Dahaba A A, Schweitzer E, Fitzgerald R D, Schwarz S
Department of Anaesthesia, Lainz Hospital, Vienna, Austria.
Can J Anaesth. 2001 Dec;48(11):1084-90. doi: 10.1007/BF03020374.
To compare equi-lasting doses of a short-acting (mivacurium) to an intermediate-acting (rocuronium) neuromuscular relaxant, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic alterations, adverse events and costs, in patients undergoing laparoscopic gynecological surgery.
Sixty patients were randomly allocated to receive either 0.2 mgkg(-1) (3 x ED(95)) mivacurium or 0.5 mgkg(-1) (1.7 x ED(95)) rocuronium, under propofol/fentanyl anesthesia. T1, first twitch of the train-of-four (TOF) and TOF ratio (T4:T1) were used to evaluate neuromuscular block using the Relaxometer(R) mechanomyograph. The trachea was intubated when T1 was maximally suppressed. Neuromuscular block was maintained at 25% T1 with equi-lasting doses of 0.075 mgkg(-1) mivacurium or 0.15 mgkg(-1) rocuronium.
Mean (min) +/- SD mivacurium onset time (1.9 +/- 0.4) was longer than that of rocuronium (1.3 +/- 0.3). This did not yield a statistical difference in intubating conditions between the two groups. Interval 25-75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium (11.9 +/- 3.9, 52.6 +/- 15.5 respectively) compared to mivacurium (6.7 +/- 2.3, 39.2 +/- 8.1 respectively). More patients, 22/30, required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group. Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration. The acquisition costs of rocuronium (6.93 Euro/patient) were 23% lower compared to mivacurium (8.96 Euro/patient).
Equi-lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with erythema, compared to mivacurium.
比较短效神经肌肉阻滞剂（米库氯铵）和中效神经肌肉阻滞剂（罗库溴铵）在等效维持剂量下，用于接受腹腔镜妇科手术患者时的插管条件、疗效、维持剂量次数、血流动力学改变、不良事件及成本。
60例患者在丙泊酚/芬太尼麻醉下，随机分配接受0.2mg·kg⁻¹（3倍ED₉₅）米库氯铵或0.5mg·kg⁻¹（1.7倍ED₉₅）罗库溴铵。使用Relaxometer®肌动描记器，通过四个成串刺激（TOF）中的第一个颤搐（T1）和TOF比值（T4:T1）评估神经肌肉阻滞。当T1被最大程度抑制时进行气管插管。使用0.075mg·kg⁻¹米库氯铵或0.15mg·kg⁻¹罗库溴铵的等效维持剂量，将神经肌肉阻滞维持在T1的25%。
米库氯铵的平均（分钟）±标准差起效时间（1.9±0.4）长于罗库溴铵（1.3±0.3）。但两组间插管条件无统计学差异。与米库氯铵（分别为6.7±2.3、39.2±8.1）相比，罗库溴铵给药后，25 - 75% T1恢复间隔和恢复至0.8 TOF的时间延长（分别为11.9±3.9、52.6±15.5）。与罗库溴铵组的14/30例患者相比，更多患者（22/30）需要米库氯铵维持剂量。米库氯铵给药后，动脉血压下降，13/30例患者出现红斑。罗库溴铵的购置成本（6.93欧元/患者）比米库氯铵（8.96欧元/患者）低23%。
与米库氯铵相比，等效维持剂量的罗库溴铵能更快产生良好的插管条件，改善血流动力学稳定性，减少维持剂量的给药频率，且不伴有红斑。
