| ObjectiveMicrolaryngosurgery under the Suspensive Laryngoscope is a common short operation in clinical. Its operating place is special because the airway is also occupied by anesthesist, the hemodynamics changes are severe during operation, the time of operation is short which need a rapid return to consciousness, so it request a profound anesthesia.Target - controlled infusion based on pharmacokinetics and phar-macodynetics, the velocity of infusion is controlled by computer, adjusting the drug concentration of plasma or effect - site to achieve the clinical demand of accommodation of anesthesia, sedation or analgesi-a.Microlaryngosurgery is often performed under general anesthesia with trachea! intubating or intravenous anesthesia with high frequency ventilation. With the propofol intravenous anesthesia extensively appli-cated in clinical, it is used in microlaryngosurgery also. In this study, we performed microlaryngosurgery under total intravenous anesthesia with propofol by target - controlled infusion system, and investigate the feasibility that patients keep spontaneous respiration without intubation during operation, to provide a safe and simple anesthetic method for microlaryngosurgery.Methods45 patients ( ASA I to II) with polyp, nodule or cyst of vocal cord scheduled for an elective microlaryngoscopy were randomly allocated to three groups with 15 patients each group. All patients were premedicated with muscular diazepam 0. 2mg/kg and atropine 0. 01mg/kg 30 minutes before the procedure. Patients in group I receive target - controlled infusion with propofol alone and 1 or 2 g /kg with fentanyl supplementation before propofol TCI in group II or III.Perform a local anaesthesia with 2% lidocaine spray to mouth and body of tongue and then provide oxygen transnasal with 5 litre per minute. Open venous pass and connect with Graseby 3500 infusion pump. Start propofol infusion with the target concentration 2 g /ml and add it 0. 5 g /ml every time till loss of consciousness. Put a catheter with inside diamete 2 ~3mm transnasal to posterior wall of pharynx and provide oxygen with 5 litre per minute through an elongate tract. Add the target concentration of propofol again when placement of the laryngoscope till the patients have no resistance at insertion of the laryngoscope and maintain this concentration. Start operation after a surface anaesthesia to vocal cord with 2% lidocaine spray, and adjust the target concentration of propofol to a proper level to maintain a certain depth of anesthesia during operation. Stop propofol infusion when the operation is over, give oxygen till awakening. Inject ephed-rine or atropine if significant hypotension or bradycardia is occurred during operation.Monitoring mean arterial blood pressure, heart rate, respiratory rate and electrocardiograph continuously, Blood sample was taken before anesthesia, after induction and after placement of the laryngo-scope for arterial blood gas analysis. Recording the target concentrations and consumption dose of propofol when loss of consciousness, after placement of the laryngoscope, cessation of propofol and awakening. The interval of operation and the time from cessation of propofol infusion to awakening are also recorded. Observing the occurance numbers of adverse response such as cephalalgia, nausea or vomiting and consciousness during operation . The data were presented as the mean standard deviation (x s) , statistic procedure was proceed with SPSS10. 0 statistics software. Statistical significance was determined by analysis of variance for inter - group and intra - group comparisons, p < 0. 05 was considered statistically significant and p < 0. 01 was considered statistically very significant.ResultsThe ages, weights, interval of operation, essential life sign and the blood - gas parameter before operation had no significant difference in three groups . The target concentration of propofol at induction were 4. 68,4.27 and 4. 15 g/ml in group I , II and III. Decrease of MAP, HR, RR, Sp02, PaO2 and incre...
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