Fisher D M, Cronnelly R, Sharma M, Miller R D
Anesthesiology. 1984 Oct;61(4):428-33. doi: 10.1097/00000542-198410000-00011.
The dose-response relationship, onset, duration of action, atropine requirement, and pharmacokinetic variables of edrophonium were determined in infants and children during N2O-halothane anesthesia. The technique of steady state infusion of d-tubocurarine anesthesia. The technique of steady state infusion of d-tubocurarine (dTc) was used to determine the ED50 for edrophonium (i.e., the dose producing 50% antagonism of 90% neuromuscular depression) in 4 infants (145 micrograms/kg) and 12 children (233 microgram/kg). The reported values for ED50 for edrophonium (obtained under similar anesthetic conditions) is 128 micrograms/kg for adults. These three dose-response curves do not differ statistically; however, there was greater variability among infants and children than adults. Time to peak antagonism was similar for all three age groups. Duration of antagonism was determined in six infants and six children and did not differ from the reported value for adults. The optimal dose and time of administration of atropine were established by administering edrophonium (1 mg/kg) and atropine (10-20 micrograms/kg) to 24 infants and children. The smallest changes in heart rate and systolic blood pressure occurred when atropine (10 micrograms/kg) was given 30 s before edrophonium. The pharmacokinetics of edrophonium (1 mg/kg) were studied in four infants and four children and were compared with published values for adults: distribution and elimination half-lives and distribution volumes were similar for the three groups. Total clearance (ml.kg-1.min-1) was greatest for infants (17.8 +/- 1.2) compared with children (14.2 +/- 7.3) and adults (8.3 +/- 2.9). The authors conclude that the dose of edrophonium required toantagonize dTc-induced neuromuscular blockade is similar or possibly greater for infants and children than for adults.(ABSTRACT TRUNCATED AT 250 WORDS)
在氧化亚氮-氟烷麻醉期间，测定了婴儿和儿童体内依酚氯铵的剂量-反应关系、起效时间、作用持续时间、阿托品需求量及药代动力学变量。采用持续输注d-筒箭毒碱（dTc）维持麻醉的技术，测定了4例婴儿（145微克/千克）和12例儿童（233微克/千克）体内依酚氯铵的半数有效剂量（ED50），即产生90%神经肌肉阻滞中50%拮抗作用的剂量。依酚氯铵的ED50报告值（在相似麻醉条件下获得），成人为128微克/千克。这三条剂量-反应曲线无统计学差异；然而，婴儿和儿童组比成人组变异性更大。三个年龄组达到最大拮抗作用的时间相似。在6例婴儿和6例儿童中测定了拮抗作用的持续时间，与成人的报告值无差异。通过给24例婴儿和儿童注射依酚氯铵（1毫克/千克）和阿托品（10 - 20微克/千克），确定了阿托品的最佳剂量和给药时间。在依酚氯铵给药前30秒给予阿托品（10微克/千克）时，心率和收缩压的变化最小。在4例婴儿和4例儿童中研究了依酚氯铵（1毫克/千克）的药代动力学，并与已发表的成人值进行比较：三组的分布半衰期、消除半衰期和分布容积相似。婴儿的总清除率（毫升·千克-1·分钟-1）（17.8±1.2）最高，其次是儿童（14.2±7.3）和成人（8.3±2.9）。作者得出结论，拮抗dTc诱导的神经肌肉阻滞所需的依酚氯铵剂量，婴儿和儿童与成人相似或可能更高。（摘要截选至250词）
