Prades J M, Navez M L, Martin C
Service O.R.L., C.H.U. Bellevue, Saint-Etienne.
Ann Otolaryngol Chir Cervicofac. 1987;104(8):587-91.
Principal anatomical "targets" and physiological consequences of cervical epidural anesthesia are outlined, technic and aims of the method discussed and 53 patients (class ASA I and II) receiving major cervical surgery, mainly for cancer, reviewed. Effectiveness of cervical epidural anesthesia was rated as excellent for total pharyngo-laryngectomy, with or without flaps, total laryngectomy, lymph node curettage and thyroidectomy, moderate for reconstructive laryngectomy and only fair for transmaxillary buccopharyngectomy. Advantages of the method concern principally the postoperative period: immediate awakening (92% of cases) in the operating room whatever the duration of surgery, avoiding intensive care, and pain relief for at least 48 hours (85% of cases) by maintenance of catheter. Contraindications include hypocoagulability, local or general infection and impossibility of adjusting heart rate, and the method is not applicable for all patients in whom general anesthesia with assisted ventilation is contraindicated.
概述了颈段硬膜外麻醉的主要解剖“靶点”和生理后果，讨论了该方法的技术和目的，并回顾了53例主要因癌症接受颈部大手术的患者（ASA I级和II级）。颈段硬膜外麻醉对全喉咽切除术（无论有无皮瓣）、全喉切除术、淋巴结刮除术和甲状腺切除术的有效性被评为优秀，对重建性喉切除术为中等，对经上颌颊咽切除术仅为一般。该方法的优点主要涉及术后阶段：无论手术时间长短，92%的病例在手术室立即苏醒，避免了重症监护，通过保留导管至少48小时（85%的病例）缓解疼痛。禁忌症包括凝血功能低下、局部或全身感染以及无法调节心率，并且该方法不适用于所有禁忌全身麻醉并辅助通气的患者。
