Table of Contents

April 2008




孫鵬飛譯 薛張綱校

Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials

W. Scott Beattie, Duminda N. Wijeysundera, Keyvan Karkouti, Stuart McCluskey, and Gordon Tait

Anesth Analg 2008 106: 1039-1048.


黃施偉 譯,馬皓琳 李士通 校

Differential Increase of Mitochondrial Matrix Volume by Sevoflurane in Isolated Cardiac Mitochondria

Matthias L. Riess, Alexandre D. Costa, Richard Carlson, Jr, Keith D. Garlid, André Heinen, and David F. Stowe

Anesth Analg 2008 106: 1049-1055.


陶穎瑩 陳傑

Postoperative Anemia and Quality of Life After Primary Hip Arthroplasty in Patients Over 65 Years Old

Niamh P. Conlon, Eilis P. Bale, G. Peter Herbison, and Maire McCarroll

Anesth Analg 2008 106: 1056-1061.


劉沁譯 薛張綱校

Cardiac Arrests Associated with Hyperkalemia During Red Blood Cell Transfusion: A Case Series

Hugh M. Smith, Stacy J. Farrow, SRNA, Joel D. Ackerman, James R. Stubbs, and Juraj Sprung

Anesth Analg 2008 106: 1062-1069.


邱郁薇 馬皓琳 李士通

Characterization of the Coagulation Deficit in Porcine Dilutional Coagulopathy and Substitution with a Prothrombin Complex Concentrate

Gerhard Dickneite, Baerbel Doerr, and Franz Kaspereit

Anesth Analg 2008 106: 1070-1077.


趙燕星 陳傑

Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Thorsten Haas, Dietmar Fries, Carmen Holz, Petra Innerhofer, Werner Streif, Anton Klingler, Alexander Hanke, and Corinna Velik-Salchner

Anesth Analg 2008 106: 1078-1086.


秦敏菊譯 薛張綱校

Antifibrinolytic Therapy in Surgery for Congenital Heart Disease (Review Article)

Michael P. Eaton

Anesth Analg 2008 106: 1087-1100.



張瑩譯  馬皓琳 李士通校

The Relationship Between Bispectral Index and Propofol During Target-Controlled Infusion Anesthesia: A Comparative Study Between Children and Young Adults

Agnes Rigouzzo, Laure Girault, Nicolas Louvet, Frederique Servin, Tom De-Smet, Veronique Piat, Robert Seeman, Isabelle Murat, and Isabelle Constant

Anesth Analg 2008 106: 1109-1116.


潘錢玲 陳傑

The Effects of Oral Ondansetron Disintegrating Tablets for Prevention of At-Home Emesis in Pediatric Patients After Ear-Nose-Throat Surgery

Peter J. Davis, Kathleen M. Fertal, Karen R. Boretsky, Gina M. Fedel, Michael D. Ingram, Susan K. Woelfel, Paul C. Hoffmann, Harshad Gurnaney, and Michael C. Young

Anesth Analg 2008 106: 1117-1121.


胡豔譯  薛張剛校

A Comparison of the End-Tidal Sevoflurane Concentration for Removal of the Laryngeal Mask Airway and Laryngeal Tube in Anesthetized Children

Jeong-Rim Lee, Young-Sun Lee, Chong Sung Kim, Seong Deok Kim, and Hee-Soo Kim

Anesth Analg 2008 106: 1122-1125.



胡湘    馬皓琳 李士通 校)

One-Year Experience with Day-of-Surgery Pregnancy Testing Before Elective Orthopedic Procedures

Richard L. Kahn, Maureen A. Stanton, Sarani Tong-Ngork, Gregory A. Liguori, Chris R. Edmonds, and David S. Levine

Anesth Analg 2008 106: 1127-1131.


王騰 陳傑

The Importance of Increased Neck Circumference to Intubation Difficulties in Obese Patients

Hélène Gonzalez, Vincent Minville, Khedija Delanoue, Michel Mazerolles, Dominique Concina, and Olivier Fourcade

Anesth Analg 2008 106: 1132-1136.



黃凝譯  薛張綱校

The µ Opioid Receptor Mediates Morphine-Induced Tumor Necrosis Factor and Interleukin-6 Inhibition in Toll-Like Receptor 2-Stimulated Monocytes

Marie-Pierre Bonnet, Hélène Beloeil, Dan Benhamou, Jean-Xavier Mazoit, and Karim Asehnoune

Anesth Analg 2008 106: 1142-1149.

七氟醚介導的p38絲裂原活化的應激酶的活化與Jurkat T細胞的凋亡無關

吳進   馬皓琳 李士通

Sevoflurane-Mediated Activation of p38-Mitogen-Activated Stresskinase is Independent of Apoptosis in Jurkat T-Cells

Martin Roesslein, Michael Frick, Volker Auwaerter, Matjaz Humar, Ulrich Goebel, Christian Schwer, Klaus K. Geiger, Heike L. Pahl, Benedikt H. J. Pannen, and Torsten Loop

Anesth Analg 2008 106: 1150-1160.


張燕 陳傑

Inhibition of the HERG Channel by Droperidol Depends on Channel Gating and Involves the S6 Residue F656

Tao Luo, Ailin Luo, Miu Liu, and Xianyi Liu

Anesth Analg 2008 106: 1161-1170.


宣麗真譯 薛張綱校

Comparative Pharmacodynamic Modeling Using Bispectral and Narcotrend-Index With and Without a Pharmacodynamic Plateau During Sevoflurane Anesthesia

Sascha Kreuer, Jörgen Bruhn, Elisabeth Walter, Reinhard Larsen, Christian C. Apfel, Ulrich Grundmann, Andreas Biedler, and Wolfram Wilhelm

Anesth Analg 2008 106: 1171-1181.



唐亮   馬皓琳 李士通   

Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms?

Maxime Cannesson, Bertrand Delannoy, Antoine Morand, Pascal Rosamel, Yassin Attof, Olivier Bastien, and Jean-Jacques Lehot

Anesth Analg 2008 106: 1189-1194.


慧譯 馬皓琳 李士通校

The Ability of a Novel Algorithm for Automatic Estimation of the Respiratory Variations in Arterial Pulse Pressure to Monitor Fluid Responsiveness in the Operating Room

Maxime Cannesson, Juliette Slieker, Olivier Desebbe, Christian Bauer, Pascal Chiari, Roland Hénaine, and Jean-Jacques Lehot

Anesth Analg 2008 106: 1195-1200.


胡瀟 陳傑

Online Monitoring of Pulse Pressure Variation to Guide Fluid Therapy After Cardiac Surgery

Jose Otavio Auler, Jr., Filomena Galas, Ludhmila Hajjar, Luciana Santos, Thiago Carvalho, and Frédéric Michard

Anesth Analg 2008 106: 1201-1206.


施穎譯 薛張綱校

The Predictive Performance of a Pharmacokinetic Model for Manually Adjusted Infusion of Liquid Sevofluorane for Use with the Anesthetic-Conserving Device (AnaConDa): A Clinical Study

Javier F. Belda, Marina Soro, Rafael Badenes, Andreas Meiser, María Luisa García, Gerardo Aguilar, and Francisco J. Martí

Anesth Analg 2008 106: 1207-1214.



姜旭暉   馬皓琳 李士通

Desflurane Affords Greater Protection Than Halothane in the Function of Mitochondria Against Forebrain Ischemia Reperfusion Injury in Rats

Bing Zhang, Xia Wei, Xiaoguang Cui, Huacheng Zhou, Wengang Ding, and Wenzhi Li

Anesth Analg 2008 106: 1242-1249.



陳偉 陳傑

Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty

Kenneth J. Kardash, Frederic Sarrazin, Michael J. Tessler, and Ana M. Velly

Anesth Analg 2008 106: 1253-1257.


劉婷潔譯 薛張綱校

A Prospective Randomized Trial on the Role of Perioperative Celecoxib Administration for Total Knee Arthroplasty: Improving Clinical Outcomes

Scott S. Reuben, Asokumar Buvenandran, Brennan Katz, and Jeffrey S. Kroin

Anesth Analg 2008 106: 1258-1264.


潘方立 陳傑

Chronic Phantom Limb Pain: The Effects of Calcitonin, Ketamine, and Their Combination on Pain and Sensory Thresholds

Urs Eichenberger, Frank Neff, Gorazd Sveticic, Steinar Björgo, Steen Petersen-Felix, Lars Arendt-Nielsen, and Michele Curatolo

Anesth Analg 2008 106: 1265-1273.


章一靜譯 薛張綱校

Intravascular Injection in Lumbar Medial Branch Block: A Prospective Evaluation of 1433 Injections

Chul Joong Lee, Yong Chul Kim, Jae Hyuck Shin, Francis Sahngun Nahm, Hyo Min Lee, Yun Suk Choi, Sang Chul Lee, Justin Sang Ko, Tae Hyeong Kim, Woo Seok Sim, Chung Su Kim, and Hyun Sung Cho

Anesth Analg 2008 106: 1274-1278.


張曦 譯,馬皓琳 李士通

Dermatome Variation of Lumbosacral Nerve Roots in Patients with Transitional Lumbosacral Vertebrae

Yang Hyun Kim, Pyung Bok Lee, Chul Joong Lee, Sang Chul Lee, Yong Chul Kim, and Jin Huh

Anesth Analg 2008 106: 1279-1283.

在大鼠胸深層肌肉離斷後背角小膠質細胞環氧合酶- 1和神經元環氧合酶-2上調

杜唯佳 陳傑

Upregulation of Dorsal Horn Microglial Cyclooxygenase-1 and Neuronal Cyclooxygenase-2 After Thoracic Deep Muscle Incisions in the Rat

Jeffrey S. Kroin, Mayumi Takatori, Jinyuan Li, Er-Yun Chen, Asokumar Buvanendran, and Kenneth J. Tuman

Anesth Analg 2008 106: 1288-1295.


夏俊明譯 薛張綱校

Midazolam Administration Reverses Thermal Hyperalgesia and Prevents {gamma}-Aminobutyric Acid Transporter Loss in a Rodent Model of Neuropathic Pain

Andre Shih, Vjekoslav Miletic, Gordana Miletic, and Lesley J. Smith

Anesth Analg 2008 106: 1296-1302.


周雅春 馬皓琳 李士通

Suppression of Noxious-Induced C-Fos Expression in the Rat Lumbar Spinal Cord by Isoflurane Alone or Combined with Fentanyl

Mathieu G. Sommers, Nha-Khanh Nguyen, Jan G. Veening, Kris C. Vissers, Merel Ritskes-Hoitinga, and Jan van Egmond

Anesth Analg 2008 106: 1303-1308.


於章傑 陳傑

Antiallodynic and Antihyperalgesic Effect of Milnacipran in Mice with Spinal Nerve Ligation

Takahiro Suzuki, Kazuyoshi Ueta, Shinji Tamagaki, and Takashi Mashimo

Anesth Analg 2008 106: 1309-1315.


蔣宗明譯 薛張綱校

Stimulating Catheters for Continuous Femoral Nerve Blockade After Total Knee Arthroplasty: A Randomized, Controlled, Double-Blinded Trial

Michael J. Barrington, David J. Olive, Craig A. McCutcheon, Christopher Scarff, Simone Said, Roman Kluger, Nicola Gillett, and Peter Choong

Anesth Analg 2008 106: 1316-1321.


沈浩   馬皓琳 李士通校

The Effects of Intravenous Granisetron on the Sensory and Motor Blockade Produced by Intrathecal Bupivacaine

Hany A. Mowafi, Samer A. Arab, Salah A. Ismail, and AbdulMohsin Al-Ghamdi

Anesth Analg 2008 106: 1322-1325.



Postoperative Anemia and Quality of Life After Primary Hip Arthroplasty in Patients Over 65 Years Old

Niamh P. Conlon, FCARCSI*, Eilis P. Bale, RGN*, G. Peter Herbison, MSc{dagger}, and Maire McCarroll, FCARCSI*

From the *Department of Anesthesia, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland; and {dagger}Department of Preventive and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand.

Anesth Analg 2008 106: 1056-1061.



方法:大於65歲初次行髖關節成形術的病人,進行為期三個月的術後隨訪,瞭解病人出院時的血色素水準與其在術後兩月主觀評估生活品質的相關性。採用SF-36量表和FACT-Anemia 問卷表在術前及術後兩月評估患者生活品質。並計算術後第八天的血色素水準與SF-36量表和FACT-Anemia 問卷表結果(術前及術後兩月)間的相關係數。

結果87位病人入組研究,其中79位病人採集到術後兩月的資料。術後第八天血色素水準與SF-36量表資料變化間的相關性為0.49p<0.0005),與FACT-Anemia 問卷表資料變化間的相關性為0.46p=<0.0005)。該相關性不受年齡、是否存在重大心血管疾病或是否輸血影響。


(陶穎瑩 陳傑 校)

BACKGROUND: It is uncertain whether anemia in elderly patients after primary hip arthroplasty has an effect on their quality of life.

METHODS: We conducted a prospective observational study over 3 mo to investigate the association between discharge hemoglobin levels and subjective experience of quality of life at 2 mo postoperatively in patients aged over 65 yr who were scheduled for primary hip arthroplasty. Quality of life was measured preoperatively and at 2 mo postoperatively using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Functional Assessment of Cancer Therapy Anemia (FACT-Anemia) subscale. Pearson correlation coefficients between change in SF-36 and FACT-Anemia subscale scores (from preoperatively to 2 mo postoperatively) and hemoglobin on Day 8 were calculated.

RESULTS: Eighty-seven patients were included in the study. Data were available at 2 mo postoperatively from 79 of these patients. The correlation between Day 8 postoperative hemoglobin and change in SF-36 was 0.49 (P < 0.0005) and change in FACT-Anemia subscale score was 0.46 (P =< 0.0005). The correlation was not significantly changed after adjusting for advancing age, presence of significant cardiovascular disease, or whether the patient was transfused.

CONCLUSIONS: We found a positive correlation between hemoglobin levels on discharge and change in quality of life scores from preoperatively to 2 mo postoperatively in patients over 65 yr old after primary hip arthroplasty.


Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Thorsten Haas, MD*, Dietmar Fries, MD{dagger}, Carmen Holz, MD*, Petra Innerhofer, MD*, Werner Streif, MD{ddagger}, Anton Klingler, PhD§, Alexander Hanke, MD||, and Corinna Velik-Salchner, MD*

From the Departments of *Anaesthesiology and Critical Care Medicine, {dagger}General and Surgical Critical Care Medicine, {ddagger}Pediatrics, Innsbruck Medical University, §Department of General and Transplant Surgery, Division of Theoretical Surgery, Innsbruck Medical University, Innsbruck, Austria; and ||Department of Anaesthesiology and Intensive Care Medicine, University Clinics of Essen, Essen, Germany.

Anesth Analg 2008 106: 1078-1086.


背景:創傷病人用小容量高滲鹽水/羥乙基澱粉200/0.62(HS-HES) 復蘇較使用晶體液或膠體液更有效。上述四種液體均可導致劑量依賴性稀釋性凝血功能紊亂,並對止血功能產生影響,但很少資料顯示應用低容量復蘇後對凝血功能影響。

方法:thrombelastometry (ROTEM®)研究了30頭豬(體重35-45kg)失血60%[1484ml(1369-1624ml)],以4ml/kgHS-HES或以11的比例輸注4%明膠或6%HES130/0.4來補充丟失的血容量。為了在有出血傾向時比較ROTEM各變數的變化(凝血時間,血栓形成時間,{alpha}角,血栓硬度,人纖維蛋白原聚合作用),行肝臟切開術並測定出血量。

結果:與輸注4%明膠(4.5mm(3.0,5.8)]HES130/0.4 [3.5mm(2.3,4.0)]相比,輸注HS-HES [11mm(10,11),p=0.0034]後人纖維蛋白原聚合中位數(25%75%)明顯增高。輸注HS-HES後肝切口平均失血量為725ml900375),輸注4%明膠平均失血量為1625ml12751950),輸注6%HES130/0.4(p=0.004)平均失血量為1600ml15001800)。各組血流動力學均穩定,但灌注壓不同。


(趙燕星 陳傑 校)

BACKGROUND: Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All IV fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation.

METHODS: Using thrombelastometry (ROTEM®), we studied 30 pigs (weighing 35–45 kg) after withdrawal of 60% of blood volume [1484 mL (1369–1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, {alpha}angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured.

RESULTS: Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures.

CONCLUSIONS: Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.



The Effects of Oral Ondansetron Disintegrating Tablets for Prevention of At-Home Emesis in Pediatric Patients After Ear-Nose-Throat Surgery

Peter J. Davis, MD*{dagger}, Kathleen M. Fertal, RN, CCRC{dagger}, Karen R. Boretsky, MD*{dagger}, Gina M. Fedel, MD*{dagger}, Michael D. Ingram, MD*, Susan K. Woelfel, MD*{dagger}, Paul C. Hoffmann, RPh{ddagger}, Harshad Gurnaney, MD*{dagger}, and Michael C. Young, MS*{dagger}

From the *University of Pittsburgh School of Medicine, Departments of {dagger}Anesthesiology, and {ddagger}Pharmacy, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania.

Anesth Analg 2008 106: 1117-1121.






(潘錢玲 陳傑 校)

BACKGROUND: Tonsillectomy and adenoidectomy are associated with a frequent incidence of vomiting, both in the hospital and at home. We evaluated the effects of oral ondansetron disintegrating tablets (ODT) on the incidence of at-home emesis in children undergoing tonsillectomy with and without adenoidectomy and with and without bilateral myringotomy and tube insertion.

METHODS: All patients underwent inhaled mask induction with nitrous oxide, oxygen, and sevoflurane. Morphine, dexamethasone, and ondansetron were administered to all patients intraoperatively. Postoperative pain was treated with fentanyl or acetaminophen with codeine. Rescue antiemetics in the postanesthesia care unit or same day surgery unit were administered for three emetic episodes within 15 min, or upon patient or parent request. Patients were randomized for at-home administration of five doses of either ondansetron ODT or a placebo. All patients were followed for the first 3 days after surgery. At-home emesis was the primary outcome variable.

RESULTS: Two hundred and twenty-one patients were entered into the study, yielding 200 evaluable subjects. At-home emesis occurred in 15 (14.5%) of the 103 children who received ODT, and 31 (32%) of the 97 children in the placebo group, P = 0.004. Subgroup analysis demonstrated efficacy in patients who did not require rescue medication for nausea and vomiting while in the hospital, but did not demonstrate efficacy for patients who required rescue medication.

CONCLUSIONS: At-home use of ODT may prevent emesis in children during the first 3 days after tonsillectomy in children. Patients who require rescue after prophylactic treatment for nausea and vomiting in the hospital may not respond to prophylactic ondansatron ODT at home.



The Importance of Increased Neck Circumference to Intubation Difficulties in Obese Patients

Hélène Gonzalez, MD*, Vincent Minville, MD, MSc*{dagger}, Khedija Delanoue, MD*, Michel Mazerolles, MD*, Dominique Concina, MD*, and Olivier Fourcade, MD, PhD*

From the *Department of Anesthesiology and Intensive Care, GRCB 48, University Hospital of Toulouse, and {dagger}Physiology Laboratory, INSERM U 858, Toulouse University Hospital Rangueil, Toulouse, France.

Anesth Analg 2008 106: 1132-1136.



方法:作者前瞻性比較了70名肥胖病人[體重指數(BMI)30kg/m2]61個較瘦病人(BMI<30kg/m2)困難插管的發生率。困難插管評分>5定義為困難插管,  ≤5為非困難插管。術前測量體重指數,頸圍(在甲狀輭骨水準),張口度,頦胸距離和甲頦距離,及阻塞性睡眠呼吸暫停綜合征病史和其他幾項評分(Mallampati, Wilson, El Ganzouri)。在直接喉鏡檢查並評估,並記錄IDS



(王騰 陳傑 校)

BACKGROUND: Using the intubation difficulty scale (IDS), we sought to confirm that obese patients are more difficult to intubate than lean patients. We assessed classical bedside tests and included neck circumference.

METHODS: We prospectively compared the incidence of difficult tracheal intubation in 70 obese [body mass index (BMI) ≥30 kg/m2] and 61 lean patients (BMI <30 kg/m2). The IDS scores, categorized as difficult intubation (IDS >5) or not (IDS ≤5), and the patient data, were compared between lean and obese patients. Preoperative measurements [BMI, neck circumference (at the level of the thyroid cartilage), width of mouth opening, sternomental distance, and thyromental distance], medical history of obstructive sleep apnea syndrome, and several scores (Mallampati, Wilson, El Ganzouri) were recorded. The view during direct laryngoscopy was graded, and the IDS was recorded. We then compared patients with IDS ≤5 and >5, concerning each item.

RESULTS: The results indicate that difficult tracheal intubation is more frequent in obese than in lean patients (14.3% vs 3%; P = 0.03). In the patients with IDS > 5, thyromental distance, BMI, large neck circumference, and higher Mallampati score were the only predictors of potential intubation problems.

CONCLUSION: We found that problematic intubation was associated with thyromental distance, increasing neck circumference, BMI, and a Mallampati score of ≥3. Neck circumference should be assessed preoperatively to predict difficult intubation.



Inhibition of the HERG Channel by Droperidol Depends on Channel Gating and Involves the S6 Residue F656

Tao Luo, MD, PhD*{dagger}, Ailin Luo, MD, PhD{dagger}, Miu Liu, MD*, and Xianyi Liu, MD*

From the Department of Anesthesiology, *Renmin Hospital of Wuhan University, and {dagger}Tongji Hospital of Huazhong University of Science and Technology, Wuhan, China.

Anesth Analg 2008 106: 1161-1170.




方法:人類胚胎腎293細胞,異源表達野生型和突變型HERG鉀通道,採用全細胞膜片鉗技術( 22-24攝氏度)記錄電流。

結果: HERG鉀通道尾電流描記脈衝中,50毫伏時氟呱利多IC50 77.3 ± 9.6 nmmol(n = 8)。初期為快速阻斷且其抑制作用在藥物洗出後逆轉。氟呱利多主要作用在開放和失活狀態時HERG鉀通道。在較快頻率時較強穩態水準阻滯是功能依賴性。啟動曲線向更負電位元移動(P < 0.05, n = 8),且100 nM氟呱利多失活時程明顯縮短(P < 0.05, n = 8)。但對HERG通道失活無相關影響。由氟呱利多導致HERG通道阻滯的強度在Phe-656(苯丙氨酸-656)突變到Thr(蘇氨酸)或Ser-631(絲氨酸-631)突變到Ala(丙氨酸)時顯著降低。但Phe-656突變到ThrF656M/S631A雙突變時氟呱利多對通道阻滯的敏感性無影響。


(張燕 陳傑 校)

BACKGROUND: Droperidol has a central antiemetic action and is widely used in the fields of psychiatry, anesthesia, and emergency medicine. It has been associated with prolongation of the QT interval of the electrocardiogram, and it may also be associated with torsades de pointes and sudden death. Although QT prolongation is consistent with droperidol-induced increases in cardiac ventricular action potential duration, the cellular mechanism for these observations has not been clearly studied. The rapidly activating delayed rectifier potassium channel, IKr, is a primary site of action of drugs causing QT prolongation and is encoded by the human-ether-a-go-go-related gene (HERG). To determine the mechanism underlying these clinical findings, we investigated the effect of droperidol on human HERG potassium channels.

METHODS: Wild type and mutant HERG channels were heterologously expressed in human embryonic kidney 293 cells, and the current was recorded by using whole cell patch clamp technique (22–24°C).

RESULTS: HERG tail currents following test pulses to 50 mV were inhibited by droperidol with an IC50 of 77.3 ± 9.6 nM (n = 8). The onset of block was fast and inhibition was completely reversible upon washout. Droperidol affected HERG channels mainly in their open and inactivated states. The effects were use-dependent with a stronger steady-state level of block at higher frequencies. The activation curve was slightly shifted towards more negative potentials (P < 0.05, n = 8) and the time course of inactivation was significantly decreased (P < 0.05, n = 8) by 100 nM droperidol. But there was no relevant effect on HERG channel deactivation. The potency for block of HERG channels by droperidol was significantly decreased with mutation of Phe-656 to Thr or mutation of Ser-631 to Ala, respectively. However, mutation of Phe-656 to Met or the double mutation F656M/S631A had no effect on channel sensitivity to block by droperidol.

CONCLUSIONS: Droperidolpotently inhibits transfected HERG channels and this is the probable mechanism for QT prolongation. Channel blockade shows greatest affinity for the open and inactivated state. Aromatic residue at position 656 may participate in droperidol binding, and inactivation gating can induce a conformational state that optimizes droperidol binding to the channel.


Online Monitoring of Pulse Pressure Variation to Guide Fluid Therapy After Cardiac Surgery

Jose Otavio Auler, Jr., MD, PhD*, Filomena Galas, MD, PhD*, Ludhmila Hajjar, MD*, Luciana Santos, MD*, Thiago Carvalho, MD*, and Frédéric Michard, MD, PhD{dagger}

From the *Department of Anesthesia and Critical Care, Heart Institute, INCOR, Hospital das Clinicas, University of Sao Paulo, SP, Brazil; and {dagger}Department of Anesthesia and Critical Care, Béclère Hospital-University Paris XI, Paris, France.

Anesth Analg 2008 106: 1201-1206.


背景:由機械通氣引起的動脈壓波動(△PP)已被認為是液體治療反應的預測因數。直到現在,△PP需在脫機時(由一台電腦記錄或一張紙列印出動脈壓波形)計算 ,或由特定的心輸出量監測儀測定,限制了這一參數的廣泛使用。最近,一個新方法已被用於標準的床邊監測並自動計算和即時監測△PP。這種方法是否能夠可靠預測液體反應仍有待證實。


結果39名患者(占總數66%,為液體治療反應組)在液體輸入後心排量增加了15%。在液體輸入之前,液體治療反應組和無反應組的右房壓和肺動脈嵌壓相當。相反,反應者組的△PP比無反應者組的△PP高(17%±3% 對應9%±2%P<0.001)。△PP12%作為停止治療值時靈敏度為97%和特異性為95%


(胡瀟 陳傑 校)

BACKGROUND: The arterial pulse pressure variation induced by mechanical ventilation ({Delta}PP) has been shown to be a predictor of fluid responsiveness. Until now, {Delta}PP has had to be calculated offline (from a computer recording or a paper printing of the arterial pressure curve), or to be derived from specific cardiac output monitors, limiting the widespread use of this parameter. Recently, a method has been developed for the automatic calculation and real-time monitoring of {Delta}PP using standard bedside monitors. Whether this method is to predict reliable predictor of fluid responsiveness remains to be determined.

METHODS: We conducted a prospective clinical study in 59 mechanically ventilated patients in the postoperative period of cardiac surgery. Patients studied were considered at low risk for complications related to fluid administration (pulmonary artery occlusion pressure <20 mm Hg, left ventricular ejection fraction ≥40%). All patients were instrumented with an arterial line and a pulmonary artery catheter. Cardiac filling pressures and cardiac output were measured before and after intravascular fluid administration (20 mL/kg of lactated Ringer’s solution over 20 min), whereas {Delta}PP was automatically calculated and continuously monitored.

RESULTS: Fluid administration increased cardiac output by at least 15% in 39 patients (66% = responders). Before fluid administration, responders and nonresponders were comparable with regard to right atrial and pulmonary artery occlusion pressures. In contrast, {Delta}PP was significantly greater in responders than in nonresponders (17% ± 3% vs 9% ± 2%, P < 0.001). The {Delta}PP cut-off value of 12% allowed identification of responders with a sensitivity of 97% and a specificity of 95%.

CONCLUSION: Automatic real-time monitoring of {Delta}PP is possible using a standard bedside monitor and was found to be a reliable method to predict fluid responsiveness after cardiac surgery. Additional studies are needed to determine if this technique can be used to avoid the complications of fluid administration in high-risk patients.




Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty

Kenneth J. Kardash, MD*, Frederic Sarrazin, BEng, MD*, Michael J. Tessler, MD*, and Ana M. Velly, DDS, PhD{dagger}{ddagger}

From the *Department of Anesthesia and {dagger}Center of Clinical Epidemiology and Community Studies, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada; and {ddagger}Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, Minnesota.

Anesth Analg 2008 106: 1253-1257.




結果:地塞米松組中術中應用丙泊酚鎮靜的劑量顯著增加(234.6 ± 160.1 vs 138.8 ± 122.7 mg, P = 0.02)。運動性疼痛減輕(NRS 評分: 2.7, 95% CI: 2.2–3.1 vs 6.8, 6.4–7.2; P < 0.0001)。在任何時間內靜息狀態下疼痛和累積的嗎啡用量均無顯著差異。48h時地塞米松組C反應蛋白水準較對照組降低。對照組中有7名患者出現術後噁心,而地塞米松組只有一名患者。

結論:全髖成形術術前單劑量靜注地塞米松40mg對術後有長時抑制炎症反應效應並減輕24h 運動性疼痛。

(陳偉 陳傑 校)

BACKGROUND: Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption.

METHODS: Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery. IV patient-controlled analgesia morphine, ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain (0–10 numeric rating scale, NRS) at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h.

RESULTS: The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group (234.6 ± 160.1 vs 138.8 ± 122.7 mg, P = 0.02). Dynamic pain was greatly reduced in the dexamethasone group (NRS score: 2.7, 95% CI: 2.2–3.1 vs 6.8, 6.4–7.2; P < 0.0001). There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone (52.4 mg/mL, 28.2–76.6 vs 194.2, 168.9–219.4; P < 0.0001). Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea (P = 0.05).

CONCLUSIONS: A single, preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.



Chronic Phantom Limb Pain: The Effects of Calcitonin, Ketamine, and Their Combination on Pain and Sensory Thresholds

Urs Eichenberger, MD*, Frank Neff, MD{dagger}, Gorazd Sveticic, MD{dagger}, Steinar Björgo, MD*, Steen Petersen-Felix, MD, PhD{dagger}, Lars Arendt-Nielsen, PhD{ddagger}, and Michele Curatolo, MD, PhD*

From the *Division of Pain Therapy, Department of Anesthesiology, University Hospital of Bern, Inselspital, Switzerland; {dagger}Department of Anesthesiology, University Hospital of Bern, Inselspital, Switzerland; and {ddagger}Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction, Aalborg University, Denmark.

Anesth Analg 2008 106: 1265-1273.



方法20名受試者隨機、雙盲、交叉接受4種藥物:降鈣素200IE;氯胺酮0.4mg/kg(僅10 名受試者);降鈣素200IE0.4mg/kg氯胺酮;安慰劑:0.9%生理鹽水。注射前、注射期間,注射末和注射後48h進行幻肢痛程度的檢測(視覺類比量表)。在注射前和注射期間通過電、熱和壓力刺激檢測痛閾。



(潘方立 陳傑 校)

BACKGROUND: Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. The overall literature on N-methyl-d-aspartate antagonists is equivocal. We tested the hypothesis that calcitonin, ketamine, and their combination are effective in treating chronic phantom limb pain. Our secondary aim was to improve our understanding of the mechanisms of action of the investigated drugs using quantitative sensory testing.

METHODS: Twenty patients received, in a randomized, double-blind, crossover manner, 4 IV infusions of: 200 IE calcitonin; ketamine 0.4 mg/kg (only 10 patients); 200 IE of calcitonin combined with ketamine 0.4 mg/kg; placebo, 0.9% saline. Intensity of phantom pain (visual analog scale) was recorded before, during, at the end, and the 48 h after each infusion. Pain thresholds after electrical, thermal, and pressure stimulation were recorded before and during each infusion.

RESULTS: Ketamine, but not calcitonin, reduced phantom limb pain. The combination was not superior to ketamine alone. There was no difference in basal pain thresholds between the amputated and contralateral side except for pressure pain. Pain thresholds were unaffected by calcitonin. The analgesic effect of the combination of calcitonin and ketamine was associated with a significant increase in electrical thresholds, but with no change in pressure and heat thresholds.

CONCLUSIONS: Our results question the usefulness of calcitonin in chronic phantom limb pain and stress the potential interest of N-methyl-d-aspartate antagonists. Sensory assessments indicated that peripheral mechanisms are unlikely important determinants of phantom limb pain. Ketamine, but not calcitonin, affects central sensitization processes that are probably involved in the pathophysiology of phantom limb pain.


在大鼠胸深層肌肉離斷後背角小膠質細胞環氧合酶- 1和神經元環氧合酶-2上調

Upregulation of Dorsal Horn Microglial Cyclooxygenase-1 and Neuronal Cyclooxygenase-2 After Thoracic Deep Muscle Incisions in the Rat

Jeffrey S. Kroin, PhD*, Mayumi Takatori, MD*, Jinyuan Li, MD, PhD*, Er-Yun Chen, MD{dagger}, Asokumar Buvanendran, MD*, and Kenneth J. Tuman, MD*

From the Departments of *Anesthesiology, and {dagger}Neurology, Rush Medical College, Chicago, Illinois.

Anesth Analg 2008 106: 1288-1295.






(杜唯佳 陳傑 校)

BACKGROUND: Plantar hindpaw incision produces hyperalgesia, transient upregulation of cyclooxygenase-2 (COX-2) and prolonged upregulation of cyclooxygenase-1 (COX-1) in rat lumbar spinal cord. Our hypothesis in this study was that a deep thoracic incision causes COX-1 and COX-2 upregulation in the dorsal horn coincident with pain-related behavior, and that specific cell types contribute to this increase in COX expression.

METHODS: A left lateral thoracic skin incision was made in anesthetized rats, and superficial and deep muscles were incised. Postoperative pain-related behavior was quantified by recording exploratory rearing. Four and 24 h postsurgery, COX-1 and COX-2 immunohistochemistry, with co-labeling for cell type, were performed on the spinal cord.

RESULTS: Deep thoracic muscle incision produced a 42% decrease in rearing compared to sham skin-incision controls at 4 h postsurgery (P = 0.001). There was an increase in both COX-1 and COX-2 immunoreactivity in the thoracic dorsal horn at 4 h postsurgery on the ipsilateral side of surgery animals compared to the ipsilateral side of control animals, contralateral side of surgery animals or contralateral side of control animals. No surgery-induced differences were seen at the lumbar level. At 24 h postsurgery, there was no longer a decrease in rearing, and no surgery-induced differences in COX-1 or COX-2 were seen at any level. At 4 h postsurgery, 96% of COX-1 immunoreactive cells co-localized with microglia and 98% of COX-2 immunoreactive cells co-localized with neurons.

CONCLUSIONS: A unilateral deep thoracic wound produces pain-related behavior and, at the same time, ipsilateral upregulation of microglial COX-1 and neuronal COX-2 in the thoracic dorsal horn.



Antiallodynic and Antihyperalgesic Effect of Milnacipran in Mice with Spinal Nerve Ligation

Takahiro Suzuki, MD, PhD, Kazuyoshi Ueta, MD, PhD, Shinji Tamagaki, MD, and Takashi Mashimo, MD, PhD

From the Department of Anesthesiology, Osaka University Medical School, Osaka, Japan.

Anesth Analg 2008 106: 1309-1315.


方法:牢固結紮C57BL6雄鼠的左側第五腰神經。使用von Frey毛和輻射熱分別測試結紮側和健側的對觸覺刺激的撤回閾值和對熱刺激的撤回潛伏期。

結果:以口服(7.5–120 mg/kg)、鞘內注射、腦室內注射或局部(210 ng–21 µg)的途徑給予米那普侖。系統、鞘內和腦室內的給藥增加了神經結紮鼠的撤回閾值和撤回潛伏期,而局部注射卻無作用。在評估米那普侖鎮痛效果的3天前,使用特異性的神經毒素、6-羥基多巴胺或5,7-二羥色胺來耗竭脊神經5-羥色胺能或去甲腎上腺素能神經元。在假手術組,這種對脊神經5-羥色胺能和去甲腎上腺素能的去神經方法減弱了米那普侖的鎮痛作用。在試驗組,米那普侖的鎮痛作用能被阻斷去甲腎上腺素能神經元的方法所減弱,而阻斷5-羥色胺能神經元則無效。


(於章傑 陳傑 校)

BACKGROUND: The antidepressant, milnacipran, has been reported to have antinociceptive, antiallodynic, and antihyperalgesic effects. In this study, we examined the mechanisms of the antiallodynic and antihyperalgesic effects of milnacipran in a model of neuropathic pain induced by spinal nerve ligation in mice.

METHODS: The fifth left lumbar nerve of male C57BL6 mice was tightly ligated. Withdrawal threshold to tactile stimulation and withdrawal latency to heat stimulation in the injured or contralateral paw was tested by using von Frey filaments and radiant heat, respectively.

RESULTS: Milnacipran was administered either orally (7.5–120 mg/kg), intrathecally, intracerebroventricularly, or locally (210 ng–21 µg). Both systemic, intrathecal and intracerebroventricular milnacipran increased withdrawal threshold and withdrawal latency in nerve-ligated mice whereas local injection had no effect. Depletion of spinal serotonergic or noradrenergic neurons was achieved by use of the specific neurotoxins, 6-hydroxydopamine or 5,7-dihydroxytryptamine, applied intrathecally 3 days before evaluation of the analgesic effect of milnacipran. Spinal serotonergic and noradrenergic denervation attenuated the effect of milnacipran in sham-operated mice. In nerve-ligated mice, however, the effect of milnacipran was lost after noradrenergic denervation but not after serotonergic denervation.

CONCLUSIONS: We concluded that the antiallodynic and antihyperalgesic effects of milnacipran on neuropathic pain induced by spinal nerve ligation are principally mediated through action at supraspinal and spinal sites via activation of the spinal noradrenergic system.



Differential Increase of Mitochondrial Matrix Volume by Sevoflurane in Isolated Cardiac Mitochondria

Matthias L. Riess, MD, PhD*, Alexandre D. Costa, PhD{dagger}, Richard Carlson, Jr, BS*, Keith D. Garlid, MD, PhD{dagger}, André Heinen, MD*, and David F. Stowe, MD, PhD{ddagger}§||#

From the *Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin; {dagger}Department of Biology, Portland State University, Portland, Oregon; and Departments of {ddagger}Anesthesiology and §Physiology, Cardiovascular Research Center, Medical College of Wisconsin and ||VA Medical Center Research Service, and #Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.

Anesth Analg 2008; 106:1049-1055



結果:與對照組相比,30300µM的七氟烷(約0.2-2.1vol%)增加MMV 30%50%,這與二氮嗪的作用相似。這些增加作用被5-HD所阻斷。不過,更高濃度的七氟烷(1000 µM; 7.1 vol %)卻對MMV無影響。


(黃施偉 譯,馬皓琳 李士通 校)

BACKGROUND: Mitochondrial (m) adenosine triphosphate sensitive potassium (KATP) channel opening has been reported to trigger and/or mediate cardioprotection by volatile anesthetics. However, the effects of volatile anesthetics on mitochondrial function are not well understood. Prevention of mitochondrial matrix volume (MMV) contraction during ischemia may contribute to cardioprotection against ischemia/reperfusion injury. We investigated whether sevoflurane increases MMV and if this increase is mediated by mKATP channel opening.

METHODS: Mitochondria from fresh guinea pig hearts were isolated and diluted in buffer that included oligomycin and ATP to inhibit ATP synthesis. Changes in MMV by diazoxide, a known mKATP channel opener, and by different sevoflurane concentrations, were measured by light absorption at 520 nm in the absence or presence of the mKATP channel blocker, 5-hydroxydecanoate.

RESULTS: Compared with control, 30–300 µM sevoflurane (approximately 0.2–2.1 vol %) increased MMV by 30%–55%, which was similar to the effect of diazoxide. These increases were blocked by 5-hydroxydecanoate. Higher sevoflurane concentration (1000 µM; 7.1 vol %), however, had no effect on MMV.

CONCLUSIONS: In clinically relevant concentrations, sevoflurane increases MMV via mKATP channel opening. Preservation of mitochondrial integrity may contribute to the cardioprotective effects of sevoflurane against ischemia/reperfusion injury. Impaired mitochondrial function at supraclinical anesthetic concentrations may explain the observed biphasic response. These findings add to our understanding of the intracellular mechanisms of volatile anesthetics as cardioprotective drugs.


Characterization of the Coagulation Deficit in Porcine Dilutional Coagulopathy and Substitution with a Prothrombin Complex Concentrate

Gerhard Dickneite, PhD, Baerbel Doerr, and Franz Kaspereit

From the Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany.

Anesth Analg 2008; 106:1070-1077

背景:本研究使用豬的模型觀察使用一個凝血酶原複合體濃縮物(PCC)(Beriplex P/N,包含凝血因數IIVIIIXX)是否能糾正凝血障礙以及動脈或靜脈大量出血。

方法:豬麻醉誘導後製作稀釋性凝血障礙的模型,分次放血(約全身血容量的65%),然後自體輸注紅細胞,並用羥乙基澱粉(Infukoll 6%1000mL進行容量擴充。試驗豬隨機分為三組:非處理組、安慰劑組和使用35 U/kg PCC進行處理組。動脈或靜脈出血採用脾切除或骨損傷模型。在基礎點、稀釋後、給予處理後以及脾切除或骨損傷後不同時點取血進行血栓彈力酶圖、血常規以及凝血試驗。主要終點為損傷後到止血的時間。

結果:血液稀釋導致凝血因數濃度下降到約35%,凝血酶原時間延長。血小板數量從約400,000/µL降低到約100,000/µL,而且血小板的凝聚和黏附均受損。PCC可有效替代缺乏的凝血酶原因子(IIVIIIXX),使延長的凝血酶原時間恢復正常。脾切除後,使用PCC可比稀釋對照組顯著縮短止血時間(中位數, 35 vs 82.5 min; P < 0.0001),血容量的丟失未明顯減少(均值,275 vs 589 mL)。骨損傷後PCC還可顯著縮短止血時程(中位數,27 vs 97 min P < 0.0011)和出血量(均值, 71 vs 589 mLP < 0.0017)。


(邱鬱薇 馬皓琳 李士通 校)

BACKGROUND: In this study, we used a porcine model to investigate whether impaired coagulation and severe arterial or venous bleeding could be normalized by substitution with a prothrombin complex concentrate (PCC), Beriplex P/N, containing coagulation factors II, VII, IX, and X.

METHODS: Dilutional coagulopathy was induced in anesthetized pigs by fractionated blood withdrawal (approximately 65% of total volume), followed by erythrocyte retransfusion and volume substitution with a total of 1000 mL of hydroxyethyl starch (Infukoll 6%). Animals were randomized to no treatment, treatment with placebo, or treatment with 35 U/kg PCC. Arterial (spleen incision) or venous (bone injury) bleeding was inflicted. Thromboelastometry, hematology, and coagulation tests were performed at baseline, after dilution, and after study treatments had been administered and injury inflicted. The primary end-point was postinjury time to hemostasis.

RESULTS: Hemodilution resulted in a decrease in coagulation factor concentrations to approximately 35% and prolonged prothrombin time. Platelet numbers decreased from approximately 400,000 to approximately 100,000/µL, and aggregation and adhesion were impaired. PCC effectively substituted the deficient prothrombin factors (II, VII, IX, and X) and normalized the prolonged prothrombin time. After spleen injury, PCC significantly reduced time to hemostasis versus dilutional control (median, 35 vs 82.5 min; P < 0.0001), and produced a nonsignificant trend towards reduction in blood loss (mean, 275 vs 589 mL). PCC also significantly reduced time to hemostasis (median, 27 vs 97 min; P < 0.0011) and blood loss (mean, 71 vs 589 mL; P < 0.0017) after bone injury.

CONCLUSIONS: Dilutional coagulopathy produced a generalized decrease in coagulation factors and impaired platelet function. Substitution with PCC effectively normalized coagulation and significantly improved hemostasis after venous and arterial bleeding.


The Relationship Between Bispectral Index and Propofol During Target-Controlled Infusion Anesthesia: A Comparative Study Between Children and Young Adults

Agnes Rigouzzo, MD*, Laure Girault, MD*, Nicolas Louvet, MD*, Frederique Servin, MD, PhD{dagger}, Tom De-Smet{ddagger}, Veronique Piat, MD*, Robert Seeman, MD*, Isabelle Murat, MD, PhD*, and Isabelle Constant, MD, PhD*

From the *Service d'Anesthésie Pédiatrique, Hôpital Armand Trousseau, {dagger}Service d'Anesthésie, Hôpital Bichat, AP-HP, Paris, France; and {ddagger}Demed Engineering, Temse, Belgium.

Anesth Analg 2008; 106:1109-1116


方法:研究物件為45例青春期前兒童和45例青春期後成人,行丙泊酚TCI麻醉,兒童使用Kataria模式,成人使用Schnider模式。使用Rugloop軟體持續記錄所有來自於BISTCI系統的資料。研究中持續加用瑞芬太尼 (0.25 µg · kg–1 · min–1)。手術結束後所有患者的丙泊酚靶控血漿濃度(Ct)隨機設為23456 µg/mL ,穩定12分鐘。而且大多數患者另外靶控BIS50 ± 5,也維持12分鐘。在每個12分鐘的穩態期後,記錄CtBIS ,並測定丙泊酚血漿濃度(Cm)。用Hill方程式和靶控BIS 50測定對應於一半最大效應(BIS50)的CtCm

結果:兒童與成人相似,BIS 值與對應的丙泊酚Ct Cm 有高度相關性,符合經典Emax劑量效應曲線。從劑量效應曲線導出的丙泊酚ECt50ECm50,兒童要高於成人:ECm50 4.0 (3.6–4.5) µg/mL3.3 (3.0–3.7) µg/mL〔均值(95%CI)〕( P < 0.001) 。當靶控BIS值為50時,臨床上得到的兒童CtCm也高於成人(Cm504.3 ± 1.1 µg/mL3.4 ± 1.2 µg/mL(均值±標準差),P < 0.05)Ct普遍低估Cm,這個偏差兒童大於成人:2.6 ± 2.6 µg/mL1.7 ± 1.6 µg/mL (P = 0.05)


(張瑩譯  馬皓琳 李士通校)

BACKGROUND: In this prospective study, we compared the relationship between propofol concentrations and bispectral index (BIS) in children versus young adults anesthetized with target-controlled infusion (TCI) of propofol.

METHODS: Forty-five prepubertal subjects (children) and 45 postpubertal subjects (adults) were studied. All patients were anesthetized with TCI of propofol, based on the Kataria et al.'s model for children and on the Schnider et al.'s model for adults. All data from the BIS and the TCI system were continuously recorded using Rugloop software. Remifentanil was continuously administered throughout the study (0.25 µg · kg–1 · min–1). In all patients, after the end of surgery, a 12-min period with a stable target plasma concentration (Ct) of propofol, randomly assigned at 2, 3, 4, 5, and 6 µg/mL, was performed. In addition, in most of the patients, another 12-min period was performed during which the BIS was targeted at 50 ± 5. After each 12-min steady-state period, the Ct and BIS were noted and the plasma concentration of propofol was measured (Cm). The Ct and Cm corresponding to half maximal effect (BIS50) was determined by the Hill equation, and by targeting BIS at 50.

RESULTS: In children, as in adults, BIS values were highly correlated with the corresponding Ct or Cm of propofol following classical Emax dose–response curves. The ECt50 and the ECm50, derived from the dose–response curves, were higher in children than in adults: ECm50: 4.0 (3.6–4.5) µg/mL vs 3.3 (3.0–3.7) µg/mL [mean (95% CI)], P < 0.001; as well were the Ct and Cm clinically obtained when BIS was targeted at 50 (Cm50: 4.3 ± 1.1 µg/mL vs 3.4 ± 1.2 µg/mL, (mean ± sd) P < 0.05, children versus adults). Cm was generally under-estimated by the Ct, and the bias was higher in children than in adults: 2.6 ± 2.6 µg/mL vs 1.7 ± 1.6 µg/mL (P = 0.05).

CONCLUSIONS: The good relationship between propofol and BIS demonstrated in children as in adults suggested a slightly lower sensitivity to propofol in children. As the predictability of plasma propofol concentrations with the classical pharmacokinetic/pharmacodynamic models is limited in children, a cerebral pharmacodynamic feedback, such as BIS, may be useful in this population.


One-Year Experience with Day-of-Surgery Pregnancy Testing Before Elective Orthopedic Procedures

Richard L. Kahn, MD*{dagger}, Maureen A. Stanton, RN*, Sarani Tong-Ngork, BS*, Gregory A. Liguori, MD*{dagger}, Chris R. Edmonds, MD*{dagger}, and David S. Levine, MD*{dagger}

From the *Department of Anesthesiology, Hospital for Special Surgery, and {dagger}Weill Medical College of Cornell University, New York City, New York.

Anesth Analg 2008; 106:1127-1131





(胡湘    馬皓琳 李士通 校)

BACKGROUND: Elective surgery is generally postponed in pregnancy. A policy of testing for urine human chorionic gonadotropin (hCG) in all women of childbearing age on the day of surgery was initiated at an elective orthopedic surgery facility. This is a retrospective report of our 1 yr experience and the associated costs.

METHODS: Records were reviewed from January 3, 2005, through January 2, 2006, to determine the number of urine hCG tests performed, and the disposition of all patients with a positive result. Costs were calculated using the charges for testing supplies and laboratory labor.

RESULTS: During the first year of policy implementation, 2588 of 2595 women of childbearing age underwent urine hCG testing. Five patients had a positive result, and surgery was cancelled. Of these five, three were previously unrecognized pregnancies, one an unrecognized asymptomatic ectopic pregnancy, and one a false-positive result in a perimenopausal woman. Three other women had a "weak positive" urine result, followed by a negative serum hCG. Surgery proceeded in all three. The calculated cost was $5.03 per urine test, and $3273 for each true positive result.

CONCLUSIONS: A policy of routinely performing urine hCG pregnancy tests in women of childbearing age on the day of surgery was effective in detecting unrecognized pregnancy. This resulted in a postponement of elective surgery in all cases. Of 2588 women tested, one had surgery postponed because of a false-positive result. The cost of $3273 per true positive test must be compared with the benefit.

七氟醚介導的p38絲裂原活化的應激酶的活化與Jurkat T細胞的凋亡無關

Sevoflurane-Mediated Activation of p38-Mitogen-Activated Stresskinase is Independent of Apoptosis in Jurkat T-Cells

Martin Roesslein, MD*, Michael Frick, MD§, Volker Auwaerter, PhD{dagger}, Matjaz Humar, PhD*, Ulrich Goebel, MD*, Christian Schwer, MD*, Klaus K. Geiger, MD*, Heike L. Pahl, PhD*, Benedikt H. J. Pannen, MD{ddagger}, and Torsten Loop, MD*

From the Departments of *Anesthesiology and Critical Care Medicine, {dagger}Forensic Medicine, University Hospital, Freiburg, Germany; {ddagger}Department of Anesthesiology and Critical Care Medicine, University Hospital, Duesseldorf; §Department of Medicine, University Hospital, Wuerzburg, Germany.

Anesth Analg 2008; 106:1150-1160

背景麻醉導致的炎症應激反應的調節可能與傷口感染或者肺炎等感染併發症的易感性增高有關。七氟醚是啟動物蛋白-1(一種即時早期轉錄因數)的特殊抑制物,能誘導T細胞的凋亡。因為p38與凋亡的促進或抑制有關,因此我們研究七氟醚誘導的Jurkat T細胞凋亡是否由p38活化所介導。

方法:在體外把Jurkat T細胞暴露於不同濃度的七氟醚、異氟醚或地氟醚。用蛋白質斑跡法來測量絲裂原活化蛋白(MAP)激酶、上游區激酶、下游區轉錄啟動因數-2 (ATF-2)以及細胞凋亡蛋白酶(半胱天冬酶-3 加工處理的磷醯化。在底物ATF-2免疫沉澱和磷醯化後用蛋白質斑跡法來測量p38激酶的活性。用綠色螢光蛋白-膜聯蛋白V染色後用流式細胞計量術來測定細胞凋亡。

結果:地氟醚沒有作用,而七氟醚和異氟醚可誘導p38的磷醯化,七氟醚可誘導p38激酶的活性。七氟醚對MAP激酶ERK JNK沒有作用。七氟醚的暴露也可誘導凋亡信號調節激酶—1(ASK1)MAP激酶的激酶36(MKK3/MKK6)以及ATF-2的磷醯化。用一般的半胱天冬酶抑制物苄氧羰基纈--天冬氨酸-(O-Me)-氟甲基酮(Z-VAD.fmk)對細胞進行預處理不能阻止七氟醚誘導的p38的磷醯化。用特殊的p38抑制物SB202190 SB203580進行預處理不能阻止異氟醚和七氟醚介導的半胱天冬酶-3的加工處理和細胞凋亡。

結論:七氟醚是 Jurkat T細胞內凋亡信號調節激酶-1MKK3/MKK6p38MAP激酶串聯反應的一種特異啟動物。我們的資料表明七氟醚誘導的p38的活化不受半胱天冬酶活化的影響。而且,七氟醚誘導的細胞凋亡與p38 MAP激酶的活化無關。

(吳進   馬皓琳 李士通 校)

BACKGROUND: Modulation of the inflammatory stress response by anesthesia may be responsible for an increased susceptibility to infectious complications, such as wound infection or pneumonia. Sevoflurane, a specific inhibitor of activator protein-1, an immediate early transcription factor, induces apoptosis in T-cells. Because p38 can be involved either in pro- or antiapoptotic processes, we examined whether the sevoflurane-induced apoptosis is mediated by p38 activation in Jurkat T-cells.

METHODS: Jurkat T-cells were exposed to different concentrations of sevoflurane, isoflurane, or desflurane in vitro. Phosphorylation of mitogen-activated protein (MAP) kinases, upstream kinases, downstream activating transcription factor 2 ATF-2, and caspase-3 processing were evaluated by Western blot. p38 kinase activity was evaluated after immunoprecipitation and phosphorylation of the substrate ATF-2 using Western blot. Apoptosis was assessed using flow cytometry after staining with green fluorescent protein-annexin V.

RESULTS: While desflurane had no effect, sevoflurane and isoflurane induced p38 phosphorylation with sevoflurane inducing p38 kinase activity. Sevoflurane did not affect the MAP kinases ERK and JNK. Sevoflurane exposure also induced phosphorylation of apoptosis signal-regulating kinase-1 (ASK1), MAP kinase kinases 3 and 6 (MKK3/MKK6), and ATF-2. Pretreatment of cells with the general caspase inhibitor Z-VAD.fmk did not prevent the sevoflurane-induced phosphorylation of p38. Isoflurane- and sevoflurane-mediated caspase-3 processing and apoptosis could not be abolished by pretreatment with the specific p38 inhibitors SB202190 and SB203580.

CONCLUSIONS: Sevoflurane is a specific activator of the apoptosis signal-regulating kinase-1-, MKK3/MKK6-p38 MAP kinase cascade in Jurkat T-cells. Our data suggest that sevoflurane-induced p38 activation is not affected by caspase activation. Furthermore, sevoflurane-induced apoptosis is not dependent on p38 MAP kinase activation.


Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms?

Maxime Cannesson, MD, Bertrand Delannoy, MD, Antoine Morand, MD, Pascal Rosamel, MD, Yassin Attof, MD, Olivier Bastien, MD, PhD, and Jean-Jacques Lehot, MD, PhD

From the Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital and Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France.

Anesth Analg 2008; 106:1189-1194

背景:呼吸的變異在脈搏氧飽和度儀的描記圖中的波形振幅({Delta}POP)對前負荷的變化比較敏感,並且能夠預測機械通氣患者的液體反應性。但是它不能夠簡單地通過床邊監護設備來計算出來。脈搏變異指數(PVI, Masimo公司, Irvine, CA)是能夠自動計算{Delta}POP的一種新的演算法則。我們研究的目的是測試這種新儀器自動連續監測{Delta}POP的能力。


結果:PVI{Delta}POP之間的相關性非常顯著(r = 0.92P < 0.05)。在75個數據中,有4256%)個數據的{Delta}POP>13%PVI的閾值是11.5%,能夠區分{Delta}POP >13%{Delta}POP ≤13%。它的靈敏性是93%,特異性是97%PVI來預測{Delta}POP >13%的曲線下面積是0.990 ± 0.07


(唐亮   馬皓琳 李士通 校)      

BACKGROUND: Respiratory variations in the pulse oximeter plethysmographic waveform amplitude ({Delta}POP) are sensitive to changes in preload and can predict fluid responsiveness in mechanically ventilated patients. However, they cannot be easily calculated from a bedside monitor. Pleth variability index (PVI, Masimo Corp., Irvine, CA) is a new algorithm that automatically calculates {Delta}POP. The aim of our study was to test the ability of this new device to automatically and continuously monitor {Delta}POP.

METHODS: Twenty-five patients were studied after induction of general anesthesia. PVI automatically and continuously calculates the respiratory variations in the plethysmography waveform amplitude (perfusion index). Data (mean arterial blood pressure, central venous pressure, respiratory variations in arterial pulse pressure, {Delta}POP, and PVI) were recorded at baseline in anti-Trendelenburg position and, finally, in Trendelenburg position.

RESULTS: There was a significant relationship between PVI and {Delta}POP (r = 0.92; P < 0.05). Over the 75 measurements, 42 (56%) presented a {Delta}POP value >13%. A PVI threshold value of 11.5% was able to discriminate between {Delta}POP >13% and {Delta}POP ≤13% with a sensitivity of 93% and a specificity of 97%. Area under the curve for PVI to predict {Delta}POP >13% was 0.990 ± 0.07.

CONCLUSION: This study is the first to demonstrate the ability of PVI, an index automatically derived from the pulse oximeter waveform analysis, to automatically and continuously monitor {Delta}POP. This new index has potential clinical applications for noninvasive fluid responsiveness monitoring.



The Ability of a Novel Algorithm for Automatic Estimation of the Respiratory Variations in Arterial Pulse Pressure to Monitor Fluid Responsiveness in the Operating Room
Maxime Cannesson, MD*, Juliette Slieker, MD*, Olivier Desebbe, MD*, Christian Bauer, MD*, Pascal Chiari, MD, PhD*, Roland Hénaine, MD†, and Jean-Jacques Lehot, MD*

From the Hospices Civils de Lyon, Departments of *Anesthesiology and Intensive Care, †Cardiac Surgery, Louis Pradel Hospital, Claude Bernard Lyon 1 university, Lyon, France.

Anesth Analg 2008 106: 1195-1200.




結果:200對收集的資料中[DELTA]PPman[DELTA]PPauto的一致性為0.7% ± 3.4% (平均偏倚 ± sd)17例患者對容量擴充有反應。允許鑒別容量擴充反應者的[DELTA]PPman閾值為12%,靈敏度88%,特異性100%。允許鑒別容量擴充反應者的[DELTA]PPauto閾值為10%,靈敏度82%,特異性88%

結論: [DELTA]PPauto[DELTA]PPman有高度相關性,是液體反應性的精確預測因數,並能持續監測[DELTA]PP。這種新穎的運算方式有潛在的臨床應用可能。

(朱 慧譯 馬皓琳 李士通校)

BACKGROUND: Respiratory variations in arterial pulse pressure ([DELTA]PPman) are accurate predictors of fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. In our study, we assessed the clinical utility of a novel algorithm for automatic estimation of [DELTA]PP ([DELTA]PPauto).

METHODS: We studied 25 patients referred for coronary artery bypass grafting. [DELTA]PPauto was continuously displayed using a method based on automatic detection algorithms, kernel smoothing, and rank-order filters. All patients were under general anesthesia, mechanical ventilation, and were also monitored with a pulmonary artery catheter. [DELTA]PPman and [DELTA]PPauto were recorded simultaneously at eight steps during surgery including before and after intravascular volume expansion (500 mL hetastarch). Responders to volume expansion were defined as patients whose cardiac index increased by more than 15% after volume expansion.

RESULTS: Agreement between [DELTA]PPman and [DELTA]PPauto over the 200 pairs of collected data was 0.7% ± 3.4% (mean bias ± sd). Seventeen patients were responders to volume expansion. A threshold [DELTA]PPman value of 12% allowed discrimination of responders to volume expansion with a sensitivity of 88% and a specificity of 100%. A threshold [DELTA]PPauto value of 10% allowed discrimination of responders to volume expansion with a sensitivity of 82% and a specificity of 88%.

CONCLUSION: [DELTA]PPauto is strongly correlated to [DELTA]PPman is an accurate predictor of fluid responsiveness, and allows continuous monitoring of [DELTA]PP. This novel algorithm has potential clinical applications.






Desflurane Affords Greater Protection Than Halothane in the Function of Mitochondria Against Forebrain Ischemia Reperfusion Injury in Rats

Bing Zhang, MD, PhD, Xia Wei, MD, Xiaoguang Cui, MD, PhD, Huacheng Zhou, MD, PhD, Wengang Ding, MD, PhD, and Wenzhi Li, MD, PhD

From the Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.

Anesth Analg 2008; 106:1242-1249


方法:四十只成年雄性Wistar大鼠被隨機分成四組(每組十隻):對照組、1.5MAC氟烷組、1.0MAC地氟醚組和1.5MAC地氟醚組。在吸入1.5MAC氟烷或1.0MAC1.5MAC地氟醚40分鐘後通過夾閉兩側頸總動脈和降低動脈血壓造成前腦缺血。在分離得到腦線粒體後,用40–200 µM Ca2+通過分光光度計分析線粒體膜的通透性,附加若丹明123染料通過螢光分光光度計測得線粒體膜電位。線粒體呼吸鏈複合物的活性也通過分光光度計測得。

結果:這些結果顯示在前腦缺血再灌注損傷後有明顯的線粒體腫脹、附加Ca2+後膜電位喪失及呼吸鏈複合物I+IIIIV的活性受抑制。與1.5MAC氟烷組相比,1.01.5MAC地氟醚組分別減少線粒體腫脹23.9% (P < 0.001) 23.2% (P < 0.001),抑制膜電位損耗22.4% (P = 0.013) 20.4% (P = 0.027)1.0MAC地氟醚組和1.5MAC地氟醚組中呼吸鏈複合物I+IIIIV的活性與1.5MAC氟烷組相比得到較好的保護,分別達到34.6% (P = 0.027)38.7% (P = 0.011)53.9% (P = 0.009)55.8% (P = 0.007)


(薑旭暉   馬皓琳 李士通 校)

BACKGROUND: Halothane and desflurane have been shown to attenuate neuronal injury; however, the effects of these anesthetics on mitochondria are unclear. We investigated whether halothane and desflurane affect the function of mitochondria after cerebral ischemia in rats.

METHODS: Forty male Wistar rats were randomly divided into four groups (n = 10 each): sham group; 1.5 minimal alveolar concentration (MAC) halothane group; 1.0 MAC desflurane; and 1.5 MAC desflurane group. Forebrain ischemia was induced after 40-min inhalation of 1.5 MAC halothane, 1.0 MAC or 1.5 MAC desflurane by clamping the bilateral common carotid arteries and decreasing arterial blood pressure. After isolation of the brain mitochondria, mitochondrial membrane permeability was assayed spectrophotometrically with 40–200 µM Ca2+, and mitochondrial membrane potentials were measured by a fluorospectrophotometer with the addition of rhodamine 123. The activities of mitochondrial respiratory chain complexes were also assayed spectrophotometrically.

RESULTS: The results showed obvious mitochondrial swelling, loss of membrane potential with the addition of Ca2+, and inhibition of the activities of complexes I + III and IV after forebrain ischemia reperfusion injury. Compared with the 1.5 MAC halothane group, 1.0 and 1.5 MAC desflurane reduced mitochondrial swelling by 23.9% (P < 0.001) and 23.2% (P < 0.001), whereas membrane potential dissipation was suppressed by 22.4% (P = 0.013) and 20.4% (P = 0.027). The activities of complexes I + III and IV were better preserved in 1.0 MAC and 1.5 MAC desflurane groups than in the 1.5 MAC halothane group by 34.6% (P = 0.027), 38.7% (P = 0.011), 53.9% (P = 0.009), and 55.8% (P = 0.007), respectively.

CONCLUSIONS: Desflurane shows better preservation of mitochondrial function at 4 h after cerebral ischemia reperfusion injury, indicated by inhibition of mitochondrial swelling, increase of membrane potential, and improvement of functions of mitochondria respiratory complexes I + III and IV when compared with halothane.


Dermatome Variation of Lumbosacral Nerve Roots in Patients with Transitional Lumbosacral Vertebrae

Yang Hyun Kim, MD*, Pyung Bok Lee, MD*, Chul Joong Lee, MD{dagger}, Sang Chul Lee, MD{dagger}, Yong Chul Kim, MD{dagger}, and Jin Huh, MD{ddagger}

From the *Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, {dagger}Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, and {ddagger}Department of Anesthesiology and Pain Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea.

Anesth Analg 2008; 106:1279-1283


方法:我們用Castellvi’s 標準來確定移行椎的存在。有移行椎伴腰骶神經根病的病人納入研究。用電刺激進行選擇性神經根阻滯。有腰化S1或者骶化L5的病人中S1L5神經根壓迫造成的神經病學症狀,分別和正常構型病人的L5或者S1神經根壓迫比較。

結果32個病人有移行椎,其中12個有腰化S120個有骶化L5。腰化S1 (L6) 神經根造成的運動和感覺症狀的分佈和刺激正常構型中的S1神經根相似。在17個病人中,刺激骶化L4神經根引起的運動感覺症狀分佈和刺激正常構型中的L5神經根相似。


(張曦 譯,馬皓琳 李士通 校)

BACKGROUND: The presence of a transitional vertebra can create difficulty in identifying the lumbar level corresponding to an exiting nerve root at the time of a spinal nerve block. We investigated the possibility that the muscle innervation pattern and sensory dermatomes of the lumbar nerve roots are altered when a lumbosacral transitional vertebra is present using electrical stimulation.

METHODS: We determined the existence of transitional vertebrae using Castellvi’s criteria. Patients having transitional vertebrae with lumbosacral radiculopathy were recruited for the study. Selective nerve root blocks using electrical stimulation were performed. Neurologic symptoms caused by S1 or L5 nerve root compression in the patients with a lumbarized S1 or sacralized L5, respectively, were compared with those caused by either L5 or S1 nerve root compression in patients with a normal configuration.

RESULTS: Thirty-two patients had transitional vertebrae, of whom 12 had a lumbarized S1 and 20 had a sacralized L5. The distribution of motor and sensory symptoms caused by the lumbarized S1 (L6) nerve root stimulation was similar to that of the S1 nerve root stimulation in the normal configuration. In 17 patients, the distribution of motor and sensory symptoms caused by the sacralized L4 nerve root stimulation was similar to that of L5 nerve root stimulation in the normal configuration.

CONCLUSIONS: Our findings suggest that the function of the lumbosacral nerve roots is altered in patients with a sacralized L5, and that the L4 nerve root serves the usual function of the L5 nerve root.


The Effects of Intravenous Granisetron on the Sensory and Motor Blockade Produced by Intrathecal Bupivacaine

Hany A. Mowafi, MBBch, MSc, MD, Samer A. Arab, MD, Salah A. Ismail, MBBch, MSc, MD, and AbdulMohsin Al-Ghamdi, MBBch, MD

From the Department of Anesthesia, Faculty of Medicine, King Faisal University, Saudi Arabia.

Anesth Analg 2008; 106:1322-1325



結果:兩組之間比較感覺阻滯的最高平面和達到最高感覺阻滯水準的時間沒有顯著性差異。與對照組相比,注射格拉司瓊的患者感覺平面消退兩個節段的時間明顯縮短(69.8 ± 25.5 min vs 88.0 ± 27.8 min, P = 0.036),消退到T12的時間(105.5 ± 25.1 min vs 127.0 ± 30.5 min, P = 0.019)和消退到S1的時間(162.8 ± 41.1 min vs 189.8 ± 39.8 min, P = 0.041)也明顯縮短。相反,在運動阻滯方面的任何研究時間兩組之間沒有顯著差異。兩組之間血流動力學方面也沒有顯著差異。


(沈浩   馬皓琳 李士通校)

BACKGROUND: We hypothesized that pretreatment with IV granisetron would affect the sensory and motor components of spinal blockade through 5-HT3 receptor blockade.

METHODS: Forty unpremedicated patients scheduled for elective knee arthroscopy under spinal anesthesia were randomly allocated to receive either IV granisetron 1 mg (granisetron group) or saline (control group) on arrival to the operating room. Two and half milliliters (12.5 mg) of hyperbaric bupivacaine 0.5% was injected intrathecally. Regression of the sensory level and motor blockade, and the hemodynamic changes were evaluated.

RESULTS: There were no significant differences between the two groups in the maximum cephalad spread of sensory block or the time to maximum sensory level. Compared with the control group, patients who received granisetron had significantly faster sensory regression times by two segments (69.8 ± 25.5 min vs 88.0 ± 27.8 min, P = 0.036), to segment T12 (105.5 ± 25.1 min vs 127.0 ± 30.5 min, P = 0.019) and to segment S1 (162.8 ± 41.1 min vs 189.8 ± 39.8 min, P = 0.041), respectively. In contrast, motor block did not differ between the two groups at any study time. No significant differences were detected between the two study groups in the hemodynamic data.

CONCLUSION: We concluded that IV granisetron facilitated a faster recovery of sensory block after bupivacaine subarachnoid anesthesia.


Suppression of Noxious-Induced C-Fos Expression in the Rat Lumbar Spinal Cord by Isoflurane Alone or Combined with Fentanyl

Mathieu G. Sommers, DVM*, Nha-Khanh Nguyen, MSc{dagger}, Jan G. Veening, PhD{dagger}{ddagger}, Kris C. Vissers, MD, PhD, FIPP§, Merel Ritskes-Hoitinga, DVM, PhD, Dipl ECLAM*, and Jan van Egmond, PhD§

From the *Central Animal Laboratory, {dagger}Department of Anatomy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; {ddagger}Department of Psychopharmacology, UIPS, Utrecht University, Utrecht, The Netherlands; and §Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Anesth Analg 2008; 106:1303-1308


方法:實驗方案為包含4個組的隨機區組設計:23/4最低肺泡氣體濃度(MAC)異氟醚淺麻醉組(無刺激的/NIWR刺激的)和2NIWR刺激的手術麻醉組(11/2 MAC異氟醚麻醉和3/4 MAC異氟醚複合芬太尼400–600 µg · kg–1 · h–1麻醉 )。在對大鼠後爪進行2小時的週期性電刺激後定量測定脊髓背角中Fos免疫反應陽性的神經元數目。

結果:異氟醚對腰段c-fos基因表達的主要抑制效應表現於脊髓板層II淺層(P = 0.02),而芬太尼則在板層V處表現出最強的抑制效應(P = 0.05)


(周雅春 馬皓琳 李士通 校)

BACKGROUND: Although our understanding of nociceptive processing during anesthesia has increased greatly over the last decade, many patients still experience hyperalgesia and acute pain postoperatively. The noxious-induced withdrawal reflex (NIWR) model is specifically designed and validated to quantitatively study the reaction on painful, multimodal stimuli in animals under anesthetic conditions. Since the anesthetic mechanisms differ between inhaled anesthetics and opioids, we evaluated the differential effects of isoflurane and fentanyl on c-fos expression at the lumbar level as a measure of nociceptive information transfer during general anesthesia.

METHODS: The experimental setup consisted of a randomized block design with four experimental groups: two light 3/4minimum alveolar concentration (MAC) isoflurane anesthesia groups (unstimulated/NIWR-stimulated) and two NIWR-stimulated surgical anesthesia groups (11/2 MAC isoflurane anesthesia and 3/4MAC isoflurane anesthesia combined with fentanyl 400–600 µg · kg–1 · h–1). After 2 h of intermittent electrical stimulation of the hind paw of the rat, the number of Fos immunoreactive (Fos-IR) neurons in the dorsal horn was measured quantitatively.

RESULTS: The main suppressive effects on lumbar c-fos expression of isoflurane were observed in the superficial lamina II (P = 0.02), whereas fentanyl showed the strongest effects in lamina V (P = 0.05).

CONCLUSIONS: This study demonstrates that the NIWR model combined with spinal Fos-immunoreactivity is a suitable and useful model for evaluating the differential effects of inhaled anesthetics and opioids on nociceptive information transfer during general anesthesia.



Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials

W. Scott Beattie, MD,PhD*, Duminda N. Wijeysundera, MD, Keyvan Karkouti, MD, MSc, Stuart McCluskey, MD, PhD*, and Gordon Tait, PhD*

From the Departments of *Anesthesia, and {dagger}Health Policy Management, and Evaluation/Clinical Epidemiology, Toronto General Hospital and University of Toronto, Toronto, Ontario.

.Anesth Analg 2008; 106:1039-1048




結果:這些研究的結果綜合起來沒有顯示β-阻滯藥有顯著的心臟保護作用,而且研究和研究之間有很大差異性(OR = 0.76; 95% CI = 0.4–1.4; P = 0.38 heterogeneity: I2 = 34%).然而,基於最大心率的研究分組卻顯示這樣的結果:最大心率低於100bpm的試驗和心臟保護有關(OR = 0.23; 95% CI = 0.08–0.65; P = 0.005),而最大心率高於100bpm的試驗和心臟保護無關(OR = 1.17; 95% CI = 0.79–1.80; P = 0.43),並且沒有組內差異。對β-阻滯藥影響下的心率和術後心梗比值比取對數作回歸分析表明:β-阻滯藥對最大心率,平均心率,心率變異性的效應和心梗的比值比成線性關聯(r2 = 0.63; P < 0.001),即藥物對心率效果越明顯,術後心梗的發生越少。綜觀整個研究,β-阻滯藥在降低術後心率方面有很大差異性。在一定程度上,這一差異性和藥物類型有關,特別是美托洛爾以及和鈣通道阻滯劑的混合使用。鈣通道阻滯劑和包括美托洛爾在內的β-阻滯藥一起使用能對心率產生更大控制。心率對β-阻滯藥的反應大不一樣。25%服用β-阻滯藥的患者在心率大於100bpm時有臨床事件發生,而15%的安慰劑對照患者也有心動過緩,如果服用的是β-阻滯藥而非安慰劑這時就要降低藥量了。最後,該分析發現圍術期β-阻滯藥的使用和心動過緩有關(OR = 3.49; 95% CI = 2.4–5.9),也和充血性心衰有關(OR = 1.68; 95% CI = 1.00–2.8).


(孫鵬飛譯 薛張綱校)

BACKGROUND: Recent meta-analyses assessing the efficacy of perioperative β-blockade trials have failed to show a reduction in postoperative morbidity and mortality. Tight control of heart rate (HR) has been suggested to improve these outcomes. Meta-analyses have not considered the influence of tight HR control on the efficacy of perioperative β-blockade.

METHODS: Using previously published search strategies, we identified all randomized trials evaluating perioperative β-blockers after noncardiac surgery. This search yielded 10 trials with 2176 patients. We used the data from these studies to correlate measures of HR control with major postoperative outcomes, primarily in-hospital myocardial infarction (MI). Odds ratio (OR) and 95% confidence intervals (CI) were calculated, and metaregression was performed correlating measures of HR control with MI.

RESULTS: The combined results of all studies did not show a significant cardioprotective effect of β-blockers, with considerable heterogeneity among the studies (OR = 0.76; 95% CI = 0.4–1.4; P = 0.38 heterogeneity: I2 = 34%). However, grouping the trials on the basis of maximal HR showed that trials where the estimated maximal HR was <100 bpm were associated with cardioprotection (OR = 0.23; 95% CI = 0.08–0.65; P = 0.005) whereas trials where the estimated maximal HR was >100 bpm did not demonstrate cardioprotection (OR = 1.17; 95% CI = 0.79–1.80; P = 0.43) with no heterogeneity. Moreover, metaregression of the HR response to β-blockade against the log OR of postoperative MI demonstrated a linear association between the effect of β-blockade on the mean, maximal, and variation in HR and the OR of an MI (r2 = 0.63; P < 0.001) where a larger effect of β-blockers on HR was associated with a decreased incidence of postoperative MI. Across all studies, β-blockade resulted in a reduction in postoperative HR (weighted mean difference: 8.6 bpm; 95% CI = –9.6 to –7.6; I2 = 85.3%) with considerable heterogeneity. This large heterogeneity in HR response to β-blockade was found to be related, in part, to the type of β-blocker, specifically, metoprolol, and the concomitant use of calcium channel blockers. Calcium channel blocker use and β-blockers other than metoprolol resulted in more effective control of HR. There was wide variability in the HR response to β-blockade. Twenty-five percent of patients receiving β-blockers had episodes when the HRs were more than 100 bpm, although 15% of placebo patients also had bradycardia, which would have required a dose reduction had they been administered β-blockers. Finally, this analysis found that perioperative β-blockade was associated with an increased incidence of bradycardia (OR = 3.49; 95% CI = 2.4–5.9) and congestive heart failure (OR = 1.68; 95% CI = 1.00–2.8).

CONCLUSIONS: The trials that achieve the most effective control of HR are associated with a reduced incidence of postoperative MI, suggesting that effective control of HR is important for achieving cardioprotection. Second, this analysis demonstrates that administration of β-blockers does not reliably decrease HRs in all patients, and may be associated with increased side effects. Judicious use of combination therapy with other drugs may be necessary to achieve effective postoperative control of HR.



Cardiac Arrests Associated with Hyperkalemia During Red Blood Cell Transfusion: A Case Series

Hugh M. Smith, Stacy J. Farrow, SRNA, Joel D. Ackerman, James R. Stubbs, and Juraj Sprung

From the Departments of *Anesthesiology and {dagger}Transfusion Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Anesth Analg 2008 106: 1062-1069.




結果:我們共找出了16名輸血相關的高鉀性心跳驟停患者,其中成人11名,兒童5名。大多數病人進行了以下三種手術:腫瘤手術,大血管手術及外傷手術。在心跳驟停時的血清鉀濃度為7.2 ±1.4 mEq/L(範圍為5.9-9.2 mEq/L),而心跳驟停前所輸注的紅細胞量的範圍為1個單位(輸予一2.7kg的新生兒)~54個單位。且幾乎所有的患者在心跳驟停的同時都伴有酸中毒、高血糖、低血鈣及低體溫的發生。其中14位病人(87.5%)是通過中心靜脈通路進行的紅細胞輸注,而使用商業性的快速輸注裝置(快速輸注泵)者在11位成人中占8(72.7%),而其餘所有的病人都是通過加壓袋或注射泵來進行快速輸注的。他們的平均復蘇時間為32min(範圍從2-127 min不等)。院內存活率為12.5%


(劉沁譯 薛張綱校)

BACKGROUND: Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell (RBC) administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion.

METHODS: We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperative transfusion-associated hyperkalemic cardiac arrest.

RESULTS: We identified 16 patients with transfusion-associated hyperkalemic cardiac arrest, 11 adult and 5 pediatric. The majority of patients underwent three types of surgery: cancer, major vascular, and trauma. The mean serum potassium concentration measured during cardiac arrest was 7.2 _ 1.4 mEq/L (range, 5.9 –9.2mEq/L). The number of RBC units administered before cardiac arrest ranged between 1 (in a 2.7 kg neonate) and 54. Nearly all patients were acidotic, hyperglycemic, hypocalcemic, and hypothermic at the time of arrest. Fourteen(87.5%) patients received RBC via central venous access. Commercial rapid infusion devices (pumps) were used in 8 of 11 (72.7%) of the adult patients, but RBC units were rapidly administered (pressure bags, syringe pumped) in all remaining patients. Mean resuscitation duration was 32 min (range, 2–127 min). The inhospital survival rate was 12.5%.

CONCLUSION: The pathogenesis of transfusion-associated hyperkalemic cardiac arrest is multifactorial and potassium increase from RBC administration is complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. Large transfusion of banked RBCs and conditions associated with massive hemorrhage should raise awareness of the potential for hyperkalemia and trigger preventative measures.




Antifibrinolytic Therapy in Surgery for Congenital Heart Disease

Eaton, Michael P. MD

From the Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Anesth Analg 2008.106(4):1087-1100



(秦敏菊譯 薛張綱校)

AbstractThe efficacy of the serine protease inhibitor, aprotinin, and the lysine analogs, [epsilon]-aminocaproic acid and tranexamic acid, in reducing bleeding and transfusion in adults undergoing cardiac surgery is well established. Although children undergoing cardiac surgery are clearly at high risk for bleeding and transfusion, the risks and benefits of this therapy for the pediatric population are less well understood. There is a reasonable body of literature examining antifibrinolytic therapy in congenital heart surgery, but the large variability in patients studied, procedures, methods, and dosing schemes makes a quantitative analysis of this literature impractical. A qualitative review of this literature reveals significant support for the efficacy of all three drugs for decreasing bleeding and transfusion in congenital heart surgery, likely with more benefit in certain populations. Limited data suggest that there is no difference in efficacy among the three drugs, although aprotinin may have unique antiinflammatory effects that are of benefit in pediatric patients. There is not enough evidence to draw any conclusions about the safety of these drugs in children, although it appears that the risk of anaphylaxis with aprotinin in children may be less than in adults. Dosing schemes used for these drugs have been variable and not always based on sound pharmacologic principles, despite available pharmacokinetic and pharmacodynamic data. Further research should be directed toward establishing safety, evaluating the relative efficacy of the two classes of drugs, proving benefit in specific patient groups, and better defining effective dosing schemes.




A Comparison of the End-Tidal Sevoflurane Concentration for Removal of the Laryngeal Mask Airway and Laryngeal Tube in Anesthetized Children

Jeong-Rim Lee, Young-Sun Lee, Chong Sung Kim, Seong Deok Kim, and Hee-Soo Kim

Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea

Anesth Analg 2008 106: 1122-1125.



方法:隨機的選擇40名年齡在8-12歲之間的兒童,隨機的選擇使用喉罩或氣管導管。全麻誘導使用七氟醚,後插入喉罩或氣管導管。麻醉維持依賴七氟醚和氧氣。在手術結束時,可以得到一個預定的至少在10分鐘內拔除喉罩或氣管導管的呼末七氟醚濃度。用dixon 的自上而下的方法,將拔除喉罩及氣管導管時七氟迷的濃度增大0.2%,確定能成功的避免嗆咳,磨牙,有目的的體動,呼吸抑制,喉痙攣,去氧飽和。



(胡豔譯  薛張剛校)

BACKGROUND: In this study we quantified and compared the optimal sevoflurane concentration required to prevent coughing or moving during or after removal of the laryngeal mask airway (LMA) and the laryngeal tube (LT) in anesthetized children.

METHODS: Forty unpremedicated children, aged 8 mo to 12 yr, were randomly allocated to receive the LMA or LT. General anesthesia was induced via mask with sevoflurane and the LMA or LT was inserted. Anesthesia was maintained with sevoflurane and oxygen. At the end of surgery, a predetermined end-tidal sevoflurane concentration was maintained for at least 10 min and the LMA or LT was removed. Using Dixon's up-down method, the concentration for LMA and LT removal was determined by adjusting the dose by a 0.2% increment. Success was defined by the absence of coughing, teeth clenching, gross purposeful movement, breath holding, laryngospasm, and desaturation.

RESULTS: The end-tidal concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.90%, in 95% of children was 2.15%. For the LT, the concentrations were 1.83% and 2.00%. The 50% effective dose values did not differ significantly between groups.

CONCLUSIONS: LMA and LT removal in 95% of anesthetized children (aged 8 mo to 12 yr) can be safely accomplished without coughing, moving, or any other airway complications at 0.86 and 0.80 minimum alveolar anesthetic concentration, respectively, and a similar concentration should be used for removal of the LT or LMA in children.



The mu opioid receptor mediates morphine-induced tumor necrosis factor and interleukin-6 inhibition in toll-like receptor 2-stimulated monocytes

Bonnet MP, Beloeil H, Benhamou D, Mazoit JX, Asehnoune K.

Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.

Anesth Analg 2008 106: 1142-1149.




結果:促炎性反應因數:嗎啡對受PGN刺激的單核細胞產生細胞因數有明顯的劑量和濃度依賴性抑制。μ型阿片受體的激動可顯著的調節嗎啡導致的單核細胞生成TNFIL6受抑。在受PGN刺激的PBMCs,嗎啡明顯抑制TNF的生成,但對IL6生成抑制不明顯。在嗎啡導致的PBMCs生成TNF受抑過程中,並未涉及μ型阿片受體。抗炎性反應因數:無論是在單核細胞還是PBMCs IL-10都不是導致受PGN刺激的單核細胞生成TNFIL6受抑的因素。


(黃凝譯  薛張綱校)

BACKGROUND: Morphine possesses immunomodulatory effects but its intrinsic mechanisms, especially in the toll-like receptor 2 (TLR2) signaling pathway, are only partially understood. In this study, we evaluated the effects of morphine on tumor necrosis factor (TNF), interleukin-6 (IL-6), and interleukin-10 (IL-10) production in TLR2-stimulated human monocytes and identified the involvement of the different opioid receptors, and of the lymphocyte-to-monocyte contact.

METHODS: Peripheral blood mononuclear cells (PBMCs) were isolated from fresh blood by centrifugation on a density gradient. Monocytes were secondarily separated using a high-gradient magnetic cell sorting kit with specific anti-CD14 antibodies. Monocytes or PBMCs were pretreated with opioid receptors antagonists before being cultured with morphine and peptidoglycan (PGN) from Staphylococcus aureus (specific TLR2 agonist). The amount of TNF, IL-6, and IL-10 was measured in the supernatant enzyme-linked immunosorbent assay.

RESULTS: Proinflammatory cytokines: Morphine significantly inhibited the production of cytokines in a dose and concentration-dependent manner in PGN-stimulated monocytes. Mu opioid receptor activation specifically mediated this morphine-induced TNF and IL-6 inhibition in monocytes. Morphine significantly inhibited the TNF, but not the IL-6 production, in PGN-stimulated PBMCs. The mu opioid receptor was not involved in this morphine-induced TNF inhibition in PBMCs. Antiinflammatory cytokines: IL-10 was not a factor for the inhibition of TNF and IL-6 production after PGN stimulation in either monocytes or PBMCs cultures.

CONCLUSIONS: The mu opioid receptor mediates morphine-induced TNF and IL-6 inhibition in PGN-stimulated monocytes, but not in PBMCs. A direct monocyte-to-lymphocyte contact (PBMCs) alters the inhibitory effects of morphine observed on monocytes alone. IL-10 is not a factor for the inhibition of TNF or for IL-6 production. Interactions between TLR2 and mu opioid intracellular pathways remain to be studied to delineate these morphine immunosuppressive effects.




Comparative Pharmacodynamic Modeling Using Bispectral and Narcotrend-Index With and Without a Pharmacodynamic Plateau During Sevoflurane Anesthesia

Kreuer, Sascha MD*; Bruhn, Jörgen MD†; Walter, Elisabeth MD*; Larsen, Reinhard MD*; Apfel, Christian C. MD‡; Grundmann, Ulrich MD*; Biedler, Andreas MD*; Wilhelm, Wolfram MD§

From the *Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Saarland, Germany; {dagger}Department of Anesthesiology, UMC St. Radboud, Nijmegen, The Netherlands; {ddagger}Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco; and §Department of Anesthesiology and Intensive Care Medicine, St. Marien-Hospital, Luenen, NRW, Germany.

Anesth Analg 2008 106: 1171-1181.


背景:我們比較了有和沒有平頂曲線效應兩種藥效學模型,用雙頻指數(BIS, Aspect Medical Systems, Natick, MA, version XP)和Narcotrend指數(NCT, MonitorTechnik, Bad Bramstedt, Germany, version 4.0)來測量腦電活動以評價七氟醚的藥效。此外,我們嘗試分析平頂效應的起源。

方法:我們調查了26例被安排做根治性前列腺切除術的成年病人。在全麻誘導後至少45分鐘,呼氣末七氟醚濃度在1 vol% 4 vol%之間不等。為了評價濃度和腦電指數的關係,我們使用了兩種不同的藥效學模型來記錄有和沒有爆發性抑制時的BISNCT值:一種是基於單S型曲線的傳統模型,另一種是基於雙S型曲線的新型模型。模型的參數是由非線性混合效應模型VGloboMax, Hanover)的最小似然法估計的。兩種模型的統計顯著性由似然比檢驗。

結果:呼氣末七氟醚濃度從1.04 ± 0.17 vol%4.43 ± 0.43 vol% ,新的雙S型曲線的藥動/藥效學模型和傳統的單S型曲線的Emax模型之間似然數的對數值分別是:BIS監測為396 (P < 0.001)NCT1121 (P < 0.001)。平頂定位於最大[delta]波和爆發抑制比增加之間改變時。


(宣麗真譯 薛張綱校)

BACKGROUND: We compared two pharmacodynamic models, one with and one without a plateau effect. Bispectral indices (BIS, Aspect Medical Systems, Natick, MA, version XP) and Narcotrend (NCT, MonitorTechnik, Bad Bramstedt, Germany, version 4.0) were used as an electroencephalographic measure of sevoflurane drug effect. In addition, we tried to analyze the origin of the plateau.

METHODS: We investigated 26 adult patients scheduled for radical prostatectomy. At least 45 min after induction of general anesthesia, end-tidal sevoflurane concentrations were varied between 1 vol% and 4 vol%. To evaluate the relationship between concentrations and electroencephalographic indices, two different pharmacodynamic models were applied: a conventional model based on a single sigmoidal curve, and a novel model based on two sigmoidal curves for BIS and NCT values with and without burst suppression. The parameters of the models were estimated by NONMEM V (GloboMax, Hanover) by minimizing log likelihood. Statistical significance between the two models was calculated by the likelihood ratio test.

RESULTS: The end-tidal sevoflurane concentration ranged from 1.04 ± 0.17 vol% to 4.43 ± 0.43 vol%. The difference between the log likelihood values of the new pharmacokinetic/pharmacodynamic model with two connected sigmoidal curves and the classical Emax model with one sigmoidal curve is 396 (P < 0.001) for the BIS monitor and 1121 (P < 0.001) for the NCT. The plateau is positioned at the change between the maximum [delta] power and the increase of burst suppression ratio.

CONCLUSION: A pharmacokinetic/pharmacodynamic model consisting of two sigmoid curves with an intervening plateau describes the effect of sevoflurane on BIS and NCT indices better than a model with a single sigmoid curve.



The Predictive Performance of a Pharmacokinetic Model for Manually Adjusted Infusion of Liquid Sevofluorane for Use with the Anesthetic-Conserving Device (AnaConDa): A Clinical Study

Javier F. Belda, MD, PhD*, Marina Soro, MD, PhD{dagger}, Rafael Badenes, MD{dagger}, Andreas Meiser, MD, PhD{ddagger}, María Luisa García, MD{dagger}, Gerardo Aguilar, MD, PhD{dagger}, and Francisco J. Martí, MD, PhD{dagger}

From the *Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Valencia, Spain; {dagger}Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario, Valencia, Spain; and {ddagger}Klinik fur Anaesthesiologie, St. Josef-Hospital, Klinikum der Ruhr-Universitat, Bochum, Germany

Anesth Analg 2008 106: 1207-1214.



方法:我們研究了50例通過AnaConDa使用七氟醚的 ICU患者,他們被隨機分為三組。 6小時內分別以呼末七氟醚濃度1 1%組 15例)和1.5 1.5 組, 15例)為目標調整輸液計畫,調節初始劑量,在10分鐘內達到目標,然後減少至維持劑量,此後每小時調整一次,在呼吸回路中測定七氟醚的實際濃度,並與目標值進行比較。第三組(20例)則採用增加或減少靶濃度( ± 0.3 3小時的方法,評價七氟醚濃度的實際改變。通過計算性能誤差率(PE)評價輸液計畫的可行性,通過計算精確度(median absolute PE, MDAPE)和偏移(median PE, MDPE)評價輸液計畫的有效性。

結果: 1 1.5 ,增加濃度0.3 及降低濃度0.3 %組的性能參數(平均值±標準差, )分別是: MDAPE 5.3 ± 5.5 2.6 ± 4.0 5.0 ± 5.6 5.5 ± 5.4 ; MDPE  –5.3 ± 5.5–2.3 ± 4.1–0.1 ± 7.10.2 ± 5.41 %和1.5 %組進行各類比較後無顯著差異。


(施穎譯 薛張綱校)

BACKGROUND: The Anesthetic-Conserving Device (AnaConDa) can be used to administer inhaled anesthetics using an intensive care unit (ICU) ventilator. We evaluated the predictive performance of a simple manually adjusted pump infusion scheme, for infusion of liquid sevoflurane to the AnaConDa.

METHODS: We studied 50 ICU patients who received sevoflurane via the AnaConDa. They were randomly divided into three groups. A 6-h infusion of liquid anesthetic was adjusted according to the infusion scheme to a target end-tidal sevoflurane concentration of 1% (Group 1%, n = 15) and 1.5% (Group 1.5%, n = 15). The initial rate was adjusted to reach the target concentration in 10 min and then the infusion was reduced to the first hour maintenance rate and readjusted once each hour afterwards. The actual concentrations were measured in the breathing circuit and compared with the target values. In the third group (n = 20) we used the model to increase and decrease the target concentration (±0.3%) for 3 h and evaluated the actual change in concentration achieved. The ability of the infusion scheme to provide the target concentration was quantified by calculating the performance error (PE). Infusion scheme performance was evaluated in terms of accuracy (median absolute PE, MDAPE) and bias (median PE, MDPE).

RESULTS: Performance parameters (mean ± sd, %) were for 1%, 1.5%, increase of concentration by 0.3% and decrease of concentration by 0.3% groups, respectively: MDAPE 5.3 ± 5.5, 2.6 ± 4.0, 5.0 ± 5.6, 5.5 ± 5.4; MDPE –5.3 ± 5.5, –2.3 ± 4.1, –0.1 ± 7.1, 0.2 ± 5.4. No significant differences were found between means of all performance parameters when the 1% and 1.5% groups were compared.

CONCLUSIONS: There is an excellent 6-h predictive performance of a simplified pharmacokinetic model for manually adjusted infusion of liquid sevoflurane when using the AnaConDa to deliver sevoflurane to ICU patients.



A prospective randomized trial on the role of perioperative celecoxib administration for total knee arthroplasty: improving clinical outcomes.

Reuben SS, Buvenandran A, Katz B, Kroin JS.

Department of Anesthesiology, Baystate Medical Center and the Tufts University School of Medicine, Springfield, MA 01199, USA.

Anesth Analg. 2008 106(4):1258-64,




結果:服用塞來考昔的試驗組在術後40小時內比對照組所需使用的硬膜外鎮痛藥少:安慰劑組232.8+/-2.0ml,塞來考昔組209.1+/-1.8ml(P < 0.001)。在家中的術後4-10天塞來考昔組的患者每個時間測定點運動時的疼痛強度都有所緩解(F = 109.7, P < 0.001),而且在家中消耗歐克西克錠(一種麻醉性的生物鹼,和可待因有關的,用作止育藥和鎮靜藥)也比對照組患者少(F = 417.8, P < 0.001)。在術後1-3天,兩組患者進行伸展的主動運動有差別(F = 50.7, P < 0.001),塞來考昔組的患者在所有時間點上都具有更大的伸展度。與對照組比較,試驗組的患者更早能將患膝屈曲至90(P < 0.001)。在之後12個月的隨訪中塞來考昔組患者(93.3 +/- 0.6)比對照組患者(86.4 +/- 0.9)獲得更高的全膝關節置換術後社會能力得分(P < 0.001)。在術後短期內塞來考昔組患者不良反應事件(噁心、嘔吐、瘙癢)發生較對照組少。


(劉婷潔譯 薛張綱校)

                                                                                                                                                                                                                                                                                                        BACKGROUND: Total knee arthroplasty (TKA) is associated with considerable postoperative pain, which, if unrelieved, may result in prolonged hospital stay, inability to participate in rehabilitation programs, poor outcomes, and greater use of healthcare resources. The hypothesis of this study is that perioperative administration of celecoxib wil l improve analgesic efficacy, with a resultant improvement in short- and long-term clinical outcomes after TKA.

METHODS: We studied 200 patients undergoing elective TKA in a prospective, randomized, double-blind, placebo-controlled fashion. All patients underwent a similar perioperative anesthetic/analgesic procedure. After completion of surgery, patients were started on an epidural infusion with patient-controlled epidural analgesia. Patients were instructed to keep their numerical rating score pain < or = 3. Patients were randomly assigned to one of two groups: celecoxib or placebo. The celecoxib group received celecoxib 100 mg orally twice a day 7 days before surgery. On the day of surgery, celecoxib 400 mg was administered 1-2 h before surgery and then 200 mg every 12 h for 10 postoperative days. The control group received matching placebo capsules at the same times. The primary objective of this study was to determine whether the perioperative use of celecoxib reduces the amount of postoperative opioid consumption. Secondary objectives were to determine whether celecoxib is associated with improved clinical outcomes and a reduction in opioid-related adverse effects.

RESULTS: The celecoxib group required less patient-controlled epidural analgesia over the 40-h postoperative period: placebo 232.8 +/- 2.0 mL, celecoxib 209.1 +/- 1.8 mL (P < 0.001). At home over days 4-10 after surgery, the celecoxib group had reduced pain intensity with movement (F = 109.7, P < 0.001) at all time points. The celecoxib group also consumed less oxycodone at home than placebo group (F = 417.8, P < 0.001). With active movement, range of motion (ROM) differed between the two groups over postoperative days 1-3 (F = 50.7, P < 0.001), with the celecoxib group having greater ROM at all time points. There was earlier achievement of 90 degrees knee flexion with celecoxib compared with placebo (P < 0.001). Celecoxib patients had a better overall Knee Society Score (93.3 +/- 0.6) than placebo patients (86.4 +/- 0.9) at 12-mo follow-up (P < 0.001). The incidence of side effects (nausea, vomiting, and pruritus) in the immediate postoperative period was less in the celecoxib group.

 CONCLUSIONS: Perioperative use of celecoxib reduces postoperative pain, opioid consumption, opioid-related adverse effects, and is associated with long-term benefits including improved knee function and less time to achieve effective knee ROM after TKA.




Intravascular Injection in Lumbar Medial Branch Block: A Prospective Evaluation of 1433 Injections

Chul Joong Lee, Yong Chul Kim, Jae Hyuck Shin, Francis Sahngun Nahm, Hyo Min Lee, Yun Suk Choi, Sang Chul Lee, Justin Sang Ko, Tae Hyeong Kim, Woo Seok Sim, Chung Su Kim, and Hyun Sung Cho

 From the *Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and {dagger}Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Anesth Analg 2008 106: 1274-1278


背景腰內側支傳導阻滯 mbb 的結果和有效性在很大程度上依賴於技術的準確性。血管內攝取造成對阻滯的假陰性反應並出現各種併發症。在目前的研究中,我們前瞻性地評價了血管內注射發病率和相關因素,此外,我們評估效率普遍接受的安全管理措施,如間歇透視檢查,以避免血管內注射。

方法 我們預期地審查了1433腰神經在七位醫師執行的456名患者的MBBs。志向測試、斑點造影和在即時螢光鏡的形象化之下的對比射入繼續地進行了,無需改變位置針。 血液反燃和血管內的對比傳播出現的發生在斑點幅射線照相的圖像和在即時螢光透視法期間被檢查了。 各種因素的研究,為血管內注射,包括醫師的經驗,病人的年齡,性別,針量具,阻滯脊髓水準。

結果:沒有具體的因素被發現,影響發病的血管吸收,在座。總體發病率的內吸收為6.1 ,神經阻滯( 1433分之88 ,並有30人,這些預言preinjection心願(敏感性= 34.1 )和52所當場照相(敏感性= 59.1


章一靜譯 薛張綱校

BACKGROUND: The successful outcome and validity of lumbar medial branch block (MBB) are largely dependent on technique accuracy. Intravascular uptake of injectate causes a false-negative response to block and is associated with various possible complications. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as preinjection aspiration and intermittent fluoroscopy to avoid intravascular injections.

METHODS: We prospectively examined 1433 lumbar MBBs in 456 patients performed by seven physicians. Aspiration test, spot radiography, and contrast injection under real-time fluoroscopic visualization were performed sequentially without repositioning the needle. Incidences of blood flashback and the presence of intravascular contrast spread on spot radiographic images and during real-time fluoroscopy were checked. The factors studied for intravascular injection included physician experience, patient age and sex, needle gauge, and block spinal level.

RESULTS: No specific factors were found to affect the incidence of intravascular uptake during block. The overall incidence of intravascular uptake was 6.1% per nerve block (88/1433), and 30 of these were predicted by preinjection aspiration (sensitivity = 34.1%) and 52 by spot radiography (sensitivity = 59.1%).

CONCLUSIONS: The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during lumbar MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.




Midazolam Administration Reverses Thermal Hyperalgesia and Prevents {gamma}-Aminobutyric Acid Transporter Loss in a Rodent Model of Neuropathic Pain

Andre Shih, DVM*, Vjekoslav Miletic, PhD{dagger}, Gordana Miletic, PhD{dagger}, and Lesley J. Smith, DVM{ddagger} From the *Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida; {dagger}Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; and {ddagger}Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin.

Anesth Analg 2008 106: 1296-1302.



方法:分別在CCI之前以及之後的3天和7天用熱刺激縮爪潛伏期試驗來評價痛覺過敏。動物隨機接受滲透性微泵輸注咪達唑侖(2.0 mg · kg–1 · h–1),氟馬西尼(0.004 mg · kg–1 · h–1),咪達唑侖複合氟馬西,或生理鹽水(0.01 mg · kg–1 · h–1)。四組經過模擬手術(無神經結紮)後的大鼠作為對照接受配對治療。手術7天后使用蛋白質免疫印跡法評價腰段脊髓後角GABA轉運體1GAT-1)的水準。



(夏俊明譯 薛張綱校)

BACKGROUND: Loss of {gamma}-aminobutyric acid (GABA) inhibition in the spinal dorsal horn may contribute to neuropathic pain. Here we examined whether systemic administration of the benzodiazepine midazolam would alleviate thermal hyperalgesia due to chronic constriction injury (CCI) of the sciatic nerve.

METHODS: Hyperalgesia was evaluated with the thermal paw withdrawal latency test before, and 3 and 7 days after CCI. Animals randomly received, via osmotic minipump infusion, midazolam (2.0 mg · kg–1 · h–1), flumazenil (0.004 mg · kg–1 · h–1), midazolam plus flumazenil at the same doses, or saline (0.01 mg · kg–1 · h–1). Four groups of sham-operated rats (surgery without nerve ligation) received matched treatments. Levels of the GABA transporter 1 (GAT-1) in the lumbar spinal dorsal horn were estimated using western immunoblots 7 days after surgery.

RESULTS: Saline-treated CCI rats developed thermal hyperalgesia on Day 3 with a more pronounced effect on Day 7. Continuous midazolam infusion prevented thermal hyperalgesia on both days. The antihyperalgesic effect of midazolam was reversed by the coadministration of flumazenil. Infusion of flumazenil alone had no effect on the thermal hyperalgesia in CCI rats. Sham-operated rats treated with saline, midazolam, or midazolam plus flumazenil exhibited no thermal hyperalgesia. Unexpectedly, thermal paw withdrawal latency in sham animals treated with flumazenil alone was significantly decreased. Changes in GAT-1 levels paralleled the behavior. Midazolam prevented the CCI-associated decreases, and flumazenil reversed midazolam's effect. Flumazenil alone did not modify GAT-1 levels in CCI animals but in sham animals the transporter levels were significantly reduced.

CONCLUSIONS: GABA inhibition plays an important role in neuropathic pain. Continuous systemic benzodiazepine administration may prove effective in alleviating neuropathic pain.


Stimulating Catheters for Continuous Femoral Nerve Blockade After Total Knee Arthroplasty :A Randomized, Controlled, Double-Blinded Trial

Michael J. Barrington, David J. Olive, Craig A. McCutcheon, Christopher Scarff, Simone Said, Roman Kluger, Nicola Gillett, and Peter ChoongFrom the Departments of *Anaesthesia, {dagger}Physiotherapy, and {ddagger}Orthopaedic Surgery, St. Vincent's Hospital, Melbourne, Australia.

Anesth Analg 2008 106: 1316-1321.


背景:連續股神經阻滯(CFNB)常用于全膝關節成形術(TKA)術後鎮痛. CFNB可以通過多種操作方法得以實施。神經刺激儀探針置管(SC)有在進針時確認導管放置於神經附近的好處。


結果:股神經分佈區域感覺阻滯比例為(9095)%,且在所有測定時間組間無明顯差異。在第一個24小時與SC組嗎啡18 (2–51) mg (P = 0.69)相比,NSC組則需要 19.5 (1–67)mg1090%的中位數)。第一個24小時內,嗎啡用量組間差異95%可信區間為(-8 5 mg。而靜息狀態下POD1POD2視覺類比評分和主動與被動物理治療時視覺類比評分,以及術後早期恢復指標兩組間均無差異。


(蔣宗明譯 薛張綱校)

BACKGROUND: Continuous femoral nerve blockade (CFNB) is often used for postoperative analgesia after total knee arthroplasty (TKA). CFNB can be instituted using a variety of techniques. Stimulating catheters (SC) have the advantage of confirming placement of the catheter close to the nerve during advancement.

METHODS: In this randomized, controlled, double-blind trial, we compared a SC with a nonstimulating catheter (NSC) technique for institution of CFNB and its effects on quality of analgesia after TKA performed under general anesthesia in 82 patients. Patients were randomized to have CFNB instituted using either a NSC or a SC technique. Sensory blockade was assessed 10 and 20 min after injection of lidocaine via femoral catheter and on postoperative days 1 (POD 1) and 2 (POD 2). A standardized multimodal analgesic technique, including a single injection sciatic block (preoperative), IV morphine (patient-controlled analgesia), celecoxib, and paracetamol, was administered to all patients. Outcome variables included morphine requirements, pain scores, and markers of early recovery.

RESULTS: The proportion of patients with sensory blockade in the femoral nerve distribution was between 90% and 95% at all measurement times with no difference between groups. In the first 24 h, the NSC group required 19.5 (1–67) [median (10th–90th centiles)] mg morphine compared with the SC Group 18 (2–51) mg (P = 0.69). At 24 h, the 95% confidence interval for difference in morphine consumption between groups was -8 to 5 mg. There was no difference between groups in visual analog scale scores at rest on POD 1 and POD 2, during active and passive physiotherapy; and in markers of early recovery after surgery.

CONCLUSIONS: In this study, blind catheter advancement was as reliable as a SC technique for establishing and maintaining CFNB for postoperative analgesia as a part of multimodal analgesia technique after TKA.