阿曲库铵在新生儿、婴儿和儿童中的输注。剂量需求研究。

Infusion of atracurium in neonates, infants and children. A study of dose requirements.

作者信息

Kalli I, Meretoja O A

机构信息

Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.

出版信息

Br J Anaesth. 1988 May;60(6):651-4. doi: 10.1093/bja/60.6.651.

DOI:10.1093/bja/60.6.651

PMID:3377949

Abstract

The doses of atracurium (by infusion) required to maintain steady-state (90-95%) neuromuscular block were assessed in 75 children aged 9 days to 17 yr during balanced anaesthesia. Following the intubating dose of atracurium 0.4 mg kg-1 and after the recovery of single twitch to 5-10% of control (monitored by evoked EMG of hypothenar muscle), an infusion of atracurium 0.5 mg kg-1 h-1 was started. In 22 of the patients this initial rate resulted in the desired steady state; 32 patients required one, and 21 required two or more adjustments in rate. The mean single twitch value at steady-state was 6.6 +/- 0.3% (SEM), which is equal to 93% neuromuscular block. The infusion requirement to maintain the steady state neuromuscular block in all paediatric patients more than 1 month old was constant (0.53 +/- 0.01 mg kg-1 h-1). The infusion requirement of neonates up to 1 month old was 25% less (0.40 +/- 0.02 mg kg-1 h-1; P = 0.003). A significant correlation (n = 75, r = 0.76, P less than 0.001) was found between the infusion rate (mg m-2 h-1) and the logarithm of the body surface area.

摘要

在平衡麻醉期间，对75名年龄在9天至17岁的儿童进行评估，以确定维持稳态（90 - 95%）神经肌肉阻滞所需的阿曲库铵（通过输注）剂量。给予0.4 mg/kg的阿曲库铵插管剂量后，在单刺激恢复至对照值的5 - 10%（通过小鱼际肌诱发肌电图监测）后，开始以0.5 mg·kg⁻¹·h⁻¹的速率输注阿曲库铵。22例患者的初始输注速率产生了所需的稳态；32例患者需要调整一次，21例患者需要调整两次或更多次输注速率。稳态时的平均单刺激值为6.6±0.3%（标准误），相当于93%的神经肌肉阻滞。所有1个月以上儿科患者维持稳态神经肌肉阻滞的输注需求量是恒定的（0.53±0.01 mg·kg⁻¹·h⁻¹）。1个月以内的新生儿输注需求量少25%（0.40±0.02 mg·kg⁻¹·h⁻¹；P = 0.003）。输注速率（mg·m⁻²·h⁻¹）与体表面积的对数之间存在显著相关性（n = 75，r = 0.76，P < 0.001）。