Dailey P A, Fisher D M, Shnider S M, Baysinger C L, Shinohara Y, Miller R D, Abboud T K, Kim K C
Anesthesiology. 1984 Jun;60(6):569-74. doi: 10.1097/00000542-198406000-00009.
Vecuronium and pancuronium were compared for placental transfer, pharmacokinetic variables, and neonatal effects during cesarean section under general anesthesia. Eighteen women underwent rapid-sequence intravenous induction using d-tubocurarine, succinylcholine, thiopental, and oxygen. Immediately after tracheal intubation, an intravenous injection of vecuronium (n = 11) or pancuronium (n = 7), 0.04 mg/kg, was given. Maternal venous blood samples were obtained before induction and at frequent intervals for 4 h after administration of vecuronium or pancuronium. Also, maternal venous and umbilical-cord arterial and venous blood samples were obtained at delivery. To describe placental transfer and maternal pharmacokinetics of the drugs, serum drug concentrations were determined using single-ion-monitoring mass spectrometry. The Apgar score and Neurologic and Adaptive Capacity Score (NACS) were used to evaluate neonatal condition. Both drugs crossed the placenta, as demonstrated by low concentrations of vecuronium (8.5-26.4 ng/ml) or pancuronium (12.2-34.2 ng/ml) found in umbilical venous blood. At delivery, the ratio of the drug concentration in umbilical venous blood to that in maternal venous blood was 0.11 +/- 0.02 for vecuronium and 0.19 +/- 0.03 for pancuronium. Vecuronium had a more rapid clearance (6.4 +/- 0.4 ml X kg-1 X min-1, mean +/- SE) and a shorter elimination half-life (36 +/- 1.8 min) than pancuronium (3.0 +/- 0.1 ml X kg-1 X min-1 and 72 +/- 6 min, respectively). No other pharmacokinetic differences were found between the drugs. Neonatal outcome was not affected adversely by either muscle relaxant, as assessed by Apgar scores and NACSs . The short duration of action, the minimal placental transfer, and the apparent lack of clinical neuromuscular effects on the newborn suggest that vecuronium should be a useful muscle relaxant for cesarean section.
在全身麻醉下剖宫产过程中，比较了维库溴铵和泮库溴铵的胎盘转运、药代动力学变量及对新生儿的影响。18名妇女采用筒箭毒碱、琥珀酰胆碱、硫喷妥钠和氧气进行快速序贯静脉诱导。气管插管后立即静脉注射维库溴铵（n = 11）或泮库溴铵（n = 7），剂量为0.04 mg/kg。在诱导前以及给予维库溴铵或泮库溴铵后4小时内频繁采集母体静脉血样本。此外，在分娩时采集母体静脉血、脐动脉血和脐静脉血样本。为描述药物的胎盘转运和母体药代动力学，使用单离子监测质谱法测定血清药物浓度。采用阿氏评分和神经与适应能力评分（NACS）评估新生儿状况。脐静脉血中发现低浓度的维库溴铵（8.5 - 26.4 ng/ml）或泮库溴铵（12.2 - 34.2 ng/ml），证明两种药物均能穿过胎盘。分娩时，维库溴铵脐静脉血与母体静脉血药物浓度之比为0.11±0.02，泮库溴铵为0.19±0.03。维库溴铵的清除率（6.4±0.4 ml·kg⁻¹·min⁻¹，均值±标准误）比泮库溴铵（分别为3.0±0.1 ml·kg⁻¹·min⁻¹）更快，消除半衰期（36±1.8分钟）比泮库溴铵（72±6分钟）更短。两种药物在其他药代动力学方面未发现差异。根据阿氏评分和NACS评估，两种肌肉松弛剂均未对新生儿结局产生不良影响。作用时间短、胎盘转运极少以及对新生儿明显缺乏临床神经肌肉效应表明，维库溴铵应是剖宫产中一种有用的肌肉松弛剂。
