Zoremba N, Schälte G, Bruells C, Pühringer F K
Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Sankt Elisabeth Hospital Gütersloh, Stadtring Kattenstroth 130, 33332, Gütersloh, Deutschland.
Klinik für Anästhesiologie, Universitätsklinikum, RWTH Aachen, Aachen, Deutschland.
Anaesthesist. 2017 May;66(5):353-359. doi: 10.1007/s00101-017-0289-1.
Due to the great advantages, it is not possible to imagine current practice in anesthesia without the adminstration of muscle relaxants. For a long time the administration of succinylcholine for rapid sequence induction (RSI) was considered to be the state of the art for patients at risk for aspiration. The favorable characteristics are, however, accompanied by many, sometimes severe side effects. Due to the development of non-depolarizing muscle relaxants, in particular rocuronium in combination with sugammadex, there is the possibility to achieve a profile of action similar to succinylcholine with low side effects. After the introduction of sugammadex onto the market, further substances were conceived, which enable a complete encapsulation of muscle relaxants. Calabadion is a very promising new substance for the antagonization of muscle relaxants, which can antagonize the action of steroid as well as benzylisoquinoline types. In the USA new muscle relaxants are currently being tested, which have a rapid onset and the effect can be reversed by L‑cysteine. One of the most promising substances is gantacurium, which is currently being tested in the USA in phase III trials. It remains to be seen whether these muscle relaxants, which are not yet on the market and drugs for reversal of neuromuscular blockade have the potential to become a real alternative to the combination of rocuronium and sugammadex.
由于具有诸多显著优势，很难想象当前麻醉实践中没有肌肉松弛剂的使用会是怎样的情况。长期以来，琥珀酰胆碱用于快速顺序诱导（RSI）被认为是有误吸风险患者的最佳选择。然而，其良好特性伴随着许多有时甚至是严重的副作用。由于非去极化肌肉松弛剂的发展，特别是罗库溴铵与舒更葡糖钠联合使用，使得有可能实现与琥珀酰胆碱相似的作用模式且副作用较小。舒更葡糖钠上市后，人们又设想了其他物质，这些物质能够完全包裹肌肉松弛剂。卡拉巴定是一种非常有前景的新型肌肉松弛剂拮抗剂，它可以拮抗甾体类以及苄基异喹啉类肌肉松弛剂的作用。在美国，目前正在测试新型肌肉松弛剂，它们起效迅速，其作用可被L-半胱氨酸逆转。最有前景的物质之一是甘氨酰环磷酰胺，目前正在美国进行III期试验。这些尚未上市的肌肉松弛剂以及神经肌肉阻滞逆转药物是否有可能真正替代罗库溴铵和舒更葡糖钠的联合使用，仍有待观察。
