Anesthesia & Analgesia
Table of Content
CARDIOVASCULAR ANESTHESIA:非心?手?患者的心肌保? 一??量系??价
(?雪? ? 庄心良 校）
Pharmacologic Myocardial Protection in Patients Undergoing Noncardiac Surgery: A Quantitative Systematic Review
Robert D. Stevens, Haran Burri, and Martin R. Tramèr
Anesth Analg 2003 97: 623-633.?通道阻??（CCB）?少非心?手?后心??病率的作用--Meta分析
(?旭? ? 薛?? 校）
Calcium Channel Blockers for Reducing Cardiac Morbidity After Noncardiac Surgery: A Meta-Analysis
Duminda N. Wijeysundera and W. Scott Beattie
Anesth Analg 2003 97: 634-641.?食道超?心??的?种不同?量左室射血??方法的?估
(殷文? ? 王祥瑞 校)
An Assessment of Two Different Methods of Left Ventricular Ejection Time Measurement by Transesophageal Echocardiography
Madhav Swaminathan, Barbara G. Phillips-Bute, and Joseph P. Mathew
Anesth Analg 2003 97: 642-647.原位肝移植?中食道超?引?下?皮????旁路置管
(?施? ?，庄心良 校）
Transesophageal Echocardiography-Guided Placement of Internal Jugular Percutaneous Venovenous Bypass Cannula in Orthotopic Liver Transplantation
Raymond M. Planinsic, Ramona Nicolau-Raducu, John C. Caldwell, Shushma Aggarwal, and Ibtesam Hilmi
Anesth Analg 2003 97: 648-649.
(?旭? ? 薛?? 校）
Perioperative Continuous Peripheral Nerve Blocks with Disposable Infusion Pumps in Children: A Prospective Descriptive Study
Christophe Dadure, Philippe Pirat, Olivier Raux, Rachel Troncin, Alain Rochette, Christine Ricard, and Xavier Capdevila
Anesth Analg 2003 97: 687-690.
Inhaled Anesthetics and Immobility: Mechanisms, Mysteries, and Minimum Alveolar Anesthetic Concentration(Review Article)
James M. Sonner, Joseph F. Antognini, Robert C. Dutton, Pamela Flood, Andrew T. Gray, R. Adron Harris, Gregg E. Homanics, Joan Kendig, Beverley Orser, Douglas E. Raines, James Trudell, Bryce Vissel, and Edmond I Eger, II
Anesth Analg 2003 97: 718-740.狗大?膜?害/Orphanin FQ(N/OFQ)?合位?的特?
(?旭? ? 薛?? 校）
Characterization of Nociceptin/Orphanin FQ Binding Sites in Dog Brain Membranes(Review Article)
Emma E. Johnson, Helen Gibson, Beverley Nicol, Johannes Zanzinger, Peter Widdowson, Mark Hawthorn, Géza Toth, Judit Farkas, Remo Guerrini, and David G. Lambert
Anesth Analg 2003 97: 741-747.硬膜外可?定?老鼠?力感受器交感神?反?的抑制依?异氟醚?度
(殷文? ? 王祥瑞 校)
Epidural Clonidine Suppresses the Baroreceptor-Sympathetic Response Depending on Isoflurane Concentrations in Cats(Review Article)
Yoshikazu Ikeda, Kiyonobu Nishikawa, Kenji Ohashi, Takashi Mori, and Akira Asada
Anesth Analg 2003 97: 748-754.咪?唑?可引起狗疲?膈肌的功能障?并影?其恢复
(?雪? ? 庄心良 校）
Midazolam-Induced Muscle Dysfunction and Its Recovery in Fatigued Diaphragm in Dogs(Review Article)
Yoshitaka Fujii, Aki Uemura, and Hidenori Toyooka
Anesth Analg 2003 97: 755-758.多沙普?可使兔??降低并呈?量相?性
(梁雅芬 ? 薛?? 校）
Doxapram Produces a Dose-Dependent Reduction in the Shivering Threshold in Rabbits(Review Article)
Katsumi Okuyama, Takashi Matsukawa, Makoto Ozaki, Daniel I. Sessler, Tomoki Nishiyama, Makoto Imamura, and Teruo Kumazawa
Anesth Analg 2003 97: 759-762.2-Bromomelationin的催眠和?痛效?
(? 波 ? 王祥瑞 校)
The Hypnotic and Analgesic Effects of 2-Bromomelatonin(Review Article)
Mohamed Naguib, Max T. Baker, Gilberto Spadoni, and Marc Gregerson
Anesth Analg 2003 97: 763-768.
TECHNOLOGY, COMPUTING, AND SIMULATION:大?半球同步化?和?中麻醉的需求
(王立中 ? 庄心良 校）
Hemispheric Synchronized Sounds and Intraoperative Anesthetic Requirements
Susan Dabu-Bondoc, Jacqueline Drummond-Lewis, Dorothy Gaal, Maryanne McGinn, Alison A. Caldwell-Andrews, and Zeev N. Kain
Anesth Analg 2003 97: 772-775.胸科手?麻醉??皮CO2与呼气末CO2??的?估比?
(梁雅芬 ? 薛?? 校）
A Comparative Evaluation of Transcutaneous and End-Tidal Measurements of CO2 in Thoracic Anesthesia
Motoko Oshibuchi, Sungsam Cho, Tetsuya Hara, Shiro Tomiyasu, Tetsuji Makita, and Koji Sumikawa
Anesth Analg 2003 97: 776-779.在复合全麻和硬膜外麻醉?程中麻?素可增加病人的????指?，而新福林?不能
(? 波 ? 王祥瑞 校)
Ephedrine, but Not Phenylephrine, Increases Bispectral Index Values During Combined General and Epidural Anesthesia
Tadahiko Ishiyama, Takeshi Oguchi, Tetsuya Iijima, Takashi Matsukawa, Satoshi Kashimoto, and Teruo Kumazawa
Anesth Analg 2003 97: 780-784.
(王士雷 ? 庄心良 校）
Defining Neuropathic Pain(Medical Intelligence)
Anesth Analg 2003 97: 785-790.?解疼痛可以改善慢性疼痛患者的行?和情??？
(王柯 ? 薛?? 校）
Does Pain Relief Improve Pain Behavior and Mood in Chronic Pain Patients?(Medical Intelligence)
Sabine M. Sator-Katzenschlager, Andreas W. Schiesser, Sibylle A. Kozek-Langenecker, Gerhard Benetka, Gudrun Langer, and Hans-Georg Kress
Anesth Analg 2003 97: 791-797.神??固醇?物的?痛作用：阿法沙?和阿法多???啡??痛?的增?作用的比?
(忻?? ? 王祥瑞 校)
Antinociceptive Properties of Neurosteroids: A Comparison of Alphadolone and Alphaxalone in Potentiation of Opioid Antinociception(Medical Intelligence)
L. Winter, R. Nadeson, A. P. Tucker, and C. S. Goodchild
Anesth Analg 2003 97: 798-805.?布啡及其?效酯在大鼠中的抗?害作用
(王士雷 ? 庄心良 校）
The Antinociceptive Effect of Nalbuphine and Its Long-Acting Esters in Rats(Medical Intelligence)
Koung-Shing Chu, Jhi-Joung Wang, Oliver Yoa-Pu Hu, Shung-Tai Ho, and Yu-Wen Chen
Anesth Analg 2003 97: 806-809.在辣椒素引起痛??敏的自愿者中??使用雷米芬太尼??生撤?性的痛??敏
王柯 ? 薛?? 校）
Intravenous Remifentanil Produces Withdrawal Hyperalgesia in Volunteers with Capsaicin-Induced Hyperalgesia(Medical Intelligence)
David D. Hood, Regina Curry, and James C. Eisenach
Anesth Analg 2003 97: 810-815.氟?利多??啡自控?痛病人的止吐作用：?机，?照，多种?量-效?的研究。
(忻?? ? 王祥瑞 校)
The Antiemetic Efficacy of Droperidol Added to Morphine Patient-Controlled Analgesia: A Randomized, Controlled, Multicenter Dose-Finding Study(Medical Intelligence)
Xavier Culebras, Jean-Baptiste Corpataux, Giovanni Gaggero, and Martin R. Tramèr
Anesth Analg 2003 97: 816-821.?后?痛?手?免疫反?的影?
(?施? ?，庄心良 校）
The Effects of Postoperative Pain Management on Immune Response to Surgery(Medical Intelligence)
Benzion Beilin, Yehuda Shavit, Evelyn Trabekin, Boris Mordashev, Eduard Mayburd, Alexander Zeidel, and Hanna Bessler
Anesth Analg 2003 97: 822-827.定量的感???能????于坐骨神?痛患者硬膜外注射?固醇
(王柯 ? 薛?? 校)
Can Quantitative Sensory Testing Predict the Outcome of Epidural Steroid Injections in Sciatica? A Preliminary Study(Medical Intelligence)
Elad Schiff and Elon Eisenberg
Anesth Analg 2003 97: 828-832.
CRITICAL CARE AND TRAUMA:??病人?敷料?使用异丙酚自控??：?量效?的研究
(朱 ? ? 王祥瑞 校)
Patient-Controlled Sedation Using Propofol for Dressing Changes in Burn Patients: A Dose-Finding Study
Claudia Coimbra, Manon Choinière, and Thomas M. Hemmerling
Anesth Analg 2003 97: 839-842.小?量氯胺酮?腹部大手?后住ICU的病人?啡用量的影?
（王士雷 ? 庄心良 校）
The Effects of Small-Dose Ketamine on Morphine Consumption in Surgical Intensive Care Unit Patients After Major Abdominal Surgery
Nicolas Guillou, Michèle Tanguy, Philippe Seguin, Bernard Branger, Jean-Pierre Campion, and Yannick Mallédant
Anesth Analg 2003 97: 843-847.
(方芳 ? 薛?? 校)
Measuring Cerebral Oxygenation During Normobaric Hyperoxia: A Comparison of Tissue Microprobes, Near-Infrared Spectroscopy, and Jugular Venous Oximetry in Head Injury
Andrew D. McLeod, Farrell Igielman, Clare Elwell, Mark Cope, and Martin Smith
Anesth Analg 2003 97: 851-856.兔子模型中?胞?黏附分子-1（ICAM-1）的?克隆抗体在硬膜外的治?作用：?胞?黏附分子-1（ICAM-1）引起脊索缺血的机制
(?羽霄 ? 王祥瑞 校)
The Therapeutic Effects of Epidural Intercellular Adhesion Molecule-1 Monoclonal Antibody in a Rabbit Model: Involvement of the Intercellular Adhesion Molecule-1 Pathway in Spinal Cord Ischemia
Kamatham A. Naidu, Eugene S. Fu, E. Truitt Sutton, Leon D. Prockop, and Alan Cantor
Anesth Analg 2003 97: 857-862.
(王士雷 ? 庄心良 校）
Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison
Antoine G. M. Aya, Roseline Mangin, Nathalie Vialles, Jean-Michel Ferrer, Colette Robert, Jacques Ripart, and Jean-Emmanuel de La Coussaye
Anesth Analg 2003 97: 867-872.在晚期分娩?鞘?注射25ug芬太尼合用2.5mg的重比重布比卡因与合用等比重布比卡因相比延?了?痛??
(方芳 ? 薛?? 校)
Hyperbaric Bupivacaine 2.5 mg Prolongs Analgesia Compared with Plain Bupivacaine When Added to Intrathecal Fentanyl 25 μg in Advanced Labor
Wendy H. L. Teoh and Alex T. H. Sia
Anesth Analg 2003 97: 873-877.母白鼠暴露于可卡因下?新生白鼠心功能的影?
(朱 ? ? 王祥瑞 校)
The Effect of Maternal Cocaine Exposure on Neonatal Rat Cardiac Function
Lena S. Sun, Shin Takuma, Rui Lui, and Shunichi Homma
Anesth Analg 2003 97: 878-882.
(王士雷 ? 庄心良 校）
Onset Time, Quality of Blockade, and Duration of Three-in-One Blocks with Levobupivacaine and Bupivacaine
Bernhard Urbanek, Andreas Duma, Oliver Kimberger, Gudrun Huber, Peter Marhofer, Michael Zimpfer, and Stephan Kapral
Anesth Analg 2003 97: 888-892.家兔中肺??比卡因和左旋布比卡因的?取
(方芳 ? 薛?? 校)
Pulmonary Uptake of Ropivacaine and Levobupivacaine in Rabbits
Shigeo Ohmura, Akiko Sugano, Masayuki Kawada, and Ken Yamamoto
Anesth Analg 2003 97: 893-897.
非心?手?患者的心肌保? 一??量系??价Myocardial Protection in Patients Undergoing Noncardiac Surgery: A Quantitative Systematic Review
Robert D. Stevens, MD*, Haran Burri, MD, and Martin R. Tramer, MD DPhil*
*Division of Anesthesiology, Department APSIC (Anesthesiology, Pharmacology & Surgical Intensive Care) and Division of Cardiology, Geneva University Hospitals, Switzerland
Anesth Analg 2003 97: 623-633.
一些?床????了不同的?物是否能?低非心?手?患者的?后心?并?症。我?采用?量系??估法??些???果?行了整理。?Medline, Embase, 和 Cochrane ?据?搜索相?的?机化的??，提取有?心肌缺血、心肌梗塞、30天心?死亡率和不良反?的?据。 ?用固定效?模型整和?据，以Peto 的差率（OR）和95%可信限（CI）numbers-needed-to-treat/harm (NNT/H)表?。?中的21???含3646名患者：11???使用ß受体阻??（6种?，866名患者），6?使用可?定或米伐西醇（共614名患者），3 ??用地?硫卓或?拉帕米（共121名患者）和?用硝酸甘油的一???（有45名患者）。所有??均有一??用安慰?的?照。ß-受体阻??能?少手?期?的缺血(7.6%： 20.2%安慰?; OR 0.32 [95% CI, 0.170.58]; NNT 8) 2-受体激??只能?少手?期?的缺血(19.4% ： 32.8%; OR 0.47 [95% CI, 0.330.68]; NNT 7). ß-受体阻??能降低?生心肌梗塞的危?(0.9% versus 5.2%; OR 0.19 [95% CI, 0.080.48]; NNT 23)但研究高危患者的??只有2?。 2-受体激???心肌梗塞?生?明?作用(6.1% versus 7.3%; OR 0.85 [95% CI, 0.621.14]). ß-受体阻??能明?降低因心?死亡的危?（ 3.9% ： 0.8% OR 0.25 [95% CI, 0.090.73], NNT 32）. 2-受体激??也能明??少其死亡率（2.3% ： 1.1% OR 0.50 [95% CI, 0.280.91], NNT 83）。?通道阻??和硝酸甘油?有?些作用。最常?的副作用是心???。24.5%?用ß-受体阻??的患者?生心???而?照?只有9.1% (OR 3.76 [95% CI, 2.455.77], NNH 6).
（?雪? ? 庄心良 校）
A number of drugs have been tested in clinical trials to decrease cardiac complications in patients undergoing noncardiac surgery. To compare the results of these studies, we conducted a quantitative systematic review. Medline, Embase, and Cochrane databases were searched for randomized trials that assessed myocardial ischemia, myocardial infarction, 30-day cardiac mortality, and adverse effects. Data were combined using a fixed-effect model and expressed as Peto odds ratios (OR) with 95% confidence interval (CI) and as numbers-needed-to-treat/harm (NNT/H). Twenty-one trials involving 3646 patients were included: 11 trials using s-blockers (6 drugs; 866 patients), 6 clonidine or mivazerol (614 patients), 3 diltiazem or verapamil (121 patients), and 1 nitroglycerin (45 patients). All trials had an inactive control; there were no direct comparisons. s-blockers decreased ischemic episodes during surgery (7.6% versus 20.2% with placebo; OR 0.32 [95% CI, 0.17–0.58]; NNT 8) and after surgery (15.2% versus 27.9% with control; OR 0.46 [95% CI, 0.26–0.81]; NNT 8). 2-agonists decreased ischemia during surgery only (19.4% versus 32.8%; OR 0.47 [95% CI, 0.33–0.68]; NNT 7). s-blockers reduced the risk of myocardial infarction (0.9% versus 5.2%; OR 0.19 [95% CI, 0.08–0.48]; NNT 23) but only when 2 trials with high-risk patients were included. The effect of 2-agonists on myocardial infarction was not significant (6.1% versus 7.3%; OR 0.85 [95% CI, 0.62–1.14]). s-blockers significantly decreased the risk of cardiac death from 3.9% to 0.8% (OR 0.25 [95% CI, 0.09–0.73], NNT 32). 2-agonists significantly decreased the risk of cardiac death from 2.3% to 1.1% (OR 0.50 [95% CI, 0.28–0.91], NNT 83). For calcium channel blockers and nitroglycerin, evidence of any benefit was lacking. The most common adverse effect was bradycardia, which occurred in 24.5% of patients receiving a s adrenergic blocker versus 9.1% of controls (OR 3.76 [95% CI, 2.45–5.77], NNH 6).
原位肝移植?中食道超?引?下?皮????旁路置管Transesophageal Echocardiography-Guided Placement of Internal Jugular Percutaneous Venovenous Bypass Cannula in Orthotopic Liver Transplantation
Raymond M. Planinsic, MD, Ramona Nicolau-Raducu, MD, John C. Caldwell, MD, Shushma Aggarwal, MD, and Ibtesam Hilmi, MD
Department of Anesthesiology, University of Pittsburgh Medical Center, Pennsylvania
Anesth Analg 2003 97: 648-649.
（?施? ?，庄心良 校）
Venovenous bypass has improved patient survival and decreased morbidity and mortality in the field of orthotopic liver transplantation. The standard at many transplant centers is the use of the internal jugular percutaneous venovenous bypass cannulae (PVVBC) for venous return to the patient. Placement of these large (18F) PVVBC may lead to several complications and requires confirmation before use. Use of transesophageal echocardiography, an effective and rapid method to guide placement of the PVVBC and minimize potential complications associated with insertion of the device, is described.
吸入麻醉?和制?：机制、疑惑和最低肺泡有效?度 Inhaled Anesthetics and Immobility: Mechanisms, Mysteries, and Minimum Alveolar Anesthetic Concentration (Review Article)
James M. Sonner, MD*, Joseph F. Antognini, MD, Robert C. Dutton, MD*, Pamela Flood, MD, Andrew T. Gray, MD PhD*, R. Adron Harris, PhD, Gregg E. Homanics, PhD||, Joan Kendig, PhD?, Beverley Orser, MD#, Douglas E. Raines, MD**, James Trudell, PhD?, Bryce Vissel, PhD, and Edmond I Eger, II, MD* Section Editor
*Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; Department of Anesthesiology, University of California, Davis, California; Columbia University, New York, New York; University of Texas, Austin, Texas; ||University of Pittsburgh, Pittsburgh, Pennsylvania; ?Stanford University, Palo Alto, California; #University of Toronto, Toronto, Canada; **Department of Anaesthesia, Harvard Medical School, Cambridge, Massachusetts; and Garvan Institute of Medical Research, Darlinghurst, Australia
Anesth Analg 2003 97: 718-740.
Studies using molecular modeling, genetic engineering, neurophysiology/pharmacology, and whole animals have advanced our understanding of where and how inhaled anesthetics act to produce immobility (minimum alveolar anesthetic concentration; MAC) by actions on the spinal cord. Numerous ligand- and voltage-gated channels might plausibly mediate MAC, and specific animo acid sites in certain receptors present likely candidates for mediation. However, in vivo studies to date suggest that several channels or receptors may not be mediators (e.g., -aminobutyric acid A, acetylcholine, potassium, 5-hydroxytryptamine-3, opioids, and 2-adrenergic), whereas other receptors/channels (e.g., glycine, N-methyl-D-aspartate, and sodium) remain credible candidates.
Midazolam-Induced Muscle Dysfunction and Its Recovery in Fatigued Diaphragm in Dogs
Yoshitaka Fujii, MD, Aki Uemura, MD, and Hidenori Toyooka, MD
Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, Tsukuba City, Ibaraki, Japan
Anesth Analg 2003;97:755-758
咪?唑??泛用于??和麻醉，它能?少非疲?膈肌的收?。然而，它?疲?膈肌的作用可能是引起呼吸障?的原因之一。因此，我?研究咪?唑??疲?膈肌的影?极其恢复。?狗分?三?每?8?。每?均用?歇性超????刺激引?膈肌疲?，?率?20-Hz刺激 30 min.膈肌疲?后，? I不用?; ? II?予???量的咪?唑? (0.1 mg · kg-1 · h-1);? III?予麻醉?量的咪?唑? (0.5 mg · kg-1 · h-1) 。以跨膈? (Pdi) 和 整和?活?(Edi) ?估膈肌功能（收?性和?活?性）。膈肌疲??， Pdi 在低?刺激(20-Hz)??基?值下降stimulation decreased from baseline values (P < 0.05),而高?刺激??化(100-Hz), and Edi 在每种刺激均??化。??咪?唑?的?注， 在? II和? III, Pdi在?种刺激及 Edi 在 100-Hz ?疲??的值降低 (P < 0.05)。 Pdi 和 Edi的降低? III比? II 明?(P < 0.05).。咪?唑?用?60 min?止后,在 II, Pdi和Edi由咪?唑?引起的值(P < 0.05)恢复到疲?值 。而? III,咪?唑?引?的Pdi 和Edi值未?生?化 。因此，咪?唑?以?量依?性使狗的疲?膈肌?生功能障?，???量的咪?唑?不延?其恢复，而麻醉?量的咪?唑??此作用。
（?雪? ? 庄心良 校）
Midazolam, widely used for sedation and anesthesia, decreases contractility in nonfatigued diaphragm; however, its effects on contractility in fatigued diaphragm that are implicated as a cause of respiratory failure have not been established. We therefore studied the effects of midazolam on diaphragm muscle function and recovery in fatigued diaphragm. Dogs were divided into three groups of eight each. In each group, diaphragmatic fatigue was induced by intermittent supramaximal bilateral electrophrenic stimulation at a frequency of 20-Hz stimulation for 30 min. When fatigue was established, Group I received no study drug; Group II was infused with a sedative dose (0.1 mg · kg-1 · h-1) of midazolam; and Group III was infused with an anesthetic dose (0.5 mg · kg-1 · h-1) of midazolam. We assessed diaphragm muscle function (contractility and electrical activity) by transdiaphragmatic pressure (Pdi) and integrated electrical activity of the diaphragm (Edi). In the presence of fatigue, Pdi at low-frequency (20-Hz) stimulation decreased from baseline values (P < 0.05), Pdi at high-frequency (100-Hz) stimulation did not change, and Edi to each stimulus did not change. With an infusion of midazolam, in Groups II and III, Pdi at both stimuli and Edi at 100-Hz stimulation decreased from fatigued values (P < 0.05). The decrease in Pdi and Edi was more in Group III than in Group II (P < 0.05). At 60 min after the cessation of midazolam administration, in Group II, Pdi and Edi recovered from midazolam-induced values (P < 0.05) and returned to fatigued values. In Group III, Pdi and Edi did not change from midazolam-induced values. We conclude that midazolam causes, in a dose-related manner, diaphragm muscle dysfunction in fatigued canine diaphragm and that at a sedative dose, but not at an anesthetic dose, midazolam does not delay its recovery.
大?半球同步化?和?中麻醉的需求Hemispheric Synchronized Sounds and Intraoperative Anesthetic Requirements
Susan Dabu-Bondoc, MD*, Jacqueline Drummond-Lewis, MD*, Dorothy Gaal, MD*, Maryanne McGinn, MA*, Alison A. Caldwell-Andrews, PhD*, and Zeev N. Kain, MD*,,
Departments of *Anesthesiology, Pediatrics, and Child Psychiatry, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
Anesth Analg 2003 97: 772-775.
大?半球同步化最近被作??少?前焦?和?中麻醉?、?痛?用量的措施之一。本研究?察HemisyncR??麻醉??深度的影?。在知情同意后，把全麻和??病人分?二?，?理??予HemisyncR?(n = 31)，?照??空白磁?(n = 29)。??的于?均在?前和?中。异丙酚麻醉?主，????及?持所需异丙酚的?量，BIS??确保所有病人麻醉??一致。我??????异丙酚的??(2.49 ± 0.59 mg/kg versus 2.60 ± 0.59 mg/kg; P = 0.48)及?持?量(0.141 ± 0.02 mg · kg-1 · min-1 versus 0.146 ± 0.04 mg · kg-1 · min-1; P = 0.62)?差异，??病人焦?程度?差异。??：HemisyncR?不影?全麻病人的??作用。
（王立中 ? 庄心良 校）
Hemispheric synchronization is currently promoted as a treatment for preoperative anxiety and for reduction of intraoperative anesthetic and analgesic consumption. We designed this study to examine the effect of HemisyncR sounds on anesthetic hypnotic depth. After obtaining informed consent, we randomized subjects undergoing general anesthesia and outpatient surgery into two groups: the treatment group received HemisyncR sounds (n = 31), and the control group received a blank cassette tape (n = 29). Both groups received the intervention in the preoperative area and during the surgical procedure. Subjects underwent a propofol-based anesthetic regimen, and propofol doses required for the induction and maintenance of anesthesia were recorded. A bispectral index monitor was used to ensure that the hypnotic component of the anesthetic state was the same in all patients. We found no differences in the amount of propofol used during the induction of anesthesia (2.49 ± 0.59 mg/kg versus 2.60 ± 0.59 mg/kg; P = 0.48) or the maintenance of anesthesia (0.141 ± 0.02 mg · kg-1 · min-1 versus 0.146 ± 0.04 mg · kg-1 · min-1; P = 0.62) between the HemisyncR and control groups. We also found no differences between the HemisyncR group and the control group for participants with high state anxiety (P = not significant). We conclude that HemisyncR sounds do not reduce the hypnotic component of the anesthetic state of patients undergoing general anesthesia and surgery.
定?神?病理性痛Defining Neuropathic Pain
Misha-Miroslav Backonja, MD
Departments of Neurology, Anesthesiology, and Rehabilitation Medicine, University of Wisconsin Medical School, University of Wisconsin, Madison
Anesth Analg 2003 97: 785-790.
（王士雷 ? 庄心良 校）
A practical definition of neuropathic pain based on the distinction between neuropathic and inflammatory pain mechanisms is suggested. Neuropathic pain is in this case is defined as pain occurring in an area of the body affected by neurological disease. In addition to pain, the patient is likely to have weakness and numbness at the same time.
?布啡及其?效酯在大鼠中的抗?害作用The Antinociceptive Effect of Nalbuphine and Its Long-Acting Esters in Rats
Koung-Shing Chu, MD*, Jhi-Joung Wang, MD DMS*, Oliver Yoa-Pu Hu, PhD, Shung-Tai Ho, MD, and Yu-Wen Chen, MS*
*Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Research and Education, National Defense Medical Center, Taipei, Taiwan; and Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
Anesth Analg 2003 97: 806-809.
患???持?性疼痛的病人非常需要?效?痛?。本研究??察三种?布啡酯－?布啡丙酸?、?布啡庚酸?和?布啡奎酸?的?痛效果和持???。每?12只SD大鼠?行二?研究。研究1?价肌注?布啡酯0.25, 1.25, 2.5, 25和250 μmol/kg 的抗?害效果。研究2?价肌注25 μmol/kg?布啡酯的抗?害作用。?果?示，?布啡2.5, 25和250 μmol/kg ?生?量依?性的抗?害作用，持???分??1.5, 2和4 h 。肌注25μmol/kg?布啡丙酸?、?布啡庚酸?和?布啡奎酸?的抗?害作用??分?是5, 30和60 h。??：在等摩?分子的情?下，?布啡酯的抗?害作用比?布啡?酸的???。
（王士雷 ? 庄心良 校）
A long-acting analgesic is particularly desirable in patients with long-lasting pain. In this study, we evaluated the antinociceptive effect and duration of action of three nalbuphine esters—nalbuphine propionate, enanthate, and decanoate—and observed whether these esters had a long-acting effect. Male Sprague-Dawley rats (n = 12 in each group) were used. Two studies were performed. In Study 1, we evaluated the antinociceptive effect of IM nalbuphine HCl with dosages of 0.25, 1.25, 2.5, 25, and 250 μmol/kg. In Study 2, we evaluated the antinociceptive effects of IM nalbuphine base and esters with a dosage of 25 μmol/kg. After 2.5, 25, and 250 μmol/kg IM injections, we found that nalbuphine HCl produced a dose-related antinociceptive effect with durations of action of 1.5, 2, and 4 h, respectively. After a 25 μmol/kg IM injection, the durations of action of the nalbuphine esters, nalbuphine propionate, enanthate, and decanoate were 5, 30, and 60 h, respectively. We conclude that, on an equimolar basis, nalbuphine esters produce relatively longer durations of action than nalbuphine HCl.
?后?痛?手?免疫反?的影?The Effects of Postoperative Pain Management on Immune Response to Surgery
Benzion Beilin, MD*, Yehuda Shavit, PhD, Evelyn Trabekin, MD, Boris Mordashev, MD*, Eduard Mayburd, MD*, Alexander Zeidel, MD*, and Hanna Bessler, PhD
*Department of Anesthesiology and Research Institute, Rabin Medical Center, Golda-Hasharon Campus, affiliated with the Sackler School of Medicine, Tel-Aviv University; Department of Anesthesiology, Schneider Children’s Medical Center, Petah Tiqva; and Department of Psychology, Hebrew University, Jerusalem, Israel
Anesth Analg 2003 97: 822-827
手?可引起免疫改?，可能是????、麻醉、?后疼痛以及心理?激的?合作用。在本研究中，我?比?了不同?后?痛技???后免疫功能的影?。住院行腹部手?的病人?机接受三种?后?痛技?中的一种：按需?予阿片??物（?歇性阿片??物治?（IOR）），病人自控?痛（PCA）以及病人自控硬膜外?痛（PCEA）。?后疼痛被?估。手?前及?后24、48和72小???行血?采集。分??定IL-1ß、IL-2、和IL-6的水平，NK?胞的?胞毒性以及淋巴?胞的分裂反?。同IOR和PCA?相比，PCEA?病人?后24小?疼痛?分?低。淋巴?胞分裂反?在起初的24小?各?均被抑制，PCEA?在72小?恢复到?前水平，而PCA?仍保持抑制。IL-1ß 和 IL-6的量在IOA和PCA?有增加，而PCEA??几??化。硬膜外混合?用阿片??和局麻?可?少?后病人淋巴?胞增殖功能的抑制并可??炎前?胞因子的反?。
（?施? ?，庄心良 校）
Surgery is associated with immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. In the present study, we compared the effects of several postoperative pain management techniques on postoperative immune function. Patients hospitalized for abdominal surgery were randomly assigned to one of three postoperative pain management techniques: opiates on demand (intermittent opiate regimen [IOR]), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA). Postoperative pain was assessed. Blood samples were collected before and 24, 48, and 72 h after surgery. Production of interleukin (IL)-1s, IL-2, and IL-6, natural killer cell cytotoxicity, and lymphocyte mitogenic responses were assessed. Patients of the PCEA group exhibited lower pain scores in the first 24 h after surgery compared with patients of the IOR and PCA groups. Mitogenic responses were suppressed in all groups in the first 24 h, returned to preoperative values by 72 h in the PCEA group, but remained suppressed in the PCA group. Production of IL-1s and IL-6 increased in the IOR and PCA groups, whereas it remained almost unchanged in the PCEA group. Patients receiving an epidural mixture of opiate and local anesthetics (PCEA group) exhibited reduced suppression of lymphocyte proliferation and attenuated proinflammatory cytokine response in the postoperative period.
小?量氯胺酮?腹部大手?后住ICU的病人?啡用量的影?The Effects of Small-Dose Ketamine on Morphine Consumption in Surgical Intensive Care Unit Patients After Major Abdominal Surgery
Nicolas Guillou, MD*, Michele Tanguy, MD*, Philippe Seguin, MD*, Bernard Branger, MD, Jean-Pierre Campion, MD, and Yannick Malledant, MD*
*Surgical Intensive Care Unit, Biostatistical Unit, and Surgical Unit, Hopital Pontchaillou, Rennes, France
Anesth Analg 2003 97: 843-847.
本研究?价氯胺酮?腹部大手?后住ICU的病人的?痛效果。病人?机?用?啡复合安慰?自控?痛或?啡复合氯胺酮自控?痛。?啡的?荷?量?2mg，每次按??量?1mg，?定???7min。氯胺酮初始量?0.5mg/kg，第一?24h以2 μg · kg-1 · min-1 速度?注，以后按1 μg · kg-1 · min-1 的速度?注。??48h?每4h的?啡累?用量和VAS?分。?果，??在??或是在休息的情?下，VAS?值均很小。氯胺酮??啡的用量?著小于?照?。??：小?量氯胺酮是腹部大手?后住ICU病人?啡自控?痛的很有价值的?助?。
（王士雷 ? 庄心良 校）
In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. Ketamine was administered with an initial bolus of 0.5 mg/kg followed by a perfusion of 2 μg · kg-1 · min-1 during the first 24 h and 1 μg · kg-1 · min-1 during the following 24 h. The 4-h cumulative morphine doses were measured over 48 h. The VAS scores at rest and at The mobilization were measured every 4 h during 48 h. A total of 101 patients were enrolled, and 93 were analyzed (41 in Group K and 52 in Group M). VAS scores at rest and at mobilization were similar. cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.
?重先兆子???腰麻分娩?低血?的?生率少于健康??：前瞻性?列研究Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison
Antoine G. M. Aya, MD PhD, Roseline Mangin, MD MSc, Nathalie Vialles, MD, Jean-Michel Ferrer, MD, Colette Robert, MD, Jacques Ripart, MD PhD, and Jean-Emmanuel de La Coussaye, MD PhD
Division of Anesthesiology, Pain Management, Emergency and Critical Care Medicine, University Hospital, Nimes, France
Anesth Analg 2003 97: 867-872.
本研究比??重先兆子?和健康??剖???与腰麻有?的低血?的?生率。在???注液体后，用重比重0.5%布比卡因－?芬太尼－?啡?行腰麻。在注?前以及注?后30min?每2分???血?。?床有意?的低血?以?用麻?素??准（??血?降低基?值的30%以上或健康??体循?血?<100 mm Hg）。?管先兆制????健康???液量少（(1653 ± 331 mL? 1895 ± 150 mL; P = 0.005)，布比卡因用量多（10.5 ± 0.9?10.0 ± 0.7 mg; P = 0.019），但是，其低血?的?生率低(16.6%?53.3%; P = 0.006)，且低血?程度??，需要麻?素的量少。?重先兆子?的???生低血?的危?性比健康??少6倍。
（王士雷 ? 庄心良 校）
In this prospective cohort study, we compared the incidence and severity of spinal anesthesia (SA)-associated hypotension in severely preeclamptic (n = 30) versus healthy (n = 30) parturients undergoing cesarean delivery. After the administration of IV fluids, SA was performed with hyperbaric 0.5% bupivacaine, sufentanil, and morphine. Blood pressure (BP) was recorded before and at 2-min intervals for 30 min after SA. Clinically significant hypotension was defined as the need for ephedrine (systolic BP decrease to <100 mm Hg in healthy parturients or 30% decrease in mean BP in both groups). Despite receiving a smaller fluid volume (1653 ± 331 mL versus 1895 ± 150 mL; P = 0.005) and a larger bupivacaine dose (10.5 ± 0.9 mg versus 10.0 ± 0.7 mg; P = 0.019), the severely preeclamptic patients had a less frequent incidence of clinically significant hypotension (16.6% versus 53.3%; P = 0.006), which was less severe and required less ephedrine. The risk of hypotension was almost six times less in severely preeclamptic patients (odds ratio, 0.17; 95% confidence interval, 0.05–0.58; P = 0.006) than that in healthy patients.
左旋布比卡因和布比卡因神?阻?的起效??、阻??量和持???Onset Time, Quality of Blockade, and Duration of Three-in-One Blocks with Levobupivacaine and Bupivacaine
Bernhard Urbanek, MD, Andreas Duma, Oliver Kimberger, MD, Gudrun Huber, MD, Peter Marhofer, MD, Michael Zimpfer, MD MBA, and Stephan Kapral, MD
Department of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria
Anesth Analg 2003 97: 888-892.
左旋布比卡因是消旋布比卡因的S(-)-立体异构体。在用于Three-in-One神?阻??其重要的?效?特性?未被很好的??。我??60例ASA IIII行下肢手?的病人?行了研究。在神?刺激器的引?下穿刺并注射0.5%布比卡因、0.5%左旋布比卡因或0.25%??卡因20ml。以?刺法确定股神?支配的中??域?确定感?阻?起效??、阻??量和阻???。神?阻?等??分通?其与??的分值（100%（感?正常）至0%（?感?））?算。三?病人起效???有差?，阻??量也?明?不同，但0.25% 左旋布比卡因完全阻?的例??少(P = 0.02)。0.25% 左旋布比卡因的阻???707 min (551863 min)?著少于0.5%布比卡因1053 min (8021304 min)和0.5%左旋布比卡因1001 min (8441158 min)。??：0.5%左旋布比卡因可以代替0.5%布比卡因用于three-in-one神?阻?。
(王士雷 ? 庄心良 校）
Levobupivacaine is the isolated S(-)-stereoisomer of racemic bupivacaine. Important pharmacodynamic properties of levobupivacaine have not been determined for the femoral three-in-one block. In this randomized, controlled, double-blinded trial, we studied 60 ASA physical status I–III patients scheduled for surgery of the lower limb. A nerve-stimulator-guided three-in-one block was performed as supplemental analgesic therapy with 20 mL of bupivacaine 0.5% (n = 20), levobupivacaine 0.5% (n = 20), or levobupivacaine 0.25% (n = 20). Sensory onset time, quality of blockade, and duration of blockade were assessed by pinprick test in the central sensory innervation region of the femoral nerve (distribution of the anterior femoral cutaneous nerve). A rating scale from 100% (normal sensation) to 0% (no sensation at all) as compared with the contralateral leg was used. No significant difference in sensory onset time among the three local anesthetic solutions was observed (mean [95% confidence interval]): bupivacaine 0.5%, 27 min (20–33 min); levobupivacaine 0.5%, 24 min (18–30 min); and levobupivacaine 0.25%, 30 min (23–36 min) (P = 0.49). The analgesic quality of the blockade was also not significantly different among the three groups, whereas a complete sensory block was achieved in significantly fewer patients in the levobupivacaine 0.25% group (P = 0.02). The duration of blockade was significantly shorter with levobupivacaine 0.25% compared with the other groups: bupivacaine 0.5%, 1053 min (802–1304 min); levobupivacaine 0.5%, 1001 min (844–1158 min); and levobupivacaine 0.25%, 707 min (551–863 min) (P = 0.01). Levobupivacaine 0.5% is recommended instead of bupivacaine 0.5% for the three-in-one block.
?食道超?心??的?种不同?量左室射血??方法的?估An Assessment of Two Different Methods of Left Ventricular Ejection Time Measurement by Transesophageal Echocardiography
Madhav Swaminathan, MD, Barbara G. Phillips-Bute, PhD, and Joseph P. Mathew, MD
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
Anesth Analg 2003;97:642-647
左室射血??（LVET）是?估左心室??的一?重要?成部分。?种?量方法通常依靠持?多普勒?波?量某??主??瓣的血流速率。?然M型超?也用??量LVET，但它并((?有与多普勒方法比??。我?要??的假?是通??食道超?心??方法用M 型超??量主??瓣?放的持???与多普勒?量LVET具有可比性。?31名接受非主??瓣手?的病人中?行?量。持?多普勒?波?定的某??主??血流速率与M型?定的主??瓣?放??相比?。M型超?与多普勒之?具有很好的相?性（r＝0.86；P<0.0001）。?性???示?种技??有?著差?（P>0.1）。Bland-Altman分析?示?偏倚。我?肯定了通??食道超?心??方法用M 型超??量主??瓣?放的持???与多普勒?量LVET具有可比性?一假?。M型超?也?是一种可以??的多普勒?法，特?是??瓣膜流速梯度不易?得?。M 型超?是一种??，但?常未利用的?食道超?心??估算LVET的方法。
(殷文? ? 王祥瑞 校)
Left ventricular ejection time (LVET) is an important component in evaluating left ventricular performance. This measurement is usually made by measuring the timing of the transaortic valve flow velocity by continuous-wave Doppler. Although M-mode has also been used for measuring LVET, it has not been compared with the Doppler method. We tested the hypothesis that the M-mode-measured duration of aortic valve opening is comparable to Doppler-derived measurement of LVET by transesophageal echocardiography (TEE). Measurements were made in 31 patients undergoing nonaortic valve cardiac surgery. The timing of transaortic flow by continuous-wave Doppler was compared with the M-mode-derived timing of aortic valve opening. There was close correlation (Pearson correlation coefficient, r = 0.86; P < 0.0001) between M-mode and Doppler measurements. There was no significant difference between the two techniques by linearity tests (P > 0.1). Bland-Altman analysis showed no significant bias. We confirmed the hypothesis that M-mode-derived measurement of LVET is comparable to Doppler-derived measurement of LVET. M-mode may be an acceptable alternative to the Doppler method, especially when transvalvular velocity gradients cannot be readily obtained. M-mode is a simple, yet often underused, method of evaluating LVET during TEE.
硬膜外可?定?老鼠?力感受器交感神?反?的抑制依?异氟醚?度Epidural Clonidine Suppresses the Baroreceptor-Sympathetic Response Depending on Isoflurane Concentrations in Cats
Yoshikazu Ikeda, MD*, Kiyonobu Nishikawa, MD*, Kenji Ohashi, MD, Takashi Mori, MD*, and Akira Asada, MD*
*Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan; and Department of Anesthesia, Hoshigaoka Kosei-nenkin Hospital, Osaka, Japan
Anesth Analg 2003;97:748-754
硬膜外使用可?定??致交感神?活?降低??的低血?和心跳?慢。在??研究中，我?想要?明硬膜外可?定引起的?力反射的?化。36只老鼠被分?6?，在0.5，1.0或1.5?最小肺泡麻醉?度（MAC）异氟醚麻醉下胸段硬膜外?予可?定4 μg/kg或利多卡因2mg/kg。?量心率（HR），平均???（MAP）和心交感神?活?（CSNA）。降??和升??分????注射硝酸甘油10 μg/kg和苯?上腺素10 μg/kg。?力反射通?相?于最大MAP?化的CSNA?化和HR?化?估?（分??△CSNA/△MAP和△HR/△MAP）。?些?量?果在硬膜外?物使用前和使用后30分??得。硬膜外使用可?定和利多卡因降低MAP，CSNA和HR在近似的范??。所有?中降?反?的△CSNA/△MAP和△HR/△MAP被硬膜外使用可?定和利多卡因所抑制除了可?定0.5MAC异氟醚?。所有?的升?反射均被抑制。我?的??是在异氟醚麻醉>1.0MAC?胸段硬膜外使用可?定?抑制?力反射，?与在0.5MAC异氟醚麻醉?使用利多卡因相比有某些益?，??优?是在意外低血??生?可以保存?力反射的敏感性。
(殷文? ? 王祥瑞 校)
Epidural administration of clonidine induces hypotension and bradycardia secondary to decreased sympathetic nerve activity. In this study, we sought to elucidate the change in baroreflex response caused by epidural clonidine. Thirty-six cats were allocated to six groups (n = 6 each) and were given either thoracic epidural clonidine 4 μg/kg or lidocaine 2 mg/kg during 0.5, 1.0, or 1.5 minimum alveolar anesthetic concentration (MAC) isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), and cardiac sympathetic nerve activity (CSNA) were measured. Depressor and pressor responses were induced by IV nitroprusside 10 μg/kg and phenylephrine 10 μg/kg, respectively. Baroreflex was evaluated by the change in both CSNA and HR relative to the peak change in MAP (CSNA/MAP and HR/MAP, respectively). These measurements were performed before and 30 min after epidural drug administration. Epidural clonidine and lidocaine decreased HR, MAP, and CSNA by similar extents. CSNA/MAP and HR/MAP for depressor response were suppressed with epidural lidocaine and clonidine in all groups but the clonidine 0.5 MAC isoflurane group (0.197 ± 0.053 to 0.063 ± 0.014 and 0.717 ± 0.156 to 0.177 ± 0.038, respectively, by epidural lidocaine [P < 0.05] but 0.221 ± 0.028 to 0.164 ± 0.041 and 0.721 ± 0.177 to 0.945 ± 0.239, respectively, by epidural clonidine during 0.5 MAC isoflurane). Those for pressor response were suppressed in all groups. We conclude that thoracic epidural clonidine suppresses baroreflex gain during isoflurane anesthesia >1.0 MAC but may offer certain advantages compared with epidural lidocaine during 0.5 MAC isoflurane by virtue of preserving baroreflex sensitivity when inadvertent hypotension occurs.
2-Bromomelationin的催眠和?痛效? The Hypnotic and Analgesic Effects of 2-Bromomelatonin
Mohamed Naguib, MB BCh, MSc, FFARCSI, MD*, Max T. Baker, PhD*, Gilberto Spadoni, PhD, and Marc Gregerson, BS*
Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa; and Institute of Medicinal Chemistry and Toxicology, University of Urbino, piazza Rinascimento, Italy
Anesth Analg 2003;97:763-768
(? 波 ? 王祥瑞 校)
2-Bromomelatonin is an analog of melatonin with a higher melatonin receptor affinity. We tested the hypnotic and analgesic properties of 2-bromomelatonin and compared them with those of propofol. Sprague-Dawley rats were assigned to receive 2-bromomelatonin or propofol IV, or morphine intraperitoneally. Righting reflex and response to tail clamping were assessed. Both 2-bromomelatonin and propofol caused a dose-dependent increase in the percent of rats displaying loss of both the righting reflex and the response to tail clamping. 2-Bromomelatonin was comparable to propofol in terms of its rapid onset and short duration of hypnosis. The 50% effective dose (95% confidence interval) for loss of righting reflex for propofol and 2-bromomelatonin were 3.7 (3.4–4.0) and 38 (35–41) mg/kg, respectively. Corresponding values for loss of response to tail clamp were 2.9 (3.5–4.0) and 21 (15–30) mg/kg, respectively. 2-Bromomelatonin is approximately 6–10 times less potent than propofol depending on the end-point used. Intraperitoneal 30 mg/kg morphine did not affect the righting reflex, but resulted in loss of response to tail clamping in all animals. 2-Bromomelatonin can exert hypnotic and antinocifensive effects similar to that observed with propofol. Unlike propofol, the reduced nocifensive behavior persisted after the animals had regained their righting reflex. This study provides evidence that 2-bromomelatonin has properties that are desirable in anesthetics or anesthetic adjuvants.
在复合全麻和硬膜外麻醉?程中麻?素可增加病人的????指?，而新福林?不能Ephedrine, but Not Phenylephrine, Increases Bispectral Index Values During Combined General and Epidural Anesthesia
Tadahiko Ishiyama, MD PhD, Takeshi Oguchi, MD PhD, Tetsuya Iijima, MD, Takashi Matsukawa, MD PhD, Satoshi Kashimoto, MD PhD, and Teruo Kumazawa, MD PhD
Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
Anesth Analg 2003;97:780-784
(? 波 ? 王祥瑞 校)
Ephedrine and phenylephrine are used to treat hypotension during combined general and epidural anesthesia, and they may change anesthetic depth. In the current study, we evaluated the effects of ephedrine versus phenylephrine on bispectral index (BIS) during combined general and epidural anesthesia. After injection of ropivacaine through the epidural catheter, general anesthesia was induced with propofol and vecuronium, and was maintained with 0.75% sevoflurane. Approximately 10 min after the intubation, BIS was recorded as a baseline value. Patients with decreases in arterial blood pressure <30% of the preanesthetic values were defined as control group (n = 9). Patients who had to be treated for larger decreases in arterial blood pressure were randomly assigned to receive ephedrine 0.1 mg/kg (n = 17) or phenylephrine 2 μg/kg (n = 17). BIS values were recorded at 1-min intervals for 10 min. BIS in the ephedrine group was significantly larger from 7 to 10 min than that in the control and phenylephrine groups (P < 0.05). Seven patients in the ephedrine group had BIS >60, whereas no patient in the control and phenylephrine groups had BIS >60 (P < 0.005). Ephedrine, but not phenylephrine, increased BIS during general anesthesia combined with epidural anesthesia.
神??固醇?物的?痛作用：阿法沙?和阿法多???啡??痛?的增?作用的比?Antinociceptive Properties of Neurosteroids: A Comparison of Alphadolone and Alphaxalone in Potentiation of Opioid Antinociception
L. Winter, R. Nadeson, A. P. Tucker, and C. S. Goodchild
Monash University Department of Anaesthesia, Monash Medical Centre, Clayton, Victoria, Australia
Anesth Analg 2003;97:798-805
本研究中，我?研究了???予?啡??物芬太尼，?啡和氧可酮和合并?予?种神??固醇??物：阿法沙?和阿法多???痛和??作用的影?。??啡??物和神??固醇??物分?注射入Wistar雄鼠的腹腔?，以open-field活???和rotarod?器?判???效果。在未????量前，?出?痛作用的?量-反?曲?。在非???量下，芬太尼、?啡和氧可酮均可?生?量依?性的?尾反?（tail flick latency,TFL）。由于?种神??固醇?均不能改?TFL，所以通??流?度?判?非???量下??种???痛作用的影?。在?流??中，阿法多?可?生明?的?痛作用，而阿法沙???此作用。?管??用阿法多?不影?TFL，但与三种?痛?合用后均可使TFL的?量-反?曲?左移。阿法沙???用?和合并?啡??物?均?影?。与?啡??物合用?，?种?均???作用。我?得出??：与?啡、芬太尼和氧可酮合用?，阿法多?可增??痛作用而不加深??作用，而阿法沙??此作用。
(忻?? ? 王祥瑞 校)
In this study, we investigated the antinociceptive and sedative effects of the opioids fentanyl, morphine, and oxycodone given alone and in combination with two neurosteroids: alphadolone and alphaxalone. An open-field activity monitor and rotarod apparatus were used to define the sedative effects caused by opioid and neurosteroid compounds given alone intraperitoneally to male Wistar rats. Dose-response curves for antinociception were constructed using only nonsedative doses of these drugs. At nonsedating doses, fentanyl, morphine, and oxycodone all caused dose-dependent tail flick latency (TFL) antinociceptive effects. Because neither neurosteroid altered TFL, electrical current was used as the test to determine doses of neurosteroid that caused antinociceptive effects at nonsedative doses. Alphadolone 10 mg/kg intraperitoneally caused significant antinociceptive effects in the electrical test but alphaxalone did not. All three opioid dose-response curves for TFL antinociception were shifted to the left by coadministration of alphadolone even though alphadolone alone had no effect on TFL. Alphaxalone given alone had no antinociceptive effects at nonsedative doses and it had no effect on opioid antinociception. Neither neurosteroid caused sedative effects when combined with opioids. We conclude that coadministration of alphadolone, but not alphaxalone, with morphine, fentanyl, or oxycodone potentiates antinociception and that this effect is not caused by an increase in sedation.
氟?利多??啡自控?痛病人的止吐作用：?机，?照，多种?量-效?的研究。The Antiemetic Efficacy of Droperidol Added to Morphine Patient-Controlled Analgesia: A Randomized, Controlled, Multicenter Dose-Finding Study
Xavier Culebras, MD*, Jean-Baptiste Corpataux, MD, Giovanni Gaggero, MD, and Martin R. Tramer, MD DPhil*
*Division d’Anesthesie, Departement APSIC (Anestheie, Pharmacologie et Soins Intensif de Chirurgie), Hopitaux Universitaires de Geneve, Geneve, Switzerland; Service d’Anesthesie, Hopital de La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland; and Service d’Anesthesie, Hopital Sud Fribourgeois, Riaz, Switzerland
Anesth Analg 2003;97:816-821
氟?利多用于?啡自控?痛病人止吐的?量-效??不明确。我???后用?啡自控?痛（1mg/?次，5分??定）的病人?机分?四?：?氟?利多?（?照?）或氟?利多5，15，或50ug/mg?啡。??24小??的效果和副作用，并在95%的可信????行需要治??（NNT）和需要刺激?（NNH）的分析。?行分析的?照??82人，氟?利多5ug??82人，15ug??82人，50ug??83人。氟?利多的平均用量在5ug?中?0.2mg/24hr,15ug?中?0.61 mg/24hr, 50ug?中?2.04mg/24hr。在?照?中?心的?生率?48.8%，5ug?中?42.7%（与?照?的NNT相比，16[95%的可信??，4.711]），15ug?中?32.9%（NNT，6.3[3.3100]），50ug?中?21.7%（NNT，3.7[2.47.6]）。?吐?生率在?照??24.4%，5ug?中?23.2%（NNT，82[78.5]），15ug?中?22.0%（NNT，41[6.59.5]），50ug?中?12%（NNT，8.1[4.2142]）。皮?瘙痒的?生率在?照??12.2%，5ug?中?6.1%（NNT，16[6.737]），15ug和50ug?中?2.4%（NNT，10[5.752]）。?照?中??的?生率?2.4%，5ug?中?8.5%（NNH，16[7.7123]），15ug?中?6.1%（NNH，27），
(忻?? ? 王祥瑞 校)
The antiemetic dose response of droperidol when it is added to patient-controlled analgesia with morphine is not well known. We randomly allocated adults who received postoperative morphine patient-controlled analgesia (1-mg bolus, 5-min lockout) to one of four regimens: no droperidol (control) or 5, 15, or 50 μg of droperidol per milligram of morphine. Efficacy and adverse effects were recorded during 24 h and were analyzed with number needed to treat (NNT) and number needed to harm with 95% confidence intervals. Data from 82 controls, 82 patients receiving droperidol 5 μg, 82 receiving droperidol 15 μg, and 83 receiving droperidol 50 μg were analyzed. Average consumption of droperidol per 24 h was 0.2 mg with the 5-μg regimen, 0.61 mg with the 15-μg regimen, and 2.04 mg with the 50-μg regimen. In controls, the incidence of nausea was 48.8%; with droperidol 5 μg, it was 42.7% (NNT compared with control, 16 [95% confidence interval, 4.7 to -11]); with 15 μg, it was 32.9% (NNT, 6.3 [3.3–100]); and with 50 μg, it was 21.7% (NNT, 3.7 [2.4 to 7.6]). In controls, the incidence of vomiting was 24.4%; with droperidol 5 μg, it was 23.2% (NNT compared with control, 82 [7 to -8.5]); with 15 μg, it was 22.0% (NNT, 41 [6.5 to -9.6]); and with 50 μg, it was 12% (NNT, 8.1 [4.2–142]). In controls, the incidence of pruritus was 12.2%; with droperidol 5 μg, it was 6.1% (NNT compared with control, 16 [6.7 to -37]); and with 15 and 50 μg, it was 2.4% (NNT, 10 [5.7–52]). In controls, the incidence of sedation was 2.4%; with droperidol 5 μg, it was 8.5% (number needed to harm (NNH) compared with control, 16 [7.7 to -123]); with 15 μg, it was 6.1% (NNH, 27 [10 to -40]); and with 50 μg, it was 18.1% (NNH, 6.4 [4.1–15]). There were no extrapyramidal symptoms and no cardiac adverse events. There was no difference in patient satisfaction. The optimal antiemetic dose of droperidol is 15–50 μg/mg of morphine. Larger doses may have more antivomiting efficacy but are likely to be unacceptably sedating.
??病人?敷料?使用异丙酚自控??：?量效?的研究Patient-Controlled Sedation Using Propofol for Dressing Changes in Burn Patients: A Dose-Finding Study
Claudia Coimbra, MSc MD, FRCPC*, Manon Choiniere, PhD, and Thomas M. Hemmerling, MD DEAA*
Department of *Anesthesiology and Burn Centre, Hotel-Dieu, Centre Hospitalier de l’Universite de Montreal (CHUM), Universite de Montreal, Quebec, Canada
Anesth Analg 2003;97:839-842
(朱 ? ? 王祥瑞 校)
he first change of dressings after skin grafting in burn patients is a source of great anxiety because of pain anticipation and the immediate and first confrontation with the result of skin grafting. We designed this dose-finding study to determine the feasibility and safety of patient-controlled sedation (PCS) using propofol during these procedures. Twenty patients were familiarized with the PCS and asked to use PCS whenever they felt uncomfortable or anxious. Analgesia was provided by a single bolus of morphine IV 15 min before the procedure according to their daily intake. The first 10 patients used a fixed bolus of propofol 0.3 mg/kg and a lockout of 5 min. The degree of sedation was measured using bispectral index (BIS) monitoring. Demands versus delivery of propofol boluses were recorded. Within 1 h after the procedure, pain intensity was evaluated and satisfaction scores obtained from patients and nurses performing the dressing changes. In the first 10 patients, there were no respiratory rates <10 breaths/min, systolic and diastolic blood pressure were within 25% of baseline values, and peripheral saturation stayed more than 94% with additional small flow oxygen via nasal insufflation. There were double the demands than actual deliveries of propofol boluses. The BIS did not show significant decreases of <80 in any patient reflecting an insufficient state of sedation. Because the interim analysis of the efficacy of the PCS setup showed an insufficient state of sedation, a different PCS setup was evaluated in a second group of 10 patients (an individualized propofol bolus, titrated to achieve a significant decrease of BIS or a sleepy state, and no lockout period). The second group of patients showed a more effective sedation, with respiratory and hemodynamic variables being not significantly different from the first group of patients. PCS with propofol is feasible in burn patients and can be used safely. To provide an optimal sedation, we suggest to initially titrate the bolus to achieve a significant decrease of BIS or a clinically effective state of sedation and to abolish the lockout interval.
兔子模型中?胞?黏附分子-1（ICAM-1）的?克隆抗体在硬膜外的治?作用：?胞?黏附分子-1（ICAM-1）引起脊索缺血的机制The Therapeutic Effects of Epidural Intercellular Adhesion Molecule-1 Monoclonal Antibody in a Rabbit Model: Involvement of the Intercellular Adhesion Molecule-1 Pathway in Spinal Cord Ischemia
Kamatham A. Naidu, PhD*, Eugene S. Fu, MD, E. Truitt Sutton, PhD, Leon D. Prockop, MD*, and Alan Cantor, PhD
Departments of *Neurology, Anesthesiology, and Physiology, College of Medicine, University of South Florida, Tampa, Florida; and Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
Anesth Analg 2003;97:857-862
(?羽霄 ? 王祥瑞 校)
The pathophysiology of ischemia/reperfusion injury involves extravascular migration of leukocytes from the bloodstream to the site of injury. Leukocyte adhesion and intercellular adhesion molecule-1 (ICAM-1) play an important role in the recruitment of leukocytes to the site of injury. In this study, we evaluated the role of the ICAM-1 in spinal cord ischemia and the therapeutic effects of epidural ICAM-1 monoclonal antibody (Mab). The descending aorta was occluded below the renal artery with an aneurysm clip in rabbits anesthetized with halothane. The following variables were evaluated, in addition to ICAM-1 expression in the lumbar spinal cord, in animals receiving saline or ICAM-1 Mab via the epidural route: (1) leukocyte recruitment in the lumen of capillary vessels of the lumbar spinal cord (L6-7) at 8 h after 30 min of aortic occlusion and (2) neurological evaluation at 20 h after aortic occlusion of 10, 15, 17.5, 20, or 25 min. Paraplegia was graded with the following scale: Grade 0, no deficit; Grade 1, partial deficit; and Grade 2, complete paraplegia. Spinal cord ischemia increased the expression of ICAM-1 in the endothelium of spinal cord capillaries and led to capillary leukocyte recruitment and extravascular migration into the lumbar spinal cord parenchyma, which was ablated with epidural ICAM-1 Mab. Epidural ICAM-1 Mab reduced neurological deficits and offered neuroprotection. These findings demonstrate the involvement of the ICAM-1 pathway in spinal cord ischemia and the neuroprotective effects of epidural ICAM-1 Mab. Strategies to ameliorate spinal cord ischemia may entail the administration of leukocyte antiadhesion molecules into the neuraxial space.
母白鼠暴露于可卡因下?新生白鼠心功能的影?The Effect of Maternal Cocaine Exposure on Neonatal Rat Cardiac Function
Lena S. Sun, MD*,, Shin Takuma, MD, Rui Lui, MD, and Shunichi Homma, MD
Departments of *Anesthesiology, Pediatrics, and Medicine, College of Physicians and Surgeons of Columbia University, New York, New York
Anesth Analg 2003;97:878-882
(朱 ? ? 王祥瑞 校)
Fetal cocaine exposure has been associated with a variety of cardiovascular dysfunctions in humans. We treated pregnant rats with either saline or cocaine at 60 mg/kg by gastric lavage for the entire gestational period and for 14 days after parturition. We then performed high-frequency transthoracic echocardiography to determine whether cocaine exposure affected neonatal cardiac contractile function in vivo in 7- and 14-day-old neonatal rats. All studies were performed in the unsedated, conscious state. Heart rate (HR) and systolic function, expressed as fractional area of change at the midpapillary muscle level, were calculated from two-dimensional images. Resting HR was faster in the cocaine-exposed group at both ages, but baseline contractile function was not different between control (CTL) and cocaine-exposed (COC) neonatal rats. Dobutamine induced a significant increase in HR in all groups at only the largest dose tested (Day 7 CTL HR increased from 438 ± 3 bpm to 462 ± 10 bpm; Day 7 COC HR increased from 466 ± 3 bpm to 493 ± 7 bpm; Day 14 CTL HR increased from 443 ± 4 bpm to 487 ± 4 bpm; Day 14 COC HR increased from 477 ± 4 bpm to 501 ± 5 bpm). Dobutamine elicited a significant increase in contractile response at both Day 7 (from 76.6% ± 0.6% to 81.5% ± 0.7%) and Day 14 in CTL (from 78.2% ± 0.7% to 81.9% ± 0.7%), but not in COC, animals (from 76.7% ± 0.8% to 78.9% ± 0.8% at Day 7 and from 76.8% ± 1.1% to 79.3% ± 0.8% at Day 14). Epinephrine induced a significant increase in contractile response in CTL, but not in COC, rats at Day 7 and had no effect on fractional area of change at 14 days of age in either CTL or COC animals. Our results indicate that perinatal cocaine exposure does not modify resting contractile function but attenuates the contractile response to ß-adrenoceptor stimulation in the neonatal rat. These results suggest that perinatal cocaine exposure may lead to decreased responsiveness to inotropic drugs during the early neonatal period.
?通道阻??（CCB）?少非心?手?后心??病率的作用--Meta分析Calcium Channel Blockers for Reducing Cardiac Morbidity After NoncardiacSurgery: A Meta-Analysis
Duminda N. Wijeysundera, MD*, and W. Scott Beattie, MD PhD, FRCPC
From the *Department of Anesthesia, University of Toronto, and the Department of Anesthesia, University Health Network, University of Toronto, Toronto, ON
Anesth Analg 2003;97:634-641
心?并?症是非心?手?后死亡的主要原因。?管CCB理?上?此有益但仍未在?手?期?理中?泛?用。?篇系?性???估了CCB在非心?外科手?中的效能。搜索了MEDLINE、EMBASE、SCIENCE CITATION IDEX、PUBMED及相?目?中（??言限制）?价CCB在非心?外科手?中作用的?机控制性研究(RCT)。由?位??者?立的???于死亡、心梗(MI)、缺血、室上速(SVT)及充血性心衰(CHR)的?据，?算治?效果在95％置信??(CI)下的相?危?度(RR),?共包括了11份研究(?1007名患者)。CCB?著?少缺血(RR0.49,95%CI0.3-0.8,P=0.004)和SVT(RR0.52,95%CI0.37-0.72,P<0.0001)CCB也与死亡率及MI呈?相?。在post hoc分析中，CCB?著?少死亡/心梗比值(RR0.35,95%CI0.15-0.86,P=0.02)及主要病?事件(MME)，确切的?如死亡、MI、CHF(RR0.39,95%CI0.17-0.89,P=0.02).在?群分析中，硫氮酮?著?少缺血、SVT、死亡/心梗比值及MME。此次Meta分析?示了CCB能?著?少在非心?外科手?中的缺血、SVT及复合??。?些益?主要?功于硫氮酮，并提示需在大的RCT中????行?一步?价。
（?旭? ? 薛?? 校）
Cardiac complications are the leading cause of death after noncardiac surgery. Despite theoretical benefits, calcium channel blockers (CCB) are not widely used in the perioperative setting. This systematic review assessed the efficacy of CCBs during noncardiac surgery. MEDLINE, EMBASE, Science Citation Index, PubMed, and reference lists were searched without language restriction for randomized controlled trials (RCT) evaluating CCBs during noncardiac surgery. Two reviewers independently abstracted data on death, myocardial infarction (MI), ischemia, supraventricular tachyarrhythmia (SVT), and congestive heart failure (CHF). Treatment effects were calculated as relative risks (RR) with 95% confidence intervals (CI). Eleven studies (1007 patients) were included. CCBs significantly reduced ischemia (RR, 0.49; 95% CI, 0.30–0.80; P = 0.004) and SVT (RR, 0.52; 95% CI, 0.37–0.72; P < 0.0001). CCBs were associated with trends towards reduced death and MI. In post hoc analyses, CCBs significantly reduced death/MI (RR, 0.35; 95% CI, 0.15–0.86; P = 0.02) and major morbid events (MME), defined as death, MI, or CHF (RR, 0.39; 95% CI, 0.17–0.89; P = 0.02). In subgroup analyses, diltiazem significantly reduced ischemia, SVT, death/MI, and MMEs. This meta-analysis shows CCBs significantly reduced ischemia, SVT, and combined end-points in the setting of noncardiac surgery. The majority of these benefits are attributable to diltiazem, suggesting the need for further evaluation of this drug in a large RCT.
小儿中?用一次性注射泵?行?手?期持?性周?神?阻?(CPNB)--前瞻描述性研究Perioperative Continuous Peripheral Nerve Blocks with Disposable Infusion Pumps in Children: A Prospective Descriptive Study
Christophe Dadure, MD, Philippe Pirat, MD, Olivier Raux, MD, Rachel Troncin, MD, Alain Rochette, MD, Christine Ricard, MD, and Xavier Capdevila, MD PhD
Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
Anesth Analg 2003 97: 687-690
（?旭? ? 薛?? 校）
Continuous peripheral nerve blocks (CPNB) after pediatric major orthopedic surgery are not widely used. We conducted a prospective descriptive study to evaluate the effectiveness of disposable elastomeric pumps for CPNB in children. After inducing general anesthesia, 25 consecutive children scheduled for major orthopedic surgery received a 0.5-mL/kg bolus of a mixture of 1% lidocaine with epinephrine and 0.25% bupivacaine in axillary, femoral, or popliteal catheters. After surgery, disposable pumps with 0.2% ropivacaine were connected. Pump flows were adjusted to the patient’s weight. Postoperative pain was evaluated using a visual analog scale or Children and Infants Postoperative Pain Scale scores at H1, H6, H12, H24, and H48, as well as amounts of rescue analgesia, adverse events, and motor and sensory block. An ambulation score for the children was also evaluated. Eleven popliteal, nine femoral, and five axillary continuous blocks were performed. All the blocks were effective for surgery. The mean total dose consumption of 0.2% ropivacaine was 10.1 mg/kg. Disposable pump flow varied from -9.61% to +8.6% compared with the theoretical one. Postoperative analgesia was excellent. The median of pain score was zero at each period studied. Sensory and motor block were noted at H1 and decreased from the sixth hour. No adverse events were noted. We concluded that the use of elastomeric disposable pumps for CPNB in children was an effective technique
狗大?膜?害/Orphanin FQ(N/OFQ)?合位?的特?Characterization of Nociceptin/Orphanin FQ Binding Sites in Dog Brain Membranes
Emma E. Johnson, BSc(Hons)*, Helen Gibson, BSc(Hons)*, Beverley Nicol, PhD, Johannes Zanzinger, PhD, Peter Widdowson, PhD, Mark Hawthorn, PhD, Geza Toth, PhD, Judit Farkas, PhD, Remo Guerrini, PhD, and David G. Lambert, PhD*
*University Department of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary, Leicester, United Kingdom; Veterinary Medicine Research & Development, Pfizer Ltd., Sandwich, Kent, United Kingdom; Isotope Laboratory, Institute of Biochemistry, Biological Research Centre, Szeged, Hungary; and Department of Pharmaceutical Sciences and Biotechnology Centre, University of Ferrara, Ferrara, Italy
Anesth Analg 2003 97: 741-747
（?旭? ? 薛?? 校）
Nociceptin/orphanin FQ (N/OFQ) is the endogenous ligand for the N/OFQ receptor (NOP), whose characteristics in the dog are unknown. We therefore compared [3H]N/OFQ binding in dog and rat brain membranes. Radioligand saturation/competition studies with these membranes and leucyl-[3H]N/OFQ(1–17)OH or the novel radioligand [3H]N/OFQ(1–13)NH2 were performed to determine receptor density and ligand affinity. The density of classic opioid receptors was determined by using [3H]diprenorphine. Leucyl-[3H]N/OFQ(1–17)OH binding was concentration dependent and saturable in dog (maximum binding capacity [Bmax], 28.7 ± 2.8 fmol/mg of protein; equilibrium dissociation constant as negative log [pKd], 10.27 ± 0.11) and rat (Bmax, 137.0 ± 12.9 fmol/mg of protein; pKd, 10.41 ± 0.05). In comparison, the Bmax and pKd of [3H]diprenorphine were, respectively, 77.7 ± 5.3 fmol/mg of protein and 9.74 ± 0.09 in dog and 79.1 ± 18.2 fmol/mg of protein and 9.51 ± 0.04 in rat. In dog, [3H]N/OFQ(1–13)NH2 binding to NOP receptors was also saturable (Bmax, 23.7 ± 2.0 fmol/mg of protein; pKd, 10.16 ± 0.12). In both species, leucyl-[3H]N/OFQ(1–17)OH was displaced by various NOP ligands. Dynorphin A, N/OFQ(1–5)NH2, and nocistatin were essentially inactive. There was a significant positive correlation (r2 = 0.95; P < 0.0001) between pKi values (an estimate of affinity) obtained in displacement studies in rat and dog. We have demonstrated a low density of NOP receptors, measured with two radioligands, in dog, and these receptors display a high degree of pharmacological similarity with those natively expressed in the rat.
多沙普?可使兔??降低并呈?量相?性Doxapram Produces a Dose-Dependent Reduction in the Shivering Threshold in Rabbits
Katsumi Okuyama, MD*, Takashi Matsukawa, MD*, Makoto Ozaki, MD, Daniel I. Sessler, MD, Tomoki Nishiyama, MD, Makoto Imamura, MD*, and Teruo Kumazawa, MD*
Departments of Anesthesia, *University of Yamanashi, Faculty of Medicine, Yamanashi; Tokyo Women’s Medical University, and Tokyo University School of Medicine, Tokyo, Japan; and Outcomes ResearchTM Institute and Departments of Anesthesiology, University of Louisville, Louisville, Kentucky
Anesth Analg 2003 97: 759-762.
多巴胺?一种?度??神???，?注射到下丘?或下丘?旁?可引起低?。多沙普?刺激???体?放多巴胺，??可通?相同或至少部分相同的机制引起中?反?。我?通??一??，以待??多沙普?在兔中确?可以降低??，并呈?量相?的假?。24只?异氟醚麻醉的兔子，?机分?三?：1）生理?水?（?照?）；2）多沙普?. 0.25mg/kg/h 3)多沙普?.0.50mg/kg/h。 ?些?量均在推荐的人体???量范??。然后?一??直?的U形??极灌注10C的水，体?以每小?2－3C的速度下降，??食道?端?度即中心?度。另一?察者（即盲者）?价?抖的程度。以?始?抖?的中心?度??值，?据采取??分析，P<0.05??有?著差异。?果??三??血流?力?及呼吸?化有可比性。?照?兔子???36.3＋/-0.3C, 第2?兔子???34.8+/-0.5C, 第三?兔子???33.7+/-0.6C。每???的??均有?著差?（P<0.001）。如果多沙普?在人体?也有?似的抑制作用的?，?有重要的?床意?。本研究提示，多沙普?确?可降低??，并呈?量相?性。因此可行?一步研究以确定此?在??治?性低??能否抑制反?性寒?。
（梁雅芬 ? 薛?? 校）
Dopamine is a thermoregulatory neurotransmitter that provokes hypothermia when injected in or near the hypothalamus. Doxapram stimulates release of dopamine from carotid bodies, but is known to have central effects that are probably, at least in part, similarly mediated. We thus tested the hypothesis that doxapram produces a substantial, dose-dependent reduction in the shivering threshold in rabbits. Twenty-four rabbits, anesthetized with isoflurane, were randomly assigned to 1) saline (control), 2) 0.25 mg · kg-1 · h-1 doxapram, or 3) 0.50 mg · kg-1 · h-1 doxapram. These doses are within the recommended range for humans. Body temperature was reduced at a rate of 2° to 3°C/h by perfusing water at 10°C through a U-shaped thermode positioned in the colon. Core temperatures were recorded from the distal esophagus. A blinded observer evaluated shivering. Core temperature at the onset of shivering defined the threshold. Data were analyzed with a one-way analysis of variance; P < 0.05 was considered statistically significant. Hemodynamic and respiratory responses were comparable in the groups. The control rabbits shivered at 36.3° ± 0.3°C, those given 0.25 mg · kg-1 · h-1 doxapram shivered at 34.8° ± 0.5°C, and those given 0.50 mg · kg-1 · h-1 shivered at 33.7° ± 0.6°C. All the shivering thresholds significantly (P < 0.001) differed from one another. The magnitude of this inhibition, if similar in humans, would be clinically important.
胸科手?麻醉??皮CO2与呼气末CO2??的?估比?Comparative Evaluation of Transcutaneous and End-Tidal Measurements of CO2 in Thoracic Anesthesia
Motoko Oshibuchi, MD, Sungsam Cho, MD, Tetsuya Hara, MD, Shiro Tomiyasu, MD, Tetsuji Makita, MD, and Koji Sumikawa, MD
Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
Anesth Analg 2003 97: 776-779.
通??一研究，我??估了胸科手?麻醉下?皮CO2??(PTCCO2)与呼气末CO2(PET CO2)??相比的准确性。26例行?胸肺切除的患者（?些患者都需要一??的?肺通气??），取??位行机械通气，在?肺(TLV)和?肺通气(OLV)期?每隔15分??定PTCCO2. PET CO2和??血CO2分?(Pa CO2)，所有患者均按??流程完成了??。Bland-Altman分析表明，PTCCO2和Pa CO2相比，?肺?的偏差?-0.4mmHg，精确度?+/-2.5mmHg; ?肺?偏差?1.4mmHg，精确度?+/-4.3mmHg。PET CO2和Pa CO2相比，?肺?的偏差?-5.8mmHg，精确度?+/-4.1mmHg; ?肺?偏差?-7.1mmHg，精确度?+/-4.6mmHg。由此可?，PTCCO2??在胸科手?麻醉?可以正确反映??CO2水平。本研究提示，?皮CO2??在胸科手?麻醉??肺或?肺通气?都比呼气末CO2更加准确地反映????CO2分?水平。
（梁雅芬 ? 薛?? 校）
We performed this study to assess the accuracy of transcutaneous CO2 (PTCCO2) monitoring compared with end-tidal CO2 (PETCO2) in thoracic anesthesia. Twenty-six patients undergoing pneumonectomy with thoracotomy for which a long period of one-lung ventilation (OLV) was required were studied. The lungs were mechanically ventilated in the lateral decubitus position. PTCCO2, PETCO2, and arterial CO2 (PaCO2) were simultaneously measured during two-lung ventilation (TLV) and during OLV at intervals of 15 min. All patients completed the study protocol. Bland-Altman analysis revealed a bias of -0.4 mm Hg with a precision of ±2.5 mm Hg during OLV and 1.4 mm Hg with ±4.3 mm Hg during TLV when PTCCO2 and PaCO2 were compared and revealed a bias of -5.8 mm Hg with a precision of ±4.1 mm Hg during OLV and -7.1 mm Hg with ±4.6 mm Hg during TLV when PETCO2 and PaCO2 were compared. We conclude that PTCCO2 monitoring is accurate for evaluating CO2 levels during thoracic anesthesia.
?解疼痛可以改善慢性疼痛患者的行?和情??？Does Pain Relief Improve Pain Behavior and Mood in Chronic Pain Patients?
Sabine M. Sator-Katzenschlager, MD*, Andreas W. Schiesser, PhD, Sibylle A. Kozek-Langenecker, MD*, Gerhard Benetka, PhD, Gudrun Langer, MD*, and Hans-Georg Kress, MD PhD*
Anesth Analg 2003 97: 791-797
慢性疼痛是一种主?体?，不?有身体的而且有心理和社?的原因。在????中，我?研究慢性疼痛患者疼痛有效?解是否能改善情?、行?和?知方面的??。我??于在我?大?疼痛治?中心就?的477位患者在第一年?行前瞻性研究，病人接受了?物?法、?灸?法、?皮神?刺激、理?和有?性的疼痛治?。疼痛的?度和性?采用??模??定?准和多?疼痛?定?准?行?估，?于心理和社?方面的?估使用疼痛行??查表和情?特征?查表。疼痛?度的明??解（??模??分，治?前7.35，12?月后1.03，P＝0.01；多?疼痛?定，F = 6.185; P < 0.001）伴??行?和?知反面的改善（疼痛行??查表，F = 9.483; P = 0.002）。然而，情?和心理健康?有改善（情?特征, F = 0.416; P = 0.551）。作者???解疼痛?度可以改善行?和?知功能?不能提高心理健康和?知的?估。
（王柯 ? 薛?? 校）
Chronic pain is a subjective experience and has not only physical, but also psychological and social dimensions. In the present study, we sought to determine whether an effective pain reduction would improve mood, behavioral, and cognitive outcome measures in chronic pain patients. Four-hundred-seventy-seven patients entering pain therapy at our university pain center were prospectively studied during the first year of treatment. Patients received pharmacotherapy, acupuncture, transcutaneous nerve stimulation, physiotherapy, and invasive pain treatment. Intensity and quality of pain were assessed with the Visual Analog Scale and Multidimensional Pain Scale. Psychological and social aspects were evaluated using the Pain Behavior Questionnaire and the Profile of Mood States questionnaire. Significant reductions in pain intensity (Visual Analog Scale, 7.35 at pretreatment and 1.03 after 12 mo; P = 0.01; Multidimensional Pain Scale, F = 6.185; P < 0.001) were accompanied by improvements in behavioral and cognitive dimensions (Pain Behavior Questionnaire, F = 9.483; P = 0.002). However, mood and psychological well-being did not improve (Profile of Mood States, F = 0.416; P = 0.551). The authors conclude that reducing pain intensity improves behavioral and cognitive dimensions but not psychological well-being and cognitive assessment.
在辣椒素引起痛??敏的自愿者中??使用雷米芬太尼??生撤?性的痛??敏Intravenous Remifentanil Produces Withdrawal Hyperalgesia in Volunteers with Capsaicin-Induced Hyperalgesia
David D. Hood, MD, Regina Curry, RN, and James C. Eisenach, MD
Department of Anesthesiology and Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Anesth Analg 2003 97: 810-815.
通?超前?痛的机制?中使用阿片??物可能是有益的，也可能因??生了急性耐受而?病人有害。?里我?在自愿者身上建立一??定的痛??敏的模型??明是否??一段??使用阿片??物人体??生痛?敏感性增高。我?所研究的都是健康人。局部使用辣椒素和??加?的方法可以引起一定范?的痛??敏和异常性疼痛。由?算机控制??持??注雷米芬太尼的?度?定?使?于有害的?刺激做出疼痛?告的人??少70%，并且在?一?度?持60-100分?，?注?程之中和?注之后的痛??敏和异常疼痛的范??被?量出?。雷米芬太尼（目??度是3.1 ± 1.2 ng/mL）?注?程中?少的痛??敏和异常疼痛的范?分?是33% ± 31%和65% ± 28%（P<0.05），?注后痛??敏和异常疼痛的范?持?增大，4小?后的范?分?是180% ± 47%和180% ± 86%。我?的研究表明短期使用阿片?物可以增加?疼痛的敏感性?停?后?小?，如果用于手?期?，???增加?后?痛的用?量，增加而不是降低?后的疼痛。
（王柯 ? 薛?? 校）
Opioids administered during surgery may be beneficial by preempting postoperative pain or detrimental by causing acute tolerance. We used a stable model of hyperalgesia in volunteers to test whether acute opioid exposure also results in such pain sensitization over a period of hours in humans. Ten healthy volunteers were studied. Areas of mechanical hyperalgesia and allodynia were induced by topical capsaicin application plus intermittent heating. Computer-controlled IV remifentanil infusion was titrated to a targeted plasma concentration that reduced pain report to noxious heat by 70% and was maintained at this level for 60–100 min. Areas of hyperalgesia and allodynia were measured during and after remifentanil infusion. Remifentanil (targeted concentration of 3.1 ± 1.2 ng/mL) reduced areas of hyperalgesia and allodynia by 33% ± 31% and 65% ± 28%, respectively, during infusion (P < 0.05). Areas of hyperalgesia and allodynia continuously enlarged 4 h after remifentanil was stopped, to 180% ± 47% and 180% ± 86%, respectively. This study demonstrates that acute opioid exposure enhances hypersensitivity for hours after exposure. If applicable to the surgical setting, this could increase the dose of opioid required for postoperative analgesia and enhance, rather than inhibit, postoperative pain.
的效果?？初步研究Can Quantitative Sensory Testing Predict the Outcome of Epidural Steroid Injections in Sciatica? A Preliminary Study
Elad Schiff, MD*, and Elon Eisenberg, M
*Department of Internal Medicine B, Bnai-Zion Medical Center and Pain Relief Unit, Rambam Medical Center, and the Haifa Pain Research Group, the Technion, Israel Institute of Technology, Haifa, Israel
Anesth Analg 2003 97: 828-832.
(王柯 ? 薛?? 校)
Quantitative Sensory Testing (QST) is a psycho-physiological test used to identify dysfunction of individual nerve fiber types. In the present study, we investigated whether selective nerve fiber dysfunction, as assessed by QST, correlates with the effectiveness of epidural steroid injections (ESI) in patients with lumbar radiculopathy. Twenty patients with unilateral painful sciatica caused by disc herniation participated in this open study. Before ESI, quantitative thermal and mechanical sensory testing was conducted at the most painful dermatome and the contralateral dermatome. The primary outcome measure used was the self-recording of pain intensity twice daily with a 0–10 numerical pain scale (NPS). Secondary efficacy measures included the Short Form of the McGill Pain Questionnaire, the straight leg raising test, and the lumbar range of motion. A significant difference in all types of sensory thresholds between the affected and the contralateral dermatomes was detected at baseline. All outcome measures improved subsequent to the ESI. A significant positive correlation was found between the increase in cold sensation thresholds of the affected dermatome (A-fiber dysfunction) and the improvement in NPS. The increase in touch and vibration thresholds (As-fiber dysfunction) was found to be inversely correlated with the improvement in NPS. No correlation was found between heat sensation thresholds (C fibers) and any of the outcome measures. These results suggest that QST has the potential to be an important tool in the selection of the appropriate treatment (e.g., ESI versus surgery) for patients with sciatica and may assist in identifying the mechanisms of pain generation in these patients.
等?高氧??下?量大?的氧合：?外??使用??微探子，近?外?分光?及???血氧?定三种技?的比?Measuring Cerebral Oxygenation During Normobaric Hyperoxia:A Comparison of Tissue Microprobes, Near-Infrared Spectroscopy, and Jugular Venous Oximetry in Head Injury
Andrew D. McLeod, FRCA*, Farrell Igielman, FRCA*, Clare Elwell, PhD, Mark Cope, PhD, and Martin Smith, FRCA*
Departments of *Neuroanaesthesia and Medical Physics & Bioengineering, The National Hospital for Neurology and Neurosurgery, University College London Hospitals & Centre for Anaesthesia, UCL, London, United Kingdom
Anesth Analg 2003 97: 851-856.
我?在八位患?重?外?并?于等?高氧合的病人中使用了近?外?分光??量了???血氧?和度，?氧分?和大?氧指?的相??化。?些病患在使用基?吸入氧分?（FIO2）通气一段??后，?吸入氧分?改?1.0 ，0.6和低于基?值0.02-0.05。在FIO2 1.0 和 0.6的情?下，???的氧?和度（平均值+-?准差）?基???的79% ± 7%分?提高到89%± 6% 和84% ± 8%；?的氧分??30 ± 5 mm Hg分?提高到147 ± 36 mm Hg 和63 ± 6 mm Hg；??氧指??78% ± 3%分?增加到83% ± 5% 和80% ± 4%。?吸入氧分?降到基?值以下???氧指?降?76.2% ± 3.0%。?三种?量以相似的形式在?化但?化的程度和反?的速度是不同的。在?外?中吸入氧分?影?了?氧合的?化。
(方芳 ? 薛?? 校)
Measuring Cerebral Oxygenation DWe measured simultaneous changes in jugular venous oxygen saturation, brain tissue oxygen tension, and cerebral tissue oxygen index by using near-infrared spectroscopy during normobaric hyperoxygenation in eight severely brain-injured patients. Patients were ventilated at their baseline fraction of inspired oxygen (FIO2), followed by stepped changes in FIO2 to 1.0, 0.6, and 0.02–0.05 less than baseline. There was an increase (P < 0.01) in jugular venous saturation (mean ± SD) from a baseline value of 79% ± 7% to 89% ± 6% and 84% ± 8% at an FIO2 of 1.0 and 0.6, respectively. The changes in brain tissue oxygen tension were from a baseline of 30 ± 5 mm Hg to 147 ± 36 mm Hg and 63 ± 6 mm Hg at an FIO2 of 1.0 and 0.6, respectively (P < 0.01). The baseline tissue oxygen index was 78% ± 3%, and this increased to 83% ± 5% and 80% ± 4% at an FIO2 of 1.0 and 0.6, respectively. There was a reduction (P < 0.05) in tissue oxygen index to 76.2% ± 3.0% when the FIO2 was reduced to less than baseline. The changes in the three variables followed similar patterns but varied in their degree and speed of response. During brain injury, FIO2 affects measured variables of cerebral oxygenation.
在晚期分娩?鞘?注射25ug芬太尼合用2.5mg的重比重布比卡因与合用等比重布比卡因相比延?了?痛??Hyperbaric Bupivacaine 2.5 mg Prolongs Analgesia Compared with Plain Bupivacaine When Added to Intrathecal Fentanyl 25 μg in Advanced Labor
Wendy H. L. Teoh, MBBS, and Alex T. H. Sia, MMed
Department of Anesthesia, KK Women’s & Children’s Hospital, Singapore
Anesth Analg 2003 97: 873-877
我??查了脊麻的病人在?予鞘?首?低比重芬太尼后，使用??的鞘?重比重布比卡因的效果。37位?口大于5cm的初??被?机的分???。?P（N=19）使用25ug芬太尼和2.5mg等比重布比卡因。?H（N=18）使用25ug芬太尼和2.5mg重比重布比卡因（加入8%葡萄糖）。?种混合液使用??鞘?注射（25ug芬太尼用2ml生理?水稀?，在0.5 mL 0.5%布比卡因后?入）。病人保持?干抬高30度位30分?。我?使用0-100的疼痛分度法。在使用硬膜外/脊麻?痛前，阻?后5，15，30分?分??估。H?患者平均?痛??（122 min;范? 80210 min）比P?（95 min; 范? 75125 min）???。H?窄的皮?感?阻??（最高的感?阻?平面T8，?P在T4）。??副反?相似。在?种背景下，重比重布比卡因比等比重布比卡因延?了椎管??痛的??。
(方芳 ? 薛?? 校)
We investigated the effect of sequential administration of intrathecal (IT) hyperbaric bupivacaine (after the initial administration of IT hypobaric fentanyl) on the duration of spinal analgesia. Thirty-seven nulliparous parturients with a cervical dilation 5 cm were randomized to receive either IT fentanyl 25 μg and plain bupivacaine 2.5 mg (group P; n = 19) or IT fentanyl 25 μg and hyperbaric (with 8% glucose) bupivacaine 2.5 mg (group H; n = 18). The two components of the IT injectate were administered sequentially (fentanyl 25 μg diluted in 2 mL of normal saline, immediately followed by 0.5 mL of 0.5% bupivacaine). Patients were then positioned with their torso elevated at 30° for 30 min. Pain scores using 0–100 visual analog scales were collected before combined spinal/epidural analgesia and at 5, 15, and 30 min after the block. Patients in Group H had a longer median duration of analgesia (122 min; range, 80–210 min) than Group P (95 min; range, 75–125 min) (P < 0.01). Group H also had a more limited dermatomal spread (median highest sensory level of T8 versus T4 in group P; P < 0.05). The side-effect profile was similar. Under these circumstances, hyperbaric bupivacaine conferred an increased duration of IT analgesia compared with plain bupivacaine.
家兔中肺??比卡因和左旋布比卡因的?取Pulmonary Uptake of Ropivacaine and Levobupivacaine in Rabbits
Shigeo Ohmura, MD, Akiko Sugano, MD, Masayuki Kawada, MD, and Ken Yamamoto, MD
Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
Anesth Analg 2003 97: 893-897.
通?肺?局麻?的?取可以?低????注的毒性。我?比?了在家兔体?注射一??量后肺??比卡因和左旋布比卡因的?取。16只?于麻醉??的兔子被?机分??比卡因和左旋布比卡因??。下腔???快速注射?比卡因或左旋布比卡因0.5 mg/kg和???（一种???指示?）0.25 mg/kg。???以1.2-s的?隔??采?30 s。每??品中局麻?和???的?度取?于局麻?在肺中的首??取。左旋布比卡因的首??取（31.4% ± 8.3%）比?比卡因（22.9% ± 5.6%）大，最大的???物?度?比卡因(21.2 ± 2.8 μg/mL)比左旋布比卡因(18.6 ± 1.9 μg/mL)大。我?推出使用一??量的?物后肺?左旋布比卡因的?取比?比卡因大。因此，???注?比卡因比左旋布比卡因心?毒性小的优?可能通??少肺的?取而??的。
(方芳 ? 薛?? 校)
Local anesthetic toxicity produced by an inadvertent IV injection is attenuated by the pulmonary uptake of local anesthetics. We compared the pulmonary uptake of ropivacaine and levobupivacaine after a bolus injection in rabbits. Sixteen anesthetized rabbits were randomly assigned to either a ropivacaine group or a levobupivacaine group. A bolus containing ropivacaine or levobupivacaine 0.5 mg/kg and indocyanine green (an intravascular indicator) 0.25 mg/kg was injected rapidly into the vena cava. Arterial blood samples were collected serially at 1.2-s intervals for 30 s. Concentrations of local anesthetic and indocyanine green in each sample were determined for the calculation of first-pass uptake of a local anesthetic in the lung. The first-pass uptake of levobupivacaine (31.4% ± 8.3%; mean ± SD) was larger than that of ropivacaine (22.9% ± 5.6%), and the maximum arterial concentration of ropivacaine (21.2 ± 2.8 μg/mL) was larger than that of levobupivacaine (18.6 ± 1.9 μg/mL). We conclude that the pulmonary uptake of levobupivacaine is larger than that of ropivacaine after a bolus injection. Therefore, the advantages of ropivacaine over levobupivacaine in terms of less cardiovascular toxicity may be offset by the smaller pulmonary uptake after an inadvertent IV injection.