Combined spinal-epidural anesthesia in obstetrics and Gynecology surgery

Combined spinal-epidural anesthesia (CSEA) is a new type of anaesthesia, with spinal anesthesia onset (SA) to improve rapidly, and continuous epidural (EA) of time flexible, surgical epidural analgesia, etc., I will now homes in obstetrics and Gynecology surgery CSEA and satisfactory anesthetic effect, are reported below.

1 information and general information about the methods in 1.1 ASAI ~ II level, age 20 ~ 52, weight 45 ~ 85kg patients choosing surgery and obstetrics 120 cases, of which row subtotal of 60 cases, hysterectomy 20 cases, cesarean 20 cases and egg cystectomy 20 cases.

Randomly divided into two groups: combined spinal-epidural anesthesia Group (CSEA, n = 60) and continuous epidural Group (EA, n = 60).

1.2 anesthesia two groups of patients with preoperative preparation and before the same Chamber and continuous monitoring heart rate, blood pressure and electrocardiogram, pulse oximetry.

Enter the balance before the anesthesia liquid 300 ~ 500ml, two groups of patients are routinely line epidural puncture: CSEA Group selects camel man company production of disposable spinal-epidural puncture needle puncture point select L2, 3, use resistance disappears judge the epidural needles into the epidural space, the use of epidural 25G lumbar puncture holes worn Dura (significant breakthrough sense), spare needle core, see the slow flow of cerebrospinal fluid, velocity injected 0.75% cloth card for 1 ~ 2ml, exit lumbar puncture, needle through the epidural catheter to head to pin-prick 3cm method test block scope, and intra-adjust 15min CSEA group so that the plane up to T6 body position, otherwise the epidural append local anesthetics. EA group injection test, last minute time inject anesthetics enable anesthesia to T6.

1.3 observation results of both sets of indicators 1.4 with gender, age, weight, no significant differences between the two sets of injection to the operation starting time, significantly shorter than the CSEA group EA group, show the CSEA induction time is short, and EA on epidural anesthetic used less, the majority of narcotic excellent rate.

Two sets of changes in blood pressure drops, ephedrine dosage no significant compared to the two groups, intraoperative traction response required auxiliary intravenous anesthetics EA group more than CSEA group, after the two groups are not headache, back pain and other complications, CSEA group compared with the EA group has obvious advantages.

2 discuss and gynaecological surgery for pelvic deep and deterring road, require anesthesia have adequate analgesia and muscle relaxation, EA has fewer complications, so the amount of good controllability, postoperative pain, etc., but the anesthesia induced long, block anesthesia incompetence or high incidence (9.56%), and even up to 25% for obesity, uterine fibroids larger, uterine neck myoma of patients with pelvic operation to beneficiary brings certain difficulties.

SA although short induction of anesthesia, analgesia muscle relaxation satisfaction, but the time difference of controllability of anesthesia, is not conducive to postoperative pain, postoperative pain, high incidence of nausea and vomiting.

CSEA group combines the spinal and epidural anesthesia onset of advantage, improve the rapid, reliable, controllable, and the amount is relatively small and can be used for postoperative analgesia, etc., while reducing postoperative pain and low blood pressure and other side effects and complications rate.

The choice of long-acting local anesthetics ridges bupivacaine, basically meet the operation requirements, through the epidural catheter, can complement the spinal anesthetic plane after; and because of the lack of operative time Director to supplement inadequate spinal timelines and epidural analgesia.

Due to the built-in lumbar puncture core design using a ballpoint pen, wear out Dura without cut fiber, only put Dura fiber extrusion opened a crack; lumbar puncture after the exit, craking quickly close, lumbar spinal fluid spills decreased, the incidence of postoperative pain.

Comparison with the EA group has clear advantages, which can be widely used in Gynecologic Surgery, to local hospitals more understanding of anesthesia.

(Practice editing: Zhang lijuan)