The Study Of Postoperative Residual Curarization Of Mivacurium Chloride In Elderly Patients

Objective:This study is in order to investigate the advantage of neuromuscular blockade recovery of Mivacurium venous infusion in elderly patients,the effect of Neostigmine on Mivacurium Chloride in postoperative recovery of elderly patients with anesthesia,and the relationship between muscle relaxant recovery and plasma cholinesterase.Methods:A total of 90 patients(64 males,26 females,aged 65~73 years,ASA grade I or II)who underwent laparoscopic surgery for gastrointestinal tumor under general anesthesia,were randomly divided into 4 groups.Patients in the studying group(group A,n=22)used Mivacurium Chloride and group(group C,n=20)used Cisatracurium Besilate were given a dosage of eostigmine 20 ug/kg after the end of surgery,and patients in contrast group(group B,n=24)used Mivacurium Chloride and group(group D,n=24)used Cisatracurium Besilate were given 0.9% saline solution.Monitored the contract reaction of adductor pollicis through train-of-four ratio(TOFR)by stimulating ulnar nerve.Record condition of recovery from neuromuscular blocked,untoward effect after operation,the activity of the plasmacholinesterase at the time of induction of anaesthesia and extubation.Results: The age,height,weight,BMI,operation time,infusion volume,hemorrhage,urine volume,postoperative temperature,postoperatively expired concentration of sevoflurane,the activity of the plasmacholinesterase,recovery score and sedation score had no difference(P>0.05).Activity decline of the plasmacholinesterase was obviously related with infusion liquid volume,while activity of the plasmacholinesterase before operation was obviously related with the activity of the plasmacholinesterase at the time of extubation(P<0.05),HR,SBP,MAP,DBP and CVP of the 4 group at the time of the induction of anaesthesia,the end of operation,extubation and 5 min,10 min after extubation had no difference(P>0.05).Group A was lower than group B and D obviously at the recovery of TOFR to 25%,25% to 70%(recovery index time),0% to 70%,70% to 90% and the time from stopping infusion to extubation.Group B was lower than group C and D obviously at the recovery of TOFR to 25%,25% to 70%(recovery index time),0% to 70%,70% to 90% and the time from stopping infusion to extubation.Group A was lower than group C obviously at the recovery of TOFR to 25%,to 70%,70% to 90%,recovery index time and the time from stopping infusion to extubation.The results were statistically significant(P<0.05).The TOFR of group A was higher than group B at the time of 5 min,10 min,30 min after extubation.The TOFR of Group A was higher than group C at the time of the end of operation.The TOFR of group A was higher than group D at the time of extubation and 5 min,10 min,30 min after extubation.The TOFR of Group B was higher than group D at the time of end of operation,extubation and 5 min,10 min,30 min after extubation.The TOFR of Group C was higher than group D at the time of 5 min,10 min,30 min after extubation(P <0.05).The difference of the incidence of TOFR < 0.7 of the Group A was lower than group B at the time of 5 min,10 min after extubation and the difference of the incidence of TOFR < 0.9 of the Group A was lower than group B at the time of 10 min,30 min after extubation.The difference of the incidence of TOFR < 0.7 of the group A was lower than group D at the time of extubation and 5 min,10 min,30 min after extubation,the difference of the incidence of TOFR < 0.9 of the group A was lower than group D at the time of 10 min,30 min after extubation.The difference of the incidence of TOFR < 0.7 of the group B was lower than group C at the time of 5 min,10 min after extubation,the difference of the incidence of TOFR < 0.9 of the group B was lower than group C at the time of 10 min after extubation.The difference of the incidence of TOFR < 0.7 of the Group B was lower than group D at the time of extubation and 5 min after extubation,the difference of the incidence of TOFR < 0.9 of the group B was lower than group D at the time of 30 min after extubation.The difference of the incidence of TOFR < 0.7 of the group C was lower than group D at the time of extubation and 5 min,10 min,30 min after extubation,the difference of the incidence of TOFR < 0.9 of the group C was lower than group D at the time of 10 min,30 min after extubation(P <0.05).The activity of the plasmacholinesterase(D1 and D2)appeared to be negatively related to the time of the recovery of TOFR to 25 %,recovery index time,to 70 %,70 % to 90 % and the time from stopping infusion to extubation,while D1 and D2 did not appeare to be negatively related to the TOFR at the time of end of operation,extubation and 5 min,10 min,30 min after extubation(P>0.05).Conclusion: The time of muscle relaxation recovery of Mivacurium Chloride was short and the incidence of PORC was low,there was obvious significance for Neostigmine to resume muscle force in Mivacurium Chloride postoperative recovery in the elderly patients.