Effect Of Closed-loop Target Controlled Infusion Of Cisatracurium On Monitoring Of Recurrent Laryngeal Nerve During Thyroid Surgery

Objective: To investigate the effect of closed-loop target controlled infusion of cisatracurium on monitoring of recurrent laryngeal nerve during thyroid surgery.Methods: From August 2019 to February 2020,60 patients with elective thyroid surgery under general anesthesia,benign and malignant thyroid lesions,ASAⅠ～Ⅱgrade,without cardio-cerebrovascular disease,according to the random number table method,patients were divided into closed-loop target controlled infusion group(group D)and control group(group C),30 cases in each group.In group D,closed-loop target controlled infusion of cisatracurium was used.The intraoperative Train-of-four(TOF)values were maintained at 2 or 3,and the skeletal muscular relaxants was stopped 30 minutes before the end of the operation.In group C,0.1 mg/kg cisatracurium was intravenously injected during induction of anesthesia,and no skeletal muscular relaxants were added during the operation.The rest of the anesthesia induction drugs and anesthesia maintenance drugs are the same.During the operation,the dosage of propofol and remifentanil was adjusted according to the BIS value and vital signs.Record the basic situation of the patient’s age,sex,height,weight,ASA classification,operation time,anesthesia time,infusion volume,bleeding volume and anesthetic drug usage.Record the mean arterial pressure(MAP)and heart rate(HR)of patients before induction of anesthesia(T0),before tracheal intubation(T1),during tracheal intubation(T2),before tracheal extubation(T3)and during tracheal extubation(T4).The occurrence of adverse cardiovascular reactions and the use of cardiovascular drugs during the perioperative period were recorded separately.Both groups of patients underwent intraoperative nerve monitoring,the amplitude changes of the recurrent laryngeal nerve and vagus nerve were recorded before thyroid separation and after thyroidectomy,respectively.Record the patient’s intraoperative body movements and postoperative complications.Results: There was no significant difference in age,sex ratio,height,weight,ASA classification,operation time,anesthesia time,infusion volume and bleeding volume between the two groups of patients(P > 0.05).There was no statistically significant difference in the use of fentanyl,dexamethasone and tropisetron between the two groups of patients(P > 0.05);compared with group C,the amount of cisatracurium in patients in group D increased(P < 0.05),but the amount of propofol and remifentanil used in the operation was significantly reduced(P < 0.05).There was no significant difference in MAP and HR between the two groups at T0(P > 0.05);compared with T0,the MAP and HR of the two groups increased significantly at T2 and T4(P < 0.05),T1 The time point was significantly decreased(P < 0.05),and there was no statistically significant difference at T3 time point(P > 0.05);compared with group C,MAP and HR were significantly decreased at T2 point in group D(P < 0.05).There was no significant difference in the incidence of bradycardia,tachycardia,hypotension and hypertension between the two groups(P > 0.05).There was no significant difference in the usage rate of atropine,esmolol,ephedrine and urapidil between the two groups(P > 0.05).The amplitudes of the recurrent laryngeal nerve and vagus nerve in both groups were >100 μ V,indicating successful monitoring.Compared with group C,although the myoelectric amplitudes of the recurrent laryngeal nerve and vagus nerve in group D decreased,there was no statistically significant difference between the recurrent laryngeal nerve and vagus nerve before and after thyroid separation and between groups(all P > 0.05)..Compared with group C,the incidence of intraoperative body movement and postoperative complications in group D was significantly reduced(P < 0.05).Conclusion: Closed-loop target controlled infusion of cisatracurium does not affect the monitoring of the recurrent laryngeal nerve during thyroid surgery,it can reduce the intraoperative body movement and postoperative complications,and can stabilize hemodynamics and reduce the use of anesthetic drugs.,with good clinical application value.