Clinical Research Of Small Doses Of Cisatracurium With Target-controlled Infusion Of Remifentanil And Propofol During Operation With Suspension Laryngoscopy

Objective:Toevaluate whether the anesthesia method ofsmall doses of Cis-atracuriumwith target-controlled infusion of remifentanil and propofol during operation withsuspension laryngoscopy is feasible or not.Study the least does of Cis-atracurium canused in operation with suspension laryngoscopy.Methods:34ASAⅠ一Ⅱ patients scheduled for the surgery through suspensionlaryngoscopy were randomly dividedinto two groups：cisatracurium1.5×ED95,(Agroup， n=17,9males and8females),cisatracurium1.0×ED95,(Agroup，8males and9females n=17).Induction of anesthesia：The target plasma concentration of remifentanil was set at5ng/L,1minute to reach the target concentration. after1min, starts the target tocontrol infusion propofol,the hypothesis blood plasma target density3μg/L,1minachieves the blood medicine depth. Group Abefore the anesthesia induction2min thefirst static note0.3time of ED95ciasatracurium.Aand B two groups in Remifentanilreaches the blood plasma target density, distinguished static note1.2times of ED95and1time of ED95ciasatracurium, in5s injects to finish.After the patients realize thedisappearance, starts the TOF stimulation,6th minute fashionable trachea cannula. Inthe technique target density maintains invariably, when supports the laryngoscope takesout stops the medicine, conforms to the cupping standard time to draw out theendotracheal tube. Monitoring indicators：General monitor:SBP,DBP,MAP,HR,SPO2. Monitoringtime points：baseline value (T0)，before intubation1minute (T1),immediatelyintubation(T2)，immediately after intubation2minutes(T3),immediately suspensionlayngoscope was inserted (T4)，intraoperative maximum blood pressure(T5),immediately extubation (T6).Neuromuscular blockade monitor:Peripheral nerve stimulator of the pollicisadductor to atrain-of-fou(TOF),stimulation pulse width at200us,stimulation at15sintervals with submaximal current50mA,cisatracurium was administered.monitor thevalue of TOFr and T1.(1)After given pre—injection, estimated whether the patientswere sensitive about calling their names,whether could open their eyes,stretched outtongues,at the same time observed swallowing and breathing.(2)Neuromuscularblockade monitoring indicators:1.the onset time periods of the2groups(the time fromthe end of the cisatracurium bolus to T1reached the lowest value)2.T1maximalneuromuscular block rates.3T1neuromuscular block rates when intubation.4T1neuromuscular block rates when suspension layngoscope was inserted.5Whether theneuromuscular block was suitable for operation and whether the patients moved inoperation.6TOFr immediately extubation.Other monitor:Assessment ofintubation.Record the time from induction of anesthesia to intubation;the time from thesuspension layngoscope was removed to extubation.Assessment of awakening qualityand the degree of pain at5min after extubation.Results:There were no statistically significant differences among the two groupsin sex,age,weight,height,et al(P>0.05),time from intubation to suspension layngoscopewas inserted,time from suspension layngoscope was inserted toremoved.(P>0.05).Values of HR,DBP,MAP in each time point were not significantdifference (P>0.05) between the two groups. While SBP value at T1time point wasstatistically difference (P<0.05) in the group Aand B.and T0was higher than T1.Thedifferences were statistically significant betweenAand B in T1maximalneuromuscular block rates;T1neuromuscular block rates when intubation;T1neuromuscular block rates when suspension layngoscope was inserted,group B was higher than group A(P<0.01).TOFr immediately extubation was statistically difference,group B was higher than group A(P<0.05).The onset time periods of the2groups werestatistically difference,Ais shorter than B(P<0.05).The proportion of intubatingconditions graded as ’excellent’ was group Ahigher than group B,but there was notsignificant difference (P>0.05).No patients moved in operation in two groups.Those differences of the two groups of the time from induction of anesthesia tointubation;spontaneous breathing recovery time，extubation and awakening time werestatistic significance (P<0.05),Group Ais longer than group B.Those differences of thetwo groups of the awakening quality were not statistically significant (P>0.05)；painscore was no statistical significance between the two groups (P>0.05).Conclusions:1.The anesthesia method with target-controlled infusion of remifentanil andpropofol is suitable for operation with suspension laryngoscopy,The anesthesia effectis accurate, in the technique circulation is stable.2..Although cis-atracurium1.0×ED95cannot achieve the muscle relaxation to becomplete, but may satisfy the trachea cannula and support laryngoscope surgeryneeds.Coordinates the small dosage neostigmine use, may reduce under the supportlaryngoscope the muscle relaxation request of vocal cord polyp excision surgery.