Anesthesia & Analgesia

March 2007

 

CARDIOVASCULAR ANESTHESIA:

有关超声介导中心静脉置管应用的调查

邱郁薇 马皓琳 李士通校

A Survey of the Use of Ultrasound During Central Venous Catheterization

Peter L. Bailey, Laurent G. Glance, Michael P. Eaton, Bob Parshall, and Scott McIntosh

Anesth Analg 2007 104: 491-497.

PEDIATRIC ANESTHESIA:

婴儿儿童的麻醉药物使用

王时来译 薛张纲校

Use of Anesthetic Agents in Neonates and Young Children (Special Article)

R. Daniel Mellon, Arthur F. Simone, and Bob A. Rappaport

Anesth Analg 2007 104: 509-520.

肺脉高压患儿行非心脏手术或心导管术的围术期并发症

丁震敏 陈杰

Perioperative Complications in Children with Pulmonary Hypertension Undergoing Noncardiac Surgery or Cardiac Catheterization

Mario J. Carmosino, Robert H. Friesen, Aimee Doran, and Dunbar D. Ivy

Anesth Analg 2007 104: 521-527.

在小儿麻醉用于拔除喉罩通气道的七氟醚最低肺泡浓度

胡湘 马皓琳 李士通

Minimum Alveolar Concentration of Sevoflurane for Laryngeal Mask Airway Removal in Anesthetized Children

Jeong-Rim Lee, Seong-Deok Kim, Chong-Sung Kim, Tae-Gyoon Yoon, and Hee-Soo Kim

Anesth Analg 2007 104: 528-531.

可乐定对儿童术后外周神经阻滞镇痛的影响

陈勇柱译 薛张纲校

The Effects of Clonidine on Postoperative Analgesia After Peripheral Nerve Blockade in Children

Giovanni Cucchiaro and Arjunan Ganesh

Anesth Analg 2007 104: 532-537.

AMBULATORY ANESTHESIA:

围术期耳电针法对第三磨牙拔除术后的疼痛和镇痛药用量没有影响

顾新宇 陈杰

Perioperative Auricular Electroacupuncture Has No Effect on Pain and Analgesic Consumption After Third Molar Tooth Extraction

Andrea Michalek-Sauberer, Harald Heinzl, Sabine M. Sator-Katzenschlager, Gabriel Monov, Erich Knolle, and Hans Georg Kress

Anesth Analg 2007 104: 542-547.

比较枢复宁和异丙嗪治疗用枢复宁预防失败的患者术后恶心和呕吐的效果:一项回顾性数据库分析

彭中美 马皓琳 李士通

A Comparison of Ondansetron with Promethazine for Treating Postoperative Nausea and Vomiting in Patients Who Received Prophylaxis with Ondansetron: A Retrospective Database Analysis (Brief Report)

Ashraf S. Habib, Johnatan Reuveni, Akiko Taguchi, William D. White, and Tong J. Gan

Anesth Analg 2007 104: 548-551.

接受经尿道操作的老年病人的鞘内麻醉:一项为了寻找合适剂量的研究(简要的)

周时蓓译 薛张纲校

Intrathecal Anesthesia for Elderly Patients Undergoing Short Transurethral Procedures: A Dose-Finding Study (Brief Report)

Edna Zohar, Yossi Noga, Uri Rislick, Ilan Leibovitch, and Brian Fredman

Anesth Analg 2007 104: 552-554.

ANESTHETIC PHARMACOLOGY:

一项有关选择性肌松药结合剂——速克美松安全逆转罗库溴铵深度神经肌肉阻滞的随机剂量探究的II期研究

杨卫红 陈杰

A Randomized, Dose-Finding, Phase II Study of the Selective Relaxant Binding Drug, Sugammadex, Capable of Safely Reversing Profound Rocuronium-Induced Neuromuscular Block

Scott B. Groudine, Roy Soto, Cynthia Lien, David Drover, and Kevin Roberts

Anesth Analg 2007 104: 555-562.

新药Sugammadex逆转罗库溴铵引起的神经肌肉阻滞在异丙酚或七氟醚麻醉维持下同样有效

唐李隽 马皓琳 李士通

Reversal of Rocuronium-Induced Neuromuscular Block with the Novel Drug Sugammadex Is Equally Effective Under Maintenance Anesthesia with Propofol or Sevoflurane

Bernard F. Vanacker, Karel M. Vermeyen, Michel M. R. F. Struys, Henk Rietbergen, Eugene Vandermeersch, Vera Saldien, Alain F. Kalmar, and Martine E. Prins

Anesth Analg 2007 104: 563-568.

Sugammadex逆转罗库溴铵诱导的神经肌肉阻滞,与使用新斯的明-格隆溴铵或腾喜龙-阿托品的比较.

薛张纲校

Sugammadex Reversal of Rocuronium-Induced Neuromuscular Blockade: A Comparison with Neostigmine–Glycopyrrolate and Edrophonium–Atropine

Ozlem Sacan, Paul F. White, Burcu Tufanogullari, and Kevin Klein

Anesth Analg 2007 104: 569-574.

速克美松:临神经肌肉药理学的另一个里程碑

杨卫红 陈杰

Sugammadex: Another Milestone in Clinical Neuromuscular Pharmacology (Medical Intelligence)

Mohamed Naguib

Anesth Analg 2007 104: 575-581.

高碳酸血症性过度通气可以缩短异氟醚麻醉后苏醒时间

姜旭晖译 马皓琳,李士通校

Hypercapnic Hyperventilation Shortens Emergence Time from Isoflurane Anesthesia

Derek J. Sakata, Nishant A. Gopalakrishnan, Joseph A. Orr, Julia L. White, and Dwayne R. Westenskow

Anesth Analg 2007 104: 587-591.

TECHNOLOGY, COMPUTING, AND SIMULATION:

电子提示仪能增程序文档记录依从性以专业费用的销

陈佳莉译 薛张纲校

Electronic Reminders Improve Procedure Documentation Compliance and Professional Fee Reimbursement

Sachin Kheterpal, Ruchika Gupta, James M. Blum, Kevin K. Tremper, Michael O’Reilly, and Paul E. Kazanjian

Anesth Analg 2007 104: 592-597.

自主呼吸期间氧气清除术用于测定能残气量的准确性研究

杨卫红 陈杰

The Accuracy of the Oxygen Washout Technique for Functional Residual Capacity Assessment During Spontaneous Breathing

Hermann Heinze, Bernhard Schaaf, Jochen Grefer, Karl Klotz, and Wolfgang Eichler

Anesth Analg 2007 104: 598-604.

脑态指数在异丙酚麻醉深度递增过程中的表现:与双谱指数比较

黄佳佳 译,马皓琳 李士通

Performance of the Cerebral State Index During Increasing Levels of Propofol Anesthesia: A Comparison with the Bispectral Index

Luis I. Cortínez, Alejandro E. Delfino, Ricardo Fuentes, and Hernán R. Muñoz

Anesth Analg 2007 104: 605-610.

用超声术评价声门下管径的可行性

陈珺珺译 薛张纲校

The Feasibility of Ultrasound to Assess Subglottic Diameter (Technical Communication)

Karim Lakhal, Xavier Delplace, Jean-Philippe Cottier, François Tranquart, Xavier Sauvagnac, Colette Mercier, Jacques Fusciardi, and Marc Laffon

Anesth Analg 2007 104: 611-614.

ECONOMICS, EDUCATION, AND POLICY:

关于麻醉前门,信息整合手术室内滞留:对执业麻醉医师的调查结果

印洁敏 陈杰

Preanesthesia Clinics, Information Management, and Operating Room Delays: Results of a Survey of Practicing Anesthesiologists

Natalie F. Holt, David G. Silverman, Ravindra Prasad, James Dziura, and Keith J. Ruskin

Anesth Analg 2007 104: 615-618.

CRITICAL CARE AND TRAUMA:

由急症科医生完成的院外病人食道支气管插管

裘毅敏译,马皓琳 李士通校

The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians

Arnd Timmermann, Sebastian G. Russo, Christoph Eich, Markus Roessler, Ulrich Braun, William H. Rosenblatt, and Micheal Quintel

Anesth Analg 2007 104: 619-623..

D-甲羟基淀粉在大鼠模型中对伴毛细血管渗漏的多菌性脓毒症的炎性作用

佳译 薛张纲校

Hydroxyethyl Starch, but Not Modified Fluid Gelatin, Affects Inflammatory Response in a Rat Model of Polymicrobial Sepsis with Capillary Leakage

Xiaomei Feng, Jian Liu, Min Yu, Sihai Zhu, and Jianguo Xu

Anesth Analg 2007 104: 624-630.

慢性变态反应哮喘模型中七氟醚麻醉对肺学与组织学的影响

宋翠侠 陈杰

Lung Mechanics and Histology During Sevoflurane Anesthesia in a Model of Chronic Allergic Asthma

Shirley Moreira Burburan, Debora Gonçalves Xisto, Halina Cidrini Ferreira, Douglas dos Reis Riva, Giovanna Marcella Cavalcante Carvalho, Walter Araujo Zin, and Patricia Rieken Macêdo Rocco

Anesth Analg 2007 104: 631-637.

七氟醚对受内毒素损伤肺泡皮细胞的免疫调制作用

周雅春 马皓琳 李士通

The Immunomodulatory Effect of Sevoflurane in Endotoxin-Injured Alveolar Epithelial Cells

Dominik Suter, Donat R. Spahn, Stephan Blumenthal, Livia Reyes, Christa Booy, Birgit Roth Z'graggen, and Beatrice Beck-Schimmer

Anesth Analg 2007 104: 638-645.

针刺足三里(ST36)能减弱脂多糖诱导的大鼠急性肾损伤但不能减弱肝损伤

璇译 薛张纲校

Acupuncture Stimulation of ST36 (Zusanli) Attenuates Acute Renal but Not Hepatic Injury in Lipopolysaccharide-Stimulated Rats

Chin-Liang Huang, Pei-Shan Tsai, Tao-Yeuan Wang, Li-Ping Yan, Heng-Ze Xu, and Chun-Jen Huang

Anesth Analg 2007 104: 646-654

NEUROSURGICAL ANESTHESIA:

静注尼卡地平和前列腺素E1对兔主脉钳闭开放后引起的大脑软脑膜微脉收缩效应作用的比较研究  

郑丽 陈杰

The Comparative Effects of Intravenous Nicardipine and Prostaglandin E1 on the Cerebral Pial Arteriolar Constriction Seen After Unclamping of an Aortic Cross-Clamp in Rabbits

Masahiko Kumazawa, Hiroki Iida, Masayoshi Uchida, Mami Iida, Motoyasu Takenaka, and Shuji Dohi

Anesth Analg 2007 104: 659-665.

OBSTETRIC ANESTHESIA:

分析剖宫产手术中血红细胞回收再利用的输注实践和作用

张曦 译,马皓琳 李士通

An Analysis of Transfusion Practice and the Role of Intraoperative Red Blood Cell Salvage During Cesarean Delivery

Jill Fong, Edith D. Gurewitsch, Hey-Joo Kang, Lisa Kump, and Patricia Fogarty Mack

Anesth Analg 2007 104: 666-672.

使用背景剂量输注机控指令单次给药孕妇自控硬膜外镇痛的对照试验

王光妍译 薛张纲校

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

Alex T. Sia, Yvonne Lim, and Cecilia Ocampo

Anesth Analg 2007 104: 673-678.

麻下行剖宫产患者中预防性使用格拉司琼并不能预防产后恶心呕吐

李惟一 陈杰

The Prophylactic Granisetron Does Not Prevent Postdelivery Nausea and Vomiting During Elective Cesarean Delivery Under Spinal Anesthesia

Mrinalini Balki, Shilpa Kasodekar, Sudhir Dhumne, and Jose C. A. Carvalho

Anesth Analg 2007 104: 679-683.

GENERAL ARTICLE:

实施血液细胞回收时修正吸引导致的溶血

张莹 马皓琳 李士通

Modification of Suction-Induced Hemolysis During Cell Salvage

Jonathan H. Waters, Brandon Williams, Mark H. Yazer, and Marina V. Kameneva

Anesth Analg 2007 104: 684-687.

ANALGESIA:

术后镇痛对手术后主要并发症的影响:一项系统的最新的证据

俪译 薛张钢校

Effect of Postoperative Analgesia on Major Postoperative Complications: A Systematic Update of the Evidence

Spencer S. Liu and Christopher L. Wu

Anesth Analg 2007 104: 689-702.

10. 慢性疼痛医学中有关健康的生活质量的入门文书

张美荣 陈杰

A Primer on Health-Related Quality of Life in Chronic Pain Medicine (Medical Intelligence)

Thomas R. Vetter

Anesth Analg 2007 104: 703-718.

大鼠福尔马林试验中大麻酯受体激剂WIN55,212-2和布比卡因之间伤害的协同作用

黄施伟 译,马皓琳、李士通

Antinociceptive Synergy Between the Cannabinoid Receptor Agonist WIN 55,212-2 and Bupivacaine in the Rat Formalin Test

Sinyoung Kang, Chi Hyo Kim, Heeseung Lee, Dong Yeon Kim, Jong In Han, Rack Kyung Chung, and Guie Yong Lee

Anesth Analg 2007 104: 719-725.

地塞米松对吗啡耐受大鼠髓谷氨酰胺合成酶谷氨酸脱氢酶表达的影响

霞译 薛张纲校

The Effect of Dexamethasone on Spinal Glutamine Synthetase and Glutamate Dehydrogenase Expression in Morphine-Tolerant Rats

Gong-Jhe Wu, Zhi-Hong Wen, Wu-Fu Chen, Yi-Chen Chang, Chen-Hwan Cherng, and Chih-Shung Wong

nesth Analg 2007 104: 726-730.

双侧髂腹股沟神经阻滞可以减少非腹腔镜妇科手术的女性患者的吗啡用量

詹琼慧 陈杰

Bilateral Ilioinguinal Nerve Block Decreases Morphine Consumption in Female Patients Undergoing Nonlaparoscopic Gynecologic Surgery

Fabienne Oriola, Yannick Toque, Anne Mary, Odile Gagneur, Sadek Beloucif, and Hervé Dupont

Anesth Analg 2007 104: 731-734.

 

有关超声介导中心静脉置管应用的调查

A Survey of the Use of Ultrasound During Central Venous Catheterization

Peter L. Bailey, MD*, Laurent G. Glance, MD*, Michael P. Eaton, MD*, Bob Parshall, BS*, and Scott McIntosh, PhD{dagger}

From the Departments of *Anesthesiology and {dagger}Community and Preventive Medicine, University of Rochester, Rochester, New York.

Anesth Analg 2007;104:491-497

背景:中心静脉置管(CVC)过程中的并发症并不罕见,而且可能相当严重。一些人推荐在CVC过程中使用超声(US)来提高患者安全性。我们进行了一项调查来评估US使用的频率和影响它使用的因素。

方法:我们对心血管麻醉医师协会的所有成员进行了一项电子调查。采用单变量和多变量对数回归来分析US使用的机率与医院医师等因素之间的关系。所有检验采用双侧检验,P<0.05为差异有统计学意义。

结果:4235名会员中,1494名进行了答复(答复率=35.3%)。2/3的答复者中从未或几乎从未使用过US,而仅有15%的应答者经常或几乎经常使用US33%的答复者从来或几乎从来没有US设备,而41%的答复者称始终或几乎始终拥有US设备。US设备的可用性与CVC中使用超声的机率密切相关(校正OR = 18.9P <0.001)。最常见的不使用US的原因是没有明显必要使用US”46%)。在US的使用中,作为援救或屏幕检查进路(72%)比实时应用(26%)更为普遍。

结论:CVC过程中US的使用还很局限,而且它的使用率与设备的拥有率最密切相关。作为屏幕检查进路和援救原因使用US比实时导向更为常见。我们的调查提示目前在CVC过程中US的使用与循证医学的推荐还有差距。

(邱郁薇 马皓琳 李士通校)

BACKGROUND: Complications during central venous catheterization (CVC) are not rare and can be serious. The use of ultrasound (US) during CVC has been recommended to improve patient safety. We performed a survey to evaluate the frequency of, and factors influencing, US use.

METHODS: We conducted an electronic survey of all members of the Society of Cardiovascular Anesthesiologists. Univariate and multivariate logistic regressions were used to assess the association between the frequency of US use and hospital and physician factors. All tests were two-sided, and a P value <0.05 was considered statistically significant.

RESULTS: Of the 4235 members, 1494 responded (response rate = 35.3%). Two-thirds of the respondents never, or almost never, use US, whereas only 15% always, or almost always, use US. Thirty-three percent of the respondents never, or almost never, have US available, whereas 41% stated that US is always, or almost always, available. Availability of US equipment was strongly associated with US use for CVC (adj OR = 18.9; P value <0.001). The most common reason cited for not using US was "no apparent need for the use of US" (46%). When US was used, rescue or screening approaches were more common (72%) than real-time use (26%).

CONCLUSIONS: The use of US during CVC remains limited and is most strongly associated with the availability of equipment. Screening and rescue use of US are more common than real-time guidance. Our survey suggests that current use of US during CVC differs from existing evidence-based recommendations.

 

 

在小儿麻醉用于拔除喉罩通气道的七氟醚最低肺泡浓度

Minimum Alveolar Concentration of Sevoflurane for Laryngeal Mask Airway Removal in Anesthetized Children

Jeong-Rim Lee, MD, Seong-Deok Kim, MD, PhD, Chong-Sung Kim, MD, PhD, Tae-Gyoon Yoon, MD, PhD, and Hee-Soo Kim, MD, PhD

From the Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea.

Anesth Analg 2007;104:528-531

背景:在儿童,当病人还处于麻醉态时拔除喉罩通气道(LMA)是比较适合的。我们尝试测定在儿童中可以拔除LMA的最佳七氟醚的最低肺泡浓度(MAC),而又无气道并发症。

方法:我们研究了25个无术前用药的7-10岁、ASA I级、接受泌尿外科或整形外科手术的儿童。全麻诱导采用经面罩给予氧气混合七氟醚。插入LMA以氧气混合七氟醚维持麻醉。术毕在呼气末七氟醚浓度减少到预期的水平时拔除LMA,用下序贯方法(每步增减0.2%)来确定七氟醚的浓度。成的拔除标志为拔除时或拔除后一分钟内无咳嗽、牙关紧闭、有目的的大体、屏气或者喉痉挛。

结果:50%成拔除LMA的七氟醚MAC1.84%95%可信区间1.45%-1.96%),成拔除95%的有效浓度为2.17%95%可信区间2.02%-3.48%)。

结论:七氟醚呼气末浓度为1.84%时,在50%的麻醉儿童中可达到安全的LMA拔除且无咳嗽、体或任何其它气道并发症。

(胡湘 马皓琳 李士通 校)

BACKGROUND: In children, it is preferable to remove the laryngeal mask airway (LMA) when the patient is still anesthetized. We sought to determine the optimal minimum alveolar concentration of sevoflurane that would allow removal of the LMA in children without airway complications.

METHODS: We studied 25 unpremedicated children between 7 mo and 10 yr of age, ASA Status I, undergoing urologic or plastic surgery. General anesthesia was induced with sevoflurane and oxygen given via mask. The LMA was inserted and anesthesia was maintained with sevoflurane in oxygen. The LMA was removed at the end of surgery when the end-tidal sevoflurane concentration had reduced to a predetermined level, determined by the up-and-down method, with 0.2% as a step size. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal, was considered to be successful.

RESULTS: The minimum alveolar concentration of sevoflurane at which 50% of LMA removals were successful was 1.84% (95% confidence limits, 1.45%–1.96%), and the 95% effective dose for successful removal was 2.17% (95% confidence limits, 2.02%–3.48%).

CONCLUSIONS: LMA removal may be accomplished without coughing, moving, or any other airway complication at 1.84% end-tidal sevoflurane concentration in 50% of anesthetized children.

 

 

比较枢复宁和异丙嗪治疗用枢复宁预防失败的患者术后恶心和呕吐的效果:一项回顾性数据库分析

A Comparison of Ondansetron with Promethazine for Treating Postoperative Nausea and Vomiting in Patients Who Received Prophylaxis with Ondansetron: A Retrospective Database Analysis

 

Ashraf S. Habib, MBBCh, MSc, FRCA, Johnatan Reuveni, Akiko Taguchi, MD, PhD, William D. White, MPH, and Tong J. Gan, MB, FRCA, FFARCS(I)

From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

Anesth Analg 2007;104:548-551

背景:对于止吐药治疗接受术后恶心呕吐(PONV)预防患者PONV的效果的资料很少。

方法:在这个回顾性资料分析中,我们比较了异丙嗪和枢复宁在接受全身麻醉且枢复宁预防失败的成人中治疗PONV的有效性。

结果:在枢复宁预防性治疗失败后,3062例患者接受枢复宁,752例患者接受异丙嗪治疗。应用异丙嗪后的完全有效率(PONV和进一步解救药)68%,枢复宁是50% (P < 0.0001)6.26mg异丙嗪和较大剂量异丙嗪之间无差异。

结论:异丙嗪治疗枢复宁预防无效后的PONV比枢复宁显著有效。异丙嗪6.25mg同较大剂量一样有效.

(彭中美 马皓琳 李士通 )

BACKGROUND: There are little data on the efficacy of antiemetics for treating postoperative nausea and vomiting (PONV) in patients who received prior PONV prophylaxis.

METHODS: In this retrospective database analysis, we compared the efficacy of ondansetron with that of promethazine for treating PONV in adults receiving general anesthesia who failed ondansetron prophylaxis.

RESULTS: Three thousand sixty-two patients received ondansetron and 752 received promethazine after failure of ondansetron prophylaxis. The complete response (no PONV and no further rescue) was 68% after administration of promethazine and 50% after ondansetron administration (P < 0.0001). There was no difference in complete response between 6.25 mg and higher doses of promethazine.

CONCLUSIONS: Promethazine was significantly more effective than ondansetron for treating PONV after failed ondansetron prophylaxis. Promethazine 6.25 mg was as effective as higher doses.

 

 

新药Sugammadex逆转罗库溴铵引起的神经肌肉阻滞在异丙酚或七氟醚麻醉维持下同样有效

Reversal of Rocuronium-Induced Neuromuscular Block with the Novel Drug Sugammadex Is Equally Effective Under Maintenance Anesthesia with Propofol or Sevoflurane

Bernard F. Vanacker, MD, PhD*, Karel M. Vermeyen, MD, PhD{dagger}, Michel M. R. F. Struys, MD, PhD{ddagger}, Henk Rietbergen, MSc, Eugene Vandermeersch, MD, PhD*, Vera Saldien, MD{dagger}, Alain F. Kalmar, MD{ddagger}, and Martine E. Prins, MSc

From the *University Hospitals Leuven, KU Leuven, Belgium; {dagger}University Hospital Antwerp, Antwerp, Belgium; {ddagger}Ghent University Hospital, Ghent, Belgium; NV Organon, Oss, The Netherlands.

Anesth Analg 2007;104:563-568
在本研究中我们调查了新药sugammadex逆转罗库溴铵引起的神经肌肉阻滞(NMB)在异丙酚或七氟醚麻醉维持的患者中是否同样有效。用异丙酚诱导后,将患者随机分为异丙酚组(n = 21)和七氟醚组(n = 21)。给予罗库溴铵0.6 mg/kg用以气管插管。速度描记法监测NMB。当四个成串刺激比率中的第二个肌颤搐再现时,单次静脉注入sugammadex 2.0 mg/kg。主要终点是从开始给予sugammadex到四个成串刺激比率恢复至0.9。异丙酚和七氟醚麻醉后的平均恢复时间都是1.8分钟。两组恢复时间差异的95%可信区间 (–0.5 +0.4 min)在预定义的等价间期(–1 +1 min)内,表明NMB恢复不受麻醉维持的影响。13名患者(异丙酚n = 4; 七氟醚n = 9)出现不良事件,其中治疗相关性的有4(异丙酚n = 3; 七氟醚n = 1)。没有治疗相关的严重不良事件、停药或死亡。未发生残余性麻痹。某种程度Sugammadex的安全性在异丙酚麻醉下较七氟醚更满意。

(唐李隽 马皓琳 李士通 校)

In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. NMB was monitored using acceleromyography. At reappearance of the second twitch of the train-of-four ratio, sugammadex 2.0 mg/kg was administered by IV bolus. The primary end-point was time from start of sugammadex administration to recovery of train-of-four ratio to 0.9. Mean recovery time was 1.8 min after both propofol and sevoflurane anesthesia. The 95% confidence interval for the difference in recovery time between the 2 groups (–0.5 to +0.4 min) was well within the predefined equivalence interval (–1 to +1 min), indicating that recovery from NMB was unaffected by maintenance anesthesia. Thirteen patients (propofol n = 4; sevoflurane n = 9) experienced adverse events; these were treatment-related in 4 patients (propofol n = 3; sevoflurane n = 1). There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.

 

 

高碳酸血症性过度通气可以缩短异氟醚麻醉后苏醒时间

Hypercapnic Hyperventilation Shortens Emergence Time from Isoflurane Anesthesia

 

Derek J. Sakata, MD, Nishant A. Gopalakrishnan, BS, Joseph A. Orr, PhD, Julia L. White, RN, BS, CCRC, and Dwayne R. Westenskow, PhD

From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah.

Anesth Analg 2007;104:587-591

背景:最近的调查发现,为了缩短用挥发性麻醉的手术后苏醒时间,78%的麻醉医师使用过度通气来将麻醉剂从肺内快速洗出。过度通气的做法还没有在临 广泛运用,这是因为过度通气造成的低脉血二氧化碳分压会减少脑血流且制呼吸驱。通过增病人的气道死腔量可以在过度通气时简单安全地维持正常或轻微增高的脉血二氧化碳分压值。

方法:我们让二十个外科手术病人接受1MAC的异氟醚吸入麻醉,一组轻度高碳酸血症(ETCO2约为28mmHg),一组轻度低碳酸血症(ETCO2约为55mmHg),然后比较他们之间异氟醚洗出时间的区别。一病人在洗出时分钟通气量倍,通过插入额外气道死腔量来维持ETCO2在过度通气时接近55mmHg。活性碳吸附剂罐吸附死腔里的麻醉气体。所有病人在洗出时新鲜气体流量都增到10L/min

结果:每当用重复呼吸和麻醉剂吸附维持的高碳酸血症性过度通气时,从关闭挥发罐到睁开眼睛嘴巴的时间、气管拔管时间标准化BIS达到0.95的时间均较快(P<0.001)。拔管时间平均缩短59%

结论:通过过度通气来将麻醉剂从肺内快速洗出以通过CO2重复呼吸来诱发过度通气过程中的高碳酸血症,可以显著缩短异氟醚麻醉的苏醒时间。当提供挥发性麻醉剂快速洗出很重要时,尤其是一直到术毕都维持高浓度挥发性麻醉剂或者无预的手术突然结束的情况下,应该考虑采用以这种方法。

(姜旭晖译 马皓琳,李士通校)

BACKGROUND: To shorten emergence time after a procedure using volatile anesthesia, 78% of anesthesiologists recently surveyed used hyperventilation to rapidly clear the anesthetic from the lungs. Hyperventilation has not been universally adapted into clinical practice because it also decreases the Paco2, which decreases cerebral bloodflow and depresses respiratory drive. Adding deadspace to the patient’s airway may be a simple and safe method of maintaining a normal or slightly increased Paco2 during hyperventilation.

METHODS: We evaluated the differences in emergence time in 20 surgical patients undergoing 1 MAC of isoflurane under mild hypocapnia (ETco2 approximately 28 mmHg) and mild hypercapnia (ETco2 approximately 55 mmHg). The minute ventilation in half the patients was doubled during emergence, and hypercapnia was maintained by insertion of additional airway deadspace to keep the ETco2 close to 55 mmHg during hyperventilation. A charcoal canister adsorbed the volatile anesthetic from the deadspace. Fresh gas flows were increased to 10 L/min during emergence in all patients.

RESULTS: The time between turning off the vaporizer and the time when the patients opened their eyes and mouths, the time of tracheal extubation, and the time for normalized bispectral index to increase to 0.95 were faster whenever hypercapnic hyperventilation was maintained using rebreathing and anesthetic adsorption (P < 0.001). The time to tracheal extubation was shortened by an average of 59%.

CONCLUSIONS: The emergence time after isoflurane anesthesia can be shortened significantly by using hyperventilation to rapidly clear the anesthetic from the lungs and CO2 rebreathing to induce hypercapnia during hyperventilation. The device should be considered when it is important to provide a rapid emergence, especially after surgical procedures where a high concentration of the volatile anesthetic was maintained right up to the end of the procedure, or where surgery ends abruptly and without warning.

 

 

脑态指数在异丙酚麻醉深度递增过程中的表现:与双谱指数比较

Performance of the Cerebral State Index During Increasing Levels of Propofol Anesthesia: A Comparison with the Bispectral Index

Luis I. Cortínez, MD, Alejandro E. Delfino, MD, Ricardo Fuentes, MD, and Hernán R. Muñoz, MD, MSc

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

Anesth Analg 2007;104:605-610

背景:脑态监测仪是测量麻醉深度的一种新型仪器。在这项研究中,我们比较了异丙酚麻醉中脑态监测与双谱指数(BIS)监测。

方法:15位健康患者接受持续异丙酚输注麻醉(300 mL/h)。记录脑态指数(CSI)BIS直至爆发性制比60%。评价基线变异率、预测概率两指数间的吻合度。同时评估意识丧失的临标志。

结果:平均BISCSI唤醒值分别为95.691.6 (P = 0.01)。估计的BISCSI的预测概率值分别为0.87 ± 0.080.86 ± 0.08(平均值±标准差)NS)。当估计的效应部位异丙酚浓度从5 µg/mL增到 8 µg/mL时,CSI趋于稳定在6040。效应部位异丙酚浓度从7 µg/mL增到 10 µg/mL时,BIS稳定在4020。平均BIS-CSI差异为–7.495%吻合限22.2–36.9。与爆发性制比相关的BISCSI分别为–0.60–0.97(P < 0.01)。预计的50%95%病人睫毛反射消失时的BISCSI值不同(P < 0.05)

结论:异丙酚诱导过程中两种监测总体的表现是相似的。然而,这两种监测不同的学特性显示,BIS可能是评价中等麻醉深度较为有效的指数,而CSI用于评价更深的麻醉深度较好。

(黄佳佳 译,马皓琳 李士通 校)

BACKGROUND: The cerebral state monitor is a new device to measure depth of anesthesia. In this study we compared the cerebral state monitor with the bispectral index (BIS) monitor during propofol anesthesia.

METHODS: Fifteen healthy patients received a continuous infusion of propofol (300 mL/h). The cerebral state index (CSI) and the BIS values were recorded until burst suppression ratio 60%. Baseline variability, prediction probability, and agreement analysis between indices were evaluated. Clinical markers of loss of consciousness were also assessed.

RESULTS: Mean awake BIS and CSI values were 95.6 and 91.6, respectively (P = 0.01). BIS and CSI prediction probability values (mean ± sd) were estimated to be 0.87 ± 0.08 and 0.86 ± 0.08, respectively (NS). The CSI tended to stabilize at values of 60–40 when estimated propofol concentrations at the effect site increased from 5 to 8 µg/mL. The BIS stabilized at values of 40–20 when the propofol concentrations at the effect site increased from 7 to 10 µg/mL. The mean BIS-CSI difference was –7.4 with 95% limits of agreement of 22.2 and –36.9. The BIS and CSI correlation with the burst suppression ratio was –0.60 and –0.97, respectively (P < 0.01). Predicted BIS and CSI values for loss of eyelash reflex in 50% and 95% of the patients were different (P < 0.05).

CONCLUSION: The overall performance of both monitors during propofol induction was similar. However, the different dynamic profiles of these monitors indicate that BIS may be a more useful index for evaluating intermediate anesthetic levels, whereas CSI may be better for evaluating deeper anesthetic levels.

 

 

由急症科医生完成的院外病人食道支气管插管

The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians

Arnd Timmermann, MD, DEAA*, Sebastian G. Russo, MD*, Christoph Eich, MD, DEAA*, Markus Roessler, MD, DEAA*, Ulrich Braun, MD, PhD*, William H. Rosenblatt, MD, PhD{dagger}, and Micheal Quintel, MD, PhD*

From the *Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Goettingen, Germany; and {dagger}Department of Anesthesiology, School of Medicine, Yale University, New Haven, Connecticut.

Anesth Analg 2007;104:619-623

背景:对于危重或创伤病人而言,气道的快速建立是院前急救人员的首要问题。院外病人的气管插管是颇具挑战性的。未被认识到的插管误入食道是临的灾难。

方法:我们持续地对需空运并由初级急症科医生完成院外气管插管的病人进行了一个观察性的前瞻性研究,以测定未被认识到的食道支气管内插管的数目。研究医生通过结合直接明视、呼气末二氧化碳检测、食道检测装置体检来确定气管导管的位置。

结果:在5年的研究阶段,初级急症科医生连续对149位患者实行了院外气管插管,并随后由研究医生进行评估。患者平均年龄为57.0 (±22.7) 岁,99位(66.4%)患者为男性。研究医生确定16例(10.7%)和10例(6.7%)气管导管已分别置于右支气管主干和食道内。所有误入食道的插管都被检测到并由研究医生予纠正,但10位患者中有7位在治疗的最初24小时内死亡。

结论:未被认识到误入食道的插管是常见的,且与高死亡率相关。插管入食道可通过呼气末二氧化碳监测食道检测装置来发现。院外医人员需在气道处理方面接受持续的培训,并需要提供额外的验证设备来帮确定气管导管的位置。

(裘毅敏译,马皓琳 李士通校)

 

BACKGROUND: Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster.

METHODS: We performed an observational, prospective study of consecutive patients requiring transport by air and out-of-hospital tracheal intubation, performed by primary emergency physicians to quantify the number of unrecognized esophageal and endobronchial intubations. Tracheal tube placement was verified on scene by a study physician using a combination of direct visualization, end-tidal carbon dioxide detection, esophageal detection device, and physical examination.

RESULTS: During the 5-yr study period 149 consecutive out-of-hospital tracheal intubations were performed by primary emergency physicians and subsequently evaluated by the study physicians. The mean patient age was 57.0 (±22.7) yr and 99 patients (66.4%) were men. The tracheal tube was determined by the study physician to have been placed in the right mainstem bronchus or esophagus in 16 (10.7%) and 10 (6.7%) patients, respectively. All esophageal intubations were detected and corrected by the study physician at the scene, but 7 of these 10 patients died within the first 24 h of treatment.

CONCLUSION: The incidence of unrecognized esophageal intubation is frequent and is associated with a high mortality rate. Esophageal intubation can be detected with end-tidal carbon dioxide monitoring and an esophageal detection device. Out-of-hospital care providers should receive continuing training in airway management, and should be provided additional confirmatory adjuncts to aid in the determination of tracheal tube placement.

 

 

七氟醚对受内毒素损伤肺泡皮细胞的免疫调制作用

The Immunomodulatory Effect of Sevoflurane in Endotoxin-Injured Alveolar Epithelial Cells

Dominik Suter, MD*{dagger}, Donat R. Spahn, MD*, Stephan Blumenthal, MD, Livia Reyes{dagger}, Christa Booy{dagger}, Birgit Roth Z'graggen, PhD{dagger}, and Beatrice Beck-Schimmer, MD*{dagger}

From the Institutes of *Anesthesiology, {dagger}Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich; and Department of Anesthesiology, Orthopedic University Clinic Zurich Balgrist, Zurich, Switzerland.

Anesth Analg 2007;104:638-645

背景:内毒素所致肺损伤是用于描述急性肺损伤免疫病理学机制的一个有效实验体系。尽管挥发性麻醉药直接接触到肺泡皮细胞(AEC),但是关于麻醉药对此类细胞作用的信息非常有限。本实验研究了吸入麻醉药七氟醚预处理对受脂多糖(LPS)损伤的AEC的作用。

方法:AEC1.1vol%的七氟醚孵育0.5小时后用LPS刺激5小时。分析单核细胞趋化蛋白-1MCP-1)、巨噬细胞炎性蛋白-MIP-1ß)、巨噬细胞炎性蛋白-2MIP-2)、细胞因子诱导中性粒细胞趋化物-1CINC-1)和细胞间黏附分子-1ICAM-1)的表达。同时通过趋化和黏附试验进行能测试以阐明检测结果之间的生物学联系。

结果:七氟醚-LPS组中,经七氟醚预处理的AECMCP-1蛋白表达较无七氟醚-LPS细胞下调50(P < 0.05)。七氟醚使LPS刺激过的细胞中的MIP-1ß浓度降低32(P < 0.05)MIP-2浓度降低29% (P < 0.05)CINC-1浓度降低20% (P < 0.05)ICAM-1蛋白表达减弱36(P < 0.05)。此种制使得中性粒细胞炎症应答产生本质变化。七氟醚处理的LPS细胞中的趋化活性减少33(P < 0.001)且中性粒细胞对AEC的黏附也减少47(P < 0.001)

结论:本研究显示七氟醚可改变LPS-诱导的炎症应答,该作用不仅与炎性介质表达方式有关,还与其减少中性粒细胞等效应细胞聚集的生物学效应有关。

(周雅春 马皓琳 李士通 校)

BACKGROUND: Endotoxin-induced lung injury is a useful experimental system for the characterization of immunopathologic mechanisms in acute lung injury. Although alveolar epithelial cells (AEC) are directly exposed to volatile anesthetics, there is limited information about the effect of anesthetics on these cells. In this study we investigated the effect of pretreatment with the inhaled anesthetic sevoflurane on lipopolysaccharide (LPS)-injured AEC.

METHODS: AEC were incubated with 1.1 vol % sevoflurane for 0.5 h, followed by LPS stimulation for 5 h. Expression of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1ß (MIP-1ß), macrophage inflammatory protein-2 (MIP-2), cytokine-induced neutrophil chemoattractant-1 (CINC-1), and intercellular adhesion molecule-1 (ICAM-1) was analyzed. In addition, functional tests were performed through chemotaxis and adherence assays to underline the biological relevance of the findings.

RESULTS: Exposure of AEC to sevoflurane resulted in a 50% downregulation of MCP-1 protein in the sevoflurane-LPS group when compared with non-sevoflurane- LPS cells (P < 0.05). MIP-1ß concentration in LPS-stimulated cells decreased by 32% with sevoflurane (P < 0.05), MIP-2 by 29% (P < 0.05), and CINC-1 by 20% (P < 0.05). ICAM-1 protein expression was attenuated by 36% (P < 0.05). This inhibition caused substantial changes in the inflammatory response of neutrophils. 33% less chemotactic activity was seen in sevoflurane-treated LPS cells (P < 0.001) as well as 47% decreased adhesion of neutrophils to AEC (P < 0.001).

CONCLUSIONS: This study shows that sevoflurane alters the LPS-induced inflammatory response, not only with respect to the expression pattern of inflammatory mediators, but also regarding the biological consequences with less accumulation of effector cells such as neutrophils.

 

 

分析剖宫产手术中血红细胞回收再利用的输注实践和作用

An Analysis of Transfusion Practice and the Role of Intraoperative Red Blood Cell Salvage During Cesarean Delivery

Jill Fong, MD*, Edith D. Gurewitsch, MD{dagger}, Hey-Joo Kang, MD{ddagger}, Lisa Kump, MD, and Patricia Fogarty Mack, MD*

From the *Departments of Anesthesiology and {ddagger}Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medical Center; {dagger}Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine; and Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York.

Anesth Analg 2007;104:666-672

背景:我们寻求确定手术中回收的红细胞(RBC)输注理论可能减少剖宫产病人恰当的输同种异体的红细胞到何种程度。

方法:回顾了199211日到1996630日和199861日到2003630日需要血液输注的剖宫产病人的医疗记录。对于每位病人,我们都计算了如果进行术中自体输血,理论可以避免的同种异体红细胞的单位数。计算基于估计血液丢失量、术前红细胞压积和产生一个红细胞单位所需的回收血量。红细胞输注的恰当性用推荐的红细胞输注指南来确定,即在持续出血的病人是否血红蛋白<7 gm/dL

结果:小百分比的剖宫产病人(1.8%)接受了血液制品的输注。接受了血液输注的207位病人中,回收利用红细胞可以理论减少115位病人(55.6%)进行同种异体红细胞输注。这115位病人中只有75.7%是恰当地输注了红细胞。

结论:理论,基于最好、平均和最差的红细胞回收计算,分别有25.1%21.2% 或者14.5%的恰当输血的患者可以完全避免同种异体红细胞的输注。

(张曦 译,马皓琳 李士通 校)

BACKGROUND: We sought to determine to what extent intraoperative salvaged red blood cells (RBC) might theoretically reduce exposure to appropriately transfused allogenic erythrocytes in Cesarean delivery patients.

METHODS: Medical records of Cesarean delivery patients requiring blood transfusions from January 1, 1992 to June 30, 1996 and June 1, 1998 to June 30, 2003 were reviewed. For each patient, we calculated the number of allogenic RBC units that could have theoretically been avoided had intraoperative autotransfusion been performed, based upon estimated blood loss, preoperative hematocrit, and the amount of retrieved blood needed to yield a single RBC unit. RBC transfusion appropriateness was determined using the recommended guideline of transfusing RBCs if the hemoglobin is <7 gm/dL in a patient with continuing bleeding.

RESULTS: A small percentage of Cesarean delivery patients (1.8%) received blood product transfusions. Of 207 patients receiving blood transfusions, salvaged erythrocytes could have theoretically decreased exposure to allogenic RBCs in 115 (55.6%) patients. Only 75.7% of these 115 patients were appropriately transfused with erythrocytes.

CONCLUSION: Theoretically, based on best, average, and worst RBC salvage recovery calculations, 25.1%, 21.2%, or 14.5% of the appropriately transfused patients, respectively, could have completely avoided allogenic RBC transfusion.

 

 

实施血液细胞回收时修正吸引导致的溶血

Modification of Suction-Induced Hemolysis During Cell Salvage

Jonathan H. Waters, MD*, Brandon Williams, BS{dagger}, Mark H. Yazer, MD, FRCPC{ddagger}, and Marina V. Kameneva, PhD{dagger}||

From the *Department of Anesthesiology, Magee Womens Hospital of University of Pittsburgh Medical center; Departments of {dagger}Bioengineering and {ddagger}Pathology, The Institute for Transfusion Medicine; and ||McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA.

Anesth Analg 2007;104:684-687

背景:实施血液细胞回收时收集红细胞的有效程度取决于多种因素,包括吸引压。本研究中,我们试图确定吸引压对有效收集红细胞的影响,并且鉴定吸引对回收血液的影响最小化的方法。

方法:将60mL全血等分放置于烧杯或平皿中,用100300mm Hg负压吸引。测定并比较不同条件下的溶血量。将血液用生理盐水1:1稀,重复同样实验。

结果:溶血量由0.21%2.29%不等。用300mmHg负压从平皿中吸引时,溶血量最大。血液用生理盐水稀后,溶血量降低。因此,从外科手术野吸引回收血液应使用最小的吸引负压,并尽量减小血液和空气的接触面积。

结论:从手术野吸引回收血液时用生理盐水稀,可以明显减少血液损伤。虽然吸引直接导致的溶血并不多,但吸引时态血液和空气接触面导致的红细胞损伤,从而不利地影响血液细胞回收的有效性。

(张莹 马皓琳 李士通 校)

BACKGROUND: The efficiency of red blood cell collection during cell salvage is dictated by multiple variables, including suction pressure. In this study, we attempted to determine the influence of suction pressure on the efficiency of cell salvage and to identify methods for minimizing the impact of suction on salvaged blood.

METHODS: Whole blood was placed in 60-mL aliquots either in a beaker or on a flat surface and suctioned at 100 and 300 mm Hg. The amount of hemolysis was measured and compared under the varying conditions. The experiments were repeated with the blood diluted with normal saline solution in a 1:1 mix.

RESULTS: Hemolysis ranged from 0.21% to 2.29%. Hemolysis was greatest when whole blood was suctioned from a flat surface at 300 mm Hg. It was reduced when the blood was diluted with saline. Blood suctioned from a surgical field during cell salvage should be done with minimal suction pressures and with the goal of minimizing blood–air interfaces.

CONCLUSIONS: Significant reduction of blood damage can be obtained by diluting blood with normal saline while suctioning it from the surgical field. Although immediate hemolysis due to suctioning was not very high, the red blood cell damage from suctioning produced by a dynamic blood–air interface might adversely affect the efficiency of cell salvage.

 

 

大鼠福尔马林试验中大麻酯受体激剂WIN55,212-2和布比卡因之间伤害的协同作用

Antinociceptive Synergy Between the Cannabinoid Receptor Agonist WIN 55,212-2 and Bupivacaine in the Rat Formalin Test

Sinyoung Kang, MD, PhD, Chi Hyo Kim, MD, PhD, Heeseung Lee, MD, Dong Yeon Kim, MD, PhD, Jong In Han, MD, PhD, Rack Kyung Chung, MD, PhD, and Guie Yong Lee, MD, PhD

From the Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical College, Seoul, Korea.

Anesth Analg 2007;104:719-725

背景:大麻酯类和局麻药之间的镇痛协同作用尚无研究。我们通过使用福尔马林试验试图判定鞘内注射大麻酯受体激剂(WIN 55,212-2)和布比卡因之间相互作用的特性。

方法:在雄性SD大鼠置入腰段鞘内导管。在鞘内注射WIN 55,212-2、布比卡因或二者混合液之后,将50μL5%的福尔马林注入大鼠后爪皮下。绘制剂量-反应曲线,并确定每一单用药物各自的ED50 (50%有效剂量)值。测试固定比例的WIN 55,212-2和布比卡因混合液在福尔马林试验中的联合伤害效应,并使用等辐射分析法来确定二者的药理学相互作用。

结果:鞘内注射WIN 55,212-2、布比卡因或二者混合液可在福尔马林试验的1期和2期产生剂量依赖的退缩数量减少。等辐射分析发现鞘内注射WIN 55,212-2和布比卡因在福尔马林试验的两个期内都呈协同作用。联合应用后,ED50值明显小于理论的相效应值(P<0.05)。

结论:这些结果提示鞘内联合应用WIN 55,212-2和布比卡因在福尔马林两期均产生协同的伤害相互作用。

(黄施伟 译,马皓琳、李士通 校)

BACKGROUND: The analgesic interaction between cannabinoids and local anesthetics has not been investigated. We sought to determine the nature of the interaction between the intrathecal cannabinoid receptor agonist (WIN 55,212-2) and bupivacaine using the formalin test.

METHODS: Lumbar intrathecal catheters were implanted in male Sprague-Dawley rats. After intrathecal administration of WIN 55,212-2, bupivacaine, or their combination, 50 µL of 5% formalin was injected subcutaneously into the hindpaw. Dose–response curves were established and the respective ED50 (50% effective dose) values were determined for each agent alone. Fixed-ratio combinations of WIN 55,212-2 and bupivacaine were tested for combined antinociceptive effects in the formalin test and an isobolographic analysis was performed to characterize the pharmacologic interaction of both drugs.

RESULTS: Intrathecally administered WIN 55,212-2, bupivacaine, or their combination produced a dose-dependent decrease in the number of flinches during Phase 1 and 2 of the formalin test. Isobolographic analysis revealed a synergistic interaction between intrathecal WIN 55,212-2 and bupivacaine in both phases of the formalin test. In combination, the ED50 value was significantly smaller than the theoretical additive value (P < 0.05).

CONCLUSIONS: These results demonstrate that intrathecally coadministered WIN 55,212-2 and bupivacaine provide synergistic antinociceptive interaction in both phases of the formalin test.

 

肺脉高压患儿行非心脏手术或心导管术的围术期并发症

Perioperative Complications in Children with Pulmonary Hypertension Undergoing Noncardiac Surgery or Cardiac Catheterization

Mario J. Carmosino, MD*, Robert H. Friesen, MD*, Aimee Doran, CPNP{dagger}, and Dunbar D. Ivy, MD{dagger}

From the Departments of *Anesthesiology; and {dagger}Pediatrics (Cardiology), The Children’s Hospital and University of Colorado School of Medicine, Denver, Colorado.

Anesth Analg 2007 104: 521-527.

 

背景:肺脉高压可导致严重的心能不全,被认为与围术期心血管并发症发生的危险增相关。

方法:作者回顾分析1999年到2004年期间肺脉高压患儿行非心脏手术或心导管术期间麻醉或镇静的医学记录。研究其术中至术后48h之内发生并发症的诱因、类型和相关因素。

结果 156名患儿(平均年龄4.0岁)共进行了256次手术操作。引起PAH的病因包括特发性的(原发)(56%),先心病(21%),慢性肺病(14%),慢性气道阻塞(4%)和慢性肝病(4%)。68%病人基础肺脉高压是亚系统的,19%是系统性的,13%是超系统的。麻醉方法:镇静(22%),全麻吸入麻醉(58%),全身静脉麻醉(20%)。8名患儿(5.1%,总操作数的3.1%)发生了较小的并发症。而在行心导管术时有7名患儿(总患儿的4.5%,的心导管操作数的5.0%,占所有操作的2.7%)发生了较严重的并发症,包括心脏骤停和肺高压危象。其中有两个患儿(患儿的1.3%,操作的0.8%)死于肺高压危象。通过多变量回归分析显示超系统肺脉高压是较大并发症的重要预测因素(OR=8.1P=0.02)。而并发症与年龄,PAH的病因,麻醉类型和气道管理没有明显相关性。

结论:患有超系统的PAH患儿围术期严重并发症的风险较大,包括心脏停止和肺高压危象。

(丁震敏 陈杰 校)

BACKGROUND: Pulmonary arterial hypertension (PAH) can lead to significant cardiac dysfunction and is considered to be associated with an increased risk of perioperative cardiovascular complications.

METHODS: We reviewed the medical records of children with PAH who underwent anesthesia or sedation for noncardiac surgical procedures or cardiac catheterizations from 1999 to 2004. The incidence, type, and associated factors of complications occurring intraoperatively through 48 h postoperatively were examined.

RESULTS: Two hundred fifty-six procedures were performed in 156 patients (median age 4.0 yr). PAH etiology was 56% idiopathic (primary), 21% congenital heart disease, 14% chronic lung disease, 4% chronic airway obstruction, and 4% chronic liver disease. Baseline pulmonary artery pressure was subsystemic in 68% patients, systemic in 19%, and suprasystemic in 13%. The anesthetic techniques were 22% sedation, 58% general inhaled, 20% general IV. Minor complications occurred in eight patients (5.1% of patients, 3.1% of procedures). Major complications, including cardiac arrest and pulmonary hypertensive crisis, occurred in seven patients during cardiac catheterization procedures (4.5% of patients, 5.0% of cardiac catheterization procedures, 2.7% of all procedures). There were two deaths associated with pulmonary hypertensive crisis (1.3% of patients, 0.8% of procedures). Baseline suprasystemic PAH was a significant predictor of major complications by multivariate logistic regression analysis (OR = 8.1, P = 0.02). Complications were not significantly associated with age, etiology of PAH, type of anesthetic, or airway management.

CONCLUSION: Children with suprasystemic PAH have a significant risk of major perioperative complications, including cardiac arrest and pulmonary hypertensive crisis.

 

围术期耳电针法对第三磨牙拔除术后的疼痛和镇痛药用量没有影响

Perioperative Auricular Electroacupuncture Has No Effect on Pain and Analgesic Consumption After Third Molar Tooth Extraction

Andrea Michalek-Sauberer, MD*, Harald Heinzl, PhD{dagger}, Sabine M. Sator-Katzenschlager, MD*, Gabriel Monov, MD{ddagger}, Erich Knolle, MD*, and Hans Georg Kress, MD, PhD*

From the *Department of Anesthesiology and General Intensive Care Medicine (B); {dagger}Core Unit for Medical Statistics and Informatics; and {ddagger}Bernhard Gottlieb Department of Oral Surgery, Medical University of Vienna, Austria.

Anesth Analg 2007 104: 542-547.

 

背景:既往研究显示耳针(AA)能够缓解急性和慢性疼痛。作者前瞻性、随机的、双盲、对照研究了149位患者耳电针(AE)对局麻下行单侧下颌第三磨牙拔除术后第一个48小时镇痛和止痛药用量的影响。

方法:患者接受耳电针(AEn=76)或耳针(无电刺激)(AAn=37),采用2/100Hz的交替电刺激或用金属盘替代针的假电刺激或无无针电刺激(NNn=36)。在整个研究过程中AA点为牙穴(1),声门穴(55),口腔穴(84)。用5级评分法评定疼痛并记录扑热息痛500mg片需要量和额外镇痛药物甲灭酸500mg的需要量。

结果:疼痛为中等度或更严重的平均中位数数(四分位数、下四分位数)分别为:AE组:33%12%64%),AA组:22%6%56%),NN组:30%7%53%),组间无显著差异。需要扑热息痛500mg片剂的平均值(AE组:5.2片(0-12),AA组:4.6片(0-11),NN组:5.4片(0-10)需要额外镇痛药甲灭酸的患者比例(AE:19%AA:18%NN:19%)也均无明显差异。

结论:不论AEAA都不能减轻第三磨牙拔除术的急性疼痛的疼痛度和减少镇痛药用量。

(顾新宇 陈杰 校)

BACKGROUND: Auricular acupuncture (AA) has been shown to alleviate acute and chronic pain. We investigated the effects of auricular electroacupuncture (AE) on pain and analgesic drug consumption in the first 48 h after unilateral mandibular third molar tooth extraction under local anesthesia in a prospective, randomized, double-blind, placebo-controlled study in 149 patients.

METHODS: Patients received either AA with electrical stimulation (AE, n = 76) or without (AA, n = 37) electrical stimulation at an alternating frequency of 2/100 Hz or a sham AE with metal plates instead of needles and no electrical stimulation, no-needle (NN, n = 36) at the AA points 1 (tooth), 55 (Shen men) and 84 (mouth) during the entire study period. Regularly rated pain intensity (five-point verbal rating scale), consumption of acetaminophen 500 mg tablets and additional rescue medication with mefenamic acid 500 mg were assessed.

RESULTS: The median fraction of time when pain was rated as moderate or worse (upper and lower quartile): AE: 33% (12%, 64%), AA: 22% (6%, 56%), NN: 30% (7%, 53%) did not differ significantly among the treatment groups. There were no significant differences in mean number of acetaminophen 500 mg tablets (range): AE: 5.2 (0–12), AA: 4.6 (0–11), NN: 5.4 (0–10) or percentage of patients requiring additional mefenamic acid: AE: 19%, AA: 18%, NN: 19%.

CONCLUSION: We conclude that neither AE nor AA alone reduce either pain intensity or analgesic consumption in a molar tooth extraction model of acute pain.

 

一项有关选择性肌松药结合剂——速克美松安全逆转罗库溴铵深度神经肌肉阻滞的随机剂量探究的II期研究

A Randomized, Dose-Finding, Phase II Study of the Selective Relaxant Binding Drug, Sugammadex, Capable of Safely Reversing Profound Rocuronium-Induced Neuromuscular Block

Scott B. Groudine, MD*, Roy Soto, MD{dagger}, Cynthia Lien, MD{ddagger}, David Drover, MD, and Kevin Roberts, MD*

From the *Department of Anesthesiology, Albany Medical Center, Albany, New York; {dagger}Health Sciences Center, Stony Brook University Hospital, Stony Brook, New York; {ddagger}Department of Anesthesiology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, New York; and Department of Anesthesia, Stanford Medical Center, Stanford, California.

Anesth Analg 2007 104: 555-562.

 

背景:逆转深度神经肌肉阻滞仍是临一个重要的课题。速克美松是一个改良的γ环精,与甾体类神经肌肉阻滞药结合,促其从烟碱样受体解离。速克美松是第一个选择性肌松药结合剂。

方法 50名患者入选速克美松II期的效能和安全范围的研究。受试者接受氧化亚氮和丙酚麻醉,随机分组分别给予罗库溴铵0.6mg/kg1.2mg/kg,并给予0.51.02.04.08.0mg/kg之一剂量的速克美松。使用的神经肌肉监测仪是TOF Watch SX®速度仪。TOF0.9定义为肌松恢复。均在强直后计数为12的深度阻滞态下应用速克美松。

结果:除了低剂量的组(0.51.0mg/kg)部分受试者肌松未能充分逆转外,其余应用速克美松的受试者的神经肌肉阻滞作用均被逆转。在速克美松2mg/kg组中,所有的受试者均得以充分逆转,但恢复时间具有明显的变异性(1.815.20min)。肌松逆转有剂量依赖性时间变异性减小和逆转速度提高。大剂量组(8mg/kg)平均恢复时间为1.2min(范围0.82.1min)。研究中无严重副作用。

结论:速克美松耐受良好、可迅速有效地逆转深度罗库溴铵神经肌肉阻滞。随着剂量的增,平均恢复时间缩短。罗库溴铵诱导的深度神经肌肉阻滞可被速克美松(≥2mg/kg)有效逆转。

(杨卫红 陈杰 校)

BACKGROUND: The reversal of a deep neuromuscular blockade remains a significant clinical problem. Sugammadex, a modified {gamma}-cyclodextrin, encapsulates steroidal neuromuscular blocking drugs, promoting their rapid dissociation from nicotinic receptors. Sugammadex is the first drug that acts as a selective relaxant binding agent.

METHODS: We enrolled 50 patients into a Phase II dose-finding study of the efficacy and safety of sugammadex. Subjects, anesthetized with nitrous oxide and propofol, were randomized to one of two doses of rocuronium (0.6 or 1.2 mg/kg) and to one of five doses of sugammadex (0.5, 1.0, 2.0, 4.0, or 8.0 mg/kg). Neuromuscular monitoring was performed using the TOF Watch SX® acceleromyograph. Recovery was defined as a train-of-four ratio 0.9. Sugammadex was administered during profound block when neuromuscular monitoring demonstrated a posttetanic count of one or two.

RESULTS: Reversal of neuromuscular block was obtained after administration of sugammadex in all but the lowest dose groups (0.5–1.0 mg/kg) where several subjects could not be adequately reversed. At the 2 mg/kg dose all patients were reversed with sugammadex, but there was significant variability (1.8–15.2 min). Patient variability decreased and speed of recovery increased in a dose-dependent manner. At the highest dose (8 mg/kg), mean recovery time was 1.2 min (range 0.8–2.1 min). No serious adverse events were reported during this trial.

CONCLUSIONS: Sugammadex was well tolerated and effective in rapidly reversing profound rocuronium-induced neuromuscular block. The mean time to recovery decreased with increasing doses. Profound rocuronium-induced neuromuscular block can be reversed successfully with sugammadex at doses 2 mg/kg.


速克美松:临神经肌肉药理学的另一个里程碑

Sugammadex: Another Milestone in Clinical Neuromuscular Pharmacology

Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD

From the Department of Anesthesiology and Pain Medicine, Unit 409, Anderson Cancer Center, The University of Texas M. D., Houston, Texas.

Anesth Analg 2007 104: 575-581.

近期正在进行III期临试验的速克美松,作为革命性的处于实验研究的拮药物,引入临实践可能会改变临神经肌肉药理学的局面。速克美松——一种经修饰的γ-环精——与甾体类神经肌肉阻断剂以11比例(罗库溴铵>维库溴铵>>潘库溴铵)形成相当致密的水溶性复合物来发挥作用。在罗库溴铵诱发的神经肌肉阻断中,静脉给予速克美松会形成一浓度梯度变化使罗库溴铵分子从神经肌接头重新进入血浆,使神经肌接头快速恢复活性。速克美松没有生物学活性,不与血浆蛋白结合,使用安全而且有很好的耐受性。此外,其对乙酰胆碱酯酶或体内其它任何受体系统都不起作用。作为一拮剂该复合物的效能并不取决于该环精复合物的经肾脏排泄率。人体与物研究证实,在不存在肌无的情况下,速克美松能逆转由罗库溴铵生产的程度相当深的神经肌肉阻断,因而对增患者安全有利。速克美松同样有利于使用罗库溴铵进行的快速麻醉诱导,它能提供比1.0mg/kg琥珀酰胆碱更好的快速的起效和终效。而且不需要另胆碱酯酶制剂和胆碱能药来拮残余神经肌肉阻断作用,意味着不会产生由于使用这些药物而生产的心血管和其它的一些副作用。临使用速克美松能避免罗库溴铵和甾体类神经肌肉阻断剂的拮所产生的缺点。

(杨卫红 陈杰 校)

Sugammadex is a revolutionary investigational reversal drug currently undergoing Phase III testing whose introduction into clinical practice may change the face of clinical neuromuscular pharmacology. A modified {gamma}-cyclodextrin, sugammadex exerts its effect by forming very tight water-soluble complexes at a 1:1 ratio with steroidal neuromuscular blocking drugs (rocuronium > vecuronium >> pancuronium). During rocuronium-induced neuromuscular blockade, the IV administration of sugammadex creates a concentration gradient favoring the movement of rocuronium molecules from the neuromuscular junction back into the plasma, which results in a fast recovery of neuromuscular function. Sugammadex is biologically inactive, does not bind to plasma proteins, and appears to be safe and well tolerated. Additionally, it has no effect on acetylcholinesterase or any receptor system in the body. The compound's efficacy as an antagonist does not appear to rely on renal excretion of the cyclodextrin-relaxant complex. Human and animal studies have demonstrated that sugammadex can reverse very deep neuromuscular blockade induced by rocuronium without muscle weakness. Its future clinical use should decrease the incidence of postoperative muscle weakness, and thus contribute to increased patient safety. Sugammadex will also facilitate the use of rocuronium for rapid sequence induction of anesthesia by providing a faster onset-offset profile than that seen with 1.0 mg/kg succinylcholine. Furthermore, no additional anticholinesterase or anticholinergic drugs would be needed for antagonism of residual neuromuscular blockade, which would mean the end of the cardiovascular and other side effects of these compounds. The clinical use of sugammadex promises to eliminate many of the shortcomings in our current practice with regard to the antagonism of rocuronium and possibly other steroidal neuromuscular blockers.

 

自主呼吸期间氧气清除术用于测定能残气量的准确性研究。

The Accuracy of the Oxygen Washout Technique for Functional Residual Capacity Assessment During Spontaneous Breathing

Hermann Heinze, MD*, Bernhard Schaaf, MD{dagger}, Jochen Grefer, MD*, Karl Klotz, MD*, and Wolfgang Eichler, MD*

From the Departments of *Anesthesiology and {dagger}Medicine III, University of Luebeck, Luebeck, Germany.

Anesth Analg 2007 104: 598-604.

 

背景:能残气量(FRC)的测定对于肺损伤病人监测有着重要意义。仪器的缺乏妨碍了常规边FRC的测定。最近有一种简易自的利用氧气清除的FRC测定方法。本研究拟评估氧气清除术用于测定FRC的准确性。

方法LUFU系统(DraegerLuebeckGermany)用于评估氧气清除术测定FRC,是一种可变的多重呼吸氮清除仪。这种术使用一种旁流氧气分析仪测定从吸气末到呼气末期间的FiO2快速变化来计算FRC。运用了三种方法测定23名健康的、自主呼吸的、坐姿的志愿者的FRC1)氦气稀法(FRCHe),2)躯体体积描计法(FRCbp),3)氧气清除法(FRCO2)。

结果:FRCO2(平均4.1±1.1L,范围2.46.9L)与FRCHe(平均4.0±1.0L,范围2.46.2L;偏移FRCO2:-0.2±0.4L)和FRCbp(平均4.2±1.0L,范围2.86.1L;偏移FRCO20.1±0.6L)变化一致。

结论:在自主呼吸的健康志愿者中,与FRCHeFRCbp比较,使用LUFU系统的氧气清除术测定FRC的偏移和精确度可被临接受。

(杨卫红 陈杰 校)

BACKGROUND: Measurement of functional residual capacity (FRC) is of considerable interest for monitoring patients with lung injury. The lack of instruments has impeded routine bedside FRC measurement. Recently, a simple automated method for FRC assessment by O2 washout has been introduced. We designed this study to evaluate the accuracy of FRC measurement using the O2 washout technique.

METHODS: The LUFU system (Draeger, Luebeck, Germany) estimates FRC by O2 washout, a variant of multiple breath nitrogen washout. This technique uses a sidestream O2-analyzer to calculate FRC from end-inspired and end-expired O2 concentrations during fast changes of Fio2. We measured FRC in 23 healthy, spontaneously breathing volunteers in the sitting position using three techniques: 1) helium dilution (FRC-He), 2) body plethysmography (FRC-bp), 3) oxygen washout (FRC-O2).

RESULTS: FRC-O2 (mean 4.1 ± 1.1 L, range 2.4–6.9 L) corresponds with FRC-He (mean 4.0 ± 1.0 L, range 2.4–6.2 L; bias of FRC-O2: –0.2 ± 0.4 L) and FRC-bp (mean 4.2 ± 1.0 L, range 2.8–6.1 L; bias of FRC-O2: 0.1 ± 0.6 L).

CONCLUSIONS: The bias and precision of the O2 washout technique using the LUFU system were clinically acceptable when compared with FRC-He and FRC-bp for FRC assessment in spontaneously breathing volunteers.


关于麻醉前门,信息整合手术室内滞留:对执业麻醉医师的调查结果

Preanesthesia Clinics, Information Management, and Operating Room Delays: Results of a Survey of Practicing Anesthesiologists

Natalie F. Holt, MD, MPH*, David G. Silverman, MD*, Ravindra Prasad, MD{dagger}, James Dziura, PhD, MPH{ddagger}, and Keith J. Ruskin, MD*

From the Departments of *Anesthesiology and Neurosurgery, Yale University School of Medicine; {ddagger}Department of Biostatistics, General Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut; {dagger}Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and ||ASA Committee on Electronic Media and Information Technology, American Society of Anesthesiologists, Park Ridge, Illinois.

Anesth Analg 2007 104: 615-618.

 

背景:麻醉前门(PECs)的目的之一是确保病人做好充分的术前准备,从而降低日间手术延迟或临时取消的发生率。在一些单中心研究中,已证实了PECs的积极作用。然而,关于其整体的使用和有效性的资料尚有限。

方法:作者给参2005年美国麻醉学年会的出席者分发了一份调查问卷。问卷介绍了PECs在国内的普率其最常见的工作方式,并要求应答者论述PEC访视对降低因患者信息缺失而造成的日间手术延误的发生率的影响。

结果:1857份问卷返回。其中79%的应答者在设有PEC的医疗机构工作。57%的应答者指出,在没有进行麻醉前评估的日间手术病人中,每10人中至少有1人手术延迟。而在术前进行麻醉前PEC访视的病人中,有23%的应答者了相同的手术延误率。

结论:无论是否进行麻醉前评估,由于病人信息的缺失导致日间手术延迟的发生仍较为普遍。导致手术延迟的原因可能包括信息传递有误,对于术前准备缺乏一致的标准或其它制度的因素。

(印洁敏 陈杰 校)

BACKGROUND: One purpose of preanesthesia evaluation clinics (PECs) is to decrease the incidence of day-of-surgery delays and cancellations by ensuring that patients are medically ready for surgery. In several single-center studies, PECs have been shown to have a positive impact. However, limited information is available regarding their overall use and perceived effectiveness.

METHODS: A survey was distributed to attendees of the 2005 Annual Meeting of the American Society of Anesthesiologists. The survey addressed the national prevalence of PECs and the most common methods for referral to them. Respondents were also asked to address the impact of PEC visits on perceived prevalence of day-of-surgery delays caused by missing patient information.

RESULTS: One thousand eight hundred fifty-seven surveys were returned. Sixty- nine percent of respondents worked at institutions with a PEC. Fifty-seven percent of respondents indicated that delays occur in at least 1 in 10 patients not seen for preanesthesia evaluation prior to the day of surgery. For patients who had a PEC visit prior to surgery, the same frequency of delays was reported by 23% of respondents.

CONCLUSIONS: Day-of-surgery delays caused by missing information remain relatively common despite preanesthesia evaluation. Possible causes for these delays include failures of information transfer, lack of consensus on criteria for surgical readiness, or other institutional factors.


慢性变态反应哮喘模型中七氟醚麻醉对肺学与组织学的影响

Lung Mechanics and Histology During Sevoflurane Anesthesia in a Model of Chronic Allergic Asthma

Shirley Moreira Burburan, MD, MSc*{dagger}, Debora Gonçalves Xisto, RRT{dagger}, Halina Cidrini Ferreira, RRT{ddagger}, Douglas dos Reis Riva{ddagger}, Giovanna Marcella Cavalcante Carvalho{ddagger}, Walter Araujo Zin, MD, PhD{ddagger}, and Patricia Rieken Macêdo Rocco, MD, PhD{dagger}

From the *Division of Anesthesiology, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro; and Laboratories of {dagger}Pulmonary Investigation and {ddagger}Respiration Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

Anesth Analg 2007 104: 631-637.

 

背景:尚没有研究证实七氟醚在慢性炎症和气道重塑中的作用,例如哮喘发作中出现的情况,本文作者研究了七氟醚麻醉在慢性变态反应性哮喘中对呼吸的影响,研究肺学并分析肺的形态改变,从而判定生理学的改变是否可以反映潜在的形态改变。

方法 36BALB/c小鼠(重为20-25g)随机分为4组。在卵清蛋白(OVA)组,卵清蛋白致敏小鼠接受反复卵清蛋白刺激;SAL组,用生理盐水替代卵清蛋白。在最后一次刺激之后的24h,小鼠接受巴比妥钠(PENTO20mg/Kg i.p.)或七氟醚(SEVO,1MAC)麻醉。用肺膨胀末阻断法分析肺的静态顺应性(Est),阻({Delta}P1),粘弹性/变异性({Delta}P2),最后将肺脏固定和染色以分析其组织学的变化。

结果:在OVASEVO组的物{Delta}P138%),{Delta}P224%)和Est22%)均低于OVAPENTO组。在组织学方面,OVASEVO组的物气道扩张(16%)更明显,而肺泡塌陷度(25%)则较后组低。在SALSEVO组的物{Delta}P135%)低于SALPENTO组,而前者的气道直径(12%)则大于后者。

结论;对于慢性变态反应哮喘,七氟醚作用于主气道与肺周围气道,降低{Delta}P 1{Delta}P 2Est

(宋翠侠 陈杰 校)

BACKGROUND: There are no studies examining the effects of sevoflurane on a chronically inflamed and remodeled airway, such as that found in asthma. In the present study, we sought to define the respiratory effects of sevoflurane in a model of chronic allergic asthma. For this purpose, pulmonary mechanics were studied and lung morphometry analyzed to determine whether the physiological modifications reflected underlying morphological changes.

METHODS: Thirty-six BALB/c mice (20–25 g) were randomly divided into four groups. In OVA groups, mice were sensitized with ovalbumin and exposed to repeated ovalbumin challenges. In SAL groups, mice received saline using the same protocol. Twenty-four hours after the last challenge, the animals were anesthetized with pentobarbital sodium (PENTO, 20 mg/kg i.p.) or sevoflurane (SEVO, 1 MAC). Lung static elastance (Est), resistive ({Delta}P1) and viscoelastic/inhomogeneous ({Delta}P2) pressure decreases were analyzed by an end-inflation occlusion method. Lungs were fixed and stained for histological analysis.

RESULTS: Animals in the OVASEVO group showed lower {Delta}P1 (38%), {Delta}P2 (24%), and Est (22%) than animals in the OVAPENTO group. Histology demonstrated greater airway dilation (16%) and a lower degree of alveolar collapse (25%) in the OVASEVO compared with OVAPENTO group. {Delta}P1 was lower (35%) and airway diameters larger (12%) in the SALSEVO compared with SALPENTO group.

CONCLUSION: Sevoflurane anesthesia acted both at airway level and lung periphery reducing ({Delta}P1 and {Delta}P2 pressures, and Est in chronic allergic asthma.


静注尼卡地平和前列腺素E1对兔主脉钳闭开放后引起的大脑软脑膜微脉收缩效应作用的比较研究  

The Comparative Effects of Intravenous Nicardipine and Prostaglandin E1 on the Cerebral Pial Arteriolar Constriction Seen After Unclamping of an Aortic Cross-Clamp in Rabbits

Masahiko Kumazawa, MD*, Hiroki Iida, MD*, Masayoshi Uchida, MD{dagger}, Mami Iida, MD{ddagger}, Motoyasu Takenaka, MD*, and Shuji Dohi, MD*

From the Departments of *Anesthesiology and Pain Medicine, and {ddagger}Cardiology, Gifu University Graduate School of Medicine, Gifu City, Gifu; {dagger}Department of Anesthesia, Chubu Rosai Hospital, Nagoya; and Department of Nutrition and Food Science, Faculty of Home Economics, Gifu Women's University, Gifu, Japan.

Anesth Analg 2007 104: 659-665. [

 

背景:主脉手术期间,强血管扩张剂尼卡地平和前列腺素E1常用于处理系统性高血压或肺高压。

方法:通过闭合兔颅脑窗分别在以下时间点测量软脑膜微脉地直径:在用药前、用药后15min、主脉钳闭即刻、钳闭后20min主脉开放后0-60min。分别用以下药物:静注0.9%生理盐水(对照组);尼卡地平(剂量分别为在0.11.0,或10ug.kg-1.min-1),或PGE1(剂量分别为0.11.0,或10ug.kg-1.min-1)。

结果:在开放夹闭的主脉后,大脑微脉地直径在对照组显著缩小,且持续了至少60min,在60min时,与基础相比,大的微脉(R75um)的直径缩小了16%,小的微脉(R75um)的直径缩小了27%。小剂量的尼卡地平对主脉开放后引起地反射性血管收缩效应没有影响,大剂量地尼卡地平显著地弱了大小微脉的血管收缩作用(在60min时,大的微脉直径缩小6%10%,小的微脉直径收缩10%18%)。而在开放夹闭的主脉之后的5分钟甚至更长时间内,相对于对照组静注PGE1对软脑膜大小微脉收缩效应无显著影响。

结论:大剂量的尼卡地平可以弱主脉开放引起的软脑膜微脉的收缩作用,而PGE1无此效应。

(郑丽 陈杰 校)

BACKGROUND: The potent vasodilators nicardipine and prostaglandin E1 (PGE1) are useful for the treatment of systemic hypertension or pulmonary hypertension during aortic surgery.

METHODS: We measured cerebral pial arteriolar diameters, using a rabbit closed cranial window preparation: before (baseline) and 15 min after the start of an IV infusion (preclamp) (0.9% saline [control group], nicardipine [at 0.1, 1.0, or 10 µg·kg–1·min–1], or PGE1 [at 0.1 or 1.0 µg·kg–1·min–1]), just after aortic clamping, 20 min after clamping, and at 0–60 min after unclamping.

RESULTS: In the control group, a significant decrease in diameter persisted for at least 60 min after unclamping (maximum [at 60 min], –16% for large [75 µm], and –27% for small [<75 µm] arterioles versus baseline). Although the aortic unclamping-induced vasoconstriction was unaffected under the smallest dose of nicardipine, it was significantly attenuated under larger doses in both large and small arterioles (residual vasoconstriction, –10% and –6% for large and –18% and –10% for small arterioles; at 60 min). The pial arteriolar constriction observed at 5 min or more after unclamping in the control group was not altered by PGE1 in either large or small arterioles.

CONCLUSIONS: The larger doses of nicardipine, but neither dose of PGE1, attenuated aortic unclamping-induced sustained cerebral pial arteriolar constriction.



麻下行剖宫产患者中预防性使用格拉司琼并不能预防产后恶心呕吐

The Prophylactic Granisetron Does Not Prevent Postdelivery Nausea and Vomiting During Elective Cesarean Delivery Under Spinal Anesthesia

Mrinalini Balki, MD, Shilpa Kasodekar, MD, Sudhir Dhumne, MD, and Jose C. A. Carvalho, MD, PhD

From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Ontario, Canada.

Anesth Analg 2007 104: 679-683.

背景:区域麻醉下剖宫产患者围手术期的恶心呕吐受诸多因素影响,预防性呕吐措施是否有效仍有争论。在这个实验中,作者尝试着严格控制其它诱发因素来确定预防性使用格拉司琼是否对于麻下行剖宫产的患者能起到预防围手术期恶心呕吐的作用。

方法:这个随机,双盲,安慰剂对照研究中,共入组176名产妇。在静脉输入10ml/kg的林格氏平衡液后,用0.75%重比重布比卡因15mg,,太尼10ug,吗啡100ug进行麻。通过使用一定量的新福林,将患者的血压维持在基础水平。分娩后静注缩宫素0.5IU并持续静脉输注。在钳闭脐带后,给予格拉司琼1mg或等量的生理盐水。如果出现持续的恶心呕吐则静注苯海拉明50mg。统计产后恶心呕吐的发生率,需要紧急呕吐、低血压、疼痛和其他副作用的发生率。

结果:在使用格拉司琼呕吐组中,产后恶心呕吐发身生率为20.4%,对照组为17.0%(P=0.56NS)。术中低血压的发生率,分娩前为9.6%,分娩后为6.2%,两组相近。术中疼痛(2.2%4.5%P=0.68)和需要紧急呕吐(8%6.8%P=0.77)的发生率两组均相似。

结论:尽管严格控制了多种可能导致呕吐的因素,选择性剖宫产患者围术期恶心呕吐的发生率仍高达18%,且在本研究情况下预防性使用格拉司琼1mg对产后恶心呕吐无效。

(李惟一 陈杰 校)

BACKGROUND: Intraoperative nausea and vomiting (IONV) during cesarean delivery (CD) under regional anesthesia has multiple etiologies, and the role of prophylactic antiemetics for prevention of IONV remains controversial. In this trial we sought to determine the efficacy of granisetron for prevention of IONV during elective CD under spinal anesthesia with strict control of the causative factors.

METHODS: The study was conducted as a randomized, double-blind, placebo-controlled trial in 176 parturients. After administration of 10 mL/kg of lactated Ringer’s solution, spinal anesthesia was administered with 0.75% hyperbaric bupivacaine 15 mg, fentanyl 10 µg, and morphine 100 µg. Systolic blood pressure was maintained at 100% of baseline with aliquots of phenylephrine. Oxytocin 0.5 IU was administered IV upon delivery followed by a maintenance infusion. The patients received either granisetron 1 mg or normal saline IV immediately after cord clamping. In case of persistent IONV, rescue dimenhydrinate 50 mg IV was administered. The primary outcome was the presence of postdelivery IONV. Secondary outcomes included the need for rescue antiemetic, hypotension, pain, and adverse effects.

RESULTS: The incidence of postdelivery IONV was 20.4% in the granisetron group and 17.0% in the control group (P = 0.56, NS). The incidence of intraoperative hypotension, pre- (9.6%) and postdelivery (6.2%), was similar in both groups. The incidence of postdelivery pain (2.2% vs 4.5%, P = 0.68) and the requirement for rescue antiemetic (8% vs 6.8%, P = 0.77) were similar in the granisetron and control groups.

CONCLUSIONS: Despite strict control of the causative factors, IONV still affects 18% of patients undergoing elective CD, and prophylactic granisetron 1 mg is ineffective under the studied circumstances.


10. 慢性疼痛医学中有关健康的生活质量的入门文书

A Primer on Health-Related Quality of Life in Chronic Pain Medicine

Thomas R. Vetter, MD

From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.

Anesth Analg 2007 104: 703-718.

背景:疼痛是一个复杂又独特的经历,病人常常很难用传统的疼痛强度等级来完全描述。健康的生活质量是一种附的尺度,可以用它来评估病人对慢性疼痛经历的主观看法和对生活的不良影响。健康的生活质量包括健康的各个方面和病人认为的幸福的各个方面,特别是他们的身体的,情感的,认知的能,和他们在家庭、工作场所和社区参有意义的活的能。

方法 通过系统研究医学文献形成测量方法形成文书并用于健康生活质量评估中验证。将这些方法用于慢性疼痛医学的临实践和研究中。

结果:这一入门文书提供了全面的健康生活质量观念,可用于各种各样的对成年人健康生活质量的测量,也可用于遭受慢性疼痛的儿童和青少年。

结论:作者使用的方法能够用于常规地评估成年人和小儿的慢性疼痛医学方面的健康生活质量。然而,需进一步研究促进广泛应用并克服障碍。基于有效检测健康生活质量的方法对于有价值的分析和正式的决策分析模型是必须的。

(张美荣 陈杰 校)

BACKGROUND: Pain is a complex and individual experience that is often difficult for patients to fully describe using a conventional pain intensity scale. Health-related quality of life is an additional metric by which to assess patients’ subjective perspective on their chronic pain experience and its adverse effect on their lives. Health-related quality of life encompasses those aspects of health and well-being valued by patients, specifically, their physical, emotional, and cognitive function, and their ability to participate in meaningful activities within their family, workplace, and community.

METHODS: A methodical search of the medical literature was undertaken to identify the most commonly applied health-related quality of life measurement instruments. These measurement instruments were then assessed within the context of chronic pain medicine clinical practice and research.

RESULTS: This primer provides an overview of the concept of health-related quality of life as a clinical measurement and the specific means by which to measure health-related quality of life across various cultures in adults, as well as in children and adolescents, suffering from chronic pain conditions.

CONCLUSIONS: We have the ability and impetus to routinely assess adult and pediatric health-related quality of life in chronic pain medicine. However, further attention needs to be focused on overcoming barriers to the more widespread measurement of health-related quality of life. A valid preference-based, utility measure of health-related quality of life is a requirement for performing a cost-utility (cost-effectiveness) analysis and undertaking formal decision analysis modeling.

 

双侧髂腹股沟神经阻滞可以减少非腹腔镜妇科手术的女性患者的吗啡用量

Bilateral Ilioinguinal Nerve Block Decreases Morphine Consumption in Female Patients Undergoing Nonlaparoscopic Gynecologic Surgery

Fabienne Oriola, MD*, Yannick Toque, MD*, Anne Mary, MD*, Odile Gagneur, MD{dagger}, Sadek Beloucif, MD, PhD*, and Hervé Dupont, MD, PhD*

From the *Department of Anesthesiology B and Medical and Surgical ICU and {dagger}Department of Gynecologic Surgery, Amiens University Hospital, Amiens, France.

Anesth Analg 2007 104: 731-734.

背景:双侧髂腹股沟神经阻滞对妇科手术尤其是子宫切除术患者术后的疼痛控制可能有利。

方法:作者进行了一项前瞻性、随机、双盲研究,将患者分为阻滞组——罗哌卡因+可乐定和对照组——生理盐水。比较其术后两天的吗啡使用量。所有患者都接受预防性给予止吐药物和多模式静脉镇痛。

结果:随机选择70名患者,阻滞组在术后两天的吗啡使用量较对照组低51%(21±9mg41±24mgP<0.0001)。这种差异不仅在于吗啡使用量,而且表现为两天后的差异。两组患者的视觉模拟评分是一致的,吗啡的副作用无差异。

结论:子宫切除术后双侧髂腹股沟神经阻滞减少术后两天一的吗啡用量,而吗啡副作用方面无差异。

(詹琼慧 陈杰 校)

BACKGROUND: Bilateral ilioinguinal nerve block may be useful to control postoperative pain in gynecologic surgery, especially hysterectomy.

METHODS: In a prospective, randomized, double-blind study, we compared the combination of ropivacaine and clonidine (block group) versus saline (control group). The main objective of this study was to compare the total dose of morphine required during the first two postoperative days. All patients received antiemetic prophylaxis and multimodal IV analgesia.

RESULTS: Seventy patients were randomized. The total morphine consumption during the first two postoperative days was decreased by 51% in the block group compared with the control group (21 ± 9 mg vs 41 ± 24 mg, P < 0.0001). This difference was not only due to morphine titration, but remained significant over the following 2 days. The course of the visual analog scale was equivalent between the two groups. No difference was observed in the side effects of morphine.

CONCLUSION: The use of bilateral ilioinguinal nerve block for postoperative analgesia after hysterectomy decreased morphine consumption by one-half during the first two postoperative days without differences in side effects from morphine between groups.


婴儿儿童的麻醉药物使用

Use of Anesthetic Agents in Neonates and Young Children (Special Article)

R. Daniel Mellon, PhD, Arthur F. Simone, MD, PhD, and Bob A. Rappaport, MD From the Division of Anesthesia, Analgesia, and Rheumatology Products, Office of Drug Evaluation II, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Department of Health and Human Services, Silver Spring, Maryland.

Anesth Analg 2007 104: 509-520.

 

背景:一些镇静和麻醉药物的使用在幼小物模型产生了病理性中枢神经系统改变。这些观测结果引起了关于这些药物在儿科患者的使用的关注。我们总结了在发育中的物身的发现,并记录了食品药品管理局(FDA)其他组织对儿科患者潜在风险进行评估的步骤。食品药品管理局认为这是与麻醉协会就关注这一问题展开的一次意见交换。

方法:我们查阅了测试常用的麻醉药物对发育中的大脑的神经毒性作用的物研究文献。调查策略包括在下列常用和特定术语中交叉神经毒性和神经细胞凋亡这两个关键词:麻醉、N-甲基-D-天门冬氨酸(NMDA)、克他命、咪达唑仑、拉西泮、太尼、美沙醇、吗啡、meperidine、异氟醚、笑气、七氟醚、氟烷、恩氟烷、地氟醚、异丙酚、依托醚酯、巴比妥、甲氧氟烷和氯胺酮。我们总结了一些由食品药品管理局发起的老鼠和猴子的研究,最初是测试克他命作为一典型麻醉药诱发发育大脑的神经退行性变化的潜在风险。

结果:众多的啮齿类物研究显示NMDA受体拮剂包括克他命会诱发发育大脑的神经退行性变化。克他命的效应是剂量依赖性的。数据提示限制暴露可以限制神经退变的潜在风险。还有证据显示其他常用麻醉药如异氟醚可以在啮齿类模型诱发神经退变,在同时使用咪达唑仑或笑气时可能剧这一效应。几乎没有关于检测神经退变潜在的能结果的物模型的记录。然而,有人道了啮齿类物的细微但却长期的行为改变的研究。虽然导致神经退变的克他命的用药剂量和时间略大于临实际,但是异氟醚却不是这样。还没有足够的活体试验数据支持或反驳这些发现的临适用性。

结论:物研究显示神经退变伴随可能的认知改变对于婴儿和小儿患者麻醉药物的应用是一项长期的潜在风险。现有的非临数据提示不仅NMDA受体拮剂还有其他强γ-氨基酸信号转换的药物对发育的大脑有潜在的神经毒性。联合用药的潜在风险激活受体系统或强减轻神经毒性还未知。然而现有的非临数据显示一些联合用药的毒性大于任何的单独应用。数据资料的缺乏使我们无法指出哪些麻醉药物更为安全。持续的幼年物的研究将提供关于风险问题的进一步的信息。FDA期望与麻醉协会和药品行业合作发展进一步评估麻醉药物对婴儿和小儿安全性的策略,以提供资料数据指导临为儿科患者作出尽可能可靠的麻醉药物选择。

(王时来译 薛张纲校)

BACKGROUND: Some drugs used for sedation and anesthesia produce histopathologic central nervous system changes in juvenile animal models. These observations have raised concerns regarding the use of these drugs in pediatric patients. We summarized the findings in developing animals and describe the steps that the Food and Drug Administration (FDA) and others are taking to assess potential risks in pediatric patients. The FDA views this communication as opening a dialog with the anesthesia community to address this issue.

METHODS: We reviewed the available animal studies literature examining the potential neurotoxic effects of commonly used anesthetic drugs on the developing brain. The search strategy involved crossing the keywords neurotoxic and neuroapoptosis with the following general and specific terms: anesthetic, N-methyl-d-aspartate (NMDA), ketamine, midazolam, lorazepam, fentanyl, methadone, morphine, meperidine, isoflurane, nitrous oxide, sevoflurane, halothane, enflurane, desflurane, propofol, etomidate, barbiturate, methoxyflurane, and chloral hydrate. We summarized several studies sponsored by the FDA in rats and monkeys, initially examining the potential for ketamine, as a prototypical agent, to induce neurodegeneration in the developing brain.

RESULTS: Numerous animal studies in rodents indicate that NMDA receptor antagonists, including ketamine, induce neurodegeneration in the developing brain. The effects of ketamine are dose dependent. The data suggest that limiting exposure limits the potential for neurodegeneration. There is also evidence that other general anesthetics, such as isoflurane, can induce neurodegeneration in rodent models, which may be exacerbated by concurrent administration of midazolam or nitrous oxide. There are very few studies that have examined the potential functional consequences of the neurodegeneration noted in the animal models. However, the studies that have been reported suggest subtle, but prolonged, behavioral changes in rodents. Although the doses and durations of ketamine exposure that resulted in neurodegeneration were slightly larger than those used in the clinical setting, those associated with isoflurane were not. There are insufficient human data to either support or refute the clinical applicability of these findings.

CONCLUSIONS: Animal studies suggest that neurodegeneration, with possible cognitive sequelae, is a potential long-term risk of anesthetics in neonatal and young pediatric patients. The existing nonclinical data implicate not only NMDA-receptor antagonists, but also drugs that potentiate {gamma}-aminobutyric acid signal transduction, as potentially neurotoxic to the developing brain. The potential for the combination of drugs that have activity at both receptor systems or that can induce more or less neurotoxicity is not clear; however, recent nonclinical data suggest that some combinations may be more neurotoxic than the individual components. The lack of information to date precludes the ability to designate any one anesthetic agent or regimen as safer than any other. Ongoing studies in juvenile animals should provide additional information regarding the risks. The FDA anticipates working with the anesthesia community and pharmaceutical industry to develop strategies for further assessing the safety of anesthetics in neonates and young children, and for providing data to guide clinicians in making the most informed decisions possible when choosing anesthetic regimens for their pediatric patients.

 

 

可乐定对儿童术后外周神经阻滞镇痛的影响

The effects of clonidine on postoperative analgesia after peripheral nerve blockade in children

 

Giovanni Cucchiaro and Arjunan Ganesh

Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

Anesth Analg 2007 104: 532-537

 

背景:可乐定对外周神经阻滞术后感觉神经阻断的持续时间的影响是有争议的。我们评价了可乐定对儿童各类外周神经阻滞术后感觉和运神经阻断的持续时间和疼痛时间的影响。

方法:我们回顾了从200210月至200512月间费城儿童医院的部分记录,其中包含为儿童术后镇痛行锁骨臂丛、腰丛、骨神经、髂腰筋膜或坐骨神经阻滞的记录。这些病人在术后即出院。

结果:215例病人(47%)应用布比卡因或罗哌卡因的区域麻醉(LA)220例病人(53%)应用区域麻醉用可乐定(LAC)。感觉神经阻滞的持续时间在LAC (17.2 +/- 5 h)中明显要比LA (13.2 +/- 5 h) (P = 0.0001)得长.阻滞持续时间的增与外周神经阻滞的方式。运神经阻滞的持续时间在LAC (9.6 +/- 5 vs 4.3 +/- 4 h, P = 0.014)中明显要长.LAC组中两名病人和LA组中一名病人出现长时间的阻滞区域麻木(最长72小时)。未观察到皮肤感觉异常和不悦异常感。

结论:布比卡因和罗哌卡因中用可乐定可以延长感觉神经阻滞的时间,增强运神经阻滞的范围。

陈勇柱译 薛张纲校)

BACKGROUND: The effect of clonidine on the duration of sensory blockade after peripheral nerve blockade is controversial. We evaluated the effects of clonidine on the duration of sensory and motor block and analgesia time in children who underwent a variety of peripheral nerve blocks.

METHODS: We reviewed the regional anesthesia database that contains data on children

who underwent an infraclavicular, lumbar plexus, femoral, fascia iliaca or sciatic nerve block for postoperative analgesia at The Children's Hospital of Philadelphia between October 2002 and December 2005. Patients were prospectively followed after the nerve block.

RESULTS: Two hundred fifteen patients (47%) received either bupivacaine or ropivacaine local anesthetic (LA) and 220 (53%) a combination of local anesthetic and clonidine (LAC). The duration of sensory block was significantly longer in the LAC (17.2 +/- 5 h) compared with that in the LA group (13.2 +/- 5 h) (P = 0.0001). The increase in duration was independent from the type of peripheral nerve block, local anesthetic used and operation performed. The motor block duration was significantly longer in the LAC group (9.6 +/- 5 vs 4.3 +/- 4 h, P = 0.014). Two patients in the LAC and one in the LA group experience prolonged numbness (max 72 h). No paresthesia or dysesthesia was observed.

CONCLUSION: The addition of clonidine to bupivacaine and ropivacaine can extend

sensory block by a few hours, and increase the incidence of motor blocks.

 

接受经尿道操作的老年病人的鞘内麻醉:一项为了寻找合适剂量的研究(简要的)

Intrathecal Anesthesia for Elderly Patients Undergoing Short Transurethral Procedures: A Dose-Finding Study (Brief Report)

Edna Zohar, Yossi Noga, Uri Rislick, Ilan Leibovitch, and Brian Fredman

Department of Anesthesiology, Intensive Care and Pain Management, Meir Medical Center, Kfar Saba, Israel.

Anesth Analg 2007 104: 552-554

 

100个接受经尿道操作(〈45分钟)的老年病人(>或者=65岁)鞘内注射7.5mg布比卡因,或者5mg布比卡因+20mug太尼,或者4mg布比卡因+20mug太尼,或者3mg布比卡因+20mug太尼。3mg布比卡因+太尼这一组中,操作过程中需“补救”的太尼剂量更大(P0.03)。用药后患者能够很好的行走的时间(分钟)是以一种剂量依赖的方式递减的(分别为:157 +/- 50 vs 147 +/- 37 vs 128 +/- 40 vs 116 +/- 29)。根据研究显示,鞘内注射4mg布比卡因和20mug太尼能够提供令人满意的镇痛和维持稳定的血流学,以良好的恢复。

(周时蓓译 薛张纲校)

One hundred elderly men (> or =65 yr) undergoing transurethral procedures (<45 min) received bupivacaine 7.5 mg, or bupivacaine 5 mg + fentanyl 20 mug, or bupivacaine 4 mg + fentanyl 20 mug, or bupivacaine 3 mg + fentanyl 20 mug, intrathecally. Intraoperative "rescue" fentanyl requirements were higher (P < 0.03) in group bupivacaine 3 mg + fentanyl. Times (min) to ambulation eligibility were decreased in a dose-dependant manner (157 +/- 50 vs 147 +/- 37 vs 128 +/- 40 vs 116 +/- 29, respectively). Of the techniques studied, intrathecal bupivacaine 4 mg + fentanyl 20 mug provided adequate analgesia and was associated with hemodynamic stability and a favorable recovery profile.

 

 

Sugammadex逆转罗库溴铵诱导的神经肌肉阻滞,与使用新斯的明-格隆溴铵或腾喜龙-阿托品的比较.

Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.

Sacan O, White PF, Tufanogullari B, Klein K.

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9068, USA.

Anesth Analg. 2007 Mar;104(3):569-74

 

背景:Sugammadex是一种被修饰的γ-环式精复合物,它可快速逆转残余罗库溴铵的神经肌肉阻滞.我们用实验来证明Sugammadex比通常使用的胆碱酯酶药物如腾喜龙和新斯的明对于适度残余的罗库溴铵诱导的阻滞有更迅速的逆转作用.

方法:60个病人进行任意由标准地氟醚-瑞太尼-罗库溴铵诱导的手术,其中20个病人在应用最后一次罗库溴铵剂量15分钟甚至更长时间后接受Sugammadex,4mg/kg静脉推注以逆转神经肌肉阻滞,20个病人用腾喜龙,1mg/kg,联合阿托品,10μg/kg静脉推注,另外20个病人用新斯的明,70μg/kg联合格隆溴铵,14μg/kg静脉推注,利用速肌描记法来记录他们对于四个成串刺激(TOF)的反应.同时迅速记录使用逆转剂前之后30分钟病人的平均脉压和心率,并在苏醒室内观察逆转剂使用后的副作用.

结果:这三组病人有相似的统计学特征,在接受逆转剂前使用的罗库溴铵总量也相同,尽管他们对四个成串刺激中T1的反应相似,但接受Sugammadex组在TOF比率恢复至0.70.9所使用的时间明显短于腾喜龙组和新斯的明组,分别为Sugammadex(71±25秒和107±61),腾喜龙(202±171秒和331±27),新斯的明(625±341秒和1044±590).Sugammadex组中所有病人的TOF比率都在接受逆转剂后5分钟以内恢复至0.70.9,而在腾喜龙组中却没有病人出现恢复,新斯的明组中5%的病人得到恢复.新斯的明和格隆溴铵组的病人在使用逆转剂后2分钟5分钟的心率明显高于Sugammadex.最后,Sugammadex组发生口干的概率明显下降,5%,而新斯的明组和腾喜龙组分别为85%95%.

结论:Sugammadex,4mg/kg静脉推注,比新斯的明(70μg/kg静脉推注)和腾喜龙(1μg/kg静脉推注)更快更有效地逆转残余的神经肌肉阻滞.同时,使用Sugammadex比当前我们使用的复合逆转剂更少发生口干的情况.

( 薛张纲校)

BACKGROUND: Sugammadex is a modified [gamma] cyclodextrin compound, which encapsulates rocuronium to provide for a rapid reversal of residual neuromuscular blockade. We tested the hypothesis that sugammadex would provide for a more rapid reversal of a moderately profound residual rocuronium-induced blockade than the commonly used cholinesterase inhibitors, edrophonium and neostigmine. METHODS: Sixty patients undergoing elective surgery procedures with a standardized desflurane-remifentanil-rocuronium anesthetic technique received either sugammadex, 4 mg/kg IV (n = 20), edrophonium, 1 mg/kg IV and atropine, 10 microg/kg IV (n = 20), or neostigmine, 70 microg/kg IV and glycopyrrolate, 14 microg/kg IV (n = 20) for reversal of neuromuscular blockade at 15 min or longer after the last dose of rocuronium using acceleromyography to record the train-of-four (TOF) responses. Mean arterial blood pressure and heart rate values were recorded immediately before and for 30 min after reversal drug administration. Side effects were noted at discharge from the postanesthesia care unit. RESULTS: The three groups were similar with respect to their demographic characteristics and total dosages of rocuronium prior to administering the study medication. Although the initial twitch heights (T1) at the time of reversal were similar in all three groups, the time to achieve TOF ratios of 0.7 and 0.9 were significantly shorter with sugammadex (71 +/- 25 and 107 +/- 61 s) than edrophonium (202 +/- 171 and 331 +/- 27 s) or neostigmine (625 +/- 341 and 1044 +/- 590 s). All patients in the sugammadex group achieved a TOF ratio of 0.9 < or =5 min after reversal administration compared with none and 5% in the edrophonium and neostigmine groups, respectively. Heart rate values at 2 and 5 min after reversal were significantly higher in the neostigmine-glycopyrrolate group compared with that in sugammadex. Finally, the incidence of dry mouth was significantly reduced in the sugammadex group (5% vs 85% and 95% in the neostigmine and edrophonium groups, respectively). CONCLUSION: Sugammadex, 4 mg/kg IV, more rapidly and effectively reversed residual neuromuscular blockade when compared with neostigmine (70 microg/kg IV) and edrophonium (1 mg/kg IV). Use of sugammadex was associated with less frequent dry mouth than that with the currently used reversal drug combinations.

 

 

电子提示仪能增程序文档记录依从性以专业费用的销

Electronic Reminders Improve Procedure Documentation Compliance and Professional Fee Reimbursement

Sachin Kheterpal, MD, MBA, Ruchika Gupta, MD, James M. Blum, MD, Kevin K. Tremper, PhD, MD, Michael O’Reilly, MD, MS, and Paul E. Kazanjian, MD

From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.

Anesth Analg 2007 104: 592-597.

 

背景:法医学,临医学和销需要完整和精确的文档记录凭证。我们试图确定和改善围手术期脉置管的文档记录的依从率

方法:我们首先查阅了12 个磁光盘的电子麻醉记录以建立脉置管文档记录的基线依从率。住院医生和有执照的理麻醉师被随机分配到控制组和试验组。当手术开始切口到麻醉终止被记录到电子记录仪时,记录仪照例会制作出一张有创脉血压变图表。如果一个病例使用了脉置管,但是没有观察到这个过程的记录,那么被分配到这个病例的住院医生和有执照的理麻醉师会收到数字传呼机和电子邮件的提示。控制组的实验者不会收到数字传呼机或电子邮件讯息。在2个磁光盘之后,所有的人员都会收到提示。

结果:我们观察到基线依从率为80%2459个置管病例中记录了1963个)。在2个磁光盘的试验期内,控制组的实验者在202个脉置管中记录了152个(75%),而试验组在201个脉置管中记录了177个(88%)(p<0.001)。当所有人员都开始收到提示后,在随后的2个磁光盘期间内,314个脉置管中有309个被记录下来(98%)。如果将这样一个依从率推12个磁光盘的预期的脉置管,则每年专业费用的销会增40,500美元。

结论:三级理过程的复杂性使文档记录不完善。不昂贵的自提示仪能够极大地增依从性,且不需要复杂的正负反馈机制。

(陈佳莉译 薛张纲校)

BACKGROUND: Medicolegal, clinical, and reimbursement needs warrant complete and accurate documentation. We sought to identify and improve our compliance rate for the documentation of arterial catheterization in the perioperative setting.

METHODS: We first reviewed 12 mo of electronic anesthesia records to establish a baseline compliance rate for arterial catheter documentation. Residents and Certified Registered Nurse Anesthetists were randomly assigned to a control group and experimental group. When surgical incision and anesthesia end were documented in the electronic record keeper, a reminder routine checked for an invasive arterial blood pressure tracing. If a case used an arterial catheter, but no procedure note was observed, the resident or Certified Registered Nurse Anesthetist assigned to the case was sent an automated alphanumeric pager and e-mail reminder. Providers in the control group received no pager or e-mail message. After 2 mo, all staff received the reminders.

RESULTS: A baseline compliance rate of 80% was observed (1963 of 2459 catheters documented). During the 2-mo study period, providers in the control group documented 152 of 202 (75%) arterial catheters, and the experimental group documented 177 of 201 (88%) arterial lines (P < 0.001). After all staff began receiving reminders, 309 of 314 arterial lines were documented in a subsequent 2 mo period (98%). Extrapolating this compliance rate to 12 mo of expected arterial catheter placement would result in an annual incremental $40,500 of professional fee reimbursement.

CONCLUSIONS: The complexity of the tertiary care process results in documentation deficiencies. Inexpensive automated reminders can drastically improve compliance without the need for complicated negative or positive feedback.

 

 

用超声术评价声门下管径的可行性

The Feasibility of Ultrasound to Assess Subglottic Diameter

Karim Lakhal, MD*, Xavier Delplace, MD*, Jean-Philippe Cottier, MD{dagger}, François Tranquart, MD{ddagger}, Xavier Sauvagnac, MD*, Colette Mercier, MD*, Jacques Fusciardi, MD*, and Marc Laffon, MD*

From the *Groupement d’Anesthésie Réanimation, {dagger}Service de Neuroradiologie, and {ddagger}Groupement d’Imagerie Médicale, CHU Tours, Tours, France.

Anesth Analg 2007 104: 611-614.

 

背景:对于健康的病人,声门下呼吸道的最窄的地方位于环软骨水平。由于导管的管径过大会损伤气管粘膜,并导致插管后喘鸣或声门下狭窄,因此这个狭窄部位决定了气管插管时选择气管导管的尺寸。遗憾的是,依赖于身高、体重或年龄而决定的导管尺寸并不可靠。了解气道管径,特别是可以应用旁无创伤的方法了解在麻醉和重症监中是有帮的。

方法;我们对19个志愿者(27 ± 3岁,其中9个女性)研究,分别比较超声和核磁共振测量环软骨处的管径。

结果:两种方法测量的结果高度相近(r = 0.99, P < 0.05)Bland–Altman分析得偏移是0.14 mm, a precision of 精确度0.33 mm,允许限度是 –0.68 mm/0.96 mm.

结论:对年轻成人来说,超声在评价声门下呼吸道管径方面是可行的。

(陈珺珺译 薛张纲校)

BACKGROUND: In healthy patients, the narrowest diameter of the subglottic upper airway is the width of the air-column at the level of the cricoid cartilage. This diameter governs the selection of the endotracheal tube size, as excessive tube diameter may damage the tracheal mucosa leading to postextubation stridor or subglottic stenosis. Unfortunately, selecting endotracheal tube size based on height, weight, or age does not reliably lead to the proper tube. The knowledge of airway diameter, especially using a bedside noninvasive tool, could therefore be helpful in anesthesia and intensive care

METHODS: We studied 19 healthy volunteers (27 ± 3 yr, nine females) to compare the transverse diameter of the cricoid lumen assessed by ultrasonography and magnetic resonance imaging.

RESULTS: We found a strong correlation between the two techniques (r = 0.99, P < 0.05) confirmed by Bland–Altman analysis with a bias of 0.14 mm, a precision of 0.33 mm, and limits of agreement of –0.68 mm/0.96 mm.

CONCLUSION: In young healthy adults, ultrasonography appeared to be a reliable tool to assess the diameter of the subglottic upper airway.

 

 

D-甲羟基淀粉在大鼠模型中对伴毛细血管渗漏的多菌性脓毒症的炎性作用

Hydroxyethyl Starch, but Not Modified Fluid Gelatin, Affects Inflammatory Response in a Rat Model of Polymicrobial Sepsis with Capillary Leakage

Xiaomei Feng, MD, PhD, Jian Liu, PhD, Min Yu, PhD, Sihai Zhu, MD, and Jianguo Xu, MD, PhD

From the Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, People’s Republic of China.

Anesth Analg 2007 104: 624-630.

 
背景:容量治疗对脓毒症的病人有明显的提高组织灌注和维持血液学稳定的作用。MFGHES是最广泛应用的胶体。在这个研究中,我们通过CLP的感染小鼠,研究HESMFG在肺毛细血管渗透压的作用,并研究是否有炎机制。
方法:将物随机的分为八组:盐类控制组,CLP和盐类,CLPHES (7.5, 15, and 30 
mL/kg); CLP and MFG (7.5, 15, and 30 mL/kg). 
每组20只小鼠,十个被用来测肺毛细血管渗透压,十个被用来测其他因素,。CLP后四小时,注射一定量的HESMFG。外科手术后六小时,测量肺毛细血管渗透压,肿瘤坏死因子,内皮素,炎性巨噬细胞,白介素-1mRNA表达,肺组织学改变,细胞核因子-B也同时被测量。
结果:HESMFG可以剂量依赖性的显著减小肺毛细血管渗透压。另外,HES还能降低肿瘤坏死因子,内皮素,炎性巨噬细胞,白介素-1mRNA表达,肺组织学改变,细胞核因子-B,而MFG没有这样的作用。
结论:HES可以通过调炎性反应来降低毛细血管渗透压,而对MFG并没有这样的炎机制。 

(秦 佳译 薛张纲校)

BACKGROUND: Intravascular volume therapy is crucial in septic patients to improve tissue perfusion and maintain stable hemodynamics. Modified fluid gelatins (MFG) and medium weight hydroxyethyl starches (HES) are the most widely used synthetic colloids. Our aim in this study, performed in septic rats challenged by cecal ligation and puncture (CLP), was to investigate the effects of HES and MFG on pulmonary capillary leakage and to determine whether an antiinflammatory mechanism was involved.

METHODS: Animals were randomly allocated to eight groups: saline control; CLP and saline; CLP and HES (7.5, 15, and 30 mL/kg); CLP and MFG (7.5, 15, and 30 mL/kg). Each group had 20 rats, 10 of which were used for pulmonary capillary leakage and 10 for other measurements. Four hours after CLP, the specified doses of HES or MFG were infused. Six hours after surgery, pulmonary capillary leakage, levels of tumor necrosis factor-{alpha}, interleukin-1ß, and macrophage inflammatory protein-2, intercellular adhesion molecule-1 mRNA expression, myeloperoxidase activity, lung histological changes, and nuclear factor-{kappa}B activation were measured.

RESULTS: HES and MFG significantly attenuated the increase in capillary leakage in a dose-dependent manner. In addition, HES could decrease tumor necrosis factor-{alpha}, interleukin-1ß, and macrophage inflammatory protein-2 expression, intercellular adhesion molecule-1 mRNA expression, myeloperoxidase activity, neutrophil infiltration, and nuclear factor-{kappa}B activation, whereas MFG could not.

CONCLUSIONS: HES may attenuate capillary leakage by modulating an inflammatory response, whereas an antiinflammatory mechanism was not involved in the effects of MFG on capillary leakage.

 

 

针刺足三里(ST36)能减弱脂多糖诱导的大鼠急性肾损伤但不能减弱肝损伤

Acupuncture stimulation of ST36 (Zusanli) attenuates acute renal but not hepatic injury in lipopolysaccharide-stimulated rats.

Huang CL, Tsai PS, Wang TY, Yan LP, Xu HZ, Huang CJ.

Acupuncture and Moxibustion Institute, Nanjing University of Traditional Chinese Medicine, Nanjing, China.

Anesth Analg 2007 104: 646-654.

 

背景:探究针刺足三里对脓毒血症致肝肾损伤的影响。方法:将120只大鼠随机分为10组:1)脂多糖(LPS),2)生理盐水(NS),3)足三里后LPS 4)足三里后NS 5LPS后足三里, 6NS后足三里,7)假手术后LPS8)假手术后NS 9LPS后假手术,10NS后假手术。对足三里后LPS、足三里后NS、假手术后LPS假手术后NS组的大鼠,先针刺足三里或非穴位点30分钟,然后注射LPSNS。对LPS后足三里、NS后足三里、LPS后假手术NS后假手术组,注射LPSNS 3小时后针刺足三里或非穴位点30分钟。注射LPS 6小时后处死大鼠。结果:LPS诱导了明显的肝肾损伤,同时提升了肝肾NO浓度和可诱导NO合酶(iNOS)表达水平。预先针刺足三里能显著减弱LPS导致的肾损伤,肾NO浓度和iNOS表达的升高受到制。然而,针刺足三里不改变LPS导致的肝损伤,肝NO浓度和iNOS表达的升高不受影响。另外,LPS诱导之后针刺足三里对LPS所致器官损伤、NO浓度或iNOS表达变化无作用。结论:预先针刺足三里在大鼠身能显著减弱脓毒血症诱导的肾损伤,但不能减弱肝损伤,脓毒血症诱导后针刺无保作用。

(罗 璇译 薛张纲校)

BACKGROUND: We sought to determine the effects of ST36 acupuncture on sepsis-induced kidney and liver injuries. METHODS: A total of 120 rats were randomized into 10 groups: 1) lipopolysaccharide (LPS), 2) normal saline (N/S), 3) LPS + ST36, 4) ST36, 5) LPS + P-ST36, 6) P-ST36, 7) LPS + Sham, 8) Sham, 9) LPS + P-Sham, and 10) P-Sham groups. Rats in the LPS + ST36, ST36, LPS +Sham, and Sham groups received ST36 (designated as "ST36") or a nonacupoint (designated as "Sham") acupuncture for 30 min followed by LPS or N/S injection. Rats in the LPS + P-ST36, P-ST36, LPS + P-Sham, and P-Sham groups received LPS or N/S injection for 3 h followed by a 30 min of ST36 or a "nonacupoint" acupuncture. Rats were killed at 6 h after LPS injection. RESULTS: LPS caused prominent kidney and liver injuries. The renal and hepatic nitric oxide (NO) concentrations and inducible NO synthase (iNOS) expression were also increased by LPS. ST36 acupuncture pretreatment significantly attenuated the LPS-induced kidney injury and the increases in renal NO concentration and iNOS expression. However, ST36 acupuncture pretreatment did not affect the LPS-induced liver injury and increases in hepatic NO concentration or iNOS expression. Furthermore, ST36 acupuncture performed after LPS did not affect the LPS-induced organ injuries or increases in NO concentration and iNOS expression. CONCLUSIONS: ST36 acupuncture pretreatment significantly attenuated sepsis-induced kidney, but not liver, injury in rats, whereas ST36 acupuncture performed after sepsis induction had no protective effects against sepsis-induced organ injuries.

 

 

使用背景剂量输注机控指令单次给药孕妇自控硬膜外镇痛的对照试验

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

Alex T. Sia, MMED, Yvonne Lim, MMED, and Cecilia Ocampo, MD

From the Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.

Anesth Analg 2007;104:673-678

 

背景:目前,连续背景剂量输注式给药的产妇自控硬膜外镇痛(PCEA)术已经在产妇分娩时广泛使用。我们比较了新的硬膜外背景剂量输注同时间断单次给药的方法:PCEA机控自单次给药(PCEA+AMB),和PCEA背景剂量持续输注(PCEA+BCI)。我们猜测使用背景剂量间断单次给药硬的膜外阻滞麻醉的费会比背景持续输注法少。

方法:我们将42名处于早期产程的健康娠妇女在成接受腰硬联合镇痛后,随机分为两组,一组接受PCEA+BCI (n = 21,单次给药5ml,锁定时间 10分钟, 背景剂量 5 mL/h) ,另一组接受PCEA+AMB (n = 21, 患者自控单次给药 5 mL, 锁定时间 10 分钟,背景剂量自单次给药5ml/h[ 略去自控单次给药在最后一小时内顺利给入]),两组均给予0.1%的罗哌卡因+太尼2 µg/mL

结果:我们发现使用PECA+AMB方法会减少平均每小时罗哌卡因的费,亦即,基本计算结果(PCEA+AMB组:均值=6.5ml,方差=3.4PCEA+BCI:均值=7.5ml,方差2.0, P=0.011.PCEA+AMB组患者没有使用自控单次给药的比例更高一些(PCEA+BCI6/21 PCEA+AMB1/21p=0.03)。第一次使用自控单次给药距离腰影联合镇痛后的时间,在PCEA+AMB组明显延长(PCEA+AMB组平均时间:15分钟;PCEA+IMB组平均时间:315分钟,p=0.04 log检验)。在疼痛评分以副作用方面没有差异。

结论:我们的研究显示,PCEA+ABM减少了镇痛费用,以可以作为硬膜外镇痛维持的有用的模式。

(王光妍译 薛张纲校)

BACKGROUND: The use of parturient-controlled epidural analgesia (PCEA) with a basal infusion is commonly used in laboring women. We compared a novel approach of providing basal intermittent boluses concurrently with PCEA: PCEA plus automated mandatory boluses (PCEA+AMB) versus PCEA plus basal continuous infusion (PCEA+BCI). We hypothesized that epidural local anesthetic consumption would be lower if basal intermittent boluses were used instead of a basal infusion.

METHODS: We randomized 42 healthy parturients in early labor to receive 0.1% ropivacaine + fentanyl 2 µg/mL either via PCEA+BCI (n = 21,bolus 5 mL, lockout 10 min, basal infusion 5 mL/h) or via PCEA+AMB (n = 21, patient-activated bolus of 5 mL, lockout 10 min, basal automated boluses of 5 mL/h [omitted if a patient-activated bolus was successfully administered in the last 1 h]) after successful induction of combined spinal epidural analgesia.

RESULTS: We found a reduction in the hourly consumption of ropivacaine with PCEA+AMB, i.e., the primary outcome measure (mean = 6.5 mL, sd = 3.4 in the PCEA+AMB group vs 7.5 mL, sd = 2.0 PCEA+BCI group, P = 0.011). A larger proportion of parturients in the PCEA+AMB group did not self-bolus (6/21 vs 1/21 in PCEA+BCI, P = 0.03). The time to the first self-bolus after combined spinal epidural was longer in the PCEA+AMB group (mean survival time 315 min vs 190 min in PCEA+BCI group, P = 0.04 by log rank test). There was no difference in pain scores or side effects.

CONCLUSION: Our study showed that PCEA+AMB reduced analgesic consumption and could be useful as the mode of maintenance for epidural analgesia.

 

 

术后镇痛对手术后主要并发症的影响:一项系统的最新的证据

Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence.

Spencer S. Liu and Christopher L. Wu

Department of Anesthesiology, Hospital for Special Surgery and the Weill College of Medicine of Cornell University, New York, New York 10021, USA. liusp@hss.edu

Anesth Analg 2007 104: 689-702.

 

背景:很少有独立的临试验有足够的课题数目能确定术后镇痛的效果。

方法:我们有系统地在Medline医学文献检索系统以Cochrane数据库中搜索过去十年中的文献,并且注意集中到meta分析和大型的随机对照临试验。

结果:18meta分析,10篇系统回顾,8篇随机对照试验,以2篇观察文章被作为回顾或评论。用局麻药的硬膜外镇痛具有最大的理论潜,同时也是一项被研究的非常透彻的术。大多数证据证明硬膜外镇痛只有对行大血管手术或有高危因素的病人具有减少心血管以肺部的并发症的效果。这项发现可能在大型手术向微创介入术的快速发展中显的不太相关,(比如:腔内腹主脉修复)那就会只有很小的并发症的危险。还有一致的证据表明局麻药的硬膜外镇痛与大型腹部手术后发生肠梗阻有关。没有最新的证据证明神经阻滞,伤口引流管周围的局部麻醉,IV级病人用阿片类药物控制性镇痛或者是其他全身性多样的止痛药对手术后并发症有任何临意义的处。

结论:总的来说,没有足够的证据确定或否认术后镇痛术对手术后的死亡率或发病率有什么影响。这主要是因为没有足够的课题数量能够发现当前低发生率的术后并发症之间的差异。

(张 俪译 薛张钢校)

BACKGROUND: Few individual clinical trials have had sufficient subject numbers to definitively determine the effects of postoperative analgesia on major outcomes. METHODS: We systematically searched the Medline and the Cochrane Library databases for the past decade and focused on meta-analyses and large, randomized, controlled trials. RESULTS: Eighteen meta-analyses, 10 systematic reviews, 8 additional randomized, controlled trials, and 2 observational database articles were identified for review or comment. Epidural analgesia with local anesthetics has the greatest theoretical potential to affect major outcomes and has been the most thoroughly investigated technique. The majority of evidence favors an ability of epidural analgesia to reduce postoperative cardiovascular and pulmonary complications only after major vascular surgery or in high-risk patients. This finding may become irrelevant because of rapid conversion of major surgery to minimally invasive techniques (e.g., endoluminal abdominal aortic repair) that carry less risk of complications. There is also consistent evidence that epidural analgesia with local anesthetics is associated with faster resolution of postoperative ileus after major abdominal surgery. Again, this finding may also become irrelevant with the adoption of laparoscopic techniques and multimodal fast-track programs for abdominal surgery. There is no current evidence that perineural analgesia, continuous wound catheters using local anesthetics, IV patient-controlled analgesia with opioids, or addition of multimodal systemic analgesics have any clinically significant beneficial effect on postoperative complications. CONCLUSIONS: Overall, there is insufficient evidence to confirm or deny the ability of postoperative analgesic techniques to affect major postoperative mortality or morbidity. This is primarily due to typically insufficient subject numbers to detect differences in currently low incidences of postoperative complications.

 

 

地塞米松对吗啡耐受大鼠髓谷氨酰胺合成酶谷氨酸脱氢酶表达的影响

The effect of dexamethasone on spinal glutamine synthetase and glutamate dehydrogenase expression in morphine-tolerant rats

Wu GJ, Wen ZH, Chen WF, Chang YC, Cherng CH, Wong CS

Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Anesth Analg 2007 104:726-730

 

背景:兴奋性氨基酸在吗啡耐受产生过程中起着重要的作用。最近我们证明单次剂量的吗啡导致吗啡耐受大鼠脑液中兴奋性氨基酸浓度升高,而地塞米松制吗啡耐受性的进展。我们进一步检验了鞘内注射地塞米松对吗啡耐受性进展髓细胞内谷氨酸代谢酶(谷氨酸脱氢酶、谷氨酰胺合成酶)表达的影响。方法:将雄性Wistar大鼠植入鞘内导管后分为四组,分别输注吗啡(15mg/h)、生理盐水(1mg/h)、地塞米松(2mg/h)地塞米松(2mg/h)+吗啡(15mg/h),持续五天。第五天,取髓作谷氨酸脱氢酶和合成酶的Western印记分析。结果:谷氨酸脱氢酶和合成酶浓度在吗啡耐受大鼠髓中下调。同期输注地塞米松减弱吗啡耐受性和相关的谷氨酸脱氢酶和合成酶下调。结论:鞘注地塞米松减弱长期应用吗啡导致的谷氨酸脱氢酶和合成酶的下调伤害感受性耐受。

(孙 霞译 薛张纲校)

BACKGROUND: Excitatory amino acids play an important role in morphine tolerance. Recently, we demonstrated that a single morphine challenge induces an increase in spinal cerebrospinal fluid excitatory amino acid concentrations in morphine-tolerant rats, and that dexamethasone inhibits the development of morphine tolerance. We further examined the effect of intrathecal dexamethasone infusion on the development of morphine tolerance and on expression of the intracellular glutamate metabolizing enzymes, glutamate dehydrogenase and glutamine synthetase, in the spinal cord. METHODS: Male Wistar rats, implanted with an intrathecal catheter, were divided into four groups that were infused for 5 days with intrathecal morphine (15 microg/h), saline (1 microL/h), dexamethasone (2 microg/h), or dexamethasone (2 microg/h) plus morphine (15 microg/h). On Day 5, the spinal cords were removed and prepared for Western blot analysis of glutamate dehydrogenase and glutamate synthetase. RESULTS: Glutamate dehydrogenase and glutamate synthetase concentrations were downregulated in the morphine-tolerant rat spinal cords. Concurrent infusion of dexamethasone attenuated morphine tolerance and the associated glutamate dehydrogenase and glutamate synthetase downregulation. CONCLUSION: Intrathecal dexamethasone attenuates long-term morphine infusion-induced glutamate dehydrogenase and glutamate synthetase downregulation and antinociceptive tolerance.