老年患者顺式阿曲库铵不同用药方式的作用时效比较

目的观察顺式阿曲库铵两种不同用药方式在老年患者腹部手术中的肌松效应及对恢复速度的影响。方法 32例ASAⅡ～Ⅲ级择期老年腹部手术患者,随机分为两组（Ⅰ组和Ⅱ组,每组16例）。麻醉诱导均采用咪唑安定、异丙酚及芬太尼,以瑞芬太尼和异丙酚维持麻醉。Ⅰ组术中每当T1恢复到10%时单次静脉推注0.05～0.1mg/kg顺式阿曲库铵,Ⅱ组当T1恢复到5%时开始微量泵输注顺式阿曲库铵（2～3μg/（kg.min））,两组维持肌松T1〈10%,直到手术关腹后停止给药。术中记录肌松作用时间、最后注药或停药距T1为25%时间、恢复指数,并计算单位时间用药量。结果两组肌松效应和恢复指数相比均无统计学差异（P〉0.05）,单位时间用药量亦无统计学差异（P〉0.05）;最后注药或停药距T1为25%时间,Ⅰ组长于Ⅱ组（P〈0.05）。结论顺式阿曲库铵用于老年患者麻醉可产生良好的肌松效应,术中持续微量泵注射顺式阿曲库铵较为合理。     

七氟醚与异氟醚对老年患者持续输注顺式阿曲库铵肌松效应的影响

目的 比较吸入等效浓度七氟醚和异氟醚麻醉下对老年患者持续输注顺式阿曲库铵肌松效应的影响.方法 全麻下行耳鼻喉或颌面外科手术老年患者60例,随机均分为三组.七氟醚组(S组)和异氟醚组(Ⅰ组)分别吸入等效浓度(呼气末浓度1 MAC)七氟醚和异氟醚维持麻醉,对照组(C组)靶控输注丙泊酚(血浆靶浓度为2～3 μg/ml)维持麻醉,同时三组均持续输注顺式阿曲库铵,使T1稳定在基础值的10％,采用TOF-Watch SX肌松监测仪行拇内收肌肌松监测.记录初始剂量顺式阿曲库铵起效时间、术中输注速率、恢复指数(T1恢复25％至75％)和TOFr恢复至0.9的时间.结果 给药30 min后各时点S组和Ⅰ组顺式阿曲库铵输注速率小于C组(P＜0.05).给药45 min后各时点I组顺式阿曲库铵输注速率高于S组(P＜0.05).结论 等效浓度七氟醚和异氟醚麻醉下均能增强老年患者持续输注顺式阿曲库铵的肌松效应.     

肝移植术患者罗库溴铵不同给药方式肌松效果的比较

目的 比较肝移植术患者间断静脉注射(Ⅳ)、静脉输注(CI)和靶控输注(TCI)罗库溴铵的肌松效果.方法 拟行肝移植术的患者36例,性别不限,年龄21～63岁,体重48～80 kg,Child-Pugh评分7～9分,肝功能Child分级B或C级,随机分为3组(n=12):Ⅳ组、CI组和TCI组.采用TOF模式进行肌松监测,Ⅳ组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期T1恢复至25%时、无肝期和新肝期T4/T1(TOFR)恢复至25%时追加0.15 mg/kg.TCI组:麻醉诱导时靶控输注罗库溴铵,初始效应室靶浓度3μg/ml,调整靶浓度,维持T1 5%～10%;无肝期和新肝期开始时暂停TCI,随后以效应室靶浓度0.1μg/ml再次输注,调整靶浓度,维持T15%～10%.CI组:麻醉诱导时静脉注射罗库溴铵0.6 mg/kg,无肝前期以30μg·kg-1·min-1的速率开始静脉输注,调节输注速率,维持T1 5%～10%,无肝期和新肝期开始时暂停CI,随后以1μg·kg-1·min-1的速率静脉再次输注,调整输注速率,维持T15%～10%.各组于肌松达最大效应时行气管插管,于缝合腹膜后停止给药.记录麻醉诱导时罗库溴铵肌松起效时间、T1最大抑制程度和气管插管条件满意情况;记录各组无肝期T1 25%恢复时间及TOFR 25%恢复时间,新肝期停药后T125%恢复时间、TOFR 25%恢复时间、TOFR 75%恢复时间、TOFR90%恢复时间及恢复指数;记录罗库溴铵总用量.结果 与Ⅳ组比较,TCI组和CI组气管插管条件满意率、罗库溴铵总用量、麻醉诱导时罗库溴铵起效时间、T1最大抑制程度和各期肌松恢复情况差异均无统计学意义(P＞0.05).肌松效应监测图显示Ⅳ组各期罗库溴铵肌松效应波动较大,TCI组和CI组各期肌松效应较为平稳.结论 采用Ⅳ、CI和TCI给药时,肝移植术患者罗库溴铵肌松起效和恢复情况无差异,而采用TCI或CI给药时,肌松效应较Ⅳ更加平稳.     

小儿不同剂量顺式阿曲库铵的肌松作用

目的通过观察小儿不同剂量顺式阿曲库铵的肌松作用,评价是否存在封顶效应,探讨小儿合适的麻醉诱导剂量。方法45例择期手术的息儿,年龄15～50月,ASAⅠ或Ⅱ级,随机分为3组(n=15):顺式阿曲库铵0.1 mg/kg组(A组)、顺式阿曲库铵0.15 mg/kg组(B组)、顺式阿曲库铵0.2 mg/kg(C组)。采用TOF-Guard肌松监测仪对尺神经行连续四个成串(TOF)刺激,监测拇内收肌肌颤搐变化;静脉注射异丙酚2 mg/kg、芬太尼2μg/kg及相应剂量顺式阿曲库铵麻醉诱导,吸入O2-N2O和静脉持续输注异丙酚维持麻醉;评价气臂插管条件评估分级,监测诱导期间血液动力学变化,记录起效时间(肌松药注毕至T1达最大抑制的时间)、临床肌松维持时间(肌松药注毕至T1恢复5%的时间)、临床肌松有效作用时间(T1从最大抑制至恢复25%的时间)、恢复指数(T1恢复从25%至75%的时间)、体内肌松作用时间(肌松药注毕至T1恢复95%的时间)。结果3组气管插管条件评估分级比较差异无统计学意义;三组T1达最大抑制时心率、平均动脉压组间和组内比较差异均无统计学意义。与A组相比,B组、C组起效时间较短,临床肌松维持时间、临床肌松有效作用时间、体内肌松作用时间较长(P<0.01);三组恢复指数差异无统计学意义。与B组相比,C组起效时间差异无统计学意义,但临床肌松维持时间、临床肌松有效作用时间、体内肌松作用时间较长(P<0.05或0.01)。结论小儿芬太尼复合异丙酚时,顺式阿曲库铵0.15 mg/kg(3倍ED95)是麻醉诱导的适宜剂量。     

年龄对顺式阿曲库铵靶控输注药效学的影响

目的探讨靶控输注(TCI)顺式阿曲库铵时年龄对其药效学的影响。方法接受丙泊酚-N2O/O2-芬太尼复合麻醉的患者40例均分为Ⅰ组(62～85岁)和Ⅱ组(20～59岁)。在四个成串刺激(TOF)监测下静注顺式阿曲库铵0.15mg/kg。待TOF的T1为0时行气管插管,并对插管条件进行评级。待T1恢复至5%时开始TCI阿曲库铵,保持T1<10%。记录神经肌肉阻滞的起效时间、无反应期、阻滞维持时间和停药后肌松恢复时间,并记录顺式阿曲库铵的用药量。结果两组起效时间及恢复指数差异无统计学意义;Ⅰ组无反应期、阻滞维持时间和停药后肌松恢复时间明显长于Ⅱ组(P<0.05);顺式阿曲库铵的平均用药量明显少于Ⅱ组(P<0.05)。结论老年患者TCI顺式阿曲库铵用药量虽然相应减少,但其恢复过程仍较青壮年延长。     

顺式阿曲库铵闭环注射系统在腹腔镜手术中的应用

目的 探讨顺式阿曲库铵闭环注射在腹腔镜手术中的肌松效果.方法 选择腹腔镜手术患者20例,随机均分成闭环注射组(G组)和对照组(C组).C组持续输注顺式阿曲库铵1.5～2 μg·kg-1·min-1直至手术结束前30 min;G组输注顺式阿曲库铵0.8μg·kg-1 ·min-1,设定肌松深度反馈值T1=15％,近手术结束时由研究实施者根据术中肌松监测指标决定停药时机.记录麻醉时间、顺式阿曲库铵的总用量、恢复指数、TOFr75及TOFr90.结果 G组顺式阿曲库铵总用量均明显少于C组(P＜0.05),恢复指数、TOFr75及TOFr90明显缩短于C组(P＜0.05).结论 与持续输注方式相比,闭环肌松药注射方式肌松药用量更少,恢复指数、TOFr75和TOFr90明显缩短,实现个性化和合理化用药.     

不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌肌松效应的比较

目的 比较不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌的肌松效应.方法 全麻患者25例,ASA Ⅰ或Ⅱ级,年龄42～64岁,体重51～81 kg,随机分为2组,顺式阿曲库铵0.075ms/ks组(Ⅰ组,n=11)和顺式阿曲库铵0.15 mg/kg组(Ⅱ组,n=14).静脉注射咪达唑仑0.035～0.045mg/kg、异丙酚1.5～2 mg/kg、芬太尼0.1～0.2 mg、顺式阿曲库铵0.075 mg/kg或0.15 mg/kg行麻醉诱导,吸入50%氧化亚氮、间断静脉注射芬太尼维持麻醉.采用2台TOF-Watch SX加速度肌松监测仪同步监测眼轮匝肌和拇内收肌的神经肌肉阻滞情况,记录肌松起效时间、无反应期及T25%和T75%恢复时间.于眼轮匝肌肌颤搐抑制75%～80%时行气管插管,并评价气管插管条件.结果 2组气管插管条件良好且差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组拇内收肌和眼轮匝肌肌松起效时间缩短,T25%恢复时间、T75%恢复时间和无反应期延长(P<0.01);与拇内收肌比较,Ⅰ组眼轮匝肌T75%恢复时间缩短,Ⅱ组眼轮匝肌无反应期和T25%恢复时间缩短(P<0.05或0.01).结论 顺式阿曲库铵对拇内收肌和眼轮匝肌的肌松效应呈剂量依赖性,眼轮匝肌对顺式阿曲库铵的敏感性低于拇内收肌;监测顺式阿曲库铵对眼轮匝肌神经肌肉阻滞情况可有效指导气管插管.     

阻塞性黄疸伴肝功能不全患者顺式阿曲库铵的肌松效应

目的 观察单次静脉注射顺式阿曲席铵在阻塞性黄疸伴有肝功能不全患者的肌松效应.方法 30例择期行上腹部手术的患者均分为阻塞性黄疸伴有肝功能不全(Child-Pugh B级)组(G组)和肝功能正常组(C组).麻醉诱导均采用丙泊酚3 μg/ml、雷米芬太尼3～6 ng/ml、顺式阿曲库铵0.15 mg/kg后气管插管,评估插管条件,记录顺式阿曲库铵的肌松作用指标.结果 G组肌松起效时间较C组明显延长(P＜0.01);两组最大阻滞程度、插管条件、最大效应持续时间、单个颤搐刺激反应强度(T1)10%恢复时间、T125%恢复时间、T175%恢复时间、TOF比(T4/T1)70%恢复时间、恢复指数差异均无统计学意义.结论 阻塞性黄疸伴有肝功能小全患者单次静注顺式阿曲库铵后肌松起效时间明显长于肝功能正常者.     

肝移植术中顺阿曲库铵不同给药方式对肌松效果的影响

目的 探讨在肝移植术中间断静脉注射(Ⅳ)和持续输注(CI)两种给药方式下顺阿曲库铵的肌松效果.方法 选择首次行原位肝移植术患者20例,ASAⅢ或Ⅳ级,随机均分为Ⅳ组和CI组.记录麻醉诱导时肌松起效时间及气管插管条件满意度.记录无肝前期、无肝期、新肝期顺阿曲库铵维持用量.结果 Ⅳ组和CI组气管插管时顺阿曲库铵起效时间分别为(8.4±1.5) min和(9.1±1.9) min;气管插管条件满意率分别为100％与90％,差异均无统计学意义.在无肝前期、无肝期、新肝期Ⅳ组阿曲库铵用量明显大于CI组(P＜0.05).结论 肝移植术中持续静脉注射顺阿曲库铵的方式比间断静脉注射顺阿曲库铵的方式更便利、更节省药物.     

性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响

目的 探讨性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响.方法 择期全麻手术患者240例,年龄20～60岁,ASA分级Ⅰ或Ⅱ级,BMI 20～30 kg/m2,随机分为2组(n=120):顺阿曲库铵组和罗库溴铵组,各组按性别和麻醉药再分4个亚组(n=30):女性异丙酚组、男性异丙酚组、女性七氟醚组和男性七氟醚组.各异丙酚组靶控输注异丙酚,血浆靶浓度2～6 μg/ml,各七氟醚组吸入七氟醚,于靶控输注或待呼气末七氟醚浓度稳定于1.71%5 min后,静脉注射顺阿曲库铵0.15 mg/kg或罗库溴铵0.6 mg/kg.记录肌松起效时间、肌松作用峰值时间、T1 25%恢复时间和TOFR25%恢复时间.结果 与异丙酚麻醉比较,女性患者七氟醚麻醉时,罗库溴铵TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,男性患者七氟醚麻醉时,罗库溴铵起效时间缩短,肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长(P＜0.05或0.01);七氟醚麻醉时与男性患者比较,女性患者罗库溴铵T1 25%恢复时间和TOFR 25%恢复时间缩短,顺阿曲库铵起效时间缩短(P＜0.05或0.01).结论 七氟醚对罗库溴铵肌松的增强作用存在性别差异,男性强于女性;对顺阿曲库铵肌松的增强作用无明显性别差异.     

Dose-response relationships for infusions of Althesin or methohexitone

A technique is described for the determination of equipotent rates of infusion of intravenous hypnotic agents. Two end points have been defined; the rates needed to suppress the initial response to the surgical incision in 50% (ED50) and 95% (ED95) of patients receiving continuous infusion anaesthesia to supplement 67% nitrous oxide in oxygen. For patients aged 20-60 years, and premedicated with morphine 0.15 mg/kg intramuscularly, the ED50 values for Althesin (as alphaxalone) and methohexitone by infusion were 13.7 and 48.8 micrograms/kg/minute respectively. The ED95 values were 18.1 and 75.9 micrograms/kg/minute. For patients of a similar age premedicated with diazepam 10 mg orally, the ED50 values for Althesin and methohexitone were 18.5 and 66.0 micrograms/kg/minute respectively; while the ED95 values were 24.2 and 80.8 micrograms/kg/minute.     

Ketamine as analgesic for total intravenous anaesthesia with propofol

A prospective study of 18 patients who underwent noncardiac surgery was performed to study the use of ketamine as an analgesic during total intravenous anaesthesia with propofol. A comparison was made with the combination propofol/fentanyl. The propofol/ketamine combination resulted in haemodynamically stable anaesthesia without the need for additional analgesics. Postoperative behaviour was normal in all patients and none of the patients reported dreaming during or after the operation. Propofol seems to be effective in eliminating side effects of a subanaesthetic dose of ketamine in humans. We recommend the propofol/ketamine combination for total intravenous anaesthesia for surgery when stable haemodynamics are required.     

The effects of speed of injection on induction with propofol A comparison with etomidate

One hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diastolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.     

Comparison of propofol and thiopentone for induction of anaesthesia in premedicated patients

Thirty premedicated ASA I or II patients scheduled for minor gynaecological surgery, were randomly allocated to receive either 1.5 mg/kg or 2 mg/kg propofol of the new emulsion formulation, or 4 mg/kg thiopentone, given over 20 seconds. Anaesthesia was successfully induced in all 30 patients. The mean (SEM) induction times were for propofol 1.5 mg/kg 33.3(3.2) seconds, for 2 mg/kg 30.5(2.7) seconds and for thiopentone 34.6(2.7) seconds. The incidence of apnoea greater than 10 seconds, was respectively 60, 80 and 80%, and the mean duration of apnoea 30.8(5.3), 37.1(5.0) and 23.7(5.0) seconds. The mean systolic blood pressure decreased after propofol 1.5 mg/kg by 16.0 mmHg, after 2 mg/kg by 18.6 mmHg, and increased after thiopentone by 1 mmHg, 2 minutes after injection. Heart rate increased significantly 2 minutes after thiopentone by an average of 15.1 beats/minute, but not after propofol. Pain was not reported during or after the injection. No major adverse reactions occurred at induction or during maintenance of anaesthesia with an inhalation agent. One patient who received 2 mg/kg propofol and isoflurane vomited for 24 hours. The recovery of anaesthesia after propofol induction, was quicker than after thiopentone.     

A comparison of the induction characteristics of thiopentone and propofol (2, 6-di-isopropyl phenol)

A study has been undertaken to compare the induction characteristics of the new intravenous anaesthetic agent 2,6 di-isopropyl phenol, newly prepared in a lipid emulsion (propofol) with those of thiopentone. Despite a significantly higher incidence of pain on injection and spontaneous movement, the new agent was felt to perform comparably to thiopentone as an induction agent. Unfortunately, propofol caused decreases in blood pressure which were significantly greater than those seen after thiopentone. This feature may prove to be a considerable hurdle to the general acceptance of propofol.     

Intravenous regional anaesthesia with ketamine

Ketamine, 40 ml 0.5% solution, was used in the technique of intravenous regional anaesthesia in 14 patients undergoing upper limb surgery. Satisfactory analgesia was obtained in 12 of the patients. The method is limited by the fact that all patients became unconscious within a few minutes of tourniquet release, and that this could not be prevented by naloxone.     

Total intravenous anaesthesia for laparoscopy

Two techniques of total intravenous anaesthesia for laparoscopy were compared in 80 patients. Group 1 received alfentanil, propofol and vecuronium, and Group 2 alfentanil, midazolam, ketamine and vecuronium. Haemodynamic stability after induction and the pressor response to tracheal intubation were significantly different. There was no significant difference in recovery times between the two groups and little difference in other postoperative sequelae.