The Optimal Additional Dose Of Cisatracurium In Recurrent Laryngeal Nerve Monitoring Anesthesia

Objective: To avoid recurrent laryngeal nerve injury during thyroid surgery,nerve monitors are often used to monitor and locate the nerve.The use of muscle relaxation drugs during general anesthesia can interfere with nerve monitoring,but too low dose may cause swallowing or body movement during the operation,increasing the risk of surgery.The aim of this study was to investigate the optimal supplemental dose of cisatracurium benzoylate in endoscopic thyroid surgery.Method: In this experiment,sequential method was used to administer the drug,and the concentration gradient was set at 0.01mg/kg.This experiment requires at least six nadir points to occur at the end of the experiment.We selected ASAI-II patients who underwent endoscopic thyroid surgery in The Fourth Affiliated Clinical Hospital of Xinjiang Medical University from April 2020 to November2020.All patients received conventional anesthesia induction,intraoperative propofol and remifentanil were maintained intravenously,without the use of inhaled anesthesia.Maintain PETCO2 between 30-35 mm Hg and BIS between 40-60.Intraoperative TOF was performed to monitor the muscle block.T2 and amplitude V2 were recorded when TOF returned to 100%,and then muscle relaxation was added,and amplitude V3 was measured3 minutes later.According to the preliminary experimental results,the additional dose in the first case was 0.04mg/kg.If V3 was greater than V2,the concentration gradient of the additional dose in the next case would be increased by 0.01mg/kg until V3 was less than100 uv.then the concentration gradient of the additional dose in the next case would be decreased by 0.01mg/kg.Results: The recovery degree of TOF increased with the increase of time.Probit modified sequential method obtained that the ED50 of additional muscle relaxation was 0.025(0.022～0.028)mg/kg,and the ED95 was 0.42(0.039～0.045)mg/kg.Conclusion: When 0.025(0.022～0.028)mg/kg was used as the additional dose,satisfactory muscle relaxation effect could be obtained in the operation without affecting the intraoperative nerve monitoring.