Effects Of Different Does Of Domestic And Imported Rocuronium On Hemodynamics In Patients Undergoing Neurosurgery

Objective: To obseve intubating conditions and hemodynamic effcts of diffierent doses of domestic and import rocuronium in neurosurgical patients undergoing total intravenous anesthesia, and discuss the differences of correlation parameters.Methods: Forty-eight ASA and Mallapati physical statusⅠandⅡpatients of both sexes ,aged 18～60yrs,weighted 51～79kg, were scheduled for elective neurosurgical operation under total intravenous anesthesia,patients were randomly divided into four groups.GroupⅠ(n=12) received domestic rocuronium 0.9mg/kg, GroupⅡ(n=12) received domestic rocuronium 1.2mg/kg, GroupⅢ(n=12) received import rocuronium 0.9mg/kg, GroupⅣ(n=12) received import rocuronium 1.2mg/kg.after transferring the patiens into the operating room.Standard monitoring including five lead ECG,Spo2,automated non-invasive arterial pressue,were insituted.A forearm vein cannula were inserted using a 20G IV needle,and midazolam (0.04mg/kg) was administered. patients received i.v. Ringer′s solution with rate of 5ml/kg/h.The radial artery connulatin was performed with 16G needle puncture under local anesthesia.After the success of puncture, Edwards Lifescience Vigollence detector was connected to monitor cardic output (CO),cardic index(CI), strock volume(SV), strock volume index(SVI),mean artery pressue(MAP), and other indicators. The upper lime in the reverse side was connected with muscle relaxation TOF-guard monitoring device to monitor muscle relaxation time under test. When hemodynamic parameters reached level off (for 3 times the fluctuation of the measured HR and MAP is below 10%) the measured time T0 was estabolished, and baseline hemodynamic measurements including HR,MAP,CO,CI,SV and SVI were obtained . Patients were uptaken with facemask for 3 min (oxygen flow 5L/min). In all patients,anesthesia was induced with an effect compartment-controlled infusion of remifentanil ,targeted at2～3ug\ml,and propofol with the target controlled infusion plasma concentration of 3ug/ml.The time of induction was set 2 min. Assisted respiration was needed depending on the condition.When patients were unconsciousness, started up muscle relaxation monitor (TOP-Wacth) and used the single stimulus acceleration monitor mode (0.1Hz)to monitor the degree of neuromuscular. After all the monitoring parameters were stable, hemodynamic dates were recorded and the measured time was defined as T1.The rocuronium was administered into the forearm vein respectively. After the patients lost breathing, Controlled ventilation was immediately performed manually using a tight-fitting face mask until intubation. When the muscle Sundarbaned muscle maximum block ,the neuromuscular block time was recored as onset time.,and hemodynamic dates of T2 were measured. At the same time ,tracheal intubation was performed by the anesthesiologist who assessed the conditions of intubation,which was graded as excellent(jaw relaxation is good,vocal cored is open and no response to tube),good(jaw relaxation is fair, vocal cored is moving, response to tube is slight coughing and movement)and poor(jaw relaxation is difficult, vocal cored is closing, response to tube is sever coughing and bucking). The patients were mechanically ventilated . PETCO2 was maintained between 35-45 mm Hg by seting oxygen flow rate 1L/min, tidal volume 8ml/kg, inspiratory to expiratory ratio of 1:1.5 and adjusting respiratory rate. Anesthesia was maintained with TCI of propofol (3μg/ml) combined with remifentanil (2-4ng/ml) to maintain BIS index between 45-55. During the surgery, infused compound sodium chloride injection with rate of 5ml/kg/h to keep the balance of body fluid. Hemodynamic dates were collected immediately before induction of anesthesia (T0), after induction of anesthesia (T1), after injection of rocuronium (T2), after intubation (T3), endotracheal intubation after 1min (T4), 2min (T5), 3min (T6), 4min (T7), 5min (T8), 6min (T9), 7min (T10), 8min (T11), 9min (T12), 10min (T13). and observed whether the patients had adverse reactions such as skin flush, rash, bronchial spasm and so on.No stimulations were peformed after intubation until ten minutes later.Results:1 There were no statistical differences among each group about the general condition (P>0.05). All the patients didn't appear adverse reactions such as skin flush, rash, bronchial spasm and so on during experiment.2 Evaluation of hemodynamics: there were no statistical differences about the HR,MAP,CO,CI,SV,SV among each group at different time points (P>0.05). Compared with T0, the HR,MAP,CO,CI,SV,SV were lower at T1,T2, and higher at T3 among each group (P<0.05), Compared with T2, there were no statistical difference at T6 to T13(P>0.05).3 Evaluation of onset time:The mean±SD onset time were 61.8±28.5s, 47.5±12.4s, 63.2±24.7s and 43.8±9.7s for groupⅠ, groupⅡ, groupⅢand groupⅣrespectively.Compared with groupⅠand groupⅡ, there were no statistical differences about the onset time in groupⅢand groupⅣ(P>0.05); compared with groupⅠand groupⅢ, there were significant differences about the onset time in groupⅡand groupⅣ(P<0.01).4 Evaluation of intubation conditions: there were no statistical differences about the intubation conditions among each group (P>0.05). All the intubation conditions can reach the level of excellent or good and the success ratio of endotracheal intubation can be 100%.Conclusion: Both 3 and 4 times the ED95 dose of domestic and imported rocuronium can gain satisfying intubation conditions and have no visible influence on hemodynamics. Compared with 3 times the ED95 dose of domestic and imported rocuronium, 4 times the ED95 dose of domestic and imported rocuronium can significantly shorten the onset time.