Snoek Merel A J, van Lemmen Maarten A, van der Schrier Rutger, van Velzen Monique, Dahan Albert, Boon Martijn
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
MediD Consultancy Group, Amsterdam, The Netherlands; Centre for Human Drug Research, Leiden, The Netherlands; Outcomes Research Consortium, Houston, Texas.
Anesthesiology. 2025 Oct 1;143(4):873-882. doi: 10.1097/ALN.0000000000005650. Epub 2025 Jul 11.
Neuromuscular blocking agents inhibit the peripheral chemoreflex. This study examined the effect of 2 and 4 mg/kg sugammadex compared to spontaneous recovery of neuromuscular block on the recovery of the acute hypoxic ventilatory response (AHVR).
This was a two-experiment, randomized, controlled trial in healthy volunteers. Participants received a continuous infusion of rocuronium, to achieve stable symptoms of neuromuscular block in the head and neck region (symptomatic neuromuscular block). Thereafter, neuromuscular block was allowed to recover spontaneously in the first experiment, while in experiment 2, volunteers were randomized to receive 2 mg/kg or 4 mg/kg sugammadex for reversal. The depth of neuromuscular block was assessed with electromyography at the adductor pollicis muscle. AHVR was measured at baseline, during stable neuromuscular block, and at 0, 20, and 40 min after recovery.
A total of 37 volunteers were enrolled; data from 27 volunteers were eligible for analysis. AHVR was reduced by 32% (mean difference vs. baseline, -0.22 l · % -1 · min -1 ; 95% CI, -0.32 to -0.12) during symptomatic neuromuscular block (mean train-of-four ratio, 0.42 ± 0.22;). At the disappearance of all symptoms, AHVR remained on average depressed by 23% (mean difference, -0.16 l · % -1 · min -1 ; 95% CI, -0.28 to -0.04). In 57% of volunteers after spontaneous recovery versus 28% after sugammadex reversal, AHVR did not return to baseline values during the measurement period. In addition, the magnitude of residual AHVR depression was greater after spontaneous recovery compared to reversal with sugammadex. However, on average AHVR was not significantly different from baseline at 20 and 40 min after recovery in any group.
The AHVR after reversal of a minimal neuromuscular block with sugammadex did not significantly differ with spontaneous recovery of neuromuscular block. However, fewer patients had residual depression of AHVR when sugammadex was used. In all groups, a considerable proportion of patients had residual depression of the AHVR 40 min after recovery.
神经肌肉阻滞剂会抑制外周化学反射。本研究比较了2mg/kg和4mg/kg舒更葡糖与神经肌肉阻滞自发恢复相比，对急性低氧通气反应（AHVR）恢复的影响。
这是一项针对健康志愿者的两阶段随机对照试验。参与者接受罗库溴铵持续输注，以在头颈部区域实现稳定的神经肌肉阻滞症状（有症状的神经肌肉阻滞）。此后，在第一个实验中让神经肌肉阻滞自发恢复，而在实验2中，志愿者被随机分组接受2mg/kg或4mg/kg舒更葡糖进行逆转。通过拇收肌肌电图评估神经肌肉阻滞的深度。在基线、稳定的神经肌肉阻滞期间以及恢复后0、20和40分钟测量AHVR。
共招募了37名志愿者；27名志愿者的数据符合分析条件。在有症状的神经肌肉阻滞期间（平均四个成串刺激比值为0.42±0.22），AHVR降低了32%（与基线相比的平均差值为-0.22 l·% -1·min -1；95%CI为-0.32至-0.12）。在所有症状消失时，AHVR平均仍降低23%（平均差值为-0.16 l·% -1·min -1；95%CI为-0.28至-0.04）。在自发恢复后的志愿者中，57%的人在测量期间AHVR未恢复到基线值，而在舒更葡糖逆转后的志愿者中这一比例为28%。此外，与舒更葡糖逆转相比，自发恢复后AHVR残留降低的幅度更大。然而，在任何组中，恢复后20和40分钟时AHVR平均与基线无显著差异。
用舒更葡糖逆转最小程度的神经肌肉阻滞后的AHVR与神经肌肉阻滞自发恢复相比无显著差异。然而，使用舒更葡糖时AHVR残留降低的患者较少。在所有组中，相当一部分患者在恢复后40分钟时AHVR仍有残留降低。
