Korhonen Anna-Maija
Department of Intensive Care Medicine, Meilahti University Hospital, Finland.
Curr Opin Anaesthesiol. 2006 Dec;19(6):612-6. doi: 10.1097/ACO.0b013e32801042c7.
An increasing number of day-case surgical patients is challenging the presently used methods of anaesthesia: reliable surgical anaesthesia should be fast, with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia a knowledge of special spinal anaesthesia techniques is essential. This review brings together important issues concerning the spinal technique, anaesthetic agents and benefits as well as the disadvantages of spinal anaesthesia in outpatients.
For surgical procedures in one lower limb, a low dose of hyperbaric bupivacaine with standardized spinal anaesthesia technique produces a reliable block, with low incidence of side effects and home-readiness equal to spinal anaesthesia with lidocaine (50 mg) or general anaesthesia (desflurane), whereas ropivacaine has not shown benefits over spinal anaesthesia with bupivacaine. 'Walk-in, walk-out' spinals with an extremely low dose of lidocaine and opioids for gynaecological laparoscopy created the concept of selective spinal anaesthesia. Reintroduction of chloroprocaine may provide a solution for bilateral, short-acting spinal anaesthesia in the future.
To produce reliable spinal anaesthesia with a reasonable recovery time it is essential to understand the factors affecting the spread of spinal block and to choose the optimal drug and adequate dose for specific surgical procedures.
日间手术患者数量的不断增加对目前使用的麻醉方法提出了挑战：可靠的手术麻醉应起效迅速、恢复快且副作用最小。为了与现代门诊全身麻醉竞争，掌握特殊的脊髓麻醉技术至关重要。本综述汇集了有关脊髓麻醉技术、麻醉药物以及门诊脊髓麻醉的益处和缺点等重要问题。
对于单一下肢的外科手术，采用标准化脊髓麻醉技术使用低剂量的高压布比卡因可产生可靠的阻滞效果，副作用发生率低，且出院准备时间与使用利多卡因（50毫克）的脊髓麻醉或全身麻醉（地氟烷）相当，而罗哌卡因在脊髓麻醉方面并未显示出优于布比卡因的优势。用于妇科腹腔镜检查的极低剂量利多卡因和阿片类药物的“即来即走”脊髓麻醉开创了选择性脊髓麻醉的概念。重新引入氯普鲁卡因可能为未来的双侧短效脊髓麻醉提供解决方案。
为了产生可靠的脊髓麻醉并具有合理的恢复时间，了解影响脊髓阻滞扩散的因素并为特定外科手术选择最佳药物和适当剂量至关重要。
