Norman David
Naval School of Health Sciences at Portsmouth Naval Medical Center, Portsmouth, Va., USA.
AANA J. 2003 Dec;71(6):449-53.
The choice of using air or saline in epidural syringes during the loss-of-resistance technique, for identifying the epidural space, has been based largely on personal preference of the anesthesia provider. A survey of practice in the United Kingdom, thought to be similar to practice in the United States, revealed that the majority of anesthesia providers use air. Case reports have appeared in the literature suggesting that air may be harmful to patients or, at the very least, impede the onset and quality of epidural analgesia. Two studies have evaluated air vs saline to determine whether one may lead to more rapid or better quality epidural analgesia in laboring parturients. Results are mixed. However, they seem to indicate that the use of saline for the loss-of-resistance may result in more rapid and satisfactory quality of pain relief in laboring parturients. Current anesthesia literature suggests using saline with an air bubble in the loss-of-resistance syringe. Many anesthesia training programs continue to teach the use of air, saline, and saline with an air bubble. Further studies may help to determine whether there is a scientific or safety basis for using air vs saline.
在阻力消失法确定硬膜外腔时，硬膜外注射器中使用空气还是生理盐水，很大程度上取决于麻醉医生的个人偏好。一项针对英国麻醉实践的调查（认为与美国相似）显示，大多数麻醉医生使用空气。文献中出现的病例报告表明，空气可能对患者有害，或者至少会妨碍硬膜外镇痛的起效和质量。两项研究对空气和生理盐水进行了评估，以确定哪一种可能使分娩产妇的硬膜外镇痛起效更快或质量更好。结果不一。然而，它们似乎表明，在阻力消失法中使用生理盐水可能会使分娩产妇更快获得更满意的疼痛缓解。当前的麻醉学文献建议在阻力消失注射器中使用带气泡的生理盐水。许多麻醉培训项目仍在教授使用空气、生理盐水以及带气泡的生理盐水。进一步的研究可能有助于确定使用空气与生理盐水是否有科学或安全依据。
