Department of Anesthesia and Critical Care, Centre Hospitalier Universitaire, Institut de la Sante et de la Recherche Medicale, CIC-EC CIE6, Nancy, France.
Anesthesiology. 2010 Jan;112(1):34-40. doi: 10.1097/ALN.0b013e3181c53863.
Low degrees of residual paralysis (i.e., a train-of-four [TOF] ratio > 0.4) are relatively frequent, difficult to detect, and still potentially harmful. Unfortunately, the appropriate dose of anticholinesterase for this situation has not been determined. This may be of clinical interest because a high dose of neostigmine given at a shallow level of neuromuscular block may produce neuromuscular weakness. The purpose of this study was to investigate the dose-effect relationship of neostigmine to antagonize residual paralysis corresponding to a TOF ratio of 0.4 and 0.6.
Recovery after 10, 20, 30 microg/kg neostigmine or placebo given at either 0.4 or 0.6 TOF ratio was assessed by acceleromyography in 120 patients undergoing intravenous anesthesia. Time to a 0.9 and 1.0 TOF ratio was measured, and the probability of successful reversal within 10 min after the respective neostigmine doses was calculated. In addition, the dose of neostigmine needed to achieve the recovery targets in 5 or 10 min was also determined.
When given at a TOF ratio of either 0.4 or 0.6, time to 0.9 and 1.0 TOF ratio was significantly shorter with any dose of neostigmine than without. The probability of successful reversal after 20 microg/kg neostigmine was 100% when a TOF ratio of 0.9 was the target; for a TOF ratio of 1.0, the probability was 93% and 67%, dependent on whether the dose of neostigmine was given at TOF ratio of 0.6 or 0.4, respectively. With a dose of 30 microg/kg, a TOF ratio of 1.0 is expected to be reached within approximately 5 min. Low doses of neostigmine are required to reach a TOF ratio of 0.9 or to accept an interval of 10 min.
Reduced doses (10-30 microg/kg) of neostigmine are effective in antagonizing shallow atracurium block. For successful reversal within 10 min, as little as 20 microg/kg neostigmine may be sufficient. These dose recommendations are specific for atracurium and an intravenous anesthetic background.
残留神经肌肉阻滞程度较低（即四成肌颤搐比[TOF]＞0.4）较为常见，难以察觉，仍可能具有潜在危害。遗憾的是，目前尚未确定针对这种情况的合适抗胆碱酯酶剂量。这可能具有临床意义，因为在深度神经肌肉阻滞的情况下给予大剂量新斯的明可能会导致神经肌肉无力。本研究旨在探讨新斯的明拮抗 TOF 比为 0.4 和 0.6 时对应的残留神经肌肉阻滞的量效关系。
120 例行静脉麻醉的患者，以 TOF 比 0.4 或 0.6 给予 10、20、30μg/kg 新斯的明或安慰剂后，通过肌动描记术评估恢复情况。测量达到 0.9 和 1.0 TOF 比的时间，并计算各自新斯的明剂量后 10 分钟内成功逆转的概率。此外，还确定了达到 5 分钟或 10 分钟恢复目标所需的新斯的明剂量。
以 TOF 比 0.4 或 0.6 给予新斯的明时，任何剂量的新斯的明都比未给予新斯的明时达到 0.9 和 1.0 TOF 比的时间显著缩短。当目标 TOF 比为 0.9 时，20μg/kg 新斯的明的成功逆转概率为 100%；当目标 TOF 比为 1.0 时，成功概率分别为 93%和 67%，这取决于新斯的明剂量是在 TOF 比为 0.6 还是 0.4 时给予的。给予 30μg/kg 新斯的明时，预计在大约 5 分钟内可达到 1.0 TOF 比。达到 0.9 或接受 10 分钟间隔所需的新斯的明剂量较低。
新斯的明的低剂量（10-30μg/kg）可有效拮抗阿曲库铵轻度阻滞。要在 10 分钟内成功逆转，只需 20μg/kg 新斯的明即可。这些剂量建议是针对阿曲库铵和静脉麻醉背景的。
