氟烷、异氟烷和七氟烷对儿童罗库溴铵输注的影响。

The influence of halothane, isoflurane and sevoflurane on rocuronium infusion in children.

作者信息

Woloszczuk-Gebicka B, Lapczynski T, Wierzejski W

机构信息

Department of Anaesthesiology and Intensive Therapy, Memorial Children's Health Institute, Warsaw, Poland.

出版信息

Acta Anaesthesiol Scand. 2001 Jan;45(1):73-7. doi: 10.1034/j.1399-6576.2001.450112.x.

DOI:10.1034/j.1399-6576.2001.450112.x

PMID:11152037

Abstract

BACKGROUND

Rocuronium is a non-depolarizing neuromuscular blocking agent with intermediate duration of action and without significant cumulative properties, suitable for continuous infusion. This study was designed to determine the infusion requirements in children under nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane anaesthesia.

METHODS

Forty children, 3-11 years old, ASA physical status group I or II were studied. They were randomly allocated to receive fentanyl-nitrous oxide, 1 MAC halothane-nitrous oxide, 1 MAC isoflurane-nitrous oxide or 1 MAC sevoflurane-nitrous oxide anaesthesia. Rocuronium, 0.6 mg(-1) was used to facilitate endotracheal intubation. Electromyographic response of adductor pollicis to train-of-four (TOF) stimulation, 2 Hz for 2 s, applied to the ulnar nerve at 10-s intervals was recorded using Relaxograph (Datex, Helsinki, Finland). Once the first twitch response (T1) returned to 5%, muscle relaxation was maintained by continuous infusion of rocuronium, adjusted automatically in a closed-loop system to maintain a stable 90-99% T1 depression. The block was considered stable if it changed by no more than 2% over a 10-min observation period.

RESULTS

Halothane, isoflurane and sevoflurane groups had ower infusion requirements than the fentanyl-nitrous oxide group (P<0.00075). Rocuronium requirement (mean +/- SD) at one hour from the commencement of anaesthesia was 16.7+/-2.3, 13.6+/-3.7, 13.1+/-5.1 and 8.4+/-1.6 microg x kg(-1) x min(-1) for children receiving fentanyl-nitrous oxide, halothane, isoflurane and sevoflurane anaesthesia, respectively.

CONCLUSIONS

The rocuronium infusion rate required to maintain stable 90-99% T1 depression was reduced by approximately 20% with halothane and isoflurane anaesthesia, and by 50% with evoflurane anaesthesia when compared to fentanyl-nitrous oxide anaesthesia. Significant patient-to-patient variability of infusion rate makes monitoring of neuromuscular transmission necessary.

摘要

背景

罗库溴铵是一种中效非去极化神经肌肉阻滞剂，无明显蓄积作用，适用于持续输注。本研究旨在确定在氧化亚氮与芬太尼、氟烷、异氟烷或七氟烷麻醉下儿童的输注需求量。

方法

对40例3 - 11岁、ASA身体状况分级为I或II级的儿童进行研究。他们被随机分配接受芬太尼 - 氧化亚氮、1 MAC氟烷 - 氧化亚氮、1 MAC异氟烷 - 氧化亚氮或1 MAC七氟烷 - 氧化亚氮麻醉。使用0.6 mg/kg的罗库溴铵辅助气管插管。使用Relaxograph（Datex，芬兰赫尔辛基）记录拇内收肌对以2 Hz频率持续2秒、每隔10秒施加于尺神经的四个成串刺激（TOF）的肌电图反应。一旦第一个肌颤搐反应（T1）恢复到5%，通过持续输注罗库溴铵维持肌肉松弛，在闭环系统中自动调整以维持稳定的T1抑制在90 - 99%。如果在10分钟观察期内阻滞变化不超过2%，则认为阻滞稳定。

结果

氟烷、异氟烷和七氟烷组的输注需求量低于芬太尼 - 氧化亚氮组（P < 0.00075）。接受芬太尼 - 氧化亚氮、氟烷、异氟烷和七氟烷麻醉的儿童在麻醉开始后1小时的罗库溴铵需求量（平均值±标准差）分别为16.7±2.3、13.6±3.7、13.1±5.1和8.4±1.6 μg·kg⁻¹·min⁻¹。