PPH术中应用蛛网膜下腔麻醉与硬膜外麻醉的效果比较

为观察PPH术中应用蛛网膜下腔麻醉与硬膜外麻醉的效果,将行PPH治疗的重度痔患者80例随机分为对照组和观察组,每组40例.对照组患者采用蛛网膜下腔麻醉,观察组患者采用硬膜外麻醉,比较2组患者手术情况、麻醉感觉阻滞情况、麻醉效果、运动阻滞情况及不良反应.结果显示,2组患者手术情况、麻醉感觉阻滞情况比较差异无统计学意义(P...     

PPH手术中严重的迷走神经反射70例分析

目的:探讨PPH手术中出现严重迷走神经反射的原因和治疗方法。方法:分析70例PPH术中出现严重迷走神经反射患者的资料,了解术前患者合并心血管疾病与术中发生严重迷走神经反射的关系,总结出现严重迷走神经反射的处理方法。结果:腹部坠胀不适,恶心、呕吐、心率、血压急剧下降等是PPH手术中出现严重的迷走神经反射时的常见临床表现,合并心脏功能性或器质性疾病是PPH手术中出现严重迷走神经反射的高危因素。结论:通过适当的处理可以使PPH术中严重迷走神经反射的病人顺利的通过手术,得到康复。     

低剂量罗哌卡因蛛网膜下阻滞麻醉用于混合痔手术的临床观察

目的观察低剂量罗哌卡因用于蛛网膜下阻滞麻醉下混合痔手术的临床效果。方法以170例混合痔手术患者为研究对象,按随机数字表法分为研究组(85例)和对照组(85例)。研究组予以低剂量罗哌卡因(0.5%浓度1.6ml)蛛网膜下阻滞麻醉,对照组予以常规剂量(0.5%浓度2.5ml)蛛网膜下阻滞麻醉。记录患者手术时间及术中出血量,测试患者阻滞平面情况;比较麻醉阻滞起效与持续时间差异,观察术中肛门松弛和牵拉反应,评价患者术后疼痛反应,统计麻醉不良反应差异。结果两组阻滞平面达到T8以上患者比例、术中肛门松弛率及牵拉反射发生率(91.76%、100.00%和3.53%vs 95.29%、100.00%和2.35%)差异无统计学意义(P0.05);两组术后VAS评分(2.83±0.50 vs 2.76±0.46)差异无统计学意义(P0.05);研究组感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞持续时间和运动阻滞持续时间均显著短于对照组(P0.05);研究组麻醉不良反应总体发生率(5.88%)显著低于对照组(17.65%)(P0.05)。结论低剂量罗哌卡因蛛网膜下阻滞麻醉用于混合痔切除手术,在保证围术期麻醉效果情况下,可有效缩短麻醉起效时间和麻醉后恢复时间,降低麻醉不良反应发生率。     

局部麻醉施行PPH术126例体会

吻合器痔上黏膜环切术(procedure for Pmlapse and Hemorrhoids,PPH)多以蛛网膜下腔麻醉或骶管阻滞为主.近年来我科主要选择局部麻醉开展此手术,麻醉效果满意,术后并发症少.同时降低了麻醉风险性及治疗费用.缩短了手术治疗时间,报道如下.     

罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术的临床观察

目的 探讨罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术的麻醉效果.方法 AsA Ⅰ～Ⅱ级肛门直肠手术患者60例,按数字随机法分成两组,分别采用0.75%布比卡因(B组)和0.75%罗哌卡因(L组)施行蛛网膜下腔阻滞用于肛门直肠手术.观察两组患者感觉阻滞维持时间和麻醉效果.结果 B组患者麻醉效果满意率明显高于L组,感觉阻滞时间L组明显长于B组.结论 0.75%罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术虽然有较高的安全性和长效性,但麻醉效果略逊于0.75%布比卡因.     

不同浓度罗哌卡因蛛网膜下腔麻醉在肛周手术中的应用

探讨不同剂量罗哌卡因蛛网膜下腔阻滞麻醉在肛周手术中的效果。选择蛛网膜下腔阻滞麻醉下行肛周手术的患者93例,随机分为三组,每组31例。A组:采用0.75%罗哌卡因2.0 mL;B组:采用0.5%罗哌卡因2.0 mL;C组:采用0.25%罗哌卡因2.0 mL。观察并记录麻醉起效时间、麻醉效果、术后运动阻滞及尿潴留发生情况。三组患者感觉阻滞起效时间及麻醉优良率比较差异无统计学意义(P0.05)。术毕时下肢运动阻滞0~I级者:A组(31/31,100.0%)和B组(10/31,32.3%)明显高于C组(4/31,12.9%,P0.05)。尿潴留发生率:C组(2/31,6.5%)明显低于A组(7/31,22.6%)和B组(11/31,35.5%,P0.05)。采用0.25%罗哌卡因2.0 mL蛛网膜下腔阻滞麻醉行肛周手术,麻醉效果确切、下肢运动神经阻滞轻且尿潴留发生率低。     

不同浓度与剂量的布比卡因对蛛网膜下腔阻滞患者术后尿潴留的影响

目的观察不同浓度和剂量布比卡因对蛛网膜下腔阻滞患者术后尿潴留的影响。方法下腹部或下肢手术患者120例,随机分为4组,分别采用0.250%(Ⅰ组),0.375%(Ⅱ组),0.500%(Ⅲ组)等比重布比卡因3 ml于L_(2-3)间隙行蛛网膜下腔阻滞,并于硬膜外向头侧置管3 cm。对照组(C组)采用0.5%罗哌卡因单纯硬膜外麻醉。观察患者麻醉效果、生命体征变化,记录处理过程,手术24 h后随访患者排尿功能的改变以及是否留置尿管。结果与Ⅰ组比较,Ⅱ组和Ⅲ组患者单次蛛网膜下腔阻滞效果更优(P0.05),Ⅱ组和Ⅲ组差异无统计学意义P0.05);术后尿管留置率:Ⅰ组、Ⅱ组、C组三组比较差异无统计学意义(P0.05),且均低于Ⅲ组(P0.05)。结论 0.375%布比卡因3ml用于蛛网膜下腔阻滞能较快达到手术麻醉要求,且有较低尿潴留的发生率。     

罗哌卡因复合舒芬太尼蛛网膜下腔阻滞麻醉用于剖宫产术的效果

目的探讨罗哌卡因复合舒芬太尼蛛网膜下腔阻滞麻醉用于剖宫产术的效果。方法随机将蛛网膜下腔阻滞麻醉下择期行剖宫产术的88例产妇分为2组,各44例。对照组应用0.75%罗哌卡因,观察组采用0.75%罗哌卡因复合舒芬太尼。比较2组的麻醉效果。结果观察组达到阻滞平面的时间短于对照组,镇痛维持时间长于对照组,差异有统计学意义(P<0.05)。2组新生儿5 min Apgar评分、心率、平均动脉压,以及不良反应发生率,差异均无统计学意义(P>0.05)。结论 0.75%罗哌卡因复合舒芬太尼行蛛网膜下腔阻滞麻醉用于剖宫产术,麻醉效果良好、术中血流动力学稳定、不良反应少、安全性较高。     

肥胖产妇剖宫产手术中蛛网膜下腔布比卡因运动阻滞的ED50

目的探讨以蛛网膜下腔布比卡因运动阻滞半数有效量(ED_(50))为脊麻给药剂量参考可否降低肥胖产妇剖宫产术中不良反应的发生率。方法 ASA Ⅰ或Ⅱ级择期剖宫产手术的肥胖产妇110例,体重指数(BMI)>30 kg/m~2,行腰硬联合麻醉,随机分为观察组和对照组.每组55例。观察组脊麻药含芬太尼20 μg,以 ED_(50)为脊麻给药剂量参考。用序贯法分别测定两组患者脊麻后0.5%布比卡因运动阻滞的 ED_(50),并观察两组产妇术中不良发应的发生率。结果两组患者 ED_(50)差异无统计学意义;观察组术中低血压、心律失常和恶心呕吐的发生率分别为10.0%、3.3%和6.7%,显著低于对照组的43.3%、20.0%和26.7%(P<0.05)。结论肥胖产妇剖宫产手术行腰硬联合麻醉时,以0.5%布比卡因蛛网膜下腔运动阻滞的 ED_(50)为脊麻给药剂量参考,可以降低术中不良反应的发生率。     

下肢手术患者罗哌卡因与布比卡因蛛网膜下腔阻滞效果的比较前瞻性、多中心、随机、双盲研究

目的 比较单侧下肢手术患者罗哌卡因和布比卡因蛛网膜下腔阻滞的效果.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行单侧下肢手术患者218例,ASA Ⅰ或Ⅱ级,年龄18～64岁,体重指数18～24 kg/m2,性别不限.随机分为2组,R组(n=110)蛛网膜下腔注射5 ms/ml罗哌卡因3.5 ml;B组(n=108)蛛网膜下腔注射5 mg/ml布比卡因2.5 ml.采用改良的Bromage评分法评估非术侧下肢的运动阻滞效果,记录起效时间和维持时间;采用针刺法评估感觉阻滞效果,记录起效时间和维持时间;评估术中麻醉质量与肌松效果;记录不良反应的发生情况.结果 与B组比较,R组运动阻滞起效时间延长,运动阻滞和感觉阻滞维持时间缩短(P＜0.05或0.01),感觉阻滞起效时间差异无统计学意义(P＞0.05);两组运动阻滞和感觉阻滞有效率差异无统计学意义(P＞0.05);两组麻醉质量和肌松效果均较好,麻醉质量比较差异无统计学意义(P＞0.05),R组肌松效果优于B组(P＜0.05);两组不良事件发生率均较低,且差异无统计学意义(P＞0.05).结论 下肢手术患者采用罗哌卡因蛛网膜下腔阻滞时,术中麻醉质量及肌松效果良好,且其运动阻滞维持时间较布比卡因短,有利于术后的恢复,其临床效果更具优越性.     

膀胱肿瘤电切术中行闭孔神经阻滞防止闭孔神经反射的效果分析

目的 探讨经尿道膀胱肿瘤电切术中采用闭孔神经阻滞防止闭孔神经反射的临床效果.方法 对214例膀胱癌患者行经尿道电切术,治疗组113例在腰-硬联合麻醉基础上进行闭孔神经阻滞,而对照组101例仅行单纯腰-硬联合麻醉.结果 治疗组闭孔神经反射发生率（9.7%）明显低于对照组（22.8%）（P〈0.05）,两组复发率差异无统计学意义（21.2% vs 25.7%,P＆gt;0.05）.结论 在经尿道膀胱肿瘤电切术中采取闭孔神经阻滞能明显减少闭孔神经反射的发生,提高手术的安全性和有效性,临床效果良好.     

静脉全麻、局麻结合术后长效止痛在肛肠病手术中的应用

为了最大限度地减轻肛肠病手术的术中、术后疼痛,将静脉全麻、局麻结合术后长效止痛用于PPH等多种肛门病手术患者90例（治疗组）,同时与椎管麻醉（对照1组）、局麻（对照2组）进行对比观察。结果显示,静脉全麻、局麻结合术后长效止痛的麻醉方法,可达到肛门病下术术中、术后最佳镇痛效果,无尿潴留,并发症发生率明显降低,手术麻醉效果明显优于对照组。结果表明,这是一种全程无痛治疗肛肠病的手术麻醉方法。     

超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果

目的通过对比不同麻醉方式下闭孔神经反射的发生情况,探讨经尿道膀胱肿瘤电切术中预防闭孔神经反射的有效方式。方法选取需行经尿道膀胱肿瘤电切术的膀胱侧壁肿瘤患者160例,男134例,女26例,ASAⅠ~Ⅲ级,随机分为四组:全凭静脉麻醉组(G组),腰-硬联合麻醉组(C组),腰-硬联合麻醉复合静脉麻醉组(V组),腰-硬联合麻醉复合闭孔神经阻滞(obturator nerve block,ONB)组(O组),每组40例。记录不同麻醉方式下闭孔神经反射的发生情况。结果O组闭孔神经反射发生率(7.5%)明显低于C组(32.5%,P=0.005)和V组(40.0%,P=0.001),与G组闭孔神经反射发生率(5.0%)差异无统计学意义(P=0.644)。结论腰-硬联合麻醉复合闭孔神经阻滞与全凭静脉麻醉均可有效预防闭孔神经反射的发生。     

两种不同麻醉方式下施实PPH手术的临床对比研究

目的比较不同麻醉方式下施实吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)的麻醉效果。方法将84例接受PPH的患者随机分为2组。对照组在腰硬联合麻醉下行PPH治疗;治疗组在局麻下行PPH治疗。分别对手术时间、疼痛感、手术费用等各方面进行比较。结果治疗组患者的手术时间、手术费用及术后尿潴留发生率方面均优于对照组。术中、术后疼痛感评分方面2组无差异。结论对于PPH手术,局麻是安全可行的,且较腰硬联合麻醉下行PPH治疗具有手术时间短、费用低、尿潴留减少等优势。     

The use of central regional anesthesia techniques in Sweden: results of a nation-wide survey

Background: Epidural and subarachnoid anesthesia are well established central regional techniques for surgical anesthesia. TWO additional techniques, combined spinal epidural (CSE) block and continuous spinal anesthesia (CSA), have recently become popular. However, data on nation-wide use of central regional blocks are not available.
Method: With the aims to survey the use of central regional techniques, to evaluate the risk of complications to central regional blocks and to document the use of continuous epidural techniques for postoperative pain management in Sweden during 1993, a questionnaire was mailed to all 105 Swedish anesthesiology departments.
Results: Questionnaires were returned by 62 departments, representing all categories of Swedish hospitals. Central regional blocks were used for surgical anesthesia in 2040% of reported surgical procedures. Subarachnoid anesthesia was the main technique for orthopedic surgery on the lower limb, elective cesarean section and transurethral resection of the prostate. Epidural block was used for orthopedic and vascular surgery. CSE block was used by 42 departments and CSA by 21 departments. Postoperative epidural analgesia was used by 59 departments, most commonly with continuous infusion of local anesthestics and/or epidural bolusdoses of morphine. Nineteen neurological sequelae were reported after epidural (n=7) and subarachnoid (n=12) blocks. Routines for registration of complications varied greatly.
Conclusions: Subarachnoid block was preferred for shorter surgical procedures (<60 min), whereas epidural and CSE blocks were chosen when severe postoperative pain could be anticipated, as continuous epidural analgesia was well established for postoperative pain management. Improved routines for registration of complications to central regional blocks are needed.     

The timing of intravenous crystalloid administration and incidence of cardiovascular side effects during spinal anesthesia: the results from a randomized controlled trial.

We conducted a randomized clinical trial to evaluate the efficacy of crystalloids in preventing spinal-induced hypotension (SIH) and cardiovascular side effects (CVSE) in a group of surgical patients. Participants were assigned to receive lactated Ringer's solution at 1-2 mL/min (Placebo group, n = 142); lactated Ringer's at 20 mL/kg starting 20 min before spinal block (n = 130); or lactated Ringer's at 20 mL/kg starting at the time of spinal block (n = 132). SIH was defined as a decrease of > or = 30% in baseline systolic blood pressure, and CVSE as SIH plus nausea, vomiting, or faintness requiring treatment. The incidence of SIH was similar in all treatment groups. Compared to placebo, crystalloid administration at the time of spinal block resulted in a significant reduction in the proportion of patients developing CVSE from 9.9% to 2.3%. The corresponding relative proportion was 0.23 (95% confidence interval, 0.07-0.78; P = 0.019), and one additional case of CVSE was avoided for each 13 patients receiving crystalloids at the time of spinal block instead of placebo. Administration of crystalloids at the time of spinal block seems to be effective because it provides additional intravascular fluids during the period of highest risk of CVSE after spinal anesthesia. IMPLICATIONS: Crystalloids are frequently administered to nonobstetric patients minutes before spinal anesthesia to prevent cardiovascular side effects (CVSE). This randomized controlled trial shows that although crystalloids administered before spinal block result in no clinical benefit, they significantly reduce the risk of CVSE when administered at the time of spinal block.     

Efficacy of topical administration of lidocaine through a Malinckrodt Hi-Lo Jet tube in lessening cough during recovery from general anesthesia]

To achieve tracheal anesthesia during intubation, an endotracheal tube was purposely designed. The tube had multiple laser-induced perforations in its lower portion produced that allowed administration of the local anesthetic in a pulverized form. We evaluated the efficacy of lidocaine 2% in preventing cough during recovery from general anesthesia. The goal of this study was to perform a topical anesthesia of the hypopharynx, larynx, and trachea. This attenuates the laryngeal reflex occurring during anesthesia recovery and therefore, prevents from potential complications. Sixteen patients ASA I-II underwent surgery with general anesthesia. They were prospectively studied following a randomized double blind protocol. The control group received saline infusion (n = 6) whereas the experimental group (n = 10) was treated with lidocaine. At the end of the anesthesia period, the presence of cough was treated with the test solution. In 90% of cases treated with lidocaine, cough disappeared in about 30 seconds and patients tolerated the endotracheal tube until extubation was performed. All patients who received saline solution presented cough until extubation.     

Supraspinal pupillary effects of intravenous and epidural fentanyl during isoflurane anesthesia

BACKGROUND AND OBJECTIVES: Epidural fentanyl has been shown to gain rapid access to the circulation resulting in supraspinal effects. We compared the supraspinal effects of fentanyl via epidural versus intravenous (IV) routes, during isoflurane anesthesia. Supraspinal fentanyl effect was evaluated as a reduction of pupillary reflex dilation (PRD) measured with infrared pupillometry. METHODS: Eighteen patients undergoing abdominal procedures were studied during combined epidural and general anesthesia. General anesthesia was provided by 0.55 to 0.70% end-tidal isofurane in air:oxygen (50:50). Sensory block of the surgical field was established with bupivacaine 0.375% and confirmed by absence of PRD to cutaneous stimulation. A high cervical dermatome was then stimulated (60 to 70 mA) at 5-minute intervals via cutaneous needle electrodes, and PRD was measured with each stimulation, using infrared pupillometry. Baseline PRD was determined and then a randomized injection of cpidueral saline (n = 6), epidural fentanyl 3 microg/kg (n = 6), or IV fentanyl 3 microg/kg (n = 6) was given. Subsequently, PRD was measured at 5, 10, 20, 30, 40, 60, and 80 minutes. Maximum change in PRD and time to maximum change were calculated for each group. RESULTS: Following epidural injection, suppression of PRD was highly variable among subjects. The maximum suppression was 70+/-15% at 23.3+/-10.3 minutes for the epidural group and 96+/-3% at 10.8+/-7.4 min for the IV group (P<.0001). Epidural saline produced no effect. CONCLUSIONS: Supraspinal effects of epidural fentanyl can be assessed during general anesthesia using infrared pupillometry. Epidural fentanyl 3 microg/kg produces significant but variable supraspinal effects during 0.5 minimum alveolar concentration isoflurane anesthesia.     

The incidence of complex regional pain syndrome after fasciectomy for Dupuytren's contracture: a prospective observational study of four anesthetic techniques

The development of complex regional pain syndrome (CRPS) is not an uncommon complication after Dupuytren's surgery. Despite increasing research interest, little is known regarding which patients are at increased risk for developing CRPS and what is the optimal perioperative treatment strategy for preventing the occurrence of this disease after surgery. We prospectively evaluated the use of four anesthetic techniques (general anesthesia, axillary block, and IV regional anesthesia [IVRA] with lidocaine with or without clonidine) for patients undergoing fasciectomy for Dupuytren's contracture. All patients were followed in the Pain Management Center at 1, 3, and 12 mo postoperatively by a blinded physician to evaluate the presence of CRPS. Significantly (P < 0.01) more patients developed postoperative CRPS in the general anesthesia group (n = 25; 24%) and the IVRA lidocaine group (n = 12; 25%) compared with either the axillary block group (n = 5; 5%) or the IVRA lidocaine and clonidine group (n = 3; 6%). We conclude that axillary block or IVRA with clonidine offers a significant advantage for decreasing the incidence of CRPS compared with either IVRA with lidocaine alone or general anesthesia for patients undergoing Dupuytren's surgery.