Kirkegaard-Nielsen H, Helbo-Hansen H S, Lindholm P, Severinsen I K, Pedersen H S, Jensen E W
Department of Anaesthesia and Intensive Care, Odense University Hospital, Denmark.
Can J Anaesth. 1996 Sep;43(9):932-8. doi: 10.1007/BF03011807.
The aim of the study was to determine the optimum time for administration of neostigmine during recovery from atracurium-induced neuromuscular blockade.
The study comprised 103 patients anaesthetised with midazolam, fentanyl, thiopentone, halothane, and nitrous oxide. Relaxation was induced with atracurium 0.5 mg. kg-1 and maintained with supplements of 0.15 mg. kg-1. The ulnar nerve was stimulated with train-of-four (TOF) and double burst stimulation (DBS). Evoked MMG responses were recorded. Patients were randomized to spontaneous recovery (n = 20) or to assisted recovery by neostigmine (0.07 mg.kg-1) at varying intervals (6-50 min) from the last atracurium dose (n = 83).
The reversal time (time from administration of neostigmine to TOF ratio 0.7) was always < 13 min, when T1 (first twitch in TOF) was detectable or when D1 (first twitch in DBS) was > 5%. Total assisted recovery time (time from last supplemental atracurium dose to TOF ratio 0.7) increased with increasing T1 and D1 twitch heights (P < 0.05). The curve fitted to the scattergram with total assisted recovery time vs time from last atracurium supplement to neostigmine administration decreased to reach a minimum after which it increased to approach the line of identity. The minimum of the curve (total assisted recovery time 30.7 min) was reached when neostigmine was given 18.6 min after last atracurium supplement. At this time the T1 and D1 twitch height averaged 4 and 8% respectively. If prolongation of the minimum total recovery time of 2.5% is accepted, neostigmine can be given at T1 and D1 twitch height values of 0 to 8% and 4 to 15%, respectively.
The optimum time for neostigmine administration, taking both the reversal time and total recovery time into consideration, is when 0 < T1 < 8% or when 5 < D1 < 15%. Giving neostigmine at more profound degrees of blockade prolongs reversal time, while giving neostigmine later in the recovery phase prolongs total recovery time.
本研究旨在确定阿曲库铵诱导的神经肌肉阻滞恢复过程中使用新斯的明的最佳给药时间。
本研究纳入了103例接受咪达唑仑、芬太尼、硫喷妥钠、氟烷和氧化亚氮麻醉的患者。用0.5mg·kg-1阿曲库铵诱导肌肉松弛,并以0.15mg·kg-1补充维持。用四个成串刺激(TOF)和双重爆发刺激(DBS)刺激尺神经。记录诱发的肌电图反应。患者被随机分为自主恢复组(n = 20)或在末次阿曲库铵给药后不同间隔时间(6 - 50分钟)给予新斯的明(0.07mg·kg-1)辅助恢复组(n = 83)。
当可检测到T1(TOF中的第一个抽搐)或D1(DBS中的第一个抽搐)> 5%时,逆转时间(从给予新斯的明到TOF比值0.7的时间)始终< 13分钟。总辅助恢复时间(从末次补充阿曲库铵剂量到TOF比值0.7的时间)随着T1和D1抽搐高度的增加而增加(P < 0.05)。将总辅助恢复时间与从末次阿曲库铵补充到给予新斯的明的时间绘制散点图,拟合的曲线先下降至最低点,之后又上升接近恒等线。在末次阿曲库铵补充后18.6分钟给予新斯的明时达到曲线最低点(总辅助恢复时间30.7分钟)。此时T1和D1抽搐高度平均分别为4%和8%。如果接受总恢复时间最小值延长2.5%,则新斯的明可分别在T1和D1抽搐高度值为0至8%和4至15%时给予。
综合考虑逆转时间和总恢复时间,新斯的明的最佳给药时间是0 < T1 < 8%或5 < D1 < 15%时。在更深程度的阻滞时给予新斯的明会延长逆转时间,而在恢复阶段较晚时给予新斯的明会延长总恢复时间。