Lin Shih-Pin, Chang Kuang-Yi, Chen Yu-Ju, Lin Su-Man, Chang Wen-Kuei, Chan Kwok-Hon, Ting Chien-Kun
Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Jan;72(1):15-9. doi: 10.1016/S1726-4901(09)70014-0.
The priming technique, in which a small dose of nondepolarizing muscle relaxant is administered 3-6 minutes before giving the intubation dose, can speed up the onset of muscle relaxation in patients with paralysis during intubation. We investigated the priming technique and compared 2 different priming agents (rocuronium and cisatracurium) at a priming time of 3 minutes and its effect on decreasing the onset time of cisatracurium.
A total of 60 patients with ASA physical status I-II scheduled for elective surgery were enrolled. After induction with propofol and fentanyl, the patients were randomized into 1 of 3 groups. Group 1 received rocuronium 0.06 mg/kg as a priming dose. Group 2 received cisatracurium 0.01 mg/kg as a priming dose. Group 3 received normal saline and constituted the control group. After a 3-minute priming time, intubation doses of cisatracurium were given (Groups 1 and 2, 0.14 mg/kg; Group 3, 0.15 mg/kg). First twitch height percentage (T1/T0%; % of control) and train-of-four percentage (T4/T1%) were recorded every 10 seconds from baseline until T1/T0% reached 0.
Rocuronium (Group 1) and cisatracurium (Group 2) significantly accelerated the onset of cisatracurium (Group 1, 117.0 +/- 29.0 seconds; Group 2, 151.0 +/- 37.5 seconds; Group 3, 221.5 +/- 36.6 seconds; all p < 0.001).
Priming with rocuronium or cisatracurium for 3 minutes significantly accelerated the onset of cisatracurium. Priming with rocuronium for 3 minutes improved the onset time of cisatracurium even more than priming with cisatracurium itself.
预注技术是在给予插管剂量前3 - 6分钟给予小剂量非去极化肌松药，可加快插管时瘫痪患者的肌肉松弛起效时间。我们研究了预注技术，并比较了两种不同的预注药物（罗库溴铵和顺式阿曲库铵）在3分钟预注时间时的情况及其对缩短顺式阿曲库铵起效时间的影响。
共纳入60例拟行择期手术的ASA身体状况I - II级患者。在丙泊酚和芬太尼诱导后，将患者随机分为3组中的1组。第1组接受0.06 mg/kg罗库溴铵作为预注剂量。第2组接受0.01 mg/kg顺式阿曲库铵作为预注剂量。第3组接受生理盐水，为对照组。在3分钟预注时间后，给予顺式阿曲库铵插管剂量（第1组和第2组为0.14 mg/kg；第3组为0.15 mg/kg）。从基线开始每10秒记录一次首个肌颤搐高度百分比（T1/T0%；对照百分比）和四个成串刺激百分比（T4/T1%），直至T1/T0%降至0。
罗库溴铵（第1组）和顺式阿曲库铵（第2组）显著加快了顺式阿曲库铵的起效（第1组，117.0±29.0秒；第2组，151.0±37.5秒；第3组，221.5±36.6秒；均p < 0.001）。
用罗库溴铵或顺式阿曲库铵预注3分钟可显著加快顺式阿曲库铵的起效。用罗库溴铵预注3分钟比用顺式阿曲库铵本身预注更能改善顺式阿曲库铵的起效时间。
