Table of Contents
March 2008
CARDIOVASCULAR ANESTHESIOLOGY:
胡瀟 譯 陳傑 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.
抗凝血酶對VIII因數缺乏血漿中重組啟動VII因數凝血效應的影響
孫鵬飛譯 薛張綱校
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.
姜旭暉 譯 馬皓琳 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.
聯合給予活化Ⅶ因數(NovoSeven®)和纖維蛋白原(Haemocomplettan® P)後能改善血塊形成
王鵬 譯 陳傑 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.
章一靜譯 薛張綱校
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.
多功能襯墊式充氣加溫系統在近常溫的體外迴圈下心臟外科手術中的效果
邱郁薇 譯 馬皓琳 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.
陶穎瑩 譯 陳傑 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:
胡豔譯 薛張剛校
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.
適用於以麻醉為基礎的小兒慢性疼痛醫療方案的病兒群體的臨床特點
張瑩譯 馬皓琳 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 譯 陳傑 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:
黃凝譯 薛張綱校
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 譯 馬皓琳 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.
閃光燈在減輕靜脈置管術疼痛的作用：一個前瞻性、隨機、安慰對照研究
王騰 譯 陳傑 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:
關於異丙酚合用70%氙與合用70%笑氣時50%有效濃度（EC50）的比較
施穎譯 薛張綱校
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.
大鼠的肝臟缺血再灌注損傷模型中七氟醚與異氟醚麻醉的肝能量代謝及其不同的保護效應
唐亮 譯 馬皓琳 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.
不同化合物對野生型、突變型A型γ氨基丁酸和甘氨酸受體的麻醉樣作用
趙燕星 譯 陳傑 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.
異丙酚對人類5-HT3A受體的分子作用：通過相似的酚類衍生物增強和抑制
宣麗真譯 薛張綱校
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.
高血糖減弱異氟烷在血管平滑肌細胞中誘導的ATP敏感的鉀通道啟動作用
黃施偉 譯 馬皓琳 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.
鄭麗 譯 陳傑 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:
劉沁譯 薛張綱校
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 譯 馬皓琳 李士通 校
Spectral
Entropy Predicts Auditory Recall in Volunteers
Daryn H. Moller and Ira J. Rampil
Anesth Analg 2008 106: 873-879.
異丙酚與fospropofol（一種新型異丙酚前體）的互動式網路仿真
陶穎瑩 譯 陳傑 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:
食管部分切除術中胸段硬膜外應用布比卡因與靜脈內腎上腺素輸注對胃管引流的影響
劉婷潔譯 薛張綱校
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:
黃佳佳譯，馬皓琳 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:
張燕 譯 陳傑 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:
秦敏菊譯 薛張綱校
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.
裘毅敏譯，馬皓琳 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-缺血損傷後氙氣/低溫神經保護措施：呼吸和鎮靜效應
潘方立 譯 陳傑 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.
夏俊明譯 薛張綱校
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:
在接受異丙酚複合芬太尼麻醉的患者中神經肌肉阻滯水平對強直後運動誘發電位的幅度和經顱刺激的運動反應的影響
唐李雋 譯 馬皓琳 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.
手法穩定氣管插管期間的頸椎移動：直接喉鏡法與GlideScope視頻喉鏡法的比較
印潔敏 譯 陳傑 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:
發展中國家的麻醉和相關學科的現狀：一項尚比亞共和國的全國性調查
陳珺珺譯 薛張綱校
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:
塞來考昔圍手術期給藥與僅僅在術後給藥對接受大的整形外科手術病人術後影響的比較
吳進 譯 馬皓琳 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.
一項前瞻性隨機雙盲研究測定胸段硬膜外給新斯的明對腹主動脈術後腸麻痹的影響
宋翠俠 譯 陳傑 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:
嗎啡鞘內注射抑制爪炎症性水腫：一氧化氮（NO）和環磷鳥苷(cGMP)的作用
蔣宗明譯 薛張綱校
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.
鞘內注射環氧化酶-1抑制劑、環氧化酶-2抑制劑或非選擇性抑制劑對疼痛行為和脊髓Fos樣免疫反應的影響
顏濤 譯，馬皓琳 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.
一氧化氮合酶抑制劑和環氧合酶抑制劑在小鼠甲醛誘導疼痛中的相互作用：一項等輻射分析研究
潘錢玲 譯 陳傑 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.
固定劑量的氟烷、異氟醚或異丙酚，並沒有優先抑制帶有上行投射的腰段脊髓背角神經元的實驗鼠的有害熱誘發反應
陳珺珺譯 薛張綱校
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:
患者自控持續斜角肌間溝阻滯能促進開放性肩部手術後的早期功能康復嗎？
朱 慧譯 馬皓琳 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.
改良乳房根治術術後羅呱卡因連續傷口浸潤麻醉與單次椎旁神經阻滯的比較
陳偉 譯 陳傑 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.
陳珺珺譯 薛張綱校
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 譯 馬皓琳 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.
陳珺珺譯 薛張綱校
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： 體外迴圈期間，特別是深低溫停迴圈時抗凝血酶水平降低。低抗凝血酶水平可能導致促凝和抗凝因數間的不平衡導致系統性血栓形成。作者假設體外迴圈後病人血漿中加入促凝因數後低水平的抗凝血酶可能導致凝血酶產生增加。
方法：5例接受深低溫停迴圈心臟手術的病人在肝素化前和體外迴圈後抽取血液標本。抗凝血酶水平由產色反應來確定並由正常活性的百分比來表達。抗凝和促凝物質的平衡通過在病人血漿中加入正常人的血漿、抗凝血酶缺陷的血漿和提純的抗凝血酶來實現 。ThrombinoscopeTM系統用於評估給或不給抗凝血酶時的凝血酶。
結果：在體外迴圈前後，抗凝血酶水平分別為82.0% (中位數71.0, 最大值109) 和 37.0% (中位數34.0, 最大值41.0)，(P < 0.05)。當體外迴圈後的血漿加入正常抗凝血酶（105%）的捐獻者血漿後凝血酶56.6 nM (中位數42.1, 最大值61.0), 並保持在 61.1 nM (中位數54.9, 最大值64.5)。當加入抗凝血酶缺乏病人的血漿後，凝血酶（中位數，範圍）從56.6nM(中位數42.1, 最大值61.0)增至117 nM (中位數95.0, 最大值188) (P < 0.05)。當加入提純的抗凝血酶後，凝血酶減少到12.2 nM (中位數9.0, 最大值29.3) (P < 0.05)。
結論：深低溫停迴圈患者體外迴圈後血漿抗凝血酶活性顯著下降。資料顯示在不給予抗凝血酶的情況下給予凝血因數可能導致過多的凝血酶生成，臨床上有潛在導致高凝狀態的可能。
（胡瀟 譯 陳傑 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.
聯合給予活化Ⅶ因數(NovoSeven®)和纖維蛋白原(Haemocomplettan® P)後能改善血塊形成
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：重組活化Ⅶ因數（rFVIIa）常用於治療難治性心臟術後出血。然而，止血作用還取決於凝集因數，包括纖維蛋白原，在血管損傷部位形成穩定的血小板栓子。作者比較了單獨使用rFVIIa，纖維蛋白原以及聯合使用時的止血效果。
方法：採集 12例志願者和7例體外迴圈患者血液樣本。在體外，志願者的血漿加入肝素（0.1U/ml）或纖溶酶原（0.1ug/ml）以模擬凝血功能紊亂，然後加入rFVIIa（1.5ug/ml）、纖維蛋白原（100mg/dl）或聯合給予rFVIIa及纖維蛋白原，以此來評價它們的促凝血功能。通過血栓彈力圖比較它們對凝血功能的影響。測定血栓的形成時間、第一個血栓形成時間以及血栓的最大硬度。凝血酶定量實驗用來測定添加纖維蛋白原和（或）rFVIIa後凝血酶的產生。
結果：在肝素化的志願者的血漿中，加入rFVIIa可以導致血凝塊形成時間從663秒縮短到435秒，但不影響血栓的最大硬度。纖維蛋白原可使血栓最大硬度從26.0mm增加到30.5mm，但它不影響血凝塊形成時間。在肝素化血漿樣本中聯合給予rFVIIa和纖維蛋白原，可以最大程度地將血凝塊形成時間縮短到359s(324–522s)以及將血栓最大硬度增加到29mm (27.8–31.0)。在給予組織型纖溶酶原的志願者的血漿中，纖溶現象比加入rFVIIa增加了45%。體外迴圈術後，在給予rFVIIa和纖維蛋白原後血凝塊形成時間和血栓最大硬度均改善了。凝血酶定量試驗說明了rFVIIa可以提高血栓形成的時間和凝血酶活化的速度，而纖維蛋白原沒有這些作用。
結論：給予rFVIIa後纖維蛋白形成時間和凝血酶產生均縮短，但只有另外給予纖維蛋白原後產生纖維蛋白凝塊強度增強。體外迴圈後全血通過聯合給與rFVIIa和纖維蛋白原而改善血凝塊形成。
（王鵬 譯 陳傑 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.
資料顯示進行血管外科手術的病人，其冠狀動脈相關的心臟併發症發生率呈現持續增高。
而術前進行冠狀動脈造影的病人如果顯示有接受冠脈血運重建術來改善術前及長期心臟功能的必要，則術前心臟功能評估對這些高危病人極為有益。然而目前的冠脈血運重建術與藥物治療在減少心臟併發症的效果上孰優孰劣仍存在爭議。本綜述根據最近發表的文獻總結並比較了選擇性血管手術的病人術前冠脈血運重建術治療與保守性藥物治療兩者效果。
（陶穎瑩 譯 陳傑 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：複雜的先天性心臟病的嬰兒需在深低溫停迴圈（HCA）下手術。有人認為，選擇性腦灌注（SCP）可以提供足夠的腦血流而減輕缺血性腦損傷。作者採用近紅外光譜法監測腦灌注和組織氧合情況，研究不同SCP下血流速度，並且與HCA相比較。
方法：21頭小豬在18°C行體外迴圈，然後行HCA或以25或50mL · kg–1 · min–1行SCP 90min，分別為HCV組、SCP25組和SCP50組。通過近紅外光譜法測定由吲哚青綠血管造影劑的血流指數（BFI）以及組織氧合指數（TOI）。用經顱多普勒超聲測定平均腦血流速度(FVmean)。
結果： SCP50組較HCV組（無血流）和SCP25組，其BFI和FVmean都有顯著增高。SCP50組的TOI較基礎水平增高，並高於HCV組和SCP25組。SCP組50的顱內壓較基礎水平沒有顯著升高。
結論：BFI和FVmean都顯示了SCP50組的腦灌注較HCV組和SCP25組增高。SCP25組和SCP50組的TOI較HCA組有明顯提高。SCP在25mL · kg–1 · min–1時可能提供最合適的腦保護。
（杜唯佳 譯 陳傑 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.
閃光燈在減輕靜脈置管術疼痛的作用：一個前瞻性、隨機、安慰對照研究
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：儘管操作中有有令人不適的疼痛經歷，靜脈置管術常在無鎮痛的情況下完成的。各種各樣的藥物和非藥物措施嘗試用於減輕靜脈置管帶來的疼痛。本文研究閃光燈減輕靜脈置管術疼痛的作用。
方法：前瞻性、隨機研究90名成年人（15—60歲），ASA分級在Ⅰ--Ⅱ級，不分性別，行擇期LC術患者。隨機分為三組，每組30人。第一組（對照組）；第二組（分散注意組）：不用閃光燈照相；第三組（閃光組）：手背小靜脈不明顯的患者在靜脈置管術前用閃光燈給予拍照，然後迅速行靜脈穿刺置管，置入18號導管。
結果：每組均有2名患者因第一次置入未成功而在後期分析中刪除。閃光組靜脈置管時疼痛比較輕，疼痛率為50%（14/28），而另兩組為100%（28/28）（p﹤0.01）。用視覺類比評分測定靜脈置管術疼痛程度（0—100；0即沒有疼痛，100是最痛）。閃光組的靜脈置管疼痛減輕的程度比分散注意力組大（p﹤0.01）
結論：靜脈置管術前應用閃光燈是減輕置管疼痛的一種安全、有效、簡單易用的方法。
（王騰 譯 陳傑 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.
不同化合物對野生型、突變型A型γ氨基丁酸和甘氨酸受體的麻醉樣作用
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.
介紹：沒有理論認為吸入麻醉藥的作用通過其揮發特性發揮其與生物學靶組織發生生物物理學相互作用而產生麻醉效應。證實突變導致吸入麻醉藥對各種受體作用減弱有助於證明具有麻醉作用的非揮發性麻醉藥所作用的受體。在以前的研究中，作者證實這些化合物 帶電荷或蒸氣壓特別低，而且這些化合物具有類似吸入麻醉藥的方式作用麻醉敏感受體。本研究通過比較它們對野生型A型γ氨基丁酸（GABAA）或甘氨酸受體和突變受體的作用，驗證是否這些化合物或是其他帶電化合物，相同於揮發性麻醉藥的機制。突變受體是通過設計對吸入麻醉藥相對耐藥而確定。
方法：檢測β-羥基丁酸、氯化銨、二乙基鄰苯二甲酸酯和GABA對甘氨酸受體同價同效基因α1和突變基因α1（S267I）的作用。檢測硫酸十二烷基頭孢匹胺和甘氨酸對α1β2γ2s和突變基因α1（S270I）β2γ2sGABA受體的作用。受體來源於非洲蟾蜍平滑肌細胞，用兩個電極電壓夾的方法。對於GABAA受體和甘氨酸受體，異氟醚和乙醇作為陽性對照，異丙酚作為陰性對照（如由突變導致無作用）。
結果：β-羥基丁酸、氯化銨、二乙基鄰苯二甲酸酯和GABA均增強甘氨酸受體功能。這種作用可被S267I突變體降低。硫酸十二烷基頭孢匹胺和甘氨酸增強GABAA受體功能，S270I突變體減弱這種作用。
結論：上述發現支持化合物調節GABA A或甘氨酸受體通過類似異氟醚和乙醇的作用機制的假說。比較藥物對麻醉敏感型野生受體與相對不敏感型突變受體的作用，可能幫助尋找有麻醉作用的化合物。
（趙燕星 譯 陳傑 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.
人體外周血單核細胞產生痛敏肽/孤啡肽前體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： 外周血單核細胞（PBMC）轉錄非典型的阿片樣物質痛敏肽/孤啡肽（N/OFQ）受體（NOP）mRNA。筆者檢測了N/OFQ前體，促N/OFQ前體（pp N/OFQ）。
方法：取10名健康志願者PBMC，用聚合酶鏈反應（PCR）技術檢測pp N/OFQ。
結果： 凝膠PCR法中所有樣本中均檢出pp N/OFQ mRNA擴增子。這點通過定量即時PCR技術證實（mRNA 30.91+0.18）。
結論：這組資料提示PBMC轉錄pp N/OFQ，且表達NOP，意味NOP可能參與PBMC的自身調節。
（鄭麗 譯 陳傑 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.
異丙酚與fospropofol（一種新型異丙酚前體）的互動式網路仿真
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.
根據近期發表的有關異丙酚及fospropofol（一種新型異丙酚前體）藥代及藥效學資料，本文作者建立了使用這兩種藥的互動式網路仿真。其中fospropofol是一種新型水溶性異丙酚前體藥物，其達到峰濃度的時間晚於異丙酚。而建立的模型能使麻醉醫師瞭解使用兩種藥物間的區別。另外該模型的附加優點在於保留了原試驗中不同試驗方案中不同病人間的差異。
（陶穎瑩 譯 陳傑 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：預防術後噁心和嘔吐的指南實施廣泛，但由於沒有很好的執行，效果可能有限。 作者作者假設利用電子決策支援（簡稱DS）系統，能顯著改善指南的執行。
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：來自作者的地區教學醫院的選擇性手術患者的醫學資料常規收錄入術前門診麻醉資訊處理系統。 預防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.術後噁心和嘔吐指南確診為"高危"患者，作為預防術後噁心和嘔吐物件，根據是在場的至少有以下3個危險因數：女性，術後噁心和嘔吐史或暈動病，不吸煙體質，和預期術後使用阿片類藥物。 Using automated reminders, we studied the effect of DS on guidelines adherence using an off-on-off design.使用自動提醒方法，研究決策支援對指南執行的作用。 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.結果：在2005年11月和2006年6月期間，對照組，決策支持組以及後決策支持組包括患者分別有 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.由於強制性資料錄入，術後噁心和嘔吐高危患者的比例由對照組28 ％ ，上升到決策支持組32％和後決策支持組31％。 During the control period, 38% of all high-risk patients were prescribed PONV prophylaxis.對照組38％的高危患者開具了預防性術後噁心和嘔吐處方。 而決策支持組比例上升至73％ ，後決策支持組下降至37％ 。
CONCLUSION: Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.結論：術後噁心和嘔吐的高危病人中，電子決策支援系統增強了預防術後噁心和嘔吐開具處方指南的執行。
（張燕 譯 陳傑 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-缺血損傷後氙氣/低溫神經保護措施：呼吸和鎮靜效應
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：低溫(HT)能降低圍產期窒息引起的神經損傷，氙氣(XE)能增強此作用。筆者研究了缺氧-缺血(HI)損傷後不同濃度氙氣在正常體溫37℃（NT）和低體溫32℃（HT）的鎮靜作用及對呼吸的影響以確定能使7天齡的新生大鼠產生自主呼吸抑制的氙氣濃度。
方法：（I）三組對照組，分別為空白對照、禁食正常體溫對照組（NT）和禁食低溫對照組（HT）。（II）六組行HI損傷（結紮頸動脈後吸8%氧氣90min）。之後三組分別為正常體溫吸空氣、50%氙氣和70%氙氣（NTAir,NT50%Xe,NT70%Xe），另三組為低溫吸空氣、50%氙氣和70%氙氣（HTAir,HT50%Xe,HT70%Xe）。監測血氣、血糖和乳酸並記錄鎮靜狀態（自主運動和呼吸頻率）。
結果：70只新生大鼠的血液生化資料全部獲得。（I）對照組在NT或HT禁食9h後血氣、血糖和乳酸均正常。（II）HI損傷後，與對照組和NTAir組相比，在NT和HT吸70%氙氣組PCO2、pH較低，而HTAir組和HT50%Xe組僅有pH較低。HT70%Xe組PCO2最高、pH最低，鎮靜效果最好。
結論：在HI損傷後，70%氙氣與吸空氣和對照組在NT 和HT都能產生鎮靜、呼吸抑制、CO2瀦留和pH下降。50%的氙氣則避免了這些影響。
（潘方立 譯 陳傑 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.
手法穩定氣管插管期間的頸椎移動：直接喉鏡法與GlideScope視頻喉鏡法的比較
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：對於頸椎有潛在病損的患者，採用何種最佳氣管插管技術仍然具有爭議。作者運用連續螢光照相，進行了一項前瞻性研究，比較直接喉鏡法（DL）與GlideScope視頻喉鏡法（GVL）氣管插管時頸椎移動，期間由助手手法保持患者頭部的穩定。
方法：選擇20例沒有頸椎病變的患者。在全麻誘導使用神經肌肉阻滯後，隨機採用DL或GVL行氣管插管。拍攝插管期間頸椎移動的螢光顯像照片，並將其分成四個階段：氣道操作前的基礎圖像，顯現聲門，氣管導管進入聲門，氣管插管。測定每位患者每個階段枕部至C5活動的峰值，計算平均值，利用兩因素方差分析比較每種方法產生的頸椎移動。對枕部至C1分別旋轉10，15或20度的患者的比例，和聲門顯現的質量同樣做了研究。
結果：各個階段的頸椎平均移動度在DL和GVL之間沒有顯著差異（P在0.22～0.70）。兩種插管技術對頸椎產生的移動主要都是使頸椎前端伸展，且主要發生在顯露聲門時。在枕部至C1的伸展幅度大於10，15或20度的這部分患者中插管基本沒有困難。GVL對聲門的顯露明顯優於DL。
結論：在全身麻醉使用神經肌肉阻滯的情況下，手法保持頭部穩定，採用GVL與DL進行氣管插管時前者更好地顯露聲門，但並不能減少對非病理性頸椎的移動度。
（印潔敏 譯 陳傑 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.
一項前瞻性隨機雙盲研究測定胸段硬膜外給新斯的明對腹主動脈術後腸麻痹的影響
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：腸梗阻是腹主動脈術後胃腸道主要的併發症之一，可導致死亡率增加，住院時間延長和醫藥費的增加，在這項研究中作者評估了胸段硬膜外給與新斯的明對腹主動脈術後腸麻痹的作用。
方法： 45名行腹主動脈手術的患者參與了這項研究，所有的患者接受一致的全麻與硬膜外麻醉。全麻誘導前在T7-T8椎間隙置入硬膜外導管，15min後給予0.5%布比卡因20ml。分別在手術結束以及術後8h經硬膜外導管給予單次劑量新斯的明（1ug/kg，生理鹽水稀釋成5ml，1組），對照組（2組）同樣的途徑給5ml生理鹽水。術後入ICU病房，記錄腸鳴音次數以及每日排氣排便次數。
結果：1組較2組，第一次腸鳴音和排氣時間明顯縮短（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）。兩組病人第一次排便時間相似(p>0.05)。2組比1組病人噁心發生率高（p<0.05），兩組病人術後併發症發生率相似(p>0.05)
結論：胸段硬膜外給新斯的明促進腸鳴音恢復，縮短腹主動脈術後腸持麻痹續時間。
（宋翠俠 譯 陳傑 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.
一氧化氮合酶抑制劑和環氧合酶抑制劑在小鼠甲醛誘導疼痛中的相互作用：一項等輻射分析研究
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:關於NO和COX在角叉菜膠誘導的炎症反應中對前列腺素生成的相互作用已經有報導。但是，關於iNO抑制因數和COX抑制因數在痛覺中相互作用的報導則很少。因此，本研究意在評價S-甲基異硫脲硫酸鹽（中度選擇性iNO抑制因數）與羅非考昔（選擇性COX-2抑制因數）和甲酚那酸（非選擇性抑制因數）在小鼠甲醛誘導痛中的相互作用。
方法：通過對小鼠甲醛誘導痛的後期表現，即在注射甲醛後小鼠舔其後爪所花費的時間來研究S-甲基異硫脲硫酸鹽、羅非考昔、甲酚那酸及將其混合使用時的劑量反應關係。這種相互作用通過將三種藥物同時給藥或將S-甲基異硫脲硫酸鹽與每一COX抑制因數混合給藥來評估。而其相互作用則通過等輻射法進行分析。
結果：單獨給藥時在甲醛誘導的後期可產生劑量依賴性抑制，其效價的強弱次序為羅非考昔>甲酚那酸>S-甲基異硫脲硫酸鹽。而對混合劑即S-甲基異硫脲硫酸鹽和羅非考昔，或甲酚那酸的等輻射分析則顯示有協同作用。對於相同的混合物實驗獲得的ED50要比理論上相加獲得的ED50明顯低，這驗證了iNOS或NO及COX亞型的協同作用。
結論：研究發現NOS和COX抑制因數在小鼠甲醛誘導痛中有明顯的協同作用，為疼痛控制提供了一個可行的方法。
（潘錢玲 譯 陳傑 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.
改良乳房根治術術後羅呱卡因連續傷口浸潤麻醉與單次椎旁神經阻滯的比較
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：連續浸潤麻醉與胸段椎旁神經阻滯用於乳房手術後的效能至今未作過對比研究。在這個研究中，作者評估乳房切除術後兩者的鎮痛作用和嗎啡鎮痛用量。
方法：48名接受腋窩切開改良乳房根治術患者隨機接受0.5%羅呱卡因20ml的術前胸段椎旁神經阻滯或0.5%羅呱卡因連續性浸潤麻醉，浸潤麻醉的輸注速度為2ml/h，方式是在術畢時放置兩根導管在手術部位的皮下，導管留置術後24小時。所有患者都接受全身麻醉。記錄術後24h嗎啡用量，疼痛評分和疼痛限制的肩關節活動，以及併發症的發生率，包括術後噁心嘔吐。
結果：兩組的嗎啡用量相近。兩者疼痛評分均較低。術後4h，胸段椎旁神經阻滯組在術後疼痛與疼痛限制性活動方面較輕，而在術後16h和24h，連續性局部浸潤麻醉組優於胸段椎旁神經阻滯組。連續性局部浸潤麻醉組中術後噁心嘔吐的發生率相對頻繁。
結論：腋窩切開乳房切除術後，連續性傷口局部浸潤麻醉為較好的椎旁神經阻滯替換方法。
（陳偉 譯 陳傑 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： 在顱縫早閉的修復過程中，由於大量失血和凝血因數的消耗及稀釋常導致的凝血異常，所以建議運用冷沉澱物、新鮮冰凍血漿和血小板進行治療。但是在大多數的歐洲國家冷沉澱物並不常備，新鮮冰凍血漿在糾正纖維蛋白原缺乏方面的有效性也很有限。我們報導了我們用人纖維蛋白原濃縮物（Hemocomplettan®）來改善兒童受損的纖維蛋白原聚合的經驗。
方法： 我們從進行大顱面手術的連續九例小兒的麻醉記錄單、用藥記錄、實驗室和血栓彈力圖（ROTEM®）資料庫，回顧性收集例行凝血試驗結果、ROTEM®、補液需要量、給予的人纖維蛋白原濃縮物和術後病程的數據。
結果： 九個小兒年齡為12（8，22）個月，體重為9.5（9，10）kg，手術持續時間為6.4（4.5，7.2）小時，術中估計出血為估計血容量的80%（49%，92%），以上資料表示方法為中位數（25%，75%百分位數）。由ROTEM®檢測到的纖維蛋白素原聚合作用受損是稀釋性凝血功能紊亂的主要根本問題。所有病例（如果需要）均通過反復給予人纖維蛋白原濃縮物（每次劑量30 mg/kg）而不輸注冰凍新鮮血漿和血小板達到了有效的止血，且無不良反應。所有小兒均在術後幾小時內順利脫離機械通氣，並儘快就能離開重症監護病房。
結論： 給予纖維蛋白原濃縮物可以有效改善小兒顱縫早閉手術中稀釋性凝血病的主要根本問題，即纖維蛋白素原的聚合和總體的凝血強度。
（薑旭暉 譯 馬皓琳 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.
多功能襯墊式充氣加溫系統在近常溫的體外迴圈下心臟外科手術中的效果
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：一種新的襯墊式充氣加溫系統已可用於心臟外科手術。本試驗目的是驗證在近常溫體外迴圈手術中，標準體溫保護聯合襯墊式充氣加溫是否可以維持術中核心溫度，減少停機後體溫下降（體外迴圈停止後60min核心溫度下降最多）。
方法：常規、非急症心臟外科手術患者隨機分為兩組：常規體溫保護組（輸液加溫以及消極隔離，n=30）和常規保溫聯合使用積極的襯墊式充氣加溫系統（n=30 Arizant Healthcare Model
635, Eden Prairie, 明尼蘇達州）。圍術期用膀胱導管每15分鐘記錄核心體溫。比較兩組CPB前、CPB中及CPB後溫度差異。
結果：由於各種原因4例患者資料被剔除，剩餘常規處理組29例和充氣加溫組27例。兩組最初溫度相似，但充氣加溫組在體外迴圈開始時溫度高於常規處理組（36.3°C ± 0.6°C比35.7°C ± 0.7°C, P = 0.002）。兩組體外迴圈中最低溫度（充氣組35.5°C ± 1.5°C比常規組35.3°C ± 1.3°C, P = 0.67）、體外迴圈結束時體溫（36.7°C ± 0.4°C比36.6°C ± 0.4°C, P > 0.99）及出手術室即刻的體溫（36.5°C ± 0.4°C比36.2°C ± 0.5°C, P = 0.36）均無差異。後下降兩組也無顯著差異（充氣加溫組0.03°C ± 0.54°C比常規組0.21°C ± 0.51°C，P = 0.20）。
結論：在近常溫體溫管理中加入聯合襯墊式充氣加溫系統能夠顯著提高體外迴圈前的體溫，但對核心溫度無更多的臨床重要影響。
（邱鬱薇 譯 馬皓琳 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.
適用於以麻醉為基礎的小兒慢性疼痛醫療方案的病兒群體的臨床特點
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：小兒慢性疼痛非常常見，且導致很多醫療費用，是個人和公眾都關注的健康問題。本研究的主要目的是為建立一個適用於以麻醉為基礎的小兒慢性疼痛治療方案的病兒的描述性臨床輪廓。我們打算將這個病人輪廓充當為需要評估的更正式人群的替代者。
方法：本研究使用定量觀察方法。獨立研究變數包括初步的疼痛相關診斷、疼痛症狀的持續時間、病人年齡、病人性別、保險狀態、完整的生物學家系單位、全日制學校出勤率、在家學習及抑鬱和/或焦慮共病。用以往研究證實很有效的一系列測量儀錶，從屬的研究變數包括病人自述的疼痛程度、病人自述或家長代述的健康相關的生活質量、不良家庭影響和父母滿意度。研究資料的收集發生於到慢性疼痛醫療診所初診時，但和醫護人員接觸前。
結果：研究物件(n =
100)大多是青少年女性，其慢性疼痛持續時間大於1年，疼痛常伴有臨床上明顯的焦慮和抑鬱。與國家和州立標準比較，生物學家系單位不完整 (P
< 0.001)、不能參加全日制學校的學習 (P
< 0.001)和需要家居教育(P < 0.001) 的百分比顯著不成比例。95%的本群患兒先前至少由一個其他亞專科治療過其慢性疼痛狀況。平均患兒自述或家長代述的健康相關生活質量評分（PedsQL總分）也明顯低於以前在風濕病患兒（P
< 0.0001）、偏頭痛患兒（P
< 0.0001）和癌症患兒 (P
< 0.0001) 觀察到的PedsQL總分值。
結論：患有慢性疼痛的病兒在接受麻醉為基礎的慢性疼痛治療計畫之前，大多接受過其他亞專科的治療，其健康相關的生活質量明顯較低。用常規方法估計慢性疼痛患兒健康相關的生活質量非常簡便，而且有實際意義。還需要將注意力集中于病兒應對機制的能力的連貫描述、有無使疼痛增強或減輕的父母行為，以及已經存在的父母疼痛和殘疾。
（張瑩譯 馬皓琳 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
我們比較了孩子行門診手術的母親和自己行手術的女性病人的焦慮。我們發現母親與行腹部較大手術的病人有相似的焦慮，而與行較小手術的病人相比更為焦慮。母性焦慮的預測因素是孩子的年齡和母性的監護應對。
（彭中美 譯 馬皓琳 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.
大鼠的肝臟缺血再灌注損傷模型中七氟醚與異氟醚麻醉的肝能量代謝及其不同的保護效應
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：我們研究了異氟醚和七氟醚對加溫的肝缺血再灌注（IR）模型中的細胞因數、肝組織的血流（HTBF）、貯能量及肝臟結構的影響。
方法：將72只Wistar鼠隨機分成3組：對照組，不進行吸入麻醉；七氟醚組，2%的七氟醚；異氟醚組，1.5%的異氟醚。在進行吸入麻醉30分鐘後，使這些大鼠肝缺血45分鐘及2小時和4小時的再灌注。在缺血期末、再灌注2小時、再灌注4小時分別處死一部分鼠。通過檢測天冬氨酸轉氨酶（AST）、丙氨酸轉氨酶（ALT）、HTBF、丙二醛、腫瘤壞死因數（TNF）-_files/image079.gif){kind=small}
、白細胞介素(IL)-1β、能荷以及組織學檢查來評估肝臟損傷的程度。
結果：對照組和異氟醚組血清丙氨酸轉氨酶和天冬氨酸轉氨酶的水平相似，而七氟醚組在缺血後階段明顯降低（P < 0.01）。七氟醚組的HTBF顯著優於異氟醚組，而對照組較差。組織的丙二醛水平在再灌注2小時後七氟醚組明顯低於異氟醚組，而在對照組的缺血後階段達到最大值。在缺血後、再灌注2小時和4小時中，腫瘤壞死因數-_files/image080.gif){kind=small}
及白細胞介素-1β在七氟醚組最低，在對照組最高，但是沒有統計學意義（P > 0.05）。在七氟醚組，肝的三磷酸腺苷和能荷在所有測量時間點都明顯較高。在七氟醚及異氟醚組內，在缺血後階段的能荷比較低。七氟醚組的肝細胞損傷程度最小。
結論：在肝臟缺血前、缺血時、缺血後給予臨床上適當濃度的七氟醚都能很好的保護肝臟免於缺血再灌注損傷，而異氟醚對肝缺血再灌注損傷的效應不是很顯著。
（唐亮 譯 馬皓琳 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.
高血糖減弱異氟烷在血管平滑肌細胞中誘導的ATP敏感的鉀通道啟動作用
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：異氟烷啟動血管ATP敏感鉀（ＫATP）通道，並可引起血管擴張。本研究中，我們探討高血糖是否改變異氟烷對血管ＫATP通道的啟動作用。
方法：血管平滑肌細胞分別在含正常葡萄糖(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)的培養基中孵育24ｈ後，我們使用細胞粘附式的膜片鉗方法測試異氟烷對ＫATP通道活性的影響。主動脈中的過氧化物水平通過光澤精增強的化學發光技術進行測定。
結果：與NG（0.17 ± 0.02）和LG（0.15 ± 0.02）相比，HG（0.06 ± 0.01）孵育的動脈血管平滑肌細胞中異氟烷誘導的開放概率明顯減少（P 均< 0.05）。蛋白激酶C（PKC）的抑制劑（鈣磷酸蛋白C和PKC抑制劑20–28）預處理血管平滑肌細胞明顯減少HG對異氟烷誘導ＫATP通道活性的抑制作用。同時，PKC的啟動劑PMA可模擬HG的作用。HG孵育的動脈中過氧化物釋放明顯增加（18.3 ± 11.5相對光單位（RLU）· s–1 · mg–1;
與NG比較P < 0.05）。用一種細胞滲透性過氧化物清除劑聚乙烯乙二醇－過氧化物歧化酶（250 U/mL）同時孵育，顯著減少HG誘導的過氧化物的增加，但無法減少HG對異氟烷誘導ＫATP通道活性的抑制作用。
結論：我們的實驗結果提示高血糖的代謝性應激可以削弱異氟烷誘導的血管KATP通道啟動作用（經過度啟動PKC介導）。在圍術期高血糖患者中，這可能妨礙其冠狀動脈對異氟烷的舒張反應從而導致缺血或缺氧。
（黃施偉 譯，馬皓琳 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.
志願者中光譜熵預測聽覺知曉
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
背景資料：從一個病人的角度看，術中記憶喪失是全麻的一個重要部分。在沒有特異性的方法來減少術中知曉的情況下，其發生率在普外科手術人群中約為0.2%，且可能在某些亞人群中會更高。我們嘗試檢驗了一種新的以光譜熵為基礎的臨床腦電圖監測儀預測知曉的有效性。
方法：我們用非盲交叉設計對16名志願者進行研究，來評價丙泊酚或七氟醚鎮靜過程中，光譜熵與行為指標之間的相關性。我們考慮到的指標包括單詞知曉和對於口頭指令的運動反應。同時我們測定了口頭指令對腦電圖熵的刺激性作用。用對數回歸、受試者操作特性以及預計概率來分析資料。
結果：狀態熵和反應熵與兩個反應指標均密切相關。在多種情況下這些參數的預計概率範圍在0.85到0.96之間。口頭指令運動反應以劑量和藥物依賴性方式增高熵。
結論：在這群年輕健康的志願者中熵參數看來是預測知曉的可靠指標。這些研究結果認為將這些研究延伸到其他麻醉藥和手術病人是合理的。
（沈浩 譯 馬皓琳 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：伴隨著分娩鎮痛起效的母體兒茶酚胺改變包括腎上腺素（EPI）減少，但是去甲腎上腺素(NE)不變。因為在迴圈濃度中EPI以β腎上腺能作用為主，而NE以α腎上腺能作用為主，因此我們推斷這樣的改變會引起子宮小動脈的收縮。
方法：從18只臨產Sprague-Dawley大鼠中分離出來的子宮微血管（內徑73–120 µm），在保持近于正常氣壓的無流量狀態下用電鏡觀察。腔外給藥到表面灌流儲水池，並記錄血管穩態下的內徑。分別建立NE及NE中加入腎上腺素能拮抗劑呱唑嗪、EPI（類血栓素U46619預收縮血管20%－30％後）及EPI中加入β腎上腺素能拮抗劑普萘洛爾和10–8 M EPI存在時給予NE的劑量效應曲線。洗出試驗模擬分娩鎮痛起效過程中母體兒茶酚胺的變化：同時加入10–8 M的EPI 和10–6.5 M的NE (EC50)，然後只用NE洗，接著用β2腎上腺素能激動劑特布他林和NE。洗出規程在有普萘洛爾存在的情況下再重複一遍。
結果：NE引起劑量依賴性的血管收縮(P < 0.0001)，可以被呱唑嗪阻斷(P < 0.0001)。EPI加到經過U46619預收縮的微血管後，在低濃度時可以引起血管擴張，高濃度時引起血管收縮(P < 0.0001)。普萘洛爾可以逆轉這種單相的劑量依賴性血管收縮反應(P < 0.0001)。用10–8 M EPI預處理沒有經過預收縮的血管，可以顯著減弱NE引起的血管收縮作用(P < 0.0001)。在洗出試驗中，在NE持續存在的情況下，除出EPI可以引起血管收縮，且這種收縮作用可以被特布他林逆轉。普萘洛爾可以阻斷EPI和特布他林的作用。
結論：這些結果表明，EPI在產婦血漿中發現的濃度下可以擴張子宮阻力血管，並減弱由NE引起的血管收縮作用。這個觀察結果可能提示了人類孕婦分娩鎮痛起效時伴隨的子宮血流變化，因為有效的鎮痛伴隨著迴圈EPI水平的急性下降。
（黃佳佳譯，馬皓琳 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：加壓素是一種心肺復蘇時選用的藥物，因為一些實驗研究已顯示，其在增加全身組織的灌注壓和改善腦灌注壓且不增加心肌氧耗方面優於腎上腺素。我們使用軟膜窗孔製品，觀察加壓素局部用於兔軟膜血管上時的作用及兔腦缺血後作用是否改變(n = 27)。
方法：我們首先檢驗局部應用精氨酸加壓素(AVP) (10–11 M、10–9 M、10–7 M及10–5 M，連續地)的作用。然後我們通過頸部驅血帶充氣加全身性低血壓，或單純全身性低血壓導致腦缺血5分鐘，並觀察腦缺血前後局部應用AVP(10–9 M及10–7 M, 連續地)的作用。
結果：(a)10–11
M AVP可擴張軟膜小動脈的直徑[7%
± 11% (P =
0.014 與基礎值比較)]，但10–9 M、10–7 M及10–5 M AVP可收縮軟膜小動脈直徑[分別為7% ± 14%、20% ± 14%及16% ± 16% (P 均< 0.05)]，(b)低血壓前可收縮軟膜小動脈直徑(10–9 M AVP 收縮7% ± 10%, 10–7
M AVP收縮20% ± 15%)，缺血前可收縮軟膜小動脈直徑(10–9 M AVP 收縮7% ± 11%，10–7 M AVP 收縮21% ± 15% )。然而，缺血後5分鐘，由10–7 M AVP引起的血管收縮作用明顯下降，但不單是由於低血壓[低血壓對照組：10–9 M AVP 收縮7% ± 10%，10–7 M AVP 收縮19% ± 14%；缺血組：10–9 M AVP 收縮5% ± 11%，10–7 M AVP 收縮10% ± 13%(P = 0.35 與低血壓組對照)]。
結論：AVP的局部應用（這裏使用的最低濃度除外）可引起麻醉兔軟膜小動脈濃度依賴性血管收縮。在短暫（5分鐘）的腦缺血後，10–7 M AVP的血管收縮作用減少。
（裘毅敏譯，馬皓琳 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.
在接受異丙酚複合芬太尼麻醉的患者中神經肌肉阻滯水平對強直後運動誘發電位的幅度和經顱刺激的運動反應的影響
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：監測肌源性運動誘發電位（MEPs）過程中患者對經顱刺激的活動反應可能干擾手術。我們最近報導了一種可以增強肌源性MEPs幅度的新技術叫做“強直後MEPs(p-MEPs)”，該技術在經顱刺激前給予外周神經強直刺激。我們進行本研究來確定集中于患者運動的p-MEPs監測中神經肌肉阻滯的適當水平。
方法：15名異丙酚/芬太尼麻醉患者，記錄拇展肌對經顱電刺激反應的傳統MEPs (c-MEPs)和p-MEPs。記錄p-MEPs時，在經顱刺激前6秒先給予脛後神經一個50mA強度、持續5秒的強直刺激。通過記錄對腕部正中神經超強電刺激的反應中的拇外展短肌複合肌肉動作電位(T1)的幅度來評估神經肌肉阻滯的水平。記錄T1為對照值的50％時的c-MEP和p-MEP基線後，注射0.1 mg/kg維庫溴銨並記錄c-MEPs和p-MEPs幅度。用範圍為1到4的運動評分評估患者運動（1=沒有運動，4＝劇烈運動）。
結果：T1、%T1、c-MEPs和p-MEPs的幅度及運動評分在給予維庫溴銨後平行改變。在維庫溴銨投藥前和投藥後15－45分鐘p-MEPs的幅度比c-MEPs明顯高。當T1和％T1分別小於和等於1mV和10％時，所有患者的運動評分為1或2，提示顯微鏡手術是能做得到的，而不會干擾手術操作。當T1在1 mV (0.8–1.2 mV)左右時，記錄c-MEPs和p-MEPs的成功率分別是73% (11/15)和100% (15/15)。
結論：異丙酚/芬太尼麻醉下，T1為1mV時可以記錄p-MEP，這時患者對經顱刺激的運動反應不會干擾手術。這種技術可以用於不存在術前運動缺陷的患者，否則在手術操作中的患者運動不太可取。
（唐李雋 譯 馬皓琳 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.
塞來考昔圍手術期給藥與僅僅在術後給藥對接受大的整形外科手術病人術後影響的比較
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：圍手術期應用環氧合酶(COX)-2抑制劑一直有著爭議。有一種假設是在大整形手術的術前或者術後應用塞來考昔並且在手術後連續應用三天能提高病人鎮痛效果以及改善臨床預後，我們設計這次隨機、雙盲、安慰劑對照實驗的目的就是為了證明這一假設。這次實驗的另外一個目的是為了弄清圍手術期應用塞來考昔是否比單單在術後應用更有優勢。
方法：120名接受大的整形外科手術（比如隆胸，腹壁成形術）的知情同意過的病人施行標準全身麻醉，被隨機分成了下面三組：1）對照組（n=40）術前和術後分別口服兩粒安慰劑，並且在術後三天口服安慰劑，一粒BID；2）術後給藥組（n=40）術前口服兩粒安慰劑，術後口服兩粒塞來考昔（一粒200mg），術後三天口服塞來考昔，一粒200mg BID；3）圍手術期給藥組（n=40）術前30－90分鐘口服兩粒塞來考昔（一粒200mg），術後口服兩粒安慰劑，術後三天口服塞來考昔，一粒200mg BID。術後每隔一定時間記錄下患者的疼痛評分、對鎮痛藥的需求以及不良反應。在手術後的第24、48、72小時以及第七天隨訪評價患者的出院後疼痛、鎮痛需求、腸功能的恢復、日常活動的恢復、康復的質量以及病人對疼痛控制的滿意程度。
結果：與對照組相比，應用塞來考昔的兩組在術後首個三天在減少術後疼痛以及對阿片類鎮痛藥的需求上有著相似且明顯的效果(P < 0.01)。在應用塞來考昔的兩組中，病人腸功能和日常活動的恢復時間分別比對照組早1天和2天。另外，在應用塞來考昔的兩組中，病人對疼痛控制和康復質量的滿意度明顯比對照組提高(P < 0.05)。
結論：手術當天以及術後三天口服塞來考昔400mg能有效改善大的整形外科手術病人術後的控制疼痛以及康復速度和質量。然而，圍手術期給藥與僅僅在術後給藥相比並沒有優勢。
（吳進 譯 馬皓琳 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.
鞘內注射環氧化酶-1抑制劑、環氧化酶-2抑制劑或非選擇性抑制劑對疼痛行為和脊髓Fos樣免疫反應的影響
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：前列腺素由環氧化酶（COX）合成，被認為在傷害性感受在脊髓的傳遞中起重要作用。Fos的表達是脊髓神經元活化的指標。我們檢驗了鞘內注射選擇性和非選擇性COX抑制劑對脊髓C-Fos表達的影響。
方法：為檢驗COX-1和COX-2在脊髓傷害性感受傳遞中的相對作用，我們檢測了選擇性COX-1抑制劑SC560、選擇性COX-2抑制劑塞來考昔和非選擇性COX抑制劑酮咯酸對福馬林誘發的行為和脊髓類c-Fos免疫反應（FLI）的影響。大鼠在後爪足底皮下注射福馬林（5%，50μL）前分別鞘內注射上述藥物（30、60或90µg）。對照組在注射福馬林前鞘內注射溶劑。
結果：給予塞來考昔或酮咯酸90µg的大鼠第一相縮爪行為減少，給予各劑量酮咯酸或90µg塞來考昔的大鼠第二相縮爪行為減少（P <
0.05）。給予塞來考昔或酮咯酸90µg的大鼠脊髓第I–II層區FLI明顯減少（P < 0.05）。相反，在脊髓第V–VI層區僅酮咯酸60µg或90µg組出現FLI的大量減少（P < 0.05）。在脊髓第V–VI層區的FLI表達與第二相縮爪行為有顯著相關性（(P < 0.05)。
結論：COX-1和COX-2的雙效抑制劑既抑制福馬林誘發的行為也抑制脊髓腰段各區FLI表達。FLI在脊髓第I–II層區的表達可能不是藥物產生抗-超敏反應能力的良好指標，而FLI在脊髓第V–VI層區的表達與第二相行為反應相關。
（顏濤 譯，馬皓琳 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.
患者自控持續斜角肌間溝阻滯能促進開放性肩部手術後的早期功能康復嗎？
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：肩部手術後早日活動在成功的功能康復中起重要作用。然而，術後疼痛常減少甚至妨礙有效的物理治療。我們研究了開放性肩部手術後由患者自控斜角肌間溝阻滯技術產生的鎮痛對早期功能康復的影響。
方法：87例患者隨機分成兩組：患者自控持續斜角肌間溝阻滯組（patient-controlled continuous
interscalene block ，PCISB）和患者自控靜脈（阿片類）鎮痛組（patient-controlled analgesia，PCA）。術前行斜角肌間溝阻滯，另外鎮痛方案在麻醉後監護室中開始進行並持續72小時。術後第2、3天每天進行60min標準化物理治療。最大活動度被定義為在疼痛這個限制因素下所能達到的活動範圍。在術前1天和術後3天用能評估疼痛、日常生活活動、運動的力度和範圍的多模式評分系統（常數評分）來評價功能康復的效果。還通過術後72h和院內物理治療過程中的視覺類比評分來監測最大疼痛強度。
結果：斜角肌間溝阻滯的常數評分等級顯著提高。然而，兩組間可動性和力量亞評分無顯著差異。與PCA比較，6h（P < 0.001）、24h （P = 0.044）和72h（ P = 0.013）時的靜息疼痛評分以及術後48h時物理治療過程中的疼痛評分(P = 0.016) 證明PCISB更有效。
結論：與基於阿片類的PCA比較，PCISB改善鎮痛，但不促進肩關節早期功能恢復。
（朱 慧譯 馬皓琳 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