Study On The Feasibility And Safety Of Total Intravenous Anesthesia With Or Without Muscle Relaxation In Laryngeal Microsurgery

Objective:To investigate the effect of propofol and remifentanil anesthesia with or without muscle relaxation mode on laryngeal microsurgery mobility and safety.Methods:From July 2018 to July 2019,70 patients in our hospital were selected for laryngeal microsurgery.They were randomly divided into two groups:no muscle relaxation（NR）and micuronium chloride（MIV）.Each group had 35 patients.All patients were given normal fasting water and atropine 0.5 mg intramuscularly half an hour before operation.After entering the room,the venous access was established,and the lactate nallinger solution was infused continuously in 8-10 ml/（kg·h）.The multifunctional monitor monitors ECG,Sp O_2,HR,BIS and P_ETCO₂.IAP was monitored continuously after successful radial artery puncture.Patients lie on their back,face mask inhaled oxygen（5L/min,3min）,intravenous midazolam 0.03mg/kg,target controlled infusion of propofol 3-4μg/ml and remifentanil 4-6ng/ml;MIV group intravenous injection of micuchloramine 0.2mg/kg,NR group did not give any muscle relaxant.After the disappearance of ciliary reflex,the mask was pressurized and oxygenated for 3min,the glottis was exposed by laryngoscope,the tracheal surface anesthesia was performed by 4ml laryngeal anesthesia tube with 2%lidocaine,and the oxygen was continuously pressurized.When the target concentration of propofol and remifentanil in plasma and the concentration of the effect chamber reach equilibrium,the intubation is connected to the anesthesia machine.During the operation,propofol and remifentanil were infused continuously to maintain anesthesia and IPPV controlled ventilation.Target controlled infusion was stopped 5 minutes before operation.According to Cooper’s score,the condition of tracheal intubation was evaluated;life parameters such as HR,SBP,DBP,Sp O₂,P_ETCO₂and BIS were monitored and recorded at the time points of 10 minutes’rest（T1）,2 minutes’induction（T2）,3 minutes’intubation（T3）,4 minutes’support laryngoscope insertion（T4）,5 minutes’extubation（T5）.The venous blood of T1,T3 and T5 were collected,and the supernatant was kept for examination after centrifugation.The levels of serum COR,e,DA and NE were measured;the dosage of propofol and remifentanil,the recovery time of spontaneous respiration,the recovery time of eyelash reflex,the recovery time of command action,the time of extubation and the time of leaving the recovery room were compared between the two groups;the NRS and OAAs scores of the two groups were compared;the adverse reactions and complications after anesthesia were recorded.Results:（1）Evaluation of tracheal intubation conditions:all cases were intubated by the same operator.The clinical satisfaction of NR group（74.3%）was lower than that of MIV group（100%）.There was significant difference between the two groups（P<0.05）.（2）Vital signs at different time points:there was no significant difference in HR,SBP,DBP,Sp O₂,P_ETCO₂and other vital parameters between the two groups at the corresponding time points（P>0.05）.There was no significant difference between the two groups（P>0.05）.There was no significant difference in BIS between NR group and MIV group at T1 and T2 time points（P>0.05）.The BIS values of T3,T4and T5 in NR group（44.7±3.3,42.6±4.4,84.7±5.2）were significantly lower than that in MIV group（54.9±3.7,52.7±4.7,92.7±5.2）,and there was significant difference between the two groups（P<0.05）.（3）Stress indexes at different time points:there was no significant difference in the stress level parameters of COR,E,DA,NE between the two groups（P>0.05）.（4）The results showed that the dosage of propofol（72.6±10.3μg/（kg·min））and remifentanil（0.19±0.06μg/（kg·min））in NR group was higher than that in MIV group（61.6±6.3μg/（kg·min））and（0.13±0.04μg/（kg·min））,and there was significant difference between the two groups（P<0.05）.There was no significant difference between the two groups in the time of spontaneous respiration,ciliary reflex,command action recovery,extubation and leaving the recovery room（P>0.05）.（5）The NRS score of NR group was lower than that of MIV group（2.1±0.6 vs 4.0±0.6）,and OAAs score was higher than that of MIV group（4.1±1.0 vs 3.1±0.9）.There was statistical difference between the two groups（P<0.05）.（6）The incidence of adverse events in NR group was higher than that in MIV group（14.3%vs 5.7%）.There was no significant difference between the two groups（P>0.05）.Conclusion:（1）Target controlled infusion of propofol and remifentanil with or without muscle relaxants can be safely used in laryngeal microsurgery.The hemodynamic changes and stress response intensity are acceptable during the operation.The two groups are similar in the recovery period of anesthesia,and the effect is satisfactory.（2）The tracheal intubation condition of MIV group was better than that of NR group,and there was no residual muscle relaxation during the recovery period,suggesting that the tracheal intubation condition with muscle relaxant was better during the induction period.（3）Intubation without muscle relaxation may increase the difficulty of tracheal intubation,only as a choice in some special cases.