[Continuous spinal anesthesia using bupivacaine. Report of experiences].

IF 1.9 Q2 POLITICAL SCIENCE Regional-Anaesthesie Pub Date : 1988-07-01
M Jöhr
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Abstract

Continuous spinal anesthesia has not yet found general acceptance, although it is a simple and efficient method. Its main advantage is allowing a reliable block to be built up step by step while carefully monitoring the cardiovascular changes. Postspinal headache can be avoided by restricting the use of elderly patients. At our institution, continuous spinal anesthesia has been administered to geriatric high-risk patients for more than 6 years. We report our experience from the year 1986. PATIENTS AND METHODS. Over a 1-year period continuous spinal anesthesia was used for 157 patients with a mean age of 80.4 years (Fig. 1). Of these patients 111 (70.7%) were classified as ASA 3-5 (Fig. 2). In 2 cases a myocardial infarction dated back only 4 and 11 days. The most common indications for surgery were hip fractures (97, 61.8%) and vascular occlusions (37, 23.6%). An 18G Tuohy needle was used for lumbar puncture. The catheter (Portex minipack) was advanced 3-6 cm into the subarachnoid space. Plain bupivacaine 0.5% was injected in small increments until the desired block level was achieved. The catheters were removed immediately after surgery. RESULTS. In 155 of 157 cases surgery was completed under regional anesthesia. Two patients had to be intubated intraoperatively (1 unexpected laparatomy during vascular surgery, 1 with insufficient block for lumbar sympathectomy). The main technical problem was impossibility to advance the catheter into the subarachnoid space despite free flow of CSF (5 cases). For these patients single-shot spinal (4 cases) or epidural anesthesia (1 case) was used.(ABSTRACT TRUNCATED AT 250 WORDS)

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布比卡因持续脊髓麻醉。经验报告]。
虽然连续脊髓麻醉是一种简单有效的方法,但尚未被普遍接受。它的主要优点是在仔细监测心血管变化的同时,允许逐步建立可靠的块。限制老年患者使用可避免脊柱后头痛。在我们的机构,连续脊髓麻醉已被用于老年高危患者超过6年。我们报告1986年以来的经验。患者和方法。157例平均年龄80.4岁的患者在1年的时间内接受了持续的脊髓麻醉(图1)。其中111例(70.7%)被分类为ASA 3-5(图2)。2例心肌梗死的时间分别为4天和11天。最常见的手术指征是髋部骨折(97,61.8%)和血管闭塞(37,23.6%)。腰椎穿刺采用18G Tuohy针。导管(Portex minipack)进入蛛网膜下腔3-6厘米。少量注射0.5%的普通布比卡因,直至达到所需的阻滞水平。手术后立即拔除导管。结果。157例中155例手术在区域麻醉下完成。2例患者必须在术中插管(1例在血管手术中意外剖腹探查,1例在腰交感神经切除术中阻滞不足)。主要技术问题是在脑脊液自由流动的情况下无法将导管推进到蛛网膜下腔(5例)。4例采用单针脊髓麻醉或1例采用硬膜外麻醉。(摘要删节250字)
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来源期刊
CiteScore
3.50
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[An epidural spinal abscess as a lethal complication of peridural anesthesia]. [Knotting of a peridural catheter]. [A simple technique for estimating the level of analgesia in regional anesthesia]. [CSE--the combination of spinal and epidural anesthesia]. [Comments on the paper by R. Schürg et al. Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section].
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