Hemmerling T M, Schuettler J, Schwilden H
Department of Anesthesiology, University of Erlangen-Nuremberg, Germany.
Can J Anaesth. 2001 Jun;48(6):532-7. doi: 10.1007/BF03016828.
The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closed-loop feedback control.
Fifty-six patients (18-85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6-8 mg.kg(-1).hr(-1) propofol. After bolus application of 0.1 mg.kg(-1) cisatracurium, a T1%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate Iss. The Iss was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallis- test, followed by rank sum test, corrected for the number of comparisons, P <0.05 was regarded as showing significant difference.
ETI in the isoflurane group was 35.6 +/- 8.6 microg.m(-2).min(-1), in the sevoflurane group 36.4+/- 11.9 microg m(-2).min(-1), in the desflurane group 23.8 +/- 6.3 microg.m(-2).min(-1). The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 61.7 +/- 25.3 microg.m(-2).min(-1) (P <0.002). The ETI in the desflurane group was significantly lower than in all other groups (P <0.02).
In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41% and 60%, respectively.
本研究采用闭环反馈控制，探究顺式阿曲库铵累积剂量需求与异氟烷、七氟烷、地氟烷或丙泊酚麻醉之间的相互作用。
对56例患者（18 - 85岁，玻璃体切除术时长超过1小时）进行研究。在挥发性麻醉剂组中，采用1.3 MAC的异氟烷、七氟烷或地氟烷维持麻醉；在丙泊酚组中，通过持续输注6 - 8 mg·kg⁻¹·h⁻¹的丙泊酚维持麻醉。在静脉推注0.1 mg·kg⁻¹顺式阿曲库铵后，采用闭环反馈控制输注顺式阿曲库铵，维持T1%水平为对照水平的10%（每20秒进行一次四个成串刺激）。根据渐近稳态输注速率Iss估算有效治疗输注速率（ETI）。Iss通过将一条渐近线拟合到测量的累积剂量需求曲线上得出。使用Kruskal - Wallis检验比较不同组的ETI，随后进行秩和检验，并对比较次数进行校正，P < 0.05被视为显示出显著差异。
异氟烷组的ETI为35.6 ± 8.6 μg·m⁻²·min⁻¹，七氟烷组为36.4 ± 11.9 μg·m⁻²·min⁻¹，地氟烷组为23.8 ± 6.3 μg·m⁻²·min⁻¹。挥发性麻醉剂组的ETI均显著低于丙泊酚组的ETI（61.7 ± 25.3 μg·m⁻²·min⁻¹，P < 0.002）。地氟烷组的ETI显著低于所有其他组（P < 0.02）。
与丙泊酚相比，异氟烷、七氟烷和地氟烷可分别将维持90%神经肌肉阻滞所需的顺式阿曲库铵累积剂量需求降低42%、41%和60%。
