Anesthesia & Analgesia
March 2006
Table of Content
CARDIOVASCULAR ANESTHESIA:
行冠脈搭橋手術的老年病人的纖維蛋白溶解和血小板活性增加
（彭中美 譯 馬皓琳 李士通 校）
Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery
Hilde Pleym, Alexander Wahba, Vibeke Videm, Arne Åsberg, Stian Lydersen, Lise Bjella, Ola Dale, and Roar Stenseth
Anesth Analg 2006 102: 660-667.
區域麻醉下行頸動脈內膜切除術中使用右美托咪定（dexmedetomidine）鎮靜和血流動力學控制與傳統治療方法的比較
(殷文淵 譯 陳傑 校)
A Comparison of Dexmedetomidine Versus Conventional Therapy for Sedation and Hemodynamic Control During Carotid Endarterectomy Performed Under Regional Anesthesia
Craig A. McCutcheon, Ruari M. Orme, David A. Scott, Michael J. Davies, and Desmond P. McGlade
Anesth Analg 2006 102: 668-675.
（孫敏莉譯 薛張綱校）
Diazepam Enhances Inotropic Responses to Dopamine in Rat Ventricular Myocardium
María Jesús Juan-Fita, María Luisa Vargas, and Jesús Hernández
Anesth Analg 2006 102: 676-681.
（金 琳譯 薛張綱校）
Diazepam Attenuates Phenylephrine-Induced Contractions in Rat Aorta
Soon-Eun Park, Ju-Tae Sohn, Cheol Kim, Ki Churl Chang, Il-Woo Shin, Kyeong-Eon Park, Heon-Keun Lee, and Young-Kyun Chung
Anesth Analg 2006 102: 682-689.
PEDIATRIC ANESTHESIA:
（裘毅敏 譯 馬皓琳 李士通 校）
Avoiding Transfusions in Children Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Trials of Aprotinin
Donald M. Arnold, Dean A. Fergusson, Anthony K.C. Chan, Richard J. Cook, Graeme A. Fraser, Wendy Lim, Morris A. Blajchman, and Deborah J. Cook
Anesth Analg 2006 102: 731-737.
兒童在N2O/O2/丙泊酚麻醉期間使用0.1mg/kg劑量的順式阿曲庫銨的藥代和藥效動力學
(朱輝 譯 陳傑 校)
Pharmacokinetics and Pharmacodynamics of a 0.1 mg/kg Dose of Cisatracurium Besylate in Children During N2O/O2/Propofol Anesthesia
Karynn Imbeault, Davina E. Withington, and France Varin
Anesth Analg 2006 102: 738-743
連續硬膜外和連續膕神經阻滯用於小兒足部手術術後鎮痛：前瞻、對比、隨機性研究
（吳德華譯 薛張綱校）
Continuous Epidural Block Versus Continuous Popliteal Nerve Block for Postoperative Pain Relief After Major Podiatric Surgery in Children: A Prospective, Comparative Randomized Study
Christophe Dadure, Sophie Bringuier, Florence Nicolas, Luke Bromilow, Olivier Raux, Alain Rochette, and Xavier Capdevila
Anesth Analg 2006 102: 744-749.
麻醉兒童的上呼吸道塌陷
（張瑩 譯，馬皓琳 李士通 校）
Upper Airway Collapsibility in Anesthetized Children
Ronald S. Litman, Joseph M. McDonough, Carole L. Marcus, Alan R. Schwartz, and Denham S. Ward
Anesth Analg 2006 102: 750-754.
AMBULATORY ANESTHESIA:
舌下含服吡羅昔康進行術後鎮痛：術前和術後用藥的隨機、雙盲研究
(張美榮 譯 陳傑 校)
Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study
Hans-F Gramke, Jurgen J. J. Petry, Marcel E. Durieux, Jean-P Mustaki, Marcel Vercauteren, Georges Verheecke, and Marco A. E. Marcus
Anesth Analg 2006 102: 755-758
ANESTHETIC PHARMACOLOGY:
（金 路譯 薛張綱校）
Determinants of Volatile General Anesthetic Potency: A Preliminary Three-Dimensional Pharmacophore for Halogenated Anesthetics
Jason C. Sewell and John W. Sear
Anesth Analg 2006 102: 764-771.
靜脈麻醉藥對大鼠海馬CA1區抑制性通路的作用強於吸入麻醉藥
（周雅春 譯馬皓琳 李士通 校）
Intravenous Anesthetics Are More Effective than Volatile Anesthetics on Inhibitory Pathways in Rat Hippocampal CA1
Takehisa Asahi, Koki Hirota, Rika Sasaki, Yamazaki Mitsuaki, and Sheldon H. Roth
Anesth Analg 2006 102: 772-778.
呼吸興奮劑多沙普侖抑制TASK相關鉀通道功能，但不影響最低肺泡有效麻醉濃度
（鄭麗 譯 陳傑 校）
The Ventilatory Stimulant Doxapram Inhibits TASK Tandem Pore (K2P) Potassium Channel Function but Does Not Affect Minimum Alveolar Anesthetic Concentration
Joseph F. Cotten, Bharat Keshavaprasad, Michael J. Laster, Edmond I. Eger, II, and C. Spencer Yost
Anesth Analg 2006 102: 779-785.
（王麗珺譯 薛張綱校）
Augmented Activity of Adenosine Triphosphate-Sensitive K+ Channels Induced by Droperidol in the Rat Aorta
Hiroyuki Kinoshita, Mayuko Dojo, Katsutoshi Nakahata, Yoshiki Kimoto, Tetsuya Kakutani, Kazuhiro Mizumoto, and Yoshio Hatano
Anesth Analg 2006 102: 786-791.
布比卡因異構體對Wistar大鼠心肌細胞內鈣的調節
（黃施偉 譯，馬皓琳 李士通 校）
Regulation of Intracellular Calcium by Bupivacaine Isomers in Cardiac Myocytes from Wistar Rats
Núbia G. B. Chedid, Roberto T. Sudo, Marli I. S. Aguiar, Margarete M. Trachez, Masako O. Masuda, and Gisele Zapata-Sudo
Anesth Analg 2006 102: 792-798.
（顏濤 譯 馬皓琳 李士通 校）
Chromosomal Substitution-Dependent Differences in Cardiovascular Responses to Sodium Pentobarbital
Thomas A. Stekiel, Stephen J. Contney, Zeljko J. Bosnjak, John P. Kampine, Richard J. Roman, and William J. Stekiel
Anesth Analg 2006 102: 799-805.
氯胺酮削弱離體新生鼠的脊髓交感活性並非通過N-甲基-d-天門冬氨酸受體介導
（顧新宇 譯 陳傑 校）
Ketamine Attenuates Sympathetic Activity Through Mechanisms not Mediated by N-Methyl-d-Aspartate Receptors in the Isolated Spinal Cord of Neonatal Rats
Chiu-Ming Ho and Chun-Kuei Su
Anesth Analg 2006 102: 806-810.
TECHNOLOGY, COMPUTING, AND SIMULATION:
一個雙盲對照的實驗評價三個多元的困難氣道模型的預期作用
(陸文清譯 薛張綱校)
Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Controlled Study
Mohamed Naguib, Franklin L. Scamman, Cormac O'Sullivan, John Aker, Alan F. Ross, Steven Kosmach, and Joe E. Ensor
Anesth Analg 2006 102: 818-824.
腦電描計法定位在常規臨床實踐中的應用：氣管插管時皮層覺醒？
（邱鬱薇 譯 馬皓琳 李士通 校）
Electroencephalographic Mapping During Routine Clinical Practice: Cortical Arousal During Tracheal Intubation?
Wolfgang J. Kox, Christian von Heymann, Judith Heinze, Leslie S. Prichep, E. Roy John, and Ingrid Rundshagen
Anesth Analg 2006 102: 825-831.
PAIN MEDICINE:
福馬林實驗中大鼠的超聲發聲：一種測量疼痛引起情感變化程度的方法？
（蘇殿三 譯 陳傑 校）
Ultrasonic
Rat Vocalizations During the Formalin Test: A Measure of the Affective
Dimension of Pain?
Alexandre R. Oliveira and Helena M. T. Barros
Anesth Analg 2006 102: 832-839.
(周荻 譯 薛張綱校)
Amantadine Sulfate Reduces Experimental Sensitization and Pain in Chronic Back Pain Patients
Dieter Kleinböhl, Roman Görtelmeyer, Hans-Joachim Bender, and Rupert Hölzl
Anesth Analg 2006 102: 840-847.
（潘志英 譯 陳傑 校）
Intrathecal Catheter Granuloma Associated with Isolated Baclofen Infusion
Paul M. Murphy, Danielle E. Skouvaklis, Ryan J.J. Amadeo, Craig Haberman, David H. Brazier, and Michael J. Cousins
Anesth Analg 2006 102: 848-852.
CRITICAL CARE AND TRAUMA:
（王慧琳譯 薛張綱校）
The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor
E. Andrew Ochroch, Michael W. Russell, William C. Hanson, III, Gayle A. Devine, Andrew J. Cucchiara, Mark G. Weiner, and Sanford J. Schwartz
Anesth Analg 2006 102: 868-875.
（黃麗娜 譯 馬皓琳 李士通 校）
The Effects of Tramadol and Fentanyl on Gastrointestinal Motility in Septic Rats
Ismet Topcu, N. Zeynep Ekici, Rusen Isik, and Melek Sakarya
Anesth Analg 2006 102: 876-881. it.
NEUROSURGICAL ANESTHESIA:
（丁希喆 譯 陳傑 校）
Anesthetic Complications of Awake Craniotomies for Epilepsy Surgery
Andrius P. Skucas and Alan A. Artru
Anesth Analg 2006 102: 882-887.
(徐麗穎譯 薛張綱校)
The Effects of Stimulation Pattern and Sevoflurane Concentration on Intraoperative Motor-Evoked Potentials
Peter C. Reinacher, Hans-Joachi
m Priebe, Winfried Blumrich, Josef Zentner, and Kai M. Scheufler
Anesth Analg 2006 102: 888-895.
OBSTETRIC ANESTHESIA:
（黃佳佳 譯 馬皓琳 李士通 校）
P6 Acupressure Does Not Prevent Emesis During Spinal Anesthesia for Cesarean Delivery
Chiu-Ming Ho, Hsin-Jung Tsai, Kwok-Hon Chan, and Shen-Kou Tsai
Anesth Analg 2006 102: 900-903.
程式化硬膜外間斷給藥和連續給藥用於分娩鎮痛的隨機比較
（趙延華 譯 陳傑 校）
A Randomized Comparison of Programmed Intermittent Epidural Bolus with Continuous Epidural Infusion for Labor Analgesia
Cynthia A. Wong, John T. Ratliff, John T. Sullivan, Barbara M. Scavone, Paloma Toledo, and Robert J. McCarthy
Anesth Analg 2006 102: 904-909
REGIONAL ANESTHESIA:
（孫卓真譯 薛張綱校）
Infraclavicular Brachial Plexus Block Versus Humeral Block in Trauma Patients: A Comparison of Patient Comfort
Vincent Minville, Olivier Fourcade, Lamia Idabouk, Jonathan Claassen, Clément Chassery, Luc Nguyen, Jean-Claude Pourrut, and Dan Benhamou
Anesth Analg 2006 102: 912-915.
（趙雪蓮 譯 馬皓琳 李士通 校）
The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia
Selda Sen, Bakiye Ugur, Osman N. Aydin, Mustafa Ogurlu, Feray Gursoy, and Oner Savk
Anesth Analg 2006 102: 916-920.
（肖潔 譯 陳傑 校）
The Epidural Test Dose: A Review
Joanne Guay
Anesth Analg 2006 102: 921-929.
α-氨基羥甲基惡唑丙酸受體拮抗劑對於丁卡因鞘內給藥所引起的神經毒性的效應
（韓曉丹譯 薛張綱校）
The Effects of an AMPA Receptor Antagonist on the Neurotoxicity of Tetracaine Intrathecally Administered in Rabbits
Yumika Koizumi, Mishiya Matsumoto, Atsuo Yamashita, Shunsuke Tsuruta, Takanao Ohtake, and Takefumi Sakabe
Anesth Analg 2006 102: 930-936.
GENERAL ARTICLES:
（馬皓琳 譯 李士通 校）
Postoperative Upper Airway Obstruction After Recovery of the Train of Four Ratio of the Adductor Pollicis Muscle from Neuromuscular Blockade
Matthias Eikermann, Manfred Blobner, Harald Groeben, Christopher Rex, Thomas Grote, Markus Neuhäuser, Martin Beiderlinden, and Jürgen Peters
Anesth Analg 2006 102: 937-942.
羅庫溴銨在快速誘導插管中不比琥珀酰膽鹼有更多的聲帶損傷：一項隨機、前瞻性對照研究
（鄭擁軍 譯 陳傑 校）
Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial
Thomas Mencke, Heike Knoll, Jan-Uwe Schreiber, Matthias Echternach, Sarah Klein, Gabriele Noeldge-Schomburg, and Malte Silomon
Anesth Analg 2006 102: 943-949.
膝關節成形術中止血帶使用時間延長後麻醉，病人和手術風險因素對神經系統併發症的影響
（鍾靜譯 薛張綱校）
Anesthetic, Patient, and Surgical Risk Factors for Neurologic Complications After Prolonged Total Tourniquet Time During Total Knee Arthroplasty
Terese T. Horlocker, James R. Hebl, Bhargavi Gali, Christopher J. Jankowski, Christopher M. Burkle, Daniel J. Berry, Fernando A. Zepeda, Susanna R. Stevens, and Darrell R. Schroeder
Anesth Analg 2006 102: 950-955
全身麻醉不縮短老年大鼠的平均壽命
（陳瑋 譯 馬皓琳 李士通 校）
General Anesthesia Does Not Reduce Life Expectancy in Aged Rats
Deborah J. Culley, Alexander Loguinov, Rustam Yukhananov, and Gregory Crosby
Anesth Analg 2006 102: 956-959.
區域麻醉下行頸動脈內膜切除術中使用右美托咪定（dexmedetomidine）鎮靜和血流動力學控制與傳統治療方法的比較
A Comparison of Dexmedetomidine Versus Conventional Therapy for Sedation and Hemodynamic Control During Carotid Endarterectomy Performed Under Regional Anesthesia
Craig A. McCutcheon, MBBS, FANZCA, Ruari M. Orme, MBBS, FANZCA, David A. Scott, MBBS, PhD, FANZCA, Michael J. Davies, MBBS, MD, FANZCA, and Desmond P. McGlade, MBBS, FANZCA
Anesth Analg 2006 102: 668-675.
右美托咪定（DEX)的可滴定鎮靜和交感神經調節的特性提示它也許適合在區域麻醉下頸動脈內膜切除術（CEA)中使用。作者在56名區域麻醉下行頸動脈內膜切除術的病人中進行了一個隨機雙盲的研究，比較使用DEX和傳統的使用咪唑安定和芬太尼（STD）的標準鎮靜技術下的血流動力學。兩組均滴定至Ramsay鎮靜評分2-4分。主要的結果是處理動脈血壓和心率偏移出預定範圍所需的用藥次數。同時也比較血流動力學恢復情況，病人滿意度和不良心血管和神經事件。所有的血流動力學干涉次數沒有差別(DEX 80% 比 STD 79%; P = 1.0)。可是，兩組中干涉的內容不同：DEX組病人由於高血壓和/或心動過速所需干涉的次數少於STD組(DEX 40% 比 STD 72%; P = 0.03)。DEX組中每名病人由於高血壓和/或心動過速所需干涉的次數也較少。在動脈分流期間由於高血壓和/或心動過速所需治療的病人數沒有差異。在麻醉後恢復室，較多的DEX組病人需要血管活性藥物干預(DEX組 11名, 44%, 比STD組4名, 14%; P = 0.03)。主要為了低血壓(DEX 7, 28% 比STD 3, 11%; P = 0.16)。在麻醉恢復室中，不需額外鎮痛的病人數DEX組明顯多於STD組 (DEX組 18, 72% 比STD組 11, 38%; P = 0.027)。DEX組提供了一種可供選擇的清醒CEA中鎮靜的方法，但其並不優於標準鎮靜技術。
（殷文淵 譯 陳傑 校）
The properties of dexmedetomidine (DEX) that result in titratable sedation and sympathetic modulation suggest that it would be suitable for use during carotid endarterectomy (CEA) performed under regional anesthesia. We performed a randomized, double-blind study in 56 patients having CEA under regional anesthesia and compared hemodynamic control using DEX versus a conventional sedation technique using midazolam and fentanyl standard (STD). Sedation was titrated to a Ramsay Sedation Score of 2–4 in both groups. The primary outcome was the number of pharmacological interventions required to treat deviations of arterial blood pressure and heart rate outside of predetermined limits. We also compared recovery hemodynamic profiles, patient satisfaction, and adverse cardiac and neurological events. There was no difference in the overall rate of hemodynamic interventions (DEX 80% versus STD 79%; P = 1.0). However, the nature of interventions differed in that patients in the DEX group were less likely to require treatment for hypertension and/or tachycardia (DEX 40% versus STD 72%; P = 0.03). The number of interventions per patient for hypertension and/or tachycardia was also lesser in the DEX group (P = 0.02). There were no significant differences in the numbers of patients needing intraoperative treatment for hypotension or bradycardia or in the need for intraarterial shunting. In the postanesthesia care unit, more patients in the DEX group required hemodynamic drug interventions (DEX 11, 44%, versus STD 4, 14%; P = 0.03). These were primarily for hypotension (DEX 7, 28% versus STD 3, 11%; P = 0.16). The number of patients requiring no additional pain relief in the postanesthesia care unit was significantly larger for patients in the DEX group (DEX 18, 72% versus STD 11, 38%; P = 0.027). DEX provides an acceptable alternative, without superiority to standard techniques for sedation during awake CEA.
兒童在N2O/O2/丙泊酚麻醉期間使用0.1mg/kg劑量的順式阿曲庫銨的藥代和藥效動力學
Pharmacokinetics and Pharmacodynamics of a 0.1 mg/kg Dose of Cisatracurium Besylate in Children During N2O/O2/Propofol Anesthesia
Karynn Imbeault, B Pharm, Davina E. Withington, FRCA, MRCP(UK), and France Varin, B Pharm, PhD
Faculté de Pharmacie, Université de Montréal, Department of Anesthesia, Montreal Children’s Hospital/McGill University, Montreal, Quebec, Canada
Anesth Analg 2006 102: 738-743.
此文研究9名1-6歲兒童（平均年齡3.75歲，平均體重，17.1kg）在丙泊酚-氧化亞氮麻醉期間使用阿曲庫銨的藥代和藥效動力學。實施神經肌肉監測。在靜脈注射0.1mg/kg阿曲庫銨前及注射後2，5，10，30，60，90，120分鐘分別抽取血樣本，通過高性能的液相色譜法來計算血漿內阿曲庫銨濃度。起效時間為2.5±0.8分鐘，肌顫搐25％恢復時間為37.6±10.2分鐘，25％－75％的恢復指數為10.9±3.分鐘。藥物分佈和清除半衰期分別為3.5±0.9分鐘和22.9±4.5分鐘。達穩態分佈容積（0.207±0.031L/kg）和總體內清除率（6.8±0.7ml/min/kg）都明顯高於成人。結果顯示除了肌顫搐25％恢復時間較長外，阿曲庫銨的藥效動力學與小兒氟烷或阿片類藥物麻醉時結果相似。儘管血漿有效室平衡速度常數（0.115±0.025min-1）2倍于成人，但50％阻滯的有效室濃度是相同的（129±27ng/ml）。
（朱輝 譯 陳傑 校）
We studied the pharmacokinetics and pharmacodynamics of cisatracurium in 9 children (mean weight, 17.1 kg) aged 1–6 yr (mean, 3.75 yr) during propofol-nitrous oxide anesthesia. Neuromuscular monitoring was performed. Venous samples were taken before injection of a 0.1 mg/kg dose of cisatracurium and then at 2, 5, 10, 30, 60, 90, and 120 min. Cisatracurium plasma concentrations were determined by high performance liquid chromatography. Onset time was 2.5 ± 0.8 min, recovery to 25% of baseline twitch height was 37.6 ± 10.2 min, and the 25%–75% recovery index was 10.9 ± 3.7 min. Distribution and elimination half-lives were 3.5 ± 0.9 min and 22.9 ± 4.5 min, respectively. Steady-state volume of distribution (0.207 ± 0.031 L/kg) and total body clearance (6.8 ± 0.7 mL/min/kg) were significantly larger than those published for adults. Pharmacodynamic results were comparable to those obtained in pediatric studies during halothane or opioid anesthesia with the exception of a longer recovery to 25% baseline. Although the plasma-effect compartment equilibration rate constant was twofold faster (0.115 ± 0.025 min–1) than that published for cisatracurium in adults, the effect compartment concentration corresponding to 50% block was similar (129 ± 27 ng/mL).
舌下含服吡羅昔康進行術後鎮痛：術前和術後用藥的隨機、雙盲研究
Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study
Hans-F Gramke, MD, Jurgen J. J. Petry, MD, Marcel E. Durieux, MD, PhD, Jean-P Mustaki, MD, Marcel Vercauteren, MD, PhD, Georges Verheecke, MD, and Marco A. E. Marcus, MD, PhD
University Hospital Maastricht, Department of Anesthesiology and Pain Treatment, Maastricht, The Netherlands; Hopital de Zone Morges, Service d’ Anesthesiologie, Morges, Switzerland; Universitair Ziekenhuis Antwerpen, Dienst Anesthesiologie, Edegem, Belgium; Klinieken Noord Antwerpen, Dienst Anesthesiologie, Brasschaat, Belgium
Anesth Analg 2006 102: 755-758.
非甾體抗炎藥物已經被用於超前鎮痛。在這個隨機的雙盲研究中，作者研究術前舌下含服吡羅昔康是否比術後應用更有效。選擇52個擇期全麻下行腹腔鏡下雙側腹股溝疝修補術手術病人。術前組（n＝25）病人術前2小時舌下含服吡羅昔康40mg，術後10min給予一片安慰劑。術後組（n＝27）病人術前2小時給予一片安慰劑，術後10min舌下含服吡羅昔康40mg。在靜注曲馬多100mg初始劑量後，病人開始應用曲馬多自控鎮痛並記錄整個過程。在恢復期和術後6，20和30小時進行疼痛評分。結果顯示術前組病人術後6小時和20小時的疼痛評分較低，術後30小時的曲馬多累積消耗較少。研究結果表明術前舌下含服吡羅昔康比術後應用更有效。因為兩組的疼痛評分都較低，從這個研究得到的結果和臨床的關聯性還不明確。
（張美榮 譯 陳傑 校）
Nonsteroidal antiinflammatory drugs have been used to obtain preemptive analgesia. We investigated, in this randomized, double-blind study, whether sublingual (s.l.) piroxicam given before was more effective than that given after surgery. Fifty-two patients scheduled for laparoscopic bilateral inguinal hernia repair under general anesthesia were enrolled. Group PRE (25 patients) received 40 mg of piroxicam s.l. 2 h before surgery and a placebo 10 min after surgery. Group POST (27 patients) were treated with a placebo 2 h before surgery and received 40 mg of piroxicam s.l. 10 min after surgery. After an initial dose of 100 mg tramadol IV, patient-controlled analgesia with tramadol was started and recorded. Visual analog scores were assessed in the recovery and at 6, 20, and 30 h postoperatively. Significantly lower visual analog scores were found in group PRE at 6 and 20 h. Significantly smaller cumulative tramadol consumption was observed after 30 h in group PRE. In summary, our findings suggest that preoperative s.l. piroxicam is more effective than the postoperative administration. Because of the low pain scores in both groups, the clinical relevance of these findings is not clear from this study.
呼吸興奮劑多沙普侖抑制TASK相關鉀通道功能，但不影響最低肺泡有效麻醉濃度
The Ventilatory Stimulant Doxapram Inhibits TASK Tandem Pore (K2P) Potassium Channel Function but Does Not Affect Minimum Alveolar Anesthetic Concentration
Joseph F. Cotten, MD, PhD, Bharat Keshavaprasad, MD, Michael J. Laster, DVM, Edmond I. Eger, II, MD, and C. Spencer Yost, MD
Department of Anesthesia and Perioperative Care, University of California San Francisco
Anesth Analg 2006 102: 779-785.
TASK-1（KCNK3）(TWIK相關酸敏感鉀離子通道1)和TASK-3(KCNK9)是串聯的鉀通道亞單位，常在頸動脈體和腦幹表達。酸PH值和缺氧抑制TASK-1和TASK-3功能，而氟烷增強其功能。因此推測這些通道作用與通氣調節和揮發性麻醉藥的作用機制相關。.多沙普侖興奮呼吸作用是通過頸動脈體起效，作者假設這種興奮作用可能通過抑制TASK-1或TASK-3發揮作用。作者在爪蟾卵表達TASK-1，TASK-3，TASK-1/TASK-3異二聚體，嵌合體K通道,並研究多沙普侖對它們作用。多沙普侖抑制了TASK-1(半數有效濃度[EC50],410nM),TASK-3(EC50,37uM)和TASK-1/TASK[-3異二聚體通道的功能(EC50, 9 µM)。嵌合體研究顯示TASK-1的末端羥基對於多沙普侖抑制效應具有重要作用。其他K2p通道的出現抑制效應時需要更高的濃度。為了檢測TASK-1和TASK-3在氟烷產生不動性效應中的作用，作者給大鼠靜脈注射多沙普侖，結果氟烷的最低肺泡有效濃度並沒有發生變化。結果顯示：雖然TASK-1和TASK-3在氟烷產生的不動效應中未起到作用，但其似乎是多沙普侖的呼吸效應中的分子水平作用位點。
（鄭麗 譯 陳傑 校）
TWIK-related acid-sensitive K+-1 (TASK-1 [KCNK3]) and TASK-3 (KCNK9) are tandem pore (K2P) potassium (K) channel subunits expressed in carotid bodies and the brainstem. Acidic pH values and hypoxia inhibit TASK-1 and TASK-3 channel function, and halothane enhances this function. These channels have putative roles in ventilatory regulation and volatile anesthetic mechanisms. Doxapram stimulates ventilation through an effect on carotid bodies, and we hypothesized that stimulation might result from inhibition of TASK-1 or TASK-3 K channel function. To address this, we expressed TASK-1, TASK-3, TASK-1/TASK-3 heterodimeric, and TASK-1/TASK-3 chimeric K channels in Xenopus oocytes and studied the effects of doxapram on their function. Doxapram inhibited TASK-1 (half-maximal effective concentration [EC50], 410 nM), TASK-3 (EC50, 37 µM), and TASK-1/TASK-3 heterodimeric channel function (EC50, 9 µM). Chimera studies suggested that the carboxy terminus of TASK-1 is important for doxapram inhibition. Other K2P channels required significantly larger concentrations for inhibition. To test the role of TASK-1 and TASK-3 in halothane-induced immobility, the minimum alveolar anesthetic concentration for halothane was determined and found unchanged in rats receiving doxapram by IV infusion. Our data indicate that TASK-1 and TASK-3 do not play a role in mediating the immobility produced by halothane, although they are plausible molecular targets for the ventilatory effects of doxapram.
氯胺酮削弱離體新生鼠的脊髓交感活性並非通過N-甲基-d-天門冬氨酸受體介導
Ketamine Attenuates Sympathetic Activity Through Mechanisms not Mediated by N-Methyl-d-Aspartate Receptors in the Isolated Spinal Cord of Neonatal Rats
Chiu-Ming Ho, MD, PhD*, and Chun-Kuei Su, PhD_files/image001.gif){kind=small}
*Department of Anesthesiology, Taipei Veterans General
Hospital and National Yang-Ming University; _files/image002.gif){kind=small}
Institute
of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
Anesth Analg 2006 102: 806-810.
儘管氯胺酮的中樞機制還不明確，但還是被認為具有擬交感活性。在新生鼠的離體內臟脊髓神經標本上，作者先前的研究表明交感活性的增強是胸部脊髓自發產生的。本研究作者設計一項實驗來觀察對脊髓應用氯胺酮是否增加交感活性，這一作用是否依賴於N-甲基-d-天門冬氨酸受體（NMDA）。應用氯胺酮後產生濃度依賴的交感活性降低。應用濃度分別為10，20，40，80，120uM氯胺酮，降低交感活性分別到82.6%+4.4%(P<0.05)，61.7%+5.1%，42.8%+4.2%，24.9%+4.4%，9.2%+2.7%(P<0.01，每組n=8)。氯胺酮抑制50%交感活性的濃度為32uM。預先給予DL-2-氨基-5-phosphonovaleric acid，一種選擇性競爭N-甲基-d-天門冬氨酸受體拮抗劑，並不改變氯胺酮產生交感活性的抑制作用。上述結果顯示氯胺酮產生的交感活性的降低並非通過NMDA的機制。
（顧新宇 譯 陳傑 校）
Ketamine is believed to have sympathomimetic effects, although the central mechanism remains unclear. Using an in vitro splanchnic nerve-spinal cord preparation from neonatal rats, our previous investigations have demonstrated that tonic sympathetic activity is spontaneously generated from the thoracic spinal cord. We designed this study to investigate whether applications of ketamine to the cord would augment sympathetic activity and whether this action was dependent on N-methyl-d-aspartate receptors. Bath application of ketamine significantly reduced sympathetic activity in a concentration-dependent manner. Ketamine in 10, 20, 40, 80, and 120 µM reduced the sympathetic activity to 82.6% ± 4.4% (P < 0.05), 61.7% ± 5.1%, 42.8% ± 4.2%, 24.9% ± 4.4%, and 9.2% ± 2.7% of the control value, respectively (P < 0.01, n = 8 for each test). The 50% inhibitory concentration of ketamine on sympathetic activity was 32 µM. Pretreatment with DL-2-amino-5-phosphonovaleric acid, a selective competitive N-methyl-d-aspartate receptor antagonist, did not alter ketamine-induced depression of sympathetic activity. These results suggest that ketamine reduces sympathetic activity by mechanisms that are independent of N-methyl-d-aspartate receptor activity.
福馬林實驗中大鼠的超聲發聲：一種測量疼痛引起情感變化程度的方法？
Ultrasonic Rat Vocalizations During the Formalin Test: A Measure of the Affective Dimension of Pain?
Alexandre R. Oliveira, MD, and Helena M. T. Barros, MD, PhD*
Pharmacology Division, Fundação Faculdade Federal de Ciências Medicas de Porto Alegre
福馬林實驗中大鼠超聲發聲（USV）散佈情況還沒有得到證實。作者進行了兩項試驗來確定能誘導產生USV的福馬林濃度、福馬林實驗中USV的散佈與運動行為間的關係以及嗎啡和納洛酮對USV的影響。在實驗1中，三組不同的大鼠的前爪皮下注射5％、10％或12.5％的福馬林。實驗2是為了明確在12.5％組的福馬林實驗中注射嗎啡1、2.5或5mg/kg對USV的影響。而另外兩組的大鼠每個嗎啡劑量接受納洛酮2mg/kg來明確阿片類藥物的作用特點。每5分鐘測量USV和運動行為，共測量了40分鐘。並且將實驗分為早期（0－5min），中期（5－20min），晚期（20－40min）。試驗中，主要在福馬林注射間期，尤其在注入12.5％福馬林後檢測發聲。在可逆性納洛酮使用模式中，嗎啡能抑制USV。這證明了福馬林實驗中USV的情況，獲得了另一種非反射性行為的測量方法來幫助臨床上明確這種大鼠疼痛模型中相關的完整的行為模式的特徵。
（蘇殿三 譯 陳傑 校）
The emission of ultrasonic vocalization (USV) by rats submitted to the formalin test has not yet been demonstrated. We performed two experiments to establish the formalin concentration to induce USV and the relationship of USV emission with motor behaviors and the effects of morphine and naloxone on USV during the formalin test. Male Wistar rats were used. In Experiment 1, 3 different groups of rats were subcutaneously injected with 5%, 10%, or 12.5% formalin in 1 of the anterior paws. Experiment 2 was intended to verify the effect of morphine 1, 2.5, or 5 mg/kg on USV during the 12.5% formalin test, whereas other groups of rats received naloxone 2 mg/kg with each one of the morphine doses to verify the specificity of opioid action. USV and motor behaviors were simultaneously measured in 5-min windows for 40 min, and early (0–5 min), interphase (5–20 min), and late (20–40 min) phases of the test were characterized. Vocalization was detected mostly during the interphase of the formalin test, mainly after formalin 12.5%. Morphine suppressed USV in a naloxone-reversible manner. This is a demonstration of USV during the formalin test, allowing the inclusion of an additional nonreflex behavioral measure to help characterize more clinically relevant integrated behavioral patterns in this rat model of pain.
.巴氯芬注射相關的鞘內導管肉芽腫
Intrathecal Catheter Granuloma Associated with Isolated Baclofen Infusion
Paul M. Murphy, MB, MRCPI, FCARCSI*, Danielle E.
Skouvaklis, MD*, Ryan J.J. Amadeo, MD*, Craig Haberman,
MD*, David H. Brazier, MD_files/image003.gif){kind=small}
,
and Michael J. Cousins, AM, MD, FFPMANZCA*
*University of Sydney Pain Management and Research Institute
and _files/image004.gif){kind=small}
Department of
Radiology, Royal North Shore Hospital, St. Leonards, Australia
Anesth Analg 2006 102: 848-852.
當口服巴氯芬效果不佳時，鞘內注射（IT）巴氯芬是一種有效的控制痙攣狀態的方法。作者提供以下病例：一例57歲婦女，C6節段水平以下癱瘓。儘管逐步加大口服巴氯芬劑量達到80 mg/d仍然無法控制嚴重的痙攣。鞘內注射（IT）巴氯芬反應良好，經植入的泵進行鞘內注射，初始劑量200µg/d。2周後由於導管移位，重新調整導管位置。鞘內注射巴氯芬的劑量逐漸加大到400 µg/d達到較好的控制水平。經過一段持續輸注後，儘管加大劑量，她的下肢開始發生嚴重的進行行肌肉痙攣。脊髓CT (X線)造影照片以排除機械性因素，導管沒有移位元或破裂，但是顯示導管尖端有塊狀物質。先前使用單獨使用巴氯芬鞘內注射並未見有導管尖端肉芽腫的報導。這表明儘管少見，但是使用鞘內注射巴氯芬的病人如果神經系統功能改變或藥量需求顯著增加，其發生導管相關肉芽腫的可能性仍要考慮。
（潘志英 譯 陳傑 校）
Intrathecal (IT) baclofen is an effective management strategy for controlling spasticity in patients unresponsive to maximal oral therapy. We present the case of a 57-yr-old woman who was rendered quadriplegic after a complete spinal cord transection at the C6 level. Her course was complicated by severe spasms, which were uncontrolled despite titrating orally administered baclofen to 80 mg/d. IT baclofen testing was performed with good response, and administration was commenced via an implanted intrathecal pump 6 mo after the injury at an initial dose of 200µg/d. Catheter revision was required 2 wk later as a result of catheter displacement. The initial IT baclofen dose was gradually increased to achieve good control at a level of 400 µg/d. After a period of stability lasting 38 mo, her lower limb spasms dramatically increased in severity and remained poorly controlled despite repeated dose increases. Contrast pumpogram and computed tomography myelogram were performed to exclude a mechanical cause for this apparent increase in baclofen requirement. These investigations revealed neither catheter displacement nor fracture as suspected but, rather, displayed the presence of a catheter tip-associated mass. Catheter tip granuloma has not previously been described in a patient receiving IT baclofen alone. This suggests that although uncommon, the possibility of catheter-associated granuloma must be considered in all patients receiving IT baclofen presenting with altered neurological function or significant increase in drug requirement.
Anesthetic Complications of Awake Craniotomies for Epilepsy Surgery
Andrius P. Skucas, MD, and Alan A. Artru, MD
Department of Anesthesiology, University of Washington, School of Medicine, Seattle, Washington
Anesth Analg 2006 102: 882-887.
清醒開顱手術經常用於切除靠近腦部重要功能區的癲癇放電灶。在作者醫院內清醒開顱手術中，常在局部麻醉和開顱時使用異丙酚，保持病人的自主通氣，而不置入氣管導管或者喉罩。在需要病人說話、動作、以及感覺定位和腦電圖定位時暫停使用異丙酚。當切除以及關顱時再繼續使用異丙酚鎮靜。作者對332名基於應用異丙酚的“沉睡－清醒－沉睡（asleep-awake-asleep,AAA）”技術而不插管的病人以及129個氣管插管全麻後進行癲癇開顱術的病人進行了回顧性比較研究。作者比較了術中呼吸以及血流動力學併發症以及痙攣、噁心、腦水腫、病人活動、出血、誤吸、空氣栓塞、死亡的發生率。AAA病人中很少出現呼吸問題，但與氣管插管全麻的病人相比高血壓、低血壓、心動過速的發生率較高，這些在術中都得到了適當的處理。只有一例使用AAA技術的病人出現了不良臨床後果。
（丁希喆 譯 陳傑 校）
Awake craniotomies are often performed for resection of epileptogenic foci close to vital areas of the brain. For awake craniotomies at our institution, propofol is infused during local anesthetic injection and craniotomy, spontaneous ventilation is preserved, and no endotracheal tube or laryngeal mask airway is used. Propofol is discontinued for language, motor, and/or sensory mapping and for electrocorticography. Patients are re-sedated with propofol for resection and closure. We performed a retrospective chart review of 332 propofol-based "asleep-awake-asleep" (AAA) techniques with unsecured airways and 129 general anesthesia with endotracheal intubation craniotomies for epilepsy surgery. We compared the incidence of intraoperative respiratory and hemodynamic complications and incidence of seizures, nausea, brain swelling, patient movement, bleeding, aspiration, air embolism, and death. Airway compromise was uncommon in AAA cases and although incidences of hypertension, hypotension, and tachycardia were statistically increased in AAA versus general anesthesia craniotomy, these were treated appropriately. In only one patient the use of our AAA technique may have contributed to a poor clinical outcome.
程式化硬膜外間斷給藥和連續給藥用於分娩鎮痛的隨機比較
A Randomized Comparison of Programmed Intermittent Epidural Bolus with Continuous Epidural Infusion for Labor Analgesia
Cynthia A. Wong, MD, John T. Ratliff, MD, John T. Sullivan, MD, Barbara M. Scavone, MD, Paloma Toledo, MD, and Robert J. McCarthy, PharmD
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Ilinois
Address correspondence to Cynthia A. Wong, MD, Department of Anesthesiology, 251 E. Huron Street, F5-704, Chicago, IL 60611.
Anesth Analg 2006 102: 904-909.
通過硬膜外導管給予麻醉藥液時，間斷給藥與持續給藥相比前者可能使藥液在硬膜外間隙的分佈更好。在該隨機雙盲的研究中，作者比較了接受程式化硬膜外間斷給藥（PIEB）和連續給藥（CEI）分娩鎮痛的布比卡因用量、硬膜外追加鎮痛的需要、鎮痛效果和滿意情況。主要的結果是用於鎮痛的布比卡因每小時用量。宮頸擴張2-5cm將分娩的經產婦，行鞘內和硬膜外聯合鎮痛。病人隨機分為PIEB組（鞘內給藥45min後開始每30min注射6ml麻醉藥液）或者CEI組（鞘內給藥15min後開始按12ml/h連續給藥）。硬膜外鎮痛藥液是布比卡因0.625 mg/mL和芬太尼2 µg/mL。突發性疼痛時兩組病人均通過自控硬膜外鎮痛（PCEA），手動給予0.125%布比卡因來緩解。布比卡因每小時用量的中位數在PIEB組(n = 63)和CEI組(n = 63)分別為10.5 mg/h（95%可信區間為9.5–11.8 mg/h）、12.3 mg/h（95%可信區間為10.5–14.0 mg/h) ，PIEB組較少(P < 0.01)。PIEB組需要手動加藥來緩解疼痛的幾率較低（兩組的率差為22%，其95%可信區間為5%-38%）。PIEB組的滿意評分更高。分娩痛、PCEA 需求以及PCEA用量在兩組間沒有區別。PIEB和CEI分別與PECA聯合用於硬膜外分娩鎮痛的維持時，鎮痛效果相同，但前者的布比卡因用量更少且病人滿意度更好。（趙延華 譯 陳傑 校）
Bolus injection through an epidural catheter may result in better distribution of anesthetic solution in the epidural space compared with continuous infusion of the same anesthetic solution. In this randomized, double-blind study we compared total bupivacaine consumption, need for supplemental epidural analgesia, quality of analgesia, and patient satisfaction in women who received programmed intermittent epidural boluses (PIEB) compared with continuous epidural infusion (CEI) for maintenance of labor analgesia. The primary outcome variable was bupivacaine consumption per hour of analgesia. Combined spinal epidural analgesia was initiated in multiparas scheduled for induction of labor with cervical dilation between 2 and 5 cm. Subjects were randomized to PIEB (6-mL bolus every 30 min beginning 45 min after the intrathecal injection) or CEI (12-mL/h infusion beginning 15 min the after the intrathecal injection). The epidural analgesia solution was bupivacaine 0.625 mg/mL and fentanyl 2 µg/mL. Breakthrough pain in both groups was treated initially with patient-controlled epidural analgesia (PCEA) followed by manual bolus rescue analgesia using bupivacaine 0.125%. The median total bupivacaine dose per hour of analgesia was less in the PIEB (n = 63) (10.5 mg/h; 95% confidence interval, 9.5–11.8 mg/h) compared with the CEI group (n = 63) (12.3 mg/h; 95% confidence interval, 10.5–14.0 mg/h) (P < 0.01), fewer manual rescue boluses were required (rate difference 22%, 95% confidence interval of difference 5% to 38%), and satisfaction scores were higher. Labor pain, PCEA requests, and delivered PCEA doses did not differ. PIEB combined with PCEA provided similar analgesia, but with a smaller bupivacaine dose and better patient satisfaction compared with CEI with PCEA for maintenance of epidural labor analgesia.
The Epidural Test Dose: A Review
Joanne Guay, MD, FRCPC
Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Canada
Anesth Analg 2006 102: 921-929.
本綜述系統地調查了有關傳統的硬膜外試驗劑量的作用和其他測試方法及時發現硬膜外穿刺針或導管誤入血管內、鞘內、硬膜下腔的有關情況。為了測試誤入血管方法，至少有來自不同的研究中心的兩項隨機對照試驗，用靈敏度（S）和陽性預測值（PPV_files/image005.gif){kind=small}
80）方法檢測不同的人群中方法的可靠性。成年非孕患者，用腎上腺素（10或15µg）注射方法：以收縮壓增高_files/image006.gif){kind=small}
15mmHg為標準時S＝80-100和93-100；PPV=80-100或83-100。以收縮壓增高_files/image007.gif){kind=small}
15mmHg或心率增快_files/image008.gif){kind=small}
10bpm為標準，注射腎上腺素10µg時S = 100， PPV = 83–100。注射腎上腺素15µg時S = 100， PPV = 83–100。懷孕患者用注射芬太尼（100µg）方法，以5分鐘內發生鎮靜，困倦，或頭暈為標準，該方法的S=92-100；PPV=91-95。小兒患者用注射腎上腺素（0.5µg/kg）方法，以注射後收縮壓增高15mmHg為標準，該方法S=81-100；PPV=100。相反，以上三類人群中尋找更好的測試方法及時發現硬膜外穿刺針或導管誤入鞘內或硬膜下腔還需進行大量的研究。
（肖潔 譯 陳傑 校）
This review systematically examines the literature on the
ability of the classical epidural test dose and other strategies to
detect intravascular, intrathecal, or subdural epidural needle/catheter
misplacement. For detection of simulated intravascular misplacements,
a sensitivity (S) and a positive predictive value (PPV) _files/image009.gif){kind=small}
80 demonstrated by at least two randomized controlled trials
coming from two different centers were determined for the following
tests and patient populations: Nonpregnant adult patients = increase
in systolic blood pressure (SBP) _files/image010.gif){kind=small}
15 mm Hg (S
= 80–100 and 93–100; PPV = 80–100 and 83–100) or either an
increase in SBP _files/image011.gif){kind=small}
15 mm Hg or an increase in
heart rate _files/image012.gif){kind=small}
10 bpm after the
injection of 10 (S = 100; PPV = 83–100) or 15 µg of epinephrine (S =
100; PPV = 83–100); pregnant patients = sedation, drowsiness, or
dizziness within 5 min after the injection of 100 µg of fentanyl (S
= 92–100; PPV = 91–95); and children = increase in SBP _files/image013.gif){kind=small}
15 mm Hg after the
injection of 0.5 µg/kg of epinephrine (S = 81–100; PPV = 100).
Conversely, more studies are required to determine the best
strategies to detect intrathecal and subdural epidural needle/catheter
misplacements in these three patient populations.
羅庫溴銨在快速誘導插管中不比琥珀酰膽鹼有更多的聲帶損傷：一項隨機、前瞻性對照研究
Rocuronium Is Not Associated with More Vocal Cord Injuries than Succinylcholine After Rapid-Sequence Induction: A Randomized, Prospective, Controlled Trial
Thomas Mencke, MD*, Heike Knoll, MD_files/image014.gif){kind=small}
, Jan-Uwe
Schreiber, MD_files/image015.gif){kind=small}
, Matthias
Echternach, MD_files/image016.gif){kind=small}
, Sarah Klein,
MD_files/image017.gif){kind=small}
, Gabriele
Noeldge-Schomburg, MD*, and Malte Silomon, MD||
*Department of Anaesthesia and Intensive Care Medicine,
University of Rostock, Rostock, _files/image018.gif){kind=small}
Department of
Anaesthesia and Intensive Care Medicine, _files/image019.gif){kind=small}
Department
of Otorhinolaryngology, University of the Saarland, Homburg/Saar, ||Department
of Anaesthesia and Intensive Care Medicine, Catholic Hospital, Koblenz, Germany
Anesth Analg 2006 102: 943-949.
術後聲嘶(PH)、咽喉痛（ST）及聲帶損傷（VCI）是全身麻醉後的常見併發症。插管暴露條件越好則喉部損傷的幾率越小。本研究選取160例病人隨機分為兩組，進行羅庫溴銨與琥珀酰膽鹼在快速誘導插管中對聲帶損傷的比較。琥珀酰膽鹼組（S組）誘導用藥為：琥珀酰膽鹼1.0 mg/kg，硫噴妥鈉5.0 mg/kg以及芬太尼3.0 µg/kg；羅庫溴銨組（V組）為：羅庫溴銨1.0 mg/kg，其餘用藥相同。術後24、48和72小時進行聲嘶、咽喉痛損傷評估，聲嘶超過三天的患者行鏡檢觀察聲帶損傷情況。研究結果表明：與羅庫溴銨相比，琥珀酰膽鹼能提供更佳的插管條件。最佳插管條件兩組分別為57% 和21% ；臨床可接受的插管條件為89%和59% (P < 0.001)。聲嘶、咽喉痛及聲帶損傷在兩組無顯著差別。琥珀酰膽鹼組與羅庫溴銨組相比：PH分別為50%和51%(P = 0.99)；VCI為3%和1% (P = 0.98); ST為39%和28% (P = 0.22)。兩組患者術後肌痛也沒有顯著差別，琥珀酰膽鹼組為39% ，羅庫溴銨組為 29% (P = 0.25)。綜上所述：琥珀酰膽鹼和羅庫溴銨在術後聲嘶、聲帶損傷、咽喉痛和肌痛的發生率方面相似，但琥珀酰膽鹼能提供更好的插管條件。
（鄭擁軍 譯 陳傑 校）
Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. In this prospective trial, 160 patients were randomized in 2 groups to receive thiopental 5.0 mg/kg, fentanyl 3.0 µg/kg, succinylcholine 1.0 mg/kg, or rocuronium 0.6 mg/kg during RSI. PH and ST were assessed at 24, 48, and 72 h after surgery, VCI were examined by stroboscopy in those patients who had PH >3 days. Excellent and clinically acceptable intubating conditions were significantly increased in the succinylcholine group compared with the rocuronium group: 57% versus 21% and 89% versus 59%, respectively (P < 0.001). The incidence and severity of PH, and VCI between the succinylcholine and the rocuronium groups did not differ significantly: PH: 50% versus 51% (P = 0.99) and VCI: 3% versus 1% (P = 0.98), respectively. Similar findings were found for ST, 39% versus 28% (P = 0.22), and postoperative myalgia, 39% versus 29% (P = 0.25), respectively. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.
Diazepam enhances inotropic responses to dopamine in rat
ventricular myocardium.
Juan-Fita MJ, Vargas ML, Hernandez J.
Departmento de Farmacologia, Facultad de
Medicina, Murcia, Spain.
Anesth
Analg. 2006 Mar;102(3):676-81
地西泮抑制4型磷酸二酯酶，並且提高某些3',5'環磷酸腺苷(cAMP)-依賴的正性肌力藥的反應。我們尋求明確是否地西泮和選擇性4型磷酸二酯酶抑制劑咯利普（rolipram）可以提高收縮反應以及提高鼠心肌經多巴胺誘導產生的cAMP水平。多巴胺(3-100 mic - roM)產生濃度依賴性的正性肌力效應(-log EC50 = 5.21
+/- 0.2, n = 5)，地西泮10
microM(-log EC50 = 5.40 +/- 0.08, n = 6, P < 0.05)或rolipram(-log EC50 = 5.41 +/- 0.1, n = 6,
P < 0.05)1microM時，這種效應被擴大。地西泮的這種效應既不能被微摩爾伽瑪氨基丁酸（GABA）所模擬，也不能被濃度為5 microM的外周及中樞的苯二氮卓類受體拮抗劑，氟馬西尼和PK 11195所拮抗。在組織中，由於地西泮(1073 +/- 97.7, n
= 6, P < 0.05)或rolipram
(1034.0 +/- 245.2, n = 5, P < 0.05)的存在，由多巴胺(744.4
+/- 111.8, n = 5)產生的cAMP水平(pmol/g)被增強。因此，地西泮，像rolipram，在鼠心肌增強多巴胺的收縮力和生物化學效應。這種效應不能經苯二氮卓類受體來調節，但這大概是地西泮4型磷酸二酯酶抑制的結果。
（孫敏莉譯 薛張綱校）
Diazepam inhibits phosphodiesterase type 4 and enhances the effect of some 3',5'-cyclic adenosine monophosphate (cAMP)-dependent positive inotropic drugs. We sought to determine whether diazepam and the selective phosphodiesterase type 4 inhibitor rolipram enhances the contractile response and cAMP levels induced by dopamine in rat myocardium. Dopamine (3-100 microM) produced concentration-dependent positive inotropic effects (-log EC50 = 5.21 +/- 0.2, n = 5), which were augmented in the presence of 10 microM diazepam (-log EC50 = 5.40 +/- 0.08, n = 6, P < 0.05) or 1 microM rolipram (-log EC50 = 5.41 +/- 0.1, n = 6, P < 0.05). The effect of diazepam was not mimicked by 100 microM gamma-aminobutyric acid nor it was antagonized by a 5 microM concentration of the blockers of central and peripheral type benzodiazepine receptors, flumazenil and PK 11195. cAMP levels (pmol/g) produced by dopamine (744.4 +/- 111.8, n = 5) in this tissue were enhanced by the presence of diazepam (1073 +/- 97.7, n = 6, P < 0.05) or rolipram (1034.0 +/- 245.2, n = 5, P < 0.05). Therefore, diazepam, like rolipram, augments the inotropic and biochemical effects of dopamine in rat myocardium. This effect is not mediated by benzodiazepine receptors but is probably the consequence of the phosphodiesterase type 4 inhibitory activity of diazepam.
Diazepam Attenuates Phenylephrine-Induced Contractions in Rat Aorta
Soon-Eun Park, MD*,
Ju-Tae Sohn, MD_files/image020.gif){kind=small}
_files/image021.gif){kind=small}
, Cheol Kim, MD_files/image022.gif){kind=small}
, Ki Churl Chang,
PhD_files/image023.gif){kind=small}
_files/image024.gif){kind=small}
, Il-Woo Shin, MD_files/image025.gif){kind=small}
, Kyeong-Eon
Park, MD_files/image026.gif){kind=small}
, Heon-Keun Lee, MD_files/image027.gif){kind=small}
, and Young-Kyun Chung, MD_files/image028.gif){kind=small}
Anesth Analg 2006 102: 682-689.
在這項體外試驗中，我們研究了地西泮對新福林引起的鼠主動脈收縮作用的影響，並且證實其相關的細胞結構——內皮源性血管鬆弛因數。我們做了有或無地西泮時新福林和氯化鉀的濃度－反應曲線。在有或無地西泮時，分別用NW－硝基－L－精氨酸甲酯、PK 11195、四乙銨及吲哚美辛預處理完整的環形血管內皮得到新福林濃度－反應曲線。新福林可使完整的環形血管內皮收縮，而地西泮（7 x 10–7 M）可減弱這種作用，無論是否有內皮細胞存在，大劑量（5 x 10–6 M）地西泮可減弱新福林引起的主動脈環收縮。若使用NW－硝基－L－精氨酸甲酯進行預處理，可以完全避免地西泮對新福林濃度反應曲線的上述作用。使用地西泮（5 x 10–6 M）預處理可增強NW－硝基－L－精氨酸甲酯（10–4 M）對血管環的收縮作用。這些結果表明，超臨床濃度的地西泮可增加內皮細胞氧化亞氮的活性，直接影響血管平滑肌，從而減弱新福林引起的血管收縮作用。
（金 琳譯 薛張綱校）
In this in vitro study we examined the effects of diazepam on a phenylephrine-induced contraction in rat aorta and determined the associated cellular mechanism focusing on the endothelium-derived vasodilators. The concentration-response curves for phenylephrine and potassium chloride were generated in the presence or absence of diazepam. Phenylephrine concentration-response curves were generated from the endothelium-intact rings pretreated independently with NW-nitro-l-arginine methyl ester, PK 11195, tetraethylammonium, and indomethacin in the presence or absence of diazepam. Diazepam (7 x 10–7 M) attenuated the phenylephrine-induced contraction in the endothelium-intact rings, whereas a large dose (5 x 10–6 M) of diazepam attenuated the phenylephrine-induced contraction in the aortic rings with or without the endothelium. A pretreatment with the NW-nitro-l-arginine methyl ester completely abolished the diazepam (7 x 10–7 M)-induced attenuation of the phenylephrine concentration-response curve, as well as the diazepam (5 x 10–6 M)-induced attenuation of the maximal contractile response to phenylephrine. The NW-nitro-l-arginine methyl ester (10–4 M)-induced contraction was enhanced in the rings pretreated with diazepam (5 x 10–6 M). These results indicate that a supra clinical concentration of diazepam attenuates phenylephrine-induced contraction by increasing endothelial nitric oxide activity and directly affecting vascular smooth muscle.
連續硬膜外和連續膕神經阻滯用於小兒足部手術術後鎮痛：前瞻、對比、隨機性研究
Continuous epidural block versus continuous popliteal nerve block for postoperative pain relief after major podiatric surgery in children: a prospective, comparative randomized study.
Dadure C. Bringuier S. Nicolas F. Bromilow L. Raux O. Rochette A. Capdevila X.
Department of Anesthesia, Lapeyronie University Hospital, Montpellier, France.
Anesthesia & Analgesia. 102(3):744-9, 2006 Mar.
小兒足部和踝部手術術後是非常疼痛的，嗎啡和連續硬膜外阻滯（CEB）的副作用又限制了其在小兒中的應用。連續膕神經阻滯（CPNB）在這方面的應用未見報道。本研究我們評價了CPNB和CEB用於小兒足部手術術後鎮痛的效果及其副作用。52例足部手術小兒患者按年齡和鎮痛方法分為四組。全麻後，0.5-1.0ml/kg 0.25％布比卡因和1.0％利多卡因含1：200000的腎上腺素的混合液注入硬膜外或膕神經周圍。術後0.1ml/kg.h（CPNB）或0.2ml/kg.h（CEB）的0.2％羅派卡因用於術後鎮痛48h。常規給予尼氟滅酸（Niflumic acid ）。記錄每組的副作用。評估活動後1、6、12、18、24、36、48h的疼痛情況，補救用藥量（一線藥丙岶他莫30mg/kg 4次/日或二線藥0.2mg/kg納布啡 iv）和運動阻滯情況。記錄48h父母的滿意情況。CEB組27例，CPNB組25例。1－6歲患者32例（CPNB15例；CEB17例），7－12歲患者20例（CPNB10;CEB10）。兩組鎮痛方法和兩組年齡組中術後鎮痛都滿意，術後運動阻滯程度兩組鎮痛方法中相同。副作用（1－6歲組中術後噁心、嘔吐、尿瀦溜和局麻藥無法連續輸注）在CEB組中發生更頻繁（p< 0.05）。CEB組86％和CPNB組100％的父母滿意。我們的結論：雖然兩組鎮痛方法都可產生滿意的術後鎮痛，但是CPNB有更少的尿瀦留、噁心、嘔吐等副作用。因此，我們認為CPNB是1－12歲的患兒行足部手術理想的術後鎮痛方法。
（吳德華譯 薛張綱校）
Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. In this prospective, randomized study we evaluated the effectiveness and adverse events of CPNB or CEB in children after podiatric surgery. Fifty-two children scheduled for foot surgery were separated into four groups by age and analgesia technique. After general anesthesia, 0.5 to 1 mL/kg of an equal-volume mixture of 0.25% bupivacaine and 1% lidocaine with 1:200000 epinephrine was injected via epidural or popliteal catheters. In the postoperative period, 0.1 mL x kg(-1) x h(-1) (group CPNB) or 0.2 mL x kg(-1) x h(-1) (group CEB) of 0.2% ropivacaine was administered for 48 h. Niflumic acid was routinely used. Adverse events were noted in each treatment group. Postoperative pain during motion was evaluated at 1, 6, 12, 18, 24, 36, and 48 h. Requirement for rescue analgesia (first-line propacetamol 30 mg/kg 4 times daily or second-line 0.2 mg/kg IV nalbuphine), and motor blockade were recorded. Parental satisfaction was noted at 48 h. Twenty-seven patients were included in the CEB groups and 25 in CPNB groups. There were 32 children 1 to 6 yr of age (CPNB = 15; CEB = 17) and 20 children 7 to 12 yr of age (CPNB = 10; CEB = 10). The demographic data were comparable among groups. Postoperative analgesia was excellent for the two continuous block techniques and in the two age groups. Motor block intensity was equal between techniques. Adverse events (postoperative nausea or vomiting, urinary retention, and premature discontinuation of local anesthetic infusion in the 1- to 6-yr-old group) were significantly more frequent in the CEB group (P < 0.05). Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent postoperative analgesia in this study, CPNB was associated with less urinary retention and nausea and vomiting. Therefore, we recommend CPNB as the ideal form of postoperative analgesia after major podiatric surgery in 1- to 12-yr-old children.
Determinants of Volatile General Anesthetic Potency: A Preliminary Three-Dimensional Pharmacophore for Halogenated Anesthetics
Jason C. Sewell, PhD, and John W. Sear, PhD, FFARCS
Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK
Address correspondence to John W. Sear, PhD, FFARCS, Nuffield Department of Anaesthetics, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Anesth Analg 2006 102: 764-771.
我們採用比較分子力場分析方法研究了鹵化麻醉劑固定活性的分子基礎。從文獻中獲得69種不同結構的麻醉劑的體外效能資料（用最小肺泡氣濃度表示，MAC）。這些藥物被隨機分配到由活性模型決定的訓練組（n＝52）和獨立的評估模型的預測效能的測試組（n＝17）。這些麻醉劑結構上的排列特點使之該組中效能最強的藥物 CF2H-(CF2)3-CH2OH 的分子結構和靜息電位非常相似。這些麻醉劑中形狀和排列與之相似度最差的（根據碳指數計算）被保留下來用作為比較分子力場分析方法模型。最終的模型說明了訓練組化合物中觀測活性的94.2％的變異。此模型顯示了對訓練組(cross –vali dated, r2 = 0.705)和隨機排除的測試組麻醉劑(r2 = 0.837)的良好的預測能力。三維藥效團圖來自對關鍵區域的空間分佈的鑒別，該區原子空間排列和靜電相互作用在決定鹵化藥物的固定活性非常重要，並且可用來和早先發表的從非鹵化揮發性麻醉劑得來的圖形相比較。
（金 路譯 薛張綱校）
We investigated the molecular basis for the immobilizing activity of halogenated volatile anesthetics using comparative molecular field analysis. In vivo potency data (expressed as minimum alveolar concentrations) for 69 structurally diverse anesthetics were obtained from the literature. The drugs were randomly divided into a training set (n = 52) used to derive the activity model and a test set (n = 17) used to independently assess the model's predictive power. The anesthetic structures were aligned so as to maximize their similarity in molecular shape and electrostatic potential to the most potent drug in the group, CF2H-(CF2)3-CH2OH. The conformers and alignments of the anesthetics with maximum similarity (calculated as Carbo indices) were retained and used to derive the comparative molecular field analysis models. The final model explained 94.2% of the variance in the observed activities of the training set compounds. The model showed good predictive capability for both the training set (cross-validated r2 = 0.705) and randomly excluded test set anesthetics (r2 = 0.837). Three-dimensional pharmacophoric maps were derived to identify the spatial distribution of key areas where steric and electrostatic interactions are important in determining immobilizing activity of the halogenated drugs and were compared with our previously published maps obtained for nonhalogenated volatile anesthetics.
Augmented Activity of Adenosine Triphosphate-Sensitive K+ Channels Induced by Droperidol in the Rat Aorta
Hiroyuki Kinoshita, Mayuko Dojo, Katsutoshi Nakahata, Yoshiki Kimoto, Tetsuya Kakutani, Kazuhiro Mizumoto, and Yoshio Hatano
Department of Anesthesiology, Wakayama Medical University, Wakayama, Wakayama, Japan
Anesth Analg 2006 102: 786-791
氟呱利多能引起心肌細胞鉀通道的抑制.然而,其對血管鉀通道的作用尚不明確。因此,我們進行該試驗來研究是否氟呱利多影響了血管平滑肌細三磷酸腺苷(ATP)敏感性鉀通道的活性。分別記錄無內皮的大鼠主動脈環的膜電位。 左克羅卡林(10-8 到 10-5 M 或 10-5 M)引起的血管舒張和超級化被格列本脲(10-5 M)完全拮抗,後者是ATP敏感性鉀通道抑制劑。氟派利多(10-7 M)和α腎上腺受體拮抗劑酚妥拉明(3 × 10-9 M)引起類似的血管擴張(大約是罌粟堿3 × 10-4 M引起的最大血管舒張程度的20%),而格列本脲不能改變由氟呱利多引起的血管舒張。氟呱利多(3 × 10-8M 到 10-7M)強化了左克羅卡林引起的血管擴張和超級化,而酚妥拉明(3 × 10-9 M)不能改變這種血管舒張. 格列本脲(10-5 M)拮抗了由左克羅卡林和氟派利多(10-7 M)引起的血管舒張和超級化。這些結果提示,氟派利多通過ATP敏感性鉀通道增加了血管舒張作用。然而,這種強化作用未必是抑制了血管平滑肌細胞的α腎上腺受體而起效的。
（王麗珺譯 薛張綱校）
Droperidol produces the inhibition of K+ channels in cardiac myocytes. However, the effects of droperidol on K+ channels have not been studied in blood vessels. Therefore, we designed the present study to determine whether droperidol modulates the activity of adenosine triphosphate (ATP)-sensitive K+ channels in vascular smooth muscle cells. Rat aortic rings without endothelium were suspended or used for isometric force and membrane potential recordings, respectively. Vasorelaxation and hyperpolarization induced by levcromakalim (10-8 to 10-5 M or 10-5 M, respectively) were completely abolished by the ATP-sensitive K+ channel antagonist glibenclamide (10-5 M). Droperidol (10-7 M) and an [alpha]-adrenergic receptor antagonist phentolamine (3 × 10-9 M) caused a similar vasodilator effect (approximately 20% of vasorelaxation compared with maximal vasorelaxation induced by papaverine [3 × 10-4 M]), whereas glibenclamide did not alter vasorelaxation induced by droperidol. Droperidol (3 × 10-8M to 10-7M) augmented vasorelaxation and hyperpolarization produced by levcromakalim, whereas phentolamine (3 × 10-9 M) did not alter this vasorelaxation. Glibenclamide (10-5 M) abolished the vasodilating and hyperpolarizing effects of levcromakalim in the aorta treated with droperidol (10-7 M). These results suggest that droperidol augments vasodilator activity via ATP-sensitive K+ channels. However, it is unlikely that this augmentation is mediated by the inhibition of [alpha]-adrenergic receptors in vascular smooth muscles.
一個雙盲對照的實驗評價三個多元的困難氣道模型的預期作用
Predictive performance of three multivariate difficult tracheal
intubation models: a double-blind, case-controlled study.
Naguib M, Scamman FL, O'Sullivan C, Aker J, Ross AF, Kosmach
S, Ensor JE.
Department of Anesthesiology and Pain Medicine, Unit 409, The University of
Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Anesth Analg. 2006 Mar;102(3):818-24
我們用一個雙盲對照的實驗來評價三個多元的臨床模型（Wilson, Arne, and Naguib模型）在預測意外的困難插管的作用。實驗組包括97例已經發生的意外困難插管的病人。每一個插管困難的病人都有一個容易插管的病人作為對照。術後，一個調查者去評價這兩個病人。臨床評價包括病人的體重、身高、年齡、Mallampat評分、甲頦距離、胸甲距離、頸周長、Wilson危險積分、困難插管史及與喉鏡暴露困難和插管困難相關的疾病。Naguib模型在靈敏度（81.4%）上明顯比Arne(54.6%)模型和 Wilson (40.2%)模型高（P < 0.0001）。Naguib (76.8%) 和 Arne (74.7%)模型比Wilson 模型 (66.5%)區分出更準確的插管率。Arne、Wilson和Naguib模型的特異性分別為94.9%、92.8%和 72.2%，ROC曲線下麵積分別為0.87、0.79和 0.82。我們新的用來預測困難插管的模型通過logistic回歸和甲頦距離、Mallampati 評分、和身高已經改進了。這個模型的靈敏度為82.5％，特異度為85.6％，ROC曲線下面積為0.90。
(陸文清譯 薛張綱校)
We performed a case-controlled, double-blind study to examine the performance of three multivariate clinical models (Wilson, Arne, and Naguib models) in the prediction of unanticipated difficult intubation. The study group consisted of 97 patients in whom an unanticipated difficult intubation had occurred. For each difficult intubation patient, a matched control patient was selected in whom tracheal intubation had been easily accomplished. Postoperatively, a blinded investigator evaluated both patients. The clinical assessment included the patient's weight, height, age, Mallampati score, interincisor gap, thyromental distance, thyrosternal distance, neck circumference, Wilson risk sum score, history of previous difficult intubation, and diseases associated with difficult laryngoscopy or intubation. The Naguib model was significantly more sensitive (81.4%; P < 0.0001) than the Arne (54.6%) or Wilson (40.2%) models. Both the Naguib (76.8%) and Arne (74.7%) model classified more intubations correctly (P = 0.01) than the Wilson model (66.5%). The specificity of Arne, Wilson, and Naguib model was 94.9%, 92.8%, and 72.2%, respectively (P < 0.0001). The corresponding area under the receiver operating characteristic curve was 0.87, 0.79, and 0.82, respectively. Our new model for prediction of difficult intubation was developed using logistic regression and includes thyromental distance, Mallampati score, interincisor gap, and height. This model is 82.5% sensitive and 85.6% specific with an area under the receiver operating characteristic curve of 0.90.
Amantadine Sulfate Reduces Experimental Sensitization and
Pain in Chronic Back Pain Patients
Dieter Kleinböhl, PhD*, Roman Görtelmeyer,
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, Hans-Joachim Bender,
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, and Rupert Hölzl,
PhD*
*Laboratory for Clinical Psychophysiology,
Otto-Selz-Institute, University of Mannheim; _files/image031.gif){kind=small}
Medical
Biometrics and Data Management, Merz Pharmaceuticals GmbH, Frankfurt; and _files/image032.gif){kind=small}
Institute of
Anesthesiology and Intensive Care, University Hospital Mannheim, University of
Heidelberg, Germany
Anesth Analg 2006 102: 840-847.
我們研究了在慢性肌肉骨骼痛的病人中已確定增強的實驗敏感性的生理心理量是否能用N-甲基-d-門冬氨酸受體拮抗劑，金剛烷胺來減輕。並且這種敏感性的減輕是否伴有臨床疼痛的協同改善。敏感性是通過短期敏感性的實驗緊張熱模型與協同的主觀和行為心理比例來評估的。二十六例慢性背痛病人加入這一項隨機，雙盲，安慰劑對照的研究，一周的治療期間每天接受安慰劑或100mg的硫酸金剛烷胺。參與者在治療前和治療後完成定量的疼痛閾值感覺和實驗敏感性測試，在治療前，中，後完成臨床疼痛分級。實驗敏感性增強和臨床疼痛在接受實驗藥的病人中減輕。最終，試驗敏感性在那些無痛苦強度水平接觸熱的早期敏感性增加病人和在有痛苦強度水平敏感性增強的病人中增強，正如先前所示。經過一周的治療，試驗敏感性在使用硫酸金剛烷胺的病人中減輕但安慰劑則沒有。我們總結得出，如果與增強的敏感性有關，N-甲基-d-門冬氨酸受體拮抗劑輔助治療慢性疼痛可能對慢性疼痛有益，當時的定量感覺測試總結可以用來驗證這一點。
(周荻 譯 薛張綱校)
We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this.
The Impact of Continuous Pulse Oximetry Monitoring on Intensive Care Unit Admissions from a Postsurgical Care Floor
E. Andrew Ochroch, Michael W. Russell, William C. Hanson, III, Gayle A. Devine, Andrew J. Cucchiara, Mark G. Weiner, and Sanford J. Schwartz
Anesthesia and Cardiopulmonary Services, University Health Systems East, Philadelphia, Pennsylvania, USA.
Anesth Analg 2006 102: 868-875.
持續脈搏氧監測(CPOX)能夠增加警醒,減少肺部併發症,因而有效降低了入ICU的幾率.在一項1219例隨機非盲的研究中(通過一個擁有33個床位的心胸手術術後監護病房),我們比較了CPOX和標準監測對於術後入ICU的概率.結果表明,兩種監測對於再入ICU的概率無差別.除了年齡偏大和體質差,需要入ICU的病人中,有監測的要比沒有監測的在監護上花費的時間短(平均預算花費要相差28195美元;P=0.04).進行CPOX改變了病人入ICU的原因但並不改變入ICU的幾率.在CPOX組,入ICU的時間及花費要大大降低.CPOX對於肺部併發症的早期干預或是預防的作用尚需確證. CPOX不能降低入ICU的幾率和死亡率以及整個住院的花費,目前尚不清楚此監測對於心胸手術術後恢復的好處.
（王慧琳譯 薛張綱校）
Continuous pulse oximetry (CPOX) has the potential to increase vigilance and decrease pulmonary complications and thus decrease intensive care unit (ICU) admissions. In a randomized nonblinded study of 1219 subjects we compared the effects of CPOX and standard monitoring on the rate of transfer to an ICU from a 33-bed postcardiothoracic surgery care floor. There was no difference in the rate of ICU readmission between the CPOX and standard monitor groups. Despite older age and comorbidity, estimated cost to time of censoring (enrollment to completion of the study) was less in the monitored patients who required ICU transfer than in the unmonitored patients who required ICU transfer (mean estimated cost difference of 28,195 dollars; P = 0.04). Use of CPOX altered the reasons that patients were transferred to an ICU but did not affect the rate of transfer. The duration, and thus estimated cost, of ICU stay was significantly less in the CPOX-monitored group. The potential for CPOX to allow for early intervention, or perhaps prevention of pulmonary complications, needs to be explored. Routine CPOX monitoring did not reduce transfer to ICU, mortality, or overall estimated cost of hospitalization, and it is unclear if there is any real benefit from the application of this technology in patients on a general care floor who are recovering from cardiothoracic surgery.
The Effects of Stimulation Pattern and Sevoflurane Concentration on Intraoperative Motor-Evoked Potentials
Reinacher PC, Priebe HJ, Blumrich W, Zentner J, Scheufler KM.
Department of Neurosurgery, University Hospital, Aachen, Germany
Anesth Analg. 2006 Mar;102(3):888-95
術中運動誘發電位(MEPs)監測在吸入麻醉期間的有效性由於揮發性麻醉藥對MEP信號的抑制作用而受到限制。我們研究了不同刺激模式和呼末七氟醚濃度對術中腦電MEP的影響。在12名行顱骨切開術的病人中，隨機給予不同的刺激模式(300-500 V, 100-1000 Hz, 1-5 個刺激)和不同的(0.5, 0.75, 和 1.0)七氟醚最低肺泡有效濃度(MAC)，同時持續輸注瑞芬太尼0.2 microg x kg(-1) x min(-1)。經魚際肌和小魚際肌記錄MEPs，並在不知各自MAC的情況下進行分析。三因素方差分析顯示了刺激強度，頻率和刺激個數漸增對MEP振幅的重要影響(P < 0.05)。在1000 Hz 和 300 V傳遞的4個刺激下觀察到最大MEP振幅和成功記錄比率。只在魚際肌記錄點觀察到七氟醚濃度(0.5 相對0.75 和 1 MAC)對MEP振幅的重要影響(P < 0.05)。得出結論，刺激模式的變化可導致MEP特徵的顯著改變，而七氟醚濃度的改變產生的影響較小。結果表明在1 MAC的七氟醚和0.2 microg x kg(-1) x min(-1)瑞芬太尼持續輸注下，高頻重複刺激使得MEP監測得以在術中適用。
(徐麗穎譯 薛張綱校)
The usefulness of intraoperative monitoring of motor-evoked potentials (MEPs) during inhaled anesthesia is limited by the suppressive effects of volatile anesthetics on MEP signals. We investigated the effects of different stimulation patterns and end-tidal concentrations of sevoflurane on intraoperative transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V, 100-1000 Hz, 1-5 stimuli) and multiples (0.5, 0.75, and 1.0) of minimum alveolar concentration (MAC) of sevoflurane were varied randomly while remifentanil was administered at a constant rate of 0.2 microg x kg(-1) x min(-1). MEPs were recorded from thenar and hypothenar muscles and analyzed without knowledge of the respective MAC. Three-way analysis of variance revealed significant main effects for increasing stimulation intensity, frequency, and number of stimuli on MEP amplitude (P < 0.05). Maximum MEP amplitudes and recording success rates were observed during 4 stimuli delivered at 1000 Hz and 300 V. A significant main effect of sevoflurane concentration (0.5 versus 0.75 and 1 MAC multiple) on MEP amplitude was observed at the thenar recording site only (P < 0.05). In conclusion, MEP characteristics varied significantly with changes in stimulation pattern and less so with changes in sevoflurane concentration. The results suggest that high frequency repetitive stimulation allows intraoperative use of MEP monitoring during up to 1 MAC multiple of sevoflurane and constant infusion of remifentanil up to 0.2 microg x kg(-1) x min(-1).
Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort.
Minville V, Fourcade O, Idabouk L, Claassen J, Chassery C, Nguyen L, Pourrut JC, Benhamou D
Department of anesthesiology and intensive care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France.
Anesth Analg 2006 102: 912-915.
在這項前瞻性、隨機性的研究中，我們比較了由肱骨阻滯(HB)與鎖骨下臂叢阻滯(HB)引起的疼痛的程度，假設ICB引起的疼痛比HB小。研究物件是急診行上臂外科手術的病人，他們隨機接受ICB(組 I, n = 52 )或HB(組 H, n = 52 )。病人被要求在被阻滯過程中對疼痛的程度進行量化，使用的方法是通過從0到100mm的評分表來對以下4種在操作過程中會產生不愉快的事件進行評分以便找出其中最令人不愉快的事件，包括皮膚穿刺、用針頭對神經定位、局麻藥的注射和電刺激。從阻滯完全後30分鐘內每5分鐘測量一次。通過觀察評分表發現組 H的疼痛評分為35 +/- 27而組 I的為19 +/- 18(P < 0.0011)。電刺激是所有不愉快事件中最令人不愉快的(組 H的疼痛評分為29 +/- 15 mm而組 I的為15 +/- 10 mm) (P < 0.019)。組 I所用的操作時間大大短於組 H(ICB, 6 +/- 4 分鐘而HB, 10 +/- 4 分鐘; P < 0.0001)。兩者的起效時間分別為ICB 13 +/- 7分鐘，HB 9 +/- 3 分鐘(P < 0.05)。期間沒有觀察到嚴重的併發症。總之，在同樣的穿刺成功率下ICB與HB相較引起的疼痛更少。
（孫卓真譯 薛張綱校）
In this prospective randomized study, we compared humeral block (HB) and infraclavicular brachial plexus block (ICB) with pain caused by the block as a primary outcome, assuming that ICB would cause less pain than HB. Patients undergoing emergency upper limb surgery were included in this study and received either ICB (group I, n = 52 patients) or HB (group H, n = 52 patients). Patients were asked to quantify the severity of the pain during the procedure using a visual analog scale from 0 to 100 mm and to identify which of the 4 components of the procedure was most unpleasant (skin transfixion, needle redirection in search of the nerves, local anesthetic injections, or electrical stimulation). The block was assessed every 5 min for 30 min after completion of the block. Overall visual analog scale scores for the block were 35 +/- 27 mm in group H versus 19 +/- 18 mm in group I (P < 0.0011). Electrical stimulation was the most unpleasant part of the block (group H, 29 +/- 15 mm versus group I, 15 +/- 10 mm) (P < 0.019). Time to perform the block was significantly shorter in group I (ICB, 6 +/- 4 min versus HB, 10 +/- 4 min; P < 0.0001). The onset time was 13 +/- 7 min for ICB and 9 +/- 3 min for HB (P < 0.05). No serious complications were observed. In summary, ICB is less painful, compared with HB, with a similar success rate.
α-氨基羥甲基惡唑丙酸受體拮抗劑對於丁卡因鞘內給藥所引起的神經毒性的效應
The effects of an AMPA receptor antagonist on the neurotoxicity of tetracaine intrathecally administered in rabbits.
Koizumi Y, Matsumoto M, Yamashita A, Tsuruta S, Ohtake T, Sakabe T.
Department of Anesthesiology-Resuscitology Yamaguchi University School of Medicine, Yamaguchi, Japan.
Anesth Analg 2006 102: 930-936.
我們已經報導了在大鼠鞘內給予大劑量的局麻藥將會導致腦脊液中谷氨酸濃度上升和造成神經毒性。在新近的研究中我們發現AMPA受體拮抗劑和YM872的鞘內給藥將會降低丁卡因的神經毒性。我們首先研究了在大鼠鞘內分別給予YM872 10、30、100和300mug時的效應。YM872會產生可逆性的劑量依賴性的運動和神經阻滯。然後我們評估了YM872（300mug時）對於丁卡因引起的谷氨酸釋放和神經毒性的調節作用。YM872的預處理不會減低1% 或2%丁卡因所引起的腦脊液中谷氨酸的濃度。為了評估神經毒性，我們將大鼠分成四組（每組六隻），鞘內分別給予1％丁卡因和鹽水（1％T）；1％丁卡因和YM872（1％TY）;2％丁卡因和鹽水（2％T）；2％丁卡因和YM872（2％TY）。鹽水、YM872和丁卡因都是0.3ml。鹽水和YM872在丁卡因給藥前30分鐘給藥。神經學和組織病理學的評估將在給藥後一周進行。用了1％T後分別有兩隻和一隻動物出現運動和感覺功能異常，而用了2％T後有五隻動物出現運動和感覺功能異常。YM872對於2％丁卡因引起的運動功能障礙和神經損害有改善作用。在2％TY組，三隻大鼠運動功能正常，而另三只有輕微的異常（能跳躍，但不正常）；在2％T組，有四隻大鼠表現為輕微的功能異常（不能跳躍）。在2％TY組只有兩隻大鼠表現為神經元染色質溶解，而在2%T組有五隻大鼠表現為4－16神經元染色質溶解。結果顯示AMPA受體拮抗劑與丁卡因在脊髓引起的神經毒性有關，至少是部分相關。
（韓曉丹譯 薛張綱校）
We have reported that large concentrations of intrathecal local anesthetics increase glutamate concentrations in the cerebrospinal fluid (CSF) and cause neuronal injury in rabbits. In the current study we determined whether an alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor antagonist, YM872, administered intrathecally, reduces neuronal injury caused by tetracaine. We first examined the effects of intrathecal YM872 10, 30, 100, or 300 mug in rabbits (n = 3 in each). YM872 produced reversible motor and sensory block in a dose-dependent manner. Then, we evaluated modulatory effects of YM872 (300 mug) on tetracaine-induced glutamate release and neuronal injury. Pretreatment of YM872 did not attenuate 1% or 2% tetracaine-induced increases in cerebrospinal fluid glutamate concentrations (n = 3 in each). For evaluation of neuronal injury, rabbits were assigned to 4 groups (n = 6 in each) and intrathecally received 1% tetracaine and saline (1%T), 1% tetracaine and YM872 (1%TY), 2% tetracaine and saline (2%T), or 2% tetracaine and YM872 (2%TY). The volume of saline, YM872, and tetracaine was 0.3 mL. Saline or YM872 was administered 30 min before tetracaine administration. Neurological and histopathological assessments were performed 1 wk after the administration. Two and 1 animals respectively, showed motor and sensory dysfunction in 1%T, whereas 5 animals showed both motor and sensory dysfunction in 2%T. YM872 improved 2% tetracaine-induced motor dysfunction and neuronal damage (chromatolytic neurons, identified by round-shaped cytoplasm with loss of Nissl substance from the central part of the cell and eccentric nuclei). In 2%TY, 3 animals showed normal motor function and 3 showed mild dysfunction (ability to hop, but not normally), whereas 4 animals showed moderate dysfunction (inability to hop) in 2%T (P = 0.042). Only 2 animals showed one chromatolytic neuron in 2%TY, whereas 5 animals showed 4-16 chromatolytic neurons in 2%T (P = 0.020). These results suggest that AMPA receptor activation is involved, at least in part, in the tetracaine-induced neurotoxicity in the spinal cord.
膝關節成形術中止血帶使用時間延長後麻醉，病人和手術風險因素對神經系統併發症的影響
Anesthetic, patient, and surgical risk factors for
neurologic complications after prolonged total tourniquet time during total
knee arthroplasty.
Horlocker TT, Hebl JR, Gali B, Jankowski CJ, Burkle CM, Berry DJ, Zepeda FA, Stevens SR, Schroeder DR.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Anesth Analg 2006 102: 950-955.
止血帶長時間充氣的神經損傷緣自缺血和機械創傷的綜合效果。止血帶放氣10－30分鐘給予組織再灌注的時間，然後再充氣，這已作為止血帶使用的推薦方法。然而，這一指南在臨床上並沒有被很好的執行。我們回顧一下五年間1001個行膝關節置換術的病人，手術期間止血帶的使用時間超過了120分鐘。他們平均止血帶的使用時間為145＋/—25分鐘（120－308）。其中759個病人，止血帶在手術中未間斷。371個病人在術中在兩次充氣中有一次放氣，23個病人在三次充氣中有兩次放氣。在90個病人中有129種神經系統併發症（脛、腓神經併發症），發生率為7。7％。85例腓神經損傷和44例脛神經損傷。在39例中，脛、腓神經都有損傷。有76例腓神經損傷（89％）和44例脛神經損傷（100％）得到了恢復。年齡越小(P < 0.001; 優勢比 = 0.7/每十歲)、止血帶時間越長(P < 0.001; 優勢比 = 2.8 /每30分鐘)、術前屈曲攣縮>20度(P = 0.002; 優勢比= 3.9)術後神經系統損傷就越大。在一項116例病人的研究中，其止血帶時間>或=180分鐘，放氣時間的延長和神經系統併發症發生率下降有關。我們的結論是：神經系統的損傷和總的止血帶時間有關，而再灌注間隔能降低神經損傷的發生。
（鍾靜譯 薛張綱校）
Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10-30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. We retrospectively reviewed the medical records of 1001 patients undergoing 1166 primary or revision knee replacements with tourniquet time more than 120 min during a 5-yr interval. Mean total tourniquet time was 145 +/- 25 min (range, 120-308 min). In 759 patients, the tourniquet inflation was uninterrupted. Two tourniquet inflations, interrupted by a single deflation, were noted in 371 patients, and 3 tourniquet inflations interrupted by 2 deflation intervals were noted in 23 patients. A total of 129 neurologic complications (peroneal and/or tibial nerve palsies) were noted in 90 patients for an overall incidence of 7.7%. Eighty-five cases involved the peroneal nerve and 44 cases involved the tibial nerve. In 39 cases, both peroneal and tibial deficits were noted. Complete neurologic recovery occurred in 76 (89%) peroneal and 44 (100%) tibial palsies. Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20 degrees (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times > or =180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.
行冠脈搭橋手術的老年病人的纖維蛋白溶解和血小板活性增加
Increased Fibrinolysis and Platelet Activation in Elderly Patients Undergoing Coronary Bypass Surgery
Hilde Pleym, MD*, Alexander Wahba, MD,
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¶, Vibeke Videm, MD, PhD_files/image034.gif){kind=small}
#, Arne Åsberg, MD, PhD_files/image035.gif){kind=small}
, Stian Lydersen, PhD||, Lise Bjella, MD,
Ola Dale, MD, PhD*, and Roar Stenseth, MD, PhD¶
*Department of Cardiothoracic Anesthesia and Intensive Care, _files/image036.gif){kind=small}
Department of
Cardiothoracic Surgery, _files/image037.gif){kind=small}
Department of
Immunology and Transfusion Medicine, and _files/image038.gif){kind=small}
Department
of Medical Biochemistry, St. Olav University Hospital, and ||Unit for Applied
Clinical Research, ¶Department of Circulation and Medical Imaging, and
#Department of Laboratory Medicine, Children's and Women's Health, Norwegian
University of Science and Technology, Trondheim, Norway
Anesth Analg 2006;102:660-667
心臟手術後出血再探查使併發症發生率和死亡率增高。老年心臟手術病人的過度出血和再探查的危險性增加。在本研究中我們比較了行冠脈搭橋術的老年病人與較年輕病人圍手術期的凝血功能。本研究中包括25個老年病人（≥75歲）和25個較年輕病人（<60歲）。分別在術前、術後30分鐘、3小時和約20小時采血樣分析血小板計數、國際標準化比值、活化部分凝血活酶時間、纖維蛋白原含量、D-二聚體、抗凝血酶、凝血酶原片段1 + 2、凝血酶－抗凝血酶複合物、纖溶酶抑制物、中性粒細胞啟動肽2和血小板－單核細胞凝集物。老年病人的凝血系統活性較高。特別的是，老年病人與較年輕病人相比，術後纖維蛋白溶解和血小板活性顯著增加。
（彭中美 譯 馬皓琳 李士通 校）
Reexploration for hemorrhage after cardiac surgery is associated with increased morbidity and mortality. Elderly cardiac surgical patients have an increased risk of excessive bleeding and reexploration. In the present study we investigated the perioperative hemostatic function in elderly patients compared with younger patients undergoing coronary artery bypass grafting. Twenty-five elderly (75 yr and older) and 25 younger (younger than 60 yr) patients were included in the study. Blood samples for the analysis of platelet counts, international normalized ratio, activated partial thromboplastin time, fibrinogen, d-dimer, antithrombin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, plasmin inhibitor, neutrophil-activating peptide 2, and platelet-monocyte complexes were drawn preoperatively, 30 min, and 3 h postoperatively and approximately 20 h postoperatively. Elderly patients had an increased activation of the hemostatic system. In particular, elderly patients showed a more pronounced increase in fibrinolysis and platelet activation postoperatively compared with younger patients.
Avoiding Transfusions in Children Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Trials of Aprotinin
Donald M. Arnold, MD, FRCP(C)*_files/image039.gif){kind=small}
, Dean A. Fergusson, PhD¶, Anthony K.C.
Chan, MD, FRCP(C)_files/image040.gif){kind=small}
, Richard J. Cook, PhD**, Graeme A.
Fraser, MD, FRCP(C)_files/image041.gif){kind=small}
***, Wendy Lim, MD, FRCP(C)_files/image042.gif){kind=small}
,, Morris A. Blajchman, MD FRCPC(C)*_files/image043.gif){kind=small}
_files/image044.gif){kind=small}
, and Deborah J. Cook, MSc, MD, FRCP(C)_files/image045.gif){kind=small}
#
*Canadian Blood Services; Departments of _files/image046.gif){kind=small}
Medicine, _files/image047.gif){kind=small}
Pediatrics, _files/image048.gif){kind=small}
Pathology and Molecular
Medicine, and #Medicine & Epidemiology and Biostatistics, McMaster
University, Hamilton, Ontario; ¶Centre for Transfusion Research, University of
Ottawa, Ottawa, Ontario; **Department of Statistics and Actuarial Science,
University of Waterloo, Waterloo, Ontario; and ***Juravinski Cancer Centre,
Hamilton, Ontario, Canada
Anesth Analg 2006;102:731-737
儘管抑肽酶（一種強效的抗纖溶藥）在兒童中的療效尚不明確，它能減少在心臟手術中接受輸血的成年病人比例。我們對所有體外迴圈下行矯正或姑息心臟手術的患兒中進行抑肽酶的隨機對照試驗的英語文獻進行了系統性回顧。對所有的研究都評定了方法質量，並檢查證實系不同來源。我們測定了抑肽酶對輸血患兒比例、輸血量及胸導管引流量的影響。有包括626名合格患兒的12個試驗達到入選標準。抑肽酶能減少在心臟手術中接受紅細胞或全血輸注的患兒比例33%（相對風險=0.67; 95%可信區間，0.51 to 0.89）。抑肽酶對輸血量或術後胸導管引流量並沒有明顯作用。大部分研究的方法質量較差，並很少用預先確定的輸血適應證。總之，抑肽酶能減少在體外迴圈的心臟手術中接受輸血的患兒比例。常規建議在這個人群中使用抑肽酶前，尚需高質量試驗證明有重要臨床結果。
（裘毅敏 譯 馬皓琳 李士通 校）
Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving children undergoing corrective or palliative cardiac surgery with cardiopulmonary bypass. All studies were assessed for methodological quality, and sources of heterogeneity were examined. We measured the effect of aprotinin on the proportion of children transfused, the volume of blood transfused, and the volume of chest tube drainage. Twelve trials enrolling 626 eligible children met the inclusion criteria. Aprotinin reduced the proportion of children who received red blood cell or whole blood transfusions during cardiac surgery by 33% (relative risk = 0.67; 95% confidence interval, 0.51 to 0.89). Aprotinin did not have a significant effect on the volume of blood transfused or on the amount of postoperative chest tube drainage. Most of the studies were of poor methodological quality and predefined transfusion triggers were infrequently used. Overall, aprotinin reduced the proportion of children who received blood transfusion during cardiac surgery with cardiopulmonary bypass. Further high-quality trials with clinically important outcomes may be warranted before aprotinin can be routinely recommended in this population.
麻醉兒童的上呼吸道塌陷
Upper Airway Collapsibility in Anesthetized Children
Ronald S. Litman, DO, Joseph M. McDonough, MS, Carole L. Marcus, MBBCh, Alan R. Schwartz, MD, and Denham S. Ward, MD, PhD
Department of Anesthesiology, University of Rochester, Rochester, New York; Department of Anesthesiology and Critical Care, Division of Pulmonary Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
Anesth Analg 2006;102:750-754
我們擬使用氣道負壓動力學裝置，建立可行的方法測定麻醉後保留自發呼吸兒童上呼吸道的狹窄程度。第二個目的是比較給予七氟醚或氟烷後上呼吸道梗阻的差異。病人隨機用七氟醚或氟烷進行吸入麻醉誘導。每個病人調整濃度到1MAC值(氟烷0.9%，七氟醚 2.5%)，由一位元不知用藥情況的麻醉者托面罩，除了口咽通氣道，不用任何人為氣道開放手法。由插入麻醉環路的產生可調節負壓的真空機使上呼吸道部分梗阻時測定吸氣流速。標記面罩中不同負壓時相對應的吸氣峰流速，並用直線相關分析推測到流速為零時的壓力，即咽部閉合的臨界壓（Pcrit）。有14例兒童參加實驗，每組7人。即使負壓達到–9 cm H2O，氟烷組中仍有2例患兒沒有出現限制流量的氣道梗阻。七氟醚的Pcrit範圍為–6.7到–11.6 (平均值±標準差–9.8 ± 1.9) cm H2O。氟烷的Pcrit範圍為–8.1到–33 (平均值±標準差–19.4 ± 9.3) cm H2O (七氟醚與氟烷相比，P=0.048)。我們得出結論，當使用氣道負壓動力學裝置時，等效濃度的氟烷較七氟醚更少導致上呼吸道梗阻。
（張瑩 譯，馬皓琳 李士通 校）
We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. Each was adjusted to their 1 MAC value (0.9% for halothane and 2.5% for sevoflurane) and a blinded anesthesia provider held the facemask without performing manual airway opening maneuvers but with inclusion of an oral airway device. Inspiratory flows were measured during partial upper airway obstruction created by an adjustable negative pressure-generating vacuum motor inserted into the anesthesia circuit. Critical closing pressure of the pharynx (Pcrit) was obtained by plotting the peak inspiratory flow of the obstructed breaths against the corresponding negative pressure in the facemask and extrapolating to zero airflow using linear correlation. Fourteen children were enrolled, seven in each anesthetic group. Two children in the halothane group did not develop flow-limited airway obstruction despite negative pressures as low as –9 cm H2O. Pcrit for sevoflurane ranged from –6.7 to –11.6 (mean ± sd, –9.8 ± 1.9) cm H2O. Pcrit for halothane ranged from –8.1 to –33 (mean ± sd, –19.4 ± 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.
靜脈麻醉藥對大鼠海馬CA1區抑制性通路的作用強於吸入麻醉藥
Intravenous Anesthetics Are More Effective than Volatile Anesthetics on Inhibitory Pathways in Rat Hippocampal CA1
Takehisa Asahi, MD*, Koki Hirota, MD, PhD*,
Rika Sasaki, MD, PhD*, Yamazaki Mitsuaki, MD, PhD*, and
Sheldon H. Roth, PhD_files/image049.gif){kind=small}
*Department of Anesthesiology, University of Toyama, Japan;
and _files/image050.gif){kind=small}
Departments of
Pharmacology & Therapeutics and Anaesthesia, Faculty of Medicine,
University of Calgary, Alberta, Canada
Anesth Analg 2006;102:772-778
在本研究中，我們通過觀察吸入麻醉藥和靜脈全麻藥對有或無返回抑制時的興奮性突觸傳遞的作用，以闡明興奮性突觸與抑制性突觸何者為全麻藥作用的主要靶位點。記錄大鼠海馬腦片CA1區錐體神經細胞場群峰電位（fPSs）。順行刺激Schaffer側支連合纖維（Sch），測量CA1區誘發場群峰電位（PS[Sch]）。此外，在逆向刺激海馬白質（Alv）以產生返回抑制後，記錄刺激Sch所產生的fPSs（PS[Alv+Sch]）。觀察到七氟醚（0.5%-5%）和異氟醚（0.5%-5%）主要抑制PS[Sch]，且對PS[Alv+Sch]也有附加的濃度依賴性的抑制作用。計算所得七氟醚和異氟醚抑制PS[Sch] 及PS[Alv+Sch]的 50％有效濃度（EC50）分別為5.3 vol% 和 3.9 vol% （七氟醚） 及 1.7 vol% 和1.1 vol% （異氟醚）。與之相比，硫噴妥鈉 （2.0 x 10–5–5.0
x 10–4 mol/L）都呈濃度依賴性地減小PS[Sch] 和PS[Alv+Sch] 。計算所得硫噴妥鈉抑制
PS[Sch] 和PS[Alv+Sch]
的EC50值分別為 3.4 x 10–4
和 5.7 x 10–5 mol/L。丙泊酚 (2.0 x 10–5–3.5
x 10–4 mol/L) 對PS[Sch] 幾乎沒有作用，但是卻抑制 PS[Alv+Sch] ，其計算所得 EC50
值為 5.1 x 10–4 mol/L。有返回抑制時靜脈麻醉藥的作用可被γ－氨基丁酸－A受體拮抗劑甲碘荷包牡丹堿所拮抗。此外所有麻醉藥均延長返回抑制，其延長時限從100ms（七氟醚和異氟醚）至400ms（丙泊酚）不等。結果提示七氟醚和異氟醚主要抑制谷氨酸介導的順行通路，而硫噴妥鈉和丙泊酚增強_files/image051.gif){kind=small}
γ－氨基丁酸－A介導的CA1區神經元返回抑制通路，因此對全麻藥機理具有藥物特異性和通路特異性提供了進一步的證據。
（周雅春 譯馬皓琳 李士通 校）
In this study, we have examined the effects of both volatile
and IV general anesthetics on excitatory synaptic transmission, with
and without recurrent inhibition, to clarify whether excitatory or
inhibitory synapses are the major targets of action. Field population
spike amplitudes (fPSs) of CA1 pyramidal neurons were recorded in
rat hippocampal slices. Schaffer-collateral-commissural fibers (Sch)
were stimulated orthodromically, and the evoked fPSs (PS[Sch]) in
CA1 area were measured. In addition, the fPSs (PS[Alv+Sch]) elicited
by stimulation of the Sch after antidromic stimulation of the alveus
hippocampi (Alv) to produce recurrent inhibition were determined. It
was observed that sevoflurane (0.5%–5%) and isoflurane (0.5%–5%)
primarily inhibited PS[Sch] and also produced additive inhibition on
the PS[Alv+Sch] in a concentration-dependent manner. The calculated
50% effective concentration (EC50) values for PS[Sch] and
PS[Alv+Sch] were 5.3 vol% and 3.9 vol% (sevoflurane) and 1.7 vol%
and 1.1 vol% (isoflurane), respectively. In comparison, thiopental
(2.0 x 10–5–5.0 x 10–4 mol/L) reduced both the
PS[Sch] and PS[Alv+Sch] in a concentration-dependent manner. The
calculated EC50 values for thiopental on PS[Sch] and
PS[Alv+Sch] were 3.4 x 10–4 and 5.7 x 10–5
mol/L, respectively. Propofol (2.0 x 10–5–3.5 x 10–4
mol/L) had little effect on the PS[Sch] but reduced PS[Alv+Sch] with
a calculated EC50 value of 5.1 x 10–4 mol/L.
The effects of the IV anesthetics with recurrent inhibition were
antagonized in the presence of the _files/image052.gif){kind=small}
-aminobutyric
acid-A-receptor antagonist bicuculline methiodide. In addition, all
anesthetics prolonged recurrent inhibition from 100 ms (sevoflurane
and isoflurane) to 400 ms (propofol). The results suggest that
sevoflurane and isoflurane inhibit mainly on glutamate-mediated
orthodromic pathways, whereas thiopental and propofol enhance _files/image053.gif){kind=small}
-aminobutyric
acid-A-mediated recurrent inhibitory pathways in CA1 neurons, thus
providing further evidence that the mechanisms of general
anesthetics are drug- and pathway-specific.
布比卡因異構體對Wistar大鼠心肌細胞內鈣的調節
Regulation of Intracellular Calcium by Bupivacaine Isomers in Cardiac Myocytes from Wistar Rats
Núbia G. B. Chedid, PhD, Roberto T. Sudo, MD, PhD, Marli I. S. Aguiar, Margarete M. Trachez, MD, PhD, Masako O. Masuda, PhD, and Gisele Zapata-Sudo, MD, PhD
Departamento de Farmacologia Básica e Clínica, ICB, Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Serviço de Anestesiologia, Universidade Federal Fluminense, Rio de Janeiro, Brazil
Anesth Analg 2006;102:792-798
本研究中我們探討了布比卡因消旋混合體（RS(±)布比卡因）和其異構體（S(-)布比卡因和R(+)布比卡因）對Wistar大鼠心室肌細胞內鈣轉運的影響。酶解分離製備單個心室肌細胞，並用Ca2+ 螢光指示劑fura 2-am標記來評估收縮期和舒張期細胞內的Ca2+ 濃度。S(-)布比卡因(10 µM)明顯提高了Ca2+瞬態的振幅峰值和增長速率，分別為對照組的155% ± 54% (P < 0.05) 和 194% ± 94% (P < 0.01)。然而，試驗的任何濃度的R(+)布比卡因都對這二項參數無影響。皂角苷包被的心室肌纖維被用來研究布比卡因通過光面內質網（SR）對細胞內Ca2+ 調節的影響以及其對收縮系統Ca2+敏感性的影響。S(-)、R(+)和RS(±)布比卡因促使Ca2+從SR內釋放(P < 0.01)。在SR斷裂的心室肌細胞內，布比卡因和其異構體(5 mM)增強了收縮系統對Ca2+的敏感性。S(-)、RS(+)和R(±)布比卡因使得pCa50從5.8 ± 0.1、5.8 ± 0.1和5.8 ± 0.1明顯增至6.1 ± 0.1 (P < 0.05)、6.0 ± 0.1 (P < 0.05)和6.1 ± 0.1 (P < 0.05)。通過啟動RyR2引起Ca2+從SR釋放可以用來解釋心肌細胞內Ca2+瞬態的增加。心肌細胞內Ca2+的增加體現了S(-)布比卡因的立體選擇性。
（黃施偉 譯，馬皓琳 李士通 校）
In this study we investigated the effects of a racemic mixture of bupivacaine (RS(±)bupivacaine) and its isomers (S(-)bupivacaine and R(+)bupivacaine) on the Ca2+ handling by ventricular myocytes from Wistar rats. Single ventricular myocytes were enzymatically isolated and loaded with the fluorescent Ca2+ indicator fura 2-am to estimate intracellular Ca2+ concentration during contraction and relaxation cycles. S(-)bupivacaine (10 µM) significantly increased peak amplitude and the rate of increase of Ca2+ transients in 155% ± 54% (P < 0.05) and 194% ± 94% (P < 0.01) of control. However, exposure to R(+)bupivacaine had no effect on either peak amplitude or rate of increase at any concentration tested. Saponin-skinned ventricular fibers were used to investigate the effect of bupivacaine on the intracellular Ca2+ regulation by sarcoplasmic reticulum (SR) and on the Ca2+ sensitivity of contractile system. S(-), R(+), and RS(±)bupivacaine induced Ca2+ release from SR (P < 0.01). In SR-disrupted skinned ventricular cells, bupivacaine and its isomers (5 mM) increased the sensitivity of contractile system to Ca2+. S(-), RS(±), and R(+)bupivacaine significantly increased pCa50 from 5.8 ± 0.1, 5.8 ± 0.1, and 5.8 ± 0.1, to 6.1 ± 0.1 (P < 0.05), 6.0 ± 0.1 (P < 0.05), and 6.1 ± 0.1 (P < 0.05). Ca2+ release from SR through RyR2 activation could explain the increase of Ca2+ transients in cardiac cells. Increased intracellular Ca2+ in cardiac myocytes display a stereoselectivity to S(-)bupivacaine.
Chromosomal Substitution-Dependent Differences in Cardiovascular Responses to Sodium Pentobarbital
Thomas A. Stekiel, MD, Stephen J. Contney, MS, Zeljko J. Bosnjak, PhD, John P. Kampine, MD, PhD, Richard J. Roman, PhD, and William J. Stekiel, PhD
Departments of Anesthesiology and Physiology, Medical College of Wisconsin, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
Anesth Analg 2006;102:799-805
在本研究中，我們提出了關於正常血壓的Dahl鹽敏感性大鼠（SS）較Brown Norway（BN）大鼠對戊巴比妥鈉（PTB）心血管敏感性增強的原創性實驗室觀察。我們還使用了獨特的染色體取代株動物來確認我們的初步觀察結果，即這種差異與第13染色體有關。對SS、BN和具有BN染色體取代物的SS動物連續給予濃度逐漸增高的PTB，直至產生心血管虛脫。對自主呼吸和控制通氣的情況均作了研究。也測定了局部交感神經支配完整或者被消除的這些動物中大濃度（450µg/mL）和小濃度（35µg/mL）PTB對腸系膜上動脈血管平滑肌（VSM）細胞原位跨膜電位的影響。用變數分析以鑒別組間的顯著性差異。儘管PTB的血漿清除率事實上相同，在自主呼吸和控制通氣的情況下，SS和其他株動物達到迴圈虛脫時給予的PTB累積劑量均比BN和SS.13BN（BN動物第13染色體滲入到SS）約少35%–45%。在神經系統完整的製備中，大劑量PTB引起的VSM超極化比SS和SS.16BN而非BN和SS.13BN株中的小劑量大4-5倍。去神經支配可以消除這種株間差異。這些結果表明，SS大鼠對PTB的心血管敏感性增高與阻力血管VSM跨膜電位超極化增加有關，這個作用與第13染色體有關。
（顏濤 譯 馬皓琳 李士通 校）
In this study we addressed initial laboratory observations of enhanced cardiovascular sensitivity to sodium pentobarbital (PTB) in normotensive Dahl Salt Sensitive rats (SS) compared to Brown Norway (BN) rats. We also used unique consomic (chromosomal substitution) strains to confirm preliminary observations that such differences were related to chromosome 13. Increasing concentrations of PTB were administered sequentially to SS, BN, and SS strains with BN chromosomal substitutions until the point of cardiovascular collapse. Both spontaneous and controlled ventilation were studied. The effect of large (450 µg/mL) and small (35 µg/mL) concentrations of PTB on in situ transmembrane potential of mesenteric arterial vascular smooth muscle (VSM) cells was also measured in these animals with local sympathetic innervation both intact and eliminated. An analysis of variance was used to identify significant differences among groups. Despite virtually identical plasma clearance of PTB, cardiovascular collapse occurred at approximately 35%–45% smaller cumulative doses of administered PTB in SS and other strains compared with BN and SS.13BN (introgression of BN chromosome 13 into an SS) in both spontaneous and controlled ventilation. In neurally intact preparations, large dose PTB-induced VSM hyperpolarization was 4–5 times greater than the small dose in SS and SS.16BN but not in BN and SS.13BN strains. Denervation eliminated this strain difference. These results suggest that enhanced cardiovascular sensitivity to PTB in SS rats is related to greater hyperpolarization of VSM transmembrane potential in resistance vessels and this effect is associated with chromosome 13.
腦電描計法定位在常規臨床實踐中的應用：氣管插管時皮層覺醒？
Electroencephalographic Mapping During Routine Clinical Practice: Cortical Arousal During Tracheal Intubation?
Wolfgang J. Kox, MD*, Christian von
Heymann, MD_files/image054.gif){kind=small}
, Judith Heinze_files/image055.gif){kind=small}
, Leslie S.
Prichep, PhD_files/image056.gif){kind=small}
_files/image057.gif){kind=small}
, E. Roy John, PhD_files/image058.gif){kind=small}
_files/image059.gif){kind=small}
, and Ingrid Rundshagen, MD_files/image060.gif){kind=small}
*University Hospital of Muenster, Muenster, Germany; _files/image061.gif){kind=small}
Department of
Anesthesiology, University Hospital Charité, Humboldt University of Berlin,
Campus Charité Mitte, Berlin, Germany; _files/image062.gif){kind=small}
Brain
Research Laboratories, NYU School of Medicine, New York, NY; _files/image063.gif){kind=small}
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
Anesth Analg 2006;102:825-831
我們對42例病人的腦電圖（EEG）採用定量分析來評估標準臨床實踐中用依託咪酯和舒芬太尼誘導後氣管插管的影響。EEG記錄來源於八個雙極電極，並根據年齡預計的δ，θ，α和β頻段相對功率的標準化資料行Z轉換。氣管插管會導致典型的皮層覺醒，這一點從EEG頻率加速可以看出。各頻率段均見顯著影響，以α頻段最為顯著，額顳區雙側均增加最多。（F值：δ－9.592，P<0.001; θ-1.691, P<0.001; α-18.439, P<0.001; β-4.504, P<0.001)。麻醉誘導時α和δ功率的改變與依託咪酯的劑量相關（P<0.05）。氣管插管後腦部頂枕區α功率的改變與舒芬太尼的劑量相關（P<0.05）。在常規臨床實踐中，舒芬太尼和依託咪酯的劑量個體化滴定並不足以阻斷氣管插管的強傷害性刺激，從而導致皮層覺醒。這種皮層覺醒現象的臨床影響尚未確定。
（邱鬱薇 譯 馬皓琳 李士通 校）
We used quantitative analysis of the electroencephalogram (EEG) in 42 patients to assess the effect of tracheal intubation after induction of anesthesia with etomidate and sufentanil using standard clinical practice. The EEG was recorded from eight bipolar electrode derivations and Z-transformed relative to age expected normative data for relative power in the delta, theta, alpha, and beta frequency bands. Tracheal intubation resulted in classical cortical arousal, as indicated by acceleration of the EEG frequencies. Significant effects were seen in all frequency bands, most pronounced in the alpha frequency band, with the largest increase bilaterally in the fronto-temporal regions (F-values: Delta – 9.592, P < 0.001; theta – 1.691, P < 0.001; alpha – 18.439, P < 0.001; beta – 4.504, P < 0.001). Changes in alpha and delta power during induction of anesthesia were correlated with the dose of etomidate (P < 0.05). Changes in alpha after tracheal intubation were correlated at the parietooccipital brain regions to the dose of sufentanil (P < 0.05). Individual titration of the dose of etomidate and sufentanil, as during routine clinical practice, is not sufficient to block the strong noxious stimulation of tracheal intubation and results in cortical arousal. The clinical impact of this cortical wake-up phenomenon is undetermined.
The Effects of Tramadol and Fentanyl on Gastrointestinal Motility in Septic Rats
Ismet Topcu, N. Zeynep Ekici, Rusen Isik, and Melek Sakarya
Department of Anesthesiology and Intensive Care, Celal Bayar University, Manisa, Turkey
Anesth Analg 2006;102:876-881
在此研究中，我們研究了曲馬多和芬太尼對盲腸結紮和穿孔（GLP）這一實驗模型中急性全身性炎症期胃腸道運輸（GIT）的影響。120只瑞士－白化體雄性大鼠隨機分為6組：第一組為假手術加鹽水，第二組為假手術加芬太尼，第三組為假手術加曲馬多，第四組為GLP組加鹽水，第五組為GLP組加芬太尼，第六組為GLP組加曲馬多。給予木炭混懸液作為胃內進食以衡量GIT水平。第一到六組的GIT%(均數±標準差)分別為46.1% ± 9.8%、43.2% ± 9.8%、45.9% ± 10.2%、33.2% ± 9.2%、24.9% ± 4.1%及31.8% ± 8.4%。第五組的GIT%明顯低於第一、二、三及四組(P < 0.05)。第六組的平均數明顯低於第一、二及三組(P < 0.05)，但與第四和五組沒有差異(P > 0.05)。芬太尼的抗通過作用在膿毒症的實驗模型中顯示增強，但是曲馬多的GIT並沒有降低。這被認為是膿毒症中伴隨的內源性阿片系統啟動以及受體增量調節的結果。
（黃麗娜 譯 馬皓琳 李士通 校）
In this study, we investigated the effects of tramadol and fentanyl on gastrointestinal transit (GIT) during acute systemic inflammation in an experimental model of cecal ligation and perforation (CLP). One-hundred-twenty male Swiss-Albino rats were divided randomly into 6 groups: Group I = sham-operated + saline; Group II = sham-operated + fentanyl; Group III = sham-operated + tramadol; Group IV = CLP + saline; Group V = CLP + fentanyl; Group VI = CLP + tramadol. Suspension of charcoal was administered as an intragastric meal to measure the GIT. GIT% (mean ± sd) were 46.1% ± 9.8%, 43.2% ± 9.8%, 45.9% ± 10.2%, 33.2% ± 9.2%, 24.9% ± 4.1%, and 31.8% ± 8.4% in Groups I, II, III, IV, V, and VI, respectively. GIT% was significantly less in Group V than in Groups I, II, III, and IV (P < 0.05). The Group VI mean value was significantly lower than those of Groups I, II, and III (P < 0.05) but not different from those of Groups IV and V (P > 0.05). The antitransit effect of fentanyl was shown to have increased in the experimental sepsis model, but no decrease in GIT was obtained with tramadol. This was thought to be the result of an associated endogenic opioid system activation and receptor upregulation in sepsis.
P6 Acupressure Does Not Prevent Emesis During Spinal Anesthesia for Cesarean Delivery
Chiu-Ming Ho, MD, PhD*, Hsin-Jung Tsai,
MD_files/image064.gif){kind=small}
, Kwok-Hon Chan, MD*, and Shen-Kou Tsai,
MD, PhD*
*Department of Anesthesiology, Taipei Veterans General
Hospital and National Yang-Ming University; _files/image065.gif){kind=small}
Department
of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
Anesth Analg 2006;102:900-903
噁心嘔吐是剖宮產脊麻中的主要不良作用。刺激內關穴是一種用於有效抗嘔吐的中國傳統針灸技術。在這項研究中，我們評估了內關穴針壓在剖宮產脊麻產婦中的抗嘔吐作用。110名預定擇期剖宮產的孕婦參與了此項隨機雙盲對照研究。在脊麻開始前半小時，產婦隨機分至在雙側內關穴的針壓組和安慰劑組，並觀察研究期中其噁心嘔吐的發生情況。母體特徵兩組間沒有顯著的統計學差異。術中噁心的發生率為64% (針壓組) 和71% (對照組) (P = 0.416)，術中嘔吐的發生率為22% (針壓組) 和27% (對照組) (P = 0.506)。這一結果顯示，預防性應用雙側內關穴針壓不能防止剖宮產脊麻中噁心嘔吐的發生。
（黃佳佳 譯 馬皓琳 李士通 校）
Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery. Stimulation of the P6 (Neiguan) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purposes. In this study, we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery. In a randomized, double-blind, controlled trial, 110 parturients scheduled for elective cesarean delivery were enrolled in the study. Thirty minutes before initiation of spinal anesthesia, parturients were randomized to acupressure bands or placebo bands bilaterally on the P6 acupoint and nausea and vomiting were observed over the study period. There were no statistically significant differences in maternal characteristics. Incidence rates for intraoperative nausea were 64% (acupressure group) and 71% (control group) (P = 0.416), with an incidence of intraoperative vomiting of 22% (acupressure group) and 27% (control group) (P = 0.506). The results suggest that prophylactic use of acupressure bands bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery.
The Analgesic Effect of Nitroglycerin Added to Lidocaine on Intravenous Regional Anesthesia
Selda Sen, MD, Bakiye Ugur, MD, Osman N. Ayd_files/image066.jpg){kind=small}
n, MD, Mustafa Ogurlu, MD, Feray Gursoy, MD, and Oner Savk, MD
Department of Anesthesiology and Reanimation, Department of Orthopedics, and Traumatology Adnan Menderes University, Medical Faculty, Aydin, Turkey
Anesth Analg 2006;102:916-920
我們評價了在局部靜脈麻醉中當硝酸甘油加入利多卡因時的鎮痛作用。行手部手術的30例病人隨機分為2組。對照組（C組，n＝15）應用 3 mg/kg利多卡因並用生理鹽水稀釋總容量為40ml；硝酸甘油組（NTG組，n=15）在同上溶液中加入200µg NTG。在術中記錄血流動力學參數、止血帶充氣前及充氣後1、5、10、20和30 min時測得的止血帶疼痛值和鎮痛藥需要量。記錄止血帶放氣後1和30min、2和4 h時的視覺類比評分（VAS）分值、第一次需要鎮痛藥的時間、術後第一個24小時內總的鎮痛藥消耗量及不良反應。發現NTG組的感覺和運動阻滯起效時間較短(在NTG組和C組分別為3.2 ± 1.1比4.5 ± 1.2 min; P = 0.01 和 3.3 ± 1.6比5.2 ± 1.8; P = 0.009)，感覺和運動阻滯的恢復時間較長(在NTG組和C組分別為6.8 ± 1.6比3.1 ± 1.2 min；P < 0.0001 和 7.3 ± 1.3比3.6 ± 0.8；P < 0.0001)，止血帶疼痛的VAS評分較低(P = 0.023)以及麻醉質量得以改善(P < 0.05)。止血帶放鬆後和術後階段中NTG組的VAS評分也較低(P = 0.001)。NTG組對第一次需要鎮痛藥的時間較C組更晚一些(225 ± 74 min比39 ± 33 min ，P < 0.0001)。NTG組對術後鎮痛的要求明顯較少(P < 0.0001)，但是兩組的不良反應發生沒有差別。我們得出結論在利多卡因中加入硝酸甘油用於局部靜脈麻醉可以改善感覺和運動的阻滯、止血帶疼痛和術後鎮痛而沒有不良反應。
（趙雪蓮 譯 馬皓琳 李士通 校）
We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 µg NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 ± 1.1 versus 4.5 ± 1.2 min; P = 0.01 and 3.3 ± 1.6 versus 5.2 ± 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 ± 1.6 versus 3.1 ± 1.2 min P < 0.0001 and 7.3 ± 1.3 versus 3.6 ± 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 ± 74 min versus 39 ± 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.
Postoperative Upper Airway Obstruction After Recovery of the Train of Four Ratio of the Adductor Pollicis Muscle from Neuromuscular Blockade
Matthias Eikermann, MD*, Manfred
Blobner, MD_files/image067.gif){kind=small}
, Harald Groeben, MD*,
Christopher Rex, MD_files/image068.gif){kind=small}
, Thomas Grote*, Markus
Neuhäuser, PhD_files/image069.gif){kind=small}
, Martin Beiderlinden, MD*, and
Jürgen Peters, MD*
*Klinik für Anästhesiologie und Intensivmedizin,
Universitätsklinikum Essen; _files/image070.gif){kind=small}
Klinik für Anästhesiologie, Technische Universität München; _files/image071.gif){kind=small}
Klinik
für Anästhesiologie und Operative Intensivmedizin, Kreiskliniken Reutlingen;
and _files/image072.gif){kind=small}
Institut für
Medizinische Informatik, Biometrie und Epidemiologie, Germany
Anesth Analg 2006;102:937-942
麻醉藥以及即使最小量的神經肌肉阻滯可導致上呼吸道阻塞（UAO）。在本研究中我們用肺活量測定法對四個成串刺激比率>0.9的患者評估UAO的發生率（即50%肺活量時最大呼氣流速與最大吸氣流速的比〔MEF50/MIF50〕>1）並確定UAO是否由神經肌肉阻滯引起（定義為用力肺活量〔FVC〕衰減，即在連續肺活量測定操作時從第一個FVC值到第二個值降低≥10%）。患者接受丙泊酚和阿片類作為麻醉。用一系列的3次重複肺活量測定操作進行肺活量測定：第一次誘導前（術前用藥咪唑安定），第二次氣管導管拔除後（TOF比：0.9或更大）及第三次30 min後。氣管導管拔除後即刻和30 min後，130例患者中分別有48例和6例由於鎮靜不能進行適當的肺活量測定。UAO的發生率從誘導前基線的82/130（63%）顯著增高到拔管後的70/82（83%）（P < 0.01），隨後在30 min內降低到在基線觀察到的值（80/124，65%）。氣管導管拔除後50%肺活量時的平均最大呼氣流速與最大吸氣流速比比基線顯著增大（增加20%；1.39 ± 1.01比1.73 ± 1.02；P < 0.01），隨後顯著減小到在基線值（1.49 ± 0.93）。拔管後沒有統計學上有意義的FVC衰減，且只在2例患者中觀察到≥10%的FVC衰減。因此，TOF比率恢復到0.9預計了無神經肌肉阻滯劑引起UAO的高度可能性，但仍有極端的情況發生，即TOF比儘管已恢復，神經肌肉阻滯作用對上呼吸道通暢性仍可能持續影響。
（馬皓琳 譯 李士通 校）
Anesthetics, and even minimal residual neuromuscular blockade,
may lead to upper airway obstruction (UAO). In this study we assessed
by spirometry in patients with a train-of-four (TOF) ratio >0.9
the incidence of UAO (i.e., the ratio of maximal expiratory flow and
maximal inspiratory flow at 50% of vital capacity [MEF50/MIF50]
>1) and determined if UAO is induced by neuromuscular blockade
(defined by a forced vital capacity [FVC] fade, i.e., a decrease in
values of FVC from the first to the second consecutive spirometric
maneuver of _files/image073.gif){kind=small}
10%). Patients received
propofol and opioids for anesthesia. Spirometry was performed by a
series of 3 repetitive spirometric maneuvers: the first before
induction (under midazolam premedication), the second after tracheal
extubation (TOF ratio: 0.9 or more), and the third 30 min later.
Immediately after tracheal extubation and 30 min later, 48 and 6 of
130 patients, respectively, were not able to perform spirometry
appropriately because of sedation. The incidence of UAO increased
significantly (P < 0.01) from 82 of 130 patients (63%) at
preinduction baseline to 70 of 82 patients (85%) after extubation,
and subsequently decreased within 30 min to values observed at
baseline (80 of 124 patients, 65%). The mean maximal expiratory flow
and maximal inspiratory flow at 50% of vital capacity ratio after
tracheal extubation was significantly increased from baseline (by
20%; 1.39 ± 1.01 versus 1.73 ± 1.02; P < 0.01), and subsequently
decreased significantly to values observed at baseline (1.49 ±
0.93). A statistically significant FVC fade was not present, and a
FVC fade of _files/image074.gif){kind=small}
10% was observed in only 2
patients after extubation. Thus, recovery of the TOF ratio to 0.9
predicts with high probability an absence of neuromuscular blocking
drug-induced UAO, but outliers, i.e., persistent effects of
neuromuscular blockade on upper airway integrity despite recovery of
the TOF ratio, may still occur.
全身麻醉不縮短老年大鼠的平均壽命
General Anesthesia Does Not Reduce Life Expectancy in Aged Rats
Deborah J. Culley, MD, Alexander Loguinov, PhD, Rustam Yukhananov, MD, PhD, and Gregory Crosby, MD
Department of Anesthesia, Division on Aging, Harvard Medical School, Brigham & Women’s Hospital, Boston, Massachusetts; Logstat, Pasadena, California
Anesth Analg 2006;102:956-959
一項新近的臨床研究證明在用雙譜指數監測測得的深麻醉使中年和老年手術患者的一年死亡率增加。我們在之前已經證明老年大鼠在應用1.2%異氟醚-70%笑氣-30%氧氣的全身麻醉後會產生幾個星期的認知功能損害。然而，2小時1.2%異氟醚-70%笑氣-30%氧氣的全身麻醉對齧齒類動物的平均壽命的作用仍是未知的，而且可能已混淆我們的結果。因此，我們設計了本研究來確定全身麻醉是否會改變老年大鼠的平均壽命。16只22個月大的Fischer 344大鼠隨機分為兩組，麻醉組接受2小時1.2%異氟醚-70%笑氣-30%氧氣的全身麻醉，對照組接受30%氧氣（每組各8只）。大鼠在富氧的環境中恢復，然後把它們放在它們原來的常規條件下的籠子裏。記錄給予麻醉至死亡的天數，產生Kaplan-Meier生存曲線，應用對數等級核對總和引導方法進行統計學上的比較。長期生存在對照組和麻醉組之間沒有差別。因此，1.2%異氟醚-70%笑氣-30%氧氣的全身麻醉不縮短老年Fischer 344大鼠的平均壽命。
（陳瑋 譯 馬皓琳 李士通 校）
A recent clinical study demonstrated that deep anesthesia, as measured by Bispectral index monitoring, was associated with increased 1-yr mortality among middle-aged and elderly surgical patients. We have previously demonstrated impaired cognitive performance in aged rats for weeks after general anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen. However, the effects of 2 h of anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen on rodent life expectancy are unknown and may have confounded our results. Accordingly, we designed this study to determine if general anesthesia alters life expectancy in aged rats. Sixteen 22-mo-old Fischer 344 rats were randomized to anesthesia for 2 h with 1.2% isoflurane-70% nitrous oxide-30% oxygen or a control group that received 30% oxygen (n = 8 per group). Rats recovered in an enriched oxygen environment and then were placed in their home cage under routine conditions. The number of days between anesthesia administration and death were recorded and Kaplan-Meier survival curves generated and compared statistically using the log-rank test and bootstrap method. There was no difference in long-term survival between the control and anesthesia groups. Hence, general anesthesia with 1.2% isoflurane-70% nitrous oxide-30% oxygen does not reduce life expectancy in aged Fischer 344 rats.