Continuous Infusion Of Mivacurium For Thyroid Surgery Of Intraoperative Nerve Monitoring Under General Anesthesia:A Clinical Trial

Part Ⅰ Sequential method for the determination of the maximum dose of continuous infusion of mivacurium for Intraoperative Nerve Monitoring of inhalation combined anesthesia thyroid surgeryObjective:To investigate the maximum dose of continuous infusion of mivacurium for monitoring neurological function and observing its adverse reactions during thyroid surgery.Methods:Twenty-eight patients undergoing intraoperative neurological monitoring of thyroid surgery were treated with continuous infusion of mivacurium at a rate of 5.43μg/kg/min,based on the response of the previous patient to the neurological function monitor,to up or down-regulate the infusion dose of the next patient.The depth of anesthesia was maintained with sevoflurane and remifentanil during surgery.The LD50 and 95%CI of mivacurium were calculated by Brownlee’s up-and-down sequential method.Results:The EC50 for continuous infusion of mivacurium was 8.94μg/kg/min and the 95%confidence interval was 8.89μg/kg/min-8.99μg/kg/min during thyroid surgery,without affecting neurological function monitoring.Transient chest skin redness occurred after induction in 9 patients(32.1%).Intubation difficulties and intraoperative body motion were not occurred in all patients.Summary:Among patients who are maintained by inhalation combined with anesthesia.The EC50 for continuous infusion of mivacurium was 8.94 ug/kg/min and the 95%confidence interval was 8.89 ug/kg/min-8.99ug/kg/min during thyroid surgery.No serious adverse reactions were observed during the operation.Part Ⅱ Sequential method for the determination of the maximum dose of continuous infusion of mivacurium for Intraoperative Nerve Monitoring of total intravenous anesthesia thyroid surgeryObjective:To investigate the maximum dose of continuous infusion of mivacurium for monitoring neurological function and observing its adverse reactions during thyroid surgery under total intravenous anesthesia(TIVA).Methods:Thirty patients undergoing intraoperative neurological monitoring of thyroid surgery were treated with continuous infusion of mivacurium at a rate of 14.97μg/kg/min,based on the response of the previous patient to the neurological function monitor,to up or down-regulate the infusion dose of the next patient.The depth of anesthesia was maintained with propofol and remifentanil during surgery.The EC50 and 95%CI of mivacurium were calculated by Brownlee’s up-and-down sequential method.Results:The EC50 for continuous infusion of mivacurium was 18.88μg/kg/min and the 95%confidence interval was 17.34 μg/kg/min-20.54μg/kg/min during thyroid surgery,without affecting neurological function monitoring.Transient chest skin redness occurred after induction in 1 patients(3.3%).Intubation difficulties and intraoperative body motion were not occurred in all patients.Summary:Among patients who are maintained by inhalation combined with anesthesia.The EC50 for continuous infusion of mivacurium was 18.88 ug/kg/min and the 95%confidence interval was 17.34μg/kg/min-20.54μg/kg/min during thyroid surgery.No serious adverse reactions were observed during the operation.Conclusion:Mivacurium can be used for continuous neurological monitoring during thyroid surgery by continuous infusion.Within a certain dose range,it can achieve certain muscle relaxation without affecting the laryngeal return and monitoring of the laryngeal nerve,which is convenient for better anesthesia management.No obvious adverse reactions were observed during the operation.Under intravenous-inhalation combined anesthesia or total intravenous anesthesia,continuous infusion of micuriochlor can achieve good results.