Ummenhofer W C, Kindler C, Tschalèr G, Hampl K F, Drewe J, Urwyler A
Department of Anaesthesia, University of Basel, Kantonsspital, Switzerland.
Can J Anaesth. 1998 May;45(5 Pt 1):417-23. doi: 10.1007/BF03012576.
Succinylcholine is known to increase the tone of the masseter muscles. As excessive jaw tension may complicate rapid sequence induction, we investigated three induction techniques, all including the use of succinylcholine, with respect to masseter muscle tone, neuromuscular blockade, intubation conditions, and time course of intubation.
Sixty adult patients were allocated to one of three induction groups: Group THIO received 5 mg.kg-1 thiopentone, Group THIO/ATR received 5 mg.kg-1 thiopentone plus 0.05 mg.kg-1 atracurium for precurarization, and Group PROP received 2.5 mg.kg-1 propofol. All patients received 3 micrograms.kg-1 fentanyl and 1.5 mg.kg-1 succinylcholine. Time for induction of anaesthesia was recorded, and, after inserting a Grass Force Transducer between upper and lower incisors, jaw tone and the time course of jaw tension was recorded before and after the administration of succinylcholine.
No differences in the onset of sleep were observed among the three groups (Group THIO 33 +/- 2 sec: THIO/ATR 30 +/- 2 sec: PROP 35 +/- 2 sec, mean +/- SE). Masseter preloads following induction of anaesthesia were similar in all three groups (THIO 16.4 +/- 2.1 N: THIO/ATR 15.1 +/- 2.0 N: PROP 12.7 +/- 1.6 N). However, after administration of succinylcholine, the increase in masseter tone was less in Groups PROP (5.0 +/- 1.1 N) and THIO/ATR (6.4 +/- 2.1 N) than in Group THIO (12.4 +/- 3.0 N; P < 0.05).
Jaw tension after administration of succinylcholine is influenced by the choice of induction agent. The increase of masseter muscle tone is lower following propofol or thiopentone/atracurium induction than with thiopentone alone.
已知琥珀酰胆碱可增加咬肌肌张力。由于过度的下颌张力可能使快速顺序诱导变得复杂，我们研究了三种诱导技术，所有技术均使用琥珀酰胆碱，涉及咬肌肌张力、神经肌肉阻滞、插管条件及插管时间过程。
60例成年患者被分配至三个诱导组之一：硫喷妥钠组（THIO）给予5mg·kg⁻¹硫喷妥钠；硫喷妥钠/阿曲库铵组（THIO/ATR）给予5mg·kg⁻¹硫喷妥钠加0.05mg·kg⁻¹阿曲库铵进行预箭毒化；丙泊酚组（PROP）给予2.5mg·kg⁻¹丙泊酚。所有患者均给予3μg·kg⁻¹芬太尼和1.5mg·kg⁻¹琥珀酰胆碱。记录麻醉诱导时间，在上下切牙间插入Grass力传感器后，记录给予琥珀酰胆碱前后的下颌张力及下颌张力的时间过程。
三组之间睡眠开始时间无差异（硫喷妥钠组33±2秒：硫喷妥钠/阿曲库铵组30±2秒：丙泊酚组35±2秒，均值±标准误）。麻醉诱导后三组的咬肌预负荷相似（硫喷妥钠组16.4±2.1N：硫喷妥钠/阿曲库铵组15.1±2.0N：丙泊酚组12.7±1.6N）。然而，给予琥珀酰胆碱后，丙泊酚组（5.0±1.1N）和硫喷妥钠/阿曲库铵组（6.4±2.1N）咬肌肌张力的增加低于硫喷妥钠组（12.4±3.0N；P<0.05）。
给予琥珀酰胆碱后的下颌张力受诱导药物选择的影响。丙泊酚或硫喷妥钠/阿曲库铵诱导后咬肌肌张力的增加低于单独使用硫喷妥钠。
