Trévien V, Lienhart A, Just B, Chandon M, Baras E, Camatte S
Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Paris, France.
Acta Anaesthesiol Scand Suppl. 1995;106:66-9. doi: 10.1111/j.1399-6576.1995.tb04314.x.
The effectiveness of neostigmine 40 micrograms/kg for antagonism of two different levels of neuromuscular blockade, induced by a bolus dose of mivacurium 0.15 mg/kg, was studied in 45 patients. The patients were anaesthetized with thiopentone, fentanyl, nitrous oxide in oxygen, and enflurane. Neostigmine was administered at either 10% recovery of the twitch height (TH10) at the adductor pollicis muscle (n = 14) or upon reappearance of the first response at the orbicularis oculi muscle (OO1) after train-of-four (TOF) stimulation (n = 16), the latter representing a deeper degree of neuromuscular blockade. Fifteen of the 45 patients did not receive neostigmine (control group). Neostigmine administration at OO1 rather than at TH10 at the adductor pollicis muscle caused reversal of neuromuscular blockade to occur 8 min earlier and shortened the time to reach 25% recovery of the twitch height (TH25) at the adductor pollicis muscle by about 5 min, compared with the control group. However, the time needed to reach a T4/T1 ratio > or = 0.8 was similar in both the early and late neostigmine administration groups, being 9 min faster than in the control group. It can be concluded that there is no advantage in administering neostigmine at profound neuromuscular blockade to achieve clinically adequate recovery (T4/T1 ratio > or = 0.8). However, the time between injection of mivacurium and TH25 may be shortened by using neostigmine at profound neuromuscular blockade, a procedure which may be useful in case of unpredictably difficult intubation, since diaphragmatic movements usually reappear at TH25.
在45例患者中研究了新斯的明40微克/千克对抗由单次静脉注射米库氯铵0.15毫克/千克诱导的两种不同程度神经肌肉阻滞的效果。患者用硫喷妥钠、芬太尼、氧化亚氮和恩氟烷进行麻醉。新斯的明在拇收肌肌颤搐高度恢复至10%（TH10）时给药（n = 14），或在四个成串刺激（TOF）后眼轮匝肌首次出现反应（OO1）时给药（n = 16），后者代表更深程度的神经肌肉阻滞。45例患者中有15例未接受新斯的明（对照组）。与对照组相比，在眼轮匝肌OO1时而非拇收肌TH10时给予新斯的明，神经肌肉阻滞的逆转提前8分钟出现，并且拇收肌肌颤搐高度恢复至25%（TH25）的时间缩短了约5分钟。然而，新斯的明早期给药组和晚期给药组达到T4/T1比值≥0.8所需的时间相似，比对照组快9分钟。可以得出结论，在深度神经肌肉阻滞时给予新斯的明以实现临床上足够的恢复（T4/T1比值≥0.8）并无优势。然而，在深度神经肌肉阻滞时使用新斯的明可缩短米库氯铵注射至TH25的时间，在插管不可预测地困难的情况下，这一方法可能有用，因为膈肌运动通常在TH25时重新出现。
