年轻和老年成年人中米库氯铵的持续输注

Goudsouzian N, Chakravorti S, Denman W, Schwartz A, Yang H S, Cook D R

Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.

Can J Anaesth. 1997 Sep;44(9):955-62. doi: 10.1007/BF03011967.

PURPOSE

This study was designed to evaluate pharmacodynamically and pharmacokinetically if the cis-cis isomer of mivacurium contributed to neuromuscular block during prolonged infusions lasting more than four hours in young adult and elderly (> 60 yr) patients.

METHODS

The mechanomyogramic neuromuscular response of the adductor pollicis was recorded in 32 adults 18-59 yr. and 19 elderly (> 60 yr.) patients during N2O:O2:opioid anaesthesia. The mivacurium infusion rate was adjusted to maintain single twitch depression at 95 +/- 4% of control. Blood samples were taken every 30 min to determine the plasma concentration of cis-cis isomer of mivacurium. At the end of the surgical procedure, patients were allowed to recover spontaneously to at least 25% of control twitch response.

RESULTS

The mean mivacurium infusion requirement to maintain 97 +/- 1 (mean +/- SD)% depression of the twitch response was 6.0 +/- 0.4 micrograms.kg-1.min-1 in young adults, and 4.3 +/- 0.3 micrograms.kg-1.min-1 in elderly patients (P < 0.001). The infusion requirement in patients with low plasma cholinesterase activity was the lowest 2.4 +/- 1.2 micrograms.kg-1.min-1. Plasma cis-cis isomer concentrations reached peak levels within one-two hours and remained relatively constant throughout the duration of infusion even in patients with low cholinesterase activity. There was no relationship between duration of infusion, plasma concentrations of cis-cis isomer and the early recovery indices of mivacurium (up to 25%). Neuromuscular transmission recovered adequately with or without antagonism in all patients.

CONCLUSION

When the mivacurium infusion was titrated to maintain 95 +/- 4% twitch depression, the plasma concentration of the cis-cis isomer did not increase during prolonged infusions (four hours) and neuromuscular transmission recovers satisfactorily.

目的

本研究旨在从药效学和药代动力学方面评估，在年轻成人和老年（>60岁）患者持续输注超过4小时的过程中，米库氯铵的顺 - 顺异构体是否会导致神经肌肉阻滞。

方法

在32名18 - 59岁的成人和19名老年（>60岁）患者接受氧化亚氮：氧气：阿片类麻醉期间，记录拇内收肌的机械肌电图神经肌肉反应。调整米库氯铵的输注速率，以维持单次颤搐抑制在对照值的95±4%。每30分钟采集血样，以测定米库氯铵顺 - 顺异构体的血浆浓度。手术结束时，让患者自发恢复至至少对照颤搐反应的25%。

结果

维持颤搐反应抑制在97±1（均值±标准差）%时，年轻成人米库氯铵的平均输注需求量为6.0±0.4微克·千克⁻¹·分钟⁻¹，老年患者为4.3±0.3微克·千克⁻¹·分钟⁻¹（P<0.001）。血浆胆碱酯酶活性低的患者输注需求量最低，为2.4±1.2微克·千克⁻¹·分钟⁻¹。血浆顺 - 顺异构体浓度在1 - 2小时内达到峰值水平，并且在整个输注期间保持相对恒定，即使是胆碱酯酶活性低的患者。输注持续时间、顺 - 顺异构体血浆浓度与米库氯铵的早期恢复指标（至25%）之间没有关系。所有患者无论是否使用拮抗剂，神经肌肉传递均充分恢复。