Department of Anesthesia and Intensive Care, Buccheri La Ferla Fatebenefratelli Hospital-Palermo, Italy.
Minerva Anestesiol. 2010 Sep;76(9):714-9. Epub 2010 Jul 1.
The aim of this study was to evaluate the number of conversions from spinal anesthesia (SA) into general anesthesia (GA) in a large number of patients who underwent surgery over a period of twenty-one years.
From the hospital's database, all surgical procedures performed under SA between January 1, 1988 and December 31, 2008 were retrieved. From this file, all SA cases converted into GA cases requiring endotracheal intubation were selected. Patients were divided in four groups, according to the reason for GA: IMPOSS (SA impossible to perform), FAIL (SA non profound enough for allowing surgery, even with light sedation), INSUFF (SA inadequate for unexpected prolonged duration of surgery), and COMPL (occurrence of complications associated with SA and requiring rapid control of ventilation). Anesthesiologists who performed SA were divided according their experience. The outcomes of patients converted to GA were compared with a matched sample of patients who received planned GA.
A total of 35,960 SA cases were performed from 1988 to 2008; 29,220 and 6,740 SA cases were for elective and emergency surgery, respectively. Two hundred seventeen (0.6%) SA cases were converted into GA cases; 80.2% and 19.8% of the conversions were recorded in elective and emergency operations, respectively, with obstetric operations being the most prevalent (82/217). The primary reasons for the conversions, in a rank order, were INSUFF 107 (49.3%), FAIL 84 (38.7%), IMPOSS 13 (5.9%), and COMPL 13 (5.9%). Complications more frequently occurred in the aged population (P<0.05). Anesthesiologists with less experience had higher percentages of FAIL, IMPOSS, INSUFF, and COMPL SA cases in comparison with experienced anesthesiologists (odd ratios being 4.7, 3.0, 2.4, and 4.4, respectively). There was no difference in the frequency of complications compared to a matched sample of 1,000 patients who underwent GA (P=0.65).
SA has been found to be a safe and highly effective technique. Failure of SA was infrequent in a large number of patients surveyed and most often occurred with less experienced anesthesiologists. Conversion to GA did not produced different outcomes in comparison with planned GA. Prospective studies with a definite protocol for recording data performed on a large number of patients may help in determining the factors associated with conversion from SA into GA and how to avoid these unexpected situations.
本研究旨在评估在 21 年期间对大量手术患者进行椎管内麻醉（SA）转为全身麻醉（GA）的数量。
从医院数据库中检索 1988 年 1 月 1 日至 2008 年 12 月 31 日期间进行的所有 SA 手术。从该文件中，选择所有需要气管内插管转为 GA 的 SA 转为 GA 病例。根据 GA 的原因将患者分为四组：IMPOSS（无法进行 SA）、FAIL（SA 不够深，即使给予轻度镇静也无法进行手术）、INSUFF（SA 不足以应对意外延长的手术时间）和 COMPL（与 SA 相关的并发症并需要快速控制通气）。进行 SA 的麻醉师根据其经验进行分组。比较了转为 GA 的患者的结果与接受计划 GA 的患者的匹配样本。
1988 年至 2008 年共进行了 35960 例 SA 手术；29220 例和 6740 例分别为择期和急诊手术。217 例（0.6%）SA 病例转为 GA 病例；择期和急诊手术的转化率分别为 80.2%和 19.8%，产科手术最为常见（82/217）。转换的主要原因按等级顺序排列依次为 INSUFF 107 例（49.3%）、FAIL 84 例（38.7%）、IMPOSS 13 例（5.9%）和 COMPL 13 例（5.9%）。并发症更常发生在老年人群中（P<0.05）。经验较少的麻醉师在 FAIL、IMPOSS、INSUFF 和 COMPL 方面的 SA 病例百分比高于经验丰富的麻醉师（比值比分别为 4.7、3.0、2.4 和 4.4）。与 1000 名接受 GA 的患者的匹配样本相比，并发症的发生率没有差异（P=0.65）。
SA 已被证明是一种安全且非常有效的技术。在调查的大量患者中，SA 失败并不常见，并且大多数情况下发生在经验较少的麻醉师中。与计划 GA 相比，转为 GA 并未产生不同的结果。对大量患者进行具有明确数据记录方案的前瞻性研究可能有助于确定从 SA 转为 GA 的相关因素以及如何避免这些意外情况。
