Plumley M H, Bevan J C, Saddler J M, Donati F, Bevan D R
Department of Anesthesia, The Montreal Children's Hospital, Room C-1119, 2300 Tupper, H3H 1P3, Montreal, Quebec, Canada.
Can J Anaesth. 1990 Jan;37(1):15-20. doi: 10.1007/BF03007477.
This study was performed to détérmine the effects of various doses of succinylcholine on resting tension and evoked twitch height at the masséter and adductor pollicis muscles in children. Twenty patients, aged 3-10yr, ASA physical status I or II, were randomly assigned to receive succinylcholine 0.15, 0.25, 0.50 or 1.00 mg · kg, during halothane-nitrous oxide anaesthesia. Supramaximal train-of-four stimulation was applied simultaneously to the ulnar nerve and the nerve to the masséter. Transducers recorded force at the jaw and the thumb. Maximum blockade of the first twitch (T) and maximum resting tension change were measured. Potency of succinylcholine at the two muscles was estimated by linear regression of the logit transformation of T versus log dose. The relationship between resting tension change and log dose was established by linear regression. The masséter muscle was more sensitive to succinylcholine than the adductor pollicis with an ED of 0.28 ± 0.02 (mean ±SEM) vs 0.44 ± 0.05 mg · kg (P < 0.05). Onset of neuromuscular blockade was faster at the masséter, and recovery occurred simultaneously in both muscles. A dose-related increase in resting tension was observed in both muscles, but its magnitude was five times greater at the masséter. With succinylcholine, 1 mg · kg, this increase was 51.6 ± 16.8 g at the masséter and 9.1 ± 2.3 g at the adductor pollicis. Tension returned to baseline within 1-2 min. It is concluded that in children (1) succinylcholine produces dose-related changes in resting tension; (2) this effect, although quantitatively important at the masséter, is not restricted to that muscle; and (3) relatively small doses of succinylcholine are required to block neuromuscular transmission at the jaw.
本研究旨在确定不同剂量琥珀酰胆碱对儿童咬肌和拇内收肌静息张力及诱发抽搐高度的影响。20例年龄3 - 10岁、ASA身体状况I或II级的患儿，在氟烷 - 氧化亚氮麻醉期间被随机分配接受0.15、0.25、0.50或1.00 mg·kg的琥珀酰胆碱。对尺神经和咬肌神经同时施加超强强直刺激。换能器记录下颌和拇指处的力量。测量第一次抽搐（T）的最大阻滞和最大静息张力变化。通过T的对数几率变换与对数剂量的线性回归估计琥珀酰胆碱在两块肌肉中的效价。通过线性回归建立静息张力变化与对数剂量之间的关系。咬肌对琥珀酰胆碱比拇内收肌更敏感，其半数有效量为0.28±0.02（均值±标准误）mg·kg，而拇内收肌为0.44±0.05 mg·kg（P<0.05）。咬肌神经肌肉阻滞的起效更快，两块肌肉同时恢复。在两块肌肉中均观察到静息张力随剂量增加，但咬肌的增加幅度是拇内收肌的五倍。给予1 mg·kg琥珀酰胆碱时，咬肌的增加为51.6±16.8 g，拇内收肌为9.1±2.3 g。张力在1 - 2分钟内恢复到基线。结论是，在儿童中：（1）琥珀酰胆碱产生与剂量相关的静息张力变化；（2）这种效应虽然在咬肌中在数量上很重要，但并不局限于该肌肉；（3）在颌部阻断神经肌肉传递所需的琥珀酰胆碱剂量相对较小。
