Aldrete J Antonio, Reza-Medina Marisela, Daud Olga, Lalin-Iglesias Silvia, Chiodetti Gustavo, Guevara Uriah, Wikinski Jaime A, Torrieri Alberto
Arachnoiditis Clinic, The Arachnoiditis Foundation, Inc, Birmingham, AL 35243, USA.
J Clin Anesth. 2005 Jun;17(4):304-13. doi: 10.1016/j.jclinane.2004.08.011.
We undertook this case series to determine if preexisting neurological disease is exacerbated by either spinal or epidural anesthesia. In the website of the Arachnoiditis Foundation, we posted an offer to advise anesthesiologists in cases of neurological problems after either of these techniques was used. Contacts were made first by way of the Internet, confirmed by telephone, and maintained by fax, e-mail, or by special mail. Patients here described were cared for and observed by one of the authors, in a hospital, in Argentina or in Mexico. A total of 7 adult, ASA physical status I and II patients, including 3 men and 4 women, with subtle symptoms of neurological disease before anesthesia, are described. Two patients had continuous lumbar epidural anesthesia, 3 had spinals; in 2 more, attempted epidural blocks led to accidental dural puncture and were converted to subarachnoid anesthetics. All patients accepted neuraxial anesthesia without informing the anesthesiologists that they had mild neurological symptoms before surgery. Because anesthesiologists did not specifically inquire about subclinical neurological symptoms or prior neurological disease, anesthesiologists are advised to carefully inquire about prior neurological disease whether neuraxial anesthesia techniques are considered.
我们开展了这个病例系列研究，以确定既往存在的神经系统疾病是否会因脊髓麻醉或硬膜外麻醉而加重。在蛛网膜炎基金会的网站上，我们发布了一项提议，即在使用这两种技术之一后出现神经问题的情况下为麻醉医生提供建议。首先通过互联网进行联系，通过电话确认，然后通过传真、电子邮件或特快专递保持联系。这里描述的患者由其中一位作者在阿根廷或墨西哥的一家医院进行护理和观察。总共描述了7例美国麻醉医师协会（ASA）身体状况为I级和II级的成年患者，包括3名男性和4名女性，在麻醉前有轻微的神经系统疾病症状。2例患者接受了连续腰段硬膜外麻醉，3例接受了脊髓麻醉；另外2例中，硬膜外阻滞操作导致意外硬膜穿刺，随后改为蛛网膜下腔麻醉。所有患者均接受了椎管内麻醉，且未告知麻醉医生他们在手术前有轻微的神经系统症状。由于麻醉医生没有专门询问亚临床神经系统症状或既往神经系统疾病，因此建议麻醉医生在考虑采用椎管内麻醉技术时仔细询问患者既往神经系统疾病史。
