Limongi Juliana Arruda Godoy, Lins Rossana Sant'anna de Melo
Hospital das Clínicas da Universidade Federal de Pernambuco - HC-UFPE, Brazil.
Rev Bras Anestesiol. 2011 Jan-Feb;61(1):110-20. doi: 10.1016/S0034-7094(11)70012-5.
Spinal anesthesia is an integral part of the daily routine of countless anesthesiologists. It is considered to be a safe procedure, although some complications related to this technique, among them the most feared is cardiopulmonary arrest (cardiac arrest, CA), do exist. The real incidence of CA related to spinal anesthesia, as well as its etiology, is not known and has motivated this review article.
Articles published in the last twenty years in Medline indexed journals and in a textbook were reviewed. The objective of the present review was to identify the incidence of spinal block anesthesia-related CA and the etiology of those cases. We also tried to identify possible risk factors. Finally, treatment strategies described in the literature were reviewed in order to determine the best conduct when facing a case of CA during spinal anesthesia.
The incidence of spinal anesthesia-related CA varies, and it seems to be lower when compared to that of general anesthesia. In the past, it was believed that CA was due to hypoxemia related especially to excessive sedation. However, nowadays, it is known that the etiology of CA during spinal block anesthesia is related to cardiocirculatory factors, mainly a reduction of preload resulting from sympathetic blockade. Other factors that increase the risk of developing CA also exist. Among those factors, the following should be mentioned: changes in patient positioning and hypovolemia. It is very important to institute treatment as soon as possible. Besides a vagolytic agent, early use of a sympathomimetic drug, especially adrenaline, is also recommended to minimize damage to the patient.
脊髓麻醉是无数麻醉医生日常工作中不可或缺的一部分。尽管存在一些与该技术相关的并发症，其中最令人恐惧的是心肺骤停（心脏骤停，CA），但它仍被认为是一种安全的操作。与脊髓麻醉相关的CA的实际发生率及其病因尚不清楚，这促使了本文的撰写。
回顾了过去二十年在被Medline索引的期刊和一本教科书中发表的文章。本综述的目的是确定脊髓阻滞麻醉相关CA的发生率以及这些病例的病因。我们还试图找出可能的风险因素。最后，对文献中描述的治疗策略进行了回顾，以确定在脊髓麻醉期间遇到CA病例时的最佳处理方法。
脊髓麻醉相关CA的发生率各不相同，与全身麻醉相比似乎更低。过去，人们认为CA是由于低氧血症，尤其是过度镇静所致。然而，如今已知脊髓阻滞麻醉期间CA的病因与心血管循环因素有关，主要是交感神经阻滞导致的前负荷降低。还存在其他增加发生CA风险的因素。在这些因素中，应提及以下几点：患者体位改变和血容量不足。尽快进行治疗非常重要。除了解迷走神经药物外，还建议早期使用拟交感神经药物，尤其是肾上腺素，以尽量减少对患者的损害。
