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.

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.

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.

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.

Objective To investigate the accurancy of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy (CEA).Methods Ninety patients (71 males, 19 females, aged 18-80 years, ASA physical status grade Ⅱ or Ⅲ) undergoing CEA using general anesthesia were studied.Bilateral SSEP and MEP were monitored during CEA and the intraoperative changes of SSEP and MEP amplitude and latency were analyzed before, during and after ICA cross-clamping until CEA ended.Neurological dysfunction was investigated within 5 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of neurological dysfunction.Results Fourteen cases (15.6%) were diagnosed as post-operative neurological dysfunction.The sensitivity, specificity of SSEP in detecting the occurrence of intraoperative brain ischemia were 79%, 92%, respectively.The sensitivity, specificity of MEP was 86%, 89% respectively.The sensitivity, specificity, of SSEP+MEP was 79%, 99% respectively.Conclusion During the carotid endarter ectomy,SSEP predicts the occurrence of cerebral ischemia with a high specificity.MEP has a high sensitivity.The combination monitoring of SSEP+MEP can improve the specificity, make up for the shortcomings of single monitoring.

Objective Recent studies showed that change in plasma and cerebrospinal fluid (CSF) level of S100B protein was closely related to cerebral damage. The aim of this study was to investigate if deliberate hypotension induced by isoflurane can increase the release of S100B protein in CSF during clipping of intracranial aneurysm.Methods Thirty ASA Ⅰ - Ⅱ patients (16 male, 14 female) aged 24-68 yr undergoing elective intracranial aneurysm clipping were randomly divided into two groups : group A deliberate hypotension ( n = 15) and group B control ( n = 15) in which BP was maintained at normal level during operation. In both groups anesthesia was induced with midazolam 0.06 mg? kg-1 , fentanyl 3-5 ?g? kg-1 , propofol 2 mg? kg-1 and vecuronium 0.1 mg ? kg-1 and maintained with 1.2% isoflurane and intermittent intravenous (i. v.) blouses of fentanyl and vecuronium. After tracheal intubation the patients were mechanically ventilated (VT 8-10 ml?kg-1 , RR 12 bpm, I :E = 1:2). PaCO, was maintained at 35-40 mm Hg, In group A deliberate hypotension was induced by increasing the inhaled concentration of isoflurane until BP was reduced by 30 % -40 % of the baseline value. After clipping of aneurysm MAP was restored to baseline level. CSF level of S100B protein was measured before deliberate hypotension and 0, 2, 4 h after aneurysm clipping. Results (1) MAP was decreased from (95 ? 12) mm Hg to (59 ? 5) mm Hg 30 min after deliberate hypotension was started and restored to (75 ? 8) mm Hg 30 min after aneurysm was clipped. In group A both systemic peripheral vascular resistance and myocardial contraction acceleration were decreased but cardiac output and HR remained stable, as compared with those in group B. (2) CSF level of S100B protein was significantly increased 4 h after aneuuysm clipping in both groups but CSF level of S100B protein was significantly higher in group A than that in group B. Conclusion Deliberate hypotension induced by isoflurane increases the release of S100B protein and may worsen cerebral vasospasm and be detrimental to perioperative cerebral protection.

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

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.

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.

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.