Anesthesia & Analgesia
July 2009
CARDIOVASCULAR ANESTHESIOLOGY:
ε-氨基己酸和抑肽酶應用於行初次冠狀動脈旁路分離手術患者後在纖維蛋白溶解和血液流失方面的效果：一個隨機雙盲，安慰劑控制的無差別試驗
單嘉琪譯
薛張綱校
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.
全血多極凝集測定儀是一種可靠的阿司匹林誘導的血小板功能障礙的床邊檢驗方法
劉世文 譯 陳傑 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:
在體外迴圈下行先天性心臟病手術的病人使用抑肽酶與腎功能不全的關係
顏濤譯， 馬皓琳 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指數提示兒童丙泊酚誘導期間的年齡相關性變化
范羽譯 薛張綱校
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.
葉樂 譯 陳傑 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:
評估用甘草漱口減少術後咽喉痛的有效性：一個前瞻性、隨機、單盲研究
彭中美 譯 馬皓琳 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:
七氟烷麻醉狀態下右美托咪定，異丙酚和咪達唑侖對兔子呼吸CO2反應性，動脈壓及心率影響的比較。
黃劍譯 薛張綱校
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.
張磊 譯 陳傑 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.
家兔給予新型苯二氮卓受體激動劑JM-1232(–)後的寒戰閾值
周雅春 譯 馬皓琳 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.
活體適度的氦氣吸入可降低炎性反應，但不能防止缺血再灌注時的內皮損傷
李瑩譯 薛張綱校
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.
丁俊雲 譯 陳傑 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:
脈搏波形分析和經食管超聲心動圖：兩種方法在腹腔鏡結腸手術中測定心輸出量的比較
姚敏敏譯
薛張綱校
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監護儀能估測混合靜脈血紅蛋白氧飽和度嗎？
舒慧剛 譯 陳傑 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:
江繼宏 譯
馬皓琳 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.
俞佳譯 薛張綱校
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:
懷曉蓉 譯 陳傑 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.
肺募集反應對病態肥胖病人容積性二氧化碳描記圖III相斜率的影響
王宏翻譯，李士通，馬皓琳校正
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.
肺泡複張及高PEEP措施應用於有血管內容量負荷的病態肥胖病人後，並不對血流動力學產生影響
陳珺珺譯，薛張綱校
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-氯普魯卡因與嗎啡的相互作用——一項關於嗎啡鎮痛時效的隨機對照試驗
趙嫣紅 譯 陳傑 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-羥色胺拮抗劑對剖宮產中接受鞘內嗎啡的產婦瘙癢、噁心嘔吐的預防和治療作用：系統性回顧和Meta分析
黃佳佳譯，馬皓琳
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:
張玥琪譯，薛張綱校
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.
開顱手術中動脈血二氧化碳分壓與七氟醚對腦毛細靜脈血流、腦血流及血氧飽和度的影響
朱紫瑜 譯 陳傑 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.
發育中大鼠腦的器官型海馬腦片模型中氧和葡萄糖缺失：對N-甲基-d-天門冬氨酸亞單位組成的影響
黃施偉 譯，馬皓琳 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:
張釗譯 薛張綱校
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 譯 陳傑 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 譯 馬皓琳 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.
滴注或注射提純的天然辣椒堿對大鼠後肢感覺-運動行為或截骨修復術無有害影響
朱蘭芳譯
薛張綱校
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.
黃丹 譯 陳傑 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.
比較超聲和神經刺激儀引導肌間溝法臂叢神經阻滯用於肩關節門診手術後神經症狀的前瞻性隨機對照試驗
朱 慧譯 馬皓琳 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.
陳珺珺譯
薛張綱校
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.
超聲引導下腋路臂叢神經阻滯（局部麻醉藥混合液20ml）與全麻在上肢外傷手術中的比較：一項單盲、前瞻、隨機、對照試驗
張燕 譯 陳傑 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.
在體外迴圈下行先天性心臟病手術的病人使用抑肽酶與腎功能不全的關係
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：在成人體外迴圈（CPB）期間使用大劑量抑肽酶與術後腎功能不全有關，但對接受複雜先天性心臟病手術的兒童的作用並未確定。
方法：我們採用回顧性群組分析方法研究了在2004年7月至2006年7月間需要體外迴圈行先天性心臟病手術的病兒。患兒的人口統計學資料和按Aristotle外科複雜性分級劃分的手術風險都作為協變數。按照RIFLE標準（一種根據血清肌酐值將急性腎損傷按嚴重程度分為R-風險，I-損傷，F-衰竭的國際公認的分類法）確定腎功能不全。採用單因素、多因素邏輯回歸分析和傾向性評分方法分析資料。使用與使用抑肽酶相關的預處理協變數進行傾向性評分。接著採用對傾向性評分和術中測定值作為協變數進行多因素邏輯回歸分析。認為P<0.05有統計學顯著性。
結果：395例進行心臟手術的病兒中，55%使用了抑肽酶，而45%未用。組群中31%曾接受過心臟手術，17%為新生兒。按照RIFLE標準，80例病兒(20.3%)術後有急性腎功能損傷；其中53例(13.4%)有腎功能不全風險，23例(5.8%)存在腎損傷，4例(0.7%)為腎衰竭。使用抑肽酶的病兒在既往心臟手術(54.1% vs 5%)、敗血症(6.9% vs.0.0%)，心力衰竭(24.8% vs 12.4%)、機械通氣(25.2% vs 2.8%)或機械迴圈支持(6.0% vs.0.6%)的發生率更高。使用抑肽酶的患兒，Aristotle外科分級4級(26.6% vs 2.8%)者更多，使用利尿藥(63.8% vs 26.6%)、血管緊張素轉換酶抑制劑(21.1% vs 7.9%)、米力農(25.7% vs 4.5%)和強心劑(16.1% vs 2.3%)治療者也更多。儘管未調整的腎功能不全風險存在明顯差異，根據術前傾向性評分調整後卻顯示使用抑肽酶與腎功能不全沒有相關性 (OR 1.32; 95% CI 0.55–3.19)。體外迴圈時間是唯一與腎功能不全產生有關的獨立因素 (OR 1.0; 95% CI 1.009–1.014)。
結論：使用抑肽酶的患兒同時伴有產生術後腎功能不全的術前危險因素的可能性更大。然而，當恰當地考慮了相關危險因素時，使用抑肽酶看來與兒童術後即時的產生腎功能不全高危險性不相關。
（顏濤譯， 馬皓琳 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.
評估用甘草漱口減少術後咽喉痛的有效性：一個前瞻性、隨機、單盲研究
An Evaluation of the
Efficacy of Licorice Gargle for Attenuating Postoperative Sore Throat: A
Prospective, Randomized, Single-Blind Study
Anil Agarwal, MD*, Devendra Gupta, MD*, Ghanshyam
Yadav, MD*, Puneet Goyal, MD, DM*, Prabhat K. Singh, MD*,
and Uttam Singh, PhD
From the *Department of
Anesthesiology and Biostatics, Sanjay Gandhi Post Graduate Institute
of Medical Sciences, Lucknow, India.
Anesth Analg 2009;
109:77-81
背景：術後咽喉痛（POST）是主要的術後併發症。甘草作為一個祛痰藥可用來治療咳嗽和感冒。在本研究中，我們評估可甘草漱口來減少術後喉痛的效果。
方法：40個成年人（18-60歲），ASA分級I和II，行擇期腰椎板切除術，隨機分為兩組，每組20例。C組：用水；L組加0.5 g甘草在水裏。使兩組標準化地都在麻醉前5分鐘，用30毫升混合液漱口。在術後0、2、4、和24小時，監測休息和吞咽時術後咽喉痛的發生率和嚴重度及術後副作用。用直觀類比標度（在0-100之間；0表示沒有咽喉痛，100表示可想像的最嚴重的咽喉痛）評估術後咽喉痛的嚴重度。氣管導管拔後立即評估拔管後咳嗽。用Z試驗和Fisher’s精確試驗分析資料。P < 0.05表示有顯著性意義。
結果：L組與C組在休息和吞咽的所有時間點相比，術後咽喉痛（發生率和嚴重度）減少（P < 0.05），只有在24小時休息狀態時的術後喉痛嚴重度兩組相似（P > 0.05）。拔管後咳嗽在L組比C組明顯減少（P < 0.05）。兩組間副作用沒有明顯差異（P > 0.05）。
結論：麻醉前5分鐘用甘草漱口可有效地減少術後咽喉痛的發生率和嚴重度。
（彭中美 譯 馬皓琳 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 0.5 g licorice in water. Both groups received a 30 mL
mixture for 30 s, 5 min before anesthesia which was standardized.
The incidence and severity of POST at rest and on swallowing and
side effects were assessed at 0, 2, 4, and 24 h, postoperatively.
Severity of POST was assessed by visual analog scale (between 0 and
100 mm; where 0 means no sore throat and 100 means worst imaginable
sore throat). Postextubation cough was assessed immediately after
tracheal extubation. Data were analyzed by Z test and Fisher’s
exact test. P < 0.05 was considered as significant.
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.
家兔給予新型苯二氮卓受體激動劑JM-1232(–)後的寒戰閾值
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(–) 是一種新型異二氫吲哚衍生物，通過作用於
-氨基丁酸A型（GABAA）受體的苯二氮卓位元點顯示出鎮靜催眠活性。另一GABAA受體激動劑咪達唑侖的標準劑量可輕度降低人的寒戰閾值。本研究旨在確定JM-1232(–)可降低寒戰閾值到何種程度。
方法： 給予0.2最小肺泡麻醉濃度（MAC）異氟醚後處於淺麻醉狀態的18只家兔隨機分為三組，分別靜脈輸注1)生理鹽水(對照組), 2) 0.01 mg · kg–1
· min–1 JM-1232(–)或3) 0.1 mg · kg–1 · min–1
JM-1232(–)。通過置於結腸內的U形塑膠管灌注10°C的水使得家兔體溫以2-3°C/h的速度下降。當不知分組情況的觀察者觀察到家兔寒戰或家兔中心體溫降至34°C時，停止降溫。記錄經由食道遠端測得的中心體溫，寒戰開始時的中心體溫定義為寒戰閾值。資料分析採用單因素方差分析和Student-Newman-Keuls檢驗。結果表示為平均值 ± 標準差; P < 0.05 認為有統計學意義。
結果：靜脈輸注生理鹽水的家兔在體溫36.5 ± 0.3°C時發生寒戰。以0.01 mg · kg–1 · min–1速度靜脈輸注JM-1232(–) 的6個家兔中有5個在體溫35.7 ± 0.8°C時發生寒戰，並有一個家兔在體溫降到34.0°C時也沒發生寒戰。以0.1 mg · kg–1 · min–1速度靜脈輸注JM-1232(–)的家兔在體溫達到34°C中止降溫之前都未發生寒戰。
結論：低劑量JM-1232(–)可使家兔寒戰閾值降低約0.8°C，這一結果與給予人術前用藥劑量咪達唑侖後的效果相似。相對而言，10倍劑量的JM-1232(–)可使寒戰閾值降低2.5°C以上。這個閾值降低幅度很大且可能利於治療性降溫的實施。
（周雅春 譯 馬皓琳 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 2-3°C/h by perfusing water at 10°C
though a U-shaped plastic tube positioned in the colon. Cooling
continued until shivering was observed by an investigator blinded to
treatment, or until core temperature reached 34°C. Core
temperatures were recorded from the distal esophagus, and core
temperature at the onset of shivering defined the threshold. Data
were analyzed by one-way analysis of variance with
Student-Newman-Keuls tests. Results are presented as means ±
sd; P < 0.05 was considered statistically significant.
RESULTS: The rabbits given a saline infusion shivered at
36.5 ± 0.3°C. Five of the six rabbits given
JM-1232(–) at a rate of 0.01 mg · kg–1
· min–1 shivered at 35.7 ± 0.8°C, and one of
these rabbits failed to shiver at 34.0°C. None of the rabbits
given JM-1232(–) at a rate of 0.1 mg · kg–1
· min–1 shivered before reaching the 34.0°C cutoff
temperature.
CONCLUSION: A low dose of JM-1232(–) reduced the
shivering threshold in rabbits approximately 0.8°C which is
similar to the effects in humans given premedication doses of midazolam.
In contrast, a 10-fold larger dose reduced the threshold more than
2.5°C. This is a substantial decrement and might facilitate induction
of therapeutic hypothermia.
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, University of Washington School of Medicine, Seattle,
Washington.
Anesth Analg 2009;
109:124-129
背景：外周靜脈和動脈置管後嚴重併發症已有很多報導。為了評估麻醉醫生在外周血管置管中的責任，我們回顧了美國麻醉醫師協會索賠終審資料庫。
方法：把外周血管置管相關的索賠歸為與靜脈內或動脈導管有關。與靜脈內導管有關的併發症按併發症的類型加以分類。我們比較了資料庫中與因靜脈內導管有關的索賠和所有的其他（非外周置管）索賠之間的病人和病例特徵、損傷嚴重度和賠償金額。賠償金額用日用品價格指數調整到2007年的美金金額。
結果：與外周血管置管相關的索賠占資料庫中總索賠的2% (n = 140/6894例索賠)，其中大多數(91%)與靜脈內導管相關(n = 127)。最常見的併發症包括：皮膚壞死(28%)、隆起/感染(17%)、神經損傷(17%)、筋膜切開後疤痕(16%)以及空氣栓塞(8%)。大約一半(55%)的併發症發生於藥物或液體滲出血管後。與其他索賠相比，靜脈內置管相關索賠涉及的心臟外科手術病例部分較大(25%相比其他2%, P < 0.001)，急診手術病例部分較小(8%相比其他22%, P < 0.001)。與動脈導管有關的索賠較少(n = 13, 8%)，其中只有7例與橈動脈置管有關。
結論：與靜脈內導管相關的索賠是麻醉醫生的一個重要責任根源，其中大約一半是因為藥物或液體滲出血管。橈動脈置管相關的索賠比較少見。
(江繼宏 譯
馬皓琳 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.
肺募集反應對病態肥胖病人容積性二氧化碳描記圖III相斜率的影響
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，我們分析肺泡復原（ARS）和呼氣末正壓（PEEP）選擇對病態肥胖病人容積性二氧化碳描記圖(VC)III相斜率(SIII)的影響。
方法：十一個麻醉的病態肥胖病人是研究物件。肺以潮氣量10 mL·kg–1、呼吸頻率12-14次/分鐘、吸呼比1:2及吸入氣氧含量 0.4的方式通氣。通過5步將呼氣末壓從0增加到15 cm H2O完成ARS。在肺徵募期間，限制平臺壓在50 cm H2O範圍內，而增加潮氣量到呼吸機的最大值1400ml，PEEP增加到20 cm H2O 持續2分鐘。此後，把PEEP每步減少5 cm H2O地從15 cm H2O減少到0。在PEEP每個階段，測定容積二氧化碳描記圖、動脈血氣和肺的力學資料。
結果：呼氣末正壓為0時與ARS後PEEP 15 cm H2O 時比較，SIII從0.014 ± 0.006 減少到 0.005 ± 0.005 mm Hg/mL(15ARS,
P < 0.05)。比較ARS前後的值，我們發現SIII減少伴隨著動脈氧分壓(27%, P < 0.002)和順應性(32%, P < 0.001)的增加，然而，動脈二氧化碳分壓減少8％(P < 0.038)。接受者操作特徵曲線分析（曲線下面積：0.81，敏感性：0.75，特異性：0.74，P < 0.001）顯示SIII可以很好的預測肺募集反應。
結論：VC中SIII對麻醉的病態肥胖病人肺募集反應後發現最優的PEEP水平是有用的。
（王宏翻譯，李士通，馬皓琳校正）
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 15 cm H2O. During lung
recruitment, plateau pressure was limited to 50 cm H2O,
whereas tidal volume was increased to the ventilator’s maximum
value of 1400 mL, and PEEP was increased to 20 cm H2O for
2 min. Thereafter, PEEP was reduced in steps of 5 cm H2O, from
15 to 0. VC, arterial blood gases, and lung mechanics data were
determined for each PEEP step.
RESULTS: SIII decreased from 0.014 ± 0.006 to 0.005 ±
0.005 mm Hg/mL when 0 end-expiratory pressure was compared against
15 cm H2O of PEEP after ARS (15ARS, P < 0.05).
This decrement in SIII was accompanied by
increases in Pao2 (27%, P < 0.002) and
compliance (32%, P < 0.001), whereas Paco2 decreased
by 8% (P < 0.038) when comparing values before and after
ARS. A good prediction of the lung recruitment effect by SIII
was derived from the receiver operating characteristic curve
analysis (area under the curve of 0.81, sensitivity of 0.75, and
specificity of 0.74; P < 0.001).
CONCLUSION: The SIII in VC was useful to
detect the optimal level of PEEP after lung recruitment in
anesthetized morbidly obese patients.
5-羥色胺拮抗劑對剖宮產中接受鞘內嗎啡的產婦瘙癢、噁心嘔吐的預防和治療作用：系統性回顧和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：我們完成了一個系統性回顧以決定5-羥色胺（5-HT3）受體拮抗劑對剖宮產中接受腰麻及鞘內嗎啡的產婦瘙癢、噁心嘔吐的預防和治療作用。
方法：我們回顧了比較5-HT3受體拮抗劑和安慰劑對產婦瘙癢和/或噁心嘔吐預防和治療作用的隨機對照試驗的報導。這些文章根據其有效度進行評分，由作者獨立地提取資料資料，並且用相關危險度（RR）和95%可信區間（CI）進行總結分析。
結果：本系統性回顧包括了九例隨機對照試驗。九例實驗中共有1152例病人，其中539例接受5-HT3受體拮抗劑，413例接受安慰劑，200例接受其他止吐藥的產婦沒有包括在分析中。預防性使用5-HT3受體拮抗劑並沒有比安慰劑減少瘙癢的發生率(80.7%比85.8%, RR [95% CI] = 0.94
[0.81–1.09])。然而，它們的使用減少了劇烈瘙癢的發生率及其需要治療的概率（需要治療的病例數分別為12和15）。他們的使用對於頑固性瘙癢的治療效力比安慰劑要高，其需要治療的病例數為3。使用5-HT3受體拮抗劑組較安慰劑組術後噁心(22.0%比33.6%, RR [95% CI] =
0.75[0.58–0.96])和嘔吐的發生率(7.7%比16.8%, RR [95% CI] = 0.49
[0.30–0.81])顯著降低，術後需要止吐治療的概率也顯著降低(9%比23%, RR [95% CI] = 0.38 [0.21–0.68])。
結論：雖然在剖宮產使用鞘內嗎啡的產婦中，預防性使用5-HT3受體拮抗劑並不能有效地減少瘙癢的發生率，但是它們可以顯著降低瘙癢的嚴重性及其需要治療的概率，也可以減少術後噁心嘔吐的發生率及需要止吐治療的概率。它們對於頑固性瘙癢也有有效的治療作用。雖然仍需要進行更多的研究，但是現有的資料表明，對於剖宮產使用鞘內嗎啡的產婦來說，應該考慮常規預防性使用這些藥物。
（黃佳佳譯，馬皓琳
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.
發育中大鼠腦的器官型海馬腦片模型中氧和葡萄糖缺失：對N-甲基-d-天門冬氨酸亞單位組成的影響
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：器官型海馬腦片（OHS）常用于小兒腦損傷相關藥物的神經保護效應的篩選。供體新生大鼠的日齡的重要性和N-甲基-d-天門冬氨酸（NMDA）受體亞單位組成尚未被闡明。本研究中，我們評估了氧-葡萄糖缺失（OGD）在發育中大鼠腦中的日齡依賴效應並判斷OGD是否調製NMDA受體亞單位的組成。
方法：分別製備出生後（PND）4、7、14和21天新生大鼠的OHS並在體外培養7天。腦片接觸OGD的時間為5-60 min。24和72 h之後，測定OHS的存活以及NMDA亞單位的組成。
結果：由PND14和21新生大鼠製備的OHS中細胞死亡明顯(P < 0.001)，OGD時間分別為5min和10min。由PND7新生大鼠製備的OHS中，OGD時間直至20 min才出現明顯的神經變性(P < 0.001)。在由PND4和PND7新生大鼠製備的OHS中，OGD接觸與NMDA受體亞單位組成從NR2B占主導向NR2A占主導的轉變相關。
結論：本次新生大鼠OHS的離體研究結果，支持OGD和神經細胞死亡之間存在日齡及NMDA受體亞單位組成依賴性的關係。
（黃施偉 譯，馬皓琳 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 NR2A predominant subunit composition.
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, Pellegrin Hospital, Bordeaux,
France.
Anesth Analg 2009;
109:240-244
背景：神經外科手術後的疼痛是一個有爭議的問題。這種疼痛為輕到中度，對其治療往往是不足夠的。手術部位進行局麻藥的浸潤麻醉對顱骨切開術後的疼痛是有短暫的幫助，但是對於慢性疼痛的治療還沒有進行過評估。因此我們設計了這個研究，來證實羅呱卡因頭皮浸潤麻醉能減輕顱內腫瘤切除術後急性和持續性疼痛的假設。
方法：這是一個前瞻性的、單盲研究。選擇標準為顱內腫瘤切除術患者，年齡18～80歲，有能力理解和使用視覺類比評價尺規（VAS）。排除標準為有顱骨切除手術史、長期吸毒和神經系統疾病。所有入選的患者隨機分成I組（浸潤組）和C組（對照組）。術後鎮痛為對乙酰氨基酚聯合納布啡靜脈注射。手術結束時，I組在手術部位用0.75％的羅呱卡因20ml進行浸潤麻醉。在第一個24小時每小時進行急性疼痛的VAS評估。羅呱卡因的鎮痛效果通過納布啡的用量和VAS的分數來評估。持續性疼痛的發生率和神經性疼痛在手術後2個月進行評估。我們用Student’s t檢驗比較納布啡的總用量，反復測量並分別用post hoc Bonferroni法t核對總和Fisher確切檢驗法對VAS分數和慢性及神經性疼痛進行方差分析。。
結果：共有52名患者入選，I組25名、C組27名。兩組人口統計學和手術中的資料相似。I組結果顯示在術後第一天對於減少納布啡的用量沒有顯著變化趨勢，11.2 ± 9.2 mg對C組16.6 ± 11.0 mg (平均值±標準差, P =
0.054)。VAS評分C組明顯較高。術後2個月，持續性疼痛在I組明顯較低，2/24 (8%)對14/25 (56%), P
= 0.0003。I組1名患者(4.1%)對C組6名患者(25%)(P = 0.04)出現有神經性疼痛。
結論：由於顱內腫瘤切除術的疼痛為中度，所以在術後急性期對於羅呱卡因的頭皮浸潤麻醉有限制的影響。儘管如此，這些浸潤麻醉對於限制延遲持續性疼痛尤其是神經性疼痛的作用可能有利於神經外科手術患者的康復以及他們的生活質量。
（唐亮 譯 馬皓琳 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, 25 in Group I and
27 in Group C. Demographic and intraoperative data were similar between
groups. Group I showed a nonsignificant trend toward reduced
nalbuphine consumption during the first postoperative day, 11.2
± 9.2 mg vs 16.6 ± 11.0 mg for Group C (mean ±
sd, P = 0.054). VAS scores were significantly higher in Group
C. Two months after surgery, persistent pain was significantly lower
in Group I, 2/24 (8%) vs 14/25 (56%), P = 0.0003. One patient
(4.1%) in Group I versus six (25%) patients in Group C (P =
0.04) experienced neuropathic pain.
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.
比較超聲和神經刺激儀引導肌間溝法臂叢神經阻滯用於肩關節門診手術後神經症狀的前瞻性隨機對照試驗
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, Weill
College of Medicine of Cornell University, New York.
Anesth Analg 2009;
109:265－271
背景：區域麻醉中超聲可視性能減少神經內注射和併發神經症狀的風險，但還未進行正式評估。因此，我們進行這個隨機臨床試驗來比較超聲和神經刺激儀引導的肌間溝法臂叢神經阻滯用於肩關節鏡檢查來判斷超聲是否能減少術後神經症狀的發生率。
方法：230例患者隨機分為兩組施行標準化肌間溝法臂叢阻滯（超聲或神經刺激儀輔助下），使用5cm長的22g Stimuplex®絕緣針注射1.5%鹽酸甲呱卡因（含1:300,000腎上腺素及NaCO3 1 meq/10 mL）。在術前（用問卷和體檢）、術後約1周（用問卷）和術後4-6周（問卷和體檢）用一項神經學家設計的標準化神經學評價方法進行評價。術後神經症狀的診斷由一位不知阻滯方法的神經專家確定。
結果：對219例患者進行了評估。超聲的應用降低了阻滯操作時針穿過神經的數量（1比3, 中位數, P < 0.001），提高了5分鐘時評估的運動神經阻滯效果（P = 0.04），但未減少神經阻滯施行的時間（兩組均為5分鐘）。沒有患者因阻滯失敗改上全麻，而且兩組患者滿意度相似（神經刺激儀組96%，超聲組92%）。術後1周隨訪時和後期隨訪時的神經症狀的發生率相似，術後1周隨訪時神經刺激儀組為11%(95% CI 5%–17%)，超聲組為8% (95% CI 3%–13%)，後期隨訪時神經刺激儀組為7% (95% CI 3%–12%)，超聲組為6% (95% CI 2%–11%)。術後神經症狀的嚴重程度兩組相似，分級中位數為重度。症狀主要是感覺的，包括疼痛，麻刺或感覺異常。
結論：超聲減少肌間溝法臂叢阻滯操作時針穿過神經的數量，提高5分鐘時的運動神經阻滯效果。然而，我們並未觀察到在阻滯失敗、患者滿意度及術後神經症狀發生率和嚴重程度上有明顯差異。
（朱 慧譯 馬皓琳 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 5 cm, 22 g Stimuplex® insulated needle with
1.5% mepivacaine with 1:300,000 epinephrine and NaCO3 (1
meq/10 mL). A standardized neurological assessment tool
(questionnaire and physical examination) designed by a neurologist
was administered before surgery (both components), at approximately
1 wk after surgery (questionnaire), and at approximately 4–6
weeks after surgery (both components). Diagnosis of postoperative
neurological symptoms was determined by a neurologist blinded to
block technique.
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.
全血多極凝集測定儀是一種可靠的阿司匹林誘導的血小板功能障礙的床邊檢驗方法
Whole Blood Multiple Electrode Aggregometry Is a
Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction
Csilla Jámbor, MD*,
Christian F. Weber, MD, 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處方藥，除鎮痛和抗炎作用之外，還有潛在的抗血小板凝集作用。阿司匹林誘導的血小板功能障礙與不同的臨床條件有關，包括複雜的外科手術同時服用阿司匹林致出血風險高的患者。在這項研究中，作者評估了單次口服阿司匹林500mg後血小板的凝集功能。應用多極凝集測定儀(MEA)測定凝血功能，通過比較採集血液樣本的不同時間間隔的測試結果來確定這種方法在床邊檢驗的可用性。
方法：研究包括24名健康志願者。在基礎狀態時取血後所有志願者接受阿司匹林500mg。在應用阿司匹林後4,
24, 56, 80, 和 124 h 時采血。每個取血時點即刻或取血後30min、60min行凝血功能檢查。在用凝血酶受體啟動肽(TRAPtest,
32 µM)或花生四烯酸(ASPItest,
0.5 mM)刺激後檢測全血MEA。用Bonferroni 相關重複方差分析檢測時點間差異。通過計算變異係數確定不精確性。P < 0.05為統計學差異有意義。。
結果：攝入阿司匹林4h後血小板聚集的ASPItest明顯降低，攝入阿司匹林第二天，ASPItest恢復，但個體差異顯著。阿司匹林攝入五天後，ASPItest回到基礎值。TRAPtest無顯著差異。樣本測試時間並不影響TRAPtest或ASPItest值。ASPItest的變異係數為10 ％和TRAPtest的變異係數為7 ％。
結論：MEA
能可靠檢測阿司匹林對凝血功能的影響。值得注意的是所有健康志願者服用阿司匹林500mg後導致花生四烯酸致血小板凝集的作用完全逆轉。5天內隨著時間延長血小板聚集功能逐漸恢復但有個體差異。血液標本存放時間對ASPItest
或TRAPtest檢測無影響。測試均能床邊完成。本研究測試的可重複性在現代床邊分析儀要求的範圍內。
（劉世文 譯 陳傑 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, 0.5 mM). Repeated measurement analysis of variance with a Bonferroni correction for multiple comparisons was performed to detect differences between time points. Assay imprecision was determined by calculating the coefficient of variation. The level of statistical significance was set to P < 0.05.
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, Johns Hopkins University School of Medicine, Baltimore,
Maryland.
Anesth Analg 2009 109: 60-75.
1 ％ -3 ％的兒童受到阻塞性睡眠呼吸暫停綜合征（OSA）的影響。所有需要麻醉的外科手術和診斷性治療中常可碰見OSA的患兒。小兒，扁桃腺切除術是最常見的外科治療OSA的方法。因此，麻醉醫生的當務之急是熟悉OSA患兒潛在的麻醉併發症和術後相關問題。國家專業醫療協會認識並提出對於OSA患兒應加強圍手術期護理。2002年美國兒科學會發表兒科OSA臨床實踐的指南。指南指出麻醉併發症風險呈現上升趨勢，儘管未曾提及具體的麻醉事件。2006年，美國麻醉醫師學會出版了一本關於OSA病人圍術期管理的實踐指南，指出兒科相關的危險因數是肥胖，3歲以下兒童圍術期手術風險增加與扁桃體切除術有關。然而，1歲以下OSA兒童的圍術期管理則未在指南中提及。因此，關於圍術期OSA兒童的護理仍有許多問題。
在這篇綜述中作者復習了兒童OSA相關的文獻，探討了其病理生理及目前的治療方案，以及這些年幼及潛在高風險的患兒圍手術期處理方法。
（葉樂 譯 陳傑 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 American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA.
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.
妊娠早期異丙酚誘導和恢復麻醉的效應室濃度的預測
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, Paris,
France.
Anesth Analg 2009 109: 90-95.
背景：據稱由於孕酮的原因，妊娠降低了對催眠藥的要求。然而，妊娠和黃體酮對異丙酚的用量的影響未完全闡明。作者進行這項研究，以確定麻醉誘導使意識喪失時異丙酚的劑量和預測效應室的濃度，以及妊娠早期麻醉過程中麻醉藥用量是否減少。並驗證血孕酮是否與異丙酚劑量和效應室濃度在意識喪失方面相關。
方法： 57例ASA I-II級的婦女選擇終止妊娠和55位婦女進行陰道穿刺卵母細胞體外受精。用1
％異丙酚以200ml/min？的速度麻醉誘導。誘導過程中記錄在意識喪失時異丙酚劑量和計算的效應室濃度（
Schnider模型）。另計算麻醉時患者能睜眼時的效應室濃度。手術後測定血孕酮濃度。
結果：與未孕對照組相比，懷孕組意識喪失時異丙酚平均（
± 1SD ）劑量較少(108.57
± 20.04 vs 117.59 ± 17.98 mg, respectively; P = 0.014) 。同樣，懷孕組所計算的異丙酚效應室濃度明顯低於對照組（分別為
4.59 ± 0.72與5.01 ± 0.64 μg / ml時， P=0.0014 ） 。這兩組在麻醉過程中能睜眼時的效應室濃度無差異。意識喪失時所觀察的血孕酮和異丙酚劑量或異丙酚效應室濃度的關係無顯著相關性。
結論：在妊娠早期意識喪失時異丙酚劑量和預測異丙酚效應室濃度減少。但不能用黃體酮濃度變化來解釋。
（張磊 譯 陳傑 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.
硫噴妥鈉抑制脂多糖誘導的組織因數的表達
Thiopental
Inhibits Lipopolysaccharide-Induced Tissue Factor Expression
Matthias Hartmann, Priv
Doz Dr med*, Semih Özlügedik, Dr med, and Juergen Peters, Prof Dr med*
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：在革蘭氏陰性菌引起敗血症時，脂多糖（
LPS ）刺激Toll樣受體4 ，從而啟動免疫系統，並在單核細胞上表達組織因數，進而可能發生血管內凝血，心肌缺血，多器官功能障礙。因為硫噴妥鈉已被證實具有調節免疫系統的作用，作者假設硫噴妥鈉能改變LPS誘導組織因數的表達。
方法： 1. 用硫噴妥鈉（ 0 ，0.25，0.5， 1mg/ml）和脂多糖（
100µg/mL）枸櫞酸化全血樣本4小時。再鈣化後，凝血時間（
CT ）是由ROTEM來測定。 2. LPS誘導縮短CT的機制通過使用組織因數受體阻滯劑活性位點抑制因數VIIA和蛋白質合成抑制劑放線菌酮來確定。3.
制定組織因數影響CT的濃度反應曲線。
結果：脂多糖縮短了CT，由618
± 122 s到192 ± 33秒（ n = 6; P < 0.05） 。CT的縮短通過組織因數的合成媒介，因為蛋白質合成抑制和組織因數的阻斷影響消除了LPS作用。硫噴妥鈉明顯抑制LPS誘導的CT縮短（372
± 86 s; n = 6; P < 0.001 ）
。通過CT與組織因數標準曲線比較後表明，硫噴妥鈉降低了LPS誘導組織因數活性達86
％ 。排除硫噴妥鈉對凝血的直接影響，因為組織因數誘導的CT沒有受到巴比妥酸鹽的影響。
結論：在全血樣本中硫噴妥鈉明顯抑制LPS誘導組織因數的表達。
（丁俊雲 譯 陳傑 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監護儀能估測混合靜脈血紅蛋白氧飽和度嗎？
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：作者假設，混合靜脈血紅蛋白氧飽和度（ SvO2 ）可通過無創心輸出量（NICO）監測以計算二氧化碳產生、心輸出量和動脈血氧飽和度來估測。
方法： 23名進行主動脈瘤修復的患者使用肺動脈導管監測SvO2和NICO監測心輸出量。通過NICO計算出的SvO2值與使用肺動脈導管實測的SvO2值進行比較。這一估測的準確性由Bland-Altman方法進行分析。另利用相關分析評估SvO2估測值和SvO2值的變化。
結果： SvO2估測值與實測值的偏倚及範圍-2.1 ％
± 11.2 ％
。SvO2估測值與實測值的變化相關。
結論：來自NICO的SvO2估測值不能與肺動脈導管的實測值互換使用。還需更完善的方法以便獲得更可靠的SvO2值。然而，在未作中心靜脈導管插管時，SvO2值變化較大時這方法可用來作為氧供需失衡而的預警信號。
（舒慧剛 譯 陳傑 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*, Matthias Lubnow, MD, Michael Gruber, PhD*, Christoph Selig,
MD, 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：酸吸入是一個可能在全身麻醉發生的嚴重併發症。
Studies show that β-agonists
have beneficial effects on lung injury.研究表明， β －激動劑對於肺損傷有有益的影響。
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，作者測試了霧化吸入β
-受體激動劑非諾特羅對酸誘導肺損傷齧鼠動物模式肺變數的影響。
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：在這項前瞻性，隨機，對照研究中，作者評估了吸入非諾特羅對於酸誘導肺損傷大鼠模型的肺氧合、炎症、以及肺組織的影響。 Sprague-Dawley rats underwent sevoflurane anesthesia with tracheotomy and carotid catheter insertion.七氟醚麻醉的Sprague - Dawley大鼠進行了氣管切開術和置入頸內動脈導管。 Lung injury was induced by instillation of 0.4 mL/kg 0.1 M hydrochloric acid.通過滴注0.4ml/kg 0.1M的鹽酸誘導肺損傷。The lungs were ventilated for 6 h and randomized to receive either fenoterol inhalation 10 µg or saline inhalation, both at 15 and 180 min after acid aspiration.肺進行6 h的通氣後，吸入酸15min和180 min後隨機吸入10ug非諾特羅或吸入生理鹽水。記錄Mean arterial blood pressures and peak airway pressures were documented, arterial blood gases were determined at 30, 90, 180, 270, and 360 min, and postmortem histology was subsequently examined.平均動脈壓力和氣道峰壓力，測定30、90、180、 270以及360min