Rawal N
Department of Anaesthesiology and Intensive Care, Orebro Medical Centre Hospital, Orebro, Sweden.
Curr Opin Anaesthesiol. 2000 Oct;13(5):531-7. doi: 10.1097/00001503-200010000-00008.
Combining regional and general anaesthesia can have many advantages, particularly in patients undergoing major thoracic, abdominal or orthopaedic surgery. The use of regional anaesthetic techniques in anaesthetized children is an accepted standard of care, because needle and procedure phobias are very common and can result in severe anxiety, an inability to cooperate and sudden unpredictable movement. Epidural local anaesthetics have the potential of attenuating sympathetic hyperactivity, maintaining bowel peristalsis, sparing the use of opioids, and facilitating postoperative feeding and out-of-bed activity. Catheter techniques allow excellent and prolonged postoperative analgesia using epidural or peripheral nerve blocks. However, the superiority of regional techniques for hip fracture surgery and carotid endarterectomy has been disputed in several recent studies. As part of the combination technique, epidural block may in fact decrease blood flow in free flap surgery by a steal phenomenon, and increase intrapulmonary shunting during one-lung ventilation. The present review focuses on the use of a combination of regional and general anaesthesia for a variety of surgical procedures. It also compares the two anaesthetic techniques in elderly patients. The review is based on studies published during the past year.
联合区域麻醉和全身麻醉有诸多优点，尤其对于接受大型胸科、腹部或骨科手术的患者。在麻醉儿童中使用区域麻醉技术是公认的标准治疗方法，因为对针头和操作的恐惧非常普遍，可能导致严重焦虑、无法配合以及突然不可预测的动作。硬膜外局部麻醉剂有减轻交感神经过度兴奋、维持肠道蠕动、减少阿片类药物使用以及促进术后进食和离床活动的潜力。导管技术可通过硬膜外或外周神经阻滞实现出色且持久的术后镇痛。然而，区域技术在髋部骨折手术和颈动脉内膜切除术方面的优势在最近的几项研究中受到了质疑。作为联合技术的一部分，硬膜外阻滞实际上可能因盗血现象而减少游离皮瓣手术中的血流，并在单肺通气期间增加肺内分流。本综述重点关注区域麻醉和全身麻醉联合用于各种外科手术的情况。它还比较了这两种麻醉技术在老年患者中的应用。该综述基于过去一年发表的研究。
