Site Effect Concentrations of Remifentanil and Propofol for Intubation without Use of Neuromuscular Agent for Thyroid Surgery

Objective: Thyroid surgery needs accuracy with the aim to limit major complications--that is to say injury of recurrent laryngeal nerve. To help the surgeon, tracheal tube with recurrent laryngeal nerve monitoring can be used. This technique is possible when no muscle relaxant is injected. Remifentanil use with an objective of effect site concentration appears to be a solution for anesthesia for this type of surgery. Our work consists in studying the optimal concentration needed to realize the surgery without the necessity to use muscle relaxant and with the lowest side effects.Method: Observation of practice in the department of Ear, Nose and Throat (ENT) surgery at Brest University Hospital. Fifty-two patients undergoing thyroid surgery were assigned in 4 groups according to site effect remifentanil concentration: 4, 6, 7, and 8 ng/mL. Intubation was done by a tracheal tube with EMG electrodes to monitor recurrent laryngeal nerve during surgery. Noninvasive arterial blood pressure, heart rate changes, a...