Electrical safety in the operating room: important old wine, disguised new bottles.
Electrical safety in the operating room: important old wine, disguised new bottles.
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手术室用电安全：重要的旧酒，伪装的新瓶。
DOI：
10.1213/00000539-199403000-00001
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发表时间：
1994
影响因子：
5.7
通讯作者：
J. Ehrenwerth
中科院分区：
文献类型：
--
作者：
L. Litt;J. Ehrenwerth
麻醉和手术是在技术密集的环境中进行的，这些环境总是有潜在的危险。尽管如此，麻醉师很少被迫在术中面对电气安全问题，特别是微电击。然而，在这一期中，McNm等人（1）报告了两例通过肺动脉（PA）导管进行微电击的病例。作者对两种心脏微休克的快速诊断和治疗值得赞扬，这两种微休克的发生率很低，但其性质是众所周知的。麻醉师通常担心植入可程控心脏起搏器的患者在单极电外科手术期间发生纤颤和心律失常。事实上，影响起搏器功能的最常见医疗设备是单极电外科手术（2）。然而，McNechty等人强调，由于PA导管的导线（在通往热敏电阻的途中）穿过心脏，因此，具有PA导管的患者始终可能容易受到电外科手术引起的心脏微电击。McNynth等人处理的急诊类型可能比术中恶性高热（MH）发生频率低。然而，MH和心脏微休克都是麻醉师应该认识和治疗的危机的例子，尽管许多人永远不会遇到任何一个。奇怪的是，尽管许多麻醉师对与恶性高热的诊断和治疗相关的新概念毫无兴趣，但很少有麻醉师对电气安全的新方面感到兴奋。这篇社论的价值现在应该很明显了。应鼓励麻醉医师从McNyndham等人的观察中获益，并将这两个案例作为手术室电气安全的新旧问题的提醒（3-9）。由于电容耦合（a），在McNm等人的PA导管中诱导微冲击电流
A nesthesia and surgery are conducted in technologically intense environments that are always potentially hazardous. Despite this, anesthesiologists are rarely forced intraoperatively to confront electrical safety problems, especially microshock. However, in this issue McNulty et al. (1) report two cases of microshock conducted via a pulmonary artery (PA) catheter. The authors deserve commendation for their rapid diagnosis and treatment of two situations of cardiac microshock, whose occurrence is rare but whose nature is very well known. Anesthesiologists are commonly concerned about fibrillation and dysrhythmia occurring during unipolar electrosurgery in patients with implanted, programmable cardiac pacemakers. Indeed, the most common piece of medical equipment to affect pacemaker function is unipolar electrosurgery (2). McNulty et al. emphasize, however, that patients having a PA catheter in place are always potentially susceptible to electrosurgically caused cardiac microshock, because of the PA catheter’s wire (on the way to the thermistor) that passes through the heart. The type of emergency that McNulty et al. dealt with probably occurs less frequently than intraoperative malignant hyperthermia (MH). However, both MH and cardiac microshock are examples of crises that anesthesiologists are expected to recognize and treat, although many will never encounter either one. Curiously, although many anesthesiologists have no trouble becoming interested in new concepts related to the diagnosis and treatment of malignant hyperthermia, few anesthesiologists exhibit excitement about being refreshed with new aspects of electrical safety. The vaison d‘2tre for this editorial should now be apparent. Anesthesiologists should be encouraged to benefit from the observations of McNulty et al. and use these two cases as reminders of old and new issues in operating room electrical safety (3-9). Microshock current was induced in the PA catheters of McNulty et al. because of capacitive coupling (a