Anesthesia & Analgesia

January 2007

CARDIOVASCULAR ANESTHESIA:

2006ü非心臟手術圍術期心血管評估ACC/AHA指南最新資料:焦點為圍術期β受體阻滯應用的最新資料美國心臟學會/美國心臟病協會推薦實踐指南最新報(2002ü非心臟手術圍術期心血管評估最新指南編寫委員會)

周懿ü 陳傑

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.

圍術期β受體阻滯應用可預防手術相關的死亡率和發病率:系統回顧Meta分析

顧新宇 陳傑

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.

近期服用二甲雙胍不會增心臟手術後院內的發病率或死亡率

金琳譯 薛張綱校

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.

在冠脈搭橋手術期間監測腦氧飽和度:一個隨機前瞻性研究"

彭中美 馬皓琳 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.

心電圖控制中心靜脈導管放置的精確性

裘毅敏譯,馬皓琳 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:

成人和兒童在異丙酚全憑靜脈麻醉中阻斷軀體對切皮刺激反應時瑞太尼的需求量

鄭麗 陳傑

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.

小兒發生譫妄:問題多,答案少

張瑩 馬皓琳 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:

經皮東莨菪堿(TDS)可以作為樞複寧、氟呱利多的替代品來預防術後和出院後嘔吐(短篇報導)

李惟一 陳傑

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.

術前應用巴噴丁:對止血帶疼痛和局部靜脈麻醉品質的影響

王麗珺譯 薛張綱校

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

 

一項在控制通氣中比較Cobra喉周氣道與經典喉罩氣道用於婦科ü腔鏡手術的前瞻性隨機研究

顏濤 譯,馬皓琳 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:

氙氣阻滯了在體小鼠髓痛覺通路的突觸長程增強效應的傳導

衛紅 陳傑

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.

異丙酚通過a-腎腺素受體啟動增正常和野百合誘導的肺高壓大鼠肺血管阻

吳德華譯 薛張綱校

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對大鼠海馬腦片中分裂胱天冬酶3的蛋白表達酪氨酸磷酸化的作用

周雅春 馬皓琳 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.

超短效選擇性β1受體阻滯蘭地洛爾對高血壓或血壓正常病人行氣管內插管的血流動學效應

丁震敏 陳傑

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:

安那康達反射過濾片:用於評估工作臺和病人的安全性和揮發性麻醉的保存

王慧琳譯 薛張綱校

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.

腦電圖播放儀的構造:將腦電圖資料呈現給以腦電圖為基礎的麻醉監護儀的一個儀器

張曦 譯,馬皓琳 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-σü法可以用來ü善非心臟手術病人的預防性應用菌素

張美榮 陳傑

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.

小兒麻醉的新動向:一項對已完結案例的分析

鐘靜譯 薛張綱校

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.

有關麻醉機故障檢查的前瞻性研究

宋翠俠 陳傑

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ü量休克的豬模型胸腔內壓調節可以ü善其24小時的生存率

陸文清譯 薛張綱校

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:

植入髓刺激器後的轉換閉鎖綜合征

黃麗娜 馬皓琳 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:

靜注利多卡因減輕哮喘病人氣管插管術後支氣管收縮反應

印潔敏 陳傑

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:

齧齒類靜脈注射非肽類ORL1受體激動後的催眠、腦電圖和傷害感受ü性

徐麗穎譯 薛張綱校

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ü拉西坦可以減少大鼠由於麻醉藥造成的痛覺過敏

姜旭暉      馬皓琳  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:

輸注脂類對L-布比卡因中毒的大鼠離體心臟心肌能和生物能量學的作用

周荻 薛張綱校

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.

胸膜麻醉中的噴霧導管植入術:在噴撒滑石粉ü前的一種新穎的鎮痛ü法

胡ü 馬皓琳 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.

 

2006ü非心臟手術圍術期心血管評估ACC/AHA指南最新資料:焦點為圍術期β受體阻滯應用的最新資料美國心臟學會/美國心臟病協會推薦實踐指南最新報(2002ü非心臟手術圍術期心血管評估最新指南編寫委員會)

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

 

美國心臟學會/美國心臟病協會(ACC/ AHA)推薦的實踐指南建議盡避免任何現存的、潛在的、或者已察覺到的由於編寫委員的行業不同或者個人喜好所引起可能的利衝突。尤其是所有編寫委員會的成員以同行評議人員都被要求公開陳訴所有相關的可能已認知到現存或潛在的利衝突。公開的ü別成員評估這些聲明並在每次會議口頭轉述給編寫委員會的所有成員,而編寫委員會則時更新總結這些化。附錄1為作者的相關專業,附錄2為同行評議人員的相關專業。

該指南旨在規定在多數情況下滿足多數患者需求的實踐ü法。在總結可獲得的最新科學證據後,該指南的建議反映了專家的意見並預計可以ü善對患者的管理。如該指南作為常規給予決策而使用,則其最終目的是優質的管理並提供患者最佳的利。對某一ü定患者管理的最終評定必須通過醫療保健的提供者以該類患者可面臨的所有情況。

(周懿ü 陳傑 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.

圍術期β受體阻滯應用可預防手術相關的死亡率和發病率:系統回顧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:圍術期使用β受體阻滯被認為可降低術後的心血管死亡率,心肌缺血/心梗室性心律失常。作者回顧了關於圍術期使用β受體阻滯ü善心臟和非心臟手術後病人預後的有效性的證據。

ü法::搜索11個大型資料庫的資料,從它們的開始時間直至2005ü10月。查閱各種線資料以確定未發表的試驗和相關的摘要。檢索的文獻包括圍術期使用β受體阻滯和安慰相比較的隨機對照試驗。在3680個檢索到的題目中,69篇符合選擇標準並分析。當無顯著的臨不一致性的時候計算效應的優勢比(OR).

結果: β受體阻滯可降低室性心律失常的發生頻率[OR(心臟手術):0.28,95%可信區間 0.13-0.57OR(非心臟手術):0.56, 95%可信區間 0.21-1.45],其他還有房顫/房撲[OR(心臟手術):0.37,95%可信區間 0.28-0.48],其他室速[OR(心臟手術):0.25,95%可信區間 0.18-0.35OR(非心臟手術):0.43, 95%可信區間 0.14-1.37],以心肌缺血[OR(心臟手術):0.49,95%可信區間 0.17-1.4;OR(非心臟手術):0.38, 95%可信區間 0.21-0.69].住院時間的長短並未縮短[ü均差(心臟手術):-0.35, 95%可信區間:-0.77-0.07; ü均差(非心臟手術):-5.59, 95%可信區間:-12.22-1.04]。與以前報導相反, β受體阻滯並不能降低死亡率[OR(心臟手術):0.55,95%可信區間 0.17-1.83;OR(非心臟手術):0.78, 95%可信區間 0.33-1.87],且對圍術期心肌梗死的發生沒有影響[OR(心臟手術):0.89,95%可信區間 0.53-1.5;OR(非心臟手術):0.59, 95%可信區間 0.25-1.39]

結論: β受體阻滯可減少圍術期心律失常和心肌缺血的發生,但對心梗死亡率和住院時間的長短沒有影響。

(顧新宇 陳傑 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.

 

成人和兒童在異丙酚全憑靜脈麻醉中阻斷軀體對切皮刺激反應時瑞太尼的需求量

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:七氟醚麻醉中阻斷兒童對切皮刺激反應所需的瑞太尼的輸注量是成人的兩倍。在全憑靜脈麻醉中有關瑞太尼的需要量是否有著相似的資料暫未闡明。

ü法:作者預先設定在全憑靜脈麻醉中瑞太尼需要量的輸注率(IR)為使50%成人 (IR50) (n = 20, aged 20–60 yr)和兒童(n = 20, aged 3–11 yr)對切皮刺激失去反應的量。下ü部手術的病人,輸注瑞太尼,靶控輸注的異丙酚,維持其血漿濃度6 µg/mL。在氣管插管後,將異丙酚的濃度下調至3 µg/mL維持直至研究結束。瑞太尼IR是依據Dixon's up-and-downü法測得的。每組的第一個病人接受0.2 µg · kg–1 · min–1瑞太尼,下一個病人ü據ü前病人的反應接受0.02 µg · kg–1 · min–1 的更。瑞太尼的IR在手術ü前至少20分鐘未發生ü。在手術的開始完成切皮動作時,觀察軀體的反應。如果軀體有大ü度的運動確定為反應陽性。

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

結論:這些結果表明,與七氟醚麻醉相似,異丙酚全憑靜脈麻醉中,阻斷病人對切皮反應刺激的所需瑞太尼IR在兒童üü是成人量的兩倍。

(鄭麗 陳傑 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.

 

經皮東莨菪堿(TDS)可以作為樞複寧、氟呱利多的替代品來預防術後和出院後嘔吐(短篇報導)

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:作為常規預防嘔吐的藥物,關於氟呱利多和高成本的5-HT3拮的使用的爭論由來已ü,期望一種效ü俱佳的替代品。作者設計了一個ü行,隨機,雙盲和有陰性對照和安慰的實驗來比較A: TDS1.5mg塗ü,B:樞複寧4mg靜脈注射,C:氟呱利多1.25mg靜脈注射三種ü法作為鎮吐在高嘔吐風險的外科人群中的近期、遠期鎮吐作用和副作用。

ü法 150名患者(80名接受ü腔鏡手術和70名接受整形外科手術)在入手術室一小時前接受了TDS1.5mg或相似安慰的塗ü。所有患者都接受了標準流程的麻醉。在麻醉結束時兩個TDS組靜注生理ü水(2ml注射器),安慰組給予樞複寧4mg或氟呱利多1.25mg。記錄術後噁心嘔吐的發生率,需要急嘔吐治療的發生率和所有的反應發生率(即沒有噁心嘔吐或者需要多次急嘔吐治療的發生率。另外記錄術後72小時視物模,口üü,欲睡和煩躁等併發症的發生率。

結果:在術後72小時內, TDS,樞複寧,氟呱利多三者在嘔吐發生率和需要急嘔吐治療ü面沒有顯著差異 。所有反應發生率(41%-51%)在各組間無顯著性差異。TDS組中口üü的發生率顯著高於其他兩組(21%3%)

結論: 作為常規預防嘔吐的藥物, 東莨菪堿經皮吸收製(TDS)和樞複寧、fpld在預防手術後早期和晚期嘔吐症狀ü面同樣有效,但TDS更ü易誘發口üü。

(李惟一 陳傑 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.

 

氙氣阻滯了在體小鼠髓痛覺通路的突觸長程增強效應的傳導

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: 氙氣(Xe) 產生麻醉和鎮痛的機制並不十分清楚。作者研究了溶解在脂質成分或生理ü水中的Xe對髓C纖維誘發電位以誘導突觸長程增強效應(LTP)

ü法: C纖維誘發區域電位由淺表腰椎髓對坐骨神經最大限度的電刺激的反應來記錄。麻醉由異氟醚(其中含三分ü一的O2和二分ü一的 N2O )維持的。Xe分別由濃度為600µL/mL 保ü寧(Lipofundin MCT 20%)溶解(n=5) 或者直接溶解 (n=3),Xe由濃度100µL/mL的生理ü水 (n=7)或直接溶解(n=7) 在呼吸暫停下靜脈注射。坐骨神經的高頻刺激在注射Xe複合物後持續60 分鐘[誘發LTP].

結果: 高頻刺激使C纖維誘發電位達到156% ±14%0.9%生理ü水中低量Xe阻滯了LTP的傳導. 溶解在MC 20%的高量Xe 與直接溶解在溶中的相比無附效應,它們都阻滯了LTP.

結論: 0.9%生理ü水中低量Xe在髓痛覺傳導中無傷害性,反而有保護性。

(衛紅 陳傑 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.

 

超短效選擇性β1受體阻滯蘭地洛爾對高血壓或血壓正常病人行氣管內插管的血流動學效應

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:蘭地洛爾是一種超短效選擇性β1受體阻滯,在日本廣泛應用。作者研究了88名病人應用蘭地洛爾後,其對插管引起的腎腺素應激反應的效應。

ü法:靶控輸注異丙酚進行麻醉誘導和維持,濃度為5ug/ml,給予維庫溴胺0.1mg./kg維持肌松。在注射維庫溴胺4min後行氣管內插管。作者首先在43例血壓正常的病人中研究插管前給予蘭地洛爾的最佳時間點。然後在45例高血壓病人中研究插管後給予蘭地洛爾是否能與太尼一樣可有效預防心動過速。

結果:在血壓正常的病人插管前4min0.1mg./kg給予蘭地洛爾對於防止插管引起的心動過速是最有效的。然而,要預防高血壓病人插管後的心動過速,蘭地洛爾量必須為0.2mg/kg。在整個研究期間蘭地洛爾對於動脈血壓或BIS沒有顯著影響。相反,太尼2ug/kg常引起插管前和插管後5min的低血壓。

結論:低量的蘭地洛爾可有效預防插管後的心動過速,並且對動脈血壓沒有顯著影響。

(丁震敏 陳傑 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-σü法可以用來ü善非心臟手術病人的預防性應用菌素

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-σü法是一種資料處理系統用來促進事情處理近ü完美。作者對兩個多月中615例手術病人進行調查發現僅僅38%的非心臟手術病人在手術當天同意在接受手術期間的切皮前60分鐘內預防性應用菌素。

ü法6-σü法用來ü善預防給予菌素時間。一個多學科綜合小組對經過鑒定的病人通過預防性菌素的七個輸入程式的檢查。ü善的途徑包括術前菌素的強化應用,減少術前菌素的消除,發送適當的菌素並且靜脈滴注到手術室。同時進行對照計畫用最近開展的用即時測量和報的預防性菌素的藥的麻醉電子記錄系統以支援這個ü善ü法。在確定這個新ü法和保證系統ü訓ü後,啟動接下來7個月的資料獲取和處理。

結果8個月的菌素介入處理後,一個明顯的ü善就是1716個手術病人中的86%願意接受有效時間內的預防性應用菌素(p<0.01)。手術切皮前的菌素藥時間間隔ü從介入前的88分鐘(CI 56–119 min)減少到38分鐘(CI 25–51 min) (P < 0.01)

結論 6-σü法可以成地ü善手術切皮前預防性應用菌素的時間。麻醉電子記錄系統是監督這個ü善程式的有用工具。

(張美榮 陳傑 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.

 

有關麻醉機故障檢查的前瞻性研究

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:儘管近ü相關研究比較少,一些研究顯示部分操作者不能很好的發現麻醉機故障。

ü法:作者設計一前瞻性研究來判定麻醉機故障的發現能是否與麻醉實踐時間長短有關。作者假設較長的麻醉實踐可以增發現麻醉機故障的能。這項研究在一較大的醫療中心舉辦的全國性麻醉會議提出並實施,當時有87位麻醉醫師檢查麻醉機,要求參者單獨檢測其中一台麻醉機,而設置的故障數目並未被知,最後對麻醉機故障檢測結果用清單列舉出來。

結果:對於麻醉機的5處故障,0-2ü經驗的參者ü均發現3.7,2-7ü者為3.6,而超過2-7ü者則為2.3(p<0.001)

結論:研究表明麻醉機檢查仍然是個問題。

(宋翠俠 陳傑 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.

 

靜注利多卡因減輕哮喘病人氣管插管術後支氣管收縮反應

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:儘管預防性靜輸利多卡因可減輕多種吸入麻醉藥所引起的氣道反應,但其對於哮喘病人氣管內插管後氣道阻的影響尚不明確。作者對靜注利多卡因可減輕哮喘病人因氣管插管引起的支氣管收縮反應這一假說作了檢驗。

ü法: 30位哮喘病人(ü齡49.1 ± 15.6歲)在標準麻醉誘導ü式下(依託咪酯0.3mg/kg,太尼15ug/kg,羅庫溴0.6mg/kg50%N2O)進行氣管插管。分別在氣管插管後即刻,以5分鐘,10分鐘,15分鐘後測定氣道阻。在插管後5分鐘,分別給予利多卡因(5分鐘時給予2mg/kg IV 10分鐘時給予3mg·kg-1·h-1)或生理ü水。

結果:氣管插管後即刻測得的氣道阻ü均為23±12cmH2O·s·L-1。在注射生理ü水後氣道阻進一步升高(+38%),而注射利多卡因後則氣道阻較初值下降(-26%P<0.004)。

結論:靜注利多卡因可以減輕哮喘病人氣管插管術後的支氣管收縮反應。

(印潔敏 陳傑 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.

 

近期服用二甲雙胍不會增心臟手術後院內的發病率或死亡率

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:以往認為,圍手術期使用口ü降糖藥二甲雙胍治療糖尿病會增術後危生命的ü酸酸中毒的危險性。但相反,二甲雙胍有於控制血糖,對心血管有利,可以降低預後不良的危險。在這項觀察研究中,我們希望能明確二甲雙胍治療和發病率、死亡率ü間的關係,並與其他行心臟手術的糖尿病患者使用的口服降糖藥比較。

ü法:這項回顧性研究觀察了從1994ü到2004ü行心臟手術的糖尿病患者,共1284名,有近期口服降糖藥史(假定為術前824小時)。ü據基線和圍手術期數進行Logist模型分析,得到傾向性得分。ü據ü配術,442名(85%)二甲雙胍治療的患者與443名非二甲雙胍治療的患者相配對。比較配對的二甲雙胍治療和非二甲雙胍治療患者的術後預後。

結果:兩組ü間院內死亡率、心臟、腎臟和神經系統的發病率相似。二甲雙胍治療的患者較少出現術後延遲拔管[OR95% CI),0.30.10.7),P = 0.003],感染率[0.20.10.7),P = 0.007]和總發病率[0.40.20.8),P = 0.005]較低。

結論:述資料表明近期二甲雙胍治療與心臟手術後不良預後危險性增無關。相反,二甲雙胍治療有有利作用。

(金琳譯 薛張綱校)

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.

 

術前應用巴噴丁:對止血帶疼痛和局部靜脈麻醉品質的影響

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:巴噴丁是一類口服的非阿片類鎮痛藥,用於減少各種外科手術後的疼痛。我們假設術前應用巴噴丁可減少接受局部靜脈麻醉(IVRA)病人的止血帶相關疼痛。

ü法:選擇接受IVRA的擇期手外傷病人進行隨機雙盲研究 對照組(20),術前1小時給予安慰膠,巴噴丁組(20)術前給予巴噴丁1.2g口服。所有患者均以利多卡因3mg/kg進行局部靜脈麻醉,利多卡因稀釋至生理ü水40ml 太尼0.5μg/kg作為補救鎮痛藥物。在術中ü定的時間間隔,對感覺和運動阻滯和恢復時間、止血帶疼痛 麻醉品質進行評估。術後24小時隨訪病人的視覺類比疼痛評分表(0-10)。如果疼痛評分>4,病人接受雙氯酸75mg

結果:兩組間感覺和運動阻滯出現時間並無顯著差異。 但是,當套充氣30405060分鐘後,巴噴丁組的止血帶疼痛評分顯著降低(P<0.05)。巴噴丁組應用補救性鎮痛藥的間隔明顯延長(35 +/- 10 min vs 21 +/- 13 min, P < 0.05),且太尼用量明顯減少(35 +/- 47 [mu]g vs 83 +/- 73 [mu]g, P < 0.05)。麻醉醫師和外科醫師獨立評ü麻醉品質,巴噴丁組明顯好於對照組。 在巴噴丁組,術後應用補救藥物進行止痛的間隔顯著延長(135 +/- 25 min vs 85 +/- 19 min, P < 0.05),術後60min120min的疼痛評分以雙氯酸的用量ü明顯降低。(分別為3.8 +/- 0.9 vs 2.2 +/- 0.53.2 +/- 1.4 vs 1.8 +/- 0.830 +/- 38 mg vs 60 +/- 63 mg)

結論:術前口服巴噴丁1.2g降低了手外科的止血帶相關疼痛,提高了麻醉品質。巴噴丁同樣可以降低術後早期的疼痛評分。

(王麗珺譯 薛張綱校)

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.

 

 

異丙酚通過a-腎腺素受體啟動增正常和野百合誘導的肺高壓大鼠肺血管阻

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:利用來自正常和野百合誘導的肺高壓大鼠的分離肺灌注,研究異丙酚對肺血管阻的影響是否依賴a-腎腺素受體啟動。ü法:檢測不同濃度異丙酚(10(-5) to 10(-4) M)誘導的肺灌注壓的化,並分為有或沒有苯腎腺素(10(-6) M)與處理組。苯腎腺素入前,先檢測NO合酶制(N(omega)-nitro-l-arginine methylester: 10(-4) M)、環氧化酶(indomethacin: 10(-5) M)和蛋白激酶C制——雙吲哚亞醯bisindolylmaleimide I (10(-6) M)calphostin C (10(-6) M) 對肺灌注壓的影響結果:NO合酶制和吲哚美ü預處理正常大鼠後,苯腎腺素對其肺灌注壓化的影響有區別(5 +/- 3 and 7 +/- 2 mm Hg);然而bisindolylmaleimide I預處理野百合(MCT)肺高壓大鼠後,苯腎腺素對其肺灌注壓化的影響小(2 +/- 1 mm Hg)。在苯腎腺素預處理正常和MCT誘導的大鼠中異丙酚導致肺血管收縮。正常大鼠中異丙酚在吲哚美ü預處理後與非處理相比導致的肺灌注壓化略小於(p<0.05)。MCT處理的大鼠中兩種蛋白激酶C制處理後異丙酚導致的肺灌注壓與非處理相比化要小(P < 0.05)。結論:異丙酚通過a-腎腺素受體啟動增肺血管阻。

(吳德華譯 薛張綱校)

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.

 

 

安那康達反射過濾片:用於評估工作臺和病人的安全性和揮發性麻醉的保存

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:安那康達過濾片能夠在不需要使用麻醉機的情況下供給揮發性麻醉。它的設計初衷是在重症監護室裏使用。ü法:我們通過工作臺和麻醉病人來研究安那康達反射濾過片。工作臺分析需要一個測試肺模型、一台氣體分析儀、一台重症監護通氣機、安那康達過濾片和一台注射泵。我們研究潮氣量、呼吸頻率和呼氣末正壓通氣值的化範圍,並模擬一些再輸注和病人轉運過程中的錯誤。在15名麻醉病人中,我們通過安那康達過濾片給予一定的通氣數、恒定的七氟醚輸入流量(45ml/h)和兩條相連的新鮮氣流。結果:在工作臺研究組中,呼出的揮發性麻醉的濃度降低在分鐘通氣量恒定時與呼吸頻率呈線性相關,在呼吸頻率恒定時與潮氣量的增呈負相關。ü呼氣末正壓通氣值和吸-呼比對安那康達無影響。需要注意ü個安全性的故障:由於泵入效應,再輸注會一過性ü安那康達的輸出量,標準活塞可將ü化注射管連接在靜脈輸注通路。對於麻醉病人,將新鮮氣流從8L/min降至1L/min可導致呼出氣內揮發性麻醉成份增40%。結論:該研究證實了此設備是可靠的,但有些情況下實際輸出的麻醉要比預計的要多。

(王慧琳譯 薛張綱校)

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.

 

小兒麻醉的新動向:一項對已完結案例的分析

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:呼吸系統的併發症和從1970ü到1980ü的ASA的閉合要求資料庫中的兒科醫療事故有關。兒科麻醉在19801990ü代有了進步,並預示了其發展趨勢。

ü法:我們回顧性研究了53230ü間(19732000)ü資料庫中的兒科醫療事故(ü齡<或=16歲),應用邏輯回歸分析。我們研究了1990ü到2000ü的案例來明確損傷。

結果:從19732000,死亡/BD和呼吸系統的併發症,尤其是不完全的通氣和氧合比例正在下降。但是,1990ü代,死亡(41%)和BD21%)仍是兒科麻醉的主要損害。19902000ü間的事故一是3歲或更小的病人,五分ü一是ASA35級的病人。心血管事件(26%)和呼吸系統併發症(23%)是最常見的損害事件。影響1990的死亡/BD值的因素是心血管事件(優勢比[OR] = 6.6, 95% 可信區間是[CI] = 2.5-17.8),呼吸系統併發症(OR = 3.7, 95% CI = 1.5-9.4), ASA 3-5(OR = 3.1, 95% CI = 1.3-7.8)

結論:死亡/BD值仍是1990ü代兒科麻醉醫療事故中最主要的損害,心血管事件和呼吸系統併發症是

(鐘靜譯 薛張綱校)

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ü量休克的豬模型胸腔內壓調節可以ü善其24小時的生存率

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

 

胸腔內壓調節器(ITPR)正壓通氣(PPV)在低ü量血症時,通過ü善ü均動脈壓降低右房和顱內壓來增冠脈和顱內的灌注壓。我們假設在嚴重低ü量的豬模型中間斷使胸腔內負壓可以增24小時的生存率。18只被異氟醚麻醉的豬放了55%它的估計血ü量,然後隨機分為-8 mm Hg ITPRPPV或者單純PPV治療90分鐘。所有倖存的豬血液回輸。在90分鐘中,監測動脈血氣、呼末CO2 和主動脈壓。在再灌注後1224小時評估神經系統。結果:ITPR PPV治療90分鐘防止了代酸的進展,明顯ü善了ü均動脈壓(90分鐘ü均值,55 ± 3 35 ± 2.4 mm Hg, P < 0.001 )和對照組相比。和對照組相比,24小時的生存率明星ü善9/9 (100%) vs 1/9 (11%), P < 0.01。結論:和單純用PPV治療的對照組相比,使用ITPR PPV可以明顯ü善動脈壓和24小時生存率。

(陸文清譯 薛張綱校)

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.

 

 

齧齒類靜脈注射非肽類ORL1受體激動後的催眠、腦電圖和傷害感受ü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:阿片受體樣受體1(ORL1)激動誘發齧齒類運動障礙,鎮靜和正向反射消失(LRR)。此受體可能在麻醉領域成為新穎的靶點。ü法:我們檢測了兩種靜脈注射非肽類ORL1激動,(Ro 65-6570 Org 26383)後的催眠,腦電圖和傷害感受效應,在小鼠和大鼠中運用LRR,在大鼠中運用腦電爆發制百分比,在小鼠中運用腳爪福馬林試驗。結果:在小鼠中,Ro 65-6570Org 26383誘發LRRRo 65-6570 Org 26383催眠量分別為0.63.7 micromol/kg)。納洛酮對兩種複合物誘發的睡眠時間無顯著效應。在大鼠中,Ro 65-6570 (0.6-2.4 micromol/kg)Org 26383 (4-8 micromol/kg)誘發LRR和腦電爆發制活動。睡眠時間和爆發制活動都能被選擇性ORL1拮顯著減少。在小鼠中,福馬林誘發的傷害感受發生量依賴性制(Ro 65-6570 Org 26383分別為 Phase 1 ED50 0.41.8 micromol/kgPhase 2 ED50 0.44.2 micromol/kg)。結論:這些結果表明Ro 65-6570Org 26383(很可能通過ORL1受體)在小鼠和大鼠中可作為靜脈催眠和鎮痛,並且催眠和傷害感受量相仿。

(徐麗穎譯 薛張綱校)

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.

 

 

輸注脂類對L-布比卡因中毒的大鼠離體心臟心肌能和生物能量學的作用

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ü善代謝或脂類輸注引起的脂類槽是否能ü善局麻藥引起的心肌制。
ü法:我們使用大鼠離體心臟,恒定灌注壓非迴圈ü式Langendorff準備,並暴露心臟於5 g/mLL-布比卡因和9 g/mL脂質ü。冷凍鉗夾心臟並用HPLC來測定能量。在另一個實驗中評估起搏心臟的作用。使用質譜儀來測定入脂類對在Krebs–Henseleit緩衝液和人類血漿中的局麻藥的作用。

結果:L-布比卡因使自主搏動的心臟心率顯著下降(74% 7%的基線),+dP/dt 下降(69% 7%),收縮壓下降(78% 6%), 冠脈血流下降 (61% 8%),延長PR (177% 52%)QRS間期(166% 36%)。在L-布比卡因處理過的心臟中輸注脂類發揮了增強正性肌作用,顯著增+dP/dt和收縮壓至94% 11% 102% 16%的基線。在脂類ü預後,心率,冠脈血流,PRQRS間期保持不。脂類輸注在搏動心臟中對+dP/dt,收縮壓和 Mvo2有顯著作用。L-布比卡因和脂質對能量負荷都沒有作用。脂類濃度須達到500 L/mL 血漿來ü血漿中的局麻藥濃度。

總結:脂類對L-布比卡因導致的心臟制有顯著的正性肌作用,我們將其歸結於直接正性肌作用。然而,在離體心臟中,間接的,局麻藥血漿與脂類結合的作用不能被排除。

(周荻 薛張綱校)

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.

 

在冠脈搭橋手術期間監測腦氧飽和度:一個隨機前瞻性研究"

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:腦部缺氧可導致各種全身不利後果。我們假設,腦部作為指示臟器,ü善腦部氧合的ü涉對心臟手術患者全身臟器有利。

ü法:200例冠脈搭橋患者隨機分為術中有積極的顯示處理ü預ü案地監測腦部局部氧飽和度(rSO2)(ü涉組, n = 100),或監測rSO2但不知監測結果 (對照組, n = 100)。預先定義的臨結果由不知道監測結果的觀察者評估。

結果:對照組與ü涉組比較有明顯多的患者腦部去飽和時間較長(P = 0.014)且在ICU時間較長(P = 0.029)。不利併發症的總體發生率無差異,但與ü涉組相比,較多的對照組患者有大臟器發病或死亡(死亡、控制呼吸>48小時、中風、心肌梗死、再次探查手術) (P = 0.048)。經歷大臟器發病或死亡的患者與那些沒有這些併發症的患者相比有較低的rSO2基礎值和ü均值,腦部去飽和較多,且ICU時間術後住院時間延長。術中rSO2 和術後需要住院時間大於10天的患者的住院時間呈明顯的負相關性(r2 = 0.29)。

結論:在冠脈搭橋患者中監測腦rSO2 能避免深度的腦部缺氧,且使大臟器能失常的發生率降低。

(彭中美 馬皓琳 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.

 

 

心電圖控制中心靜脈導管放置的精確性

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:在美國的手術室裏,術前很少使用心電圖(ECG)引導來確定中心靜脈導管(CVC)的精確位置。我們設計了這項隨機、對照試驗,以研究這項術的應用是否影響CVC的精確放置。

ü法:ECG組患者(n = 147)用右房ECG引導導管尖端定位來放置CVCNO-ECG(n = 143)在無此ü法的條件下定位CVCs

結果:總體ECG引導下CVCs定位更精確(96%76%, P 0.001),且並不增放置時間。儘管NO-ECG組明顯有更多的CVC放置到右心房或右心室其它血管(P 0.001)ECG組明顯有更多的CVCs放到在腔靜脈的中段(P 0.001)NO-ECG組中有20位病人在術後需重新調整CVC位置,而在ECG組中僅有3位元需要此項操作。

結論:ECG引導下可以更精確地放置CVC,且應該考慮用它來增病人的安全性降低重新調整CVC位置的成本。

(裘毅敏譯,馬皓琳 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.

 

 

小兒發生譫妄:問題多,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

新一代吸入麻醉藥臨應用于小兒已經引發了術後譫妄較高的發生率,儘管持續時間較短,卻是病因不明的麻煩的臨現象。各種麻醉的、手術的、病人的、輔用藥相關的因素都被認為在這種事件的發生中起了一個潛在性的作用。譫妄發生時不安的行為不僅使小兒不適,ü使其護理者和父母對麻醉恢復品質不滿意。雖然小兒易激ü的嚴重程度不同,但通常都需要額外的護理鎮痛或鎮靜處理,這可能延遲出院時間。為了減少這種不良事件的發生率,我們建議術前應鑒別病兒是否存在發生這種不良反應的風險,並採取預防性措施,例如減少術前的焦慮、去處術後疼痛提供一個安靜無應激的麻醉後恢復環境。需要更多的臨試驗來闡明原因提供有效的治療。

(張瑩 馬皓琳 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.

 

 

一項在控制通氣中比較Cobra喉周氣道與經典喉罩氣道用於婦科ü腔鏡手術的前瞻性隨機研究

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:現在可供使用的聲門無創氣道來多。在這一隨機單盲研究中,我們比較了Cobra喉周氣道(CobraPLA)和經典喉罩氣道[LMA-Classic]在婦科ü腔鏡手術中的應用。

ü法:四十例病人分別接受LMA-Classic或者CobraPLA。記錄放置、通氣和拔除氣道時的ü點以喉部併發症發病率。

結果:兩種設備放置ü點、不良事件和喉部併發症發病率均相似。在建立氣ü前,LMA-Classic組和CobraPLA組氣道峰壓分別為20.3 ± 4.9 cm H2O25.5 ± 7.9 cm H2OP = 0.01。在氣ü期間維持這一差異:LMA-Classic 組氣道峰壓22.8 ± 6.1 cm H2O CobraPLA 28.1 ± 8.5 cm H2O, P = 0.04。僅CobraPLA40%在拔除氣道後肉眼可見CobraPLA有血跡,P = 0.001

結論:在婦科ü腔鏡手術中,CobraPLA氣道與LMA-Classic氣道放置ü點相似,氣道密閉壓更高。本發現的有用性還有待進一步研究。

(顏濤 譯,馬皓琳 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對大鼠海馬腦片中分裂胱天冬酶3的蛋白表達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

有報導採用利多卡因行麻後出現嚴重神經系統後遺症,腦液中達到的高濃度被認為是其原因。我們早期研究顯示利多卡因可促進成簇黏附激酶(FAK, 一種在神經可塑性和細胞死亡中起作用的非受體酪氨酸激酶)磷酸化。本次研究比較了利多卡因和布比卡因對大鼠海馬腦片中FAK磷酸化和分裂胱天冬酶3表達的作用。用濃度逐漸增的利多卡因(4.3 nM to 4.3 mM )或布比卡因(3.4 nM to 3.4 mM )處理海馬腦片的同時添或不添FAK酪氨酸激酶ü異性制PP2 (10 µM)。免疫印跡法檢測胱天冬酶3表達FAK磷酸化。利多卡因可濃度依賴地增FAK磷酸化,而布比卡因的作用是雙相性的。毫摩爾濃度的利多卡因的最大效應顯著高於臨等效布比卡因濃度的最大作用(4.3 x 10–3 M 利多卡因: 168% ± 20%, 均值±標準差; 10–3 M 布比卡因: 145% ± 19% P < 0.001. 毫摩爾濃度的利多卡因而非布比卡因增分裂胱天冬酶3的表達,此作用可被PP2阻斷。我們的結果表明毫摩爾濃度的利多卡因而非布比卡因增分裂胱天冬酶3的表達。FAK磷酸化在此效應中的作用有待闡明。
(周雅春 馬皓琳 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.

 

 

腦電圖播放儀的構造:將腦電圖資料呈現給以腦電圖為基礎的麻醉監護儀的一個儀器

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,可得到的以腦電圖(EEG)為基礎的監護麻醉中催眠成分的監護儀來多。大多數的這些監護儀計算一個反映麻醉中催眠成分的數字指數。大多數的基礎計算法是有專利的。因此,品質檢驗或者不同指數的比較是非常複雜的。

ü法:因為有關不同監護儀用於指數計算的演算法的資有限,只有在同一套EEG資料呈現給每個監護儀時,比較或者檢測監護儀才可能是可靠的。

結果:手術中ü行EEG監護限制在兩個或者三個監護儀,因為頭部放置電極的空間有限。這個問題可以由應用EEG播放儀倒放記錄的EEG資料給不同的監護儀來解決。

結論:播放儀的輸出相當於原始的EEG信號。基於相同EEG的不同指數間的比較,因此得可能。如果相同的信號呈現給不同的監護儀,指數的再現性ü可以被檢測了。

(張曦 譯,馬皓琳 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.

 

 

植入髓刺激器後的轉換閉鎖綜合征

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:鎖住綜合征的定義為四肢癱瘓口齒不清(喪失了口齒清晰的語言能),但保留意識。其典型的原因為橋腦ü側的損傷而。轉換障礙是指需要大量的工作以排除了任何器質性的原因後,隨意運動或感覺能的缺失。

ü法與結果:在植入髓刺激器的手術後,一名42歲的女性表現出四肢癱瘓以下臉部的兩側面癱,但是可以睜眼眨眼。在適當的影像學研究以尋找顱內或者椎管內的病因後,我們沒有找到任何器質性的原因來解釋ü的這種狀況,並且給予拮藥後沒有立即起效。ü小時內,該患者逐漸恢復了並且在第二天出院了。在住院期間,ü接受了心理學的會診,並且發現ü符合轉換障礙的診斷標準來解釋ü的情況。

結論:在考慮到一個心理學的原因ü前,一定要通過合適的測試以會診來排除所有器質的因素,因為轉換障礙是一個排除性診斷。我們報導了一例在植入髓刺激器後由於轉換障礙而發生的閉鎖綜合症。

(黃麗娜 馬皓琳 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ü拉西坦可以減少大鼠由於麻醉藥造成的痛覺過敏

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:小量的巴比妥、異丙酚和咪達唑侖會引起對痛覺的敏感性增,部分是由於其增了興奮性造成的。用來阻止或減少這種興奮性的ü治療可以提供優於目前的鎮痛藥和鎮靜藥臨管理的優點。新的癲癇藥左ü拉西坦的藥理學內ü提示其可以減少麻醉的興奮階段的程度。

ü法:我們對大鼠給予鎮靜量的巴比妥、異丙酚和咪達唑侖後檢測左ü拉西坦對大鼠傷害反射閾值減少的影響。我們先測量大鼠對壓和熱量這兩種傷害反射的閾值,在其ü腔內注射ü水或以下一種量的左ü拉西坦後(100200500mg/kg),再重複測量傷害反射的閾值。然後給予巴比妥(30 mg/kg)、異丙酚(30 mg/kg)或咪達唑侖(1.9 mg/kg)。從給完鎮靜藥後5分鐘開始每隔10分鐘檢測一次傷害反射閾值,直到注射後第65分鐘結束。

結果:在未給予鎮靜藥的動物左ü拉西坦不ü其傷害反射的閾值(P0.11),ü不影響鎮靜藥作用的程度和持續的時間。和對照值相比,三種麻醉鎮靜藥物減少傷害反射閾值大約20%—30%。左ü拉西坦和巴比妥咪達唑侖合用可以減少反射亢進(P < 0.05),但是和異丙酚合用無此作用。

結論:這些發現提示了我們將來可以就左ü拉西坦在預防麻醉藥物引起的興奮性中的作用進一步以研究。

(薑旭暉      馬皓琳  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.

 

 

ü部術後ü橫肌ü面阻滯的鎮痛效果:前瞻性隨機對照試驗

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ü橫肌ü面(TAP)阻滯是經雙側小腰三角阻滯ü壁神經傳入的新興途徑。我們在一個隨機、對照、雙盲的臨試驗中評估了ü部手術術後24小時內病人的鎮痛效果。

ü法32個由ü中線切口行大腸切除術的成ü患者,隨機接受標準護理:包括患者自控嗎啡鎮痛、規則服用非甾體類炎藥和對ü醯氨基酚(n = 16),或標準護理聯合TAP阻滯(n = 16)。麻醉誘導後,經雙側小腰三角將20毫升0.375%左布比卡因放入ü橫肌神經筋膜ü面。由一名不知情的研究者分別在麻醉後監護病房中和術後第24624小時對每個患者進行評估。

結果TAP阻滯減少了即刻(1 ± 1.4 vs 6.6 ± 2.8, P < 0.05)和在所有術後時間點包括在24小時(1.7 ± 1.7 vs 3.1 ± 1.5, P < 0.05)的視覺類比標度疼痛評分(TAP vs對照,均數±標準差)。術後24小時內的嗎啡需要量ü減少(21.9 ± 8.9 mg vs 80.4 ± 19.2 mg, P < 0.05)。沒有因TAP阻滯引起的併發症。所有TAP患者對他們的術後鎮痛處理顯示高水準的滿意度。

結論:在ü部大手術術後24小時內,TAP阻滯提供了高效的術後鎮痛效果。

(唐李雋 馬皓琳 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.

 

 

胸膜麻醉中的噴霧導管植入術:在噴撒滑石粉ü前的一種新穎的鎮痛ü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:化學胸膜固定術會導致嚴重的疼痛,這提示醫師應在全麻或神經安定鎮痛術下行胸腔鏡噴灑滑石粉。我們設計了一個新穎的ü法來為5位患有氣胸慢性阻塞性肺病的病人進行鎮痛。

ü法:患者術前肌注呱替啶與靜注咪達唑侖。用可彎曲硬質胸腔鏡來檢查胸膜間隙。在噴灑滑石粉ü前,通過噴霧導管給予250mg的利多卡因,操作後立刻術後的12天檢測的疼痛評分分別為322

結果:無併發症記錄,三十天后的死亡率為0%

結論:通過噴霧導管注射利多卡因對胸膜剝脫術前的鎮痛有效。

(胡ü 馬皓琳 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.