Hirasaki A, Uehara K, Asao Y, Maeta M
Department of Anesthesia, Tottori Municipal Hospital.
Masui. 2000 Jun;49(6):615-9.
Positioning of patients with cervical spinal lesions under general anesthesia may lead to serious neurological complications. The authors attempted awake pronation in eighteen patients to minimize the risks. In all patients, cervical instability or cervical spinal cord compression was diagnosed, and posterior fusion or laminoplasty under general anesthesia was planned. Naso-tracheal intubation was performed by broncho-fiberoptic scope under topical anesthesia and light sedation. After tracheal intubation, pronation was completed while patients were still awake. Twelve patients could change their position almost by themselves, and needed only a little assistance of the medical staff. After the patients settled in appropriate position, general anesthesia was induced. Neurological status was assessed before and after the intubation, and just before the induction of general anesthesia, to prove the absence of complications. Operations were accomplished without major troubles in all patients. During post anesthetic interviews, eight patients had memory of the positioning, but none of them had any complaints about the procedure. Awake pronation may be useful to minimize the risk of neurological complications related to positioning of surgical patients, and also need less assistance by medical staff.
全身麻醉下颈椎脊髓损伤患者的体位摆放可能会导致严重的神经并发症。作者尝试对18例患者进行清醒俯卧位以将风险降至最低。所有患者均被诊断为颈椎不稳或颈椎脊髓受压，并计划在全身麻醉下进行后路融合或椎板成形术。在表面麻醉和轻度镇静下通过支气管纤维镜进行鼻气管插管。气管插管后，在患者仍清醒时完成俯卧位摆放。12例患者几乎可以自行改变体位，仅需医护人员稍加协助。患者安置到合适体位后，诱导全身麻醉。在插管前后以及即将诱导全身麻醉前评估神经状态，以证明无并发症发生。所有患者手术均顺利完成。在麻醉后访视中，8例患者对体位摆放有记忆，但均未对该操作提出任何抱怨。清醒俯卧位可能有助于将手术患者体位摆放相关的神经并发症风险降至最低，并且所需医护人员协助较少。
