| ObjectiveTo avoid the recurrent laryngeal nerve injury, nerve monitoring is essential in the thyroid surgery. The muscle relaxants can significant influent the muscle electrophysiology. The current study was designed to observe the different doses of rocuronium on recurrent laryngeal nerve monitoring during thyroidectomy.Data and methods1. Materials:Ninety patients in Qilu Hospital of Shandong University from January to May2013, ASA grade I～I were enrolled in this study.The patients are aged from20to67years old, weigh from51to76kg,18male and72female. All patients with hyperthyroidism, severe hypertension, cardiac insufficiency, hepatic insufficiency, renal insufficiency, diseases of endocrine system and nervous system were excluded in this study.2. Technique:All patients were performed general anesthesia with endotracheal intubation. The endotracheal tubes were the standard Never Integrity Monitor (NIM) type, produced by American Medtronic, Inc. The anesthetic induction were midazolam0.05mg/kg, propofol1.5-2mg/kg, fentanyl3ug/kg, rocuronium bromide0.3mg/kg (Group A),0.6mg/kg (Group B) and0.9mg/kg (Group C). After endotracheal Intubation, the patients should be given mechanical ventilation by anesthesia respirator. Sevoflurane (1-1.5%) was used for anesthetic maintenance. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded. The intubation conditions were compared with Cooper’s scoring,8-9scores are excellent,6-7scores are good,3-5scores are normal and0-2scores are bad. The time from the injection of muscle relaxant to recurrent laryngeal nerve testing was also recorded.3. Nerve monitoring:The blue centre of Never Integrity Monitor (NIM) tracheal tube was placed in the vocal cords through indirect laryngoscope. The reference electrodes were to be inserted in the shoulder muscle of patients. The time from muscle relaxant being dosed to the start of nerve monitor, TOF numbers and the amplitude variation of recurrent laryngeal nerve (the monitor is effective when the amplitude variation is more than100uV) were recorded respectively.4. Statistical analysis:The software SPSS13.0was used in analyzing measurement data, which was expressed as Mean±SD. The one-way analysis of variance (ANOVA) was used among groups and the enumeration data is compared through X2detection. The p<0.05was considered significant.Results:There was no significant difference in the sex, age and weight among the three groups’ patients. All patients’ blood pressure and heart rate were lower in post-dose than in pre-dose, whereas higher after intubation. There were no significant difference in SBP and DBP between Group B and Group C (P>0.05). However, the blood pressure and heart rate after intubation in Group A were obviously higher compared with the other two groups (P<0.05)Five patients bucking and body moving were observed in Group A when were inserted the tubes. The TOF value was12±6%and intubation excellent rate was only23%in Group A, while the TOF value was0and the intubation excellent rates were93%and96%in Group B and C, respectively.The lowest TOF in Group A was3, so the time from TOF to the first muscle twitch was zero. In Group B, it needed32±12min to recover one muscle twitch and39±13min to recover two muscles twitch, and it took48±13min to recover one and55±1muscle twitch4to recover two muscles twitch in Group C.It took40±8min from muscle relaxants dosed to the start of recurrent laryngeal nerve detect for all the patients. According to the study, when all the patients’ TOF were zero, the recurrent laryngeal nerve couldn’t be detected. When the first muscle twitch was detected, myoelectric activities could be detected; when two or more than two muscle twitch were detected, we could find myoelectric activity of recurrent laryngeal nerve on every patient and the voltage was more than300mv.The patients in group A were all detectable, but nine of them moved their bodies during operation and needed to deepen sevoflurane to complete the operation.28patients in group B were detectable while the rest two patients could be detectable after seven minutes or so. During operation, there were no body moving and deglutition during the operation. In Group C,11patients were detectable and19patients could be detectable after8-20min. There were no body moving and deglutition during the operation.Conclusion:Double ED95rocuronium bromide can fit the needs of anesthesia induction and operation without influent the monitoring of recurrent laryngeal nerve, it can be used for intraoperative nerve monitoring during thyroid surgery. |
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