Lowry D W, Mirakhur R K, McCarthy G J, Carroll M T, McCourt K C
Department of Anaesthetics, The Queen's University of Belfast, Northern Ireland.
Anesth Analg. 1998 Oct;87(4):936-40. doi: 10.1097/00000539-199810000-00036.
The potency and time course of action of rocuronium were studied in patients anesthetized with 66% nitrous oxide in oxygen and 1.5 minimum alveolar anesthetic concentration of sevoflurane or isoflurane, or a propofol infusion. Potency was estimated by using the single-bolus technique. Neuromuscular block was measured by stimulation of the ulnar nerve and by recording the force of contraction of the adductor pollicis muscle. The mean (95% confidence limits) of the 50% and 95% effective doses were estimated tobe 142 (129-157) and 265 (233-301) microg/ kg, 165 (146-187) and 324 (265-396) microg/kg, and 183 (163-207) and 398 (316-502) microg/kg during sevoflurane, isoflurane, and propofol anesthesia, respectively (P < 0.05 for sevoflurane versus propofol). The mean +/- SD times to onset of maximal block after rocuronium 0.6 mg/kg were 0.96 +/- 0.16, 0.90 +/- 0.16, and 1.02 +/- 0.15 min during sevoflurane, isoflurane, and propofol anesthesia, respectively. The respective times to recovery of the first response in the train-of-four (TOF) stimulation (T1) to 25% and 90% were 45 +/- 13.1 and 83 +/- 29.3 min, 35 +/- 6.1 and 56 +/- 15.9 min, and 35 +/- 9.2 and 55 +/- 19.4 min. The times to recovery of the TOF ratio to 0.8 were 103 +/- 30.7, 69 +/- 20.4, and 62 +/- 21.1 min, and the 25%-75% recovery indices were 26 +/- 11.7, 12 +/- 5.0, and 14 +/- 6.9 min, respectively. There were no differences among groups in the times for onset of action or to recovery of T1 to 25%. However, the times for recovery of T1 to 90%, TOF ratio to 0.8, and recovery index in the sevoflurane group were all significantly longer compared with the other two groups (P < 0.05, < 0.01, and < 0.01, respectively). We conclude that the effects of rocuronium, especially duration of action, are significantly enhanced during sevoflurane compared with isoflurane and propofol anesthesia.
In routine clinical use, the effects of rocuronium are enhanced by sevoflurane, in comparison with isoflurane and propofol anesthesia, and the recovery is slower. Particular attention should be paid to monitoring of neuromuscular block during sevoflurane anesthesia.
在使用66%氧化亚氮与氧气混合气体以及1.5倍最低肺泡有效浓度的七氟烷、异氟烷或丙泊酚持续输注进行麻醉的患者中，研究了罗库溴铵的效价和作用时效。采用单次推注技术评估效价。通过刺激尺神经并记录拇内收肌的收缩力来测量神经肌肉阻滞。七氟烷、异氟烷和丙泊酚麻醉期间，50%和95%有效剂量的平均值（95%置信区间）分别估计为142（129 - 157）和265（233 - 301）μg/kg、165（146 - 187）和324（265 - 396）μg/kg、183（163 - 207）和398（316 - 502）μg/kg（七氟烷与丙泊酚相比，P < 0.05）。罗库溴铵0.6 mg/kg给药后，达到最大阻滞的平均±标准差起效时间在七氟烷、异氟烷和丙泊酚麻醉期间分别为0.96 ± 0.16、0.90 ± 0.16和1.02 ± 0.15分钟。四个成串刺激（TOF）中第一个反应（T1）恢复至25%和90%的相应时间分别为45 ± 13.1和（83 ± 29.3）分钟、35 ± 6.1和（56 ± 15.9）分钟、35 ± 9.2和（55 ± 19.4）分钟。TOF比值恢复至0.8的时间分别为103 ± 30.7、69 ± 20.4和62 ± 21.1分钟，25% - 75%恢复指数分别为26 ± 11.7、12 ± 5.0和14 ± 6.9分钟。各组间起效时间或T1恢复至25%的时间无差异。然而，七氟烷组T1恢复至90%、TOF比值恢复至0.8以及恢复指数的时间均显著长于其他两组（分别为P < 0.05、< 0.01和< 0.01）。我们得出结论，与异氟烷和丙泊酚麻醉相比，七氟烷麻醉期间罗库溴铵的作用，尤其是作用持续时间显著增强。
在常规临床应用中，与异氟烷和丙泊酚麻醉相比，七氟烷可增强罗库溴铵的作用，且恢复较慢。在七氟烷麻醉期间应特别注意监测神经肌肉阻滞情况。
