Schramm W M, Jesenko R, Bartunek A, Gilly H
Department of Anaesthesia and General Intensive Care, University of Vienna, Austria.
Acta Anaesthesiol Scand. 1997 Nov;41(10):1319-23. doi: 10.1111/j.1399-6576.1997.tb04651.x.
For neuroanesthesia and neurocritical care the use of drugs that do not increase or preferentially decrease intracranial pressure (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) are preferred. The current study investigates the effects of a single rapid bolus dose of cisatracurium on cerebral blood flow velocity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension after severe brain trauma (Glasgow coma scale <6) under continuous sedation with sufentanil and midazolam.
Patients were randomly assigned to receive either 2xED95 (n=12) or 4xED95 (n=12) of cisatracurium as a rapid i.v. bolus injection. Before and after bolus administration mean cerebral blood flow velocity (BFV, cm/s) was measured in the middle cerebral artery using a 2-MHz transcranial Doppler sonography system, ICP (mm Hg) was measured using an extradural probe, and MAP (mm Hg) and HR (b/min) were measured during a study period of 20 min. Cerebral perfusion pressure (CPP=MAP-ICP) was also calculated.
Our data show that a single bolus dose of up to 4xED95 cisatracurium caused no significant (P<0.05) changes in BFV, ICP, CPP, MAP and HR. Possible histamine-related events were not observed during the study.
The results from this study suggest that cisatracurium is a safe neuromuscular blocking agent for use in adult severe brain-injured patients with increased ICP under mild hyperventilation and continuous sedation.
对于神经麻醉和神经重症监护，首选使用不会增加或优先降低颅内压（ICP）、改变脑灌注压（CPP）和脑血流量（CBF）的药物。本研究调查了在舒芬太尼和咪达唑仑持续镇静下，24例重度脑外伤（格拉斯哥昏迷量表<6）后颅内高压的机械通气患者单次快速推注剂量的顺式阿曲库铵对脑血流速度、ICP、CPP、平均动脉压（MAP）和心率（HR）的影响。
患者被随机分配接受2倍ED95（n=12）或4倍ED95（n=12）的顺式阿曲库铵作为快速静脉推注。在推注给药前后，使用2MHz经颅多普勒超声系统测量大脑中动脉的平均脑血流速度（BFV，cm/s），使用硬膜外探头测量ICP（mmHg），并在20分钟的研究期间测量MAP（mmHg）和HR（次/分钟）。还计算了脑灌注压（CPP=MAP-ICP）。
我们的数据表明，单次推注剂量高达4倍ED95的顺式阿曲库铵对BFV、ICP、CPP、MAP和HR没有显著（P<0.05）变化。在研究期间未观察到可能的组胺相关事件。
本研究结果表明，顺式阿曲库铵是一种安全的神经肌肉阻滞剂，可用于轻度过度通气和持续镇静下颅内压升高的成年重度脑损伤患者。
