Szalados J E, Donati F, Bevan D R
Department of Anaesthesia, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Anesth Analg. 1990 Jul;71(1):55-9. doi: 10.1213/00000539-199007000-00009.
Subparalyzing doses of d-tubocurarine (dTC) given before succinylcholine decrease the duration of neuromuscular blockade. In animal preparations, they also abolish succinylcholine-induced twitch augmentation, defined as a greater-than-maximal contraction in response to a single stimulus. To determine quantitatively the effect of dTC on succinylcholine potency and on twitch augmentation in humans, 60 adult patients, ASA physical status I or II, were assigned randomly to receive either 0.05 mg/kg of dTC or saline 2 min before induction of anesthesia with fentanyl and thiopental. Train-of-four stimulation was applied every 12 s to the ulnar nerve and the force of contraction of the adductor pollicis muscle was measured. One minute after induction of anesthesia, 0.15, 0.20, 0.25, 0.35, or 0.50 mg/kg of succinylcholine was given. The height of the first twitch (T1) reached 121% +/- 6% (mean +/- SEM) of control without dTC, and was virtually abolished by dTC pretreatment (105% +/- 1%, P less than 0.01). Twitch augmentation was more noticeable with lower doses of succinylcholine, and was not observed in the response to the fourth stimulus of the train of four (T4). The potency of succinylcholine was decreased by approximately one-half in the dTC-pretreated groups. The ED50 was 0.27 +/- 0.04 mg/kg without dTC and 0.50 +/- 0.06 mg/kg with dTC (P less than 0.002). The corresponding values for ED90 were 0.51 +/- 0.07 and 1.02 +/- 0.12 mg/kg, respectively (P less than 0.02). The ED95 values were 0.63 +/- 0.09 and 1.28 +/- 0.15 mg/kg, respectively (P less than 0.02). The slopes of the regression lines did not deviate significantly from parallelism.(ABSTRACT TRUNCATED AT 250 WORDS)
在琥珀酰胆碱给药前给予低于麻痹剂量的d -筒箭毒碱（dTC）可缩短神经肌肉阻滞的持续时间。在动物实验中，它还可消除琥珀酰胆碱诱导的抽搐增强现象，即对单个刺激产生大于最大收缩的反应。为了定量确定dTC对人体中琥珀酰胆碱效能和抽搐增强的影响，将60例美国麻醉医师协会（ASA）身体状况为I或II级的成年患者随机分为两组，在使用芬太尼和硫喷妥钠诱导麻醉前2分钟，分别给予0.05 mg/kg的dTC或生理盐水。每12秒对尺神经施加四个成串刺激，并测量拇内收肌的收缩力。麻醉诱导1分钟后，给予0.15、0.20、0.25、0.35或0.50 mg/kg的琥珀酰胆碱。在未使用dTC的情况下，第一次抽搐（T1）的高度达到对照值的121%±6%（平均值±标准误），而dTC预处理后几乎完全消失（105%±1%，P<0.01）。较低剂量的琥珀酰胆碱时抽搐增强更明显，在四个成串刺激的第四个刺激（T4）的反应中未观察到抽搐增强。在dTC预处理组中，琥珀酰胆碱的效能降低了约一半。无dTC时的半数有效剂量（ED50）为0.27±0.04 mg/kg，有dTC时为0.50±0.06 mg/kg（P<0.002）。相应的90%有效剂量（ED90）值分别为0.51±0.07和1.02±0.12 mg/kg（P<0.02）。95%有效剂量（ED95）值分别为0.63±0.09和1.28±0.15 mg/kg（P<0.02）。回归线的斜率与平行度无显著偏差。（摘要截短于250字）
