Lobato E B, Black S, De Soto H
Department of Anesthesiology, University of Florida, Gainesville, USA.
Anesth Analg. 1997 Mar;84(3):551-3. doi: 10.1097/00000539-199703000-00015.
Selective denervation to relieve severe torticollis requires surgery with the patient in the sitting position. Nerve stimulation is used to guide the procedure; therefore, patients undergo general anesthesia without muscle relaxation. Because of the risk of venous air embolism (VAE), monitoring with precordial Doppler and a multiorifice right atrial catheter has been recommended. To document the incidence of VAE and, thus, the effectiveness of monitors to detect it, consecutive patients who underwent selective peripheral denervation for torticollis between June 1993 and July 1994 were studied retrospectively, and those who underwent the procedure between August 1994 and February 1996 were studied prospectively. No VAE was documented in the retrospective group (n = 31). In the prospective group (n = 69), precordial Doppler detected one episode of VAE that lasted < 20 s and had no clinical sequelae. The incidence of complications from right atrial catheter insertion was 8% (carotid puncture, hematoma, inability to cannulate) but with no permanent sequelae. We conclude that VAE is infrequent and self-limited in association with selective denervation for torticollis. While monitoring with precordial Doppler for patients undergoing denervation for torticollis is indicated, the use of a right atrial catheter is of limited value because of associated complications and increased operating room time and cost.
选择性去神经支配术用于缓解严重斜颈，手术时患者需取坐位。手术过程中使用神经刺激来引导操作；因此，患者接受全身麻醉但不使用肌肉松弛剂。由于存在静脉空气栓塞（VAE）的风险，建议使用心前区多普勒和多孔右心房导管进行监测。为记录VAE的发生率以及监测器检测VAE的有效性，我们对1993年6月至1994年7月间接受选择性周围性斜颈去神经支配术的患者进行回顾性研究，并对1994年8月至1996年2月间接受该手术的患者进行前瞻性研究。回顾性研究组（n = 31）未记录到VAE。在前瞻性研究组（n = 69）中，心前区多普勒检测到1次持续时间< 20秒且无临床后遗症的VAE发作。右心房导管插入的并发症发生率为8%（颈动脉穿刺、血肿、无法插管），但均无永久性后遗症。我们得出结论，与选择性斜颈去神经支配术相关的VAE并不常见且为自限性。虽然对于接受去神经支配术治疗斜颈的患者，使用心前区多普勒进行监测是必要的，但由于相关并发症以及手术室时间和成本增加，使用右心房导管的价值有限。
