Anesthesia & Analgesia

 

December 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

体外循环期间的温度:监测部位之间的差异

(彭中美 马皓琳 李士通 校)

Temperature During Cardiopulmonary Bypass: The Discrepancies Between Monitored Sites (Editorial)

Nancy A. Nussmeier, Weiping Cheng, MariaRosa Marino, Tyler Spata, Shu Li, Gaile Daniels, Trevor Clark, and William K. Vaughn

Anesth Analg 2006 103: 1373-1379.

比较单侧与双侧乳内脉移植对术后纵隔引流量输液量的影响

( 琳译 薛张纲校)

A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement (Editorial)

Clarisse Berroeta, Abdel Benbara, Sophie Provenchère, Nadine Ajzenberg, Joelle Benessiano, Jean-Pol Depoix, Jean-Marie Desmonts, Bernard Iung, and Ivan Philip

Anesth Analg 2006 103: 1380-1385.

围术期静脉输注氨基酸促进非体外循环冠脉搭桥术后患者的康复缩短住院时间

(印杰敏 陈杰 校)

Perioperative Amino Acid Infusion Improves Recovery and Shortens the Duration of Hospitalization After Off-Pump Coronary Artery Bypass Grafting (Editorial)

Takako Umenai, Yasufumi Nakajima, Daniel I. Sessler, Satoshi Taniguchi, Hitoshi Yaku, and Toshiki Mizobe

Anesth Analg 2006 103: 1386-1393.

心肺转流中气道中性粒细胞介导的免疫应答激活

(邱郁薇 马皓琳 李士通 校)

Activation of a Neutrophil-Derived Inflammatory Response in the Airways During Cardiopulmonary Bypass (Editorial)

Toru Kotani, Yoshifumi Kotake, Hiroshi Morisaki, Junzo Takeda, Hideyuki Shimizu, Toshihiko Ueda, and Akitoshi Ishizaka

Anesth Analg 2006 103: 1394-1399.

兔心肌再灌注早期制调亡蛋白p53使异氟醚诱导的心脏保阈下移

(孙敏莉译 薛张纲校)

Inhibition of Apoptotic Protein p53 Lowers the Threshold of Isoflurane-Induced Cardioprotection During Early Reperfusion in Rabbits (Editorial)

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

Anesth Analg 2006 103: 1400-1405.

 

PEDIATRIC ANESTHESIA:

 

需要麻醉的择期小儿手术的日程安排:父母的看法

(张美荣 陈杰 校)

Scheduling Elective Pediatric Procedures That Require Anesthesia: The Perspective of Parents

Edward R. Mariano, Larry F. Chu, Chandra Ramamoorthy, and Alex Macario

Anesth Analg 2006 103: 1426-1431.

AMBULATORY ANESTHESIA:

超声引导下外周神经置管连续神经阻滞的门病人的管理:620例病人的处理经验

(黄丽娜 马皓琳 李士通 校)

Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Jeffrey D. Swenson, Nathan Bay, Evelyn Loose, Byron Bankhead, Jennifer Davis, Timothy C. Beals, Nathaniel A. Bryan, Robert T. Burks, and Patrick E. Greis

Anesth Analg 2006 103: 1436-1443.

小剂量氯胺酮降低异丙酚注射痛.

(吴德华译 薛张纲校)

Small-Dose Ketamine Reduces the Pain of Propofol Injection

Seung-Woo Koo, Sun-Jun Cho, Young-Kug Kim, Kyung-Don Ham, and Jai-Hyun Hwang

Anesth Analg 2006 103: 1444-1447.

ANESTHETIC PHARMACOLOGY:

术前用退黑激素类药物对异丙酚和硫贲妥钠麻醉诱导的剂量-反应曲线的影响:一项前瞻性、随机、双盲研究

(郑丽 陈杰 校)

The Effects of Melatonin Premedication on Propofol and Thiopental Induction Dose–Response Curves: A Prospective, Randomized, Double-Blind Study

Mohamed Naguib, Abdulhamid H. Samarkandi, Mohamed A. Moniem, Emad El-Din Mansour, Ahmad A. Alshaer, Hasan A. Al-Ayyaf, Awatif Fadin, and Saleh W. Alharby

Anesth Analg 2006 103: 1448-1452.

运阻滞浓度的异氟醚与丙酚在神经元终结具有相似的效果

(胡湘译 马皓琳 李士通校)

Isoflurane and Propofol Have Similar Effects on Spinal Neuronal Windup at Concentrations that Block Movement

Kevin P. Ng and Joseph F. Antognini

Anesth Analg 2006 103: 1453-1458.

氧化亚氮和氙气对大鼠伏核细胞外多巴胺的不同作用:一个微量渗析试验

(李惟一 陈杰 校)

The Differential Effects of Nitrous Oxide and Xenon on Extracellular Dopamine Levels in the Rat Nucleus Accumbens: A Microdialysis Study

Sachiyo Sakamoto, Shinichi Nakao, Munehiro Masuzawa, Takefumi Inada, Mervyn Maze, Nicholas P. Franks, and Koh Shingu

Anesth Analg 2006 103: 1459-1463.

TECHNOLOGY, COMPUTING, AND SIMULATION:

监测脑电双频指数或频谱熵能否减少七氟醚用量

(裘毅敏译,马皓琳 李士通校)

Does Monitoring Bispectral Index or Spectral Entropy Reduce Sevoflurane Use?

Isabelle Aimé, Nicolas Verroust, Cécile Masson-Lefoll, Guillaume Taylor, Pierre-Antoine Laloë, Ngai Liu, and Marc Fischler

Anesth Analg 2006 103: 1469-1477.

脉压和体积描记态指数对低血压患者液体治疗反应性测试的比较:一项临试验

(王丽君译 薛张纲校)

Arterial Versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial

Giuseppe Natalini, Antonio Rosano, Maria Taranto, Barbara Faggian, Elena Vittorielli, and Achille Bernardini

Anesth Analg 2006 103: 1478-1484.

体外自除颤器并不会受公共场所外界电磁场的影响而发生假阳性除击

(韩晓丹译 薛张纲校)

Automated External Defibrillators Do Not Recommend False Positive Shocks Under the Influence of Electromagnetic Fields Present at Public Locations

Roman Fleischhackl, Florian Singer, Bernhard Roessler, Jasmin Arrich, Sabine Fleischhackl, Heidrun Losert, Thomas Uray, Klemens Koehler, Fritz Sterz, Martina Mittlboeck, and Klaus Hoerauf

Anesth Analg 2006 103: 1485-1488.

用于检测单肺通气的双腔管声学监测

(丁震敏 陈杰 校)

Acoustic Monitoring of Double-Lumen Ventilated Lungs for the Detection of Selective Unilateral Lung Ventilation (Technical Communication)

Shai Tejman-Yarden, Dror Lederman, Israel Eilig, Alexander Zlotnik, Nathan Weksler, Arnon Cohen, and Gabriel M. Gurman

Anesth Analg 2006 103: 1489-1493.

ECONOMICS, EDUCATION, AND POLICY:

为改良围术期生素药而重新设计的一项新制度和程序

(唐李隽 马皓琳 李士通 校)

A System and Process Redesign to Improve Perioperative Antibiotic Administration

Gary Kanter, Neil Roy Connelly, and Jan Fitzgerald

Anesth Analg 2006 103: 1517-1521.

CRITICAL CARE AND TRAUMA:

脓毒血症和感染性休克患者的血浆蛋白组改变

( 荻译 薛张纲校)

Changes in the Serum Proteome of Patients with Sepsis and Septic Shock (Brief Report)

Armin Kalenka, Robert E. Feldmann, Jr, Kevin Otero, Martin H. Maurer, Klaus F. Waschke, and Fritz Fiedler

Anesth Analg 2006 103: 1522-1526

NEUROSURGICAL ANESTHESIA:

大鼠创伤性脑损伤后以脑电图定向的高剂量和低剂量丙酚输注对于组织病理学损伤的影响

(詹琼慧 陈杰 校)

The Effect of Electroencephalogram-Targeted High- and Low-Dose Propofol Infusion on Histopathological Damage After Traumatic Brain Injury in the Rat

Eva Eberspächer, Kerstin Heimann, Regina Hollweck, Christian Werner, Gerhard Schneider, and Kristin Engelhard

Anesth Analg 2006 103: 1527-1533.

OBSTETRIC ANESTHESIA:

试验剂量利多卡因对产程早期硬膜外给予新斯的明和舒太尼合液后镇痛运能的影响

(黄佳佳 译,马皓琳 李士通 校)

The Effect of a Lidocaine Test Dose on Analgesia and Mobility After an Epidural Combination of Neostigmine and Sufentanil in Early Labor

Fabienne Roelants, Valérie Mercier-Fuzier, and Patricia M. Lavand’homme

Anesth Analg 2006 103: 1534-1539.

临产妇女行腰硬联合麻醉同单次腰麻相比不能获得更高位的感觉神经阻滞

(王慧琳译 薛张纲校)

Combined Spinal Epidural Does Not Cause a Higher Sensory Block than Single Shot Spinal Technique for Cesarean Delivery in Laboring Women (Brief Report)

Yvonne Lim, Wendy Teoh, and Alex T. Sia

Anesth Analg 2006 103: 1540-1542.

GENERAL ARTICLES:

O型血非O型血病人在用6%羟乙基淀粉行急性等容血液稀后的凝血指标

(杨卫红 陈杰 校)

The Hemostatic Profiles of Patients with Type O and Non-O Blood After Acute Normovolemic Hemodilution with 6% Hydroxyethyl Starch (130/0.4)

Jin Gu Kang, Hyun Joo Ahn, Gaab Soo Kim, Tae Soo Hahm, Jeong Jin Lee, Mi Sook Gwak, and Soo Joo Choi

Anesth Analg 2006 103: 1543-1548.

术中输注氨基酸引起合成代谢与麻醉方式无关

(黄施伟 译,马皓琳 李士通校)

Intraoperative Infusion of Amino Acids Induces Anabolism Independent of the Type of Anesthesia

Francesco Donatelli, Thomas Schricker, Piervirgilio Parrella, Francisco Asenjo, Linda Wykes, and Franco Carli

Anesth Analg 2006 103: 1549-1556.

ANALGESIA:

神经细胞粘附分子体阻断冷水漂浮应激诱导的镇痛效应和淋巴细胞与培养背根神经神经元间的细胞粘附

(徐丽颖译 薛张纲校)

The Neural Cell Adhesion Molecule Antibody Blocks Cold Water Swim Stress-Induced Analgesia and Cell Adhesion Between Lymphocytes and Cultured Dorsal Root Ganglion Neurons

Susan Hua, Siobhan Hermanussen, Linda Tang, Greg R. Monteith, and Peter J. Cabot

Anesth Analg 2006 103: 1558-1564.

单侧全膝关成型术后连续性股神经镇痛:应用刺激与非刺激导管的比较

(周懿之 陈杰 校)

Continuous Femoral Nerve Analgesia After Unilateral Total Knee Arthroplasty: Stimulating Versus Nonstimulating Catheters

Salim M. Hayek, R. Michael Ritchey, Daniel Sessler, Robert Helfand, Samuel Samuel, Meng Xu, Michael Beven, Demetrios Bourdakos, Wael Barsoum, and Peter Brooks

Anesth Analg 2006 103: 1565-1570.

腘窝处坐骨神经的后路阻滞:比较单次和两次注射法

(张莹 马皓琳 李士通校)

The Posterior Approach to the Sciatic Nerve in the Popliteal Fossa: A Comparison of Single- Versus Double-Injection Technique (Brief Report)

Xavier March, Olga Pineda, Maria M. Garcia, Dolores Caramés, and Antonio Villalonga

Anesth Analg 2006 103: 1571-1573

通过磁共振定位锁骨下臂丛神经阻滞时离臂丛三支最近的最佳解剖位置

(吴德华译 薛张纲校)

Use of Magnetic Resonance Imaging to Define the Anatomical Location Closest to All Three Cords of the Infraclavicular Brachial Plexus (Brief Report)

Axel R. Sauter, Hans-Jørgen Smith, Audun Stubhaug, Michael S. Dodgson, and Øivind Klaastad

Anesth Analg 2006 103: 1574-1576.

 

围术期静脉输注氨基酸促进非体外循环冠脉搭桥术后患者的康复缩短住院时间

Perioperative Amino Acid Infusion Improves Recovery and Shortens the Duration of Hospitalization After Off-Pump Coronary Artery Bypass Grafting

Takako Umenai, MD*, Yasufumi Nakajima, MD, PhD*, Daniel I. Sessler, MD{dagger}{ddagger}, Satoshi Taniguchi, MD*, Hitoshi Yaku, MD, PhD||, and Toshiki Mizobe, MD, PhD*

From the *Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan; {dagger}Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, Ohio; {ddagger}Outcomes Research Institute, and Department of Anesthesiology, University of Louisville, Kentucky; and ||Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Japan.

Anesth Analg 2006 103: 1386-1393.

围术期静脉输注氨基酸有于维持妇产科和矫形外科手术患者的术中中心体温改善预后。本研究前瞻性研究了静脉输注氨基酸对患者的食道中心温度,以对非体外循环冠脉搭桥术(CABG)预后的影响。180例连续的选择性或急非体外循环CABG病例随机分为两组:静脉输注氨基酸组(术前2小时起以4KJ/kg/h的速率输注)和生理盐水组(以同样的时间和剂量输注生理盐水)。输注生理盐水组的患者在手术结束后食道中心温度平均为35.6(35.3-35.8)℃〔(平均值(95%可信区间)〕,氨基酸组则为36.1(35.9-36.3)℃(P0.01)。Kaplan-Meier分析表明接受氨基酸输注的患者术后需要行机械通气的持续时间较输注生理盐水组明显缩短〔中位数(95%可信区间),3.0(2.5-3.9) 小时比4.5(3.8-5.8)小时;P0.01〕。此外,输注氨基酸的患者在ICU停留的时间〔20(19.5-38.4) 小时比44(21-45)小时;P=0.001〕,和住院治疗的时间〔10(9-11) 天对比12(11-13)天;P=0.004〕均显著缩短。围术期静脉输注氨基酸能有效地减少非体外循环CABG患者术中低体温的发生并改善其术后的恢复。

(印杰敏 陈杰 校)

Perioperative amino acid infusion helps maintain core temperature and improves patient outcomes after gynecologic and orthopedic surgery. In the present study we prospectively determined the effect of amino acid infusion on esophageal core temperature and postoperative outcomes during off-pump coronary artery bypass grafting (CABG). One-hundred-eighty consecutive patients undergoing primary elective or urgent off-pump CABG were randomly divided into two groups: the IV amino acid infusion group (4 kJ kg–1 h–1 starting 2 h before surgery) and the saline infusion group (similar period and volume of saline infusion). The esophageal core temperature at the end of surgery was 35.6 (35.3–35.8)°C [mean (95% confidence interval)] in the saline infusion group and 36.1°C (35.9–36.3)°C in the amino acid infusion group (P = 0.01). Kaplan–Meier analysis demonstrated that patients given amino acids required a significantly shorter duration of postoperative mechanical ventilation than patients given saline [median (95% confidence interval), 3.0 (2.5–3.9) vs 4.5 (3.8–5.8) h; P = 0.01]. Furthermore, intensive care unit stay [20 (19.5–38.4) vs 44 (21–45) h; P = 0.001] and days until fit for discharge from hospital [10 (9–11) vs 12 (11–13) days; P = 0.004] were significantly shorter in patients given amino acid. Perioperative amino acid infusion in patients undergoing off-pump CABG effectively minimizes intraoperative hypothermia and improves postoperative recovery.

 

需要麻醉的择期小儿手术的日程安排:父母的看法

Scheduling Elective Pediatric Procedures That Require Anesthesia: The Perspective of Parents

Edward R. Mariano, MD*, Larry F. Chu, MD, MS (Biochemistry), MS (Epidemiology){dagger}, Chandra Ramamoorthy, MBBS{dagger}, and Alex Macario, MD, MBA{dagger}{ddagger}

From the *Department of Anesthesia, University of California, San Diego School of Medicine, San Diego; and {dagger}Departments of Anesthesia, {ddagger}Health Research and Policy, Stanford University School of Medicine, Stanford, California.

Anesth Analg 2006 103: 1426-1431.

每日需要麻醉的择期小儿手术在数量的变化可能导致手术室资源和病例负担之间的不平衡。计划手术和进行手术的时间之间的间隔长,手术室的利用率就高。在这个研究中,作者研究影响父母安排他们的孩子手术的因素。并想了解父母的理想目标和可接受的最长的等待时间和是否影响手术的决定,比如影响行程安排。随机选择250名拟行择期手术的小儿的父母,236名完成分析,14例没有回复。父母提前安排小儿手术时间的中位数是4.3周(变范围是2.08.6周),理想的等待时间间隔是3周(变范围是24周),最长的可接受间隔是6周(变范围是410周)。和一般的手术相比,父母乐意去等待更长的时间去安排心脏的手术(4周,p=0.004)和整形手术(3.5周,p=0.024)。父母对孩子疾病严重性的认识、最早有空时间和外科医生的建议是影响手术安排的最重要的三个因素。手术安排的时间表和父母有否时间有很大关系({tau}b = 0.72, P < 0.0001)。意外的是并没有显示父母乐意首选在假期或夏季安排手术。

(张美荣 陈杰 校)

Daily variability in volume of elective pediatric procedures that require anesthesia may lead to an imbalance between available operating room resources and case load. Longer intervals between scheduling and the surgical date generally result in higher operating room utilization. In this study, we sought to determine which factors influence when parents schedule their children for procedures. We also aimed to identify parents’ ideal and longest acceptable waiting intervals and determine whether type of procedure, for example, affects scheduling. From a convenience sample of 250 randomly selected parents of children presenting for elective surgery, 236 completed surveys were analyzed. The remaining 14 surveys were not returned. Overall, parents scheduled their child’s procedure a median of 4.3 wk (interquartile range 2.0–8.6) in advance and reported an ideal waiting interval of 3 wk (interquartile range 2–4), and longest acceptable interval of 6 wk (interquartile range 4–10). Parents were willing to wait longer to schedule cardiac (4 wk, P = 0.004) and plastic (3.5 wk, P = 0.024) surgery when compared with general surgical procedures. Overall, parents ranked severity of the child’s illness, earliest available time, and surgeon’s suggested date as the three most important factors influencing when their child’s surgery is scheduled. The timetable for scheduling procedures was highly correlated with both mother and father having available time off work ({tau}b = 0.72, P < 0.0001). Surprisingly, parents did not show a preference for scheduling cases during vacation or summer months.


术前用退黑激素类药物对异丙酚和硫贲妥钠麻醉诱导的剂量-反应曲线的影响:一项前瞻性、随机、双盲研究

The Effects of Melatonin Premedication on Propofol and Thiopental Induction Dose–Response Curves: A Prospective, Randomized, Double-Blind Study

Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}, Mohamed A. Moniem, MD{dagger}, Emad El-Din Mansour, MD{dagger}, Ahmad A. Alshaer, MD{dagger}, Hasan A. Al-Ayyaf, MB, BCh{dagger}, Awatif Fadin, MB, BCh{dagger}, and Saleh W. Alharby, MB, BS, FRCS (Glas){ddagger}

From the *Department of Anesthesiology and Pain Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; and Departments of {dagger}Anesthesia and {ddagger}Surgery, King Saud University, Riyadh, Saudi Arabia.

Anesth Analg 2006 103: 1448-1452.

 

背景:退黑激素对术中静脉麻醉需要量的影响至还未研究过。作者通过言语命令和睫毛刺激反应来研究术前用退黑激素类药物对异丙酚联合硫贲妥钠静脉麻醉剂量-反应曲线的影响。

方法:这项前瞻性、随机、双盲研究包括了200ASA I级的成年男性。病人术前口服0.2 mg/kg的退黑激素或是一片安慰剂(每组n = 100 )。大约50min后,10位退黑激素的亚组和10位安慰剂的亚组接受了不同剂量的异丙酚(0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg)或是硫贲妥纳(0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg)的静脉麻醉诱导。在异丙酚或是硫贲妥纳最后给药60秒以后测定每个病人对于指令的反应,“睁开你的眼睛”,和睫毛刺激反应。用概率分析法描绘剂量-反应曲线。

结果 :术前应用退黑激素减少了对言语命令和睫毛反应的消失时硫贲妥纳ED50值,分别从3.4 mg/kg (95%可信区间, 3.2–3.5 mg/kg)3.7 mg/kg (3.5–3.9 mg/kg) 下降到 2.7 mg/kg (2.6–2.9 mg/kg)2.6 mg/kg (2.5–2.7 mg/kg) (P < 0.05).。相对应的异丙酚的ED50值也分别从1.5 mg/kg (1.4–1.6 mg/kg)1.6 mg/kg (1.5–1.7 mg/kg)下降到0.9 mg/kg (0.8–0.96 mg/kg)0.9 mg/kg (0.8–0.95 mg/kg), (P < 0.05)

结论:术前用退黑激素类药物显著降低静脉麻醉异丙酚和硫贲妥钠的需求量。

(郑丽 陈杰 校)

BACKGROUND: The effect of melatonin on the intraoperative requirements for IV anesthetics has not been documented. We studied the effect of melatonin premedication on the propofol and thiopental dose–response curves for abolition of responses to verbal commands and eyelash stimulation.

METHODS: This prospective, randomized, double-blind study included 200 adults with ASA physical status I. Patients received either 0.2 mg/kg melatonin or a placebo orally for premedication (n = 100 per group). Approximately 50 min later, subgroups of 10 melatonin and 10 placebo patients were administered various doses of propofol (0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg) or thiopental (2.0, 3.0, 4.0, 5.0, or 6.0 mg/kg) for anesthetic induction. The ability of each patient to respond to the command, "open your eyes," and the disappearance of the eyelash reflex were assessed 60 s after the end of the injection of propofol or thiopental. Dose–response curves were determined by probit analysis.

RESULTS: Melatonin premedication decreased thiopental ED50 values for loss of response to verbal command and eyelash reflex from 3.4 mg/kg (95%confidence interval, 3.2–3.5 mg/kg) and 3.7 mg/kg (3.5–3.9 mg/kg) to 2.7 mg/kg (2.6–2.9 mg/kg) and 2.6 mg/kg (2.5–2.7 mg/kg), respectively (P < 0.05). Corresponding propofol ED50 values decreased from 1.5 mg/kg (1.4–1.6 mg/kg) and 1.6 mg/kg (1.5–1.7 mg/kg) to 0.9 mg/kg (0.8–0.96 mg/kg) and 0.9 mg/kg (0.8–0.95 mg/kg), respectively(P < 0.05)

CONCLUSIONS: Melatonin premedication significantly decreased the doses of both propofol and thiopental required to induce anesthesia.

 

氧化亚氮和氙气对大鼠伏核细胞外多巴胺的不同作用:一个微量渗析试验

The Differential Effects of Nitrous Oxide and Xenon on Extracellular Dopamine Levels in the Rat Nucleus Accumbens: A Microdialysis Study

Sachiyo Sakamoto, MD*, Shinichi Nakao, MD, PhD*, Munehiro Masuzawa, MD, PhD*, Takefumi Inada, MD*, Mervyn Maze, MBChB, FRCP, FRCA, FMedSci{dagger}, Nicholas P. Franks, PhD, FMedSci{dagger}, and Koh Shingu, MD, PhD*

From the *Department of Anesthesiology, Kansai Medical University, Osaka, Japan and {dagger}Magill Department of Anaesthesia, Chelsea and Westminster Hospital and Biophysics Section, The Blackett Laboratory, Imperial College of Science, Technology and Medicine, London, United Kingdom.

Anesth Analg 2006 103: 1459-1463.

 

伏核(NAC)放多巴胺在许多精神药物和成瘾性药物(比如N-甲基-d-天冬氨酸:谷氨酸的一种亚型的对物)的药理作用中起着非常重要的作用。虽然氧化亚氮和氙气都是N-甲基-d-天冬氨酸的受体拮剂,他们产生精神毒性的潜在机制不一。因此,作者研究它们在伴或不伴氯胺酮的情况下对于NAC中细胞外多巴胺的作用。

方法:35只大鼠在NAC中植入微量渗析探针。随机分为六组:1.暴露在40%的氧气中60min2. 暴露在60%的氧化亚氮(0.27MAC)60min3. 暴露在43%的氙气(0.27MAC)60min4. 暴露在40%的氧气中70min5. 暴露在60%的氧化亚氮中70min6. 暴露在43%的氙气中70min。其中4,5,6三组在停止气体暴露10分钟后腹腔注射氯胺酮(80mg/kg)。每20分钟采集样本一次,使用液相色谱分析仪测定多巴胺水平。

结果:氧化亚氮,而不是氙气显著增了多巴胺水平。氯胺酮显著增了小鼠多巴胺的水平,可以被氙气,而不是氧化亚氮制。这些数据提示氧化亚氮和氙气不同的神经心理作用部分源于它们对于多巴胺系统不同的作用效果。

(李惟一 陈杰 校)

Dopamine release in the nucleus accumbens (NAC) plays a crucial role in the action of various psychotropic and addictive drugs, such as antagonists of the N-methyl-d-aspartate subtype of the glutamate. Although both nitrous oxide and xenon are N-methyl-d-aspartate receptor antagonists, they differ in their potential for producing neuropsychological toxicity; therefore, we decided to examine their effects on both spontaneous and ketamine-induced extracellular dopamine levels in the NAC. A microdialysis probe was implanted into the NAC in each of 35 rats, which were randomly assigned to one of six groups: exposure to 40% O2, exposure to 60% nitrous oxide (0.27 MAC), exposure to 43% xenon (0.27 MAC) for 60 min, and three groups exposed to either 40% O2, 60% nitrous oxide, or 43% xenon for 70 min and 80 mg/kg ketamine was given i.p. 10 min after the initiation of gas exposure. Perfusate samples were collected every 20 min, and the dopamine levels were measured using a high-performance liquid chromatography system. Nitrous oxide, but not xenon, significantly increased the dopamine level. Ketamine significantly increased the dopamine level, and this was significantly inhibited by xenon, but not by nitrous oxide. These data suggest that the difference in neuropsychological activity between nitrous oxide and xenon is partly due to their differential effects on the mesolimbic dopamine system.

 

用于检测单肺通气的双腔管声学监测

Acoustic Monitoring of Double-Lumen Ventilated Lungs for the Detection of Selective Unilateral Lung Ventilation (Technical Communication)

Shai Tejman-Yarden, MD*, Dror Lederman, MSc{dagger}, Israel Eilig, MD, Alexander Zlotnik, MD, Nathan Weksler, MD, Arnon Cohen, PhD (RIP){dagger}{ddagger}, and Gabriel M. Gurman, MD

From the *Division Of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel; {dagger}Department of Electrical and Computer Engineering, Ben Gurion University of the Negev, Beer Sheva, Israel; and Division of Anesthesiology and Critical Care, Soroka Medical Center, Beer Sheva, Israel.

Anesth Analg 2006 103: 1489-1493.

 

单肺插管(OLI)是气管插管最常见并发症之一。现在尚没有一个有效的监测工具可早期检测出OLI。在本研究中,作者研究了声学分析对OLI检测的有效性。采集11名胸部手术需要使用双腔导管的患者的肺部呼吸音。在诱导术前确认了导管适当的位置后,开始记录隔离肺的通气情况。主要通过3个电压型扩音器收集样本,在胸部每一侧各放置一个,另一个置于右前臂,以采集背部噪音标本。分析各信号能量,区分呼吸和静止期。根据每侧肺信号能量的比率,将每次呼吸分为下列3个类别之一:双肺通气,选择性右肺通气和选择性左肺通气。在这11名患者中行右肺通气时有10个病人为单肺通气;行左肺通气时所有病人均为单肺通气。这个研究提示声学监测可有效检测选择性单肺通气,对于早期断OLI可能有用。

(丁震敏 陈杰 校)

One-lung intubation (OLI) is among the most common complications of endotracheal intubation. None of the monitoring tools now available has proved effective for its early detection. In this study we investigated the efficacy of acoustic analysis for the detection of OLI. We collected lung sounds from 11 patients undergoing thoracic surgery requiring the placement of a double-lumen tube. Recordings of separate lung ventilation were performed after induction and confirmation of adequate tube positioning, before surgery. Samples of lung sounds were collected by three piezoelectric microphones, one on each side of the chest and one on the right forearm, for background noise sampling. The samples were filtered, the signals’ energy envelopes were calculated, and segmentation to breath and rest periods was performed. Each respiration was classified into one of the three categories: bilateral ventilation, selective right-lung ventilation, or selective left-lung ventilation, on the basis of the ratio between the energy signals of each lung. OLI was accurately identified in 10 of the 11 patients during right OLI and in all 11 patients during left OLI. This study suggests that acoustic monitoring is effective for the detection of selective lung ventilation and may be useful for early diagnosis of OLI.

 

大鼠创伤性脑损伤后以脑电图定向的高剂量和低剂量丙酚输注对于组织病理学损伤的影响

The Effect of Electroencephalogram-Targeted High- and Low-Dose Propofol Infusion on Histopathological Damage After Traumatic Brain Injury in the Rat

Eva Eberspächer, DVM*, Kerstin Heimann, DVM{dagger}, Regina Hollweck, DS{ddagger}, Christian Werner, MD, Gerhard Schneider, MD{dagger}, and Kristin Engelhard, MD

From the *Department of Surgical and Radiological Sciences, Veterinary Medical Teaching Hospital, University of California at Davis, Davis, California; {dagger}Klinik für Anaesthesiologie; and {ddagger}Department for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; §Klinik für Anästhesiologie, Klinikum der Johannes Gutenberg-Universität, Mainz, Germany.

Anesth Analg 2006 103: 1527-1533.

背景:丙酚常用于创伤性脑损伤后患者的镇静,但有关脑损伤后剂量依赖性的丙酚神经保效应尚未阐明。作者比较了大鼠皮质损伤(CCI)在应用以脑电图为定向的高剂量和低剂量丙酚六小时后的组织病理学损伤。

方法:物随机分为CCI/低丙酚组(脑电图制比率1~5%)、CCI/高丙酚组(脑电图制率30%~40%)、对照组CCI/氟烷(1.0%氟烷)或伪组/氟烷。脑组织切片使用甲酚紫(KV)和苏木红染色来评估海马的损伤容积、嗜酸性粒细胞数量和细胞凋亡蛋白酶(caspase-3)活性。

结果:不同组中海马的损伤容积(mm3)和嗜酸性粒细胞无显著性差异【损伤容积:CCI/低丙酚组为31.55±14.66(KV)53.77±8.62(HE)CCI/高丙酚组33.81±10.57(KV)52.30±11.55HE);CCI/氟烷组36.42±17.06(KV)57.95±8.49HE)】。在所有CCI组中均发生同侧海马细胞凋亡蛋白酶激活。

结论:尽管皮质神经元能存在不同水平,但在短时期的组织病理学损伤中并没有差异。这些结果对丙酚的神经保效应与脑代谢需求的降低有关的观点提出了挑战。

(詹琼慧 陈杰 校)

BACKGROUND: Propofol is commonly used to sedate patients after traumatic brain injury. However, the dose-dependent neuroprotective effects of propofol after head trauma are unknown. We compared histopathological damage after 6 h of electroencephalogram-targeted high- and low-dose propofol infusion in rats subjected to controlled cortical impact (CCI).

METHODS: Animals were randomly assigned to CCI/propofol with electroencephalogram burst-suppression-ratio 1%–5% (CCI/lowprop), CCI/propofol with burst-suppression-ratio 30%–40% (CCI/highprop), control group CCI/1.0 vol % halothane (CCI/halo), or sham group with halothane anesthesia (SHAM/halo). Brain slices were stained with kresyl violet (KV) and hematoxylin/eosin (HE) to evaluate lesion volume, number of eosinophilic cells, and activation of caspase-3 in the hippocampus.

RESULTS: Lesion volume (mm3) and number of eosinophilic cells in the hippocampus did not differ significantly [lesion volumes: CCI/lowprop 31.55 ± 14.66 (KV) and 53.77 ± 8.62 (HE); CCI/highprop 33.81 ± 10.57 (KV) and 52.30 ± 11.55 (HE); CCI/halo 36.42 ± 17.06 (KV) and 57.95 ± 8.49 (HE)]. Activation of caspase-3 occurred in the ipsilateral hippocampus in all CCI-groups.

CONCLUSION: Despite different levels of cortical neuronal function, there were no relevant differences in the short-term histopathological damage. These results challenge the view that the neuroprotective effect of propofol relates to the suppression of cerebral metabolic demand.

 

O型血非O型血病人在用6%羟乙基淀粉行急性等容血液稀后的凝血指标

The Hemostatic Profiles of Patients with Type O and Non-O Blood After Acute Normovolemic Hemodilution with 6% Hydroxyethyl Starch (130/0.4)

Jin Gu Kang, MD, Hyun Joo Ahn, MD, Gaab Soo Kim, MD, Tae Soo Hahm, MD, Jeong Jin Lee, MD, Mi Sook Gwak, MD, and Soo Joo Choi, MD

From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Anesth Analg 2006 103: 1543-1548.

 

背景:O型血的人群一般认为有着缺乏第VIII因子(纤维蛋白稳定因子)和血管假性血友病因子(vWF)的倾向。如果这属实的话,那么O型血的人在用羟乙基淀粉(HES)行等容血液稀后更容易出现凝血障碍,包括血液稀和羟乙基淀粉相关的凝血障碍。

方法:30名非O15O型血患者,ASAIII,行两个段以水平的柱外科手术病人参与了此项研究。在麻醉诱导之后,预计30%的血容量已经丧失,同时予以6% HES(130/0.4)补充血容量。凝血指标则在等容血液稀时(To)和发生后30分钟 (T30)两个时间点进行监测。

结果:发生急性血液稀之前和之后,第VIII因子活性,血管假性血友病因子原水平 (vWF:ag) vWF瑞斯托菌素辅因子活性在O型血病例中均低于非O型血病人,且O型血病例在发生血液稀之后其数值低于正常值范畴。而且其降低的幅度比单纯血液稀引起的要高。血栓弹性描记图的最大幅度和凝血指数在发生正常血容量型血液稀的O型人群中均低于正常值。vWF:ag的降低和失血量密切相关,且在O型人群中更为显著。

结论:在使用HES行等容血液稀的O型人群存在更大程度的凝血危害和第VIII因子活性,血管假性血友病因子原 (vWF:ag) vWF瑞斯托菌素辅因子活性水平的降低。

 

(杨卫红 陈杰 校)

BACKGROUND: Individuals with Type O blood have been reported to have a tendency toward reduced Factor VIII and von Willebrand Factor (vWF) levels. If this is true, patients with Type O blood might be vulnerable to coagulopathy during acute normovolemic hemodilution using hydroxyethyl starch (HES), both from hemodilution as well as HES-related coagulopathy.

METHODS: Thirty non-O and 15 type O ASA 1 or 2 patients scheduled for spinal surgery involving more than two spinal levels were enrolled for the study. After anesthesia induction, 30% of the estimated blood volume was removed, and the volume was simultaneously replaced with 6% HES (130/0.4). Coagulation profiles were measured before (T0) and 30 min after acute normovolemic hemodilution (T30).

RESULTS: Factor VIII activity, vWF antigen levels (vWF:ag), and vWF ristocetin cofactor activity (vWF:RCof) were lower in the O group than in the non-O group before and after acute normovolemic hemodilution, and decreased below the normal range in the O group after acute normovolemic hemodilution. The decrease was beyond that expected from hemodilution alone. Maximum amplitude and coagulation index of the thromboelastogram decreased below the normal range in the O group after acute normovolemic hemodilution. The decrease in vWF:ag was related to the degree of blood loss, and was greater in patients in the O group.

CONCLUSIONS: Patients with Type O blood may have increased coagulation compromise, and greater dilution of Factor VIII activity, vWF:ag, and vWF:RCof after acute normovolemic hemodilution with HES.

 

单侧全膝关成型术后连续性股神经镇痛:应用刺激与非刺激导管的比较

Continuous Femoral Nerve Analgesia After Unilateral Total Knee Arthroplasty: Stimulating Versus Nonstimulating Catheters

Salim M. Hayek, MD, PhD*{dagger}{ddagger}, R. Michael Ritchey, MD*||, Daniel Sessler, MD{dagger}{ddagger}, Robert Helfand, MD||, Samuel Samuel, MD*, Meng Xu, MS, Michael Beven, BA*, Demetrios Bourdakos, MD||, Wael Barsoum, MD#, and Peter Brooks, MD#

From the Departments of *Pain Management, {dagger}Outcomes Research, ||General Anesthesiology, ¶Quantitative Health Sciences, and #Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio; {ddagger}Outcomes Research Institute; and Department of Anesthesiology, University of Louisville, Louisville, Kentucky.

Anesth Analg 2006 103: 1565-1570

 

背景连续性股神经镇痛可缓解全膝关成型术(TKA)后的疼痛,改善能的恢复。而刺激导管可能利于导管更精确的放置。

方法作者设计了一随机前瞻性研究来调查41TKA病人比较使用刺激导管与非刺激导管有关情况。所用病人都接受经静脉患者自控的镇痛作为缓解疼痛的辅措施。实验的主要目的是调查应用刺激导管是否较应用非刺激导管,能减少局部麻醉药的用量。另外研究其它方面的差异,包括术后疼痛评分,阿片类药物的使用,副作用以急性期能矫形结果。

结果两组的镇痛效果均满意,罗哌卡因用药量并没有明显差异;刺激导管组罗哌卡因给药剂量的中位数为8.2mL/h,而非刺激性导管组为8.8mL/hP0.26(中位数差值-0.6,95%可信区间,-2.30.6)。同时注意到两组治疗组间,经静脉患者自控镇痛的太尼用量;VAS

评分;急性期能性矫形结果;副作用以口服阿片类药物的使用量并没有明显的差别。

结论在全膝关成型术(TKA)后连续性股神经镇痛中使用刺激导管与传统的非刺激导管比较并没有明显的优点。

(周懿之 陈杰 校)

BACKGROUND: Continuous femoral analgesia provides extended pain relief and improved functional recovery for total knee arthroplasty (TKA). Stimulating catheters may allow more accurate placement of catheters.

METHODS: We performed a randomized prospective study to investigate the use of stimulating catheters versus nonstimulating catheters in 41 patients undergoing TKA. All patients received IV patient-controlled anesthesia for supplementary pain relief. The principal aim of the trial was to examine whether a stimulating catheter allowed the use of lesser amounts of local anesthetics than a nonstimulating catheter. The additional variables we examined included postoperative pain scores, opioid use, side effects, and acute functional orthopedic outcomes.

RESULTS: Analgesia was satisfactory in both groups, but there were no statistically significant differences in the amount of ropivacaine administered; the median amount of ropivacaine given to patients in the stimulating catheter group was 8.2 mL/h vs 8.8 mL/h for patients with nonstimulating catheters, P = 0.26 (median difference –0.6; 95% confidence interval, –2.3 to 0.6). No significant differences between the treatment groups were noted for the amount of fentanyl dispensed by the IV patient-controlled anesthesia, numeric pain rating scale scores, acute functional orthopedic outcomes, side effects, or amounts of oral opioids consumed.

CONCLUSION: The use of stimulating catheters in continuous femoral nerve blocks for TKA does not offer significant benefits over traditional nonstimulating catheters.

 

比较单侧与双侧乳内脉移植对术后纵隔引流量输液量的影响

A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement (Editorial)

Clarisse Berroeta, Abdel Benbara, Sophie Provenchère, Nadine Ajzenberg, Joelle Benessiano, Jean-Pol Depoix, Jean-Marie Desmonts, Bernard Iung, and Ivan Philip

Address correspondence to: Dr C. Berroeta, Département d'Anesthésie, Hôpital Bichat-Claude Bernard 46, rue Henri Huchard, 75877 Paris Cedex 18, France. Address e-mail to clarisse.berroeta@bch.ap-hop-paris.fr.

Anesth Analg 2006 103: 1380-1385.

 

现已明确,冠脉旁路手术中使用左乳内脉(LIMA)移植较自体隐静脉移植为佳。而与以两种方法相比,使用双侧乳内脉(BIMA)移植早期和晚期的通畅率更高,患者的长期生存率更高,再次手术发生心脏事件的可能性更小。但另一方面,双侧乳内脉移植可能会增术后出血的危险性,因此有关的争论也总是围绕着围手术期问题。我们希望通过这项研究,明确BIMA移植是否是首次择期冠脉血管形成术患者术后出血使用血制品的独立危险因素。连续33位准备行BIMA移植的患者与66位单一LIMA移植的患者配对。LIMA组术后纵隔引流量明显少于BIMA组(中位数:722 mL vs 920 mLP = 0.0001)。56名患者使用了血制品(LIMABIMA组分别是56%与51%,P = 0.67)。多因素分析表明,BIMA与手术时间是术后引流量增多的独立危险因素。然而对数回归分析表明,与心肺旁路红细胞压积和手术时间不同,BIMA与血制品的使用的联系并无显著意义(红细胞压积升高1%与手术时间1分钟的OR 95% CI分别为:0.89 [0.80–0.96]P = 0.01 1.009 [1.001–1.019]P = 0.04)。结论:述数据支持BIMA移植轻度增术后引流量但对输血输液量无影响的结论。

(金 琳译 薛张纲校)

The superiority of the left internal mammary artery (LIMA) graft over autogenous saphenous vein as a bypass conduit in coronary artery bypass surgery has been well established. Early and late patency rates of bilateral internal mammary artery (BIMA) grafts exceed those of vein grafts, and patients who receive BIMA have improved long-term survival rates and more freedom from reoperations and other cardiac events. But because of other concerns, particularly the question of increased risk of postoperative bleeding, controversy still surrounds the perioperative period. In the present study, we sought to determine whether BIMA grafting was an independent risk factor of postoperative bleeding and of blood product use in patients undergoing primary elective coronary artery revascularization. For this purpose, 33 consecutive patients scheduled for BIMA grafting were matched with 66 patients operated on by single LIMA grafting. Patients in the LIMA group had significantly less postoperative mediastinal drainage than those in the BIMA group (median: 722 vs 920 mL, P = 0.0001). Fifty-six patients received blood products (56% vs 51% in LIMA and BIMA groups, respectively; P = 0.67). In multivariate analysis, BIMA and operative duration were independent predictors of increased postoperative drainage. Nevertheless, in logistic regression, BIMA was not significantly associated with blood product use, unlike precardiopulmonary bypass hematocrit and duration of surgery (OR and 95% CI: 0.89 [0.80–0.96] P = 0.01; 1.009 [1.001–1.019] P = 0.04, for an increase of 1% in hematocrit and 1 min in duration of surgery, respectively). In conclusion, these data support the idea that BIMA graft slightly increases postoperative drainage but not transfusion requirement.

 

 

兔心肌再灌注早期制调亡蛋白p53使异氟醚诱导的心脏保阈下移

Inhibition of Apoptotic Protein p53 Lowers the Threshold of Isoflurane-Induced Cardioprotection During Early Reperfusion in Rabbits (Editorial)

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

Anesth Analg 2006 103: 1400-1405.

 

介绍:暴露于异氟醚之前和在再灌注早期,通过激活磷脂酰肌醇-3-激酶(PI3K)介导的信号传导来心肌梗塞。调亡蛋白p53PI3K来调,p53的制缺血损伤。我们检测这样的假说,在活体制p53使异氟醚诱导的保阈下移。

方法:家兔(n = 73)监测血流学,并使其冠脉左前降支阻断30min再灌注3小时,接受0.9%的生理盐水(对照),异氟醚(0.51.0MAC)在再灌注之前给予3min和再灌注之后给予2minp53制剂PFT-αpifithrin-α1.53.0 mg/kg),0.5MAC的异氟醚1.5 mg/kg PFT-α其他家兔在选择性PI3K制剂wortmannin(0.6 mg/kg)或线粒体通透性转换孔道开放剂苍术苷(atractyloside5 mg/kg)预处理后接受3.0 mg/kg PFT-α0.5MAC的异氟醚1.5 mg/kg PFT-α

结果:当与对照相比(45%±2%[均数±标准差]),异氟醚(1.0而不是0.5MAC, PFT-α3.0而不是1.5 mg/kg),以0.5MAC异氟醚1.5 mg/kg PFT-α的结合显著(P < 0.05)减少心肌梗塞面积(左心室面积危险度分别为21%±4%, 43% ±7%, 22%±4%, 45%±4%,28%±3%氯化三苯基四氮唑染色)。苍术苷,而不是wortmannin,阻止3.0 mg/kg PFT-α诱导的心脏保,然而苍术苷和wortmannin阻滞由0.5MAC异氟醚1.5 mg/kg PFT-α产生的梗塞面积减少

结论:这样的结果提示在活体再灌注早期制调亡蛋白p53降低异氟醚诱导的心脏保的阈值。

(孙敏莉译 薛张纲校)

INTRODUCTION: Exposure to isoflurane before and during early reperfusion protects against myocardial infarction by activating phosphatidylinositol-3-kinase (PI3K)-mediated signaling. The apoptotic protein, p53, is regulated by PI3K, and inhibition of p53 protects against ischemic injury. We tested the hypothesis that p53 inhibition lowers the threshold of isoflurane-induced postconditioning in vivo.
METHODS: Rabbits (n = 73) instrumented for hemodynamic measurement and subjected to a 30-min left anterior descending coronary artery occlusion and 3-h reperfusion received 0.9% saline (control), isoflurane (0.5 or 1.0 minimum alveolar concentration [MAC]) administered for 3 min before and 2 min after reperfusion, the p53 inhibitor pifithrin-[alpha] (1.5 or 3.0 mg/kg), or 0.5 MAC isoflurane plus 1.5 mg/kg pifithrin-[alpha]. Other rabbits received 3.0 mg/kg pifithrin-[alpha] or 0.5 MAC isoflurane plus 1.5 mg/kg pifithrin-[alpha] after pretreatment with the selective PI3K inhibitor wortmannin (0.6 mg/kg) or the mitochondrial permeability transition pore opener atractyloside (5 mg/kg).
RESULTS: Isoflurane (1.0 but not 0.5 MAC), pifithrin-[alpha] (3.0 but not 1.5 mg/kg), and the combination of 0.5 MAC isoflurane plus 1.5 mg/kg pifithrin-[alpha] significantly (P < 0.05) reduced infarct size (21% +/- 4%, 43% +/- 7%, 22% +/- 4%, 45% +/- 4%, and 28% +/- 3% [mean +/- sd], respectively, of left ventricular area at risk; triphenyltetrazolium chloride staining) when compared with control (45% +/- 2%). Atractyloside, but not wortmannin, abolished 3.0 mg/kg pifithrin-[alpha]-induced cardioprotection, whereas atractyloside and wortmannin blocked reductions in infarct size produced by 0.5 MAC isoflurane plus 1.5 mg/kg pifithrin-[alpha].
CONCLUSION: The results indicate that inhibition of the apoptotic protein p53 lowers the threshold of isoflurane-induced cardioprotection during early reperfusion in vivo.

 

Small-dose ketamine reduces the pain of propofol injection.

小剂量氯胺酮降低异丙酚注射痛.

Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. ]

Department of Anesthesia and Pain Medicine, Asan Medical Center, Seoul, Korea. Anesth Analg. 2006 Dec;103(6):1444-7. 

 

背景:麻醉诱导期间异丙酚静脉注射引起疼痛。氯胺酮显示了可以降低注射痛。本研究我们建立了氯胺酮降低异丙酚注射痛的最佳剂量。方法:240例选择性外科手术患者随机分成8组;其中5组在研究的第一部分,另3组在研究的第二部分。部分一,各组患者在异丙酚2.5mg/kg注射前分别立即给NSS组),利多卡因(L组),氯胺酮10ug/kgK10组,50ug/kgK50组)或100ug/kgK100组)。部分二,在异丙酚注射前3min给最佳剂量氯胺酮(100ug/kg)(Pre组)、和氯胺酮混合注射(KP)、或在术前口服咪唑安定后给(M组)。由不知情的麻醉医生给患者每5秒钟进行一次注射痛评分。结果:第一部分,K100组和利多卡因组注射痛的发生率和疼痛强度最低(P<0.001)。第二部分,相对于KP组和Pre组,K100M组的疼痛评分明显降低(P<0.05)。诱导期间,各组平均脉压和心率没有显著差别。结论: 氯胺酮100ug/kg在异丙酚注射前立即给予是实时降低注射痛异丙酚注射痛的最佳剂量。

(吴德华译 薛张纲校)

BACKGROUND: I.v. injection of propofol during anesthetic induction induces pain. Ketamine has been shown to reduce injection pain. In this study, we established the optimal dose of ketamine to prevent the pain of injection with propofol. METHODS: Two hundred forty patients presenting for elective surgery were randomly allocated into eight groups; five groups during the first part of the study and three groups during the second part. In Part 1, patients received saline (Group S), lidocaine (Group L), ketamine 10 microg/kg (Group K10), 50 microg/kg (Group K50), or 100 microg/kg (Group K100), respectively, immediately followed by propofol 2.5 mg/kg. In Part 2, the optimal dose of ketamine (100 microg/kg) was administered 3 min before propofol (Group Pre), mixed with propofol solution (Group KP), or after oral midazolam premedication (Group M). An anesthesiologist blinded to the study group monitored each patient's pain score at 5-s intervals. RESULTS: In Part 1, the incidence and intensity of pain were the lowest in the K100 and L groups (P < 0.001). In Part 2, the patients in the K100 and M groups had significantly lower pain scores compared with the KP and Pre groups (P < 0.05). During induction, there were no significant intergroup differences in mean arterial blood pressure and heart rate in all groups. CONCLUSIONS: Administration of ketamine 100 microg/kg immediately before propofol injection provided the optimal dose and timing to reduce propofol-induced pain on injection.

 

 

脉压和体积描记态指数对低血压患者液体治疗反应性测试的比较:一项临试验

Arterial Versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial

Giuseppe Natalini, Antonio Rosano, Maria Taranto, Barbara Faggian, Elena Vittorielli, and Achille Bernardini

Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Poliambulanza Foundation Hospital, Brescia, Italy.

Anesth Analg 2006 103: 1478-1484.

 

该试验我们比较了由直接脉测压得到的呼吸相关性变异指数和由脉搏氧饱和度测得的体积描记指数,对于预测补液试验后心排量增的不同作用。我们对22名患者进行32次补液试验,这些患者均有肺脉导管监测。扩容前后分别记录血流学和体积描记数据。若心脏指数较基线值提高不足15%定义为无反应者。无反应者的脉脉搏变异和体积描记脉搏变异较有反应者均降低(前者[10 +/- 4]% vs [19 +/- 13]%, P = 0.020;后者[12 +/- 7]% vs [21 +/- 14]%, P = 0.034)。脉压和体积描记的脉搏变异收缩期变异均相似(前者ROC曲线下面积分别为0.74 vs 0.72P = 0.90;后者ROC曲线下面积分别为0.64 vs 0.72P = 0.50)。由脉和体积描记脉搏变异波形的改变收缩期变异的改变来鉴别无反应者(前者曲线下面积分别为0.80 vs 0.87,P = 0.40,后者曲线下面积分别为0.84 vs 0.80, P = 0.76)。对受试人群而言,体积描记且呼吸作用相关的血流学指数和直接测脉压对于预测液体治疗的反应性一样有效。体积描记指数为预测扩容后心排量的增提供了一种无创的方法。

(王丽君译 薛张纲校)

In the present study, we compared indices of respiratory-induced variation obtained from direct arterial blood pressure measurement with analogous indices obtained from the plethysmogram measured by the pulse oximeter to assess the value of these indices for predicting the cardiac output increase in response to a fluid challenge. Thirty-two fluid challenges were performed in 22 hypotensive patients who were also monitored with a pulmonary artery catheter. Hemodynamic and plethysmographic data were collected before and after intravascular volume expansion. Patients were classified as nonresponders if their cardiac index did not increase by 15% from baseline. Nonresponding patients had both lower arterial pulse variation ([10 +/- 4]% vs [19 +/- 13]%, P = 0.020) and lower plethysmographic pulse variation ([12 +/- 7]% vs [21 +/- 14]%, P = 0.034) when compared with responders. Fluid responsiveness was similarly predicted by arterial and plethysmographic pulse variations (area under ROC curve 0.74 vs 0.72, respectively, P = 0.90) and by arterial and plethysmographic systolic variation (area under ROC curve 0.64 vs 0.72, respectively, P = 0.50). Nonresponders were identified by changes in pulse variation both on arterial and plethysmographic waveform (area under ROC curve 0.80 vs 0.87, respectively, P = 0.40) and by changes in arterial and plethysmographic systolic variations (area under ROC curve 0.84 vs 0.80, respectively, P = 0.76). In the population studied, plethysmographic dynamic indices of respiratory-induced variation were just as useful for predicting fluid responsiveness as the analogous indices derived from direct arterial blood pressure measurement. These plethysmographic indices could provide a noninvasive tool for predicting the cardiac output increase by administering fluid.

 

 

体外自除颤器并不会受公共场所外界电磁场的影响而发生假阳性除击

Automated External Defibrillators Do Not Recommend False Positive Shocks Under the Influence of Electromagnetic Fields Present at Public Locations

Roman Fleischhackl, MD*{dagger}, Florian Singer, MD*, Bernhard Roessler, MD*{ddagger}, Jasmin Arrich, MD{dagger}, Sabine Fleischhackl, MD*, Heidrun Losert, MD{dagger}, Thomas Uray, MD{dagger}, Klemens Koehler, MD{dagger}, Fritz Sterz, MD{dagger}, Martina Mittlboeck, MSc, PhD, and Klaus Hoerauf, MD, PhD*{ddagger}

From the *Research Institute, Vienna Red Cross; Departments of {dagger}Emergency Medicine and {ddagger}Anaesthesia and Intensive Medicine; Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria.

Anesth Analg 2006 103: 1485-1488.

 

电磁场降低心电图的信号质量,会使得外部自除颤器出现误差。我们设计了这项关于AED设备在健康志愿者使用的随机、前瞻性研究。我们选择了繁忙的公共场所作为除颤的测试场所。强磁场在火车站和速、减速的火车旁被发现。主要的结果变量是奥地利经常使用的五项AED中的窦性心律的电击绝对量。对于数据分析,统计学家对于AED的模型试验是不知道的。数据分析基于实验设计每个方案的评估进行。在390例中没有一例假阳性发生。AED是安全的,甚至于在电磁场很强的火车站旁。

(韩晓丹译 薛张纲校)

Electromagnetic fields (EMF) reduce the signal quality of electrocardiograms and may lead to the misinterpretation by automated external defibrillators (AED). We designed this investigation as a prospective study, with a randomized sequence of AED applications on healthy volunteers. We chose busy public places where public access defibrillation was possible as test locations. Strong EMF were sought and found at train stations next to accelerating and decelerating trains. The primary outcome variable was the absolute number of shocks advised in the presence of sinus rhythm by five commonly used AED in Austria. For data analysis, the statistician was blinded in regard to the AED models tested. Data analysis was based on a per protocol evaluation. Of 390 tests run, 0 cases of false positive results occurred (95% CI: 0–0.77). AED can be regarded as safe, even with the interference of EMF present at train stations.

 

 

脓毒血症和感染性休克患者的血浆蛋白组改变

Changes in the Serum Proteome of Patients with Sepsis and Septic Shock

Armin Kalenka, MD*, Robert E. Feldmann, Jr, PhD{dagger}, Kevin Otero*, Martin H. Maurer, MD{dagger}, Klaus F. Waschke, MD*, and Fritz Fiedler, MD*

From the *Department of Anesthesiology and Critical Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany; and {dagger}Department of Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany.

Anesth Analg 2006 103: 1522-1526.

 

背景:脓毒血症依然是重症监室里最主要的致死原因。我们的目的是要阐明在第28天的幸存者(SURV)和非幸存者(NON-SURV)可能的早期血浆变化。

方法:我们应用蛋白质组术分析脓毒血症和感染性休克患者的血浆样本。18名脓毒血症和感染性休克患者的血浆样本在断后第一个12小时内就被收集。在第28天患者被分为幸存者组和非幸存者组。

结果:7名患者幸存,11名患者死亡。使用蛋白质组分析方法,双向凝胶电泳检测到每块凝胶大于200点。在幸存者和非幸存者组间发现一个差异蛋白表达,透露了为何蛋白变更仍未在脓毒血症中被描述。

结论:我们的结果显示蛋白质组描述是一项检测脓毒血症患者蛋白表达学的有用方法,与单独的遗传研究相比,可以使我们更接近于完成综合的分子描述。

(周 荻译 薛张纲校)

BACKGROUND: Sepsis is still the leading cause of death in the intensive care unit. Our goal was to elucidate potential early differences in serum between survivors (SURV) and non-survivors (NON-SURV) on day 28.

METHODS: We applied proteomic technology to serum samples of patients with sepsis and septic shock. Serum samples from 18 patients with sepsis and septic shock were obtained during the first 12 h after diagnosis of septic shock. Patients were grouped into SURV and NON-SURV on day 28.

RESULTS: Seven patients survived and 11 patients died. Using proteome analysis, two-dimensional gel electrophoresis detected more than 200 spots per gel. A differential protein expression was discovered between SURV and NON-SURV, whereby protein alterations not yet described in sepsis were revealed.

CONCLUSIONS: Our results show that proteomic profiling is a useful approach for detecting protein expression dynamics in septic patients, and may bring us closer to achieving a comprehensive molecular profiling compared with genetic studies alone.

临产妇女行腰硬联合麻醉同单次腰麻相比不能获得更高位的感觉神经阻滞

Combined Spinal Epidural Does Not Cause a Higher Sensory Block than Single Shot Spinal Technique for Cesarean Delivery in Laboring Women (Brief Report)

Yvonne Lim, Wendy Teoh, and Alex T. Sia

Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.

Anesth Analg 2006 103: 1540-1542.

 

研究背景:已有道指出,择期行剖宫产的妇女采用腰硬联合麻醉可获得比同等剂量单次腰麻更高位的感觉阻滞。我们想证实在不同硬膜外压的产妇中,此说法是否正确。方法:随机选择40ASAI级确定行剖宫产的临产妇入组双盲试验。S组(n=20)鞘内行单次腰麻注射2ml0.5%的高比重布比卡因,CS组(n=20)行腰硬联合麻醉注射同等剂量高比重布比卡因。结果:我们发现两组完成了相似的最高感觉阻滞平面(S组:平均胸3,最低胸6,最高胸1CS组:平均胸3,最低胸4,最高颈7P=0.517)。结论:同之前的非临产产妇的道相比,我们的研究发现,腰硬联合麻醉在临产妇行剖宫产中的阻滞特性与单次腰麻相比无差别。

(王慧琳译 薛张纲校)

BACKGROUND: The combined spinal epidural (CSE) technique has been shown to result in a higher sensory block than an equivalent single shot spinal (SSS) in women undergoing elective cesarean delivery. We tested whether this is true also in laboring women who may have variable epidural pressures. METHODS: We randomized 40 ASA I parturients in established labor for cesarean delivery into our double-blind study. Group S (n = 20) intrathecally received 2 mL of 0.5% hyperbaric bupivacaine by SSS and group CS received CSE (n = 20) of an equivalent dose of hyperbaric bupivacaine. RESULTS: We found that similar maximal sensory blocks were achieved in both groups (group S: median T3 [min-max] T6-1 versus group CS: median T3 [min-max] T4-C7, P = 0.517). CONCLUSION: As compared with previous reports in nonlaboring parturients, the block characteristics of CSE in our study were indistinguishable from those of SSS in laboring parturients for cesarean delivery.

 

 

神经细胞粘附分子体阻断冷水漂浮应激诱导的镇痛效应和淋巴细胞与培养背根神经神经元间的细胞粘附

The neural cell adhesion molecule antibody blocks cold water swim stress-induced analgesia and cell adhesion between lymphocytes and cultured dorsal root ganglion neurons

Hua S, Hermanussen S, Tang L, Monteith GR, Cabot PJ

The School of Pharmacy, The University of Queensland, 4072, Queensland, Australia

Anesth Analg. 2006 Dec;103(6):1558-64

 

背景:阿片封闭的免疫细胞以定向方式迁移到炎性组织并附着于感觉神经纤维。这些细胞在非常接近这些纤维时放阿片肽,从而避免了在局部被肽酶降解,并将阿片肽传递至阿片受体而发挥伤害感受效应。方法:神经细胞粘附分子(anti-NCAM)的这种效应是通过在弗氏佐剂诱发足部炎症的Wistar大鼠中采用冷水漂浮应激诱导的伤害感受来评估的。同时对热和机械刺激进行镇痛测评。细胞粘附试验检测了β内啡呔和NCAM体的效应,细胞间粘附分子-1作用于培养背根神经神经元和离体淋巴细胞。将钙黄绿素标记至新鲜离体淋巴细胞的荧光法来确定淋巴细胞粘合。结果:NCAM制淋巴细胞和培养感觉神经元间的直接粘合。这种粘合也被证实为阿片依赖性——在1微克β内啡呔存在下,淋巴细胞与培养感觉神经元的粘合被制,而可被100微克纳洛酮逆转。此外,NCAM阻断了热和机械刺激导致的足部炎症中的冷水漂浮诱导的镇痛效应。然而NCAM并不影响太尼诱导的伤害感受效应。结论:这项研究提供了淋巴细胞粘附感觉神经元中细胞粘附分子作用的深入观察与免疫相关伤害感受的联系。

(徐丽颖译 薛张纲校)

BACKGROUND: Opioid-containing immune cells migrate in a site-directed manner into inflamed tissue and adhere to sensory nerve fibers. These cells release opioid peptides in close proximity to these fibers, thereby avoiding localized degradation by peptidases, and delivering opioid peptides proximal to opioid receptors to provide antinociception. METHODS: The effects of the anti-neural-cell-adhesion molecule (anti-NCAM) were assessed on cold water swim stress-induced antinociception in Wistar rats with Freund's adjuvant-induced inflammation of one hindpaw. Algesiometry was assessed for both thermal and mechanical stimuli. Cell adhesion experiments examining the effects of beta-endorphin and antibodies to NCAM and intercellular cell adhesion molecule-1 and were performed on cultured dorsal root ganglion neurons and isolated lymphocytes. Lymphocyte binding was determined by fluorescence using calcein AM loaded into freshly isolated lymphocytes. RESULTS: The direct adhesion between lymphocytes and cultured sensory neurons was inhibited by anti-NCAM. This adhesion was also demonstrated to be opioid dependent, with lymphocyte adhesion to cultured sensory neurons reduced in the presence of 1 microM beta-endorphin, which was reversed by 100 microM naloxone. Moreover, anti-NCAM blocked cold-water-swim-induced analgesia in inflamed paws both to thermal and mechanical stimuli. However, anti-NCAM did not affect fentanyl-induced antinociception. CONCLUSIONS: This study provides insight into the role of cell adhesion molecules in lymphocyte adhesion to sensory neurons and a link to immune-derived antinociception.

 

 

通过磁共振定位锁骨下臂丛神经阻滞时离臂丛三支最近的最佳解剖位置

Use of Magnetic Resonance Imaging to Define the Anatomical Location Closest to All Three Cords of the Infraclavicular Brachial Plexus

Axel R. Sauter, MD*, Hans-Jørgen Smith, DMSc{dagger}{ddagger}, Audun Stubhaug, DMSc*, Michael S. Dodgson, FRCA, and Øivind Klaastad, DMSc

From the *Department of Anesthesiology, Rikshospitalet (Faculty Division), University of Oslo, Norway; {dagger}Department of Radiology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway; {ddagger}Department of Radiology, University of Oslo, Norway; and Department of Anesthesiology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.

Anesth Analg 2006 103: 1574-1576.

 

锁骨下径路经常用来做臂丛神经阻滞。我们在志愿者身用磁共振成像来区别单侧矢面臂丛神经阻滞时的臂丛神经和腋下血管。20个志愿者中,臂丛神经各支定位于离腋脉2cm以内,大约占圆形腋鞘的2/3。我们得出一个离臂丛各支最近的注射点位,针尖指向头端后侧并于脉相邻。我们得出结论,本研究可能对在超声引导下锁骨下进路臂丛神经阻滞的有帮。然而,我们的建议还需要进一步的临研究证实。

(吴德华译 薛张纲校)

Infraclavicular techniques are often used to perform brachial plexus blocks. In our volunteer study we used magnetic resonance imaging to identify the brachial plexus and axillary vessels in a sagittal plane corresponding to the lateral sagittal infraclavicular block. In 20 volunteers, all cords were positioned within 2 cm from the artery approximately within 2/3 of a circle. We derived an injection site that was closest to all cords, cranio-posterior and adjacent to the axillary artery. We conclude that this knowledge may be useful for the performance of infraclavicular blocks aided by ultrasound. However, our proposals should be tested by clinical studies.

 

体外循环期间的温度:监测部位之间的差异

Temperature During Cardiopulmonary Bypass: The Discrepancies Between Monitored Sites

Nancy A. Nussmeier, MD*{dagger}, Weiping Cheng, MD{ddagger}, MariaRosa Marino, MD, Tyler Spata, BS*, Shu Li, MD*, Gaile Daniels*, Trevor Clark, AS*, and William K. Vaughn, PhD||

From the *Division of Cardiovascular Anesthesiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas; {dagger}Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; {ddagger}Department of Anesthesiology, Fu Wai Cardiovascular Hospital and Peking Union Medical College, Beijing, China; Department of Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy; and ||Division of Biostatistics and Epidemiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas.

Anesth Analg 2006;103:1373-1379

 

我们对患者进行研究以确定在低温体外循环期间通常的监测部位的体温记录是否充分反映脑部温度。研究I(n = 12)中,在颈静脉球监测的温度与鼻咽、食道、膀胱、和直肠中记录的温度比较。研究II(n = 30)中,在膜型氧合器的脉输出口也监测体温。一个校准的记录仪持续地同时记录所有的温度。研究I发现在降温和复温期间颈静脉球和所有其他身体部位的温度之间有较大的差异。颈静脉球和其他身体部位之间的温度差异程度有相当的个体变异。研究II产生相同的结果,也显示在降温3.3 ± 1.3 min后和复温16.5 ± 5.5 min后颈静脉球温度与通过膜型氧合器的脉输出口进入患者体内的血液温度达到平衡。方差分析显示脉输出口是所有监测部位中相对于颈静脉球平均差异最小的(P < 0.001)。总之,体温监测在降温期间高估了颈静脉球的温度,而在复温期间又低估了。而脉输出口血液温度提供了一个较好的近似值。

(彭中美 马皓琳 李士通 校)

We performed studies in patients to determine whether temperature recordings from sites commonly monitored during hypothermic cardiopulmonary bypass adequately reflect cerebral temperature. In Study I (n = 12), temperatures monitored in the jugular bulb (JB) were compared with those recorded in the nasopharynx, esophagus, bladder, and rectum. In Study II (n = 30), temperature was also monitored in the arterial outlet of the membrane oxygenator. A calibrated recorder continuously and simultaneously recorded all temperatures. Study I found large temperature discrepancies between the JB and all other body sites during cooling and rewarming. There was considerable interindividual variability in the degree of discrepancy between the JB and other sites. Study II produced similar results but also showed that JB temperature reached equilibration with the temperature of blood entering the patient via the arterial outlet of the membrane oxygenator after cooling for 3.3 ± 1.3 min and after rewarming for 16.5 ± 5.5 min. Analysis of variance revealed that this arterial outlet site had the smallest average discrepancy of all temperature sites relative to the JB site (P < 0.001). In summary, temperatures measured in body sites over-estimated JB temperature during cooling and under-estimated it during rewarming, whereas arterial outlet blood temperature provided a good approximation.

 

 

心肺转流中气道中性粒细胞介导的免疫应答激活

Activation of a Neutrophil-Derived Inflammatory Response in the Airways During Cardiopulmonary Bypass

Toru Kotani, MD*, Yoshifumi Kotake, MD{dagger}, Hiroshi Morisaki, MD{dagger}, Junzo Takeda, MD{dagger}, Hideyuki Shimizu, MD{ddagger}, Toshihiko Ueda, MD{ddagger}, and Akitoshi Ishizaka, MD

From the *Department of Anesthesiology, Tokyo Women's Medical University, Shinjuku, Tokyo 162-8666, Japan; and Department of {dagger}Anesthesiology, {ddagger}Cardiovascular Surgery, and Medicine, Keio University School of Medicine, Tokyo, Japan.

Anesth Analg 2006;103:1394-1399

心肺转流(CPB)被认为会导致术后肺能障碍。为更严密地检测CPB过程中发生在气道内的炎症性过程,我们在新的支气管镜微量试样探针的辅下,连续检测了11名行主脉弓脉瘤修补术的病人的炎性介质。麻醉诱导后、肺再灌注即刻和术毕三个时点进行皮细胞衬液(ELF)和脉血同时取样。结果发现术毕脉血氧分压/吸入氧分压比值下降(P0.029)。尽管术毕ELF中白介素(IL)-8IL6和中性粒细胞弹性蛋白酶浓度明显升高(中位数分别=23,200181812,900 µg/mL,但于低氧血症程度无相关性。在肺再灌注时点,中性粒细胞弹性蛋白酶浓度明显升高,早于IL8IL6,且与输血无相关性。术毕ELFIL6浓度与总输血量相关({rho}

 
= 0.731, P = 0.011)。这些结果提示在CPB早期中性粒细胞介导的免疫应答被激活.

(邱郁薇 马皓琳 李士通 校)

Cardiopulmonary bypass (CPB) is believed to cause postoperative lung dysfunction. To more closely examine the inflammatory processes occurring in the airways during CPB, we serially measured inflammatory mediators, with the assistance of a new bronchoscopic microsample probe, in 11 patients undergoing repair of aortic arch aneurysms. Epithelial lining fluid (ELF) and arterial blood were sampled simultaneously after induction of anesthesia, at the time of pulmonary reperfusion, and at the end of surgery. A decrease in the Pao2/Fio2 ratio was observed at the end of surgery (P = 0.029). Although the ELF concentrations of interleukin (IL)-8, IL-6, and neutrophil elastase had increased significantly at the end of surgery (median = 23,200, 1818, and 12,900 µg/mL, respectively), they did not correlate with the degree of hypoxemia. Neutrophil elastase increased significantly at the time of pulmonary reperfusion, before IL-8 and IL-6, and independently of blood transfusions. At the end of surgery, IL-6 in ELF correlated with total blood transfusion volume ({rho} = 0.731, P = 0.011). These results indicate that a neutrophil-derived inflammatory response is activated in the airway in the early phase of CPB.

 

 

超声引导下外周神经置管连续神经阻滞的门病人的管理:620例病人的处理经验

Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Jeffrey D. Swenson, MD*, Nathan Bay, MD*, Evelyn Loose, MD*, Byron Bankhead, MD*, Jennifer Davis, MD*, Timothy C. Beals, MD{dagger}, Nathaniel A. Bryan, MD{dagger}, Robert T. Burks, MD{dagger}, and Patrick E. Greis, MD{dagger}

From the Departments of *Anesthesiology, Health Science Center and {dagger}Orthopaedic Surgery, Orthopaedic Center, University of Utah, Salt Lake City, UT.

Anesth Analg 2006;103:1436-1443

背景:连续外周神经阻滞(CPNB)是整形术后镇痛的最佳选择,但因为担心可能会发生与导管有关的并发症,并不常地用于门病人。而且,在这种情况下病人可能难以与医生进行方便的沟通。我们研究了用事先制订好试验方案施行的CPNB治疗的620名门病人。

方法:所有的置管均在超声直接显像下进行。这些患者接受了充分的口头和书面的术前指导,并且在术后阶段可以便利地与麻醉医生进行连续的电话交流。术后第一天,所有的病人均在家里接受了电话联系。而且,每位病人在出院2周内均看过外科医生,并被检查过。

结果:在620名患者中,有190名是肌间沟(臂丛),206名髂筋膜(股神经),224名腘窝(坐骨神经)置管。2名患者(0.3%)发生了与神经阻滞有关的并发症。这两名患者均在手术后6周内症消退。26名患者(4.2%)术后要求麻醉医生术后干预。1名患者回到医院要求拔除导管。

结论:在用CPNB处理的大样本的门病人中,让人讶的是,极少需要麻醉医生的干预。同样,患者们能够可以在不需要额外随访地在家里管理并且拔除导管。这就表示,在有足够的指导和与卫生保健人员的电话联络后,患者们可以在家中很舒适地管理并且拔除CPNB导管。

(黄丽娜 马皓琳 李士通 校)

BACKGROUND: Continuous peripheral nerve block (CPNB) is an optimal choice for analgesia after orthopedic procedures, but is not commonly used in outpatients because of concern regarding the possibility of catheter-related complications. In addition, it may be difficult to provide adequate patient access to physicians in this setting. We present 620 outpatients who were treated with CPNB using an established protocol.

METHODS: All catheters were placed using direct ultrasound visualization. These patients received extensive oral and written preoperative instruction and were provided continuous telephone access to the anesthesiologist during the postoperative period. All patients were also contacted at home by telephone on the first postoperative day. In addition, each patient was seen and examined by the surgeon within 2 wk of hospital discharge.

RESULTS: Of the 620 patients, there were 190 interscalene (brachial plexus), 206 fascia iliaca (femoral nerve), and 224 popliteal fossa (sciatic nerve) catheters. Two patients (0.3%) had complications related to the nerve block. In both of these patients, the symptoms resolved within 6 wk of surgery. Twenty-six patients (4.2%) required postoperative interventions by the anesthesiologist. One patient returned to the hospital for catheter removal.

CONCLUSIONS: In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.

 

 

运阻滞浓度的异氟醚与丙酚在神经元终结具有相似的效果

Isoflurane and Propofol Have Similar Effects on Spinal Neuronal Windup at Concentrations that Block Movement

Kevin P. Ng, MD, and Joseph F. Antognini, MD

From the Department of Anesthesiology and Pain Medicine, University of California, Davis, California.

Anesth Analg 2006;103:1453-1458

背景:我们研究了异氟醚和丙酚在完整老鼠髓中神经元终结的作用。我们假设丙酚会比异氟醚制终结效果更强。

方法:在交叉设计实验中,老鼠分别给予0.81.2最小肺泡浓度(MAC)的异氟醚0.81.2 ED50(有效剂量50%)的丙酚,记录来自腰椎神经后根索的单个单位的信息。(n = 13)。分别给予0.113 Hz20次电刺激。分析来自C纤维范围(每次刺激后100–400 ms )C纤维与后发放混合范围(100–1000 ms)3Hz刺激下100–333 ms范围的神经元反应。绝对的终结也会被记算(20个刺激的作电位总和-对第一个刺激的20倍反应)。

结果:1Hz时,异氟醚(0.81.2 MAC)所有的由20次刺激(100–1000 ms 范围)总计的作电位(平均值,标准误)分别为571 ± 106 742 ± 214,丙酚(0.8 1.2 ED50)分别为586 ± 148 641 ± 143 (P = NS) 0.1 Hz刺激相对应的值为345 ± 104370 ± 108430 ± 86403 ± 106 (P = NS)3Hz(100–333 ms范围)266 ± 66333 ± 76343 ± 85、和252 ± 72 (P = NS)1Hz1.2 MAC异氟醚在100–1000 ms范围的绝对终结要高于0.8 MAC 异氟醚和0.8 1.2 ED50 的丙酚 (分别为232 ± 3188 ± 65210 ± 41)

结论:这些数据表明,异氟醚与丙酚在髓中的神经元终结有相似效果,虽然在1.2 MAC异氟醚下对1 Hz 刺激产生的绝对终结较强。.

(胡湘译 马皓琳 李士通校)

BACKGROUND: We investigated the actions of isoflurane and propofol on neuronal windup in the spinal cord of intact rats. We hypothesized that propofol would depress windup more than isoflurane.

METHODS: In a cross-over design, rats received 0.8 and 1.2 minimum alveolar concentration (MAC) isoflurane and 0.8 and 1.2 ED50 (effective dose50%) of propofol, as recordings were made from single units in the lumbar cord (n = 13). Electrical stimuli were applied (20 stimuli at 0.1, 1, and 3 Hz). Neuronal responses were analyzed for those occurring in the C-fiber range (100–400 ms after each stimulus), combined C-fiber and afterdischarge range (100–1000 ms) and the 100–333 ms range for the 3 Hz stimuli. Absolute windup was also calculated (the sum of action potentials for 20 stimuli – 20 x response to the first stimulus).

RESULTS: At 1 Hz, total action potentials (mean, standard error) summed across the 20 stimuli (100–1000 ms range) were 571 ± 106 and 742 ± 214 for isoflurane (at 0.8 and 1.2 MAC) and 586 ± 148 and 641 ± 143 for propofol (at 0.8 and 1.2 ED50), respectively (P = NS); corresponding values for the 0.1 Hz stimuli were 345 ± 104, 370 ± 108, 430 ± 86, and 403 ± 106 (P = NS), and for the 3 Hz stimuli (100–333 ms range) were 266 ± 66, 333 ± 76, 343 ± 85, and 252 ± 72 (P = NS). Absolute windup in the 100–1000 ms range was greater for 1.2 MAC isoflurane at 1 Hz (445 ± 82, P < 0.01), when compared with absolute windup at 0.8 MAC isoflurane and 0.8 and 1.2 ED50 propofol (232 ± 31, 88 ± 65, and 210 ± 41, respectively).

CONCLUSIONS: These data suggest that isoflurane and propofol have similar effects on neuronal windup in the spinal cord, although there was enhanced absolute windup at 1.2 MAC isoflurane for the 1 Hz stimulus.

 

 

监测脑电双频指数或频谱熵能否减少七氟醚用量

Does Monitoring Bispectral Index or Spectral Entropy Reduce Sevoflurane Use?

Isabelle Aimé, MD, Nicolas Verroust, MD, Cécile Masson-Lefoll, MD, Guillaume Taylor, MD, Pierre-Antoine Laloë, MD, Ngai Liu, MD, and Marc Fischler, MD

From the Department of Anesthesiology, Hôpital Foch, Suresnes, France; and Faculté de Médecine, Université Paris Ile-de-France Ouest, France.

Anesth Analg 2006;103:1469-1477

已证实使用脑电双频指数(BIS)可减少吸入麻醉药的消耗量,但还缺少频谱熵方面的数据。将140位预定行持续1小时以手术的成年病人预先随机分组,分别接受由BIS或频谱熵或仅仅临变量控制的麻醉。用异丙酚苏太尼进行麻醉诱导。此后持续输注苏太尼。在1 L/min O2/N2O中给予七氟醚。在标准操作组根据常规的临变量来调七氟醚浓度,而BIS频谱熵指导组控制在40-60区间。七氟醚挥发罐在麻醉前后分别称重,并计算消耗量。除体重外,组间的一般情况有可比性(谱熵指导组较重,P < 0.05)。与标准操作组相比,使用BIS或频谱熵监测的病人七氟醚的需要量减少29%(根据病人的体重麻醉持续时间标准化的七氟醚消耗量,P < 0.03),太尼量相似。在标准操作组观察到一种无意的改善(正性偏倚)。结论:BIS频谱熵监测对七氟醚有相同的省效应。

(裘毅敏译,马皓琳 李士通校)

A decrease in volatile anesthetic consumption has been demonstrated using bispectral index (BIS), whereas data concerning spectral entropy are lacking. One hundred and forty adult patients scheduled for surgical procedures lasting more than 1 h were prospectively randomized to receive an anesthetic controlled either by BIS or by spectral entropy or solely by clinical variables. Anesthesia was induced with propofol and sufentanil. Sufentanil was infused continuously thereafter. Sevoflurane was administered in 1 L/min O2/N2O. The sevoflurane concentration was adjusted according to conventional clinical variables in the standard practice group, whereas the 40–60 interval was applied for the BIS and spectral entropy-guided groups. The sevoflurane vaporizer was weighed before and after anesthesia, and consumption was calculated. Groups were comparable for demographic data except for weight (heavier in the spectral entropy-guided group, P < 0.05). Compared with standard practice, patients with BIS or spectral entropy monitoring required 29% less sevoflurane (normalized sevoflurane consumption to the weights of the patients and to the durations of anesthesia; both P < 0.03) and a similar sufentanil dose. An unintended improvement in the standard practice group (positive bias) was observed. In conclusion, BIS and spectral entropy monitoring have the same sparing effect of sevoflurane.

 

 

为改良围术期生素药而重新设计的一项新制度和程序

A System and Process Redesign to Improve Perioperative Antibiotic Administration

Gary Kanter, MD, Neil Roy Connelly, MD, and Jan Fitzgerald, RN, MS

From the Department of Anesthesiology and Division of Healthcare Quality, Baystate Medical Center, Springfield, Massachusetts.

Anesth Analg 2006;103:1517-1521

外科感染是造成患者损伤、死亡和医疗费用过多的一个主要原因。集思广后,我们制定了围术期生素药的三大焦点:生素的合理选择、在切皮前60分钟内给予生素、预防性生素在术后24小时内停药。麻醉医师被认定为最可能在切皮前60分钟内完成生素成给予的参与者其中。药顺序、说明、生素制备有所变化。对所有与会的手术室工作人员和器械巡回都进行宣教。显著地显示结果,并提供反馈。合理生素选择的基线从82%提高到现在的95%。干预前的药-切皮时间是79(范围32380)分钟,其中有11%在药后60分钟内切皮。当前的药-切皮的时间在19(范围095)分钟,在60分钟内的数量占了95%。建立该程序前,手术部位感染率为3.8%,而现在则大约为1.4%。我们描述了用以改良生素药的我们的这种程序。在此期间,手术部位感染率显著降低。

(唐李隽 马皓琳 李士通 校)

Surgical infection is a leading cause of patient injury, mortality, and excess health care costs. As part of a collaborative effort, we instituted three main focuses for perioperative antibiotic administration: appropriate selection of antibiotics, administration of antibiotics within 60 min before incision, and discontinuation of prophylactic antibiotics within 24 h of surgery. Anesthesiologists were identified as the practitioners most likely to accomplish the successful administration of antibiotics within 60 min before incision. Changes were made in ordering, documentation, and antibiotic preparation. Education was provided to all operating room staff at meetings and grand round presentations. Results were prominently displayed, and feedback was provided. The baseline appropriate antibiotic selection was 82% and is now 95% The preintervention administration-incision time was 79 (range, 32–380) min, with 11% within the 60 min before incision. The administration-incision time is currently 19 (range, 0–95) min, and the number within 60 min is 95%. Before the institution of the process, the rate of surgical site infections was 3.8%, and is now approximately 1.4%. We describe our process used to improve antibiotic administration. During this time, the surgical site infection rate has been significantly reduced.

 

 

试验剂量利多卡因对产程早期硬膜外给予新斯的明和舒太尼合液后镇痛运能的影响

The Effect of a Lidocaine Test Dose on Analgesia and Mobility After an Epidural Combination of Neostigmine and Sufentanil in Early Labor

Fabienne Roelants, MD, Valérie Mercier-Fuzier, MD, and Patricia M. Lavand’homme, MD, PhD

From the Department of Anesthesiology, Université Catholique de Louvain, St. Luc Hospital, Brussels, Belgium.

Anesth Analg 2006;103:1534-1539

我们以前阐述过硬膜外舒太尼和胆碱脂酶制剂新斯的明产生择期分娩镇痛的有效性。因为传统的利多卡因肾腺素的试验剂量可能改变后续硬膜外药物的药效,我们进行这个研究以衡量利多卡因试验剂量对产程早期硬膜外新斯的明和舒太尼合液产生的镇痛效果的影响。80位健康产妇随机分为两组,接受:2%利多卡因和1:200,000肾腺素合液或生理盐水和1:200,000肾腺素合液的3ml试验剂量,三分钟后给予硬膜外新斯的明500µg舒太尼10µg。注药后30min记录疼痛评分和初始单剂量后要求额外镇痛的时间。通过产妇坐、站立、屈膝和行走能评估注药后30min的运能。试验剂量利多卡因速了硬膜外新斯的明和舒太尼合液单剂量注射产生的镇痛的起效(5 min vs 15 min)并延长了持续时间(122 ± 53 min vs 98 ± 54 min; P = 0.02)。相反,试验剂量并没有显著弱坐、站立或者屈膝的能。然而,行走的能却减弱(57% vs 82%; P = 0.04)。总之,传统的利多卡因试验剂量可以显著增分娩早期硬膜外新斯的明和利多卡因合液的镇痛效果,但是将影响行走能。

(黄佳佳 译,马皓琳 李士通 校)

We previously demonstrated the effectiveness of epidural sufentanil and the cholinesterase inhibitor, neostigmine, to initiate selective labor analgesia. Because the traditional lidocaine plus epinephrine test dose (TD) may alter the effect of subsequent epidural drugs, we undertook this investigation to evaluate the impact of a lidocaine TD on analgesia from a combination of epidural neostigmine plus sufentanil administered in early labor. Eighty healthy parturients were randomly allocated to two groups to receive a 3 mL-TD, either lidocaine 2%–epinephrine (1:200,000) or saline–epinephrine (1:200,000), followed 3 min later by epidural neostigmine 500 µg plus sufentanil 10 µg. Pain scores were recorded for 30 min after injection, as was the time elapsed from initial bolus until request for supplemental analgesia. Thirty minutes after injection, adequacy of motor function was evaluated by the parturient’s ability to sit, stand up, bend her knees, and walk. Lidocaine TD hastened the onset (5 min vs 15 min) and increased duration (122 ± 53 min vs 98 ± 54 min; P = 0.02) of analgesia from epidural neostigmine plus sufentanil bolus. In contrast, the TD did not significantly impair the ability to sit, stand up, or bend the knees. The ability to ambulate, however, was reduced (57% vs 82%; P = 0.04). In conclusion, a traditional lidocaine TD significantly enhances the analgesic effect from the epidural neostigmine plus sufentanil combination, but affects ambulation in early labor.

 

 

术中输注氨基酸引起合成代谢与麻醉方式无关

Intraoperative Infusion of Amino Acids Induces Anabolism Independent of the Type of Anesthesia

Francesco Donatelli, MD*, Thomas Schricker, MD, PhD*, Piervirgilio Parrella, SD{dagger}, Francisco Asenjo, MD*, Linda Wykes, PhD{ddagger}, and Franco Carli, MD, MPhil*

From the *Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada; {dagger}Department of Cardiac Surgery, Ospedali Riuniti di Bergamo, Bergamo, Italy; and {ddagger}School of Dietetics and Human Nutrition, McGill University, MacDonald Campus, Montreal, Quebec, Canada.

Anesth Analg 2006;103:1549-1556

背景:接受硬膜外复合浅全麻或单纯全麻的患者输注葡萄糖不能形成正蛋白质平衡。我们试图证实与全麻相比,接受硬膜外阻滞的患者静注氨基酸进行营养支持可产生更明显的蛋白质平衡。

方法:16例患者随机分组,分别接受地氟醚全麻(对照组)或全麻复合硬膜外镇痛(EDA组)。术前禁食32h之后开始预先恒定输注稳定的同位素示踪剂l-[1-13C]亮氨酸和[6,6-2H2]葡萄糖(3h禁食态),并且在术中持续3h在此期间静脉输注氨基酸(进食态)。

结果:与禁食态相比,亮氨酸出现的内生速率下降程度两组间相似,而蛋白合成增,两组间亦无差别。两组的亮氨酸氧化均未发生改变。输注氨基酸之后内源性葡萄糖生成保持不变,但两组葡萄糖清除均减少。血糖、血浆皮质醇、血清胰岛素和胰高血糖素的浓度升高程度在两组间相同。

结论:硬膜外麻醉对氨基酸引起的合成代谢无额外处。

(黄施伟 译,马皓琳 李士通校)

BACKGROUND: The infusion of dextrose in patients receiving epidural and light general anesthesia or general anesthesia alone failed to achieve a positive protein balance. We sought to verify the hypothesis that nutritional supplementation with IV amino acids induced a greater protein balance in patients receiving epidural blockade compared with those receiving general anesthesia.

METHODS: Sixteen patients were randomly assigned to receive either general anesthesia with desflurane (control group) or general anesthesia combined with epidural analgesia (EDA group). A primed constant infusion of stable isotope tracers l-[1-13C]leucine and [6,6-2H2]glucose was started after a 32-h fast before surgery, (3 h of fasted state), and continued for 3 h during surgery during which amino acids were infused IV (fed state).

RESULTS: Compared with the fasted state, the endogenous rate of appearance of leucine decreased to a similar extent in both groups, and protein synthesis increased, with no difference between the two groups. Leucine oxidation did not change in either group. After amino acids infusion, endogenous glucose production remained unchanged and glucose clearance decreased in both groups. Blood glucose, plasma cortisol, serum insulin, and glucagon concentrations increased to the same extent in both groups.

CONCLUSIONS: Epidural anesthesia provided no additional benefit beyond the anabolism obtained with amino acids.

 

 

腘窝处坐骨神经的后路阻滞:比较单次和两次注射法

The Posterior Approach to the Sciatic Nerve in the Popliteal Fossa: A Comparison of Single- Versus Double-Injection Technique

Xavier March, MD*, Olga Pineda, MD*, Maria M. Garcia, PhD{dagger}, Dolores Caramés, MD*, and Antonio Villalonga, PhD*

From the *Servei d’Anestèsia, Reanimació i Terapèutica del Dolor and {dagger}Institut de Investigació Biomédica de Girona, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.

Anesth Analg 2006;103:1571-1573

在前瞻性、随机、单盲研究中,我们对足部和踝部手术病人,在神经刺激器的引导下从腘窝后路用1%甲哌卡因阻滞坐骨神经,比较单次或两次注射,以评价有效性、起效时间和并发症。在单次注射组(S, n=30),神经刺激器激发足内翻或跖屈后给予1%甲哌卡因25mL。在两次注射组(D, n=30),足外翻和背屈后注射12.5mL的溶液,足跖屈后再给予12.5mL。除了两组腓浅神经阻滞的起效时间(组S和组D分别为18 [13] min11.4 [7.5] minP < 0.05)和组D腓浅神经和胫神经阻滞的起效时间之间(分别为11.4 [7.5] min22.3 [11.3] minP < 0.05)有显著差异以外,两组感觉神经完全阻滞的平均起效时间(标准差)没有显著性差异(21.9 [14.2] min vs 22.1 [13.8] min)。组S病人有77%达到完全镇痛,组D病人87%完全镇痛(P = 0.22)。组S和组D 腓深神经达到完全镇痛的比例为80%97%(P < 0.05)。阻滞过程中组D发生异感更多见(17% vs 40%) (P < 0.05)。我们得出结论,坐骨神经的两次神经刺激引导的阻滞的起效时间和成率,与单次神经刺激相仿,在阻滞操作过程中异感更多见。

(张莹 马皓琳 李士通校)

We compared single-injection and double-injection of the sciatic nerve with nerve stimulation in the posterior popliteal approach using mepivacaine 1% in a prospective, randomized and single-blind study to evaluate effectiveness, delay of onset, and complications in patients undergoing foot and ankle surgery. In the single-injection group (Group S, n = 30), 25 mL of mepivacaine 1% was administered after eliciting foot inversion or plantar flexion. In the double-injection group (Group D, n = 30), 12.5 mL of the solution was injected after eversion or dorsiflexion and 12.5 mL after plantar flexion of the foot. Mean differences (sd) between the two groups from onset time to complete sensory block were not significant (21.9 [14.2] min vs 22.1 [13.8] min) except for the superficial peroneal nerve block (18 [13] min vs 11.4 [7.5] min, Group S and D, respectively; P < 0.05) and, in Group D, between the superficial peroneal and tibial nerve blocks (11.4 [7.5] min vs 22.3 [11.3] min, respectively; P < 0.05). Complete analgesia was achieved in 77% of Group S patients and in 87% of Group D (P = 0.22). Complete analgesia of the deep peroneal nerve was achieved in 80% and 97% in Group S and D, respectively; P < 0.05. There were more paresthesias during block procedure in Group D (17% vs 40%) (P < 0.05). We conclude that double-nerve stimulation of the sciatic nerve gives similar complete onset times and overall success rate to single-nerve stimulation and more paresthesias during block performance.