Gin T, Derrick J L, Chan M T, Chui P T, Mak T W
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Anesth Analg. 1998 Jan;86(1):82-5. doi: 10.1097/00000539-199801000-00016.
Postpartum patients have decreased plasma cholinesterase activity, which may slow the metabolism of mivacurium. We compared the duration of a mivacurium neuromuscular block in 11 women undergoing postpartum tubal ligation 36-99 h after delivery with that in 11 control women undergoing gynecological surgery. Anesthesia was induced with propofol and fentanyl and maintained with propofol and nitrous oxide. Neuromuscular block was monitored by electromyography, and the ulnar nerve was stimulated transcutaneously using a train-of-four pattern. Patients received a bolus dose of mivacurium 0.15 mg/kg. The median (range) duration of neuromuscular block until 25% recovery of the first twitch response was longer in the postpartum group, 19.4 (15.6-25.2) min, compared with the control group, 16.3 (11.0-23.4) min (P = 0.04). The median (range) plasma cholinesterase activity was decreased in the postpartum group, 4.0 (0.1-5.5) kU/L, compared with the control group, 7.1 (6.2-10.0) kU/L (P < 0.001). The duration of neuromuscular block was inversely correlated with cholinesterase activity (Kendall rank correlation tau = -0.43, P = 0.005). The slight prolongation of neuromuscular block should not be significant clinically.
Postpartum patients have decreased amounts of the plasma cholinesterase enzyme. This would slow the metabolism of the muscle relaxant mivacurium. However, the duration of muscle paralysis is only prolonged by approximately 3 min, which would not normally cause any significant problems.
产后患者血浆胆碱酯酶活性降低，这可能会减缓米库氯铵的代谢。我们比较了11例产后36 - 99小时接受产后输卵管结扎术的女性与11例接受妇科手术的对照女性米库氯铵神经肌肉阻滞的持续时间。麻醉诱导采用丙泊酚和芬太尼，维持采用丙泊酚和氧化亚氮。通过肌电图监测神经肌肉阻滞，并使用四个成串刺激模式经皮刺激尺神经。患者接受0.15 mg/kg的米库氯铵推注剂量。与对照组相比，产后组直到第一个抽搐反应恢复25%时神经肌肉阻滞的中位（范围）持续时间更长，分别为19.4（15.6 - 25.2）分钟和16.3（11.0 - 23.4）分钟（P = 0.04）。与对照组相比，产后组血浆胆碱酯酶活性的中位（范围）降低，分别为4.0（0.1 - 5.5）kU/L和7.1（6.2 - 10.0）kU/L（P < 0.001）。神经肌肉阻滞的持续时间与胆碱酯酶活性呈负相关（肯德尔等级相关系数tau = -0.43，P = 0.005）。神经肌肉阻滞的轻微延长在临床上应无显著意义。
产后患者血浆胆碱酯酶的量减少。这会减缓肌肉松弛剂米库氯铵的代谢。然而，肌肉麻痹的持续时间仅延长约3分钟，通常不会引起任何重大问题。
