世界首例清醒下冠脉搭桥手术（印度）
[flash]http://v.blog.sohu.com/fo/v4/4067150[/flash] 感谢分享，把介绍帖出来[attach]9989[/attach]
Dr Vivek Jawali, chief cardiovascular surgeon along with his team at Wockhardt Heart Hospital at Bangalore have set a global benchmark by performing the first coronary bypass surgery along with an aortic valve replacement without using general anaesthesia or ventilator support while the patient was on a heart lung machine.The technique of high thoracic epidural analgesia is a highly precision based methodology which involves injection of micro doses of local anaesthetic in the epidural space around the spinal cord which anaesthetises only the chest region while the rest of the system is fully awake.
This technique is a boon for patients having multifaceted medical complications, required a bypass surgery and an aortic valve replacement. His lung condition did not permit the use of a ventilator and he was high risk for general anaesthesia. With his surgery being rejected at various centres before he came to us, his best chance of survival was an open heart surgery without general anaesthesia, in other words, an awake heart surgery. We give him that chance using the technique of high thoracic epidural analgesia and a new direction in heart surgery has been unveiled," recounted Dr Jawali.
Dr Vivek Jawali and Dr Murali Chakravarthy, chief cardiac anaesthetist of Wockhardt Heart Institute are the national pioneers of awake coronary bypass surgery on beating heart through full chest incisions and over the last few years have performed more than 500 awake heart surgeries and have ten international publications on this topic in the leading journals of the world to their credit.
Skynews of UK profiles in this film a patient undergoing a painless awake heart cardiac bypass surgery that is safe for patients who are high risk for general anaesthesia. and this now throws open the possibility of cardiac surgery for many patients (many in their most productive years) who are termed inoperable," explained Dr Jawali. wockhardt Heart Hospital at Bangalore, India is now a preferred destination for cardiac patients not only in India but also from all over the US, UK, Canada, Middle East and Africas. It is also a teaching center for clinicians from the sub-continent. 难以置信,,是有利还是有弊呢,,值得思考 是硬麻吗？好像不太现实啊 WHO is the chinese surgeon? do you know? [b]回复 [url=http://www.xqnmz.com/redirect.php?goto=findpost&pid=98872&ptid=13026]5#[/url] [i]doctorsj[/i] [/b]
No , I don't know him. There are many doctors from different places visit this hospital to learn from them this technique of awake CABG .
In Malaysia, doctors from National Heart Institute had done quite a few cases, and I heard they learnt the technique from India,too.
This technique of awake open heart surgeries had been described for many years.It had been done in the west , too. This video report was out about 3 years ago.
But still considered a new developement.
High thoracic epidural is quite commonly done in China , so I think this has a good potential to develope in China . [b]回复 [url=http://www.xqnmz.com/redirect.php?goto=findpost&pid=98864&ptid=13026]4#[/url] [i]zyymzk301[/i] [/b]
是的，是硬膜外麻醉。有相当多文献描述和讨论这种做法，并不是最新的了，只是不太普遍。因为它也有它的利弊。而且心外手术医生的技术必须很好。 早在6年前就听说印度人在硬膜外麻醉下实施体外循环手术，真是难以置信！
清醒麻醉下冠脉搭桥手术：这是麻醉的更高境界，并且是硬膜外的最高境界。 太佩服了！简直是把硬膜外麻醉发挥到了极致！ 在患者清醒下实施手术，特别是这种刺激很大的手术，我承认是医学的进步，特别是我们麻醉镇痛学的进步，但这样的医学尝试，是否人性化呢？我很难想象当患者在清醒的情况下，会心安理得的接受这样危险的手术。 太不可思议了，硬膜外得打多高呀？ 估计要穿刺C7～T1或T1～T2，低浓度局麻药。 长见识了:) 清醒下做这种手术有什么优点？更安全？更快恢复？ [i=s] 本帖最后由 1001 于 2010-3-29 20:44 编辑 [/i]
是否全麻就比硬外麻更安全，大量的有创监测就是重视，贵重药品就比廉价药更有效，值得深思。
叹息，中国麻醉医师最善长的的东西被印度医师抢了先。 中国麻醉医师最善长的的东西被印度医师抢了先...自大了不是？ [quote]早在6年前就听说印度人在硬膜外麻醉下实施体外循环手术，真是难以置信！
清醒麻醉下冠脉搭桥手术：这是麻醉 ...
[size=2][color=#999999]梨花客栈 发表于 2010-3-3 23:39[/color] [url=http://www.xqnmz.com/redirect.php?goto=findpost&pid=98937&ptid=13026][img]http://www.xqnmz.com/images/common/back.gif[/img][/url][/size][/quote]
不是体外循环。其实国内也有报道，不过一直未曾见过，估计不是太成功，否则早就大范围推广了 硬外穿刺点选多高呀？ 健康报好像报道过 国内也有针刺麻醉开胸的 应该属于更高层次吧 具体麻醉管理是怎么实施的啊?
这和外科医生的水平有很大关系吧. [b]回复 [url=http://www.xqnmz.com/redirect.php?goto=findpost&pid=119098&ptid=13026]20#[/url] [i]xiaoppp[/i] [/b]
[b]那是肯定的.是团队合作,双方都必须手艺很好才行.[/b] 我们医院的针刺麻醉也有雷同 [b]回复 [url=http://www.xqnmz.com/redirect.php?goto=findpost&pid=122396&ptid=13026]22#[/url] [i]tangqiou2001[/i] [/b]
不妨写到论坛来与大家分享，如何？ 怎么做到的？ 医生也得:)胆子大一点 是硬膜外麻醉吗？这种麻醉方式对病人是利是弊，值得商榷。
手术的实施难度会不会比全麻状态下更难？
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