Kahn R L, Hargett M J
Department of Anesthesiology, Hospital for Special Surgery, New York 10021, USA.
Anesth Analg. 1999 Feb;88(2):378-81.
Shoulder surgery is often performed with patients in the sitting position under interscalene block anesthesia. Vasovagal episodes, characterized by a sudden decrease in heart rate and/or blood pressure, have a reported incidence of 17%-24% in this setting. We performed a retrospective study to determine whether there was an association between the use of beta-adrenergic blockers and the incidence of these episodes. Of the 150 patients identified, 20 (13.3%) had a vasovagal event. Similar proportions of patients had received a beta-adrenergic blocker in the group who had a vasovagal event compared with those who did not (20% vs 18%; P = 0.95). No other differences could be identified. We conclude that vasovagal episodes occur frequently in this setting with no identifiable risk factors. Beta-adrenergic blockers were not associated retrospectively with either an increased or decreased incidence of these episodes. The most likely mechanism involves the Bezold-Jarisch reflex.
In this retrospective study of 150 patients who underwent shoulder surgery in the sitting position under interscalene block, we found a 13% incidence of vasovagal episodes. Unlike a previous study, this was not affected by the use of beta-blockers. A randomized, prospective study is necessary to clarify this issue.
肩部手术通常在患者处于坐位并接受肌间沟阻滞麻醉的情况下进行。以心率和/或血压突然下降为特征的血管迷走神经事件在这种情况下的报告发生率为17%-24%。我们进行了一项回顾性研究，以确定使用β-肾上腺素能阻滞剂与这些事件的发生率之间是否存在关联。在确定的150例患者中，20例（13.3%）发生了血管迷走神经事件。与未发生血管迷走神经事件的患者相比，发生该事件的患者组中接受β-肾上腺素能阻滞剂的比例相似（20%对18%；P = 0.95）。未发现其他差异。我们得出结论，在这种情况下血管迷走神经事件频繁发生，且没有可识别的危险因素。回顾性分析显示，β-肾上腺素能阻滞剂与这些事件的发生率增加或降低均无关联。最可能的机制涉及贝佐尔德-雅里什反射。
在这项对150例在坐位下接受肌间沟阻滞进行肩部手术的患者的回顾性研究中，我们发现血管迷走神经事件的发生率为13%。与之前的研究不同，这不受β-阻滞剂使用的影响。有必要进行一项随机前瞻性研究来阐明这个问题。
