Galvagno Samuel M, Brayanov Jordan, Williams George, George Edward E
Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201.
Respiratory Motion Inc., 411 Waverley Oaks Road No. 150, Waltham, MA 02452.
Mil Med. 2017 Mar;182(S1):78-86. doi: 10.7205/MILMED-D-16-00048.
Care of military casualties requires not only assessment of patient, injury, and setting, but also the consequences of care decisions on other organ systems. In contemporary conflicts, pelviperineal and lower extremity trauma are common injuries, yet the optimal perioperative anesthetic and analgesic care remains unclear. Residual anesthesia and opioids can cause respiratory depression, specifically postoperative respiratory depression and opioid-induced respiratory depression. This observational study quantified and compared the incidences of respiratory depression following general anesthesia (GA) and spinal anesthesia (SA) for lower extremity surgery. Respiratory data were collected from 173 patients receiving either GA (n = 43) or SA (n = 130) via a bioimpedance-based respiratory volume monitor. Patients were further subdivided by postoperative opioid administration. The overall incidence of respiratory depression was significantly higher in the SA group (48/130 vs. 6/43, p = 0.004). These findings suggest that, while SA may be considered the safer alternative, it may in fact introduce confounding factors, which increase the risk of respiratory depression. Ensuring adequate respiratory status is particularly critical for the military population, as combat casualties are often monitored in understaffed environments following surgery. Using an SA strategy instead of GA may not prevent postoperative respiratory depression, and respiratory volume monitor monitoring may be useful to optimize care.
军事伤员的护理不仅需要评估患者、损伤情况和环境，还需要考虑护理决策对其他器官系统的影响。在当代冲突中，骨盆会阴和下肢创伤是常见的损伤，但围手术期最佳的麻醉和镇痛护理仍不明确。残留的麻醉剂和阿片类药物可导致呼吸抑制，特别是术后呼吸抑制和阿片类药物引起的呼吸抑制。这项观察性研究对下肢手术全身麻醉（GA）和脊髓麻醉（SA）后呼吸抑制的发生率进行了量化和比较。通过基于生物阻抗的呼吸容积监测仪收集了173例接受GA（n = 43）或SA（n = 130）患者的呼吸数据。患者根据术后阿片类药物的使用情况进一步细分。SA组呼吸抑制的总体发生率显著更高（48/130 vs. 6/43，p = 0.004）。这些发现表明，虽然SA可能被认为是更安全的选择，但实际上它可能引入混杂因素，增加呼吸抑制的风险。确保足够的呼吸状态对军人尤为关键，因为战斗伤员术后往往在人员不足的环境中接受监测。采用SA策略而非GA可能无法预防术后呼吸抑制，呼吸容积监测仪监测可能有助于优化护理。
