罗库溴铵与生理盐水用于麻醉诱导时有效面罩通气的比较：一项双盲随机安慰剂对照试验。

Rocuronium versus saline for effective facemask ventilation during anesthesia induction: a double-blinded randomized placebo-controlled trial.

机构信息

Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan.

Department of Anesthesiology, Chiba University Hospital, Chiba, Japan.

出版信息

BMC Anesthesiol. 2022 Jun 3;22(1):173. doi: 10.1186/s12871-022-01717-2.

DOI:10.1186/s12871-022-01717-2

PMID:35659538

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9164462/

Abstract

BACKGROUND

Mask ventilation progressively improves after loss of consciousness during anesthesia induction possibly due to progression of muscle paralysis. This double-blinded randomized placebo-controlled study aimed to test a hypothesis that muscle paralysis improves mask ventilation during anesthesia induction.

METHODS

Forty-four adults patients including moderate to severe obstructive sleep apnea undergoing scheduled surgeries under elective general anesthesia participated in this study. Randomly-determined test drug either rocuronium or saline was blinded to the patient and anesthesia provider. One-handed mask ventilation with an anesthesia ventilator providing a constant driving pressure and respiratory rate (15 breaths per minute) was performed during anesthesia induction, and changes of capnogram waveform and tidal volume were assessed for one minute. The needed breaths for achieving plateaued-capnogram (primary variable) within 15 consecutive breaths were compared between the test drugs.

RESULTS

Measurements were successful in 38 participants. Twenty-one and seventeen patients were allocated into saline and rocuronium respectively. The number of breaths achieving plateaued capnogram did not differ between the saline (95% C.I.: 6.2 to 12.8 breaths) and rocuronium groups (95% C.I.: 5.6 to 12.7 breaths) (p = 0.779). Mean tidal volume changes from breath 1 was significantly greater in rocuronium group than saline group (95% C.I.: 0.56 to 0.99 versus 3.51 to 4.53 ml kg-IBW, p = 0.006). Significantly more patients in rocuronium group (94%) achieved tidal volume greater than 5 mg kg-ideal body weight within one minute than those in saline group (62%) (p = 0.026). Presence of obstructive sleep apnea did not affect effectiveness of rocuronium for improvement of tidal volume during one-handed mask ventilation.

CONCLUSIONS

Use of rocuronium facilitates tidal volume improvement during one-handed mask ventilation even in patients with moderate to severe obstructive sleep apnea.

TRIAL REGISTRATION

The clinical trial was registered at (05/12/2013, UMIN000012495): https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000014515.

摘要

背景

在麻醉诱导过程中意识丧失后，面罩通气逐渐改善，这可能是由于肌肉麻痹的进展所致。本项双盲随机安慰剂对照研究旨在验证一个假设，即肌肉麻痹可改善麻醉诱导期间的面罩通气。

方法

本研究纳入 44 名接受择期全身麻醉下手术的中重度阻塞性睡眠呼吸暂停患者。随机确定的测试药物为罗库溴铵或生理盐水，患者和麻醉提供者对此均不知情。在麻醉诱导期间，使用麻醉呼吸机提供恒定驱动压力和呼吸频率（15 次/分钟）进行单手面罩通气，并评估 1 分钟内呼气末二氧化碳波形和潮气量的变化。比较两种测试药物在 15 次连续呼吸内达到平台呼气末二氧化碳（主要变量）所需的呼吸次数。

结果

38 名参与者的测量成功。21 名和 17 名患者分别分配至生理盐水组和罗库溴铵组。生理盐水组（95%置信区间：6.2 至 12.8 次）和罗库溴铵组（95%置信区间：5.6 至 12.7 次）达到平台呼气末二氧化碳所需的呼吸次数无差异（p=0.779）。与生理盐水组相比，罗库溴铵组从第 1 次呼吸开始的潮气量变化均值明显更大（95%置信区间：0.56 至 0.99 与 3.51 至 4.53 ml/kg-IBW，p=0.006）。罗库溴铵组在 1 分钟内达到大于 5mg/kg-理想体重的潮气量的患者比例（94%）显著高于生理盐水组（62%）（p=0.026）。中重度阻塞性睡眠呼吸暂停患者使用罗库溴铵后，单手面罩通气时的潮气量改善效果不受影响。