新斯的明逆转后喉肌电图恢复时顺式阿曲库铵与罗库溴铵引起的神经肌肉阻滞的比较：猪模型研究。
A comparison between cisatracurium and rocuronium-induced neuromuscular block on laryngeal electromyography recovery after neostigmine reversal in a porcine model.
机构信息
Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 8;13:875597. doi: 10.3389/fendo.2022.875597. eCollection 2022.
BACKGROUND
Inducing and reversing neuromuscular block is essential to a positive outcome of thyroid surgery, with intraoperative neuromonitoring (IONM) being used to decrease recurrent and superior laryngeal nerve injuries and improve vocal outcome. Neostigmine is a non-specific broad-spectrum and inexpensive reversal agent for neuromuscular blocking agents (NMBAs). The aim of this porcine study was to explore the effect of neostigmine on electromyography (EMG) signal recovery profile following the commonly used NMBAs, cisatracurium and rocuronium.
METHODS
Twelve piglets were allocated into two groups with six piglets in each group. When stable baseline EMG signals were obtained, a neuromuscular block was induced by intravenous cisatracurium 0.2 mg/kg (group C) or rocuronium 0.6 mg/kg (group R) for each piglet. We compared laryngeal EMG tracing with spontaneous recovery (control) and neostigmine (0.04 mg/kg) reversal for each group. The time course of real-time laryngeal EMG signals was observed for 30 min from NMBA injection. Effects of neostigmine on EMG signal were assessed at 50% EMG recovery and by the maximum neuromuscular block recovery degree from the baseline value.
RESULTS
Neostigmine shortened the recovery time to 50% EMG amplitude in both group C (16.5 [2.5] vs. 29.0 [2.0] min, <0.01) and group R (16.5[2.5] vs. 26.5 [1.5] min, <0.05) compared to spontaneous recovery, respectively. Neostigmine reversal also enhanced the maximum degree of EMG amplitude recovery in both group C (83.6 [5.1] vs. 47.2 [6.1] %, <0.01) and group R (85.6 [18.2]vs. 57.1 [6.3] %, <0.05) compared to spontaneous recovery, respectively. The reversal effect of neostigmine did not differ significantly between cisatracurium and rocuronium.
CONCLUSIONS
This porcine model demonstrated that neostigmine provides an adequate and timely IONM signal suppressed by both cisatracurium and rocuronium. These results can potentially expand the options for precision neuromuscular block management during IONM to improve vocal outcomes in thyroid surgery patients.
背景
诱导和逆转神经肌肉阻滞对于甲状腺手术的良好效果至关重要，术中神经监测（IONM）被用于降低喉返神经和上喉返神经损伤的发生率，并改善嗓音效果。新斯的明是非特异性、广谱且廉价的神经肌肉阻滞剂（NMBAs）拮抗剂。本研究旨在探讨新斯的明对临床常用的两种 NMBAs（顺式阿曲库铵和罗库溴铵）诱导的电肌图（EMG）信号恢复特征的影响。
方法
12 头小猪随机分为两组，每组 6 头。当获得稳定的基础 EMG 信号时，每头小猪静脉注射顺式阿曲库铵 0.2mg/kg（C 组）或罗库溴铵 0.6mg/kg（R 组）诱导神经肌肉阻滞。我们比较了每组的喉肌 EMG 描记与自发恢复（对照）和新斯的明（0.04mg/kg）逆转的情况。从 NMBA 注射开始，实时喉肌 EMG 信号的时间进程被观察 30 分钟。通过 50%EMG 恢复和从基线值的最大神经肌肉阻滞恢复程度评估新斯的明对 EMG 信号的影响。
结果
与自发恢复相比，新斯的明分别使 C 组（16.5[2.5] vs. 29.0[2.0]min，<0.01）和 R 组（16.5[2.5] vs. 26.5[1.5]min，<0.05）的恢复到 50%EMG 振幅的时间缩短。新斯的明逆转也增强了 C 组（83.6[5.1] vs. 47.2[6.1]%，<0.01）和 R 组（85.6[18.2] vs. 57.1[6.3]%，<0.05）的最大 EMG 振幅恢复程度，与自发恢复相比。新斯的明在顺式阿曲库铵和罗库溴铵之间的逆转效果无显著差异。
结论
本研究建立的猪模型表明，新斯的明可提供足够和及时的 IONM 信号，且对顺式阿曲库铵和罗库溴铵均有抑制作用。这些结果可能为 IONM 期间精准神经肌肉阻滞管理提供更多选择，以改善甲状腺手术患者的嗓音效果。
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