Imbelloni Luiz Eduardo, Vieira Eneida Maria, Sperni Francine, Guizellini Rosa Helena, Tolentino Ana Paula
Institute for Regional Anaesthesia, Hospital de Base da FAMERP, São José do Rio Preto, SP, Brazil.
Paediatr Anaesth. 2006 Jan;16(1):43-8. doi: 10.1111/j.1460-9592.2005.01680.x.
Spinal anesthesia in expert hands is an excellent method for children for appropriate surgery. The aim of this study was to evaluate the effects of spinal anesthesia with isobaric solutions in 307 consecutive cases from May 2001 to August 2002.
In this prospective study, 307 patients from 0 to 12 years of age were scheduled for spinal anesthesia with enantiomeric mixture of bupivacaine (S75 : 25R) 0.5% or racemic bupivacaine 0.5% or lidocaine 2% without glucose, for surgery compatible with the technique. The following were assessed: latency of analgesia, motor block, maximum length and duration of sensory blockade, cardiovascular changes, incidence of headache or transient neurological symptoms and cost.
The onset of sensory block occurred at 2.36 +/- 0.95 min. Duration of surgery was 1.29 +/- 0.83 h and the duration of stay in the postanesthesia care unit was 39.72 +/- 26.84 min. The highest level of analgesia ranged from T(9) to T(4) (mean T(6)). Onset of motor block was <2 min in all children and each had a modified Bromage score of 3 at the beginning of the surgery. At the end of the surgery 9% had score 3, 16%, score 2, 46%, score 1 and 29%, zero. Seventy five percent of all patients recovered from motor block 1 or zero at the end of the surgery. Patients older than 1 year were able to walk in 3.79 +/- 0.73 h. There was no case of oxygen desaturation. Hypotension and bradycardia occurred in one patient. Spinal anesthesia failed in five patients. Three children developed postdural puncture headache (PDPH), the youngest aged 2 years. PDPH in all three was mild or moderate. Transient radicular symptoms were not observed. The final cost of the spinal anesthesia was R dollars 49.00 compared with a mean cost of general anesthesia of R dollars 105.00.
Spinal anesthesia continues to gain acceptance as an alternative to general anesthesia in children. There has also been an increased use of spinal anesthesia for other surgical procedures including lower extremity orthopedic procedures as well as specific surgery procedures above the umbilicus and in patients past the neonatal period. Spinal anesthesia in children is a special method suitable for use only by anesthesiologists, expert in administering spinal anesthesia for adults. It was 54% less than the cost of general anesthesia.
在经验丰富的医生操作下，脊髓麻醉对于适合的儿童手术来说是一种极佳的方法。本研究的目的是评估2001年5月至2002年8月连续307例病例中使用等比重溶液进行脊髓麻醉的效果。
在这项前瞻性研究中，307例0至12岁的患者计划接受布比卡因对映体混合物（S75:25R）0.5%或消旋布比卡因0.5%或不含葡萄糖的2%利多卡因的脊髓麻醉，用于适合该技术的手术。评估以下内容：镇痛潜伏期、运动阻滞、感觉阻滞的最大长度和持续时间、心血管变化、头痛或短暂性神经症状的发生率以及费用。
感觉阻滞起效时间为2.36±0.95分钟。手术时间为1.29±0.83小时，麻醉后护理单元停留时间为39.72±26.84分钟。最高镇痛平面范围为T(9)至T(4)（平均T(6)）。所有儿童运动阻滞起效时间均<2分钟，且在手术开始时每位儿童的改良Bromage评分均为3分。手术结束时，9%的患者评分为3分，16%为2分，46%为1分，29%为0分。所有患者中有75%在手术结束时运动阻滞恢复至1分或0分。1岁以上的患者在3.79±0.73小时后能够行走。无低氧血症病例。1例患者出现低血压和心动过缓。5例患者脊髓麻醉失败。3例儿童发生了硬膜穿刺后头痛（PDPH），最年轻的为2岁。所有3例的PDPH均为轻度或中度。未观察到短暂性神经根症状。脊髓麻醉的最终费用为49.00雷亚尔，而全身麻醉的平均费用为105.00雷亚尔。
脊髓麻醉作为儿童全身麻醉的替代方法，越来越被接受。脊髓麻醉在其他外科手术中的使用也有所增加，包括下肢骨科手术以及脐以上的特定手术和新生儿期后的患者。儿童脊髓麻醉是一种特殊方法，仅适用于擅长为成人实施脊髓麻醉的麻醉医生。其费用比全身麻醉低54%。
