Ohnishi Y, Uchida O, Nakajima T, Kitaguchi K, Takaki O, Ohsumi H, Kuro M
Department of Anesthesiology, National Cardiovascular Center, Suita.
Masui. 1993 Jul;42(7):995-1001.
In 31 patients undergoing coronary artery bypass grafting, we investigated the maintenance doses of pancuronium and vecuronium during hypothermic cardiopulmonary bypass. For all patients, the height of the first twitch of the train-of-four (T1) was measured with evoked electromyogram. During operation, T1 was kept from 5 to 15 per cent of control. Infusion doses of both muscle relaxants were controlled with a personal computer. During hypothermic cardiopulmonary bypass (body temperature 28 degrees C), requirement of both muscle relaxants decreased for about 90 per cent compared with pre bypass values. We consider that the prolongation of neuromuscular blockade is attributable to hypothermia rather than to other factors of cardiopulmonary bypass. After rewarming, maintenance dose of vecuronium remained about a half of the dose required in pre-bypass period. It suggests that elimination of vecuronium from liver and kidney is hindered not only during hypothermia but also after rewarming.
在31例行冠状动脉搭桥术的患者中,我们研究了低温体外循环期间泮库溴铵和维库溴铵的维持剂量。对所有患者,通过诱发肌电图测量四个成串刺激(T1)的第一次颤搐高度。手术期间,T1保持在对照值的5%至15%。两种肌肉松弛剂的输注剂量均由个人计算机控制。在低温体外循环(体温28℃)期间,与体外循环前的值相比,两种肌肉松弛剂的需求量均降低了约90%。我们认为神经肌肉阻滞的延长归因于低温而非体外循环的其他因素。复温后,维库溴铵的维持剂量约为体外循环前所需剂量的一半。这表明维库溴铵不仅在低温期间,而且在复温后从肝脏和肾脏的消除均受到阻碍。