Abstract
Objective To investigate the effect of a single dose of cisatracurium induction on introperative recurrent laryngeal nerve monitoring nerve electromyographic signal.Methods Seventy-nine thyroid cancer or reoperative patients were divided into two groups:sevoflurane (group Ⅰ,n =40) and cisatracurium (group Ⅱ,n =39) by random.Proceed the muscle injection of penehyclidine hydrochloride 1 mg thirty minutes preoperative.Open the vein circuit after going into the operating room,routine monitoring electrocardiogram (ECG) and oxygen saturation (SpO2).Sevoflurane (group Ⅰ) were treated with midazolam 2 mg,propofol 2 mg/kg,sulfentanyl 0.5 μg/kg by vein,and manual control inhaled sevoflurane after patients lost consciousness.Insert the electromyographic (EMG) endotracheal tube with glidescope after the gas monitor showed twice macat at the end of breath.Cisatracurium (group Ⅱ) were treated with Midazolam 2 mg,Propofol 2 mg/kg,sulfentanyl 0.5 μg/kg and cisatracurium 0.05 mg/kg by vein.Insert the EMG endotracheal tube with glidescope 5 minutes later.Sevoflurane (group Ⅰ) insert the EMG endotracheal when the end of expiratory concentration reach 4 minimum alveolar concentration (MAC).Record the Cooper' s score for conditions of tracheal intubation in two groups.Both groups applied continuous sevoflurane inhalation to sustain,and intraoperative sustain the depth of anesthesia between 1.4 and 1.6 MAC.Record at the time of tube insertion,expose the vagus nerve within thirty minutes,use NIM-response 3.0 nerve EMG monitor from forty minutes,stimulate with 1 mA current,record the electromyographic signal every five minutes.Monitor forty-five minutes continuously and record the blood pressure and pulse at the same time.Results The Cooper' s score in two groups,group Ⅰ was8.6 ± 1.3,group Ⅱ was 7.5 ± 2.2.Cooper score of intubating conditions more significant difference in group,group Ⅰ can provide a more stable intubation conditions.The electromyographic signal in two groups,group Ⅰ was (1 163 ± 723),(1 196 ±787),(1 201±987),(1 287±946),(1 258±836),(1 306±963),(1 327±954),(1 306±824),(1 316±967) μV; groupⅡ was (1 659±1 140),(1 684±1 032),(1 689±983),(1 698 ± 1 040),(1 606 ±939),(1 623 ±891),(1 597 ±961),(1 683 ±962),(1 591 ±908) μV.Both groups of patients could measure the vagus nerve/recurrent laryngeal nerve signal (V/R Signal) at thirty minute,and the continuity of EMG signal satisfied the monitoring requirement.The comparison of the signal value of two groups didn' t have statistical significance.The blood pressure and pulse both had rising tendency before and after intubation,but didn' t have statistical significance.The blood pressure,pulse and intubation reaction of group Ⅰ were higher than group Ⅱ,but didn' t have statistical significance.Conclusion Two kinds of anesthesia induction methods both satisfied the need of intraoperative neurophysiological monitoring (IONM).However,a single dose (0.05 mg/kg) of cisatracurium was easy to accept by both patients and anesthesia doctors. Key words: Cisatracurium ; Sevoflurane ; Intubation ; Intraoperative nerve monitoring
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