Watanabe S, Yamaguchi H, Ishizawa Y
Department of Anesthesia, Mito Saiseikai General Hospital, Ibaraki, Japan.
Anesth Analg. 1991 Oct;73(4):391-3. doi: 10.1213/00000539-199110000-00003.
We studied whether cerebrospinal fluid pressure difference between full-flexed and non-full-flexed lateral position (dP) influences the spread of intrathecally (i.e., spinal) administered anesthetic solution (SSA). Forty-two women, 18-60 yr old, who underwent gynecologic surgery under spinal anesthesia were enrolled in the study. They were divided into two groups (group 1: less than 40 yr old, group 2: greater than or equal to 40 yr old). Before spinal anesthetic injection, we measured the pressure difference produced by postural change from the right lateral decubitus position (non-full-flexed) for needle insertion at the L2-3 interspace to a full-flexed lateral decubitus position with a spinal needle in place. After they returned to the non-full-flexed lateral position, 14 mg of plain tetracaine in 10% dextrose solution (2.8 mL) was injected intrathecally in each patient. Pressure differences had a significant correlation with the cephalad levels of spinal anesthesia in each group; the larger pressure difference was associated with a larger SSA. The relationship was stronger in the younger group (correlation coefficients, 0.82 and 0.63; P-values less than 0.01 in groups 1 and 2, respectively). Three patients in group 1 developed T-2 anesthesia, whereas no one in group 2 did (P less than 0.01), and their pressure difference values ranged from 12 to 16 cm H2O, substantially larger than those of the other patients in group 1. Five patients in group 2 developed T-3 anesthesia, whereas no patient in group 1 (P less than 0.01) did, and their pressure differences were not essentially larger than those of the rest in the same group. The authors conclude that pressure differences correlated with the SSA, although the mechanism remains to be clarified. It seems possible to predict which patient in the younger patient group may develop unintentional high spinal anesthesia (T-3 or higher) by measuring pressure differences.
我们研究了完全屈曲侧卧位与非完全屈曲侧卧位之间的脑脊液压力差（dP）是否会影响鞘内（即脊髓）注射麻醉溶液（SSA）的扩散。42名年龄在18至60岁之间、接受脊髓麻醉下妇科手术的女性纳入本研究。她们被分为两组（第1组：年龄小于40岁，第2组：年龄大于或等于40岁）。在脊髓麻醉注射前，我们测量了从右侧卧位（非完全屈曲）L2 - 3间隙穿刺置针到完全屈曲侧卧位时体位改变产生的压力差。在她们回到非完全屈曲侧卧位后，向每位患者鞘内注射14mg的普鲁卡因于10%葡萄糖溶液（2.8mL）中。压力差与每组脊髓麻醉的头端平面显著相关；压力差越大，SSA越大。这种关系在年轻组中更强（相关系数分别为0.82和0.63；第1组和第2组的P值均小于0.01）。第1组中有3例出现T - 2平面麻醉，而第2组中无人出现（P小于0.01），且她们的压力差值范围为12至16cmH₂O，显著大于第1组中的其他患者。第2组中有5例出现T - 3平面麻醉，而第1组中无患者出现（P小于0.01），且她们的压力差与同组其他患者相比并无本质上的增大。作者得出结论，尽管机制尚待阐明，但压力差与SSA相关。通过测量压力差似乎有可能预测年轻患者组中哪些患者可能会发生意外的高位脊髓麻醉（T - 3或更高平面）。
