Gorback M S, Graubert D A
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
J Clin Anesth. 1990 May-Jun;2(3):163-7. doi: 10.1016/0952-8180(90)90091-g.
The effects of patient physiology and the prior administration of a nondepolarizing muscle relaxant on the frequency of gastroesophageal reflux during induction with thiopental sodium and succinylcholine were investigated. Forty patients underwent anesthetic induction during continuous esophageal pH monitoring. Twenty patients had preoperative symptoms of gastroesophageal reflux, and 20 asymptomatic patients served as controls. Half the patients in each group received a small dose of nondepolarizing muscle relaxant prior to induction. Five patients (25%) with gastroesophageal reflux and none of the control patients showed significant decreases in esophageal pH during induction. Two of these patients received prior administration of a nondepolarizing drug. In all five patients, reflux occurred during laryngoscopy and intubation, suggesting the possibility that succinylcholine did not play a role in the generation of reflux. Preoperative gastroesophageal reflux symptomatology is associated with an increased frequency of reflux during induction, and the vulnerable period seems to occur after the achievement of neuromuscular blockade during laryngoscopy. Preinduction administration of a non-depolarizing muscle relaxant prior to succinylcholine use had no demonstrable effect on the frequency of reflux during induction, although the numbers studied were too small to be conclusive.
研究了患者生理状况以及非去极化肌松药的预先使用对硫喷妥钠和琥珀酰胆碱诱导期间胃食管反流频率的影响。40例患者在连续食管pH监测下接受麻醉诱导。20例患者有胃食管反流的术前症状，20例无症状患者作为对照。每组中有一半患者在诱导前接受小剂量非去极化肌松药。5例（25%）有胃食管反流的患者在诱导期间食管pH显著下降，而对照患者无一例出现这种情况。其中2例患者预先使用了非去极化药物。在所有5例患者中，反流发生在喉镜检查和插管期间，提示琥珀酰胆碱在反流产生中可能不起作用。术前胃食管反流症状与诱导期间反流频率增加有关，且易发生期似乎出现在喉镜检查期间实现神经肌肉阻滞之后。在使用琥珀酰胆碱之前预先给予非去极化肌松药对诱导期间反流频率没有明显影响，尽管研究的病例数太少，无法得出定论。
