Peri‐operative care for the elderly
Peri‐operative care for the elderly
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老年人围手术期护理
DOI：
10.1111/anae.12616
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发表时间：
2014
期刊：
影响因子：
10.7
通讯作者：
T. Rajamanickam
中科院分区：
文献类型：
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作者：
T. Rajamanickam
萨哈博士正确地暗示，关于神经轴传导阻滞的皮肤准备的争论是一个不确定的问题。Evans等人的论文提供了证据来支持这样一种观点，即应用方式可能与防腐剂的选择和浓度一样重要，这一点我在我的原始社论[2]中强调过。我知道CareFusion（英国贝辛斯托克）已经改变了他们的一些标签警告，现在显示了他们的设备范围内使用2%氯己定在70%酒精中，有或没有染色（ChloraPrep）的一致性，并且不再将“腰椎穿刺”作为禁忌症。这意味着使用该设备进行脊髓麻醉的皮肤准备将不再违反产品许可，但如果发生导致蛛网膜炎的污染，这仍然不太可能提供法律保护。虽然使用这种设备必须在很大程度上减少污染的风险，但它并不能完全消除污染，而且必须特别采取预防措施，将棉签的把手放在上面，以避免内容物滴落到戴着手套的手或无菌领域。可能减少的污染几率必须与使用2%溶液而不是0.5%溶液的潜在风险相平衡，尽管在实验条件下，在皮肤干燥的情况下，针头上携带的化学物质很少，这一事实可以让人感到些许安慰。我注意到萨哈医生的论点，即一些防止污染的预防措施对于没有辅助的麻醉师来说很难实施。我坚定地认为，对于任何无菌程序，在硬膜外分娩镇痛时，助手的在场是必不可少的。
Dr Saha is right to imply that the debate on skin preparation for neuraxial block is a fluid one. The paper by Evans et al. [1] provides evidence to support the view that the mode of application may be as important as the choice and concentration of antiseptic, a point which I emphasised in my original editorial [2]. I am aware that CareFusion (Basingstoke, UK) have changed some of their labelled warnings, which now show consistency across the range of their devices for applying 2% chlorhexidine in 70% alcohol, with or without tint (ChloraPrep ), and no longer include ‘lumbar puncture’ as a contra-indication. This means that using the device for skin preparation for spinal anaesthesia will no longer be in breach of the product licence, but this is still unlikely to provide legal protection if contamination leading to arachnoiditis occurs. While the use of such devices must go some considerable way towards minimising the risk of contamination, it does not remove it altogether, and precautions must be particularly taken to hold the swabstick with the handle uppermost, to avoid the contents’ dripping down on to the gloved hand or sterile field. The probable reduced chance of contamination must still be balanced against the potential risk of using a 2% solution rather than 0.5%, although some comfort can be taken from the fact that very little chemical appears to be carried on the point of a needle inserted in experimental conditions through skin that has been allowed to dry [3]. I note Dr Saha’s contention that some precautionary measures for preventing contamination would be difficult for the unassisted anaesthetist to implement. I am firmly of the view that, as for any aseptic procedure, the presence of an assistant during the siting of an epidural for labour analgesia is essential.