[新斯的明对罗库溴铵或顺式阿曲库铵神经肌肉阻滞过程的影响：一项随机双盲试验]

[Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial].

作者信息

Barrio J, San Miguel G, García V, Pelegrín F

机构信息

Servicio de Anestesiología, Hospital Arnau de Vilanova, Valencia.

出版信息

Rev Esp Anestesiol Reanim. 2007 Aug-Sep;54(7):399-404.

PMID:17953333

Abstract

OBJECTIVES

To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine.

MATERIAL AND METHODS

Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25%, or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance.

RESULTS

Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04 [0.32] minutes) compared with cisatracurium at (2.58 [0.81] minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes).

CONCLUSION

Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%).

摘要

目的

比较在静脉麻醉期间，罗库溴铵和顺式阿曲库铵在神经肌肉阻滞方面的时间进程，包括自主恢复时间或新斯的明给药后的恢复时间。

材料与方法

将美国麻醉医师协会（ASA）分级为1 - 2级的患者随机分组，接受单次注射95%有效剂量两倍的罗库溴铵或顺式阿曲库铵进行全身麻醉的盲法给药，然后在四个成串刺激（TOF）首次出现5%或25%的恢复时给予新斯的明加阿托品，或者在首次TOF出现25%的恢复时给予生理盐水作为安慰剂。通过加速度肌电图监测神经肌肉阻滞情况。组间比较采用学生t检验和方差分析。

结果

共纳入60例患者。罗库溴铵的平均（标准差）起效时间更快，为（1.04 [0.32]分钟），而顺式阿曲库铵为（2.58 [0.81]分钟），且持续时间更短：罗库溴铵组5%恢复至首次颤搐的时间为30（6.4）分钟，顺式阿曲库铵组为38.1（9.7）分钟。当逆转神经肌肉阻滞时，罗库溴铵的总阻滞持续时间（至TOF比值80%的时间）也较短，但在未使用新斯的明时，阻滞逆转时间无差异：罗库溴铵阻滞恢复时间为62（18.9）分钟，顺式阿曲库铵阻滞恢复时间为66.96（15.9）分钟。在未进行逆转时，在给予神经肌肉阻滞剂60分钟和90分钟时，高比例患者的TOF比值低于80%（接受罗库溴铵的患者，60分钟时为60%，90分钟时为20%；接受顺式阿曲库铵的患者，60分钟时为80%，90分钟时为40%）。