Whalley D G, D'Amico J A, Rybicki L A, Gottlieb A, Ryckman J V, Schoenwald P K, Bedocs N M
Department of General Anesthesiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Reg Anesth. 1995 Sep-Oct;20(5):407-11.
A study was done to determine whether a difference existed in the quality and time to maximum anesthesia between the induction of lumbar epidural anesthesia in the sitting and supine position in patients undergoing infrainguinal arterial reconstruction.
An epidural catheter was inserted at L3-L4 in 40 patients who were randomly assigned to two groups. In group 1, with the patient sitting, 3 mL lidocaine 1.5% with 5 micrograms/mL epinephrine was given as a test dose, followed 3 minutes later by 12 mL bupivacaine 0.75% injected over 2 minutes through the catheter. After remaining in the sitting position for 5 minutes, the patient was placed supine and the quality of anesthesia assessed at 3-minute intervals for 30 minutes. Anesthesia was assessed by loss of sensation to pinprick and the Bromage scale for loss of motor function. In group 2, after placement of the catheter, the patient was immediately placed supine, the same doses of local anesthesia were given at the same time intervals as in group 1, and the onset of anesthesia was similarly assessed. In addition to a comparison between groups in the quality and time to maximum anesthesia, a correlation was sought between these variables and the age, weight, height, and body surface area (BSA) of the patients in each group.
The demographically similar groups showed no difference in maximum cephalad spread of anesthesia (median, interquartile range; group 1: T4, T2.5-T6; group 2: T4, T2.5-T7), motor block (group 1: 3, 2-4; group 2: 4, 4-6), or time to maximum motor block (mean +/- SD; group 1, 17.4 +/- 8.7 minutes; group 2, 17.9 +/- 6.8 minutes). The time to maximum cephalad spread of anesthesia was shorter in group 1 (13.8 +/- 6.9 minutes; group 2, 18.6 +/- 6.6 minutes; P = .03). Neither the age nor weight of the patients in either group had any influence on the quality and time to maximum anesthesia. There was, however, a significant correlation between the height (r = 0.48, P = .0303) and BSA (r = 0.48, P = .0318) of the patients in group 1 and the time to maximum cephalad spread of anesthesia.
When lumbar epidural anesthesia was induced in the sitting rather than supine position, the time to maximum cephalad spread was shorter and correlated directly with the height and BSA of the patient. The position of the patient during induction had no effect on the final level of cephalad spread and degree of motor block.
开展一项研究以确定在接受腹股沟下动脉重建术的患者中，坐位与仰卧位进行腰段硬膜外麻醉诱导时，麻醉质量及达到最大麻醉效果的时间是否存在差异。
将40例患者随机分为两组，于L3-L4间隙置入硬膜外导管。第1组患者取坐位，给予3 mL含5微克/毫升肾上腺素的1.5%利多卡因作为试验剂量，3分钟后通过导管在2分钟内注入12 mL 0.75%布比卡因。保持坐位5分钟后，患者改为仰卧位，每隔3分钟评估一次麻醉质量，共评估30分钟。通过针刺感觉丧失及运动功能丧失的 Bromage 评分评估麻醉效果。第2组患者在置入导管后立即取仰卧位，按照与第1组相同的时间间隔给予相同剂量的局部麻醉药，并以同样的方式评估麻醉起效情况。除比较两组间麻醉质量及达到最大麻醉效果的时间外，还探寻这些变量与每组患者的年龄、体重、身高及体表面积（BSA）之间的相关性。
两组人口统计学特征相似，在麻醉最高向头端扩散范围（中位数，四分位间距；第1组：T4，T2.5-T6；第2组：T4，T2.5-T7）、运动阻滞（第1组：3，2-4；第2组：4，4-6）或达到最大运动阻滞的时间（均值±标准差；第1组，17.4±8.7分钟；第2组，17.9±6.8分钟）方面均无差异。第1组达到麻醉最高向头端扩散的时间较短（13.8±6.9分钟；第2组，18.6±6.6分钟；P = 0.03）。两组患者的年龄和体重均对麻醉质量及达到最大麻醉效果的时间无任何影响。然而，第1组患者的身高（r = 0.48，P = 0.0303）和体表面积（r = 0.48，P = 0.0318）与达到麻醉最高向头端扩散的时间之间存在显著相关性。
腰段硬膜外麻醉诱导时采用坐位而非仰卧位，达到麻醉最高向头端扩散的时间较短，且与患者的身高和体表面积直接相关。诱导时患者的体位对最终向头端扩散的水平及运动阻滞程度无影响。
