Huh Hyub, Park Jeong Jun, Kim Ji Yeong, Kim Tae Hoon, Yoon Seung Zhoo, Shin Hye Won, Lee Hye-Won, Lim Hye-Ja, Cho Jang Eun
Department of Anaesthesiology and Pain Medicine, Anam Hospital Korea University College of Medicine, Seoul, Republic of Korea.
Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Int J Pediatr Otorhinolaryngol. 2017 Oct;101:70-74. doi: 10.1016/j.ijporl.2017.07.030. Epub 2017 Jul 25.
Adenotonsillectomy is a short surgical procedure under general anaesthesia in children. An ideal muscle relaxant for adenotonsillectomy would create an intense neuromuscular block while having a quick recovery time without postoperative morbidity. We compared the effect of different doses of rocuronium for the tracheal intubation in children under 5% sevoflurane and fentanyl.
75 children (aged 3-10 years, ASA I) scheduled for adenotonsillectomy were enrolled. Anaesthesia was induced with propofol 2.5 mg/kg, followed by fentanyl 2 μg/kg. After mask ventilation with 5 vol% sevoflurane in 100% oxygen for 2 min, 2 ml of study drug was administered intravenously, i.e., either normal saline (S Group) or one of two doses (0.15 or 0.3 mg/kg) of rocuronium. We assessed conditions during tracheal intubation and also recorded the surgical condition, the time from discontinuation of sevoflurane to extubation and PAED scale, pain scores in PACU.
Rocuronium groups (96% and 100%, respectively; P < 0.01) showed statistically superior clinically acceptable intubating conditions than the saline group (72%). The 0.3 mg/kg rocuronium (80%) treatment clearly resulted in excellent intubating conditions compared with the 0.15 mg/kg group (44%; p = 0.028). There was no significant difference in the time to extubation and surgical condition, and in the postoperative measures of emergence delirium, pain, and recovery time among the three groups.
A dose of 0.3 mg/kg rocuronium may provide optimal intubating conditions without delayed recovery in 5% sevoflurane anaesthesia with fentanyl in children undergoing adenotonsillectomy.
NCT02467595.
腺样体扁桃体切除术是儿童在全身麻醉下进行的一种简短外科手术。用于腺样体扁桃体切除术的理想肌肉松弛剂应能产生强烈的神经肌肉阻滞作用，同时恢复时间短且无术后并发症。我们比较了不同剂量罗库溴铵在5%七氟醚和芬太尼麻醉下对5岁以下儿童气管插管的效果。
纳入75例计划行腺样体扁桃体切除术的儿童（年龄3 - 10岁，ASA I级）。采用2.5 mg/kg丙泊酚诱导麻醉，随后给予2 μg/kg芬太尼。在100%氧气中用5%七氟醚面罩通气2分钟后，静脉注射2 ml研究药物，即生理盐水（S组）或两种剂量（0.15或0.3 mg/kg）的罗库溴铵之一。我们评估了气管插管时的情况，并记录了手术情况、从停用七氟醚到拔管的时间以及小儿麻醉苏醒期谵妄评分（PAED量表）、麻醉后恢复室（PACU）的疼痛评分。
罗库溴铵组（分别为96%和100%；P < 0.01）在临床上可接受的插管条件方面在统计学上优于生理盐水组（72%）。与0.15 mg/kg组（44%；p = 0.028）相比，0.3 mg/kg罗库溴铵治疗组（80%）明显产生了优良的插管条件。三组在拔管时间、手术情况以及术后苏醒期谵妄、疼痛和恢复时间的指标方面均无显著差异。
对于接受腺样体扁桃体切除术的儿童，在5%七氟醚和芬太尼麻醉中，0.3 mg/kg的罗库溴铵剂量可能提供最佳的插管条件且不会延迟恢复。
NCT02467595。
