顺式阿曲库铵和阿曲库铵对喉部及拇内收肌神经肌肉阻滞作用的比较。

Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis.

作者信息

Kirov K, Motamed C, Decailliot F, Behforouz N, Duvaldestin P

机构信息

Department of Anesthesia, Hôpital Henri Mondor, AP-HP, University of Paris XII, Paris, France.

出版信息

Acta Anaesthesiol Scand. 2004 May;48(5):577-81. doi: 10.1111/j.1399-6576.2004.00378.x.

DOI:10.1111/j.1399-6576.2004.00378.x

PMID:15101851

Abstract

BACKGROUND

Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this alone would be the greatest advantage in replacing atracurium for the facilitation of tracheal intubation. On the other hand, 2 ED(95) doses of cisatracurium (100 micro g/kg) do not yield satisfactory intubating conditions such as those seen with equipotent doses of atracurium and therefore the recommended intubating dose of cisatracurium is 3 ED(95). To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium directly at the larynx adductors in humans.

METHODS

The study was conducted in 54 patients (ASA class I or II) undergoing peripheral surgery requiring general anesthesia. Cisatracurium 25-150 micro g/kg or atracurium 120-500 micro g/kg intravenous (i.v.) boluses doses were administered during anesthesia with propofol, nitrous oxide, oxygen and fentanyl. Neuromuscular block was measured by electromyography (single twitch stimulation every 10 s) at the larynx and the adductor pollicis. The dose-response effect measured at both muscles included maximum neuromuscular blockade achieved (Emax), the time to maximum depression of twitch height (onset) and time to spontaneous recovery of the twitch height to 25%, 75% and 90% (T25, T75, T90) of control value.

RESULT

The onset at the larynx was of 196 +/- 28 s after the 100 micro g/kg cisatracurium dose compared with 140 +/- 14 s after the 500 micro g/kg atracurium dose (P < 0.05). Emax at the larynx was 92 +/- 1% and 98 +/- 1% after 100 micro g/kg cisatracurium and 500 micro g/kg atracurium, respectively (P < 0.05). The time to onset of maximum suppression Emax = 100 +/- 0% after a 150 micro g/kg cisatracurium dose was 148 +/- 29 s. At the larynx, the ED(50) was 25 micro g/kg for cisatracurium and 180 micro g/kg for atracurium and the ED(95) was 87 micro g/kg for cisatracurium compared with 400 micro g/kg for atracurium.

CONCLUSION

The slow onset time at the laryngeal muscles after cisatracurium can be explained by the higher potency as compared with atracurium.

摘要

背景

与阿曲库铵不同，顺式阿曲库铵不会产生组胺诱导的心血管效应，仅此一点便是其取代阿曲库铵用于辅助气管插管的最大优势。另一方面，2倍95%有效剂量（ED(95)）的顺式阿曲库铵（100μg/kg）无法产生如等效剂量阿曲库铵那样令人满意的插管条件，因此推荐的顺式阿曲库铵插管剂量为3倍ED(95)。为了更好地理解这种差异，我们直接评估了阿曲库铵和顺式阿曲库铵在人体喉内收肌处的效价和起效时间。

方法

该研究在54例接受需要全身麻醉的外周手术的患者（美国麻醉医师协会分级I或II级）中进行。在使用丙泊酚、氧化亚氮、氧气和芬太尼麻醉期间，静脉推注25 - 150μg/kg的顺式阿曲库铵或120 - 500μg/kg的阿曲库铵。通过肌电图（每10秒单次颤搐刺激）在喉部和拇内收肌处测量神经肌肉阻滞。在两块肌肉处测量的剂量 - 反应效应包括达到的最大神经肌肉阻滞（Emax）、颤搐高度最大抑制的时间（起效时间）以及颤搐高度自发恢复至对照值的25%、75%和90%的时间（T25、T75、T90）。

结果

100μg/kg顺式阿曲库铵剂量后喉部的起效时间为196±28秒，而500μg/kg阿曲库铵剂量后为140±14秒（P < 0.05）。100μg/kg顺式阿曲库铵和500μg/kg阿曲库铵后喉部的Emax分别为92±1%和98±1%（P < 0.05）。150μg/kg顺式阿曲库铵剂量后达到最大抑制Emax = 100±0%的起效时间为148±29秒。在喉部，顺式阿曲库铵的ED(50)为25μg/kg，阿曲库铵为180μg/kg；顺式阿曲库铵的ED(95)为87μg/kg，阿曲库铵为400μg/kg。