Naguib M, Samarkandi A H, Ammar A, Turkistani A
Department of Anaesthesia, King Saud University, Faculty of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Br J Anaesth. 1997 Oct;79(4):450-5. doi: 10.1093/bja/79.4.450.
The use of suxamethonium in children is associated with undesirable side effects. The synergistic effect of a rocuronium-mivacurium combination can be considered as an acceptable alternative to suxamethonium in clinical practice. The calculated ED50 of the rocuronium-mivacurium mixture was only 62% of the predicted value assuming a purely additive interaction. The use of this combination has not been evaluated in children. In this two-part study, we assessed the intubating conditions and pharmacodynamics of suxamethonium, rocuronium, mivacurium or a rocuronium-mivacurium combinations in children. We studied 120 ASA I children of both sexes, aged 3-10 yr. Children were premedicated with trimeprazine 2 mg kg-1 orally, and received fentanyl 2 micrograms kg-1 and propofol 2 mg kg-1 for induction of anaesthesia. They were allocated randomly to receive one of the following drugs or drug combinations: suxamethonium 1.0 mg kg-1, mivacurium 0.2 mg kg-1, rocuronium 0.6 or 0.9 mg kg-1, mivacurium 0.1 mg kg-1 with rocuronium 0.3 mg kg-1 or mivacurium 0.15 mg kg-1 with rocuronium 0.45 mg kg-1. In part 1, 60 s after administration of the neuromuscular blocking drug or drug combination, tracheal intubation was performed in 60 children by mimicking rapid sequence induction, and intubating conditions were evaluated by a blinded investigator according to a standard score. In part 2, neuromuscular monitoring was established before administration of neuromuscular blocking agent(s) and the time from injection of drug or drug combination until complete ablation of T1 (onset) and recovery of T1 to 25% (duration) were recorded in another 60 children. The frequency of distribution of excellent or good intubating conditions in the higher dose of rocuronium and the combination groups were similar to those in the suxamethonium group, but significantly different (P < 0.05) from those in the mivacurium group. Mean onset time was faster in the suxamethonium (55.1 (SD 11.4) s), rocuronium 0.9 mg kg-1 (70.5 (37.7) s), mivacurium 0.1 mg kg-1 with rocuronium 0.3 mg kg-1 (67 (35.9) s) and mivacurium 0.15 mg kg-1 with rocuronium 0.45 mg kg-1 (55 (26.7) s) groups compared with the mivacurium 0.2 mg kg-1 (116 (26.8) s) and rocuronium 0.6 mg kg-1 (97.9 (29) s) groups. This study demonstrated that the combination of rocuronium 0.45 mg kg-1 and mivacurium 0.15 mg kg-1 could possibly be considered as an acceptable alternative to suxamethonium when rapid sequence induction of anaesthesia is indicated in children because it provides uniform excellent intubating conditions and complete neuromuscular block in < 60 s.
在儿童中使用琥珀胆碱会产生不良副作用。在临床实践中，罗库溴铵与米库氯铵联合使用的协同效应可被视为琥珀胆碱的一种可接受替代方案。假设存在纯粹的相加作用，计算得出的罗库溴铵 - 米库氯铵混合物的半数有效剂量（ED50）仅为预测值的62%。这种联合用药在儿童中的应用尚未得到评估。在这项分为两部分的研究中，我们评估了琥珀胆碱、罗库溴铵、米库氯铵或罗库溴铵 - 米库氯铵联合用药在儿童中的插管条件和药效学。我们研究了120名年龄在3至10岁的ASA I级男女儿童。儿童术前口服2 mg/kg的异丙嗪进行预处理，并接受2 μg/kg的芬太尼和2 mg/kg的丙泊酚用于诱导麻醉。他们被随机分配接受以下药物或药物组合之一：1.0 mg/kg的琥珀胆碱、0.2 mg/kg的米库氯铵、0.6或0.9 mg/kg的罗库溴铵、0.1 mg/kg的米库氯铵与0.3 mg/kg的罗库溴铵组合或0.15 mg/kg的米库氯铵与0.45 mg/kg的罗库溴铵组合。在第一部分中，在给予神经肌肉阻滞药物或药物组合60秒后，通过模拟快速顺序诱导对60名儿童进行气管插管，并由一名盲法研究者根据标准评分评估插管条件。在第二部分中，在给予神经肌肉阻滞剂之前建立神经肌肉监测，并记录另外60名儿童从注射药物或药物组合到T1完全消失（起效时间）以及T1恢复到25%（持续时间）的时间。高剂量罗库溴铵组和联合用药组中优良插管条件的分布频率与琥珀胆碱组相似，但与米库氯铵组有显著差异（P < 0.05）。琥珀胆碱组（55.1（标准差11.4）秒）、0.9 mg/kg罗库溴铵组（70.5（37.7）秒）、0.1 mg/kg米库氯铵与0.3 mg/kg罗库溴铵组合组（67（35.9）秒）和0.15 mg/kg米库氯铵与0.45 mg/kg罗库溴铵组合组（55（26.7）秒）的平均起效时间比0.2 mg/kg米库氯铵组（116（26.8）秒）和0.6 mg/kg罗库溴铵组（97.9（29）秒）更快。这项研究表明，当儿童需要进行快速顺序诱导麻醉时，0.45 mg/kg的罗库溴铵与0.15 mg/kg的米库氯铵联合用药可能被视为琥珀胆碱的一种可接受替代方案，因为它能在<60秒内提供一致的优良插管条件和完全的神经肌肉阻滞。
