Effects Of Cis-atracurium Besilate For Injection On The Electroencephalogram In Patients Undergoing Intracranial Aneurysm Surgery

Objective:To observe the effect of different doses of cis-atracurium besilate on motor evoked potential in patients with intracranial aneurysm surgery.Methods:Forty-eight patients,male or female,aged 18-70 yr,ASA physical statusⅠorⅡpatients,Hunt-Hess physical status 0-Ⅱ,weighted45⁹0 kg,with BMI<30kg/m²,acceptted intracranial aneurysm surgery under motor evoked potential.Those patients were randomly assigned to four groups（n=12 each）.Anesthesia was induced with mindazolam 0.05mg/kg,sufentanil 0.3μg/kg,cis-atracurium 0.15mg/kg,propofol 1.5-2.5mg/kg or etomidate 0.1-0.15 mg/kg.Under BIS 45-55,anesthesia was mained with propofol 3-5mg/（kg·h）,remifentanil 0.1-0.3μg/（kg·min）,cis-atracurium0.625μg/（kg·min）（groupⅡ）、0.833μg/（kg·min）（groupⅢ）,1.000μg/（kg·min）（groupⅣ）and the same quantity of physiology saline（groupⅠ）.The incidences of HR,MAP,TOF,motor evoked potential,airway pressure,spontaneous breathing and body movement at body movement at each time point,for example,Intravwntricular（T₁）,opening dura mater（T₂）,clipping of intracranial aneurysm（T₃）,closing cerebral dura mate（T₄）,were observed and recorded.Results:1.There was no significant difference between the general conditions of four groups（P>0.05）.2.Hemodynamic change:HR:There was no significant difference among the four groups.MAP:Compared with groupⅠ,groupⅢat T₃ and T₄significantly reduced（P<0.05）,groupⅣat T₄ significantly reduced（P<0.05）.Compared with T₁,T₂ in groupⅠandⅡsignificantly reduced（P<0.05）,T₃ in groupⅡandⅢsignificantly reduced（P<0.05）,T₄ in groupⅡsignificantly reduced（P<0.05）.Compared with T₂,T₄ in groupⅠsignificantly increased（P<0.05）.3.Four groups of patients with the comparison of TOF:Compared with GroupⅠ,groupⅢsignificantly reduced at T₃ and T₄（P<0.05）,groupⅣsignificantly reduced at T₂,T₃ and T₄（P<0.05）.Compared with GroupⅡ,groupⅢsignificantly reduced at T₃ and T₄（P<0.05）,groupⅣsignificantly reduced at T₃ and T₄（P<0.05）.Compared with T₁,T₂ significantly reduced in GroupⅢandⅣ,T₄ significantly reduced in GroupⅢandⅣ（P<0.05）.4.Motor evoked potentials were induced in all groups at all times.5.Four groups of patients with the comparison of airway pressure:GroupⅡcompared groupⅢat T₂（P﹤0.05）.There was no significant difference among other groups（P>0.05）.6.Four groups of patients with the comparison of body movement and autonomous repiration:There was one case,groupⅠat T3,restoring autonomous breathing.There was one case,groupⅠat T4,appearing body movement.However,there was no significant difference among the four groups（P>0.05）.Conclusions:With the monitoring of motor evoked potentials,after TOF backing and the motor evoked potentials leading,there were two groups continuous pumping cis-atracurium 0.833μg/（kg·min）（groupⅢ）and1.000μg/（kg·min）（groupⅣ）satisfying operation requirements.Using these dose had no significant effect on motor evoked potential monitoring and effectively reduced the TOF.It made the circulatory system more stable and reduced potentially risk of the occurrence of spontaneous breathing and body movement.In summary,this measure will increase the safety of surgery.