Liu S S
Department of Anesthesiology, Virginia Mason Medical Center and the University of Washington, Seattle, USA.
Reg Anesth. 1997 Nov-Dec;22(6):500-10.
Spinal anesthesia is used for ambulatory surgical procedures. We provide an overview of the use of local anesthetics, use of continuous techniques, and use of adjuncts for optimization of spinal anesthesia for ambulatory surgery.
Review of current literature and critical analysis of selected manuscripts.
Small doses of lidocaine (approximately 40 mg) and bupivacaine (approximately 7.5 mg) are appropriate for ambulatory surgery. Increasing concentration of local anesthetic solution may result in increased duration of anesthesia and recovery. While use of hyperbaric solutions consistently produce more cephalad sensory block, use of isobaric solutions provide adequate sensory and motor block for lower extremity surgical procedures. The use of continuous techniques may provide valuable anesthetic titration, as small doses of spinal anesthetics may produce highly variable results. Epinephrine is not recommended as an adjunct due to prolongation of recovery time. In contrast, intrathecal fentanyl may prolong surgical anesthesia without prolonging recovery.
Ambulatory spinal anesthesia may be optimized by selection of dose, concentration, and baricity of local anesthetic. Use of a continuous technique or an intrathecal adjunct may also be valuable means to optimize spinal anesthesia for ambulatory surgery.
蛛网膜下腔麻醉用于门诊手术。我们综述了局部麻醉药的使用、连续技术的应用以及辅助用药，以优化门诊手术的蛛网膜下腔麻醉。
回顾当前文献并对所选文稿进行批判性分析。
小剂量利多卡因（约40mg）和布比卡因（约7.5mg）适用于门诊手术。增加局部麻醉药溶液的浓度可能会延长麻醉和恢复时间。虽然使用重比重溶液始终会产生更高位的感觉阻滞，但等比重溶液可为下肢手术提供足够的感觉和运动阻滞。连续技术的应用可实现有价值的麻醉滴定，因为小剂量蛛网膜下腔麻醉药可能会产生高度可变的结果。由于恢复时间延长，不建议使用肾上腺素作为辅助用药。相比之下，鞘内注射芬太尼可延长手术麻醉时间而不延长恢复时间。
通过选择局部麻醉药的剂量、浓度和比重可优化门诊蛛网膜下腔麻醉。使用连续技术或鞘内辅助用药也是优化门诊手术蛛网膜下腔麻醉的有价值方法。
