Anesthesia & Analgesia

May 2007

 

 

CARDIOVASCULAR ANESTHESIA:

性别差别对于老年病人冠脉手术后脑卒中风险的影响

裘毅敏译,马皓琳 李士通校

Gender Differences in Stroke Risk Among the Elderly After Coronary Artery Surgery

Tomoko Goto, Tomoko Baba, Asuka Ito, Kengo Maekawa, and Takaaki Koshiji

Anesth Analg 2007 104: 1016-1022.

择期冠脉旁路移植术(CABG)病人术前存在认知障碍

印洁敏 陈杰

Preexisting Cognitive Impairment in Patients Scheduled for Elective Coronary Artery Bypass Graft Surgery

Brendan S. Silbert, David A. Scott, Lisbeth A. Evered, Matthew S. Lewis, and Paul T. Maruff

Anesth Analg 2007 104: 1023-1028.

胸科手术单肺通气过程中压控制通气与容量控制通气的比较

俪译 薛张刚校

Pressure-Controlled Versus Volume-Controlled Ventilation During One-Lung Ventilation for Thoracic Surgery

M. Carmen Unzueta, J. Ignacio Casas, and M. Victoria Moral

Anesth Analg 2007 104: 1029-1033.

PEDIATRIC ANESTHESIA:

6-18个月婴儿术后应用酮咯酸氨丁三醇:对吗啡的应用、安全性评估和立体特异药代学的影响

张曦 译,马皓琳 李士通

Postoperative Ketorolac Tromethamine Use in Infants Aged 6–18 Months: The Effect on Morphine Usage, Safety Assessment, and Stereo-Specific Pharmacokinetics

Anne M. Lynn, Heidi Bradford, Eric D. Kantor, Kok-Yong Seng, David H. Salinger, James Chen, Richard G. Ellenbogen, Paolo Vicini, and Gail D. Anderson

Anesth Analg 2007 104: 1040-1051.

行扁桃体摘除术或增殖腺扁桃体摘除术的小儿患者使用地塞米松(0.0625-0.1mg/kg)预防呕吐、减轻疼痛、缩短首次摄入液体的时间和声音改变的发生率没有剂量递增效应

顾新宇 陈杰

There Is No Dose-Escalation Response to Dexamethasone (0.0625–1.0 mg/kg) in Pediatric Tonsillectomy or Adenotonsillectomy Patients for Preventing Vomiting, Reducing Pain, Shortening Time to First Liquid Intake, or the Incidence of Voice Change

Michelle S. Kim, Charles J. Coté, Carmen Cristoloveanu, Andrew G. Roth, Polina Vornov, Melissa A. Jennings, John P. Maddalozzo, and Cristine Sullivan

Anesth Analg 2007 104: 1052-1058.

对预行脉转接术的新生儿应用血浆B型利钠肽的时程价值

霞译 薛张纲校

Time Course and Prognostic Value of Plasma B-type Natriuretic Peptide Concentration in Neonates Undergoing the Arterial Switch Operation

Maxime Cannesson, Clara Bionda, Bruno Gostoli, Olivier Raisky, Sylvie di Filippo, Dominique Bompard, Catherine Védrinne, Robert Rousson, Jean Ninet, Jean Neidecker, and Jean-Jacques Lehot

Anesth Analg 2007 104: 1059-1065.

新生儿缺氧-缺血后异氟醚延迟性预处理会减少成熟小鼠即时死亡率并改善纹体的能

黄丽娜 李士通 马皓琳

Isoflurane-Delayed Preconditioning Reduces Immediate Mortality and Improves Striatal Function in Adult Mice After Neonatal Hypoxia–Ischemia

John J. McAuliffe, Bernadin Joseph, and Charles V. Vorhees

Anesth Analg 2007 104: 1066-1077.

AMBULATORY ANESTHESIA:

A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting

宋翠侠 陈杰

A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting

Tong J. Gan, Christian C. Apfel, Anthony Kovac, Beverly K. Philip, Neil Singla, Harold Minkowitz, Ashraf S. Habib, Jennifer Knighton, Alexandra D. Carides, Hong Zhang, Kevin J. Horgan, Judith K. Evans, Francasca C. Lawson, and The Aprepitant-PONV Study Group

Anesth Analg 2007 104: 1082-1089.

ANESTHETIC PHARMACOLOGY:

一些氟化杂环烷(Oxolanes)和杂环丁烷(Oxetanes)的麻醉药特性

王时来译 薛张纲校

Anesthetic Properties of Some Fluorinated Oxolanes and Oxetanes

Edmond I. Eger, II, David Lemal, Michael J. Laster, Mark Liao, Katarzyna Jankowska, Anilkumar Raghavanpillai, Anatoliy V. Popov, Yonghong Gan, and Yan Lou

Anesth Analg 2007 104: 1090-1097.

利多卡因、MK801MAC

Lidocaine, MK-801, and MAC              

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

Anesth Analg 2007 104: 1098-1102.

太尼对卵白蛋白致敏的大鼠气道的收缩效应的影响

郑丽 陈杰

The Effects of Fentanyl on the Contractile Response of Ovalbumin-Sensitized Rat Trachea

Kenji Nishioka, Osamu Shibata, Masakazu Yamaguchi, Tetsuji Makita, and Koji Sumikawa

Anesth Analg 2007 104: 1103-1108.

哮喘病人全身应用利多卡因对于气道张和肺能的影响

施杨译,薛张纲校

The Effects of Systemic Lidocaine on Airway Tone and Pulmonary Function in Asthmatic Subjects

Herng-Yu Sucie Chang, Alkis Togias, and Robert H. Brown

Anesth Analg 2007 104: 1109-1115.

左布比卡因与麦糖基-ß-环精联合应用可以延长大鼠鞘内和坐骨神经阻滞的时间

张美荣 陈杰

Prolongation of Intrathecal and Sciatic Nerve Blocks Using a Complex of Levobupivacaine with Maltosyl-ß-Cyclodextrin in Rats

Ken Karashima, Masahiko Taniguchi, Tadashi Nakamura, Mayumi Takasaki, Kanako Matsuo, Mitsuru Irikura, and Tetsumi Irie

Anesth Analg 2007 104: 1121-1128.

鼠脑蛋白的七氟醚麻醉效应:一项蛋白质组的时间-过程分析

陈佳莉译 薛张纲校

The Effects of Sevoflurane Anesthesia on Rat Brain Proteins: A Proteomic Time-Course Analysis

Armin Kalenka, Jochen Hinkelbein, Robert E. Feldmann, Jr, Wolfgang Kuschinsky, Klaus F. Waschke, and Martin H. Maurer

Anesth Analg 2007 104: 1129-1135.

全麻药对大鼠小胶质细胞系中P2X7 P2Y受体的影响

颜涛 译, 马皓琳 李士通校

The Effects of General Anesthetics on P2X7 and P2Y Receptors in a Rat Microglial Cell Line

Mika Nakanishi, Takashi Mori, Kiyonobu Nishikawa, Makoto Sawada, Miyuki Kuno, and Akira Asada

Anesth Analg 2007 104: 1136-1144.

TECHNOLOGY, COMPUTING, AND SIMULATION:

双频指数(BIS)引导下的全身麻醉合并胸段硬膜外镇痛可减少快通道结肠手术的恢复时间

杨卫红 陈杰

Bispectral Index-Guided General Anesthesia in Combination with Thoracic Epidural Analgesia Reduces Recovery Time in Fast-Track Colon Surgery

Jochen Mayer, Joachim Boldt, Alexander Schellhaaß, Björn Hiller, and Stefan W. Suttner

Anesth Analg 2007 104: 1145-1149.

星神经的经皮电刺激对创伤病人入院前得脉搏血氧测定信号质量得影响

陈珺珺译 薛张纲校

The Influence of Stellate Ganglion Transcutaneous Electrical Nerve Stimulation on Signal Quality of Pulse Oximetry in Prehospital Trauma Care

Renate Barker, Thomas Lang, Helmut Hager, Barbara Steinlechner, Klaus Hoerauf, Michael Zimpfer, and Alexander Kober

Anesth Analg 2007 104: 1150-1153.

CRITICL CARE AND TRAUMA:

低温对内毒素预处理的肺的作用

周雅春 马皓琳 李士通

The Effects of Hypothermia on Endotoxin-Primed Lung

Jae-Yong Chin, Younsuck Koh, Mi Joung Kim, Han Seong Kim, Woo-Sung Kim, Dong-Soon Kim, Won-Dong Kim, and Chae-Man Lim

Anesth Analg 2007 104: 1171-1178.

NEUROSURGICAL ANESTHESIA:

σ受体激剂通过保bcl-2而具有离体神经保作用

丁震敏 陈杰

Sigma Receptor Agonists Provide Neuroprotection In Vitro by Preserving bcl-2

Sufang Yang, Anish Bhardwaj, Jian Cheng, Nabil J. Alkayed, Patricia D. Hurn, and Jeffrey R. Kirsch

Anesth Analg 2007 104: 1179-1184.

OBSTETRIC ANESTHESIA:

腰椎横向超声可以为分娩硬膜外穿刺准确定位

姜旭晖译,马皓琳,李士通校

Ultrasound Using the Transverse Approach to the Lumbar Spine Provides Reliable Landmarks for Labor Epidurals

Cristian Arzola, Sharon Davies, Ayman Rofaeel, and Jose C. A. Carvalho

Anesth Analg 2007 104: 1188-1192.

GENERAL ARTICLES:

环软骨施压妨碍麻醉态下患者ProSeal喉罩的插入和通气

詹琼慧 陈杰

Cricoid Pressure Impedes Insertion of, and Ventilation Through, the ProSeal Laryngeal Mask Airway in Anesthetized, Paralyzed Patients

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

Anesth Analg 2007 104: 1195-1198.

催眠 与外科 :过去,现在和将来

吴德华译 薛张纲校

Hypnosis and Surgery: Past, Present, and Future (Review Article)

Albrecht H. K. Wobst

Anesth Analg 2007 104: 1199-1208.

PAIN MEDICINE:

外周神经应用辣椒素类似物可预防环扎大鼠坐骨神经造成的痛觉过敏

璇译 薛张纲校

Perineural Resiniferatoxin Prevents the Development of Hyperalgesia Produced by Loose Ligation of the Sciatic Nerve in Rats

Igor Kissin, Cristina F. Freitas, and Edwin L. Bradley, Jr

Anesth Analg 2007 104: 1210-1216.

腰段硬膜外类固醇注射用于治疗腰椎间盘膨出患者的效果

唐李隽 马皓琳 李士通

The Efficacy of Lumbar Epidural Steroid Injections in Patients with Lumbar Disc Herniations

William E. Ackerman, III and Mahmood Ahmad

Anesth Analg 2007 104: 1217-1222.

慢性疼痛个体人的注意和工作记忆痕迹分散

李惟一 陈杰

Disruption of Attention and Working Memory Traces in Individuals with Chronic Pain

Bruce D. Dick and Saifudin Rashiq

Anesth Analg 2007 104: 1223-1229.

全膝关置换术后硬膜外可乐定镇痛的量效学研究

王光妍译 薛张纲校

Epidural Clonidine for Postoperative Pain After Total Knee Arthroplasty: A Dose–Response Study

Yuan-Shiou Huang, Liu-Chi Lin, Billy K. Huh, Michael J. Sheen, Chun-Chang Yeh, Chih-Shung Wong, and Ching-Tang Wu

Anesth Analg 2007 104: 1230-1235.

PAIN MECHANISMS:

多方面截断大鼠坐骨神经与股神经末稍后的神经性疼痛测量的症精确度:一项探查性行为分析

Refinement of Symptoms of Neuropathic Pain Measurements After Various Transections of the Nerve Endings of the Sciatic and Femoral Nerve in Rats: An Exploratory Behavioral Analysis

Marie P. Van Remoortere, Theo F. Meert, Kris C. Vissers, Hans Coppenolle, and Hugo Adriaensen

Anesth Analg 2007 104: 1236-1245.

雌激素通过改变瞬时型感受器电位-1能从从而放大宫颈扩张导致的疼痛

周懿之 陈杰

Estrogen Amplifies Pain Responses to Uterine Cervical Distension in Rats by Altering Transient Receptor Potential-1 Function

Tao Yan, Baogang Liu, Dongping Du, James C. Eisenach, and Chuanyao Tong

Anesth Analg 2007 104: 1246-1250.

右美沙去甲右美沙在小鼠表皮浸润止痛中具有局部麻醉作用

陈勇柱译 薛张纲校

Dextromethorphan or Dextrorphan Have a Local Anesthetic Effect on Infiltrative Cutaneous Analgesia in Rats

Yu-Wen Chen, Koung-Shing Chu, Ching-Nan Lin, Jann-Inn Tzeng, Chin-Chen Chu, Mao-Tsun Lin, and Jhi-Joung Wang

Anesth Analg 2007 104: 1251-1255.

阿密曲替林是人Kv1.1Kv7.2/7.3通道的强效阻滞剂

张莹 马皓琳 李士通校

Amitriptyline Is a Potent Blocker of Human Kv1.1 and Kv7.2/7.3 Channels

Mark A. Punke and Patrick Friederich

Anesth Analg 2007 104: 1256-1264.

REGIONAL ANESTHESIA:

超声引导下的局部麻醉:最新的观念与将来的趋

杨卫红 陈杰

Ultrasound-Guided Regional Anesthesia: Current Concepts and Future Trends (Medical Intelligence)

Peter Marhofer and Vincent W. S. Chan

Anesth Analg 2007 104: 1265-1269.

超声引导下股骨中段外侧坐骨神经阻滞:一项随机比较设计实验

周时蓓译 薛张纲校

Ultrasound Guidance for Lateral Midfemoral Sciatic Nerve Block: A Prospective, Comparative, Randomized Study (Medical Intelligence)

Vicente Domingo-Triadó, Salvador Selfa, Francisco Martínez, Dolores Sánchez-Contreras, Montserrat Reche, Jose Tecles, María T. Crespo, Jose M. Palanca, and Blanca Moro

Anesth Analg 2007 104: 1270-1274.

超声介导下使用神经刺激法进行锁骨下神经阻滞:一项前瞻性随机试验

邱郁薇 马皓琳 李士通

Neurostimulation in Ultrasound-Guided Infraclavicular Block: A Prospective Randomized Trial (Medical Intelligence)

Emmanuel Dingemans, Stephan R. Williams, Geneviève Arcand, Philippe Chouinard, Patrick Harris, Monique Ruel, and François Girard

Anesth Analg 2007 104: 1275-1280.

运用超声术和组织学检查研究活体猪模型的神经内注射和电刺激

李惟一 陈杰

An Ultrasonographic and Histological Study of Intraneural Injection and Electrical Stimulation in Pigs (Brief Report)

Vincent W. S. Chan, Richard Brull, Colin J. L. McCartney, Daquan Xu, Sherif Abbas, and Patrick Shannon

Anesth Analg 2007 104: 1281-1284.

 

择期冠脉旁路移植术(CABG)病人术前存在认知障碍

Preexisting Cognitive Impairment in Patients Scheduled for Elective Coronary Artery Bypass Graft Surgery

Brendan S. Silbert, MB, BS, FANZCA*, David A. Scott, MB, BS, PhD, FANZCA*, Lisbeth A. Evered, BSc*, Matthew S. Lewis, BApp Sci (Hons), PhD*{dagger}, and Paul T. Maruff, PhD{dagger}

From the *Department of Anaesthesia, Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital; and {dagger}School of Psychological Science, La Trobe University, Melbourne, Australia.

Anesth Analg 2007 104: 1023-1028.

 

背景:如果要对择期CABG的病人是否会发生认知改变做出有效的推论,术前对这些病人认知障碍的发病情况进行准确的评估是非常必要的。这样的评估,需与一组并不患有心血管疾病的健康人进行比较。

方法:在一项回顾性观察研究中,349名拟行择期CABG的病人接受了神经心理测试。将其测试结果与没有心血管疾病的170名健康对照者相比较,其中有较多的年龄和智商(IQ)匹配的女性。如果在总共7项测试中有两项或更多的测试中,患者组的测试分值比对照组的分值减少超过2个标准差(sd),则认为存在认知障碍。

结果:择期CABG病人的测试结果除了在有槽拼板测试和健康对照组的差异不明显外,在其他的测试项中都明显比对照组差。对两组的测试结果分析发现患者组在言语学习测试中表现出的能减退最为严重。拟行择期CABG病人中,有122名(35%)术前存在认知障碍。先前患有心肌梗塞,年龄和IQ是独立预测认知障碍的指标。

结论:认知障碍普遍存在于将进行择期CABG的病人中。在评估择期CABG对认知能的影响时必须考虑到术前已经存在的认知障碍。

(印洁敏 陈杰 校)

BACKGROUND: An accurate assessment of the prevalence of cognitive impairment in patients scheduled for coronary artery bypass graft (CABG) surgery is necessary if valid assumptions regarding cognitive change are to be made. Such an assessment requires the use of a healthy control group free of cardiovascular disease.

METHODS: In a retrospective observational study, 349 patients scheduled for CABG surgery underwent neuropsychological testing. We compared the results with those from a group of 170 healthy controls without cardiovascular disease and containing more female patients who were matched for age and IQ score. Cognitive impairment was defined as test scores 2 sd less than the controls on two or more of the seven tests.

RESULTS: The CABG surgery patients performed significantly worse than the control group on all tests except the Grooved Pegboard test (nondominant). When analyzed by group, performance on the verbal learning test was the most impaired. Cognitive impairment was present in 122 (35%) of CABG surgery patients before their procedure. Prior myocardial infarction, age, and IQ were independent predictors of cognitive impairment.

CONCLUSIONS: Cognitive impairment is prevalent in patients presenting for CABG surgery. Impaired cognition before surgery must be considered when assessing the effects of CABG surgery on cognitive performance.

 

行扁桃体摘除术或增殖腺扁桃体摘除术的小儿患者使用地塞米松(0.0625-0.1mg/kg)预防呕吐、减轻疼痛、缩短首次摄入液体的时间和声音改变的发生率没有剂量递增效应

There Is No Dose-Escalation Response to Dexamethasone (0.0625–1.0 mg/kg) in Pediatric Tonsillectomy or Adenotonsillectomy Patients for Preventing Vomiting, Reducing Pain, Shortening Time to First Liquid Intake, or the Incidence of Voice Change

Michelle S. Kim, MD*, Charles J. Coté, MD{dagger}, Carmen Cristoloveanu, MD{ddagger}, Andrew G. Roth, MD{ddagger}, Polina Vornov, MD{ddagger}, Melissa A. Jennings, RN*{ddagger}, John P. Maddalozzo, MD, and Cristine Sullivan, MBA, MS||

From the *Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; {dagger}Department of Anesthesia and Critical Care, Division of Pediatric Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts; {ddagger}Department of Pediatric Anesthesia, Division of Clinical Otolaryngology, ||The Mary Ann and J. Milburn Smith Child Health Research Program, Feinberg School of Medicine, Northwestern University, Children's Memorial Hospital, Chicago, Illinois.

Anesth Analg 2007 104: 1052-1058.

 

背景:如果事先没有给予预防措施,扁桃体摘除术易出现术后恶心、呕吐(PONV)。先前已有研究证实某一剂量的地塞米松可降低PONV的发生率。但影响临预后的地塞米松最有效剂量尚未确定。

方法125名患儿入选该随机、双盲、前瞻性的地塞米松剂量递增研究,剂量分别为0.06250.1250.251mg/kg,最大剂量为24mg。用非参数方差分析方法分析治疗组术后0-5h5-24h期间呕吐的发生率Cox Proportional Likelihood Ratio Test用于比较治疗组中首次呕吐的时间和首次疼痛用药时间。

结果:在整个研究中,5种剂量的地塞米松对呕吐发生率无明显区别。次要治疗结果(止痛需求、首次摄取液体时间、声音变化)也无明显区别。

结论:对于行扁桃体摘除术或增殖腺扁桃体摘除术为预防PONV或降低其他次要治疗结果的发生率,给予最低剂量的地塞米松(0.0625mg/kg)与最高剂量(1.0mg/kg)一样有效。这类患儿中,为预防PONV使用高剂量地塞米松是没有必要的。

(顾新宇 陈杰 校)

BACKGROUND: Tonsillectomy is associated with postoperative nausea and vomiting (PONV) if no prophylaxis is administered. Previous studies have shown that a single dose of dexamethasone decreases the incidence of PONV. The most effective dose of dexamethasone to affect clinical outcome is yet to be defined.

METHODS: One-hundred-twenty-five children were enrolled in a double-blind, prospective, randomized, dose-escalating study of dexamethasone: 0.0625, 0.125, 0.25, 0.5, or 1 mg/kg, maximum dose 24 mg. Nonparametric ANOVA was used to analyze the incidence of vomiting by treatment group for 0 to ≤5 h, >5 to 24 h. The Cox Proportional Likelihood Ratio Test was used to compare the time of first vomit and time to first pain medication across treatment groups.

RESULTS: There was no difference in the incidence of vomiting for the five escalating doses of dexamethasone in the time period. There were no differences in secondary outcomes (analgesic requirements, time to first liquid, and change in voice) across treatment groups.

CONCLUSION: We conclude that the lowest dose of dexamethasone (0.0625 mg/kg) was as effective as the highest dose of dexamethasone (1.0 mg/kg) for preventing PONV or reducing the incidence of other secondary outcomes following tonsillectomy or adenotonsillectomy. There is no justification for the use of high-dose dexamethasone for the prevention of PONV in this cohort of children.

 

神经激肽1NK1)拮剂Aprepitant与昂丹司琼预防术后恶心呕吐的一项随机双盲比较研究

A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting

Tong J. Gan, MD*, Christian C. Apfel, MD, PhD{dagger}, Anthony Kovac, MD{ddagger}, Beverly K. Philip, MD, Neil Singla, MD, PhD||, Harold Minkowitz, MD, Ashraf S. Habib, MBBCh, MSc, FRCA*, Jennifer Knighton, MS#, Alexandra D. Carides, PhD#, Hong Zhang, PhD#, Kevin J. Horgan, MD#, Judith K. Evans, MD#, Francasca C. Lawson, MD#, and The Aprepitant-PONV Study Group**

From the *Department of Anesthesiology, Duke University Medical Centre, Durham, North Carolina; {dagger}Department of Anesthesiology and Perioperative Care, University of California, San Francisco, Medical Center at Mt. Zion, San Francisco, California; {ddagger}University of Kansas Medical Center, Kansas City, Kansas; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ||Huntington Memorial Hospital, Clinical Management Services, Inc., Pasadena, California; ¶Memorial Hermann Memorial City Hospital, Houston, TX; and #Merck Research Laboratories, Blue Bell, Pennsylvania.

Anesth Analg 2007 104: 1082-1089.

 

背景:目前使用的止吐药并不完全有效,NK1受体拮剂是一种新型的止吐药,它对化疗诱发的恶心呕吐有确切效果。本研究首次评估NK1受体拮剂Aprepitant对术后恶心呕吐的疗效和耐受性。

方法在此项多中心、双盲试验中,805名患者术前随机分别给予Aprepitant 40mg口服或, Aprepitant125mg口服,或昂丹司琼4mg静注,行全麻下开腹手术。评估术后48h恶心、呕吐的发生使用治疗药物。使用逻辑回归方法比较。

结果:各组间主要治疗终点(术后 0-24h没有呕吐并无需治疗药物)发生率没有显著差异,比例分别为Aprepitant 40mg45% Aprepitant 125 mg 组为43%,昂丹司琼4mg组为42%。无呕吐率Aprepitant 40mg组(90%), Aprepitant125mg组(95%)(0-24h)较昂丹司琼4mg 组(74%)高(p<0.001)。但呕吐治疗药物使用与否以恶心的控制并无显著差异。0-48h期间Aprepitant两种剂量下无呕吐发生率也较高(p<0.001)。治疗过程中副反应无显著差异。

结论:在术后第一个24h 48hAprepitant比昂丹司琼预防呕吐更有效。但呕吐治疗药物恶心的控制并无显著差异。

(宋翠侠 陈杰 校)

BACKGROUND: Antiemetics currently in use are not totally effective. Neurokinin-1 receptor antagonists are a new class of antiemetic that have shown promise for chemotherapy-induced nausea and vomiting. This is the first study evaluating the efficacy and tolerability of the neurokinin-1 receptor antagonist, aprepitant, for the prevention of postoperative nausea and vomiting.

METHODS: In this multicenter, double-blind trial, we randomly assigned 805 patients receiving general anesthesia for open abdominal surgery to a preoperative dose of aprepitant 40 mg orally, aprepitant 125 mg orally, or ondansetron 4 mg IV. Vomiting, nausea, and use of rescue therapy were assessed over 48 h after surgery. Treatments were compared using logistic regression.

RESULTS: Incidence rates for the primary end point (complete response [no vomiting and no use of rescue] over 0–24 h after surgery, tested for superiority of aprepitant) were not different across groups (45% with aprepitant 40 mg, 43% with aprepitant 125 mg, and 42% with ondansetron). The incidence of no vomiting (0–24 h) was higher with aprepitant 40 mg (90%) and aprepitant 125 mg (95%) versus ondansetron (74%) (P < 0.001 for both comparisons), although between-treatment use of rescue and nausea control was not different. Both aprepitant doses also had higher incidences of no vomiting over 0–48 h (P < 0.001). No statistically significant differences were seen among the side effect profiles of the treatments.

CONCLUSIONS: Aprepitant was superior to ondansetron for prevention of vomiting in the first 24 and 48 h, but no significant differences were observed between aprepitant and ondansetron for nausea control, use of rescue, or complete response.

 

太尼对卵白蛋白致敏的大鼠气道的收缩效应的影响

The Effects of Fentanyl on the Contractile Response of Ovalbumin-Sensitized Rat Trachea

Kenji Nishioka, MD, Osamu Shibata, MD, Masakazu Yamaguchi, MD, Tetsuji Makita, MD, and Koji Sumikawa, MD

From the Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.

Anesth Analg 2007 104: 1103-1108.

 

背景:太尼是否会引起气道高反应性至仍不明确。本文作者研究了太尼对卵白蛋白(OA)致敏的大鼠气道的收缩效应的影响。

方法10ugOA与佐剂混合后通过腹腔内注射使大鼠致敏。15天后,将大鼠气道切成3毫米宽的环形管道。测量OA导致气道紧张度,并且研究应用纳络酮时太尼作用。第二步研究胆碱能神经和血清素在收缩反应中的作用,通过河豚毒素和酮舍林研究太尼的作用。最后研究致敏大鼠机械通气情况下,注射OA前后呼吸系统的阻。

结果:太尼剂量依赖性地弱OA导致的收缩效应,纳络酮可部分拮太尼这一作用。河豚毒素和酮舍林都可以弱OA引起的收缩效应。河豚毒素存在的情况下,太尼的作用并不会因此增强。而存在酮舍林时,OA导致的收缩效应几乎都被太尼拮了。OA增高致敏大鼠呼吸系统阻,这一效应可被太尼弱。

结论:太尼通过阻断气道平滑肌胆碱能神经弱了致敏大鼠气道高反应性。

(郑丽 陈杰 校)

BACKGROUND: It is not clear whether fentanyl affects a hyperresponsive airway. We examined the effects of fentanyl on the contractile response of ovalbumin (OA)-sensitized rat tracheas.

METHODS: Rats were sensitized with a single intraperitoneal injection of 10 µg of OA mixed with adjuvant. Fourteen days later, the trachea was cut into 3-mm-wide rings. The OA-induced tension was measured, and the effects of fentanyl were studied in the presence of naloxone. Second, the role of cholinergic nerves and serotonin in the contraction and the effects of fentanyl were examined using tetrodotoxin and ketanserin. Third, lungs of sensitized rats were ventilated, and respiratory system resistance was calculated before and after the administration of OA in the presence of fentanyl.

RESULTS: Fentanyl dose-dependently attenuated the OA-induced contraction, and naloxone partly reversed it. Both tetrodotoxin and ketanserin attenuated the contraction. Fentanyl had no further effect on the contraction in the presence of tetrodotoxin, whereas the contraction was nearly abolished by fentanyl in the presence of ketanserin. OA increased respiratory system resistance in sensitized rats, and this effect was attenuated by fentanyl.

CONCLUSIONS: Fentanyl attenuates the airway hyperresponsiveness of sensitized rat trachea through the inhibition of cholinergic nerves on the smooth muscle.

 

左布比卡因与麦糖基-ß-环精联合应用可以延长大鼠鞘内和坐骨神经阻滞的时间

Prolongation of Intrathecal and Sciatic Nerve Blocks Using a Complex of Levobupivacaine with Maltosyl-ß-Cyclodextrin in Rats

Ken Karashima, MD*, Masahiko Taniguchi, MD, PhD*, Tadashi Nakamura, MD*, Mayumi Takasaki, MD, PhD*, Kanako Matsuo, MS{dagger}, Mitsuru Irikura, PhD{dagger}, and Tetsumi Irie, PhD{dagger}

From the *Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan; and {dagger}Division of Clinical Chemistry and Informatics, Graduate School of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.

Anesth Analg 2007 104: 1121-1128.

背景:作者用环精为基础的给药系统包括左布比卡因联合麦糖基-ß-环精(G2-ß-CD)应用于大鼠的神经和坐骨神经阻滞以研究是否延长局部麻醉作用的时间。

方法:大鼠随机分为四组(每组六个),分别接受30µL1%左布比卡因联合0(对照组),50, 100, 200 mM G2-ß-CD应用于腰麻。研究腰麻后肌紧张和尾部摆的潜伏期。另外四组大鼠(每组六个)分别接受0.5% 1%左布比卡因联合0100 mM G2-ß-CD行坐骨神经阻滞。研究给药到坐骨神经阻滞期间本体感受,运能和伤害感受的变化。

结果:腰麻组,所有的大鼠在注射局麻药后立即停止尾部摆。1%左布比卡因联合100 mM (80.0 ± 8.9 min) 200 mM (91.7 ± 7.0 min) G2-ß-CD的肌紧张恢复平均时间比对照组(38.3 ± 3.1 min)明显延长,但是尾部摆潜伏期没有延长。坐骨神经阻滞组,所有的大鼠在左旋布比卡因注射后暂时不。0.5%左旋布比卡因联合 100 mM G2-ß-CD麻醉作用时间是单纯应用0.5%左旋布比卡因的两倍,1%左旋布比卡因联合 100 mM G2-ß-CD麻醉作用时间是单纯应用1%左旋布比卡因的1.4倍。

结论:左旋布比卡因联合应用G2-ß-CD可以延长大鼠左旋布比卡因在腰麻和坐骨神经阻滞的麻醉作用时间

(张美荣 陈杰 校)

BACKGROUND: We used a cyclodextrin-based drug delivery system, consisting of levobupivacaine complexed with maltosyl-ß-cyclodextrin (G2-ß-CD), in spinal and sciatic nerve blocks in rats to investigate prolongation of the local anesthetic effect.

METHODS: Rats were assigned to four groups (n = 6 in each) and received intrathecally 30 µL of 1% levobupivacaine complexed with 0 (control), 50, 100, or 200 mM of G2-ß-CD. Muscle tone and tail flick latency were studied after intrathecal administration. Four more groups (n = 6) of rats received a sciatic nerve block with 0.5% or 1% levobupivacaine complexed with either 0 or 100 mM of G2-ß-CD. The time course of changes in proprioception, motor function, and nociception after circumferential subcutaneous administration to the sciatic nerve was examined.

RESULTS: With the intrathecal block, all rats stopped tail movement immediately after injection of the local anesthetic. The mean time to recovery of muscle tone with 1% levobupivacaine complexed with 100 mM (80.0 ± 8.9 min) and 200 mM (91.7 ± 7.0 min) of G2-ß-CD was significantly longer than that of the control group (38.3 ± 3.1 min), but tail flick latency was not prolonged. With the sciatic nerve block, all rats were temporarily immobilized after levobupivacaine injection. The anesthetic effects of 0.5% levobupivacaine with 100 mM of G2-ß-CD were twice as long as those for 0.5% levobupivacaine alone, and those of 1% levobupivacaine with 100 mM of G2-ß-CD were 1.4 times longer than those for 1% levobupivacaine alone.

CONCLUSIONS: The complex of levobupivacaine with G2-ß-CD prolonged the anesthetic effect of levobupivacaine in both intrathecal and sciatic nerve blocks in rats.


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双频指数(BIS)引导下的全身麻醉合并胸段硬膜外镇痛可减少快通道结肠手术的恢复时间

Bispectral Index-Guided General Anesthesia in Combination with Thoracic Epidural Analgesia Reduces Recovery Time in Fast-Track Colon Surgery

Jochen Mayer, MD*, Joachim Boldt, MD, PhD*, Alexander Schellhaaß, MD*, Björn Hiller, MD{dagger}, and Stefan W. Suttner, MD*

From the *Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Germany and {dagger}Department of General Surgery, Klinikum Ludwigshafen, Germany.

Anesth Analg 2007 104: 1145-1149.

 

背景: BIS引导下全身麻醉的恢复的因素已在不同人群中得以评估。使用BIS的处是不一致的。作者设计了此项研究,以评估BIS引导下的全身麻醉对要求快通道肠道手术的价值。

方法:44例接受开腹结肠切除术的病人随机分成两组:BIS-引导组(BIS , n = 22)或临引导组(常规监组, n = 22),均在放置硬膜外导管后静脉注射丙酚。在术后监室期间,对拔管时间,药物费用,血流学异常的发生率,术后当天下活的能,以病人对整个麻醉过程的满意度等方面进行评估。

结果:BIS-引导组,拔管时间明显较早(7.6 vs. 15.4 min, P < 0.01) ,术后监室的滞留时间明显缩短 (51 vs. 85 min, P < 0.01)。所有的麻醉用药费用减少了23% ,且需处理的低血压发生率在BIS组也明显较低。而下活能,麻醉满意度,并发症的发生率两组间无明显差异。

结论: BIS-引导组静脉麻醉合并硬膜外镇痛易于迅速恢复并减少快通道结肠手术病人的医疗支出。
(杨卫红 陈杰 校)

BACKGROUND: The impact of bispectral index (BIS)-guided general anesthesia on recovery from general anesthesia has been evaluated in different patient populations. The benefit of using BIS has been inconsistent. We designed this study to examine the value of BIS-guided anesthesia in a fast-track setting where the goal is rapid recovery.

METHODS: Forty-four patients undergoing open colon resection were randomly assigned to receive either BIS-guided (BIS group, n = 22) or clinically guided (standard care group, n = 22) total IV anesthesia with propofol after placing a thoracic epidural catheter. Duration of postanesthesia care unit stay, time to tracheal extubation, direct drug cost, the incidence of hemodynamic abnormalities, ability of ambulation on the day of surgery, and patient satisfaction with anesthetic management were assessed.

RESULTS: In the BIS-guided group, tracheal extubation was achieved significantly earlier (7.6 vs. 15.4 min, P < 0.01) and the postanesthesia care unit stay was significantly shorter (51 vs. 85 min, P < 0.01). Total anesthetic drug cost was reduced by 23% and the incidence of hypotension requiring treatment was significantly lower in the BIS group. Early ambulation, patient satisfaction, and incidence of adverse events were not significantly different between the groups.

CONCLUSIONS: BIS-guided IV anesthesia in combination with thoracic epidural analgesia facilitates rapid recovery and reduces the overall cost of care in patients undergoing fast-track colon surgery.

 

σ受体激剂通过保bcl-2而具有离体神经保作用

Sigma Receptor Agonists Provide Neuroprotection In Vitro by Preserving bcl-2

Sufang Yang, MD*, Anish Bhardwaj, MD{dagger}{ddagger}, Jian Cheng, PhD*, Nabil J. Alkayed, MD, PhD*, Patricia D. Hurn, PhD*, and Jeffrey R. Kirsch, MD*

From the Department of *Anesthesiology and Peri-operative Medicine, Oregon Health and Science University, Portland, Oregon; {dagger}Department of Neurology; and {ddagger}Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Anesth Analg 2007 104: 1179-1184.

背景:在几种物中,σ受体激剂可减弱实验性局部脑缺血后的脑损伤,作者检测了经典σ1受体激剂,4-苯丁基哌啶(PPBP)可通过某个机制包括细胞凋亡蛋白bcl-2保神经的假说。

方法:将原始的皮质神经培养物暴露在无氧-葡萄糖(OGD)或谷氨酸(100um)下2h。在创伤前15分钟开始使用PPBP或创伤后15分钟开始并持续24h。在另一组试验中,培养的神经在用PPBP治疗前2h以剂量依赖模式使用σ1受体拮剂林卡唑。使用钙黄绿素-AM和丙碘化物特异性的监测存活和死亡的细胞。bcl-2bax的表达通过定量实时聚合酶链逆转录和western blotting法测定,并通过TUNEL染色法检测DNA损伤。

结果PPBP的提前治疗可减轻OGD或谷氨酸(50100um)诱发的脑损伤,这个保作用可被林卡唑逆转(细胞死亡率:OGD48±2%OGD±PPBP 31±3%OGD±PPBP+林卡唑 46±2%)。PPBP治疗提高bcl-2而不是baxMRNA水平。PPBPOGD损伤后的bcl-2蛋白作用可被林卡唑完全消除。最后,PPBP可降低OGD损伤后的TUNEL细胞数量,这提示少数细胞具有明显的DNA损伤。

结论:这些数据显示PPBP通过保性基因如bcl-2产生保作用而减少细胞死亡。

(丁震敏 陈杰 校)

BACKGROUND: Sigma ({sigma})-receptor agonists attenuate brain injury after experimental focal cerebral ischemia in several species. We tested the hypothesis that the potent, prototypical {sigma}1-receptor agonist, 4-phenyl-1-(4-phenylbutyl) piperidine (PPBP), protects neurons by a mechanism involving the antiapoptotic protein bcl-2.

METHODS: Primary cortical neuronal cultures were exposed to either 2 h of oxygen–glucose deprivation (OGD) or glutamate (100 µM). PPBP treatment was initiated either 15 min prior to the insult or at 15 min postinsult then continued for 24 h. In another set of experiments, cultured neurons were preincubated for 2 h prior to PPBP treatment with {sigma}1-receptor antagonist, rimcazole, in a dose-dependent manner. Alive and dead cells were detected with calcein-AM and propidium iodide respectively. Bcl-2 and bax expression were determined by quantitative real time reverse transcription polymerase chain reaction and western blotting, and DNA damage was detected by TUNEL staining.

RESULTS: PPBP pretreatment attenuated neuronal injury induced by OGD or glutamate (50 or 100 µM). This protection was reversed with rimcazole (cell death: OGD 48 ± 2%, OGD plus PPBP 31 ± 3%, OGD plus PPBP with rimcazole 46 ± 2%). PPBP treatment increased bcl-2 but not bax mRNA levels. PPBP's ability to preserve bcl-2 protein after OGD by PPBP was fully abolished by rimcazole. Lastly, PPBP reduced the number of TUNEL-positive cells after OGD, suggesting fewer cells with overt DNA damage.

CONCLUSIONS: These data demonstrate that PPBP reduces cell death in vitro by a mechanism involving receptor-dependent preservation of protective genes such as bcl-2

 

环软骨施压妨碍麻醉态下患者ProSeal喉罩的插入和通气

Cricoid Pressure Impedes Insertion of, and Ventilation Through, the ProSeal Laryngeal Mask Airway in Anesthetized, Paralyzed Patients

Cheng W. Li, PhD, Fu S. Xue, MD, Ya C. Xu, MD, Yi Liu, MD, Peng Mao, MD, Kun P. Liu, MD, Quan Y. Yang, MD, Guo H. Zhang, PhD, and Hai T. Sun, MD

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

Anesth Analg 2007 104: 1195-1198.

背景:作者设计了一项前瞻性的对照研究,用以评估麻醉患者中环软骨施压是否影响喉罩(ProSeal LMA)的插入和通气。

方法:麻醉诱导后,使用前端带有环软骨压的指引工具帮喉罩(ProSeal LMA)尽可能深地插入气道内,套压设置为60cmH2O,记录下通气量和解剖位置,并记录气道封闭压,然后放环软骨压,喉罩进一步插入气道重新定位,并再次记录述数据。

结果:在放环软骨压重新放置的喉罩位置后,肺通气量、解剖位置和气道封闭压都显著优于通过环软骨压所确定的喉罩位置(P<0.05)。无论有没有环软骨压的存在,间歇正压通气的呼出潮气量是相近的,但吸气峰压从带有环软骨压时的28cmH2O降低至放环软骨压后的14cmH2OP<0.05)。

结论:使用环软骨施压妨碍喉罩插到合适的位置,插入喉罩时短暂的放环软骨压可以使得该装置位于合适位置的前端。当纠正喉罩位置后,环软骨施压并不改变潮气量,但显著增吸气峰压。

(詹琼慧 陈杰 校)

BACKGROUND: We designed this prospective self-controlled study to assess whether cricoid pressure hampers placement of and ventilation through the ProSeal laryngeal mask airway (ProSeal LMA) in anesthetized, paralyzed adult patients.

METHODS: After induction of anesthesia, the ProSeal LMA was inserted using the introducer tool with cricoid pressure advanced as far as possible, and the cuff pressure was set at 60 cm H2O. Ventilation adequacy and anatomic position were scored using measures previously described for ProSeal LMA assessment. Airway seal pressure was recorded. Cricoid pressure was then released, the ProSeal LMA further advanced and reseated, and the assessment repeated.

RESULTS: Lung ventilation scores, anatomic position scores, and airway seal pressure were significantly better after release of cricoid pressure and reseating of the ProSeal LMA than in the first position, where the ProSeal LMA was seated with cricoid pressure (P < 0.05). Expiratory tidal volume during intermittent positive pressure ventilation was similar with and without cricoid pressure, but peak inspiratory pressure decreased from 28 cm H2O with cricoid pressure to 14 cm H2O without cricoid pressure (P < 0.05).

CONCLUSIONS: Cricoid pressure applied before insertion hampered proper placement of the ProSeal LMA. Temporary cricoid pressure release during insertion allowed the device to be advanced to the proper position. After correct placement of the ProSeal LMA, application of cricoid pressure did not change tidal volume, but produced a significant increase in peak inspiratory pressure.

 

慢性疼痛个体人的注意和工作记忆痕迹分散

Disruption of Attention and Working Memory Traces in Individuals with Chronic Pain

Bruce D. Dick, PhD*{dagger}{ddagger}, and Saifudin Rashiq, MB, MSc, FRCPC*{ddagger}

From the Departments of *Anesthesiology and Pain Medicine and {dagger}Psychiatry, University of Alberta; and {ddagger}Multidisciplinary Pain Centre, University of Alberta Hospital, Edmonton, AB, Canada.

Anesth Analg 2007 104: 1223-1229.

 

背景:研究已经发现慢性疼痛能够分散人的注意,而且这种对注意的影响足以导致显著的能障碍、降低病患的生活质量。作者希望通过这个实验来测定究竟慢性疼痛在多大程度影响人的注意和记忆。

方法:在患者接受镇痛治疗前后,分别对患者进行计算机化的工作记忆测定和神经心理学的注意测定。

结果:三分之二的慢性疼痛患者的注意评分都在临损伤的范围之内。这些结果是不受年龄,教育水平,睡眠质量和疼痛是否减轻等因素的影响。因为有道药物治疗对评分有潜在的影响,所以药物治疗也被记录在内。那些高度注意损伤的患者在工作性记忆测试中表现出有显著的,更大程度的记忆困难。

结论:这些发现提示存在一种特的认知机制:记忆的维持是受慢性疼痛的影响。认知能不被短期的局部镇痛所改善。

(李惟一 陈杰 校)

BACKGROUND: Research has found that chronic pain disrupts attention and that this disruption can lead to significant functional impairment and decreased quality of life. We conducted the present study to examine how attention and memory are disrupted by chronic pain.

METHODS: Computerized tests of working memory were given to participants with chronic pain along with a neuropsychological test of attention before and after procedures resulting in analgesia.

RESULTS: Two-thirds of participants with chronic pain had scores in the clinically impaired range on attentional tasks. These results were independent of age, education level, sleep disruption, and pain relief. Medication use was also recorded and is reported to account for potential effects of medication on task performance. Those participants with the highest level of impairment had significantly greater difficulties in maintaining a memory trace during a challenging test of working memory.

CONCLUSIONS: These findings point to a specific cognitive mechanism, the maintenance of the memory trace, that is affected by chronic pain during task performance. Cognitive function was not improved by short-term local analgesia.


雌激素通过改变瞬时型感受器电位-1能从从而放大宫颈扩张导致的疼痛

Estrogen Amplifies Pain Responses to Uterine Cervical Distension in Rats by Altering Transient Receptor Potential-1 Function

Tao Yan, MD, PhD, Baogang Liu, MD, PhD, Dongping Du, MD, PhD, James C. Eisenach, MD, and Chuanyao Tong, MD

From the Department of Anesthesiology and the Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Anesth Analg 2007 104: 1246-1250.

 

引言:已知雌激素能增敏疼痛刺激反应,但尚不清楚是否归因于宫颈的急慢性疼痛。先前的研究显示兴奋瞬时型感受器电位-1通道(TRPV1)可增敏内脏器官,而雌激素可增宫颈的TRPV1的表达。本研究测试了雌激素是否能增强大鼠宫颈扩张的反应以是否与TRPV1通道有关。

方法:选择卵巢切除的大鼠,给予或不给予雌激素,麻醉后记录不同等级的宫颈扩张时腹壁下神经和腹部肌肉对刺激的的反应。记录给予TRPV1拮剂capsaizepine或该拮剂载体前后单个腹壁下神经纤维的冲发放。

结果:给予雌激素治疗的宫颈扩张的大鼠的腹部肌肉收缩反射的反应增强。予雌激素治疗大鼠宫颈扩张时给予capsaizepine后,腹壁下神经的传入反射减弱,而未给予雌激素替代的大鼠则没有述反应。capsaizepine不能减少卵巢切除物未接受雌激素替代的宫颈扩张的反应。

结论:以数据显示TRPV1通道对雌激素缺失宫颈的普通牵拉感觉并不重要。相反,TRPV1的能对雌激素诱发的致敏作用有影响。这些资料提出以下可能:自宫颈的急慢性疼痛,比如产程或者癌症,可能被雌激素增强或被TRPV1的拮剂减弱。

(周懿之 陈杰 校)

INTRODUCTION: Estrogen sensitizes responses to painful stimuli, but its contribution to acute and chronic pain from the uterine cervix is unknown. Previous studies link the excitatory transient receptor potiential-1 channel (TRPV-1) to sensitization in viscera, and show that estrogen increases TRPV-1 expression in afferents from the uterine cervix. Here, we tested whether estrogen enhanced responses to uterine cervical distension in rats, and whether this involved TRPV-1 channels.

METHODS: Ovariectomized rats, with or without estrogen replacement, were anesthetized and hypogastric nerve and abdominal muscle contraction reflex responses to graded uterine cervical distension were recorded. Single unit hypogastric nerve fiber firing was measured before and after acute treatment with the TRPV-1 antagonist, capsaizepine, or vehicle.

RESULTS: Abdominal muscle contraction reflex responses to uterine cervical distension were enhanced in estrogen-treated rats. Hypogastric afferent responses to cervical distension were reduced by capsaizepine in estrogen-treated animals, but were unaffected in ovariectomized animals without estrogen replacement.

CONCLUSIONS: These data suggest that the TRPV-1 channel is unimportant for normal mechanosensation in the cervix in the absence of estrogen, since capsaizepine failed to reduce responses to uterine cervical distension in rats without estrogen replacement. In contrast, TRPV-1 function is important for estrogen-induced sensitization. These data raise the possibility that acute and chronic pain coming from the cervix, such as labor or cancer, may be enhanced by estrogen and might be reduced by antagonists of TRPV-1.


超声引导下的局部麻醉:最新的观念与将来的趋

Ultrasound-Guided Regional Anesthesia: Current Concepts and Future Trends

Peter Marhofer, MD*, and Vincent W. S. Chan, MD, FRCPC{dagger}

From the *Department of Anaesthesia and Intensive Care Medicine, Medical University Vienna, Vienna, Austria; and {dagger}Department of Anesthesia, University of Toronto, Toronto, Canada.

Anesth Analg 2007 104: 1265-1269.

 

有关超声引导下的局部麻醉的领域目前发展十分迅速。初步的数据,尽管很有限,但也提示超声可以提高阻滞成率,降低并发症。在这篇综述中,作者将介绍超声显象的基本原理相关术支持方面的内容,着重阐述一些临结果,讨论超声引导下的局部麻醉的局限性,思索其对未来临麻醉的指导作用以该术的辅效。

(杨卫红 陈杰 校)

The scope of ultrasound imaging guidance for regional anesthesia is growing rapidly. Preliminary data, although limited, suggest that ultrasound can improve block success rate and decrease complications. In this review, we describe the basic principles of ultrasound scanning and needling techniques for nerve blocks, highlight some of the data on clinical outcome, discuss specific limitations of ultrasound for regional anesthesia, and speculate on the future direction for physician training and competency assessment with this technology.

 

运用超声术和组织学检查研究活体猪模型的神经内注射和电刺激

An Ultrasonographic and Histological Study of Intraneural Injection and Electrical Stimulation in Pigs

Vincent W. S. Chan, MD*, Richard Brull, MD*, Colin J. L. McCartney, MB, ChB*, Daquan Xu, MB{dagger}, Sherif Abbas, MD{dagger}, and Patrick Shannon, MSc, MD{ddagger}

From the *Departments of Anesthesia, {ddagger}Pathology, University of Toronto; and {dagger}Department of Anesthesia, Toronto Western Hospital, Ontario, Canada.

Anesth Analg 2007 104: 1281-1284.

 

背景:本实验作者评估了神经内刺激针最小刺激电流神经内注射的超声像图。

方法28头活体猪的臂丛神经中插入2cm的探针,记录引起肌肉收缩的最小刺激电流注入5ml染料后超声像图。

结果:肌肉收缩的最小刺激电流是0.43mA(范围0.12-1.8mA)。在28例中24例观察到神经的膨胀。此24例中,组织学检查提示有神经外膜的穿透。没有证据表明在任何神经束存在发育异常。

结论:超声有于发现神经内注射,大于0.5mA的运反应不能排除刺激针置入神经内。神经内注射和神经能不全的关系仍不明确。

(李惟一 陈杰 校)

BACKGROUND: In this study we evaluated the minimum stimulating current associated with intraneural needle placement and sonographic appearance of intraneural injection.

METHODS: We inserted a needle 2 cm inside 28 pig nerves (brachial plexus in vivo), recorded the minimum current to elicit a motor response, and injected dye (5 mL) under ultrasound (US) imaging.

RESULTS: The minimum current to elicit a motor response was 0.43 mA (range: 0.12–1.8 mA). Nerve expansion was visualized by US in 24 of 28 nerves. Histology revealed penetration of the epineurium in these same 24 nerves. There was no evidence of dysplasia within the fascicle of any nerve.

CONCLUSIONS: US may prove useful to detect intraneural injection, whereas a motor response above 0.5 mA may not exclude intraneural needle placement. The correlation between intraneural injection and neurological dysfunction remains unclear.


胸科手术单肺通气过程中压控制通气与容量控制通气的比较

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery

M. Carmen Unzueta, J. Ignacio Casas, and M. Victoria Moral

Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.

Anesth Analg 2007 104: 1029-1033.

 

背景:压控制通气(PCV)已经成为被推荐的一种方式运用于行胸外科手术单肺通气(OLV)的病人来改善氧合。在这个实验中,我们对比了单肺通气中压控制通气模式与容量控制通气(VCV)模式,观察PCV是否能改善脉血氧。方法:58个术前肺能良好的行胸外科手术的病人被随机分为两组。A组的病人单肺通气时先行30分钟的容量控制通气,然后再行相同时间的压控制通气。B组的病人单肺通气时先行30分钟的压控制通气,再行相同时间的容量控制通气。在每种通气模式的最后测一个气道压以脉血气。结果:两种模式下单肺通气的脉氧合没有区别,容量控制模式(Pao2, 206.1 +/- 62.4 mm Hg),压控制模式(Pao2, 202.1 +/- 56.4 mm Hg; P = 0.534)。气道压在压控制模式比容量控制模式的要低(24.43 +/- 3.42 cm H2O vs. 34.16 +/- 5.21 cm H2O; P < 0.001)。结论:对于肺能情况良好的病人单肺通气时使用压控制模式与容量控制模式比较并没有改善氧供,但是压控制模式的确可以降低气道压。需要做进一步的研究针对患有严重的阻塞性或限制性通气障碍

(张 俪译 薛张刚校)

BACKGROUND: Pressure-controlled ventilation (PCV) has been suggested as a tool to improve oxygenation during one-lung ventilation (OLV) for patients undergoing thoracic surgery. In this study we investigated whether PCV results in improved arterial oxygenation compared with volume-controlled ventilation (VCV) during OLV. METHODS: Fifty-eight patients with good preoperative pulmonary function scheduled for thoracic surgery were prospectively randomized into two groups. Those in group A underwent OLV initially with VCV for 30 min followed by PCV for a similar period of time. Those in group B underwent OLV initially with PCV for 30 min followed by VCV for a similar duration. Airway pressures and arterial blood gases were obtained during OLV at the end of each ventilatory mode. RESULTS: There were no differences during OLV in arterial oxygenation between VCV (Pao2, 206.1 +/- 62.4 mm Hg) and PCV (Pao2, 202.1 +/- 56.4 mm Hg; P = 0.534). Peak airway pressure was lower with PCV than with VCV (24.43 +/- 3.42 cm H2O vs. 34.16 +/- 5.21 cm H2O; P < 0.001). CONCLUSIONS: The use of PCV during OLV does not lead to improved oxygenation during OLV compared with VCV for patients with good preoperative pulmonary function, but PCV did lead to lower peak airway pressures. Further study is needed for patients with severe obstructive or restrictive pulmonary disease

 

对预行脉转接术的新生儿应用血浆B型利钠肽的时程价值

Time Course and Prognostic Value of Plasma B-type Natriuretic Peptide Concentration in Neonates Undergoing the Arterial Switch Operation

Maxime Cannesson, MD*, Clara Bionda, MD{dagger}, Bruno Gostoli, MD*, Olivier Raisky, MD, PhD{ddagger}, Sylvie di Filippo, MD, PhD, Dominique Bompard, MD*, Catherine Védrinne, MD, PhD*, Robert Rousson, MD, PhD{dagger}, Jean Ninet, MD{ddagger}, Jean Neidecker, MD*, and Jean-Jacques Lehot, MD, PhD*

From the Departments of *Anesthesiology and Intensive Care, {dagger}Biochemistry, {ddagger}Cardiac Surgery, and Pediatric Cardiology, Hospices Civils de Lyon, Louis Pradel Hospital and Claude Bernard Lyon 1 University, Lyon, France.

Address correspondence and reprint requests to Maxime Cannesson, Service d'Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 avenue du Doyen Lépine, 69500 Bron, France.

Anesth Analg 2007 104: 1059-1065.

 

背景:血浆B型利钠肽(BNP)可以预防成人心脏外科的术后并发症。我们的目标是调查预行脉转接手术(ASO)以使大脉转位(TGA)的新生儿的BNP学程序价值。方法:在30个新生儿中,分别于ASO术前、术后立即、术后6122448小时测量BNP浓度。以手术72小时后病人需要机械通气或存在低心排量综合征来确定为有复杂的术后进展。通过研究术后BNP的浓度来预测是否有复杂性进展。结果:气管插管时间、缩血管药维持时间、ICU停留时间分别为6848121)小时、7869141)小时9676149)小时。有复杂术后进展的病人术后6小时12小时BNP浓度高于单纯进展者〔分别为459 (210–897) vs 137 (67–248) ng/L 547 (193–868) vs 185 (79–354) ng/LP < 0.05〕,并且前者的气管插管时间、缩血管药维持时间、ICU停留时间长于后者〔分别为96 (70–190) vs 50 (48–66)小时, 100 (83–190) vs 70 (59–72) 小时, 120 (90–240) vs 84 (72–96) 小时, P < 0.05〕。术后6小时BNP浓度大于160 ng/L作为预测复杂性预后的指标的有93%的敏感度67%的特异度。结论:BNP浓度可以预测行ASO的新生儿的不良预后。这个指标有潜在的临价值。

(孙 霞译 薛张纲校)

BACKGROUND: Plasma B-type natriuretic peptide (BNP) can predict postoperative complications after cardiac surgery in adults. Our aim was to investigate BNP kinetics and prognostic value in neonates undergoing the arterial switch operation (ASO) for transposition of the great arteries (TGA). METHODS: We measured BNP concentrations in 30 neonates before, immediately after, and 6, 12, 24, and 48 h after ASO for TGA. Complicated postoperative evolution was defined as patients requiring mechanical ventilation or presenting low cardiac output syndrome for more than 72 h. We studied the ability of postoperative BNP concentrations to predict complicated evolution. RESULTS: Intubation duration, inotropic support duration, and intensive care unit stay were 68 (48–121) h, 78 (69–141) h, and 96 (76–149) h respectively. Patients with complicated evolution had higher 6 and 12-h BNP concentrations than patients with simple evolution (459 (210–897) vs 137 (67–248) ng/L and 547 (193–868) vs 185 (79–354) ng/L respectively; P < 0.05) and had longer intubation, inotropic support, and intensive care unit stay (96 (70–190) vs 50 (48–66) h, 100 (83–190) vs 70 (59–72) h, and 120 (90–240) vs 84 (72–96) h, P < 0.05). A 6-h BNP concentration >160 ng/L was able to predict complicated evolution with a sensitivity of 93% and a specificity of 67%. CONCLUSION: In neonates, BNP concentrations can predict adverse outcome in the postoperative period after ASO for TGA. This marker has potential clinical applications.

 

一些氟化杂环烷(Oxolanes)和杂环丁烷(Oxetanes)的麻醉药特性

Anesthetic Properties of Some Fluorinated Oxolanes and Oxetanes

Edmond I. Eger, II, MD*, David Lemal, PhD{dagger}, Michael J. Laster, DVM*, Mark Liao, BS*, Katarzyna Jankowska, DVM*, Anilkumar Raghavanpillai, PhD{dagger}, Anatoliy V. Popov, PhD{dagger}, Yonghong Gan, PhD{dagger}, and Yan Lou, MS{dagger}

From the *Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0464; and {dagger}Department of Chemistry, Dartmouth College, Hanover, New Hampshire 03755-3564.

.Anesth Analg 2007 104: 1090-1097.

 

背景:新的高效吸入麻醉药的研究进展缓慢,一大原因是现有的两个出色的药物,地氟醚和七氟醚。尽管如此,无论地氟醚还是七氟醚都不是最完美的麻醉药,地氟醚会刺激心肺系统,而七氟醚(尽管迅速)苏醒较缓慢。七氟醚同时会导致搐和术后兴奋。方法和结果:在近期的道中,我们阐述了31环单氟化醚的理化和麻醉特性。尽管制造了集中新的麻醉药,但是没有一个比七氟醚更好。剩余的醚要么不稳定,要么会产生明显的中枢系统刺激,包括搐。结论:我们发现这些环醚类并没有显示出优于地氟醚或七氟醚的地方。

(王时来译 薛张纲校)

BACKGROUND: The search for new potent inhaled anesthetics has slowed, in large part because of the excellence of the two most recent additions, desflurane and sevoflurane. Nonetheless, neither desflurane nor sevoflurane are ideal anesthetics, desflurane causing cardiorespiratory stimulation, and sevoflurane having a slower (albeit rapid) recovery from anesthesia. Sevoflurane also can produce convulsions and postoperative agitation. METHODS AND RESULTS: In the present report, we describe the physical and anesthetic properties of 31 cyclic ethers halogenated solely with fluorine. Although several produced anesthesia, none had solubilities that would make them better than sevoflurane. The remaining ethers were unstable or produced obvious central nervous system irritation, including convulsions. CONCLUSIONS: We find that none of these cyclic ethers appear to provide advantages over desflurane or sevoflurane.

 

哮喘病人全身应用利多卡因对于气道张和肺能的影响

The Effects of Systemic Lidocaine on Airway Tone and Pulmonary Function in Asthmatic Subjects

Herng-Yu Sucie Chang, Alkis Togias, and Robert H. Brown

Department of Environmental Health Sciences, The Johns Hopkins University, Baltimore, Maryland 21205, USA

Anesth Analg 2007 104: 1109-1115

 

背景:为了防止哮喘病人反应性的支气管收缩,局麻药常常通过气雾剂吸入或静脉途径作为麻醉辅用药.利多卡因可弱气道对引起张增的神经刺激的反应,但是关于利多卡因对基础气道张效果的资料却很少.因此我们就要来测试一下在哮喘病人中,利多卡因对基础气道张的效应.方法:CT来分析15个患有哮喘的自愿者分别在基础条件和在输注利多卡因情况下的小、中、大气道(直径分别为2-5,5-8,8mm).同时分析肺泡腔的直径、肺泡壁厚度和肺能在应用利多卡因前后的变化.结果:利多卡因引起1秒肺能测试中用潮气量的明显下降(7±2%,P=0.06),与基础态相比,输注利多卡因也可引起肺泡腔直径少许但明显的缩小(-3±-0.5%,P<0.001).并且,第一秒用潮气量的变化和肺泡腔大小的变化呈明显的相关性(r2=0.47,P=0.01).结论:利多卡因能弱气道对通过感觉神经通路引起支气管痉挛的药物的反应,但它并不减小基础态下的气道张.相反,即使是通过静脉注射利多卡因,也可明显地增气道张,引起气道狭窄.因此,当用利多卡因来预防由插管导致的支气管痉挛时,也应该时时通过听来检测气道况.

(施杨译,薛张纲校)

BACKGROUND: To prevent reflex-induced bronchoconstriction in patients with asthma, local anesthetics are commonly administered by aerosol or IV as adjunct medication. Lidocaine attenuates responsiveness to a neurally active stimulus that increases tone, but there is scant information about the effect of lidocaine on baseline airway tone. Therefore we examined the effects of IV lidocaine on baseline airway tone in asthmatic subjects. METHODS: Small, medium, and large airways (2-5, 5-8, >8 mm diameter) were analyzed by computed tomography in 15 asthmatic volunteers under baseline conditions and during infusion of lidocaine. Changes in luminal airway diameter and wall thickness from baseline to during lidocaine infusion, and the change in pulmonary function induced by lidocaine, were analyzed. RESULTS: Lidocaine caused a significant decrease in the forced expiratory volume in 1 s pulmonary function measure (7 +/- 2%, P = 0.006). There was also a small but significant decrease in the airway luminal diameter at total lung capacity during lidocaine infusion compared to baseline (-3 +/- 0.5%, P < 0.001). Moreover, there was a significant correlation between the change in forced expiratory volume in 1 s and the change in airway luminal diameter at total lung capacity (r2 = 0.47, P = 0.01). CONCLUSION: Lidocaine, which reduces airway responsiveness to drugs that cause bronchospasm through sensory nerve activation, did not reduce baseline airway tone. Instead, even when administered IV, lidocaine significantly increased airway tone and caused airway narrowing. Therefore, while the administration of lidocaine can prevent intubation-induced bronchospasm, the airways should be constantly monitored by auscultation even during IV lidocaine administration.

 

鼠脑蛋白的七氟醚麻醉效应:一项蛋白质组的时间-过程分析

The Effects of Sevoflurane Anesthesia on Rat Brain Proteins: A Proteomic Time-Course Analysis

Armin Kalenka, MD*, Jochen Hinkelbein, MD*, Robert E. Feldmann, Jr, PhD{dagger}, Wolfgang Kuschinsky, MD{dagger}, Klaus F. Waschke, MD*, and Martin H. Maurer, MD{dagger}

Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.

Anesth Analg 2007 104: 1129-1135

 

背景:新近的研究显示了老鼠在地氟醚麻醉后总计三天的脑蛋白表达的变化。在本项研究中,我们观察到了七氟醚麻醉后长达28天的蛋白质组水平的持续性变化的存在。方法:我们让老鼠处于含2.4%七氟醚的空气中3小时,让其自发吸入七氟醚使其麻醉。这些老鼠(每组6个)分别在麻醉后立即、72小时或28天被处死。我们取出死亡老鼠的大脑,并用二维凝胶电子分析仪和聚集光谱测定法绘制全部蛋白表达谱。数据通过方差分析进行统计分析(P<0.01),得出表达因子的一系列双重改变。结果:我们发现麻醉后即刻有11个蛋白质点调有差别。在麻醉后72小时有17个蛋白质表达有差别。在麻醉后28天只有一个蛋白质点调有差别。这些调有差别的蛋白的难以理解的靶向可归因于突触间隙泡处理和细胞-细胞传递。结论:七氟醚诱导相关的蛋白质表达谱在 1MAC麻醉后即刻和72小时后有改变。麻醉后28天,除了一个蛋白质外的所有蛋白质均回到丰度的基线水平。

(陈佳莉译 薛张纲校)

BACKGROUND: Recent studies showed changes in cerebral protein expression up to 3 days after desflurane anesthesia in rats. In the present study, we investigated the existence of persisting changes on the proteome level after sevoflurane anesthesia that persisted for as long as 28 days after anesthesia. METHODS: Rats were anesthetized by spontaneous inhalation of 2.4% sevoflurane in air for 3 h. Animals (n = 6 for each group) were killed either directly, 72 h, or 28 days after anesthesia. Brains were removed and subjected to global protein expression profiling based on two-dimensional gel electrophoresis and mass spectrometry. Expression factors were compared to results from untreated conscious animals at each time point. Data were statistically analyzed by ANOVA (P < 0.01) and a cut of more than two-fold change in the expression factor. RESULTS: We found 11 protein spots differentially regulated directly after anesthesia. Seventeen proteins were differentially expressed 72 h after the anesthesia. Only one spot was differentially regulated 28 days after anesthesia. The plausible targets of these differentially regulated proteins can be attributed to synaptic vesicle handling and cell–cell communication. CONCLUSIONS: Sevoflurane induced relevant changes in protein expression profiles directly and 72 h after an anesthesia with 1 MAC. Twenty-eight days after the anesthesia, all proteins except one had returned to baseline levels of abundance.

 

星神经的经皮电刺激对创伤病人入院前得脉搏血氧测定信号质量得影响

The Influence of Stellate Ganglion Transcutaneous Electrical Nerve Stimulation on Signal Quality of Pulse Oximetry in Prehospital Trauma Care

Renate Barker, MD, Thomas Lang, MD, Helmut Hager, MD, Barbara Steinlechner, MD, Klaus Hoerauf, MD, Michael Zimpfer, MD, and Alexander Kober, MD

From the Department of Anesthesia and General Intensive Care, Medical University of Vienna, Vienna, Austria.

Anesth Analg 2007 104: 1150-1153.

 

背景:准确的外周脉血氧饱和度监测是住院前急的重要工具。这种监测要求有适当的体积描记的搏。信号的质量会因为外周环境的低温造成血管收缩而降低。阻断星神经可以改善外周血管的灌注,可以通过直接输液或经皮神经电刺激(TENS)实现。我们评估了星神经经皮神经电刺激是否可以减少血管收缩,从而改善外周脉搏血氧定量测定的信号监测质量。方法:我们研究了53名因轻微创伤而送往医院的病人。我们记录了病人的生命体症,包括送往医院前和之后中心和皮肤温度。脉搏氧饱和度感受器夹在病人两只手的第二个手指。一侧的星神经的TENS在开始送往医院途中进行。脉搏血氧定量监测会因为信号过低而警,并且双侧分开记录。 结果:相比于另一测,进行TENS一侧的手的警显著减少(TENS侧平均警次数是 3.1 [1–15],相比于另一侧的8.8 [1–28] P < 0.05)。失控持续时间也缩短(进行TENS一侧持续时间平均为77 [16–239] s ,相比于另一侧的333 [78–1002] s) 结论:数据显示通过TENS阻断星神经可以改善入院前病人的外周脉搏血氧测定的质量。

(陈珺珺译 薛张纲校)

BACKGROUND: Accurate monitoring of the peripheral arterial oxygen saturation has become an important tool in the prehospital emergency medicine. This monitoring requires an adequate plethysmographic pulsation. Signal quality is diminished by cold ambient temperature due to vasoconstriction. Blockade of the stellate ganglion can improve peripheral vascular perfusion and can be achieved by direct injection or transcutaneous electrical nerve stimulation (TENS) stimulation. We evaluated whether TENS on the stellate ganglion would reduce vasoconstriction and thereby improve signal detection quality of peripheral pulse oximetry. METHODS: In our study, 53 patients with minor trauma who required transport to the hospital were enrolled. We recorded vital signs, including core and skin temperature before and after transport to the hospital. Pulse oximetry sensors were attached to the patient’s second finger on both hands. TENS of the stellate ganglion was started on one side after the beginning of the transport. Pulse oximeter alerts, due to poor signal detection, were recorded for each side separately. RESULTS: On the hand treated with TENS we detected a significant reduction of alerts compared to the other side (mean alerts TENS 3.1 [1–15] versus control side 8.8 [1–28] P < 0.05). The duration of dropouts was shorter as well (mean duration TENS 77 [16–239] s versus control side 333 [78–1002] s). CONCLUSION: The data indicate that blockade of the stellate ganglion with TENS improves signal quality of pulse oximeters in the prehospital setting.

 

催眠 与外科 :过去,现在和将来

Hypnosis and surgery: past, present, and future

Wobst AH

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA.

Anesth analg, 2007 may; 104(5):1199-208

 

催眠曾经被认为是一种主观态的感应,通过暗示可以引出知觉或记忆的改变。自从18世纪第一次公众证实了由Mesmer实验的“物吸引(animal magne- tism)”现象,这种利用心理学工具已经极大地吸引着医学界和公众的眼球。运用催眠来改变疼痛的感觉和记忆可以追溯到几世纪以前。然而完全理解这种心理暗示其与麻醉学中药理学的对比却鲜有进展。目前,由于催眠似乎能够辅和可能强有知觉的镇静,因此引起了很大的兴趣。当代临研究者声称联合镇痛与催眠运用于小的外科手术较传统的药理麻醉更有优,患者和外科医生之间更有亲切感。疼痛通路的基本研究涉到疼痛屈曲反射和正电子发射x线断层扫描,它们可以产生与催眠相关联的生理学反应的客观数据。本文,我们回顾了这种古老的治疗性工具——暗示的量——的历史、基础和临研究以现代实践运用。

(吴德华译 薛张纲校)

Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. Yet little progress has been made to fully comprehend or appreciate its potential compared to the pharmacologic advances in anesthesiology. Recently, hypnosis has aroused interest, as hypnosis seems to complement and possibly enhance conscious sedation. Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.

 

外周神经应用辣椒素类似物可预防环扎大鼠坐骨神经造成的痛觉过敏

Perineural resiniferatoxin prevents the development of hyperalgesia produced by loose ligation of the sciatic nerve in rat

Kissin I, Freitas CF, Bradley EL Jr.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

Anesth Analg. 2007 104(5):1210-6

 

背景:辣椒素受体(TRPV1)存在于外周神经纤维中;受辣椒素刺激,介导降钙素基因相关肽其他神经肽的放,参与神经炎症反应。另一方面,神经损伤后放多种炎症介质,也能激活或致敏TRPV1受体。这些发现提示阻断TRPV1受体有预防神经病变的保作用。本研究检测了一个假说,即外周神经应用辣椒素类似物(RTX)能阻止大鼠坐骨神经环扎松紧带造成的痛觉过敏的进展。方法:在雄性Sprague-Dawley大鼠坐骨神经处,经皮注射单次剂量的RTX0.0005%,0.1ml)或对照剂,3h后行手术,环绕注药神经放置四条松紧带。评估对伤害性热刺激的反应(缩爪潜伏期、爪时间)、对反复von Frey filaments刺激的反应后爪姿的改变(展趾,跖屈,外旋)。结果:术前外周神经应用RTX可完全防止环扎导致的缩爪潜伏期缩短、爪时间的增和对von Frey filaments刺激的缩爪频率增。RTX还表现出对后爪姿不足进展的预防作用,但不完全,例如,术后7天,爪姿积分(0-6RTX组为1.69+/-0.92而对照组为4.06+/-1.68P<0.005)。在已发生神经病变的背景下应用RTX作用有限,热痛觉减退持续时间相对较短。结论:外周神经应用RTX能阻止坐骨神经环扎松紧带所致神经病变的进展。有望通过外周用药经TRPV1受体途径预防外周神经术后的神经性疼痛。

(罗 璇译 薛张纲校)

BACKGROUND: The vanilloid receptors (TRPV1) are found in peripheral nerve fibers; their stimulation by capsaicin leads to release of calcitonin gene-related peptide and other neuropeptides participating in neuroinflammation. On the other hand, various inflammatory mediators, released after nerve damage, can activate or sensitize the TRPV1 receptors. These findings together suggest a protective effect of TRPV1 receptor blockade in neuropathy. In the present study, we tested the hypothesis that perineural resiniferatoxin (RTX) can prevent the development of hyperalgesia caused by placing loosely constrictive ligatures around the sciatic nerve. METHODS: Male Sprague-Dawley rats received a single percutaneous injection of RTX (0.0005%, 0.1 mL) or vehicle at the sciatic nerve, and underwent surgery 3 h later to place four loose ligatures around the nerve on the side of drug administration. Responses to noxious heat (withdrawal latency, paw-lift duration), repetitive stimulation with von Frey filaments, and changes in hindpaw posture (toe spread, ventroflexion, and foot exorotation) were assessed. RESULTS: Perineural RTX administered before surgery completely prevented ligation-induced reduction in withdrawal latency, increase in paw lift duration and increase in withdrawal frequency to von Frey filaments. The preventive effect of RTX on the development of deficits in hindpaw posture was pronounced but not complete, e.g., on day 7 after surgery, the cumulative paw-posture score (0-6) was 1.69 +/- 0.92 with RTX and 4.06 +/- 1.68 with vehicle (P < 0.005). The effect of RTX used against the background of already developed neuropathy was limited to thermal hypoalgesia lasting for a relatively short period. CONCLUSION: Perineural RTX prevents the development of neuropathy caused by placing loosely constrictive ligatures on the sciatic nerve. Perioperative use of drugs acting via the TRPV1 receptors may hold the promise for preventing neuropathic pain after surgery on peripheral nerves.

 

全膝关置换术后硬膜外可乐定镇痛的量效学研究

Epidural Clonidine for Postoperative Pain After Total Knee Arthroplasty: A Dose–Response Study

Yuan-Shiou Huang, MD*, Liu-Chi Lin, MD{dagger}, Billy K. Huh, MD, PhD{ddagger}, Michael J. Sheen, MD*, Chun-Chang Yeh, MD*, Chih-Shung Wong, MD, PhD*, and Ching-Tang Wu, MD*

From the Departments of *Anesthesiology, {dagger}Orthopaedics, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China; and {ddagger}Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

Anesth Analg 2007;104:1230-1235

 

背景:联合可乐定,局麻药和阿片类药物可以改善膝关置换术后硬膜外镇痛效果.在这项研究中,我们想要测定可以提供最佳镇痛效果以最小副作用的硬膜外可乐定剂量.方法:八十个接受全膝关置换术的病人, ASA 评分在I–III,被随机分成四组,每组20个人.每一个病人都接受相同的硬膜外麻醉操作.手术后, C0, C1, C2, C4组接受PCEA,使用可乐定(各组的可乐定浓度分别为0,1.0, 2.0,4.0ug/ml)0.1的吗啡入0.2%的罗哌卡因.镇痛效果的评估包括了两个方面,PCEA消耗的容量,疼痛范围视觉模型所测定的术后第1,2,4,12, 24, 48, 72个小在静息以活时的疼痛程度.术后记录72小时内的收缩压,心率,镇静,感觉和运阻断情况.结果:C0,C1,C2,C4组得PCEA用量分别为71.8 ± 19.5 mL, 49.6 ± 12.3 mL, 48.1 ± 9.3 mL, and 39.4 ± 9.0 mL.使用可乐定组的患者术后疼痛发生明显减少(P = 0.002).C4,四位病人的感觉阻滞时间延长,一位病人同时出现深度镇静以感觉运阻滞时间延长.在镇痛费,没有显著的统计学差异(P = 0.78),而且发现C1C2组病人之间疼痛程度有显著差异(P=0.06).结论:与吗啡和罗哌卡因配伍硬膜外术后镇痛,可乐定镇痛最佳浓度为1.0 µg/mL

(王光妍译 薛张纲校)

BACKGROUND: Combinations of epidural clonidine, local anesthetics, and opioids have improved postoperative analgesia after total knee arthroplasty. In this study we sought to determine the optimal epidural bolus dose of clonidine, which provides the best analgesia and fewest side effects.METHODS: Eighty ASA I–III patients, who underwent total knee arthroplasty were randomly assigned to one of four groups of 20 patients each. Identical epidural anesthesia procedures were used for all groups. After surgery, groups C0, C1, C2, and C4 received patient-controlled epidural analgesia (PCEA) with clonidine (0, 1.0, 2.0, or 4.0 µg/mL, respectively) and morphine (0.1 mg/mL) in 0.2% ropivacaine. The analgesia effect was estimated by PCEA consumption volume and visual analog pain scale at rest and with movement at 1, 2, 4, 12, 24, 48, and 72 h after surgery. Systolic blood pressure, heart rate, sedation, and sensory and motor blockade were also recorded for 72 h after surgery.RESULTS: The PCEA consumption volume for groups C0, C1, C2, and C4 were 71.8 ± 19.5 mL, 49.6 ± 12.3 mL, 48.1 ± 9.3 mL, and 39.4 ± 9.0 mL, respectively. The clonidine groups experienced less postoperative pain (P = 0.002). In the C4 group, four patients had prolonged sensory blockade and one patient had both severe sedation and prolonged sensory motor blockade. No significant statistical difference in analgesic consumption (P = 0.78) and pain intensity (P = 0.66) between groups C1 and C2 were noted. CONCLUSIONS: The optimal amount of epidural clonidine in a solution of morphine and ropivacaine.

 

右美沙去甲右美沙在小鼠表皮浸润止痛中具有局部麻醉作用

Dextromethorphan or dextrorphan have a local anesthetic effect on infiltrative cutaneous analgesia in rats.

Chen YW, Chu KS, Lin CN, Tzeng JI, Chu CC, Lin MT, Wang JJ.

Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.

Anesth Analg 2007 104: 1251-1255.

 

背景:右美沙阻断了局部麻醉的靶位点钠通道。在研究当中我们评价右美沙是否具有局部麻醉作用。方法:我们将右美沙其活性代谢产物去甲右美沙和利多卡因分别注射小鼠的皮下,观察它们的表皮麻醉情况。药物之间的相互作用和生理安全指数(LD50s/ED50s)也被评价。结果: 右美沙去甲右美沙在皮下注射后具有局部麻醉作用。它们的效是右美沙〉去甲右美沙〉利多卡因(组间P < 0.01)。右美沙或去甲右美沙合用利多卡因将产生叠效应。右美沙和去甲右美沙在生理安全指数分别比利多卡因高2.4- 1.9-倍。结论:右美沙和去甲右美沙比利多卡因在局部麻醉局用更高的效能,但具有更高的生理安全指数。右美沙或去甲右美沙和利多卡因的联合注射将产生叠效应。

(陈勇柱译 薛张纲校)

BACKGROUND: Dextromethorphan blocks sodium channels, the site of action of local anesthetics. In this study we evaluated whether dextromethorphan has a local anesthetic effect. METHODS: We administered dextromethorphan and its active metabolite--dextrorphan, and lidocaine subcutaneously to rats and tested them for cutaneous anesthesia. Drug-drug interactions and systemic safety indices (LD50s/ED50s) were also evaluated. RESULTS: Dextromethorphan and dextrorphan had a local anesthetic effect after cutaneous infiltration. The ranking of potencies was dextromethorphan > dextrorphan > lidocaine (P < 0.01 for each comparison). A combination of dextromethorphan or dextrorphan with lidocaine produced an additive effect. Dextromethorphan and dextrorphan had 2.4- and 1.9-fold higher system safety indices than did lidocaine. CONCLUSION: Dextromethorphan and dextrorphan were more potent local anesthetics than lidocaine, but with higher systemic safety indices. Coadministration of dextromethorphan or dextrorphan with lidocaine produced an additive effect.

 

超声引导下股骨中段外侧坐骨神经阻滞:一项随机比较设计实验

Ultrasound Guidance for Lateral Midfemoral Sciatic Nerve Block: A Prospective, Comparative, Randomized Study (Medical Intelligence)
Vicente Domingo-Triadó, Salvador Selfa, Francisco Martínez, Dolores Sánchez-Contreras, Montserrat Reche, Jose Tecles, María T. Crespo, Jose M. Palanca, and Blanca Moro

Department of Anesthesiology, Hospital Lluis Alcanyis, Xativa, Valencia, Spain

Anesth Analg 2007 104: 1270-1274.

 

在股骨中段水平阻滞坐骨神经时经常会使用神经刺激术。我们调查研究在股骨中段外侧水平定位阻滞坐骨神经时使用超声与神经刺激相结合的方式较之仅仅使用神经刺激术的效能。61位行择期足部和踝关手术的患者参与了这项随机设计实验。在做股骨中段水平外侧坐骨神经阻滞时,30位患者是在超声引导术下完成的(US组),而另外31位是在没有超声引导术下完成的(ES组)。在使用神经刺激器时一旦获得令人满意的体反应,就给与35ml0.5%的啰哌卡因。实验所需要记录的几条重要数据是:试图获得一个令人满意的体反应的次数,第一次尝试就能成地定位神经的比例,有良好的效果和足够的持续时间的感觉运的阻滞,以麻醉区域的分布。第一次尝试就能成地定位坐骨神经在US组中毫无疑问地比ES组中更经常的发生(76.6% 41.9%; P < 0.001)。感觉阻滞的效果对充气止血带的忍受能在US组中也更好(P < 0.01)。我们得出如下结论,超声结合神经刺激方法提高了感觉阻滞的效果对于充气止血带的忍受能,减少了在股骨中段水平行坐骨神经阻滞时的尝试次数。

(周时蓓译 薛张纲校)

Block of the sciatic nerve at the midfemoral level is usually performed using nerve stimulation techniques. We investigated the efficacy of ultrasound, combined with nerve stimulation, to locate and block the sciatic nerve at the lateral midfemoral level compared to nerve stimulation alone. Sixty-one patients scheduled for foot and ankle surgery were enrolled in this prospective, randomized study. Thirty patients underwent a lateral block of the sciatic nerve at the midfemoral level guided by ultrasound (group US) and 31 patients received the block without ultrasound (group ES). Once an adequate motor response was obtained using nerve stimulation, 35 mL of ropivacaine 0.5% was administered. The main end-points of the study were: number of attempts to obtain an adequate motor response, success rate of nerve location at the first attempt, quality and duration of both sensory and motor blocks, and anesthetic distribution. The success of sciatic nerve location at the first attempt was significantly more frequent in the US group than in the ES group (76.6% versus 41.9%; P < 0.001). The quality of the sensory block and the tolerance to the pneumatic tourniquet were also significantly better in the US group (P < 0.01). We conclude that ultrasound combined with nerve stimulation improved the quality of the sensory block and the tolerance to the pneumatic tourniquet, reducing the number of attempts to perform sciatic nerve block at the midfemoral level.

 

性别差别对于老年病人冠脉手术后脑卒中风险的影响

Gender Differences in Stroke Risk Among the Elderly After Coronary Artery Surgery

 

Tomoko Goto, MD*, Tomoko Baba, MD*, Asuka Ito, MD*, Kengo Maekawa, MD*, and Takaaki Koshiji, MD{dagger}

From the Departments of *Anesthesiology and {dagger}Cardiovascular Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan.

Anesth Analg 2007;104:1016-1022

背景:已有研究显示:女性比男性更容易发生冠脉搭桥术(CABG)后的脑卒中,但性别差别对于全身脉粥样硬化的影响尚未得到充分研究。我们研究了老年(年龄60) CABG术后的患者,因颈颅颈脉升主脉粥样硬化其他危险因素导致的脑卒中的发生率中的性别差别。

方法:前瞻性收集720位行CABG术患者 (31.8%女性) 的数据。所有的患者在术前接受脑的磁共振影象血流影象学检查来评估已有的脑梗塞、颈脉狭窄颅内脉狭窄。术中进行主脉周超声检查以评估升主脉的脉粥样硬化。对所有的患者在术前术后第七天用Hasegawa痴呆量表监测认知态。

结果:与男性相比,女性年龄更大,有更多的高血压颅内脉狭窄发生。而男性在高脂血症、外周血管疾病、腹主脉瘤、吸烟史、重度冠脉狭窄重度升主脉粥样硬化方面的发生率明显增高。与女性相比,尽管男性在先兆脑梗或术前认知缺损的发生率没有差异,但男性患者围术期脑卒中的发生率最低限度地高于女性(3.9%1.3%, P = 0.066)。先兆脑梗、升主脉粥样硬化、已有的认知缺损外周血管疾病是围术期脑卒中的单变量预测因素。逐步逻辑回归分析证实,先兆脑梗主脉粥样硬化是围术期脑卒中明显的独立的预测因素。

结论:这些数据显示:男性脑卒中的危险因素较女性更多,包括重度冠脉狭窄、重度主脉粥样硬化外周血管疾病。男女在先兆脑梗术前认知缺损的发生率相似。

(裘毅敏译,马皓琳 李士通校)

 

BACKGROUND: Previous studies have shown that women are at higher risk than men for stroke after coronary artery bypass graft (CABG) surgery, but gender differences in systemic atherosclerosis have not been studied adequately. We investigated gender differences in the incidence of craniocervical and ascending aortic atherosclerosis and other risk factors for stroke in elderly patients (age 60 yr) undergoing CABG surgery.

METHODS: Data were prospectively collected on 720 patients (31.8% women) undergoing CABG surgery. All patients underwent preoperative brain magnetic resonance imaging and angiography to assess for prior cerebral infarctions, carotid artery stenosis, and intracranial arterial stenosis. Epiaortic ultrasound was performed at the time of surgery to assess for atherosclerosis of the ascending aorta. Cognitive status was measured using the Hasegawa-dementia score in all patients before surgery and on the seventh postoperative day.

RESULTS: Women were older and had more hypertension and intracranial arterial stenosis than did men. Men had significantly higher rates of hyperlipidemia, peripheral vascular disease, abdominal aortic aneurysm, smoking history, severe carotid artery stenosis, and severe aortic atherosclerosis than did women. Although there were no differences in prior cerebral infarction or preoperative cognitive impairment, the rate of perioperative stroke was marginally higher in men than in women (3.9% vs 1.3%, P = 0.066). Univariate predictors of perioperative stroke were prior cerebral infarctions, ascending aortic atherosclerosis, preexisting cognitive impairment, and peripheral vascular disease. Stepwise logistic regression analysis demonstrated that significant independent predictors of perioperative stroke were prior cerebral infarctions and aortic atherosclerosis.

CONCLUSIONS: These data suggest that men are more likely than women to have risk factors for stroke, including severe carotid artery stenosis, severe aortic atherosclerosis, and peripheral vascular disease. The rates of prior cerebral infarction and preoperative cognitive impairment were similar between genders.


6-18个月婴儿术后应用酮咯酸氨丁三醇:对吗啡的应用、安全性评估和立体特异药代学的影响

Postoperative Ketorolac Tromethamine Use in Infants Aged 6–18 Months: The Effect on Morphine Usage, Safety Assessment, and Stereo-Specific Pharmacokinetics

 

Anne M. Lynn, MD*, Heidi Bradford, BA*, Eric D. Kantor, BA{dagger}, Kok-Yong Seng, MS{ddagger}, David H. Salinger, PhD{ddagger}, James Chen, MD*, Richard G. Ellenbogen, MD, Paolo Vicini, PhD{ddagger}, and Gail D. Anderson, PhD{dagger}

From the Departments of *Anesthesia and Pain Management and Neurosurgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine; {dagger}Department of Pharmacy, University of Washington School of Pharmacy; {ddagger}Department of Bioengineering, University of Washington College of Engineering and the School of Medicine, Seattle, Washington.

Anesth Analg 2007;104:1040-1051

背景:非甾体炎药已经在治疗儿童的术后疼痛方面很有用。当前美国唯一可用的胃肠外非甾体炎药是有环氧酶-1和环氧酶-2作用的酮咯酸氨丁三醇。酮咯酸的婴儿药代学资料稀少,使剂量确定困难。给予的酮咯酸是一个外消旋混合物,S(-)异构体产生镇痛效应。此研究中,我们描述一群25个婴儿和刚会走路的孩子,接受单剂量静脉注射外消旋酮咯酸的群体药代学,并评估病人变异对酮咯酸分布的潜在影响。

方法:在此双盲,安慰剂对照试验中,研究37个婴儿和刚会走路的孩子(年龄6-18个月)术后酮咯酸药代学、安全性和镇痛效果。术后第一天,婴儿随机接受十分钟的静脉注射安慰剂、0.5或者1 mg/kg酮咯酸。给药后12小时收集血样。数据分析采用非房室的和房室的(非线性混和效应模型)方法。以逐步方式分析包括体重、年龄和手术过程在内的病人变量来确定其对酮咯酸药代学的潜在影响。

结果:二室模型最好地描述了数据。包含的变量不显著减少非线性混和效应模型目标函数值和嵌套模型的药代学参数的主体间可变性。估算的R(+)异构体的中央室分布体积的平均值和标准误差为1200 ± 163 mL (个体间差异的变异系数, 13.6%),周围室的分布体积为828 ± 108 mL (13.0%),从中央室的清除率7.52 ± 0.7 mL/min (9.3%),推断清除衰期238 ± 48 minS(–)异构体的相应值分别为2320 ± 34 (14.6%)224 ± 193 mL (86.2%)45.3 ± 5.5 mL/min (12.1%)50 ± 42 min。应用群体药代学参数进行的剂量模拟显示S(–) 酮咯酸没有蓄积,但是R(+)酮咯酸平稳增。安全性评估显示对肾能或肝能测试、外科引流或者连续血氧含量在安慰剂和酮咯酸组之间没有副作用。累积应用吗啡显示病人间的变异很大,组间没有不同。

结论:婴儿和刚会走路的儿童(年龄6-18个月)中酮咯酸立体异构体特异性清除率显示镇痛的S(-)异构体消除快速。对外科引流、测量的血氧饱和度、肾或者肝能测试未见副作用。每4或者6小时模拟单剂量应用0.5或者1 mg/kg,不会导致镇痛的异构体S(–) 酮咯酸畜积,但是导致R(+)酮咯酸的增。大于6个月的婴儿可能需要缩短剂量间隔。

(张曦 译,马皓琳 李士通 校)

 

BACKGROUND: Nonsteroidal antiinflammatory drugs have been useful for treating postoperative pain in children. The only parenteral nonsteroidal antiinflammatory drug currently available in the United States is ketorolac tromethamine with cyclooxygenase-1 and cyclooxygenase-2 effects. Information on the pharmacokinetics of ketorolac in infants is sparse, making dosing difficult. Ketorolac is administered as a racemic mixture with the S(–) isomer responsible for the analgesic effect. In this study, we describe the population pharmacokinetics of ketorolac in a group of 25 infants and toddlers who received a single IV administration of racemic ketorolac and evaluate the potential influence of patient covariates on ketorolac disposition.

METHODS: In this double-blind, placebo-controlled study, ketorolac pharmacokinetic, safety, and analgesic effects were studied in 37 infants and toddlers (aged 6–18 mo) postoperatively. On postoperative day 1, infants were randomized to receive placebo, 0.5, or 1 mg/kg ketorolac as a 10-min IV infusion. Blood samples were collected up to 12-h after dosing. The data were analyzed using noncompartmental and compartmental (nonlinear mixed-effects model) means. The patient covariates, including body weight, age, and surgical procedure, were analyzed in a stepwise fashion to identify their potential influence on ketorolac pharmacokinetics.

RESULTS: The data were best described by a two-compartmental model. Inclusion of covariates did not significantly decrease the nonlinear mixed-effects model objective function values and between-subject variability in the pharmacokinetic parameters of nested models. The mean and standard error of the estimates of the R(+) isomer were central volume of distribution 1200 ± 163 mL (coefficient of variation of interindividual variability, 13.6%), peripheral volume of distribution 828 ± 108 mL (13.0%), clearance from the central compartment 7.52 ± 0.7 mL/min (9.3%), and extrapolated elimination half-life 238 ± 48 min. Those of the S(–) isomer were 2320 ± 34 (14.6%), 224 ± 193 mL (86.2%), 45.3 ± 5.5 mL/min (12.1%), and 50 ± 42 min respectively. Dosing simulations, using population pharmacokinetic parameters, showed no accumulation of S(–) ketorolac but steady increases in R(+) ketorolac. Safety assessment showed no adverse effects on renal or hepatic function tests, surgical drain output, or continuous oximetry between placebo and ketorolac groups. Cumulative morphine administration showed large interpatient variability and was not different between groups.

CONCLUSION: The stereo-isomer-specific clearance of ketorolac in infants and toddlers (aged 6–18 mo) shows rapid elimination of the analgesic S(–) isomer. No adverse effects on surgical drain output, oximetry measured saturations, renal or hepatic function tests were seen. Simulation of single dosing at 0.5 or 1 mg/kg every 4 or 6 h does not lead to accumulation of S(–) ketorolac, the analgesic isomer, but does result in increases in R(+) ketorolac. Shorter dose intervals may be needed in infants older than 6 mo.


新生儿缺氧-缺血后异氟醚延迟性预处理会减少成熟小鼠即时死亡率并改善纹体的能

Isoflurane-Delayed Preconditioning Reduces Immediate Mortality and Improves Striatal Function in Adult Mice After Neonatal Hypoxia–Ischemia

 

John J. McAuliffe, MD, MBA, FAAP*, Bernadin Joseph, BS*, and Charles V. Vorhees, PhD{dagger}

From the *Department of Anesthesia, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio; and {dagger}Department of Pediatrics, Division of Neurology, Cincinnati Children's Research Foundation and University of Cincinnati, Cincinnati, Ohio.

Anesth Analg 2007;104:1066-1077

背景:已经发现缺氧-缺血前暴露于缺氧和异氟醚有于新生大鼠的神经保。我们研究了异氟醚、缺氧或者是室内空气的延缓性预处理对生后10天经历了65min缺氧-缺血的小鼠运和认知能的长期效应。

方法:9天大的C57x129T2 F1小鼠接受1.8%的异氟醚、缺氧(氮气中的氧气10%)或者假物(室内空气)预处理。第二天,在65min的缺氧或者是室内空气的处理后,对小鼠实行永久的右颈总脉结扎术或者假结扎。在70天时,应用一组Morris水迷宫测验检查其学习。通过其对去水吗啡注射剂的反应评价纹体的能。对成熟鼠脑(P120)的纹体背海马的切片进行组织学分析。

结果:在新生鼠严重的缺氧-缺血前24hr进行异氟醚预处理可以使断奶前的死亡率从20%减少至0%P < 0.04),并且改善成熟小鼠的纹体能,其是通过去水吗啡注射后的沿轨道运行的能评价的(P < 0.028),但在空间有关的记忆水迷宫测试中的表现并无改善。缺氧预处理相对于假的预处理组,可以提高对隐藏迷宫的学习,但并没有更难去降低迷宫测验的空间记忆。它对断奶前的死亡率去水吗啡的反应并无显著影响。组织学分析显示海马区在未行预处理组和异氟醚预处理组有相等的损害。

结论:异氟醚和缺氧对新生小鼠的延缓性预处理范例中,有选择性的能性神经保作用。

(黄丽娜 李士通 马皓琳 校)

 

BACKGROUND: Exposure to hypoxia and isoflurane (Iso) before hypoxia–ischemia has been found to be neuroprotective in neonatal rats. We investigated the long-term effects of delayed preconditioning with Iso, hypoxia, or room air on motor and cognitive function in mice that had 65 min of hypoxia–ischemia on postnatal day 10.

METHODS: Nine-day-old C57x129T2 F1 mice received either 1.8% Iso, hypoxic (10% O2 in N2), or sham (room air) preconditioning. The following day, the mice were subjected to permanent right common carotid ligation or sham ligation followed by 65 min of hypoxia, or room air. At 70 days of age, learning was tested using a series of Morris water maze tests. Striatal function was assessed by response to apomorphine injection. Histological analysis was performed on adult brain (P120) sections of striatum and dorsal hippocampus.

RESULTS: Iso preconditioning 24 h before severe neonatal hypoxia–ischemia reduced preweaning mortality from 20% to 0% (P < 0.04) and improved striatal function in adult mice, as assessed by circling after apomorphine injection (P < 0.028), but no improvements in performance were noted in the spatial-reference memory water maze tests. Hypoxic preconditioning improved learning relative to the sham-preconditioned group on the hidden maze, but not the more difficult reduced maze test of spatial memory. It had no significant effect on preweaning mortality and apomorphine response. Histologic analysis showed the hippocampus of non-preconditioned and Iso-preconditioned animals to be equally injured.

CONCLUSION: Iso and hypoxia confer selective functional neuroprotection in a delayed preconditioning paradigm in neonatal mice.


利多卡因、MK801MAC       

Lidocaine, MK-801, and MAC

 

Yi Zhang, MD{dagger}, Michael J. Laster, DVM*, Edmond I. Eger, II, MD*, Manohar Sharma, PhD*, and James M. Sonner, MD*

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

Anesth Analg 2007;104:1098-1102

背景:以前的研究发现,局麻药/钠离子通道阻滞剂利多卡因大剂量使用可以产生和NMDA受体拮剂地佐环平(癫痫药 MK801)一样的降低吸入药物MAC的作用。已有研究提示吸入麻醉药阻断钠离子通道就是损害通过NMDA受体的传递的一个可能原因。我们假设纵然利多卡因和MK801 在不同位点影响NMDA神经传递,但是其对MAC的净效应是相同的。

方法:我们测定不同的利多卡因输注对于大鼠环丙烷、氟烷、异氟醚和邻二氟苯MAC的影响。同时我们也测定了利多卡因复合MK801注射对于大鼠异氟醚和邻二氟苯的MAC的影响。

结果:我们的数据和预测相反。A、我们发现利多卡因没有封顶效应,在一些单独运用利多卡因的实验中结果几乎是恒定的;B、注射利多卡因并不能降低邻二氟苯MAC,却能降低其他吸入麻醉药的MACC、与邻二氟苯相比,添MK801能同样地影响利多卡因输注所产生的异氟醚和邻二氟苯MAC的降低作用。

结论:利多卡因并不能通过减少神经末梢中谷氨酸的放来原发性地降低MAC

 

BACKGROUND: Previous studies have found that the local anesthetic/sodium channel blocker lidocaine decreased MAC by maximum amounts approximately equal to the decreases produced by dizocilpine (MK-801), a N-methyl-d-aspartate (NMDA) receptor antagonist. Blockade of sodium channels by inhaled anesthetics has been suggested as a possible cause for impairment of transmission through NMDA receptors. We postulated that the net effect of lidocaine and MK-801 on MAC would be the same, albeit by affecting NMDA neurotransmission at different points.

METHODS: We measured the effect of various lidocaine infusions on the MAC of cyclopropane, halothane, isoflurane, and o-difluorobenzene in rats. We also measured the effect of concurrent lidocaine-MK-801 infusion on the MAC of isoflurane and o-difluorobenzene.

RESULTS: Our data contradicted our predictions. (a) We found no limit to the effect of lidocaine infusion, in some cases finding that lidocaine, alone, produced immobility; (b) lidocaine infusion did not decrease the MAC of o-difluorobenzene differently from the MAC of other inhaled anesthetics; and (c) the addition of MK-801 equally affected the decrease in MAC produced by lidocaine infusion for isoflurane versus o-difluorobenzene.

CONCLUSION: Lidocaine does not primarily decrease MAC by decreasing the release of glutamate from nerve terminals.


全麻药对大鼠小胶质细胞系中P2X7 P2Y受体的影响

The Effects of General Anesthetics on P2X7 and P2Y Receptors in a Rat Microglial Cell Line

 

Mika Nakanishi, MD*, Takashi Mori, MD, PhD*, Kiyonobu Nishikawa, MD, PhD*, Makoto Sawada, PhD{dagger}, Miyuki Kuno, MD, PhD{ddagger}, and Akira Asada, MD, PhD*

From the *Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; {dagger}Department of Brain Science, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Aichi, Japan; and {ddagger}Department of Physiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Anesth Analg 2007;104:1136-1144

背景:小胶质细胞在脑对缺氧和创伤的炎症反应中起重要的调作用。小胶质细胞表达的离子向型P2X受体和代谢向型P2Y受体(P2YRs)能被来自受损的脑细胞或星形胶质细胞产生的细胞外三磷酸腺苷(ATP)所激活,且参与由脑损伤诱发的信号通路。尽管一些吸入和静脉麻醉药能通过神经元机制产生神经保效应,对全麻药在病理态下如何调小胶质细胞的反应仍属未知。我们检验了不同的全麻药在大鼠小胶质细胞系对嘌呤能反应的影响。

方法:在全细胞构型下通过U管系统给予ATP获得持续激活电流。在研究中多次给予ATPATP产生的非脱敏感电流呈现P2X7 受体特征。用Ca2+敏感的荧光染色剂(fura-2)测定P2YRs介导的细胞内钙离子移。

结果:高至最小肺泡浓度3倍的吸入麻醉药(七氟烷、异氟烷和氟烷)对P2X7 受体介导电流无影响。静脉麻醉药(氯胺酮、丙酚和硫喷妥钠)可逆性强P2X7 受体介导电流。P2X7 受体激活强度与辛醇/缓冲液分配系数无关。低浓度硫喷妥轻微制P2X7 受体介导电流,表明其对P2X7 受体具有双向性作用。研究中所试验的全身麻醉药对P2Y受体介导的细胞内Ca2+移均无影响。

结论:我们的结果表明,在病理态下,静脉麻醉药(尤其是硫喷妥钠和丙酚)能通过P2X7 受体调小胶质细胞的能。

(颜涛 译, 马皓琳 李士通校)

 

BACKGROUND: Microglial cells play important roles in coordinating the inflammatory brain responses to hypoxia and trauma. Ionotropic P2X receptors and metabotropic P2Y receptors (P2YRs) expressed in microglia can be activated by extracellular adenosine triphosphate (ATP) derived from damaged cells or astrocytes, and participate in the signaling pathways evoked in brain insult. Although several inhaled and IV anesthetics produce neuroprotective effects through neuronal mechanisms, little is known about how general anesthetics modulate microglial responses in the pathological state. We examined the effects of various general anesthetics on purinergic responses in a rat microglial cell line.

METHODS: Currents were consistently activated by applications of ATP via a U-tube system under the whole-cell configuration. ATP-induced nondesensitizing currents observed after several applications of ATP exhibited characteristics of P2X7 receptors. The P2YRs-mediated mobilization of intracellular Ca2+ was measured using a Ca2+-sensitive fluorescent dye (fura-2).

RESULTS: Inhaled anesthetics (sevoflurane, isoflurane, and halothane) at doses three times as high as minimum alveolar concentrations had no effect on the P2X7Rs-mediated currents. IV anesthetics (ketamine, propofol, and thiopental) enhanced the P2X7Rs-mediated currents reversibly. The potencies for activation of P2X7Rs were not correlated with the octanol/buffer partition coefficients. Thiopental, at low concentrations, slightly inhibited the P2X7Rs-mediated currents, suggesting its dual actions on P2X7Rs. The P2YRs-mediated mobilization of intracellular Ca2+ was not affected by any of the general anesthetics tested.

CONCLUSIONS: Our results suggest that IV anesthetics, particularly thiopental and propofol, may modulate microglial functions through P2X7Rs in pathological conditions.


低温对内毒素预处理的肺的作用

The Effects of Hypothermia on Endotoxin-Primed Lung

 

Jae-Yong Chin, MD*, Younsuck Koh, MD, FCCM*, Mi Joung Kim, MS*, Han Seong Kim, MD{dagger}, Woo-Sung Kim, MD*, Dong-Soon Kim, MD*, Won-Dong Kim, MD*, and Chae-Man Lim, MD*

From the *Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and {dagger}Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Koyang-Si, Korea.

Anesth Analg 2007;104:1171-1178

研究背景:低温可能对内毒素诱导的急性肺损伤有保作用。大多数研究在发生中性粒细胞炎症反应之前给予低温,并无临相关性。本研究旨在探讨在中性粒细胞炎症反应启后给予低温是否能减轻内毒素诱导的急性肺损伤。

研究方法:第一个实验中,大鼠分为以下4组:1)生理盐水组,大鼠气管内滴入生理盐水/1小时后处死;2LPS预处理组,大鼠气管内灌注脂多糖(LPS/1小时后处死;3LPSNT组,大鼠气管内灌注LPS/6小时后处死,所有过程均在正常体温下(NT)(37 ± 0.5°C)完成;4LPS-HT组,大鼠气管内灌注LPS/6小时后处死,在灌注LPS1小时将大鼠体温降至32 ± 0.5°C,维持低体温5小时。取肺灌洗液行生化检测。第二个实验附26只大鼠,完全按照述实验方法分为生理盐水组(n=2)、LPS-NT组(n12)和LPSHT组(n12),取新鲜肺泡中性粒细胞池进行氧化爆发评估。

研究结果 LPSNT组肺的中性粒细胞计数、蛋白质水平、乳酸脱氢酶活性肺髓过氧化物酶活性均高于LPS预处理组。LPSHT组支气管肺泡灌洗液中性粒细胞计数、蛋白质水平、乳酸脱氢酶活性显微镜下肺泡中性粒细胞浸润计数均低于LPSHT组。LPSHT组中性粒细胞受刺激后过氧化氢产量低于LPSNT组。

结论:即使在中性粒细胞炎症反应启之后给予低温仍可有效减轻内毒素诱导的急性肺损伤。

(周雅春 马皓琳 李士通 校)

 

BACKGROUND: Hypothermia may be effective for endotoxin-induced acute lung injury. In most studies, hypothermia was induced before the development of neutrophilic inflammation, which would be clinically irrelevant. We investigated whether hypothermia induced after the onset of such neutrophilic inflammation reduces acute lung injury.

METHODS: In the first experiment, rats were allocated to one of four groups: intratracheal saline instillation/killed at 1 h (saline), intratracheal lipopolysaccharide (LPS) instillation/killed at 1 h (LPS-primed), intratracheal LPS instillation/killed at 6 h (LPS-NT), all under normothermia (NT) (37 ± 0.5°C) throughout study, and intratracheal LPS instillation/killed at 6 h with hypothermia (HT) (32 ± 0.5°C) for the last 5 h of study (LPS-HT). Lungs were lavaged for biochemical measurements. In the second experiment in 26 additional rats, we followed exactly the same protocol as described above for the saline group (n = 2), LPS-NT (n = 12), and LPS-HT (n = 12), and obtained a fresh pool of alveolar neutrophils to assess oxidative burst.

RESULTS: Compared with the LPS-primed group, the neutrophil count, protein level, and lactate dehydrogenase activity in the bronchoalveolar lavage fluid, and myeloperoxidase activity of the lung were all higher in the LPS-NT group. Compared with this LPS-NT group, the neutrophil count, protein level, and lactate dehydrogenase activity in the bronchoalveolar lavage fluid, and microscopic scores for alveolar neutrophilic infiltration were all lower in the LPS-HT group. The stimulated production of hydrogen peroxide in neutrophils was lower in the LPS-HT group than in the LPS-NT group.

CONCLUSION: Hypothermia, applied even after the onset of neutrophilic inflammation, was effective in reducing endotoxin-induced acute lung injury.


腰椎横向超声可以为分娩硬膜外穿刺准确定位

Ultrasound Using the Transverse Approach to the Lumbar Spine Provides Reliable Landmarks for Labor Epidurals

 

Cristian Arzola, MD, Sharon Davies, MD, Ayman Rofaeel, MD, and Jose C. A. Carvalho, MD, PhD

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

Anesth Analg 2007;104:1188-1192

背景:在最近的研究中柱超声成像已经在硬膜外腔间隙的定位中得到应用。在本研究中我们评估了横向超声单屏显像的方法在分娩硬膜外定位中的精度和准度。

方法:我们选入了61位要求进行分娩硬膜外的病人,我们通过超声成像(横向切面,25MHz弯曲排列的探针)来识别正中线、椎间隙和从皮肤到硬膜外间隙的距离(超声深度单位用UD表示)。在硬膜外穿刺过程中我们记录下穿刺点的成率,并测定硬膜外间隙到最近的标记过的图针的一距离(针的深度用ND表示)。我们通过一致性相关系数和95%一致限的Bland–Altman分析计算了UDND的相关性。

结果:孕妇的平均年龄是33±4.6岁,体重指数是29.7±4.8UD4.66±0.68cm, ND4.65±0.72cm。穿刺点的成率是91.8%73.8%病人不需重新进针。UDND之间的一致性相关系数是0.88195%可信区间是0.820–0.94295%一致限是–0.666 to 0.687 cm

结论:我们发现超声决定穿刺点有很高水平的成率,UDND之间有很好的一致性。这提示了我们提出的横向超声单屏显像的方法对分娩硬膜外进针是可靠的指导。

(姜旭晖译,马皓琳,李士通校)

 

BACKGROUND: Ultrasound imaging of the spine has recently been proposed to facilitate identification of the epidural space. In this study, we assessed the accuracy and precision of the transverse approach, using a "single-screen" method, to facilitate labor epidurals.

METHODS: We enrolled 61 patients requesting labor epidurals. Ultrasound imaging (transverse approach, 2–5 MHz curved array probe) identified the midline, the intervertebral space, and the distance from the skin to the epidural space (ultrasound depth/UD). During the epidural puncture, we recorded the success of the insertion point, and measured the distance to the epidural space to the nearest half-centimeter of the marked Tuohy needle (needle depth/ND). We calculated the agreement between UD and ND by the concordance correlation coefficient and Bland–Altman analysis with 95% limits of agreement.

RESULTS: The average maternal age was 33 ± 4.6 yr, body mass index 29.7 ± 4.8, UD 4.66 ± 0.68 cm, and ND 4.65 ± 0.72 cm. The success of the insertion point was 91.8%, with no need to redirect the needle in 73.8% of the patients. The concordance correlation coefficient between UD and ND was 0.881 (95% CI 0.820–0.942). The 95% limits of agreement were –0.666 to 0.687 cm.

CONCLUSIONS: We found a good level of success in the ultrasound-determined insertion point, and very good agreement between UD and ND. This suggests that our proposed ultrasound single-screen method, using the transverse approach, can be a reliable guide to facilitate labor epidural insertion.


腰段硬膜外类固醇注射用于治疗腰椎间盘膨出患者的效果

The Efficacy of Lumbar Epidural Steroid Injections in Patients with Lumbar Disc Herniations

 

William E. Ackerman, III, MD*, and Mahmood Ahmad, MD{dagger}

From the *Pain Medicine Consultants P.A., Little Rock, Arkansas 72223 and {dagger}United Pain Care Inc., Sherwood, Arkansas 72120.

Anesth Analg 2007;104:1217-1222

引言:腰段硬膜外类固醇注射可通过三种途径实现:经尾骨(C)、椎板间 (IL) 或经闭孔神经 (TF)。此次研究旨在确定述术用于治疗腰椎间盘膨出所致神经根痛的效果。

方法90名年龄1860岁,患有L5-S1椎间盘膨出伴神经根痛的患者,被随机分成三组,接受每2周一次至各组最大剂量的硬膜外类固醇注射疗法。评估疼痛缓解、无、活度水平。

结果:疼痛缓解在TF注射组最为显著。从研究开始至第24周,疼痛缓解程度如下:C组:完全疼痛缓解1/30,部分疼痛缓解16/30,未缓解 13/30 IL组:完全疼痛缓解3/30,部分疼痛缓解15/30,未缓解12/30 TF组:完全疼痛缓解9/30,部分疼痛缓解 16/30,未缓解5/30

结论TF经路的硬膜外类固醇给药比CIL经路更有效。我们认为这个观察结果的原因可能为用TF法时,类固醇进入腹侧硬膜外腔的概率较高。

(唐李隽 马皓琳 李士通 校)

 

INTRODUCTION: Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations.

METHODS: Ninety patients aged 18–60 years with L5-S1 disk herniations and radicular pain were randomly assigned to one of these groups to have epidural steroid injection therapy every 2 wk for a maximum of three injections. Pain relief, disability, and activity levels were assessed.

RESULTS: Pain relief was significantly more effective with TF injections. At 24 wk from the initiation of this study, pain relief was as follows: C: complete pain relief: 1/30, partial pain relief: 16/30, and no relief: 13/30; IL: complete pain relief: 3/30, partial pain relief: 15/30, and no relief: 12/30; and TF: complete pain relief: 9/30, partial pain relief: 16/30, and no relief: 5/30.

CONCLUSIONS: The TF route of epidural steroid placement is more effective than the C or IL routes. We attribute this observation to a higher incidence of steroid placement in the ventral epidural space when the TF method is used.


多方面截断大鼠坐骨神经与股神经末稍后的神经性疼痛测量的症精确度:一项探查性行为分析

Refinement of Symptoms of Neuropathic Pain Measurements After Various Transections of the Nerve Endings of the Sciatic and Femoral Nerve in Rats: An Exploratory Behavioral Analysis

 

Marie P. Van Remoortere, MD*, Theo F. Meert, PhD, PhD{dagger}, Kris C. Vissers, MD, PhD, FIPP{ddagger}, Hans Coppenolle, PhD, and Hugo Adriaensen, MD, PhD*

From the *Department of Anesthesiology, University hospital of Antwerp, Edegem, Belgium; {dagger}CNS, Pain and Alzheimer Discovery, Johnson & Johnson Pharmaceutical Research & Development, Beerse, Belgium; {ddagger}Department of Anesthesiology and Palliative Care, UMC St. Radboud, Nijmegen, The Netherlands; and Department of Biometrics & Clinical Informatics, Johnson & Johnson Pharmaceuticals Research & Development, Beerse, Belgium.

Anesth Analg 2007;104:1236-1245

背景:很多物模型被用来研究神经性疼痛的基础病理生理学机制。绝大多数的这些模型依赖于结扎所选择的神经使物肢体部分去神经。在此项研究中,我们通过分别单独或联合横切隐神经、胫神经、腓神经完成分布在大鼠后爪跖侧的三个周围神经的破坏。

方法:在为期12周的阶段里用感觉试验来评定大鼠后爪光滑皮肤三个不同解剖学区域(内侧、中部、外侧)的神经疼痛症的发展。机械性痛觉过敏(针刺), 异常性冷疼痛(丙酮)和异常后爪姿持续表现在胫神经和胫神经联合隐神经横断的大鼠中。

结果:胫神经和腓肠神经的横断导致异常性冷疼痛和中等强度的机械性痛觉过敏。胫神经或隐神经,或两者的同时横切没有导致特别的神经性疼痛行为和适当刺激后累的后爪异常的姿。

结论:交错的神经分布支配可以使结扎神经来研究外周神经病的解变复杂。

 

BACKGROUND: Many animal models can be used to study the underlying pathophysiological mechanisms of neuropathic pain. Most of these models rely on a partial denervation of the limb of the animal by ligating a selected nerve. In this study, we performed nerve lesions on three peripheral nerves supplying the plantar side of the rat hindpaw by differentially transecting the saphenous, the tibial, and the sural nerves alone or in paired combinations.

METHODS: The development of neuropathic pain symptoms at three different anatomical areas (medial, central, and lateral) of the glabrous skin of the hindpaw was evaluated by sensory testing over a 12-wk period. Mechanical hyperalgesia (pinprick), cold allodynia (acetone), and abnormalities of hindpaw posture were continuously present in animals with tibial and tibial and saphenous nerve transection.

RESULTS: Transection of the tibial and sural nerves induced cold allodynia and moderate mechanical hyperalgesia. Transection of the sural, the saphenous, or both nerves simultaneously induced no signs of specific neuropathic pain behavior and no abnormalities in posture of the affected hindpaw were noted after adequate stimulation.

CONCLUSIONS: The overlapping innervation of nerve distribution can complicate the interpretation of nerve ligation studies of peripheral neuropathies.


阿密曲替林是人Kv1.1Kv7.2/7.3通道的强效阻滞剂

Amitriptyline Is a Potent Blocker of Human Kv1.1 and Kv7.2/7.3 Channels

 

Mark A. Punke, MD, and Patrick Friederich, MD

From the Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Anesth Analg 2007;104:1256-1264

背景:Kv1.1Kv7.2/7.3通道控制神经细胞的兴奋性。因为神经细胞的过度兴奋是神经性疼痛、癫痫和焦虑的一个体征,所以这些通道可能是阿密曲替林通过改变神经细胞兴奋性来产生药理学和毒理学作用的重要分子靶向。阿密曲替林这些作用的分子机制目前尚未完全阐明,因此我们研究的目的是阐明阿密曲替林与人Kv1.1Kv7.2/7.3通道、Kv7.2/7.3通道开放剂瑞替滨相互作用的特征。

方法:Kv1.1Kv7.2/7.3通道表达在人胚胎肾细胞和中国仓鼠卵母巢细胞,使用膜片钳术研究阿密曲替林和瑞替滨的作用。

结果:阿密曲替林呈可逆和浓度依赖地制Kv1.1Kv7.2/7.3通道。IC50值分别为22±3µM(n=33)10±1µM (n=40)Kv7.2/7.3通道的去活内向电流也受到制,IC50值为4.2±0.6 µM(n=32)。阿密曲替林可逆地制Kv7.2/7.3通道使静息膜电位去极化。瑞替滨逆转阿密曲替林对Kv7.2/7.3通道电流的制作用,以膜电位去极化作用。

结论:因为阿密曲替林仅在产生毒理学的相关血药浓度制Kv1.1Kv7.2/7.3 通道,因此我们的研究表明了这些通道在阿密曲替林的神经兴奋性不良反应中起的作用。由于阿密曲替林的制作用可以被瑞替滨逆转,在治疗神经性疼痛时,将阿密曲替林和瑞替滨复合给药可以有额外的处。

(张莹 马皓琳 李士通校)

 

BACKGROUND: Kv1.1 and Kv7.2/7.3 channels control excitability of neuronal cells. As hyperexcitability is a sign of neuropathic pain, epilepsy, and anxiety disorders, these channels may be important molecular targets of amitriptyline that cause pharmacological as well as toxicological effects by altering neuronal excitability. Since the molecular mechanisms underlying these effects of amitriptyline have not been fully elucidated, we aimed to characterize the interaction of amitriptyline with human Kv1.1 and Kv7.2/7.3 channels. We also intended to establish the interaction of amitriptyline with the Kv7.2/7.3 channel opener, retigabine.

METHODS: Kv1.1 and Kv7.2/7.3 channels were expressed in human embryonic kidney cells and in Chinese hamster ovary cells. The effects of amitriptyline and retigabine were studied with the patch-clamp technique.

RESULTS: Amitriptyline inhibited Kv1.1 and Kv7.2/7.3 channels in a concentration-dependent and reversible manner. The IC50-value was 22 ± 3 µM (n = 33) and 10 ± 1 µM (n = 40), respectively. Deactivating inward currents of Kv7.2/7.3 channels were inhibited with an IC50-value of 4.2 ± 0.6 µM (n = 32). Inhibition of Kv7.2/7.3 channels by amitriptyline reversibly depolarized the resting membrane potential. Retigabine reversed both the inhibitory action of amitriptyline on Kv7.2/7.3 channels as well as the depolarization of the membrane potential.

CONCLUSIONS: Since amitriptyline inhibited Kv1.1 and Kv7.2/7.3 channels only at toxicologically relevant plasma concentrations, our results suggest a role for these channels in the neuroexcitatory side effects of amitriptyline. As the inhibitory effects of amitriptyline were reversed by retigabine, a combination of amitriptyline and retigabine could be of additional benefit in the therapy of neuropathic pain.


超声介导下使用神经刺激法进行锁骨下神经阻滞:一项前瞻性随机试验

Neurostimulation in Ultrasound-Guided Infraclavicular Block: A Prospective Randomized Trial

 

Emmanuel Dingemans, MD*, Stephan R. Williams, MD, PhD*, Geneviève Arcand, MD, FRCPC*, Philippe Chouinard, MD, FRCPC*, Patrick Harris, MD, FRCSC{dagger}, Monique Ruel, RN*, and François Girard, MD, FRCPC*

From the Department of *Anesthesiology and {dagger}Surgery, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Canada

Anesth Analg 2007;104:1275-1280

超声介导下(USG)进行锁骨下神经阻滞可以对进针和局麻药的分布提供实时显像。USG阻滞时,局麻药扩散的显像是否能取代神经刺激作为局麻药注射的终点,还从来没有正式评价过。因此,在这项前瞻性随机研究中,我们选取了72例计划行手或前臂手术的患者,比较USG行锁骨下神经阻滞时,单独应用USGU组)和USG联合神经刺激(S组)神经阻滞术完成的速度和阻滞效果。在U组,局麻药放置在U型分布的后面,在腋脉的各个侧面尽可能少的注射(29例患者注射了1次,6例患者注射了2次,3例患者注射了3次)。在S组,当用0.30.6mA之间的刺激电流获得远端运反应后,单次注射1.5%利多卡因、0.125%的布比卡因和肾腺素1:200 000(最后浓度)共 0.5 mL/kgU组操作时间明显短于S(分别为3.1 ± 1.6 分钟和5.2 ± 4.7分钟, P = 0.006)S37%的病人局麻药主要扩散在腋脉前面,63%的病人局麻药主要扩散在后面。注射后30分钟,U86%的病人肌皮神经、正中神经、尺神经、桡神经达到完全性感觉阻滞,而在S组仅有57%的病人达到(P = 0.007)。U组病人单次注射和多次注射两种情况下完全阻滞的成率相同,均为86%。阻滞需要追的发生率,U组为8%S组为26%P = 0.049)。S组中一例病人由于20分钟后肢体远端不能得到刺激而失败退出。我们得出结论,当将局麻药扩散显像用作注射的终点时,USG锁骨下神经阻滞使操作快,而且产生了较高的成率。局麻药在腋脉后外侧的扩散预示阻滞成,减少了直接神经显像的需要。

(邱郁薇 马皓琳 李士通 校)

 

Ultrasound guidance (USG) for infraclavicular blocks provides real time visualization of the advancing needle and local anesthetic distribution. Whether visualization of local anesthetic spread can supplant neurostimulation as the end point for local anesthetic injection during USG block has never been formally evaluated. Therefore, for this prospective randomized study, we recruited 72 patients scheduled for hand or forearm surgery and compared the speed of execution and quality of USG infraclavicular block with either USG alone (Group U) or USG combined with neurostimulation (Group S). In Group U, local anesthetic was deposited in a U-shaped distribution posterior and to each side of the axillary artery using as few injections as possible (1, 2, and 3 injections in 29, 6, and 3 patients, respectively). In Group S, a single injection was made after obtaining a distal motor response with a stimulating current between 0.3 and 0.6 mA. The anesthetic solution consisted of 0.5 mL/kg of lidocaine 1.5%, bupivacaine 0.125%, and epinephrine 1:200 000 (final concentrations). Procedure times were significantly shorter in Group U compared with Group S (3.1 ± 1.6 min and 5.2 ± 4.7 min, respectively; P = 0.006). In Group S, anesthetic spread was mainly anterior to the axillary artery in 37% of patients and mainly posterior in 63% of patients. Thirty minutes after the injection, 86% of patients in Group U had complete sensory block in the musculocutaneous, median, radial, and ulnar nerve territories compared with 57% in Group S (P = 0.007). Patients blocked in Group U with a single injection had the same rate of complete block (86%) as those blocked with more than one injection (86%). Block supplementation rates were 8% in Group U versus 26% in Group S (P = 0.049). Block failure occurred in one patient in Group S because of an inability to obtain a distal stimulation after 20 min. We conclude that USG infraclavicular block is more rapidly performed and yields a higher success rate when visualization of local anesthetic spread is used as the end point for injection. Posterolateral spread of local anesthetic around the axillary artery predicts successful block, circumventing the need for direct nerve visualization.