Investigate The Muscle Relaxant Effect Of Mivacurium And Cisatracurium Besilate In ENT Surgery

Objective: This study to analyze the muscle relaxant effect of Mivacurium and Cisatracurium Besilate by the muscle relaxants integrated closed-loop target controlled injection system in ENT surgery. To explore the muscle relaxant effect of Mivacurium and Cisatracurium Besilate in ENT surgery from a clinical anesthesiology point of view.Methods: Choose general anesthesia ENT surgery 70 patients, aged 25-60 years old, the American Society of Anesthesiologists(ASA) grade Ⅰ-Ⅱ grade. 70 patients were randomly divided into two groups(n=30), such as Mivacurium continuous infusion(group M) and Cisatracurium Besilate continuous infusion(group C),each group include 35 cases who do not have sinificant heart,lung,liver,renal and neuromuscular diseases. General state of the patient’s body can be no serious cardiopulmonary dysfunction. The preoperative routine examination of liver and kidney function was normal, no diseases affecting neuromuscular function, no imbalance in electrolyte and water before surgery. None of the patients has the disease which can influence the function of neuromusclar transmission and denies drug allergies. Preoperative fasting 6-8h, forbidden to drink 4h. All patients had preoperative drug contraindications. Preoperative drug phenobarbital was given 0.2g, atropine 0.5mg. All the patients into the operating room after the opening of venous access connect the monitor and bispectral index(BIS) monitor, surgery the routine monitoring of heart rate(HR) 、 mean arterial pressure(MAP),respiratory rate(RR),pulse oxygen saturation(Sp O2),end-tidal carbon dioxide partial pressure(PETCO2) and bispectral index(BIS) values. After the above operation, the patient vital signs were stable to begin induction intravenous midazolam 0.05mg/kg, sufentanil 0.3-0.4μg/kg, plasma concentrations of target-controlled propofol 2μg/ml, until the patient lost consciousness began scaling, using four clusters stimulus way, correcting the first twitch response(T1) remained at about the height of the base value is set to 100%. After calibration open CLMRIS-1 closed loop muscle relaxant injection system, the closed-loop system to give the injection of muscle relaxant muscle relaxants. When the four clusters to be stimulated to maximum suppression T1 start intubation by the same anaesthetist who has extensive experience in the application of electronic video laryngoscope anesthesiologists. After a successful connection intubation and mechanical ventilation anesthesia machine, set tidal volume 8ml/kg, respiratory rate 12/min, respiratory ratio of 1:2. Plasma target-controlled continuous intravenous infusion of propofol and remifentanil. When neuromuscular monitoring reach CLMRIS-1 injection of muscle relaxant closed loop feedback system set conditions(count 3) begins to increase after three consecutive drug. When neuromuscular monitoring below feedback condition(count 3) after two consecutive rate is converted to maintain.According to the pharmacological properties of the surgery process and the two muscle relaxants in 20 minutes before the end of surgery to stop muscle relaxants, but still line neuromuscular monitoring.After the surgery do not use antagonistic muscle relaxant drugs. About 10 minutes before the end of surgery to disable propofol and remifentanil. Extubation opportunity for conscious patients, coughing and swallowing reflex, muscle strength, respiratory function recovered satisfactorily. With burglary(T1), induce immediate(T2), intubation(T3), the end of surgery(T4), recovery of consciousness(T5), extubation(T6), the chamber(T7) for seven time points were observed and recorded the following data:(1) mean arterial pressure(MAP), respiratory(RR), heart rate(HR), end-tidal carbon dioxide partial pressure(PETCO2) and pulse oxygen saturation(Sp O2);(2) bispectral index(BIS) values and TOF value;(3) intubation time(t1), the infusion was stopped after muscle relaxants TOF value to 25% of the time(t2), recovery index time(t3), in stopping the infusion of muscle relaxant TOF is restored after the drug to 90% of the time(t4), extubation time(t5) and the room time(t6);(4) record and adverse neurological recovery of muscle function;(5) intubation classification.Results:1 Group M and group C patients were perioperative hemodynamic parameters(T1 to T7 at different time points MAP, RR, HR, PETCO2, Sp O2) of no significant difference(P> 0.05).2 The two groups of patients at each time point T1 to T7 BIS and TOF value comparison group M T4 and T7 two time points BIS values were significantly higher than group C; T4 to T7 four time points TOF value of M was significantly higher than C group, the difference was statistically significant(P<0.05); BIS and TOF values of the other time points the difference was not statistically significant(P<0.05).3 Group M intubation time(t1), stop the infusion of muscle relaxants TOF value after recovery to 25 % of the time(t2), recovery index time(t3), muscle relaxants after stopping the infusion TOF values recovered to 90% of the time(t4), extubation time(t5) and the room time(t6) compared with group C were less than group C, the difference was statistically significant(P <0.05).4 Starting from anesthesia to 1h after extubation time segment, the two groups of patients with postoperative adverse reactions: the skin flushing or rash in M group were more than that in group C; the incidence of postoperative nausea and vomiting, muscle relaxants residual in M group less than those in group C.5 According to the improved method of intubation conditions Krieg grade, the Cisatracurium Besilate group and Mivacurium group are all have one example of two grade and the rest are one grape. All patients were successfully operated, not because of the occurrence of body movement, cough or muscle relaxant effect surgeon proposed changes CLMRIS-1 difference between the closed-loop system, the muscle relaxant injections Cisatracurium Besilate and Mivacurium input program and then withdraw from the study. The surgeon ’s satisfaction rate of 100 %.Conclusion: The closed-loop system sustained muscle relaxant injections pumped Mivacurium perioperative rapid recovery of neuromuscular function, less postoperative residual NMB, mild adverse reactions, compared with cis- acid atracurium more suitable for ENT surgery.