在接受腹部下部手术的前早产婴儿中唤醒尾部麻醉:叙述性回顾
Geoff P Frawley1,2,3, Alexander John McCann1
1Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.
Paediatric anaesthesia
|December 26, 2023
概括
这次审查发现,对于早产婴儿清醒后尾麻醉的证据不足. 高失败率和高脊髓麻醉等风险表明,与其他麻醉方法相比,没有明显的优势.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 区域麻醉技术 区域麻醉技术
- 新生儿手术 新生儿手术
背景情况:
- 以尾部麻醉为基础的技术用于早产和早产婴儿的下腹手术.
- 评估这些技术的文献对于优化新生儿手术护理至关重要.
研究的目的:
- 进行关于早产和早产婴儿接受腹部下部手术的尾部麻醉技术的文献叙事审查.
- 评估"清醒"尾尾麻醉在这个脆弱人群中的有效性和安全性.
主要方法:
- 从开始到2023年8月,在Medline,PubMed,Embase和Cochrane图书馆进行了全面的文献搜索,遵守PRISMA指南.
- 在211个确定的物品中,有45个物品符合纳入标准,包括1548例尾部麻醉 (清醒,镇静或脊柱-尾部外周结合).
主要成果:
- 整体麻醉失效率为7.2%,脊柱-尾尾外周麻醉 (CSEA) 率最高 (13.7%),镇静尾尾麻醉率最低 (5.85%).
- 术周呼吸暂停发生率在镇静尾部麻醉时最高 (8.16%),而高脊柱麻醉在清醒尾部麻醉时最常发生 (1.97%).
- 该审查受到不完整的数据报告,小样本大小和缺乏高质量的随机对照试验的限制.
结论:
- 没有足够的证据来支持或反驳"清醒"尾尾麻醉在早产和前早产婴儿的好处.
- 高剂量的局部麻醉剂,失败率和高脊柱麻醉的发生率表明,尾巴技术可能不会比醒着的脊柱麻醉或区域阻断的全身麻醉提供优势.
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