Fuchs-Buder T, Ziegenfuss T, Lysakowski K, Tassonyi E
Department of Anaesthesia and Critical Care, University of the Saarland, Homburg/Saar, Germany.
Br J Anaesth. 1999 Jan;82(1):61-5. doi: 10.1093/bja/82.1.61.
We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmine-induced recovery in patients pretreated with MgSO4 (group A) or saline (group B) (n = 12 each). The height of T1, 5 min after neostigmine, was 43 (7)% in group A and 65 (6)% in group B (P < 0.01). Respective values after 10 min were 59 (7)% and 83 (5)% (P < 0.01). TOF ratio, 5 min after neostigmine, was 29 (6)% in group A and 29 (5)% in group B. Respective values after 10 min were 38 (11)% and 51 (7)% (P < 0.01). To gain insight into the mechanisms leading to delayed recovery after MgSO4, we calculated assisted recovery, defined as neostigmine-induced recovery minus mean spontaneous recovery. Spontaneous recovery was assessed in another 24 patients. Patients in group C received MgSO4/vecuronium and patients in group D vecuronium only (n = 12 each). Five minutes after neostigmine, assisted recovery was 22 (7)% in the MgSO4 pretreated patients and 28 (6)% in controls (P < 0.05). Ten minutes after neostigmine, values were 24 (7)% and 22 (6)%. Maximum assisted recovery was not influenced by MgSO4 pretreatment (27 (6)% in group A and 32 (6)% in group B) and time to maximum effect was comparable between groups: 6 (4-10) min and 7 (5-8) min, respectively. We conclude that neostigmine-induced recovery was attenuated in patients treated with MgSO4. This was mainly a result of slower spontaneous recovery and not decreased response to neostigmine.
我们研究了新斯的明在有或无硫酸镁（MgSO4）预处理情况下拮抗维库溴铵诱导的神经肌肉阻滞的剂量效应关系。通过四个成串刺激（TOF）的肌电图评估神经肌肉阻滞情况。首先，我们测定了用MgSO4预处理的患者（A组）或生理盐水预处理的患者（B组）（每组n = 12）中新斯的明诱导的恢复情况。新斯的明给药5分钟后，A组T1的高度为43（7）%，B组为65（6）%（P < 0.01）。10分钟后的相应值分别为59（7）%和83（5）%（P < 0.01）。新斯的明给药5分钟后，A组的TOF比值为29（6）%，B组为29（5）%。10分钟后的相应值分别为38（11）%和51（7）%（P < 0.01）。为深入了解MgSO4后恢复延迟的机制，我们计算了辅助恢复，定义为新斯的明诱导的恢复减去平均自发恢复。在另外24例患者中评估自发恢复情况。C组患者接受MgSO4/维库溴铵，D组患者仅接受维库溴铵（每组n = 12）。新斯的明给药5分钟后，MgSO4预处理患者的辅助恢复为22（7）%，对照组为28（6）%（P < 0.05）。新斯的明给药10分钟后，数值分别为24（7）%和22（6）%。最大辅助恢复不受MgSO4预处理的影响（A组为27（6）%，B组为32（6）%），且达到最大效应的时间在两组之间相当：分别为6（4 - 10）分钟和7（5 - 8）分钟。我们得出结论，MgSO4治疗的患者中新斯的明诱导的恢复减弱。这主要是自发恢复较慢的结果，而非对新斯的明的反应降低。
