Ballantyne J C, Chang Y
Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
Anesth Analg. 1997 Sep;85(3):476-82. doi: 10.1097/00000539-199709000-00002.
To test the hypothesis that the use of long-acting muscle relaxants is associated with prolonged postoperative recovery when compared with the use of shorter-acting relaxants, we undertook a retrospective study of 270 patients with induced paralysis recovering from general anesthesia. We calculated the mean recovery time associated with each muscle relaxant used. Regression analyses were performed to control for potential confounding of the results by length and type of surgery, as well as age and sex. Taking these into account, the adjusted difference in mean recovery time between patients receiving short- and intermediate-acting relaxants (mivacurium, atracurium, and vecuronium) versus those receiving long-acting relaxants (d-tubocurarine, pancuronium, and pancuronium and d-tubocurarine combination) was 30 min (95% confidence interval [CI] 8-53). The adjusted difference in mean recovery time between patients receiving vecuronium and those receiving pancuronium (i.e., the single most frequently used drug in each category) was 33 min (95% CI 1-66). Shortened recovery time accounted for an estimated average $37.95 decrease in recovery room charge per patient when vecuronium was used instead of pancuronium, versus a $22.84 increase in drug cost. Our data and analyses support the hypothesis that the use of long-acting muscle relaxants is associated with prolonged recovery after surgery and provide preliminary evidence that restricting the use of the more expensive, shorter-acting muscle relaxants may represent a false economy.
In this retrospective study, the use of old-fashioned, inexpensive, long-acting paralyzing drugs was found to be associated with prolonged postoperative recovery. This has implications when deciding whether, as an economic measure, to restrict the use of the more expensive, shorter-acting paralyzing drugs, because prolonged recovery also has a price.
为验证与使用短效肌松药相比，使用长效肌松药会导致术后恢复时间延长这一假说，我们对270例全麻诱导麻痹后恢复的患者进行了一项回顾性研究。我们计算了每种使用的肌松药相关的平均恢复时间。进行回归分析以控制手术时长和类型、年龄及性别对结果可能产生的混杂影响。考虑到这些因素，接受短效和中效肌松药（米库氯铵、阿曲库铵和维库溴铵）的患者与接受长效肌松药（筒箭毒碱、泮库溴铵以及泮库溴铵与筒箭毒碱联合用药）的患者在平均恢复时间上的调整差异为30分钟（95%置信区间[CI] 8 - 53）。接受维库溴铵的患者与接受泮库溴铵的患者（即每类中最常用的单一药物）在平均恢复时间上的调整差异为33分钟（95% CI 1 - 66）。当使用维库溴铵而非泮库溴铵时，恢复时间缩短估计每位患者的恢复室费用平均降低37.95美元，而药物成本增加22.84美元。我们的数据和分析支持了使用长效肌松药与术后恢复时间延长相关这一假说，并提供了初步证据表明限制使用更昂贵的短效肌松药可能是一种错误的节省开支方式。
在这项回顾性研究中，发现使用老式、便宜的长效麻痹药物与术后恢复时间延长相关。这对于决定是否作为一项经济措施限制使用更昂贵的短效麻痹药物具有启示意义，因为恢复时间延长也是有代价的。
