Levy J H, Pitts M, Thanopoulos A, Szlam F, Bastian R, Kim J
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Anesth Analg. 1999 Aug;89(2):290-5. doi: 10.1097/00000539-199908000-00005.
Neuromuscular blocking drugs may have variable effects on heart rate (HR) and blood pressure. Rapacuronium is a rapid-acting, steroidal-derived neuromuscular blocking drug whose hemodynamic effects have not been characterized. We studied the effects of 1, 2, and 3 mg/kg rapacuronium on histamine release, HR, and blood pressure in 47 ASA physical status II or III adult patients after the induction of anesthesia with etomidate/fentanyl/N2O. Plasma histamine concentrations were measured before induction and immediately before and 1, 3, and 5 min after the rapid administration of rapacuronium. Mean arterial pressure (MAP) decreased after rapacuronium administration, but there were no significant differences among the groups for changes in HR or MAP, and there was no correlation between changes in MAP or HR and increases in histamine levels. There were no changes in HR or MAP among five patients who had significant (> or = 1 ng/mL) increases in histamine from baselin. Seven patients had bronchospasm without increases in plasma histamine levels. Rapacuronium 2-3 mg/kg increased plasma histamine levels. However, clinically significant histamine-related sequelae did not occur in this population with 1- to 3-mg/kg doses of rapacuronium, and cardiovascular changes were not directly correlated with histamine release. Rapacuronium administration can produce hypotension via mechanisms that do not seem to be related to histamine release.
Rapacuronium, a new steroidal-derived muscle relaxant, may release histamine and produce slight changes in blood pressure and heart rate after administration.
神经肌肉阻滞药物对心率（HR）和血压可能有不同影响。瑞帕库溴铵是一种速效、甾体类神经肌肉阻滞药物，其血流动力学效应尚未明确。我们研究了1、2和3mg/kg瑞帕库溴铵对47例美国麻醉医师协会（ASA）身体状况为II或III级的成年患者在依托咪酯/芬太尼/氧化亚氮诱导麻醉后组胺释放、HR和血压的影响。在诱导前、快速给予瑞帕库溴铵前即刻以及给药后1、3和5分钟测量血浆组胺浓度。给予瑞帕库溴铵后平均动脉压（MAP）下降，但各组间HR或MAP的变化无显著差异，且MAP或HR的变化与组胺水平升高之间无相关性。5例组胺水平较基础值显著升高（≥1ng/mL）的患者HR和MAP无变化。7例患者发生支气管痉挛但血浆组胺水平未升高。2 - 3mg/kg瑞帕库溴铵可使血浆组胺水平升高。然而，在给予1 - 3mg/kg剂量瑞帕库溴铵的这群患者中未出现临床上显著的组胺相关后遗症，且心血管变化与组胺释放无直接相关性。给予瑞帕库溴铵可通过似乎与组胺释放无关的机制导致低血压。
瑞帕库溴铵，一种新型甾体类肌肉松弛剂，给药后可能释放组胺并使血压和心率产生轻微变化。
