Reshmika Palem, Dutta Amitabh, Malhotra Savitar, Sethi Nitin, Sood Jayashree
Institute of Anaesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Asian J Anesthesiol. 2023 Dec 1;61(4):153-160. doi: 10.6859/aja.202312_61(4).0001.
Deep neuromuscular blockade (d-NMB) is an essential requirement for carboperitoneum during laparoscopy surgery. However, sustaining d-NMB till the completion of surgery delays the reversal of the residual block. Therefore, there is a merit in exploring the effect of synergistic vecuronium-atracurium combination on the duration-of-action of d-NMB during "laparoscopic" surgery when we compare intubating bolus non-depolarizers (atracurium, vecuronium) administered alone. This study aims to evaluate whether the synergistic effect atracurium-vecuronium combination increases duration-of-action of d-NMB "laparoscopic" surgery settings.
Forty-eight patients (18-60 years, American Society of Anesthesiologists physical status- II/III, either sex) undergoing laparoscopic cholecystectomy were randomly allocated to receive vecuronium (vecuronium group, n = 16) or atracurium (atracurium group, n = 16) or vecuroniumatr-acurium combination (vecuronium-atracurium combination group, n = 16) and analyzed for the effects on the duration-of-action (primary objective); onset-of-action, reversibility, and quality of intubating conditions (secondary objectives) profile of neuromuscular blockade in patients undergoing laparoscopic cholecystectomy.
Duration-of-action of neuromuscular blockade was significantly longer in patients who received atracurium-vecuronium combination (53.9 ± 9.7 minutes) versus atracurium-alone (41.1 ± 3.8 minutes) or vecuronium-alone (43.5 ± 9.2 minutes) (P = 0.000). No difference was found for the time to onset-of-action (vecuronium [198.1 ± 34.9 seconds], atracurium [188.5 ± 50.6 seconds], or atracurium-vecuronium combination [196.3 ± 46.3 seconds] [P = 0.829]); time for the reversal of muscle relaxation effect (vecuronium [559.9 ± 216.2 seconds], atracurium [584.7 ± 258.3 seconds], and atracurium-vecuronium combination [555.0 ± 205.4 seconds] [P = 0.925]); and quality-of-intubating conditions (vecuronium group [9.6 ± 1.3]; atracurium group [10.0 ± 0.0]; atracurium-vecuronium group [10.0 ± 0.0] [P = 0.182]).
The synergistic effect of the atracurium-vecuronium combination leads to an increased duration-of-action of d-NMB during laparoscopic cholecystectomy without impacting onset-of-action, quality of intubating conditions, and reversal of muscle relaxant effect.
深度神经肌肉阻滞（d-NMB）是腹腔镜手术中建立气腹的必要条件。然而，维持深度神经肌肉阻滞直至手术结束会延迟残余阻滞的逆转。因此，当我们比较单独给予插管推注非去极化肌松药（阿曲库铵、维库溴铵）时，探索维库溴铵 - 阿曲库铵联合用药对腹腔镜手术中深度神经肌肉阻滞作用持续时间的影响具有一定价值。本研究旨在评估阿曲库铵 - 维库溴铵联合用药的协同效应是否能增加腹腔镜手术中深度神经肌肉阻滞的作用持续时间。
48例（年龄18 - 60岁，美国麻醉医师协会身体状况分级为II/III级，性别不限）行腹腔镜胆囊切除术的患者被随机分配接受维库溴铵（维库溴铵组，n = 16）或阿曲库铵（阿曲库铵组，n = 16）或维库溴铵 - 阿曲库铵联合用药（维库溴铵 - 阿曲库铵联合组，n = 16），并分析其对腹腔镜胆囊切除术患者神经肌肉阻滞作用持续时间（主要目标）、起效时间、恢复时间和插管条件质量（次要目标）的影响。
接受阿曲库铵 - 维库溴铵联合用药的患者神经肌肉阻滞作用持续时间（53.9 ± 9.7分钟）明显长于单独使用阿曲库铵（41.1 ± 3.8分钟）或单独使用维库溴铵（43.5 ± 9.2分钟）（P = 0.000）。在起效时间（维库溴铵[198.1 ± 34.9秒]、阿曲库铵[188.5 ± 50.6秒]或阿曲库铵 - 维库溴铵联合用药[196.3 ± 46.3秒][P = 0.829]）、肌肉松弛效应恢复时间（维库溴铵[559.9 ± 216.2秒]、阿曲库铵[584.7 ± 258.3秒]和阿曲库铵 - 维库溴铵联合用药[555.0 ± 205.4秒][P = 0.925]）以及插管条件质量（维库溴铵组[9.6 ± 1.3]；阿曲库铵组[10.0 ± 0.0]；阿曲库铵 - 维库溴铵联合组[10.0 ± 0.0][P = 0.182]）方面未发现差异。
阿曲库铵 - 维库溴铵联合用药的协同效应可使腹腔镜胆囊切除术中深度神经肌肉阻滞的作用持续时间延长，且不影响起效时间、插管条件质量和肌肉松弛效应的恢复。
