Total Intravenous Anesthesia And Inhalation Anesthesia On The Comparative Study Of Thyroid Surgery

Objective:To observe the needs of the recurrent laryngeal nerve monitoring in thyroid surgery, do not use muscle relaxants in the case of target-controlled infusion of propofol total intravenous anesthesia with sevoflurane anesthesia comparative study.Methods:from May 2010 to December 2010 in our hospital for elective thyroid surgery 80 patients, ASA grade (American Society of Anesthesiologists physical status classification of patients) I～II level, heart function I II level,25 cases were male, female,55 were aged 23 to 65 years old, weighing 42～85 kg, BMI 20～25kg/m2, all patients had no hyperthyroidism, severe hypertension, heart, liver dysfunction, endocrine system and nervous system diseases. Experiment were randomly divided into two groups, each group of 40 people, total intravenous group (A group), inhalation anesthesia group (B group). A group of anesthesia induction:The DiprifusorTCI System Administration, enter the patient's age, weight, TCI propofol target plasma concentration of 4 u g/kg, midazolam (midazolam) 0.02～0.05mg/kg, sufentanil (sufentanil) 0.4～0.6μg/kg, rapid intravenous induction. NIM is inserted after the full effect of drug tracheal tube during operation according to the situation, adjust the propofol target plasma concentrations. Group B Induction of Anesthesia:midazolam (midazolam) 0.02～0.05mg/kg, sufentanil (sufentanil) 0.4～0.6ug/kg, propofol (propofol) 1.5～2.0 mg /kg, rapid intravenous induction, the full effect of drugs after tracheal tube insertion NIM, surgery according to the situation, adjust the inspired concentration of sevoflurane. A group of skin closure, stop the propofol infusion, B group skin closure, sevoflurane stop. The two groups do not use during surgery antiemetic. After entering the operating room routine monitoring of patients with systolic blood pressure (SBP), diastolic blood pressure (DBP), electrocardiogram (ECG), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PECO2). Intraoperative continuous monitoring of bispectral index (BIS). Intubation, two groups of patients observed before induction (T1), induction (T2), intubation (T3), after intubation lmin (T4) surgery when interim View Chaqie Pi (T5), after skin incision 5min (T6), after skin incision 30min (T7) observed two groups of patients with extubation spontaneous breathing is restored (T8), immediate extubation (T9), after extubation 5min (T10),10 periods of the SBP, DBP, HR, and recovery period without agitation and sense of recovery. And in Tl-T9 patients with arterial blood collected at each time point measurement of plasma cortisol levels and blood sugar. Presented for normal circadian rhythm of cortisol secretion and plasma cortisol concentrations for the morning the highest realization, and to 10μg/(L·h) the rate of decline, all patients were selected the first morning of elective surgery patients. The first day after surgery were also recorded whether the nausea and vomiting (PONV). Statistical analysis using statistical software SPSS13.0 processing, measurement data using mean±standard deviation (x±s), said group data were compared with repeated measure analysis of variance between groups of data were compared with paired t test, p<0.05 that the difference was statistically significant.Results:1. general information on the two groups were differences between groups was not significant (P> 0.05).2. after induction (T2) two groups ofatients with SBP, DBP, HR has decreased, and the T1 was statistically significant (P<0.05), but differences between groups was not significant (P> 0.05).3. tracheal intubation (T4) of stimulation, B group SBP, DBP, HR increased significantly compared with T1 was statistically significant (P <0.05), deepening anesthesia, blood pressure, heart rate decreased. The patients in group A in the SBP, DBP, HR is relatively stable, which can be restored to the level of T1 (P> 0.05).4. end of surgery, anesthesia extubation (T8), B group SBP, DBP, HR were significantly increased compared with the Tlwas significantly (P<0.05).5. before induction (T1) no significant difference between two groups of BIS after induction (T2), after intubation lmin (T3) to the end of surgery, BIS was significantly decreased (P<0.05) were statistically significant. lmin after intubation, BIS groups and restoration of spontaneous breathing (T7) A group was significantly lower than B group (P<0.05).6. B group T5 moment Cor, BG were higher than A group, the difference was statistically significant (P<0.05).7. Induction time, recovery time and extubation time between the two groups was not significant.Conclusion:do not use muscle relaxants in the case of the controlled infusion of propofol during surgery can make patients more stable hemodynamics and reduce the stress response produced by trauma, so that induction of anesthesia and extubation of the more smooth and improve the quality of anesthesia.