Effect Of Cisatracurium Muscle Relaxation On Intraoperative Recurrent Laryngeal Nerve Monitoring In Patients With Thyroid Carcinoma Surgery

Objective:Study of cisatracurium maintain muscle relaxation effect on laryngeal nerve monitoring Methods:90 cases of thyroid carcinoma in No.1 Hospital of Jilin University for elective surgery were choosed from July 2016 to July 2017,aged 30-60 years old,ASA grade I-II,operation time in 1-2 hours,according to the maintenance dose of cisatracurium patients were randomly divided into three groups,30 cases in each group.Anesthesia was induced with midazolam 0.03mg/kg,fentanyl 3-4ug/kg propofol and cisatracurium 2-3mg/kg,0.1mg/kg,Narcotrend and <46 value after 3 minutes,tracheal intubation,laryngoscope(tracheal intubation for special laryngeal nerve monitoring catheter)and mechanical ventilation.Regulate VT(6-8ml/kg)and maintain end expiratory carbon dioxide 35 mm Hg-45 mm Hg.During the operation,micropump was used to pump propofol and remifentanil.In group A,no muscle relaxant was added during operation.B group was added with muscle relaxant 0.05mg/kg after 40 min induction,and C group was added with muscle relaxation 0.1mg/kg after 40 min.Records of three groups of patients with general information such as age,weight,sex ratio and operation time were recorded;when entering the operating room(T1),after induction of anesthesia(T2),intubation(T3),to the end of cisatracurium after 40min(T4),50min(T5),60min(T6),70min(T7)each time the SBP,DBP,HP;The time of electrical signal disappearance and the time of electrical signals were recorded after adding the muscle relaxant.The peak values of electrical signals of the recurrent laryngeal nerve in T4,T5 and T6 were recorded at different time points,and the number of body movements in each group was recorded.Results:There was no significant difference in the general data of the three groups,such as sex ratio,age,weight and operation time(P > 0.05).Compared with the T1 time,the T3,SBP,DBP and HP values of the three groups increased significantly.The T2,T4,T5,T6,T7 time,SBP,T6 and T7 values of the three groups were significantly decreased,the differences were statistically significant(< 0.05).B,C two groups T5,T6 time and T4 time,SBP,DBP,HP value did not decrease significantly,the difference was not statistically significant(P > 0.05).In group B,in 30 patients,1 patients lost the electrical signals after adding muscle relaxants.2 of the C group did not disappear,and the average time of electrical signals was 15.8 minutes.Compared with the T4 moment,T5 moment peak value of group B decreased significantly,T6,T7 time peak value increased significantly in C group at T5;only 4 cases of measured signals,T6,T7 time peak value decreased significantly;compared with A group,B group,T6,T5 in T7 time peak value decreased significantly,and A,B two groups,C group,T6 T7 time peak value decreased significantly,the differences were statistically significant(P < 0.05).In group A,there were 5 patients with body movement(16.67%),1 cases in group B and no group in group C.Conclusions:Maintenance of anesthesia dose 0.05mg/kg,95% effective dose(95percent effective dose,ED95)of cisatracurium can meet the operation need of muscle relaxation,and does not affect the monitoring of recurrent laryngeal nerve.