Kang Seung Youn, Kim Hyeun Sung, Kang Hyun
Department of Anesthesiology and Pain Medicine, Nanoori Hospital Gangnam, Seoul, Republic of Korea.
Department of Neurosurgery, Cheongdam Harrison Hospital Gangnam, Seoul, Republic of Korea.
J Pain Res. 2025 Sep 10;18:4727-4741. doi: 10.2147/JPR.S531946. eCollection 2025.
This study examines the hemodynamic responses elicited by epidural, subdural, and combined epidural-subdural anesthesia during spinal surgery, with a focus on anesthetic levels and ASA classifications. It integrates image findings to enhance understanding of the anesthetic impact on hemodynamic stability.
A retrospective analysis was conducted involving patients who underwent endoscopic, open, or fusion spine surgeries with epidural anesthesia and monitored anesthesia care (MAC) between March 2018 and September 2023. Comprehensive demographic data, details regarding anesthetic levels, ASA class and hemodynamic measurements were systematically collected. Additionally, fluoroscopic images were assessed to investigate the distribution patterns of anesthetics and their relationship to hemodynamic outcomes.
In patients undergoing epidural, subdural, and combined epidural-subdural anesthesia with high-level blocks above T5 and classified as ASA class III or higher, no significant differences were observed in hypotensive events or vasopressor usage compared to those with lower-level blocks or ASA classifications. The mean duration of surgery was 90.6 ± 40.9, 105.4 ± 42.5, and 100.8 ± 46.6 minutes, respectively, across the three groups. Subdural anesthesia exhibited a similar hemodynamic profile, with milder blood pressure decreases. Imaging analysis indicated distinct anesthetic distribution patterns primarily in the posterior epidural and subdural spaces, which helped preserve anterior sympathetic and motor functions, suggesting a relationship between fluoroscopic imaging features and hemodynamic stability.
Hemodynamic stability was maintained in the subdural and combined epidural-subdural groups compared to the epidural group in ASA I to III patients. However, epidural anesthesia showed better hemodynamic outcomes for ASA class above III. High-level epidural and subdural anesthesia primarily induced posterior diffusion, resulting in minimal anterior sympathetic block while preserving stability. These findings suggest that epidural anesthesia may be a viable alternative for spinal surgeries and applicable to other procedures for patients with high ASA classifications.
本研究探讨脊柱手术期间硬膜外、硬膜下及联合硬膜外-硬膜下麻醉引起的血流动力学反应，重点关注麻醉平面和美国麻醉医师协会（ASA）分级。本研究整合影像学结果以加深对麻醉对血流动力学稳定性影响的理解。
对2018年3月至2023年9月期间接受硬膜外麻醉的内镜、开放或融合脊柱手术及监测麻醉护理（MAC）的患者进行回顾性分析。系统收集了全面的人口统计学数据、麻醉平面细节、ASA分级及血流动力学测量数据。此外，评估了透视图像以研究麻醉剂的分布模式及其与血流动力学结果的关系。
在接受硬膜外、硬膜下及联合硬膜外-硬膜下麻醉且阻滞平面高于T5且ASA分级为III级或更高的患者中，与阻滞平面较低或ASA分级较低的患者相比，在低血压事件或血管升压药使用方面未观察到显著差异。三组患者的平均手术时间分别为90.6±40.9、105.4±42.5和100.8±46.6分钟。硬膜下麻醉表现出相似的血流动力学特征，血压下降较轻。影像学分析表明，麻醉剂主要分布在硬膜外和硬膜下后间隙，有助于保留前部交感神经和运动功能，提示透视成像特征与血流动力学稳定性之间存在关联。
在ASA I至III级患者中，与硬膜外组相比，硬膜下组和联合硬膜外-硬膜下组维持了血流动力学稳定性。然而，对于ASA分级高于III级的患者，硬膜外麻醉显示出更好的血流动力学结果。高位硬膜外和硬膜下麻醉主要引起向后扩散，导致前部交感神经阻滞最小化，同时保持稳定性。这些发现表明，硬膜外麻醉可能是脊柱手术的一种可行替代方法，适用于ASA分级高的患者的其他手术。
