Objective To investigate the effects of muscle relaxants on motor evoked potentials (MEPs) monitoring during intracranial surgery. Methods 62 patients with neurological tumor were divided into 2 groups: muscle relaxant group (n=21) and non-muscle relaxant group (n=41). The incidence of successful MEPs monitoring was investigated. Results The incidence of successful MEPs monitoring was 76.2% in the muscle relaxant group and 41.5% in the non-muscle relaxant group (P<0.05). Conclusion Muscle relaxants can affect the MEP monitoring, which would not be administered as possible during anesthesia for intracranial surgery in functional area.

ObjectiveTo investigate the postoperative analgesic activity offlurbiprofen to intracranial aneurysm patients who went under endovascular treatment with propofol and remifentanil anesthesia.Methods Totally 40 ASA physical status Ⅰ - Ⅱ intracranial aneurysm patients were randomly scheduled flurbiprofen group (group F, 20 cases) and control group (group C, 20 cases). The patients in group F were given flurbiprofen 1 mg/kg respectively at 10 min before operation and at the end of the operation; while the patients in group C were given fat milk at the same time. The patients' circulation of the two groups before and after operation,the headache visual analog scores (VAS) and body comfort score (BCS) were observed.ResultsThe mean arterial pressure(MAP) in group C after operation 1,2 and 3 h were significantly higher than that before operation (P ＜ 0.05 ); the heart rate in group C after operation had no significantly difference compared with before operation (P ＞0.05). The MAP and the beart rate in group F had no significantly differences before and after operation(P ＞ 0.05 ). The VAS of postoperation headache after operation 1,2 and 3 h were (0.30 ± 0.65 ), (0.30 ± 0.57) and (0.25 ± 0.44) scores in group F, which were significantly lower than those in group C [ (3.25 ± 1.58), (3.00 ± 1.56) and (2.90 ± 1.48 ) scores](P ＜ 0.05 ) ; the BCS after operation in group F after operation 1,2 and 3 h were (3.30 ±0.86), (3.45 ±0.86) and(3.62 ±0.86)scores, which were significantly higher than those in group C [ ( 1.20 ± 1.00), ( 1.45 ± 0.94) and ( 1.50 ±1.00)scores](P＜ 0.05 ). ConclusionFlurbiprofen can reduce intracranial aneurysm patient's postoperative headache under endovascular treatment.

To evaluate the effects of sevoflurane and isoflurane at 1.0 minimum alveolar concentration (MAC) on intracranial pressure(ICP) in patients undergoing craniotomy.Method:Sixteen patients without pre-existing increased ICP subjected to craniotomy for pituitary adenoma or craniopharyngioma were intubated with midazolam, fentanyl and atracurium.After intubation,midazolam and atracurium were pumped intravenously for 30 min.Then,sevoflurane or isoflurane was inhaled and the patients were randomly divided into two groups:A:1.0 MAC sevoflurane:B:1.0 MAC isoflurane.In the whole procedure,PaCO_2 with an average of 5.3 kPa was maintained. ICP was measured continuously by placement of a catheter into lumbar subarachoid space.Result:Sevoflurane maintained cerebral perfusion pressure slightly better than equipotent dose of isoflurane. During sevoflurane administration at 1.0 MAC.ICP decreased slighly,then increased gradually.However,ICP remained stable in group B.Conclusion:Sevoflurane and isoflurane at 1.0 MAC,Combined with midazolam and fentanyl,can be administered safely to the patients without preexisting increased ICP.

Up to now,the researches of postoperative headache have been focused on the pain of the incision of scalp,however,other kinds of headache have not been thought highly of.To find and determine the reasons of postoperative headache and treat depending on the pathogenesis of the pain are the main goal in the future.The authors investigated and reviewed the pathogenesis of cervicogenic headache after craniotomy and proposed the therapeutic strategy in this article.

Objective To compare the efficacy and safety of the target controlled administration of sufentanil and intermittent sufentanil during awake craniotomy. Methods 40 patients were randomized into target controlled infusion of sufentanil group (n=20) and intermittent sufentanil group (n=20) and compared. Results The hemodynamic parameters were similar in the two groups. However, target controlled infusion of sufentanil was associated with significantly lower respiratory rate （P<0.05）, higher end tidal CO2 （P<0.05）, and higher dosage of sufentanil （P<0.01）, compared with those of intermittent sufentanil. Conclusion Intermittent sufentanil infusion is associated with less respiratory depression than target controlled administration of sufentanil in awake craniotomy.

Objective To assess the efficacy of the laryngeal mask airway i-gel (LMA i-gel) in patients undergoing neuro-interventional surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 20-60 yr,body mass index ＜ 30 kg/m2, undergoing elective neuro-interventional surgery, were randomized into 2 groups (n = 20 each):LMA i-gel group (group I) and LMA ProSeal group (group P). After induction of anesthesia with TCI of propofol and remifentanil, LMA i-gel and LMA ProSeal were inserted in group I and P respectively. The patients were mechanically ventilated and PETCO2 was maintented at 35-40 mm Hg,SpO2 at 99%-100%. BP and HR were monitored and recorded before induction, immediately after induction, at 1, 3 and 5 min after insertion of LMA and immediately after removal of LMA. The success rate, LMA placement time, leak pressure, peak airway pressure and complications were recorded. Results There was no significant difference in the success rate, the LMA platcement time and peak airway pressure between the two groups (P ＞ 0.05). BP and HR were within the normal range during operation in both groups. The leak pressure and incidence of blood stain and sore throat were significantly lower in group I than in group P (P ＜ 0.05). Conclusion LMA i-gel can provide adequate ventilation during operation with less complications and can be used effectively for neuro-interventional surgery.

ObjectiveTo compare the clinical efficacy and safety of anesthesia induction between inhalation of sevoflurane and intravenous injection of propofol for laryngeal mask airway (LMA) insertion in elderly patients.Methods40,ASA physical grade Ⅰ ～ Ⅱ patients scheduled to receive elective total knee arthroplasty were allocated to 2 groups at random. Patients in group one( G1 ) received intravenous induction of propofol infusion by a targetcontrolled infusion system which was set at the effect-site concentration of 4.0μg/ml,while patients in group two(G2)received inhalational induction with sevoflurane using vital capacity manoeuver at the target of end-expiratory concentration of 3.0％. We observed the whole procedure of anesthesia induction and LMA insertion, while recording the changes in hemodynamic state and occurrence of adverse events. ResultsMore than 85％ patients achieved LMA insertion at first attempt using either induction manoeuver. Although consciousness loss time in G1 was 39. ls longer than G2, there was no difference in anesthesia induction time for LMA insertion between these two groups. Contrary to a significant decrease in MAP following induction for patients in G1, there appeared hemodynamically stable in patients of G2,while apnea also significantly seldom occurred in G2 as compared to G1 (20％ vs 85％ ,P ＜0. 05).ConclusionAs compared to intrvenous induction with propofol, inhalation induction with sevoflurane provided a valuable alternative for LMA insertion in adults.

Objective To study the effects of arterial carbon dioxide tension(PaCO 2)on the quantitative electroencephalogram(qEEG)during isoflurane anesthesia Methods Fifteen ASA grade Ⅰ Ⅱ patients,scheduled for intraspinal or transspphenoidal surgery, were studied during 1MAC steady state isoflurane anesthesia qEEG were recorded continuously, while PaCO 2 approached approximately 26 5 mmHg, 35 2mmHg or 45 7 mmHg respectively randomly by regulating the minute volume Results Hypocapnia caused significant increases in all power bands (P

Objective To compare the dexmedetomidine and midazolam administered intranasally for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.Methods Forty pediatric patients of both sexes, aged 2-7 yr, weighing 1 1-26 kg, of American Society of Anesthesiology Anesthesiologists physical status Ⅱ, were equally and randomly assigned into either midazolam group (group M) and dexmedetomidine group (group D).Group M received midazolam 0.2 mg/kg administered intranasally, and group D received dexmedetomidine 2 μg/kg administered intranasally in the room for preoperative preparation.The pediatric patients were separated from their patients at 30 min after administration.Oxygen was inhaled by mask after admission to the operating room, and venipuncture was performed.The responses to nasal mucous membrane irritation and separation from their parents were recorded.Ramsay sedation scores were recorded when the patients were separated from their parents.The occurrence of bradycardia, hypotension, hypertension and hyoxemia was recorded from the end of administration until venipuncture.Results The pediatric patients were successfully separated from their patients in the two groups.Compared with group M, the incidence of responses to nasal mucous membrane irritation was significantly decreased, and Ramsay sedation scores were increased in group D (P＜0.05).No pediatric patients developed adverse reactions such as bradycardia, hypotension, hypertension and hyoxemia in the two groups.Conclusion Dexmedetomidine administered intranasally provides better efficacy than midazolam when used for preoperative sedation in the pediatric patients undergoing neurosurgical procedures.

Objective To evaluate protective ventilation(PV) versus conventional ventilation(CV) for surgery in the prone position.Methods We searched PubMed, Embase, the Cochrane Library, WanFang Data and other Chinese databases to collect the randomized controlled trails (RCTs) on intraoperative PV in comparison with CV for surgery in the prone position.Two authors independently identified the studies, performed data extraction and assessed the risks of bias in the included studies according to the Cochrane Handbook for Systematic Reviews of Interventions.The reviewers conducted data analyses with RevMan software.Results A total of 9 RCTs involving 449 participants were included.The results showed that the incidence of postoperative pulmonary complications (RR 0.30, 95% CI 0.12~0.73, P<0.01) and peak pressure (MD-3.52, 95% CI-6.93~-0.11, P<0.05) were lower in the PV group.Intraoperative PaO2/FiO2 was higher (MD 37.28, 95% CI 22.67~51.89, P<0.001) and alveolar-arterial oxygen difference was lower (MD-45.50, 95% CI-61.35~-29.65, P<0.001) in the PV group.Conclusions Low tidal volume ventilation in combination with positive end-expiratory pressure (with or without recruitment maneuver) decreases postoperative pulmonary complications,reduces peak pressure and improves oxygenation for surgery in the prone position.