Leykin Y, Pellis T, Lucca M, Gullo A
Department of Anaesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy.
Anaesth Intensive Care. 2005 Aug;33(4):462-8. doi: 10.1177/0310057X0503300407.
A small priming dose of rocuronium can shorten the onset time of neuromuscular blockade. Induction agents with less cardiovascular depression also reduce the onset time. We hypothesized that ketamine, compared to thiopentone, would reduce onset time and improve intubating conditions following priming. Sixty patients ASA I to II, randomized by computer-generated sequence to four groups were investigated in a double-blind controlled trial. In the two groups with priming, 0.04 mg/kg of rocuronium was followed by three minutes of priming interval. Induction was followed by an intubation dose of 0.4 mg/kg of rocuronium. After 30 seconds, intubation was attempted within a further 20 seconds. In the two control groups, the same sequence was repeated except sham priming (saline) was given. For induction, S-ketamine (1 mg/kg) or thiopentone (4 mg/kg) were administered. Intubating conditions were graded as excellent, good, poor, or not possible. Neuromuscular transmission was monitored by acceleromyography of the thumb. There were no measured differences in onset time of neuromuscular block or in haemodynamics between the groups. The proportion of good to excellent intubating conditions was higher when ketamine was preceded by priming compared to ketamine without priming (87% vs 20%; P<0.05). In both priming and control groups intubating conditions were improved when using ketamine compared to thiopentone (P<0.05). The mechanism of this effect was not clear from this study.
小剂量预注罗库溴铵可缩短神经肌肉阻滞的起效时间。心血管抑制作用较小的诱导药物也可缩短起效时间。我们推测，与硫喷妥钠相比，氯胺酮在预注后可缩短起效时间并改善插管条件。在一项双盲对照试验中，对60例ASA I至II级患者进行了研究，通过计算机生成的序列将其随机分为四组。在两组预注组中，先给予0.04mg/kg的罗库溴铵，然后有3分钟的预注间隔。诱导后给予0.4mg/kg的罗库溴铵插管剂量。30秒后，在接下来的20秒内尝试插管。在两个对照组中，除了给予假预注（生理盐水）外，重复相同的序列。诱导时，给予S-氯胺酮（1mg/kg）或硫喷妥钠（4mg/kg）。插管条件分为优、良、差或无法插管。通过拇指的加速度肌电图监测神经肌肉传递。两组之间神经肌肉阻滞的起效时间或血流动力学方面没有测量到差异。与未预注氯胺酮相比，预注氯胺酮后插管条件优至良的比例更高（87%对20%；P<0.05）。在预注组和对照组中，与硫喷妥钠相比，使用氯胺酮时插管条件均得到改善（P<0.05）。本研究尚不清楚这种效应的机制。
