清醒骶管麻醉对行下腹部手术的婴儿全身和局部脑灌注的影响
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清醒骶管麻醉对行下腹部手术的婴儿全身和局部脑灌注的影响
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：接受全身麻醉的婴儿发生严重呼吸和心血管危险事件的风险增加。对于接受下腹部小手术的婴儿来说，清醒骶管麻醉是一种选择。虽然临床经验显示术中血流动力学状况稳定，但尚无研究评估此类手术过程中的全身和局部脑灌注。
目的：本研究的目的是评估清醒骶管麻醉对婴儿全身和局部脑灌注的影响。
设计：前瞻性观察队列研究。
单位：综合性儿童医院麻醉科，2017年11月至2018年6月。
研究对象：20例择期在清醒骶管麻醉下行下腹部手术的婴儿(停经后年龄36~54周，体重1800~5700g)。
干预措施：监测指标包括心脏指数(使用电测速仪)和局部脑血氧饱和度(使用近红外光谱)。骶管阻滞采用0.3%罗哌卡因1ml·kg-1。低血压定义为平均动脉压(BP)低于35 mmHg，局部脑氧饱和降低定义为局部脑氧饱和度低于基线的80%。
主要观察指标：清醒骶管麻醉下平均动脉压、心脏指数和局部脑氧饱和度参数。
结果：平均动脉压、心脏指数和局部脑氧饱和度保持在预定下限以上。未观察到低血压或局部脑饱和度降低的情况。手术时间35±13(20~71)min。手术结束后转入新生儿病房，术后22±15min(6~55min)喂奶。5名早产儿在术中发生了限制性呼吸暂停。
结论：本研究表明，清醒骶管麻醉不会削弱婴儿的全身和局部脑灌注。
原始文献来源：Beck CE, Sümpelmann R, Nickel K, et al. Systemic and regional cerebral perfusion in small infants undergoing minor lower abdominal surgery under awake caudal anaesthesia：An observational study[J]. Eur J Anaesthesiol 2020 Aug;37(8) DOI：10.1097/EJA.0000000000001150
Systemic and regional cerebral perfusion in small infants undergoing minor lower abdominal surgery under awake caudal anaesthesia
An observational study
Abstract
BACKGROUND Infants undergoing general anaesthesia have an increased risk of severe respiratory and cardiovascular critical events. Awake caudal anaesthesia is an alternative for small infants undergoing minor lower abdominal surgery. While clinical experience has shown stable intraoperative haemodynamic conditions, there are no studies evaluating systemic and regional cerebral perfusion during such a procedure.
OBJECTIVES The purpose of this study was to evaluate the effects of awake caudal anaesthesia on systemic and regional cerebral perfusion in small infants.
DESIGN A prospective observational cohort study.
SETTING Clinic of Anaesthesiology, University Children’s Hospital, between November 2017 and June 2018.
PATIENTS Twenty small infants (postmenstrual age 36 to 54 weeks, weight 1800 to 5700 g) scheduled for lower abdominal surgery under awake caudal anaesthesia were enrolled in this study.
INTERVENTION Standard monitoring was expanded to include cardiac index using electrical velocimetry and regional cerebral oxygen saturation using near infrared spectroscopy. The caudal block was performed with 0.3% ropivacaine 1 ml·kg-1 Hypotension was defined as mean arterial blood pressure (BP) less than 35 mmHg and regional cerebral desaturation as regional cerebral oxygen saturation less than 80% of baseline.
MAIN OUTCOMES Mean arterial BP, cardiac index and regional cerebral oxygen saturation parameters under awake caudal anaesthesia.
RESULTS Mean arterial BP, cardiac index and regional cerebral oxygen saturation remained above the predefined lower limits. No episodes of hypotension or regional cerebral desaturation were observed. Operation time was 35±13 (range 20 to 71) min. The infants were discharged to the neonatal ward after the end of surgery, and milk was fed 22±15 (range 6 to 55) min thereafter. Five preterm infants experienced self-limiting episodes of apnoea intra-operatively.
CONCLUSION The current study shows that awake caudal anaesthesia does not impair systemic and regional cerebral perfusion in small infants.
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