Anesthesia & Analgesia

February 2007

 

PEDIATRIC ANESTHESIA:

格隆溴不能減少呼吸道感染兒童圍術期不良事件的發生

周懿之 陳傑

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.

低量蛛網膜下腔嗎啡用於兒童術後鎮痛的評價

(陳勇柱譯 薛張綱校)

Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children

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

Anesth Analg 2007 104: 271-276.

一項探討以兒童年齡為標準差對七氟醚MAC值的影響

姜旭暉      馬皓琳  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.

經鼻和經口纖維支氣管鏡插管對小兒麻醉中迴圈的影響

李惟一 陳傑

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:

靜態磁療法不能減少疼痛或阿片類藥物的需求:一項隨機雙盲試驗

周時蓓譯 薛張綱校

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.

耳針用於牙科患者焦慮:一項隨機對照試驗

馬皓琳 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.

針刺治療促進NO的產生和增強局部迴圈

衛紅 陳傑

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.

利用正電子發射體層攝影術發現L1-4針灸麻醉可減少健康人體中腦豆狀核的血流量

施譯 薛張綱校

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 穴位針壓法:對雙頻指數、血清褪黑素、血漿β-內啡肽應激的影響

黃施偉 譯,馬皓琳 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:

麻醉藥結合位元點的共同化學基序

丁震敏 陳傑

The Common Chemical Motifs Within Anesthetic Binding Sites

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

Anesth Analg 2007 104: 318-324.

中低瑞太尼輸注率不會改BIS指數監測下的異丙酚TCI麻醉維持需要濃度

陳佳莉譯 薛張綱校

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、異氟烷和七氟烷增鈣誘發的重組人心臟肌鈣蛋白C構型改動學

顏濤 譯, 馬皓琳 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.

苯二氮卓類藥物對大鼠大腦皮層切片苯基二氫喹唑啉能系統的效應

顧新宇 陳傑

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:

利用相位解析光譜測量行心肺分流術的病人的光程長

陳珺珺譯 薛張綱校

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.

腹部手術期間體液平衡的定量分析

黃麗娜 馬皓琳 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:

用阿司匹林觸發的脂氧素A4類似物後能減弱脂多糖誘導的小鼠急性肺損傷:血紅素氧酶-1的作用

周密 陳傑

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

關於脂質AE5564的二期雙盲安慰對照的增量實驗,實驗物件:行心肺分流術的心外科病人

佳譯 薛張綱校

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.

心臟手術後兩個不同的康復策略對肺和血流動學的影響

馬皓琳 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.

氣道壓與吸氣時間對細菌易位的影響

宋翠俠 陳傑

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

綿胎兒對母體全麻的全身中樞反應

璿譯 薛張綱校

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.

多胎娠和單胎娠產婦在剖宮產麻中血管收縮藥用量血流動學化的前瞻性比較

黃佳佳譯,馬皓琳 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.

最小容量和最小量的布比卡因(0.125%w/v0.25%w/v)用於硬膜外分娩鎮痛的比較研究

印潔敏 陳傑

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

健康產婦和先兆子癇婦產的凝血能:一項血小板能分析儀(PFA-100®)和血栓彈性描記器(TEG®)的測定分析報

王光妍譯 薛張綱校

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.

昂丹司或者格拉司是否能預防剖腹產後蛛網膜下腔應用嗎啡誘發的瘙癢?

彭中美 馬皓琳 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:

一種新型血漿替代品羥乙基澱粉:用血栓彈性描記圖和全血凝集度方法測定凝血能的離體研究

張美榮 陳傑

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.

新型咽通氣道襯與傳統喉罩在行眼科手術病人中的效果與舒適度比較

儷譯 薛張綱校

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:

定義紅斑性肢痛病的可治療病因:急性青少年期自身免疫性細纖維軸突病

唐李雋 馬皓琳 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:

斜角肌間隙置入電刺激導管是否改善肩部外科手術後疼痛或能-----一項前瞻性的、隨機、雙盲試驗

鄭麗 陳傑

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.

最理想的鎖骨下臂叢神經阻滯運動反應

霞譯 薛張綱校)

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.

 

低量蛛網膜下腔嗎啡用於兒童術後鎮痛的評價

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:評價低量蛛網膜下腔嗎啡(4-5 mcg/kg)在兒童各類常規手術術後鎮痛處理中的效果與安全性。

方法:回顧了200310月至20063月間在費城兒童醫院接受低量蛛網膜下腔嗎啡術後鎮痛的病人的疼痛管理資料庫和醫學記錄。病人在接受24-48h的低量蛛網膜下腔嗎啡術後鎮痛後出院。

結果:187位元病人的醫學記錄被入選。他們的平均年齡在5.6 +/- 5.1歲(中位數4.0IQR 1.0-10.0)。病人在第一個24h期間出現最大疼痛評級(參照FLACC評級, FLACC評級以數字分)是0(IQR 0-3)0 (IQR 0-4)。第一次給予阿片類藥物的平均時間是22.4 +/- 16.9 h (範圍:0-48 h, 95% 可信區間: 19.9-24.8 h)。70%的病人不需接受任何阿片類藥物(口服或靜注)。在接受阿片類藥物的117位病人中,有59位(50%)僅需用羥二氫可待因酮可。33%的病人需用酮咯酸氨基丁三醇處理,其中11%單用,22%合用靜注或口服阿片類藥物。噁心嘔吐、皮膚瘙癢和尿瀦留的發生率分別是32%, 37%6%。有一位病人出現短暫的腦液漏性頭痛,另有兩位病人因手術60分鐘後出現低氧血症而給予吸氧。需要輔通氣或納絡酮的嚴重呼吸制現象未觀察到。

結論:在兒科病人中應用低量蛛網膜下腔嗎啡術後鎮痛是一種安全有效的手段。

(陳勇柱譯 薛張綱校)

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.

 

 

靜態磁療法不能減少疼痛或阿片類藥物的需求:一項隨機雙盲試驗

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.

 

一個發展中的具有數百億美元的市場,包括磁性項鏈,手鐲,腰帶,鞋,背帶,等等,用於緩解疼痛,雖然幾乎沒有證據證明它們的效。我們試圖證明磁性療法對於手術後病人的疼痛程度阿片類藥物使用的有效性。我們設計了一個隨機化雙盲對照試驗。165名年紀大於12歲,並且在蘇醒室中有中度至重度疼痛的患者被隨機分到磁性療法組(n=81)和安慰治療組(n=84)。止痛裝置被放置在外科切口2個小時。患者每10分鐘以0-10分為刻度評價自己的疼痛程度,並且除非評分<=4分,否則就要接受一次額外量的嗎啡。疼痛程度在2組之間是近乎相同的。磁性療法組的疼痛程度評分的均數大於對照組0.0495%可信區間,-0.40.5)。對阿片類藥物的需求在2組之間也是相近的。磁性療法組比起對照組所需要的嗎啡量要大1.5mg95%可信區間,-1.84.0)。磁性療法對於緩解術後急性疼痛的程度或者阿片類藥物的使用是缺乏有效性的,並且在這種背景下是不應當被推薦用來緩解疼痛的。

(周時蓓譯 薛張綱校)

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.

 

 

利用正電子發射體層攝影術發現L1-4針灸麻醉可減少健康人體中腦豆狀核的血流量

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

 

為了最大化地減少外源性因素的影響,13個志願者在七氟醚1MAC下進行麻醉,同時第一組(N=7)進行腰14的針灸麻醉,第二組(N=6)進行第三和第四掌骨間的針刺以作為安慰對照組。在基礎的吸入麻醉和吸入聯合針灸麻醉中分別運用了正電子發射掃描。第一組顯示在右中央前回和左豆狀核的腦血流有明顯的減少,減少量分別為20%和17%。第二組顯示右中央前回腦血流減少22%,豆狀核中卻沒有發現明顯的改。這些資料表明,針尖對皮膚的穿透會影響中央前回的腦血流量,而腰14的針灸麻醉會影響豆狀核

(施譯 薛張綱校)

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.

 

 

中低瑞太尼輸注率不會改BIS指數監測下的異丙酚TCI麻醉維持需要濃度

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:我們研究同時使用不同瑞太尼輸注率能否使BIS值降低到5050以下所需要的異丙酚的EC50值降低(能夠使50%的病人產生反應的有效濃度)。

方法:將72ASAⅠ或Ⅱ的成年病人隨機分成6組進行氣管內插管和異丙酚TCI輸注。給予B0.1µg/kg/min的瑞太尼,C0.15µg/kg/minD0.2µg/kg/minE0.3µg/min/minF0.4µg/kg/minA組作為控制組不給予瑞太尼。在同一組裏,第一個病人給予的異丙酚TCI濃度為4µg/ml,他的反應決定了同一瑞太尼組中後一個病人的異丙酚效應室濃度(Dixon“-下”方法)。如果BIS>50,那麼下一個病人就給予高於這個濃度的異丙酚,反之,如果BIS<=50,下一個病人就給予低於這個濃度的異丙酚。同時還可以研究兩個藥物結合使用時的血流動學效應。

結果:異丙酚EC50值的化範圍為2.4-2.9µg/ml。我們發現瑞太尼對異丙酚的EC50沒有增作用。然而,沒有給予瑞太尼組的病人對異丙酚的反應化範圍較大。給予瑞太尼組的病人有心率下降。

結論:輸注瑞太尼不會降低在沒有刺激時的麻醉病人的異丙酚需要量。異丙酚的TCI水準不會因為同時輸注瑞太尼而降低。

(陳佳莉譯 薛張綱校)

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.

 

 

利用相位解析光譜測量行心肺分流術的病人的光程長

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:雖然近紅外光譜術(NIRS)的可靠性還不能確定,但它仍被用於在心臟手術中監測大腦的氧合。儘管光程長一般被認為是恒定不的,但最近有證據顯示,動物實驗中急性血液稀釋可以影響光程長。我們最近的研究旨在研究在行心肺分流術的病人中光程長是否會化,以這些化是否影響NIRS的值。

方法:9個擇期行心肺分流的心臟手術病人參與了這次研究。分別通過相位解析光譜和NIRO 100測量每個人的光程長和大腦的NIRS的值(氧合血紅蛋白[{Delta}O2Hb]和氧合指數)。光程長,血紅蛋白濃度和NIRS值按以下順序測量:1)麻醉誘導完,2)心肺分流後的10分鐘,3)心肺分流後的60分鐘,4)心肺分流後的1小時。通過Pearson相關係數和多重回歸分析光程長和其他可因素的關係。

結果:光程長在心肺分流後明顯增,從10分鐘的27.7–30.8 cm增至60分鐘的31.3 cm (P < 0.0001)。血紅蛋白濃度明顯下降(從10分鐘的11.2 7.1 g/dL降至60分鐘的 7.7 g/dL P < 0.0001). 光程長和血紅蛋白濃度之間有明顯的相關性(r = 0.55, P < 0.001)。光譜長度和血紅蛋白濃度化的百分比有明顯的相關性。多重回歸分析顯示光程長是氧合血紅蛋白的一個重要決定因素。

結論:結果顯示光程長會隨著心肺分流的進程化,並且可以影響氧合血紅蛋白。

(陳珺珺譯 薛張綱校)

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.

 

 

關於脂質AE5564的二期雙盲安慰對照的增量實驗,實驗物件:行心肺分流術的心外科病人

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:脂質A,內毒素的一種毒性成分,與心外科術後的多種併發症相關,包括發熱、血管擴張、肺和腎臟能的衰退。E5564可以防治人動物的內毒素誘發性炎症。在這個實驗中,我們評估在行心外科手術的病人中應用E5564的安全性,並獲取其對於內毒素干預的外科併發症的預防作用的初步的效值。

方法:在9個醫院進行隨機,雙盲,安慰對照的實驗.實驗物件為冠狀動脈分流術的病人和/或具心肺分流的心血管手術病人。在心肺分流術前1h分別給予病人安慰,2mgE556412mgE5564,或28mgE5564

結果:監護資料並未提示有明顯的安全性方面的影響,並增量到最大量28mg.實驗組和對照組在對於系統炎症和器官能衰退的控制並無統計學意義。

結論:這個二期實驗表明,脂質A—E5564,與心外科術後的併發證並無明顯關係。對於擇期的心外科病人用E5564來拮脂質A並無明顯處。

(秦 佳譯 薛張綱校)

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.

 

 

綿胎兒對母體全麻的全身中樞反應

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:通常推薦娠4-6月為孕母行外科手術的適宜時機,儘管還不清楚這段時間胎兒對麻醉的反應。本文評價了綿早期胎兒對咪達唑侖、硫噴妥鈉、異氟醚標準麻醉的反應。方法:預先連接儀器至早孕綿,在全身麻醉前、中結束後4h測量資料。異氟醚中度降低胎兒的血壓心率,而拔管伴有胎兒心率和平均動脈壓升高。結果:觀察到胎兒SaO2起初升高,而後緩慢降至基線水準。胎兒腦中氧化血紅蛋白化<10%(無顯著性),去氧血紅蛋白和總血紅蛋白化<5%。總體,雖然異氟醚不獨立地增早期胎兒腦中O2水準(與晚期胎兒和成人不同),但後者即使在胎兒平均動脈壓下降超過20%的時候仍然保持穩定。也就是說,未能找到反映損傷的大腦氧合化。結論:母體手術對早期胎兒的任何負面影響都不能單用全身麻醉對胎兒的作用來解釋。

(羅 璿譯 薛張綱校)

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.

 

 

健康產婦和先兆子癇婦產的凝血能:一項血小板能分析儀(PFA-100®)和血栓彈性描記器(TEG®)的測定分析報

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®是一項受關注的血小板能分析儀,它能測量血小板栓子在體外的形成速度,用關閉時間(CT)來描述。這項方法可以提示初級止血早於區域麻醉。在這項前瞻性觀察性的研究中,在運用PFA TEG測定比較正常娠和先兆子癇的婦女的血小板能之前,我們對健康娠人群進行測定計算出95%的可信區間。

研究方法:測定血常規,凝血能包括vW因數,CTTEG測試。結果用平均值表示。

研究結果:先兆子癇的嚴重程度與CT時間延長有關係,甚至在正常血小板記數中表現出來。在嚴重的先兆子癇,PFA100 CT(均值:155s)超過了對照組的95%可信區間(80-139s)。相比之下,在嚴重的先兆子癇中TEG MA值(平均值:71mm)仍然在正常娠MA值的95%可信區間內(6482mm)。

結論:我們可以推論,逐漸嚴重的先兆子癇產婦中原發性凝血能障礙可以用PFA100檢測出來,但是TEG不能。

(王光妍譯 薛張綱校)

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.

 

新型咽通氣道襯與傳統喉罩在行眼科手術病人中的效果與舒適度比較

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:新型咽通氣道襯近期進入臨實際應用中。它沒有膨脹的氣,因為新型咽通氣道襯的形狀與咽部的解剖形態相似。

方法:我們對124名在全麻下行眼科手術的成年病人(ASA I-III)進行了試驗,比較了新型咽通氣道襯與傳統喉罩的操作性,安全性,咽部的封閉效果和病人的舒適度。

結果:用新型咽通氣道襯直接放置到位的比例為88%,有一點困難的占10%,病例中有明顯困難的比例為0%。放置失敗的占病人數的2%。在傳統喉罩組中,直接置管成的占90%,有一點困難的占8%,有明顯困難的占2%,操作失敗的占病人數的0%。新型咽通氣道襯的最大密封壓為24 +/- 6毫米水柱,傳統喉罩組為24 +/- 4毫米水柱。有19%的病人的在SLIPA組中發生胃內充氣,在傳統喉罩組中有3%(P<0.05)。沒有發生胃內容物反流的情況。所有的病例都能平穩拔管。裝置表面的血跡在新型咽通氣道襯組中為20%而喉罩組中為11%。主訴有咽喉部疼痛的在新型咽通氣道襯組與傳統喉罩組中分別為2%和14%。

結論:新型咽通氣道襯是相對喉罩來講對接受小手術病人的另一種可選擇的方式。然而,它有較高的胃內充氣的發生率,有可能會增吸入的危險性。

(張 儷譯 薛張綱校)

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.

 

 

最理想的鎖骨下臂叢神經阻滯運動反應

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們用倍刺激引起鎖骨下臂叢神經反射,以觀察視神經反應來比較成率。

方法:該研究包括了628位使用鎖骨下臂叢神經反射阻滯行急診肢外科手術的病人。肌皮神經被最先阻滯,繼而根據視神經定位評估病人,發現產生橈側反應占54%,正中反應占35%,尺側反應 11%。阻滯所用量為1.5%利多卡因1/400,000的腎腺素共40毫升。在完成阻滯後30分鐘,每5分鐘評估效果。

結果:橈側反應組成率為96%,正中反應組為89%,尺側反應組為90%(P<0.05).組間完成阻滯產生效應的時間無顯著差異.未觀察到嚴重併發症.

結論:最初定位並阻滯肌皮神經,隨後注射局麻藥產生橈側反應的成率略高於產生正中反應或尺側反應者.

( 霞譯 薛張綱校)

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.

 

格隆溴不能減少呼吸道感染兒童圍術期不良事件的發生

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.

 

最近兩項研究發現對患有呼吸道感染的擇期手術兒童,大量呼吸道分泌物並不是圍術期不良事件發生的獨立危險因素。因此本實驗來檢驗患呼吸道感染的小兒使用膽鹼藥物是否能減少圍術期呼吸系統不良事件的發生。130名患有呼吸道感染的擇期手術兒童(1月齡到18歲)隨機分組,分別給予格隆溴0.01mg/kg或安慰,並隨訪圍術期呼吸系統不良事件的發生和嚴重程度。兩組患者在人口學分佈、呼吸道感染的症狀、麻醉管理以手術操作方面均相似。結果顯示格隆溴和安慰組間圍術期呼吸道不良事件的發生和嚴重程度並沒有明顯的統計學差異(45.2%37.5%P=NS)。此外,存在肺充血和分泌物的兒童經單獨分析後發現兩組之間的預後也沒有區別(45.0%37.0%)。然而,與安慰組比較,格隆溴組出院時間較短(83.9分鐘比111.4分鐘,P=0.024),術後噁心嘔吐的發生較少(10.7%33.3%,P=0.005)。述結果表明患呼吸道感染的兒童麻醉誘導後給予格隆溴並不能減少圍術期呼吸系統不良事件的發生,不需作為該人群的臨用藥常規。

(周懿之 陳傑 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.

 

經鼻和經口纖維支氣管鏡插管對小兒麻醉中迴圈的影響

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:既往的研究顯示成人經鼻和經口纖維支氣管鏡插管的迴圈影響不同,其在小兒麻醉中是否有相似的差異仍然未知。

方法:在這個隨機的臨實驗中, 663歲至9歲的擇期整形手術兒童,ASAI-II級,隨機分組,比較他們在經鼻和經口纖支鏡插管過程中血壓和心率的化。用太尼、異丙酚和萬可松進行誘導插管。分別在麻醉前(基礎值),誘導後(誘導後水準),插管當時和插管後5分鐘內記錄無創血壓和心率,同時記錄整個過程中血壓和心率的最大值。

結果:經鼻組所用插管時間顯著長於經口插管組。與基礎值和誘導後水準相比,無論經鼻組還是經口組,纖支鏡插管導致心率和血壓顯著增。經鼻組的血壓和心率(插管時,插管後和最大值)都顯著低於經口插管組。達到最高收縮壓和最快心率所用時間在經鼻組顯著長於經口組。經鼻組血壓、心率恢復到誘導後水準所用時間短於經口組。插管後達到心率和收縮壓最大值的時間在組間沒有差異。

結論:無論經鼻還是經口纖支鏡插管都顯著增心率和血壓,經鼻插管組對迴圈的影響小於經口插管組。

(李惟一 陳傑 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.

 

針刺治療促進NO的產生和增強局部迴圈

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.

 

儘管針刺治療廣為應用,但是其對疼痛影響的機制和療效尚未闡明。最近發現在經絡和穴位中NO 合成酶活性增強。因為NO是局部迴圈中主要調節因數,而且迴圈的改可以影響疼痛的發展和持續作用,作者假設針刺治療可調節NO的水準。有關針刺治療對局部NO水準和迴圈的效應,作者進行了一項隨機、雙盲、交叉研究,20名志願者進行為期一周的治療,分別在手掌和前臂進行真偽針刺治療。NO血漿濃度在針刺治療的手臂中有顯著升高(5min2.8±1.5 umol/L60min2.5±1.4 umol/L)。針刺手臂後的手掌皮下組織血流亦增,且與NO的增相關。在偽針刺的手臂中沒有以化。結論:針刺增了治療區域的NO水準,從而提高了局部血流。這些調節作用可能有於針刺治療中的鎮痛效果.

(衛紅 陳傑 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.

 

麻醉藥結合位元點的共同化學基序

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:獲得麻醉藥與蛋白質相結合的晶體結構目前仍不太可能,這一結構可能是神經細胞作用靶點,如配基門控型離子通道。然而,在X線下能找到麻醉藥-蛋白質複合體的晶體結構,但其並不與麻醉作用相關。許多關於麻醉藥-蛋白質相互作用的有用資可從氟烷-膽固醇氧化酶、溴仿-熒蟲素酶、氟烷-白蛋白和二氯乙烷-脫鹵素酶的X線下的晶體結構衍生而來。這些結構都顯示麻醉藥-蛋白質在原子水準相互作用。

方法:作者通過已知文獻獲得溴仿-熒蟲素酶、氟烷-白蛋白和二氯乙烷-脫鹵素酶、氟烷-膽固醇氧化酶的配位。然後通過增氫、剪輯成細胞亞型、進行一系列的制性的分子學優選來改良這些配位。最後通過分子-量子學分析麻醉藥結合位點的化。

結果:麻醉藥結合位點即麻醉藥-蛋白質複合體結合點都具有相同的特點,稱之為“結合基序”。這些基序的共同特徵是:通過親兩性的結合位點起極化和非極化作用,包括存在有弱氫鍵與氨基酸和水分子的相互作用。而學分析也證明了親兩性結合位點對完全疏水性麻醉藥的極化效應。這種極化是非常有用的。

結論:麻醉藥結合蛋白質包括親兩性作用。

(丁震敏 陳傑 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.

 

苯二氮卓類藥物對大鼠大腦皮層切片苯基二氫喹唑啉能系統的效應

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:有報導苯基二氫喹唑啉能神經元可媒介情緒化,而苯二氮卓類藥物可與苯基二氫喹唑啉能神經元相互作用。

方法:檢測大鼠大腦皮層切片苯基二氫喹唑啉能神經元與苯二氮卓類受體在苯基二氫喹唑啉AK+誘發的去甲腎腺素釋放之間的相互關係。

結果:咪達唑倫、地西泮、氟硝西泮呈濃度依賴性制苯基二氫喹唑啉AK+誘導的去甲腎腺素的釋放。咪達唑倫誘導苯基二氫喹唑啉A去甲腎腺素釋放的IC500.87Um,p<0.01)明顯低於地西泮和氟硝西泮(約60Um),而K+誘導去甲腎腺素釋放IC50在苯二氮卓類藥物間沒有差異。

結論:苯基二氫喹唑啉能神經元和中樞苯二氮卓類受體之間可能沒有相互作用。

(顧新宇 陳傑 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.

 

用阿司匹林觸發的脂氧素A4類似物後能減弱脂多糖誘導的小鼠急性肺損傷:血紅素氧酶-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:作者假設用15--16-旁氟苯基脂氧素A4ATL)治療後可以減輕小鼠脂多糖(LPS)誘導的急性肺損傷。

方法:所有動物隨機分為6組(每組6只)。假載體組小鼠在生理鹽水補液後的60min0.9%NS治療。假ATL組與假載體組開始治療方法相同, 60min後用ATL0.7mg/kg,靜脈注射),假ZnPP組和假載體組開始治療相同, 60min後用鋅原撲啉Ⅸ(ZnPP25mg/kg靜脈注射)。在LPS載體組,小鼠在給予LPS60min後用載體治療。LPSATL組和LPS載體組方法一樣,只是它們使用ATLZnPPATLLPS組和LPSATL組一樣,但是在使用ATL30min給予ZnPP

結果:吸入LPS增了支氣管肺泡灌洗液中炎症細胞的數量,TNF-α和蛋白濃度,且誘導肺組織損傷和水腫。用ATL治療可以制TNF-α,NO和丙二醛產物,肺水腫、脂質過氧化和中性細胞浸潤均減輕。此外,ATL還促進肺組織血紅素氧酶-1的形成,並促進其活性增。ATL的有作用被ZnPP消。

結論:用ATL治療後能顯著減少LPS誘導的小鼠急性肺損傷。

(周密 陳傑 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.

 

氣道壓與吸氣時間對細菌易位的影響

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:機械通氣時,較高的吸氣峰壓可以誘發肺損傷,並使細菌由肺易位到體循環。作者研究了機械通氣時使用與不使用外源形呼氣末正壓(PEEP)兩種情況下延長吸氣時間對氣管內種植細菌易位的影響。

方法:給予大鼠壓控制通氣模型行機械通氣,吸氣峰壓(PIP)為14cm H2OPEEP0,吸呼比(IE)為12,吸入氧濃度(FiO2)為1.0。然後經氣管造口種植105 cfu/mL綠膿桿菌0.5m,隨機分為六組:2個低壓組(LP),分別為LP1/2組:PIP14 cm H2OPEEP0IE=1/2LP2/1組: PIP14cmH2OPEEP0 cm H2OIE=212個高壓組(HP),分別為HP1/2組:PIP30cmH2OPEEP0IE=12HP2/1組:PIP30cmH2OPEEP0IE=212HP PEEP組(HPP),分別為HPP 1/2組:PIP 30cmH2O PEEP10cmH2OIE=1/2HPP2/1組,PIP 30cmH2OPEEP10cmH2OIE=2/1。每30分鐘做1次血培。將小鼠處死後取其肺臟製成標本。

結果:與基礎值相比,在LP1/2組、LP2/1組、HP1/2HP2/1組在處死前最後一點的Pao2均降低,但是只有HP1/2Pao2的下降到統計學有意義水準。在HPP2/1組細菌易位率高於HPP1/2組(P=0.01

結論:高PIP組,無論是否延長吸氣時間均增細菌易位。在高PIPPEEP可以制細菌易位。但在延長吸氣時間後PEEP的制易位作用消失。

(宋翠俠 陳傑 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.


最小容量和最小量的布比卡因(0.125%w/v0.25%w/v)用於硬膜外分娩鎮痛的比較研究

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:本研究中作者擬探索兩種不同濃度的布比卡因用於硬膜外分娩鎮痛的最小有效容量(MLAV)和量(MLAD)。

方法:80名女性隨機、雙盲分成兩組分別給予首量0.125%w/v)或0.25%w/v)的布比卡因。初始容量為15mL。根據鎮痛效果確定追量。如30min內的VAS100-100),表明鎮痛有效,則下一名女性接受的藥物容量減少2mL。如VAS不能達到10的標準,下一名女性的給藥容量則增2mL

結果:根據DixonMassey公式,分別計算兩種濃度藥物在95%可信區間(CI)內的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)。兩者之間的差異明顯(P=0.002)。在以兩種局麻藥容量下的MLAD分別是17.0mg95%CI15.5-18.5),和23.1mg(17.2-28.9),(P=0.045)。

結論:0.125%(w/v)布比卡因要與0.25%w/v)布比卡因產生相同的鎮痛效果,需增50%的藥物容量,卻可以減少25%的藥物量。減少藥物的使用量而不降低其作用效果,可以降低局麻藥中毒的風險從而提高用藥的安全性。

(印潔敏 陳傑 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.


一種新型血漿替代品羥乙基澱粉:用血栓彈性描記圖和全血凝集度方法測定凝血能的離體研究

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:羥乙基澱粉(HES)作為血容量替代品使用較少的原因可能由於異常的凝血能的報導。本文作者進行了盲法離體研究,比較一種新型HES、傳統的HES和乳酸林格液三者對止血作用的影響。

方法:取10名健康男性青年志願者血液,用新型6%HES130/0.42(平衡HES)、傳統型6% HES130/0.42(非平衡HES)或乳酸林格液稀釋血液,稀釋濃度分別為10%30%50%。入兩種啟動(凝血活酶-磷脂監測內源系統,凝血激酶監測外源系統)描繪旋轉的血栓彈性描記圖。入二磷酸腺苷、膠原或凝血酶啟動因數蛋白測定全血凝集度以評估血小板能。

結果:非平衡HES30%50%組)比平衡HES的血液凝集時間明顯延長。非平衡HES稀釋50%組比平衡HES的最大血凝的硬度明顯減弱。非平衡HES稀釋50%組比平衡液HES組,在入二磷酸腺苷、膠原、或凝血酶啟動因數蛋白時全血凝集度明顯降低。

結論:平衡HES製比非平衡HES製,在血栓彈性描記圖資料和血小板凝集能方面影小較小,尤其在稀釋度較高時。將來的臨研究可能顯示出平衡HES對血液凝固的影響較小。

(張美榮 陳傑 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.

 

斜角肌間隙置入電刺激導管是否改善肩部外科手術後疼痛或能-----一項前瞻性的、隨機、雙盲試驗

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:在這項前瞻性的、隨機、雙盲的試驗中作者研究了在肩部外科手術過程應用電刺激導管中以術後對能改善

方法:在用輸出量小於0.5mv的神經刺激器引出足夠的肌肉顫搐後,或是通過傳統盲探法(傳統導管即CC組,n=20)或是通過電刺激導管(刺激導管即SC組,n=20)在神經周圍置管。一次性注入1% 丙胺卡因40ml0.75%羅呱卡因10ml組成的混合液,之後病人自控注射0.2%羅呱卡因(注射速率8ml/h,單次量2ml,鎖定時間為20min

結果:SC組運動阻滯較快,而感覺阻滯組間無差異,術後兩天疼痛評分大致相同。術後6SC組臨客觀肩部能評分(恒量分值)較SC組改善。

結論:應用可刺激導管可速運動阻滯,不改善對術後鎮痛,但可明顯改善肩部手術後6周的能。

(鄭麗 陳傑 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.

一項探討以兒童年齡為標準差對七氟醚MAC值的影響

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間期延長伴有尖端扭轉性心動過速(TdP),但是很難預測藥物引起的尖端扭轉。心肌透壁性複極化消散(TDR)增強,而非QT間期延長本身使TdP的易感性增高。TDR可以從心電圖T波的波峰與波結尾之間的間期(Tp-e)來測得。因此Tp-e是一個很容易測定藥物引起尖端扭轉的測定法。一些麻醉藥延長QT間期,可是它們對TDR的影響我們還不瞭解。

方法:我們給54個未術前用藥的310歲、ASA分級III級的兒童隨機吸入經過年齡標準校正的11.251.5MAC的七氟醚,從而研究七氟醚對校正的QTQTc)和Tp-e間期的影響。在吸入七氟醚前後記錄十二導聯心電圖。用2路方差分析對QTcTp-e進行組間和組內比較。吸入七氟醚後Tp-e的化為主要的研究資料。

結果:所有量的七氟醚都顯著延長手術前的QTc間期(P<0.005),無量-反應關係,但是七氟醚對術前的Tp-e沒有影響。

討論:七氟醚在健康兒童顯著延長QTc,但是並不增通過Tp-e測得的複極化消散,這提示尖端扭轉的產生很低或無,且使其不太可能增TdP的易感性。

(薑旭暉      馬皓琳  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.

 

 

耳針用於牙科患者焦慮:一項隨機對照試驗

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

耳針可以是用於急性焦慮的有效治療方法,但缺乏針刺與已證實的標準藥物治療之間的直接比較。在本研究中我們比較了耳針與鼻內給予咪達唑侖、安慰針刺無處理對減少牙科患者焦慮的有效性。拔牙患者(n = 67)隨機分入(i)耳針、(ii)安慰針刺和(iii)鼻內給予咪達唑侖,並與無處理組比較。干預前、干預後30 min時拔牙後評定焦慮。持續評定生理學數。將無處理組作為對照,耳針組和咪達唑侖組在30 min時的焦慮顯著低於安慰針刺組(Spielberger Stait-Trait焦慮清單 X1 P 分別為= 0.012<0.001)。而且如果進行耳針或鼻內應用咪達唑侖,由牙科醫生評定的患者合作性顯著改善(P分別 = 0.0320.049)。結論,耳針和鼻內給予咪達唑侖對於牙科患者焦慮的處理具有相似的有效性。

(馬皓琳 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 穴位針壓法:對雙頻指數、血清褪黑素、血漿β-內啡肽應激的影響

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”穴位針壓法可降低雙頻指數(BIS)值應激。

方法:我們對12例志願者,在extra 1 穴位一個假穴位針壓前、針壓10min後、無針壓後以每次干預結束後1h分別測定BIS、褪黑素、β-內啡肽以言語應激評分值。

結果:extra 1 穴位針壓後BIS和言語應激評分值均降低(P值分別為0.00010.008),但褪黑素和β-內啡肽無化。

結論:extra 1 穴位針壓法對褪黑素和β-內啡肽水準無影響。

(黃施偉 譯,馬皓琳 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、異氟烷和七氟烷增鈣誘發的重組人心臟肌鈣蛋白C構型改動學

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、異氟烷和七氟烷產生的負性肌副作用,通常由可用的細胞內鈣離子減少來介導。其他可能的機制包括細胞內鈣處理過程改、肌纖凝蛋白橫橋迴圈受損和/或鈣誘導的調節性肌鈣蛋白複合體構象化的改造。

方法:我們採用停流和鈣滴定術,觀察了氟烷、異氟烷和七氟烷對分離的IAANSHrcTnCIAANS)標記的人重組心肌肌鈣蛋白C的鈣依賴動學的影響。

結果:在對照組,在-最大螢光強度的鈣濃度(Kd)是2.1 ± 0.1 mM。揮發性麻醉藥呈濃度依賴性增鈣敏感性,七氟烷 (Kd 1.5–1.7 mM, P = 0.001) > 氟烷 (Kd 1.7–1.9 mM, P < 0.01) > 異氟烷 (Kd 1.8–1.9 mM, P < 0.05)。在4°C時,述藥物使鈣與HrcTnCIAANS快速解離後構象改的率常數(koff(c))中度延長,其作用強度氟烷和異氟烷>七氟烷。

結論:這些機制可能消鈣利用度減少的效應,且是揮發性麻醉藥存在時心肌纖維舒張期縮短(可能是不完全的)的主要原因。

(顏濤 譯, 馬皓琳 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.

 

 

腹部手術期間體液平衡的定量分析

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:手術創傷會引起創傷組織中組織間液急性增多。用靜脈輸液處理體液增多會引起與血管內容量過多相關的術後併發症。組織間液增多的定量預測可能使我們更好地瞭解關於液體管理和其引發的血管內液與血管外液平衡之間的關係。

方法:我們應用了一種描述液體和蛋白動態分佈和運輸的數學模型,目的是定量化血管內室和血管外室之間的液體平衡。對一個70kg男性施行模擬的4小時腹部外科手術,並計算了血漿中、組織間液尿量中液體容積的化。為了驗證該模型,我們將得到的這些結果與在施行擇期腹部手術的30名患者通過節段性生物電阻測定的結果作了比較。

結果:該模型預言,與標準狀態相比,外科創傷會導致損傷組織間液增多705ml,而血漿容量會下降356ml。手術過程中,達到正常血漿容量是不可能的,即使補液速度幾乎達到20ml · kg–1 · h–1。生物電阻和模型預測之間身體不同部位組織間液容量化的偏倚和一致限,在四肢分別為–131ml 325ml,在軀幹為–157 ml834 ml

結論:該模型顯示,提高補液速度在10 ml · kg–1 · h–1以,並不會對血漿容量產生預期效應,相反會增間液容量。

(黃麗娜 馬皓琳 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.

 

 

心臟手術後兩個不同的康復策略對肺和血流動學的影響

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:我們的研究的目的是評價開放性心臟手術後兩個不同的康復策略對肺和血流動學的影響。

方法:進行冠脈搭橋的60例患者在術後隨機分入三組:用持續氣道正壓(CPAP)的康復策略(CPAP-40組,n = 20)、通過呼氣末正壓(PEEP)的康復(PEEP-20組,n = 20)和5 cm H2O PEEPPEEP-5組,n = 20)。在CPAP-40組,40 cm H2O吸氣峰壓應用30 s,然後PEEP降低到20 cm H2O,且用基礎參數持續通氣,PEEP降低直到達到最好的Pao2。在PEEP-20組,設定20 cm H2O PEEP持續2 min,調整潮氣量以達到40 cm H2O的吸入氣道峰壓,然後降低PEEP直到達到最好的Pao2。在PEEP-5組,術後用5 cm H2O PEEP

結果:在干預過程中CPAP-40組的平均動脈壓低於PEEP-20組(P < 0.01)和PEEP-5組(P < 0.01)。在機械通氣期間兩個策略組中的氧合高於PEEP-5組。在此期間以外,組間無顯著差異。術後第一天PEEP-5組的肺不張評分(1.3 ± 0.9)高於CPAP-40組(0.65 ± 0.6P = 0.01)和PEEP-2-組(0.65 ± 0.5P = 0.01)。

結論:用後策略PEEP的康復方法增高氧合,同樣地減少肺不張,而PEEP-20提供了比CPAP策略更穩定的血流動學情況。

(馬皓琳 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.

 

 

多胎娠和單胎娠產婦在剖宮產麻中血管收縮藥用量血流動學化的前瞻性比較

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:人們經常認為,在剖宮產麻和硬膜外麻醉中,多胎娠比單胎娠產婦更容易產生嚴重的低血壓。然而,很少有可用的定量資料來支援這一論斷。在這項研究中,我們前瞻性地比較了多胎娠和單胎娠產婦在擇期剖宮產麻期間血管收縮藥的用量血流動學化情況。

方法:在剖宮產麻期間採用相同麻醉管理的40名多胎娠產婦和60名單胎對照者參與了此項研究。靜脈預充容量後,產婦接受椎管內布比卡因-太尼麻醉並向左傾斜。間羥胺持續輸注以保持收縮壓在基礎值90%–100%。比較兩組血管收縮藥用量、收縮壓的最小值最大值低血壓、高血壓以噁心/嘔吐的發生率。

結果:兩組間所有的參數結果都是相似的。到切開子宮為止,多胎娠的間羥胺總用量 (平均2.9mg 四分位範圍2.03.7mg)和單胎娠 (平均3.1mg,四分位範圍2.33.9mg)相似(P = 0.25; 平均差0.30 mg, 95% 可信區間為 –0.20 0.90 mg)。兩組間新生兒情況相似。

結論:在剖宮產麻期間,多胎娠產婦並不比單胎娠產婦存在更大的血流動學不穩定性。

(黃佳佳譯,馬皓琳 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.

 

 

昂丹司或者格拉司是否能預防剖腹產後蛛網膜下腔應用嗎啡誘發的瘙癢?

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:我們比較了昂丹司和格拉司預防剖腹產後蛛網膜下腔應用嗎啡引起的瘙癢的效果。

方法:在隨機分為G組(格拉司3 mg IV, n = 45),O組(昂丹司8 mg IV, n = 42),S組(生理鹽水IV, n = 42)的產婦中評定瘙癢的發生率。

結果:三組瘙癢的發生率無明顯差異(S組:86.6% O組:83.3% and G組:88%)

結論:與生理鹽水比較,昂丹司和格拉司都不能減少蛛網膜下腔應用嗎啡誘發的瘙癢。

(彭中美 馬皓琳 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.

 

 

定義紅斑性肢痛病的可治療病因:急性青少年期自身免疫性細纖維軸突病

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

“紅斑性肢痛病(erythromelalgia)”和“紅斑性肢痛(erythermalgia)”描述的情況通常從能夠減輕疾病和對症治療的病因診斷來規定。我們描述一個無其他疾病的20歲男子紅斑性肢痛病的急性起病情況。儘管應用很多痛覺過敏藥,雙側遠端肢體痛和血管舒張仍持續存在。皮神經末梢病理學檢查顯示嚴重的細纖維佔優勢的軸突病。針對表現出的自身免疫性多發性神經病進行治療:大量皮質激素、利多卡因局部浸潤4天、潑尼松逐漸減量,最終治癒。在其他病例中也有類似發現,由此我們試驗性地描述紅斑性肢痛病的一個新的可治療病因:急性青少年期自身免疫性細纖維軸突病。在該次報中我們評估了診斷和治療的多項指標。

(唐李雋 馬皓琳 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.