利多卡因混合芬太尼—潘库溴铵用于静脉局部麻醉

目的：了解利多卡因混合芬太尼－潘库溴铵静脉局部麻醉能否降低利多卡因的剂量。方法：80例前臂和手部手术患者（ASAⅠ-Ⅱ级）分成二组,用0．6ml/kg的0．25％利多卡因（1．5mg/kg)混合1ug/kg芬太尼－0．5mg潘库溴铵或者0．5％利多卡因（3mg/kg)进行静脉局部麻醉。每5min1次,测量感觉和运动神经阻滞时间至手术开始,手术结束,松开止血带后,每5min1次,测量感觉和运动神经恢复时间;记录术后镇痛时间,结果：两组患者均取得满意的麻醉效果,两组间感觉和运动阻滞起效有明显差异,A组明显快于B组（P＜0．05）,松开止血带后,感觉和运动恢复时间,两组相比无明显差异（P＞0．05）,术后镇痛时间,两组间亦无明显差异（P＞0．05）,结论：25％利多卡因混合芬太尼－劣库溴铵具有0．5％利多卡因相同的静脉局部麻醉效果,可减少局麻药剂量和潜在系统毒性。     

人工流产术前宫颈及子宫内膜麻醉的镇痛效果探讨

目的　探讨宫颈与子宫内膜两部位联合麻醉、普鲁卡因与利多卡因两药物配合应用在人工流产术中的镇痛效果。方法　人工流产术前对麻醉组 10 6例行普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉。术中记录受术者腹痛程度、无阻力插入宫颈内口的扩张器号、出血量、人流综合征例数等指标。按照世界卫生组织规定疼痛标准及人工流产综合征反应进行评价 ,同期选择按传统机械扩宫法 10 4例做对照。结果　麻醉组镇痛有效率95 3% ,宫口松驰有效率 95 3% ,人流综合征无 1例发生。两组比较P均 <0 0 0 1。两组出血量比较无差异 ,无利多卡因毒性反应发生。结论　人工流产术前普鲁卡因宫颈浸润麻醉和利多卡因子宫内膜表面麻醉镇痛效果显著 ,可大大降低人流综合征的发生 ,避免利多卡因的毒性反应     

依托咪酯联合丙泊酚麻醉在老年患者无痛胃肠镜检查中的应用效果观察

为观察依托咪酯、丙泊酚药物联合应用在老年患者无痛胃肠镜检查中的麻醉效果,将我院行无痛胃肠镜检查的老年患者600例分为观察组324例和对照组276例。对照组患者给予丙泊酚药物进行麻醉,观察组患者给予依托咪酯、丙泊酚药物联合麻醉,比较2组患者麻醉效果、认知功能以及不良反应发生情况。结果显示,观察组患者苏醒时间、检查时间、定向力恢复时间、麻醉诱导时间均短于对照组(P <0.05),观察组患者认知功能显著高于对照组(P <0.05),观察组患者不良反应发生率低于对照组(P <0.05)。结果表明,老年患者无痛胃肠镜检查中应用依托咪酯、丙泊酚药物联合麻醉效果显著,可提高患者术后认知功能,降低患者术后不良反应发生率。     

局部浸润麻醉应用于拇外翻术后镇痛的可行性研究

目的：探讨罗哌卡因联合复方倍他米松局部浸润麻醉在拇外翻术后镇痛中的临床疗效及不良反应。方法：自2019年9月至2020年12月手术治疗拇外翻患者48例,根据术后不同镇痛方式分为联合局部浸润组和静脉镇痛泵组。联合局部浸润组24例,男2例,女22例;年龄21~78（58.3±7.7）岁;行软组织松解加Chevron截骨15例,行跖趾关节融合9例;术后即刻应用罗哌卡因联合复方倍他米松混合稀释液20 ml局部浸润麻醉1次。镇痛静脉镇痛泵组24例,男3例,女21例;年龄23~81（56.8±8.3）岁;行软组织松解加Chevron截骨17例,跖趾关节融合7例;术后即刻静脉镇痛泵进行镇痛,设置基础流量为2 ml/h,自控剂量为0.5 ml,锁定时间15 min。记录患者术后12、24、48、72 h疼痛视觉模拟评分（visual analogue scale,VAS）,同时记录术后24 h换药时VAS,记录术后0~12 h、12~24 h、24~48 h药品不良反应发生情况,并记录拆线后刀口愈合情况。结果：所有患者获得随访,时间14~17（14.60±0.92） d。术后联合局部浸润组与静脉镇痛泵组12、24、48 h VAS比较差异有统计学意义（P<0.05）。术后两组72 h VAS比较差异无统计学意义（P>0.05）。两组术后0~12 h发生药品不良反应例数比较差异无统计学意义（P>0.05）;术后12~24 h发生药品不良反应例数比较差异有统计学意义（P<0.05）;术后24~48 h两组均未发生麻醉药品不良反应。拆线后两组刀口愈合等级比较差异无统计学意义（P>0.05）。结论：与静脉镇痛泵镇痛相比,罗哌卡因联合复方倍他米松的局部浸润麻醉在不增加麻醉药品不良反应的情况下,可显著降低患者拇外翻术后伤口疼痛,且不增加刀口感染风险。     

The response to ether anesthesia and to electric stimulation of glycolytic metabolites in a red and a white muscle of the rat

Summary Since ether anesthesia lowered ATP by 25% in red, but not in white muscle, and only when the spinal neurones were intact, we suggested that small or intermediate muscle units were activated under ether anesthesia [8].In order to prove this postulate, some glycolytic metabolites, known to rise under muscular activation, are studied in the white musculus adductor magnus and in the red musculus pyramidalis of the rat: glucose-1-phosphate, glucose-6-phosphate, fructose-6-phosphate, fructose-1-6-diphosphate, -glycerophosphate, lactate, pyruvate, and dihydroxyacetone phosphate.The conditions compared are: Inactin (5-ethyl-5(methyl-propyl)-2-thiobarbituric acid)-anesthesia, diethyl ether anesthesia, and tetanic contraction under Inactin anesthesia.The histological assay with Sudan-black B staining shows 34.2±7.3% dark fibers in m. pyramidalis and 0.2±4.8% dark fibers in m. adductor magnus.Glucose-1-phosphate, fructose-1-6-diphosphate, and -glycerophosphate are elevated under ether anesthesia in both muscles versus Inactin anesthesia by 100–200%.Lactate in both muscles and pyruvate in the red muscle are slightly elevated under ether (by 40%) versus Inactin anesthesia.Under tetanic contraction the metabolites studied rise considerably in both muscles.As glycogen is lowered in rat muscle under ether [9], the present results suggest an activation of glycogen phosphorylase and of phosphofructokinase in both the red and the white muscle under ether anesthesia, which results in augmented glycolysis.The comparatively small increment of pyruvate and lactate in the presence of a high increment of -glycerophosphate under ether anesthesia is considered to indicate an asynchronous activation of fibers with unimpaired circulation and oxidative metabolism.     

原位肝移植术的麻醉管理

目的：研究原位肝移植术病人围手术期的麻醉管理。方法：对45例原位肝移植术病人,在围手术期采用全身麻醉或全身麻醉复合硬膜外阻滞;术中加强监测血液动力学、出血量、呼吸功能、血气、生化、凝血功能、体温、尿量及血糖;无肝期采用体外静脉转流。根据成人原位肝移植术无肝前期、无肝期、新肝期的特点,给予相应的麻醉处理。结果：⑴1例因大量出血死亡。术中29例输血2000-4000ml,7例输血4000-6000ml,8例输血大于6000ml;⑵地我肝期应用体外静脉转流能使术中血液动力学趋于稳定;⑶本组病人除大出血外,手术各期无明显酸碱紊乱;⑷围术期电解质主要表现为低钙;⑸术中体温变化大;⑹凝血功能有一定程度紊乱,需补充凝血因子、适当使用止血药以及鱼精蛋白中和肝素;⑺围术期血糖偏高,新肝期血糖逐渐下降。结论：肝移植各期的麻醉管理和监测非常重要,无肝期采用体外静脉转流,有助于循环稳定、无明显酸中毒及高钾血症。     

Block of the N-methyl-d-aspartate receptor by phenycyclidine-like drugs is influenced by alternative splicing

N-methyl-d-aspartate (NMDA) receptors were expressed in Xenopus oocytes from injected mRNA. The presence of an alternatively-spliced insertion encoding 21 amino acids at the N-terminus of the NMDAR1 (NR1₁₁₁) subunit, made homomeric assemblies of the receptor more sensitive to ketamine and MK-801 than receptors assembled from NMDAR1 subunits lacking this insert (NR1₀₁₁ and NR1₀₀₁). The influence of this insert was maintained when NR1 subunits were co-expressed in heteromeric combinations with NR2B. The increased sensitivity of the receptors containing the insert (NR1₀₀₁) was accompanied by a faster on-rate for drug action than was observed for receptors lacking the insert (NR1₀₁₁ and NR1₀₀₁). Our results suggest that the action of phencyclidine-like drugs is influenced by the presence of Insertion I in the NMDA isoforms, generated by alternative splicing.     

A review of recovery from sevoflurane anaesthesia: comparisons with isoflurane and propofol including meta-analysis

BACKGROUND: Sevoflurane has a lower blood:gas partition coefficient than isoflurane and thus should be associated with a more rapid recovery from anaesthesia. METHODS: A review and meta-analysis were employed to examine the recovery profiles of adult patients following anaesthesia, comparing sevoflurane to isoflurane and sevoflurane to propofol. RESULTS: There were significant differences in times to several recovery events that favoured sevoflurane to isoflurane anaesthesia, including time to emergence, response to commands, extubation, and orientation. Likewise, there were significant differences in times to the same recovery events following anaesthesia with sevoflurane versus propofol. There were no differences in time to recovery room discharge when comparing sevoflurane to isoflurane or propofol. CONCLUSION: The observed differences between sevoflurane and isoflurane or propofol anaesthesia support the postulate that the use of sevoflurane is associated with a more rapid recovery from anaesthesia than either isoflurane or propofol.     

Ventricular fibrillation related to reversal of the neuromuscular blockade in a patient with long QT syndrome

The long QT syndrome (LQTS) is associated with syncopal attacks or even sudden death at a young age due to ventricular fibrillation. We report a patient with an undiagnosed LQTS who had an episode of cardiac arrest during the final part of general anesthesia, immediately after the drugs for reversal of the neuromuscular blockade were given. We suggest that the administration of glycopyrronium might have been the provoking factor in this patient.