Hemodynamic changes and oxygen consumption in burned patients during enflurane or isoflurane anesthesia

The effects of enflurane or isoflurane anesthesia on the systemic circulation and whole-body oxygen (O2) uptake (VO2) of 15 burn patients undergoing wound excision and skin grafting procedures were studied. The possibility that burn wound excision might adversely affect pulmonary circulation was also investigated. The patients were preanesthetically in a hyperdynamic-hypermetabolic state, characterized by a resting cardiac index (CI) of 6.2 +/- 0.9 L.min-1.m-2 (mean +/- SD), a VO2 (calculated using the Fick principle) of 213 +/- 44 mL.min-1.m-2, a normal mean systemic arterial pressure (MAP) (92 +/- 15 mm Hg), and markedly decreased systemic vascular resistance (SVR) (570 +/- 162 dynes.sec.cm-5). Mean pulmonary arterial pressure (MPAP) preanesthetically was slightly increased (21 +/- 3 mm Hg), while pulmonary vascular resistance (PVR) was in the low-normal range (59 +/- 16 dynes.sec.cm-5). No difference among the effects of enflurane and isoflurane on systemic and pulmonary hemodynamics and metabolic rate was detected. Induction of anesthesia was associated with a decrease in VO2, CI, MAP, and MPAP (P less than 0.001), while SVR and PVR did not change. The decrease in CI paralleled the decrease in VO2, thereby maintaining whole-body O2 supply-demand balance. VO2 decreased most likely because of lessened tissue O2 requirements. When anesthesia was discontinued, all metabolic and hemodynamic variables promptly returned to preanesthetic values. No effect of burn wound excision on pulmonary circulation was detected.     

雷米芬太尼静脉全麻诱导期血流动力学变化

目的 比较霄米芬太及芬太尼静脉全麻诱导对患者血流动力学的影响.方法 60例ASA.Ⅰ或Ⅱ级的择期手术患者,年龄18～65岁.随机均分成雷米芬太尼组(R组)和芬太尼组(F组),分别以雷米分太尼1 μg/kg或芬太尼3/μg/kg进行麻醉诱导,用胸阻抗法监测麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1 min(T3)、5 min(T4)时的HR、SBP、DBP、心排血量(CO)、外周血管阻力(SVR)、加速度指数(ACI)、胸腔液体水平(TFC)和左心作功(LCW)的变化.结果 T1时两组HR、SBP、DBP、CO、SVR、LCW均低于T0时(P<0.05或P<0.01),T4时F组HR、SBP、DBP、CO、LCW显著低于T0时和R组(P<0.05或P<0.01).R组T2、T3时,F组T2～T4时SVR均高于T0时(P<0.05).结论 1μg/kg雷米芬太尼较3 μg/kg芬太尼更能有效维待全麻诱导期气管插管血流动力学平稳.     

老年冠心病患者全麻恢复期血液动力学变化

目的观察老年冠心病患者于雷米芬太尼-丙泊酚或七氟醚-N2O全麻恢复期血液动力学变化,寻求合理处理,减少老年冠心病患者非心脏手术后心肌再损害。方法32例65~82岁经本院心内科诊断的冠心病患者,ASAⅡ级,分别七氟醚-N2O-O2(SE)吸入或雷米芬太尼-丙泊酚(RP)静脉维持麻醉。芬太尼3μg/kg、咪唑安定0·05mg/kg并吸入纯氧和5%国产七氟醚诱导,琥珀胆碱2mg/kg后,置入LMA-ProSeal喉罩,分别吸入国产七氟醚-N2O-O2或静滴国产雷米芬太尼-丙泊酚,间断0·05mg/kg维库溴铵维持机械通气,调整通气量,使PETCO2保持35~45mmHg。术毕停药,记录停药~睁眼、停药~拔除喉罩时间。术中全程BioZICG无创血液动力学监测,记录恢复期各时点心率(HR)、心输出量(CO)、胸液成分(TFC)、心肌加速度指数(ACI)、外周血管阻力(SVR)、MAP、左心作功(LCW)备分析。结果两组恢复期HR、CO、MAP、ACI、LCW均较术期升高,自停药9min后HR、MAP、LCW高于停药前水平(P<0·05)。SE组自停药9min后HR、MAP分别增加16·7%和13·8%。RP组自停药9min后HR、MAP、LCW分别增加16·9%、13·5%、36·7%。在恢复期两组SVR与停药前比较差异无显著意义,但与诱导前比较两组均呈明显上升趋势,SE组与RP组分别增加了26·4%和15·6%。两组停药~睁眼、停药~拔除喉罩时间无差别。结论雷米芬太尼-丙泊酚静脉麻醉对老年冠心病患者全麻恢复期循环功能抑制轻;但因雷米芬太尼作用消除快,痛反应出现早,应于停药前追加适量芬太尼或舒芬太尼等长效镇痛药,或开启镇痛泵,以消除应激带来的心肌氧耗增加。七氟醚-N2O-O2全麻恢复期,后遗镇痛效应续时较短,亦应考虑适当镇痛。     

Hemodynamic responses during induction of anesthesia with halothane-nitrous oxide in children with or without atropine premedication

Forty three children ranged from 1yr. to 6yr. were randomly assigned to non-atropinized group (n = 20; A(–)) and atropinized group (0.015mg·kg^–1 i.m., n = 23; A(+)). Control hemodynamics were measured under 0.5% halothane and 67% nitrous oxide and 33% oxygen for three minutes, and then halothane was increased to 2.5% and maintained for 15min. In the A(–) group, stroke volume (SV) decreased to 64%, heart rate (HR) increased from 100/min to 111/min, and blood pressure (BP) decreased from 65mmHg to 62mmHg. Skin blood flow (SBF) concomitantly measured by a laser doppler flowmeter decreased to 48% and total peripheral resistance (TPR) increased to 128%. In the A(+) group, HR increased from 117/min to 132/min (P 0.05, vs. A(–) group), BP decreased from 67mmHg to 66mmHg. SV decreased to 71% (P 0.05, vs. A(–) group). Changes in SBF and TPR were 68% and 128% respectively. End-expired halothane concentration in the A(+) group increased slower than in the A(–) group but not significantly. The results indicate increased sympathetic tone would work as a compensating mechanism for decreased SV and CO. Atropine premedication attenuated cardiovascular depression by maintaing HR and possibly by delaying induction speed of anesthesia. In conclusion, halotane-nitrous oxide anesthesia decreased SV without a marked decrease in heart rate and blood pressure in children. This decrease in SV and BP was attenuated by atropine premedication.(Kawana S, Namiki A, Morita Y, et al.: Hemodynamic responses during induction on anesthesia with halothane-nitrous oxide in children with or without atropine premedication. J Anesth 6: 63–68, 1992)     

An open-label comparison of local anesthesia with or without sedation for minor hand surgery

Background

The purpose of this study was to assess satisfaction and pain intensity in patients undergoing minor hand surgery under local anesthesia (LA) with or without sedation.

Methods

Seventy-three adult patients presenting to two hand surgeons were enrolled in this prospective observational study in 2012. They completed questionnaires prior to surgery (current pain intensity, Patient Health Questionnaire-2 (PHQ-2) to measure symptoms of depression, Pain Self-Efficacy Questionnaire (PSEQ) to assess the effective coping strategy of pain self-efficacy) and within 48 h after surgery (satisfaction with surgery, satisfaction with anesthesia, pain during the injection, and pain during the procedure). Thirty-seven patients had carpal tunnel release (bilateral in 3), 22 had release of one or more trigger digits, and 12 had excision of a benign tumor, gouty tophus (1 patient), or foreign body (1 patient). Forty-six patients chose LA and 27 chose LA with sedation.

Results

There was no difference in satisfaction with surgery or anesthesia by the type of anesthesia. Satisfaction with surgery was associated with older age alone. Satisfaction with anesthesia was associated with no prior surgery for the same condition. Pain during injection and during the procedure were significantly higher without sedation. Pain during injection was associated with younger age and LA. No factors were associated with pain during the procedure.

Conclusions

Patients that had local anesthesia immediately prior to incision with tourniquet use during surgery had more pain during the procedure but were equally satisfied on average with surgery and with anesthesia compared to patients that had sedation.     

舒芬太尼与芬太尼用于心脏手术对血液动力学的影响

目的探讨舒芬太尼麻醉用于心脏手术对血液动力学的影响。方法随机选择40例择期冠脉搭桥或瓣膜置换手术患者,分为舒芬太尼组和芬太尼组,每组20例。分别在麻醉诱导前(T1)、插管后5min(T2)、转流前即刻(T3)、停机后即刻(T4)、停机后10min(T5)、关胸后(T6)、手术结束时(T7)记录HR、SBP、DBP、心输出量(CO)、每搏量(SV)、周身血管阻力(SVR)。结果两组患者HR在T3~T7时均显著高于T1时(P<0·05),SBP、DBP均低于T1时,SVR在T4~T7时较T3时有所降低,而两组间各时点血液动力学指标差异均无显著意义。结论舒芬太尼麻醉与等效剂量芬太尼麻醉一样可以安全的应用于心脏手术。     

A double blind comparison of lidocaine 2% with or without glucose for spinal anesthesia

The aim of the study was to compare lidocaine 2% plain to lidocaine 2% with glucose 8% for spinal anesthesia. Forty male patients scheduled for urologic surgery participated. The patients were randomly divided into two groups: the plain (P) group received 4 ml of glucose-free lidocaine 2%, the heavy (H) group received 4 ml of lidocaine 2% containing 8% glucose. After the injection, the patients remained in the sitting position for three minutes before they were placed supine.
The onset and maximum level of sensory blockade were similar with both preparations (T7-T8). In both groups there were respectively 3 (P) and 4 (H) patients who did not acquire a sensory level above T10. There was a tendency towards a longer duration of sensory blockade in the P group. The patients in both groups developed an almost complete motor blockade within approximately 10 minutes. Duration of complete motorblockade of the lower extremities was significantly shorter for the H group: 59.1 ±6.5 minutes (mean±SEM) than the P group: 89.5±6.4 minutes.
We consider lidocaine 2% with or without glucose a suitable agent for subarachnoid anesthesia for short procedures. As hyperbaric lidocaine results in a more rapid recovery of motor blockade, it may have advantages for patients in day-case settings.     

罗库溴铵对风湿性心脏病患者血液动力学的影响

目的 比较风湿性心脏病瓣膜置换术诱导期间罗库溴铵和维库溴铵对患者血液动力学的影响。方法 选择20例瓣膜置换术患者采用随机双盲法分成两组(n=10例)。在肌松及双频脑电指数(BIS)监测下，依次给予咪唑安定(0．05～0．1mg／kg)、芬太尼(10～15μg／kg)及等效剂量的罗库溴铵0．6mg／kg或维库溴铵0．1mg／kg。记录和计算麻醉诱导前至插管后30min(1次／min)两组的血液动力学指标。结果 在使用罗库溴铵后1～7min，心率增加了7．54％～17．43％，动脉收缩压增加了12．3％～16．94％，心率收缩压乘积增加了13．96％～22．67％，均高于维库溴铵组。每搏指数在插管后5min下降了13．5％～19．5％，每搏量下降了11．3％～23．8％，明显低于维库溴铵组。其余血液动力学指标在两组间差异无显著性。结论 在心功能Ⅲ级以上的风湿性心脏病患者进行瓣膜置换术麻醉中慎重选用罗库溴铵，但较适用于心动过缓及低血压的患者。     

Intra- and postoperative heart rate changes following propofol anesthesia; a comparison with isoflurane anesthesia

Bradycardia during propofol anesthesia is well known, but bradycardia after propofol anesthesia has not been studied well. We compared perioperative heart rates in patients who had undergone gynecological surgery under lumbar epidural anesthesia supplemented with light general anesthesia using isoflurane and nitrous oxide in oxygen (Group Iso, n = 25) with those who had received lumbar epidural anesthesia supplemented with propofol (Group Prop, n = 25). The heart rates for the Group Prop were significantly lower (P < 0.05) than those for the Group Iso after the induction of anesthesia up to 2 hours after surgery. Two patients in the Group Prop developed bradycardia below 50 bpm 1 and 2 hours after surgery. In one of them intravenous atropine was necessary to treat bradycardia. We conclude that more attention should be paid to postoperative as well as intraoperative bradycardia in patients who receive propofol.     

无肌松药全身麻醉下进行脊柱手术的临床研究

目的比较使用和不使用肌松药全身麻醉下进行脊柱手术的优缺点。方法 70例ASAⅠ或Ⅱ级脊柱手术病人,随机均分为研究组（T组）和对照组（C组）。用琥珀酰胆碱诱导插管后,T组只用丙泊酚、瑞芬太尼维持麻醉,C组按常规使用阿曲库铵。术中维持BIS值在30～60之间,记录两组病人麻醉前（T₀）、插管后即刻（T₁）、切皮时（T₂）、手术后30min（T₃）、60min（T₄）和拔管时（T₅）的BIS值和TOFr,比较两组丙泊酚和瑞芬太尼用量、睁眼时间、拔管时间、拔管后20min警觉与镇静评分（OAA/S）及不良反应,术后请手术医师评价肌松效果。结果两组病人瑞芬太尼用量、外科肌松效果评价、术中体动次数、血管活性药使用次数差异无统计学意义;T₂～T₅时T组TOFr明显高于C组（P<0.01）,T₅时T组BIS明显高于C组（P<0.05）。丙泊酚用量多于C组（P<0.05）,睁眼时间、拔管时间明显短于C组（P<0.01或P<0.05）,拔管后20minOAA/S评分明显低于C组（P<0.01）。结论无肌松药全身麻醉下进行脊柱手术患者呼吸恢复早、拔管快、清醒程度好,具有优势。     

Hemodynamic changes before and after anesthesia for renal transplantation

Renal transplantation has come into use as a treatment for renal insufficiency, but infusion management before and after anesthesia for this operation is important. In order to prevent acute necrosis of the uriniferous tubules and to obtain urine outflow in early postoperative stage, a recent practice has been to give rapid infusions of large amounts of fluid, starting during the anastomosis of the renal vessels. We gave a large amount of intraoperative fluid to six patients undergoing transplantation of cadaver kidneys. A Swan-Ganz catheter was inserted into the pulmonary artery and infusion management was performed so as to maintain the pulmonary arterial pressure above 15 mmHg and the pulmonary capillary wedge pressure above 10 mmHg. The cardiac output increased as a result, and no pulmonary edema was seen. We believe that our method of infusion management using a Swan-Ganz catheter is a useful technique in such cases.     

Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

Introduction: There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited. Methods: We reviewed our experience with 44 unsupplemented SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO₂) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants. Results: There was no significant change in systolic, diastolic, or mean blood pressures from pre‐SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO₂ across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia. Conclusions: The data suggest that SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.     

丙泊酚伍用亚麻醉剂量氯胺酮对创伤病人麻醉诱导时血液动力学的影响

目的探讨丙泊酚伍用亚麻醉剂量氯胺酮对创伤病人全麻诱导时血液动力学的影响。方法将60例创伤休克病人随机分为丙泊酚组(Ⅰ组),丙泊酚复合亚麻醉剂量氯胺酮组(Ⅱ组),每组30例。诱导时依次静注芬太尼2μg/kg、咪唑安定0.05 mg/kg、罗库溴铵0.8 mg/kg,同时Ⅰ组丙泊酚血浆靶控输注(TCI)4μg/ml,Ⅱ组丙泊酚TCI 2μg/ml加氯胺酮0.5 mg/kg。采用Bioz.com阻抗法血液动力学连续监护系统监测HR、BP、心脏指数(CI)、每搏指数(SI)、周身血管阻力指数(SVRI)、加速度指数(ACI)等指标。结果与基础值比较,两组HR诱导时均显著增快(P<0.05)。Ⅰ组SBP、CI、SI、SVRI诱导时均显著下降(P<0.05),而Ⅱ组以上各项指标均无显著变化。Ⅰ组在麻醉诱导时SBP、CI、SI较Ⅱ组显著下降(P<0.05),其余各时点也有一定下降,但差异无显著意义。两组间在各时点的HR、DBP、ACI差异均无显著意义。结论丙泊酚伍用亚麻醉剂量氯胺酮有利于保持创伤病人全麻诱导时血液动力学的稳定。     

Percutaneous nephrolithotomy in patients with or without a history of open nephrolithotomy

BACKGROUND AND PURPOSE: Whether a history of open nephrolithotomy affects the efficacy and morbidity of percutaneous interventions remains unsettled. We investigated this issue in our patients. PATIENTS AND METHODS: A series of 51 men and 14 women who had undergone nephrolithotomy at least once (group A; mean age 40 years) were compared with 73 men and 44 women submitting to percutaneous nephrolithotomy (PCNL) as their first surgery (group B; mean age 43 years). All patients were operated on by the same surgeons over the same period of time. Fifty patients (81.5%) in group A harbored a single stone, whereas 35.9% of patients in group B had single stones (P < 0.001). However, the two groups were similar in terms of stone laterality, the right:left ratio being 1.03 in group A and 0.67 in group B (P = 0.22). RESULTS: The proportion of patients in whom PCNL failed to clear all the stones even though access was obtained did not differ in the two groups (6.15% in group A and 8.55% in group B; P = 0.77). The collecting system was inaccessible in 6.2% and 5.1% of patients, respectively (P = 0.74). Pyelonephritis or abnormal bleeding occurred in similar proportions in the two groups (P = 0.72 and P = 0.74, respectively). No other surgical complications occurred in either group. CONCLUSION: A history of open nephrolithotomy does not adversely affect the efficacy or morbidity of PCNL.