Quantification of exhaled propofol is not feasible during single-lung ventilation using double-lumen tubes: A multicenter prospective observational trial

Background

Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes.

Methods

In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration.

Results

In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation.

Conclusion

During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation.

Registration of Clinical Trial

DRKS-ID DRKS00014788 ( www.drks.de ).     

基于“肺膀胱别通”浅析针刺肺经穴调治膀胱病

肺与膀胱相通,上为荣养周身以御邪,下以气化排浊调津液,从肺与膀胱关系可以看出,太阳之气与肺气共同卫外,以顾护肌表皮毛,故临床针刺治疗太阳体证时可考虑从肺经穴入手。临床取肺经穴位调治膀胱及其经脉病时,应辨别虚实,采取对应的补泻手法,考虑大部分肺经穴提插、捻转补泻手法不便施展,笔者认为可根据辨证采用更为合适的迎随补泻、徐疾补泻、开阖补泻,即观其脉证,补泻择之。其实不仅肺经穴可治膀胱病,膀胱经穴亦可治肺病,由于肺与膀胱两者经气互通,其中一条经上的穴位可治疗另一条相通经的循行部位或主治方向的疾病。虽然脏腑别通理论在针灸学上具备广泛应用的基础,但因表里经脏腑相互属络关系,更多被提及、应用的是"肺与大肠相关"。容易忽视"肺膀胱别通"在"卫气供给""津液代谢"上的关联。故在临床针刺治疗膀胱病时,可从有别于常规、传统的选经取穴上论治,亦可基于"肺与膀胱相关"以膀胱经穴治肺病,或以两经同取的方式指导针刺治疗相关病证。     

碳离子和质子治疗胰腺癌安全性和有效性的系统评价及Meta分析

目的 评价碳离子和质子治疗胰腺癌（PaC）的安全性和有效性。方法 检索数据库纳入碳离子和质子治疗PaC的临床研究，检索时间为自建库至2019年6月。两位研究者独立筛选文献、提取资料。采用STATA 12.0和MetaAnalyst Beta 3.13软件进行Meta分析。结果 共纳入8篇文献，包含459例PaC患者。效应模型Meta分析显示，碳离子和质子治疗PaC的2、3、5级胃肠道溃疡发生率分别为7%、2%、0；2、3、4级厌食症发生率分别为6%、3%、0；1、2年总生存率（OS）分别为77%、45%；2年局部控制率为81%；1年无局部进展率为88%；1年局部复发率为15%。碳离子和质子治疗PaC的2、3、2～3级胃肠道溃疡发生率分别为6.8%、1.5%、9.2%和3.5%、8.3%、6.1%（均P>0.05）；1、2年OS分别为77.1%、44.4%和77.6%、49.7%（P均>0.05）。结论 碳离子和质子治疗PaC安全有效，两者的安全性和有效性相似。     

卒中溶栓绿色通道优化研究及实施效果分析

目的探讨卒中溶栓绿色通道的构建、整改对发病到实施溶栓的时间（onset to treatment time,OTT）、院内溶栓时间（door to needle time，DNT）、临床疗效及预后的影响。 方法收集通过绿色通道溶栓患者118例的临床资料，以时间为界分为对照组57例和观察组61例。比较2组OTT、DNT、DNT≤60 min比率、临床疗效、并发症发生情况、美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale,NIHSS）评分、Barthel指数（Barthel index，BI）评分、改良Rankin量表（Modified Rankin Scale,mRS）评分等。 结果观察组OTT、DNT短于对照组，DNT≤60 min比例高于对照组（P＜0.01）。经过溶栓治疗72 h后，观察组临床疗效优于对照组，总有效率高于对照组（P＜0.01）。2组总并发症发生率和病死率差异均无统计学意义（P＞0.05）。2组NIHSS评分均呈逐渐降低趋势，观察组NIHSS评分低于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。2组BI评分均呈逐渐升高趋势，观察组BI评分高于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.01）。治疗3个月以后，观察组mRS评分明显低于对照组，≤2分比例高于对照组（P＜0.01）。 结论卒中溶栓绿色通道的建立，能够显著缩短OTT、DNT，提高临床疗效，减轻残障程度，取得良好的社会效益。     

The adverse-effect profile of lacosamide

ABSTRACT

Introduction: Lacosamide has been used in epilepsy patients in the United States, Europe and Asia since it was approved by the FDA in 2008. Many patients have benefited from this drug as a new generation of sodium channel blocker. With the worldwide use of this drug, its adverse effects have gradually emerged, especially some rare adverse events.

Areas covered: The present review aims to summarize the adverse effects of lacosamide reported in the literature in recent years to promote the safe clinical application of the drug.

Expert opinion: In more than 10 years of experience in drug usage, adverse reactions of lacosamide have also been gradually discovered. The review showed that lacosamide is safe and effective in antiepileptic treatment, and its common side effects are dizziness, headache, drowsiness, diplopia, and cardiovascular abnormalities. Skin rashes, hematotoxicity and heart damage, psychological symptoms and suicide risk have also been reported and emphasized.