Effect Of Different Induced Doses Of Rocuronium On Recurrent Laryngeal Nerve Monitoring During Endoscopic Thyroidectomy

Objective To investigate the effect of different induced doses of rocuronium bromide on the monitoring of recurrent laryngeal nerve in endoscopic thyroid surgery.Methods A total of 116 patients who underwent complete endoscopic thyroid surgery through areolar approach were selected from October 2021 to October 2022 in the Cancer Hospital of Ningxia Medical University General Hospital,and recurrent laryngeal nerve monitoring was required during the operation.Patients were divided into three groups according to the dose of rocuronium bromide given during anesthesia induction.Group A was given 0.30 mg/kg rocuronium bromide(n=39),group B was given 0.45 mg/kg rocuronium bromide(n=39)and group C was given 0.60 mg/kg rocuronium bromide(n=38).Endotracheal intubation was performed under visual laryngoscope after induction under general anesthesia.At a Train of four stimulation(TOF)value of 0,a standard enhanced nerve monitoring endotracheal catheter manufactured by Medtronic was inserted(7.0# endotracheal catheter was selected for male patients,Female patients were treated with 6.0# tracheal catheter).TOF-Watch SX muscle relaxation monitor was used to monitor muscle relaxation throughout the operation.All patients in the three groups were treated with intravenous anesthesia to maintain the depth of anesthesia.No additional rocuronium bromide was added until the end of neurological monitoring.Observe and record the following indicators:(1)The time and EMG amplitude from intravenous administration of rocuronium bromide to first occurrence of recurrent laryngeal nerve EMG in three groups.(2)from the intravenous injections of the interaction between rocuronium to successful intubation time and endotracheal intubation conditions used score(Cooper ’s evaluation method).(3)Propofol and remifentanil doses consumed during the perioperative period.(4)HR,MAP and PI values of patients during anesthesia induction(T0),TOF value 0(T1),TOF value 25%(T2),TOF value 50%(T3),and TOF value 75%(T4).(5)Perioperative special conditions(hypotension,hypertension,bradycardia,tachycardia,intraoperative body movement,etc.).(6)postoperative throat pain,hoarseness,muscle pain is happening.Results(1)The mean time from intravenous injection of rocuronium bromide to the first monitoring of recurrent laryngeal nerve electromyogram in group A,B and C was 23.00±5.29 min,23.85±4.80 min and 25.61±5.39 min,respectively,and there was no significant difference among the three groups(P= 0.058).There was no significant difference between group B(787.46±293.46 μV)and group C(726.84±300.07 μV)from intravenous injection of rocuronium bromide to the first monitoring of the EMG signal of recurrent laryngeal nerve;The difference between group A(1060.74±388.21μV)and group B was statistically significant(P<0.001);The difference between groups A and C was statistically significant(P<0.001).(2)The mean time from intravenous injection of rocuronium bromide to successful intubation in group A,B and C was 191.38±16.11 s,129.41±23.90 s and 76.47±19.77 s,respectively,and the difference was statistically significant.The score of endotracheal intubation conditions in group A was compared with that in group B,and the difference was statistically significant(P<0.05);Comparison of tracheal intubation condition evaluation between groups A and C showed statistically significant difference(P<0.05);There was no statistical significance in the evaluation of endotracheal intubation conditions between groups B and C(P>0.05).(3)There was no statistical significance in the usage of propofol and remifentanil among the three groups(P>0.05).(4)Comparison of HR,MAP and PI values of patients at each time point showed no statistical significance(P>0.05).(5)Compared with the other two groups,patients in group A were more likely to have adverse events such as hypotension and bradycardia during perioperative period,and had a higher incidence of postoperative throat pain.Conclusion(1)In endoscopic thyroid surgery,0.30mg/kg rocuronium bromide enables the surgeon to observe the best recurrent laryngeal nerve myoelectric amplitude.(2)In endoscopic thyroid surgery,0.60mg/kg rocuronium bromide can achieve a shorter intubation time and a better intubation environment,while monitoring a better recurrent laryngeal nerve EMG signal.