布比卡因硬膜外麻醉对泮库溴铵肌松时效的影响

目的;观察布比卡因硬膜外麻醉对泮库溴铵肌松时效的影响,为临床减少复合全麻用药提供理论依据。方法:40例行上腹部手术患者,随机分为两组。A组选用泮库溴铵肌松全麻。B组选用泮库溴铵肌松全麻加用布比卡因硬膜外麻醉。分别观察两组泮库溴铵肌松时效。结果:A组和B组泮库溴铵肌松起效时间分别为3.7±0.5分和3.5±0.7分(P>0.05)。无反应期分别为35±4.1分和38±2.3分(P<0.01)。25％NMB恢复时间分别为41±6.7分和48±5.6分(P<0.01)。75％NMB恢复时间分别为71±8.1分和89±6.7分(P<0.01)。恢复指数分别为30.1±1.7和31.1±1.6(P>0.05)。结论:布比卡因硬膜外麻醉可使泮库溴铵肌松时效增强。     

七氟醚、异氟醚和安氟醚麻醉对哌库溴铵肌松作用影响的比较

哌库溴铵是一种由泮库溴铵衍化而来的长效非去 极化类固醇类肌松药,其肌松作用与泮库溴铵相同,几无心血管副作用和组胺释放作用。但与七氟醚合用时的相互作用尚无报道。为此,作者比较了哌库溴铵在七氟醚麻醉下与安氟醚和异氟醚麻醉下的肌松作用。择27例ASA分级1或2级行择期耳鼻喉或整形小手术的成年病人(女18例,男9例,22～60岁)进行研究。所有病人均无肾脏、肝脏或神经肌肉疾病及服用,     

冠脉搭桥时比较哌库溴铵和泮库溴铵对病人血流动力学和血浆儿茶酚胺的影响

泮库溴铵兼有解迷走和拟交感神经作用,所以在冠心病病人手术期间使用可以拮抗阿片类药物对循环的不良影响。但给冠心病病人使用芬太尼—泮库溴铵诱导时,约25％在心电图上显示心肌缺血,心率比基础值增快28％～57％,提示泮库溴铵可能增大去甲肾上腺素的血浆浓度。哌库溴铵的结构类似泮库溴铵,肌松作用与药代动力学也相仿,但对自律神经系统却无影响。冠状搭桥术时,为了观察用哌库溴铵诱导和气管插管对心血管及血浆儿茶酚铵的影响,因此与使用泮库溴铵进行比较。     

泮库溴铵和阿曲库铵对慢肌和快肌神经肌肉阻滞效应的比较研究

应用１４只大鼠坐骨神经－比目鱼肌（慢肌）、胫骨前肌（快肌）在体实验模型，以肌松药累积给药方法，比较泮库溴铵和阿曲库铵对慢肌和快肌神经肌肉阻滞的效应。结果发现在慢肌和快肌之间，泮库溴铵或阿曲库铵肌肉颤搐抑制的ＥＤ５０、ＥＤ９０、恢复指数、最大阻滞和最大恢复基本相似（Ｐ〉０．０５）。提示慢肌与快肌人间泮库溴铵或阿曲库铵神经肌肉阻滞的量－效关系和时－效关系无明显差异。     

硫酸镁对顺阿曲库铵肌松效应时效关系的影响

顺式阿曲库铵是阿曲库铵的同分异构体,其肌松效应约为阿曲库铵的3倍.因其起效时间较长,快速诱导气管插管时常采用增大用药剂量的方法缩短其起效时间,但易导致肌松维持和恢复时间延长.研究表明,镁离子可有效缩短维库溴铵、泮库溴铵及阿曲库铵的起效时间[1-3],而其对顺阿曲库铵的起效时间的影响尚不清楚.因此本研究拟探讨硫酸镁对顺阿曲库铵肌松效应时效关系的影响.     

持续肌松在ICU成年危重病患者中的应用指南

不同的推荐级别共给出了３种可在成年患者中常规应用的持续肌松的推荐用药方法，包括泮库溴铵，维库溴铵和肌松监测的使用等。     

给患儿持续点滴维库溴铵

作者给在重症监护治疗室(ICU)内进行机械通气的患儿,使用静滴维库溴铵,既提高通气疗效,又加快透明膜疾病患儿的恢复,而且比其它肌松药例如箭毒或泮库溴铵(本可松)优越。维库溴铵药效短,无蓄积,对心血管也无明显副     

肌松药对心血管及自主神经的影响

心血管手术的麻醉均离不开肌松药,而常用的肌松药又可能发生心血管的副作用。主要通过兴奋或抑制周围自主神经(植物神经)或从组织中肥大细胞和循环中嗜碱细胞释放组胺及可能产生血管活性物质影响血流动力学改变。去极化肌松药如琥珀胆碱去极化时可继发高血钾症。非去极化肌松药中甾类如泮库溴铵(Pan)多可阻滞心脏毒蕈样受体出现心动过速     

肾脏病与肌肉松驰药

本文讨论肌肉松驰药在慢性肾衰病人麻醉期应用。概述了这些病人应用筒箭毒、阿库溴铵和泮库溴铵的缺点及阿屈库铵和维库溴铵的优点。初步报道了哌库溴铵、美维松、达可松和罗库溴铵在肾病患者应用中的利弊。     

肾脏病与肌肉松弛药

本文讨论肌肉松弛药在慢性肾衰病人麻醉期间的应用。概述了这些病人应用简箭毒、阿库溴铵和泮库溴铵的缺点及阿屈库铵和维库溴铵的优点,初步报道了哌库溴铵、美维松、达可松和罗库溴铵在肾病患者应用中的利弊。     

Onset Time for Alcuronium and Pancuronium after Cremophor-Containing Anaesthetics

Cremophor is a nonionic, surface-acting agent, previously shown to bind to proteins and biological membranes. The compound is used as a solvent for certain anaesthetics. The effects of this surfactant on the onset times for alcuronium and pancuronium were investigated. Both artery-to-muscle (A-M) and vein-to-muscle (V-M) onset times were determined after cremophor- and non-cremophor-containing induction agents. Circulatory effects of the surfactant were investigated by measuring the blood velocity of the brachial artery using pulsed Doppler ultrasound. A significant reduction in both A-M and V-M onset times was found for pancuronium after cremophor-containing anaesthetics. However, no difference was found for the onset times for alcuronium in the two induction groups. In contrast to alcuronium, there was no significant difference between A-M and V-M onset times for pancuronium. Arterial blood velocity was found to be practically the same after cremophor and non-cremophor induction agents. The possibility of a stronger affinity of pancuronium than alcuronium to intravascular binding sites is suggested. Cremophor might, due to its protein and membrane effects, interfere with pancuronium association to these sites.     

Comparison of the hemodynamic effects of fazadinium, pancuronium and alcuronium in coronary insufficiency (30 cases)

Cardiovascular effects of neuromuscular blocking agents mainly guide the choice of these relaxants in patients with cardiovascular disease. The purpose of this study was to compare the hemodynamic effects of fazadinium (1 mg . kg-1), pancuronium (0,08 mg . kg-1) and alcuronium (0,2 mg . kg-1) in 30 coronary patients without beta-blocking therapy. No hemodynamic changes were observed after pancuronium. Fazadinium induced at the fifth minute a mean five p. 100 decrease in mean arterial pressure, cardiac index, stroke volume and systemic vascular resistance. At the fifth minute with alcuronium, mean arterial pressure decreased (22 p. 100) (p less than 0.01) with a decrease in cardiac index (12 p. 100), stroke volume (8 p. 100) and systemic vascular resistance (10 p. 100). This study shows that pancuronium and fazadinium are well tolerated. Alcuronium induces at the fifth minute a significant decrease in arterial pressure. This effect does not seem to be deleterious in normovolemic patient with coronary artery disease without beta-blocking therapy.     

ARTERIAL HYPOTENSION CAUSED BY A COMBINATION OF RAISED INTRATHORACIC PRESSURE AND CERTAIN MUSCLE RELAXANTS

A pilot study was made of the effects of raised intrathoracicpressure on arterial blood pressure shortly after the intravenousadministration of three non-depolarizing muscle relaxants. Meanairway pressure was measured as an index of intrathoracic pressureduring intermittent positive pressure respiration. Appreciablefalls of blood pressure were observed within 10–15 minutesafter the administration of tubocurarine and to a lesser extentafter alcuronium but not after administration of pancuronium.This effect was especially marked in elderly patients and thosewith severe cardiovascular disease.     

BRADYCARDIA DURING ANTAGONISM OF PANCURONIUM-INDUCED NEUROMUSCULAR BLOCK

Heart rate was compared in matched patients during antagonismof neuromuscular block induced by tubocurarine, pancuroniumor alcuronium with neostigmine 0.03 mg kg^–1 preceded byatropine 0.015 mg kg^–1. The frequency of bradycardia wasgreater during antagonism of pancuronium compared with alcuronium.Although there was a difference between the group receivingpancuronium and that receiving tubocurarine, it was not statisticallysignificant. The decrease in heart rate was more rapid and profoundin the pancuronium group; seven of the 15 patients who receivedpancuronium required an additional dose of atropine as comparedwith only one patient who received tubocurarine. However, thedifference in heart rate between those who received pancuroniumand those receiving tubocurarine was short-lasting, whereasthe heart rate of those who received alcuronium was higher thanthat in the other groups during the entire 60-min period ofobservation. The findings with pancuronium may be a result ofits inhibitory effect on serum cholinesterase.     

RELATIVE POTENCY OF ORG NC 45, PANCURONIUM, ALCURONIUM AND TUBOCURARINE IN ANAESTHETIZED MAN

The relative potency, time-course of action and cardiovasculareffects of Org NC 45, a new non-depolarizing neuromuscular blockingagent, have been compared with those of pancuronium, alcuroniumand tubocurarine in 64 anaesthetized patients. The relativepotency (ED₅₀) to Org NC45 was 1.74, 3.69 and 8.57 respectively.In doses which caused useful surgical relaxation, duration ofaction of Org NC 45 was 34%, 39% and 26% that of pancuronium,alcuronium and tubocurarine. After administration of repeateddoses no cumulation was seen for Org NC 45. The new drug wasfree from any effect on arterial pressure and heart rate.     

Does the choice of the neuromuscular blocking agent affect the cardiovascular response to intubation?

Heart rate and arterial pressure changes induced by tracheal intubation, 3 min after administration of atracurium, vecuronium, tubocurarine, pancuronium or alcuronium, have been studied under thiopentonenitrous oxide-oxygen anaesthesia supplemented by either 0.5% halothane or fentanyl 2 micrograms kg-1. Pancuronium and alcuronium were associated with the greatest increase in heart rate and tubocurarine with the greatest decrease in arterial pressure prior to intubation. Following intubation, all groups, with the exception of tubocurarine showed a similar and significant rise in heart and arterial pressure when compared with control values. The cardiovascular response to intubation, particularly the effect on heart rate, was less marked when fentanyl was given at induction and was short lived with atracurium and vecuronium. Although those patients who received tubocurarine showed no significant rise in arterial pressure following tracheal intubation, this was due to significant hypotension occurring in this group prior to intubation.     

Comparison of muscle relaxants in clinical use.

A prospective clinical comparison of d-tubocurarine, alcuronium, gallamine and pancuronium was performed in 400 surgical patients. Various parameters usually followed during clinical anaesthesia were recorded from the beginning of, to the recovery from anaesthesia. Endotracheal intubation was performed with or without suxamethonium. Intubation was always possible in 1-3 min when different muscle relaxants were used in the following initial doses: d-tubocurarine 0.4 mg/kg, alcuronium 0.3 mg/kg, gallamine 1.8 mg/kg, and suxamethonium 0.8 mg/kg. However, there was a statistically significant inferiority of the d-tubocurarine and gallamine groups. The use of suxamethonium seemed to shorten the duration of the initial dose of the nondepolarising agents and also to increase especially the dose of gallamine when calculated as mg/kg/h. It should be mentioned that the non-depolarising agents were given soon after suxamethonium without waiting for the return of spontaneous respiration. Pancuronium and alcuronium caused least changes in the cardiovascular parameters. Erythematous skin reactions were seen mostly after the use of d-tubocurarine and suxamethonium. This could depend on histamine liberating potency of these muscle relaxants.     

QT interval of the ECG, heart rate and arterial pressure using five non-depolarizing muscle relaxants for intubation

The QT interval, heart rate and arterial pressure were measured during anaesthetic induction in 186 patients without cardiovascular diseases or any preoperative drugs. The study was randomized and double-blind. The patients were premedicated with either pethidine 1 mg/kg + atropine 0.01 mg/kg or with only pethidine 1 mg/kg i.m. Anaesthesia was induced with thiopental. After both types of premedication, either d-tubocurarine 0.5 mg/kg, alcuronium 0.3 mg/kg, pancuronium 0.1 mg/kg, vecuronium 0.1 mg/kg or atracurium 0.5 mg/kg was injected after thiopental. Laryngoscopy was performed 4 min after the relaxant. The control values of the QT intervals (mean value 433 ms, range of the mean values 422-453 ms), were comparable. After thiopental, the mean values in the groups were no longer in the normal range (less than 440 ms). After atropine, the values at 3 min were statistically significantly prolonged in the pancuronium, atracurium and alcuronium groups, but not in the other groups, when compared with the values after thiopental. In the absence of atropine, no statistically significant prolongation of the QT interval occurred. After intubation in the absence of atropine, the values were statistically significantly prolonged in the alcuronium, pancuronium, vecuronium and atracurium groups and in the presence of atropine in the atracurium group when compared with the preceding values. The QT intervals were prolonged only in relation to the increased heart rate. At 6.5 min, the values in all groups were decreased to about the same level as before intubation. The mean control values of the heart rate were between 80 and 90 b.p.m. in the atropine-treated groups and between 70 and 80 b.p.m. in the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Precurarization on the Blood Pressure and Heart Rate Changes Induced by Suxamethonium Facilitated Laryngoscopy and Intubation

The effects of precurarization on blood pressure and heart rate increases during laryngoscopy and intubation were studied in 60 surgical patients, who were randomly allocated to four groups, receiving as a pretreatment d-tubocurarine (0.05 mg/kg), alcuronium (0.03 mg/kg), pancuronium (0.008 mg/kg) or saline in a double-blind fashion. d-Tubocurarine and alcuronium pretreatments seemed to attenuate the blood pressure increase during laryngoscopy and intubation under suxamethonium. Moreover, d-tubocurarine pretreatment protected effectively against high blood-pressure increases. Heart-rate increases were of the same magnitude in all the pretrealed groups. d-Tubocurarine pretreat ment abolished suxamethonium-induced fasciculations completely, whereas alcuronium pretreatment gave protection in 93% and pancuronium pretreatment in 43% of patients.     

Five Non-Depolarizing Muscle Relaxants in Precurarization

Five different non-depolarizing muscle relaxants and a control solution of saline were studied as precurarization agents. Two hundred and twenty-two surgical patients (ASA I-II) were allocated in a double-blind fashion to one of the following groups: d-tubocurarine 0.05 mg/kg, alcuronium 0.03 mg/kg, pancuronium 0.01 mg/kg, gallamine 0.25 mg/kg, ORG NC-45 (vecuronium) 0.01 mg/kg and saline solution 0.005 ml/kg. Pretreatment was performed 4 min before administering a 1.5 mg/kg bolus of succinylcholine (SCh). Fasciculations, intubation conditions, duration of neuromuscular blockade after SCh, serum potassium changes and postoperative myalgias (in 60 patients) were recorded. All the drugs studied prevented fasciculations significantly (P less than 0.05) more than in the control group. d-Tubocurarine and alcuronium were superior to the others in this respect. Intubation conditions were best in the control and pancuronium groups, but there was no significant difference between the pancuronium and d-tubocurarine or between the d-tubocurarine and alcuronium groups. Pancuronium pretreatment prolonged the SCh block significantly, whereas other agents shortened the duration of the SCh block. The antagonism of the SCh block apparently also affected intubation conditions, although intubation remained satisfactory. A statistically significant rise in serum potassium level was measured only in the control and pancuronium groups. In the control and pancuronium groups, four patients out of 10 had postoperative myalgias, whereas in the other groups only one or none out of 10 had them (0/10 vs. 4/10; 0.10 greater than P greater than 0.05). In conclusion, d-tubocurarine and alcuronium seem to have advantages over pancuronium, ORG NC-45 and gallamine for precurarization.