长托宁用于全麻术前用药的效果观察

目的:观察长托宁作为全麻病人麻醉前用药对心血管系统和呼吸道分泌物的影响.方法:随机选择20例需全麻手术病人,在麻醉诱导前静注长托宁0.015 mg/kg,观察注药前、后5、10、20分钟各时点的血压、心率、脉搏氧饱和度及口干程度以及术中术毕口腔和呼吸道分泌物情况.结果:病人使用长托宁后5、10、20分钟的血压、心率与使用前相比有下降趋势,但无统计学意义(P＞0.05),脉搏氧饱和度未见明显改变,用药10分钟病人有轻度口干,术毕拔除气管导管时口腔及呼吸道分泌物较少.结论:长托宁用于全麻病人麻醉前给药效果满意.     

剖宫产孕妇硬膜外给局麻药的药代动力学

为了解孕妇硬膜外给局麻药的药代动力学，选择２０名实施剖宫产手术的健康临产妇，随机分成硬膜外腔给予了哌卡因组（Ｂ１组）和给予利多卡因组（Ｌ组）。另外， ６例非妊娠患者硬膜外腔给予了哌卡因（Ｂ２组）。Ｂ１和Ｂ２组均给予０．７５％丁哌卡因１～１．５ｍｇ·ｋｇ－１，Ｌ组给予２％利多卡因４～４．５ｍｇ·ｋｇ－１。采用高效液相色谱（ＨＰＬＣ）测定硬膜外给药后血浆药物浓度。结果表明三组病例血药浓度均在安全范围内。Ｂ１组的血药浓度达高峰时间（Ｔｐｅａｋ）和脐静脉与母体血药浓度比（ＵＶ／ＭＶ）值均小于Ｌ组，表明丁哌卡因在硬膜外腔的吸收比利多卡因快，且透过胎盘屏障的药量小于利多卡因，新生儿Ａｐｇａｒ评分在娩出后５分钟均为１０分。Ｂ１组的药代动力学参数与Ｂ２组基本相似。结论：剖宫产手术硬膜外腔给予临床剂量的局麻药是安全的。     

Hemodynamic effects of KRN2391 (potassium channel opener) in halothane-anesthetized dogs

The cardiovascular responses to an infusion of KRN2391, a potassium channel opener, was studied in halothane-anesthetized dogs. Intravenous administration of KRN2391 at 1.0 and 5.0 μg·kg⁻¹·min⁻¹ for 60 min produced dose-dependent decreases in mean arterial pressure (MAP) and systemic vascular resistance (SVR) associated with dose-dependent increases in the cardiac index (CI) and stroke volume index (SVI) but was not accompanied by an increase in heart rate (HR). The maximum decrease in MAP during the infusion of KRN2391 at 1.0 and 5.0 μg·kg⁻¹·min⁻¹ was −13±7% (P<0.01) and −37±10% (P<0.01), respectively. The maximum reduction in SVR after 1.0 and 5.0 μg·kg⁻¹·min⁻¹ was −20±11% (P<0.01) and −60±16% (P<0.01), respectively. A KRN2391 infusion of 1.0 and 5.0 μg·kg⁻¹·min⁻¹ increased Cl a maximum of 11±13% (P<0.05) and 65±33% (P<0.01), respectively. KRN2391 1.0 μg·kg⁻¹·min⁻¹ showed a tendency to increase SVI but this change was not significant, KRN2391 5.0 μg·kg⁻¹·min⁻¹, however, produced a significant increase in SVI. The present results demonstrate that the decrease in MAP and the increases in CI and SVI caused by KRN2391 are due to a reduction in the afterload. Therefore, we conclude that these cardiovascular profiles of KRN2391 may be benificial in perioperative uses including the control of systemic blood pressure and the treatment of hypertension during halothane anesthesia in clinical practice.     

Effect of epidural anesthesia on colorectal anastomosis

PURPOSE: Epidural anesthesia is believed to benefit colorectal anastomotic blood flow because of the sympathetic blockade it produces. Our purpose is to measure with tonometry the effect of epidural anesthesia on colorectal anastomotic oxygenation. PATIENTS AND METHODS: Fifteen patients operated on for rectal cancer (radical anterior resection) were monitored postoperatively using tonometers placed in the stomach (celiac trunk), transverse colon (superior mesenteric artery), and the anastomotic area during the operation. An epidural catheter was placed at L1-2, and on the first postoperative day, 8 ml of bupivacaine (0.25 percent) was administered. The anesthetic effect extended up to T-4. Intramucosal pH (pHi) at the three locations was measured before, during, and after the epidural blockade. RESULTS: Gastric and transverse colon pHi increased during the epidural blockade from 7.35±0.01 to 7.41±0.01 and from 7.34±0.02 to 7.40±0.02, respectively. The anastomotic pHi decreased from 7.3±0.02 to 7.24±0.03 under the epidural and increased up to 7.34±0.02 after withdrawal of the effect on the following day. All pHi variations were statistically significant (P<0.05, paired Student'st-test and Wilcoxon's test), because it was the comparison between gastric and transverse colon pHi with the anastomotic pHi during the epidural (P<0.05, one-way analysis of variance and Kruskal-Wallis tests). None of the patients developed anastomotic or other complications. CONCLUSIONS: Epidural anesthesia with bupivacaine causes a significant decrease in the oxygenation-perfusion state of colorectal anastomosis in comparison with the increase in other areas of the digestive tract. Further studies need to be done to see if other epidural anesthetic-analgesic protocols also worsen colorectal anastomotic blood flow.Supported in part by a grant from the Spanish Society of Digestive Diseases, Madrid, Spain. All tonometric catheters and drugs were donated by the Clinic University Hospital of Valencia, Spain.Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.     

Clinical office anesthesia: The use of propofol for the induction and maintenance of general anesthesia

Ambulatory surgery has become routine for many plastic surgery procedures. Anesthesia techniques including general anesthesia by inhalation and intravenous infusion and the dissociative technique have all been used successfully for outpatient anesthesia. Propofol (Diprivan), a relatively new agent, has proven to be a safe and effective general anesthesia agent for outpatient surgery. We report on our experience with propofol as an induction agent and continuous drip for general anesthesia maintenance in 100 consecutive outpatient, plastic surgery procedures performed in an office facility. Assessment factors were recovery-room time, nausea and vomiting in the recovery room and at home, hallucinations, patients' recollection of anesthesia experience, and overall patient satisfaction.     

“Helper:” A critical events prompter for unexpected emergencies

Objective. The medical practitioner is faced with an increasing list of protocols and algorithms related to patient care. These recommendations are often difficult to recall, particularly in stressful emergency situations. Using advanced cardiac life support (ACLS) protocols, we built a computer-based system to exhibit precompiled response plans for medical emergencies. To validate the usefulness of this prompting device, we tested application of two of the nine ACLS algorithms, pulseless ventricular fibrillation/ventricular tachycardia (Vfib/Vtach) and bradycardia, in a simulated operating room (OR) environment.Methods. The system utilized the software authoring system IconAuthor (Aimtec Inc., Nashua, NH) and a touch-screen monitor (DiamondScan, Microtouch, Methuen, MA). Prior to testing our system, all 39 subjects were given time to familiarize themselves with its operation. Subsequently, all subjects were videotaped while managing a standard simulated anesthetic. During the anesthetic, the subjects were presented with two emergency scenarios, not viewed during the familiarization period. The electrocardiographic (EKG) signals for normal sinus rhythm, ventricular fibrillation, and second-degree heart block were presented. By random selection, the prompter was available to half of the subjects for help with arrhythmia management (experimental group), while to half it was not (control group).Results. A total of 39 subjects completed the exercise. Use of the prompter enabled significantly more subjects to administer correct drugs and dosages during ventricular fibrillation. The correct lidocaine dose was chosen more often by the experimental group than by the control (p=0.015); similarly MgSO₄ was appropriately ordered more often in the experimental group (p=0.003). During second-degree heart block, atropine was correctly followed with a dopamine infusion (p=0.004), and epinephrine infusion was ordered for refractory bradycardia (p=0.002) more often in the experimental than the control group.Conclusions. These data demonstrate the value of a prompting device at the anesthesia workstation. We foresee the use of such prompters in many areas of medicine.This study was made possible by a grant from the Anesthesia Patient Safety Foundation. Results were presented, in part, at the meeting of the STA/SEA Orlando, Florida, January 1994.     

MRI诊断腰椎间盘术后粘连和突出复发

失败的下腰椎手术是个复杂的问题，由于其症状和体征不典型，单靠临床检查很难明确诊断，而脊髓造影和常规ＣＴ等检查也很难区别突出复发和硬膜外粘连。本文分析了３２例再手术患者ＭＲＩ图象，并与第二次手术所见对比，发现２７例ＭＲＩ诊断准确，３例假阳性，２例因信号缺失不能明确诊断。     

Radiographic changes induced after cervical facet radiofrequency denervation

BACKGROUND CONTEXT: Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection. PURPOSE: To report post-procedure inflammatory changes after cervical facet RFD. STUDY DESIGN: Case report. PATIENT SAMPLE: A 35-year-old Caucasian female. METHODS: Retrospective case review. RESULTS: The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess. CONCLUSIONS: Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.     

袖珍式野战静脉麻醉控制器的研制

介绍一种采用单片机开发的按药代动力学参数控制注射泵注射给药,从而控制手术患者静脉麻醉深度,适合野战条件下使用的小型化静脉麻醉系统.该系统具有控制精度高、功能扩展能力强以及使用方便等特点,并已在临床推广应用.     

局麻胸腔镜清创术治疗脓胸实用性研究

目的探讨脓胸患者经局麻胸腔镜清创术治疗的实用价值。方法在局麻下用硬质电视胸腔镜行脓胸清创术，介绍操作方法及清创步骤，观察患者的耐受性及疗效。结果总有效率为90．6％，早、中、晚期治疗有效率分别是100．0％、90．9％、50．0％。术中监测患者对操作的反应及血氧饱和度、呼吸、脉搏、心电图改变均无统计学意义。结论局麻胸腔镜清创术在患者清醒状态下操作，除抽净黏稠脓液外尚可取出团块状脓苔及坏死组织，打穿包裹性脓腔，充分冲洗，可迅速控制感染。方法简单，避免全麻气管插管带来的并发症，术后恢复快，适应证广，患者易耐受，是治疗脓胸的实用方法。