Somri Mostafa, Tome Riad, Yanovski Boris, Asfandiarov Eldar, Carmi Nurit, Mogilner Joerge, David Bader, Gaitini Luis A
Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Paediatr Anaesth. 2007 Nov;17(11):1059-65. doi: 10.1111/j.1460-9592.2007.02278.x.
Combined spinal-epidural anesthesia (CSE-A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery.
Spinal anesthesia was performed in 28 neonates and infants with isobaric bupivacaine 0.5%, 1 mg.kg(-1) followed by placement of a caudal epidural catheter to thoracic spinal segments. The catheter tip position was confirmed radiographically. Respiratory and hemodynamic data were collected before and after the CSE-A and throughout the operation, as a measure of anesthetic effectiveness. Complications related to the anesthesia technique were collected as a measure of the anesthetic technique safety.
Satisfactory surgical anesthesia was achieved in 24 neonates and infants, four patients were converted to general anesthesia. Respiratory and hemodynamic variables did not change significantly during surgery, compared with baseline values: oxygen saturation (P = 0.07), systolic and diastolic blood pressures (P = 0.143, P = 0.198 respectively), heart rate (P = 0.080) and respiratory rate (P = 0.127). However, twenty infants were fussy during the surgical procedures and were calmed with intravenous midazolam; our patients required oxygen supplementation and transient manual ventilation intraoperatively.
Combined spinal-epidural anesthesia could be considered as an effective anesthetic technique for elective major upper abdominal surgery in awake or sedated neonates and infants, and could be used cautiously by a pediatric anesthesiologist as an alternate to general anesthesia in high-risk neonates and infants undergoing upper gastrointestinal surgery.
据报道，腰麻-硬膜外联合麻醉（CSE-A）对脐下手术的儿科患者安全有效。我们的主要目的是描述我们在择期进行上腹部大手术的新生儿和婴儿中应用该技术的经验。
对28例新生儿和婴儿实施腰麻，使用0.5%等比重布比卡因，剂量为1mg·kg⁻¹，随后在胸段脊髓节段置入骶管硬膜外导管。通过影像学检查确认导管尖端位置。在CSE-A前后及整个手术过程中收集呼吸和血流动力学数据，作为麻醉效果的衡量指标。收集与麻醉技术相关的并发症，作为麻醉技术安全性的衡量指标。
24例新生儿和婴儿实现了满意的手术麻醉，4例患者转为全身麻醉。与基线值相比，手术期间呼吸和血流动力学变量无显著变化：血氧饱和度（P = 0.07）、收缩压和舒张压（分别为P = 0.143、P = 0.198）、心率（P = 0.080）和呼吸频率（P = 0.127）。然而，20例婴儿在手术过程中烦躁不安，通过静脉注射咪达唑仑使其平静；我们的患者术中需要吸氧和短暂的手动通气。
腰麻-硬膜外联合麻醉可被视为清醒或镇静的新生儿和婴儿择期进行上腹部大手术的有效麻醉技术，对于接受上消化道手术的高危新生儿和婴儿，儿科麻醉医生可谨慎使用该技术作为全身麻醉的替代方法。
