Isobaric Spinal Anesthesia for Paraplegic Patients

脊髓損傷超越T6者易於手術期間發生自主性反射亢進(autonomic hyperreflexia)而造成困擾或誘發併發症。文獻雖有多種處理方法之建議及使用，但意見還未臻一致。著者等於1982至1997之十五年中，會應用等比重脊髓麻醉(isobaric spinal anesthesia)於十三例是項患者獲得良好效果。故而認爲等比重脊髓麻醉是此種患者之優良麻醉選擇。謹報告我們的臨床經驗，並回溯文獻作扼要之討論就教於海內外同道。

關鍵字

脊髓損傷；異常反射；脊髓麻醉

並列摘要

It has long been understood that patients with spinal cord injury (SCI) above T6-7 may develop autonomic hyperreflexia (AH) and pose an anesthetic challenge. To date, there is no consensus regarding anesthesia management of these patients among anesthesiologists. Many anesthetic techniques have been proposed and used with varying success, but none of them is uniformly successful Topical anesthetics may not block the stretch receptors and AH might still be initiated. A deep anesthesia with potent volatile agents is often necessary to prevent or treat AH. Thus, the incidence of hypotension is no different than that associated with neuraxial anesthesia. Failures with potent vasodilators such as sodium nitroprusside also have been reported. Currently, the block of the afferent pathways by neuraxial anesthesia is considered to be the most effective means of preventing AH. However because the level of neuraxial anesthesia is difficult to detect in SCI patients, excessive high level block and subsequent severe hypotension may occur. When an isobaric solution is used, due to the lack of baricity/patient position interaction, migration of the local anesthetic is usually insignificant, so the level of anesthesia is easier to control and predict. In the past fifteen years (1982-1997), we have used isobaric spinal anesthesia (ISA) in thirteen patients with SCI for various surgical procedures. Although four of these patients had previous history of AH, there was not a single incidence of AH during the perioperative period. Our favorable experiences lead us to believe that ISA is a useful anesthetic technique for SCI patients undergoing surgery.

並列關鍵字

Spinal cord injury ； Reflex, abnormal ； Anesthesia, spinal

國際替代計量

Isobaric Spinal Anesthesia for Paraplegic Patients

全文下載

主題瀏覽