Table of Contents

March 2009




单嘉琪译 薛张纲校

Prognostic Value of Troponin I Levels for Predicting Adverse Cardiovascular Outcomes in Postmenopausal Women Undergoing Cardiac Surgery

Joshua D. Stearns, Victor G. Dávila-Román, Benico Barzilai, Richard E. Thompson, Kelly L. Grogan, Betsy Thomas, and Charles W. Hogue, Jr

Anesth Analg 2009 108: 719-726.


郑丽 译 陈杰 校

Fast-Track Anesthesia and Cardiac Surgery: A Retrospective Cohort Study of 7989 Patients

Vesna Svircevic, Arno P. Nierich, Karel G. M. Moons, George J. Brandon Bravo Bruinsma, Cor J. Kalkman, and Diederik van Dijk

Anesth Analg 2009 108: 727-733.



Does Thromboelastography Predict Postoperative Thromboembolic Events? A Systematic Review of the Literature

Yue Dai, Anna Lee, Lester A. H. Critchley, and Paul F. White
Anesth Analg 2009 108: 734-742.


范羽译 薛张纲校

Detection of Protamine and Heparin After Termination of Cardiopulmonary Bypass by Thrombelastometry (ROTEM®): Results of a Pilot Study

Markus Mittermayr, Corinna Velik-Salchner, Berndt Stalzer, Josef Margreiter, Anton Klingler, Werner Streif, Dietmar Fries, and Petra Innerhofer

Anesth Analg 2009 108: 743-750.


刘世文 译 陈杰 校

The Effects of Fibrinogen Levels on Thromboelastometric Variables in the Presence of Thrombocytopenia

Thomas Lang, Kai Johanning, Helfried Metzler, Siegfried Piepenbrock, Cristina Solomon, Niels Rahe-Meyer, and Kenichi A. Tanaka

Anesth Analg 2009 108: 751-758.


裘毅敏译,马皓 琳 李士通校

Noninfectious Serious Hazards of Transfusion (Review Article)

Jeanne E. Hendrickson and Christopher D. Hillyer

Anesth Analg 2009 108: 759-769.


叶乐 译 陈杰 校

Transfusion-Related Acute Lung Injury: Current Concepts for the Clinician (Review Article)

Darrell J. Triulzi

Anesth Analg 2009 108: 770-776.


周雅春 译   马皓琳 李士通 校

Cardiac Surgery in the Parturient (Review Article)

Shobana Chandrasekhar, Christopher R. Cook, and Charles D. Collard

Anesth Analg 2009 108: 777-785.



黄剑译 薛张纲校

The Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia With Propofol for Procedures Outside the Operating Room: A Report From the Pediatric Sedation Research Consortium

Joseph P. Cravero, Michael L. Beach, George T. Blike, Susan M. Gallagher, James H. Hertzog, and Pediatric Sedation Research Consortium

Anesth Analg 2009 108: 795-804.


张磊 译 陈杰 校

Relative Analgesic Potencies of Levobupivacaine and Ropivacaine for Caudal Anesthesia in Children

Pablo Ingelmo, Geoff Frawley, Marinella Astuto, Chris Duffy, Susan Donath, Nicola Disma, Giuseppe Rosano, Roberto Fumagalli, and Antonio Gullo

Anesth Analg 2009 108: 805-813.


李莹译 薛张纲校

The Reliability of Continuous Noninvasive Finger Blood Pressure Measurement in Critically Ill Children

Joris Lemson, Charlotte M. Hofhuizen, Olaf Schraa, Jos J. Settels, Gert Jan Scheffer, and Johannes G. van der Hoeven

Anesth Analg 2009 108: 814-821.


张莹译 李士通 马皓琳

Real-Time Assessment of Perioperative Behaviors and Prediction of Perioperative Outcomes (Brief Report)

Senthilkumar Sadhasivam, Lindsey L. Cohen, Alexandra Szabova, Anna Varughese, Charles Dean Kurth, Paul Willging, Yu Wang, Todd G. Nick, and Joel Gunter Anesth

Analg 2009 108: 822-826.



姚敏敏译 薛张纲校

Manual Versus Target-Controlled Infusion Remifentanil Administration in Spontaneously Breathing Patients

Annelies T. Moerman, Luc L. Herregods, Martine M. De Vos, Eric P. Mortier, and Michel M. R. F. Struys

Anesth Analg 2009 108: 828-834.



张燕 译 陈杰 校

Methemoglobinemia Related to Local Anesthetics: A Summary of 242 Episodes

Joanne Guay

Anesth Analg 2009 108: 837-845.


黄丽娜  译 马皓琳 李士通 校

The Effect of Residual Neuromuscular Blockade on the Speed of Reversal with Sugammadex

Paul F. White, Burcu Tufanogullari, Ozlem Sacan, Edward G. Pavlin, Oscar J. Viegas, Harold S. Minkowitz, and M. E. Hudson

Anesth Analg 2009 108: 846-851.


俞佳译 薛张纲校

A Comparison of Propofol and Remifentanil Target-Controlled Infusions to Facilitate Fiberoptic Nasotracheal Intubation

Alexandre Lallo, Valerie Billard, and Jean-Louis Bourgain

Anesth Analg 2009 108: 852-857.


舒慧刚 译 陈杰 校

Xenon Preconditioning: The Role of Prosurvival Signaling, Mitochondrial Permeability Transition and Bioenergetics in Rats

Yasushi Mio, Yon Hee Shim, Ebony Richards, Zeljko J. Bosnjak, Paul S. Pagel, and Martin Bienengraeber

Anesth Analg 2009 108: 858-866.


江继宏 译  马皓琳 李士通 校

Proprioceptive Function Is More Sensitive than Motor Function to Desflurane Anesthesia

Linda S. Barter, Laurie O. Mark, and Joseph F. Antognini

Anesth Analg 2009 108: 867-872.




An Evaluation of a Novel Software Tool for Detecting Changes in Physiological Monitoring

J. Mark Ansermino, Jeremy P. Daniels, Randy T. Hewgill, Joanne Lim, Ping Yang, Chris J. Brouse, Guy A. Dumont, and John B. Bowering

Anesth Analg 2009 108: 873-880.


丁俊云 译 陈杰 校

Noninvasive Cardiac Output Measurement in Heart Failure Subjects on Circulatory Support

Rob Phillips, Peter Lichtenthal, Julie Sloniger, Darryl Burstow, Malcolm West, and Jack Copeland

Anesth Analg 2009 108: 881-886.


周姝婧 译 陈杰 校

Minimally Invasive Cardiac Output Monitoring in the Perioperative Setting (Review Article)

Duane J. Funk, Eugene W. Moretti, and Tong J. Gan

Anesth Analg 2009 108: 887-897.



张钊译 薛张纲校

Changes in Functional Residual Capacity During Weaning from Mechanical Ventilation: A Pilot Study

Hermann Heinze, Beate Sedemund-Adib, Matthias Heringlake, Torsten Meier, and Wolfgang Eichler

Anesth Analg 2009 108: 911-915.



Alcohol Use Disorder and Perioperative Immune Dysfunction (Review Article)

Alexandra Lau, Vera von Dossow, Michael Sander, Martin MacGuill, Nadine Lanzke, and Claudia Spies

Anesth Analg 2009 108: 916-920.



黄佳佳译,马皓琳 李士通校

Patient-Controlled Epidural Analgesia for Labor (Review Article)

Stephen H. Halpern and Brendan Carvalho

Anesth Analg 2009 108: 921-928.



朱兰芳译 薛张纲

The Teaching of Professionalism During Residency: Why It Is Failing and a Suggestion to Improve Its Success (Review Article)

Robert R. Gaiser

Anesth Analg 2009 108: 948-954.



黄丹 译 陈杰 校

Early Anesthetic Preconditioning in Mixed Cortical Neuronal-Glial Cell Cultures Subjected to Oxygen-Glucose Deprivation: The Role of Adenosine Triphosphate Dependent Potassium Channels and Reactive Oxygen Species in Sevoflurane-Induced Neuroprotection

Lionel J. Velly, Paula T. Canas, Benjamin A. Guillet, Christelle N. Labrande, Frédérique M. Masmejean, André L. Nieoullon, François M. Gouin, Nicolas J. Bruder, and Pascale S. Pisano

Anesth Analg 2009 108: 955-963.


颜涛 译 马皓琳 李士通 校

Cyclic Adenosine Monophosphate Response Element-Binding Protein Phosphorylation and Neuroprotection by 4-Phenyl-1-(4-Phenylbutyl) Piperidine (PPBP)

Sufang Yang, Nabil J. Alkayed, Patricia D. Hurn, and Jeffrey R. Kirsch

Anesth Analg 2009 108: 964-970.


陈珺珺译 薛张纲校

Cerebral Resuscitation After Cardiocirculatory Arrest (Review Article)

Andreas Schneider, Bernd W. Böttiger, and Erik Popp

Anesth Analg 2009 108: 971-979.



周姝婧 译 陈杰 校

The Analgesic Effect of a Metered-Dose 8% Lidocaine Pump Spray In Posttraumatic Peripheral Neuropathy: A Pilot Study

Akifumi Kanai, Yuka Segawa, Takashi Okamoto, Masanori Koto, and Hirotsugu Okamoto

Anesth Analg 2009 108: 987-991.


唐李隽    马皓琳  李士通 

Capsicum Plaster at the Hegu Point Reduces Postoperative Analgesic Requirement After Orthognathic Surgery

Kyo S. Kim, Kyu N. Kim, Kyung G. Hwang, and Chang J. Park

Anesth Analg 2009 108: 992-996.


陈珺珺译 薛张纲校

Cytotoxicity of Local Anesthetics in Human Neuronal Cells

Rosalia Perez-Castro, Sohin Patel, Zayra V. Garavito-Aguilar, Andrew Rosenberg, Esperanza Recio-Pinto, Jin Zhang, Thomas J. J. Blanck, and Fang Xu

Anesth Analg 2009 108: 997-1007.


黄施伟 译,马皓琳 李士通 校

The Antinociceptive Effects and Pharmacological Properties of JM-1232(-): A Novel Isoindoline Derivative

Shunsuke Chiba, Tomoki Nishiyama, and Yoshitsugu Yamada

Anesth Analg 2009 108: 1008-1014.


陈珺珺译 薛张纲校

Ifenprodil Induced Antinociception and Decreased the Expression of NR2B Subunits in the Dorsal Horn After Chronic Dorsal Root Ganglia Compression in Rats

Wei Zhang, Chang-Xi Shi, Xiao-ping Gu, Zheng-Liang Ma, and Wei Zhu

Anesth Analg 2009 108: 1015-1020.


朱 慧译 马皓琳 李士通校

Lidocaine Injection into the Rat Dorsal Root Ganglion Causes Neuroinflammation

Livia Puljak, Sanja Lovric Kojundzic, Quinn H. Hogan, and Damir Sapunar

Anesth Analg 2009 108: 1021-1026.


怀晓蓉 译 陈杰 校

An Absorbable Local Anesthetic Matrix Provides Several Days of Functional Sciatic Nerve Blockade

Chi-Fei Wang, Alimorad G. Djalali, Ankur Gandhi, David Knaack, Umberto De Girolami, Gary Strichartz, and Peter Gerner

Anesth Analg 2009 108: 1027-1033.


赵嫣红 译 陈杰 校

The Efficacy of Skin Temperature for Block Assessment After Infraclavicular Brachial Plexus Block

Vincent Minville, Agnés Gendre, Jan Hirsch, Stein Silva, Benoît Bourdet, Carole Barbero, Olivier Fourcade, Kamran Samii, and Hervé Bouaziz

Anesth Analg 2009 108: 1034-1036.


陈珺珺译 薛张纲校

Ultrasound-Guided Obturator Nerve Block: A Sonoanatomic Study of a New Methodologic Approach

Taylan Akkaya, Emine Ozturk, Ayhan Comert, Yesim Ates, Haluk Gumus, Halil Ozturk,

Ibrahim Tekdemir, and Alaittin Elhan

Anesth Analg 2009 108: 1037-1041.


Prognostic Value of Troponin I Levels for Predicting Adverse Cardiovascular Outcomes in Postmenopausal Women Undergoing Cardiac Surgery

Stearns, Joshua D. MD; Davila-Roman, Victor G. MD; Barzilai, Benico MD; Thompson, Richard E. PhD; Grogan, Kelly L. MD; Thomas, Betsy RN; Hogue, Charles W. Jr MD

From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; {dagger}Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; {ddagger}Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and §Department of Clinical Research, Washington University School of Medicine, St. Louis, Missouri.

Anesthesia & Analgesia  March 2009.108(3):719-726,



方法:此次研究的队列来自于先前一个已报道的临床试验,那个研究旨在评估老年妇女中17[beta]-雌二醇的神经保护潜能。在那个研究中,175名未接受雌激素替代治疗且将择期行冠脉旁路移植术(有无瓣膜手术均可)的绝经后妇女经双盲随机分成两组,分别自手术前一天开始接受17[beta]-雌二醇或安慰剂治疗,至术后五天。在术前,术后入重症监护室当日以及术后头四天分别进行连续十二导联心电图及血清肌钙蛋白I浓度检测。我们这次研究的主要终检值是重大的心血管不良事件(MACE),即Q波型心肌梗死,低心排量以及术后三十天内死亡。Q波型心肌梗死的诊断需有两位内科医生分别独立进行评估,两者意见一致方为最终诊断。低心排量状态是指在不考虑具体治疗的情况下心脏指数小于2.0 L · min-1 · m-2超过八个小时。

结果:术后第一天的肌钙蛋白I水平被用于预测重大的心血管不良事件(MACE)(受试者曲线下面级=0.862)。将肌钙蛋白I的终检值定于>7.6 ng/mL95%可信区间,6.4–10.8)可提供鉴别患者是否存在发生重大心血管不良事件(MACE)风险的最佳敏感性和特异性。由肌钙蛋白水平来识别一个患者是否合并有心血管事件,其阴性预测价值很高(96%),而阳性预测价值却一般(40%)。围手术期接受17[beta]-雌二醇治疗的妇女与安慰剂组比较,术后肌钙蛋白I的水平并无差异;并且重大心血管不良事件(MACE)的发生率并不受17[beta]-雌二醇治疗的影响。


(单嘉琪译 薛张纲校)

BACKGROUND: Adverse cardiac events that follow cardiac surgery are an important source of perioperative morbidity and mortality for women. Troponin I provides a sensitive measure of cardiac injury, but the levels after cardiac surgery may vary between sexes. Our purpose in this study was to evaluate the prognostic value of troponin I levels for predicting cardiovascular complications in postmenopausal women undergoing cardiac surgery.

METHODS: The cohort of this study were women enrolled in a previously reported clinical trial evaluating the neuroprotective potential of 17[beta]-estradiol in elderly women. In that study, 175 postmenopausal women not receiving estrogen replacement therapy and scheduled to undergo coronary artery bypass graft (with or without valve surgery) were prospectively randomized to receive 17[beta]-estradiol or placebo in a double-blind manner beginning the day before surgery and continuing for 5 days postoperatively. Serial 12-lead electrocardiograms were performed and serum troponin I concentrations were measured before surgery, after surgery on arrival in the intensive care unit, and for the first four postoperative days. The primary end-point of the present study was major adverse cardiovascular events (MACE) defined as a Q-wave myocardial infarction, low cardiac output state or death within 30 days of surgery. The diagnosis of Q-wave myocardial infarction was made independently by two physicians blinded to treatment and patient outcomes with the final diagnosis requiring consensus. Low cardiac output state was defined as cardiac index <2.0 L [middle dot] min-1 [middle dot] m-2 for >8 h regardless of treatment.

RESULTS: Troponin I levels on postoperative day 1 were predictive of MACE (area under the receiver operator curve = 0.862). A cutoff point for troponin I of >7.6 ng/mL (95% confidence interval, 6.4-10.8) provided the optimal sensitivity and specificity for identifying patients at risk for MACE. The negative predictive value of a troponin I level for identifying a patient with a composite cardiovascular outcome was high (96%) and the positive predictive value moderate (40%). Postoperative troponin I levels were not different between women receiving perioperative 17[beta]-estradiol treatment compared with placebo and the frequency of MACE was not influenced by 17[beta]-estradiol treatment.

CONCLUSIONS: In postmenopausal women, elevated troponin I levels on postoperative day 1 are predictive of MACE. Monitoring of perioperative troponin I levels might provide a means for stratifying patients at risk for adverse cardiovascular events.




Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM): results of a pilot study.

Mittermayr M, Velik-Salchner C, Stalzer B, Margreiter J, Klingler A, Streif W, Fries D, Innerhofer PFrom the *Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria; {dagger}Assign Data Management and Biostatistics GmbH, Innsbruck, Austria; and {ddagger}Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria.

Anesth Analg 2009 Mar; 108(3):743-50.






(范羽译 薛张纲校)

BACKGROUND: Our goal of this study was to determine whether protamine's effects on coagulation can be detected and differentiated from those of heparin when using thrombelastometry (ROTEM).
METHODS: To reverse the effects of heparin after cardiopulmonary bypass (CPB), 22 consecutive patients undergoing aortocoronary bypass graft surgery were included. According to clinical routine, all patients received a first dose of protamine calculated from the total amount of heparin given; additional protamine (70 U/kg) was administered to patients with activated clotting time (ACT) above baseline and clinical signs of diffuse bleeding. Simultaneously, routine ACT measurements, ROTEM assays (heparin-sensitive INTEM, and heparinase-containing HEPTEM test) and standard coagulation tests were performed, and the activity of coagulation factors as well as antifactor Xa activity measured.
RESULTS: Administration of additional protamine (n = 16) resulted in a statistically significant increase in coagulation times on the intrinsically activated test (INTEM-CT), namely from (mean [+/-SD]) 219.8 (+/-19.1) s to 241.1 (+/-21.7) s (P < 0.001), and on the heparinase-containing test (HEPTEM-CT), namely from 210.2 (+/-19.9) s to 226.8 (+/-21.8) s (P < 0.001). These changes were not observed in patients receiving a single protamine dose (n = 6). The INTEM-CT:HEPTEM-CT ratio correctly identified 56 of the 58 samples as not containing residual heparin and correctly detected residual heparin in 3 of the only 6 samples showing elevated antifactor Xa values after CPB.
CONCLUSION: Our preliminary data show that at termination of CPB administration of additional protamine results in a brief prolongation of coagulation times on the INTEM and HEPTEM test and that ROTEM might be useful in excluding residual heparin in cases showing prolonged ACT.




The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.

Joseph P. Cravero, Michael L. Beach, George T. Blike, Susan M. Gallagher, James H. Hertzog, and Pediatric Sedation Research Consortium

From the *Department of Anesthesiology and Pediatrics; {dagger}Department of Anesthesiology and Community and Family Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; and {ddagger}Department of Anesthesiology, Division of Critical Care Medicine, Alfred I duPont Hospital for Children, Wilmington, Delaware.

Anesth Analg 2009 108: 795-804.



病例选择和方法:数据由儿科镇静研究协会(Pediatric Sedation Research Consortium,PSRC)收集。这一国际性的协会致力于改进镇静/麻醉在儿童中的应用。协会的成员们按一定的规程前瞻性持续收集接受镇静及镇静/麻醉治疗的病例数据。主要的入选标准是在手术室外诊疗中对某些形式的镇静/麻醉的需求度,无排除标准。统计数据,主要疾病,并存疾病,治疗方法,所用药物,治疗和恢复时间,麻醉药物剂量效用关系,气道控制及恶性事件都由网络化的数据收集工具进行收集汇总。本研究中,我们评价了所有以异丙酚为主要镇静/麻醉治疗药物的情况。



(黄剑译 薛张纲校)

OBJECTIVE: We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care.

PATIENTS AND METHODS: Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of institutions dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients receiving sedation or sedation/anesthesia for procedures. The primary inclusion criterion was the need for some form of sedation/anesthesia to perform a diagnostic or therapeutic procedure outside the operating room. There were no exclusion criteria. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, procedure and recovery times, medication doses outcomes of anesthesia, airway interventions and adverse events were collected and reported using web-based data collection tool. For this study, we evaluated all instances where propofol was used as the primary drug in the sedation/anesthesia technique.

RESULTS: Thirty-seven locations submitted data on 49,836 propofol sedation/anesthesia encounters during the study period from July 1, 2004 until September 1, 2007. There were no deaths. Cardiopulmonary resuscitation was required twice. Aspiration during sedation/anesthesia occurred four times. Less serious events were more common with O(2) desaturation below 90% for more than 30 s, occurring 154 times per 10,000 sedation/anesthesia administrations. Central apnea or airway obstruction occurred 575 times per 10,000 sedation/anesthesia administrations. Stridor, laryngospasm, excessive secretions, and vomiting had frequencies of 50, 96, 341, and 49 per 10,000 encounters, respectively. Unexpected admissions (increases in levels of care required) occurred at a rate of 7.1 per 10,000 encounters. In an unadjusted analysis, the rate of pulmonary adverse events was not different for anesthesiologists versus other providers.

CONCLUSIONS: We report the largest series of pediatric propofol sedation/anesthesia for procedures outside the operating room. The data indicate that propofol sedation/anesthesia is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation/anesthesia services. However, the safety of this practice is dependent on a system's ability to manage less serious events. We propose that our data suggest variables for training and credentialing providers of propofol sedation/anesthesia and the system characteristics that promote safe use of this drug.




The Reliability of Continuous Noninvasive Finger Blood Pressure Measurement in Critically Ill Children

Joris Lemson, MD*, Charlotte M. Hofhuizen, MD{dagger}, Olaf Schraa, MSc{ddagger}, Jos J. Settels, MSc{ddagger}, Gert Jan Scheffer, MD, PhD{dagger}, and Johannes G. van der Hoeven, MD, PhD*

From the Departments of *Intensive Care Medicine, {dagger}Anesthesiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and {ddagger}BMEYE BV, Amsterdam, The Netherlands.

Anesth Analg 2009 108: 814-821.




结果:试验包括了35222kg的患儿。总共测定了152FINAP,其中4.6%没有成功。比较FINAPIAP,收缩压、舒张压、平均动脉压的偏差分别是–16.2, –7.7, and –10.2 mm Hg。置信区间(LOA)分别是26.1%, 30.1%,22.6%.。经指尖血压换算的肱动脉血压与IAP相比较,偏差分别是–11.8, 0.6–0.9 mm Hg LOA分别是21.7%, 8.9%, 8.9% 。无创的振动法血压测定与IAP相比偏差分别是–6.8, –0.9,–3.8 mm HgLOA分别是18.2%, 38.6%, 22.1%


(李莹译 薛张纲校)

INTRODUCTION: Continuous noninvasive arterial blood pressure can be measured in finger arteries using an inflatable finger cuff (FINAP) with a special device and has proven to be feasible and reliable in adults. We studied prototype pediatric finger cuffs and pediatric software to compare this blood pressure measurement with intraarterially measured blood pressure (IAP) in critically ill children.

METHODS: We included sedated and mechanically ventilated children admitted to our pediatric intensive care unit. We performed simultaneous arterial blood pressure measurements during a relatively stable hemodynamic period and compared FINAP, IAP, and the noninvasive blood pressure oscillometric technique. We also compared IAP to a reconstruction of brachial pressure from finger pressure.

RESULTS: Thirty-five children between 2 and 22 kg body weight were included. In total, 152 attempts to record a FINAP pressure were performed of which 4.6% were unsuccessful. When comparing FINAP to IAP, bias was –16.2, –7.7, and –10.2 mm Hg for systolic arterial blood pressure, diastolic arterial blood pressure, and mean arterial blood pressure. Limits of  agreement (LOA) were respectively 26.1%, 30.1%, and 22.6%. When reconstruction of brachial pressure from finger pressure was compared to IAP, these results were –11.8, 0.6, and –0.9 mm Hg for bias and 21.7%, 8.9%, and 8.9% for LOA. When noninvasive blood pressure oscillometric technique was compared to IAP, the results were: –6.8, –0.9, and –3.8 mm Hg for bias and 18.2%, 38.6%, and 22.1% for LOA.

CONCLUSION: Beta type continuous noninvasive arterial blood pressure monitoring using a finger cuff with brachial arterial waveform reconstruction seems reliable in hemodynamically stable critically ill children.




Manual Versus Target-Controlled Infusion Remifentanil Administration in Spontaneously Breathing Patients

Annelies T. Moerman, MD*, Luc L. Herregods, MD, PhD*, Martine M. De Vos, MD, PhD{dagger}, Eric P. Mortier, MD, Dsc*, and Michel M. R. F. Struys, MD, PhD

From the Departments of *Anesthesiology and Gastro-Enterology, Ghent University Hospital; Department of Anesthesiology, Ghent University, Gent, Belgium; and Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Anesth Analg 2009 108: 828-834



方法:进行肠镜检查的病人被随机分配接受人工控制输注瑞芬太尼(MCI)(0.125µg每公斤每分钟的速度输注两分钟,然后以0.05µg每公斤每分钟的速度持续输注)、靶控输注瑞芬太尼(1 ng/mL)或安慰剂(普通生理盐水靶控输注或同样的速度手控输注)。所有的病人都接受靶控输注丙泊酚,靶浓度调整至能提供深度镇静,病人对口头指令没有反应,但是在没有帮助的情况下保持自主通气。

结果:很明显,接受安慰剂组的病人更多地出现了体动、咳嗽、和呃逆,短暂的影响了检查。三组间在血流动力学及恢复期的差异没有临床意义。通过靶控输注瑞芬太尼减少了丙泊酚的用量。同人工控制输注瑞芬太尼相比,靶控输注瑞芬太尼时通气不足及呼吸暂停的发生率下降。(TCI n = 7, MCI n = 16, P < 0.05)

结论:同单用丙泊酚相比,在保持自主呼吸的深度镇静病人中,联用瑞芬太尼和丙泊酚能为肠镜检查提供更好的条件。同人工控制输注相比,靶控输注瑞芬太尼减少了丙泊酚的用量,同时呼吸暂停和呼吸抑制的发生率更低(TCI n = 7, MCI n = 16, P < 0.05)。

(姚敏敏译 薛张纲校)

BACKGROUND: The combination of propofol-remifentanil for procedural deep sedation in spontaneously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controlled infusion (TCI) might optimize drug delivery. In this prospective, randomized, double-blind study in patients undergoing elective colonoscopy, we thus tried to answer two questions: first, if adding remifentanil to propofol surpasses the disadvantages of the combination of these two products, and second, if administration of remifentanil via TCI decreases the incidence of side effects, compared to manually controlled administration.

METHODS: Patients undergoing elective colonoscopy were randomly assigned to receive remifentanil via manually controlled continuous infusion (MCI) (0.125 µg · kg–1 · min–1 for 2 min followed by a continuous infusion of 0.05 µg · kg–1 · min–1), TCI remifentanil (1 ng/mL), or placebo (normal saline either as TCI or manual infusion of equivalent rate). All patients received TCI propofol, adjusted to a target concentration level that provided deep sedation in which patients were not responsive to verbal commands, but maintained spontaneous ventilation without assistance.

RESULTS: Significantly more patients in the placebo group showed movement, cough and hiccup, which transiently interfered with the examination. There were no clinically significant differences in hemodynamic or recovery variables among all groups. Remifentanil administered via TCI resulted in a decrease in propofol requirements. The incidence of hypopnea and apnea was less frequent when remifentanil was administered via TCI compared to MCI (TCI n = 7, MCI n = 16, P < 0.05).

CONCLUSION: The combination of remifentanil and propofol for deep sedation in spontaneously breathing patients, offered better conditions for colonoscopy than propofol used as a single drug. Remifentanil administered via TCI resulted in a decrease in propofol dosing and in a lower incidence in apnea and respiratory depression (TCI n = 7, MCI n = 16, P < 0.05), compared to manually controlled administration of remifentanil.




A Comparison of Propofol and Remifentanil Target-Controlled Infusions to Facilitate Fiberoptic Nasotracheal Intubation

Alexandre Lallo, MD, FRCPC*{dagger}, Valerie Billard, MD*, and Jean-Louis Bourgain, MD*

From the *Department of Anesthesiology, Institut Gustave Roussy, Villejuif, France; and {dagger}Department of Anesthesiology, Centre Hospitalier de l’université de Montréal, Hopital Notre-Dame. Montréal, Quebec, Canada.

Anesth Analg 2009 108: 852-857



方法60名需要光纤下经鼻气管插管的患者经随机分配接受PR靶控输注。局部麻醉后,TCI一开始设置为2.5 µg/mL (P) 1.5 ng/mL (R),然后根据患者的反应增量,每次1 µg/mL (P) 0.5 ng/mL (R)。目标血药浓度和镇静水平在每一步都被记录,以及在手术以后评估总药量,调整次数,插管条件,患者不舒适和回忆。

结果:插管持续时间,成功率和药物增加的次数在两组之间并无差异。最终血药浓度在3.9 ± 1.4 µg/mL (P)2.4 ± 0.8 ng/mL (R)(各自总量142 ± 55 mg 77 ± 27 µg)之时,插管条件在两组中同样好。插管后最低的spO2和最高的呼末CO2没有差别。没有观察到喉痉挛和重大的血流动力学改变。在P组中出现了一例由于阻塞性呼吸暂停引起的缺氧。P组的患者显著的更镇静和不合作。在R组中回忆发生更频繁,而疼痛分数在两组中同样低。


(俞佳译 薛张纲校)

INTRODUCTION: Successful fiberoptic intubation requires both patient comfort and good intubating conditions. In this study we compared the efficacy and ease of titration of propofol (P) and remifentanil (R) target-controlled infusions (TCI) during fiberoptic intubation.

METHODS: Sixty patients requiring fiberoptic nasotracheal intubation were randomized to receive (P) or (R) effect-site TCI. After topical anesthesia, TCI was set to 2.5 µg/mL (P) or 1.5 ng/mL (R) then titrated by 1 µg/mL (P) or 0.5 ng/mL (R) increments according to patient reactions. Targets and level of sedation were recorded at each step as well as total dose, number of adjustments, intubating conditions, discomfort, and recall assessed after surgery.

RESULTS: Intubation duration, success rate, and number of increments did not differ between groups. Intubating conditions were good  in both groups, with a final target of 3.9 ± 1.4 µg/mL (P) or 2.4 ± 0.8 ng/mL (R) (total dose 142 ± 55 mg and 77 ± 27 µg, respectively). There was no difference in minimal Spo2 and maximal end-tidal CO2 after intubation. No laryngospasm or significant hemodynamic instability was observed. There was one major hypoxemia due to obstructive apnea in group P. Patients in group P were significantly more sedated and less cooperative. Recall was more frequent in group R, whereas pain scores were equally low in both groups.

CONCLUSION: Both R and P TCI can be rapidly titrated to achieve good intubating conditions and patient comfort. R allows for more patient cooperation, making it safer when spontaneous ventilation is paramount.




An Evaluation of a Novel Software Tool for Detecting Changes in Physiological Monitoring

J. Mark Ansermino, Jeremy P. Daniels, Randy T. Hewgill, Joanne Lim, Ping Yang, Chris J. Brouse, Guy A. Dumont, and John B. Bowering From the *Department of Anesthesiology, Pharmacology and Therapeutics, and {dagger}Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada.

Anesth Analg 2009 108: 873-880.







BACKGROUND: We have developed a software tool (iAssist) to assist clinicians as they monitor the physiological data that guide their actions during anesthesia. The system tracks the statistical properties of multiple dynamic physiological processes and identifies new trend patterns. We report our initial evaluation of this tool (in pseudo real-time) and compare the detection of trend changes to a post hoc visual review of the full trend. We suggest a combination of criteria by which to evaluate the performance of monitoring devices that aim to enhance trend detection.

METHODS: Nineteen children and 28 adults consented to be included in the study, encompassing more than 68 h of anesthesia. In each surgical case, an anesthesiologist reported all perceived clinical changes in monitoring in real-time. A trained observer simultaneously documented the verbally reported changes and every anesthesiologist action. The same cases were subsequently evaluated offline (in pseudo real-time) by a novel software tool (iAssist). Heart rate, end-tidal carbon dioxide, exhaled minute ventilation, and respiratory rate were modeled using a dynamic linear growth model whose noise distribution was estimated by an adaptive Kalman filter based on a recursive expectation-maximization method. Changes were detected by adaptive local Cumulative Sum testing. Changes in the mean arterial noninvasive blood pressures and oxygen saturation were detected using adaptive Cumulative Sum testing on a filtered residual from an exponentially weighted moving averaging filter. In post hoc analysis, each change detected by iAssist was graded independently by two clinicians using a graphical display of the whole case. Missed changes were recorded.

RESULTS: The iAssist software tool detected 869 true positive changes (at an average of 12.76/h) with a sensitivity of 0.91 and positive predictive value of 0.87. The post hoc review identified 91 missed changes (at an average of 1.34/h), resulting in an overall ratio of true positive rates to false-negative rates of 9.55. The clinicians in real-time reported 209 changes in trend (at an average of 3.07/h).

CONCLUSION: The algorithms perform favorably compared with a visual inspection of the complete trend. Further research is needed to identify when and how to draw the clinician's attention to these changes.




Changes in functional residual capacity during weaning from mechanical ventilation: a pilot study.

Heinze H, Sedemund-Adib B, Heringlake M, Meier T, Eichler W

.From the *Department of Anesthesiology, Pharmacology and Therapeutics, and {dagger}Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada.

Anesth Analg 2009 108: 911-915.



方法:LUFU系统(Dräger Medical, Lübeck, Germany)通过使用旁流氧气分析仪分析混有氮气的呼出气体中的氧气来估计FRC。心脏手术病人术后首先使用双相正压通气(BiPAP),并附加10 mbar的PEEP。适当调整供气压力上限使潮气量达到of 6-8 mL/kg (BIPAP 10)。30分钟后,上压和下压限值均降低3 mbar (BIPAP 7)。当可测得患者自主呼吸时,将机械通气模式转换为PSV下的持续气道正压通气 (CPAP) 模式,并且使用之前与BIPAP相符合的压力支持及压力下限作为CPAP的压力水平。30分钟后重复测量(CPAP 7_2)

结果10名患者入组研究,FRC减少(BIPAP 10: 3.6 [1.0] L; BIPAP 7: 3.1 [0.9] L; CPAP 7_1: 2.9 [0.9] L; CPAP 7_2: 2.7 [0.6] L [Mean (SD)]; 方差多变量分析: P = 0.017), PF (BIPAP 10: 420 [114] mm Hg; BIPAP 7: 405 [110] mm Hg; CPAP 7_1: 353 [70] mm Hg; CPAP 7_2: 340 [70] mm Hg [Mean (SD)]; 方差多变量分析: P = 0.045)。全程PaCO(2)无显著性变化(P = 0.221)

结论在心脏手术脱管期间FRC的下降最终可以(部分) 用肺泡不张的原因来解释。这种变化能否对脱管期间有指导意义仍然需要进一步研究。

(张钊译 薛张纲校)

BACKGROUND: Reduction of high positive end-expiratory pressure levels and pressure support ventilation (PSV) are frequently used before tracheal extubation in critically ill patients, but the impact of PSV on functional residual capacity (FRC) is unknown. In this study, we sought to detect the changes of FRC and pulmonary function during a weaning protocol in patients ventilated after cardiac surgery.

METHODS: The LUFU system (Dräger Medical, Lübeck, Germany) estimates FRC by oxygen washout, a variant of multiple breath nitrogen washout, using a sidestream O(2) analyzer. Postoperative cardiac surgery patients were initially ventilated using biphasic positive airway pressure ventilation (BiPAP) with a positive end-expiratory pressure of 10 mbar. The upper pressure limit was adjusted to deliver a tidal volume of 6-8 mL/kg (BIPAP 10). After 30 min, the upper and lower pressure limits were both reduced by 3 mbar (BIPAP 7). When spontaneous breathing efforts were detected, ventilation mode was switched to continuous positive airway pressure (CPAP) with PSV using the former lower pressure limit as the CPAP level and the corresponding pressure support of the former BIPAP adjustment (CPAP 7_1). Measurements were repeated after 30 min (CPAP 7_2).

RESULTS: Ten patients were studied. FRC decreased (BIPAP 10: 3.6 [1.0] L; BIPAP 7: 3.1 [0.9] L; CPAP 7_1: 2.9 [0.9] L; CPAP 7_2: 2.7 [0.6] L [Mean (SD)]; MANOVA: P = 0.017), as did PF ratio (BIPAP 10: 420 [114] mm Hg; BIPAP 7: 405 [110] mm Hg; CPAP 7_1: 353 [70] mm Hg; CPAP 7_2: 340 [70] mm Hg [Mean (SD)]; MANOVA: P = 0.045). PaCO(2) did not change significantly over time (P = 0.221).

CONCLUSION: Decreasing FRC during the weaning process after cardiac surgery may, at least in part, be explained by alveolar derecruitment. Whether this variable could help guide a weaning protocol has to be studied further.




The Teaching of Professionalism During Residency: Why It Is Failing and a Suggestion to Improve Its Success (Review Article)
Robert R. Gaiser

From the Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Anesth Analg 2009 108: 948-954.



(朱兰芳译 薛张纲)

Professionalism is one of the core competencies to be taught and evaluated during residency. A review of the literature suggests that professionalism is not completely understood or practiced. The teaching of professionalism has been incorporated into the educational programs for residents. However, residents learn from two curriculums: the stated curriculum and a hidden curriculum. The hidden curriculum represents the actions observed by the resident of the faculty in the hospital. The impact of this hidden curriculum upon professional behavior by the resident is significant. Due to the hidden curriculum, a possible means of improving professionalism involves the development of a program for faculty. This program must include not only topics but time for personal reflection of one’s knowledge and actions. Self-reflection allows for the development of a true understanding and practice of professionalism and may improve professional behavior.




Cerebral Resuscitation After Cardiocirculatory Arrest

Andreas Schneider, MD*, Bernd W. Böttiger, MD*, and Erik Popp, MD{dagger}

From the *Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Germany; and {dagger}Department of Anesthesiology, University of Heidelberg, Germany.

Anesth Analg 2009 108: 971-979.



(陈珺珺译 薛张纲校)

Cardiopulmonary resuscitation can restore spontaneous circulation in up to 50% of patients suffering from cardiac arrest. However, most of these patients still die during the postresuscitation period. Mortality is largely due to neuronal injury after global cerebral ischemia. There is, therefore, a clear need for therapies, which restore and protect brain function after cardiac arrest. Several years ago, mild therapeutic hypothermia was introduced into clinical practice. It represents the first treatment to improve both survival and neurological outcome of patients after out-of-hospital cardiac arrest, according to randomized clinical trials. In addition to therapeutic hypothermia, various other therapeutic options are currently being investigated experimentally and/or clinically. These include thrombolytic therapy, specific infusion regimens, or antiapoptotic drugs. In this article, we review both the pathophysiological background and the efficacy  of different measures that might be useful for cerebral resuscitation.


Cytotoxicity of Local Anesthetics in Human Neuronal Cells

Rosalia Perez-Castro, MS*, Sohin Patel, MD*, Zayra V. Garavito-Aguilar, BS*, Andrew Rosenberg, MD{dagger}, Esperanza Recio-Pinto, PhD*, Jin Zhang, MD*, Thomas J. J. Blanck, MD, PhD*, and Fang Xu, PhD*

From the *Department of Anesthesiology, New York University School of Medicine; and {dagger}Department of Anesthesiology, NYU Hospital for Joint Diseases, New York, New York.

Anesth Analg 2009 108: 997-1007.



方法:人SH-SY5Y神经瘤细胞暴露于六种局麻药(布比卡因、罗派卡因、甲派卡因、利多卡因、普鲁卡因和氯普鲁卡因),通过MTT-(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetra-odium bromide) 比色法测定生存的数量,通过荧光成像的方法,测定LIVE/DEAD®反应物(calcein/AM and ethidium homodimer-1)评估质量。 此外,通过FLICATM测定与细胞凋亡相关的caspase-3/-7的激活。此外,还评估了局麻药介导的去极化和氯化氨甲酰胆碱激动引起的胞内Ca2+的反应。



(陈珺珺译 薛张纲校)

BACKGROUND: In addition to inhibiting the excitation conduction process in peripheral nerves, local anesthetics (LAs) cause toxic effects on the central nervous system, cardiovascular system, neuromuscular junction, and cell metabolism. Different postoperative neurological complications are ascribed to the cytotoxicity of LAs, but the underlying mechanisms remain unclear. Because the clinical concentrations of LAs far exceed their EC50 for inhibiting ion channel activity, ion channel block alone might not be sufficient to explain LA-induced cell death. However, it may contribute to cell death in combination with other actions. In this study, we compared the cytotoxicity of six frequently used LAs and will discuss the possible mechanism(s) underlying their toxicity.

METHODS: In human SH-SY5Y neuroblastoma cells, viability upon exposure to six LAs (bupivacaine, ropivacaine, mepivacaine, lidocaine, procaine, and chloroprocaine) was quantitatively determined by the MTT-(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetra-odium bromide) colorimetry assay and qualitatively confirmed by fluorescence imaging, using the LIVE/DEAD® assay reagents (calcein/AM and ethidium homodimer-1). In addition, apoptotic activity was assessed by measuring the activation of caspase-3/-7 by imaging using a fluorescent caspase inhibitor (FLICATM). Furthermore, LA effects on depolarization- and carbachol-stimulated intracellular Ca2+-responses were also evaluated.

RESULTS: 1) After a 10-min treatment, all six LAs decreased cell viability in a concentration-dependent fashion. Their killing potency was procaine ≤mepivacaine < lidocaine < chloroprocaine < ropivacaine < bupivacaine (based on LD50, the concentration at which 50% of cells were dead). Among these six LAs, only bupivacaine and lidocaine killed all cells with increasing concentration. 2) Both bupivacaine and lidocaine activated caspase-3/-7. Caspase activation required higher levels of lidocaine than bupivacaine. Moreover, the caspase activation by bupivacaine was slower than by lidocaine. Lidocaine at high concentrations caused an immediate caspase activation, but did not cause significant caspase activation at concentrations lower than 10 mM. 3) Procaine and chloroprocaine concentration-dependently inhibited the cytosolic Ca2+-response evoked by depolarization or receptor-activation in a similar manner as a previous observation made with bupivacaine, ropivacaine, mepivacaine, and lidocaine. None of the LAs caused a significant increase in the basal and Ca2+-evoked cytosolic Ca2+-level.

CONCLUSION: LAs can cause rapid cell death, which is primarily due to necrosis. Lidocaine and bupivacaine can trigger apoptosis with either increased time of exposure or increased concentration. These effects might be related to postoperative neurologic injury. Lidocaine, linked to the highest incidence of transient neurological symptoms, was not the most toxic LA, whereas bupivacaine, a drug causing a very low incidence of transient neurological symptoms, was the most toxic LA in our cell model. This suggests that cytotoxicity-induced nerve injury might have different mechanisms for different LAs and different target(s) other than neurons.




Ifenprodil Induced Antinociception and Decreased the Expression of NR2B Subunits in the Dorsal Horn After Chronic Dorsal Root Ganglia Compression in Rats

Wei Zhang, MD, Chang-Xi Shi, MD, Xiao-ping Gu, MD, PhD, Zheng-Liang Ma, MD, PhD, and Wei Zhu, MD

From the Department of Anesthesiology, Drum Tower Hospital, Medical Department of Nanjing University, Jiangsu Province, China.

Anesth Analg 2009 108: 1015-1020.






(陈珺珺译 薛张纲校)

BACKGROUND: Spinal N-methyl d-aspartate receptors play an important role in the pathogenesis of neuropathic pain, and administration of N-methyl d-aspartate receptor antagonists can attenuate this hyperpathia. Ifenprodil is an antagonist selective for N-methyl d-aspartate receptor 2B (NR2B) subunits. Several researches have reported effective analgesia of ifenprodil in animal models of neuropathic pain. We extended this work to include chronic compression of the dorsal root ganglia (CCD).

METHODS: The paw withdrawal mechanical threshold and paw withdrawal thermal latency tests were used to assess mechanical allodynia  and thermal hyperalgesia after a CCD operation and intrathecal injection of ifenprodil. We used immunohistochemistry and immunoblotting to investigate the effect of ifenprodil on NR2B subunits expression in CCD rats.

RESULTS: The data revealed increased expression of NR2B subunits in the superficial dorsal horn in CCD rats. We found that, in addition to a marked suppression of thermal hyperalgesia and mechanical allodynia, intrathecal injection ifenprodil treatment causes a decreased expression of NR2B in the spinal cord.

CONCLUSIONS: These data suggest that ifenprodil induced anti nociception in CCD rats and provided further evidence for the important role of NR2B subunits in the development of neuropathic pain.




Ultrasound-Guided Obturator Nerve Block: A Sonoanatomic Study of a New Methodologic Approach

Taylan Akkaya, MD*, Emine Ozturk, MD{dagger}, Ayhan Comert, MD{ddagger}, Yesim Ates, MD§, Haluk Gumus, MD*, Halil Ozturk, MD{dagger}, Ibrahim Tekdemir, MD{ddagger}, and Alaittin Elhan, MD{ddagger}

From the Departments of *Anesthesia and Pain Unit, {dagger}Radiology, Ministry of Health Diskapi Yildirim Beyazit Research and Educational Hospital, Ankara-Turkey; Departments of {ddagger}Anatomy, and §Anesthesiology and Reanimation, Ankara University, Ankara-Turkey.

Anesth Analg 2009 108: 1037-1041.




结果:在志愿者上,通过超声可见闭孔神经主干、前后分支的的比例分别是12/16,13/16和7/16。在志愿者身上获得的特定标志间的距离分别是:闭孔神经-股静脉为12.9 ± 2.9 mm ,闭孔神经-耻骨结节为19.9 ± 2.6 mm。在病人身上获得的测量数据为:股动脉-针尖距离为 18.5 ± 2.4 mm,进针深度为 48.3 ± 10.4 mm,耻骨结节- 穿刺点的水平距离为 18.8 ± 2.0 mm,耻骨结节-穿刺点的垂直距离为 21.1 ± 2.9 mm。与基础值相比,在病人处得到的直观类比标度计分较低。93%的病人(15人中14人)对阻滞的效果表示满意。


(陈珺珺译 薛张纲校)

BACKGROUND: Obturator nerve block is one of the most technically challenging regional anesthesia techniques. Recently, the characteristics of the nerve have been described using ultrasound. However, clinical application of proximal ultrasound-guided obturator nerve block on patients has not been reported. In this study, we used ultrasound to describe the anatomical localization of the obturator nerve and its two branches in cadavers, volunteers, and also patients.

METHODS: A hyperechoic triangular shape formed by the superior  pubic ramus, posterior margin of the pectineus muscle and anterior aspect of the external obturator muscle containing the obturator vessels and nerve was defined by ultrasound imaging in cadavers. In eight volunteers, bilateral obturator nerve images were obtained and the distances to specific landmarks (femoral artery, femoral vein, and pubic tubercle) were recorded. Ultrasound-guided obturator nerve block was further performed in 15 patients by using the previously defined approach. The final distance of the needle tip to the femoral artery, distances between the needle insertion point to the pubic tubercle and the depth of needle insertion were recorded.

RESULTS: The rates of common obturator nerve, anterior and branching obturator nerve pattern visibility with ultrasound were determined in 12/16, 13/16, and 7/16 sites in volunteers, respectively. Mean (sd) values of critical landmarks obtained from volunteers were obturator nerve-femoral vein 12.9 ± 2.9 mm and obturator nerve-pubic tubercle 19.9 ± 2.6 mm. Mean measurements obtained from patients were: femoral artery- needle tip 18.5 ± 2.4 mm, needle depth 48.3 ± 10.4 mm, pubic tubercle- needle insertion point (horizontal) 18.8 ± 2.0 mm, and pubic tubercle- needle insertion point (vertical) 21.1 ± 2.9 mm. Visual analog scale scores obtained from patients at 1 and 24 h were lower compared to baseline values (P < 0.001). Ninety-three percent (14 of 15) of the patients reported satisfaction from the block.

CONCLUSIONS: Landmarks defined in this clinical trial can be used in patients for obturator nerve block with ultrasound guidance.



Fast-Track Anesthesia and Cardiac Surgery: A Retrospective Cohort Study of 7989 Patients

Vesna Svircevic, MD*, Arno P. Nierich, MD, PhD{dagger}, Karel G. M. Moons, PhD*{ddagger}, George J. Brandon Bravo Bruinsma, MD, PhD§, Cor J. Kalkman, MD, PhD*, and Diederik van Dijk, MD, PhD*||

From the *Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands; {dagger}Department of Anesthesiology, Isala Clinics, Groot Weezenland 20, Zwolle, The Netherlands; {ddagger}Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; §Department of Cardiothoracic Surgery, Isala Clinics, Groot Weezenland 20, Zwolle, The Netherlands; and ||Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.

Anesth Analg 2009 108: 727-733.




结果 CCA4020例,FTCA3969例。FTCA组病人年龄略大,较多并存疾病及较多的换瓣手术。住院期间死亡率CCA组为1.9%FTCA2.3%FTCACCA组与死亡率比值为1.2095%区间,0.65-1.32P=0.66),调整后比值为0.92。住院期间心肌梗死率CCA5.2%FTCA5.5%P=0.61,中风发生率CCA0.9%,FTCA1.3%(P=0.06),肾衰发生率组间相当(0.8%P=0.84)。FTCA组机械通气时间短于CCA组(6vs12hP ≤0.001),但ICU入驻时间平均值要比CCA组长1小时(23vs22hP ≤0.001)。虽然两组的住院时间平均值都是6 天,但CCA组第90百分位病人的住院天数为13 天,FTCA组为18 天(P ≤0.001)。

结论: 源自7989例心脏手术病人的数据显示没有证据表明应用FTCA增加不良后果的风险。

(郑丽 译 陈杰 校)

BACKGROUND: Fast-track cardiac anesthesia (FTCA) has been widely implemented but its safety has not been evaluated in sufficiently powered studies.

METHODS: We compared outcomes of patients undergoing FTCA with a historical control group undergoing conventional high-dose opioid cardiac anesthesia (CCA). The primary outcome measure was the incidence of in-hospital mortality. Secondary outcome measures were the incidence of in-hospital acute myocardial infarction, renal failure, and stroke. We also compared duration of mechanical ventilation and length of hospitalization in the intensive care unit and postoperative ward.

RESULTS: The CCA group comprised 4020 patients and the FTCA Group 3969 patients. The patients in the FTCA group were slightly older, had more comorbidities, and were more likely to undergo valve surgery than the CCA group. The incidence of in-hospital mortality was 1.9% in the CCA group and 2.3% in the FTCA group. Compared with the CCA group, the crude odds ratio for mortality in the FTCA group was 1.20 (95% confidence interval 0.88–1.64, P = 0.25) and the adjusted odds ratio was 0.92 (95% confidence interval, 0.65–1.32, P = 0.66). The incidence of myocardial infarction and stroke in the CCA and FTCA groups were 5.2% and 5.5% (P = 0.61), and 0.9% and 1.3%, (P = 0.06), respectively, whereas the incidence of acute renal failure was similar in both groups (0.8%, P = 0.84). The duration of mechanical ventilation was shorter in the FTCA patients compared with the CCA group (6 vs 12 h, P ≤0.001), but their median intensive care stay was 1 h longer (23 vs 22 h, P ≤0.001). Although the median duration of hospitalization was 6.0 days in both groups, the 90th percentile of the hospitalization time was 13 days in the CCA group and 18 days in the FTCA group (P ≤0.001).

CONCLUSIONS: These data from 7989 cardiac surgical patients showed no evidence of an increased risk of adverse outcomes in patients undergoing FTCA.


The Effects of Fibrinogen Levels on Thromboelastometric Variables in the Presence of Thrombocytopenia

Thomas Lang, MD*{dagger}, Kai Johanning, MD*, Helfried Metzler, MD{ddagger}, Siegfried Piepenbrock, MD*, Cristina Solomon, MD*, Niels Rahe-Meyer, MD, PhD*, and Kenichi A. Tanaka, MD, MSc§

From the *Department of Anesthesiology, Medical School, Hannover, Germany; {dagger}Werlhof Institut, Hannover, Germany, {ddagger}Department of Anesthesiology, University Medical School, Graz, Austria; and §Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.

Anesth Analg 2009 108: 751-758.



方法:采集健康志愿者血液标本。血小板计数对血凝块强度〔通过测量血凝块最大弹性(MCE)〕的影响通过ROTEM评估。富含血小板血浆(PRP)用自体血浆调节到一般水平血小板计数再测量。PRPs被调整为10 x 103 mm–3 50 x 103 mm–3100 x 103 mm–3,纤维蛋白原浓度集中在550780mg/dl。用FIBTEM法在不依赖血小板附着作用下分析纤维蛋白对血块的聚合作用。另外回顾性分析两组中血小板减少患者血块强度(MCE)。

结果:血块强度在血小板计数低于100 x 103 mm–3时减少,计数多于400 x 103 mm–3时血块强度增强。即使在低血小板计数(10 x 103 mm–3)时,增加纤维蛋白原浓度呈浓度依赖性增加血凝块强度。在904例血小板减少患者分析获得的数据证实了血凝块强度和血浆纤维蛋白原水平呈正相关。


(刘世文 译 陈杰 校)

BACKGROUND: The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM®). In this study, we investigated the effect of fibrinogen concentration and its relative contribution to overall clot strength using ROTEM.

METHODS: Blood samples were collected from healthy volunteers. The effects of platelet count on clot strength, determined by maximum clot elasticity (MCE), were evaluated on ROTEM using platelet-rich plasma (PRP) adjusted with autologous plasma to generate a range of platelet counts. PRPs were adjusted to 10 x 103 mm–3, 50 x 103 mm–3, and 100 x 103 mm–3 and spiked with fibrinogen concentrates at 550 and 780 mg/dL. The effect of fibrin polymerization on clot strength, independent of platelet attachment, was analyzed by the cytochalasin D-modified thromboelastometry (FIBTEM®) method. Additional retrospective analysis of clot strength (MCE) in two groups of thrombocytopenic patients was conducted.

RESULTS: Clot strength (MCE) decreased at a platelet count below 100 x 103 mm–3, whereas increases in MCE peaked and reached a plateau at platelet counts from 400 x 103 mm–3. Increasing fibrinogen concentrations in PRP increased clot strength in a concentration-dependent manner, even at low platelet counts (10 x 103 mm–3). The positive correlation between clot strength and plasma fibrinogen level was also confirmed in the analysis of the data obtained from 904 thrombocytopenic patients.

CONCLUSIONS: These in vitro and clinical data indicate that the clot strength increases in a fibrinogen concentration-dependent manner independent of platelet count, when analyzed by ROTEM. The maintenance of fibrinogen concentration is critical in the presence of thrombocytopenia. EXTEM® (extrinsic activation) and FIBTEM may be useful in guiding fibrinogen repletion therapy.


Transfusion-Related Acute Lung Injury: Current Concepts for the Clinician

Darrell J. Triulzi, MD

From the Department of Pathology, Division of Transfusion Medicine, University of Pittsburgh Medical Center, Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.

Anesth Analg 2009 108: 770-776.


在美国输血相关的发病率和死亡率的首要原因是输血相关的急性肺损伤(TRALI)TRALI诊断标准为:在可以排除心衰或血管容量负荷过重的情况下,输血6小时内的发生的缺氧和双肺水肿。主要的鉴别诊断是输血相关循环超负荷。支持治疗的方法包括给氧和机械通气。利尿并无特效,激素的作用也未证实。患者通常数天内痊愈。所有类型的血液制品都曾与急性肺损伤相关。但是,富含血浆成分的制品,如新鲜冰冻血浆和血浆分离置换法血小板,最常发生。目前尚不能完全解释急性肺损伤的发病机制。多数情况下与针对人类白细胞抗原( HLA I/人类白细胞抗原II类或中性粒细胞特异性抗原[尤其是HNA- 3A]的抗体, 和供血者血浆里的白细胞抗体有关。肺血管内皮细胞的活化是导致急性肺损伤的重要因素,可能解释了手术或重症监护病房里观察到的患者的大多数情况。输血中的白细胞凝集抗体结合肺血管内皮细胞局部的中性粒细胞,导致激活和释放氧化酶和其他有害生物活性物质,造成毛细血管渗漏。在少数急性肺损伤中下,不能证实存在抗体,则假定输注的血液成分里的中性粒细胞促发因素可以调节急性肺损伤患者肺血管内皮活化,所谓的两次打击的机制。对抗白细胞抗体作用的进一步认识,以减少了引起急性肺损伤风险。曾经怀孕过一次的女性血液中常常带有HLA抗体,总患病率为24 %,其发生概率随曾经怀孕的次数而递增。自从认识到HLA抗体同急性肺损伤有关,中心血站已采取策略是主要从男性的捐助者获取血浆成分。为了降低机采血小板相应的风险,采取事先检测女性血小板捐助者的HLA抗体。需要更进一步的研究来了解导致急性肺损伤相关血液成分和患者的危险因素,推广新的治疗方案和措施,以减少发生急性肺损伤的风险。

(叶乐 译 陈杰 校)

The leading cause of transfusion-related morbidity and mortality in the United States is transfusion-related acute lung injury (TRALI). Diagnostic criteria for TRALI have recently been developed and primarily consist of hypoxia and bilateral pulmonary edema occurring during or within 6 h of a transfusion in the absence of cardiac failure or intravascular volume overload. The primary differential diagnosis is transfusion-associated circulatory overload and differentiation can be difficult. Treatment is supportive with oxygen and mechanical ventilation. Diuresis is not indicated and the role of steroids is unproven. Patients typically recover within a few days. All types of blood products have been associated with TRALI, however, the plasma-rich components, such as fresh frozen plasma and apheresis platelets, have been most frequently implicated. The pathogenesis of TRALI is not completely understood. Leukocyte antibodies in donor plasma have been implicated in most cases with antibodies directed at human leukocyte antigen (HLA) class I, HLA class II or neutrophil-specific antigens, particularly HNA-3a. Activation of pulmonary endothelium is important in the development of TRALI and may account for most cases being observed in surgical or intensive care unit patients. Transfused leukoagglutinating antibodies bind to recipients’ neutrophils localized to pulmonary endothelium resulting in activation and release of oxidases and other damaging biologic response modifiers that cause capillary leak. In a minority of TRALI cases, no antibodies are identified and it is postulated that neutrophil priming factors in the transfused component can mediate TRALI in a patient with pulmonary endothelial activation, the so called "two hit" mechanism. Recognition of the role of anti-leukocyte antibodies has led to new strategies to reduce the risk of TRALI. Female blood donors with a previous pregnancy frequently have HLA antibodies with an overall prevalence of 24% and increasing prevalence related to the number of previous pregnancies. Since HLA antibodies have been implicated in TRALI, blood centers have adopted policies to produce plasma components primarily from male donors. Strategies to reduce the risk from apheresis platelets are problematic and are likely to involve testing female apheresis platelet donors for HLA antibodies. Much more research is needed to understand the blood component and patient risk factors for TRALI so that novel strategies for treatment and additional measures to reduce the risk of TRALI can be developed.


Relative Analgesic Potencies of Levobupivacaine and Ropivacaine for Caudal Anesthesia in Children

Pablo Ingelmo, MD*, Geoff Frawley, MD{dagger}, Marinella Astuto, MD*, Chris Duffy, MD{dagger}, Susan Donath, PhD{ddagger}, Nicola Disma, MD§, Giuseppe Rosano, MD§, Roberto Fumagalli, MD*, and Antonio Gullo, MD§

From the *Department of Perioperative Medicine and Intensive, A.O. San Gerardo, Monza, Dipartimento di medicina sperimentale ambientale e biotecnologie mediche, Università degli Studi Milano Bicocca, Milan, Italy; {dagger}Department of Paediatric Anesthesia and Pain Management, Royal Children’s Hospital. Melbourne Australia; {ddagger}Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, University of Melbourne Australia; and §Department of Anesthesia, A.O.U. Policlinico Catania, Università degli Studi di Catania, Italy.

Anesth Analg 2009 108: 805-813.



方法:前瞻性、随机、双盲研究比较儿童骶管罗哌卡因和左旋布比卡因镇痛的剂量反应曲线。第一部分, 80名男童随机接受罗哌卡因或左旋布比卡因。第二部分,32名患者随机接受剂量为ED50-ED95 范围内50%有效剂量以描绘剂量反应曲线。

结果:以罗哌卡因和左旋布比卡因行骶管阻滞的ED50无显着差异。以狄克逊法估计左旋布比卡因ED500.069 % ( 95 CI0.056 -0.082 % )和罗哌卡因是0.075 % ( 95 CI0.058 -0.092 % ) 。左旋布比卡因等张回归法ED50ED95分别为0.068 0.04-0.09 )和0.20 % ( 95 CI0.16 -0.24 % ) 。罗哌卡因ED50ED95分别为0.066 0.033-0.098 )和0.225 % ( 95 CI0.21 -0.24 % ) 。

结论:儿童接受一个MAC的七氟醚下,左旋布比卡因和罗哌卡因骶管阻滞ED50没有显着性差异的。ED50药效比为0.92ED95药效比为0.89 ,表明左旋布比卡因和罗哌卡因在骶管麻醉时有相似的效力。

(张磊 译 陈杰 校)

BACKGROUND: Comparing relative potency of new local anesthetics, such as levobupivacaine and ropivacaine, by the minimum local analgesic concentration model has not been described for caudal anesthesia. Therefore, we performed a prospective, randomized, double-blind study to determine the minimum local analgesic concentrations of a caudal single shot of ropivacaine and levobupivacaine in children and to describe the upper dose-response curve.

METHODS: We performed a two-stage prospective, randomized, double-blind study comparing the dose-response curves of caudal ropivacaine and levobupivacaine in children. In phase 1, 80 boys were randomized to receive either ropivacaine or levobupivacaine. In the second phase a further 32 patients were randomly allocated to receive caudal anesthesia with doses designed to delineate the upper dose-response range (the 50% effective dose [ED50]-ED95 range).

RESULTS: There were no significant differences in ED50 values for caudal ropivacaine and levobupivacaine. The ED50 for levobupivacaine estimated from the Dixon Massey method was 0.069% (95% CI 0.056%-0.082%) and for ropivacaine was 0.075% (95% CI 0.058%-0.092%). Estimated by isotonic regression the ED50 and ED95 respectively of levobupivacaine were 0.068 (0.04-0.09) and 0.20% (95% CI 0.16%-0.24%). For ropivacaine ED 50 and ED95 were 0.066 (0.033-0.098) and 0.225% (95% CI 0.21%-0.24%).

CONCLUSIONS: In children receiving one minimum alveolar anesthetic concentration of sevoflurane, there were no significant differences in the ED50 for caudal levobupivacaine and ropivacaine. The potency ratio at ED50 was 0.92 and 0.89 at ED95, indicating that caudal levobupivacaine and ropivacaine have a similar potency.


Methemoglobinemia Related to Local Anesthetics: A Summary of 242 Episodes

Joanne Guay, MD, FRCPC

From the Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal Canada.

Anesth Analg 2009 108: 837-845.

结果:共有242个个案( 40.1 %刊登在2000年或之后)。红褐色的血液表明高铁血红蛋白血症,但其它颜色可能会被发现。在91.8%的个案中脉搏血氧仪饱和度( 小于或等于 90 % )与动脉血氧分压( 大于或等于 70毫米汞柱)存在偏差。用脉搏血氧仪测定的血氧饱和度和共同血氧饱和度之间的差异从-6.2 %至44.7 % 。6个月以上的儿童使用剂量超过2.5
mg/kg的单纯丙胺卡因可诱导高铁血红蛋白血症。在成人,丙胺卡因的剂量应低于5.0mg/kg.,存在肾功能不全时减少到3.2 mg/kg.和如果同时使用其他氧化药物时减少到1.3 mg/kg.。一个单纯苯佐卡因喷雾剂可能导致高铁血红蛋白血症。在相对较低的血红蛋白值时可以观察到临床症状,包括32.2%的儿童和29.1 %的成人出现昏迷。在给予亚甲蓝后,59.9 %患者出现反弹性高铁血红蛋白血症并持续18h。高铁血红蛋白血症的并发症包括缺氧性脑病,心肌梗塞和死亡。 

(张燕 译 陈杰 校)

BACKGROUND: The purpose of this article is to summarize all episodes of local anesthetic-related methemoglobinemia found in the medical literature.

METHODS: I performed a search of the American National Library of Medicine's PubMed with the following key words: "local anesthetic" and "methemoglobinemia."

RESULTS: Two-hundred-forty-two episodes (40.1% published in year 2000 or after) were found. Chocolate-colored blood suggests methemoglobinemia but other colors may be found. A discrepancy between the pulse oximeter saturation (≤90%) and the arterial oxygen partial pressure (≥70 mm Hg) was present in 91.8% of the episodes. The difference between oxygen saturation measured by pulse oximetry and co-oximetry varied from –6.2% to 44.7%. Plain prilocaine may induce clinically symptomatic methemoglobinemia in children older than 6 mo at doses exceeding 2.5 mg/kg. In adults, the dose of prilocaine should be kept lower than 5.0 mg/kg, which is reduced to 3.2 mg/kg in the presence of renal insufficiency and to 1.3 mg/kg if other oxidizing drugs are used concurrently. A single spray of benzocaine may induce methemoglobinemia. Clinical symptoms may be observed at relatively low methemoglobin values, including coma at 32.2 and 29.1% in children and adults, respectively. Rebound methemoglobinemia (benzocaine on mucous membranes) with methemoglobin values as high as 59.9% may occur up to 18 h after methylene blue administration. Complications of methemoglobinemia include hypoxic encephalopathy, myocardial infarction, and death.

CONCLUSION: Benzocaine should no longer be used. Prilocaine should not be used in children younger than 6-mo-old, in pregnant women, or in patients taking other oxidizing drugs. The dose should be limited to 2.5 mg/kg.


Xenon Preconditioning: The Role of Prosurvival Signaling, Mitochondrial Permeability Transition and Bioenergetics in Rats

Yasushi Mio, MD*{dagger}, Yon Hee Shim, MD*, Ebony Richards, BS*, Zeljko J. Bosnjak, PhD*, Paul S. Pagel, MD, PhD*, and Martin Bienengraeber, PhD*{ddagger}

From the *Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin; {dagger}Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan; and {ddagger}Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee; Wisconsin.

Anesth Analg 2009 108: 858-866.



方法:雄性Wistar大鼠在血流动力学监测下接受30min左冠状动脉前降支阻塞和2 h再灌注。大鼠随机接受70 % 氮气/30 %的氧气(对照组)或三个周期的吸入70 % 氙气/30 %氧气5min间隙吸入氧/氮混合气体5min。使用三苯染色测量心肌梗死面积。对照组和氙气处理组大鼠的离体心脏用于磷酸化AktGSK - 3βWestern免疫印迹和孤立的线粒体。线粒体缺氧/复氧前后的氧耗决定了线粒体通透性转换孔的开放。

结果:与对照组相比,氙气显著减少心肌梗死面积( 32 ± 459 ± 4 %,P < 0.05 )和增加磷酸化AktGSK- 3β 。与对照组相比,氙气预处理保存分离线粒体的呼吸状态。氙气预处理组诱导线粒体膜去极化所需的Ca2 +浓度较大(分别为 78 ± 1756 ± 17 μm) 。磷酸肌醇-3激酶的抑制剂wortmannin阻止了氙气对梗死面积和呼吸的效应。

结论:结果表明,氙气预处理减少心肌梗死面积, 磷酸化 AktGSK-3β,维护线粒体功能,抑制钙离子诱导的线粒体通透性转换孔开放。这些数据表明,氙气诱导心脏保护的发生,是因为激活促存活线粒体,并使它们更不容易受到缺血再灌注损伤。

(舒慧刚 译 陈杰 校)

BACKGROUND: Similar to volatile anesthetics, the anesthetic noble gas xenon protects the heart from ischemia/reperfusion injury, but the mechanisms responsible for this phenomenon are not fully understood. We tested the hypothesis that xenon-induced cardioprotection is mediated by prosurvival signaling kinases that target mitochondria.

METHODS: Male Wistar rats instrumented for hemodynamic measurements were subjected to a 30 min left anterior descending coronary artery occlusion and 2 h reperfusion. Rats were randomly assigned to receive 70% nitrogen/30% oxygen (control) or three 5-min cycles of 70% xenon/30% oxygen interspersed with the oxygen/nitrogen mixture administered for 5 min followed by a 15 min memory period. Myocardial infarct size was measured using triphenyltetrazolium staining. Additional hearts from control and xenon-pretreated rats were excised for Western blotting of Akt and glycogen synthase kinase 3 β (GSK-3β) phosphorylation and isolation of mitochondria. Mitochondrial oxygen consumption before and after hypoxia/reoxygenation and mitochondrial permeability transition pore opening were determined.

RESULTS: Xenon significantly (P < 0.05) reduced myocardial infarct size compared with control (32 ± 4 and 59% ± 4% of the left ventricular area at risk; mean ± sd) and enhanced phosphorylation of Akt and GSK-3β. Xenon pretreatment preserved state 3 respiration of isolated mitochondria compared with the results obtained in the absence of the gas. The Ca2+ concentration required to induce mitochondrial membrane depolarization was larger in the presence compared with the absence of xenon pretreatment (78 ± 17 and 56 ± 17 µM, respectively). The phosphoinositol-3-kinase-kinase inhibitor wortmannin blocked the effect of xenon on infarct size and respiration.

CONCLUSIONS: These results indicate that xenon preconditioning reduces myocardial infarct size, phosphorylates Akt, and GSK-3β, preserves mitochondrial function, and inhibits Ca2+-induced mitochondrial permeability transition pore opening. These data suggest that xenon-induced cardioprotection occurs because of activation of prosurvival signaling that targets mitochondria and renders them less vulnerable to ischemia-reperfusion injury.


Noninvasive Cardiac Output Measurement in Heart Failure Subjects on Circulatory Support

Rob Phillips, MPhil*, Peter Lichtenthal, MD{dagger}, Julie Sloniger, MS{dagger}, Darryl Burstow, MD*, Malcolm West, MD*, and Jack Copeland, MD{ddagger}

From the *Department of Medicine, The University of Queensland, Brisbane, Australia; {dagger}Department of Anesthesiology, and {ddagger}Department of Surgery, The University of Arizona College of Medicine, Tucson, Arizona.

Anesth Analg 2009 108: 881-886.


背景:尽管存在效力不明、使用困难、安全性等问题,肺动脉导管(PAC)监测仍广泛用于围术期心脏外科重症监护室病人血流动力学的监测和管理。 USCOM是一种无创性连续多普勒波直接测量心输出量( CO )的装置,可作为PAC的替代者。 尽管USCOM的可靠性未获公认,相对于PAC该方法在心脏外科重症监护病房中有着更好的可用性。作者在应用完全型人工心脏 (TAH)控制心衰患者中比较了应用USCOMCardioWest监测心输出量的差别。
TAH患者的心输出量、每搏输出量(SV)和心率( HR ) 。CardioWest 通过187个项目的测试获得了508个不同的配对数据。用Bland-Altman法分析比较。

结果CardioWest USCOM测得的心输出量、每搏输出量和心率的平均值及标准差( ±标准差)分别为7.33 ± 0.467.34 ± 0.51L/min 56.2 ± 3.856.6 ± 3.8 mL131 ± 3130 ± 4bpm。心输出量在5.29.3 L/min之间。两种方法对测量心输出量、每搏输出量和心率的平均差分别是-0.01 ± 0.23 L/min -0.34 ± 1.97 mL0.9 ± 2.3bpm,平均百分比差异分别为-0.3 % , -0.6 %和0.7 % 。心输出量、每搏输出量和心率的一致性百分比分别为6.4 % , 7.1 %和3.6 % 。
结论: 对心衰行

(丁俊云 译 陈杰 校)

BACKGROUND: Pulmonary artery catheter (PAC) thermodilution is commonly used in the perioperative cardiac surgical intensive care unit for measurement and management of central hemodynamics despite questions about effectiveness, difficulty of use, and safety. USCOM is a noninvasive continuous wave Doppler device for direct measurement of cardiac output (CO) and is an alternative to PAC. USCOM validation has predominantly been in the cardiac surgical intensive care unit against PAC, despite the recognized limitations in reliability of the method. We compared USCOM CO measurements with the CardioWest, an orthotopic total artificial heart (TAH), in heart failure (HF) subjects during controlled interventions.

METHOD: CO, stroke volume (SV), and heart rate (HR) were measured in a blinded fashion using the CardioWest and the USCOM device in TAH HF patients. Five-hundred eight paired measures from 18 examinations of seven subjects were acquired as flow was varied by the CardioWest controller. Bland-Altman analysis was used to compare agreement.

RESULTS: Mean values and standard deviations (±sd) for CO, SV, and HR by CardioWest and USCOM were 7.33 ± 0.46 and 7.34 ± 0.51 L/min, 56.2 ± 3.8 and 56.6 ± 3.8 mL, and 131 ± 3 and 130 ± 4 bpm, respectively. CO ranged from 5.2 to 9.3 L/min. The mean differences between methods for CO, SV, and HR were –0.01 ± 0.23 L/min, –0.34 ± 1.97 mL, and 0.9 ± 2.3 bpm, respectively, with mean percentage differences of –0.3%, –0.6%, and 0.7%. The percentage limits of agreement for CO, SV, and HR were 6.4%, 7.1%, and 3.6%.

DISCUSSION: USCOM is a feasible and accurate method for noninvasive measurement and monitoring of CO in TAH HF patients and may have a wider application in diagnosis and management of cardiovascular disease.




Minimally Invasive Cardiac Output Monitoring in the Perioperative Setting

Duane J. Funk, MD, FRCPC, Eugene W. Moretti, MD, MHsc, and Tong J. Gan, MB, MHS, FRCA, FFARCS(I)

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

Anesth Analg 2009 108: 887-897.


随着患者年龄的增长及其并存病的升高,我们日益需求围术期对患者的生理学指标,如心排出量(cardiac outputCO)、液体治疗后的响应性和组织灌注情况进行跟踪监测的设备。 麻醉医师所持有的用于监测患者CO的工具 是肺动脉导管或者经食管超声心动图。这些装置都存在着一定的缺陷,并且可能会引起并发症。最近,已有一些新的装置投入市场(包括食管多普勒监测、脉搏波形分析、指示剂稀释、胸部生物电阻抗和部分无重复吸入系统等),它们能够无创监测CO,并且在某些情况下评估患者对液体治疗的反应。在这篇综述中,作者描述了这些新装置所涉及的技术,有关应用的研究,以及它们在应用过程中的缺陷。

(周姝婧 译 陈杰 校)

With advancing age and increased co-morbidities in patients, the need for monitoring devices during the perioperative period that allow clinicians to track physiologic variables, such as cardiac output (CO), fluid responsiveness and tissue perfusion, is increasing. Until recently, the only tool available to anesthesiologists to monitor CO was either a pulmonary artery catheter or transesophageal echocardiograph. These devices have their limitations and potential for morbidity. Several new devices (including esophageal Doppler monitors, pulse contour analysis, indicator dilution, thoracic bioimpedance and partial non-rebreathing systems) have recently been marketed which have the ability to monitor CO noninvasively and, in some cases, assess the patient’s ability to respond to fluid challenges. In this review, we will describe these new devices including the technology, studies on their efficacy and the limitations of their use.


Early Anesthetic Preconditioning in Mixed Cortical Neuronal-Glial Cell Cultures Subjected to Oxygen-Glucose Deprivation: The Role of Adenosine Triphosphate Dependent Potassium Channels and Reactive Oxygen Species in Sevoflurane-Induced Neuroprotection

Lionel J. Velly, MD*{dagger}, Paula T. Canas, MD*, Benjamin A. Guillet, PhD{dagger};, Christelle N. Labrande, PhD{dagger}, Frédérique M. Masmejean, BS{ddagger}, André L. Nieoullon, PhD{ddagger}, François M. Gouin, MD*, Nicolas J. Bruder, MD*, and Pascale S. Pisano, PhD{dagger}

From the *Department of Anesthesia, Centre Hospitalier Universitaire Timone Adultes, Marseille, France; {dagger}Laboratory of Pharmacodynamic, UMR INSERM 608, Marseille, France; and {ddagger}Laboratory IC2N, UMR6186 CNRS, Université de la Méditerranée, Marseille, France.

Anesth Analg 2009 108: 955-963.


背景:这项关于混合皮层神经元-神经胶质细胞培养遭受短时氧糖缺失(OGD)的研究的目的是 :1)比较在氧糖缺失之前(预处理)或期间(直接神经保护)增加七氟醚所产生的神经保护作用。2)探讨在七氟醚的早期预处理作用机制中,三磷酸腺苷敏感性钾(KATP)通道参与的可能性和细胞内活性氧(ROS)的水平。

方法:成熟的混合皮层神经元-神经胶质细胞在厌氧培养室里暴露90min的氧糖缺失,随后复氧。OGD前随机给予七氟醚(0.03-3.4Mm90min和停用60min(早期预处理)或 OGD期间应用七氟醚90min(直接神经保护作用)。在乳酸脱氢酶释放到培养基法量化24小时细胞死亡数。用2’-7’ 二氯荧光素乙酰乙酸盐来评估七氟醚预处理后细胞内活性氧的产生。



(黄丹 译 陈杰 校)

BACKGROUND: The purpose of the present study, on mixed cortical neuronal-glial cell cultures subjected to transient oxygen-glucose deprivation (OGD) was: i) to compare the neuroprotection afforded by sevoflurane added either before (preconditioning) or during (direct neuroprotection) the OGD and ii) to explore the possible involvement of adenosine triphosphate-sensitive potassium (KATP) channels and intracellular reactive oxygen species (ROS) levels in the mechanism of the early preconditioning effect of sevoflurane.

METHODS: Mature mixed cortical neuronal-glial cell cultures were exposed to 90-min OGD in an anaerobic chamber followed by reoxygenation. Sevoflurane (0.03–3.4 mM) was randomly administered for 90 min and discontinued 60 min before OGD (early preconditioning) or during the 90-min OGD (direct neuroprotection). Cell death was quantified 24 h after the OGD by lactate dehydrogenase release into the bathing medium. Intracellular ROS generation was assessed at the end of sevoflurane preconditioning using 2',7'-dichlorofluorescin diacetate.

RESULTS: Sevoflurane preconditioning elicited a potent threshold-dependent neuroprotective effect at concentrations higher than 0.07 mM and sevoflurane added during OGD elicited a dose dependent neuroprotective effect. Blockers of KATP channels (glibenclamide 0.3 µM and 5 hydroxydecanoic acid 50 µM), or ROS-scavengers (N-2-mercaptopropionyl glycine 100 µM and N-acetylcysteine 50 µM), although they did not affect cell viability, counteracted the neuroprotection produced by early sevoflurane preconditioning. Sevoflurane exposure during preconditioning induced a significant increase in ROS levels which was prevented by both ROS scavengers and blockers of KATP channels.

CONCLUSION: Early sevoflurane preconditioning induced a threshold-dependent protection of mixed cortical neuronal-glial cell cultures against OGD by mechanisms that seem to involve opening KATP channels, thereby leading to generation of ROS.


The Analgesic Effect of a Metered-Dose 8% Lidocaine Pump Spray In Posttraumatic Peripheral Neuropathy: A Pilot Study

Akifumi Kanai, MD, PhD, Yuka Segawa, MD, Takashi Okamoto, MD, Masanori Koto, MD, and Hirotsugu Okamoto, MD, PhD

From the Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan.

Anesth Analg 2009 108: 987-991.


背景:利多卡因表面贴片能够有效地治疗创伤后外周神经病变(posttraumatic peripheral neuropathy,PTPN),但由于需要额外使用,它不适用于爆发性疼痛。在这里,作者评估了8%利多卡因喷雾泵(Xylocaine pump spray,XPS)对由手术或损伤所致的外周神经病理性疼痛的效果。




(周姝婧 译 陈杰 校)

BACKGROUND: A topical lidocaine patch is effective in the treatment of posttraumatic peripheral neuropathy (PTPN), but it is not suited for breakthrough pain because of difficulty with an additional application. Here, we examined the effect of 8% lidocaine pump spray (Xylocaine pump spray®, XPS) on peripheral neuropathic pain caused by surgery or injury.

METHODS: Thirty-one patients with PTPN were randomized to receive either XPS or saline placebo pump spray applied to painful skin areas. The optimal dose of up to 30 sprays (0.1 mL/single spray, 30 times) was individually determined as the dose which completely covered the painful site. After a 7-day period, the patients were crossed over to receive the optimal dose of the alternative spray. Pain was assessed with a visual analog scale.

RESULTS: XPS, but not placebo pump spray, significantly decreased the visual analog scale for continuing pain and tactile allodynia. The effect persisted for a median of 5 h (range, 2–60 h) after application. Mild side effects were reported in three patients with XPS consisting of local irritation (n = 3) and local flare (n = 1). All adverse events disappeared without medication within a few hours.

CONCLUSIONS: The present study suggests that XPS provides a significant improvement in PTPN due to its prompt analgesia, lack of systemic side effects and convenience.



An Absorbable Local Anesthetic Matrix Provides Several Days of Functional Sciatic Nerve Blockade

Chi-Fei Wang, MD*, Alimorad G. Djalali, MD, PhD*, Ankur Gandhi, PhD{dagger}, David Knaack, PhD{dagger}, Umberto De Girolami, MD{ddagger}, Gary Strichartz, PhD*, and Peter Gerner, MD*

From the *Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; {dagger}Orthocon, Inc., North Brunswick, New Jersey; and {ddagger}Division of Neuropathology, Department of Pathology, Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts.

Anesth Analg 2009 108: 1027-1033.


背景:周围神经的功能性阻滞是局部麻醉的基本目的,期待其作用持久,涵盖或超过整个手术期。现有的局麻药在一个单剂量给药后提供的有效镇痛时间小于8—12h。作者报告了一个可用于骨科,植入性的、可控制释放的药物给予装置, 包括一个FDA批准的包含利多卡因基质),能够局部释放几天之久。

方法Xybrex,一个可吸收,控制释放的给药装置,包括16%w/w)利多卡因,在雄性大鼠(300-350 gm)中植入在坐骨神经附近,每只大鼠的利多卡因剂量分别为5.310.61632mg。作为对照,盐酸利多卡因溶液(0.2 mL 2% = 4 mg)注射在非常靠近坐骨神经的地方。通过用镊子夹捏外侧脚趾的行为来评估大鼠痛觉,同时通过量化伸肌的推力来评估运动阻滞。在植入后24h4d4wk评估可能的坐骨神经的神经毒性。在体外测量利多卡因从装置中释放动力学。在2.56.51024.25h时收集样本测定利多卡因。

结果Xybrex在高剂量(分别为300600mg/ka,包含1632mg的利多卡因游离碱)提供了对于一个强烈的夹捏完全的镇痛分别为7.0 ± 2.0 h, 6.9± 1.7 h ,和一个不完全的镇痛分别为60.0 ± 5.4 h, 58.8 ±4.2 h,相对于由2%的利多卡因溶液(包含4mg利多卡因)引起的坐骨神经阻滞完全镇痛为 0.61± 0.03 h 和不完全镇痛为0.96 ±0.03 h 。这些同样高剂量的Xybrex 产生了完全的运动阻滞分别为17.0± 3.3 h, 17.6 ± 3.3 h ,并且完全恢复分别为352.0 ± 55.7 h (14.7 ± 2.3 d) 579.0 ±36.1 h (24.1 ± 1.5 d)。数据以平均 ± SE的形式记录。所有的Xybrex 组和2%利多卡因组相比时P < 0.001 。在靠近坐骨神经0.1mm的结缔组织和肌肉中小的局部组织炎症/病状,两组动物中均能观察到。实验中没有全身中毒征象。离体研究显示药物释放呈指数动力学特征,对比无时程性伤害缺乏意味着持续伤害性刺激在神经与该药装置间利多卡因直接的、局部作用,而无先前释放药物的累积效应


(怀晓蓉 译 陈杰 校)

BACKGROUND: Functional blockade of peripheral nerves is the primary objective of local anesthesia, and it is often desirable to have a persistent blockade, sustained throughout and beyond a surgical procedure. Current local anesthetics give effective analgesia for <8–12 h after a single bolus injection. We report on an implantable, controlled-release drug delivery system intended for use in bone and consisting of a Food and Drug Administration-approved matrix containing lidocaine that is capable of local delivery for several days.

METHODS: XybrexTM, an absorbable, controlled-release delivery system containing 16% (w/w) lidocaine, was implanted next to the sciatic nerve of male rats (300–350 gm), at lidocaine doses of 5.3, 10.6, 16, and 32 mg lidocaine per rat. For comparison, a lidocaine HCl solution (0.2 mL, 2% = 4 mg) was injected in close proximity to the sciatic nerve. Rats were assessed behaviorally for analgesia by a forceps pinch of the lateral digits, and for motor block by quantifying the extensor postural thrust. Potential neurotoxicity of sciatic nerves was evaluated histologically at 24 h, 4 days, and 4 wk after implantation. The kinetics of lidocaine’s release from the matrix was measured in vitro by ultraviolet detection of lidocaine in samples collected at 2.5, 6.5, 20, and 24.25 h.

RESULTS: Xybrex at the highest doses (300 and 600 mg/kg, containing 16 and 32 mg of lidocaine free base, respectively) provided complete analgesia to an intense pinch for 7.0 ± 2.0 h, 6.9 ± 1.7 h and partial analgesia for 60.0 ± 5.4 h, 58.8 ± 4.2 h, respectively, compared to 0.61 ± 0.03 h of complete analgesia and 0.96 ± 0.03 h of partial analgesia by sciatic block from the 2% lidocaine solution (containing 4 mg lidocaine). These same high doses of Xybrex produced complete motor block for 17.0 ± 3.3 h, 17.6 ± 3.3 h with full recovery in 352.0 ± 55.7 h (14.7 ± 2.3 days), 579.0 ± 36.1 h (24.1 ± 1.5 days) respectively. Data are reported as mean ± se. P < 0.001 for all Xybrex groups compared to the 2% lidocaine group. Minor local tissue inflammation/pathology, primarily in the connective tissue and muscle 0.1 mm adjacent to the nerve, was observed equally in animals treated with Xybrex and 2% lidocaine solution. There were no behavioral signs of systemic toxicity. The in vitro release followed exponential kinetics and。its comparison to the time-course of functional nociceptive deficit implied that the duration of nociception represented the local, immediate interaction of lidocaine between the nerve and the matrix and not a cumulative effect of previously released drug.

CONCLUSIONS: Xybrex is an absorbable, controlled-release drug delivery system that provides several days of analgesia for rat peripheral nerves without apparent significant local neurotoxicity or systemic toxicity.



The Efficacy of Skin Temperature for Block Assessment After Infraclavicular Brachial Plexus Block

Vincent Minville, MD*, Agnés Gendre, MD*, Jan Hirsch, MD{dagger}, Stein Silva, MD*, Benoît Bourdet, MD*, Carole Barbero, MD*, Olivier Fourcade, MD, PhD*, Kamran Samii, MD*, and Hervé Bouaziz, MD, PhD{ddagger}

From the *Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France; {dagger}Cardiovascular Research Institute, University of California, San Francisco, California; and {ddagger}Department of Anesthesiology and Intensive Care, University Hospital of Nancy, Nancy, France.

Anesth Analg 2009 108: 1034-1036.




结果:被阻滞神经总数为12030位患者,每位患者4根神经)。其中25例患者神经阻滞成功,4例由于阻滞失败需要静脉麻醉辅助,1例患者实施全麻。不同神经分布区域的皮肤温度变化无显著性差异。同一区域的皮肤温度在神经阻滞后升高,与阻滞前相比有显著性差异(T5T30P < 0.0001)。同一时间神经阻滞区域与非神经阻滞区域的平均皮肤温度有显著性差异(T5P < 0.05 T10T30P< 0.0001)。当阻滞后5分钟和10分钟,特定感觉区域的皮肤温度升高≥1°C,则对应的神经被阻滞(评分=0)。因此,当阻滞后5分钟和10分钟四条神经区域的皮肤温度都发生变化,那么在30分钟后神经成功阻滞。本研究中,患者的对侧上肢和中心体温无变化。


(赵嫣红 译 陈杰 校)

BACKGROUND: Although it has been reported that an increase in skin temperature indicates block success with higher specificity and sensibility than skin sensitivity to pinprick and cold, the methodology previously used computer-assisted infrared thermography, a technique that is expensive and requires substantial personnel training. In this prospective observational study, we evaluated whether a simple infrared thermometer can reliably predict block effectiveness after infraclavicular brachial plexus blockade.

METHODS: Thirty consecutive patients undergoing upper limb surgery under infraclavicular block were enrolled. From the end of the local anesthetic injection, skin temperature was measured in all four major nerve distribution areas, and the sensory block onset (using cold and pinprick with 0 = no sensation to 2 = normal) were evaluated every 5 min for 30 min. A successful block was defined as the absence of sensation to cold (swab soaked with alcohol) and pinprick (needle) with a score of "0" within 30 min after the injection in the 4 major nerve distribution areas (radial, ulnar, median and musculocutaneous). Skin temperature measurements were performed using a noncontact temperature probe.

RESULTS: One-hundred-twenty nerves (30 patients, 4 nerves per patient) were anesthetized. Twenty-five patients had a successful block. Four patients required supplementation for block failure. General anesthesia was performed in one patient. Skin temperature variation was not different among different nerves. There was a statistically significant increase in cutaneous temperature after nerve block compared to the same skin area before the procedure (P < 0.0001 from T5 to T30). Average temperature variations in blocked versus unblocked nerves at the same time were significantly different (P < 0.05 at T5 then P < 0.0001 from T10 to T30). When temperature in a specific sensory territory increased 1°C or more, at 5 and 10 min, the specific nerve was blocked (the score was "0"). Thus, when temperature changes in all 4 nerves were noted at 5 and 10 min, the block was successful at 30 min. No change in temperature in the contralateral arm or in the core temperature was observed.

CONCLUSION: Skin temperature assessment with an infrared thermometer is a reliable, simple and early indicator of a successful nerve block.



Does Thromboelastography Predict Postoperative Thromboembolic Events? A Systematic Review of the Literature

Yue Dai, MB, MSc*, Anna Lee, PhD*, Lester A. H. Critchley, MD*, and Paul F. White, PhD, MD{dagger}

From the *Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China; and {dagger}Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.

Anesth Analg 2009; 108:734-742















BACKGROUND: Since thromboelastography (TEG) can detect hypercoagulable states, it is a potentially useful test for predicting postoperative thromboembolic complications. Therefore, we performed a systematic review of the literature to evaluate the accuracy of TEG in predicting postoperative thromboembolic events.

METHODS: PUBMED and EMBASE electronic databases were searched by two independent investigators to identify prospective studies involving adult patients undergoing operative procedures in which a TEG test was performed perioperatively and outcomes were measured by reference standards. The quality of included studies was assessed and measures of diagnostic test accuracy were estimated for each included study.

RESULTS: Ten studies (with a total of 1056 patients) were included in this analysis; however, only five reported measures of TEG test accuracy. The overall quality of the studies and level of diagnostic evaluation of the studies were highly variable, from poor to good. As there were variations in the definition of hypercoagulability, TEG methodology and patient characteristics, reference standards used and outcomes measured, a meta-analysis was not undertaken. The sensitivity and specificity ranged from 0% to 100% and 62% to 92%, respectively. The diagnostic odds ratio ranged from 1.5 to 27.7; area under the curve ranged from 0.57 to 0.91. Of the TEG variables, maximum amplitude seems to be the best parameter to identify hypercoagulable states and to predict thromboembolic events.

CONCLUSIONS: The predictive accuracy of TEG for postoperative thromboembolic events is highly variable. To determine if the TEG is a clinically useful screening test in high-risk surgical populations, more prospective studies are needed.



Noninfectious Serious Hazards of Transfusion

Jeanne E. Hendrickson, MD*{dagger}, and Christopher D. Hillyer, MD*

From the *Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, and {dagger}AFLAC Cancer Center and Blood Disorders Service, Children’s Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.

Anesth Analg 2009; 108:759-769




、脓毒血症和变应/ 荨麻疹/过敏)到更罕见的并发症。这些包括误输血、输血相关的急性肺损伤





琳 李士通校)

As infectious complications from blood transfusion have decreased because of improved donor questionnaires and sophisticated infectious disease blood screening, noninfectious serious hazards of transfusion (NISHOTs) have emerged as the most common complications of transfusion. The category of NISHOTs is very broad, including everything from well-described and categorized transfusion reactions (hemolytic, febrile, septic, and allergic/urticarial/anaphylactic) to lesser known complications. These include mistransfusion, transfusion-related acute lung injury, transfusion-associated circulatory overload, posttransfusion purpura, transfusion-associated graft versus host disease, microchimerism, transfusion-related immunomodulation, alloimmunization, metabolic derangements, coagulopathic complications of massive transfusion, complications from red cell storage lesions, complications from over or undertransfusion, and iron overload.

In recent years, NISHOTs have attracted more attention than ever before, both in the lay press and in the scientific community. As the list of potential complications from blood transfusion grows, investigators have focused on the morbidity and mortality of liberal versus restrictive red blood cell transfusion, as well as the potential dangers of transfusing "older" versus "younger" blood. In this article, we review NISHOTs, focusing on the most recent concerns and literature.


Cardiac Surgery in the Parturient

Shobana Chandrasekhar, MD, Christopher R. Cook, DO, and Charles D. Collard, MD

From the Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Texas Heart® Institute, St. Luke’s Episcopal Hospital, Houston, TX.

Anesth Analg 2009; 108:777-785

心脏疾病为妊娠期非产科性死亡的主要原因,在产妇中的发病率为1%-3%,由此引起的孕产妇死亡率为10%—15%。先天性心脏病在育龄妇女已越来越多见,占妊娠期心脏疾病的比例越来越高(可达75%)。孕产妇未经治疗的心脏疾病使得胎儿也处于危险之中。新生儿并发症的独立预测因素包括产妇纽约心脏协会心衰分级>2、妊娠期抗凝药物的运用、吸烟史,多胎妊娠和左室流出道梗阻。由于产妇心外科手术发病率和死亡率高于非妊娠患者,故大多数有心脏疾病的产妇首先接受药物治疗,同时准备在药物治疗失败后接受心外科手术治疗。心外科手术期产妇死亡的危险因素包括血管活性药物、年龄、手术类型、二次手术和产妇心功能分级。胎儿死亡的危险因素包括产妇年龄>35岁、心功能分级、二次手术、急诊手术、心肌保护的类型和缺氧时间。虽然如此,通过如下措施可达到可以接受的产妇和胎儿围术期死亡率:术前早期发现产妇心血管失代偿状态、采用胎儿监护、在手术前分娩可存活胎儿以及在妊娠4月到6月时安排择期手术。此外,体外循环期间使产妇携氧能力和子宫血流量达到最佳状态也可降低胎儿死亡率。目前产妇体外循环的建议包括:1)维持泵流量>2.5 L · min–1 · m–2 、灌注压 >70 mm Hg;2)维持血细胞比容> 28%;3)如果可行,采用常温灌注;4)采用搏动血流;5)采用α-pH稳态管理。

(周雅春 译   马皓琳 李士通 校)

Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%–3% of pregnancies and accounting for 10%–15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L · min–1 · m–2 and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using {alpha}-stat pH management.


Real-Time Assessment of Perioperative Behaviors and Prediction of Perioperative Outcomes

Senthilkumar Sadhasivam, MD, MPH*, Lindsey L. Cohen, PhD{dagger}, Alexandra Szabova, MD*, Anna Varughese, MD*, Charles Dean Kurth, MD*, Paul Willging, MD{ddagger}, Yu Wang, MS§, Todd G. Nick, PhD§, and Joel Gunter, MD*

From the *Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; {dagger}Department of Psychology, Georgia State University, Atlanta, Georgia; {ddagger}Department of Otorhinolaryngology, and §Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Anesth Analg 2009; 108:822-826




讨论: PACBIS是第一种可用来评估小儿及其父母围术期行为的实时评分方法。PACBIS鉴别出的特殊行为可提供干预的目标,以改善围术期经历和术后预后。

(张莹译 李士通 马皓琳 校)

Background and Aims: New onset maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, attention-seeking, and fear of being alone are common in children after outpatient surgery. Preoperative anxiety, fear and distress behaviors of children predict postoperative maladaptive behaviors as well as emergence delirium. Parental anxiety has also been found to influence children’s preoperative anxiety. Currently, there is no real-time and feasible tool to effectively measure perioperative behaviors of children and parents. We developed a simple and real-time scale, the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to assess perioperative child and parent behaviors that might predict postoperative problematic behavior and emergence excitement.

METHODS: We used the PACBIS to evaluate perioperative behaviors during anesthetic induction and recovery in a sample of 89 children undergoing tonsillectomies and adenoidectomies, and their parents. Preoperative anxiety with the modified Yale Preoperative Anxiety Scale, compliance with induction of anesthesia with Induction Compliance Checklist, and incidence of emergence excitement were also recorded.

RESULTS: The PACBIS demonstrated good concurrent validity with modified Yale Preoperative Anxiety Scale and Induction Compliance Checklist and predicted postanesthetic emergence excitement.

DISCUSSION: The PACBIS is the first real-time scoring instrument that evaluates children’s and parents’ perioperative behavior. The specific behaviors identified by the PACBIS might provide targets for interventions to improve perioperative experiences and postoperative outcomes.


The Effect of Residual Neuromuscular Blockade on the Speed of Reversal with Sugammadex

Paul F. White, PhD, MD*, Burcu Tufanogullari, MD*, Ozlem Sacan, MD*, Edward G. Pavlin, MD{dagger}, Oscar J. Viegas, MD{ddagger}, Harold S. Minkowitz, MD§, and M. E. Hudson, MD||

From the *Departments of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas; {dagger}Departments of Anesthesiology and Pain Management, University of Washington, Seattle, Washington; {ddagger}Departments of Anesthesiology and Pain Management, Indiana University, Indianapolis, Indiana; §Departments of Anesthesiology and Pain Management Memorial Hermann Memorial City Hospital, Houston, Texas; and ||Departments of Anesthesiology and Pain Management University of Pittsburgh, Pittsburg, Pennsylvania.

Anesth Analg 2009; 108:846-851

背景:Sugammadex是一种改良的γ环糊精复合物其将罗库溴铵包裹起来导致残余肌松的快速逆转。我们对一个多中心的研究得到的数据进行了post hoc分析,模仿了标准的临床试验以验证假说,即在给予拮抗药时对神经肌肉刺激肌有无颤搐反应是否会影响sugammadex的逆转效应的速度和完全性。

方法:171名行以挥发性麻醉药为基础行全身麻醉并同意进行试验的病人加入了多中心观察性研究。所有的病人用罗库溴铵0.6 mg/kg静脉注射行气管内插管,手术中需要时用0.15 mg/kg推注维持。从麻醉诱导到手术过程结束后四个成串(TOF)比率(TOFR)恢复到≥0.9,用TOF-Watch®-SX加速度肌松监测仪在笔记本电脑记录TOF反应,评价罗库溴铵引起的阻滞深度。在罗库溴铵末次剂量后>15min给予sugammadex 4 mg/kg静推,以拮抗其神经肌肉阻滞。将在给予拮抗药时对TOF刺激没有反应 (n = 89)或有≥1个肌颤搐 (n = 82)的病人的恢复数据进行比较。

结果:没有肌颤搐出现的病人较多是女性(占60%),并且这些病人的罗库溴铵末次剂量与给予拮抗药之间的时间间隔较短 (31±18比45±23 min, P < 0.05)。无肌颤搐组的TOFR恢复到0.9的时间较出现1个以上肌颤搐组长(173±162比104±73 s, P < 0.05)。总起来说,无肌颤搐组有84%的病人的TOFR于5min内恢复到0.9,而出现1个以上肌颤搐组则有91%病人(P < 0.05)。在无肌颤搐组和出现1个以上肌颤搐组,达到TOFR0.9的时间分别从0.8min到 22.3min,0.7min 到8.5min。


(黄丽娜  译 马皓琳 李士通 校)

BACKGROUND: Sugammadex is a modified {gamma}cyclodextrin compound which encapsulates rocuronium resulting in rapid reversal of residual neuromuscular blockade. We performed a post hoc analysis of data from a multicenter study designed to mimic standard clinical practice which would test the hypothesis that the presence (versus the absence) of a twitch response to neuromuscular stimulation at the time of reversal drug administration would influence the speed and completeness of the reversal effect of sugammadex.

METHODS: One-hundred-seventy-one consenting patients undergoing general anesthesia with a volatile-based anesthetic technique were enrolled in a multicenter observational study. All patients received rocuronium, 0.6 mg/kg IV for tracheal intubation and maintenance boluses of 0.15 mg/kg IV as needed during surgery. The degree of rocuronium-induced blockade was assessed during anesthesia using a TOF-Watch®-SX acceleromyograph to record the train-of-four (TOF) responses on a laptop computer from induction of anesthesia until the TOF ratio returned to ≥0.9 after completion of the surgical procedure. The patients received sugammadex, 4 mg/kg IV, for reversal of neuromuscular blockade >15 min after the last dose of rocuronium. Recovery data were compared in patients with either no (0) (n = 89) or ≥1 twitch (n = 82) in response to TOF stimulation at the time of reversal drug administration.

RESULTS: The patients without a twitch response were more likely to be female (60% vs 40%) and had a shorter time interval between the last bolus dose of rocuronium and the administration of the reversal drug (31±18 vs 45±23 min, P < 0.05). The time to achieve a TOF ratio of 0.9 was prolonged in the 0 twitch group compared with the ≥1 twitch response group (173±162 vs 104±73 s, P < 0.05). Overall, 84% of the patients in the 0 twitch group recovered to a TOF of 0.9 in ≤5 min compared to 91% of the patients in the group with ≥1 twitch (P < 0.05). The times to achieve a TOF of 0.9 varied from 0.8 to 22.3 and 0.7 to 8.5 min in the 0 twitch and ≥1 twitch groups, respectively.

CONCLUSION: Reversal of rocuronium-induced neuromuscular blockade by sugammadex was influenced by the degree of residual blockade at the time the reversal drug was administered. Despite the wide variability, reversal of the TOF ratio to 0.9 occurred ≤5 min in more than 80% of the patients regardless of the number of twitches at the time of reversal drug administration.


Proprioceptive Function Is More Sensitive than Motor Function to Desflurane Anesthesia

Linda S. Barter, MVSc, PhD*, Laurie O. Mark, BA*, and Joseph F. Antognini, MD*{dagger}

From the Departments of *Anesthesiology and Pain Medicine, and the {dagger}Section of Neurobiology, Physiology and Behavior, University of California, Davis, California.

Anesth Analg 2009; 108:867-872


方法:给予11只刺毁脑脊髓的北方豹蛙0、0.4、0.8和1.2倍产生制动效果的半数有效量(ED50)的地氟烷,额外7只随机顺序给予0和0.4 ED50地氟烷。采用前肢电刺激引出后肢擦拭反射,录像记录用于随后分析。测量30s刺激过程中引出的后肢等长张力。

结果:与0 ED50相比,0.4 ED50地氟烷组擦拭潜伏期从0.8(0.1, 4.0)明显延长至17.3 (0.4, 30.0)s(中位数[最小值,最大值]);后足运动距离从0.42 (0.09, 1.82) 增加至 0.89 (0.16, 4.82) m;后足与刺激源之间的最短距离从1 (0, 5) 增加至7 (1, 40) mm。后足最大运动速度和等长张力没有变化,但是后肢力从7.3 (1.7, 23.6) 减少至3.2 (1.4, 13.8) N. s,这相当于运动次数从12 (3, 28) 减少至 8 (2, 14)次。地氟烷剂量从0.4增加至0.8 ED50,运动功能的抑制效应开始显现,表现为最大张力从2.0 (0.6, 5.5)降低至0.8 (0.1, 1.6) N,总力从3.2 (1.4, 13.8)减少至0.9 (0.0, 2.5) N.s。


(江继宏 译  马皓琳 李士通 校)

BACKGROUND: Evaluating the effects of sub-immobilizing anesthetic doses on movement will identify target neural circuits for investigation as sites of action for anesthetic-induced immobility.

METHODS: Eleven pithed Northern Leopard frogs received 0, 0.4, 0.8, and 1.2 times the 50% effective dose for production of immobility (ED50) of desflurane and a further 7 received 0 and 0.4 ED50 desflurane in random order. An electric stimulus applied to the forelimb elicited a hindlimb wiping reflex that was captured on video for later analysis. Isometric tension developed in the hindlimb during the 30 s stimulus application was measured.

RESULTS: Compared to 0 ED50, 0.4 ED50 desflurane significantly increased latency to wipe 0.8 (0.1, 4.0) to 17.3 (0.4, 30.0) s (median [min max]), distance traveled by the hindfoot 0.42 (0.09, 1.82) to 0.89 (0.16, 4.82) m, and proximity of the hindfoot to stimulus 1 (0, 5) to 7 (1, 40) mm. It did not alter hindlimb maximum velocity or isometric tension but significantly reduced total hindlimb force 7.3 (1.7, 23.6) to 3.2 (1.4, 13.8) N. s proportionate to a reduced number of movements from 12 (3, 28) to 8 (2, 14). From 0.4 to 0.8 ED50, motor depressant effects of desflurane became apparent with significant reductions in maximum tension from 2.0 (0.6, 5.5) to 0.8 (0.1, 1.6) N and total force from 3.2 (1.4, 13.8) to 0.9 (0.0, 2.5) N.s.

CONCLUSIONS: Proprioceptive function is more sensitive to anesthetic-induced depression than motor function in frogs. This suggests that the most anesthetic-sensitive component of the spinal neural circuitry underlying movement generation in response to noxious stimulus is prior to the level of the motoneuron.



Alcohol Use Disorder and Perioperative Immune Dysfunction

Alexandra Lau, MD, Vera von Dossow, MD, Michael Sander, MD, Martin MacGuill, MD, Nadine Lanzke, DVM, and Claudia Spies, MD

From the Department of Anesthesiology and Intensive Care Medicine Unit, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Hospital Berlin, Berlin, Germany.

Anesth Analg 2009; 108:916-920



The anesthesiological sequelae of long-term alcohol abuse include a three to fivefold increased risk of postoperative infection, prolonged intensive care unit stays and longer hospital stays. The cause of the higher infection rates is an altered immune response in long-term alcoholic patients. Preoperatively, the T helper cells 1 to T helper cells 2 ratio is depressed in long-term alcoholic patients and remains suppressed after surgery. The lower preoperative T helper cells 1 to T helper cells 2 ratio is predictive of later onset of infections. Postoperatively, the cytotoxic lymphocyte (Tc1/Tc2) ratio is decreased in long-term alcoholic patients and remains depressed for 5 days. The interleukin (IL)-6/IL-10 ratio and the lipopolysaccharide-stimulated interferon {gamma}/IL-10 ratio in whole blood cells are decreased after surgery in long-term alcoholic patients. Depressed Tc1/Tc2, IL-6/IL-10 and lipopolysaccharide-stimulated interferon {gamma}/IL-10 ratios in the postoperative period are predictive of subsequent postoperative infections. Perioperative interventions should aim to minimize dysregulation of the immune system.


Patient-Controlled Epidural Analgesia for Labor

Stephen H. Halpern, MD, MSc, FRCPC*, and Brendan Carvalho, MBBCh, FRCA{dagger}

From the *Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; and {dagger}Department of Anesthesia, Stanford University School of Medicine, Stanford, California.

Anesth Analg 2009; 108:921-928

病人自控硬膜外镇痛(PCEA)在20年前就已应用于临床分娩。PCEA技术与持续硬膜外输注相比具有明显的优势。我们利用MEDLINE 和EMBASE(1988–2008年4月1日)中所有在分娩中应用PCEA进行如下比较之一的随机对照实验进行了一个系统回顾:有无背景输注剂量,用罗哌卡因还是布比卡因,高浓度还是低浓度局部麻醉药,以及新方法或是标准方法。重要的结果数据有:母亲镇痛情况、满意度评分、运动阻滞以及额外临床医生介入的发生率。持续背景剂量输注提高了母亲镇痛水平,并减少了额外临床医生介入。高单次剂量(5mL以上)比低单次剂量能提供更好的镇痛。低浓度的布比卡因或罗哌卡因可以提供极好的镇痛并且无明显的运动阻滞。PCEA的很多方法可提供有效的分娩镇痛。持续背景剂量输注的高容量稀释局麻药溶液似乎是一个最成功的方法。对新的给药方式(例如程序控制强制性间断剂量注射和电脑控制的反馈给药)的研究正在进行中。

(黄佳佳译,马皓琳 李士通校)

Patient-controlled epidural analgesia (PCEA) for labor was introduced into clinical practice 20 yr ago. The PCEA technique has been shown to have significant benefits when compared with continuous epidural infusion. We conducted a systematic review using MEDLINE and EMBASE (1988–April 1, 2008) of all randomized, controlled trials in parturients who received PCEA in labor in which one of the following comparisons were made: background infusion versus none; ropivacaine versus bupivacaine; high versus low concentrations of local anesthetics; and new strategies versus standard strategies. The outcomes of interest were maternal analgesia, satisfaction, motor block, and the incidence of unscheduled clinician interventions.

A continuous background infusion improved maternal analgesia and reduced unscheduled clinician interventions. Larger bolus doses (more than 5 mL) may provide better analgesia compared with small boluses. Low concentrations of bupivacaine or ropivacaine provide excellent analgesia without significant motor block. Many strategies with PCEA can provide effective labor analgesia. High volume, dilute local anesthetic solutions with a continuous background infusion appear to be the most successful strategy. Research into new delivery strategies, such as mandatory programmed intermittent boluses and computerized feedback dosing, is ongoing.


Cyclic Adenosine Monophosphate Response Element-Binding Protein Phosphorylation and Neuroprotection by 4-Phenyl-1-(4-Phenylbutyl) Piperidine (PPBP)

Sufang Yang, MD, Nabil J. Alkayed, MD, PhD, Patricia D. Hurn, PhD, and Jeffrey R. Kirsch, MD

From the Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon.

Anesth Analg 2009; 108:964-970

背景:已有研究表明有效的原型ς1-受体激动剂4-苯基-1-(4-b苯基丁基) 哌啶(PPBP)能阻止初级培养的皮层神经元剥夺氧糖后细胞死亡。我们假设PPBP通过激活转录因子环磷腺苷反应元素结合蛋白(CREB)相关的机制来保护神经元并对该假设进行了验证。

方法: 原代培养皮层神经元暴露于OGD2小时,恢复24小时。在损伤前15分钟开始PPBP处理,同时使用或不使用ς1-受体拮抗剂林卡唑以及已知能激活信号传导链而导致CREB磷酸化的蛋白激酶抑制剂,例如H89 (蛋白激酶A抑制剂)、 LY294002(PI3K抑制剂)、U0126(MEK1/2抑制剂)或KN62(钙调蛋白激酶II抑制剂)。在OGD处理后24小时用乳酸脱氢酶测试法分析神经元细胞死亡。用免疫印迹分析法检测再充氧后30min、1h和3h的CREB磷酸化水平。用Quantity One图像分析软件对斑点作定量分析。

结果: PPBP 增加OGD恢复1h 后CREB磷酸化,该作用可被林卡唑取消(PPBP组1.7 ± 0.2,PPBP加林卡唑组0.8 ± 0.1,对照于只有OGD组为0.9 ± 0.1,p-CREB/CREB)。PPBP引起的CREB磷酸化增加可被H89阻断(0.5 ± 0.07) 而非U0126、KN62或LY294002阻断。PPBP处理能预防OGD导致的细胞死亡,而H89预处理会阻断这种保护作用(PPBP组0.18 ± 0.02,PPBP加H89组0.27 ± 0.03,对照于只有OGD组0.33 ± 0.02,乳酸脱氢酶分析法)。LY294002、UO126或KN62预处理对PPBP的神经保护作用无影响。


(颜涛 译 马皓琳 李士通 校)

BACKGROUND: Previous studies show that the potent, prototypical {varsigma}1-receptor agonist 4-phenyl-1-(4-phenylbutyl) piperidine (PPBP) prevents cell death after oxygen-glucose deprivation (OGD) in primary cortical neuronal cultures. We tested the hypothesis that PPBP protects neurons by a mechanism involving activation of the transcription factor cyclic adenosine monophosphate response element-binding protein (CREB).

METHODS: Primary cultured cortical neurons were exposed to 2 h of OGD and allowed to recover for 24 h, and PPBP treatment was initiated 15 min before the insult in the presence and absence of the {varsigma}1-receptor antagonist rimcazole and inhibitors against protein kinases known to activate signal transduction cascades that result in CREB phosphorylation, such as H89 (protein kinase A inhibitor), LY294002 (PI3K inhibitor), U0126 (MEK1/2 inhibitor), or KN62 calmodulin kinase II inhibitor). Neuronal cell death was assayed by lactate dehydrogenase measurement 24 h after OGD. CREB phosphorylation was measured by immunoblot analysis at 30 min, 1 h, and 3 h of reoxygenation. Blots were quantitatively analyzed using Quantity One image analysis software.

RESULTS: PPBP increased CREB phosphorylation at 1 h after recovery from OGD, which was abolished by rimcazole (1.7 ± 0.2 in PPBP and 0.8 ± 0.1 in PPBP plus rimcazole with OGD compared with 0.9 ± 0.1 in OGD alone, p-CREB/CREB). The PPBP-induced increase in CREB phosphorylation was blocked by H89 (0.5 ± 0.07) but not U0126, KN62, or LY294002. PPBP treatment prevented OGD-induced cell death and pretreatment with H89 blocked this protection (0.18 ± 0.02 in PPBP and 0.27 ± 0.03 in PPBP plus H89 with OGD compared with 0.33 ± 0.02 in OGD alone, lactate dehydrogenase assay). Pretreatment with LY294002, UO126, or KN62 had no effect on neuronal protection by PPBP.

CONCLUSIONS: These data suggest that the mechanism of neuroprotection by PPBP may be linked to CREB phosphorylation.


Capsicum Plaster at the Hegu Point Reduces Postoperative Analgesic Requirement After Orthognathic Surgery

Kyo S. Kim, MD, PhD*, Kyu N. Kim, MD*, Kyung G. Hwang, DMD, PhD{dagger}, and Chang J. Park, DMD, PhD{dagger}

From the Departments of *Anesthesiology, and {dagger}Dental Surgery, Hanyang University Hospital, Seoul, Korea.

Anesth Analg 2009; 108:992-996

背景:辣椒膏用于经典的中国针刺穴位,是除针灸外的另一种能有效预防术后恶心呕吐、咽喉痛和疼痛的方法。在本研究中,我们调查了辣椒膏用于合谷穴(LI 4)对双侧下颌升支矢状劈开切骨术病人的术后镇痛效果。


结果:术后24小时内病人自控镇痛的总量(含6.5 µg/mL芬太尼和1.2 mg/mL酮咯酸)在合谷组(26.8 ± 3.4 mL)较对照组(44.2 ± 7.3 mL)和假性组(42.1 ± 6.9 mL)减少(P < 0.01)。合谷组较其他组,术后恶心呕吐的发生率和额外药物的需要减少,而且总体满意得分更高(P < 0.01)。


(唐李隽    马皓琳  李士通  校)

BACKGROUND: Capsicum plaster at classical Chinese acupoints is an alternative to acupuncture, which has been used as an effective method for preventing postoperative nausea and vomiting, sore throat, and pain. In this study, we investigated the postoperative analgesic efficacy of capsicum plaster at Hegu (LI 4) acupoints in patients after bilateral sagittal split ramus osteotomy.

METHODS: A double-blind, sham-controlled study was conducted with 84 patients undergoing orthognathic surgery, and who were randomly assigned to three treatment regimens (n = 28 each): Hegu group = capsicum plaster at Hegu acupoints and placebo tape on the shoulders as a nonacupoint; sham group = capsicum plaster on the shoulders and placebo tape at Hegu acupoints; and control group = placebo tape at Hegu acupoints and on the shoulders. The capsicum plaster was applied before induction of anesthesia and maintained for 8 h per day for 3 postoperative days.

RESULTS: The total amount of patient-controlled analgesia, containing 6.5 µg/mL fentanyl and 1.2 mg/mL ketorolac, administered in the first 24 h after the operation was decreased in the Hegu group (26.8 ± 3.4 mL) compared with the control (44.2 ± 7.3 mL) and sham (42.1 ± 6.9 mL) groups (P < 0.01). The incidence of postoperative nausea and vomiting and the need for rescue medication were reduced, and the overall satisfaction score was greater in the Hegu group compared with other groups (P < 0.01).

CONCLUSION: The capsicum plaster at the Hegu acupoints decreased the postoperative opioid requirements and opioid-related side effects in patients after orthognathic surgery.


The Antinociceptive Effects and Pharmacological Properties of JM-1232(-): A Novel Isoindoline Derivative

Shunsuke Chiba, MD, Tomoki Nishiyama, MD, PhD, and Yoshitsugu Yamada, MD, PhD

From the Department of Anesthesiology, The University of Tokyo, Tokyo, Japan.

Anesth Analg 2009; 108:1008-1014

背景:一种异二氢吲哚衍生物JM-1232(-) 被作为一种镇静和镇痛药来开发。我们进行本研究以观察其对小鼠身上三种不同的伤害性感受的镇痛效应。

方法:雄性ddY小鼠分别接受腹腔内(IP)注射JM-1232(-)1、3或10 mg/kg(每一试验的每一剂量n = 8)。使用生理盐水作为对照。IP注药后120min进行热板或夹尾试验。乙酸试验:在IP注药后15min将0.6%的乙酸溶液按10mL/kg进行IP注射。IP注酸后5min开始记录腹部收缩的次数10min。当观察镇痛效应时,在给予最大有效剂量的JM-1232(-)之前分别皮下注射纳络酮或氟吗泽尼。使用转轮试验,每5min记录一次轮子转动的数量,共记录120min。

结果:在热板、夹尾和乙酸试验中,IP JM-1232(-) 产生明显的镇痛效应,其50%有效剂量分别为2.96 mg/kg (CI: 2.65–3.30 mg/kg)、3.06 mg/kg (CI: 2.69–3.47 mg/kg)和2.27 mg/kg (CI: 1.46–3.53 mg/kg)。在所有试验中,JM-1232(-) 产生的镇痛效应被氟吗泽尼(5 mg/kg)而非纳络酮(10 mg/kg)所拮抗。在转轮试验中,JM-1232(-)对运动行为无剂量依赖性作用。


(黄施伟 译,马皓琳 李士通 校)

BACKGROUND: An isoindoline derivative, JM-1232(-) was developed as a sedative and analgesic drug. We performed the present study to investigate its antinociceptive effects on three different nociceptions in mice.

METHODS: Mail ddY mice were administered intraperitoneal (IP) JM-1232(-) 1,3 or 10 mg/kg (n = 8 for each dose in each test). Saline was used as a control. The hotplate or tail pressure test was performed for 120 min after IP drug injection. Acetic acid 0.6% solution in 10 mL/kg was IP administered 15 min after IP drug injection in the acetic acid test. The number of abdominal constriction episodes was counted for 10 min, starting 5 min after IP administration of the acid. When the analgesic effect was observed, naloxone or flumazenil was subcutaneously administered before administration of the maximum effective dose of JM-1232(-). Using the wheel running test, the number of wheel revolutions was recorded every 5 min for 120 min.

RESULTS: In the hotplate, tail pressure and acetic acid tests, IP JM-1232(-) produced significant antinociceptive effects with a 50% effective dose of 2.96 mg/kg (CI: 2.65–3.30 mg/kg), 3.06 mg/kg (CI: 2.69–3.47 mg/kg) and 2.27 mg/kg (CI: 1.46–3.53 mg/kg), respectively. In all tests, JM-1232(-)-induced antinociception was antagonized by flumazenil (5 mg/kg) but not by naloxone (10 mg/kg). In the running wheel test, there was no dose-dependent effect of JM-1232(-) on locomotor activity.

CONCLUSION: Systemically administered JM-1232(-) had antinociceptive effects on acute thermal, mechanical-induced pain, and visceral pain in mice. These effects might be mediated by benzodiazepine- {gamma}-aminobutyric acid type A receptors but not by opioid receptors.


Lidocaine Injection into the Rat Dorsal Root Ganglion Causes Neuroinflammation

Livia Puljak, MD, PhD*, Sanja Lovric Kojundzic, MD*, Quinn H. Hogan, MD{dagger}, and Damir Sapunar, MD, PhD*

From the *Department of Histology and Embryology, University of Split School of Medicine, Croatia; and {dagger}Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Anesth Analg 2009; 108:1021-1026

背景: 选择性脊神经阻滞过程中脊神经或后根神经节(DRG)的损伤是潜在的严重并发症,至今仍未被充分地研究。我们假设局麻药注入这些组织会导致炎性反应及痛觉过敏。

方法:在部分椎板切除术后的大鼠L5脊神经或后根神经节注入4 µL利多卡因或生理盐水,评估其炎性和行为反应。在术前和术后通过足部伤害性机械刺激的反应来进行行为测试,以此研究痛觉过敏。DRG被收集染色,计数神经元周围的免疫反应性神经胶质细胞环。



(朱 慧译 马皓琳 李士通校)

BACKGROUND: Injury of a spinal nerve or dorsal root ganglion (DRG) during selective spinal nerve blocks is a potentially serious complication that has not been adequately investigated. Our hypothesis was that local anesthetic injection into these structures may result in an inflammatory response and hyperalgesia.

METHODS: We evaluated inflammatory and behavioral responses after injection of 4 µL lidocaine or saline into the L5 spinal nerve or DRG of rats after partial laminectomy. Behavioral testing was performed before and after surgery to examine hyperalgesia in response to nociceptive mechanical stimulation of the foot. DRGs were harvested and stained, and rings of immunoreactive glial cells around neurons were counted.

RESULTS: Animals demonstrated hyperalgesia on the ipsilateral paw up to 4 days after lidocaine injection into the DRG but not after injection into the spinal nerve. The number of glial fibrillary acid protein immunopositive glial cell rings, which represent activation of satellite cells, significantly increased in DRGs after injection of lidocaine into either the DRG or the spinal nerve. The number of glial fibrillary acid protein-positive cells in the lidocaine-injected group was significantly larger than in the saline-injected group. Sporadic OX-42 immunopositive cells, which represent activated microglia, were also seen in lidocaine-injected DRGs. Testing for Pan-T expression, which labels activated T lymphocytes, showed no positive cells.

CONCLUSIONS: Lidocaine injection into the DRG may produce hyperalgesia, possibly due to activation of resident satellite glial cells. In a clinical setting, local anesthetic injection into the DRG should be avoided during selective spinal nerve blocks.