Johansson Sofia, Lind Morten Nikolaj
Dan Med J. 2017 Sep;64(9).
Aortic stenosis is a valvular lesion that poses several haemodynamic challenges for the anaesthesiologist. The use of central regional anaesthesia is traditionally regarded as contraindicated in patients with severe aortic stenosis due to its sympatholytic effect, potentially causing loss of vascular tone and ultimately diminished cardiac output. The aim of this paper was to review current literature to find evidence for or against the use of neuroaxial blockade in patients with aortic stenosis.
We searched PubMed for relevant articles, using the following MeSH terms: "aortic valve stenosis", "epidural anesthesia", "spinal anesthesia" and "epidural analgesia". Only English language literature was included. Papers concerning aortic stenosis and obstetrical anaesthesia were excluded.
There are no randomised clinical trials on the subject, and existing literature is extremely sparse. Four retrospective studies and eight case reports counting a total of ten patients were found. All report successful use of neuroaxial blockade in patients with aortic stenosis, without severe haemodynamic alterations. In addition, data indicate that postepidural analgesia improves outcome compared with conventional analgesia.
To the best of our knowledge, there is no clinical evidence supporting the notion that central regional anaesthesia has any adverse effects on patients with aortic stenosis. Carefully managed neuroaxial blockade could become a useful alternative to general anaesthesia in this patient group. However, evidence is sparse and of questionable quality. Large prospective randomised clinical trials are required to establish best practise.
主动脉瓣狭窄是一种瓣膜病变，给麻醉医生带来了诸多血流动力学方面的挑战。由于其具有交感神经阻滞作用，传统上认为严重主动脉瓣狭窄患者禁忌使用中枢区域麻醉，因为这可能导致血管张力丧失，最终使心输出量减少。本文旨在回顾当前文献，寻找支持或反对在主动脉瓣狭窄患者中使用神经轴阻滞的证据。
我们在PubMed上搜索相关文章，使用了以下医学主题词：“主动脉瓣狭窄”、“硬膜外麻醉”、“脊髓麻醉”和“硬膜外镇痛”。仅纳入英文文献。排除了有关主动脉瓣狭窄和产科麻醉的文章。
关于该主题没有随机临床试验，现有文献极为稀少。共找到四项回顾性研究和八篇病例报告，涉及十名患者。所有报告均表明在主动脉瓣狭窄患者中成功使用了神经轴阻滞，且未出现严重血流动力学改变。此外，数据表明与传统镇痛相比，硬膜外镇痛可改善预后。
据我们所知，没有临床证据支持中枢区域麻醉会对主动脉瓣狭窄患者产生任何不利影响这一观点。对于该患者群体，精心管理的神经轴阻滞可能成为全身麻醉的一种有用替代方法。然而，证据稀少且质量存疑。需要进行大型前瞻性随机临床试验以确立最佳实践。
