Nightingale D A
Br J Anaesth. 1986;58 Suppl 1:32S-36S. doi: 10.1093/bja/58.suppl_1.32s.
Atracurium was administered to neonatal patients on 270 occasions without any difficulties being encountered. More detailed observations in 60 patients showed that, in 16 neonates 3 days of age and older, with a core temperature greater than 36 degrees C, the standard dose of atracurium 500 micrograms kg-1 had a mean duration of clinical effect of 23.1 +/- 3.4 min--the shortest in any group of children so far studied in Liverpool. In only three of the 16 was antagonism of residual neuromuscular blockade considered to be necessary. In 34 infants, anaesthetized within 48 h of birth, we identified distinct subgroups. In 12, comparable except for age to the patients described above, 500 +/- 50 micrograms kg-1 lasted a mean time of 32.4 +/- 8.6 min, nearly 50% longer and with more than twice the standard deviation. In eight infants in whom the central body temperature decreased to less than 36 degrees C, the standard dose of atracurium lasted a mean time of 47.5 +/- 11.8 min. These results suggest that it might be advantageous to reduce the initial dose of atracurium in the smaller newborn infants, particularly if their body temperature is less than normal. To date, a reduced dose of 300 +/- 30 micrograms kg-1 has been given to 10 patients and in this small group the mean duration of clinical effect was 24.5 +/- 10.1 min.
在270例新生儿患者中使用了阿曲库铵，未遇到任何困难。对60例患者进行的更详细观察表明，在16例年龄3天及以上、核心体温高于36摄氏度的新生儿中，阿曲库铵的标准剂量500微克/千克的平均临床效应持续时间为23.1±3.4分钟，是利物浦迄今为止所研究的任何一组儿童中最短的。在这16例患者中，只有3例被认为需要对抗残余的神经肌肉阻滞。在34例出生后48小时内接受麻醉的婴儿中，我们确定了不同的亚组。在12例除年龄外与上述患者相当的婴儿中，500±50微克/千克的持续时间平均为32.4±8.6分钟，几乎长了50%，标准差是标准剂量组的两倍多。在8例中心体温降至36摄氏度以下的婴儿中，阿曲库铵的标准剂量平均持续时间为47.5±11.8分钟。这些结果表明，对于较小的新生儿，尤其是体温低于正常水平的新生儿，减少阿曲库铵的初始剂量可能是有益的。迄今为止，已对10例患者给予了300±30微克/千克的减少剂量，在这个小群体中，临床效应的平均持续时间为24.5±10.1分钟。
