Anesthesia & Analgesia

August 2007

 

CARDIOVASCULAR ANESTHESIOLOGY:

酚卞明對左心發育不良綜合征的治療作用:一項核心綜述

儷譯 薛張綱校

Phenoxybenzamine in the Treatment of Hypoplastic Left Heart Syndrome: A Core Review (Editorial)

Nina A. Guzzetta

Anesth Analg 2007 105: 312-315.

麻醉預處理與麻醉後處理相結合較單獨麻醉預處理或麻醉後處理無優勢

胡瀟 陳傑

Anesthetic Preconditioning Combined with Postconditioning Offers No Additional Benefit Over Preconditioning or Postconditioning Alone (Editorial)

David I. Deyhimy, Neal W. Fleming, Ian G. Brodkin, and Hong Liu

Anesth Analg 2007 105: 316-324

七氟烷(而非丙泊酚)可防止豬冠狀動脈內由神經鞘氨醇磷酸膽鹼引起的Rho激酶依賴性收縮

Sevoflurane, but Not Propofol, Prevents Rho Kinase-Dependent Contraction Induced by Sphingosylphosphorylcholine in the Porcine Coronary Artery (Editorial)

Hiroyuki Kinoshita, Naoyuki Matsuda, Yoshiki Kimoto, Setsuko Tohyama, Keiko Hama, Katsutoshi Nakahata, and Yoshio Hatano

Anesth Analg 2007 105: 325-329.

PEDIATRIC ANESTHESIOLOGY:

先心患者行心臟手術發生與麻醉相關的心臟停搏的頻率

霞譯 薛張綱校

The Frequency of Anesthesia-Related Cardiac Arrests in Patients with Congenital Heart Disease Undergoing Cardiac Surgery

Kirsten C. Odegard, James A. DiNardo, Barry D. Kussman, Avinash Shukla, James Harrington, Al Casta, Francis X. McGowan, Jr, Paul R. Hickey, Emile A. Bacha, Ravi R. Thiagarajan, and Peter C. Laussen

Anesth Analg 2007 105: 335-343.

兒童患者與麻醉相關的心跳驟停:來自於兒科圍手術期心跳驟停的記錄

宋翠俠 陳傑

Anesthesia-Related Cardiac Arrest in Children: Update from the Pediatric Perioperative Cardiac Arrest Registry

Sanjay M. Bhananker, Chandra Ramamoorthy, Jeremy M. Geiduschek, Karen L. Posner, Karen B. Domino, Charles M. Haberkern, John S. Campos, and Jeffrey P. Morray

Anesth Analg 2007 105: 344-350.

新生兒開始發病的多系統炎性疾病患兒的麻醉處理

彭中美 馬皓琳 李士通

The Anesthetic Management of Children with Neonatal-Onset Multi-System Inflammatory Disease

Christine F. Lauro, Raphaela Goldbach-Mansky, Margaret Schmidt, and Zenaide M. N. Quezado

Anesth Analg 2007 105: 351-357.

針對兒童的近期研究資訊:關於兩種方法的報告

王時來譯 薛張綱校

Presenting Research Information to Children: A Tale of Two Methods

Alan R. Tait, Terri Voepel-Lewis, and Shobha Malviya

Anesth Analg 2007 105: 358-364.

頭低腳高位類比瓦爾薩瓦動作,肝臟加壓不能改變雙向格林分流患者右頸內靜脈的大小

潘方立 陳傑

Trendelenburg Position, Simulated Valsalva Maneuver, and Liver Compression Do Not Alter the Size of the Right Internal Jugular Vein in Patients with a Bidirectional Glenn Shunt

Koichi Yuki, Kelly Chilson, Kirsten C. Odegard, and James A. DiNardo

Anesth Analg 2007 105: 365-368.

AMBULATORY ANESTHESIOLOGY:

全麻誘導氣囊-面罩通氣時適當保留假牙的影響

張曦 譯,馬皓琳 李士通

The Effect of Leaving Dentures in Place on Bag-Mask Ventilation at Induction of General Anesthesia

Niamh P. Conlon, Richard P. Sullivan, Peter G. Herbison, Mathew Zacharias, and Donal J. Buggy

Anesth Analg 2007 105: 370-373.

ANESTHETIC PHARMACOLOGY:

鼻內用右旋美托咪啶鎮靜及鎮痛作用的雙盲交叉實驗評估

楊譯 薛張綱校

A Double-Blind, Crossover Assessment of the Sedative and Analgesic Effects of Intranasal Dexmedetomidine

Vivian M. Yuen, Michael G. Irwin, Theresa W. Hui, Man K. Yuen, and Libby H. Y. Lee

Anesth Analg 2007 105: 374-380.

小鼠第七染色體上存在影響異氟醚最低肺泡濃度的數量性狀遺傳位點

王鵬 陳傑

Mouse Chromosome 7 Harbors a Quantitative Trait Locus for Isoflurane Minimum Alveolar Concentration

Michael Cascio, Yilei Xing, Diane Gong, John Popovich, Edmond I. Eger, II, Saunak Sen, Gary Peltz, and James M. Sonner

Anesth Analg 2007 105: 381-385.

共同釋放的神經遞質對A型γ氨基丁酸受體、士的甯敏感性甘氨酸受體和N-甲基-d-天冬氨酸受體的麻醉藥樣調節

顏濤 譯, 馬皓琳 李士通

Anesthetic-Like Modulation of a {gamma}-Aminobutyric Acid Type A, Strychnine-Sensitive Glycine, and N-Methyl-d-Aspartate Receptors by Coreleased Neurotransmitters

Pavle S. Milutinovic, Liya Yang, Robert S. Cantor, Edmond I. Eger, II, and James M. Sonner

Anesth Analg 2007 105: 386-392.

增塑劑鄰苯二甲酸二異辛酯調製A型γ-氨基丁酸和甘氨酸受體的功能

陳佳莉譯 薛張剛校

The Plasticizer Di(2-ethylhexyl) Phthalate Modulates {gamma}-Aminobutyric Acid Type A and Glycine Receptor Function (Technical Communication)

Liya Yang, Pavle S. Milutinovic, Robert J. Brosnan, Edmond I. Eger, II, and James M. Sonner

Anesth Analg 2007 105: 393-396.

TECHNOLOGY, COMPUTING, AND SIMULATION:

呼吸音聲學監測在單肺插管定位中的應用

於章傑 陳傑

Acoustic Monitoring of Lung Sounds for the Detection of One-Lung Intubation

S. Tejman-Yarden, A. Zlotnik, L. Weizman, J. Tabrikian, A. Cohen, N. Weksler, and G. M. Gurman

Anesth Analg 2007 105: 397-404.

麻醉資訊管理系統:對當前實行政策和實踐的一個調查報告

沈浩 馬皓琳 李士通

Anesthesia Information Management Systems: A Survey of Current Implementation Policies and Practices

Richard H. Epstein, Michael M. Vigoda, and David M. Feinstein

Anesth Analg 2007 105: 405-411.

PATIENT SAFETY:

持續血氧和二氧化碳監測揭示病人自控鎮痛患者中頻發的低氧飽和度和呼吸緩慢

陳珺珺譯 薛張綱校

Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia

Frank J. Overdyk, Rickey Carter, Ray R. Maddox, Jarred Callura, Amy E. Herrin, and Craig Henriquez

Anesth Analg 2007 105: 412-418.

病人對麻醉滿意度的預測因素

杜唯佳 陳傑

Factors Predictive of Patient Satisfaction with Anesthesia

Maurizia Capuzzo, Giuseppe Gilli, Laura Paparella, Gaetano Gritti, Davide Gambi, Margherita Bianconi, Francesco Giunta, Cosimetta Buccoliero, and Raffaele Alvisi

Anesth Analg 2007 105: 435-442.

圍術期患者的安全性:正確的病人、正確的手術、正確的左右側——一個多面性、跨組織、干預性研究

胡湘 馬皓琳 李士通校

Perioperative Patient Safety: Correct Patient, Correct Surgery, Correct Side—A Multifaceted, Cross-Organizational, Interventional Study

Edna Zohar, Yossi Noga, Ehud Davidson, Margalit Kantor, and Brian Fredman

Anesth Analg 2007 105: 443-447.

CRITICAL CARE AND TRAUMA:

用機械通氣相關的脈搏波體積描計變異預測心臟手術後患者液體治療反應性

璿譯 薛張綱校

Ventilation-Induced Plethysmographic Variations Predict Fluid Responsiveness in Ventilated Postoperative Cardiac Surgery Patients

Piet A. H. Wyffels, Pieter-Jan Durnez, Johan Helderweirt, Willem M. A. Stockman, and Dirk De Kegel

Anesth Analg 2007 105: 448-452.

胸段硬膜外鎮痛在實驗性胰腺炎中對受體依賴性及非受體依賴性肺血管收縮中的作用

陶穎瑩 陳傑

The Role of Thoracic Epidural Analgesia in Receptor-Dependent and Receptor-Independent Pulmonary Vasoconstriction in Experimental Pancreatitis

Stefan Lauer, Hendrik Freise, Lars G. Fischer, Kai Singbartl, Hugo V. Aken, Markus M. Lerch, and Andreas W. Sielenkämper

Anesth Analg 2007 105: 453-459.

OBSTETRIC ANESTHESIOLOGY:

在置管前預先填充硬膜外間隙可以減少硬膜外導管置入血管的發生率

姜旭暉 馬皓琳 李士通

Predistention of the Epidural Space Before Catheter Insertion Reduces the Incidence of Intravascular Epidural Catheter Insertion

Shmuel Evron, Vladimir Gladkov, Daniel I. Sessler, Vadim Khazin, Oscar Sadan, Mona Boaz, and Tiberiu Ezri

Anesth Analg 2007 105: 460-464.

GENERAL ARTICLES:

膝關節成形術中充足補液與限制補液的對比:一項隨機雙盲研究

黃麗娜 李士通 馬皓琳

Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

Kathrine Holte, Billy B. Kristensen, Lotte Valentiner, Nicolai B. Foss, Henrik Husted, and Henrik Kehlet

Anesth Analg 2007 105: 465-474.

鐳射前列腺切除術的麻醉

王光妍譯 薛張綱校

Laser Resection of the Prostate: Implications for Anesthesia (Medical Intelligence)

Richard A. Hanson, Mark H. Zornow, Michael J. Conlin, and Ansgar M. Brambrink

Anesth Analg 2007 105: 475-479.

ANALGESIA:

乳房手術前應用非類固醇類抗炎藥(羅非考昔)中加入地塞米松會延長術後鎮痛效應

張燕 陳傑

The Prolonged Postoperative Analgesic Effect When Dexamethasone Is Added to a Nonsteroidal Antiinflammatory Drug (Rofecoxib) Before Breast Surgery

Hval Kjetil, Thagaard K. Sem, Schlichting Ellen, and Raeder Johan

Anesth Analg 2007 105: 481-486.

腺苷作為非阿片類鎮痛劑在圍術期的應用

吳儉 馬皓琳 李士通

Adenosine as a Non-Opioid Analgesic in the Perioperative Setting (Review Article)

Tong J. Gan and Ashraf S. Habib

Anesth Analg 2007 105: 487-494.

針刺對清醒和麻醉狀態下志願者的血氧水準依賴信號的影響:一項試驗性研究

陳勇柱譯 薛張綱校

Acupuncture-Induced Blood Oxygenation Level-Dependent Signals in Awake and Anesthetized Volunteers: A Pilot Study

Shu-Ming Wang, R. Todd Constable, Fuyuze S. Tokoglu, Dana A. Weiss, David Freyle, and Zeev N. Kain

Anesth Analg 2007 105: 499-506.

三種不同濃度的羅呱卡因聯合芬太尼用於病人自控硬膜外鎮痛的比較

陳偉 陳傑

A Comparison of Three Different Concentrations of Ropivacaine with Fentanyl for Patient-Controlled Epidural Analgesia

Tetsuya Iijima, Tadahiko Ishiyama, Satoshi Kashimoto, Toshiaki Yamaguchi, Tomio Andoh, Kazumi Hanawa, Izumi Tanzawa, Keisi Kawata, Takehisa Hanawa, and Yoshimitsu Hiejima

Anesth Analg 2007 105: 507-511.

局麻藥低熔混合物(EMLA®)減輕非鎮靜患者行肱骨徑路神經阻滯時的疼痛

朱慧 馬皓琳 李士通

Eutectic Mixture of Local Anesthetic (EMLA®) Decreases Pain During Humeral Block Placement in Nonsedated Patients

David Samson, Vincent Minville, Clément Chassery, Luc Nguyen, Antoine Pianezza, Olivier Fourcade, Anna Rabinowitz, and Kamran Samii

Anesth Analg 2007 105: 512-515.

可樂定1 µg/kg對青少年使用單純布比卡因脊髓麻醉是一個安全有效的佐劑

周時蓓譯 薛張綱校

Clonidine 1 µg/kg Is a Safe and Effective Adjuvant to Plain Bupivacaine in Spinal Anesthesia in Adolescents

Olfa Kaabachi, Amine Zarghouni, Rami Ouezini, Ahmed Ben Abdelaziz, Olfa Chattaoui, and Hannu Kokki

Anesth Analg 2007 105: 516-519.

羅呱卡因脊麻在下肢手術中應用:劑量-效應的研究

Spinal Ropivacaine for Lower Limb Surgery: A Dose–Response Study

Ying Y. Lee, Warwick D. Ngan Kee, Hang K. Chang, Chi L. So, and Tony Gin

Anesth Analg 2007 105: 520-523.

曲馬多對局部或區域麻醉後併發感染細菌的抗菌活力

裘毅敏譯,馬皓琳 李士通校

The Antibacterial Activity of Tramadol Against Bacteria Associated with Infectious Complications After Local or Regional Anesthesia

Zohreh Tamanai-Shacoori, Valliollah Shacoori, Anne Jolivet-Gougeon, Jean-Marie Vo Van, Martine Repère, Pierre-Yves Donnio, and Martine Bonnaure-Mallet

Anesth Analg 2007 105: 524-527.

改良股正中入路坐骨神經阻滯法:誘發運動反應和感覺阻滯的關係(簡要報告)

王麗珺譯 薛張綱校

A Modified Mid-Femoral Approach to the Sciatic Nerve Block: A Correlation Between Evoked Motor Response and Sensory Block (Brief Report)

Antoine Pianezza, Marie-Luce Gilbert, Vincent Minville, Daren Filsinger, Quentin Gobert, Alain Guérot, Régis Fuzier, and Olivier Fourcade

Anesth Analg 2007 105: 528-530.

5%利多卡因進行腰麻的麻醉持續時間在長期濫用阿片類藥物者用與非濫用者間的比較

潘錢玲 陳傑

The Duration of Spinal Anesthesia with 5% Lidocaine in Chronic Opium Abusers Compared with Nonabusers (Brief Report)

Maryam Vosoughian, Ali Dabbagh, Samira Rajaei, and Hassan Maftuh

Anesth Analg 2007 105: 531-533.

 

麻醉預處理與麻醉後處理相結合較單獨麻醉預處理或麻醉後處理無優勢

Anesthetic Preconditioning Combined with Postconditioning Offers No Additional Benefit Over Preconditioning or Postconditioning Alone

David I. Deyhimy, MD*, Neal W. Fleming, MD, PhD*, Ian G. Brodkin, MD{dagger}, and Hong Liu, MD*

From the *Department of Anesthesiology and Pain Medicine, University of California, Davis, California; and {dagger}Department of Anesthesiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.

Anesth Analg 2007 105: 316-324.

 

背景:近來的研究表明麻醉預處理和麻醉後處理與心肌缺血預處理減少心肌梗死的面積程度相當。作者假定七氟醚的預處理和後處理相結合能更好地保護心肌。
方法Langendorff 灌注的大鼠心臟分成四組:對照組、預處理組、後處理組及預處理結合後處理組。在再灌注時,測量左心室功能(左室舒張壓、左室舒張末期壓及dp/dt)。再灌注末期,氯化2,3,5三苯基四唑染色法測定梗死灶面積。核磁共振法測量細胞內pH, Na+ Ca2+
結果:相對於對照組,治療組的左心室舒張壓、左室舒張末壓、左室dp/dtmax dp/dtmin顯著改善。心肌梗死面積在預處理組、後處理組、二者結合組分別為24%± 7%16%±8%22%±7%,而對照組為44%±8%,差異顯著(P<0.05)。相對於對照組,實驗組在再灌注末期胞內Na+Ca2+均顯著減少,但實驗組間無差別。
結論:七氟醚的後處理與預處理在全心缺血後保護心肌功能上一樣有效。麻醉前與麻醉後處理相結合相對於單獨麻醉預處理或麻醉後處理無優勢。

(胡瀟 陳傑 校)

BACKGROUND: Recent investigations demonstrate that anesthetic preconditioning and postconditioning reduce myocardial infarct size to a degree comparable to that achieved with ischemic preconditioning. We hypothesized that the combination of sevoflurane preconditioning and postconditioning would result in greater preservation of myocardium.

METHODS: Langendorff perfused rat hearts were divided into four groups: control, preconditioning, postconditioning, and preconditioning plus postconditioning. During reperfusion, left ventricular function (left ventricular developed pressure, left ventricular end diastolic pressure, and dp/dt) were measured. At the end of reperfusion, the infarct sizes were measured with 2,3,5 triphenyltetrazolium chloride staining. Nuclear magnetic resonance was used to measure intracellular pH, Na+, and Ca2+.

RESULTS: Left ventricular developed pressure, left ventricular end diastolic pressure, left ventricular dp/dtmax and dp/dtmin were significantly improved in the treatment groups when compared with those in the controls. Myocardial infarct size (24% ± 7%, 16% ± 8%, and 22% ± 7% in preconditioning, postconditioning, and pre-plus postconditioning groups versus 44% ± 8% in the control group, P < 0.05) and intracellular Na+ and Ca2+ were significantly decreased in all experimental groups at the end of reperfusion when compared with those in control. However, there were no differences between these variables in each treatment group.

CONCLUSION: Sevoflurane postconditioning is as effective as preconditioning in protecting myocardial function after global ischemia. The combination of sevoflurane preconditioning and postconditioning offered no additional benefit over either intervention alone.


兒童患者與麻醉相關的心跳驟停:來自於兒科圍手術期心跳驟停的記錄

Anesthesia-Related Cardiac Arrest in Children: Update from the Pediatric Perioperative Cardiac Arrest Registry

Sanjay M. Bhananker, MD, FRCA*, Chandra Ramamoorthy, MD{dagger}, Jeremy M. Geiduschek, MD*, Karen L. Posner, PhD*, Karen B. Domino, MD, MPH*, Charles M. Haberkern, MD, MPH*, John S. Campos, MA*, and Jeffrey P. Morray, MD{ddagger}

From the *Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; {dagger}Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California; and {ddagger}Department of Anesthesiology, Phoenix Children's Hospital and Valley Anesthesiology Consultants, Phoenix, Arizona.

Anesth Analg 2007 105: 344-350.

背景:來自于兒科病人圍手術期心跳驟停(POCA)的記錄(1994–1997)表明與用藥相關,常常源於氟烷對心血管的抑制作用。兒科麻醉的變化可能改變心跳驟停的原因。

方法:80個為兒童提供麻醉的北美研究機構志願編入兒科圍手術期心跳驟停的記錄中。其中≤18歲發生心跳驟停兒童的每個標準資料形式均是匿名的。分析1998-2004年與心跳驟停有關的麻醉及其他相關因素。

結果:從19982004 年,193例(49%)心跳驟停者是與麻醉相關的,而藥物相關者僅占18%,相比與1994-199737%有顯著差異(p0.05〉。最常見因素是心血管方面,占總的 41%,其中失血引起的血容量減少以及輸入庫血引起的血鉀過高是比較常見的因素。在呼吸因素(27%)中喉痙攣引起的氣道阻塞最常見。器具相關因素中中心靜脈導管置入引起的血管損傷是最常見的。麻醉監護不同階段的心跳驟停因素也不相同(P < 0.01),心血管和呼吸因素引起的心跳驟停分別發生於外科手術期間及術後階段。

結論:與氟烷引起的心血管抑制相關的心跳驟停的比例降低也許與兒童患者麻醉中氟烷的 使用減少有關,通過採取預防措施可能使各類心跳驟停發生率降低。

(宋翠俠 陳傑 校)

BACKGROUND: The initial findings from the Pediatric Perioperative Cardiac Arrest (POCA) Registry revealed that medication-related causes, often cardiovascular depression from halothane, were the most common. Changes in pediatric anesthesia practice may have altered the causes of cardiac arrest in anesthetized children.

METHODS: Nearly 80 North American institutions that provide anesthesia for children voluntarily enrolled in the Pediatric Perioperative Cardiac Arrest Registry. A standardized data form for each perioperative cardiac arrest in children ≤18 yr of age was submitted anonymously. We analyzed causes of anesthesia-related cardiac arrests and related factors in 1998–2004.

RESULTS: From 1998 to 2004, 193 arrests (49%) were related to anesthesia. Medication-related arrests accounted for 18% of all arrests, compared with 37% from 1994 to 1997 (P < 0.05). Cardiovascular causes of cardiac arrest were the most common (41% of all arrests), with hypovolemia from blood loss and hyperkalemia from transfusion of stored blood the most common identifiable cardiovascular causes. Among respiratory causes of arrest (27%), airway obstruction from laryngospasm was the most common cause. Vascular injury incurred during placement of central venous catheters was the most common equipment-related cause of arrest. The cause of arrest varied by phase of anesthesia care (P < 0.01). Cardiovascular and respiratory causes occurred most commonly in the surgical and postsurgical phases, respectively.

CONCLUSIONS: A reduction in the proportion of arrests related to cardiovascular depression due to halothane may be related to the declining use of halothane in pediatric anesthetic practice. The incidence of the most common remaining causes of arrest in each category may be reduced through preventive measures.

 

 

頭低腳高位類比瓦爾薩瓦動作,肝臟加壓不能改變雙向格林分流患者右頸內靜脈的大小

Trendelenburg Position, Simulated Valsalva Maneuver, and Liver Compression Do Not Alter the Size of the Right Internal Jugular Vein in Patients with a Bidirectional Glenn Shunt

Koichi Yuki, MD*, Kelly Chilson, MD{dagger}, Kirsten C. Odegard, MD*, and James A. DiNardo, MD*

From the *Cardiac Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts; {dagger}Department of Anesthesiology, Washington University, Saint Louis, Missouri; and {ddagger}Department of Anaesthesia, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2007 105: 365-368.

背景:超聲越來越多地用於幫助兒童患者的右頸內靜脈導管的置入。如果沒有心臟疾病,變換體位及加強措施能增大右頸內靜脈(RIJV)橫斷面積(CSA),並有助於導管置入。本文作者研究這些措施在兒童雙向格林分流(BDG)的Fontan 手術時右頸內靜脈橫斷面積的影響。

方法21名兒童行BDGFontan手術,通過超聲面積法(sonosite)測定右頸內靜脈(RIJV)橫斷面積(CSA)。聯合使用兩種體位〔仰臥位(S)和15度頭低腳高位(T), 兩種加強措施〔肝臟加壓(L)和瓦爾薩瓦動作(V)〕。每個患者使用八種獨立的措施(S,S+L,S+V,S+L+V,T,T+V,T+L,T+L+V)。重複測量的資料用單因素方差分析及配對T檢驗比較分析。

結果:右頸內靜脈橫斷面積沒有顯著變化。

結論:改變體位和增強措施對於BDG Fontan手術患者右頸內靜脈沒有促進作用,因為這些措施不增加右頸內靜脈橫斷面積。

(潘方立 陳傑 校)

BACKGROUND: Ultrasound is increasingly used to facilitate right internal jugular vein (RIJV) cannulation in children. In children without cardiac disease, position changes and enhancement maneuvers increase RIJV cross-sectional area (CSA) and further facilitate cannulation. We investigated the effect of these maneuvers on RIJV CSA in children with a bidirectional Glenn (BDG) shunt presenting for a Fontan procedure.

METHODS: The CSA (cm2) of the RIJV in 21 children with a BDG shunt presenting for a Fontan procedure was assessed by ultrasonic planimetry (SonoSite). Two positions, supine (S) and 15° Trendelenburg (T); and two enhancements maneuvers, manual liver compression (L) and a simulated Valsalva maneuver (V) were utilized in combination. Eight separate measurements (S, S + L, S + V, S + L + V, T, T + L, T + V, T + L + V) were made in each patient. Data were analyzed using one-way analysis of variance with repeated measures and with Tukey post hoc pairwise comparison analysis.

RESULTS: No significant change in the RIJV CSA or % change in CSA from baseline (S) was observed.

CONCLUSIONS: Position changes and enhancement maneuvers are unlikely to facilitate RIJV cannulation in BDG shunt patients presenting for Fontan procedure because these interventions do not increase RIJV CSA.


 

小鼠第七染色體上存在影響異氟醚最低肺泡濃度的數量性狀遺傳位點

Mouse Chromosome 7 Harbors a Quantitative Trait Locus for Isoflurane Minimum Alveolar Concentration

Michael Cascio, BS*, Yilei Xing, MD*, Diane Gong, PharmD{dagger}, John Popovich, BS*, Edmond I. Eger, II, MD*, Saunak Sen, PhD{ddagger}, Gary Peltz, MD, PhD§, and James M. Sonner, MD*

From the *Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA; {dagger}The Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin; {ddagger}Department of Biostatistics, University of California, San Francisco, CA; and §Department of Genetics and Genomics, Roche Palo Alto, Palo Alto, CA.

Anesth Analg 2007 105: 381-385.

 
背景:異氟醚的最低肺泡濃度具有數量特性,因為在不同的人群中是不同的。控制數量特性的基因組上的特定位點或基因的特定成分叫做量控位點。在這項研究中作者探尋小鼠中控制異氟醚肺泡最低濃度的量控位點。
方法:為完成這項研究,異氟醚的最低肺泡濃度不同的兩種小鼠(C57BL/6JLP/J),通過兩代的繁殖使得基因重新組合。這些小鼠的基因被標示特殊的標誌。應用一種獨立的計算方法來識別異氟醚的肺泡最低濃度量控位點的不同點。研究中,測量19種純系小鼠的異氟醚最低肺泡濃度,並且通過科學的方法尋找基因上的變異的部位,並基於單個的核苷酸的多態性,研究純系小鼠的異氟醚肺泡最低濃度的差異的相關性。
結論:兩種基因分析的方法顯示小鼠異氟醚肺泡最低濃度的量控位點存在於第七染色體。

(王鵬 陳傑 校)

BACKGROUND: The minimum alveolar concentration (MAC) of isoflurane is a quantitative trait because it varies continuously in a population. The location on the genome of genes or other genetic elements controlling quantiative traits is called quantitative trait loci (QTLs). In this study we sought to detect a quantitative trait locus underlying isoflurane MAC in mice.

METHODS: To accomplish this, two inbred mouse strains differing in isoflurane MAC, the C57BL/6J and LP/J mouse strains, were bred through two generations to produce genetic recombination. These animals were genotyped for microsatellite markers. We also applied an independent, computational method for identifying QTL-regulating differences in isoflurane MAC. In this approach, the isoflurane MAC was measured in a panel of 19 inbred strains, and computationally searched for genomic intervals where the pattern of genetic variation, based on single nucleotide polymorphisms, correlated with the differences in isoflurane MAC among inbred strains.

RESULTS AND CONCLUSIONS: Both methods of genetic analysis identified a QTL for isoflurane MAC that was located on the proximal part of mouse chromosome 7.


呼吸音聲學監測在單肺插管定位中的應用

Acoustic Monitoring of Lung Sounds for the Detection of One-Lung Intubation

S. Tejman-Yarden, MD*, A. Zlotnik, MD{dagger}, L. Weizman, MSc{ddagger}, J. Tabrikian, PhD{ddagger}, A. Cohen, PhD{ddagger}, N. Weksler, MD{dagger}, and G. M. Gurman, MD{dagger}

From the Divisions of *Pediatrics; {dagger}Anesthesiology and Critical Care, Soroka Medical Center; and {ddagger}Electrical and Computer Engineering Department, Ben Gurion University of the Negev, Beer-Sheva, Israel.

Anesth Analg 2007 105: 397-404.

 

背景:傳統的早期確定單肺插管(OLI)方法缺乏特異性且存在爭議。在此項研究中,作者評估了OLI的新的聲學監測系統。

方法:收集24個預定行常規外科手術對象的呼吸音。在麻醉誘導和氣管插管定位時,使用4個壓電傳聲器放置於背部行呼吸音採樣。為了OLI,氣管內導管置入氣管並逐漸深入直到左側胸壁呼吸音減弱、消失。再逐步退管直至雙側呼吸音對稱。光導纖支鏡確定最終的導管位置。聲學分析通過多重輸入多重輸出(MIMO)系統,其中多元自回歸模型測定進肺與出肺相關的聲音並分級,通過廣義似然比檢驗確定通氣肺數目,而不需通過原始呼吸音資料重建。

結果:此項OLI檢測運算有95.2%的靈敏度和4.8%的假陽性率。

結論:更高的靈敏度需要以更高的假陽性率為代價。

(於章傑 陳傑 校)

INTRODUCTION: Monitoring methods for the early diagnosis of one-lung intubation (OLI) are nonspecific and controversial. In this study, we evaluated a new acoustic monitoring system for the detection of OLI.

METHODS: Lung sounds were collected from 24 adult surgical patients scheduled for routine surgical procedures. Four piezoelectric microphones attached to the patients' backs were used to sample lung sounds during induction of anesthesia and endotracheal tube positioning. To achieve OLI, the endotracheal tube was inserted and advanced down the airway so that diminished or no breath sounds were heard on the left side of the chest. The tube was then withdrawn stepwise until equal breath sounds were heard. Fiberoptic bronchoscopy confirmed the tube's final position. Acoustic analyses were preformed by a new algorithm which assumes a Multiple Input Multiple Output system, in which a multidimensional Auto-Regressive model relates the input (lungs) and the output (recorded sounds) and a classifier, based on a Generalized Likelihood Ratio Test, indicates the number of ventilated lungs without reconstructing the original lung sounds from the recorded samples.

RESULTS: This algorithm achieved an OLI detection probability of 95.2% with a false alarm probability of 4.8%.

CONCLUSION: Higher detection values can be achieved at the price of a higher incidence of false alarms.


病人對麻醉滿意度的預測因素

Factors Predictive of Patient Satisfaction with Anesthesia

Maurizia Capuzzo, MD*, Giuseppe Gilli{dagger}, Laura Paparella, MD{ddagger}, Gaetano Gritti, MD§, Davide Gambi, MD||, Margherita Bianconi, MD, Francesco Giunta, MD#, Cosimetta Buccoliero, MD*, and Raffaele Alvisi, MD*

From the *Department of Surgical, Anesthetic and Radiological Sciences, Section of Anesthesiology and Intensive Care, and {dagger}Department of Health Physics, University Hospital of Ferrara, Ferrara; {ddagger}Departments of Medical and Surgical Specialties, and §Medicine, Surgery, and Critical Care, Section of Anesthesiology and Intensive Care, University Hospital, Florence; ||Service of Anesthesia and Intensive care, Hospital Nuovo Ospedale S. Giovanni di Dio, Florence; ¶Department of Emergency, Section of Anesthesia and Intensive Care, University Hospital of Ferrara, Ferrara; #Department of Anesthesiology and Intensive Care, University Hospital of S. Chiara, Pisa, Italy.

Anesth Analg 2007 105: 435-442.

背景:在這個多因素的前瞻性研究中,作者通過對術後至少住院24小時的病人進行觀察以發現影響病人對麻醉滿意度的相關因素。

方法:研究在六個中心進行。病人年齡都在18歲以上,並且所接受的普外科手術種類範圍很廣,他們被要求回答10個有關對麻醉滿意度的問題(總分,010)和一些相關問題來評估他們以往的健康狀況(總分010)。麻醉科工作人員也被邀填寫一份Maslach Burnout調查。

結果:結果收到了1290位病人的滿意評估問卷(平均年齡在61±16歲,男性占54.4%)。總體平均滿意度積分為8.795%可信區間:8.7-8.8),<9的有632人(49%),9的有658人(51%)。Maslach Burnout調查中有55位麻醉醫師和68位護士遞交了答卷。通過對總體平均滿意度積分9的人群進行多變數回歸分析,發現有五個因素起了重要的作用:1)接受過麻醉專業護理人員圍手術期護理;2)術前給予麻醉宣傳單;3)術後至少有兩個麻醉醫師訪視;4)既往健康狀況積分>8.55)年齡大於70歲。工作人員的勞累程度與病人的滿意度無任何關聯。

結論:住院病人的滿意度可以通過以下幾個方面得以改善:外科病房護理由麻醉專業的護理人員承擔,術前給病人一份書面的麻醉資訊宣傳單以及術後加強訪視。

(杜唯佳 陳傑 校)

BACKGROUND: In this multicenter prospective study, we identified factors associated with satisfaction with anesthesia in patients staying in hospital at least 24 h after surgery.

METHODS: The study was performed in six centers. Inpatients aged more than 18 yr, who underwent a wide range of common surgical procedures, were asked to answer a 10-item instrument to measure patient satisfaction with anesthesia (mean score range, 0–10) and some specific questions, and to rate their perceived health (score, 0–10). Anesthesia staff members were invited to self-compile a Maslach Burnout Inventory.

RESULTS: The satisfaction evaluation questionnaire was returned by 1290 patients (mean age, 61 ± 16 yr; males, 54.4%). The mean global satisfaction score was 8.7 (95% CI: 8.7–8.8), being <9 in 632 (49%) and ≥9 in 658 (51%) patients. The Maslach Burnout Inventory was returned by 55 anesthesiologists and 68 nurses. Multivariate regression identified five variables as significant predictors of a mean global satisfaction of ≥9: 1) having been treated in a service with perioperative nurses specifically dedicated only to anesthesia; 2) having been treated where anesthesia information leaflets were provided preoperatively; 3) having received more than two anesthesiologist visits after surgery; 4) having a perceived health score >8.5; and 5) being older that 70 yr. No relationship was found between staff burnout and patient satisfaction.

CONCLUSIONS: Inpatient satisfaction can be improved by an organization in which surgical suite nurses are dedicated only to anesthesia, a written anesthesia information leaflet is given during the preoperative visit and postoperative visits are enhanced.


胸段硬膜外鎮痛在實驗性胰腺炎中對受體依賴性及非受體依賴性肺血管收縮中的作用

The Role of Thoracic Epidural Analgesia in Receptor-Dependent and Receptor-Independent Pulmonary Vasoconstriction in Experimental Pancreatitis

Stefan Lauer, MD*, Hendrik Freise, MD*, Lars G. Fischer, MD*, Kai Singbartl, MD*, Hugo V. Aken, MD, FRCA, FANZCA*, Markus M. Lerch, MD{dagger}, and Andreas W. Sielenkämper, MD, MSc*

From the *Department of Anesthesiology and Intensive Care Medicine, University Hospital Muenster, Germany; and {dagger}Department of Gastroenterology, Endocrinology and Nutrition, Ernst-Moritz-Arndt Universität, Greifswald, Germany.

Anesth Analg 2007 105: 453-459.

 

背景:急性胰腺炎通常會導致肺部損傷、肺血管內皮細胞功能的損害以及肺血管收縮影響。如果暫不考慮胸段硬膜外腔鎮痛(TEA)在嚴重疾病中可能帶來的各種潛在危險,該技術在部分胰腺炎病人的鎮痛方面是頗為重要的。儘管有證據顯示硬膜外鎮痛通過有效鎮痛能改善肺功能,但連續硬膜外阻滯對肺血管內皮細胞的功能損害有何作用尚未清楚。

方法:在清醒的患胰腺炎大鼠在體模型上,進行TEA,同時監測血氣、動脈血壓、呼出氣一氧化氮。隨後在離體肺灌流模型中研究受體依賴性及非受體依賴性肺血管收縮。通過監測肺髓過氧物酶活性反映白細胞在肺部的聚集,通過監測幹/濕比例反映肺水腫情況。

結果:急性胰腺炎期間會損害肺的氧合能力、代謝情況,以及引起乳酸酸中毒和呼出氣一氧化氮水準升高,而這些情況在假手術組中顯示可被TEA所改善 TEA能部分改善胰腺炎中發生的低血壓。離體肺灌流模型中,與血管緊張素I I相關受體依賴性肺血管收縮功能在急性胰腺炎期間下降,反映出肺血管平滑肌細胞功能損害。低氧性肺血管收縮功能同樣受到損害。而採用TEA能部分恢復肺血管對血管緊張素I I和低氧刺激的收縮反應。緩激肽誘導產生肺血管收縮,反映出肺內皮細胞功能損害、肺髓過氧物酶活性及肺水腫程度均不受TEA影響。

結論:研究證實了TEA改善胰腺炎相關的肺血管反應能力及氣體交換能力的損害。

(陶穎瑩 陳傑 校)

BACKGROUND: Acute pancreatitis commonly results in lung injury and deterioration of pulmonary endothelial function and vasoregulation. Despite a variety of potential risks with the use of thoracic epidural analgesia (TEA) in the critically ill, this technique is an important component of pain management in pancreatitis in selected cases. Although there is evidence that epidural analgesia improves lung function through effective pain relief, the influence of continuously applied epidural local anesthetics on pulmonary endothelial dysfunction is still unknown.

METHODS: In an in vivo model of TEA in awake rats with acute pancreatitis, we evaluated blood gas analysis, arterial blood pressure, and exhaled nitric oxide. This was followed by in vitro studies of receptor-dependent and receptor-independent pulmonary vasoconstriction using an isolated perfused lung model. Pulmonary myeloperoxidase activity, indicating leukocyte sequestration into the lungs and wet/dry ratio evaluating pulmonary edema, were also measured.

RESULTS: Deteriorated oxygenation, metabolic and lactate acidosis, as well as exhaled nitric oxide levels occurring during acute pancreatitis, were reduced by TEA to levels observed in sham-operated animals. TEA also partially ameliorated the hypotension occurring in pancreatitis. In isolated perfused lungs, receptor-dependent vasoconstriction due to angiotensin II was reduced during acute pancreatitis, indicating pulmonary vascular smooth muscle cell dysfunction. Hypoxic pulmonary vasoconstriction was likewise abolished. Treatment with TEA partly restored the vasoreactivity to angiotensin II and hypoxia. Bradykinin-induced vasoconstriction, indicating pulmonary endothelial dysfunction, myeloperoxidase activity and the degree of pulmonary edema, was not influenced by TEA.

CONCLUSIONS: Our study demonstrated that TEA improves pancreatitis-associated impairment of pulmonary vasoreactivity and gas exchange.

 

 

乳房手術前應用非類固醇類抗炎藥(羅非考昔)中加入地塞米松會延長術後鎮痛效應

The Prolonged Postoperative Analgesic Effect When Dexamethasone Is Added to a Nonsteroidal Antiinflammatory Drug (Rofecoxib) Before Breast Surgery

Hval Kjetil, MD*, Thagaard K. Sem, MD*, Schlichting Ellen, MD, PhD{dagger}, and Raeder Johan, MD, PhD*

From the Departments of *Anaesthesia and {dagger}Surgery, Ullevaal University Hospital; and University of Oslo, Faculty Division, Ullevaal University Hospital, Oslo, Norway.

Anesth Analg 2007 105: 481-486.

 

背景:糖皮質激素具有鎮痛效應。在這個研究中,作者評價了地塞米松在包括長效非類固醇類抗炎藥的多模式術後鎮痛中的效果。

方法:一百名接受乳癌手術的病人作為研究物件。他們在異丙酚和瑞芬太尼麻醉前口服撲熱息痛2g和羅非考昔50mg,這些病人以雙盲、隨機接受地塞米松16mg靜脈注射或安慰劑。在手術結束前,兩組病人都接受靜脈注射芬太尼1ug/kg和傷口處局部浸潤0.25%布比卡因2040ml.

結果:術後剛開始的4h內在疼痛評分或搶救藥物治療中兩組間沒有差別。安慰劑組病人,咳嗽或肩膀活動時的疼痛均分是3(以010分比例),而地塞米松組疼痛均分是1,沒達到統計學意義(P0.06)。在術後2472h內,安慰劑組病人,咳嗽或肩膀活動時的疼痛均分是2,而地塞米松組是1,有統計學意義(P0.05)。在術後424h地塞米松組病人40%不痛,安慰劑組為24%,差異無統計學意義(P0.09)。在術後2472h內地塞米松組不痛的病人為46%,安慰劑組為28%(P0.06)。地塞米松組術後第一個晚上睡眠品質差的病人(68%)較對照組多(44%)(P0.05

結論:地塞米松16mg加到包括有非類固醇類抗炎藥(羅非考昔)的多模式鎮痛法中,延長(24h72h)術後鎮痛效應。

(張燕 陳傑 校)

BACKGROUND: Glucocorticoids provide analgesia. In this study, we evaluated the effects of adding dexamethasone to a multimodal postoperative analgesic regimen, including a long-acting nonsteroidal antiinflammatory drug.

METHODS: One-hundred patients admitted for ambulatory breast cancer surgery were studied. They received paracetamol 2 g and rofecoxib 50 mg orally 1 h before start of general anesthesia with propofol and remifentanil. The patients were then randomized to receive, in a double-blind manner, either dexamethasone 16 mg IV or placebo. Both groups received fentanyl 1 µg/kg IV and 20–40 mL bupivacaine 2.5 mg/mL wound infiltration before the end of surgery.

RESULTS: There was no difference in pain scores or rescue medication between the groups during the first 4 h after surgery. After discharge, the median pain score during coughing or shoulder movement was 3 on a 0–10 scale in patients receiving placebo, and 1 in the patients receiving dexamethasone, which did not reach statistical significance (P = 0.06). From 24 to 72 h, the median pain with coughing or shoulder movement in patients receiving placebo was 2, and 1 in patients receiving dexamethasone, which did reach statistical significance (P < 0.05). Forty percent of patients receiving dexamethasone were pain free from 4 to 24 h, compared with 24% of patients receiving placebo, a difference that did not reach statistical significance (P = 0.09). Similarly, 46% of patients receiving dexamethasone were pain free from 24 to 72 h, compared with 28% of patients receiving placebo (P = 0.06). More patients had slept poorly on the first night in the dexamethasone group than in the control group, 68% vs 44%, (P < 0.05).

CONCLUSIONS: Dexamethasone 16 mg provides prolonged postoperative analgesia from 24 to 72 h after surgery when added to a multimodal regimen including nonsteroidal antiinflammatory drug (rofecoxib).

 

 

三種不同濃度的羅呱卡因聯合芬太尼用於病人自控硬膜外鎮痛的比較

A Comparison of Three Different Concentrations of Ropivacaine with Fentanyl for Patient-Controlled Epidural Analgesia

Tetsuya Iijima, MD*, Tadahiko Ishiyama, MD, PhD*, Satoshi Kashimoto, MD, PhD*, Toshiaki Yamaguchi, MD, PhD*, Tomio Andoh, MD, PhD*, Kazumi Hanawa, MSc{dagger}, Izumi Tanzawa, BSc{dagger}, Keisi Kawata, BSc{dagger}, Takehisa Hanawa, PhD{dagger}, and Yoshimitsu Hiejima, PhD{ddagger}

From the *Department of Anesthesiology, Faculty of Medicine, University of Yamanashi; {dagger}Department of Pharmacy, University of Yamanashi Hospital, Yamanashi, Japan; and {ddagger}School of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan.

Anesth Analg 2007 105: 507-511.

背景:羅呱卡因聯合芬太尼用於病人自控硬膜外鎮痛以保存腸道功能,提供鎮痛作用並保存活動能力的理想濃度仍不清楚。

方法:312名擬行婦科下腹部手術的女性患者隨機分別接受005%0.075%.和0.1%羅呱卡因聯合14ug/ml芬太尼,25ug/ml氟呱利多。病人自控硬膜外鎮痛設定如下:初始 劑量5ml,夜間輸注速度2ml/h,白天時間不予輸注,一次快速輸注量為2ml,鎖定時間為10分鐘,腸道功能評定首先通過排氣和排便,疼痛評定通過主觀視覺角度,腸蠕動功能評定通過Bromage評分。資料收集在同一天手術日,術後第一天的早上和晚上以及術後第二天的早上。

結果:在這三個組中胃腸道的動力沒有什麼不同,三個組的結果表明產生相同的鎮痛效果和腸蠕動功能沒有減弱。

結論:0.05%羅呱卡因能提供保存良好的胃腸道功能,優異的術後疼痛,且無運動阻滯。

(陳偉 陳傑 校)

BACKGROUND: The optimal concentration of ropivacaine in combination with fentanyl for patient-controlled epidural analgesia focusing on preservation of bowel function, analgesia, and motor function remains unclear.

METHODS: Three hundred-twelve women scheduled to undergo gynecologic lower abdominal surgery, were randomly allocated to receive ropivacaine 0.05, 0.075, or 0.1% in combination with fentanyl 4 µg/mL and droperidol 25 µg/mL. The settings of patient-controlled epidural analgesia were as follows: initial loading volume 5 mL, background infusion 2 mL/h during night-time, no background infusion during daytime, bolus volume 2 mL, and lockout interval 10 min. Bowel function was evaluated by the first passage of flatus and feces. Pain was assessed with a visual analog scale, and motor function was examined by modified Bromage scale. Data were collected in the evening on the day of surgery, in the morning and in the evening on the first postoperative day, and in the morning on the second postoperative day.

RESULTS: Gastrointestinal motility was not different among the three groups. All three solutions produced equivalent analgesia and no motor blockade.

CONCLUSION: We conclude that ropivacaine 0.05% is sufficient to preserve gastrointestinal motility, and provides excellent postoperative pain relief without motor blockade.


羅呱卡因脊麻在下肢手術中應用:劑量-效應的研究

Spinal Ropivacaine for Lower Limb Surgery: A Dose–Response Study

Ying Y. Lee, FFARCSI, MScPainM*{dagger}, Warwick D. Ngan Kee, MD*, Hang K. Chang, MBBS{dagger}, Chi L. So, MBBS{dagger}, and Tony Gin, MD*

From the *Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; {dagger}Department of Anaesthesiology and Operating Theatre Services, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China.

Anesth Analg 2007 105: 520-523.

 

背景:羅呱卡因脊麻在下肢手術中藥物劑量與效應之間的關係尚未完全明確。

方法:作者前瞻性、隨機、雙盲研究60名擬在腰-硬聯合麻醉下行下肢手術的患者。患者鞘內分別注射五種劑量的羅呱卡因(用生理鹽水稀釋至2.8ml):2471014mg。如果一個劑量可以在20分鐘內使病人T12水準兩側的皮膚冷感覺阻斷,且能夠至少維持50分鐘內不追加藥物並確保手術的進行,這一劑量就認定為有效。

結果:設定的五個劑量的成功率分別是:0%,0%,42%,83%,100%。並由此衍算出羅派卡因的ED507.6mg95CI:6.28.7mg),ED9511.4mg95CI:9.718.3mg)。且隨著劑量的增加向頭測的感覺和運動的阻滯平面逐漸上升。

結論:羅呱卡因在50min左右的下肢外科手術中的ED50,ED95分別是7.6mg11.4mg。這一結果為我們在不同的臨床情況下選擇最佳羅呱卡因的麻醉劑量提供了的依據。

Abstract

BACKGROUND: The dose–response relationship for spinal ropivacaine in patients undergoing surgery of the lower extremity has not been fully determined.

METHODS: We performed a prospective, randomized, double-blind study of 60 patients scheduled for lower limb surgery under combined spinal–epidural anesthesia. Patients were assigned to receive 1 of 5 doses of intrathecal ropivacaine: 2, 4, 7, 10, or 14 mg diluted to 2.8 mL with normal saline. A dose was considered successful if a sensory block to cold was achieved bilaterally at the T12 dermatome within 20 min and surgery proceeded without supplementation for at least 50 min.

RESULTS: Anesthesia was successful in 0, 0, 42, 83, and 100% of the 2, 4, 7, 10, and 14 mg groups, respectively. The derived value for ED50 was 7.6 mg (95% CI: 6.2–8.7 mg) and for ED95 was 11.4 mg (95% CI: 9.7–18.3 mg). The cephalic level of sensory block and the degree of motor block increased with larger doses of ropivacaine.

CONCLUSION: The ED50 and ED95 for spinal ropivacaine in lower limb surgery of 50 min duration or less were 7.6 and 11.4 mg, respectively. This provides a useful guide for clinicians to choose the optimal dose of spinal ropivacaine under different clinical situations.

 

5%利多卡因進行腰麻的麻醉持續時間在長期濫用阿片類藥物者用與非濫用者間的比較

The Duration of Spinal Anesthesia with 5% Lidocaine in Chronic Opium Abusers Compared with Nonabusers

Maryam Vosoughian, MD*, Ali Dabbagh, MD*, Samira Rajaei, MD{dagger}, and Hassan Maftuh, MD*

From the *Department of Anesthesiology, Faculty of Medicine, Shaheed Beheshti University; and {dagger}Department of Immunology, Faculty of Medicine, Tehran University, Tehran, Iran.

Anesth Analg 2007 105: 531-533.

 

背景:既往研究顯示長期濫用阿片類藥物者的痛閾較低。本研究作者試圖證明長期濫用阿片類藥物影響局麻藥蛛網膜下腔阻滯時的麻醉持續時間。

 方法:在這項病例對照研究中,從大學附屬醫院的所有入院需要進行擇期下腹部手術的病人中選出50名濫用阿片類藥物者及50名非濫用阿片類藥物者。所有的病人接受5%的高濃度不含防腐劑的利多卡因100mg及葡萄糖配成的混合藥液進行蛛網膜下腔阻滯。

結果:濫用阿片類藥物者的麻醉持續時間(60±7 min)比非濫用阿片類藥物者(83±10min) 明顯縮短(P0.0001)

 結論:阿片類藥物濫用者蛛網膜下腔阻滯的麻醉持續時間縮短。

(潘錢玲 陳傑 校)

BACKGROUND: It has been demonstrated that chronic opium abusers have lower thresholds for pain. In this study we sought to determine whether chronic opium abuse has any effect on the duration of spinal block by local anesthetics.

METHODS: In a case-controlled study, 50 opium abusers and 50 nonabusers undergoing lower abdomen operations were selected from among the patients admitted to a university hospital for elective surgery. All patients received 100 mg hyperbaric preservative-free 5% lidocaine in dextrose, intrathecally.

RESULTS: The duration of anesthesia was much shorter in the opium abusers (60 ± 7 min) than in the nonabusers (83 ± 10 min) (P < 0.0001).

CONCLUSION: The study documents a shortened duration of spinal block in opium abusers.


酚卞明對左心發育不良綜合征的治療作用:一項核心綜述

Phenoxybenzamine in the Treatment of Hypoplastic Left Heart Syndrome: A Core Review

Nina A. Guzzetta

From the Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.

Anesth Analg 2007 105: 312-315.

 

對新生兒行Norwood心臟重建術後的圍手術處理是相當複雜的。新生兒單個的心室儲備及肺動脈和全身的迴圈對肺血流和全身的血流形成了細微的平衡。精細地調控肺和全身血管阻力對預防額外的肺血流對全身氧供的消耗十分必要。一項新興的旨在改善早期死亡率的治療策略是在手術過程中使用酚卞明,一種全身性血管擴張劑。最大限度的全身血管擴張被認為會減少心室的前負荷,並能通過改善術後全身血管阻力的波動來使得迴圈更為穩定。雖然這種策略在很多中心已經普及,但卻沒有經過仔細的審查。在接下來的綜述裏介紹了酚卞明藥理的概述,Norwood術式的外科和生理過程和贊成使用或反對使用酚卞明的討論。

(張 儷譯 薛張綱校)

Perioperative management of neonates after the Norwood procedure is extremely complex. Limited reserve of the neonatal single ventricle and the parallel arrangement of the pulmonary and systemic circuits result in a tenuous balance between pulmonary and systemic blood flows. Precise manipulations of both pulmonary and systemic vascular resistance are necessary to prevent excessive pulmonary blood flow at the expense of systemic oxygen delivery. An emerging treatment strategy aimed at improving early mortality is the intraoperative administration of phenoxybenzamine, a profound systemic vasodilator. Maximum systemic vasodilation is thought to reduce afterload of the single ventricle and produce a more stable parallel circulation by ameliorating the postoperative fluctuations in systemic vascular resistance. Although this strategy has gained popularity at many centers, it is not without scrutiny. The following review provides an overview of the pharmacology of phenoxybenzamine, the surgical and physiologic implications of the Norwood procedure, and a discussion of the pros and cons of phenoxybenzamine administration.

 

 

先心患者行心臟手術發生與麻醉相關的心臟停搏的頻率

The Frequency of Anesthesia-Related Cardiac Arrests in Patients with Congenital Heart Disease Undergoing Cardiac Surgery
Kirsten C. Odegard, MD*, James A. DiNardo, MD*, Barry D. Kussman, MBBCh, Avinash Shukla, MD*, James Harrington, MD*, Al Casta, MD*, Francis X. McGowan, Jr, MD*, Paul R. Hickey, MD*, Emile A. Bacha, MD, Ravi R. Thiagarajan, MBBS, and Peter C. Laussen, MBBS*

From the Departments of *Anesthesiology, Perioperative and Pain Medicine, {dagger}Cardiac Surgery, and {ddagger}Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2007 105: 335-343.

 

背景:據報導,兒科麻醉中麻醉相關的心臟停搏頻率為每10000例中有1.4-4.6例。ASA評分>III及年幼是危險因數。先心病人可能有更高的危險性。因此,在此項研究中,我們評估在一個大型兒科治療中心欲行心臟手術的先心患者發生麻醉相關的心臟停搏的頻率。

方法:根據建立的資料登記顯示,從20001月到200512月,所有的心臟停搏都發生於心臟手術室。一次心臟停搏被定義為任何需要胸外或胸內按壓的,不管有沒有直接的電複律。被認為與麻醉相關的事件被分為很可能相關或可能相關。結果:在5213例麻醉中有40個病人發生了41次心臟停搏(平均年齡2.9個月;範圍為2-23歲),總體發生率為0.79%78%發生於要求心肺旁路的開放過程,22%發生於不要求心肺旁路的閉和過程。11例心臟停搏被分類為與麻醉極相關(n=6)或可能相關(n=5),(每10000例麻醉中21.1例)但沒有死亡的;30例被分類為操作相關。新生兒與麻醉相關的,或與操作相關的心臟停搏發生率最高。這與事件發生的年份及麻醉醫師的經驗無關。結論:行心臟手術的病人發生與麻醉相關的心臟停搏的頻率有所增加,但與增加的死亡率並沒有關係。新生兒和嬰兒為高風險人群。仔細的術前準備和預防對保證及時有效的復蘇非常重要。

(孫 霞譯 薛張綱校)

BACKGROUND: The frequency of anesthesia-related cardiac arrests during pediatric anesthesia has been reported between 1.4 and 4.6 per 10,000 anesthetics. ASA physical status >III and younger age are risk factors. Patients with congenital cardiac disease may also be at increased risk. Therefore, in this study, we evaluated the frequency of cardiac arrest in patients with congenital heart disease undergoing cardiac surgery at a large pediatric tertiary referral center. METHODS: Using an established data registry, all cardiac arrests from January 2000 through December 2005 occurring in the cardiac operating rooms were reviewed. A cardiac arrest was defined as any event requiring external or internal chest compressions, with or without direct cardioversion. Events determined to be anesthesia-related were classified as likely related or possibly related. RESULTS: There were 41 cardiac arrests in 40 patients (median age, 2.9 mo; range, 2 days to 23 yr) during 5213 anesthetics over the time period, for an overall frequency of 0.79%; 78% were open procedures requiring cardiopulmonary bypass and 22% closed procedures not requiring cardiopulmonary bypass. Eleven cardiac arrests (26.8%) were classified as either likely (n = 6) or possibly related (n = 5) to anesthesia, (21.1 per 10,000 anesthetics) but with no mortality; 30 were categorized as procedure-related. The incidence of anesthesia-related and procedure-related cardiac arrests was highest in neonates (P < 0.001). There was no association with year of event or experience of the anesthesiologist. CONCLUSION: The frequency of anesthesia-related cardiac arrest in patients undergoing cardiac surgery is increased, but is not associated with an increase in mortality. Neonates and infants are at higher risk. Careful preparation and anticipation is important to ensure timely and effective resuscitation.

 

 

針對兒童的近期研究資訊:關於兩種方法的報告

Presenting Research Information to Children: A Tale of Two Methods

Alan R. Tait, PhD, Terri Voepel-Lewis, MSN, RN, and Shobha Malviya, MD

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

Anesth Analg 2007 105: 358-364.

 

背景:兒童的研究資訊常以一種難以理解的方式呈現。因此,我們設計了這個研究,用來檢測關於兒童理解力的書面研究資訊,提高了可讀性和可行性後的效果。方法:190717歲的住院兒童參與了研究,他們有的接受手術治療,有的接受藥物治療,並且隨機的受到一份標準的研究資料或是一份提高了可讀性和可行性的改良版。然後孩子們接受面試,確定他們對八個研究單元的理解,包括風險、權益、方案等,他們的反應由兩名獨立的鑒定人員記錄。結果:被隨機分配到改良版的孩子對資料的總體理解和對方案和權益的理解都明顯優於另一組(P<0.05)。改良版對較幼小的孩子(710歲)對材料的理解的提高更為有效,包括改良的版式、年齡,閱讀能力和孩子閱讀資料的程度。對於兩種版式,81.3%的孩子更傾向于改良版,因為它更易於接受和閱讀。大字體和插圖的應用也很受歡迎。結論:這一研究結果表明:為了更好的滿足兒童不同年齡和閱讀認知能力而對研究資料作出的改良可以提高他們對材料的理解力和接受力。

(王時來譯 薛張綱校)

BACKGROUND: Research information for children is often presented in a manner that is difficult to understand. We designed this study, therefore, to examine the effect of improved readability and processability of written study information on childrens' understanding. METHODS: One-hundred-ninety children aged 7–17 yr who were hospitalized for a surgical procedure or medical treatment were randomized to receive study information using either a standard form or a modified form with improved readability and processability. Children were interviewed to determine their understanding of eight study elements, including the risks, benefits, protocol, etc., and their responses scored by two independent assessors. RESULTS: Children who were randomized to the modified form had significantly greater overall understanding of the information and greater understanding of the protocol and benefits (P < 0.05). The modified form was particularly effective in improving younger children's (7–10 yr) understanding of the material. Multivariate analysis identified several predictors of understanding, including the modified format, age, reading ability and the degree to which the child read the information. When shown both forms, 81.3% of children preferred the modified form stating that it was "friendlier" and "easier to read." The use of a larger font size and pictures were particularly popular. CONCLUSIONS: Results of this study suggest that modification of study information to better fit the ages and meet the reading and cognitive abilities of children results in their improved understanding and acceptance of the material.

 

 

鼻內用右旋美托咪啶鎮靜及鎮痛作用的雙盲交叉實驗評估

A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine.

Vivian M. Yuen, Michael G. Irwin, Theresa W. Hui, Man K. Yuen, and Libby H. Y. Lee

From the Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, Hong Kong.

Anesth Analg 2007 105: 374-380.

 

背景:α2受體激動劑右旋美托咪啶具有易喚醒的鎮靜作用以及無呼吸抑制的鎮痛作用.這些特性可能使之成為很有用的麻醉術前用藥,儘管外周給藥並不可取.我們通過健康志願者鼻內用右旋美托咪啶來評估其鎮靜,抗焦慮,鎮痛和血流動力學作用.方法:實驗採用了KOCH設計,雙盲交叉對照的方法.實驗共分成3,A安慰劑組 B鼻內用右旋美托咪啶組(1毫克/公斤體重)C右旋美托咪啶組(1.5毫克/公斤體重).18個研究物件都參與到2個實驗期.在進行了基礎的各項改良評估如警覺/鎮痛比度表,視覺直觀疼痛比度表,腦電雙頻指數,視覺直觀焦慮比度表,電子測痛儀測得的疼痛閾,收縮壓和舒張壓,心率以及呼吸頻率,氧飽和度後給藥.這些檢測在每期研究中都重複進行.結果: 鼻內用右旋美托咪啶是可以耐受的.通過發現腦電雙頻指數,收縮壓和舒張壓,心率的下降,無論1mg/kg還是1.5mg/kg的右旋美托咪啶都比安慰劑組有更顯著的鎮靜作用.給藥後45分鐘產生效果,其鎮痛效果的峰值發生在90-150分鐘後.A,B,C組收縮壓最大下降值分別為6%,23%21%.而對疼痛閾,氧飽和度以及呼吸頻率卻沒有影響.由於在基礎水準研究物件都沒有焦慮,其抗焦慮作用不能被評估.結論: 右旋美托咪啶的鼻內用藥途徑是有效方便可行的.今後的研究將把重點放在無創途徑用右旋美托咪啶對於各種臨床情況的價值評估上,包括其用於誘導前的麻醉用藥.

( 楊譯 薛張綱校)

BACKGROUND: The alpha2-receptor agonist, dexmedetomidine, provides sedation with facilitated arousal and analgesia with no respiratory depression. These properties render it potentially useful for anesthesia premedication, although parenteral administration is not practical in this setting. We designed this study to evaluate the sedative, anxiolytic, analgesic, and hemodynamic effects of dexmedetomidine administered intranasally in healthy volunteers. METHODS: Koch's design for crossover trials (three-treatment and two-period design) was adopted. The study was double-blind and there were three treatment groups: A (placebo), B (intranasal dexmedetomidine 1 microg/kg) and C (intranasal dexmedetomidine 1.5 microg/kg). Each of the 18 subjects participated in two study periods. The study drug was administered intranasally after baseline observations of modified Observer Assessment of Alertness/Sedation Scale, visual analog scale of sedation, bispectral index, visual analog scale of anxiety, pain pressure threshold measured by an electronic algometer, systolic blood pressure (SBP) and diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation. These were repeated during the course of the study. RESULTS: Intranasal dexmedetomidine was well tolerated. Both 1 and 1.5 microg/kg doses equally produced significant sedation and decreases in bispectral index, SBP, diastolic blood pressure, and heart rate when compared with placebo (P < 0.05). The onset of sedation occurred at 45 min with a peak effect at 90-150 min. The maximum reduction in SBP was 6%, 23%, and 21% for Groups A, B, and C respectively. There was no effect on pain pressure threshold, oxygen saturation or respiratory rate. Anxiolysis could not be evaluated as no subjects were anxious at baseline. CONCLUSION: The intranasal route is effective, well tolerated, and convenient for the administration of dexmedetomidine. Future studies are required to evaluate the possible role of the noninvasive route of administration of dexmedetomidine in various clinical settings, including its role as premedication prior to induction of anesthesia.

 

 

增塑劑鄰苯二甲酸二異辛酯調製A型γ-氨基丁酸和甘氨酸受體的功能

The Plasticizer Di(2-ethylhexyl) Phthalate Modulates {gamma}-Aminobutyric Acid Type A and Glycine Receptor Function

Liya Yang, Pavle S. Milutinovic, Robert J. Brosnan, Edmond I. Eger, II, and James M. Sonner

From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; and The Department of Surgical and Radiological Sciences, University of California, School of Veterinary Medicine, Davis, California.

Anesth Analg 2007 105: 393-396.

 

介紹:由聚氯乙烯(PVC)組成的靜脈(IV)液體袋含有鄰苯二甲酸二異辛酯(DEHP),使PVC具有伸縮性。據報導,鄰苯二甲酸酯能夠抑制對吸入麻醉藥敏感的神經元煙鹼型乙醯膽鹼受體。這增加了DEHP調製其他半胱氨酸環受體的功能,諸如A型γ-氨基丁酸(GABAA)和甘氨酸受體,這樣,DEHP增塑的PVC干擾了這些受體的麻醉機制的電生理研究。方法:{alpha}1ß2 GABAA{alpha}1甘氨酸受體能在非洲爪蟾卵母細胞中表達並且通過雙電極電壓鉗夾法研究測得。我們用激動劑誘導的電流測量含DEHP增塑的PVC的靜脈容量袋以及DEHP飽和度的緩衝效應。結果:甘氨酸受體的激動劑誘導的電流被含DEHP增塑的PVC的靜脈容量袋的緩衝增加了291.9% ± 84.5%,被DEHP飽和度的緩衝增加了70.8% ± 16.7%{alpha}1ß2 GABAA受體的激動劑誘導的電流被含DEHP增塑的PVC的靜脈容量袋的緩衝減少了19.3% ± 3.2%,被DEHP飽和度的緩衝減少了31.7% ± 7.0%。結論:增塑劑DEHP同時調製了GABAA和甘氨酸受體的功能。如果DEHP增塑的PVC出現在實驗裝置中,DEHP污染會混雜這些受體麻醉機制的電生理研究的結果。

(陳佳莉譯 薛張剛校)

INTRODUCTION: Intravenous (IV) fluid bags made of polyvinyl chloride (PVC) often contain the plasticizer di(2-ethylhexyl) phthalate (DEHP) to make the PVC flexible. Phthalate esters have been reported to inhibit neuronal nicotinic acetylcholine receptors, which are sensitive to many inhaled anesthetics. This raises the possibility that DEHP might modulate the function of other cys-loop receptors, such as {gamma}-amino butyric acid type A (GABAA) and glycine receptors, and that DEHP-plasticized PVC might interfere with electrophysiologic studies of anesthetic mechanisms on those receptors. METHODS: {alpha}1ß2 GABAA and {alpha}1 glycine receptors were expressed in Xenopus laevis oocytes and studied using two-electrode voltage clamping. We then measured the effect of buffers from IV bags containing DEHP-plasticized PVC, and of buffers saturated with DEHP, on agonist-induced currents. RESULTS: Agonist-induced currents from glycine receptors were enhanced by buffers from IV bags containing DEHP-plasticized PVC by 291.9% ± 84.5% (mean ± se) and from saturated solutions of DEHP by 70.8% ± 16.7%. Agonist-induced currents from {alpha}1ß2 GABAA receptors were inhibited by buffers from IV bags containing DEHP-plasticized PVC by 19.3% ± 3.2% and by 31.7% ± 7.0% from buffers saturated with DEHP. CONCLUSIONS: The plasticizer DEHP modulates the function of both GABAA and glycine receptors. DEHP contamination can confound the results of electrophysiologic studies of anesthetic mechanisms on these receptors if DEHP-plasticized PVC is present in the experimental apparatus.

 

 

持續血氧和二氧化碳監測揭示病人自控鎮痛患者中頻發的低氧飽和度和呼吸緩慢

Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia

Frank J. Overdyk, MSEE, MD, Diplomate ABA*, Rickey Carter, PhD{dagger}, Ray R. Maddox, PharmD{ddagger}, Jarred Callura, BS§, Amy E. Herrin, MS{dagger}, and Craig Henriquez, PhD§

From the Departments of *Anesthesia and Perioperative Medicine, and {dagger}Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina; {ddagger}Department of Clinical Pharmacy, Research, and Pulmonary Medicine, St. Joseph's/Candler Medical Center, Savannah, Georgia; and §Department of Biomedical Engineering, Duke University, Durham, North Carolina.

Anesth Analg 2007 105: 412-418.

 

背景:病人自控鎮痛(PCA)最嚴重的併發症是呼吸抑制(RD)。在文獻中呼吸抑制的發生率通過間歇採樣脈搏氧飽和度(SPO2)和呼吸頻率,其數值偏離正常域值得到。方法:術後病人給予嗎啡和呱替啶PCA鎮痛,我們在病房持續監測氧飽和度和二氧化碳圖。護士在聽到監護儀因為呼吸狀態異常報警後進行干預。結果:總共分析了178名病人,分別有12%和41%出現過低氧飽和度(SPO2<90%)和呼吸緩慢(呼吸頻率<10),持續時間達到3分鐘或更長。有一個病人需要正壓通氣,沒有病人需要鹽酸納洛酮拮抗。年齡大於65歲和病態肥胖的病人低氧飽和度的發生率比較高。年齡大於65歲的病人呼吸緩慢的發生率較高,相比之下病態肥胖的病人發生呼吸緩慢的相對比較少。結論:我們的研究中,應用相同的域值標準和相對較嚴格的持續時間標準,與呼吸抑制相關的呼吸緩慢的發生率比文獻報導中高出1%到2%,我們通過低氧飽和度監測呼吸抑制的發生率與術前評估的結果是一致的。我們的結論是,因為呼吸抑制可以導致呼吸停止,因此持續呼吸監測對PCA病人的安全是合適的選擇。我們需要較合適的報警設置,以減少因為呼吸抑制而觸發的過頻繁的報警。

(陳珺珺譯 薛張綱校)

BACKGROUND: The most serious complication of patient-controlled analgesia (PCA) is respiratory depression (RD). The incidence of RD in the literature is derived from intermittent sampling of pulse oximetry (Spo2) and respiratory rate and defined as a deviation below an arbitrary threshold. METHODS: We monitored postsurgical patients in a hospital ward receiving morphine or meperidine PCA with continuous oximetry and capnography. Nurses responding to audible monitor bedside alarms documented respiratory status and interventions. RESULTS: A total of 178 patients were included in the analysis, 12% and 41% of whom had episodes of desaturation (Spo2 <90%) and bradypnea (respiratory rate <10) lasting 3 min or more. One patient required "rescue" with positive pressure ventilation, and none required naloxone. Patients over 65 years of age and the morbidly obese were at greater risk for desaturation. Patients over 65 years of age were also more likely to have bradypnea, whereas the morbidly obese and patients receiving continuous infusions were less likely to have bradypnea. CONCLUSIONS: Our incidence of RD by bradypnea is significantly higher than the 1%2% incidence in the literature, using the same threshold criteria but more stringent duration criteria, while our incidence of RD based on desaturation is consistent with previous estimates. We conclude that continuous respiratory monitoring is optimal for the safe administration of PCA, because any RD event can progress to respiratory arrest if undetected. Better alarm algorithms must be implemented to reduce the frequent alarms triggered by threshold criteria for RD.

 

 

用機械通氣相關的脈搏波體積描計變異預測心臟手術後患者液體治療反應性

Ventilation-induced plethysmographic variations predict fluid responsiveness in ventilated postoperative cardiac surgery patients.

Wyffels PA, Durnez PJ, Helderweirt J, Stockman WM, De Kegel D.

Department of Anaesthesiology, UZ Gasthuisberg, Leuven, Belgium.

Anesth Analg. 2007;105:448-452

 

背景:已經證明,相比中心靜脈壓(CVP)或肺動脈閉塞壓(PAOP),機械通氣相關的脈壓變異(PPV)是一種更好的預測液體治療後的心輸出量變化的指標。測量指尖脈搏產生的體積描計波形與動脈血壓的波形相似。方法:通過對32名行心臟手術病人的觀察性研究,解答這種廣泛使用的無創監測能否預測液體治療反應性。輸入500ml6%羥乙基澱粉後,分別使用PPVCVPPAOP、舒張期肺動脈壓以及機械通氣相關的脈搏波體積描計變異性(VPV)預測心輸出量變化,並作一比較。結果:PPVVPV與心輸出量變化有很好的相關性(P<0.05)。接收器進行特徵性分析顯示曲線下面積PPV0.937VPV0.892PPVVPV預測15%心輸出量變化的適宜閾值都是變異率11.3%。結論:本研究表明,VPVPPV一樣,是比CVPPAOP更可靠的預測液體治療反應性的指標。

(羅 璿譯 薛張綱校)

BACKGROUND: It has been shown that ventilation-induced pulse pressure variation (PPV) is a better variable than central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) for predicting cardiac output changes after fluid administration. The plethysmographic wave form measured with a fingertip pulse is very similar to the arterial blood pressure curve. METHODS: We investigated whether this widely used, noninvasive instrument could predict fluid responsiveness by conducting an observational study in 32 patients who had undergone cardiac surgery. We compared PPV, CVP, PAOP, diastolic pulmonary artery pressure, and ventilation-induced plethysmographic variation (VPV) for predicting the cardiac output change after the administration of 500 mL 6% hydroxyethylstarch. RESULTS: We found a good correlation between cardiac output changes and both PPV and VPV (P < 0.05). Receiver operating characteristic analysis revealed an area under the curve of 0.937 for PPV and 0.892 for VPV. The optimal thresholds were a variation of 11.3% for both PPV and VPV in predicting a 15% increase in cardiac output. CONCLUSION: This study shows that VPV, like PPV, is a more reliable predictor of fluid responsiveness than CVP and PAOP.

 

 

鐳射前列腺切除術的麻醉

Laser Resection of the Prostate: Implications for Anesthesia 

Richard A. Hanson, MD*, Mark H. Zornow, MD*, Michael J. Conlin, MD{dagger}, and Ansgar M. Brambrink, MD, PhD*

From the Departments of *Anesthesiology and Peri-Operative Medicine, and {dagger}Surgery, Division of Urology, Oregon Health and Science University, Portland, Oregon.

Anesth Analg 2007 105: 475-479.

 

背景:鈥鐳射:釔鋁石榴石和鉀鈦磷使得經尿道前列腺切除術幾乎不吸收任何沖洗液以及出血量減少到最低。經典的經尿道前列腺切除術的麻醉,我們經常是選擇蛛網膜下腔阻滯,這樣我們可以在監護過程中發現繼發於沖洗液吸收引起的經尿道前列腺切術術綜合征。新的雷射技術允許醫生和麻醉醫生有更多的選擇,選擇最適合病人的麻醉方式。方法:在這項研究中,我們回顧了泌尿外科的文獻,對近期的鐳射前列腺切除術的概況有所瞭解。同時我們部分遮罩了這類文獻,關於特殊患者的潛在影響和圍手術期管理。結果:我們的研究提示,在經尿道鐳射術中麻醉醫生可以安全的選擇全麻,甚至是在移動的情況下。這包括有心血管疾病或者接受持續抗凝治療的患者。結論:我們沒有發現有特別的研究關於討論接受鐳射手術的最佳麻醉方式的文章。因此,臨床研究需要更好的去確定各種麻醉方式的風險和獲益。

(王光妍譯 薛張綱校)

BACKGROUND: Holmium:yttrium-aluminum-garnet and potassium-titanyl- phosphate lasers make it possible to perform transurethral prostate resection with almost no absorption of irrigant and minimal blood loss. Subarachnoid block is usually administered for classical transurethral resection of the prostate, so that the patient can be monitored for the onset of transurethral resection of the prostate syndrome secondary to irrigant absorption. New laser resection techniques may allow the patient and anesthesiologist to choose options most appropriate for the patients medical conditions and preference. METHODS: In this study, we review the urologic literature to provide an overview of current laser technology for prostate reduction surgery. We also screened this literature for evidence of potential effects on anesthesia care for special patient groups as well as for overall perioperative management.RESULTS: Our findings suggest that the anesthesiologist may now safely offer general anesthesia for endourologic laser surgery, even on an ambulatory basis. This includes patients with cardiovascular disease or receiving continuous anticoagulation therapy.CONCLUSION: We found no studies specifically aimed at evaluating best anesthetic practices for patients undergoing laser procedures. Therefore, clinical research is needed to better define the risks and benefits of the various anesthetic alternatives.

 

 

針刺對清醒和麻醉狀態下志願者的血氧水準依賴信號的影響:一項試驗性研究

Acupuncture-induced blood oxygenation level-dependent signals in awake and anesthetized volunteers: a pilot study.

Wang SM, Constable RT, Tokoglu FS, Weiss DA, Freyle D, Kain ZN.

Center for Advancement of Perioperative Health, Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA.

Anesth Analg 2007 105: 499-506.

 

背景:在全麻病人中應用針刺的臨床效應,有許多矛盾的資料。我們假設:這些矛盾的資料由於麻醉中針刺對中樞神經系統活動的抑制的結果,而中樞神經系統活動可以通過MRI來顯示。方法:通過交叉設計,在清醒和以異丙酚誘導的全麻兩種試驗條件下的志願者接受標準化的胃部36針手法針刺。fMRI(功能磁共振成像)在兩組試驗期間被應用。配對t試驗分析用來檢驗兩組間的BOLD信號的區別。後續的分析驗證六個相關的區域(丘腦、紅核、腦島、導水管周圍灰質、反壓舌脊腦回和下顳區)腦血流的變化結果:通過BOLD ,我們發現在包括中央後回反壓舌脊腦回、左後腦島、雙前葉楔、丘腦、紅核和黑質的大腦區域有明顯區別(樣本100P < 0.01)。修正了背景腦血流的後續的分析發現:BOLD信號在兩組間的不同是直接由於區域腦血流的改變導致的。結論: 通以異丙酚誘導的全麻會減少對針刺刺激的神經生理反應。但仍需進一步研究來確定這些發現的臨床意義。

(陳勇柱譯 薛張綱校)

BACKGROUND: There are conflicting data regarding clinical efficacy of acupuncture applied while patients are under general anesthesia. We hypothesize that these conflicting data are a result of the inhibitory effect of anesthesia on acupuncture-induced central nervous system activity that can be demonstrated using magnetic resonance imaging. METHODS: Using a crossover study design, volunteers received standardized Stomach 36 manual acupuncture in two experimental conditions: while undergoing a propofol-based general anesthetic, and while awake. Functional magnetic resonance imaging was conducted during both experimental sessions. Paired-t-test analyses were performed to examine the differences in acupuncture-induced blood oxygenation level-dependent (BOLD) signals between awake and anesthesia conditions. A secondary analysis was performed to account for the changes in regional cerebral blood flow at six regions of interest (thalamus, red nucleus, insula, periaqueductal gray, retrosplenial cingular gyri, and the inferior temporal region). RESULTS: Using BOLD, we found significant differences between the two experimental sessions in brain areas, including postcentral gyri, retrosplenial cingular area, left posterior insula, bilateral precuneus, thalamus, red nuclei, and substantia nigra (cluster 100, P < 0.01). A secondary analysis correcting for background cerebral blood flow found that BOLD signal differences between experimental conditions were not directly caused by changes in regional blood flow. DISCUSSION: Propofol-based anesthesia reduces the neurophysiological response to acupuncture stimulation as measured by acupuncture-induced BOLD signals. Further work should be conducted to determine the clinical significance of these findings.

 

 

可樂定1 µg/kg對青少年使用單純布比卡因脊髓麻醉是一個安全有效的佐劑

Clonidine 1 µg/kg Is a Safe and Effective Adjuvant to Plain Bupivacaine in Spinal Anesthesia in Adolescents

Olfa Kaabachi, Amine Zarghouni, Rami Ouezini, Ahmed Ben Abdelaziz, Olfa Chattaoui, and Hannu Kokki

Department of Anesthesiology and Intensive Care, Kassab Orthopedic Institute, Tunis, Tunisia.

Anesth Analg 2007 105: 516-519

 

背景:脊髓麻醉正在日益多地被用於青少年。然而,僅僅用布比卡因的麻醉對於既定手術也許時間太短了。在布比卡因中添加2µg /kg的可樂定可以延長麻醉時間,但是也許會導致低血壓。在現在的研究中,我們調查青少年脊髓麻醉時鞘內使用1µg /kg的可樂定作為布比卡因的添加劑的安全性和有效性。方法:八十三位青少年,51位男性,年齡10-15歲,入選這項安慰劑對照的隨機實驗。患者給與脊髓麻醉,單純用0.5%等比重的布比卡因0.2-0.4 mg/kg或者布比卡因加可樂定1µg /kg。感覺阻滯的持續時間是最主要的測量結果。結果:可樂定延長了感覺和運動阻滯的時間。2個皮區間的感覺復原時間在添加可樂定組是136 minsd,56),而在對照組是107 minsd,42)(95%置信區間:5-53 min, P = 0.02)。完全的運動阻滯的恢復在可樂定組是251 min(sd, 79),而對照組181 min (sd, 59) (95%置信區間: 39-103 min, P = 0.001)。首劑之後痛覺恢復的時間在可樂定組中要長,461 min (sd, 147),而對照組330 min (sd, 138) (95% 置信區間: 53-207 min, P = 0.01)。兩組中低血壓和心動過緩發生的頻率是沒有區別的。結論:在青少年中,1µg /kg的可樂定可以延長布比卡因所致的感覺阻滯的時間達30 min以及術後止痛時間延長120 min,並且沒有嚴重的不良時間。

(周時蓓譯 薛張綱校)

BACKGROUND: Spinal anesthesia is increasingly used in adolescents. However, the anesthesia provided by bupivacaine alone may be too short for the planned surgery. The addition of clonidine 2 microg/kg to bupivacaine provides a prolonged anesthetic action but may be associated with hypotension. In the present study, we investigated the efficacy and safety of intrathecal clonidine 1 mug/kg in adjunction to bupivacaine in spinal anesthesia in adolescents. METHODS: Eighty-three adolescents, 51 males, aged 10-15 yr, scheduled for orthopedic surgery were enrolled in this placebo-controlled, randomized study. Patients were given spinal anesthesia either with plain 0.5% isobaric bupivacaine 0.2-0.4 mg/kg or bupivacaine with clonidine 1 microg/kg. The duration of sensory block was the primary outcome measure. RESULTS: Clonidine prolonged the duration of both the sensory and motor block. The time to regression of sensory block by two dermatomes was 136 (mean) (sd, 56) min in the adolescents with clonidine versus 107 min (sd, 42) in the controls (95% CI for diff: 5-53 min, P = 0.02). The time to full recovery of motor block was 251 min (sd, 79) in the adolescents with clonidine versus 181 min (sd, 59) in the controls (95% CI: 39-103 min, P = 0.001). Time to the first dose of rescue analgesia was longer in the adolescents with clonidine, 461 min (sd, 147) versus 330 min (sd, 138) in the controls (95% CI: 53-207 min, P = 0.01). There was no difference in the frequency of hypotension or bradycardia between the groups. CONCLUSION: In adolescents, clonidine 1 microg/kg prolonged the duration of sensory block achieved with bupivacaine by 30 min and postoperative analgesia by 120 min without severe adverse events.

 

 

改良股正中入路坐骨神經阻滯法:誘發運動反應和感覺阻滯的關係(簡要報告)

A Modified Mid-Femoral Approach to the Sciatic Nerve Block: A Correlation Between Evoked Motor Response and Sensory Block (Brief Report)

Antoine Pianezza, Marie-Luce Gilbert, Vincent Minville, Daren Filsinger, Quentin Gobert, Alain Guérot, Régis Fuzier, and Olivier Fourcade

Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France.

Anesth Analg 2007 105: 528-530.

股正中入路外側坐骨神經阻滯(LSMF)為單次注射阻滯所有坐骨神經分支提供了可靠、安全、有效的方法。然而,我們不知道當用單次注射技術實施LSMF時,坐骨神經的哪個分支(脛神經[T]或腓總神經[CP])能提供更好的成功率。在該前瞻研究中,我們比較了T運動反應和CP運動反應的成功率。方法:95名行踝關節或足部手術的病人入選。當第一次誘發TCP的運動反應時,注入0.475%的羅呱卡因30ml,最小強度為0.30.5mA。結果:72名病人分入T組,23名分入CP組。當坐骨神經感覺阻滯完全時認為成功。T反應和CP反應的成功率分別為90%(65)70%(16)( P < 0.05)。實施阻滯的時間(CP: 4.5 +/- 3 min T: 4.5 +/- 4 min; P = NS)及感覺和運動起效的時間組間無顯著性差異。兩組均未見併發症。結論:我們認為,在實施改良的LSMF阻滯時,T分支的誘發運動反應較CP反應具有更高的成功率。

(王麗珺譯 薛張綱校)

BACKGROUND: The lateral sciatic mid-femoral block (LSMF), proved to be reliable, safe, and effective on both branches of the sciatic nerve with a single injection. However, we do not know which component of the sciatic nerve (the tibial [T] or the common peroneal [CP]) produces a better success rate when performing a LSMF with a single injection technique. In this prospective study we compared the success rate of the T motor response with the CP motor response. METHODS: Ninety-five patients undergoing ankle or foot surgery were enrolled. Thirty milliliters of 0.475% ropivacaine was injected at the first evoked motor response, either T or CP, with a minimal intensity between 0.3 and 0.5 mA. RESULTS: Seventy-two patients were included in group T and 23 in group CP. The block was considered a success when a complete sensory block of the sciatic nerve was obtained. The success rate was 90% (65) for the T response and 70% (16) for the CP response (P < 0.05).Time to perform the block (CP: 4.5 +/- 3 min vs T: 4.5 +/- 4 min; P = NS) as well as sensory and motor onset times were not significantly different between groups. No complications were observed in either group. CONCLUSION: We conclude that the evoked motor response of the T branch is associated with a higher success rate than a CP response using the modified LSMF block.

 

七氟烷(而非丙泊酚)可防止豬冠狀動脈內由神經鞘氨醇磷酸膽鹼引起的Rho激酶依賴性收縮

Sevoflurane, but Not Propofol, Prevents Rho Kinase-Dependent Contraction Induced by Sphingosylphosphorylcholine in the Porcine Coronary Artery

Hiroyuki Kinoshita, MD, PhD*, Naoyuki Matsuda, MD, PhD{dagger}, Yoshiki Kimoto, MD, PhD*, Setsuko Tohyama, MD{ddagger}, Keiko Hama, MD*, Katsutoshi Nakahata, MD, PhD*, and Yoshio Hatano, MD, PhD*

From the *Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan; {dagger}Departments of Anesthesiology and Molecular Medical Pharmacology, Toyama University School of Medicine, Toyama, Japan; and {ddagger}Departments of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Sapporo, Japan.

Anesth Analg 2007;105:325-329

 

背景:神經鞘氨醇磷酸膽鹼可通過啟動Rho激酶來引起冠脈痙攣。我們設計了目前的實驗來檢驗麻醉藥對豬冠狀動脈內由神經鞘氨醇磷酸膽鹼引起的Rho激酶啟動的不同效應。

方法:不含內皮的豬冠狀動脈環在含改良Krebs–Ringer碳酸氫鹽溶液中的組織水浴中制得。分別在無或有七氟烷、丙泊酚或一種選擇性Rho激酶抑制劑Y27632(應用神經鞘氨醇磷酸膽鹼前15min時加入)的情況下,使用等長張力記錄得到對神經鞘氨醇磷酸膽鹼反應的濃度-反應曲線。Rho A由細胞內向質膜的易位和肌球蛋白輕鏈磷酸酶的肌球蛋白-定靶亞單位的磷酸化通過蛋白質印跡法來測定。

結果:神經鞘氨醇磷酸膽鹼(10–710–5 M)引起豬冠狀動脈的收縮,該效應可被選擇性Rho激酶抑制劑Y276322 x 10–6 M)所取消。七氟烷(1.7%)減少神經鞘氨醇磷酸膽鹼誘導的冠脈收縮,而較高濃度的七氟烷(3.4%)可取消其作用(P < 0.05)。相反,丙泊酚(3 x 10–6 M10–5 M)對由神經鞘氨醇磷酸膽鹼引起的冠脈收縮沒有影響。七氟烷,而非丙泊酚減少了細胞內Rho A向質膜的易位。七氟烷和Y27632(而非丙泊酚)相似地減少了肌球蛋白輕鏈磷酸酶的肌球蛋白-定靶亞單位的磷酸化(分別減少64.4%70.8%P < 0.05)。

結論:神經鞘氨醇磷酸膽鹼通過啟動Rho激酶而引起冠狀動脈收縮。七氟烷(而非丙泊酚)抑制此途徑,從而防止血管收縮。

 

BACKGROUND: Sphingosylphosphorylcholine may induce coronary vasospasm by the activation of Rho kinase. We designed the current study to examine the differential effects of anesthetics on Rho kinase activation induced by sphingosylphosphorylcholine in porcine coronary arteries.

METHODS: Rings of porcine coronary artery without endothelium were prepared in tissue bath containing modified Krebs–Ringer bicarbonate solution. Using isometric force recording, concentration–response curves in response to sphingosylphosphorylcholine were obtained in the absence or in the presence of sevoflurane, propofol, or a selective Rho kinase inhibitor Y27632, which was added 15 min before the application of sphingosylphosphorylcholine. Intracellular translocation of Rho A toward the plasma membrane and phosphorylation of the myosin-targeting subunit of myosin light chain phosphatase were also evaluated by Western blotting.

RESULTS: Sphingosylphosphorylcholine (10–7 to 10–5 M) produced contraction of the porcine coronary artery, which was abolished by a selective Rho kinase inhibitor Y27632 (2 x 10–6 M). Sevoflurane (1.7%) reduced sphingosylphosphorylcholine-induced coronary artery constriction, and the higher concentration (3.4%) abolished it (P < 0.05). In contrast, propofol (3 x 10–6 M and 10–5 M) had no effect on coronary artery constriction due to sphingosylphosphorylcholine. Sevoflurane, but not propofol, reduced intracellular translocation of Rho A toward the plasma membrane. Sevoflurane and Y27632, but not propofol, similarly decreased (64.4% or 70.8% reduction, respectively, P < 0.05) phosphorylation of the myosin-targeting subunit of myosin light chain phosphatase.

CONCLUSIONS: Sphingosylphosphorylcholine induces coronary vasocontriction via activation of Rho kinase. Sevoflurane, but not propofol, inhibits this pathway, resulting in prevention of vasoconstriction.

 

 

新生兒開始發病的多系統炎性疾病患兒的麻醉處理

The Anesthetic Management of Children with Neonatal-Onset Multi-System Inflammatory Disease

Christine F. Lauro, AB*, Raphaela Goldbach-Mansky, MD{dagger}, Margaret Schmidt, CRNA*, and Zenaide M. N. Quezado, MD*

From the *Department of Anesthesia and Surgical Services, National Institutes of Health Clinical Center; and {dagger}National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland.

Anesth Analg 2007;105:351-357

 

背景:新生兒開始發病的多系統炎性病(NOMID)是一種罕見的常染色體顯性遺傳性疾病,屬於自身炎性疾病逐漸龐大的範疇,表現特徵為蕁麻疹、關節病和慢性無菌性腦膜炎,它合併有冷刺激誘發的自身炎性基因CIASI的突變,該基因是編碼蛋白質和cryopyrin。由於對於該疾病的麻醉考慮知之甚少,我們尋求鑒別NOMID的主要特徵和各自的麻醉和圍術期含義的方法。

方法:我們在2003年到2006年研究了為做有創性診斷和治療干預進行麻醉的NOMID兒童圍麻醉期記錄。另外,我們對該疾病的遺傳學、臨床、和生物化學異常進行了廣泛的文獻回顧。

結果: NOMID兒童17例(平均年齡8歲,範圍9-11歲)為了診斷性和治療性手術進行了麻醉。所有病人都累及神經系統,包括顱內壓升高、慢性無菌性腦膜炎,和發育遲緩;7例有骨肥大,15例有眼部和14例有耳部NOMID的臨床表現。儘管疾病是複雜的,但圍術期過程是簡單的,且沒有觀察到嚴重的不良反應。

結論:本研究第一次研究了NOMID(一種伴有關節炎、回歸熱、蕁麻疹和慢性無菌性腦膜炎的自身炎性疾病)的麻醉含義。對於兒科麻醉醫師而言,發熱和無菌性腦膜炎的存在可能使對用於擇期手術的麻醉藥的管理較少令人滿意,我們的發現提示沒有活動性感染的證據時,即使有發熱和慢性無菌性腦膜炎,全身和局域麻醉都可用于NOMID病人而無不良併發症。

(彭中美 馬皓琳 李士通 校)

BACKGROUND: Neonatal-onset multi-system inflammatory disease (NOMID), a rare autosomal dominantly inherited disease, belongs to a growing spectrum of autoinflammatory diseases, is characterized by urticarial rash, arthropathy, and chronic aseptic meningitis, and is associated with mutations in the cold-induced autoinflammatory gene, CIAS1, the gene that encodes the protein, cryopyrin. As little is known about the anesthetic considerations of the disease, we sought to identify the main features and respective anesthetic and perioperative implications of NOMID.

METHODS: We examined perianesthetic records of children with NOMID who were anesthetized for invasive diagnostic and therapeutic interventions between 2003 and 2006. In addition, we conducted an extensive literature review of the genetic, clinical, and biochemical abnormalities of the disease.

RESULTS: Seventeen children with NOMID (median age 8 yr, range 9 mo to 11 yr) were anesthetized for diagnostic and therapeutic procedures. All patients had neurological involvement, including increased intracranial pressure, chronic aseptic meningitis, and developmental delay; 7 had bony overgrowth, 15 ocular, and 14 otological manifestations of NOMID. Despite the complexity of the disease, the perioperative course was uncomplicated, and no serious adverse events were observed.

CONCLUSIONS: This study is the first to investigate the anesthetic implications of NOMID, an autoinflammatory disease associated with arthropathy, recurrent fevers, urticarial rash, and chronic aseptic meningitis. While for the pediatric anesthesiologist, the presence of fever and aseptic meningitis might make the conduct of anesthetics for elective procedures less desirable, our findings suggest that without evidence of active infection, even in the presence of fever and chronic aseptic meningitis, general and regional anesthesia may be conducted in patients with NOMID without untoward complications.



全麻誘導氣囊-面罩通氣時適當保留假牙的影響

The Effect of Leaving Dentures in Place on Bag-Mask Ventilation at Induction of General Anesthesia

Niamh P. Conlon, FCARCSI*{dagger}, Richard P. Sullivan, MBChB*, Peter G. Herbison, MSc*, Mathew Zacharias, PhD*, and Donal J. Buggy, MD{dagger}{ddagger}

From the *Department of Anesthesia, Dunedin Hospital, Dunedin, New Zealand; {dagger}Department of Anesthesia, Mater Misericordiae University Hospital, Dublin, Ireland; and {ddagger}Outcomes Research Institute, Cleveland Clinic, Cleveland, Ohio.

Anesth Analg 2007;105:370-373

背景:手術麻醉前無牙病人去除假牙的最佳時間還不確定。

方法:我們進行了一個前瞻、隨機、對照試驗來評估全麻誘導氣囊-面罩通氣時,不去除假牙的影響。166個無牙的病人被隨機分成兩組。保留假牙組,麻醉誘導後氣囊-面罩通氣時保留假牙。去除假牙組,氣囊-面罩通氣前去除假牙。由麻醉醫師評估氣囊-面罩通氣難度。

結果:成功的氣囊-面罩通氣的定義是3 L/min 新鮮氣體流量及調節壓力限制在20 cm H2O時,ETco2 上升到20 mmHg並回到基線。在保留假牙組,61/ 84 (73%)達到成功氣囊-面罩通氣。去除假牙組為40/81 (49%)(優勢比0.3795% CI = 0.19–0.70P = 0.002)。

結論:我們推斷,全麻誘導時如保留無牙病人的假牙在原處,氣囊-面罩通氣更容易。

(張曦 譯,馬皓琳 李士通 校)

BACKGROUND: The optimum timing for denture removal in edentulous patients before anesthesia and surgery is uncertain.

METHODS: We conducted a prospective, randomized, controlled trial to evaluate the effect of leaving dentures in during bag-mask ventilation at induction of general anesthesia. One hundred sixty-six edentulous patients were randomized to two groups. The Dentures-In group was bag-mask ventilated after induction of anesthesia with dentures left in place. The Dentures-Out group patients had their dentures removed before bag-mask ventilation. The degree of difficulty of bag-mask ventilation was assessed by the anesthesiologist.

RESULTS: Successful bag-mask ventilation, as defined by a increase in ETco2 to 20 mm Hg and back to baseline with 3 L/min fresh gas flow and the adjustable pressure limiting valve at 20 cm H2O, was achieved in 61 of 84 (73%) of the Dentures-In patients compared with 40 of 81 (49%) of the Dentures-Out patients (odds ratio 0.37, 95% CI = 0.19–0.70, P = 0.002).

CONCLUSION: We conclude that bag-mask ventilation is easier in edentulate patients when their dentures are left in situ during induction of general anesthesia.



共同釋放的神經遞質對A型γ氨基丁酸受體、士的甯敏感性甘氨酸受體和N-甲基-d-天冬氨酸受體的麻醉藥樣調節

Anesthetic-Like Modulation of a {gamma}-Aminobutyric Acid Type A, Strychnine-Sensitive Glycine, and N-Methyl-d-Aspartate Receptors by Coreleased Neurotransmitters

Pavle S. Milutinovic, MS*, Liya Yang, PhD{dagger}, Robert S. Cantor, PhD{ddagger}, Edmond I. Eger, II, MD{dagger}, and James M. Sonner, MD{dagger}

From the *University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; {dagger}Department of Anesthesia and Perioperative Care, University of California, San Francisco; {ddagger}Department of Chemistry, Dartmouth College, Hanover, New Hampshire.

Anesth Analg 2007;105:386-392

介紹:近來提出的一種麻醉機理預言共同釋放的神經遞質是非天然的激動劑,以類似麻醉藥的方式對神經遞質受體進行調節。

方法:我們通過將乙醯膽鹼應用於NR1/NR2ANMDA受體、甘氨酸用於野生型{alpha}1ß2型和抗麻醉藥的{alpha}1(S270I)ß2 GABA A型受體及將GABA應用于同源性{alpha}1野生型甘氨酸受體和抗麻醉藥型{alpha}1 S267I甘氨酸受體來檢驗此預測。在爪蟾卵母細胞表達受體,並用雙電極電壓鉗技術進行研究。

結果:我們發現,乙醯膽鹼抑制NMDA受體功能,GABA增強甘氨酸受體功能,以及甘氨酸增強對GABA A型受體功能。作為具有麻醉藥活性的化合物,GABA對抗麻醉藥的S267I甘氨酸受體功能的增強作用遠小於對野生型受體的作用。甘氨酸增強野生型GABA A型受體功能,但抑制抗麻醉藥S270I GABA A型受體功能。

結論:這些結果表明,共同釋放到對麻醉藥敏感的受體的神經遞質是非天然激動劑,能以類似麻醉藥的機制調節這些受體的功能。這些發現支持最近的麻醉藥作用理論。

(顏濤 譯, 馬皓琳 李士通 校)

INTRODUCTION: A mechanism of anesthesia has recently been proposed which predicts that coreleased neurotransmitters may modulate neurotransmitter receptors for which they are not the native agonist in a manner similar to anesthetics.

METHODS: We tested this prediction by applying acetylcholine to a NR1/NR2A N-methyl-d-aspartate receptor, glycine to a wild-type {alpha}1ß2 and anesthetic-resistant {alpha}1(S270I)ß2 {gamma}-amino-butyric acid (GABA) type A receptor, and GABA to a homomeric {alpha}1 wild type and anesthetic-resistant {alpha}1 S267I glycine receptor. Receptors were expressed in Xenopus laevis oocytes and studied using two-electrode voltage clamping.

RESULTS: We found inhibition of N-methyl-d-aspartate receptor function by acetylcholine, enhancement of glycine receptor function by GABA, and enhancement of GABA type A receptor function by glycine. As expected of compounds with anesthetic activity, GABA showed far less potentiation (enhancement) of the function of the anesthetic-resistant S267I glycine receptor than that of the wild-type receptor. Glycine potentiated the function of wild-type GABA type A receptors but inhibited the function of the anesthetic-resistant S270I GABA type A receptor.

CONCLUSIONS: These results show that neurotransmitters that are coreleased onto anesthetic-sensitive receptors may modulate the function of receptors for which they are not the native agonist via an anesthetic-like mechanism. These findings lend support to a recent theory of anesthetic action.




麻醉資訊管理系統:對當前實行政策和實踐的一個調查報告

Anesthesia Information Management Systems: A Survey of Current Implementation Policies and Practices

Richard H. Epstein, MD*, Michael M. Vigoda, MD, MBA{dagger}, and David M. Feinstein{ddagger}

From the *Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania; {dagger}Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida; and {ddagger}Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2007;105:405-411

背景資料:麻醉資訊管理系統(AIMS)的使用逐年增加,但是麻醉專業機構並沒有發表意見來指導配置及影響記賬、安全性、醫療合法性以及依從性問題的政策決定。

方法:由美國麻醉技術協會委員會建立的一個45個問題構成的調查,發給18個獨立機構的臨床管理人員,這些機構中分別安裝了六種不同的AIMS系統。這項調查的主要目的是建立一個當前政策和實踐方面的基線。

結果:僅有超過2/3的人對於調查問題中25%的問題表示認同。報告的很多配置可能增加拒付、醫療保險和醫療補助的不配合、安全漏洞和醫療合法防禦的困難。

結論:建議由麻醉專業組織如美國麻醉技術協會制定指導方針來協助AIMS的配置,可以幫助這些麻醉部門避免可能導致顯著財務和法律風險的問題。

(沈浩 馬皓琳 李士通 校)
BACKGROUND: Anesthesia information management systems (AIMS) implementation is increasing, but there are no published recommendations from anesthesia professional societies to guide configuration and policy decisions that affect billing, security, medical–legal, and compliance issues.

METHODS: A 45-question structured survey was developed by a committee of the Society for Technology in Anesthesia and was sent to the clinical administrator at 18 separate institutions, comprising six different installed AIMS systems. The primary goal of the survey was to establish a baseline of current policies and practices.

RESULTS: There was more than two-third agreement among respondents for only 25% of questions. A number of configurations reported may increase exposure to billing denial, Medicare and Medicaid noncompliance, security breeches, and medical–legal defense difficulties.

CONCLUSIONS: Developing guidelines by anesthesia professional organizations such as Society for Technology in Anesthesia to assist in the configuration of AIMS is recommended to help anesthesia departments avoid problems that may result in significant financial and legal risk.



圍術期患者的安全性:正確的病人、正確的手術、正確的左右側——一個多面性、跨組織、干預性研究

Perioperative Patient Safety: Correct Patient, Correct Surgery, Correct Side—A Multifaceted, Cross-Organizational, Interventional Study

Edna Zohar, MD, MHA*, Yossi Noga, BSc, MD, MHA*, Ehud Davidson, MD{dagger}, Margalit Kantor, RN, MA{dagger}, and Brian Fredman, MB, BCh*

From the *Departments of Anesthesiology, Critical Care and Pain Management; and {dagger}Hospital Administration, Meir Medical Center, Kfar Saba, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Anesth Analg 2007;105:443-447

背景:在圍術期準備時,確保患者有一個安全的環境是很重要的。在這樣的考慮下,在我們的手術室服務中用到了“患者安全第一”這樣的一個哲學思想。

方法:在此項干預研究的第一期(2001-2002),我們定義和完成了此項干預的組織和教育方面。此後,進行執行期(20032005)。鑒於我們的0容忍政策,如果在手術室等待區發現患者對麻醉和手術的準備中有較大錯誤,患者將被送回到原先的科室(“失敗”),手術將被延期直到較大錯誤被更正。

結果:共記錄了15856位元患者的資料。在3年的執行期,112位患者(0.17%)被送回原科室。與2003年相比較,2004年與2005年的大錯誤發生顯著減少(P<0.002)(分別為1.04%0.59%0.49%)。此外,逐步邏輯回歸表明由患者準備不足所引起的較大錯誤發生率呈時間相關性顯著減少(優勢比=1.4895% CI1.16-1.87)。另外,平均失敗間隔時間分別為2003年的6.6天,2004年的11.2天和2005年的14.7天(P<0.03)。最後證實,隨著時間過去,患者的準備工作顯著改善提高(P < 0.0001),而全部患者的準備工作得分=100%

結論:教育和提高意識可以減少圍術期錯誤。然而,即使是仔細設計適當的政策,仍然不能建立無錯的環境。因此,必須在持續的基礎上完成監護和系統分析。

(胡湘 馬皓琳 李士通校)

BACKGROUND: It is important to ensure a patient-safe environment in the perioperative setting. With this in mind, a "patient-safety first" philosophy was adopted within our operating room service.

METHODS: During the first phase of the interventional study (2001–2002), we defined and executed the organizational and educational aspects of the intervention. Thereafter, the implementation phase (2003–2005) was performed. According to our zero tolerance policy, in the event that a major error in patient readiness for anesthesia and surgery was found in the operating room holding area, the patient would be returned to the parent department ("failure") and the surgical procedure delayed until the major error was corrected.

RESULTS: The data of 15,856 patients were recorded. During the 3-yr implementation period, 112 patients (0.71%) were returned to the department. A statistically significant (P < 0.002) reduction in major errors was recorded when comparing the year 2003 to the years 2004 and 2005 (1.04, 0.59, and 0.49% for the years 2003, 2004, and 2005, respectively). Furthermore, stepwise logistic regression demonstrated a time-dependant significant decrease in the incidence of a major error that resulted from inadequate patient preparation (odds ratio = 1.48, 95% CI: 1.16–1.87). In addition, the mean time between failures was 6.6, 11.2, and 14.7 days for the years 2003, 2004, and 2005, respectively (P < 0.03). Finally, a significant (P < 0.0001) improvement in patient preparation over time, as well as the overall probability that the patient preparation score = 100% (P < 0.001), were demonstrated.

CONCLUSIONS: Education and increased awareness can decrease perioperative errors. However, even with a carefully designed policy in place, an error-free environment was not achieved. Therefore, monitoring and system analysis should be performed on a continuing basis.



在置管前預先填充硬膜外間隙可以減少硬膜外導管置入血管的發生率

Predistention of the Epidural Space Before Catheter Insertion Reduces the Incidence of Intravascular Epidural Catheter Insertion

Shmuel Evron, MD*{dagger}, Vladimir Gladkov, MD*, Daniel I. Sessler, MD{ddagger}{dagger}, Vadim Khazin, MD*, Oscar Sadan, MD§, Mona Boaz, PhD¶, and Tiberiu Ezri, MD*{dagger}

From the *Department of Anesthesia, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Israel; {dagger}Outcomes Research Institute and Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky; {ddagger}Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio; §Departments of Obstetrics and Gynecology and ¶Epidemiology, Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Israel.

Anesth Analg 2007;105:460-464

背景:在硬膜外麻醉或硬膜外鎮痛過程中意外地將導管置入硬膜外靜脈是一個常見的併發症。在一個試驗性研究和一些以往的報導的基礎上,我們驗證了以下假設,在硬膜外置管前用鹽水預先填充硬膜外間隙可以便於置管而且降低這個併發症的發生率。

方法:203名分娩婦女被隨機分成兩組,用阻力消失方法給予硬膜外穿刺,未填充組在硬膜外間隙注射2ml生理鹽水,填充組則注射5ml生理鹽水。填充組在置入硬膜外導管前注射器栓始終連接在導針上保持關閉。然後兩組都通過硬膜外導管注射1.5%的利多卡因3ml作為試驗劑量。

結果:填充組導管誤置入血管的發生率更低(2%16%P=0.0001),且91%的填充組病人未發生任何未阻滯節段,未填充組67%P=0.0001)。兩組的鎮痛起效時間差異很小且沒有重要的臨床意義(5±2分鐘比6±3分鐘,P=0.0001)。兩組鎮痛品質(視覺評分和羅呱卡因消耗量)相似。

結論:硬膜外置管前在硬膜外間隙注射5ml生理鹽水可以減少導管誤置入靜脈的發生率和未阻滯節段的數目。

(薑旭暉 馬皓琳 李士通 校)

BACKGROUND: Accidental cannulation of an epidural vein is a common complication associated with epidural anesthesia or analgesia. On the basis of a pilot study and previous reports, we tested the hypothesis that predistention of the epidural space with saline before epidural catheterization would ease catheter insertion and decrease the incidence of this complication.

METHODS: Two-hundred-three laboring women were randomly assigned to receive an epidural with loss of resistance technique with 2 mL (nondistention) or 5 mL saline (distention). In the distention group, the syringe plunger was held closed before epidural catheter insertion. Then in both groups, a test dose of 3 mL of 1.5% lidocaine was injected through the epidural catheter.

RESULTS: There were fewer accidental intravascular catheter placements (2% vs 16%, P = 0.0001) in the distention group, and 91% of patients in this group did not have any unblocked segments versus 67% in the nondistension group (P = 0.0001). The difference in onset time of analgesia was small (5.0 ± 2 min vs 6 ± 3 min, P = 0.0001) and not clinically important. The quality of analgesia (visual analog scores and ropivacaine consumption) was similar between groups.

CONCLUSIONS: Distention of the epidural space with 5 mL saline before epidural catheter insertion decreased the incidence of accidental venous cannulation and the number of unblocked segments.




膝關節成形術中充足補液與限制補液的對比:一項隨機雙盲研究

Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study

Kathrine Holte, MD*, Billy B. Kristensen, MD{dagger}, Lotte Valentiner, RN*, Nicolai B. Foss, MD{dagger}, Henrik Husted, MD{ddagger}, and Henrik Kehlet, MD, PhD§

From the Departments of *Surgical Gastroenterology, {dagger}Anesthesiology, and {ddagger}Orthopedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark; and §Section for Surgical Pathophysiology, Rigshospitalet, Denmark.

Anesth Analg 2007;105:465-474

背景:描述圍術期液體量與器官功能之間關係的資料很少。在這項研究中,我們研究了在膝關節成形術中兩種血管內補液管理水準(“充足”比“限制”)對作為主要結果變數的生理學恢復的影響。

方法:在一個雙盲研究中,將48ASA I–III 級,擇期行快通道膝關節成形術的病人隨機分入圍術期血管內限制補液組和充足補液組。病人們均恒速輸注乳酸林格液以及標準體積的膠體液。圍術期管理的其他方面(包括麻醉、術前液體狀況以及術後管理)均標準化。主要的結果變數包括肺功能(肺量測定法)、運動能力(“定時的起床和行走”測試)、凝血功能(血栓彈性描記®)、術後的低氧血症(夜間的脈搏血氧飽和度測定)、術後腸梗阻(排便)和病人的主觀恢復程度(VAS評分)。住院期和併發症也記錄在冊。

結果:所有病人嚴格遵循液體應用指南。充足補液組的中位數為4250mL,變化範圍在3150–5200 mL,而限制補液組分別為1740 mL1100–2165 mL。並且前者會導致術後6小時的肺功能改善、術後24–48 小時的顯著的高凝性及降低嘔吐的幾率。其他評定的圍術期生理恢復參數(術後低氧血症、運動能力或者是病人的主觀恢復水準)沒有總體差別。兩組的住院天數也無差異(兩組的中位數均為4天,無顯著性差異)。

結論:相比限制補液而言,快通道膝關節成形術中的充足補液可能會引起顯著的高凝,減少嘔吐,但對其他恢復指數和住院天數卻無差異。

(黃麗娜 李士通 馬皓琳 校)

BACKGROUND: There are few data describing the relationship between amount of perioperative fluid and organ function. In this study we investigated the effects of two levels of intravascular fluid administration ("liberal" versus "restrictive") in knee arthroplasty on physiological recovery as the primary outcome variable.

METHODS: In a double-blind study, 48 ASA I–III patients undergoing fast-track elective knee arthroplasty were randomized to restrictive or liberal perioperative intravascular fluid administration. Patients received a fixed rate infusion of Ringer’s lactate solution with a standardized volume of colloid. All other aspects of perioperative management (including anesthesia, preoperative fluid status, and postoperative management) were standardized. Primary outcome variables included pulmonary function (spirometry), exercise capacity ("timed up and go" test), coagulation (Thrombelastograph®), postoperative hypoxemia (nocturnal pulse oximetry), postoperative ileus (defecation), and subjective patient recovery (visual analog scales). Hospital stay and complications were also noted.

RESULTS: Fluid guidelines were followed strictly in all patients. Liberal (median 4250 mL, range 3150–5200 mL) compared with restrictive (median 1740 mL, range 1100–2165 mL) intravascular fluid administration led to improved pulmonary function 6 h postoperatively, significant hypercoagulability 24–48 h postoperatively, and reduced incidence of vomiting. There were no overall differences in the other assessed perioperative physiological recovery variables (postoperative hypoxemia, exercise capacity or subjective patient recovery variables). No difference was found in hospital stay (median 4 days in both groups, not significant).

CONCLUSION: A liberal compared to a restrictive intravascular fluid regimen may lead to significant hypercoagulability and a reduction in vomiting, but without differences in other recovery variables or hospital stay after fast-track knee arthroplasty.



腺苷作為非阿片類鎮痛劑在圍術期的應用

Adenosine as a Non-Opioid Analgesic in the Perioperative Setting

Tong J. Gan, MB, FRCA, FFARCSI, and Ashraf S. Habib, MB, FRCA

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

Anesth Analg 2007;105:487-494

人體中普遍存在的代謝中間產物腺苷,幾乎涉及細胞功能的每個方面,包括神經調節和傳遞。腺苷A1 A2 受體廣泛分佈於腦和脊髓,是疼痛治療的新穎的非阿片類靶位。在臨床試驗(包括與安慰劑和雷米芬太尼輸注比較的雙盲研究)中已發現腺苷作為非麻醉性鎮痛劑對麻醉患者的潛在作用。這些研究提示相比於安慰劑或雷米芬太尼,術中輸注腺苷穩定中心血流動力學,減少手術中麻醉需求。此外,較低的疼痛評分和減少的阿片類消耗顯示腺苷改善術後恢復。在目前腺苷產物已被批准使用的基礎上,已很好地顯示了腺苷的安全特性。與其運用有關的最常見不良事件包括面部潮紅、胸部不適、呼吸困難、頭痛、胃腸不適和頭暈。這些反應通常短暫且耐受良好。需要進一步試驗來保證研究腺苷作為非阿片類鎮痛劑在圍術期的完全的潛在作用。

(吳儉 馬皓琳 李士通 校)

Adenosine, a ubiquitous metabolic intermediate in the body, is involved in nearly every aspect of cell function, including neuromodulation and neurotransmission. Adenosine A1 and A2 receptors are widely distributed in the brain and spinal cord, and are a novel, non-opiate target for pain management. The potential of adenosine as a non-narcotic analgesic in anesthetized patients has been explored in clinical trials, including double-blind studies versus placebo and remifentanil infusion. These studies suggest that, compared to placebo or remifentanil, an intraoperative adenosine infusion stabilizes core hemodynamics and reduces the requirement for anesthesia during surgery. Further, adenosine improves postoperative recovery, as indicated by lower pain scores and less opioid consumption. The safety profile of adenosine has been well characterized based on use of currently approved adenosine products. The most common adverse events associated with its use include flushing, chest discomfort, dyspnea, headache, gastrointestinal discomfort, and lightheadedness. These effects are generally well tolerated and transient. Further studies are warranted to investigate the full potential of adenosine as a non-opioid analgesic in the perioperative setting.



局麻藥低熔混合物(EMLA®)減輕非鎮靜患者行肱骨徑路神經阻滯時的疼痛

Eutectic Mixture of Local Anesthetic (EMLA®) Decreases Pain During Humeral Block Placement in Nonsedated Patients

David Samson, MD*, Vincent Minville, MD*, Clément Chassery, MD*, Luc Nguyen, MD*, Antoine Pianezza, MD*, Olivier Fourcade, MD, PhD*, Anna Rabinowitz, MS{dagger}, and Kamran Samii, MD*

From the *Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France; and {dagger}Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Anesth Analg 2007;105:512-515

背景:我們評估了在實施神經阻滯前應用局麻藥低熔混合物(EMLA®)凝膠的潛在效果。

方法:前瞻性地選取60例擬行肘部遠端手術且能順從肱骨中徑路神經阻滯的患者,隨機分為3組。E組:實施神經阻滯前60分鐘局部應用EMLA乳劑,另外操作前5分鐘靜脈給予2ml生理鹽水;P組:局部應用安慰劑乳劑,靜脈給予2ml生理鹽水;S組:局部應用安慰劑乳劑,靜脈給予2ml生理鹽水內含0.1 µg/kg舒芬太尼。用100-mm視覺疼痛評分(VAS)記錄皮膚穿刺時的疼痛和整個操作過程中的總體疼痛(0分無疼痛,100分最疼痛)。

結果:E組與P組、S組比較疼痛較輕(5 ± 3 mm33 ± 20 mm30 ± 18 mm, P < 0.0001)P組在整個阻滯過程中的疼痛比E組更多(P = 0.01)

結論:用EMLA的患者在肱骨中徑路神經阻滯的針穿刺和整個操作過程中疼痛較輕。

(朱慧 馬皓琳 李士通 校)

BACKGROUND: We evaluated the potential role of an euctectic mixture of local anesthetic (EMLA®) cream application before performing midhumeral block.

METHODS: Sixty patients undergoing surgery distal to the elbow amenable to a humeral block were prospectively recruited for the study. The patients were randomly allocated to 1 of 3 groups: Group E: topical EMLA cream 60 min before block plus 2 mL IV normal saline 5 min before procedure; Group P: topical sham cream plus 2 mL IV normal saline, and Group S: topical sham cream plus 0.1 µg/kg of sufentanil in 2 mL solution IV. Pain experienced during skin puncture, and overall pain for the whole procedure were rated using a 100-mm visual analog scale (0: no pain to 100: worst pain).

RESULTS: Patients in Group E experienced less pain compared with those in Groups P and S (5 ± 3 mm vs 33 ± 20 mm and 30 ± 18 mm, respectively, P < 0.0001). The pain experienced throughout the complete humeral block was more substantial in Group P than in Group E (P = 0.01).

CONCLUSION: The patients who received EMLA cream had less pain with needle puncture as well as throughout the performance of humeral block.


曲馬多對局部或區域麻醉後併發感染細菌的抗菌活力

The Antibacterial Activity of Tramadol Against Bacteria Associated with Infectious Complications After Local or Regional Anesthesia

Zohreh Tamanai-Shacoori, PhD*, Valliollah Shacoori, PhD{dagger}, Anne Jolivet-Gougeon, PhD*, Jean-Marie Vo Van, MD{ddagger}, Martine Repère, Pharm D{dagger}, Pierre-Yves Donnio, PhD*, and Martine Bonnaure-Mallet, PhD*

From the *Equipe de Microbiologie, UPRES-EA 1254, Université de Rennes I, France; {dagger}Laboratoire de Biochimie Médicale A; and {ddagger}Département d’Anesthésiologie, CHR de Rennes, France.

Anesth Analg 2007;105:524-527

背景資料:曲馬多是可待因的合成模擬藥,兼有阿片類藥物及局麻藥的特性。他一直被當作中樞性鎮痛藥使用,近來作為一個局麻藥進行皮下及皮內注射。我們在沒有任何局部麻醉藥的情況下,觀察曲馬多針對可以引起局部或區域麻醉後感染併發症的大腸桿菌、金黃色葡萄球菌、表皮葡萄球菌及綠膿桿菌病原菌的體外抗菌活性。

方法:細菌培養18小時,稀釋在無菌生理鹽水,與曲馬多6.2512.5 25 mg/mL一起在37°C的條件下孵化624小時。然後將混合物移植至血瓊脂培養基上, 37°C孵化 24小時後記錄菌落計數。

結果: 與對照組相比,曲馬多對於大腸桿菌及表皮葡萄球菌有抗菌活性:在25 mg/mL 6 小時組或12.5 mg/mL 24小時組,曲馬多能使大腸桿菌菌落計數下降約7 log10 (100% 殺滅)(P < 0.001)。曲馬多 25 mg/mL 24小時組得到相似的結果,使綠膿桿菌菌株數下降近6 log10100%殺滅)(P < 0.001)。曲馬多25 mg/mL 對於金黃色葡萄球菌及綠膿桿菌的抗菌效力較低,24小時後,使這些菌株的生長下降3log10 (P < 0.001)

結論:曲馬多對於大腸桿菌及表皮葡萄球菌的殺菌活性具有時間及劑量依賴性。對於金黃色葡萄球菌及綠膿桿菌也同樣具有抗菌活性。曲馬多的抗菌特性可能對減少局部或區域麻醉後細菌感染的風險是有益的。

(裘毅敏譯,馬皓琳 李士通校)

BACKGROUND: Tramadol is a synthetic analog of codeine with opioid and local anesthetic properties. It is used as a central-acting analgesic, and recently, in subcutaneous or intradermal injections, as a local anesthetic. We investigated in vitro the antibacterial activity of tramadol in the absence of any local anesthetics against Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa pathogens that can cause infectious complications after local or regional anesthesia.

METHODS: Bacterial cultures were grown for 18 h, diluted in sterile physiological saline, and incubated for 6 or 24 h at 37°C with 6.25, 12.5, or 25 mg/mL tramadol. The mixtures were then plated onto blood agar and colony counts were recorded after 24 h incubation at 37°C.

RESULTS: Tramadol had bactericidal activity against E. coli and S. epidermidis compared with controls: at 25 mg/mL for 6 h or at 12.5 mg/mL for 24 h, tramadol decreased by approximately 7 log10 (P < 0.001) the colony counts of E. coli (100% kill). Similar results were obtained with S. epidermidis, with approximately 6 log10 reduction (100% kill) when tramadol was used at 25 mg/mL for 24 h (P < 0.001). The antibacterial effect of 25 mg/mL tramadol was lower against S. aureus and P. aeruginosa, reducing the growth of these strains by approximately 3log10 after 24 h (P < 0.001).

CONCLUSIONS: Tramadol has dose- and time-dependent bactericidal activity against E. coli and S. epidermidis, as well as antibacterial activity against S. aureus and P. aeruginosa. The antibacterial properties of tramadol may be useful for reducing the risk of bacterial infection after local or regional anesthesia.