Plaud B, Laffon M, Ecoffey C, Meistelman C
Service d'Anesthésie-Réanimation Chirurgicale 2, Hôpital Pontchaillou, Rennes, France.
Can J Anaesth. 1997 Jul;44(7):712-6. doi: 10.1007/BF03013383.
The aim of the study was to compare visual estimation of onset of neuromuscular blockade at both the adductor pollicis (AP) and the orbicularis oculi (OO) in children and to determine if monitoring the OO could predict good intubating conditions during vecuronium-induced neuromuscular blockade.
Thirty ASAI--II children (1.5-9 yr) were studied. Anaesthesia was induced with 6-8 mg.kg-1 thiopentone. The ulnar nerve at the wrist and the temporal branch of the facial nerve were stimulated every 10 sec using train-of-four (TOF) stimuli. Vecuronium, 0.15 mg.kg-1, was administered as a bolus. The responses at both the OO and the AP were evaluated visually. Patients were randomly divided into two groups. In the AP group (n = 15), the trachea was intubated when the AP was completely blocked. In the OO group (n = 15), intubation was performed when the OO was completely blocked. Intubating conditions were scored on a scale of 1 to 4.
All the patients had complete blockade at both the orbicularis oculi and the adductor pollicis. In the two group, time from injection of vecuronium to complete neuromuscular blockade was shorter at the orbicularis oculi than at the adductor pollicis, 1.5 +/- 0.5 min vs 2.3 +/- 0.7 min, respectively, (P < 0.05; mean +/- SD) in the AP group, 1.7 +/- 0.3 min vs 2.3 +/- 0.8 min, respectively in the OO group (P < 0.05). Intubating conditions were excellent in all patient except one, where it was rated as good. They did not differ between groups.
Following administration of 0.15 mg.kg-1 vecuronium in children, monitoring of the OO can detect good intubating conditions 0.7 min earlier than with monitoring of the AP.
本研究旨在比较儿童拇内收肌（AP）和眼轮匝肌（OO）神经肌肉阻滞起效的视觉评估，并确定监测眼轮匝肌是否能预测维库溴铵诱导的神经肌肉阻滞期间良好的插管条件。
研究了30例ASA I-II级儿童（1.5 - 9岁）。用6 - 8mg·kg-1硫喷妥钠诱导麻醉。每隔10秒使用四个成串刺激（TOF）刺激腕部尺神经和面神经颞支。静脉推注0.15mg·kg-1维库溴铵。对眼轮匝肌和拇内收肌的反应进行视觉评估。患者随机分为两组。在拇内收肌组（n = 15），当拇内收肌完全阻滞时进行气管插管。在眼轮匝肌组（n = 15），当眼轮匝肌完全阻滞时进行插管。插管条件按1至4分进行评分。
所有患者的眼轮匝肌和拇内收肌均完全阻滞。在两组中，维库溴铵注射至完全神经肌肉阻滞的时间在眼轮匝肌比拇内收肌短，在拇内收肌组分别为1.5±0.5分钟和2.3±0.7分钟（P < 0.05；均值±标准差），在眼轮匝肌组分别为1.7±0.3分钟和2.3±0.8分钟（P < 0.05）。除1例评为良好外，所有患者的插管条件均为优秀。两组之间无差异。
儿童静脉注射0.15mg·kg-1维库溴铵后，监测眼轮匝肌比监测拇内收肌能提前0.7分钟检测到良好的插管条件。
