米库氯铵或维库溴铵用于小儿耳鼻喉科手术：临床经验与成本分析

Lysakowski C, Fuchs-Buder T, Tassonyi E

Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Switzerland.

Anaesthesist. 2000 May;49(5):387-91. doi: 10.1007/s001010070106.

BACKGROUND

The present study compared the quality of neuromuscular block and costs after equipotent doses of mivacurium and vecuronium in the context of paediatric ENT surgery.

METHODS

A total of 30 children undergoing elective tonsillectomy were included and randomised in two groups (n = 15 for each) according to the neuromuscular blocking agent (NMBA) used. Anaesthesia was induced with alfentanil (15 micrograms/kg), propofol (3 mg/kg) and either 0.2 mg/kg mivacurium or 0.14 mg/kg vecuronium. For maintenance of anaesthesia propofol (8-12 mg/kg/h) was given. Neuromuscular block was assessed by electromyography using train-of four stimulation and the following parameters were quantified: Twitch height (T1) 2 min after the initial bolus of the myorelaxant; duration until recovery to 10% T1, number and duration of bolus injections of the myorelaxant needed to maintain neuromuscular block to a T1 < 10%. In addition, the intubating conditions, number of patients needing pharmacological reversal at the end of surgery, adverse reactions and the costs for neuromuscular block and pharmacological antagonization were assessed.

RESULTS

Intubation conditions were comparable between both study groups: mivacurium--excellent: 7, good: 5, not acceptable: 1; vecuronium--excellent: 11, good: 4 (n.s.). T1 at 2 min was 16 (15)% for mivacurium and 6 (9)% for vecuronium (P < 0.05). Time to 10% T1 recovery was 6.1 (1.7) min for mivacurium and 21.8 (3.7) min for vecuronium (P < 0.01). In the mivacurium group 7 repetitive doses (range: 4-18) were needed to maintain T1 < 10% during surgery, whereas children treated with vecuronium needed only 1 maintenance dose (range: 0-2) (P < 0.01). Two children in the mivacurium group and 11 in the vecuronium group required pharmacological reversal of the NMB at the end of surgery (P < 0.01). The overall costs of NMB were significantly higher in the mivacurium group as compared to vecuronium 12.88 (4.5) Euro vs 9.96 (2.4) Euro; P < 0.05.

CONCLUSIONS

In conclusion, mivacurium-induced NMB is of very short duration in paediatric patients, and therefore repetitive doses are required to maintain a deep neuromuscular block. Nevertheless, residual paralysis is less frequent after mivacurium. The neuromuscular block after mivacurium was more expensive and residual paralysis less frequent compared to vecuronium.

背景

本研究在小儿耳鼻喉科手术中比较了等效剂量的米库氯铵和维库溴铵后的神经肌肉阻滞质量及成本。

方法

总共纳入30例行择期扁桃体切除术的儿童，并根据所使用的神经肌肉阻滞剂（NMBA）随机分为两组（每组n = 15）。用阿芬太尼（15微克/千克）、丙泊酚（3毫克/千克）以及0.2毫克/千克米库氯铵或0.14毫克/千克维库溴铵诱导麻醉。维持麻醉时给予丙泊酚（8 - 12毫克/千克/小时）。使用四个成串刺激通过肌电图评估神经肌肉阻滞，并对以下参数进行量化：肌松剂初始推注后2分钟的颤搐高度（T1）；恢复至10% T1的持续时间；维持神经肌肉阻滞至T1 < 10%所需的肌松剂推注次数和持续时间。此外，评估插管条件、手术结束时需要药物逆转的患者数量、不良反应以及神经肌肉阻滞和药物拮抗的成本。

结果

两个研究组之间的插管条件相当：米库氯铵组——优：7例，良：5例，差：1例；维库溴铵组——优：11例，良：4例（无显著差异）。米库氯铵组2分钟时的T1为16（15）%，维库溴铵组为6（9）%（P < 0.05）。米库氯铵组恢复至10% T1的时间为6.1（1.7）分钟，维库溴铵组为21.8（3.7）分钟（P < 0.01）。米库氯铵组在手术期间需要7次重复剂量（范围：4 - 18次）以维持T1 < 10%，而维库溴铵治疗的儿童仅需要1次维持剂量（范围：0 - 2次）（P < 0.01）。米库氯铵组有2名儿童，维库溴铵组有11名儿童在手术结束时需要对神经肌肉阻滞进行药物逆转（P < 0.01）。与维库溴铵相比，米库氯铵组神经肌肉阻滞的总体成本显著更高，分别为12.88（4.5）欧元和9.96（2.4）欧元；P < 0.05。