Wulf H, Hauschild S, Proppe D, Ledowski T
Klinik für Anästhesiologie und Operative Intensivmedizin, Christian-Albrechts-Universität zu Kiel.
Anaesthesiol Reanim. 1998;23(4):88-92.
To evaluate the enhancement of mivacurium-induced neuromuscular block by potent inhalational anaesthetic agents, dose-effect curves for mivacurium were determined in 84 patients scheduled for minor elective surgery during anaesthesia with 1.5 MAC (70% N2O) desflurane, sevoflurane and isoflurane and compared with those under total intravenous anaesthesia (TIVA). Acceleromyography (TOF-Guard) and train of four (TOF) stimulation of the ulnar nerve were used (2 Hz every 12 s). Mivacurium was administered in increments of 25 micrograms kg-1 until a depression of T1 > 95% was reached. ANOVA was used for statistical analysis (alpha = 0.05, beta = 0.2). The depression of T1 during potent inhalational anaesthesia was enhanced compared with TIVA. The ED50 and ED95 of mivacurium were 27 +/- 11 (SD) and 58 +/- 26 micrograms kg-1 for desflurane; 28 +/- 10 and 64 +/- 23 micrograms kg-1 for sevoflurane; and 27 +/- 13 and 55 +/- 27 micrograms kg-1 for isoflurane and were significantly lower than the 35 +/- 7 and 71 +/- 20 micrograms kg-1 for TIVA. The duration 25% revealed a significant difference between the volatile anaesthetic groups (10 +/- 2, 11 +/- 3, 11 +/- 3 min respectively) and the TIVA control group (8 +/- 3 min). The recovery index 25/75 and TOFO.80 were significantly prolonged by desflurane, sevoflurane and isoflurane compared with TIVA (RI25/75 9 +/- 4, 9 +/- 4, 10 +/- 5 respectively vs. 5 +/- 2 min; TOFO.80 27 +/- 10, 28 +/- 9, 29 +/- 9 respectively vs. 18 +/- 4 min). We conclude that the neuromuscular blocking effect of mivacurium is enhanced during anaesthesia with desflurane, isoflurane and sevoflurane compared with TIVA. The duration of action and the recovery time are prolonged. The dose of mivacurium used should be reduced if anaesthesia is maintained with volatile anaesthetics.
为评估强效吸入麻醉药对米库氯铵诱导的神经肌肉阻滞的增强作用，在84例计划接受小型择期手术的患者中，分别在使用1.5MAC（70%氧化亚氮）地氟烷、七氟烷和异氟烷麻醉期间以及全静脉麻醉（TIVA）下，测定米库氯铵的量效曲线。采用加速度肌电图（TOF-Guard）和尺神经四个成串刺激（TOF）（每12秒2Hz）。米库氯铵以25微克/千克的增量给药，直至T1抑制>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的抑制增强。地氟烷麻醉时米库氯铵的ED50和ED95分别为27±11（标准差）和58±26微克/千克；七氟烷为28±10和64±23微克/千克；异氟烷为27±13和55±27微克/千克，均显著低于TIVA时的35±7和71±20微克/千克。作用持续时间25%在挥发性麻醉药组（分别为10±2、11±3、11±3分钟）和TIVA对照组（8±3分钟）之间显示出显著差异。与TIVA相比，地氟烷、七氟烷和异氟烷显著延长了恢复指数25/75和TOF0.80（RI25/75分别为9±4、9±4、10±5分钟对5±2分钟；TOF0.80分别为27±10、28±9、29±9分钟对18±4分钟）。我们得出结论，与TIVA相比，在使用地氟烷、异氟烷和七氟烷麻醉期间，米库氯铵的神经肌肉阻滞作用增强。作用持续时间和恢复时间延长。如果使用挥发性麻醉药维持麻醉，米库氯铵的使用剂量应减少。
