在复杂的大动脉手术中进行神经轴麻醉:在高风险患者中是一种可行的选择
Raed Sami Altowairki1, Muzackir Abubaker Mohammed1, Khalid Nasser Bin Ghali1
1Department of Anesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Saudi journal of anaesthesia
|February 19, 2026
概括
胸部外周麻醉 (TEA) 为患有外周动脉疾病的高风险患者进行复杂的大动脉重建提供了全身麻醉 (GA) 的安全替代方案. 这种方法可以减少心脏压力并改善结果.
科学领域:
- 血管外科 血管外科
- 麻醉学 麻醉学
- 心脏病学 心脏病学
背景情况:
- 动脉封闭性疾病 (AIOD) 需要复杂的血管重建,通常是在全身麻醉 (GA) 下进行的.
- 对于患有晚期心脏病的患者来说,GA具有显著的风险,包括减少喷射分数.
- 高风险患者的外周动脉疾病管理需要仔细考虑麻醉.
研究的目的:
- 在患有严重心脏损伤的患者中使用胸部外周麻醉 (TEA) 进行广泛的AIOD修复的情况下报告.
- 评估TEA作为高风险血管外科手术中GA的替代品的可行性和安全性.
主要方法:
- 一名51岁的男性患有关键四肢缺血症,广泛的AIOD和严重的缺血性心脏病,接受了大动脉双绕道,大动脉内关节切除术,双侧股骨内关节切除术和深度整形术.
- 该手术是在胸部外围麻醉 (TEA) 和手术内镇静下进行的.
- 血液动力学管理包括为低血压注射诺拉皮内林,以及术后止痛使用外周注射罗皮瓦卡因-芬太尼和多模式药物.
主要成果:
- 胸腔外围麻醉 (TEA) 提供了有效的手术麻醉,血液动力学稳定性和优异的疼痛缓解.
- 患者经历了稳定的术后过程,ICU监测最小,疼痛得到良好控制.
- 没有报告与麻醉相关的重大手术前或术后并发症.
结论:
- 胸腔外周麻醉 (TEA) 是对进行广泛的大动脉手术的高风险患者的全身麻醉 (GA) 的可行且安全的替代方案.
- 在精选的血管外科手术患者中,TEA可以减轻心脏压力,增强疼痛管理,减少肺部并发症.
- 建议进行进一步的研究,以支持区域麻醉技术在高风险血管手术中的更广泛应用.
相关概念视频
Aneurysm IV: Nursing Management
491
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
491
Local Anesthetics: Clinical Application as Spinal Anesthesia
1.6K
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
1.6K
Aneurysm III: Interprofessional Care
338
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
338
General Anesthesia: Overview
756
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
756
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
1.5K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
1.5K
Local Anesthetics: Clinical Application as Epidural Anesthesia
805
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
805


