Gallinger E Iu, Seleznev M N, Babalian G V
Anesteziol Reanimatol. 1997 Sep-Oct(5):60-2.
The efficacy of combined spinal epidural anesthesia (CSEA) for femoral to distal artery bypass surgery is assessed. Thirty-eight patients were divided into 3 groups. CSE block was performed at L3-L4 (26G pensil-point spinal needle and 18G catheter). In group I (n = 14) blocking was induced with 20 mg of 1% lidocaine and maintained with 2% lidocaine through an epidural catheter. Group II (n = 15) received spinal plain 20 mg of 0.5% bupivacaine. In group III (n = 9) the initial dose of plain 0.5% bupivacaine was 3 ml (15 mg); 5 min after the first bolus the incremental dose of plain bupivacaine 3 ml (15 mg) was injected and spinal needle was withdrawn. Epidural 0.5% bupivacaine was injected as needed. Sensory blockade was assessed by the pinprick test. Two patients in group I (18.2%) were in need of general anesthesia (GA) (inadequate dissemination of solution in 1 case and catheter kinking in the other). In group II GA had to be performed in 1 case because surgery was longer than planned. In group III anesthesia was effective in all cases. The mean level of sensory block in group I was T11.2 +/- 0.4, in group II T9.4 +/- 0.5, and in group III T8.6 +/- 0.55 (p > 0.05). The mean dose of bupivacaine per segment in groups II and III was 1.47 +/- 0.08 and 2.08 +/- 0.01, respectively (p < 0.05), use of epidural catheter during surgery 40 and 11%, respectively (p < 0.05). Arterial pressure drop was 10.8, 14.1, and 11.6% in groups I, II, and III, respectively. The mean total dose was 735 +/- 89 mg (172 +/- 14 mg/h) in the lidocaine group, in group II 38.5 +/- 6.4 mg (10.25 +/- 1.15 mg/h), and in group III 32.8 +/- 2.8 mg (7.46 +/- 1.67 mg/h) (p < 0.05). No neurological problems or PDPH were observed in any of the patients and no vasoactive drugs were needed. CSEA is fit for anesthesia for peripheral vascular surgery. CSEA with double spinal injection is preferable, for it provides a longer anesthesia and hemodynamic stability.
评估腰麻-硬膜外联合麻醉（CSEA）用于股动脉至远端动脉搭桥手术的效果。38例患者分为3组。在L3-L4间隙行CSE阻滞（使用26G铅笔尖腰麻针和18G导管）。I组（n = 14）用20mg 1%利多卡因诱导阻滞，通过硬膜外导管用2%利多卡因维持。II组（n = 15）接受20mg 0.5%布比卡因单纯腰麻。III组（n = 9）0.5%布比卡因原液的初始剂量为3ml（15mg）；首次推注后5分钟，注入0.5%布比卡因原液递增剂量3ml（15mg），然后拔出腰麻针。根据需要注入硬膜外0.5%布比卡因。通过针刺试验评估感觉阻滞。I组有2例患者（18.2%）需要全身麻醉（GA）（1例是溶液扩散不足，另1例是导管扭结）。II组有1例因手术时间长于计划而需行GA。III组所有病例麻醉均有效。I组感觉阻滞平均平面为T11.2±0.4，II组为T9.4±0.5，III组为T8.6±0.55（p>0.05）。II组和III组每节段布比卡因平均剂量分别为1.47±0.08和2.08±0.01（p<0.05），手术中硬膜外导管使用率分别为40%和11%（p<0.05）。I、II、III组动脉压下降分别为10.8%、14.1%和11.6%。利多卡因组平均总剂量为735±89mg（172±14mg/h），II组为38.5±6.4mg（10.25±1.15mg/h），III组为32.8±2.8mg（7.46±1.67mg/h）（p<0.05）。所有患者均未观察到神经问题或腰麻后头痛，且无需血管活性药物。CSEA适用于外周血管手术麻醉。双次腰麻注射的CSEA更可取，因为它能提供更长时间的麻醉和血流动力学稳定性。
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