Braga Angélica de Fátima de Assunção, Potério Glória Maria Braga, Braga Franklin Sarmento da Silva, Cremonesi Eugesse, Siqueira Francisco Pena, Carvalho Vanessa H
Departamento de Anestesiologia, Faculdade de Ciências Médicas, Universidade de Campinas.
Rev Bras Anestesiol. 2003 Feb;53(1):9-16.
The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses.
Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated.
Mean times for maximum neuromuscular block onset were: Group I (3.90 +/- 0.60 min and 3.88 +/- 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 +/- 0.40 min and 2 +/- 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes.
Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes.
预注技术是缩短非去极化神经肌肉阻滞剂起效时间的一种替代方法。本研究旨在评估不同单次或分次剂量的顺式阿曲库铵所确定的最大神经肌肉阻滞起效时间、气管插管条件及心血管循环变化。
80例美国麻醉医师协会（ASA）分级为Ⅰ级和Ⅱ级的患者参与本研究，根据顺式阿曲库铵剂量分为两组：Ⅰ组（0.1mg/kg）和Ⅱ组（0.2mg/kg）。根据所采用的肌松技术组成亚组：P1和P2亚组（预注剂量）——分别给予0.02mg/kg或0.04mg/kg顺式阿曲库铵，1分钟后分别再给予0.08mg/kg或0.16mg/kg相同的神经肌肉阻滞剂；U1和U2亚组——分别给予0.1mg/kg或0.2mg/kg顺式阿曲库铵的总推注量。用依托咪酯诱导麻醉，之前给予阿芬太尼。每隔12秒施加四个成串刺激（TOF）以监测神经肌肉功能。评估最大神经肌肉阻滞起效时间、气管插管条件及血流动力学参数（动脉平均血压和心率）的变化。
最大神经肌肉阻滞起效的平均时间为：Ⅰ组（P1亚组和U1亚组分别为3.90±0.60分钟和3.88±0.74分钟）和Ⅱ组（P2亚组和U2亚组分别为1.40±0.40分钟和2±0.30分钟），无显著差异。P1和P2亚组之间以及U1和U2亚组之间的比较显示出统计学上的显著差异。所有患者的气管插管条件均可接受，且无心血管变化。
与推注相比，分次给予顺式阿曲库铵并未缩短最大神经肌肉阻滞起效时间。然而，它们产生了可接受的气管插管条件，且无心血管变化。
