Magorian T, Flannery K B, Miller R D
Department of Anesthesia, University of California, San Francisco 94115.
Anesthesiology. 1993 Nov;79(5):913-8. doi: 10.1097/00000542-199311000-00007.
Succinylcholine has been the agent of choice when clinical conditions require emergency airway protection during a rapid-sequence induction of anesthesia. Rocuronium, a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reactions associated with succinylcholine, may be an alternative to succinylcholine. To test this hypothesis, the authors compared rocuronium with succinylcholine and vecuronium for rapid-sequence induction of anesthesia.
Fifty patients, ASA 1-3, were randomly designated to receive one of three intravenous doses of rocuronium (0.6, 0.9, and 1.2 mg/kg), vecuronium (0.1 mg/kg), or succinylcholine (1.0 mg/kg). Patients were premedicated with midazolam and fentanyl, and received 2-7 mg/kg thiopental for induction of anesthesia. Sixty seconds after receiving a muscle relaxant, intubation of the trachea was attempted by a clinician who was blinded to the muscle relaxant administered. Neuromuscular monitoring was established before administration of the muscle relaxant. The time from injection of muscle relaxant until complete ablation of T1 (onset) and recovery of T1 to 25% (duration) were recorded. Tracheal intubating conditions were evaluated, and the presence or absence of fasciculations was noted.
Onset times for patients receiving 0.9 mg/kg (75 +/- 28 s) and 1.2 mg/kg rocuronium (55 +/- 14 s), and succinylcholine (50 +/- 17 s) were similar. Onset times for the groups given 0.6 mg/kg rocuronium (89 +/- 33 s) and vecuronium (144 +/- 39 s) were significantly longer. Clinical duration of action was longest with 1.2 mg/kg rocuronium, similar with 0.6 and 0.9 mg/kg rocuronium, and vecuronium, and least with succinylcholine.
There is a dose-dependent decrease in onset time with rocuronium. The onset times for the two larger doses of rocuronium were similar to that for succinylcholine, but clinical duration of action with rocuronium was significantly longer. The brief onset time achieved with rocuronium indicates that administration of 0.9-1.2 mg/kg is an acceptable alternative to succinylcholine for rapid-sequence induction of anesthesia.
当临床情况需要在快速顺序诱导麻醉期间进行紧急气道保护时，琥珀酰胆碱一直是首选药物。罗库溴铵是一种起效迅速的新型非去极化肌松药，且无琥珀酰胆碱相关的不良反应，可能是琥珀酰胆碱的替代药物。为验证这一假设，作者将罗库溴铵与琥珀酰胆碱和维库溴铵用于快速顺序诱导麻醉进行了比较。
50例ASA 1 - 3级患者被随机指定接受三种静脉剂量之一的罗库溴铵（0.6、0.9和1.2mg/kg）、维库溴铵（0.1mg/kg）或琥珀酰胆碱（1.0mg/kg）。患者术前用咪达唑仑和芬太尼进行预处理，并接受2 - 7mg/kg硫喷妥钠诱导麻醉。在接受肌松药60秒后，由一名对所给予的肌松药不知情的临床医生尝试进行气管插管。在给予肌松药前建立神经肌肉监测。记录从注射肌松药到T1完全消失（起效时间）以及T1恢复到25%（持续时间）的时间。评估气管插管条件，并记录是否存在肌束震颤。
接受0.9mg/kg（75±28秒）和1.2mg/kg罗库溴铵（55±14秒）以及琥珀酰胆碱（50±17秒）的患者起效时间相似。给予0.6mg/kg罗库溴铵（89±33秒）和维库溴铵（144±39秒）的组起效时间明显更长。1.2mg/kg罗库溴铵的临床作用持续时间最长，0.6和0.9mg/kg罗库溴铵以及维库溴铵相似，琥珀酰胆碱最短。
罗库溴铵的起效时间呈剂量依赖性缩短。两种较大剂量罗库溴铵的起效时间与琥珀酰胆碱相似，但罗库溴铵的临床作用持续时间明显更长。罗库溴铵实现的短暂起效时间表明，给予0.9 - 1.2mg/kg可作为琥珀酰胆碱用于快速顺序诱导麻醉的可接受替代方案。
