Tani Y, Terai T, Yukioka H, Fujimori M
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School.
Masui. 1993 Sep;42(9):1371-4.
A 60-year-old woman was admitted to our hospital for surgical treatment of the left inguinal hernia. She had suffered from diabetes insipidus for ten years, and hormonal study revealed low plasma level of vasopressin. She has been taking nasally desmopressin acetate 5 micrograms twice a day and urinary output has been well controlled around 1200-1400 ml.day-1. CT-scan showed empty sella without any pituitary tumors. There were no evidences of increased intracranial pressure and neurological deficit. Following nasal instillation of desmopressin acetate 5 micrograms one hour before anesthesia, spinal anesthesia was performed with tetracaine 10 mg. Cephalad sensory block assessed by pinprick spread to T6 within 10 minutes. Systolic blood pressure gradually decreased from 120 to 90 mmHg, although no vasoconstrictors were needed. Arterial blood pressure was stable during the surgery. The operation lasted 80 minutes with 650 ml of fluid replacement, blood loss of 50 g and urinary output of 25 ml. She had no postspinal headache nor neurological deficit after surgery. Empty sella syndrome associated with diabetes insipidus is rare. Low spinal anesthesia can be performed safely whenever there is no evidence of increased intracranial pressure, although care should be taken for perioperative fluid and circulatory management.
一名60岁女性因左侧腹股沟疝入我院接受手术治疗。她患尿崩症已十年，激素检查显示血管加压素血浆水平较低。她一直每日两次经鼻服用5微克醋酸去氨加压素，尿量控制良好，约为1200 - 1400毫升/天。CT扫描显示蝶鞍空虚，无垂体肿瘤。没有颅内压升高和神经功能缺损的证据。在麻醉前1小时经鼻滴入5微克醋酸去氨加压素后，用10毫克丁卡因进行脊髓麻醉。通过针刺评估，头侧感觉阻滞在10分钟内扩散至T6。收缩压逐渐从120毫米汞柱降至90毫米汞柱，尽管无需使用血管收缩剂。手术期间动脉血压稳定。手术持续80分钟，补液650毫升，失血50克，尿量25毫升。术后她无脊髓穿刺后头痛及神经功能缺损。与尿崩症相关的蝶鞍空虚综合征罕见。只要没有颅内压升高的证据，低平面脊髓麻醉可以安全实施，不过围手术期应注意液体和循环管理。
