Wulf H, Kahl M, Ledowski T
Department of Anaesthesiology and Intensive Care, Hospital of the Christian-Albrechts-University, Kiel, Germany.
Br J Anaesth. 1998 Mar;80(3):308-12. doi: 10.1093/bja/80.3.308.
We have evaluated the enhancement of cisatracurium-induced neuromuscular block by potent inhalation anaesthetic agents, by constructing dose-effect curves for cisatracurium in 84 patients during anaesthesia with 1.5 MAC (70% nitrous oxide) desflurane, sevoflurane, isoflurane or total i.v. anaesthesia (TIVA). Acceleromyography (TOF-Guard) and train-of-four (TOF) stimulation of the ulnar nerve were used (2 Hz every 12 s). Cisatracurium was administered in increments of 15 micrograms kg-1 until depression of T1/T0 > 95% was reached. ANOVA was used for statistical analysis (alpha = 0.05, beta = 0.2). Depression of T1/T0 during potent inhalation anaesthesia was enhanced compared with TIVA. ED50 and ED95 values of cisatracurium were 15 (SD 5) and 34 (10) micrograms kg-1 for desflurane; 15 (4) and 32 (7) micrograms kg-1 for sevoflurane; and 15 (5) and 33 (9) micrograms kg-1 for isoflurane. These were significantly lower than the values for TIVA (21 (4) and 51 (13) micrograms kg-1) (P < 0.01 in each case). After equi-effective dosing, times to T1/T0 = 25% were similar in all groups (19 (7), 19 (5), 20 (5) vs 16 (4) min). Recovery index25-75% and time to a TOF ration of 0.70 were prolonged significantly by desflurane and sevoflurane compared with TIVA (18 (5), 19 (8) vs 12 (4) min and 43 (11), 44 (10) vs 35 (5) min, respectively), whereas the difference was not significant for isoflurane (14 (6) and 41 (7) min).
我们通过构建84例患者在使用1.5 MAC（70%氧化亚氮）地氟烷、七氟烷、异氟烷或全静脉麻醉（TIVA）进行麻醉期间顺式阿曲库铵的剂量-效应曲线，评估了强效吸入麻醉剂对顺式阿曲库铵诱导的神经肌肉阻滞的增强作用。采用加速度肌电图（TOF-Guard）和尺神经四个成串刺激（TOF）（每12秒2 Hz）。顺式阿曲库铵以15微克/千克的增量给药，直至T1/T0降低>95%。采用方差分析进行统计分析（α = 0.05，β = 0.2）。与TIVA相比，强效吸入麻醉期间T1/T0的降低更为明显。地氟烷组顺式阿曲库铵的ED50和ED95值分别为15（标准差5）和34（10）微克/千克；七氟烷组为15（4）和32（7）微克/千克；异氟烷组为15（5）和33（9）微克/千克。这些值显著低于TIVA组的值（21（4）和51（13）微克/千克）（每组P < 0.01）。给予等效剂量后，所有组达到T1/T0 = 25%的时间相似（19（7）、19（5）、20（5）对16（4）分钟）。与TIVA相比，地氟烷和七氟烷显著延长了恢复指数25 - 75%以及达到TOF比值0.70的时间（分别为18（5）、19（八）对12（4）分钟和43（11）、44（10）对35（5）分钟），而异氟烷的差异不显著（14（6）和41（7）分钟）。
