Takeda Junzo
Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582.
Masui. 2008 Jul;57(7):845-52.
Neuromuscular blocking agents are used to facilitate tracheal intubation and surgical procedure in ambulatory anesthesia. However, the ideal neuromuscular blocking agents for ambulatory anesthesia are not yet available. The only depolarizing neuromuscular blocking agent, suxamethonium, is still widely used by its rapid onset and short duration of action producing excellent intubating conditions, in spite of its numerous adverse effects. Nondepolarizing neuromuscular agents have proved to be associated with postoperative residual block more frequently than it was thought before. The use of neostigmine for reversal and the measurement of the TOF ratio during recovery are recommended after intermediate-acting neuromuscular blocking agents. Some studies have shown that tracheal intubation without neuromuscular agents may be associated with postoperative hoarseness and vocal cord injuries. Sugammadex will resolve many issues in using nondepolarizing neuromuscular agents in ambulatory anesthesia.
神经肌肉阻滞剂用于门诊麻醉中辅助气管插管和手术操作。然而,目前尚无适用于门诊麻醉的理想神经肌肉阻滞剂。唯一的去极化神经肌肉阻滞剂琥珀胆碱,尽管有诸多不良反应,但因其起效迅速、作用时间短能产生极佳的插管条件,仍被广泛使用。非去极化神经肌肉阻滞剂被证明比以往认为的更常与术后残余阻滞相关。使用中效神经肌肉阻滞剂后,建议使用新斯的明进行逆转并在恢复过程中测量强直刺激后计数比值。一些研究表明,不使用神经肌肉阻滞剂进行气管插管可能与术后声音嘶哑和声带损伤有关。舒更葡糖钠将解决门诊麻醉中使用非去极化神经肌肉阻滞剂的许多问题。