Hereditary neuropathy with liability to pressure palsies (HNPP) in hand surgery: reminds and warn against a usually unrecognised disease

Tomacula is a rare hereditary disease due to a deletion on chromosome 17. Clinical presentation varies but patients usually complain of recurrent paraesthesiaes and palsies related to compression or trauma of a peripheral nerve. Diagnosis is based on electrophysiological studies, nerve biopsies and genetic tests. Implications for the patient and family members are a genetic counselling and some simple preventive measures. Although there is no curative treatment for this neuropathy, surgery can be useful for decompression of nerves and neurolysis. However, the surgical act increases the risk of nerve damage. Knowing about the diagnosis can help the patient and the surgical team avoid causing lesions.     

Caudal block and light sevoflurane mask anesthesia in high-risk infants: an audit of 98 cases

Objective

In order to reduce the risk of postoperative apnoea, awake spinal anaesthesia or awake caudal anaesthesia are recommended for hernia surgery in newborn babies and former premature infants aged less than 60 weeks of amenorrhoea. However, additional sedation is sometimes necessary. Our working hypothesis was that a general anaesthesia with a face mask (sevoflurane) with no opiates nor neuromuscular blocking agents, maintaining the infant's spontaneous breathing and combined with a caudal anaesthesia, could provide a safe and effective alternative.

Study design

The epidemiological and technical data about the patient and the anaesthesia, as well as any per- and postoperative complications, were collected prospectively and analysed retrospectively.

Patients and methods

Ninety-eight infants undergoing hernia surgery were included during the period from 2003 to 2008.

Results

Caudal anaesthesia proved successful at first attempt in 69% of the infants (term or premature). Three attempts were needed in 8% of the infants born at term and 2% of the infants born prematurely. One failure was recorded. Seven patients presented one episode of peroperative apnoea; they were easily taken care of by means of brief face mask ventilation. The follow-up of these seven infants did not reveal any reappearance of postoperative apnoea/bradypnoea.

Conclusion

The technique proposed is an effective alternative to the awake locoregional anaesthesia techniques: it provides excellent conditions for surgery and presents similar perioperative morbidity and risk of postoperative apnoea.     

依托咪酯和丙泊酚单一制剂在胃镜操作全麻方案的比较研究

目的 比较依托咪酯和丙泊酚单一制剂在全麻胃镜操作中的应用特点.方法 择期行胃镜检查术100例,用随机数字表法随机分为依托咪酯(E)组和丙泊酚(P)组,双盲法给药.E组静注依托咪酯0.3 mg/kg,术中胃镜置入时追加0.1 mg/kg.P组静注丙泊酚2.5 mg/kg,术中胃镜置入时追加1 mg/kg.Ramsay分级...     

七氟醚与丙泊酚在小儿斜视手术麻醉的应用效果观察

目的 探究在小儿斜视手术麻醉中采用七氟醚与丙泊酚的效果。方法 选取我院2021年10月-2023年 10月收治的72例斜视患儿为研究对象,采用随机数字表法分为对照组和观察组,各36例,对照组输注丙泊 酚,观察组吸入七氟醚,比较两组生命体征、麻醉恢复情况、躁动发生率。结果 两组DBP、SBP比较,差 异无统计学意义（P ＞0.05）;观察组T2、T3、T4、T5时刻HR高于对照组（P ＜0.05）;观察组PACU停留 时间、Steward达到4分时间长于对照组,自主呼吸恢复时间短于对照组（P ＜0.05）,拔除气管导管时间短 于对照组,差异无统计学意义（P＞0.05）;观察组麻醉诱导期、麻醉苏醒期躁动发生率高于对照组,但差 异无统计学意义（P＞0.05）。结论 在小儿斜视手术麻醉中使用七氟醚吸入的效果更好,能改善患儿生命 体征,加快自主呼吸恢复时间,值得临床应用。     

咪唑安定与丙泊酚对脑电双频指数的影响

目的测定和比较咪唑安定与丙泊酚诱导时半数病人入睡时的脑电双频指数（BIS50）和半数有效量（ED50）。方法选择60例无服用精神药物和镇静催眠药物史、无术前用药的门诊手术病人（ASAⅠ～Ⅱ级），随机均分为咪唑安定组（M组）和丙泊酚组（P组），以半数效量序贯法分别进行咪唑安定与丙泊酚诱导的睡眠观察，以对语言指令和睫毛反射消失为入睡指标，同时记录BIS的变化。对取得的数据以直线回归的方法和加权均数法分别求得咪唑安定、丙泊酚的BIS50和ED50。结果咪唑安定诱导后，术峤病人与入睡病人的BIS值均较用药前的基础值明显下降，但下降幅度在两类病人之间差异无统计学意义，BISso和EDso分别为：77．02（95％可信区间为：71．08～85．86）和0．1237mg／kg（95％可信区间为：0．0990-0．1540mg／kg）。丙泊酚诱导时未睡病人的BIS值下降不明显，而入睡病人的BIS值显著下降，两者之间差异有统计学意义（P〈0．05）。丙泊酚的BIS50和ED50分别是79．17（95％可信区间为：72．08～88．55）和1．0192mg／kg（95％可信区间为：0．9400～1．1480mg／kg）。结论咪唑安定和丙泊酚对BIS的影响有较大的差异。与丙泊酚比较，BIS值与咪唑安定催眠效果的相关性小于丙泊酚。     

丙泊酚滥用和依赖性的研究进展

丙泊酚广泛用于麻醉诱导、维持和用于ICU镇静.除临床用药外,静脉注射丙泊酚可使人产生欣快感、愉悦、性幻想和去抑制.临床资料和动物实验研究发现丙泊酚存在滥用和依赖.现就丙泊酚滥用的一些临床报道和造成依赖的可能机制作一综述.     

异丙酚目标控制输注系统性能的临床研究

目的 评价异丙酚目标控制输液（ＴＣＩ）系统的性能。方法 自行编制内嵌药代动力学模型的控制程序。１２例择期手术病人,用上述程序控制佳士比３４００注射泵进行异丙酚给药,使用Ｔａｃｋｌｅｙ发表的参数,ＨＰＬＣ荧光法检测血药浓度。结果 １８３个血标本的执行误差的中位数（ＭＤＰＥ）＝－６．８％,执行误差绝对值的中位数（ＭＤＡＰＥ０＝１７．９％,分散度＝０．３５％／ｈ,摆动度＝１８．３％。诱导和切皮前后的血流     

异丙酚联合芬太尼用于无痛人工流产术中知晓的临床观察

目的比较异丙酚、异丙酚联合芬太尼在无痛人工流产中术中知晓发生率及相关因素。方法选择2000例无痛人工流产患者,随机分为A、B两组,分别用异丙酚、异丙酚＋芬太尼进行静脉麻醉。术后监测患者术中知晓情况。结果术中知晓在A组中有5例,B组中未发生。结论术中知晓可在无痛人工流产中发生,联合使用芬太尼可有效防止术中知晓的发生。     

右美托咪定与丙泊酚麻醉诱导时的协同作用

目的评价右美托咪定和丙泊酚麻醉诱导时镇静作用的相互影响。方法择期全麻手术患者75例,男36例,女39例,年龄18～65岁,BMI 20～25kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法均分为三组,每组25例:丙泊酚组(A组)、右美托咪定组(B组)、丙泊酚复合右美托咪定组(C组),每组再根据不同药物剂量分为5个亚组,相邻两组剂量等比为1.25,采用点斜法计算ED_(50)及其95%可信区间(CI)。结果A组丙泊酚诱导剂量ED_(50)为1.25 mg/kg(95%CI 0.90～1.45mg/kg),B组右美托咪定麻醉诱导剂量ED_(50)为1.35μg/kg(95%CI 0.95～1.50μg/kg),C组丙泊酚和右美托咪定诱导剂量ED_(50)分别为0.65mg/kg(95%CI 0.50～0.90mg/kg)和0.40μg/kg(95%CI 0.34～0.65μg/kg)。等辐射分析法判定丙泊酚和右美托咪定之间在镇静效应上呈现协同作用。结论右美托咪定复合丙泊酚可以产生明显的镇静效应协同作用。     

丙泊酚和七氟醚对成年患者校正QT间期影响的Meta分析

目的 系统性评价丙泊酚与七氟醚分别用于成年患者全身麻醉诱导时对ECG校正QT间期(corrected QT,QTc)的影响.方法 计算机检索PubMed、Embase、Cochrane图书馆、中国知网、维普网等数据库的相关文献,并对相关文献的参考文献进行进一步的检索,收集七氟醚和丙泊酚用于成年人手术全身麻醉诱导的随机对照实验(randomized-controlled trial,RCT),采用Cochrane系统评价员手册评价纳入文献的质量,采用RevMan5.0软件对收集的资料进行Meta分析.结果 纳入7项研究,共计313名患者,Meta分析结果显示:七氟醚与丙泊酚比较,具有明显的延长心肌复极时程的作用[加权均数差(weighted mean difference,WMD)=-23.53,95%CI(-30.57~-16.49)](P<0.01),但对于HR[(WMD=0.22,95%CI(-4.92~5.36)]及MAP[(WMD=-2.23,95%CI(-8.66~4.20)]的影响二者差异并无统计学意义(P>0.05).结论 与丙泊酚相比,七氟醚可明显延长心肌复极时程,增加心律失常发生的风险,且二者对于血流动力学的影响无明显差异,提示在麻醉诱导过程中,丙泊酚对于心脏电生理的影响较小,是一种良好的麻醉诱导药.     

两种浓度丙泊酚用于腹腔镜胆囊切除术患者药物效应比较

目的 比较相同剂量1％丙泊酚与2％丙泊酚用于腹腔镜胆囊切除术患者的药物效应及达到相同药物效应时的药物用量.方法 选择拟行腹腔镜胆囊切除术患者100例,采用随机数字表法分为两组(每组50例):输注1％丙泊酚组(Ⅰ组)、输注2％丙泊酚组(Ⅱ组).诱导剂量均为2 mg/kg,整个麻醉过程中用Narcotrend麻醉深度监护仪监测麻醉深度,诱导完成后根据Narcotrend指数调整两组丙泊酚的泵速.观察患者Narcotrend指数下降到36的时间、意识消失时间、监测诱导开始15 min内MAP和HR下降百分比、丙泊酚第1小时用量及停药至Narcotrend指数恢复到65的时间.结果 两组患者意识消失时间及Narcotrend指数下降到36的时间Ⅰ组分别为(115±45)s和(136±54)s,Ⅱ组分别为(156±60)s和(183±61)s,Ⅰ组短于Ⅱ组(P＜0.05).丙？白酚使用总量和丙泊酚第1小时用量Ⅰ组分别为(41±15)ml和(36±10) ml,Ⅱ组的2倍用药量分别为(53±18) ml和(46±15)ml,Ⅱ组的2倍用药量大于Ⅰ组用药量(P＜0.05).结论 2％丙泊酚麻醉药用量的2倍大于1％丙泊酚,而不是等量的,这说明1％丙泊酚的药效可能强于2％丙泊酚,2％丙泊酚经济效益相对较低.     

丙泊酚的药效及对脂代谢的影响

目的观察丙泊酚的药效学及对家兔脂代谢的影响。方法家兔12只,随机分为1%丙泊酚组(Ⅰ组)和2%丙泊酚组(Ⅱ组),每组6只。两组丙泊酚单次首次剂量均为6mg/kg,以0.6mg/s从家兔耳缘静脉分别匀速注射,观察和记录家兔头正位反射消失时间。注射完毕后接麻醉注射泵以400μg·kg-1·min-1的速度持续输注丙泊酚6h,记录心率、血压和呼吸等生命体征变化及停药后苏醒时间。并于静注前、静注完毕、持续输注5、30min及1、3、6h和苏醒时分别抽血行血气分析,检测血药浓度及血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)的浓度。结果Ⅰ组家兔血清TG浓度在持续输注1、3和6h与静注前比较均有显著增高(P<0.01),血清TC浓度仅在持续输注6h较静注前增高(P<0.01);Ⅱ组在6h的血清TG浓度高于用药前(P<0.01),但同时点仍低于Ⅰ组(P<0.01)。结论2%丙泊酚与1%丙泊酚的药效相似,但2%丙泊酚能明显延缓脂代谢紊乱的发生时间。     

Effect of patient-controlled sedation with propofol on patient satisfaction: A randomized study

Background

In this trial we sought to determine whether propofol-based patient-controlled sedation (PCS) during diagnostic cerebral angiography would result in improved patient satisfaction compared to placebo-based PCS.

Methods

We randomly assigned 61 patients to receive propofol-based PCS (n = 33, 15 mg bolus in 9 s) or placebo-based PCS (n = 28, bolus of 1.5 mL of a 20% lipid emulsion in 9 s). We recorded the number of PCS bolus requirements, the need for rescue sedative drugs, and physiological variables. Prior to the procedure, the anxiety level of each patient was evaluated using the Anxiety State Traits Assessment (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The quality of patient conditioning was quoted by both the anesthetist and neuroradiologist using Visual Analog Scale (VAS). The day following the procedure, patients were given the EVAN questionnaire, a validated tool for assessing patient satisfaction.

Results

Both groups were similar in term of demographics, American Society of Anesthesiologist (ASA) physical status scores, STAI and APAIS scores, and procedure lengths. There were no differences between groups in EVAN scores 76.9 ± 16.1 vs. 75.7 ± 12.8; P = 0.78. The number of PCS bolus requirements was significantly higher in the placebo group 3.96 ± 9.5 vs. 3.13 ± 3.1 (P = 0.02). No adverse event was recorded.

Conclusion

This prospective, double-blind, randomized study showed that sedation using propofol PCS did not improve patients’ satisfaction during diagnostic cerebral angiography. Therefore, an anesthetist should be rapidly available on request but not necessarily present during the whole procedure.     

Maintenance of unconsciousness with low plasma propofol concentrations in the neohepatic phase of liver transplantation using bispectral index-guided propofol anesthesia: A case report

The authors present a case where a drug-effect parameter, the bispectral index, was used to guide propofol infusion when propofol–remifentanil anesthesia was used for liver transplantation. The target concentration of remifentanil was kept constant throughout the operation, and the bispectral index indicated that propofol infusion was not required during the anhepatic and neohepatic phases of the operation. The measured plasma propofol concentrations during the neohepatic phase were far below the usual values that are used to maintain anesthesia. However, the bispectral index indicated a state of unconsciousness. The patient regained consciousness rapidly several minutes after administration of neostigmine and secession of remifentanil infusion. The measured plasma propofol concentrations were similar before and after recovery of consciousness. The possible mechanisms for the maintenance of anesthesia at reduced propofol concentrations are multifactorial and may be related to reduced liver function as well as an interaction between propofol and remifentanil or the use of a neuromuscular relaxant to suppress somatic afferent activity.     

丙泊酚效应位消除速率常数和50%有效浓度的测定

目的　确定以脑电双频指数 (BIS)作为效应指标时的效应位消除速率常数 (ke0 )和5 0 %有效浓度 (EC50 ) ,并探讨年龄对这些参数的影响。方法　 12例患者按年龄分为老年组 (≥ 6 5岁 ,n =6 )和青壮年组 (<6 5岁 ,n =6 ) ,分别持续输注丙泊酚 6 0ml/h和 75ml/h直至意识消失。持续监测BIS直至恢复至用药前 95 %以上。ke0和EC50 根据“S”最大效应曲线计算。结果　老年组和青壮年组BIS的EC50 分别为 4 71μg/ml和 4 0 2 μg/ml(P >0 0 5 ) ;ke0分别为 0 4 36 /min和 0 35 6 /min(P >0 0 5 )。结论　年龄不影响BIS随丙泊酚浓度上升而降低的速度 ,反之亦然。以BIS作为效应指标时 ,年龄对丙泊酚的药效学无明显影响。     

Chromic acid burns: systematic prevention of systemic toxicity

Chromic acid burns can lead to systemic toxicity by cutaneous absorption of the chrome seen surfaces more than 1% of the total body surface area. In order to illustrate the necessity of anticipate systematically this toxicity by a specific treatment, we describe the case of a patient with systemic toxicity in the least severe situation of chromic acid burn: the chromic acid was diluted to 0,02%, the burn was superficial second degree, both thermic and chemical, on the forearm, and extended only to 1% of the total body surface area. In spite of the specific treatment, our patient had a blood transfer of the chrome, however without any consequences on the renal and hepatic functions. He cicatrised in 2 weeks, and his blood and urinary chromium levels were normalised in 3 weeks. Without this specific early treatment, what would have been the consequences of a systemic toxicity even more important?     

老年和青壮年病人异丙酚全麻诱导的药代动力学比较

目的 观察老年病人异丙酚单次静注全麻诱导的药动学特征,并与青壮年进行比较。方法18例ASAⅠ～Ⅱ级的择期手术病人,按照年龄大小分成两组,青壮年组(n=6,A组):年龄31～57岁(平均46.5岁),麻醉诱导用异丙酚1.5mg·kg-1、咪达唑仑0.03～0.06mg·kg-1、芬太尼3～5μg·kg-1和维库溴铵0.1mg·kg-1;老年组(n=12,E组):年龄67～81岁(平均74.0岁),再以75岁为界分成两个亚组,E1组(n=6,67～73岁,平均69.3岁)和E2组(n=6,76～81岁,平均78.7岁),麻醉诱导用异丙酚1.0mg·kg-1,其余同A组。经前臂静脉注射异丙酚,分别于注射前和注射后1、2、4、6、10、15、30、45、60、75、90、120、150、180、240、300、360min从右颈内静脉采血3ml,肝素抗凝、离心后取上层血浆于4℃下保存。用高效液相色谱荧光法检测血浆中异丙酚浓度,3P87软件计算药代动力学参数。结果18例病人异丙酚的药动学特征均符合三室开放模型,A组注药后1,2,4,6,10min的平均血药浓度值经剂量校正后均低于E组及其亚组(P<0.05),2min时尤为明显(P<0.01)。E组与E1组和E2组相比较,各数值间均无显著差异;E2组与E1组相比,仅T1/2β较长(p<0.05)。与A组相比,E组的Vc明显减少(P<0.01),CL显著下降(P<0.01),K31明显变小(P<0.01),T1/2β也较长(P<0.05)。结论 异丙酚用于老年人麻     

全麻诱导气管插管时大脑皮层电活动与血流动力学的变化——比较异丙酚和硫喷妥钠的药理作用

目的：探讨数量化脑电图在反映麻醉诱导气管插管期间脑电的活动程度，以及ＥＥＧ和心血管反应相关性研究。方法：７０例ＡＳＡⅠ级病人，随机双盲分两组，组Ⅰ（ｎ＝３５）硫喷妥钠，组Ⅱ（ｎ＝３５）异丙酚。硫喷妥钠或异丙酚和琥珀胆碱行气管插管。分别于诱导前、诱导后、气管插管后１～２分和３～５分监测数量化脑电图、ＭＡＰ、ＨＲ、ＳｐＯ２的变化。结果：诱导前，两组病人的ＥＥＧ及血流动力学参数无差异。诱导后，ＥＥＧ抑制，ＳＥＦ、ＭＦ、ＢＩＳ下降，δＲ升高，但两组之间无区别；异丙酚组ＭＡＰ降低程度大于硫喷妥钠组（Ｐ＜０．０１），ＨＲ无差异。气管插管后，ＥＥＧ活化，ＳＥＦ、ＭＦ、ＢＩＳ升高（Ｐ＜０．０１），δＲ降低（Ｐ＜０．０１），异丙酚组ＥＥＧ各参数的变化程度轻于硫喷妥钠组（Ｐ＜０．０１）；异丙酚组ＭＡＰ和ＨＲ升高程度小于硫喷妥钠组（Ｐ＜０．０１）。结论：气管插管前，等效剂量的异丙酚和硫喷妥钠对中枢神经的抑制程度类似，气管插管后，异丙酚组的ＥＥＧ活化程度及血流动力学的变化明显轻于硫喷妥钠。