硫酸镁可降低重症肌无力患者为获得满意的双腔气管导管置入条件所需的罗库溴铵剂量。

Magnesium sulfate reduces the rocuronium dose needed for satisfactory double lumen tube placement conditions in patients with myasthenia gravis.

作者信息

Fei Shoujun, Xia Hengfu, Chen Xiaowei, Pang Dazhi, Xu Xuebing

机构信息

Department of Anaesthesiology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.

Department of Thoracic surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.

出版信息

BMC Anesthesiol. 2019 Aug 31;19(1):170. doi: 10.1186/s12871-019-0841-4.

DOI:10.1186/s12871-019-0841-4

PMID:31472669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6717642/

Abstract

BACKGROUND

Using a minimum dose of neuromuscular blockade (NMB) to achieve intubation condition is one of the goals in anaesthesia management of patients with myasthenia gravis (MG) for thoracoscopic (VATS) thymectomy. However, tracheal intubation with double lumen tube (DLT) could be challenging if intubation condition is not optimal. This double-blind randomised controlled study was designed to investigate whether magnesium sulfate would reduce the rocuronium dose needed for DLT intubation and improve the DLT placement condition for patients with MG who were scheduled for video-assisted thoracoscopic (VATS) thymectomy.

METHODS

Recruited patients were randomly assigned to receive magnesium sulfate 60 mg.kg or normal saline (control) prior to the administration of NMB. Titrating dose of rocuronium was administered to achieve train of four (TOF) ratio less than 10% before DLT intubation. The primary outcome was the rocuronium dose required to achieve TOF ratio less than 10%. The secondary outcome was intubation condition for DLT placement.

RESULTS

Twenty-three patients had received magnesium sulfate and 22 patients had received normal saline before rocuronium administration. The required rocuronium dose [mean (standard deviation)] were 0.10 (0.05) mg.kg and 0.28(0.17) mg.kg in patients who had magnesium sulfate and normal saline respectively(P < 0.0001). With a similar depth of neuromuscular blockade and depth of anaesthesia, 100% of patients in the magnesium sulfate group and 72.7% of patients in the control group showed excellent intubation condition (P = 0.027) respectively. The patients in both groups had similar emergence characteristics.

CONCLUSIONS

Magnesium sulfate is associated with a decrease in rocuronium requirement for an optimal DLT intubation condition in patients with MG for VATS thymectomy.

TRIAL REGISTRATION

Clinical Trial Registry of China ( http://www.chictr.org.cn ) identifier: ChiCTR-1800017696, retrospectively registered on August 10, 2018.

摘要

背景

使用最小剂量的神经肌肉阻滞（NMB）以达到插管条件是重症肌无力（MG）患者行胸腔镜（VATS）胸腺切除术麻醉管理的目标之一。然而，如果插管条件不理想，使用双腔气管导管（DLT）进行气管插管可能具有挑战性。本双盲随机对照研究旨在调查硫酸镁是否会减少MG患者行电视辅助胸腔镜（VATS）胸腺切除术时DLT插管所需的罗库溴铵剂量，并改善DLT置入条件。

方法

招募的患者在给予NMB之前被随机分配接受60mg/kg硫酸镁或生理盐水（对照组）。在DLT插管前给予滴定剂量的罗库溴铵以达到四个成串刺激（TOF）比值小于10%。主要结局是达到TOF比值小于10%所需的罗库溴铵剂量。次要结局是DLT置入的插管条件。

结果

23例患者在给予罗库溴铵前接受了硫酸镁，22例患者接受了生理盐水。接受硫酸镁和生理盐水的患者所需罗库溴铵剂量[均值（标准差）]分别为0.10（0.05）mg/kg和0.28（0.17）mg/kg（P<0.0001）。在神经肌肉阻滞深度和麻醉深度相似的情况下，硫酸镁组100%的患者和对照组72.7%的患者显示出良好的插管条件（P=0.027）。两组患者的苏醒特征相似。