Shenkman Ze'ev, Johnson Victor M, Zurakowski David, Arnon Shmuel, Sethna Navil F
Department of Anesthesia, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Paediatr Anaesth. 2012 Sep;22(9):865-70. doi: 10.1111/j.1460-9592.2012.03873.x. Epub 2012 May 15.
There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited.
We reviewed our experience with 44 unsupplemented SA with 1 mg·kg(-1) of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO(2)) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants.
There was no significant change in systolic, diastolic, or mean blood pressures from pre-SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO(2) across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia.
The data suggest that SA with 1 mg·kg(-1) of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.
关于脊髓麻醉（SA）对血流动力学的影响，存在相互矛盾的报道。关于SA对先天性心脏病（CHD）婴儿血流动力学影响的数据有限。
我们回顾了44例未补充用药的SA经验，这些SA使用1mg·kg⁻¹的高压丁卡因或布比卡因，用于非青紫型CHD的早产儿和前早产儿。评估了血流动力学和氧合血红蛋白饱和度（SpO₂）。没有给任何婴儿术前静脉推注液体或使用阿托品。
与手术结束时相比，SA诱导前的收缩压、舒张压或平均血压没有显著变化。心率有小幅但系统性的下降（平均变化为每分钟10次心跳，P<0.01），但仍在该年龄的正常范围内。在整个时间过程中，SpO₂有小幅但临床上无显著意义的升高。术中，两名婴儿出现短暂的呼吸暂停发作。没有婴儿出现术后呼吸暂停、氧饱和度下降或心动过缓。
数据表明，1mg·kg⁻¹的高压丁卡因或布比卡因SA可安全地用作非青紫型CHD婴儿腹股沟疝修补术的唯一麻醉方法，即使在限制液体摄入的情况下，且显然这些婴儿的呼吸并发症最少。
