Halter F, Niesel H C, Gladrow W, Kaiser H
Anästhesie-Abteilung, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen/Rhein.
Anaesthesist. 1998 Sep;47(9):747-56. doi: 10.1007/s001010050622.
Incomplete anaesthesia is a major clinical problem both in single spinal and in single epidural anaesthesia. The clinical efficacy of epidural anaesthesia with augmentation (aEA) and combined epidural and spinal anesthesia (CSE) for cesarean section was investigated in a prospective randomized study on 45 patients.
Anaesthesia extending up to Th5 was aimed for. Depending on the patient's height, epidural anaesthesia was administered with a dose of 18-22 ml 0.5% bupivacaine and spinal anaesthesia with a dose of 11-15 mg 0.5% bupivacaine. Augmentation was carried out in all cases in epidural anaesthesia, initially with 7.5 ml 1% Lidocaine with epinephrine 1:400,000, raised by 1.5 ml per missing segment. The epidural reinjection in CSE was carried out as necessary with 9.5-15 ml 1% lidocaine with epinephrine, depending on the height and difference from the segment Th5.
The extension of anaesthesia achieved in epidural anaesthesia after an initial dose of 101.8 mg bupivacaine and augmenting dose of 99 mg lidocaine reached the segment Th5. The primary spinal anaesthesia dose up to 15 mg corresponding to height led to a segmental extension to a maximum of Th3 under CSE. Augmentation was necessary in 13 patients; in 5 cases because of inadequate extent of anaesthesia and 8 cases because of pain resulting from premature reversion. The augmenting dose required was 13.9 ml. Readiness for operation was attained after 19.8 min (aEA) and after 10.5 min (CSE). No patient required analgesics before delivery. The additional analgesic requirement during operation was 63.6% (aEA) and 39.1% (CSE). Taking into account pain in the area of surgery, the requirement of analgesics was 50% (aEA) vs. 17.4% (CSE). Antiemetics were required in 18.2 (aEA) and in 65.2% (CSE). The systolic blood pressure fell by 17.7% (aEA) and in 30.3% (CSE). The minimum systolic pressure was observed after 13.4 min in aEA, and after 9.5 min in CSE. The APGAR score and the umbilical pH did not show any differences. General anaesthesia was not required in any case.
在单次脊髓麻醉和单次硬膜外麻醉中，麻醉不全都是一个主要的临床问题。在一项针对45例患者的前瞻性随机研究中，调查了增强型硬膜外麻醉（aEA）和腰麻-硬膜外联合麻醉（CSE）用于剖宫产的临床效果。
目标是使麻醉平面达到胸5。根据患者身高，硬膜外麻醉给予18 - 22毫升0.5%布比卡因，脊髓麻醉给予11 - 15毫克0.5%布比卡因。所有硬膜外麻醉病例均进行增强，最初给予7.5毫升1%含肾上腺素1:400,000的利多卡因，每缺一个节段增加1.5毫升。CSE中硬膜外追加注射根据身高和与胸5节段的差距，必要时给予9.5 - 15毫升1%含肾上腺素的利多卡因。
初始剂量101.8毫克布比卡因和追加剂量99毫克利多卡因后，硬膜外麻醉达到的麻醉平面达到胸5节段。在CSE中，对应身高的脊髓麻醉初始剂量最高达15毫克，节段性麻醉平面最高达到胸3。13例患者需要追加药物；5例是因为麻醉范围不足，8例是因为过早恢复导致疼痛。所需追加剂量为13.9毫升。aEA组在19.8分钟后、CSE组在10.5分钟后达到手术准备状态。分娩前无患者需要使用镇痛药。术中额外镇痛药需求aEA组为63.6%，CSE组为39.1%。考虑手术区域疼痛，镇痛药需求aEA组为50%，CSE组为17.4%。aEA组18.2%、CSE组65.2%的患者需要使用止吐药。收缩压aEA组下降17.7%，CSE组下降30.3%。aEA组在13.4分钟后、CSE组在9.5分钟后观察到最低收缩压。阿氏评分和脐动脉血pH值无差异。所有病例均未需要全身麻醉。
