Braga Angélica de Fátima de Assunção, Braga Franklin Sarmento da Silva, Potério Glória Maria Braga, Cremonesi Eugesse, Mauro Gislaine
Departamento de Anestesiologia, Faculdade de Ciências Médicas, UNICAMP.
Rev Bras Anestesiol. 2002 Sep;52(5):517-24. doi: 10.1590/s0034-70942002000500001.
The effects of neuromuscular blockers on the neuromuscular junction are potentiated by volatile anesthetics. This study aimed at evaluating the influence of sevoflurane and isoflurane on the recovery of cisatracurium- induced neuromuscular block.
Ninety ASA I and II patients undergoing elective surgeries under general anesthesia were included in this study. Patients were allocated in three groups: Group I (sevoflurane), Group II (isoflurane) and Group III (propofol). All patients were premedicated with intramuscular midazolam (0.1 mg.kg-1) 30 min before surgery. Anesthesia was induced with alfentanil (50 microg.kg-1), propofol (2.5 mg.kg-1) and cisatracurium (0.15 mg.kg-1). Patients were then ventilated under mask with 100% O2 until disappearance of all TOF responses when laryngoscopy and tracheal intubation were performed. Volatile agents for anesthetic maintenance were introduced immediately after tracheal intubation in 2% and 1% concentrations, respectively, for sevoflurane and isoflurane, as well as the propofol continuous infusion (7 to 10 mg.kg-1.h-1) for Group III. All patients received a 50% mixture of O2 and N2O. Neuromuscular function was monitored by adductor pollicis muscle acceleromyography with TOF stimulation at 15-second intervals. Clinical duration of neuromuscular block (T1(25%)) and recovery index (RI=T1(25-75%)) were evaluated.
Mean time and standard deviation for clinical duration (T1(25%)) and recovery index (RI=T1(25-75%)) were respectively: Group I (66.2 +/- 13.42 min and 23.6 +/- 5.02 min), Group II (54.4 +/- 6.58 min and 14.9 +/- 3.82 min) and Group III (47.2 +/- 7.43 min and 16.2 +/- 2.93 min). There were significant differences in clinical duration between Groups I and II, I and III and II and III. There was a significant difference in recovery index between Group I and the other groups.
The recovery from cisatracurium-induced neuromuscular block was longer during anesthesia with volatile agents as compared to propofol. The most pronounced effect was observed with sevoflurane.
挥发性麻醉药可增强神经肌肉阻滞剂对神经肌肉接头的作用。本研究旨在评估七氟烷和异氟烷对顺式阿曲库铵诱导的神经肌肉阻滞恢复的影响。
本研究纳入了90例接受全身麻醉下择期手术的美国麻醉医师协会（ASA）I级和II级患者。患者被分为三组：I组（七氟烷）、II组（异氟烷）和III组（丙泊酚）。所有患者在手术前30分钟肌内注射咪达唑仑（0.1mg·kg-1）进行术前用药。麻醉诱导采用阿芬太尼（50μg·kg-1）、丙泊酚（2.5mg·kg-1）和顺式阿曲库铵（0.15mg·kg-1）。然后患者面罩通气吸入100%氧气，直至喉镜检查和气管插管时所有四个成串刺激（TOF）反应消失。气管插管后立即分别以2%和1%的浓度引入用于麻醉维持的挥发性麻醉药，即七氟烷和异氟烷，III组则持续输注丙泊酚（7至10mg·kg-1·h-1）。所有患者吸入50%氧气和50%氧化亚氮的混合气体。通过拇内收肌加速度肌电图以15秒的间隔进行TOF刺激来监测神经肌肉功能。评估神经肌肉阻滞的临床持续时间（T1(25%)）和恢复指数（RI = T1(25 - 75%)）。
临床持续时间（T1(25%)）和恢复指数（RI = T1(25 - 75%)）的平均时间和标准差分别为：I组（66.2±13.42分钟和23.6±5.02分钟）、II组（54.4±6.58分钟和14.9±3.82分钟）和III组（47.2±7.43分钟和16.2±2.93分钟）。I组与II组、I组与III组以及II组与III组之间的临床持续时间存在显著差异。I组与其他组之间的恢复指数存在显著差异。
与丙泊酚相比，挥发性麻醉药麻醉期间顺式阿曲库铵诱导的神经肌肉阻滞恢复时间更长。七氟烷的作用最为明显。
