透视术在强直性脊柱炎麻醉治疗中的作用

Journal of Anaesthesia and Critical Care Reports Pub Date : 2021-01-10 DOI:10.13107/jaccr.2021.v07i02.180

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引用次数: 0

摘要

强直性颈椎病患者有严重畸形时，选择全麻还是区域麻醉一直是一个挑战。无论是在机构还是在较小的私人医院，区域麻醉总是一种选择。Schewley和他的同事比较了10年来区域麻醉和全身麻醉的情况，发现区域麻醉是同样好的选择。[1]许多病例报告表明，对于严重强直性颈椎病患者，区域麻醉可能是一种更安全的选择。[2]作者利用透视技术实现了神经轴向通路。然而，对于没有慢性疼痛管理背景的麻醉师来说，透视图像的解释可能是困难的。此外，由于其他手术室可能很忙，以便稍后进行手术，因此透视检查的可用性可能会有所变化。在神经轴向难以找到间隙的情况下，使用超声检查间隙可能是有用的。大多数从事区域麻醉的麻醉师都具有使用超声波的专业知识，并且能够轻松地解释图像。超声心动图也可以帮助术前确定和计划中枢神经轴传导阻滞。[4]在这种情况下，有许多使用USG指导进行轴突麻醉的病例报告。[3]然而，中枢神经轴阻滞在这些患者中是有风险的。硬膜外麻醉的放置在技术上是困难的，并且与硬膜外血肿的风险增加有关。Wulf报道，在30年的硬膜外麻醉相关脊髓血肿的综合回顾中，51例脊髓血肿患者中有5例发生在AS患者中。年时期。这些与插入困难或创伤性插入有关。在这篇综述文章中，他还提到强直性脊柱病是脊髓或硬膜外血肿的危险因素之一。[5]Li等也报道了一例患者硬膜外血肿的病例

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Fluoroscopy comes to the rescue in anaesthesia management of a case of ankylosing spondylitis

Ankylosing spondylosis is always a challenge when patient has severe deformities to choose between general anaesthesia versus regional anaesthesia. Regional anaesthesia is always a choice either at institutionally or at smaller private hospital set ups. Schewley and colleagues compared regional versus general anaesthesia over 10 years and shown that regional anaesthesia is equally good choice.[1] There are many case reports which suggest that regional anaesthesia could be a safer option in severe Ankylosing spondylosis patients.[2] Author has managed to achieve neuraxial access by using fluoroscopy. However, interpretation of images by fluoroscopy could be difficult for anaesthetists without chronic pain management background. Also, availability of fluoroscopy could be variable as it may be busy in other theatres to be available later for surgery. Use of ultrasound to view spaces could be useful in cases with difficult neuraxial access to find the space. Most of the anaesthetists practising regional anaesthesia have expertise in using ultra-sound and also are comfortable to interpret the images. USG could also be helpful in pre-operative setting to identify and plan for central neuraxial blockade. [4] There are many case reports of use of USG guidance for neuraxial anaesthesia in such cases. [3] However, central neuraxial blocks in these patient comes with risks. The placement of epidural anaesthesia is technically difficult and is associated with an increased risk of an epidural haematoma. Wulf reported five out of 51 patients with spinal haematoma occurred in patients with AS in a comprehensive review of spinal haematoma associated with epidural anaesthesia over a 30?year period. These were related to difficult or traumatic insertion. In this his review article, he also mentions Ankylosing spondylosis as one of the risk factor for spinal or epidural haemoatoma. [5] Li et al also present a case report where patient developed epidural haematoma after epidura

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Journal of Anaesthesia and Critical Care Reports

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