Barrio J, Asensio I, Molina I, Sanmiguel G, García V
Servicio de Anestesiología y Reanimación, Hospital Arnau de Vilanova, Valencia.
Rev Esp Anestesiol Reanim. 2003 Jun-Jul;50(6):262-6.
To evaluate the effect of sevoflurane on a neuromuscular block from mivacurium in continuous infusion.
Fourteen ASA I-II patients receiving general anesthesia for orthopedic procedures on the knee. The neuromuscular block was monitored by acceleromyography in the adductor pollicis muscle after stimulation of the cubital nerve. Anaesthesia was induced with propofol and remifentanil. After orotracheal intubation, mivacurium was given in continuous infusion adjusted to obtain a stable submaximal block defined as a variation in the block of 3% more or less for 10 minutes (first response on a train of four [T1] between 40% and 60% of the calibrated value). Values for T1, the T4/T1 ratio (TR) and temperature over the thenar eminence were recorded at 3 moments: control moment (infusion of mivacurium and sevoflurane at an expired fraction of 1.5% for 30 minutes) and post-sevoflurane moment (perfusion of mivacurium and sevoflurane at an expired fraction of 0% for 15 minutes). Statistical analysis was by analysis of variance and post-hoc contrast (Tukey).
Results are expressed as means with standard error between parentheses. We found that values at T1(%) and TR(%) were significantly lower at the sevoflurane moments (T1 = 43.11 [1]; TR = 25.68 [1]) and the post-sevoflurane moment (T1 = 36.29 [2]; TR = 25.06 [2]) than at the control moment (T1 = 53.18 [1]; TR = 38.93 [1]) (P < .05). T1 was significantly lower at the post-sevoflurane moment than at the sevoflurane moment (P < .05) but TR did not differ significantly.
Sevoflurane causes a significant increase in the neuromuscular block maintained by mivacurium in continuous infusion and the increase lasts at least 15 minutes after the halogenated agent is cleared from blood.
评估七氟醚对持续输注米库氯铵所致神经肌肉阻滞的影响。
14例美国麻醉医师协会（ASA）分级为I-II级的患者，接受膝关节骨科手术的全身麻醉。刺激肘神经后，通过拇收肌的加速度肌电图监测神经肌肉阻滞情况。采用丙泊酚和瑞芬太尼诱导麻醉。经口气管插管后，持续输注米库氯铵，并进行调整以获得稳定的次最大阻滞，定义为阻滞在10分钟内变化不超过3%（四个成串刺激[T1]的首次反应在校准值的40%至60%之间）。在三个时刻记录T1值、T4/T1比值（TR）以及大鱼际的温度：对照时刻（输注米库氯铵且七氟醚呼气末浓度为1.5%持续30分钟）和七氟醚后时刻（输注米库氯铵且七氟醚呼气末浓度为0%持续15分钟）。采用方差分析和事后对比（Tukey检验）进行统计分析。
结果以括号内带标准误的均值表示。我们发现，七氟醚时刻（T1 = 43.11 [1]；TR = 25.68 [1]）和七氟醚后时刻（T1 = 36.29 [2]；TR = 25.06 [2]）的T1（%）和TR（%）值显著低于对照时刻（T1 = 53.18 [1]；TR = 38.93 [1]）（P <.05）。七氟醚后时刻的T1显著低于七氟醚时刻（P <.05），但TR差异无统计学意义。
七氟醚可使持续输注米库氯铵维持的神经肌肉阻滞显著增强，且在血液中卤化剂清除后，这种增强至少持续15分钟。
