Dominguez J, Lobato R D, Rivas J J, Gargallo M C, Castells V, Gozalo A, Sarabia R
Service of Neurosurgery, Hospital 12 Octubre, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
Neurosurgery. 1994 Mar;34(3):422-7; discussion 427-8. doi: 10.1227/00006123-199403000-00006.
Percutaneous compression of the trigeminal ganglion, which is currently being used for the control of trigeminal neuralgia, induces marked intraoperative elevations of the systemic blood pressure and heart rate changes, which may increase the risk of cardiovascular complications. We have analyzed the characteristics of the arterial hypertensive response and the cardiac rhythm changes induced by percutaneous compression of the trigeminal ganglion in 42 consecutive, unselected patients undergoing operations for essential trigeminal neuralgia under three different regimens of anesthesia. The first 22 patients (Group 1) underwent operations under brief general anesthesia without endotracheal intubation. The following 10 patients (Group 2) had general anesthesia with intubation and mechanical ventilation and received larger doses of hypnotic and analgesic agents. Finally, 10 more patients (Group 3), who had general anesthesia with intubation, underwent local anesthetic blockade of Meckel's cave (injection of 1 ml of 1% lidocaine) before ganglion compression. Foramen ovale puncture elicited bradycardia in the majority of the patients of Groups 2 and 3, but only four patients (18%) of Group 1 showed bradycardia. Ganglion compression caused marked tachycardia in all patients of Groups 1 and 2; about one-third of the patients also had extrasystoles. By contrast, patients of Group 3, who had local anesthetic blockade of Meckel's cave before ganglion compression, did not develop tachycardia or extrasystoles. Foramen ovale puncture elicited marked elevations of the systemic blood pressure in all patients. Ganglion compression further increased blood pressure, except in patients of Group 3, who had local anesthetic blockade of Meckel's cave.(ABSTRACT TRUNCATED AT 250 WORDS)
经皮三叉神经节压迫术目前用于控制三叉神经痛，术中会引起全身血压显著升高和心率变化，这可能增加心血管并发症的风险。我们分析了42例连续、未经筛选的原发性三叉神经痛手术患者在三种不同麻醉方案下，经皮三叉神经节压迫术引起的动脉高血压反应和心律律律变化特征。前22例患者（第1组）在无气管插管的短暂全身麻醉下接受手术。接下来的10例患者（第2组）进行插管全身麻醉和机械通气，并接受更大剂量的催眠药和镇痛药。最后，另外10例插管全身麻醉的患者（第3组）在神经节压迫前对Meckel腔进行局部麻醉阻滞（注射1 ml 1%利多卡因）。卵圆孔穿刺在第2组和第3组的大多数患者中引起心动过缓，但第1组只有4例患者（18%）出现心动过缓。神经节压迫在第1组和第2组的所有患者中引起明显的心动过速；约三分之一的患者还出现早搏。相比之下，第3组在神经节压迫前对Meckel腔进行局部麻醉阻滞的患者未出现心动过速或早搏。卵圆孔穿刺在所有患者中引起全身血压显著升高。神经节压迫进一步升高血压，但第3组在神经节压迫前对Meckel腔进行局部麻醉阻滞的患者除外。（摘要截短于250字）
