| Objective: To comparative studies the effect on intraoperative wake-up time and quality of sufentanil and fentanyl for orthomorphia of spinal deformity, discusses the operation method of intraoperatie wake-up test of orthomorphia for serious rigid scoliosis and kyphosis, evaluate the effect of orthomorphia and wake-up test.Methods: 38 cases of patients with spinal deformity were treated by orthomorphia. They were randomly divided into sufentanil group(group S) and fentanyl group(group F) with 19 patients in each group. Begin anesthesia induction with intravenous infusion 0.1 mg/kg midazolam, 1mg/kg propofol, 0.15mg/kg atracurium and 0.2μg/kg sufentanil or 4μg/kg fentanyl. Maintenance of anesthesia with continuous pump injection 4mg/(kg·h)propofol, 1μg/(kg·h)atracurium, sufentanil 0.1μg/(kg·h) or fentanyl 1μg/(kg·h). Stop pump inject atracurium, sufentanil or fentanyl in the time of 30min before need awakening. Stop pump injection propofol in the time of need awakening, and begin the process of wake up. After wake up successfully, if it is necessary to maintain long wake-up time state, continue to pump inject propofol, sufentanil or fentanyl to maintain anesthesia. After the process of wake-up test, if it is necessary to wake up again in later, intravenous infusion 0.5 mg/kg propofol, continue to pump injection propofol, sufentanil or fentanyl to maintain anesthesia. Stop pump inject all the drugs in the time of 15min before the new wake-up test. If it is not necessary to wake up again, intravenous infusion 0.5 mg/kg propofol, 0.05 mg/kg atracurium, continue to pump inject propofol, atracurium, sufentanil or fentanyl to maintain anesthesia. The wake-up time and quality were compared.26 cases of patients with serious rigid scoliosis were treated by staging distraction by improved halo-pelvic combined anterior and posterior approach surgery. They were randomly divided into group S and group F with 13 patients in each group. The preoperative Cobb's angle of scoliosis was 91.07°±11.64°and the preoperative Cobb's angle of kyphosis was 66.23°±14.30°. The bending films showed a flexibility of scoliosis with an average of 12.1%. The anesthesia method was same as above. They were waked up 3 times while after nailing, osteotomy or installation titanium rod and correction. The wake-up time were compared.12 cases of patients with kyphosis were treated by"V"osteotomy. The preoperative Cobb's angle of kyphosis was 73.41°±18.33°. The anesthesia method was same as above. They were keep in the wake-up state after wake up successfully and the process of correction were proceed under wake-up state.Results: The gender, age, weight and operation time were no statistically significant differences between group S and group F in the research of"comparative studies the effect on intraoperative wake-up time and quality of sufentanil and fentanyl". The recovery time of spontaneous breathing, open eyes, instruction moves of group S were shorter than group F (p<0.05). The wake-up quality of two groups were statistically significant differences (p<0.05). 1 cases of patients with intraoperative pain and awareness in group F. Both groups had no other complications.26 cases of patients with serious rigid scoliosis were successfully awakening with 78 times. All the wake-up time of group S were short than group F (p<0.05). The wake-up time of second time and third time of two groups was statistically significant differences between the first time (p<0.05). There were no statistically significant differences between the second time and third time wake-up time (p>0.05). There were 3 cases of nerve injury after wake up and the nerve function were restored after remove the damage factors. The postoperation cobb'angle of scoliosis was 32.42°±7.66°with a correction rate of 63.99%±9.80% (p<0.05). The postoperation cobb'angle of kyphosis was 31.76°±7.26°with a correction rate of 51.50%±8.5% (p < 0.05).12 cases of patients with kyphosis were wake up successfully after osteotomy. The deformity was corrected in a long wake-up time state. The wake-up time was 10-30min with an average of 18.41min±7.201min. 1 case of patients with nerve injury while correct, and the nerve function was restored after splaying intervertebral moderately. The postoperation cobb'angle of kyphosis was 19.17°±11.19°with a correction rate of 60.71%±8.06% (p<0.05). The cobb'angle of kyphosis was 21.25°±10.78°when follow-up with a lost rate of 1.25%±1.53% (p> 0.05). There was no statistically significance difference although the cobb'angle of kyphosis have lost partly.Conclusion: This method of intraoperative wake-up is effective. The wake-up time of the anesthesia which use sufentanil is shorter than use fentanyl , and the wake-up quality is more higher.The method of treat patients with serious rigid scoliosis by staging distraction by improved halo-pelvic combined anterior and posterior approach surgery is effective. Nerve injury can be find through many times of intraoperative wake-up in different period and can be avoid successfully. The second and third wake-up time was statistically significant differences between the first wake-up time. There are no statistically significant differences between the second and third wake-up time.The method of treat patients with kyphosis by"V"osteotomy is effective. Nerve injury can be avoided through long wake-up time state of intraoperative wake-up. |
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