Continuous Spinal Anesthesia in Precarious Patients: An Experience in Lubumbashi DR Congo  

作　　者：Wasso Milinganyo Eddy Timothée Dontaine Sagboze Zalambo Sandra Kibonge Mukakala Augustin Zirhumana Namegabe Franck Somwa Muhemedi Lucien Mukalay Banza Yves Tshisuz Nawej Christian Nguz A. Kutshid Nathan Kanyanda Nafatalewa Dimitri Ilunga Banza Mannix Mulewa Umba Deogracias Manika Muteya Michel Mbuyi Musanzayi Sébastien Arung Kalau Willy Iteke Fefe Karl-Rivain Wasso Milinganyo Eddy;Timothée Dontaine;Sagboze Zalambo Sandra;Kibonge Mukakala Augustin;Zirhumana Namegabe Franck;Somwa Muhemedi Lucien;Mukalay Banza Yves;Tshisuz Nawej Christian;Nguz A. Kutshid Nathan;Kanyanda Nafatalewa Dimitri;Ilunga Banza Mannix;Mulewa Umba Deogracias;Manika Muteya Michel;Mbuyi Musanzayi Sébastien;Arung Kalau Willy;Iteke Fefe Karl-Rivain(Department of Anesthesia and Critical Care, University Clinics of Lubumbashi, Lubumbashi, DR Congo;Department of Surgery, Great Hospital of Charleroi, Charleroi, Belgium;Department of Surgery, University Clinics of Lubumbashi, Lubumbashi, DR Congo;Department of Surgery, Medicine School, Official University of Bukavu, Bukavu, DR Congo;Department of Anesthesia and Critical Care, Diamant Medical Center, Lubumbashi, DR Congo)

机构地区：[1]Department of Anesthesia and Critical Care, University Clinics of Lubumbashi, Lubumbashi, DR Congo [2]Department of Surgery, Great Hospital of Charleroi, Charleroi, Belgium [3]Department of Surgery, University Clinics of Lubumbashi, Lubumbashi, DR Congo [4]Department of Surgery, Medicine School, Official University of Bukavu, Bukavu, DR Congo [5]Department of Anesthesia and Critical Care, Diamant Medical Center, Lubumbashi, DR Congo

出　　处：《Open Journal of Anesthesiology》2023年第11期226-233,共8页麻醉学期刊（英文）

摘　　要：Background: Continuous spinal anesthesia (CSA) is an underused technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia (SSA) usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. It is indicated in elderly patients undergoing lower limbs and sub umbilical surgery. Aim: This work aims to highlight the advantages of CSA on hemodynamic stability and as an alternative to heavy anesthetic procedures in already fragile patients. Case presentation: Our cases were two elderly patients, both of them with past stories of cardiac diseases. Both of them were undergoing amputation indicated for wet gangrene on lower limbs. They had unstable hemodynamics states due to inflammatory state. They were all rated ASA 3. CSA was performed with low doses of local anesthetics and maintenance by reinjections of mixture with the same doses. The interventions took place without major incidents and all patients survived. Conclusion: CSA is an underused technique in modern anesthesia. However, there is renewed interest due to the quality of the blocs and the hemodynamics stability. We report a case series of 2 elderly patients with past stories of cardiac diseases undergoing amputation for dry gangrene that had been operated under CSA.Background: Continuous spinal anesthesia (CSA) is an underused technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia (SSA) usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. It is indicated in elderly patients undergoing lower limbs and sub umbilical surgery. Aim: This work aims to highlight the advantages of CSA on hemodynamic stability and as an alternative to heavy anesthetic procedures in already fragile patients. Case presentation: Our cases were two elderly patients, both of them with past stories of cardiac diseases. Both of them were undergoing amputation indicated for wet gangrene on lower limbs. They had unstable hemodynamics states due to inflammatory state. They were all rated ASA 3. CSA was performed with low doses of local anesthetics and maintenance by reinjections of mixture with the same doses. The interventions took place without major incidents and all patients survived. Conclusion: CSA is an underused technique in modern anesthesia. However, there is renewed interest due to the quality of the blocs and the hemodynamics stability. We report a case series of 2 elderly patients with past stories of cardiac diseases undergoing amputation for dry gangrene that had been operated under CSA.

关 键 词：Continuous Spinal Anesthesia (CSA) Precarious Patient Dry Gangrene Elderly Subject DR Congo 

分 类 号：R61[医药卫生—外科学]