Faura A, Izquierdo E, Pelegrí M D
Servicio de Anestesiología y Reanimación, Hospital de Viladecans, Barcelona.
Rev Esp Anestesiol Reanim. 1999 Jun-Jul;46(6):256-63.
Spinal anesthesia is the technique of choice for many outpatient procedures. With appropriate screening and preparation, it can provide excellent surgical conditions and highly satisfactory anesthesia for the patient, while remaining cost-effective. Intradural anesthesia has advantages over epidural anesthesia: technical simplicity, rapid onset, efficacy and depth of blockade. Its use has been controversial, however, for many years due to the potential risk of headache after puncture of the dura mater. Epidural anesthesia causes fewer hemodynamic changes and provides greater dose flexibility and local anesthetic concentration, with less risk of headache after accidental puncture of the dura mater. The drawbacks are that it takes longer to perform and onset of blockade comes later. Both techniques are valid alternatives to general anesthesia in outpatient surgery. The choice of one over the other will depend on patient characteristics, availability of a presurgical area, and the anesthesiologist's skill.
脊髓麻醉是许多门诊手术的首选技术。经过适当的筛查和准备，它可以为患者提供良好的手术条件和高度满意的麻醉效果，同时保持成本效益。硬膜内麻醉比硬膜外麻醉具有优势：技术简单、起效迅速、阻滞效果和深度良好。然而，由于穿刺硬脊膜后有发生头痛的潜在风险，多年来其使用一直存在争议。硬膜外麻醉引起的血流动力学变化较少，提供了更大的剂量灵活性和局部麻醉药浓度，意外穿刺硬脊膜后头痛风险较小。缺点是操作时间较长，阻滞起效较晚。在门诊手术中，这两种技术都是全身麻醉的有效替代方法。选择其中一种还是另一种将取决于患者特征、术前区域的可用性以及麻醉医生的技能。
