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眼科麻醉(作者译)

[Anesthesia in ophthalmology (author's transl)].

作者信息

Gemperlé M

出版信息

Klin Monbl Augenheilkd. 1977 Feb;170(2):326-9.

PMID:853670
Abstract

General anesthesia in ophthalmological surgery has become a great fashion. However there are still many problems especially in intraocular surgery. The eye with normal intraocular pressure generally needs no special technique. Most of the usual anesthesia produce a slight hypotonia with the exception of Succinylcholine, whose effect is contrary. Unfortunately this is not the case in eyes with pathologically increased intraocular pressure as in the different forms of glaucoma. Eye surgeons and anesthesists therefore look for solutions to this problem which in principle consist in the application of medicaments, which not seldom are rather agressive. The controlled hypotension by ganglion blockers, the curarisation in the state of being awake, the rapid perfusion of solutions with high osmotique effect (isolated or associated) represent such measures. The one has the disadvantage to be applied during so-called subvigile anesthesias where the security that the patient is asleep is rather doubtful; the other has the disadvantage that it requires a rapid perfusion of solutions with highly osmotic effect. It goes without saying that these conditions represent risks especially if one considers that the candidates for this type of intervention very often are senile persons with prearious cardiovascular equilibrium, with insufficient renal function and with insufficient arterial cerebral circulation. These are some of the problems which are to be discussed.

摘要

眼科手术中的全身麻醉已成为一种大趋势。然而,仍然存在许多问题,尤其是在眼内手术中。眼压正常的眼睛一般不需要特殊技术。除了琥珀酰胆碱(其作用相反)外,大多数常用麻醉剂都会导致轻微的眼压降低。不幸的是,在患有病理性眼压升高的眼睛中,如不同类型的青光眼,情况并非如此。因此,眼科医生和麻醉师在寻找解决这个问题的方法,原则上这些方法包括使用药物,而这些药物往往具有相当大的刺激性。通过神经节阻滞剂进行控制性低血压、清醒状态下的箭毒化、快速输注具有高渗透作用的溶液(单独或联合使用)就是这样的措施。前者的缺点是在所谓的浅麻醉期间应用,此时患者是否入睡的安全性相当可疑;后者的缺点是需要快速输注具有高渗透作用的溶液。不言而喻,这些情况存在风险,尤其是考虑到这类手术的患者往往是心血管平衡不稳定、肾功能不全和脑动脉循环不足的老年人。这些是一些有待讨论的问题。

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