Kirby Gregory A, Guo Wenjuan, Mitchell John D, Ma Haobo
Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Anesthesiology, Peking Union Medical College Hospital, Beijing, CHN.
Cureus. 2021 Jan 7;13(1):e12556. doi: 10.7759/cureus.12556.
In geriatric patients scheduled for hip or knee surgery, neuraxial anesthesia is a safe and effective anesthesia method and may be a better option than general anesthesia. Unfortunately, establishing neuraxial anesthesia is not always easy in this group of patients. Anatomical abnormalities, such as spinal stenosis, scoliosis, and narrowed interspaces, contribute to the difficulties that anesthesiologists face while performing these procedures. The classic Taylor's approach targets the widest interspace, L5-S1, as the needle insertion site and accordingly has an increased success rate in difficult neuraxial anesthesia. As this technique historically relies solely on palpation, it might be difficult in patients with less prominent or distorted anatomic landmarks. Ultrasonography or fluoroscopy guidance may help to better target the epidural or subarachnoid space, but both have limitations due to equipment availability or provider expertise. The modified Taylor's approach we propose in this case report is based on preoperative lumbar x-ray interpretation when point-of-care image guidance cannot be performed. By measuring on the patient's preoperative lumbar x-ray, we successfully performed a modified Taylor's approach of spinal anesthesia on an elderly patient with severe scoliosis. She underwent open reduction and internal fixation (ORIF) of the left femur with satisfactory pain control and no complications.
在计划进行髋部或膝部手术的老年患者中，神经轴索麻醉是一种安全有效的麻醉方法，可能比全身麻醉更好。不幸的是，在这类患者中建立神经轴索麻醉并不总是容易的。解剖学异常，如椎管狭窄、脊柱侧弯和椎间隙变窄，增加了麻醉医生在进行这些操作时面临的困难。经典的泰勒入路以最宽的椎间隙L5-S1作为穿刺点，因此在困难的神经轴索麻醉中成功率更高。由于该技术历来仅依靠触诊，对于解剖标志不明显或扭曲的患者可能会有困难。超声或透视引导可能有助于更好地定位硬膜外或蛛网膜下腔，但由于设备可用性或操作者专业知识的原因，两者都有局限性。在本病例报告中，我们提出的改良泰勒入路是基于在无法进行床旁影像引导时对术前腰椎X线片的解读。通过在患者术前腰椎X线片上测量，我们成功地对一名患有严重脊柱侧弯的老年患者实施了改良泰勒入路的脊髓麻醉。她接受了左股骨切开复位内固定术（ORIF），疼痛控制良好，无并发症。
