Kaplan R F, Garcia M, Hannallah R S
Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010.
Can J Anaesth. 1995 Jan;42(1):16-20. doi: 10.1007/BF03010565.
The neuromuscular blocking effects of mivacurium during sevoflurane or halothane anaesthesia was studied in 38 paediatric patients aged 1-12 yr. All received premedication with midazolam, 0.5 mg.kg-1 po and an inhalational induction with up to 3 MAC of either agent in 70% N2O and O2. The ulnar nerve was stimulated at the wrist by a train-of-four stimulus every ten seconds and the force of adduction of the thumb recorded with a Myotrace force transducer. Anaesthesia was maintained with a one MAC end-tidal equivalent of either volatile agent for five minutes before patients received mivacurium (0.2 mg.kg-1) iv. The onset of maximal blockade occurred in 2.4 +/- 1.26 (mean +/- SD) min with halothane and 1.8 +/- 0.54 min with sevoflurane (NS). Four patients failed to achieve 100% block (3 halothane, 1 sevoflurane). The times from injection to 5, 75, and 95% recovery during sevoflurane (9.8 +/- 2.6, 19.5 +/- 4.4, and 24.2 +/- 4.8 min) were greater than during halothane anaesthesia (7.2 +/- 2.2, 15.0 +/- 4.0, 19.2 +/- 4.9 min, respectively (P < 0.005). All patients demonstrated complete spontaneous recovery of neuromuscular function (T1 > 95%, T4/T1 > 75%) during the surgery which lasted 24-63 min. All patients showed clinical signs of full recovery of neuromuscular blockade (i.e., headlift, gag, or cough). Pharmacological reversal was not required. It is concluded that following a single intubating dose of mivacurium, the time to maximum relaxation was not different during halothane and sevoflurane anaesthesia; recovery times to 5, 75 and 95% twitch height were longer during sevoflurane anaesthesia and neuromuscular reversal was not necessary.
在38例1至12岁的儿科患者中，研究了七氟醚或氟烷麻醉期间米库氯铵的神经肌肉阻滞作用。所有患者均接受咪达唑仑0.5mg·kg-1口服进行术前用药，并在70%氧化亚氮和氧气中使用高达3倍最低肺泡有效浓度（MAC）的上述任一药物进行吸入诱导。每隔10秒在手腕处用四个成串刺激刺激尺神经，并用肌动图力传感器记录拇指内收力。在患者静脉注射米库氯铵（0.2mg·kg-1）前，用相当于1倍MAC呼气末浓度的上述任一挥发性药物维持麻醉5分钟。使用氟烷时，最大阻滞起效时间为2.4±1.26（均值±标准差）分钟，使用七氟醚时为1.8±0.54分钟（无显著性差异）。4例患者未能达到100%阻滞（3例使用氟烷，1例使用七氟醚）。七氟醚麻醉期间从注射到恢复至5%、75%和95%的时间（分别为9.8±2.6、19.5±4.4和24.2±4.8分钟）长于氟烷麻醉期间（分别为7.2±2.2、15.0±4.0和19.2±4.9分钟，P<0.005）。所有患者在持续24至63分钟的手术过程中均表现出神经肌肉功能完全自发恢复（T1>95%，T4/T1>75%）。所有患者均表现出神经肌肉阻滞完全恢复的临床体征（即抬头、吞咽反射或咳嗽）。无需进行药物逆转。结论是，单次插管剂量的米库氯铵给药后，氟烷和七氟醚麻醉期间达到最大松弛的时间无差异；七氟醚麻醉期间恢复至5%、75%和95%抽搐高度的时间更长，且无需进行神经肌肉逆转。
