| Brain regions surgery is one of the challenges faced by the neurosurgery clinical physicians, is also the focus of the21st century global nerve surgery to solve one of. Maximize the diseased control seizures, as much as possible to protect normal brain tissue around the lesion is the developing direction of modern neurosurgery, and is also a new strategy of brain functional area surgery, namely to solve lesion resection extent and patients neurologic trade-offs between to shield.Epilepsy surgery epileptogenic zone of the functional areas of the origin of tumor, should be completely removed, but the ribbon lesions, performer should not only know what place is the cutting, need to know which parts can’t be cut.Therefore, intraoperative awakens the precise epileptogenic zone localization becomes the key to successful operation.With the development of imaging, minimally invasive surgery technology, neurosurgery is becoming more and more meticulous, especially involving the functional areas of brain tumors, epilepsy, vascular malformation, such as surgery, as well as resection of lesions, as much as possible to retain maximum normal brain tissue and to avoid the damage of nerve function, therefore, accurate positioning brain regions is the key.Although locating method is diversiform, but as a result of brain tissue after lesion anatomy shift and individual differences, to movement, sensory and intraoperative localization of language area still to awaken and electrical stimulation under the condition of patients and doctors to communicate as the gold standard. If under general anesthesia endotracheal intubation or placement laryngeal mask airway when wake up, all needs to pull out the endotracheal tube or laryngeal mask, waiting for monitoring and positioning to end in the placement, not only has not safe risk, and the operation is very inconvenient, encounter emergencies such as seizures in a difficult and difficult to handle.In order to improve the safety of anesthesia and convenient operation, and solve the implementation of the general anesthesia can maintain good ventilation, and can be awakened in patients after pronunciation speech cerebral function positioning this problem, we conducted a series of research, developed the pharyngeal cavity catheter (Ⅰ) of the esophagus, esophagus, nasopharyngeal cavity catheter (Ⅱ) and attract catheter nasopharyngeal cavity catheter (Ⅲ) of the esophagus. All three types of ventilation equipment, the successful development and application of the glottis, solved:(1) Good ventilation effect to ensure the implementation of the safety of the general anesthesia, that is to say, in the brain regions after the start and operation of two stages to the safety of general anesthesia, to ensure that patients have enough sedation analgesia and muscle relaxation, conditional execute surgical craniotomy, epileptogenic zone resection of tumor, or brain lesions such as vascular malformation;(2) The airway and pronunciation organs non-hold in patients awake can speak pronunciation, and communicate with the doctor, so as to realize accurate positioning of brain regions, which solved the contradiction between ventilation and speech;(3) The esophagus is a closed to avoid the reflux and aspiration of gastric contents, and attract the catheter can prevent the tube side hole is plugged, discharge to ensure that the catheter unobstructed;(4) Convenient operation simple, catheter balloon inflated is feasible after mechanical ventilation, wake expel gas in pharyngeal airbags, patients can talk, don’t need to repeatedly drawing tube intubation, reduce the risk of airway control;(5) Condition changes for emergency treatment, such as seizures, can be an immediate sedatives or nondepolarizing agent, the mechanical ventilation and airbag filling line implement general anesthesia or other emergency treatment, greatly improved the safety of anesthesia.Dexmedetomidine (DEX) is powerful alpha2agonists adrenaline.Alpha2adrenergic receptor mainly distributed in the sympathetic nerve endings and adrenaline neurons of the central nervous system, after being stimulated can inhibit the release of norepinephrine.Its microphones set right as a new selective alpha2agonists adrenaline has sedative and analgesic and anti anxiety, and so on. Work fast, time is short, both sedative and analgesic action and no respiratory inhibition is its greatest advantage compared with other traditional sedative drugs, dexmedetomidine under fixed role mainly in cortex, does not involve gamma-aminobutyric acid (GABA) system, so does not harm the cognitive function, not interfere with the cortical eeg examination results, will not affect the cortex localization and function test, its unique "conscious sedation", similar to the nature of non-rem sleep, in the case of no stimulation in patients with sleep state, but easy to be awakened verbal stimuli, and cooperation and communication with medical staff, stimulate go off to sleep again, and almost no inhibition for breathing.Now think of DEX sedation does not affect the electrophysiological monitoring functional neurosurgery.DEX also has stable hemodynamics, restrain stress reaction, reduce the dosage of anesthetic and opioids and chills, and so on.The above characteristics are suitable for the brain functional areas in awakening.These features make the wake up time is significantly longer than propofol, adverse reactions decreased significantly, and more stable hemodynamics during the wake up.DEX reduces the choking cough and the number of the happening of the body to move, let patients more comfortable during the wake up, it also can reduce intracranial pressure and improve the safety of the operation.In clinic, especially in recent years more and more application of dexmedetomidine were used during neurosurgical brain regions anesthesia.The Esophageal nasopharyngeal catheter which is a Ventilation equipment that can speech outside the ventilation device.Objective: To evaluate the self-developed to address the noise outside the ventilation equipment-Ventilation ducts of esophageal nasopharynx effects and speech function. Methods: No.6.5endotracheal tube of the front opening closed catheter tip with Cuff,8～10cm away from the top office with a cuff, the conduit between the two capsule on the open side of6holes. Catheter through the nose after the nose to the posterior pharyngeal wall, front-end into the esophagus, the side openings in the hypopharyngeal cavity, the upper and lower ends may also be closed after the balloon inflated esophagus, nasopharynx and oropharynx, catheter outside the mouth and the anesthesia machine to connect. Gas catheter side holes into the hypopharyngeal cavity, can only be formed through the glottis into the respiratory tract to achieve a closed breathing circuit and ventilation. Clinical anesthesia for laparoscopy in20cases, brain areas anesthesia in6cases, observed effects of ventilation and speech. Results:26patients with catheter smoothly, once in place, gas leakage0-56ml, an average of26±10ml, airway pressure of12-25cmH2O, an average of16±4cmH20. Blood gas analysis, normal, clear speech, fluent, can answer questions in accordance with instructions. Conclusion: Esophageal nasopharyngeal catheter is a new sound with a tube to the speech outside the ventilation device. After the catheter can be tightly closed esophagus, nasopharynx and oropharynx, the basic activity is not limited head and neck, with good ventilation effect, when the upper airbag exhaust the speech with the word spit clear, fluent in the language areas of brain function can meet Intraoperative wake-up, according to the needs of the speech pronunciation instruction.The application of dexmedetomidine in the anesthesia of the brain functional areas surgery.Objective: Study the feasibility of the application of dexmedetomidine in the anesthesia of the brain functional areas surgery, and compare the appropriate dosage that neither affect electroencephalogram nor brain functional areas electrophysiological monitoring. Methods:60patients with ASA Ⅰ-Ⅱ selective cerebral functional area surgery, male34cases, female26cases, ages18to45years old,40～74kg weight. Using the random number table method, the random is divided into four groups (n=15). The control group (group C) intravenous injection saline10ml/h, the dexmedetomidine group intravenous injection respectively0.25μg·kg-1·h-1(group D1),0.5μg·kg-1·h-1(group D2),1μg·kg-1·h-1(group D3). Three groups of intravenous loading doses within15min. And then respectively with the rate0.25μg·kg-1·h-1、0.5μg·kg-1·h-1or1μg·kg-1·h-1until the end of surgery by intravenous infusion. Intraoperative propofol, remifentanyl, cis-atracurium by vein to maintain anesthesia, according to the BIS index to adjust the depth of anesthesia,reducing propofol and starting the saline or dexmedetomidine infusion before monitoring. Records of electroencephalogram and electrophysiological monitoring of the situation, the dosage of propofol, remifentanyl, cis-atracurium, recovery times, the changes of blood pressure, heart rate and the occurrence of adverse reactions intraoperative. Results: Compared with group C, Dl, D2and D3group BIS value has significantly decreased (P<0.05); ECoG of group C is higher, the inclusion of the interference wave is more, sometimes visible propofol caused the outbreak of the inhibition; ECoG from the previous three groups amplitude D3group was obviously low;D1and D2set of ECoG amplitude is moderate. Conclusion: Brain function lesion resection in patients with epilepsy in anesthesia appropriate ECoG and electrophysiological monitoring right beautiful mi fixed dose range is O.25μg·kg-1·h-1and0.5μg·kg-1·h-1, more suitable for the brain functional areas of focal epilepsy surgery anesthesia.The clinical use of dexmedetomidine in the wake-up surgery of brain function language areas.Objective: To observe the effects of the α2adrenaline receptor agonists-Dexmedetomidine (DEX) used in the wake-up surgery of brain function language areas. Methods:There were20patients of ASA Ⅰ～Ⅱ the brain function language area surgery with general anesthesia. During the operation, timely discontinuation the use of anesthesia drugs, and only use the Dexmedetomidine0.1～0.2ug/kg·h and Remifentanyl0.05ug/kg·min to maintain, then wake up the patients and keep patients awake. Observation the awake time and the BP, HR, intracranial pressure, the clarity of the speech, the effects of complete instructions and adverse reaction. Results:All the20cases were awaked in10min after discontinuation the use of drugs with clear and smooth speech, complete instructions, no obvious adverse reaction. And the operation effects were good. Conclusions:Dexmedetomidine used for the brain function language area of intraoperative awaken general surgery with the advantage of easy to control and awaken, the patients’ good cooperation, slight circulation and respiratory disturbance. |
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