Chen Yongjie, Huang Lianjun, Li Yang, Tong Li, Wang Xiaochen, Hu Keshi, Feng Zeguo
Anesthesia and Operation Center, General Hospital of PLA, Beijing 100853, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2018 Dec 30;38(12):1472-1475. doi: 10.12122/j.issn.1673-4254.2018.12.12.
To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery.
Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. The depth of anesthesia was maintained with sevoflurane and remifentanil during the surgery. The LD50 and 95% of mivacurium were calculated using Brownlee's up-and-down sequential method.
The LD50 of continuously infused mivacurium was 8.94 μg?kg?min (95% : 8.89- 8.99 μg?kg?min) during thyroid surgery, which did not affect neurological function monitoring. Transient chest skin redness occurred after induction in 9 patients (32.1%). None of the patients experienced intubation difficulties or showed intraoperative body motions during the surgery.
In patients undergoing thyroid surgery under anesthesia maintained by inhalation and intravenous infusion, the LD50 of mivacurium was 8.94 μg?kg?min (95% : 8.89-8.99 μg?kg?min) for continuous infusion, which does not cause serious adverse effects during the operation.
确定甲状腺手术中持续输注米库氯铵用于术中神经监测的最大剂量，并观察其不良反应。
28例接受甲状腺手术并进行术中神经监测的患者，初始米库氯铵输注速率为5.43μg·kg⁻¹·min⁻¹，根据神经监测结果，下一位患者的输注速率根据上一位患者的反应进行调整。术中使用七氟醚和瑞芬太尼维持麻醉深度。采用Brownlee上下序贯法计算米库氯铵的半数致死量（LD50）及95%可信区间。
甲状腺手术中持续输注米库氯铵的LD50为8.94μg·kg⁻¹·min⁻¹（95%可信区间：8.89 - 8.99μg·kg⁻¹·min⁻¹），不影响神经功能监测。9例患者（32.1%）诱导后出现短暂胸部皮肤发红。手术过程中无患者出现插管困难或术中身体活动。
在吸入和静脉联合麻醉下进行甲状腺手术的患者中，持续输注米库氯铵的LD50为8.94μg·kg⁻¹·min⁻¹（95%可信区间：8.89 - 8.99μg·kg⁻¹·min⁻¹），术中不会引起严重不良反应。
