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首页> 外文期刊>International journal of obstetric anesthesia >Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit.
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Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit.

机译：硬膜外分娩镇痛不足后剖宫产的脊髓麻醉：回顾性审核。

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BACKGROUND: High blocks have been reported when spinal anesthesia is used for cesarean section following inadequate labor epidural analgesia. We have therefore modified the practice at our institution to minimize this risk and conducted a retrospective observational study of outcome following the change of practice. METHOD: The records of 115 women with inadequate epidural labor analgesia who required cesarean section between July 1998 and January 2002 were studied. No epidural boluses were administered in the 30 min preceding spinal anesthesia and a reduced spinal dose, median (range) 9.38 mg (7.5-11.3 mg) of 0.75% hyperbaric bupivacaine and fentanyl 15 microg (10-25 microg) was used. Patients were left sitting for 2 min and then positioned supine with left uterine displacement and were closely monitored for symptoms or signs that would suggest a high block. RESULTS: No parturient developed a high spinal necessitating intubation, and there was no adverse neonatal outcome. CONCLUSION: These findings donot conclusively establish this method as safe, but should spinal anesthesia for cesarean section following suboptimal labor epidural analgesia be considered, avoiding epidural boluses immediately preceding spinal injection, using a lower spinal dose, and delayed supine positioning following spinal injection may be advisable.
机译：背景：据报道，由于硬膜外分娩镇痛作用不足而进行剖宫产术时采用了脊髓麻醉。因此，我们对机构的实践进行了修改，以最大程度地降低这种风险，并根据实践的变化对结果进行了回顾性观察研究。方法：研究记录了1998年7月至2002年1月间需要剖宫产的115例硬膜外分娩镇痛不足的妇女的记录。脊髓麻醉前30分钟未给予硬膜外推注，减少了脊髓剂量，使用了9.38 mg（7.5-11.3 mg）的0.75％高压布比卡因和芬太尼15 microg（10-25 microg）。患者静坐2分钟，然后仰卧，左子宫移位，并严密监测症状或体征，提示其高度阻塞。结果：没有产妇发展为需要插管的高脊柱，并且没有不良的新生儿结局。结论：这些发现并不能最终确定该方法的安全性，但应考虑在次优硬膜外分娩镇痛后进行剖宫产术中的脊髓麻醉，避免在脊柱注射前立即使用硬膜外大剂量，使用较低的脊柱剂量，并应在注射后延迟仰卧位。明智的。

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