Inberg P, Kassila M, Vilkki S, Tarkkila P, Neuvonen P
Department of Anaesthesia, Tampere University Hospital, Finland.
Acta Anaesthesiol Scand. 1995 May;39(4):518-22. doi: 10.1111/j.1399-6576.1995.tb04111.x.
Nowadays, microvascular reconstructions are performed with high success rate even in small children. The combination of general anaesthesia and axillary plexus block was used in this prospective study in order to achieve optimal surgical conditions in these challenging operations. Fifteen children under eight years of age (1-8 years) were anaesthetised with a standardised anaesthesia method using a combination of general anaesthesia and axillary plexus block for microvascular toe-to-hand transfer. The duration of anaesthesia varied between 7.5-14.5 hours (mean 11 h). The difference in peripheral skin temperature was used to indicate the difference in peripheral circulation. Due to plexus block, the mean skin temperature in the operated hand was 1.4 degrees C higher than in the opposite extremity at the end of the operation. In the early postoperative phase the temperature difference increased to 4.8 degrees C (P < 0.01) due to vasoconstriction in the control hand. The mean temperature in the transplant was 33.3 +/- 2.4 degrees C at the end of the operation. Primary microvascular results were good in all but two children who needed reoperations. All of the transfers survived. The mean central temperature increased progressively during the operation from 36.2 degrees C to 37.6 degrees C. One 1-year-old child developed a moderate hyperthermia of 39.1 degrees C. According to this study axillary plexus block can be combined with general anaesthesia in prolonged microvascular operations. When the effect of general anaesthesia ceased, the plexus block effectively increased peripheral circulation in the operated hand.
如今，即使是小儿患者，微血管重建手术的成功率也很高。在这项前瞻性研究中，采用全身麻醉与腋神经丛阻滞相结合的方法，以便在这些具有挑战性的手术中获得最佳手术条件。15名8岁以下（1 - 8岁）儿童接受了标准化麻醉方法，采用全身麻醉与腋神经丛阻滞相结合进行微血管趾-手移植手术。麻醉持续时间在7.5 - 14.5小时之间（平均11小时）。外周皮肤温度差异用于指示外周循环的差异。由于神经丛阻滞，手术结束时手术侧手的平均皮肤温度比另一侧肢体高1.4摄氏度。术后早期，由于对照侧手血管收缩，温度差异增加到4.8摄氏度（P < 0.01）。手术结束时移植组织的平均温度为33.3 ± 2.4摄氏度。除两名需要再次手术的儿童外，所有患者的微血管初步结果良好。所有移植均存活。术中平均中心温度从36.2摄氏度逐渐升至37.6摄氏度。一名1岁儿童出现了39.1摄氏度的中度高热。根据这项研究，在长时间的微血管手术中，腋神经丛阻滞可与全身麻醉联合使用。当全身麻醉效果消失时，神经丛阻滞可有效增加手术侧手的外周循环。
