| Objective:To investigate the anesthetic effect of desflurane combined with remifentanil guided by bispectral index in neuromonitoring thyroidectomy and analyze its hemodynamics,dosage,extubation time and adverse reactions.Methods:Using random number table,90 patients who underwent selective thyroidectomy with nerve monitoring in our hospital were selected and randomly divided into three groups: desflurane inhalation anesthesia maintenance group(group D),desflurane combined with remifentanil anesthesia maintenance group(group R)and propofol combined with remifentanil anesthesia maintenance group(group P),with 30 cases in each group.All patients in the three groups were induced by target-controlled infusion of propofol-remifentanil and intravenous injection of cis atracurium,and endotracheal intubation was performed after induction.In group D,desflurane was inhaled to maintain the MAC at 1.2-1.4.Anesthesia maintenance method of group R used desflurane combined with remifentanil,adjust the amount of desflurane according to BIS to keep BIS between 45 and 60,and adjust the dosage of remifentanil according to hemodynamics.while group P used propofol to maintain the depth of anesthesia,remifentanil was injected intravenously and its dosage was adjusted according to hemodynamics.All the patients in the three groups were given oxycodone 10 minutes before the end of the operation.The intraoperative hemodynamics of the patients were recorded: mean arterial(MAP),heart rate(HR),Sp O2 and BIS were recorded at entry(T0),intubation(T1),skin incision(T2),tumor resection(T3)and extubation(T4).The intraoperative dosage of desflurane and remifentanil were recorded.Record the dosage of desflurane and remifentanil during operation.The intraoperative MAC values of groups were recorded.Record the extubation time of the patient after waking up.The adverse reactions of the patients were recorded,such as nausea and vomiting,agitation,cough,lethargy and awareness.Results:(1)Intraoperative hemodynamics: at T3,MAP in R group was lower than that in D and P groups(P< 0.05),while heart rate in D group was faster than that in R and P groups at T2,T3,T4(P< 0.05),and there was no significant difference in BIS and Sp O2 among the three groups.(2)Drug dosage: the dosage of remifentanil in group R was less than that in group P(P< 0.05).The dosage of desflurane in group R was lower than that in group D,and the intraoperative MAC value was lower in group R than in group D.(3)the time of extubation after operation: the time of extubation in group R was significantly shorter than that in group P and D(P< 0.05),and there was no significant difference between groups D and P(P> 0.05).(4)adverse reactions: the incidence of postoperative nausea and vomiting in group D was higher than that in group R and P(P< 0.05),and there was no significant difference between groups R and P(P> 0.05).The incidence of lethargy in group R was lower than that in group D and P(P< 0.05).There was no significant difference in agitation,cough and awareness among the three groups.Conclusion:The anesthesia maintenance methods of desflurane combined with remifentanil and propofol combined with remifentanil could meet the anesthetic needs of patients undergoing thyroidectomy with nerve monitoring,In the desflurane combined with remifentanil group,the hemodynamics was more stable,the awake extubation time was shorter,the dosage of remifentanil was less,and the probability of postoperative adverse reactions was low.Compared with the maintenance method of desflurane combined with remifentanil anesthesia,the maintenance method of pure desflurane inhalation anesthesia had less stable hemodynamics,longer awake extubation time,large dosage of desflurane,The incidence of postoperative adverse reactions such as nausea,vomiting and lethargy was high.The anesthesia maintenance method of desflurane combined with remifentanil was more suitable for the anesthesia of thyroidectomy under nerve monitoring. |
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