胸外外麻醉的初级失败:重新审视
De Q Tran1, Karin Booysen2, Hendrik J Botha2
1Anesthesia, McGill University, Montreal, Quebec, Canada de_tran@hotmail.com.
胸部外围止痛疗法 (TEA) 的初级失效率可以超过20%. 使用光学或波形分析等确认方法可以将故障率降低到2%.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 医疗器械 医疗器械
背景情况:
- 胸外外麻醉 (TEA) 的初级失败是一个重要的临床问题,在教学医院的发病率超过20%.
- 阻力丧失 (LOR) 技术,通常用于胸腔外周腔空间识别,具有低的特异性,导致初级TEA失败.
- 非表皮性LOR的潜在原因包括脊柱间带囊,非合的带,椎肌肉,肌际平面和胸部椎空间.
研究的目的:
- 评估各种确认方式的有效性,以减少初级胸腔外周止痛疗法的失效.
- 为了比较实时超声波指导与光镜等传统方法的有效性和效率.
- 确定未来研究的领域,包括成本效益,新手操作员的辅助和具有挑战性的解剖学.
主要方法:
- 随机试验的审查和证据证实LOR的确认方式.
- 光镜,外腔外带波形分析,电刺激和超声波的比较.
- 经验丰富的操作人员对实时超声波指导的评估.
主要成果:
- 随机试验表明,光学,外围注射波形分析,以及可能的电刺激可以将TEA初级失效率降低到2%.
- 术前超声波扫描与传统的LOR相比没有任何额外的好处.
- 当经验丰富的操作人员进行实时超声波指导时,其效果和效率与光镜相比较.
结论:
- 光学和波形分析等验证技术显著降低了初级TEA失效率.
- 实时超声波指导是经验丰富的从业者对光镜的可行替代方案.
- 需要进一步的研究来确定最佳的成本效益的确认方法,特别是对于新手用户和复杂的解剖学,并调查它们对二次失败率的影响.
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