Nakanishi Rie, Nishimura Shinya, Kimura Motoko, Miyazaki Yoshiya, Hamada Takamitsu, Mori Takahiko
Department of Anesthesiology, Osaka General Medical Center Osaka 558-8558.
Masui. 2008 May;57(5):628-30.
A 21-year-old morbidly obese parturient with a body mass index of 45.5 kg x m(-2) underwent an emergent cesarean section for obstructed labor under combined spinal and epidural anesthesia. At age 15, she was diagnosed as borderline personality disorder. In spite of the drug therapy, her mental status was unstable. During anesthesia and surgery, her psychiatrist attended beside her to ease her anxiety and mental stress. An experienced anesthesiologist encouraged her and maintained her in the sitting position during epidural catheterization and spinal puncture. The distance between the skin and the epidural space was about 6.5 cm at the L3-4 interspace via midline approach. An epidural catheter was inserted 5 cm cephalad. Subsequently, the L4-5 subarachnoid space was accessed at a depth of about 7.0 cm. A 3 ml bolus of 0.5% hyperbaric bupivacaine was given. The anesthetic level was T4 at the start of the operation. Throughout the surgery, sufficient analgesia was obtained and any complication such as severe hypotension or respiratory depression did not develop and her postoperative course was uneventful.
一名21岁、体重指数为45.5 kg/m²的病态肥胖产妇在腰麻-硬膜外联合麻醉下因产程梗阻接受了急诊剖宫产手术。她15岁时被诊断为边缘型人格障碍。尽管接受了药物治疗，但其精神状态仍不稳定。在麻醉和手术期间，她的精神科医生在其身旁，以缓解她的焦虑和精神压力。一位经验丰富的麻醉医生鼓励她，并在硬膜外导管置入和腰穿过程中让她保持坐姿。经中线入路，在L3-4椎间隙皮肤至硬膜外腔的距离约为6.5 cm。将硬膜外导管向头端置入5 cm。随后，在约7.0 cm的深度进入L4-5蛛网膜下腔。给予3 ml的0.5%重比重布比卡因推注。手术开始时麻醉平面为T4。在整个手术过程中，获得了充分的镇痛效果，未出现严重低血压或呼吸抑制等并发症，其术后过程顺利。
