Anaesthetic Management with Dexmedetomidine for Intraoperative Awake Test in Correction of Scoliosis; a Case Report

Damage to spinal cord and its subsequent neurological deficits have been recognized as the complications of scoliosisrepair surgery. Wake up test has been a safe, simple and reliable method to recognize such complications. Dexmedetomidineand Sevoflurane were the main anaesthetics for a 14 year old girl who underwent a scoliosis repair surgery with the intraoperative wake-up test and hemodynamic stability. The analgesic property of Dexmedetomidine was complemented by thecontinuous Fentanyl infusion. Dexmedetomidine, Sevoflurane and continuous Fentanyl infusions were administered toachieve the maintenance of the anesthesia. These anaesthetic regimens produced a satisfactory result for the intra operativehemodynamic stability and the wake-up test with the minimum complication. Here, a case of scoliotic repair surgery waspresented using Dexmetomidine, Sevoflurane and Fentanyl infusion as the safe anaesthetic regimens.

Impact of dexmedetomidine anesthesia on intraoperative wake-up test in Brucellar spondylitis undergoing surgery / 中华地方病学杂志

Objective To observe the effects of dexmedetomidine on intraoperative wake-up test in Brucellar spondylitis (BS) patients undergoing surgical operation.Methods Using the case control method,thirty-two patients undergoing BS surgical operation from January 2014 to December 2017 in Harbin the Fifth Hospital were enrolled in this study,the patients were randomly classified into the experimental group (n =16) and the control group (n =16).The two groups were anesthetized with midazolam,propofol,sufentanil and cisatracurium,then anesthesia was maintained with sevoffurane inhalation and a continuous intravenous infusion of remifentanil.In the experimental group,dexmedetomidine 0.4 μg· kg-1·h-1 was administered after tracheal intubation,while equal volume saline solution was given to control group.When the wake-up test was performed,the values of mean arterial pressure (MAP),heart rate (HR) and bispectral index (BIS) were recorded at the time points of preinduction (T0),just before wake-up (T1) and awakening (T2).The wake-up time,the amount of bleeding during the wake-up period,the wake-up quality rating and the sedation score were recorded.Results There was significant difference in HR and MAP at T0,T1 versus at T2 in control group [(98.8 ± 21.0) time/min vs (84.5 ± 8.1),(81.8 ± 1.7) time/min,(90.2 ± 7.5) mmHg vs (76.2 ± 5.7),(74.6 ± 8.5) mmHg,1 mmHg =0.133 kPa,P ＜ 0.05].In experimental group,HR and MAP were lower than those in control group at T2,and the difference between the two groups was statistically significant [(86.3 ± 12.3) time/min vs (98.8 ± 21.0) time/min,(77.9 ± 6.3) mmHg vs (90.2 ± 7.5) mmHg,t =-2.901,-4.995,P ＜ 0.05).The wake-up test quality was significantly better in test group than that in control group,the difference was statistically significant (excellent:13 cases vs 4 cases,good:2 cases vs 6 cases,poor:1 case vs 6 cases,x2 =4.571,P ＜ 0.05).The wake-up time and the amount of bleeding during wake-up period were less than that in control group,the difference was statistically significant [(14.5 ± 3.6) min vs (26.1 ± 4.5) min,(239.8 ± 53.9) ml vs (317.3 ± 54.8) ml,t =-7.980,-4.032,P ＜ 0.05].Conclusion Dexmedetomidine when continuous pumped at a rate of 0.4 μg· kg-1· h-1 could reduce the hemodynamic stress response during the wake-up test,improve the wakeup test quality,shorten the wake-up time and effectively improve the safety factor of operation during Brucellar surgical operation.

Comparison of intraoperative wake-up test performed under different methods of anesthesia in pa-tients undergoing scoliosis correction / 中华麻醉学杂志

Objective To compare the intraoperative wake-up test performed under different meth-ods of anesthesia in the patients undergoing scoliosis correction. Methods Sixty American Society of An-esthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 14-35 yr, undergoing elective scoliosis correction, were divided into dexmedetomidine-based anesthesia group (D group) and sevoflurane-based anesthesia group (S group), with 30 cases in each group. Patients were tracheally intubated after induc-tion of anesthesia. Maintenance of anesthesia was as follows: remifentanil 0. 3 μg·kg-1 ·min-1 was intra-venously infused, dexmedetomidine 0. 2 μg·kg-1 ·h-1 was intravenously infused in group D, and group S inhaled low flow sevoflurane 1 L∕min with the end-tidal concentration of 0. 8％ - 1. 5％. Narcotrend index value was maintained at 30-45. The wake-up time, adverse events, requirement for vasoactive agents and blood loss during wake-up test were recorded. The wake-up quality was evaluated. Results All the pa-tients successfully completed wake-up tests. Compared with group S, the wake-up quality was significantly increased, the incidence of agitation and bucking was decreased during wake-up test, the blood loss was reduced during wake-up test (P<0. 05), and no significant change was found in wake-up time or require-ment for vasoactive agents in group D (P>0. 05). Conclusion Dexmedetomidine-based anesthesia pro-duces better efficacy for intraoperative wake-up test than sevoflurane-based anesthesia in the patients under-going scoliosis correction.

Effect of dexmedetomidine on quality of intraoperative wake-up test in patients undergoing balloon occlusion test of the internal carotid artery / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.

Effects of different head positions during operation on wake-up time and quality among ankylosing spondylitis patients with thoracolumbar kyphosis following pedicle subtraction osteotomy / 现代临床护理

Objective To investigate the effects of different head positions during operation on wake-up time and quality among ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO).Methods Sixty patients were included in this study.All of them,treated with intravenous anesthesia,took the bow-prone position.The patients were randomly divided into two groups:the experiment group where the head was elevated by 10° and the control group where the head was not elevated.The two groups were compared in respect of wake-up time and quality of wake-up test.Results The wake-up time in the experiment group was significantly shorter as compared to that of the control group (1 3.7±2.0 min vs.24.2±2.7min,P＜0.05).The wake-up quality was better as well.Conclusion Elevation of the head by 10° can shorten wake-up time and improve the quality of wake-up test during the procedure of PSO for AS patients with thoracolumbar kyphosis.

Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial / Comparação de propofol e midazolam em pacientes submetidos à cirurgia de coluna vertebral com teste de despertar no intraoperatório: estudo clínico randomizado

BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg-1 for group P or midazolam 0.5 mg kg-1 for group M with remifentanil 0.5 µg kg-1 and cisatracurium 0.15 mg kg-1 for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg-1 h-1 and in group M, midazolam 0.5 mg mg kg-1 were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30 s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.

JUSTIFICATIVA E OBJETIVOS: A instrumentação em cirurgias de correção de deformidades da coluna vertebral tem risco de 0,5 a 5% de lesionar a medula espinhal. O teste de despertar é usado para a detecção precoce dessas lesões. Neste estudo comparamos os efeitos de propofol e midazolam durante o teste de despertar em cirurgia de escoliose. MÉTODOS: Trinta pacientes foram designados de forma aleatória para os grupos P e M. A anestesia foi induzida com propofol (2,5 mg kg-1) no grupo P ou midazolam (0,5 mg kg-1) no grupo M, com remifentanil (0,5 µg kg-1) e cisatracúrio (0,15 mg kg-1) em ambos os grupos. A manutenção da anestesia foi feita com O2/ar e infusões de remifentanil e cisatracúrio. Nos grupos P e M, respectivamente, doses de propofol (6-10 mg kg-1 h-1) e de midazolam (0,5 mg mg kg-1) foram preferidas. Aproximadamente 15 min antes do teste de despertar, todos os medicamentos foram interrompidos. No teste de despertar, o anestesiologista pedia ao paciente que abrisse os olhos e apertasse sua mão a cada 30 s até que o paciente respondesse. Depois, o paciente era solicitado a mexer os dedos dos pés. Os parâmetros hemodinâmicos, o tempo de abertura dos olhos e o movimento apropriado sob comando verbal foram avaliados. A frequência do BIS foi registrada durante toda a cirurgia. RESULTADOS: O tempo de abertura dos olhos foi de 9 ± 2,15 min no grupo P e de 7 ± 3,15 min no grupo M. O tempo de movimento motor foi de 12 ± 2,55 min no grupo P e de 21,25 ± 3,93 min no grupo M. CONCLUSÃO: Propofol proporcionou melhores condições de despertar e possibilitou uma melhor avaliação neurológica dentro dos mesmos valores do BIS que midazolam.

Quality of intraoperative wake-up test in patients undergoing scoliosis correction surgery under etomidate-based anesthesia / 中华麻醉学杂志

Objective To evaluate the quality of intraoperative wake?up test in the patients undergoing scoliosis correction surgery under etomidate?based anesthesia. Methods Thirty patients of both sexes, aged 13-32 yr, weighing 40-65 kg, of ASA physical statusⅠorⅡ, undergoing elective scoliosis correction surgery, were randomly assigned into etomidate group ( group E, n=15 ) or propofol group (group P, n=15) using a random number table. Anesthesia was induced with etomid 0.3 mg∕kg (group E) or propofol 2mg∕kg ( group P ) injected intravenously, midazolam, fentanyl and rocuronium. The patients were mechanically ventilated after naso?tracheal intubation. Etomidate 0.6-1. 2 mg · kg-1 · h-1 and propofol 8- 10 mg·kg-1 ·h-1 were infused intravenously during surgery in E and P groups, respectively. Both remifentanil and cisatracurium were used for maintenance of anesthesia in the two groups. Cisatracurium infusion was stopped before wake?up test. The infusion rate of propofol was adjusted to 4 mg·kg-1 ·h-1 at 15 min before wake?up test. After the scoliotic angle was corrected, infusion of etomidate and propofol was stopped, and the infusion rate of remifentanil was adjusted to 0.025μg·kg-1 ·min-1 in both groups. The wake?up time was recorded, and the quality of wake?up was assessed. Mean arterial pressure (MAP) and heart rate were recorded before anesthesia ( T0 ) , immediately before the patients were awakened ( T1 ) , when the patients responded to commands from doctors ( T2 ) , and after anesthesia was deepened ( T3 ) . At T0 , the end of surgery ( T4 ) , and 24 h after surgery ( T5 ) , blood samples were collected from the internal jugular vein for determination of plasma cortisol concentrations. Results The patients were awakened successfully in the two groups, and there were no significant differences in the wake?up time, quality of wake?up, and MAP, HR and plasma cortisol concentrations at each time point between the two groups. MAP and HR were significantly higher at T2 than at T0 in the two groups. MAP and HR were within the normal range during wake?up test, and no patients developed severer cardiovascular events in the two groups. Conclusion Etomidate?based anesthesia provides better quality of intraoperative wake?up test in the patients undergoing scoliosis correction surgery, which is similar to that of propofol?based anesthesia.

Effect of dexmedetomidine on quality of wake-up test in patients undergoing posterior osteotomy correction surgery / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on quality of wake-up test in the patients undergoing posterior osteotomy correction surgery.Methods Ninety-seven patients of both sexes,aged 17-59 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 18.5-25.0 kg/m2 and global kyphosis angle＞60°,scheduled for elective posterior osteotomy correction surgery under general anesthesia,were randomly divided into 2 groups using a random number table:control group C (n=46) and group D (n =51).In group D,dexmedetomidine 1.0 μg/kg was infused over 15 min before induction of anesthesia,and group C received the equal volume of normal saline instead.Anesthesia was induced with iv midazolam,propofol,fentanyl,vecuronium and dexamethasone in C and D groups.Mechanical ventilation was performed after tracheal intubation.Anesthesia was maintained with infusion of cisstracurium,propofol and remifentanil.Dexmedetomidine 0.3 μg · kg-1 · h-1 was infused throughout the surgery in group D,and meanwhile normal saline was given throughout the surgery in group C.The anesthetic drugs for maintenance except dexmedetomidine were discontinued at the beginning of the wake-up test.The wake-up time was recorded and the wake-up quality was assessed.Ramsay sedation scores and Riker sedation-agitation scale scores were also recorded when all the patients were successfully awakened.The development of cardiovascular events during wake-up test and intraoperative awareness was recorded.Results The wake-up quality was significantly higher,Riker sedation-agitation scale scores were lower,Ramsay sedation scores were higher,the incidence of nausea and vomiting was lower,and no significant change was found in wake-up time in group D.No intraoperative awareness was observed in the two groups.Conclusion Dexmedetomidine can raise wake-up quality without prolonging wake-up time and with stable hemodynamics and fewer side effects in the patients undergoing posterior osteotomy correction surgery.

Effect of dexmedetomidine on awareness during intraoperative wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia / 重庆医学

Objective To investigate the effect of dexmedetomidine on awareness during intraoperative Wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia .Methods 36 patients ,requiring intraoperative arousal test during posterior spinal surgery were randomly divided into the group D (DEX ,n= 18) and C (NS ,n= 18) .DEX 1 μg/kg followed by 0 .2 μg · kg -1 · h-1 and equal volume NS were infused respectively 10 min before anesthesia induction and maintenance of anesthe-sia in two groups .Hemodynamic parameters were monitored 5 min(T1) before anesthesia induction ,3 min(T2)after anesthesia in-duction ,at the beginning of wake-up test(T3) ,at the end of the test(T4) and 5 min(T5) after deepen anesthesia respectively . Meanwhile the wake-up time ,success rate of arousal ,incidence agitation and the dosage of nitroglycerin during wake-up were also recorded .Results Successive rate of arousal awakening time between two group had no statistically significance (P>0 .05) .less in-cidence of agitation was found in group D compared with group C ,the dosage of nitroglycerin used during wake-up in group D was less than that in group C(P<0 .05) .Conclusion Dexmedetomidine auxiliary propofol remifentanil anesthesia can effectively implement intraoperative wake up ,during the awakening the hemodynamic was more smoothly ,and it has lower incidence of adverse events .

Comparative study of propofol combined with sufentanil or remifentanil in wake-up test during scoliosis surgery / 临床麻醉学杂志

Objective To compare the influence of propofol combined with sufentanil or remifentanil on the quality of wake-up during scoliosis surgery by wake-up test.Methods Fifty pa-tients undergoing scoliosis surgery were randomized into two groups.During the surgery,propofol combined with sufentanily 0.3-0.6 μg·kg-1·h-1 (group SF)or remifentanil 0.2-0.3 μg·kg-1·min-1 (group RF)were continuously infused to maintain anesthesia,and BIS was maintained at 40-60.In wake-up test,the infusion of sufentanyl in group SF was paused and,the infusion rate of remifentanil in group RF was adjusted to 0.05 μg·kg-1·min-1 until the patient completed the wake-up test under instruction.The time that spontaneous breathing occurred,body movement was detected and the capa-bility to follow instructions in both two groups were recorded.MAP,HR,PET CO2 were measured at the time 10 min after medication adjustment (T1 ),waking up(T2 )and 10 min after waking up (T3 ), respectively,in both two groups.Wake-up quality was also recorded.Results The time that sponta-neous breathing occurred,body movement was detected and the capability to follow instructions in group RF were significantly shorter than those in group SF (P <0.05).At T2 the incidence of agita-tion in group RF was significantly higher than that in group SF(P <0.05).And the hemodynamics of group SF were more stable than those of group RF (P <0.05).Conclusion Propofol combined with sufentanil can improve wake-up quality during scoliosis surgery,but the wake-up time is relatively lon-ger.

Effect of dexmedetomidine on stress responses during wake-up test in patients undergoing cerebral functional area operation performed under propofol combined with remifentanil anesthesia / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on the stress responses during wakeup test in patients undergoing cerebral functional area operation performed under propofol combined with remifentanil anesthesia.Methods Thirty-six ASA physical status Ⅰ or Ⅱ patients,undergoing cerebral functional area operation requiring wake-up test,aged 18-60 yr,weighing 50-70kg,were randomly divided into control group (group C) or dexmedetomidine group (group D) with 18 cases in each group.Dexmedetomidine 0.8 μg/kg was infused over 10 min before induction of anesthesia followed by infusion at 0.4 μg·kg-1 · h-1 in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with target-controlled infusion of propofol and remifentanil and iv injection of cisatracurium.At 30 min prior to wake-up test,target-controlled infusion of propofol and application of mulscle relaxants were stopped,the target plasma concentration of remifentanil was decreased to 1 ng/ml,and in group D the infusion rate of dexmedetomidine was decreased to 0.1 μg·kg 1· h-1.Anesthesia time and consumption of anesthetics before wake-up test,wake-up time,and development of complications and intraoperative awareness during wake-up test were recorded.At 30 min prior to wake-up test (T1),immediately after wake-up (T2),at 5 min after wake-up (T3),and at 10 min after the anesthetic depth was deepened (T4),HR,mean arterial pressure and BIS value were recorded and blood samples were taken for determination of plasma concentrations of epinephrine (E) and norepinephrine (NE).Results Compared with group C,the consumption of propofol and remifentanil was significantly reduced before wake-up,the incidence of hypertension was decreased during wake-up test,and HR and plasma E and NE concentrations were decreased at each time point (P ＜ 0.05),and no significant difference in mean arterial pressure and BIS value was found in group D (P ＞ 0.05).Tachycardia,restlessness,bucking and awareness were not observed during wake-up test in group D.Conclusion Dexmedetomidine can inhibit the stress responses during wake-up test and raise the quality of wake-up test in patients undergoing cerebral functional area operation performed under propofol combined with remifentanil anesthesia.

Bispectral index and their relation with consciousness of the patients who receive desflurane or sevoflurane anesthesia during wake-up test for spinal surgery for correction / 대한마취과학회지

BACKGROUND: Wake-up tests may be necessary during surgery for kypho-scoliosis to ensure that spinal function remains intact. It is difficult to predict the time when patients can respond to a verbal command. We evaluated the effectiveness of the bispectral index (BIS) and its relation to patients' levels of consciousness in wake-up tests during desflurane and sevoflurane anesthesia. METHODS: Eighteen patients each were enrolled in the desflurane and sevoflurane groups for spinal correction surgery. We measured BIS values, blood pressure, heart rate, and consciousness state and time, at the points when patients responded during the wake-up test. RESULTS: The BIS values when patients made fists upon a verbal command (T3) were 86.7 +/- 7.5 for desflurane and 90.3 +/- 5.4 for sevoflurane. Patients in the desflurane group had significantly shorter wake up delays than those in the sevoflurane group (6.9 +/- 1.8 min vs. 11.8 +/- 3.6 min). However, there was no difference between the groups in the time between the response to a verbal command and the time when a patient moved their toes in response to verbal commands. No recall of the wake-up tests occurred in either group. CONCLUSIONS: The values obtained using the BIS index could to some extent predict the time of a patient's and would be informative during desflurane and sevoflurane anesthesia. Moreover, desflurane permitted faster responses to verbal commands than sevoflurane, and allowed the wake-up test to be performed sooner.

Effect of dexmedetomidine on intraoperative wake-up test in patients undergoing scoliosis surgery / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on intraoperative wake-up test in patients undergoing scoliosis surgery.Methods Sixty ASA Ⅰ patients,aged 13-18 yr,scheduled for elective scoliosis surgery,were randomly divided into 2 groups (n =30 each) ∶ sufentanil group (group S) and dexmedetomidine combined with sufentanil group (group DS).Anesthesia was induced with sufentanil,etomidate and cisatracurium,and maintained with target-controlled inhalation of sevoflurane combined with target-controlled infusion of sufentanil in both groups.In group DS,dexmedetomidine 0.2 μg·kg-1 · h-1 was infused during operation,while the equal volume of normal saline was given instead in group S.Before the wake-up test,cisatracurium infusion was stopped,the end-tidal concentration of sevoflurane was adjusted to 0,and the target effect-site concentration of sufentanil was adjusted to 0.1 and 0.08 ng/ml in groups S and DS,respectively.The wake-up test was performed 5 min later.The wake-up time and bucking/restlessness and cardiovascular events during the wake-up test were recorded.The occurrence of intraoperative awareness was recorded in the patients who were followed up after operation.Results No cardiovascular events occurred during the wake-up test in group DS.The wake-up time was significantly shorter and the incidences of cardiovascular events and bucking/restlessness were significantly lower in group DS than in group S (P ＜ 0.05).No intraoperative awareness occurred in the patients.Conclusion Dexme-detomidine can be used for intraoperative wake-up test in patients undergoing scoliosis surgery,with shorter wakeup time,stable hemodymamics and fewer adverse reactions.

Effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined intravenous propofol-remifentanil anesthesia / 中华麻醉学杂志

Objective To evatluate the effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined iv propofol-remifentanil anesthesia.Methods Twenty-seven ASA Ⅰ or Ⅱ patients (both sexes) aged 17-43 yr with a body mass index of 20-24 kg/m2 undergoing op-eration on cerebral functional area during which intraoperative wake-up test was performed were randomly divided into control group (group C,n =13) and dexmedetomidine group (group D,n =14).Anesthesia was induced with midazolam,sufentanil,etomidate and rocuronium and maintained with TCl of propofol (Cp =3-5 μg/ml) and remifentanil (Ce =2-6 ng/ml).BIS value was maintained at 55-65.In group D after dura of brain was opened,a loading dose of dexmedetomidine 0.3 μg/kg was administered iv over 15 min followed by continuous iv infusion at 0.2 μg· kg-1 · h-1 while TCI of propofol and remifentanil were suspended.In group C after opening of dura,Cp of propofol TCI was reduced to 0.5 μg/ml and Ce of remifentanil to 0.5 ng/ml.The wake-up time and development of hypertension,tachycardia,headache,dysphoria,delirium and awareness were recorded.Results All patients were successfully awakened.There was no significant difference in wake-up time between the 2 groups (P ＞0.05).The incidences of hypertension,tachycardia,headache and awareness were significantly lower in group D than in group C (P ＜ 0.05).Conclusion Dexmedetomidine does not affect intraoperative wake-up time during operation on cerebral functional area performed under iv propofol-remifentanil anesthesia,but can significantly reduce the incidence of adverse effects.

Itraoperative wake-up test during surgery for severe ossification of ligamentum flavum / 中华创伤杂志

Objective To assess the efficacy and safety of intraoperative wake-up test during surgery for ossification of the ligamentum flavum(OLF). Methods Between June 2004 and June 2010,35 patients(23 males and 12 females,at age range of 32-71 years,mean 50.5 years) with OLF underwent posterior decompressive laminectomy and excision of OLF.The operation wag performed on the cervical vertebrae in four patients,on the thoracic vertebrae in 24 and on the lumbar spine in seven,with monosegmental OLF in 14 patients and multisegmental OLF in 21.The outcomes were evaluated using Japanese Orthopaedic Association (JOA) scale. Results The operation lasted for mean 190 minutes (120-260 minutes),with the blood loss for mean 350 ml (220-520 ml)and the mean 2.4(1-5) lamin receiving decompression.The follow-up period ranged from 6 to 72 months (mean 29.5 months).The JOA score was improved from 4.302±1.023 preoperatively to 8.327±1.032 at the final follow-up (P<0.01).The neurological symptoms was aggravated during operation in three patients,for whom the muscles force recovered gradually in two patients but one showed no change after special measures.No serious complication was found in the other patients postoperatively. Conclusions The wake-up test can serve as an effective monitoring during the procedure ofthe decompressive laninectomy in the patients with severe OLF and decrease the occurrence of neurologic deficit complications.

Comparison on anesthetic effects of remifentanil and fentanyl for posterior scoliosis correction / 中国临床药理学与治疗学

AIM:To compare the effects of remifentanil and fentanyl for posterior scoliosis correction and the influences on postoperative pain.METHODS:Forty patients scheduled for posterior scoliosis correction(ASAⅠ-Ⅱ,aged 11-18 years)were randomly divided into group remifentanil(group R)and group fentanyl(group F).Anesthesia was maintained with propofol,vecuronium bromide and sevoflurane.Intravenous remifentanil(0.2 ?g?kg-1?min-1)and fentanyl(1 ?g?kg-1?h-1)were continuously administered for analgesia.Vecuronium bromide and analgesics were discontinued around 30 min before the wake-up test.The wake up time from propofol and sevoflurane discontinuation to movement of the patient's toe were recorded.In group R,once remifentanil infusion was stopped before surgery ended,the patients were injected with fentanyl 2 ?g/kg.All of the patients received intravenous fentanyl(10 ?g?kg-1?min-1)for postoperative analgesia and were interviewed for pain degree during the first 24 h after surgery.RESULTS:The wake-up time were(12.3?5.7)min in group R and(21.6?6.5)min in group F(P

Alternative Result of Wake-up Test according to Position Change during a Spinal Fusion / 대한마취과학회지

There are rare but serious complications-especially risk of paraplegia when instrumentation by surgery is used to correct a spinal deformity. Wake-up tests may be necessary during scoliosis or kyphosis surgery to ensure that spinal function remains intact. We tried four spinal fusions for ankylosing spondylitis of a 62 year-old woman. We were not able to fix the rod for fusion because of a presenting positive wake-up test in the previous two prone-positioned operations. In last operation we decided on normotensive anesthesia with fentanyl-propofol in a lateral decubitus position, and then surgical instrumentation was completed after we made sure of a negative weak-up test. There were no postoperative sequelae. The lateral approach to the thoracic disc space during spinal fusion may produce minimum disruption of the normal spinal musculoskeletal anatomy, avoid retraction of the spinal cord and preserve the neurovascular bundle and the segmental radicular arteries to the spinal cord.