Table of Contents
March 2008
CARDIOVASCULAR ANESTHESIOLOGY:
胡潇 译 陈杰 校
Antithrombin Deficiency Increases Thrombin
Activity After Prolonged Cardiopulmonary Bypass
Roman Sniecinski, Fania Szlam, Edward P. Chen, Stephen O. Bader, Jerrold H. Levy, and Kenichi A. Tanaka
Anesth Analg 2008 106: 713-718.
抗凝血酶对VIII因子缺乏血浆中重组激活VII因子凝血效应的影响
孙鹏飞译 薛张纲校
Antithrombin Affects Hemostatic Response to
Recombinant Activated Factor VII in Factor VIII Deficient Plasma
Fania Szlam, Taro Taketomi, Chelsea A. Sheppard, Christine L. Kempton, Jerrold H. Levy, and Kenichi A. Tanaka
Anesth Analg 2008 106: 719-724.
姜旭晖 译 马皓琳 李士通
校
Fibrinogen in Craniosynostosis Surgery
Thorsten Haas, Dietmar Fries, Corinna Velik-Salchner, Elgar Oswald, and Petra Innerhofer
Anesth Analg 2008 106: 725-731.
联合给予活化Ⅶ因子(NovoSeven®)和纤维蛋白原(Haemocomplettan® P)后能改善血块形成
王鹏 译 陈杰 校
Improved Clot Formation by Combined
Administration of Activated Factor VII (NovoSeven®) and Fibrinogen
(Haemocomplettan® P)
Kenichi A. Tanaka, Taro Taketomi, Fania Szlam, Andreas Calatzis, and Jerrold H. Levy
Anesth Analg 2008 106: 732-738.
章一静译
薛张纲校
The Effect of Limited Rewarming and Postoperative Hypothermia on
Cognitive Function in a Rat Cardiopulmonary Bypass Model
Fellery de Lange, Wilbert L. Jones, George Burkhard Mackensen, and Hilary P. Grocott
Anesth Analg 2008 106: 739-745.
多功能衬垫式充气加温系统在近常温的体外循环下心脏外科手术中的效果
邱郁薇 译 马皓琳 李士通 校
An Evaluation of a Full-Access Underbody
Forced-Air Warming System During Near-Normothermic, On-pump Cardiac Surgery
Steven R. Insler, Mohamed H. Bakri, Fady Nageeb, Edward Mascha, Tomislav Mihaljevic, and Daniel I. Sessler
Anesth Analg 2008 106: 746-750.
陶颖莹 译 陈杰 校
Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery: A Core Review (Review Article)
Miklos D. Kertai
Anesth Analg 2008 106: 751-758.
PEDIATRIC ANESTHESIOLOGY:
胡艳译 薛张刚校
The Effect of Lung Expansion and Positive End-Expiratory Pressure on Respiratory Mechanics in Anesthetized Children
Athanasios G. Kaditis, Etsuro K. Motoyama, Walter Zin, Nobuhiro Maekawa, Isuta Nishio, Taiyo Imai, and Joseph Milic-Emili
Anesth Analg 2008 106: 775-785.
适用于以麻醉为基础的小儿慢性疼痛医疗方案的病儿群体的临床特点
张莹译 马皓琳 李士通校
A Clinical Profile of
a Cohort of Patients Referred to an Anesthesiology-Based Pediatric Chronic Pain
Medicine Program
Thomas R. Vetter
Anesth Analg 2008 106: 786-794.
杜唯佳 译 陈杰 校
Measurement of Blood Flow Index During Antegrade Selective Cerebral Perfusion with Near-Infrared Spectroscopy in Newborn Piglets
Patrick Meybohm, Grischa Hoffmann, Jochen Renner, Andreas Boening, Erol Cavus, Markus Steinfath, Jens Scholz, and Berthold Bein
Anesth Analg 2008 106: 795-803.
AMBULATORY ANESTHESIOLOGY:
黄凝译 薛张纲校
An Efficient Screening Tool for Preoperative Depression: The Geriatric Depression Scale-Short Form
Diana S. Bass, Deborah K. Attix, Barbara Phillips-Bute, and Terri G. Monk
Anesth Analg 2008 106: 805-809.
彭中美 译 马皓琳 李士通 校
A Comparison of Preoperative Anxiety in
Female Patients with Mothers of Children Undergoing Surgery (Brief
Report)
Jill MacLaren and Zeev N. Kain
Anesth Analg 2008 106: 810-813.
闪光灯在减轻静脉置管术疼痛的作用：一个前瞻性、随机、安慰对照研究
王腾 译 陈杰 校
The Role of a Flash of Light for Attenuation
of Venous Cannulation Pain: A Prospective, Randomized, Placebo-Controlled Study (Brief
Report)
Anil Agarwal, Ghanshyam Yadav, Devendra Gupta, Manish Tandon, Prabhat Kumar Singh, and Uttam Singh
Anesth Analg 2008 106: 814-816.
ANESTHETIC PHARMACOLOGY:
关于异丙酚合用70%氙与合用70%笑气时50%有效浓度（EC50）的比较
施颖译 薛张纲校
The Effective Concentration 50 (EC50) for Propofol with 70% Xenon Versus 70% Nitrous Oxide
Ahmed R. Barakat, Markus N. Schreiber, Joachim Flaschar, Michael Georgieff, and Stefan Schraag
Anesth Analg 2008 106: 823-829.
大鼠的肝脏缺血再灌注损伤模型中七氟醚与异氟醚麻醉的肝能量代谢及其不同的保护效应
唐亮 译 马皓琳 李士通 校
Hepatic Energy Metabolism and the Differential Protective Effects of Sevoflurane and Isoflurane Anesthesia in a Rat Hepatic Ischemia-Reperfusion Injury Model
Nurdan Bedirli, Ebru Ofluoglu, Mustafa Kerem, Gulten Utebey, Murat Alper, Demet Yilmazer, Abdulkadir Bedirli, Onur Ozlu, and Hatice Pasaoglu
Anesth Analg 2008 106: 830-837.
不同化合物对野生型、突变型A型γ氨基丁酸和甘氨酸受体的麻醉样作用
赵燕星 译 陈杰 校
The Anesthetic-Like Effects of Diverse
Compounds on Wild-Type and Mutant 
-Aminobutyric Acid Type A and Glycine Receptors
Liya Yang and James M. Sonner
Anesth Analg 2008 106: 838-845.
异丙酚对人类5-HT3A受体的分子作用：通过相似的酚类衍生物增强和抑制
宣丽真译 薛张纲校
Molecular Actions of Propofol on Human 5-HT3A
Receptors: Enhancement as Well as Inhibition by Closely Related Phenol
Derivatives
Martin Barann, Isabelle Linden, Stefan Witten, and Bernd W. Urban
Anesth Analg 2008 106: 846-857.
高血糖减弱异氟烷在血管平滑肌细胞中诱导的ATP敏感的钾通道激活作用
黄施伟 译 马皓琳 李士通 校
Hyperglycemia Impairs Isoflurane-Induced
Adenosine Triphosphate-Sensitive Potassium Channel Activation in Vascular
Smooth Muscle Cells
Takashi Kawano, Katsuya Tanaka, Kazuaki Mawatari, Shuzo Oshita, Akira Takahashi, and Yutaka Nakaya
Anesth Analg 2008 106: 858-864.
郑丽 译 陈杰 校
Human Peripheral Blood Mononuclear Cells
Produce Pre-Pro-Nociceptin/Orphanin FQ mRNA (Brief Report)
John P. Williams, Jonathan P. Thompson, David J. Rowbotham, and David G. Lambert
Anesth Analg 2008 106: 865-866.
TECHNOLOGY, COMPUTING, AND SIMULATION:
刘沁译 薛张纲校
Cardiac Output Derived from Arterial Pressure Waveform Analysis in Patients Undergoing Cardiac Surgery: Validity of a Second Generation Device
Jochen Mayer, Joachim Boldt, Michael W. Wolf, Johannes Lang, and Stefan Suttner
Anesth Analg 2008 106: 867-872.
沈浩 译 马皓琳 李士通
校
Spectral Entropy Predicts Auditory Recall in
Volunteers
Daryn H. Moller and Ira J. Rampil
Anesth Analg 2008 106: 873-879.
异丙酚与fospropofol（一种新型异丙酚前体）的交互式网络仿真
陶颖莹 译 陈杰 校
Interactive Web Simulation for Propofol and Fospropofol, a New Propofol Prodrug (Technical Communication)
Sinan Yavas, David Lizdas, Nikolaus Gravenstein, and Samsun Lampotang
Anesth Analg 2008 106: 880-883.
CRITICAL CARE AND TRAUMA:
食管部分切除术中胸段硬膜外应用布比卡因与静脉内肾上腺素输注对胃管引流的影响
刘婷洁译 薛张纲校
The Effect of Thoracic Epidural Bupivacaine and an Intravenous
Adrenaline Infusion on Gastric Tube Blood Flow During Esophagectomy (Brief Report)
Omar Y. Al-Rawi, Stephen H. Pennefather, Richard D. Page, Ishani Dave, and Glen N. Russell
Anesth Analg 2008 106: 884-887.
OBSTETRIC ANESTHESIOLOGY:
黄佳佳译，马皓琳 李士通校
The Effect of Maternal Catecholamines on the
Caliber of Gravid Uterine Microvessels
Scott Segal and Steven Y. Wang
Anesth Analg 2008 106: 888-892.
ECONOMICS, EDUCATION, AND POLICY:
张燕 译 陈杰 校
Decision Support Increases Guideline
Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis
Fabian O. Kooij, Toni Klok, Markus W. Hollmann, and Jasper E. Kal
Anesth Analg 2008 106: 893-898.
NEUROSURGICAL ANESTHESIOLOGY:
秦敏菊译 薛张纲校
The Effect of Clonidine Infusion on Distribution of Regional Cerebral Blood Flow in Volunteers
Vincent Bonhomme, Pierre Maquet, Christophe Phillips, Alain Plenevaux, Pol Hans, Andre Luxen, Maurice Lamy, and Steven Laureys
Anesth Analg 2008 106: 899-909.
裘毅敏译，马皓琳 李士通校
The Effects of Transient Cerebral Ischemia on
Vasopressin-Induced Vasoconstriction in Rabbit Cerebral Vessels
Masahiko Kumazawa, Hiroki Iida, Masayoshi Uchida, Mami Iida, Motoyasu Takenaka, Naokazu Fukuoka, Tomohiro Michino, and Shuji Dohi
Anesth Analg 2008 106: 910-915.
自主呼吸的新生大鼠缺氧-缺血损伤后氙气/低温神经保护措施：呼吸和镇静效应
潘方立 译 陈杰 校
Xenon/Hypothermia Neuroprotection Regimes in
Spontaneously Breathing Neonatal Rats After Hypoxic-Ischemic Insult: The
Respiratory and Sedative Effects
John Dingley, Catherine Hobbs, James Ferguson, Janet Stone, and Marianne Thoresen
Anesth Analg 2008 106: 916-923.
夏俊明译 薛张纲校
Dehydration Induced by Bowel Preparation in
Older Adults Does Not Result in Cognitive Dysfunction
Gareth L. Ackland, Jane Harrington, Paul Downie, James W. Holding, Deepak Singh-Ranger, Konstandina Griva, Michael G. Mythen, and Stanton P. Newman
Anesth Analg 2008 106: 924-929.
NEUROSURGICAL ANESTHESIA:
在接受异丙酚复合芬太尼麻醉的患者中神经肌肉阻滞水平对强直后运动诱发电位的幅度和经颅刺激的运动反应的影响
唐李隽 译 马皓琳 李士通校
The Effects of the Neuromuscular Blockade
Levels on Amplitudes of Posttetanic Motor-Evoked Potentials and Movement in
Response to Transcranial Stimulation in Patients Receiving Propofol and
Fentanyl Anesthesia
Yuri Yamamoto, Masahiko Kawaguchi, Hironobu Hayashi, Toshinori Horiuchi, Satoki Inoue, Hiroyuki Nakase, Toshisuke Sakaki, and Hitoshi Furuya
Anesth Analg 2008 106: 930-934.
手法稳定气管插管期间的颈椎移动：直接喉镜法与GlideScope视频喉镜法的比较
印洁敏 译 陈杰 校
Cervical Spine Motion During Tracheal
Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus
GlideScope® Videolaryngoscopy
Arnaud Robitaille, Stephan R. Williams, Marie-Hélène Tremblay, François Guilbert, Mélanie Thériault, and Pierre Drolet
Anesth Analg 2008 106: 935-941.
GENERAL ARTICLES:
发展中国家的麻醉和相关学科的现状：一项赞比亚共和国的全国性调查
陈珺珺译 薛张纲校
Anesthesia and Its Allied Disciplines in the Developing World: A Nationwide Survey of the Republic of Zambia
Stefan Jochberger, Feruza Ismailova, Wolfgang Lederer, Viktoria D. Mayr, Günter Luckner, Volker Wenzel, Hanno Ulmer, Walter R. Hasibeder, Martin W. Dünser For the "Helfen Berührt" Study Team
Anesth Analg 2008 106: 942-948.
PAIN MEDICINE:
塞来考昔围手术期给药与仅仅在术后给药对接受大的整形外科手术病人术后影响的比较
吴进 译 马皓琳 李士通 校
Perioperative Versus Postoperative Celecoxib
on Patient Outcomes After Major Plastic Surgery Procedures
Tiffany Sun, Ozlem Sacan, Paul F. White, Jayne Coleman, Rod J. Rohrich, and Jeffrey M. Kenkel
Anesth Analg 2008 106: 950-958.
一项前瞻性随机双盲研究测定胸段硬膜外给新斯的明对腹主动脉术后肠麻痹的影响
宋翠侠 译 陈杰 校
A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery
Esra Caliskan, Ayda Turkoz, Mesut Sener, Nesrin Bozdogan, Oner Gulcan, and Riza Turkoz
Anesth Analg 2008 106: 959-964.
PAIN MECHANISMS:
吗啡鞘内注射抑制爪炎症性水肿：一氧化氮（NO）和环磷鸟苷(cGMP)的作用
蒋宗明译 薛张纲校
Intrathecally Injected Morphine Inhibits Inflammatory Paw Edema: The Involvement of Nitric Oxide and Cyclic-Guanosine Monophosphate
Sara Comelli Brock and Carlos Rogério Tonussi
Anesth Analg 2008 106: 965-971.
鞘内注射环氧化酶-1抑制剂、环氧化酶-2抑制剂或非选择性抑制剂对疼痛行为和脊髓Fos样免疫反应的影响
颜涛 译，马皓琳 李士通
校
The Effects of Intrathecal
Cyclooxygenase-1, Cyclooxygenase-2, or Nonselective Inhibitors on Pain Behavior
and Spinal Fos-Like Immunoreactivity
Il Ok Lee and Youngsun Seo
Anesth Analg 2008 106: 972-977.
一氧化氮合酶抑制剂和环氧合酶抑制剂在小鼠甲醛诱导疼痛中的相互作用：一项等辐射分析研究
潘钱玲 译 陈杰 校
The Interaction Between Inhibitors of Nitric
Oxide Synthase and Cyclooxygenase in Formalin-Induced Pain in Mice: An
Isobolographic Study
Abdul-Shakoor Bhat, Surendra Kumar Tandan, Dinesh Kumar, Vamsi Krishna, and Vellanki Ravi Prakash
Anesth Analg 2008 106: 978-984.
固定剂量的氟烷、异氟醚或异丙酚，并没有优先抑制带有上行投射的腰段脊髓背角神经元的实验鼠的有害热诱发反应
陈珺珺译 薛张纲校
Immobilizing Doses of Halothane, Isoflurane or Propofol, Do Not Preferentially Depress Noxious Heat-Evoked Responses of Rat Lumbar Dorsal Horn Neurons with Ascending Projections
Linda S. Barter, Laurie O. Mark, Steven L. Jinks, Earl E. Carstens, and Joseph F. Antognini
Anesth Analg 2008 106: 985-990.
REGIONAL ANESTHESIA:
患者自控持续斜角肌间沟阻滞能促进开放性肩部手术后的早期功能康复吗？
朱 慧译 马皓琳 李士通校
Does Patient-Controlled Continuous Interscalene
Block Improve Early Functional Rehabilitation After Open Shoulder Surgery?
Klaus Hofmann-Kiefer, Tim Eiser, Daniel Chappell, Stephan Leuschner, Peter Conzen, and Dirk Schwender
Anesth Analg 2008 106: 991-996.
改良乳房根治术术后罗哌卡因连续伤口浸润麻醉与单次椎旁神经阻滞的比较
陈伟 译 陈杰 校
A Prospective Comparison of Continuous Wound
Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After
Modified Radical Mastectomy
Tatiana Sidiropoulou, Oreste Buonomo, Eleonora Fabbi, Maria Beatrice Silvi, Georgia Kostopanagiotou, Alessandro Fabrizio Sabato, and Mario Dauri
Anesth Analg 2008 106: 997-1001.
陈珺珺译 薛张纲校
The Effects of Prehydration on the Properties
of Cerebrospinal Fluid and the Spread of Isobaric Spinal Anesthetic Drug
Byung Seop Shin, Justin Sang Ko, Mi Sook Gwak, Mikyung Yang, Chung Su Kim, Tae Soo Hahm, Sang Min Lee, Hyun Sung Cho, Sung Tae Kim, Ji Hye Kim, and Gaab Soo Kim
Anesth Analg 2008 106: 1002-1007.
胡湘 译 马皓琳 李士通
校
Vasoconstriction and Analgesic Efficacy of
Locally Infiltrated Levobupivacaine for Nasal Surgery
Yavuz Demiraran, Ozcan Ozturk, Ender Guclu, Abdulkadir Iskender, Mehmet Hakan Ergin, and Abdurahman Tokmak
Anesth Analg 2008 106: 1008-1011.
陈珺珺译 薛张纲校
A Simplified Approach to Vertical Infraclavicular Brachial Plexus Blockade Using Hand-Held Doppler (Brief Report)
Steven Renes, Laura Clark, Mathieu Gielen, Huub Spoormans, Janneke Giele, and Anupama Wadhwa
Anesth Analg 2008 106: 1012-1014.
Antithrombin Deficiency Increases
Thrombin Activity After Prolonged Cardiopulmonary Bypass
Roman Sniecinski, MD*, Fania
Szlam, MMSc*, Edward P. Chen, MD_files/image002.gif){kind=small}
,
Stephen O. Bader, MD*, Jerrold H. Levy, MD*, and Kenichi
A. Tanaka, MD, MSc*
From the Departments of *Anesthesiology,
and _files/image003.gif){kind=small}
Surgery
(Cardiothoracic), Emory University School of Medicine, Atlanta, Georgia.
Anesth Analg 2008 106: 713-718.
背景： 体外循环期间，特别是深低温停循环时抗凝血酶水平降低。低抗凝血酶水平可能导致促凝和抗凝因子间的不平衡导致系统性血栓形成。作者假设体外循环后病人血浆中加入促凝因子后低水平的抗凝血酶可能导致凝血酶产生增加。
方法：5例接受深低温停循环心脏手术的病人在肝素化前和体外循环后抽取血液标本。抗凝血酶水平由产色反应来确定并由正常活性的百分比来表达。抗凝和促凝物质的平衡通过在病人血浆中加入正常人的血浆、抗凝血酶缺陷的血浆和提纯的抗凝血酶来实现 。ThrombinoscopeTM系统用于评估给或不给抗凝血酶时的凝血酶。
结果：在体外循环前后，抗凝血酶水平分别为82.0% (中位数71.0, 最大值109) 和 37.0% (中位数34.0, 最大值41.0)，(P < 0.05)。当体外循环后的血浆加入正常抗凝血酶（105%）的捐献者血浆后凝血酶56.6 nM (中位数42.1, 最大值61.0), 并保持在 61.1 nM (中位数54.9, 最大值64.5)。当加入抗凝血酶缺乏病人的血浆后，凝血酶（中位数，范围）从56.6nM(中位数42.1, 最大值61.0)增至117 nM (中位数95.0, 最大值188) (P < 0.05)。当加入提纯的抗凝血酶后，凝血酶减少到12.2 nM (中位数9.0, 最大值29.3) (P < 0.05)。
结论：深低温停循环患者体外循环后血浆抗凝血酶活性显著下降。数据显示在不给予抗凝血酶的情况下给予凝血因子可能导致过多的凝血酶生成，临床上有潜在导致高凝状态的可能。
（胡潇 译 陈杰 校）
BACKGROUND: Antithrombin (AT) levels decrease during cardiopulmonary bypass (CPB), particularly when combined with deep hypothermic circulatory arrest (DHCA). Low AT levels might lead to imbalance of pro- and anticoagulant factors promoting systemic thrombotic events. We hypothesized that low levels of AT might lead to increased in vitro thrombin generation when procoagulant factors are added to the patient's plasma after CPB.
METHODS: Blood samples were obtained before heparinization and after separation from CPB from five patients undergoing cardiac surgery with DHCA. AT levels were determined by chromogenic assay and expressed as a percent of normal activity. The balance between procoagulant and anticoagulant elements was manipulated in the patients' plasma by adding normal donor plasma, AT-deficient plasma, or purified AT. The ThrombinoscopeTM system was used to evaluate thrombin generation with and without AT supplementation.
RESULTS: AT levels (median, range) were 82.0% (71.0, 109) and 37.0% (34.0, 41.0) of normal before and after separation from CPB, respectively (P < 0.05). Peak thrombin generation (median, range) was 56.6 nM (42.1, 61.0) in plasma after CPB, and it remained at 61.1 nM (54.9, 64.5) when a donor plasma with normal AT (105%) was added. When AT-deficient plasma was added to the patient's plasma, peak thrombin generation (median, range) was increased from 56.6 nM (42.0, 61.0) to 117 nM (95.0, 188) (P < 0.05 versus control). After the addition of purified AT, the peak thrombin generation was reduced to 12.2 nM (9.0, 29.3) (P < 0.05 versus control).
CONCLUSION: Plasma AT activity is severely decreased after CPB with DHCA. Our data suggest that the administration of coagulation factor components without AT repletion may lead to excessive thrombin generation, which clinically, may potentially lead to a hypercoagulable state.
联合给予活化Ⅶ因子(NovoSeven®)和纤维蛋白原(Haemocomplettan®
P)后能改善血块形成
Improved Clot Formation by Combined
Administration of Activated Factor VII (NovoSeven®) and Fibrinogen
(Haemocomplettan® P)
Kenichi A. Tanaka, MD, MSc*,
Taro Taketomi, MD*, Fania Szlam, MMSc*, Andreas Calatzis,
MD_files/image004.gif){kind=small}
,
and Jerrold H. Levy, MD*
From the *Department of Anesthesiology,
Division of Cardiothoracic Anesthesia, Emory University School of Medicine,
Atlanta, Georgia; and _files/image005.gif){kind=small}
Haemostasis
and Transfusion Medicine, Munich University Clinic, Munich, Germany.
Anesth Analg 2008 106: 732-738.
背景：重组活化Ⅶ因子（rFVIIa）常用于治疗难治性心脏术后出血。然而，止血作用还取决于凝集因子，包括纤维蛋白原，在血管损伤部位形成稳定的血小板栓子。作者比较了单独使用rFVIIa，纤维蛋白原以及联合使用时的止血效果。
方法：采集 12例志愿者和7例体外循环患者血液样本。在体外，志愿者的血浆加入肝素（0.1U/ml）或纤溶酶原（0.1ug/ml）以模拟凝血功能紊乱，然后加入rFVIIa（1.5ug/ml）、纤维蛋白原（100mg/dl）或联合给予rFVIIa及纤维蛋白原，以此来评价它们的促凝血功能。通过血栓弹力图比较它们对凝血功能的影响。测定血栓的形成时间、第一个血栓形成时间以及血栓的最大硬度。凝血酶定量实验用来测定添加纤维蛋白原和（或）rFVIIa后凝血酶的产生。
结果：在肝素化的志愿者的血浆中，加入rFVIIa可以导致血凝块形成时间从663秒缩短到435秒，但不影响血栓的最大硬度。纤维蛋白原可使血栓最大硬度从26.0mm增加到30.5mm，但它不影响血凝块形成时间。在肝素化血浆样本中联合给予rFVIIa和纤维蛋白原，可以最大程度地将血凝块形成时间缩短到359s(324–522s)以及将血栓最大硬度增加到29mm (27.8–31.0)。在给予组织型纤溶酶原的志愿者的血浆中，纤溶现象比加入rFVIIa增加了45%。体外循环术后，在给予rFVIIa和纤维蛋白原后血凝块形成时间和血栓最大硬度均改善了。凝血酶定量试验说明了rFVIIa可以提高血栓形成的时间和凝血酶活化的速度，而纤维蛋白原没有这些作用。
结论：给予rFVIIa后纤维蛋白形成时间和凝血酶产生均缩短，但只有另外给予纤维蛋白原后产生纤维蛋白凝块强度增强。体外循环后全血通过联合给与rFVIIa和纤维蛋白原而改善血凝块形成。
（王鹏 译 陈杰 校）
BACKGROUND: Recombinant
activated factor VII (rFVIIa) is increasingly used for treating
refractory bleeding after cardiac surgery. However, hemostasis also
depends on coagulation factors, including fibrinogen, which
stabilizes platelet plugs at sites of vascular injury. We compared
the hemostatic effects of rFVIIa, fibrinogen, or their combination.
METHODS: Blood samples were obtained from 12 volunteers and from 7 patients after cardiopulmonary bypass (CPB). The in vitro effects of rFVIIa (1.5 µg/mL), fibrinogen (100 mg/dL), and the combination were evaluated under simulated coagulopathy in volunteer plasma using heparin (0.1 U/mL) or tissue plasminogen activator (0.1 µg/mL). Hemostatic interventions were compared using thromboelastometry, which measures clotting time (CT, s), angle of thrombus formation, and maximal clot firmness (MCF, mm). The ThrombinoscopeTM was used to quantitate thrombin generation after addition of fibrinogen and/or rFVIIa.
RESULTS: In heparinized volunteer plasma, rFVIIa shortened CT (1st and 3rd quartiles) from 663 (522–736) to 435 (397–531) s, but it did not affect MCF. Fibrinogen increased MCF from 26.0 (24.4–26.7) to 30.5 (26.3–31.5) mm without affecting CT. The combination of rFVIIa and fibrinogen in heparinized samples was most effective in improving CT to 359 (324–522) s and MCF to 29 (27.8–31.0) mm. In tissue plasminogen activator-treated volunteer plasma, fibrinolysis increased by more than 45% by the addition of rFVIIa. After CPB, both CT and MCF were most improved with coadministration of rFVIIa and fibrinogen. Thrombinoscope evaluation demonstrated that rFVIIa decreased the lag time and increased peak thrombin generation, whereas fibrinogen had no effect.
CONCLUSION: The
onset of fibrin formation and thrombin generation were shortened
after rFVIIa addition, but fibrin clot strength was only increased
after fibrinogen supplementation. In vitro clot
formation was most improved by using both rFVIIa and fibrinogen in
whole blood after CPB.
Preoperative Coronary Revascularization
in High-Risk Patients Undergoing Vascular Surgery: A Core Review
Miklos D. Kertai, MD, PhD*_files/image006.gif){kind=small}
From the *Department of Cardiothoracic
Anaesthesia, Semmelweis University, Budapest, Hungary; and _files/image007.gif){kind=small}
Department
of Anesthesia, Harefield Hospital, London, UK.
Anesth Analg 2008 106: 751-758.
数据显示进行血管外科手术的病人，其冠状动脉相关的心脏并发症发生率呈现持续增高。
而术前进行冠状动脉造影的病人如果显示有接受冠脉血运重建术来改善术前及长期心脏功能的必要，则术前心脏功能评估对这些高危病人极为有益。然而目前的冠脉血运重建术与药物治疗在减少心脏并发症的效果上孰优孰劣仍存在争议。本综述根据最近发表的文献总结并比较了选择性血管手术的病人术前冠脉血运重建术治疗与保守性药物治疗两者效果。
（陶颖莹 译 陈杰 校）
Patients undergoing vascular surgery are at increased risk for cardiac complications related to the presence of underlying coronary artery disease. Preoperative cardiac evaluation may help to identify high-risk patients in whom coronary angiography may be planned with subsequent coronary revascularization for the purpose of improving perioperative and long-term cardiac outcomes. However, the indications and efficacy for type of revascularization for the reduction of cardiac complications compared to medical therapy has been controversial. My aim in this review is to summarize the role of preoperative revascularization compared to conservative medical therapy before elective vascular surgery using current evidence from published studies.
Measurement of Blood Flow Index During
Antegrade Selective Cerebral Perfusion with Near-Infrared Spectroscopy in
Newborn Piglets
Patrick Meybohm, MD*_files/image008.gif){kind=small}
,
Grischa Hoffmann, MD_files/image010.gif){kind=small}
,
Jochen Renner, MD*_files/image011.gif){kind=small}
,
Andreas Boening, MD_files/image012.gif){kind=small}
,
Erol Cavus, MD*, Markus Steinfath, MD*, Jens Scholz, MD*,
and Berthold Bein, MD, DEAA*_files/image013.gif){kind=small}
From the *Department of Anaesthesiology and
Intensive Care Medicine, _files/image014.gif){kind=small}
Pediatric
Anesthesia Research Unit, and _files/image015.gif){kind=small}
Department
of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus
Kiel, Germany.
Anesth Analg 2008 106: 795-803.
背景：复杂的先天性心脏病的婴儿需在深低温停循环（HCA）下手术。有人认为，选择性脑灌注（SCP）可以提供足够的脑血流而减轻缺血性脑损伤。作者采用近红外光谱法监测脑灌注和组织氧合情况，研究不同SCP下血流速度，并且与HCA相比较。
方法：21头小猪在18°C行体外循环，然后行HCA或以25或50mL · kg–1 · min–1行SCP 90min，分别为HCV组、SCP25组和SCP50组。通过近红外光谱法测定由吲哚青绿血管造影剂的血流指数（BFI）以及组织氧合指数（TOI）。用经颅多普勒超声测定平均脑血流速度(FVmean)。
结果： SCP50组较HCV组（无血流）和SCP25组，其BFI和FVmean都有显著增高。SCP50组的TOI较基础水平增高，并高于HCV组和SCP25组。SCP组50的颅内压较基础水平没有显著升高。
结论：BFI和FVmean都显示了SCP50组的脑灌注较HCV组和SCP25组增高。SCP25组和SCP50组的TOI较HCA组有明显提高。SCP在25mL · kg–1 · min–1时可能提供最合适的脑保护。
（杜唯佳 译 陈杰 校）
BACKGROUND: Neonates with complex congenital heart defects have traditionally undergone surgery during deep hypothermic cardiac arrest (HCA). Selective cerebral perfusion (SCP) is thought to minimize ischemic brain injury by providing adequate cerebral blood flow. We investigated SCP with different flow rates compared with HCA with respect to cerebral perfusion and tissue oxygenation as assessed by near-infrared spectroscopy.
METHODS: Twenty-one piglets were placed on cardiopulmonary bypass at 18°C, then underwent either HCA or SCP at 25 or 50 mL · kg–1 · min–1 for 90 min. The blood flow index (BFI) derived by indocyanine green and tissue oxygen index (TOI) were determined by near-infrared spectroscopy. Mean cerebral blood flow velocity (FVmean) was recorded by transcranial Doppler ultrasound.
RESULTS: Both BFI and FVmean increased significantly (126 ± 27% of baseline; 19 ± 2 cm/s) in the SCP 50 group compared with HCA (no flow) and SCP 25 (65 ± 24%; 10 ± 1 cm/s), respectively. TOI increased in the SCP 50 group compared with baseline (74 ± 4% vs 65 ± 4%), and was higher compared with HCA (52 ± 2%) and SCP 25 (59 ± 2%). Intracranial pressure increased nonsignificantly compared with baseline in the SCP 50 group.
CONCLUSIONS: Both BFI and FVmean suggested increased cerebral perfusion in the SCP 50 group compared with the HCA and SCP 25 groups. TOI was significantly higher in both the SCP 25 and SCP 50 groups compared with HCA. SCP at 25 mL · kg–1 · min–1 may be most appropriate for cerebral protection.
闪光灯在减轻静脉置管术疼痛的作用：一个前瞻性、随机、安慰对照研究
The Role of a Flash of Light for
Attenuation of Venous Cannulation Pain: A Prospective, Randomized,
Placebo-Controlled Study
Anil Agarwal, MD*, Ghanshyam
Yadav, MD*, Devendra Gupta, MD*, Manish Tandon, MD*,
Prabhat Kumar Singh, MD*, and Uttam Singh, PhD_files/image016.gif){kind=small}
From the Departments of *Anaesthesiology
and _files/image017.gif){kind=small}
Biostatics,
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Anesth Analg 2008 106: 814-816.
背景：尽管操作中有有令人不适的疼痛经历，静脉置管术常在无镇痛的情况下完成的。各种各样的药物和非药物措施尝试用于减轻静脉置管带来的疼痛。本文研究闪光灯减轻静脉置管术疼痛的作用。
方法：前瞻性、随机研究90名成年人（15—60岁），ASA分级在Ⅰ--Ⅱ级，不分性别，行择期LC术患者。随机分为三组，每组30人。第一组（对照组）；第二组（分散注意组）：不用闪光灯照相；第三组（闪光組）：手背小静脉不明显的患者在静脉置管术前用闪光灯给予拍照，然后迅速行静脉穿刺置管，置入18号导管。
结果：每组均有2名患者因第一次置入未成功而在后期分析中删除。闪光组静脉置管时疼痛比较轻，疼痛率为50%（14/28），而另两组为100%（28/28）（p﹤0.01）。用视觉模拟评分测定静脉置管术疼痛程度（0—100；0即没有疼痛，100是最痛）。闪光组的静脉置管疼痛减轻的程度比分散注意力组大（p﹤0.01）
结论：静脉置管术前应用闪光灯是减轻置管疼痛的一种安全、有效、简单易用的方法。
（王腾 译 陈杰 校）
BACKGROUND: Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain.
METHODS: Ninety adults (15–60 yr), ASA physical status I and II, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group I (control); Group II (distraction): photographed without a flash of light; and Group III (flash): photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula.
RESULTS: Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i.e., 50% (14 of 28) when compared to 100% (28 of 28) observed in the other two study groups (P < 0.01). Severity of venous cannulation pain as assessed by the Visual Analog Scale scores (between 0 and 100; where 0 = no pain and 100 = worst imaginable pain) presented as median (interquartile range) were reduced in the flash [10(20)] and distraction [20(10)] groups compared with the control group [40(20)] (P < 0.01). The severity of venous cannulation pain was also reduced in the flash group compared with the distraction group (P < 0.01).
CONCLUSION: We conclude that a flash of light before venous cannulation is a safe, effective, and easy-to-use method for minimizing venous cannulation pain.
不同化合物对野生型、突变型A型γ氨基丁酸和甘氨酸受体的麻醉样作用
The Anesthetic-Like Effects of Diverse
Compounds on Wild-Type and Mutant _files/image019.gif){kind=small}
-Aminobutyric
Acid Type A and Glycine Receptors
Liya Yang, PhD, and James M. Sonner, MD
From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California.
Anesth Analg 2008 106: 838-845.
介绍：没有理论认为吸入麻醉药的作用通过其挥发特性发挥其与生物学靶组织发生生物物理学相互作用而产生麻醉效应。证实突变导致吸入麻醉药对各种受体作用减弱有助于证明具有麻醉作用的非挥发性麻醉药所作用的受体。在以前的研究中，作者证实这些化合物 带电荷或蒸气压特别低，而且这些化合物具有类似吸入麻醉药的方式作用麻醉敏感受体。本研究通过比较它们对野生型A型γ氨基丁酸（GABAA）或甘氨酸受体和突变受体的作用，验证是否这些化合物或是其他带电化合物，相同于挥发性麻醉药的机制。突变受体是通过设计对吸入麻醉药相对耐药而确定。
方法：检测β-羟基丁酸、氯化铵、二乙基邻苯二甲酸酯和GABA对甘氨酸受体同价同效基因α1和突变基因α1（S267I）的作用。检测硫酸十二烷基头孢匹胺和甘氨酸对α1β2γ2s和突变基因α1（S270I）β2γ2sGABA受体的作用。受体来源于非洲蟾蜍平滑肌细胞，用两个电极电压夹的方法。对于GABAA受体和甘氨酸受体，异氟醚和乙醇作为阳性对照，异丙酚作为阴性对照（如由突变导致无作用）。
结果：β-羟基丁酸、氯化铵、二乙基邻苯二甲酸酯和GABA均增强甘氨酸受体功能。这种作用可被S267I突变体降低。硫酸十二烷基头孢匹胺和甘氨酸增强GABAA受体功能，S270I突变体减弱这种作用。
结论：上述发现支持化合物调节GABA A或甘氨酸受体通过类似异氟醚和乙醇的作用机制的假说。比较药物对麻醉敏感型野生受体与相对不敏感型突变受体的作用，可能帮助寻找有麻醉作用的化合物。
（赵燕星 译 陈杰 校）
INTRODUCTION: No theory of inhaled anesthetic action requires volatility
of the anesthetic to accomplish the biophysical interaction of
anesthetic with biological target. The identification of mutations
that attenuate the effect of inhaled anesthetics on various
receptors raises the possibility that nonvolatile compounds with
anesthetic effects can be identified with the aid of these receptors.
In previous studies, we identified compounds that were either
charged or had an exceptionally low vapor pressure and which
modulated anesthetic-sensitive receptors in a manner similar to
inhaled anesthetics. We tested whether these, and another charged
compound, shared a common mechanism with volatile anesthetics, by
comparing their effect on wild-type _files/image021.gif){kind=small}
-aminobutyric
acid type A (GABAA) or glycine receptors and mutant receptors
that were engineered to be relatively resistant to inhaled anesthetics.
METHODS: The
effect of β-hydroxybutyric acid, ammonium chloride, diethylhexyl
phthalate, and GABA were tested on homomeric _files/image023.gif){kind=small}
1
and mutant _files/image024.gif){kind=small}
1
(S267I) glycine receptors. The effect of sodium dodecyl sulfate and
glycine were tested on _files/image025.gif){kind=small}
1b2_files/image026.gif){kind=small}
2s
and mutant _files/image027.gif){kind=small}
1(S270I)β2_files/image028.gif){kind=small}
2s
GABAA receptors. Receptors were expressed in Xenopus
laevis oocytes and studied using two-electrode
voltage clamping. For both GABAA and glycine receptors,
isoflurane and ethanol were used as positive controls and propofol
as a negative control (i.e., unaffected by the mutation).
RESULTS: β-hydroxybutyric acid, ammonium chloride, diethylhexyl phthalate, and GABA all enhanced glycine receptor function. This effect was reduced by the S267I mutations. Sodium dodecyl sulfate and glycine enhanced GABAA receptor function, and the S270I mutation attenuated this effect.
CONCLUSION: These findings support the hypothesis that the compounds studied modulate GABAA or glycine receptors by a mechanism similar to that of isoflurane and ethanol. Comparing the effect of drugs on anesthetic-sensitive wild-type receptors with relatively less sensitive mutant receptors may help identify compounds with anesthetic effects.
人体外周血单核细胞产生痛敏肽/孤啡肽前体mRNA
Human Peripheral Blood Mononuclear Cells
Produce Pre-Pro-Nociceptin/Orphanin FQ mRNA
John P. Williams, FRCA*,
Jonathan P. Thompson, MD, FRCA*, David J. Rowbotham, MD, FRCA_files/image029.gif){kind=small}
,
and David G. Lambert, PhD*
From the Departments of *Cardiovascular
Sciences (Pharmacology and Therapeutics Group), and _files/image030.gif){kind=small}
Health
Sciences, Division of Anaesthesia, Critical Care and Pain Management,
University of Leicester, Leicester Royal Infirmary, Leicester, UK.
Anesth Analg 2008 106: 865-866.
背景： 外周血单核细胞（PBMC）转录非典型的阿片样物质痛敏肽/孤啡肽（N/OFQ）受体（NOP）mRNA。笔者检测了N/OFQ前体，促N/OFQ前体（pp N/OFQ）。
方法：取10名健康志愿者PBMC，用聚合酶链反应（PCR）技术检测pp N/OFQ。
结果： 凝胶PCR法中所有样本中均检出pp N/OFQ mRNA扩增子。这点通过定量实时PCR技术证实（mRNA 30.91+0.18）。
结论：这组数据提示PBMC转录pp N/OFQ，且表达NOP，意味NOP可能参与PBMC的自身调节。
（郑丽 译 陈杰 校）
BACKGROUND: Peripheral blood mononuclear cells (PBMC) transcribe mRNA for the nonclassical opioid nociceptin/orphanin FQ (N/OFQ) receptor (NOP). We probed for the N/OFQ precursor, pre-pro-N/OFQ (ppN/OFQ).
METHODS: Using PBMC from 10 healthy volunteers we probed for ppN/OFQ using polymerase chain reaction (PCR) based experimental paradigms.
RESULTS: In gel-based PCR, we detected amplicons consistent with ppN/OFQ mRNA in all samples. This was confirmed in quantitative real-time PCR with cycle thresholds (representing quantity of mRNA) of 30.91 ± 0.18 (n = 10).
CONCLUSIONS: These data indicate that PBMCs transcribe ppN/OFQ which, coupled with NOP expression, suggest NOP may be involved in the autoregulation of PBMCs.
异丙酚与fospropofol（一种新型异丙酚前体）的交互式网络仿真
Interactive Web Simulation for Propofol
and Fospropofol, a New Propofol Prodrug
Sinan Yavas, MD, David Lizdas, Nikolaus Gravenstein, MD, and Samsun Lampotang, PhD
From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
Anesth Analg 2008 106: 880-883.
根据近期发表的有关异丙酚及fospropofol（一种新型异丙酚前体）药代及药效学数据，本文作者建立了使用这两种药的交互式网络仿真。其中fospropofol是一种新型水溶性异丙酚前体药物，其达到峰浓度的时间晚于异丙酚。而建立的模型能使麻醉医师了解使用两种药物间的区别。另外该模型的附加优点在于保留了原试验中不同试验方案中不同病人间的差异。
（陶颖莹 译 陈杰 校）
Using pharmacokinetic and pharmacodynamic data published in the scientific literature, we have developed interactive on-line simulations to model administration of propofol and fospropofol, a new water-soluble prodrug formulation of propofol. The prodrug formulation of fospropofol leads to a delayed onset to peak concentrations of propofol. A comparison simulation that overlays administration of fospropofol and propofol allows clinicians to understand the differences of administering fospropofol and traditional propofol. The simulations have the added advantage of allowing for differences among patients documented in test studies and the use of different models.
Decision Support Increases Guideline
Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis
Fabian O. Kooij,
MD*_files/image031.gif){kind=small}
, Toni Klok, MD*, Markus W.
Hollmann, MD, PhD, DEAA_files/image032.gif){kind=small}
, and Jasper E. Kal, MD, PhD*
From the *Department of Anesthesiology,
Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands and _files/image033.gif){kind=small}
Department
of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
Anesth Analg 2008 106: 893-898.
背景：预防术后恶心和呕吐的指南实施广泛，但由于没有很好的执行，效果可能有限。 作者作者假设利用电子决策支持（简称DS）系统，能显著改善指南的执行。
METHODS: Medical information of all patients undergoing elective surgery in our regional teaching hospital is routinely entered in an anesthesia information management system at the preoperative screening clinic.方法：来自作者的地区教学医院的选择性手术患者的医学资料常规收录入术前门诊麻醉信息处理系统。 预防Our departmental PONV prevention guidelines identifies patients as "high-risk" and thus eligible for PONV prophylaxis based on the presence of at least three of the following risk factors: female gender, history of PONV or motion sickness, nonsmoker status, and anticipated use of postoperative opioids.术后恶心和呕吐指南确诊为"高危"患者，作为预防术后恶心和呕吐对象，根据是在场的至少有以下3个危险因子：女性，术后恶心和呕吐史或晕动病，不吸烟体质，和预期术后使用阿片类药物。 Using automated reminders, we studied the effect of DS on guidelines adherence using an off-on-off design.使用自动提醒方法，研究决策支持对指南执行的作用。 In these three study periods, we queried for all consecutive patients visiting the preoperative screening clinic who were eligible for PONV prophylaxis and studied how often it was prescribed correctly.
RESULTS: Between November 2005 and June 2006, 1340, 2715, and 1035 patients were included in the control, DS and post-DS periods, respectively.结果：在2005年11月和2006年6月期间，对照组，决策支持组以及后决策支持组包括患者分别有 1340 ，2715和1035例。As a result of mandatory data entry of risk factors, the percentage of high-risk PONV patients increased from 28% in the control period to 32% and 31% in the DS and post-DS periods, respectively.由于强制性数据录入，术后恶心和呕吐高危患者的比例由对照组28 ％ ，上升到决策支持组32％和后决策支持组31％。 During the control period, 38% of all high-risk patients were prescribed PONV prophylaxis.对照组38％的高危患者开具了预防性术后恶心和呕吐处方。 而决策支持组比例上升至73％ ，后决策支持组下降至37％ 。
CONCLUSION: Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.结论：术后恶心和呕吐的高危病人中，电子决策支持系统增强了预防术后恶心和呕吐开具处方指南的执行。
（张燕 译 陈杰 校）
BACKGROUND: Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence.
METHODS: Medical information of all patients undergoing elective surgery in our regional teaching hospital is routinely entered in an anesthesia information management system at the preoperative screening clinic. Our departmental PONV prevention guidelines identifies patients as "high-risk" and thus eligible for PONV prophylaxis based on the presence of at least three of the following risk factors: female gender, history of PONV or motion sickness, nonsmoker status, and anticipated use of postoperative opioids. Using automated reminders, we studied the effect of DS on guidelines adherence using an off–on–off design. In these three study periods, we queried for all consecutive patients visiting the preoperative screening clinic who were eligible for PONV prophylaxis and studied how often it was prescribed correctly.
RESULTS: Between November 2005 and June 2006, 1340, 2715, and 1035 patients were included in the control, DS and post-DS periods, respectively. As a result of mandatory data entry of risk factors, the percentage of high-risk PONV patients increased from 28% in the control period to 32% and 31% in the DS and post-DS periods, respectively. During the control period, 38% of all high-risk patients were prescribed PONV prophylaxis. This increased to 73% during the DS period and decreased to 37% in the post-DS period.
CONCLUSION: Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.
自主呼吸的新生大鼠缺氧-缺血损伤后氙气/低温神经保护措施：呼吸和镇静效应
Xenon/Hypothermia Neuroprotection
Regimes in Spontaneously Breathing Neonatal Rats After Hypoxic-Ischemic Insult:
The Respiratory and Sedative Effects
John Dingley, MD*_files/image034.gif){kind=small}
,
Catherine Hobbs, PhD*, James Ferguson, BSc*, Janet Stone,
PhD_files/image035.gif){kind=small}
,
and Marianne Thoresen, MD, PhD*
From the *Clinical Science at South
Bristol, Child Health, University of Bristol, St. Michael's Hospital, Bristol,
UK; _files/image036.gif){kind=small}
University
of Wales Swansea, Singleton Park, Swansea, UK; and _files/image037.gif){kind=small}
Department
of Biochemistry, Children's Hospital, Bristol, UK.
Anesth Analg 2008 106: 916-923.
背景：低温(HT)能降低围产期窒息引起的神经损伤，氙气(XE)能增强此作用。笔者研究了缺氧-缺血(HI)损伤后不同浓度氙气在正常体温37℃（NT）和低体温32℃（HT）的镇静作用及对呼吸的影响以确定能使7天龄的新生大鼠产生自主呼吸抑制的氙气浓度。
方法：（I）三组对照组，分别为空白对照、禁食正常体温对照组（NT）和禁食低温对照组（HT）。（II）六组行HI损伤（结扎颈动脉后吸8%氧气90min）。之后三组分别为正常体温吸空气、50%氙气和70%氙气（NTAir,NT50%Xe,NT70%Xe），另三组为低温吸空气、50%氙气和70%氙气（HTAir,HT50%Xe,HT70%Xe）。监测血气、血糖和乳酸并记录镇静状态（自主运动和呼吸频率）。
结果：70只新生大鼠的血液生化数据全部获得。（I）对照组在NT或HT禁食9h后血气、血糖和乳酸均正常。（II）HI损伤后，与对照组和NTAir组相比，在NT和HT吸70%氙气组PCO2、pH较低，而HTAir组和HT50%Xe组仅有pH较低。HT70%Xe组PCO2最高、pH最低，镇静效果最好。
结论：在HI损伤后，70%氙气与吸空气和对照组在NT 和HT都能产生镇静、呼吸抑制、CO2潴留和pH下降。50%的氙气则避免了这些影响。
（潘方立 译 陈杰 校）
BACKGROUND: Hypothermia (HT) reduces neuronal injury after perinatal asphyxia. The anesthetic gas xenon (XE) may enhance this effect. We investigated the sedative and respiratory effects of variable XE concentrations at 37°C normothermia (NT) or 32°C HT after a hypoxic-ischemic (HI) insult to determine the concentration at which XE was a respiratory depressant in spontaneously breathing 7-day-old rat pups.
METHODS: (I) In three control groups, the effects of fasting at NT and HT were investigated. (II) Six groups were subjected to a HI insult (left carotid ligation then 90 min breathing 8% oxygen); three then breathed Air, 50%Xe or 70%Xe for 5 h at NT (NTAir, NT50%Xe, NT70%Xe), while three breathed identical mixtures during HT (HTAir, HT50%Xe, or HT70%Xe), in addition to a control group. Blood gases, glucose, and lactate were measured. Sedation (spontaneous movement/respiratory rate) was recorded.
RESULTS: Blood chemistry data were successfully obtained from 70 pups. (I) Pups maintained normal blood gas, glucose, and lactate values after 9 h fasting at NT or HT. (II) After HI insult, in comparison with control and NTAir groups, 70%Xe at both NT and HT produced higher PCO2 and lower pH values while the HTAir and HT50%Xe groups only had lower pH values. The HT70%Xe combination produced the highest PCO2 and lowest pH values (56.8 mm Hg, 7.35, respectively) and the greatest sedative effect.
CONCLUSION: After HI insult, 70%Xe at both NT and HT induced sedation, respiratory depression, CO2 retention, and a decrease in pH relative to air and control groups. The effects were largely avoided with 50%Xe.
手法稳定气管插管期间的颈椎移动：直接喉镜法与GlideScope视频喉镜法的比较
Cervical Spine Motion During Tracheal
Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus
GlideScope® Videolaryngoscopy
Arnaud
Robitaille, MD*, Stephan R. Williams, MD*, Marie-Hélène
Tremblay, MD*, François Guilbert, MD, FRCPC_files/image038.gif){kind=small}
, Mélanie Thériault, MD_files/image039.gif){kind=small}
, and Pierre Drolet, MD, FRCPC_files/image040.gif){kind=small}
From the
Departments of *Anesthesiology and _files/image041.gif){kind=small}
Radiology, Centre Hospitalier de
l'Université de Montréal, Hôpital Notre-Dame, and _files/image042.gif){kind=small}
Department of Anesthesiology, Hôpital
Maisonneuve-Rosemont, Montréal, Canada.
Anesth Analg 2008 106: 935-941.
背景：对于颈椎有潜在病损的患者，采用何种最佳气管插管技术仍然具有争议。作者运用连续荧光照相，进行了一项前瞻性研究，比较直接喉镜法（DL）与GlideScope视频喉镜法（GVL）气管插管时颈椎移动，期间由助手手法保持患者头部的稳定。
方法：选择20例没有颈椎病变的患者。在全麻诱导使用神经肌肉阻滞后，随机采用DL或GVL行气管插管。拍摄插管期间颈椎移动的荧光显像照片，并将其分成四个阶段：气道操作前的基础图像，显现声门，气管导管进入声门，气管插管。测定每位患者每个阶段枕部至C5活动的峰值，计算平均值，利用两因素方差分析比较每种方法产生的颈椎移动。对枕部至C1分别旋转10，15或20度的患者的比例，和声门显现的质量同样做了研究。
结果：各个阶段的颈椎平均移动度在DL和GVL之间没有显著差异（P在0.22～0.70）。两种插管技术对颈椎产生的移动主要都是使颈椎前端伸展，且主要发生在显露声门时。在枕部至C1的伸展幅度大于10，15或20度的这部分患者中插管基本没有困难。GVL对声门的显露明显优于DL。
结论：在全身麻醉使用神经肌肉阻滞的情况下，手法保持头部稳定，采用GVL与DL进行气管插管时前者更好地显露声门，但并不能减少对非病理性颈椎的移动度。
（印洁敏 译 陈杰 校）
BACKGROUND: The optimal tracheal intubation technique for patients with potential cervical (C) spine injury remains controversial. Using continuous cinefluoroscopy, we conducted a prospective study comparing C-spine movement during intubation using direct laryngoscopy (DL) or GlideScope® videolaryngoscopy (GVL), with uninterrupted manual in-line stabilization of the head by an assistant.
METHODS: Twenty patients without C-spine pathology were studied. After induction of general anesthesia with neuromuscular blockade, both DL and GVL were performed on every patient in random order. Cinefluoroscopic images of C-spine movement during GVL and DL were acquired and divided into four stages: a baseline image before airway manipulation, glottic visualization, insertion of the endotracheal tube into the glottis, and tracheal intubation. Peak segmental motion from the occiput to C5 was measured offline for each patient and each stage, averages were calculated, and movements induced by each instrument were compared using a two-way ANOVA. Also studied were the proportion of patients with occiput-C1 rotation exceeding 10, 15, or 20 degrees, and the quality of glottic visualization.
RESULTS: No significant difference was found between DL and GVL regarding average segmental spine movement at any level (P values between 0.22 and 0.70). During both techniques, motion was mainly an extension concentrated in the rostral C-spine and occurred predominantly during glottic visualization. The proportion of patients with occiput-C1 extension of more than 10, 15, or 20 degrees was not significantly different. Glottic visualization was significantly better with GVL compared with DL.
CONCLUSION: During intubation under general anesthesia with neuromuscular blockade and manual in-line stabilization, the use of GVL produced better glottic visualization, but did not significantly decrease movement of the nonpathologic C-spine when compared with DL.
一项前瞻性随机双盲研究测定胸段硬膜外给新斯的明对腹主动脉术后肠麻痹的影响
A Prospective Randomized Double-Blind
Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative
Ileus After Abdominal Aortic Surgery
Esra Caliskan, MD*, Ayda Turkoz,
MD*, Mesut Sener, MD*, Nesrin Bozdogan, MD*,
Oner Gulcan, MD_files/image043.gif){kind=small}
,
and Riza Turkoz, MD_files/image044.gif){kind=small}
From the Departments of *Anesthesiology and
Reanimation, and _files/image045.gif){kind=small}
Cardiovascular
Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
Anesth Analg 2008 106: 959-964.
背景：肠梗阻是腹主动脉术后胃肠道主要的并发症之一，可导致死亡率增加，住院时间延长和医药费的增加，在这项研究中作者评估了胸段硬膜外给与新斯的明对腹主动脉术后肠麻痹的作用。
方法： 45名行腹主动脉手术的患者参与了这项研究，所有的患者接受一致的全麻与硬膜外麻醉。全麻诱导前在T7-T8椎间隙置入硬膜外导管，15min后给予0.5%布比卡因20ml。分别在手术结束以及术后8h经硬膜外导管给予单次剂量新斯的明（1ug/kg，生理盐水稀释成5ml，1组），对照组（2组）同样的途径给5ml生理盐水。术后入ICU病房，记录肠鸣音次数以及每日排气排便次数。
结果：1组较2组，第一次肠鸣音和排气时间明显缩短（11.6 ± 11.2 h vs 22.6 ± 12.8 h 和 21.8 ± 15.6 h vs 36.6 ± 19.1 h , P < 0.05）。两组病人第一次排便时间相似(p>0.05)。2组比1组病人恶心发生率高（p<0.05），两组病人术后并发症发生率相似(p>0.05)
结论：胸段硬膜外给新斯的明促进肠鸣音恢复，缩短腹主动脉术后肠持麻痹续时间。
（宋翠侠 译 陈杰 校）
BACKGROUND: Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery.
METHODS: We enrolled 45 patients who were scheduled for elective abdominal aortic surgery at our institution. All patients received identical general and epidural anesthesia. Before the induction of general anesthesia, an epidural catheter was placed at the T7–T8 intervertebral space, and 20 mL bupivacaine (0.5%) was injected over 15 min. Patients were randomized into two groups. Patients received a 5 mL bolus of neostigmine (1 µg/kg) diluted with normal saline (Group 1) or a 5 mL bolus of normal saline (Group 2) via an epidural catheter at the end of surgery and 8 h postoperatively. Times of bowel sounds were recorded postoperatively in the intensive care unit. Times of daily passage of flatus and defecation also were recorded.
RESULTS: Times to the first bowel sounds and the first flatus were significantly shorter in Group 1 than they were in Group 2 (11.6 ± 11.2 h vs 22.6 ± 12.8 h and 21.8 ± 15.6 h vs 36.6 ± 19.1 h, respectively, P < 0.05). The times to first defecation were similar in both groups (P > 0.05). Nausea was more frequent in patients in Group 2 than in Group 1 (P < 0.05). The incidence of postoperative complications was similar between the groups (P > 0.05).
CONCLUSIONS: Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.
一氧化氮合酶抑制剂和环氧合酶抑制剂在小鼠甲醛诱导疼痛中的相互作用：一项等辐射分析研究
The Interaction Between Inhibitors of
Nitric Oxide Synthase and Cyclooxygenase in Formalin-Induced Pain in Mice: An
Isobolographic Study
Abdul-Shakoor Bhat, PhD, Surendra Kumar Tandan, PhD, Dinesh Kumar, PhD, Vamsi Krishna, PhD, and Vellanki Ravi Prakash, PhD
From the Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India.
Anesth Analg 2008 106: 978-984.
背景:关于NO和COX在角叉菜胶诱导的炎症反应中对前列腺素生成的相互作用已经有报道。但是，关于iNO抑制因子和COX抑制因子在痛觉中相互作用的报道则很少。因此，本研究意在评价S-甲基异硫脲硫酸盐（中度选择性iNO抑制因子）与罗非考昔（选择性COX-2抑制因子）和甲酚那酸（非选择性抑制因子）在小鼠甲醛诱导痛中的相互作用。
方法：通过对小鼠甲醛诱导痛的后期表现，即在注射甲醛后小鼠舔其后爪所花费的时间来研究S-甲基异硫脲硫酸盐、罗非考昔、甲酚那酸及将其混合使用时的剂量反应关系。这种相互作用通过将三种药物同时给药或将S-甲基异硫脲硫酸盐与每一COX抑制因子混合给药来评估。而其相互作用则通过等辐射法进行分析。
结果：单独给药时在甲醛诱导的后期可产生剂量依赖性抑制，其效价的强弱次序为罗非考昔>甲酚那酸>S-甲基异硫脲硫酸盐。而对混合剂即S-甲基异硫脲硫酸盐和罗非考昔，或甲酚那酸的等辐射分析则显示有协同作用。对于相同的混合物实验获得的ED50要比理论上相加获得的ED50明显低，这验证了iNOS或NO及COX亚型的协同作用。
结论：研究发现NOS和COX抑制因子在小鼠甲醛诱导痛中有明显的协同作用，为疼痛控制提供了一个可行的方法。
（潘钱玲 译 陈杰 校）
BACKGROUND: An interaction between nitric oxide (NO) and cyclooxygenases (COX) in the production of prostaglandins in carrageenan-induced inflammation has been established. However, limited information is available about the interaction between inducible NO synthase (iNOS) and COX inhibitors in pain perception. Therefore, in the present study we assessed the nature of the interaction between S-methylisothiourea (a moderately selective iNOS inhibitor) with rofecoxib (selective COX-2 inhibitor) and mefenamic acid (a nonselective COX inhibitor) in formalin- induced pain in mice.
METHODS: The dose-response relation of S-methylisothiourea, rofecoxib, mefenamic acid, and their combination was studied in the late phase of formalin-induced pain in mice over the time spent in licking the hindpaw after formalin injection. The interaction was evaluated by simultaneous administration of fixed proportions of S-methylisothiourea with each COX inhibitor and the nature of the interaction was determined by isobolographic analysis.
RESULTS: Each drug alone produced a dose-dependent suppression of the late stage of formalin-induced behaviors with rank order of potency being rofecoxib > mefenamic acid > S-methylisothiourea. Isobolographic analysis of the combination of S-methylisothiourea with rofecoxib or mefenamic acid revealed a synergistic interaction. The experimental ED50 of the combination was significantly lower than the theoretical additive ED50 of the corresponding drug combination that substantiated the synergistic interaction between iNOS or NO and COX isoforms.
CONCLUSIONS: Our results explicitly indicate the synergistic nature of the interaction between NOS and COX inhibitors in formalin-induced nociceptive behavior in mice, and provide an alternative approach for controlling pain.
改良乳房根治术术后罗哌卡因连续伤口浸润麻醉与单次椎旁神经阻滞的比较
A Prospective Comparison of Continuous
Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block
After Modified Radical Mastectomy
Tatiana Sidiropoulou, MD*,
Oreste Buonomo, MD_files/image046.gif){kind=small}
,
Eleonora Fabbi, MD_files/image047.gif){kind=small}
,
Maria Beatrice Silvi, MD_files/image048.gif){kind=small}
,
Georgia Kostopanagiotou, MD*, Alessandro Fabrizio Sabato, MD_files/image049.gif){kind=small}
,
and Mario Dauri, MD_files/image050.gif){kind=small}
From the *Second Department of
Anesthesiology, University of Athens, Attikon Hospital, Athens, Greece; _files/image051.gif){kind=small}
Thoracic
Surgery Division, Tor Vergata University, Rome, Italy; and _files/image052.gif){kind=small}
Department
of Anesthesiology and Intensive Care, Tor Vergata University, Rome, Italy.
Anesth Analg 2008 106: 997-1001.
背景：连续浸润麻醉与胸段椎旁神经阻滞用于乳房手术后的效能至今未作过对比研究。在这个研究中，作者评估乳房切除术后两者的镇痛作用和吗啡镇痛用量。
方法：48名接受腋窝切开改良乳房根治术患者随机接受0.5%罗哌卡因20ml的术前胸段椎旁神经阻滞或0.5%罗哌卡因连续性浸润麻醉，浸润麻醉的输注速度为2ml/h，方式是在术毕时放置两根导管在手术部位的皮下，导管留置术后24小时。所有患者都接受全身麻醉。记录术后24h吗啡用量，疼痛评分和疼痛限制的肩关节活动，以及并发症的发生率，包括术后恶心呕吐。
结果：两组的吗啡用量相近。两者疼痛评分均较低。术后4h，胸段椎旁神经阻滞组在术后疼痛与疼痛限制性活动方面较轻，而在术后16h和24h，连续性局部浸润麻醉组优于胸段椎旁神经阻滞组。连续性局部浸润麻醉组中术后恶心呕吐的发生率相对频繁。
结论：腋窝切开乳房切除术后，连续性伤口局部浸润麻醉为较好的椎旁神经阻滞替换方法。
（陈伟 译 陈杰 校）
BACKGROUND: The efficacy of continuous wound infiltration with local anesthetic has not been compared with that of thoracic paravertebral block (PVB) after breast surgery. In this study, we evaluated the analgesic efficacy and morphine consumption of the two techniques after mastectomy.
METHODS: Forty-eight patients undergoing modified radical mastectomy with axillary dissection were randomly assigned to either a preoperative PVB with 20 mL of ropivacaine 0.5% (group PVB) or a continuous ropivacaine 0.5% infusion (CRI) at a 2 mL/h rate for each of two multilumen catheters placed subcutaneously at the end of the procedure (group CRI). The catheters were left in place for 24 h postoperatively. A standardized general anesthetic was administered to all patients. Postoperative morphine consumption, pain scores and painful restricted movement of the shoulder for 24 h postoperatively as well as incidence of adverse events, including postoperative nausea and vomiting, were recorded.
RESULTS: Morphine consumption was similar between groups (PVB: 42.6 ± 11 vs CRI: 38.7 ± 11 mg in 24 h, P = 0.225). Absolute pain scores were low in both groups. Four hours after surgery, group PVB showed a significant reduction in postoperative pain (PVB: 0 [0–10] vs CRI: 0 [0–30], P = 0.002) and reduced painful restricted movement (P = 0.004), whereas the CRI group had lower pain scores (PVB: 10 [0–30] vs CRI: 0 [0–20], P = 0.034) and painful restricted movement (P = 0.043) 16 and 24 h (PVB: 10 [0–30] vs CRI: 0 [0–30], P = 0.012) after surgery. Postoperative nausea and vomiting was significantly more frequent in the CRI group (P = 0.017).
CONCLUSIONS: Continuous wound infiltration of local anesthetics is an effective alternative to paravertebral analgesia after mastectomy with axillary dissection.
Fibrinogen in Craniosynostosis Surgery
Thorsten Haas, MD*,
Dietmar Fries, MD_files/image053.gif){kind=small}
, Corinna Velik-Salchner, MD*,
Elgar Oswald, MD*, and Petra Innerhofer, MD*
From the Departments of *Anaesthesiology
and Critical Care Medicine, and _files/image054.gif){kind=small}
General
and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck,
Austria.
Anesth Analg 2008; 106:725-731
背景： 在颅缝早闭的修复过程中，由于大量失血和凝血因子的消耗及稀释常导致的凝血异常，所以建议运用冷沉淀物、新鲜冰冻血浆和血小板进行治疗。但是在大多数的欧洲国家冷沉淀物并不常备，新鲜冰冻血浆在纠正纤维蛋白原缺乏方面的有效性也很有限。我们报道了我们用人纤维蛋白原浓缩物（Hemocomplettan®）来改善儿童受损的纤维蛋白原聚合的经验。
方法： 我们从进行大颅面手术的连续九例小儿的麻醉记录单、用药记录、实验室和血栓弹力图（ROTEM®）数据库，回顾性收集例行凝血试验结果、ROTEM®、补液需要量、给予的人纤维蛋白原浓缩物和术后病程的数据。
结果： 九个小儿年龄为12（8，22）个月，体重为9.5（9，10）kg，手术持续时间为6.4（4.5，7.2）小时，术中估计出血为估计血容量的80%（49%，92%），以上数据表示方法为中位数（25%，75%百分位数）。由ROTEM®检测到的纤维蛋白素原聚合作用受损是稀释性凝血功能紊乱的主要根本问题。所有病例（如果需要）均通过反复给予人纤维蛋白原浓缩物（每次剂量30 mg/kg）而不输注冰冻新鲜血浆和血小板达到了有效的止血，且无不良反应。所有小儿均在术后几小时内顺利脱离机械通气，并尽快就能离开重症监护病房。
结论： 给予纤维蛋白原浓缩物可以有效改善小儿颅缝早闭手术中稀释性凝血病的主要根本问题，即纤维蛋白素原的聚合和总体的凝血强度。
（姜旭晖 译 马皓琳 李士通 校）
BACKGROUND: During
craniosynostosis repair, massive blood loss, consumption and
dilution of clotting factors often result in coagulopathy, for which
cryoprecipitate, fresh frozen plasma (FFP), and platelets are
recommended for treatment. However, cryoprecipitate is not available
in most European countries, and the efficacy of FFP in correcting
fibrinogen deficiency is limited. We report our experience with human
fibrinogen concentrate (Hemocomplettan®) used to improve impaired
fibrinogen polymerization in children.
METHODS: Results
of routine coagulation tests, thrombelastometry (ROTEM®),
transfusion requirements, administration of fibrinogen concentrate,
and data on the postoperative course of nine consecutive children
undergoing major craniofacial surgery were retrospectively collected
from anesthesia protocols, medical charts, laboratory and ROTEM®
databases.
RESULTS: The
nine children aged 12 (8, 22) mo (median [25th, 75th percentile]),
weighing 9.5 (9, 10) kg had a calculated blood loss of 80 (49, 92)%
of calculated blood volume during the surgery lasting 6.4 (4.5, 7.2)
h. Impaired fibrinogen polymerization detected by ROTEM® was the
main problem underlying dilutional coagulopathy. In all cases,
sufficient hemostasis was achieved without adverse effects by
administering (if necessary), repeated doses of fibrinogen
concentrates (each single dose 30 mg/kg) without FFP or platelet
transfusions. All children were successfully weaned from mechanical
ventilation within a few hours and were able to be discharged early
from the Intensive Care Unit.
CONCLUSIONS: Administration of fibrinogen concentrate effectively improves
fibrinogen polymerization and total clot strength, which were the
main underlying problems of dilutional coagulopathy in children
undergoing craniosynostosis surgery.
多功能衬垫式充气加温系统在近常温的体外循环下心脏外科手术中的效果
An Evaluation of a Full-Access Underbody
Forced-Air Warming System During Near-Normothermic, On-pump Cardiac Surgery
Steven R. Insler, DO*_files/image055.gif){kind=small}
,
Mohamed H. Bakri, MD, PhD_files/image056.gif){kind=small}
,
Fady Nageeb, MD_files/image057.gif){kind=small}
,
Edward Mascha, PhD_files/image058.gif){kind=small}
_files/image060.gif){kind=small}
,
Tomislav Mihaljevic, MD||, and Daniel I. Sessler, MD_files/image061.gif){kind=small}
From the Departments of *Cardiothoracic
Anesthesia, _files/image062.gif){kind=small}
Outcomes
Research, _files/image063.gif){kind=small}
Quantitative
Health Sciences, and ||Cardiovascular Surgery The Cleveland Clinic, Cleveland,
Ohio; and _files/image064.gif){kind=small}
Division
of Anesthesia, Critical Care, and Comprehensive Pain Management, The Cleveland
Clinic, Cleveland, Ohio.
Anesth Analg 2008; 106:746-750
背景：一种新的衬垫式充气加温系统已可用于心脏外科手术。本试验目的是验证在近常温体外循环手术中，标准体温保护联合衬垫式充气加温是否可以维持术中核心温度，减少停机后体温下降（体外循环停止后60min核心温度下降最多）。
方法：常规、非急症心脏外科手术患者随机分为两组：常规体温保护组（输液加温以及消极隔离，n=30）和常规保温联合使用积极的衬垫式充气加温系统（n=30 Arizant Healthcare Model 635, Eden Prairie, 明尼苏达州）。围术期用膀胱导管每15分钟记录核心体温。比较两组CPB前、CPB中及CPB后温度差异。
结果：由于各种原因4例患者数据被剔除，剩余常规处理组29例和充气加温组27例。两组最初温度相似，但充气加温组在体外循环开始时温度高于常规处理组（36.3°C ± 0.6°C比35.7°C ± 0.7°C, P = 0.002）。两组体外循环中最低温度（充气组35.5°C ±
1.5°C比常规组35.3°C
± 1.3°C, P = 0.67）、体外循环结束时体温（36.7°C ± 0.4°C比36.6°C ± 0.4°C, P > 0.99）及出手术室即刻的体温（36.5°C ± 0.4°C比36.2°C ± 0.5°C, P = 0.36）均无差异。后下降两组也无显著差异（充气加温组0.03°C
± 0.54°C比常规组0.21°C
± 0.51°C，P = 0.20）。
结论：在近常温体温管理中加入联合衬垫式充气加温系统能够显著提高体外循环前的体温，但对核心温度无更多的临床重要影响。
（邱郁薇 译 马皓琳
李士通 校）
BACKGROUND: A
new underbody forced-air warming system is available for use during
cardiac surgery. We tested the hypothesis combining underbody
forced-air warming with standard thermal management would maintain
intraoperative core temperature and reduce core temperature
after-drop (largest decrease in core temperature in the 60 min after
bypass) in patients undergoing near-normothermic cardiopulmonary
bypass (CPB).
METHODS: Patients
undergoing routine, nonemergent cardiac surgery were randomly
assigned to routine thermal management (fluid warming and passive
insulation, n = 30) or routine management supplemented
by an active underbody forced-air system (n =
30; Arizant Healthcare Model 635, Eden Prairie, MN). Core body
temperature was measured by bladder catheter at 15-min intervals
during the perioperative period. Comparisons were made between
groups for temperature before, during, and after CPB.
RESULTS: Data
from four patients were excluded for cause, leaving 29 patients in
the routine management group and 27 patients in the forced-air
group. Initial temperatures were similar, but temperatures in the
forced-air group were higher than in the routine group at the start
of CPB (36.3°C ± 0.6°C vs 35.7°C ± 0.7°C, P = 0.002). There were no differences between groups in
the lowest temperatures during CPB (forced air, 35.5°C ± 1.5°C vs
routine, 35.3°C ± 1.3°C, P = 0.67);
the end of CPB (36.7°C ± 0.4°C vs 36.6°C ± 0.4°C, P > 0.99); or the temperature at departure from the
operating room (36.5°C ± 0.4°C vs 36.2°C ± 0.5°C, P = 0.36). After-drop was 0.03°C ± 0.54°C in patients
randomized to underbody forced-air warming and 0.21°C ± 0.51°C in
those assigned to routine management (P = 0.20).
CONCLUSIONS: Adding an underbody forced-air warming system to the
near-normothermic thermal management protocol significantly increased
pre-bypass temperature; however, it had no further clinically
important effect on core temperature.
适用于以麻醉为基础的小儿慢性疼痛医疗方案的病儿群体的临床特点
A Clinical Profile of a Cohort of
Patients Referred to an Anesthesiology-Based Pediatric Chronic Pain Medicine
Program
Thomas R. Vetter, MD, MPH
From the Department of Anesthesia, Riley
Hospital for Children, Indiana University School of Medicine, Indianapolis,
Indiana.
Anesth Analg 2008; 106:786-794
背景：小儿慢性疼痛非常常见，且导致很多医疗费用，是个人和公众都关注的健康问题。本研究的主要目的是为建立一个适用于以麻醉为基础的小儿慢性疼痛治疗方案的病儿的描述性临床轮廓。我们打算将这个病人轮廓充当为需要评估的更正式人群的替代者。
方法：本研究使用定量观察方法。独立研究变量包括初步的疼痛相关诊断、疼痛症状的持续时间、病人年龄、病人性别、保险状态、完整的生物学家系单位、全日制学校出勤率、在家学习及抑郁和/或焦虑共病。用以往研究证实很有效的一系列测量仪表，从属的研究变量包括病人自述的疼痛程度、病人自述或家长代述的健康相关的生活质量、不良家庭影响和父母满意度。研究资料的收集发生于到慢性疼痛医疗诊所初诊时，但和医护人员接触前。
结果：研究对象(n = 100)大多是青少年女性，其慢性疼痛持续时间大于1年，疼痛常伴有临床上明显的焦虑和抑郁。与国家和州立标准比较，生物学家系单位不完整 (P < 0.001)、不能参加全日制学校的学习 (P < 0.001)和需要家居教育(P < 0.001) 的百分比显著不成比例。95%的本群患儿先前至少由一个其他亚专科治疗过其慢性疼痛状况。平均患儿自述或家长代述的健康相关生活质量评分（PedsQL总分）也明显低于以前在风湿病患儿（P < 0.0001）、偏头痛患儿（P < 0.0001）和癌症患儿 (P < 0.0001) 观察到的PedsQL总分值。
结论：患有慢性疼痛的病儿在接受麻醉为基础的慢性疼痛治疗计划之前，大多接受过其他亚专科的治疗，其健康相关的生活质量明显较低。用常规方法估计慢性疼痛患儿健康相关的生活质量非常简便，而且有实际意义。还需要将注意力集中于病儿应对机制的能力的连贯描述、有无使疼痛增强或减轻的父母行为，以及已经存在的父母疼痛和残疾。
（张莹译 马皓琳 李士通校）
BACKGROUND: Pediatric
chronic pain is very common and results in significant health care
costs. Pediatric chronic pain is both an individual and a public
health concern. The primary objective of this study was to generate
a descriptive clinical profile of the patients referred to an
anesthesiology-based pediatric chronic pain medicine program. This
patient profile was intended to serve as a surrogate for a more
formal population needs assessment.
METHODS: A
quantitative observational study design was applied. The independent
study variables included the primary pain-related diagnosis,
duration of pain symptoms, patient age, patient sex, insurance
status, an intact biological family unit, fulltime school
attendance, home schooling, and comorbid depression and/or anxiety.
Using a series of previously well-validated measurement instruments,
the dependent study variables included self-reported chronic pain
intensity, self-reported and parent proxy-reported health-related
quality of life, adverse family impact, and parental satisfaction.
Study data collection occurred at the time of the first visit to the
pediatric chronic pain medicine clinic but before interacting with
any health care provider.
RESULTS: The
enrolled patients (n = 100) were predominantly
adolescent females, whose chronic pain had persisted for >1 yr
and whose pain was frequently accompanied by clinically significant anxiety
and depression. As compared with national and state norms, a
significantly disproportionate percentage had a nonintact biological
family unit (P < 0.001), was not attending
school fulltime (P < 0.001), and
was intentionally being home-schooled (P < 0.001). Ninety-five percent of the present cohort of patients
had previously been under the care of at least one other
subspecialist for their chronic pain condition. The mean initial
patient self-reported and initial parent proxy-reported health-related
quality of life scores (PedsQL Total Score) were also significantly
lower than the PedsQL Total Score values previously observed in
pediatric rheumatology patients (P < 0.0001),
pediatric migraine patients (P < 0.0001), and
pediatric cancer patients (P <
0.0001).
CONCLUSIONS: Pediatric chronic pain patients previously under the care
of another subspecialist and subsequently referred to an
anesthesiology-based pediatric chronic pain medicine program seemed
to be experiencing significantly worse health-related quality of
life. The routine assessment of chronic pain-related pediatric
health-related quality of life seems feasible and worthwhile.
Attention also needs to be focused on consistently addressing the
strength of a patient's coping mechanisms, the presence of
pain-promoting versus pain-reducing parental behaviors, and
preexisting parental pain and disability.
A Comparison of Preoperative Anxiety in
Female Patients with Mothers of Children Undergoing Surgery
Jill MacLaren, PhD*_files/image065.gif){kind=small}
,
and Zeev N. Kain, MD, MBA*_files/image066.gif){kind=small}
_files/image067.gif){kind=small}
From the *Center of the Advancement of
Perioperative Health® and the _files/image068.gif){kind=small}
Departments
of Anesthesiology, Pediatrics, and Child Psychiatry, Yale University School of
Medicine, New Haven, Connecticut and the _files/image069.gif){kind=small}
Depatment
of Anesthesiology, University of California Irvine, Irvine, California.
Anesth Analg 2008; 106:810-813
我们比较了孩子行门诊手术的母亲和自己行手术的女性病人的焦虑。我们发现母亲与行腹部较大手术的病人有相似的焦虑，而与行较小手术的病人相比更为焦虑。母性焦虑的预测因素是孩子的年龄和母性的监护应对。
（彭中美 译 马皓琳
李士通 校）
We compared anxiety in mothers of children
undergoing ambulatory surgery with female patients undergoing
surgery themselves. We found that mothers were as anxious as
patients undergoing major abdominal surgery and more anxious than
patients undergoing minor surgery. Predictors of maternal anxiety
were child age and maternal monitoring coping.
大鼠的肝脏缺血再灌注损伤模型中七氟醚与异氟醚麻醉的肝能量代谢及其不同的保护效应
Hepatic Energy Metabolism and the
Differential Protective Effects of Sevoflurane and Isoflurane Anesthesia in a
Rat Hepatic Ischemia-Reperfusion Injury Model
Nurdan Bedirli, MD*, Ebru
Ofluoglu, PhD_files/image070.gif){kind=small}
,
Mustafa Kerem, MD_files/image071.gif){kind=small}
,
Gulten Utebey, MD*, Murat Alper, MD_files/image072.gif){kind=small}
,
Demet Yilmazer, MD_files/image073.gif){kind=small}
,
Abdulkadir Bedirli, MD_files/image074.gif){kind=small}
,
Onur Ozlu, MD*, and Hatice Pasaoglu, MD_files/image075.gif){kind=small}
From the *Department of Anesthesiology,
Diskapi Training and Research Hospital; Departments of _files/image076.gif){kind=small}
Biochemistry
and _files/image077.gif){kind=small}
General
Surgery, Gazi University Medical School; and _files/image078.gif){kind=small}
Department
of Pathology, Diskapi Training and Research Hospital, Ankara, Turkey.
Anesth Analg 2008; 106:830-837
背景：我们研究了异氟醚和七氟醚对加温的肝缺血再灌注（IR）模型中的细胞因子、肝组织的血流（HTBF）、贮能量及肝脏结构的影响。
方法：将72只Wistar鼠随机分成3组：对照组，不进行吸入麻醉；七氟醚组，2%的七氟醚；异氟醚组，1.5%的异氟醚。在进行吸入麻醉30分钟后，使这些大鼠肝缺血45分钟及2小时和4小时的再灌注。在缺血期末、再灌注2小时、再灌注4小时分别处死一部分鼠。通过检测天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、HTBF、丙二醛、肿瘤坏死因子（TNF）-_files/image079.gif){kind=small}
、白细胞介素(IL)-1β、能荷以及组织学检查来评估肝脏损伤的程度。
结果：对照组和异氟醚组血清丙氨酸转氨酶和天冬氨酸转氨酶的水平相似，而七氟醚组在缺血后阶段明显降低（P < 0.01）。七氟醚组的HTBF显著优于异氟醚组，而对照组较差。组织的丙二醛水平在再灌注2小时后七氟醚组明显低于异氟醚组，而在对照组的缺血后阶段达到最大值。在缺血后、再灌注2小时和4小时中，肿瘤坏死因子-_files/image080.gif){kind=small}
及白细胞介素-1β在七氟醚组最低，在对照组最高，但是没有统计学意义（P
> 0.05）。在七氟醚组，肝的三磷酸腺苷和能荷在所有测量时间点都明显较高。在七氟醚及异氟醚组内，在缺血后阶段的能荷比较低。七氟醚组的肝细胞损伤程度最小。
结论：在肝脏缺血前、缺血时、缺血后给予临床上适当浓度的七氟醚都能很好的保护肝脏免于缺血再灌注损伤，而异氟醚对肝缺血再灌注损伤的效应不是很显著。
（唐亮
译 马皓琳
李士通 校）
BACKGROUND: We
investigated the effects of isoflurane and sevoflurane in a warm
liver ischemia-reperfusion (IR) model on cytokines, hepatic tissue
blood flow (HTBF), energy content, and liver structure.
METHODS: Seventy-two
Wistar rats were randomly assigned into 1 of 3 groups: Control
group, no volatile anesthetics; sevoflurane group, 2% sevoflurane;
isoflurane group, 1.5% isoflurane. Thirty minutes after the start of
volatile anesthetics, rats were subjected to 45 min hepatic ischemia
and 2 and 4 h of reperfusion. Rats were killed at the end of
ischemia, 2 and 4 h of reperfusion. Aspartate aminotransferase and
alanine aminotransferase, HTBF, malondialdehyde, tumor necrosis
factor (TNF)-_files/image081.gif){kind=small}
,
interleukin (IL)-1β, energy charge, and histologic examination were
used to evaluate the extent of liver injury.
RESULTS: Serum
alanine aminotransferase and aspartate aminotransferase levels were
similar in control and isoflurane groups while there was a
significant decrease in the sevoflurane group in the postischemic period
(P < 0.01). HTBF was remarkably better in the
sevoflurane group than in the isoflurane group and worse in the control
group. Tissue malondialdehyde levels were significantly low in
the sevoflurane group compared with the isoflurane group at 2 h of
reperfusion (P < 0.05) and reached its
maximum value in the postischemic period in the control group. After
ischemia, 2 and 4 h of reperfusion, tumor necrosis factor-_files/image082.gif){kind=small}
and interleukin-1β values were lowest in the sevoflurane group and
highest in the control group but it was not statistically significant
(P > 0.05). In the sevoflurane group, hepatic
adenosine triphosphate and energy charge were significantly high
at all measurement times. At the postischemic period, energy charge
was lower compared with the sevoflurane and isoflurane groups. The
degree of hepatocyte injury was small in the sevoflurane group.
CONCLUSIONS: Clinically relevant concentrations of sevoflurane given
before, during, and after hepatic ischemia protected the liver
against IR injury, whereas the effects of isoflurane on hepatic IR
injury were not notable.
高血糖减弱异氟烷在血管平滑肌细胞中诱导的ATP敏感的钾通道激活作用
Hyperglycemia Impairs Isoflurane-Induced
Adenosine Triphosphate-Sensitive Potassium Channel Activation in Vascular
Smooth Muscle Cells
Takashi Kawano, MD*, Katsuya
Tanaka, MD*, Kazuaki Mawatari, PhD_files/image083.gif){kind=small}
,
Shuzo Oshita, MD*, Akira Takahashi, MD_files/image084.gif){kind=small}
,
and Yutaka Nakaya, MD_files/image085.gif){kind=small}
From the Departments of *Anesthesiology,
Tokushima University School of Medicine, and _files/image086.gif){kind=small}
Nutrition
and Metabolism, Institute of Health Biosciences, Tokushima University School of
Medicine, Tokushima, Japan.
Anesth Analg 2008; 106:858-864
背景：异氟烷激活血管ATP敏感钾（ＫATP）通道，并可引起血管扩张。本研究中，我们探讨高血糖是否改变异氟烷对血管ＫATP通道的激活作用。
方法：血管平滑肌细胞分别在含正常葡萄糖(NG, 5.5 mM右旋糖)、l-葡萄糖(LG, 5.5 mM右旋糖加 17.5 mM 左旋糖)或高葡萄糖(HG, 23 mM右旋糖)的培养基中孵育24ｈ后，我们使用细胞粘附式的膜片钳方法测试异氟烷对ＫATP通道活性的影响。主动脉中的过氧化物水平通过光泽精增强的化学发光技术进行测定。
结果：与NG（0.17 ± 0.02）和LG（0.15 ± 0.02）相比，HG（0.06 ± 0.01）孵育的动脉血管平滑肌细胞中异氟烷诱导的开放概率明显减少（P 均< 0.05）。蛋白激酶C（PKC）的抑制剂（钙磷酸蛋白C和PKC抑制剂20–28）预处理血管平滑肌细胞明显减少HG对异氟烷诱导ＫATP通道活性的抑制作用。同时，PKC的激活剂PMA可模拟HG的作用。HG孵育的动脉中过氧化物释放明显增加（18.3 ± 11.5相对光单位（RLU）· s–1 · mg–1;
与NG比较P < 0.05）。用一种细胞渗透性过氧化物清除剂聚乙烯乙二醇－过氧化物歧化酶（250 U/mL）同时孵育，显著减少HG诱导的过氧化物的增加，但无法减少HG对异氟烷诱导ＫATP通道活性的抑制作用。
结论：我们的实验结果提示高血糖的代谢性应激可以削弱异氟烷诱导的血管KATP通道激活作用（经过度激活PKC介导）。在围术期高血糖患者中，这可能妨碍其冠状动脉对异氟烷的舒张反应从而导致缺血或缺氧。
（黄施伟 译，马皓琳 李士通 校）
BACKGROUND: Isoflurane
activates vascular adenosine triphosphate sensitive potassium (KATP)
channels, and may induce vasodilation. In the present study, we
investigated whether hyperglycemia modifies isoflurane activation of
vascular KATP channel.
METHODS: We
used a cell-attached patch-clamp configuration to test the effects
of isoflurane on KATP channel activity in vascular smooth
muscle cells (VSMCs) after incubation for 24 h in medium containing
normal glucose (NG, 5.5 mM d-glucose), l-glucose (LG, 5.5 mM
d-glucose plus 17.5 mM l-glucose), or high glucose (HG, 23 mM
d-glucose). Superoxide levels in aortas were measured by the
lucigenin-enhanced chemiluminescence technique.
RESULTS: Isoflurane-induced
open probabilities were significantly reduced in VSMCs from arteries
incubated in HG (0.06 ± 0.01) compared with NG (0.17 ± 0.02; P < 0.05) and LG (0.15 ± 0.02; P < 0.05). Pretreatment of VSMCs with protein kinase C
(PKC) inhibitors, calphostin C and PKC inhibitor 20–28, greatly
reduced HG inhibition of isoflurane-induced KATP channel
activity. In addition, a PKC activator, PMA, mimicked the effects of
HG. Superoxide release was significantly increased in arteries
incubated in HG (18.3 ± 11.5 relative light units (RLU) · s–1
· mg–1; P < 0.05 versus
NG). Coincubated with polyethylene glycol-superoxide dismutase (250
U/mL), a cell-permeable superoxide scavenger, greatly reduced the
HG-induced increase of superoxide, but failed to reduce HG
inhibition of isoflurane-induced KATP channel activity.
CONCLUSIONS: Our results suggest that the metabolic stress of
hyperglycemia can impair isoflurane-induced vascular KATP channel
activity mediated by excessive activation of PKC. This could impede
the coronary vasodilation response to isoflurane, causing ischemia
or hypoxia in patients with perioperative hyperglycemia.
志愿者中光谱熵预测听觉知晓
Spectral Entropy Predicts Auditory
Recall in Volunteers
Daryn H. Moller, MD, and Ira J. Rampil, MS,
MD
From the Departments of Anesthesiology and
Neurological Surgery, University Hospital, Stony Brook, New York.
Anesth Analg 2008; 106:873-879
背景资料：从一个病人的角度看，术中记忆丧失是全麻的一个重要部分。在没有特异性的方法来减少术中知晓的情况下，其发生率在普外科手术人群中约为0.2%，且可能在某些亚人群中会更高。我们尝试检验了一种新的以光谱熵为基础的临床脑电图监测仪预测知晓的有效性。
方法：我们用非盲交叉设计对16名志愿者进行研究，来评价丙泊酚或七氟醚镇静过程中，光谱熵与行为指标之间的相关性。我们考虑到的指标包括单词知晓和对于口头指令的运动反应。同时我们测定了口头指令对脑电图熵的刺激性作用。用对数回归、受试者操作特性以及预计概率来分析数据。
结果：状态熵和反应熵与两个反应指标均密切相关。在多种情况下这些参数的预计概率范围在0.85到0.96之间。口头指令运动反应以剂量和药物依赖性方式增高熵。
结论：在这群年轻健康的志愿者中熵参数看来是预测知晓的可靠指标。这些研究结果认为将这些研究延伸到其他麻醉药和手术病人是合理的。
（沈浩 译 马皓琳 李士通 校）
BACKGROUND: From
a patient's perspective, intraoperative amnesia is an essential
component of general anesthesia. Without specific strategies to
reduce recall, its incidence is approximately 0.2% in the general
surgical population and may be higher in certain subpopulations. We
sought to test the validity for predicting recall of a new spectral
entropy-based clinical electroencephalogram monitor.
METHODS: We
studied 16 volunteers in an unblinded crossover design to assess the
correlation of entropy values with behavioral end points during
sedation with either propofol or sevoflurane. The end points we
considered included word recall, and motor response to verbal
command. We also examined the stimulatory effect of verbal commands
on electroencephalogram entropy. Logistic regression, receiver
operating characteristics, and prediction probability were used to
analyze the data.
RESULTS: Both
State Entropy and Response Entropy were closely correlated with both
behavioral end points. The prediction probability of these
parameters under a variety of conditions ranged from 0.85 to 0.96.
Verbal command to move increased entropy in a dose and
drug-dependent fashion.
CONCLUSIONS: Entropy parameters in this group of young, healthy volunteers
appear to be reliable predictors of recall. These results justify
extending these studies to additional anesthetics and to surgical
patients.
The Effect of Maternal Catecholamines on
the Caliber of Gravid Uterine Microvessels
Scott Segal, MD, and Steven Y. Wang, MD,
PhD
From the Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical
School, Boston, Massachusetts.
Anesth Analg 2008; 106:888-892
背景：伴随着分娩镇痛起效的母体儿茶酚胺改变包括肾上腺素（EPI）减少，但是去甲肾上腺素(NE)不变。因为在循环浓度中EPI以β肾上腺能作用为主，而NE以α肾上腺能作用为主，因此我们推断这样的改变会引起子宫小动脉的收缩。
方法：从18只临产Sprague-Dawley大鼠中分离出来的子宫微血管（内径73–120 µm），在保持近于正常气压的无流量状态下用电镜观察。腔外给药到表面灌流储水池，并记录血管稳态下的内径。分别建立NE及NE中加入肾上腺素能拮抗剂哌唑嗪、EPI（类血栓素U46619预收缩血管20%－30％后）及EPI中加入β肾上腺素能拮抗剂普萘洛尔和10–8
M EPI存在时给予NE的剂量效应曲线。洗出试验模拟分娩镇痛起效过程中母体儿茶酚胺的变化：同时加入10–8 M的EPI 和10–6.5 M的NE (EC50)，然后只用NE洗，接着用β2肾上腺素能激动剂特布他林和NE。洗出规程在有普萘洛尔存在的情况下再重复一遍。
结果：NE引起剂量依赖性的血管收缩(P < 0.0001)，可以被哌唑嗪阻断(P < 0.0001)。EPI加到经过U46619预收缩的微血管后，在低浓度时可以引起血管扩张，高浓度时引起血管收缩(P < 0.0001)。普萘洛尔可以逆转这种单相的剂量依赖性血管收缩反应(P < 0.0001)。用10–8 M EPI预处理没有经过预收缩的血管，可以显著减弱NE引起的血管收缩作用(P < 0.0001)。在洗出试验中，在NE持续存在的情况下，除出EPI可以引起血管收缩，且这种收缩作用可以被特布他林逆转。普萘洛尔可以阻断EPI和特布他林的作用。
结论：这些结果表明，EPI在产妇血浆中发现的浓度下可以扩张子宫阻力血管，并减弱由NE引起的血管收缩作用。这个观察结果可能提示了人类孕妇分娩镇痛起效时伴随的子宫血流变化，因为有效的镇痛伴随着循环EPI水平的急性下降。
（黄佳佳译，马皓琳 李士通校）
BACKGROUND: Changes
in maternal catecholamines that accompany the onset of labor
analgesia include a decrease in epinephrine (EPI) but no change in
norepinephrine (NE). Because EPI exerts predominantly β-adrenergic,
and NE predominantly _files/image087.gif){kind=small}
-adrenergic
effects in circulating concentrations, we hypothesized that these
changes could lead to uterine arteriole vasoconstriction.
METHODS: Uterine
microvessels (73–120 µm internal diameter, n = 18) were harvested from near-term pregnant Sprague-Dawley rats,
isolated and studied in a pressurized no-flow state with video
microscopy. Drugs were applied extraluminally to the superfusion reservoir
and the steady-state vessel diameter recorded. Dose-response curves
were constructed for NE with and without the addition of the _files/image088.gif){kind=small}
-adrenergic
antagonist prazosin, EPI (after 20%–30% preconstruction with the
thromboxane analog U46619) with and without the addition of the
β-adrenergic antagonist propranolol, and NE in the presence of 10–8
M EPI. Washout experiments modeled the changes in circulating
maternal catecholamines observed during onset of analgesia: 10–8
M EPI and 10–6.5 M of NE (the EC50) were added
simultaneously, then washed with NE only, and then with the β2-adrenergic
agonist terbutaline and NE. The washout protocol was repeated in the
presence of propranolol.
RESULTS: NE
caused dose-dependent vasoconstriction (P <
0.0001), which was blocked by prazosin (P
< 0.0001). EPI, added to U46619-preconstricted microvessels,
caused vasodilation at lower concentrations and vasoconstriction at
higher doses (P < 0.0001).
Propranolol converted this response to monophasic dose-dependent
vasoconstriction (P < 0.0001). Pretreatment
of nonprecontracted vessels with EPI, 10–8 M, significantly
attenuated NE-induced vasoconstriction (P
< 0.0001). In washout experiments, removal of EPI with continued
presence of NE resulted in vasoconstriction that was reversed by
terbutaline. Propranolol blocked the effect of both EPI and
terbutaline.
CONCLUSIONS: The results demonstrate that EPI, in concentrations found
in the plasma of laboring women, vasodilates uterine resistance vessels
and attenuates NE-induced vasoconstriction. This observation may
have implications for changes in uterine blood flow that may
accompany the onset of labor analgesia in human parturients, as
effective analgesia is accompanied by an acute decrease in circulating
EPI levels.
The Effects of Transient Cerebral
Ischemia on Vasopressin-Induced Vasoconstriction in Rabbit Cerebral Vessels
Masahiko Kumazawa, MD*, Hiroki
Iida, MD*, Masayoshi Uchida, MD_files/image089.gif){kind=small}
,
Mami Iida, MD_files/image090.gif){kind=small}
,
Motoyasu Takenaka, MD*, Naokazu Fukuoka, MD*, Tomohiro
Michino, MD*, and Shuji Dohi, MD*
From the *Department of Anesthesiology and
Pain Medicine, Gifu University Graduate School of Medicine, Gifu City, Gifu,
Japan; _files/image091.gif){kind=small}
Department
of Anesthesiology and Critical Medicine, Oregon Health and Science University,
Portland, Oregon; and _files/image092.gif){kind=small}
Department
of Cardiology, Gifu University Graduate School of Medicine; Gifu City, Gifu,
Japan.
Anesth Analg 2008; 106:910-915
背景：加压素是一种心肺复苏时选用的药物，因为一些实验研究已显示，其在增加全身组织的灌注压和改善脑灌注压且不增加心肌氧耗方面优于肾上腺素。我们使用软膜窗孔制品，观察加压素局部用于兔软膜血管上时的作用及兔脑缺血后作用是否改变(n = 27)。
方法：我们首先检验局部应用精氨酸加压素(AVP) (10–11
M、10–9
M、10–7
M及10–5
M，连续地)的作用。然后我们通过颈部驱血带充气加全身性低血压，或单纯全身性低血压导致脑缺血5分钟，并观察脑缺血前后局部应用AVP(10–9 M及10–7 M, 连续地)的作用。
结果：(a)10–11 M AVP可扩张软膜小动脉的直径[7% ± 11% (P = 0.014 与基础值比较)]，但10–9
M、10–7
M及10–5
M AVP可收缩软膜小动脉直径[分别为7% ± 14%、20% ± 14%及16% ± 16% (P 均<
0.05)]，(b)低血压前可收缩软膜小动脉直径(10–9
M AVP 收缩7% ±
10%, 10–7 M AVP收缩20% ± 15%)，缺血前可收缩软膜小动脉直径(10–9 M AVP 收缩7% ± 11%，10–7 M AVP 收缩21% ± 15% )。然而，缺血后5分钟，由10–7 M AVP引起的血管收缩作用明显下降，但不单是由于低血压[低血压对照组：10–9 M AVP 收缩7% ± 10%，10–7 M AVP 收缩19% ± 14%；缺血组：10–9 M AVP 收缩5% ± 11%，10–7 M AVP 收缩10% ± 13%(P = 0.35 与低血压组对照)]。
结论：AVP的局部应用（这里使用的最低浓度除外）可引起麻醉兔软膜小动脉浓度依赖性血管收缩。在短暂（5分钟）的脑缺血后，10–7 M AVP的血管收缩作用减少。
（裘毅敏译，马皓琳 李士通校）
BACKGROUND: Vasopressin
is a drug of choice for use during cardiopulmonary resuscitation
because several experimental studies have shown that it is better
than epinephrine at increasing systemic perfusion pressure and
improving cerebral perfusion pressure without increasing myocardial
oxygen consumption. We used a pial window preparation to determine
the effects of vasopressin when applied topically to pial vessels
and whether any effects were altered after cerebral ischemia in
rabbits (n = 27).
METHODS: We
first examined the effects of topical application of
arginine-vasopressin (AVP) (10–11 M, 10–9 M, 10–7
M, and 10–5 M, sequentially). We then examined the
effects of topical application of AVP (10–9 M and 10–7
M, sequentially) before and after a 5-min intervention consisting of
cerebral ischemia produced by inflation of a neck tourniquet plus
systemic hypotension or systemic hypotension alone.
RESULTS: Pial
arteriolar diameters were (a) dilated by 10–11 M AVP [7% ± 11% (P = 0.014 versus baseline)], but constricted by 10–9
M, 10–7 M, and 10–5 M AVP [7% ± 14%, 20% ±
14%, and 16% ± 16% (each P < 0.05), respectively],
and (b) constricted before hypotension (7% ± 10% at 10–9
M, 20% ± 15% at 10–7 M) or ischemia (7% ± 11% at 10–9
M, 21% ± 15% at 10–7 M). However, after the 5-min of ischemia, the
decrease in diameter induced by 10–7 M AVP was
significantly reduced but not by hypotension alone [hypotension
control group: 7% ± 10% at 10–9 M, 19% ± 14% at 10–7
M; ischemia group: 5% ± 11% at 10–9 M, 10% ± 13% at 10–7
M (P = 0.35 versus hypotension control)].
CONCLUSIONS: Topical application of AVP (except at the lowest concentration
used here) induced concentration-dependent vasoconstriction of pial
arterioles in anesthetized rabbits. The vasoconstrictor effect of 10–7
M AVP was reduced after transient (5-min) cerebral ischemia.
在接受异丙酚复合芬太尼麻醉的患者中神经肌肉阻滞水平对强直后运动诱发电位的幅度和经颅刺激的运动反应的影响
The Effects of the Neuromuscular
Blockade Levels on Amplitudes of Posttetanic Motor-Evoked Potentials and
Movement in Response to Transcranial Stimulation in Patients Receiving Propofol
and Fentanyl Anesthesia
Yuri Yamamoto, MD*, Masahiko
Kawaguchi, MD*, Hironobu Hayashi, MD*, Toshinori
Horiuchi, MD*, Satoki Inoue, MD*, Hiroyuki Nakase, MD_files/image093.gif){kind=small}
,
Toshisuke Sakaki, MD_files/image094.gif){kind=small}
,
and Hitoshi Furuya, MD*
From the Departments of *Anesthesiology and
_files/image095.gif){kind=small}
Neurosurgery,
Nara Medical University, Nara, Japan.
Anesth Analg 2008; 106:930-934
背景：监测肌源性运动诱发电位（MEPs）过程中患者对经颅刺激的活动反应可能干扰手术。我们最近报道了一种可以增强肌源性MEPs幅度的新技术叫做“强直后MEPs(p-MEPs)”，该技术在经颅刺激前给予外周神经强直刺激。我们进行本研究来确定集中于患者运动的p-MEPs监测中神经肌肉阻滞的适当水平。
方法：15名异丙酚/芬太尼麻醉患者，记录拇展肌对经颅电刺激反应的传统MEPs
(c-MEPs)和p-MEPs。记录p-MEPs时，在经颅刺激前6秒先给予胫后神经一个50mA强度、持续5秒的强直刺激。通过记录对腕部正中神经超强电刺激的反应中的拇外展短肌复合肌肉动作电位(T1)的幅度来评估神经肌肉阻滞的水平。记录T1为对照值的50％时的c-MEP和p-MEP基线后，注射0.1 mg/kg维库溴铵并记录c-MEPs和p-MEPs幅度。用范围为1到4的运动评分评估患者运动（1=没有运动，4＝剧烈运动）。
结果：T1、%T1、c-MEPs和p-MEPs的幅度及运动评分在给予维库溴铵后平行改变。在维库溴铵投药前和投药后15－45分钟p-MEPs的幅度比c-MEPs明显高。当T1和％T1分别小于和等于1mV和10％时，所有患者的运动评分为1或2，提示显微镜手术是能做得到的，而不会干扰手术操作。当T1在1 mV (0.8–1.2 mV)左右时，记录c-MEPs和p-MEPs的成功率分别是73% (11/15)和100% (15/15)。
结论：异丙酚/芬太尼麻醉下，T1为1mV时可以记录p-MEP，这时患者对经颅刺激的运动反应不会干扰手术。这种技术可以用于不存在术前运动缺陷的患者，否则在手术操作中的患者运动不太可取。
（唐李隽 译 马皓琳
李士通校）
BACKGROUND: Patient
movement in response to transcranial stimulation during monitoring
of myogenic motor-evoked potentials (MEPs) may interfere with
surgery. We recently reported a new technique to augment the
amplitudes of myogenic MEPs, called "post-tetanic MEPs
(p-MEPs)," in which tetanic stimulation of a peripheral nerve
was applied prior to transcranial stimulation. We conducted the
present study to determine an appropriate level of neuromuscular blockade
during the monitoring of p-MEPs with a focus on patient movement.
METHODS: In
15 patients under propofol/fentanyl anesthesia, conventional MEPs
(c-MEPs) and p-MEPs in response to transcranial electrical
stimulation were recorded from the abductor hallucis muscle. For
p-MEP recording, tetanic stimulation to the posterior tibial nerve
at an intensity of 50 mA for 5 s was started 6 s prior to
transcranial stimulation. The level of neuromuscular blockade was
assessed by recording the amplitude of compound muscle action
potentials (T1) from the abductor hallucis brevis muscle in response
to supramaximal electrical stimulation of the median nerve at the
wrist. After the baseline recordings of c-MEP and p-MEP at a T1 of
50% of control, 0.1 mg/kg of vecuronium was injected and the
amplitudes of c-MEPs and p-MEPs were recorded. Patient movement was
also assessed with the movement score ranging from 1 to 4 (1 = no
movement, 4 = severe movement).
RESULTS: T1,
%T1, the amplitudes of c-MEPs and p-MEPs, and the movement score
changed in parallel after the administration of vecuronium. The
amplitudes of p-MEPs before and 15–45 min after the administration
of vecuronium were significantly higher than those of c-MEPs. When
T1 and %T1 were less than and equal to 1 mV and 10%, respectively,
the movement score was 1 or 2 in all patients, indicating that
microscopic surgery was possible without the interruption of
surgical procedures. When T1 was around 1 mV (0.8–1.2 mV), the
success rates of recording of c-MEPs and p-MEPs were 73% (11 of 15)
and 100% (15 of 15), respectively.
CONCLUSIONS: Under propofol/fentanyl anesthesia, p-MEP could be
recorded at a T1 of 1 mV, in which patient movement in response to
transcranial stimulation did not interfere with surgery. This
technique may be used in patients without preoperative motor
deficits, in which patient movement during surgical procedures is
not preferable.
塞来考昔围手术期给药与仅仅在术后给药对接受大的整形外科手术病人术后影响的比较
Perioperative Versus Postoperative
Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures
Tiffany Sun, BS*_files/image096.gif){kind=small}
,
Ozlem Sacan, MD*_files/image097.gif){kind=small}
,
Paul F. White, PhD, MD, FANZCA*_files/image098.gif){kind=small}
,
Jayne Coleman, MD*_files/image099.gif){kind=small}
,
Rod J. Rohrich, MD, FACS*_files/image100.gif){kind=small}
,
and Jeffrey M. Kenkel, MD, FACS*_files/image101.gif){kind=small}
From the Departments of *Anesthesiology and
Pain Management, and _files/image102.gif){kind=small}
Plastic
Surgery; University of Texas Southwestern Medical Center at Dallas, Dallas,
Texas.
Anesth Analg 2008; 106:950-958
背景：围手术期应用环氧合酶(COX)-2抑制剂一直有着争议。有一种假设是在大整形手术的术前或者术后应用塞来考昔并且在手术后连续应用三天能提高病人镇痛效果以及改善临床预后，我们设计这次随机、双盲、安慰剂对照实验的目的就是为了证明这一假设。这次实验的另外一个目的是为了弄清围手术期应用塞来考昔是否比单单在术后应用更有优势。
方法：120名接受大的整形外科手术（比如隆胸，腹壁成形术）的知情同意过的病人施行标准全身麻醉，被随机分成了下面三组：1）对照组（n=40）术前和术后分别口服两粒安慰剂，并且在术后三天口服安慰剂，一粒BID；2）术后给药组（n=40）术前口服两粒安慰剂，术后口服两粒塞来考昔（一粒200mg），术后三天口服塞来考昔，一粒200mg BID；3）围手术期给药组（n=40）术前30－90分钟口服两粒塞来考昔（一粒200mg），术后口服两粒安慰剂，术后三天口服塞来考昔，一粒200mg BID。术后每隔一定时间记录下患者的疼痛评分、对镇痛药的需求以及不良反应。在手术后的第24、48、72小时以及第七天随访评价患者的出院后疼痛、镇痛需求、肠功能的恢复、日常活动的恢复、康复的质量以及病人对疼痛控制的满意程度。
结果：与对照组相比，应用塞来考昔的两组在术后首个三天在减少术后疼痛以及对阿片类镇痛药的需求上有着相似且明显的效果(P < 0.01)。在应用塞来考昔的两组中，病人肠功能和日常活动的恢复时间分别比对照组早1天和2天。另外，在应用塞来考昔的两组中，病人对疼痛控制和康复质量的满意度明显比对照组提高(P < 0.05)。
结论：手术当天以及术后三天口服塞来考昔400mg能有效改善大的整形外科手术病人术后的控制疼痛以及康复速度和质量。然而，围手术期给药与仅仅在术后给药相比并没有优势。
（吴进 译 马皓琳 李士通 校）
BACKGROUND: Controversy
continues to surround the use of cyclooxygenase (COX)-2 inhibitors
in the perioperative period. We designed this randomized,
double-blind, placebo-controlled study to examine the hypothesis
that administration of celecoxib preoperatively or postoperatively
and for 3 days after major plastic surgery would improve pain
control and clinically important patient outcomes. Another objective
of the study was to determine whether perioperative administration
of celecoxib offered any advantages over postoperative
administration alone.
METHODS: One
hundred and twenty healthy consenting patients undergoing major
plastic surgery (e.g., breast augmentation, abdominoplasty procedures)
using a standardized general anesthetic technique were randomized to
one of three treatment groups: 1) control group (n = 40) received two placebos orally before and after
surgery, as well as one placebo BID for 3 days after surgery; 2)
postoperative group (n = 40) received two
placebos before surgery and 2 celecoxib 200 mg po after surgery,
followed by one celecoxib 200 mg po BID on postoperative day #1, #2
and #3; and 3) perioperative group (n
= 40) received 2 celecoxib 200 mg po 30–90 min before surgery, and
two placebos after surgery, followed by one celecoxib 200 mg po BID
on postoperative day #1, #2, and #3. Pain scores, the need for
rescue analgesics, and side effects were recorded at specific time
intervals in the postoperative period. Follow-up evaluations were
performed at 24, 48, 72 h, and 7 days after surgery to assess
postdischarge pain, analgesic requirements, return of bowel
function, resumption of normal daily activities, quality of
recovery, as well as patient satisfaction with pain management.
RESULTS: Compared
with the control group, the two celecoxib groups had similar
significant reductions in postoperative pain and need for opioid
analgesics during the first three postoperative days (P < 0.01). Patients recovered bowel function 1 day earlier
and resumed normal activities 2 days earlier in the celecoxib
groups. In addition, patient satisfaction with pain management and
quality of recovery were significantly improved in the celecoxib
(versus control) groups (P < 0.05).
CONCLUSION: Celecoxib
(400 mg po) administered on the day of surgery and for 3 days
postoperatively is effective in improving postoperative pain
management, as well as the speed and quality of recovery after major
plastic surgery. However, perioperative administration offers no
advantages over simply giving the drug after surgery.
鞘内注射环氧化酶-1抑制剂、环氧化酶-2抑制剂或非选择性抑制剂对疼痛行为和脊髓Fos样免疫反应的影响
The Effects of Intrathecal
Cyclooxygenase-1, Cyclooxygenase-2, or Nonselective Inhibitors on Pain Behavior
and Spinal Fos-Like Immunoreactivity
Il Ok Lee, MD, PhD, and Youngsun Seo, MD,
PhD
From the Departments of Anesthesiology and
Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
Anesth Analg 2008; 106:972-977
背景：前列腺素由环氧化酶（COX）合成，被认为在伤害性感受在脊髓的传递中起重要作用。Fos的表达是脊髓神经元活化的指标。我们检验了鞘内注射选择性和非选择性COX抑制剂对脊髓C-Fos表达的影响。
方法：为检验COX-1和COX-2在脊髓伤害性感受传递中的相对作用，我们检测了选择性COX-1抑制剂SC560、选择性COX-2抑制剂塞来考昔和非选择性COX抑制剂酮咯酸对福尔马林诱发的行为和脊髓类c-Fos免疫反应（FLI）的影响。大鼠在后爪足底皮下注射福尔马林（5%，50μL）前分别鞘内注射上述药物（30、60或90µg）。对照组在注射福尔马林前鞘内注射溶剂。
结果：给予塞来考昔或酮咯酸90µg的大鼠第一相缩爪行为减少，给予各剂量酮咯酸或90µg塞来考昔的大鼠第二相缩爪行为减少（P < 0.05）。给予塞来考昔或酮咯酸90µg的大鼠脊髓第I–II层区FLI明显减少（P < 0.05）。相反，在脊髓第V–VI层区仅酮咯酸60µg或90µg组出现FLI的大量减少（P < 0.05）。在脊髓第V–VI层区的FLI表达与第二相缩爪行为有显著相关性（(P < 0.05)。
结论：COX-1和COX-2的双效抑制剂既抑制福尔马林诱发的行为也抑制脊髓腰段各区FLI表达。FLI在脊髓第I–II层区的表达可能不是药物产生抗-超敏反应能力的良好指标，而FLI在脊髓第V–VI层区的表达与第二相行为反应相关。
（颜涛
译，马皓琳 李士通
校）
BACKGROUND: Prostaglandins
are synthesized by cyclooxygenase (COX) and are thought to play an
important role in nociceptive transmission in the spinal cord. Fos
expression is an indicator of spinal neuron activation. We examined
the role of intrathecal selective and nonspecific COX inhibitors on
spinal C-Fos expression.
METHODS: To
evaluate the relative contribution of COX-1 and COX-2 in nociceptive
transmission in the spinal cord, we assessed the effects of the
selective COX-1 inhibitor SC 560, the selective COX-2 inhibitor celecoxib,
and the nonselective COX inhibitor ketorolac on formalin-evoked
behavior and spinal c-Fos-like immunoreactivity (FLI). Rats received
each of the drugs (30, 60, or 90 µg) intrathecally before the
subcutaneous administration of formalin (5%, 50 µL) to the plantar
surface of a hindpaw. The control group received vehicle
intrathecally before the administration of formalin.
RESULTS: Phase
1 flinching behavior decreased in rats given celecoxib or ketorolac
90 µg. Phase 2 flinching behavior decreased in rats given all doses
of ketorolac or celecoxib 90 µg (P
< 0.05). The FLI was significantly reduced in rats given
celecoxib or ketorolac 90 µg for laminae I–II (P < 0.05). By contrast, for laminae V–VI, only the
ketorolac 60 or 90 µg treatment group demonstrated a larger decrease
in FLI (P < 0.05). The FLI expression in
laminae V–VI had a significant correlation with phase 2
flinching behavior (P < 0.05).
CONCLUSIONS: A dual inhibitor of COX-1 and COX-2 suppressed both
responses of formalin-evoked behaviors and FLI expression of whole
laminae in the lumbar spinal cord. FLI expression of laminae I–II
alone may not be a good indicator of the ability to produce
anti-hypersensitivity; however, the FLI of laminae V–VI correlates
with phase 2 responses.
患者自控持续斜角肌间沟阻滞能促进开放性肩部手术后的早期功能康复吗？
Does Patient-Controlled Continuous
Interscalene Block Improve Early Functional Rehabilitation After Open Shoulder
Surgery?
Klaus
Hofmann-Kiefer, MD*, Tim Eiser, MD*, Daniel Chappell, MD*,
Stephan Leuschner, MD_files/image103.gif){kind=small}
, Peter Conzen, MD*, and Dirk
Schwender, MD_files/image104.gif){kind=small}
From the *Clinic of Anesthesiology/Critical
Care Medicine and Pain Therapy (M.A.B., P.C.), Ludwig-Maximilians-University,
City of Munich, Germany; _files/image105.gif){kind=small}
Department
of Anesthesia, Municipal Hospital Friedrichshafen, City of Friedrichshafen,
Germany; and _files/image106.gif){kind=small}
Department
of Anesthesia, Municipal Hospital Luebeck, City of Luebeck, Germany.
Anesth Analg 2008; 106:991-996
背景：肩部手术后早日活动在成功的功能康复中起重要作用。然而，术后疼痛常减少甚至妨碍有效的物理治疗。我们研究了开放性肩部手术后由患者自控斜角肌间沟阻滞技术产生的镇痛对早期功能康复的影响。
方法：87例患者随机分成两组：患者自控持续斜角肌间沟阻滞组（patient-controlled continuous interscalene block ，PCISB）和患者自控静脉（阿片类）镇痛组（patient-controlled
analgesia，PCA）。术前行斜角肌间沟阻滞，另外镇痛方案在麻醉后监护室中开始进行并持续72小时。术后第2、3天每天进行60min标准化物理治疗。最大活动度被定义为在疼痛这个限制因素下所能达到的活动范围。在术前1天和术后3天用能评估疼痛、日常生活活动、运动的力度和范围的多模式评分系统（常数评分）来评价功能康复的效果。还通过术后72h和院内物理治疗过程中的视觉模拟评分来监测最大疼痛强度。
结果：斜角肌间沟阻滞的常数评分等级显著提高。然而，两组间可动性和力量亚评分无显著差异。与PCA比较，6h（P < 0.001）、24h （P = 0.044）和72h（ P = 0.013）时的静息疼痛评分以及术后48h时物理治疗过程中的疼痛评分(P = 0.016) 证明PCISB更有效。
结论：与基于阿片类的PCA比较，PCISB改善镇痛，但不促进肩关节早期功能恢复。
（朱 慧译 马皓琳
李士通校）
BACKGROUND: Early
mobilization after shoulder surgery plays a vital role in successful
functional rehabilitation. However, postoperative pain often
reduces, or even prevents, effective physiotherapy. We investigated
the effect of analgesia via patient-controlled interscalene
technique on early functional rehabilitation after open shoulder
surgery.
METHODS: Eighty-seven
patients were randomly assigned to one of two groups:
patient-controlled continuous interscalene block (PCISB) and
patient-controlled IV (opioid) analgesia (PCA). Interscalene block
was performed preoperatively; otherwise analgesic protocols were
started in the postanesthesia care unit and were continued for 72 h.
Physiotherapy was performed for 60 min a day on day 2 and 3 after
surgery according to a standardized protocol. Maximum mobility was
defined as the range of motion that could be achieved with pain as
the limiting factor. Efficiency of functional rehabilitation was
evaluated 1 day before and 3 days after surgery with the help of a
multimodal scoring system (Constant-Score) that evaluates pain,
daily life activity, strength and range of motion. Maximum intensity
of pain was also monitored via Visual Analog Scales for the first 72
h after surgery and during in-hospital physiotherapy.
RESULTS: Constant-Score
rates were significantly improved by the interscalene block.
However, no significant differences in mobility and strength
sub-scores were observed between the groups. Compared with PCA,
PCISB proved to be beneficial concerning pain at rest at 6 h (P < 0.001), 24 h (P = 0.044), and
72 h (P = 0.013) and for pain during
physiotherapy at 48 h after surgery (P = 0.016).
CONCLUSION: Compared
with opioid-based PCA, PCISB improved analgesia, but not function,
during early rehabilitation of the shoulder joint.
Vasoconstriction and Analgesic Efficacy
of Locally Infiltrated Levobupivacaine for Nasal Surgery
Yavuz Demiraran, MD*, Ozcan
Ozturk, MD_files/image107.gif){kind=small}
,
Ender Guclu, MD_files/image108.gif){kind=small}
,
Abdulkadir Iskender, MD*, Mehmet Hakan Ergin, MD*, and
Abdurahman Tokmak, MD_files/image109.gif){kind=small}
From the Departments of *Anesthesiology,
and _files/image110.gif){kind=small}
Otorhinolaryngology,
University of Duzce, Duzce Faculty of Medicine, Duzce, Turkey.
Anesth Analg 2008; 106:1008-1011
背景：在此项研究中，我们比较了切皮前给予行鼻部手术的病人2%利多卡因加肾上腺素（LA）和单纯0.25%左旋布比卡因（LB）以术后镇痛和收缩血管。
方法：60例病人随机分组，接受全麻下切皮前局部浸润。LB组接受0.25%左旋布比卡因，LA组接受2%利多卡因加肾上腺素（增加容量注射）。记录术中血流动力学变化、术前和术后血红蛋白和红细胞压积值。记录所有患者术后30分钟及1、2、8、12和24小时的视觉模拟标度（VAS）评分和最初24小时里再予镇痛治疗的需要。
结果：在术后30分钟和1、2、8及12小时时，LB组的VAS评分低于LA组（分别为P < 0.0001、P = 0.002、P = 0.023、P < 0.0001及P = 0.011）。与LA组比较，LB组镇痛药的需要显著降低（P=0.038）。LB组的术前和术后血红蛋白和红细胞压积值有显著差异性（P=0.014和0.025）。LA组的术前和术后血红蛋白和红细胞压积值有显著差异性(P = 0.031和0.024)。
结论：我们认为，在鼻部手术中左旋布比卡因局部浸润比利多卡因加肾上腺素的术后镇痛作用显著增加和持续时间更长。
（胡湘 译 马皓琳 李士通 校）
BACKGROUND: In
this study, we compared the use of preincisional lidocaine 2% with
epinephrine (LA) and levobupivacaine 0.25% plain (LB) for
postoperative analgesia and vasoconstriction in patients undergoing
nasal surgery.
METHODS: Sixty
patients were randomly assigned to receive preincisional local
infiltration under general anesthesia. Group LB received levobupivacaine
0.25%, and group LA received epinephrine plus lidocaine 2% (add
volume injected). Intraoperative hemodynamic changes, pre- and
postoperative hemoglobin and hematocrit values were recorded. Visual
analog scale values 30 min and 1, 2, 8, 12, and 24 h postoperatively
and the need for rescue analgesic treatment in the first 24 h of all
patients was recorded.
RESULTS: At
30 min and 1, 2, 8, and 12 h postoperatively, visual analog scale
values were lower in group LB than in group LA (P < 0.0001, P = 0.002, P = 0.023, P < 0.0001, and P = 0.011, respectively). The analgesic requirement was
significantly lower in group LB when compared with that in group LA
(P = 0.038). Group LB had significant
differences between preoperative and postoperative hemoglobin and
hematocrit values (P = 0.014 and 0.025).
Group LA had significant differences between preoperative and
postoperative hemoglobin and hematocrit values (P = 0.031 and 0.024).
CONCLUSIONS: We conclude that postoperative analgesia in nasal surgery
with local infiltration of levobupivacaine was significantly more
potent and longer lasting than that achieved by lidocaine plus
epinephrine.
抗凝血酶对VIII因子缺乏血浆中重组激活VII因子凝血效应的影响
Antithrombin Affects Hemostatic Response
to Recombinant Activated Factor VII in Factor VIII Deficient Plasma
Fania Szlam,
MMSc*, Taro Taketomi, MD*, Chelsea A. Sheppard, MD_files/image111.gif){kind=small}
,
Christine L. Kempton, MD_files/image112.gif){kind=small}
,
Jerrold H. Levy, MD*, and Kenichi A. Tanaka, MD, MSc* From
the Departments of *Anesthesiology, _files/image113.gif){kind=small}
Pathology
and _files/image114.gif){kind=small}
Hematology/Oncology,
Emory University School of Medicine, Atlanta, Georgia.
Anesth Analg 2008 106: 719-724.
背景：rFVIIa（重组激活VII因子）用于外伤和接受外科手术的病人时易有血栓形成的并发症，但在血友病人身上却很少见。他们的出血体质和凝血酶形成减少有关，而rFVIIa可以促进凝血酶的形成。一般来说，从破损血管弥散出来的凝血酶很快被抗凝血酶（AT）灭活。评估AT水平对高凝后VIII因子缺乏的血浆中凝血酶形成的影响有助于更好的理解促凝因子如rFVIIa因子如何导致术后病人血栓形成。我们假设AT浓度的降低会增强VIII因子缺乏血浆中rFVIIa的促凝效应。
方法：利用血栓弹力图和凝血酶化验的方法做活体内比照研究VIII因子缺乏血浆和VIII因子/AT缺乏血浆中凝血酶的形成。评估加入的rFVIIa对这两组效应的差别
结果：正如所料，VIII因子缺乏的血浆中基于血栓弹力图的血栓延迟形成的现象被rFVIIa所逆转。当AT为正常值的20%-50%时，血栓形成加快，对rFVIIa的反应也得到强化。VIII因子缺乏的血浆中凝血酶形成和AT水平成负相关。补充的rFVIIa缩短凝血酶形成的延后时间，但对凝血酶形成的总量没有影响。
结论：利用缺乏VIII因子的血浆作为凝血酶形成受抑模型，论证了活体内低AT水平增强rFVIIa的凝血效应。FVIII水平正常或升高的外伤和手术病人的AT减少被认为有潜在的血栓形成倾向。因此非血友病人接受FVIII治疗期间监测AT水平有助于减少血栓形成的并发症。
（孙鹏飞译 薛张纲校）
BACKGROUND: Thromboembolic complications can occur with recombinant activated factor VII (rFVIIa) treatment in trauma and surgical patients but they are infrequent in hemophiliacs. Bleeding diathesis in these conditions is often attributed to reduced thrombin generation, which may be improved with rFVIIa. Normally, thrombin that diffuses from local vascular injury sites is quickly inactivated by antithrombin (AT). Evaluating the influence of AT levels on thrombin generation in hypocoagulable FVIII-deficient plasma would be a simple approach to better understand how procoagulant stimuli, such as rFVIIa, might result in postoperative thrombotic complications. We hypothesize that reduced AT concentrations would increase the procoagulant effects of rFVIIa in FVIII-deficient plasma.
METHODS: Thrombin generation was evaluated in vitro in FVIII-deficient and AT/FVIII-deficient plasma using thrombelastography and a thrombin generation assay (ThrombinoscopeTM). The effect of added rFVIIa on these variables was evaluated.
RESULTS: Delayed thrombus formation based on thrombelastography in FVIII-deficient plasma was predictably reversed by rFVIIa. Improved thrombus formation and responses to rFVIIa were observed when AT levels were 20%–50% of normal. Thrombin generation in FVIII-deficient plasma increased in an inverse relationship to AT levels. Supplemental rFVIIa decreased the lag time of thrombin generation but not the amount of thrombin generated.
CONCLUSIONS: Using FVIII-deficient plasma as a model of reduced thrombin generation, we demonstrate that low AT levels enhance in vitro hemostatic responses to rFVIIa. Reduced AT levels in trauma and surgical patients with normal or increased FVIII levels may be considered potentially prothrombotic. Monitoring of AT levels during rFVIIa therapy may thus reduce thrombotic complications in nonhemophiliacs.
The Effect of Limited Rewarming and Postoperative Hypothermia on
Cognitive Function in a Rat Cardiopulmonary Bypass Model
Fellery de Lange, MD*, Wilbert L. Jones, MD*, George Burkhard
Mackensen, MD, PhD*, and Hilary P. Grocott, MD, FRCPC*
From the *Department of Anesthesiology, Duke
University Medical Center, Durham, North Carolina; and _files/image115.gif){kind=small}
Department
of Perioperative Care and Emergency Medicine, University Medical Center
Utrecht, Utrecht, The Netherlands.
Anesth Analg 2008 106: 739-745.
背景：临床研究未能证明低温对预防体外循环（ CPB ）术后认知功能障碍（ pocd ）有显着的好处 。有一种解释为，也许是发生在CPB的结尾再加热期间潜在地有害大脑极高热，抵销低体温症的防护好处。在这项研究中，我们调查了CPB温度的相对影响，再加热战略和在鼠CPB模型的手术后温度 。
方法：四组雄性大鼠经手术准备，并受到90分钟的体外循环。 A组为常温（ 37.5 ℃ ）期间和之后体外循环。 B组进行了低温（ 32 ° C ）的体外循环，在最后分流术时复温至37.5 °C。 C组低温（ 32 °C ）的体外循环，再是有限复温至35 ℃之间。 D组有常温体外循环与术后低温（ 35 ° C ）诱导。依据术后3-9天在水迷宫中的表现比较各组的pocd。病理分析大脑（ CA1区和CA3海马区）也是一个依据。
结果：仅仅在（ B组与A组）或体外循环后（ D组与A组）低温诱导对改善无明显好处。低温诱导在体外循环并持续到术后时期对POCD产生了一个显着的改善，在水迷宫表现相对于其他所有温度regimens （ C组与A组， P值0.044 ， C组与B组， P值0.011 ， C组与组发展， P值为0.012 ） 。 在各小组中的组织病理学区别中未被展示。
结论： 低体温(32°C) CPB加上有限再加热和长时期的手术后低体温(35°C)减少大鼠CPB术后POCD的发生
（章一静译 薛张纲校）
BACKGROUND: Clinical studies have failed to demonstrate significant benefits of hypothermia for the prevention of postoperative cognitive dysfunction (POCD) after cardiopulmonary bypass (CPB). One explanation for this might be that potentially injurious cerebral hyperthermia occurs during rewarming at the end of CPB, off-setting the protective benefits of hypothermia. In this study, we investigated the relative influence of CPB temperature, rewarming strategies, and postoperative temperature in a rat CPB model.
METHODS: Four groups of male
Sprague-Dawley rats were surgically prepared and subjected to 90 min of CPB.
Group A was normothermic (37.5°C) during and after CPB. Group B underwent
hypothermic (32°C) CPB, followed by rewarming to 37.5°C at the end of bypass.
Group C had hypothermic (32°C) CPB, followed by limited rewarming to 35°C.
Group D had normothermic CPB with hypothermia (35°C) induced only
postoperatively. Groups were compared for POCD determined by the performance in
the Morris water maze on postoperative days 3–9. Histologic analysis of the
brains (CA1 and CA3 hippocampal regions) was also performed.
RESULTS: Hypothermia induced only
during (group B versus group A) or after CPB (group D versus group A) conferred
no significant POCD benefit. Hypothermia when induced during CPB and continued
into the postoperative period resulted in a significant improvement in water
maze performance versus all other temperature regimens (group C versus group A,
P = 0.044; group C versus group B, P = 0.011; group C versus group D, P =
0.012). No histological differences among groups were demonstrated.
CONCLUSIONS: The combination of
hypothermic (32°C) CPB coupled with limited rewarming and prolonged postoperative
hypothermia (35°C) decreased POCD after CPB in rats.
The effect of lung expansion and
positive end-expiratory pressure on respiratory mechanics in anesthetized
children
Athanasios G.
Kaditis, MD*_files/image116.gif){kind=small}
,
Etsuro K. Motoyama, MD*_files/image117.gif){kind=small}
,
Walter Zin, PhD_files/image118.gif){kind=small}
,
Nobuhiro Maekawa, MD_files/image119.gif){kind=small}
||,
Isuta Nishio, MD_files/image120.gif){kind=small}
¶,
Taiyo Imai, MD*, and Joseph Milic-Emili, MD#
From the *Department of Pediatrics,
University of Pittsburgh School of Medicine and Children's Hospital of
Pittsburgh, Pittsburgh, Pennsylvania; _files/image121.gif){kind=small}
Department
of Pediatrics, University of Thessaly School of Medicine, Larissa, Greece; _files/image122.gif){kind=small}
Department
of Anesthesiology University of Pittsburgh School of Medicine and Children's
Hospital of Pittsburgh, Pittsburgh, Pennsylvania; _files/image123.gif){kind=small}
Carlos
Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio
de Janeiro, Brazil; ||Department of Anesthesiology, Kobe University School of
Medicine, Kobe, Japan; ¶Department of Anesthesiology, University of WA,
Seattle, Washington; #Meakins-Christie Laboratories, Department of Physiology,
McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Anesth Analg 2008 106: 775-785
背景：影像研究提示儿童全身麻醉时易引起肺膨胀不全。扶助呼吸及呼吸末正压通气有利于预防肺膨胀不全。然而儿童在全麻过程中的生理改变未得到阐明。
方法：在八个麻醉时使用机械通气的儿童中（平均年龄：3.5岁；范围2.3-6.5），我们测定平静呼吸时的顺应性(E(st))和气流阻力(R(int))，及在使用恒定流量和吸气末阻塞扶助呼吸时因组织的粘弹性所致的顺应性及阻力(分别计为deltaE和deltaR)，包括0呼吸末压及5cmH2O呼吸末压进行比较。
结果：当吸气流量(V(I))恒定及终末零压通气时，吸气末肺容量（总容量V(T)）由8ML/kg增加致20ML/kg，导致E(st)由1.06cmH2O/mL降到0.82cmH2O/mL, deltaE由0.16至0.09，R(int)由0.13cmH2O/mL*s*kg至0.11cmH2O/mL*s*kg，然而deltaR由0.08增加至0.12（P<0.05）。与使用呼吸末正压通气的结论相似。吸气流量(V(I))由8ML/kg增至26ML/kg及吸气末肺容量（V（T））恒定，终末零压通气时，E(st)由1.09cmH2O/mL降到0.9cmH2O/mL, deltaR由0.17至0.06（P<0.01），但是R(int)和deltaE没有改变。呼吸末正压通气时顺应性和阻力对吸气流量和肺容量有相似的依赖性。
结论：在总容量增加（增至16mL/kg加呼吸末正压通气）时E(st)稳定下降提示当呼吸末正压通气时呼气末舒张容量（功能残气量）显著下降。终末零压通气和呼吸末正压通气时结论相似提示扶助呼吸和氧气-氮气通气可以预防气道闭塞。
（胡艳译 薛张刚校）
BACKGROUND: Imaging studies have shown that general anesthesia in children results in atelectasis. Lung recruitment total lung capacity (TLC) maneuvers plus positive end-expiratory pressure (PEEP) are effective in preventing atelectasis. However, physiological changes in children during general anesthesia have not been elucidated.
METHODS: In eight anesthetized and mechanically ventilated children (median age: 3.5 years; range: 2.3-6.5), we measured static respiratory system elastance (E(st)), flow resistance (R(int)), and elastance and resistance components resulting from tissue viscoelasticity (deltaE and deltaR, respectively) using the constant inflow, end-inspiratory occlusion method preceded by TLC maneuvers, both with zero PEEP (ZEEP) and PEEP (5 cm H2O) for comparison.
RESULTS: With constant inspiratory flow V(I) and ZEEP, increases in end-inspiratory lung volume above relaxation volume (tidal volume, V(T)) from 8 to 20 mL x kg(-1) resulted in decreases in E(st) from 1.06 to 0.82 cm H2O x mL(-1) x kg, deltaE from 0.16 to 0.09, and R(int) from 0.13 to 0.11 cm H2O x mL(-1) x s x kg, whereas deltaR increased from 0.08 to 0.12 (P < 0.05). Similar relationships were found with PEEP. Increases in V(I) (8 to 26 mL x s(-1) x kg) with constant V(T) and ZEEP resulted in decreases in E(st) from 1.09 to 0.9 and deltaR from 0.17 to 0.06 (P < 0.01), whereas deltaE and R(int) did not change. There was a similar flow and volume dependence of elastance and resistance with PEEP.
CONCLUSIONS: The observed steady decreases in E(st) with increasing V(T) (up to 16 mL/kg with PEEP) indicate marked reductions in end-expiratory relaxation volume (functional residual capacity) even with PEEP. Similarity in results with ZEEP and PEEP suggests that TLC-maneuvers and O2-N2 ventilation prevented airway closure throughout the study.
An efficient screening tool for
preoperative depression: the Geriatric Depression Scale-Short Form
. Diana S. Bass, BS*, Deborah K. Attix,
PhD, ABPP/ABCN*, Barbara Phillips-Bute, PhD_files/image124.gif){kind=small}
,
and Terri G. Monk, MD, ABA_files/image125.gif){kind=small}
_files/image126.gif){kind=small}
From the
*Division of Neurology, Division of Medical Psychology, Duke University Medical
Center, _files/image127.gif){kind=small}
Department
of Anesthesiology, Duke University Medical Center, and _files/image128.gif){kind=small}
Department
of Anesthesiology, Durham Veterans Affairs Medical Center, Durham, North
Carolina.
Anesth Analg 2008 106: 805-809.
背景：抑郁症是一种在外科术前患者中高发的心理疾患，对多数患者的术后转归产生严重影响。因此，获得一种简单快捷的抑郁症筛查工具指导临床治疗和改善术后转归很有必要。
方法：本研究以非心外科手术外大型手术术前住院患者为研究对象，研究样本人群中术前抑郁症的患病率。同时，以老年抑郁症评估简表（GDS-SF）作为抑郁症的评估工具，将结果按年龄、性别分组，验证其与Beck抑郁量表(BSI)评估结果的相关性,以评估该简表作为筛查工具的可靠性。
结果：以BSI量表评估抑郁症，在1043名术前候选者组成的样本中，所获抑郁症患病率显著高于健康社区人群患病率。抑郁症女性发病较男性常见(P=0.02)，老年人发病较中年和青少年少见(分别为P＝0.03和0.003)。此外，同一年龄组中，BDI和GDS-SF的评估结果高度一致。
结论：上述数据再度证明术前人群抑郁症筛查的必要性，并证实，作为医生可选且可及的快速术前抑郁症评估工具，GDS-SF量表的评估结果可靠。
（黄凝译 薛张纲校）
BACKGROUND: Depression is highly prevalent in patients before surgery, and it has been widely shown to have a serious impact on their postoperative outcomes. It would therefore be desirable for physicians to obtain a quick, simple screen to evaluate depression to consider treatment of symptomatology and potentially optimize postoperative outcomes.
METHODS: In this study, we investigated the prevalence of depression in a presurgical inpatient sample undergoing major, noncardiac surgery. In addition, we sought to establish the Geriatric Depression Scale-Short Form (GDS-SF) as a valid screening tool for depression by examining its relationship to the Beck Depression inventory (BDI) by age and gender.
RESULTS: In our sample of 1043 presurgical candidates, prevalence of depression as established by the BDI was significantly higher than rates consistently found in healthy community samples. Depression was more common in women than in men (P = 0.02), and depression rates were lower in elders relative to middle-aged and younger groups (P = 0.003 and 0.003, respectively). In addition, we found that there was a high correlation between the BDI and the GDS-SF within each of the age groups.
CONCLUSIONS: These data further support the need for depression screens in presurgical populations and establish the validity of the GDS-SF as a valid quick assessment alternative available to physicians.
关于异丙酚合用70%氙与合用70%笑气时50%有效浓度（EC50）的比较
The Effective Concentration 50 (EC50) for Propofol with 70% Xenon Versus 70% Nitrous Oxide
Ahmed R. Barakat, MD, FRCA*, Markus N. Schreiber, MD_files/image129.gif){kind=small}
, Joachim Flaschar,
Dipl.-Ing. (FH)_files/image130.gif){kind=small}
,
Michael Georgieff, MD_files/image131.gif){kind=small}
,
and Stefan Schraag, MD* From the *Department of Perioperative Medicine, Golden Jubilee National
Hospital, Clydebank, UK; and _files/image132.gif){kind=small}
Department
of Anesthesiology, University of Ulm, Germany.
Anesth Analg 2008 106: 823-829.
背景：氙在麻醉中有许多成功应用，例如疼痛控制及器官保护。然而它的MAC为70%，因此无法单独使用。在此，我们将异丙酚与氙合用达到50%及95%有效麻醉时的用量与异丙酚合用笑气时进行比较。
方法：我们将75名无术前应用70%氙及70%笑气的女性患者随机分成2组，每组的第一位患者在麻醉诱导时予以吸氧及4.5 µg/mL靶浓度的异丙酚。用Dixon的上下来回法决定下一位患者的异丙酚浓度。异丙酚起效后，给予患者面罩吸氧气及70%氙或70%笑气15分钟。随后观察她们在切皮时及其后60秒内的反应，记录为运动或不动。应用概率分析比较异丙酚在各组的50%有效浓度及95%有效浓度（EC50和EC95）。
结果：异丙酚合用70%氙的EC50为1.5µg/mL，EC95为2.3 µg/mL。异丙酚合用70%笑气的EC50及EC95分别为2.2 及8.2 µg/mL。在相同有效浓度下，合用70%氙时异丙酚所需用量为合用70%笑气时的32%至72%。听力觉醒在吸入氙时较吸入笑气时更易发生。
结论：氙比笑气更有效，但在切皮前后仍需合用少量催眠药以对抗刺激作用。
（施颖译 薛张纲校）
BACKGROUND: Xenon anesthesia has many favorable properties, such as pain modulation and organ protection. However, due to its MAC of 70%, it cannot be used as a sole anesthetic. We estimated the amount of propofol required to supplement xenon to produce adequate anesthesia in 50% and 95% of patients in comparison with nitrous oxide.
METHODS: We randomized 75 premedicated female patients to receive either 70% xenon or 70% nitrous oxide in oxygen supplemented by propofol target-controlled infusion anesthesia starting with 4.5 µg/mL for the first patient in each group. Dixon's up and down method was used to determine the propofol concentration for subsequent patients. After induction of anesthesia with propofol, patients breathed 70% xenon or 70% nitrous oxide in oxygen via a facemask for 15 min. They were then observed for movement in response to skin incision for 60 s after the incision and assigned as movers or nonmovers. Probit analysis was used to estimate the effective concentration 50% and 95% (EC50 and EC95) for propofol in both groups.
RESULTS: The EC50 for propofol with 70% xenon was1.5µg/mL and the EC95 was 2.3 µg/mL. The EC50 and EC95 values for propofol with nitrous oxide were 2.2 and 8.2 µg/mL, respectively. This implies a reduction of propofol requirements between 32% (EC50) and 72% (EC95) by xenon compared with nitrous oxide. The suppression of auditory evoked potentials was more pronounced with xenon than with nitrous oxide.
CONCLUSION: Xenon seems to be clinically more potent than nitrous oxide, but still requires minimal supplement of a hypnotic anesthetic to suppress noxious stimulation during and after skin incision.
异丙酚对人类5-HT3A受体的分子作用：通过相似的酚类衍生物增强和抑制
Molecular Actions of Propofol on Human
5-HT3A Receptors: Enhancement as Well as Inhibition by Closely
Related Phenol Derivatives
Martin Barann, PhD, Isabelle Linden, PhD, Stefan Witten, PhD, and Bernd W.
Urban, PhD
From the
Department of Anesthesiology and Intensive Care Medicine, University of Bonn,
Bonn, Germany.
Anesth Analg 2008 106: 846-857.
背景：5-HT3受体是与术后恶心和呕吐有关的兴奋性配体门控离子通道，它们能够被麻醉剂异丙酚抑制，相反，增强抑制性配体门控离子通道如r-氨基丁酸A型受体及甘氨酸受体的效应。为了研究这种完全相反的作用的分子机制，我们研究了异丙酚和其次级疏水衍生物2 -异丙基酚和苯酚对人体5-HT3A受体的作用。
方法：包含能够稳定转录5-HT3A受体亚基的cDNA的人类胚胎肾293细胞作为膜片钳（游离膜外面向外式膜片）。用快速溶解交换系统（ 2毫秒）应用药物 ，其浓度通过高效液相色谱法测定。
结果：当应用至平衡状态（5 -羟色胺脉冲前60秒及脉冲期间），异丙酚能抑制人5-HT3A受体（IC50 = 18 ± 1.0 µM），令人惊异的是，在平衡时，次级疏水衍生物抑制 人5-HT3A受体的效价与异丙酚相似（IC50
= 17 ± 3.2 µM），而苯酚的效价则很低 （IC50 = 1.6 ± 0.2 mM）。在电流引出前改变给药持续时间，
然后在药物仍然存在时加入 5-HT，异丙酚的（平衡）效应有快慢两个过程（[tau]IN-1
= 35 ms，[tau]IN-2
= 4.8 s）；2 -异丙基酚为[tau]IN-1 =
64 ms，[tau]IN-2
= 6.6 s；苯酚为[tau]IN-1
< 10 ms，[tau]IN-2
= 20.4 s。当与5-HT一同短时间内给药（开放式给药），异丙酚明显地抑制电流，加速5-HT诱导的脱敏作用 ，相反，2-异丙基酚和苯酚增强电流，减慢脱敏作用。慢脱敏作用也在5-HT的衍生物5-羟吲哚（1mM）上被观察到，苯却没有。当5-HT浓度从30降到3µM时，苯酚、2 -异丙基酚、异丙酚的快速效应更显著，而慢速效应则对5-HT不敏感。
结论：异丙酚被证实对5-HT3A受体至少有两种相互独立的作用，而在两种相关的较小分子的酚类衍生物中所看到的增强作用则不能被检测到。5-HT依赖和5-HT非依赖两种相互作用因为这三种药物而著称。从其疏水性来看，异丙酚的效价比期望的低。潜在机制似乎涉及酚羟基，疏水相互作用并和空间结构限制。
（宣丽真译 薛张纲校）
BACKGROUND:
5-Hydroxytryptamine type 3 (5-HT3) receptors are excitatory
ligand-gated ion channels which are involved in postoperative nausea and
vomiting. They are depressed by the anesthetic propofol, which, in contrast,
enhances the activity of inhibitory ligand-gated ion channels such as
[gamma]-aminobutyric acid type A receptors and glycine receptors. To
investigate the molecular mechanisms responsible for these contrasting actions,
we examined the kinetics of the action of propofol and its lesser hydrophobic
derivatives 2-isopropylphenol and phenol on human 5-HT3A receptors.
METHODS: Human
embryonic kidney 293 cells containing stably transfected cDNA of the human 5-HT3A
receptor subunit were patch clamped (excised outside-out patches). Drugs were
applied with a fast solution exchange system (within 2 ms) and their
concentrations were determined by high performance liquid chromatography.
RESULTS:
When applied in equilibrium (60 s before and during the 5-HT pulse), propofol
inhibited human 5-HT3A receptors (IC50 = 18 ± 1.0 µM). In equilibrium,
the less hydrophobic 2-isopropylphenol was surprisingly a similarly potent
inhibitor of human 5-HT3A receptors (IC50 = 17 ± 3.2 µM), whereas phenol
was considerably less potent (IC50 = 1.6 ± 0.2 mM). Varying the duration
of drug application before currents were elicited, and then applying 5-HT still
in the presence of the drug revealed that fast and slow processes contributed
to the (equilibrium) effects of propofol ([tau]IN-1 = 35 ms and
[tau]IN-2 = 4.8 s), 2-isopropylphenol ([tau]IN-1 = 64 ms
and [tau]IN-2 = 6.6 s), and phenol ([tau]IN-1 < 10 ms,
[tau]IN-2 = 20.4 s). When applied transiently together with 5-HT
(open channel application), propofol depressed currents and accelerated the
5-HT-induced desensitization significantly, whereas, in contrast,
2-isopropylphenol and phenol increased currents and slowed desensitization.
Slowed desensitization was also observed for 5-hydroxyindole (1 mM), a 5-HT
derivative, but not for benzene. The fast effects of phenol, 2-isopropylphenol,
and propofol were more pronounced when the 5-HT concentration was decreased
from 30 to 3 µM, whereas the slow effects were not sensitive to 5-HT.
CONCLUSIONS: At least two separate inhibitory actions on 5-HT3A receptors could be identified for propofol, whereas the enhancing action seen for the two related smaller phenol derivatives could no longer be detected. 5-HT-dependent and 5-HT-independent interactions could be distinguished for all three drugs. Propofol was less potent than expected from its hydrophobic properties. Underlying mechanisms appear to involve the phenolic hydroxyl group, hydrophobic interactions, and steric restrictions.
Cardiac Output Derived from Arterial Pressure Waveform Analysis in Patients Undergoing Cardiac Surgery: Validity of a Second Generation Device
Jochen Mayer, MD, Joachim Boldt, MD, Michael W. Wolf, MD, Johannes Lang, MD, and Stefan Suttner, MD
From the Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Germany.
Anesth Analg 2008 106: 867-872.
背景：近来介绍过的一种能根据动脉波形来测定心输出量而不需要行有创监测(如FloTrac/VigileoTM)的仪器仍备受争议。因此我们在心脏手术病人中设计了一个现况研究，通过与经肺动脉导管以间歇热稀释法测定心输出量的比较，来评价这种经改良的检测技术。
方法：40位ASA分级为III级行冠脉搭桥（CPB）手术的病人被选入此项研究。经同步热稀释法及FloTrac/Vigileo仪分别在诱导后即刻(设时间为T1)，行CPB之前(T2)，行CPB之后(T3)，关闭胸骨之后(T4)，入ICU即刻(T5) ，及术后4h (T6)，8h (T7)，24h (T8) 测得心输出量(CO)，再由体表面积换算得心输出指数(CI)。最后我们设定一个≤30%的差错率来作为该新方法与标准的热稀释法间的评判标准。
结果：我们共分析了所得的282对测量数据。经热稀释法测得的CI其范围从1.2—4.1 L /(min · m2) (平均2.5 ± 0.54 L /(min · m2))。偏倚和精确度(设精确度为偏倚的1.96个标准差)为0.19 L /(min · m2) 和± 0.60 L /(min · m2)，显示在整个围手术期(T1–8) 用第二代动脉压波形仪评估CI其总的差错率为24.6%，而通过对单在手术期间(T1–4)及ICU内(T5–8)这两个亚组的分析，又可得出其差错率分别为28.3%和20.7%。
结论：在行冠脉搭桥手术的病人中，经改良的第二代半侵入式动脉波形仪在手术期间及手术后所测得的CI值，与以间歇热稀释法测定的CI值显示了很好的一致性。
（刘沁译 薛张纲校）
BACKGROUND: The performance of a recently introduced, arterial waveform-based device for measuring cardiac output (CO) without the need of invasive calibration (FloTrac/VigileoTM) has been controversial. We designed the present study to assess the validity of an improved version of this monitoring technique compared with intermittent thermodilution CO measurement using a pulmonary artery catheter in patients undergoing cardiac surgery.
METHODS: Forty ASA III patients scheduled for elective coronary artery bypass grafting with cardiopulmonary bypass (CPB) were studied. Simultaneous CO measurements by bolus thermodilution and the FloTrac/Vigileo device were obtained after induction of anesthesia (T1), before CPB (T2), after CPB (T3), after sternal closure (T4), on arrival in the intensive care unit (T5), 4 h (T6), 8 h (T7), and 24 h after surgery (T8). CO was indexed to the body surface area (cardiac index, CI). A percentage error of 30% or less was established as the criterion for method interchangeability.
RESULTS: Two hundred and eighty-two data pairs were analyzed. Thermodilution CI ranged from 1.2 to 4.1 L · min–1 · m–2 (mean 2.5 ± 0.54 L · min–1 · m–2). Bias and precision (1.96 sd of the bias) were 0.19 L · min–1 · m–2 and ± 0.60 L · min–1 · m–2, resulting in an overall percentage error of 24.6%. Subgroup analysis revealed a percentage error of 28.3% for data pairs obtained intraoperatively (T1–4) and 20.7% in intensive care unit (T5–8).
CONCLUSION: CI values obtained by the improved, second generation semiinvasive arterial waveform device showed good intraoperative and postoperative agreement with intermittent pulmonary artery thermodilution CI measurements in patients undergoing coronary artery bypass graft surgery.
食管部分切除术中胸段硬膜外应用布比卡因与静脉内肾上腺素输注对胃管引流的影响
The
effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion
on gastric tube blood flow during esophagectomy.
Omar Y. Al-Rawi,
FRCA*, Stephen H. Pennefather, MRCP, FRCA*, Richard D.
Page, FRCS_files/image133.gif){kind=small}
,
Ishani Dave, FRCA*, and Glen N. Russell, FRCA*
From the
Departments of *Anaesthesia and _files/image134.gif){kind=small}
Thoracic
Surgery, Cardiothoracic Centre, Liverpool, United Kingdom.
Anesth
Analg 2008 106: 884-887.
背景：胃管坏死是食管部分切除术后吻合口漏的一个主要原因。胃管末端吻合口处引流量的减少与吻合口漏有关。
方法：我们前瞻性的研究了术中胸段硬膜外应用布比卡因与之后肾上腺素的输注对血流动力学及胃管引流量的影响。
结果：给予硬膜外药物显著地减少了胃管末端吻合口引流量(P<0.01)，输注肾上腺素后胃管引流量恢复到基线水平。
结论：胸段硬膜外布比卡因的给予会减少胃管末端吻合口处的引流量。
（刘婷洁译 薛张纲校）
BACKGROUND: Gastric tube necrosis
is a major cause of anastomotic leak after esophagectomy. A correlation has
been shown between reduced flux at the anastomotic end of the gastric tube and
anastomotic leaks.
METHODS: We prospectively
studied the effect of intraoperative thoracic epidural bupivacaine and subsequent
adrenaline infusion on hemodynamics and flux in the gastric tube.
RESULTS: Administering the
epidural bolus significantly decreased flux at the anastomotic end of the
gastric tube (P < 0.01). Gastric flux was returned to baseline by an
adrenaline infusion.
CONCLUSIONS: The administration of
a thoracic epidural bolus may decrease flux at the anastomotic end of the
gastric tube.
The Effect of Clonidine Infusion on
Distribution of Regional Cerebral Blood Flow in Volunteers
Vincent
Bonhomme, MD, MSc*, Pierre Maquet, MD, PhD_files/image135.gif){kind=small}
_files/image136.gif){kind=small}
,
Christophe Phillips, PhD_files/image137.gif){kind=small}
,
Alain Plenevaux, PhD_files/image138.gif){kind=small}
,
Pol Hans, MD*, Andre Luxen, PhD_files/image139.gif){kind=small}
,
Maurice Lamy, MD*, and Steven Laureys, MD, PhD_files/image140.gif){kind=small}
_files/image141.gif){kind=small}
From the *University Department of Anesthesia and Intensive Care Medicine, CHU
de Liege and CHR de la Citadelle, and _files/image142.gif){kind=small}
Cyclotron
Research Center, and _files/image143.gif){kind=small}
Department
of Neurology, University of Liege and CHU de Liege, Liege, Belgium
Anesth Analg 2008 106: 899-909.
背景：a-2肾上腺素受体激动剂能通过它对蓝斑的作用在大脑的意识功能部分保留时起到快速而可逆的镇静作用。我们这次观察性研究的目的，就是想摹绘出哪些脑区的活动会被输注可乐定而影响，从而更好的了解它的作用区域，特别是了解它