Helbo-Hansen H S, Jensen B, Nørreslet J, Kirkegaard-Nielsen H, de Haas I M
Department of Anaesthesia and Intensive Care, Odense University Hospital, Denmark.
Acta Anaesthesiol Scand. 1995 May;39(4):498-502. doi: 10.1111/j.1399-6576.1995.tb04107.x.
Disappearance of response to single twitch stimulation (STS) or train-of-four stimulation (TOF) of the ulnar nerve is insufficient as predictive guide for intubating conditions during onset of non-depolarizing neuromuscular block. Double burst stimulation (DBS) appears to be a more reliable indicator of the optimal time for intubation. In the present study, the disappearance of tactile detectable response to 0.1 Hz single twitch stimulation (STS) of the ulnar nerve was compared with disappearance of response to 0.1 Hz single burst stimulation (three stimuli at 50 Hz = SBS) as predictor for optimal intubating conditions during onset of block induced by 0.08 mg.kg-1 of vecuronium in 100 patients under light general anaesthesia where thiopentone was used as the sole anaesthetic. Intubation was performed immediately after disappearance of the twitch response. Likewise 0.05 Hz STS and 0.05 Hz SBS stimulation were compared under identical circumstances in another 100 patients. Intubating conditions were unacceptable in 10%, 14%, 8% and 10% of the patients in the 0.1 Hz STS, 0.1 Hz SBS, 0.05 Hz STS and 0.05 Hz SBS groups, respectively. There were no significant differences between the groups. In conclusion, neither absence of response to STS stimulation nor absence of response to SBS stimulation of the ulnar nerve at either 0.1 Hz or 0.05 Hz frequency does guarantee acceptable intubating conditions during onset of neuromuscular block induced by vecuronium 0.08 mg.kg-1 when thiopentone is used as the sole anaesthetic.
在非去极化神经肌肉阻滞起效期间，尺神经单刺激（STS）或四个成串刺激（TOF）反应消失，作为气管插管条件的预测指标并不充分。双爆发刺激（DBS）似乎是插管最佳时机更可靠的指标。在本研究中，比较了在100例使用硫喷妥钠作为唯一麻醉剂的浅全身麻醉患者中，尺神经0.1Hz单刺激（STS）触觉可检测反应消失与0.1Hz单爆发刺激（50Hz三个刺激=SBS）反应消失，作为维库溴铵0.08mg·kg-1诱导阻滞起效期间最佳插管条件的预测指标。抽搐反应消失后立即进行插管。同样，在另外100例患者相同情况下比较了0.05Hz STS和0.05Hz SBS刺激。在0.1Hz STS、0.1Hz SBS、0.05Hz STS和0.05Hz SBS组中，分别有10%、14%、8%和10%的患者插管条件不可接受。各组之间无显著差异。总之，当使用硫喷妥钠作为唯一麻醉剂时，在维库溴铵0.08mg·kg-1诱导神经肌肉阻滞起效期间，尺神经0.1Hz或0.05Hz频率下对STS刺激无反应或对SBS刺激无反应均不能保证可接受的插管条件。
