Department of Anesthesiology and Pain Management, The University of Texas at Southwestern Medical Center, Dallas, Texas.
Department of Anesthesiology, Keck Hospital of University of Southern California, Los Angeles, California, USA.
Curr Opin Anaesthesiol. 2023 Apr 1;36(2):163-167. doi: 10.1097/ACO.0000000000001225. Epub 2022 Dec 6.
Traumatic brain injury is widespread and has significant morbidity and mortality. Patients with severe traumatic brain injury often necessitate intubation. The paralytic for rapid sequence induction and intubation for the patient with traumatic brain injury has not been standardized.
Rapid sequence induction is the standard of care for patients with traumatic brain injury. Historically, succinylcholine has been the agent of choice due to its fast onset and short duration of action, but it has numerous adverse effects such as increased intracranial pressure and hyperkalemia. Rocuronium, when dosed appropriately, provides neuromuscular blockade as quickly and effectively as succinylcholine but was previously avoided due to its prolonged duration of action which precluded neurologic examination. However, with the widespread availability of sugammadex, rocuronium is able to be reversed in a timely manner.
In patients with traumatic brain injury necessitating intubation, rocuronium appears to be safer than succinylcholine.
颅脑创伤广泛存在，具有显著的发病率和死亡率。严重颅脑创伤患者常需插管。对于颅脑创伤患者，快速序贯诱导和插管的麻痹剂尚未标准化。
快速序贯诱导是颅脑创伤患者的标准治疗方法。历史上，由于琥珀胆碱起效快、作用时间短，一直是首选药物，但它有许多不良反应，如颅内压升高和高钾血症。罗库溴铵在适当剂量下可迅速有效地提供神经肌肉阻滞，但由于其作用时间延长，会妨碍神经检查，因此之前一直被避免使用。然而，随着 sugammadex 的广泛应用，罗库溴铵能够及时逆转。
在需要插管的颅脑创伤患者中，罗库溴铵似乎比琥珀胆碱更安全。
