Effects Of Different Doses Of Cis-atracurium On Motor Evoked Potentials During Intracranial Tumor Resection

Objective:To investigate the effects of different doses of cis-atracurium on the quality of MEP,hemodynamic stability and the incidence of body motion in patients with intracranial tumor resection during continuous anesthesia maintenance.Methods:Sixty patients undergoing neurosurgery receiving?MEP?monitoring at the First Affiliated Hospital of Nanchang University were randomly divided into 3groups?n=20each?.D1 group:anesthesia maintenance period pumping cis-atracurium0.5ug·kg^-1·min^-1;D2 group:anesthesia maintenance period pumping cis-atracurium0.7ug·kg^-1·min^-1;Group N:control group,didn't apply muscle relaxant after induction of anesthesiae.HR,MAP,SPO2,and BIS values were recorded when the patient entered the room?T₀?,when the skin was cut?T₁?,when the tumor was completely resected?T₂?,at the end of the operation?T₃?,and immediately after extubation?T₄?;Before the muscle relaxant?H₀?,when the dura mater was cut?H₁?,after the dura mater was cut for 1 h?H₂?,the tumor tissue was cut?H₃?,the MEP amplitude and latency induced by the transcranial electrical stimulation of the thenar muscle were also recorded.Record TOF count of muscle relaxation degree in H₁,H₂and H₃ in groups D1 and D2,and the success rate of MEP monitoring.Dose of propofol in anesthesia maintenance period;patient recovery index and perioperative adverse reaction were also recorded.Results:There were no significant differences in gender,age,weight and operative time between the three groups?P>0.05?.Compared with T₀,HR and MAP were increased at T₁,HR and MAP were decreased significantly at T₃?T₄ in group N,HR and MAP were increased at T₁ in groups D1and D2?P<0.05?;compared with groups D1and D2,HR and MAP were decreased at T₃?T₄ in group N?P<0.05?.The amount of propofol in group N was higher than that in group D1 and D2?P<0.05?.Compared with H₀,the amplitudes at H₁,H₂,H₃ in groups D1 and D2 were significantly decreased,the latency of MEP at H₁,H₂,H₃ in group D2 was increased?P<0.05?;compared with group N,the amplitude at H₁,H₂,H₃ were decreased in group D1,at the same time,amplitude was decreased and the latency was increased?P<0.05?;compared with group D1,the amplitude at H₁,H₂,H₃ were decreased and the latency were increased?P<0.05?.There was no significant difference in the success rate of MEP between the three groups and TOF counts between the D1 and D2 groups at different time points were also no significant difference?P>0.05?.The recovery time,spontaneous breathing recovery time and extubation time of the groups D1 and D2were longer than those of the N group?P<0.05?;The incidence of hypotension and body motion in group N was higher than that in group D1 and D2?P<0.05?.Conclusion:During intracranial tumor resection by MEP,anesthesia was induced by intravenous injection of cis-atracurium 1.5 mg/kg,followed by 0.5 ug·kg^-1·min^-1,and satisfactory MEP waveform and blood flow were obtained during operation.The kinetics are stable and significantly reduce the incidence of body motion.