Anesthetic considerations for patients with acute cervical spinal cord injury

Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures.To this end,anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan.Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews,consider cervical spinal cord movement and compression during airway management,and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations.During induction,anesthesiologists should avoid hypotension and depolarizing muscle relaxants.Mean artery pressure should be maintained within 85–90 mmHg（1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management）.Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained.Intraoperative neurophysiological monitoring is a useful option.Anesthesiologists should be attentive to postoperative respiratory insufficiency（carefully considering postoperative extubation）,thrombus,and infection.In conclusion,anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.

Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naive Adult Patients

Background： Intravenous （IV） oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose （ED50） and the 95% effective dose （ED95） of an IV bolus ofoxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone. Methods： Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon＇s up-and-down method was used to obtain ED50, data for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men （step size was 0.01 mg/kg）. Next, a dose-response curve from the probit analysis was generated to determine the ED50 and ED95 to blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 ,in before propofol injection. Results： Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED50, and ED95 of oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg （95% confidence interval [CI], 0.220-0.328 mg/kg） and 0.357 mg/kg （95% （21, 0.297-2.563 mg/kg）, respectively. In men, the ED50 and ED95 were 0.324 mg/kg （95% CL 0.274-0.381 mg/kg） and 0.454 mg/kg （95% CI, 0.384-2.862 mg/kg）, respectively. Men required 28% more oxycodone than women for induction （P 〈 0.01 ）. The most common adverse events were dizziness （87.3%）, vertigo （66.7%）, sedation （74.6%）, and respiratory depression （66.7%）. Conclusions： Oxycodone can be used for induction to prevent intubation reactions. Gender affected the ED50 and ED95 ofoxycodone for blunting the tracheal intuhation reaction.