七氟醚及丙泊酚分别复合瑞芬太尼诱导用于纤支镜气管插管比较

目的 比较七氟醚(SEV)与丙泊酚(PRO)复合瑞芬太尼麻醉诱导,用于纤支镜(FOB)气管捕管的效果及血流动力学.方法 24例需择期气管插管全麻手术而预计气道插管无困难患者,随机分为SEV组及PRO组,分别以七氟醚或丙泊酚复合瑞芬太尼诱导下行FOB插管.记录诱导期间血压、心率、脉搏氧饱和度,Narcotrend指数(NI)监测麻醉深度,记录意识消失时间、插管时间、插管评分、用药量及不良反应.结果 两组患者意识消失时间、插管时何、插管评分及瑞芬太尼用量差异无显著意义.两组患者均很快入睡,插管成功.两组血压、心率诱导后较诱导前降低,插管后无明显增高,均在正常范围,组间比较无显著差异.两组NI值在诱导后及插管期均较诱导前明显降低,SEV组N1值在插管2min后高于PRO组,其余时间点两组差异无显著意义.两组未见明显不良反应,对插管过程无记忆.结论 七氟醚及丙泊酚分别复合瑞芬太尼麻醉诱导均可用于无全麻诱导禁忌患者FOB气管插管,两种方法诱导迅速,提供满意的插管条件,且血流动力学平稳.     

肺移植研究现状及移植期的规范化管理

肺移植是终末期肺疾病患者唯一的治疗手段,该领域也是目前国际范围内的研究热点。相关研究既促进了肺移植的进步与发展,也改善了移植后患者的生活质量。随着肺移植技术的发展,适应人群相关指南不断修订,供体肺来源也一直是所有移植中心亟待解决的问题。移植期的规范化管理涉及麻醉诱导、术中液体管理、气道管理、重要步骤的处理及术后疼痛管理等方面。体外生命支持(ECLS)包括体外循环(CPB)及体外膜肺氧合(ECMO)。随着ECLS技术的发展,ECMO作为肺移植桥梁在术中及术后循环支持中的优更加突出,帮助受体患者顺利度过肺移植窗口期。虽然肺移植在基础科学和临床研究方面都有许多进展,但要提高移植后的生存率,还须克服包括如何成功完成肺移植、扩大肺供体库、诱导耐受、预防移植后并发症、原发性移植物功能障碍(PGD)、细胞和抗体介导的排斥反应以及感染等在内的诸多问题。     

Should we monitor alveolar and inspiratory concentrations of anesthetic and respiratory gases?

One essayist suggests that continuous monitoring of alveolar and inspiratory concentrations of anesthetic and respiratory gases has little or no positive effect on patient outcome and may even be detrimental to patients. Such monitoring, he says, tends to remove anesthesiologists from personal contact with their patients. He recommends careful monitoring of fresh gas concentrations leaving the anesthetic machine, careful monitoring of inspired gas in a circle absorption breathing system, and improved training of anesthesiologists to prevent human error. Another essayist suggests that continuous monitoring of alveolar and inspiratory concentrations of anesthetic and respiratory gases is cost-effective and relatively simple. He says that such monitoring, without being a source of legal problems for its users, improves the quality of patient care.     

The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain: a randomized,blinded, prospective study

Background Context

Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.

Anesthesia for removal of inhaled foreign bodies in children

BACKGROUND: Foreign body aspiration may be a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. Both controlled and spontaneous ventilation techniques have been used during anesthesia for bronchoscopic foreign body removal. There is no prospective study in the literature comparing these two techniques. This prospective randomized clinical trial was undertaken to compare spontaneous and controlled ventilation during anesthesia for removal of inhaled foreign bodies in children. METHODS: Thirty-six children posted for rigid bronchoscopy for removal of airway foreign bodies over a period of 2 years and 2 months in our institution were studied. After induction with sleep dose of thiopentone or halothane, they were randomly allocated to one of the two groups. In group I, 17 children were ventilated after obtaining paralysis with suxamethonium. In group II, 19 children were breathing halothane spontaneously in 100% oxygen. RESULTS: All the patients in the spontaneous ventilation group had to be converted to assisted ventilation because of either desaturation or inadequate depth of anesthesia. There was a significantly higher incidence of coughing and bucking in the spontaneous ventilation group compared with the controlled ventilation group (P = 0.0012). CONCLUSION: Use of controlled ventilation with muscle relaxants and inhalation anesthesia provides an even and adequate depth of anesthesia for rigid bronchoscopy.     

Comparing the Effects of Single Shot Sciatic Nerve Block Versus Posterior Capsule Local Anesthetic Infiltration on Analgesia and Functional Outcome After Total Knee Arthroplasty : A Prospective,Randomized, Double-Blinded,Controlled Trial

Peripheral nerve blocks appear to provide effective analgesia for patients undergoing total knee arthroplasty. Although the literature supports the use of femoral nerve block, addition of sciatic nerve block is controversial. In this study we investigated the value of sciatic nerve block and an alternative technique of posterior capsule local anesthetic infiltration analgesia. 100 patients were prospectively randomized into three groups. Group 1: sciatic nerve block; Group 2: posterior local anesthetic infiltration; Group 3: control. All patients received a femoral nerve block and spinal anesthesia. There were no differences in pain scores between groups. Sciatic nerve block provided a brief clinically insignificant opioid sparing effect. We conclude that sciatic nerve block and posterior local anesthetic infiltration do not provide significant analgesic benefits.     

局部麻醉药经聚乳酸-羟基乙酸共聚物缓释给药的研究

背景 临床常用局部麻醉药物的体内生物半衰期短,且局部组织的高药物浓度极易产生中枢神经和心血管毒性反应. 目的 综述局部麻醉药聚乳酸羟基乙酸共聚物[poly (lactic-co-glycolic acid),PLGA]缓释给药系统的研究进展. 内容 阐述PLGA相关研究,局部麻醉药PLGA微粒的类型与制备工艺,PLGA在不同动物实验模型的研究结果,临床研究进展及存在的缺陷和改进等四方面的相关内容. 趋向 局部麻醉药缓释系统的研究能够为临床提供更好的镇痛药物和麻醉方式,但是在载药量、生产工艺等方面还有待改进.     

Propofol block of I(h) contributes to the suppression of neuronal excitability and rhythmic burst firing in thalamocortical neurons

Although the depressant effects of the general anesthetic propofol on thalamocortical relay neurons clearly involve gamma-aminobutyric acid (GABA)(A) receptors, other mechanisms may be involved. The hyperpolarization-activated cation current (I(h)) regulates excitability and rhythmic firing in thalamocortical relay neurons in the ventrobasal (VB) complex of the thalamus. Here we investigated the effects of propofol on I(h)-related function in vitro and in vivo. In whole-cell current-clamp recordings from VB neurons in mouse (P23-35) brain slices, propofol markedly reduced the voltage sag and low-threshold rebound excitation that are characteristic of the activation of I(h). In whole-cell voltage-clamp recordings, propofol suppressed the I(h) conductance and slowed the kinetics of activation. The block of I(h) by propofol was associated with decreased regularity and frequency of delta-oscillations in VB neurons. The principal source of the I(h) current in these neurons is the hyperpolarization-activated cyclic nucleotide-gated (HCN) type 2 channel. In human embryonic kidney (HEK)293 cells expressing recombinant mouse HCN2 channels, propofol decreased I(h) and slowed the rate of channel activation. We also investigated whether propofol might have persistent effects on thalamic excitability in the mouse. Three hours following an injection of propofol sufficient to produce loss-of-righting reflex in mice (P35), I(h) was decreased, and this was accompanied by a corresponding decrease in HCN2 and HCN4 immunoreactivity in thalamocortical neurons in vivo. These results suggest that suppression of I(h) may contribute to the inhibition of thalamocortical activity during propofol anesthesia. Longer-term effects represent a novel form of propofol-mediated regulation of I(h).