Ponhold H, Vicenzi M N
Univ. Klinik f. Anästhesiologie u. Intensivmedizin, Graz, Austria.
Br J Anaesth. 1998 Nov;81(5):723-6. doi: 10.1093/bja/81.5.723.
We administered 0.5% plain bupivacaine 4 ml intrathecally (L2-3 or L3-4) in three groups of 20 patients, according to the position in which they were nursed in the post-anaesthesia care unit (PACU): supine horizontal, 30 degrees Trendelenburg or hammock position (trunk and legs 30 degrees elevated). Patients were observed until anaesthesia descended to less than S1. The incidence of severe bradycardia (heart rate < 50 beat min-1) in the PACU was significantly higher in patients in the Trendelenburg position (60%) than in the horizontal (20%, P < 0.01) or hammock (10%, P < 0.005) position. After 90 min, following admission to the PACU, only patients in the hammock position did not have severe bradycardia. In this late phase, the incidence of severe bradycardia in the Trendelenburg group was 35% (P < 0.005) and 10% in patients in the supine horizontal position. In four patients, severe bradycardia first occurred later than 90 min after admission to the PACU. The latest occurrence of severe bradycardia was recorded 320 min after admission to the PACU. We conclude that for recovery from spinal anaesthesia, the Trendelenburg position should not be used and the hammock position is preferred.
我们将4毫升0.5%的布比卡因原液经鞘内注射（于L2 - 3或L3 - 4间隙），分为三组，每组20例患者，根据他们在麻醉后护理单元（PACU）的护理体位：仰卧水平位、头低脚高30度位或吊床位（躯干和腿部抬高30度）。观察患者直至麻醉平面降至S1以下。在PACU中，头低脚高体位患者发生严重心动过缓（心率<50次/分钟）的发生率（60%）显著高于水平位（20%，P<0.01）或吊床位（10%，P<0.005）患者。进入PACU 90分钟后，只有吊床位患者未发生严重心动过缓。在这个后期阶段，头低脚高组严重心动过缓的发生率为35%（P<0.005），仰卧水平位患者为10%。有4例患者，严重心动过缓首次发生于进入PACU 90分钟之后。严重心动过缓最晚发生于进入PACU 320分钟后。我们得出结论，对于腰麻恢复，不应采用头低脚高体位，而首选吊床位。
