Vercauteren M, Heytens L
Department of Anaesthesia, University Hospital Antwerp, Edegem, Belgium.
Acta Anaesthesiol Scand. 2007 Aug;51(7):831-8. doi: 10.1111/j.1399-6576.2007.01325.x. Epub 2007 May 4.
Pre-existing neurological and muscular disease may be a specific concern for anaesthetists as they need to consider the effect of anaesthesia upon the disease, vice versa, and the interaction of anaesthesia with the medication taken by the patient. Despite a lack of controlled studies, many anaesthetists, being afraid of a claim, will prefer general rather than regional anaesthesia in these patients. Nevertheless regional anaesthesia certainly merits its place because it offers undeniable advantages. A good pre-operative examination is very important while patients should also be informed about peri-operative implications of anaesthesia, surgery and stress. Paraesthesias, epinephrine and high concentrations of local anaesthetics should be avoided in the majority of the diseases. Some diseases may benefit from epidural anaesthesia while for others a spinal technique may be the technique of preference. Special attention should be paid to patients with spinal stenosis despite recent reassuring reports with respect to safety of regional anaesthetic techniques. Anaesthetists should not automatically take all responsibility in case of progressive or new deficit after the procedure.
对于麻醉医生来说，患者既往存在的神经和肌肉疾病可能是一个特殊的关注点，因为他们需要考虑麻醉对该疾病的影响，反之亦然，以及麻醉与患者所服用药物之间的相互作用。尽管缺乏对照研究，但许多麻醉医生出于对索赔的担忧，在这些患者中会更倾向于选择全身麻醉而非区域麻醉。然而，区域麻醉确实有其存在的价值，因为它具有不可否认的优势。术前进行全面的检查非常重要，同时还应告知患者麻醉、手术和应激对围手术期的影响。在大多数疾病中，应避免出现感觉异常、使用肾上腺素和高浓度局部麻醉药。某些疾病可能受益于硬膜外麻醉，而对另一些疾病而言，脊髓麻醉技术可能是首选。尽管最近有关于区域麻醉技术安全性的令人安心的报道，但对于患有椎管狭窄的患者仍应给予特别关注。如果在术后出现病情进展或新的神经功能缺损，麻醉医生不应自动承担所有责任。
