0.15mg/kg 顺式阿曲库铵在年轻和老年患者中起效时间、作用持续时间和插管条件的比较。

Comparison of onset time, duration of action, and intubating conditions after cisatracurium 0.15 mg/kg in young and elderly patients.

机构信息

Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, Section 6011, DK-2100, Copenhagen, Denmark.

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

出版信息

BMC Anesthesiol. 2022 Nov 7;22(1):339. doi: 10.1186/s12871-022-01881-5.

DOI:10.1186/s12871-022-01881-5

PMID:36344924

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9639316/

Abstract

INTRODUCTION

Tracheal intubation during anesthesia can be facilitated by the neuromuscular blocking agent cisatracurium. However, limited data exists about onset time, duration of action and effect on intubating conditions in elderly patients above 80 years of age. We hypothesized that elderly patients would present a longer onset time and duration of action compared to younger adults.

METHODS

This prospective observational study included 31 young (18-40 years) and 29 elderly (≥ 80 years) patients. Patients were given fentanyl 2 μg/kg and propofol 1.5-2.5 mg/kg for induction of anesthesia and maintained with remifentanil and propofol. Monitoring of neuromuscular function was performed with acceleromyography. Primary outcome was onset time defined as time from injection of cisatracurium 0.15 mg/kg (based on ideal body weight) to a train-of-four (TOF) count of 0. Other outcomes included duration of action (time to TOF ratio ≥ 0.9), intubation conditions using the Fuchs-Buder scale and the Intubating Difficulty Scale (IDS), and occurrence of hoarseness and sore throat postoperatively.

RESULTS

Elderly patients had significantly longer onset time compared with younger patients; 297 seconds (SD 120) vs. 199 seconds (SD 59) (difference: 98 seconds (95% CI: 49-147), P < 0.001)). Duration of action was also significantly longer in elderly patients compared with younger patients; 89 minutes (SD 17) vs. 77 minutes (SD 14) (difference: 12 minutes (95% CI: 2.5-20.5) P = 0.01)). No difference was found in the proportion of excellent intubating conditions (Fuchs-Buder); 19/29 (66%) vs 21/31 (68%) (P = 0.86) or IDS score (P = 0.74). A larger proportion of elderly patients reported hoarseness 24 hours postoperatively; 62% vs 34% P = 0.04.

CONCLUSION

In elderly patients cisatracurium 0.15 mg/kg had significantly longer onset time and duration of action compared with younger patients. No difference was found in intubating conditions at a TOF count of 0.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT04921735, date of registration 10 June 2021).

摘要

介绍

麻醉期间气管插管可通过神经肌肉阻滞剂顺阿曲库铵来辅助。然而，关于 80 岁以上老年患者的起效时间、作用持续时间和插管条件的相关数据有限。我们假设与年轻成年人相比，老年患者的起效时间和作用持续时间会更长。

方法

本前瞻性观察研究纳入 31 名年轻（18-40 岁）和 29 名老年（≥80 岁）患者。患者给予芬太尼 2μg/kg 和丙泊酚 1.5-2.5mg/kg 进行麻醉诱导，并用瑞芬太尼和丙泊酚维持麻醉。使用加速度肌描记术监测神经肌肉功能。主要结局为起效时间，定义为顺阿曲库铵 0.15mg/kg（基于理想体重）注射至四个成串刺激（TOF）计数为 0 的时间。其他结局包括作用持续时间（TOF 比值≥0.9 时的时间）、使用 Fuchs-Buder 量表和插管难度量表（IDS）评估的插管条件以及术后声音嘶哑和咽喉痛的发生情况。

结果

老年患者的起效时间明显长于年轻患者，分别为 297 秒（SD 120）和 199 秒（SD 59）（差异：98 秒（95%CI：49-147），P<0.001）。老年患者的作用持续时间也明显长于年轻患者，分别为 89 分钟（SD 17）和 77 分钟（SD 14）（差异：12 分钟（95%CI：2.5-20.5），P=0.01）。两组优秀插管条件（Fuchs-Buder）的比例无差异（19/29 [66%] vs 21/31 [68%]）（P=0.86）或 IDS 评分（P=0.74）。老年患者术后 24 小时报告声音嘶哑的比例更大，分别为 62%和 34%（P=0.04）。