Dresner M, Pinder A
Department of Anaesthesia, Leeds General Infirmary, Leeds, UK.
Int J Obstet Anesth. 2009 Apr;18(2):131-6. doi: 10.1016/j.ijoa.2008.09.009. Epub 2009 Jan 31.
Cardiac disease in pregnancy is now the leading medical cause of maternal mortality in the UK. Whilst anaesthesia has not been the precipitant of this morbidity, its safety cannot be taken for granted. Spinal catheter anaesthesia, a relatively uncommon choice in obstetric practice, offers the potential of maintaining haemodynamic stability through accurate and gradual titration of neuraxial blockade.
Thirty-four women with cardiac disease requiring caesarean section were selected for spinal catheter anaesthesia. All received invasive arterial pressure measurement but in only two were central venous catheters sited. After inserting a 24-gauge Braun Spinocath, spinal anaesthesia was induced using diamorphine 300 microg and 0.5% hyperbaric bupivacaine in 0.25-mL increments. Technical problems, block quality and haemodynamic stability were recorded.
Successful anaesthesia was achieved in 33 women. Spinal catheterisation proved impossible in one case, but the catheter was successfully used to provide epidural anaesthesia. There were no conversions to general anaesthesia. Eight women (24%) received supplementation with intravenous alfentanil, but all reported high satisfaction. Mild, transient hypotension occurred in six women (18%), and there was one case of vasovagal syncope induced by rapid exteriorisation of the uterus. Three patients (8.8%) experienced post dural puncture headache requiring a blood patch; two had received repeat dural puncture during catheter insertion.
Incremental spinal catheter anaesthesia offers effective anaesthesia with excellent haemodynamic control. Post dural puncture headache is of concern, and whilst it may be addressed by product modification, it currently limits widespread use of the Braun Spinocath in obstetric practice.
在英国，妊娠合并心脏病现已成为孕产妇死亡的主要医学原因。虽然麻醉并非这种发病率的促发因素，但其安全性也不能被视为理所当然。脊髓导管麻醉在产科实践中是一种相对不常见的选择，它通过精确且逐步滴定神经轴阻滞，具有维持血流动力学稳定的潜力。
选择34例患有心脏病且需要剖宫产的女性接受脊髓导管麻醉。所有人均接受有创动脉压测量，但仅2人留置了中心静脉导管。插入24G的贝朗Spinocath脊髓穿刺针后，使用300微克二氢吗啡酮和0.5%重比重布比卡因，以0.25毫升递增剂量诱导脊髓麻醉。记录技术问题、阻滞质量和血流动力学稳定性。
33例女性麻醉成功。1例无法进行脊髓导管插入，但导管成功用于提供硬膜外麻醉。无转为全身麻醉的情况。8例女性（24%）接受了静脉注射阿芬太尼补充，但所有人均表示高度满意。6例女性（18%）出现轻度、短暂性低血压，1例因子宫快速娩出诱发血管迷走性晕厥。3例患者（8.8%）发生硬膜穿刺后头痛，需要进行血补丁治疗；2例在导管插入期间接受了重复硬膜穿刺。
递增式脊髓导管麻醉可提供有效的麻醉，并具有出色的血流动力学控制。硬膜穿刺后头痛令人担忧，虽然可通过产品改进来解决，但目前它限制了贝朗Spinocath在产科实践中的广泛应用。
