Bird T M, Strunin L
Can Anaesth Soc J. 1984 Jan;31(1):51-60. doi: 10.1007/BF03011483.
With the advent of surgery under the operating microscope microvascular surgical techniques requiring prolonged anaesthesia have greatly increased in number. Local anaesthetic techniques, whilst often producing excellent surgical conditions, are limited by the duration of action of the anaesthetic agents and by the ability of the patient to remain still, often in uncomfortable positions, for periods of up to twenty hours. The use of indwelling catheters as a means of prolonging the duration of nerve blocks is discussed along with methods of sedation or general anaesthesia to enable the patient to tolerate lengthy surgical intervention. Present general anaesthetic techniques may not be ideally suited to long surgical procedures. The problems and possible alternatives are discussed. Sympathetic ganglion blockade, intravenous regional blockade and systemic vasodilator therapy are discussed as a means of improving the success rate of these procedures. The general principles of patient management such as fluid balance, temperature control, patient positioning and control of the operating room environment assume a much greater significance when related to the provision of prolonged general anaesthesia, whilst the effect of extended periods of work on operating personnel must also be considered.
随着手术显微镜下手术的出现，需要长时间麻醉的微血管外科技术的数量大幅增加。局部麻醉技术虽然常常能创造出极佳的手术条件，但受到麻醉剂作用时间以及患者在长达二十小时的时间内保持静止（通常处于不舒服的姿势）能力的限制。文中讨论了使用留置导管来延长神经阻滞持续时间的方法，以及使用镇静或全身麻醉以使患者耐受长时间手术干预的方法。目前的全身麻醉技术可能并非完全适用于长时间的外科手术。文中讨论了相关问题及可能的替代方法。交感神经节阻滞、静脉区域阻滞和全身血管扩张剂疗法作为提高这些手术成功率的手段进行了讨论。与提供长时间全身麻醉相关时，诸如液体平衡、体温控制、患者体位和手术室环境控制等患者管理的一般原则具有更为重要的意义，同时还必须考虑长时间工作对手术人员的影响。
