Veiga-Ruiz G, Domínguez N, Orozco J, Janda M, Hofmockel R, Alvarez-Gómez J A
Hospital Universitario Santa María del Rosell. Cartagena, España.
Rev Esp Anestesiol Reanim. 2009 Jun-Jul;56(6):349-54. doi: 10.1016/s0034-9356(09)70407-4.
Sugammadex reverses neuromuscular blockade induced by aminosteroid agents by encapsulating these agents. The objective of this study was to compare the efficacy and safety of sugammadex to reverse a rocuronium-induced neuromuscular blockade in long-duration surgery in association with inhaled or intravenous anesthesia.
We performed a randomized, double-blind, multicenter trial of 20 ASA 1-3 patients aged between 18 and 69 years and scheduled for elective surgery lasting at least 120 minutes. Anesthesia was induced with remifentanil and rocuronium at a dosage of 0.6 mg x kg(-1), and neuromuscular function was monitored by means of acceleromyography. After randomization, anesthesia was maintained with sevoflurane or with propofol for total intravenous anesthesia. Patients in both groups also received an infusion of remifentanil for analgesia and rocuronium to maintain a block of greater than 90%. After surgery, sugammadex was administered at a dosage of 2 mg x kg(-1) on reappearance of the second train-of-four (TOF) twitch (T2) and the times until recovery of T4/T1 ratios of 0.7, 0.8, and 0.9 (main endpoints). Mean arterial pressure and heart rate were recorded at baseline and after 2, 5, 10, and 30 minutes (secondary outcome measures).
Although less rocuronium was consumed in the sevoflurane group than in the propofol group and the time between the start of sugammadex administration until recovery of a TOF ratio of 0.9 was shorter for the sevoflurane group than for propofol group (mean [SD], 1.46 [0.30] minutes and 1.89 [0.62] minutes, respectively), these differences were not significant. No signs of recurarization or associated adverse effects were observed.
Sugammadex effectively and safely reverses a rocuronium-induced neuromuscular blockade in less than 2 minutes in long-duration surgery performed under both inhaled and intravenous anesthesia. The interaction of neuromuscular blocking agents with sevoflurane appears not to affect the reversal time of sugammadex in such operations.
舒更葡糖钠通过包裹甾体类药物来逆转其诱导的神经肌肉阻滞。本研究的目的是比较舒更葡糖钠在与吸入或静脉麻醉联合用于长时间手术中逆转罗库溴铵诱导的神经肌肉阻滞的疗效和安全性。
我们对20例年龄在18至69岁之间、计划进行至少120分钟择期手术的美国麻醉医师协会（ASA）1 - 3级患者进行了一项随机、双盲、多中心试验。使用瑞芬太尼和剂量为0.6 mg/kg⁻¹的罗库溴铵诱导麻醉，并通过加速度肌电图监测神经肌肉功能。随机分组后，使用七氟醚或丙泊酚维持麻醉以进行全静脉麻醉。两组患者均接受瑞芬太尼输注用于镇痛以及罗库溴铵输注以维持大于90%的阻滞。手术后，在四个成串刺激（TOF）中的第二个肌颤搐（T2）再次出现时，以2 mg/kg⁻¹的剂量给予舒更葡糖钠，并记录达到T4/T1比值为0.7、0.8和0.9的恢复时间（主要终点）。在基线以及给药后2、5、10和30分钟记录平均动脉压和心率（次要观察指标）。
尽管七氟醚组消耗的罗库溴铵比丙泊酚组少，且七氟醚组从开始给予舒更葡糖钠直至TOF比值恢复到0.9的时间比丙泊酚组短（均值[标准差]分别为1.46[0.30]分钟和1.89[0.62]分钟），但这些差异并不显著。未观察到再次出现肌松或相关不良反应的迹象。
在吸入和静脉麻醉下进行的长时间手术中，舒更葡糖钠能在不到2分钟的时间内有效且安全地逆转罗库溴铵诱导的神经肌肉阻滞。在这类手术中，神经肌肉阻滞剂与七氟醚的相互作用似乎不影响舒更葡糖钠的逆转时间。
