Effect of target controlled infusion of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy

Abstract

Objective To evaluate the effect of target controlled infusion (TCI) of Remifentanil com-bined with cervical plexus block in patients with bilateral subtotal thyroidectomy.Methods 30 cases of ASA Ⅰ～Ⅱ patients with selective bilateral subtotal thyroideetomy,the ages between 30 to 64 years old, received TCI of Remifentanil after satisfactory cervical plexus block 5 minutes before operations.Initial target plasma concentration was 1.6ng/ml.During operation, adjusted the target concentration according to the patients? situation and the stimu-lating intensity, increasing or decreasing of 0.2ng/ml by degrees every time, until reached the Ramsay sedation scale at 2～3 score.. Or, the sedation reached verbal pain scores (VPS) at 0～1 score. Then, the patients were stopped taking the medicine 5 minutes before the end of operation. Recorded the mean arterial pressure (MAP), heart rate (HR), pulse,oxygen saturation (SpO2), Ramsay sedation scale, and VPS at the time before cervical plexus block (T0), the time after cervical plexus block (T1), 5 minutes after operation(T2), 30 minutes after operation(T3), trachea were pulled in evidence(T4), and at the end of operation (T5).Recorded the appearance adverse reactions including: respiratory inhibition, muscles stiffness, nausea and vomitting, Itch of skin, etc.And, recorded the biggest plasma target con-centration and calculated the average plasma target cnncentration.Results Comparing with T0,the MAP, SpO2 at every time was short of statistic significance (P>0.05), Ramsay sedation scale and VPS began to hoist at T2, reached pinnacle at T3, T4, and descended at T5(P<0.05), all Ramsay sedation scale at 2～3 score and VPS at 0～1 score. The effect of sedation and analgesia were excellent. There was no adverse event occurred. The final plasma target concentration of Remifentanil was 1.6～5ng/ml.The maintained average concentration was (3.4±1.0)ng/ml.Con-clusions The effect of target controlled infusion (TCI) of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy is safe. It can reach the purpose of analgesia with waking state, and there is no apparently adverse event occurred. Key words: Cervical plexus; Nerves block; Remifentanil; Thyroid gland