Combined Spinal Epidural Anesthesia Effects Of Cerebrospinal Fluid Is Pumped Back To The Anesthetic Effect

Objective: Research on combined spinal epidural anesthesia in cerebrospinal fluid is pumped back to the level of anesthesia effect of dose effect relationship, is the study of the different amount of cerebrospinal fluid is pumped back, back to the influence of extraction speed, injection rate on the anesthesia plane. Methods : Select the ASA I-II adult under combined spinal epidural anesthesia in 180 cases, were randomly divided into 3 groups of S(S1,S2, S3 group), 60 patients in each group(n=60), each S group and then divided into 3 group 9 group(V1, V2, V3, V4, V5, V6, V7, V8, V9, n=20), group S1(V1, V2, V3), group S2(V4, V5, V6), group S3(V7, V8, V9). When that S1, S2,S3 group in the L3 ~ 4 gap for subarachnoid puncture is successful, S1 group pumping back 0.5ml cerebrospinal fluid,S2 pumping back 0.8ml cerebrospinal fluid l,S3 group pumping back 1.0ml cerebrospinal fluid,V1, V4, V7 to0.05ml/s speed withdrawing the cerebrospinal fluid and bolus drug, V2, V5, V8 to 0.1ml/s speed withdrawing the cerebrospinal fluid and bolus drug, V3, V6, V9 to 0.2ml/s speed withdrawing the cerebrospinal fluid and medicine injecting,Dilution of local anesthetics ropivacaine hydrochloride(0.75%Naropin, AstraZeneca), to return to their pumping speed for pushing medicine,anesthesia during continuous observation of blood pressure, heart rate, level of anesthesia, anesthetic effect.Were measured after administration of 5min, 10 min,15min decreased sensation and pain disappear plane plane,And detailed record into the operation room before anesthesia basic blood pressure T0, immediately after give anesthetics blood pressure T1, to 5min T2 to blood pressure after anesthetic, anesthetic blood pressure of 10 min to T3, 15 min to T4 after anesthetic blood pressure, blood pressure of 20 min to T5 after anesthesia,anesthetic blood pressure of 30 min T6,and corresponding to each time the heart rate and HR0, HR1, HR2, HR3, HR4, HR5, HR6. Results: The greater the amount of pull back, pull back faster, sensory block to rise faster, the higher the plane, T5 plane of sensory block percentage is S3>S2>S1; V2、5、8 were higher than V1 、4、 7,but close to V3、6、 9. Different from the back, back to the pumping speed of different block level of pain, uncertainty, did not find the regularity, the occurrence of such a situation, consider whether it is pumped back to the large amount of cerebrospinal fluid, cerebrospinal fluid flow speed faster, so that the spread of local anesthetics and higher. On the other hand,withdrawing the cerebrospinal fluid of large amount of dilute local anesthetic,resulting in decrease in the concentration of the drug concentration, and the pain completely block is relatively high, and the sensory nerve motor nerve block is fast, and the required concentration is low. But with the back of cerebrospinal fluid and injection drug operation may change the flow characteristics of the normal cerebrospinal fluid circulation, the block level of pain is uncertain. In this study, despite the use of different quantity cerebrospinal fluid pumping and pumping and injection rate, but are in a safe range, small influence on blood pressure and heart rate remained stable, the anesthesia process.Conclusions:Clinical observation found that the pumping back different quantity in combinedspinal epidural anesthesia, the effect of different back speed on the level of sensory block of the larger, less influence of pain block plane, no difference of blood pressure and heart rate(P>0.05), the specific effects, mechanism of cerebrospinal fluid mechanics is not clear, need further study.