Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders
Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders
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DOI：
10.1213/01.ane.0000220896.56427.53
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发表时间：
2006-07-01
影响因子：
5.7
通讯作者：
Schroeder, Darrell R.
中科院分区：
文献类型：
--
作者：
Hebl, James R.;Horlocker, Terese T.;Schroeder, Darrell R.
从历史上看，对已有中枢神经系统（CNS）疾病的患者使用区域麻醉技术被认为是相对禁忌的。人们普遍担心机械性创伤、局麻药毒性或神经缺血会导致神经系统结果恶化。我们检查了先前存在中枢神经系统疾病且随后接受椎管阻滞的患者新发或进行性神经系统并发症的频率。回顾性审查了梅奥诊所 1988 年至 2000 年期间有中枢神经系统疾病病史且随后接受椎管内麻醉或镇痛的所有患者的医疗记录。 139 名 (n = 139) 名患者被确定纳入研究。患者平均年龄为 60 +/- 17 岁。性别分布为 86 名（62%）男性和 53 名（38%）女性。手术麻醉时，中枢神经系统疾病确诊时间平均为 23 +/- 23 岁，其中 74 名 (53%) 患者报告出现活动性神经系统症状。 75 名患者 (54%) 接受脊髓麻醉，58 名患者 (42%) 接受硬膜外麻醉或镇痛，4 名患者 (3%) 接受连续脊髓麻醉，2 名患者 (1%) 接受脊髓-硬膜外联合技术。布比卡因是所有技术中最常用的局部麻醉剂。 72 名 (52%) 患者的注射液中添加了肾上腺素。共有 15 例 (11%) 技术并发症，其中最常发生的是无意引起的感觉异常和创伤性针头放置。 136 名 (98%) 患者报告获得满意的阻滞。与术前发现相比，没有出现新的或恶化的术后神经功能缺损（0.0%；95% 置信区间，0.0%-0.3%）。我们的结论是，对于既往存在中枢神经系统疾病的患者，与椎管内麻醉和镇痛相关的风险可能并不像以前想象的那么频繁，并且椎管内阻滞不应被视为该患者群体的绝对禁忌症。
Historically, the use of regional anesthetic techniques in patients with preexisting central nervous system (CNS) disorders has been considered relatively contraindicated. The fear of worsening neurologic outcome secondary to mechanical trauma, local anesthetic toxicity, or neural ischemia is commonly reported. We examined the frequency of new or progressive neurologic complications in patients with preexisting CNS disorders who subsequently underwent neuraxial blockade. The medical records of all patients at the Mayo Clinic from the period 1988 to 2000 with a history of a CNS disorder who subsequently received neuraxial anesthesia or analgesia were retrospectively reviewed. One-hundred-thirty-nine (n = 139) patients were identified for study inclusion. Mean patient age was 60 +/- 17 yr. Gender distribution was 86 (62%) males and 53 (38%) females. An established CNS disorder diagnosis was present a mean of 23 +/- 23 yr at the time of surgical anesthesia, with 74 (53%) patients reporting active neurologic symptoms. Spinal anesthesia was performed in 75 (54%) patients, epidural anesthesia or analgesia in 58 (42%) patients, continuous spinal anesthesia in 4 (3%) patients, and a combined spinal-epidural technique in 2 (1%) patients. Bupivacaine was the local anesthetic most commonly used in all techniques. Epinephrine was added to the injectate in 72 (52%) patients. There were 15 (11%) technical complications, with the unintentional elicitation of a paresthesia and traumatic needle placement occurring most frequently. A satisfactory block was reported in 136 (98%) patients. No new or worsening postoperative neurologic deficits occurred when compared to preoperative findings (0.0%; 95% confidence interval, 0.0%-0.3%). We conclude that the risks commonly associated with neuraxial anesthesia and analgesia in patients with preexisting CNS disorders may not be as frequent as once thought and that neuraxial blockade should not be considered an absolute contraindication within this patient population.