Application of the Cerebral Palsy Rehabilitation System in the Digital Community on the Thumb Adduction Deformity / 现代生物医学进展

Objective:To explore the effect of digital rehabilitation system on the recovery of infants with cerebral palsy.Methods:Twenty-one children with cerebral palsy were treated with residual cerebral palsy in Putuo District,and 21 children with cerebral palsy were followed up.The patients were divided into two groups (n =21).The control group was treated by routine OT training by the parents,and the treatment group was treated with the digital rehabilitation system.Three months later,the efficacy was evaluated and compared.Results:After 3 months of treatment,the total effective rate (effective rate and effective rate) of the two groups was 90.5％ and 81％,respectively,and the treatment group was significantly higher than the control group (P ＜0.05).The PROM of the two groups was improved (P ＜0.01),and the PROM in the treatment group was significantly higher than that in the control group (P ＜0.05).FMFM was significantly higher than that before treatment (P ＜0.01),and FMFM was significantly higher in the treatment group than in the control group (P ＜0.01).Conclusion:Family (community) digital rehabilitation system can effectively improve the rehabilitation of children with cerebral palsy.

The Neuromuscular Pharmacodynamics for Rocuronium at the Adductor Pollicis and the Flexor Hallucis Brevis Muscle / 대한마취과학회지

BACKGROUND: Neuromuscular block is commonly monitored using the adductor pollicis (AP) because of its easy access. However, the hand may not always be accessible for neuromuscular monitoring during surgery. In that situation, monitoring of the flexor hallucis brevis (FHB) secondary to stimulation of the tibial nerve at the ankle joint may be used as an alternative. METHODS: During propofol and remifentanil anesthesia, acceleromyography of the thumb and big toe were recorded. Single twitch responses were measured simultaneously after cumulative administration of rocuronium from 80 to 200microgram/kg at intervals of 40microgram/kg. Furthermore, the amount of rocuronium required for 50% and 95% twitch height depression were calculated. Rocuronium was infused continuously to maintain 5% to 15% twitch responses. We also obtained the onset, duration of action, and antagonism effect of neostigmine from both muscles via neostigmine (20microgram/kg) administration. RESULTS: ED50 and ED95 were significantly lower in the AP than in the FHB. The highest twitch response at peak and neostigmine antagonism were significantly higher in the FHB than in the AP. However, there was no significant difference in the onset time or duration of neostigmine between AP and FHB. CONCLUSIONS: Due to its resistance to rocuronium, the onset of FHB is not a good indicator of optimal conditions for tracheal intubation. Also, because of its higher antagonism effect, there is potential risk of overlooking a residual block. Sufficient recovery of the block should be readjusted to estimate recovery in the FHB with the use of other reliable clinical tests.

Rocuronium Onset at the Adductor Pollicis and Masseter Muscles for Endotracheal Intubation in Children / 대한마취과학회지

BACKGROUND: Masseter muscle is a better predictor of good intubating conditions than adductor pollicis after the administration of rocuronium in adults. We compared the onset of rocuronium at the masseter muscle to that at the adductor pollicis to determine which is the more suitable predictor of good intubating conditions using rocuronium in children. METHODS: Fifty children aged from 1 to 6 years old, were anesthetized with thiopental sodium and sevoflurane. The ulnar nerve was stimulated to monitor the relaxation of the adductor pollicis, and the mandibular nerve for monitoring masseter muscle relaxation. Rocuronium 0.6 mg/kg was administered. We measured the time to maximal blckade of the masseter muscle (M-0%). We recorded the percentage of relaxation of the adductor pollicis (AP-%) at M-0% and the time of the maximal blockade of the adductor pollicis (AP-0%), from the administration of rocuronium. Endotracheal intubation was started when the masseter muscle contraction was maximally blocked. RESULTS: M-0% occurred at 37.4 +/- 15.4 s, and AP-% was 32.4 +/- 32.2% at M-0%. AP-0% occurred at 54.8 +/- 19.0 s. The time gap between M-0% and AP-0% was 16.8 +/- 18.3 s. Intubation was at 64.4 +/- 19.4 s from the administration of rocuronium. CONCLUSIONS: The time gap between M-0% and AP-0% was very short in children. Therefore, the monitoring of muscle relaxation on masseter muscle is not straightforward, and therefore, not advised.

Influence of Succinylcholine on the Potency of Vecuronium at the Larynx and the Adductor Pollicis / 대한마취과학회지

No abstract available.

Onset and Duration of Succinylcholine and Vecuronium Neuromuscular Blockade at Laryngeal Adductor and Adductor Pollicis Muscles / 대한마취과학회지

Adequate relaxation of the laryngeal adductor muscle is required to obtain good tracheal intubating condition. But we couldnt check rountinely laryngeal adductor muscle response, so we quantify the effects of succinylcholine and vecuronium at the laryngeal adductor muscles and the adductor pollicis. Twenty adult patients of ASA physical status 1-2 were studied during propofol-fentanyl anesthesia. The trachea was intubated without the use of muscle relaxants and the tube cuff placed between the vocal cords. Succinylcholine 1.5 mg/kg or vecuronium 0.1 mg/kg was given as a single bolus by random allocation. Muscular activity was evoked with supramaximal stimuli in a train-of-four sequence every 12 sec to the ulnar nerve and the anterior branch of the recurrent laryngeal nerve at the notch of the thyroid cartilage and forehead. Neuromuscular transmission was monitored at wrist by mechano-myography and laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. Pressure inside the cuff was measured with an air-filled transducer. TOF responses of both sites were continuously recorded on strip chart. Lag time and onset time were no statistically significant differences at the laryngeal adductor and adductor pollicis after succinylcholine or vecuronium bolus injection. Clinical durations were significantly shorter at the laryngeal adductor than at the adductor pollicis after succinylcholine and vecuronium injection. In one patient, onset of neuromuscular blocking effect with vecuronium was 125 sec slower at the laryngeal adductor than at the adductor pollicis. We recommand that if vecuronium is selected for gentle and smooth tracheal intubation, intubation will be delayed sufficient time after adductor pollicis relaxation.

Assessment of Facial Nerve and Ulnar Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation / 대한마취과학회지

Stimulation of ulnar nerve and. measurement of adductor pollicis response have been used for many years in clinical practice and research, but different muscles respond differently to relaxants, both in terms of onset and duration of blockade. The onset time of neuromuscular blockade at the vocal cords and at the orbicularis oculi muscle(OO) was similar, and was shorter than at the adductor pollicis muscle(AP). The purpose of this study was to examine which will be the best stimulus among double burst stimulation(DBS), train of four(TOF) and single twitch stimulation(STS) on OO or AP for an indicator of the optimal tiime for tracheal intubation. Two hundreds and thirty six healthy patients were randomly allocated to six groups in which DBS(n=34), TOF(n=36) and STS(n=37) group in OO group, and DBS(n=43), TOF(n=43) and STS(n=43) group in AP grouy. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained with 1% enfluraae until intubation. Neuromuscular block was induced by intravenous vecuronium 0.1 mg/kg and applied facial nerve or ulnar nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher & Paykel Co.) continuously. The complete relaxation time of OO group was closely observed with authors naked eyes, but the time of AP group were measured by tactile response of thumb. Tracheal intubation was tried immediately by the author after complete disappearance of the muscle contraction. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cord opening, coughing reflex and response to laryngoscopy attempts. The results were as follows: 1) The intubation time of OO group was 195.97+/-12.82 sec. in DBS group, 182+/-8.46 sec. in TOF group and 167.73+/-6.24sec. in STS group, respectively and there were no significance among groups. 2) The intubation time of AP group was 290.56+/-12.1sec. in DBS group, 276.79+/-10.32sec. in TOF group and 230.16+/-9.88sec, in STS group, respectively and there were no significance among groups. But the intubation time of AP group was significantly prolonged more than that of OO group. as much as 95 sec. of DBS group, 94 sec. of TOF group and 63 sec. of STS group, respectively(p<0.05). 3) There were no significance of vocal cords opening and response to laryngoscopy attempts in three groups, but DBS group(6%) was statistically less cough reflex than TOF(37%) and STS group(33%) in OO group(p<0.05). There were no significance of the intubation responses among three groups in AP group. 4) Coughing reflex ratio(positive cough cases/total cases X 100) of OO group(36%) was significantly more than that of AP group(12%) in TOF group, and coughing reflex ratio of OO group (32%) was significantly more than that of AP group(12%) in STS group, but there were no significance of coughing reflex ratio between OO and AP group in DBS group. With the above results the authors concluded that DBS on facial nerve observed orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation, and facial nerve stimuli was more sensitive than ulnar nerve stimuli due to reduce 95 sec. of intubation time. The optimal intubation time was about 196 sec. after vecuronium(0.1 mg/kg).