不同静脉注射速度对小儿罗库溴铵注射痛反应的影响

目的 观察静脉注射速度对小儿罗库溴铵静脉注射痛反应的影响.方法 全麻下择期手术患儿60例均分为两组,给予咪唑安定、氯胺酮,入睡后给予罗库溴铵0.6 mg/kg(浓度10mg/ml).A组注速≤3 s,B组注速60 s.采用加速度肌松监测仪监测肌松指标,观察罗库溴铵静脉注射痛反应、气管插管条件和肌松起效时间.结果 B组静脉注射痛反应的发生率明显低于A组(P<0.01);两组插管条件和肌松起效时间的差异无统计学意义.结论 缓慢静脉注射罗库溴铵能明显减轻罗库溴铵静脉注射痛,对气管插管条件和肌松起效时间无明显影响.     

芬太尼预防罗库溴铵注药痛的研究

目的观察罗库溴铵注药痛的发生率、致痛程度以及预先注射芬太尼的预防效果。方法拟行全身麻醉的成年手术患者175例。麻醉诱导时用限时法给予罗库溴铵。按给予罗库溴铵前的处理方法将患者随机分成七组,每组25例。～Ⅳ组将左上臂包裹的气压止血带加压至70mmHg以阻断静脉回流。于左手背静脉注射预处理药物：Ⅰ组为生理盐水3ml;Ⅱ～Ⅳ组为芬太尼2μg／kg,速度3ml／10s。Ⅰ组和Ⅱ组注药后30S松开止血带,Ⅲ组和Ⅳ组分别于注药后60S和120S松开止血带,立即在该静脉10S内注入罗库溴铵0．6mg／kg。Ⅴ～Ⅶ组不用止血带,以3ml／10s速度注入芬太尼2μg／kg;Ⅴ组、Ⅵ组和Ⅶ组分别在注药后30、60S和120S后于该静脉10S内注入罗库溴铵0．6mg／kg。观察患者在注射罗库溴铵时的反应,并对各种反应评估分级。结果罗库溴铵注药痛发生率Ⅰ组达92％,明显高于Ⅳ组（64％）和Ⅶ组（52％）（P〈0．01）;Ⅰ组中、重度注药痛发生率达56％,而Ⅳ组和Ⅶ组均为轻度疼痛。Ⅳ组与Ⅶ组注药痛组间比较差异无统计学意义。Ⅱ组和Ⅲ组注药痛发生率均为84％,V组和Ⅵ组分别为96％和88％,和Ⅰ组相似。Ⅵ组中、重度注药痛发生率（12％）比Ⅰ组明显减少（P〈o、05）。结论麻醉诱导时预先静脉注射芬太尼2μg／kg,不论是否用止血带阻断静脉回流,120S后再注入罗库溴铵时,均能有效降低罗库溴铵注药痛的发生率和致痛程度。     

罗库溴铵复合麻黄碱预先给药对全麻患者罗库溴铵肌松效应的影响

目的 探讨罗库溴铵复合麻黄碱预先给药对罗库溴铵肌松效应的影响.方法 择期全麻手术患者100例,ASAⅠ或Ⅱ级,年龄23～64岁,体重42～88 kg,身高150～181 cm,随机分为5组(n=20):罗库溴铵组(C组)、罗库溴铵预先给药组(R组)、麻黄碱预先给药组(E组)、罗库溴铵复合麻黄碱预先给药组(RE组)和琥珀酰胆碱组(S组).麻醉诱导前R组、E组和RE组分别静脉注射罗库溴铵0.06 mg/kg、麻黄碱70 μg/kg、罗库溴铵0.06 mg/kg复合麻黄碱70 μg/kg,C组和S组无预先给药.麻醉诱导后4 min时C组和E组静脉注射罗库溴铵0.6 mg/kg,R组和RE组静脉注射罗库溴铵0.54 mg/kg,S组静脉注射琥珀酰胆碱1 mg/kg.采用Cooper法评分标准评定气管插管条件.记录从麻醉诱导时静脉注射罗库溴铵完毕至肌颤搐(Th)降至25%、10%、0的时间(分别为T25、T10、T0)和Th恢复至25%、50%的时间(分别为RT25、RT50)、肌松维持时间(从T0至RT25的时间),麻醉诱导期间每分钟记录1次心率、收缩压、舒张压和平均动脉压.结果 各组气管插管条件差异无统计学意义(P＞0.05);与C组比较,其余4组T25、T10、T0均缩短,S组RT25、RT50缩短(P＜0.05);与RE组和S组比较,R组和E组T0延长(P＜0.05);与S组比较,C组、R组、E组和RE组肌松维持时间延长(P＜0.05).结论 罗库溴铵复合麻黄碱预先给药后罗库溴铵肌松起效时间短于单独预先给药,但对肌松程度和维持时间无明显影响.     

手术病人不同静脉给药方式对罗库溴铵肌松作用的影响

罗库溴铵是目前临床上起效较快的中时效非去极化肌松药，但罗库溴铵与其他非去极化肌松药一样存在术后肌松残留作用，罗库溴铵长时间持续输注时较其他肌松药更容易引起术后残留。由于计算机以及各种药物输注系统在麻醉中的应用，肌松药静脉给药方式已越来越多。但是不同静脉给药方式对罗库溴铵肌松作用的影响尚需进一步探讨。本研究拟探讨靶控输注（TCI）、持续输注（CI）及静脉注射（Ⅳ）三种给药方式对罗库溴铵肌松作用的影响，为临床应用提供参考。     

罗库溴铵预注效果

罗库溴铵是一种起效快、中等作用时效的新型甾类非去极化肌松药。本研究通过比较罗库溴铵单剂量法和预注给药的气管插管效果并分析其药效过程,为临床合理有效的使用罗库溴铵进行气管插管提供依据。资料与方法一般资料　选择无神经肌肉疾患及水电解质紊乱的成年全麻手术患者45例,年龄20～59岁,ＡＳＡ级Ⅰ～Ⅱ,面罩吸氧5分钟后静注硫喷妥钠5ｍｇ/ｋｇ,然后静注肌松药。所有患者均在静脉注射肌松药1分钟时进行气管插管,接麻醉机行机械间歇正压通气,保持ＰＥＴＣＯ2475ｋＰａ左右。方法　45例患者随机分为三组,Ⅰ组(单次给药组)给予罗库溴铵06ｍ…     

罗库溴铵静脉注射部位疼痛的减轻方法观察

临床常用的静脉麻醉药，其中不少可引起病人注射部位疼痛，据统计50％-100％病人在接受某些亚剂量静脉麻醉药时常主诉不适或疼痛，因此，临床上已提出一些减轻或解除注射部位疼痛的方法，例如先静脉注射咪畦唑仑、芬太尼和利多卡因；或先静脉注射丙泊酚或硫喷妥钠，然后再注射罗库溴铵等方法，     

罗库溴铵在快速气管插管中的应用

罗库溴铵是目前起效最快的非去极化肌松药,其对喉肌的作用快于拇指内收肌,用2ED95剂量罗库溴铵的插管 条件较琥珀胆碱差,不同麻醉诱导药物可影响罗库溴铵的气管插管条件,用限时原则或预注原则行快速诱导气管插管时 2ED95剂量的罗库溴铵与1.5mg·kg-1琥珀胆碱插管条件相当。     

终末期肝病患者罗库溴铵的代谢途径

目的 探讨终末期肝病患者罗库溴铵的代谢途径.方法 拟行肝移植术的终末期肝病患者20例,年龄21～64岁,体重54～80 kg,ASAⅡ级或Ⅲ级.静脉注射异丙酚、芬太尼和罗库溴铵麻醉诱导,气管插管后机械通气.采用四个成串刺激监测肌松程度.麻醉维持:静脉输注异丙酚,吸入N2O,间断静脉注射芬太尼;待T1恢复到5%时,颈内静脉输注罗库溴铵,初始输注速率为3μg·kg-1·min-1,调节输注速率维持T15%～15%.记录无肝前期、无肝期及新肝期罗库溴铵用量,无肝期与无肝前期罗库溴铵用量的比值与术前Child-Push评分进行直线相关分析.结果 无肝前期、无肝期、新肝期罗库溴铵用量分别为3.2±1.2、1.7±0.6、(2.1±0.7)μg·kg-1·min-1,无肝期和新肝期罗库溴铵用量较无肝前期下降(P＜0.01),新肝期较无肝期罗库溴铵用量增加(P＜0.01).无肝期罗库溴铵用量为无肝前期的(54±16)%,无肝期与无肝前期罗库溴铵用量的比值与术前Child-Push评分成正相关(r=0.54,P＜0.05).结论 终末期肝病患者罗库溴铵更多地依赖肝外代谢.     

不同年龄患儿罗库溴铵药效学的比较

目的 比较新生儿、婴儿、幼儿和儿童罗库溴铵的药效学.方法 择期全麻手术患儿160例,ASAⅠ或Ⅱ级,根据年龄分为4组(n=40):新生儿组、婴儿组、幼儿组及儿童组.各组随机选取患儿20例,采用4次累积给药法静脉注射罗库溴铵,初始剂量:新生儿组40 μg/kg,婴儿组80 μg/kg,幼儿组及儿童组均为120 μg/kg,后3次均追加罗库溴铵40μg/kg.每次给药后.观察TOF反应.当T1连续3次稳定不变时,给予下一次剂量.采用概率单位法计算T1抑制50%、90%、95%的用药量(ED50、ED90、ED95).各组随机选取20例患儿,静脉注射2倍ED95剂量的罗库溴铵,记录肌松起效时间、高峰时间、临床肌松时间、体内作用时间和恢复指数.结果 与新生儿组比较,幼儿组和儿童组罗库溴铵ED50、ED90和ED95均升高(P<0.01),婴儿组上述指标差异无统计学意义(P>0.05).婴儿组、幼儿组和儿童组罗库溴铵起效时间、临床肌松时间和体内作用时间缩短,恢复指数降低(P<0.01);与幼儿组比较.儿童组罗库溴铵ED50、ED90和ED95升高(P<0.01).结论 不同年龄患儿对罗库溴铵的量效关系和时效关系存在明显的差别,新生儿对罗库溴铵的敏感性最强.     

全麻诱导后静脉注射罗库溴铵时的回避反应

目的：观察小儿与成年人在全麻诱导后，继以罗库溴铵静脉注射时的回避反应。方法：选择60例择期手术全身麻醉患者，年龄2岁至65岁，按年龄大小分为两组；小儿组，2-10岁，共30名；成人组，20—65岁，共30名。在硫贲妥钠静脉诱导后，继以罗库溴铵静脉注射（10秒），观察注药期间肢体不自主回避反应的发生频率与严重程度，并进行两组比较。结果：两组患者的性别无显着性差异，年龄、体重均有显着性差异。小儿组患者与成人组患者的回避反应发生频率与严重程度有显着性差异。结论：小儿患者在罗库溴铵注药时的回避反应发生频率与严重程度较成人患者为明显。     

Dilution of rocuronium to 0.5 mg/mL with 0.9% NaCl eliminates the pain during intravenous injection in awake patients

In a randomized, double-blinded, controlled study, we evaluated the effect of diluting rocuronium 10 mg/mL to 1 or 0.5 mg/mL with 0.9% NaCl on the pain associated with IV administration of rocuronium with small doses given before succinylcholine or nondepolarizing agent administration. One hundred fifty patients undergoing surgical procedures that required general anesthesia were randomized into three groups. Group 1 received rocuronium 10 mg/mL. Groups 2 and 3 received 1 and 0.5 mg/mL of rocuronium, respectively. Patient demographics, pain scores, osmolality, and the pH of the solutions were recorded. Group 1 had the most intense and frequent pain response. Eighty percent of patients in this group reported pain on injection. In Group 2, the incidence and intensity of pain were significantly less when compared with those of Group 1. In this group, 38% of patients reported pain during injection. In Group 3, none of the patients experienced pain on injection. The pH values and osmolalities of study solutions were not significantly different among groups. In conclusion, in awake patients, dilution of rocuronium 10 mg/mL at small doses given before succinylcholine or nondepolarizing agent administration of 0.06 mg/kg to 0.5 mg/mL with 0.9% NaCl is a simple and cost-effective strategy for preventing pain during IV rocuronium injection.     

Effect of narcotic pretreatment on pain after rocuronium injection: a randomized,double-blind controlled comparison with lidocaine

Various strategies have been studied to reduce the discomfort of rocuronium pain. These studies have shown fentanyl and lidocaine to be effective in reducing the incidence of pain on rocuronium injection. This prospective, randomized, and double-blind study was carried out on 80 neurosurgical patients for whom pain on rocuronium injection was assessed after pretreatment with lidocaine, fentanyl, sufentanil, or normal saline. The 80 neurosurgical patients were randomly allocated to anyone of the groups to receive lidocaine, fentanyl, sufentanil, or normal saline prior to being given rocuronium. The patients were asked about any discomfort in the hand, and also to rank that discomfort on a 5-point scale. In the normal saline group, the incidence of pain was 95%, of which 90% had very severe pain. In the lidocaine group, only 10% of patients reported pain, which was mild in nature. In the fentanyl group, 95% of patients had pain, of whom 25% had severe to very severe pain. In the sufentanil group, 85% of patients reported pain, of whom 25% fell into the severe to very severe group. We found that lidocaine was best at decreasing the incidence of pain on intravenous (i.v.) injection of rocuronium. Although the incidence of pain on injection of rocuronium with both fentanyl and sufentanil was high, the intensity was definitely reduced, with most patients falling in the mild pain group.     

Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment

We have assessed the incidence of pain on injection of rocuronium and evaluated if pretreatment with lidocaine i.v. reduced it, in a randomized, controlled study in 90 patients. We found that 37% of patients who received lidocaine 10 mg pretreatment had pain on injection of rocuronium compared with 77% of patients who received saline pretreatment and 7% of patients who were pretreated with lidocaine 30 mg (P < 0.05 in each instance compared with control). In addition, patients pretreated with lidocaine were less likely to suffer moderate or severe pain. Both lidocaine 10 mg and 30 mg i.v. given before administration of rocuronium significantly reduced the incidence and severity of pain on injection of rocuronium, and the higher dose was more effective.      

Cisatracurium or rocuronium versus rocuronium-cisatracurium combination

The present report evaluates the incidence of pain on intravenous injection and the condition of tracheal intubation at one minute following the administration of cisatracurium or rocuronium versus rocuronium-cisatracurium combination. We studied 60 patients, ASA 1, aged 18-60 years, undergoing elective surgical procedures. The patients were randomly assigned to 3 groups who received intravenously either 0.15 mg/kg cisatracurium [2ED95], 0,6 mg rocuronium [2ED95] or a combination of 0.075 mg/kg cisatracurium [1ED95], plus 0.3 mg rocuronium [1ED95]. In the awake patients, the pain on injection of muscle relaxant was assessed on a four point scale (none, mild, moderate, severe). Administration of the relaxant was followed by 1-2 mg/kg of lidocaine and 2 mg/kg propofol. Orotracheal intubation was performed 60 seconds following the administration of the relaxant. The intubating conditions were assessed and rated as excellent, good, fair or poor. The administration of 2ED95 cisatracurium resulted in poor intubating conditions at 60s, without pain on injection. In contrast, the administration of 2ED95 rocuronium resulted in excellent or good intubating conditions at 60s associated with high incidence of pain on injection in most of the patients. However, the combination of 1ED95 cisatracurium with 1ED95 rocuronium provided similar intubating conditions to the 2ED95 rocuronium alone, associated with a significantly less pain on injection.     

Spontaneous movements associated with rocuronium: is pain on injection the cause?

Spontaneous movements are sometimes observed of the arm into which rocuronium is administered. In order to assess a possible relationship between these movements and pain, we injected in 10 awake, ASA I patients, in a double-blind manner, both rocuronium 1 ml (10 mg) and 0.9% NaCI 1 ml (placebo), with a 30-s interval in between. None of the patients receiving placebo complained of pain, but eight of 10 patients reported a strong burning pain during injection of rocuronium with brisk flexion of the elbow and wrist, similar to those observed in patients after induction of anaesthesia. A second injection of rocuronium did not produce such pain and no movements were observed. We conclude that injection of rocuronium is associated with severe, burning pain of short duration, responsible for the spontaneous movements in the arm observed after induction of anaesthesia.      

Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium

OBJECTIVE: To determine the effect of esmolol on the frequency and severity of pain and withdrawal reactions after injection of rocuronium and to compare it with lidocaine and placebo. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Single university hospital. PATIENTS: 120 ASA physical status I and II patients undergoing general anesthesia for elective surgery. INTERVENTIONS: Patients were randomized to receive esmolol (0.5 mg/kg), lidocaine (0.5 mg/kg), or placebo, followed by a subparalyzing dose of rocuronium. After induction of anesthesia with propofol and fentanyl, an intubating dose of rocuronium 0.6 mg/kg was given. MEASUREMENTS: Patients were observed after injection of rocuronium 0.05 mg/kg, then immediately asked if they had pain in the arm. The response was assessed; discomfort, pain, and withdrawal of the hand were recorded and graded using a 4-point scale (none, mild, moderate, or severe). After the intubating dose of rocuronium, withdrawal reactions were scored as follows: (a) no pain response, (b) pain limited to the wrist, (c) pain limited to the elbow/shoulder, or (d) generalized pain response. RESULTS: 31 patients (77.5%) in the esmolol group, 32 (80%) in the lidocaine group, and 15 (37.5%) in the placebo group reported no pain (both groups vs placebo, P < 0.001). Moderate pain was seen in only one patient receiving lidocaine, in 6 placebo patients, but in none in the esmolol group (esmolol vs placebo, P < 0.05). Severe pain was felt by 8 patients receiving placebo, but by none receiving esmolol or lidocaine (P < 0.01). Frequency of withdrawal response after rocuronium was 2.5%, 17.5%, and 40% in the esmolol, lidocaine, and placebo groups, respectively (esmolol group vs placebo, P < 0.001; lidocaine group vs placebo, P < 0.05). CONCLUSION: Esmolol, like lidocaine, reduces the frequency of pain and withdrawal reaction associated with rocuronium injection.     

The prevention of pain from injection of rocuronium by magnesium sulphate,lignocaine, sodium bicarbonate and alfentanil

We compared the efficacy of magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil in minimizing pain due to injection of rocuronium in 250 patients. After tourniquet application on the forearm, the patients were given saline, magnesium sulphate, lignocaine, sodium bicarbonate 8.4% or alfentanil, diluted into a 3 ml solution. The occlusion was released after 20 seconds, and rocuronium was injected over 10 to 15 seconds. The patients were observed and asked immediately if they had pain in the arm and the response was assessed. Reactions such as discomfort and pain, withdrawal of the hand and screaming after the administering of the rocuronium were recorded as side-effects and patients were reassessed at 24 hours postoperatively. We concluded that magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil decreased the level of rocuronium injection pain. Of these drugs, magnesium sulphate, lignocaine and sodium bicarbonate were the most effective while alfentanil was the least effective.     

Women report more pain on injection of a precurarization dose of rocuronium: a randomized, prospective, placebo-controlled trial

BACKGROUND: The purpose of this study was to investigate whether gender influences the perception of pain on injection of rocuronium. METHODS: In this prospective, placebo-controlled trial 120 patients were randomized into four groups to receive rocuronium 0.03 mg kg(-1) (40 female and 40 male patients) or saline (20 female and 20 male patients). The incidence and severity of the injection pain after administration of the study drug was compared between female and male patients using a numerical rating scale (0-10). Signs of local irritation, i.e. erythema and thrombophlebitis, were assessed up to 48 h after surgery. RESULTS: In 26 (32.5%) of the 80 patients receiving rocuronium, pain on injection was observed. This occurred significantly more frequently in the female compared with male patients: 18 (45%) vs. eight (20%), respectively (P = 0.032). The severity was more pronounced in the women than in the men (P = 0.020). The incidence of the rocuronium-associated pain was significantly increased compared with the Saline groups (P < 0.001). After surgery no patient complained of any residual pain and no local signs were observed in any patient during the study period. CONCLUSIONS: Women experienced more pain on injection of rocuronium than men, moreover this is an additional evidence for gender-related differences in pain perception. When rocuronium is used as a precurarization agent, an analgesic pretreatment (e.g. opioids) should be considered, especially for female patients.     

Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients

BACKGROUND: We investigated the incidence of withdrawal, local reactions and pain on injection of rocuronium in 120 adult ASA I-II patients undergoing general anaesthesia (group A: 60 male patients, group B: 60 female patients). METHODS: After induction of anaesthesia with propofol and remifentanil, rocuronium 0.6 mg kg(-1) was injected in a separate intravenous cannula on the opposite arm. The patient's response to the injection of rocuronium was graded using a four-point scale. The appearance of local signs (i.e. erythema, venous sequelae) on the arm where rocuronium had been injected was recorded at the end of the injection as well as 1 h and 24 h after recovery from anaesthesia. Moreover, patients were asked 24 h after recovery from anaesthesia whether they had recall of pain or movements in this arm during induction of anaesthesia. RESULTS: In 26 of the 120 patients (22%) included, withdrawal reactions after injection of rocuronium were observed. Of these 26 patients, 16 (13%) had severe movements. The overall incidence of withdrawal reactions after rocuronium as well as the incidence of severe reactions was significantly higher in female patients compared to male patients (overall incidence: 18 females (30%) vs. 8 males (13%), P<0.05; severe reaction: 13 females (22%) vs. 3 males (5%), P<0.05). No local reactions were observed and no patient remembered any pain or movements during induction of anaesthesia. CONCLUSION: The incidence and the degree of withdrawal reactions in response to the injection of rocuronium were significantly higher in women than in men. This was not associated with adverse clinical consequences for the patient's outcome.