Soto Mesa Diego, Fayad Fayad Mounir, Pérez Arviza Laura, Del Valle Ruiz Verónica, Cosío Carreño Fernando, Arguelles Tamargo Luis, Amorín Díaz Manuel, Fernández-Pello Montes Sergio
Diego Soto Mesa, Mounir Fayad Fayad, Laura Pérez Arviza, Verónica Del Valle Ruiz, Fernando Cosío Carreño, Luis Arguelles Tamargo, Department of Anaesthesiology, Hospital of Cabueñes, 33394 Gijón, Spain.
World J Clin Cases. 2015 Apr 16;3(4):360-7. doi: 10.12998/wjcc.v3.i4.360.
To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuronium-induced neuromuscular blockade (NMB).
Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification I-II, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg (group A) or 4 mg/kg (group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables (arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.
Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively. The estimated difference in recovery time between groups was 24 s (95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8 (group A: 101 s; group B: 82.5 s) and 0.7 (group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB.
A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-Of-Four is reached.
评估七氟烷和瑞芬太尼维持麻醉以及深度罗库溴铵诱导神经肌肉阻滞（NMB）后，两种不同剂量舒更葡糖钠的效果。
年龄在20至65岁之间、美国麻醉医师协会身体状况分级为I-II级、接受妇科手术的患者纳入一项前瞻性、对比性随机研究。注射0.6mg/kg罗库溴铵诱导NMB，随后以0.3 - 0.6mg/kg每小时持续输注以维持深度阻滞。用七氟烷和瑞芬太尼维持麻醉。最后，手术结束时，当四个成串刺激首次出现反应时，A组给予2mg/kg（A组）或4mg/kg（B组）舒更葡糖钠推注。主要临床终点是恢复至四个成串刺激比值为0.9的时间。记录的其他变量包括恢复至四个成串刺激比值为0.7、0.8的时间、血流动力学变量（基线、开始给予舒更葡糖钠时以及第2、5和10分钟时的动脉血压和心率）以及麻醉后护理单元1小时后出现的不良事件。
32例患者纳入研究：A组16例患者，B组16例患者。每组仅记录14例患者，因为每组各有2例患者在第10分钟时动脉压值丢失。两组具有可比性。A组和B组从开始给予舒更葡糖钠至四个成串刺激比值达到0.9的中位恢复时间分别为129秒和110秒。两组恢复时间的估计差异为24秒（95%CI：0至45秒，霍奇斯 - 莱曼估计量），完全在预定义的等效区间内。从开始给予舒更葡糖钠至四个成串刺激比值恢复到0.8（A组：101秒；B组：82.5秒）和0.7（A组：90秒；B组：65秒）的时间在两组之间不等效。两组之间动脉压和心率值无显著变化，且无一例患者显示残留或复发性NMB的任何临床证据。
持续输注罗库溴铵后给予2mg/kg舒更葡糖钠，当四个成串刺激首次出现反应时足以逆转NMB。
