Bevan J C, Collins L, Fowler C, Kahwaji R, Rosen H D, Smith M F, de Scheepers L D, Stephenson C A, Bevan D R
Department of Anaesthesia, British Columbia's Children's Hospital, Vancouver, Canada.
Anesth Analg. 1999 Aug;89(2):333-9. doi: 10.1097/00000539-199908000-00016.
We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated.
These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.
我们研究了新斯的明给药时机对罗库溴铵或维库溴铵所致神经肌肉阻滞恢复的影响。80名成人和80名儿童在丙泊酚/芬太尼/氧化亚氮麻醉期间随机接受0.45mg/kg罗库溴铵或0.075mg/kg维库溴铵。通过四个成串刺激（TOF）和拇内收肌肌电图监测神经肌肉阻滞。进一步随机分为对照组（不给新斯的明）或在肌松药给药后5分钟给予0.07mg/kg新斯的明/0.01mg/kg格隆溴铵进行逆转，或在第一个肌颤搐（T1）恢复至1%、10%或25%时进行逆转。另外8名成人和8名儿童接受1.5mg/kg琥珀胆碱。在每个年龄组，罗库溴铵和维库溴铵给药后T1和TOF的自发恢复相似，但儿童恢复更快（P<0.05）。成人罗库溴铵和维库溴铵给药后T1自发恢复至TOF0.7的时间分别为45.7±11.5分钟和52.5±15.6分钟；儿童分别为28.8±7.8分钟和34.6±9.0分钟。新斯的明在所有逆转组中均加速了恢复（P<0.05），约加速40%，但从肌松药给药至TOF0.7的时间相似，且与新斯的明给药时机无关。琥珀胆碱给药后成人（9.4±5.0分钟）和儿童（8.4±1.1分钟）恢复至T1 90%的时间相似，且短于罗库溴铵或维库溴铵给药后任何逆转组恢复至TOF0.7的时间。新斯的明给药后儿童罗库溴铵和维库溴铵阻滞的恢复比成人更快。逆转后神经肌肉功能的恢复不受新斯的明给药时机的影响。这些结果表明，强烈的罗库溴铵或维库溴铵神经肌肉阻滞的逆转不必延迟至已证明有明显的神经肌肉功能恢复之后。
这些结果表明，强烈的罗库溴铵或维库溴铵神经肌肉阻滞的逆转不必延迟至已证明有明显的神经肌肉功能恢复之后。虽然儿童自发和新斯的明辅助的恢复比成人更快，但两者功能恢复的速度均不及琥珀胆碱给药后。
