Kulkarni Malavika, Chuchendra L S, Bhavya P J
Department of Anaesthesia, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):55-59. doi: 10.4103/aer.AER_212_17.
The onset time of neuromuscular blockade is a crucial time associated with the risk of hypoxia and pulmonary aspiration. Various strategies have been undertaken to shorten this onset time. Therefore, we investigated the effects of bolus of 20 ml saline followed by limb elevation after administration of rocuronium in a dose of 0.6 mg/kg to study the onset time.
Thirty patients were randomly allocated to the bolus saline group or control group. General anesthesia was induced and maintained with fentanyl and propofol. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by 20 ml saline bolus and limb elevation in the study group compared to administration of 0.6 mg/kg in a running drip only in the control. Onset of neuromuscular block was assessed by acceleromyography at the adductor pollicis muscle with train-of-four stimulation.
The lag time was shorter in bolus group (34 s median) than in control group (45 s median), < 0.017. The onset time was shorter in bolus group (55 s median) than in control group (110 s median), < 0.001. The T1 recovery to 25% was longer in bolus group (42 min median) than in control group (39 min median) which was statistically not significant.
Rocuronium 0.6 mg/kg IV followed by bolus 20 ml saline and concomitant limb elevation resulted in shorter lag time, faster onset of neuromuscular blockade, good intubating conditions without prolonging clinical duration of action when compared to the control.
神经肌肉阻滞的起效时间是一个与缺氧和肺误吸风险相关的关键时间。已经采取了各种策略来缩短这个起效时间。因此，我们研究了在给予0.6mg/kg罗库溴铵后静脉推注20ml生理盐水并抬高肢体对起效时间的影响。
30例患者被随机分配至推注生理盐水组或对照组。采用芬太尼和丙泊酚诱导并维持全身麻醉。研究组静脉注射0.6mg/kg罗库溴铵后推注20ml生理盐水并抬高肢体，而对照组仅持续静脉滴注0.6mg/kg罗库溴铵。通过对拇内收肌进行四个成串刺激，用加速度肌电图评估神经肌肉阻滞的起效情况。
推注组的滞后时间较短（中位数为34秒），短于对照组（中位数为45秒），P<0.017。推注组的起效时间较短（中位数为55秒），短于对照组（中位数为110秒），P<0.001。推注组T1恢复至25%的时间较长（中位数为42分钟），长于对照组（中位数为39分钟），但差异无统计学意义。
与对照组相比，静脉注射0.6mg/kg罗库溴铵后推注20ml生理盐水并同时抬高肢体可导致滞后时间缩短、神经肌肉阻滞起效更快、插管条件良好且不延长临床作用持续时间。
