Brown D L, Ransom D M, Hall J A, Leicht C H, Schroeder D R, Offord K P
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Anesth Analg. 1995 Aug;81(2):321-8. doi: 10.1097/00000539-199508000-00020.
We sought to determine the contemporary frequency of seizures, and the associated cardiovascular changes, resulting from local anesthetic-induced seizures in all patients undergoing brachial plexus, epidural, and caudal regional anesthetics. We investigated the following variables: development and treatment of seizure or cardiac arrest during the regional anesthetic, type of anesthetic (including local anesthetic used), gender, age, ASA physical status class and type of operation (elective or emergent). In addition, each patient who experienced a seizure underwent retrospective review of the acute event to determine the arterial blood pressure and heart rate changes accompanying the seizure, as well as details of the regional block technique. There was a significant difference between the rate of seizure development between epidural, brachia, and caudal anesthetics, with caudal > brachial > epidural. A significant difference was also noted in the rate of seizure development within types of brachial block, with supraclavicular and interscalene > axillary. No adverse cardiovascular, pulmonary or nervous system events were associated with any of the seizures, including the 16 patients who received bupivacaine blocks. The frequency of local anesthetic-induced seizures stratified by block type has a wide range, and cardiovascular collapse after bupivacaine-associated seizure has a low incidence.
我们试图确定在所有接受臂丛神经、硬膜外和骶管区域麻醉的患者中，局部麻醉药诱发癫痫发作的当代发生率以及相关的心血管变化。我们调查了以下变量：区域麻醉期间癫痫发作或心脏骤停的发生与治疗情况、麻醉类型（包括所用局部麻醉药）、性别、年龄、美国麻醉医师协会（ASA）身体状况分级以及手术类型（择期或急诊）。此外，对每例发生癫痫发作的患者进行急性事件的回顾性分析，以确定癫痫发作时的动脉血压和心率变化，以及区域阻滞技术的细节。硬膜外麻醉、臂丛神经麻醉和骶管麻醉之间癫痫发作发生率存在显著差异，骶管麻醉＞臂丛神经麻醉＞硬膜外麻醉。臂丛阻滞类型之间癫痫发作发生率也存在显著差异，锁骨上和肌间沟阻滞＞腋路阻滞。包括16例接受布比卡因阻滞的患者在内，所有癫痫发作均未伴有不良心血管、肺部或神经系统事件。按阻滞类型分层的局部麻醉药诱发癫痫发作的发生率范围很广，布比卡因相关癫痫发作后心血管衰竭的发生率较低。
