Study of Cardiac Arrest Associated with Spinal Anesthesia

为了明确脊髓麻醉下心脏骤停的原因，我们研究了与脊髓麻醉相关的心脏骤停。我们收集文献资料、司法报告和向当地医学会报告的医疗事故病例。共收集病例33例。患者的平均年龄为13岁。作为脊髓麻醉的局麻药，主要使用二布卡因或其复合物。主要并发症有发绀、低血压、呼吸困难、呼吸停止。这些症状在脊髓麻醉后30分钟内被发现。这些病例在整个手术过程中都平安无事，直到突然发生变化。对这些危机的即时治疗也因个案而异。进行人工通气、心脏按摩、气道建立、吸氧及给药。然而，这些治疗在某些情况下几乎没有效果。大约一半的病人在6小时内死亡，许多幸存的病人变成了植物人。死亡或休克的病因可分为过敏性休克、特发性休克、呼吸功能不全等。根据一项麻醉死亡率的累积研究，与脊髓麻醉相关的麻醉死亡发生率在青春期非常高。这不仅是因为急性阑尾炎在这个年龄组中很常见，而且麻醉本身一定有一定的特定风险。脊髓麻醉由外科医生亲自执行，病人由循环护士而不是麻醉师监护。考虑到这些主要的并发症，以下风险因素可以被挑选出来；过敏反应、特异反应、高剂量麻醉、交感神经反应异常、监测不良、处理不当。综合这些因素可能导致脊髓麻醉下的心脏骤停。因此，无论何时给予脊髓麻醉，这些因素都应尽可能消除。少

In order to clarify the cause of cardiac arrest under spinal anesthesia, we studied cardiac arrest associated with spinal anesthesia. We collected cases from literatures, judicial reports and malpractice cases reported to local medical association.Thirty three cases were collected. The mean age of patients was thirteen years old. As local anesthetic for spinal anesthesia, dibucaineor or its complex was mainly used. There was variation of initial signs of the major complication, which was consisted of cyanosis, hypotension, dyspnea, respiratory arrest. These signs were noted within 30 minutes after spinal anesthesia. These cases had been uneventful throughout the procedure until sudden changes occured.Immediate treatment for these crises also varies with the individual cases. Artificial ventilation, cardiac massage, establishment of airway, oxygen inhalation and administration of vasopressor were done.Nevertheless, these treatments hardly effected for some cases. About the half of the p … More atients died in 6 hours and many survived patients became vegetable state. The etiology of death or shock was classified as anaphylactic shock, idio-syncracy, respiratory insufficiency and so on.According to a cumulative study of anesthetic mortality, the incidence of anesthetic death associated with spinal anesthesia was extremely high in puberty ages. This is not only because an acute appendicitis is frequently seen in this age group, but also there must be a certain specific risk in anesthesia itself. Spinal anesthesia was performed by a surgeon himself and patients were seen by a circulating nurse instead of anesthetists.Concerning about this major complications, the following risk factors can be picked up ; allergic response, idiosyncrasy, high level anesthesia, abnormal sympathetic response, poorly monitoring and inappropriate management. Combining these factors might cause cardiac arrest under spinal anesthesia. Therefore these factors should be removed as much as possible whenever spinal anesthesia are given. Less