Deepika K, Bikhazi G B, Mikati H M, Namba M, Foldes F F
Department of Anesthesiology, University of Miami School of Medicine, FL 33101.
J Clin Anesth. 1992 Mar-Apr;4(2):106-10. doi: 10.1016/0952-8180(92)90024-u.
To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mg/kg.
Randomized, unblinded study.
Operating rooms and postanesthetic recovery unit of a university-affiliated general hospital.
Thirty female ASA physical status I and II patients scheduled for intraperitoneal surgery divided into two groups of 15 each.
Anesthesia was induced and maintained with sufentanil, droperidol, thiopental sodium, and nitrous oxide in oxygen. Patients in Group 1 were given vecuronium 0.015 mg/kg 4 minutes before induction and vecuronium 0.285 mg/kg 1 minute after induction. Patients in Group 2 received a single 0.3 mg/kg dose of vecuronium 1 minute after thiopental sodium. The ulnar nerve was stimulated every 10 seconds with train-of-four supramaximal impulses of 0.2 millisecond duration at 2 Hz. The compound electromyogram (EMG) of the adductor pollicis was continuously recorded. The trachea was intubated when the amplitude of the EMG decreased to 15% to 25% of control. At the end of surgery, residual neuromuscular block was reversed with edrophonium 0.75 mg/kg.
All patients in Group 1 could be intubated in 80 seconds or less, and the longest onset time was 120 seconds. In Group 2, the longest intubation time was 140 seconds, and the longest onset time was 200 seconds. Clinical durations in both groups were unpredictable, ranging from 47 to 185 minutes in Group 1 and from 63 to 160 minutes in Group 2. Ten of the 30 patients required an additional 0.5 mg/kg of edrophonium for antagonism of the residual neuromuscular block. There were no significant changes in heart rate or blood pressure attributable to vecuronium.
Seventy-five percent to 85% neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mg/kg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mg/kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubating dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.
确定预注对0.3mg/kg维库溴铵插管时间和起效时间的影响。
随机、非盲法研究。
一所大学附属医院的手术室和麻醉后恢复室。
30例计划行腹腔手术的ASA身体状况Ⅰ级和Ⅱ级的女性患者，分为两组，每组15例。
采用舒芬太尼、氟哌利多、硫喷妥钠和氧气-氧化亚氮诱导并维持麻醉。第1组患者在诱导前4分钟给予0.015mg/kg维库溴铵，诱导后1分钟给予0.285mg/kg维库溴铵。第2组患者在硫喷妥钠后1分钟给予单次0.3mg/kg维库溴铵剂量。每隔10秒用2Hz的0.2毫秒持续时间的四个超强刺激串刺激尺神经。持续记录拇内收肌的复合肌电图（EMG）。当EMG幅度降至对照值的15%至25%时进行气管插管。手术结束时，用0.75mg/kg依酚氯铵逆转残余的神经肌肉阻滞。
第1组所有患者均可在80秒或更短时间内插管，最长起效时间为120秒。第2组最长插管时间为140秒，最长起效时间为200秒。两组的临床持续时间均不可预测，第1组为47至185分钟，第2组为63至160分钟。30例患者中有10例需要额外给予0.5mg/kg依酚氯铵以拮抗残余的神经肌肉阻滞。维库溴铵对心率或血压无显著影响。
当0.3mg/kg维库溴铵分次给药时，在80秒或更短时间内可产生无创伤气管插管所需的拇内收肌75%至85%的神经肌肉阻滞，单次推注给药时则在140秒或更短时间内产生。0.3mg/kg维库溴铵的临床持续时间长且不可预测，逆转残余神经肌肉阻滞可能需要更大剂量的抗胆碱酯酶药物。建议仅在需要长时间麻醉后机械通气的长时间手术患者中使用0.3mg/kg维库溴铵的插管剂量。
