Dahaba A A, Perelman S I, Moskowitz D M, Bennett H L, Shander A, Oettl K, Reibnegger G, Metzler H
Department of Anaesthesiology and Intensive Care Medicine, Graz Medical University, Graz, Austria.
Br J Anaesth. 2006 Oct;97(4):482-8. doi: 10.1093/bja/ael207. Epub 2006 Jul 27.
Acute normovolaemic haemodilution (ANH) is an effective strategy for avoiding or reducing allogeneic blood transfusion. We aimed to study its effect on the pharmacological profile of rocuronium.
In two study centres, 28 patients undergoing major surgery with ANH were matched with 28 control patients. In the dose-response groups, using the mechanomyograph, neuromuscular block of six consecutive incremental doses of rocuronium 50 microg kg(-1), followed by 300 microg kg(-1), was evaluated. In the pharmacokinetics groups, serial arterial blood samples were withdrawn for rocuronium assay after a single dose of rocuronium 600 microg kg(-1).
ANH resulted in a shift to the left of rocuronium dose-response curve. Rocuronium effective dose(95) (ED(95)) was 26% lower (P<0.05) in the ANH group [283.4 (92.0) microg kg(-1)] compared with the control group [383.5 (127.3) microg kg(-1)]. Times from administration of last incremental dose until 25% of first response of train-of-four (TOF) recovery (Dur(25)) and 0.8 TOF ratio recovery (Dur(0.8)) were 28% longer in the ANH group [39.9 (8.4), 66.7 (14.2) min] compared with the control group [31.1 (6.6), 52.1 (15.8) min] (P<0.01, P<0.05), respectively. Volume of distribution was higher (P<0.01), central clearance was lower (P<0.05) and terminal elimination half-life was longer (P<0.0001) in the ANH group [234.97 (47.11) ml kg(-1), 4.70 (0.94) ml kg(-1) min(-1), 77.29 (12.25) min] compared with the control group [181.22 (35.73) ml kg(-1), 5.71 (1.29) ml kg(-1) min(-1), 56.86 (10.05) min, respectively].
ANH resulted in prolongation of rocuronium time-course of action, thus careful monitoring of neuromuscular block is recommended in patients who undergo ANH.
急性等容血液稀释（ANH）是避免或减少异体输血的一种有效策略。我们旨在研究其对罗库溴铵药理学特征的影响。
在两个研究中心，28例行ANH大手术的患者与28例对照患者进行匹配。在剂量反应组中，使用肌动描记器评估连续6次递增剂量的罗库溴铵50μg/kg（-1），随后给予300μg/kg（-1）时的神经肌肉阻滞情况。在药代动力学组中，单次给予罗库溴铵600μg/kg（-1）后，连续采集动脉血样进行罗库溴铵测定。
ANH导致罗库溴铵剂量反应曲线左移。ANH组[283.4（92.0）μg/kg（-1）]的罗库溴铵有效剂量（95）（ED（95））比对照组[383.5（1）27.3）μg/kg（-1）]低26%（P<0.05）。从给予最后一次递增剂量到四个成串刺激（TOF）恢复的第一个反应的25%（Dur（25））和0.8 TOF比值恢复（Dur（0.8））的时间，ANH组[39.9（）8.4），66.7（14.2）分钟]比对照组[31.1（6.6），52.1（15.8）分钟]分别延长了28%（P<0.01，P<0.05）。ANH组[234.97（47.11）ml/kg（-1），4.70（0.94）ml/kg（-1）min（-1），77.29（12.25）分钟]的分布容积较高（P<0.01），中央清除率较低（P<0.05），终末消除半衰期较长（P<0.0001），而对照组分别为[181.22（35.73）ml/kg（-1），5.71（1.29）ml/kg（-1）min（-1），56.86（10.05）分钟]。
ANH导致罗库溴铵作用时间延长，因此建议对接受ANH的患者进行神经肌肉阻滞的仔细监测。
