Noda J, Ohama J, Suzuki S
Department of Anesthesiology, Okazaki Municipal Hospital.
Masui. 1994 Aug;43(8):1251-5.
Epidural anesthesia is currently used for the operation of patients who have bronchial asthma. We have ascertained the effectiveness of cervical epidural block for the treatment of status asthmaticus even in the ICU. The present patient had repeated history of severe asthma and was no longer expected to respond to the routine therapy. After we failed to wean him from the ventilator several times, we performed cervical epidural block on him. His condition improved dramatically after the block and he was easily weaned from the ventilator. The three notable improvements are (1) no use of sedatives, (2) normalized arterial blood pH with decrease in expiratory resistance and (3) stabilization of circulation. Sympathetic nervous system is excited in patients with asthmatic attack. As a result, high concentrations of catecholamines deteriorate general condition of patients. On the other hand, cervical epidural block seems to be effective to prevent hyperactive sympathetic nervous system. Our result suggests that alpha-adrenergic effect of epinephrine which is given as a routine therapeutic drug, will very likely worsen asthmatic attack.
目前，硬膜外麻醉用于支气管哮喘患者的手术。我们已经确定，即使在重症监护病房（ICU），颈段硬膜外阻滞对治疗哮喘持续状态也是有效的。该患者有严重哮喘反复发作史，预计对常规治疗不再有反应。在我们多次尝试使其脱机失败后，对他实施了颈段硬膜外阻滞。阻滞后他的病情显著改善，并且很容易就脱机了。三个显著的改善是：（1）无需使用镇静剂；（2）动脉血pH值恢复正常，呼气阻力降低；（3）循环稳定。哮喘发作患者的交感神经系统兴奋。结果，高浓度的儿茶酚胺会使患者的一般状况恶化。另一方面，颈段硬膜外阻滞似乎对预防交感神经系统功能亢进有效。我们的结果表明，作为常规治疗药物使用的肾上腺素的α-肾上腺素能效应很可能会加重哮喘发作。
