups. The doses for the IT, IV, and IM groups were set at 1.50, 0.300, and 2.25 mg/kg, respectively. The onset of action in the IT group (127 ± 17 s) was significantly earlier than that in the IM group (267 ± 62 s), and significantly later than that in the IV group (18 ± 7 s) (P < 0.05 by analysis of variance and the Tukey-Kramer analysis). The duration of action in the IT group (794 ± 162 s) was significantly longer than that in the IV group (93 ± 30 s) but not significantly different from that in the IM group (743 ± 131 s). The recovery index in the IT group (134 ± 30 s) was significantly shorter than that in the IM group (222 ± 47 s) and significantly longer than that in the IV group (32 ± 12 s). Although IT administration of vecuronium is still slower than IV administration, it appears to be more advantageous as compared with IM administration, given the more rapid absorption and faster onset of action.

 

经皮血气二氧化碳监测小鼠诱导性通气制

Transcutaneous Blood Gas CO2 Monitoring of Induced Ventilatory Depression in Mice

Peyman Sahbaie, MD*, Shohreh Madanlou, MD*, Parham Gharagozlou, MD*, J. David Clark, MD, PhD{dagger}, Jelveh Lameh, PhD*, and Timothy M. Delorey, PhD*

From the *Molecular Research Institute, Mountain View, California; {dagger}VA Palo Alto Health Care System and Stanford University Department of Anesthesiology, Palo Alto, California.

Anesth Analg 2006;103:620-625

 

我们评估了在小鼠监测经皮二氧化碳分压(Ptcco2)这项简便非创伤性术以确定其是否能够精确可重复的评估小鼠的通气制。为了达到此目标,异氟醚吸入麻醉的雄性C57Bl/6小鼠吸入不同百分比的二氧化碳或太尼(已知的呼吸制药物),监测Ptcco2 Paco2 (脉血二氧化碳分压)。所有剂量的太尼都会使Ptcco2 20分钟内显著增,并且Ptcco2 值在生理盐水组与太尼组间的差异具有统计学意义(P < 0.0001)。Paco2 值与Ptcco2 值之间具有很好的相关性(r2 = 0.91)。Bland-Altman分析也发现在小鼠身Ptcco2 能准确可靠地反映Paco2。因此发现,在一定条件下,Ptcco2 测量值能可靠地反映小鼠的Paco2。因此在不同条件下较大样本量的小鼠模型,Ptcco2 术可以用作为快速定量的评估广谱药物呼吸制特性的一个手段。

(邱郁薇 马皓琳 李士通 校)

We assessed a simple, noninvasive method of monitoring transcutaneous partial pressure of CO2 (Ptcco2) in mice to determine whether it would provide an accurate and reproducible method to assess ventilatory depression in mice. To this end, Ptcco2 and Paco2 (partial pressure of arterial CO2) measurements were performed on isoflurane-anesthetized male C57Bl/6 mice breathing differing percentages of CO2 or fentanyl, a known ventilatory depressive drug. All doses of fentanyl produced a sharp increase in Ptcco2 values within 20 min with difference in Ptcco2 values between saline and all fentanyl groups being statistically significant (P < 0.0001). A good correlation between Paco2 and Ptcco2 values was established (r2 = 0.91). A Bland-Altman analysis likewise found that Ptcco2 measurements in the mice reliably and accurately reflected their Paco2 values. Therefore, under controlled conditions, Ptcco2 measurements were found to reliably reflect Paco2 values in mice. Consequently, the Ptcco2 method can be used as a means to rapidly and quantitatively assess the ventilatory depressive properties of a wide spectrum of drugs, under varying conditions in numerous mouse models.

 

七氟醚复合静脉太尼麻醉时脑电图 Bicoherence的变化

Changes in Electroencephalographic Bicoherence During Sevoflurane Anesthesia Combined with Intravenous Fentanyl

Yasuhiro Morimoto, MD, Satoshi Hagihira, MD*, Satoshi Yamashita, MD, Yasuhiko Iida, MD, Mishiya Matsumoto, MD, Syunsuke Tsuruta, MD, and Takefumi Sakabe, MD

From the Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Yamaguchi, Japan; and *Department of Anesthesiology, Osaka University Graduate School of Medicine.

Anesth Analg 2006;103:641-645

 

随着介绍双频指数(BIS)作为度量全麻中病人的镇静程度,注意已被集中于脑电图(EEG)的双频谱分析。在本研究中,我们评估了EEG bicoherence和七氟醚浓度之间的关系。16个预定择期腹部手术的ASA I–II级病人入选研究。用5%七氟醚麻醉诱导,七氟醚和氧气(50%)维持麻醉。手术开始前,静脉注射太尼(2 µg/kg),然后持续输注(2 µg · kg–1 · h–1)。应用我们建立的软件,在呼气末七氟醚浓度分别为0.5%0.8%1.1%1.4%1.7%2.0%2.3%时,记录EEG bicoherenceBIS95%边缘频率(SEF95)。在浅麻醉下,EEG bicoherence值低,随着七氟醚浓度的增,bicoherence的两个峰沿对角线出现(f1 = f2)。当七氟醚浓度增到1.4%,第一个(4 Hz附近)和第二个(10 Hz附近)峰都变高(分别为37.7% ± 7.5%35.1% ± 9.0%)。但是当七氟醚浓度继续增,第一个峰变平而第二个峰趋向于轻微下降。在七氟醚浓度增高时BIS值减小,在1.4%和更高七氟醚浓度时,BIS值变平稳。在七氟醚浓度增到2.3%SEF95也减少。因此,两个bicoherence峰的分布模式可能比BIS监测术中七氟醚的麻醉效应更好。

(张曦   马皓琳 李士通  校)

With the introduction of bispectral index (BIS) as a measure of a patient’s sedation during general anesthesia, attention has been directed toward bispectral analysis of electroencephalography (EEG). In the present study we evaluated the relationship between EEG bicoherence and sevoflurane concentration. Sixteen ASA physical status I–II patients scheduled for elective abdominal surgery were enrolled in the study. Anesthesia was induced with 5% sevoflurane and maintained with sevoflurane and oxygen (50%). Just before surgery, IV fentanyl (2 µg/kg) was given and then continuously infused (2 µg · kg–1 · h–1). Using software we developed, EEG bicoherence, BIS, and 95% spectral edge frequency (SEF95) were recorded at end-tidal sevoflurane concentrations of 0.5%, 0.8%, 1.1%, 1.4%, 1.7%, 2.0%, and 2.3%. Under light anesthesia, EEG bicoherence values were low. With increasing sevoflurane concentrations, 2 peaks of bicoherence emerged along the diagonal line (f1 = f2). Both the first (at around 4 Hz) and second (at around 10 Hz) grew higher (37.7% ± 7.5% and 35.1% ± 9.0%, respectively) as the sevoflurane concentration increased to 1.4%. However, the first peak leveled off whereas the second tended to decrease slightly with further increases in sevoflurane concentration. The BIS value decreased as the sevoflurane concentration increased and leveled off at 1.4% and higher concentrations of sevoflurane. The SEF 95 also decreased as the sevoflurane concentration increased up to 2.3%. Thus the distribution pattern of the two bicoherence peaks is likely to be better than BIS of the anesthetic effect of sevoflurane during surgery.

 

伐地考昔用于剖宫产术后镇痛:一个随机、双盲、安慰剂对照研究

Valdecoxib for Postoperative Pain Management After Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Study

Brendan Carvalho, MBBCh, FRCA*, Larry Chu, MD, MS*, Andrea Fuller, MD{dagger}, Sheila E. Cohen, MB, ChB*, and Edward T. Riley, MD*

From the *Department of Anesthesia, Stanford University School of Medicine Stanford, California; {dagger}Northern Colorado Anesthesia Professional Consultants, Fort Collins, Colorado.

Anesth Analg 2006;103:664-670

 

尽管非甾体类炎药可改善剖宫产术后疼痛缓解,但是它们具有出血等潜在的副作用。围术期环氧化酶(COX-2 制剂在很多手术模型中显示出了与非甾体类炎药相似的镇痛作用,但在剖宫产术后尚无研究。我们设计这个随机双盲实验以研究伐地考昔在剖宫产术后的镇痛效应其减少阿片用量的作用。麻下择期剖宫产的健康产妇随机分成两组,术后72小时内每12小时口服伐地考昔20mg或安慰剂。在研究进行期间,由于COX-2制剂的安全问题日明显,评估48位病人后中止了此次研究。我们发现,在伐地考昔组和安慰剂组之间总的麻醉性镇痛药用量无差异(换算成吗啡等效剂量分别为121 ± 70 mg 143 ± 77 mg; P = 0.26)。两组间静息活疼痛近似,尽管此后的检验效率足已发现有临意义的差异。静脉吗啡用量、首次要求镇痛药时间、病人满意度、副作用、母乳喂养成能性活也均无显著性差异。所有病人术后疼痛都控制较好。直到现在还不支持鞘内入吗啡的麻下剖宫产术后用伐地考昔。

(黄佳佳译,李士通 马皓琳校)

Although nonsteroidal antiinflammatory drugs (NSAIDs) improve postoperative pain relief after cesarean delivery, they carry potential side effects (e.g., bleeding). Perioperative cyclooxygenase (COX)-2 inhibitors show similar analgesic efficacy to nonsteroidal antiinflammatory drugs in many surgical models but have not been studied after cesarean delivery. We designed this randomized double-blind study to determine the analgesic efficacy and opioid-sparing effects of valdecoxib after cesarean delivery. Healthy patients undergoing elective cesarean delivery under spinal anesthesia were randomized to receive oral valdecoxib 20 mg or placebo every 12 h for 72 h postoperatively. As a result of cyclooxygenase-2 inhibitors safety concerns that became apparent during this study, the study was terminated early after evaluating 48 patients. We found no differences in total analgesic consumption between the valdecoxib and placebo groups (121 ± 70 versus 143 ± 77 morphine mg-equivalents, respectively; P = 0.26). Pain at rest and during activity were similar between the groups despite adequate post hoc power to have detected a clinically significant difference. There were also no differences in IV morphine requirements, time to first analgesic request, patient satisfaction, side effects, breast-feeding success, or functional activity. Postoperative pain was generally well controlled. Adding valdecoxib after cesarean delivery under spinal anesthesia with intrathecal morphine is not supported at this time.

 

开腹手术期间的血管内补液管理与血流学的变化

Intravascular Fluid Administration and Hemodynamic Performance During Open Abdominal Surgery

Christer H. Svensén, MD, PhD, DEAA*, Joel Olsson, MD, PhD, DEAA*, and Robert G. Hahn, MD, PhD{dagger}

From the *Department of Anesthesiology, University of Texas Medical Branch, Galveston; {dagger}Karolinska Institute, Stockholm, Sweden.

Anesth Analg 2006;103:671-676

 

我们对十位接受腹部开放性手术的病人研究了是否能将肺脉导管测量到的中心血流学表示补液治疗的药效学。我们检测了病人在45 min里静滴乳酸林格氏溶液25 mL/kg,输液期时与输液后血浆稀度(血浆稀度常作为一项血容量扩充的指标)与血流学变化的相关程度。肺脉楔压与中心静脉压升高对静脉输液有反应,与相应的血浆稀度相关。十位病人中的六位表现为心排出量的下降,有可能是继发于周围血管的阻增(无效者),而其余的则表现为心排出量的增(有效者)。容量学分析提示有效的病人中有54%的输注液体在输注结束时存在于中央液腔,研究结束时为25%,无效者则分别为25%3%。结论:一的接受腹部开放性手术的病人对晶体液的反应是心排出量下降。肺脉楔压与中心静脉压对不同程度的血浆稀有较连贯的反映,可以用来模拟应用容量学计算的液体治疗方案。

(胡湘 马皓琳 李士通 校)

We studied whether central hemodynamics measured by a pulmonary artery catheter can serve as a pharmacodynamic expression of fluid therapy in 10 patients undergoing open abdominal surgery. We examined how closely hemodynamic variables follow plasma dilution, which is an index of plasma volume expansion, during and after an IV infusion of 25 mL/kg of lactated Ringer’s solution over 45 min. Pulmonary artery wedge pressure and central venous pressure responded to IV fluid with an increase that correlated with accompanying plasma dilution. Six of 10 patients showed a decrease in cardiac output that was probably secondary to an increase in peripheral vascular resistance (nonresponders), whereas the rest increased cardiac output (responders). Volume kinetic analysis suggested that 54% of the infused fluid resided in the central fluid space at the end of the infusion and 25% at the end of the study in the responders compared with 25% and 3%, respectively, in nonresponders. In conclusion, half of the patients undergoing open abdominal surgery responded to crystalloid fluid with a decrease in cardiac output. Pulmonary artery wedge pressure and central venous pressure responded more consistently to different degrees of plasma dilution, which can be simulated for various fluid regimens using volume kinetics.

 

鞘内注射环氧化酶-1制剂而非环氧化酶-2制剂能够逆转剖腹手术对大鼠探索行为的影响

Intrathecal Administration of a Cylcooxygenase-1, but Not a Cyclooxygenase-2 Inhibitor, Reverses the Effects of Laparotomy on Exploratory Activity in Rats

Thomas J. Martin, PhD*, Nancy L. Buechler, BS*, and James C. Eisenach, MD{dagger}

From the Departments of *Physiology and Pharmacology and {dagger}Anesthesiology, the Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Anesth Analg 2006;103:690-695

 

切开性手术后对机械性刺激超敏感的研究提示,髓内环氧化酶(COX-1而非COX-2参与了术后疼痛。在本研究中,我们想通过研究自主探索行为而非撤退反射来确定COX同酶在剖腹手术后的作用。成年雄性SD大鼠于异氟烷麻醉下行肋下剖腹术或仅接受麻醉未手术。在术后第一天,鞘内注射二甲基亚砜(溶剂)或COX-1制剂SC560或者COX-2制剂NS-398后,监测大鼠的探索性运行为。在鞘内未放置导管组和鞘内注射溶剂的对照组,剖腹术使物的移、竖立以快速小幅运(刻板作)行为减少的幅度相同。SC-560能够剂量相关性地使物恢复到正常的探索行为,当SC-560剂量达到20µg或更高时,物的探索行为可以完全恢复。相反,直至50µgNS-398均不能增物的探索行为。探索行为和剖腹手术的这些数据与切开手术后的反射性退缩反应相一致,并且显示COX-1制减少术后的疼痛反应。髓COX-1制使探索行为(包括伸长腹肌的后腿站立行为)完全恢复。这些数据提示髓中的靶COX-1可产生术后镇痛。

(颜涛 马皓琳 李士通 校)

Studies of hypersensitivity to mechanical stimuli after incisional surgery suggest that cyclooxygenase (COX)-1, but not COX-2, in the spinal cord participates in postoperative pain. In the current study, we sought to determine the role of COX isoenzymes after laparotomy, examining spontaneous exploratory behavior rather than withdrawal reflexes. Adult male Sprague-Dawley rats underwent subcostal laparotomy surgery under isoflurane anesthesia or received anesthesia without surgery. Exploratory locomotor activity was measured on the first postoperative day after intrathecal injection of dimethyl sulfoxide (vehicle) or COX-1 (SC-560) or COX-2 (NS-398) inhibitors. Laparotomy reduced ambulation, rearing, and rapid small movements (stereotypy) similarly in animals without intrathecal catheters and those receiving intrathecal vehicle control. SC-560 produced a dose-related return to normal exploratory behavior with complete return at doses of 20 µg and larger. In contrast, NS-398 in doses up to 50 µg failed to increase exploratory behavior. These data with exploratory behavior and laparotomy agree with studies with reflexive withdrawal responses after incisional surgery and indicate that COX-1 inhibition reduces pain responses after surgery. Spinal COX-1 inhibition completely restores exploratory activity, including rearing behavior that stretches the abdominal muscles. These data suggest that targeting COX-1 in the spinal cord may produce postoperative analgesia.

 

腹式全子宫切除术后足三里穴应用辣椒素贴剂的镇痛作用

The Analgesic Effects of Capsicum Plaster at the Zusanli Point After Abdominal Hysterectomy

Kyo S. Kim, MD, PhD, and Yu M. Nam, MD

From the Department of Anesthesiology, Hanyang University Hospital, Seoul, Korea.

Anesth Analg 2006;103:709-713

 

背景:针灸已被用作阿片类镇痛剂术后疼痛治疗的补充疗法。我们设计了这个双盲、假治疗-对照研究来评价辣椒素贴剂(PAS)用于足三里(ST-36)穴对于术后阿片类镇痛药需求量、副作用和恢复特性的影响。

方法:90例接受腹式全子宫切除手术的女性患者随机分为3个治疗组(每组30人):足三里组患者足三里穴使用PAS,假治疗组患者在肩膀非穴位处使用PAS,对照组在足三里穴使用安慰贴带。麻醉诱导前术后3天每天8个小时使用PAS

结果:足三里组术后24小时吗啡用量(31.5 ± 6.8 mL)显著小于对照组(44.3 ± 10.1 mL)和假治疗组(44.6 ± 10.4 mL) (P < 0.01)。足三里组术后72小时副作用发生率治疗性止吐药使用率均低于其他两组(P < 0.01)

结论:足三里穴使用PAS可减少腹式全子宫切除术后患者阿片类药物的需求量与阿片类药物相关的副作用。

(周雅春 马皓琳 李士通 校)

BACKGROUND: Acupuncture has been used to supplement opioid analgesics for postoperative pain control. We designed this double-blind, sham-controlled study to assess the effectiveness of capsicum plaster (PAS) at Zusanli (ST-36) acupoints on postoperative opioid analgesic requirement, side effects, and recovery profile.

METHODS: Ninety women undergoing total abdominal hysterectomy were randomly assigned to 3 treatment regimens (n = 30 each): group Zusanli = PAS at Zusanli acupoints, group sham = PAS at the nonacupoints on the shoulders, and group control = placebo tape at Zusanli acupoints. The PAS was applied before induction of anesthesia and maintained for 8 h per day for 3 postoperative days.

RESULTS: The total amount of morphine administered in the first 24 h after the operation was significantly decreased in group Zusanli (31.5 ± 6.8 mL) compared with groups control (44.3 ± 10.1 mL) and sham (44.6 ± 10.4 mL) (P < 0.01). The incidence of postoperative side effects and the use of rescue antiemetics during the 72 h after surgery were significantly reduced in group Zusanli compared with other groups (P < 0.01).

CONCLUSION: PAS at Zusanli points decreased the postoperative opioid requirement and opioid-related side effects of patients undergoing abdominal hysterectomy.

 

通过亚麻醉剂量的右旋氯胺酮来调疼痛成像

Imaging Pain Modulation by Subanesthetic S-(+)-Ketamine

Till Sprenger, MD*, Michael Valet, MD*, Ralph Woltmann, MD*, Claus Zimmer, MD{ddagger}, Rainer Freynhagen, MD, DEAA, Eberhard F. Kochs, MD{dagger}, Thomas R. Tölle, MD, PhD*, and Klaus J. Wagner, MD{dagger}

From the *Neurologische Klinik und Poliklinik, Technische Universität München; {dagger}Klinik für Anaesthesiologie, Technische Universität München; {ddagger}Institut für Röntgendiagnostik, Technische Universität München; Klinik für Anaesthesiologie, Universität Düsseldorf, Germany.

Anesth Analg 2006;103:729-737

 

小剂量右旋氯胺酮对大脑处理疼痛的影响知道得很少。我们调查了静脉注射亚麻醉剂量的右旋氯胺酮对实验性疼痛热刺激的感知的影响。对健康的志愿者在分别给予安慰剂或剂量逐渐增的氯胺酮输注(0.050.10.15 mg · kg–1 · h–1)和疼痛刺激时用磁共振能成像以评估。监测生命指标,并对所有实验对象均在数字等级标尺进行疼痛强度和不愉快事件的等级评定。用精神行为问卷来评定意识的改变。随着氯胺酮用量的增,疼痛不愉快事件减少(0.15 mg · kg–1 · h–1的氯胺酮和安慰剂相比下降 55.1%)。疼痛强度的等级也随氯胺酮剂量增相应减少,但程度较低(下降23.1%)。给予安慰剂时,观察到了典型的疼痛刺激系统(丘脑、岛叶、扣带束和额前皮质)激活,而给予氯胺酮时的疼痛影像表现为剂量依赖性的疼痛引起的大脑激活减弱。分析剂量依赖性的氯胺酮对疼痛的作用显示第二级体感性皮层(S2)、岛叶和前扣带回皮质的激活减弱。前扣带回皮质的这个部分(中扣带束皮质)和情感疼痛成分相关,氯胺酮可有效调疼痛的情感过程。

(姜旭晖 马皓琳 李士通校)

Little is known about the effects of low-dose S-(+)-ketamine on the cerebral processing of pain. We investigated the effects of subanesthetic IV S-(+)-ketamine doses on the perception of experimental painful heat stimuli. Healthy volunteers were evaluated with functional magnetic resonance imaging (fMRI) while receiving the painful stimuli in conjunction with placebo and increasing doses (0.05, 0.1, 0.15 mg · kg–1 · h–1) of ketamine infusion. Vital variables were monitored and all subjects rated pain intensity and unpleasantness on a numerical rating scale. Alterations in consciousness were measured using a psycho-behavioral questionnaire. Pain unpleasantness declined as ketamine dosage was increased (55.1% decrease, placebo versus 0.15 mg · kg–1 · h–1 ketamine). Pain intensity ratings also decreased with increasing ketamine dosage but to a lesser extent (23.1% decrease). During placebo administration, a typical pain activation network (thalamus, insula, cingulate, and prefrontal cortex) was found, whereas decreased pain perception with ketamine was associated with a dose-dependent reduction of pain-induced cerebral activations. Analysis of the dose-dependent ketamine effects on pain processing showed a decreasing activation of the secondary somatosensory cortex (S2), insula and anterior cingulate cortex. This part of the anterior cingulate cortex (midcingulate cortex) has been linked with the affective pain component that underlines the potency of ketamine in modulating affective pain processing.

 

吗啡对人类5-HT 3A受体的影响

The Effects of Morphine on Human 5-HT3A Receptors

Maria Wittmann, MD, I. Peters, MS, T. Schaaf, MS, H. C. Wartenberg, MD, S. Wirz, MD, J. Nadstawek, MD, B. W. Urban, PhD, and M. Barann, PhD

From the Klink und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätskliniken Bonn, Bonn, Germany.

Anesth Analg 2006;103:747-752

 

5-HT 3受体是配体门控离子通道,参与呕吐和疼痛的调控。在本实验中,我们研究了阿片类镇痛药吗啡是否对人类5-HT 3受体有特的作用。将人类5-HT 3A受体的cDNA稳态转染入HEK-293细胞的全细胞碎片,使用膜片钳术观察吗啡对5-HT诱发的细胞电流的影响。细胞膜电位为负值时,5-HT呈浓度依赖地诱发内向电流。5-HT 3受体拮剂昂丹司琼(0.3 nM)呈可逆地制5-HT诱发的信号。吗啡可逆地制5-HT诱发电流的峰值,IC501.1 µMHill 系数 1.2。随着5-HT浓度的增高,吗啡的制作用逐步减弱,说明两者具有竞争作用。此外,吗啡存在时电流的激活和失活学明显减慢。吗啡的拮剂纳洛酮,也可制5-HT诱发的电流 (例如,3 µM纳洛酮可制17%的电流)。吗啡和纳洛酮的作用不呈相。吗啡的效能竞争性制作用说明了吗啡作用于某一受体部位的机制,而非对细胞膜的非特异性作用。

(张莹 马皓琳 李士通校)

5-HT3 receptors are ligand-gated ion channels that are involved in the modulation of emesis and pain. In this study, we investigated whether the opioid analgesic, morphine, exerts specific effects on human 5-HT3 receptors. Whole-cell patches from HEK-293 cells stably transfected with the human 5-HT3A receptor cDNA were used to determine the effects of morphine on the 5-HT-induced currents using the patch clamp technique. At negative membrane potentials, 5-HT induced inward currents in a concentration-dependent manner. The 5-HT3 receptor antagonist, ondansetron, (0.3 nM) reversibly inhibited the 5-HT-induced signals. Morphine reversibly suppressed 5-HT-induced peak currents as a function of concentration (IC50 = 1.1 µM, Hill coefficient = 1.2). The block by morphine decreased with increasing 5-HT concentrations, suggesting a competitive effect. In addition, the activation, as well as the inactivation, kinetics of the currents were significantly slowed in the presence of morphine. The morphine antagonist, naloxone, also inhibited 5-HT-induced currents (e.g., at 3 µM by 17%). The effects of morphine and naloxone were not additive. The potency of morphine and the competitivity of the blocking effect points to a specific mechanism at a receptor site rather than an unspecific membrane effect.

 

坐骨神经和股神经联合阻滞下全膝关成形术中的罗哌卡因和布比卡因的药效学

The Pharmacodynamics of Ropivacaine and Bupivacaine in Combined Sciatic and Femoral Nerve Blocks for Total Knee Arthroplasty

Pierre Beaulieu, MD, PhD, FRCA, Denis Babin, MSc, and Thomas Hemmerling, MD, DEAA

From the Department of Anesthesiology, CHUM Hôtel-Dieu, Montreal, Quebec, Canada.

Anesth Analg 2006;103:768-774

 

与布比卡因相比罗哌卡因在区域麻醉中的效价仍有争议。因此,我们比较了相同浓度的布比卡因和罗哌卡因在实行坐骨神经和股神经联合阻滞的膝关成形术患者的药效学。麻醉诱导前五十名患者分别在坐骨神经(15 mL)和股神经(25 mL)处注射0.5%布比卡因(n = 25) 0.5% 罗哌卡因(n = 25)。记录股神经、隐神经、腓总神经、胫神经分配区域的感觉缺失和恢复(以对侧为对照的冷觉的%)以运能(无收缩或正常肌)。并且评估48小时里的疼痛评分和吗啡消耗量。在感觉和运阻滞起效方面布比卡因和罗哌卡因没有差异。然而,感觉和运的恢复罗哌卡因组则较快,但仅在坐骨神经和感觉恢复在2428小时、运能在1220小时的情况下较显著。总体,疼痛评分和吗啡消耗量很接近。综所述,在坐骨神经和股神经联合阻滞的消退期布比卡因和罗哌卡因是有差异的。一种评估坐骨神经和股神经阻滞的全新的系统方法由此提出。
(唐李隽   马皓琳 李士通 校)

The potency of ropivacaine compared with bupivacaine in regional anesthesia remains controversial. Therefore, we compared the pharmacodynamics of equal concentrations of bupivacaine and ropivacaine in combined sciatic and femoral nerve blocks for patients undergoing knee arthroplasty. Fifty patients received 40 mL of either 0.5% bupivacaine (n = 25) or 0.5% ropivacaine (n = 25) divided between the sciatic (15 mL) and the femoral (25 mL) nerves before induction of anesthesia. Loss and recovery of sensory (% of cold sensation compared to opposite side) and motor (no contraction or normal muscle force) functions were recorded in the distribution of the femoral, saphenous, common peroneal, and tibial nerves. Pain scores and morphine consumption over 48 h were also evaluated. There were no difference between bupivacaine and ropivacaine in terms of onset of sensory and motor blockade. However, resolution of sensory and motor function was faster in the ropivacaine group but only significantly so for the sciatic nerve and between 24 to 28 h for sensory resolution and 12 to 20 h for motor function. Overall, pain scores and morphine consumption were similar. In conclusion, we showed that block resolution is different between bupivacaine and ropivacaine when administered for combined sciatic and femoral nerve blocks. A new systematic method to assess sciatic and femoral nerve blockade is proposed.

 

与异氟醚相比,体外循环过程中使用大剂量异丙酚可减少冠脉手术患者心肌损伤的生化标志物

Large-Dose Propofol During Cardiopulmonary Bypass Decreases Biochemical Markers of Myocardial Injury in Coronary Surgery Patients: A Comparison with Isoflurane

Zhengyuan Xia, Zhiyong Huang, and David M. Ansley

From the *Anesthesiology Research Laboratory, Department of Anesthesiology, Renmin Hospital of Wuhan University; Shenzhen Sun Yat-sen Cardiovascular Hospital, China; and Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, Canada.

Anesth Analg 2006,103: 527-532

 

我们观察到若在体外循环(CPB)过程中大异丙酚的用量以增强其氧化作用可起到心脏保作用。54位冠脉旁路手术的患者随机分为异丙酚低剂量组(P组,n18)、异丙酚高剂量组(HiP组,n18)、异氟醚组(I组,n18)。诱导插管后使用异氟醚(I组,吸入浓度为1%-3.5%)或异丙酚持续输注(P组,60µg · kg–1 · min–1)维持麻醉。在HiP组,CPB开始前10min至脉开放后15min这一段时间内,异丙酚的维持剂量增高至120 µg · kg–1 · min–1,随后降至60µg · kg–1 · min–1直至手术结束。组P、组HiP、组I脉钳闭的时间分别为83 ± 2488 ± 2281 ± 20分钟(P > 0.1)。与组P和组I相比,组HiPCPB8小时一种氧化应激的标志物——丙酮醛产物(malondialdehydeMDA)明显减少,CPB24小时cTnI明显减少(P < 0.05)。与组I相比,组HiP的患者脱离CPB时需要使用的正性肌药物明显减少;术后全身血管阻明显减小。组HiPCPB24小时的平均心脏指数较组I、组P明显增高(组I、组P、组HiP分别为2.2 ± 0.12.3 ± 0.22.8 ± 0.3 L · min–1 · m–2)。与组I相比,组HiP患者ICU的停留时间明显缩短。我们认为,与异氟醚和小剂量异丙酚相比,在CPB中使用大剂量异丙酚可以减少术后心肌细胞损伤。

(金  琳译  薛张纲 校)

 We investigated if increasing propofol's dosage to augment its antioxidant capacity during cardiopulmonary bypass (CPB) could confer cardiac protection. Fifty-four coronary artery bypass graft surgery patients were randomly assigned to small-dose propofol (Group P; n = 18), large-dose propofol (Group HiP; n = 18), or isoflurane Group (Group I; n = 18). After the induction, anesthesia was maintained with an inspired concentration of isoflurane 1%–3.5% (Group I) or a continuous infusion of propofol 60 µg · kg–1 · min–1 (Group P) throughout the surgery. In Group HiP, this dose of propofol was increased to 120 µg · kg–1 · min–1 for 10 min before the onset of CPB until 15 min after aortic unclamping and then decreased to 60 µg · kg–1 · min–1 until the end of surgery. The duration of aortic cross-clamping was 83 ± 24, 88 ± 22, and 81 ± 20 min in Group P, Group HiP, and Group I, respectively (P > 0.1). Plasma malondialdehyde, a marker of oxidative stress, was significantly lower at 8 h after CPB, and Troponin I was lower at 24 h after CPB in Group HiP compared with Group P and Group I (P < 0.05). There was a significant reduction in inotropic requirements for separation from CPB in Group HiP compared with Group I. Postoperative systemic vascular resistance was significantly reduced in Group HiP as compared with Group I. Mean cardiac index was significantly higher at 24 h after CPB in Group HiP compared with Group P and Group I (P < 0.05) (Group I, 2.2 ± 0.1; Group P, 2.3 ± 0.2; and Group HiP, 2.8 ± 0.3 L · min–1 · m–2, respectively). The duration of intensive care unit stay was significantly shorter in Group Hi-P compared with Group I. We conclude that administration of a large dose of propofol during CPB attenuates postoperative myocardial cellular damage as compared with isoflurane or small-dose propofol anesthesia.

 

 糖尿病弱离子通道阻断剂的心律失常作用

Diabetes Mellitus Reduces the Antiarrhythmic Effect of Ion Channel Blockers

Isao Ito, Yukio Hayashi, Yusuke Kawai, Mitsuo Iwasaki, Koji Takada, Takahiko Kamibayashi, Atsushi Yamatodani, and Takashi Mashimo

Department of Anesthesiology, School of Allied Health Sciences, Osaka University Faculty of Medicine, Osaka , Japan .

Anesth Analg 2006 103: 545-550

 

我们设计的实验研究是检测是否在糖尿病鼠糖尿病可以影响氟卡胺,钠通道阻滞剂;E-4031,钾通道阻滞剂;和维拉帕米,钙通道阻滞剂的心律失常作用。实验是在经链唑霉素处理后在246周无损伤的糖尿病鼠身进行。鼠经氟烷麻醉,同时监测其持续脉血压和心室早期收缩。通过在15秒内诱导3次或更多的心室早期收缩的肾腺素最小剂量作为致心律失常肾腺素量。应用氟卡胺的鼠致心律失常肾腺素量为8.2 +/- 2.2微克/kg (平均值 +/- sd),经链唑霉素处理后,246周无损伤糖尿病鼠分别7.4 +/- 6.1, 5.5 +/- 2.8,和2.0 +/- 0.5 微克/kg。相似的,E-40317.7 +/- 2.6, 2.3 +/- 0.7, 2.0 +/- 0.7, 1.2 +/- 0.5微克/kg,维拉帕米是8.2 +/- 2.1, 3.1 +/- 1.2, 2.3 +/- 0.9,和1.5 +/- 0.5微克/kg。胰岛素部分的逆转阻断剂的心律失常作用。我们推断糖尿病弱氟卡胺、E-4031和维拉帕米的心律失常作用。

(孙敏莉译 薛张纲校)

We designed the present study to examine whether diabetes mellitus affects the antiarrhythmic effect of flecainide, a sodium channel blocker, E-4031, a potassium channel blocker, and verapamil, a calcium channel blocker, in diabetic rats. The experiments were performed in intact and diabetic rats 2, 4, and 6 wk after administration of streptozotocin. Rats were anesthetized with halothane and monitored continuously for arterial blood pressure and premature ventricular contractions. The arrhythmogenic dose of epinephrine was defined as the smallest dose producing 3 or more premature ventricular contractions within a 15-s period. The arrhythmogenic doses of epinephrine in the presence of flecainide were 8.2 +/- 2.2 (mean +/- sd), 7.4 +/- 6.1, 5.5 +/- 2.8, and 2.0 +/- 0.5 microg/kg in intact and diabetic rats 2, 4, and 6 wk after streptozotocin administration, respectively. Similarly, the arrhythmogenic doses of epinephrine in the presence of E-4031 were 7.7 +/- 2.6, 2.3 +/- 0.7, 2.0 +/- 0.7, and 1.2 +/- 0.5 microg/kg, and those in the presence of verapamil were 8.2 +/- 2.1, 3.1 +/- 1.2, 2.3 +/- 0.9, and 1.5 +/- 0.5 microg/kg. Insulin partially recovered the antiarrhythmic effect of the blockers. We concluded that diabetes mellitus reduces the antiarrhythmic effects of flecainide, E-4031, and verapamil.

                                                           

 小儿肝移植术中低钾血症:发生率与风险因素

Intraoperative Hypokalemia in Pediatric Liver Transplantation: Incidence and Risk Factors

 Victor W. Xia, Bin Du, Albert Tran, Luke Liu, Ke-Qin Hu, Jonathan R. Hiatt, Ronald W. Busuttil, and Randolph H. Steadman

the Departments of *Anesthesiology and †Surgery, David Geffen School of Medicine, University of California , Los Angeles ,

Los Angeles, California ; ‡Division of Gastroenterology, University of California , Irvine Medical Center , Orange , California ; §Department of Anesthesiology, 2nd Affiliated Hospital, Kunming Medical College , Kunming , China .

Anesth Analg 2006 103: 587-593.

 

回顾性研究268例肝移植患儿,我们研究了术中钾乱的发生和开放前开放后低钾血症的风险因素。总体,低钾血症是小儿患者肝移植期主要的乱,发生率72.0%。低钾血症在开放后比开放前更常见。高钾血症虽然是明确的常见的并发症,但在小儿肝移植期间并不常见。通过逻辑斯谛回归分析,开放前基础血钾水平≤3.5 mmol/L、基础K+≥5mmol/L和肌酐≤0.5mg/dL是低钾血症的预测因素;体重≤15kg K+≤3.5 mmol/L,新鲜冰冻血浆输注大于90mL/kg和术前存在腹水是开放后低钾血症的独立预测因素。这些研究支持使用K+替代治疗维持血钾正常,避免小儿肝移植低钾血症相关的潜在的并发症,特别是有低钾血症高风险的小儿。

(吴德华译 薛张纲校)

 In this retrospective study of 268 children undergoing liver transplantation, we investigated the incidence of intraoperative potassium (K_) disturbances and the risk factors for hypokalemia in the preperfusion and postreperfusion periods. Overall, hypokalemia was the predominant disturbance, occurring in 72.0% of pediatric patients during liver transplantation. Hypokalemia was more common during the postreperfusion period than the prereperfusion period. Hyperkalemia, though a commonly cited complication, was infrequent during pediatric liver

transplantation. Using multivariate logistic regression analysis, baseline serum K_ ≤3.5 mmol/L, base excess≥5 mmol/L, and creatinine≤0.5 mg/dL were found to be predictors for hypokalemia in the prereperfusion period; and body weight≤15 kg, K_≤3.5 mmol/L, fresh-frozen plasma transfusion>90 mL/kg, and absence of ascites at surgery were independent predictors for hypokalemia in the postreperfusion period. These findings support the use of K_ replacement to maintain normokalemia and avoid the potential complications related to hypokalemia in pediatric liver transplantation, especially in children with the risk factors for hypokalemia.

 

 低浓度的地卡因延缓神经生长,并不损害神经突和生长锥

Tetracaine at a small concentration delayed nerve growth without destroying neurites and growth cones.

 

Sekimoto K, Saito S, Goto F.

Department of Anesthesiology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi , Japan .

Anesth Analg. 2006 ,103:608-14

 

局麻药高浓度应用于神经元时有直接的神经毒害作用和诱导生长锥崩溃作用。能而,长时间暴露在低浓度的局麻药对神经元的影响未见道。本研究检测了低浓度地卡因对鸡胚胎根部神经突生长是否有减慢减慢作用。地卡因对神经元的影响通过显微镜、神经突生长率、量化形态学分析、生长锥崩溃分析和Western blot 分析来评价。大于5uM的高浓度局麻药实施24h48h后,神经突生长明显减慢。10uM20uM的地卡因应用后24h48h,生长锥丝伪足缩短数量明显减少。神经元细胞体内肌蛋白数量增,其与对神经突和生长锥的影响相反——分别给予51020uM地卡因后48h其肌蛋白数量减少。结论,连续暴露在低浓度地卡因可延缓神经突生长,降低丝伪足的数量和减少神经突肌蛋白数量。

 (吴德华译 薛张纲校)

Local anesthetics have direct neurotoxicity and induce growth cone collapse when applied to neurons at large concentrations. However, the effects of prolonged exposure to local anesthetics at a small concentration have never been studied. We examined whether neurite growth was slowed by tetracaine at small concentrations in chick embryo dorsal root ganglions. The effects of tetracaine were examined microscopically and by a neurite growth rate assay, quantitative morphologic assay, growth cone collapse assay, and Western blot assay. Neurite growth 24 and 48 h after application was delayed significantly when tetracaine was applied at a concentration larger than 5 microM. Filopodia of growth cones retracted, and their number was significantly decreased 24 and 48 h after the application of 10 and 20 microM of tetracaine. The quantity of actin in cell bodies increased, contrary to the effect on neurites and growth cones, where actin decreased 48 h after the application of 5, 10, and 20 microM of tetracaine. In conclusion, continuous exposure to tetracaine at small concentrations delayed neurite growth, reduced the number of filopodia, and decreased actin content.

 

 海豚的单侧大脑球的BIS 监测

Bispectral Index Monitoring of Unihemispheric Effects in Dolphins

 Howard RS, Finneran JJ, Ridgway SH.

Department of Anesthesiology, Naval Medical Center , San Diego , California 92134-5000 , USA .

Anesth Analg. 2006 Sep;103(3):626-32

 

在海豚入睡时,它们的脑电活的改变仅在一侧的大脑球显示,换而言之就是海豚的左脑与右脑可以轮替地休息。在宽吻海豚属中,我们用BIS监测可以发现两个球之间脑电活的不平衡。我们在海豚大脑的两边同步放置BIS传感器,通常但不总是发现两边BIS值的巨大差异(左边60而右边90)。这种情况不仅发生在不使用药物的海豚身,在使用了异丙酚、阿托品和或地西泮的物身也可发现。观测通常在海豚于水中休息后持续3小时左右。单侧球效应在海豚身是可以通过药物诱导出现的。海豚以其接近于人类的大脑向我们提供了一个用于研究人类大脑单侧球效应的物模型。

(孙卓真译 薛张纲校)

When dolphins sleepTheir electroencephalographic activity may change in only one cerebral hemisphere; i.e., the left and right brain hemispheres can take turns sleeping. We demonstrate that the bispectral index (BIS) monitor can detect interhemispheric asymmetry in the dolphin species Tursiops truncatus. Using two BIS sensors placed simultaneously over each side of the dolphin's head, we often, but not always, found significant differences between the two BIS values (e.g., left side 60 and right side 90) in non-medicated animals and in animals given propofol, atropine, and/or diazepam. Observations were each made over a period of approximately 3 h on dolphins resting out of the water. Unihemispheric effects may be inducible pharmacologically in dolphins. The dolphin, with its human-sized brain, may provide an animal model for study of unihemispheric effects in humans.

 

 压控制通气模式中气管内插管部分梗阻的呼气流量改变检测

Change in Expiratory Flow Detects Partial Endotracheal Tube Obstruction in Pressure-Controlled Ventilation

 Rafael Kawati, MD, PhD*, Laszlo Vimlati, MD*, Josef Guttmann, PhD , Göran Hedenstierna, MD, PhD , Ulf Sjöstrand, MD, PhD*, Stefan Schumann, PhD ,and Michael Lichtwarck-Aschoff, MD, PhD

From the Departments of *Surgical, and Medical Sci ences, University Hospital, Uppsala, Sweden; Department of Anesthesiology and Critical Care Medicine, University Hospital, Freiburg, Germany; Department of Anesthesiology and Critical Care Medicine, Klinikum Augsburg, Augsburg, Germany.

Anesth Analg 2006;103:650-657


在压控制通气模式(PCV)中,只有极端程度的气管内导管(ETT)狭窄才能通过监测潮气量(VT)发现。为了评估PCV中的气管内导管梗阻程度并与VT监测比较,我们制造了三种不同程度的部分气管内导管梗阻,在11只麻醉态下的健康小猪中使用4种不同内直径(ID 9.08.07.06.0mm )的气管导管。描绘出呼气流量溢量( e–V)曲线,计算15%呼气时间(Te)的时间常量( e)。我们还计算了第一个15%呼气时间所占的呼气量分数(Vex fract,15)并比较了三种梗阻程度的变化与完整呼气潮气量。潮气量监测无法发现气管内导管狭窄。相反,Vex fract,15下降和 e增与气管内导管的狭窄增显著相关(IDs9.08.07.06.0,平均Vex fract,15分别为195, 180, 146, and 134 mLIDs9.08.07.06.0的平均 e分别为380, 491, 635, 794 ms)。我们总结当弹性回缩使 e适当得到考虑, e Vex fract,15分析可在PCV模式中监测气管内导管部分梗阻。

(周  荻译 薛张纲校)

Only extreme degrees of endotracheal tube (ETT) narrowing can be detected with monitoring of tidal volume (VT) during pressure-controlled ventilation (PCV). To assess the degree of ETT obstruction in PCV and to compare it to VT monitoring, we produced 3 levels of partial ETT obstruction in 11 healthy anesthetized piglets using ETTs of 4 different inner diameters (IDs 9.0, 8.0, 7.0, and 6.0 mm ). An expiratory flow over volume ( e–V) curve was plotted and the time constant ( e) at 15% of expiration time (Te) was calculated. We also calculated the fractional volume expired during the first 15% of Te (Vex fract,15) and compared those variables to full expiratory VT for each of the 3 obstructions. VT monitoring failed to detect ETT narrowing. By contrast, Vex fract,15 decreased and e increased significantly with increasing ETT narrowing (for IDs 9.0, 8.0, 7.0, and 6.0, mean Vex fract,15 was 195, 180, 146, and 134 mL respectively and mean e was 380, 491, 635, 794 ms for IDs 9.0, 8.0, 7.0, and 6.0 respectively). We conclude that when the elastic recoil that drives e is appropriately considered, analysis of e and Vex fract,15 detects partial ETT obstruction during PCV.

                                                          

 高碳酸血症可以改善病态肥胖手术病人的组织氧供

Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

 Helmut Hager, MD* , Dayakar Reddy, MD*, Goutham Mandadi, MD*, Debra Pulley, MD , J. Chris Eagon, MD , Daniel I. Sessler, MD||, and Andrea Kurz, MD¶

Address correspondence to Helmut Hager, MD, Department of Anesthesiology and General Intensive Care Medicine, Medical University Vienna, Austria.

Anesth Analg 2006;103:677-681

 

在病态肥胖的手术病人中,伤口感染的发生率增,部分是因为这些病人的组织氧合处在边缘态。不像瘦的病人,在病态肥胖的病人中,增吸入氧浓度(Fio2)只能轻微的改善组织氧合。轻微的高碳酸血症可以改善瘦的病人的组织氧合,但在病态肥胖的病人中还没有被评价。因此我们假设,在Fio2 80%的腹部手术病态肥胖的病人中,轻微的高碳酸血症可以明显改善组织氧合。三十位择期行开腹胃切除的病态肥胖(体重指数61.5 ± 17 kg /m2)的病人被随机分为正常碳酸血症(n15,呼末二氧化碳35 mm Hg)或高碳酸血症(n15,呼末二氧化碳50 mm Hg);Fio280%。麻醉管理和其他影响因素被控制。组织氧合通过极谱分析探针在臂皮下测量。人口统计学特性、心血管指标和脉血氧分压(正常碳酸血症222 ± 48 对高碳酸血症230 ± 68 mm HgP = 0.705)组间无差异。但是组织氧合高碳酸血症高于正常碳酸血症(78 ± 31 56 ± 13 mm Hg; P = 0.029)。所以,轻微的高碳酸血症改善组织氧合在临是有价值的,并且可以减少病态肥胖病人的伤口感染率。

(陆文清译 薛张纲校)

Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given Fio2 80% during major abdominal surgery.Thirty obese patients (body mass index 61.5 ± 17 kg /m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n = 15, end-tidal Pco2 35 mm Hg) or hypercapnia (n = 15, end-tidal Pco2 50 mm Hg); Fio2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer.Demographic characteristics, cardiovascular measurements, and Pao2 (222 ± 48 versus 230 ± 68 mm Hg in normocapnic versus hypercapnic; mean ± sd; P = 0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78 ± 31 versus 56 ± 13 mm Hg; P = 0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients.

 

 静脉应用酮洛来克对辣椒素诱发的深部组织痛觉过敏的作用

The Effect of Intravenous Ketorolac on Capsaicin-Induced Deep Tissue Hyperalgesia

 Kumar, Keeran MD; Polston, Greg R. MD; Wallace, Mark S. MD

the Department of Anesthesiology, University of California San Diego , San Diego , California

Anesth Analg 2006,103:696-702,

 

临前期和临试验已强调小量持续传入冲可导致中枢易化,可经系统给予NSAIDS药物予以弱。然而,这些研究采用的都是经皮痛觉过敏模型。在这项研究中,我们评估了静注酮洛来克对肌注辣椒素导致深部组织痛觉过敏的试验模型的效应。我们采用了双盲对照队列设计。研究对象在间隔一周的两部分试验中分别接受60mg酮洛来克或安慰剂。随后在尺侧腕屈肌注射辣椒素(100 [mu]g in 10 [mu]L)。注射后0, 5, 10, 15, 20, 25分钟后记录自发痛觉评分、按压痛觉评分、显著疼痛、痛觉分布区域和疼痛性质。然后标记皮肤知觉,测定热和机械阈值。肌注辣椒素可产生可靠的疼痛主诉、痛觉过敏和牵涉痛。酮洛来克对辣椒素导致的自发痛、诱发痛、痛觉分布或继发痛觉过敏没有作用。这项研究的发现支持了采用肌注辣椒素痛觉模型进行进一步药理研究的可行性。

(徐丽颖译 薛张纲校)

 Preclinical and clinical studies have emphasized that persistent small afferent input will induce a state of central facilitation that can be attenuated by systemically administered nonsteroidal antiinflammatory drugs. However, these studies have been performed using cutaneous models of hyperalgesia. In this study we evaluated the effects of IV ketorolac on an experimental model of deep tissue hyperalgesia using IM capsaicin. We used a double-blind, placebo-controlled, crossover design. Ten subjects received 60 mg of ketorolac or placebo in 2 sessions separated by 1 wk. Capsaicin (100 [mu]g in 10 [mu]L) was then injected into the flexor carpi ulnaris muscle of the left forearm. After injection, spontaneous pain scores, pressure pain scores, gripping pain, pain distribution, and pain quality were recorded at 0, 5, 10, 15, 20, and 25 min. Cutaneous allodynia and dysesthesia were then mapped and thermal and mechanical thresholds were measured. The IM injection of capsaicin resulted in a reliable report of pain, hyperalgesia, and referred pain. Ketorolac had no effect on spontaneous pain, elicited pain, pain distribution, or secondary hyperalgesia induced by capsaicin. The findings of this study support the feasibility of further pharmacological studies using the IM capsaicin pain model.

 

 给大鼠间歇性腰穿:一种新的实验方法用于研究阿片类药物的耐受性

Intermittent Lumbar Puncture in Rats: A Novel Method for the Experimental Study of Opioid Tolerance (Technical Communication)

 Jijun J. Xu, Brittan C. Walla, Miguel F. Diaz, Gregory N. Fuller, and Howard B. Gutstein

Department of Anesthesiology and Molecular Genetics, Program in Genes and Development, Graduate School of Biomedical Sciences, University of Texas , M.D. Anderson Cancer Center , Houston , TX 77030 , USA .

Anesth Analg 2006 103: 714-720.

 

给大鼠蛛网膜下腔注入阿片类药物已成为研究阿片类药物药理学的重要方法,包括其无痛和耐受性。蛛网膜下腔置管,无论是通过颈椎还是腰段,已成为往髓内给予阿片药物的主要方法。然而,这类方法会导致诸多并发症。为了避免这些问题,我们发明了一种方法来研究用阿片药物进行麻,即给大鼠间歇性行腰穿。此法避免了置管相关的合并症。我们已证实了此法可用于研究阿片药物用于麻的耐受性且不会引起合并症。间歇性腰穿应被证实是一种有效的研究阿片药物用于麻的无痛性和耐受性的方法。

 (王慧琳译 薛张纲校)

 Spinal subarachnoid opioid administration in rats has been a very important method for studying the pharmacological effects of opioids, including analgesia and tolerance. Intrathecal catheterization, either through the cervical or lumbar approach, has been the predominant method used to deliver opioids spinally. However, these methods have potential undesirable complications. To help mitigate these problems, we have developed a method of intermittent lumbar puncture in rats to study the effects of chronic spinal opioid administration. This method avoids cat heter-associated morbidity. We demonstrate that this method can be readily used to induce spinal opioid tolerance without causing morbidity. Intermittent lumbar puncture should prove to be a useful technique for investigating mechanisms of spinal opioid analgesia and opioid tolerance development.

 

 痛敏肽受体在笑气的痛敏反应中的作用

The involvemenr of the nociceptin receptor in the antinociceptive action of nitrous oxide

 Himukashi S, Takeshima H, Koyanagi S, Shichino T, Fukuda K.

Department of Anesthesia, Kyoto University Hospital , Kyoto , Japan .

Anesth Analg 2006 103: 738-741.

 

痛敏肽和它的受体广泛分布于中枢神经系统,参与痛敏的调。我们曾道过挥发性麻醉药的MAC在痛敏肽受体剔除(NOP-/-)的小鼠和野生型小鼠无差别。最近的研究中我们研究了痛敏肽系统是否参与了笑气的痛敏反应。我们发现笑气对NOP-/-型小鼠的麻醉作用低于NOP+/+。而且,用氟烷和笑气复合麻醉,腹腔内注射酸性物质,NOP-/-小鼠会出现血浆促肾腺皮质激素升高,而NOP+/+没有。一项免疫组织化学研究表明笑气可以使NOP+/+小鼠的c-Fos表达,但NOP-/-没有。这些结果显示笑气的痛敏反应至少部分是由痛敏肽介导的。

(钟静译 薛张纲校)

Nociceptin and its receptor are widely expressed in the central nervous system and are involved in the modulation of nociception. We have previously reported that the minimum anesthetic alveolar concentrations for volatile anesthetics do not differ between nociceptin receptor knockout (NOP-/-) mice and wild-type (NOP+/+) mice. In the present study, we investigated whether the nociceptin system is involved in the antinociceptive action of nitrous oxide. Using the acetic acid-induced writhing test, we showed that nitrous oxide had significantly less analgesic action in NOP-/- mice than in NOP+/+ mice. Furthermore, when anesthetized with a mixture of halothane and nitrous oxide (70%), intraperitoneal injection of acetic acid resulted in an increase of plasma adrenocorticotropic hormone concentrations in NOP-/- mice but not in NOP+/+ mice. An immunohistochemical study showed that nitrous oxide exposure induced c-Fos _expression in the spinal cords of NOP+/+ mice but not in those of NOP-/- mice. These results together suggest that the antinociceptive action of nitrous oxide is, at least partly, mediated by the nociceptin system.

 

 氟烷和异氟醚对非麻醉下去大脑大鼠背角神经元的不同作用

The Differential Effects of Halothane and Isoflurane on Windup of Dorsal Horn Neurons Selected in Unanesthetized Decerebrated Rats

 Toshihiko Mitsuyo, Robert C. Dutton, Joseph F. Antognini, and Earl Carstens

San Francisco; and Department of Anesthesiology and Pain Medicine and Section of Neurobiology, Physiology, and Behavior, University of California , Davis .

Anesth Analg 2006 103: 753-760.

 

氟烷和异氟醚,在围最小肺泡气有效浓度(MAC)的范围内,对髓伤害性神经元产生不同作用。为什么氟烷在0.81.2MAC的范围内,进一步降低了它们的反应,而异氟醚却没有类似作用呢?我们研究了在01.2MAC的范围内,这些麻醉气体是否对终末产生不同作用,是否进一步提高神经元对重复伤害性刺激的反应。在去大脑大鼠,从背角神经元终末到201HzC纤维的电刺激,记录单个单位的数据。应用平行交叉试验来测定氟烷和异氟醚(0, 0.4, 0.8 1.2 MAC)。随着氟烷和异氟醚的浓度从0增到1.2MAC,制首次刺激反应的作用增,还增了对所有刺激反应总和的制(分别到34% ± 8% 50% ± 8%, P < 0.05)。从00.8MAC,两种麻醉气体都可制终末(即总反应-20×首次反应),但只有氟烷能在1.2MAC时使之进一步降低。0MAC时的神经元反应在0.8MAC时,只是部分,而非全部受制。剂量依赖性终末制与时间疼痛的减少相一致。氟烷1.2MAC时有进一步的制,异氟醚却没有,提示了两者固定作用的位点不同。固定性看来并非是由麻醉气体对伤害性神经元这一亚群的制介导的。

(王丽珺译 薛张纲校)

Halothane and isoflurane, in the peri-minimum alveolar anesthetic concentration (MAC) range, exert differential effects on spinal nociceptive neurons, whereby halothane further depresses their  responses from 0.8 to 1.2 MAC, whereas isoflurane does not. We presently investigated if these anesthetics differentially affect windup, the progressive increase in neuronal responses to repetitive noxious stimuli, over a broad concentration range from 0 to 1.2 MAC. In decerebrated rats, single-unit recordings were made from dorsal horn neurons exhibiting windup to 20 1-Hz C-fiber strength electrical stimuli. Halothane and isoflurane (0, 0.4, 0.8, and 1.2 MAC) were tested in a counterbalanced crossover protocol. Increasing halothane and isoflurane from 0 to 1.2 MAC progressively suppressed the response to the first stimulus, as well as summed responses to all stimuli (to 34% ± 8% and 50% ± 8%, respectively; P < 0.05). Absolute windup (summed response minus 20x the first response) was suppressed by both anesthetics from 0 to 0.8 MAC, with further depression by halothane but not isoflurane at 1.2 MAC. Responses of neurons isolated at 0 MAC were partially, but never totally, depressed at 0.8 MAC. The dose-dependent suppression of windup is consistent with reduced temporal summation of pain. Further depression at 1.2 MAC halothane, but not isoflurane, suggests different sites of immobilizing action for these two anesthetics. Immobility seems to not be mediated by severe anesthetic depression of a subpopulation of nociceptive neurons.