Olkkola K T, Schwilden H
Department of Clinical Pharmacology, University of Helsinki, Finland.
Anesthesiology. 1990 Oct;73(4):614-8. doi: 10.1097/00000542-199010000-00005.
The authors used closed-loop feedback control of infusion of atracurium to study the effect of prior administration of succinylcholine on neuromuscular blockade induced by atracurium in patients undergoing otolaryngologic surgery. Anesthesia was maintained with nitrous oxide in oxygen, flunitrazepam, and fentanyl. Of 14 patients given atracurium, seven were given prior administration of succinylcholine and seven were not. Interaction between the two drugs was quantified by determining the asymptotic steady-state rate of infusion necessary to produce a constant 90% neuromuscular blockade. This was accomplished by applying nonlinear curve-fitting to data on the cumulative dose requirement during anesthesia. The neuromuscular blocking effect of atracurium was found to be greater after prior administration of succinylcholine. The asymptotic steady-state rate of infusion (+/- SD) for atracurium was 0.27 +/- 0.06 mg.kg-1.h-1 for patients given succinylcholine and 0.38 +/- 0.10 mg.kg-1.h-1 for those not given succinylcholine. The clinical implication of this study is that the clinician should be aware of the fact that an induction dose of 1 mg/kg of succinylcholine does reduce atracurium requirement for 90% neuromuscular blockade by approximately 30%.
作者采用阿曲库铵输注的闭环反馈控制，来研究在接受耳鼻喉科手术的患者中，预先给予琥珀酰胆碱对阿曲库铵所致神经肌肉阻滞作用的影响。麻醉维持采用氧化亚氮、氧气、氟硝西泮和芬太尼。在14例给予阿曲库铵的患者中，7例预先给予了琥珀酰胆碱，7例未给予。通过确定产生持续90%神经肌肉阻滞所需的渐近稳态输注速率，对这两种药物之间的相互作用进行量化。这是通过对麻醉期间累积剂量需求的数据应用非线性曲线拟合来实现的。结果发现，预先给予琥珀酰胆碱后，阿曲库铵的神经肌肉阻滞作用更强。给予琥珀酰胆碱的患者，阿曲库铵的渐近稳态输注速率（±标准差）为0.27±0.06mg·kg⁻¹·h⁻¹，未给予琥珀酰胆碱的患者为0.38±0.10mg·kg⁻¹·h⁻¹。这项研究的临床意义在于，临床医生应意识到，1mg/kg琥珀酰胆碱的诱导剂量确实会使达到90%神经肌肉阻滞时阿曲库铵的需求量降低约30%。
