Anesthesia & Analgesia
July 2009
CARDIOVASCULAR ANESTHESIOLOGY:
ε-氨基己酸和抑肽酶应用于行初次冠状动脉旁路分离手术患者后在纤维蛋白溶解和血液流失方面的效果：一个随机双盲，安慰剂控制的无差别试验
单嘉琪译 薛张纲校
The Effect of Epsilon-Aminocaproic Acid and
Aprotinin on Fibrinolysis and Blood Loss in Patients Undergoing Primary,
Isolated Coronary Artery Bypass Surgery: A Randomized, Double-Blind,
Placebo-Controlled, Noninferiority Trial
Philip E. Greilich, Michael E. Jessen, Neeraj Satyanarayana, Charles W. Whitten, Gregory A. Nuttall, Joseph M. Beckham, Michael H. Wall, and John F. Butterworth
Anesth Analg 2009 109: 15-24.
全血多极凝集测定仪是一种可靠的阿司匹林诱导的血小板功能障碍的床边检验方法
刘世文 译 陈杰 校
Whole Blood Multiple Electrode Aggregometry
Is a Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction
Csilla Jámbor, Christian F. Weber, Konstanze Gerhardt, Wulf Dietrich, Michael Spannagl, Bernhard Heindl, and Bernhard Zwissler
Anesth Analg 2009 109: 25-31.
PEDIATRIC ANESTHESIOLOGY:
在体外循环下行先天性心脏病手术的病人使用抑肽酶与肾功能不全的关系
颜涛译， 马皓琳 李士通 校
The Association of Renal Dysfunction and the
Use of Aprotinin in Patients Undergoing Congenital Cardiac Surgery Requiring
Cardiopulmonary Bypass
Ana Manrique, Edmund H. Jooste, Bradley A. Kuch, Steven E. Lichtenstein, Victor Morell, Ricardo Munoz, Demetrius Ellis, and Peter J. Davis
Anesth Analg 2009 109: 45-52.
Narcotrend指数提示儿童丙泊酚诱导期间的年龄相关性变化
范羽译 薛张纲校
The Narcotrend Index Indicates Age-Related
Changes During Propofol Induction in Children
Sinikka Münte, Jaakko Klockars, Mark van Gils, Arja Hiller, Michael Winterhalter, Christina Quandt, Matthias Gross, and Tomi Taivainen
Anesth Analg 2009 109: 53-59.
叶乐 译 陈杰 校
Perioperative Management of Children with
Obstructive Sleep Apnea (Review Article)
Deborah A. Schwengel, Laura M. Sterni, David E. Tunkel, and Eugenie S. Heitmiller
Anesth Analg 2009 109: 60-75.
AMBULATORY ANESTHESIOLOGY:
评估用甘草漱口减少术后咽喉痛的有效性：一个前瞻性、随机、单盲研究
彭中美 译
马皓琳 李士通 校\
An Evaluation of the Efficacy of Licorice
Gargle for Attenuating Postoperative Sore Throat: A Prospective, Randomized,
Single-Blind Study
Anil Agarwal, Devendra Gupta, Ghanshyam Yadav, Puneet Goyal, Prabhat K. Singh, and Uttam Singh
Anesth Analg 2009 109: 77-81.
ANESTHETIC PHARMACOLOGY:
七氟烷麻醉状态下右美托咪定，异丙酚和咪达唑仑对兔子呼吸CO2反应性，动脉压及心率影响的比较。
黄剑译 薛张纲校
A Comparison of the Effects on Respiratory Carbon Dioxide Response,
Arterial Blood Pressure, and Heart Rate of Dexmedetomidine, Propofol, and
Midazolam in Sevoflurane-Anesthetized Rabbits
Cheng Chang, Akinori Uchiyama, Ling Ma, Takashi Mashimo, and Yuji Fujino
Anesth Analg 2009 109: 84-89.
张磊 译 陈杰 校
Predicted Propofol Effect-Site Concentration for Induction and Emergence of Anesthesia During Early Pregnancy
Nicolas Mongardon, Frédérique Servin, Mathilde Perrin, Ennoufous Bedairia, Sylvie Retout, Chadi Yazbeck, Philippe Faucher, Philippe Montravers, Jean-Marie Desmonts, and Jean Guglielminotti
Anesth Analg 2009 109: 90-95.
家兔给予新型苯二氮卓受体激动剂JM-1232(–)后的寒战阈值
周雅春 译 马皓琳 李士通 校
The Shivering Threshold in Rabbits with
JM-1232(–), a New Benzodiazepine Receptor Agonist
Taishi Masamune, Hiroaki Sato, Katsumi Okuyama, Yusuke Imai, Hironobu Iwashita, Tadahiko Ishiyama, Takeshi Oguchi, Daniel I. Sessler, and Takashi Matsukawa
Anesth Analg 2009 109: 96-100.
活体适度的氦气吸入可降低炎性反应，但不能防止缺血再灌注时的内皮损伤
李莹译 薛张纲校
Helium Breathing Provides Modest Antiinflammatory,
but No Endothelial Protection Against Ischemia-Reperfusion Injury in Humans In
Vivo
Eliana Lucchinetti, Johannes Wacker, Christian Maurer, Marius Keel, Luc Härter, Kathrin Zaugg, and Michael Zaugg
Anesth Analg 2009 109: 101-108.
丁俊云 译 陈杰 校
Thiopental Inhibits Lipopolysaccharide-Induced Tissue Factor Expression
Matthias Hartmann, Priv Doz D, Semih Özlügedik, and Juergen Peters
Anesth Analg 2009 109: 109-113.
TECHNOLOGY, COMPUTING, AND SIMULATION:
脉搏波形分析和经食管超声心动图：两种方法在腹腔镜结肠手术中测定心输出量的比较
姚敏敏译 薛张纲校
Pulse Contour Analysis and Transesophageal
Echocardiography: A Comparison of Measurements of Cardiac Output During
Laparoscopic Colon Surgery
Mario R. Concha, Verónica F. Mertz, Luis I. Cortínez, Katya A. González, and Jean M. Butte
Anesth Analg 2009 109: 114-118.
NICO监护仪能估测混合静脉血红蛋白氧饱和度吗？
舒慧刚 译 陈杰 校
Can Mixed Venous Hemoglobin Oxygen Saturation
Be Estimated Using a NICO Monitor? (Technical Communication)
Yoshifumi Kotake, Takashige Yamada, Hiromasa Nagata, Takeshi Suzuki, and Junzo Takeda
Anesth Analg 2009 109: 119-123.
PATIENT SAFETY:
江继宏 译 马皓琳 李士通 校
Liability Related to Peripheral Venous and
Arterial Catheterization: A Closed Claims Analysis
Sanjay M. Bhananker, Derek W. Liau, Preetma K. Kooner, Karen L. Posner, Robert A. Caplan, and Karen B. Domino
Anesth Analg 2009 109: 124-129.
俞佳译 薛张纲校
Eliminating Arterial Injury During Central
Venous Catheterization Using Manometry
Catalin S. Ezaru, Michael P. Mangione, Todd M. Oravitz, James W. Ibinson, and Richard J. Bjerke
Anesth Analg 2009 109: 130-134.
CRITICAL CARE AND TRAUMA:
怀晓蓉 译 陈杰 校
The Effects of Fenoterol Inhalation After
Acid Aspiration-Induced Lung Injury
Michael T. Pawlik, Thomas Schubert, Susanne Hopf, Matthias Lubnow, Michael Gruber, Christoph Selig, Kai Taeger, and Karl P. Ittner
Anesth Analg 2009 109: 143-150.
肺募集反应对病态肥胖病人容积性二氧化碳描记图III相斜率的影响
王宏翻译，李士通，马皓琳校正
The Effects of Lung Recruitment on the Phase
III Slope of Volumetric Capnography in Morbidly Obese Patients
Stephan H. Böhm, Stefan Maisch, Alexandra von Sandersleben, Oliver Thamm, Isabel Passoni, Jorge Martinez Arca, and Gerardo Tusman
Anesth Analg 2009 109: 151-159.
肺泡复张及高PEEP措施应用于有血管内容量负荷的病态肥胖病人后，并不对血流动力学产生影响
陈珺珺译，薛张纲校
Alveolar Recruitment Strategy and High Positive End-Expiratory Pressure Levels Do Not Affect Hemodynamics in Morbidly Obese Intravascular Volume-Loaded Patients (Brief Report)
Stephan H. Bohm, Oliver C. Thamm, Alexandra von Sandersleben, Katrin Bangert, Thomas E. Langwieler, Gerardo Tusman, Tim G. Strate, and Thomas G. Standl
Anesth Analg 2009 109: 160-163.
OBSTETRIC ANESTHESIOLOGY:
硬膜外注射2-氯普鲁卡因与吗啡的相互作用——一项关于吗啡镇痛时效的随机对照试验
赵嫣红 译 陈杰 校
The Interaction Between Epidural
2-Chloroprocaine and Morphine: A Randomized Controlled Trial of the Effect of
Drug Administration Timing on the Efficacy of Morphine Analgesia
Paloma Toledo, Robert J. McCarthy, Mary Jane Ebarvia, Christopher J. Huser, and Cynthia A. Wong
Anesth Analg 2009 109: 168-173.
5-羟色胺拮抗剂对剖宫产中接受鞘内吗啡的产妇瘙痒、恶心呕吐的预防和治疗作用：系统性回顾和Meta分析
黄佳佳译，马皓琳 李士通校
Serotonin Receptor Antagonists for the
Prevention and Treatment of Pruritus, Nausea, and Vomiting in Women Undergoing
Cesarean Delivery with Intrathecal Morphine: A Systematic Review and
Meta-Analysis
Ronald B. George, Terrence K. Allen, and Ashraf S. Habib
Anesth Analg 2009 109: 174-182.
NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE:
张玥琪译，薛张纲校
The Effect of Sedation on Intracranial
Pressure in Patients with an Intracranial Space-Occupying Lesion: Remifentanil
Versus Propofol
Francois Girard, Robert Moumdjian, Daniel Boudreault, Philippe Chouinard, Alain Bouthilier, and Monique Ruel
Anesth Analg 2009 109: 194-198.
开颅手术中动脉血二氧化碳分压与七氟醚对脑毛细静脉血流、脑血流及血氧饱和度的影响
朱紫瑜 译 陈杰 校
The Effects of Arterial Carbon Dioxide
Partial Pressure and Sevoflurane on Capillary Venous Cerebral Blood Flow and
Oxygen Saturation During Craniotomy
Klaus Ulrich Klein, Martin Glaser, Robert Reisch, Achim Tresch, Christian Werner, and Kristin Engelhard
Anesth Analg 2009 109: 199-204.
发育中大鼠脑的器官型海马脑片模型中氧和葡萄糖缺失：对N-甲基-d-天门冬氨酸亚单位组成的影响
黄施伟 译，马皓琳 李士通 校
Oxygen and Glucose Deprivation in an
Organotypic Hippocampal Slice Model of the Developing Rat Brain: The Effects on
N-Methyl-d-Aspartate Subunit Composition
Lisa Wise-Faberowski, Prairie Neeley Robinson, Sarah Rich, and David S. Warner
Anesth Analg 2009 109: 205-210.
GENERAL ARTICLES:
张钊译 薛张纲校
The Effect of Duration of Surgery on Fluid Balance During Abdominal Surgery: A Mathematical Model
Tsuneo Tatara, Yoshiaki Nagao, and Chikara Tashiro
Anesth Analg 2009 109: 211-216.
ANALGESIA:
周姝婧 译 陈杰 校
Intravascular Flow Patterns in Transforaminal
Epidural Injections: A Comparative Study of the Cervical and Lumbar Vertebral
Segments
Do Wan Kim, Kyung Ream Han, Chan Kim, and Yun Jeong Chae
Anesth Analg 2009 109: 233-239.
唐亮 译 马皓琳 李士通 校
The Analgesic Properties of
Scalp Infiltrations with Ropivacaine After Intracranial Tumoral Resection
Hélène Batoz, Olivier Verdonck, Christelle Pellerin, Gaëlle Roux, and Pierre Maurette
Anesth Analg 2009 109: 240-244.
滴注或注射提纯的天然辣椒碱对大鼠后肢感觉-运动行为或截骨修复术无有害影响
朱兰芳译 薛张纲校
Instilled or Injected Purified Natural Capsaicin Has No Adverse Effects on Rat Hindlimb Sensory-Motor Behavior or Osteotomy Repair
Susan M. Kramer, Jonelle R. May, Daniel J. Patrick,
Luc Chouinard, Marilyne Boyer, Nancy Doyle, Aurore Varela, Susan Y. Smith, and
Eric Longstaff
Anesth Analg 2009 109: 249-257.
黄丹 译 陈杰 校
Mexiletine and Lidocaine Suppress the
Excitability of Dorsal Horn Neurons
Andrea Olschewski, Rose Schnoebel-Ehehalt, Yingji Li, Bi Tang, Michael E. Bräu, and Matthias Wolff
Anesth Analg 2009 109: 258-264.
比较超声和神经刺激仪引导肌间沟法臂丛神经阻滞用于肩关节门诊手术后神经症状的前瞻性随机对照试验
朱 慧译 马皓琳 李士通校
A Prospective, Randomized, Controlled Trial
Comparing Ultrasound Versus Nerve Stimulator Guidance for Interscalene Block
for Ambulatory Shoulder Surgery for Postoperative Neurological Symptoms
Spencer S. Liu, Victor M. Zayas, Michael A. Gordon, Jonathan C. Beathe, Daniel B. Maalouf, Leonardo Paroli, Gregory A. Liguori, Jaime Ortiz, Valeria Buschiazzo, Justin Ngeow, Teena Shetty, and Jacques T. Ya Deau
Anesth Analg 2009 109: 265-271.
陈珺珺译 薛张纲校
Regional Blockade in Patients with a History
of a Seizure Disorder
Sandra L. Kopp, Kimberly P. Wynd, Terese T. Horlocker, James R. Hebl, and Jack L. Wilson
Anesth Analg 2009 109: 272-278.
超声引导下腋路臂丛神经阻滞（局部麻醉药混合液20ml）与全麻在上肢外伤手术中的比较：一项单盲、前瞻、随机、对照试验
张燕 译 陈杰 校
Ultrasound-Guided Axillary Brachial Plexus Block with 20 Milliliters Local Anesthetic Mixture Versus General Anesthesia for Upper Limb Trauma Surgery: An Observer-Blinded, Prospective, Randomized, Controlled Trial (Brief Report)
Brian D. O’Donnell, Helen Ryan, Owen O’Sullivan, and Gabrielle Iohom
Anesth Analg 2009 109: 279-283.
在体外循环下行先天性心脏病手术的病人使用抑肽酶与肾功能不全的关系
The
Association of Renal Dysfunction and the Use of Aprotinin in Patients
Undergoing Congenital Cardiac Surgery Requiring Cardiopulmonary Bypass
Ana Manrique, MD*, Edmund H. Jooste, MB,
ChB
,
Bradley A. Kuch, BS, RRT-NPS
,
Steven E. Lichtenstein, MD,
Victor Morell, MD*, Ricardo Munoz, MD
,
Demetrius Ellis, MD||, and Peter J. Davis, MD
From
the Departments of *Cardiovascular Surgery, Anesthesiology,
Critical
Care Medicine, Pediatric
Cardiac Critical Care, and ||Nephrology, Children’s Hospital of
Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania.
Anesth
Analg 2009; 109:45-52
背景：在成人体外循环（CPB）期间使用大剂量抑肽酶与术后肾功能不全有关，但对接受复杂先天性心脏病手术的儿童的作用并未确定。
方法：我们采用回顾性群组分析方法研究了在2004年7月至2006年7月间需要体外循环行先天性心脏病手术的病儿。患儿的人口统计学资料和按Aristotle外科复杂性分级划分的手术风险都作为协变量。按照RIFLE标准（一种根据血清肌酐值将急性肾损伤按严重程度分为R-风险，I-损伤，F-衰竭的国际公认的分类法）确定肾功能不全。采用单因素、多因素逻辑回归分析和倾向性评分方法分析资料。使用与使用抑肽酶相关的预处理协变量进行倾向性评分。接着采用对倾向性评分和术中测定值作为协变量进行多因素逻辑回归分析。认为P<0.05有统计学显著性。
结果：395例进行心脏手术的病儿中，55%使用了抑肽酶，而45%未用。组群中31%曾接受过心脏手术，17%为新生儿。按照RIFLE标准，80例病儿(20.3%)术后有急性肾功能损伤；其中53例(13.4%)有肾功能不全风险，23例(5.8%)存在肾损伤，4例(0.7%)为肾衰竭。使用抑肽酶的病儿在既往心脏手术(54.1% vs 5%)、败血症(6.9% vs.0.0%)，心力衰竭(24.8% vs 12.4%)、机械通气(25.2% vs 2.8%)或机械循环支持(6.0% vs.0.6%)的发生率更高。使用抑肽酶的患儿，Aristotle外科分级4级(26.6% vs 2.8%)者更多，使用利尿药(63.8% vs 26.6%)、血管紧张素转换酶抑制剂(21.1% vs 7.9%)、米力农(25.7% vs 4.5%)和强心剂(16.1% vs 2.3%)治疗者也更多。尽管未调整的肾功能不全风险存在明显差异，根据术前倾向性评分调整后却显示使用抑肽酶与肾功能不全没有相关性 (OR 1.32; 95% CI
0.55–3.19)。体外循环时间是唯一与肾功能不全产生有关的独立因素 (OR 1.0; 95% CI 1.009–1.014)。
结论：使用抑肽酶的患儿同时伴有产生术后肾功能不全的术前危险因素的可能性更大。然而，当恰当地考虑了相关危险因素时，使用抑肽酶看来与儿童术后即时的产生肾功能不全高危险性不相关。
（颜涛译， 马皓琳 李士通 校）
BACKGROUND:
The use of
large-dose aprotinin during cardiopulmonary bypass (CPB) in adult
patients has been linked to postoperative renal dysfunction, but its
effect on the pediatric population undergoing complex congenital
cardiac operations is not well defined.
METHODS:
We used a
retrospective cohort analysis to evaluate children undergoing
cardiac surgery requiring CPB between July 2004 and July 2006.
Demographic data and surgical risk quantified by the Aristotle
surgical complexity level were analyzed as covariates. Renal
dysfunction was defined according to the RIFLE criteria, an
international consensus classification which defines three grades of
increasing severity of acute kidney injury: risk (Class R), injury
(Class I), and failure (Class F) based on serum creatinine values. A
univariate and multivariate logistic regression analysis and a
propensity score were used to analyze the data. The propensity score
was developed using pretreatment covariates associated with the
administration of aprotinin. A multivariate logistic regression was
then used with the propensity score and intraoperative measures as
covariates. A P value <0.05 was considered statistically
significant.
RESULTS:
Among 395
patients who underwent cardiac surgery, 55% received aprotinin and
45% did not. Thirty-one percent of the cohort had previous cardiac
surgery; 17% were neonates. According to the RIFLE criteria, 80 of
the patients (20.3%) had acute kidney injury in the postoperative
period; 53 (13.4%) had risk of renal dysfunction with 23 (5.8%)
having injury and four patients (0.7%) having failure. Those
receiving aprotinin had a higher incidence of previous cardiac
surgery (54.1% vs 5%), sepsis (6.9% vs.0.0%), heart failure (24.8%
vs 12.4%), mechanical ventilation (25.2% vs 2.8%), or mechanical
circulatory support (6.0% vs.0.6%). More patients had an Aristotle
level of 4 (26.6% vs 2.8%) and were treated with diuretics (63.8%
vs 26.6%), angiotensin converting enzyme inhibitors (21.1% vs 7.9%),
milrinone (25.7% vs 4.5%), and inotropic support (16.1% vs 2.3%).
Although there was a significant difference in the unadjusted risk
of renal dysfunction, adjustment with the preoperative propensity
score revealed that there was no association between aprotinin and
renal dysfunction (OR 1.32; 95% CI 0.55–3.19). The duration of
CPB was the only independent variable associated with the
development of renal dysfunction (OR 1.0; 95% CI 1.009–1.014).
CONCLUSIONS:
Patients who
receive aprotinin are more likely to present with preoperative risk
factors for the development of postoperative renal dysfunction.
However, when associated risk factors are properly considered, the
use of aprotinin does not seem to be associated with a higher risk
of developing renal dysfunction in the immediate postoperative
period in children.
评估用甘草漱口减少术后咽喉痛的有效性：一个前瞻性、随机、单盲研究
An
Evaluation of the Efficacy of Licorice Gargle for Attenuating Postoperative
Sore Throat: A Prospective, Randomized, Single-Blind Study
Anil Agarwal, MD*,
From
the *Department of Anesthesiology and Biostatics,
Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Anesth
Analg 2009; 109:77-81
背景：术后咽喉痛（POST）是主要的术后并发症。甘草作为一个祛痰药可用来治疗咳嗽和感冒。在本研究中，我们评估可甘草漱口来减少术后喉痛的效果。
方法：40个成年人（18-60岁），ASA分级I和II，行择期腰椎板切除术，随机分为两组，每组20例。C组：用水；L组加
结果：L组与C组在休息和吞咽的所有时间点相比，术后咽喉痛（发生率和严重度）减少（P < 0.05），只有在24小时休息状态时的术后喉痛严重度两组相似（P > 0.05）。拔管后咳嗽在L组比C组明显减少（P < 0.05）。两组间副作用没有明显差异（P > 0.05）。
结论：麻醉前5分钟用甘草漱口可有效地减少术后咽喉痛的发生率和严重度。
（彭中美 译 马皓琳 李士通 校）
BACKGROUND:
Postoperative
sore throat (POST) contributes to postoperative morbidity. Licorice
has been used as an expectorant in cough and cold preparations. In
this study, we evaluated the efficacy of licorice gargle for
attenuating POST.
METHODS:
Forty adults
(18-60 yr), ASA physical status I and II of either sex, undergoing
elective lumber laminectomy were randomized into two groups of 20
each. Group C: received water; Group L: received
RESULTS:
POST (incidence
and severity) was reduced in the Group L compared with Group C at
rest and on swallowing for all time points (P < 0.05),
except that the severity of POST at rest, at 24 h, was similar in
both groups (P > 0.05). Postextubation cough was reduced
in Group L compared with Group C (P < 0.05). There was no
difference in side effects between groups (P > 0.05).
CONCLUSION:
Licorice gargle
performed 5 min before anesthesia is effective in attenuating the
incidence and severity of POST.
家兔给予新型苯二氮卓受体激动剂JM-1232(–)后的寒战阈值
The
Shivering Threshold in Rabbits with JM-1232(–), a New Benzodiazepine
Receptor Agonist
Taishi Masamune, MD*, Hiroaki Sato, MD*,
Katsumi Okuyama, MD, PhD,
Yusuke Imai, MD,
Hironobu Iwashita, MD, PhD*, Tadahiko Ishiyama, MD, PhD*,
Takeshi Oguchi, MD, PhD,
Daniel I. Sessler, MD,
and Takashi Matsukawa, MD, PhD
From
the *Operating Theater, Yamanashi University Hospital, Yamanashi, Japan; Department
of Anesthesiology, University of Yamanashi, Japan; Department
of Anesthesia, Kanoiwa General Hospital, Yamanashi, Japan; and Department
of Outcomes Research, The Cleveland Clinic, Cleveland, Ohio.
Anesth
Analg 2009; 109:96-100
背景：JM-1232(–) 是一种新型异二氢吲哚衍生物，通过作用于
-氨基丁酸A型（GABAA）受体的苯二氮卓位点显示出镇静催眠活性。另一GABAA受体激动剂咪达唑仑的标准剂量可轻度降低人的寒战阈值。本研究旨在确定JM-1232(–)可降低寒战阈值到何种程度。
方法： 给予0.2最小肺泡麻醉浓度（MAC）异氟醚后处于浅麻醉状态的18只家兔随机分为三组，分别静脉输注1)生理盐水(对照组), 2) 0.01 mg · kg–1
· min–1 JM-1232(–)或3) 0.1 mg · kg–1
· min–1 JM-1232(–)。通过置于结肠内的U形塑料管灌注
结果：静脉输注生理盐水的家兔在体温36.5 ±
结论：低剂量JM-1232(–)可使家兔寒战阈值降低约
（周雅春 译 马皓琳 李士通 校）
BACKGROUND:
JM-1232(–)
is a novel isoindoline derivative which shows sedative and hypnotic
activities through the benzodiazepine site of -aminobutyric
acid type A (GABAA) receptors. Typical doses of
midazolam, another GABAA receptor agonist, slightly reduce
the shivering threshold in humans. We thus determined the extent to
which JM-1232(–) decreases the shivering threshold.
METHODS:
Eighteen
rabbits, lightly anesthetized with isoflurane 0.2 minimum alveolar
anesthetic concentration (MAC), were randomly assigned to infusions
of 1) saline (control), 2) 0.01 mg · kg–1
· min–1 JM-1232(–), or 3) 0.1 mg
· kg–1 · min–1
JM-1232(–). Body temperature was reduced at a rate of 2
RESULTS:
The rabbits
given a saline infusion shivered at 36.5 ±
CONCLUSION:
A low dose of
JM-1232(–) reduced the shivering threshold in rabbits
approximately
Liability
Related to Peripheral Venous and Arterial Catheterization: A Closed Claims
Analysis
Sanjay M. Bhananker, MD, FRCA, Derek W. Liau, MD,
Preetma K. Kooner, BA, BS, Karen L. Posner, PhD, Robert A. Caplan, MD, and
Karen B. Domino, MD, MPH
From
the Department of Anesthesiology,
Anesth
Analg 2009; 109:124-129
背景：外周静脉和动脉置管后严重并发症已有很多报导。为了评估麻醉医生在外周血管置管中的责任，我们回顾了美
方法：把外周血管置管相关的索赔归为与静脉内或动脉导管有关。与静脉内导管有关的并发症按并发症的类型加以分类。我们比较了数据库中与因静脉内导管有关的索赔和所有的其他（非外周置管）索赔之间的病人和病例特征、损伤严重度和赔偿金额。赔偿金额用日用品价格指数调整到2007年的美金金额。
结果：与外周血管置管相关的索赔占数据库中总索赔的2% (n = 140/6894例索赔)，其中大多数(91%)与静脉内导管相关(n = 127)。最常见的并发症包括：皮肤坏死(28%)、隆起/感染(17%)、神经损伤(17%)、筋膜切开后疤痕(16%)以及空气栓塞(8%)。大约一半(55%)的并发症发生于药物或液体渗出血管后。与其他索赔相比，静脉内置管相关索赔涉及的心脏外科手术病例部分较大(25%相比其他2%, P < 0.001)，急诊手术病例部分较小(8%相比其他22%, P < 0.001)。与动脉导管有关的索赔较少(n = 13, 8%)，其中只有7例与桡动脉置管有关。
结论：与静脉内导管相关的索赔是麻醉医生的一个重要责任根源，其中大约一半是因为药物或液体渗出血管。桡动脉置管相关的索赔比较少见。
(江继宏 译 马皓琳 李士通 校）
BACKGROUND:
Serious
complications after peripheral IV and arterial vascular cannulations
have been reported. To assess liability associated with these
peripheral vascular catheters for anesthesiologists, we reviewed
claims in the American Society of Anesthesiologists Closed Claims
database.
METHODS:
Claims related
to peripheral vascular catheterization were categorized as related
to IV or arterial catheters. Complications related to IV catheters
were categorized as to type of complication. Patient and case
characteristics, severity of injury, and payments were compared
between claims related to IV catheters and all other (nonperipheral
catheter) claims in the database. Payment amounts were adjusted to
2007-dollar amounts using the consumer price index.
RESULTS:
Claims related
to peripheral vascular catheterization accounted for 2% of claims in
the database (n = 140 of 6894 claims), most (91%) associated
with IV catheters (n = 127). The most common complications
were skin slough (28%), swelling/infection (17%), nerve damage
(17%), fasciotomy scars (16%), and air embolism (8%). Approximately
half of these complications (55%) occurred after extravasation of
drugs or fluids. Compared with other claims, IV claims involved a
larger proportion of cardiac surgery (25% vs 2% for other, P
< 0.001) and smaller proportion of emergency procedures (8% vs
22% for other, P < 0.001). Claims related to arterial
catheters were few (n = 13, 8%), with only seven associated
with radial artery catheterization.
CONCLUSIONS:
Claims related
to IV catheters were an important source of liability for
anesthesiologists, approximately half of which resulted from
extravasation of drugs or fluid. Claims related to radial arterial
catheterization were uncommon.
肺募集反应对病态肥胖病人容积性二氧化碳描记图III相斜率的影响
The
Effects of Lung Recruitment on the Phase III Slope of Volumetric Capnography in
Morbidly Obese Patients
Stephan H. Böhm, MD*, Stefan Maisch,
MD*, Alexandra von Sandersleben, MD*, Oliver Thamm, MD*,
Isabel Passoni, PhD,
Jorge Martinez Arca, MSc,
and Gerardo Tusman, MD
From
the *Clinic of Anesthesiology, University Hospital, Hamburg-Eppendorf, Hamburg,
Germany; currently
at Clinic of Plastic and Reconstructive Surgery, Burn Care Center, Hospital
Cologne-Merheim, University of Witten/Herdecke, Germany; Department
of Bioengineering, University of Mar del Plata, Argentina; and Department
of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
Anesth
Analg 2009; 109:151-159
背景：在本研究中，我们分析肺泡复原（ARS）和呼气末正压（PEEP）选择对病态肥胖病人容积性二氧化碳描记图(VC)III相斜率(SIII)的影响。
方法：十一个麻醉的病态肥胖病人是研究对象。肺以潮气量10 mL·kg–1、呼吸频率12-14次/分钟、吸呼比1:2及吸入气氧含量 0.4的方式通气。通过5步将呼气末压从0增加到
结果：呼气末正压为0时与ARS后PEEP
结论：VC中SIII对麻醉的病态肥胖病人肺募集反应后发现最优的PEEP水平是有用的。
（王宏翻译，李士通，马皓琳校正）
BACKGROUND:
In this study,
we analyzed the effect of the alveolar recruitment strategy (ARS)
and positive end-expiratory pressure (PEEP) titration on Phase III
slope (SIII) of volumetric capnography (VC) in
morbidly obese patients.
METHODS:
Eleven
anesthetized morbidly obese patients were studied. Lungs were
ventilated with tidal volumes of 10 mL · kg–1, respiratory
rates of 12–14 bpm, inspiration:expiration ratio of 1:2, and
Fio2 of 0.4. ARS was performed by increasing PEEP in
steps of five from 0 end-expiratory pressure to
RESULTS:
SIII decreased from 0.014 ±
0.006 to 0.005 ±
CONCLUSION:
The SIII
in VC was useful to detect the optimal level of PEEP after lung
recruitment in anesthetized morbidly obese patients.
5-羟色胺拮抗剂对剖宫产中接受鞘内吗啡的产妇瘙痒、恶心呕吐的预防和治疗作用：系统性回顾和Meta分析
Serotonin
Receptor Antagonists for the Prevention and Treatment of Pruritus, Nausea, and
Vomiting in Women Undergoing Cesarean Delivery with Intrathecal Morphine: A
Systematic Review and Meta-Analysis
Ronald B. George, MD, FRCPC*, Terrence K.
Allen, MBBS, FRCA,
and Ashraf S. Habib, MBBCh, MSc, FRCA
From
the *Department of Women’s and Obstetric Anesthesia, IWK Health Centre,
Dalhousie University, Halifax, Nova Scotia, Canada; and Department
of Anesthesiology, Division of Women’s Anesthesia, Duke University
Medical Center, Durham, North Carolina.
Anesth
Analg 2009; 109:174-182
背景：我们完成了一个系统性回顾以决定5-羟色胺（5-HT3）受体拮抗剂对剖宫产中接受腰麻及鞘内吗啡的产妇瘙痒、恶心呕吐的预防和治疗作用。
方法：我们回顾了比较5-HT3受体拮抗剂和安慰剂对产妇瘙痒和/或恶心呕吐预防和治疗作用的随机对照试验的报道。这些文章根据其有效度进行评分，由作者独立地提取数据资料，并且用相关危险度（RR）和95%可信区间（CI）进行总结分析。
结果：本系统性回顾包括了九例随机对照试验。九例实验中共有1152例病人，其中539例接受5-HT3受体拮抗剂，413例接受安慰剂，200例接受其他止吐药的产妇没有包括在分析中。预防性使用5-HT3受体拮抗剂并没有比安慰剂减少瘙痒的发生率(80.7%比85.8%, RR [95% CI] = 0.94 [0.81–1.09])。然而，它们的使用减少了剧烈瘙痒的发生率及其需要治疗的概率（需要治疗的病例数分别为12和15）。他们的使用对于顽固性瘙痒的治疗效力比安慰剂要高，其需要治疗的病例数为3。使用5-HT3受体拮抗剂组较安慰剂组术后恶心(22.0%比33.6%, RR [95% CI] = 0.75[0.58–0.96])和呕吐的发生率(7.7%比16.8%, RR [95% CI] = 0.49 [0.30–0.81])显著降低，术后需要止吐治疗的概率也显著降低(9%比23%, RR [95% CI] = 0.38 [0.21–0.68])。
结论：虽然在剖宫产使用鞘内吗啡的产妇中，预防性使用5-HT3受体拮抗剂并不能有效地减少瘙痒的发生率，但是它们可以显著降低瘙痒的严重性及其需要治疗的概率，也可以减少术后恶心呕吐的发生率及需要止吐治疗的概率。它们对于顽固性瘙痒也有有效的治疗作用。虽然仍需要进行更多的研究，但是现有的数据表明，对于剖宫产使用鞘内吗啡的产妇来说，应该考虑常规预防性使用这些药物。
（黄佳佳译，马皓琳 李士通校）
BACKGROUND:
We performed a
systematic review to determine the overall efficacy of serotonin
(5-HT3) receptor antagonists for the prevention and
treatment of pruritus, nausea, and vomiting in women receiving
spinal anesthesia with intrathecal morphine for cesarean delivery.
METHODS:
Reports of
randomized, controlled trials that compared prophylaxis or treatment
of pruritus and/or nausea, and vomiting using one of the 5-HT3
receptor antagonists or placebo in women undergoing cesarean
delivery were reviewed. The articles were scored for validity and
data were extracted by the authors independently and summarized
using relative risks (RR) with 95% confidence intervals (CI).
RESULTS:
Nine
randomized, controlled trials were included in the systematic
review. The nine trials had a total of 1152 patients enrolled; 539
received 5-HT3 receptor antagonists, 413 received placebo,
and 200 received other antiemetics and were not included in the
analysis. The incidence of pruritus was not reduced with 5-HT3
receptor antagonists prophylaxis compared with placebo (80.7% vs
85.8%, RR [95% CI] = 0.94 [0.81–1.09]). However, their use
reduced the incidence of severe pruritus and the need for treatment
of pruritus (number-needed-to-treat = 12 and 15, respectively).
Their use for the treatment of established pruritus showed improved
efficacy compared with placebo with a number-needed-to-treat of
three. There was a significant reduction in the incidence of
postoperative nausea (22.0% vs 33.6%, RR [95% CI] = 0.75[0.58–0.96])
and vomiting (7.7% vs 16.8%, RR [95% CI] = 0.49 [0.30–0.81]), and
the need for postoperative rescue antiemetic treatment with the use
of 5-HT3 receptor antagonists when compared with placebo (9%
vs 23%, RR [95% CI] = 0.38 [0.21–0.68]).
CONCLUSIONS:
Although
prophylactic 5-HT3 receptor antagonists were ineffective
in reducing the incidence of pruritus, they significantly reduced
the severity and the need for treatment of pruritus, the incidence
of postoperative nausea and vomiting, and the need for rescue
antiemetic therapy in parturients who received intrathecal morphine
for cesarean delivery. They were also effective for the treatment of
established pruritus. Although more studies are warranted, the
current data suggest that the routine prophylactic use of those
drugs should be considered in this patient population.
发育中大鼠脑的器官型海马脑片模型中氧和葡萄糖缺失：对N-甲基-d-天门冬氨酸亚单位组成的影响
Oxygen
and Glucose Deprivation in an Organotypic Hippocampal Slice Model of the
Developing Rat Brain: The Effects on N-Methyl-d-Aspartate Subunit
Composition
Lisa Wise-Faberowski, MD*, Prairie Neeley
Robinson, MD*, Sarah Rich, BS*, and David S. Warner, MD
From
the *The Children’s Hospital Pediatric Anesthesia Laboratory, Department
of Anesthesiology, University of Colorado Health Sciences Center, Aurora,
Colorado; and Departments
of Anesthesiology, Neurobiology, and Surgery, Multidisciplinary Neuroprotection
Laboratories, Duke University Medical Center, Durham, North Carolina.
Anesth
Analg 2009; 109:205-210
背景：器官型海马脑片（OHS）常用于小儿脑损伤相关药物的神经保护效应的筛选。供体新生大鼠的日龄的重要性和N-甲基-d-天门冬氨酸（NMDA）受体亚单位组成尚未被阐明。本研究中，我们评估了氧-葡萄糖缺失（OGD）在发育中大鼠脑中的日龄依赖效应并判断OGD是否调制NMDA受体亚单位的组成。
方法：分别制备出生后（PND）4、7、14和21天新生大鼠的OHS并在体外培养7天。脑片接触OGD的时间为5-60 min。24和72 h之后，测定OHS的存活以及NMDA亚单位的组成。
结果：由PND14和21新生大鼠制备的OHS中细胞死亡明显(P < 0.001)，OGD时间分别为5min和10min。由PND7新生大鼠制备的OHS中，OGD时间直至20 min才出现明显的神经变性(P < 0.001)。在由PND4和PND7新生大鼠制备的OHS中，OGD接触与NMDA受体亚单位组成从NR2B占主导向NR
结论：本次新生大鼠OHS的离体研究结果，支持OGD和神经细胞死亡之间存在日龄及NMDA受体亚单位组成依赖性的关系。
（黄施伟 译，马皓琳 李士通 校）
BACKGROUND:
Oganotypic
hippocampal slices (OHS) are commonly used to screen for
neuroprotective effects of pharmacological agents relevant to
pediatric brain injury. The importance of donor rat pup age and N-methyl-d-aspartate
(NMDA) receptor subunit composition have not been addressed. In this
study, we evaluated the age-dependent effect of oxygen-glucose
deprivation (OGD) in the developing rat brain and determined whether
OGD modulates the NMDA receptor subunit composition.
METHODS:
OHS were
prepared from rat pups on postnatal days (PND) 4, 7, 14, and 21 and
cultured 7 days in vitro. The slices were exposed to OGD for
durations of 5–60 min. After 24 and 72 h, OHS survival and
NMDA subunit composition were assessed.
RESULTS:
Cell death was
evident in OHS prepared from PND 14 and 21 rat pups (P <
0.001) with OGD durations of 5 and 10 min, respectively. In OHS
prepared from PND7 rat pups, neurodegeneration was not evident until
20 min OGD (P < 0.001). Exposure to OGD in OHS prepared
from PND4 and PND7 rat pups was associated with a transition in the
NMDA receptor subunit composition from NR2B predominant to NR
CONCLUSIONS:
This in
vitro neonatal rat pup investigation using OHS supports both an
age and an NMDA receptor subunit composition-dependent relationship
between OGD and neuronal cell death.
The
Analgesic Properties of Scalp Infiltrations with Ropivacaine After Intracranial
Tumoral Resection
Hélène Batoz, MD, Olivier Verdonck,
MD, Christelle Pellerin, MD, Gaëlle Roux, MD, and Pierre Maurette, PhD
From
the Department of Anesthesiology and Intensive Care Unit III,
Anesth
Analg 2009; 109:240-244
背景：神经外科手术后的疼痛是一个有争议的问题。这种疼痛为轻到中度，对其治疗往往是不足够的。手术部位进行局麻药的浸润麻醉对颅骨切开术后的疼痛是有短暂的帮助，但是对于慢性疼痛的治疗还没有进行过评估。因此我们设计了这个研究，来证实罗哌卡因头皮浸润麻醉能减轻颅内肿瘤切除术后急性和持续性疼痛的假设。
方法：这是一个前瞻性的、单盲研究。选择标准为颅内肿瘤切除术患者，年龄18～80岁，有能力理解和使用视觉模拟评价标尺（VAS）。排除标准为有颅骨切除手术史、长期吸毒和神经系统疾病。所有入选的患者随机分成I组（浸润组）和C组（对照组）。术后镇痛为对乙酰氨基酚联合纳布啡静脉注射。手术结束时，I组在手术部位用0.75％的罗哌卡因20ml进行浸润麻醉。在第一个24小时每小时进行急性疼痛的VAS评估。罗哌卡因的镇痛效果通过纳布啡的用量和VAS的分数来评估。持续性疼痛的发生率和神经性疼痛在手术后2个月进行评估。我们用Student’s t检验比较纳布啡的总用量，反复测量并分别用post hoc Bonferroni法t检验和Fisher确切检验法对VAS分数和慢性及神经性疼痛进行方差分析。。
结果：共有52名患者入选，I组25名、C组27名。两组人口统计学和手术中的数据相似。I组结果显示在术后第一天对于减少纳布啡的用量没有显著变化趋势，11.2 ± 9.2 mg对C组16.6 ± 11.0 mg (平均值±标准差, P = 0.054)。VAS评分C组明显较高。术后2个月，持续性疼痛在I组明显较低，2/24 (8%)对14/25 (56%), P
= 0.0003。I组1名患者(4.1%)对C组6名患者(25%)(P = 0.04)出现有神经性疼痛。
结论：由于颅内肿瘤切除术的疼痛为中度，所以在术后急性期对于罗哌卡因的头皮浸润麻醉有限制的影响。尽管如此，这些浸润麻醉对于限制延迟持续性疼痛尤其是神经性疼痛的作用可能有利于神经外科手术患者的康复以及他们的生活质量。
（唐亮 译 马皓琳 李士通 校）
BACKGROUND:
The issue of
postoperative pain after neurosurgery is controversial. It has been
reported as mild to moderate and its treatment may be inadequate.
Infiltration of the surgical site with local anesthetics has
provided transient benefit after craniotomy, but its effect on
chronic pain has not been evaluated. Accordingly, we designed the
present study to test the hypothesis that ropivacaine infiltration
of the scalp reduces acute and persistent postoperative pain after
intracranial tumor resection.
METHODS:
This was a
prospective, single-blinded study. Inclusion criteria were
intracranial tumor resection, age 
18
or 
80
yr, and ability to understand and use a visual analog scale (VAS).
Exclusion criteria were history of craniotomy, chronic drug abuse,
and neurologic disorders. All eligible patients were randomly
included in Group I (infiltration) or C (control). Postoperative
analgesia was IV acetaminophen combined with nalbuphine. At the end
of the surgery, Group I received an infiltration of the surgical
site with 20 mL of ropivacaine 0.75%. Acute pain was evaluated
hourly by VAS during the first 24 h. The analgesic effect of
ropivacaine was evaluated based on total consumption of nalbuphine
and VAS scores. The incidence of persistent pain and neuropathic
pain was assessed at the 2-mo postoperative evaluation. We used the
Student’s t-test to compare total nalbuphine
consumption, repeated measures analysis of variance with post hoc
Bonferroni t-test for VAS score and the Fisher’s exact
test for chronic and neuropathic pain.
RESULTS:
Fifty-two
patients were enrolled,
CONCLUSIONS:
Because pain is
moderate after intracranial tumor resection, there is limited
interest in scalp infiltrations with ropivacaine in the acute
postoperative period. Nevertheless, these infiltrations may be
relevant for the rehabilitation of neurosurgical patients and their
quality of life by limiting the development of persistent pain and
particularly neuropathic pain.
比较超声和神经刺激仪引导肌间沟法臂丛神经阻滞用于肩关节门诊手术后神经症状的前瞻性随机对照试验
A
Prospective, Randomized, Controlled Trial Comparing Ultrasound Versus Nerve
Stimulator Guidance for Interscalene Block for Ambulatory Shoulder Surgery for
Postoperative Neurological Symptoms
Spencer S. Liu, MD*, Victor M. Zayas, MD*,
Michael A. Gordon, MD*, Jonathan C. Beathe, MD*, Daniel
B. Maalouf, MD*, Leonardo Paroli, MD*, Gregory A.
Liguori, MD*, Jaime Ortiz, MD*, Valeria Buschiazzo*,
Justin Ngeow, BA*, Teena Shetty, MD,
and Jacques T. Ya Deau, MD, PhD*
From
the Departments of *Anesthesiology, and Neurology,
Hospital for Special Surgery,
Anesth
Analg 2009; 109:265－271
背景：区域麻醉中超声可视性能减少神经内注射和并发神经症状的风险，但还未进行正式评估。因此，我们进行这个随机临床试验来比较超声和神经刺激仪引导的肌间沟法臂丛神经阻滞用于肩关节镜检查来判断超声是否能减少术后神经症状的发生率。
方法：230例患者随机分为两组施行标准化肌间沟法臂丛阻滞（超声或神经刺激仪辅助下），使用
结果：对219例患者进行了评估。超声的应用降低了阻滞操作时针穿过神经的数量（1比3, 中位数, P < 0.001），提高了5分钟时评估的运动神经阻滞效果（P = 0.04），但未减少神经阻滞施行的时间（两组均为5分钟）。没有患者因阻滞失败改上全麻，而且两组患者满意度相似（神经刺激仪组96%，超声组92%）。术后1周随访时和后期随访时的神经症状的发生率相似，术后1周随访时神经刺激仪组为11%(95% CI 5%–17%)，超声组为8% (95% CI 3%–13%)，后期随访时神经刺激仪组为7% (95% CI 3%–12%)，超声组为6% (95% CI 2%–11%)。术后神经症状的严重程度两组相似，分级中位数为重度。症状主要是感觉的，包括疼痛，麻刺或感觉异常。
结论：超声减少肌间沟法臂丛阻滞操作时针穿过神经的数量，提高5分钟时的运动神经阻滞效果。然而，我们并未观察到在阻滞失败、患者满意度及术后神经症状发生率和严重程度上有明显差异。
（朱 慧译 马皓琳 李士通校）
BACKGROUND:
Visualization
with ultrasound during regional anesthesia may reduce the risk of
intraneural injection and subsequent neurological symptoms but has
not been formally assessed. Thus, we performed this randomized
clinical trial comparing ultrasound versus nerve stimulator-guided
interscalene blocks for shoulder arthroscopy to determine whether
ultrasound could reduce the incidence of postoperative neurological
symptoms.
METHODS:
Two hundred
thirty patients were randomized to a standardized interscalene block
with either ultrasound or nerve stimulator with a
RESULTS:
Two hundred
nineteen patients were evaluated. Use of ultrasound decreased the
number of needle passes for block performance (1 vs 3, median, P
< 0.001), enhanced motor block at the 5-min assessment (P
= 0.04) but did not decrease block performance time (5 min for
both). No patient required conversion to general anesthesia for
failed block, and patient satisfaction was similar in both groups
(96% nerve stimulator and 92% ultrasound). The incidence of
postoperative neurological symptoms was similar at 1 wk follow-up
with 11% (95% CI of 5%–17%) for nerve stimulator and 8% (95%
CI of 3%–13%) for ultrasound and was similar at late follow-up
with 7% (95% CI of 3%–12%) for nerve stimulator and 6% (95% CI
of 2%–11%) for ultrasound. The severity of postoperative
neurological symptoms was similar between groups with a median
patient rating of moderate. Symptoms were primarily sensory and
consisted of pain, tingling, or paresthesias.
CONCLUSIONS: Ultrasound reduced the number of needle passes needed to perform interscalene block and enhanced motor block at the 5 min assessment; however, we did not observe significant differences in block failures, patient satisfaction or incidence, and severity of postoperative neurological symptoms.
全血多极凝集测定仪是一种可靠的阿司匹林诱导的血小板功能障碍的床边检验方法
Whole Blood Multiple Electrode
Aggregometry Is a Reliable Point-of-Care Test of Aspirin-Induced Platelet
Dysfunction
, Konstanze Gerhardt, Wulf Dietrich, PhD*,
Michael Spannagl, PhD*, Bernhard Heindl, PhD*,
and Bernhard Zwissler, PhD*
From the *Clinic for Anesthesiology, Department
of Transfusion Medicine and Hemostaseology, University of Munich, Germany; and Department
of Anesthesiology, Intensive Care and Pain Medicine, Goethe-University
Frankfurt am Main, Germany.
Anesth Analg 2009 109: 25-31.
背景：阿司匹林是最常用的非处方药，除镇痛和抗炎作用之外，还有潜在的抗血小板凝集作用。阿司匹林诱导的血小板功能障碍与不同的临床条件有关，包括复杂的外科手术同时服用阿司匹林致出血风险高的患者。在这项研究中，作者评估了单次口服阿司匹林500mg后血小板的凝集功能。应用多极凝集测定仪(MEA)测定凝血功能，通过比较采集血液样本的不同时间间隔的测试结果来确定这种方法在床边检验的可用性。
方法：研究包括24名健康志愿者。在基础状态时取血后所有志愿者接受阿司匹林500mg。在应用阿司匹林后4, 24, 56, 80, 和 124 h 时采血。每个取血时点即刻或取血后30min、60min行凝血功能检查。在用凝血酶受体激活肽(TRAPtest, 32 µM)或花生四烯酸(ASPItest,
结果：摄入阿司匹林4h后血小板聚集的ASPItest明显降低，摄入阿司匹林第二天，ASPItest恢复，但个体差异显著。阿司匹林摄入五天后，ASPItest回到基础值。TRAPtest无显著差异。样本测试时间并不影响TRAPtest或ASPItest值。ASPItest的变异系数为10 ％和TRAPtest的变异系数为7 ％。
结论：MEA 能可靠检测阿司匹林对凝血功能的影响。值得注意的是所有健康志愿者服用阿司匹林500mg后导致花生四烯酸致血小板凝集的作用完全逆转。5天内随着时间延长血小板聚集功能逐渐恢复但有个体差异。血液标本存放时间对ASPItest 或TRAPtest检测无影响。测试均能床边完成。本研究测试的可重复性在现代床边分析仪要求的范围内。
（刘世文 译 陈杰 校）
BACKGROUND: Aspirin is one of the most commonly ingested over-the-counter drugs. In addition to its analgesic and antiinflammatory actions, it also potently inhibits platelet aggregation. Evaluation of aspirin-induced platelet dysfunction is relevant in various clinical situations, including during complex surgeries with high bleeding risk in individuals who have ingested aspirin. In this study, we examined the suitability of multiple electrode aggregometry (MEA) for time course assessment of the antiplatelet effects of a single oral dose of 500 mg aspirin. We also determined the applicability of this method in the point-of-care (POC) setting by comparing the results of the test after different time intervals after blood sampling.
METHOD: Twenty-four adult volunteers
were enrolled in the study. After blood drawing at baseline, 500 mg aspirin was
administered to all volunteers. Blood samples were taken at 4, 24,
56, 80, and 124 h after aspirin ingestion. At each time point,
measurements were performed immediately and 30 and 60 min after
drawing blood. Whole blood MEA was performed after stimulation with
thrombin receptor activating peptide (TRAPtest, 32 µM) and
arachidonic acid (ASPItest,
RESULTS: Platelet aggregation by ASPItest was markedly decreased 4 h after aspirin intake. From the second day after aspirin intake, ASPItest values recovered with high interindividual variability, and 5 days after aspirin intake, ASPItest values did not differ significantly from baseline. TRAP-induced platelet aggregation (TRAPtest) showed no systematic changes during the study period. The resting time of the sample did not affect TRAPtest or ASPItest values. The coefficients of variation were 10% for the ASPItest and 7% for the TRAPtest.
CONCLUSIONS: MEA reliably detected the effects of aspirin. Notably, 500 mg aspirin caused complete inhibition of arachidonic acid-induced platelet aggregation for 2 days in all volunteers. Aggregation returned to baseline values with a wide interindividual variation in time course by day 5. No resting time for the blood sample was required for ASPItest or TRAPtest. These assays can be implemented as real POC tests. The reproducibility of the assays studied here is within the range of modern POC analyzers.
Perioperative Management of Children
with Obstructive Sleep Apnea
Deborah
A. Schwengel, MD*, Laura M. Sterni, MD, David E. Tunkel, MD*, and Eugenie S. Heitmiller, MD*
From the Departments of
*Anesthesiology/Critical Care Medicine, Pediatrics,
and Otolaryngology
Head and Neck Surgery,
Anesth Analg 2009 109: 60-75.
1 ％ -3 ％的儿童受到阻塞性睡眠呼吸暂停综合征（OSA）的影响。所有需要麻醉的外科手术和诊断性治疗中常可碰见OSA的患儿。小儿，扁桃腺切除术是最常见的外科治疗OSA的方法。因此，麻醉医生的当务之急是熟悉OSA患儿潜在的麻醉并发症和术后相关问题。国家专业医疗协会认识并提出对于OSA患儿应加强围手术期护理。2002年美国儿科学会发表儿科OSA临床实践的指南。指南指出麻醉并发症风险呈现上升趋势，尽管未曾提及具体的麻醉事件。2006年，美
在这篇综述中作者复习了儿童OSA相关的文献，探讨了其病理生理及目前的治疗方案，以及这些年幼及潜在高风险的患儿围手术期处理方法。
（叶乐 译 陈杰 校）
Obstructive sleep apnea syndrome (OSA)
affects 1%-3% of children. Children with OSA can present for all
types of surgical and diagnostic procedures requiring anesthesia,
with adenotonsillectomy being the most common surgical treatment for
OSA in the pediatric age group. Thus, it is imperative that the
anesthesiologist be familiar with the potential anesthetic
complications and immediate postoperative problems associated with
OSA. The significant implications that the presence of OSA imposes
on perioperative care have been recognized by national medical
professional societies. The
In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.
妊娠早期异丙酚诱导和恢复麻醉的效应室浓度的预测
Predicted
Propofol Effect-Site Concentration for Induction and Emergence of Anesthesia
During Early Pregnancy
Nicolas
Mongardon, MD*, Frédérique Servin, MD, PhD*,
Mathilde Perrin, MD*, Ennoufous Bedairia, MD*, Sylvie
Retout, PhD,
Chadi Yazbeck, MD, PhD,
Philippe Faucher, MD,
Philippe Montravers, MD, PhD*, Jean-Marie Desmonts, MD*,
and Jean Guglielminotti, MD*
From the *Département
d’Anesthésie et de Réanimation Chirurgicale; Département
d’Epidémiologie, Biostatistique et Recherche Clinique; and Service
de Gynécologie et d’Obstétrique, Assistance
Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard,
Anesth Analg 2009 109: 90-95.
背景：据称由于孕酮的原因，妊娠降低了对催眠药的要求。然而，妊娠和黄体酮对异丙酚的用量的影响未完全阐明。作者进行这项研究，以确定麻醉诱导使意识丧失时异丙酚的剂量和预测效应室的浓度，以及妊娠早期麻醉过程中麻醉药用量是否减少。并验证血孕酮是否与异丙酚剂量和效应室浓度在意识丧失方面相关。
方法： 57例ASA I-II级的妇女选择终止妊娠和55位妇女进行阴道穿刺卵母细胞体外受精。用1 ％异丙酚以200ml/min？的速度麻醉诱导。诱导过程中记录在意识丧失时异丙酚剂量和计算的效应室浓度（ Schnider模型）。另计算麻醉时患者能睁眼时的效应室浓度。手术后测定血孕酮浓度。
结果：与未孕对照组相比，怀孕组意识丧失时异丙酚平均（ ± 1SD ）剂量较少(108.57 ± 20.04 vs 117.59 ± 17.98 mg,
respectively; P = 0.014) 。同样，怀孕组所计算的异丙酚效应室浓度明显低于对照组（分别为 4.59 ± 0.72与5.01 ± 0.64 μg / ml时， P=0.0014 ） 。这两组在麻醉过程中能睁眼时的效应室浓度无差异。意识丧失时所观察的血孕酮和异丙酚剂量或异丙酚效应室浓度的关系无显着相关性。
结论：在妊娠早期意识丧失时异丙酚剂量和预测异丙酚效应室浓度减少。但不能用黄体酮浓度变化来解释。
（张磊 译 陈杰 校）
BACKGROUND: Pregnancy is associated with decreased hypnotic requirement, allegedly related to progesterone. However, the effects of pregnancy and progesterone on propofol requirement have not been thoroughly investigated. We conducted this study to determine whether propofol dose and predicted effect-site concentration for loss of consciousness (LOC) during induction of anesthesia, and eye opening during emergence from anesthesia, are decreased during early pregnancy. We also investigated whether blood progesterone was correlated with propofol dose and effect-site concentration for LOC.
METHODS: We studied 57 ASA I-II women patients undergoing elective termination of pregnancy and 55 control patients undergoing transvaginal oocyte puncture for in vitro fertilization. Anesthesia was induced by administration of a 1% propofol infusion at 200 mL/min. Propofol dose and calculated effect-site concentration (Schnider model) were recorded at the time of LOC during induction. We also calculated effect-site concentration at the time of eye opening upon emergence from anesthesia. Blood progesterone was measured after surgery.
RESULTS: Mean (±1 sd) propofol dose at LOC was significantly reduced in the pregnant patients compared with the nonpregnant control patients (108.57 ± 20.04 vs 117.59 ± 17.98 mg, respectively; P = 0.014). Similarly, the calculated propofol effect-site concentration at LOC was significantly lower in the pregnant patients than the nonpregnant control patients (4.59 ± 0.72 vs 5.01 ± 0.64 µg/mL, respectively; P = 0.0014). There was no difference in the calculated effect-site concentration on eye opening upon emergence. No significant relationship was observed between blood progesterone and propofol dose or calculated propofol effect-site concentration at LOC.
CONCLUSION: Propofol dose and predicted propofol effect-site concentration at LOC are decreased during early pregnancy. Progesterone does not explain this result.
硫喷妥钠抑制脂多糖诱导的组织因子的表达
Thiopental Inhibits
Lipopolysaccharide-Induced Tissue Factor Expression
Matthias
Hartmann, ,
and Juergen Peters,
From the *Klinik für
Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen,
Universitätsklinikum Essen, Essen, Germany; and Klinik
für Anästhesiologie, Universität Düsseldorf,
Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Anesth Analg 2009 109: 109-113.
背景：在革兰氏阴性菌引起败血症时，脂多糖（ LPS ）刺激Toll样受体4 ，从而激活免疫系统，并在单核细胞上表达组织因子，进而可能发生血管内凝血，心肌缺血，多器官功能障碍。因为硫喷妥钠已被证实具有调节免疫系统的作用，作者假设硫喷妥钠能改变LPS诱导组织因子的表达。
方法： 1. 用硫喷妥钠（ 0 ，0.25，0.5， 1mg/ml）和脂多糖（ 100µg/mL）枸橼酸化全血样本4小时。再钙化后，凝血时间（ CT ）是由ROTEM来测定。 2. LPS诱导缩短CT的机制通过使用组织因子受体阻滞剂活性位点抑制因子VIIA和蛋白质合成抑制剂放线菌酮来确定。3. 制定组织因子影响CT的浓度反应曲线。
结果：脂多糖缩短了CT，由618 ± 122 s到192 ± 33秒（ n = 6; P < 0.05） 。CT的缩短通过组织因子的合成媒介，因为蛋白质合成抑制和组织因子的阻断影响消除了LPS作用。硫喷妥钠明显抑制LPS诱导的CT缩短（372 ± 86 s; n = 6; P < 0.001 ） 。通过CT与组织因子标准曲线比较后表明，硫喷妥钠降低了LPS诱导组织因子活性达86 ％ 。排除硫喷妥钠对凝血的直接影响，因为组织因子诱导的CT没有受到巴比妥酸盐的影响。
结论：在全血样本中硫喷妥钠明显抑制LPS诱导组织因子的表达。
（丁俊云 译 陈杰 校）
BACKGROUND: During Gram-negative sepsis, lipopolysaccharide (LPS) stimulates toll-like receptor 4, resulting in an activation of the immune system and the expression of tissue factor on monocytes. As a consequence, intravascular coagulation, ischemia, and multiorgan dysfunction may occur. Because thiopental has been described to modulate the immune system, we tested the hypothesis that thiopental alters the LPS-induced tissue factor expression.
METHODS: (i) Citrated whole blood samples were incubated with thiopental (0, 0.25, 0.5, 1 mg/mL) and LPS (100 µg/mL) for 4 h. After recalcification, clotting time (CT) was determined by rotational thrombelastometry. (ii) The mechanism of the LPS-induced shortening of CT was investigated using the tissue factor blocker active-site inhibited factor VIIa and the protein synthesis inhibitor cycloheximide. (iii) A concentration response curve for the effect of tissue factor on CT was generated.
RESULTS: LPS shortened CT from 618 ± 122 s to 192 ± 33 s (n = 6; P < 0.05). Shortening of CT was mediated by synthesis of tissue factor, because both inhibition of protein synthesis and blockade of tissue factor effects abolished this effect of LPS. Thiopental markedly inhibited the LPS-induced shortening of CT (372 ± 86 s; n = 6; P < 0.001). Comparison of CT with a tissue factor standard curve demonstrated that thiopental reduced the LPS-induced tissue factor activity up to 86%. A direct effect of thiopental on coagulation was excluded, because tissue factor-induced CT was not affected by the barbiturate.
CONCLUSIONS: Thiopental markedly
inhibits the LPS-induced tissue factor expression in whole blood
samples.
NICO监护仪能估测混合静脉血红蛋白氧饱和度吗？
Can Mixed Venous Hemoglobin Oxygen
Saturation Be Estimated Using a NICO Monitor?
Yoshifumi
Kotake, MD, PhD*, Takashige Yamada, MD,
Hiromasa Nagata, MD,
Takeshi Suzuki, MD, PhD,
and Junzo Takeda, MD, PhD
From the *Department of Anesthesiology,
Toho University Medical Center Ohmori Hospital; and Department
of Anesthesiology, School of Medicine, Keio University, Tokyo, Japan.
Anesth Analg 2009 109: 119-123.
背景：作者假设，混合静脉血红蛋白氧饱和度（ SvO2 ）可通过无创心输出量（NICO）监测以计算二氧化碳产生、心输出量和动脉血氧饱和度来估测。
方法： 23名进行主动脉瘤修复的患者使用肺动脉导管监测SvO2和NICO监测心输出量。通过NICO计算出的SvO2值与使用肺动脉导管实测的SvO2值进行比较。这一估测的准确性由Bland-Altman方法进行分析。另利用相关分析评估SvO2估测值和SvO2值的变化。
结果： SvO2估测值与实测值的偏倚及范围-2.1 ％ ± 11.2
％ 。SvO2估测值与实测值的变化相关。
结论：来自NICO的SvO2估测值不能与肺动脉导管的实测值互换使用。还需更完善的方法以便获得更可靠的SvO2值。然而，在未作中心静脉导管插管时，SvO2值变化较大时这方法可用来作为氧供需失衡而的预警信号。
（舒慧刚 译 陈杰 校）
BACKGROUND: We hypothesized that mixed venous hemoglobin oxygen saturation (SvO2) can be estimated by calculation from CO2 production, cardiac output, and arterial oxygen saturation measured using a noninvasive cardiac output (NICO) monitor (Novametrix-Respironics, Wallingford, CT).
METHODS: Twenty-three patients undergoing aortic aneurysm repair underwent SvO2 monitoring using a pulmonary artery catheter and cardiac output monitoring using a NICO monitor. The estimated SvO2 value calculated from NICO monitor-derived values was compared with the SvO2 value measured using a pulmonary artery catheter. The accuracy of this estimation was analyzed with Bland-Altman method. The ability of this estimation to track the change of SvO2 was also evaluated using correlation analysis to compare the changes of estimated SvO2 and measured SvO2.
RESULTS: The bias ± limits of agreement of the estimated SvO2 against measured SvO2 was –2.1% ± 11.2%. The change of estimated SvO2 was modestly correlated with the change of measured SvO2.
CONCLUSIONS: SvO2 derived from the values measured by the NICO monitor cannot be used interchangeably with the values measured spectrophotometrically using the pulmonary artery catheter. More refinement is required to obtain more reliable estimate of SvO2 less invasively. However, large changes of SvO2 may be detected with this method and can be used as a precautionary sign when the balance between oxygen supply and demand is compromised without inserting a central venous catheter.
The Effects of Fenoterol Inhalation
After Acid Aspiration-Induced Lung Injury
Michael
T. Pawlik, MD*, Thomas Schubert, MD,
Susanne Hopf, MD*, ,
Michael Gruber, PhD*, ,
Kai Taeger, MD, PhD*, and Karl P. Ittner, MD*
From the Departments of *Anesthesiology, Pathology,
Cardiology,
Pulmonology and Intensive Care, University Hospital, Regensburg, Germany; and Department
of Anesthesiology, University Hospital Ulm, Ulm, Germany.
Anesth Analg 2009 109: 143-150.
BACKGROUND: Acid aspiration is a serious complication that can occur during general anesthesia.背景：酸吸入是一个可能在全身麻醉发生的严重并发症。 Studies show that β-agonists have beneficial effects on lung injury.研究表明， β －激动剂对于肺损伤有有益的影响。 Therefore, we tested the effect of the nebulized β-agonist fenoterol on lung variables in a rodent model of acid-induced lung injury.因此，作者测试了雾化吸入β -受体激动剂非诺特罗对酸诱导肺损伤啮鼠动物模式肺变量的影响。
METHODS: In a prospective,
randomized, and controlled study, we evaluated the effects of fenoterol
inhalation on lung oxygenation, inflammation, and pulmonary histology in a rat
model of acid-induced lung injury.方法：在这项前瞻性，随机，对照研究中，作者评估了吸入非诺特罗对于酸诱导肺损伤大鼠模型的肺氧合、炎症、以及肺组织的影响。 Sprague-Dawley
rats underwent sevoflurane anesthesia with tracheotomy and carotid catheter
insertion.七氟醚麻醉的Sprague - Dawley大鼠进行了气管切开术和置入颈内动脉导管。 Lung injury
was induced by instillation of 0.4 mL/kg 0.1 M hydrochloric acid.通过滴注0.4ml/kg
RESULTS: Inhalation treatment with 10 µg fenoterol significantly increased oxygenation after 270 and 360 min when compared with placebo.结果：与安慰剂相比，10ug非诺特罗的吸入治疗后270和360min显著增加了氧合作用。 Fenoterol-treated rats showed a significant decrease in IL-6 and TNF- levels and in the wet/dry weight ratio of the lungs.非诺特罗治疗的大鼠显示出了 IL - 6和TNF 水平以及肺部湿/干比的显著降低。 在非诺特罗组The histologic appearance showed significantly less interstitial edema and leukocyte infiltration in the fenoterol group.组织学表现展现了明显减少的间质水肿及白细胞浸润。 支气管肺泡灌洗液中The concentration of fenoterol was 10.3 µg/L (median) in the BALF and <1 µg/L in the plasma.非诺特罗的浓度为10.3ug/l（中位数）在和 血浆中浓度< 1ug/l。
CONCLUSIONS: Fenoterol inhalation improved oxygenation after 270 and 360 min, attenuated the release of TNF- and IL-6, and diminished the lung edema and infiltration of polymorphonuclear leukocytes.结论：吸入非诺特罗270和360min氧合改善，降低TNF和IL－6的释放 ，且减少肺水肿和多形核细胞浸润。
(怀晓蓉 译 陈杰 校)
BACKGROUND: Acid aspiration is a serious complication that can occur during general anesthesia. Studies show that β-agonists have beneficial effects on lung injury. Therefore, we tested the effect of the nebulized β-agonist fenoterol on lung variables in a rodent model of acid-induced lung injury.
METHODS: In
a prospective, randomized, and controlled study, we evaluated the effects
of fenoterol inhalation on lung oxygenation, inflammation, and
pulmonary histology in a rat model of acid-induced lung injury.
Sprague-Dawley rats underwent sevoflurane anesthesia with
tracheotomy and carotid catheter insertion. Lung injury was induced
by instillation of 0.4 mL/kg 
and interleukin (IL)-6 were determined in the BALF, and lungs were
dried for determination of the wet/dry ratio.
RESULTS: Inhalation
treatment with 10 µg fenoterol significantly increased
oxygenation after 270 and 360 min when compared with placebo.
Fenoterol-treated rats showed a significant decrease in IL-6 and TNF-
levels and in the wet/dry weight ratio of the lungs. The histologic
appearance showed significantly less interstitial edema and
leukocyte infiltration in the fenoterol group. The concentration of
fenoterol was 10.3 µg/L (median) in the BALF and <1
µg/L in the plasma.
CONCLUSIONS: Fenoterol
inhalation improved oxygenation after 270 and 360 min, attenuated
the release of TNF-
and IL-6, and diminished the lung edema and infiltration of
polymorphonuclear leukocytes.
硬膜外注射2-氯普鲁卡因与吗啡的相互作用——一项关于吗啡镇痛时效的随机对照试验
The Interaction Between Epidural
2-Chloroprocaine and Morphine: A Randomized Controlled Trial of the Effect of
Drug Administration Timing on the Efficacy of Morphine Analgesia
Paloma Toledo, MD, Robert J. McCarthy, PharmD, Mary Jane Ebarvia, BS, RN, Christopher J. Huser, MD, and Cynthia A. Wong, MD
From the Department of Anesthesiology,
Northwestern
Anesth Analg 2009 109: 168-173.
背景：与利多卡因相比，硬膜外吗啡伍用2-氯普鲁卡因镇痛作用降低已不常用。2-氯普鲁卡因与吗啡之间的相互作用机制至今未明。可能的机制包括两种药物之间药物反应时间及作用时程的不同以及阿片受体对抗性。本实验中作者选取了产后输卵管结扎的病人，假设在硬膜外注射2-氯普鲁卡因前30分钟注射吗啡会导致的术后镇痛的时程及效果与硬膜外给予利多卡因后注射吗啡是一致的。
方法：实验选取阴道分娩后行双侧输卵管结扎并实施硬膜外镇痛的患者，随机分为三组，其中一组在实施硬膜外给予3%2-氯普鲁卡因镇痛前30分钟预注吗啡，另一组则预注生理盐水，第三组则硬膜外给予2%利多卡因术后镇痛，并且在手术切皮后，三组硬膜外不输注任何药物包括吗啡及生理盐水。镇痛时效定义为从吗啡输注到患者要求追加镇痛剂量的时间。硬膜外吗啡的作用时程采用Kaplan-Meier组间分析及log-rank检验。
结果：在硬膜外注射2-氯普鲁卡因前30分钟注射吗啡（n=29）导致较长的镇痛时程(28.6 h [95% CI 4.4–52.7])。而在2-氯普鲁卡因后注射吗啡(n = 30)其作用时程为(2.2 h [95% CI 0–4.8]) (P = 0.006)。硬膜外注射2-氯普鲁卡因前注射吗啡与注射利多卡因后注射吗啡两者的作用时程相似(n = 28) (25.8 h [95% CI 10.7–40.9]) (P = 0.83)。在麻醉术后复苏室内对两组进行疼痛评分也无明显差异。而该疼痛评分在产后恢复室内硬膜外注射2-氯普鲁卡因后注射吗啡这组中评分较高。在48小时内吗啡的追加量相似，并且在阿片类药物相关副作用中无明显差异。
结论：这项研究证实在硬膜外输注2-氯普鲁卡因前30分钟输注吗啡其作用时程与输注利多卡因后输注吗啡的镇痛时程是相似的。这提示硬膜外吗啡与2-氯普鲁卡因的相互作用是由于两种药物的作用时程，在2-氯普鲁卡因前输注吗啡能有效的阻滞阿片类药物受体对抗性。
(赵嫣红 译 陈杰 校)
BACKGROUND: The efficacy and duration of epidural morphine analgesia is diminished when administered after 2-chloroprocaine compared with lidocaine. The mechanism of the interaction between 2-chloroprocaine and morphine is unknown. Possible explanations include differences in the latency and duration of action of the two drugs or opioid receptor antagonism. We hypothesized that administration of epidural morphine 30 min before the initiation of 2-chloroprocaine anesthesia would result in postoperative analgesia of similar duration and quality to that achieved by epidural morphine after the initiation of lidocaine anesthesia in patients undergoing postpartum tubal ligation.
METHODS: Subjects undergoing bilateral postpartum tubal ligation after vaginal delivery with epidural analgesia were randomized to one of three groups. Subjects received epidural morphine or saline 30 min before the initiation of analgesia with 3% 2-chloroprocaine (two groups) or 2% lidocaine (one group), and at the time of surgical incision, they received either epidural saline or morphine. The duration of analgesia was defined as the time from morphine administration until the first request for supplemental analgesia. Duration of epidural morphine analgesia was compared among groups using Kaplan–Meier survival analysis and the log-rank test.
RESULTS: Administration of epidural morphine 30 min before the initiation of 2-chloroprocaine anesthesia (n = 29) resulted in a longer median duration of analgesia (28.6 h [95% CI 4.4–52.7]) compared with the administration of morphine after 2-chloroprocaine anesthesia (n = 30) (2.2 h [95% CI 0–4.8]) (P = 0.006). The median duration of analgesia observed when morphine was administered before 2-chloroprocaine was similar to that observed when morphine was administered after initiation of lidocaine anesthesia (n = 28) (25.8 h [95% CI 10.7–40.9]) (P = 0.83). Pain scores were not different in the postanesthesia care unit, but were higher on admission to the postpartum unit in the subjects receiving morphine after 2-chloroprocaine. Supplemental morphine equivalents administered in the first 48 h were similar among groups and there were no differences in opioid-related side effects.
DISCUSSION: This study demonstrates that administration of epidural morphine 30 min before epidural anesthesia with 2-chloroprocaine provides a similar duration of analgesia as epidural morphine after epidural lidocaine anesthesia. This suggests that the observed interaction between epidural morphine and 2-chloroprocaine is a result of differences in latency and duration of action of the two drugs, or that the administration of morphine before 2-chloroprocaine effectively blocks a receptor site antagonism.
开颅手术中动脉血二氧化碳分压与七氟醚对脑毛细静脉血流、脑血流及血氧饱和度的影响
The Effects of Arterial Carbon Dioxide
Partial Pressure and Sevoflurane on Capillary Venous Cerebral Blood Flow and
Oxygen Saturation During Craniotomy
Klaus
Ulrich Klein, MD*, Martin Glaser, MD,
Robert Reisch, MD, PhD,
Achim Tresch, MSc,
Christian Werner, MD, PhD*, and Kristin Engelhard, MD, PhD*
From the Departments of *Anesthesiology, Neurosurgery,
Johannes Gutenberg-University, Mainz, Germany; and Department
of Chemistry and Biochemistry, Gene Center Munich,
Ludwig-Maximilians-University, Munich, Germany.
Anesth Analg 2009 109: 199-204.
背景：术中常规监测脑血流及氧合是一项技术挑战。通过二氧化碳对脑血管产生的生理反应，作者旨在研究一先进的神经监测装置(oxygen-to-see, O2CTM device)，在毛细静脉水平，对开颅手术病人的区域脑血流(rvCBF)，流速(rvVelo)，氧饱和度(srvO2)以及血色素(rvHb)的同步监测意义。
方法： 26名神经外科病人随机分配接受呼气末浓度为1.4%或者2%七氟醚。开颅后，在手术侧，在肉眼可见正常的脑组织表面放置一光纤探头。每位病人同步监测低动脉二氧化碳分压（35mmHg）或高动脉二氧化碳分压（45mmHg）时脑深度为
结果：在脑组织深度
结论：二氧化碳分压造成的脑血流和流速增加提示在呼气末浓度1.4%和2%七氟醚麻醉下，高二氧化碳可造成保护性血管扩张。氧饱和度连续升高提示高二氧化碳分压导致脑动静脉中氧降低存在差异。血色素量不变表示，监测中没有血液丢失。数据显示，此装置可以监测脑微血管主要静脉在不同二氧化碳分压水平的血流和氧饱和度。
(朱紫瑜 译 陈杰 校)
BACKGROUND: Intraoperative routine monitoring of cerebral blood flow and oxygenation remains a technological challenge. Using the physiological principle of carbon dioxide reactivity of cerebral vasculature, we investigated a recently developed neuromonitoring device (oxygen-to-see, O2CTM device) for simultaneous measurements of regional cerebral blood flow (rvCBF), blood flow velocity (rvVelo), oxygen saturation (srvO2), and hemoglobin amount (rvHb) at the capillary venous level in patients subjected to craniotomy.
METHODS: Twenty-six
neurosurgical patients were randomly assigned to anesthesia with
1.4% or 2.0% sevoflurane end-tidal concentration. After craniotomy,
a fiberoptic probe was applied on a macroscopically healthy surface
of cerebral tissue next to the site of surgery. Simultaneous
measurements in 2 and
RESULTS: RvCBF
and rvVelo were elevated by Paco2 independent of
sevoflurane concentration in 2 and
CONCLUSIONS: Increases in rvCBF and rvVelo by Paco2 suggest preserved hypercapnic vasodilation under anesthesia with sevoflurane 1.4% and 2.0% end-tidal concentration. A consecutive increase in srvO2 implies that cerebral arteriovenous difference in oxygen was decreased by elevated Paco2. Unchanged levels of rvHb signify that there was no blood loss during measurements. Data suggest that the device allows detection of local changes in blood flow and oxygen saturation in response to different Paco2 levels in predominant venous cerebral microvessels.
Intravascular Flow Patterns in
Transforaminal Epidural Injections: A Comparative Study of the Cervical and
Lumbar Vertebral Segments
Do Wan
Kim, MD, Kyung Ream
From the Department of Anesthesiology and
Pain Medicine, Pain Clinic,
Anesth Analg 2009 109: 233-239.
背景：经椎孔硬膜外注射（transforaminal epidural injection，TEI）通常用于神经根性疼痛的治疗。然而，许多已发表的研究表明，TEI的实施经常伴有严重的并发症，其中大多发生在颈椎水平。对该并发症的一种解释是操作者不慎将药物注入了血管内。作者拟鉴别在实施TEI时颈椎和腰椎水平血管内注射的发生率。
方法：将伴有根性疼痛症状或者有带状疱疹相关疼痛的患者前瞻性地分为2组，各由一位作者对其实施颈椎或腰椎TEI（lumbar TEIs，LTEIs）。以双平面X线透视确认了穿刺针的理想位置后，操作者在X线透视下以0.3-0.5ml/s的速度持续注入由非离子型造影剂和生理盐水组成的混合液3ml的实时显影。
结果：研究共实施了182例TEI。56例（30.8%）的注射液扩散至血管内，其中45例发生在颈段TEI（cervical TEI，CTEI），11例为LTEI。其中，52.1%CTEI和9%LTEI注射液同时扩散至神经周围和血管内，11.3%CTEI和0.9%LTEI病例的注射液仅扩散至血管内。
结论：实施CTEI和LTEI时，注射液误入血管的发生率前者明显高于后者，表明操作者应更加谨慎地实施CTEI。此外，与之前的报道相比，实施CTEI时注射液误入血管的发生率明显偏高。这一发现提示在实施操作时，需要加入适量的造影剂（3ml）以探测注射液是否注入了血管内，注射液同时扩散至血管内和神经周围的情况尤为突出。
(周姝婧 译 陈杰 校)
BACKGROUND: Transforaminal epidural injection (TEI) is commonly used in the treatment of radicular pain. However, there have been many published cases of serious complications after a TEI, occurring most often in cervical levels. One of the presumptive reasons for this complication is inadvertent intravascular injection. We sought to identify the incidence of intravascular injections in cervical and lumbar spinal segments during TEI.
METHODS: All patients with radicular symptoms or herpes zoster-associated pain underwent cervical and lumbar TEIs (LTEIs) prospectively by one of the authors. After an ideal needle position was confirmed by biplanar fluoroscopy, 3 mL of a mixture containing nonionic contrast and normal saline was continuously injected at the rate of 0.3–0.5 mL/s with real-time fluoroscopic visualization.
RESULTS: One hundred eighty-two TEIs were performed. Fifty-six cases (30.8%) showed intravascular spreading patterns, 45 cases occurring during a cervical TEI (CTEI) and 11 during a LTEI. The incidences of simultaneous perineural and vascular injection in cervical and LTEIs were 52.1% and 9%, respectively, and pure vascular flow pattern rates in cervical and LTEIs were 11.3% and 0.9%, respectively.
CONCLUSION: The incidence of vascular injection in CTEIs is significantly higher than in LTEIs, suggesting that CTEIs should be performed more cautiously. Furthermore, the vascular injection rate of CTEIs is much higher than that previously reported. This finding suggests the need for a proper volume of contrast injection (3 mL) to detect vascular flow, especially in simultaneous perineural and vascular injections.
Mexiletine and Lidocaine Suppress the
Excitability of Dorsal Horn Neurons
Andrea
Olschewski, MD, PhD*,
Rose Schnoebel-Ehehalt, MD*, Yingji Li, MD, PhD,
Bi Tang, MD,
Michael E. Bräu, MD, PhD*, and Matthias Wolff, MD, PhD*
From the *Departments of Anaesthesiology,
Intensive Care Medicine, Pain Therapy, University Clinic Giessen and Marburg
GmbH, Giessen, Germany; Experimental
Anaesthesiology, University Clinic of Anaesthesia and Intensive Care Medicine,
Medical University of Graz, Austria; Department
of Pulmonology, University Clinic of Internal Medicine, Medical University of
Graz, Austria; and Department
of Physiology, Justus-Liebig-University, Giessen, Germany.
Anesth Analg 2009 109: 258-264.
背景：神经受损后，后角神经元的敏化作用和痛觉异化路径改变了脊髓信号输出，导致痛觉提高及慢性疼痛综合症。临床上使用剂量不足以阻滞传导的Na+通道阻滞剂可缓解这种慢性疼痛。尽管对这些药对传入的影响作用关注备至，很少有研究关注他们对中央感觉神经的兴奋作用。因此作者研究了Na+阻滞剂美西律和利多卡因对感觉神经后角神经元的作用。
方法：用膜片钳技术记录美西律和利多卡因对年轻大鼠不同种类的后角神经元（强化发热、适应发热和单峰神经元）的作用。
结果：所有三种不同神经元对美西律和利多卡因的反应呈剂量依赖性。两种局部麻醉药可逆性抑制Na+ 和K+电流。对Na+传导阻滞的最大半数抑制浓度为89± 2 或54 ± 6 µM，对K+传导阻滞的延迟整流浓度分别为利多卡因582 ± 36 及美西律398 ± 14 µM。对Na+ 和 K+ 连续电流的抑制改变了单个动作电位的特性并降低强直发放和适应发放神经元的发放频率。
结论：在与临床相关的浓度中，通过阻滞Na+ 、K+通道降低感觉神经后角神经元的兴奋性。研究证实利多卡因和美西律除了其周围神经作用外，它们对中枢神经系统中电压门控离子通道的调节作用在疼痛治疗中的抗伤害作用中有重要意义。
(黄丹 译 陈杰 校)
BACKGROUND: Spinal sensitization and facilitatory processes in dorsal horn neurons after nerve injury alter spinal outflow leading to enhanced pain perception and chronic pain syndromes. Clinically used Na+ channel blockers at doses which do not block conduction can relieve such chronic pain. Although much attention has been paid to their effect upon afferents, less work has been done with their effect on the excitability of central sensory neurons. Thus, we investigated the effects of the Na+ channel blockers mexiletine and lidocaine on sensory spinal dorsal horn neurons.
METHODS: Patch-clamp recordings were directly performed in visualized neurons of the substantia gelatinosa in the spinal cord of young rats to investigate the effect of mexiletine and lidocaine in different types of dorsal horn neurons (tonically firing, adapting-firing, and single spike neurons).
RESULTS: All three different types of neurons responded dose-dependently to mexiletine and lidocaine. Both local anesthetics reversibly inhibited Na+ and K+ currents. The half-maximal inhibitory concentration for Na+ conductance block was 89 ± 2 or 54 ± 6 µM and for delayed-rectifier K+ conductance block was 582 ± 36 or 398 ± 14 µM for lidocaine and mexiletine, respectively. The inhibition of Na+ and K+ currents consecutively altered the properties of single action potentials and reduced the firing rate of tonically firing and adapting-firing neurons.
CONCLUSIONS: In clinically relevant concentrations, lidocaine and mexiletine reduced the excitability of sensory dorsal horn neurons via a blockade of Na+ and K+ channels. Our work confirms that, in addition to the peripheral effects of lidocaine and mexiletine, modulation of voltage-gated ion channels in the central nervous system contributes to the antinociceptive effects of these drugs used in pain therapy.
超声引导下腋路臂丛神经阻滞（局部麻醉药混合液20ml）与全麻在上肢外伤手术中的比较：一项单盲、前瞻、随机、对照试验
Ultrasound-Guided Axillary Brachial
Plexus Block with 20 Milliliters Local Anesthetic Mixture Versus General
Anesthesia for Upper Limb Trauma Surgery: An Observer-Blinded, Prospective,
Randomized, Controlled Trial
Brian D. O’Donnell, MB, FCARCSI, MSc, Helen Ryan, MB, BCh, BAO, Owen O’Sullivan, MB, FCARCSI, and Gabrielle Iohom, FCARCSI, MD, PhD
From the Department of Anesthesia,
Anesth Analg 2009 109: 279-283.
目的：作者随机、对照研究低剂量超声引导腋路臂丛神经阻滞与全身麻醉的麻醉效果及预后。
方法：患者随机接受超声引导腋路臂丛神经阻滞或全身麻醉。超声引导腋路臂丛神经阻滞使用一种针面朝外进路的方法。超声引导定位正中神经、尺神经、桡神经、和肌皮神经后，分别注射至多5毫升的局麻药（等份混合2%利多卡因与加入7.5mg/mL可乐定的0.5%布比卡因并加入1：200000肾上腺素）。局麻药注射总量不超过20毫升。全身麻醉标准包括用芬太尼和异丙酚诱导，使用七氟醚和N2O的混合气体来维持。疼痛评分分别在在恢复室术后2 ， 6 ， 24 ， 48小时和7天获得。并评估不需入恢复室人次和出院时间。
结果：所有超声引导腋路臂丛神经阻滞的患者取得了令人满意的麻醉效果。超声引导腋路臂丛神经阻滞组患者在恢复室、术后2小时、6小时，视觉模拟疼痛评分较低（分别为：0.3[1.3]对55.8 [36.5]，P<0.001；0.3[1.3]对45[29.6]，P< 0.00，；1.1[2.7]对4[2.8]，P<0.01）。所有超声引导腋路臂丛神经阻滞患者无需在恢复室进行观察，且较接受全麻的病人更早出院（ 30min对120min，30/240， P<0.0001 ） 。
结论：与全身麻醉相比，在上肢外伤手术，超声引导腋路臂丛神经阻滞（使用20ml局部麻醉药混合液）提供了令人满意的麻醉和镇痛效果。
(张燕 译 陈杰 校)
OBJECTIVE: We performed a randomized, controlled trial comparing low-dose ultrasound-guided axillary block with general anesthesia evaluating anesthetic and perioperative analgesic outcomes.
METHODS: Patients were randomized to either ultrasound-guided axillary block or general anesthesia. Ultrasound-guided axillary block was performed using a needle-out-of-plane approach. Up to 5 mL of local anesthetic injectate (equal parts 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine with 7.5 mg/mL clonidine) was injected after identifying the median, ulnar, radial, and musculocutaneous nerves. A maximum of 20 mL local anesthetic injectate was used. General anesthesia was standardized to include induction with fentanyl and propofol, maintenance with sevoflurane in an oxygen/nitrous oxide mixture. Pain scores were measured in the recovery room and at 2, 6, 24, 48 h, and 7 days. Ability to bypass the recovery room and time to achieve hospital discharge criteria were also assessed.
RESULTS: All ultrasound-guided axillary block patients achieved satisfactory anesthesia. The ultrasound-guided axillary block group had lower visual analog scale pain scores in the recovery room (0.3 [1.3] vs 55.8 [36.5], P < 0.001), and visual rating scale pain scores at 2 h (0.3 [1.3] vs 45 [29.6], P < 0.001), and at 6 h (1.1 [2.7] vs 4 [2.8], P < 0.01). All ultrasound-guided axillary block patients bypassed the recovery room and attained earlier hospital discharge criteria (30 min vs 120 min 30/240 P < 0.0001 median [range]).
CONCLUSIONS: Ultrasound-guided axillary brachial plexus block with 20 mL local anesthetic mixture provided satisfactory anesthesia and superior analgesia after upper limb trauma surgery when compared with general anesthesia.
ε-氨基己酸和抑肽酶应用于行初次冠状动脉旁路分离手术患者后在纤维蛋白溶解和血液流失方面的效果：一个随机双盲，安慰剂控制的无差别试验
The Effect of Epsilon-Aminocaproic Acid and Aprotinin on
Fibrinolysis and Blood Loss in Patients Undergoing Primary, Isolated Coronary
Artery Bypass Surgery: A Randomized, Double-Blind, Placebo-Controlled,
Noninferiority Trial. Philip E. Greilich, MD, FAHA*, Michael E. Jessen, MD,
Neeraj Satyanarayana, BS*, Charles W. Whitten, MD*,
Gregory A. Nuttall, MD,
Joseph M. Beckham, MD*, Michael H. Wall, MD,
and John F. Butterworth, MD||
From the Departments of *Anesthesiology and Pain Management, and Cardiovascular
and Thoracic Surgery, University of Texas Southwestern Medical Center at
Dallas, Dallas, Texas; Department
of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department
of Anesthesiology, Washington University, St. Louis, Missouri; and ||Department
of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.
Anesth Analg 2009 109: 15-24.
背景：直到现在，抑肽酶仍是唯一一个美国法定认可的可应用于心血管手术的抗纤维蛋白溶解的药物。而最有可能替代抑肽酶的ε-氨基己酸（EACA）还未被充分地与抑肽酶比较。我们所要进行的研究正是要测试这一假说成立与否，即合理剂量地应用ε-氨基己酸，其在减少纤维蛋白溶解和血液流失方面的效果与抑肽酶并无差别。
方法：78位择期行初次冠状动脉旁路分离手术的患者被随机地分为三组进行双盲实验：一组应用“全Hammersmith”剂量的抑肽酶，一组应用大剂量的ε-氨基己酸（以100mg/kg为初始符合剂量，另将含ε-氨基己酸
结果：组间比较ε-氨基己酸与抑肽酶，两者的D-二聚体形成的峰值（-3.58 ug/L，95% 可信区间： -203~195ug/L）和24小时胸管引流量（67 mL，95% 可信区间：-90~230 mL）的差别均在预先设定的无差被可信区间范围内（分别为250ug/mL 和350 mL），完全符合两者无差别的标准。生理盐水安慰剂组与ε-氨基己酸组和抑肽酶组比较，后两者D-二聚体形成的峰值均明显降低（ε-氨基己酸组 589ug/L，95%可信区间为399~788ug/L，P<0.0001；抑肽酶组 585ug/L，95%可信区间为393~778ug/L，P<0.0001）。同样的，与生理盐水安慰剂比较，应用ε-氨基己酸组和抑肽酶组的24小时胸管引流量也明显减少（ε-氨基己酸组 239 mL，95%可信区间为50~415 mL，P<0.05；抑肽酶组 323 mL，95%可信区间为105~485 mL，P<0.05）。血浆ε-氨基己酸的水平可以很好地维持在靶浓度260ug/mL以上。
结论：行初次冠状动脉旁路分离手术的患者应用ε-氨基己酸，如按用药指南合理剂量给予，则其在减少纤维蛋白溶解和血液流失方面的效果与抑肽酶无差别。
（单嘉琪译 薛张纲校）
BACKGROUND: Until recently, aprotinin was the only antifibrinolytic
drug with a licensed indication in cardiac surgery in the
METHODS: Seventy-eight patients scheduled for primary, isolated coronary artery bypass graft surgery were randomly assigned to receive
"full Hammersmith" dose aprotinin,
high dose EACA (100 mg/kg initial loading dose,