Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications.

AIMS: To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS: Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS: Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION: IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.     

听觉诱发电位指数指导全凭静脉麻醉期间病人输注异丙酚的效果

目的探讨听觉诱发电位指数(AAI)指导全凭静脉麻醉期间病人输注异丙酚的效果。方法择期全麻下行腹腔镜胆囊切除术病人60例,ASAⅠ或Ⅱ级,随机分为2组(n=30):试验组(Ⅰ组)和对照组(Ⅱ组)。静脉诱导气管插管后,持续输注0．2μg·kg-1·min-1瑞芬太尼以维持合适的麻醉深度。Ⅰ组通过监测AAI调节异丙酚输注速率,使AAI维持在30以下,Ⅱ组根据病人血压及心率调节异丙酚输注速率,每5分钟增减0．01 mg·kg-1·min-1异丙酚。记录气腹前(T1)、气腹后(T2)、分离胆囊(T3)、腹腔冲洗(T4)、手术结束(T5)时2组的血压、心率、AAI和输注异丙酚的速率,同时记录2组异丙酚、维库溴铵、瑞芬太尼用量、术毕睁眼时间、应答时间和拔管时间。结果2组各时间点AAI差异有统计学意义(P<0．05),与Ⅱ组相比,Ⅰ组输注异丙酚速率以及总用量减少(P<0．05)。术后24 h随访病人均无术中知晓。结论AAI指导全凭静脉麻醉输注异丙酚用于腹腔镜胆囊切除术病人,可较好的控制麻醉深度,指导合理用药,避免病人术中知晓。     

刺激视上核对大鼠痛阈及电针镇痛的影响

以钾离子透引起的大鼠甩尾反应为痛指标，观察了电和化学刺激视上核（ＳＯＮ）对大鼠痛阈（ＰＴ）和电针（ＥＡ）镇痛的影响。电刺激ＳＯＮ后，ＰＴ明显高于假刺激组（Ｐ＜０．０５～０．００１），电刺激ＳＯＮ后电针足三里，镇痛效应明显提高，并有明显的量效关系。电刺激ＳＯＮ的近旁部位（０．５—１ｍｍ）对ＰＴ及电针镇痛无明显影响。ＳＯＮ内注射Ｌ－谷氨酸（Ｌ－Ｇｌｕ）后痛阈和电针镇痛效应都明显对照组，也有明显的量效关     

The use of propofol and alfentanil by infusion in military anaesthesia

A total intravenous technique using propofol and alfentanil was used successfully in four battlefield casualties treated at a British Military Field Hospital during the recent Gulf conflict. All patients made a rapid recovery of adequate quality for prompt evacuation. We believe that the use of propofol and alfentanil as an induction and maintenance regimen for military anaesthesia merits further evaluation and comparison with established techniques.     

黄芪注射液对冠心病病人心电图的影响

目的：观察黄芪注射液对冠心病病人心电图的影响。方法：冠心病６０例（男性４５例，女性１５例，年龄５４±ｓ１３ａ），采用黄芪注射液２０ｍＬ＋５％葡萄糖氯化钠注射液２５０ｍＬ，静脉滴注，ｑｄ，连用２ｗｋ。结果：治疗后心电图Ｐｔｆ－Ｖ１绝对值减小，缺血型ＳＴ－Ｔ明显改善。结论：黄芪注射液能明显改善冠心病心肌缺血之ＳＴ－Ｔ改变及左心功能不全所致的Ｐｔｆ－Ｖ１负值增大。     

Influence of anaesthesia and muscle relaxation on intubating conditions and sympathoadrenal response to tracheal intubation

Background : The study aimed to assess the relative influence of anaesthesia and muscle relaxation on intubating conditions and the haemodynamic and catecholamine responses to tracheal intubation.
Methods : Sixty ASA 1 or 2 patients were randomly assigned to one of four groups (15 patients each) that differed in the depth of anaesthesia (thiopentone plus fentanyl 2.5 μg kg^-1 or thiopentone alone) and the degree of vecuronium–induced neuromuscular block (100% or _>: 65%) at intubation. Muscle relaxation was measured at 0.1 Hz by means of mechanomyography. Heart rate (HR) and mean arterial blood pressure (MAP) were measured before and after induction of anaesthesia, and 1 min and 5 min following intubation, while adrenaline (A) and noradrenaline concentrations (NA) were determined from arterial blood samples.
Results : Intubating conditions were improved primarily by providing complete muscle relaxation at the adductor pollicis muscle (P<0.001) and to a lesser extent by adding fentanyl to thiopentone (P=0.04). The response of HR and MAP to tracheal intubation was attenuated mainly by fentanyl (P<0.001). Complete muscle relaxation further diminished the response of MAP to intubation (P=0.03). Changes in A and NA were dependent on the depth of anaesthesia only (P =>0.01).
Conclusion : The results of the study demonstrate that the sympathoadrenal response to intubation is attenuated by adding fentanyl (2.5 kg^-1) to an induction regimen with thiopentone, whereas provision of complete muscle relaxation at the adductor pollicis muscle is necessary to attain smooth intubating conditions.     

Retardation of pain development: a case of recovery from congenital insensitivity to pain

Congenital analgesia is a rare genetic disorder. We report here that a 12-year-old boy was able to recover from congenital insensitivity to pain. Neurological examinations revealed that there was a 'stocking' distribution of pain decrement on the lower extremities under the patient's knee joints. Magnetic Resonance Imaging (MRI) of his brain showed gyrus thinning with sulcus widening at both sides of the parietal lobe. Southern blot hybridization probed with cDNAs of various opioid receptors did not detect any significant abnormality. Our results suggest that this rare case may not be genetically determined.     

Intubating conditions provided by propofol and alfentanil - acceptable, but not ideal

Background: The use of muscle relaxants to facilitate intubation is associated with several side effects regardless of whether depolarizing or non-depolarizing drugs are used. In the present study we compared the intubating conditions, haemodynamic responses and changes in oxygen saturation following induction with alfentanil and propofol or alfentanil, thiopental and suxamethonium.
Methods: Eighty patients (ASA I or II) were in a double-blind manner assigned to receive either of the two induction methods. Intubating conditions were assessed on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. Heart rate, systolic arterial pressure and oxygen saturation were monitored throughout the procedure.
Results: The use of alfentanil and propofol resulted in significantly lower scored intubation points. Systolic arterial pressure decreased and heart rate increased significantly in the alfentanil-thiopental-suxamethonium group as compared to the alfentanil-propofol group. There were no significant changes in oxygen saturation.
Conclusion: The results show that propofol and alfentanil in combination provides haemodynamic stability and unaltered oxygen saturation but less optimal intubating conditions.