| Objective: The aim is to compare with extubation reactions, postoperative adverse reactions and recovery time between desflurane and sevoflurane in obese patients undergoing nerve monitoring complexity thyroidectomyMethod: A total of obesity 60 cases aging between 32~60 were selected, randomly divided into 2 groups, namely Desflurane Group(30 cases) and Sevoflurane Group(30 cases). Check up the anesthesia machine in the operating room before the patient arrived. The narcotic drugs and items are prepared. Rescue medication and vasopressors are ready. Make sure not to rush the process of anesthesia. Patients were required for anesthesia detection,such as ECG 、 blood oxygen saturation、blood pressure(performed the invasive monitoring of radial artery when necessary) 、 BIS 、 PETCO2.Patients come to the operating room and are opened peripheral venous access, preoperative medicine is penehyclidine 0.5mg(ten minutes before anesthesia induction by titrator).The patients all accepted complexity thyroidectomy under general anesthesia. After entering the operation room, patients were given preoperative care and oxygen. Induction of anesthesia was achieved in all patients with by 1ED95 rocuronium bromide 0.3 mg/kg, midazolam 2 mg, propofol 2 mg/kg and sufentanil 0.5 μg/kg. Excessive ventilation 5 minutes later, make the concentration of the muscle relaxant peak for endotracheal intubation.The drugs facilitate tracheal intubation with special endotracheal tube of nerve monitoring function., then mechanical ventilation, tidal volume 8~10ml/kg,respiratory rate12/min(an adjustment may be needed for the surgery accordingly), then open the inhalation anesthetics. Multifunctional monitor is used to continuing monitoring non-invasive blood pressure(NIBP), heart rate(HR),ECG, blood oxygen saturation.Inhalation anesthetics were used for maintenance of anesthesia, and 1.2~1.4 MAC of desflurane or sevoflurane maintained the anesthesia. Stopping medication after surgery, we recorded the moment when spontaneous breathing recovered, the time to open the eyes, the time to follow instructions, extubated time and the time to recover the orientation. We also recorded the blood pressure and heart rate at the extubated time, 1 minute, 2 minutes, 3 minutes and 4 minutes after extubation. OAA/S score was accessed 5min, 10 min, 20 min and 30 min later after extubation. The patients were observed whether they had cough, nausea or vomiting. The patients who had the sore throat and the result of the fiber electronic laryngoscopy were recorded postoperation. SPSS 20.0 software was used to analysis results in this study.Results: There were no statistical differences in age, BMI index and operative time. Desflurane Group showed significantly shorter time in spontaneous breathing recovery, opening eyes, following instructions, extubated time and the orientation recovery than Sevoflurane Group(P<0.05). It is shown that no statistically significant differences in the OAA/S scores at different time points(P>0.05). Patients in 2 groups showed similar tendency in heart rate and mean arterial pressure from extubation time to 4 minutes later after. There’s no difference between the incidence of patients in 2 groups showing cough, nausea, vomiting and other side effects. No statistically differences were recorded in fiber electronic laryngoscopy test and sore throat.Conclusion: Compared with sevoflurane, desflurane has a certain clinical application advantages applying in obese patients with nerve monitoring complexity thyroidectomy, showing that recovery time and extubation time shortened obviously. |
PDF Full Text Request