阿片类镇痛药体外对精子运动的影响

目的:观察阿片类镇痛药体外对人精子运动功能的影响。方法:试验选取20例精子活力正常的精液标本,每例精液均一式19份,1份为对照,余分别与3种浓度下的6种不同阿片类镇痛药于37℃温箱孵育4 h,分别于15 min(t1)、2 h(t2)、4 h(t3)3个时间点用计算机辅助精液分析系统(CASA)分析精子活力。结果:①1×10-5、2×10-3、0.05 mg/ml芬太尼作用的精子,其3个时间点的(a+b)级精子百分率与对照组相比均显著降低(P<0.05);②1×10-5、2×10-3、0.05 mg/ml阿芬太尼作用的精子,其3个时间点的(a+b)级精子百分率与对照组相比均显著降低(P<0.05);③1×10-5、2×10-3、0.05 mg/ml舒芬太尼作用的精子,其3个时间点的(a+b)级精子百分率与对照组相比均显著降低(P<0.05);④1×10-5 mg/ml布托啡诺作用的精子,其3个时间点的(a+b)级精子百分率与对照组相比均无显著变化(P>0.05),2×10-3、0.05 mg/ml布托啡诺3个时间点的(a+b)级精子百分率与对照组相比均显著降低(P<0.05);⑤1×10-5 mg/ml地佐辛作用的精子,其3个时间点的(a+b)级精子百分率与对照组相比均无显著变化(P>0.05),0.05、0.5 mg/ml地佐辛3个时间点的(a+b)级精子百分率与对照组相比均显著降低(P<0.05);⑥3×10-5、0.05 mg/ml喷他佐辛处理精子,其3个时间点的(a+b)级精子百分率与对照组相比均无显著变化(P>0.05),而0.5 mg/ml喷他佐辛3个时间点的(a+b)级精子百分率与对照组相比均显著增加(P<0.05);⑦0.05 mg/ml布托啡诺作用精子15 min可产生精子活力完全抑制(制动效应),以及2×10-3mg/ml布托啡诺作用精子2 h,0.05、0.5 mg/ml地佐辛作用精子2 h时均产生制动效应;而芬太尼、阿芬太尼、舒芬太尼在0.05 mg/ml作用精子并未发现此效应。⑧0.05 mg/ml舒芬太尼、布托啡诺、地佐辛、芬太尼、阿芬太尼作用精子15 min活力衰减程度:舒芬太尼、布托啡诺、地佐辛与阿芬太尼相比均有显著性的差异(P<0.05),芬太尼与阿芬太尼相比无显著性差别(P>0.05)。结论:不同阿片受体镇痛药在相同作用时间内,低浓度布托啡诺、地佐辛对精子运动无影响,高浓度呈现完全抑制精子活力,而相同低浓度芬太尼、阿芬太尼、舒芬太尼均显著抑制精子活力,所测相同浓度范围内仅部分抑制精子活力。与此相反,高浓度喷他佐辛可促进精子运动。     

精液留取后不同时间分析对精子运动参数的影响

目的:探讨精液留取后不同时间进行计算机辅助精液分析系统(CASA)分析对精子运动参数的影响。方法:选择92例精液标本,精子密度均大于20×106/ml,液化时间均小于20min。精液留取后置37℃孵箱,在20、30、60、90min时,采用CASA进行精液参数分析。结果:30、60、90min时a级精子百分率、b级精子百分率分别显著低于20min时的a级精子百分率、b级精子百分率(P<0.05)。60min、90min时c级精子百分率分别显著低于20min、30min时的c级精子百分率(P<0.05)。c级精子百分率在20min和30min时无明显差异(P>0.05)。30、60、90min时(a+b)级精子百分率、(a+b+c)级精子百分率则均显著低于20min时(a+b)级精子百分率、(a+b+c)级精子百分率(P<0.05)。鞭打频率(BCF)在30min时则显著高于20min(P<0.05)。90min时侧摆幅度(ALH)与30min时相比显著降低(P<0.05)。90min时摆动性(WOB)与20、30min时比显著增高(P<0.05)。90min时曲线速度(VCL)显著低于20、30min时的曲线速度(P<0.05)。30、60、90min时的前向性(STR)与20min相比显著降低(P<0.05)。9min时的平均路径速度(VAP)、直线速度(VSL)分别均显著低于20min时的平均路径速度、直线速度(P<0.05)。精子密度、平均移动角度(MAD)、直线性(LIN)在4个不同时间点分析时均无显著性差异(P>0.05)。结论:精液常规分析中精液留取后至分析的时间需要标准化,对正常液化标本,精子留取后30～60min精子运动参数分析相对恒定。     

精液常规参数初检合格后不同时间点再分析结果及其与精子DNA损伤的关系

目的:探讨完全液化且常规参数初检合格的精液标本,于不同时间再分析的结果差异,及精子DNA碎片化指数(DFI)与精子活动力改变的相关性。方法:选取127份符合纳入标准的精液标本,分别于取样后15、30、60 min时采用计算机辅助精液分析(CASA)系统进行分析。精子形态分析采用Shorr染色法,吖啶橙试验(AOT)检测DFI。结果:3个时间点精子浓度、a级和b级精子百分率均无统计学差异(P>0.05)。取样15 min时a+b和a+b+c级精子百分率显著高于30和60 min时的结果(P<0.05),后两者间无统计学差异(P>0.05)。不同时间精子活动力各项指标中,至少有1项由"正常组"变为"异常组"的发生率为25.2%,两组间DFI和形态学无统计学差异(P>0.05)。取样后15到60 min变化的精子活动力指标中,a、a+b、a+b+c级下降值与DFI存在正相关性(P<0.05)。结论:取样后15 min内完全液化并初查参数合格的精液标本,30～60 min内复查时,a级和b级精子百分率波动并无显著差异,而a+b级及a+b+c级精子则可能显著下降,精子活动力指标可能出现异常。故应至少进行2次精液分析,综合评估生育力。如2次结果差异较大,尤其是a级精子百分率下降幅度较大,则可能与精子DNA损伤有关,需进一步行精子DNA损伤检测。     

“益精方”对小鼠精子尾部特异性钙通道CatSper1的影响

目的:观察"益精方"对环磷酰胺所致少弱精子症模型小鼠精子尾部特异性钙通道CatSper1的影响。方法:将40只雄性昆明小鼠随机分为对照组(CG)、模型组(MG)、小剂量中药治疗组(SG)和大剂量中药治疗组(LG),按60mg/kg体重给CG小鼠腹腔注射生理盐水(NS),给MG、SG、LG小鼠腹腔注射环磷酰胺,每天1次,连续5d,第6d开始按体重分别给SG和LG小鼠灌服"益精方",剂量分别为人类常规用量(以60kg为标准)的1倍和5倍,MG小鼠给予等体积的NS灌胃,每天1次,连续34d,CG常规饲养,然后对小鼠进行精液常规分析,并用RT-PCR法检测小鼠精子CatSper1的表达。结果:CG、MG、SG和LG组小鼠附睾精子密度分别为(5.20±1.34)、(1.73±0.03)、(2.08±0.01)、(3.31±0.56)×106/ml,a+b级精子百分率分别为(14.49±0.30)%、(6.64±1.88)%、(11.99±1.01)%、(19.40±3.13)%,a+b+c级精子百分率分别为(68.39±15.13)%、(39.96±4.89)%、(62.28±4.43)%、(73.61±5.05)%,MG组精子密度、a+b级精子百分率、a+b+c级精子百分率显著低于CG组(P<0.05),经治疗后LG组精子密度、a+b级精子百分率、a+b+c级精子百分率明显增加,与MG组比较有显著性差异(P<0.05),而与CG组在a+b级精子百分率和a+b+c级精子百分率上没有明显区别。CatSper1的表达量在CG、MG、SG和LG组分别为0.76±0.05、0.73±0.03、0.75±0.12、0.85±0.04,LG组显著高于MG组(P<0.05),而与CG组比较没有明显区别。结论:腹腔注射环磷酰胺可使小鼠精子密度、a+b级精子百分率、a+b+c级精子百分率降低,CatSper1表达量下降,大剂量"益精方"可以通过提高CatSper1的表达量,增加小鼠精子密度、a+b级和a+b+c级精子百分率,从而达到治疗少弱精子症的目的。     

苏州地区2640例男性不育症患者精液质量分析

目的:研究苏州地区男性不育症患者精液质量状况。方法:采用计算机辅助精液分析技术,检测2 640例以不育为主诉的男性精液标本的质量。结果:2 640份精液标本中,各项指标均正常的精液占27.35%;a+b级精子百分率异常者占47.35%(1 250/2 640);精子活动率异常者占42.39%(1 119/2 640)。精子活动率和a+b级精子百分率随患者年龄增加呈降低趋势,尤以40岁以上男性降低更为明显。弱精子症和少精子症发病率分别为37.31%(985/2 640)和8.94%(236/2 640),且30岁以上不育男性随年龄增加有增高趋势。随着精子活动率和精子浓度的下降,精子的9项运动参数VCL、VSL、VAP、MAD、LIN、STR、WOB、ALH、BCF明显降低。结论:苏州地区不育男性主要表现为精子活动率降低,尤其是a+b级精子百分率的降低。由于精子活动率、活力以及少精子症和弱精子症的发病率均与年龄有关,提示男性亦有合适的生育年龄。     

18～35岁男性军人精液质量调查

目的:了解部队男性官兵精液质量现况。方法:采用手工方法与计算机辅助精液分析对某部1054例基层官兵进行了精液参数10项分析,并根据年龄分为18～20岁,21～25岁,26～30岁和31～35岁4组,分析并比较各组精液参数。结果:1054例青壮年男性精液量为(2.6±1.4)ml、精子密度为(55.9±46.5)×106/ml、a+b级精子(47.1±19.0)%、精子存活率为(70.6±22.1)%、正常形态精子率为(84.7±10.2)%、顶体完整率为(86.1±7.2)%。18～20岁组精液量少、粘度大、pH值偏碱性,与其他3组相比,差异有显著性(P<0.05)。精液质量指标符合WHO标准的百分率为精液量73.5%、液化时间91.1%、pH值93.0%、a+b级精子45.5%、精子存活率86.7%、精子密度80.4%、正常形态精子率为98.2%、精子总数为78.0%,上述各项指标都符合WHO标准的对象仅占40.2%。结论:18～35岁部队基层官兵男性精液质量现况好于国内同类文献报道。在不同年龄分组研究中26～30岁年龄组人员精液质量好于其他年龄组。     

颐和春胶囊对少弱精子症治疗效果的临床观察

目的:观察颐和春胶囊对少弱精子症患者的治疗效果。方法:选取因少弱精子症而导致不育的181例患者,随机分为治疗组93例(其中少精子症者42例,弱精子症者20例,少弱精子症者31例)给予颐和春胶囊(4粒/d,2次/d)联合左卡尼汀口服液(2～3 g/d,早、晚2次或早、中、晚3次用餐时口服);对照组88例(其中少精子症者39例,弱精子症者22例,少弱精子症者27例)仅使用左卡尼丁口服液,用法与治疗组相同。治疗3个月后,对比两组的精子浓度、a级精子百分率、(a+b)级精子百分率以及配偶妊娠率。结果:181例患者中,治疗组有5例,对照组有2例因未遵医嘱规律服药而计入脱落病例。治疗前,两组患者的精子浓度、a级精子百分率及(a+b)级精子百分率的差异均无统计学意义(P>0.05);治疗后两组各亚组精子浓度和活力均比治疗前显著增加(P<0.05)。治疗后,治疗组与对照组比较,少精子症者精子浓度[(21.07±6.98)×10~6/ml vs(16.56±1.82)×10~6/ml]、a级精子百分率[(27.53±3.34)%vs(26.88±1.35)%]、(a+b)级精子百分率[(53.32±3.16)%vs(52.63±2.48)%],弱精子症者精子浓度[(26.36±3.37)×10~6/ml vs(24.42±2.21)×10~6/ml]、a级精子百分率[(25.28±4.64)%vs(21.32±3.28)%]、(a+b)级精子百分率[(49.19±2.87)%vs(45.64±1.78)%],少弱精子者精子浓度[(19.38±3.39)×10~6/ml vs(18.75±1.35)×10~6/ml]、a级精子百分率[(22.65±4.81)%vs(21.31±2.42)%]、(a+b)级精子百分率[(48.74±5.61)%vs(44.36±1.32)%]均增加更显著(P<0.05)。治疗组患者配偶的妊娠率为36.4%(32/88),显著高于对照组[15.1%(13/86)],P<0.01]。结论:颐和春胶囊联合左卡尼丁口服液治疗少弱精子症效果明显。     

男性不育患者精液质量与精子顶体酶活性关系分析

目的:分析男性不育患者精液参数与精子顶体酶活性变化,探讨精液质量与顶体酶活性的关系。方法:对214例男性不育患者的精液作精子顶体酶活性、弹性蛋白酶、果糖、α葡糖苷酶、锌、酸性磷酸酶、精子尾部低渗肿胀试验检测,同时精子质量检测仪作精液分析。以检出精子顶体酶活性正常的(48.2~218.7μIU/106精子)111例作为对照组,与顶体酶活性异常(<48.2μIU/106精子)的103例精液参数作对比分析。结果:两组精液参数的精子密度、精子活动率、a+b级精子百分率、精子尾部低渗肿胀试验差异均有非常显著性(P<0.001)。弹性蛋白酶差异有显著性(P<0.05)。果糖、α葡糖苷酶差异亦有显著性(P<0.05)。精液量、锌、酸性磷酸酶差异无显著性(P>0.05)。结论:精子顶体酶活性与精液质量关系密切,精子顶体酶活性是反映精液质量的一项可靠指标。     

老年和成年患者依托咪酯诱导时雷米芬太尼抑制气管插管反应的半数有效血浆浓度

目的测定老年和成年患者依托咪酯诱导时雷米芬太尼抑制气管插管反应的半数有效血浆浓度(Cp50)。方法择期全麻手术患者40例,ASAⅠ或Ⅱ级,年龄19~80岁,体重指数20~30kg/m2,按年龄分为青壮年组(19~64岁)和老年组(65~80岁),每组20例。雷米芬太尼靶控输注5min后,静脉注射0.3mg/kg的依托咪酯,患者意识消失后给予罗库溴铵行气管插管。雷米芬太尼的血浆靶浓度按序贯法确定,相邻血浆靶浓度之间的比率为1.2。结果0.3mg/kg依托咪酯诱导时,老年组和青壮年组雷米芬太尼抑制气管插管的Cp50分别为4.11μg/L和3.37μg/L,95%可信区间分别为3.90~4.34μg/L和3.02~3.75μg/L。结论老年和青壮年患者在复合0.3mg/kg的依托咪酯行麻醉诱导时,雷米芬太尼抑制气管插管反应的Cp50分别为4.11g/L和3.37μg/L。     

复方玄驹胶囊联合枸橼酸他莫昔芬治疗少弱精子症男性不育患者的临床疗效观察

目的探讨复方玄驹胶囊联合枸橼酸他莫昔芬片治疗少弱精子症男性不育的临床疗效。方法选取2013年2月至11月在成都市妇女儿童中心医院生殖男科门诊就诊的102例少弱精子症男性不育患者,给予复方玄驹胶囊联合枸橼酸他莫昔芬片口服治疗12周后,以精液体积、精子总数、a级精子比例、(a+b)级精子比例以及正常精子百分率为指标进行评估,同时观察其中72例原发不育和30例继发不育患者治疗前后相应各项精液参数的变化情况。结果 91例患者完成本试验性治疗,包括64例原发不育患者和27例继发不育患者。91例患者治疗后精子总数、a级精子比例、(a+b)级精子比例都较治疗前有显著性提高,差异有统计学意义(P<0.01)。其中64例原发不育患者治疗前后精子总数、a级精子比例、(a+b)级精子比例也都较治疗前有显著性提高,差异亦有统计学意义(P<0.01),但27例继发不育患者治疗后只有(a+b)级精子比例有显著性提高,差异有统计学意义(P<0.05)。结论复方玄驹胶囊联合枸橼酸他莫昔芬片能够明显地改善少弱精子症男性不育患者的精液质量,尤其在提高精子活力方面效果显著。     

阿片受体、迷走神经和交感神经在瑞芬太尼诱发兔心血管抑制中的作用

目的 探讨阿片受体、迷走神经和交感神经在瑞芬太尼诱发兔心血管抑制中的作用.方法 健康新西兰白兔40只,雌雄不拘,2～6月龄,随机分为5组(n=8),R组静脉注射瑞芬太尼5.0μg/kg;N+R组静脉注射纳洛酮40μg/,2 min后静脉注射瑞芬太尼5.0μg/kg;V+R组切断颈部双侧迷走神经后,静脉注射瑞芬太尼5.0 μg/kg;S+R组行硬膜外穿刺,进行交感神经阻滞后,静脉注射瑞芬太尼5.0 μg/kg;V+S+R组切断颈部双侧迷走神经后,进行交感神经阻滞,然后静脉注射瑞芬太尼5.0μg/kg.于注射瑞芬太尼前1 min(T0)、注射后30 s(T1)、1 min(T2)、2 min(T3)、3 min(T4)、4 min(T5)、5 min(T6)、10 min(T7)、15 min(T8)、20 min(T9)时记录HR和MAP.结果 与T0时比较,各组T1时HR均减慢(P＜0.05);N+R组各时点MAP差异无统计学意义(P＞0.05),其余组T1-7时MAP均降低(P＜0.05);与R组比较,N+R组T1-7时MAP均升高(P＜0.05),其余组HR差异无统计学意义(P＞0.05).结论 瑞芬太尼减慢兔HR的机制与阿片受体、迷走神经和交感神经均无关;而其降低血压的机制与激活阿片受体有关.     

Anesthetic Potency of Remifentanil in Dogs

Background: Remifentanil is an opioid that is rapidly inactivated by esterases in blood and tissues. This study examined the anesthetic potency and efficacy of remifentanil in terms of its reduction of enflurane minimum alveolar concentration (MAC) in dogs.

Methods: Twenty-five dogs were anesthetized with enflurane. One group received incremental infusion rates of remifentanil from 0.055 to 5.5 micro gram *symbol* kg sup -1 *symbol* min sup -1. A second group received constant rate infusions of remifentanil of 1.0 micro gram *symbol* kg sup -1 *symbol* min sup -1 for 6-8 h. Enflurane MAC was measured before, hourly during remifentanil infusion, and at the end of the experiment after naloxone administration. A third group received alternating infusions of 0.5 and 1.0 micro gram *symbol* kg sup -1 *symbol* min sup -1 with MAC determinations made 30 min after each change in the infusion rate. Heart rate, mean arterial pressure, and remifentanil blood concentrations were measured during MAC determinations.

Results: Enflurane MAC was reduced up to a maximum of 63.0+/- 10.4% (mean+/-SD) in a dose-dependent manner by remifentanil infusion. The dose producing a 50% reduction in the enflurane MAC was calculated as 0.72 micro gram *symbol* kg sup -1 *symbol* min sup -1 and the corresponding blood concentration was calculated as 9.2 ng/ml. Enflurane MAC reduction remained stable during continuous, constant rate infusions for periods of 6-8 h without any signs of tolerance. Recovery of enflurane MAC to baseline occurred in 30 min (earliest measurement) after stopping the remifentanil infusion.     

High-dose remifentanil increases blood pressure and heart rate mediated by sympatho-activation in conscious rats

Purpose

The ultra-short-acting μ-opioid receptor agonist, remifentanil, is commonly used in clinical anesthesia; however, there are limited data about the hemodynamic effects of remifentanil itself without anesthetics. We investigated the effects of an ultra-short-acting μ-opioid receptor agonist, remifentanil, on cardiovascular and sympathetic function in conscious rats.

Methods

The mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) were recorded during continuous intravenous (i.v.) infusion of remifentanil at a moderate-dose (0.25 and 0.5 μg/kg/min) and a high-dose (1.0 and 2.0 μg/kg/min) in conscious intact and sino-aortic denervated (SAD) rats. Baroreflex sensitivity was examined during remifentanil administration. Rats were administered saline or naloxone to assess the involvement of the μ-opioid receptor in the remifentanil-induced responses.

Results

High-dose remifentanil induced biphasic changes in MAP and HR. Mediated by sympatho-activation, these parameters increased after briefly decreasing once. Subpressor-dose remifentanil enhanced baroreflex sensitivity. Changes in MAP, HR, and RSNA induced by remifentanil were inhibited by naloxone.

Conclusions

High-dose remifentanil decreases MAP and HR transiently and increases these parameters mediated by the activation of sympathetic nerve activity in conscious rats.     

Comparison of Remifentanil and Fentanyl in Patients Undergoing Craniotomy for Supratentorial Space-occupying Lesions

Background: Remifentanil hydrochloride is an ultra-short-acting, esterase-metabolized micro-opioid receptor agonist. This study compared the use of remifentanil or fentanyl during elective supratentorial craniotomy for space-occupying lesions.

Methods: Sixty-three adults gave written informed consent for this prospective, randomized, double-blind, multiple-center trial. Anesthesia was induced with thiopental, pancuronium, nitrous oxide/oxygen, and fentanyl (n = 32; 2 micro gram [center dot] kg [center dot] sup -1 min sup -1) or remifentanil (n = 31; 1 micro [center dot] kg sup -1 [center dot] min sup -1). After tracheal intubation, infusion rates were reduced to 0.03 micro gram [center dot] kg sup -1 [center dot] min sup -1 (fentanyl) or 0.2 micro gram [center dot] kg sup -1 [center dot] min sup -1 (remifentanil) and then adjusted to maintain anesthesia and stable hemodynamics. Isoflurane was given only after specified infusion rate increases had occurred. At the time of the first burr hole, intracranial pressure was measured in a subset of patients. At bone flap replacement either saline (fentanyl group) or remifentanil ([nearly equal] 0.2 micro gram [center dot] kg sup -1 [center dot] min sup -1) were infused until dressing completion. Hemodynamics and time to recovery were monitored for 60 min. Analgesic requirements and nausea and vomiting were observed for 24 h. Neurological examinations were performed before operation and on postoperative days 1 and 7.

Results: Induction hemodynamics were similar. Systolic blood pressure was greater in the patients receiving fentanyl after tracheal intubation (fentanyl = 127 +/- 18 mmHg; remifentanil = 113 +/- 18 mmHg; P = 0.004). Intracranial pressure (fentanyl = 14 +/- 13 mmHg; remifentanil = 13 +/- 10 mmHg) and cerebral perfusion pressure (fentanyl = 76 +/- 19 mmHg; remifentanil = 78 +/- 14 mmHg) were similar. Isoflurane use was greater in the patients who received fentanyl. Median time to tracheal extubation was similar (fentanyl = 4 min: range = -1 to 40 min; remifentanil = 5 min: range = 1 to 15 min). Seven patients receiving fentanyl and none receiving remifentanil required naloxone. Postoperative systolic blood pressure was greater (fentanyl = 134 +/- 16 mmHg; remifentanil = 147 +/- 15 mmHg; P = 0.001) and analgesics were required earlier in patients receiving remifentanil. Incidences of nausea and vomiting were similar.     

Enhancement of Spinal N-Methyl-d-aspartate Receptor Function by Remifentanil Action at [delta]-Opioid Receptors as a Mechanism for Acute Opioid-induced Hyperalgesia or Tolerance

Background: Intraoperative remifentanil infusions have been associated with postoperative opioid-induced hyperalgesia and tolerance. Using a previously identified subpopulation of spinal neurons that displays an augmentation in N-methyl-d-aspartate (NMDA) receptor current after chronic morphine, investigations were undertaken to determine whether remifentanil induces acute increases in NMDA responses that are concentration dependent and receptor subtype dependent.

Methods: Electrophysiologic recordings of NMDA current were made from cultured rat dorsal horn neurons treated with remifentanil at various concentrations for 60 min. Selective [mu]- or [delta]-opioid receptor inhibitors and agonists were used to determine the site of action of remifentanil.

Results: Remifentanil at 4, 6, and 8 nm, but not higher or lower concentrations, caused significant mean increases in NMDA peak current amplitude of 37.30% (P < 0.001), 30.19% (P < 0.001), and 23.52% (P = 0.025), respectively, over control conditions. This occurred by 36 min of remifentanil perfusion and persisted throughout its washout. Inhibition by 100 nm naloxone or 1 nm naltrindole attenuated the remifentanil-induced NMDA response increase. Selective [delta]-opioid agonists [D-Pen2, D-Pen5]enkephalin and deltorphin II displayed a similar bell-shaped concentration-response relation for the enhancement of NMDA responses, and 10 nm deltorphin II occluded the effects of 4 nm remifentanil on NMDA responses.     

Vasorelaxant effect of opioid analgesics on the isolated human radial artery

BACKGROUND AND OBJECTIVE: Arterial grafts are prone to vasospasm. Opioid analgesics are commonly used in the perioperative course of cardiac surgical procedures. Therefore, we investigated the direct effects of morphine, meperidine, fentanyl and remifentanil on the human radial artery. METHODS: Radial artery segments, obtained from 20 patients, were precontracted with phenylephrine. Using the organ bath technique, the endothelium-independent vasodilatation was tested in vitro by addition of cumulative concentrations of morphine, meperidine, fentanyl and remifentanil in separate organ baths, in the presence or absence of naloxone. Indomethacin and NG-nitro-L-arginine methyl ester was added to all organ bath in order to determine the effects of prostaglandins and nitric oxide, respectively. RESULTS: Morphine (10(-8) - 10(-4) mol L-1), meperidine (10(-10) - 10(-6) mol L-1), fentanyl (10(-10) - 10(-6) mol L-1) and remifentanil (10(-8) - 10(-4) mol L-1) caused a concentration-dependent vasorelaxation in the human being artery rings. The relaxations in the presence of naloxane did not change. The maximal relaxant effects of meperidine and fentanyl were significantly greater than those of morphine and remifentanil (P < 0.05). CONCLUSIONS: These findings indicate that morphine, meperidine, fentanyl and remifentanil produce concentration-dependent and endothelium-independent relaxations in human being radial artery rings. Meperidine and fentanyl are more potent relaxant agents than morphine and remifentanil in the human being radial artery in vitro.     

A Comparison of Remifentanil and Morphine Sulfate for Acute Postoperative Analgesia after Total Intravenous Anesthesia with Remifentanil and Propofol

Background: The transition from remifentanil intraoperative anesthesia to postoperative analgesia must be planned carefully due to the short duration of action (3-10 min) of remifentanil hydrochloride, a potent, esterase-metabolized micro-opioid agonist. This study compared the efficacy and safety of transition regimens using remifentanil or morphine sulfate for immediate postoperative pain relief in patients who had surgery under general anesthesia with remifentanil/propofol.

Methods: One hundred fifty patients who had received open-label remifentanil and propofol for intraoperative anesthesia participated in this multicenter, double-blind, double-dummy study and were randomly assigned to either the remifentanil (R) group or the morphine sulfate (M) group. Twenty minutes before the anticipated end of surgery, the propofol infusion was decreased by 50%, and patients received either a placebo bolus (R group) or a bolus of 0.15 mg/kg morphine (M group). At the end of surgery, the propofol and remifentanil maintenance infusions were discontinued and the analgesic infusion was started: either 0.1 micro gram [center dot] kg sup -1 [center dot] min sup -1 remifentanil (R group) or placebo analgesic infusion (M group). During the 25 min after tracheal extubation, remifentanil titrations in increments of 0.025 micro gram [center dot] kg sup -1 [center dot] min sup -1 and placebo boluses (R group), or 2 mg intravenous morphine boluses and placebo rate increases (M group) were administered as necessary at 5-min intervals to control pain. Patients received the 0.075 mg/kg intravenous morphine bolus (R group) or placebo (M group) at 25 and 30 min after extubation, and the analgesic infusion was discontinued at 35 min. From 35 to 65 minutes after extubation, both groups received 2-6 mg open-label morphine analgesia every 5 min as needed.

Results: Successful analgesia, defined as no or mild pain with adequate respiration (respiratory rate [RR] >or= to 8 breaths/min and pulse oximetry >or= to 90%), was achieved in more patients in the R group than in the M group (58% vs. 33%, respectively) at 25 min after extubation (P < 0.05). The median remifentanil rate for successful analgesia was 0.125 micro gram [center dot] kg sup -1 [center dot] min sup -1 (range, 0.05-0.23 micro gram [center dot] kg sup -1 [center dot] min sup -1), and the median number of 2-mg morphine boluses used was 2 (range, 0-5 boluses). At 35 min after extubation, >or= to 74% of patients in both groups experienced moderate to severe pain. Median recovery times from the end of surgery were similar between groups. Transient respiratory depression, apnea, or both were the most frequent adverse events (14% for the R group vs. 6% for the M group; P > 0.05).     

A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function

We compared the recovery profile and postoperative SpO(2) after the administration of general anesthesia with either sevoflurane-remifentanil or sevoflurane-sufentanil in 30 healthy patients undergoing upper abdominal surgery. They were randomly allocated to receive general anesthesia with sevoflurane and small doses of either remifentanil (n = 15) or sufentanil (n = 15), followed by postoperative epidural analgesia. The median sevoflurane minimum alveolar anesthetic concentration-hour was 2.3 (1.2-6.3) in group Remifentanil and 2.6 (1.4-5.2) in group Sufentanil (P: = 0.39), while the median consumption of remifentanil was 1.3 mg (0.7-3.4 mg) and sufentanil 0.09 mg (0.05-0.6 mg). Tracheal extubation required 10 min (6-18 min) with remifentanil and 14 min (8-24 min) with sufentanil (P: = 0.05); however, no differences in time to discharge from the recovery area were reported (24 min [12-75 min] with remifentanil and 30 min [12-135 min] with sufentanil; P: = 0. 35). From the first to seventh hour after surgery, SpO(2) was decreased more in the sufentanil than in the remifentanil group (P: = 0.001), and seven patients in the sufentanil group showed at least one episode with SpO(2) < or = 90% for more than 1 min (P: = 0.006) (median: 1 episode; range: 0-17 episodes; P: = 0.003). When added to sevoflurane, remifentanil is as effective as sufentanil during the intraoperative period, but provides shorter time to tracheal extubation and fewer effects on postoperative SpO(2) in the first 7 h after surgery. Implications: In this double-blinded study, we evaluated the effects of adding small infusions of either remifentanil or sufentanil to sevoflurane in combination with postoperative epidural analgesia for upper abdominal surgery. We demonstrated that remifentanil is as effective as sufentanil during the intraoperative period, but that it provides shorter time to extubation and fewer effects on postoperative SpO(2) in the first 7 h after surgery.     

刺五加水提物体外对弱精子症患者精子运动参数的影响

目的:研究不同浓度的刺五加水提物体外对弱精子症患者精子运动的影响,探讨其可能的作用机制。方法:将35例弱精子症患者经手淫法获得并通过上游优化处理的精子,与不同浓度刺五加水提物共同孵育30、60、120、180 m in后,应用计算机辅助精子分析系统(CASA)观察不同浓度(2.5、5、10、20 g/L)刺五加水提物对人精子各运动参数的作用。结果:不同浓度刺五加水提物能明显提高弱精子症患者精子的运动能力,在浓度为5 g/L和10 g/L时,精子活率(MOT)、前向运动精子百分率、曲线运动速度(VCL)、直线运动速度(VSL)和平均路径速度(VAP)与空白对照组相比,差异均有显著性(P<0.05)。结论:刺五加水提物在体外能明显改善弱精子症患者精子运动能力,其最佳浓度为10 g/L。     

General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma

PURPOSE: To describe the anesthetic management of a parturient with a large acoustic neuroma undergoing general anesthesia with remifentanil for Cesarean section. CLINICAL FEATURES: A near-term parturient presented with a large intracranial mass. Cesarean section under general anesthesia was elected one week prior to craniotomy for tumour resection. Remifentanil infusion, 0.2-1.0 microg x kg(-1) x min(-1), was used from induction to emergence of general anesthesia. The neonate was born seven minutes after the remifentanil infusion was started. She had normal umbilical cord pH and her Apgar scores were 7 and 8, at one and five minutes respectively. Although the neonate received supplemental oxygen, she did not require naloxone. Both mother and neonate made an uneventful recovery. CONCLUSION: Remifentanil was effective in producing stable hemodynamic conditions, without severe neonatal respiratory depression, during induction and maintenance of general anesthesia for a Cesarean delivery in a parturient with a large intracranial tumour.