Saberski L R, Kondamuri S, Osinubi O Y
Yale Center for Pain Management, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Reg Anesth. 1997 Jan-Feb;22(1):3-15. doi: 10.1016/s1098-7339(06)80050-7.
The major determinant of successful epidural anesthesia is the localization of the epidural space. The manual loss of resistance technique is widely used by anesthesiologists in identifying the epidural space. Should air or saline be used in detecting the point of loss of resistance? No consensus exists as to which technique is superior, and individual providers currently use the technique with which they are most comfortable. The incidence of adverse effects associated with the use of epidural air is unknown and may be underreported as the effects may be unrecognized or considered trivial. The authors comprehensively review the complications of epidural air from published reports.
Using the appropriate key words, the authors searched the Medline (National Library of Congress) scientific data bank from 1966 to 1995, for case reports of epidural complications.
There are few prospective, controlled, double-blinded studies comparing the relative merits of using air versus saline for the loss of resistance technique of epidural placement. There are, however, numerous case reports. Complications associated with the use of air for the loss of resistance technique included pneumocephalus, spinal cord and nerve root compression, retroperitoneal air, subcutaneous emphysema, and venous air embolism. Additionally, inadequate analgesia and paresthesia have been associated with the loss of resistance technique using air. Transient and permanent neurologic sequelae have been attributed to some of the complications. The simultaneous administration of nitrous oxide and positive. Pressure ventilation has also been reported to expand localized collections of air, resulting in heightened symptoms.
The potential complications associated with the use of air for identifying the epidural space with the loss of resistance technique may outweigh the benefits. The use of saline to identify the epidural space may help to reduce the incidence of these complications.
硬膜外麻醉成功的主要决定因素是硬膜外间隙的定位。麻醉医生广泛采用手控阻力消失法来确定硬膜外间隙。在检测阻力消失点时应使用空气还是生理盐水？对于哪种技术更优尚无共识，目前个体从业者使用他们最熟悉的技术。与硬膜外注入空气相关的不良反应发生率未知，且可能因未被识别或认为微不足道而报告不足。作者对已发表报告中硬膜外注入空气的并发症进行了全面综述。
作者使用适当的关键词，检索了1966年至1995年美国国会图书馆的医学数据库（Medline），以查找硬膜外并发症的病例报告。
很少有前瞻性、对照、双盲研究比较使用空气与生理盐水进行硬膜外置管阻力消失法的相对优缺点。然而，有大量病例报告。与使用空气进行阻力消失法相关的并发症包括气颅、脊髓和神经根受压、腹膜后积气、皮下气肿和静脉空气栓塞。此外，使用空气进行阻力消失法还与镇痛不足和感觉异常有关。一些并发症已导致短暂和永久性神经后遗症。据报道，同时给予氧化亚氮和正压通气也会使局部积气扩大，从而加重症状。
使用空气通过阻力消失法确定硬膜外间隙的潜在并发症可能超过其益处。使用生理盐水确定硬膜外间隙可能有助于降低这些并发症的发生率。
