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[神经肌肉监测在神经放射学诊断麻醉期间的重要性]

[The importance of neuromuscular monitoring during anesthesia for neuroradiologic diagnosis].

作者信息

Schönstedt R, Böhrer H

机构信息

Klinik für Anästhesiologie, Ruprecht-Karls-Universität Heidelberg.

出版信息

Anaesthesiol Reanim. 1993;18(2):53-6.

PMID:8397672
Abstract

Muscle relaxants are essential in anaesthesia for neuroradiological diagnosis. In addition, neurosurgical and neurological patients often face, because of their basic illness, respiratory danger, which can increase postoperatively through the use of muscle relaxants during anaesthesia. Because of their pharmacodynamic properties and side-effects, muscle relaxants must be clearly differentiated from one another and used selectively for the different phases of anaesthesia-intubation, calmness during examination and recovery from neuromuscular block with extubation. During planned extubation in particular, no residual relaxation or danger of recurarization must exist during the recovery stage from neuromuscular block. For investigations with planned extubation, only the muscle relaxants atracurium and vecuronium with their medium-long effect should be applied. A high degree of safety is provided by neuromuscular block and especially in the recovery phase. Using relaxometers it is possible to determine individual relaxant requirements, avoid under- and overdoses, carry out an antagonism at the correct time and prevent residual relaxation situations so that respiratory insufficiency can be reliably excluded.

摘要

肌肉松弛剂在神经放射学诊断麻醉中至关重要。此外,神经外科和神经内科患者由于其基础疾病,常面临呼吸风险,而麻醉期间使用肌肉松弛剂会使术后呼吸风险增加。由于其药效学特性和副作用,必须明确区分不同的肌肉松弛剂,并根据麻醉的不同阶段——插管、检查时的平静状态以及神经肌肉阻滞恢复和拔管过程,有选择地使用。特别是在计划拔管时,神经肌肉阻滞恢复阶段不能存在残余松弛或再箭毒化的风险。对于计划拔管的检查,仅应使用中长效的肌肉松弛剂阿曲库铵和维库溴铵。神经肌肉阻滞尤其是在恢复阶段可提供高度安全性。使用松弛计能够确定个体对松弛剂的需求,避免用药不足和过量,在正确时间进行拮抗,并防止出现残余松弛情况,从而可靠地排除呼吸功能不全。

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