頁籤選單縮合
題 名 | Clinical Study of Failure in Continuous Spinal Anesthesia with Bupivacaine=連續性Bupivacaine脊椎麻醉失敗經驗的臨床研究 |
---|---|
作 者 | 龔家騏; 林仙養; 湯兆舜; 吳宗正; 孫維仁; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 14:8 1998.08[民87.08] |
頁 次 | 頁486-491 |
分類號 | 416.5 |
關鍵詞 | 連續性脊椎麻醉; Continuous spinal anesthesia; CSA; Bupivacaine; Lidocaine; |
語 文 | 英文(English) |
中文摘要 | 背景:連續性脊椎麻醉已被認為較單一注射劑量的脊椎麻醉具有注射劑量可調節 性,血液動力穩定性的優點。但對麻醉醫師而言,脊椎麻醉的失敗並不少見。在此,我們報 告在處理連續性脊椎麻醉失敗時的經驗及討論造成失敗的可能原因。 方法:採回溯性研究 236 位(皆大於 65 歲,ASA Ⅲ)接受泌尿外科, 骨科手術的病例。 使用 0.2 % Bupivacaine 做連續性脊椎麻醉, 在 20 mg Bupivacaine 注射後 30 分鐘, 若在皮節區 T10 有針刺痛感( pin prick test )即認定為連續性脊椎麻醉失敗。 隨即改 以 5 mL 1 % Lidocaine 注射。記錄 Lidocaine 的失敗率,感覺和運動阻斷的情形,以及 失敗的病例改以 1 % Lidocaine 救援的成功率及所需要 Lidocaine 的平均劑量。 結果:236 位病例中有 11 個病例被認定為 Bupivacaine 連續性脊椎麻醉失敗, 失敗率為 4.7 %。在隨即改以 5 mL 1 % Lidocaine 注射後,5 分鐘內,有 9 個病例馬上產生溫度 ,感覺和運動阻斷的情形。有 2 個病例,需要注射較多劑量的 Lidocaine 才可以達到相同 阻斷的情形。 Lidocaine 救援的成功率 100 %, 所需要 Lidocaine 的平均劑量 52 ± 4.5mg。 結論:在區域性麻醉時失敗的原因包括技術不良、病人因素、藥品因素。本研究發現,造成 連續性脊椎麻醉失敗的原因中,局部麻醉藥本身的問題可能扮演著主要的角色。 |
英文摘要 | Background: Continuous spinal anesthesia (CSA) has been considered to be better in temporal and dose flexibility, as well as hemodynamic stability than single dose spinal anesthesia. However, the failure of spinal anesthesia is not a rare experience for anesthesiologists. Here we present our experience in solving the problem and discuss the possible causes for the failure. Methods: 236 cases were studied retrospectively from January to December in 1996. All were over 65 years old, ASA Ⅲ, scheduled for transurethral procedures or orthopedic operation. CSA was performed with 0.2% bupivacaine. Failed CSA was confirmed by positive pin-prick test at T10 dermatome(umbillicus) 30 minutes after 20 mg bupivacaine was injected. For failed cases, 5 mL 1% lidocaine was injected intrathecally for rescue. The failure rate, sensory and motor blockade, success rate by changing to lidocaine and its dosage were recorded. Results: Eleven of 236 cases (4.7%) were considered spinal failure since the initial 20 mg bupivacaine could not provide adequate T10 anesthesia in 30 minutes. Addition of 5 mL 1% lidocaine produced a profound sensory and motor blockade in 9 cases, while further lidocaine injection was required in two cases. The success rate by rescuing lidocaine was 100% with an average lidocaine consumption by 52.5 ± 4.5 mg. Discussion: Factors contributed to failure spinal anesthesia including failure of technique, errors of judgment, maldistribution and failure of local anesthetic itself. However, we thought that change of pH value of local anesthetic in CSF may play a great part in these failed CSAs. Despite the reasons for failure, we demonstrate that failure of continuous spinal anesthesia by 0.2% bupivacaine can be readily resolved by 1% lidocaine. |
本系統中英文摘要資訊取自各篇刊載內容。