Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
Otolaryngol Head Neck Surg. 2020 Jun;162(6):853-859. doi: 10.1177/0194599820912030. Epub 2020 Mar 17.
To examine the influence of sevoflurane-based combined intravenous and inhaled anesthesia versus propofol-based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy.
A randomized controlled trial.
The present study was conducted in a tertiary hospital.
Forty patients were randomly assigned to a sevoflurane-based combined intravenous and inhalation group (group S) or a propofol-based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard.
The time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5-49.3]) than in group P (37.0 minutes [33.3-41.5], = .028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S ( = .006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups.
Combined intravenous and inhaled anesthesia based on sevoflurane-remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol-remifentanil in patients undergoing thyroidectomy.
研究七氟醚复合静脉吸入麻醉与丙泊酚全凭静脉麻醉（TIVA）对甲状腺切除术术中神经监测（IONM）的影响。
随机对照试验。
本研究在一家三级医院进行。
40 名患者被随机分为七氟醚复合静脉吸入组（S 组）或丙泊酚 TIVA 组（P 组）。两组均采用咪达唑仑、舒芬太尼、丙泊酚和顺式阿曲库铵诱导麻醉，S 组采用七氟醚和瑞芬太尼维持麻醉，P 组采用丙泊酚和瑞芬太尼 TIVA 维持麻醉。根据 IONM 公式标准间歇性进行 IONM。
S 组（中位数，41.0 分钟[四分位距，37.5-49.3]）首次检测到正肌电图（EMG）信号的时间明显长于 P 组（37.0 分钟[33.3-41.5]， =.028）。P 组所有患者在初始监测时均有正 EMG 信号，而 S 组 8 例（40.0%）患者无正 EMG 信号。P 组初始监测时正 EMG 信号的发生率明显高于 S 组（ =.006）。V1、R1、R2 和 V2 的诱发电位振幅在两组间相似。
与丙泊酚-瑞芬太尼 TIVA 相比，甲状腺切除术患者中，七氟醚-瑞芬太尼复合静脉吸入麻醉可延长 IONM 检测到正 EMG 信号的时间。
