Department of Anesthesiology and Intensive Care Medicine, Faculté de Médecine Toulouse-Rangueil, EA 4564-MATN, Institut Louis Bugnard (IFR 150), CHU Toulouse, Université Toulouse III Paul Sabatier, F-31000 Toulouse, France.
Ann Intensive Care. 2014 Feb 11;4(1):3. doi: 10.1186/2110-5820-4-3.
Data from previous studies indicate that optimal conditions for intubation are met 120 seconds after administration of 0.15 mg.kg-1 cisatracurium (ED95 × 3) following the induction of anesthesia. The aim of this study was to compare the doses required for complete paralysis after induction of anesthesia in ICU patients with the dose used in patients undergoing elective surgery.
Seventeen ICU patients undergoing percutaneous tracheostomy and 17 patients undergoing an elective surgical procedure under muscle relaxation were included. In both groups, an initial intravenous bolus of cisatracurium besylate was given at a dose of 0.15 mg.kg-1 followed by repeated boluses of 0.03 mg.kg-1 every four minutes. The objective was to obtain no response to the train-of-four (TOF). The contractile response of the corrugator supercilii muscle was monitored every minute by observing the TOF in response to a peripheral nerve stimulator with a constant current set to 60 mA.
After the initial dose of cisatracurium, none of ICU patients (0/17) versus 15/17 of the elective surgery patients were completely paralyzed (P < 0.0001). There was a delay in the onset of neuromuscular blockade among the ICU patients. The cumulative doses of cisatracurium were significantly higher in the ICU group with 38 ± 14 mg (that is, 10 ± 4.7 ED95) versus 11 ± 2 mg (that is, 3 ± 0.3 ED95) in the elective surgery group (P < 0.0001).
The dosing of cisatracrurium for ICU patients, which is based on the dose recommended for elective anesthesia, is unsuitable because the onset is too slow. This phenomenon is probably caused by changes in the pharmacodynamics and pharmacokinetics. These data suggest that neuromuscular monitoring should be used in the ICU.
先前的研究数据表明，在麻醉诱导后给予 0.15mg/kg-1 顺式阿曲库铵（ED95×3）120 秒后，插管的最佳条件得到满足。本研究旨在比较 ICU 患者在麻醉诱导后完全瘫痪所需的剂量与接受选择性手术患者的剂量。
纳入 17 例接受经皮气管切开术的 ICU 患者和 17 例接受肌松下择期手术的患者。两组患者均给予顺式阿曲库铵苯磺酸盐初始静脉推注剂量 0.15mg/kg-1，随后每 4 分钟重复推注 0.03mg/kg-1。目的是使四成串（TOF）无反应。通过观察对恒流 60mA 的外周神经刺激器的 TOF，监测每一分钟眉弓肌的收缩反应。
在初始顺式阿曲库铵剂量后，ICU 患者中无 17 例（0/17）与 17 例择期手术患者中 15 例（15/17）完全瘫痪（P<0.0001）。ICU 患者的神经肌肉阻滞起效延迟。ICU 组顺式阿曲库铵的累积剂量明显高于择期手术组，分别为 38±14mg（即 10±4.7ED95）与 11±2mg（即 3±0.3ED95）（P<0.0001）。
基于推荐用于择期麻醉的剂量为 ICU 患者设定的顺式阿曲库铵剂量不合适，因为起效太慢。这种现象可能是由于药效学和药代动力学的变化引起的。这些数据表明，应在 ICU 中使用神经肌肉监测。
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