氙气麻醉

近年来有关氙气的基础和临床研究越来越多,人们对氙气的药理学特性也有了更深一步的了解。由于氙气具有许多理想吸入麻醉药的特性,但价格又特别昂贵,因此关于氙气在临床上的应用前景近年来引起不少的争论。总体而言,氙气的临床应用前景被普遍看好。在欧洲的个别国家,如俄罗斯,氙气已被应用于临床。本文就氙气的历史发展、物理和化学特性及药理作用等方面作一综述。     

氙气麻醉

近年来有关氙气的基础和临床研究越来越多，人们对氙气的药理学特性也有了更深一步的了解。由于氙气具有许多理想吸入麻醉药的特性，但价格又特别昂贵，因此关于氙气在临床上的应用前景近年来引起不少的争论。总体而言，氙气的临床应用前景被普遍看好。在欧洲的个别国家，如俄罗斯，氙气已被应用于临床。本文就氙气的历史发展、物理和化学特性及药理作用等方面作一综述。     

氙气吸入麻醉的研究进展

近年来发现氙气具有理想吸入麻醉药的许多特性,将来有可能成为临床上主要的麻醉用药之一。本文将从其理化性质、药理作用、临床应用及其优缺点等方面进行总结。     

氙气吸入麻醉的研究进展

近年来发现氙气具有理想吸入麻醉药的许多特性,将来有可能成为临床上主要的麻醉用药之一。本文钭从其理化性质、药理作用、临床及其优缺点等方面进行总结。     

右旋氯胺酮在成年人临床麻醉中的应用

背景 右旋氯胺酮在欧美各国已广泛使用,与我国临床使用的消旋氯胺酮比较,其麻醉、镇痛效应更强,精神副反应及分泌物更少,苏醒时间更短.目的 综述右旋氯胺酮的临床应用,为该药在国内麻醉中的应用提供参考.内容 就右旋氯胺酮在麻醉诱导与维持、疼痛治疗、ICU的镇静镇痛及小儿麻醉等方面的临床应用进行归纳总结.趋向 使右旋氯胺酮更加安全、有效、广泛地应用于临床.     

经导管主动脉瓣置换术麻醉进展

背景 对于手术禁忌或高风险手术的重度主动脉瓣狭窄患者,经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)已作为开放性手术的替代疗法.麻醉是保证手术成功的关键. 目的 总结目前关于TAVI麻醉监测管理的最新进展,为临床医师提供参考. 内容 从术前评估、麻醉方法、术中监测、术中以及术后管理等5个方面综述TAVI的麻醉进展. 趋向 目前国内TAVI麻醉研究较少,麻醉医师安全有效地监测管理是保证手术成功的关键因素.     

氙气在小鼠大脑中动脉短暂性梗塞模型上的神经元保护作用

麻醉气体,其特性包括相对较高的心血管安全性(同等或优于传统麻醉药),与其他大多数气体相比较好的药物动力学或药效学特点。越来越多的临床和实验研究表明,氙气作为一种气体麻醉药,具有镇痛、诱导苏醒迅速和对心血管影响小的特点。另外,由于其对环境影响小,因此适用于吸入麻醉。但是,由于其价格昂贵,在临床应用中也因此受到了限制。     

盐酸氯普鲁卡因的临床研究进展

盐酸氯普鲁卡因属苯甲酸酯类的局部麻醉药,是在普鲁卡因的结构基础上引入-Cl基因,在化学结构上形成了麻醉效应强、麻醉后恢复快的优点.可以安全广泛的应用于临床麻醉.此文就盐酸氯普鲁卡因的硬膜外麻醉、脊髓麻醉、局部浸润麻醉、外周神经阻滞和区域静脉麻醉等方面的临床研究进展进行综述.     

氙气在小鼠大脑中动脉短暂性梗塞模型上的神经元保护作用

麻醉气体，其特性包括相对较高的心血管安全性(同等或优于传统麻醉药)，与其他大多数气体相比较好的药物动力学或药效学特点。越来越多的临床和实验研究表明，氙气作为一种气体麻醉药，具有镇痛、诱导苏醒迅速和对心血管影响小的特点。另外，由于其对环境影响小，因此适用于吸入麻醉。但是，由于其价格昂贵，在临床应用中也因此受到了限制。     

氙气麻醉对健康受试者大脑糖代谢与脑血流耦联关系的影响:采用正电子计算机断层显像技术的研究

背景 全身麻醉药能够改变脑局部糖代谢(regional cerebral glucose metabolism,rCMRglc)和脑血流(cerebral blood flow,CBF)之间的相互关系.本研究应用正电子计算机断层显像(positron emission tomography,PET)研究技术评价氙气麻醉...     

Xenon, a modern anaesthesia gas

Xenon is an interesting anesthetic as it appears to lack negative inotropicy and vasodilatation, giving great advantages to both patients with limited cardiovascular reserve or those who require hemodynamic stability. It has low toxicity and is not teratogenic. Xenon gives rapid induction and recovery, due to its low blood/gas partition coefficient (0.15), and has a MAC of 63%. Several vitro studies showed that Xenon may protect neural cells against ischaemic injury. Its low blood solubility can take to diffusion hypoxia if Xenon is not substituted by 100% oxygen at the end of anesthesia. It has been shown that, compared to other anesthetic regimens, Xenon anesthesia produces the highest regional blood flow in the brain, liver, kidney and intestine. In conclusion, the most important positive effects of Xenon are cardiovascular stability, cerebral protection and favourable pharmacokinetics. Negative points are high cost and the limited number of ventilators supplying Xenon.     

瑞马唑仑在全身麻醉中的应用进展

瑞马唑仑是一种新型的超短效药物,具有起效快、代谢迅速、无蓄积、血流动力学稳定、呼吸抑制轻、不依赖肝肾代谢、代谢产物无活性,且可被特异性拮抗药氟马西尼快速拮抗等优势。由于其良好的作用特点,瑞马唑仑被广泛应用于无痛内镜诊疗、重症监护病房镇静和区域阻滞麻醉辅助镇静。目前瑞马唑仑在全身麻醉中的应用研究逐渐增加,多项研究证实了瑞马唑仑在全身麻醉诱导和维持中安全性与有效性。现就瑞马唑仑的药理学特性及其在麻醉诱导和维持阶段的临床研究作一综述,为其临床麻醉应用提供参考。     

局部麻醉药脊髓神经毒性及其防治研究进展

近年来,有关局麻药脊髓神经毒性的报道日渐增多并业已引起广泛的关注。本文就局麻药脊髓神经毒性的临床表现,可能发生机制、相关影响因素以及综合防治措施作一简要综述。     

脊柱手术机器人在脊柱外科手术中的应用进展

过去十年间,智能医疗技术已经成为研究的热点方向,并衍生出图像辅助AI和肿瘤诊断辅助系统等一系列技术.在外科领域,外科机器人是最有吸引力的智能技术之一.经过近十年的发展,机器人在脊柱外科手术中显露出巨大优势,已有大量关于准确性和辐射量的研究报道.但是,文献查阅过程中亦暴露出机器人的一些不足,促使我们对脊柱机器人的综合评价进行了回顾.此综述总结了已发表文章中提到的结果和我们已总结而未发表的结论,希望这些总结有助于研究人员将来对机器人进行针对性的改进,并拓宽脊柱手术机器人的未来方向.脊柱手术机器人技术被认为在未来应用中前景光明,但是与其他现有的应用技术相比,亟须解决应用范围窄、应用深度浅和优势不突出的缺点.     

Animal models for studying penile hemodynamics

Animal models for the study of erectile function monitoring the changes in intracavernous pressure (ICP) during penile erection was reviewed. The development of new models using small commercially-available experimental animals, rats and mice, in the last decade facilitated in vivo investigation of erectile physiology. The techniqueenabled to evaluate even subtle erectile responses by analyzing ICP and systemic blood pressure. Moreover, the method has been well improved and studies using conscious animal models without the influence of any drug or anesthesia are more appropriate in exploring the precise physiological and pharmacological mechanisms in erection. Also, more natural and physiological sexual arousal instead of electrical or pharmacological stimulation is desirable in most of the studies.This article reviewed the development of ICP studies in rats and mice.     

Continuous spinal anesthesia and analgesia in obstetrics

The development of the technique of continuous spinal anesthesia as it relates to the obstetric population is recounted. The advantages and disadvantages of continuous spinal anesthesia are examined, currently available catheters and kits are reviewed, and strategies for the management of continuous spinal techniques for labor analgesia and surgical anesthesia are discussed. Continuous spinal anesthesia may have particular value over other regional techniques in several specific clinical circumstances.     

Xenon - noble gas with organprotective properties

Besides it's anaesthetic properties, xenon may induce biological effects that may protect various organs from ischaemia-reperfusion injury. Xenon is an antagonist of the NMDA-receptor and reduces the neuronal injury mediated via these receptors. In contrast to other NMDA-receptor antagonists, xenon has no neurotoxic side effects. Xenon also protects the heart in ischaemia-reperfusion situations. Xenon reduces the post-ischaemic reperfusion injury and offers cardioprotection by inducing pharmacological preconditioning. These organ protective properties of xenon might be useful in special clinical situations.     

Possible and proved benefits of peridural analgesia

Regional anesthesia is supposed to be of some help in improving the outcome of surgical patients. Actually this assumption is largely accepted, even if clear scientific demonstrations have not been obtained. At present there are data showing the advantages, as to survival and complications, especially for major orthopedic surgery. These data have been shown by important and clarifying meta-analyses. Unfortunately, for other types of surgery, advantages have been scarcely demonstrated, due to the low number of patients involved in clinical trials. Anyway, it is underlined that regional anesthesia, and especially epidural block, is much more convenient for the patients than general anesthesia. It seems also convenient from the economic point of view, since the pharmaco-economic studies present in the literature showed the possibility to save money, using regional anesthesia and regional analgesia.     

Effect of Xenon on elevated intracranial pressure as compared with nitrous oxide and total intravenous anesthesia in pigs

BACKGROUND: Xenon in low concentrations has been investigated in neuroradiology to measure cerebral blood flow (CBF). Several reports have suggested that inhalation of Xenon might increase intracranial pressure (ICP) by increasing the cerebral blood flow and blood volume, raising concerns about using Xenon as an anesthetic in higher concentrations for head-injured patients. A porcine study is presented in which the effects of inhaled 75% Xenon on elevated ICP, cerebral perfusion pressure and the efficacy of hyperventilation for ICP treatment were compared with nitrous oxide anesthesia and total intravenous anesthesia (TIVA). METHODS: Twenty-one pentobarbital-anesthetized pigs (age: 12-16 weeks) were randomly assigned to three groups to receive either 4 h of Xenon-oxygen ventilation, nitrous oxide-oxygen ventilation or air-oxygen (75%/25%) ventilation, respectively. After instrumentation for parenchymal ICP measurement and ICP manipulation, an epidurally placed 6-F balloon catheter was inflated until a target ICP of 20 mmHg was achieved. After 4 h of anesthesia hyper- and hypoventilation maneuvers were performed and consecutive ICP and CBF changes were investigated. RESULTS: Intracranial pressure and CBF increased significantly in the nitrous oxide group as compared with the controls. There was no increase of ICP or CBF in the Xenon or control group. Intracranial pressure changed in all three groups corresponding to hyper- and hypoventilation. CONCLUSIONS: During Xenon anesthesia, elevated ICP is not increased further and is partially reversible by hyperventilation. Our study suggests that inhalation of 75% Xenon seems not to be contraindicated in patients with elevated ICP.     

Xenon anesthesia for liver transplant surgery: a report of four cases

It is well established that patients presenting for orthotopic liver transplantation pose challenging surgical and anesthesiological problems. Intraoperatively, severe hemodynamic instability due to profuse bleeding and acute cardiomyopathy during reperfusion are major concerns. In addition, ischemia-reperfusion injury can compromise postoperative graft function. Xenon, with its potential to maintain hemodynamic stability, preserve cardiac function, and protect the liver graft of the recipient, seems to be a promising anesthetic agent for liver transplant surgery. To date, xenon has not been used as an anesthetic in liver transplantations. We therefore have reported our initial experience with four patients who underwent orthotopic deceased donor liver transplantation under xenon anesthesia. Although all patients had advanced liver disease and experienced significant intraoperative bleeding, their intraoperative courses, including reperfusion, under xenon anesthesia were remarkably stable. The patients required only moderate, temporary catecholamine support, which was withdrawn at the end of the surgery. Xenon anesthesia for liver transplant procedures proved to be feasible. Immediate postoperative organ function was satisfactory in all patients.