Dhonneur G, Kirov K, Slavov V, Duvaldestin P
Department of Anesthesia, Henri Mondor Hospital, Creteil, France.
Anesthesiology. 1999 Apr;90(4):951-5. doi: 10.1097/00000542-199904000-00004.
Paralysis of the vocal cords is one objective of using relaxants to facilitate tracheal intubation. This study compares the neuromuscular blocking effect of succinylcholine and rocuronium on the larynx, the diaphragm, and the adductor pollicis muscle.
Electromyographic response was used to compare the neuromuscular blocking effect of succinylcholine and rocuronium on the laryngeal adductor muscles, the diaphragm, and the adductor pollicis muscle. Sixteen patients undergoing elective surgery were anesthetized with propofol and fentanyl, and their tracheas were intubated without neuromuscular blocking agents. The recurrent laryngeal and phrenic nerves were stimulated at the neck. The electromyographic response was recorded from electrodes placed on the endotracheal tube and intercostally before and after administration of 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium.
The maximum effect was greater at the adductor pollicis (100 and 99%) than at the larynx (96 and 97%) and the diaphragm (94 and 96%) after administration of succinylcholine and rocuronium, respectively (P < or = 0.05). Onset time was not different between the larynx (58+/-10 s), the diaphragm (57+/-8 s), and the adductor pollicis (54+/-13 s), after succinylcholine (all mean +/- SD). After rocuronium, onset time was 124+/-39 s at the larynx, 130+/-44 s at the diaphragm, and 115+/-21 s at the adductor pollicis. After succinylcholine administration, time to 90% recovery was 8.3+/-3.2, 7.2+/-3.5, and 9.1+/-3.0 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Time to 90% recovery after rocuronium administration was 34.9+/-7.6, 30.4+/-4.2, and 49.1+/-11.4 min at the larynx, the diaphragm, and the adductor pollicis, respectively.
Neuromuscular blocking effect of muscle relaxants on the larynx can be measured noninvasively by electromyography. Although the larynx appears to be resistant to muscle relaxants, we could not demonstrate that its onset time differed from that of peripheral muscles.
声带麻痹是使用松弛剂辅助气管插管的一个目标。本研究比较了琥珀酰胆碱和罗库溴铵对喉部、膈肌及拇内收肌的神经肌肉阻滞作用。
采用肌电图反应比较琥珀酰胆碱和罗库溴铵对喉内收肌、膈肌及拇内收肌的神经肌肉阻滞作用。16例择期手术患者用丙泊酚和芬太尼麻醉，在未使用神经肌肉阻滞剂的情况下进行气管插管。在颈部刺激喉返神经和膈神经。在给予1mg/kg琥珀酰胆碱或0.6mg/kg罗库溴铵之前和之后，从置于气管导管上和肋间的电极记录肌电图反应。
分别给予琥珀酰胆碱和罗库溴铵后，拇内收肌的最大效应（分别为100%和99%）大于喉部（分别为96%和97%）和膈肌（分别为94%和96%）（P≤0.05）。琥珀酰胆碱给药后，喉部（58±10秒）、膈肌（57±8秒）和拇内收肌（54±13秒）的起效时间无差异（均为平均值±标准差）。罗库溴铵给药后，喉部起效时间为124±39秒，膈肌为130±44秒，拇内收肌为115±21秒。给予琥珀酰胆碱后，喉部、膈肌和拇内收肌恢复至90%的时间分别为8.3±3.2、7.2±3.5和9.1±3.0分钟。罗库溴铵给药后，喉部、膈肌和拇内收肌恢复至90%的时间分别为34.9±7.6、30.4±4.2和49.1±11.4分钟。
肌肉松弛剂对喉部的神经肌肉阻滞作用可用肌电图进行无创测量。虽然喉部似乎对肌肉松弛剂有抵抗性，但我们未能证明其起效时间与外周肌肉不同。
