Table of Contents
September 2008
CARDIOVASCULAR ANESTHESIOLOGY:
吸入低濃度七氟烷增強抗消化性潰瘍藥物替普瑞酮的遲發性心臟保護作用
王宏 譯
馬皓琳 李士通 校
Low-Dose
Sevoflurane Inhalation Enhances Late Cardioprotection from the Anti-Ulcer Drug Geranylgeranylacetone
Hiroshi Kitahata, Junpei Nozaki, Shinji Kawahito, Takehito Tomino, and Shuzo Oshita
Anesth Analg 2008 107: 755-761.
胡豔譯 薛張剛校
The
Mechanism of Helium-Induced Preconditioning: A Direct Role for Nitric Oxide in
Rabbits
Paul S. Pagel, John G. Krolikowski, Phillip F. Pratt, Jr, Yon Hee Shim, Julien Amour, David C. Warltier, and Dorothee Weihrauch
Anesth Analg 2008 107: 762-768.
抑制糖原合成激酶或細胞凋亡蛋白p53降低了氦在體心肌保護的閾值：線粒體通透性的作用
潘方立 譯 陳傑 校
Inhibition
of Glycogen Synthase Kinase or the Apoptotic Protein p53 Lowers the Threshold
of Helium Cardioprotection In Vivo: The Role of Mitochondrial
Permeability Transition
Paul S. Pagel, John G. Krolikowski, Phillip F. Pratt, Jr, Yon Hee Shim, Julien Amour, David C. Warltier, and Dorothee Weihrauch
Anesth Analg 2008 107: 769-775.
江繼宏 譯
馬皓琳 李士通 校
Attenuation
of Isoflurane-Induced Preconditioning and Reactive Oxygen Species Production in
the Senescent Rat Heart
Long T. Nguyen, Mario J. Rebecchi, Leon C. Moore, Peter S. A. Glass, Peter R. Brink, and Lixin Liu
Anesth Analg 2008 107: 776-782.
黃凝譯 薛張綱校
The
Efficacy of Aprotinin in Arterial Switch Operations in Infants
Chinnamuthu Murugesan, Sanjay Kumar Banakal, Rajnish Garg, Shankaraiah Keshavamurthy, and Kanchi Muralidhar
Anesth Analg 2008
107: 783-787.
PEDIATRIC ANESTHESIOLOGY:
硫噴妥鈉/七氟醚麻醉下小兒的正中神經軀體感覺誘發電位及酮基布洛芬和芬太尼的對其的附加作用
周姝婧 譯 陳傑 校
Somatosensory
Evoked Potentials by Median Nerve Stimulation in Children During
Thiopental/Sevoflurane Anesthesia and the Additive Effects of Ketoprofen and
Fentanyl
Susanna Westerén-Punnonen, Heidi Yppärilä-Wolters, Juhani Partanen, Kari Nieminen, Antti Hyvärinen, and Hannu Kokki
Anesth Analg 2008 107: 799-805.
張瑩譯 馬皓琳 李士通校
The Effect of Propofol Concentration on Dispersion of Myocardial Repolarization in Children
Helen V. Hume-Smith, Shubhayan Sanatani, Joanne Lim, Anthony Chau, and Simon D. Whyte
Anesth Analg 2008 107: 806-810.
蔣宗明譯 薛張綱校
Extra-1
Acupressure for Children Undergoing Anesthesia
Shu-Ming Wang, Sandra Escalera, Eric C. Lin, Inna Maranets, and Zeev N. Kain
Anesth Analg 2008
107: 811-816.
AMBULATORY ANESTHESIOLOGY:
於章傑 譯 陳傑 校
The
Dose–Response of Nitrous Oxide in Postoperative Nausea in Patients Undergoing
Gynecologic Laparoscopic Surgery: A Preliminary Study
Boris Mraovic, Tatjana Simurina, Zdenko Sonicki, Neven Skitarelic, and Tong J. Gan
Anesth Analg 2008 107: 818-823.
張曦 譯，馬皓琳 李士通 校
The
Duration of Intrathecal Bupivacaine Mixed with Lidocaine
Sung-Jin Lee, Sun-Joon Bai, Jong-Seok Lee, Won-Ok Kim, Yang-Sik Shin, and Ki-Young Lee
Anesth Analg 2008
107: 824-827.
ANESTHETIC PHARMACOLOGY:
我們是否還需要一個新的例證來闡明吸入性麻醉藥產生麻醉效應的機制？
劉沁譯 薛張綱校
Is a New
Paradigm Needed to Explain How Inhaled Anesthetics Produce Immobility? (Review
Article)
Edmond I. Eger,
II, Douglas E. Raines, Steven L. Shafer, Hugh C. Hemmings, Jr, and James M.
Sonner
Anesth Analg 2008 107: 832-848.
趙嫣紅 譯 陳傑 校
A
Hypothesis on the Origin and Evolution of the Response to Inhaled Anesthetics (Review
Article)
James M. Sonner
Anesth Analg 2008
107: 849-854.
表面活性物質對受體功能的麻醉藥樣調變：對麻醉介面理論的一個檢驗
黃施偉 譯，馬皓琳 李士通 校
Anesthetic-Like Modulation of Receptor Function by Surfactants: A Test of the Interfacial Theory of Anesthesia
Liya Yang and James M. Sonner
Anesth Analg 2008
107: 868-874.
劉婷潔譯 薛張綱校
Intrathecal
Veratridine Administration Increases Minimum Alveolar Concentration in Rats
Yi Zhang, Manohar Sharma, Edmond I. Eger, II, Michael J. Laster, Hugh C. Hemmings, Jr, and R. Adron Harris
Anesth Analg 2008 107: 875-878.
懷曉蓉 譯 陳傑 校
Increases
in Spinal Cerebrospinal Fluid Potassium Concentration Do Not Increase
Isoflurane Minimum Alveolar Concentration in Rats
Dimitry Shnayderman, Michael J. Laster, Edmond I. Eger, II, Irene Oh, Yi Zhang, Steven L. Jinks, Joseph F. Antognini, and Douglas E. Raines
Anesth Analg 2008 107: 879-884.
顏濤 譯，馬皓琳 李士通 校
Isoflurane
Prevents Nicotine-Evoked Norepinephrine Release from the Mouse Spinal Cord at
Low Clinical Concentrations
Thomas J. Rowley and Pamela Flood
Anesth Analg 2008
107: 885-889.
TECHNOLOGY, COMPUTING, AND SIMULATION:
紅外測量人類呼吸中的二氧化碳：回顧從Tyndall到現在的“呼吸通過”裝置
唐亮 譯 馬皓琳 李士通 校
Infrared
Measurement of Carbon Dioxide in the Human Breath: "Breathe-Through"
Devices from Tyndall to the Present Day (Special
Article)
Michael B. Jaffe
Anesth Analg 2008 107: 890-904.
秦敏菊譯 薛張綱校
A Pilot
Study of Neonatal and Pediatric Esophageal Pulse Oximetry (Technical
Communication)
Panayiotis A. Kyriacou, Deric P. Jones, Richard M. Langford, and Andy J. Petros
Anesth Analg 2008
107: 905-908.
PATIENT SAFETY:
葉樂 譯 陳傑 校
An In-Vivo Metabolic Test for Detecting
Malignant Hyperthermia Susceptibility in Humans: A Pilot Study
Frank Schuster, Thomas Metterlein, Sabrina Negele, Peter Kranke, Ralf M. Muellenbach, Ulrich Schwemmer, Norbert Roewer, and Martin Anetseder
Anesth Analg 2008 107: 909-914.
施穎譯 薛張綱校
Patients with Difficult Intubation May Need Referral to Sleep Clinics
Frances Chung, Balaji Yegneswaran, Francisco Herrera, Alex Shenderey, and Colin M. Shapiro
Anesth Analg 2008
107: 915-920.
CRITICAL CARE AND TRAUMA:
張磊 譯 陳傑 校
Determinants
of Tidal Volumes with Adaptive Support Ventilation: A Multicenter Observational
Study
Dave A. Dongelmans, Denise P. Veelo, Alexander Bindels, Jan M. Binnekade, Kees Koppenol, Matty Koopmans, Joke C. Korevaar, Michael A. Kuiper, and Marcus J. Schultz
Anesth Analg 2008 107: 932-937.
吳進 譯
馬皓琳 李士通 校
Adaptive
Support Ventilation with Percutaneous Dilatational Tracheotomy: A Clinical
Study (Brief
Report)
Denise P. Veelo, Dave A. Dongelmans, Pauline Middelhoek, Johanna C. Korevaar, and Marcus J. Schultz
Anesth Analg 2008 107: 938-940.
孫鵬飛譯 薛張綱校
Functional
Residual Capacity Changes After Different Endotracheal Suctioning Methods (Brief
Report)
Hermann Heinze, Beate Sedemund-Adib, Matthias Heringlake, Ulrich W. Gosch, and Wolfgang Eichler
Anesth Analg 2008
107: 941-944.
OBSTETRIC ANESTHESIOLOGY:
朱紫瑜 譯 陳傑 校
An
Evaluation of the Postoperative Antihyperalgesic and Analgesic Effects of
Intrathecal Clonidine Administered During Elective Cesarean Delivery
Patricia M. Lavand’homme, Fabienne Roelants, Hilde Waterloos, Valerie Collet, and Marc F. De Kock
Anesth Analg 2008 107: 948-955.
姜旭暉譯，馬皓琳，李士通校
Respiratory
Depression After Neuraxial Opioids in the Obstetric Setting (Review
Article)
Brendan Carvalho
Anesth Analg 2008
107: 956-961.
NEUROSURGICAL ANESTHESIOLOGY:
夏俊明譯 薛張綱校
Cerebral
Perfusion Pressure in Neurotrauma: A Review (Review
Article)
Hayden White and
Bala Venkatesh
Anesth Analg 2008
107: 979-988.
GENERAL ARTICLES:
陶穎瑩 譯 陳傑 校
Lengthening
of the Trachea During Neck Extension: Which Part of the Trachea Is Stretched?
David T. Wong, Hao Weng, Eunice Lam, Hai-Bao Song, and Jin Liu
Anesth Analg 2008 107: 989-993.
鋼絲強化矽樹脂管與Parker管及聚氯乙烯管用于正常氣道患者全麻下經喉罩插管的比較
裘毅敏譯，馬皓琳、李士通校
A Comparison
of a Silicone Wire-Reinforced Tube with the Parker and Polyvinyl Chloride Tubes
for Tracheal Intubation Through an Intubating Laryngeal Mask Airway in Patients
with Normal Airways Undergoing General Anesthesia
Ghassan E. Kanazi, Mohammed El-Khatib, Viviane G. Nasr, Romeo Kaddoum, Achir Al-Alami, Anis S. Baraka, and Chakib M. Ayoub
Anesth Analg 2008
107: 994-997.
ANALGESIA:
章一靜譯 薛張綱校
Transdermal Nicotine for
Analgesia After Radical Retropubic Prostatectomy
Ashraf S. Habib, William D. White, Magdi A. El Gasim, Gamal Saleh, Thomas J. Polascik, Judd W. Moul, and Tong J. Gan
Anesth Analg 2008 107: 999-1004.
丁俊雲 譯 陳傑 校
Transdermal
Nicotine Patch for Postoperative Pain Management: A Pilot Dose-Ranging Study
Daewha Hong, Jessamyn Conell-Price, Sean Cheng, and Pamela Flood
Anesth Analg 2008 107: 1005-1010.
朱慧譯 馬皓琳 李士通校
Transdermal
Nicotine Patch Failed to Improve Postoperative Pain Management
Alparslan Turan, Paul F. White, Onur Koyuncu, Beyhan Karamanliodlu, Gaye Kaya, and Christian C. Apfel
Anesth Analg 2008 107: 1011-1017.
宣麗真譯 薛張綱校
The Impact
of Blood Pressure and Baroreflex Sensitivity on Wind-Up
Ok Yung Chung and Stephen Bruehl
Anesth Analg 2008 107: 1018-1025.
舒慧剛 譯 陳傑 校
A
Systematic Review of Randomized Trials Evaluating Regional Techniques for
Postthoracotomy Analgesia
Girish P. Joshi, Francis Bonnet, Rajesh Shah, Roseanne C. Wilkinson, Frederic Camu, Barrie Fischer, Edmund A. M. Neugebauer, Narinder Rawal, Stephan A. Schug, Christian Simanski, and Henrik Kehlet
Anesth Analg 2008 107: 1026-1040.
持續輸注低劑量的氯胺酮改善頸椎手術後病人自控鎮痛的芬太尼的鎮痛效果
黃麗娜 譯 馬皓琳 李士通 校
Continuous
Low-Dose Ketamine Improves the Analgesic Effects of Fentanyl Patient-Controlled
Analgesia After Cervical Spine Surgery (Brief
Report)
Masanori Yamauchi, Makoto Asano, Masanori Watanabe, Soushi Iwasaki, Shingo Furuse, and Akiyoshi Namiki
Anesth Analg 2008 107: 1041-1044.
在小鼠損傷的背根神經元中通過恢復鈣內流可以糾正胞膜的過度興奮狀態
陳珺珺譯 薛張綱校
Restoration
of Calcium Influx Corrects Membrane Hyperexcitability in Injured Rat Dorsal
Root Ganglion Neurons
Quinn Hogan, Philipp Lirk, Mark Poroli, Marcel Rigaud, Andreas Fuchs, Patrick Fillip, Marko Ljubkovic, Geza Gemes, and Damir Sapunar
Anesth Analg 2008 107: 1045-1051.
杜唯佳 譯 陳傑 校
The
Antinociceptive Response to Nicotinic Agonists in a Mouse Model of
Postoperative Pain
Thomas J. Rowley, James Payappilly, Jeffery Lu, and Pamela Flood
Anesth Analg 2008 107: 1052-1057.
砷化鎵鋁（830nm）低水準鐳射預照射血液可增強大鼠外周內源性阿片類物質鎮痛作用
周雅春 譯 馬皓琳 李士通 校
Pre-Irradiation
of Blood by Gallium Aluminum Arsenide (830 nm) Low-Level Laser Enhances
Peripheral Endogenous Opioid Analgesia in Rats
Satoshi Hagiwara, Hideo Iwasaka, Akira Hasegawa, and Takayuki Noguchi
Anesth Analg 2008 107: 1058-1063.
結紮小鼠脊神經後，神經妥樂平通過啟動下行疼痛抑制系統起到鎮痛作用
陳珺珺譯 薛張綱校
The
Antiallodynic Effect of Neurotropin® Is Mediated via Activation of Descending
Pain Inhibitory Systems in Rats with Spinal Nerve Ligation
Ryohei Okazaki, Hiroyoshi Namba, Hiroyuki Yoshida, Hisashi Okai, Tomoshi Miura, and Minoru Kawamura
Anesth Analg 2008
107: 1064-1069.
REGIONAL ANESTHESIA:
劉世文 譯 陳傑 校
Ultrasound
Imaging Accurately Identifies the Lateral Femoral Cutaneous Nerve
Irene Ng, Himat Vaghadia, Peter T. Choi, and Naeder Helmy
Anesth Analg 2008 107: 1070-1074.
比較超聲“雙泡征”引導的鎖骨下臂叢神經阻滯和神經刺激器引導的腋路臂叢神經阻滯
黃佳佳譯，馬皓琳 李士通 校
A
Comparison Between Ultrasound-Guided Infraclavicular Block Using the
"Double Bubble" Sign and Neurostimulation-Guided Axillary Block (Brief
Report)
De Q. H. Tran, Antonio Clemente, Don Q. Tran, and Roderick J. Finlayson
Anesth Analg 2008 107: 1075-1078.
陳珺珺譯 薛張綱校
Epidural
Multiorifice Catheters Function as Single-Orifice Catheters: An In Vitro Study (Brief
Report)
Allison J. Fegley, Jerrold Lerman, and Richard Wissler
Anesth Analg 2008 107: 1079-1081.
The
mechanism of helium-induced preconditioning: a direct role for nitric oxide in
rabbits.
Paul S.
Pagel, John G. Krolikowski, Phillip F. Pratt, Jr, Yon Hee Shim, Julien Amour,
David C. Warltier, and Dorothee Weihrauch
Department
of Anesthesiology, Medical College of Wisconsin, Clement J. Zablocki Veterans
Affairs Medical Center, Anesthesia Service, 5000 W. National Ave., Milwaukee,
WI 53295, USA.
Anesth
Analg 2008 107: 762-768.
背景：氦誘導預處理通過啟動已存的信號來防止心肌梗，這一作用是否由內皮一氧化氮合酶產生的一氧化氮介導還是未知的。我們假設氦誘導對活體心肌的保護作用是由一氧化氮介導的進行試驗。
方法：我們將62只兔子進行血流動力學檢測，給與非選擇性一氧化氮合酶——N-硝基-L-精氨酸甲酯（L-NAME; 10 mg/kg）或者給與選擇性的一氧化氮合酶抑制劑——鹽酸氨基胍（AG; 300 mg/kg）或者給與神經選擇性一氧化氮合酶抑制劑——7-硝基吲唑（7-NI; 50 mg/kg）進行預處理，同時給與0.9%的生理鹽水（對照組）或者吸入70%氦和30%氧的混合氣5分鐘，再吸入空氧混合氣5分鐘，如此3個迴圈後，將冠狀動脈左前降支阻斷30分鐘，然後進行3小時的再灌注。所有兔子，無論是用沒用L-NAME均用DAF-2DA螢光探針及共聚焦鐳射顯微鏡檢查有無一氧化氮的產生。
結果：氦減少梗塞的心肌面積（24%+/-4%左室面積）（P<0.05），對照組為46%+/-4%，L-NAME, AG, 和 7-NI單獨使用不能改變心肌梗塞得面積。L-NAME可以拮抗氦誘導的心肌保護。與對照組相比，氦可以提高DAF-2DA螢光（26 +/- 8 vs 15 +/- 5 U）。用L-NAME預處理後氦誘導的不能增強DAF-2DA螢光。
結論：結果提示氦的心肌保護作用是由活體內皮的一氧化氮合酶產生的一氧化氮介導的。
（胡豔譯 薛張剛校）
BACKGROUND: Helium produces preconditioning
against myocardial infarction by activating prosurvival signaling, but whether
nitric oxide (NO) generated by endothelial NO synthase plays a role in this
phenomenon is unknown. We tested the hypothesis that NO mediates helium-induced
cardioprotection in vivo.
METHODS: Rabbits (n = 62) instrumented
for hemodynamic measurement were subjected to a 30-min left anterior descending
coronary artery occlusion and 3 h reperfusion, and received 0.9% saline
(control) or three cycles of 70% helium-30% oxygen administered for 5 min
interspersed with 5 min of an air-oxygen mixture before left anterior
descending coronary artery occlusion in the absence or presence of pretreatment
with the nonselective NOS inhibitor N-nitro-l-arginine methyl ester (L-NAME; 10
mg/kg), the selective inducible NOS inhibitor aminoguanidine hydrochloride (AG;
300 mg/kg), or selective neuronal NOS inhibitor 7-nitroindazole (7-NI; 50
mg/kg). In additional rabbits, the fluorescent probe 4,5-diaminofluroscein
diacetate (DAF-2DA) and confocal laser microscopy were used to detect NO
production in the absence or presence of helium with or without L-NAME pretreatment.
RESULTS: Helium reduced (P < 0.05)
infarct size (24% +/- 4% of the left ventricular area at risk; mean +/- sd)
compared with control (46% +/- 3%). L-NAME, AG, and 7-NI did not alter
myocardial infarct size when administered alone. L-NAME, but not 7-NI or AG,
abolished helium-induced cardioprotection. Helium enhanced DAF-2DA fluorescence
compared with control (26 +/- 8 vs 15 +/- 5 U, respectively). Pretreatment with
L-NAME abolished these helium-induced increases in DAF-2DA fluorescence.
CONCLUSIONS: The results indicate that
cardioprotection by helium is mediated by NO that is probably generated by
endothelial NOS in vivo.
The Efficacy of Aprotinin in Arterial Switch Operations in Infants
Chinnamuthu Murugesan, MD, Sanjay Kumar Banakal, MD, Rajnish
Garg, MD,Shankaraiah Keshavamurthy, MD, and Kanchi Muralidhar, MD
From the Department of Anesthesiology, Narayana Hrudayalaya Institute of
Medical Sciences, Bangalore, India.
Anesth
Analg 2008 107: 783-787.
背景：此研究評價了在嬰兒動脈轉流手術中應用總劑量40,000血管舒緩素抑制單(KIU)/kg的抑肽酶對減少術後出血和血液製品需要量是否有效。
方法：採用前瞻性、雙盲、隨機化研究，選取50名因大動脈轉位行動脈轉接術的嬰兒。患兒隨機分入安慰劑組，25名患兒接受生理鹽水治療，另25名患兒麻醉誘導後接20,000KIU/kg抑肽酶，後再予20,000KIU/kg抑肽酶加入泵預沖液中。測量在重症監護病房最初24小時內經胸管引流的術後出血量和血液製品需要量(mL/kg/24 h)。
結果：術後最初24小時出血量安慰劑組(49.7 ± 11.9 mL/kg/24
h)顯著高於(P < 0.0001)抑肽酶組(37.1 ± 3.5
mL/kg/24 h)。接受抑肽酶組新鮮冰凍血漿(mL/kg/24h)和濃縮血小板(mL/kg/24h)需要量明顯減少(P <
0.0001)，但輸注血液製品患者的比例並未降低。抑肽酶組接受所有同種異體血液製品的總數[範圍 (中位數) = 2–4 (3)]少於安慰劑組[範圍(中位數) = 7–14 (10)]。抑肽酶組因過量出血再手術的比例亦顯著少於安慰劑組(16% vs 32%)
(P =
0.01).
結論：本研究推斷抑肽酶能減少術後早期出血量及新鮮冰凍血漿和血小板輸注需要量(mL/kg/24 h)。能減少治療人群中遠期使用血液製品的總數和因過量出血再手術的比例。
（黃凝譯 薛張綱校）
BACKGROUND: In the present study we assessed whether aprotinin at
a total dose (40,000 kallikrein inhibitor units (KIU)/kg) is
effective in reducing postoperative blood loss and blood product
requirement after arterial switch operations in infants.
METHODS: A prospective, double-blind, randomized study, evaluated 50
infants who underwent arterial switch operations for transposition of
great arteries. Patients were randomized into a placebo group, 25
patients who received normal saline and a treatment group, 25
patients who received 20,000 KIU/kg of aprotinin after induction of
anesthesia, followed by 20,000 KIU/kg of aprotinin added to
pump prime. Postoperative blood loss through the thoracic chest
tubes and blood product requirements (mL/kg/24 h) were measured
for the first 24 h in the intensive care unit.
RESULTS: Postoperative blood loss in the first 24 h was significantly (P < 0.0001)
higher in the placebo group (49.7 ± 11.9 mL/kg/24 h) as
compared to the aprotinin group (37.1 ± 3.5 mL/kg/24 h).
Requirements for fresh frozen plasma (mL/kg/24h) and use of platelet
concentrate transfusion (mL/kg/24 h) were significantly less in
patients who received aprotinin (P < 0.0001),
but did not reduce the proportion of patients transfused with
blood products. The number of total donor exposures to all allogenic blood
products was less in the aprotinin group [range (median) = 2–4
(3)] than the placebo group [range(median) = 7–14 (10)]. The re-exploration for
excessive bleeding was significantly less with aprotinin group
(16% vs 32%) (P = 0.01).
CONCLUSION: Our study concludes that aprotinin decreased the postoperative
blood loss and requirement of transfusion of fresh frozen
plasma and platelets (mL/kg/24 h) during the early postoperative period.
Further, it reduced the number of donor exposures and re-exploration
for excessive bleeding in the treatment population.
Extra-1 Acupressure for Children Undergoing Anesthesia
Shu-Ming
Wang, Sandra Escalera, Eric C. Lin, Inna Maranets, and Zeev N. Kain
From the
Departments of *Anesthesiology, _files/image002.gif){kind=small}
Pediatrics, and _files/image004.gif){kind=small}
Child and Adolescent Psychiatry,
Yale University School of Medicine, New Haven, Connecticut; and _files/image006.gif){kind=small}
Departments of Anesthesiology,
Pediatrics, and Psychiatry and Human Behavior, University of California,
Irvine, Irvine, California, and ¶Children’s Hospital of Orange County, Orange,
California.
Anesth
Analg 2008 107: 811-816.
背景：針灸及其相關技術被輔助用於圍術期麻醉處理。我們研究擬行內鏡手術兒童患者（印堂）指壓療法能否減輕術前焦慮和減少圍術期異丙酚的需求量。
方法：52例兒童患者隨機分為在印堂或其假想部位接受指壓療法治療干預。治療干預開始前所有兒童均採用雙頻指數（BIS）進行監測。評價基礎狀態和進入手術室前病人焦慮情況，通過靜脈使用異丙酚維持BIS值於40-60之間。
結果：研究結果顯示干預治療後，印堂針灸治療兒童焦慮程度降低而假想組則增加(-9% [-3 to -15] vs
2% [-6 to 7.4], P = 0.012)。相比，術前等待時兩組間BIS值差異無統計學意義。同時也發現兩組間圍術期異丙酚用量無明顯差別(214 ± 76 µg · kg-1
· min-1 vs 229 ± 95 µg · kg-1 · min-1, P =
0.52)。
結論：內鏡手術兒童患者在印堂處採用指壓療法能減輕其術前焦慮程度；而對BIS值以及圍術期異丙酚需要量無影響。
（蔣宗明譯 薛張綱校）
BACKGROUND: Acupuncture and related techniques have been used
as adjuncts for perioperative anesthesia management. We examined whether
acupressure in the Extra-1 (Yin-Tang) point would result in decreased
preprocedural anxiety and reduced intraprocedural propofol requirements in a
group of children undergoing endoscopic procedures.
METHODS: Fifty-two children were randomized to receive acupressure bead
intervention either at the Extra-1 acupuncture point or at a sham point. A
Bispectral Index (BIS) monitor was applied to all children before the onset of
the intervention. Anxiety was assessed at baseline and before entrance to the
operating room. Anesthetic techniques were standardized and maintained with IV
propofol infusion titrated to keep BIS values of 40–60.
RESULTS: We found that after the intervention, children in the Extra-1 group
experienced reduced anxiety whereas children in the sham group experienced
increased anxiety (-9% [-3 to -15] vs 2% [-6 to 7.4], P = 0.012). In contrast,
no significant changes in BIS values were observed in the preprocedural waiting
period between groups (P = ns). We also found that total intraprocedural
propofol requirements did not differ between the two study groups (214 ± 76 µg
· kg-1 · min-1 vs 229 ± 95 µg · kg-1 · min-1,
P = 0.52).
CONCLUSIONS: We conclude that acupressure bead intervention at
Extra-1 acupoint reduces preprocedural anxiety in children undergoing
endoscopic procedures. This intervention, however, has no impact on BIS values
or intraprocedural propofol requirements.
我們是否還需要一個新的例證來闡明吸入性麻醉藥產生麻醉效應的機制？
Is
a New Paradigm Needed to Explain How Inhaled Anesthetics Produce Immobility?
Edmond
I. Eger, II, Douglas E. Raines, Steven L. Shafer, Hugh C. Hemmings, Jr, and
James M. Sonner
From the
*Department of Anesthesia and Perioperative Care, University of California, San
Francisco, California; _files/image007.gif){kind=small}
Department of Anesthesia and
Critical Care, Massachusetts General Hospital and Harvard Medical School,
Boston, Massachusetts; _files/image008.gif){kind=small}
Department of Anesthesia,
Columbia University, New York City, New York; and _files/image009.gif){kind=small}
Departments of Anesthesiology and
Pharmacology, Weill Cornell Medical College, New York City, New York.
Anesth
Analg 2008 107: 832-848.
摘要：目前關於吸入性麻醉藥在面對有害刺激時產生麻醉效應的機制還是一個似是而非的論點。有許多發現，例如它的可加性，都說明了吸入性麻醉藥其產生麻醉效應是通過作用於一個普遍的位點。但是，二十多年的著重研究並沒有發現任何一個配體門控或是電壓門控的通道可以單獨介導產生麻醉效應。事實上，大多數假設的靶位僅提供了極小甚至的無效的介導作用。例如阿片類受體、5-羥色氨3受體、A型酪氨酸受體和谷氨酸受體。而鉀通道和鈣通道則表現出了與其麻醉機制的無關性，或是僅起到了較次要的作用。並且，目前也尚無任何配體門控或是電壓門控通道的協同作用能夠足以解釋這種介導機制。而另一些假定靶位（如鈉通道）還值得我們深入的研究，但吸入性麻醉藥其麻醉效應的產生是通過一個非特異途徑的可能性還仍然存在。
（劉沁譯 薛張綱校）
A
paradox arises from present information concerning the mechanism(s) by which
inhaled anesthetics produce immobility in the face of noxious stimulation.
Several findings, such as additivity, suggest a common site at which inhaled
anesthetics act to produce immobility. However, two decades of focused
investigation have not identified a ligand- or voltage-gated channel that alone
is sufficient to mediate immobility. Indeed, most putative targets provide
minimal or no mediation. For example, opioid, 5-HT3, -aminobutyric acid type A
and glutamate receptors, and potassium and calcium channels appear to be
irrelevant or play only minor roles. Furthermore, no combination of actions on
ligand- or voltage-gated channels seems sufficient. A few plausible targets
(e.g. sodium channels) merit further study, but there remains the possibility
that immobilization results from a nonspecific mechanism.
大鼠蛛網膜下腔注射藜蘆定增加MAC值的研究
Intrathecal
veratridine administration increases minimum alveolar concentration in rats.
Zhang Y, Sharma M, Eger EI 2nd, Laster MJ, Hemmings HC Jr, Harris RA.
Department
of Anesthesiology, Fuwai Hospital and Cardiovascular Institute, Beijing, China.
Anesth
Analg 2008 107: 875-878.
背景：幾項研究的結果指出吸入麻醉藥抑制鈉通道蛋白轉運體的運作。我們假定蛛網膜下腔注射藜蘆定能增加鈉通道的活性和效應則會增加MAC值。
方法：我們測量大鼠在不同濃度藜蘆定注入蛛網膜下腔所引起的異氟烷MAC值的改變並與側腦室灌注所得的結果進行比較。
結果：與預期的一樣，蛛網膜下腔注射藜蘆定會增加MAC值。最大注射濃度（25 pg／ml）也在兩隻大鼠中表現出肢體神經元性損害，和MAC峰效應的降低。1.6 pg／ml的濃度產生MAC值最大增幅（21%）。腦室注入1.6和6.4 pg／ml的濃度不改變MAC值，給與大鼠25 pg／ml則大鼠死亡。
結論：一個與吸入麻醉藥抑制鈉通道蛋白轉運體的運作有關的研究發現蛛網膜下腔給與藜蘆定會增加異氟烷MAC值。
（劉婷潔譯 薛張綱校）
BACKGROUND: Results from several studies
point to sodium channels as potential mediators of the immobility produced by
inhaled anesthetics. We hypothesized that the intrathecal administration of
veratridine, a drug that enhances the activity or effect of sodium channels,
should increase MAC.
METHODS: We measured the change in
isoflurane MAC caused by intrathecal infusion of various concentrations of
veratridine into the lumbothoracic subarachnoid space of rats. We compared
these result with those obtained from intracerebroventricular infusion.
RESULTS: As predicted, intrathecal
infusion of veratridine increased MAC. The greatest infused concentration (25
microM) also produced neuronal injury in the hindlimbs of two rats and
decreased the peak effect on MAC. A concentration of 1.6 microM produced the
largest (21%) increase in MAC. Intraventricular infusion of 1.6 and 6.4 microM
veratridine did not alter MAC. Rats given 25 microM died.
CONCLUSIONS: Intrathecal administration of
veratradine increases MAC of isoflurane, a finding consistent with a role for
sodium channels as potential mediators of the immobility produced by inhaled
anesthetics.
A
Pilot Study of Neonatal and Pediatric Esophageal Pulse Oximetry
Panayiotis
A. Kyriacou, Deric P. Jones, Richard M. Langford, Andy J. Petros
From the
*School of Engineering and Mathematical Sciences, City University, London, EC1V
0HB, UK; _files/image010.gif){kind=small}
St. Bartholomew's Hospital,
Bart's and The London NHS Trust, London, EC1A 7BE, UK; and _files/image011.gif){kind=small}
Paediatric and Neonatal Intensive
Care Unit Great Ormond Street Hospital for Children Great Ormond Street London
WC1N 3JH, UK.
Anesth
Analg 2008 107: 905-908
背景： 在這個實驗性研究中，我們探究了在嬰兒中把食管作為探測脈搏氧飽和度的新位點是否合適。
方法：一種新型的微型經食管脈搏血氧探測儀已經被研製成。本次研究了五個病例（一個兒童及四個新生兒）。
結果：所有病例的脈搏血氧飽和度值均可被測知。運用Bland and Altman曲線來分析經食管探測法以及傳統的趾端探測法的平均測定值，可以發現這兩種脈搏氧飽和度測定法的偏倚及界限分別是+0.3%和+1.7%~—1.0%。
結論：這個研究提示，食管可以成為兒童及小兒檢測血氧飽和度的另一個位點。
（秦敏菊譯 薛張綱校）
BACKGROUND: In this pilot study we explored
the suitability of the esophagus as a new measuring site for blood oxygen
saturation (Spo2) in neonates.
METHODS: A new miniaturized esophageal
pulse oximeter has been developed. Five patients (one child and four neonates)
were studied.
RESULTS: Spo2 values were obtained in the
esophagus of all patients. A Bland and Altman plot of the difference between
Spo2 values from the esophageal pulse oximeter and a commercial toe pulse
oximeter against their mean showed that the bias and the limits of agreement
between the two pulse oximeters were +0.3% and +1.7% to -1.0%, respectively.
CONCLUSIONS: This study suggests that the
esophagus can be used as an alternative site for monitoring blood oxygen
saturation in children and neonates.
Patients
with Difficult Intubation May Need Referral to Sleep Clinics
Frances
Chung, FRCPC*, Balaji Yegneswaran, MBBS*, Francisco Herrera, MD*, Alex
Shenderey, MD*, and Colin M. Shapiro, FRCPC
From the
Departments of *Anesthesia, and _files/image012.gif){kind=small}
Psychiatry, University of
Toronto, University Health Network, Toronto Western Hospital, Toronto, Ontario,
Canada.
Anesth
Analg 2008 107: 915-920.
目的：上呼吸道異常增加阻塞性睡眠呼吸暫停（OSA）和困難氣管插管的風險。兩者均造成顯著臨床問題，並增加圍手術期的發病率和死亡率。我們猜測，困難氣管插管的患者有較高的OSA患病率，而那些存在難以預料的困難插管患者，可能需要轉介到睡眠診所檢測多導睡眠圖（ PSG ） 。
方法：按Cormack和Lehane法，根據直接喉鏡所見，挑選術前評估為四級的患者，在來自四家醫院的麻醉師顧問幫助下，將其中需要兩次及以上嘗試氣管插管方可成功者，列入研究範圍。收集患者呼吸暫停低通氣指數（AHI）資料及術後情況。AHI>5/小時者為ASO陽性。用t檢驗及2檢驗比較所得臨床和PSG資料。
結果：在20個月中， 84例困難氣管插管患者被轉介到研究，其中33例患者同意參加。 66 ％ （33例中的22例）的患者患有OSA（AHI> 5/小時）。在這22例 OSA患者中， 10例（64％）為輕度OSA（AHI 5-15），6例（18％）為中度OSA（AHI > 15/小時），6例（18 ％）為嚴重OSA（AHI > 30/小時）。33例患者中，11例（33 ％）被推薦進行持續氣道正壓通氣治療。OSA組與非OSA組間，在性別、頸部大小及睡眠品質方面有顯著差異，但在年齡及體重指數方面無明顯差異。
結論： 根據PSG，66 ％接受睡眠監測的困難氣管插管患者被診斷為OSA。困難氣管插管是OSA的高危因素，應根據睡眠呼吸暫停的症狀和體征進行篩選。由此篩選出的患者，應考慮轉介到一個睡眠診所檢測PSG以確診。
（施穎譯 薛張綱校）
PURPOSE: Upper airway abnormalities carry
the risk of obstructive sleep apnea (OSA) and difficult tracheal intubations.
Both conditions contribute to significant clinical problems and have increased
perioperative morbidity and mortality. We hypothesized that patients who
presented with difficult intubation would have a very high prevalence of OSA
and that those with unexpected difficult intubation may require referral to
sleep clinics for polysomnography (PSG).
METHODS: Patients classified as a grade
4 Cormack and Lehane on direct laryngoscopic view, and who required more than
two attempts for successful endotracheal intubation, were referred to the study
by consultant anesthesiologists at four hospitals. Apnea-hypopnea index (AHI)
data and postoperative events were collected. Patients with AHI >5/h were
considered positive for OSA. Clinical and PSG variables were compared using t-tests
and 2 test.
RESULTS: Over a 20-mo period, 84 patients
with a difficult intubation were referred into the study. Thirty-three patients
agreed to participate. Sixty-six percent (22 of 33) had OSA (AHI >5/h). Of
the 22 OSA patients, 10 patients (64%) had mild OSA (AHI 5–15), 6 (18%) had
moderate OSA (AHI >15/h), and 6 (18%) had severe OSA (AHI >30/h). Of the
33 patients, 11 patients (33%) were recommended for continuous positive airway
pressure treatment. Between the OSA group and the non-OSA group, there were
significant differences in gender, neck size, and the quality of sleep, but
there were no significant differences in age and body mass index.
CONCLUSIONS: Sixty-six percent of patients
with unexpected difficult intubation who consented to undergo a sleep study
were diagnosed with OSA by PSG. Patients with difficult intubation are at high
risk for OSA and should be screened for signs and symptoms of sleep apnea.
Screening for OSA should be considered by referral to a sleep clinic for PSG.
不同氣管內吸引方法對FRC的影響
Functional
Residual Capacity Changes After Different Endotracheal Suctioning Methods
Hermann Heinze, MD, Beate Sedemund-Adib, MD, Matthias
Heringlake, MD, Ulrich W. Gosch, MD, and Wolfgang Eichler, MD
From the
Department of Anesthesiology, University of Luebeck, Luebeck, Germany.
Anesth
Analg 2008 107: 941-944.
背景：我們的目的是研究三種不同的氣管內吸引方法對FRC的影響。
方法：用交叉設計方法，20個心臟手術後的病人按照隨機順序接受了三種不同的氣管內吸引方法：壓力控制通氣下的密閉吸引，容量控制通氣下的密閉吸引，開放式吸引。在吸引之前和20分鐘之後分別測量FRC。
結果和結論：不管用何種吸引方法，心臟手術後的病人接受吸引後FRC都降低。一些病人還有很顯著的FRC改變。常規的FRC測量可以完善呼吸系統檢測，從而有助於呼吸系統疾病的治療。
（ 孫鵬飛譯 薛張綱校）
BACKGROUND: Our primary objective was to
investigate the effects of three different endotracheal suctioning
procedures on functional
residual
capacity
(FRC).
METHODS:
Using a crossover design, postoperative cardiac surgery patients (n = 20) received three different suctioning methods in
randomized order: closed suctioning during pressure-controlled ventilation,
closed suctioning
during volume-controlled ventilation, and open suctioning. FRC was
measured before and 20 min after the intervention.
RESULTS
AND CONCLUSIONS:
FRC is reduced in postcardiac surgery patients after suctioning,
regardless of which method
is used. Certain patients may have very pronounced changes of FRC.
Routine FRC measurements could complement respiratory monitoring to
optimize respiratory therapy.
Cerebral
Perfusion Pressure in Neurotrauma: A Review
Hayden
White, MD*, and Bala Venkatesh, MD_files/image013.gif){kind=small}
From the
*Department of Critical Care, Logan Hospital, Griffiths University, Brisbane,
Australia; and _files/image014.gif){kind=small}
Department of Intensive Care,
Princess Alexandra and Wesley Hospitals, University of Queensland, Brisbane,
Australia.
Anesth
Analg 2008 107: 979-988.
摘要：目前已經認識到低腦血流量（及低腦灌注壓（CPP））與腦外傷的不良預後相關。但還不十分明確的是改變腦血流量或者CPP是否可以帶來臨床症狀的好轉。初步研究指出增加CPP可能有益，美國腦部創傷基金會在1996年的指南中公認了這一點，並且將目標值確立為70 mmHg。但是，由於缺少明確的益處以及併發症的增多使得此目標值降至60 mmHg。最近，由於有證據表明腦創傷後自我調節功能可能受損，一些研究者計畫對CPP進行個體化的管理。此外，隨著神經檢測技術的進步，臨床工作者可以更加精確地監控腦代謝及血流動力學。至今未止尚沒有強有力的證據來支持此項計畫。在此之前，當前的CPP管理方式仍將繼續沿用。
（夏俊明譯 薛張綱校）
Abstract
It is
now well recognized that low cerebral blood flow (and cerebral
perfusion pressure (CPP)) is associated with poor outcome after
traumatic brain injury. What is less clear is whether altering
cerebral blood flow or CPP will lead to clinical improvement. Initial
studies indicated that increasing CPP may be beneficial and the
Brain Trauma Foundation acknowledged this by incorporating a target
of 70 mm Hg in the 1996 guidelines. However, the lack of a
demonstrable benefit and the increased complication rate associated
with this approach led to a reduction in the CPP goal to 60 mm Hg.
More recently, evidence that autoregulation may be disrupted after
traumatic brain injury has led some authors to propose an
individualized approach to CPP management. Furthermore, with the
advent of advanced neuromonitoring techniques, clinicians are able
to more closely monitor the effects of hemodynamic manipulations on
cerebral metabolism. As yet, there is no strong outcome evidence to
support this approach. Until then, the current debate over the
optimal approach to CPP management is likely to continue.
血壓和壓力感受器敏感性對興奮性升級現象的影響
The Impact of Blood Pressure and Baroreflex Sensitivity on Wind-Up
Chung, Ok Yung MD, MBA; Bruehl, Stephen PhD
From the
Department of Anesthesiology, Vanderbilt University School of Medicine,
Nashville, Tennessee.
Anesth
Analg 2008 107: 1018-1025.
背景：對急性疼痛來說，提高的靜息血壓和自發性壓力感受器敏感性與痛覺減退有關。這些關聯在慢性疼痛明顯不同。我們研究了興奮性升級現象（中樞致敏的標誌）的程度是否同樣受血壓和壓力感受器敏感性的影響，以及這些關聯在慢性疼痛是否改變。
方法：對30名健康者和26名慢性背痛受試者的血壓和BRS（序列法）進行評估，然後完成一個標準化熱刺激記錄來評估興奮性升級現象。這項記錄在安慰劑組和α-2腎上腺素受體阻斷劑育亨賓組完成，來測試α-2腎上腺素受體機制的影響。
結果：1）在健康對照組，較高的收縮壓與較低的興奮性升級現象有關（ P < 0.05 ），但是這在慢性疼痛者中相反（ P < 0.05 ）；2 ）在健康對照組，較高的BRS與較低的興奮性升級現象有關（ P < 0.05 ），但是在慢性疼痛受試者中無關；3 ）只有在慢性疼痛組較高的收縮壓是與較低的BRS有關的（ P < 0.05 ） ；4 ） α-2腎上腺素受體阻斷劑對興奮性升級現象並沒有顯著著影響。
結論：這些結果表明，在健康個體升高的靜息血壓和自發性壓力感受器敏感性與痛覺減退有關，包括中樞致敏（由興奮性升級現象反應）減低和下行抑制增強。慢性疼痛的存在顯著改變了這些相互作用的性質。在重疊系統調節心血管系統和慢性疼痛患者的疼痛之間正常交互作用的逆轉可能使血壓和心率的健康緩衝作用變成不穩定的和最終較高的血壓和心血管發病率。
（宣麗真譯 薛張綱校）
BACKGROUND: Elevated resting blood pressure (BP) and
spontaneous baroreflex sensitivity (BRS) are associated with hypoalgesia to
acute pain. These associations are significantly altered in chronic pain. We
investigated whether degree of wind-up (marker for central sensitization) is
similarly influenced by BP and BRS, and whether these associations are altered
by chronic pain.
METHODS: BP and BRS (sequence method) were assessed in 30 healthy and 26 chronic
back pain subjects who then completed a standardized thermal stimulation
protocol to assess wind-up. This protocol was performed under placebo and
[alpha]-2 adrenergic (ADRA2) blockade with yohimbine in counterbalanced order
to test for the influence of ADRA2 mechanisms.
RESULTS: 1) In healthy controls, higher systolic BP was associated with lower
wind-up (P < 0.05) but this was reversed in chronic pain subjects (P <
0.05); 2) higher BRS was associated with lower wind-up in healthy controls (P
< 0.05) but not in the chronic pain group; 3) higher systolic BP was
associated with lower BRS only in the chronic pain group (P < 0.05); and 4)
ADRA2 receptor blockade did not significantly affect wind-up.
CONCLUSIONS: These findings suggest that hypoalgesia associated
with elevated resting BP and BRS in healthy individuals involves both
diminished central sensitization (reflected in wind-up) and enhanced descending
inhibition. The presence of chronic pain significantly alters the nature of
these interactions. The reversal of normal interactions between overlapping
systems modulating cardiovascular systems and pain in chronic pain patients may
shift the healthy buffering of BP and heart rate toward instability and eventual
higher BP and cardiovascular morbidity.
透皮吸收煙鹼用於前列腺術後鎮痛
Transdermal Nicotine for Analgesia After Radical Retropubic
Prostatectomy
Ashraf S. Habib, MBBCh, MSc, FRCA*, William D.
White, MPH*, Magdi A. El Gasim, MD*, Gamal Saleh, MD*,
Thomas J. Polascik, MD_files/image015.gif){kind=small}
, Judd W.
Moul, MD_files/image016.gif){kind=small}
, and Tong J.
Gan, MB, FRCA*
From the
*Department of Anesthesiology, _files/image017.gif){kind=small}
Division of Urologic Surgery and
Duke Prostate Center, Department of Surgery, Duke University Medical System,
Durham, North Carolina.
Anesth
Analg 2008 107: 999-1004
背景：以往的動物和人類研究表明，煙鹼可能有鎮痛作用。我們假設對於全麻下實施經恥骨後前列腺根治術(RRP)的患者，術前應用7mg煙鹼，會導致減少術後鎮痛的需求。
方法：不吸煙者經歷全麻下行RRP參加了這項前瞻性，雙盲，安慰劑對照研究。病人隨機分成兩組：在麻醉誘導前30-60分鐘，分別耳後透皮給予7毫克煙鹼或安慰劑。麻醉按常規。術後鎮痛是標準的應用嗎啡病人自控鎮痛並且每6小時給予痛力克15mg靜推。在蘇醒室、術後6、12和24小時收集資料。
結果： 分析了90例患者： 44在煙鹼組和46在安慰劑組。兩組病人在年齡，身高，體重， ASA的分級，手術長度，術中芬太尼的用量等方面沒有顯著差異。煙鹼組顯著降低24 h內嗎啡的用量（平均值±標準差）： 33.3 ± 30.8mg，相比於44.7 ± 26.4mg（ P = 0.0059 ，時間x治療P值0.0031 ） 。但是，在咳嗽和休息時疼痛的報告沒有差異。此外，還有無顯著差異的團體在發生術後噁心嘔吐或需要救援antiemetics
。不過，相比於安慰劑組，在煙鹼組，最高的噁心口頭評定量表評分較高，（中位數， 25％至75％=為4 ， 0-6與0 ， 0-6 ， P值0.0158 ） 。術後24 h內血漿中煙鹼含量和術後嗎啡消費量呈負相關，在蘇醒室（ P =
0.049 ） ，以及在術後6、12、24小時均如此（ P =
0.002）。
結論： 對於全麻下行RRP手術的患者，術前的應用7mg煙鹼可以顯著減少阿片類的消費量。儘管減少阿片類藥物的使用，但是使用透皮吸收的煙鹼並沒有降低疼痛評分或術後噁心嘔吐的發生。
（章一靜譯 薛張綱校）
BACKGROUND: Previous animal and human studies
suggested that nicotine might have an antinociceptive effect. We hypothesized
that the preoperative application of a 7 mg nicotine patch would result in
reduced postoperative analgesic requirements in patients undergoing radical
retropubic prostatectomy (RRP) under general anesthesia.
METHODS: Nonsmokers undergoing RRP under
general anesthesia were enrolled in this prospective, double-blind,
placebo-controlled study. Patients were randomly assigned to receive a patch of
7 mg nicotine or placebo applied behind the ear 30–60 min before induction of
anesthesia. The anesthetic technique was standardized. Postoperative analgesia
was provided with a standardized morphine patient-controlled analgesia and 6
hourly ketorolac 15 mg IV. Data were collected in the postanesthesia care unit
and at 6, 12, and 24 h after surgery.
RESULTS: Ninety patients were included in
the analysis: 44 in the nicotine group and 46 in the placebo group. The groups
did not differ significantly with respect to age, height, weight, ASA class,
length of surgery, or amounts of intraoperative fentanyl received. The nicotine
group showed significantly lower cumulative morphine consumption at 24 h (mean ± sd): 33.3 ± 30.8 mg vs 44.7 ± 26.4 mg (P = 0.0059, time x
treatment P = 0.0031). However, the repeated measures tests found no difference
in amount of pain reported on coughing or at rest, either as treatment effects
or in interaction with time. In post hoc comparisons, there was no significant
difference in amount of pain reported on coughing or at rest at any of the
times assessed. There were also no significant differences between the groups
in the incidence of postoperative nausea and vomiting or the need for rescue
antiemetics. However, the maximum nausea verbal rating scale score was higher
in the nicotine than in the placebo group (median, 25th to 75th percentiles =
4, 0–6 vs 0, 0–6, P = 0.0158). There was a significant negative correlation
between the 24 h plasma nicotine levels and postoperative morphine consumption
in the postanesthesia care unit (P = 0.049), as well as at 6, 12, and 24 h (P =
0.002).
CONCLUSION: The preoperative application of
a 7 mg nicotine patch resulted in a significant reduction in opioid consumption
in patients undergoing RRP under general anesthesia. Despite this reduction in
opioid use, there was no reduction in pain scores or postoperative nausea and
vomiting with the use of transdermal nicotine.
在小鼠損傷的背根神經元中通過恢復鈣內流可以糾正胞膜的過度興奮狀態
Restoration
of Calcium Influx Corrects Membrane Hyperexcitability in Injured Rat Dorsal
Root Ganglion Neurons
Quinn
Hogan, MD*_files/image018.gif){kind=small}
, Philipp Lirk, MD*_files/image019.gif){kind=small}
, Mark Poroli, BS*,
Marcel Rigaud, MD*_files/image020.gif){kind=small}
, Andreas Fuchs, MD*_files/image021.gif){kind=small}
, Patrick Fillip, MD*,
Marko Ljubkovic, MD*||, Geza Gemes, MD*_files/image022.gif){kind=small}
, and Damir Sapunar, MD, PhD*||
From the
*Department of Anesthesiology, Medical College of Wisconsin, _files/image023.gif){kind=small}
Milwaukee Veterans Administration
Medical Center, Milwaukee, Wisconsin; _files/image024.gif){kind=small}
Department of Anesthesiology and
Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria; _files/image025.gif){kind=small}
Department of Intensive Care and
Anesthesiology, Medical University of Graz, Graz, Austria; and ||University of
Split Medical School, Split, Croatia.
Anesth
Analg 2008 107: 1045-1051.
背景：我們已經知道，在軸索顯微外科，減少神經元細胞膜Ca2+內流(ICa)可以增加神經元的興奮性。基於此，我們預見增加損傷神經元的ICa可以糾正其高興奮狀態
方法：增加或減少跨膜ICa可以改變細胞膜的生物物理特性和興奮性，我們使用細胞內記錄儀器，在結紮脊神經後，測定非解離的後根神經節的A型神經元的這一特性。
結果：當增加細胞外液Ca2+
的水準可以促進 ICa，使超極化減少，觸發點抑制，在選擇性激動劑NS1619 and NS309激動Ca2+促發的K+ 流動時也可以出現。降低細胞外Ca2+的濃度產生相反的效應，與以往觀察到的未損傷神經元有相似的作用
結論：這些發現表明，軸索顯微外科術後機體感覺神經元的過度興奮和Ca2+內流減少有關，修復ICa的措施可以用來治療周圍神經病引起的疼痛。
（陳珺珺譯 薛張綱校）
BACKGROUND: We have previously shown that a
decrease of inward Ca2+ flux (ICa) across the
sensory neuron plasmalemma, such as happens after axotomy, increases neuronal
excitability. From this, we predicted that increasing ICa
in injured neurons should correct their hyperexcitability.
METHODS: The influence of increased or
decreased ICa upon membrane biophysical variables and
excitability was determined during recording from A-type neurons in
non dissociated dorsal root ganglia after spinal nerve ligation
using an intracellular recording technique.
RESULTS: When the bath Ca2+
level was increased to promote ICa, the
after-hyperpolarization was decreased and repetitive firing was
suppressed, which also followed amplification of Ca2+-activated
K+ current with selective agents NS1619 and NS309. A
decreased external bath Ca2+ concentration had the opposite effects,
similar to previous observations in uninjured neurons.
CONCLUSIONS:
These findings
indicate that at least a part of the hyperexcitability of somatic
sensory neurons after axotomy is attributable to diminished inward
Ca2+ flux, and that measures to restore ICa
may potentially be therapeutic for painful peripheral neuropathy.
結紮小鼠脊神經後，神經妥樂平通過啟動下行疼痛抑制系統起到鎮痛作用
The
Antiallodynic Effect of Neurotropin® Is Mediated via Activation of Descending
Pain Inhibitory Systems in Rats with Spinal Nerve Ligation
Ryohei
Okazaki, Hiroyoshi Namba, Hiroyuki Yoshida, Hisashi Okai, Tomoshi Miura, and
Minoru Kawamura
From the
Department of Development Research, Institute of Bio-active Science, Nippon
Zoki Pharmaceutical Co., Ltd., 442-1, Kinashi, Kato, Hyogo, 673-1461, Japan.
Anesth
Analg 2008 107: 1064-1069.
背景：神經妥樂平是一種從接種牛痘病毒後而發炎的兔子皮膚中分離出來的非蛋白質提取物，在日本被廣泛用於治療諸如神經性疼痛等慢性疼痛病。儘管已經進行了一些針對神經妥樂平鎮痛機理的研究，然而，這個機理仍然沒被正確澄清。
方法：在使用戊巴比妥麻醉的情況下，將老鼠的左側第五腰神經用縫線結紮起來。機械鎮痛效果通過測試老鼠後爪在用von Frey細絲刺激後退縮闕值測定。在神經結紮後的28天進行行為測試。左側第五腰神經被結紮（(L5-SNL)的小鼠用三種途徑給藥：靜脈、鞘內或腦室內使用神經妥樂平。我們測定了L5-SNL小鼠在使用神經妥樂平鎮痛後，去甲腎上腺素，5-羥色胺能和γ-氨基丁酸(GABA)拮抗劑的效應。在鞘內分別注射育亨賓（_files/image027.gif){kind=small}
2腎上腺素能受體拮抗劑），酒石酸酮舍林（5-HT2A受體拮抗劑），MDL72,222（5-HT3受體拮抗劑），甲基氯化荷包牡丹堿（γ-氨基丁酸受體拮抗劑）和CGP35,348（γ-氨基丁酸受體拮抗劑）。
結果：靜脈注射神經妥樂平(50–100 NU/kg)能引起L5-SNL小鼠的抗痛覺超敏效應。而且，腦室注射神經妥樂平(400 mNU/鼠)，而非鞘內注射神經妥樂平能抑制痛覺超敏。神經妥樂平的抗痛覺超敏作用（100NU/Kg，靜脈內注射）可以被育亨賓鞘內注射（10 NU /鼠）、酮舍林（30 NU /鼠）、MDL72,222(30 NU /鼠)、荷包牡丹堿(0.6 NU /鼠)和CGP35348 (30 NU /鼠)所抑制。另一方面，鞘內注射m-CPBG（5-HT3受體激動劑）的抗痛覺超敏作用通過鞘內注射荷包牡丹堿和CGP35348被逆轉，這表明5-HT3受體和脊椎抑制性中間神經元（γ-氨基丁酸能神經元）的相互作用。
結論：這些結果表明神經妥樂平的鎮痛作用是通過啟動疼痛下行抑制系統實現的，如去甲腎上腺素系統和5-羥色胺能系統，它們是從脊髓發出至脊髓背側角。此外，通過脊髓背側角5-HT3受體激動劑引起的抑制性γ-氨基丁酸能神經元的啟動也參與樂神經妥樂平的抗痛覺超敏作用。
（陳珺珺譯 薛張綱校）
BACKGROUND:
Neurotropin®, a
nonprotein extract isolated from inflamed skin of rabbits inoculated
with vaccinia virus, is widely used in Japan to treat chronic pain
such as neuropathic pain. Although some studies have been conducted
on the mechanism of the antiallodynic action of Neurotropin, this
mechanism has yet to be adequately clarified.
METHODS: The left fifth lumbar nerve of rats was tightly ligated with silk sutures under pentobarbital anesthesia.
Mechanical allodynia was confirmed by measuring the hindpaw withdrawal threshold in response to
application of von Frey filaments. Behavioral tests were performed
at 28 days after nerve ligation. Neurotropin was administered IV, intrathecally
or intra cerebro ventricularly in L5 spinal nerve ligation (L5-SNL)
rats. We examined the effects of noradrenergic, serotonergic and _files/image029.gif){kind=small}
-aminobutyric acid (GABA)ergic antagonists on the antiallodynic
action of Neurotropin in L5-SNL rats. Yohimbine hydrochloride
(yohimbine) was used as an _files/image030.gif){kind=small}
2 adrenoceptor antagonist,
ketanserin tartrate (ketanserin) as a 5-HT2A receptor antagonist,
MDL72,222 as a 5-HT3 receptor antagonist, (-)-bicuculline methobromide
(bicuculline) as a GABAA receptor antagonist, and CGP35,348
as a GABAB receptor antagonist, and intrathecally injected.
RESULTS: IV (50–100 NU/kg) doses of
Neurotropin elicited an anti allodynic action in L5-SNL rats.
Moreover, intracerebroventricular (400 mNU/rat), but not
intrathecal, injection of Neurotropin inhibited allodynia. The
antiallodynic action of Neurotropin (100 NU/kg, IV) was antagonized
by intrathecal injections of yohimbine (10 nmol/rat), ketanserin (30
nmol/rat), MDL72,222(30 nmol/rat), bicuculline (0.6 nmol/rat) and
CGP35348 (30 nmol/rat). On the other hand, the antiallodynic action
of intrathecally injected m-CPBG (5-HT3 receptor agonist)
was reversed by intrathecal injection of bicuculline and CGP35348,
suggesting interaction of 5-HT3 receptors and spinal
inhibitory (GABAergic) interneurons.
CONCLUSIONS: These results suggest that the
antiallodynic effect of Neurotropin is mediated via activation of
descending pain inhibitory systems, such as the noradrenergic and
serotonergic systems, which project from supraspinal sites to the
spinal dorsal horn. In addition, activation of inhibitory GABAergic
interneurons via 5-HT3 receptors by serotonin released in the
spinal dorsal horn may also be involved in the antiallodynic action
of Neurotropin.
Epidural
Multiorifice Catheters Function as Single-Orifice Catheters: An In Vitro Study
Allison
J. Fegley, MD*, Jerrold Lerman, MD, FRCPC, FANZCA*_files/image031.gif){kind=small}
, and Richard Wissler, MD, PhD*
From the
*Strong Memorial Hospital, University of Rochester, Rochester, New York; and _files/image032.gif){kind=small}
Women and Children's Hospital of
Buffalo, SUNY, Buffalo, New York.
Anesth
Analg 2008 107: 1079-1081.
在一項離體實驗中，我們通過可選擇孔數量的多孔導管決定流速。鹽水以1和360mL/h通過Baxter和 Abbott公司及Alaris輸注泵經Portex或
Braun 20號的多孔導管輸注。我們通過輸注和人工推注的方法，並記錄了開放導管的數目及持續輸注的壓力。單孔輸注速率<80mL/h，雙孔速率在100至280mL/h，三孔速率>300mL/h。Braun導管的壓力大於Portex導管壓力的40％。12名住院醫生使用3個孔的導管人工輸注。在臨床應用中，20號的多孔導管和單孔導管的功能相似，但是多孔導管可以用於增加負荷劑量。
（陳珺珺譯 薛張綱校）
In an in
vitro study, we
determined the flow rates required to use selective orifices of
multi orifice catheters. Saline was infused at rates between 1 and
360 mL/h through Portex and Braun
20-gauge multiorifice catheters using Baxter, Abbott Laboratories, and
Alaris infusion pumps. The numbers of orifices used via infusion and manual injection,
and the pressure within the catheter during continuous infusion,
were recorded. Infusion rates <80 mL/h used one orifice, between
100 and 280 mL/h used two orifices, and >300 mL/h used three
orifices. Catheter pressures with Braun catheters were 40% greater
than with Portex catheters. Manual injections by all 12 residents
used all three orifices. Twenty-gauge multi orifice catheters
function as single-orifice catheters at clinically relevant infusion
rates, but function as multiorifice catheters during manual boluses.
抑制糖原合成激酶或細胞凋亡蛋白p53降低了氦在體心肌保護的閾值：線粒體通透性的作用
Inhibition
of Glycogen Synthase Kinase or the Apoptotic Protein p53 Lowers the Threshold
of Helium Cardioprotection In Vivo: The Role of Mitochondrial Permeability
Transition
Paul S.
Pagel, MD, PhD, John G. Krolikowski, BS, Phillip F. Pratt, Jr, PhD, Yon Hee
Shim, MD, Julien Amour, MD, PhD, David C. Warltier, MD, PhD, and Dorothee Weihrauch,
DVM, PhD
From the
Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center,
Milwaukee, Wisconsin.
Anesth
Analg 2008 107: 769-775.
背景：促成活的信號激酶抑制糖原合成激酶3B（GSK-3B）的活性並促進細胞凋亡蛋白p53的降解。氦氣通過啟動促成活激酶產生心肌保護的作用，但GSK和p53是否介導這個過程尚未闡明。筆者假設抑制糖原合成激酶或細胞凋亡蛋白p53通過改變線粒體膜的通透性從而降低在體心肌保護的閾值
方法：85只家兔行血流動力學監測，阻斷前降支（LAD）30min並再灌注3h，在阻斷LAD前給與0.9%的生理鹽水(對照)，或1、3、5次週期性吸入70%氦氣－30%氧氣（氧濃度0.30）的混合氣體5min再複吸３０％氧的空氣氧氣複合氣體。其他的家兔在前降支阻斷前在給或不給mPTP的開啟藥物蒼木酐（5mg/kg）下給與GSK抑制劑SB216763(SB21:0.2或0.6mg/kg)，p53抑制劑皮斐松-a(PIF;1.5 g/kg或3.0g/kg)，或 SB21(0.2mg/kg)或PIF(1.5kg/mg)加1個週期的氦氣。
結果：氦氣組心肌梗塞的面積(吸入氦氣1、3、5個週期後梗死面積分別為35±6[n=7],25±4[n=7],20±3%[n=6])較對照組（44±6%[n=7]）小（P<0.05）。SB21(0.6 mg/kg [n=7])組和PIF(3.0[n=6])組心肌梗死減小，但小劑量組SB21（0.2mg/kg[n=6])及PIF（1.5mg/kg[n=7])未見減小。SB21(0.2mg/kg)和PIF (1.5mg/kg)加吸入氦氣（1個週期，n=6）具有相當於吸入3個週期氦氣後減少梗塞面積的效應，且這一效應能被蒼木酐阻斷。
結論：抑制GSK或p53通過mPTP機制降低了在體氦氣介導的心肌保護的閾值。
（潘方立 譯 陳傑 校）
BACKGROUND:
Prosurvival
signaling kinases inhibit glycogen synthase kinase-3β (GSK-3β)
activity and stimulate apoptotic protein p53 degradation. Helium
produces cardioprotection by activating prosurvival kinases, but
whether GSK and p53 inhibition mediate this process is unknown. We
tested the hypothesis that inhibition of GSK or p53 lowers the
threshold of helium cardioprotection via a mitochondrial
permeability transition pore (mPTP)-dependent mechanism.
METHODS:
Rabbits (n = 85) instrumented for
hemodynamic measurement and subjected to a 30 min left anterior
descending coronary artery (LAD) occlusion and 3 h reperfusion
received 0.9% saline (control), or 1, 3, or 5 cycles of 70%
helium-30% oxygen administered for 5 min interspersed with 5 min of
an air-oxygen mixture (fraction of inspired oxygen concentration =
0.30) before LAD occlusion. Other rabbits received the GSK inhibitor
SB 216763 (SB21; 0.2 or 0.6 mg/kg), the p53 inhibitor pifithrin-_files/image033.gif){kind=small}
(PIF; 1.5 or 3.0 mg/kg),
or SB21 (0.2 mg/kg) or PIF (1.5 mg/kg) plus helium (1 cycle) before
LAD occlusion in the presence or absence of the mPTP opener
atractyloside (5 mg/kg).
RESULTS:
Helium reduced (P < 0.05) myocardial infarct
size (35 ± 6 [n = 7], 25 ± 4 [n = 7], and 20 ± 3% [n = 6] of area at risk, 1, 3, and 5 cycles,
respectively) compared with control (44 ± 6% [n = 7]). SB21 (0.6 [n = 7] but not 0.2
mg/kg [n =
6]) and PIF (3.0 [n = 6] but not 1.5 mg/kg [n = 7]) also reduced necrosis. SB21 (0.2
mg/kg) or 1.5 mg/kg PIF (1.5 mg/kg) plus helium (1 cycle; n = 6 per group) decreased
infarct size to an equivalent degree as three cycles of helium
alone, and this cardioprotection was blocked by atractyloside (n = 7 per group).
CONCLUSIONS:
Inhibition of
GSK or p53 lowers the threshold of helium-induced preconditioning
via a mPTP-dependent mechanism in vivo.
硫噴妥鈉/七氟醚麻醉下小兒的正中神經軀體感覺誘發電位及酮基布洛芬和芬太尼的對其的附加作用
Somatosensory
Evoked Potentials by Median Nerve Stimulation in Children During
Thiopental/Sevoflurane Anesthesia and the Additive Effects of Ketoprofen and
Fentanyl
Susanna
Westerén-Punnonen, MD*, Heidi Yppärilä-Wolters, PhD*_files/image034.gif){kind=small}
, Juhani Partanen, MD, PhD*_files/image035.gif){kind=small}
, Kari Nieminen, MD_files/image036.gif){kind=small}
, Antti Hyvärinen, MD||,
and Hannu Kokki, MD, PhD_files/image037.gif){kind=small}
¶
From the
*Department of Clinical Neurophysiology, Kuopio University Hospital, Finland; _files/image038.gif){kind=small}
VTT Information Technology,
Tampere, Finland; _files/image039.gif){kind=small}
Department of Clinical
Neurophysiology, Helsinki University Hospital, Jorvi Hospital, Espoo, Finland; _files/image040.gif){kind=small}
Department of Anesthesiology and
Intensive Care, Kuopio University Hospital, Finland; ||Department of
Otorhinolaryngology, Kuopio University Hospital, Finland; ¶Department of
Pharmacology and Toxicology, University of Kuopio.
Anesth
Analg 2008 107: 799-805.
背景：軀體感覺誘發電位（SEP）通常用於術中判斷脊髓和腦功能。一般說來，揮發性麻醉藥對SEP很敏感，但對於七氟醚麻醉維持時對兒童SEP的影響目前知之甚少。在麻醉中經常使用的鎮痛藥和其他輔助用藥可能也會影響SEP。在這一前瞻性臨床研究中，作者用苯二氮卓類和巴比妥類藥物對27位3-8歲健康兒童實施靜脈麻醉誘導後，給予其七氟醚進行麻醉維持，以評估七氟醚對於正中神經SEP的影響。此外，作者同時評估了酮基布洛芬和芬太尼這兩種鎮痛藥對於SEP的影響。
方法：測定患兒正中神經的SEP後，靜脈給予麻醉前用藥咪達唑侖0.1mg/kg，根據不同分組（給予酮基布洛芬和芬太尼或不給）給予鎮痛藥，然後在麻醉維持過程中記錄3次SEP值：①吸入七氟醚15分鐘後呼氣末七氟醚的濃度達到2%時；②吸入後25分鐘（給/不給予酮基布洛芬1mg/kg）；③吸入後35分鐘（給/不給予芬太尼1ug/kg）。
結果：與基礎測量值相比，N20潛伏期和中樞傳導時間在七氟醚維持麻醉中均有所延長（前者P=0.015，後者P=0.001）。鎮痛藥的使用對N20潛伏期和中樞傳導時間沒有影響。在5-8歲患兒中，平均N20-P25振幅有所下降（P=0.008）。此外，在年長兒中聯合應用酮基布洛芬和芬太尼後N20-P25振幅也有所下降（P=0.03）。但在年幼兒中未發現有下降的現象。
結論：在小兒，2%七氟醚可以通過與其他吸入麻醉藥相似的方式延長正中神經的SEP潛伏期。雖然吸入七氟醚時可以監測SEP，但應根據個體差異調整吸入劑量。聯合應用酮基布洛芬和芬太尼並不影響SEP潛伏期，但可降低年長兒皮質電位的振幅。
（周姝婧 譯 陳傑 校）
BACKGROUND:
Somatosensory
evoked potentials (SEPs) are used to determine the spinal cord and
brain function during surgical procedures. In general, SEPs are
sensitive to volatile anesthetics, but little is known about the
effects of anesthesia maintenance with sevoflurane on SEPs in
children. Analgesics are often provided during anesthesia, and
supplementary drugs may also affect the SEPs. In this prospective
clinical trial of 27 healthy, 3- to 8-yr-old children, we evaluated
the effects of sevoflurane anesthesia after IV induction with
benzodiazepine and barbiturate on median nerve SEP. In addition, the
effects of two analgesics (ketoprofen and fentanyl) on SEPs were
evaluated.
METHODS:
Median nerve
SEPs were recorded before premedication with midazolam 0.1 mg/kg IV,
and at three separate times during anesthesia maintenance with
sevoflurane 2% end-tidal concentration in air/oxygen (after 15 min
of sevoflurane inhalation), supplemented with/without ketoprofen 1
mg/kg (after 25 min) and fentanyl 1 µg/kg (after 35 min).
RESULTS:
Compared with
baseline measurements, an increase both in N20 latency (P = 0.015) and in central
conduction time (P = 0.001) was noted during anesthesia maintenance with
sevoflurane. The administration of analgesics did not have an
influence on the N20 latency or central conduction time. In children
5 to 8 yr of age, the mean cortical N20-P25 amplitude was decreased
(P =
0.008). In addition, in older children, the N20-P25 amplitude decreased
after the co-administration of ketoprofen and fentanyl compared with
the values measured before the analgesics (P = 0.03). These decreases were
not seen in the younger children.
DISCUSSION:
In children,
anesthesia maintenance with 2% sevoflurane prolongs median SEP
latencies in a manner that is similar to those reported for other
volatile anesthetics. However, SEP monitoring can be done with
sevoflurane inhalation, but the dosage should be adjusted due to
interindividual variabilty. Co-administration of ketoprofen, and
fentanyl did not affect the SEP latencies, but post hoc analysis suggested that older
children had a decrease in cortical amplitudes.
The
Dose–Response of Nitrous Oxide in Postoperative Nausea in Patients Undergoing
Gynecologic Laparoscopic Surgery: A Preliminary Study
Boris
Mraovic, MD*, Tatjana _files/image042.gif){kind=small}
imurina, MD, MSc_files/image043.gif){kind=small}
, Zdenko Sonicki, MD, PhD_files/image044.gif){kind=small}
, Neven Skitareli_files/image046.gif){kind=small}
, MD, PhD_files/image047.gif){kind=small}
, and Tong J. Gan, MD||
From the
*Department of Anesthesiology, Thomas Jefferson University, Philadelphia,
Pennsylvania; _files/image048.gif){kind=small}
Department of Anesthesiology and
ICU, General Hospital Zadar, Zadar, Croatia; _files/image049.gif){kind=small}
Department of Medical Statistics,
Epidemiology and Medical Informatics, School of Public Health "Andrija _files/image050.gif){kind=small}
tampar," Faculty of
Medicine, University of Zagreb, Zagreb, Croatia; _files/image051.gif){kind=small}
ENT Department, General Hospital
Zadar, Zadar, Croatia; and ||Department of Anesthesiology, Duke University
Medical Center, Durham, North Carolina.
Anesth
Analg 2008 107: 818-823.
背景：氧化亞氮（N2O）是否增加婦科腔鏡手術術後噁心嘔吐（PONV）發生率仍有爭議。其發生率可能與麻醉氣體吸入的濃度有關。作者研究了氧化亞氮與術後噁心嘔吐的發生是否存在劑量相關效應。
方法：接受婦科腔鏡手術的患者隨機分為三組：吸入30%氧－空氣組（G0, n = 46）、吸入50% N2O－氧混合組（G50，n = 46）、吸入70% N2O－氧混合組（G70, n = 4５）。使用標準的全麻技術但並不給予預防噁心嘔吐藥物。控制術前已知的PONV危險因素。胃複安為解救藥物。評價術後二小時、二十四小時內的噁心、嘔吐、使用解救藥物的發生率及疼痛視覺評分（VAS）。
結果：各組的一般情況具有可比性，包括可能影響PONV的危險因素。PONV的24小時發生率分別為：G0組33%（15/46）、G50組46%(21/46)、 G70組62%(28/45)(P=0.018)。組間分析發現G0和G70組之間有統計學差異(P=0.018)，但其他組合之間卻無差異。在噁心發生率方面具有相似的差異：G0=26%,G50=35%,G70=56%,P=0.012；但在嘔吐發生率方面儘管有相似的趨勢，卻無統計學差異(G0=28%,G50=35%,G70=42%,P=0.377)。噁心的嚴重程度（用VAS 100mm評估）與N2O濃度之間呈正相關（
G0=10.9,G50=12.7,G70=20.5,P=0.027）。同時分析24小時內最高的VAS評分。在解救藥物使用率、疼痛VAS評分和阿片類藥物使用量（術後二小時、二十四小時內）方面各組無差異。
結論：N2O增加婦科腔鏡手術術後噁心發生率。這項初步實驗提示N2O可能以劑量相關的方式增加PONV的發生率。每組至少需要400個以上的樣本量方能揭示其組間的統計學差異性。作者不建議在婦科腔鏡手術中使用高濃度的N2O。
（於章傑 譯 陳傑 校）
BACKGROUND:
Whether nitrous
oxide (N2O) increases the incidence of postoperative
nausea and vomiting (PONV) after laparoscopic gynecologic surgery is
still controversial, which may be due to the administration of
different concentrations of inspired N2O. We investigated
whether N2O results in a dose–response increase in PONV.
METHODS:
Patients
undergoing gynecologic laparoscopic surgery were randomized to
receive 30% oxygen with air (G0, n = 46), 50% N2O with
oxygen (G50, n
= 46), or 70% N2O with oxygen (G70, n = 45). A standardized general
anesthetic was used with no PONV prophylaxis. Known risk factors for
PONV were controlled. Metoclopramide was used as a rescue
antiemetic. The incidence of nausea, vomiting, use of rescue
antiemetic, and pain visual analog scale (VAS) score was measured at
2 and 24 h postoperatively.
RESULTS:
Patient
demographics were comparable, and there were no differences among
groups regarding factors that may influence PONV. The incidence of
PONV at 24 h was 33% (15 of 46) in the G0 group, 46% (21 of 46) in
the G50 group, and 62% (28 of 45) in the G70 group (P = 0.018). Subgroup analysis
revealed a difference between G0 versus G70 groups (P = 0.018), but no significant
difference between G0 versus G50 groups and G50 versus G70 groups. The
incidence of nausea showed a similar difference (G0 = 26%, G50 =
35%, and G70 = 56%; P = 0.012), but the incidence of vomiting was not different
among the groups although there was a trend (G0 = 28%, G50 = 35%,
and G70 = 42%; P = 0.377). The severity of nausea (measured by VAS 100 mm)
was significantly increased with increasing N2O
concentration (G0 = 10.9, G50 = 12.7, and G70 = 20.5; P = 0.027). The highest VAS score
during 24 h was used for the analysis. There was no difference in
the use of a rescue antiemetic among groups. Pain VAS scores and
opioids consumption were not different among groups (at 2 and 24 h
after surgery).
CONCLUSIONS:
N2O
increases the incidence of postoperative nausea after gynecologic
laparoscopic surgery. This preliminary finding indicates that N2O
may increase PONV in a dose-dependent fashion. A study with a sample
size of >400 patients in each group would be necessary to
demonstrate a statistically significant difference among each of
these three groups. We do not recommend using a high concentration
of N2O in this clinical setting.
A
Hypothesis on the Origin and Evolution of the Response to Inhaled Anesthetics
James M.
Sonner, MD
From the
Department of Anesthesia and Perioperative Care, University of California, San
Francisco, California.
Anesth Analg 2008 107:
849-854.
本文作者提出了有機體對吸入麻醉藥反應的進化論假說。作者推測，機體對吸入麻醉藥的反應是由於離子通道，這種對吸入麻醉藥的敏感性世代沿襲下來，由我們共同的祖先——單細胞生物裏的麻醉敏感性離子通道並遺傳下來（例如，單細胞生物還未產生神經系統對吸入麻醉藥的適應性反應，而其離子通道對吸入麻醉藥的反應要早於多細胞生物）。這種敏感性在多細胞生物裏被細化為神經突觸。
值得注意的是，作者推測，1）單細胞生物被選擇的有益特性是離子通道對環境中化合物的協同應答，而這會影響離子通道的構象平衡； 2）這種協同反應防止了正電荷進入細胞而產生有害後果，因此增加了生物體的適應性； 3）這些複合物（包括陰離子，陽離子，兩性離子和一些不帶電化合物）模擬了吸入麻醉藥在機體內的介面活性，並且通過改變連接離子通道的雙分子層結構來調節離子通道的功能。
假說包括了吸入麻醉藥已知特性。此外，這個假設也適合於那些非揮發性麻醉藥有類麻醉作用的物質對離子通道調節作用，包括那些在健康人與身患疾病人身上的調節離子通道功能的內源性複合物。後者包括代謝物在一些器官衰竭的終末階段以及一般的代謝疾病。這些預言部分已被研究並被證實。
（趙嫣紅 譯 陳傑 校）
In this
article, I present an evolutionary explanation for why organisms
respond to inhaled anesthetics. It is conjectured that organisms
today respond to inhaled anesthetics owing to the sensitivity of ion
channels to inhaled anesthetics, which in turn has arisen by common
descent from ancestral, anesthetic-sensitive ion channels in
one-celled organisms (i.e., that the response to anesthetics did not
arise as an adaptation of the nervous system, but rather of ion
channels that preceded the origin of multicellularity). This
sensitivity may have been refined by continuing selection at
synapses in multicellular organisms.
In
particular, it is hypothesized that 1) the beneficial trait that was
selected for in one-celled organisms was the coordinated response of
ion channels to compounds that were present in the environment,
which influenced the conformational equilibrium of ion channels; 2)
this coordinated response prevented the deleterious consequences of
entry of positive charges into the cell, thereby increasing the
fitness of the organism; and 3) these compounds (which may have
included organic anions, cations, and zwitterions as well as
uncharged compounds) mimicked inhaled anesthetics in that they were
interfacially active, and modulated ion channel function by altering
bilayer properties coupled to channel function.
The
proposed hypothesis is consistent with known properties of inhaled
anesthetics. In addition, it leads to testable experimental predictions
of nonvolatile compounds having anesthetic-like modulatory effects
on ion channels and in animals, including endogenous compounds that
may modulate ion channel function in health and disease. The latter
included metabolites that are increased in some types of end-stage
organ failure, and genetic metabolic diseases. Several of these
predictions have been tested and proved to be correct.
，
腦脊髓液中鉀離子濃度的增加並不引起大鼠異氟醚MAC的增加
Increases
in Spinal Cerebrospinal Fluid Potassium Concentration Do Not Increase
Isoflurane Minimum Alveolar Concentration in Rats
Dimitry
Shnayderman, BS*, Michael J. Laster, DVM*, Edmond I.
Eger, II, MD*, Irene Oh, BS*, Yi Zhang, MD*, Steven L. Jinks, PhD_files/image052.gif){kind=small}
, Joseph F. Antognini, MD_files/image053.gif){kind=small}
, and Douglas E. Raines, MD_files/image054.gif){kind=small}
From the
*Department of Anesthesia and Perioperative Care, University of California, San
Francisco, California; _files/image055.gif){kind=small}
Department of Anesthesiology and
Pain Medicine, University of California, Davis, California; and _files/image056.gif){kind=small}
Department of Anesthesia and
Critical Care, The Massachusetts General Hospital, Boston, Massachusetts.
Anesth
Analg 2008 107: 879-884.
背景：以往的研究顯示異氟醚的MAC與脊髓周圍腦脊液的鈉離子濃度相關。脊髓為吸入麻醉藥制動作用主要作用位點。如果這一相關性是由脊髓刺激提高所致，輸注高鉀液會有相似作用。相反，如果鉀離子此效應缺失可能解釋鉀離子通道並不介導吸入麻醉藥的制動作用，而鈉離子通道仍為介體。本文作者研究了改變鞘內鉀離子濃度對MAC的影響。
方法：大鼠鞘內置管，腰部鞘內給予貧鉀、富鉀液體，測定異氟醚應用前24h、使用中及24h後的MAC。另測定滲透壓對（輸注甘露醇）MAC的影響和鈉離子滲入脊髓情況。
結果：異氟醚的MAC在鞘內輸注鉀離子導致濃度升高後無顯著變化。在輸注KCl濃度超過12倍正常濃度後（29 mEq/L）大鼠自主活動時異氟醚濃度稍降低，有時為一個MAC，但平均MAC未超過對照MAC。在最大輸注濃度（58.1 mEq/L）時MAC明顯降低且隨後未恢復至正常（如此高濃度可產生損傷）。輸注低濃度鉀溶液時並不影響MAC。鞘內注射鈉離子可滲入脊髓。
結論：上述結果並不支援鉀通道媒介或調製MAC。
（懷曉蓉 譯 陳傑 校）
BACKGROUND:
Previous studies
demonstrated that MAC for isoflurane directly correlates with the
concentration of Na+ in cerebrospinal fluid surrounding
the spinal cord, the primary site for mediation of the immobility
produced by inhaled anesthetics. If this correlation resulted from
increased irritability of the cord, then infusion of increased
concentrations of potassium (K+) might be predicted to
act similarly. However, an absence of effect of K+ might be
interpreted to indicate that K+ channels do not mediate the immobility
produced by inhaled anesthetics whereas Na+ channels remain
as potential mediators. Accordingly, in the present study, we
examined the effect of altering intrathecal concentrations of K+
on MAC.
METHODS:
In rats prepared
with chronic indwelling intrathecal catheters, we infused solutions
deficient in K+ and with an excess of K+ into
the lumbar space and measured MAC for isoflurane 24 h before,
during, and 24 h after infusion. Rats similarly prepared were tested
for the effect of altered osmolarity on MAC (accomplished by
infusion of mannitol) and for the penetration of Na+ into
the cord.
RESULTS:
MAC of
isoflurane never significantly increased with increasing
concentrations of K+ infused intrathecally. At infused concentrations
exceeding 12 times the normal concentration of KCl, i.e., 29 mEq/L,
rats moved spontaneously at isoflurane concentrations just below,
and sometimes at MAC, but the average MAC in these rats did not
exceed their control MAC. At the largest infused concentration (58.1
mEq/L), MAC significantly decreased and did not subsequently return
to normal (i.e., such large concentrations produced injury).
Infusions of lower concentrations of K+ had no effect on
MAC. Infusion of osmotically equivalent solutions of mannitol did
not affect MAC. Na+ infused intrathecally measurably
penetrated the spinal cord.
CONCLUSIONS:
The results do
not support a mediation or modulation of MAC by K+
channels.
An In-Vivo Metabolic Test for Detecting
Malignant Hyperthermia Susceptibility in Humans: A Pilot Study
Frank
Schuster, MD*, Thomas Metterlein, MD*, Sabrina Negele, MS*,
Peter Kranke, MD*, Ralf M. Muellenbach, MD*, Ulrich Schwemmer,
MD*, Norbert Roewer, MD*, and Martin Anetseder, MD_files/image057.gif){kind=small}
From the
*Department of Anesthesiology, University of Würzburg, Germany; _files/image058.gif){kind=small}
Department of Anesthesiology,
Hospital Landshut-Achdorf, Germany.
Anesth
Analg 2008 107: 909-914.
引言：離體收縮試驗以診斷惡性高熱（MH）需肌組織活檢，它可能給病人帶來嚴重的副作用。在研究過多篇不同的試驗計畫書後作者提出一個創傷相對較小的測試，通過肌注咖啡因和氟烷，測定局部的乳酸值，以區別高熱易感人群（MHS）和非易感人群（MHN）間差異。
方法：在8名先前已診斷為MHS的患者（其三個代表基因突變，GLY2434ARG，THR2206MET,ARG614CYS），和7名MHN，以及7名對照組患者的股肌中埋入兩個可進行微型探針。在在平衡和乳酸水準基線記錄後，局部注射單次負荷劑量咖啡因（200uL，80 Mm）和4%的氟烷200uL（容積百分比，大豆油懸浮液）。乳酸含量由分光光度法測定。資料採用中位數及四分位數間距表示。
結果：儘管各研究組的乳酸基線值在注射前是相似的，但在注射咖啡因後，局部乳酸值在MHS組（2.0（1.8-2.6） mM）顯著大於MHN組(0.8(0.6-1.1)mM)和對照組(0.8（0.6-0.8）mM。氟烷也引起MHS組【8.6 （3.7-8.9 ）Mm】比MHN組【 0.9（0.5-1.1）mM】和對照組【1.7（0.9-2.3）mM】乳酸值高。但MHN組有一名患者和對照組兩名患者乳酸增加。另外，血流動力學和代謝參數在組間無差異。
結論：通過局部注射咖啡因和氟烷後檢測乳酸代謝，是一種創傷性和副作用較小的方法，以便檢測惡性高熱的易感人群。
（葉樂 譯 陳傑 校）
INTRODUCTION:
In vitro contracture testing to diagnose
malignant hyperthermia (MH) susceptibility requires a muscle biopsy,
which may be associated with severe side effects for the patient.
After investigation of several different protocols, we present a
less invasive metabolic test that involves IM injection of caffeine
and halothane, and subsequent measurement of interstitial lactate to
differentiate between MH susceptible (MHS) and MH non-susceptible
(MHN) individuals.
METHODS:
Two
microdialysis probes with attached microtubing for trigger injection
were inserted into the lateral vastus muscle of eight previously
diagnosed MHS patients (representing three genetic variants
Gly2434Arg, Thr2206Met, and Arg614Cys), seven MHN patients, and
seven control individuals. After equilibration and lactate baseline
recording, a single bolus of 200 µL caffeine 80 mM and a suspension
of 200 µL halothane 4%V/V in soy bean oil (triggers) were injected
locally. Lactate was measured spectrophotometrically. Data are
presented as medians and interquartile ranges.
RESULTS:
Although
baseline lactate values were similar in the investigated groups
before trigger injection, caffeine increased local lactate in MHS
patients significantly more (2.0 [1.8–2.6] mM) than in MHN (0.8
[0.6–1.1] mM) or in control individuals (0.8 [0.6–0.8 mM]).
Similarly, halothane lead to a significant lactate increase in MHS
compared to MHN and control individuals (8.6 [3.7–8.9] mM vs 0.9
[0.5–1.1] mM and 1.7 [0.9–2.3] mM, respectively). However, a
relevant increase of lactate was observed in one MHN and in two
control individuals. Systemic hemodynamic and metabolic variables
did not differ between the investigated groups.
DISCUSSION:
Metabolic
monitoring of IM lactate after local caffeine and halothane
injection may allow less invasive testing to detect MH
susceptibility, without systemic side effects.
Determinants
of Tidal Volumes with Adaptive Support Ventilation: A Multicenter Observational
Study
Dave A.
Dongelmans*, Denise P. Veelo*_files/image059.gif){kind=small}
, Alexander Bindels_files/image060.gif){kind=small}
, Jan M. Binnekade*,
Kees Koppenol_files/image061.gif){kind=small}
, Matty Koopmans_files/image062.gif){kind=small}
, Joke C. Korevaar||,
Michael A. Kuiper*_files/image063.gif){kind=small}
¶, and Marcus J.
Schultz*¶#
From the
*Department of Intensive Care Medicine, _files/image064.gif){kind=small}
Department of Anesthesiology,
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; _files/image065.gif){kind=small}
Department of Intensive Care
Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; _files/image066.gif){kind=small}
Department of Intensive Care
Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands; ||Department
of Clinical Epidemiology and Biostatistics, Academic Medical Center, University
of Amsterdam, Amsterdam, The Netherlands; ¶HERMES Critical Care Group,
Amsterdam, The Netherlands; and #Laboratory for Experimental Intensive Care and
Anesthesiology (L.E.I.C.A), Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands.
Anesth
Analg 2008 107: 932-937. [
引言：本文作者研究了心胸外科手術病人自適應輔助通氣（ASV），並研究微處理器機械通氣模型下潮氣量的確定及影響因素。
方法：本研究為前瞻性、多中心、觀察研究，包括3個荷蘭ICU，時間長達5個多月。機械通氣資料在患者入ICU後穩定時收集。
結果：採集346位元心胸外科手術病人資料：262位病人使用ASV，而84位病人使用壓力控制/壓力支援通氣。使用ASV組的病人平均潮氣量為7.1 ±1.6ml/kg。換算成理想體重潮氣量為8.3 ±1.5ml/kg，在一些正確的預設體重病人中（例如：理想體重），潮氣量為8.1 ±1.4ml/kg。而在壓力控制或壓力支持通氣組病人理想體重的潮氣量為7.3 ±1.4ml/kg（與ASV相比P<0.001）。多變數計算回歸分析顯示ASV的潮氣量取決於兩個參數：呼吸頻率和預設體重。
結論：ASV的潮氣量取決於兩個參數：呼吸頻率和預設體重。第一個因素在臨床上不是很重要，因為呼吸頻率是由電腦自動選擇。第二個因素在臨床上很重要，因為它是唯一的可以被醫生影響的因素。研究資料顯示了在使用ASV時設置正確體重的重要性。在相當數量使用ASV的病人中，理想體重的潮氣量>8ml/kg。今後尚需隨機臨床試驗比較ASV與其他通氣模式的差異。
（張磊 譯 陳傑 校）
INTRODUCTION:
In the present
study, we investigated the behavior of adaptive support ventilation
(ASV) in patients after cardiothoracic surgery. We determined tidal
volumes (Vt) and factors that influence Vt with this mode of microprocessor-controlled
mechanical ventilation (MV).
METHODS:
This was a
prospective, multicenter, observational study in three Dutch
intensive care units over a 5-mo period. MV data were collected
during steady-state after arrival in the intensive care unit.
RESULTS:
Data were
collected for 346 consecutive patients after cardiothoracic surgery:
262 patients weaned with ASV, and 84 patients weaned with
pressure-controlled/pressure-support MV. With ASV the mean (± sd) Vt
expressed per kilogram actual body weight was 7.1 ± 1.6 mL.
Expressed per kilogram ideal body weight (IBW), Vt was 8.3 ± 1.5 mL.
In patients with a correctly set body weight (SBW) (i.e., the IBW),
Vt was 8.1 ± 1.4 mL/kg. With pressure-controlled/pressure-support-MV
Vt was 7.3 ± 1.4 mL/kg IBW (P < 0.001 vs ASV). Multivariate logistic
regression analysis showed Vt with ASV to be dependent on only two
parameters: respiratory rate and the correctness of SBW.
CONCLUSIONS:
Vt with ASV
seems to be dependent on two parameters: respiratory rate and the
correctness of SBW. The first factor is not clinically important
because respiratory rate is automatically chosen by the
microprocessor. The second factor is clinically important because it
is the only factor that can be influenced by the operator. Our data
show the importance of setting the correct weight with ASV. With
ASV, Vt are >8 mL/kg IBW in a substantial number of patients.
Randomized clinical trials should be performed to compare ASV with
other ventilation modes.
An
Evaluation of the Postoperative Antihyperalgesic and Analgesic Effects of
Intrathecal Clonidine Administered During Elective Cesarean Delivery
Patricia
M. Lavand’homme, MD, PhD, Fabienne Roelants, MD, Hilde Waterloos, RN, Valerie
Collet, MSc, and Marc F. De Kock, MD, PhD
From the
Department of Anesthesiology, St Luc Hospital Medical School, Université
Catholique de Louvain, Brussels, Belgium.
Anesth
Analg 2008 107: 948-955.
背景：鞘內注射可樂定提高剖腹產術中麻醉和術後鎮痛。可樂定同時還具有抗痛覺過敏的特性。痛覺過敏歸因於術後疼痛並可能增加術後慢性疼痛的風險。在此研究中，作者評估了鞘內可樂定注射剖腹產術後抗痛覺過敏作用。
方法：96名接受選擇性剖腹產術的產婦隨機分組，分別接受：鞘內布比卡因-舒芬太尼（BS組），布比卡因-舒芬太尼-可樂定75ug（BSC組），或者布比卡因-可樂定150ug（BC組）。首先評價的是切口周圍點狀機械性痛覺過敏的程度和發生率，通過對剖腹產術後24小時和48小時的von Frey毛髮刺激反應來評定。同時評估術後嗎啡需要量、疼痛評分和1、3、6月的後遺痛情況。
結果：BC組在術後48小時切口周圍痛覺過敏的範圍明顯減少（中位數，25-75個百分點，分別為BC1.0(1.0-3.3)cm2，BS組9.5(5.0-14.0)cm2，BSC組5.0（2.5-12.3）cm2（與BS組相比P=0.002）。BC組的術後48小時痛覺過敏發生率同樣較低，分別為BC組16%，BS組41%，BSC34%（與BS組相比P=0.03）。各組間的術後嗎啡量、疼痛評分、後遺痛的發生率和強度無差異。
結果：相比於鞘內使用布比卡因-舒芬太尼和鞘內使用可樂定75ug-布比卡因-舒芬太尼，鞘內使用150ug可樂定聯合布比卡因具有抗痛覺過敏的作用，顯著減少選擇性剖腹產後48小時切口周圍點狀機械性痛覺過敏的程度和發生率。
（朱紫瑜 譯 陳傑 校）
BACKGROUND:
Intrathecal
clonidine improves intraoperative anesthesia and postoperative
analgesia after cesarean delivery. Clonidine also possesses
antihyperalgesic properties. Hyperalgesia contributes to
postoperative pain and may be associated with increased risk of
chronic pain after surgery. In this study, we evaluated the postoperative
antihyperalgesic effect of intrathecal clonidine after caesarean
delivery.
METHODS:
Ninety-six
parturients undergoing elective cesarean delivery were randomly
assigned to receive intrathecal bupivacaine-sufentanil (BS group),
bupivacaine-sufentanil-clonidine 75 µg (BSC group), or
bupivacaine-clonidine 150 µg (BC group). The primary outcome was the
extent and the incidence of periincisional punctate mechanical
hyperalgesia as assessed by response to application of a von Frey
filament at 24 and 48 h after cesarean delivery. Postoperative
morphine requirements and pain scores, as well as residual pain at
1, 3, and 6 mo, were also assessed.
RESULTS:
The BC group had
a significantly reduced area of periincisional hyperalgesia at 48 h
(median, 25th–75th percentiles): 1.0 (1.0 – 3.3) cm2 vs
9.5 (5.0–14.0) cm2 in the BS group vs 5.0 (2.5–12.3) cm2
in the BSC group (P = 0.02 with the BS group). The incidence of hyperalgesia at
48 h was also lower in the BC group: 16% vs 41% in the BS group vs
34% in the BSC group (P = 0.03 with BS group). Postoperative
morphine consumption, pain scores, and incidence and intensity of
residual pain did not differ among groups.
CONCLUSIONS:
Intrathecal
clonidine 150 µg combined with bupivacaine had a postoperative
antihyperalgesic effect expressed as a significant reduction in the
extent and incidence of periincisional punctate mechanical hyperalgesia
at 48 h after elective cesarean delivery compared with intrathecal
bupivacaine-sufentanil and intrathecal clonidine 75
µg-bupivacaine-sufentanil.
Lengthening
of the Trachea During Neck Extension: Which Part of the Trachea Is Stretched?
David T.
Wong, MD*, Hao Weng, MD_files/image067.gif){kind=small}
, Eunice Lam_files/image068.gif){kind=small}
, Hai-Bao Song, MD£,
and Jin Liu, MD£
From the
*Department of Anesthesiology, University of Toronto, Canada; _files/image069.gif){kind=small}
Department of Anesthesiology,
Dongfeng General Hospital, Yunyang Medical College, No.10 Da-Ling-Lu street,
Shiyan, Hubei, 442008, People’s Republic of China; and _files/image070.gif){kind=small}
Student, Health Science Program,
McMaster University, Hamilton, Canada; £Department of Anesthesiology, West
China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of
China.
Anesth
Analg 2008 107: 989-993.
背景：作者試圖研究三種不同頸部位置時從上門齒至氣管隆突的氣道三部分各自長度改變。
方法：20名擇期手術患者入組本實驗。將氣道分為三段：上門齒至聲帶（UI-VC）、聲帶至胸骨切跡（VC-SN）、胸骨切跡至氣管隆突（SN-CA）。患者予全麻誘導並行氣管插管，連接呼吸機行機械通氣。將支氣管鏡經氣管導管連接處置入氣管導管內插入直至其頂端觸及隆突並予以支氣管鏡上膠帶標記，隨後緩慢退出支氣管鏡並分別於胸骨切跡（透光法確認）聲帶及上門齒（支氣管鏡直視）時膠帶標記。分別測量病人頸部處屈位（相當於頭部墊10ｃm枕頭）、自然位（相當於頭部墊5cm枕頭）、伸位（相當於頭部不墊枕頭）時四個標記間的三段距離以獲得氣管三段部分的各自長度，並對所獲得資料進行方差分析及配對t檢驗。
結果 ：UI-VC, VC-SN, 和 SN-CA三段的長度分別為12.1 ± 1.49、5.37 ± 0.95和8.24 ± 1.16cm。當頸部從屈位至伸位變化中UI-VC和 VC-SN長度分別增加0.36 ± 0.68cm（P=0.027）及1.74 ± 0.48cm（P<0.001）。SN-CA段長度減少0.12± 0.70cm（NS），而UI-CA的總長度增加1.99 ±0.7cm（P<0.001）。在頸部位置處於屈位、自然位和伸位時SN-CA段分別占總長度的64%、61%和56%，但其長度無顯著變化。
結論：當頸部從屈位至伸位變化中，UI-CA的總長度增加1.99cm。氣道三段組成中以VC-SN段長度增加1.74cm為甚，UI-VC段只增加0.36cm而SN-CA段長度無明顯改變。三種體位中SN-CA段平均占UI-CA總長度的60%。本實驗發現可以解釋為何插管病人頸部伸展時其原本固定的氣管導管會滑向深處。
（陶穎瑩 譯 陳傑 校）
BACKGROUND:
We sought to
determine the distances of the three segments of the airway from
upper incisors to carina in intubated patients in three different
neck positions.
METHODS:
Twenty patients
undergoing elective surgery were studied. The airway was divided into
three segments: upper incisor to vocal cords (UI-VC), vocal cords to
sternal notch (VC-SN), and sternal notch to the carina (SN-CA).
After general anesthesia and tracheal tube placement, the circuit
was connected and the lungs ventilated. A bronchoscope was inserted
through a ported elbow adapter until the tip just contacted carina.
A marker tape was placed on the bronchoscope immediately above the
adapter port. As the bronchoscope was withdrawn to the sternal notch
(by transillumination), vocal cords and upper incisor (endoscopic visualization),
three corresponding markers were placed along the bronchoscope. The
three segments of the airway were obtained by measuring the
distances between the four markers. Measurements were taken with the
patient’s neck in flexion (10 cm pillow), neutral (5 cm pillow), and
extension (no pillow) positions. Repeated measure analysis of
variance and paired t-tests were used for analysis of the data.
RESULTS:
The UI-VC,
VC-SN, and SN-CA distances were 12.01 ± 1.49, 5.37 ± 0.95, 8.24 ±
1.16 cm. From neck flexion to extension, UI-VC and VC-SN increased
by 0.36 ± 0.68 cm (P = 0.027) and 1.74 ± 0.48 cm (P < 0.001) respectively; SN-CA
decreased by 0.12 ± 0.70 cm (NS). Overall, UI-CA increased by 1.99 ±
0.70 cm (P
< 0.001). SN-CA represented 64%, 61%, 56% of the VC-CA distance
with the neck in flexion, neutral, and extension respectively. SN-CA
did not change significantly among the head positions (NS).
CONCLUSIONS:
From neck
flexion to extension, the UI-CA distance increased by 1.99 cm. The
major contribution to this lengthening was an increase of the VC-SN
distance by 1.74 cm; UI-VC increased by 0.36 cm whereas SN-CA did
not change significantly. Averaging the three neck positions, SN-CA
represented 60% of the VC-CA distance. Our findings may explain why
tracheal tubes fixed at the mouth ascend in the trachea with neck
extension.
經皮煙鹼貼劑作為術後疼痛處理:一項劑量範圍研究
Transdermal
Nicotine Patch for Postoperative Pain Management: A Pilot Dose-Ranging Study
Daewha
Hong, MS, Jessamyn Conell-Price, BA, Sean Cheng, MD, and Pamela Flood, MD
From the
Department of Anesthesiology, Columbia University Medical Center, New York
City, New York.
Anesth
Analg 2008 107: 1005-1010.
背景: 動物試驗表明煙鹼具有術後鎮痛作用。人類應用經鼻煙鹼噴劑有不等的效果，可能是由於藥代動力學及不同情況病人如經常暴露於煙鹼的吸煙者存有變異性。在這項研究中，作者僅在非吸煙者中進行術前應用經皮煙鹼貼劑鎮痛效果的試驗。
方法:本研究對40名擬行普外科手術，術後要求行自控鎮痛且住院的患者進行一項隨機、雙盲、前瞻性、安慰劑-對照研究。術前應用劑量分別為0、5、10和15mg的經皮煙鹼貼劑。主要的結果參數為是數位化評定量表（NRS）來判定術後一小時和術後五天疼痛評分。次要的結果參數是疼痛藥選用，對血流動力學的影響，噁心發生率和鎮靜作用等。
結果:
在術後一小時(P=0.003,平均NRS減少1.4,95% CI=0.3-2.6)和術後五天 (P=0.03,平均NRS減少1.0,95% CI=0.1-1.9)的疼痛評定中可以看出，與應用安慰劑處理的病人相比，應用了煙鹼的病人有更低疼痛評分。當煙鹼的用量超過５mg時，其有效性已經不再增加。在煙鹼組減少了疼痛藥的使用同時，增加了噁心的發生，減少了心動過速的發生和略微降低了收縮壓的傾向，但是這些作用均不顯著。
結論：在普外科手術，經皮使用煙鹼5-15mg，可以減低術後疼痛評分但是並不能減少麻醉性鎮痛藥的使用量，也不能降低阿片類鎮痛藥物相關的副作用。
（丁俊雲 譯 陳傑 校）
BACKGROUND:
Nicotine has
been shown to be antinociceptive in the postoperative period in
animal studies. Human studies with nasal nicotine sprays have had
mixed results, possibly due to variability in pharmacokinetics and
potential patient variables such as exposure to nicotine in tobacco
smokers. In this pilot study, we examined the analgesic effect of a
transdermal nicotine patch applied before surgery in nonsmokers.
METHODS:
We conducted a
randomized, double-blind, prospective placebo-controlled trial of 40
subjects, undergoing general surgery that required postoperative
patient-controlled analgesia and an overnight hospital admission.
Immediately before surgery, a transdermal nicotine patch containing
0, 5, 10, or 15 mg was applied. The primary outcome variable was
pain report using a numerical rating scale (NRS) in the first hour
after surgery and over the next 5 days. Secondary outcomes were pain
medication use, hemodynamic values, nausea, and sedation.
RESULTS:
Patients treated
with nicotine reported lower pain scores when compared with those
treated with placebo during the first hour after surgery (P = 0.003, average NRS decrease
= 1.4, 95% CI = 0.3–2.6) and for 5 days after surgery (P = 0.03, average NRS decrease =
1.0, 95% CI = 0.1–1.9). There was no increased benefit of nicotine
with doses larger than 5 mg. There was a trend suggesting decreased
pain medicine use, increased nausea, decreased tachycardia, and
slightly decreased systolic blood pressure in the nicotine groups,
but these values did not reach significance.
CONCLUSIONS:
Transdermal
nicotine, 5–15 mg, reduced postoperative pain scores but failed to
decrease the need for opioid analgesics or opioid-related side
effects after general surgical procedures.
A
Systematic Review of Randomized Trials Evaluating Regional Techniques for
Postthoracotomy Analgesia
Girish
P. Joshi, MB, BS, MD,FFARCSI*, Francis Bonnet, MD, FRCA_files/image071.gif){kind=small}
, Rajesh Shah, FRCS (C/Th)_files/image072.gif){kind=small}
, Roseanne C. Wilkinson, PhD_files/image073.gif){kind=small}
, Frederic Camu, MD||,
Barrie Fischer, FRCA¶, Edmund A. M. Neugebauer, PhD#,
Narinder Rawal, MD**, Stephan A. Schug, MD (Cgn), FANZCA, FFP MANZCA_files/image074.gif){kind=small}
_files/image075.gif){kind=small}
, Christian Simanski, MD_files/image076.gif){kind=small}
_files/image077.gif){kind=small}
, and Henrik Kehlet, MD_files/image078.gif){kind=small}
_files/image079.gif){kind=small}
From the
*Department of Anesthesiology and Pain Management, University of TX
Southwestern Medical Center, Dallas, Texas; _files/image080.gif){kind=small}
Hôpital Tenon Assistance Publique
Hôpitaux de Paris and Université Pierre and Marie Curie, Paris, France; _files/image081.gif){kind=small}
Wythenshawe Hospital, Manchester,
UK; _files/image082.gif){kind=small}
Choice Pharma, Hitchin, UK; ||Department
of Anesthesiology, Flemish Free University of Brussels Medical Center,
Brussels, Belgium; ¶Department of Anaesthesia, Alexandra Hospital, Redditch,
Worcestershire, UK; #Institute for Research in Operative Medicine, University
of Witten/Herdecke, Cologne, Germany; **Department of Anaesthesiology and
Intensive Care, Örebro Medical Center Hospital, Örebro, Sweden; _files/image083.gif){kind=small}
_files/image084.gif){kind=small}
School of Medicine and
Pharmacology, The University of Western Australia, Perth, Western Australia,
Australia; _files/image085.gif){kind=small}
_files/image086.gif){kind=small}
Department of Trauma and
Orthopaedic Surgery Cologne-Merheim, University of Witten/Herdecke, Cologne,
Germany; and _files/image087.gif){kind=small}
_files/image088.gif){kind=small}
Section for Surgical
Pathophysiology 4074, The Juliane Marie Centre, Rigshospitalet, Copenhagen,
Denmark.
Anesth
Analg 2008 107: 1026-1040.
背景：開胸手術可導致嚴重的術後疼痛和肺功能的減弱，因此術後的區域鎮痛已被深入的研究。胸段的硬膜外鎮痛被普遍的認為是最好的方法，然而需要評估與其他技術的差異，指導臨床實踐，尋求需要進一步研究的領域。
方法：在這項隨機試驗的系統綜述中作者評估了胸部硬膜外、椎旁、鞘內注射、肋間和胸膜間等鎮痛技術在成人的開胸手術中的應用的相互比較，並與全身應用阿片類藥物鎮痛比較。並對術後疼痛，鎮痛藥的使用量，以及併發症作分析。
結果：持續的椎旁阻滯和硬膜外的局麻藥鎮痛同樣有效，並且能降低低血壓的發生率。與全身藥物鎮痛相比，椎旁阻滯能降低肺部併發症的發生率，而胸段硬膜外鎮痛則無此作用。胸段硬膜外鎮痛比鞘內注射和肋間技術優越，而它們都優於系統性藥物鎮痛；胸膜間的鎮痛則顯得不足。
結論：無論是胸段硬膜外鎮痛加阿片類藥物還是持續的椎旁阻滯都可以使用。如果不能用這些技術或者是存在禁忌，鞘內注射阿片類藥物或者肋間神經阻滯也可以，儘管持續鎮痛的時間略顯不足，需要輔助應用系統性藥物鎮痛。定量薈萃分析受到實驗設計的限制，且量本樣數也較少。還需進一步的研究以確定最適宜的硬膜外的藥物組合，嚴格評估椎旁持續輸注的風險和優點以及肋間技術與胸段硬膜外鎮痛的比較。
（舒慧剛 譯 陳傑 校）
BACKGROUND:
Thoracotomy
induces severe postoperative pain and impairment of pulmonary
function, and therefore regional analgesia has been intensively
studied in this procedure. Thoracic epidural analgesia is commonly
considered the "gold standard" in this setting; however,
evaluation of the evidence is needed to assess the comparative
benefits of alternative techniques, guide clinical practice and
identify areas requiring further research.
METHODS:
In this
systematic review of randomized trials we evaluated thoracic
epidural, paravertebral, intrathecal, intercostal, and interpleural
analgesic techniques, compared to each other and to systemic opioid
analgesia, in adult thoracotomy. Postoperative pain, analgesic use,
and complications were analyzed.
RESULTS:
Continuous
paravertebral block was as effective as thoracic epidural analgesia
with local anesthetic (LA) but was associated with a reduced
incidence of hypotension. Paravertebral block reduced the incidence
of pulmonary complications compared with systemic analgesia, whereas
thoracic epidural analgesia did not. Thoracic epidural analgesia was
superior to intrathecal and intercostal techniques, although these
were superior to systemic analgesia; interpleural analgesia was inadequate.
CONCLUSIONS:
Either thoracic
epidural analgesia with LA plus opioid or continuous paravertebral
block with LA can be recommended. Where these techniques are not
possible, or are contraindicated, intrathecal opioid or intercostal
nerve block are recommended despite insufficient duration of
analgesia, which requires the use of supplementary systemic
analgesia. Quantitative meta-analyses were limited by heterogeneity
in study design, and subject numbers were small. Further well
designed studies are required to investigate the optimum components
of the epidural solution and to rigorously evaluate the
risks/benefits of continuous infusion paravertebral and intercostal
techniques compared with thoracic epidural analgesia.
The Antinociceptive
Response to Nicotinic Agonists in a Mouse Model of Postoperative Pain
Thomas
J. Rowley, MA, James Payappilly, Jeffery Lu, MD, and Pamela Flood, MD
From the
Department of Anesthesiology, Columbia University, New York City, New York.
Anesth Analg
2008 107: 1052-1057.
背景:尼古丁, 中樞煙鹼受體的廣譜激動劑，具有術後鎮痛效應。許多亞型的特異性煙鹼受體激動劑在動物模型中具有抗傷害作用，但是對於實驗模型有高度的依賴性。本文作者研究了選擇性作用於_files/image089.gif){kind=small}
4β2 和 _files/image090.gif){kind=small}
7的煙鹼受體激動劑對於小鼠術後疼痛模型的作用，探究哪一煙鹼受體亞型在今後臨床研究更具意義。
方法： 小鼠在足切皮後，作者用一定劑量的配體選擇性作用於_files/image091.gif){kind=small}
4β2 和 _files/image092.gif){kind=small}
7煙鹼受體，給藥前後分別測定熱潛伏期和壓力閾值。在研究中，為了證明尼古丁可以降低疼痛輸入，一組小鼠用磷酸化的cAMP反應結合蛋白(CREB)在脊髓腰段進行了染色。
結果：在熱和壓力測試中，尼古丁和位變異煙鹼（_files/image093.gif){kind=small}
4β2選擇性）可以作為一種非常有效的止痛藥。_files/image094.gif){kind=small}
7部分受體激動劑GTS-21可以顯著延長術後熱潛伏期，但是不改變壓力閾值。選擇性_files/image095.gif){kind=small}
7受體拮抗劑methyllicaconitine可以降低尼古丁延長熱潛伏期的效能，但是對壓力閾值沒有影響。細胞核用pCREB染色的脊髓背角淺層細胞的數量在術側成倍增加，使用尼古丁後呈劑量依賴性降低。
結論：研究表明尼古丁可以減少疼痛傳輸至脊髓背角淺層和深層。結果也同樣支持_files/image096.gif){kind=small}
4β2 和 _files/image097.gif){kind=small}
7煙鹼受體介導抗傷害作用。
（杜唯佳 譯 陳傑 校）
BACKGROUND:
Nicotine, the
prototypical broad spectrum agonist at central nicotinic receptors,
has analgesic action after surgery. Various subtype-specific
nicotinic agonists have antinociceptive effects in animal models,
but the response is highly dependent on the model tested. In an
effort to determine what nicotinic subtypes might be targeted in
future clinical studies, we tested agonists selective for _files/image098.gif){kind=small}
4β2 and _files/image099.gif){kind=small}
7 containing nicotinic receptors
in a mouse model of postoperative pain.
METHODS:
After paw
incision, mice were tested for heat latency and pressure threshold
before and after treatment with a dose range of ligands selective
for _files/image100.gif){kind=small}
4β2 and _files/image101.gif){kind=small}
7 containing nicotinic receptors.
To demonstrate that nicotine reduced nociceptive input in this
model, the lumbar spinal cords of a subgroup of these mice were
stained for the phosphorylated form if CREB.
RESULTS:
Nicotine and
metanicotine (_files/image102.gif){kind=small}
4β2 selective) were fully
effective as an analgesic in heat and pressure testing. The _files/image103.gif){kind=small}
7 partial agonist GTS-21
significantly increased the heat latency after surgery, but did not
alter pressure threshold. The _files/image104.gif){kind=small}
7 selective antagonist methyllicaconitine
decreased the efficacy of nicotine to increase heat latency but did
not affect pressure threshold. The number of cells in the
superficial dorsal horn with nuclei that stained for pCREB was
double on the surgical side and the ratio was reduced by nicotine in
a dose-dependent manner.
CONCLUSIONS:
Our findings
suggest that nicotine reduced nociceptive input to the superficial
and deep dorsal horn. It also provides support for _files/image105.gif){kind=small}
4β2 and _files/image106.gif){kind=small}
7 nicotinic-mediated
antinociceptive actions.
Ultrasound
Imaging Accurately Identifies the Lateral Femoral Cutaneous Nerve
Irene
Ng, MBBS, FANZCA*, Himat Vaghadia, MBBS, FRCPC, FFARCS*,
Peter T. Choi, MD, MSc (Epid), FRCPC_files/image107.gif){kind=small}
, and Naeder Helmy, MD_files/image108.gif){kind=small}
From the
*Department of Anesthesia, the Vancouver Hospital, Vancouver, British Columbia,
Canada; and _files/image109.gif){kind=small}
Department of Anesthesiology,
Pharmacology and Therapeutics and the Vancouver Coastal Health Research
Institute, The University of British Columbia, Vancouver, British Columbia,
Canada; and _files/image110.gif){kind=small}
Department of Orthopedic Surgery,
The Vancouver Hospital, Vancouver, British Columbia, Canada.
Anesth
Analg 2008 107: 1070-1074.
背景：股外側皮神經（LFCN）麻醉在股前外側手術時很有用的，作者通過在屍體和志願者對比用超聲和解剖標誌來定位驗證超聲的準確性。
方法：20具屍體，在超聲的引導下用一根針刺入股外側皮神經的靶點，注入綠色的染料，再在解剖標誌的定位下刺入第二根針，通過分離肌肉組織來確定股外側皮神經，染色評估針的位置，用神經刺激來驗證雙側股外側皮神經的位置，它們的位置通過超聲和解剖位置來比較。
結果：在超聲引導下刺入屍體的19根針，其中16根觸及到了股外側皮神經，針尖與神經的平行距離幾乎是0，利用解剖標誌定位的19根針中只有一根接觸到神經，其他針尖到神經的平均距離是18.0mm，在超聲引導下的20個志願者中，16例符合股外側皮神經的位置的，記錄器標誌到股外側皮神經的距離為0.0mm，在用解剖標誌定位的20例中，沒有一例觸及到股外側皮神經，記錄器標誌到股外側皮神經的距離為15.0mm，
結論：通過超聲定位股外側皮神經在技術上可行並比解剖標誌定位法更準確。
（劉世文 譯 陳傑 校）
BACKGROUND:
Anesthesia of
the lateral femoral cutaneous nerve (LFCN) is useful in surgery
involving the anterolateral thigh. We investigated the accuracy of
ultrasound compared with anatomical landmarks in identifying the
LFCN in human cadavers and volunteers.
METHODS:
Twenty cadavers
were examined. A needle was inserted targeting the LFCN with
ultrasound guidance and green dye was injected. A second needle was
inserted using anatomical landmarks. The LFCN was identified by
dissection, and coloring of the LFCN and needle positions were
evaluated. A volunteer study with 10 individuals was performed.
Transdermal nerve stimulation was used to identify the LFCN
bilaterally. Its position was compared with marked positions
identified in advance using ultrasound and anatomical landmarks.
RESULTS:
Sixteen of 19
needles inserted under ultrasound guidance in the cadavers were in
contact with the LFCN. The median horizontal distance from the needle
tip to the nerve was 0.0 mm (interquartile range [IQR], 0.0-0.0 mm).
Only 1 of 19 needles inserted using anatomical landmarks was in
contact with the LFCN. The median horizontal distance from the
needle tip to the nerve was 18.0 mm (IQR, 11.0–23.0 mm). Sixteen of
20 marked positions made using ultrasound guidance corresponded to
the identified LFCN in volunteers. The median horizontal distance
from the pen-mark to the LFCN was 0.0 mm (IQR, 0.0-0.0 mm). None of
the 20 marked positions made with anatomical landmarks corresponded
to the LFCN. The median horizontal distance from the pen-mark to
the LFCN was 15.0 mm (IQR, 10.8–20.0 mm).
CONCLUSIONS:
Identification
of the LFCN by ultrasound is technically feasible and more accurate
than anatomical landmarks.
吸入低濃度七氟烷增強抗消化性潰瘍藥物替普瑞酮的遲發性心臟保護作用
Low-Dose
Sevoflurane Inhalation Enhances Late Cardioprotection from the Anti-Ulcer Drug
Geranylgeranylacetone
Hiroshi
Kitahata, MD*, Junpei Nozaki, MD_files/image111.gif){kind=small}
, Shinji Kawahito, MD*,
Takehito Tomino, BS*, and Shuzo Oshita, MD*
From the
*Department of Anesthesiology, The University of Tokushima Graduate School,
Institute of Health Biosciences, Tokushima, Japan; and _files/image112.gif){kind=small}
Department of Anesthesiology,
Naruto Hospital, Tokushima.
Anesth
Analg 2008; 107:755-761
背景：我們在兔子身上觀察七氟烷能否增強抗消化性胃潰瘍藥物替普瑞酮(GGA)誘發的遲發性心臟保護作用。
方法：S(+)-氯胺酮和塞拉嗪麻醉的兔子被分到七個試驗組：對照（僅有溶媒）組、GGA組、七氟烷組、GGA+七氟烷組、5-羥基葵酸鈉(5HD)組、GGA+5HD組和熱應激組。所有兔子冠狀動脈阻斷30分鐘後接受3小時的再灌注。冠狀動脈阻斷前24小時，兔子靜脈注射溶媒、GGA(10mg/kg)或熱應激（42°C，15分鐘）預處理。心肌缺血前吸入七氟烷（0.5MAC）或靜脈注射5HD(5mg/kg)。測量各實驗組兔子心肌梗塞面積和頻臨缺血區面積以及熱休克蛋白（Hsp）70水準。
結果：相對於溶媒，GGA顯著減少心肌梗塞面積與頻臨缺血區面積的比值（39 ± 10%比59 ± 9%, P < 0.02）。七氟烷增強GGA誘發的心臟保護作用(23 ± 17%, P < 0.05比GGA)。5HD取消GGA的心臟保護作用（56 ±
15%, P <
0.01）。相對于對照組，GGA增加Hsp70的表達(0.69 ± 0.15比0.36 ± 0.05, P < 0.02)。聯合應用GGA和七氟烷與單獨應用GGA對Hsp70表達的影響沒有顯著性差異(0.69 ± 0.16, P > 0.98)。
結論：GGA減少心肌梗塞面積似乎與增加Hsp70表達有關；七氟烷增強GGA誘發的心肌保護效應。
（王宏 譯 馬皓琳 李士通 校）
BACKGROUND:
We investigated
in rabbits whether sevoflurane enhances late cardioprotection
induced by geranylgeranylacetone (GGA), a gastric antiulcer drug.
METHODS:
S(+)-ketamine
and xylazine-anesthetized rabbits were assigned to one of seven
experimental groups: a control (vehicle only) group, a GGA group, a
sevoflurane group, a GGA+sevoflurane group, a sodium
5-hydroxydecanoate (5HD) group, a GGA + 5HD group, and a heat stress
group. All rabbits were subjected to 30 min of coronary artery
occlusion followed by 3 h of reperfusion. Rabbits were pretreated
with IV vehicle, GGA (10 mg/kg), or heat stress (42°C for 15 min) 24
h before coronary occlusion. Sevoflurane (0.5 minimum alveolar
concentration) or 5HD (5 mg/kg) were administered before myocardial
ischemia. Myocardial infarct size and the area at risk for ischemia
were measured, and heat shock protein (Hsp) 70 levels in each
experimental group were determined.
RESULTS:
Compared with
vehicle only, GGA significantly reduced the size of myocardial infarction
in relation to the area at risk (39 ± 10% vs 59 ± 9%, P < 0.02). Sevoflurane enhanced
the GGA-induced cardioprotection (23 ± 17%, P < 0.05 vs GGA). The
cardioprotective effect of GGA was abolished by administration of
5HD (56 ± 15%, P < 0.01). GGA enhanced Hsp 70 expression compared with
that in the control group (0.69 ± 0.15 vs 0.36 ± 0.05, P < 0.02). Administration of
GGA with sevoflurane resulted in the same level of Hsp 70 expression
as GGA (0.69 ± 0.16, P > 0.98).
CONCLUSIONS:
GGA appears to
reduce myocardial infarct size in association with increased Hsp 70
expression. Sevoflurane enhances the GGA-induced cardioprotective
effect.
Attenuation
of Isoflurane-Induced Preconditioning and Reactive Oxygen Species Production in
the Senescent Rat Heart
Long T.
Nguyen, MD*, Mario J. Rebecchi, PhD*, Leon C. Moore, PhD_files/image113.gif){kind=small}
, Peter S. A. Glass, MB, ChB*,
Peter R. Brink, PhD