Sivevski Atanas G, Karadjova Dafina, Ivanov Emilija, Kartalov Andrijan
Department of Anaesthesia, Clinical Center Mother Teresa, University Clinic for Gynecology and Obstetrics, Skopje, Macedonia.
Clinical Center Mother Teresa, University Clinic for TOARILUC, Skopje, Macedonia.
Front Med (Lausanne). 2018 Sep 24;5:254. doi: 10.3389/fmed.2018.00254. eCollection 2018.
Neuraxial anesthesia is recommended as a well-accepted option to minimize the perioperative side effects in the geriatric patients. The available data from the current researches have shifted the focus from the conventional approach to spinal anesthesia to the concept of low dose local anesthetic combined with opioids. What remains clear from all these studies is that hemodynamic stability is much better in patients who received low-doses of intrathecal bupivacaine in combination with opioids, which is possibly result of a potent synergistic nociceptive analgesic effect and their minimal potential effects on sympathetic pathways thus minimizing spinal hypotension. Spinal anesthesia with 5-10 mg of 0.5% heavy bupivacaine, fentanyl 20 mcg and 100 mcg of long-acting morphine added to the perioperative plan decreased the incidence of spinal hypotension and improved perioperative outcomes in the geriatric patients undergoing (low segment) surgical procedures. These findings may be of interest in the gynecologic geriatric surgery also in which area there are very few studies concerning the use of low-dose concept.
神经轴索麻醉被推荐作为一种广泛接受的选择，以尽量减少老年患者围手术期的副作用。当前研究的现有数据已将焦点从传统的脊髓麻醉方法转向低剂量局部麻醉药与阿片类药物联合使用的概念。所有这些研究中仍然明确的是，接受低剂量鞘内布比卡因联合阿片类药物的患者血流动力学稳定性要好得多，这可能是强效协同伤害性镇痛作用以及它们对交感神经通路潜在影响最小从而使脊髓低血压降至最低的结果。在围手术期计划中加入5-10毫克0.5%重比重布比卡因、20微克芬太尼和100微克长效吗啡进行脊髓麻醉，可降低老年患者（低节段）手术过程中脊髓低血压的发生率，并改善围手术期结局。这些发现可能在老年妇科手术中也很有意义，在该领域关于低剂量概念使用的研究非常少。
