气管内硬膜外联合麻醉下的超前镇痛

目的 研究气管内硬膜外联合麻醉下，硬膜外给药时间不同、全麻诱导药物不同对术后镇痛产生的影响。方法 开腹行切除肝癌、胃癌的病人120例，随机分为A、B、C、D4组，每组30例。A组：在T8-9经硬膜外注入1％利多卡因和0．25％布比卡因混合液6～8ml，再经硬膜外注入含吗啡2mg、氟哌利多2．5mg的生理盐水10ml；全身麻醉诱导药物为芬太尼3μg／kg，异丙酚1～1．5mg／kg，琥珀胆碱2mg／kg。B组：诱导药物中不使用芬太尼，用利多卡因1～1．5mg／kg代替，术中也不使用芬太尼，其余条件同A组。C组：在T8-9行硬膜外穿刺，之后行全身麻醉诱导，诱导药物为芬太尼3μg／kg，异丙酚2—2．5mg／kg，琥珀胆碱2mg／kg，必要时可加芬太尼2～3μg／kg。切皮后90min，经硬膜外注入1％利多卡因和0．25％布比卡因6～8ml，再经硬膜外注入含吗啡2mg、氟哌利多2．5mg的生理盐水10ml。D组：诱导药物中不使用芬太尼，用利多卡因1～1．5mg／kg代替，术中也不使用芬太尼，其余条件同C组。分别于术毕后4、8、24、48h观察视觉模拟评分（VAS）、镇痛药消耗量、恶心、呕吐、瘙痒等指标。结果 A组的药物消耗量最少、镇痛效果最好；B组和C组次之；D组的药物消耗量最大，镇痛效果最差。结论 硬膜外复合气管内麻醉时，硬膜外麻醉与芬太尼同时使用，术后镇痛效果最好。     

硬膜外阻滞复合全身麻醉在胸腔手术中的应用

<正> 自2000年1月至今,我院对40例择期胸腔手术患者采用了硬膜外阻滞复合全麻,均取得良好效果,现报告如下: 1 资料与方法 1.1 一般资料:择期胸腔手术患者40例,男27例,女13例,年龄40～68岁,ASAⅠ～Ⅱ级,采用硬膜外阻滞复合全身麻醉(A组);另选40例手中种类、年龄、性别均与A组类同患者,采用单纯静脉麻醉进行对照(B组)。 1.2 麻醉方法:术前30min肌注鲁米那0.1g和阿托品0.5mg。A组先行于T_(6-8)作硬膜外穿刺置管,注入1％利多卡因为试验量,观察无腰麻症状后注入1.6％利多卡因10ml,出现麻醉平面后,再行全麻诱导插管,以1％普鲁卡因、芬太尼、琥珀胆碱复合液维持麻醉,每隔30～45min经硬膜外导管注入1.6％利多卡因5ml。术毕向硬膜外腔注入吗啡3mg+氟哌啶3mg+生理盐水10ml行术后镇痛。B组单用静脉麻醉,方法同     

小剂量氯胺酮复合芬太尼术后静脉镇痛

目的　比较小剂量氯胺酮联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者 12 0例 ,随机均分为三组 ,每组 4 0例 ,以一次性静脉镇痛泵 (2ml/h)分别行静脉术后镇痛。F组 :单纯芬太尼镇痛 ,0 4 μg·kg-1·h-1芬太尼 +5mg氟哌利多。KF1组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +40 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。KF2组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +80 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。各组镇痛泵中药物均用医用盐水稀释至 10 0ml。观察各组患者镇痛 4 8小时内的静息镇痛评分 (VAS方法 )、恶心呕吐、皮肤瘙痒、尿潴留和幻觉的发生情况。结果　三组患者的静息镇痛评分在 12小时内KF1组和KF2组明显低于F组 (P <0 0 5 ) ,而在 12小时后没有明显差别 (P >0 0 5 ) ;恶心呕吐、皮肤瘙痒和尿潴留发生率KF1组和KF2组显著低于F组 (P <0 0 1)。KF1组和KF2组之间在静息镇痛评分和并发症发生方面没有明显差别。三组中均无幻觉发生。结论　小剂量氯胺酮用于术后静脉镇痛可明显减少芬太尼的剂量 ,使恶心呕吐、皮肤瘙痒和尿潴留发生率降低 ,镇痛效果明显优于单纯芬太尼术后静脉镇痛     

芬太尼应用于妇科手术利多卡因硬膜外麻醉的临床研究

33例择期妇科手术病人,随机分为两组,即利多卡因-芬太尼组(F组)16例和利多卡因组(L组)17例。F组硬膜外用药2％利多卡因20ml加芬太尼0.1mg,加生理盐水至25ml;L组2％利多卡因20ml加生理盐水至25ml,两组均含1:20万的肾上腺素。全部病例均于L_(2～3)间隙穿刺,向头端置管3cm。研究结果表明:在妇科手术中,利多卡因-芬太尼混合液应用于硬膜外麻醉较单纯用利多卡因更能增强硬膜外麻醉的镇痛效果,延长镇痛持续时间,减少术中静脉用镇痛药,而腹肌松弛度与单纯用利多卡因相似。术中及术后24h内均未发生呼吸抑制,其他副作用两组相似。因此,利多卡因与芬太尼合用不失为一种可供选用的硬膜外麻醉方法。     

联合麻醉术中知晓与脑电双频指数关系的分析

目的　探讨硬膜外阻滞复合全身麻醉术中知晓的发生率以及脑电双频指数 (BIS)与镇静深度的关系。方法　选择ASAⅠ～Ⅱ级的肝癌手术患者 2 40例 ,麻醉方法均为硬膜外阻滞加全麻。分为两组 :异丙酚组 (P组 ,n =12 0 ) ,术前 30分钟肌注苯巴比妥钠 0 1g、阿托品 0 3mg ,诱导用芬太尼 4μg/kg、异丙酚 1 5mg/kg、琥珀胆碱 2mg/kg ,维持用异丙酚 12mg·kg-1·h-1,持续 15分钟后改为 3mg·kg-1·h-1至术毕 ;硫喷妥钠组 (T组 ,n =12 0 ) ,术前 30分钟肌注咪唑安定 0 0 75～ 0 1mg/kg、阿托品 0 3mg ,诱导用硫喷妥钠 6mg/kg替换P组的异丙酚 ,其余药相同 ,维持用 6 0 %的N2 O吸入至术毕。两组均在诱导前 15分钟开始在硬膜外导管内注入 0 5 %布比卡因 4ml。术中持续监测BIS和边缘频率 (SEF)。结果　诱导前两组患者的EEG无差异 ;诱导后 15分钟和 30分钟 ,EEG抑制 ,BIS和SEF均降低 ,组间无差异 ;诱导后 6 0分钟和 12 0分钟 ,P组的BIS和SEF比T组低 (P <0 0 5 )。P组 1例术中知晓。结论　联合麻醉中 ,用BIS监测预防术中知晓的发生缺乏精确性。     

双异丙酚、阿芬太尼静注利多卡因麻醉诱导后气管插管

为了了解双异丙酚、阿芬太尼和静注利多卡因麻醉诱导气管插管条件和血流动力学反应,作者选择60例(ASAⅠ或Ⅱ级)择期施行妇科手术病人,随机等分为四组(此四组的年龄、体重、血压和心率均相仿,术前均口服替马西泮),组1静注双异丙酚2.5mg·kg~(-1),阿芬太尼10μg·kg~(-1),生理盐水5ml;组2静注双异丙酚2.5mg·kg~(-1),阿芬太尼10μg·kg~(-1),利多卡因1mg·kg~(-1);组3静注双异丙酚2.5mg·kg~(-1),阿芬太尼     

妇科手术病人不同麻醉方法绩效的比较

目的 比较妇科手术病人单纯全麻和硬膜外复合全麻的绩效.方法 择期妇科手术病人30例,年龄18～64岁,ASA Ⅰ或Ⅱ级,随机分为2组(n=15):单纯全麻组(G组)和硬膜外复合全麻组(EG组).EG组硬膜外注射2%利多卡因试验剂量3 ml.两组静脉注射地塞米松、氟哌利多、芬太尼、异丙酚和琥珀酰胆碱麻醉诱导,气管插管后机械通气.G组吸入七氟醚及间断静脉注射芬太尼维持麻醉;EG组吸入七氟醚及间断硬膜外注射利多卡因和丁卡因维持麻醉;两组静脉注射维库溴铵维持肌松.术毕入PACU,G组采用病人自控静脉镇痛;EG组采用病人自控硬膜外镇痛.记录苏醒时间、拔管时间和PACU停留时间;记录七氟醚、芬太尼、肌松药和血管活性药物用量;于术后6、24、48 h时记录静息状态和活动状态的VAS评分以及镇痛泵实际按压次数和有效按压次数;记录术后不良反应的发生情况;计算麻醉有关费用.结果 与G组比较,EG组拔管时间和PACU停留时间缩短,七氟醚和芬太尼用量减少,术后6 h时实际按压次数和有效按压次数减少(P＜0.05或0.01),苏醒时间、各时点镇痛效果、不良反应发生率和麻醉总费用差异无统计学意义(P＞0.05).结论 与单纯全麻相比,妇科手术病人硬膜外复合全麻麻醉药物用量少,术后早期镇痛效果好,且麻醉总费用相当.     

异丙酚配合小剂量芬太尼用于门诊吸脂术麻醉的临床观察

目的　对 32例门诊吸脂术患者采用异丙酚加小剂量芬太尼的麻醉效果进行观察。方法　手术时先静脉注射芬太尼 1 μg·kg- 1 ,5分钟后再静脉注射异丙酚 0 .8～ 1 .0mg·kg- 1 ,以睫毛反射消失为意识消失的标志酌情用药。后以 0 .1～ 0 .2mg·kg- 1 ·min- 1 的速度持续输注 ,直至手术结束。结果　麻醉效果满意 ,对循环功能影响轻微 ,对呼吸抑制明显 ,5分钟内患者均可自行恢复。结论　异丙酚配合小剂量芬太尼静脉麻醉用于门诊吸脂术可靠易行 ,诱导苏醒迅速 ,且术后无循环、呼吸抑制 ,效果可靠。但术中应严密观察呼吸频率、SpO2 及Bp的变化 ,确保患者的安全     

芬太尼、吗啡、丁丙诺啡复合局麻药分别行硬膜外术后镇痛效果观察对比

目的 :探讨术后分别应用芬太尼、吗啡、丁丙诺啡复合局麻药及氟哌利多行硬膜外自控镇痛 ,观察其镇痛效果及不良反应发生率 ,综合比较哪种药物配方更理想。方法 :选择ASAⅠ～Ⅱ级 ,年龄 2 2～ 30岁 ,体重无较大差异的妇产科手术病人 6 0例 ,随机分为A、B、C三组 (每组 2 0例 ) ,均行硬膜外麻醉。术后接止痛泵行PCEA。单次剂量 1ml,锁定时间 2 0min ,术后随访 2d。结果 :从镇痛效果比较 ,A组为 50 % ,B组 75% ,C组为 80 %。结论 :芬太尼配方组不良反应少 ,但镇痛效果差 ;吗啡配方组镇痛好 ,但不良反应发生率高 ;丁丙诺啡组镇痛效果最好 ,不良反应发生率低 ,故选用丁丙诺啡 0 .6mg ,氟哌利多 2 .5mg ,复合 0 .1 1 2 5%布比卡因 1 0 0ml行妇产科手术后PCEA是一种较理想的药物配方。     

不同剂量芬太尼用于小儿全麻术后镇痛的临床研究

观察比较不同剂量芬太尼静脉持续输注于小儿全麻术后镇痛的效果和不良反应。资料与方法一般资料　选择ASAⅠ～Ⅱ级腹部手术病人 1 2 0例 ,年龄 5～ 1 5岁 ,随机分为三组 ,每组 4 0例 ,镇痛泵药量 :Ⅰ组 ,芬太尼为 8μg·kg 1 ·d 1 ;Ⅱ组 ,为 1 0 8μg·kg 1 ·d 1 ;Ⅲ组 ,为 1 2μg·kg 1 ·d 1 。全部病人全麻下手术 ,麻醉诱导阿托品0 0 1mg/kg、芬太尼 2～ 3μg/kg、丙泊酚 2～ 3mg/kg、维库溴铵 0 1～ 0 1 5mg/kg。术中ISO吸入 ,间断芬太尼、丙泊酚推注。手术开始即接注韩国艾可孚镇痛泵 ,以 2ml/h恒速输注 ,观察术毕、术后 4、8…     

Finland's first anaesthesia revealed by newspapers

Background: According to the literature on the history of anaesthesia, Finland's first anaesthesia was given on March 8, 1847 for a ligature of an aneurysm of the subclavian artery. It has, however, not been possible to verify the date with certainty. We therefore wanted to find out whether newspapers might give additional information and how this exceptionally important medical invention had been received by the Finnish newspapers.
Methods: Microfilms of the 10 newspapers which appeared in Finland in 1847 were studied at the Helsinki University library.
Results: The first report which made reference to English newspapers was published on February 10 by "Borgå Tidning". On March 6, "Helsingfors Tidningar" wrote that two anaesthesias had already been given in Helsinki; the first of them for a difficult varicose veins operation and the second for an exarticulation of a shoulder. But there was no information regarding the dates of the operations. Fortunately, both operations had been recorded in the patient diary of the clinic, although without any information about the anaesthesia. According to the diary, Johan August Örn was operated for varicose veins on February 16 and Anders Gustaf Henrikson had his right arm exarticulated on March 3. Both patients recovered. In total, only six pieces of news on anaesthesia were found.
Conclusions: Finland's first anaesthesia was given on February 16, 1847, which is three weeks earlier than had been previously assumed.     

Awareness and general anaesthesia

A state exists after the induction of anaesthesia in which patients may be aware of their surroundings yet unable to communicate. This problem of awareness and recall during general anaesthesia is a recent one in the relatively short history of anaesthesia. Prior to the introduction of muscle relaxants in 1942 by Griffith and Johnson, it was felt that "light anaesthesia" would be signified by violent movements. Today, the concepts of anaesthetic depth, awareness, and recall have become more complicated with the addition of numerous newer, shorter-acting, intravenous anaesthetic agents with varying effects on the conscious state. Several methods have been described to detect awareness. None has yet been found to be totally reliable and numerous reports of awareness can be found in the literature. Light inhalation and total intravenous anaesthesia have been blamed for the majority of these case reports. However, awareness during total intravenous anaesthesia is avoidable with the proper use of a combination of a hypnotic and an analgesic such as midazolam and alfentanil for general anaesthesia.     

Intradermal anaesthesia: comparison of several compounds

Objective: To compare the efficacy of different local anaesthetics to produce intradermal anaesthesia for venous cannulation and the discomfort associated with skin infiltration.
Measurements: A visual analog scale (VAS) for pain (0 = no pain/10 = most pain imaginable) was used to assess pain elicited by raising the skin wheal and inserting the cannula.
Main results: With regard to analgesic potency all five local anaesthetics were comparable (mean VAS–score 1.7–2.09) and effective when compared to 0.9% saline (mean VAS–score 4.2; P < 0.001). Infiltration pain was least with mepivacaine–1 (mean VAS–score 1.0; P < 0.001) and highest with procaine (mean VAS score 2.7; P < 0.001).     

Comparison of hypotensive epidural anaesthesia and spinal anaesthesia on blood loss and coagulation during and after total hip arthroplasty

BACKGROUND: Hypotensive epidural anaesthesia (HEA) is a technique for reducing peroperative blood loss by significantly lowering mean arterial pressure (MAP). METHODS: Thirty patients scheduled for primary total hip arthroplasty were given HEA (n=15) or spinal anaesthesia (SPA) (n= 15) with bupivacaine in random order. The dose of bupivacaine was titrated to provide epidural blockade up to T1-T4 and spinal blockade at least to T10. Intravenous adrenaline infusion was adjusted to achieve a MAP of about 50-60 mmHg in the HEA group. During SPA MAP was maintained above 70 mmHg with ephedrine, as needed. RESULTS: Intraoperative blood loss (median and 25th and 75th percentiles) was 400 ml (163-575) in the HEA group and 900 ml (663-1,100) in the SPA group (P<0.05). At 3 h postoperatively cumulative blood loss was still smaller in the HEA group (600 ml versus 1,100 ml, P<0.05). The cumulative number of transfused packed red cell concentrate (PRC) units was smaller in the HEA group than in the SPA group during surgery and postoperatively. Prothrombin time value was smaller in the SPA than in the HEA group (69% versus 79%, P<0.05) at 3 h postoperatively. D-dimer concentrations increased more in the SPA group at the end of the surgery and 3 h postoperatively (P<0.05). CONCLUSIONS: HEA resulted in reduced blood loss due to hypotension and reduced number of transfused PRC units during total hip arthroplasty. Based on lower prothrombin time value and higher D-dimer concentrations in the SPA group, the coagulation system might be better preserved during HEA than SPA.     

整形美容与麻醉安全

医学整形美容行业在我国已经相当流行,然而,近年来我国连续发生了多起涉及美容麻醉医疗安全的事件,其主要原因是美容行业忽视了麻醉安全问题,为此,笔者从麻醉学的角度就＂整形美容与麻醉安全＂这一问题作一初步分析及讨论。     

Treatment of ventricular fibrillation during anaesthesia in an anaesthesia simulator

Background : To evaluate treatment of ventricular fibrillation (VF) occurring during anaesthesia and the use of a full–scale simulator, 80 anaesthetists in teams of two were attending a training session in the simulator Sophus.
Methods : The sessions were recorded on videotape and reviewed with the anaesthetists afterwards. Time of treatment and the sequence were registered.
Results : Onset time for VF was the starting point. Most of the subjects changed respiratory settings. Four teams did not change inspiratory oxygen and 17 teams did not turn off the vaporiser. Cardiac compression was initiated by all teams. DCdefibrillation was not used by two teams, with 38 of 40 teams defibrillating once, 37 twice and 29 teams three times. Adrenaline was administered by 30 of 40 teams.
Conclusion : There was very little consistency among the teams regarding treatment for VF according to accepted algorithms. An anaesthesia simulator could be a tool for training and it is a safe way of demonstrating for the anaesthetist that certain treatment algorithms and behaviour during critical incidents are the most effective.     

Topical wound anaesthesia in children--a temporary postoperative pain relief

BACKGROUND: Administration of local anaesthetics into the surgical wound may modulate pain at the peripheral level. A previous study in adults has shown good analgesic effects of topical lidocaine in wounds after herniorrhaphy. METHODS: Postoperative pain relief after topical administration of 10% lidocaine aerosol in the surgical wound was investigated in a randomised, double-blind study in children undergoing inguinal hernia repair. Forty-four patients aged between 9 months and 11 years were randomised into three groups. One group received active treatment with a lidocaine aerosol 2.5-4.7 mg kg-1, one group received a placebo aerosol and one control group was untreated. Postoperative pain was evaluated by nurse assessment, self-assessment and wound palpation 0, 1, 4 and 12 h after arrival in the recovery room. RESULTS: After 1 h the incidence of pain, as estimated by behavioural assessment and self-assessment, was significantly reduced in the lidocaine group in comparison to the placebo group, but not in comparison to the control group. The reaction on wound palpation was significantly reduced in the lidocaine group compared to both the placebo and control groups. At 0, 4 and 12 h no significant differences between the groups were observed. Plasma lidocaine concentrations were measured in six patients. Maximum individual concentrations were low, ranging from 0.17 to 0.86 microgram ml-1. CONCLUSION: A very short and clinically insignificant pain relief is obtained following the administration of a lidocaine aerosol in the surgical wound. A low pain level in this model may limit the possibility to detect an effect of lidocaine.