Plaud B, Debaene B, Lequeau F, Meistelman C, Donati F
Department of Anesthesia, Institut Gustave Roussy, Villejuif, France.
Anesthesiology. 1996 Jul;85(1):77-81. doi: 10.1097/00000542-199607000-00011.
Laryngeal muscles must be paralyzed for tracheal intubation. Time to peak effect (onset time) is shorter and intensity of blockade is less at laryngeal muscles compared with the adductor pollicis. The authors' aim in this study was to determine the neuromuscular effects of mivacurium at the laryngeal adductor muscles and the adductor pollicis.
In 22 adults, anesthesia was induced and maintained with propofol and alfentanil. The force of contraction of the adductor pollicis was recorded, and the laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords after train-of-four stimulation. Mivacurium (0.07 mg.kg-1 or 0.14 mg.kg-1) was given intravenously (10s).
With 0.07 mg.kg-1 mivacurium, onset time was 151 +/- 40 s(mean +/- SD) at the larynx and 241 +/- 79 s at the adductor pollicis, respectively (P < 0.005). Maximum block was 78 +/- 18% and 95 +/- 8%, respectively (P < 0.002), and time to 90% recovery was 11.1 +/- 2.9 min and 23.3 +/- 7.6 min, respectively (P < 0.001). With 0.14 mg.kg-1 mivacurium, onset time also was more rapid at the vocal cords (137 +/- 20 s) than at the adductor pollicis (201 +/- 59 s, P < 0.01). Maximum block was 90 +/- 7% and 99 +/- 1% (P < 0.005), and time to 90% recovery was 16.4 +/- 4.9 min and 27.4 +/- 7.8 min, respectively (P < 0.01).
With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.
气管插管时必须使喉肌麻痹。与拇内收肌相比，喉肌达到最大效应的时间（起效时间）更短，且阻滞强度更小。本研究作者的目的是确定米库氯铵对喉内收肌和拇内收肌的神经肌肉效应。
对22名成年人，采用丙泊酚和阿芬太尼诱导并维持麻醉。记录拇内收肌的收缩力，并在四个成串刺激后，通过测量置于声带之间的气管导管套囊内的压力变化来评估喉部反应。静脉注射米库氯铵（0.07mg·kg-1或0.14mg·kg-1）（10秒）。
给予0.07mg·kg-1米库氯铵时，喉部起效时间为151±40秒（均值±标准差），拇内收肌为241±79秒（P<0.005）。最大阻滞分别为78±18%和95±8%（P<0.002），恢复至90%的时间分别为11.1±2.9分钟和23.3±7.6分钟（P<0.001）。给予0.14mg·kg-1米库氯铵时，声带的起效时间（137±20秒）也比拇内收肌更快（201±59秒，P<0.01）。最大阻滞分别为90±7%和99±1%（P<0.005），恢复至90%的时间分别为16.4±4.9分钟和27.4±7.8分钟（P<0.01）。
使用米库氯铵时，喉肌的起效和恢复更快，但阻滞强度小于拇内收肌。需要大于0.14mg·kg-1的米库氯铵剂量才能确保声带完全松弛。
