D'Alessio J G, Weller R S, Rosenblum M
Department of Anesthesiology, University of Tennessee School of Medicine, Memphis, USA.
Anesth Analg. 1995 Jun;80(6):1158-62. doi: 10.1097/00000539-199506000-00016.
A retrospective analysis of 116 patients who underwent shoulder arthroscopy in the sitting position with interscalene block (ISB) revealed 20 patients who experienced potentially dangerous vasovagal events characterized by sudden severe hypotension and bradycardia (Group 1). The event occurred 61 +/- 18 min after the block placement. Ninety-six patients (Group 2) did not experience a vasovagal event. Of the patients in Group 2, 18 received beta-adrenergic blockers for increasing heart rate and/or arterial blood pressure (Group 2B) while 78 did not (Group 2A). The number receiving beta-adrenergic blockers was significantly greater than in Group 1 (18/96 vs 0/20, P < 0.05). There were no significant demographic or baseline hemodynamic differences between groups, but the beta-adrenergic blocker and vagal groups showed significantly greater intraoperative peak heart rates (P < 0.05). All patients received epinephrine in their local anesthetic for ISB, incision sites, and articular irrigating solution. Total and weight-corrected epinephrine doses differed significantly between groups (lowest in Group 2A, P < 0.01). Activation of the Bezold-Jarisch reflex, induced by increased circulating epinephrine levels and the sitting position, is the postulated mechanism.
对116例在坐位下接受肌间沟阻滞（ISB）的肩关节镜手术患者进行回顾性分析，发现20例患者发生了潜在危险的血管迷走神经事件，其特征为突然严重低血压和心动过缓（第1组）。该事件发生在阻滞放置后61±18分钟。96例患者（第2组）未发生血管迷走神经事件。在第2组患者中，18例接受β-肾上腺素能阻滞剂以提高心率和/或动脉血压（第2B组），而78例未接受（第2A组）。接受β-肾上腺素能阻滞剂的人数明显多于第1组（18/96对0/20，P<0.05）。各组之间在人口统计学或基线血流动力学方面无显著差异，但β-肾上腺素能阻滞剂组和迷走神经组的术中峰值心率明显更高（P<0.05）。所有患者在用于ISB、切口部位和关节冲洗液的局部麻醉剂中均接受了肾上腺素。各组之间肾上腺素的总量和体重校正剂量有显著差异（第2A组最低，P<0.01）。推测其机制是循环肾上腺素水平升高和坐位诱发的贝佐尔德-雅里什反射激活。
