CAROTID SINUS NERVE STIMULATION FOR TREATMENT OF INTRACTABLE ANGINA PECTORIS - SURGICAL TECHNIC
CAROTID SINUS NERVE STIMULATION FOR TREATMENT OF INTRACTABLE ANGINA PECTORIS - SURGICAL TECHNIC
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DOI：
10.1097/00000658-197011000-00012
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发表时间：
1970-01-01
影响因子：
9
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
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作者：
BRAUNWALD, NS;EPSTEIN, SE;BRAUNWALD, E
方法术前24-48小时停用洋地黄、长效血管扩张剂和心得安。在预处理当天，患者预先用吗啡和阿托品给药。在局部麻醉下将动脉内针插入桡动脉，并连接到压力传感器，允许立即识别全身压力的任何变化。在手术过程中以及接下来的18至24小时内，持续监测心率和心电图。心率或血压的任何波动立即通过适当的药物治疗，如下所述。静脉滴注25 ~ 50 mg.给予利多卡因、硫喷妥钠和琥珀酰胆碱，并对患者进行插管。麻醉用笑气和硫喷妥钠诱导，用氟烷维持。根据我们的经验，这些麻醉剂的扩张作用比醚类麻醉剂的高血压作用容易处理。为了尽量减少颈动脉窦球区操作可能引起的迷走神经反射的有害循环效应，术中给予阿托品，直至心率超过75次/分或总剂量为1 mg。在颈部解剖开始之前。横切口6 cm。长度为5至7厘米。位于前胸壁锁骨下方并与锁骨平行。在切口下皮瓣下方形成一个足以容纳受体的皮下囊袋。如果有一层厚厚的脂肪组织，
Methods Digitalis, long-acting vasodilators, and propranolol are discontinued 24-48 hours prior to operation. On the day of the pro-cedure, the patients are premedicated with morphine and atropine. An intra-arterial needle is introduced into the radial artery under local anesthesia and connected to a pressure transducer, permitting immediate recognition of any alterations in systemic pressure. The heart rate and electrocardio-gram are continuously monitored during the procedure and for the next 18 to 24 hours. Any fluctuations in heart rate or blood pressure are treated immediately by the appropriate drugs, as described below. After the intravenous infusion of 25 to 50 mg. of lidocaine, sodium thiopental and succinylcholine are administered, and the patient is intubated. Anesthesia is induced with nitrous oxide and sodium thiopental and maintained with halothane. In our ex-perience it has been easier to deal pharmacologically with the hypotensive effects of these anesthetic agents than with the hy-pertensive actions of ether-like agents. In order to minimize the deleterious circula-tory effects of vagal reflexes that may be induced by manipulation in the area of the carotid sinus bulb, atropine is given intra-venously until heart rate exceeds 75 beats/min. or to a total dose of 1 mg. before dis-section in the neck is begun. A transverse incision 6 cm. in length is made, 5 to 7 cm. below and parallel to the clavicle on the anterior chest wall. A sub-cutaneous pocket just large enough to ac-commodate the receiver is developed beneath the lower flap of the incision. If a thick layer of adipose tissue is present, the