Goldhill D R, Embree P B, Ali H H, Savarese J J
Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Anaesthesia. 1988 Jun;43(6):443-6. doi: 10.1111/j.1365-2044.1988.tb06627.x.
Moderate to deep (67-99% single twitch depression) pancuronium-induced neuromuscular blockade was antagonised with neostigmine (30 micrograms/kg, 60 micrograms/kg, or 80 micrograms/kg) in combination with glycopyrronium. Twenty-seven patients were reversed from 91%-99% twitch depression. Recovery of the first twitch of a train-of-four to 95% of control twitch took at least 20 minutes with neostigmine 30 micrograms/kg. The higher doses were significantly faster (60 micrograms/kg p less than 0.05, 80 micrograms/kg p less than 0.01) and took 15.8 and 14.8 minutes respectively. Reversal to a train of four ratio of 0.75 was not consistently achieved in under 30 minutes with any dose of neostigmine. Nineteen patients were antagonised from a 67%-80% depression of first twitch and in all but two recovery to 95% of control took under 10 minutes. To achieve a train of four ratio of 0.75 took less than 12.5 minutes except in three patients, two of whom, both given neostigmine 30 micrograms/kg, took longer than 20 minutes. Neostigmine 60 micrograms/kg produced as rapid a degree of antagonism as 80 micrograms/kg. Heart rates after reversal decreased gradually in all groups, although the decrease was initially greater in the low dose neostigmine (30 micrograms/kg) group. A fixed 5:1 ratio of neostigmine and glycopyrronium will usually antagonise a moderate (70%-80%) pancuronium block to a train of four of greater than 75% within 12.5 minutes if at least 60 micrograms/kg of neostigmine is administered. More than 30 minutes may be required for reversal whatever the dose of neostigmine, for antagonism from greater than 90% twitch depression.
在泮库溴铵诱导产生中度至深度（单刺激抑制67%-99%）的神经肌肉阻滞情况下，使用新斯的明（30微克/千克、60微克/千克或80微克/千克）联合格隆溴铵进行拮抗。27例患者的颤搐抑制率从91%-99%得到逆转。新斯的明30微克/千克组，四个成串刺激中第一个颤搐恢复至对照颤搐的95%至少需要20分钟。较高剂量组恢复明显更快（60微克/千克p<0.05，80微克/千克p<0.01），分别用时15.8分钟和14.8分钟。使用任何剂量新斯的明，在30分钟内均不能始终如一地使四个成串刺激比率逆转至0.75。19例患者的第一个颤搐抑制率为67%-80%，除2例患者外，其余患者恢复至对照的95%用时均不到10分钟。除3例患者外，达到四个成串刺激比率0.75用时不到12.5分钟，其中2例使用新斯的明30微克/千克的患者用时超过20分钟。新斯的明60微克/千克产生的拮抗程度与80微克/千克相同。逆转后所有组的心率均逐渐下降，尽管低剂量新斯的明（30微克/千克）组最初下降幅度更大。如果给予至少60微克/千克的新斯的明，新斯的明与格隆溴铵固定的5:1比例通常会在12.5分钟内将中度（70%-80%）泮库溴铵阻滞拮抗至四个成串刺激大于75%。无论新斯的明剂量如何，从大于90%颤搐抑制进行拮抗可能需要超过30分钟。
