Garstka G, Fritsche K, Fischer P
Anasth Intensivther Notfallmed. 1984 Aug;19(4):195-200.
In 271 gynaecological or obstetrical patients a "combined anaesthesia method" was applied, consisting of lumbar catheter epidural analgesia and controlled ventilation with nitrous oxide/oxygen. We aim to show that by mere interaction of the local anaesthetic, with nitrous oxide, and the drugs used for premedication and during induction of anaesthesia a stage of sleep can be achieved, which, on the patient's behalf is identical with his idea of "full anaesthesia", while at the same time the use of centrally acting agents can be kept at a minimum. In incidents of sympatho-adrenergic-stimulation due to insufficient cephalad spread of the blockade and not amenable to additional doses of local anaesthetic, i.v. fentanyl or low concentrations of volatile anaesthetics were added. In the postoperative phase the patients showed a high degree of vigilance. Epidural morphine offered best pain relief with full mobility maintained. In cases with postoperative hypertensive crises, morphine was combined with bupivacaine injections. Even marked obesity or senile degenerative changes in the vertebral column proved not to constitute contraindications for this method.
在271例妇科或产科患者中应用了一种“联合麻醉方法”，该方法包括腰段导管硬膜外镇痛和氧化亚氮/氧气控制通气。我们旨在表明，仅通过局部麻醉药与氧化亚氮以及麻醉前用药和麻醉诱导期间所用药物的相互作用，就可以达到一个睡眠阶段，从患者的角度来看，这个阶段等同于他对“全身麻醉”的认知，同时可以将中枢作用药物的使用保持在最低限度。在因阻滞头端扩散不足而导致交感 - 肾上腺素能刺激且不适合追加局部麻醉药剂量的情况下，静脉注射芬太尼或低浓度挥发性麻醉药。术后患者表现出高度的警觉性。硬膜外吗啡提供了最佳的疼痛缓解效果，同时保持了充分的活动能力。在术后高血压危象的病例中，吗啡与布比卡因注射联合使用。即使是明显肥胖或脊柱存在老年性退行性改变，也证明并非该方法的禁忌证。
