Horlocker T T
Department of Anesthesiology, Mayo Medical School, Mayo Clinic, Rochester, Minnesota, USA.
Anesthesiol Clin North Am. 2000 Jun;18(2):461-85. doi: 10.1016/s0889-8537(05)70172-3.
In conclusion, major complications after neuraxial techniques are rare but can be devastating to the patient and the anesthesiologist. Prevention and management begin during the preoperative visit with a careful evaluation of the patient's medical history and appropriate preoperative discussion of the risks and benefits of the available anesthetic techniques. Alternative anesthetic techniques, such as peripheral regional techniques or general anesthesia, should be considered for patients at increased risk for neurologic complications following neuraxial block. The decision to perform a regional anesthetic technique on an anesthetized patient must be made with care, as these patients are unable to report pain on needle placement or injection of local anesthetic. Efforts should also be made to decrease neural injury in the operating room through careful patient positioning. Postoperatively, patients must be followed closely to detect potentially treatable sources of neurologic injury, including expanding spinal hematoma or epidural abscess, constrictive dressings, improperly applied casts, and increased pressure on neurologically vulnerable sites. New neurologic deficits should be evaluated promptly by a neurologist, or neurosurgeon, to document formally the patient's evolving neurologic status, arrange further testing or intervention, and provide long-term follow-up.
总之，神经轴技术后的主要并发症很少见，但对患者和麻醉医生来说可能是灾难性的。预防和管理始于术前访视，仔细评估患者的病史，并就可用麻醉技术的风险和益处进行适当的术前讨论。对于神经轴阻滞术后发生神经并发症风险增加的患者，应考虑采用外周区域技术或全身麻醉等替代麻醉技术。对麻醉患者实施区域麻醉技术时必须谨慎决定，因为这些患者无法报告穿刺针放置或注射局部麻醉药时的疼痛。还应通过仔细的患者体位摆放，努力减少手术室中的神经损伤。术后，必须密切随访患者，以发现潜在可治疗的神经损伤来源，包括扩大的脊髓血肿或硬膜外脓肿、紧身敷料、石膏应用不当以及神经易损部位压力增加。新出现的神经功能缺损应由神经科医生或神经外科医生及时评估，以正式记录患者不断变化的神经状态，安排进一步检查或干预，并提供长期随访。
