Cammu G, de Baerdemaeker L, den Blauwen N, de Mey J C, Struys M, Mortier E
Ghent University Hospital, Department of Anaesthesia, Belgium.
Eur J Anaesthesiol. 2002 Feb;19(2):129-34. doi: 10.1017/s0265021502000236.
Monitoring of neuromuscular blockade still often relies on clinical judgement. Moreover, there are substantial national differences in the use of agents to 'reverse' their effects. We investigated the recovery characteristics and incidence of postoperative residual curarization after cisatracurium and rocuronium infusions for long duration interventions without systematic antagonism.
In 30 patients undergoing major surgery, we measured infusion dose requirements for rocuronium and cisatracurium during propofol anaesthesia. Infusions were discontinued at the beginning of surgical closure; spontaneous recovery of neuromuscular function was awaited in both groups. Neostigmine (50 microg kg(-1)) was administered only when a patient started to wake without a train-of-four ratio (TOF) of 0.9.
In the cisatracurium and rocuronium groups, four (27%) and one (7%) patients, respectively, had a TOF ratio > or = 0.9 at the end of surgery. The TOF ratio in each group at that time was 51 +/- 32% for cisatracurium and 47 +/- 31% for rocuronium (P = 0.78). Six patients (40%) in the cisatracurium group and seven (47%) in the rocuronium group required neostigmine. The TOF ratio at the time of reversal was 63 +/- 7% for cisatracurium and 40 +/- 19% for rocuronium (P = 0.01). The time interval between the end of surgery and a TOF ratio of 0.9 was 10 +/- 9 min for cisatracurium and 18 +/- 13 min for rocuronium (P = n.s.).
Patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarization when the block is not antagonized. When 'reversal' is not attempted, cisatracurium seems to be safer than rocuronium.
神经肌肉阻滞的监测目前仍常常依赖临床判断。此外，在使用药物“逆转”其作用方面，各国存在显著差异。我们研究了在长时间手术中持续输注顺式阿曲库铵和罗库溴铵且不进行系统拮抗时的恢复特征及术后残余肌松的发生率。
选取30例接受大手术的患者，在丙泊酚麻醉期间测量罗库溴铵和顺式阿曲库铵的输注剂量需求。手术结束缝皮时停止输注；两组均等待神经肌肉功能的自发恢复。仅当患者苏醒但四个成串刺激（TOF）比值未达到0.9时，才给予新斯的明（50μg/kg）。
在顺式阿曲库铵组和罗库溴铵组中，分别有4例（27%）和1例（7%）患者在手术结束时TOF比值≥0.9。此时，顺式阿曲库铵组和罗库溴铵组的TOF比值分别为51±32%和47±31%（P = 0.78）。顺式阿曲库铵组有6例患者（40%）、罗库溴铵组有7例患者（47%）需要使用新斯的明。逆转时顺式阿曲库铵组和罗库溴铵组的TOF比值分别为63±7%和40±19%（P = 0.01）。手术结束至TOF比值达到0.9的时间间隔，顺式阿曲库铵组为10±9分钟，罗库溴铵组为18±13分钟（P无统计学意义）。
当不进行拮抗时，接受顺式阿曲库铵或罗库溴铵输注的患者术后残余肌松的发生率较高。在不尝试“逆转”时，顺式阿曲库铵似乎比罗库溴铵更安全。
