Koenig K L
Division of Emergency Medicine, University of California, Irvine Medical Center, Orange.
Ann Emerg Med. 1992 Aug;21(8):929-32. doi: 10.1016/s0196-0644(05)82930-0.
Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration. Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration.
Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium.
A prospective, randomized, double-blind study.
An inner-city county trauma center with 70,000 patient visits per year.
Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium.
Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine (1 mg/kg) IV. Patients were randomized to receive either minidose succinylcholine (0.1 mg/kg) or pancuronium (0.03 mg/kg) IV one minute prior to the full paralytic dose of succinylcholine (1.5 mg/kg) IV. Fasciculations were recorded using a graded visual scale.
Of 46 patients, eight of 19 (42%) in the pancuronium group and six of 27 (22%) in the succinylcholine group experienced fasciculations. No statistically significant difference in fasciculations was detected between the two groups using chi 2 analysis. Complete relaxation of the cords was present in all but two patients, one in each group. No patient in either group experienced emesis or significant dysrhythmias.
Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting. Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients.
快速顺序诱导插管期间的肌束震颤可能导致颅内压升高以及呕吐和误吸。标准的快速顺序诱导插管在给予琥珀酰胆碱之前需要使用非去极化阻滞剂。
对于头部创伤患者，在快速顺序诱导插管期间，使用小剂量琥珀酰胆碱预防肌束震颤与使用去极化剂量的潘库溴铵一样安全有效。
一项前瞻性、随机、双盲研究。
一个每年有70000例患者就诊的市中心县创伤中心。
需要快速顺序诱导插管且对琥珀酰胆碱或潘库溴铵无禁忌证的成年头部创伤患者。
每位符合纳入标准的需要快速顺序诱导插管的头部创伤患者接受标准的快速顺序诱导插管操作并静脉注射利多卡因（1mg/kg）。患者被随机分为两组，在静脉注射全量麻痹剂量的琥珀酰胆碱（1.5mg/kg）前1分钟，一组静脉注射小剂量琥珀酰胆碱（0.1mg/kg），另一组静脉注射潘库溴铵（0.03mg/kg）。使用分级视觉量表记录肌束震颤情况。
46例患者中，潘库溴铵组19例中有8例（42%）出现肌束震颤，琥珀酰胆碱组27例中有6例（22%）出现肌束震颤。使用卡方分析，两组之间在肌束震颤方面未检测到统计学上的显著差异。除两组各有1例患者外，其余所有患者声带均完全松弛。两组均无患者出现呕吐或明显的心律失常。
在急诊科环境中，对于头部创伤患者的快速顺序诱导插管，小剂量琥珀酰胆碱预处理引起的肌束震颤发生率并不高于潘库溴铵。因此，琥珀酰胆碱可作为头部创伤患者快速顺序诱导插管的唯一麻痹剂。
