Jalkanen L, Rautoma P, Taivainen T, Meretoja O A
Department of Anesthesiology, Children's Hospital University of Helsinki, Finland.
Anesth Analg. 1998 Jan;86(1):62-5. doi: 10.1097/00000539-199801000-00012.
We evaluated whether mivacurium maintains its short duration of effect when preceded by atracurium or cisatracurium in 45 children during propofol/alfentanil/N2O/O2 anesthesia. Neuromuscular response was recorded by using an adductor pollicis electromyogram (EMG). Children were randomized to receive two doses of atracurium (350 micrograms/kg and 70 micrograms/kg in Group AM), cisatracurium (64 micrograms/kg and 10 micrograms/kg in Group CM), or mivacurium (200 micrograms/kg and 100 micrograms/kg in Group MM), followed by a final dose of mivacurium 100 micrograms/kg. The second and third doses of the muscle relaxants were administered at 25% EMG recovery. After the final dose of mivacurium, the times to 95% of EMG recovery in groups AM, CM, and MM were (median with 10-90 percentile range) 33.0 (28.0-40.0) min, 30.7 (26.0-40.3) min, and 10.3 (8.0-14.0) min, respectively (P < 0.0001). The recovery times to a train-of-four ratio of 0.70 were 30.3 (24.7-37.0) min, 28.0 (24.7-37.7) min, and 10.3 (8.0-13.7) min for groups AM, CM, and MM, respectively (P < 0.0001). Thus, the duration of effect of mivacurium was prolonged by 200% if preceded by either atracurium or cisatracurium.
We compared the pharmacodynamics of mivacurium given alone or preceded by atracurium or cisatracurium in children. The duration of effects of mivacurium was prolonged by 200% if preceded by either atracurium or cisatracurium. This implies that mivacurium has a short duration of effect only when given as a single relaxant.
我们评估了在45名接受丙泊酚/阿芬太尼/氧化亚氮/氧气麻醉的儿童中，在阿曲库铵或顺式阿曲库铵之前使用米库氯铵时，米库氯铵是否能维持其短时效作用。通过使用拇内收肌肌电图（EMG）记录神经肌肉反应。儿童被随机分为三组，分别接受两剂阿曲库铵（AM组，350微克/千克和70微克/千克）、顺式阿曲库铵（CM组，64微克/千克和10微克/千克）或米库氯铵（MM组，200微克/千克和100微克/千克），随后给予最后一剂100微克/千克的米库氯铵。肌肉松弛剂的第二剂和第三剂在肌电图恢复25%时给予。在最后一剂米库氯铵给药后，AM组、CM组和MM组达到肌电图恢复95%的时间（中位数及10 - 90百分位数范围）分别为33.0（28.0 - 40.0）分钟、30.7（26.0 - 40.3）分钟和10.3（8.0 - 14.0）分钟（P < 0.0001）。AM组、CM组和MM组的四个成串刺激比值恢复到0.70的时间分别为30.3（24.7 - 37.0）分钟、28.0（24.7 - 37.7）分钟和10.3（8.0 - 13.7）分钟（P < 0.0001）。因此，如果在阿曲库铵或顺式阿曲库铵之前使用，米库氯铵的作用持续时间会延长200%。
我们比较了单独使用米库氯铵或在阿曲库铵或顺式阿曲库铵之前使用米库氯铵在儿童中的药效学。如果在阿曲库铵或顺式阿曲库铵之前使用，米库氯铵的作用持续时间会延长200%。这意味着米库氯铵只有在作为单一松弛剂使用时作用持续时间才短。
