罗哌卡因复合地佐辛在臂丛神经阻滞中的应用

目的:观察罗哌卡因复合地佐辛行臂丛神经阻滞对麻醉和镇痛效果的影响.方法:将90例需臂丛神经阻滞行肱骨切开复位内固定术的患者随机均分成A、B、C 3组(每组30例),局麻药均为0.33%罗哌卡因30 mL,A组不用地佐辛,B组在局麻药中加地佐辛0.1 mg/kg,C组阻滞完成后即静脉注射地佐辛0.1 mg/kg.结果:B组感觉与运动神经阻滞起效时间快于A、C组(P<0.01),镇痛持续时间长于A、C组(P<0.01),术中、术后VAS疼痛评分低于A、C组(P<0.05,P<0.01);C组不良反应的发生率高于A、B两组.结论:罗哌卡因复合地佐辛行臂丛神经阻滞,可缩短阻滞起效时间,增强阻滞效果和延长镇痛时间,不良反应少.     

甲磺酸罗哌卡因和盐酸罗哌卡因肌间沟臂丛神经阻滞的比较

目的 观察0.596%甲磺酸罗哌卡因和0.5%盐酸罗哌卡因在超声引导下行肌间沟臂丛神经阻滞的效果.方法 60例上肢手术行肌间沟臂丛麻醉的患者,随机均分成两组:A组给予0.596%甲磺酸罗哌卡因30 ml;B组给予0.5%盐酸罗哌卡因30 ml.比较两组感觉及运动阻滞起效时间、阻滞程度、运动恢复时间、镇痛持续时间和不良反应.结果 A组尺神经感觉阻滞起效时间显著快于B组[(38.30±14.65)min vs.(48.03±22.34)min](P<0.05).注药60 min A组尺神经感觉完全阻滞29例(96.7%),显著多于B组的20例(66.7%)(P<0.05).结论 0.596%甲磺酸罗哌卡因的尺神经感觉阻滞优于0.5%盐酸罗哌卡因.     

罗哌卡因复合右美托咪定对臂丛神经阻滞的影响

目的观察罗哌卡因复合右美托咪定对行喙突入路臂丛神经阻滞的影响。方法择期上肢手术患者60例,随机分成罗哌卡因组(R组)和右美托咪定复合罗哌卡因组(RD组),每组30例。患者在喙突内下2 cm处,在神经刺激器引导下给予药物,R、RD组分别给予罗哌卡因200 mg及罗哌卡因200 mg复合右美托咪定1 μg/kg,容量均为40 ml。记录患者手术侧臂丛感觉和运动阻滞起效时间、感觉和运动阻滞持续时间。记录患者给药前、给药后15、30、60、90、120 min的HR、SBP、DBP及SpO2。同时记录RD组给药前和给药后30 min非手术上肢的镇痛评分。记录两组患者不良反应发生情况。结果 R组感觉、运动阻滞起效时间明显长于RD组,感觉、运动的阻滞持续时间明显短于RD组(P0.01);R组给药后30、60、90、120 min的HR明显快于、MAP明显高于RD组(P0.05)。RD组给药前和给药后30 min非手术上肢的镇痛评分差异无统计学意义。RD组中有7例患者出现HR减慢,需要阿托品处理。结论罗哌卡因复合右美托咪定行臂丛神经阻滞可缩短臂丛神经的感觉、运动阻滞起效时间,延长感觉、运动阻滞持续时间。     

相同浓度不同容量罗哌卡因超声引导锁骨上臂丛神经阻滞对膈肌麻痹的影响

目的观察超声引导锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)使用相同浓度不同容量罗哌卡因对膈肌麻痹的影响。方法选择拟行右上肢骨折术后取内固定装置术的患者72例,男32例,女40例,年龄18~65岁,ASA I或II级。随机分为两组:0.375%罗哌卡因20ml组(A组)和0.375%罗哌卡因30ml(B组),每组36例。所有患者在超声引导下行锁骨上臂丛神经阻滞,记录臂丛各主要神经根的感觉阻滞、运动阻滞的起效时间和持续时间,并观察两组患者不良反应的发生情况。采用M型超声测量阻滞前、阻滞后30min时两组平静呼吸和用力呼吸的膈肌移动度,通过观察膈肌移动度的变化来反映膈肌麻痹情况,并计算膈肌麻痹率。结果两组患者感觉阻滞起效时间、感觉阻滞和运动阻滞持续时间差异均无统计学意义。B组运动阻滞起效时间明显短于A组(P0.05)。阻滞后30min A组和B组分别有12例(33.3%)和22例(61.1%)患者出现膈肌麻痹,B组膈肌麻痹率明显高于A组(P0.05)。结论 0.375%罗哌卡因20 ml与30ml在超声引导下行锁骨上臂丛神经阻滞均可达到理想的臂丛阻滞效果,0.375%罗哌卡因20 ml引起膈肌麻痹较少。     

布托啡诺复合局麻药用于臂丛神经阻滞的临床观察

目的研究布托啡诺复合利多卡因和左旋布比卡因用于臂丛神经阻滞的镇痛效果。方法选择上肢手术患者40例,ASAⅠ或Ⅱ级,随机均分为两组,A组:0.06%布托啡诺+1%利多卡因+0.375%左旋布比卡因20 ml,B组:1%利多卡因+0.375%左旋布比卡因20 ml。分别记录两组麻醉起效时间、痛觉消失时间、镇痛持续时间,同时采用VAS评分评价镇痛效果。结果 A组镇痛持续时间明显长于B组(P<0.05)。A组麻醉后4、6、8 h静息VAS评分显著低于B组(P<0.05)。结论布托啡诺复合利多卡因和左旋布比卡因用于臂丛神经阻滞能够延长麻醉镇痛持续时间。     

罗哌卡因复合舒芬太尼或地佐辛连续股神经阻滞在全膝关节置换术后镇痛中的应用

目的观察罗哌卡因与罗哌卡因复合舒芬太尼或地佐辛连续股神经阻滞(FNB)在全膝关节置换术(TKA)术后镇痛中的效果。方法择期行单侧TKA患者60例,采用统一麻醉和手术方案,术后FNB自控镇痛48h,持续剂量2ml/h,总量100ml。随机将患者均分为三组:罗哌卡因组(R组):0.225%罗哌卡因;罗哌卡因复合地佐辛组(D组):0.15%罗哌卡因含地佐辛10 mg;罗哌卡因复合舒芬太尼组(S组):0.15%罗哌卡因含舒芬太尼1μg/kg。记录三组患者术后1、3及7d静息状态下VAS(RVAS)评分、主动功能锻炼时VAS(AVAS)评分和被动功能锻炼时VAS(PVAS)评分;记录其他镇痛药物用量、不良事件发生情况。结果术后1、3、7d三组患者RVAS评分,术后1、7d的AVAS评分和术后1d的PVAS评分明显低于术前(P0.05);术后3d,S组与D组RVAS评分明显高于R组(P0.05)。三组术后恶心呕吐及谵妄发生率差异无统计学意义。结论罗哌卡因复合舒芬太尼或地佐辛用于FNB,可提供良好的TKA术后镇痛效果,且不增加不良反应;但0.15%罗哌卡因复合舒芬太尼或地佐辛不及0.225%罗哌卡因镇痛维持时间长,复合地佐辛这一现象更明显。     

1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中的比较

目的观察1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中麻醉效果的比较。方法择期行肌间沟臂丛神经阻滞锁骨骨折成年患者30例,ASAⅠ~Ⅱ级,随机分为2组(n=15);1%甲哌卡因组(M组)和0.5%罗哌卡因组(R组)。两组均在神经刺激仪引导下,以肌间沟入路行臂丛神经阻滞,M组和R组分别注入1%甲哌卡因25 mL和0.5%罗哌卡因25 mL。观察两组血流动力学,感觉、运动阻滞起效及恢复时间,术后VAS评分,不良反应及麻醉满意度。结果与R组比较,M组感觉、运动阻滞起效时间缩短,阻滞恢复时间缩短(P0.05),术后6 h、12 h的VAS评分增加(P0.05)。结论 1%甲哌卡因与0.5%罗哌卡因行肌间沟臂丛神经阻滞,均能满足锁骨骨折手术。采用1%甲哌卡因较0.5%罗哌卡因起效更快,且感觉、运动恢复更早,利于早期活动,但术后镇痛效果不如0.5%罗哌卡因。     

罗哌卡因复合芬太尼肋间神经阻滞麻醉效果及对术后镇痛的影响

目的观察罗哌卡因复合芬太尼用于乳腺区段切除手术中肋间神经阻滞效果及术后镇痛作用。方法选择ASAⅠ或Ⅱ级择期行乳腺肿块区段切除术的患者60例,随机分为两组,每组30例。肋间神经使用0.375%罗哌卡因(Ⅰ组)或0.375%罗哌卡因+芬太尼2μg/ml(Ⅱ组)。观察两组麻醉起效时间、阻滞完善时间、麻醉维持时间、术后24 h镇痛效果及不良反应,记录麻醉期间RR、MAP、HR及SpO2的变化。结果与Ⅰ组比较,Ⅱ组麻醉起效时间和麻醉阻滞完善时间缩短(P<0.05)、维持时间延长(P<0.01);术后4、8、12 h VAS评分Ⅱ组降低(P<0.01)。两组患者生命体征、不良反应发生率差异无统计学意义。结论芬太尼可增强罗哌卡因肋间神经阻滞麻醉的效果,延长术后镇痛时效。     

罗哌卡因用于断指再植手术肌间沟臂丛神经阻滞的效应

目的 探讨罗哌卡因用于断指再植手术肌间沟臂丛神经阻滞的效应.方法 对2008年3月至9月,分别用0.50%的罗哌卡因和0.375%的布比卡因25 ml行肌间沟臂丛神经阻滞进行的断指再植手术72例进行分析.结果 罗哌卡因对感觉神经阻滞的起效时间明显缩短,维持时间明显延长,对运动神经阻滞的起效时间和维持时间均明显缩短,毒副作用与并发症明显减少.结论 罗哌卡因用于断指再植手术肌间沟臂丛神经阻滞麻醉比布比卡因起效迅速、镇痛持续时间长,麻醉效果满意.     

等剂量不同浓度罗哌卡因用于臂丛神经阻滞效果及血药浓度观察

目的探讨罗哌卡因用于肌间沟臂丛神经阻滞效果与血药浓度的关系。方法择期行上肢骨科手术患者60例,随机均分为三组,罗哌卡因150 mg分别配成20 ml(0.75%,A组)、30 ml(0.5%,B组)和40 ml(0.375%,C组),神经刺激仪定位行肌间沟臂丛神经阻滞。观察感觉、运动阻滞情况;高效液相法测定注药后10、15、20、30、60、90、120 min静脉血罗哌卡因浓度。结果感觉和运动阻滞起效时间均为A组相似文献   

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.