Analysis of Abnormalities of Intraoperative Neurophysiological Monitoring in Spine and Spinal Cord Surgery under General Anesthesia / 中国康复理论与实践

@#Objective To analyze the factors related with intraoperative neurophysiological monitoring (IONM) in spine and spinal cord surgery under general anesthesia, in order to increase the effectiveness of IONM. Methods A retrospective study was performed on patients who received somatosensory-evoked potential (SEP) and motor-evoked potentials (MEP) in spine surgery under general anesthesia from Ju-ly, 2011 to January, 2016. Results Data from 104 patients were collected in which 18 cases had abnormal SEP and 17 cases had abnormal MEP. A single factor analysis indicated that abnormal SEP was related to concentration of inhalation anesthetic (CIA), hypothermia in peri-operative period (HTM), and type of anesthesia (χ2>6.219, P<0.05), whereas abnormal MEP was related to CIA, hypotension in periopera-tive period (HTN), and additional muscular relaxants (χ2>4.125, P<0.05). Logistic regression analysis indicated that abnormal SEP was relat-ed to CIA and HTM, whereas abnormal MEP was related to CIA and HTN (P<0.05). Conclusion CIA, HTM, and HTN were possible fac-tors related with IONM in spine surgery under general anesthesia.

Effect of Intravesical Botulinum Toxin Injection on Pain of Bladder Pain Syndrome:A Meta-analysis / 中国康复理论与实践

Objective To systemically evaluate the effect of intravesical Botulinum toxin on pain of patientspain syndrom. Methods The following databases as Cochrane Library, PubMed, Web of Science, Embase, Springer, Wiley, Science Direct, OVID were searched to col-lect the randomized controlled trials (RCTs) with the treatment of intravesical Botulinum toxin vs. 0.9%sodium chloride for patients with bladder pain syndrome. Two reviewers screened the trials according to the inclusion and exclusion criterias, extracted the data, assessed the quality, and the changes of Visual Analogue Scales (VAS) before and after treatment were used to conduct Meta analysis with RevMan5.2 software. Results Five studies were included with a total of 218 patients, there were 127 cases in intravesical Botulinum toxin group and 91 cases in 0.9%sodium chloride group. Meta analysis showed that the pain relief effect of intravesical Botulinum toxin was better than that of 0.9%sodium chloride. Conclusion Intravesical Botulinum toxin can relieve the pain of patients with bladder pain syndrome.

Application of Airtraq(R) Optical Laryngoscope Combined with Bronchofibroscope for Endotracheal Intubation in Patients with Cervical Spine Injury / 中国康复理论与实践

Objective To explore the application of Airtraq(R) optical laryngoscope combined with bronchofibroscope for endotracheal in-tubation (EI) in patients with cervical spine injury (CSI). Methods 50 patients with CSI undergoing spine surgery under combined general anesthesia were randomly assigned to two groups, group A (n=25) received EI by using Airtraq(R) optical laryngoscope and group AF (n=25) received EI by using Airtraq(R) optical laryngoscope combined with bronchofibroscope. The intubation time (IT), success rate of single intuba-tion (SRSI), hemodynamic changes in endotracheal intubation, and complications related to EI were observed. Results IT was significantly longer in group A than in group AF (P0.05). Conclusion Airtraq(R) optical laryngoscope combined with bronchofibroscope would be safely and effectively used for EI in patients with CSI.

Factors Related with Prolonged Anesthesia Recovery in Patients with Cerebral Palsy after General Anesthesia / 中国康复理论与实践

Objective To explore the factors related with prolonged anesthesia recovery (PAR) in patients with cerebral palsy after gener-al anesthesia. Methods 293 patients with cerebral palsy who received lower limbs orthopedics (LLO) under general anesthesia during July, 2009 to August, 2014 were retrospected and the factors related to PAR were analyzed. Results 37 patients (12.6%) suffered from PAR. There was significant difference in factors including body-weight, grade of physical status for anesthesia according to American Association of Anesthesiologists (ASA), the style to set a venous channel, blood loss, general anesthesia combined with epidural anesthesia (GAEA), in-tra-operative inhalation anesthetics, and serious adverse events (SAE) between patients with or without PAR, according to single factor anal-ysis with chi-square test. It was significant that the factors of ASA grade (B=1.490), SAE (B=2.159) and GAEA (B=-1.487) according to non-conditional logistic analysis. Conclusion PAR is related to several factors and GAEA combined with general anesthesia contributes to the recovery of patients with cerebral palsy.

Application of Multimodal Analgesia in Lower Extremity Orthopedic Surgery for Patients with Cerebral Palsy following Spasm / 中国康复理论与实践

Objective To observe the application of multimodal analgesia (MA) in lower extremity orthopedic surgery (LEOS) for pa-tients with cerebral palsy (CP). Methods 100 CP patients following spasm undergoing LEOS under combined general anesthesia were ran-domly assigned into group C (n=50) and group M (n=50). In group M, the methods including a small dose of intravenous ketamine (0.25 mg/kg) 15 minutes before skin incision, 0.25%ropivacaine hydrochloride in surgical area with infiltration anesthesia just before skin incision, and an intravenous infusion of sufentanil (0.05μg/kg/h) combined with remifentanil (0.2μg/kg/min) were performed. In group C, the meth-ods mentioned above were not performed. The intravenous analgesia pump for single-use was prescribed for the patients in both groups. The postoperative analgesic effect (PAE) and side effects were observed. Results 4 dropped in group C. PAE in group M was significantly superi-or to that in group C (P0.05). Conclusion MA could increase PAE in LEOS for CP patients following spasm and the safety was not influenced.

Application of Multimodal Analgesia in Lower Extremity Orthopedic Surgery for Patients with Cerebral Palsy following Spasm / 中国康复理论与实践

@# Objective To observe the application of multimodal analgesia (MA) in lower extremity orthopedic surgery (LEOS) for patients with cerebral palsy (CP). Methods 100 CP patients following spasm undergoing LEOS under combined general anesthesia were randomly assigned into group C (n=50) and group M (n=50). In group M, the methods including a small dose of intravenous ketamine (0.25 mg/ kg) 15 minutes before skin incision, 0.25% ropivacaine hydrochloride in surgical area with infiltration anesthesia just before skin incision, and an intravenous infusion of sufentanil (0.05 μg/kg/h) combined with remifentanil (0.2 μg/kg/min) were performed. In group C, the methods mentioned above were not performed. The intravenous analgesia pump for single-use was prescribed for the patients in both groups. The postoperative analgesic effect (PAE) and side effects were observed. Results 4 dropped in group C. PAE in group M was significantly superior to that in group C (P<0.05), and the doctors as well as the caretakers for the patients were more satisfactory with the outcome (P<0.001). There was no significantly difference in the side effects between two groups (P>0.05). Conclusion MA could increase PAE in LEOS for CP patients following spasm and the safety was not influenced.

Factors Related with Postoperative Agitation in Patients with Cerebral Palsy / 中国康复理论与实践

@#Objective To explore the risk factors for postoperative agitation (PA) in patients with cerebral palsy (CP). Methods 199 patients with CP receiving selective posterior rhizotomy or lower limbs orthopedics under combined intravenous and inhalational anesthesia were reviewed. Results 30 patients suffered from PA (15%), who tended to be younger, less body mass, and administered less anesthetics.Conclusion It may prevent PA of sufficient intra-operative and postoperative analgesia, necessary psychological intervention and sedatives.

Standardized Training for Anesthesiologists in Rehabilitation Hospitals / 中国康复理论与实践

@#Because many patients in rehabilitation hospitals still require advanced surgical treatments and chronic pain managements, therefore, anesthesiologists in these hospitals are very important in clinical practice. To use experience of training for anesthesiologists in general hospitals and to consider characters of patients and operations in rehabilitation hospitals are essential to educate anesthesiologists who are qualified in rehabilitation hospitals. The concrete measures include consummating the evaluation system, using available advantages and improving the quality of training, establishing special training programs suitable for characters of rehabilitation, and integrating rehabilitation medicine to other medical fields.

Percutaneous Endoscopic Gastrostomy on Patients with Central Nervous System Injuries / 中国康复理论与实践

@#ObjectiveTo explore the percutaneous endoscopic gastrostomy on patients with central nervous system injuries in neurological rehabilitation and to establish enteral nutrition.MethodsThirty-two patients with central nervous system were enrolled for percutaneous gastrostomy, using the Pull technique.ResultsThe successful rate of percutaneous gastrostomy as Pull technique was 100%, 2 cases of stomach bleeding through endoscopy. Straining the fixation gasket and partial compression stoped bleeding. One patient appeared swelling and secretions in abdominal incisions, and recovered after dealing with local iodophor and changing fresh dressing. Hypostatic pneumonia occurred in one patient, and improved after anti-infective treatment. No serious complications occurred.ConclusionPercutaneous gastrostomy is a simple and safe for the patients with central nervous system injuries.

Analgesia of Femoral Nerve Block on Knee Stiffness in Rehabilitation Training after Surgery / 中国康复理论与实践

@#ObjectiveTo compare the effect of rehabilitation training after surgical intervention of knee stiffness (SIKS) between femoral nerve block (FNB) and epidural nerve block (ENB).Methods60 patients undergoing SIKS at one knee joint were randomly assigned to two groups: 40 patients accepting a catheter for FNB in group A and 20 patients accepting a catheter for ENB in group B. All patients participated in passive rehabilitation therapy (PRT) and active rehabilitation therapy (ART) at 12 hours, 24 hours, 36 hours, and 48 hours after operation. 10 ml of lidocaine were applied via these catheters before rehabilitation therapy. The visual analogue score (VAS) for pain in PRT, the time needed from the end of PRT to the start of ART, and the incidence of side effects such as hypotension or nausea were recorded.ResultsThere was no significant difference in VAS between groups A and B. The time needed from the end of PRT to the start of ART in group A was significantly less than that of group B. The incidence of hypotension or nausea in group A was significantly less than those of group B.ConclusionFNB provides the same analgesic effect as ENB, has less time needed from the end of PRT to the start of ART, and lowers incidence of hypotension or nausea.

Effect of Neostigmine on Cardiovascular Response from Neuromuscular Electrical Stimulation in Selective Posterior Rhizotomy for Patients with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effect of intravenous pre-injection of neostigmine on cardiovascular response(CVR) caused by neuromuscular electrical stimulation(NMES) in selective posterior rhizotomy(SPR) for patients with cerebral palsy.Methods 56 patients with cerebral palsy undergoing SPR at lumbarsacral segments under general anesthesia were randomly assigned to 2 groups: intravenous neostigmine 0.04 mg/kg(no more than 1 mg in total) and intravenous atropine 0.02 mg/kg(no more than 0.5 mg in total) 5 min before NMES in group N,and intravenous normal saline 0.12 ml/kg instead in group C.The systolic blood pressure(SBP) and heart rate(HR) at following time points: before skin incision(T1),before intravenous neostigmine/atropine or normal saline injection(T2),1 min after NMES(T3),and 10 min after NMES(T4).Results SBP and HR at T3 in group N were significantly lower than those in group C(P<0.01).No significant difference was found at T1,T2 and T4 between two groups(P>0.05).Cases who needed extra dose of fentanyl during NMES in group N were significantly lower than those in group C(P<0.01).Conclusion Intravenous pre-injection of neostigmine before NMES can effectively decrease the CVR caused by NMES.

Continuous Intravenous Infusion of Low Dose of Ketamine Combined with Morphine Used For Postoperative Analgesia in Patients with Cervical Spinal Cord Injury / 中国康复理论与实践

@#ObjectiveTo evaluate the effect and the side-effect of continuous intravenous infusion of low dose of ketamine combined with morphine for postoperative analgesia in patients with cervical spinal cord injury, and determine the suitable dosage of ketamine. Methods87 patients with cervical spinal cord injury scheduled for the cervical vertebra operation via posterior routine under intravenous and inhalation combined anesthesia were randomly allocated into three groups, i.e. Group M (morphine 0.02 mg/kg·h), Group MK1 (morphine 0.02 mg/kg·h + ketamine 0.02 mg/kg·h), and Group MK2 (morphine 0.02 mg/kg·h + ketamine 0.04 mg/kg·h), to accept intravenous postoperative analgesia. The pain scores of VAS, sedation scores, the incidence of side-effect including itching, nausea, vomiting, and central excitatory phenomena, and SpO2 were recorded at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h after operation. ResultsThe pain score of group MK2 at each time point was significantly lower than that of group M or group MK1 (P<0.01), and there was no significant difference between group M and group MK1 (P>0.05). There was not significant difference among the three groups (P>0.05) on sedation scores. No significant difference was found in the incidence of nausea, vomiting, or itching among these groups (P>0.05), although the nausea and vomiting (18.5%) and itching (7.4%) were a little higher in Group M. No case with central excitatory phenomena was found in each group. At each time point, no significant difference was found in SpO2 among these groups groups (P>0.05), and all the SpO2 values were not less than 96%. Conclusion0.04 mg/kg·h of ketamine can enhance the efficacy of morphine (0.02 mg/kg·h) and do not increase side-effect events.

Postoperative Analgesic Effects of Flurbiprofen Axetil Applied Preoperatively on Patients with Spinal Cord Injury / 中国康复理论与实践

@# Objective To observe the post-operative analgesic effect of flurbiprofen Axetil applied preoperatively on patients with spinal cord injury(SCI).Methods46 SCI patients undergoing spine surgery under general anesthesia were randomly divided into the flurbiprofen axetil group(group F)and control group(group C)with 23 cases in each group.Before cutting skin,flurbiprofen axetil(1 mg/kg)was injected intravenously in the group F,and normal saline(1 ml/kg)was infected intravenously in the group C.The scores of Visual Analogue Scale(VAS)for pain at postoperative 2,4,8,24,and 48 hours,and the incidence of side effects within 48 hours after operation were recorded.ResultsVAS scores at the time of 2,4,8,and 24 h after operation in the group F were significantly lower than that in the group C(P<0.05).But VAS scores of two groups at 48 h were not significantly different(P>0.05).The incidences of side effects of two groups were also not significantly different(P>0.05).ConclusionFlurbiprofen axetil applied preoperatively can release pain of SCI patients after spine surgery,and does not increase the incidence of side effects.

Comparison of Total Intravenous Anesthesia and Combined Inhalation and Intravenous Anesthesia in Lower Limbs Orthopedics for Patients with Cerebral Palsy / 中国康复理论与实践

@#Objective To compare the characteristics of total intravenous anesthesia (TIA) with manual assisted ventilation and combined inhalation and intravenous anesthesia (CIIA) with mechanical ventilation in lower limbs orthopedics for patients with cerebral palsy.Methods 50 patients with cerebral palsy undergoing scheduled lower limbs orthopedics were randomly divided into the TIA group and CIIA group with 25 cases in each group. The patients of the TIA group were treated with manual assisted ventilation. Those of the CIIA group were treated with fast induction, endotracheal intubation, inhalated and intravenous anesthetics maintaining the anesthesia and mechanical ventilation. The recovery time after operation and post-operative side effects including nausea, vomiting, and psychomotor agitation of all patients were observed.Results The recovery time of the patients in the CIIA group was significantly longer than that in the TIA group ( P<0.01), and post-operative psychomotor agitation was significantly higher than that in the TIA group ( P<0.05). However, there was no significant difference in nausea or vomiting found between two groups ( P>0.05).Conclusion Patients treated with TIA is easier to recovery and has fewer side effects than those treated with CIIA.

Change of glucose in plasma in selective posterior rhizotomy at lumbar and sacral regions on cerebral palsy children / 中国康复理论与实践

@#Objective To investigate the carbohydrate metabolism during selective posterior rhizotomy (PCR) at lumbar and sacral regions on cerebral palsy children (CPC).Methods62 CPC who received SPR at lumbar and sacral regions under combined intravenous and inhalation anesthesia were tested with the level of glucose (Glu) in plasma at different time during the operation.Results and ConclusionThere is no significant difference of Glu at different time during the operation, however, the Glu level shows an elevating trend at 3 and 10 minutes after posterior root electric stimulation.

The anesthesia for selective posterior rhizotomy at lumbar and sacral regions on juvenile cerebral palsy patients / 中国组织工程研究

Objective To summarize the anesthesia techniques performed in the selective posterior rhizotomy(SPR) at lumbar and sacral regions（ L＆ R） on juvenile cerebral palsy(CP) patients. Method 144 CP patients below 10 years were successfully erformed SPR at L＆ R under combined intravenous and inhalation anesthesia (CIIA) in prone position with threshold values of each nerve root being measured by means of nerve root electric stimulus (NRES). Result All patients were performed SPR and NRES successfully although blood pressure and heart rate increased significantly while NRES. Conclusion CIIA is safe and effective for juvenile CP patients to be performed SPR at L＆ R.