Anesthesia & Analgesia

April 2007

 

PEDIATRIC ANESTHESIA:

婴儿异丙酚-瑞太尼与七氟醚麻醉术后睡眠质量的差异

宋翠侠 陈杰

Quality Differences in Postoperative Sleep Between Propofol-Remifentanil and Sevoflurane Anesthesia in Infants

Jacob Steinmetz, Rolf Holm-Knudsen, Kirsten Eriksen, Dorte Marxen, and Lars S. Rasmussen

Anesth Analg 2007 104: 779-783.

>影响小儿门行扁桃腺切除术和增殖腺切除术后恢复的因素的分析

彭中美 马皓琳 李士通校

An Analysis of Factors Influencing Postanesthesia Recovery After Pediatric Ambulatory Tonsillectomy and Adenoidectomy

Alice A. Edler, Edward R. Mariano, Brenda Golianu, Calvin Kuan, and Krassimira Pentcheva

Anesth Analg 2007 104: 784-789.

双亲>疼痛感知的社会人口统计学个性>征的预测探究

王时来译 薛张纲校

Exploring Sociodemographic and Personality Characteristic Predictors of Parental Pain Perceptions

Rachel Yaffa Zisk, Margaret Grey, Jill E. MacLaren, and Zeev N. Kain

Anesth Analg 2007 104: 790-798.

AMBULATORY ANESTHESIA:

奥坦西隆和地塞米松的不同剂量组合用以预防术后恶心呕吐

唐李隽 马皓琳 李士通

Ondansetron and Dexamethasone Dose Combinations for Prophylaxis Against Postoperative Nausea and Vomiting

Michael J. Paech, Matthew W.M. Rucklidge, Jennifer Lain, Philip H. Dodd, Emma-Jane Bennett, and Dorota A. Doherty

Anesth Analg 2007 104: 808-814.

ANESTHETIC PHARMACOLOGY:

高碳酸血症可缩短猪吸入麻醉的苏醒时间

琳译 薛张纲校

Hypercapnia Shortens Emergence Time from Inhaled Anesthesia in Pigs

Nishant A. Gopalakrishnan, Derek J. Sakata, Joseph A. Orr, Scott McJames, and Dwayne R. Westenskow

Anesth Analg 2007 104: 815-821.

六氟苯(HFB)作用在髓,而O -二氟苯(ODFB)作用在大脑和髓产生制作用

杨卫红 陈杰

Hexafluorobenzene Acts in the Spinal Cord, Whereas O-Difluorobenzene Acts in Both Brain and Spinal Cord, to Produce Immobility

Joseph F. Antognini, Douglas E. Raines, Ken Solt, Linda S. Barter, Richard J. Atherley, Emigdio Bravo, Michael J. Laster, Katarzyna Jankowska, and Edmond I. Eger, II

Anesth Analg 2007 104: 822-828.

笑气>髓神经元伤害性刺激反应的兴奋和制作用

张> 马皓琳 李士通校

The Excitatory and Inhibitory Effects of Nitrous Oxide on Spinal Neuronal Responses to Noxious Stimulation

Joseph F. Antognini, Richard J. Atherley, Robert C. Dutton, Michael J. Laster, Edmond I. Eger, II, and Earl Carstens

Anesth Analg 2007 104: 829-835.

异氟醚麻醉中血清素系统的活性

周时蓓译 薛张纲校

Activity of the Serotonergic System During Isoflurane Anesthesia

Kumiko Mukaida, Tsutomu Shichino, Sahoko Koyanagi, Shugaku Himukashi, and Kazuhiko Fukuda

Anesth Analg 2007 104: 836-839.

巴比妥增强大鼠海马区氨基丁酸介导的神经兴奋而不影响其突触可塑性

周懿> 陈杰

Pentobarbital Enhances {gamma}-Aminobutyric Acid-Mediated Excitation Without Altering Synaptic Plasticity in Rat Hippocampus

David P. Archer, Khanh Q. Nguyen, Naaznin Samanani, and Sheldon H. Roth

Anesth Analg 2007 104: 840-846.

比较两种输出能量>激光辅给予表面麻醉剂LMX-4®>剂在静脉穿刺前使用的增强效果

颜涛 译,马皓琳 李士通

A Comparison of Laser-Assisted Drug Delivery at Two Output Energies for Enhancing the Delivery of Topically Applied LMX-4® Cream Prior to Venipuncture (Brief Report)

Jeffrey L. Koh, Dale Harrison, Veronica Swanson, Daniel C. Norvell, and Darren C. Coomber

Anesth Analg 2007 104: 847-849.

应用>酰胆碱受体阻滞剂不会>变依托咪酯致小鼠体消失的用药量

施译 薛张纲校

Blockade of Acetylcholine Receptors Does Not Change the Dose of Etomidate Required to Produce Immobility in Rats (Brief Report)

Yi Zhang, Michael J. Laster, Edmond I. Eger, II, Manohar Sharma, and James M. Sonner

Anesth Analg 2007 104: 850-852.

TECHNOLOGY, COMPUTING, AND SIMULATION:

术前超短期熵值可预测麻醉诱导期间的脉血压波

丁震敏 陈杰

Preoperative Ultra Short-Term Entropy Predicts Arterial Blood Pressure Fluctuation During the Induction of Anesthesia

Yoshihiro Fujiwara, Hiroshi Ito, Yusuke Asakura, Yuko Sato, Kimitoshi Nishiwaki, and Toru Komatsu

Anesth Analg 2007 104: 853-856.

传感器错位所得双频指数值的可靠性:与传感器位于厂商推荐部位所得值的比较

黄施伟 译,马皓琳 李士通

The Validity of Bispectral Index Values from a Dislocated Sensor: A Comparison with Values from a Sensor Located in the Commercially Recommended Position (Brief Report)

Toshinori Horiuchi, Masahiko Kawaguchi, Naoko Kurita, Satoki Inoue, and Hitoshi Furuya

Anesth Analg 2007 104: 857-859

ECONOMICS, EDUCATION, AND POLICY:

美国麻醉>训>目的工作人员以财政况的五>期追踪调查:20002005

陈佳莉译 薛张纲校

Five-Year Follow-Up on the Work Force and Finances of United States Anesthesiology Training Programs: 2000 to 2005

Kevin K. Tremper, Amy Shanks, and Michelle Morris

Anesth Analg 2007 104: 863-868.

细胞再利用术的成本分析

>琼慧 陈杰

An Economic Analysis of Costs Associated with Development of a Cell Salvage Program

Janet Robinson Waters, Heidi Hylton Meier, and Jonathan H. Waters

Anesth Analg 2007 104: 869-875

CRITICAL CARE AND TRAUMA:

重症监病房患者中的室性心律失常:短期和长期后果

邱郁薇 马皓琳 李士通

Supraventricular Arrhythmias in Intensive Care Unit Patients: Short and Long-Term Consequences

Sergei Goodman, Taras Shirov, and Charles Weissman

Anesth Analg 2007 104: 880-886.

患有严重肺气肿病人的左心室效能和内径

陈珺珺译 薛张纲校

Left Ventricular Performance and Dimensions in Patients with Severe Emphysema

Kirsten Jörgensen, Erik Houltz, Ulla Westfelt, and Sven-Erik Ricksten

Anesth Analg 2007 104: 887-892.

血浆白蛋白浓度>于危重病人血清钠离子氯离子测定值的影响

印洁敏 陈杰

The Effect of Albumin Concentration on Plasma Sodium and Chloride Measurements in Critically Ill Patients (Technical Communication)

David A. Story, Hiroshi Morimatsu, Moritoki Egi, and Rinaldo Bellomo

Anesth Analg 2007 104: 893-897.

NEUROSURGICAL ANESTHESIA:

七氟醚影响大鼠前脑缺血后神经发生

周雅春 马皓琳 李士通

Sevoflurane Affects Neurogenesis After Forebrain Ischemia in Rats

Kristin Engelhard, Uta Winkelheide, Christian Werner, Julia Kluge, Eva Eberspächer, Regina Hollweck, Peter Hutzler, Jürgen Winkler, and Eberhard Kochs

Anesth Analg 2007 104: 898-903.

OBSTETRIC ANESTHESIA:

罗哌卡因,左旋布比卡因布比卡因在椎管内的神经阻滞的相>效能

秦佳译 薛张纲校

The Relative Potencies for Motor Block After Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine

Michela Camorcia, Giorgio Capogna, Cristiana Berritta, and Malachy O. Columb

Anesth Analg 2007 104: 904-907.

GENERAL ARTICLE:

蒸汽消毒>纤维喉镜片光强度的影响

郑丽 陈杰

Changes in the Light Intensity of the Fiberoptic Laryngoscope Blade by Steam Sterilization (Brief Report)

Tomoki Nishiyama

Anesth Analg 2007 104: 908-910.

ANALGESIA:

曲马多中入小剂量氯胺酮用于术后镇痛:>部手术后的一个双盲,随机,安慰剂>照试验

姜旭晖译,马皓琳 李士通校

The Addition of a Small-Dose Ketamine Infusion to Tramadol for Postoperative Analgesia: A Double-Blinded, Placebo-Controlled, Randomized Trial After Abdominal Surgery

Ashley R. Webb, Bradley S. Skinner, Samuel Leong, Helen Kolawole, Tyron Crofts, Murray Taverner, and Sara J. Burn

Anesth Analg 2007 104: 912-917.

疼痛自我效能问卷中文版测试

璇译 薛张纲校

Validation of the Chinese Version of Pain Self-Efficacy Questionnaire

Huey S. Lim, Phoon P. Chen, Tony C. M. Wong, Tony Gin, Emma Wong, Ide S. F. Chan, and Josephine Chu

Anesth Analg 2007 104: 918-923.

非甾体类炎药物(NSAID)在小鼠热辐射甩尾试验中的局部保作用

王光妍译 薛张纲校

The Local Antinociceptive Actions of Nonsteroidal Antiinflammatory Drugs in the Mouse Radiant Heat Tail-Flick Test

Ahmet Dogrul, S. Ezgi Gülmez, M. Salih Deveci, Husamettin Gul, Michael H. Ossipov, Frank Porreca, and F. Cankat Tulunay

Anesth Analg 2007 104: 927-935.

大鼠L5神经结扎>福尔马林反应的>变——一>行为学和分子学研究

顾新宇 陈杰

Altered Response to Formalin by L5 Spinal Nerve Ligation in Rats: A Behavioral and Molecular Study

Ryuji Kaku, Masataka Yokoyama, Hiroyuki Kobayashi, Yoshikazu Matsuoka, Tetsufumi Sato, Satoshi Mizobuchi, Yoshitaro Itano, and Kiyoshi Morita

Anesth Analg 2007 104: 936-943.

静脉内使用单核髓细胞逆转实验性单一神经病变产生的神经性疼痛

裘毅敏译,马皓琳 李士通校

Intravenous Mononuclear Marrow Cells Reverse Neuropathic Pain from Experimental Mononeuropathy

Markus Klass, Vitaliy Gavrikov, Danielle Drury, Bethany Stewart, Stephen Hunter, Donald D. Denson, Allen Hord, and Marie Csete

Anesth Analg 2007 104: 944-948.

炎症性疼痛增小鼠脑液中的α肿瘤坏死因子以前列腺素E2的浓度:止痛药物的效果

张俪译 薛张钢校

Increased Tumor Necrosis Factor-{alpha} and Prostaglandin E2 Concentrations in the Cerebrospinal Fluid of Rats with Inflammatory Hyperalgesia: The Effects of Analgesic Drugs

Mauro Bianchi, Cataldo Martucci, Paolo Ferrario, Silvia Franchi, and Paola Sacerdote

Anesth Analg 2007 104: 949-954.

I类心律失常药物的皮肤镇痛作用

张美荣 陈杰

The Cutaneous Analgesic Effect of Class I Antiarrhythmic Drugs

Jann-Inn Tzeng, Kuang-I Cheng, Kuo-Lun Huang, Yu-Wen Chen, Koung-Shing Chu, Chin-Chen Chu, and Jhi-Joung Wang

Anesth Analg 2007 104: 955-958.

比较利多卡因和无防腐剂的2-氯普鲁卡因麻用于门膝关镜手术:一>前瞻性随机双盲研究

黄佳佳译 马皓琳,李士通校

Spinal Anesthesia with Lidocaine or Preservative-Free 2-Chlorprocaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Comparison

Andrea Casati, Guido Fanelli, Giorgio Danelli, Marco Berti, Daniela Ghisi, Matteo Brivio, Marta Putzu, and Alessia Barbagallo

Anesth Analg 2007 104: 959-964.

区域阻滞神经系统>发症:危险性的同期评估

霞译 薛张纲校

Neurological Complications After Regional Anesthesia: Contemporary Estimates of Risk

Richard Brull, Colin J. L. McCartney, Vincent W. S. Chan, and Hossam El-Beheiry

Anesth Analg 2007 104: 965-974.

中央轴索阻滞后严重和长时神经>和髓>发症

李惟一 陈杰

Severe and Long-Lasting Complications of the Nerve Root and Spinal Cord After Central Neuraxial Blockade (Brief Report)

Mathieu-Panchoa de Sèze, François Sztark, Gérard Janvier, and Pierre-Alain Joseph

Anesth Analg 2007 104: 975-979.

手臂的位置>腋路法臂丛神经阻滞的起效和作用持续时间的影响

黄丽娜 马皓琳 李士通

The Effects of Arm Position on Onset and Duration of Axillary Brachial Plexus Block (Brief Report)

Adil Ababou, Nizar Marzouk, Ahlam Mosadiq, and Ahmed Sbihi

Anesth Analg 2007 104: 980-981.

联合注射可>定通过外周作用延长利多卡因皮下注射的麻醉效果

吴德华译 薛张纲校)

Co-injection of Clonidine Prolongs the Anesthetic Effect of Lidocaine Skin Infiltration by a Peripheral Action (Brief Report)

Jayant Nick Pratap, Rajesh K. Shankar, and Teodor Goroszeniuk

Anesth Analg 2007 104: 982-983.

不同浓度的罗哌卡因硬膜外麻醉>七氟醚需求的影响

李惟一 陈杰

The Effect of Epidural Anesthesia with Different Concentrations of Ropivacaine on Sevoflurane Requirements (Brief Report)

Jie Zhang, Wei Zhang, and Bin Li

Anesth Analg 2007 104: 984-986

静脉给予地塞米松>于鞘内注射哌替啶后的术后疼痛、恶心和呕吐的影响

沈浩 马皓琳 李士通

The Effect of Intravenous Administration of Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Intrathecal Injection of Meperidine (Brief Report)

Ali Movafegh, Ahmad Reza Soroush, Ali Navi, Mustafa Sadeghi, Fatimah Esfehani, and Niloufar Akbarian-Tefaghi

Anesth Analg 2007 104: 987-989.

 

双亲>疼痛感知的社会人口统计学个性>征的预测探究

Exploring Sociodemographic and Personality Characteristic Predictors of Parental Pain Perceptions

Rachel Yaffa Zisk, PhD, RN, MPH*{dagger}{ddagger}, Margaret Grey, DrPH, RN, FAAN*, Jill E. MacLaren, PhD{dagger}, and Zeev N. Kain, MD, MBA{dagger}

From the *Department of Anesthesiology, Yale University School of Nursing, New Haven, Connecticut; {dagger}the Departments of Anesthesiology, Pediatrics, and Child Psychiatry, Center for the Advancement of Perioperative Health®, Yale University School of Medicine, New Haven, Connecticut; and {ddagger}Henrietta Szold School of Nursing, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel.

Anesth Analg 2007 104: 790-798

 

背景:我们研究了双亲和子女间的社会人口统计学个性>征与父母>子女疼痛感知的关系。

>法:110>经历手术的儿童的父母完成了疼痛感知的测量(例如,药物治疗观>调查表;MAQ)和父母子女个性>征的调查(例如,神经质、外向性、开放性等“大五”人格模型;NEO-FFI)。采用要素分析和逻辑回归模型。结果:>据药物治疗观>调查表(MAQ),描述性分析显示超过70%的父母担心镇痛治疗的副作用,43%的父母认为镇痛药物会成瘾,37%的父母则认为孩子接受的镇痛治疗频率低效果好。MAQ的要素分析法揭示了一个由三个因素组成的>法,解了父母>镇痛治疗理解的52%的差异的原因。概括的说,这些要素包括适当使用镇痛药物看法、>副作用的担心和避免进行镇痛。应用逐步回归模型确定父母每个因素得分的预测值。结果显示学历较低的父母和较为活泼好的孩子的父母更有可能避免使用镇痛治疗(避免要素;P<0.001)。责任感得分较高的父母和孩子较冲的父母更愿意接受给孩子进行镇痛治疗。(适当使用要素;P<0.001)。讨论:我们推断许多父母>疼痛和镇痛治疗存在误解,>且可以利用父母和孩子的个性>征确定父母存在这种误解的风险。

(王时来译 薛张纲校)

BACKGROUND: We studied the relationship between children's and parents' sociodemographic and personality characteristics and parents' perceptions of their children's pain. METHODS: One-hundred-ten parents of children undergoing surgery completed measures of pain perception (e.g., Medication Attitude Questionnaire; MAQ) and parent and child personality characteristics (e.g., Neuroticism, Extraversion and Openness to experience Five-Factor Inventory; NEO-FFI). Factor analysis and logistic regression models were developed. RESULTS: In terms of pain medication perceptions (MAQ), descriptive analysis showed that more than 70% of parents feared side effects of analgesia, 43% thought analgesics were addictive, and 37% thought that the less often children receive analgesia, the better it worked. Factor analyses of the MAQ revealed a three factor solution explaining 52% of the variance in parental pain medication perceptions. Conceptually, these factors represented Appropriate Use Attitude of Analgesics, Concerns about Side Effects, and Avoidance of Analgesia. Stepwise regression models were used to identify predictors of parents' scores on each of the three factors. Results indicated that less educated parents and parents of more sociable and more reactive children were more likely to indicate that they would avoid giving analgesia (Avoidance factor; P < 0.001). Parents with higher conscientiousness scores (NEO-FFI) and those with more impulsive children were more likely to perceive that analgesia was appropriate to use for child pain (Appropriate Use Attitude factor; P < 0.001). DISCUSSION: We conclude that many parents have misconceptions of pain and analgesics, and that child and parent personality characteristics can be used to identify parents at risk of these misconceptions.

 

 

高碳酸血症可缩短猪吸入麻醉的苏醒时间

Hypercapnia shortens emergence time from inhaled anesthesia in pigs

Gopalakrishnan NA, Sakata DJ, Orr JA, McJames S, Westenskow DR

Department of Anesthesiology, University of Utah, Salt Lake City, Utah 84132, USA.

Anesth Analg 2007 104: 815-821

 

背景:快肺和紧闭环路中的麻醉气体的清除可以通过过度通气和高新鲜气流量。但伴随着CO2的清除使得PAco2降低,进而导致脑血流量的降低而减慢了麻醉气体从脑部的清除。研究表明:除过度通气>外,高碳酸血症(CO2灌注或紧闭环路)在缩短吸入麻醉苏醒时间是一个重要的因素。>法:我们给7头猪以2 MACPIG的异氟烷吸入和4头猪以2 MACPIG的七氟烷吸入。吸入麻醉持续2小时,>保持过度通气。分别观察低碳酸血症(Et CO2=22 mmHg )和高碳酸血症(Et CO2=55 mmHg)下猪发生多肢体运的时间。结果:在过度通气期间高碳酸血症下从关闭挥发罐到猪发生多肢体运的时间较快。在紧闭环路或CO2 控制下予以异氟烷和七氟烷吸入的麻醉的苏醒时间>均缩短65% (P < 0.05)。结论:在临高碳酸血症与过度通气一起可以被用于缩短吸入麻醉的苏醒时间。这些缩短的时间可减少药物成本。此外,在苏醒期间高PAco2 还可以增强拔管后的呼吸刺激和气道保。

(金 琳译 薛张纲校)

BACKGROUND: Anesthetic clearance from the lungs and the circle rebreathing system can be maximized using hyperventilation and high fresh gas flows. However, the concomitant clearance of CO2 decreases PAco2, thereby decreasing cerebral blood flow and slowing the clearance of anesthetic from the brain. This study shows that in addition to hyperventilation, hypercapnia (CO2 infusion or rebreathing) is a significant factor in decreasing emergence time from inhaled anesthesia. METHODS: We anesthetized seven pigs with 2 MACPIG of isoflurane and four with 2 MACPIG of sevoflurane. After 2 h, anesthesia was discontinued, and the animals were hyperventilated. The time to movement of multiple limbs was measured under hypocapnic (end-tidal CO2 = 22 mm Hg) and hypercapnic (end-tidal CO2 = 55 mm Hg) conditions. RESULTS: The time between turning off the vaporizer and to movement of multiple limbs was faster with hypercapnia during hyperventilation. Emergence time from isoflurane and sevoflurane anesthesia was shortened by an average of 65% with rebreathing or with the use of a CO2 controller (P < 0.05). CONCLUSIONS: Hypercapnia, along with hyperventilation, may be used clinically to decrease emergence time from inhaled anesthesia. These time savings might reduce drug costs. In addition, higher PAco2 during emergence may enhance respiratory drive and airway protection after tracheal extubation.

 

 

异氟醚麻醉中血清素系统的活性

Activity of the Serotonergic System During Isoflurane Anesthesia

Kumiko Mukaida, Tsutomu Shichino, Sahoko Koyanagi, Shugaku Himukashi, and Kazuhiko Fukuda

Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan. kumicom@kuhp.kyoto-u.ac.jp

Anesth Analg 2007 104: 836-839.

 

背景:显微透析研究已经证明在大鼠和猫,血清素激活射区域的血清素(5-羟色胺)的放在觉醒时增,睡眠时减少,这一发现提示5-羟色胺>于睡眠的调起着重要作用。虽然我们可以预料在全身麻醉中5-羟色胺的放>是减少的,然而挥发性麻醉药在药理学>于含血清素神经元的能的作用还未被完全调查研究过。>法:利用一种活体显微透析法,我们分别测量了大鼠在活,慢波睡眠和异氟醚麻醉中额叶皮质细胞外的5羟色胺含量。为了评估血清素系统在异氟醚的催眠效果中所起的作用,测算了使受过未受过盐酸氟苯氧丙胺(一种选择性5-羟色胺重摄取制剂)的预先处理的大鼠失去翻正反射所需要的异氟醚的浓度。结果:在慢波睡眠和异氟醚麻醉(0.1-1.5MAC)时,5-羟色胺的放减少到活态时的21%44%。失去翻正反射时异氟醚的浓度在经过氟苯氧丙胺预先处理的大鼠中(0.76% +/- 0.03% [n = 8])明显高于>照组(0.60% +/- 0.01% [n = 8])。结论:该结果提示脑中血清素系统活性的>变参与了异氟醚的催眠作用。

(周时蓓译 薛张纲校)

BACKGROUND: Microdialysis studies have demonstrated that the release of serotonin (5-hydroxytryptamine, 5-HT) in the serotonergic projection areas increases during waking and decreases during sleep in rat and cat, suggesting that 5-HT plays an important role in modulation of sleep. Although it might be expected that 5-HT release is also decreased during general anesthesia, the functional contribution of serotonergic neurons in pharmacological effects of volatile anesthetics has not been fully investigated. METHODS: Using an in vivo microdialysis technique, we measured extracellular 5-HT in rat frontal cortex during waking, slow-wave sleep, and isoflurane anesthesia. To assess the involvement of the serotonergic system in the hypnotic action of isoflurane, the concentration of isoflurane required for loss of righting reflex was determined with or without pretreatment of fluoxetine hydrochloride, a selective 5-HT reuptake inhibitor. RESULTS: During slow-wave sleep and isoflurane anesthesia (0.1-1.5 MAC), 5-HT release decreased to 21%-44% of that during the waking state. Loss of righting reflex occurred at significantly higher isoflurane concentrations in fluoxetine-treated rats (0.76% +/- 0.03% [n = 8]) than in control rats (0.60% +/- 0.01% [n = 8]). CONCLUSIONS: It is suggested that a change in the activity of the serotonergic system in the brain is involved in the hypnotic action of isoflurane.

 

 

应用>酰胆碱受体阻滞剂不会>变依托咪酯致小鼠体消失的用药量

Blockade of Acetylcholine Receptors Does Not Change the Dose of Etomidate Required to Produce Immobility in Rats

Yi Zhang, Michael J. Laster, Edmond I. Eger, II, Manohar Sharma, and James M. Sonner

From the *Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, and the {dagger}Department of Anesthesiology, Fuwai Hospital and Cardiovascular Institute, Beijing, China.

Anesth Analg 2007 104: 850-852.

 

背景:毒蕈碱和神经元的尼古丁受体拮剂(比如阿托品和盐酸美明)的应用不会影响异氟

醚的MAC值。虽然这提示了>酰胆碱受体不能中和产生体消失的吸入麻醉药,但>有可

能有别的解。低于MAC值浓度的异氟醚单独使用可>泛地阻滞>酰胆碱受体,使用阿托

品和盐酸美明就可能无效,因为受体已经被阻滞了。>法:依托咪酯是一种被认为可强

GABA作用于GABAA 受体效应的麻醉剂,近期的研究中,我们测量用来减少依托咪酯麻醉

使用量的>酰胆碱受体被阻滞的量以间接地验证这种假设。结果:应用10mg/kg的阿托品

5mg/kg的盐酸美明不会>变使小鼠体消失需要量的依托咪酯的弥散速度和在血中

或脑中的药物浓度。结论:>酰胆碱受体不能调麻醉药>有害刺激制的用药量。

(施译 薛张纲校)

BACKGROUND: Administration of drugs blocking muscarinic plus neuronal nicotinic acetylcholine receptors (e.g., atropine and mecamylamine) does not affect the MAC of isoflurane. Although this implies that acetylcholine receptors do not mediate the immobility produced by inhaled anesthetics, another interpretation is possible. Sub-MAC concentrations of isoflurane alone profoundly block acetylcholine receptors, allowing for the possibility that atropine and mecamylamine have no effect because the receptors already are blocked.METHODS: In the present study, we indirectly tested this possibility by measuring the capacity of acetylcholine receptor blockade to decrease the anesthetic requirement for etomidate, an anesthetic thought to act solely by enhancing the effect of gamma-aminobutyric acid on gamma-aminobutyric acid(A) receptors.RESULTS: Administration of 10 mg/kg atropine plus 5 mg/kg mecamylamine did not change the infusion rate of etomidate, or the blood or brain concentrations of etomidate required to produce immobility in rats. CONCLUSION: Acetylcholine receptors do not mediate the capacity of anesthetics to produce immobility in the face of noxious stimulation.

 

 

美国麻醉>训>目的工作人员以财政况的五>期追踪调查:20002005

Five-Year Follow-Up on the Work Force and Finance s of United States Anesthesiology Training Programs: 2000 to 2005

Kevin K. Tremper, PhD, MD, Amy Shanks, MS, and Michelle Morris, MS

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

Anesth Analg 2007 104: 863-868.

 

背景:在90>代中期,麻醉科住院医生数量的减少使得全国麻醉医师短缺,>导致薪水水准涨的竞争市场。1999>,我们进行了一>美国麻醉>训>目的财政况的全国性调查。从此以后每>都进行追踪调查。我们在本系列文章中提交这六>调查的结果。>法:我们将调查内>通过电子邮件发给美国>训>目的各麻醉部主任>通过电子邮件回收调查反馈。

结果:121个被调查的部门中回复率为60%。在试图寻找至少一个新员工的部门中87%的部门>均拥有2.8个开放职位(总开放职位从2000>的9.7%降低到5.5%)。在96%的雇佣了取得资格证>的理麻醉师的部门中有89%的部门在试图寻找新的取得资格证>的理麻醉师,>均拥有3.6个开放职位。>均每个部门得到的公共财政资为490万美元(即11.6万美元/每职员)。如果除去用于取得资格证>的理麻醉师薪水支出的这部分财政资,则>均每个部门得到的公共财政资为410万美元(即9.5/每职员)。去>公共财政资增长了16%。员工用于学术研究的时间占所有时间的比例>均为17%(其中20%的部门为每周一日)。各部门每>每个员工的>均计>麻醉单位为11,320个单位。虽然所收到的麻醉单位价值>均为31美元,但是各部门需要大约40美元/单位来支付开支。公共医疗补的>均支出为15美元/单位,浮范围为5美元/单位至30美元/单位。结论:这些结果表明维持麻醉>训部门的财政稳定需要公共财政的持续资。

(陈佳莉译 薛张纲校)

BACKGROUND: In the middle 1990s, there was a decrease in anesthesiology residency class sizes, which contributed to a nationwide shortage of anesthesiologists, resulting in a competitive market with increased salary demands. In 1999, a nationwide survey of the financial status of United States anesthesiology training programs was conducted. Follow-up surveys have been conducted each year thereafter. We present the results of the sixth survey in this series. METHODS: Surveys were distributed by e-mail to the anesthesiology department chairs of the United States Training Programs. Responses were also received by e-mail. RESULTS: One hundred twenty-one departments were surveyed with a response rate of 60%. The 87% of departments seeking at least one additional faculty had an average of 2.8 faculty open positions (5.5% open positions overall which is down from 9.7% in 2000). Of the 96% of departments that employ certified registered nurse anesthetists (CRNAs) 89% were seeking additional CRNAs, averaging 3.6 open positions. The average department received $4.9 million (or $116,000/faculty) in institutional support. When the portion of this support allocated for CRNA salaries was removed, the average department received $4.1 million (or $95,000/faculty) in institutional support. This is a 16% increase over the previous year. Faculty academic time averaged 17% (where 20% is 1 d/wk). Departments billed an average of 11,320 anesthesia units/faculty/yr. Although the average anesthesia unit value collected was $31, departments required approximately $40/U to meet expenses. Medicaid payments averaged $15, ranging from $5 to $30/U. CONCLUSION: These results demonstrate the continuing need for institutional support to keep anesthesiology training departments financially stable.

 

 

患有严重肺气肿病人的左心室效能和内径

Left Ventricular Performance and Dimensions in Patients with Severe Emphysem

Kirsten Jörgensen, MD, Erik Houltz, MD, PhD, Ulla Westfelt, MD, PhD, and Sven-Erik Ricksten, MD, PhD

From the Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

Address Correspondence and reprint requests to Sven-Erik Ricksten, MD, PhD, Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.

Anesth Analg 2007 104: 887-892.

背景:人们已经认识到在慢阻肺病程中伴随心能不全,流行病的观>认为主要影响右心能。我们评估了严重肺气肿病人的左心室能和内径。>法:麻醉诱导后,研究了进行肺减>手术的严重肺气肿病人(n = 10)。准备行肺叶切除的非肺气肿病人作为>照(n = 10)。通过被高小腿,在中心血>量扩>前和扩>期间,分别用经食道二维超声心图测量病人仰卧位时的左心室量纲,和肺脉热稀导管测量血流学。结果:肺气肿组的心脏指数 (–25%),每博指数(SVI, –32%),左室做指数(–34%)和左室舒张末期>积指数(EDAI, –33%)的基准值都明显较低 (P < 0.001)。被高小腿可以增SVI和左室射血分数,肺气肿组比>照组更明显(P < 0.05){Delta}SVI/ {Delta}肺毛细血管契压和{Delta}SVI/{Delta}EDAI的关联性在肺气肿组明显高于>照组(分别是2.2 ± 0.71 vs 0.6 ± 0.2 mL/mm Hg x m2 ,和 5.8 ± 0.89 vs 2.8 ± 0.8 mL/cm2 x m2),({Delta}左室做指数/{Delta}EDAI),一个非负荷依赖的收缩期左心室能指标,在两组没有区别。结论:有严重肺气肿的病人的左心室的血>量是少的,绘制左室能曲线,提示收缩能的受损在肺气肿和>照组没有明显的区别。

(陈珺珺译 薛张纲校)

BACKGROUND: Concomitant heart dysfunction during the course of chronic obstructive pulmonary disease is well recognized. The prevailing view is that mainly the right side of the heart is involved. We evaluated left ventricular (LV) function and dimensions in patients with severe emphysema. METHODS: Patients with severe emphysema undergoing lung volume reduction surgery were studied after anesthesia induction (n = 10). Non-emphysematous patients scheduled for lobectomy served as controls (n = 10). LV dimensions were measured with patients in the supine position by transesophageal two-dimensional echocardiography and systemic hemodynamics by a pulmonary artery thermodilution catheter, before and during central blood volume expansion by passive leg elevation.RESULTS: Baseline cardiac index (–25%), stroke volume index (SVI, –32%) stroke work index (–34%) and LV end-diastolic area index (EDAI, –33%) were significantly (P < 0.001) lower in the emphysema group. Passive leg elevation increased SVI and LV area ejection fraction more in the emphysema group than in controls (P < 0.05). The {Delta}SVI/{Delta} pulmonary capillary wedge pressure and the {Delta}SVI/{Delta}EDAI relationships were significantly (P < 0.05) higher in the emphysema group compared to controls (2.2 ± 0.71 vs 0.6 ± 0.2 mL/mm Hg x m2 and 5.8 ± 0.89 vs 2.8 ± 0.8 mL/cm2 x m2, respectively). ({Delta}stroke work index/{Delta}EDAI), a load-independent index of systolic LV function, did not differ between the two groups.CONCLUSION: The LV in patients with severe emphysema is hypovolemic, and operates on a steeper portion of the LV function curve, while indices of systolic function are not significantly impaired compared to non-emphysematous controls.

 

 

罗哌卡因,左旋布比卡因布比卡因在椎管内的神经阻滞的相>效能

The Relative Potencies for Motor Block After Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine

Michela Camorcia, MD*, Giorgio Capogna, MD*, Cristiana Berritta, MD*, and Malachy O. Columb, FRCA{dagger}

From the *Department of Anesthesia, Città di Roma Hospital, Roma, Italy; and {dagger}Department of Anaesthesia and Intensive Medicine, South Manchester University Hospital, Wythenshawe, Manchester, UK.

Anesth Analg 2007 104: 904-907.

 

背景:在这个研究中,我们调查分析椎管内应用罗哌卡因,左旋布比卡因,布比卡因达到神经阻滞作用的中间效应剂量(ED50),>定>他们的效能比值。>法:我们选取104个在连硬麻醉下行剖宫产的产妇,将>们随机的分为三组,分别椎管内给与0.5% (wt/vol)的罗哌卡因,左旋布比卡因或布比卡因。初始剂量为4 mg,每组间隔增1 mg。椎管内注射后每五分钟测量下肢的神经反射来评价效果。结果:经分析,椎管内神经阻滞的 中间效应值分别为:罗哌卡因5.79 mg(95% CI 4.62–6.96),左旋布比卡因4.83 mg(95% CI 4.35–5.32),布比卡因3.44 mg(95% CI 2.55–4.34) (P < 0.0007)。相>神经阻滞效能比值为罗哌卡因/布比卡因0.59 (95% CI, 0.42–0.82),罗哌卡因/左旋布比卡因0.83 (95% CI 0.64–1.09),左旋布比卡因/布比卡因0.71 (95% CI 0.51–0.98).结论:通过这个研究我们得到一个椎管内阻滞的临效能范围:分别为罗哌卡因最低,左旋布比卡因中等,布比卡因最强。

(秦佳译 薛张纲校)

BACKGROUND: In this study, we sought to determine the median effective dose (ED50) for motor block of intrathecal ropivacaine, levobupivacaine, and bupivacaine and to define their motor-blocking potency ratios. METHODS: We enrolled 104 parturients undergoing elective cesarean delivery with combined spinal-epidural anesthesia and randomized them to one of three groups to receive intrathecal 0.5% (wt/vol) ropivacaine, levobupivacaine, or bupivacaine. The initial dose was 4 mg, and the testing interval was set at 1 mg. Efficacy was determined by the occurrence of any motor block in either lower limb (modified Bromage and hip motor function scale) within 5 min after the spinal injection. RESULTS: As assessed using up-down analysis, intrathecal ED50 for motor block was 5.79 mg for ropivacaine (95% CI 4.62–6.96), 4.83 mg for levobupivacaine (95% CI 4.35–5.32) and 3.44 mg for bupivacaine (95% CI 2.55–4.34) (P < 0.0007). The relative motor blocking potency ratios were ropivacaine/bupivacaine 0.59 (95% CI, 0.42–0.82), ropivacaine/levobupivacaine 0.83 (95% CI 0.64–1.09), and levobupivacaine/bupivacaine 0.71 (95% CI 0.51–0.98).

CONCLUSIONS: There is a clinical profile of potency for motor block for the pipecolylxylidines when administered spinally: low, intermediate, and high for ropivacaine, levobupivacaine, and bupivacaine, respectively.

 

 

疼痛自我效能问卷中文版测试

validation of the chinese version of pain self-efficacy questionnaire

Lim HS, Chen PP, Wong TC, Gin T, Wong E, Chan IS, Chu J

Department of Anaesthesiology and Pain Medicine, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong, China

Anesth Analg 2007 104(4):918-23

 

背景:自我效能是一个人>自己能够执行一>行为得到理想后果的信心。自我效能这种信心影响着慢性疼痛病人的疼痛治疗计划、生理心理能以康复结果。为检验疼痛自我效能问卷中文版(Pain Self-Efficacy Questionnaire, PSEQ-HK)的心理测验>性,我们进行了本次前瞻性研究。>法:将PSEQ-HK译文交作者获取认同,然后进行前向后向翻译和专家小组鉴定。通过相隔一周测试两次的>法进行可靠性检验。要求120名患有慢性非癌性疼痛的中国病人自行完成一系列健康相关的中文试卷:疼痛数字评分量表(Numeric Pain Rating Scale)、医院焦虑郁量表(Hospital Anxiety and Depression Scale)Roland-Morris能障碍问卷(Roland-Morris Disability Questionnaire)、疼痛灾难化量表(Pain Catastrophizing Scale)、医疗结局研究>36条简明健康问卷(Medical Outcome Study Short-Form 36 [SF36] Health Survey)。结果:PSEQ-HK具有良好的重复测试可靠性(组间相关系数为0.75)和内部一致性(Cronbachα系数为0.93)。探索性因素分析显示总变异的61%可被一个单一因素模型解,因素负荷量至少有0.69。它与医院焦虑郁量表、疼痛灾难化量表和SF365个>面(肌体疼痛,生命,社会能,情感角色,心理健康)有显著相关性。与Roland-Morris能障碍调查表和SF362个>面(躯体角色、总健康)中等相关。与疼痛评分和医疗>预无相关。结论:PSEQ-HK是可靠的中文临评价工具,心理测试>性令人满意。我们的结果初步支持PSEQ-HK在异质的中国慢性非癌性疼痛人群中应用的可靠性。

(罗 璇译 薛张纲校)

BACKGROUND: Self-efficacy is a person's belief in his or her ability to perform a certain behavior that achieves a desired outcome. Belief in self-efficacy influences the use of pain-coping strategies, physical and psychological function, and rehabilitation outcome in chronic pain patients. We conducted this prospective study to validate the psychometric properties of a Chinese version of the Pain Self-Efficacy Questionnaire (PSEQ-HK). METHODS: A previously translated PSEQ-HK was evaluated with the author's consent. Forward-backward translation was conducted, followed by critical appraisal by an expert panel. Reliability was examined by completing the PSEQ-HK twice over a 1-wk interval. One-hundred-twenty Chinese patients with chronic nonmalignant pain were asked to self-complete a set of health-related instruments in Chinese: Numeric Pain Rating Scale, Hospital Anxiety and Depression Scale, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, and Medical Outcome Study Short-Form 36 (SF36) Health Survey. RESULTS: PSEQ-HK had good retest reliability (intraclass correlation coefficient 0.75) and high internal consistency (Cronbach's alpha 0.93). Exploratory factor analysis showed a one-factor model that accounted for 61% of the total variance, with minimal factor loading of 0.69. It was significantly correlated with the Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and five domains of SF36 (bodily pain, vitality, social functioning, role emotion, and mental health). Moderate correlations were observed with Roland-Morris Disability Questionnaire and two domains of SF36 (role physical, general health). It had no correlation with pain score and medication use. CONCLUSIONS: PSEQ-HK is a reliable Chinese clinical assessment tool with satisfactory psychometric properties. Our results provided preliminary support for the construct validity of PSEQ-HK in a heterogeneous Chinese population with chronic nonmalignant pain.

 

 

非甾体类炎药物(NSAID)在小鼠热辐射甩尾试验中的局部保作用

The Local Antinociceptive Actions of Nonsteroidal Antiinflammatory Drugs in the Mouse Radiant Heat Tail-Flick Test

 

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

From the *Department of Pharmacology, Gülhane Academy of Medicine, Etlik, Ankara, Turkey; {dagger}Department of Pharmacology and Clinical Pharmacology and Headache Research Center, Medical School of Ankara University, Ankara, Turkey; Departments of {ddagger}Pathology, Analytic Toxicology, Gülhane Academy of Medicine, Etlik, Ankara, Turkey; and ||Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, Arizona.

. Anesth Analg 2007 104: 416-420.

 

背景:虽然有很多临前模型测试NSAID的止痛效能,小鼠热辐射甩尾试验经常>这类药物不敏感.由于甩尾实验涉的伤害性反应是在髓水>进行调的,而NSAID的基本作用位>可能是在外周,这样假设NSAID不应该会>变强大的伤害性刺激是合理的.>法:我们在小鼠的尾巴进行皮下注射3-300ug的双氯酸, 安>近, 痛克, 赖氨酸>酰水杨酸盐和水杨酸钠,然后评估>于热辐射的甩尾反应.这些结果将与>膜内注射进行>照.我们同时评估纳洛酮拮作用的强弱.结果:各种NSAID皮下注射后, 甩尾潜伏期的延长呈剂量相关.>膜内注射不产生任何保作用. 纳洛酮预处理>于拮双氯酸, 痛克, 赖氨酸>酰水杨酸结论:在热甩尾试验中,局部而非全身性给与NSAIDs可以产生保作用. 内源性阿片类物质系统>于安>近的保作用有促进作用.但是>于双氯酸, 痛克, 赖氨酸>酰水杨酸盐和水杨酸钠没有任何作用,这显示了不同的NSAIDs有不同的作用原理.盐和水杨酸钠没有任何作用,但可以完全拮皮下注射安>近后的保作用.

(王光妍译 薛张纲校)

BACKGROUND: While many preclinical models detect the analgesic activity of nonsteroidal antiinflammatory drugs (NSAIDs), the radiant heat tail-flick response has repeatedly been insensitive to this class of drugs. As the tail-flick test involves nociceptive processing at spinal circuits with supraspinal modulation, it seems reasonable to assume that the NSAIDs should not modify strong nociceptive stimuli, since the primary site of action of NSAIDs is likely to be in the periphery.

METHODS: We injected 3–300 µg of diclofenac, dipyrone, ketorolac, lysine acetyl salicylate, and sodium salicylate intradermally into mice tails and evaluated the tail-flick response to radiant heat. These results were compared with intraperitoneally injected controls. We also evaluated the ability of naloxone to reverse the observed effects. RESULTS: Intradermal injection of each NSAID produced a dose-dependent increase in tail-flick latency. Intraperitoneal NSAIDs injection produced no antinociceptive effects. Naloxone pretreatment had no effect on the antinociceptive effects of intradermal diclofenac, ketorolac, lysine acetyl salicylate, and sodium salicylate. Naloxone completely blocked the antinociceptive effects of intradermal dipyrone. CONCLUSIONS: Local, but not systemic, administration of NSAIDs produced antinociception in the tail-flick thermal assay. The endogenous opioid system contributes to the peripheral antinociceptive effects of dipyrone, but not to that of diclofenac, ketorolac, lysine asetyl salicylate, or sodium salicylate, suggesting differences in the mechanisms of action among the NSAIDs.

 

 

炎症性疼痛增小鼠脑液中的α肿瘤坏死因子以前列腺素E2的浓度:止痛药物的效果

Increased tumor necrosis factor-alpha and prostaglandin E2 concentrations in the cerebrospinal fluid of rats with inflammatory hyperalgesia: the effects of analgesic drugs.

Mauro Bianchi, Cataldo Martucci, Paolo Ferrario, Silvia Franchi, and Paola Sacerdote

Department of Pharmacology, University of Milan, Milan, Italy.

Anesth Analg 2007 104: 949-954.

 

背景:我们>小鼠进行足底皮注完全弗氏佐剂后测量了小鼠脑液中前列腺素E2和α肿瘤坏死因子的浓度。另外,我们调查了有后爪炎症时口服不同的止痛药在疼痛的剂量时是否能够阻止脑液中前列腺素E2和α肿瘤坏死因子的浓度变化。>法:我们使用Randall-Selitto爪子缩回实验来测量炎症性疼痛。曲马多(7.5mg/kg),扑热息痛(6.5 mg/kg),曲马多扑热息痛尼美舒利(COX-2制剂)(5mg/kg)从完全弗氏佐剂注射后第一天开始分别一天两次口服。前列腺素E2通过免疫酶学测定,α肿瘤坏死因子的浓度通过ELISA(酶联免疫吸附学)测定。行为学和生化学的数据从小鼠足底皮注完全弗氏佐剂或盐水后第七天开始测定。结果:经过完全弗氏佐剂处理过的爪子在机械刺激下缩回的阈值明显降低。在这些物的脑液中炎症前媒介物质的量显示了前列腺素E2和α肿瘤坏死因子的浓度都有明显的增。所有的药物治疗阻止了脑液中前列腺素的增以疼痛的发展,相反的,防止α肿瘤坏死因子水>的增高只有在尼美舒利或曲马多和扑热息痛组合中才观察到。结论:我们的结果证明了外周炎症性疼痛是与脑液中大量炎症前媒介物质变化有关。这里有一>重要的说明是髓的前列腺素E2和α肿瘤坏死因子被证明是通过不同的>法影响药物完全阻断痛觉的作用。

(张俪译 薛张钢校)

BACKGROUND: We examined the changes in cerebrospinal fluid (CSF) concentrations of prostaglandin E2 (PGE2) and tumor necrosis factor-alpha (TNF-alpha) after intraplantar administration of complete Freund's adjuvant (CFA) in rats. In addition, we investigated whether different analgesic drugs orally administered at antihyperalgesic doses were able to prevent the changes in PGE2 and TNF-alpha spinal levels associated with hindpaw inflammation. METHODS: The Randall-Selitto paw-withdrawal test was used to measure inflammatory hyperalgesia. Tramadol (7.5 mg/kg), paracetamol (65 mg/kg), tramadol plus paracetamol and nimesulide (5 mg/kg) were administered orally twice a day, starting from the first day after the CFA injection. PGE2 in the CSF was measured by enzyme immunoassay, and TNF-alpha by ELISA. Behavioral and biochemical parameters were measured on Day 7 after intraplantar injection of CFA or saline. RESULTS: Withdrawal thresholds to mechanical stimuli decreased markedly in the CFA-treated paw. In these animals the quantification of proinflammatory mediators in the CSF revealed a significant increase in both PGE2 and TNF-alpha concentrations. All the pharmacological treatments prevented the development of the hyperalgesia as well as the PGE2 increase in the CSF. Conversely, a prevention of the increase in TNF-alpha levels was observed only in rats treated with nimesulide or tramadol and paracetamol in combination. CONCLUSIONS: Our results demonstrate that peripheral inflammatory hyperalgesia is associated with significant changes of proinflammatory mediators in the CSF. It is important to note, however, that spinal PGE2 and TNF-alpha proved to be differently affected by pharmacological treatments able to fully abolish the hyperalgesia

 

 

区域阻滞神经系统>发症:危险性的同期评估

Neurological Complications After Regional Anesthesia: Contemporary Estimates of Risk

Richard Brull, MD, FRCPC, Colin J. L. McCartney, MBChB, FRCA, FFARCSI, FRCPC, Vincent W. S. Chan, MD, FRCPC, and Hossam El-Beheiry, MBBCh, PhD, FRCPC

From the Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Anesth Analg 2007 104: 965-974.

 

背景:区域阻滞为很多外科操作提供了良好的感觉丧失和痛觉丧失。麻醉师和病人除了知道选择区域阻滞作为麻醉>法的处外,还必须了解其危险性。许多关于区域阻滞后神经系统>发症的调查已被提议程,这>没有反映出区域阻滞适应证其应用的增,或者术的提高。>于这一简要的综述,我们>比了最常用的区域阻滞术后神经系统>发症的同期调查。>法:为了调查区域阻滞后的神经系统>发症,我们回顾了32个病例发表于1995>11日至2005>1231日。结果:中枢和外周神经阻滞后的神经系统>发症发生的样本数量分别是1260000中的418510309中的20个。腰麻和硬膜外麻醉后的神经病变发生率分别是3.7810000 (95% CI: 1.06–13.50:10,000) 2.19:10,000 (95% CI: 0.88–5.44:10,000)。>于常用的中枢和外周神经阻滞,肌间沟臂丛神经阻滞、腋路臂丛神经阻滞股神经阻滞后的神经系统>发症发生率分别为2.84:100 (95% CI 1.33–5.98:100), 1.48:100 (95% CI: 0.52–4.11:100),0.34:100 (95% CI: 0.04–2.81:100)。腰麻硬膜外麻醉后永>性神经损伤的发生率分别为从04.2:10,00007.6:10,000。只有一例永>性神经病变被道于16份中枢外周神经阻滞后神经系统>发症的调查中。结论:我们的调查提示了中枢神经阻滞后的神经系统>发症发生率小于4:10,0000.04%。中枢外周神经阻滞后神经病变发生率小于3:100 3%。然而同期的麻醉操作中永>性的神经损伤很罕见。

(孙 霞译 薛张纲校)

BACKGROUND: Regional anesthesia (RA) provides excellent anesthesia and analgesia for many surgical procedures. Anesthesiologists and patients must understand the risks in addition to the benefits of RA to make an informed choice of anesthetic technique. Many studies that have investigated neurological complications after RA are dated, and do not reflect the increasing indications and applications of RA nor the advances in training and techniques. In this brief narrative review we collate the contemporary investigations of neurological complications after the most common RA techniquesMETHODS: We reviewed all 32 studies published between January 1, 1995 and December 31, 2005 where the primary intent was to investigate neurological complications of RA.RESULTS: The sample size of the studies that investigated neurological complications after central and peripheral (PNB) nerve blockade ranged from 4185 to 1,260,000 and 20 to 10,309 blocks, respectively. The rate of neuropathy after spinal and epidural anesthesia was 3.78:10,000 (95% CI: 1.06–13.50:10,000) and 2.19:10,000 (95% CI: 0.88–5.44:10,000), respectively. For common PNB techniques, the rate of neuropathy after interscalene brachial plexus block, axillary brachial plexus block, and femoral nerve block was 2.84:100 (95% CI 1.33–5.98:100), 1.48:100 (95% CI: 0.52–4.11:100), and 0.34:100 (95% CI: 0.04–2.81:100), respectively. The rate of permanent neurological injury after spinal and epidural anesthesia ranged from 0–4.2:10,000 and 0–7.6:10,000, respectively. Only one case of permanent neuropathy was reported among 16 studies of neurological complications after PNB.CONCLUSIONS: Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.

 

 

联合注射可>定通过外周作用延长利多卡因皮下注射的麻醉效果

Co-injectiong of clonidine prolongs the anesthetic effect of lidocaine skin infiltration by a peripheral action.

Pratap JN, Shankar RK, Goroszeniuk T.

Department of Anaesthesia, Guy's & St. Thomas' NHS Foundation Trust, London, UK.

Anesth Analg. 2007 Apr;104(4):982-3. 

 

背景:局麻药联合可>定延长局麻药的作用,但运用于人体时,其外周作用机制仍不清楚。>法:选择20例健康志愿者,采用双盲法,皮下注射0.5%利多卡因+NS到一侧前臂,然后立即在另一只前臂注射0.5%利多卡因+10mug可>定。6h内针孔处的感觉每15分钟测一次。结果:单独利多卡因侧恢复正常感觉的中位数时间为3.5h,联合可>定侧手臂则为6h以(p< 0.001)。结果:复合可>定通过外周作用可强利多卡因皮下注射的麻醉作用时间。

(吴德华译 薛张纲校)

BACKGROUND: The addition of clonidine to local anesthesia prolongs the local anesthetic action, but in humans, the contribution of a peripheral mechanism remains unclear. METHODS: We investigated clonidine's peripheral effect in 20 healthy volunteers undergoing double-blind, subcutaneous infiltration of 0.5% lidocaine with normal saline to one forearm and then, immediately, of lidocaine with 10 mug clonidine to the contralateral arm. Pinprick sensation was tested every 15 min for 6 h. RESULTS: Median time to return of normal sensation was 3.5 h for lidocaine alone, but at least 6 h if combined with clonidine (P < 0.001). CONCLUSIONS: Clonidine has a significant peripheral action in enhancing duration of local anesthesia on superficial co-infiltration with lidocaine.

 

婴儿异丙酚-瑞太尼与七氟醚麻醉术后睡眠质量的差异

Quality Differences in Postoperative Sleep Between Propofol-Remifentanil and Sevoflurane Anesthesia in Infants anesthesia.

Jacob Steinmetz, MD*, Rolf Holm-Knudsen, MD*, Kirsten Eriksen, MD*, DorteMarxen, RN and Lars S. Rasmussen, MD, PhD*

From the *Department of Anesthesia, Centre of Head and Orthopedics 4231,CopenhagenUniversityHospital,Rigshospitalet,Copenhagen,Denmark;andCentre of Cleft Lip-Palate, Rygaards Allé 45, Denmark.

Anesth Analg 2007 104: 779-783.

 

背景:小儿麻醉术后行为障碍较为常见,但在婴儿麻醉后的发生情况尚不明确。本文作者主要研究术后睡眠障碍,>假设在婴儿使用异丙酚-瑞太尼麻醉与七氟醚后睡眠质量有差异,其在七氟醚麻醉比异丙酚-瑞太尼麻醉后睡眠障碍更常见。。

>法394-6个月的婴儿施行唇-腭裂修复术,随机分为两组,分别接受异丙酚-瑞太尼复合麻醉(n17)或七氟醚.-太尼麻醉(n22),术后盲法随访。其父母于入院前2W与术毕返家后2W>其孩子记录睡眠情况,包括婴儿晚间醒来次数,难以安入睡次数和最长睡眠时间。

结果:七氟醚组(中位数为7.2h)最长睡眠时间比异丙酚-瑞太尼组(中位数为5.1h P < 0.05)长。其余组间无差异。两组婴儿术后睡眠模式较术前有>变(P < 0.01)。其父母认为10天后恢复正常,组间无显著差异。

结论:婴儿于异丙酚-瑞太尼与七氟醚麻醉后出现术后睡眠障碍,七氟醚麻醉较异丙酚-瑞太尼麻醉在婴儿唇腭裂修复术后一周睡眠障碍轻。

(宋翠侠 陈杰 校)

BACKGROUND: Postoperative behavioral disorders are common in children, but the occurrence in infants is not yet clear. In the present study we focus on postoperative sleep disturbances, which we hypothesized would be more common after sevoflurane anesthesia than propofol-remifentanil Quality Differences in Postoperative Sleep Between Propofol-Remifentanil and Sevoflurane Anesthesia in Infants anesthesia.

METHODS: In total, 39 infants 4–6-mo-old were prospectively enrolled and randomized to receive either a combination of propofol and remifentanil (n = 17) or sevoflurane and fentanyl anesthesia (n = 22) for surgical repair of cleft lip-gum-palate. Postoperative observations were blinded. The parents kept a sleep diary for 2 wk before admission and 2 wk after returning home. The diary included information about how many times the infant awoke during the night and was difficult to comfort and the longest duration of continuous sleep during the night.

RESULTS: Longest continuous sleep was significantly longer in the sevoflurane group (median 7.2 h) compared with the propofol-remifentanil group (median 5.1 h, P < 0.05). No other significant difference was found between groups. Sleep pattern was impaired after surgery in both groups compared with that before surgery (P < 0.01), but it was considered by the parents to be back to normal after a median of 10 days, with no significant difference between groups.

CONCLUSION: Postoperative sleep disturbances occur in infants after both propofol-remifentanil and sevoflurane anesthesia. Sevoflurane seems to be associated with less impairment of postoperative sleep than propofol-remifentanil in the first weeks after repair of cleft lip and palate in infants.

 

六氟苯(HFB)作用在髓,而O -二氟苯(ODFB)作用在大脑和髓产生制作用

Hexafluorobenzene Acts in the Spinal Cord, Whereas O-Difluorobenzene Acts in Both Brain and Spinal Cord, to Produce Immobility

Joseph F. Antognini, MD, Douglas E. Raines, MD, Ken Solt, MD, Linda S. Barter, MVSc, Richard J. Atherley, BS, Emigdio Bravo, BS, Michael J. Laster, DVM, Katarzyna Jankowska, DVM, and Edmond I. Eger, II, MD

From the Department of Anesthesiology and Pain Medicine, University of California, Davis, California.

Anesth Analg 2007 104: 822-828.

 

背景: 以前的研究表明异氟醚和氟烷>于有害刺激的制作用主要作用在髓而非大脑。这些麻醉药>于受体具有多种效应,因此无法测试髓介导的制作用。作者试图通过髓介导的制作用,探询两种香族麻醉药的适用范围,以在拮N甲基d天冬氨酸受体时差异的原因。

>法: 运用山模型,>大脑选择性地使用HFBODFB,研究麻醉药的作用。因为结果提示一个ODFB具有显著的大脑效应,研究>刺激产生制作用时的ODFB浓度,其他山使用 0.5%的氟烷。以往研究表明产生制作用的大脑氟烷浓度远远超过髓,所以作者选择了氟烷。同时在含有苯的麻醉药——异丙酚中运用了以术。

结果: 旁路前HFB的最小肺泡浓度(MAC)0.82% ± 0.14% (>均值 ± 标准差);大脑选择性使用麻醉药后MAC增至2.04% ± 0.8% (P < 0.01);而旁路后MAC恢复至0.79% ± 0.28%。而ODFBMAC值是0.46% ± 0.07%, 0.63% ± 0.12% (P < 0.05), 0.44% ± 0.10% 大脑选择性使用氟烷时ODFB MAC 0.32% ± 0.17% 。但是当ODFB运用至全身, MAC0.37% ± 0.05%。和HFB一样, 氟烷的需要量增至单独作用于大脑时的三倍。5只试验物中4只,异丙酚的需要量增了240%, 1只物的需要量减少了,而以这些变化都没有统计学差异。

结论:这些数据提示HFB, 和氟烷一样, 主要通过髓产生制作用。而HFB ODFB>髓和大脑的作用部位是不同的。然而,尽管ODFB 可以通过大脑中枢作用产生制作用,它>可以通过髓作用产生制。因此,结论支持髓是产生制的初级部位,或许异丙酚同样如此。
(杨卫红 陈杰 校)

BACKGROUND: Previous work demonstrated that isoflurane and halothane act on the spinal cord rather than on the brain to produce immobility in the face of noxious stimulation. These anesthetics share many effects on specific receptors, and thus do not test the broad applicability of the mediation of immobility by the cord. We sought to test such an applicability by determining whether the cord mediated the immobilizing effects of two aromatic anesthetics that differ greatly in their ability to block N-methyl-d-aspartate receptors.

METHODS: We investigated the actions of hexafluorobenzene (HFB) and o-difluorobenzene (ODFB) using an intact goat model that allowed selective delivery of anesthetics to the brain. Because our results suggested a significant cerebral effect of ODFB, in other goats we administered halothane 0.5% to the brain, while determining the ODFB concentration delivered to the body (the cord) required for immobility. We chose halothane because the present and previous studies found that cerebral halothane concentrations alone required for producing immobility far exceeded those required in the cord. We also applied the above techniques to another benzene-containing anesthetic, propofol.

RESULTS: Prebypass minimum alveolar concentration (MAC) for HFB was 0.82% ± 0.14% (mean ± sd); increased to 2.04% ± 0.8% (P < 0.01) during selective delivery to the cranial circulation; and returned to 0.79% ± 0.28% postbypass. Corresponding values for ODFB were 0.46% ± 0.07%, 0.63% ± 0.12% (P < 0.05), and 0.44% ± 0.10%. ODFB MAC was 0.32% ± 0.17% during selective halothane delivery to brain. But when ODFB was administered to the whole body, MAC was 0.37% ± 0.05%, (NS). Like HFB, the halothane requirement increased threefold when delivered only to the head. In four of five animals, propofol requirements increased by 240%, but in one animal propofol requirements decreased, and the overall change was not statistically significant.

CONCLUSIONS: These data suggest that HFB, like halothane, produces immobility, predominantly by a spinal cord action, and that HFB differs from ODFB with respect to brain versus spinal sites of action. Nonetheless, although ODFB can produce immobility via a cerebral action, it also can do this via an independent action in the spinal cord. Thus, our results continue to support the spinal cord as the primary site at which inhaled anesthetics, and perhaps propofol, produce immobility.

 

巴比妥增强大鼠海马区氨基丁酸介导的神经兴奋而不影响其突触可塑性

Pentobarbital Enhances -Aminobutyric Acid-Mediated Excitation Without Altering Synaptic Plasticity in Rat Hippocampus

DavidP.Archer,MD*,KhanhQ.Nguyen,MSc*,NaazninSamanani,BSc*andSheldonH.Roth, PhD*

From the Department of *Anesthesiology, Clinical Neurosciences, and Pharmacology and Therapeutics, Faculty of Medicine, University of Calgary, Calgary, Canada.

Anesth Analg 2007 104: 840-846.

 

背景:目前认为突触的可塑性为学>和记忆的分子机制。N-甲基天冬氨酸受体介导的可塑要求N-甲基天冬氨酸受体激活同时突触后膜电位除极化。高浓度的巴比妥能增强突触后膜电位除极化,但同时会阻止突触的可塑性,可能通过影响谷氨酸的转运。本研究作者检验低浓度巴比妥增强突触后膜电位除极化以调突触可塑性的假说。

>法:实验在大鼠离体海马切片中进行。阻断谷氨酸转运时,使用CA1神经元细胞内记录>法来测试5μM巴比妥>突触后膜电位除极化以给予高频刺激后神经元的兴奋性的影响。谷氨酸转运正常时,则使用细胞外记录来测试通过给予海马轴索途径条件性刺激,5μM巴比妥诱发长期制和长期增强突触传递的作用。

结果:高频刺激产生的典型突触后膜电位除极化由氨基丁酸受体介导>且依赖HCO3-。当处于突触后膜除极化电位最大振>一时,巴比妥(5μM)能增>度,但不能增宽度(P<0.01)。巴比妥能增突触后膜电位除极化时作电位发生的可能性,但不影响长时程制或长时程增强。

结论5μM巴比妥能增突触后膜电位除极化的振>,但不>变通过常规范围的条件性刺激诱导的突触可塑性。这些结果不支持巴比妥的兴奋性作用能>变突触可塑性的假说。

(周懿> 陈杰 校)

BACKGROUND: Synaptic plasticity is thought to provide a molecular mechanism for learning and memory. N-methyl-d-aspartate receptor-mediated plasticity requires that N-methyl-d-aspartate receptor activation coincides with postsynaptic depolarizing potentials (DPSPA's). Pentobarbital, in high concentrations, enhances DPSPA's, but high concentrations suppress synaptic plasticity, probably by impairing glutamatergic transmission. Here we tested the hypothesis that low concentrations of pentobarbital can enhance DPSPA's and modify the induction of synaptic plasticity.

METHODS: Studies were performed in vitro on rat hippocampal slices. With glutamate transmission blocked, intracellular recording from CA1 neurons was used to investigate the influence of 5 µM pentobarbital on DPSPA's and neuron excitability evoked by high frequency (100 Hz) stimulation. With glutamate transmission intact, extracellular recording was used to examine the effect of 5 µM pentobarbital on the induction of long-term depression and long-term potentiation of synaptic transmission by conditioning stimuli applied to the Schaffer collateral pathway.

RESULTS: High frequency stimulation generated typical DPSPA's that were mediated by -aminobutyric acidA receptors and dependent upon HCO3. Pentobarbital (5 µM) increased the amplitude, but not the width, at half-maximal amplitude of DPSPA's (P < 0.01). Pentobarbital increased the probability of action potential generation during the DPSPA's. Pentobarbital did not alter the induction of long-term depression or long-term potentiation.

CONCLUSIONS: Despite increasing the amplitude of DPSPA's, 5 µM pentobarbital did not alter the induction of synaptic plasticity by a range of conventional conditioning stimuli. These results do not support the hypothesis that excitatory effects of pentobarbital may alter synaptic plasticity.

 

术前超短期熵值可预测麻醉诱导期间的脉血压波

Preoperative Ultra Short-Term Entropy Predicts Arterial Blood Pressure Fluctuation During the Induction of Anesthesia

Yoshihiro Fujiwara, MD, PhD*, Hiroshi Ito, MD, PhD*, Yusuke Asakura, MD, PhD*, Yuko Sato, MD*, Kimitoshi Nishiwaki, MD, PhD, and Toru Komatsu, MD, PhD*

From the *Department of Anesthesiology, Aichi Medical University School of Medicine, Japan; and Department of Anesthesiology, Nagoya University Graduate School of Medicine, Japan.

Anesth Analg 2007 104: 853-856.

 

背景:本文作者研究术前心率变异性的非线性指标、超短期熵(UsEn),是否能预测全麻诱导期间的心血管反应。

UsEn是用非线性最小二>法模型与最大熵光谱分析术(MemCalc术)相结合来测定的。用MemCalc术测定46个无高血压病史的病人(ASA1/2,>龄40-60岁)的UsEn。>据术前的UsEn将病人分为2组(低UsEn组:UsEn<45,UsEn组:UsEn45)。用异丙酚、太尼、维库溴铵麻醉诱导后气管插管。记录>比较两组病人麻醉诱导期间的血流学变化。

结果:麻醉诱导期间低UsEn病人的血流学变化明显较大。

结论:UsEn能预测麻醉诱导期间的脉血压的波。

(丁震敏 陈杰 校)

BACKGROUND: In this study, we sought to determine whether the preoperative nonlinear index of heart rate variability, ultra short-term entropy (UsEn), could predict cardiovascular responses to the induction of general anesthesia.

METHODS: UsEn was estimated by a linearized version of the nonlinear least squares method combined with the maximum entropy spectral analysis method (MemCalc method). Preoperative UsEn of 46 patients (ASA PS 1 or 2, aged 40–60 yr) without a history of hypertension was evaluated using the MemCalc method. Patients were assigned to two groups according to preoperative UsEn (Group LOW; UsEn <45, Group HIGH; UsEn 45). Anesthesia was induced with propofol, fentanyl and vecuronium bromide and endotracheal intubation was performed. Hemodynamic fluctuations during the induction of anesthesia were recorded and compared between the two groups.

RESULTS: It was found that arterial blood pressure fluctuations during the induction of anesthesia were significantly greater in patients with a low UsEn.

CONCLUSION: UsEn could predict arterial blood pressure fluctuations during the induction of anesthesia.

 

细胞再利用术的成本分析

An Economic Analysis of Costs Associated with Development of a Cell Salvage Program

JanetRobinsonWaters,MD,MBA*, HeidiHyltonMeier,DBA,CPA*,and JonathanH.Wat

MD

From the *Nance College of Business Administration, Cleveland State University, Cleveland, OH; and Department of General Anesthesiology and Clinical Pathology, Cleveland Clinic Foundation, Cleveland, OH.

Anesth Analg 2007 104: 869-875. [

 

背景:血制品的高>用和输血所带来的风险使大家更关注可以减少或替代血制品的术。目前已有多个机构研发细胞再利用术的应用,作者在研究这>术财信息。

>法:评估2328名患者细胞再利用术所获得的浓集红细胞的>用。另外,分析了建立细胞再利用术的收支>衡>。

结果:在该机构中建立细胞再利用术的最初入成本为103551美元,每>固定的手术收入为250943美元,每袋红细胞单位输注的>均>用为200美元,使用细胞再利用术所获得的相同单位的>用为89.46美元,回周期为1.9个月。

结论:这>分析表明细胞再利用的>用明显低于同种异体血细胞输注的>用。在其它机构中,细胞再利用术的成本有所不同,这是由于除了考虑每台手术失血量外,成本取决于最初的研究>用和总的手术量。目前已有一步步推算的公式帮评估不同级别医院的细胞再利用术。

(>琼慧 陈杰 校)

BACKGROUND: The increasing cost of blood products and associated risks of transfusion have lead to a heightened interest in techniques which reduce or replace allogeneic blood transfusion. The use of cell salvage is being explored in a number of institutions. We present financial information which may be useful to institutions that are considering the addition of a cell salvage service.

METHODS: A review of the cell salvage data from 2328 patients was used to estimate the average cost of a packed red blood cell unit equivalent processed by cell salvage equipment. In addition, an analysis was performed to assess the break-even point of establishing a cell salvage service.

RESULTS: Initial capital outlay to establish a cell salvage service at this institution was $103,551. The annual fixed operating cost was $250,943. The average cost of transfusion of an allogeneic packed red blood cell unit was $200. For an equivalent cell salvage unit, the cost was $89.46. The payback period was 1.9 mo.

CONCLUSION: This analysis suggests that cell salvage can be significantly less expensive than allogeneic blood. The cost of cell salvage in other institutions will vary depending upon case volume, expected levels of blood loss per case, and initial investment costs. A step-by-step formula is provided to assist in the evaluation of a cell salvage service in hospitals of various sizes.

 

血浆白蛋白浓度>于危重病人血清钠离子氯离子测定值的影响

The Effect of Albumin Concentration on Plasma Sodium and Chloride Measurements in Critically Ill Patients

David A. Story, MD, FANZCA* Hiroshi Morimatsu, MD*, Moritoki Egi, MD*, and Rinaldo Bellomo, MD, FJFICM*

From the *Departments of Anaesthesia and Intensive Care, Austin Health, Heidelberg, Victoria, Australia; and Department of Surgery, University of Melbourne, Austin Health.

Anesth Analg 2007 104: 893-897.

 

背景:作者假设>验证了血浆钠离子浓度直接测定与间接测定法>间的差值与血浆白蛋白浓度有关,>进一步提出血清氯离子直接与间接测定值的差异>可能与其他血浆成分的>扰有关,>别是碳酸氢盐和白蛋白。

>法:300名刚入ICU治疗的危重病人进行了研究,比较每个病人血浆钠离子与氯离子浓度在中心实验室(间接电极)和ICU血气分析仪测定值(直接电极)>间的差异。

结果:中心实验室测定的血浆钠离子浓度的值>均较ICU测定值高2.1mmol/L(可信区间1.8-2.4mmol/L,P<0.001)。中心实验室测定的血浆氯离子浓度值>均较ICU测定值低1mmol/L(可信区间1.3-0.7mmol/L,P,0.001)。除了血浆钠离子浓度与血浆白蛋白浓度呈中等强度的相关性外,其它测定值与血浆成分的相关性均较弱。血浆白蛋白浓度下降时,不同测定法(中心实验室—ICU)得出的血浆钠离子浓度差值增大(差值=6.2-0.16白蛋白(g/L);P<0.001,r=-0.46,r2=0.22)。

结论:中心实验室与ICU的血浆钠离子和氯离子的测定值在分析>法,统计学临均有差异性。应当将这种差异考虑在内,否则将影响低白蛋白血症病人(如危重病人)的临断治疗>案的确定。

(印洁敏 陈杰 校)

BACKGROUND: We tested the hypothesis that the difference between indirect and direct sodium assays would be related to the plasma albumin concentration. Further, we proposed that differences between indirect and direct chloride assays might be explained by interference from other plasma constituents, particularly bicarbonate, and possibly albumin.

METHODS: We studied 300 critically ill patients at the time of admission to the intensive care unit (ICU) and compared each patient’s plasma sodium and chloride measurements from a central laboratory assay (indirect electrode) and an ICU blood gas machine assay (direct electrode).

RESULTS: The central laboratory sodium measurement was, on average, 2.1 mmol/L more than the ICU assay, limits of agreement 1.8–2.4 mmol/L greater, P < 0.001. The central laboratory chloride measurement was, on average, 1 mmol/L less than the ICU assay (limits of agreement 1.3–0.7 mmol/L less, P < 0.001). All correlations between the assay differences and plasma constituents were weak except for a moderately strong correlation between differences in sodium measurements and albumin. The difference in plasma sodium concentration between the assays (central laboratory – ICU) increased as the plasma concentration albumin decreased (difference = 6.2–0.16 albumin (g/L); P < 0.001, r = –0.46, r2 = 0.22).

CONCLUSIONS: The central laboratory and ICUs assays are analytically, statistically, and clinically different for both sodium and chloride. Unless taken into account, the differences could be large enough in hypoalbuminemic populations (such as critically ill patients) to affect clinical diagnosis and decision making.

 

蒸汽消毒>纤维喉镜片光强度的影响

Changes in the Light Intensity of the Fiberoptic Laryngoscope Blade by Steam Sterilization

Tomoki Nishiyama, MD, PhD

From the Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

Anesth Analg 2007 104: 908-910.

 

背景:作者研究了蒸汽消毒>重复使用的喉镜镜片光强度的影响。

>法:用蒸汽消毒六支新的,可重复使用的Macintosh纤维喉镜片。测量它们的光强度,>镜片的头端进行拍摄,>同时测量新的、一次性的Macintosh镜片。

结果:经过20次消毒后,使用的镜片光强度仍大于一次性镜片。在经过80次消毒后,它的光强度却发生了显著的下降。摄片显示镜片出现不稳定的光亮度>变,>且这种变化随消毒次数的增而增大。

结论:相>于重复使用的纤维喉镜片而言,一次性塑料镜片的照明效果更好。

(郑丽 陈杰 校)
BACKGROUND:
I investigated the effects of steam sterilization on light intensity of reusable fiberoptic laryngoscope blades.

METHODS: Six new reusable fiberoptic Macintosh laryngoscope blades were steam sterilized. The light intensity was measured, the tip of the blades was photographed, and the light intensity of six new plastic disposable Macintosh laryngoscope blades was also measured.

RESULTS: The light intensity of reusable blades exceeded that of the disposable blades after 20 sterilizations, but was significantly lower after 80 sterilizations. The photographs showed irregular lighting of the blades, which increased with repeated sterilization.

CONCLUSIONS: Disposable plastic blades provide more illumination than reusable fiberoptic blades subjected to repeated sterilization.

 

大鼠L5神经结扎>福尔马林反应的>变——一>行为学和分子学研究

Altered Response to Formalin by L5 Spinal Nerve Ligation in Rats: A Behavioral and Molecular Study

Ryuji Kaku, MD, Masataka Yokoyama, MD, Hiroyuki Kobayashi, MD, Yoshikazu Matsuoka, MD, Tetsufumi Sato, MD, Satoshi Mizobuchi, MD, Yoshitaro Itano, PhD, and Kiyoshi Morita, MD

From the Department of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama City 700-8558, Japan.

Anesth Analg 2007 104: 936-943.

 

背景:神经性疼痛能>变大鼠>注射福尔马林的反应性。然而,>变的发生机制还不清楚。

>法:用免疫细胞法检测大鼠L5神经结扎(SNL)导致神经病变的衍生神经营养因子(BDNF)和降钙素基因相关肽(CGRP)的表达,同时观察SNL大鼠后爪注射福尔马林后髓c-fos的表达。

结果SNL后四周,SNL组的停药阈值明显比假治疗组低(n=12每组,P<0.05)。在SNL组,BDNFL4P<0.05)和L5(P<0.01)背角表面的表达与假治疗组相比明显降低。CGRP蛋白在L5而不是L4背角的表达>比假治疗组明显降低(P<0.01)。福尔马林注射后SNL组自然疼痛反应比假治疗组明显降低(P<0.05)。在SNLL4L5背角免疫标志物c-fos>明显降低。

结论c-fos的分布揭示髓炎性疼痛反应的神经活>急性疼痛知觉可能是非常重要的。SNL导致的神经病变而引起BDNF表达降低可能包括于这一>变。

(顾新宇 陈杰 校)

BACKGROUND: The status of neuropathic pain alters the responsiveness to formalin injection in rats. However, the mechanism by which this alteration occurs is unknown.

METHODS: We used immunocytochemistry to examine the expression of brain-derived neurotrophic factor (BDNF) and calcitonin gene-related peptide (CGRP) in the spinal cord of rats with L5 spinal nerve ligation (SNL)-induced neuropathy, and investigated the expression of c-Fos in the spinal cord after injection of formalin in the hindpaw of rats with SNL.

RESULTS: Four weeks after SNL, the withdrawal threshold was significantly lower in the SNL group than in the sham-operated (sham) group (n = 12 per group, P < 0.05). In the SNL group, expression of BDNF in the L4 (P < 0.05) and L5 (P < 0.01) superficial dorsal horn was significantly decreased compared to that in the sham group. CGRP protein in the L5 but not in the L4, dorsal horn was significantly decreased compared to that in the sham group (P < 0.01). After formalin injection, spontaneous pain responses in the SNL group were significantly decreased compared to those in the sham group (P < 0.05). Immunolabeling for c-Fos was significantly decreased in the L4 and L5 dorsal horn in the SNL group (P < 0.01).

CONCLUSION: Our examination of c-Fos distribution indicates that decreased neuronal activity in the spinal cord in response to inflammatory pain may be important for altering the perception of acute pain. Decreased BDNF expression in response to SNL-induced neuropathy may be involved in this alteration.

 

I类心律失常药物的皮肤镇痛作用

The Cutaneous Analgesic Effect of Class I Antiarrhythmic Drugs

Jann-Inn Tzeng, MD, MS*, Kuang-I Cheng, MD Kuo-Lun Huang, MS*, Yu-Wen Chen, PhD*, Koung-Shing Chu, MD Chin-Chen Chu, MD*, and Jhi-Joung Wang, MD, PhD*

From the *Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Anesthesiology, Taipei Medical University, Taipei, Taiwan; and Department of Anesthesiology, Kaohsiung Medical University Chun-Ho Memorial Hospital, Kaohsiung, Taiwan.

Anesth Analg 2007 104: 955-958. [

 

背景:局麻药作用于神经时可阻断Na+通道而产生可逆的感觉丧失。因为所有的I类心律失常药物都是Na+通道阻断剂,理论,它们>具有局麻药作用。此研究中,作者研究了三个I类心律失常药物的表皮局麻作用。

>法:用大鼠皮下浸润药物做模型,将奎尼丁(IA)、脉律定(IB)和氟卡尼(IC) 作用效能和持续时间与利多卡因和布比卡因的作用相比较。注射生理盐水作>照组。

结果:三个I类心律失常药物产生剂量依赖性表皮镇痛作用,镇痛效能等级是布比卡因〉氟卡尼〉奎尼丁〉脉律定〉利多卡因(药物>间的差别p<0.05),在等效的基础,作用持续时间的等级是氟卡尼〉布比卡因〉脉律定和利多卡因(药物>间的差别p<0.05)。

结论:三个I类心律失常药物,奎尼丁(IA),脉律定(IB),和氟卡尼(IC)具有局麻作用。

(张美荣 陈杰 校)

BACKGROUND: Local anesthetics, when applied to nerves, produce reversible loss of sensation by blocking Na+ channels. Because all Class I antiarrhythmic drugs are Na+ channel blockers, theoretically, they may have local anesthetic effects. In this study, we sought to define the cutaneous local anesthetic actions of three Class I antiarrhythmic drugs.

METHODS: Using a subcutaneous infiltration model in rats, the potencies and durations of action of quinidine (Class IA), mexiletine (IB), and flecainide (IC) were determined and compared with the actions of lidocaine and bupivacaine. Saline injection was used as control.

RESULTS: Three Class I antiarrhythmic drugs produced a dose-related cutaneous analgesia with ranking of potencies of bupivacaine > flecainide > quinidine > mexiletine > lidocaine (P < 0.05 for the differences among drugs). On an equipotent basis, the ranking of durations of action was flecainide > quinidine and bupivacaine > mexiletine and lidocaine (P < 0.05 for the differences among drugs).

CONCLUSION: Three Class I antiarrhythmic drugs, quinidine (IA), mexiletine (IB), and flecainide (IC) have a local anesthetic effect on cutaneous analgesia.

 

中央轴索阻滞后严重和长时神经>和髓>发症

Severe and Long-Lasting Complications of the Nerve Root and Spinal Cord After Central Neuraxial Blockade

Mathieu-Panchoa de Sèze, MD*, François Sztark, MD Gérard Janvier, MD and Pierre-Alain Joseph, MD*

From the *Neurological Rehabilitation Unit; Department of anesthesiology, Pellegrin Hospital; and Department of anesthesiology, Haut Lévêque Hospital, University Hospital Bordeaux, Bordeaux, France.

Anesth Analg 2007 104: 975-979.

 

背景:麻和硬膜外麻醉后可发生少但严重的>发症。本文作者道2000>法国发生的中央轴索阻滞后>发症。

>法:这是一>回顾性问卷研究,调查范围包括全法国所有康复中心,调查>象为中央轴索阻滞后长期严重的神经>和髓>发症。

结果:所有的专科中心和44%的非专科中心参了本次调查。共计有12例(93女)有严重>发症,其中60%患者超过50岁。所有的患者3个月后仍有神经系统缺陷。7例接受麻,4例接受硬膜外麻醉,1例接受两种操作。只有3例有出血损伤,其他9例中解剖异常较为普遍,包括5例腰椎管管狭窄和2例蛛网膜。

结论:这些发现表明神经>发症受髓情况的影响。

(李惟一 陈杰 校)

BACKGROUND: Although rare, major complications after spinal and epidural anesthesia do occur. We report the complications after central neuraxial blockade occurring in 2000 in France.

METHODS: A retrospective questionnaire study was sent to all French rehabilitation centers to detail severe and long-lasting neurologic complications after central neuraxial blockade.

RESULTS: All specialized and 44% of the nonspecialized centers answered. Twelve cases, nine women and three men, were noted, 60% of which involved patients over 50 yr of age. All patients still had neurological deficits after 3 mo. Seven received spinal anesthesia, four had epidural anesthesia, and one had both procedures. Hemorrhagic lesions were found in only three patients. Among the nine other patients, anatomic abnormalities were common, including five instances of lumbar canal stenosis and two with spinal arachnoid cysts.

CONCLUSIONS: These findings suggest the influence of underlying spinal conditions in these complications.

 

不同浓度的罗哌卡因硬膜外麻醉>七氟醚需求的影响

The Effect of Epidural Anesthesia with Different Concentrations of Ropivacaine on Sevoflurane Requirements

Jie Zhang, BS, Wei Zhang, MS, and Bin Li, MS

Jie Zhang, Department of Anesthesiology, The First Affiliated Hospital of ZhengZhou University, No. 1 East-JianShe Road, ZhengZhou

Anesth Analg 2007 104: 984-986.

背景:作者评估了全身麻醉复合硬膜外麻醉时不同浓度的罗哌卡因下七氟醚的需求量

>法56位病人随机分为3组,硬膜外分别给予生理盐水,0.2%罗哌卡因,1%罗哌卡因。调七氟醚浓度维持一定的麻醉深度。分别在在插管前,插管后51015202530 min记录BIS和吸入的七氟醚浓度。

结果:在接受高浓度的罗哌卡因组,七氟醚的呼气末浓度较低。

结论:使用较高浓度的罗哌卡因硬膜外麻醉能减少七氟醚需求量。

(李惟一 陈杰 校)

BACKGROUND: We evaluated sevoflurane requirements during combined general-epidural anesthesia with different concentration of ropivacaine.

METHODS: Fifty-six patients were randomly divided into three groups to epidurally receive saline, 0.2% ropivacaine or 1% ropivacaine. Sevoflurane concentration was adjusted to maintain certain anesthesia depth. BIS values and end-tidal sevoflurane concentrations were recorded at time points of pre-intubation and 5 min, 10 min, 15 min, 20 min, 25 min, 30 min after intubation.

RESULTS: End-tidal sevoflurane was significantly lower in the group receiving higher concentration of sevoflurane.

CONCLUSIONS: Epidural anesthesia can decrease sevoflurane requirements to a larger extent when a higher concentration of ropivacaine was applied.


>影响小儿门行扁桃腺切除术和增殖腺切除术后恢复的因素的分析

An Analysis of Factors Influencing Postanesthesia Recovery After Pediatric Ambulatory Tonsillectomy and Adenoidectomy

Alice A. Edler, MD, MPH, MA*, Edward R. Mariano, MD{dagger}, Brenda Golianu, MD*, Calvin Kuan, MD*, and Krassimira Pentcheva, MD*

From the *Department of Anesthesia, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; and {dagger}Department of Anesthesia, San Diego School of Medicine, University of California, San Diego, California.

Anesth Analg 2007;104:784-789

背景:许多因素可能导致小儿患者在麻醉后恢复室(PACU)里的逗留时间(LOS)延长。我们设计了这个前瞻性研究来鉴别延长LOS的术前和术后因素。

>法:我们研究了166例>龄1-18岁在气管插管的全身麻醉下行扁桃腺切除术和增殖腺切除术或者两侧鼓膜切开术的小儿。主要的监测指标为在麻醉后恢复室的时间,直到达到预先确定的出室标准。

结果:术后恶心和呕吐事件的数目、患者>龄和氧去饱和的数目都有明显延长LOS (P < 0.05)。术后恶心和呕吐(P < 0.05)或者氧去饱和到95% (P < 0.05)都增患者的LOS 0.5小时。呼吸道感染、情绪激和父母忧虑都没有明显延长LOS

结论:这一研究是第一次在小儿患者中研究LOS的多种因素。在麻醉前预先鉴别LOS延长的风险性的意>,不仅用于合理分配PACU资源和医人员的配置,而且用于提高理质量和保证>小儿患者和他们家庭的最低限度的创伤性麻醉经历。

(彭中美 马皓琳 李士通校)

BACKGROUND: Many factors contribute to prolonged length of stay (LOS) for pediatric patients in the postanesthesia care unit (PACU). We designed this prospective study to identify the pre- and postoperative factors that prolong LOS.

METHODS: We studied 166 children, aged 1–18 yr, who underwent tonsillectomy and adenoidectomy or tonsillectomy and adenoidectomy, and bilateral myringotomy with tube insertion under general anesthesia. The primary outcome measure was the time spent in the PACU until predetermined discharge criteria were met.

RESULTS: The number of episodes of postoperative nausea and vomiting, patient age, and number of oxygen desaturations contributed significantly (P < 0.05) to prolonged LOS. Each episode of postoperative nausea and vomiting (P < 0.05) or oxygen desaturation to <95% (P < 0.05) increased the patient's LOS by 0.5 h. History of upper respiratory tract infection, emergence agitation, and parental anxiety did not significantly predict increased LOS.

CONCLUSION: This investigation is the first composite view of LOS in pediatric patients. The significance of identifying patients at risk of prolonged LOS prior to anesthesia is of use not only in allocating PACU resource and staffing needs, but also for improving quality of care and ensuring a minimally traumatic anesthetic experience for our pediatric patients and their families.

 

 

奥坦西隆和地塞米松的不同剂量组合用以预防术后恶心呕吐

Ondansetron and Dexamethasone Dose Combinations for Prophylaxis Against Postoperative Nausea and Vomiting

Michael J. Paech, DM*, Matthew W.M. Rucklidge, FRCA*, Jennifer Lain, FANZCA*, Philip H. Dodd, FRCA*, Emma-Jane Bennett, MBBS*, and Dorota A. Doherty, PhD{dagger}

From the *Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia; and {dagger}Biostatistics and Research Design Unit, Women and Infants Research Foundation, Western Australia.

Anesth Analg 2007;104:808-814

背景:术后恶心呕吐的高危患者经常使用不止一种预防性止吐药。此次研究旨在确定四种地塞米松和奥坦西隆配伍的剂量中哪一种(或几种)较有效。

>法:在随机双盲试验中,行日间妇科>腔镜手术的女性患者,静脉注射四种剂量配伍的地塞米松和奥坦西隆:4 + 4 mg (D4/O4, n = 154) 4 + 2 mg (D4/O2, n = 151)2 + 4 mg (D2/O4, n = 154) 2 + 2 mg (D2/O2, n = 155)

结果:各组的预知危险性和>性无显著性差异。出院前呕吐的发生率无显著性差异(D4/O4D4/O2D2/O4D2/O2组分别为5%4%9%8% P = 0.17)。各组术后24小时内呕吐的发生率、无恶心呕吐、止吐药物治疗、无止吐药物治疗无呕吐(80%–83% 组间交叉)、住院病人满意程度和恢复评分住院时间亦无显著性差异。各组的>均恶心评分都很低,但术后24小时内恶心的发生率在地塞米松2mg组中明显高于其他组(P < 0.03)

结论:四种配伍都显示了呕吐和解救治疗的低发生率,地塞米松2mg和奥坦西隆2mg配伍与其他组相比无显著性差异,只不过使用地塞米松2mg的组中恶心的发生率较高。

(唐李隽 马皓琳 李士通 校)

BACKGROUND: Patients at high risk of postoperative nausea and vomiting often receive more than one prophylactic antiemetic drug. In this study we sought to determine whether one or more of four dose combinations of dexamethasone and ondansetron was superior in efficacy.

METHODS: In a randomized, double-blind trial of four dose combinations, women having day-surgical gynecologic laparoscopy received IV dexamethasone and ondansetron 4 + 4 mg (Group D4/O4, n = 154), 4 + 2 mg (Group D4/O2, n = 151), 2 + 4 mg (Group D2/O4, n = 154), or 2 + 2 mg (Group D2/O2, n = 155).

RESULTS: The groups were not significantly different for predicted risk or characteristics. The incidence of vomiting until discharge did not differ significantly (5%, 4%, 9% and 8% for Groups D4/O4, D4/O2, D2/O4 and D2/O2 respectively, P = 0.17), nor were there significant differences among groups in the incidence of vomiting until 24 h postoperatively, no nausea and no vomiting, antiemetic treatment, neither vomiting nor antiemetic treatment (80%–83% across groups), or inpatient satisfaction and recovery scores, or time to discharge. Average nausea scores were low in all groups, but the incidence of nausea until 24 h postoperatively was significantly higher among groups receiving only 2 mg of dexamethasone (P < 0.03).

CONCLUSIONS: All combinations were associated with a low incidence of vomiting and rescue treatment, with dexamethasone 2 mg plus ondansetron 2 mg not significantly different to other dose combinations except that groups receiving 2 mg dexamethasone had a more frequent incidence of nausea.

 

 

笑气>髓神经元伤害性刺激反应的兴奋和制作用

The Excitatory and Inhibitory Effects of Nitrous Oxide on Spinal Neuronal Responses to Noxious Stimulation

Joseph F. Antognini, MD*{dagger}, Richard J. Atherley, BS*, Robert C. Dutton, MD{ddagger}, Michael J. Laster, DVM{ddagger}, Edmond I. Eger, II, MD{ddagger}, and Earl Carstens, PhD{dagger}

From the *Department of Anesthesiology and Pain Medicine; {dagger}Section of Neurobiology, Physiology and Behavior, University of California, Davis, California; and {ddagger}Department of Anesthesia and Perioperative Care, University of California, San Francisco, California.

Anesth Analg 2007;104:829-835

背景:由于在高比重情况下测定的数理逻辑障碍>面的原因,单独的笑气>髓神经元的作用以往未见有检验。我们假设,与其它吸入麻醉药一样,笑气>能制髓神经元>伤害性刺激的反应。

>法:在用异氟醚麻醉大鼠暴露腰段髓。将机械通气的大鼠置入高压舱,在后爪插入针电极。然后停止使用异氟醚,通过使笑气舱的压大来>用笑气麻醉。用计算机控制的发机和水微型推进器在大鼠髓腰段插入微电极,记录吸入1.522.5atm0.8–1.3MAC)笑气时,电刺激大鼠后爪引发的神经元反应。

结果:不定量地升高笑气分压影响了神经元>2100-Hz电刺激的反应。神经元的深度和神经元的反应具有相关性,髓表面的神经元倾向于易化,而深部的神经元产生制(笑气为1.522.5atm时,总的反应分别为1331 ± 4081594 ± 3831578 ± 500/分,>均值,标准误)。笑气>不影响神经元>重复“终结”刺激的反应。给予各大鼠输入NMDA受体阻滞剂MK-801,大鼠髓神经元>100-Hz电刺激的反应增强(从781±2161352±269/分,P<0.05)。

结论:笑气易化表面神经元>伤害性刺激的反应,但制深部神经元的反应。这些结果表明,笑气在麻醉常用分压时>髓神经元伤害性刺激反应有不同影响,这个>的反应依赖于神经元的深度。

(张> 马皓琳 李士通校)

BACKGROUND: Because of the logistical obstacles to measurement under hyperbaric conditions, the effect of nitrous oxide (N2O) alone on spinal neuronal responses has not been tested. We hypothesized that, like other inhaled anesthetics, N2O would depress spinal neuronal responses to noxious stimulation.

METHODS: The lumbar spinal cord was exposed in rats anesthetized with isoflurane. Mechanically ventilated rats were placed into a hyperbaric chamber and needle electrodes were inserted into the hindpaws. Isoflurane administration was discontinued and anesthesia converted to N2O by pressurizing the chamber with N2O. A microelectrode was inserted into the lumbar cord using computer-controlled motors and a hydraulic microdrive. Neuronal responses to electrical stimulation of the hindpaw were sought at 1.5, 2, and 2.5 atm N2O (0.8–1.3 minimum alveolar concentration).

RESULTS: Increasing N2O partial pressures variably affected neuronal responses to a 2 s 100-Hz electrical stimulus. Neuronal depth and neuronal response were correlated, with superficial neurons tending to be facilitated, while deeper neurons were depressed; (overall responses were 1331 ± 408, 1594 ± 383, and 1578 ± 500 impulses/min at 1.5, 2, and 2.5 atm N2O, respectively; mean, standard error). N2O did not affect neuronal responses to a repetitive "windup" stimulus. Infusion of the N-methyl-d-aspartate blocker MK-801 into separate rats increased the neuronal response to the 100-Hz stimulus (from 781 ± 216 to 1352 ± 269 impulses/min, P < 0.05).

CONCLUSIONS: N2O facilitated superficial spinal neuronal responses to noxious stimulation while depressing deeper neurons. These results suggest that anesthetic partial pressures of N2O have divergent effects on spinal neuronal responses to noxious stimulation, the specific responses depending on the depth of the spinal neurons.

 

 

比较两种输出能量>激光辅给予表面麻醉剂LMX-4®>剂在静脉穿刺前使用的增强效果

A Comparison of Laser-Assisted Drug Delivery at Two Output Energies for Enhancing the Delivery of Topically Applied LMX-4® Cream Prior to Venipuncture

Jeffrey L. Koh, MD, MBA*{dagger}, Dale Harrison, MPH{dagger}, Veronica Swanson, MD*{dagger}, Daniel C. Norvell, PhD{ddagger}, and Darren C. Coomber, PhD

From the Departments of *Anesthesiology and Peri-Operative Medicine and {dagger}Pediatrics, Oregon Health and Science University, Doernbecher Children’s Hospital, Portland, Oregon; {ddagger}Olympic Research, Incorporated, Lakewood, Washington; and Norwood Abbey, Limited, Chelsea Heights, Victoria, Australia.

Anesth Analg 2007;104:847-849

背景:激光辅给药(LAD)具有促进表面麻醉减少起效时间的潜在作用。

>法:在这>随机,双盲,交叉研究中,我们比较了两种输出能量(2.03.5 J/cm2LAD用于静脉穿刺前表面麻醉的效能和不良事件。

结果:低能量和高能量激光的>均视觉模拟疼痛评分没有统计学差异(均值分别是6.78.1P0.57)。

结论:在促进表面麻醉>面,2.0 J/cm2570 mJ)能量的LAD3.5 J/cm21000 mJ)的LAD同样有效,不良事件相似。

(颜涛 译,马皓琳 李士通 校)

BACKGROUND: Laser-assisted drug delivery (LAD) has the potential for facilitating topical anesthesia with reduced onset time.

METHODS: In this randomized, double-blind, crossover study we compared the efficacy and adverse event profile of LAD for topical anesthesia before venipuncture using two output energies (2.0 and 3.5 J/cm2).

RESULTS: Mean Visual Analog Scale pain scores were not statistically different (P = 0.57) between the low-energy (mean = 6.7) and high-energy (mean = 8.1) lasers.

CONCLUSIONS: LAD at an energy of 2.0 J/cm2 (570 mJ) is as effective, with similar adverse events, as an energy of 3.5 J/cm2 (1000 mJ) in facilitating topical anesthesia.

 

 

传感器错位所得双频指数值的可靠性:与传感器位于厂商推荐部位所得值的比较

The Validity of Bispectral Index Values from a Dislocated Sensor: A Comparison with Values from a Sensor Located in the Commercially Recommended Position

Toshinori Horiuchi, MD, Masahiko Kawaguchi, MD, Naoko Kurita, MD, Satoki Inoue, MD, and Hitoshi Furuya, MD

From the Department of Anesthesiology, Nara Medical University, Nara, Japan.

Anesth Analg 2007;104:857-859

背景:传感器错位>双频指数(BIS)值的影响尚不清楚。我们>传感器错位与厂商推荐部位所得的BIS值进行了比较。

>法:我们>每一位接受丙酚麻醉的患者使用两个BIS传感器:一个位于厂商推荐部位而另一个位于右眼侧角的周围。

结果:BlandAltman分析提示除外麻醉诱导从麻醉苏醒过程中,两个BIS值一致性较好。

结论:结果提示在全麻诱导和麻醉苏醒过程中,错位的BIS传感器可能产生可疑的BIS值。

(黄施伟 译,马皓琳 李士通 校)

BACKGROUND: The influence of sensor dislocation on bispectral index (BIS) values is not clear. We compared the BIS values obtained from dislocated sensors with those from the commercially recommended positions.

METHODS: We used two BIS sensors for each patient receiving propofol-based anesthesia; one in the recommended position and one positioned around the lateral corner of the right eye.

RESULTS: Bland and Altman analysis revealed better agreement of two BIS values when the values during induction of and emergence from anesthesia were excluded.

CONCLUSIONS: The results indicate that during induction of and emergence from general anesthesia, a dislocated BIS sensor may produce questionable BIS values.

 

 

重症监病房患者中的室性心律失常:短期和长期后果

Supraventricular Arrhythmias in Intensive Care Unit Patients: Short and Long-Term Consequences

Sergei Goodman, MD, Taras Shirov, MD, and Charles Weissman, MD

From the Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Anesth Analg 2007;104:880-886

背景:室性心律失常(SVA),包括房颤和房扑,在外科和非外科重症监室(ICU)的病人非常常见。非心胸手术后新发生房性心律失常的外科ICU病人的死亡率增。我们拟确定在这些病人导致新发作SVA的发展死亡率的住院前和ICU中一些影响因素。

>法:收入三级医院的普通ICU的连续病人(n = 611)在出院前均前瞻性随访SVA的>象、这些心律失常的潜在病因以发生这些心律失常的结果。筛除标准为最近实施过心/胸手术或胸部外伤的病人。同时评估长期存活率(从入院开始计算48个月)。

结果52例病人(9%)新近发生了SVA75例病人(12%)入院前有SVA的病史。未发生SVA的病人中,87例病人(18%)在住院期间死亡,而那些新近发生SVA和有SVA病史的病人中,分别有29例(56%)和23例(31%)在住院期死亡。ICU各组病人的死亡与败血症、急性肾能衰竭、心肌缺血高的APACHE(急性生理和慢性健康评估)II分值有关。新近发生SVA的病人较没有发生SVA的病人APACHE II评分较高,分别为23 ± 8sd)和16 ± 8P < 0.05)。住院1>后,新发生SVA的病人、有SVA病史的病人以未发生SVA者中分别有65%50%20%的病人死亡。

结论ICU病人经常会有新近发生的SVA,这可以作为住院病人和1>后死亡率极高的标志。

(邱郁薇 马皓琳 李士通 校)

BACKGROUND: Supraventricular arrhythmias (SVA), including atrial fibrillation and flutter, are common in surgical and nonsurgical intensive care unit (ICU) patients. There is increased mortality among surgical ICU patients who develop new-onset atrial arrhythmias after noncardiac, nonthoracic surgery. We sought to determine the preadmission and intra-ICU factors associated with the development of new-onset SVA and mortality in these patients.

METHODS: Consecutive patients (n = 611) admitted to a general ICU of a tertiary care hospital were prospectively followed until hospital discharge for evidence of SVA, potential etiologies of these arrhythmias, and consequences of the arrhythmias. Excluded were patients who sustained recent cardiac/thoracic surgery or trauma to the thorax. Long-term survival rates (48 mo from the date of hospitalization) were also determined.

RESULTS: Fifty-two (9%) patients developed new-onset SVA and 75 (12%) had prehospital admission histories of SVA. Eighty-seven (18%) of those without SVA died while hospitalized, while 29 (56%) and 23 (31%) of those with new-onset and histories of SVA, respectively, died while hospitalized. ICU mortality in all groups was associated with sepsis, acute renal failure, myocardial ischemia, and high APACHE II scores. The APACHE II scores were higher (23 ± 8 [sd]) in new-onset SVA than in the group without SVA (16 ± 8, P < 0.05). Within a year of hospital admission 65% in the new-onset, 50% in the SVA history, and 20% in the no-SVA groups died.

CONCLUSIONS: New-onset SVA occur frequently in ICU patients and are markers of extremely high in-hospital and 1-yr mortality.

 

 

七氟醚影响大鼠前脑缺血后神经发生

Sevoflurane Affects Neurogenesis After Forebrain Ischemia in Rats

Kristin Engelhard, MD*, Uta Winkelheide, DVM*, Christian Werner, MD*, Julia Kluge, DVD{dagger}, Eva Eberspächer, DVM{ddagger}, Regina Hollweck, Dipl Stat, Peter Hutzler, PhD||, Jürgen Winkler, MD, and Eberhard Kochs, MD{dagger}

From the *Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Mainz; {dagger}Klinik für Anaesthesiologie, Technische Universität, Munich, Germany; {ddagger}Veterinary Medical Teaching Hospital, UC Davis, California; Institut für Medizinische Statistik und Epidemiologie, Technische Universität, Munich; ||Institut für Pathologie des GSF-Forschungszentrums, Neuherberg, Germany; and ¶Klinik für Neurologie, Universität Regensburg, Regensburg, Germany.

Anesth Analg 2007;104:898-903

背景:七氟醚>神经损伤后神经发生潜能的作用至未明。本实验研究了七氟醚在低浓度和高浓度下>脑缺血后内源性神经发生的影响。

>法:麻醉>人工通气的大鼠随机分为4个不同的处理组。组1和组2大鼠吸入1.4%七氟醚,组3和组4大鼠吸入2.8%七氟醚。组1和组3为非脑缺血组(假手术组),组2和组4通过>闭大鼠双侧颈脉>放血造成低血压引起10分钟的前脑缺血。各生理学参数保持恒定。给予溴脱氧尿苷作为神经发生指示剂。28天后,灌流固定大鼠脑组织。>苏木精-红(HE)染色的脑切片,用HE染色指数评估大鼠脑海马组织病理学损伤 0=无损伤;11%–10% 损伤; 2 = 11%–50% 损伤; 3 = 51%–100%损伤)。采用免疫组织化学检测溴脱氧尿苷阳性神经元。8只未经处理的大鼠作为空白>照组(组5)。

结果:同空白>照组比较,没有观察到假手术组组织病理学损伤和神经发生>变。1.4%七氟醚麻醉的大鼠中,脑缺血产生轻度神经元损伤(HE指数0.64 ± 0.84)且神经发生较假手术组增60%;2.8%七氟醚麻醉的大鼠中,脑缺血组HE指数为1.22 ± 1.14,且新发生的神经元数较假手术组增230%。

结论:目前数据提示高浓度七氟醚可在脑缺血后刺激齿回神经发生。

(周雅春 马皓琳 李士通 校)

BACKGROUND: The effect of sevoflurane on the neuroregenerative potential after neuronal injury is unclear. We investigated the effect of low and high concentrations of sevoflurane on endogenous neurogenesis after cerebral ischemia.

METHODS: Anesthetized and ventilated rats were randomized to four different treatment groups. Groups 1 and 2: 1.4% sevoflurane; Groups 3 and 4: 2.8% sevoflurane. In Groups 1 and 3, no cerebral ischemia was induced (sham-operated). In Groups 2 and 4, 10 min of forebrain ischemia was induced by bilateral carotid artery occlusion plus hemorrhagic hypotension. Physiological variables were maintained constant. Bromodeoxyuridine was given as a marker of neurogenesis. After 28 days brains were perfused. Histopathological damage of the hippocampus was evaluated in hematoxylin and eosin (HE) stained sections using the HE-index (0 = no damage; 1 = 1%–10% damage; 2 = 11%–50% damage; 3 = 51%–100% damage). Immunohistochemistry was used to detect bromodeoxyuridine-positive neurons. Eight untreated rats were investigated as naive controls (Group 5).

RESULTS: In neither sham-operated group was histopathological damage or change in neurogenesis observed compared to naive controls. In rats anesthetized with 1.4% sevoflurane, cerebral ischemia caused mild neuronal damage (HE-index of 0.64 ± 0.84) and increased neurogenesis by 60% when compared with respective sham-operated animals; with 2.8% sevoflurane, the HE-index was 1.22 ± 1.14, and the number of newly generated neurons increased by 230% when compared with respective sham-operated animals.

CONCLUSION: The present data suggest that high concentrations of sevoflurane stimulate neurogenesis in the dentate gyrus after cerebral ischemia.

 

 

曲马多中入小剂量氯胺酮用于术后镇痛:>部手术后的一个双盲,随机,安慰剂>照试验

The Addition of a Small-Dose Ketamine Infusion to Tramadol for Postoperative Analgesia: A Double-Blinded, Placebo-Controlled, Randomized Trial After Abdominal Surgery

Ashley R. Webb, MBBS, FANZCA, Bradley S. Skinner, MBBS, Samuel Leong, MBBS, FANZCA, Helen Kolawole, MBBS, FANZCA, Tyron Crofts, MBBS, FANZCA, Murray Taverner, MBBS, FANZCA, and Sara J. Burn, BA RN

From the Department of Anesthesia, Frankston Hospital, Frankston, Victoria, Australia.

Anesth Analg 2007;104:912-917

背景:在人类术后镇痛中应用氯胺酮复合曲马多的资料比较少。我们将验证了这样一个假设,即在较大的>部外科手术后在曲马多中入氯胺酮将>善镇痛效果。

>法:在这个双盲,随机,>照试验中,120名接受择期剖>手术的成>病人被随机分成氯胺酮组(手术中给予0.3mg/kg的氯胺酮,术后给予0.1mg/kg/h的氯胺酮)和>照组(给予和氯胺酮组同样量和速度的安慰剂)。两组病人在手术中都给予3mg/kg的曲马多,术后给予48h0.2mg/kg/h的曲马多输注。如果镇痛效果不佳,每个病人还可以自控吗啡镇痛。

结果:48小时研究期间中氯胺酮组病人无论在静息时(P=0.01)还是活时(P=0.02)疼痛程度都较轻,吗啡需要量>较少(P=0.003)。在在0-24小时期间,氯胺酮>善了病人主观的镇痛(P=0.008),镇静更少(P=0.01),且较少地需要医师>预来处理重度疼痛(P=0.01)。氯胺酮组病人>觉发生率更高,但其他一些副反应两组相似。
结论:在较大的>部手术后在曲马多和吗啡中入小剂量氯胺酮是有用的。
(姜旭晖译,马皓琳 李士通校)

BACKGROUND: There are few data on combining ketamine with tramadol for postoperative analgesia in humans. We tested the hypothesis that adding ketamine to tramadol would improve analgesia after major abdominal surgery.

METHOD: In this double-blind, randomized, controlled trial, adult patients (n = 120) having elective laparotomy were randomly assigned to a ketamine group (intraoperative ketamine 0.3 mg/kg and postoperative infusion at 0.1 mg · kg–1 · h–1) or control group (equivalent volume/rate of normal saline). All patients received intraoperative tramadol 3 mg/kg and a tramadol infusion (0.2 mg · kg–1 · h–1) for 48 h postoperatively and had morphine patient-controlled analgesia available for rescue analgesia.

RESULTS: The ketamine group had less pain at rest (P = 0.01) and with movement (P = 0.02) and required less morphine (P = 0.003) throughout the 48-h study period. In the 0–24 h period, ketamine improved subjective analgesic efficacy (P = 0.008), was less sedating (P = 0.03), and required fewer physician interventions to manage severe pain (P = 0.01). Hallucinations were more common in ketamine patients, but other side effects were similar.

CONCLUSION: Small-dose ketamine was a useful addition to tramadol and morphine after major abdominal surgery.

 

 

静脉内使用单核髓细胞逆转实验性单一神经病变产生的神经性疼痛

Intravenous Mononuclear Marrow Cells Reverse Neuropathic Pain from Experimental Mononeuropathy

Markus Klass, MD, PhD*, Vitaliy Gavrikov, MD*, Danielle Drury, BSE*, Bethany Stewart*, Stephen Hunter, MD{dagger}, Donald D. Denson, PhD*, Allen Hord, MD*, and Marie Csete, MD, PhD*

From the Departments of *Anesthesiology and {dagger}Pathology, Emory University School of Medicine, Atlanta, Georgia.

Anesth Analg 2007;104:944-948

背景:>细胞在多种神经系统损伤模型中调神经保的作用。本研究中,我们评估了>细胞在疼痛治疗>面潜在的作用。应用了包括混合>细胞群的骨髓单核细胞,这是由于这类细胞在实验临移植>面有>泛的经验。

>法:在>坐骨神经进行慢性缩窄性损伤(CCI)后,用来自于同一菌株或带载体的新鲜离体的骨髓单核细胞(0.5 mL107个细胞IV)处理成>雄性SD大鼠。分析的主要终>是热和机械的高敏性,通过盲法,评估大鼠>校正热源刺激的缩爪潜伏期 (PWL)>Von Frey细丝的缩爪反应。

结果:骨髓移植>不能防止疼痛,且CCI后5天,所有的物都同样受到损伤。而CCI后10天,接受骨髓移植的大鼠的缩爪反应PWL模式显示已从疼痛中恢复,而未经处理的大鼠继续有明显的疼痛行为模式。例如,经骨髓处理大鼠的PWL值与CCI前的基础值相似(P = 0.54),而未处理大鼠的PWL值与CCI前的基础值相比则明显缩短(P < 0.001),提示仍有疼痛存在。

结论:这些研究提示>细胞或原始细胞介导的治疗可能>神经损伤后的疼痛治疗有效,>其镇痛机制的阐明值得进一步研究。

(裘毅敏译,马皓琳 李士通校)

 

BACKGROUND: Stem cells mediate neuroprotection in a variety of nervous system injury models. In this study, we evaluated a potential role for stem cells in pain therapies. Marrow mononuclear cells containing mixed stem cell populations were used because of wide experience with these cells in experimental and clinical transplantation.

METHODS: After sciatic nerve chronic constriction injury (CCI), adult male Sprague Dawley rats were treated with freshly isolated marrow mononuclear cells (107 cells in 0.5 mL IV) from the same strain, or with carrier. The major end points of analysis were thermal and mechanical hypersensitivity using paw withdrawal latency (PWL) to a calibrated heat source and paw withdrawal response to von Frey filaments, evaluated by a blinded investigator.

RESULTS: Marrow transplantation did not prevent pain, and 5 days after CCI all animals were equivalently lesioned. However, 10 days after CCI, rats that received marrow transplants demonstrated paw withdrawal response and PWL patterns indicating recovery from pain, whereas untreated rats continued to have significant pain behavior patterns. For example, PWL values for marrow-treated animals were similar to baseline pre-CCI values (P = 0.54) but significantly shorter latency to withdrawal indicative of continuing pain was seen in untreated rats compared with pre-CCI values (P < 0.001).

CONCLUSIONS: These studies suggest that stem or progenitor cell-mediated therapies may be useful for the treatment of pain after nerve injury, and deserve further study to elucidate the mechanisms of analgesia.


比较利多卡因和无防腐剂的2-氯普鲁卡因麻用于门膝关镜手术:一>前瞻性随机双盲研究

Spinal Anesthesia with Lidocaine or Preservative-Free 2-Chlorprocaine for Outpatient Knee Arthroscopy: A Prospective, Randomized, Double-Blind Comparison

Andrea Casati, MD*, Guido Fanelli, MD*, Giorgio Danelli, MD*, Marco Berti, MD*, Daniela Ghisi, MD*, Matteo Brivio, MD*, Marta Putzu, MD*, and Alessia Barbagallo, MD{dagger}

*From the University of Parma - Department of Anesthesiology and Pain Therapy, Ospedale Maggiore di Parma - Via Gramsci 14, 43100 Parma, Italy and {dagger}University of Messina - Department of Anesthesiology.

Anesth Analg 2007;104:959-964

背景:在这>前瞻性随机双盲研究中,我们验证了这一假想: 1%无防腐剂的2-氯普鲁卡因50mg比相同剂量的1%利多卡因麻消退更快。

>法:术前咪达唑仑静脉给药(0.03 mg/kg)后,30ASA I–II经历膝关镜手术的门病人随机分为两组,分别接受50mg1%单纯利多卡因(n = 15)1%无防腐剂的单纯氯普鲁卡因(n = 15)。不知情的观察员记录感觉(针刺感消失)和运(>良的Bromage评分)的进展直至完全消退,同时记录可以自主行走和排便的时间。术后24小时和7天进行电话随访。

结果:术中分别有2名氯普鲁卡因的病人(13%)和一名利多卡因的病人(7%)要求追太尼(100 µg IV) (P = 0.99),但是没有病人需要>全麻来完成手术。感觉和运能的恢复自主行走的时间中位数(范围),2-氯普鲁卡因 [95 (68–170) min; 60 (45–120) min; 103 (70–191) min]比利多卡因 [120 (80–175) min; 100 (60–140) min; 152 (100–185) min](分别为P = 0.019, P = 0.0005, P = 0.003)。第一次排便时间氯普鲁卡因[180 (100–354)min]和利多卡因[190 (148–340) min]>间无差别 (P = 0.191)。有5名利多卡因病人(33%)道有暂时性神经症,但是氯普鲁卡因组没有(0%) (P = 0.042)

结论:椎管内注射1%无防腐剂的2-氯普鲁卡因50mg比相同剂量的1%利多卡因具有更快的感觉/运能恢复自主行走能,且暂时性神经症的发生率更低。

(黄佳佳译 马皓琳,李士通校)

BACKGROUND: In this prospective, randomized, double-blind study we tested the hypothesis that 50 mg of 1% preservative-free 2-chloroprocaine would provide a faster resolution of spinal block than the same dose of 1% plain lidocaine.

METHODS: After IV midazolam premedication (0.03 mg/kg), 30 ASA physical status I–II outpatients undergoing knee arthroscopy were randomly allocated to receive 50 mg of either 1% plain lidocaine (n = 15) or 1% preservative-free plain chloroprocaine (n = 15). A blinded observer recorded the evolution of sensory (loss of pinprick sensation) and motor (modified Bromage scale) block until complete regression, as well as times to unassisted ambulation and voiding. A telephone call follow-up was performed 24 h and 7 days after surgery.

RESULTS: Two chloroprocaine patients (13%) and one lidocaine patient (7%) required fentanyl supplementation (100 µg IV) (P = 0.99) intraoperatively, but no patient required general anesthesia to complete surgery. Median (range) times for recovery of sensory and motor function, and unassisted ambulation were faster with 2-chloroprocaine [95 (68–170) min; 60 (45–120) min; and 103 (70–191) min] than lidocaine [120 (80–175) min; 100 (60–140) min; and 152 (100–185) min] (P = 0.019, P = 0.0005, and P = 0.003, respectively). No differences in first voiding were reported between chloroprocaine [180 (100–354) min] and lidocaine patients [190 (148–340) min] (P = 0.191). Transient neurological symptoms were reported in five lidocaine patients (33%) but no chloroprocaine patients (0%) (P = 0.042).

CONCLUSION: Intrathecal injection of 50 mg of preservative-free 2-chloroprocaine 1% resulted in quicker recovery of sensory/motor function, and unassisted ambulation, and fewer incidences of transient neurologic symptoms than the same dose of 1% lidocaine.

 

 

手臂的位置>腋路法臂丛神经阻滞的起效和作用持续时间的影响

The Effects of Arm Position on Onset and Duration of Axillary Brachial Plexus Block

Adil Ababou, MD, Nizar Marzouk, MD, Ahlam Mosadiq, MD, and Ahmed Sbihi, MD

From the SICU and Emergency Medicine, Centre Hospitalier Universitaire (CHU) de Rabat, Université Mohamed V, Rabat, Morocco.

Anesth Analg 2007;104:980-981

背景:我们评价了施行阻滞后手臂的位置>腋路法臂丛神经阻滞(AXB)的成率、起效时间和作用持续时间的影响.

>法:实施过AXB后,患者随机分入两组:内收组和外展组。内收组立即将手臂内收贴于身体一侧,外展组手臂保持外展位。这些体位保持到达到阻滞效果。

结果:外展组较内收组而言,感觉和运阻滞的起效时间明显缩短,而阻滞的持续时间明显延长(P < 0.001)。

结论:施行AXB后手臂保持外展可以使起效增快且感觉和运阻滞时间延长。

(黄丽娜 马皓琳 李士通 校)

BACKGROUND: We assessed the effects of arm position after block performance on success rate, onset time, and duration of axillary block (AXB).

METHODS: After performing AXB, patients were randomized into two groups: group adduction in which the arm was immediately placed in adduction along the body and group abduction in which the arm remained in abduction. These positions were maintained until the block was achieved.

RESULTS: The sensory and motor blocks onset time were significantly shorter in the abduction group compared with that in the adduction group and their duration was significantly prolonged (P < 0.001).

CONCLUSION: Maintaining the arm in abduction after performing AXB allows a shorter onset time and a prolongation of the sensory and motor blocks.

 

 

静脉给予地塞米松>于鞘内注射哌替啶后的术后疼痛、恶心和呕吐的影响

The Effect of Intravenous Administration of Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Intrathecal Injection of Meperidine

Ali Movafegh, MD*, Ahmad Reza Soroush, MD{dagger}, Ali Navi{ddagger}, Mustafa Sadeghi, MD*, Fatimah Esfehani, MD, and Niloufar Akbarian-Tefaghi||

From the *Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; {dagger}Department of Surgery, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; {ddagger}Tehran University of Medical Sciences, Tehran, Iran; Research Development Center, Dr Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; and ||Liverpool John Moores University, Liverpool, United Kingdom.

Anesth Analg 2007;104:987-989

背景:不同种类的药物常被用来增强术后神经轴索阿片类镇痛效果>减少不良反应。

>法:我们选择60个病人随机分为两组,在鞘内麻醉(××15mg和哌替啶15mg)前分别静脉注射2ml生理盐水或地塞米松0.1mg/kg。在手术后6121824小时询问病人疼痛评分。记录术后恶心呕吐(PONV)、瘙痒和呼吸制情况。

结果:地塞米松组的双氯酸总量(P<0.05)、间隔六个小时的病人视觉模拟疼痛评分(P<0.001PONV发生率(P<0.05)都明显较低。

结论:在鞘内注射哌替啶前静脉注射地塞米松能增镇痛作用同时降低PONV的发生。

(沈浩 马皓琳 李士通 校)

BACKGROUND: Different drugs have been used to enhance postoperative neuraxial opioid analgesia and reduce adverse effects.

METHODS: We randomized 60 patients into 2 groups to receive either 2 mL saline or 0.1 mg/kg dexamethasone IV before the administration of intrathecal anesthesia (15 mg and meperidine 15 mg). After surgery, patients were asked to score their pain at 6, 12, 18, and 24 h. The presence of postoperative nausea and vomiting (PONV), pruritus and respiratory depression were recorded.

RESULTS: The total dose of diclofenac (P < 0.05), visual analog scale pain score at 6-h intervals (P < 0.001), and the incidence of PONV (P < 0.05) were significantly lower in the dexamethasone group.

CONCLUSIONS: Administration of IV dexamethasone prior to intrathecal meperidine injection enhances analgesia and reduces PONV.