Anesthesia & Analgesia

April 2007

 

PEDIATRIC ANESTHESIA:

嬰兒異丙酚-瑞太尼與七氟醚麻醉術後睡眠品質的差異

宋翠俠 陳傑

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.

對影響小兒門診行扁桃腺切除術和增殖腺切除術後恢復的因素的分析

彭中美 馬皓琳 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.

雙親對疼痛感知的社會人口統計學個性特徵的預測探究

王時來譯 薛張綱校

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:

奧坦西隆和地塞米松的不同量組合用以預防術後噁心嘔吐

唐李雋 馬皓琳 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:

高碳酸血症可縮短豬吸入麻醉的蘇醒時間

琳譯 薛張綱校

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)作用在大腦和髓產生制動作用

衛紅 陳傑

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.

笑氣對髓神經元傷害性刺激反應的興奮和制作用

張瑩 馬皓琳 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.

異氟醚麻醉中血清素系統的活性

周時蓓譯 薛張綱校

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.

巴比妥增強大鼠海馬區氨基丁酸介導的神經興奮而不影響其突觸可塑性

周懿之 陳傑

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.

比較兩種輸出能量對鐳射輔給予表面麻醉LMX-4®乳在靜脈穿刺前使用的增強效果

顏濤 譯,馬皓琳 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.

應用乙醯膽鹼受體阻滯不會改依託咪酯致小鼠體動消失的用藥量

施譯 薛張綱校

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:

術前超短期熵值可預測麻醉誘導期間的動脈血壓波動

丁震敏 陳傑

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.

感測器錯位所得雙頻指數值的可靠性:與感測器位於廠商推薦部位所得值的比較

黃施偉 譯,馬皓琳 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:

美國麻醉培訓專案的工作人員以財政狀況的五年期追蹤調查報:20002005

陳佳莉譯 薛張綱校

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.

細胞再利用術的成本分析

詹慧 陳傑

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:

重症監護病房患者中的室性心律失常:短期和長期後果

邱郁薇 馬皓琳 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.

患有嚴重肺氣腫病人的左心室效能和內徑

陳珺珺譯 薛張綱校

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.

血漿白蛋白濃度對於危重病人血清鈉離子氯離子測定值的影響

印潔敏 陳傑

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:

七氟醚影響大鼠前腦缺血後神經發生

周雅春 馬皓琳 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:

羅呱卡因,左旋布比卡因布比卡因在椎管內的神經阻滯的相對效能

秦佳譯 薛張綱校

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:

蒸汽消毒對纖維喉鏡片光強度的影響

鄭麗 陳傑

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

Tomoki Nishiyama

Anesth Analg 2007 104: 908-910.

ANALGESIA:

曲馬多中入小量氯胺酮用於術後鎮痛:腹部手術後的一個雙盲,隨機,安慰對照試驗

姜旭暉譯,馬皓琳 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.

疼痛自我效能問卷中文版測試報

璿譯 薛張綱校

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.

非甾體類炎藥物(NSAID)在小鼠熱輻射甩尾試驗中的局部保護作用

王光妍譯 薛張綱校

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神經結紮對福馬林反應的改——一項行為學和分子學研究

顧新宇 陳傑

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.

靜脈內使用單核髓細胞逆轉實驗性單一神經病產生的神經性疼痛

裘毅敏譯,馬皓琳 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.

炎症性疼痛增小鼠腦液中的α腫瘤壞死因數以前列腺素E2的濃度:止痛藥物的效果

張儷譯 薛張鋼校

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類心律失常藥物的皮膚鎮痛作用

張美榮 陳傑

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.

比較利多卡因和無防腐的2-氯普魯卡因麻用於門診膝關節鏡手術:一項前瞻性隨機雙盲研究

黃佳佳譯 馬皓琳,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.

區域阻滯神經系統併發症:危險性的同期評估

霞譯 薛張綱校

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.

中央軸索阻滯後嚴重和長時神經根和髓併發症

李惟一 陳傑

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.

手臂的位置對腋路法臂叢神經阻滯的起效和作用持續時間的影響

黃麗娜 馬皓琳 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.

聯合注射可樂定通過外周作用延長利多卡因皮下注射的麻醉效果

吳德華譯 薛張綱校)

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.

不同濃度的羅呱卡因硬膜外麻醉對七氟醚需求的影響

李惟一 陳傑

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

靜脈給予地塞米松對於鞘內注射呱替啶後的術後疼痛、噁心和嘔吐的影響

沈浩 馬皓琳 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.

 

雙親對疼痛感知的社會人口統計學個性特徵的預測探究

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:我們研究了雙親和子女間的社會人口統計學個性特徵與父母對子女疼痛感知的關係。

方法:110對經歷手術的兒童的父母完成了疼痛感知的測量(例如,藥物治療觀點調查表;MAQ)和父母子女個性特徵的調查(例如,神經質、外向性、開放性等“大五”人格模型;NEO-FFI)。採用要素分析和邏輯回歸模型。結果:根據藥物治療觀點調查表(MAQ),描述性分析顯示超過70%的父母擔心鎮痛治療的副作用,43%的父母認為鎮痛藥物會成癮,37%的父母則認為孩子接受的鎮痛治療頻率低效果好。MAQ的要素分析法揭示了一個由三個因素組成的方法,解釋了父母對鎮痛治療理解的52%的差異的原因。概括的說,這些要素包括適當使用鎮痛藥物看法、對副作用的擔心和避免進行鎮痛。應用逐步回歸模型確定父母每個因素得分的預測值。結果顯示學歷較低的父母和較為活潑好動的孩子的父母更有可能避免使用鎮痛治療(避免要素;P<0.001)。責任感得分較高的父母和孩子較衝動的父母更願意接受給孩子進行鎮痛治療。(適當使用要素;P<0.001)。討論:我們推斷許多父母對疼痛和鎮痛治療存在誤解,並且可以利用父母和孩子的個性特徵確定父母存在這種誤解的風險。

(王時來譯 薛張綱校)

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.

 

 

高碳酸血症可縮短豬吸入麻醉的蘇醒時間

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:快肺和閉環路中的麻醉氣體的清除可以通過過度通氣和高新鮮氣流量。但伴隨著CO2的清除使得PAco2降低,進而導致腦血流量的降低而減慢了麻醉氣體從腦部的清除。研究表明:除過度通氣之外,高碳酸血症(CO2灌注或閉環路)在縮短吸入麻醉蘇醒時間是一個重要的因素。方法:我們給7頭豬以2 MACPIG的異氟烷吸入和4頭豬以2 MACPIG的七氟烷吸入。吸入麻醉持續2小時,並保持過度通氣。分別觀察低碳酸血症(Et CO2=22 mmHg )和高碳酸血症(Et CO2=55 mmHg)下豬發生多肢體運動的時間。結果:在過度通氣期間高碳酸血症下從關閉揮發罐到豬發生多肢體運動的時間較快。在閉環路或CO2 控制下予以異氟烷和七氟烷吸入的麻醉的蘇醒時間平均縮短65% (P < 0.05)。結論:在臨高碳酸血症與過度通氣一起可以被用於縮短吸入麻醉的蘇醒時間。這些縮短的時間可減少藥物成本。此外,在蘇醒期間高PAco2 還可以增強拔管後的呼吸刺激和氣道保護。

(金 琳譯 薛張綱校)

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.

 

 

異氟醚麻醉中血清素系統的活性

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:顯微透析研究已經證明在大鼠和貓,血清素啟動射區域的血清素(5-羥色胺)的釋放在覺醒時增,睡眠時減少,這一發現提示5-羥色胺對於睡眠的調節起著重要作用。雖然我們可以預料在全身麻醉中5-羥色胺的釋放也是減少的,然而揮發性麻醉藥在藥理學對於含血清素神經元的能的作用還未被完全調查研究過。方法:利用一種活體顯微透析法,我們分別測量了大鼠在活動,慢波睡眠和異氟醚麻醉中額葉皮質細胞外的5羥色胺含量。為了評估血清素系統在異氟醚的催眠效果中所起的作用,測算了使受過未受過鹽酸氟苯氧丙胺(一種選擇性5-羥色胺重攝取制)的預先處理的大鼠失去翻正反射所需要的異氟醚的濃度。結果:在慢波睡眠和異氟醚麻醉(0.1-1.5MAC)時,5-羥色胺的釋放減少到活動狀態時的21%44%。失去翻正反射時異氟醚的濃度在經過氟苯氧丙胺預先處理的大鼠中(0.76% +/- 0.03% [n = 8])明顯高於對照組(0.60% +/- 0.01% [n = 8])。結論:該結果提示腦中血清素系統活性的改參與了異氟醚的催眠作用。

(周時蓓譯 薛張綱校)

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.

 

 

應用乙醯膽鹼受體阻滯不會改依託咪酯致小鼠體動消失的用藥量

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:毒蕈堿和神經元的尼古丁受體拮(比如阿托品和鹽酸美明)的應用不會影響異氟

醚的MAC值。雖然這提示了乙醯膽鹼受體不能中和產生體動消失的吸入麻醉藥,但也有可

能有別的解釋。低於MAC值濃度的異氟醚單獨使用可廣泛地阻滯乙醯膽鹼受體,使用阿托

品和鹽酸美明就可能無效,因為受體已經被阻滯了。方法:依託咪酯是一種被認為可強

GABA作用於GABAA 受體效應的麻醉,近期的研究中,我們測量用來減少依託咪酯麻醉

使用量的乙醯膽鹼受體被阻滯的量以間接地驗證這種假設。結果:應用10mg/kg的阿托品

5mg/kg的鹽酸美明不會改使小鼠體動消失需要量的依託咪酯的彌散速度和在血中

或腦中的藥物濃度。結論:乙醯膽鹼受體不能調節麻醉藥對有害刺激制的用藥量。

(施譯 薛張綱校)

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.

 

 

美國麻醉培訓專案的工作人員以財政狀況的五年期追蹤調查報: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年代中期,麻醉科住院醫生數量的減少使得全國麻醉醫師短缺,並導致薪水水準漲的競爭市場。1999年,我們進行了一項美國麻醉培訓項目的財政狀況的全國性調查。從此以後每年都進行追蹤調查。我們在本系列文章中提交這六項調查的結果。方法:我們將調查內容通過電子郵件發給美國培訓專案的各麻醉部主任並通過電子郵件回收調查回饋。

結果:121個被調查的部門中回復率為60%。在試圖尋找至少一個新員工的部門中87%的部門平均擁有2.8個開放職位(總開放職位從2000年的9.7%降低到5.5%)。在96%的雇傭了取得資格證書的護理麻醉師的部門中有89%的部門在試圖尋找新的取得資格證書的護理麻醉師,平均擁有3.6個開放職位。平均每個部門得到的公共財政資為490萬美元(即11.6萬美元/每職員)。如果除去用於取得資格證書的護理麻醉師薪水支出的這部分財政資,則平均每個部門得到的公共財政資為410萬美元(即9.5/每職員)。去年公共財政資增長了16%。員工用於學術研究的時間占所有時間的比例平均為17%(其中20%的部門為每週一日)。各部門每年每個員工的平均計費麻醉單位為11,320個單位。雖然所收到的麻醉單位價值平均為31美元,但是各部門需要大約40美元/單位來支付開支。公共醫療補的平均支出為15美元/單位,浮動範圍為5美元/單位至30美元/單位。結論:這些結果表明維持麻醉培訓部門的財政穩定需要公共財政的持續資。

(陳佳莉譯 薛張綱校)

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.

 

 

患有嚴重肺氣腫病人的左心室效能和內徑

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:人們已經認識到在慢阻肺病程中伴隨心能不全,流行病的觀點認為主要影響右心能。我們評估了嚴重肺氣腫病人的左心室能和內徑。方法:麻醉誘導後,研究了進行肺減容手術的嚴重肺氣腫病人(n = 10)。準備行肺葉切除的非肺氣腫病人作為對照(n = 10)。通過被動高小腿,在中心血容量擴容前和擴容期間,分別用經食道二維超聲心動圖測量病人仰臥位時的左心室量綱,和肺動脈熱稀釋導管測量血流動學。結果:肺氣腫組的心臟指數 (–25%),每博指數(SVI, –32%),左室做指數(–34%)和左室舒張末期容積指數(EDAI, –33%)的基準值都明顯較低 (P < 0.001)。被動高小腿可以增SVI和左室射血分數,肺氣腫組比對照組更明顯(P < 0.05){Delta}SVI/ {Delta}肺毛細血管契壓和{Delta}SVI/{Delta}EDAI的關聯性在肺氣腫組明顯高於對照組(分別是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}左室做指數/{Delta}EDAI),一個非負荷依賴的收縮期左心室能指標,在兩組沒有區別。結論:有嚴重肺氣腫的病人的左心室的血容量是少的,繪製左室能曲線,提示收縮能的受損在肺氣腫和對照組沒有明顯的區別。

(陳珺珺譯 薛張綱校)

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.

 

 

羅呱卡因,左旋布比卡因布比卡因在椎管內的神經阻滯的相對效能

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:在這個研究中,我們調查分析椎管內應用羅呱卡因,左旋布比卡因,布比卡因達到神經阻滯作用的中間效應量(ED50),並定義他們的效能比值。方法:我們選取104個在連硬麻醉下行剖宮產的產婦,將她們隨機的分為三組,分別椎管內給與0.5% (wt/vol)的羅呱卡因,左旋布比卡因或布比卡因。初始量為4 mg,每組間隔增1 mg。椎管內注射後每五分鐘測量下肢的神經反射來評價效果。結果:經分析,椎管內神經阻滯的 中間效應值分別為:羅呱卡因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)。相對神經阻滯效能比值為羅呱卡因/布比卡因0.59 (95% CI, 0.42–0.82),羅呱卡因/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).結論:通過這個研究我們得到一個椎管內阻滯的臨效能範圍:分別為羅呱卡因最低,左旋布比卡因中等,布比卡因最強。

(秦佳譯 薛張綱校)

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.

 

 

疼痛自我效能問卷中文版測試報

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:自我效能是一個人對自己能夠執行一項行為得到理想後果的信心。自我效能這種信心影響著慢性疼痛病人的疼痛治療計畫、生理心理能以康復結果。為檢驗疼痛自我效能問卷中文版(Pain Self-Efficacy Questionnaire, PSEQ-HK)的心理測驗特性,我們進行了本次前瞻性研究。方法:將PSEQ-HK譯文交作者獲取認同,然後進行前向後向翻譯和專家小組鑒定。通過相隔一周測試兩次的方法進行可靠性檢驗。要求120名患有慢性非癌性疼痛的中國病人自行完成一系列健康相關的中文試卷:疼痛數位評分量表(Numeric Pain Rating Scale)、醫院焦慮鬱量表(Hospital Anxiety and Depression Scale)Roland-Morris能障礙問卷(Roland-Morris Disability Questionnaire)、疼痛災難化量表(Pain Catastrophizing Scale)、醫療結局研究之36條簡明健康問卷(Medical Outcome Study Short-Form 36 [SF36] Health Survey)。結果:PSEQ-HK具有良好的重複測試可靠性(組間相關係數為0.75)和內部一致性(Cronbachα係數為0.93)。探索性因素分析顯示總異的61%可被一個單一因素模型解釋,因素負荷量至少有0.69。它與醫院焦慮鬱量表、疼痛災難化量表和SF365個方面(肌體疼痛,生命,社會能,情感角色,心理健康)有顯著相關性。與Roland-Morris能障礙調查表和SF362個方面(軀體角色、總健康)中等相關。與疼痛評分和醫療干預無相關。結論:PSEQ-HK是可靠的中文臨評價工具,心理測試特性令人滿意。我們的結果初步支持PSEQ-HK在異質的中國慢性非癌性疼痛人群中應用的可靠性。

(羅 璿譯 薛張綱校)

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.

 

 

非甾體類炎藥物(NSAID)在小鼠熱輻射甩尾試驗中的局部保護作用

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:雖然有很多臨前模型測試NSAID的止痛效能,小鼠熱輻射甩尾試驗經常對這類藥物不敏感.由於甩尾實驗涉的傷害性反應是在髓水準進行調節的,而NSAID的基本作用位點可能是在外周,這樣假設NSAID不應該會改強大的傷害性刺激是合理的.方法:我們在小鼠的尾巴進行皮下注射3-300ug的雙氯酸, 安乃近, 痛克, 賴氨酸乙醯水酸鹽和水酸鈉,然後評估對於熱輻射的甩尾反應.這些結果將與腹膜內注射進行對照.我們同時評估納洛酮拮作用的強弱.結果:各種NSAID皮下注射後, 甩尾潛伏期的延長呈量相關.腹膜內注射不產生任何保護作用. 納洛酮預處理對於拮雙氯酸, 痛克, 賴氨酸乙醯水酸結論:在熱甩尾試驗中,局部而非全身性給與NSAIDs可以產生保護作用. 內源性阿片類物質系統對於安乃近的保護作用有促進作用.但是對於雙氯酸, 痛克, 賴氨酸乙醯水酸鹽和水酸鈉沒有任何作用,這顯示了不同的NSAIDs有不同的作用原理.鹽和水酸鈉沒有任何作用,但可以完全拮皮下注射安乃近後的保護作用.

(王光妍譯 薛張綱校)

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.

 

 

炎症性疼痛增小鼠腦液中的α腫瘤壞死因數以前列腺素E2的濃度:止痛藥物的效果

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:我們對小鼠進行足底皮注完全弗氏佐後測量了小鼠腦液中前列腺素E2和α腫瘤壞死因數的濃度。另外,我們調查了有後爪炎症時口服不同的止痛藥在疼痛的量時是否能夠阻止腦液中前列腺素E2和α腫瘤壞死因數的濃度化。方法:我們使用Randall-Selitto爪子縮回實驗來測量炎症性疼痛。曲馬多(7.5mg/kg),撲熱息痛(6.5 mg/kg),曲馬多撲熱息痛尼美舒利(COX-2制)(5mg/kg)從完全弗氏佐注射後第一天開始分別一天兩次口服。前列腺素E2通過免疫酶學測定,α腫瘤壞死因數的濃度通過ELISA(酶聯免疫吸附學)測定。行為學和生化學的資料從小鼠足底皮注完全弗氏佐或鹽水後第七天開始測定。結果:經過完全弗氏佐處理過的爪子在機械刺激下縮回的閾值明顯降低。在這些動物的腦液中炎症前媒介物質的量顯示了前列腺素E2和α腫瘤壞死因數的濃度都有明顯的增。所有的藥物治療阻止了腦液中前列腺素的增以疼痛的發展,相反的,防止α腫瘤壞死因數水準的增高只有在尼美舒利或曲馬多和撲熱息痛組合中才觀察到。結論:我們的結果證明了外周炎症性疼痛是與腦液中大量炎症前媒介物質化有關。這裏有一點重要的說明是髓的前列腺素E2和α腫瘤壞死因數被證明是通過不同的方法影響藥物完全阻斷痛覺的作用。

(張儷譯 薛張鋼校)

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

 

 

區域阻滯神經系統併發症:危險性的同期評估

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:區域阻滯為很多外科操作提供了良好的感覺喪失和痛覺喪失。麻醉師和病人除了知道選擇區域阻滯作為麻醉方法的處外,還必須瞭解其危險性。許多關於區域阻滯後神經系統併發症的調查已被提議程,這並沒有反映出區域阻滯適應證其應用的增,或者術的提高。對於這一簡要的綜述,我們對比了最常用的區域阻滯術後神經系統併發症的同期調查。方法:為了調查區域阻滯後的神經系統併發症,我們回顧了32個病例發表於199511日至20051231日。結果:中樞和外周神經阻滯後的神經系統併發症發生的樣本數量分別是1260000中的418510309中的20個。腰麻和硬膜外麻醉後的神經病發生率分別是3.7810000 (95% CI: 1.06–13.50:10,000) 2.19:10,000 (95% CI: 0.88–5.44:10,000)。對於常用的中樞和外周神經阻滯,肌間溝臂叢神經阻滯、腋路臂叢神經阻滯股神經阻滯後的神經系統併發症發生率分別為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)。腰麻硬膜外麻醉後永久性神經損傷的發生率分別為從04.2:10,00007.6:10,000。只有一例永久性神經病被報導於16份中樞外周神經阻滯後神經系統併發症的調查中。結論:我們的調查提示了中樞神經阻滯後的神經系統併發症發生率小於4:10,0000.04%。中樞外周神經阻滯後神經病發生率小於3:100 3%。然而同期的麻醉操作中永久性的神經損傷很罕見。

(孫 霞譯 薛張綱校)

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.

 

 

聯合注射可樂定通過外周作用延長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:局麻藥聯合可樂定延長局麻藥的作用,但運用于人體時,其外周作用機制仍不清楚。方法:選擇20例健康志願者,採用雙盲法,皮下注射0.5%利多卡因+NS到一側前臂,然後立即在另一隻前臂注射0.5%利多卡因+10mug可樂定。6h內針孔處的感覺每15分鐘測一次。結果:單獨利多卡因側恢復正常感覺的中位數時間為3.5h,聯合可樂定側手臂則為6h以(p< 0.001)。結果:複合可樂定通過外周作用可強利多卡因皮下注射的麻醉作用時間。

(吳德華譯 薛張綱校)

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.

 

嬰兒異丙酚-瑞太尼與七氟醚麻醉術後睡眠品質的差異

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:小兒麻醉術後行為障礙較為常見,但在嬰兒麻醉後的發生情況尚不明確。本文作者主要研究術後睡眠障礙,並假設在嬰兒使用異丙酚-瑞太尼麻醉與七氟醚後睡眠品質有差異,其在七氟醚麻醉比異丙酚-瑞太尼麻醉後睡眠障礙更常見。。

方法394-6個月的嬰兒施行唇-齶裂修復術,隨機分為兩組,分別接受異丙酚-瑞太尼複合麻醉(n17)或七氟醚.-太尼麻醉(n22),術後盲法隨訪。其父母于入院前2W與術畢返家後2W對其孩子記錄睡眠情況,包括嬰兒晚間醒來次數,難以安撫入睡次數和最長睡眠時間。

結果:七氟醚組(中位數為7.2h)最長睡眠時間比異丙酚-瑞太尼組(中位數為5.1h P < 0.05)長。其餘組間無差異。兩組嬰兒術後睡眠模式較術前有改(P < 0.01)。其父母認為10天后恢復正常,組間無顯著差異。

結論:嬰兒于異丙酚-瑞太尼與七氟醚麻醉後出現術後睡眠障礙,七氟醚麻醉較異丙酚-瑞太尼麻醉在嬰兒唇齶裂修復術後一周睡眠障礙輕。

(宋翠俠 陳傑 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)作用在大腦和髓產生制動作用

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: 以前的研究表明異氟醚和氟烷對於有害刺激的制動作用主要作用在髓而非大腦。這些麻醉藥對於受體具有多種效應,因此無法測試髓介導的制動作用。作者試圖通過髓介導的制動作用,探詢兩種香族麻醉藥的適用範圍,以在拮N甲基d天冬氨酸受體時差異的原因。

方法: 運用山模型,對大腦選擇性地使用HFBODFB,研究麻醉藥的作用。因為結果提示一個ODFB具有顯著的大腦效應,研究對刺激產生制動作用時的ODFB濃度,其他山使用 0.5%的氟烷。以往研究表明產生制動作用的大腦氟烷濃度遠遠超過髓,所以作者選擇了氟烷。同時在含有苯的麻醉藥——異丙酚中運用了以術。

結果: 旁路前HFB的最小肺泡濃度(MAC)0.82% ± 0.14% (平均值 ± 標準差);大腦選擇性使用麻醉藥後MAC增至2.04% ± 0.8% (P < 0.01);而旁路後MAC恢復至0.79% ± 0.28%。而ODFBMAC值是0.46% ± 0.07%, 0.63% ± 0.12% (P < 0.05), 0.44% ± 0.10% 大腦選擇性使用氟烷時ODFB MAC 0.32% ± 0.17% 。但是當ODFB運用至全身, MAC0.37% ± 0.05%。和HFB一樣, 氟烷的需要量增至單獨作用于大腦時的三倍。5只試驗動物中4只,異丙酚的需要量增了240%, 1只動物的需要量減少了,而以這些化都沒有統計學差異。

結論:這些資料提示HFB, 和氟烷一樣, 主要通過髓產生制動作用。而HFB ODFB對髓和大腦的作用部位是不同的。然而,儘管ODFB 可以通過大腦中樞作用產生制動作用,它也可以通過髓作用產生制動。因此,結論支持髓是產生制動的初級部位,或許異丙酚同樣如此。
(衛紅 陳傑 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.

 

巴比妥增強大鼠海馬區氨基丁酸介導的神經興奮而不影響其突觸可塑性

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:目前認為突觸的可塑性為學習和記憶的分子機制。N-甲基天冬氨酸受體介導的可塑要求N-甲基天冬氨酸受體啟動同時突觸後膜電位除極化。高濃度的巴比妥能增強突觸後膜電位除極化,但同時會阻止突觸的可塑性,可能通過影響谷氨酸的轉運。本研究作者檢驗低濃度巴比妥增強突觸後膜電位除極化以調節突觸可塑性的假說。

方法:實驗在大鼠離體海馬切片中進行。阻斷谷氨酸轉運時,使用CA1神經元細胞內記錄方法來測試5μM巴比妥對突觸後膜電位除極化以給予高頻刺激後神經元的興奮性的影響。谷氨酸轉運正常時,則使用細胞外記錄來測試通過給予海馬軸索途徑條件性刺激,5μM巴比妥誘發長期制和長期增強突觸傳遞的作用。

結果:高頻刺激產生的典型突觸後膜電位除極化由氨基丁酸受體介導並且依賴HCO3-。當處於突觸後膜除極化電位最大振幅一時,巴比妥(5μM)能增幅度,但不能增寬度(P<0.01)。巴比妥能增突觸後膜電位除極化時動作電位發生的可能性,但不影響長時程制或長時程增強。

結論5μM巴比妥能增突觸後膜電位除極化的振幅,但不改通過常規範圍的條件性刺激誘導的突觸可塑性。這些結果不支持巴比妥的興奮性作用能改突觸可塑性的假說。

(周懿之 陳傑 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.

 

術前超短期熵值可預測麻醉誘導期間的動脈血壓波動

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:本文作者研究術前心率異性的非線性指標、超短期熵(UsEn),是否能預測全麻誘導期間的心血管反應。

UsEn是用非線性最小二乘法模型與最大熵光譜分析術(MemCalc術)相結合來測定的。用MemCalc術測定46個無高血壓病史的病人(ASA1/2,年齡40-60歲)的UsEn。根據術前的UsEn將病人分為2組(低UsEn組:UsEn<45,UsEn組:UsEn45)。用異丙酚、太尼、維庫溴麻醉誘導後氣管插管。記錄並比較兩組病人麻醉誘導期間的血流動學化。

結果:麻醉誘導期間低UsEn病人的血流動學化明顯較大。

結論:UsEn能預測麻醉誘導期間的動脈血壓的波動。

(丁震敏 陳傑 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.

 

細胞再利用術的成本分析

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:血製品的高費用和輸血所帶來的風險使大家更關注可以減少或替代血製品的術。目前已有多個機構研發細胞再利用術的應用,作者在研究這項術財務資。

方法:評估2328名患者細胞再利用術所獲得的濃集紅細胞的費用。另外,分析了建立細胞再利用術的收支平衡點。

結果:在該機構中建立細胞再利用術的最初入成本為103551美元,每年固定的手術收入為250943美元,每袋紅細胞單位輸注的平均費用為200美元,使用細胞再利用術所獲得的相同單位的費用為89.46美元,回報週期為1.9個月。

結論:這項分析表明細胞再利用的費用明顯低於同種異體血細胞輸注的費用。在其他機構中,細胞再利用術的成本有所不同,這是由於除了考慮每台手術失血量外,成本取決於最初的研究費用和總的手術量。目前已有一步步推算的公式幫評估不同級別醫院的細胞再利用術。

(詹慧 陳傑 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.

 

血漿白蛋白濃度對於危重病人血清鈉離子氯離子測定值的影響

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:作者假設並驗證了血漿鈉離子濃度直接測定與間接測定法之間的差值與血漿白蛋白濃度有關,並進一步提出血清氯離子直接與間接測定值的差異也可能與其他血漿成分的干擾有關,特別是碳酸氫鹽和白蛋白。

方法:300名剛入ICU治療的危重病人進行了研究,比較每個病人血漿鈉離子與氯離子濃度在中心實驗室(間接電極)和ICU血氣分析儀測定值(直接電極)之間的差異。

結果:中心實驗室測定的血漿鈉離子濃度的值平均較ICU測定值高2.1mmol/L(可信區間1.8-2.4mmol/L,P<0.001)。中心實驗室測定的血漿氯離子濃度值平均較ICU測定值低1mmol/L(可信區間1.3-0.7mmol/L,P,0.001)。除了血漿鈉離子濃度與血漿白蛋白濃度呈中等強度的相關性外,其他測定值與血漿成分的相關性均較弱。血漿白蛋白濃度下降時,不同測定法(中心實驗室—ICU)得出的血漿鈉離子濃度差值增大(差值=6.2-0.16白蛋白(g/L);P<0.001,r=-0.46,r2=0.22)。

結論:中心實驗室與ICU的血漿鈉離子和氯離子的測定值在分析方法,統計學臨均有差異性。應當將這種差異考慮在內,否則將影響低白蛋白血症病人(如危重病人)的臨診斷治療方案的確定。

(印潔敏 陳傑 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.

 

蒸汽消毒對纖維喉鏡片光強度的影響

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對重複使用的喉鏡鏡片光強度的影響。

方法:用蒸汽消毒六支新的,可重複使用的Macintosh纖維喉鏡片。測量它們的光強度,對鏡片的頭端進行拍攝,並同時測量新的、一次性的Macintosh鏡片。

結果:經過20次消毒後,使用的鏡片光強度仍大於一次性鏡片。在經過80次消毒後,它的光強度卻發生了顯著的下降。攝片顯示鏡片出現不穩定的光亮度改,並且這種化隨消毒次數的增而增大。

結論:相對於重複使用的纖維喉鏡片而言,一次性塑膠鏡片的照明效果更好。

(鄭麗 陳傑 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神經結紮對福馬林反應的改——一項行為學和分子學研究

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:神經性疼痛能改大鼠對注射福馬林的反應性。然而,改的發生機制還不清楚。

方法:用免疫細胞法檢測大鼠L5神經結紮(SNL)導致神經病的衍生神經營因數(BDNF)和降鈣素基因相關肽(CGRP)的表達,同時觀察SNL大鼠後爪注射福馬林後髓c-fos的表達。

結果SNL後四周,SNL組的停藥閾值明顯比假治療組低(n=12每組,P<0.05)。在SNL組,BDNFL4P<0.05)和L5(P<0.01)背角表面的表達與假治療組相比明顯降低。CGRP蛋白在L5而不是L4背角的表達也比假治療組明顯降低(P<0.01)。福馬林注射後SNL組自然疼痛反應比假治療組明顯降低(P<0.05)。在SNLL4L5背角免疫標誌物c-fos也明顯降低。

結論c-fos的分佈揭示髓炎性疼痛反應的神經活動對急性疼痛知覺可能是非常重要的。SNL導致的神經病而引起BDNF表達降低可能包括於這一改。

(顧新宇 陳傑 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類心律失常藥物的皮膚鎮痛作用

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:局麻藥作用于神經時可阻斷Na+通道而產生可逆的感覺喪失。因為所有的I類心律失常藥物都是Na+通道阻斷,理論,它們也具有局麻藥作用。此研究中,作者研究了三個I類心律失常藥物的表皮局麻作用。

方法:用大鼠皮下浸潤藥物做模型,將奎尼丁(IA)、脈律定(IB)和氟卡尼(IC) 作用效能和持續時間與利多卡因和布比卡因的作用相比較。注射生理鹽水作對照組。

結果:三個I類心律失常藥物產生量依賴性表皮鎮痛作用,鎮痛效能等級是布比卡因〉氟卡尼〉奎尼丁〉脈律定〉利多卡因(藥物之間的差別p<0.05),在等效的基礎,作用持續時間的等級是氟卡尼〉布比卡因〉脈律定和利多卡因(藥物之間的差別p<0.05)。

結論:三個I類心律失常藥物,奎尼丁(IA),脈律定(IB),和氟卡尼(IC)具有局麻作用。

(張美榮 陳傑 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.

 

中央軸索阻滯後嚴重和長時神經根和髓併發症

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:麻和硬膜外麻醉後可發生少但嚴重的併發症。本文作者報導2000年法國發生的中央軸索阻滯後併發症。

方法:這是一項回顧性問卷研究,調查範圍包括全法國所有康復中心,調查對象為中央軸索阻滯後長期嚴重的神經根和髓併發症。

結果:所有的專科中心和44%的非專科中心參了本次調查。共計有12例(93女)有嚴重併發症,其中60%患者超過50歲。所有的患者3個月後仍有神經系統缺陷。7例接受麻,4例接受硬膜外麻醉,1例接受兩種操作。只有3例有出血損傷,其他9例中解剖異常較為普遍,包括5例腰椎管管狹窄和2例蛛網膜。

結論:這些發現表明神經併發症受髓情況的影響。

(李惟一 陳傑 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.

 

不同濃度的羅呱卡因硬膜外麻醉對七氟醚需求的影響

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:作者評估了全身麻醉複合硬膜外麻醉時不同濃度的羅呱卡因下七氟醚的需求量

方法56位病人隨機分為3組,硬膜外分別給予生理鹽水,0.2%羅呱卡因,1%羅呱卡因。調節七氟醚濃度維持一定的麻醉深度。分別在在插管前,插管後51015202530 min記錄BIS和吸入的七氟醚濃度。

結果:在接受高濃度的羅呱卡因組,七氟醚的呼氣末濃度較低。

結論:使用較高濃度的羅呱卡因硬膜外麻醉能減少七氟醚需求量。

(李惟一 陳傑 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.


對影響小兒門診行扁桃腺切除術和增殖腺切除術後恢復的因素的分析

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:許多因素可能導致小兒患者在麻醉後恢復室(PACU)裏的逗留時間(LOS)延長。我們設計了這個前瞻性研究來鑒別延長LOS的術前和術後因素。

方法:我們研究了166例年齡1-18歲在氣管插管的全身麻醉下行扁桃腺切除術和增殖腺切除術或者兩側鼓膜切開術的小兒。主要的監測指標為在麻醉後恢復室的時間,直到達到預先確定的出室標準。

結果:術後噁心和嘔吐事件的數目、患者年齡和氧去飽和的數目都有明顯延長LOS (P < 0.05)。術後噁心和嘔吐(P < 0.05)或者氧去飽和到95% (P < 0.05)都增患者的LOS 0.5小時。呼吸道感染、情緒激動和父母憂慮都沒有明顯延長LOS

結論:這一研究是第一次在小兒患者中研究LOS的多種因素。在麻醉前預先鑒別LOS延長的風險性的意義,不僅用於合理分配PACU資源和醫務人員的配置,而且用於提高護理品質和保證對小兒患者和他們家庭的最低限度的創傷性麻醉經歷。

(彭中美 馬皓琳 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.

 

 

奧坦西隆和地塞米松的不同量組合用以預防術後噁心嘔吐

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:術後噁心嘔吐的高危患者經常使用不止一種預防性止吐藥。此次研究旨在確定四種地塞米松和奧坦西隆配伍的量中哪一種(或幾種)較有效。

方法:在隨機雙盲試驗中,行日間婦科腹腔鏡手術的女性患者,靜脈注射四種量配伍的地塞米松和奧坦西隆: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)

結果:各組的預知危險性和特性無顯著性差異。出院前嘔吐的發生率無顯著性差異(D4/O4D4/O2D2/O4D2/O2組分別為5%4%9%8% P = 0.17)。各組術後24小時內嘔吐的發生率、無噁心嘔吐、止吐藥物治療、無止吐藥物治療無嘔吐(80%–83% 組間交叉)、住院病人滿意程度和恢復評分住院時間亦無顯著性差異。各組的平均噁心評分都很低,但術後24小時內噁心的發生率在地塞米松2mg組中明顯高於其他組(P < 0.03)

結論:四種配伍都顯示了嘔吐和解救治療的低發生率,地塞米松2mg和奧坦西隆2mg配伍與其他組相比無顯著性差異,只不過使用地塞米松2mg的組中噁心的發生率較高。

(唐李雋 馬皓琳 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.

 

 

笑氣對髓神經元傷害性刺激反應的興奮和制作用

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:由於在高比重情況下測定的數理邏輯障礙方面的原因,單獨的笑氣對髓神經元的作用以往未見有檢驗。我們假設,與其他吸入麻醉藥一樣,笑氣也能制髓神經元對傷害性刺激的反應。

方法:在用異氟醚麻醉大鼠暴露腰段髓。將機械通氣的大鼠置入高壓艙,在後爪插入針狀電極。然後停止使用異氟醚,通過使笑氣艙的壓大來改用笑氣麻醉。用電腦控制的發動機和水微型推進器在大鼠髓腰段插入微電極,記錄吸入1.522.5atm0.8–1.3MAC)笑氣時,電刺激大鼠後爪引發的神經元反應。

結果:不定量地升高笑氣分壓影響了神經元對2100-Hz電刺激的反應。神經元的深度和神經元的反應具有相關性,髓表面的神經元傾向于易化,而深部的神經元產生制(笑氣為1.522.5atm時,總的反應分別為1331 ± 4081594 ± 3831578 ± 500/分,平均值,標準誤)。笑氣並不影響神經元對重複“終結”刺激的反應。給予各大鼠輸入NMDA受體阻滯MK-801,大鼠髓神經元對100-Hz電刺激的反應增強(從781±2161352±269/分,P<0.05)。

結論:笑氣易化表面神經元對傷害性刺激的反應,但制深部神經元的反應。這些結果表明,笑氣在麻醉常用分壓時對髓神經元傷害性刺激反應有不同影響,這個特的反應依賴於神經元的深度。

(張瑩 馬皓琳 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.

 

 

比較兩種輸出能量對鐳射輔給予表面麻醉LMX-4®乳在靜脈穿刺前使用的增強效果

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:鐳射輔給藥(LAD)具有促進表面麻醉減少起效時間的潛在作用。

方法:在這項隨機,雙盲,交叉研究中,我們比較了兩種輸出能量(2.03.5 J/cm2LAD用於靜脈穿刺前表面麻醉的效能和不良事件。

結果:低能量和高能量鐳射的平均視覺類比疼痛評分沒有統計學差異(均值分別是6.78.1P0.57)。

結論:在促進表面麻醉方面,2.0 J/cm2570 mJ)能量的LAD3.5 J/cm21000 mJ)的LAD同樣有效,不良事件相似。

(顏濤 譯,馬皓琳 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.

 

 

感測器錯位所得雙頻指數值的可靠性:與感測器位於廠商推薦部位所得值的比較

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:感測器錯位對雙頻指數(BIS)值的影響尚不清楚。我們對感測器錯位與廠商推薦部位所得的BIS值進行了比較。

方法:我們對每一位接受丙酚麻醉的患者使用兩個BIS感測器:一個位於廠商推薦部位而另一個位於右眼側角的周圍。

結果:BlandAltman分析提示除外麻醉誘導從麻醉蘇醒過程中,兩個BIS值一致性較好。

結論:結果提示在全麻誘導和麻醉蘇醒過程中,錯位的BIS感測器可能產生可疑的BIS值。

(黃施偉 譯,馬皓琳 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.

 

 

重症監護病房患者中的室性心律失常:短期和長期後果

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),包括房顫和房撲,在外科和非外科重症監護室(ICU)的病人非常常見。非心胸手術後新發生房性心律失常的外科ICU病人的死亡率增。我們擬確定在這些病人導致新發作SVA的發展死亡率的住院前和ICU中一些影響因素。

方法:收入三級醫院的普通ICU的連續病人(n = 611)在出院前均前瞻性隨訪SVA的跡象、這些心律失常的潛在病因以發生這些心律失常的結果。篩除標準為最近實施過心/胸手術或胸部外傷的病人。同時評估長期存活率(從入院開始計算48個月)。

結果52例病人(9%)新近發生了SVA75例病人(12%)入院前有SVA的病史。未發生SVA的病人中,87例病人(18%)在住院期間死亡,而那些新近發生SVA和有SVA病史的病人中,分別有29例(56%)和23例(31%)在住院期死亡。ICU各組病人的死亡與敗血症、急性腎能衰竭、心肌缺血高的APACHE(急性生理和慢性健康評估)II分值有關。新近發生SVA的病人較沒有發生SVA的病人APACHE II評分較高,分別為23 ± 8sd)和16 ± 8P < 0.05)。住院1年後,新發生SVA的病人、有SVA病史的病人以未發生SVA者中分別有65%50%20%的病人死亡。

結論ICU病人經常會有新近發生的SVA,這可以作為住院病人和1年後死亡率極高的標誌。

(邱鬱薇 馬皓琳 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.

 

 

七氟醚影響大鼠前腦缺血後神經發生

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:七氟醚對神經損傷後神經發生潛能的作用至未明。本實驗研究了七氟醚在低濃度和高濃度下對腦缺血後內源性神經發生的影響。

方法:麻醉並人工通氣的大鼠隨機分為4個不同的處理組。組1和組2大鼠吸入1.4%七氟醚,組3和組4大鼠吸入2.8%七氟醚。組1和組3為非腦缺血組(假手術組),組2和組4通過夾閉大鼠雙側頸動脈並放血造成低血壓引起10分鐘的前腦缺血。各生理學參數保持恒定。給予溴去氧尿苷作為神經發生指示。28天后,灌流固定大鼠腦組織。對蘇木精-紅(HE)染色的腦切片,用HE染色指數評估大鼠腦海馬組織病理學損傷 0=無損傷;11%–10% 損傷; 2 = 11%–50% 損傷; 3 = 51%–100%損傷)。採用免疫組織化學檢測溴去氧尿苷陽性神經元。8只未經處理的大鼠作為空白對照組(組5)。

結果:同空白對照組比較,沒有觀察到假手術組組織病理學損傷和神經發生改。1.4%七氟醚麻醉的大鼠中,腦缺血產生輕度神經元損傷(HE指數0.64 ± 0.84)且神經發生較假手術組增60%;2.8%七氟醚麻醉的大鼠中,腦缺血組HE指數為1.22 ± 1.14,且新發生的神經元數較假手術組增230%。

結論:目前資料提示高濃度七氟醚可在腦缺血後刺激齒狀回神經發生。

(周雅春 馬皓琳 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.

 

 

曲馬多中入小量氯胺酮用於術後鎮痛:腹部手術後的一個雙盲,隨機,安慰對照試驗

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:在人類術後鎮痛中應用氯胺酮複合曲馬多的資料比較少。我們將驗證了這樣一個假設,即在較大的腹部外科手術後在曲馬多中入氯胺酮將改善鎮痛效果。

方法:在這個雙盲,隨機,對照試驗中,120名接受擇期剖腹手術的成年病人被隨機分成氯胺酮組(手術中給予0.3mg/kg的氯胺酮,術後給予0.1mg/kg/h的氯胺酮)和對照組(給予和氯胺酮組同樣量和速度的安慰)。兩組病人在手術中都給予3mg/kg的曲馬多,術後給予48h0.2mg/kg/h的曲馬多輸注。如果鎮痛效果不佳,每個病人還可以自控嗎啡鎮痛。

結果:48小時研究期間中氯胺酮組病人無論在靜息時(P=0.01)還是活動時(P=0.02)疼痛程度都較輕,嗎啡需要量也較少(P=0.003)。在在0-24小時期間,氯胺酮改善了病人主觀的鎮痛(P=0.008),鎮靜更少(P=0.01),且較少地需要醫師干預來處理重度疼痛(P=0.01)。氯胺酮組病人幻覺發生率更高,但其他一些副反應兩組相似。
結論:在較大的腹部手術後在曲馬多和嗎啡中入小量氯胺酮是有用的。
(姜旭暉譯,馬皓琳 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.

 

 

靜脈內使用單核髓細胞逆轉實驗性單一神經病產生的神經性疼痛

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:幹細胞在多種神經系統損傷模型中調節神經保護的作用。本研究中,我們評估了幹細胞在疼痛治療方面潛在的作用。應用了包括混合幹細胞群的骨髓單核細胞,這是由於這類細胞在實驗臨移植方面有廣泛的經驗。

方法:在對坐骨神經進行慢性縮窄性損傷(CCI)後,用來自於同一菌株或帶載體的新鮮離體的骨髓單核細胞(0.5 mL107個細胞IV)處理成年雄性SD大鼠。分析的主要終點是熱和機械的高敏性,通過盲法,評估大鼠對校正熱源刺激的縮爪潛伏期 (PWL)Von Frey細絲的縮爪反應。

結果:骨髓移植並不能防止疼痛,且CCI後5天,所有的動物都同樣受到損傷。而CCI後10天,接受骨髓移植的大鼠的縮爪反應PWL模式顯示已從疼痛中恢復,而未經處理的大鼠繼續有明顯的疼痛行為模式。例如,經骨髓處理大鼠的PWL值與CCI前的基礎值相似(P = 0.54),而未處理大鼠的PWL值與CCI前的基礎值相比則明顯縮短(P < 0.001),提示仍有疼痛存在。

結論:這些研究提示幹細胞或原始細胞介導的治療可能對神經損傷後的疼痛治療有效,對其鎮痛機制的闡明值得進一步研究。

(裘毅敏譯,馬皓琳 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.


比較利多卡因和無防腐的2-氯普魯卡因麻用於門診膝關節鏡手術:一項前瞻性隨機雙盲研究

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:在這項前瞻性隨機雙盲研究中,我們驗證了這一假想: 1%無防腐的2-氯普魯卡因50mg比相同量的1%利多卡因麻消退更快。

方法:術前咪達唑侖靜脈給藥(0.03 mg/kg)後,30ASA I–II經歷膝關節鏡手術的門診病人隨機分為兩組,分別接受50mg1%單純利多卡因(n = 15)1%無防腐的單純氯普魯卡因(n = 15)。不知情的觀察員記錄感覺(針刺感消失)和運動(改良的Bromage評分)的進展直至完全消退,同時記錄可以自主行走和排便的時間。術後24小時和7天進行電話隨訪。

結果:術中分別有2名氯普魯卡因的病人(13%)和一名利多卡因的病人(7%)要求追太尼(100 µg IV) (P = 0.99),但是沒有病人需要改全麻來完成手術。感覺和運動能的恢復自主行走的時間中位數(範圍),2-氯普魯卡因 [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](分別為P = 0.019, P = 0.0005, P = 0.003)。第一次排便時間氯普魯卡因[180 (100–354)min]和利多卡因[190 (148–340) min]之間無差別 (P = 0.191)。有5名利多卡因病人(33%)報導有暫時性神經症狀,但是氯普魯卡因組沒有(0%) (P = 0.042)

結論:椎管內注射1%無防腐的2-氯普魯卡因50mg比相同量的1%利多卡因具有更快的感覺/運動能恢復自主行走能,且暫時性神經症狀的發生率更低。

(黃佳佳譯 馬皓琳,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.

 

 

手臂的位置對腋路法臂叢神經阻滯的起效和作用持續時間的影響

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:我們評價了施行阻滯後手臂的位置對腋路法臂叢神經阻滯(AXB)的成率、起效時間和作用持續時間的影響.

方法:實施過AXB後,患者隨機分入兩組:內收組和外展組。內收組立即將手臂內收貼於身體一側,外展組手臂保持外展位。這些體位保持到達到阻滯效果。

結果:外展組較內收組而言,感覺和運動阻滯的起效時間明顯縮短,而阻滯的持續時間明顯延長(P < 0.001)。

結論:施行AXB後手臂保持外展可以使起效增快且感覺和運動阻滯時間延長。

(黃麗娜 馬皓琳 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.

 

 

靜脈給予地塞米松對於鞘內注射呱替啶後的術後疼痛、噁心和嘔吐的影響

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:不同種類的藥物常被用來增強術後神經軸索阿片類鎮痛效果並減少不良反應。

方法:我們選擇60個病人隨機分為兩組,在鞘內麻醉(××15mg和呱替啶15mg)前分別靜脈注射2ml生理鹽水或地塞米松0.1mg/kg。在手術後6121824小時詢問病人疼痛評分。記錄術後噁心嘔吐(PONV)、瘙癢和呼吸制情況。

結果:地塞米松組的雙氯酸總量(P<0.05)、間隔六個小時的病人視覺類比疼痛評分(P<0.001PONV發生率(P<0.05)都明顯較低。

結論:在鞘內注射呱替啶前靜脈注射地塞米松能增鎮痛作用同時降低PONV的發生。

(沈浩 馬皓琳 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.