Department of Anesthesiology, Gunma University Hospital, Gunma, Japan.
J ECT. 2013 Mar;29(1):33-6. doi: 10.1097/YCT.0b013e31826cf348.
This study was conducted to (1) compare the recovery times from rocuronium-induced muscle relaxation after reversal with sugammadex between young and elderly patients undergoing electroconvulsive therapy (ECT), and (2) to examine the existence of a correlation between cardiac index and reversibility of rocuronium-induced neuromuscular block with sugammadex after ECT.
Seventeen patients (young group, 50 years or younger, n = 8; elderly group, 70 years or older, n = 9) who were scheduled to undergo ECT were studied. Anesthesia was induced using propofol (1.0 mg/kg) followed by rocuronium (0.6 mg/kg). Assisted mask ventilation was initiated with 100% oxygen. Cardiac index was monitored noninvasively throughout the procedure. After the first twitch of the train of four (TOF) was assessed as being zero by neuromuscular monitoring, an electroshock stimulus was applied bilaterally. Immediately after the seizure stopped, patients were given 8-mg/kg sugammadex intravenously to reverse the muscle relaxation. Neuromuscular monitoring was continued until recovery of the TOF ratio to 0.9 at the tibial nerve in the leg. The time to recovery of the TOF to 0.1 and 0.9 was compared in both groups.
Although no significant difference in return to a TOF of 0.1 was found between the groups, there were significant differences in both recovery to a TOF of 0.9 and the time interval to the first spontaneous breath between groups (time to recovery to a TOF of 0.9, young group, 403 ± 37 seconds; elderly group, 443 ± 36 seconds; P < 0.05). In contrast, there was no relationship between cardiac index after ECT and recovery time to TOF of 0.9.
Although recovery time to TOF of 0.9 after the administration of 8.0-mg/kg sugammadex was longer in the elderly patients than in the young patients, it had no relationship with cardiac output after ECT.
本研究旨在：（1）比较接受电抽搐治疗（ECT）的年轻和老年患者使用琥珀酸舒更葡糖钠逆转罗库溴铵诱导的肌松后恢复时间；（2）研究在 ECT 后使用琥珀酸舒更葡糖钠逆转罗库溴铵诱导的神经肌肉阻滞时，心指数与罗库溴铵的可逆转性之间是否存在相关性。
研究了 17 名计划接受 ECT 的患者（年轻组：年龄 50 岁或以下，n = 8；老年组：年龄 70 岁或以上，n = 9）。使用丙泊酚（1.0mg/kg）诱导麻醉，随后给予罗库溴铵（0.6mg/kg）。辅助面罩通气采用 100%氧气。整个过程中通过非侵入性监测心指数。当肌电图监测到四串肌颤搐（TOF）的第一个颤搐为零时，给予双侧电抽搐刺激。抽搐停止后，立即给予 8mg/kg 的琥珀酸舒更葡糖钠静脉注射以逆转肌肉松弛。继续进行肌电图监测，直至在腿部的胫神经处 TOF 比值恢复至 0.9。比较两组患者恢复至 TOF 0.1 和 0.9 的时间。
两组患者恢复至 TOF 0.1 的时间无显著差异，但恢复至 TOF 0.9 的时间以及首次自主呼吸的时间间隔存在显著差异（恢复至 TOF 0.9 的时间，年轻组：403 ± 37 秒；老年组：443 ± 36 秒；P < 0.05）。相反，ECT 后心指数与恢复至 TOF 0.9 的时间无相关性。
尽管在给予 8.0mg/kg 琥珀酸舒更葡糖钠后，老年患者恢复至 TOF 0.9 的时间长于年轻患者，但与 ECT 后心输出量无关。
