Gambling D R, Mayson K, McMorland G H, Moore R
Department of Anaesthesia, Faculty of Medicine, University of British Columbia, Vancouver.
Reg Anesth. 1989 May-Jun;14(3):133-7.
The relationship between patient height and total volume of lidocaine hydrocarbonate (1.73%) with epinephrine, required to produce epidural anesthesia for Cesarean section, was studied. Volume of local anesthetic, time to maximum block, highest segmental block, and number of spinal segments blocked were recorded. The segmental dose requirement (SDR) was calculated. All the results from 9 "short" (less than 5'2") and 18 "tall" (greater than 5'2") patients were compared. There were no intergroup differences between any of the measured variables, and a scatterplot showed no linear relationship between patient height and the volume of the local anesthetic used. The mean values obtained for volume of local anesthetic used in both subgroups were compared with suggested arbitrary volumes of 25 ml for "tall" patients and 18 ml for "short" patients, used as a single-dose through an epidural needle. Using a one-sample hypothesis test, a significant difference was seen in tall patients (16.0 +/- 2.9 v 25; p less than .001), but not in the short subgroup (15.9 +/- 3.2 v 18; p less than .082). Patient height is a poor predictor of the volume of lidocaine hydrocarbonate required for epidural anesthesia in pregnant women. Selecting an arbitrary volume of local anaesthetic for use as a single epidural dose may result in either an excessively high or inadequate segmental block. Well-controlled titration of local anesthetic through an epidural catheter is recommended for elective Cesarean section.
研究了剖宫产硬膜外麻醉所需患者身高与含肾上腺素的碳酸利多卡因（1.73%）总量之间的关系。记录局部麻醉药的用量、达到最大阻滞的时间、最高节段阻滞以及被阻滞的脊髓节段数。计算节段剂量需求（SDR）。比较了9例“矮个子”（身高小于5英尺2英寸）和18例“高个子”（身高大于5英尺2英寸）患者的所有结果。在任何测量变量之间均未发现组间差异，散点图显示患者身高与所用局部麻醉药的量之间无线性关系。将两个亚组中所用局部麻醉药的平均值与建议的任意量进行比较，“高个子”患者为25 ml，“矮个子”患者为18 ml，通过硬膜外针单次给药。采用单样本假设检验，在高个子患者中观察到显著差异（16.0±2.9对25；p＜0.001），但在矮个子亚组中未观察到显著差异（15.9±3.2对18；p＜0.082）。患者身高不是预测孕妇硬膜外麻醉所需碳酸利多卡因量的良好指标。选择任意量的局部麻醉药作为单次硬膜外剂量可能导致节段阻滞过高或不足。对于择期剖宫产，建议通过硬膜外导管进行局部麻醉药的良好控制滴定。
