University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Curr Opin Anaesthesiol. 2020 Dec;33(6):746-752. doi: 10.1097/ACO.0000000000000924.
General anesthesia is a popular choice for ambulatory surgery. Spinal anesthesia is often avoided because of perceived delays due to time required to administer it and prolonged onset, as well as concerns of delayed offset, which may delay recovery and discharge home. However, the reports of improved outcomes in hospitalized patients undergoing total joint arthroplasty have renewed the interest in spinal anesthesia. This review article critically assesses the role of spinal anesthesia in comparison with fast-track general anesthesia for the outpatient setting.
The purported benefits of spinal anesthesia include avoidance of airway manipulation and the adverse effects of drugs used to provide general anesthesia, improved postoperative pain, and reduced postoperative opioid requirements. Improved postoperative outcomes after spinal anesthesia in hospitalized patients may not apply to the outpatient population that tends to be relatively healthier. Also, it is unclear if spinal anesthesia is superior to fast-track general anesthesia techniques, which includes avoidance of benzodiazepine premedication, avoidance of deep anesthesia, use of an opioid-sparing approach, and minimization of neuromuscular blocking agents with appropriate reversal of residual paralysis.
The benefits of spinal anesthesia in the outpatient setting remain questionable at best. Further studies should seek clarification of these goals and outcomes.
全身麻醉是门诊手术的常用选择。椎管内麻醉常因给药所需时间和起效时间延长而被认为会延迟，以及对延迟消退的担忧，这可能会延迟恢复和出院，从而被回避。然而，在接受全关节置换术的住院患者中报告的改善结果重新激发了对椎管内麻醉的兴趣。本文批判性地评估了椎管内麻醉与快速通道全身麻醉在门诊环境中的作用。
椎管内麻醉的预期益处包括避免气道操作和用于提供全身麻醉的药物的不良反应、改善术后疼痛和减少术后阿片类药物需求。椎管内麻醉在住院患者中改善术后结果的情况可能不适用于门诊人群，因为后者往往相对更健康。此外，椎管内麻醉是否优于包括避免苯二氮䓬类药物预给药、避免深度麻醉、使用阿片类药物节约方法以及最小化肌松剂并适当逆转残留瘫痪的快速通道全身麻醉技术，目前尚不清楚。
椎管内麻醉在门诊环境中的益处充其量仍存在疑问。进一步的研究应阐明这些目标和结果。
