四种静脉麻醉药麻醉强度的临床研究

目的　研究普鲁卡因、芬太尼、异丙酚、依托咪酯对安氟醚最低肺泡有效浓度 ( MAC)、手术切皮无应激反应 MAC( MAC- BAR)的影响。方法　 12 0例择期手术病人按上述 4种药物随机分为 4组 ,每组依据测 MAC或测 MAC- BAR随机分为两小组。结果　普鲁卡因以 1mg· kg- 1· min- 1连续输注 ,降低安氟醚 MAC3 6.4 %、MAC- BAR3 6.1% ;芬太尼以 4 μg· kg- 1 负荷量加 0 .0 3 μg· kg- 1min- 1连续输注 ,降低安氟醚 MAC68.1%、MAC- BAR76.7% ;异丙酚以 3 mg· kg- 1负荷量加 5 3 .8μg· kg- 1· min- 1连续输注 ;依托咪酯以 0 .4 mg· kg- 1负荷量加 2 3 μg· kg- 1· min- 1连续输注 ,两者对安氟醚 MAC没有明显影响 ,但分别降低 MAC- BAR3 5 .5 %、2 6.1%。结论　静脉普鲁卡因麻醉虽是一种较弱的麻醉方法 ,但麻醉作用是肯定的 ;芬太尼降低安氟醚的 MAC与 MAC- BAR最显著 ;本试验剂量的异丙酚、依托咪酯镇痛作用不明显 ,但对降低机体心血管及神经内分泌应激反应有帮助     

七氟烷复合靶控输注瑞芬太尼用于腹腔镜手术的临床评价

目的评价靶控输注(target controlled infusion,TCI)瑞芬太尼复合吸入七氟烷3种不同配伍剂量用于腹腔镜手术的麻醉效果和麻醉恢复情况。方法选择ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术或腹腔镜卵巢囊肿切除术45例,随机分为3组,每组15例。3组诱导方式均相同。麻醉维持:A组为瑞芬太尼血浆靶控输注6ng/ml复合吸入0.4MAC(minimal alveolar concentration,肺泡最低有效浓度)七氟烷;B组为瑞芬太尼血浆靶控输注4ng/ml复合吸入0.65MAC七氟烷;C组为瑞芬太尼血浆靶控输注2ng/ml复合吸入1.0MAC七氟烷。观察患者麻醉和术中脑电双频指数(bispectral index,BIS)、平均动脉压(meanarterial pressure,MAP)、心率(heartrate,HR)及术后呼吸恢复时间、睁眼时间、气管导管拔管时间、定向力恢复时间等指标。结果3组病人术中生命体征平稳,无须调整七氟烷和瑞芬太尼的用量。3组术中各时点MAP、HR无统计学差异(P>0.05)。术中各时点BIS值A组明显高于B组和C组,B组明显高于C组(P<0.05)。3组病人在麻醉恢...     

Ventricular dysrhythmias following an alfentanil anesthetic in a patient on reserpine for hypertension

The case is presented of a hypertensive patient on reserpine, who developed ventricular irritability after administration of alfentanil, a new ultra-short-acting narcotic used in anesthesia. The dysrhythmias resolved after cessation of the offending agent. There are no reported cases of interaction of reserpine and alfentanil in the literature.     

手术患者不同时机导尿对苏醒期躁动和适应性比较

目的比较全麻手术患者不同时机导尿后全麻苏醒期躁动和术后1天尿管耐受性。方法将180例全麻手术患者随机分为三组,I组为术晨在病房导尿;II组为手术前1日,由巡回护士访视患者,进行心理护理后,麻醉前在手术室导尿;III组为全身麻醉平稳后由巡回护士导尿。对患者就不同时机进行导尿所引起的不舒适感、麻醉苏醒时的躁动情况及术后1日对尿管适应性进行比较。结果III组患者麻醉苏醒期躁动率明显高于I、II组,有统计学意义（P〈0.05）。术后1日患者尿管适应度,II组术后留置尿管的适应度较好,III组患者较差。结论麻醉前对患者进行心理护理后导尿可提高手术患者对留置尿管的适应度,大大降低麻醉苏醒时的躁动率。     

Hemodynamic effects of atracurium, vecuronium and pancuronium during sufentanil anesthesia for coronary artery bypass

A study was undertaken to evaluate the cardiovascular effects of sufentanil, in combination with three different muscle relaxants, used as sole anesthetic with 100% O2 in 30 patients undergoing elective coronary artery vein graft surgery. Patients were randomly allocated to receive pancuronium (P), vecuronium (V) or atracurium (A) for muscle relaxation. All patients received 15 micrograms/kg sufentanil at induction followed by 5-10 micrograms/kg sufentanil prior to sternotomy. At the 95% level of significance no statistical difference was found for any of the measured and derived cardiovascular parameters between groups P, V and A, except for a decreased systolic blood pressure in the atracurium group after induction. Sufentanil in combination with pancuronium or vecuronium provided stable hemodynamic conditions throughout anesthesia. Atracurium was less satisfactory. We conclude that there is no advantage to be gained, in the presence of beta blockade, from the use of the new generation muscle relaxants as compared to pancuronium during high-dose sufentanil anesthesia for coronary artery vein grafting.     

Non-auditory effects of noise in industry

Summary A secondary analysis of data from a national survey was carried out in order to assess the number of industrial workers exposed to noise and other adverse working conditions. This permitted us to study correlations with parameters of health. More than half of the male blue collar workers in industry and building trades (sample n = 311) reported a great deal of noise. Dirty work and strenuous physical activity were also frequently mentioned. Noise exposure is often present together with exposure to stench and dirty and dangerous work. A weak correlation exists between reported noise exposure and experienced ill-being and diminished satisfaction with their own health. This observed relationship probably underestimates the true risks.     

Evaluation of the efficacy of elastic compression stockings in prevention of hypotension during epidural anaesthesia for elective caesarean section

The ability of graduated compression elastic stockings to prevent hypotension during elective epidural caesarean section was evaluated. Twenty women were randomly assigned to two groups of ten, one group being fitted with the stockings. The incidence and degree of hypotension were the same in both groups. Graduated compression elastic stockings are of no benefit in reducing the incidence of maternal hypotension during caesarean section.     

Effects of aldehyde dehydrogenase inhibitors on hexobarbital sensitivity and neuroamine metabolism in rat brain

Several authors have found that the aldehyde dehydrogenase (ALDH) inhibitor, disulfiram, prolongs hexobarbital-induced anaesthesia. It was suggested that this effect was caused by an alteration of the serotonergic system in brain, mediated by elevated levels of biogenic aldehydes. In the present study, disulfiram (300 mg/kg) was found to cause a 4-fold prolongation of hexobarbital-induced anaesthesia, while coprine (another potent ALDH-inhibitor) had no effect. This strongly suggested that biogenic aldehydes were not involved in this effect of disulfiram. The hexobarbital concentration in brain, at the electroencephalogram (EEG) criteria used for measuring hexobarbital sensitivity, was unaffected in rats given 75-300 mg/kg disulfiram, indicating that factors other than an increased brain hexobarbital sensitivity were responsible for the prolonged anaesthesia. Also 10-100 mg/kg coprine did not affect hexobarbital sensitivity measured this way. No alteration of the dopamine level in brain was found in rats given disulfiram, and in both disulfiram- and coprine-treated rats, similar changes in the serotonergic system were found. However, the level of norepinephrine was decreased in brains of disulfiram-treated rats, but it was unaffected by coprine. Thus, norepinephrine may have been involved in the prolongation of hexobarbital-induced anaesthesia caused by disulfiram.     

高海拔地区术中运用力月西方法探讨

目的：研究在高海拔地区运用力月西（咪唑安定）在术中的不同方法和剂量对呼吸、循环的影响。方法：力月西（咪唑安定）运用于单纯上腹部胆囊切除术患者60例，且随机分为A组；单纯运用力月西组（0.05mg/kg）；B组：力月西（0．03mg/kg）和度冷丁50mg混合液静脉注射；C组：先静注50mg度冷丁，5分钟的再静注力月西0．03mg/kg，每组各20例，通过监测观察血压，血氧饱和度（SpO2)、心率（HP）变化，并行，并行镇静分级，分级标准以Breggen方法，3组患者组均无统计学差异，均未用术前药，结果：A、B、C3组术中血压、饱和度均有所下降，但无统计学意义（P＞0．05），且3组术后均不能回忆术中情况，对术中操作无记忆（顺行性遗忘），但A、B两组均有术中患者出现烦躁，几乎不能配合手术，需加大剂量后才能符合术中要求，而C组无一例发生，结论：小剂量力月西0．03mg/kg复合度冷丁间断给药的运用对血管系统影响甚微，不至于引起血压下降，镇静、抗焦虑完全，无呼吸抑制，尤为适合高海拔，低氧环境，此不失为一种较为完全的术中辅助用药。     

Effects of 2 h anesthesia with halothane on blood cell counts and serum biochemical values in sheep and calves

To examine the clinical pathology of halothane in ruminants, five healthy fat-tailed sheep aged 1 to 2 years weighing 35 to 55 kg and four healthy calves aged 2 to 4 months weighing 30 to 65 kg were used. Anesthesia was induced and maintained by halothane using a closed-circuit anesthetic machine. The average induction time was found to be around 5 min in sheep and calves. Hematological studies indicated that there was an increase in neutrophils, significantly different only in sheep at 2 h after anesthesia, and a moderate decrease in lymphocytes. Total white blood cell counts slightly increased during anesthesia. Packed cell volume (PCV) was significantly higher 1 day and 1 week after anesthesia in sheep, but not in calves. The pre-anesthetic serum cholesterol level was around three times greater in calves compared to its level in sheep. However, there was a significant decline in the cholesterol concentration in sheep during 2 h anesthesia. Creatine phosphokinase (CPK) was moderately increased after 2 h anesthesia in both sheep and calves. Moreover, ALT, AST, and ALP were slightly increased 1 day post-anesthesia. Liver biopsies taken 2 weeks after anesthesia were not indicative of any specific pathologic change in sheep or calves. There were no prominent alterations in other biochemical parameters during or after anesthesia. Therefore, it is generally concluded that halothane can be used to induce and maintain general anesthesia in sheep and calves with the least adverse effects on clinical laboratory parameters.