静注琥珀胆碱对潘库溴铵作用不同时期的影响

本文对１０例潘库溴铵作用肌松的病人，用外周神经刺激器刺激尺神经和二道生理记录仪行拇指肌力监测，观察了非去极化肌松药在体内消除的三个不同时期静注琥珀胆碱和术毕肌作作用完全消失前注射新斯的明后的肌力变化情况。作者发现：１。潘库溴铵消除过程中应用琥珀胆碱，不论是否发生短暂的肌松对抗效应，其后均能较长时间地加强肌松作用肌     

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。     

潘库溴铵与维库溴铵,阿曲库铵合用的实验研究

目的：将结构相近的潘库溴铵与维库溴铵和结构不同的潘库溴铵与阿曲库铵合用，比较其作用效果以判别相互作用的类型。方法：以刺激电极和力－位移换能器监测兔胫前肌的阻滞程度。选１５只新西兰白兔通过累积给药法求得兔三种药物的ＥＤ５０值。再将２０只新西兰白兔随机分为４组，分别采用潘库溴铵与维库溴铵、阿曲库铵合用、按不同顺序给药的方法。每种肌松药剂量为１／２×ＥＤ５０。结果：潘库溴铵与阿曲库铵合用，Ｔ１抑制９２％～９７％，明显高于５０％（Ｐ＜０．０１），提示有协同作用；而潘库溴铵与维库溴铵合用，Ｔ１仅抑制３９％～５２％。结论：非去极化肌松药间之相互作用与药物结构相关。     

硫酸镁对妇科腹腔镜手术患者阿曲库铵神经肌肉阻滞效应的影响

镁离子是维持机体许多正常生理功能所必需的物质，可影响临床麻醉中的镇静药、镇痛药及神经肌肉阻滞药的药代动力学及药效学。非去极化肌松药阿曲库铵经HofmAnn消除，具有无药物蓄积的特点而在临床中广泛应用。有研究表明镁离子可增强潘库溴铵、维库溴铵、罗库溴铵等非去极化肌松药的药效，并延长其作用时间，但镁离子对阿曲库     

罗库溴铵和维库溴铵对离体大鼠膈肌神经肌肉接头终板电位起始衰减的影响

目的探讨罗库溴铵和维库溴铵对大鼠膈肌-膈神经不均匀牵拉标本神经肌肉接头终板电位(EPP)最初衰减的影响。方法健康成年Wistar大鼠,体重160～220g,雌雄不拘。快速处死大鼠制备离体膈肌-膈神经不均匀牵拉标本;记录到正常微终板电位和EPP后,分别观察浓度为4×EC_(95)、2×EC_(95)、1×EC_(95)、0．5×EC_(95)的罗库溴铵和维库溴铵对EPP幅度及串EPP最初衰减的影响。结果罗库溴铵和维库溴铵对EPP幅度和串EPP最初衰减均有不同程度的抑制作用。与维库溴铵相比,罗库溴铵的起效时间缩短,且抑制程度较高。结论罗库溴铵和维库溴铵均有一定程度的突触前抑制作用,与维库溴铵相比,罗库溴铵起效更快、作用更强。     

维库溴铵在糖尿病患者的肌松效应

神经肌肉松弛药在糖尿病患者的肌松效益的研究报道较少。本文通过观察维库溴铵的神经肌肉阻滞时效在糖尿病与非糖尿病患者中的差异,探讨维库溴铵对糖尿病患者的肌松效应。资料与方法一般资料选择全麻下耳鼻喉科择期手术患者20例,男12例,女8例;年龄(59.7 13.4)岁,体重(61.3 15.8     

有关四种甾族类肌松药呼吸制约效应的研究

分别给全麻后大白鼠单次及持续静注预计在胫前肌（Ｔ）产生８０％￣９０％阻滞的甾族非去极化肌松药潘库溴铵、哌库溴铵（以上为长效药）、维库溴铵、罗库溴铵（以上为短效药），观察膈肌（Ｄ）与Ｔ的最大阻滞率、最大作用出现时间、阻滞恢复时间。结果：Ｄ最大作用出现时间及恢复时间均比Ｔ快，阻滞率明显低于Ｔ，持续静注时，长效药的Ｄ与Ｔ阻滞率之差更显著。结论：四种肌松药均存在呼吸制约效应，且长效药更为明显。     

围术期TOF监测与残余肌松潘库溴铵与维库溴铵的比较

目的研究潘库溴铵与维库溴铵术后残余肌松发生率,探讨围术期应用TOF监测降低术后残余肌松发生率的可行性.方法81例ASAⅠ～Ⅱ级成年择期手术病人,随机分为维库溴铵监测(V+M)组;维库溴铵未监测(V)组;潘库溴铵监测(P+M)组及潘库溴铵未监测(P)组4组.麻醉方法为静脉注射2.0～2.5mg/kg异丙酚,潘库溴铵或维库溴铵0.08～0.12mg/kg,3min后气管插管,麻醉维持应用50%N2O、异氟醚,间断给予芬太尼.使用TOF-GUARD监测仪监测肌松.P+M组和V+M组在TOF计数出现1～2个颤搐反应时给新斯的明0.04mg@kg-1、阿托品0.02mg@kg-1.拮抗;P组和V组根据临床反应判断是否给予拮抗及剂量.观察各组病人到ICU后残余肌松发生率(T4/T1＜0.70)及持续时间.结果4组病人到ICU后残余肌松发生率分别为V+M组23.80%、V组39.13%、P+M组42.11%、P组83.33%,P组残余肌松发生率显著高于V组(P＜0.01),而且监测组残余肌松发生率显著低于未监测组(P＜0.05).4组残余肌松持续时间分别为V+M组(11.11±5.48)min、V组(30.00±15.12)min、P+M组(21.15±11.62)min、P组(44.87±31.39)min,未监测组明显长于监测组(P＜0.05).未监测组潘库溴铵及维库溴铵总的用药量分别大于监测组(P＜0.05).结论1.围术期TOF监测可明显降低残余肌松发生率;2.潘库溴铵残余肌松发生率及持续时间均显著高于维库溴铵,在无神经肌肉功能监测的情况下,应用潘库溴铵应严加注意;3.应用非去极化肌松药阻滞后进行术后肌松拮抗是必要的.     

罗库溴铵和维库溴铵对大鼠离体膈肌神经肌肉接头钾离子通道的影响

目的利用成年大鼠膈肌膈神经不均匀牵拉标本,探讨罗库溴铵和维库溴铵对神经肌肉接头部位钾离子通道的影响。方法成年健康Wister大鼠,快速处死制备离体大鼠膈神经肌肉标本并制成不均匀牵张膈肌膈神经标本。观察两药相当大鼠0.5×ED95剂量时的血药浓度药物对选择性钾离子通道阻断药3,4-二氨基吡啶(3,4-DAP)引起的终板电位(EPP)时程的作用。结果罗库溴铵自给药后2min起能够明显缩短由3,4-DAP引起的70%EPP时程的延长。而维库溴铵对由3,4-DAP引起的EPP时程的延长无明显影响。结论罗库溴铵能明显缩短由钾离子通道阻断药3,4-DAP引起的EPP时程延长作用。     

新型肌肉松弛药拮抗剂舒更葡糖钠在麻醉苏醒期应用的近况

舒更葡糖钠是拮抗非去极化肌肉松弛药（肌松药）的新型药物,它能够快速、安全、可控地拮抗罗库溴铵等甾体类肌松药的神经肌肉阻滞,与传统肌松拮抗剂抗胆碱酯酶药相比,具有拮抗深度神经肌肉阻滞且不影响胆碱能系统活性的优越性,在麻醉苏醒期的临床应用具有广泛前景。文章通过对新型肌松拮抗药舒更葡糖钠的作用机制、使用效能、在特殊患者中的应...     

Effects of neuromuscular-blocking drugs in rats in vivo: direct measurements in the diaphragm and tibialis anterior muscle

BACKGROUND: Effects of neuromuscular-blocking drugs are often investigated in rodents using both the diaphragm in vitro and the tibialis anterior muscle in vivo. Differences in the properties of these muscles cannot be neglected. We evaluated the neuromuscular effects of drugs on the rat diaphragm in vivo in comparison with the tibialis anterior muscle, directly measuring twitch tension with a force transducer. METHODS: Respectively using sternotomy and an approach via the gluteal space, transducers were attached to the diaphragm and the tibialis anterior muscle. Phrenic and sciatic nerves were stimulated supramaximally by single square pulses to record isometric contraction of muscles. Pancuronium, vecuronium, or rocuronium was infused continuously at a rate adjusted repeatedly until stable tension was obtained. Effective doses for 50% (ED 50) and 90% (ED 90) depression of tension were calculated, using a cumulative infusion dosing method. RESULTS: Isometric contraction of the diaphragm could be recorded despite movements of the heart and lungs. For all three drugs, both mean ED 50 and ED 90 were more than twice as large for the diaphragm as for the tibialis anterior (P<0.05). In addition, slopes of dose-response curves for the diaphragm were significantly less steep than those of the tibialis anterior for the three drugs. CONCLUSION: Neuromuscular-blocking effects on the diaphragm can be recorded in vivo. According to direct contractile force measurement, the diaphragm is more resistant to non-depolarizing neuromuscular-blocking drugs than the tibialis anterior muscle.     

Comparison of respiratory sparing effect between pancuronium and three new nondepolarizing muscle relaxants in rats

Purpose There is a large difference in sensitivity between respiratory muscles and other limb muscles. This phenomenon, known as the respiratory sparing effect (RSE), is well established withd-tubocurarine, pancuronium, and succinylcholine. The purpose of this study is to evaluate the RSE of these new relaxants, vecuronium, pipecuronium, and ORG9426. Methods The study was done in vivo using rats. Mechanical twitch responses of tibialis anterior muscle and diaphragm stimulated with the sciatic nerve and phrenic nerve, respectively, were recorded simultaneously to monitor neuromuscular transmission. Changes of mechanical twitch responses from both muscles were compared following the injection of four kinds of muscle relaxants (pancuronium, picuronium, recuronium, and ORG9426). Results T, D (%) represents the maximum depression in tibialis anterior and diaphragm, respectively. T−D (%), which means the sensitivity difference between the two kinds of muscle, was calculated by subtracting D from T. The T−Ds of pancuronium, pipecuronium, vecuronium, and ORG9426 were 86.0±2.6%, 81.4±1.9%, 77.7±2.1%, and 74.6±2.7%, respectively. Conclusions The results indicated that the blockade produced by each muscle relaxant was lower in the diaphragm than in the anterior tibialis muscle. T−D was significantly smaller with vecuronium or ORG9426 than with pancuronium.     

Potency of pancuronium at the diaphragm and the adductor pollicis muscle in humans

The measurement of force of contraction of the adductor pollicis muscle following supramaximal stimulation of the ulnar nerve has become a standard method to assess the effect of neuromuscular blocking drugs. However, the diaphragm is regarded as resistant to these drugs, and considerable residual respiratory power might still be present after total block of adductor pollicis function. To quantify this differential effect, train-of-four stimulation was applied to the ulnar and the phrenic nerves in patients under N2O-halothane anesthesia. The force of contraction of the adductor pollicis muscle was measured with a force-displacement transducer and compared with the diaphragmatic electromyogram (EMG). Pancuronium cumulative dose-response curves for both muscles were determined in 10 ASA Class I adults. The mean dose (+/- SEM) required to depress adductor pollicis and diaphragm responses to first twitch stimulation (ED50) was 29.5 +/- 3.5 micrograms/kg and 59.5 +/- 7.0 micrograms/kg, respectively. Corresponding values for ED90 were 45 +/- 5 micrograms/kg and 95 +/- 11 micrograms/kg, respectively, indicating that the diaphragm required approximately twice as much pancuronium as the adductor pollicis block, the diaphragm was only 24 +/- 4% blocked. It is concluded that the adductor pollicis response might underestimate the degree of diaphragmatic relaxation. On the other hand, the administration of pancuronium in a dose sufficient to produce total paralysis might result in the inability to antagonize neuromuscular block in all muscles.     

Differential effect of pancuronium at the adductor pollicis, the first dorsal interosseous and the hypothenar muscles. An electromyographic and mechanomyographic dose-response study

Cumulative dose-response curves were constructed from evoked compound electromyographic (EMG) recordings in man to compare the sensitivity to pancuronium of the adductor pollicis, the hypothenar and the first dorsal interosseous muscles. Also, the EMG and mechanomyography-based sensitivity of the adductor pollicis muscle were compared. The EMG and the mechanomyogram were evaluated in random sequence in each of 21 adult thiopental, fentanyl and diazepam anesthetized patients. The EMG-based ED50 were 36-38 micrograms.kg-1 with no differences between muscles. The EMG-based ED90 of the adductor pollicis and the hypothenar muscles were 62-65 micrograms.kg-1 compared to the 60 micrograms.kg-1 of the first dorsal interosseous muscle (P < 0.05). ED50 (34 micrograms.kg-1), and ED90 (56 micrograms.kg-1) obtained from the adductor pollicis mechanomyogram were significantly lower than those based on the EMG (P < 0.05). It is concluded that differences in sensitivity to pancuronium exist between the three muscles when evaluated from the EMG, and that the apparent sensitivity of a given muscle to a muscle relaxant may depend upon whether the response is evaluated using EMG or mechanomyography.     

Different recovery of the train-of-four ratio from rocuronium-induced neuromuscular blockade in the diaphragm and the tibialis anterior muscle in rat

PURPOSE: To clarify differences between the diaphragm and the limb muscles in terms of the effects of neuromuscular blockers concerning train-of-four (TOF) ratios, we compared the recovery of twitch tensions and TOF ratios in the diaphragm and in the tibialis anterior muscle in rats in vivo. METHODS: We conducted a dose-response study in 16 rats and a recovery study in 8 rats. In the recovery study, we made phrenic nerve-diaphragm and sciatic nerve-tibialis anterior preparations simultaneously in each of 8 rats that were anesthetized intraperitoneally with pentobarbitone (30 mg x kg(-1)) and urethane (500 mg x kg(-1)). After supramaximal stimuli were applied simultaneously in a TOF pattern to both the phrenic and sciatic nerves, rocuronium was injected intravenously, at 10 mg x kg(-1). In the diaphragm and the tibialis anterior muscle, we monitored the first-twitch response to TOF stimuli (T1) and also the TOF ratios. The following variables were determined for each muscle: (1) the times at which T1 recovered to 25%, 50%, and 75% of control T1, and the times at which the TOF ratio recovered to 25%, 50%, and 75%; and (2) the values of the TOF ratio at 25%, 50%, and 75% recovery of T1. RESULTS: At 25%, 50%, and 75% recovery of T1 in the diaphragm, TOF ratios were 8.9 +/- 5.0 %, 26.7 +/- 7.7 %, and 55.9 +/- 5.4%, respectively, while in the tibialis anterior, the TOF ratios were 18.0 +/- 5.9%, 32.5 +/- 7.4%, and 54.4 +/- 7.5%, respectively (diaphragm vs tibialis anterior; P < 0.01 for comparisons at both 25% and 50% recovery of T1). CONCLUSION: Our method of simultaneous in vivo evaluation of TOF ratios in both the diaphragm and the tibialis anterior confirmed significant differences between the two muscles in relationships between first-twitch tension and the TOF ratio.     

Effects of immobilization and continuous passive motion on postoperative muscle atrophy in mature rabbits

The effects of continuous passive motion and cast immobilization on muscle atrophy were compared 3 weeks after bilateral arthrotomies on 10 mature New Zealand rabbits. The gastrocnemius, rectus femoris and tibialis anterior muscles were excised and weighed, and the dry weights of the gastrocnemius were also determined. The protein concentration and cross-sectional areas of types I and II muscle fibres in the rectus femoris and tibialis anterior muscles were measured. Compared with the results in rabbits treated by cast immobilization, continuous passive motion significantly (p less than 0.05) reduced muscle atrophy as determined from the wet and dry weights of the gastrocnemius muscles, the protein content in the tibialis anterior muscles and the cross-sectional areas of the type II fibres in the rectus femoris muscles.     

Effects of Changes in Acid-Base Balance on Neuromuscular Blockade Produced by ORG-NC 45

The effects of acute acid-base changes on the neuromuscular blocking action of ORG NC 45 (a monoquaternary homologue of pancuronium) were measured in 10 cats, utilizing a constant infusion technique. Partial NC 45 blockade was antagonized slightly in the tibialis, soleus, and diaphragm during respiratory alkalosis (pH 7.53; PaCO2 1.9 kPa), whereas metabolic alkalosis (pH 7.64; Paco2 3.5 kPa) produced significant antagonism of NC 45 block in those muscles. Respiratory acidosis (pH 6.98; Paco2 10.3 kPa) and metabolic acidosis (p H 7.13; PaCO2 4.9 kPa) significantly potentiated partial NC 45 blocks in the tibialis, soleus, and diaphragm (except in the diaphragm during metabolic acidosis). Cumulative dose responses studied in six cats showed that the NC 45 dosage required to produce 85--95% tibialis block was slightly greater than controls during respiratory and metabolic alkalosis. Conversely, significantly less NC 45 was needed to produce the same degree of block during respiratory and metabolic acidosis. In vitro studies in rat hemidiaphragms likewise showed minimal NC 45 block antagonism when pH was raised to 7.68, and significant potentiation under acidotic conditions (pH 7.05). These actions are attributed in part to an increased rate of NC 45 metabolism by alkaline hydrolysis in alkalotic states and greater molecular stability during acidosis. Possible clinical implications are discussed.     

The cardiovascular effects of vecuronium (ORG NC45) and pancuronium in patients undergoing coronary artery bypass grafting

Vecuronium is a new nondepolarizing muscle relaxant which has been shown to cause no significant cardiovascular effects. Utilizing invasive monitoring in patients undergoing coronary artery bypass grafting, the authors compared the cardiovascular effects of vecuronium (0.28 mg/kg) in seven anesthetized patients with those of pancuronium (0.1 mg/kg) in five anesthetized patients. This dose of pancuronium represents three times its ED90 (dose producing a 90% depression of evoked twitch tension), while the vecuronium dose represents twelve times its ED90. This relatively large dose of vecuronium was chosen deliberately in an attempt to manifest any possible cardiovascular effects. Following administration of vecuronium, cardiac output increased 9% and systemic vascular resistance decreased 12%, while pancuronium produced a significantly greater 17% increase in cardiac output without change in systemic vascular resistance. Heart rate and systemic mean arterial pressure did not change following vecuronium, while increasing 22% and 24%, respectively, following pancuronium. The authors conclude that large doses of vecuronium have minimal cardiovascular effects and thus offer an advantage over pancuronium in patients anesthetized for coronary artery surgery.     

Comparative study of ORG NC 45 and pancuronium during anesthesia

The muscle relaxant effects of ORG NC 45 and pancuronium were compared in anesthetized patients with normal liver and renal functions. In all patients, the muscle relaxant effect was monitored by measuring the strength of the adductor pollicis muscle elicited by supramaximal stimulation of the ulnar nerve at the wrist. Different modes of administration of the muscle relaxants were used. In order to facilitate tracheal intubation, a dose of 100 mu X kg-1 of ORG NC 45 or pancuronium was administered. This dose was followed or not according to the type of surgery by repeated doses of 25 micrograms X kg-1. The results of this study indicate that ORG NC 45 is much shorter acting than pancuronium, and non cumulative. The dose of 100 micrograms X kg-1 produced adequate conditions for tracheal intubation 3 to 4 min after the administration of the muscle relaxant. The recovery of the muscle strength to 75% of control value was achieved 46 min and 100 min after a single dose of 100 micrograms X kg-1 of ORG NC 45 and pancuronium respectively. The interval of time between repeat injections averaged 20 min for ORG NC 45 and 40 min for pancuronium.     

The potency of pancuronium at the adductor pollicis and diaphragm in infants and children

To measure the potency of pancuronium at the diaphragm and adductor pollicis in infants and children, train-of-four stimulation was applied to the ulnar and phrenic nerves under N2O-halothane anesthesia. The force of contraction of the adductor pollicis was measured and compared with the diaphragmatic electromyogram (EMG). Cumulative dose response curves were determined for pancuronium in 18 patients divided equally into three age groups: 0-1 yr, 1-3 yr, and 3-10 yr. The potency of pancuronium at both muscles decreased with increasing age (P less than 0.05), while the adductor pollicis:diaphragm potency ratio remained constant. The mean doses (+/- SEM) required to depress adductor pollicis first twitch responses by 90% (ED90) were 42 +/- 3.3 micrograms/kg in the 0-1-yr group, 47 +/- 4.2 micrograms/kg in the 1-3-yr group, and 62 +/- 4.1 micrograms/kg in the 3-10-yr group. Corresponding figures for the diaphragm were 70 +/- 4.3 micrograms/kg, 81 +/- 5.1 micrograms/kg, and 101 +/- 4.4 micrograms/kg, respectively. The ED90 ratios (diaphragm ED90/adductor pollicis ED90) in the three age groups were 1.69 +/- .07, 1.75 +/- .14, and 1.64 +/- .09, respectively. These results are consistent with similar rates of maturation of the diaphragm and the adductor pollicis muscles in infancy and childhood. Thus, train-of-four monitoring of the adductor pollicis is likely to overestimate the degree of neuromuscular blockade of the diaphragm in pediatric patients.