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 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.

Objective To observe the effect of ropivacaine in infiltration anesthesia before the end of surgical procedures for postoperative analgesia on patients with spinal cord injury. Methods 60 patients with spinal cord injury undergoing internal fixation of spine fractures under combined general anesthesia were assigned in 3 groups, who received 0.25% ropivacaine in infiltration anesthesia (group RL, n=20),0.5% ropivacaine in infiltration anesthesia (group RM, n=20), or no infiltration anesthesia (group C, n=20) before the end of surgical procedures.The time for post-anesthesia recovery (PART), agitation score (AS), and Visual Analogue Score (VAS) for pain 2 h, 6 h, 24 h, and 48 h post operation were recorded, and related side effects were observed. Results AS within 6 h postoperation was significantly less in group RL and RM than in group C (P<0.05), as well as VAS, PART, mean of arterial pressure and heart rate 2 h, 6 h, and 24 h post operative (P<0.05).There was no significant difference in side effects including postoperative nausea and vomiting, and pruritus among these groups (P>0.05). Conclusion Ropivacaine in infiltration anesthesia would provide better postoperative analgesia, decrease the incidence of postoperative agitation, and increase the safety of patients with spinal cord injury in the postoperative period.

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.

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.