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.

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.

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.

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.

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.

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.

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.