Anesthesia & Analgesia

January 2007

CARDIOVASCULAR ANESTHESIA:

2006 非心脏手术围术期心血管评估ACC/AHA指南最新资料:焦 为围术期β受体阻滞剂应用的最新资料美国心脏学会/美国心脏病协会推荐实践指南最新(2002 非心脏手术围术期心血管评估最新指南编写委员会)

周懿  陈杰

ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy — A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) (Special Article)

Anesth Analg 2007 104: 15-26.

围术期β受体阻滞剂应用可预防手术相关的死亡率和发病率:系统回顾Meta分析

顾新宇 陈杰

Perioperative ß-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis

Franz Wiesbauer, Oliver Schlager, Hans Domanovits, Brigitte Wildner, Gerald Maurer, Marcus Muellner, Hermann Blessberger, and Martin Schillinger

Anesth Analg 2007 104: 27-41.

近期服用二甲双胍不会增心脏手术后院内的发病率或死亡率

金琳译 薛张纲校

Recent Metformin Ingestion Does Not Increase In-Hospital Morbidity or Mortality After Cardiac Surgery

Andra I. Duncan, Colleen G. Koch, Meng Xu, Mariel Manlapaz, Brian Batdorf, Grzegorz Pitas, and Norman Starr

Anesth Analg 2007 104: 42-50.

在冠脉搭桥手术期间监测脑氧饱和度:一个随机前瞻性研究"

彭中美 马皓琳 李士通

Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study

John M. Murkin, Sandra J. Adams, Richard J. Novick, Mackenzie Quantz, Daniel Bainbridge, Ivan Iglesias, Andrew Cleland, Betsy Schaefer, Beverly Irwin, and Stephanie Fox

Anesth Analg 2007 104: 51-58.

心电图控制中心静脉导管放置的精确性

裘毅敏译,马皓琳 李士通校

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Ralf E. Gebhard, Peter Szmuk, Evan G. Pivalizza, Vladimir Melnikov, Christianne Vogt, and Robert D. Warters

Anesth Analg 2007 104: 65-70.

PEDIATRIC ANESTHESIA:

成人和儿童在异丙酚全凭静脉麻醉中阻断躯体 切皮刺激反应时瑞太尼的需求量

郑丽 陈杰

Remifentanil Requirements During Propofol Administration to Block the Somatic Response to Skin Incision in Children and Adults

Hernán R. Muñoz, Luis I. Cortínez, Mauricio E. Ibacache, and Fernando R. Altermatt

Anesth Analg 2007 104: 77-80.

小儿发生谵妄:问题多,答案少

张  马皓琳 李士通校

Emergence Delirium in Children: Many Questions, Few Answers (Review Article)

Gordana P. Vlajkovic and Radomir P. Sindjelic

Anesth Analg 2007 104: 84-91.

AMBULATORY ANESTHESIA:

经皮东莨菪碱(TDS)可以作为枢复宁、氟哌利多的替代品来预防术后和出院后呕吐(短篇道)

李惟一 陈杰

Transdermal Scopolamine: An Alternative to Ondansetron and Droperidol for the Prevention of Postoperative and Postdischarge Emetic Symptoms (Brief Report)

Paul F. White, Jun Tang, Dajun Song, Jayne E. Coleman, Ronald H. Wender, Babatunde Ogunnaike, Alexander Sloninsky, Rajani Kapu, Mary Shah, and Tom Webb

Anesth Analg 2007 104: 92-96.

术前应用巴喷丁: 止血带疼痛和局部静脉麻醉质量的影响

王丽珺译 薛张纲校

Premedication with Gabapentin: The Effect on Tourniquet Pain and Quality of Intravenous Regional Anesthesia (Brief Report)

Alparslan Turan, Paul F. White, Beyhan Karamanlioglu, and Zafer Pamukçu

Anesth Analg 2007 104: 97-101

 

一 在控制通气中比较Cobra喉周气道与经典喉罩气道用于妇科 腔镜手术的前瞻性随机研究

颜涛 译,马皓琳 李士通

A Randomized Prospective Study Comparing the Cobra Perilaryngeal Airway and Laryngeal Mask Airway-Classic During Controlled Ventilation for Gynecological Laparoscopy (Brief Report)

Eilish M. Galvin, Mirjam van Doorn, Juan Blazquez, Johannes F. Ubben, Freek J. Zijlstra, Jan Klein, and Serge J. C. Verbrugge

Anesth Analg 2007 104: 102-105.

ANESTHETIC PHARMACOLOGY:

氙气阻滞了在体小鼠髓痛觉通路的突触长程增强效应的传导

杨卫红 陈杰

Xenon Blocks the Induction of Synaptic Long-Term Potentiation in Pain Pathways in the Rat Spinal Cord In Vivo
Justus Benrath, Christina Kempf, Michael Georgieff, and Jürgen Sandkühler

Anesth Analg 2007 104: 106-111.

异丙酚通过a-肾腺素受体激活增正常和野百合诱导的肺高压大鼠肺血管阻

吴德华译 薛张纲校

Propofol Increases Pulmonary Vascular Resistance During {alpha}-Adrenoreceptor Activation in Normal and Monocrotaline-Induced Pulmonary Hypertensive Rats

Mitsutaka Edanaga, Masayasu Nakayama, Noriaki Kanaya, Noritsugu Tohse, and Akiyoshi Namiki

Anesth Analg 2007 104: 112-118.

利多卡因和布比卡因 大鼠海马脑片中分裂胱天冬酶3的蛋白表达酪氨酸磷酸化的作用

周雅春 马皓琳 李士通

The Effects of Lidocaine and Bupivacaine on Protein Expression of Cleaved Caspase 3 and Tyrosine Phosphorylation in the Rat Hippocampal Slice

Souhayl Dahmani, Danielle Rouelle, Pierre Gressens, and Jean Mantz

Anesth Analg 2007 104: 119-123.

超短效选择性β1受体阻滞剂兰地洛尔 高血压或血压正常病人行气管内插管的血流学效应

丁震敏 陈杰

The Hemodynamic Effects of Landiolol, an Ultra-Short-Acting ß1-Selective Blocker, on Endotracheal Intubation in Patients With and Without Hypertension

Soichiro Sugiura, Sumihiko Seki, Kohji Hidaka, Miharu Masuoka, and Hideaki Tsuchida

Anesth Analg 2007 104: 124-129.

TECHNOLOGY, COMPUTING, AND SIMULATION:

安那康达反射过滤片:用于评估工作台和病人的安全性和挥发性麻醉剂的保存

王慧琳译 薛张纲校

AnaConDa® Reflection Filter: Bench and Patient Evaluation of Safety and Volatile Anesthetic Conservation

Jerôme Berton, Cyril Sargentini, Jean-Luc Nguyen, Adrian Belii, and Laurent Beydon

Anesth Analg 2007 104: 130-134.

脑电图播放仪的构造:将脑电图数据呈现给以脑电图为基础的麻醉监仪的一个仪器

张曦 译,马皓琳 李士通

Construction of the Electroencephalogram Player: A Device to Present Electroencephalogram Data to Electroencephalogram-Based Anesthesia Monitors (Technical Communication)

Matthias Kreuzer, Eberhard F. Kochs, Stefanie Pilge, Gudrun Stockmanns, and Gerhard Schneider

Anesth Analg 2007 104: 135-139.

ECONOMICS, EDUCATION, AND POLICY:

6-σ 法可以用来 善非心脏手术病人的预防性应用菌素

张美荣 陈杰

Six Sigma Methodology Can Be Used to Improve Adherence for Antibiotic Prophylaxis In Patients Undergoing Noncardiac Surgery

Brian M. Parker, J. Michael Henderson, Sue Vitagliano, Bala G. Nair, John Petre, Walter G. Maurer, Michael F. Roizen, Monica Weber, Lori DeWitt, Jason Beedlow, Barbara Fahey, Aimee Calvert, Kitty Ribar, and Steven Gordon

Anesth Analg 2007 104: 140-146.

小儿麻醉的新向:一  已完结案例的分析

钟静译 薛张纲校

An Update on Pediatric Anesthesia Liability: A Closed Claims Analysis

Nathalia Jimenez, Karen L. Posner, Frederick W. Cheney, Robert A. Caplan, Lorri A. Lee, and Karen B. Domino

Anesth Analg 2007 104: 147-153.

有关麻醉机故障检查的前瞻性研究

宋翠侠 陈杰

A Prospective Study on Anesthesia Machine Fault Identification

Eric R. Larson, Gregory A. Nuttall, Brian D. Ogren, Dean D. Severson, Sarah A. Wood, Laurence C. Torsher, William C. Oliver, and Mary E. Shirk Marienau

Anesth Analg 2007 104: 154-156.

CRITICAL CARE AND TRAUMA:

在低 量休克的猪模型胸腔内压调可以 善其24小时的生存率

陆文清译 薛张纲校

Intrathoracic Pressure Regulation Improves 24-Hour Survival in a Porcine Model of Hypovolemic Shock

Demetris Yannopoulos, Scott McKnite, Anja Metzger, and Keith G. Lurie

Anesth Analg 2007 104: 157-162.

NEUROSURGICAL ANESTHESIA:

植入髓刺激器后的转换闭锁综合征

黄丽娜 马皓琳 李士通

Conversion Locked-In Syndrome After Implantation of a Spinal Cord Stimulator (Case Report)

David Han, Neil Roy Connelly, Alan Weintraub, Paul Kanev, and Eddie Solis

Anesth Analg 2007 104: 163-165.

GENERAL ARTICLE:

静注利多卡因减轻哮喘病人气管插管术后支气管收缩反应

印洁敏 陈杰

Intravenous Lidocaine After Tracheal Intubation Mitigates Bronchoconstriction in Patients with Asthma

Michael Adamzik, Harald Groeben, Ramin Farahani, Nils Lehmann, and Juergen Peters

Anesth Analg 2007 104: 168-172.

ANALGESIA:

啮齿类静脉注射非肽类ORL1受体激剂后的催眠、脑电图和伤害感受 性

徐丽颖译 薛张纲校

The Hypnotic, Electroencephalographic, and Antinociceptive Properties of Nonpeptide ORL1 Receptor Agonists After Intravenous Injection in Rodents

Alan J. Byford, Alison Anderson, Philip S. Jones, Ronald Palin, and Andrea K. Houghton

Anesth Analg 2007 104: 174-179

左 拉西坦可以减少大鼠由于麻醉药造成的痛觉过敏

姜旭晖      马皓琳  李士通校

Levetiracetam Reduces Anesthetic-Induced Hyperalgesia in Rats

David P. Archer, Yves Lamberty, Bing Wang, Melinda J. Davis, Naaznin Samanani, and Sheldon H. Roth

Anesth Analg 2007 104: 180-185.

REGIONAL ANESTHESIA:

输注脂类 L-布比卡因中毒的大鼠离体心脏心肌能和生物能量学的作用

周荻 薛张纲校

The Effects of Lipid Infusion on Myocardial Function and Bioenergetics in l-Bupivacaine Toxicity in the Isolated Rat Heart

Sebastian N. Stehr, Jörg C. Ziegeler, Annette Pexa, Reinhard Oertel, Andreas Deussen, Thea Koch, and Matthias Hübler

Anesth Analg 2007 104: 186-192.

胸膜麻醉中的喷雾导管植入术:在喷撒滑石粉 前的一种新颖的镇痛 法

胡  马皓琳 李士通

A Spray Catheter Technique for Pleural Anesthesia: A Novel Method for Pain Control Before Talc Poudrage (Brief Report)

Pyng Lee and Henri G. Colt

Anesth Analg 2007 104: 198-200.

 

2006 非心脏手术围术期心血管评估ACC/AHA指南最新资料:焦 为围术期β受体阻滞剂应用的最新资料美国心脏学会/美国心脏病协会推荐实践指南最新(2002 非心脏手术围术期心血管评估最新指南编写委员会)

ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy — A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliott L. Chaikof, Kirsten E. Fleischmann, William K. Freeman, James B. Froehlich, Edward K. Kasper, Judy R. Kersten, Barbara Riegel, and John F. Robb

Anesth Analg 2007;104:15-26

 

美国心脏学会/美国心脏病协会(ACC/ AHA)推荐的实践指南建议尽避免任何现存的、潜在的、或者已察觉到的由于编写委员的行业不同或者个人喜好所引起可能的利冲突。尤其是所有编写委员会的成员以同行评议人员都被要求公开陈诉所有相关的可能已认知到现存或潜在的利冲突。公开的 别成员评估这些声明 在每次会议口头转述给编写委员会的所有成员,而编写委员会则时更新总结这些变化。附录1为作者的相关专业,附录2为同行评议人员的相关专业。

该指南旨在规定在多数情况下满足多数患者需求的实践 法。在总结可获得的最新科学证据后,该指南的建议反映了专家的意见 预计可以 善 患者的管理。如该指南作为常规给予决策而使用,则其最终目的是优质的管理 提供患者最佳的利。 某一 定患者管理的最终评定必须通过医疗保健的提供者以该类患者可面临的所有情况。

(周懿  陈杰 校)

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines makes every effort to avoid any actual, potential, or perceived conflict of interest that might arise as a result of an industry relationship or personal interest of the writing committee. Specifically, all members of the writing committee, as well as peer reviewers of the document, were asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These statements are reviewed by the parent task force, reported orally to all members of the writing committee at each meeting, and updated and reviewed by the writing committee as changes occur. Please see Appendix 1 for author relationships with industry and Appendix 2 for peer reviewer relationships with industry.

These guidelines attempt to define practices that meet the needs of most patients in most circumstances. These guideline recommendations reflect a consensus of expert opinion after a thorough review of the available, current scientific evidence and are intended to improve patient care. If these guidelines are used as the basis for regulatory/payer decisions, the ultimate goal is quality of care and serving the patient’s best interests. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and patient in light of all the circumstances presented by that patient.

围术期β受体阻滞剂应用可预防手术相关的死亡率和发病率:系统回顾Meta分析

Perioperative ß-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis

Franz Wiesbauer, Oliver Schlager, Hans Domanovits, Brigitte Wildner, Gerald Maurer, Marcus Muellner, Hermann Blessberger, and Martin SchillingerFrom the Departments of *Cardiology, {dagger}Emergency Medicine, {ddagger}Angiology, and University Library, Vienna General Hospital, Medical University, Vienna, Austria.

Anesth Analg 2007 104: 27-41. .

 

背景:围术期使用β受体阻滞剂被认为可降低术后的心血管死亡率,心肌缺血/心梗室性心律失常。作者回顾了关于围术期使用β受体阻滞剂 善心脏和非心脏手术后病人预后的有效性的证据。

 法::搜索11个大型资料库的资料,从它们的开始时间直至2005 10月。查阅各种在线资料以确定未发表的试验和相关的摘要。检索的文献包括围术期使用β受体阻滞剂和安慰剂相比较的随机 照试验。在3680个检索到的题目中,69篇符合选择标准 分析。当无显著的临不一致性的时候计算效应的优比(OR).

结果: β受体阻滞剂可降低室性心律失常的发生频率[OR(心脏手术):0.28,95%可信区间 0.13-0.57OR(非心脏手术):0.56, 95%可信区间 0.21-1.45],其它还有房颤/房扑[OR(心脏手术):0.37,95%可信区间 0.28-0.48],其他室速[OR(心脏手术):0.25,95%可信区间 0.18-0.35OR(非心脏手术):0.43, 95%可信区间 0.14-1.37],以心肌缺血[OR(心脏手术):0.49,95%可信区间 0.17-1.4;OR(非心脏手术):0.38, 95%可信区间 0.21-0.69].住院时间的长短 未缩短[权 均差(心脏手术):-0.35, 95%可信区间:-0.77-0.07; 权 均差(非心脏手术):-5.59, 95%可信区间:-12.22-1.04]。与以前道相反, β受体阻滞剂 不能降低死亡率[OR(心脏手术):0.55,95%可信区间 0.17-1.83;OR(非心脏手术):0.78, 95%可信区间 0.33-1.87],且 围术期心肌梗死的发生没有影响[OR(心脏手术):0.89,95%可信区间 0.53-1.5;OR(非心脏手术):0.59, 95%可信区间 0.25-1.39]

结论: β受体阻滞剂可减少围术期心律失常和心肌缺血的发生,但 心梗死亡率和住院时间的长短没有影响。

(顾新宇 陈杰 校)

BACKGROUND: Perioperative ß-blockers are suggested to reduce cardiovascular mortality, myocardial–ischemia/infarction, and supraventricular arrhythmias after surgery. We reviewed the evidence regarding the effectiveness of perioperative ß-blockers for improving patient outcomes after cardiac and noncardiac surgery.

METHODS: Eleven large databases were searched from the time of their inception until October 2005. Various online-resources were consulted for the identification of unpublished trials and conference abstracts. We included randomized, controlled trials comparing perioperative ß-blockers with either placebo or the standard-of-care. Of the 3680 retrieved titles, 69 met inclusion criteria for analysis. Odds ratios (OR) assuming random effects were computed in the absence of significant clinical heterogeneity.

RESULTS: ß-Blockers reduced the frequency of ventricular tachyarrhythmias [OR (cardiac surgery): 0.28, 95% CI 0.13–0.57; OR (noncardiac surgery): 0.56, 95% CI 0.21–1.45], atrial fibrillation/flutter [OR (cardiac surgery): 0.37, 95% CI 0.28–0.48], other supraventricular arrhythmias [OR (cardiac surgery): 0.25, 95% CI 0.18–0.35; OR (noncardiac surgery): 0.43, 95% CI 0.14–1.37], and myocardial ischemia [OR (cardiac surgery): 0.49, 95% CI 0.17–1.4; OR (noncardiac surgery): 0.38, 95% CI 0.21–0.69]. Length of hospitalization was not reduced [weighted mean difference (cardiac surgery): –0.35 days, 95% CI –0.77–0.07; weighted mean difference (noncardiac surgery): –5.59 days, 95% CI –12.22–1.04] and, in contrast to previous reports, ß-blockers did not reduce mortality [OR (cardiac surgery): 0.55, 95% CI 0.17–1.83; OR (noncardiac surgery): 0.78, 95% CI 0.33–1.87], and they had no influence on the occurrence of perioperative myocardial infarction [OR (cardiac surgery): 0.89, 95% CI 0.53–1.5; OR (noncardiac surgery): 0.59; 0.25–1.39].

CONCLUSIONS: ß-Blockers reduced perioperative arrhythmias and myocardial ischemia, but they had no effect on myocardial infarction, mortality, or length of hospitalization.

 

成人和儿童在异丙酚全凭静脉麻醉中阻断躯体 切皮刺激反应时瑞太尼的需求量

Remifentanil Requirements During Propofol Administration to Block the Somatic Response to Skin Incision in Children and Adults

Hernán R. Muñoz, Luis I. Cortínez, Mauricio E. Ibacache, and Fernando R. Altermatt

From the Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Anesth Analg 2007 104: 77-80.

 

背景:七氟醚麻醉中阻断儿童 切皮刺激反应所需的瑞太尼的输注量是成人的两倍。在全凭静脉麻醉中有关瑞太尼的需要量是否有着相似的数据暂未阐明。

 法:作者预先设定在全凭静脉麻醉中瑞太尼需要量的输注率(IR)为使50%成人 (IR50) (n = 20, aged 20–60 yr)和儿童(n = 20, aged 3–11 yr) 切皮刺激失去反应的量。下 部手术的病人,输注瑞太尼,靶控输注的异丙酚,维持其血浆浓度6 µg/mL。在气管插管后,将异丙酚的浓度下调至3 µg/mL维持直至研究结束。瑞太尼IR是依据Dixon's up-and-down 法测得的。每组的第一个病人接受0.2 µg · kg–1 · min–1瑞太尼,下一个病人 据 前病人的反应接受0.02 µg · kg–1 · min–1 的变更。瑞太尼的IR在手术 前至少20分钟未发生 变。在手术的开始完成切皮作时,观察躯体的反应。如果躯体有大 度的运确定为反应阳性。

结果:在成人IR50 (CI95%) 0.08 (0.06–0.12) µg · kg–1 · min–1 ,儿童为0.15 (0.13–0.17) µg · kg–1 · min–1 (P < 0.001).

结论:这些结果表明,与七氟醚麻醉相似,异丙酚全凭静脉麻醉中,阻断病人 切皮反应刺激的所需瑞太尼IR在儿童几 是成人量的两倍。

(郑丽 陈杰 校)

BACKGROUND: During sevoflurane administration, children require a remifentanil infusion rate twofold higher than adults to block responses to skin incision. Similar data concerning remifentanil requirements are unavailable during total IV anesthesia.

METHODS: We prospectively determined the infusion rate (IR) of remifentanil necessary to block the somatic response to skin incision in 50% (IR50) of adults (n = 20, aged 20–60 yr) and children (n = 20, aged 3–11 yr) during propofol anesthesia. In each patient undergoing lower abdominal surgery, a remifentanil infusion was initiated, followed by target-controlled infusion of propofol set at a plasma concentration of 6 µg/mL. After tracheal intubation, propofol was reduced to 3 µg/mL until the end of the study. Remifentanil IR was determined according to Dixon's up-and-down method, with the first patient in each group receiving 0.2 µg · kg–1 · min–1 followed by the consecutive patient receiving 0.02 µg · kg–1 · min–1 modifications according to the response of the previous patient. The remifentanil IR was kept unchanged for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic response was observed. If there was any gross movement of extremity the response was considered positive.

RESULTS: The IR50 (CI95%) was 0.08 (0.06–0.12) µg · kg–1 · min–1 in adults and 0.15 (0.13–0.17) µg · kg–1 · min–1 in children (P < 0.001).

CONCLUSION: These results demonstrate that, similar to sevoflurane anesthesia, during total IV anesthesia with propofol, children require a remifentanil IR almost twofold higher than adults to block the somatic response to skin incision.

 

经皮东莨菪碱(TDS)可以作为枢复宁、氟哌利多的替代品来预防术后和出院后呕吐(短篇道)

Transdermal Scopolamine: An Alternative to Ondansetron and Droperidol for the Prevention of Postoperative and Postdischarge Emetic Symptoms (Brief Report)

Paul F. White, Jun Tang, Dajun Song, Jayne E. Coleman, Ronald H. Wender, Babatunde Ogunnaike, Alexander Sloninsky, Rajani Kapu, Mary Shah, and Tom Webb

From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and {dagger}Department of Anesthesiology, Cedars Sinai Medical Center in Los Angeles, Los Angeles, California.

Anesth Analg 2007 104: 92-96.

 

背景:作为常规预防呕吐的药物,关于氟哌利多和高成本的5-HT3拮剂的使用的争论由来已 ,期望一种效价俱佳的替代品。作者设计了一个 行,随机,双盲和有阴性 照和安慰剂的实验来比较A: TDS1.5mg涂 ,B:枢复宁4mg静脉注射,C:氟哌利多1.25mg静脉注射三种 法作为镇吐剂在高呕吐风险的外科人群中的近期、远期镇吐作用和副作用。

 法 150名患者(80名接受 腔镜手术和70名接受整形外科手术)在入手术室一小时前接受了TDS1.5mg或相似安慰剂的涂 。所有患者都接受了标准流程的麻醉。在麻醉结束时两个TDS组静注生理盐水(2ml注射器),安慰剂组给予枢复宁4mg或氟哌利多1.25mg。记录术后恶心呕吐的发生率,需要紧急呕吐治疗的发生率和所有的反应发生率(即没有恶心呕吐或者需要多次紧急呕吐治疗的发生率。另外记录术后72小时视物模,口 ,欲睡和烦躁等 发症的发生率。

结果:在术后72小时内, TDS,枢复宁,氟哌利多三者在呕吐发生率和需要紧急呕吐治疗 面没有显著差异 。所有反应发生率(41%-51%)在各组间无显著性差异。TDS组中口 的发生率显著高于其他两组(21%3%)

结论: 作为常规预防呕吐的药物, 东莨菪碱经皮吸收制剂(TDS)和枢复宁、fpld在预防手术后早期和晚期呕吐症 面同样有效,但TDS更 易诱发口 。

(李惟一 陈杰 校)

BACKGROUND: Given the controversy regarding the use of droperidol and the high cost of the 5-HT3 antagonists, a cost-effective alternative for routine use as a prophylactic antiemetic would be desirable. We designed two parallel, randomized, double-blind sham and placebo-controlled studies to compare the early and late antiemetic efficacy and adverse event profile of transdermal scopolamine (TDS) 1.5 mg, to ondansetron 4 mg IV, and droperidol 1.25 mg IV for antiemetic prophylaxis as part of a multimodal regimen in "at risk" surgical populations.

METHODS: A total of 150 patients undergoing major laparoscopic (n = 80) or plastic (n = 70) surgery procedures received either an active TDS patch (containing scopolamine 1.5 mg) or a similar appearing sham patch 60 min before entering the operating room. All patients received a standardized general anesthetic technique. A second study medication was administered in a 2-mL numbered syringe containing either saline (for the two active TDS groups), droperidol, 1.25 mg, or ondansetron, 4 mg (for the sham patch groups), and was administered IV near the end of the procedure. The occurrence of postoperative nausea and vomiting/retching, need for rescue antiemetics, and the complete response rates (i.e., absence of protracted nausea or repeated episodes of emesis requiring antiemetic rescue medication) was reported. In addition, complaints of visual disturbances, dry mouth, drowsiness, and restlessness were noted up to 72 h after surgery.

RESULTS: There were no significant differences in any of the emetic outcomes or need for rescue antiemetics among the TDS, droperidol, and ondansetron groups in the first 72 h after surgery. The complete response rates varied from 41% to 51%, and did not significantly differ among the treatment groups. The overall incidence of dry mouth was significantly more frequent in the TDS groups than in the droperidol and ondansetron groups (21% vs 3%).

CONCLUSIONS: Premedication with TDS was as effective as droperidol (1.25 mg) or ondansetron (4 mg) in preventing nausea and vomiting in the early and late postoperative periods. However, the use of a TDS patch is more likely to produce a dry mouth.

 

氙气阻滞了在体小鼠髓痛觉通路的突触长程增强效应的传导

Xenon Blocks the Induction of Synaptic Long-Term Potentiation in Pain Pathways in the Rat Spinal Cord In Vivo

Justus Benrath, Christina Kempf, Michael Georgieff, and Jürgen Sandkühler

From the *Klinische Abteilung für Anästhesie und Allgemeine Intensivmedizin B, Medizinische Universität Wien, Währinger Gürtel 18-20, AKH, A-1090 Wien, Austria; {dagger}Institut für Physiologie und Pathophysiologie, Universität Heidelberg, Im Neuenheimer Feld 326, D-69120 Heidelberg; {ddagger}Klinik für Anästhesiologie, Universitätsklinikum Ulm, Steinhövelstrasse 9, D-89075 Ulm, Germany; and Zentrum für Hirnforschung, Abteilung für Neurophysiologie, Medizinische Universität Wien, Spitalgasse 4, A-1090 Wien, Austria.

Anesth Analg 2007 104: 106-111.

背景: 氙气(Xe) 产生麻醉和镇痛的机制 不十分清楚。作者研究了溶解在脂质成分或生理盐水中的Xe 髓C纤维诱发电位以诱导突触长程增强效应(LTP)

 法: C纤维诱发区域电位由浅表腰椎髓 坐骨神经最大限度的电刺激的反应来记录。麻醉由异氟醚(其中含三分 一的O2和二分 一的 N2O )维持的。Xe分别由浓度为600µL/mL 保 宁(Lipofundin MCT 20%)溶解(n=5) 或者直接溶解 (n=3),Xe由浓度100µL/mL的生理盐水 (n=7)或直接溶解(n=7) 在呼吸暂停下静脉注射。坐骨神经的高频刺激在注射Xe复合物后持续60 分钟[诱发LTP].

结果: 高频刺激使C纤维诱发电位达到156% ±14%0.9%生理盐水中低剂量Xe阻滞了LTP的传导. 溶解在MC 20%的高剂量Xe 与直接溶解在溶剂中的相比无附效应,它们都阻滞了LTP.

结论: 0.9%生理盐水中低剂量Xe在髓痛觉传导中无伤害性,反而有保性。

(杨卫红 陈杰 校)

BACKGROUND: Xenon’s (Xe) mechanisms for producing anesthesia and analgesia are not fully understood. We tested the effect of Xe equilibrated in a lipid formulation or normal saline on spinal C-fiber-evoked potentials and on the induction of synaptic long-term potentiation (LTP).

METHODS: C-fiber-evoked field potentials were recorded in the superficial lumbar spinal cord in response to supramaximal electrical stimulation of the sciatic nerve. Anesthesia was maintained with isoflurane in one-third O2 and two-thirds N2O. Xe equilibrated at a concentration of 600 µL/mL of Lipofundin MCT® 20%, (n = 5) or solvent alone (n = 3), and Xe equilibrated at a concentration of 100 µL/mL of normal saline (n = 7) or saline alone (n = 7) was given IV under apnea. High-frequency stimulation of the sciatic nerve was applied 60 min after the injection of Xe-containing formulations or solvents [to induce LTP].

RESULTS: High-frequency stimulation potentiated C-fiber-evoked potentials to 156% ± 14% (mean ± sem) of control. Low-dose Xe in saline 0.9% blocked the induction of LTP. High-dose Xe equilibrated in MC® 20% showed no additional effect when compared with the solvent, which blocked the induction of LTP.

CONCLUSION: Low-dose Xe in saline 0.9% revealed no antinociceptive, but preventive, action in spinal pain pathways.

 

超短效选择性β1受体阻滞剂兰地洛尔 高血压或血压正常病人行气管内插管的血流学效应

The Hemodynamic Effects of Landiolol, an Ultra-Short-Acting ß1-Selective Blocker, on Endotracheal Intubation in Patients With and Without Hypertension

Soichiro Sugiura, Sumihiko Seki, Kohji Hidaka, Miharu Masuoka, and Hideaki Tsuchida

From the Department of Anesthesiology and Perioperative Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan.

Anesth Analg 2007 104: 124-129.

 

背景:兰地洛尔是一种超短效选择性β1受体阻滞剂,在日本 泛应用。作者研究了88名病人应用兰地洛尔后,其 插管引起的肾腺素应激反应的效应。

 法:靶控输注异丙酚进行麻醉诱导和维持,浓度为5ug/ml,给予维库溴胺0.1mg./kg维持肌松。在注射维库溴胺4min后行气管内插管。作者首先在43例血压正常的病人中研究插管前给予兰地洛尔的最佳时间 。然后在45例高血压病人中研究插管后给予兰地洛尔是否能与太尼一样可有效预防心过速。

结果:在血压正常的病人插管前4min0.1mg./kg给予兰地洛尔 于防止插管引起的心过速是最有效的。然而,要预防高血压病人插管后的心过速,兰地洛尔剂量必须为0.2mg/kg。在整个研究期间兰地洛尔 于脉血压或BIS没有显著影响。相反,太尼2ug/kg常引起插管前和插管后5min的低血压。

结论:低剂量的兰地洛尔可有效预防插管后的心过速, 且 脉血压没有显著影响。

(丁震敏 陈杰 校)

BACKGROUND: The ultra-short-acting ß1-selective blocker, landiolol, is widely used in Japan. We investigated the effects of landiolol on intubation-induced adrenergic response in 88 patients.

METHODS: General anesthesia was induced and maintained with target-controlled infusion of propofol at an effect–site concentration of 5 µg/mL. Muscle relaxation was obtained with 0.1 mg/kg vecuronium, and endotracheal intubation was performed 4 min after vecuronium injection. We first investigated the optimal time point for landiolol to be administered before intubation in 43 normotensive patients. Then we examined whether landiolol was as effective as fentanyl to prevent tachycardia after intubation in 45 hypertensive patients.

RESULTS: Landiolol at 0.1 mg/kg was most effective against intubation-induced tachycardia when infused 4 min before intubation in normotensive patients. However, 0.2 mg/kg landiolol was necessary to prevent tachycardia after intubation in hypertensive patients. Landiolol had no significant effects on arterial blood pressure or bispectral index at any dose throughout the study period. In contrast, 2 µg/kg fentanyl frequently caused hypotension just before and 5 min after intubation.

CONCLUSION: Low doses of landiolol can effectively prevent tachycardia after intubation without significant effects on arterial blood pressure.

 

6-σ 法可以用来 善非心脏手术病人的预防性应用菌素

Six Sigma Methodology Can Be Used to Improve Adherence for Antibiotic Prophylaxis In Patients Undergoing Noncardiac Surgery

Brian M. Parker, J. Michael Henderson, Sue Vitagliano, Bala G. Nair, John Petre, Walter G. Maurer, Michael F. Roizen, Monica Weber, Lori DeWitt, Jason Beedlow, Barbara Fahey, Aimee Calvert, Kitty Ribar, and Steven Gordon

From the Division of *Anesthesiology, Critical Care Medicine and Comprehensive Pain Management; {dagger}Surgery; {ddagger}Nursing; and Department of Infectious Disease, The Cleveland Clinic, Cleveland, Ohio.
Anesth Analg 2007 104: 140-146.

 

背景6-σ 法是一种数据处理系统用来促进事情处理近 完美。作者 两个多月中615例手术病人进行调查发现仅仅38%的非心脏手术病人在手术当天同意在接受手术期间的切皮前60分钟内预防性应用菌素。

 法6-σ 法用来 善预防给予菌素时间。一个多学科综合小组 经过鉴定的病人通过预防性菌素的七个输入程序的检查。 善的途径包括术前菌素的强化应用,减少术前菌素的消除,发送适当的菌素 且静脉滴注到手术室。同时进行 照计划用最近开展的用即时测量和的预防性菌素的药的麻醉电子记录系统以支持这个 善 法。在确定这个新 法和保证系统 训 后,启接下来7个月的数据采集和处理。

结果8个月的菌素介入处理后,一个明显的 善就是1716个手术病人中的86%愿意接受有效时间内的预防性应用菌素(p<0.01)。手术切皮前的菌素药时间间隔 从介入前的88分钟(CI 56–119 min)减少到38分钟(CI 25–51 min) (P < 0.01)

结论 6-σ 法可以成地 善手术切皮前预防性应用菌素的时间。麻醉电子记录系统是监督这个 善程序的有用工具。

(张美荣 陈杰 校)

BACKGROUND: Six Sigma methodology is a data management process that can be used to achieve a goal of near perfection in process performance. An audit of 615 surgeries over 2 mo revealed only 38% of noncardiac patients admitted on the day of surgery at our institution received perioperative antimicrobial prophylaxis within the target interval of 60 min before incision.

METHODS: Six Sigma methodology was used to improve our process of timing of antimicrobial prophylaxis administration. A multidisciplinary team was assembled which identified seven process inputs by which patients receive antimicrobial prophylaxis. Interventions for improvement included reinforcement of use of preoperative antibiotic order forms, eliminating administration of antibiotics in the preoperative admission area, and sending appropriate antibiotics and IV tubing with the patient to the operating room. We concurrently developed a control plan to sustain this improvement using a recently deployed electronic anesthesia record keeping system using real-time measurement and reporting capabilities of antimicrobial prophylaxis administration. After defining the new process and undertaking a system-wide educational effort, implementation was begun with data collection and analysis occurring over the next 7 mo.

RESULTS: For the 8-mo postintervention interval, there was a significant improvement with 86% of 1716 surgical patients receiving their antibiotic prophylaxis within the specified time frame (P < 0.01). The time interval for antibiotic administration before surgical incision also decreased from a preintervention mean of 88 (CI 56–119 min) to 38 min (CI 25–51 min) (P < 0.01).

CONCLUSION: We conclude that Six Sigma methods were used to successfully improve our process for timing of perioperative antibiotic prophylaxis before surgical incision. An electronic anesthesia record keeping system is a useful tool to monitor this process improvement.

 

有关麻醉机故障检查的前瞻性研究

A Prospective Study on Anesthesia Machine Fault Identification

Eric R. Larson, Gregory A. Nuttall, Brian D. Ogren, Dean D. Severson, Sarah A. Wood, Laurence C. Torsher, William C. Oliver, and Mary E. Shirk Marienau

From the Department of Anesthesiology, Mayo College of Medicine, Rochester, Minnesota.

Anesth Analg 2007 104: 154-156.

 

背景:尽管近 相关研究比较少,一些研究显示部分操作者不能很好的发现麻醉机故障。

 法:作者设计一前瞻性研究来判定麻醉机故障的发现能是否与麻醉实践时间长短有关。作者假设较长的麻醉实践可以增发现麻醉机故障的能。这 研究在一较大的医疗中心举的全国性麻醉会议提出 实施,当时有87位麻醉医师检查麻醉机,要求参者单独检测其中一台麻醉机,而设置的故障数目 未被知,最后 麻醉机故障检测结果用清单列举出来。

结果: 于麻醉机的5处故障,0-2 经验的参者 均发现3.7,2-7 者为3.6,而超过2-7 者则为2.3(p<0.001)

结论:研究表明麻醉机检查仍然是个问题。

(宋翠侠 陈杰 校)

BACKGROUND: Although few studies have been performed recently, several have suggested that some practitioners are not well able to detect preset anesthesia machine faults.

METHODS: We performed a prospective study to determine whether there is a correlation between duration of anesthesia practice and the ability to detect anesthesia machine faults. Our hypothesis was that more anesthesia practice would increase the ability to detect anesthesia machine faults. This study was performed during a nationally attended anesthesia meeting held at a large academic medical center, where 87 anesthesia providers were observed performing anesthesia machine checkouts. The participants were asked to individually check out an anesthesia machine with an unspecified number of preset faults. The primary outcome measures were the written listing of faults detected during an anesthesia machine checkout.

RESULTS: Of the five faults preset into the test machine, participants with 0–2 yr experience detected a mean of 3.7 faults, participants with 2–7 yr experience detected a mean of 3.6 faults, and participants with more than 7 yr experience detected a mean of 2.3 faults (P < 0.001).

CONCLUSIONS: Our prospective study demonstrated that anesthesia machine checkout continues to be a problem.

 

静注利多卡因减轻哮喘病人气管插管术后支气管收缩反应

Intravenous Lidocaine After Tracheal Intubation Mitigates Bronchoconstriction in Patients with Asthma .

Michael Adamzik, Harald Groeben, Ramin Farahani, Nils Lehmann, and Juergen Peters

From *Klinik für Anästhesiologie und Intensivmedizin; and {dagger}Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany.
Anesth Analg 2007 104: 168-172.

 

背景:尽管预防性静输利多卡因可减轻多种吸入麻醉药所引起的气道反应,但其 于哮喘病人气管内插管后气道阻的影响尚不明确。作者 静注利多卡因可减轻哮喘病人因气管插管引起的支气管收缩反应这一假说作了检验。

 法: 30位哮喘病人( 龄49.1 ± 15.6岁)在标准麻醉诱导 式下(依托咪酯0.3mg/kg,太尼15ug/kg,罗库溴铵0.6mg/kg50%N2O)进行气管插管。分别在气管插管后即刻,以5分钟,10分钟,15分钟后测定气道阻。在插管后5分钟,分别给予利多卡因(5分钟时给予2mg/kg IV 10分钟时给予3mg·kg-1·h-1)或生理盐水。

结果:气管插管后即刻测得的气道阻 均为23±12cmH2O·s·L-1。在注射生理盐水后气道阻进一步升高(+38%),而注射利多卡因后则气道阻较初值下降(-26%P<0.004)。

结论:静注利多卡因可以减轻哮喘病人气管插管术后的支气管收缩反应。

(印洁敏 陈杰 校)

BACKGROUND: Although prophylactic IV administration of lidocaine attenuates the response to a variety of inhalation challenges, its effect on airway resistance after endotracheal intubation in patients with asthma is unclear. We tested the hypothesis that IV lidocaine attenuates intubation-evoked bronchoconstriction in patients with asthma.

METHODS: Thirty patients with asthma (age 49.1 ± 15.6 yr [mean ± sd]) undergoing intubation after standardized anesthetic induction (etomidate 0.3 mg/kg, fentanyl 5 µg/kg, rocuronium 0.6 mg/kg, 50% nitrous oxide) were studied. Airway resistance was measured immediately after intubation and 5, 10, and 15 min later. Five minutes after intubation, either lidocaine (2 mg/kg IV for 5 min, followed by 3 mg · kg–1 · h–1 for 10 min) or saline was administered.

RESULTS: Airway resistance immediately after intubation averaged 23 ± 12 cm H2O · s · L–1. Airway resistance further increased (+38%) after administration of saline, but decreased (–26%, P < 0.004) to less than the initial values after lidocaine.

CONCLUSIONS: IV lidocaine given after endotracheal intubation mitigates bronchoconstriction in patients with asthma.

 

近期服用二甲双胍不会增心脏手术后院内的发病率或死亡率

Recent Metformin Ingestion Does Not Increase In-Hospital Morbidity or Mortality After Cardiac Surgery

Andra I. Duncan, Colleen G. Koch, Meng Xu, Mariel Manlapaz, Brian Batdorf, Grzegorz Pitas, and Norman Starr

Address correspondence to Andra Ibrahim Duncan, MD, Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, 9500 Euclid Avenue/G30, Cleveland, OH 44195.

Anesth Analg 2007 104: 42-50.

 

背景:以往认为,围手术期使用口 降糖药二甲双胍治疗糖尿病会增术后危生命的 酸酸中毒的危险性。但相反,二甲双胍有于控制血糖, 心血管有利,可以降低预后不良的危险。在这 观察研究中,我们希望能明确二甲双胍治疗和发病率、死亡率 间的关系, 与其他行心脏手术的糖尿病患者使用的口服降糖药比较。

 法:这 回顾性研究观察了从1994 到2004 行心脏手术的糖尿病患者,共1284名,有近期口服降糖药史(假定为术前824小时)。 据基线和围手术期变量进行Logist模型分析,得到倾向性得分。 据 配术,442名(85%)二甲双胍治疗的患者与443名非二甲双胍治疗的患者相配 。比较配 的二甲双胍治疗和非二甲双胍治疗患者的术后预后。

结果:两组 间院内死亡率、心脏、肾脏和神经系统的发病率相似。二甲双胍治疗的患者较少出现术后延迟拔管[OR95% CI),0.30.10.7),P = 0.003],感染率[0.20.10.7),P = 0.007]和总发病率[0.40.20.8),P = 0.005]较低。

结论:述数据表明近期二甲双胍治疗与心脏手术后不良预后危险性增无关。相反,二甲双胍治疗有有利作用。

(金琳译 薛张纲校)

BACKGROUND: Perioperative treatment of type 2 diabetes with metformin, an oral hypoglycemic drug, is thought to increase the risk of life-threatening postoperative lactic acidosis. In contrast, metformin improves serum glucose control and has beneficial cardiovascular effects, which may decrease the risk of adverse outcomes. In this investigation we sought to determine the influence of metformin treatment on mortality and morbidity compared with treatment with other oral hypoglycemic drugs in diabetic patients undergoing cardiac surgery.

METHODS: In this retrospective investigation, 1284 diabetic patients, with recent oral hypoglycemic ingestion (presumed to be 8–24 h preoperatively), underwent cardiac surgery from 1994–2004. Propensity scores were calculated from a logistic model which included baseline characteristics and perioperative variables. Four-hundred-forty-three (85%) of the metformin-treated patients were matched on nearest propensity score using greedy matching techniques with 443 nonmetformin-treated patients. Postoperative outcomes were compared between matched metformin- and nonmetformin-treated patients.

RESULTS: In-hospital mortality, cardiac, renal, and neurologic morbidities were similar between groups. Metformin-treated patients had less postoperative prolonged tracheal intubation [OR (95% CI), 0.3 (0.1, 0.7), P = 0.003], infection [0.2 (0.1, 0.7), P = 0.007] and overall morbidities [0.4 (0.2, 0.8), P = 0.005].

CONCLUSIONS: These data suggest that recent metformin ingestion is not associated with increased risk of adverse outcome in cardiac surgical patients. Alternatively, metformin treatment may have beneficial effects.

 

术前应用巴喷丁: 止血带疼痛和局部静脉麻醉质量的影响

Premedication with Gabapentin: The Effect on Tourniquet Pain and Quality of Intravenous Regional Anesthesia

Alparslan Turan, Paul F. White, Beyhan Karamanlioglu, and Zafer Pamukçu

the *Department of Anaesthesiology, Trakya University, Turkey; +Department of Anesthesiology and Perioperative Medicine and ++Outcomes Research Institute, University of Louisville, Kentucky; and [S]Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas

Anesth Analg 2007 104: 97-101.

 

背景:巴喷丁是一类口服的非阿片类镇痛药,用于减少各种外科手术后的疼痛。我们假设术前应用巴喷丁可减少接受局部静脉麻醉(IVRA)病人的止血带相关疼痛。

 法:选择接受IVRA的择期手外伤病人进行随机双盲研究  照组(20),术前1小时给予安慰剂胶,巴喷丁组(20)术前给予巴喷丁1.2g口服。所有患者均以利多卡因3mg/kg进行局部静脉麻醉,利多卡因稀至生理盐水40ml 太尼0.5μg/kg作为补救镇痛药物。在术中 定的时间间隔, 感觉和运阻滞和恢复时间、止血带疼痛 麻醉质量进行评估。术后24小时随访病人的视觉模拟疼痛评分表(0-10)。如果疼痛评分>4,病人接受双氯酸75mg

结果:两组间感觉和运阻滞出现时间 无显著差异。 但是,当套充气30405060分钟后,巴喷丁组的止血带疼痛评分显著降低(P<0.05)。巴喷丁组应用补救性镇痛药的间隔明显延长(35 +/- 10 min vs 21 +/- 13 min, P < 0.05),且太尼用量明显减少(35 +/- 47 [mu]g vs 83 +/- 73 [mu]g, P < 0.05)。麻醉医师和外科医师独立评价麻醉质量,巴喷丁组明显好于 照组。 在巴喷丁组,术后应用补救药物进行止痛的间隔显著延长(135 +/- 25 min vs 85 +/- 19 min, P < 0.05),术后60min120min的疼痛评分以双氯酸的用量 明显降低。(分别为3.8 +/- 0.9 vs 2.2 +/- 0.53.2 +/- 1.4 vs 1.8 +/- 0.830 +/- 38 mg vs 60 +/- 63 mg)

结论:术前口服巴喷丁1.2g降低了手外科的止血带相关疼痛,提高了麻醉质量。巴喷丁同样可以降低术后早期的疼痛评分。

(王丽珺译 薛张纲校)

BACKGROUND: Gabapentin, an oral non-opioid analgesic, has been used to decrease pain after a variety of surgical procedures. We hypothesized that premedication with gabapentin would minimize tourniquet-related pain in patients receiving IV regional anesthesia (IVRA).
METHODS: Patients undergoing elective hand surgery with IVRA were randomly assigned to one of two study groups using a double-blind study design. The control group (n = 20) received placebo capsules 1 h before the surgery, and the gabapentin group (n = 20) received gabapentin 1.2 g p.o. before the operation. IVRA was achieved in all patients with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Fentanyl, 0.5 [mu]g/kg IV, was administered as a rescue analgesic during surgery. Sensory and motor block onset and recovery times, tourniquet pain, and quality of anesthesia were assessed at specific time intervals during the perioperative period. Visual analog scale pain scores (0-10) were recorded during the 24 h follow-up period, and patients received diclofenac, 75 mg IM, if their pain score was >4.
RESULTS: The onset of the sensory and motor block did not differ between the two study groups. However, tourniquet pain scores at 30, 40, 50, and 60 min after cuff inflation were lower in the gabapentin group (P < 0.05). The time to intraoperative analgesic rescue was prolonged in the gabapentin group (35 +/- 10 min vs 21 +/- 13 min, P < 0.05), and less supplemental fentanyl was required (35 +/- 47 [mu]g vs 83 +/- 73 [mu]g, P < 0.05). The quality of anesthesia, as independently assessed by the anesthesiologist and the surgeon, was significantly better in the gabapentin (versus control) group. In the gabapentin group, the time to requesting a rescue analgesic after surgery was prolonged (135 +/- 25 min vs 85 +/- 19 min, P < 0.05), and postoperative pain scores at 60 min (3.8 +/- 0.9 vs 2.2 +/- 0.5) and 120 min (3.2 +/- 1.4 vs 1.8 +/- 0.8), as well as diclofenac consumption (30 +/- 38 mg vs 60 +/- 63 mg), were reduced after surgery.
CONCLUSIONS: Premedication with oral gabapentin (1.2 g) decreased tourniquet-related pain and improved the quality of anesthesia during hand surgery under IVRA. Gabapentin also reduced pain scores in the early postoperative period.

 

 

异丙酚通过a-肾腺素受体激活增正常和野百合诱导的肺高压大鼠肺血管阻

Propofol increases pulmonary vascular resistance during alpha-adrenoreceptor activation in normal and monocrotaline-induced pulmonary hypertensive rats.

Edanaga M, Nakayama M, Kanaya N, Tohse N, Namiki A.

Department of Anesthesiology,Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.

Anesth Analg. 2007 Jan;104(1):112-8

 

背景:利用来自正常和野百合诱导的肺高压大鼠的分离肺灌注,研究异丙酚 肺血管阻的影响是否依赖a-肾腺素受体激活。 法:检测不同浓度异丙酚(10(-5) to 10(-4) M)诱导的肺灌注压的变化, 分为有或没有苯肾腺素(10(-6) M)与处理组。苯肾腺素入前,先检测NO合酶制剂(N(omega)-nitro-l-arginine methylester: 10(-4) M)、环氧化酶(indomethacin: 10(-5) M)和蛋白激酶C制剂——双吲哚亚醯铵bisindolylmaleimide I (10(-6) M)calphostin C (10(-6) M)  肺灌注压的影响结果:NO合酶制剂和吲哚美 预处理正常大鼠后,苯肾腺素 其肺灌注压变化的影响有区别(5 +/- 3 and 7 +/- 2 mm Hg);然而bisindolylmaleimide I预处理野百合(MCT)肺高压大鼠后,苯肾腺素 其肺灌注压变化的影响小(2 +/- 1 mm Hg)。在苯肾腺素预处理正常和MCT诱导的大鼠中异丙酚导致肺血管收缩。正常大鼠中异丙酚在吲哚美 预处理后与非处理相比导致的肺灌注压变化略小于(p<0.05)。MCT处理的大鼠中两种蛋白激酶C制剂处理后异丙酚导致的肺灌注压与非处理相比变化要小(P < 0.05)。结论:异丙酚通过a-肾腺素受体激活增肺血管阻。

(吴德华译 薛张纲校)

BACKGROUND: Using isolated perfused lungs of normal or monocrotaline (MCT: 50 mg/kg)-induced pulmonary hypertensive rats, we tested the hypothesis that the pulmonary vascular effects of propofol depend on activation of the alpha-adrenoreceptor. METHODS: Changes in pulmonary perfusion pressure induced by propofol (10(-5) to 10(-4) M) were measured with or without phenylephrine (10(-6) M) pretreatment. Before phenylephrine administration, we assessed the effects of inhibitors of nitric oxide synthase (N(omega)-nitro-l-arginine methylester: 10(-4) M), cyclooxygenase (indomethacin: 10(-5) M), and protein kinase C inhibitor, bisindolylmaleimide I (10(-6) M) or calphostin C (10(-6) M). RESULTS: Changes in pulmonary perfusion pressure by phenylephrine after pretreatment of nitric oxide synthase inhibitor and indomethacin in normal rats were significant (5 +/- 3 and 7 +/- 2 mm Hg), whereas that after pretreatment of bisindolylmaleimide I were small in MCT-rats (2 +/- 1 mm Hg). Propofol caused pulmonary vasoconstriction after phenylephrine pretreatment both in normal and MCT-treated rats. In normal rats, the propofol-induced increase in pulmonary perfusion pressure after indomethacin pretreatment was slightly smaller than that in the non-pretreated lungs (P < 0.05). In MCT-treated rats, the propofol-induced increases in pulmonary perfusion pressure after both protein kinase C inhibitors were smaller than that in the non-pretreated lungs (P < 0.05). CONCLUSIONS: Propofol may increase pulmonary vascular resistance during alpha-adrenoreceptor activation.

 

 

安那康达反射过滤片:用于评估工作台和病人的安全性和挥发性麻醉剂的保存

AnaConDa® Reflection Filter: Bench and Patient Evaluation of Safety and Volatile Anesthetic Conservation

Jerôme Berton, Cyril Sargentini, Jean-Luc Nguyen, Adrian Belii, and Laurent Beydon

Anesthesia and Intensive Care Unit, Angers Teaching Hospital, Angers, France
Anesth Analg 2007 104: 130-134.

 

背景:安那康达过滤片能够在不需要使用麻醉机的情况下供给挥发性麻醉剂。它的设计初衷是在重症监室里使用。 法:我们通过工作台和麻醉病人来研究安那康达反射滤过片。工作台分析需要一个测试肺模型、一台气体分析仪、一台重症监通气机、安那康达过滤片和一台注射泵。我们研究潮气量、呼吸频率和呼气末正压通气值的变化范围, 模拟一些再输注和病人转运过程中的错误。在15名麻醉病人中,我们通过安那康达过滤片给予一定的通气变量、恒定的七氟醚输入流量(45ml/h)和两条相连的新鲜气流。结果:在工作台研究组中,呼出的挥发性麻醉剂的浓度降低在分钟通气量恒定时与呼吸频率呈线性相关,在呼吸频率恒定时与潮气量的增呈负相关。 变呼气末正压通气值和吸-呼比 安那康达无影响。需要注意几个安全性的故障:由于泵入效应,再输注会一过性 变安那康达的输出量,标准活塞可将卤化注射管连接在静脉输注通路。 于麻醉病人,将新鲜气流从8L/min降至1L/min可导致呼出气内挥发性麻醉剂成份增40%。结论:该研究证实了此设备是可靠的,但有些情况下实际输出的麻醉剂要比预计的要多。

(王慧琳译 薛张纲校)

BACKGROUND: The AnaConDa filter permits administration of volatile anesthetic without the use of an anesthesia machine. It is intended for use in the intensive care unit. METHODS: We studied the AnaConDa reflection filter on the bench and in anesthetized patients. The bench analysis used a test lung, a gas analyzer, an intensive care ventilator, the AnaConDa filter, and a syringe pump. We studied a range of tidal volume, respiratory rate, and positive end-expiratory pressure values. We simulated errors during syringe refilling and patient transportation. In 15 anesthetized patients, we used the AnaConDa with constant ventilation variables, a constant sevoflurane infusion rate (4-5 mL/h), and two consecutive fresh gas flow levels. RESULTS: In the bench study, the expired volatile anesthetic fraction decreased linearly with respiratory frequency at constant minute ventilation, and decreased markedly in a hyperbolical manner when tidal volume increased at a constant respiratory rate. Changing the positive end-expiratory pressure level and inspiration/expiration ratio did not modify the AnaConDa's performance. Several safety failures were observed: refilling caused a transient change in AnaConDa output because of a pumping effect, and a standard Luer lock made it possible to connect the halogenate syringe on an IV infusion line. In anesthetized patients, reducing fresh gas flow from 8 to 1 L/min led to a median 40% increase in the expired volatile anesthetic fraction. CONCLUSIONS: This study shows that the device is generally reliable, but that there are several conditions under which it might deliver more anesthetic than intended.

 

小儿麻醉的新向:一  已完结案例的分析

An update on pediatric anesthesia liability: a closed claims analysis

Jimenez N, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB.

Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington 98195-6540, USA.

Anesth Analg 2007 104: 147-153.

背景:呼吸系统的 发症和从1970 到1980 的ASA的闭合要求数据库中的儿科医疗事故有关。儿科麻醉在19801990 代有了进步, 预示了其发展趋。

 法:我们回顾性研究了53230 间(19732000) 数据库中的儿科医疗事故( 龄<或=16岁),应用逻辑回归分析。我们研究了1990 到2000 的案例来明确损伤。

结果:从19732000,死亡/BD和呼吸系统的 发症,尤其是不完全的通气和氧合比例正在下降。但是,1990 代,死亡(41%)和BD21%)仍是儿科麻醉的主要损害。19902000 间的事故一是3岁或更小的病人,五分 一是ASA35级的病人。心血管事件(26%)和呼吸系统 发症(23%)是最常见的损害事件。影响1990的死亡/BD值的因素是心血管事件(优比[OR] = 6.6, 95% 可信区间是[CI] = 2.5-17.8),呼吸系统 发症(OR = 3.7, 95% CI = 1.5-9.4), ASA 3-5(OR = 3.1, 95% CI = 1.3-7.8)

结论:死亡/BD值仍是1990 代儿科麻醉医疗事故中最主要的损害,心血管事件和呼吸系统 发症是

(钟静译 薛张纲校)

BACKGROUND: Respiratory complications were associated with half of pediatric malpractice claims from the 1970s to 1980s in the ASA Closed Claims Database. Advances in pediatric anesthesia practice have occurred in the 1980s and 1990s and may be reflected in liability trends. METHODS: We reviewed 532 pediatric (age < or =16 yr) malpractice claims from our database over three decades (1973-2000), using logistic regression analysis to evaluate trends over time. Claims from 1990 to 2000 (1990s) were reviewed in detail to determine damaging events and injuries. Multiple logistic regression analysis evaluated factors associated with claims for death/brain damage (BD) compared with claims for less severe injuries. RESULTS: From 1973 to 2000, there was a decrease in the proportion of claims for death/BD (P = 0.002) and respiratory events (P < 0.001), particularly for inadequate ventilation/oxygenation (P < 0.001). However, claims for death (41%) and BD (21%) remained the dominant injuries in pediatric anesthesia claims in the 1990s. Half of the claims in 1990-2000 involved patients 3 yr or younger and one-fifth were ASA 3-5. Cardiovascular (26%) and respiratory (23%) events were the most common damaging events. Factors associated with claims for death/BD in the 1990s when compared with claims for less severe injuries were cardiovascular events (odds ratio [OR] = 6.6, 95% confidence interval [CI] = 2.5-17.8), respiratory events (OR = 3.7, 95% CI = 1.5-9.4), and ASA status 3-5 (OR = 3.1, 95% CI = 1.3-7.8). CONCLUSIONS: Death/BD remained the dominant injuries in pediatric anesthesia malpractice claims in the 1990s. Cardiovascular events joined respiratory events as the major sources of liability.

 

 

在低 量休克的猪模型胸腔内压调可以 善其24小时的生存率

Intrathoracic Pressure Regulation Improves 24-Hour Survival in a Porcine Model of Hypovolemic Shock

Demetris Yannopoulos, MD*, Scott McKnite, BSc{dagger}, Anja Metzger, PhD{ddagger}, and Keith G. Lurie, MD||¶

From the *Department of Cardiology, University of Minnesota;

Anesth Analg 2007;104:157-162

 

胸腔内压调器(ITPR)正压通气(PPV)在低 量血症时,通过 善 均脉压降低右房和颅内压来增冠脉和颅内的灌注压。我们假设在严重低 量的猪模型中间断使胸腔内负压可以增24小时的生存率。18只被异氟醚麻醉的猪放了55%它的估计血 量,然后随机分为-8 mm Hg ITPRPPV或者单纯PPV治疗90分钟。所有 存的猪血液回输。在90分钟中,监测脉血气、呼末CO2 和主脉压。在再灌注后1224小时评估神经系统。结果:ITPR PPV治疗90分钟防止了代酸的进展,明显 善了 均脉压(90分钟 均值,55 ± 3   35 ± 2.4 mm Hg, P < 0.001 )和 照组相比。和 照组相比,24小时的生存率明星 善9/9 (100%) vs 1/9 (11%), P < 0.01。结论:和单纯用PPV治疗的 照组相比,使用ITPR PPV可以明显 善脉压和24小时生存率。

(陆文清译 薛张纲校)

The intrathoracic pressure regulator (ITPR) plus positive pressure ventilation (PPV) has been shown to improve coronary and cerebral perfusion pressures during hypovolemia by improving mean arterial blood pressure and by decreasing right atrial and intracranial pressures. We hypothesized that application of intermittent negative intrathoracic pressure in a pig model of severe hypovolemic hypotension would increase 24-h neurological intact survival rates. Eighteen isoflurane-anesthetized pigs were bled 55% of their estimated blood volume and were then prospectively randomized to either ITPR treatment with –8 mm Hg endotracheal pressure plus PPV or only PPV alone for 90 min. All survivors were reinfused with their own blood. Arterial blood gases, end-tidal CO2, and aortic pressures were monitored for the 90 min and neurological evaluation was performed at 12 and 24 h after reinfusion. RESULTS: ITPR plus PPV treatment for 90 min prevented the progression of metabolic acidosis and significantly improved mean arterial blood pressure (mean over 90 min, 55 ± 3 vs 35 ± 2.4 mm Hg, P < 0.001) when compared with controls. Twenty-four hour survival significantly improved with use of the ITPR when compared with untreated controls: 9/9 (100%) vs 1/9 (11%), P < 0.01. CONCLUSIONS: Use of the ITPR plus PPV for 90 min significantly increased arterial blood pressure and 24 h neurologically intact survival rates compared with controls treated with PPV alone.

 

 

啮齿类静脉注射非肽类ORL1受体激剂后的催眠、脑电图和伤害感受 性

The Hypnotic, Electroencephalographic, and Antinociceptive Properties of Nonpeptide ORL1 Receptor Agonists After Intravenous Injection in Rodents

Byford AJ, Anderson A, Jones PS, Palin R, Houghton AK

Department of Pharmacology, Organon Laboratories Ltd, Newhouse, Lanarkshire, United Kingdom.

Anesth Analg 2007 104: 174-179.

 

背景:阿片受体样受体1(ORL1)激剂诱发啮齿类运障碍,镇静和正向反射消失(LRR)。此受体可能在麻醉领域成为新颖的靶 。 法:我们检测了两种静脉注射非肽类ORL1激剂,(Ro 65-6570 Org 26383)后的催眠,脑电图和伤害感受效应,在小鼠和大鼠中运用LRR,在大鼠中运用脑电爆发制百分比,在小鼠中运用脚爪福尔马林试验。结果:在小鼠中,Ro 65-6570Org 26383诱发LRRRo 65-6570 Org 26383催眠剂量分别为0.63.7 micromol/kg)。纳洛酮 两种复合物诱发的睡眠时间无显著效应。在大鼠中,Ro 65-6570 (0.6-2.4 micromol/kg)Org 26383 (4-8 micromol/kg)诱发LRR和脑电爆发制活。睡眠时间和爆发制活都能被选择性ORL1拮剂显著减少。在小鼠中,福尔马林诱发的伤害感受发生剂量依赖性制(Ro 65-6570 Org 26383分别为 Phase 1 ED50 0.41.8 micromol/kgPhase 2 ED50 0.44.2 micromol/kg)。结论:这些结果表明Ro 65-6570Org 26383(很可能通过ORL1受体)在小鼠和大鼠中可作为静脉催眠和镇痛剂, 且催眠和伤害感受剂量相仿。

(徐丽颖译 薛张纲校)

BACKGROUND: Agonists at the opioid receptor-like receptor 1 (ORL1) induce motor impairment, sedation, and loss of righting reflex (LRR) in rodents. This receptor may provide a novel target in the field of anesthesia. METHODS: We examined the hypnotic, electroencephalographic (EEG), and antinociceptive effects of two IV administered nonpeptide ORL1 agonists, (Ro 65-6570 and Org 26383), using LRR in mice and rats, percent EEG burst suppression in rats, and formalin paw test in mice. RESULTS: In mice, Ro 65-6570 and Org 26383 produced LRR (hypnotic dose 0.6 and 3.7 micromol/kg for Ro 65-6570 and Org 26383, respectively). Naloxone had no significant effect on sleep times produced by both compounds. In rats, Ro 65-6570 (0.6-2.4 micromol/kg) and Org 26383 (4-8 micromol/kg) produced LRR and burst suppression activity in the EEG. Both sleep times and burst suppression activity were significantly reduced with a selective ORL1 antagonist. In mice, dose-dependent inhibition of formalin-induced nociceptive behaviors occurred (Phase 1 ED50 0.4 and 1.8 micromol/kg and Phase 2 ED50 0.4 and 4.2 micromol/kg for Ro 65-6570 and Org 26383, respectively). CONCLUSIONS: These results show that Ro 65-6570 and Org 26383 (probably via the ORL1 receptor) behave as IV hypnotics and analgesics in mice and rats, and that the hypnotic and antinociceptive doses are similar.

 

 

输注脂类 L-布比卡因中毒的大鼠离体心脏心肌能和生物能量学的作用

The Effects of Lipid Infusion on Myocardial Function and Bioenergetics in l-Bupivacaine Toxicity in the Isolated Rat Heart

Sebastian N. Stehr, MD*, Jrg C. Ziegeler, BS*, Annette Pexa, BS, Reinhard Oertel, PhD, Andreas Deussen, MD, Thea Koch, MD*, and Matthias Hbler, MD, DEAA*

From the *Department of Anesthesiology and Intensive Care Medicine; Institute of Physiology; and Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany.

Anesth Analg 2007;104:186-192

 

背景:至仍不清楚 善代谢或脂类输注引起的脂类槽是否能 善局麻药引起的心肌制。
 法:我们使用大鼠离体心脏,恒定灌注压非循环 式Langendorff准备, 暴露心脏于5 g/mLL-布比卡因和9 g/mL脂质 剂。冷冻钳 心脏 用HPLC来测定能量。在另一个实验中评估起搏心脏的作用。使用质谱仪来测定入脂类 在Krebs–Henseleit缓冲液和人类血浆中的局麻药的作用。

结果:L-布比卡因使自主搏的心脏心率显著下降(74% 7%的基线),+dP/dt 下降(69% 7%),收缩压下降(78% 6%), 冠脉血流下降 (61% 8%),延长PR (177% 52%)QRS间期(166% 36%)。在L-布比卡因处理过的心脏中输注脂类发挥了增强正性肌作用,显著增+dP/dt和收缩压至94% 11% 102% 16%的基线。在脂类 预后,心率,冠脉血流,PRQRS间期保持不变。脂类输注在搏心脏中 +dP/dt,收缩压和 Mvo2有显著作用。L-布比卡因和脂质 能量负荷都没有作用。脂类浓度须达到500 L/mL 血浆来 变血浆中的局麻药浓度。

总结:脂类 L-布比卡因导致的心脏制有显著的正性肌作用,我们将其归结于直接正性肌作用。然而,在离体心脏中,间接的,局麻药血浆与脂类结合的作用不能被排除。

(周荻 薛张纲校)

BACKGROUND: It is unclear whether improved metabolism or a "lipid sink" effect of lipid infusion is responsible for the positive effects in local anesthetic-induced myocardial depression.

METHODS: We used an isolated rat heart, constant-pressure perfused, nonrecirculating Langendorff preparation and exposed hearts to 5 g/mL l-bupivacaine and 9 L/mL lipid emulsion. Hearts were freeze-clamped and energy was charge measured by HPLC. In a second experiment the effects of pacing hearts was evaluated. The effects of lipid addition on local anesthetic concentrations in Krebs–Henseleit buffer and human plasma were examined by using a mass spectrometer.

RESULTS: With spontaneously beating hearts l-bupivacaine led to a significant decrease in heart rate (to 74% 7% of baseline), +dP/dt (69% 7%), systolic pressure (78% 6%), coronary flow (61% 8%), and to an increase in PR (177% 52%) and QRS intervals (166% 36%). Lipid infusion exerted a positive inotropic effect, significantly augmenting +dP/dt and systolic pressure back to 94% 11% and 102% 16% of baseline in l-bupivacaine-treated hearts. Heart rate, coronary flow, PR, and QRS intervals remained unchanged after lipid intervention. Lipid infusion in paced hearts had a significant effect on +dP/dt, systolic pressure, and Mvo2. Neither l-bupivacaine nor lipids had an effect on energy charge. A lipid concentration of 500 L/mL plasma was necessary to effect changes in the plasma concentration of local anesthetics.

CONCLUSION: Lipid application in l-bupivacaine-induced cardiac depression had a significant positive inotropic effect, which we would attribute to a direct inotropic effect. However, in an isolated heart model, indirect, local anesthetic plasma-binding effect of lipids cannot be excluded.

 

在冠脉搭桥手术期间监测脑氧饱和度:一个随机前瞻性研究"

Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study

John M. Murkin, MD, FRCPC*, Sandra J. Adams, RN*, Richard J. Novick, MD, FRCSC, Mackenzie Quantz, MD, FRCPS, Daniel Bainbridge, MD, FRCPC*, Ivan Iglesias, MD*, Andrew Cleland, RRT{ddagger}, Betsy Schaefer, BSc*, Beverly Irwin, RN*, and Stephanie Fox, RRT

From the *Department of Anesthesiology and Perioperative Medicine; {ddagger}Clinical Perfusion Services; and Division of Cardiac Surgery, University Hospital-LHSC, University of Western Ontario, London, Ontario, Canada.

Anesth Analg 2007;104:51-58

背景:脑部缺氧可导致各种全身不利后果。我们假设,脑部作为指示脏器, 善脑部氧合的 涉 心脏手术患者全身脏器有利。

 法:200例冠脉搭桥患者随机分为术中有积极的显示处理 预 案地监测脑部局部氧饱和度(rSO2)( 涉组, n = 100),或监测rSO2但不知监测结果 ( 照组, n = 100)。预先定 的临结果由不知道监测结果的观察者评估。

结果: 照组与 涉组比较有明显多的患者脑部去饱和时间较长(P = 0.014)且在ICU时间较长(P = 0.029)。不利 发症的总体发生率无差异,但与 涉组相比,较多的 照组患者有大脏器发病或死亡(死亡、控制呼吸>48小时、中风、心肌梗死、再次探查手术) (P = 0.048)。经历大脏器发病或死亡的患者与那些没有这些 发症的患者相比有较低的rSO2基础值和 均值,脑部去饱和较多,且ICU时间术后住院时间延长。术中rSO2 和术后需要住院时间大于10天的患者的住院时间呈明显的负相关性(r2 = 0.29)。

结论:在冠脉搭桥患者中监测脑rSO2 能避免深度的脑部缺氧,且使大脏器能失常的发生率降低。

(彭中美 马皓琳 李士通 )

BACKGROUND: Cerebral deoxygenation is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions to improve cerebral oxygenation would have systemic benefits in cardiac surgical patients.

METHODS: Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO2) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO2 monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer.

RESULTS: Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation >48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencing major organ morbidity or mortality had lower baseline and mean rSO2, more cerebral desaturations and longer lengths of stay in the intensive care unit and postoperative hospitalization, than patients without such complications. There was a significant (r2 = 0.29) inverse correlation between intraoperative rSO2 and duration of postoperative hospitalization in patients requiring 10 days postoperative length of stay.

CONCLUSION: Monitoring cerebral rSO2 in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.

 

 

心电图控制中心静脉导管放置的精确性

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Ralf E. Gebhard, MD*, Peter Szmuk, MD{dagger}, Evan G. Pivalizza, MBChB, FFASA{ddagger}, Vladimir Melnikov, MD{ddagger}, Christianne Vogt, MD{ddagger}, and Robert D. Warters, MD{ddagger}

From the *Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, Florida; {dagger}Department of Anesthesiology, The University of Texas Southwestern Medical School at Dallas and Children's Medical Center Dallas, Dallas; and {ddagger}Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas.

Anesth Analg 2007;104:65-70

研究背景:在美国的手术室里,术前很少使用心电图(ECG)引导来确定中心静脉导管(CVC)的精确位置。我们设计了这 随机、 照试验,以研究这 术的应用是否影响CVC的精确放置。

 法:ECG组患者(n = 147)用右房ECG引导导管尖端定位来放置CVCNO-ECG(n = 143)在无此 法的条件下定位CVCs

结果:总体ECG引导下CVCs定位更精确(96% 76%, P 0.001),且 不增放置时间。尽管NO-ECG组明显有更多的CVC放置到右心房或右心室其它血管(P 0.001)ECG组明显有更多的CVCs放到在腔静脉的中段(P 0.001)NO-ECG组中有20位病人在术后需重新调整CVC位置,而在ECG组中仅有3位需要此 操作。

结论:ECG引导下可以更精确地放置CVC,且应该考虑用它来增病人的安全性降低重新调整CVC位置的成本。

(裘毅敏译,马皓琳 李士通校)
BACKGROUND:
Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement.

METHODS: Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique.

RESULTS: Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P 0.001).

CONCLUSIONS: ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.

 

 

小儿发生谵妄:问题多,答案少

Emergence Delirium in Children: Many Questions, Few Answers

Gordana P. Vlajkovic, MD*{dagger}, and Radomir P. Sindjelic, MD, PhD*{dagger}

From the *Department of Anesthesiology, Belgrade University Medical School; and {dagger}Institute for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia.

Anesth Analg 2007;104:84-91

新一代吸入麻醉药临应用于小儿已经引发了术后谵妄较高的发生率,尽管持续时间较短,却是病因不明的麻烦的临现象。各种麻醉的、手术的、病人的、辅用药相关的因素都被认为在这种事件的发生中起了一个潜在性的作用。谵妄发生时不安的行为不仅使小儿不适, 使其理者和父母 麻醉恢复质量不满意。虽然小儿易激 的严重程度不同,但通常都需要额外的理镇痛或镇静处理,这可能延迟出院时间。为了减少这种不良事件的发生率,我们建议术前应鉴别病儿是否存在发生这种不良反应的风险, 采取预防性措施,例如减少术前的焦虑、去处术后疼痛提供一个安静无应激的麻醉后恢复环境。需要更多的临试验来阐明原因提供有效的治疗。

(张  马皓琳 李士通校)

The introduction of a new generation of inhaled anesthetics into pediatric clinical practice has been associated with a greater incidence of ED, a short-lived, but troublesome clinical phenomenon of uncertain etiology. A variety of anesthesia-, surgery-, patient-, and adjunct medication-related factors have been suggested to play a potential role in the development of such an event. Restless behavior upon emergence causes not only discomfort to the child, but also makes the caregivers and parents feel unhappy with the quality of recovery from anesthesia. Although the severity of agitation varies, it often requires additional nursing care, as well as treatment with analgesics or sedatives, which may delay discharge from hospital. To reduce the incidence of this adverse event, it is advisable to identify children at risk and take preventive measures, such as reducing preoperative anxiety, removing postoperative pain, and providing a quiet, stress-free environment for postanesthesia recovery. More clinical trials are needed to elucidate the cause as well as provide effective treatment.

 

 

一 在控制通气中比较Cobra喉周气道与经典喉罩气道用于妇科 腔镜手术的前瞻性随机研究

A Randomized Prospective Study Comparing the Cobra Perilaryngeal Airway and Laryngeal Mask Airway-Classic During Controlled Ventilation for Gynecological Laparoscopy

Eilish M. Galvin, MB, FCARCSI, Mirjam van Doorn, MD, Juan Blazquez, MD, FRCA, Johannes F. Ubben, MSc, Freek J. Zijlstra, PhD, Jan Klein, MD, PhD, and Serge J. C. Verbrugge, MD, PhD

From the Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Anesth Analg 2007;104:102-105

背景:现在可供使用的声门无创气道来多。在这一随机单盲研究中,我们比较了Cobra喉周气道(CobraPLA)和经典喉罩气道[LMA-Classic]在妇科 腔镜手术中的应用。

 法:四十例病人分别接受LMA-Classic或者CobraPLA。记录放置、通气和拔除气道时的  以喉部 发症发病率。

结果:两种设备放置  、不良事件和喉部 发症发病率均相似。在建立气 前,LMA-Classic组和CobraPLA组气道峰压分别为20.3 ± 4.9 cm H2O25.5 ± 7.9 cm H2OP = 0.01。在气 期间维持这一差异:LMA-Classic 组气道峰压22.8 ± 6.1 cm H2O CobraPLA 28.1 ± 8.5 cm H2O, P = 0.04。仅CobraPLA40%在拔除气道后肉眼可见CobraPLA有血 ,P = 0.001

结论:在妇科 腔镜手术中,CobraPLA气道与LMA-Classic气道放置  相似,气道密闭压更高。本发现的有用性还有待进一步研究。

(颜涛 译,马皓琳 李士通 校)
BACKGROUND:
An increasing number of noninvasive, supraglottic airway devices are currently available. In this randomized single-blind study, we compared the Cobra Perilaryngeal Airway (CobraPLA) to the [Laryngeal Mask Airway (LMA)-Classic] during gynecological laparoscopy.

METHODS: Forty patients received either an LMA-Classic or a CobraPLA. Insertion, ventilation and removal characteristics were noted, as well as any throat morbidity.

RESULTS: Devices were similar for insertion characteristics, adverse events, and throat morbidity. Before pneumoperitoneum, peak airway pressures were 20.3 ± 4.9 cm H2O in the LMA-Classic group versus 25.5 ± 7.9 cm H2O in the CobraPLA group, P = 0.01. This difference was maintained during pneumoperitoneum; LMA-Classic (22.8 ± 6.1 cm H2O) and CobraPLA (28.1 ± 8.5 cm H2O), P = 0.04. Macroscopic blood occurred only on the CobraPLA, seen on 40% of the devices after removal, P = 0.001.

CONCLUSION: During gynecological laparoscopy, the CobraPLA provides similar insertion characteristics, but higher airway sealing pressures than the LMA-Classic. The usefulness of this finding requires further investigation.

 

 

利多卡因和布比卡因 大鼠海马脑片中分裂胱天冬酶3的蛋白表达酪氨酸磷酸化的作用

The Effects of Lidocaine and Bupivacaine on Protein Expression of Cleaved Caspase 3 and Tyrosine Phosphorylation in the Rat Hippocampal Slice

Souhayl Dahmani, MD*{dagger}, Danielle Rouelle*{dagger}, Pierre Gressens, MD, PhD*{dagger}, and Jean Mantz, MD, PhD*{dagger}

From the *Department of Anesthesia, Beaujon University Hospital, Assistance Publique des Hôpitaux de Paris and Paris 7 University, Clichy, France; and {dagger}Institut National de la Santé et de la Recherché Médicale (INSERM U 676), Paris, France.

Anesth Analg 2007;104:119-123

有道采用利多卡因行麻后出现严重神经系统后遗症,脑液中达到的高浓度被认为是其原因。我们早期研究显示利多卡因可促进成簇黏附激酶(FAK, 一种在神经可塑性和细胞死亡中起作用的非受体酪氨酸激酶)磷酸化。本次研究比较了利多卡因和布比卡因 大鼠海马脑片中FAK磷酸化和分裂胱天冬酶3表达的作用。用浓度逐渐增的利多卡因(4.3 nM to 4.3 mM )或布比卡因(3.4 nM to 3.4 mM )处理海马脑片的同时添或不添FAK酪氨酸激酶 异性制剂PP2 (10 µM)。免疫印 法检测胱天冬酶3表达FAK磷酸化。利多卡因可浓度依赖地增FAK磷酸化,而布比卡因的作用是双相性的。毫摩尔浓度的利多卡因的最大效应显著高于临等效布比卡因浓度的最大作用(4.3 x 10–3 M 利多卡因: 168% ± 20%, 均值±标准差; 10–3 M 布比卡因: 145% ± 19% P < 0.001. 毫摩尔浓度的利多卡因而非布比卡因增分裂胱天冬酶3的表达,此作用可被PP2阻断。我们的结果表明毫摩尔浓度的利多卡因而非布比卡因增分裂胱天冬酶3的表达。FAK磷酸化在此效应中的作用有待阐明。
(周雅春 马皓琳 李士通 校)

Severe neurologic sequelae have been reported with the use of lidocaine after spinal anesthesia. This is considered a consequence of the high concentrations reached in the cerebrospinal fluid. We have previously shown that lidocaine increases the phosphorylation of focal adhesion kinase (FAK, a nonreceptor tyrosine kinase playing a role in neuronal plasticity and cell death). Here, we compared the effects of lidocaine and bupivacaine on FAK phosphorylation and cleaved caspase 3 expression in rat hippocampal slices. Slices were treated with increasing concentrations of lidocaine (4.3 nM to 4.3 mM) or bupivacaine (3.4 nM to 3.4 mM) in the presence or absence of the specific inhibitor of the FAK tyrosine kinase PP2 (10 µM). Caspase 3 expression and FAK phosphorylation were examined by immunoblotting. Lidocaine induced a concentration-related increase in FAK phosphorylation while the bupivacaine effect was biphasic. The maximal effect observed with millimolar lidocaine concentrations was significantly more than with clinically equipotent bupivacaine concentrations (4.3 x 10–3 M lidocaine: 168% ± 20%, mean value ± sd; 10–3 M bupivacaine: 145% ± 19% P < 0.001). The expression of cleaved caspase 3 was increased by lidocaine, but not bupivacaine, at millimolar concentrations and was blocked by PP2. Our results indicate that millimolar concentrations of lidocaine, but not bupivacaine, increase cleaved caspase 3 expression. The role of FAK phosphorylation in this effect remains to be clarified.

 

 

脑电图播放仪的构造:将脑电图数据呈现给以脑电图为基础的麻醉监仪的一个仪器

Construction of the Electroencephalogram Player: A Device to Present Electroencephalogram Data to Electroencephalogram-Based Anesthesia Monitors

Matthias Kreuzer, MSc*, Eberhard F. Kochs, MD*, Stefanie Pilge, MD*, Gudrun Stockmanns, PhD{dagger}, and Gerhard Schneider, MD*

From the *Department of Anesthesiology, Technische Universität München, Munich; and {dagger}Department of Computer Sciences, Universität Duisburg-Essen, Germany.

Anesth Analg 2007;104:135-139

背景:最近,可得到的以脑电图(EEG)为基础的监麻醉中催眠成分的监仪来多。大多数的这些监仪计算一个反映麻醉中催眠成分的数字指数。大多数的基础计算法是有专利的。因此,质量检验或者不同指数的比较是非常复杂的。

 法:因为有关不同监仪用于指数计算的算法的信息有限,只有在同一套EEG数据呈现给每个监仪时,比较或者检测监仪才可能是可靠的。

结果:手术中 行EEG监限制在两个或者三个监仪,因为头部放置电极的空间有限。这个问题可以由应用EEG播放仪倒放记录的EEG数据给不同的监仪来解决。

结论:播放仪的输出相当于原始的EEG信号。基于相同EEG的不同指数间的比较,因此变得可能。如果相同的信号呈现给不同的监仪,指数的再现性 可以被检测了。

(张曦 译,马皓琳 李士通 校)

BACKGROUND: Recently, an increasing number of electroencephalogram (EEG)-based monitors of the hypnotic component of anesthesia has become available. Most of these monitors calculate a numerical index reflecting the hypnotic component of anesthesia. Most of the underlying algorithms are proprietary. Therefore, a quality check or comparison of different indices is very complex.

METHODS: Because there is limited information about the algorithms used for index calculation of the different monitors, a reliable comparison or test of the monitors is possible only if the same set of EEG data are presented to each monitor.

RESULTS: Parallel EEG monitoring during surgery is limited to two or three monitors because the space for electrode placement on the head is limited. This problem can be solved by using the EEG player to play back recorded EEG data to different monitors.

CONCLUSIONS: The output of the player corresponds to the original EEG signal. A comparison of different indices based on identical EEGs is therefore possible. The index reproducibility can also be checked, if the same signal is presented to different monitors.

 

 

植入髓刺激器后的转换闭锁综合征

Conversion Locked-In Syndrome After Implantation of a Spinal Cord Stimulator

David Han*, Neil Roy Connelly, MD{dagger}, Alan Weintraub, MD{dagger}, Paul Kanev, MD, and Eddie Solis, DO{dagger}

From the *Tufts University School of Medicine, Boston; and Departments of {dagger}Anesthesiology and Neurosurgery, Baystate Medical Center; Springfield, Massachusetts.

Anesth Analg 2007;104:163-165

背景:锁住综合征的定 为四肢瘫痪口齿不清(丧失了口齿清晰的语言能),但保留意识。其典型的原因为桥脑 侧的损伤而。转换障碍是指需要大量的工作以排除了任何器质性的原因后,随意运或感觉能的缺失。

 法与结果:在植入髓刺激器的手术后,一名42岁的女性表现出四肢瘫痪以下脸部的两侧面瘫,但是可以睁眼眨眼。在适当的影像学研究以寻找颅内或者椎管内的病因后,我们没有找到任何器质性的原因来解 的这种况, 且给予拮药后没有立即起效。几小时内,该患者逐渐恢复了 且在第二天出院了。在住院期间, 接受了心理学的会, 且发现 符合转换障碍的断标准来解 的情况。

结论:在考虑到一个心理学的原因 前,一定要通过合适的测试以会来排除所有器质的因素,因为转换障碍是一个排除性断。我们道了一例在植入髓刺激器后由于转换障碍而发生的闭锁综合症。

(黄丽娜 马皓琳 李士通 校)

BACKGROUND: The locked-in syndrome is defined as quadriplegia and anarthria (loss of articulate speech) with the preservation of consciousness. It is typically caused by a lesion to the ventral pons. Conversion disorder is the deficit of voluntary motor or sensory function requiring an extensive work-up to exclude any organic cause.

METHODS AND RESULTS: After surgery for an implantation of a spinal cord stimulator, a 42-year-old woman presented with quadriplegia and lower facial diplegia, but was able to open and blink her eyes. We found no organic causes to explain her condition after appropriate radiological studies looking for intracranial or intraspinal causes, and reversal drugs were administered with no immediate effect. Over the course of several hours, the patient gradually recovered and was discharged the following day. A psychology consultation was obtained during her stay and she was found to meet the criteria for a conversion disorder to explain her condition.

CONCLUSIONS: Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion. We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder.

 

 

左 拉西坦可以减少大鼠由于麻醉药造成的痛觉过敏

Levetiracetam Reduces Anesthetic-Induced Hyperalgesia in Rats

David P. Archer, MD, MSc*{dagger}, Yves Lamberty, PhD{ddagger}, Bing Wang, MD, MSc*, Melinda J. Davis, MD*, Naaznin Samanani, BSc*, and Sheldon H. Roth, PhD*

From the Departments of *Anesthesiology, {dagger}Clinical Neurosciences, and Pharmacology and Therapeutics, Faculty of Medicine, University of Calgary, Calgary, Canada; and {ddagger}Preclinical CNS Research, UCB S.A., Braine-l’Alleud, Belgium.

Anesth Analg 2007;104:180-185

背景:小剂量的巴比妥、异丙酚和咪达唑仑会引起 痛觉的敏感性增,部分是由于其增了兴奋性造成的。用来阻止或减少这种兴奋性的 治疗可以提供优于目前的镇痛药和镇静药临管理的优 。新的癫痫药左 拉西坦的药理学内 提示其可以减少麻醉的兴奋阶段的程度。

 法:我们 大鼠给予镇静剂量的巴比妥、异丙酚和咪达唑仑后检测左 拉西坦 大鼠伤害反射阈值减少的影响。我们先测量大鼠 压和热量这两种伤害反射的阈值,在其 腔内注射盐水或以下一种剂量的左 拉西坦后(100200500mg/kg),再重复测量伤害反射的阈值。然后给予巴比妥(30 mg/kg)、异丙酚(30 mg/kg)或咪达唑仑(1.9 mg/kg)。从给完镇静药后5分钟开始每隔10分钟检测一次伤害反射阈值,直到注射后第65分钟结束。

结果:在未给予镇静药的物左 拉西坦不 变其伤害反射的阈值(P0.11), 不影响镇静药作用的程度和持续的时间。和 照值相比,三种麻醉镇静药物减少伤害反射阈值大约20%—30%。左 拉西坦和巴比妥咪达唑仑合用可以减少反射亢进(P < 0.05),但是和异丙酚合用无此作用。

结论:这些发现提示了我们将来可以就左 拉西坦在预防麻醉药物引起的兴奋性中的作用进一步以研究。

(姜旭晖      马皓琳  李士通校)

BACKGROUND: As part of an increase in excitability, small doses of pentobarbital, propofol, and midazolam induce an increased sensitivity to pain. Specific therapy to prevent or reduce this excitability may offer advantages over current clinical management with analgesics and sedatives. The pharmacological profile of the novel antiepileptic drug, levetiracetam, suggests that it may reduce the intensity of the excitatory stages of anesthesia.

METHODS: We examined the influence of levetiracetam on the reduction of the nociceptive reflex threshold in rats by sedative doses of pentobarbital, propofol, and midazolam. Measurements of nociceptive reflex threshold to pressure and heat were made and then repeated after intraperitoneal injection of saline or one of three doses of levetiracetam (100, 200, 500 mg/kg). Pentobarbital (30 mg/kg), propofol (30 mg/kg), or midazolam (1.9 mg/kg) were then administered. The reflex threshold was measured every 10 min, starting at 5 min after the sedative injection, until 65 min had elapsed.

RESULTS: Levetiracetam did not alter nociceptive reflex threshold in nonsedated animals (P = 0.11) or influence the degree or duration of sedation. The three anesthetic/sedative drugs reduced the nociceptive reflex threshold by 20%–30% of control values. Levetiracetam reduced the hyperreflexia associated with pentobarbital and midazolam (P < 0.05), but not propofol.

CONCLUSIONS: These findings support further investigation into the role of levetiracetam in the prevention of anesthetic-induced excitability.

 

 

 部术后 横肌 面阻滞的镇痛效果:前瞻性随机 照试验

The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial

John G. McDonnell, MB, FCARCSI*{dagger}, Brian O'Donnell, MB, FCARCSI{dagger}, Gerard Curley, MB*, Anne Heffernan, MB, FCARCSI{dagger}, Camillus Power, MD, FCARCSI{dagger}, and John G. Laffey, MD, MA, FCARCSI*{ddagger}

From the *Department of Anaesthesia and Intensive Care Medicine, University College Hospital, Galway; {dagger}Department of Anaesthesia and Intensive Care Medicine, Adelaide and Meath Hospitals, Tallaght, Dublin; and {ddagger}Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.

Anesth Analg 2007;104:193-197

背景 横肌 面(TAP)阻滞是经双侧小腰三角阻滞 壁神经传入的新兴途径。我们在一个随机、 照、双盲的临试验中评估了 部手术术后24小时内病人的镇痛效果。

 法32个由 中线切口行大肠切除术的成 患者,随机接受标准理:包括患者自控吗啡镇痛、规则服用非甾体类炎药和  酰氨基酚(n = 16),或标准理联合TAP阻滞(n = 16)。麻醉诱导后,经双侧小腰三角将20毫升0.375%左布比卡因放入 横肌神经筋膜 面。由一名不知情的研究者分别在麻醉后监病房中和术后第24624小时 每个患者进行评估。

结果TAP阻滞减少了即刻(1 ± 1.4 vs 6.6 ± 2.8, P < 0.05)和在所有术后时间 包括在24小时(1.7 ± 1.7 vs 3.1 ± 1.5, P < 0.05)的视觉模拟标度疼痛评分(TAP vs 照,均数±标准差)。术后24小时内的吗啡需要量 减少(21.9 ± 8.9 mg vs 80.4 ± 19.2 mg, P < 0.05)。没有因TAP阻滞引起的 发症。所有TAP患者 他们的术后镇痛处理显示高水 的满意度。

结论:在 部大手术术后24小时内,TAP阻滞提供了高效的术后镇痛效果。

(唐李隽 马皓琳 李士通 校)
BACKGROUND:
The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.

METHODS: Thirty-two adults undergoing large bowel resection via a midline abdominal incision were randomized to receive standard care, including patient-controlled morphine analgesia and regular nonsteroidal antiinflammatory drugs and acetaminophen (n = 16), or to undergo TAP block (n = 16) in addition to standard care (n = 16). After induction of anesthesia, 20 mL of 0.375% levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit. Each patient was assessed by a blinded investigator in the postanesthesia care unit and at 2, 4, 6, and 24 h postoperatively.

RESULTS: The TAP block reduced visual analog scale pain scores (TAP versus control, mean ± sd) on emergence (1 ± 1.4 vs 6.6 ± 2.8, P < 0.05), and at all postoperative time points, including at 24 h (1.7 ± 1.7 vs 3.1 ± 1.5, P < 0.05). Morphine requirements in the first 24 postoperative hours were also reduced (21.9 ± 8.9 mg vs 80.4 ± 19.2 mg, P < 0.05). There were no complications attributable to the TAP block. All TAP patients reported high levels of satisfaction with their postoperative analgesic regimen.

CONCLUSIONS: The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.

 

 

胸膜麻醉中的喷雾导管植入术:在喷撒滑石粉 前的一种新颖的镇痛 法

A Spray Catheter Technique for Pleural Anesthesia: A Novel Method for Pain Control Before Talc Poudrage

Pyng Lee, MD*, and Henri G. Colt, MD, FCCP{dagger}

From the *Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; and {dagger}Department of Pulmonary and Critical Care Medicine, University of California, Irvine Medical Center, Irvine, California.

Anesth Analg 2007;104:198-200

背景:化学胸膜固定术会导致严重的疼痛,这提示医师应在全麻或神经安定镇痛术下行胸腔镜喷洒滑石粉。我们设计了一个新颖的 法来为5位患有气胸慢性阻塞性肺病的病人进行镇痛。

 法:患者术前肌注哌替啶与静注咪达唑仑。用可弯曲硬质胸腔镜来检查胸膜间隙。在喷洒滑石粉 前,通过喷雾导管给予250mg的利多卡因,操作后立刻术后的12天检测的疼痛评分分别为322

结果:无 发症记录,三十天后的死亡率为0%

结论:通过喷雾导管注射利多卡因 胸膜剥脱术前的镇痛有效。

(胡  马皓琳 李士通 校)

 

BACKGROUND: Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease.

METHODS: Patients were premedicated with IM pethidine and IV midazolam. The pleural space was examined with the flex-rigid pleuroscope. Before talc poudrage, 250 mg lidocaine was administered via spray catheter, and pain scores measured immediately after the procedure and on postoperative days 1 and 2 were 3, 2, and 2, respectively.

RESULTS: No complications were noted, and 30-day mortality was 0%.

CONCLUSION: Lidocaine via spray catheter is effective for pain control before pleurodesis.