■术中神经监测(IONM)可降低甲状腺手术中喉返神经(RLN)损伤的风险。然而,使用神经肌肉阻断剂(NMBAs),这对改善插管条件至关重要,可能会阻碍IONM期间的肌电图反应。这个前瞻性的目标,双盲,随机对照试验旨在探索在甲状腺切除术期间,在不显著影响IONM诱发电位的情况下,在气管插管中产生足够肌肉松弛的顺式阿曲库铵的最佳剂量.
■在我们机构接受IONM甲状腺切除术的患者,美国麻醉师协会的I-II级,18-75岁,纳入体重指数低于32kg/m2的患者,并随机分配(随机数字)接受1×(C1组)或2×(C2组)有效剂量(ED95)的顺式阿曲库铵用于气管插管。病人,外科医生,负责的麻醉医师对小组分配视而不见。用舒芬太尼诱导麻醉,异丙酚,和顺式阿曲库铵(C1组0.05mg/kgin,C2组0.1mg/kg)。使用插管条件评分(Cooper评分)和插管困难量表(IDS)评估插管的容易性。组间比较间歇性IONM期间诱发电位的幅度。主要结果是Cooper得分,IDS得分,和IONM的诱发电位。
■从2019年10月至2020年11月,对53例患者进行了随机分组,对52例患者进行了分析(每组26例患者)。C1组的Cooper评分明显降低[中位数,8.0(四分位数间距,7.0-8.3)]比C2组[9.0(9.0-9.0),P<0.001]。C1组无喉外压困难喉镜检查的发生率明显高于C2组(61.5%vs.11.5%,P<0.001)。C1组中更多的患者需要辅助完成气管插管(16vs.4,P=0.001)。C1组的IDS评分明显高于[3.0(0.0-4.0)。1.0(0.0-1.0),P=0.045]。两组之间的诱发电位幅度没有显着差异。未观察到严重不良事件。
■与1×ED95相比,2×ED95剂量的顺式阿曲库铵提供了更好的插管条件和更容易的气管插管,而不会干扰IONM。
■中国临床试验注册中心(编号:ChiCTR1900022884)。
UNASSIGNED: Intraoperative neuromonitoring (IONM) reduces the risk of recurrent laryngeal nerve (RLN) injury during thyroid surgery. However, the use of neuromuscular blocking agents (NMBAs), which are essential to improve intubation conditions, may hinder the electromyographic response during IONM. The aim of this prospective, double-blind, randomized controlled
trial was to explore the optimal dosage of
cisatracurium to produce adequate muscle relaxation for tracheal intubation without significantly affecting evoked potentials of IONM during thyroidectomy.
UNASSIGNED: Patients undergoing thyroidectomy with IONM in our institution, with an American Society of Anesthesiologists grade of I-II, aged 18-75 years, and with a body mass index below 32 kg/m2 were enrolled and randomly assigned (by random numbers) to receive 1× (group C1) or 2× (group C2) the effective dose (ED95) of cisatracurium for tracheal intubation. The patients, surgeons, and anesthesiologists in charge were blinded to group assignment. Anesthesia was induced with sufentanil, propofol, and
cisatracurium (0.05 mg/kgin group C1, 0.1 mg/kg in group C2). Ease of intubation was evaluated with the intubation condition score (Cooper score) and the intubation difficulty scale (IDS). Amplitudes of evoked potentials during intermittent IONM were compared between groups. The primary outcomes were the Cooper score, the IDS score, and the evoked potentials of IONM.
UNASSIGNED: Fifty-three patients were randomized from October 2019 to November 2020, and 52 were analyzed (with 26 patients in each group). The Cooper score was significantly lower in group C1 [median, 8.0 (interquartile range, 7.0-8.3)] than in group C2 [9.0 (9.0-9.0), P<0.001]. The rate of difficult laryngoscopy without external laryngeal pressure was significantly higher in group C1 than in group C2 (61.5% vs. 11.5%, P<0.001). More patients in group C1 required assistance to complete tracheal intubation (16 vs. 4, P=0.001). The IDS score was significantly higher in group C1 [3.0 (0.0-4.0) vs. 1.0 (0.0-1.0), P=0.045]. There were no significant differences between groups in amplitudes of evoked potentials. No serious adverse events were observed.
UNASSIGNED: A dose of 2× ED95 of
cisatracurium provided better intubation conditions and easier tracheal intubation than 1× ED95, without disturbing IONM.
UNASSIGNED: Chinese Clinical
Trial Registry (No. ChiCTR1900022884).