Study of Cardiac Arrest Associated with Spinal Anesthesia

为了阐明脊麻下心脏骤停的原因，我们研究了与腰麻相关的心脏骤停。我们收集了文献、司法报告和向当地医学会报告的医疗事故案例，共收集了33例。患者的平均年龄为13岁。腰麻的局麻药主要使用地布卡因或其复合体。主要并发症的初始体征各有不同，包括发紫、低血压、呼吸困难、呼吸骤停。这些体征在脊麻后30分钟内被记录下来。这些病例在整个手术过程中一直平安无事，直到突然发生变化。对这些危象的即时治疗也因个案而异。进行了人工呼吸、心脏按摩、建立呼吸道、吸氧、血管加压剂应用等治疗，但对部分病例效果不佳。关于p…的一半更多患者在6小时内死亡，许多存活的患者变成植物人状态。死亡或休克的原因被归类为过敏性休克、特发性综合征、呼吸功能不全等。根据一项累积的麻醉死亡率研究，与脊麻相关的麻醉死亡在青春期发病率极高。这不仅是因为急性阑尾炎是这个年龄段的常见病，而且麻醉本身也一定有一定的特定风险。腰麻由外科医生亲自操作，病人由循环护士代替麻醉师进行检查。了解到这一主要并发症，可发现以下危险因素：过敏反应、特质、高度麻醉、交感反应异常、监测不力和处理不当。将这些因素结合起来，可能会在脊麻下导致心脏骤停。因此，每当给予脊麻时，应尽可能地去除这些因素。较少

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