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.     

异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

七氟醚对不同性别患者罗库溴铵肌松作用的影响

目的 比较罗库溴铵肌松效应的性别差异和七氟醚对不同性别患者罗库溴铵肌松增效作用.方法 择期手术患者120例(男:女为1:1),年龄20～60岁.ASA Ⅰ或Ⅱ级,按性别随机分为丙泊酚组和七氟醚组:女性丙泊酚组(PF组).男性丙泊酚组(PM组),女性七氟醚组(SF组),男性七氟醚组(SM组),每组30例.所有患者静脉注射咪达唑仑、芬太尼和丙泊酚行麻醉诱导,意识消失后,置入喉罩,接麻醉机辅助通气并启动肌松监测.丙泊酚组静脉输注丙泊酚维持麻醉,设定血浆靶控浓度2～6 μg/ml,输注丙泊酚5 min后静脉注射罗库溴铵0.6 mg/kg,七氟醚组在呼气末七氟醚浓度稳定于1 MAC 5 min后静脉注射罗库溴铵0.6 mg/kg.记录肌松起效时间、完全肌松时间、T1恢复到25%和TOF恢复到25%的时间.结果 PM组较PF组起效时间长,完全肌松时间、T1恢复到25%和TOF恢复到25%的时间缩短(P＜0.05).SF组TOF恢复到25%的时间较PF组延长(P＜0.05),SM组较PM组起效时间缩短,完全肌松时间、T1恢复到25%和TOF恢复到25%的时间均延长(P＜0.05).SM组T1恢复到25%和TOF恢复到z5%的时间较SF组延长(P＜0.05).结论 女性罗库溴铵起效更快,作用时间长;而七氟醚对男性罗库溴铵的增效作用优于女性.     

罗库溴铵对老年病人的药效动力学影响

目的 研究罗库溴铵对老年病人的肌松效应。方法 94例ASA Ⅰ～Ⅱ级的病人按年龄分为4组,Ⅰ组为对照组(28例,32～59岁),Ⅱ组(29例,60～69岁),Ⅲ组(27例,70～89岁)和Ⅳ组(10例,90～97岁)。四组病人均于全麻诱导时静注罗库溴铵0.6mg/kg,并进行四个成串刺激(TOF)肌松监测。术中持续静注罗库溴铵,用注射泵调控给药剂量,T_1维持10％～20％至手术结束。记录罗库溴铵起效时间、T_1为零时间、首次给药后T_110％恢复时间、停药后T_125％恢复时间以及每30min罗库溴铵用量。结果 (1)Ⅰ组病人罗库溴铵起效时间明显比其余三组长(P<0.01),Ⅳ组病人肌松起效时间快于Ⅱ组和Ⅲ组(P<0.01)。(2)Ⅰ组病人T_1为零时间明显比其余3组病人长(P<0.01),Ⅱ、Ⅲ组T_1为零时间相近(P>0.05),Ⅳ组病人则短于Ⅱ组和Ⅲ组(P<0.01)。(3)Ⅰ组和Ⅱ组首次给药后T_110％恢复时间和停药后T_125％恢复时间显著快于Ⅲ组和Ⅳ组(P<0.01)。(4)不同年龄组罗库溴铵用量不同,随年龄增加而减少(P<0.01)。结论 随着年龄的增长,尤其在高龄病人罗库溴铵起效时间,达最大效能时间增快、维持用量减少和肌松持续时间延长。     

罗库溴铵预注和麻黄碱预处理对小儿罗库溴铵肌松起效的影响

目的 观察小儿在罗库溴铵预注、麻黄碱预处理和罗库溴铵预注复合麻黄碱预处理对罗库溴铵起效时间、插管条件和肌松时效的影响.方法 选择全麻下行择期手术的患儿80例,ASA Ⅰ或Ⅱ级,随机均分为四组.在麻醉诱导前预先静注:Ⅰ组生理盐水O.5 ml,Ⅱ组罗库溴铵0.06 mg/kg,Ⅲ组麻黄碱70 μg/kg,Ⅳ组罗库溴铵0.06 mg/kg和麻黄碱70 μg/kg.预注和预处理4min后,Ⅰ、Ⅲ组静注罗库溴铵0.6 mg/kg,Ⅱ、Ⅳ组静注罗库溴铵0.54 mg/kg.待四个成串刺激(TOF)第1个颤搐反应高度(Th)达最大阻滞程度后行气管插管.记录肌颤搐抑制75%、90%和达最大阻滞程度的时间,并评估气管插管条件,同时观察HR、BP变化.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ组的最大阻滞起效时间分别为(196±43)、(140±43)、(144±35)和(100±33)s,Ⅱ、Ⅲ、Ⅳ组的起效时间明显短于Ⅰ组(P＜0.05),Ⅳ组的起效时间较Ⅱ、Ⅲ组短(P＜0.05).各组气管插管条件均达到6～9分,优良率100%.各组麻醉诱导期间均无明显的心血管不良反应.各组的临床肌松作用时间和恢复指数差异均无统计学意义.结论 罗库溴铵预注和麻黄碱预处理分别使用均能缩短小儿罗库溴铵的肌松起效时间,而两种方法复合使用可进一步加快肌松起效,但该方法对罗库溴铵的肌松时效无明显的影响.     

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.     

性别对腹部手术病人罗库溴铵肌松作用的影响

目的研究性别对腹部手术病人罗库溴铵肌松作用的影响。方法拟在全麻下行腹部手术病人24例,年龄20-59岁,ASA Ⅰ或Ⅱ级,分为男性组(M组)与女性组(F组),每组12例。静脉注射异丙酚、芬太尼、罗库溴铵0．6 mg·kg-1行麻醉诱导。以4个成串刺激(TOF)监测神经肌肉阻滞深度,T1达最低时行气管插管。异丙酚靶控输注(效应室浓度3-4μg·ml-1)及静脉注射芬太尼维持麻醉。T1恢复至10％开始输注罗库溴铵,初始速率0．7 mg·kg-1·h-1,维持T1在5％-10％,术毕停用罗库溴铵,新斯的明0．05 mg·kg-1拮抗肌松效应,记录罗库溴铵的肌松作用指标。结果与F组比较,M 组身高与体重较高,T1最大抑制程度、罗库溴铵平均用药速率、新斯的明拮抗后T1自10％恢复到50％的时间、T1自25％恢复到75％的时间差异无统计学意义,起效时间延长,最大效应持续时间、T1恢复到10％的时间缩短;M组第1个10 min罗库溴铵用药平均速率大于其它时间段,且大于F组(P< 0．05)。结论单次静脉注射罗库溴铵的肌松作用存在性别差异,女性较男性病人敏感。     

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.     

维族和汉族患者罗库溴铵肌松时效的比较

目的 比较维族和汉族患者罗库溴铵的肌松时效.方法 择期拟在全麻下行甲状腺手术的维吾尔族患者(W组)和汉族患者(H组)各15例,ASA Ⅰ或Ⅱ级,性别不限,年龄20～55岁,体重45～73 kg.静脉注射咪达唑仑、异丙酚、芬太尼和琥珀胆碱行麻醉诱导气管插管后,静脉注射罗库溴铵0.6 mg/kg,采用加速度仪单个刺激模式监测肌松起效时间、无反应期、临床维持时间、75%恢复时间和恢复指数.结果 两组肌松起效时间比较差异无统计学意义(P>0.05);与H组比较,W组无反应期、临床维持时间、75%恢复时间及恢复指数均明显缩短(P<0.05).结论 维吾尔族与汉族患者罗库溴铵的肌松时效存在明显差别,临床上用量需要考虑民族差异的影响.     

肝功能不全门脉高压病人罗库溴铵的肌松效应

目的 观察罗库溴铵在肝功能不全门脉高压病人中的肌松效应。方法 70例ASA I-Ⅱ级择期行上腹部手术的病人分为两组:门脉高压组(M组,n=36),对照组(C组,n=34),其中门脉高压组肝功能均属Child-Turcottee分级法Ⅱ级,对照组肝功能正常。两组病人麻醉诱导均为静脉注射咪唑安定0.02 mg·kg-1、异丙酚1.0 mg·kg-1、芬太尼5μg·kg-1和罗库溴铵0.6 mg·kg-1,同时进行肌松监测。麻醉维持采用吸入异氟烷及间断静脉注射芬太尼,罗库溴铵微量泵持续静注维持肌松,维持T1在10％-20％直至手术结束。记录罗库溴铵起效时间,TOF无反应时间,首次给药后,T110％恢复时间,停药后T125％恢复时间,恢复指数以及每30 min罗库溴铵维持用量。结果 M组病人肌松药起效时间、TOF完全阻断时间、首次给药后,T110％恢复时间、停药后T125％恢复时间及恢复指数比C组病人延长(P<0.01)。M组病人持续输注罗库溴铵用量明显小于C组病人(P<0.01)。结论 肝功能不全的门脉高压病人罗库溴铵起效、维持时间和肌松恢复时间明显延长,维持用量明显减少。     

地氟醚七氟醚对糖尿病患者罗库溴铵肌松效应影响的比较

目的 比较地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响.方法 择期2型糖尿病腹部手术患者60例,年龄45～64岁,ASA分级Ⅱ级,采用随机数字表法分为3组,每组20例:地氟醚组(DD组)、七氟醚组(SD组)和异丙酚组(PD组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,3组分别用异丙酚、地氟醚和七氟醚维持麻醉.记录肌松维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及T4/T1比值[四个成串刺激(train-of-four stimulation, TOF)比值].结果 DD组和SD组患者罗库溴铵的维持时间[(61±17),(60±18) min]、恢复指数[(36±12),(35±10) min]之间差异无统计学意义(P＞0.05),且均大于PD组(P＜0.05).DD组、SD组患者静脉注射罗库溴铵后60～120 min时T1/T0比值和TOF比值差异无统计学意义(P＞0.05),且均大于PD组(P＜0.05).结论 地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响差异无统计学意义.     

七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应影响的比较

目的 比较七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应的影响.方法 择期腹部手术患者60例,年龄45～64岁,ASAⅡ级,其中Ⅱ型糖尿病患者30例,随机分为2组(n=15):异丙酚组(PD组)和七氟烷组(SD组);非糖尿病患者30例,随机分为2组(n=15):异丙酚组(PN组)和七氟烷组(SN组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,PD组和PN组静脉注射罗库溴铵0.6 mg/kg后气管插管,静脉输注异丙酚维持麻醉;SD组和SN组1%地卡因充分表面麻醉后气管插管.吸入七氟烷(呼气末浓度1.71%)10 min后静脉注射罗库溴铵0.6 mg/kg,吸入七氟烷(呼气末浓度1.71%)维持麻醉.记录肌松起效时间、维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及TOF比值(T4T1比值).结果 PN组与PD组、SN组与SD组、PD组与SD组间罗库溴铵起效时间、维持时间比较差异无统计学意义(P>0.05).与SN组和PD组比较,SD组恢复指数延长(P<0.05).静脉注射罗库溴铵后60～120 min,SD组T1/T0比值和TOF比值较PD组降低(P<0.05);静脉注射罗库溴铵后80～120 min,SD组TOF比值较SN组降低(P<0.05).结论 与非糖尿病患者相比,七氟烷对糖尿病患者罗库溴铵肌松效应的强化作用进一步增强.     

Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children

This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1+/-8.8 min and the recovery index (time between T25 and T75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.     

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.     

Recovery from neuromuscular blockade after either bolus and prolonged infusions of cisatracurium or rocuronium using either isoflurane or propofol-based anesthetics

We examined the recovery characteristics of cisatracurium or rocuronium after bolus or prolonged infusion under either isoflurane or propofol anesthesia. Sixty patients undergoing neurosurgical procedures of at least 5 h were randomized to receive either isoflurane with fentanyl (Groups 1 and 2) or propofol and fentanyl (Groups 3 and 4) as their anesthetic. Groups 1 and 3 received cisatracurium 0.2 mg/kg IV bolus, spontaneously recovered, after which time an infusion was begun. Groups 2 and 4 received rocuronium 0.6 mg/kg IV, spontaneously recovered, and an infusion was begun. Before the end of surgery, the infusion was stopped and recovery of first twitch (T(1)), recovery index, clinical duration, and train-of-four (TOF) recovery was recorded and compared among groups by using appropriate statistical methods. Clinical duration was shorter for rocuronium compared with cisatracurium using either anesthetic. Cisatracurium T(1) 75% recovery after the infusion was shorter with propofol compared with isoflurane. Cisatracurium TOF 75% recovery was similar after either bolus or infusion, but rocuronium TOF 75% recovery after the infusion was delayed. Infusion rates decreased for cisatracurium but remained relatively constant for rocuronium regardless of the anesthetic used. Isoflurane enhances the effect of both muscle relaxants but prolonged cisatracurium recovery more than rocuronium. Of the two muscle relaxants studied, rocuronium's recovery was most affected by length of the infusion. Cisatracurium may be a more desired muscle relaxant for prolonged procedures because recovery was least affected by prolonged infusion. Implications: This study describes the effect of different anesthetic techniques on the recovery of two different muscle relaxants, cisatracurium and rocuronium, when administered as either a single bolus or prolonged infusion during neurosurgery. This study demonstrates the feasibility of using these relaxants for these prolonged procedures.     

国产与进口罗库溴铵的药效学及对循环功能影响的比较

目的 比较国产和进口罗库溴铵的药效学及对循环功能的影响.方法 择期全麻手术患者210例,年龄18～65岁,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=105):国产罗库溴铵组(Ⅰ组)和进口罗库溴铵组(Ⅱ组).采用TOF-Wateh(R) SX型加速度肌松监测仪刺激尺神经,观察拇内收肌颤搐情况.记录静脉注射插管剂量(0.6 mg/kg)的罗库溴铵后气管插管条件、肌松起效时间、临床作用时间、最大肌颤搐抑制程度、75%恢复时间、恢复指数、循环指标完全恢复时间、血液动力学指标及不良事件的发生情况.结果 两组肌松起效时间、临床作用时间、恢复指数、肌颤搐最大抑制程度、气管插管条件、循环指标完全恢复时间、给肌松药前后血液动力学指标及不良事件发生率比较差异无统计学意义(P＞0.05),Ⅱ组75%恢复时间长于Ⅰ组(P＜0.05).结论 国产罗库溴铵与进口罗库溴铵具有相似的药效学特性,对循环功能无明显不利影响.

Abstract：

Objective To compare the phaimacodynamics and circulatory function of domestic and imported rocuronium. Methods This is a five center study of rocuronium. Two hundred and ten ASA Ⅰ or Ⅱ patients aged 18-65 yr undergoing elective surgery under general anesthesia were randomly divided into 2 groups (n = 105 each): domestic rocuronium group (group Ⅰ ) and imported rocuronium group (group Ⅱ ) . Anesthesia was induced and maintained with TCI of propofol (target plasma concentration = 3 mg/L) and remifentanil (target effect-site concentration = 2-4 μg/L) . Tracheal intubation was facilitated with intravenous rocuronium 0.6 mg/kg. The N-M function was assessed by accelerography (TOF-Watch(R) SX, Organon, Netherlands) using TOF stimulation of ulnar nerve. Onset time, clinical duration, 75% recovery time,recovery indexes, the extent of maximal NM blockade and intubation conditions (ease of laryngoscopy, position of vocal cords and airway reaction) were monitored and recorded. BP and HR were also recorded. Results There were no significant differences in the onset time, clinical duration, recovery indexes, the extent of maximal N-M blockade, the intubation conditions, BP, HR and adverse reactions between groups Ⅰ and Ⅱ ( P ＞ 0.05) . The 75% recovery time was significantly longer in group Ⅱ than in group Ⅰ (P ＜ 0.05＝. Conclusion The pharmacodynamics of domestic and imported rocuronium is comparable. The two drugs have no adverse effect on the circulatory function.     

Pharmacodynamics and pharmacokinetics of rocuronium in intensive care patients

We have studied dose requirements, recovery times and pharmacokinetics of rocuronium in 32 intensive care patients. After an initial dose of 50 mg, rocuronium was administered as maintenance doses of 25 mg whenever two responses to train-of-four (TOF) stimulation reappeared (bolus group; n = 27) or by continuous infusion to maintain one response in the TOF (infusion group; n = 5). Median requirements for rocuronium were 27.4 (range 14.5-68.3) mg h-1 and 43.7 (30.9-50.3) mg h- 1 in patients in the bolus and infusion groups, respectively. Median total duration of rocuronium administration was 29.0 (12.4-95.5) h and 63.4 (24.0-140.3) h, respectively. Median time from administration of the last bolus dose and end of infusion to recovery of the fourth twitch in the TOF was 100 (45-300) min and 60 (15-155) min, respectively. Arterial blood samples were obtained for up to 10 h after cessation of rocuronium administration, and concentrations of the parent compound and its putative metabolites were measured using high pressure liquid chromatography (HPLC). The plasma concentration profile (n = 12) was described adequately by a two-compartment model. Mean plasma clearance (Cl), steady-state distribution volume (Vss), mean residence time (MRT) and elimination half-life (T1/2 beta) were 3.16 (SD 1.15) ml kg-1 min-1, 769 (334) ml kg-1, 262 (120) min and 337 (163) min, respectively. Recovery times, Vss, MRT, and T1/2 beta differed from previously published data obtained after rocuronium infusion of moderate duration in surgical patients.      

The effect of succinylcholine on atracurium–induced neuromuscular block

Background : The interaction between prior succinylcholine and atracurium has been found only after full recovery of succinylcholine block. We investigated whether the effect of succinylcholine on atracurium block may depend on the level of recovery from succinylcholine.
Methods : Fifty patients in 4 groups received atracurium 0.2 mg/ kg when first response (Tl) in train–of–four (TOF) after succinylcholine 1 mg/kg had recovered to 5%, 25%, 75% or 100%. A control group received only atracurium. The following indices were compared: the time from injection of atracurium to maximum block (onset time) and to return of Tl to 25% (duration 25%), maximal depression of Tl, time from 25% to 75% recovery of Tl (interval 25–75%) and time from injection of atracurium to a TOF ratio of 0.75 (duration TOF 0.75).
Results : Onset time was shorter, max Tl depression was greater and duration 25% increased the more succinylcholine recovery progressed. Neither interval 25–75% nor duration TOF 0.75 varied with the level of recovery from succinylcholine. The control group showed a shorter latency and onset time compared to the early (5%) recovery group and a longer onset time and less depressed Tl compared to the late (100%) recovery group. There was no difference between the control group and the early or late recovery groups, respectively for duration 25% or duration TOF 0.75.
Conclusion : The effect of prior administration of succinylcholine on atracurium block depends on the state of recovery from succinylcholine and concerns both its potency, onset and duration characteristics.     

Clinical study of interaction between rocuronium and some commonly used antimicrobial agents

The onset and duration of clinical relaxation and reversibility of rocuronium bromide (ORG 9426) 0.6 mg kg-1 were studied following administration of netilmicin 2 mg kg-1 (n = 10) or cefuroxime 20 mg kg-1 (n = 10) in patients undergoing urological surgery; and cefuroxime 20 mg kg-1 (n = 10) metronidazole 7.5 mg kg-1 (n = 10), metronidazole 7.5 mg kg-1 and cefuroxime 20 mg kg-1 (n = 10), or placebo (n = 10) in patients undergoing abdominal surgery under anaesthesia with thiopentone, nitrous oxide in oxygen, fentanyl and halothane. The antimicrobial agents were administered intravenously 5 min before rocuronium. Neuromuscular function was monitored using mechanomyography and train-of-four (TOF) mode of stimulation. Onset of neuromuscular block occurred in approximately 60 s with all patients achieving complete block. The mean clinical duration (+/- SD) was 50 +/- 10.7 and 44 +/- 6.7 min following netilmicin and cefuroxime respectively in patients undergoing urological surgery; and 49 +/- 13.7, 44 +/- 11.1, 48 +/- 11.1 and 38 +/- 7.3 min in the groups undergoing abdominal surgery receiving cefuroxime, metronidazole, cefuroxime and metronidazole combination and placebo respectively. There were no statistically significant differences between the groups in either the onset or the duration of clinical relaxation. Reversal of neuromuscular block with neostigmine carried out at spontaneous recovery of T1 (first response in the TOF) of 25% or more was easily achieved in all groups in 2-4 min. It is concluded that there is no significant interaction between rocuronium and single doses of the antimicrobial agents used in the present study.     

The prolonged duration of rocuronium in Chinese patients

We compared the potency and duration of action of rocuronium in Chinese and Caucasian patients during general anesthesia. Thirty-six women (18 Caucasian and 18 Chinese) and 36 children (18 Caucasian and 18 Chinese) were evaluated during the administration of propofol/fentanyl anesthesia. Patients in each age group were randomized into three subgroups to receive single doses of 0.06, 0. 12, or 0.18 mg/kg rocuronium (adults) or 0.12, 0.18, or 0.24 mg/kg rocuronium (children). Neuromuscular blockade was assessed by electromyography of the adductor pollicis after train-of-four (TOF) stimulation of the ulnar nerve. Dose response curves were constructed when maximum neuromuscular depression of the first twitch of the train (T(1)) was obtained. A second bolus dose of rocuronium was then administered to a total dose of 0.6 mg/kg. The times of spontaneous recovery to T(1) 10%, 25%, and 90% of control and to TOF 0.25, 0.50, and 0.70 were recorded. For both adults and children, recovery occurred later in Chinese than in Caucasian patients (P<0.05 for T(1) of 10%, 25%, 75%, and 90% and TOF to 0.7). The 50% effective dose was smaller in Chinese adults (125+/-63 vs. 159+/-66 microg/kg) and Chinese children (171+/-43 vs. 191+/-46 microg/kg) than in Caucasian adults and children, but the difference was not statistically significant. In adults, time to 25% T(1) recovery was 43+/-13 min in Chinese patients and 33+/-10 min in Caucasian patients (P<0.05). The corresponding values were more rapid for children: 30+/-10 and 24+/-6 min (P<0.05). We conclude that the recovery from rocuronium neuromuscular blockade was longer in Chinese compared with Caucasian patients and in adults compared with children.