Objective To investigate the effects of total intravenous anesthesia (TIVA) and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery.Methods Forty-four spinal neurosurgery patients were divided into propofol combined with remifentanil group (PR group) and sevoflurane combined with remifentanil group (SR group ), 22 cases in each group,they were induced with propofol, sufentanil and rocuronium. Anesthesia was maintained with sevoflurane in SR group while propofol in PR group. Depth of anesthesia adaption according to bispectral index (BIS)(45 -55). Blood glucose, cortisol, haemodynamics were observed at different time points. Results The mean arterial pressure(MAP) was higher after induction in PR group than that in SR group(P ＜ 0.05 ). Sixty minutes after induction, MAP was lower than that before induction in PR group (P ＜ 0.05 ). Heart rate ( HR )in both SR group and PR group were lower at 60 and 120 minutes after induction than those before induction (P ＜ 0.05). HR was lower at 5 minutes after induction in PR group than that in SR group (P ＜ 0.05). No significant difference was showed in blood glucose and cortisol between the two groups (P ＞ 0.05 ). Cortisol level was significantly lower at 120 minutes after induction than that before induction [(40.6 ± 18.3) μg/L vs. ( 129.7 ± 36.7 ) μg/L, P ＜ 0.05 ] and at 24 hours postoperative [ (93.6 ± 19.8 ) μg/L ] recovered to the level before induction in PR group. Cortisol level was significantly higher before induction than 120 minutes after induction [ ( 130.5 ± 32.1 ) μg/L vs. (51.6 ± 16.8 ) μg/L, P ＜ 0.05 ] and 24 hours postoperative was (75.9 ± 18.2) μg/L in SR group. Conclusions Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. However, longer cortisol inhibition is probably happened when using sevoflurane.

Objective To compare the efficacy and safety of lidocaine and ropivacaine for scalp block in providing adequate analgesia with minimum side effects during awake craniotomy.Methods60 patients, ASA 1～2, were randomized into either lidocaine (L) group (n=30) or ropivacaine (R) group (n=30). 1% lidocaine or 0.5% ropivacaine were taken for scalp nerve block 15 min before incision. Supplemental oxygen was given using nasal prongs that were adapted for the monitoring of end tidal CO2 and respiratory rate. Serial parameters about circulation and respiratory were measured and drug consumption were recorded.ResultsThe hemodynamic parameters of L group were higher than R group in the latter stage(P<0.05). L group was associated with significantly more consumption of sufentanil and more respiratory depression than R group(P<0.05).ConclusionRopivacaine, taking for scalp block undergoing awake craniotomy, is associated with less consumption of analgesic and less respiratory depression than lidocaine.

ObjectiveTo investigate the complications after intracranial neurosurgery in the postanesthesia care unit (PACU). Methods2166 patients enrolled into PACU after intracranial neurosurgery were reviewed. ResultsAmong the complications, the most frequent ones were hypertension (14.0%), arrhythmia (13.9%), pain (13.7%), shivering (10.5%), nausea and vomiting (9.3%), and delirium (8.6%). The least ones were hypoxemia (3.4%), respiratory obstruction (1.9%), delayed recovery (1.5%), and hypotention (0.5%). Abnormal temperature and residual block occurred at 7.2% and 22.8% in the patients who were monitored. All complications were treated immediately, and all the patients transferred to neurosurgical ward with modified Aldrete score over 9～10. ConclusionThe patient in PACU need well management to insure safe and smooth recovery from anesthesia after intracranial surgery.

Objective:To design a virtual simulation tutorial system for bone traction nursing of the lower limbs, and to investigate its application effect.Methods:Based on clinical cases, a 3D model was established for the fractured lower limb using the virtual simulation technique. The design of the model considered the position and mechanical relationship between bone traction and fracture ends, as well as the assessment and intervention of the condition after bone traction, and such factors were taken as the core elements of simulation design. Virtual experiments were conducted for the four scenarios of pre-hospital first aid, triage in the hospital, bone traction operation, and postoperative nursing. Such experiments were conducted among junior nursing undergraduates, and examination results and student satisfaction survey were used to evaluate the application effect of the experiments.Results:The teaching software consisted of four training modules, i.e., theoretical knowledge learning of fractures, preparation before bone traction operation, methods and principles of bone traction operation, and observation of conditions after bone traction. The final score of experiments was (90.99±0.58) points among the students, and the degree of satisfaction with the experimental system and the teaching model was 87.85% (441/502) and 63.35% (318/502), respectively.Conclusions:The virtual simulation experiments for bone traction nursing of the lower limbs are scientific, professional, and interesting and have a relatively high degree of satisfaction among students, and therefore, they can be applied in the education of nursing students and the continuing education of nurses.