| Merge diabetes patients during surgery for other diseases, the chronic complications is a potential risk factor during surgery and anesthesia. Diabetic neuropathy is a serious complication of diabetes. With the longer course of diserse, nervous system damage occurs in almost all diabetic patients. Before diabetic neuropathy symptoms appeared, the slowing of sensory and motor nerve conduction velocity can be detect by neuro electrophysiologic study. There are only 20 percent have symptoms because of the atypical symptoms.Muscle relaxants as a neuromuscular blocking agent is very necessary during general anesthesia, patients with diabetes mellitus undergoing elective surgery under general anesthesia must be applied with the muscle relaxant, so we should understand the effect relationship between muscle relaxants and the nervous system lesions in patients with diabetes mellitus, thereby strengthening the anesthetic management of diabetic patients. Cis-atracurium is the effect of non-depolarizing muscle relaxants, and applied widely in recent years as a new type of muscle relaxant. At present, there were some studies about effects for cis-atracurium muscle relaxation, but for diabetes patients muscle relaxation was very little.Objective:1. Determine received (IV) 3ED95 cis-atracurium application reliability at endotracheal intubation during anesthesia induction in diabetic patients.2. To investigate if there is any effect of diabetes on the cisatricurium-induced neuromuscular block in general intravenous anesthesia. Discuss the relevance between the mechanism of diabetic neuropathy and the mechanism of neuromuscular blockers. Assess the diabetes risk of surgical anesthesia in patients, and made some suggestions for clinical anesthesia and also research to provide some information for reference.Method:Forty patients into two groups: Group D (diabetic): 20 patients aged 31~70 years, weight range 51~98kg; Group N (nondiabetic): 20 patients aged 30~67 years, weight range 52~95kg. ASA grade II~III. All patients without serious diseases of heart,lung,liver,kidney and blood system, neither were alimentary tract ulcer and allergy, had not used the influence of drugs neuromuscular transmission excited. All patients were given atropine 0.5mg intramuscularly half an hour before surgery, without any other premedication. Through the vein located on the back of hand, monitoring ECG,HR,SpO2 and BP. Lying face mask oxygen uptake, General anesthesia was induced with midazolam 0.05~0.1mg/kg,fentanyl 3~5μg/kg,etomidate 0.2~0.3mg/kg. Neuromuscular function was assessed by train-of-four (TOF) stimulation of accelerometry and the percentage depression of the first response (T1) of the TOF stimulus was used as the study parameter. The sensor was fixed on the palm side of thumb, Stimulating electrode was fixed on the forearm ulnar nerve location, Stimulate the ulnar nerve, observed contraction of the thumb adductor changes stimulus frequency: 2Hz, pulse width: 0.2ms, two bunches of stimulus interval: 15ms Received (iv) 3ED95 cisatracurium in 5 seconds respectively. Endotracheal intubation and fixed after the onset of muscle relaxants, then connect the anesthesia machine for mechanical ventilation, record results after intubation. Anesthesia was maintained intraoperative vital signs of patients under propofol 4~8mg/kg·h and remifentanil 0.1~0.3μg/kg·min adjusted pump, and give a single interrupted cis-atracurium to maintain depth of anesthesia and muscle relaxation strength, so that vital signs should be stable. Intravenous anesthesia not combined inhalation anesthesia gas. Observe and record the groups. cis-atracurium onset time, clinical duration, recovery time and recovery index. Observe differences between the two groups. Measurement data obtained using mean±standard deviation ( x±s) that were analyzed by ANOVA, t-test; count data usingχ2 test, P <0.05 for the difference was statistically significant.Results:1. It can be very satisfactory result in endotracheal intubation with muscle relaxant of 3ED95 cis-atracurium, there is no statistically significant difference between 2 groups. (P>0.05) 2. Cis-atracurium clinical duration, recovery time and recovery index in group D are longer than group N, but there are no statistically significant differences between 2 groups. (P>0.05)3. Cis-atracurium onset time in group D is longer than group N, there is statistically significant difference between 2 groups. (P<0.05)Conclusions:1. Cis-atracurium onset time in group D is longer than group N, there is statistically significant difference between 2 groups. Show that there are physiological changes in nerve in diabetic patients. When muscle relaxants were used in the clinical application of anesthesia, the changes in the nervous system of diabetic should be treated seriously. Appropriate extension time for mechanical ventilation, and endotracheal intubation after post-onset muscle relaxant. Observe and note the delay effects of drugs. And we have to consider the risk of diabetes during the anesthetic management.2. Cis-atracurium clinical duration,recovery time and recovery index in group D are longer than group N, show that the chronic complications of diabetes in patients may be a certain degree effect of muscular relaxation. But there are no statistically significant differences between 2 groups. Demonstrate that when the muscle strength begin to recover spontaneously, subside of cisatracurium was analogical between diabetic and nondiabetic.3. Application with muscle relaxant of 3ED95 cis-atracurium in the induction of anesthesia and the same time neurological electrophysiology monitoring was be used in the operation can be very satisfactory result in endotracheal intubation. Diabetes does not affect endotracheal intubation. Neural electrophysiological monitoring techniques should be widely applied...
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