Jokinen J, Adametz V, Kredel M, Muellenbach R M, Hönig A, Wöckel A, Dietl J, Roewer N, Kranke P
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Anaesthesist. 2015 Feb;64(2):108-14. doi: 10.1007/s00101-014-2408-6. Epub 2014 Dec 25.
Nowadays Caesarean sections are mainly undertaken using spinal anesthesia; therefore, it is important to minimize potential side effects and risks associated with this technique. Currently, many studies have been conducted to optimize the dose of local anesthetics to avoid hypotension, which often occurs during spinal anesthesia.
In a retrospective study design the high-volume, low-concentration technique with up to 12 ml isobaric bupivacain 0.1% (1 mg/ml) and sufentanil (1 µg/ml), which has been used at the University Hospital Würzburg for many years was analyzed with respect to reliability and side effects. The use of this technique so far is unique among university hospitals in Germany.
Of the 1424 anesthesia protocols from 2001 to 2007 a total of 1368 were analyzed. Demographic data and parameters, such as location of puncture, dose and extent of anesthesia, hemodynamic stability and additional medication were recorded. A decrease of systolic blood pressure of more than 20% of the initial value was defined as hypotension.
The median volume used for spinal anesthesia was 9 ml, containing 9 mg bupivacaine and 9 µg sufentanil. The rate of hypotension was 48.8 %. No significant differences in hypotension between lower and higher volumes were detectable. In 0.84% (n=12) of the cases the procedure had to be changed to general anesthesia and additional analgesia was administered in 3 cases (0.22%).
The high-volume, low-concentration technique is an effective approach for spinal anesthesia with a small number of cases needing general anesthesia or additional analgesics. The rate of hypotension was moderate compared to other studies; however, because of the retrospective and non-randomized study design the dependence of this rate on dose and given volume should be interpreted with caution.
如今剖宫产主要采用脊髓麻醉；因此，尽量减少与该技术相关的潜在副作用和风险非常重要。目前，已经进行了许多研究来优化局部麻醉剂的剂量，以避免脊髓麻醉期间经常出现的低血压。
在一项回顾性研究设计中，分析了在维尔茨堡大学医院多年来一直使用的高容量、低浓度技术，即使用高达12毫升的0.1%（1毫克/毫升）等比重布比卡因和舒芬太尼（1微克/毫升），探讨其可靠性和副作用。到目前为止，该技术在德国大学医院中是独一无二的。
对2001年至2007年的1424份麻醉记录进行分析，共分析了1368份。记录人口统计学数据和参数，如穿刺部位、麻醉剂量和范围、血流动力学稳定性以及额外用药情况。收缩压下降超过初始值的20%被定义为低血压。
脊髓麻醉使用的中位容量为9毫升，含9毫克布比卡因和9微克舒芬太尼。低血压发生率为48.8%。未检测到较低和较高容量之间低血压存在显著差异。在0.84%（n = 12）的病例中，手术不得不改为全身麻醉，3例（0.22%）给予了额外镇痛。
高容量、低浓度技术是脊髓麻醉的一种有效方法，需要全身麻醉或额外镇痛的病例较少。与其他研究相比，低血压发生率适中；然而，由于该研究为回顾性且非随机设计，该发生率与剂量和给定容量的相关性应谨慎解读。
