Anesthesia & Analgesia

November 2007

 

CARDIOVASCULAR ANESTHESIOLOGY:

类癌心脏病患者行瓣膜手术的术中处理:对100例连续病例的回顾

彭中美   马皓琳 李士通

Intraoperative Management of Patients with Carcinoid Heart Disease Having Valvular Surgery: A Review of One Hundred Consecutive Cases

Toby N. Weingarten, Martin D. Abel, Heidi M. Connolly, Darrell R. Schroeder, and Hartzell V. Schaff

Anesth Analg 2007 105: 1192-1199.

氙气麻醉对实验性心肌梗死面积的影响

印洁敏 陈杰

The Effect of Xenon Anesthesia on the Size of Experimental Myocardial Infarction

Jan-H Baumert, Marc Hein, Christina Gerets, Thomas Baltus, Klaus E. Hecker, and Rolf Rossaint

Anesth Analg 2007 105: 1200-1206.

日常饮食剂量的大蒜不会影响血小板功能

邱郁薇 马皓琳 李士通

Garlic at Dietary Doses Does Not Impair Platelet Function

Gisela Scharbert, Madeleine L. Kalb, Monika Duris, Corinna Marschalek, and Sibylle A. Kozek-Langenecker

Anesth Analg 2007 105: 1214-1218.

.术中的三维经食道超声心动图测量心输出量的有效性和可行性

张燕 陈杰

Validation and Feasibility of Intraoperative Three-Dimensional Transesophageal Echocardiographic Cardiac Output (Brief Report)

William C. Culp, Jr, Timothy R. Ball, and Christopher J. Burnett

Anesth Analg 2007 105: 1219-1223.

PEDIATRIC ANESTHESIOLOGY:

连续外周神经阻滞用于小儿术后镇痛

吴德华译 薛张纲校

Continuous Peripheral Nerve Blockade for Inpatient and Outpatient Postoperative Analgesia in Children

 Arjunan Ganesh, John B. Rose, Lawrence Wells, Theodore Ganley, Harshad Gurnaney, Lynne G. Maxwell, Theresa DiMaggio, Karen Milovcich, Maureen Scollon, Jeffrey M. Feldman, and Giovanni Cucchiaro

Anesth Analg 2007 105: 1234-1242.

在幼年动物模型中不同负荷状态下的全心舒张末期容积

颜涛 译, 马皓琳  李士通

Global End-Diastolic Volume During Different Loading Conditions in a Pediatric Animal Model

Jochen Renner, Patrick Meybohm, Mathias Gruenewald, Markus Steinfath, Jens Scholz, Andreas Boening, and Berthold Bein

Anesth Analg 2007 105: 1243-1249.

010的数值量化法评估儿童焦虑水平的初步验证

周懿之 陈杰

Initial Validation of a Numeric Zero to Ten Scale to Measure Children's State Anxiety

Margie Crandall, Cathy Lammers, Craig Senders, Marilyn Savedra, and Jerome V. Braun

Anesth Analg 2007 105: 1250-1253.

AMBULATORY ANESTHESIOLOGY:

门诊预行LC的病人术中用艾斯洛尔代替阿片类药物可节省术后芬太尼用量

霞译 薛张纲校

Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy

Vincent Collard, Giovanni Mistraletti, Ali Taqi, Juan Francisco Asenjo, Liane S. Feldman, Gerald M. Fried, and Franco Carli

Anesth Analg 2007 105: 1255-1262.

ANESTHETIC PHARMACOLOGY:

进行腹式子宫切除的病人术前服用褪黑素对术后结果的临床影响

姜旭晖译,马皓琳,李士通校

The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy

Wolnei Caumo, Fernanda Torres, Nívio L. Moreira, Jr, Jorge A. S. Auzani, Cristiano A. Monteiro, Gustavo Londero, Diego F. M. Ribeiro, and Maria Paz L. Hidalgo

Anesth Analg 2007 105: 1263-1271.

右旋美托咪啶对七氟醚麻醉下颞叶性癫痫病人的脑电图的影响

潘钱玲 陈杰

The Effect of Dexmedetomidine on Electrocorticography in Patients with Temporal Lobe Epilepsy Under Sevoflurane Anesthesia

Yutaka Oda, Sumiko Toriyama, Katsuaki Tanaka, Tadashi Matsuura, Naoya Hamaoka, Michiharu Morino, and Akira Asada

Anesth Analg 2007 105: 1272-1277.

不同静脉麻醉药对肺静脉平滑肌肌丝钙离子敏感性的影响

王时来译 薛张纲校

The Differential Effects of Intravenous Anesthetics on Myofilament Ca2+ Sensitivity in Pulmonary Venous Smooth Muscle

Xueqin Ding and Paul A. Murray

Anesth Analg 2007 105: 1278-1286.

挥发性芳香类麻醉药不同程度地影响人{gamma}-氨基丁酸A型受体的功能

黄施伟 译,马皓琳 李士通

Volatile Aromatic Anesthetics Variably Impact Human {gamma}-Aminobutyric Acid Type A Receptor Function

Elizabeth W. Kelly, Ken Solt, and Douglas E. Raines

Anesth Analg 2007 105: 1287-1292.

NO和血管紧张素II受体介导血管紧张素II的升压作用:清醒和麻醉(Zoletil)大鼠的研究

Nitric Oxide and Angiotensin II Receptors Mediate the Pressor Effect of Angiotensin II: A Study in Conscious and Zoletil-Anesthetized Rats

Ismael F. M. S. Guarda, Wilson A. Saad, and Luiz Antonio de Arruda Camargo

Anesth Analg 2007 105: 1293-1297.

小剂量静脉注射咪达唑仑降低依托咪酯诱导的肌阵挛:对进行电复律病人的前瞻性随机实验

楊译 薛张纲校

Low-Dose Intravenous Midazolam Reduces Etomidate-Induced Myoclonus: A Prospective, Randomized Study in Patients Undergoing Elective Cardioversion

Lars Hüter, Torsten Schreiber, Michael Gugel, and Konrad Schwarzkopf

Anesth Analg 2007 105: 1298-1302.

TECHNOLOGY, COMPUTING, AND SIMULATION:

舒芬太尼-七氟醚-氧化亚氮麻醉维持中双频指数和状态熵指数的可比性

唐李隽   马皓琳  李士通

The Comparability of Bispectral Index and State Entropy Index During Maintenance of Sufentanil-Sevoflurane-Nitrous Oxide Anesthesia

Cécile Lefoll-Masson, Christophe Fermanian, Isabelle Aimé, Nicolas Verroust, Guillaume Taylor, Pierre-Antoine Laloë, Ngai Liu, Philippe Aegerter, and Marc Fischler

Anesth Analg 2007 105: 1319-1325.

微多普勒导管用于离体评估静脉气体栓塞的检测和吸引

杜唯佳 陈杰

In Vitro Evaluation of a Micro-Doppler Catheter for Detection and Aspiration of Venous Air Emboli (Technical Communication)

Paul E. Bigeleisen

Anesth Analg 2007 105: 1333-1337.

CRITICAL CARE AND TRAUMA:

针对困难拔管的连续气道通路:气道更换导管的有效性

王腾 陈杰

Continuous Airway Access for the Difficult Extubation: The Efficacy of the Airway Exchange Catheter

Thomas C. Mort

Anesth Analg 2007 105: 1357-1362.

异丙酚削弱内毒素诱导内皮细胞损伤血管紧张素转换酶脱落和肺水肿

陈佳莉译 薛张纲校

Propofol Attenuates Endotoxin-Induced Endothelial Cell Injury, Angiotensin-Converting Enzyme Shedding, and Lung Edema

E. Gina Votta-Velis, Richard D. Minshall, David J. Visintine, Maricela Castellon, and Irina V. Balyasnikova

Anesth Analg 2007 105: 1363-1370.

静脉麻醉药和维拉帕米对肠缺血-再灌注诱导肝损伤的保护作用

周雅春 李士通 马皓琳

The Protective Effects of Intravenous Anesthetics and Verapamil in Gut Ischemia/Reperfusion-Induced Liver Injury

Necat Kaplan, Hatice Yagmurdur, Kamer Kilinc, Bulent Baltaci, and Savas Tezel Anesth Analg 2007 105: 1371-1378.

在戊巴比妥麻醉的实验狗中不同的多巴酚丁胺输注速度对改善因高碳酸血症所致的膈肌收缩力下降的效果

陈珺珺译  薛张纲校

The Effects of Different Dobutamine Infusion Rates on Hypercapnic Depression of Diaphragmatic Contractility in Pentobarbital-Anesthetized Dogs

Yoshitaka Fujii and Aki Uemura

Anesth Analg 2007 105: 1379-1384.

张力性气胸穿刺减压可能进针位置的放射学评估

黄佳佳译,马皓琳、李士通校

Radiologic Assessment of Potential Sites for Needle Decompression of a Tension Pneumothorax

David B. Wax and Andrew B. Leibowitz

Anesth Analg 2007 105: 1385-1388.

NEUROSURGICAL ANESTHESIOLOGY:

血液稀释性中心血容量过高损害脑自身调节功能

陈伟 陈杰

Central Hypervolemia with Hemodilution Impairs Dynamic Cerebral Autoregulation

Yojiro Ogawa, Ken-ichi Iwasaki, Ken Aoki, Shigeki Shibata, Jitsu Kato, and Setsuro Ogawa

Anesth Analg 2007 105: 1389-1396.

缺血前以胰岛素控制血糖水平可预防大鼠的脊髓缺血性损伤

  佳译 薛张纲校

Tight Glycemic Control by Insulin, Started in the Preischemic, but Not Postischemic, Period, Protects Against Ischemic Spinal Cord Injury in Rabbits

Daisuke Nagamizo, Shunsuke Tsuruta, Mishiya Matsumoto, Hiroaki Matayoshi, Atsuo Yamashita, and Takefumi Sakabe

Anesth Analg 2007 105: 1397-1403.

故意的高碳酸血症和低碳酸血症对于功能性内窥镜下鼻窦手术过程中的术中失血和手术野质量的影响

黄丽娜   马皓琳  李士通 

The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

Vladimir Nekhendzy, Hendrikus J. M. Lemmens, Winston C. Vaughan, Edward J. Hepworth, Alexander G. Chiu, Christopher A. Church, and John G. Brock-Utne

Anesth Analg 2007 105: 1404-1409.

OBSTETRIC ANESTHESIOLOGY:

脊麻剖宫产术中使用充气式保温不能预防母体低温

璇译 薛张纲校

Intraoperative Forced Air-Warming During Cesarean Delivery Under Spinal Anesthesia Does Not Prevent Maternal Hypothermia

Alexander J. Butwick, Steven S. Lipman, and Brendan Carvalho

Anesth Analg 2007 105: 1413-1419.

GENERAL ARTICLES:

一种减少鼻衄、提高适航性的鼻插管新技术

慧译 马皓琳 李士通校

A New Technique to Reduce Epistaxis and Enhance Navigability During Nasotracheal Intubation

Kwang Suk Seo, Jae-Hun Kim, Sol Mon Yang, Hyun Jeong Kim, Jae-Hyon Bahk, and Kwang Won Yum

Anesth Analg 2007 105: 1420-1424.

ANALGESIA:

芬太尼经皮离子导入系统和静脉吗啡病人自控镇痛两者的术后疼痛控制安全性和有效性的比较:三个随机、有效对照临床实验的会聚分析

於章杰 陈杰

The Safety and Efficacy of Fentanyl Iontophoretic Transdermal System Compared with Morphine Intravenous Patient-Controlled Analgesia for Postoperative Pain Management: An Analysis of Pooled Data from Three Randomized, Active-Controlled Clinical Studies

Eugene R. Viscusi, Matthew Siccardi, C. V. Damaraju, David J. Hewitt, and Paul Kershaw

Anesth Analg 2007 105: 1428-1436.

术后接受经皮等离子渗入系统给予芬太尼和通过静脉病人自控使用吗啡进行术后疼痛管理的系统相关事件和止痛间隙

陈杰

System-Related Events and Analgesic Gaps During Postoperative Pain Management with the Fentanyl Iontophoretic Transdermal System and Morphine Intravenous Patient-Controlled Analgesia

Sunil J. Panchal, C. V. Damaraju, Winnie W. Nelson, David J. Hewitt, and Jeff R. Schein

Anesth Analg 2007 105: 1437-1441.

长期接受经皮丁丙诺啡治疗的非癌性疼痛患者的认知和精神运动行为的评估

王光妍译 薛张纲校

Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients

Oguzhan Dagtekin, Hans J. Gerbershagen, Werner Wagner, Frank Petzke, Lukas Radbruch, and Rainer Sabatowski

Anesth Analg 2007 105: 1442-1448.

PAIN MEDICINE:

术前口服普瑞巴林用于妇产科小手术术后缓解疼痛的一项随机、安慰剂对照试验

胡湘   马皓琳 李士通

A Randomized, Placebo-Controlled Trial of Preoperative Oral Pregabalin for Postoperative Pain Relief After Minor Gynecological Surgery

Michael J. Paech, Raymond Goy, Sebastian Chua, Karen Scott, Tracey Christmas, and Dorota A. Doherty

Anesth Analg 2007 105: 1449-1453.

加巴喷丁预防导管相关膀胱不适的疗效评估:一项前瞻、随机、对照、双盲研究

朱玫娟 陈杰

An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Anil Agarwal, Sanjay Dhiraaj, Sandeep Pawar, Rakesh Kapoor, Devendra Gupta, and Prabhat K. Singh

Anesth Analg 2007 105: 1454-1457.

硬膜外麻醉用于椎板切除引导定位完成脊髓刺激

周时蓓译 薛张纲校

Epidural Anesthesia for Laminectomy Lead Placement in Spinal Cord Stimulation

María Luisa García-Pérez, Rafael Badenes, Guillermo García-March, Vicente Bordes, and Francisco Javier Belda

Anesth Analg 2007 105: 1458-1461.

顽固性脊柱损伤性疼痛病人的疼痛处理:一项病例报告及文献回顾

胡湘   马皓琳 李士通

Pain Management in a Patient With Intractable Spinal Cord Injury Pain: A Case Report and Literature Review (Special Article)

Jocelyn C. Que, Philip J. Siddall, and Michael J. Cousins

Anesth Analg 2007 105: 1462-1473.

PAIN MECHANISMS:

炎性疼痛大鼠模型中外周α2-肾上腺受体参与奥卡西平的抗痛觉过敏效应

詹琼慧 陈杰

The Involvement of Peripheral {alpha}2-Adrenoceptors in the Antihyperalgesic Effect of Oxcarbazepine in a Rat Model of Inflammatory Pain

Maja A. Tomic, Sonja M. Vuckovic, Radica M. Stepanovic-Petrovic, Nenad D. Ugresic, Sonja Lj Paranos, Milica S Prostran, and Bogdan Boskovic

Anesth Analg 2007 105: 1474-1481.

鼠模型电针疗法减弱骨癌疼痛并且抑制脊椎白细胞介素的表达

威译 薛张纲校

Electroacupuncture Attenuates Bone Cancer Pain and Inhibits Spinal Interleukin-1ß Expression in a Rat Model

Rui-Xin Zhang, Aihui Li, Bing Liu, Linbo Wang, Ke Ren, Jian-Tian Qiao, Brian M. Berman, and Lixing Lao

Anesth Analg 2007 105: 1482-1488.

环孢菌素对小鼠催眠反应和疼痛反应的不同作用

沈浩   马皓琳 李士通

The Differential Effect of Cyclosporine on Hypnotic Response and Pain Reaction in Mice

Yuki Sato, Tatsushi Onaka, Eiji Kobayashi, and Norimasa Seo

Anesth Analg 2007 105: 1489-1493.

REGIONAL ANESTHESIA:

2%等比重利多卡因蛛网膜下腔麻醉后暂时性神经综合征:穿刺针类型的影响

丁震敏 陈杰

Transient Neurological Symptoms After Isobaric Subarachnoid Anesthesia with 2% Lidocaine: The Impact of Needle Type

Shmuel Evron, Victoria Gurstieva, Tiberiu Ezri, Vladimir Gladkov, Sergey Shopin, Amir Herman, Ami Sidi, and Shimon Weitzman

Anesth Analg 2007 105: 1494-1499.

关于在循环阻断(阻断血流灌注)化学灌注治疗中运用全身麻醉和脊髓麻醉的回顾性研究

陈恺铮译 薛张刚校

Recovery Profiles of General Anesthesia and Spinal Anesthesia for Chemotherapeutic Perfusion with Circulatory Block (Stop-Flow Perfusion)

Michele Carron, Ulderico Freo, Federico Innocente, Stefano Veronese, Pierluigi Pilati, Vesna Jevtovic-Todorovic, and Carlo Ori

Anesth Analg 2007 105: 1500-1503.

类癌心脏病患者行瓣膜手术的术中处理:对100例连续病例的回顾

Intraoperative Management of Patients with Carcinoid Heart Disease Having Valvular Surgery: A Review of One Hundred Consecutive Cases

Toby N. Weingarten, MD*, Martin D. Abel, MD*, Heidi M. Connolly, MD{dagger}, Darrell R. Schroeder, MS§, and Hartzell V. Schaff, MD{ddagger}

From the *Department of Anesthesiology, the {dagger}Division of Cardiovascular Disease, the {ddagger}Division of Cardiac Surgery, and the §Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Anesth Analg 2007; 105:1192-1199

背景:对类癌心脏病的心脏手术,并发有继发于类癌、心血管功能紊乱和失血的血流动力学不稳定。应用奥曲肽的同时应用血管升压药的安全性和抑肽酶的好处未明确。

方法:我们在1985-2003100例类癌心脏病患者行心脏手术的连续病例中用单变量分析回顾了血管升压药和抑肽酶对应用奥曲肽和死亡率的影响。因为死亡率下降暂时与应用抑肽酶有关,用二变量分析来鉴定其他因素对死亡率的影响。

结果:用奥曲肽(n = 89) /或血管升压药 (n = 93)治疗类癌综合症和低血压。血管升压药与应用奥曲肽增加无关。需要肾上腺素的患者不但有较高的死亡率,而且有较差的术前纽约心脏组织分级、较高的尿5-羟吲哚乙酸水平及输血需求增加。抑肽酶(n = 54)使输血需求减少,应用奥曲肽增加,但死亡率无影响。总死亡率为13%,从1985-1994年的28%下降至1995-2003年的6%。死亡率与有较大量的输血需求和体外循环持续时间较长有关。

结论:血管升压药可与奥曲肽一起用于类癌患者。死亡率升高与肾上腺素相关,可能是反映了选择偏倚,而非原发性副作用。改善类癌患者的生存率是多因素的,与应用抑肽酶无关,提示进一步抑制激肽释放酶-激肽系统对奥曲肽应用中的结果几乎无额外好处。

(彭中美   马皓琳 李士通 校)

BACKGROUND: Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises, cardiovascular dysfunction, and blood loss. The safety of vasopressors and the benefit of aprotinin during concomitant octreotide administration are uncertain.

METHODS: We reviewed the effects of vasopressors and aprotinin on octreotide administration and mortality by univariate analysis in 100 consecutive cases of cardiac surgery for carcinoid heart disease from 1985 to 2003. Because mortality declines were temporally related to the introduction of aprotinin, bivariate analyses were performed to identify other factors associated with mortality.

RESULTS: Carcinoid symptoms and hypotension were treated with octreotide (n = 89) and/or vasopressors (n = 93). Vasopressors were not associated with increased octreotide administration. Patients requiring epinephrine had higher mortality but also had worse preoperative New York Heart Association class, higher urinary 5-hydroxyindoleacetic acid levels, and increased blood transfusion requirements. Aprotinin (n = 54) was associated with decreased blood transfusion requirements, increased octreotide administration, but not mortality. Overall mortality was 13%, declining from 28% between 1985 and 1994 to 6% between 1995 and 2003. Mortality was associated with greater blood transfusion requirements and longer duration of cardiopulmonary bypass.

CONCLUSIONS: Vasopressors may be used in conjunction with octreotide in carcinoid patients. The increased mortality associated with epinephrine likely reflects selection bias rather than a primary adverse effect. The improved survival over time in carcinoid patients is multifactorial and unrelated to aprotinin administration, suggesting further inhibition of the kallikrein–kinin system has little added benefit for this outcome in the presence of octreotide.

 

 

 

日常饮食剂量的大蒜不会影响血小板功能

Garlic at Dietary Doses Does Not Impair Platelet Function

Gisela Scharbert, MD, Madeleine L. Kalb, MD, Monika Duris, MD, Corinna Marschalek, MD, and Sibylle A. Kozek-Langenecker, MD

From the Department of General Anesthesiology and Intensive Care (B), Vienna Medical University, Vienna, Austria.

Anesth Analg 2007; 105:1214-1218

背景:体外研究显示大蒜所含有的多种生物活性成分会抑制血小板功能。然而日常饮食剂量的大蒜对血小板功能的影响程度尚未得知。因此我们应用对环氧合酶I抑制情况和血小板粘附功能检测灵敏度高的重点照护监测设备,检验了生蒜对血小板功能的影响。

方法:在一个随机、交叉、观察者单盲、安慰剂对照的研究中,对18名健康志愿者在摄取含4.2g生蒜的希腊tsatsiki(verum)或不含大蒜的希腊tsatsiki(安慰剂)前和摄取5h后抽取的全血标本进行研究。在5名每日食用4.2g生蒜1周的志愿者,观察大蒜的潜在长期作用。采用血小板功能分析仪(PFA-100®)、阻抗集合度测定(Multiplate®)和血栓弹力酶图的血小板描图(Platelet MappingTM)分析血小板功能。进行体外实验来证实这些化验对大蒜诱导的血小板抑制作用的灵敏性。

结果:所有志愿者血小板功能的基础值都在正常范围。使用的任何重点照护监测检验都观察到:单次或重复口服含有生蒜的希腊tsatsiki不会抑制血小板功能。

结论:健康志愿者单次或重复食用日常饮食剂量的大蒜并不会影响血小板功能。含有社会上允许剂量大蒜的菜肴并不可能增加围术期出血的危险。未来我们将进一步研究并证实血小板抑制药物与大蒜及其他草本同时应用的潜在相加作用。

(邱郁薇 马皓琳 李士通 校)

BACKGROUND: In vitro studies suggest that various bioactive constituents of Allium sativum (garlic) inhibit platelet function. The extent, however, to which dietary doses of garlic influence platelet function remains unknown. Therefore, we tested the effect of raw garlic on platelet function using point-of-care monitoring devices sensitive for cyclooxygenase I-inhibition and platelet adhesion.

METHODS: Whole blood from 18 healthy volunteers was investigated before and 5 h after ingestion of the study medication consisting of Greek tsatsiki with 4.2 g raw garlic (verum), or Greek tsatsiki without garlic (placebo), in a randomized, crossover, observer-blinded, placebo-controlled study. The potential long-term effects of garlic were investigated in five volunteers after daily ingestion of 4.2 g of raw garlic over 1 wk. Platelet function was assessed with the Platelet Function Analyzer (PFA-100®), impedance aggregometry (Multiplate®), and thrombelastographic Platelet MappingTM. In vitro experiments were performed to prove the sensitivity of the assays to garlic-induced platelet inhibition.

RESULTS: Baseline values of platelet function were within normal range in all volunteers. Platelet function was not impaired by single and repeated oral consumption of Greek tsatsiki containing raw garlic in any point-of-care monitoring test used.

CONCLUSIONS: Platelet function is not impaired by single and repeated oral consumption of a dietary dose of garlic in healthy volunteers. Dishes containing socially acceptable doses of raw garlic are unlikely to increase the risk of perioperative bleeding. Further studies are warranted to determine the potential additive effects of platelet-inhibiting drugs combined with garlic and other herbs.

 

 

 

在幼年动物模型中不同负荷状态下的全心舒张末期容积

Global End-Diastolic Volume During Different Loading Conditions in a Pediatric Animal Model

Jochen Renner, MD*, Patrick Meybohm, MD*, Mathias Gruenewald, MD*, Markus Steinfath, MD*, Jens Scholz, MD*, Andreas Boening, MD*{dagger}, and Berthold Bein, MD, DEAA*

From the Departments of *Anaesthesiology and Intensive Care Medicine and {dagger}Cardiothoracic and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.

Anesth Analg 2007; 105:1243-1249

背景:估计婴儿和新生儿的容量状态具有挑战性。全心舒张末期容积(GEDV)和前负荷的动力学参数如脉压变异性(PPV)可能是估计心脏前负荷和液体反应性的可选参数。故而我们设计了本实验以评价在幼年动物模型中,当负荷状态快速改变时GEDVPPV是否是前负荷和液体反应性的合适参数。

方法:在不同的负荷情况下研究了19只已麻醉和机械通气的小猪(6.5 ± 0.8 kg)。记录正常容量和输入25 mL/kg羟乙基淀粉6%溶液后的血流动力学参数,包括中心静脉压、肺毛细血管楔压、PPV、用经肺温度稀释法得到的GEDV和心输出量以及通过肺动脉温度稀释法获得的心输出量和心搏量指数。

结果:在容量负荷后GEDV的百分比改变显著(25% ± 17%),并且导致除心率和体循环血管阻力指数外所有血流动力学参数的显著改变。GEDV是唯一与容量导致的心搏量指数百分比变化显著相关的前负荷参数(r = –0.61, P = 0.005)。受试者操作特征曲线下面积GEDV0.8P <0.02)而PPV 0.6 (P = ns)

结论:在本幼年动物模型中,通过经肺温度稀释法得到的GEDV是心脏前负荷的可靠指标。而且,GEDV(而非PPV)、中心静脉压和肺毛细血管楔压准确反映了液体的反应性。

(颜涛 译, 马皓琳  李士通 校)

 

BACKGROUND: Estimating volume status in infants and neonates is challenging. Global end-diastolic volume (GEDV) and dynamic variables of preload, such as pulse pressure variation (PPV), may be alternative variables for estimating cardiac preload and fluid responsiveness. Therefore, we designed the present study to evaluate whether GEDV and PPV are suitable variables of preload and fluid responsiveness during rapidly changing loading conditions in a pediatric animal model.

METHODS: Nineteen anesthetized and mechanically ventilated piglets (6.5 ± 0.8 kg) were studied during different loading conditions. Hemodynamic measurements, including central venous pressure, pulmonary capillary wedge pressure, PPV, GEDV, and cardiac output derived by transpulmonary thermodilution, cardiac output, and stroke volume index obtained by pulmonary artery thermodilution were performed at normovolemia, and after fluid administration, with 25 mL/kg of hydroxylethyl starch 6%.

RESULTS: There was a significant percentage change of GEDV after volume loading (25% ± 17%) that resulted in significant changes of all hemodynamic variables except of heart rate and systemic vascular resistance index. GEDV was the only preload variable that significantly correlated with volume-induced percentage change in stroke volume index (r = –0.61, P = 0.005). Area under the receiver operating characteristic curve was 0.8 for GEDV (P < 0.02) and 0.6 for PPV (P = ns).

CONCLUSIONS: In this pediatric animal model, GEDV derived from transpulmonary thermodilution was a reliable indicator of cardiac preload. Moreover, GEDV but not PPV, central venous pressure and pulmonary capillary wedge pressure accurately reflected fluid responsiveness.



进行腹式子宫切除的病人术前服用褪黑素对术后结果的临床影响

The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy

 

Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||

From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.

Anesth Analg 2007; 105:1263-1271

背景:褪黑素具有镇静、镇痛、抗炎、抗氧化和生物时相作用,我们研究了术前口服褪黑素对抗焦虑、镇痛以及昼夜生物作息节律效能的影响。

方法:这项随机、安慰剂对照、双盲的试验包括了33ASA分级III级、行腹式子宫切除的病人。病人被随机分成两组,一组(17例)在术前晚上和术前1小时口服褪黑素5mg,一组(16例)口服安慰剂。分析工具是视觉模拟评分、状态-特性焦虑清单和活动记录检查。

结果:术后第一个24小时里,为了防止又多一个病人报告术后非常焦虑和疼痛中重度,从而需要治疗的病人数量分别为2.5395%可信区间为1.4112.22)和2.2095%可信区间为1.268.58)。在疼痛中重度的病人中为了防止术后非常焦虑从而需要治疗的病人数为395%的可信区间为1.355.0),在疼痛轻微或不疼痛的病人中为7.595%的可行区间为1.36-无穷大)。而且用重复测定ANOVA评定发现,治疗过的病人通过病人自控镇痛需要的吗啡较少 (F[1,31] = 6.05, P = 0.02)。用活动记录检查评定的作息周期显示干预组的出院后第一个星期里的24小时节律百分率(21.16 ± 8.90)明显高于安慰剂组(14.00 ± 7.10t = –2.41, P = 0.02)。

结论:这个发现揭示术前服用褪黑素可引起临床相关的抗焦虑和镇痛作用,特别是在术后24小时以内。而且褪黑素也改善了作息昼夜节律的效能。

(姜旭晖译,马皓琳,李士通校)

BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.

METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy. Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery. The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.

RESULTS: The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively. The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain. Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02). The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).

CONCLUSIONS: This finding suggested that preoperative melatonin produced clinically relevant anxiolytic and analgesic effects, especially in the first 24 postoperative hours. Also, it improved the recovery of the potency of the rest/activity circadian rhythm.



挥发性芳香类麻醉药不同程度地影响人{gamma}-氨基丁酸A型受体的功能

Volatile Aromatic Anesthetics Variably Impact Human {gamma}-Aminobutyric Acid Type A Receptor Function

Elizabeth W. Kelly, BA*{dagger}, Ken Solt, MD*{dagger}, and Douglas E. Raines, MD*{dagger} From the *Department of Anesthesia and Critical Care, Massachusetts General Hospital, and {dagger}Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2007; 105:1287-1292

背景;{gamma}-氨基丁酸A型(GABAA)和N-甲基-d-天冬氨酸(NMDA)受体分别是中枢神经系统内重要的抑制性和兴奋性神经递质受体。在面对伤害性刺激时产生制动作用所需浓度时,挥发性芳香类麻醉药抑制NMDA受体的程度不同,强烈提示它们还作用于其它靶位以产生制动作用。在本研究中,我们试图评估GABAA受体在介导挥发性芳香类麻醉药行为作用中的可能作用。

方法:用电生理方法定量研究8种挥发性芳香类麻醉药和3种临床用麻醉药对爪蟾卵母细胞上表达的{alpha}1ß2{gamma}2L GABAA受体介导的电流的影响。

结果:在最小肺泡麻醉药浓度倍数相当的情况下,挥发性芳香类麻醉药对由低浓度GABA诱发的GABAA受体介导的电流的增强程度差异很大。总的来说,抑制NMDA受体最强的麻醉药对GABAA受体的增强作用最弱。麻醉药对GABAANMDA受体效价之间的互反关系,在临床用麻醉药异氟烷、氟烷和环丙烷中也可见到。使用不同浓度GABA的研究提示挥发性芳香类麻醉药增强GABAA受体活性是通过将开-关(门控)平衡转向通道开放状态所致。

结论:这些结果提示GABAA受体不同程度地促进了挥发性麻醉药的行为作用,且暗示了麻醉药对GABAANMDA受体作用的分子决定因素是明显不同的。

(黄施伟 译,马皓琳 李士通 校)

BACKGROUND: The {gamma}-aminobutyric acid type A (GABAA) and N-methyl-d-aspartate (NMDA) receptors are important inhibitory and excitatory neurotransmitter receptors, respectively, in the central nervous system. At the concentrations required to produce immobility in the face of a noxious stimulus, volatile aromatic anesthetics inhibit NMDA receptors to varying degrees, strongly suggesting that they also act at other targets to produce immobilization. In this study, we sought to assess the potential role that GABAA receptors play in mediating the behavioral actions of volatile aromatic anesthetics.

METHODS: Electrophysiological techniques were used to quantify the effects of eight volatile aromatic anesthetics and three clinical anesthetics on currents mediated by {alpha}1ß2{gamma}2L GABAA receptors expressed in Xenopus oocytes.

RESULTS: At equivalent minimal alveolar anesthetic concentration multiples, volatile aromatic anesthetics vary widely in the degrees to which they enhance GABAA receptor-mediated currents elicited by low concentrations of GABA. In general, anesthetics that inhibit NMDA receptors most, enhanced GABAA receptors least. This reciprocal relationship between anesthetic potency on GABAA versus NMDA receptors was also observed for the clinical anesthetics isoflurane, halothane, and cyclopropane. Studies using a range of GABA concentrations indicated that volatile aromatic anesthetics enhance GABAA receptor activity by shifting the open-close (gating) equilibrium towards the open channel state.

CONCLUSIONS: These findings suggest that GABAA receptors contribute variably to the behavioral actions of volatile anesthetics and imply that the molecular determinants of anesthetic action on NMDA and GABAA receptors are distinctly different.



舒芬太尼-七氟醚-氧化亚氮麻醉维持中双频指数和状态熵指数的可比性

The Comparability of Bispectral Index and State Entropy Index During Maintenance of Sufentanil-Sevoflurane-Nitrous Oxide Anesthesia

Cécile Lefoll-Masson, MD*, Christophe Fermanian, PhD{dagger}, Isabelle Aimé, MD*, Nicolas Verroust, MD*, Guillaume Taylor, MD*, Pierre-Antoine Laloë, MD*, Ngai Liu, MD*, Philippe Aegerter, MD, PhD{dagger}, and Marc Fischler, MD*

From the *Department of Anesthesiology, Hôpital Foch, Suresnes, France; and {dagger}Paris-Ouest Clinical Research Unit, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France.

Anesth Analg 2007; 105:1319-1325

背景:制造商推荐麻醉维持时将双频指数(BIS)或光谱熵(状态熵,SE)指数保持在4060之间。我们比较了该范围内的上述指数。

方法:数据来源于58例行舒芬太尼-七氟醚-氧化亚氮麻醉的患者。麻醉医生不知道BISSE。用Bland-Altman分析、用于一致性的Kappa系数和粗一致性部分比较间隔一分钟自动同时记录的无伪影的BISSE(7792)。判断错误的发生也被记录下来(1型错误定义为一个参数<40而另一个>602型错误定义为BISSE的值在阈值[4060]的两边)。

结果:偏移是–2,一致性的界限为-189。从所有患者得到的Kappa BIS/SE0.537 ± 0.147,粗一致性>0.80的患者为45%。1型错误判断的数目符合两种情况。当认为BISSE的差异大于5时,2型错误判断数目的中位数和四分位间距是4.5[3.0–6.0]

结论:即使BISSE一致性的界限很大、中等的Kappa值、一半以上患者的粗一致性<0.80,得出完全相反的结论(例如:根据一个参数应加深麻醉,而另一个参数则应减浅麻醉)可能是罕见的。更普遍的可能是在不作调整和加深或减浅麻醉深度之间发生错误的危险性。

(唐李隽   马皓琳  李士通 校)

 

BACKGROUND: Manufacturers recommend maintaining Bispectral (BIS) or Spectral Entropy (State Entropy, SE) indexes between 40 and 60 during the maintenance of anesthesia. We compared these indexes during this period.

METHODS: Data were obtained from 58 patients receiving sufentanil-sevoflurane-nitrous oxide anesthesia. The anesthesiologist was blinded to BIS and SE. Artifact-free concurrent BIS and SE values (7792 pairs), automatically recorded at 1-min intervals, were compared using Bland-Altman analysis, Kappa coefficient for agreement and crude proportion of agreement. The occurrence of errors of judgment (Type 1 defined as one parameter <40 and the other >60, or Type 2 defined as BIS and SE values on different sides of a threshold [40 or 60]) was also counted.

RESULTS: Bias was –2 with limits of agreement of –18 and 9. Kappa BIS/SE obtained from all patients was 0.537 ± 0.147; crude agreement >0.80 was observed in 45% of patients. Type 1 number of errors of judgment corresponded to two instances. Median and interquartile values of Type 2 number of errors of judgment were 4.5 [3.0–6.0] when considering a difference between BIS and SE more than 5.

CONCLUSION: Although limits of agreement between BIS and SE were large, Kappa value moderate, and crude agreement <0.80 in more than half of the patients, making completely contradictory decisions (e.g., deepening the anesthetic based on one parameter and lightening it based upon the other) would have been exceptional. More common would have been a risk of error between no change versus increasing or decreasing anesthetic depth.



静脉麻醉药和维拉帕米对肠缺血-再灌注诱导肝损伤的保护作用

The Protective Effects of Intravenous Anesthetics and Verapamil in Gut Ischemia/Reperfusion-Induced Liver Injury

Necat Kaplan, MD*, Hatice Yagmurdur, MD{dagger}, Kamer Kilinc, MD, PhD{ddagger}, Bulent Baltaci, MD{dagger}, and Savas Tezel, MD*

From the Ministry of Health Ankara Research and Training Hospital, *Clinic of General Surgery, {dagger}Clinic of Anesthesiology and Reanimation, Ankara, Turkey; and {ddagger}Department of Biochemistry, Hacettepe University School of Medicine, Ankara, Turkey.

Anesth Analg 2007; 105:1371-1378

背景:本实验研究了静脉麻醉药和维拉帕米对肠缺血/再灌注诱导肝损伤的保护作用。

方法:40Wistar大白鼠随机分为4组,每组10只。实验中麻醉诱导和维持1组和3组采用丙泊酚, 2组和4组采用硫喷妥钠。所有动物都在夹闭肠系膜上动脉30分钟后产生肠缺血。移除微血管夹后维持再灌注120分钟。3组和4组大鼠在再灌注之前10分钟给予维拉帕米。在缺血前、再灌注后30分钟、再灌注后120分钟时取肝脏和回肠标本进行丙二醛(MDA)测定和组织病理学检查。同时,采血进行血浆肿瘤坏死因子-α和白介素-6水平的测定。

结果:肠缺血/再灌注可使肝脏和肠的MDA含量及血清白介素水平显著升高,且与组织病理学损伤评分一致。丙泊酚可有效稳定肝脏和肠的MDA水平并减少组织损伤评分。丙泊酚组肿瘤坏死因子-α和白介素-6升高水平低于硫喷妥钠组。维拉帕米对丙泊酚没有相加保护作用。而维拉帕米加入硫喷妥钠可有效减少血清细胞因子水平和肝脏MDA含量。

结论:丙泊酚可通过抑制脂质过氧化反应和炎性细胞因子生成对肠缺血/再灌注诱导肝损伤动物模型提供保护作用。

(周雅春 李士通 马皓琳 校)

 

BACKGROUND: We investigated the protective effects of IV anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury.

METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with propofol in Groups 1 and 3 and with thiopental in Groups 2 and 4 during the experiment. All animals developed intestinal ischemia after occlusion of the superior mesenteric artery for 30 min. Reperfusion was induced by removal of the microvascular clamp and was allowed to continue for 120 min. The animals in Groups 3 and 4 were given verapamil 10 min before reperfusion. Liver and ileum samples were taken for measurement of malondialdehyde (MDA) and histopathologic examination before ischemia and 30 and 120 min after reperfusion. Blood samples were also obtained for measurement of plasma tumor necrosis factor-{alpha} and interleukin-6 levels.

RESULTS: Gut ischemia/reperfusion-induced significant increases in MDA contents of liver and gut and serum cytokines, consistent with histopathologic injury scores. Propofol effectively stabilized the MDA levels and decreased the tissue injury scores of the liver and gut. Tumor necrosis factor-{alpha} and interleukin-6 levels increased less in the propofol groups than in the thiopental groups. There was no additive preventive effect of verapamil on propofol. The addition of verapamil to thiopental was effective in decreasing the serum cytokines and liver MDA content.

CONCLUSION: Propofol may offer advantages by inhibiting lipid peroxidation and inflammatory cytokine production in an animal model of gut ischemia/reperfusion-induced liver injury.



张力性气胸穿刺减压可能进针位置的放射学评估

Radiologic Assessment of Potential Sites for Needle Decompression of a Tension Pneumothorax

David B. Wax, MD, and Andrew B. Leibowitz, MD

From the Department of Anesthesiology, Mount Sinai School of Medicine, New York City, New York.

Anesth Analg 2007; 105:1385-1388

背景:可疑张力性气胸的推荐治疗方法为立即穿刺减压。但是推荐部位和穿刺针的尺寸尚未统一,而且也有穿刺失败和医源性血胸的报道发表。我们研究了最佳穿刺针长度及3个可能穿刺减压位点的相对安全性。

方法:通过对100位成年人进行胸部CT扫描,我们测量出胸半中线(MHL)上胸骨角平面及腋前线和腋中线上剑突平面上皮肤表面至胸膜和胸腔内结构的距离及胸骨中线至内乳血管的距离。

结果:胸骨中线至MHL及内乳血管的距离中位数分别为6.1cm3.0cmMHL、腋中线及腋前线部位皮肤至胸膜距离中位数分别为3.1 (1.4–6.9)3.5 (1.7–9.3+)2.6 (1.0–7.7+) cm。总的来说,右边的安全范围比左边高,两边的MHL位置最安全。

结论:可疑张力性气胸的穿刺减压必须用一根至少7cm的穿刺针在胸骨角平面的MHL垂直于横切面刺入。这种方法应该比其他部位具有更高的成功率和安全范围。

(黄佳佳译,马皓琳、李士通校)

 

BACKGROUND: The recommended treatment of suspected tension pneumothorax is immediate needle decompression. Recommended sites and needle sizes for this procedure vary, and there are published reports of failed decompression as well as iatrogenic hemothorax. We investigated the optimal needle length and relative safety of three potential needle decompression sites.

METHODS: Using thoracic computed tomography scans of 100 adults, we measured the distance from skin surface to pleura and to intrathoracic structures at the level of the sternal angle at the midhemithoracic line (MHL), and at the level of the xiphoid process at the anterior axillary and midaxillary lines, as well as the distance from the sternal midline to internal mammary vessels.

RESULTS: Median distances from the midline to the MHL and internal mammary vessels were 6.1 and 3.0 cm, respectively. Median (range) depth-to-pleura below the skin surface at the MHL, midaxillary lines, and anterior axillary line sites was 3.1 (1.4–6.9), 3.5 (1.7–9.3+), and 2.6 (1.0–7.7+) cm, respectively. Overall, there was a lower margin of safety on the left side compared with the right side, and the MHL site was safest on both sides.

CONCLUSIONS: Needle decompression of suspected tension pneumothorax should be attempted in the MHL at the level of the sternal angle using a needle at least 7 cm long inserted perpendicular to the horizontal plane. This approach should yield the highest success rate and margin of safety compared with other sites.



故意的高碳酸血症和低碳酸血症对于功能性内窥镜下鼻窦手术过程中的术中失血和手术野质量的影响

The Effect of Deliberate Hypercapnia and Hypocapnia on Intraoperative Blood Loss and Quality of Surgical Field During Functional Endoscopic Sinus Surgery

Vladimir Nekhendzy, MD*, Hendrikus J. M. Lemmens, MD, PhD*, Winston C. Vaughan, MD{dagger}, Edward J. Hepworth, MD{dagger}, Alexander G. Chiu, MD{dagger}, Christopher A. Church, MD{dagger}, and John G. Brock-Utne, MD, PhD*

From the Departments of *Anesthesiology, and {dagger}Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.

Anesth Analg 2007; 105:1404-1409

背景:功能性内窥镜下鼻窦手术中麻醉管理的目的在于尽量减少出血且提供一个几乎完美的手术野。我们研究了故意的术中高碳酸血症和低碳酸血症是否会通过有人提出的不同二氧化碳(CO2)张力水平对鼻血管系统的调节作用,从而可能会影响围失血和手术野质量。

方法:180名患者随机分入正常血二氧化碳组(呼气末CO2ETco237 ± 2 mm Hg)、高碳酸血症组(ETco2 60 ± 2 mm Hg)和低碳酸血症组(ETco2 27 ± 2 mm Hg)。麻醉管理用丙泊酚和瑞芬太尼持续输注、氧化亚氮和中度控制性降压。出血量和手术野的状况由对分组并不知晓的外科医生评价。我们分析了各研究组之间的差异、研究组和时间对ETco2水平和血流动力学参数的影响以及失血与外科联合变量的关系。

结果:各研究组间失血和手术野质量无差异。总起来讲,低碳酸血症组的患者需要最大量的瑞芬太尼、拉贝洛尔和降压药,而高碳酸血症则需要最小量的上述药物。CT分级下的鼻窦疾病的严重程度以及手术时间是影响术中出血量的唯一独立的预测因素。

结论:功能性内窥镜下鼻窦手术中CO2的管理并不影响手术条件和出血。

(黄丽娜   马皓琳  李士通  校)

BACKGROUND: Anesthetic management during functional endoscopic sinus surgery is aimed at minimizing bleeding and establishing a near-perfect surgical field. We investigated whether deliberate intraoperative hypercapnia and hypocapnia may affect blood loss and quality of surgical field through a proposed modulating effect of different carbon dioxide (CO2) tension levels on nasal vasculature.

METHODS: One hundred and eighty patients were randomly assigned to normocapnia (end-tidal CO2 [ETco2] 37 ± 2 mm Hg), hypercapnia (ETco2 60 ± 2 mm Hg), and hypocapnia (ETco2 27 ± 2 mm Hg) groups. Anesthetic management was with propofol and remifentanil infusions, nitrous oxide, and moderate controlled hypotension. Blood loss and operating conditions were assessed by the surgeon who was blinded to group assignment. Differences among the study groups, the effect of the study group and time on ETco2 levels and hemodynamic variables, and the association of blood loss with surgical covariates were analyzed.

RESULTS: There were no differences in blood loss and quality of surgical field among the study groups. Patients in the hypocapnia group demonstrated the highest, and in the hypercapnia group, the lowest, requirements for remifentanil, labetalol, and administration of the antihypertensive medications in general. The computed tomography-graded severity of sinonasal disease and duration of surgery were the only independent predictors of intraoperative blood loss.

CONCLUSIONS: CO2 management during functional endoscopic sinus surgery does not influence operating conditions or blood loss.



一种减少鼻衄、提高适航性的鼻插管新技术

A New Technique to Reduce Epistaxis and Enhance Navigability During Nasotracheal Intubation

Kwang Suk Seo, MD*, Jae-Hun Kim, MD{dagger}, Sol Mon Yang, MD{dagger}, Hyun Jeong Kim, MD*, Jae-Hyon Bahk, MD{dagger}, and Kwang Won Yum, MD*

From the *Department of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry, and {dagger}Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Anesth Analg 2007; 105:1420-1424

背景:鼻衄是鼻插管的最常见并发症。我们比较了头端装有充气式食道听诊器的气管内导管(endotracheal tubesETT)与普通ETTs,有或无热软化时在预防鼻衄和提高适航性方面的不同。

方法:需鼻插管的牙科手术者随机分成4组(每组50人):组1,非热软化的气管内导管;组2,头端装有充气式食道听诊器的非热软化气管内导管;组3,热软化的气管内导管;组4,头端装有充气式食道听诊器的热软化气管内导管。评估气管内导管通过鼻腔的适航性和插管后鼻衄。

结果:1气管内导管通过鼻腔的适航性是最差的(P = 0.001)。组1鼻衄最严重,组2和组3相似,组4最轻(P < 0.001)

结论:头端有食道听诊器的气管内导管的使用和热软化相似,能有效预防鼻插管引起的鼻衄。热软化后的装有食道听诊器的气管内导管比单纯热软化的气管内导管在减少鼻衄方面更有效。

(朱 慧译 马皓琳 李士通校)

BACKGROUND: Epistaxis is the most common complication of nasotracheal intubation. We compared endotracheal tubes (ETT) obturated with an inflated esophageal stethoscope with normal ETTs with regard to the prevention of epistaxis and navigability, both with and without thermosoftening.

METHODS: Dental surgical patients requiring nasotracheal intubation were randomly allocated into 1 of 4 groups (n = 50 each): Group 1, nonthermosoftened ETTs; Group 2, nonthermosoftened ETTs obturated with an inflated esophageal stethoscope; Group 3, thermosoftened ETTs; and Group 4, thermosoftened ETTs obturated with an inflated esophageal stethoscope. Navigability of ETTs through the nasal cavity and postintubation epistaxis were evaluated.

RESULTS: Navigability of ETTs through the nasal cavity was the worst in Group 1 (P = 0.001). Epistaxis was the most severe in Group 1, similar between Groups 2 and 3, and the least severe in Group 4 (P < 0.001).

CONCLUSION: The use of esophageal stethoscope-obturated ETTs was effective, and comparable to thermosoftening, in preventing epistaxis associated with nasotracheal intubation. Thermosoftened, obturated ETTs were more effective than simple thermosoftened ETTs in reducing epistaxis.



术前口服普瑞巴林用于妇产科小手术术后缓解疼痛的一项随机、安慰剂对照试验

A Randomized, Placebo-Controlled Trial of Preoperative Oral Pregabalin for Postoperative Pain Relief After Minor Gynecological Surgery

 

Michael J. Paech, DM*, Raymond Goy, FANZCA{dagger}, Sebastian Chua, MMed{dagger}, Karen Scott, FRCA{dagger}, Tracey Christmas, MRCP{dagger}, and Dorota A. Doherty, PhD{ddagger}

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

Anesth Analg 2007; 105:1449-1453

背景:虽然普瑞巴林显示出对抗神经性疼痛的功效,但是罕有证据支持其术后镇痛的功效。我们的研究目的在于经历急性内脏痛的日间手术病人中的镇痛效果。无效假设为普瑞巴林与安慰剂在缓解疼痛上无显著差异。

方法:在90位行小型妇产科包括子宫手术的女性中行一项随机、双盲、平行分组、安慰剂对照试验。患者在术前约一小时接受口服普瑞巴林100mg(PG)或安慰剂(C组)。原始结果是在复苏室中的疼痛评分,且患者术后随访24小时。

结果:在复苏室里经历的疼痛(PG组中位数16、四分位距0-36C106.5-36P = 0.80)或此后疼痛组间无差异,在复苏室芬太尼的需要(PG42%C27%P = 0.12)或者术后24小时时的恢复质量(PG组中位数17、四分位距17-18C1816.5-18P = 0.75)也无组间差异。出院后轻度头晕、视觉障碍和行走困难的发生率在普瑞巴林组显著较高。

结论:单纯术前服用普瑞巴林100 mg不能缓解仅包括子宫小手术术后的急性疼痛或改善恢复。

(胡湘  马皓琳 李士通 校)

 

BACKGROUND: Although pregabalin shows efficacy against neuropathic pain, very limited evidence supports postoperative analgesic efficacy. Our study objective was to investigate analgesic efficacy in an ambulatory day surgical population experiencing acute visceral pain. The null hypothesis was that there was no significant difference in pain relief between pregabalin and placebo.

METHODS: A randomized, double-blind, parallel-group, placebo-controlled trial was performed in 90 women having minor gynecological surgery involving the uterus. Patients received either oral pregabalin 100 mg (Group PG) or placebo (Group C) approximately 1 h before surgery. The primary outcome was pain score in the recovery unit and patients were followed for 24 h.

RESULTS: There was no significant difference between groups for pain experienced in the recovery room (median, interquartile range 16, 0–36 vs 10, 6.5–36 for Groups PG and C, respectively, P = 0.80) or thereafter; nor for recovery room fentanyl requirement (42% Group PG versus 27% Group C, P = 0.12) or the quality of recovery at 24 h postoperatively (median, interquartile range score 17, 17–18 Group PG versus 18, 16.5–18 Group C, P = 0.75). The incidence of posthospital discharge light-headedness, visual disturbance, and difficulty with walking was significantly higher in the pregabalin group.

CONCLUSIONS: A single preoperative dose of 100 mg pregabalin does not reduce acute pain or improve recovery after minor surgery involving only the uterus.




 

顽固性脊柱损伤性疼痛病人的疼痛处理:一项病例报告及文献回顾

Pain Management in a Patient With Intractable Spinal Cord Injury Pain: A Case Report and Literature Review

Jocelyn C. Que, MD, MMed (Pain Mgt), DPBA, FFPMANZCA, FIPP*, Philip J. Siddall, MBBS, MMed (Pain Mgt), PhD, FFPMANZCA{dagger}, and Michael J. Cousins, AM, MD, DSc, FANZCA, FRCA, FFPMANZCA, FAChPM (RACP){dagger}

From the *Pain Management Unit, University of Santo Tomas Faculty of Medicine and Surgery, University of Santo Tomas Hospital, Manila, Philippines; and {dagger}Pain Management Research Institute, University of Sydney, Royal North Shore Hospital, Sydney, Australia.

Anesth Analg 2007; 105:1462-1473

慢性疼痛是脊柱损伤较为烦扰的后遗症之一,通常干扰病人的基本活动、有效康复和生活质量。脊髓损伤病人的疼痛通常是难以治疗的。这种困境又由于可供选择有效药理学及非药理学治疗选项的可用性有限而放大。我们使用搜索词“脊髓损伤(spinal cord injury)”或者“脊髓损伤(spinal cord injuries)”和“疼痛(pain)”或者“痉挛状态(spasticity)”或“肌肉痉挛(muscle spasms)” 1975-2005年的MEDLINE数据库鉴别出有关脊柱损伤后疼痛的相关文章。我们也从国际疼痛研究协会出版社近期出版的书里手工查找关于脊柱损伤疼痛的综述,通过参考文献列表来辨别相关论文。我们介绍了一例用针对脊髓损伤疼痛不同方面的控制疼痛计划成功治疗的难治性脊柱损伤疼痛的病人。我们回顾了这些治疗项目的证据。

(胡湘   马皓琳 李士通 校)

Chronic pain is one of the more disturbing sequelae of spinal cord injury, often interfering with the basic activities, effective rehabilitation, and quality of life of the patient. Pain in the cord-injured patient is often recalcitrant to treatment. This dilemma is amplified by the limited availability of effective pharmacological and nonpharmacological treatment options. We identified relevant articles regarding pain after spinal cord injury from the Medline database from 1975 to 2005 using the search terms "spinal cord injury" or "spinal cord injuries" and "pain" or "spasticity or "muscle spasms." We also searched by hand the review articles in a recently published book from the International Association for the Study of Pain Press on spinal cord injury pain, and identified relevant articles through reference lists. We present a patient with intractable spinal cord injury pain who was successfully treated with a pain management plan that addressed the various aspects of spinal cord injury pain. The evidence for treatment options is reviewed.

 


 

环孢菌素对小鼠催眠反应和疼痛反应的不同作用

The Differential Effect of Cyclosporine on Hypnotic Response and Pain Reaction in Mice

Yuki Sato, MD, PhD*, Tatsushi Onaka, MD, PhD{dagger}, Eiji Kobayashi, MD, PhD{ddagger}, and Norimasa Seo, MD, PhD*

From the Departments of *Anesthesiology and {dagger}Physiology; and {ddagger}Divisions of Organ Replacement Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.

Anesth Analg 2007; 105:1489-1493

背景:钙神经素抑制剂环孢菌素广泛应用于防止器官移植中的同种异体移植物排斥。避免全身给予环孢菌素,以防止药物进入脑部作用于多药耐药1mdr1)基因编码的P-糖蛋白。然而很多移植受体在注射了环孢菌素后产生了术后的神经心理学副作用,如意识错乱、抑郁和焦虑。最近,在器官和干细胞移植中钙神经素抑制剂产生的疼痛综合征(其特点为下肢重度疼痛)也已得到了认识。

方法:在本研究中,我们开发了野生型和mdrla基因灭活小鼠的行为模型,来揭示外周或中枢的环孢菌素是否改变疼痛反应及催眠敏感性。在缺乏P-糖蛋白的mdrla基因灭活小鼠可以较好地评价环孢霉素的中枢作用。在腹腔内注射环孢霉素后,我们测定了小鼠尾部浸渍试验中的甩尾潜伏期,或对戊巴比妥和氯胺酮的反应中的翻正反射消失时间。

结果:在野生型小鼠中,最大剂量的环孢菌素可以显著的延长氯胺酮导致的翻正反射消失时间,但是对于戊巴比妥产生的翻正反射消失时间没有影响。在另一方面,在mdrla基因灭活小鼠中最低剂量的环孢菌素均可以明显延长戊巴比妥和氯胺酮产生的睡眠时间。注射环孢菌素使野生型和灭活小鼠在尾部浸渍试验中的甩尾潜伏期都明显缩短。

结论:我们的结果提示在中枢的蓄积的环孢菌素增强对戊巴比妥和氯胺酮的催眠反应,而外周环孢菌素产生痛觉过敏。

(沈浩   马皓琳 李士通 校)

BACKGROUND: The calcineurin inhibitor, cyclosporine, is widely used for preventing allograft rejection in organ transplantation. Systemically administered cyclosporine is prevented from entering into the brain by the action of P-glycoprotein, encoded by the multidrug resistant 1 (mdr1) gene. However, in many transplant recipients, cyclosporine administration causes postoperative neuropsychological side effects, such as confusion, depression, and anxiety. Recently, calcineurin-inhibitor-induced pain syndrome, characterized by severe pain in the lower limbs, has also been recognized in both organ and stem-cell transplantations.

METHODS: In the present study, we developed behavioral models in wild-type and mdr1a knockout mice to reveal whether peripheral or central cyclosporine alters pain reactions and hypnotic sensitivities. Cyclosporine's central actions can be better evaluated in mdr1a knockout mice that lack P-glycoprotein. After intraperitoneal administration of cyclosporine, we examined tail-flick latency in the tail immersion test, or duration of loss of righting reflex in response to pentobarbital and ketamine.

RESULTS: In wild-type mice, the highest dose of cyclosporine significantly prolonged the duration of loss of righting reflex in response to ketamine, but not to pentobarbital. On the other hand, the lower doses of cyclosporine significantly increased both pentobarbital- and ketamine-induced sleep durations in mdr1a knockout mice. Tail-flick latencies in the tail immersion test were significantly shortened in both wild-type and knockout mice by the administration of cyclosporine.

CONCLUSIONS: Our results suggest that centrally accumulated cyclosporine enhances the hypnotic response to pentobarbital and ketamine, but peripheral cyclosporine induces hyperalgesia.

氙气麻醉对实验性心肌梗死面积的影响

The Effect of Xenon Anesthesia on the Size of Experimental Myocardial Infarction

Jan-H Baumert, MD, DEAA, Marc Hein, MD, Christina Gerets, Thomas Baltus, Klaus E. Hecker, MD, and Rolf Rossaint, MD

From the Klinik fuer Anaesthesiologie, University Clinic, Aachen, Germany.

Anesth Analg 2007 105: 1200-1206

 

背景:吸入麻醉剂能够保护心肌避免缺血再灌注损伤。在该研究中假设氙气使心肌梗死面积减少的程度与采取缺血预适应相似。

方法:36只体重在30-35kg的猪进行硫贲妥钠麻醉,并随机分成四组:对照组(单纯心肌缺血),缺血预适应组(周期性心肌缺血5次,每次5分钟),氙气预处理组(在心肌缺血前给予70%的氙气共三次,每次10分钟),以及氙气麻醉组(在心肌缺血发生前和发生后持续给予70%的氙气)。心肌缺血模型采取冠状动脉左前降支束止血带60分钟,然后给予2小时的再灌注时间而诱发。心肌梗死面积和可能发生心肌梗死的危险区分别可以用偶氮蓝与氯化三苯四唑染色测量。

结果:缺血预处理组心肌梗死面积的平均值较对照组的64%±9%减少至19%±12%P<0.001),氙气麻醉组中降至50%±9%(与对照组比较P<0.05,与缺血预处理组比较P<0.001)。氙气预处理组的心肌梗死面积与对照组相比没有减少(59%±11%P=0.41)。

结论:缺血预处理能够减少心肌梗死面积,而氙气麻醉在这方面的作用则较弱。简言之,在发生心肌缺血前间断给予氙气不能减少心肌梗死的面积。

(印洁敏 陈杰 校)

BACKGROUND: Volatile anesthetics protect the myocardium from ischemia reperfusion damage. Our hypothesis for this study was that xenon reduces the size of myocardial infarction similar in extent to the reduction associated with ischemic preconditioning.

METHODS: Thirty-six pigs weighing 30–35 kg were anesthetized with thiopental and then randomized into four groups: control (myocardial ischemia only), ischemic preconditioning (five 5-min episodes of intermittent myocardial ischemia), xenon preconditioning (three 10-min exposures to xenon 70% followed by myocardial ischemia), and xenon anesthesia (xenon 70%, continued before and after myocardial ischemia). Myocardial ischemia was induced by placing a tourniquet around the left anterior descending coronary artery for 60 min followed by 2 h of reperfusion. Myocardial infarct size and the area at risk for myocardial infarction were measured by Evans Blue and triphenyl tetrazolium chloride staining, respectively.

RESULTS: Mean (sd) myocardial infarct size was reduced from 64% ± 9% of the area at risk in the control group to 19% ± 12% with ischemic preconditioning (P < 0.001), and to 50% ± 9% with xenon anesthesia (P < 0.05 versus control, P < 0.001 versus ischemic preconditioning). Myocardial infarct size was not reduced with xenon preconditioning compared with the control group (59% ± 11%, P = 0.41).

CONCLUSION: Myocardial infarct size was reduced by ischemic preconditioning but less so by xenon anesthesia. Brief, intermittent exposure to xenon before myocardial ischemia did not reduce myocardial infarct size.

 

.术中的三维经食道超声心动图测量心输出量的有效性和可行性

Validation and Feasibility of Intraoperative Three-Dimensional Transesophageal Echocardiographic Cardiac Output

William C. Culp, Jr, MD, Timothy R. Ball, MD, and Christopher J. Burnett, MD

From the Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Scott & White Hospital, The Texas A&M University System Health Science Center College of Medicine, Temple, TX.

Anesth Analg 2007 105: 1219-1223.

 

背景: 在初步研究中,作者尝试验证三维经食道超声心动图(3DTEE)监测心输出量并评估它在术中监测的可行性.

方法: 20名接受心脏手术病人,在体外循环前循环稳定期间,同时采用3DTTE法和热稀释法测定心输出量。

结果: 2种方法测得的心输出量的相关系数是0.86. 3DTTE 的平均偏差是0.27L/min,界限是-1.642.17L/min(大约±35%)。获取三维数据平均需要43秒,对数据后期处理花费7分钟。

结论: 3DTTE能够测量心输出量,且在围术期是可行的。与热稀释法的测量值有很好的相关性,但有一个明显的偏倚和宽域。

(张燕 陈杰 校)

BACKGROUND: In this pilot study, we attempted to validate three-dimensional transesophageal echocardiography (3DTEE) cardiac output and assess its feasibility intraoperatively.

METHODS: Twenty patients undergoing cardiac surgery underwent simultaneous cardiac output determinations during the clinically stable prebypass period by 3DTEE and thermodilution.

RESULTS: The correlation coefficient between cardiac output measured by the two methods was 0.86. The 3DTEE mean bias was 0.27 L/min, limits of agreement –1.64 to 2.17 L/min (approximately ±35%). Three-dimensional data acquisition averaged 43 s; postprocessing took 7 min.

CONCLUSIONS: Three-dimensional TEE can measure cardiac output and is feasible perioperatively. Measurements have good correlation with thermodilution, though with a significant bias and wide limits of agreement.

 

010的数值量化法评估儿童焦虑水平的初步验证

Initial Validation of a Numeric Zero to Ten Scale to Measure Children's State Anxiety

Margie Crandall, RN, PhD*, Cathy Lammers, MD{dagger}, Craig Senders, MD{ddagger}, Marilyn Savedra, DNS§, and Jerome V. Braun, PhD||

From the Department of *Patient Care Services, {dagger}Anesthesiology and Pain Medicine, {ddagger}Otolaryngology, University of California, Davis, Health System; §Department of Family Health Nursing, University of California, San Francisco; and ||Department of Statistics, University of California, Davis.

Anesth Analg 2007 105: 1250-1253.

 

背景:患焦虑症的儿童在许多卫生保健检查中表现出身体和行为的异常,但由于缺乏临床实用的主观量表,很少实施焦虑和随后治疗评估。目前焦虑程度评估依靠观察或多项自我评估报告,需花费临床医生和病人大量的时间。由于焦虑是主观的,加上临床上儿童易于接受,本研究评估了010的数值量化法应用的可行性。

方法: 用描述性的相关研究方法检测010的数值化量表方法的可行性同时分批给予STAIC法(State-trait for state anxiety inventory for children)。在临床干预前挑选60位儿童,年龄在713岁,给予010量表法和STAIC法观测干预前后的焦虑评分。用线性回归和Pearson相关检验其关联程度。

结果:不论干预前后,STAIC均与焦虑量表有相关性(β=1.20, SE[β]0.34, F[1, 58]=12.74, P=0.0007; β=1.79, SE[β]=0.31, F[1, 58]=40.11, P<0.0001)。相关系数分别是干预前(r=0.424)干预后(r=0.639)。

结论:初步研究显示证010的数值量化自测法用于评估7岁左右儿童焦虑程度是可行性。

(周懿之 陈杰 校)

BACKGROUND: Although children experience physical and behavioral consequences from anxiety in many health care settings, anxiety assessment and subsequent management is not often performed because of the lack of clinically useful subjective scales. Current state anxiety scales are either observational or multidimensional self-report measures requiring significant clinician and patient time. Because anxiety is subjective, in this pilot study, we evaluated the validity of a self-report numeric 0–10 anxiety scale that is easy to administer to children in the clinical setting.

METHODS: A descriptive correlation research design was used to determine the concurrent validity for a numeric 0–10 anxiety scale with the state portion of the State-Trait Anxiety Inventory for Children (STAIC). During clinic preoperative visits, 60 children, 7–13 yr, provided anxiety scores for the 0–10 scale and the STAIC pre- and posteducation. Simple linear regression and Pearson correlation were performed to determine the strength of the relationship.

RESULTS: STAIC was associated with the anxiety scale both preeducation (ß = 1.20, SE[ß] = 0.34, F[1,58] = 12.74, P = 0.0007) and posteducation (ß = 1.97, SE[ß]) = 0.31, F[1,58] = 40.11, P < 0.0001). Correlations were moderate for pre-education (r = 0.424) and posteducation (r = 0.639).

CONCLUSIONS: This initial study supports the validity of the numeric 0–10 anxiety self-report scale to assess state anxiety in children as young as 7 yr.

 

右旋美托咪啶对七氟醚麻醉下颞叶性癫痫病人的脑电图的影响

The Effect of Dexmedetomidine on Electrocorticography in Patients with Temporal Lobe Epilepsy Under Sevoflurane Anesthesia

Yutaka Oda, MD, PhD*, Sumiko Toriyama, MD*, Katsuaki Tanaka, MD, PhD*, Tadashi Matsuura, MD*, Naoya Hamaoka, MD, PhD*, Michiharu Morino, MD, PhD{dagger}, and Akira Asada, MD, PhD*

From the Departments of *Anesthesiology and Intensive Care Medicine and {dagger}Neurosurgery, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Anesth Analg 2007 105: 1272-1277.

 

背景:尽管右旋美托咪啶常用于神经外科麻醉及神经外科危重监护的操作中,但它对那些存在异常脑电图病人的脑电活性的影响却并不清楚。脑电图是一种检验药物对脑电活性和外科治疗对癫痫疗效的敏感方法。作者研究了右旋美托咪啶对七氟醚麻醉下行癫痫外科治疗病人的脑电图的影响。

方法:选择患有药物难治性颞叶性癫痫并将进行手术切除癫痫病灶的病人。以2.5%的七氟醚维持麻醉,呼末二氧化碳分压维持在30mmHg,脑电图则是通过放在癫痫病灶同侧的颞叶中央的8条连接的电极线来记录。右旋美托咪啶以0.51.5ng/ml的血浆浓度靶控输注。每个浓度维持20分钟,而脑电图则在开始输注前及开始输注的第二个10分钟开始记录。通过Student-Newman-Keul试验获得的脑电图时频分布,每条光谱带的光谱功率密度及每个右旋美托咪啶浓度的峰值与Kruskal-Wallis试验进行比较。

结果:所有病人的所有导联中有88个导联的脑电图中位频较基线明显减少,右旋美托咪啶1.5ng/ml组和0.5ng/mlP值分别是0.0030.03。但光谱功率密度在频带为δ<4Hz,4≦θ<8Hz,8≦α<13Hz时并不改变。有棘波的导联数、所有导联的棘波数以及峰值均不受右旋美托咪啶的影响。

结论:右旋美托咪啶在血浆浓度在0.48ng/ml1.6ng/ml时可减少2.5%七氟醚麻醉下颞叶性癫痫病人脑电图的中位频率,但并不影响棘波活动。

(潘钱玲 陈杰 校)

BACKGROUND: Although dexmedetomidine is often used in neuroanesthesia and neuronal critical care practice, its effect on cerebral electrical activity in those with an abnormal electroencephalogram is not known. The electrocorticogram (ECoG), a sensitive method for examining the effect of drugs on cerebral electrical activity and surgical treatment for epilepsy, is usually guided by monitoring of the ECoG. We investigated the effect of dexmedetomidine on ECoG in patients with epilepsy undergoing surgery with sevoflurane.

METHODS: Patients with medically intractable temporal lobe epilepsy undergoing resection of the epileptic foci (n = 11) were enrolled. Under general anesthesia with 2.5% sevoflurane and end-tidal carbon dioxide tension at 30 mm Hg, ECoG was recorded by strip electrodes with eight contacts placed on the mesial temporal lobe ipsilateral to the epilepsy foci. Dexmedetomidine was given as a computer-controlled infusion to achieve target plasma concentrations of 0.5 and 1.5 ng/mL. Each concentration was maintained for 20 min and ECoG was recorded before infusion of dexmedetomidine and between the 10th and 20th min after starting infusion. The median frequency of ECoG, spectral power density of each spectral band, and number of spikes at each concentration of dexmedetomidine were compared by Kruskal–Wallis test, followed by Student–Newman–Keuls test.

RESULTS: The median frequency of ECoG in 88 leads from all leads from all patients was significantly decreased by 1.5 ng/mL of dexmedetomidine compared with those at baseline and 0.5 ng/mL (P = 0.003 and 0.03, respectively); however, spectral power densities in the frequency bands: {delta}(<4 Hz), {theta}(≥4 and <8 Hz), {alpha}(≥8 and <13 Hz), and ß (≥13 Hz), were not changed. Neither the number of leads with spikes nor the number of spikes in all leads and in the lead with highest number of spikes at baseline was affected by dexmedetomidine.

CONCLUSIONS: Dexmedetomidine at plasma concentrations of 0.48 and 1.60 ng/mL decreased the median frequency of ECoG, but did not affect spike activity in patients with temporal lobe epilepsy anesthetized with 2.5% sevoflurane.

 

NO和血管紧张素II受体介导血管紧张素II的升压作用:清醒和麻醉(Zoletil)大鼠的研究

Nitric Oxide and Angiotensin II Receptors Mediate the Pressor Effect of Angiotensin II: A Study in Conscious and Zoletil-Anesthetized Rats

Ismael F. M. S. Guarda, MD*, Wilson A. Saad, MD, PhD{dagger}{ddagger}§, and Luiz Antonio de Arruda Camargo, MD, PhD{ddagger}

From the *Department of Anesthesiology, General Hospital of University of São Paulo, {dagger}Basic Institute of Biosciences-UNITAU, Sao Paulo, Brazil; and {ddagger}Department of Physiology and Pathology, UNESP, §Department of Biological and Health Science, UNIARA, Araraquara, Sao Paulo, Brazil.

Anesth Analg 2007 105: 1293-1297.

 

背景:中枢神经系统的脑室周围结构及NO参与动脉血压的调控,全麻可能刺激中枢肾素-血管紧张素系统。本文作者研究了血管紧张素IINO在清醒和麻醉状态下大鼠系统血压中的调节作用。

方法:将不锈钢套管插入大鼠侧脑室对其进行研究。将AT1AT2血管紧张素受体拮抗剂,氯沙坦和PD123319NO合成酶抑制剂L-NAME7-硝基吲唑和NO提供剂FK409注入侧脑室。分别记录清醒状态和Zoletil麻醉下的大鼠平均动脉压。

结果:基础状态下的MAP的均数±标准差是117.5±2mmHg。血管紧张素II注入侧脑室后MAP增加到136.5±2mmHg 138.5±4mmHg16±3mmHg21±3mmHg),对照组MAP116±2mmHg120±3mmHg3±1mmHg5±2mmHg(P<0.05)L-NAME7-硝基吲唑增强了血管紧张素II的升压效果(P<0.05)。预先注射氯沙坦和PD123319会降低血管紧张素II 的升压效果和L-NAME7-硝基吲唑的增强效果(P<0.05)。Zoletil麻醉不改变血管紧张素II,(16±3mmHg21±3mmHg)或NO合成酶抑制剂的作用。

结论:内源性的NO补充了中枢血管紧张素系统调节阀的抑制性作用。AT1AT2血管紧张素受体拮抗剂影响了血管紧张素II对动脉血压的中枢控制作用。但Zoletil麻醉不影响其作用。

A fixed-ratio combination of the tranquilizer, zolazepam, with the dissociative anesthetic, tiletamine; used for injection anesthesia in dogs, cats, wild and zoo animals. It produces dose-dependent sedation to general anesthesia.
BACKGROUND:
The circumventricular structures of the central nervous system and nitric oxide are involved in arterial blood pressure control, and general anesthesia may stimulate the central renin–angiotensin system. We therefore investigated the central role of angiotensin II and nitric oxide on the regulation of systemic arterial blood pressure in conscious and anesthetized rats.

METHODS: Rats with stainless steel cannulae implanted into their lateral ventricle were studied. We injected the AT1 and AT2 angiotensin II receptor antagonists, losartan and PD123319, L-NAME, 7-nitroindazole (nitric oxide synthetase inhibitors), and FK409 (nitric oxide donor agent) into the lateral ventricles. Mean arterial blood pressure (MAP) was recorded in conscious and zoletil-anesthetized rats.

RESULTS: Mean ± sem baseline MAP was 117.5 ± 2 mm Hg. Angiotensin II injected into the brain lateral ventricle increased MAP from 136.5 ± 2 mm Hg to 138.5 ± 4 mm Hg ({Delta}16 ± 3 mm Hg to {Delta}21 ± 3 mm Hg) for all experimental groups versus control from 116 ± 2 mm Hg to 120 ± 3 mm Hg ({Delta}3 ± 1 mm Hg to {Delta}5 ± 2 mm Hg) (P < 0.05). L-NAME or 7-nitroindazole enhanced the angiotensin II pressor effect (P < 0.05). Prior injection of losartan and PD123319 decreased the angiotensin II pressor effect and the enhancement effect of L-NAME and 7-nitroindazole (P < 0.05). Zoletil anesthesia did not interfere with the effects of angiotensin II, AT1, AT2 antagonists, or nitric oxide synthetase inhibitors.

CONCLUSIONS: Endogenous nitric oxide functions tonically as a central inhibitory modulator of the angiotensinergic system. AT1 and AT2 receptors influence the angiotensin II central control of arterial blood pressure. Zoletil anesthesia did not interfere with these effects.

 

微多普勒导管用于离体评估静脉气体栓塞的检测和吸引

In Vitro Evaluation of a Micro-Doppler Catheter for Detection and Aspiration of Venous Air Emboli

Paul E. Bigeleisen, MD

From the Department of Anesthesiology, Presbyterian University Hospital, Pittsburgh, Pennsylvania.

Anesth Analg 2007 105: 1333-1337

 

背景:外科手术中,术野开放的静脉暴露于周围的空气,大气压力超过了静脉系统压力,静脉气体栓塞(VAE)可能成为手术致死的并发症。常见的检测VAE的方法有心前区多普勒监测和经食管超声心动图。心前区多普勒监测仪精确性低,经食管超声心动图不仅昂贵而且用户密集。以上两种方法都必须在腔静脉内插入隔离导管,用来探测气栓并吸出。

方法:作者制作了一个微多普勒仪,由两个陶瓷换能器组装而成,安装在一个5.8F的多腔中心静脉导管上。用这个微多普勒导管(MDC)置于一个静止槽和一人工腔静脉(AVC)用于体外测定气栓。MDC也可以用来检测静电罐的声压和电流泄漏或是AVC内的产热和气泡形成情况。

结果MDC可以检测到直径大于2mm的气泡,精确率达100%。操作者在盲视下定位气栓,10次实验均成功。同一操作者又在10次实验中完全成功地排出了气栓。测量出的声压<1.8MPa。超过24小时后,AVC内的温度没有上升,而超过4小时后AVC内也没有气泡形成。

结论:实验者制作的MDC可以探测到模拟腔静脉和心房内的气体栓子并解除气栓。导管可以经皮放置在腔静脉内。基于此设备可以测量AVC中的声压和温度,而且AVC中不会有气泡形成,因此可以安全地用于人体。而此导管是否可以用来检测并吸出手术中的VAE,比如开颅手术中可能出现的VAE,还待更多的研究加以探索。

(杜唯佳 陈杰    

BACKGROUND: Venous air embolism (VAE) is a potentially fatal complication of surgery when open veins at a surgical site are exposed to ambient air pressure which exceeds the pressure in the venous system. Common techniques of detecting VAE are precordial Doppler monitoring and transesophogeal echocardiography. Precordial Doppler monitoring has poor accuracy and transesophogeal echocardiography is expensive and user-intensive. In both methods, a separate catheter must be inserted into the vena cava so that an embolus may be aspirated if it is detected.

METHODS: We created a micro-Doppler assembly using two ceramic transducers fitted over a 5.8F multiorifice central venous catheter. This micro-Doppler catheter (MDC) was tested in vitro using a static tank and an artificial vena cava (AVC). The MDC was also tested for acoustic pressure and current leakage in the static tank and for heat generation and cavitation in the AVC.

RESULTS: The MDC was able to detect bubbles more than 2 mm in diameter with 100% accuracy. A blinded observer was able to identify the onset of vapor lock in 10 of 10 trials. The same observer was able to terminate vapor lock in 10 of 10 trials. The acoustic pressures measured were <1.8 MPa. There was no increase in temperature in the AVC over 24 h and there was no evidence of cavitation in the AVC over 4 h.

CONCLUSION: We have created a MDC that can detect air emboli and relieve vapor lock in a simulated vena cava and atrium. This catheter could be placed percutaneously in the vena cava. Based on the measurements of acoustic pressure, temperature in the AVC and lack of cavitation in the AVC, the device appears to be safe for use in humans. More studies are required to determine if the catheter could be used to detect and aspirate VAE during surgeries where VAE is likely, such as sitting craniotomy.

 

针对困难拔管的连续气道通路:气道更换导管的有效性

Continuous Airway Access for the Difficult Extubation: The Efficacy of the Airway Exchange Catheter

Thomas C. Mort, MD

Anesth Analg 2007 105: 1357-1362.

 

背景:美国麻醉学会专责小组在困难气道管理上认为拔管策略的概念应是困难插管的延伸,但还没有相关文献提供充分数据衡量插管方法的优点。用AEC(气道调换管)的方法维持气道通畅被评论为是底限数值。

方法:从预先收集的一些困难气道病人改进的数据库中得到观测分析,这些病人是监护室里已知或起初被假定为困难气道的病人。这些数据做出来是为研究重新插管的时间,企图重新气管插管的次数,固定气管导管的方法,重插管过程中低氧血症发病率以及在重建气道过程中遇见的合并症。

结果:51个留置了AEC的病人在插管试验中都失败了。其中47个在AEC下重新插管是成功的,而47个中的41个在第一次尝试中就成功。四分之三的AEC重建是失败的,AEC重建过程中不经意从声门中移位,还有一位病人在拔除气管内导管过程中发成严重的喉水肿。

结论:插管后接AEC维持持续气道通气会成为困难气道择期病人插管策略的一个重要组成部分。留置的AEC在已知或怀疑是困难气道病人插管中增加了一次插管成功的成功率,降低了病人插管不耐受或者需要气道重建的并发症的发病率。

(王腾 陈杰 校)

BACKGROUND: The American Society of Anesthesiologists Task Force on the Management of the Difficult Airway regards the concept of an extubation strategy as a logical extension of the intubation process, although the literature does not provide a sufficient basis for evaluating the merits of an extubation strategy. Use of an airway exchange catheter (AEC) to maintain access to the airway has been reported on only a limited basis.

METHODS: I reviewed an observational analysis of a prospectively collected difficult airway quality improvement database for patients who were extubated over an AEC for a known or presumed difficult airway primarily in the intensive care unit. The data were reviewed for time to reintubation, number of attempts to reintubate the trachea, method of securing the airway, incidence of hypoxemia during reintubation, and complications encountered during reestablishment of the airway.

RESULTS: Fifty-one patients with an indwelling AEC failed their extubation trial. Forty-seven of 51 AEC patients were successfully reintubated over the AEC (92%), with 41 of 47 on the first attempt (87%). In three of the four AEC reintubation failures, the AEC was inadvertently removed from the glottis during the reintubation process, and one patient had significant laryngeal edema precluding endotracheal tube advancement.

CONCLUSIONS: Maintaining continuous access to the airway postextubation via an AEC can be an important component of an extubation strategy in selected difficult airway patients. The indwelling AEC appears to increase the first-pass success rate in patients with known or suspected difficult airways and decrease the incidence of complications in patients intolerant of extubation and requiring tracheal reintubation.

 

血液稀释性中心血容量过高损害脑自身调节功能

Central Hypervolemia with Hemodilution Impairs Dynamic Cerebral Autoregulation

Yojiro Ogawa, DDS, PhD*, Ken-ichi Iwasaki, MD, PhD*, Ken Aoki, PhD*, Shigeki Shibata, MD, PhD{dagger}, Jitsu Kato, MD, PhD{dagger}, and Setsuro Ogawa, MD, PhD{dagger}

From the Departments of *Hygiene and Space Medicine and {dagger}Anesthesiology, Nihon University School of Medicine, Tokyo, Japan.

Anesth Analg 2007 105: 1389-1396.

 

背景:手术期间,中心血容量经常变化可以通过改变交感神经活动度、心输出量、血液粘滞度和脑血管舒缩等影响脑自身调节功能。然而,急性中心血容量改变对动态的大脑自身调节功能的影响尚未研究,特别是血液稀释性高血容量。

方法:作者通过平均动脉压和脑血流速度变异性两者频谱和传递函数分析中心低血容量和高血容量期间动态脑自动调节功能的变化。中心容量的快速变化通过两种水平身体负压(–15 –30 mm Hg)和分别输注两种剂量的生理盐水(15 mL/kg 30 mL/kg)来获得。然后中心静脉压和/或心排血量(用心阻抗法)变化评估中心血容量变化。

结果:平稳状态时–30 mm Hg 低身体负压(CVP降低4mmHg)下CBF速度和心排血量降低,输注生理盐水的两组(CVP增加4mmHgCBF速度和心排血量增加,而MBP无显著变化。但仅在盐水输注后MBPCBF速度变异性之间传递函数增加,显示在血流稀释性高容量期间,平均压的变化会引起脑血流的波动。

结论:虽然血容量过高和过低情况下,脑血流速度均发生改变,但只有血液稀释性中心血容量过高时损害了大脑自身调节功能。

(陈伟 陈杰 校)

BACKGROUND: Frequent changes in the perioperative central blood volume could affect cerebral autoregulation through alterations in sympathetic nerve activity, cardiac output, blood viscosity, and cerebral vasomotor tone. However, the effect of dynamic cerebral autoregulation has not been studied during acute wide-ranging changes in central blood volume, especially with respect to central hypervolemia with hemodilution.

METHODS: We evaluated dynamic cerebral autoregulation during central hypovolemia and central hypervolemia with hemodilution using spectral and transfer function analysis between mean arterial blood pressure (MBP) and cerebral blood flow (CBF) velocity variability in 12 individuals. Rapid changes in central blood volume were achieved using two levels of lower body negative pressure (–15 and –30 mm Hg) and two discrete infusions of normal saline (15 mL/kg and total 30 mL/kg). We then estimated changes in central blood volume as central venous pressure (CVP) and/or cardiac output using impedance cardiography.

RESULTS: Steady-state CBF velocity and cardiac output decreased at –30 mm Hg lower body negative pressure (changes of CVP approximately –4 mm Hg) or were increased by each saline infusion (changes of CVP 4–6 mm Hg), without a significant change in MBP. However, transfer function gain (magnitude of transfer) between MBP and CBF velocity variability significantly increased only after saline infusion, suggesting an increased magnitude of transfer from MBP oscillations to CBF fluctuations during central hypervolemia with hemodilution.

CONCLUSION: Our results suggest that, although steady-state CBF velocity changes under both central hypervolemia and hypovolemia, only hypervolemic hemodilution impairs dynamic cerebral autoregulation.

 

芬太尼经皮离子导入系统和静脉吗啡病人自控镇痛两者的术后疼痛控制安全性和有效性的比较:三个随机、有效对照临床实验的会聚分析

The Safety and Efficacy of Fentanyl Iontophoretic Transdermal System Compared with Morphine Intravenous Patient-Controlled Analgesia for Postoperative Pain Management: An Analysis of Pooled Data from Three Randomized, Active-Controlled Clinical Studies

Eugene R. Viscusi, MD*, Matthew Siccardi, MS{dagger}, C. V. Damaraju, PhD{dagger}, David J. Hewitt, MD{dagger}, and Paul Kershaw, MD{ddagger}

From the *Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania; {dagger}Ortho-McNeil Janssen Scientific Affairs, LLC; and {ddagger}Johnson & Johnson Pharmaceutical Services, Raritan, New Jersey.

Anesth Analg 2007 105: 1428-1436.

 

背景:术后疼痛常用静脉自控镇痛方法(PCA)来控制。在此项会聚分析中,作者比较经皮芬太尼离子导入系统(ITS)和经静脉吗啡输注病人自控镇痛的安全性和有效性。

方法:数据来自3个多中心、随机、有效对照试验(样本量1941)。有效性(“好”、“很好”所占比例)是基于24小时内病人对镇痛控制方法的整体评价。同时评估疼痛强度、相对剂量比、中断率和不良事件。有效性的评估经过年龄、手术方式和体重指数(BMI)的校正后得出。

结果:24小时内病人对镇痛控制方法的整体评价为“有效”方面,两者相当(芬太尼ITS80.5%;吗啡 IV PCA81.0%;差异为-0.5%; 95%可信区间为-4.0%3.0%)。在24小时平均最后疼痛强度评分方面,两者也相当(芬太尼ITS,3.1; 吗啡 IV PCA,3.0; 差异为0.07; 95%可信区间为-0.140.29)。在第6、第12、第24小时,芬太尼组和吗啡组在总体和亚群(年龄、BMI)方面的相对剂量比相似。在年龄、手术方式和BMI方面,相比吗啡IV PCA,芬太尼ITS是等效的。中断率和不良事件发生率两者也相似。

结论:这些汇集的数据代表了芬太尼和吗啡的在术后急性疼痛处理对比研究。结果显示:在以年龄和BMI定义的各个亚群,芬太尼ITS同样有效。芬太尼ITS能提供持续、安全而有效的术后镇痛。

(於章杰 陈杰 校)

BACKGROUND: Postoperative pain is often managed using IV patient-controlled analgesia (PCA). In this analysis of pooled data, we compared the safety and efficacy of the fentanyl iontophoretic transdermal system (ITS) with morphine IV PCA.

METHODS: Data were obtained from three multicenter, randomized, active-controlled trials (N = 1941). The primary efficacy measure was success ("good"/"excellent" ratings) on the 24-h patient global assessment of the method of pain control. Pain intensity, relative dosing ratios, discontinuation rates, and adverse events were assessed. Efficacy was evaluated across age, surgery type, and body mass index (BMI).

RESULTS: Comparable percentages of patients reported success on the 24-h patient global assessment of the method of pain control (fentanyl ITS, 80.5%; morphine IV PCA, 81.0%; difference = –0.5%; 95% confidence interval, –4.0% to 3.0%). Mean last pain intensity scores in the first 24 h were comparable (fentanyl ITS, 3.1; morphine IV PCA, 3.0; difference = 0.07; 95% confidence interval, –0.14 to 0.29). Relative dosing ratios of fentanyl to morphine overall and in subpopulations (age, BMI) were comparable over 6, 12, and 24 h. Fentanyl ITS was equally effective when compared with morphine IV PCA for patient subpopulations (age, surgery type, and BMI). Discontinuation rates and the incidence of adverse events were similar between groups.

CONCLUSIONS: These pooled data represent one of the largest head-to-head comparisons of fentanyl versus morphine in a postoperative acute pain setting. Results suggest that fentanyl ITS is effective across subpopulations defined by age and BMI, and support a consistent safety and efficacy profile of fentanyl delivered by fentanyl ITS for postoperative pain management.

 

术后接受经皮等离子渗入系统给予芬太尼和通过静脉病人自控使用吗啡进行术后疼痛管理的系统相关事件和止痛间隙

System-Related Events and Analgesic Gaps During Postoperative Pain Management with the Fentanyl Iontophoretic Transdermal System and Morphine Intravenous Patient-Controlled Analgesia

Sunil J. Panchal, MD*, C. V. Damaraju, PhD{dagger}, Winnie W. Nelson, PharmD, MS{ddagger}, David J. Hewitt, MD{dagger}, and Jeff R. Schein, DrPH, MPH{dagger}

From the *Coalition for Pain Education Foundation, Tampa, Florida; {dagger}Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, New Jersey; and {ddagger}Xcenda, Palm Harbor, Florida.

Anesth Analg 2007 105: 1437-1441.

 

背景:止痛的间隙(止痛效果间断)成为术后疼痛管理无效的因素。在这一项分析中,作者评估了芬太尼经皮电离子渗透系统(一种非侵入性的病人自控止痛系统ITS)和吗啡静脉病人自控镇痛(PCA行术后疼痛管理时系统相关事件(SREs及止痛间隙的发生率。

方法:收集两组开放、随机、对照试验数据, 评估全髋置换术、腹部手术或盆腔手术术后芬太尼ITS吗啡PCA的效能和安全性。通过系统相关事件、止痛间隙的发生率以及持续时间来评估。

结果:总数为 1305位病人中647位病人接受ITS658位病人接受PCA ITS发生止痛间隙的发生率明显低于PCA(分别为5.8712.01,P 0.001)。与吗啡静脉PCA相比,接受芬太尼ITS的病人不仅止痛间隙时间(15.0 min vs 20.0 min)低于总的止痛间隙的平均值,而且低于总的系统相关事件解决时间的平均值(11.0 min vs 20.0 min)多数芬太尼ITS发生SRES通过提供新的ITS解决,而吗啡静脉PCA需要采用许多其他不同的SRE 解决方法

结论:芬太尼ITS发生止痛间隙的发生率明显低于通过吗啡静脉PCA。芬太尼ITS可以提供较少的止痛间隙和更持久的连续镇痛。

(王鹏 陈杰 校)

BACKGROUND: Analgesic gaps (interruptions in analgesic delivery) contribute to ineffective postoperative pain management. In this analysis, we evaluated the incidence of analgesic gaps resulting from system-related events (SREs) for patients using the fentanyl iontophoretic transdermal system (ITS), a noninvasive patient-controlled analgesia (PCA) system, or morphine IV PCA for postoperative pain management.

METHODS: Data were pooled from two open-label, randomized, active-controlled trials that evaluated the efficacy and safety of fentanyl ITS and morphine IV PCA after total hip replacement, abdominal, or pelvic surgery. The incidence and duration of analgesic gaps resulting from SREs were assessed, along with SRE resolution times.

RESULTS: A total of 1305 patients received fentanyl ITS (n = 647) or morphine IV PCA (n = 658). Fentanyl ITS was associated with a significantly lower incidence of analgesic gaps per 100 patients compared with morphine IV PCA (5.87 vs 12.01, respectively; P < 0.001). Compared with patients receiving morphine IV PCA, patients receiving fentanyl ITS had both a numerically lower median total analgesic gap time (15.0 min vs 20.0 min) and a numerically lower median total SRE resolution time (11.0 min vs 20.0 min). Most fentanyl ITS SREs were resolved by applying a new system, whereas many different SRE resolution methods were used for morphine IV PCA.

CONCLUSIONS: Fentanyl ITS was associated with a significantly lower incidence of analgesic gaps relative to morphine IV PCA. Fentanyl ITS may provide patients with fewer interruptions and more continuous analgesic delivery.

 

加巴喷丁预防导管相关膀胱不适的疗效评估:一项前瞻、随机、对照、双盲研究

An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Anil Agarwal, MD*, Sanjay Dhiraaj, MD*, Sandeep Pawar, MD*, Rakesh Kapoor, McH{dagger}, Devendra Gupta, MD*, and Prabhat K. Singh, MD*

From the Departments of *Anesthesia and {dagger}Surgical Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Anesth Analg 2007 105: 1454-1457.

 

背景:由放置导尿管引起的导管相关膀胱不适(CRBD)是很痛苦的。在本研究中,作者评估了加巴喷丁对CRBD的预防作用。

方法:108位接受选择性经皮肾取石术患者,ASA I级或II级,男女都有,随机被分为2组,54人一组。对照组:使用安慰剂;加巴喷丁组(G组):使用加巴喷丁600mg。在术前一小时口服药物。麻醉诱导后,使用16F Foley导管进行置管,10ml生理盐水充气囊。在恢复室里分别观察患者到达时,到达后1h2h6h时,CRBD的发生率和程度(轻度,中度和重度)。

结果:加巴喷丁减少CRBD的发生率,仅为50%54/27),与之相比,对照组CRBD的发生率为80%54/43)(P<0.05)。加巴喷丁同样减少CRBD的程度,以及术后疼痛,因为观察到加巴喷丁组患者术后需要芬太尼的人数以及术后总消耗芬太尼的量有明显减少(P<0.05)。

结论:术前1h口服加巴喷丁(600mg)可以减少CRBD的发生率和程度,术后疼痛,需要芬太尼的患者人数以及术后总芬太尼使用量。

(朱玫娟 陈杰 校)

BACKGROUND: Catheter-related bladder discomfort (CRBD) secondary to catheterization of urinary bladder is distressing. In the present study, we evaluated gabapentin for preventing CRBD.

METHODS: One-hundred and eight consecutive adult patients, ASA physical status I and II, of either sex, undergoing elective percutaneous nephrolithotomy were randomized into two groups of 54 each. Group control: placebo and group G gabapentin: gabapentin 600 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL normal saline. In the postanesthesia care unit, the incidence and severity (mild, moderate, and severe) of CRBD were assessed on arrival (0) and at 1, 2, and 6 h.

RESULTS: Gabapentin reduced the incidence of CRBD to 50% (27 of 54) compared with 80% (43 of 54) observed in the control group (P < 0.05). Gabapentin also reduced the severity of CRBD and postoperative pain as observed by a reduction in the number of patients requiring any fentanyl and the total fentanyl consumption postoperatively (P < 0.05).

CONCLUSION: Gabapentin (600 mg) administered orally 1 h before surgery reduced the incidence and severity of CRBD, postoperative pain, number of patients requiring fentanyl and postoperative total fentanyl requirement.

 

炎性疼痛大鼠模型中外周α2-肾上腺受体参与奥卡西平的抗痛觉过敏效应

The Involvement of Peripheral {alpha}2-Adrenoceptors in the Antihyperalgesic Effect of Oxcarbazepine in a Rat Model of Inflammatory Pain

Maja A. Tomic, BPharm, MSc*, Sonja M. Vuckovic, MD, PhD{dagger}, Radica M. Stepanovic-Petrovic, BPharm, PhD*, Nenad D. Ugresic, BPharm, PhD*, Sonja Lj Paranos, BPharm*, Milica SProstran, MD, PhD{dagger}, and Bogdan Boskovic, BPharm, MD, PhD{ddagger}

From the *Department of Pharmacology, Faculty of Pharmacy, {dagger}Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; and {ddagger}Medical Military Academy, Belgrade, Serbia.

Anesth Analg 2007 105: 1474-1481.

 

背景:作者通过检测氢化麦角新碱(选择性α2-肾上腺素受体拮抗剂)、BRL44408(选择性α2A-肾上腺素受体拮抗剂)、MK912(选择性α2C-肾上腺素受体拮抗剂)和可乐定(α2-肾上腺素受体兴奋剂)在炎性疼痛大鼠模型中的抗痛觉过敏效应,来研究外周α2-肾上腺素能受体是否与奥卡西平的抗痛觉过敏反应有关。

方法:给大鼠跖部注射炎性前体复合物(ConA)。通过测定大鼠爪部压力来反应:1Con A产生痛觉过敏的发展过程;2)奥卡西平对于Con A所产生的痛觉过敏所发生的相应效应;3)氢化麦角新碱、BRL44408MK912、可乐定对奥卡西平的抗痛觉过敏效应的作用。

结果:奥卡西平(跖部注射10003000nmol/paw)和可乐定(跖部注射1.97.5nmol/paw)可显著减轻Con A所产生的炎性痛觉过敏,并呈剂量依赖性。氢化麦角新碱(跖部注射260520nmol/paw)、BRL44408(跖部注射100200nmol/paw)MK912(跖部注射1020nmol/paw)可显著抑制奥卡西平(跖部注射2000nmol/paw)的抗痛觉过敏效应,并呈剂量依赖性。拮抗剂的效应是局部的,因为在对侧跖部的背部并没有观察到拮抗剂的效应。当奥卡西平和可乐定以固定比例的剂量(ED501/4,1/23/4)给予时,可显著减轻Con A的痛觉过敏反应,并呈剂量依赖性,Isobolographic分析显示它们具有累加作用。

 

结论:结果证明在炎性痛觉过敏大鼠模型中,外周α2A肾上腺受体和α2C肾上腺能受体与奥卡西平的抗痛觉过敏效应有关。

(詹琼慧 陈杰 校)

BACKGROUND: We studied whether peripheral {alpha}2-adrenergic receptors are involved in the antihyperalgesic effects of oxcarbazepine by examining the effects of yohimbine (selective {alpha}2-adrenoceptor antagonist), BRL 44408 (selective {alpha}2A-adrenoceptor antagonist), MK-912 (selective {alpha}2C-adrenoceptor antagonist), and clonidine ({alpha}2-adrenoceptor agonist) on the antihyperalgesic effect of oxcarbazepine in the rat model of inflammatory pain.

METHODS: Rats were intraplantarly (i.pl.) injected with the proinflammatory compound concanavalin A (Con A). A paw-pressure test was used to determine: 1) the development of hyperalgesia induced by Con A; 2) the effects of oxcarbazepine (i.pl.) on Con A-induced hyperalgesia; and 3) the effects of i.pl. yohimbine, BRL 44408, MK-912 and clonidine on the oxcarbazepine antihyperalgesia.

RESULTS: Both oxcarbazepine (1000–3000 nmol/paw; i.pl.) and clonidine (1.9–7.5 nmol/paw; i.pl.) produced a significant dose-dependent reduction of the paw inflammatory hyperalgesia induced by Con A. Yohimbine (260 and 520 nmol/paw; i.pl.), BRL 44408 (100 and 200 nmol/paw; i.pl.) and MK-912 (10 and 20 nmol/paw; i.pl.) significantly depressed the antihyperalgesic effects of oxcarbazepine (2000 nmol/paw; i.pl.) in a dose-dependent manner. The effects of antagonists were due to local effects since they were not observed after administration into the contralateral hindpaw. Oxcarbazepine and clonidine administered jointly in fixed-dose fractions of the ED50 (1/4, 1/2, and 3/4) caused significant and dose-dependent reduction of hyperalgesia induced by Con A. Isobolographic analysis revealed an additive antihyperalgesic effect.

CONCLUSIONS: Our results indicate that the peripheral {alpha}2A and {alpha}2C adrenoceptors could be involved in the antihyperalgesic effects of oxcarbazepine in a rat model of inflammatory hyperalgesia.

 

 2%等比重利多卡因蛛网膜下腔麻醉后暂时性神经综合征:穿刺针类型的影响

Transient Neurological Symptoms After Isobaric Subarachnoid Anesthesia with 2% Lidocaine: The Impact of Needle Type

Shmuel Evron, MD*{dagger}{ddagger}, Victoria Gurstieva, RN, MPH§, Tiberiu Ezri, MD{dagger}{ddagger}, Vladimir Gladkov, MD{dagger}, Sergey Shopin, MD{dagger}, Amir Herman, MSc||, Ami Sidi, MD, and Shimon Weitzman, MD, MPH§

From the *Obstetric Anesthesia Unit, and {dagger}Department of Anesthesia, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel; {ddagger}Outcomes Research Group, Cleveland, Ohio; §Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva; ||Department of Statistics, Haifa University; and ¶Department of Urology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Anesth Analg 2007 105: 1494-1499.

 

背景:利多卡因蛛网膜下腔麻醉后暂时性神经综合征(TNS)的报道发生率达40%。作者因此设计了本临床试验以研究两种不同类型腰麻穿刺针(单孔:Atraucan和双孔:Eldor穿刺针)的TNS发生率:。

技术:99名行膀胱或前列腺手术,ASA分级为I级或Ⅱ级的患者随机接受使用26Atraucan针或26Eldor针行腰麻,麻醉药为2%等比重利多卡因40mg+芬太尼。在术后前3天内,记录患者的术后并发症,包括TNS。主要研究终点是双孔和单孔腰麻穿刺针组的TNS发生的百分比。

结果:当使用Atraucan针行腰麻时TNS的发生率较高(28.8%vs8.5%P=0.006)。截石位患者术后TNS发生率为双孔组50%,单孔组100%P=0.014)。Eldor针发生TNS的相对危险系数与Atraucan针相比为0.2995%可信区间:0.07-0.75)。

结论:使用双孔腰麻穿刺针后TNS的发生率较低,这可能与穿刺针的设计有关。

(丁震敏 陈杰 校)

BACKGROUND: The reported incidence of transient neurological symptoms (TNS) after subarachnoid lidocaine administration is as high as 40%. We designed this clinical trial to determine the incidence of TNS with two different pencil-point spinal needles: one-orifice (Atraucan) and two-orifice (Eldor) spinal needles.

METHODS: Ninety-nine ASA physical status I or II patients undergoing surgical procedures of the urinary bladder or prostate were prospectively allocated to receive spinal anesthesia with 40 mg, 2% isobaric lidocaine plus fentanyl injected through either a 26-gauge Atraucan (n = 52) or a 26-gauge Eldor (n = 47) spinal needle. During the first three postoperative days, patients were observed for postoperative complications, including TNS. The primary end-point for this trial was the percentage of TNS in both double- and single-orifice spinal needle procedures.

RESULTS: The incidence of TNS was higher when spinal anesthesia was done through the Atraucan needle (28.8% vs 8.5%, P = 0.006). Fifty percent of the patients in the double-orifice group versus 100% of the single-orifice group developed TNS after surgery in the lithotomy position (P = 0.014). The relative risk for developing TNS with the Eldor needle was 0.29 (95% CI: 0.07–0.75) compared with the Atraucan needle.

CONCLUSIONS: The use of a double-orifice spinal needle was associated with a lower incidence of TNS, which may have been due to the needle design.

异氟醚预处理的Ca2+循环蛋白独立于肌细胞膜及线粒体膜ATP敏感钾通道对心肌的保护

Myocardial protection by isoflurane preconditioning preserves Ca2+ cycling proteins independent of sarcolemmal and mitochondrial KATP channels.

An J, Bosnjak ZJ, Jiang MT.

Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.

Anesth Analg 2007 105: 1207-1213.

 

引言:吸入麻醉药的预处理(APC)提高收缩功能的恢复,减少缺血再灌注(I/R)后的钙负荷。肌细胞膜及线粒体膜ATP敏感钾通道的开放已被用于APC导致的心肌保护。在本研究中,我们研究APC在主要Ca2+循环蛋白及其相关的ATP敏感钾通道的效应。方法:我们将离体鼠心分为七组:时间组(n = 10),缺血组(n = 8)APC (n = 8),线粒体膜5-HD抑制的ATP敏感钾通道组(5-HD, 200 microM, n = 8)HMR1098抑制的细胞膜ATP敏感钾通道组(HMR, 20 microM, n = 8),和APC叠加5-HDHMR1098(n = 8)APC1.5%的异氟醚吸入15分钟开始,接着是30分钟的缺血和60分钟的再灌注后的15分钟洗出。 RyR2SERCA2a,受磷蛋白,质膜Ca2+ ATP酶和钠钙交换在匀浆被测定。结果:在I/R APC提高收缩功能的恢复(左室压力,+dP/dt, -dP/dt),但可被5-HD HMR阻断。I/R抑制RyR2SERCA2a和受磷蛋白的密度,但无质膜Ca2+ ATP酶和钠钙交换。结论:I/R导致的在心脏的抑制与主要Ca2+循环蛋白的下调有关。异氟醚的预处理阻止RyR2SERCA2a I/R 相关的降解,但它独立于敏感钾通道组的激活。

(陈勇柱译 薛张纲校)

INTRODUCTION: Anesthetic preconditioning (APC) with volatile anesthetics improves recovery of contractile function and reduces calcium overload after ischemia/reperfusion (I/R). Mitochondrial and sarcolemmal K(ATP) channel openings have been implicated in APC-induced cardioprotection. In this study, we investigated the effect of APC on major calcium cycling proteins and its relation to K(ATP) channels. METHODS: Isolated perfused rat hearts were divided into seven groups: Time control (n = 10), ischemia control (n = 8), APC (n = 8), Mitochondrial K(ATP) inhibitor 5-hydroxydecanoate (5-HD, 200 microM, n = 8), Sarcolemmal K(ATP) inhibitor HMR1098 (HMR, 20 microM, n = 8), and APC plus 5-HD or APC plus HMR1098 (n = 8 each). APC was initiated by administering 1.5% isoflurane for 15 min, followed by a 15 min washout before 30 min of myocardial ischemia and 60 min of reperfusion. Ca2+-release channels (RyR2), Ca2+-adenosine triphosphatase (SERCA2a), phospholamban, plasma membrane Ca2+ ATPase, and sodium-calcium exchanger in the homogenate were determined by Western blot assay. RESULTS: APC improved contractile recovery (left ventricular developed pressure, +dP/dt, -dP/dt) after I/R, which was blocked by 5-HD and HMR. I/R depressed the density of RyR2, SERCA2a, and phospholamban, with no changes in the density of plasma membrane Ca2+ ATPase and sodium-calcium exchanger. APC reversed I/R-induced degradation of RyR2 and SERCA2a in the presence or absence of 5HD and HMR. CONCLUSIONS: I/R-induced depression in cardiac performance is associated with a down-regulation of the major sarcoplasmic reticulum Ca2+-cycling proteins. Anesthesia preconditioning with isoflurane prevents I/R-related degradation of the RyR2 and SERCA2a in the sarcoplasmic reticulum. However, this effect was independent of its activation of K(ATP) channels.

 

连续外周神经阻滞用于小儿术后镇痛

Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in chiidren

Arjunan ganesh, john BR, Lawrence W, Theodore ganley, Harshad gurnaney, Lynne GM, Theresa D, et al.

From the department of anesthesia and critical care medicine, the children’s hospital of Philadelphia, university of Pennsylvania school of medicine, and department of orthopedics, the children’s hospital of Philadelphia, Philadelphia, Pennsylvania.

Anesth analg 2007; 105: 1234-42.

 

背景:评价连续外周神经阻滞(CPNB)用于小儿矫形外科手术术后镇痛效果。方法:回顾20032月到20067月费城儿科医院局部麻醉和术后接受CPNB镇痛的续惯性登记病例。随访患儿直到CPNB/或任何相关并发症治愈。同时记录感觉和运动神经阻滞情况、疼痛评分、阿片类镇痛药使用量和与CPNB相关的并发症。结果:217例患者放置226次外周神经导管。108例患者(112导管)带CPNB出院回家。年龄从4-18岁(13.7±3.4)。局麻药包括0.125%布比卡因(n=164),0.1%罗哌卡因(n=12),或0.15%罗哌卡因(n=17)。局麻药注射初始速度按照体重和导管位置不同设置为2-12mL/h。局麻药输注平均时间48.4±29.3h0-160h)。患者在首次82448h不需要任何镇痛的分别为56%26%21%。恶心呕吐发生率为14%(出院患者13% 住院患者15%)。并发症发生率占2.8%3例患者麻痹时间超过24h,但自然恢复;1例患者出现表面蜂窝织炎,使用抗生素后恢复;1例患者出现导管拔除困难;1例患者在开始CPNB24h后出现耳鸣,迅速夹闭导管并拔除后恢复。结论:合理的技术条件许可下,小儿矫形外科手术后使用CPNB方案进行术后镇痛是可行的,并为门诊和住院患者提供的又一种术后镇痛的方法。给患者和家属宣教和随访是快速判断和治疗不良事件的关键。

(吴德华译 薛张纲校)

BACKGROUND: This is an audit of the continuous peripheral nerve blockade (CPNB) program that was implemented at our institution to provide postoperative analgesia after orthopedic procedures in children. METHODS: We reviewed the departmental regional anesthesia registry and the medical records of consecutive children who received CPNB for postoperative analgesia at The Children’s Hospital of Philadelphia between February 2003 and July 2006. Patients were prospectively followed until cessation of the effects of CPNB and/or resolution of any related

complications. Data collected contemporaneously included presence of sensory and motor blockade, pain scores in inpatients, opioid administration, and complications related to CPNB. RESULTS: A total of 226 peripheral nerve catheters were placed in 217 patients. One hundred eight patients (112 catheters) were discharged home with CPNB. The ages ranged from 4 to 18 yr (13.7 _ 3.4). Local anesthetic solution (0.125% bupivacaine [n _ 164], 0.1% ropivacaine [n _ 12], or 0.15% ropivacaine [n _ 27]) was infused at an initial rate of 2–12 mL/h based on patients’ weights and locations of catheters. The mean duration of local anesthetic infusion was 48.4 _ 29.3 h (range 0–160 h). The percentage of patients who did not require any opioids in the first 8, 24, and 48 h after surgery was 56%, 26%, and 21%, respectively. The incidence of nausea and vomiting was 14% (13% in outpatients, 15% in inpatients). Complications were noted in 2.8% of patients. Three patients had prolonged numbness (_24 h) that resolved spontaneously; one developed superficial cellulitis that resolved with a course of antibiotics; one had difficulty removing the catheter at home and one developed tinnitus 24 h after starting CPNB that resolved quickly after clamping of the catheter followed by removal. CONCLUSION: It is feasible to implement a CPNB program to provide an alternative method of inpatient and outpatient postoperative analgesia after orthopedic surgery in children when appropriate expertise is available. Patient and family education along with frequent follow-up are crucial to detect and address adverse events promptly.

 

门诊预行LC的病人术中用艾斯洛尔代替阿片类药物可节省术后芬太尼用量

Intraoperative Esmolol Infusion in the Absence of Opioids Spares Postoperative Fentanyl in Patients Undergoing Ambulatory Laparoscopic Cholecystectomy

Vincent Collard, MD*, Giovanni Mistraletti, MD*, Ali Taqi, MD{dagger}, Juan Francisco Asenjo, MD*, Liane S. Feldman, MD{dagger}, Gerald M. Fried, MD{dagger}, and Franco Carli, MD, MPhil*

From the Departments of *Anesthesia and {dagger}Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

Anesth Analg 2007 105: 1255-1262.

 

背景:门诊手术使用阿片类药物会延长住院周转或引起非预期的住院。术中持续使用艾斯洛尔以代替阿片类药物的初期研究显示不一致的关于术后节省阿片类药物的报道。在此次研究中,我们在术后阿片类减量、副作用及出院时间等方面比较了使用艾斯洛尔与间断使用芬太尼或持续使用瑞芬太尼的区别。方法:90个病人(包括三组)进行前瞻性、随机、双盲研究。对照组(n=30)间断注射芬太尼,艾斯洛尔组(n=30)持续注射艾斯洛尔5–15 µg · kg–1 · min–1 且术中不追加阿片类药物,瑞芬太尼组(n=30)持续注射瑞芬太尼0.1–0.5 µg · kg–1 · min–1 。全麻过程被标准化,辅助用药包括扑热息痛、痛力克,皮肤切口处局麻,地米及氟哌利多。术后镇痛用芬太尼。结果:术后镇痛使用芬太尼的用量,相对于瑞芬组的237.8 ± 54.7 µg及对照组的168.1 ± 96.8 µg,艾斯洛尔组的91.5 ± 42.7µg明显减少(P < 0.0001)。术后恶心呕吐的发生率与艾斯洛尔的30%相比,对照组的66.7%及瑞芬组的67.9%明显更频繁(P < 0.01)。艾斯洛尔组达到White-Song评分12-14快于瑞芬组(P < 0.01),且离开医院要早45-60分钟(P < 0.004)。结论:术中给予艾斯洛尔使术后芬太尼及昂丹司琼的用量显著减少并且出院更早。

( 霞译 薛张纲校)

BACKGROUND: The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge. METHODS: Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study. The control group (n = 30) received intermittent doses of fentanyl, the esmolol group (n = 30) received a continuous infusion of esmolol (5–15 µg · kg–1 · min–1) and no supplemental opioids during surgery, and the remifentanil group (n = 30) received a continuous infusion of remifentanil (0.1–0.5 µg · kg–1 · min–1). General anesthesia was standardized, and adjuvant medications included acetaminophen, ketorolac, local anesthetics in the skin incisions, dexamethasone, and droperidol. Postoperative analgesia included fentanyl. RESULTS: The amount of fentanyl in the postanesthesia care unit was significantly less in the esmolol group, 91.5 ± 42.7 µg, compared with the other two groups, remifentanil, 237.8 ± 54.7 µg, control, 168.1 ± 96.8 µg (P < 0.0001). The incidence of nausea was more frequent in the control (66.7%) and remifentanil (67.9%) groups compared with the esmolol group (30%) (P < 0.01). The esmolol group reached the White-Song score of 12 of 14 faster than the remifentanil group (P < 0.01), and left the hospital 45–60 min earlier (P < 0.004). CONCLUSIONS: Intraoperative IV infusion of esmolol contributes to a significant decrease in postoperative administration of fentanyl and ondansetron and facilitates earlier discharge.

 

 

不同静脉麻醉药对肺静脉平滑肌肌丝钙离子敏感性的影响

The Differential Effects of Intravenous Anesthetics on Myofilament Ca2+ Sensitivity in Pulmonary Venous Smooth Muscle

Xueqin Ding, MD, PhD, and Paul A. Murray, PhD

From the Center for Anesthesiology Research, The Cleveland Clinic Foundation, Cleveland, Ohio.

Anesth Analg 2007 105: 1278-1286.

 

背景:肺静脉的收缩可以增加肺毛细血管压和加重肺水肿。在本次研究中,我们探查了氯胺酮、依托咪酯、硫喷妥钠和咪达唑仑对肺静脉收缩和透化处理的肺静脉平滑肌(PVSM)肌丝钙离子敏感性的直接影响。方法:我们用离体的犬肺静脉检测这些静脉麻醉药对乙酰胆碱收缩的影响。经过α毒素透化处理后同时测量载有fura-2的内皮裸露的PVSM的电压和钙离子电流。测量静脉麻醉药对缺乏或存在毒蕈碱受体活性的电压的影响(维持钙离子恒定)。在加入氯胺酮之前和之后运用免疫荧光技术和共聚焦显微镜集中PVSM细胞中细胞分配的蛋白激酶C亚型。结果:氯胺酮、依托咪酯和咪达唑仑都呈剂量依赖的减弱乙酰胆碱的收缩,然而硫喷妥钠没有影响。任何一个静脉麻醉药单独应用时在钙离子恒定时对电压都没有影响(i.e.,它们对肌丝的钙离子敏感性没有直接影响)。乙酰胆碱在钙离子恒定时增加56± 7%的电压。在乙酰胆碱激活带,硫喷妥钠、依托咪酯和咪达唑仑在钙离子恒定时对压力没有其他影响,而氯胺酮降低33% ± 3%的电压。被乙酰胆碱激活诱导的PKC{alpha}从胞质易位到胞膜可被氯胺酮阻断。结论:氯胺酮、依托咪酯,和咪达唑仑都减弱乙酰胆碱诱导的肺静脉收缩。氯胺酮通过抑制乙酰胆碱诱导的肌丝钙离子敏感性增加和乙酰胆碱诱导的PKC{alpha}易化减弱乙酰胆碱的收缩。

(王时来译 薛张纲校)

BACKGROUND: Pulmonary venous contraction can increase pulmonary capillary pressure and pulmonary edema. In the present study, we investigated the direct effects of ketamine, etomidate, thiopental, and midazolam on pulmonary venous contraction and myofilament Ca2+ sensitivity in permeabilized pulmonary venous smooth muscle (PVSM). METHODS: The effects of these IV anesthetics on acetylcholine contraction were assessed in isolated canine pulmonary vein rings. Tension and [Ca2+]i were measured simultaneously in fura-2 loaded endothelium-denuded PVSM strips after being permeabilized with {alpha}-toxin. The effects of the IV anesthetics on tension ([Ca2+]i remains constant) in the absence or the presence of muscarinic receptor activation (acetylcholine) were assessed. The immunofluorescence technique and confocal microscopy were used to localize the cellular distribution of protein kinase C (PKC) isoforms in PVSM cells before and after the addition of ketamine. RESULTS: Ketamine, etomidate, and midazolam each attenuated acetylcholine contraction dose-dependently, whereas thiopental had no effect. None of the IV anesthetics alone had an effect on tension in strips at constant [Ca2+]i (i.e., they had no direct effect on myofilament Ca2+ sensitivity). Acetylcholine increased tension by 56% ± 7% at constant [Ca2+]i. In acetylcholine-stimulated strips, etomidate, midazolam, and thiopental had no additional effect on tension at constant [Ca2+]i, whereas ketamine decreased tension by 33% ± 3%. Activation with acetylcholine induced translocation of PKC{alpha} from cytoplasm to membrane, and this effect was blocked by ketamine. CONCLUSIONS: Ketamine, etomidate, and midazolam each attenuated acetylcholine-induced pulmonary venous contraction. Ketamine attenuates acetylcholine contraction by inhibiting the acetylcholine-induced increase in myofilament Ca2+ sensitivity and the acetylcholine-induced translocation of PKC{alpha}.

 

 

小剂量静脉注射咪达唑仑降低依托咪酯诱导的肌阵挛:对进行电复律病人的前瞻性随机实验

Low-dose intravenous midazolam reduces etomidate-induced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion.

Hüter L, Schreiber T, Gugel M, Schwarzkopf K.

From the Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller- Universität Jena, Germany.

Anesth Analg. 2007 105(5):1298-302

 

背景:用依托咪酯对没有术前用药的病人进行麻醉诱导时发生肌振挛是一个常见问题.方法:在一个双盲实验中,40位将进行电复律的病人(ASA评级III-IV)在注射0.3 mg/kg依托咪酯前90秒被随机分配,使用0.015 mg/kg咪达唑仑或安慰剂.肌振挛现象和镇静作用以03分级记录,脉搏氧饱和度、无创动脉血压和心率也被记录下来.结果:咪达唑仑组中2个病人(10%)在使用依托咪酯后发生肌振挛,20个安慰剂组中的病人有10(50%)发生(P = 0.006).两组中没有发现其他不同的现象,而在依托咪酯注射后的5分钟两组的病人在苏醒方面也没有别的不同.结论:用依托咪酯进行诱导前90秒静脉注射0.015 mg/kg咪达唑仑对降低肌振挛的发生是很有效的,并且在一个短暂的过程后这并不延迟未使用术前用药的病人的苏醒.

 ( 楊译 薛张纲校)

BACKGROUND: Myoclonic movements are a common problem in unpremedicated patients during induction of anesthesia with etomidate. METHODS: In a double-blind fashion, 40 patients (ASA physical status III-IV) scheduled for elective cardioversion were randomly assigned to receive either 0.015 mg/kg midazolam or placebo 90 s before the injection of 0.3 mg/kg etomidate. Myoclonic movements and sedation were recorded on a scale between 0 and 3. Pulse oximetry, noninvasive arterial blood pressure, and heart rate were recorded during the study period. RESULTS: Two patients (10%) in the midazolam group had myoclonic movements after the administration of etomidate, whereas 10 of the 20 patients (50%) receiving placebo experienced such movements (P = 0.006). No other differences were found between the groups; in particular, there was no difference in recovery 5 min after the administration of etomidate. CONCLUSIONS: IV midazolam 0.015 mg/kg administered 90 s before induction of anesthesia with etomidate is effective in reducing myoclonic movements and does not prolong recovery in unpremedicated patients after short procedures.

 

异丙酚削弱内毒素诱导内皮细胞损伤血管紧张素转换酶脱落和肺水肿

Propofol Attenuates Endotoxin-Induced Endothelial Cell Injury, Angiotensin-Converting Enzyme Shedding, and Lung Edema
E. Gina Votta-Velis, MD*, Richard D. Minshall, PhD*{dagger}, David J. Visintine, BA*{dagger}, Maricela Castellon, BS*{dagger}, and Irina V. Balyasnikova, PhD*

Address correspondence and reprint requests to Irina V. Balyasnikova, PhD, Anesthesiology Research Center, University of Illinois at Chicago, 1819 W. Polk St. (M/C 519), Chicago, IL 60612.

Anesth Analg 2007 105: 1363-1370.

 

背景:急性肺损伤是一种常见的综合症在败血症病人中。之前,我们发现异丙酚,一种高度脂溶性的麻醉药,削弱了孤立的灌注的鼠肺的缺血-再灌注损伤和氧化肺损伤。在这篇研究中,我们评估了异丙酚在内毒素诱导的急性肺损伤和内皮功能紊乱的作用。方法:异丙酚对内毒素诱导的肺内皮损伤的作用可以用血浆和肺组织混合物血管紧张素Ⅰ转换酶活性、肺血管抗ACE单克隆抗体结合物、和肺净重和体重比值来评估。结果:为老鼠开放静脉,内毒素产生内皮细胞损伤和肺水肿,有如下症状:1)血浆ACE活性提高 2)肺ACE活性和抗-ACE单克隆抗体结合的降低 3LW/BW的降低。单克隆抗体1A2比其他抗-ACE单克隆抗体在监测使用内毒素鼠肺的ACE降低的敏感性要高1.8倍。在给老鼠注射内毒素前预注一个剂量的异丙酚会极大得抑制血中ACE活性的增加,肺中ACE活性的降低,结合在肺中的抗ACE单克隆抗体的减少,以及LW/BW比值的增加。重要的是,异丙酚还极大地增加了存活老鼠的数量。异丙酚对使用内毒素的动物的保护机制同样适合于体外,比如,异丙酚降低了在培养中的内皮细胞的损伤和从内皮细胞脱落的ACE。结论:这些结果表明异丙酚提供了极大的对内毒素诱导的肺微血管内皮细胞损伤的保护作用,以及抗ACE单克隆抗体1A2是监测内皮功能紊乱和败血症时急性肺损伤的敏感指针。

(陈佳莉译 薛张纲校)

BACKGROUND: Acute lung injury (ALI) is a frequent complication in septic patients. Previously, we found that propofol, a highly lipid-soluble anesthetic, attenuates ischemia-reperfusion and oxidative lung injury in the isolated perfused rat lung. In the present study, we evaluated the effect of propofol on endotoxin-induced ALI and endothelial dysfunction.METHODS: The effect of propofol on endotoxin-induced lung endothelial injury was evaluated by plasma and lung tissue homogenate angiotensin I converting enzyme (ACE) activity, pulmonary vascular anti-ACE monoclonal antibody binding, and lung wet weight to body weight ratio (LW/BW). RESULTS: When injected IV into rats, endotoxin produced endothelial cell injury and lung edema, as indicated by: 1) an increase in plasma ACE activity, 2) a decrease in lung ACE activity and anti-ACE monoclonal antibody binding, and 3) an increase in LW/BW. Monoclonal antibody 1A2 was up to 1.8 times more sensitive than other anti-ACE monoclonal antibodies in detecting the decrease in ACE in lungs of endotoxin-treated rats. Pretreatment of rats with a bolus of propofol before endotoxin injection significantly inhibited the increase in ACE activity in the blood, the decrease in ACE activity in the lung, the decrease in anti-ACE monoclonal antibody binding in the lung, and the increase in LW/BW ratio. Importantly, propofol also significantly increased the survival rate of endotoxin-treated animals. The protective effect of propofol in endotoxin-treated animals in vivo was confirmed in vitro, i.e., propofol decreased endothelial cell injury and ACE shedding from endothelial cells in culture.CONCLUSIONS: These results suggest that propofol offers significant protection against endotoxin-induced pulmonary microvessel endothelial cell injury and that anti-ACE monoclonal antibody 1A2 is a sensitive probe for monitoring endothelial dysfunction and ALI during sepsis.

 

 

在戊巴比妥麻醉的实验狗中不同的多巴酚丁胺输注速度对改善因高碳酸血症所致的膈肌收缩力下降的效果

The Effects of Different Dobutamine Infusion Rates on Hypercapnic Depression of Diaphragmatic Contractility in Pentobarbital-Anesthetized Dogs

Yoshitaka Fujii, MD, and Aki Uemura, MD

From the Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, Tsukuba City, Ibaraki, Japan.

Anesth Analg 2007 105: 1379-1384.

 

背景:以往有证据显示,对于高碳酸血症患者,多巴酚丁胺比多巴胺更有利于改善膈肌的收缩力。这里,我们研究了戊巴比妥麻醉的实验狗,不同的多巴酚丁胺输注速率对改善高碳酸血症所致的膈肌收缩力下降的效果。方法:实验动物被分为四组,每组六只。每组通过吸入含有10%的CO2的气体制造高碳酸血症(8090mmHg)模型。高碳酸血症模型建立后,Dob 0组不给药;Dob 5给予多巴酚丁胺5 µg·kg–1·min–1Dob 10给予多巴酚丁胺10 µg·kg–1·min–1 Dob 15给予多巴酚丁胺15 µg·kg–1·min–1 。多巴酚丁胺试验药静脉给药,持续60min。膈肌的收缩力通过测定经膈肌的压力(Pdi)评估。结果:在高碳酸血症中,每组在低频刺激和高频刺激下,Pdi相对于基线降低(P < 0.05)Dob 0, Pdi在每次刺激下没有变化。在Dob 5组,Dob 10, Dob 15,给予了试验药后,Pdi有所改善;并且在每个刺激下,与多巴酚丁胺输注速度成正相关。结论:在戊巴比妥麻醉实验狗中,多巴酚丁胺可以有效改善高碳酸血症所致的膈肌收缩力的下降,并且与输注速度成正相关。

(陈珺珺译  薛张纲校)

BACKGROUND: Previously, we demonstrated that dobutamine was more effective than dopamine for the improvement of diaphragmatic contractility during hypercapnia. Here, we studied the effects of different dobutamine infusion rates on hypercapnic depression of diaphragmatic contractility in pentobarbital-anesthetized dogs. METHODS: Animals were divided into four groups of six each. In each group, hypercapnia (80–90 mm Hg) was produced by adding 10% CO2 to inspired gas. When hypercapnia was established, group Dob 0 received no study drug; group Dob 5 was induced with dobutamine 5 µg · kg–1 · min–1; group Dob 10 was induced with dobutamine 10 µg · kg–1 · min–1; group Dob 15 was induced with dobutamine 15 µg · kg–1 · min–1. Study drugs were administered IV for 60 min. Diaphragmatic contractility was assessed by measurement of transdiaphragmatic pressure (Pdi). RESULTS: In the presence of hypercapnia, in each group, Pdi at low-frequency (20 Hz) and high-frequency (100 Hz) stimulation decreased from baseline (P < 0.05). In group Dob 0, Pdi to each stimulus did not change from hypercapnia-induced values. In groups Dob 5, Dob 10 and Dob 15, during the study drug administration, Pdi at both stimuli increased from hypercapnia-induced values (P < 0.05). There was a significant positive correlation between dobutamine infusion rates and Pdi at both stimuli (P = 0.0001). CONCLUSION: Dobutamine effectively improves hypercapnic depression of diaphragmatic contractility in an infusion rate-dependent manner in pentobarbital-anesthetized dogs.

 

 

缺血前以胰岛素控制血糖水平可预防大鼠的脊髓缺血性损伤

Tight Glycemic Control by Insulin, Started in the Preischemic, but Not Postischemic, Period, Protects Against Ischemic Spinal Cord Injury in Rabbits

Daisuke Nagamizo, MD, Shunsuke Tsuruta, MD, Mishiya Matsumoto, MD, Hiroaki Matayoshi, MD, Atsuo Yamashita, MD, and Takefumi Sakabe, MD

From the Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.

Anesth Analg 2007 105: 1397-1403

 

背景:胰岛素是否可以防止脊髓缺血性损伤还不确定。我们检测在有暂时性脊髓缺血的老鼠中,以小剂量胰岛素来纠正轻度高血糖的作用。方法:我们将老鼠分为四组(每组8个),非治疗组(c组)、缺血前胰岛素组(pre-i组)、缺血前胰岛素葡萄糖组(gi组)(血糖水平保持在c组的水平)和缺血中胰岛素组(post-i组)。对于Pre-I GI组在缺血前30分钟给与胰岛素(0.5 IU/kg),而Post-I组在再灌注后给与。阻断腹主动脉13分钟以造成脊髓缺血。缺血七天后进行神经学和组织病理学的评估。结果:Pre-I组缺血前的平均血糖水平(118 mg/dL)明显低于其他三组(158–180 mg/dL),而再灌注30分钟后Pre-I(92 mg/dL)Post-I (100 mg/dL)明显低于C (148 mg/dL) GI (140 mg/dL)Pre-I组的脊髓前动脉的正常神经元的功能评分和数量比其他组明显要高。结论:结果提示于缺血前给与小剂量的胰岛素可以预防脊髓缺血性损伤,其作用可能在于其可密切控制缺血前血糖水平。

佳译 薛张纲校)

BACKGROUND: It is not well established whether insulin protects against ischemic spinal cord injury. We examined the effects of a single dose of insulin that corrects mild hyperglycemia on the outcome after transient spinal cord ischemia in rabbits. METHODS: We assigned rabbits to four groups (n = 8 in each); untreated control (C) group, preischemic insulin (Pre-I) group, preischemic insulin with glucose (GI) group (glucose concentrations were maintained at levels similar to the C group by the administration of glucose), and postischemic insulin (Post-I) group. Insulin (0.5 IU/kg) was administered 30 min before ischemia in the Pre-I and GI groups, and just after reperfusion in the Post-I group. Spinal cord ischemia was produced by occluding the abdominal aorta for 13 min. Neurologic and histopathologic evaluations were performed 7 days after ischemia. RESULTS: The mean blood glucose concentration before ischemia in the Pre-I group (118 mg/dL) was significantly lower than in the other three groups (158–180 mg/dL) and those of 30 min after reperfusion in the Pre-I (92 mg/dL) and Post-I (100 mg/dL) groups were significantly lower than in the C (148 mg/dL) and GI (140 mg/dL) groups. The motor function score and number of normal neurons in the anterior lumbar spinal cord in the Pre-I group were significantly greater than in the other three groups. CONCLUSIONS: These results suggest that a relatively small dose of preischemic insulin protects against ischemic spinal cord injury, and that the protective effects result from tight glycemic control before ischemia.

 

脊麻剖宫产术中使用充气式保温不能预防母体低温

Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia.

Butwick AJ, Lipman SS, carvalho B.

Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.

Anesth Analg. 2007 105(4):1413-9

 

背景:术前和术中使用充气式保温系统能预防硬膜外麻醉行择期剖宫产术患者的围术期低温及寒战。术中下身使用充气式保温也能预防择期剖宫产术脊麻患者的低温么?我们测试了这一假说。方法:30名健康行择期剖宫产术脊麻患者随机分为充气保温组和对照组(覆盖相同铺单而关闭充气保温装置)。一位盲研究者间隔15分钟评估口腔温度、寒战及温度舒适评分直至出苏醒室。胎儿娩出后测脐带血气和Apgar评分。结果:两组最大核心温度改变相近(充气保温组-1.3+/-0.4摄氏度,对照组-1.3+/-0.3摄氏度,P=0.8)。核心低温(<=35.5摄氏度)发生率,充气保温组15人中有8人,对照组15人中有10人(P=0.5)。寒战发生率及严重程度两组无显著差异。脐带血气和Apgar评分两组相近(P=NS)。结论:术中下身使用充气式保温不能预防脊麻行择期剖宫产术患者术中低温或寒战。

(罗 璇译 薛张纲校)

BACKGROUND: Prewarming and intraoperative warming with forced air-warming systems prevent perioperative hypothermia and shivering in patients undergoing elective cesarean delivery with epidural anesthesia. We tested the hypothesis that intraoperative lower body forced air-warming prevents hypothermia in patients undergoing elective cesarean delivery with spinal anesthesia. METHODS: Thirty healthy patients undergoing cesarean delivery with spinal anesthesia were randomly assigned to forced air-warming or control groups (identical cover applied with forced air-warming unit switched off). A blinded investigator assessed oral temperature, shivering, and thermal comfort scores at 15-min intervals until discharge from the postanesthetic care unit. Umbilical cord blood gases and Apgar scores were also measured after delivery. RESULTS: The maximum core temperature changes were similar in the two groups (-1.3 degrees C +/- 0.4 degrees C vs -1.3 degrees C +/- 0.3 degrees C for the forced air-warming group and control group, respectively; P = 0.8). Core hypothermia (< or =35.5 degrees C) occurred in 8 of 15 patients receiving forced air-warming and in 10 of 15 unwarmed patients (P = 0.5). The incidence and severity of shivering did not significantly differ between groups. Umbilical cord blood gases and Apgar scores were similar in both groups (P = NS). CONCLUSIONS: We conclude that intraoperative lower body forced air-warming does not prevent intraoperative hypothermia or shivering in women undergoing elective cesarean delivery with spinal anesthesia.

 

 

长期接受经皮丁丙诺啡治疗的非癌性疼痛患者的认知和精神运动行为的评估

Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients

Oguzhan Dagtekin, MD*, Hans J. Gerbershagen, MD*, Werner Wagner, MD*, Frank Petzke, MD*, Lukas Radbruch, MD{dagger}, and Rainer Sabatowski, MD{ddagger}

From the *Department of Anesthesiology, University of Cologne, Cologne, Germany; {dagger}Department of Palliative Care, University of Aachen, Aachen, Germany; and {ddagger}Pain Clinic, Department of Anesthesiology, University of Dresden, Germany.

Anesth Analg 2007; 105:1442-1448

 

背景:一般认为运用阿片类药物治疗会引起认知和精神运动功能损害。一些研究已经证明了这种阿片类药物治疗对于精神运动行为和认知的影响,但是目前没有数据证明长期经皮丁丙诺啡会对驾驶能力产生影响。方法:三十位经受慢性非癌性疼痛的患者,接受稳定剂量的经皮丁丙诺啡治疗,与九十位健康志愿者进行比较(对照组)。在德国,正使用一项经过计算机设计的试验,来评估交通违法者的驾驶能力。测量注意力反应,视觉变量,运动协调性以及警惕性。这些数据测量了14个变量,对于每一项测试,都能得到相关的分数。对于基本的终点,决定了三项相关分数的总合。一项用于测评患者行为能力的疲软的统计学方法,与另一组年龄相关的对照组进行比较。如果个人行为低于对照组的第十六个百分点,按照德国法律将取消驾驶资格。结果:根据检测结果与的驾驶能力,接受经皮丁丙诺啡叔丁啡的患者并不比对照组差。驾驶能力,结果一样肯定高于对照组的第十六个百分点,与对照组并没有显著差异。结论:给慢性非癌性疼痛患者长期使用经皮丁丙诺啡不会影响驾驶能力,但是由于测试结果的个体差异性,建议使用个体评估。

(王光妍译 薛张纲校)

BACKGROUND: The therapeutic use of opioids has been associated with altered cognition and impaired psychomotor function. Several studies have demonstrated the impact of opioid therapy on psychomotor performance and cognition, but there are no data about the effect of long-term treatment with transdermal buprenorphine on driving ability.METHODS: Thirty patients suffering from chronic noncancer pain, who had been treated with stable doses of transdermal buprenorphine, included in a prospective trial and compared with 90 healthy volunteers (matched pairs). A computerized test battery, developed to assess the driving ability of traffic delinquents in Germany, was used. Attention reaction, visual orientation, motor coordination, and vigilance were evaluated. The data from 14 variables were assessed, and for each test, a relevant score was defined. As the primary end-point, the sum score of the three relevant scores was determined. A weaker statistical means to assess the patient's performance is to compare the test results to an age-independent control group. Individuals performing worse than the 16th percentile of this control group are considered to be unable to drive according to German RESULTS: According to tests that predict driving ability, patients receiving transdermal buprenorphine were shown to be noninferior to the control group. Driving ability, as defined as a result above the 16th percentile, did not differ significantly between the patients and the control groupCONCLUSION: Long-term use of transdermal buprenorphine for chronic noncancer pain does not impair driving ability, but because of the individual variability of test results, an individual assessment is recommended.

 

硬膜外麻醉用于椎板切除引导定位完成脊髓刺激

Epidural Anesthesia for Laminectomy Lead Placement in Spinal Cord Stimulation
María Luisa García-Pérez, Rafael Badenes, Guillermo García-March, Vicente Bordes, and Francisco Javier Belda

Department of Anesthesiology, Critical Care and Pain Management, Hospital Clínico Universitario de Valencia, Avda, Blasco Ibañez 17, 46010 Valencia, Spain.

Anesth Analg 2007 105: 1458-1461.

 

背景:脊髓刺激常被用于治疗慢性疼痛,并且要求是一个清醒的病人使得能够对于感觉异常点的定位达到最佳化。硬膜外麻醉也许是一种适宜的麻醉方式,但是未经评估。方法:我们完成一个公开的、前瞻性的、观察性质的、单中心研究,用于研究在硬膜外麻醉下实施椎板切除术引导定位对于治疗慢性神经性疼痛的安全性和有效性。结果:我们实验的结果表明硬膜外麻醉对于脊髓刺激引导埋植剂是一种适宜的麻醉方式。结论:这是首例实验用硬膜外麻醉完成椎板切除术引导埋植剂实现脊髓刺激。这项技术似乎是安全和有效的。

(周时蓓译 薛张纲校)

BACKGROUND: Spinal cord stimulation (SCS) is used to treat chronic pain and requires an awake patient for optimized lead positioning to locate paresthesias. Epidural anesthesia may be a suitable anesthetic but has not been evaluated. METHODS: We performed an open-label, prospective, observational, single-center study to evaluate the safety and efficacy of laminectomy lead placement under epidural anesthesia for the treatment of neuropathic chronic pain. RESULTS: The results in our study demonstrate that epidural anesthesia is a suitable technique for SCS lead implant. CONCLUSIONS: This is the first study using epidural anesthesia for SCS lead implants by laminectomy. The technique seems to be safe and effective.

 

 

鼠模型电针疗法减弱骨癌疼痛并且抑制脊椎白细胞介素的表达

Electroacupuncture Attenuates Bone Cancer Pain and Inhibits Spinal Interleukin-1ß Expression in a Rat Model

Rui-Xin Zhang,  Aihui Li,  Bing Liu,  Linbo Wang,  Ke Ren,  Jian-Tian Qiao,  Brian M. Berman,  Lixing Lao

From the *Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; {dagger}Department of Biomedical Sciences, Dental School, University of Maryland, Baltimore, Maryland; and {ddagger}Department of Neurobiology, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China

Anesth Analg 2007 105: 1482-1488.

 

背景:尽管疼痛严重影响癌症病人的生活质量,目前的治疗方法却或者疗效不佳,或者存在副作用。此次研究我们运用了骨癌所致疼痛的鼠模型,调查电针疗法对癌症导致的痛觉过敏以及由于长期存在的持续疼痛引起白细胞介素表达增加的作用。方法:我们通过注射AT3.1前列腺癌细胞进入雄性哥本哈根鼠的胫骨来诱导癌症模型。在肿瘤细胞种植后的1418天,用10赫兹/2毫安/0.4毫秒脉冲的电针刺激相当于人体GB30的穴位(环跳穴),每天30分钟,来治疗肿瘤所致疼痛。作为对照组,电针刺入GB30穴位,但不释放电刺激。在电针疗法进行治疗后的即刻以及20分钟后,测量小鼠对非有害热刺激发生爪子蜷缩反应,即产生热痛觉过敏的等待时间。通过免疫组织学及反转多聚酶链反应分别监测白细胞介素及其mRNA的表达。结果:热痛觉过敏在肿瘤细胞植入后的1218天发生进展。电针疗法显著地(P<0.05)减轻了热痛觉过敏,使小鼠发生爪子蜷缩反应的等待时间由7.0±0.3增加到9.2±0.4秒,并且同对照组比较,抑制了白细胞介素及其mRNA表达的上调。鞘内注射白细胞介素1受体拮抗剂(IL-1ra, 0.1 mg/个体鼠)同样显著抑制了肿瘤所致的热痛觉过敏。结论:数据显示电针疗法缓和了骨癌所致疼痛,至少部分作用是通过抑制白细胞介素的表达。这结果支持了电针疗法在癌性疼痛临床治疗中的应用。

(吴 威译 薛张纲校)

BACKGROUND: Although pain affects the quality of life of cancer patients, current medical treatments are either ineffective or have side effects. In the present study we investigated the effect of electroacupuncture (EA) on cancer-induced hyperalgesia and expression of interleukin-1ß (IL-1ß), upregulation of which is related to the maintenance of persistent pain, in a rat model of bone cancer pain.METHODS: Cancer was induced by injecting AT-3.1 prostate cancer cells into the tibia of male Copenhagen rats. The resulting pain was treated with 10 Hz/2 mA/0.4 ms pulse EA for 30 min daily at the equivalent of the human acupoint GB30 (Huantiao) between Days 14 and 18 after cancer cell inoculation. For sham control, EA needles were inserted into GB30 without stimulation. Thermal hyperalgesia, a decrease in paw withdrawal latency to a noxious thermal stimulus, was measured at baseline and 20 min after EA treatment. IL-1ß and its mRNA were respectively determined by immunohistochemistry and reverse transcription-polymerase chain reaction analysis.RESULTS: Thermal hyperalgesia developed between Days 12 and 18 after cancer cell inoculation. EA significantly (P0.05) attenuated this hyperalgesia, increasing paw withdrawal latency from 7.0±0.3 s to 9.2±0.4 s, and inhibited the upregulation of IL-1ß and its mRNA compared to the sham control. Intrathecal injection of IL-1 receptor antagonist (IL-1ra, 0.1 mg/rat) also significantly inhibited cancer-induced thermal hyperalgesia.CONCLUSION: The data suggest that EA alleviates bone cancer pain, at least in part bysuppressing IL-1ß expression. The results support the clinical use of EA in the treatment of cancer pain.

 

 

关于在循环阻断(阻断血流灌注)化学灌注治疗中运用全身麻醉和脊髓麻醉的回顾性研究

Recovery Profiles of General Anesthesia and Spinal Anesthesia for Chemotherapeutic Perfusion with Circulatory Block (Stop-Flow Perfusion)

Michele Carron, MD*, Ulderico Freo, MD*, Federico Innocente, MD*, Stefano Veronese, MD*, Pierluigi Pilati, MD{dagger}, Vesna Jevtovic-Todorovic, MD{ddagger}, and Carlo Ori, MD*

Address correspondence and reprint requests to Carlo Ori, MD, Institute of Anesthesiology and Intensive Care, Department of Pharmacology and Anesthesiology, University of Padova, Via C. Battisti 267, 35121 Padova, Italy.

Anesth Analg 2007; 105:1500-1503

背景:阻断血流灌注化学治疗法是一项新的对肿瘤的局部探索性治疗,通常在全麻较少情况下在脊麻下进行,我们设计了这项临床试验比较全麻和脊麻在阻断血流灌注治疗中的临床资料。方法:40名癌症患者随机接受异丙酚,笑气和芬太尼或布比卡因低腰段麻醉或骨盆阻断血流灌注记录麻醉和复苏时间,通过直观类比标度对术后疼痛评分,术后恶心呕吐以及进入苏醒室的情况。结果:全麻和脊麻在患者回家时间或患者满意度上没有差别,向比于全麻,脊麻显著减少了手术时间(3416分钟)、术后疼痛(50)、恶心(82)和术后进入麻醉苏醒室(90)的比例。总结:对于阻断血流治疗,全麻和脊麻都是有效的,但脊麻在术后期有恢复快、更好的镇痛和更少的术后恶心、呕吐的优势。

(陈恺铮译 薛张刚校)

BACKGROUND: Chemotherapeutic stop-flow perfusion is a new investigational treatment for locally advanced cancers that is usually performed under general anesthesia (GA), and, less frequently, under spinal anesthesia (SA). We designed this clinical trial to compare the clinical profiles of GA and SA for stop-flow perfusion. METHODS: Anesthesia and recovery times, scores on visual analog scales for postoperative pain, and postoperative nausea and vomiting, and admission to the postanesthesia care unit were measured in 40 cancer patients who randomly received either GA with propofol, nitrous oxide/sevoflurane, and fentanyl, or SA with bupivacaine hydrochloride for lower limb or pelvic stop-flow perfusion. RESULTS: GA and SA did not differ in times to achieve home readiness or patient satisfaction. Compared with GA, SA significantly (P < 0.05) reduced anesthesia times (34 vs 16 min), postoperative visual analog scale scores for pain (5 vs 0) and nausea (8 vs 2), and the number of admissions to the postanesthesia care unit (9 vs 0). CONCLUSIONS: For stop-flow perfusion, GA and SA are both effective, but SA provides faster recovery, superior analgesia, and less postoperative nausea and vomiting in the immediate postoperative period.