| Vocal cord polyp is a kind of common one inlaryngopharyngeal recess diseases, and the gently hurted patientswill be well with correct voice training after stimulating factorsdiminished, but the most still need exairesis. If the volume of thepolyp is fairly large with narrow base formed a stem, the exairesiscan be performed under electronic laryngoscope with surfaceanesthesia. This kind of exairesis is safe, shortcut, easy to observethe patient's pronunciation and find the effectiveness of the exairesis.Although many patients can accept the surface anesthesia, otherswith rather too thick fat, too short eribble cervical part or too largecartilage epiglottica will lead to act vocal area out difficultly, at thistime, general anesthesia will be needed to ensure enough time tomake the glottis clear. The exairesie of vocal cord polyp underpedestal laryngoscope will lead to arrhythmia, brady and evencardiac arrest because of the insertion and continued exist of thelargngoscope through stimulating laryngeal nerve by vagus reflex,and lead to pyknocardia, hypertension and even hyperkinesislarynges. To abscise these negtive reflex, the depth of anesthesia willbe strictly controlled, accordingly, maintaining a well neuromuscularblockade during anesthesia-operation to make sure of well anapneaand eligible depth of anesthesia. Local anesthesia and surface onecan be chose, but the blood used of this local is enrich, and localanet-hetic will be obsorbed into blood to make empoison. Throatsurface anesthesia will abaisse the guarding reflex, however, theexcreta, constit shivers or the bleeding will drop to air duct leadingto apnea and bellows complications, thus, general anesthesia withendotrached tube will be the most efficiency. Tracheal intubationthrough nasal will make more handling space for the operation, andthe catheter is easy to fix relatively, even diminishing the hazard ofemergency. While the operation is relative short, the requirement forthe junk is strict, not only to keep the air tube safe and smoothy butalso make operating comfort and attenuate alarm reaction, at thesame time, the operation will be finished in 20—30 minutes, so theauto breath and the mind should be recovered in no time to judge theeffect of the operate.Propofol is a new drug used in intravenous anesthesia withrapid onset, high plasma clearance rate, rapid degrade of bloodconcentration, snap analepsia, no psychiatric symptom, lowpost-operative nausea and vomit, no acute tolerance, et. especiallyproperly performed in short and minor operations. Propofol candistend peripheral vessel by inhibiting vascmotor center or blockingpart nerve ending to diliver arterenal resulting in prevention and cureof cardio-vascular effects enrised by setting pedestal laryngealendoscope. Midazolam form contributions by binding directly withGABAA acceptor, while propofol make the ion channel easy to open,thus formed joint action at GABAA level, causing lapsus memoriseas a kind of derivation drug in coordination with the propofol. It'sgenerally accepted that at least two kinds of state included in clinicanesthesia, one concerning consciousness and recall deprived, andBIS can monitor the hypnosis function arose by junk, glassing thecorticocerebral level, providing objective basement for controllingmitigate and hypnosis level in order to lessen awareness andrealization;another one concerning inhibition of bad reflex responseto nociceptive stimulus( body or haemodynamics or endocrinesecretious et.al ), which happened on subcortex,probablyindependent on conscious state. HRV can reflex excitability ofadrenergic nerve-adrenal medulla system, as a kind of indexreflexing alarm reaction to monitorning the response of organism tonociceptive stimulus.40 patients scheduled to undergo exairesis polyp of cord withpedestal laryngoscope, within 20-30 minutes, aged 20-55 yaars,weighed 50-80kg, no sever disease of heart, lung, centra nervesystem and endocrine, well performance of liver and renal function,no hypertension case history, randomly allocated to two groups:target-controlled infusion( T group,n=20 ) and enfluraneinhalation( C group,n=20 ). There was no evident difference ingender and age of the two groups( P>0.05 ). Preoperation drugswere both atropine 0.5mg injection muscel. When the patientsentered the opening room, at the time of background( T1 ), 3 minutesafter derivation( T2 ), intubation through nasal( T3 ), setting thelaryngeal( T4 ), getting out the laryngeal( T5 ), their SBP, DBP, HR,BIS and HRV would be recorded, at the same time, recoverytime( from getting laryngeal out to opening eyes ), extubationtime( from getting laryngeal out to extubation ) and follow-up visitfor the recovery after operation would be recorded, too. All the datawould be demonstrate with ( x ±SD), using SPSS12.0 software toanalytic data, analysis of variance with P check within group, paringt testing at the same time between groups, with P>0.05 the differencewill be significant.Results showed, patients of two groups had obvious drop inblood pressure, heart rate , BIS, with intensive stimulant by settinglaryngeal alarm reaction in enflurane inhalation group is manifest,the TCI group showed equability all the operating time, with lowerpostoperative complications. Through investigation of mornitoringbispectral index combining heart rate variability used in operationpatients, we found that when they combined they showed well reflexof suppression level on central nerve and reaction of anesthesiadepth reasonable. BIS and HRV combined mornitoring can findtemporary loss of conscious and recall in drugged state, inhibition oforganism to stress reaction, guiding clinical medication so as to beprecise and scientific, boosting anesthetist's competence.Conclusions: compared with enflurane inhalation group, the targetcontrolled-infusion of propofol used in exairesis of vocal polyp cordcan performed better to restrain cardiovascular reflex, and act asconvenience more proper for the short and small operations, at thesame time, BIS and HRV binding for monitoring during anesthesiawill give a good guidance for use of clinic drugs.
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