Chambers D J, Bhatia K
Manchester University NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK.
Manchester University NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK.
Int J Obstet Anesth. 2018 Aug;35:75-87. doi: 10.1016/j.ijoa.2018.03.005. Epub 2018 Mar 17.
Horner's syndrome is a rarely reported complication of neuraxial blockade. In obstetric practice, the neurological signs of Horner's syndrome may cause anxiety amongst patients and healthcare staff, but more importantly may herald the onset of maternal hypotension. Medline, CINAHL, and EMBASE databases were searched to identify cases of Horner's syndrome following obstetric neuraxial blockade. Anaesthetic technique, clinical features, anaesthetic management of the Horner's syndrome and time to resolution were assessed. Seventy-eight case reports of Horner's syndrome following obstetric neuraxial blockade were identified. Nine cases also had trigeminal nerve palsy and one case had hypoglossal nerve palsy. Amongst the 78 cases, 74% developed Horner's syndrome within one hour of a local anaesthetic bolus. The median time for resolution of Horner's syndrome was two hours, though one case was permanent. One case of Horner's syndrome was found to be due to an internal carotid artery dissection. Some cases of Horner's syndrome resolved spontaneously despite ongoing administration of epidural local anaesthetic. Hypotension was reported in 13%. Horner's syndrome is usually a benign phenomenon, the consequence of high cephalad spread of local anaesthetic, that resolves spontaneously within a few hours. Patients with a persistent Horner's syndrome, or one associated with atypical features such as neck pain, should undergo a diagnostic workup including magnetic resonance angiography of the neck. The dermatomal level of neuraxial blockade, maternal and fetal well-being should be taken into account when making decisions regarding neuraxial blockade. The presence of Horner's syndrome alone should not lead to discontinuation of neuraxial blockade.
霍纳综合征是一种报道较少的神经轴阻滞并发症。在产科实践中，霍纳综合征的神经学体征可能会引起患者和医护人员的焦虑，但更重要的是，可能预示着产妇低血压的发生。检索了医学期刊数据库（Medline）、护理学与健康领域数据库（CINAHL）和荷兰医学文摘数据库（EMBASE），以确定产科神经轴阻滞后发生霍纳综合征的病例。评估了麻醉技术、临床特征、霍纳综合征的麻醉处理及症状缓解时间。共确定了78例产科神经轴阻滞后发生霍纳综合征的病例报告。其中9例还伴有三叉神经麻痹，1例伴有舌下神经麻痹。在这78例病例中，74%在局部麻醉药推注后1小时内出现霍纳综合征。霍纳综合征症状缓解的中位时间为2小时，不过有1例未恢复。发现1例霍纳综合征是由颈内动脉夹层引起的。尽管持续给予硬膜外局部麻醉药，但仍有一些霍纳综合征病例自行缓解。13%的病例报告有低血压。霍纳综合征通常是一种良性现象，是局部麻醉药向头侧扩散过高的结果，会在数小时内自行缓解。对于持续性霍纳综合征患者，或伴有颈部疼痛等非典型特征的患者，应进行包括颈部磁共振血管造影在内的诊断性检查。在决定是否进行神经轴阻滞时，应考虑神经轴阻滞的皮节平面、母婴健康状况。仅霍纳综合征的存在不应导致神经轴阻滞的中断。
