Anesthesia & Analgesia

November 2007

 

CARDIOVASCULAR ANESTHESIOLOGY:

類癌心臟病患者行瓣膜手術的術中處理:對100例連續病例的回顧

彭中美   馬皓琳 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.

氙氣麻醉對實驗性心肌梗死面積的影響

印潔敏 陳傑

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.

日常飲食劑量的大蒜不會影響血小板功能

邱郁薇 馬皓琳 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.

.術中的三維經食道超聲心動圖測量心輸出量的有效性和可行性

張燕 陳傑

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:

連續外周神經阻滯用於小兒術後鎮痛

吳德華譯 薛張綱校

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.

在幼年動物模型中不同負荷狀態下的全心舒張末期容積

顏濤 譯, 馬皓琳  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的數值量化法評估兒童焦慮水準的初步驗證

周懿之 陳傑

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:

門診預行LC的病人術中用艾斯洛爾代替阿片類藥物可節省術後芬太尼用量

霞譯 薛張綱校

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:

進行腹式子宮切除的病人術前服用褪黑素對術後結果的臨床影響

姜旭暉譯,馬皓琳,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.

右旋美托咪啶對七氟醚麻醉下顳葉性癲癇病人的腦電圖的影響

潘錢玲 陳傑

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.

不同靜脈麻醉藥對肺靜脈平滑肌肌絲鈣離子敏感性的影響

王時來譯 薛張綱校

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.

揮發性芳香類麻醉藥不同程度地影響人{gamma}-氨基丁酸A型受體的功能

黃施偉 譯,馬皓琳 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和血管緊張素II受體介導血管緊張素II的升壓作用: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.

小劑量靜脈注射咪達唑侖降低依託咪酯誘導的肌陣攣:對進行電複律病人的前瞻性隨機實驗

楊譯 薛張綱校

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-氧化亞氮麻醉維持中雙頻指數和狀態熵指數的可比性

唐李雋   馬皓琳  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.

微多普勒導管用於離體評估靜脈氣體栓塞的檢測和吸引

杜唯佳 陳傑

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:

針對困難拔管的連續氣道通路:氣道更換導管的有效性

王騰 陳傑

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

Thomas C. Mort

Anesth Analg 2007 105: 1357-1362.

異丙酚削弱內毒素誘導內皮細胞損傷血管緊張素轉換酶脫落和肺水腫

陳佳莉譯 薛張綱校

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.

靜脈麻醉藥和維拉帕米對腸缺血-再灌注誘導肝損傷的保護作用

周雅春 李士通 馬皓琳

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.

在戊巴比妥麻醉的實驗狗中不同的多巴酚丁胺輸注速度對改善因高碳酸血症所致的膈肌收縮力下降的效果

陳珺珺譯  薛張綱校

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.

張力性氣胸穿刺減壓可能進針位置的放射學評估

黃佳佳譯,馬皓琳、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:

血液稀釋性中心血容量過高損害腦自身調節功能

陳偉 陳傑

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.

缺血前以胰島素控制血糖水準可預防大鼠的脊髓缺血性損傷

  佳譯 薛張綱校

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對於功能性內窺鏡下鼻竇手術過程中的術中失血和手術野品質的影響

黃麗娜   馬皓琳  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:

脊麻剖宮產術中使用充氣式保溫不能預防母體低溫

璿譯 薛張綱校

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:

一種減少鼻衄、提高適航性的鼻插管新技術

慧譯 馬皓琳 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:

芬太尼經皮離子導入系統和靜脈嗎啡病人自控鎮痛兩者的術後疼痛控制安全性和有效性的比較:三個隨機、有效對照臨床實驗的會聚分析

於章傑 陳傑

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.

術後接受經皮等離子滲入系統給予芬太尼和通過靜脈病人自控使用嗎啡進行術後疼痛管理的系統相關事件和止痛間隙

陳傑

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.

長期接受經皮丁丙諾啡治療的非癌性疼痛患者的認知和精神運動行為的評估

王光妍譯 薛張綱校

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:

術前口服普瑞巴林用於婦產科小手術術後緩解疼痛的一項隨機、安慰劑對照試驗

胡湘   馬皓琳 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.

加巴噴丁預防導管相關膀胱不適的療效評估:一項前瞻、隨機、對照、雙盲研究

朱玫娟 陳傑

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.

硬膜外麻醉用於椎板切除引導定位完成脊髓刺激

周時蓓譯 薛張綱校

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.

頑固性脊柱損傷性疼痛病人的疼痛處理:一項病例報告及文獻回顧

胡湘   馬皓琳 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-腎上腺受體參與奧凱西平的抗痛覺過敏效應

詹瓊慧 陳傑

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.

鼠模型電針療法減弱骨癌疼痛並且抑制脊椎白細胞介素的表達

威譯 薛張綱校

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.

環孢菌素對小鼠催眠反應和疼痛反應的不同作用

沈浩   馬皓琳 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%等比重利多卡因蛛網膜下腔麻醉後暫時性神經綜合征:穿刺針類型的影響

丁震敏 陳傑

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.

關於在迴圈阻斷(阻斷血流灌注)化學灌注治療中運用全身麻醉和脊髓麻醉的回顧性研究

陳愷錚譯 薛張剛校

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.

類癌心臟病患者行瓣膜手術的術中處理:對100例連續病例的回顧

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:對類癌心臟病的心臟手術,併發有繼發於類癌、心血管功能紊亂和失血的血流動力學不穩定。應用奧曲肽的同時應用血管升壓藥的安全性和抑肽酶的好處未明確。

方法:我們在1985-2003100例類癌心臟病患者行心臟手術的連續病例中用單變數分析回顧了血管升壓藥和抑肽酶對應用奧曲肽和死亡率的影響。因為死亡率下降暫時與應用抑肽酶有關,用二變數分析來鑒定其他因素對死亡率的影響。

結果:用奧曲肽(n = 89) /或血管升壓藥 (n = 93)治療類癌綜合症和低血壓。血管升壓藥與應用奧曲肽增加無關。需要腎上腺素的患者不但有較高的死亡率,而且有較差的術前紐約心臟組織分級、較高的尿5-羥吲哚乙酸水準及輸血需求增加。抑肽酶(n = 54)使輸血需求減少,應用奧曲肽增加,但死亡率無影響。總死亡率為13%,從1985-1994年的28%下降至1995-2003年的6%。死亡率與有較大量的輸血需求和體外迴圈持續時間較長有關。

結論:血管升壓藥可與奧曲肽一起用於類癌患者。死亡率升高與腎上腺素相關,可能是反映了選擇偏倚,而非原發性副作用。改善類癌患者的生存率是多因素的,與應用抑肽酶無關,提示進一步抑制激肽釋放酶-激肽系統對奧曲肽應用中的結果幾乎無額外好處。

(彭中美   馬皓琳 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.

 

 

 

日常飲食劑量的大蒜不會影響血小板功能

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:體外研究顯示大蒜所含有的多種生物活性成分會抑制血小板功能。然而日常飲食劑量的大蒜對血小板功能的影響程度尚未得知。因此我們應用對環氧合酶I抑制情況和血小板粘附功能檢測靈敏度高的重點照護監測設備,檢驗了生蒜對血小板功能的影響。

方法:在一個隨機、交叉、觀察者單盲、安慰劑對照的研究中,對18名健康志願者在攝取含4.2g生蒜的希臘tsatsiki(verum)或不含大蒜的希臘tsatsiki(安慰劑)前和攝取5h後抽取的全血標本進行研究。在5名每日食用4.2g生蒜1周的志願者,觀察大蒜的潛在長期作用。採用血小板功能分析儀(PFA-100®)、阻抗集合度測定(Multiplate®)和血栓彈力酶圖的血小板描圖(Platelet MappingTM)分析血小板功能。進行體外實驗來證實這些化驗對大蒜誘導的血小板抑制作用的靈敏性。

結果:所有志願者血小板功能的基礎值都在正常範圍。使用的任何重點照護監測檢驗都觀察到:單次或重複口服含有生蒜的希臘tsatsiki不會抑制血小板功能。

結論:健康志願者單次或重複食用日常飲食劑量的大蒜並不會影響血小板功能。含有社會上允許劑量大蒜的菜肴並不可能增加圍術期出血的危險。未來我們將進一步研究並證實血小板抑制藥物與大蒜及其他草本同時應用的潛在相加作用。

(邱鬱薇 馬皓琳 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.

 

 

 

在幼年動物模型中不同負荷狀態下的全心舒張末期容積

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:估計嬰兒和新生兒的容量狀態具有挑戰性。全心舒張末期容積(GEDV)和前負荷的動力學參數如脈壓變異性(PPV)可能是估計心臟前負荷和液體反應性的可選參數。故而我們設計了本實驗以評價在幼年動物模型中,當負荷狀態快速改變時GEDVPPV是否是前負荷和液體反應性的合適參數。

方法:在不同的負荷情況下研究了19只已麻醉和機械通氣的小豬(6.5 ± 0.8 kg)。記錄正常容量和輸入25 mL/kg羥乙基澱粉6%溶液後的血流動力學參數,包括中心靜脈壓、肺毛細血管楔壓、PPV、用經肺溫度稀釋法得到的GEDV和心輸出量以及通過肺動脈溫度稀釋法獲得的心輸出量和心搏量指數。

結果:在容量負荷後GEDV的百分比改變顯著(25% ± 17%),並且導致除心率和體循環血管阻力指數外所有血流動力學參數的顯著改變。GEDV是唯一與容量導致的心搏量指數百分比變化顯著相關的前負荷參數(r = –0.61, P = 0.005)。受試者操作特徵曲線下面積GEDV0.8P <0.02)而PPV 0.6 (P = ns)

結論:在本幼年動物模型中,通過經肺溫度稀釋法得到的GEDV是心臟前負荷的可靠指標。而且,GEDV(而非PPV)、中心靜脈壓和肺毛細血管楔壓準確反映了液體的反應性。

(顏濤 譯, 馬皓琳  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.



進行腹式子宮切除的病人術前服用褪黑素對術後結果的臨床影響

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:褪黑素具有鎮靜、鎮痛、抗炎、抗氧化和生物時相作用,我們研究了術前口服褪黑素對抗焦慮、鎮痛以及晝夜生物作息節律效能的影響。

方法:這項隨機、安慰劑對照、雙盲的試驗包括了33ASA分級III級、行腹式子宮切除的病人。病人被隨機分成兩組,一組(17例)在術前晚上和術前1小時口服褪黑素5mg,一組(16例)口服安慰劑。分析工具是視覺類比評分、狀態-特性焦慮清單和活動記錄檢查。

結果:術後第一個24小時裏,為了防止又多一個病人報告術後非常焦慮和疼痛中重度,從而需要治療的病人數量分別為2.5395%可信區間為1.4112.22)和2.2095%可信區間為1.268.58)。在疼痛中重度的病人中為了防止術後非常焦慮從而需要治療的病人數為395%的可信區間為1.355.0),在疼痛輕微或不疼痛的病人中為7.595%的可行區間為1.36-無窮大)。而且用重複測定ANOVA評定發現,治療過的病人通過病人自控鎮痛需要的嗎啡較少 (F[1,31] = 6.05, P = 0.02)。用活動記錄檢查評定的作息週期顯示干預組的出院後第一個星期裏的24小時節律百分率(21.16 ± 8.90)明顯高於安慰劑組(14.00 ± 7.10t = –2.41, P = 0.02)。

結論:這個發現揭示術前服用褪黑素可引起臨床相關的抗焦慮和鎮痛作用,特別是在術後24小時以內。而且褪黑素也改善了作息晝夜節律的效能。

(姜旭暉譯,馬皓琳,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.



揮發性芳香類麻醉藥不同程度地影響人{gamma}-氨基丁酸A型受體的功能

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)受體分別是中樞神經系統內重要的抑制性和興奮性神經遞質受體。在面對傷害性刺激時產生制動作用所需濃度時,揮發性芳香類麻醉藥抑制NMDA受體的程度不同,強烈提示它們還作用於其他靶位以產生制動作用。在本研究中,我們試圖評估GABAA受體在介導揮發性芳香類麻醉藥行為作用中的可能作用。

方法:用電生理方法定量研究8種揮發性芳香類麻醉藥和3種臨床用麻醉藥對爪蟾卵母細胞上表達的{alpha}1ß2{gamma}2L GABAA受體介導的電流的影響。

結果:在最小肺泡麻醉藥濃度倍數相當的情況下,揮發性芳香類麻醉藥對由低濃度GABA誘發的GABAA受體介導的電流的增強程度差異很大。總的來說,抑制NMDA受體最強的麻醉藥對GABAA受體的增強作用最弱。麻醉藥對GABAANMDA受體效價之間的互反關係,在臨床用麻醉藥異氟烷、氟烷和環丙烷中也可見到。使用不同濃度GABA的研究提示揮發性芳香類麻醉藥增強GABAA受體活性是通過將開-關(門控)平衡轉向通道開放狀態所致。

結論:這些結果提示GABAA受體不同程度地促進了揮發性麻醉藥的行為作用,且暗示了麻醉藥對GABAANMDA受體作用的分子決定因素是明顯不同的。

(黃施偉 譯,馬皓琳 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-氧化亞氮麻醉維持中雙頻指數和狀態熵指數的可比性

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:製造商推薦麻醉維持時將雙頻指數(BIS)或光譜熵(狀態熵,SE)指數保持在4060之間。我們比較了該範圍內的上述指數。

方法:數據來源於58例行舒芬太尼-七氟醚-氧化亞氮麻醉的患者。麻醉醫生不知道BISSE。用Bland-Altman分析、用於一致性的Kappa係數和粗一致性部分比較間隔一分鐘自動同時記錄的無偽影的BISSE(7792)。判斷錯誤的發生也被記錄下來(1型錯誤定義為一個參數<40而另一個>602型錯誤定義為BISSE的值在閾值[4060]的兩邊)。

結果:偏移是–2,一致性的界限為-189。從所有患者得到的Kappa BIS/SE0.537 ± 0.147,粗一致性>0.80的患者為45%。1型錯誤判斷的數目符合兩種情況。當認為BISSE的差異大於5時,2型錯誤判斷數目的中位數和四分位間距是4.5[3.0–6.0]

結論: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,得出完全相反的結論(例如:根據一個參數應加深麻醉,而另一個參數則應減淺麻醉)可能是罕見的。更普遍的可能是在不作調整和加深或減淺麻醉深度之間發生錯誤的危險性。

(唐李雋   馬皓琳  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.



靜脈麻醉藥和維拉帕米對腸缺血-再灌注誘導肝損傷的保護作用

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:本實驗研究了靜脈麻醉藥和維拉帕米對腸缺血/再灌注誘導肝損傷的保護作用。

方法:40Wistar大白鼠隨機分為4組,每組10只。實驗中麻醉誘導和維持1組和3組採用丙泊酚, 2組和4組採用硫噴妥鈉。所有動物都在夾閉腸系膜上動脈30分鐘後產生腸缺血。移除微血管夾後維持再灌注120分鐘。3組和4組大鼠在再灌注之前10分鐘給予維拉帕米。在缺血前、再灌注後30分鐘、再灌注後120分鐘時取肝臟和回腸標本進行丙二醛(MDA)測定和組織病理學檢查。同時,采血進行血漿腫瘤壞死因數-α和白介素-6水準的測定。

結果:腸缺血/再灌注可使肝臟和腸的MDA含量及血清白介素水準顯著升高,且與組織病理學損傷評分一致。丙泊酚可有效穩定肝臟和腸的MDA水準並減少組織損傷評分。丙泊酚組腫瘤壞死因數-α和白介素-6升高水準低於硫噴妥鈉組。維拉帕米對丙泊酚沒有相加保護作用。而維拉帕米加入硫噴妥鈉可有效減少血清細胞因數水準和肝臟MDA含量。

結論:丙泊酚可通過抑制脂質過氧化反應和炎性細胞因數生成對腸缺血/再灌注誘導肝損傷動物模型提供保護作用。

(周雅春 李士通 馬皓琳 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.



張力性氣胸穿刺減壓可能進針位置的放射學評估

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:可疑張力性氣胸的推薦治療方法為立即穿刺減壓。但是推薦部位和穿刺針的尺寸尚未統一,而且也有穿刺失敗和醫源性血胸的報導發表。我們研究了最佳穿刺針長度及3個可能穿刺減壓位點的相對安全性。

方法:通過對100位元成年人進行胸部CT掃描,我們測量出胸半中線(MHL)上胸骨角平面及腋前線和腋中線上劍突平面上皮膚表面至胸膜和胸腔內結構的距離及胸骨中線至內乳血管的距離。

結果:胸骨中線至MHL及內乳血管的距離中位數分別為6.1cm3.0cmMHL、腋中線及腋前線部位皮膚至胸膜距離中位數分別為3.1 (1.4–6.9)3.5 (1.7–9.3+)2.6 (1.0–7.7+) cm。總的來說,右邊的安全範圍比左邊高,兩邊的MHL位置最安全。

結論:可疑張力性氣胸的穿刺減壓必須用一根至少7cm的穿刺針在胸骨角平面的MHL垂直於橫切面刺入。這種方法應該比其他部位具有更高的成功率和安全範圍。

(黃佳佳譯,馬皓琳、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對於功能性內窺鏡下鼻竇手術過程中的術中失血和手術野品質的影響

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:功能性內窺鏡下鼻竇手術中麻醉管理的目的在於儘量減少出血且提供一個幾乎完美的手術野。我們研究了故意的術中高碳酸血症和低碳酸血症是否會通過有人提出的不同二氧化碳(CO2)張力水準對鼻血管系統的調節作用,從而可能會影響圍失血和手術野品質。

方法:180名患者隨機分入正常血二氧化碳組(呼氣末CO2ETco237 ± 2 mm Hg)、高碳酸血症組(ETco2 60 ± 2 mm Hg)和低碳酸血症組(ETco2 27 ± 2 mm Hg)。麻醉管理用丙泊酚和瑞芬太尼持續輸注、氧化亞氮和中度控制性降壓。出血量和手術野的狀況由對分組並不知曉的外科醫生評價。我們分析了各研究組之間的差異、研究組和時間對ETco2水準和血流動力學參數的影響以及失血與外科聯合變數的關係。

結果:各研究組間失血和手術野品質無差異。總起來講,低碳酸血症組的患者需要最大量的瑞芬太尼、拉貝洛爾和降壓藥,而高碳酸血症則需要最小量的上述藥物。CT分級下的鼻竇疾病的嚴重程度以及手術時間是影響術中出血量的唯一獨立的預測因素。

結論:功能性內窺鏡下鼻竇手術中CO2的管理並不影響手術條件和出血。

(黃麗娜   馬皓琳  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.



一種減少鼻衄、提高適航性的鼻插管新技術

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見併發症。我們比較了頭端裝有充氣式食道聽診器的氣管內導管(endotracheal tubesETT)與普通ETTs,有或無熱軟化時在預防鼻衄和提高適航性方面的不同。

方法:需鼻插管的牙科手術者隨機分成4組(每組50人):組1,非熱軟化的氣管內導管;組2,頭端裝有充氣式食道聽診器的非熱軟化氣管內導管;組3,熱軟化的氣管內導管;組4,頭端裝有充氣式食道聽診器的熱軟化氣管內導管。評估氣管內導管通過鼻腔的適航性和插管後鼻衄。

結果:1氣管內導管通過鼻腔的適航性是最差的(P = 0.001)。組1鼻衄最嚴重,組2和組3相似,組4最輕(P < 0.001)

結論:頭端有食道聽診器的氣管內導管的使用和熱軟化相似,能有效預防鼻插管引起的鼻衄。熱軟化後的裝有食道聽診器的氣管內導管比單純熱軟化的氣管內導管在減少鼻衄方面更有效。

(朱 慧譯 馬皓琳 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.



術前口服普瑞巴林用於婦產科小手術術後緩解疼痛的一項隨機、安慰劑對照試驗

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:雖然普瑞巴林顯示出對抗神經性疼痛的功效,但是罕有證據支持其術後鎮痛的功效。我們的研究目的在於經歷急性內臟痛的日間手術病人中的鎮痛效果。無效假設為普瑞巴林與安慰劑在緩解疼痛上無顯著差異。

方法:在90位行小型婦產科包括子宮手術的女性中行一項隨機、雙盲、平行分組、安慰劑對照試驗。患者在術前約一小時接受口服普瑞巴林100mg(PG)或安慰劑(C組)。原始結果是在復蘇室中的疼痛評分,且患者術後隨訪24小時。

結果:在復蘇室裏經歷的疼痛(PG組中位數16、四分位距0-36C106.5-36P = 0.80)或此後疼痛組間無差異,在復蘇室芬太尼的需要(PG42%C27%P = 0.12)或者術後24小時時的恢復品質(PG組中位數17、四分位距17-18C1816.5-18P = 0.75)也無組間差異。出院後輕度頭暈、視覺障礙和行走困難的發生率在普瑞巴林組顯著較高。

結論:單純術前服用普瑞巴林100 mg不能緩解僅包括子宮小手術術後的急性疼痛或改善恢復。

(胡湘  馬皓琳 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.




 

頑固性脊柱損傷性疼痛病人的疼痛處理:一項病例報告及文獻回顧

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

慢性疼痛是脊柱損傷較為煩擾的後遺症之一,通常干擾病人的基本活動、有效康復和生活品質。脊髓損傷病人的疼痛通常是難以治療的。這種困境又由於可供選擇有效藥理學及非藥理學治療選項的可用性有限而放大。我們使用搜索詞“脊髓損傷(spinal cord injury)”或者“脊髓損傷(spinal cord injuries)”和“疼痛(pain)”或者“痙攣狀態(spasticity)”或“肌肉痙攣(muscle spasms)” 1975-2005年的MEDLINE資料庫鑒別出有關脊柱損傷後疼痛的相關文章。我們也從國際疼痛研究協會出版社近期出版的書裏手工查找關於脊柱損傷疼痛的綜述,通過參考文獻列表來辨別相關論文。我們介紹了一例用針對脊髓損傷疼痛不同方面的控制疼痛計畫成功治療的難治性脊柱損傷疼痛的病人。我們回顧了這些治療項目的證據。

(胡湘   馬皓琳 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.

 


 

環孢菌素對小鼠催眠反應和疼痛反應的不同作用

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:鈣神經素抑制劑環孢菌素廣泛應用於防止器官移植中的同種異體移植物排斥。避免全身給予環孢菌素,以防止藥物進入腦部作用於多藥耐藥1mdr1)基因編碼的P-糖蛋白。然而很多移植受體在注射了環孢菌素後產生了術後的神經心理學副作用,如意識錯亂、抑鬱和焦慮。最近,在器官和幹細胞移植中鈣神經素抑制劑產生的疼痛綜合征(其特點為下肢重度疼痛)也已得到了認識。

方法:在本研究中,我們開發了野生型和mdrla基因滅活小鼠的行為模型,來揭示外周或中樞的環孢菌素是否改變疼痛反應及催眠敏感性。在缺乏P-糖蛋白的mdrla基因滅活小鼠可以較好地評價環孢黴素的中樞作用。在腹腔內注射環孢黴素後,我們測定了小鼠尾部浸漬試驗中的甩尾潛伏期,或對戊巴比妥和氯胺酮的反應中的翻正反射消失時間。

結果:在野生型小鼠中,最大劑量的環孢菌素可以顯著的延長氯胺酮導致的翻正反射消失時間,但是對於戊巴比妥產生的翻正反射消失時間沒有影響。在另一方面,在mdrla基因滅活小鼠中最低劑量的環孢菌素均可以明顯延長戊巴比妥和氯胺酮產生的睡眠時間。注射環孢菌素使野生型和滅活小鼠在尾部浸漬試驗中的甩尾潛伏期都明顯縮短。

結論:我們的結果提示在中樞的蓄積的環孢菌素增強對戊巴比妥和氯胺酮的催眠反應,而外周環孢菌素產生痛覺過敏。

(沈浩   馬皓琳 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.

氙氣麻醉對實驗性心肌梗死面積的影響

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:吸入麻醉劑能夠保護心肌避免缺血再灌注損傷。在該研究中假設氙氣使心肌梗死面積減少的程度與採取缺血預適應相似。

方法:36只體重在30-35kg的豬進行硫賁妥鈉麻醉,並隨機分成四組:對照組(單純心肌缺血),缺血預適應組(週期性心肌缺血5次,每次5分鐘),氙氣預處理組(在心肌缺血前給予70%的氙氣共三次,每次10分鐘),以及氙氣麻醉組(在心肌缺血發生前和發生後持續給予70%的氙氣)。心肌缺血模型採取冠狀動脈左前降支束止血帶60分鐘,然後給予2小時的再灌注時間而誘發。心肌梗死面積和可能發生心肌梗死的危險區分別可以用偶氮藍與氯化三苯四唑染色測量。

結果:缺血預處理組心肌梗死面積的平均值較對照組的64%±9%減少至19%±12%P<0.001),氙氣麻醉組中降至50%±9%(與對照組比較P<0.05,與缺血預處理組比較P<0.001)。氙氣預處理組的心肌梗死面積與對照組相比沒有減少(59%±11%P=0.41)。

結論:缺血預處理能夠減少心肌梗死面積,而氙氣麻醉在這方面的作用則較弱。簡言之,在發生心肌缺血前間斷給予氙氣不能減少心肌梗死的面積。

(印潔敏 陳傑 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.

 

.術中的三維經食道超聲心動圖測量心輸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,作者嘗試驗證三維經食道超聲心動圖(3DTEE)監測心輸出量並評估它在術中監測的可行性.

方法: 20名接受心臟手術病人,在體外迴圈前迴圈穩定期間,同時採用3DTTE法和熱稀釋法測定心輸出量。

結果: 2種方法測得的心輸出量的相關係數是0.86. 3DTTE 的平均偏差是0.27L/min,界限是-1.642.17L/min(大約±35%)。獲取三維資料平均需要43秒,對資料後期處理花費7分鐘。

結論: 3DTTE能夠測量心輸出量,且在圍術期是可行的。與熱稀釋法的測量值有很好的相關性,但有一個明顯的偏倚和寬域。

(張燕 陳傑 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的數值量化法評估兒童焦慮水準的初步驗證

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:患焦慮症的兒童在許多衛生保健檢查中表現出身體和行為的異常,但由於缺乏臨床實用的主觀量表,很少實施焦慮和隨後治療評估。目前焦慮程度評估依靠觀察或多項自我評估報告,需花費臨床醫生和病人大量的時間。由於焦慮是主觀的,加上臨床上兒童易於接受,本研究評估了010的數值量化法應用的可行性。

方法: 用描述性的相關研究方法檢測010的數值化量表方法的可行性同時分批給予STAIC法(State-trait for state anxiety inventory for children)。在臨床干預前挑選60位兒童,年齡在713歲,給予010量表法和STAIC法觀測干預前後的焦慮評分。用線性回歸和Pearson相關檢驗其關聯程度。

結果:不論干預前後,STAIC均與焦慮量表有相關性(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)。相關係數分別是干預前(r=0.424)干預後(r=0.639)。

結論:初步研究顯示證010的數值量化自測法用於評估7歲左右兒童焦慮程度是可行性。

(周懿之 陳傑 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.

 

右旋美托咪啶對七氟醚麻醉下顳葉性癲癇病人的腦電圖的影響

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:儘管右旋美托咪啶常用於神經外科麻醉及神經外科危重監護的操作中,但它對那些存在異常腦電圖病人的腦電活性的影響卻並不清楚。腦電圖是一種檢驗藥物對腦電活性和外科治療對癲癇療效的敏感方法。作者研究了右旋美托咪啶對七氟醚麻醉下行癲癇外科治療病人的腦電圖的影響。

方法:選擇患有藥物難治性顳葉性癲癇並將進行手術切除癲癇病灶的病人。以2.5%的七氟醚維持麻醉,呼末二氧化碳分壓維持在30mmHg,腦電圖則是通過放在癲癇病灶同側的顳葉中央的8條連接的電極線來記錄。右旋美托咪啶以0.51.5ng/ml的血漿濃度靶控輸注。每個濃度維持20分鐘,而腦電圖則在開始輸注前及開始輸注的第二個10分鐘開始記錄。通過Student-Newman-Keul試驗獲得的腦電圖時頻分佈,每條光譜帶的光譜功率密度及每個右旋美托咪啶濃度的峰值與Kruskal-Wallis試驗進行比較。

結果:所有病人的所有導聯中有88個導聯的腦電圖中位頻較基線明顯減少,右旋美托咪啶1.5ng/ml組和0.5ng/mlP值分別是0.0030.03。但光譜功率密度在頻帶為δ<4Hz,4≦θ<8Hz,8≦α<13Hz時並不改變。有棘波的導聯數、所有導聯的棘波數以及峰值均不受右旋美托咪啶的影響。

結論:右旋美托咪啶在血漿濃度在0.48ng/ml1.6ng/ml時可減少2.5%七氟醚麻醉下顳葉性癲癇病人腦電圖的中位元頻率,但並不影響棘波活動。

(潘錢玲 陳傑 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和血管緊張素II受體介導血管緊張素II的升壓作用: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:中樞神經系統的腦室周圍結構及NO參與動脈血壓的調控,全麻可能刺激中樞腎素-血管緊張素系統。本文作者研究了血管緊張素IINO在清醒和麻醉狀態下大鼠系統血壓中的調節作用。

方法:將不銹鋼套管插入大鼠側腦室對其進行研究。將AT1AT2血管緊張素受體拮抗劑,氯沙坦和PD123319NO合成酶抑制劑L-NAME7-硝基吲唑和NO提供劑FK409注入側腦室。分別記錄清醒狀態和Zoletil麻醉下的大鼠平均動脈壓。

結果:基礎狀態下的MAP的均數±標準差是117.5±2mmHg。血管緊張素II注入側腦室後MAP增加到136.5±2mmHg 138.5±4mmHg16±3mmHg21±3mmHg),對照組MAP116±2mmHg120±3mmHg3±1mmHg5±2mmHg(P<0.05)L-NAME7-硝基吲唑增強了血管緊張素II的升壓效果(P<0.05)。預先注射氯沙坦和PD123319會降低血管緊張素II 的升壓效果和L-NAME7-硝基吲唑的增強效果(P<0.05)。Zoletil麻醉不改變血管緊張素II,(16±3mmHg21±3mmHg)或NO合成酶抑制劑的作用。

結論:內源性的NO補充了中樞血管緊張素系統調節閥的抑制性作用。AT1AT2血管緊張素受體拮抗劑影響了血管緊張素II對動脈血壓的中樞控制作用。但Zoletil麻醉不影響其作用。

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.

 

微多普勒導管用於離體評估靜脈氣體栓塞的檢測和吸引

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:外科手術中,術野開放的靜脈暴露于周圍的空氣,大氣壓力超過了靜脈系統壓力,靜脈氣體栓塞(VAE)可能成為手術致死的併發症。常見的檢測VAE的方法有心前區多普勒監測和經食管超聲心動圖。心前區多普勒監測儀精確性低,經食管超聲心動圖不僅昂貴而且用戶密集。以上兩種方法都必須在腔靜脈內插入隔離導管,用來探測氣栓並吸出。

方法:作者製作了一個微多普勒儀,由兩個陶瓷換能器組裝而成,安裝在一個5.8F的多腔中心靜脈導管上。用這個微多普勒導管(MDC)置於一個靜止槽和一人工腔靜脈(AVC)用於體外測定氣栓。MDC也可以用來檢測靜電罐的聲壓和電流洩漏或是AVC內的產熱和氣泡形成情況。

結果MDC可以檢測到直徑大於2mm的氣泡,精確率達100%。操作者在盲視下定位氣栓,10次實驗均成功。同一操作者又在10次實驗中完全成功地排出了氣栓。測量出的聲壓<1.8MPa。超過24小時後,AVC內的溫度沒有上升,而超過4小時後AVC內也沒有氣泡形成。

結論:實驗者製作的MDC可以探測到模擬腔靜脈和心房內的氣體栓子並解除氣栓。導管可以經皮放置在腔靜脈內。基於此設備可以測量AVC中的聲壓和溫度,而且AVC中不會有氣泡形成,因此可以安全地用於人體。而此導管是否可以用來檢測並吸出手術中的VAE,比如開顱手術中可能出現的VAE,還待更多的研究加以探索。

(杜唯佳 陳傑    

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.

 

針對困難拔管的連續氣道通路:氣道更換導管的有效性

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:美國麻醉學會專責小組在困難氣道管理上認為拔管策略的概念應是困難插管的延伸,但還沒有相關文獻提供充分資料衡量插管方法的優點。用AEC(氣道調換管)的方法維持氣道通暢被評論為是底限數值。

方法:從預先收集的一些困難氣道病人改進的資料庫中得到觀測分析,這些病人是監護室裏已知或起初被假定為困難氣道的病人。這些資料做出來是為研究重新插管的時間,企圖重新氣管插管的次數,固定氣管導管的方法,重插管過程中低氧血症發病率以及在重建氣道過程中遇見的合併症。

結果:51個留置了AEC的病人在插管試驗中都失敗了。其中47個在AEC下重新插管是成功的,而47個中的41個在第一次嘗試中就成功。四分之三的AEC重建是失敗的,AEC重建過程中不經意從聲門中移位,還有一位病人在拔除氣管內導管過程中發成嚴重的喉水腫。

結論:插管後接AEC維持持續氣道通氣會成為困難氣道擇期病人插管策略的一個重要組成部分。留置的AEC在已知或懷疑是困難氣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氣道重建的併發症的發病率。

(王騰 陳傑 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.

 

血液稀釋性中心血容量過高損害腦自身調節功能

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:手術期間,中心血容量經常變化可以通過改變交感神經活動度、心輸出量、血液粘滯度和腦血管舒縮等影響腦自身調節功能。然而,急性中心血容量改變對動態的大腦自身調節功能的影響尚未研究,特別是血液稀釋性高血容量。

方法:作者通過平均動脈壓和腦血流速度變異性兩者頻譜和傳遞函數分析中心低血容量和高血容量期間動態腦自動調節功能的變化。中心容量的快速變化通過兩種水準身體負壓(–15 –30 mm Hg)和分別輸注兩種劑量的生理鹽水(15 mL/kg 30 mL/kg)來獲得。然後中心靜脈壓和/或心排血量(用心阻抗法)變化評估中心血容量變化。

結果:平穩狀態時–30 mm Hg 低身體負壓(CVP降低4mmHg)下CBF速度和心排血量降低,輸注生理鹽水的兩組(CVP增加4mmHgCBF速度和心排血量增加,而MBP無顯著變化。但僅在鹽水輸注後MBPCBF速度變異性之間傳遞函數增加,顯示在血流稀釋性高容量期間,平均壓的變化會引起腦血流的波動。

結論:雖然血容量過高和過低情況下,腦血流速度均發生改變,但只有血液稀釋性中心血容量過高時損害了大腦自身調節功能。

(陳偉 陳傑 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.

 

芬太尼經皮離子導入系統和靜脈嗎啡病人自控鎮痛兩者的術後疼痛控制安全性和有效性的比較:三個隨機、有效對照臨床實驗的會聚分析

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:術後疼痛常用靜脈自控鎮痛方法(PCA)來控制。在此項會聚分析中,作者比較經皮芬太尼離子導入系統(ITS)和經靜脈嗎啡輸注病人自控鎮痛的安全性和有效性。

方法:資料來自3個多中心、隨機、有效對照試驗(樣本量1941)。有效性(“好”、“很好”所占比例)是基於24小時內病人對鎮痛控制方法的整體評價。同時評估疼痛強度、相對劑量比、中斷率和不良事件。有效性的評估經過年齡、手術方式和體重指數(BMI)的校正後得出。

結果:24小時內病人對鎮痛控制方法的整體評價為“有效”方面,兩者相當(芬太尼ITS80.5%;嗎啡 IV PCA81.0%;差異為-0.5%; 95%可信區間為-4.0%3.0%)。在24小時平均最後疼痛強度評分方面,兩者也相當(芬太尼ITS,3.1; 嗎啡 IV PCA,3.0; 差異為0.07; 95%可信區間為-0.140.29)。在第6、第12、第24小時,芬太尼組和嗎啡組在總體和亞群(年齡、BMI)方面的相對劑量比相似。在年齡、手術方式和BMI方面,相比嗎啡IV PCA,芬太尼ITS是等效的。中斷率和不良事件發生率兩者也相似。

結論:這些彙集的資料代表了芬太尼和嗎啡的在術後急性疼痛處理對比研究。結果顯示:在以年齡和BMI定義的各個亞群,芬太尼ITS同樣有效。芬太尼ITS能提供持續、安全而有效的術後鎮痛。

(於章傑 陳傑 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.

 

術後接受經皮等離子滲入系統給予芬太尼和通過靜脈病人自控使用嗎啡進行術後疼痛管理的系統相關事件和止痛間隙

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:止痛的間隙(止痛效果間斷)成為術後疼痛管理無效的因素。在這一項分析中,作者評估了芬太尼經皮電離子滲透系統(一種非侵入性的病人自控止痛系統ITS)和嗎啡靜脈病人自控鎮痛(PCA行術後疼痛管理時系統相關事件(SREs及止痛間隙的發生率。

方法:收集兩組開放、隨機、對照試驗資料, 評估全髖置換術、腹部手術或盆腔手術術後芬太尼ITS嗎啡PCA的效能和安全性。通過系統相關事件、止痛間隙的發生率以及持續時間來評估。

結果:總數為 1305位病人中647位病人接受ITS658位病人接受PCA ITS發生止痛間隙的發生率明顯低於PCA(分別為5.8712.01,P 0.001)。與嗎啡靜脈PCA相比,接受芬太尼ITS的病人不僅止痛間隙時間(15.0 min vs 20.0 min)低於總的止痛間隙的平均值,而且低於總的系統相關事件解決時間的平均值(11.0 min vs 20.0 min)多數芬太尼ITS發生SRES通過提供新的ITS解決,而嗎啡靜脈PCA需要採用許多其他不同的SRE 解決方法

結論:芬太尼ITS發生止痛間隙的發生率明顯低於通過嗎啡靜脈PCA。芬太尼ITS可以提供較少的止痛間隙和更持久的連續鎮痛。

(王鵬 陳傑 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.

 

加巴噴丁預防導管相關膀胱不適的療效評估:一項前瞻、隨機、對照、雙盲研究

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:由放置導尿管引起的導管相關膀胱不適(CRBD)是很痛苦的。在本研究中,作者評估了加巴噴丁對CRBD的預防作用。

方法:108位接受選擇性經皮腎取石術患者,ASA I級或II級,男女都有,隨機被分為2組,54人一組。對照組:使用安慰劑;加巴噴丁組(G組):使用加巴噴丁600mg。在術前一小時口服藥物。麻醉誘導後,使用16F Foley導管進行置管,10ml生理鹽水充氣囊。在恢復室裏分別觀察患者到達時,到達後1h2h6h時,CRBD的發生率和程度(輕度,中度和重度)。

結果:加巴噴丁減少CRBD的發生率,僅為50%54/27),與之相比,對照組CRBD的發生率為80%54/43)(P<0.05)。加巴噴丁同樣減少CRBD的程度,以及術後疼痛,因為觀察到加巴噴丁組患者術後需要芬太尼的人數以及術後總消耗芬太尼的量有明顯減少(P<0.05)。

結論:術前1h口服加巴噴丁(600mg)可以減少CRBD的發生率和程度,術後疼痛,需要芬太尼的患者人數以及術後總芬太尼使用量。

(朱玫娟 陳傑 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-腎上腺受體參與奧凱西平的抗痛覺過敏效應

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:作者通過檢測氫化麥角新堿(選擇性α2-腎上腺素受體拮抗劑)、BRL44408(選擇性α2A-腎上腺素受體拮抗劑)、MK912(選擇性α2C-腎上腺素受體拮抗劑)和可樂定(α2-腎上腺素受體興奮劑)在炎性疼痛大鼠模型中的抗痛覺過敏效應,來研究外周α2-腎上腺素能受體是否與奧凱西平的抗痛覺過敏反應有關。

方法:給大鼠蹠部注射炎性前體複合物(ConA)。通過測定大鼠爪部壓力來反應:1Con A產生痛覺過敏的發展過程;2)奧凱西平對於Con A所產生的痛覺過敏所發生的相應效應;3)氫化麥角新堿、BRL44408MK912、可樂定對奧凱西平的抗痛覺過敏效應的作用。

結果:奧凱西平(蹠部注射10003000nmol/paw)和可樂定(蹠部注射1.97.5nmol/paw)可顯著減輕Con A所產生的炎性痛覺過敏,並呈劑量依賴性。氫化麥角新堿(蹠部注射260520nmol/paw)、BRL44408(蹠部注射100200nmol/paw)MK912(蹠部注射1020nmol/paw)可顯著抑制奧凱西平(蹠部注射2000nmol/paw)的抗痛覺過敏效應,並呈劑量依賴性。拮抗劑的效應是局部的,因為在對側蹠部的背部並沒有觀察到拮抗劑的效應。當奧凱西平和可樂定以固定比例的劑量(ED501/4,1/23/4)給予時,可顯著減輕Con A的痛覺過敏反應,並呈劑量依賴性,Isobolographic分析顯示它們具有累加作用。

 

結論:結果證明在炎性痛覺過敏大鼠模型中,外周α2A腎上腺受體和α2C腎上腺能受體與奧凱西平的抗痛覺過敏效應有關。

(詹瓊慧 陳傑 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%等比重利多卡因蛛網膜下腔麻醉後暫時性神經綜合征:穿刺針類型的影響

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:利多卡因蛛網膜下腔麻醉後暫時性神經綜合征(TNS)的報導發生率達40%。作者因此設計了本臨床試驗以研究兩種不同類型腰麻穿刺針(單孔:Atraucan和雙孔:Eldor穿刺針)的TNS發生率:。

技術:99名行膀胱或前列腺手術,ASA分級為I級或Ⅱ級的患者隨機接受使用26Atraucan針或26Eldor針行腰麻,麻醉藥為2%等比重利多卡因40mg+芬太尼。在術後前3天內,記錄患者的術後併發症,包括TNS。主要研究終點是雙孔和單孔腰麻穿刺針組的TNS發生的百分比。

結果:當使用Atraucan針行腰麻時TNS的發生率較高(28.8%vs8.5%P=0.006)。截石位患者術後TNS發生率為雙孔組50%,單孔組100%P=0.014)。Eldor針發生TNS的相對危險係數與Atraucan針相比為0.2995%可信區間:0.07-0.75)。

結論:使用雙孔腰麻穿刺針後TNS的發生率較低,這可能與穿刺針的設計有關。

(丁震敏 陳傑 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.

異氟醚預處理的Ca2+迴圈蛋白獨立於肌細胞膜及線粒體膜ATP敏感鉀通道對心肌的保護

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:吸入麻醉藥的預處理(APC)提高收縮功能的恢復,減少缺血再灌注(I/R)後的鈣負荷。肌細胞膜及線粒體膜ATP敏感鉀通道的開放已被用於APC導致的心肌保護。在本研究中,我們研究APC在主要Ca2+迴圈蛋白及其相關的ATP敏感鉀通道的效應。方法:我們將離體鼠心分為七組:時間組(n = 10),缺血組(n = 8)APC (n = 8),線粒體膜5-HD抑制的ATP敏感鉀通道組(5-HD, 200 microM, n = 8)HMR1098抑制的細胞膜ATP敏感鉀通道組(HMR, 20 microM, n = 8),和APC疊加5-HDHMR1098(n = 8)APC1.5%的異氟醚吸入15分鐘開始,接著是30分鐘的缺血和60分鐘的再灌注後的15分鐘洗出。 RyR2SERCA2a,受磷蛋白,質膜Ca2+ ATP酶和鈉鈣交換在勻漿被測定。結果:在I/R APC提高收縮功能的恢復(左室壓力,+dP/dt, -dP/dt),但可被5-HD HMR阻斷。I/R抑制RyR2SERCA2a和受磷蛋白的密度,但無質膜Ca2+ ATP酶和鈉鈣交換。結論:I/R導致的在心臟的抑制與主要Ca2+迴圈蛋白的下調有關。異氟醚的預處理阻止RyR2SERCA2a I/R 相關的降解,但它獨立於敏感鉀通道組的啟動。

(陳勇柱譯 薛張綱校)

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.

 

連續外周神經阻滯用於小兒術後鎮痛

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:評價連續外周神經阻滯(CPNB)用於小兒矯形外科手術術後鎮痛效果。方法:回顧20032月到20067月費城兒科醫院局部麻醉和術後接受CPNB鎮痛的續慣性登記病例。隨訪患兒直到CPNB/或任何相關併發症治癒。同時記錄感覺和運動神經阻滯情況、疼痛評分、阿片類鎮痛藥使用量和與CPNB相關的併發症。結果:217例患者放置226次外周神經導管。108例患者(112導管)帶CPNB出院回家。年齡從4-18歲(13.7±3.4)。局麻藥包括0.125%布比卡因(n=164),0.1%羅呱卡因(n=12),或0.15%羅呱卡因(n=17)。局麻藥注射初始速度按照體重和導管位置不同設置為2-12mL/h。局麻藥輸注平均時間48.4±29.3h0-160h)。患者在首次82448h不需要任何鎮痛的分別為56%26%21%。噁心嘔吐發生率為14%(出院患者13% 住院患者15%)。併發症發生率占2.8%3例患者麻痹時間超過24h,但自然恢復;1例患者出現表面蜂窩織炎,使用抗生素後恢復;1例患者出現導管拔除困難;1例患者在開始CPNB24h後出現耳鳴,迅速夾閉導管並拔除後恢復。結論:合理的技術條件許可下,小兒矯形外科手術後使用CPNB方案進行術後鎮痛是可行的,並為門診和住院患者提供的又一種術後鎮痛的方法。給患者和家屬宣教和隨訪是快速判斷和治療不良事件的關鍵。

(吳德華譯 薛張綱校)

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.

 

門診預行LC的病人術中用艾斯洛爾代替阿片類藥物可節省術後芬太尼用量

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:門診手術使用阿片類藥物會延長住院周轉或引起非預期的住院。術中持續使用艾斯洛爾以代替阿片類藥物的初期研究顯示不一致的關於術後節省阿片類藥物的報導。在此次研究中,我們在術後阿片類減量、副作用及出院時間等方面比較了使用艾斯洛爾與間斷使用芬太尼或持續使用瑞芬太尼的區別。方法:90個病人(包括三組)進行前瞻性、隨機、雙盲研究。對照組(n=30)間斷注射芬太尼,艾斯洛爾組(n=30)持續注射艾斯洛爾5–15 µg · kg–1 · min–1 且術中不追加阿片類藥物,瑞芬太尼組(n=30)持續注射瑞芬太尼0.1–0.5 µg · kg–1 · min–1 。全麻過程被標準化,輔助用藥包括撲熱息痛、痛力克,皮膚切口處局麻,地米及氟呱利多。術後鎮痛用芬太尼。結果:術後鎮痛使用芬太尼的用量,相對於瑞芬組的237.8 ± 54.7 µg及對照組的168.1 ± 96.8 µg,艾斯洛爾組的91.5 ± 42.7µg明顯減少(P < 0.0001)。術後噁心嘔吐的發生率與艾斯洛爾的30%相比,對照組的66.7%及瑞芬組的67.9%明顯更頻繁(P < 0.01)。艾斯洛爾組達到White-Song評分12-14快於瑞芬組(P < 0.01),且離開醫院要早45-60分鐘(P < 0.004)。結論:術中給予艾斯洛爾使術後芬太尼及昂丹司瓊的用量顯著減少並且出院更早。

( 霞譯 薛張綱校)

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.

 

 

不同靜脈麻醉藥對肺靜脈平滑肌肌絲鈣離子敏感性的影響

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:肺靜脈的收縮可以增加肺毛細血管壓和加重肺水腫。在本次研究中,我們探查了氯胺酮、依託咪酯、硫噴妥鈉和咪達唑侖對肺靜脈收縮和透化處理的肺靜脈平滑肌(PVSM)肌絲鈣離子敏感性的直接影響。方法:我們用離體的犬肺靜脈檢測這些靜脈麻醉藥對乙醯膽鹼收縮的影響。經過α毒素透化處理後同時測量載有fura-2的內皮裸露的PVSM的電壓和鈣離子電流。測量靜脈麻醉藥對缺乏或存在毒蕈堿受體活性的電壓的影響(維持鈣離子恒定)。在加入氯胺酮之前和之後運用免疫螢光技術和共聚焦顯微鏡集中PVSM細胞中細胞分配的蛋白激酶C亞型。結果:氯胺酮、依託咪酯和咪達唑侖都呈劑量依賴的減弱乙醯膽鹼的收縮,然而硫噴妥鈉沒有影響。任何一個靜脈麻醉藥單獨應用時在鈣離子恒定時對電壓都沒有影響(i.e.,它們對肌絲的鈣離子敏感性沒有直接影響)。乙醯膽鹼在鈣離子恒定時增加56± 7%的電壓。在乙醯膽鹼啟動帶,硫噴妥鈉、依託咪酯和咪達唑侖在鈣離子恒定時對壓力沒有其他影響,而氯胺酮降低33% ± 3%的電壓。被乙醯膽鹼啟動誘導的PKC{alpha}從胞質易位到胞膜可被氯胺酮阻斷。結論:氯胺酮、依託咪酯,和咪達唑侖都減弱乙醯膽鹼誘導的肺靜脈收縮。氯胺酮通過抑制乙醯膽鹼誘導的肌絲鈣離子敏感性增加和乙醯膽鹼誘導的PKC{alpha}易化減弱乙醯膽鹼的收縮。

(王時來譯 薛張綱校)

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}.

 

 

小劑量靜脈注射咪達唑侖降低依託咪酯誘導的肌陣攣:對進行電複律病人的前瞻性隨機實驗

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:用依託咪酯對沒有術前用藥的病人進行麻醉誘導時發生肌振攣是一個常見問題.方法:在一個雙盲實驗中,40位將進行電複律的病人(ASA評級III-IV)在注射0.3 mg/kg依託咪酯前90秒被隨機分配,使用0.015 mg/kg咪達唑侖或安慰劑.肌振攣現象和鎮靜作用以03分級記錄,脈搏氧飽和度、無創動脈血壓和心率也被記錄下來.結果:咪達唑侖組中2個病人(10%)在使用依託咪酯後發生肌振攣,20個安慰劑組中的病人有10(50%)發生(P = 0.006).兩組中沒有發現其他不同的現象,而在依託咪酯注射後的5分鐘兩組的病人在蘇醒方面也沒有別的不同.結論:用依託咪酯進行誘導前90秒靜脈注射0.015 mg/kg咪達唑侖對降低肌振攣的發生是很有效的,並且在一個短暫的過程後這並不延遲未使用術前用藥的病人的蘇醒.

 ( 楊譯 薛張綱校)

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.

 

異丙酚削弱內毒素誘導內皮細胞損傷血管緊張素轉換酶脫落和肺水腫

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:急性肺損傷是一種常見的綜合症在敗血症病人中。之前,我們發現異丙酚,一種高度脂溶性的麻醉藥,削弱了孤立的灌注的鼠肺的缺血-再灌注損傷和氧化肺損傷。在這篇研究中,我們評估了異丙酚在內毒素誘導的急性肺損傷和內皮功能紊亂的作用。方法:異丙酚對內毒素誘導的肺內皮損傷的作用可以用血漿和肺組織混合物血管緊張素Ⅰ轉換酶活性、肺血管抗ACE單克隆抗體結合物、和肺淨重和體重比值來評估。結果:為老鼠開放靜脈,內毒素產生內皮細胞損傷和肺水腫,有如下症狀:1)血漿ACE活性提高 2)肺ACE活性和抗-ACE單克隆抗體結合的降低 3LW/BW的降低。單克隆抗體1A2比其他抗-ACE單克隆抗體在監測使用內毒素鼠肺的ACE降低的敏感性要高1.8倍。在給老鼠注射內毒素前預注一個劑量的異丙酚會極大得抑制血中ACE活性的增加,肺中ACE活性的降低,結合在肺中的抗ACE單克隆抗體的減少,以及LW/BW比值的增加。重要的是,異丙酚還極大地增加了存活老鼠的數量。異丙酚對使用內毒素的動物的保護機制同樣適合於體外,比如,異丙酚降低了在培養中的內皮細胞的損傷和從內皮細胞脫落的ACE。結論:這些結果表明異丙酚提供了極大的對內毒素誘導的肺微血管內皮細胞損傷的保護作用,以及抗ACE單克隆抗體1A2是監測內皮功能紊亂和敗血症時急性肺損傷的敏感指針。

(陳佳莉譯 薛張綱校)

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.

 

 

在戊巴比妥麻醉的實驗狗中不同的多巴酚丁胺輸注速度對改善因高碳酸血症所致的膈肌收縮力下降的效果

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:以往有證據顯示,對於高碳酸血症患者,多巴酚丁胺比多巴胺更有利於改善膈肌的收縮力。這裏,我們研究了戊巴比妥麻醉的實驗狗,不同的多巴酚丁胺輸注速率對改善高碳酸血症所致的膈肌收縮力下降的效果。方法:實驗動物被分為四組,每組六隻。每組通過吸入含有10%的CO2的氣體製造高碳酸血症(8090mmHg)模型。高碳酸血症模型建立後,Dob 0組不給藥;Dob 5給予多巴酚丁胺5 µg·kg–1·min–1Dob 10給予多巴酚丁胺10 µg·kg–1·min–1 Dob 15給予多巴酚丁胺15 µg·kg–1·min–1 。多巴酚丁胺試驗藥靜脈給藥,持續60min。膈肌的收縮力通過測定經膈肌的壓力(Pdi)評估。結果:在高碳酸血症中,每組在低頻刺激和高頻刺激下,Pdi相對於基線降低(P < 0.05)Dob 0, Pdi在每次刺激下沒有變化。在Dob 5組,Dob 10, Dob 15,給予了試驗藥後,Pdi有所改善;並且在每個刺激下,與多巴酚丁胺輸注速度成正相關。結論:在戊巴比妥麻醉實驗狗中,多巴酚丁胺可以有效改善高碳酸血症所致的膈肌收縮力的下降,並且與輸注速度成正相關。

(陳珺珺譯  薛張綱校)

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.

 

 

缺血前以胰島素控制血糖水準可預防大鼠的脊髓缺血性損傷

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:胰島素是否可以防止脊髓缺血性損傷還不確定。我們檢測在有暫時性脊髓缺血的老鼠中,以小劑量胰島素來糾正輕度高血糖的作用。方法:我們將老鼠分為四組(每組8個),非治療組(c組)、缺血前胰島素組(pre-i組)、缺血前胰島素葡萄糖組(gi組)(血糖水準保持在c組的水準)和缺血中胰島素組(post-i組)。對於Pre-I GI組在缺血前30分鐘給與胰島素(0.5 IU/kg),而Post-I組在再灌注後給與。阻斷腹主動脈13分鐘以造成脊髓缺血。缺血七天后進行神經學和組織病理學的評估。結果:Pre-I組缺血前的平均血糖水準(118 mg/dL)明顯低於其他三組(158–180 mg/dL),而再灌注30分鐘後Pre-I(92 mg/dL)Post-I (100 mg/dL)明顯低於C (148 mg/dL) GI (140 mg/dL)Pre-I組的脊髓前動脈的正常神經元的功能評分和數量比其他組明顯要高。結論:結果提示於缺血前給與小劑量的胰島素可以預防脊髓缺血性損傷,其作用可能在於其可密切控制缺血前血糖水準。

佳譯 薛張綱校)

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.

 

脊麻剖宮產術中使用充氣式保溫不能預防母體低溫

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:術前和術中使用充氣式保溫系統能預防硬膜外麻醉行擇期剖宮產術患者的圍術期低溫及寒戰。術中下身使用充氣式保溫也能預防擇期剖宮產術脊麻患者的低溫麼?我們測試了這一假說。方法:30名健康行擇期剖宮產術脊麻患者隨機分為充氣保溫組和對照組(覆蓋相同鋪單而關閉充氣保溫裝置)。一位元盲研究者間隔15分鐘評估口腔溫度、寒戰及溫度舒適評分直至出蘇醒室。胎兒娩出後測臍帶血氣和Apgar評分。結果:兩組最大核心溫度改變相近(充氣保溫組-1.3+/-0.4攝氏度,對照組-1.3+/-0.3攝氏度,P=0.8)。核心低溫(<=35.5攝氏度)發生率,充氣保溫組15人中有8人,對照組15人中有10人(P=0.5)。寒戰發生率及嚴重程度兩組無顯著差異。臍帶血氣和Apgar評分兩組相近(P=NS)。結論:術中下身使用充氣式保溫不能預防脊麻行擇期剖宮產術患者術中低溫或寒戰。

(羅 璿譯 薛張綱校)

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.

 

 

長期接受經皮丁丙諾啡治療的非癌性疼痛患者的認知和精神運動行為的評估

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:一般認為運用阿片類藥物治療會引起認知和精神運動功能損害。一些研究已經證明了這種阿片類藥物治療對於精神運動行為和認知的影響,但是目前沒有資料證明長期經皮丁丙諾啡會對駕駛能力產生影響。方法:三十位經受慢性非癌性疼痛的患者,接受穩定劑量的經皮丁丙諾啡治療,與九十位健康志願者進行比較(對照組)。在德國,正使用一項經過電腦設計的試驗,來評估交通違法者的駕駛能力。測量注意力反應,視覺變數,運動協調性以及警惕性。這些資料測量了14個變數,對於每一項測試,都能得到相關的分數。對於基本的終點,決定了三項相關分數的總合。一項用於測評患者行為能力的疲軟的統計學方法,與另一組年齡相關的對照組進行比較。如果個人行為低於對照組的第十六個百分點,按照德國法律將取消駕駛資格。結果:根據檢測結果與的駕駛能力,接受經皮丁丙諾啡叔丁啡的患者並不比對照組差。駕駛能力,結果一樣肯定高於對照組的第十六個百分點,與對照組並沒有顯著差異。結論:給慢性非癌性疼痛患者長期使用經皮丁丙諾啡不會影響駕駛能力,但是由於測試結果的個體差異性,建議使用個體評估。

(王光妍譯 薛張綱校)

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.

 

硬膜外麻醉用於椎板切除引導定位完成脊髓刺激

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:脊髓刺激常被用於治療慢性疼痛,並且要求是一個清醒的病人使得能夠對於感覺異常點的定位達到最佳化。硬膜外麻醉也許是一種適宜的麻醉方式,但是未經評估。方法:我們完成一個公開的、前瞻性的、觀察性質的、單中心研究,用於研究在硬膜外麻醉下實施椎板切除術引導定位對於治療慢性神經性疼痛的安全性和有效性。結果:我們實驗的結果表明硬膜外麻醉對於脊髓刺激引導埋植劑是一種適宜的麻醉方式。結論:這是首例實驗用硬膜外麻醉完成椎板切除術引導埋植劑實現脊髓刺激。這項技術似乎是安全和有效的。

(周時蓓譯 薛張綱校)

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.

 

 

鼠模型電針療法減弱骨癌疼痛並且抑制脊椎白細胞介素的表達

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:儘管疼痛嚴重影響癌症病人的生活品質,目前的治療方法卻或者療效不佳,或者存在副作用。此次研究我們運用了骨癌所致疼痛的鼠模型,調查電針療法對癌症導致的痛覺過敏以及由於長期存在的持續疼痛引起白細胞介素表達增加的作用。方法:我們通過注射AT3.1前列腺癌細胞進入雄性哥本哈根鼠的脛骨來誘導癌症模型。在腫瘤細胞種植後的1418天,用10赫茲/2毫安培/0.4毫秒脈衝的電針刺激相當於人體GB30的穴位(環跳穴),每天30分鐘,來治療腫瘤所致疼痛。作為對照組,電針刺入GB30穴位,但不釋放電刺激。在電針療法進行治療後的即刻以及20分鐘後,測量小鼠對非有害熱刺激發生爪子蜷縮反應,即產生熱痛覺過敏的等待時間。通過免疫組織學及反轉多聚酶鏈反應分別監測白細胞介素及其mRNA的表達。結果:熱痛覺過敏在腫瘤細胞植入後的1218天發生進展。電針療法顯著地(P<0.05)減輕了熱痛覺過敏,使小鼠發生爪子蜷縮反應的等待時間由7.0±0.3增加到9.2±0.4秒,並且同對照組比較,抑制了白細胞介素及其mRNA表達的上調。鞘內注射白細胞介素1受體拮抗劑(IL-1ra, 0.1 mg/個體鼠)同樣顯著抑制了腫瘤所致的熱痛覺過敏。結論:資料顯示電針療法緩和了骨癌所致疼痛,至少部分作用是通過抑制白細胞介素的表達。這結果支持了電針療法在癌性疼痛臨床治療中的應用。

(吳 威譯 薛張綱校)

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.

 

 

關於在迴圈阻斷(阻斷血流灌注)化學灌注治療中運用全身麻醉和脊髓麻醉的回顧性研究

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:阻斷血流灌注化學治療法是一項新的對腫瘤的局部探索性治療,通常在全麻較少情況下在脊麻下進行,我們設計了這項臨床試驗比較全麻和脊麻在阻斷血流灌注治療中的臨床資料。方法:40名癌症患者隨機接受異丙酚,笑氣和芬太尼或布比卡因低腰段麻醉或骨盆阻斷血流灌注記錄麻醉和復蘇時間,通過直觀類比標度對術後疼痛評分,術後噁心嘔吐以及進入蘇醒室的情況。結果:全麻和脊麻在患者回家時間或患者滿意度上沒有差別,向比于全麻,脊麻顯著減少了手術時間(3416分鐘)、術後疼痛(50)、噁心(82)和術後進入麻醉蘇醒室(90)的比例。總結:對於阻斷血流治療,全麻和脊麻都是有效的,但脊麻在術後期有恢復快、更好的鎮痛和更少的術後噁心、嘔吐的優勢。

(陳愷錚譯 薛張剛校)

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.