it is not all the case, not only depends on live and kidney function, but also depends on hemodynamic. if unstable, with hypovolemia, then perfusion to kideny, even live maybe jerpodized. as a consequence, metabolic and eliminate rate of meds will decrease, therefore, it may prolong drug effect. 作者: anescn 时间: 2015-3-8 10:01
first part is regional, second is total intravenous anesthesia. spinal level dropping may be the case. one hour is reasonable time for lidocaine. next time you might want to add epinephrine for your spinal. it will substantially increase your spinal time. epidural should work for this case, bupivacaine plus fentyanl will be choice for this case. after initial lidocaine bolus. you have to remember, epidural cause poor muscles relax. if case is prolong, regional is not work well, reason could be numerous including displacement/miragtion of epidural catherder, convert to GA is warrant. well you did give large does of sufentanil。as long as you can control airway and maintain hemodynamic stable. it is fine. 作者: dr.zhang 时间: 2015-3-8 19:23
1.为什么要2点穿刺，你完全可以L2-3联合阻滞啊，你扎2点给你自己带来风险也给患者带来不必要的穿刺疼痛。2硬膜外追加给药为什么只给短效药，药物是有耐药性的。3.手术开始已经给了非那根25毫克，杜冷丁50毫克。硬膜外追加不起作用你又给予杜冷丁50毫克。这些药物对你正常患者已经足够了。你又给丙泊酚300毫克50ug的舒芬，患者怎能不呼吸抑制啊，按体重计算舒芬的计量，可是你没考虑杜冷丁，静脉药物相互协同。4，为什么不请教上级医生帮你指导一下呢。
