Application Of Different Doses Of Mivacurium Chloramine On Recurrent Laryngeal Nerve Monitoring In Thyroid Surgery

Objectives:To observe the effect of different doses of mivacurium chloramine for recurrent laryngeal nerve in thyroid operation monitoring.Methods:We selected 90 patients undergoing elective thyroid cancer radical surgery,ASA grade were I ~ II.They were randomly divided into three groups,30 cases in each group.The patients are aged from 20 to 65 years old,BMI from 18 to 28kg/m2.All patients were performed general anesthesia with endotracheal intubation.The anesthetic induction were midazolam 0.05 mg/kg,propofol 2 mg/kg,sufentanil 0.4ug/kg,mivacurium 0.20mg/kg(Group M1),mivacurium0.25mg/kg(Group M2),rocuronium bromide 0.6 mg/kg(Group R).The muscles were monitored throughout the whole process using the TOF-GUARD muscle relaxation monitor.After maximal muscle relaxation was inhibited,Medtronic's standard enhanced trachea was inserted,and the depth of anesthesia was maintained throughout the total intravenous anesthesia.The basic vital signs at the time of induction(T0),maximum muscle relaxation(T1),Train of four stimulation(TOF)value of 25%(T2),and TOF value of 75%(T3)were recorded,and the time required for laryngeal nerve detection were recorded.The time of the first laryngeal nerve detection and the amplitude of myoelectric amplitude detected by the recurrent laryngeal nerve were recorded.The adverse reactions of each group were observed,and the intraoperative body motion and skin flushing were observed.Results:There was no significant difference in the general gender,age,and body mass index between the three groups(P>0.05);There was no significant difference in mean arterial pressure and heart rate between the three groups at each time point(P>0.05)The success rate of tracheal intubation was 100% in all three groups.There was no statistically significant difference in the intubation scores of the three groups(P>0.05).However,the intubation time of M1 group was statistically significant(P<0.05),and it is longer than the other two groups.There was no significant difference between M2 group and R group(P>0.05).There was no significant difference in the time between the three groups of patients from anesthesia induction to the use of the recurrent laryngeal nerve monitor(P>0.05).The difference of the amplitude of the myoelectric potential in the three groups was statistically significant(P<0.05),but the value of the R group was lower than the other two groups.There was no significant difference between the M1 group and the M2 group(P>0.05).There were no intraoperative body motions in the patients.There were 3cases of skin flushing in the group A and 2 cases in the group B.There was no skin flushing in the group C.The incidence of adverse reactions in each group was not statistically significant(P>0.05).Conclusion : A dose of 0.25mg/kg mivacurium can meet the needs of anesthesia induction and surgery without affecting the detection of recurrent laryngeal nerve.It is suitable for anesthesia of thyroid surgery for recurrent laryngeal nerve detection.