Lien C A, Belmont M R, Wray Roth D L, Okamoto M, Abalos A, Savarese J J
The New York Hospital-Cornell Medical Center, New York, USA.
Anesthesiology. 1999 Jul;91(1):119-26. doi: 10.1097/00000542-199907000-00019.
The authors examined the plasma concentrations of the isomers of mivacurium and its pharmacodynamics during spontaeous and neostigmine-facilitated recovery after a mivacurium infusion.
Sixteen patients receiving nitrous oxide-opioid anesthesia received 0.25 mg/kg mivacurium. Patient response to neuromuscular stimulation was determined using a mechanomyograph Once T1 had recovered to 25% of its baseline height, a mivacurium infusion was begun and adjusted to maintain 95-99% neuromuscular block. The infusion was discontinued after 90 min and muscle strength allowed to recover either spontaneously or after neostigmine/glycopyrrolate (0.05/0.01 mg/kg). Plasma concentrations of the isomers of mivacurium after discontinuation of the infusion were determined using an HPLC assay. Differences between the groups were determined using a one-way analysis of variance with a Bonferroni-corrected t test or Student t test as appropriate. P < or = 0.05 was considered significant.
Differences in the times for recovery to a train-of-four ratio of 70% did not achieve statistical significance (mean+/-SD, 13.3+/-6.0 vs. 16.3+/-2.5 min for the neostigmine and spontaneous groups, respectively). Plasma cholinesterase activity decreased significantly from baseline values after administration of neostigmine (5.88+/-0.21 vs. 0.43+/-0.04 U/ml plasma). Plasma concentrations of the trans-trans isomer were significantly greater in the neostigmine group than in the spontaneous recovery group 5, 6, 8, and 10 min after discontinuation of the infusion. Differences in the plasma concentration of the cis-trans isomer did not achieve statistical significance.
Although administration of neostigmine decreased plasma cholinesterase activity and caused the trans-trans isomer to remain in the plasma at higher concentration, it did not delay recovery from mivacurium-induced block.
作者研究了米库氯铵输注后，在自主恢复和新斯的明促进恢复过程中米库氯铵异构体的血浆浓度及其药效学。
16例接受氧化亚氮-阿片类麻醉的患者接受了0.25mg/kg的米库氯铵。使用肌动描记器测定患者对神经肌肉刺激的反应。一旦T1恢复到其基线高度的25%，即开始输注米库氯铵并进行调整，以维持95%-99%的神经肌肉阻滞。90分钟后停止输注，让肌肉力量自主恢复或在给予新斯的明/格隆溴铵（0.05/0.01mg/kg）后恢复。输注停止后，使用高效液相色谱法测定米库氯铵异构体的血浆浓度。根据情况，使用经Bonferroni校正的t检验或Student t检验的单因素方差分析确定组间差异。P≤0.05被认为具有统计学意义。
恢复到四个成串刺激比值为70%的时间差异未达到统计学意义（新斯的明组和自主恢复组的平均值±标准差分别为13.3±6.0和16.3±2.5分钟）。给予新斯的明后，血浆胆碱酯酶活性较基线值显著降低（血浆分别为5.88±0.21和0.43±0.04U/ml）。输注停止后5、6、8和10分钟，新斯的明组的反式-反式异构体血浆浓度显著高于自主恢复组。顺式-反式异构体的血浆浓度差异未达到统计学意义。
虽然给予新斯的明会降低血浆胆碱酯酶活性，并使反式-反式异构体以更高浓度留在血浆中，但它并未延迟米库氯铵诱导的阻滞的恢复。
