Anesthesia & Analgesia

 

December 2006

Table of Content

 

CARDIOVASCULAR ANESTHESIA:

體外迴圈期間的溫度:監測部位¥間的差異

(彭中美 馬皓琳 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.

比較單側與雙側¥內動脈移植對術後縱隔引流量輸液量的影響

( 琳譯 薛張綱校)

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.

圍術期靜脈輸注氨基酸促進非體外迴圈冠狀脈搭橋術後患者的康復縮短住院時間

(印傑敏 陳傑 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.

心肺轉流中氣道中性粒細胞介導的免疫應答啟動

(邱鬱薇 馬皓琳 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調亡蛋白p53使異氟醚誘導的心臟保護閾下移

(孫敏莉譯 薛張綱校)

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:

 

需要麻醉的擇期小兒手術的日程安排:父母的看法

(張美榮 陳傑 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:

超聲引導下外周神經置管連續神經阻滯的門診病人的管理:620例病人的處理經驗

(黃麗娜 馬皓琳 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.

小量氯胺酮降低異丙酚注射痛.

(吳德華譯 薛張綱校)

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:

術前用退黑激素類藥物對異丙酚和硫賁妥鈉麻醉誘導的量-反應曲線的影響:一項前瞻性、隨機、雙盲研究

(鄭麗 陳傑 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.

運動阻滯濃度的異氟醚與丙酚在神經元終結具有相似的效果

(胡¥譯 馬皓琳 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.

氧化亞氮和氙氣對大鼠伏核細胞外多巴胺的不同作用:一個微量滲析試驗

(李惟一 陳傑 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:

監測腦電雙頻指數或頻譜熵能否減少七氟醚用量

(裘毅敏譯,馬皓琳 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.

動脈壓和體積描記動態指數對低血壓患者液體治療反應性測試的比較:一項臨試驗

(王麗君譯 薛張綱校)

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.

體外自動除顫器並不會受公共場所外界電磁場的影響而發生假陽性除

(韓曉¥譯 薛張綱校)

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.

用於檢測單肺通氣的雙腔管聲學監測

(丁震敏 陳傑 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:

為¥良圍術期生素藥而重新設計的一項新制度和程式

(唐李雋 馬皓琳 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:

膿毒血症和感染性休克患者的血漿蛋白組¥

( 荻譯 薛張綱校)

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:

大鼠創傷性腦損傷後以腦電圖定向的高量和低量丙酚輸注對於組¥病理學損傷的影響

(¥慧 陳傑 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:

試驗量利多卡因對產程早期硬膜外給予新斯的明和舒太尼合液後鎮痛運動能的影響

(黃佳佳 譯,馬皓琳 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.

臨產婦女行腰硬聯合麻醉同單次腰麻相比不能獲得更高位的感覺神經阻滯

(王慧琳譯 薛張綱校)

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%羥¥基澱粉行急性等¥血液稀釋後的凝血指標

(衛紅 陳傑 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.

術中輸注氨基酸引起合成代謝與麻醉¥式無關

(黃施偉 譯,馬皓琳 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:

神經細胞粘附分子體阻斷冷水漂浮應激誘導的鎮痛效應和淋巴細胞與¥背¥神經節神經元間的細胞粘附

(徐麗穎譯 薛張綱校)

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.

單側全膝關節成型術後連續性股神經鎮痛:應用刺激與非刺激導管的比較

(周懿¥ 陳傑 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.

膕窩處坐骨神經的後路阻滯:比較單次和兩次注射法

(張瑩 馬皓琳 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

通過磁共振定位鎖骨下臂叢神經阻滯時離臂叢三支最近的最佳解剖位置

(吳德華譯 薛張綱校)

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.

 

圍術期靜脈輸注氨基酸促進非體外迴圈冠狀脈搭橋術後患者的康復縮短住院時間

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.

圍術期靜脈輸注氨基酸有於維持婦產科和矯形外科手術患者的術中中心體溫¥善預後。本研究前瞻性研究了靜脈輸注氨基酸對患者的食道中心溫度,以對非體外迴圈冠脈搭橋術(CABG)預後的影響。180例連續的選擇性或急診非體外迴圈CABG病例隨機分為兩組:靜脈輸注氨基酸組(術前2小時起以4KJ/kg/h的速率輸注)和生理¥水組(以同樣的時間和量輸注生理¥水)。輸注生理¥水組的患者在手術結束後食道中心溫度¥均為35.6(35.3-35.8)℃〔(¥均值(95%可信區間)〕,氨基酸組則為36.1(35.9-36.3)℃(P0.01)。Kaplan-Meier分析表明接受氨基酸輸注的患者術後需要行機械通氣的持續時間較輸注生理¥水組明顯縮短〔中位數(95%可信區間),3.0(2.5-3.9) 小時比4.5(3.8-5.8)小時;P0.01〕。此外,輸注氨基酸的患者在ICU停留的時間〔20(19.5-38.4) 小時比44(21-45)小時;P=0.001〕,和住院治療的時間〔10(9-11) 天對比12(11-13)天;P=0.004〕均顯著縮短。圍術期靜脈輸注氨基酸能有效地減少非體外迴圈CABG患者術中低體溫的發生並¥善其術後的恢復。

(印傑敏 陳傑 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.

 

需要麻醉的擇期小兒手術的日程安排: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.

每日需要麻醉的擇期小兒手術在數量的化可能導致手術室資源和病例負擔¥間的不¥衡。計畫手術和進行手術的時間¥間的間隔長,手術室的利用率就高。在這個研究中,作者研究影響父母安排他們的孩子手術的因素。並想瞭解父母的理想目標和可接受的最長的等待時間和是否影響手術的決定,比如影響行程安排。隨機選擇250名擬行擇期手術的小兒的父母,236名完成分析,14例沒有回復。父母提前安排小兒手術時間的中位數是4.3周(動範圍是2.08.6周),理想的等待時間間隔是3周(動範圍是24周),最長的可接受間隔是6周(動範圍是410周)。和一般的手術相比,父母樂意去等待更長的時間去安排心臟的手術(4周,p=0.004)和整形手術(3.5周,p=0.024)。父母對孩子疾病嚴重性的認識、最早有空時間和外科醫生的建議是影響手術安排的最重要的三個因素。手術安排的時間表和父母有否時間有很大關係({tau}b = 0.72, P < 0.0001)。意外的是並沒有顯示父母樂意首選在假期或夏季安排手術。

(張美榮 陳傑 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.


術前用退黑激素類藥物對異丙酚和硫賁妥鈉麻醉誘導的量-反應曲線的影響:一項前瞻性、隨機、雙盲研究

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:退黑激素對術中靜脈麻醉需要量的影響至還未研究過。作者通過言語命令和睫毛刺激反應來研究術前用退黑激素類藥物對異丙酚聯合硫賁妥鈉靜脈麻醉量-反應曲線的影響。

¥法:這項前瞻性、隨機、雙盲研究包括了200ASA I級的成¥男性。病人術前口服0.2 mg/kg的退黑激素或是一片安慰(每組n = 100 )。大約50min後,10位退黑激素的亞組和10位安慰的亞組接受了不同量的異丙酚(0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg)或是硫賁妥納(0.5, 1.0, 1.5, 2.0, or 2.4 mg/kg)的靜脈麻醉誘導。在異丙酚或是硫賁妥納最後給藥60秒以後測定每個病人對於指令的反應,“睜開你的眼睛”,和睫毛刺激反應。用概率分析法描¥量-反應曲線。

結果 :術前應用退黑激素減少了對言語命令和睫毛反應的消失時硫賁妥納ED50值,分別從3.4 mg/kg (95%可信區間, 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).。相對應的異丙酚的ED50值¥分別從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)

結論:術前用退黑激素類藥物顯著降低靜脈麻醉異丙酚和硫賁妥鈉的需求量。

(鄭麗 陳傑 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.

 

氧化亞氮和氙氣對大鼠伏核細胞外多巴胺的不同作用:一個微量滲析試驗

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)釋放多巴胺在許多精神藥物和成癮性藥物(比如N-甲基-d-天冬氨酸:谷氨酸的一種亞型的對物)的藥理作用中起著非常重要的作用。雖然氧化亞氮和氙氣都是N-甲基-d-天冬氨酸的受體拮,他們產生精神毒性的潛在機制不一。因此,作者研究它們在伴或不伴氯胺酮的情況下對於NAC中細胞外多巴胺的作用。

¥法:35只大鼠在NAC中植入微量滲析探針。隨機分為六組:1.暴露在40%的氧氣中60min2. 暴露在60%的氧化亞氮(0.27MAC)60min3. 暴露在43%的氙氣(0.27MAC)60min4. 暴露在40%的氧氣中70min5. 暴露在60%的氧化亞氮中70min6. 暴露在43%的氙氣中70min。其中4,5,6三組在停止氣體暴露10分鐘後¥腔注射氯胺酮(80mg/kg)。每20分鐘採集樣本一次,使用液相色譜分析儀測定多巴胺水準。

結果:氧化亞氮,而不是氙氣顯著增了多巴胺水準。氯胺酮顯著增了小鼠多巴胺的水準,可以被氙氣,而不是氧化亞氮制。這些資料提示氧化亞氮和氙氣不同的神經心理作用部分源於它們對於多巴胺系統不同的作用效果。

(李惟一 陳傑 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.

 

用於檢測單肺通氣的雙腔管聲學監測

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.

 

單肺插管(OLI)是氣管插管最常見併發症¥一。現在尚沒有一個有效的監測工具可早期檢測出OLI。在本研究中,作者研究了聲學分析對OLI檢測的有效性。採集11名胸部手術需要使用雙腔導管的患者的肺部呼吸音。在誘導術前確認了導管適當的位置後,開始記錄隔離肺的通氣情況。主要通過3個電壓型擴音器收集樣本,在胸部每一側各放置一個,另一個置於右前臂,以採集背部噪音標本。分析各信號能量,區分呼吸和靜止期。¥據每側肺信號能量的比率,將每次呼吸分為下列3個類別¥一:雙肺通氣,選擇性右肺通氣和選擇性左肺通氣。在這11名患者中行右肺通氣時有10個病人為單肺通氣;行左肺通氣時所有病人均為單肺通氣。這個研究提示聲學監測可有效檢測選擇性單肺通氣,對於早期診斷OLI可能有用。

(丁震敏 陳傑 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.

 

大鼠創傷性腦損傷後以腦電圖定向的高量和低量丙酚輸注對於組¥病理學損傷的影響

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:丙酚常用於創傷性腦損傷後患者的鎮靜,但有關腦損傷後量依賴性的丙酚神經保護效應尚未闡明。作者比較了大鼠皮質損傷(CCI)在應用以腦電圖為定向的高量和低量丙酚六小時後的組¥病理學損傷。

¥法:動物隨機分為CCI/低丙酚組(腦電圖制比率1~5%)、CCI/高丙酚組(腦電圖制率30%~40%)、對照組CCI/氟烷(1.0%氟烷)或偽組/氟烷。腦組¥切片使用甲酚紫(KV)和蘇木紅染色來評估海馬的損傷¥積、嗜酸性粒細胞數量和細胞凋亡蛋白酶(caspase-3)活性。

結果:不同組中海馬的損傷¥積(mm3)和嗜酸性粒細胞無顯著性差異【損傷¥積:CCI/低丙酚組為31.55±14.66(KV)53.77±8.62(HE)CCI/高丙酚組33.81±10.57(KV)52.30±11.55HE);CCI/氟烷組36.42±17.06(KV)57.95±8.49HE)】。在所有CCI組中均發生同側海馬細胞凋亡蛋白酶啟動。

結論:儘管皮質神經元能存在不同水準,但在短時期的組¥病理學損傷中並沒有差異。這些結果對丙酚的神經保護效應與腦代謝需求的降低有關的觀點提出了挑戰。

(¥慧 陳傑 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%羥¥基澱粉行急性等¥血液稀釋後的凝血指標

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型血的人群一般認為有著缺¥第VIII因數(纖維蛋白穩定因數)和血管假性血友病因數(vWF)的傾向。如果這屬實的話,那麼O型血的人在用羥¥基澱粉(HES)行等¥血液稀釋後更¥易出現凝血障礙,包括血液稀釋和羥¥基澱粉相關的凝血障礙。

¥法:30名非O15O型血患者,ASAIII,行兩個節段以水準的柱外科手術病人參與了此項研究。在麻醉誘導¥後,預計30%的血¥量已經喪失,同時予以6% HES(130/0.4)補充血¥量。凝血指標則在等¥血液稀釋時(To)和發生後30分鐘 (T30)兩個時間點進行監測。

結果:發生急性血液稀釋¥前和¥後,第VIII因數活性,血管假性血友病因數原水準 (vWF:ag) vWF瑞斯托菌素輔因數活性在O型血病例中均低於非O型血病人,且O型血病例在發生血液稀釋¥後其數值低於正常值範疇。而且其降低的¥度比單純血液稀釋引起的要高。血栓彈性描記圖的最大¥度和凝血指數在發生正常血¥量型血液稀釋的O型人群中均低於正常值。vWF:ag的降低和失血量密切相關,且在O型人群中更為顯著。

結論:在使用HES行等¥血液稀釋的O型人群存在更大程度的凝血危害和第VIII因數活性,血管假性血友病因數原 (vWF:ag) vWF瑞斯托菌素輔因數活性水準的降低。

 

(衛紅 陳傑 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.

 

單側全膝關節成型術後連續性股神經鎮痛:應用刺激與非刺激導管的比較

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

 

背景連續性股神經鎮痛可緩解全膝關節成型術(TKA)後的疼痛,¥善能的恢復。而刺激導管可能利於導管更精確的放置。

¥法作者設計了一隨機前瞻性研究來調查41TKA病人比較使用刺激導管與非刺激導管有關情況。所用病人都接受經靜脈患者自控的鎮痛作為緩解疼痛的輔措施。實驗的主要目的是調查應用刺激導管是否較應用非刺激導管,能減少局部麻醉藥的用量。另外研究其他¥面的差異,包括術後疼痛評分,阿片類藥物的使用,副作用以急性期能矯形結果。

結果兩組的鎮痛效果均滿意,羅呱卡因用藥量並沒有明顯差異;刺激導管組羅呱卡因給藥量的中位數為8.2mL/h,而非刺激性導管組為8.8mL/hP0.26(中位數差值-0.6,95%可信區間,-2.30.6)。同時注意到兩組治療組間,經靜脈患者自控鎮痛的太尼用量;VAS

評分;急性期能性矯形結果;副作用以口服阿片類藥物的使用量並沒有明顯的差別。

結論在全膝關節成型術(TKA)後連續性股神經鎮痛中使用刺激導管與傳統的非刺激導管比較並沒有明顯的優點。

(周懿¥ 陳傑 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.

 

比較單側與雙側¥內動脈移植對術後縱隔引流量輸液量的影響

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.

 

現已明確,冠狀動脈旁路手術中使用左¥內動脈(LIMA)移植較自體隱靜脈移植為佳。而與以兩種¥法相比,使用雙側¥內動脈(BIMA)移植早期和晚期的通暢率更高,患者的長期生存率更高,再次手術發生心臟事件的可能性更小。但另一¥面,雙側¥內動脈移植可能會增術後出血的危險性,因此有關的爭論¥總是圍¥著圍手術期問題。我們希望通過這項研究,明確BIMA移植是否是首次擇期冠狀動脈血管形成術患者術後出血使用血製品的獨立危險因素。連續33位準備行BIMA移植的患者與66位單一LIMA移植的患者配對。LIMA組術後縱隔引流量明顯少於BIMA組(中位數:722 mL vs 920 mLP = 0.0001)。56名患者使用了血製品(LIMABIMA組分別是56%與51%,P = 0.67)。多因素分析表明,BIMA與手術時間是術後引流量增多的獨立危險因素。然而對數回歸分析表明,與心肺旁路紅細胞壓積和手術時間不同,BIMA與血製品的使用的聯¥並無顯著意義(紅細胞壓積升高1%與手術時間1分鐘的OR 95% CI分別為:0.89 [0.80–0.96]P = 0.01 1.009 [1.001–1.019]P = 0.04)。結論:述資料支援BIMA移植輕度增術後引流量但對輸血輸液量無影響的結論。

(金 琳譯 薛張綱校)

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調亡蛋白p53使異氟醚誘導的心臟保護閾下移

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¥:暴露於異氟醚¥前和在再灌注早期,通過啟動磷脂醯肌醇-3-激酶(PI3K)介導的信號傳導來心肌梗塞。調亡蛋白p53PI3K來調節,p53的制缺血損傷。我們檢測這樣的假說,在活體制p53使異氟醚誘導的保護閾下移。

¥法:家兔(n = 73)監測血流動學,並使其冠狀動脈左前降支阻斷30min再灌注3小時,接受0.9%的生理¥水(對照),異氟醚(0.51.0MAC)在再灌注¥前給予3min和再灌注¥後給予2minp53PFT-αpifithrin-α1.53.0 mg/kg),0.5MAC的異氟醚1.5 mg/kg PFT-α其他家兔在選擇性PI3Kwortmannin(0.6 mg/kg)或線粒體通透性轉換孔道開放蒼術苷(atractyloside5 mg/kg)預處理後接受3.0 mg/kg PFT-α0.5MAC的異氟醚1.5 mg/kg PFT-α

結果:當與對照相比(45%±2%[均數±標準差]),異氟醚(1.0而不是0.5MAC, PFT-α3.0而不是1.5 mg/kg),以0.5MAC異氟醚1.5 mg/kg PFT-α的結合顯著(P < 0.05)減少心肌梗塞面積(左心室面積危險度分別為21%±4%, 43% ±7%, 22%±4%, 45%±4%,28%±3%氯化三苯基四氮唑染色)。蒼術苷,而不是wortmannin,阻止3.0 mg/kg PFT-α誘導的心臟保護,然而蒼術苷和wortmannin阻滯由0.5MAC異氟醚1.5 mg/kg PFT-α產生的梗塞面積減少

結論:這樣的結果提示在活體再灌注早期制調亡蛋白p53降低異氟醚誘導的心臟保護的閾值。

(孫敏莉譯 薛張綱校)

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.

小量氯胺酮降低異丙酚注射痛.

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:麻醉誘導期間異丙酚靜脈注射引起疼痛。氯胺酮顯示了可以降低注射痛。本研究我們建立了氯胺酮降低異丙酚注射痛的最佳量。¥法:240例選擇性外科手術患者隨機分成8組;其中5組在研究的第一部分,另3組在研究的第二部分。部分一,各組患者在異丙酚2.5mg/kg注射前分別立即給NSS組),利多卡因(L組),氯胺酮10ug/kgK10組,50ug/kgK50組)或100ug/kgK100組)。部分二,在異丙酚注射前3min給最佳量氯胺酮(100ug/kg)(Pre組)、和氯胺酮混合注射(KP)、或在術前口服咪唑安定後給(M組)。由不知情的麻醉醫生給患者每5秒鐘進行一次注射痛評分。結果:第一部分,K100組和利多卡因組注射痛的發生率和疼痛強度最低(P<0.001)。第二部分,相對於KP組和Pre組,K100M組的疼痛評分明顯降低(P<0.05)。誘導期間,各組¥均動脈壓和心率沒有顯著差別。結論: 氯胺酮100ug/kg在異丙酚注射前立即給予是即時降低注射痛異丙酚注射痛的最佳量。

(吳德華譯 薛張綱校)

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.

 

 

動脈壓和體積描記動態指數對低血壓患者液體治療反應性測試的比較:一項臨試驗

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.

 

該試驗我們比較了由直接動脈測壓得到的呼吸相關性異指數和由脈搏氧飽和度測得的體積描記指數,對於預測補液試驗後心排量增的不同作用。我們對22名患者進行32次補液試驗,這些患者均有肺動脈導管監測。擴¥前後分別記錄血流動學和體積描記資料。若心臟指數較基線值提高不足15%定義為無反應者。無反應者的動脈脈搏異和體積描記脈搏異較有反應者均降低(前者[10 +/- 4]% vs [19 +/- 13]%, P = 0.020;後者[12 +/- 7]% vs [21 +/- 14]%, P = 0.034)。動脈壓和體積描記的脈搏異收縮期異均相似(前者ROC曲線下面積分別為0.74 vs 0.72P = 0.90;後者ROC曲線下麵積分別為0.64 vs 0.72P = 0.50)。由動脈和體積描記脈搏異波形的¥收縮期異的¥來鑒別無反應者(前者曲線下面積分別為0.80 vs 0.87,P = 0.40,後者曲線下麵積分別為0.84 vs 0.80, P = 0.76)。對受試人群而言,體積描記且呼吸作用相關的血流動學指數和直接測動脈壓對於預測液體治療的反應性一樣有效。體積描記指數為預測擴¥後心排量的增提供了一種無創的¥法。

(王麗君譯 薛張綱校)

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.

 

 

體外自動除顫器並不會受公共場所外界電磁場的影響而發生假陽性除

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.

 

電磁場降低心電圖的信號品質,會使得外部自動除顫器出現誤差。我們設計了這項關於AED設備在健康志願者使用的隨機、前瞻性研究。我們選擇了¥忙的公共場所作為除顫的測試場所。強磁場在火站和速、減速的火旁被發現。主要的結果數是奧地利經常使用的五項AED中的竇性心律的電絕對量。對於資料分析,統計學家對於AED的模型試驗是不知道的。資料分析基於實驗設計每個¥案的評估進行。在390例中沒有一例假陽性發生。AED是安全的,甚至於在電磁場很強的火站旁。

(韓曉¥譯 薛張綱校)

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.

 

 

膿毒血症和感染性休克患者的血漿蛋白組¥

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:膿毒血症依然是重症監護室裏最主要的致死原因。我們的目的是要闡明在第28天的倖存者(SURV)和非倖存者(NON-SURV)可能的早期血漿化。

¥法:我們應用蛋白質組術分析膿毒血症和感染性休克患者的血漿樣本。18名膿毒血症和感染性休克患者的血漿樣本在診斷後第一個12小時內就被收集。在第28天患者被分為倖存者組和非倖存者組。

結果:7名患者倖存,11名患者死亡。使用蛋白質組分析¥法,雙向凝膠電泳檢測到每凝膠大於200點。在倖存者和非倖存者組間發現一個差異蛋白表達,透露了為何蛋白更仍未在膿毒血症中被描述。

結論:我們的結果顯示蛋白質組描述是一項檢測膿毒血症患者蛋白表達動學的有用¥法,與單獨的遺傳研究相比,可以使我們更接近於完成綜合的分子描述。

(周 荻譯 薛張綱校)

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.

臨產婦女行腰硬聯合麻醉同單次腰麻相比不能獲得更高位的感覺神經阻滯

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:已有報導指出,擇期行剖宮產的婦女採用腰硬聯合麻醉可獲得比同等量單次腰麻更高位的感覺阻滯。我們想證實在不同硬膜外壓的產婦中,此說法是否正確。¥法:隨機選擇40ASAI級確定行剖宮產的臨產婦入組雙盲試驗。S組(n=20)鞘內行單次腰麻注射2ml0.5%的高比重布比卡因,CS組(n=20)行腰硬聯合麻醉注射同等量高比重布比卡因。結果:我們發現兩組完成了相似的最高感覺阻滯¥面(S組:¥均胸3,最低胸6,最高胸1CS組:¥均胸3,最低胸4,最高頸7P=0.517)。結論:同¥前的非臨產產婦的報導相比,我們的研究發現,腰硬聯合麻醉在臨產婦行剖宮產中的阻滯¥性與單次腰麻相比無差別。

(王慧琳譯 薛張綱校)

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.

 

 

神經細胞粘附分子體阻斷冷水漂浮應激誘導的鎮痛效應和淋巴細胞與¥背¥神經節神經元間的細胞粘附

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:阿片封閉的免疫細胞以定向¥式遷移到炎性組¥並附著於感覺神經纖維。這些細胞在非常接近這些纖維時釋放阿片肽,從而避免了在局部被肽酶降解,並將阿片肽傳遞至阿片受體而發揮傷害感受效應。¥法:神經細胞粘附分子(anti-NCAM)的這種效應是通過在弗氏佐誘發足部炎症的Wistar大鼠中採用冷水漂浮應激誘導的傷害感受來評估的。同時對熱和機械刺激進行鎮痛測評。細胞粘附試驗檢測了β內啡呔和NCAM體的效應,細胞間粘附分子-1作用于¥背¥神經節神經元和離體淋巴細胞。將鈣黃綠素標記至新鮮離體淋巴細胞的螢光法來確定淋巴細胞粘合。結果:NCAM制淋巴細胞和¥感覺神經元間的直接粘合。這種粘合¥被證實為阿片依賴性——在1微克β內啡呔存在下,淋巴細胞與¥感覺神經元的粘合被制,而可被100微克納洛酮逆轉。此外,NCAM阻斷了熱和機械刺激導致的足部炎症中的冷水漂浮誘導的鎮痛效應。然而NCAM並不影響太尼誘導的傷害感受效應。結論:這項研究提供了淋巴細胞粘附感覺神經元中細胞粘附分子作用的深入觀察與免疫相關傷害感受的聯¥。

(徐麗穎譯 薛張綱校)

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.

 

 

通過磁共振定位鎖骨下臂叢神經阻滯時離臂叢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.

 

鎖骨下徑路經常用來做臂叢神經阻滯。我們在志願者身用磁共振成像來區別單側矢狀面臂叢神經阻滯時的臂叢神經和腋下血管。20個志願者中,臂叢神經各支定位於離腋動脈2cm以內,大約占圓形腋鞘的2/3。我們得出一個離臂叢各支最近的注射點位,針尖指向頭端後側並於動脈相鄰。我們得出結論,本研究可能對在超聲引導下鎖骨下進路臂叢神經阻滯的有¥。然而,我們的建議還需要進一步的臨研究證實。

(吳德華譯 薛張綱校)

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.

 

體外迴圈期間的溫度:監測部位¥間的差異

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

 

我們對患者進行研究以確定在低溫體外迴圈期間通常的監測部位的體溫記錄是否充分反映腦部溫度。研究I(n = 12)中,在頸靜脈球監測的溫度與鼻咽、食道、膀胱、和直腸中記錄的溫度比較。研究II(n = 30)中,在膜型氧合器的動脈輸出口¥監測體溫。一個校準的記錄儀持續地同時記錄所有的溫度。研究I發現在降溫和複溫期間頸靜脈球和所有其他身體部位的溫度¥間有較大的差異。頸靜脈球和其他身體部位¥間的溫度差異程度有相當的個體異。研究II產生相同的結果,¥顯示在降溫3.3 ± 1.3 min後和複溫16.5 ± 5.5 min後頸靜脈球溫度與通過膜型氧合器的動脈輸出口進入患者體內的血液溫度達到¥衡。¥差分析顯示動脈輸出口是所有監測部位中相對於頸靜脈球¥均差異最小的(P < 0.001)。總¥,體溫監測在降溫期間高估了頸靜脈球的溫度,而在複溫期間又低估了。而動脈輸出口血液溫度提供了一個較好的近似值。

(彭中美 馬皓琳 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.

 

 

心肺轉流中氣道中性粒細胞介導的免疫應答啟動

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

心肺轉流(CPB)被認為會導致術後肺能障礙。為更嚴密地檢測CPB過程中發生在氣道內的炎症性過程,我們在新的支氣管鏡微量試樣探針的輔下,連續檢測了11名行主動脈弓動脈瘤修補術的病人的炎性介質。麻醉誘導後、肺再灌注即刻和術畢三個時點進行皮細胞襯液(ELF)和動脈血同時取樣。結果發現術畢動脈血氧分壓/吸入氧分壓比值下降(P0.029)。儘管術畢ELF中白介素(IL)-8IL6和中性粒細胞彈性蛋白酶濃度明顯升高(中位數分別=23,200181812,900 µg/mL,但於低氧血症程度無相關性。在肺再灌注時點,中性粒細胞彈性蛋白酶濃度明顯升高,早於IL8IL6,且與輸血無相關性。術畢ELFIL6濃度與總輸血量相關({rho}

 
= 0.731, P = 0.011)。這些結果提示在CPB早期中性粒細胞介導的免疫應答被啟動.

(邱鬱薇 馬皓琳 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.

 

 

超聲引導下外周神經置管連續神經阻滯的門診病人的管理:620例病人的處理經驗

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:連續外周神經阻滯(CPNB)是整形術後鎮痛的最佳選擇,但因為擔心可能會發生與導管有關的併發症,並不常地用於門診病人。而且,在這種情況下病人可能難以與醫生進行¥便的溝通。我們研究了用事先制訂好試驗¥案施行的CPNB治療的620名門診病人。

¥法:所有的置管均在超聲直接顯像下進行。這些患者接受了充分的口頭和書面的術前指導,並且在術後階段可以便利地與麻醉醫生進行連續的電話交流。術後第一天,所有的病人均在家裏接受了電話聯¥。而且,每位病人在出院2周內均看過外科醫生,並被檢查過。

結果:在620名患者中,有190名是肌間溝(臂叢),206名髂筋膜(股神經),224名膕窩(坐骨神經)置管。2名患者(0.3%)發生了與神經阻滯有關的併發症。這兩名患者均在手術後6周內症狀消退。26名患者(4.2%)術後要求麻醉醫生術後¥預。1名患者回到醫院要求拔除導管。

結論:在用CPNB處理的大樣本的門診病人中,讓人驚訝的是,極少需要麻醉醫生的¥預。同樣,患者們能夠可以在不需要額外隨訪地在家裏管理並且拔除導管。這就表示,在有足夠的指導和與衛生保健人員的電話聯絡後,患者們可以在家中很舒適地管理並且拔除CPNB導管。

(黃麗娜 馬皓琳 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.

 

 

運動阻滯濃度的異氟醚與丙酚在神經元終結具有相似的效果

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:我們研究了異氟醚和丙酚在完整老鼠髓中神經元終結的作用。我們假設丙酚會比異氟醚制終結效果更強。

¥法:在交叉設計實驗中,老鼠分別給予0.81.2最小肺泡濃度(MAC)的異氟醚0.81.2 ED50(有效量50%)的丙酚,記錄來自腰椎神經後¥索的單個單位的資。(n = 13)。分別給予0.113 Hz20次電刺激。分析來自C纖維範圍(每次刺激後100–400 ms )C纖維與後發放混合範圍(100–1000 ms)3Hz刺激下100–333 ms範圍的神經元反應。絕對的終結¥會被記算(20個刺激的動作電位總和-對第一個刺激的20倍反應)。

結果:1Hz時,異氟醚(0.81.2 MAC)所有的由20次刺激(100–1000 ms 範圍)總計的動作電位(¥均值,標準誤)分別為571 ± 106 742 ± 214,丙酚(0.8 1.2 ED50)分別為586 ± 148 641 ± 143 (P = NS) 0.1 Hz刺激相對應的值為345 ± 104370 ± 108430 ± 86403 ± 106 (P = NS)3Hz(100–333 ms範圍)266 ± 66333 ± 76343 ± 85、和252 ± 72 (P = NS)1Hz1.2 MAC異氟醚在100–1000 ms範圍的絕對終結要高於0.8 MAC 異氟醚和0.8 1.2 ED50 的丙酚 (分別為232 ± 3188 ± 65210 ± 41)

結論:這些資料表明,異氟醚與丙酚在髓中的神經元終結有相似效果,雖然在1.2 MAC異氟醚下對1 Hz 刺激產生的絕對終結較強。.

(胡¥譯 馬皓琳 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.

 

 

監測腦電雙頻指數或頻譜熵能否減少七氟醚用量?

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

已證實使用腦電雙頻指數(BIS)可減少吸入麻醉藥的消耗量,但還缺少頻譜熵¥面的資料。將140位預定行持續1小時以手術的成¥病人預先隨機分組,分別接受由BIS或頻譜熵或僅僅臨數控制的麻醉。用異丙酚蘇太尼進行麻醉誘導。此後持續輸注蘇太尼。在1 L/min O2/N2O中給予七氟醚。在標準操作組¥據常規的臨數來調節七氟醚濃度,而BIS頻譜熵指導組控制在40-60區間。七氟醚揮發罐在麻醉前後分別稱重,並計算消耗量。除體重外,組間的一般情況有可比性(譜熵指導組較重,P < 0.05)。與標準操作組相比,使用BIS或頻譜熵監測的病人七氟醚的需要量減少29%(¥據病人的體重麻醉持續時間標準化的七氟醚消耗量,P < 0.03),太尼量相似。在標準操作組觀察到一種無意的¥善(正性偏倚)。結論:BIS頻譜熵監測對七氟醚有相同的節省效應。

(裘毅敏譯,馬皓琳 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.

 

 

為¥良圍術期生素藥而重新設計的一項新制度和程式

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損傷、死亡和醫療費用過多的一個主要原因。集思廣後,我們制定了圍術期生素藥的三大焦點:生素的合理選擇、在切皮前60分鐘內給予生素、預防性生素在術後24小時內停藥。麻醉醫師被認定為最可能在切皮前60分鐘內完成生素成給予的參與者其中。藥順序、說明、生素製備有所化。對所有與會的手術室工作人員和器械巡迴都進行宣教。顯著地顯示結果,並提供回饋。合理生素選擇的基線從82%提高到現在的95%。¥預前的藥-切皮時間是79(範圍32380)分鐘,其中有11%在藥後60分鐘內切皮。當前的藥-切皮的時間在19(範圍095)分鐘,在60分鐘內的數量占了95%。建立該程式前,手術部位感染率為3.8%,而現在則大約為1.4%。我們描述了用以¥良生素藥的我們的這種程式。在此期間,手術部位感染率顯著降低。

(唐李雋 馬皓琳 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.

 

 

試驗量利多卡因對產程早期硬膜外給予新斯的明和舒太尼合液後鎮痛運動能的影響

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

我們以前闡述過硬膜外舒太尼和膽¥脂酶制新斯的明產生擇期分娩鎮痛的有效性。因為傳統的利多卡因腎腺素的試驗量可能¥後續硬膜外藥物的藥效,我們進行這個研究以衡量利多卡因試驗量對產程早期硬膜外新斯的明和舒太尼合液產生的鎮痛效果的影響。80位健康產婦隨機分為兩組,接受:2%利多卡因和1:200,000腎腺素合液或生理¥水和1:200,000腎腺素合液的3ml試驗量,三分鐘後給予硬膜外新斯的明500µg舒太尼10µg。注藥後30min記錄疼痛評分和初始單量後要求額外鎮痛的時間。通過產婦坐、站立、屈膝和行走能評估注藥後30min的運動能。試驗量利多卡因速了硬膜外新斯的明和舒太尼合液單量注射產生的鎮痛的起效(5 min vs 15 min)並延長了持續時間(122 ± 53 min vs 98 ± 54 min; P = 0.02)。相反,試驗量並沒有顯著弱坐、站立或者屈膝的能。然而,行走的能卻減弱(57% vs 82%; P = 0.04)。總¥,傳統的利多卡因試驗量可以顯著增分娩早期硬膜外新斯的明和利多卡因合液的鎮痛效果,但是將影響行走能。

(黃佳佳 譯,馬皓琳 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.

 

 

術中輸注氨基酸引起合成代謝與麻醉¥式無關

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:接受硬膜外複合淺全麻或單純全麻的患者輸注葡萄糖不能形成正蛋白質¥衡。我們試圖證實與全麻相比,接受硬膜外阻滯的患者靜注氨基酸進行營支持可產生更明顯的蛋白質¥衡。

¥法:16例患者隨機分組,分別接受地氟醚全麻(對照組)或全麻複合硬膜外鎮痛(EDA組)。術前禁食32h¥後開始預先恒定輸注穩定的同位素示¥l-[1-13C]亮氨酸和[6,6-2H2]葡萄糖(3h禁食狀態),並且在術中持續3h在此期間靜脈輸注氨基酸(進食狀態)。

結果:與禁食狀態相比,亮氨酸出現的內生速率下降程度兩組間相似,而蛋白合成增,兩組間亦無差別。兩組的亮氨酸氧化均未發生¥。輸注氨基酸¥後內源性葡萄糖生成保持不,但兩組葡萄糖清除均減少。血糖、血漿皮質醇、血清胰島素和胰高血糖素的濃度升高程度在兩組間相同。

結論:硬膜外麻醉對氨基酸引起的合成代謝無額外處。

(黃施偉 譯,馬皓琳 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.

 

 

膕窩處坐骨神經的後路阻滯:比較單次和兩次注射法

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、隨機、單盲研究中,我們對足部和踝部手術病人,在神經刺激器的引導下從膕窩後路用1%甲呱卡因阻滯坐骨神經,比較單次或兩次注射,以評¥有效性、起效時間和併發症。在單次注射組(S, n=30),神經刺激器激發足內翻或¥屈後給予1%甲呱卡因25mL。在兩次注射組(D, n=30),足外翻和背屈後注射12.5mL的溶液,足¥屈後再給予12.5mL。除了兩組腓淺神經阻滯的起效時間(組S和組D分別為18 [13] min11.4 [7.5] minP < 0.05)和組D腓淺神經和脛神經阻滯的起效時間¥間(分別為11.4 [7.5] min22.3 [11.3] minP < 0.05)有顯著差異以外,兩組感覺神經完全阻滯的¥均起效時間(標準差)沒有顯著性差異(21.9 [14.2] min vs 22.1 [13.8] min)。組S病人有77%達到完全鎮痛,組D病人87%完全鎮痛(P = 0.22)。組S和組D 腓深神經達到完全鎮痛的比例為80%97%(P < 0.05)。阻滯過程中組D發生異感更多見(17% vs 40%) (P < 0.05)。我們得出結論,坐骨神經的兩次神經刺激引導的阻滯的起效時間和成率,與單次神經刺激相仿,在阻滯操作過程中異感更多見。

(張瑩 馬皓琳 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.