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 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.

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 explore the application of Airtraq(R) optical laryngoscope combined with bronchofibroscope for endotracheal in-tubation (EI) in patients with cervical spine injury (CSI). Methods 50 patients with CSI undergoing spine surgery under combined general anesthesia were randomly assigned to two groups, group A (n=25) received EI by using Airtraq(R) optical laryngoscope and group AF (n=25) received EI by using Airtraq(R) optical laryngoscope combined with bronchofibroscope. The intubation time (IT), success rate of single intuba-tion (SRSI), hemodynamic changes in endotracheal intubation, and complications related to EI were observed. Results IT was significantly longer in group A than in group AF (P<0.001), and SRSI was significantly lower than in group A in group AF (P<0.05). There was no signif-icant difference in hemodynamic changes in EI and complications related to EI between two groups (P>0.05). Conclusion Airtraq(R) optical laryngoscope combined with bronchofibroscope would be safely and effectively used for EI in patients with CSI.

Objective To systemically evaluate the effect of intravesical Botulinum toxin on pain of patientspain syndrom. Methods The following databases as Cochrane Library, PubMed, Web of Science, Embase, Springer, Wiley, Science Direct, OVID were searched to col-lect the randomized controlled trials (RCTs) with the treatment of intravesical Botulinum toxin vs. 0.9%sodium chloride for patients with bladder pain syndrome. Two reviewers screened the trials according to the inclusion and exclusion criterias, extracted the data, assessed the quality, and the changes of Visual Analogue Scales (VAS) before and after treatment were used to conduct Meta analysis with RevMan5.2 software. Results Five studies were included with a total of 218 patients, there were 127 cases in intravesical Botulinum toxin group and 91 cases in 0.9%sodium chloride group. Meta analysis showed that the pain relief effect of intravesical Botulinum toxin was better than that of 0.9%sodium chloride. Conclusion Intravesical Botulinum toxin can relieve the pain of patients with bladder pain syndrome.

Objective To analyze the characteristics and influencing factors of recessive hemorrhagic loss of intertrochanteric fracture in elderly patients with PFNA .Methods The clinical data of 120 elderly patients with IFF from January 2011 to December 2017 in Rizhao Central Hospital were retrospectively analyzed .The dominant blood loss,hidden blood loss and total blood loss after PFNA were calculated ,and the influencing factors were analyzed . Results The total blood loss of 120 elderly patients with intertrochanteric fractures was (911.4 ±240.8) mL,the dominant blood loss was (255.7 ±89.7)mL,occult blood loss was (679.5 ±208.6)mL,the hidden blood loss was significantly greater than the dominant blood loss ,the difference was statistically significant (t=8.669,P<0.05). Hypertension,surgery after injury delayed more than 5d, aged >75, the preoperative use of anticoagulant drugs , unstable fracture and diabetes were the independent risk factors of hidden blood loss of PFNA (OR=2.254,1.676, 0.753,0.965,2.625,all P<0.05).Conclusion Recessive blood loss is the main cause of loss of blood in patients with intertrochanteric fracture of the femur treated with PFNA .Hypertension , surgery after injury delayed more than 5d,aged more than 75 years,the preoperative use of anticoagulant drugs ,unstable fractures and diabetes are risk factors of hidden blood loss of PFNA .

Objective: To analyze the efficacy and safety of intervertebral endoscopy in the treatment of double segmental protrusion of lumbar intervertebral disc. Methods: From February 2016 to May 2017, 126 patients with double segment lumbar disc herniation diagnosed in Rizhao Central Hospital were divided into the observation group and the control group according to the different treatment methods, with 63 cases in each group.The observation group was treated with intervertebral foramen technique, and the control group was treated with conventional fenestration.The treatment efficacy of the two groups was compared.The differences of VAS score and ODI between the two groups before and after operation were compared. Results: Compared with the control group, the observation group had shorter hospitalization time[(7.1±3.1)d vs.(11.5±4.2)d], smaller incision length[(1.2±0.3)cm vs.(4.3±1.6)cm], less blood loss[(22.3±8.2)mL vs.(36.3±9.2)mL], there were statistically significant differences between the two groups (t=9.365, 3.965, 5.566, all P<0.05). From preoperation to 6 months after operation, the VAS scores of the two groups showed a significant downward trend.There were statistically significant difference in the VAS scores between the two groups at different time points, between groups and at different time points (F=5.688, 4.589, 3.998, all P<0.05). From preoperation to 6 months after operation, the ODI of the two groups decreased first and then increased, and there was statistically significant difference between the two groups of ODI in different time points (F=4.254, P<0.05). The good rate of curative effect in the observation group was 87.3%, which in the control group was 84.1%, the difference was not statistically significant (χ²=0.259, P>0.05). There was no statistically significant difference in the incidence rate of adverse reactions between the two groups (6.4% vs.9.5%) (χ²=0.434, P>0.05). Conclusion The treatment of double segment lumbar intervertebral disc herniation with intervertebral foraminoscopy is reliable, with small tissue trauma and mild pain.

Objective To explore the risk factors for postoperative agitation (PA) in patients with cerebral palsy (CP). Methods 199 patients with CP receiving selective posterior rhizotomy or lower limbs orthopedics under combined intravenous and inhalational anesthesia were reviewed. Results 30 patients suffered from PA (15%), who tended to be younger, less body mass, and administered less anesthetics.Conclusion It may prevent PA of sufficient intra-operative and postoperative analgesia, necessary psychological intervention and sedatives.