Abdulatif M, Hegazy M
Department of Anaesthesia, Faculty of Medicine, Cairo University, Egypt.
Br J Anaesth. 1994 Jun;72(6):650-3. doi: 10.1093/bja/72.6.650.
We have tested the hypothesis that isoflurane potentiates non-depolarizing neuromuscular block via an increase in muscle blood flow. Anaesthesia was induced with thiopentone 4-5 mg kg-1 in 30 adult male patients of ASA physical status I or II and was maintained with 70% nitrous oxide in oxygen supplemented with either a bolus dose of fentanyl 4 micrograms kg-1 followed by an infusion of 1 microgram kg-1 h-1 (balanced anaesthesia group, n = 15) or 1.1% end-tidal isoflurane (isoflurane group, n = 15). Vecuronium 0.1 mg kg-1 was given for neuromuscular block. The force of contraction of the adductor pollicis of the thumb in response to ulnar nerve stimulation was recorded. Thenar muscle blood flow was measured continuously with a laser Doppler flowmeter. Times required for the first twitch in the train-of-four (T1) to recover to 25%, 75% and 90% of its control value were mean 26.3 (SD 5), 35.3 (10), 43.5 (7) min and 39.2 (15), 53 (12.5), 61.2 (10) min in the balanced anaesthesia and isoflurane groups, respectively (P < 0.01). Recovery index (time between T1 25% and 75%) was prolonged significantly in the isoflurane group. Administration of thiopentone significantly increased thenar muscle blood flow from 2.6 (1.9) and 2.2 (1.5) ml min-1/100 g to 19.2 (14) and 21.7 (16) ml min-1/100 g in the balanced anaesthesia and isoflurane groups, respectively (P < 0.001). The addition of fentanyl (balanced) or isoflurane to the anaesthetic mixture produced further increases in thenar muscle blood flow to reach, respectively, 26.2 (16) and 26.8 (13.6) ml min-1/100 g during steady state anaesthesia. Thenar muscle blood flow was comparable in the two groups throughout the study. We conclude that isoflurane prolonged vecuronium-induced neuromuscular block. This prolongation was not related primarily to increase in muscle blood flow.
我们检验了异氟烷通过增加肌肉血流量来增强非去极化神经肌肉阻滞作用的假说。对30例ASA身体状况为I或II级的成年男性患者，静脉注射硫喷妥钠4 - 5mg/kg诱导麻醉，并采用以下方式维持麻醉：一组为平衡麻醉组（n = 15），吸入70%氧化亚氮和氧气，并静脉注射芬太尼4μg/kg，随后以1μg/kg·h⁻¹的速度持续输注；另一组为异氟烷组（n = 15），吸入1.1%的异氟烷终末潮气浓度。给予维库溴铵0.1mg/kg以产生神经肌肉阻滞。记录拇指内收肌对尺神经刺激的收缩力。用激光多普勒血流仪连续测量大鱼际肌血流量。四个成串刺激（T1）中第一个颤搐恢复至其对照值25%、75%和90%所需的时间，平衡麻醉组分别为平均26.3（标准差5）、35.3（10）、43.5（7）分钟，异氟烷组分别为39.2（15）、53（12.5）、61.2（10）分钟（P < 0.01）。异氟烷组的恢复指数（T1 25%至75%之间的时间）显著延长。硫喷妥钠的给药使平衡麻醉组和异氟烷组的大鱼际肌血流量分别从2.6（1.9）和2.2（1.5）ml·min⁻¹/100g显著增加至19.2（14）和21.7（16）ml·min⁻¹/100g（P < 0.001）。在麻醉混合液中加入芬太尼（平衡麻醉组）或异氟烷，使稳态麻醉期间大鱼际肌血流量进一步增加，分别达到26.2（16）和26.8（13.6）ml·min⁻¹/100g。在整个研究过程中，两组的大鱼际肌血流量相当。我们得出结论，异氟烷延长了维库溴铵诱导的神经肌肉阻滞。这种延长主要与肌肉血流量增加无关。
