A phospholipid sensor controls mechanogating of the K+ channel TREK-1

TREK-1 (KCNK2 or K(2P)2.1) is a mechanosensitive K(2P) channel that is opened by membrane stretch as well as cell swelling. Here, we demonstrate that membrane phospholipids, including PIP(2), control channel gating and transform TREK-1 into a leak K(+) conductance. A carboxy-terminal positively charged cluster is the phospholipid-sensing domain that interacts with the plasma membrane. This region also encompasses the proton sensor E306 that is required for activation of TREK-1 by cytosolic acidosis. Protonation of E306 drastically tightens channel-phospholipid interaction and leads to TREK-1 opening at atmospheric pressure. The TREK-1-phospholipid interaction is critical for channel mechano-, pH(i)- and voltage-dependent gating.     

Phase-transition-driven synaptic exocytosis: a hypothesis and its physiological and evolutionary implications

It is proposed that the plasma membrane in the active zones of synaptic terminals contains self-assembling cooperative domains whose Ca2+-induced solidification may be the driving force of the fast neurotransmitter release in the central synapses. This hypothesis and a qualitative model of the phase-transition-driven exocytosis provide formulation of a unitary approach to a number of general problems in the physiology of animals. It allows answering the following questions, among others: (i) What is the physical reason for the existence of a narrow optimum range of body temperatures in warm-blooded species? (ii) What is the physical reason for the inevitable necessity of regular sleep in animals? (iii) Does there indeed exist any general mechanism of general anesthesia?     

外科动物实验中猪的麻醉问题

猪作为重要的实验动物,在外科实验中运用传统的麻醉方法时易引起呼吸道阻塞而死亡,我们使用全麻插管技术,并辅以术前术后各种对症处理,成功地解决了手术中猪因呼吸道阻塞而死亡的问题。     

Hemodynamic and electroencephalographic effects of epidural buprenorphine during orthopedic hindlimb surgery in sheep: A comparison with intramuscular buprenorphine and epidural saline

Epidural opioids exert segmentally limited spinal analgesia by acting at dorsal horn neurons. While the spinal cord may be the predominant site of action for hydrophilic opioids such as morphine, initial supraspinal effects have been suggested for lipophilic opioids such as buprenorphine. In view of significant systemic effects, the value of epidural administration of lipophilic opioids in human patients has been questioned. Since epidural buprenorphine may be beneficial for hindlimb surgeries in sheep, intraoperative hemodynamic and central nervous effects were evaluated. In a prospective, randomized, and placebo-controlled study, 15 adult sheep anesthetized for cranial cruciate ligament reconstruction were treated with either epidural buprenorphine (5 μg/kg, n = 5), intramuscular buprenorphine (5 μg/kg, n = 5), or epidural saline (0.15 ml/kg, n = 5) preoperatively. Heart rate, arterial blood pressures and the electroencephalographic variables /δ ratio, α/δ ratio, β/δ ratio, median power frequency (MED), and 80% spectral edge frequency were recorded before and immediately after skin incision and during drilling a tunnel through the tibia bone. Arterial pressures after epidural buprenorphine were significantly lower compared with epidural saline but were quite similar to intramuscular buprenorphine before skin incision. Mean EEG /δ ratios and MED values following epidural and intramuscular buprenorphine were significantly lower compared with epidural saline but quite similar for the two buprenorphine groups during drilling. In conclusion, similar hemodynamic and electroencephalographic effects of epidural and intramuscular buprenorphine suggest systemic effects of epidural buprenorphine in sheep.     

Drug Effects on the Release of Endogenous Acetylcholine In Vivo: Measurement by Intracerebral Dialysis and Gas Chromatography–Mass Spectrometry

Intracerebral microdialysis was combined with a sensitive and specific gas chromatographic-mass spectrometric assay to measure the release of endogenous acetylcholine in the rat striatum in vivo. In rats anesthetized with urethane (1.2 g/kg i.p.), the levels of striatal acetylcholine dialyzed into a Ringer's perfusate were: (a) reliably measurable only in the presence of physostigmine; (b) stable at between 3 and 8 h of perfusion (30-75 pmol/20 min in the presence of 75 microM physostigmine); (c) reduced by calcium-free Ringer's solution, tetrodotoxin (0.1 microM), and vesamicol (1.0 microM); and (d) increased by elevated potassium (100 mM), atropine (3-300 microM), and haloperidol (0.75 mg/kg i.p.). In conscious unrestrained rats, the spontaneous release of striatal acetylcholine was not altered significantly following the administration of urethane. The changes in acetylcholine release observed in this study are consistent with the known actions of some drugs or ionic conditions on striatal cholinergic neurotransmission and are evident under the condition of urethane anesthesia. The present results demonstrate the sensitivity and suitability of this method for monitoring endogenous striatal acetylcholine release in vivo.     

围术期手术麻醉安全体系的构建

麻醉安全性在增加,但围术期仍存有诸多挑战。“外科手术的围术期医疗模式 新策略的提出,期望有助于提高医疗质量、降低医疗成本。麻醉医师应该主动迎接时代挑战,承担起学科发展的历史使命,通过调整专业定位、规范医疗行为、加强病人安全管理建设,来构建起围术期手术麻醉的安全体系。     

硬膜外分娩镇痛转行硬膜外剖宫产麻醉失败的相关因素分析*

摘要目的：探讨采用硬膜外分娩镇痛中途转行硬膜外剖宫产麻醉失败的相关因素并对其进行分析。方法：选择来我院进行硬膜 外分娩镇痛转而形硬膜外剖宫产麻醉的产妇218 例,根据硬膜外麻醉失败的定义将其划分为成功组和失败组,对两组的一般资 料、产程中的平均动脉压、硬膜外分娩镇痛情况分别进行比较分析。结果：成功组192 例,失败组26例,两组产妇在一般资料上无 差异（P>0.05）,在转行剖宫产前成功组平均动脉压显著低于失败组（P<0.05）,补救给药的次数上成功组显著低于失败组（P<0. 05）,在镇痛持续时间上成功组显著少于失败组（P<0.05）。结论：影响硬膜外剖宫产麻醉失败的危险因素是分娩镇痛时需要补救给 药的次数增加以及镇痛所持续的时间延长,对于出现此类危险因素的产妇,应改变剖宫产麻醉方式,以最大限度地降低剖宫产麻 醉的失败率,这对于母婴并发症的减少起着积极的作用。     

小剂量右美托咪定用于局麻下玻璃体切割术的镇静效果观察

目的:探讨右美托咪定用于局麻下玻璃体切割术的镇静效果。方法:选择拟在局麻监测下行玻璃体切割术患者50例为研究对象,年龄20-72岁,ASA分级Ⅱ级~Ⅲ级,随机分为右美托咪定组(D组)和咪达唑仑组(M组),每组25例。D组患者于术前10min静脉泵注右美托咪定0.5μg/kg,后以0.2-0.4μg/kg.h的速度持续输注,M组术前10 min缓慢静脉注射咪达唑仑0.02 mg/kg,术中按需静注0.5 mg/次。维持VAS评分≤4分,Ramsay评分2-4分。记录和比较两组患者术中血压、心率、呼吸的变化、辅助用药及患者对镇静效果的满意度。结果:给药后,M组T5时点MAP较T0显著下降(P0.05),D组T10及以后各时点MAP较T0显著下降(P0.05);D组T5及以后各时点BP较T0显著下降(P0.05),但组间及M组组内BP比较差异无统计学意义(P0.05);M组T30时点HR较T0显著下降(P0.01),而在T5时,组间比较差异有统计学意义(P0.01),即D组下降更为显著。给药后各时点,D组VAS评分均显著低于M组(P0.05),30 min时达最低。两组Ramsay镇静评分给药后5 min均达2级以上,与给药前比较均显著升高(P0.05),D组给药后30 min及以后各时点Ramsay镇静评分均显著高于M组(P0.01)。给药后各时点,两组组内和组间SPO2和RR比较均无统计学差异(P0.05)。D组患者满意度较M组更高(P0.05)。结论:小剂量右美托咪定用于玻璃体切割术可使患者血流动力学平稳,镇静效果良好,疼痛感觉减轻,舒适度提高。     

罗哌卡因腰麻联合硬膜外麻醉在剖宫产手术中的应用效果

目的:探讨罗哌卡因腰麻联合硬膜外麻醉在剖宫产手术中的应用效果及安全性,为妇科手术麻醉提供可借鉴的方法。方法:对我院于2012年2月至2013年2月期间收治的100例行剖宫产术患者,均于腰硬联合麻醉方式下进行手术,按照随机数字表法,分为观察组50例与对照组50例,分别使用甲磺酸罗哌卡因与盐酸布比卡因进行麻醉,观察与对比两组患者的麻醉效果与不良反应。结果:观察组患者的运动阻滞起效时间、运动阻滞维持时间均显著低于对照组患者,差异存在统计学意义(P0.05);观察组患者与对照组患者在不良反应方面比较,差异不存在统计学意义(P0.05)。结论:罗哌卡因腰麻联合硬膜外麻醉在剖宫产手术中,产生的麻醉效果快速,且安全可靠性有保障,具备临床推广应用的价值。     

靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响研究

目的：探讨靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响。方法：选择在我院行直肠癌根治术的72例患者,将其分为观察组和对照组各36例,其中观察组给予靶控输注静脉麻醉,对照组采用腰硬联合麻醉,对两组患者手术时间、术中出血量以及免疫球蛋白水平（IgG、IgA、IgM）、血清白介素-6水平（IL-6）、肿瘤坏死因子α水平（TNF-α）以及T细胞亚群（CD3、CD4）水平进行对比。结果：观察组手术平均时间为（130．5±11．7）min,术中平均出血量为（271.3±37．8）ml,与对照组比较差异均无统计学意义（P〉0．05）;两组IgG、IgA及IgM,在T1、T2、T3及T4时刻水平比较差异均无统计学意义（P〉0．05）;两组IL-6、TNF-α、CD3及CD4在麻醉后较T1时均有明显变化,比较差异均有统计学意义（P〈0．05）,且观察组变化较对照组更为明显,两组比较差异有统计学意义（P〈0．05）。结论：靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能均存在抑制作用,且以抑制细胞免疫功能为主,而腰硬联合麻醉抑制作用较低,值得推广应用。