Kim Jong Ho, Park Sang Joon, Kwon Youngsuk, Hwang Sung Mi, Yang Hong Seuk
Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
Anesth Pain Med (Seoul). 2024 Oct;19(4):333-338. doi: 10.17085/apm.24064. Epub 2024 Oct 31.
A booster dose can result in a similar reaction to the initial dose. Neuromuscular blocking agents (NMBAs) can produce a comparable reaction in the absence of specific pathophysiologic alterations.
An initial dose of rocuronium 40 mg was given to a male patient (50 years old, height 168 cm, weight 54 kg, body mass index 19.13 kg/m2) for anesthesia. The onset was usual, but the duration was brief. Two booster doses were administered at 20 min intervals, but recovery came quickly. So, acute tolerance was suspected. Muscle function was restored to greater than train-of-four ratio 0.75 while spontaneous aided breathing was maintained without the need of further NMBAs. Following the operation, sugammadex (1.85 mg/kg) was provided to prevent residual neuromuscular inhibition.
Anesthetists must be able to suspect acute tolerance to NMBAs in patients with no unique medical history and have a plan to resolve it.
追加剂量可能会引发与初始剂量类似的反应。在不存在特定病理生理改变的情况下，神经肌肉阻滞剂（NMBAs）也可产生类似反应。
一名50岁男性患者（身高168厘米，体重54千克，体重指数19.13千克/平方米）接受麻醉时给予了40毫克罗库溴铵初始剂量。起效正常，但持续时间短暂。每隔20分钟给予两次追加剂量，但恢复迅速。因此，怀疑存在急性耐受性。肌肉功能恢复至四个成串刺激比值大于0.75，同时维持自主辅助呼吸，无需进一步使用NMBAs。术后，给予舒更葡糖钠（1.85毫克/千克）以预防残余神经肌肉抑制。
麻醉医生必须能够在无特殊病史的患者中怀疑对NMBAs的急性耐受性，并制定解决方案。
