Objective To observe the onset time,cardiovascular system reactions and side effects of anesthetic introduction with sevoflurane and to explore its reliability and safety in elderly patients. Methods Sixty American Society Anesthesiologists(ASA)Ⅰ～Ⅲ patients aged 65～78 years who were scheduled for selective operation were selected in the study.They were randomly divided into sevoflurane inhalation induction group(sevoflurane group)and propofol induction group (control group).In sevoflurane group,the concentration of inhaled sevoflurane was regulated according to downgrading method during the induction,and it was decreased by 1% every 30 seconds from the initial concentration of 7% to the maintained concentration of 4%.In control group,propofol was titrated by 1.5～2.5 mg/kg.When bispectral index(BIS)was≤60,sufentanil was administered intravenously and the patients were paralyzed with rocuronium and intubated.The extinction time of lash reflex and the achievement time of BIS≤60 in two groups were recorded.The mean arterial blood pressure(AMBP),heart rate(HR),oxygen saturation(Sp02)and BIS of the basic values before intubation,and 1 min,3 min,5 min after intubation were also recorded,respectively.The side effects during intubation such as laryngeal spasm,body movements,irritating cough,restless movement during intubation were noted.The consciousness during intubation and satisfaction with induction were followed in patients after operation. Results The extinction time of lash reflex and the achievement time of BIS≤60 were significantly longer in sevoflurane group than those in control group (both P＜0.01).In sevoflurane group.there were no differences in MBP and HR between 1 min postintubation and pre-intubation.Whereas,in control group,AMBP and HR were lower before intubation than basic values,and were higher 1 rain post-intubation than pre-intubation(P＜0.05).There were irritating cough cases both in sevoflurane group and in control group(5 vs.3),and there was no laryngeal spasm case.All patients were satisfied with the anesthesia and had no consciousness during intubation. Conclusions　Sevoflurane is a safe and effective induction agent and has little side effects.It is an ideal choice for elderly patients.

Objective To evaluate the efficacy of streamline liner of pharyngeal airway ( SLIPA) in airway management of general anesthesia. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective breast surgery were randomized into 2 groups (30 cases each): SLIPA group (group S) and laryngeal mask airway (LMA) classic group (group L). Anesthesia was induced with propofol 2 mg/kg, sufentanil 0.15 μ g/kg and vecurium 0.08 mg/kg. SLIPA or LMA was inserted with digital manipulation. Anesthesia was maintained with 1% - 2% sevofluran and 50% N2O in 50% oxygen. The parameters of controlled ventilation were same in both groups. The attempt times, seal pressure and grade of fiberoptic (FOB ) laryngoscopy were measured. SpO2, PErCO2 and peak airway pressure were monitored every 15 minutes after successful laryngeal mask insertion. The complications such as regurgitation of gastric contents and sore throat were assessed by anesthesiologist after surgery. Surgery time, anesthesia time, extubation time and emergence time were recorded. Results Success rate of LMA insertion in both groups were 100%. The first attempt success rates were 90%( 27/30) in group S and 60%( 18/30) in group L (P< 0.05), the FOB grade 4 were 67%(20/30) in group S and 37% (ll/30)in group L(P< 0.05), the maximum seal pressures were (23.6 ± 4.7)cmH2O (1 cm H2O = 0.098 kPa) in group S and (18.8 ± 4.5) cm H2O in group L (P<0.05). SpO2, PErCO2 and peak airway pressure were within normal ranges. The occurrence of sore throat was similar in group S and group L (7 cases vs 6 cases). No signs of regurgitation were detected. Conclusion The SLIPA proved to be a simple, safe and effective airway instrument with little complications during the course of general anesthesia.

Ponseti clubfoot treatment has become more popular during the last decade because of its high initial correction rate. But the most common problem affecting the long-term successful outcome is relapse of the deformity. Non-compliance with Ponseti brace protocol is a major problem associated with relapse. Although more comfortable braces have been reported to improve the compliance, they all have the same design and no significant changes have been made to the protocols. After refinement in the Ponseti method and emphasizing the importance of brace to parents, the relapse rate has been markedly decreased. Nevertheless, there are patients who do not have any recurrence although they are not completely compliant with the brace treatment, whereas other patients have a recurrence even though they are strictly compliant with the brace treatment. The aim of this article is to review the relapse of clubfoot and the function of the brace and to develop an individualized brace protocol for each patient by analyzing the mechanism of the brace and the biomechanical properties of muscles, tendons, and ligaments.
Clubfoot/physiopathology/*therapy ; Humans ; Orthotic Devices ; Patient Compliance ; Range of Motion, Articular ; Recurrence ; Treatment Outcome