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评估急诊手术中改良快速顺序诱导插管时米库氯铵的最佳剂量:一项随机双盲试验

Assessing the Optimal Dose of Mivacurium for Modified Rapid Sequence Intubation in Emergency Surgical Settings: A Randomized, Double-Blind Trial.

作者信息

Moharam Saad Ahmed, Ahmed Ismail Mohamed Abdelgawad, Elgarhy Ahmed Mahmoud, Seyam Sameh Hamdy Abdelhamid, Almalki Mohammed Talal, Said ElSharkawy Mohammed

机构信息

Anesthesiology Unit, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Anesthesiology Unit, Intensive Care and Pain Management Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

出版信息

Anesth Pain Med. 2024 Nov 27;14(5):e153629. doi: 10.5812/aapm-153629. eCollection 2024 Oct.

Abstract

BACKGROUND

Modified rapid sequence intubation (RSI) is crucial in emergency surgery, particularly for patients with a full stomach, as it allows for the administration of general anesthesia (GA).

OBJECTIVES

This work aimed to evaluate mivacurium effectiveness and optimal dose in modified RSI.

METHODS

This randomized double-blind study involved 100 patients, aged between 20 - 60 years, of both sexes, with the American Society of Anesthesiologists physical status classification of I - III, who were undergoing emergency surgery under GA. Patients were randomized into two equal groups and received mivacurium in a dose of 0.3 mg/kg in group M1 or 0.4 mg/kg in group muscarinic-2 (M2).

RESULTS

Intubating conditions were significantly better in group M2 than in group M1. The onset of adequate muscle relaxation was significantly earlier in group M2 than in group M1 (P < 0.001). At the third minute, mean arterial blood pressure recordings were significantly lower in group M2 (P = 0.04) than in group M1. The recovery time was significantly longer in group M2 than in group M1 (P < 0.001).

CONCLUSIONS

Mivacurium in a 0.4 mg/kg dose resulted in more favorable intubating conditions during RSI and a more profound, earlier onset of muscle relaxation, but with a longer recovery time compared to the 0.3 mg/kg dose.

摘要

背景

改良快速顺序诱导插管(RSI)在急诊手术中至关重要,特别是对于饱胃患者,因为它允许实施全身麻醉(GA)。

目的

本研究旨在评估米库氯铵在改良RSI中的有效性和最佳剂量。

方法

这项随机双盲研究纳入了100例年龄在20至60岁之间、性别不限、美国麻醉医师协会身体状况分级为I - III级、正在接受全身麻醉下急诊手术的患者。患者被随机分为两组,M1组接受0.3mg/kg剂量的米库氯铵,M2组接受0.4mg/kg剂量的米库氯铵。

结果

M2组的插管条件明显优于M1组。M2组达到充分肌肉松弛的起效时间明显早于M1组(P < 0.001)。在第3分钟时,M2组的平均动脉血压记录明显低于M1组(P = 0.04)。M2组的恢复时间明显长于M1组(P < 0.001)。

结论

与0.3mg/kg剂量相比,0.4mg/kg剂量的米库氯铵在RSI期间导致更有利的插管条件和更深度、更早起效的肌肉松弛,但恢复时间更长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8dfb/11895783/c876b2941c17/aapm-14-5-153629-i001.jpg

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