Anesthesia & Analgesia

February 2007

 

PEDIATRIC ANESTHESIA:

格隆溴铵不能减少呼吸道感染儿童围术期不良事件的发生

周懿之 陈杰

Glycopyrrolate Does Not Reduce the Incidence of Perioperative Adverse Events in Children with Upper Respiratory Tract Infections

Alan R. Tait, Constance Burke, Terri Voepel-Lewis, Devi Chiravuri, Deborah Wagner, and Shobha Malviya

Anesth Analg 2007 104: 265-270.

低剂量蛛网膜下腔吗啡用于儿童术后镇痛的评价

(陈勇柱译 薛张纲校)

Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children

Arjunan Ganesh, Andrew Kim, Pasquale Casale, and Giovanni Cucchiaro

Anesth Analg 2007 104: 271-276.

一项探讨以儿童年龄为标准差对七氟醚MAC值的影响

姜旭晖      马皓琳  李士通校

A Comparison of the Effect on Dispersion of Repolarization of Age-Adjusted MAC Values of Sevoflurane in Children

Simon D. Whyte, Shubhayan Sanatani, Joanne Lim, and Peter D. Booker

Anesth Analg 2007 104: 277-282.

经鼻和经口纤维支气管镜插管对小儿麻醉中循环的影响

李惟一 陈杰

Circulatory Responses to Fiberoptic Intubation in Anesthetized Children: A Comparison of Oral and Nasal Routes

Fu S. Xue, Cheng W. Li, Kun P. Liu, Hai T. Sun, Guo H. Zhang, Ya C. Xu, and Yi Liu

Anesth Analg 2007 104: 283-288.

AMBULATORY ANESTHESIA:

静态磁疗法不能减少疼痛或阿片类药物的需求:一项随机双盲试验

周时蓓译 薛张纲校

Static Magnetic Therapy Does Not Decrease Pain or Opioid Requirements: A Randomized Double-Blind Trial

M. Soledad Cepeda, Daniel B. Carr, Tony Sarquis, Nelcy Miranda, Ricardo J. Garcia, and Camilo Zarate

Anesth Analg 2007 104: 290-294.

耳针用于牙科患者焦虑:一项随机对照试验

马皓琳 李士通

Auricular Acupuncture for Dental Anxiety: A Randomized Controlled Trial

Matthias Karst, Michael Winterhalter, Sinikka Münte, Boris Francki, Apostolos Hondronikos, Andre Eckardt, Ludwig Hoy, Hartmut Buhck, Michael Bernateck, and Matthias Fink

Anesth Analg 2007 104: 295-300.

针刺治疗促进NO的产生和增强局部循环

杨卫红 陈杰

Acupuncture Enhances Generation of Nitric Oxide and Increases Local Circulation

Masahiko Tsuchiya, Eisuke F. Sato, Masayasu Inoue, and Akira Asada

Anesth Analg 2007 104: 301-307.

利用正电子发射体层摄影术发现L1-4针灸麻醉可减少健康人体中脑豆核的血流量

施杨译 薛张纲校

Acupuncture of LI-4 in Anesthetized Healthy Humans Decreases Cerebral Blood Flow in the Putamen Measured with Positron Emission Tomography (Brief Report)

Lise Schlünzen, Manouchehr S. Vafaee, and Georg E. Cold

Anesth Analg 2007 104: 308-311.

Extra 1 穴位针压法:对双频指数、血清褪黑素、血浆β-内啡肽应激的影响

黄施伟 译,马皓琳 李士通

Acupressure on the Extra 1 Acupoint: The Effect on Bispectral Index, Serum Melatonin, Plasma ß-Endorphin, and Stress (Brief Report)

Argyro Fassoulaki, Anteia Paraskeva, Georgia Kostopanagiotou, Eleftheria Tsakalozou, and Sophia Markantonis

Anesth Analg 2007 104: 312-317.

ANESTHETIC PHARMACOLOGY:

麻醉药结合位点的共同化学基序

丁震敏 陈杰

The Common Chemical Motifs Within Anesthetic Binding Sites

Edward J. Bertaccini, James R. Trudell, and Nicholas P. Franks

Anesth Analg 2007 104: 318-324.

中低瑞太尼输注率不会改变BIS指数监测下的异丙酚TCI麻醉维持需要浓度

陈佳莉译 薛张纲校

Low and Moderate Remifentanil Infusion Rates Do Not Alter Target-Controlled Infusion Propofol Concentrations Necessary to Maintain Anesthesia as Assessed by Bispectral Index Monitoring

Lars P. Wang, Peter McLoughlin, Michael J. Paech, Irina Kurowski, and Emma L. Brandon

Anesth Analg 2007 104: 325-331.

氟烷、异氟烷和七氟烷增钙诱发的重组人心脏肌钙蛋白C构型改变学

颜涛 译, 马皓琳 李士通 校)

Halothane, Isoflurane, and Sevoflurane Increase the Kinetics of Ca2+-Induced Conformational Change of Recombinant Human Cardiac Troponin C

Dirk Breukelmann and Philippe R. Housmans

Anesth Analg 2007 104: 332-337.

苯二氮卓类药物对大鼠大脑皮层切片苯基二氢喹唑啉能系统的效应

顾新宇 陈杰

The Effects of Benzodiazepines on Orexinergic Systems in Rat Cerebrocortical Slices (Brief Report)

Ying He, Mihoko Kudo, Tsuyoshi Kudo, Tetsuya Kushikata, Enyou Li, and Kazuyoshi Hirota

Anesth Analg 2007 104: 338-340.

TECHNOLOGY, COMPUTING, AND SIMULATION:

利用相位解析光谱测量行心肺分流术的病人的光程长

陈珺珺译 薛张纲校

Measurements of Optical Pathlength Using Phase-Resolved Spectroscopy in Patients Undergoing Cardiopulmonary Bypass

Kenji Yoshitani, Masahiko Kawaguchi, Takashi Okuno, Tomoko Kanoda, Yoshihiko Ohnishi, Masakazu Kuro, and Mitsunori Nishizawa

Anesth Analg 2007 104: 341-346.

腹部手术期间体液平衡的定量分析

黄丽娜 马皓琳 李士通

Quantitative Analysis of Fluid Balance During Abdominal Surgery

Tsuneo Tatara and Chikara Tashiro

Anesth Analg 2007 104: 347-354.

CRITICAL CARE AND TRAUMA:

用阿司匹林触发的脂氧素A4类似物后能减弱脂多糖诱导的小鼠急性肺损伤:血红素氧酶-1的作用

周密 陈杰

Posttreatment with Aspirin-Triggered Lipoxin A4 Analog Attenuates Lipopolysaccharide-Induced Acute Lung Injury in Mice: The Role of Heme Oxygenase-1

Sheng-Wei Jin, Li Zhang, Qin-Quan Lian, Dong Liu, Ping Wu, Shang-Long Yao, and Du-Yun Ye

Anesth Analg 2007 104: 369-377

关于脂质A拮剂E5564的二期双盲安慰剂对照的增量实验,实验对象:行心肺分流术的心外科病人

秦 佳译 薛张纲校

A Phase II, Double-Blind, Placebo-Controlled, Ascending-Dose Study of Eritoran (E5564), a Lipid A Antagonist, in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Elliott Bennett-Guerrero, Hilary P. Grocott, Jerrold H. Levy, Kevin A. Stierer, Charles W. Hogue, Albert T. Cheung, Mark F. Newman, Alison A. Carter, Daniel P. Rossignol, and Charles D. Collard

Anesth Analg 2007 104: 378-383.

心脏手术后两个不同的康复策略对肺和血流学的影响

马皓琳 李士通

The Pulmonary and Hemodynamic Effects of Two Different Recruitment Maneuvers After Cardiac Surgery

Serdar Celebi, Özge Köner, Ferdi Menda, Kubilay Korkut, Kaya Suzer, and Nahit Cakar

Anesth Analg 2007 104: 384-390.

气道压与吸气时间对细菌易位的影响

宋翠侠 陈杰

The Effects of Airway Pressure and Inspiratory Time on Bacterial Translocation

Perihan Ergin Ozcan, Nahit Cakar, Simru Tugrul, Ozkan Akinci, Atahan Cagatay, Dilek Yilmazbayhan, Figen Esen, Lutfi Telci, and Kutay Akpir

Anesth Analg 2007 104: 391-396.

OBSTETRIC ANESTHESIA:Back

绵胎儿对母体全麻的全身中枢反应

罗 璇译 薛张纲校

A Description of the Preterm Fetal Sheep Systemic and Central Responses to Maternal General Anesthesia

Rebecca J. McClaine, Kenichiro Uemura, Deborah J. McClaine, Kazufumi Shimazutsu, Sebastian G. de la Fuente, Roberto J. Manson, William D. White, William S. Eubanks, Paul B. Benni, and James D. Reynolds

Anesth Analg 2007 104: 397-406.

多胎娠和单胎娠产妇在剖宫产麻中血管收缩药用量血流学变化的前瞻性比较

黄佳佳译,马皓琳 李士通校

A Prospective Comparison of Vasopressor Requirement and Hemodynamic Changes During Spinal Anesthesia for Cesarean Delivery in Patients with Multiple Gestation Versus Singleton Pregnancy

Warwick D. Ngan Kee, Kim S. Khaw, Floria F. Ng, Manoj K. Karmakar, Lester A. Critchley, and Tony Gin

Anesth Analg 2007 104: 407-411.

最小容量和最小剂量的布比卡因(0.125%w/v0.25%w/v)用于硬膜外分娩镇痛的比较研究

印洁敏 陈杰

A Comparison of Minimum Local Anesthetic Volumes and Doses of Epidural Bupivacaine (0.125% w/v and 0.25% w/v) for Analgesia in Labor

Gordon R. Lyons, Mitko G. Kocarev, Rowan C. Wilson, and Malachy O. Columb

Anesth Analg 2007 104: 412-415

健康产妇和先兆子痫妇产的凝血能:一项血小板能分析仪(PFA-100®)和血栓弹性描记器(TEG®)的测定分析

王光妍译 薛张纲校

Hemostatic Function in Healthy Pregnant and Preeclamptic Women: An Assessment Using the Platelet Function Analyzer (PFA-100®) and Thromboelastograph®

Jeremy R. Davies, Roshan Fernando, and Stephen P. Hallworth

Anesth Analg 2007 104: 416-420.

昂丹司琼或者格拉司琼是否能预防剖腹产后蛛网膜下腔应用吗啡诱发的瘙痒?

彭中美 马皓琳 李士通

Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? (Brief Report)

Sahar M. Siddik-Sayyid, Marie T. Aouad, Samar K. Taha, Mireille S. Azar, Mona A. Hakki, Romeo N. Kaddoum, Viviane G. Nasr, Vanda G. Yazbek, and Anis S. Baraka

Anesth Analg 2007 104: 421-424.

GENERAL ARTICLES:

一种新型血浆替代品羟乙基淀粉:用血栓弹性描记图和全血凝集度方法测定凝血能的离体研究

张美荣 陈杰

A New Plasma-Adapted Hydroxyethylstarch Preparation: In Vitro Coagulation Studies Using Thrombelastography and Whole Blood Aggregometry

Joachim Boldt, Michael Wolf, and Andinet Mengistu

Anesth Analg 2007 104: 425-430.

新型咽通气道衬垫与传统喉罩在行眼科手术病人中的效果与舒适度比较

张 俪译 薛张纲校

The Effectiveness and Patient Comfort of the Novel Streamlined Pharynx Airway Liner (SLIPA®) Compared with the Conventional Laryngeal Mask Airway in Ophthalmic Surgery

Markus Lange, Thorsten Smul, Peter Zimmermann, Rudolf Kohlenberger, Norbert Roewer, and Franz Kehl

Anesth Analg 2007 104: 431-434.

ANALGESIA:

定义红斑性肢痛病的可治疗病因:急性青少年期自身免疫性细纤维轴突病变

唐李隽 马皓琳 李士通

Defining a Treatable Cause of Erythromelalgia: Acute Adolescent Autoimmune Small-Fiber Axonopathy

Joshua Paticoff, Assia Valovska, Srdjan S. Nedeljkovic, and Anne Louise Oaklander

Anesth Analg 2007 104: 438-441.

REGIONAL ANESTHESIA:

斜角肌间隙置入电刺激导管是否改善肩部外科手术后疼痛或能-----一项前瞻性的、随机、双盲试验

郑丽 陈杰

Does Interscalene Catheter Placement with Stimulating Catheters Improve Postoperative Pain or Functional Outcome After Shoulder Surgery? A Prospective, Randomized and Double-Blinded Trial

Markus F. Stevens, Robert Werdehausen, Elisabeth Golla, Sebastian Braun, Henning Hermanns, Ansgar Ilg, Reinhardt Willers, and Peter Lipfert

Anesth Analg 2007 104: 442-447.

最理想的锁骨下臂丛神经阻滞运反应

孙 霞译 薛张纲校)

The Optimal Motor Response for Infraclavicular Brachial Plexus Block

Vincent Minville, Olivier Fourcade, Benoît Bourdet, Mary Doherty, Clément Chassery, Jean-Claude Pourrut, Claude Gris, Bernard Eychennes, Aline Colombani, Kamran Samii, and Hervé Bouaziz

Anesth Analg 2007 104: 448-451.

 

低剂量蛛网膜下腔吗啡用于儿童术后镇痛的评价

Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children

Arjunan Ganesh, Andrew Kim, Pasquale Casale, and Giovanni Cucchiaro

Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, USA.

Anesth Analg 2007 104: 271-276.

 

背景:评价低剂量蛛网膜下腔吗啡(4-5 mcg/kg)在儿童各类常规手术术后镇痛处理中的效果与安全性。

方法:回顾了200310月至20063月间在费城儿童医院接受低剂量蛛网膜下腔吗啡术后镇痛的病人的疼痛管理数据库和医学记录。病人在接受24-48h的低剂量蛛网膜下腔吗啡术后镇痛后出院。

结果:187位病人的医学记录被入选。他们的平均年龄在5.6 +/- 5.1岁(中位数4.0IQR 1.0-10.0)。病人在第一个24h期间出现最大疼痛评级(参照FLACC评级, FLACC评级以数字划分)是0(IQR 0-3)0 (IQR 0-4)。第一次给予阿片类药物的平均时间是22.4 +/- 16.9 h (范围:0-48 h, 95% 可信区间: 19.9-24.8 h)。70%的病人不需接受任何阿片类药物(口服或静注)。在接受阿片类药物的117位病人中,有59位(50%)仅需用羟二氢可待因酮可。33%的病人需用酮咯酸氨基丁三醇处理,其中11%单用,22%合用静注或口服阿片类药物。恶心呕吐、皮肤瘙痒和尿潴留的发生率分别是32%, 37%6%。有一位病人出现短暂的脑液漏性头痛,另有两位病人因手术60分钟后出现低氧血症而给予吸氧。需要辅通气或纳络酮的严重呼吸制现象未观察到。

结论:在儿科病人中应用低剂量蛛网膜下腔吗啡术后镇痛是一种安全有效的手段。

(陈勇柱译 薛张纲校)

BACKGROUND: We evaluated the efficacy and safety profile of low-dose (4-5 mcg/kg) intrathecal morphine for postoperative pain management after various surgical procedures in children. METHODS: We reviewed the pain management service database and the medical records of patients who received low-dose intrathecal morphine for postoperative analgesia at The Children's Hospital of Philadelphia between October 2003 and March 2006. Patients had been prospectively followed for 24-48 h after the intrathecal morphine administration. RESULTS: The medical records of 187 patients were examined. The mean age was 5.6 +/- 5.1 yr (median 4.0, interquartile range [IQR] 1.0-10.0). The median maximum pain score during the first 24 h in patients evaluated by the FLACC score and in those evaluated by the numeric verbal rating scale, was 0 (IQR 0-3) and 0 (IQR 0-4), respectively. The mean time to first rescue opioid was 22.4 +/- 16.9 h (range: 0-48 h, 95% CI: 19.9-24.8 h). During the first 24 h after surgery, 70 patients (37%) did not receive any opioids (oral or IV). Of the 117 patients who received opioids, 59 (50%) were managed with oxycodone only. Pain was managed with ketorolac in 33% of patients, either alone (11%) or in combination with IV or oral opioids (22%). The incidence of nausea or vomiting, pruritus, and urinary retention was 32%, 37%, and 6% respectively. One patient had transient postdural puncture headache, while two patients received supplemental oxygen beyond the first 60 postoperative minutes to manage occasional episodes of hypoxemia. No severe respiratory depression requiring assisted ventilation or naloxone administration was observed. CONCLUSION: We conclude that low-dose intrathecal morphine in the pediatric population can be a useful and safe adjunct for postoperative analgesia.

 

 

静态磁疗法不能减少疼痛或阿片类药物的需求:一项随机双盲试验

Static Magnetic Therapy Does Not Decrease Pain or Opioid Requirements: A Randomized Double-Blind Trial

M. Soledad Cepeda, Daniel B. Carr, Tony Sarquis, Nelcy Miranda, Ricardo J. Garcia, and Camilo Zarate

Department of Anesthesia, San Ignacio Hospital, Bogota, Colombia

Anesth Analg 2007 104: 290-294.

 

一个发展中的具有数百亿美元的市场,包括磁性项链,手镯,腰带,鞋垫,背带,垫等等,用于缓解疼痛,虽然几乎没有证据证明它们的效。我们试图证明磁性疗法对于手术后病人的疼痛程度阿片类药物使用的有效性。我们设计了一个随机化双盲对照试验。165名年纪大于12岁,并且在苏醒室中有中度至重度疼痛的患者被随机分到磁性疗法组(n=81)和安慰剂治疗组(n=84)。止痛装置被放置在外科切口2个小时。患者每10分钟以0-10分为刻度评价自己的疼痛程度,并且除非评分<=4分,否则就要接受一次额外剂量的吗啡。疼痛程度在2组之间是近乎相同的。磁性疗法组的疼痛程度评分的均数大于对照组0.0495%可信区间,-0.40.5)。对阿片类药物的需求在2组之间也是相近的。磁性疗法组比起对照组所需要的吗啡剂量要大1.5mg95%可信区间,-1.84.0)。磁性疗法对于缓解术后急性疼痛的程度或者阿片类药物的使用是缺乏有效性的,并且在这种背景下是不应当被推荐用来缓解疼痛的。

(周时蓓译 薛张纲校)

A growing multibillion dollar industry markets magnetic necklaces, bracelets, bands, insoles, back braces, mattresses, etc., for pain relief, although there is little evidence for their efficacy. We sought to evaluate the effect of magnetic therapy on pain intensity and opioid requirements in patients with postoperative pain. We designed a randomized, double-blind, controlled trial. One-hundred-sixty-five patients older than 12 yr of age were randomized to magnetic (n = 81) or sham therapy (n = 84) upon reporting moderate-to-severe pain in the postanesthesia care unit. Devices were placed over the surgical incision and left in place for 2 h. Patients rated their pain intensity on a 0-10 scale every 10 min and received incremental doses of morphine until pain intensity was < or =4 of 10. Pain intensity levels were similar in both groups. The magnet group had on average 0.04 U more pain intensity (95% confidence interval, -0.4 to 0.5) than the sham group. Opioid requirements also were similar in both groups. The active magnet group required 1.5 mg more morphine (95% confidence interval, -1.8 to 4.0) than the sham magnet group. Magnetic therapy lacks efficacy in controlling acute postoperative pain intensity levels or opioid requirements and should not be recommended for pain relief in this setting.

 

 

利用正电子发射体层摄影术发现L1-4针灸麻醉可减少健康人体中脑豆核的血流量

Acupuncture of LI-4 in Anesthetized healthy humans decreases cerebral blood flow in the putamen measured with positron emission tomography.

Schlunzen L, Vafaee MS, Cold GE.

Department of Neuroanesthesiology, Aarhus University Hospital, Aarhus C, Denmark.

Anesth Analg 2007 104: 308-311

 

为了最大化地减少外源性因素的影响,13个志愿者在七氟醚1MAC下进行麻醉,同时第一组(N=7)进行腰14的针灸麻醉,第二组(N=6)进行第三和第四掌骨间的针刺以作为安慰剂对照组。在基础的吸入麻醉和吸入联合针灸麻醉中分别运用了正电子发射扫描。第一组显示在右中央前回和左豆核的脑血流有明显的减少,减少量分别为20%和17%。第二组显示右中央前回脑血流减少22%,豆核中却没有发现明显的改变。这些数据表明,针尖对皮肤的穿透会影响中央前回的脑血流量,而腰14的针灸麻醉会影响豆核

(施杨译 薛张纲校)

To minimize the influence of exogenous factors, 13 volunteers were anesthetized with sevoflurane 1 MAC while exposed to manual acupuncture stimulation of LI-4 (Group 1, n = 7) or a placebo point in the space between the third and fourth metacarpals (Group II, n = 6). During anesthesia (baseline) and anesthesia + acupuncture, one H2(15)O scan was performed, respectively. Group I demonstrated a significant decrease in regional cerebral blood flow in the right medial frontal gyrus (20%) and in the left putamen (17%). In Group II regional cerebral blood flow was decreased in the right medial frontal gyrus (22%); in the putamen no significant changes were observed. These data suggest that needle penetration of the skin affects the medial frontal gyrus, whereas acupuncture of LI-4 influences the putamen.

 

 

中低瑞太尼输注率不会改变BIS指数监测下的异丙酚TCI麻醉维持需要浓度

Low and Moderate Remifentanil Infusion Rates Do Not Alter Target-Controlled Infusion Propofol Concentrations Necessary to Maintain Anesthesia as Assessed by Bispectral Index Monitoring

Lars P. Wang, FANZCA*, Peter McLoughlin, FANZCA*, Michael J. Paech, FANZCA, DM WAust{dagger}, Irina Kurowski, FANZCA*, and Emma L. Brandon, FRCA*

Address correspondence and reprint requests to Lars Wang, FANZCA, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Wellington St, Perth WA 6000, Australia.

Anesth Analg 2007 104: 325-331.

 

背景:我们研究同时使用不同瑞太尼输注率能否使BIS值降低到5050以下所需要的异丙酚的EC50值降低(能够使50%的病人产生反应的有效浓度)。

方法:将72ASAⅠ或Ⅱ的成年病人随机分成6组进行气管内插管和异丙酚TCI输注。给予B0.1µg/kg/min的瑞太尼,C0.15µg/kg/minD0.2µg/kg/minE0.3µg/min/minF0.4µg/kg/minA组作为控制组不给予瑞太尼。在同一组里,第一个病人给予的异丙酚TCI浓度为4µg/ml,他的反应决定了同一瑞太尼组中后一个病人的异丙酚效应室浓度(Dixon“-下”方法)。如果BIS>50,那么下一个病人就给予高于这个浓度的异丙酚,反之,如果BIS<=50,下一个病人就给予低于这个浓度的异丙酚。同时还可以研究两个药物结合使用时的血流学效应。

结果:异丙酚EC50值的变化范围为2.4-2.9µg/ml。我们发现瑞太尼对异丙酚的EC50没有增作用。然而,没有给予瑞太尼组的病人对异丙酚的反应变化范围较大。给予瑞太尼组的病人有心率下降。

结论:输注瑞太尼不会降低在没有刺激时的麻醉病人的异丙酚需要量。异丙酚的TCI水平不会因为同时输注瑞太尼而降低。

(陈佳莉译 薛张纲校)

BACKGROUND: We investigated whether the EC50 (the effective concentration that is required to achieve a response in 50% of patients) of propofol necessary to lower the Bispectral Index (BIS) value to 50 or less was reduced by coadministration of different remifentanil infusion rates.

METHOD: Seventy-two adult ASA I or II patients undergoing endotracheal intubation and target-controlled infusion (TCI) propofol anesthesia were allocated to six groups by stratified randomization. Group B received remifentanil 0.1 µg · kg–1 · min–1, Group C 0.15 µg · kg–1 · min–1, Group D 0.2 µg · kg–1 · min–1, Group E 0.3 µg · kg–1 · min–1 and Group F 0.4 µg · kg–1 · min–1. Group A served as control and received no remifentanil. The response of the first patient to propofol TCI at 4 µg/mL determined the effect-site concentration of propofol for the next patient in the same remifentanil group (Dixon's "up-and-down" method). If BIS was >50, the next patient received more propofol, and if BIS was 50, the next patient received less propofol. The hemodynamic effects of the combinations were also studied.

RESULTS: The EC50 varied from 2.4 to 2.9 µg/mL. No additive effect of remifentanil on the EC50 of propofol was observed. However, there was a wider variation in the response to propofol when the patients received no remifentanil. There was a decrease in heart rate in the remifentanil groups.

CONCLUSION: Infusion of remifentanil did not reduce propofol requirements in the unstimulated anesthetized patient. Propofol TCI levels should not be reduced because remifentanil is coinfused.

 

 

利用相位解析光谱测量行心肺分流术的病人的光程长

Measurements of Optical Path length Using Phase-Resolved Spectroscopy in Patients Undergoing Cardiopulmonary Bypass

Kenji Yoshitani, MD*, Masahiko Kawaguchi, MD{dagger}, Takashi Okuno, MD*, Tomoko Kanoda, MD*, Yoshihiko Ohnishi, MD*, Masakazu Kuro, MD*, and Mitsunori Nishizawa, BS{ddagger}

From the *Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka; {dagger}Department of Anesthesiology, Nara Medical University, Kashihara, Nara; and {ddagger}System Engineering, Systems Division, Hamamatsu Photonics K.K. Hamamatus, Shizuoka, Japan.

Anesth Analg 2007 104: 341-346.

 

背景:虽然近红外光谱术(NIRS)的可靠性还不能确定,但它仍被用于在心脏手术中监测大脑的氧合。尽管光程长一般被认为是恒定不变的,但最近有证据显示,物实验中急性血液稀可以影响光程长。我们最近的研究旨在研究在行心肺分流术的病人中光程长是否会变化,以这些变化是否影响NIRS的值。

方法:9个择期行心肺分流的心脏手术病人参与了这次研究。分别通过相位解析光谱和NIRO 100测量每个人的光程长和大脑的NIRS的值(氧合血红蛋白[{Delta}O2Hb]和氧合指数)。光程长,血红蛋白浓度和NIRS值按以下顺序测量:1)麻醉诱导完,2)心肺分流后的10分钟,3)心肺分流后的60分钟,4)心肺分流后的1小时。通过Pearson相关系数和多重回归分析光程长和其它可变因素的关系。

结果:光程长在心肺分流后明显增,从10分钟的27.7–30.8 cm增至60分钟的31.3 cm (P < 0.0001)。血红蛋白浓度明显下降(从10分钟的11.2 7.1 g/dL降至60分钟的 7.7 g/dLP < 0.0001). 光程长和血红蛋白浓度之间有明显的相关性(r = 0.55, P < 0.001)。光谱长度和血红蛋白浓度变化的百分比有明显的相关性。多重回归分析显示光程长是氧合血红蛋白的一个重要决定因素。

结论:结果显示光程长会随着心肺分流的进程变化,并且可以影响氧合血红蛋白。

(陈珺珺译 薛张纲校)

BACKGROUND: Near infrared spectroscopy (NIRS) has been used during cardiac surgery to monitor cerebral oxygenation although the validity of this technique has yet to be established. Although optical pathlength included in the algorithm for calculating NIRS values is supposed to be constant, recent evidence has suggested that optical pathlength could be affected by acute hemodilution in animals. We conducted the present study to investigate whether optical pathlength changes during cardiopulmonary bypass (CPB), and whether these changes affect NIRS values in adult patients.

METHODS: Nine patients undergoing elective cardiac surgery with CPB were enrolled in this study. Optical pathlength and cerebral NIRS values (oxyhemoglobin [{Delta}O2Hb] and tissue oxygen index) were measured by phase-resolved spectroscopy and NIRO 100, respectively. Optical pathlength, hemoglobin concentration, and NIRS values were measured at the following points: 1) after the induction of anesthesia, 2) 10 min after the start of CPB, 3) 60 min after the start of CPB, and 4) 1 h after CPB. The associations between optical pathlength and other variables were analyzed by Pearson correlation coefficients and multiple regression analysis.

RESULTS: Optical pathlength significantly increased starting at 27.7–30.8 cm at 10 min, and 31.3 cm at 60 min after the start of CPB (P < 0.0001). Hemoglobin concentrations significantly decreased (from 11.2 to 7.1 g/dL at 10 min and 7.7 g/dL at 60 min P < 0.0001). There was a significant correlation (r = 0.55, P < 0.001) between percentage changes in pathlength and hemoglobin concentration. Multiple regression analysis showed that optical pathlength was a significant determinant of {Delta}O2Hb.

CONCLUSION: The results indicate that optical pathlength can change during CPB and its changes may affect {Delta}O2Hb.

 

 

关于脂质A拮剂E5564的二期双盲安慰剂对照的增量实验,实验对象:行心肺分流术的心外科病人

A Phase II, Double-Blind, Placebo-Controlled, Ascending-Dose Study of Eritoran (E5564), a Lipid A Antagonist, in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Elliott Bennett-Guerrero, MD*, Hilary P. Grocott, MD*, Jerrold H. Levy, MD{dagger}, Kevin A. Stierer, MD{ddagger}, Charles W. Hogue, MD, Albert T. Cheung, MD||, Mark F. Newman, MD*, Alison A. Carter, PhD, Daniel P. Rossignol, PhD, and Charles D. Collard, MD#

From the *Department of Anesthesiology, Duke University Medical Center, Durham, NC (EBG, HPG, MFN); {dagger}Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA (JHL); {ddagger}The Heart Institute at St. Joseph Medical Center, Towson, MD (KAS); Johns Hopkins University Medical School, Baltimore, MD (CWH); ||Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA (ATC); ¶Eisai Medical Research, Ridgefield Park, NJ (AAC, DPR); #Division of Cardiovascular Anesthesiology, Baylor College of Medicine, Texas Heart® Institute, St. Luke's Episcopal Hospital, Houston, TX (CDC).

Anesth Analg 2007 104: 378-383.

 

背景:脂质A,内毒素的一种毒性成分,与心外科术后的多种并发症相关,包括发热、血管扩张、肺和肾脏能的衰退。E5564可以防治人物的内毒素诱发性炎症。在这个实验中,我们评估在行心外科手术的病人中应用E5564的安全性,并获取其对于内毒素干预的外科并发症的预防作用的初步的效值。

方法:在9个医院进行随机,双盲,安慰剂对照的实验.实验对象为冠脉分流术的病人和/或具心肺分流的心血管手术病人。在心肺分流术前1h分别给予病人安慰剂,2mgE556412mgE5564,或28mgE5564

结果:监数据并未提示有明显的安全性方面的影响,并增量到最大剂量28mg.实验组和对照组在对于系统炎症和器官能衰退的控制并无统计学意义。

结论:这个二期实验表明,脂质A拮剂—E5564,与心外科术后的并发证并无明显关系。对于择期的心外科病人用E5564来拮脂质A并无明显处。

(秦 佳译 薛张纲校)

BACKGROUND: Lipid A, the toxic moiety of endotoxin, is linked to multiple complications after cardiac surgery, including fever, vasodilation, and pulmonary and renal dysfunction. The lipid A antagonist eritoran (or E5564) prevents endotoxin-induced systemic inflammation in animals and humans. In this study we assessed the safety of eritoran administration in patients undergoing cardiac surgery and obtained preliminary efficacy data for the prophylaxis of endotoxin-mediated surgical complications.

METHODS: A double-blind, randomized, ascending-dose, placebo-controlled study was conducted at nine hospitals. Patients undergoing coronary artery bypass graft and/or cardiac valvular surgery with cardiopulmonary bypass were enrolled. Patients received a 4-h infusion of placebo (n = 78) vs 2 mg (n = 24), 12 mg (n = 26), or 28 mg (n = 24) of eritoran initiated approximately 1 h before cardiopulmonary bypass.

RESULTS: No significant safety concerns were identified with continuous safety monitoring, and enrollment continued to the highest prespecified dose (28 mg). No statistically significant differences were observed in most variables related to systemic inflammation or organ dysfunction/injury.

 

CONCLUSIONS: This Phase II safety study suggests that the administration of the novel lipid A antagonist, eritoran, is not associated with overt toxicity in cardiac surgical patients. Blocking lipid A with eritoran does not appear to confer any clear benefit to elective cardiac surgical patients.

 

 

绵胎儿对母体全麻的全身中枢反应

A description of the preterm fetal sheep systemic and central responses to maternal general anesthesia

McClaine RJ, Uemura K, McClaine DJ, Shimazutsu K, de la Fuente SG, Manson RJ, White WD, Eubanks WS, Benni PB, Reynolds JD.

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA

Anesth Analg 2007 104:397-406

 

背景:通常推荐娠4-6月为孕母行外科手术的适宜时机,尽管还不清楚这段时间胎儿对麻醉的反应。本文评价了绵早期胎儿对咪达唑仑、硫喷妥钠、异氟醚标准麻醉的反应。方法:预先连接仪器至早孕绵,在全身麻醉前、中结束后4h测量数据。异氟醚中度降低胎儿的血压心率,而拔管伴有胎儿心率和平均脉压升高。结果:观察到胎儿SaO2起初升高,而后缓慢降至基线水平。胎儿脑中氧化血红蛋白变化<10%(无显著性),去氧血红蛋白和总血红蛋白变化<5%。总体,虽然异氟醚不独立地增早期胎儿脑中O2水平(与晚期胎儿和成人不同),但后者即使在胎儿平均脉压下降超过20%的时候仍然保持稳定。也就是说,未能找到反映损伤的大脑氧合变化。结论:母体手术对早期胎儿的任何负面影响都不能单用全身麻醉对胎儿的作用来解。

(罗 璇译 薛张纲校)

BACKGROUND: The second trimester is recommended as the optimal time to conduct a surgical procedure on pregnant patients, even though the fetal responses to anesthesia at this age are not known. Here we assessed the responses of preterm fetal sheep to a standard anesthetic regimen of midazolam, thiopental, and isoflurane. METHODS: Variables were monitored in previously instrumented preterm pregnant sheep before, during, and after 4 h of general anesthesia. Isoflurane produced moderate fetal hypotension and bradycardia, whereas extubation was accompanied by increases in fetal heart rate and mean arterial blood pressure. RESULTS: We observed an initial increase in fetal SaO2 followed by a gradual decline to baseline. Within the fetal brain, oxygenated hemoglobin changed by <10% (nonsignificant) and deoxygenated hemoglobin and total hemoglobin varied by <5%. Overall, although O2 levels within the preterm fetal brain were not independently enhanced by isoflurane (as occurs in the older fetus and in the adult), they did remain constant even as fetal mean arterial pressure decreased by more than 20%. By extension, we failed to identify changes in cerebral oxygenation that could be construed as injurious. CONCLUSION: Any adverse preterm fetal response to maternal surgery should not be attributed solely to the actions of general anesthesia upon the fetus.

 

 

健康产妇和先兆子痫妇产的凝血能:一项血小板能分析仪(PFA-100®)和血栓弹性描记器(TEG®)的测定分析

Hemostatic Function in Healthy Pregnant and Preeclamptic Women: An Assessment Using the Platelet Function Analyzer (PFA-100®) and Thromboelastograph®

Jeremy R. Davies, FRCA, Roshan Fernando, FRCA, and Stephen P. Hallworth, FRCA

From the Department of Anesthetics, Royal Free Hospital, London, United Kingdom.

Anesth Analg.2007; 104: 416-420

 

背景:PFA-100®是一项受关注的血小板能分析仪,它能测量血小板栓子在体外的形成速度,用关闭时间(CT)来描述。这项方法可以提示初级止血早于区域麻醉。在这项前瞻性观察性的研究中,在运用PFA TEG测定比较正常娠和先兆子痫的妇女的血小板能之前,我们对健康娠人群进行测定计算出95%的可信区间。

研究方法:测定血常规,凝血能包括vW因子,CTTEG测试。结果用平均值表示。

研究结果:先兆子痫的严重程度与CT时间延长有关系,甚至在正常血小板记数中表现出来。在严重的先兆子痫,PFA100 CT(均值:155s)超过了对照组的95%可信区间(80-139s)。相比之下,在严重的先兆子痫中TEG MA值(平均值:71mm)仍然在正常娠MA值的95%可信区间内(6482mm)。

结论:我们可以推论,逐渐严重的先兆子痫产妇中原发性凝血能障碍可以用PFA100检测出来,但是TEG不能。

(王光妍译 薛张纲校)

BACKGROUND: The PFA-100® is a point-of-care platelet function analyzer which measures the speed of formation of a platelet plug in vitro, expressed as closure time (CT) in seconds. This device could potentially be used to assess primary hemostasis prior to regional anesthesia. In this prospective, observational study we sought to establish 95% reference intervals for PFA-100 and Thromboelastograph® (TEG®) values for our normal pregnant population, before comparing the PFA and TEG in measuring platelet function in preeclamptic and healthy pregnant women at term, using confidence interval analysis and analysis of variance.

METHODS: Routine hematologic and coagulation tests were performed along with von Willebrand Factor, CT, and TEG measurements. Results are expressed as mean (sd).

RESULTS: Increased severity of preeclampsia was associated with increasing prolongation of CT, even in the presence of normal platelet counts. In severe preeclampsia, the PFA-100 CT (mean (sd): 155 (65) s) exceeded the 95% reference interval of the control group (70–139 s). In contrast, TEG maximum amplitude (MA) in severe preeclampsia (mean (sd): 71 (8) mm) remained within the 95% reference interval for MA in normal pregnancy (64–82 mm).

CONCLUSION: We conclude that impairment of primary hemostatic function with increasing severity of preeclampsia was recorded by the PFA-100 but not the TEG.

 

新型咽通气道衬垫与传统喉罩在行眼科手术病人中的效果与舒适度比较

The Effectiveness and Patient Comfort of the Novel Streamlined Pharynx Airway Liner (SLIPA®) Compared with the Conventional Laryngeal Mask Airway in Ophthalmic Surgery

Markus Lange, Thorsten Smul, Peter Zimmermann, Rudolf Kohlenberger, Norbert Roewer, and Franz Kehl

Department of Anaesthesia and Critical Care, University of Wurzburg, Wurzburg, Germany.

Anesth Analg 2007 Feb;104(2):431-4

 

背景:新型咽通气道衬垫近期进入临实际应用中。它没有膨胀的气,因为新型咽通气道衬垫的形与咽部的解剖形态相似。

方法:我们对124名在全麻下行眼科手术的成年病人(ASA I-III)进行了试验,比较了新型咽通气道衬垫与传统喉罩的操作性,安全性,咽部的封闭效果和病人的舒适度。

结果:用新型咽通气道衬垫直接放置到位的比例为88%,有一点困难的占10%,病例中有明显困难的比例为0%。放置失败的占病人数的2%。在传统喉罩组中,直接置管成的占90%,有一点困难的占8%,有明显困难的占2%,操作失败的占病人数的0%。新型咽通气道衬垫的最大密封压为24 +/- 6毫米水柱,传统喉罩组为24 +/- 4毫米水柱。有19%的病人的在SLIPA组中发生胃内充气,在传统喉罩组中有3%(P<0.05)。没有发生胃内容物反流的情况。所有的病例都能平稳拔管。装置表面的血迹在新型咽通气道衬垫组中为20%而喉罩组中为11%。主诉有咽喉部疼痛的在新型咽通气道衬垫组与传统喉罩组中分别为2%和14%。

结论:新型咽通气道衬垫是相对喉罩来讲对接受小手术病人的另一种可选择的方式。然而,它有较高的胃内充气的发生率,有可能会增吸入的危险性。

(张 俪译 薛张纲校)

BACKGROUND: The novel, disposable streamlined pharynx airway liner (SLIPA) has recently been introduced into clinical practice. It has no inflatable cuff, because the shape of the SLIPA closely resembles the anatomy of the pharynx. METHODS: We compared the SLIPA with the conventional laryngeal mask airway (LMA) regarding handling, safety, sealing of the pharynx, and patient comfort in 124 adult patients (ASA I-III) undergoing ophthalmic surgery under general anesthesia. RESULTS: Insertion of the SLIPA was straightforward in 88%, slightly difficult in 10%, and obviously difficult in 0% of cases. The SLIPA could not be inserted in 2% of patients. In the LMA group, insertion was straightforward in 90%, slightly difficult in 8%, obviously difficult in 2%, and a failure in 0% of patients. Maximum seal pressure was 24 +/- 6 mm H2O with the SLIPA and 24 +/- 4 mm H2O with the LMA. Gastric air insufflation was noticed in 19% of patients in the SLIPA group and 3% in the LMA group (P < 0.05). No regurgitation of gastric contents was observed. Removal of the airway was uneventful in all cases. Blood traces were noted on the surface of the device in 20% in the SLIPA versus 11% (n.s.) in the LMA group. Complaints of a sore throat were recorded in 2% vs. 14% in the SLIPA and the LMA group, respectively. CONCLUSION: The SLIPA is a useful alternative to the conventional LMA in patients undergoing minor surgery. However, it is associated with a higher incidence of gastric air insufflation, which may increase the risk of aspiration.

 

 

最理想的锁骨下臂丛神经阻滞运反应

The Optimal Motor Response for Infraclavicular Brachial Plexus Block

Vincent Minville, MD*, Olivier Fourcade, MD, PhD*, Benot Bourdet, MD*, Mary Doherty, MD, Clment Chassery, MD*, Jean-Claude Pourrut, MD*, Claude Gris, MD*, Bernard Eychennes, MD*, Aline Colombani, MD*, Kamran Samii, MD*, and Herv Bouaziz, MD, PhD

From the *Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France; and Department of Anesthesiology and Intensive Care, Nancy University Hospital, Nancy, France.

Anesth Analg 2007 104: 448-451.

 

背景:在此前瞻性研究中我们用倍刺激引起锁骨下臂丛神经反射,以观察视神经反应来比较成率。

方法:该研究包括了628位使用锁骨下臂丛神经反射阻滞行急肢外科手术的病人。肌皮神经被最先阻滞,继而根据视神经定位评估病人,发现产生桡侧反应占54%,正中反应占35%,尺侧反应 占11%。阻滞所用剂量为1.5%利多卡因1/400,000的肾腺素共40毫升。在完成阻滞后30分钟,每5分钟评估效果。

结果:桡侧反应组成率为96%,正中反应组为89%,尺侧反应组为90%(P<0.05).组间完成阻滞产生效应的时间无显著差异.未观察到严重并发症.

结论:最初定位并阻滞肌皮神经,随后注射局麻药产生桡侧反应的成率略高于产生正中反应或尺侧反应者.

(孙 霞译 薛张纲校)

BACKGROUND: In this prospective study we compared the success of the infraclavicular brachial plexus block using double-stimulation in regard to the second nerve response elicited with neurostimulation.

METHODS: Six-hundred-twenty-eight patients undergoing emergency upper limb surgery using infraclavicular brachial plexus block were included in this study. The musculocutaneous nerve was initially blocked and the groups were then evaluated according to the second nerve located, which was radial in 54%, median in 35%, and ulnar in 11% of patients. Blocks were performed using lidocaine 1.5% with 1/400,000 epinephrine 40 mL in all cases. The block was assessed every 5 min for 30 min after completion of the block.

RESULTS: The success rate was 96% for the radial response group, 89% for the median response group, and 90% for the ulnar response group (P < 0.05). Time to perform the block and the onset time were not significantly different among groups. No serious complications were observed.

CONCLUSION: We conclude that having initially located and blocked the musculocutaneous nerve, subsequent injection on a radial response resulted in a slightly more reliable success rate than injection with an ulnar or median response.

 

格隆溴铵不能减少呼吸道感染儿童围术期不良事件的发生

Glycopyrrolate Does Not Reduce the Incidence of Perioperative Adverse Events in Children with Upper Respiratory Tract Infections

Alan R. Tait, PhD, Constance Burke, BSN, RN, Terri Voepel-Lewis, MSN, RN, Devi Chiravuri, MD, Deborah Wagner, PharmD, and Shobha Malviya, MD

From the Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan.

Anesth Analg 2007 104: 265-270.

 

最近两项研究发现对患有呼吸道感染的择期手术儿童,大量呼吸道分泌物并不是围术期不良事件发生的独立危险因素。因此本实验来检验患呼吸道感染的小儿使用胆碱药物是否能减少围术期呼吸系统不良事件的发生。130名患有呼吸道感染的择期手术儿童(1月龄到18岁)随机分组,分别给予格隆溴铵0.01mg/kg或安慰剂,并随访围术期呼吸系统不良事件的发生和严重程度。两组患者在人口学分布、呼吸道感染的症、麻醉管理以手术操作方面均相似。结果显示格隆溴铵和安慰剂组间围术期呼吸道不良事件的发生和严重程度并没有明显的统计学差异(45.2%37.5%P=NS)。此外,存在肺充血和分泌物的儿童经单独分析后发现两组之间的预后也没有区别(45.0%37.0%)。然而,与安慰剂组比较,格隆溴铵组出院时间较短(83.9分钟比111.4分钟,P=0.024),术后恶心呕吐的发生较少(10.7%33.3%,P=0.005)。述结果表明患呼吸道感染的儿童麻醉诱导后给予格隆溴铵并不能减少围术期呼吸系统不良事件的发生,不需作为该人群的临用药常规。

(周懿之 陈杰 校)

Two recent studies have identified copious secretions as an independent risk factor for perioperative adverse events in children who present for elective surgery in the presence of an upper respiratory tract infection (URI). We designed this study, therefore, to determine whether the administration of the anticholinergic drug, glycopyrrolate, to children with URIs would reduce the incidence of adverse perioperative respiratory events. One hundred thirty children (1 mo to 18 yr of age) who presented for elective surgery with a URI were randomized to receive either 0.01 mg/kg glycopyrrolate or placebo and were followed for the appearance and severity of any perioperative respiratory adverse events. The two groups were similar with respect to demographics, presenting URI symptoms, anesthetic management, and surgical procedure. In the intention-to-treat analysis, there were no statistical differences in the incidence or severity of perioperative respiratory adverse events between the glycopyrrolate and placebo groups (45.2% vs 37.5% respectively, P = NS). Furthermore, there were no differences in outcome between the two groups when children with congestion and secretions were analyzed separately (45.0% vs 37.0%, respectively). However, compared with the placebo group, children in the glycopyrrolate group had significantly shorter discharge times (83.9 min vs 111.4 min, P = 0.024), and significantly less postoperative nausea and vomiting (10.7% vs 33.3%, P = 0.005). These results suggest that glycopyrrolate, administered after induction of anesthesia to children with URIs, does not reduce the incidence of perioperative respiratory adverse events, and thus may not be clinically indicated for routine use in this population.

 

经鼻和经口纤维支气管镜插管对小儿麻醉中循环的影响

Circulatory Responses to Fiberoptic Intubation in Anesthetized Children: A Comparison of Oral and Nasal Routes

Fu S. Xue, MD, Cheng W. Li, MD, Kun P. Liu, MD, Hai T. Sun, MD, Guo H. Zhang, MD, Ya C. Xu, MD, and Yi Liu, MD

From the Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

Anesth Analg 2007 104: 283-288.

背景:既往的研究显示成人经鼻和经口纤维支气管镜插管的循环影响不同,其在小儿麻醉中是否有相似的差异仍然未知。

方法:在这个随机的临实验中, 663岁至9岁的择期整形手术儿童,ASAI-II级,随机分组,比较他们在经鼻和经口纤支镜插管过程中血压和心率的变化。用太尼、异丙酚和万可松进行诱导插管。分别在麻醉前(基础值),诱导后(诱导后水平),插管当时和插管后5分钟内记录无创血压和心率,同时记录整个过程中血压和心率的最大值。

结果:经鼻组所用插管时间显著长于经口插管组。与基础值和诱导后水平相比,无论经鼻组还是经口组,纤支镜插管导致心率和血压显著增。经鼻组的血压和心率(插管时,插管后和最大值)都显著低于经口插管组。达到最高收缩压和最快心率所用时间在经鼻组显著长于经口组。经鼻组血压、心率恢复到诱导后水平所用时间短于经口组。插管后达到心率和收缩压最大值的时间在组间没有差异。

结论:无论经鼻还是经口纤支镜插管都显著增心率和血压,经鼻插管组对循环的影响小于经口插管组。

(李惟一 陈杰 校)

BACKGROUND: Previous studies have demonstrated a significant difference in the circulatory responses in adults to fiberoptic nasotracheal intubation (FNI) and fiberoptic orotracheal intubation (FOI). But, it is unknown whether there is a clinically relevant difference in the circulatory responses in children to these two intubation methods.

METHODS: In this randomized clinical study, we compared the arterial blood pressure and heart rate changes during FNI and FOI in 66 children, ASA physical status I-II, aged 3–9 yr scheduled for elective plastic surgery. After anesthesia induction with fentanyl-propofol and vecuronium, fiberoptic intubation was performed. Noninvasive arterial blood pressure and heart rate were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation, and every minute for the first 5 min after intubation. The maximum values of arterial blood pressure and heart rate during the observation were also recorded.

RESULTS: The total intubation time was significantly longer in the FNI group than in the FOI group. Both FOI and FNI caused significant increases in arterial blood pressure and heart rate compared with the baseline and postinduction values. Arterial blood pressure and heart rate at intubation and after intubation, and their maximum values during the observed periods were significantly lower in the FNI group compared with the FOI group. The times required to reach the maximum values of systolic blood pressure and heart rate were significantly longer in the FNI group than in the FOI group, but the times required for recovery of systolic blood pressure and heart rate to postinduction values were significantly shorter in the FNI group than in the FOI group. After the intubation, the times required to reach the peak levels of systolic blood pressure and heart rate were not significantly different between the two groups.

CONCLUSIONS: Both FOI and FNI can cause significant circulatory responses in healthy anesthetized children, and the circulatory responses to FNI are fewer and of a shorter duration than those to FOI.

 

针刺治疗促进NO的产生和增强局部循环

Acupuncture Enhances Generation of Nitric Oxide and Increases Local Circulation

Masahiko Tsuchiya*{dagger}, Eisuke F. Sato*, Masayasu Inoue*, and Akira Asada{dagger}

From the *Departments of Biochemistry and Molecular Pathology and {dagger}Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Abeno-Ku, Japan.

Anesth Analg 2007 104: 301-307.

 

尽管针刺治疗广为应用,但是其对疼痛影响的机制和疗效尚未阐明。最近发现在经络和穴位中NO 合成酶活性增强。因为NO是局部循环中主要调因子,而且循环的改变可以影响疼痛的发展和持续作用,作者假设针刺治疗可调NO的水平。有关针刺治疗对局部NO水平和循环的效应,作者进行了一项随机、双盲、交叉研究,20名志愿者进行为期一周的治疗,分别在手掌和前臂进行真伪针刺治疗。NO血浆浓度在针刺治疗的手臂中有显著升高(5min2.8±1.5 umol/L60min2.5±1.4 umol/L)。针刺手臂后的手掌皮下组织血流亦增,且与NO的增相关。在伪针刺的手臂中没有以变化。结论:针刺增了治疗区域的NO水平,从而提高了局部血流。这些调作用可能有于针刺治疗中的镇痛效果.

(杨卫红 陈杰 校)

Although it is widely used, the mechanisms and effects of acupuncture on pain are not completely understood. Recently, increased nitric oxide (NO) synthase activity has been found in meridians and acupoints. Because NO is a key regulator of local circulation, and because change in circulation can affect the development and persistence of pain, we propose that acupuncture might regulate NO levels. We studied the effects of acupuncture on local NO levels and circulation in a randomized, double-blind, crossover study with 20 volunteers, each of whom underwent one session each of real and noninvasive sham acupuncture in a single hand and forearm with a 1-wk interval between treatments. NO concentration in the plasma from the acupunctured arm was significantly increased by 2.8 ± 1.5 µmol/L at 5 min and 2.5 ± 1.4 µmol/L at 60 min after acupuncture. Blood flow in palmar subcutaneous tissue of the acupunctured arm also increased, and this correlated with the NO increase. These changes were not observed in noninvasive sham-acupunctured hands and forearms. In conclusion, acupuncture increases the NO level in treated regions and thereby increases local circulation. These regulatory effects might contribute to pain relief provided by acupuncture.

 

麻醉药结合位点的共同化学基序

The Common Chemical Motifs Within Anesthetic Binding Sites

Edward J. Bertaccini, MD*{dagger}, James R. Trudell, PhD*, and Nicholas P. Franks, PhD{ddagger}

From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; {dagger}Department of Veterans Affairs, Palo Alto VA Health Care System, Palo Alto, California; and {ddagger}Biophysics Section, Blackett Laboratory, Imperial College, London, SW7 2AZ, UK.

Anesth Analg 2007 104: 318-324.

 

背景:获得麻醉药与蛋白质相结合的晶体结构目前仍不太可能,这一结构可能是神经细胞作用靶点,如配基门控型离子通道。然而,在X线下能找到麻醉药-蛋白质复合体的晶体结构,但其并不与麻醉作用相关。许多关于麻醉药-蛋白质相互作用的有用信息可从氟烷-胆固醇氧化酶、溴仿-荧虫素酶、氟烷-白蛋白和二氯乙烷-脱卤素酶的X线下的晶体结构衍生而来。这些结构都显示麻醉药-蛋白质在原子水平相互作用。

方法:作者通过已知文献获得溴仿-荧虫素酶、氟烷-白蛋白和二氯乙烷-脱卤素酶、氟烷-胆固醇氧化酶的配位。然后通过增氢、剪辑成细胞亚型、进行一系列的制性的分子学优选来改良这些配位。最后通过分子-量子学分析麻醉药结合位点的变化。

结果:麻醉药结合位点即麻醉药-蛋白质复合体结合点都具有相同的特点,称之为“结合基序”。这些基序的共同特征是:通过亲两性的结合位点起极化和非极化作用,包括存在有弱氢键与氨基酸和水分子的相互作用。而学分析也证明了亲两性结合位点对完全疏水性麻醉药的极化效应。这种极化是非常有用的。

结论:麻醉药结合蛋白质包括亲两性作用。

(丁震敏 陈杰 校)

BACKGROUND: It is not yet possible to obtain crystal structures of anesthetic molecules bound to proteins that are plausible neuronal targets; for example, ligand-gated ion channels. However, there are x-ray crystal structures in which anesthetics are complexed with proteins that are not directly related to anesthetic action. Much useful information about anesthetic–protein interactions can be derived from the x-ray crystal structures of halothane–cholesterol oxidase, bromoform–luciferase, halothane–albumin, and dichloroethane–dehalogenase. These structures show anesthetic-protein interactions at the atomic level.

METHODS: We obtained the known coordinate files for bromoform–luciferase, halothane– albumin, dichloroethane–dehalogenase, and halothane–cholesterol oxidase. These were then modified by adding hydrogens, edited into subsets, and underwent a series of restrained molecular mechanics optimizations. Final analysis of anesthetic polarization within the anesthetic binding site occurred via combined molecular mechanics–quantum mechanics calculations.

RESULTS: The anesthetic binding sites within these well-characterized anesthetic– protein complexes possess a set of common characteristics that we refer to as "binding motifs." The common features of these motifs are polar and nonpolar interactions within an amphiphilic binding cavity, including the presence of weak hydrogen bond interactions with amino acids and water molecules. Calculations also demonstrated the polarizing effect of the amphipathic binding sites on what are otherwise considered quite hydrophobic anesthetics. This polarization appears energetically favorable.

CONCLUSIONS: Anesthetic binding to proteins involves amphipathic interactions.

 

苯二氮卓类药物对大鼠大脑皮层切片苯基二氢喹唑啉能系统的效应

The Effects of Benzodiazepines on Orexinergic Systems in Rat Cerebrocortical Slices

Ying He, MD*{dagger}, Mihoko Kudo, PhD*, Tsuyoshi Kudo, PhD*, Tetsuya Kushikata, MD*, Enyou Li, MD{dagger}, and Kazuyoshi Hirota, MD, FRCA*

From the *Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan; and {dagger}Department of Anesthesiology, First Clinical College of Harbin Medical University, Harbin, China.

Anesth Analg 2007 104: 338-340.

 

背景:有道苯基二氢喹唑啉能神经元可媒介情绪变化,而苯二氮卓类药物可与苯基二氢喹唑啉能神经元相互作用。

方法:检测大鼠大脑皮层切片苯基二氢喹唑啉能神经元与苯二氮卓类受体在苯基二氢喹唑啉AK+诱发的去甲肾腺素放之间的相互关系。

结果:咪达唑伦、地西泮、氟硝西泮呈浓度依赖性制苯基二氢喹唑啉AK+诱导的去甲肾腺素的放。咪达唑伦诱导苯基二氢喹唑啉A去甲肾腺素放的IC500.87Um,p<0.01)明显低于地西泮和氟硝西泮(约60Um),而K+诱导去甲肾腺素放IC50在苯二氮卓类药物间没有差异。

结论:苯基二氢喹唑啉能神经元和中枢苯二氮卓类受体之间可能没有相互作用。

(顾新宇 陈杰 校)

BACKGROUND: As orexin ergic (OXergic) neurons have been reported to mediate emotional changes, benzodiazepines might interact with OXergic neurons.

METHODS: We examined the interactions between OXergic neurons and benzodiazepine receptors in orexin-A (100 nM) and K+ (25 mM)-evoked norepinephrine release from rat cerebrocortical slices.

RESULTS: Midazolam, diazepam, and flunitrazepam concentration-dependently inhibited both OX-A- and K+-evoked norepinephrine release. The IC50 of midazolam for orexin-A-evoked release (0.87 µM, P < 0.01), which was insensitive to flumazenil, was significantly lower than that of diazepam and flunitrazepam (around 60 µM), whereas the IC50s for K+-evoked release were not different among the benzodiazepines.

CONCLUSION: There may be no interaction between OXergic neurons and central benzodiazepine receptors.

 

用阿司匹林触发的脂氧素A4类似物后能减弱脂多糖诱导的小鼠急性肺损伤:血红素氧酶-1的作用

Posttreatment with Aspirin-Triggered Lipoxin A4 Analog Attenuates Lipopolysaccharide-Induced Acute Lung Injury in Mice: The Role of Heme Oxygenase-1

Sheng-Wei Jin, MD, PhD*{ddagger}, Li Zhang, PhD{dagger}, Qin-Quan Lian, MD{ddagger}, Dong Liu, MD, PhD*, Ping Wu, PhD{dagger}, Shang-Long Yao, MD*, and Du-Yun Ye, PhD{dagger}

From the {ddagger}Department of Anesthesiology, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou, China; *Departments of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and {dagger}Departments of Pathophysiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Anesth Analg 2007 104: 369-377.

[

背景:作者假设用15--16-旁氟苯基脂氧素A4ATL)治疗后可以减轻小鼠脂多糖(LPS)诱导的急性肺损伤。

方法:所有物随机分为6组(每组6只)。假载体组小鼠在生理盐水补液后的60min0.9%NS治疗。假ATL组与假载体组开始治疗方法相同, 60min后用ATL0.7mg/kg,静脉注射),假ZnPP组和假载体组开始治疗相同, 60min后用锌原扑啉Ⅸ(ZnPP25mg/kg静脉注射)。在LPS载体组,小鼠在给予LPS60min后用载体治疗。LPSATL组和LPS载体组方法一样,只是它们使用ATLZnPPATLLPS组和LPSATL组一样,但是在使用ATL30min给予ZnPP

结果:吸入LPS增了支气管肺泡灌洗液中炎症细胞的数量,TNF-α和蛋白浓度,且诱导肺组织损伤和水肿。用ATL治疗可以制TNF-α,NO和丙二醛产物,肺水肿、脂质过氧化和中性细胞浸润均减轻。此外,ATL还促进肺组织血红素氧酶-1的形成,并促进其活性增。ATL的有作用被ZnPP消。

结论:用ATL治疗后能显著减少LPS诱导的小鼠急性肺损伤。

(周密 陈杰 校)

BACKGROUND: We hypothesized that posttreatment with 15-epi-16-parafluoro-phenoxy lipoxin A4 (ATL) could attenuate lipopolysaccharide (LPS)-induced acute lung injury in mice.

METHODS: All the animals were randomly assigned to one of six groups (n = 6 per group). In the sham-vehicle group, mice were treated with 0.9% saline 60 min after they were challenged with saline. The sham-ATL group was identical to the sham-vehicle group except that ATL (0.7 mg/kg, IV) was administered, and the sham-ZnPP group was identical to the sham-vehicle group except that Zinc protoporphyrin IX (ZnPP, 25 mg/kg IV) was administered. In the LPS-vehicle group, mice were treated with vehicle 60 min after they were challenged with LPS. The LPS-ATL group was identical to the LPS-vehicle group but received ATL. The ZnPP-ATL-LPS group was identical to the LPS-ATL group, but ZnPP was administered 30 min before ATL.

RESULTS: Inhalation of LPS increased inflammatory cell counts, tumor necrosis factor-{alpha}, and protein concentration in bronchoalveolar lavage fluid and also induced lung histological injury and edema. Posttreatment with ATL inhibited tumor necrosis factor-{alpha}, nitric oxide, and malondialdehyde production, with the outcome of decreased pulmonary edema, lipid peroxidation, and the infiltration of neutrophils in lung tissues. In addition, ATL promoted the formation of heme oxygenase-1 in the lung tissues. Heme oxygenase-1 activity was also increased in the lung tissues after ATL stimulation. The beneficial effects of ATL were abolished by ZnPP.

CONCLUSIONS: This study demonstrates that posttreatment with ATL significantly reduces LPS-induced acute lung injury in mice.

 

气道压与吸气时间对细菌易位的影响

The Effects of Airway Pressure and Inspiratory Time on Bacterial Translocation

Perihan Ergin Ozcan, MD*, Nahit Cakar, MD*, Simru Tugrul, MD*, Ozkan Akinci, MD*, Atahan Cagatay, MD{dagger}, Dilek Yilmazbayhan, MD{ddagger}, Figen Esen, MD*, Lutfi Telci, MD*, and Kutay Akpir, MD*

From the *Departments of Anesthesiology and Intensive Care; {dagger}Infectious Disease and Clinical Microbiology; and {ddagger}Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Anesth Analg 2007 104: 391-396.

背景:机械通气时,较高的吸气峰压可以诱发肺损伤,并使细菌由肺易位到体循环。作者研究了机械通气时使用与不使用外源形呼气末正压(PEEP)两种情况下延长吸气时间对气管内种植细菌易位的影响。

方法:给予大鼠压控制通气模型行机械通气,吸气峰压(PIP)为14cm H2OPEEP0,吸呼比(IE)为12,吸入氧浓度(FiO2)为1.0。然后经气管造口种植105 cfu/mL绿脓杆菌0.5m,随机分为六组:2个低压组(LP),分别为LP1/2组:PIP14 cm H2OPEEP0IE=1/2LP2/1组: PIP14cmH2OPEEP0 cm H2OIE=212个高压组(HP),分别为HP1/2组:PIP30cmH2OPEEP0IE=12HP2/1组:PIP30cmH2OPEEP0IE=212HP PEEP组(HPP),分别为HPP 1/2组:PIP 30cmH2O PEEP10cmH2OIE=1/2HPP2/1组,PIP 30cmH2OPEEP10cmH2OIE=2/1。每30分钟做1次血培养。将小鼠处死后取其肺脏制成标本。

结果:与基础值相比,在LP1/2组、LP2/1组、HP1/2HP2/1组在处死前最后一点的Pao2均降低,但是只有HP1/2Pao2的下降到统计学有意义水平。在HPP2/1组细菌易位率高于HPP1/2组(P=0.01

结论:高PIP组,无论是否延长吸气时间均增细菌易位。在高PIPPEEP可以制细菌易位。但在延长吸气时间后PEEP的制易位作用消失。

(宋翠侠 陈杰 校)

BACKGROUND: Mechanical ventilation with high peak inspiratory pressure (PIP) induces lung injury and bacterial translocation from the lung into the systemic circulation. We investigated the effects of increased inspiratory time on translocation of intratracheally inoculated bacteria during mechanical ventilation with and without extrinsic positive end-expiratory pressure (PEEP).

METHODS: Rats were ventilated in pressure-controlled mode with 14 cm H2O PIP, 0 cm H2O PEEP, I:E ratio 1/2, and Fio2 1.0. Subsequently, 0.5 mL of 105 cfu/mL Pseudomonas aeruginosa was inoculated through tracheostomy and rats were randomly assigned to six groups; two low-pressure groups (LP)1/2, 14 cm H2O PIP, 0 cm H2O PEEP, I:E = 1/2, and LP2/1 14 cm H2O PIP, 0 cm H2O PEEP, I:E = 2/1; two high-pressure groups (HP)1/2, 30 cm H2O PIP, 0 cm H2O PEEP, I:E = 1/2, and HP2/1, 30 cm H2O PIP, 0 cm H2O PEEP, I:E = 2/1; two HP PEEP groups (HPP)1/2, 30 cm H2O PIP, 10 cm H2O PEEP, I:E = 1/2, and HPP2/1, 30 cm H2O PIP, 10 cm H2O PEEP, I:E = 2/1. Blood cultures were obtained every 30 min. The rats were killed and their lungs were processed.

RESULTS: When compared with baseline values, Pao2 decreased in the LP1/2, LP2/1, HP1/2, and HP2/1 groups at the last time point, but the decline in Pao2 reached statistical significance in only the HP1/2 group. The bacterial translocation rate was greater in group HPP2/1 than group HPP1/2 (P = 0.01).

CONCLUSIONS: We found that high PIP, with or without prolonged inspiratory time, increased the rate of bacterial dissemination. PEEP prevented bacterial translocation in the high PIP group. However, the protective effect of PEEP was lost when inspiratory time was prolonged.


最小容量和最小剂量的布比卡因(0.125%w/v0.25%w/v)用于硬膜外分娩镇痛的比较研究

A Comparison of Minimum Local Anesthetic Volumes and Doses of Epidural Bupivacaine (0.125% w/v and 0.25% w/v) for Analgesia in Labor

Gordon R. Lyons, MD, FRCA*, Mitko G. Kocarev, MD, DEAA*, Rowan C. Wilson, MRCP, FRCA*, and Malachy O. Columb, FRCA{dagger}

From the *Department of Obstetric Anaesthesia, St James University Hospital, Leeds, UK; and {dagger}Intensive Care Unit, South Manchester University Hospital, Wythenshawe, UK.

Anesth Analg 2007 104: 412-415.

 

背景:本研究中作者拟探索两种不同浓度的布比卡因用于硬膜外分娩镇痛的最小有效容量(MLAV)和剂量(MLAD)。

方法:80名女性随机、双盲分成两组分别给予首剂量0.125%w/v)或0.25%w/v)的布比卡因。初始容量为15mL。根据镇痛效果确定追量。如30min内的VAS≤100-100),表明镇痛有效,则下一名女性接受的药物容量减少2mL。如VAS不能达到≤10的标准,下一名女性的给药容量则增2mL

结果:根据DixonMassey公式,分别计算两种浓度药物在95%可信区间(CI)内的MLAVMLAD0.125%w/v)布比卡因的MLAV13.6mL95%CI12.414.8),0.25%w/v)布比卡因的MLAV9.2mL95%CI6.911.5)。两者之间的差异明显(P=0.002)。在以两种局麻药容量下的MLAD分别是17.0mg95%CI15.5-18.5),和23.1mg(17.2-28.9),(P=0.045)。

结论:0.125%(w/v)布比卡因要与0.25%w/v)布比卡因产生相同的镇痛效果,需增50%的药物容量,却可以减少25%的药物剂量。减少药物的使用剂量而不降低其作用效果,可以降低局麻药中毒的风险从而提高用药的安全性。

(印洁敏 陈杰 校)

BACKGROUND: In this study we sought to determine and compare the minimum local anesthetic volumes (MLAV) and doses (MLAD) of two concentrations of bupivacaine for epidural pain relief in labor, and to quantify the effect on dose.

METHODS: Eighty women were randomized in a double-blind manner to receive a first bolus of either plain bupivacaine 0.125% (w/v) or 0.25% (w/v). The arbitrary starting volume was 15 mL. Subsequent volumes were decided by sequential allocation according to analgesic efficacy. A visual analog pain score 10 (0–100) within 30 min, indicated effective analgesia. The next woman received a decrement of 2 mL. A failure of the visual analog pain score to reach 10 was followed by a 2 mL increment for the next woman.

RESULTS: Using the formula of Dixon and Massey, MLAV and MLAD, with 95% confidence intervals (CI) were calculated for each concentration. MLAV was 13.6 mL (95% CI 12.4–14.8), with bupivacaine 0.125% (w/v), and 9.2 mL (95% CI 6.9–11.5) with bupivacaine 0.25% (w/v). The difference was highly significant (P = 0.002). MLAD for these volumes were 17.0 mg (95% CI 15.5–18.5), and 23.1 mg (17.2–28.9), respectively (P = 0.045).

CONCLUSIONS: Bupivacaine 0.125% (w/v) when compared with 0.25% (w/v) produced equivalent analgesia with a 50% increase in volume, but with a 25% reduction in dose. Any reduction in dose, without loss of efficacy, reduces risk of toxicity and improves safety.


一种新型血浆替代品羟乙基淀粉:用血栓弹性描记图和全血凝集度方法测定凝血能的离体研究

A New Plasma-Adapted Hydroxyethylstarch Preparation: In Vitro Coagulation Studies Using Thrombelastography and Whole Blood Aggregometry

Joachim Boldt, MD, PhD, Michael Wolf, MD, and Andinet Mengistu, MD

From the Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.

Anesth Analg 2007 104: 425-430.

背景:羟乙基淀粉(HES)作为血容量替代品使用较少的原因可能由于异常的凝血能的道。本文作者进行了盲法离体研究,比较一种新型HES、传统的HES和乳酸林格液三者对止血作用的影响。

方法:取10名健康男性青年志愿者血液,用新型6%HES130/0.42(平衡HES)、传统型6% HES130/0.42(非平衡HES)或乳酸林格液稀血液,稀浓度分别为10%30%50%。入两种激活剂(凝血活酶-磷脂监测内源系统,凝血激酶监测外源系统)描绘旋转的血栓弹性描记图。入二磷酸腺苷、胶原或凝血酶激活因子蛋白测定全血凝集度以评估血小板能。

结果:非平衡HES30%50%组)比平衡HES的血液凝集时间明显延长。非平衡HES50%组比平衡HES的最大血凝块的硬度明显减弱。非平衡HES50%组比平衡液HES组,在入二磷酸腺苷、胶原、或凝血酶激活因子蛋白时全血凝集度明显降低。

结论:平衡HES制剂比非平衡HES制剂,在血栓弹性描记图数据和血小板凝集能方面影小较小,尤其在稀度较高时。将来的临研究可能显示出平衡HES对血液凝固的影响较小。

(张美荣 陈杰 校)

BACKGROUND: The lack of acceptance of hydroxyethylstarch (HES) for intravascular volume replacement is most likely due to reports of abnormal coagulation. In a blinded in vitro study, we compared the effects on hemostasis of a new HES, prepared in a balanced solution, with a conventional HES preparation and Ringer’s lactate solution.

METHODS: Blood was taken from 10 healthy young male volunteers. Blood was diluted by 10%, 30%, and 50% using either 6% HES 130/0.42 prepared in a balanced solution, a conventional nonbalanced 6% HES 130/0.4 or Ringer’s lactate solution. Rotation thrombelastography, was performed after adding two activators (thromboplastin-phospholipid to monitor the intrinsic system; tissue factor to monitor the extrinsic system). Whole blood aggregometry adding adenosine diphosphate, collagen, and thrombin receptor-activating protein was used to assess changes of platelet function.

RESULTS: Dilution of blood (30% and 50%) resulted in clot formation time that was significantly more prolonged in the nonbalanced than in the balanced HES group. In the 50% diluted sample using the unbalanced HES, maximum clot firmness was significantly more reduced than by 50% dilution using the balanced HES. In the 50% diluent using the nonbalanced HES, adenosine diphosphate-, collagen-, and thrombin receptor activating protein-induced aggregometry was more reduced than in the balanced HES group.

CONCLUSIONS: A balanced HES preparation showed fewer negative effects on thrombelastographic data and platelet aggregation than a nonbalanced HES preparation, especially when using higher degrees of dilution. Future clinical studies may show a decreased influence of balanced HES solutions on coagulation.

 

斜角肌间隙置入电刺激导管是否改善肩部外科手术后疼痛或能-----一项前瞻性的、随机、双盲试验

Does Interscalene Catheter Placement with Stimulating Catheters Improve Postoperative Pain or Functional Outcome After Shoulder Surgery? A Prospective, Randomized and Double-Blinded Trial

Markus F. Stevens, MD, DEAA*, Robert Werdehausen*, Elisabeth Golla, MD*, Sebastian Braun, MD*, Henning Hermanns, MD*, Ansgar Ilg, MD{dagger}, Reinhardt Willers, PhD{ddagger}, and Peter Lipfert, MD, PhD*

From the Department of *Anesthesiology, {dagger}Orthopedics, and {ddagger}Informatics, University of Düsseldorf, Düsseldorf, Germany.

Anesth Analg 2007 104: 442-447.

 

背景:在这项前瞻性的、随机、双盲的试验中作者研究了在肩部外科手术过程应用电刺激导管中以术后对能改善

方法:在用输出量小于0.5mv的神经刺激器引出足够的肌肉颤搐后,或是通过传统盲探法(传统导管即CC组,n=20)或是通过电刺激导管(刺激导管即SC组,n=20)在神经周围置管。一次性注入1% 丙胺卡因40ml0.75%罗哌卡因10ml组成的混合液,之后病人自控注射0.2%罗哌卡因(注射速率8ml/h,单次剂量2ml,锁定时间为20min

结果:SC组运阻滞较快,而感觉阻滞组间无差异,术后两天疼痛评分大致相同。术后6SC组临客观肩部能评分(恒量分值)较SC组改善。

结论:应用可刺激导管可速运阻滞,不改善对术后镇痛,但可明显改善肩部手术后6周的能。

(郑丽 陈杰 校)

BACKGROUND: In this prospective, randomized, double-blind trial we investigated the use of stimulating catheters in patients during and after shoulder surgery; functional improvement being the primary outcome measurement.

METHODS: After eliciting an adequate muscular twitch at 0.5 mA nerve stimulation output, the perineural catheter was advanced either blindly (conventional catheter = CC group, n = 20) or guided by stimulation via the catheter (stimulating catheter = SC group, n = 20). A bolus of 40 mL prilocaine 1% and 10 mL ropivacaine 0.75% was injected, followed by a patient-controlled infusion of ropivacaine 0.2% (8 mL/h infusion rate, bolus 2 mL, lockout time 20 min).

RESULTS: Onset of motor block was faster in the SC group, whereas sensory block did not differ between groups. Median pain scores on two postoperative days were equal. Improvement of the objective shoulder function score (Constant Murley Score) 6 wk postoperatively was enhanced to a clinically relevant extent in the SC group compared to the CC group (P < 0.01).

CONCLUSIONS: We conclude that the use of a stimulating catheter results in a faster onset of motor block, unaltered postoperative pain, and a significantly improved functional outcome 6 wk after shoulder surgery.

一项探讨以儿童年龄为标准差对七氟醚MAC值的影响

A Comparison of the Effect on Dispersion of Repolarization of Age-Adjusted MAC Values of Sevoflurane in Children

Simon D. Whyte, MBBS, FRCA*{ddagger}, Shubhayan Sanatani, MD, BSc, FRCPC{dagger}, Joanne Lim, MASc*{ddagger}, and Peter D. Booker, MBBS, MD, FRCA¶#

From the Departments of *Pediatric Anesthesia and {dagger}Pediatric Cardiology, British Columbia Children's Hospital; {ddagger}Department of Anesthesiology, Pharmacology and Therapeutics, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; ¶Jackson-Rees Department of Anesthesia, Royal Liverpool Children's Hospital and #Department of Anesthesia, Liverpool University, Liverpool, United Kingdom.

Anesth Analg 2007;104:277-282

背景:QT间期延长伴有尖端扭转性心过速(TdP),但是很难预测药物引起的尖端扭转。心肌透壁性复极化消散(TDR)增强,而非QT间期延长本身使TdP的易感性增高。TDR可以从心电图T波的波峰与波结尾之间的间期(Tp-e)来测得。因此Tp-e是一个很容易测定药物引起尖端扭转的测定法。一些麻醉药延长QT间期,可是它们对TDR的影响我们还不了解。

方法:我们给54个未术前用药的310岁、ASA分级III级的儿童随机吸入经过年龄标准校正的11.251.5MAC的七氟醚,从而研究七氟醚对校正的QTQTc)和Tp-e间期的影响。在吸入七氟醚前后记录十二导联心电图。用2路方差分析对QTcTp-e进行组间和组内比较。吸入七氟醚后Tp-e的变化为主要的研究数据。

结果:所有剂量的七氟醚都显著延长手术前的QTc间期(P<0.005),无剂量-反应关系,但是七氟醚对术前的Tp-e没有影响。

讨论:七氟醚在健康儿童显著延长QTc,但是并不增通过Tp-e测得的复极化消散,这提示尖端扭转的产生很低或无,且使其不太可能增TdP的易感性。

(姜旭晖      马皓琳  李士通校)

BACKGROUND: QT interval prolongation is associated with torsades des pointes (TdP), but is a poor predictor of drug torsadogenicity. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall, rather than QT interval prolongation per se. TDR can be measured on the electrocardiogram as the time interval between the peak and end of the T-wave (Tp-e). Thus Tp-e is a readily measured assay of drug torsadogenicity. Several anesthetic drugs prolong the QT interval, but their effect on TDR is largely unknown.

METHODS: We investigated the effects of sevoflurane on corrected QT (QTc) and Tp-e intervals in 54 unpremedicated ASA I-II children, aged 3–10 yr, who were randomized to receive sevoflurane 1, 1.25, or 1.5 MAC, age-adjusted. Twelve-lead electrocardiograms were recorded before and after sevoflurane exposure. QTc and Tp-e were compared within and among groups using 2-way analysis of variance. Change in Tp-e after sevoflurane exposure was the primary outcome measure.

RESULTS: Sevoflurane significantly prolonged preoperative QTc at all doses (P < 0.005), with no dose-response relationship, but had no effect on preoperative Tp-e.

CONCLUSION: Sevoflurane markedly prolongs the QTc in healthy children, but does not increase dispersion of repolarization as measured by the Tp-e interval, indicating low or no torsadogenicity, and making it unlikely to increase predisposition to TdP.

 

 

耳针用于牙科患者焦虑:一项随机对照试验

Auricular Acupuncture for Dental Anxiety: A Randomized Controlled Trial

Matthias Karst, MD, PhD*, Michael Winterhalter, MD*, Sinikka Münte, MD, PhD*, Boris Francki, DS{dagger}, Apostolos Hondronikos, DS{dagger}, Andre Eckardt, DDS, MD, PhD{dagger}, Ludwig Hoy, PhD{ddagger}, Hartmut Buhck, MD, Michael Bernateck, MD*, and Matthias Fink, MD, PhD

From the Departments of *Anesthesiology, {dagger}Oral and Maxillofacial Surgery, {ddagger}Biometrics, and Physical Medicine and Rehabilitation, Pain Clinic, Hannover Medical School, Hannover, Germany.

Anesth Analg 2007;104:295-300

耳针可以是用于急性焦虑的有效治疗方法,但缺乏针刺与已证实的标准药物治疗之间的直接比较。在本研究中我们比较了耳针与鼻内给予咪达唑仑、安慰针刺无处理对减少牙科患者焦虑的有效性。拔牙患者(n = 67)随机分入(i)耳针、(ii)安慰针刺和(iii)鼻内给予咪达唑仑,并与无处理组比较。干预前、干预后30 min时拔牙后评定焦虑。持续评定生理学变量。将无处理组作为对照,耳针组和咪达唑仑组在30 min时的焦虑显著低于安慰针刺组(Spielberger Stait-Trait焦虑清单 X1 P 分别为= 0.012<0.001)。而且如果进行耳针或鼻内应用咪达唑仑,由牙科医生评定的患者合作性显著改善(P分别 = 0.0320.049)。结论,耳针和鼻内给予咪达唑仑对于牙科患者焦虑的处理具有相似的有效性。

(马皓琳 李士通 校)

Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.

 

 

Extra 1 穴位针压法:对双频指数、血清褪黑素、血浆β-内啡肽应激的影响

Acupressure on the Extra 1 Acupoint: The Effect on Bispectral Index, Serum Melatonin, Plasma ß-Endorphin, and Stress

Argyro Fassoulaki, MD, PhD, DEAA*, Anteia Paraskeva, MD, DEAA*, Georgia Kostopanagiotou, MD*, Eleftheria Tsakalozou, MSc{dagger}, and Sophia Markantonis, PhD{dagger}

From the *Department of Anesthesiology, Aretaieio Hospital, Medical School; and {dagger}Laboratory of Biopharmaceutics and Pharmacokinetics, School of Pharmacy, University of Athens, Athens, Greece.

Anesth Analg 2007;104:312-317

背景:extra 1”穴位针压法可降低双频指数(BIS)值应激。

方法:我们对12例志愿者,在extra 1 穴位一个假穴位针压前、针压10min后、无针压后以每次干预结束后1h分别测定BIS、褪黑素、β-内啡肽以言语应激评分值。

结果:extra 1 穴位针压后BIS和言语应激评分值均降低(P值分别为0.00010.008),但褪黑素和β-内啡肽无变化。

结论:extra 1 穴位针压法对褪黑素和β-内啡肽水平无影响。

(黄施伟 译,马皓琳 李士通 校)

BACKGROUND: Acupressure on the "extra 1" point decreases bispectral index (BIS) values and stress.

METHODS: We investigated the BIS, melatonin, ß-endorphin, and verbal stress score values before, after 10 min of acupressure application on the extra 1 point, on a sham point, after no acupressure, and 1 h after completion of each intervention in 12 volunteers.

RESULTS: The BIS and verbal stress score values were decreased after acupressure on the extra 1 point (P = 0.0001 and P = 0.008, respectively), but melatonin and ß-endorphin did not change.

CONCLUSION: Acupressure on the extra 1 point has no effect on melatonin and ß-endorphin levels.

 

 

氟烷、异氟烷和七氟烷增钙诱发的重组人心脏肌钙蛋白C构型改变学

Halothane, Isoflurane, and Sevoflurane Increase the Kinetics of Ca2+-Induced Conformational Change of Recombinant Human Cardiac Troponin C

Dirk Breukelmann, MD*, and Philippe R. Housmans, MD, PhD{dagger}

From the *Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany; and {dagger}Mayo Clinic and Foundation, Rochester, Minnesota.

Anesth Analg 2007;104:332-337

背景:氟烷、异氟烷和七氟烷产生的负性肌副作用,通常由可用的细胞内钙离子减少来介导。其他可能的机制包括细胞内钙处理过程改变、肌纤凝蛋白横桥循环受损和/或钙诱导的调性肌钙蛋白复合体构象变化的改造。

方法:我们采用停流和钙滴定术,观察了氟烷、异氟烷和七氟烷对分离的IAANSHrcTnCIAANS)标记的人重组心肌肌钙蛋白C的钙依赖学的影响。

结果:在对照组,在-最大荧光强度的钙浓度(Kd)是2.1 ± 0.1 mM。挥发性麻醉药呈浓度依赖性增钙敏感性,七氟烷 (Kd 1.5–1.7 mM, P = 0.001) > 氟烷 (Kd 1.7–1.9 mM, P < 0.01) > 异氟烷 (Kd 1.8–1.9 mM, P < 0.05)。在4°C时,述药物使钙与HrcTnCIAANS快速解离后构象改变的率常数(koff(c))中度延长,其作用强度氟烷和异氟烷>七氟烷。

结论:这些机制可能消钙利用度减少的效应,且是挥发性麻醉药存在时心肌纤维舒张期缩短(可能是不完全的)的主要原因。

(颜涛 译, 马皓琳 李士通 校)

BACKGROUND: Halothane, isoflurane, and sevoflurane exert negative inotropic side effects, generally mediated via a reduced availability of intracellular calcium. Other possible mechanisms include modified intracellular calcium handling, impaired actomyosin cross-bridge cycling, and/or alteration of calcium-induced conformational changes of the regulatory troponin complex.

METHODS: We investigated the effect of halothane, isoflurane, and sevoflurane on calcium-dependent kinetics of isolated human recombinant cardiac troponin C labeled with IAANS (HrcTnCIAANS) using stopped-flow and calcium titration techniques.

RESULTS: Calcium concentration at half-maximal fluorescence intensity (Kd) in the control group was 2.1 ± 0.1 mM. Volatile anesthetics increased calcium sensitivity in a concentration-dependent fashion sevoflurane (Kd 1.5–1.7 mM, P = 0.001) > halothane (Kd 1.7–1.9 mM, P < 0.01) > isoflurane (Kd 1.8–1.9 mM, P < 0.05). The rate constant of conformational changes after rapid dissociation of calcium from HrcTnCIAANS (koff(c)) was moderately prolonged at 4°C by halothane and isoflurane > sevoflurane.

CONCLUSION: These mechanisms may counteract the effects of lower calcium availability, and can be responsible for abbreviated, and possibly incomplete, relaxation of cardiac muscle fibers in the presence of volatile anesthetics.

 

 

腹部手术期间体液平衡的定量分析

Quantitative Analysis of Fluid Balance During Abdominal Surgery

Tsuneo Tatara, MD, and Chikara Tashiro, MD

From the Department of Anesthesiology, Hyogo College of Medicine, Hyogo, Japan

Anesth Analg 2007;104:347-354

背景:手术创伤会引起创伤组织中组织间液急性增多。用静脉输液处理体液增多会引起与血管内容量过多相关的术后并发症。组织间液增多的定量预测可能使我们更好地了解关于液体管理和其引发的血管内液与血管外液平衡之间的关系。

方法:我们应用了一种描述液体和蛋白态分布和运输的数学模型,目的是定量化血管内室和血管外室之间的液体平衡。对一个70kg男性施行模拟的4小时腹部外科手术,并计算了血浆中、组织间液尿量中液体容积的变化。为了验证该模型,我们将得到的这些结果与在施行择期腹部手术的30名患者通过段性生物电阻测定的结果作了比较。

结果:该模型预言,与标准态相比,外科创伤会导致损伤组织间液增多705ml,而血浆容量会下降356ml。手术过程中,达到正常血浆容量是不可能的,即使补液速度几乎达到20ml · kg–1 · h–1。生物电阻和模型预测之间身体不同部位组织间液容量变化的偏倚和一致限,在四肢分别为–131ml 325ml,在躯干为–157 ml834 ml

结论:该模型显示,提高补液速度在10 ml · kg–1 · h–1以,并不会对血浆容量产生预期效应,相反会增间液容量。

(黄丽娜 马皓琳 李士通 校)

BACKGROUND: Surgical injury causes acute sequestration of interstitial fluid in injured tissue. Fluid sequestration treated with IV fluid administration can lead to postoperative complications related to excessive intravascular volume. Quantitative prediction of interstitial fluid sequestration may foster a better understanding of the relationship between fluid administered and the resulting balance between intra- and extravascular fluid.

METHODS: We developed a mathematical model describing the dynamic distribution and transport of fluid and proteins with the goal of quantifying the balance of fluid between intra- and extravascular compartments. Fluid volume changes in the plasma, interstitial and urine compartments were calculated for a simulated 4 h abdominal surgery in a 70 kg male. To validate the model, we compared the results obtained with those measured by segmental bioelectrical impedance on 30 patients undergoing elective abdominal surgery.

RESULTS: The model predicted that, compared to the normal state, surgical injury would result in the sequestration of 705 mL of interstitial fluid in injured tissue, whereas plasma volume would undergo a 356 mL decrease. During surgery, it was not possible to obtain a normal plasma volume, even with fluid replacement at a rate of almost 20 mL · kg–1 · h–1. Bias and limit of agreement on interstitial fluid volume changes in body segments between bioelectrical impedance and model prediction were –131 and 325 mL, respectively for limbs, and –157 and 834 mL for the trunk.

CONCLUSIONS: The model shows that increasing the fluid replacement rate above 10 mL · kg–1 · h–1 does not have the desired effect on plasma volume but instead increases the interstitial volume.

 

 

心脏手术后两个不同的康复策略对肺和血流学的影响

The Pulmonary and Hemodynamic Effects of Two Different Recruitment Maneuvers After Cardiac Surgery

Serdar Celebi, MD*, Özge Köner, MD{dagger}, Ferdi Menda, MD*, Kubilay Korkut, MD{ddagger}, Kaya Suzer, MD{ddagger}, and Nahit Cakar, MD

From the Departments of *Anesthesiology and Intensive Care, {ddagger}Cardiovascular Surgery, Istanbul University Cardiology Institute; {dagger}Department of Anesthesiology and Intensive Care, Yeditepe University Hospital; and Department of Anesthesiology and Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

Anesth Analg 2007;104:384-390

背景:我们的研究的目的是评价开放性心脏手术后两个不同的康复策略对肺和血流学的影响。

方法:进行冠脉搭桥的60例患者在术后随机分入三组:用持续气道正压(CPAP)的康复策略(CPAP-40组,n = 20)、通过呼气末正压(PEEP)的康复(PEEP-20组,n = 20)和5 cm H2O PEEPPEEP-5组,n = 20)。在CPAP-40组,40 cm H2O吸气峰压应用30 s,然后PEEP降低到20 cm H2O,且用基础参数持续通气,PEEP降低直到达到最好的Pao2。在PEEP-20组,设定20 cm H2O PEEP持续2 min,调整潮气量以达到40 cm H2O的吸入气道峰压,然后降低PEEP直到达到最好的Pao2。在PEEP-5组,术后用5 cm H2O PEEP

结果:在干预过程中CPAP-40组的平均脉压低于PEEP-20组(P < 0.01)和PEEP-5组(P < 0.01)。在机械通气期间两个策略组中的氧合高于PEEP-5组。在此期间以外,组间无显著差异。术后第一天PEEP-5组的肺不张评分(1.3 ± 0.9)高于CPAP-40组(0.65 ± 0.6P = 0.01)和PEEP-2-组(0.65 ± 0.5P = 0.01)。

结论:用后策略PEEP的康复方法增高氧合,同样地减少肺不张,而PEEP-20提供了比CPAP策略更稳定的血流学情况。

(马皓琳 李士通 校)

BACKGROUND: The aim of our study was to evaluate the pulmonary and hemodynamic effects of two different recruitment maneuvers after open heart surgery.

METHODS: Sixty patients undergoing coronary artery bypass surgery were randomized into three groups after operation: recruitment maneuver with continuous positive airway pressure (CPAP) (CPAP-40 group, n = 20), recruitment by positive end-expiratory pressure (PEEP) (PEEP-20 group, n = 20), and 5 cm H2O PEEP (PEEP-5 group, n = 20). In the CPAP-40 group, 40 cm H2O peak inspiratory pressure was applied for 30 s, then PEEP was reduced to 20 cm H2O and ventilation was continued with baseline variables with PEEP decreased until the best Pao2 was achieved. In the PEEP-20 group, 20 cm H2O PEEP was set for 2 min, tidal volume was adjusted to achieve a peak inspiratory airway pressure of 40 cm H2O during the maneuver, then PEEP was decreased until the best Pao2 had been achieved. In the PEEP-5 group, 5 cm H2O PEEP was applied postoperatively.

RESULTS: The mean arterial blood pressure of the CPAP-40 group was lower than that of the PEEP-20 (P < 0.01) and PEEP-5 groups (P < 0.01) during the interventions. Oxygenation was higher in both recruitment groups than in the PEEP-5 group during the mechanical ventilation period. There was no significant difference among the groups beyond that period. The atelectasis score of the PEEP-5 group (1.3 ± 0.9) on postoperative day 1 was higher than that of the CPAP-40 (0.65 ± 0.6; P = 0.01) and PEEP-20 (0.65 ± 0.5; P = 0.01) groups.

CONCLUSIONS: The recruitment techniques with postmaneuver PEEP increased oxygenation and decreased atelectasis equally, whereas PEEP-20 provided more stable hemodynamic conditions than the CPAP maneuver.

 

 

多胎娠和单胎娠产妇在剖宫产麻中血管收缩药用量血流学变化的前瞻性比较

A Prospective Comparison of Vasopressor Requirement and Hemodynamic Changes During Spinal Anesthesia for Cesarean Delivery in Patients with Multiple Gestation Versus Singleton Pregnancy

Warwick D. Ngan Kee, MBChB, MD, FANZCA, FHKCA, FHKAM, Kim S. Khaw, MBBS, FRCA, FHKCA, FHKAM, Floria F. Ng, RN, BASc, Manoj K. Karmakar, MBBS, FRCA, FHKCA, FHKAM, Lester A. Critchley, MBChB, BMedSci, MD, FFARCSI, FHKCA, FHKAM, and Tony Gin, MBChB, MD, FRCA, FANZCA, FHKCA, FHKAM

From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.

Anesth Analg 2007;104:407-411

背景:人们经常认为,在剖宫产麻和硬膜外麻醉中,多胎娠比单胎娠产妇更容易产生严重的低血压。然而,很少有可用的定量数据来支持这一论断。在这项研究中,我们前瞻性地比较了多胎娠和单胎娠产妇在择期剖宫产麻期间血管收缩药的用量血流学变化情况。

方法:在剖宫产麻期间采用相同麻醉管理的40名多胎娠产妇和60名单胎对照者参与了此项研究。静脉预充容量后,产妇接受椎管内布比卡因-太尼麻醉并向左倾斜。间羟胺持续输注以保持收缩压在基础值90%–100%。比较两组血管收缩药用量、收缩压的最小值最大值低血压、高血压以恶心/呕吐的发生率。

结果:两组间所有的参数结果都是相似的。到切开子宫为止,多胎娠的间羟胺总用量 (平均2.9mg 四分位范围2.03.7mg)和单胎娠 (平均3.1mg,四分位范围2.33.9mg)相似(P = 0.25; 平均差0.30 mg, 95% 可信区间为 –0.20 0.90 mg)。两组间新生儿情况相似。

结论:在剖宫产麻期间,多胎娠产妇并不比单胎娠产妇存在更大的血流学不稳定性。

(黄佳佳译,马皓琳 李士通校)
BACKGROUND:
It is commonly taught that patients with multiple gestation pregnancy are prone to more severe hypotension during spinal and epidural anesthesia compared to those with singleton pregnancy. However, few quantitative data are available to support this claim. In this study, we prospectively compared vasopressor requirement and hemodynamic changes in patients with multiple gestation versus singleton pregnancy during spinal anesthesia for elective cesarean delivery.

METHODS: Forty parturients with multiple gestation and 60 singleton controls who had identical anesthetic management during spinal anesthesia for elective cesarean delivery were enrolled. After IV prehydration, patients received intrathecal bupivacaine-fentanyl and were tilted to the left. A metaraminol infusion was titrated with the target of maintaining systolic blood pressure at 90%–100% of baseline. Vasopressor dose, minimum and maximum values for systolic blood pressure and the incidences of hypotension, hypertension, and nausea/vomiting were compared.

RESULTS: All outcome variables were similar between groups. The total dose of metaraminol required until uterine incision was similar in multiple gestation pregnancy (median 2.9 [interquartile range 2.0–3.7] mg) when compared with singleton pregnancy (median 3.1 [interquartile range 2.3–3.9] mg, P = 0.25; median difference 0.30 mg, 95% confidence interval of difference –0.20 to 0.90 mg). Neonatal outcome was similar between groups.

CONCLUSION: Patients with multiple gestation pregnancy do not exhibit greater hemodynamic instability during spinal anesthesia for cesarean delivery compared to those with singleton pregnancy.

 

 

昂丹司琼或者格拉司琼是否能预防剖腹产后蛛网膜下腔应用吗啡诱发的瘙痒?

Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery?

Sahar M. Siddik-Sayyid, MD, FRCA, Marie T. Aouad, MD, Samar K. Taha, MD, Mireille S. Azar, MD, Mona A. Hakki, MD, Romeo N. Kaddoum, MD, Viviane G. Nasr, MD, Vanda G. Yazbek, MD, and Anis S. Baraka, MD, FRCA

From the Department of Anesthesiology, American University of Beirut Medical center, Beirut, Lebanon.

Anesth Analg 2007;104:421-424

背景:我们比较了昂丹司琼和格拉司琼预防剖腹产后蛛网膜下腔应用吗啡引起的瘙痒的效果。

方法:在随机分为G组(格拉司琼3 mg IV, n = 45),O组(昂丹司琼8 mg IV, n = 42),S组(生理盐水IV, n = 42)的产妇中评定瘙痒的发生率。

结果:三组瘙痒的发生率无明显差异(S组:86.6% O组:83.3% and G组:88%)

结论:与生理盐水比较,昂丹司琼和格拉司琼都不能减少蛛网膜下腔应用吗啡诱发的瘙痒。

(彭中美 马皓琳 李士通 校)

BACKGROUND: We compared the efficacy of granisetron and ondansetron for the prevention of subarachnoid morphine-induced pruritus after cesarean delivery.

METHODS: The incidence of pruritus was assessed in parturients who were randomly allocated into Group G (granisetron 3 mg IV, n = 45), Group O (ondansetron 8 mg IV, n = 42), and Group S (saline IV, n = 42).

RESULTS: The incidence of pruritus was not significantly different among the 3 groups (86.6% in Group S, 83.3% in Group O, and 88% in the Group G).

CONCLUSION: Neither prophylactic ondansetron nor granisetron reduced the incidence of subarachnoid morphine-induced pruritus when compared with the saline group.

 

 

定义红斑性肢痛病的可治疗病因:急性青少年期自身免疫性细纤维轴突病变

Defining a Treatable Cause of Erythromelalgia: Acute Adolescent Autoimmune Small-Fiber Axonopathy

 

Joshua Paticoff, MD*, Assia Valovska, MD*, Srdjan S. Nedeljkovic, MD*, and Anne Louise Oaklander, MD, PhD{dagger}

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital; and {dagger}Departments of Neurology and Pathology (Neuropathology), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2007;104:438-441

“红斑性肢痛病(erythromelalgia)”和“红斑性肢痛(erythermalgia)”描述的情况通常从能够减轻疾病和对症治疗的病因断来规定。我们描述一个无其他疾病的20岁男子红斑性肢痛病的急性起病情况。尽管应用很多痛觉过敏药,双侧远端肢体剧痛和血管舒张仍持续存在。皮神经末梢病理学检查显示严重的细纤维占优的轴突病变。针对表现出的自身免疫性多发性神经病进行治疗:大剂量皮质激素、利多卡因局部浸润4天、泼尼松逐渐减量,最终治愈。在其他病例中也有类似发现,由此我们试验性地描述红斑性肢痛病的一个新的可治疗病因:急性青少年期自身免疫性细纤维轴突病变。在该次中我们评估了断和治疗的多项指标。

(唐李隽 马皓琳 李士通 校)

Conditions described as "erythromelalgia" and "erythermalgia" are being formally specified by etiological diagnoses that enable the use of disease-modifying as well as symptomatic treatments. We describe an otherwise healthy 20-year-old man with acute-onset erythromelalgia. Severe bilateral distal limb pain and vasodilation persisted despite the use of many antihyperalgesics. Pathological examination of cutaneous nerve endings revealed severe small-fiber predominant axonopathy. Treatment of his apparent autoimmune polyneuropathy with high dose corticosteroids, 4 days of lidocaine infusion, and a prednisone taper cured him. Similarities to other cases allowed us to tentatively characterize a new treatable cause of erythromelalgia; acute adolescent autoimmune small-fiber axonopathy. In this report we evaluate various options for diagnosis and treatment.