Stress-induced opioid analgesia and activity in mice: Inhibitory influences of exposure to magnetic fields

An exposure for 30 min to a 0.5 Hz rotating magnetic field (1.5–90 G) significantly reduced immobilization stress-induced, opioid analgesia and hyperactivity in CF-1 and C-57 BL strains of mice, respectively. The magnetic exposure also eliminated the day-night rhythm in stress-induced analgesia, with maximum inhibitory effects occurring in the dark period. Pre-treatment with naloxone (1.0 mg/kg) had comparable inhibitory effects on immobilization-induced analgesia and activity. These results suggest that exposure to magnetic stimuli can significantly influence stress-induced activation of endogenous opioid systems and their behavioral and physiological consequences.     

Evidence for a supraspinal mechanism in the opioid-mediated antinociceptive effect of ketamine

Systemic ketamine (50 or 160 mg/kg, i.p.) produced an antinociceptive effect in rats on the tail flick test. This effect of ketamine was inhibited by injection of naloxone (27 nmol) into the lateral ventricle. Intrathecal ketamine (3 microns) produced a slight but significant antinociceptive effect on the tail flick test, which was not affected by injection of naloxone (27 nmol) into the lateral ventricle. Antinociception was not produced by injection of ketamine into the lateral ventricle (3 microns) or the rostral ventromedial medulla RVM (30 nmol). The role played by spinal and supraspinal opioid receptors in ketamine-induced antinociception is discussed.     

鞘内不同剂量舒芬太尼在腰硬联合阻滞分娩镇痛中的作用

目的:比较鞘内不同剂量的舒芬太尼在腰硬联合阻滞分娩镇痛中的效应.方法:选择择期初产妇180例,鞘内镇痛药物为舒芬太尼,随机分六组,剂量分别为3.0μg、4.0μg、5.0μg、6.0μg、7.0μg、8.0μg(S3组、S4组、S5组、S6组、S7组、S8组),双盲对照观察.各组镇痛方法均采用蛛网膜下腔给药后硬膜外产妇自控镇痛(PCA).各组硬膜外维持用药相同.观察记录起效时间;鞘内给药后10、15、30、60、90 min时的VAS评分;维持时间、运动阻滞、各产程时间、出血量、新生儿1和5分钟Apagr评分与全程分娩镇痛的满意度;可能出现的不良反应.结果:起效时间S3组＞S4组＞S5组≈S6组≈S7组≈S8组,以S3组最慢.S3组在各时间点镇痛效果均比S5～S8组差,60min时S4、S5组的镇痛效果与S6、S7相似,但明显弱于S8组(P＜0.05);S3组、S4组的维持时间明显短于S5～S8组(P＜0.05).S3组、S4组满意度明显差于S5～S8组(P＜0.05).各组产程时间、出血量、新生儿Apgar评分、改良Bromage评分、瘙痒发生率各组间无明显差异(P＞0.05).结论:单纯鞘内注射4.0～8.0 μg舒芬太尼均可提供安全、有效的分娩镇痛效果,但镇痛剂量以5.0～6.0μg更佳.     

Fas/FasL在罗哌卡因致PC12细胞凋亡中的表达

目的检测Fas、FasL在罗哌卡因诱导PC12细胞凋亡中表达的变化,探讨罗哌卡因的神经毒性机制。方法采用不同浓度罗哌卡因(0.1、0.5、1、2、4 mmol/L)处理PC12细胞24 h以建立细胞的神经毒性模型,CCK-8法测定细胞活力。最终将细胞随机分为三组:0.5 mmol/L组、2mmol/L组和正常对照组。各组细胞培养24 h后用光学显微镜观察细胞形态学变化(加上1 mmol/L组),流式细胞仪检测细胞凋亡,免疫荧光检测Fas、FasL表达。结果与正常对照组比较,0.5 mmol/L组和2 mmol/L组细胞活力明显降低(P0.05),细胞形态明显异常(包括1 mmol/L组),凋亡率明显升高(P0.05),Fas、FasL表达明显增强(P0.05);与0.5 mmol/L组比较,2 mmol/L组细胞凋亡率和Fas、FasL表达明显增加(P0.05)。结论罗哌卡因可诱导PC12细胞凋亡,其机制可能与Fas/FasL上调有关。     

手术后硬膜外镇痛对老年患者红细胞补体受体Ⅰ活性及丙二醛水平的影响

目的 :探讨老年患者手术后硬膜外镇痛 (PCEA)对红细胞免疫功能及丙二醛水平的影响。方法 :38例择期前列腺摘除手术老年患者随机分为PCEA组 (2 0例 )和对照组 (18例 )。PCEA组病人手术后采用硬膜外自控镇痛 ,维持视觉模拟评分 (VAS)<3分。对照组根据需要间断肌注哌替啶。分别在麻醉前 ,手术后 1、2、3、5d采静脉血样检测红细胞C3b受体花环率 (RBC -C3bRR) ,红细胞免疫复合花环率 (RBC -ICR) ,红细胞免疫粘附肿瘤细胞功能 (RBC -CaR)、红细胞免疫粘附促进因子 (RFER)、红细胞免疫粘附抑制因子 (RFIR)、丙二醛 (MDA)。结果 :麻醉前各指标两组间无显著差异 (P >0 .0 5 )。手术后 1、2、3d :PCEA组RBC -C3bRR、RFER比麻醉前明显上升 (P <0 .0 5 ) ,RBC -ICR、RFIR、MDA比麻醉前明显下降 (P <0 .0 5 )。而对照组RBC -C3bRR、RBC -CaR、RFER明显低于麻醉前 (P <0 .0 5～ 0 .0 1) ,RBC -ICR、RFIR、MDA明显高于麻醉前 (P <0 .0 5～ 0 .0 1) ,两组间有极显著差异 (P <0 .0 1)。手术后 5d时各值无显著差异 (P >0 .0 5 )。结论 :手术后PCEA能提高老年病人红细胞免疫功能和降低MDA水平 ,有助于病人康复     

治疗性触摸应用于肝癌经导管动脉化疗栓塞术后疼痛控制的研究

目的评价治疗性触摸在肝癌经导管动脉化疗栓塞(TACE)术后疼痛控制中的作用。方法根据手术日期,将71例肝癌行TACE术且主诉术后疼痛≥4分的患者分为实验组和对照组,对照组采用常规镇痛方法(曲马多加健康教育),实验组采用治疗性触摸,无效时加用曲马多。比较两组患者镇痛前后的疼痛评分、血压、脉率变化,术后3d内曲马多使用次数和量,并调查实验组患者对治疗性触摸的主观感受及评价。结果实验组疼痛明显减轻(P<0.01),血压、脉率下降,术后3d内曲马多使用次数和量均较对照组明显减少(P<0.01);自制问卷调查显示,实验组对治疗性触摸的正性评价率为94.44%。结论治疗性触摸有助于肝癌TACE术后的疼痛控制,可明显减少镇痛剂的使用量。     

Optimization of propofol dose shortens procedural sedation time, prevents resedation and removes the requirement for post-procedure physiologic monitoring

Objective: To examine the effect of propofol dosing (total dose and number of doses) on patient sedation time and likelihood of resedation. Methods: This was a prospective, observational patient series in an urban district hospital ED with 42 000 attendances per annum. Patients undergoing an emergent procedure requiring procedural sedation were included. Titrated intravenous propofol was administered according to departmental procedure. Standardized consent and data collection forms were used. Time taken for the patient to become conversational after first administration was recorded and any resedation documented. Results: Four hundred patients, undergoing 404 procedures, were enrolled for the period commencing August 2004 until March 2006. The mean initial propofol bolus was 0.8 mg/kg (SD 0.6), and mean total propofol dose was 1.8 mg/kg (SD 1.0), comprising a mean of 2.3 (SD 2.1) doses of 15.8 mg (SD 11.4). Mean sedation time was 11.8 min (SD 6.9), and increased sedation times were associated with higher total propofol dose and number of boluses (P < 0.0001). Resedation occurred in two patients (0.5%, 95% CI 0–1.6%). Conclusion: Shorter sedation times are seen with lower doses of propofol. Patients do not need prolonged post‐procedure monitoring because the occurrence of spontaneous resedation associated with propofol use is a rare event. This has implications for patient flow and staff resource allocation in a busy ED.     

Equipment and monitoring in paediatric anaesthesia

Advances in paediatric anaesthetic equipment and monitoring continue to be made. While the mainstay of airway intubating equipment currently is the direct laryngoscope, video laryngoscopes and endoscopes are increasing in their use. These continue to evolve, generating better quality pictures, with more sophisticated yet easier to use equipment. Vascular access in paediatric anaesthesia can be challenging with an increasing number of patients presenting with difficult intravenous access. Ultrasound has become an integral piece of equipment in the management of these children. As the population increases in weight, so the management of the obese paediatric patient is now a reality. This requires thought and careful planning of their perioperative care. Newer techniques such as high-flow nasal oxygen are useful both to prevent hypoxia at induction, but also to facilitate open airway surgery. Neurological monitoring in the form of near infrared spectroscopy and bispectral index are discussed with evidence relevant to paediatric practice. This article will discuss all of these devices and techniques with particular emphasis on paediatric anaesthetic practice.     

Preoperative assessment and preparation for safe paediatric anaesthesia

The delivery of anaesthesia to children and young people provides unique challenges. A careful, systematic approach to assessment and preparation can deliver a positive experience for the child, carers and staff while mitigating potential complications. Preparation for anaesthesia should encompass information gathering, assessment and planning for anatomical, physiological, social and behavioural elements specific to the child and the surgery. Delivery of appropriate information, consent and fasting are also key elements of ensuring positive perioperative outcomes. We consider the common components of preparation for the delivery of safe paediatric anaesthesia.     

低流量吸氧和静脉注射甘露醇联合应用缓解鼻部手术后疼痛的研究

目的 研究低流量吸氧和静脉注射甘露醇联合应用对鼻部手术后的镇痛效果,探讨鼻部手术后缓解疼痛的有效方法.方法 将160例鼻部手术患者随机分为A、B、C、D 4组,每组各40例.术后A组给予20%甘露醇125 ml静脉注射,B组用鼻导管经口低流量吸氧,C组同时给予20%甘露醇125ml静脉注射和鼻导管经口低流量吸氧,D组为对照组,进行常规护理.采用McGill疼痛评估方法,观察4组镇痛效果.结果 疼痛评分:C组低于A、B组,A、B组低于D组(P<0.01).鼻部肿胀程度:C组较B组(P<0.01)和A组(P<0.05)轻,A组较D组轻(P<0.01),B组与D组比较差异无统计学意义.结论 采用低流量吸氧和静脉注射甘露醇能缓解鼻部手术后疼痛,两者联合应用效果更好.