Role of cerebral oxygenation for prediction of hypotension after spinal anesthesia for caesarean section

To investigate the role of cerebral oxygen saturation (ScO₂) for prediction of hypotension after spinal anesthesia for caesarean section. Forty-five parturients undergoing elective caesarean section under spinal anesthesia were selected. Blood pressure, heart rate and pulse oxygen saturation before and after anesthesia were recorded, and the association between changes in ScO₂ before and after anesthesia with hypotension after spinal anesthesia was explored. Hypotension occurred in 32 parturients after spinal anesthesia. The decrease in ScO₂ after spinal anesthesia in parturients with hypotension was larger than in parturients without hypotension (P < 0.05). The duration from the intrathecal injection to 5 % decrease in ScO₂ was shorter than that from the intrathecal injection to the occurrence of hypotension (P < 0.05). The mean time from 5 % decrease in ScO₂ to hypotension was 38 s. The area under the receiver operation characteristic curve was 0.83 for decrease in ScO₂ for prediction of hypotension (P < 0.05), and the optimal threshold value was 4.5 %. The sensitivity, specificity, positive predictive value and negative predictive value of 4.5 % decrease in ScO₂ for prediction of hypotension were 0.75, 0.78, 0.92 and 0.47, respectively. The decrease in ScO₂ after spinal anesthesia is associated with hypotension after spinal anesthesia for cesarean section, and may be a clinically useful predictor.     

腰-硬联合麻醉时快速输注琥珀酰明胶联合麻黄碱静脉滴注预防剖宫产术中低血压

目的观察腰-硬联合麻醉时快速输注琥珀酰明胶扩容联合麻黄碱静脉滴注预防剖宫产术中低血压的效果。方法选择90例ASAⅠ~Ⅱ级在腰-硬联合麻醉下行剖宫产孕妇,采用随机数字表法随机分为A、B、C组各30例。均于腰麻前10分钟开始快速输液,30分钟内各输入液体量10 ml/kg,A组输入复方氯化钠液,B组输入琥珀酰明胶,C组输入琥珀酰明胶并于产妇平卧后静脉注射麻黄碱10 mg。输药之后,3组均以10 ml/(kg.h)的速度输注乳酸林格氏液维持。对比观察3组麻醉手术期间血压、心率的变化,3组低血压的发生率及不良反应的发生情况。结果 C组麻醉前后血压心率变化小;血流动力学比A、B组稳定(P<0.01或0.05),低血压及恶心呕吐的发生率也明显少于A、B组(P<0.05)。B组血压下降程度及低血压发生率虽小于A组,但组间比较差异无统计学意义(P>0.05)。结论腰-硬联合麻醉期间快速输注琥珀酰明胶扩容联合麻黄碱静脉滴注能有效预防剖宫产术中低血压的发生。     

Effect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section

To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. Two hundred and ninety parturients at full term, who were scheduled for cesarean section under combined spinal–epidural anesthesia were randomly divided into two groups: group control (I) and group NS (II). The epidural puncture was performed at the estimated L_3–4 interspace with a Tuohy needle attached to a 5 ml syringe. Loss of resistance to air was used to identify the epidural space. In group I no fluid was injected into the epidural space before insertion of the catheter; while in group II NS 5 ml was injected into the epidural space before catheter insertion. The incidence of blood vessel trauma and paraesthesia were evaluated. The effect of spinal anesthesia was evaluated. Blood vessel trauma in group II was significantly lower than in group I, P < 0.05. However, the incidence of paraesthesia was similar between the two groups, P > 0.05. Preloading the epidural space with NS can decrease the incidence of clinically apparent injury to blood vessels during epidural catheter placement, and can improve the effects of spinal analgesia, but does not reduce the incidence of paraesthesia.     

双下肢使用弹力绷带预防剖宫产椎管内麻醉后低血压的效果

目的观察双下肢使用弹力绷带对剖宫产椎管内麻醉后低血压的预防效果。方法便利选取2011年9月至2012年2月的100例择期剖宫产产妇,按手术日期单双日分为对照组和观察组各50例,麻醉前静脉输注羟乙基淀粉500ml,观察组椎管内麻醉后给予双下肢弹力绷带包扎,对照组未予处理;若发生低血压则给予静脉注射麻黄碱5mg,可重复使用。分别记录两组产妇麻醉后低血压发生率、最低收缩压、麻黄碱用量和产妇恶心呕吐反应等,胎儿分娩后行新生儿Apgar评分。结果对照组有32例（64％）、观察组有21例（42％）发生低血压,组间差异有统计学意义（P〈0．05）;观察组术中最低收缩压高于对照组,而麻黄碱用量和产妇恶心呕吐发生率则低于对照组（P〈0．05）;两组新生儿体质量及Apgar评分差异无统计学意义（P〉0．05）。结论剖宫产椎管内麻醉后双下肢使用弹力绷带,能减少椎管内麻醉后低血压发生率和减轻低血压程度。     

The effects of colloid pre-loading on thromboelastography prior to caesarean delivery: hydroxyethyl starch 130/0.4 versus succinylated gelatine

This prospective, randomized, double-blind study compared the effects on thromboelastography (TEG) of pre-loading with two different colloid fluids prior to spinal anaesthesia for caesarean section. Healthy full-term parturients received either 500 ml 6% hydroxyethyl starch 130/0.4 (HES, n = 25) or 500 ml 4% succinylated gelatine (GEL, n = 25) prior to spinal anaesthesia. TEG parameters including reaction time (r-time), clot formation time (k-time), clot formation rate (α-angle) and maximum amplitude (MA) were measured immediately before and after pre-loading. Both groups had significantly shorter r-time and lower MA after pre-loading. The α-angle was significantly decreased after pre-loading with HES but not with GEL. No significant differences in k-time were induced pre-loading. In conclusion, pre-loading with HES or GEL was associated with a mild hypocoagulable effect in healthy parturients presenting for elective caesarean section; however, all TEG parameters in both groups remained within or very close to the normal range after pre-loading.     

产妇腰硬联合麻醉硬膜外追加利多卡因和生理盐水对麻醉平面的影响

目的 比较产妇腰硬联合麻醉时硬膜外腔追加生理盐水和利多卡因对腰麻无痛觉平面的影响.方法 90例ASA Ⅰ～Ⅱ择期剖宫产患者,随机分为三组：空白组、利多卡因组和生理盐水组.蛛网膜下腔注药10 min后,生理盐水组和利多卡因组分别向硬膜外腔注入生理盐水8ml、1.73％碳酸利多卡因8ml,而空白组则不加药.观察记录自硬膜外注药后不同时间节点的麻醉无痛觉平面,监测用药后20 min内的血压变化,并观察T10感觉阻滞恢复时间和运动恢复时间（Bromage为3）.结果 生理盐水和利多卡因组麻醉无痛觉平面上升幅度与空白组对比差异均有统计学意义（P＜0.01）,利多卡因组血压下降＞20％需要作升压处理的概率较高,三组间的感觉阻滞维持时间和运动恢复时间比较无统计学差异（P＞0.05）.结论 剖宫产实施腰硬联合麻醉中,硬膜外腔追加生理盐水或利多卡因均能有效扩展无痛觉麻醉平面,而追加生理盐水更为安全.     

硬膜外预充液对腰硬联合阻滞剖宫产术患者硬膜外置管血管损伤及腰麻效果的影响

目的 观察硬膜外预充液预防剖宫产术患者硬膜外导管致硬膜外血管损伤及腰麻效果的影响.方法 将180例单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇,按随机数字表法分为3组,每组60例.3组产妇均取左侧卧位,L2-3椎间隙行腰硬联合穿刺.硬膜外穿刺成功后将脊麻针穿过硬膜外针内腔行蛛网膜下隙穿刺,见脑脊液回流后,注入0.75％左布比卡因2.0 mL,拔出腰麻针.Ⅰ组产妇硬膜外置管前在硬膜外腔注入生理盐水5 mL;Ⅱ组产妇硬膜外置管前在硬膜外腔注入含麻黄素15 mg的生理盐水5 mL;Ⅲ组产妇硬膜外腔直接置入导管.记录3组产妇血管损伤发生率,观察麻醉注药前(T0),经穿刺针注药液后2 min(T1),5 min(T2)HR、SBP、DBP的变化,以及采用针刺法测定注药后5、10 min时的感觉阻滞平面.结果 Ⅰ、Ⅱ、Ⅲ组血管损伤发生率分别为3.3％、1.6％及13.3％,Ⅲ组血管损伤发生率明显高于Ⅰ组和Ⅱ组(均P＜0.05),Ⅰ组和Ⅱ组比较差异无统计学意义(P＞0.05).3组产妇T1及T2的SBP较T0有明显的下降(均P＜0.05),3组间比较差异均无统计学意义(均P＞0.05).Ⅰ、Ⅱ组感觉阻滞平面较Ⅲ组明显升高(P＜0.05),Ⅰ、Ⅱ组注药后感觉阻滞平面比较差异无统计学意义(P＞0.05).结论 腰硬联合麻醉剖宫产产妇在硬膜外预充少许液体,可以预防硬膜外导管置入时损伤血管,提高剖宫产产妇腰硬联合阻滞麻醉的安全性,同时还可改善腰麻的效果.     

去氧肾上腺素和麻黄碱在蛛网膜下腔麻醉下剖宫产术中纠正低血压的比较

目的 观察去氧肾上腺素和麻黄碱在蛛网膜下腔麻醉下剖宫产术时纠正低血压的效果.方法 选取100例术中使用升压药物的初产妇,随机分为两组(n=50):E组(麻黄碱组,8 mg/ml)和P组(去氧肾上腺素组,100μg/ml).记录麻醉前、麻醉后至手术结束两种药物的使用量、产妇血压、心率和呼吸的变化,同时记录产妇恶心、呕吐的情况.在胎儿娩出即刻,进行产妇动脉血、新生儿脐动脉血和脐静脉血气分析,分别测量肾上腺素、去甲肾上腺素、去氧肾上腺素和麻黄碱的浓度.对新生儿进行1 min和5 min Apgar评分.结果 (1)两种药物的等效使用量、纠正产妇血压和产妇呼吸的变化比较没有差异.(2)新生儿1 min和5 min Apgar评分比较无统计学差异.(3)产妇心率变化去氧肾上腺素组明显小于麻黄碱组(P<0.05),产妇恶心、呕吐去氧肾上腺素组明显小于麻黄碱组(P<0.05).(4)脐动脉和脐静脉pH、碱剩余,麻黄碱组明显低于去氧肾上腺素组(p<0.05),而脐动脉PC02和脐静脉的PO2麻黄碱组明显高于去氧肾上腺素组(P<0.05),脐动脉的肾上腺素和去甲肾上腺素的浓度麻黄碱组明显高于去氧肾上腺素组(P<0.05).结论 去氧肾上腺素在蛛网膜下腔麻醉下剖宫产术中纠正产妇低血压比麻黄碱更具优势.     

剖宫产腰麻后低血压防治措施的研究进展

单次腰麻现在已经成为目前世界范围内剖宫产麻醉最常用的技术。由于产妇孕期生理发生了一系列的改变,导致低血压是腰麻剖宫产术最常见的并发症。严重的、持续的低血压会导致产妇恶心呕吐、胸闷、呼吸困难甚至心脏骤停,还可以引起胎儿缺血缺氧甚至胎儿窘迫。因此,如何防治腰麻后低血压在剖宫产手术中显得尤为重要,这也是近年来产科麻醉研究的一个热点。     

Effect of Dexmedetomidine IV on the Duration of Spinal Anesthesia with Prilocaine: A Double-Blind, Prospective Study in Adult Surgical Patients

Background: The duration of spinal anesthesia with prilocaine has been poorly documented and no English-language study has been published regarding the effects of dexmedetomidine on the duration of anesthesia with spinal prilocaine.Objective: The aim of this study was to assess the effects of dexmedetomidine IV on the duration of action of prilocaine and its associated adverse events (AEs) in spinal anesthesia.Methods: In this double-blind, prospective study, patients classified as American Society of Anesthesiologists grade I to II who were to undergo lower abdominal, anorectal, or extremity surgery with a spinal anesthetic were assigned to 1 of 2 groups. All patients were administered prilocaine 2% for spinal anesthesia. Within 10 minutes after spinal anesthesia was initiated, group 1 received a loading dose of dexmedetomidine 1 μg/kg IV, followed by a maintenance dose of 0.4 μg/kg · h for 50 minutes; group 2 (control) received the same amount of physiologic saline in the same time frame. Mean arterial pressure (MAP), heart rate (HR), duration of sensory and motor blockade, and sedation scores were tracked. Patients were observed for 4.5 hours after surgery, with follow-ups occurring up to 96 hours after surgery.Results: Eighty-three patients were assessed for study inclusion, 23 of whom were excluded. Sixty patients (42 men, 18 women; mean [SD] age, 40.56 [16.86] years) were included in the study. MAP was similar in the 2 groups throughout the study. Mean (SD) HR was significantly lower in group 1 compared with group 2 at 20 minutes (70.43 [19.28] vs 77.63 [18.14] beats per minute, respectively; P = 0.02). The mean (SD) duration of the persistence of sensory anesthesia (ie, the time required for the maximal level of anesthesia to regress 2 dermatomes) was significantly longer in group 1 compared with group 2 (148.33 [21.18] vs 122.83 [18.73] minutes; P < 0.001). The mean (SD) time to complete abolishment of motor blockade was also significantly longer in group 1 than in group 2 (215.16 [25.10] vs 190.83 [18.57] minutes; P < 0.001). The average sedation score in group 1 was significantly higher than in group 2 (P < 0.001) during anesthesia. Significantly more patients in group 1 required atropine than those in group 2 (9 vs 2 patients; P < 0.001) to treat bradycardia. There was no significant between-group difference in the number of patients who received ephedrine to treat hypotension. One patient in each group reported waist and back pain; 2 patients in each group reported nausea. Shivering occurred in 0 and 5 patients in groups 1 and 2, respectively; the between-group difference in AEs was not statistically significant. Paresthesia, postdural puncture headache, allergic reactions, total spinal anesthesia, urinary retention, or vomiting—AEs commonly associated with spinal anesthesia—were not observed or reported by either group.Conclusions: The results of this study suggest that dexmedetomidine IV significantly prolonged the duration of spinal anesthesia and provided a significantly higher level of sedation compared to placebo in this group of adult surgical patients. The treatment was generally well tolerated in all patients.     

Isobolographic analysis of interaction between nisoxetine‐ and mepivacaine‐induced spinal blockades in rats

Although nisoxetine has been shown to elicit cutaneous (peripheral) anesthesia, spinal (central) anesthesia with nisoxetine was not exposed. The aim of this study was to examine spinal anesthesia of nisoxetine and its influence on the antinociceptive action of mepivacaine. We compared nisoxetine with an established local anesthetic mepivacaine for spinal anesthesia after rats were intrathecally injected with drugs. The drugs were spinally administered alone as well as in combination, and their potencies were compared via dose–response curves and isobolographic analysis. We showed that nisoxetine, as well as mepivacaine elicited spinal anesthesia in dose‐dependent manners. On a 50% effective dose (ED₅₀) basis, the spinal block effect of nisoxetine in motor function, proprioception, and nociception [0.99 (0.91–1.10), 0.85 (0.76–0.95), 0.82 (0.74–0.89)] was more potent (P < 0.05) than that of mepivacaine [1.28 (1.21–1.34), 1.14 (1.07–1.22), 0.99 (0.93–1.05)], respectively. Furthermore, the nociceptive/sensory blockade (ED₅₀) was greater than the motor blockade in both nisoxetine and mepivacaine groups (P < 0.05). Saline group (vehicle) produced no spinal anesthesia. Coadministration of nisoxetine with mepivacaine displayed an additive effect. Our data reported nisoxetine produced significant anesthesia at spinal level, and additive interaction with the local anesthetic, mepivacaine. Intrathecal nisoxetine elicited more potent spinal anesthesia than mepivacaine.     

羟乙基淀粉130/0.4氯化钠注射液对剖宫产产妇及新生儿的影响

目的探讨羟乙基淀粉130/0.4氯化钠注射液对剖宫产产妇及新生儿的影响。方法将在我院行腰-硬联合麻醉剖宫产术的198例产妇采用简单随机抽样法将其分为观察组与对照组,每组99例。对照组给予乳酸钠林格注射液,观察组给予羟乙基淀粉130/0.4氯化钠注射液,比较两组的应用效果。结果麻醉后15 min、胎儿娩出时,观察组产妇MAP高于对照组,HR低于对照组(P<0.05)。观察组新生儿脐动脉以及脐静脉PaO2高于对照组,PaCO2低于对照组(P<0.05)。观察组产妇术中低血压、术后恶心呕吐发生率均低于对照组(P<0.05)。结论羟乙基淀粉130/0.4氯化钠注射液应用于剖宫产术,有利于术中产妇生命体征稳定、预防低血压的发生以及改善新生儿血气指标。     

腹横肌平面阻滞复合七氟醚全麻对产妇及新生儿的影响

目的观察腹横肌平面阻滞(TAPB)复合七氟醚全麻对剖宫产产妇术中血流动力学及新生儿脐动脉血气分析的影响。方法选取2017年1~6月我院ASA分级Ⅰ或Ⅱ级、单活胎足月妊娠的剖宫产产妇60例,分为TAPB复合七氟醚全麻组(T组,n=30)和腰硬联合麻醉组(C组,n=30)。T组产妇采用双侧TAPB后,七氟醚吸入全麻诱导后置入喉罩;C组产妇采用腰硬联合麻醉。记录产妇的麻醉前(T1)、麻醉后2 min(T2)、切皮时(T3)、新生儿出生后5 min(T4)、手术结束(T5)各时刻产妇心率(HR)、平均动脉压(MAP)的变化,记录手术持续时间、麻黄碱用量、术中低血压,记录新生儿出生时的脐动脉血气分析结果,新生儿的Apgar评分。结果组内比较,T组术中HR、MAP变化与麻醉前比较差异无统计学意义(P>0.05);C组产妇麻醉后HR升高,MAP下降,胎儿娩出后MAP升高(P<0.05);与C组比较,T组产妇T2时点HR低于C组,T2、T3时点MAP高于C组(P<0.05);T组测得的新生儿脐动脉血气分析pH值、动脉血氧分压(PaO 2)高于C组(P<0.05);T组测得的新生儿脐动脉血二氧化碳分压(PaCO 2)低于C组(P<0.05);2组新生儿Apgar评分差异无统计学意义(P>0.05)。结论TAPB复合七氟醚全麻对剖宫产产妇血流动力学稳定、新生儿的血气分析结果更优。     

Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

BACKGROUNDAccidental dural puncture (ADP) and subsequent post-dural puncture headache (PDPH) remain common complications of epidural procedures for obstetric anesthesia and analgesia. No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARYWe report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch (HES) to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures. ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section (CS) and in eleven parturients receiving labor analgesia. An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients. After CS, the epidural catheter was used for postoperative pain relief over a 48-h period. After delivery in eleven cases, epidural infusion was maintained for 24 h. Thereafter, 15 mL of 6% HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal. None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSIONAn incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.     

体位干预对腰硬联合麻醉剖宫产术中低血压的影响

目的探讨体位干预对腰硬联合麻醉下剖宫产术中低血压的影响。方法选择100例ASAHI级行剖宫产产妇，随机分为A、B两组，各50例，均采用腰硬联合麻醉，在扩容的同时，A组产妇右侧臀部垫一方垫，手术开始时去垫取平卧位，B组取平卧位。观察两组BP、SPO2、ECG、HR的变化，比较体位干预和非体位干预两组产妇手术中血压的变化，发生低血压的概率。结果A组产妇术中发生低血压的概率和血压下降幅度的均值小于B组（P〈0．01）。结论体位干预可有效减少腰硬联合麻醉下剖宫产术中低血压的发生，提示子宫对下腔静脉的压迫使回心血量急剧减少是引起腰硬联合麻醉下剖宫产术中低血压发生的主要原因。     

体位干预防治剖宫产术产妇仰卧位低血压综合征的效果

目的研究体位干预防治剖宫产产妇仰卧位低血压综合征(SHS)的效果。方法回顾性分析2018年12月至2019年12月收治的86例剖宫产产妇的临床资料,按照护理方法的不同将其分为参照组和体位干预组,每组43例。麻醉后,参照组采取将手术床朝向左侧并倾斜30°的体位进行护理,体位干预组采取将孕妇右侧臀部垫起4~5 cm的体位进行护理。比较两组麻醉前、麻醉20 min后舒张压、收缩压、呼吸频率、心率及麻黄碱药物使用量、不良事件发生率、新生儿Apgar评分、产妇NSNS评分。结果麻醉20 min后,两组的舒张压、收缩压低于麻醉前,但体位干预组明显高于参照组,差异具有统计学意义(P<0.05);麻醉20 min后,两组的呼吸频率、心率高于麻醉前,但体位干预组明显低于参照组,差异具有统计学意义(P<0.05)。体位干预组麻黄碱药物使用量为(5.23±1.05)mg,明显少于参照组的(8.14±1.77)mg,差异具有统计学意义(P<0.05)。体位干预组术中低血压综合征、单侧阻滞不全、低氧血症发生率均明显低于参照组,差异具有统计学意义(P<0.05)。体位干预组新生儿Apgar评分及孕妇NSNS评分均明显高于参照组,差异具有统计学意义(P<0.05)。结论剖宫产产妇采用特殊体位干预对防治SHS的效果显著,值得推广应用。     

Leg Compression Versus Control for Prevention of Spinal Anesthesia Induced Hypotension in Elective Cesarean Delivery: A Meta-Analysis of Randomized Controlled Trials

PurposeThe aim of this meta-analysis was to assess the effectiveness of leg compression versus control in preventing spinal anesthesia induced hypotension during cesarean delivery.DesignA meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, Embase, Web of Science and CENTRAL were searched for RCTs that compared leg compression with control for prevention of hypotension in patients undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was the incidence of hypotension. Subgroup analysis was performed according to leg compression methods. Secondary outcomes included nausea and vomiting, the number of vasopressor requirement, and the rates of neonatal Apgar scores ≤7 and umbilical cord blood pH ≤ 7.2.FindingsTwelve studies involving 787 patients were included in this meta-analysis. There was a significant reduction of the incidence of hypotension with leg compression versus control (RR 0.45, 95% CI 0.32 to 0.62, I² = 81%). Subgroup analysis suggested that leg wrapping may be more effective in preventing hypotension compared with elastic stockings and sequential compression mechanical devices. Leg compression also reduced maternal nausea and vasopressors requirement, but did not impact on neonatal outcomes.ConclusionsLeg compression, especially leg wrapping, decreases the incidence and severity of hypotension after spinal anesthesia in caesarean delivery. As a simple, non–pharmacologic and cost-effective intervention, leg wrapping can be used for prevention of spinal anesthesia induced hypotension in caesarean delivery, either alone or in combination with vasopressors.     

小剂量罗哌卡因复合舒芬太尼在剖宫产术麻醉中的应用效果

目的分析小剂量罗哌卡因复合舒芬太尼在剖宫产术中的应用效果。方法选取2018年3月至2018年12月在我院进行剖宫产手术的116例产妇为研究对象,根据在剖宫产术中选择的麻醉药物的不同将其分为对照组(58例,罗哌卡因)和观察组(58例,罗哌卡因+舒芬太尼)。比较两组的临床效果。结果观察组的麻醉起效时间、痛觉恢复时间均明显短于对照组,麻醉持续时间明显长于对照组(P<0.05)。术前、麻醉药物注射后1、3、5、10 min及术毕时,两组的心率和平均动脉压比较,差异均无统计学意义(P>0.05)。观察组产妇的产后不良反应总发生率及VAS评分均显著低于对照组(P<0.05)。两组新生儿出生后1、5 min时Apgar评分比较,差异均无统计学意义(P>0.05)。结论小剂量罗哌卡因复合舒芬太尼在剖宫产术麻醉中的应用效果显著,麻醉起效快,术后镇痛效果明显,且对母婴影响小,术后不良反应少,安全性高,值得临床推广应用。     

Intrathecal amantadine for prolonged spinal blockade of sensory and motor functions in rats

We aimed to compare the hypothesized local anesthetic action of amantadine (1‐adamantanamine) with that of the known local anesthetic mepivacaine. Motor, proprioceptive, and nociceptive functions were evaluated in rats after intrathecal administration. Amantadine elicited spinal anesthesia in a dose‐related fashion and produced a better sensory‐selective action over motor blockade (P < 0.01). On the 50% effective dose (ED₅₀) basis, the rank of potency on spinal motor, proprioceptive, and nociceptive block was mepivacaine > amantadine (P < 0.01 for the differences). Amantadine (63.5 μmol/kg) and mepivacaine (7.1 μmol/kg) produced complete spinal block of motor function, proprioception, and nociception. On an equipotent basis (ED₂₅, ED₅₀, and ED₇₅), the duration of amantadine was longer (P < 0.01) than that of mepivacaine on spinal motor, proprioceptive, and nociceptive block. Our preclinical data demonstrated that amantadine was less potent than mepivacaine at producing spinal anesthesia. The spinal block duration produced by amantadine was greater than that produced by mepivacaine. Both amantadine and mepivacaine produced a markedly nociceptive‐specific blockade.     

The effects of the extent of spinal block on the BIS score and regional cerebral oxygen saturation in elderly patients: A prospective,randomized, and double-blinded study

Backgrounds Patients may become sedated with␣spinal anesthesia; however, the effect of the extent of␣spinal block on the Bispectral index (BIS), a processed electroencephalographic variable, has not been fully investigated. We evaluated the influence of the extent of spinal block on BIS values and on regional cerebral oxygen saturation (rSO₂) in elderly patients. Methods A prospective, randomized, double-blinded study was performed in 55 ASA II patients undergoing urological surgery. The patients were randomly allocated into one of two groups to receive 2.7 ml of 0.5% hyperbaric bupivacaine or 1.5 ml, and then divided into two groups according to level of spinal blockade: high spinal group (Th6 and above) or low spinal group (Th12 and below). Systolic blood pressure (SBP), heart rate (HR), cardiac output (CO), stroke volume (SV), BIS values, and rSO₂ were measured for 30 min. CO and SV were evaluated using impedance cardiograph methods. Results The level of spinal blockade was Th4.7 ± 1.0 in high spinal group (n = 20) and L2.5 ± 2.2 in low spinal group (n = 20). High spinal anesthesia produced a significant decrease in SBP (p < 0.01) and SV (p < 0.01), but had no effect on CO. High spinal anesthesia significantly decreased BIS values (p < 0.01) without affecting rSO₂. There was relationship between level of spinal blockade and BIS values (r = 0.566). In contrast, no changes in above parameters were found in low spinal group. Conclusions This study provides evidence that the extent of spinal block may have significant influence on BIS values without affecting rSO₂ in elderly patients. A part of the present study was presented at the Annual Meeting of the Japan Society of Anesthesiologists, June 02–04, 2005 at Kobe, Japan. Nishikawa K,Hagiwara R, Nakamura K, Ishizeki J, Kubo K, Saito S, Goto F. The effects of the extent of spinal block on the BIS score and regional cerebral oxygen saturation in elderly patients: A prospective, randomized, and double-blinded study.