Løvstad R Z, Granhus G, Hetland S
Dept. of Anaesthesiology, Aker University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 2000 Jan;44(1):48-52. doi: 10.1034/j.1399-6576.2000.440109.x.
Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. Bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10-70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae.
突然发生的严重心动过缓/心搏停止性心脏骤停虽被认为不常见，但无疑是脊髓麻醉最严重的并发症。我们报告了4例原发性心搏停止和1例严重心动过缓的病例，这些患者均为年轻至中年的健康患者，计划在日间手术单元接受小型手术。心动过缓/心搏停止与呼吸抑制或低氧血症/高碳酸血症无关；它们在脊髓麻醉开始后的不同时间间隔（10 - 70分钟）出现，而且显然不依赖于感觉阻滞平面，感觉阻滞平面在T3至T8之间变化。1例患者在心脏停搏前数秒出现恶心，除此之外没有任何预警信号。所有患者通过迅速给予阿托品和麻黄碱均很容易复苏，对于心脏骤停患者，则进行心脏按压和氧气通气。1例患者接受了小剂量肾上腺素治疗。4例患者按计划进行了手术；1例患者手术延期。所有患者均健康出院，未留下任何后遗症。
