Anesthesia Management Of Cervical Spinal Cord Injury

Objective:Summary 100 cases of patients with traumatic carotid spinal cord injury of anesthesia management operation, in order to provide more clinical data about the safety of patients for perioperative period.Methods:Choose surgery patients with spinal cord injury traumatic carotid 100 cases from 2009 to 2011 in Shenyang military district general hospital. Male, female 85 cases of 15 cases, ages 20 ~ 75 years old, 40 ~ 105kg weight,Ⅱ~Ⅲlevel, ASA. For all patients choose static suck endotracheal tube compound general anesthesia, to assist mechanical ventilation. During the operation, monitoring blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO2) hemodynamic changes. Pay close attention to bleeding and urine output operation, according to the needs of patients input crystalloid, plasma substitute and blood products, in order to maintain the balance and circulation stabilization in quantity. Observe its catheterization methods and the anesthetic selection, perioperative hemodynamic change and treatment, the operation conditions and liquid of quantity, the hormone in application, postoperative recovery room (PACU anesthesia) for time, appear the circumstances and the corresponding processing.Result:1. The choice of methods: the anesthesia in 100 patients, 9 cases to breath therapy preoperatively do trachea cut and tracheal intubation, rest outside 91 patients, the Scope of Glide video laryngoscope intubation was 70 cases of intubation laryngeal mask (ILMA) 13 cases (14.3%), depending on the can, 8 cases (8.8% visual laryngoscope). In calm drug induced intubation tabor phenolic 12 patients choose c 32 cases, depending on the meters, acrylic esters tabor phenolic + 56 cases on meters ester. All patients are chosen for the muscle relaxant muscle relaxants depolarization. 2. Surgery and liquid discrepancy quantity: operation time 80 ~ 260min (plus or minus 24.43 min); taller Peri-operative bleeding 50 ~ 2400ml (397.1 + 470.2 ml); Urine output 642.7 + 100 ~ 2000ml (580.12 ml); Transfusion amount 4200ml (2096.9 + 10 ~ 726.04 ml), including crystalloid and colloid liquid ratio is 1.8 + 0.71:1, blood transfusions 0 ~ 1200ml.3. Hormone application: all patients 65 cases (65%) intraoperative use methyl- prednisone (MP) 40mg intravenous drip, other 35 patients (35%) perioperative also are applied the MP for treatment.4. Perioperative haemodynamic change and processing: all patients have 26 patients (26%) already happened before bradycardia (heart rate < 60 times/min), 5 patients (5%) heart rate < 50 times/min. Because all patients are used routinely atropine before when induction of general anesthesia 0.5 mg, didn't appear bradycardia phenomenon. This patient had 12 patients (12%) in > 100 times the heartbeat when intubation, after intubation/min heartbeat is back to normal. Anesthesia maintain procedure has 43 cases (43%) heart rate < 60 times/min, including 16 cases (37.2%) hemodynamic changes affect, give atropine 0.5 mg blood pressure returned to normal after the heart, not for processing the 27 cases.This patient home base mean arterial pressure (MAP) in 80 ~ 114mmHg (plus or minus 10.05 mmHg), from after the induction of general anesthesia 9 cases (9%) MAP fell more than basic value 30%, give rehydration and vascular blood pressure returned to normal after the active drug induced by the drop in blood pressure in patients after 6 cases (66.7%) composite craniocerebral trauma, 7 cases (77.8%) for completeness spinal cord injury, 3 cases of (30%) emergency surgery, 5 cases (55.5%) > 60 years old age. Anesthesia maintain procedure in 48 cases (48%) MAP based value fell by more than 30%. Many and operation hemorrhage, a change of position (a), patients emancipated prone state and the cardiovascular function, the analysis about the depth of anesthesia was a circumstance to give quick infusion colloid solution and blood pressure drug vascular activity returned to normal. There are 38 cases of patients with group (38%) intraoperative use continuous pump injection dopamine.5. Anesthesia recovering after: surgery transferred to 78 cases PACU postoperative recovery room (anesthesia) and 12 cases of critical care (transferred to emergency EICU), 10 cases of such patients awake, intraoperative Picasso breathing, muscle good or with preoperative diameter decannulation, back to orthopaedic care monitoring vital signs. 78 patients forwarded to PACU patients, they spend time in 25 ~ 160min (67.1 + 31.66 min). 2 cases of patients with surgery and underwent anterior portion regional bleeding, timely back to the operating room bleeding. 1 case patients because the road before and after joint°C temperature too low 33.3 revive delay happened.Conclusion: Traumatic cervical spinal cord injury patients'cervical poor stability, head and neck activity constraints, meanwhile hemodynamic instability still can make spinal cord blood flow and spinal cord artery perfusion pressure further reduced. And direct impact on narcotic process treatment effect and prognosis, so perioperative anesthesia the main processing and operation of the key is:1. Choose appropriate cannula methods, avoid inducing, intubation process processes improper, aggravating spinal cord secondary injury.2. Through the liquid treatment, vascular active drug application, avoid perioperative period in patients with low blood pressure, ensure sufficient supply of spinal cord blood.3. Application with spinal cord protection drugs, such as propofol, relying on meters esters, lidocaine, corticosteroids, etc.4. Cautious strict grasp decannulation indications pay close attention to life signs after extubated the change.