Tobias J D
Department of Child Health, University of Missouri, Columbia 65212, USA.
Can J Anaesth. 1997 Jan;44(1):82-4. doi: 10.1007/BF03014329.
To report increase infusion requirements of cis-atracurium during prolonged infusion (six weeks) to provide neuromuscular blockade in a child during prolonged mechanical ventilation. Despite a previous study in adult patients which demonstrated no increase in infusion requirements over five days, we noted a considerable increase over six weeks.
A seven month old infant required prolonged mechanical ventilation and neuromuscular blockade following an episode of multi-system organ failure from pseudomembranous colitis. The infusion of cis-atracurium was adjusted according to the train-of-four response obtained with a peripheral nerve stimulator using standard train-of-four monitoring. Initial infusion requirements which were 2.8 micrograms.kg-1 min-1 on day #1 increased to 22.3 micrograms.kg-1 min-1 on day #40.
Increased infusion requirements were necessary during the prolonged administration of cis-atracurium to a critically ill infant. Titration of the dose based on monitoring with a peripheral nerve stimulator is recommended.
报告在一名儿童长时间机械通气期间，为提供神经肌肉阻滞作用，持续输注顺式阿曲库铵六周时输注需求量增加的情况。尽管之前一项针对成年患者的研究表明，五天内输注需求量没有增加，但我们注意到六周内需求量显著增加。
一名七个月大的婴儿在发生假膜性结肠炎导致多系统器官衰竭后，需要长时间机械通气和神经肌肉阻滞。使用标准的四个成串刺激监测，根据外周神经刺激器获得的四个成串刺激反应来调整顺式阿曲库铵的输注量。第1天初始输注需求量为2.8微克·千克⁻¹·分钟⁻¹，到第40天增加至22.3微克·千克⁻¹·分钟⁻¹。
对于危重症婴儿，长时间给予顺式阿曲库铵期间有必要增加输注需求量。建议根据外周神经刺激器监测结果滴定剂量。
