Rodríguez J, Quintela O, López-Rivadulla M, Bárcena M, Diz C, Alvarez J
Department of Anaesthesiology and Postoperative Intensive Care, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Eur J Anaesthesiol. 2001 Mar;18(3):171-6. doi: 10.1046/j.0265-0215.2000.00806.x.
Patients with end-stage chronic renal failure are at risk of developing several serious postanaesthetic complications. Many anaesthesiologists perform brachial plexus anaesthesia with high doses of local anaesthetic in order to achieve an extensive blockade of the upper limb. Brachial plexus block is a suitable technique for anaesthesia for creation, repair or removal of vascular access for haemodialysis. The aim of this study was to measure mepivacaine plasma concentrations after axillary block with 650 mg plain mepivacaine in patients with end-stage chronic renal failure.
Mepivacaine plasma concentrations were assessed throughout a 150-min period, in 10 patients after axillary block with 650 mg plain mepivacaine (600 mg for axillary block and 50 mg for supplementation).
Mepivacaine plasma concentrations expressed in microg mL(-1) as medians and their ranges were: 1.69 (1.23--7.78) at 5 min, 5.61 (4.36--8.19) at 30 min, 8.28 (3.83--11.21) at 60 min, 7.93 (5.63--11.1) at 90 min and 6.49 (5.56--8.35) at 150 min without any symptoms of toxicity.
Brachial plexus anaesthesia with 650 mg plain mepivacaine did not result in serious systemic toxicity in these patients despite the high mepivacaine plasma concentrations found.
终末期慢性肾衰竭患者有发生多种严重麻醉后并发症的风险。许多麻醉医生使用高剂量局部麻醉药进行臂丛神经麻醉，以实现上肢的广泛阻滞。臂丛神经阻滞是一种适用于为血液透析建立、修复或移除血管通路进行麻醉的技术。本研究的目的是测量终末期慢性肾衰竭患者在接受650mg盐酸甲哌卡因单纯溶液腋路阻滞术后的血浆甲哌卡因浓度。
对10例接受650mg盐酸甲哌卡因单纯溶液腋路阻滞术（600mg用于腋路阻滞，50mg用于补充）的患者在150分钟内评估甲哌卡因血浆浓度。
以微克/毫升（μg/mL）为单位表示的甲哌卡因血浆浓度中位数及其范围为：5分钟时为1.69（1.23 - 7.78），30分钟时为5.61（4.36 - 8.19），60分钟时为8.28（3.83 - 11.21），90分钟时为7.93（5.63 - 11.1），150分钟时为6.49（5.56 - 8.35），且无任何毒性症状。
尽管所测得的甲哌卡因血浆浓度较高，但650mg盐酸甲哌卡因单纯溶液行臂丛神经麻醉未在这些患者中导致严重的全身毒性。
