Fülesdi Béla, Luterán Péter, Boktor Mena, Asztalos László, Nagy György, Brull Sorin J, Molnár Csilla
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4030 Debrecen, Hungary.
Edömér Tassonyi Neuromuscular Research Group, 4032 Debrecen, Hungary.
J Clin Med. 2025 Sep 13;14(18):6459. doi: 10.3390/jcm14186459.
There is little data available in infants on the extent to which inhalational anesthetics prolong the effects of neuromuscular blocking agents compared with intravenous agents. Here, we assessed the differences between the neuromuscular blocking effects (duration and recovery time) of a single dose of rocuronium during propofol vs. sevoflurane anesthesia. The prospective study enrolled 20 infants (4-12 months of age) scheduled for craniosynostosis surgery, randomly assigned to receive general anesthesia maintenance with sevoflurane or propofol. All patients received 0.6 mg/kg rocuronium as a single bolus dose to facilitate tracheal intubation and surgery. Primary study endpoint was the clinical duration of rocuronium, from administration until spontaneous recovery to a train-of-four ratio (TOFR) > 0.90. Secondary endpoints were times for reappearance of the first, second, third, and fourth twitches of the TOF (T1, T2, T3 and T4, respectively) in the two patient groups. There were no differences in the infants' age (sevoflurane maintenance: 5.8 ± 2.4 months; propofol maintenance: 6.7 ± 3.1 months, = 0.47) or weight (sevoflurane: 7722 ± 1644 g; propofol: 7433 ± 1782 g, = 0.71). Rocuronium onset time was 101.0 ± 55.0 s in the sevoflurane group and 83.4 ± 47.9 s in the propofol group ( = 0.46). Total duration of anesthesia was comparable in the sevoflurane (122.0 ± 23.8 min) and propofol (107.7 ± 25.2 min, = 0.18) groups. Rocuronium recovery to TOFR > 0.9 required 136 min (CI: 123.7-149.5 min) in the sevoflurane group and 61.5 min (CI: 58.0-101.0 min) in the propofol group ( < 0.001). In infants, sevoflurane maintenance enhances the neuromuscular blocking effect of a single, 0.6 mg/kg BW dose of rocuronium as compared to propofol maintenance. After discontinuation of sevoflurane, additional time is necessary to reach the acceptable TOFR >0.9 needed before tracheal extubation. The present study further underscores the importance of objective (quantitative) neuromuscular monitoring in infants to guide intraoperative management and prevent residual neuromuscular block.
与静脉麻醉药相比，关于吸入麻醉药延长婴儿神经肌肉阻滞剂作用程度的数据很少。在此，我们评估了在丙泊酚与七氟醚麻醉期间单剂量罗库溴铵的神经肌肉阻滞作用（持续时间和恢复时间）之间的差异。这项前瞻性研究纳入了20例计划进行颅缝早闭手术的婴儿（4 - 12个月龄），随机分配接受七氟醚或丙泊酚维持全身麻醉。所有患者均接受0.6mg/kg罗库溴铵单次推注剂量以利于气管插管和手术。主要研究终点是罗库溴铵的临床持续时间，从给药直至自发恢复至四个成串刺激比值（TOFR）>0.90。次要终点是两组患者四个成串刺激（TOF）的第一、第二、第三和第四个颤搐（分别为T1、T2、T3和T4）再次出现的时间。两组婴儿的年龄（七氟醚维持组：5.8±2.4个月；丙泊酚维持组：6.7±3.1个月，P = 0.47）或体重（七氟醚组：7722±1644g；丙泊酚组：7433±1782g，P = 0.71）无差异。七氟醚组罗库溴铵起效时间为101.0±55.0秒，丙泊酚组为83.4±47.9秒（P = 0.46）。七氟醚组（122.0±23.8分钟）和丙泊酚组（107.7±25.2分钟，P = 0.18）的总麻醉持续时间相当。七氟醚组罗库溴铵恢复至TOFR>0.9需要136分钟（CI：123.7 - 149.5分钟），丙泊酚组为61.5分钟（CI：58.0 - 101.0分钟）（P<0.001）。在婴儿中，与丙泊酚维持相比，七氟醚维持增强了单剂量0.6mg/kg体重罗库溴铵的神经肌肉阻滞作用。停用七氟醚后，需要额外时间才能达到气管拔管前可接受的TOFR>0.9。本研究进一步强调了在婴儿中进行客观（定量）神经肌肉监测以指导术中管理和预防残余神经肌肉阻滞的重要性。
