Clinical Effect Observation Of Sevoflurane With Different Concentrations In Myorelaxant Thyroidectomy Without Muscle Relaxant

Objective:1.To observe and compare the anesthetic effect and postoperative recovery quality of sevoflurane with different concentrations in the application of partial thyroidectomy.2.To explore the most optimal sevoflurane concentration for zero muscle relaxant thyroid surgery,and to reduce the adverse reactions caused by too little sevoflurane or excessive use,muscle relaxant residue,so as to provide experience for clinical work.Method:Ninety patients undergoing partial thyroidectomy under general anesthesia were selected from the affiliated hospital of yan'an university.Routine laboratory tests of blood coagulation,liver function and kidney function were basically normal.Age:40⁶0 years old;BMI:18³0kg/m2;exclusion of abnormal routine blood test,abnormal liver and kidney function;preoperative severe cardiovascular and cerebral vascular diseases;allergy to inhaled anesthetic drugs.Randomly divided the patients into three groups,each30 cases respectively.1 MAC sevoflurane group?S1?1.5 MAC,sevoflurane MAC sevoflurane?S2?,2MAC sevoflurane group?S3?.three groups of patients are using midazolam sevoflurane,fentanyl induction endotracheal intubation after adjustment of sevoflurane concentration to achieve stability,when cut the skin,adjusted the MAC for S1 group with 1 MAC sevoflurane concentration,S2 group with 1.5 MAC sevoflurane concentration,S3 group with 2 MAC sevoflurane concentration.All the groups were pumped injection fentanyl.During anesthesia BIS values were maintained at 40 to 60 in the three groups,and blood pressure was adjusted by increasing or decreasing the dosage of drugs or by adjusting the volume of infusion fluid when the blood pressure was increased or decreased by more than 20%of the basal blood pressure.When the MAP value was still higher than 20%of the base value after the above treatment for 3min,nicardipine was given 0.2mg/time;if the MAP value was still lower than 20%of the base value,the infusion speed was accelerated;when necessary,intravenous dopamine was injected 1mg/time;HR<50/min or>100/min,atropine was injected 0.5mg/time intravenously or etholol 1mg/time.Repeat when necessary.Thirty minutes before the end oftheoperation,thepatientwasgiven40mgintravenousinjectionof parecoxibna.Sevoflurane inhalation was stopped at the end of the operation,oxygen flow was adjusted to 3-4L/min,remifentanil pumping was stopped,and anesthesia gas absorber was connected.Postoperative intravenous analgesia pumps were used in all three groups.Observe and record the base value?T0?,during intubation?T1?,5 min after intubation?T2?,cut the skin?T3?,cut skin after 5 min?T4?,at the End of surgery?T5?,when the tube drawing?T6?,5 min after extubation?T7 has?,Mean Arterial Pressure,Mean Arterial Pressure MAP),Heart Rate,Heart Rate HR),Pulse Oxygen Saturation?Pulse Oxygen Saturation SpO₂?,breathe out at the End of the co2 partial Pressure(End-tidalA source with a bigger problem:Carbon Dioxide.Observe and record the time from the end of anesthesia to the time of calling open eyes,waking time and tracheal tube removal time.The pain score and sedation score after extubation were measured.Observe the occurrence of postoperative adverse reactions.To observe and compare the postoperative anal exhaust time and defecation time.Outcomes:1.There was no significant difference in age,height,weight among the three groups?P>0.05?.2.Among the three groups of patients,the time from the closure of sevofluraneto spontaneous breathing during extubation,to the time from spontaneous eye opening during extubation to the time of endotracheal catheter extraction in the S1 and S2 groups was significantly shorter than that in the S3 group,with statistically significant difference?P<0.05?.No statistically significant difference between the S1 and S2 groups?P>0.05?.3.There was no statistically significant difference in pain scores after extubation among the three groups.?P>0.05?.4.Comparing all the different points in time among the three groups,no statistic was showed.But the MAP of S1 group about T2,T3,T4 were lower than the intraoperative and postoperative.5.There was no difference among the three groups about the HR,PET-CO₂,SPO₂ at all the different points in time.?P>0.05?6.Heart rate at each time point was compared between groups in group S1 and group S2,and the differences were statistically significant at 5min?T2?after intubation at the time of skin resection?T3?at the end of surgery?T5?.7.The incidence of restlessness after extubation was compared among the three groups,and there was no statistical significance between S1 group and S2 group.The comparison between S1 group and S2 group and S3 group showed that P=0.03,with abvious statistically significant?P>0.05?.Patients in S3 group had a higher incidence of agitation than those in S1 group and S2 group.8.For irritability,there was no statistically significant difference between S1 group and S2 group.The comparison of S1 group and S2 group with S3 group showed P=0.03,with statistically significant difference.Other data has no statistical difference?P>0.05?.9.There was no difference among the three groups about postoperative anal exhaust time,defecation time were compared among the three groups.?P>0.05?.Conclusions:1.5 sevoflurane MAC has a more stable intraoperative hemodynamics,shorter postoperative recovery time,higher recovery quality,higher operating room utilization rate,less cost for patients,and more better fix to ERAS.