Kumar Chandra M, Corbett William A, Wilson Robert G
James Cook University Hospital, Middlesbrough TS4 3BW, UK.
Surg Oncol. 2008 Aug;17(2):73-9. doi: 10.1016/j.suronc.2007.10.025. Epub 2007 Nov 26.
Extended spinal anaesthesia using a spinal micro-catheter was used as a primary method of anaesthesia for elective colorectal cancer surgery in 68 high risk patients over a 14-year period in our institution. The technique was also useful in eight elective and 13 emergency abdominal surgeries. All patients suffered from severe chronic obstructive airway disease requiring multiple inhalers and drugs (ASA III). Thirty nine of these patients also suffered from angina, myocardial infarction, diabetes and other systemic diseases (ASA IV). Surgery included right hemicolectomy, left hemicolectomy, total colectomy, sigmoid colectomy, Hartman's resection, anterior resection of rectum, abdominoperineal resection, cholecystectomy (open and laparoscopic) and obstructed inguinal hernia requiring laparotomy. Spinal anaesthesia was performed under strict aseptic conditions with a 22 gauge spinal needle with a mixture consisting of 2.75ml of 0.5% heavy bupivacaine and 0.25ml of fentanyl (25microg). This was followed by placement of a spinal micro-catheter and the duration of anaesthesia was extended by intermittent injection of 0.5% isobaric bupivacaine. Brief hypotension occurred in 12.4% of patients during the establishment of anaesthetic block height to T6-7 and was duly treated with intravenous administration of fluid and ephedrine hydrochloride. Good anaesthesia resulted in all patients except for brief discomfort in some patients during hemicolectomy surgery possibly due to the dissection and traction on the peritoneum causing irritation to the diaphragm. The use of sedation was avoided. General anaesthesia was administered in one patient and this patient required postoperative ventilation and cardiovascular support in the Intensive Care Unit. The spinal micro-catheter was removed at the end of surgery. Postoperative pain relief was obtained by administering intravenous morphine through a patient controlled analgesia machine in the critical care ward area (High Dependency Unit). There was a low incidence of minor postoperative side effects such as nausea (14.6%), vomiting (7.9%), minor post dural puncture headache (5.6%) and pruritus (5.6%). We conclude that spinal anaesthesia with a micro-catheter may be used as a primary method of anaesthesia for colorectal cancer surgery and other major abdominal surgery in high-risk patients for whom general anaesthesia would be associated with higher morbidity and mortality.
在我们机构14年期间，对68例高危患者采用脊髓微导管进行延长脊髓麻醉，作为择期结直肠癌手术的主要麻醉方法。该技术在8例择期和13例急诊腹部手术中也很有用。所有患者均患有严重慢性阻塞性气道疾病，需要多种吸入器和药物（ASA III级）。其中39例患者还患有心绞痛、心肌梗死、糖尿病和其他全身性疾病（ASA IV级）。手术包括右半结肠切除术、左半结肠切除术、全结肠切除术、乙状结肠切除术、哈特曼切除术、直肠前切除术、腹会阴联合切除术、胆囊切除术（开放和腹腔镜）以及需要剖腹手术的嵌顿性腹股沟疝。在严格无菌条件下，使用22号脊髓穿刺针进行脊髓麻醉，混合液由2.75ml 0.5%重比重布比卡因和0.25ml芬太尼（25μg）组成。随后放置脊髓微导管，通过间歇性注射0.5%等比重布比卡因延长麻醉时间。在将麻醉阻滞平面建立至T6 - 7期间，12.4%的患者出现短暂性低血压，经静脉输注液体和盐酸麻黄碱适当处理。除部分患者在半结肠切除术期间可能因腹膜的解剖和牵拉刺激膈肌而出现短暂不适外，所有患者麻醉效果良好。避免使用镇静剂。1例患者接受全身麻醉，该患者术后需要在重症监护病房进行通气和心血管支持。手术结束时取出脊髓微导管。在重症监护病房区域（高依赖病房）通过患者自控镇痛机静脉注射吗啡获得术后疼痛缓解。术后轻微副作用发生率较低，如恶心（14.6%）、呕吐（7.9%）、轻微腰穿后头痛（5.6%）和瘙痒（5.6%）。我们得出结论，对于全身麻醉会带来更高发病率和死亡率的高危患者，脊髓微导管麻醉可作为结直肠癌手术和其他大型腹部手术的主要麻醉方法。
