Mordecai Monica M, Brull Sorin J
Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida 32224, USA.
Curr Opin Anaesthesiol. 2005 Oct;18(5):527-33. doi: 10.1097/01.aco.0000182556.09809.17.
The aim of this article is to review current practice of spinal anesthesia regarding technique and medication use; review recent applications of spinal anesthesia to subspecialty care in outpatient, cardiac, and obstetrical anesthesia; and update risk assessment associated with spinal anesthesia.
Epidural volume extension enhances the spread of local anesthetics using a combined spinal-epidural technique. Chloroprocaine has become the agent of choice at some institutions. The growth in both the number and complexity of ambulatory surgery procedures has redefined the role of spinal anesthesia for outpatients. The 27-gauge Whitacre spinal needle is associated with a lower incidence of post-dural puncture headaches. Retrospective reviews can predict the incidence of rare complications such as neurologic injury and cardiac arrest.
Innovations in technology, equipment, and needle design improved safety and decreased complication rates from spinal anesthesia. The increased popularity of ambulatory surgical procedures has resulted in more frequent use of spinal anesthesia. Intrathecal narcotic analgesia is used increasingly in fast-tracking cardiac surgical protocols. Modern anesthetic and analgesic techniques include resurgence of older agents (2-chloroprocaine) as well as new agents (levobupivacaine and ropivacaine) that are used in conjunction with adjuvant intrathecal medications (opioids, vasopressors, and alpha-2 adrenergic agonists). Surgical thromboprophylaxis and the increased use of anticoagulants in patients with cardiovascular disease have challenged anesthesiologists to update clinical guidelines to minimize the risk of hemorrhagic complications such as epidural hematoma. The risk/benefit ratio of spinal anesthesia should be individualized. The continued popularity of spinal anesthesia is due to the safety, effectiveness and efficiency of this technique.
本文旨在回顾脊髓麻醉在技术和药物使用方面的当前实践；回顾脊髓麻醉在门诊、心脏和产科麻醉等亚专业护理中的最新应用；并更新与脊髓麻醉相关的风险评估。
硬膜外容积扩展使用联合脊髓-硬膜外技术可增强局部麻醉药的扩散。氯普鲁卡因在一些机构已成为首选药物。门诊手术程序数量和复杂性的增加重新定义了脊髓麻醉在门诊患者中的作用。27号Whitacre脊髓穿刺针与较低的硬膜穿刺后头痛发生率相关。回顾性研究可以预测罕见并发症如神经损伤和心脏骤停的发生率。
技术、设备和穿刺针设计的创新提高了脊髓麻醉的安全性并降低了并发症发生率。门诊手术程序日益普及导致脊髓麻醉使用更为频繁。鞘内注射麻醉性镇痛药在心脏手术快速康复方案中使用越来越多。现代麻醉和镇痛技术包括旧药（2-氯普鲁卡因）以及新药（左旋布比卡因和罗哌卡因）的复兴，这些药物与鞘内辅助药物（阿片类药物、血管加压药和α-2肾上腺素能激动剂）联合使用。手术血栓预防以及心血管疾病患者抗凝剂使用的增加对麻醉医生提出了挑战，需要更新临床指南以尽量降低硬膜外血肿等出血性并发症的风险。脊髓麻醉的风险/效益比应个体化。脊髓麻醉持续受到欢迎是由于该技术的安全性、有效性和高效性。
