Application Of Target Controlled Infusion Propofol And Remifentanil Auxiliary Neck Plexus Block In Thyroid Gland Surgery

Objective: To approach the effect of cervical plexus block combine innovar, TCI remifentanil, TCI propofol-remifentanil in thyroid gland surgery. To evaluate the feasibility and safety of conscious sedation and analgesia, that is for guiding clinical work and researching.Methods: Ninety ASAⅠorⅡpatients, 34 males, 56 females, aged 25～59years, weighing 46～65kg, BMI<29kg/m2, undergone thyroid gland surgery under cervical plexus block were enrolled in this study. They were randomly divided into 3 groups (n=30 average). Group C: called control group; Group R: TCI remifentanil; Group P-R: TCI propofol-remifentanil. Every patient was given luminal 0.1g im before anesthesia. All patients were monitored HR, SBP, DBP, MBP, RR, RR, SpO2, and built up an intravenous transfusion after entranced into the operating room. Group C: when cervical plexus block was satisfied, innovar 1/2U was given 10 minutes before surgery. The other innovar 1/2U was given 10 minutes before the operators pulled the upper pole of thyroid. Group R: when cervical plexus block was satisfied, remifentanil was given with TCI system, at target plasma concentration, the initial value of plasma drug concentration was set up at 0.5ng/ml, administered by a TCI system. When the plasma drug concentration and effect compartment concentration equilibriumed 3 minutes, to increase or decrease the concentration with rate of 0.1～0.2ng/ml, until the OAA/S score was 3. Group P-R: when cervical plexus block was satisfied, propofol was given with TCI system, at target plasma concentration, the initial value of plasma drug concentration was set up at 1.0ng/ml, administered by a TCI system. When the plasma drug concentration and effect compartment concentration equilibriumed 3 minutes, to increase or decrease the concentration with rate of 0.1～0.2ng/ml, until the OAA/S score was the 3. And then remifentanil was induced, the initial value of plasma drug concentration was set up at 0.5ng/ml. Plasma drug concentration of remifentanil was adjusted in Group R and Group P-R, according to surgical stimulation and individual differences in pain response. Made the OAA/S score was 3 or VPS score was 0～1. Maximum plasma drug concentration of propofol was recorded at T2, Maximum plasma drug concentration of remifentanil was recorded from T2 to T5. Recorded these groups of patients'vital signs (HR, MAP, RR, SpO2, VT) from T0 to T5. The patients were quiet supinning 10 minutes after entranced into the operating room (T0). Finished cervical plexus block after 15 minutes, and the effect was satisfied (T1). Immediately before cutting the skin (T2). At 2 minutes after cutting the skin (T3). At the time when isolated the upper or lower of thyroid (T4). At the time when the skin was jointed completely (T5). To observe if the patients were with irritability, respiratory inhibition, abdominal wall stiffness, nausea, vomiting, arrhythmia, rash during the anesthesia and surgery. And to record how the patients evaluated anesthetic satisfaction and intraoperative awareness.Results: 1. To compare with the group C, the group R and group P-R were more effective analgesia during the operation (P<0.05). 2. In the group R, Maximum plasma drug concentration of remifentanil was 1.30±0.16ng/ml at T2, when the OAA/S score was the 3. And Maximum plasma drug concentration of remifentanil was 2.13±0.35ng/ml at T4, when the OAA/S score was the 3 and VPS score was 0～1. 3. To compare with the group R, the plasma drug concentration of remifentanil was required lower in the group P-R (P<0.05), when the OAA/S score was 3 or/and VPS score was 0～1. 4. In the group P-R, Maximum plasma drug concentration of propofol was 1.33±0.13μg/ml at T2, when the OAA/S score was the 3. 5. To compare with the group C, the group R was better in postoperative satisfaction scores (P<0.05); and the group P-R was better than the group R (P<0.05)。6. To compare with the group C, the HR and MAP were more effective inhibited in the group R, and the group P-R was the most at T4. 7. To compare with the group C, the group R and group P-R were lower percentage of irritability (P<0.05), but higher percentage of respiratory depression (P<0.05). Conclusion: TCI remifentanil and TCI propofol-remifentanil did better than innovar in the thyroid gland surgery, with stable hemodynamics, and provided effective sedation and analgesia. The target concentration can be regulated accordding to individual differences and surgical stimulation intensity at any time to satisfy the operation needs. And TCI propofol-remifentanil was more effective than TCI remifentanil only. But we should be alert the respiratory inhibition of remifentanil and propofol for improving the safety of anesthesia.