Abdulatif M, El-Sanabary M
Anaesthesiology Department, Faculty of Medicine, Cairo University, Egypt.
Anaesth Intensive Care. 2001 Aug;29(4):364-70. doi: 10.1177/0310057X0102900406.
This randomized, controlled study compared edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N2O anaesthesia, were studied. Cisatracurium 0.1 mg x kg(-1) was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg x kg(-1) or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n=12). Atropine 5 to 10 microg x kg(-1) was given according to edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P<0.01. The times to 10% spontaneous recovery of the first twitch (T1) were respectively, 28.4 (5.2) and 41.8 (6.1) minutes in children and adults, P<0.01. Spontaneous and antagonist assisted neuromuscular recovery was more rapid in children. Adequate neuromuscular recovery (train of four (TOF) ratio 80%) was achieved in children at 3 and 10 minutes after edrophonium 1.0 mg kg(-1) and 0.4 mg x kg(-1), respectively. A TOF ratio of 80% was not achieved, within 10 minutes, with any of the four dose levels of edrophonium in adults. The dose of edrophonium to achieve a TOF ratio of 80% (ED(TOF-80)) after 5 and 10 minutes in children were, respectively, mean (SD) 0.85 (0.38) and 0.38 (0.19) mg x kg(-1). The equivalent ED(TOF-80) in adults was outside the edrophonium dose range studied.
这项随机对照研究比较了儿童和成人拮抗顺式阿曲库铵诱导的神经肌肉阻滞所需的依酚氯铵剂量。研究对象为60名2至10岁的儿童和60名20至60岁的成人，所有受试者美国麻醉医师协会（ASA）身体状况分级为1或2级，均接受丙泊酚、芬太尼和异氟烷 - 氧化亚氮麻醉。给予顺式阿曲库铵0.1 mg·kg⁻¹以实现肌肉松弛。采用加速度仪监测神经肌肉阻滞情况。通过随机分配给予依酚氯铵0.1、0.2、0.4或1 mg·kg⁻¹或不给予抗胆碱酯酶药物（对照组），以拮抗各研究组（n = 12）中90%的神经肌肉阻滞。根据依酚氯铵剂量给予阿托品5至10 μg·kg⁻¹。顺式阿曲库铵诱导阻滞的起效时间在儿童中平均（标准差）为2.4（0.8）分钟，在成人中为4.1（2.3）分钟，P<0.01。儿童和成人首次肌颤搐（T1）恢复至10%自发恢复的时间分别为28.4（5.2）分钟和41.8（6.1）分钟，P<0.01。儿童的自发和拮抗剂辅助的神经肌肉恢复更快。在儿童中，给予依酚氯铵1.0 mg·kg⁻¹和0.4 mg·kg⁻¹后，分别在3分钟和10分钟时实现了足够的神经肌肉恢复（四个成串刺激（TOF）比值为80%）。在成人中，使用依酚氯铵的四个剂量水平中的任何一个，在10分钟内均未达到80%的TOF比值。儿童在给药5分钟和10分钟后达到80% TOF比值（ED(TOF - 80)）所需的依酚氯铵剂量分别平均（标准差）为0.85（0.38）和0.38（0.19）mg·kg⁻¹。成人中的等效ED(TOF - 80)超出了所研究的依酚氯铵剂量范围。
