异氟醚对新斯的明拮抗维库溴铵肌松作用的影响

目的：研究一定浓度的异氟醚对新斯的明拮抗维库溴铵肌松作用的影响。方法：30例病人随机分为三组（各10例）：（1）丙泊酚静脉麻醉组,即对照组（P组）。（2）观察组。以异氟醚维持麻醉,再分为两组;术中呼气未异氟醚浓度均为1MAC,临近手术结束用新斯的明拮抗时,呼气末异氟醚浓度分别为1MAC（1M组（）和0．3MAC（0．3M组）,术中各组均连续输注维库溴铵,术毕以新斯的明0．035mg/kg拮抗并记录以下数据;维库溴铵输注速率,从拮抗开始到T1恢复到90％,TOF恢复到0．7和0．9的时间拮抗后15分钟时的T1,TOF比值,结果：1M组和0．3M组维库溴铵输注速率较P组降低IP＜0．05）,新斯的明拮抗后,0．3M组和1M组T1恢复到90％,TOF恢复到0．7和0．9的时间较P组延长（P＜0．05和P＜0．01）,1M组TOF恢复到0．9的时间较0＝3M组延长（P＜0．05）,在新斯的明拮抗后15分钟,0．3M组和1M组的T1和TOF比值均低于P组（P＜0．05）,1M组的TOF比值低于0．3M组（P＜0．05）,结论：呼气未浓度为1MAC和0．3MAC的异氟醚均能影响新斯的明对维库溴铵肌松作用的拮抗。     

地氟醚、异氟醚对罗库溴铵强化作用的时间依赖性研究

目的：观察IMAC地氟醚或异氟醚对罗库溴铵强化作用的时间依赖性。方法：24例择期腹部手术病人在咪唑安定－芬太尼－异丙酚麻醉期间持续输注罗库溴铵，维持95％的肌松，达到稳态后，病人随机吸入呼气末浓度为1MAC的地氟醚或异氟醚，调整罗库溴铵的注入速率，维持95％的肌松，观察吸入地氟醚或异氟醚后罗库溴铵的注入速率随时间变化的趋势。结果：地氟醚，异氟醚都显著降低了罗库溴铵的注入速率，此效应随吸入地氟醚或异氟醚时间的延长逐渐加，吸入地氟醚或异氟醚90min后达最大效应即罗库溴铵的注入速率下降到最大值。最大下降率：地氟醚组为42．7％，异氟醚组为37．6％，结论：地氟醚，异氟醚明显增强罗库溴铵的肌松作用，其程度相近，且这种强化作用有显著的时间依赖性。     

地氟醚、异氟醚对老年患者维库溴铵肌松效应的影响

目的：观察吸入等效浓度地氟溴、异氟醚对老年患者维库溴铵肌松效应的影响。方法：30例ASA I－Ⅱ级老年患者分为3组，均吸入N2O：O2（50％：50％），其中Des组和Iso组分别吸入等效浓度地氟醚（6％）和异氟醚（1．15％），对照组为无吸入组。麻醉诱导用咪达唑仑、异丙酚和芬太尼。所有患者经颈内静脉注入总量为40μg/kg的维库溴铵。用丹麦产TOF GUARD加速度仪进行肌松监测。维库溴铵40μg/kg分为4等份分次静注，记录每次注药（10μg/kg）后的起效时间及最大阻滞效应。用累积剂量法建立3组患者的剂量反应曲线。在最后一次注药后记录：T1恢复到25％、75％、90％的时间（T125％、T175％、T190％）；TOF比值恢复到70％的时间以及恢复指数。结果：与对照组（Con)相比，Des组和Iso组维库溴铵ED50和ED95值均明显缩小（P＜0．05），且Des组比Iso组的缩小更明显（P＜0．05）。3组的起效时间差异均无显著性（P＞0．05）。两个吸入麻醉药组的T125％、T175％和T190％明显长于对照组（P＜0．05），且Des组又明显高于Iso组（P＜0．05）。两个吸入麻醉药组的TOF比值恢复到70％的时间和恢复指数RI均明显高于对照组（P＜0．05），但在两个吸入麻醉药组之间差异无显著性（P＞0．05）。结论：地氟醚、异氟醚均能明显影响老年患者维库溴铵的肌松效应，地氟醚的影响大于异氟醚。     

丙泊酚靶控输注或异氟醚吸入对罗库溴铵药效学的影响

目的　探讨丙泊酚靶控输注和异氟醚吸入对罗库溴铵药效学的影响。方法　选择无神经肌肉疾患 ,在全麻下择期手术的病人 4 8例 ,随机分成丙泊酚靶控输注组 (B组 )和异氟醚吸入组(Y组 )维持麻醉。采用TOF刺激方式监测拇内收肌的收缩反应。当T1恢复至对照值的 2 0 %时追加罗库溴铵 0 15mg/kg。记录每次追加罗库溴铵的间隔时间以及肌松恢复情况。 结果　两组肌松维持时间无明显差异 (P >0 0 5 ) ,而B组罗库溴铵总用药量明显高于Y组 (P <0 0 5 )。B组各次追加罗库溴铵间隔时间平均为 (2 6 1± 9 3)s,Y组平均间隔时间为 (36 2± 13 2 )s,明显比B组长 (P<0 0 5 )。Y组第 1、2次给药后的间隔时间相似 (P >0 0 5 ) ,第 3、4、5次给药后间隔时间也相似 (P <0 0 5 ) ,但是比第 1、2次延长 (P <0 0 5 )。Y组T1恢复到对照值的 2 5 %、5 0 %和 75 %的时间及拔管时间比B组长 (P <0 0 5 ) ,但两组的恢复指数相似 (P >0 0 5 )。结论　丙泊酚靶控输注对罗库溴铵的药效学没有影响。而异氟醚对罗库溴铵则起增效作用 ,异氟醚维持麻醉时应酌情减少罗库溴铵的用量。     

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.     

七氟醚、异氟醚对阿曲库铵肌松恢复的影响

目的 观察七氟醚、异氟醚对阿曲库铵肌松恢复的影响.方法 选择75例Ⅰ或Ⅱ级成年择期全麻手术病人随机均分为三组.Ⅰ组丙泊酚4～10 mg·kg-1·h-1泵入;Ⅱ、Ⅲ组分别吸入呼气末浓度为1 MAC的七氟醚、异氟醚.诱导插管后阿曲库铵均以30μg·kg-1·min-1的速度静脉泵入.使用Biomter加速度仪监测肌松恢复情况,记录T1恢复至25%,75%及TOFr恢复至0.7的时间.结果 Ⅱ、Ⅲ组T1恢复至25%、75%的时间及TOFr恢复至0.7的时间均比Ⅰ组显著延长(P＜0.05).恢复指数(T1从25%至75%的时间)三组比较差异无统计学意义.结论 七氟醚、异氟醚均可增加阿曲库铵残余肌松作用.     

异氟醚和地氟醚对罗库溴铵肌松作用的影响

目的：观察１．０ＭＡＣ异氟醚或地氟醚对罗库溴铵增效作用的影响。方法：选择１８例择期手术病人随机分为地氟醚和异氟醚组，每组在静脉诱导麻醉后，先测得维持９０％肌松并达到稳定后罗库溴铵的注射速率，然后吸入异氟醚或地氟醚，使呼气末浓度为１．０ＭＡＣ，再调整罗库溴铵的注入速率，维持９０％的肌松，观察吸入全麻后罗库溴铵的注射速率随时间变化的趋势。结果：异氟醚、地氟醚均显著降低了罗库溴铵的注入速率，且随吸入时间     

七氟醚、异氟醚对维库溴铵增效作用的时间依赖性

目的：观察１ＭＡＣ七氟醚或异氟醚对维库溴铵增效作用的时间依赖性。方法：４０例择期手术病人在异丙酚－芬太尼－Ｎ２Ｏ麻醉期间持续输注维库溴铵，维持９０％的肌松，达到稳态一，病人随机吸入１ＭＡＣ呼气末浓度的七氟醚或氟醚，调整维库溴铵的注入速率，维持９０％的肌松，观察吸入七氟醚或异氟醚及维库溴铵的注入速率随时间变化的趋势。结果：七氟醚、异醚都显著降低了维库溴铵的注放速率。此效应随吸七氟醚或异氟醚时间的延长     

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。     

不同浓度异氟醚对罗库溴铵肌松作用的影响

目的 观察不同浓度异氟醚对罗库溴铵肌松作用的影响。方法 60例ASA Ⅰ-Ⅱ择期手术患者,随机分为3组,每组20例。组Ⅰ静脉注射罗库溴铵0.6 mg·kg-1;组Ⅱ吸入0.6％异氟醚后静脉注入罗库溴铵0.6mg·kg-1;组Ⅲ吸入1.2％异氟醚后从静脉注入罗库溴铵0.6mg·kg-1。分别记录各组注药后肌松作用的起效时间、作用时间及T1恢复时间。结果 与组Ⅰ相比,组Ⅱ、Ⅲ起效时间明显缩短(P<0.05),TOF无反应期明显延长(P<0.01),T1恢复25％、50％、90％时间明显延长(P<0.01),且组Ⅲ较组Ⅱ延长(P<0.05),恢复指数明显延长,且组Ⅲ较组Ⅱ延长(P<0.05)。结论 吸人异氟醚能明显缩短罗库溴铵起效时间,延长罗库溴铵作用时间,临床合并使用时应注意减少用量。     

Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Reversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 microg x kg(-1) and atropine 20 microg x kg(-1) were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).     

Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children.

We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Implications: These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.     

Conditions to optimise the reversal action of neostigmine upon a vecuronium-induced neuromuscular block

Background: Since neostigmine was introduced for reversal of neuromuscular block, there has been controversy about the optimum dose for antagonizing neuromuscular block. The purpose of this study was to characterise recovery of neuromuscular transmission following a vecuronium-induced block 15 min after neostigmine administration using different stimulation patterns, and to determine the effects of different doses of neostigmine given at various pre-reversal twitch heights. Methods: Adductor pollicis (AP) mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation, was recorded 15 min after 20, 40 and 80 μg/kg neostigmine, given to reverse a vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height (TH). Fifty four ASA class I and II anaesthetised (methohexital, fentanyl, N₂O/O₂) young adult patients were studied and randomly allocated into 9 groups of 6 patients each. Results: In contrast to twitch height (TH) and residual force after 50 Hz, 5 s tetanic stimulation (RF50_Hz), the greater sensitivity of train-of-four (TOF) ratio and residual force after 100 Hz, 5 s tetanic stimulation (RF100_Hz) points out the best reversal conditions (prereversal TH and the optimal neostigmine dose) (P<0.001, two-way analysis of variance). The highest reversal scores (about 0.9 TOF ratio and RF100_Hz) were obtained when 40 μg/ kg of neostigmine was given at 25 and 50% TH. A 0.9 TOF ratio was also observed when 40 μg/kg of neostigmine was given at 10% TH, but, under these conditions, RF100_Hz was only 0.6 (P<0.05, Duncan test). Conclusion: To optimise the reversal action of neostigmine in order to obtain the highest neuromuscular transmission recovery (0.9 TOF ratio and RF100_Hz) during a vecuronium-induced neuromuscular block, the 40 μg/kg dose has to be given at 25 to 50% recovery of TH.     

Sugammadex比新斯的明更快逆转维库溴铵所致神经肌肉阻滞的多中心随机对照研究

背景 Sugammadex是一种具有特异结构的γ-环糊精,能选择性地与肌松药结合快速逆转罗库溴铵所致的神经肌肉阻滞,并较小程度地逆转维库溴铵所致的神经肌肉阻滞.该研究中,我们对比了行择期手术的患者中sugammadex和新斯的明对逆转维库溴铵所致神经肌肉阻滞的作用.方法 年龄≥18岁,ASA分级Ⅰ～Ⅲ级拟行择期手术的患...     

Can early administration of neostigmine, in single or repeated doses, alter the course of neuromuscular recovery from a vecuronium-induced neuromuscular blockade?

The authors sought to determine whether neostigmine, given at a time when no response to peripheral nerve stimulation could be elicited, hastened recovery from a vecuronium-induced neuromuscular blockade (NMB). The effect of neostigmine (70 micrograms/kg) in antagonizing a profound (no-twitch) vecuronium-induced (0.1 mg/kg) NMB in 40 healthy patients was studied. Patients were randomly assigned to one of four groups specifying the sequence of neostigmine administration. Fifteen minutes after the administration of vecuronium, when there was no detectable twitch response, each patient received either neostigmine (70 micrograms/kg) with glycopyrrolate (15 micrograms/kg) or an equivalent volume of normal saline (placebo). When T1 (the first response in the train-of-four [TOF] sequence) recovered to 10% of control, patients again received either neostigmine with glycopyrrolate in the same doses as before or the placebo. The following variables were measured: times from vecuronium injection until T1 recovered to 10% (t [10]) and 90% (t [90]) of control, and time until the TOF ratio was equal to 75% (t [TOF75]). Mean values of t (90) and t (TOF75) were shorter (54.7-75.2 min and 60.4-79.5 min, respectively) for the three groups who received neostigmine as compared with patients who received two doses of placebo (104.3 and 122.6 min, respectively). There were no differences in the t (90) and t (TOF75) values among the three groups who received neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reversal of intense neuromuscular blockade following infusion of atracurium

In order to evaluate reversal time from very intense neuromuscular blockade caused by a continuous infusion of atracurium, the time course of neostigmine induced reversal from different levels of neuromuscular blockade was evaluated using the post-tetanic count (PTC) and the train-of-four (TOF) in 30 patients anesthetized with nitrous oxide, fentanyl, and thiopental. Reversal time (time from administration of neostigmine at different PTC levels to a TOF ratio of 0.7) was found to depend upon the degree of blockade at the time of reversal. Median reversal time from a PTC of 1-2, 3-4, 5-6, 7-8, 9-10, 11-12, and greater than 13 (but less than 10% twitch height) to a TOF ratio of 0.7 was 31, 23, 19, 18, 14, and 13 min, respectively. Spontaneous recovery from PTC level of 1-2, when atracurium infusion was stopped, to a PTC level at which antagonism was induced and reversal time were both correlated to the square root of the PTC. Total recovery time (spontaneous recovery plus reversal time) was not shortened by an early injection of neostigmine. It is concluded that neostigmine administration during intense neuromuscular blockade following atracurium infusion does not shorten total recovery time and offers no clinical advantages.     

Effect of neostigmine at different levels of mivacurium-induced neuromuscular blockade

The effectiveness of neostigmine 40 μg/kg for antagonism of two different levels of neuromuscular blockade, induced by a bolus dose of mivacurium 0.15 mg/kg, was studied in 45 patients. The patients were anaesthetized with thiopentone, fentanyl, nitrous oxide in oxygen, and enflurane. Neostigmine was administered at either 10% recovery of the twitch height (TH10) at the adductor pollicis muscle ( n =14) or upon reappearance of the first response at the orbicularis oculi muscle (OO1) after train-of-four (TOF) stimulation ( n = 16), the latter representing a deeper degree of neuromuscular blockade. Fifteen of the 45 patients did not receive neostigmine (control group). Neostigmine administration at OO1 rather than at TH10 at the adductor pollicis muscle caused reversal of neuromuscular blockade to occur 8 min earlier and shortened the time to reach 25% recovery of the twitch height (TH25) at the adductor pollicis muscle by about 5 min, compared with the control group. However, the time needed to reach a T4/T1 ratio ≥0.8 was similar in both the early and late neostigmine administration groups, being 9 min faster than in the control group. It can be concluded that there is no advantage in administering neostigmine at profound neuromuscular blockade to achieve clinically adequate recovery (T4/T1 ratio ≥0.8). However, the time between injection of mivacurium and TH25 may be shortened by using neostigmine at profound neuromuscular blockade, a procedure which may be useful in case of unpredictably difficult intubation, since diaphragmatic movements usually reappear at TH25.     

Effects of residual concentrations of isoflurane on the reversal of vecuronium-induced neuromuscular blockade.

Thirty-six anesthetized patients (ASA physical status 1 or 2) undergoing elective surgery were monitored (isometric adductor pollicis mechanical activity) to detect the effects of discontinuing isoflurane anesthesia upon the reversal of vecuronium-induced neuromuscular blockade. Neuromuscular blockade was produced by vecuronium 100 micrograms/kg and additional doses of 20 micrograms/kg until completion of surgery. The patients were randomly divided into three groups: in the control group (n = 12), only fentanyl/N2O was given; in the "isostable" group (n = 12), isoflurane at an end-tidal concentration of 1.25% was maintained throughout anesthesia; in the "isostop" group (n = 12), isoflurane 1.25% was discontinued before neostigmine administration. In all groups, paralysis was antagonized with 15 micrograms/kg intravenous (iv) atropine and 40 micrograms/kg iv neostigmine when the twitch height (0.1 Hz) had regained 25% of its control value. The measured parameters were twitch height, train-of-four, and 50--100-Hz tetanic fade. No significant differences were found among the three groups with respect to the final twitch heights and tetanic fades at 50 Hz. In the isostable group, final mean train-of-four was significantly less (75%) than in the other patients (88%) (P less than 0.01). Mean tetanic fade at 100 Hz was significantly less in the isostable group (31%) than in the isostop group (57%) (P less than 0.01) and control group (84%) (P less than 0.01). We conclude that discontinuing isoflurane anesthesia for 15 min improves the reversal of a vecuronium paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neostigmine and edrophonium as antagonists of atracurium and pancuronium

Edrophonium 0.5 mg/kg or neostigmine 0.04 mg/kg were administered to two groups of 30 patients each for antagonism of atracurium- or pancuronium-induced neuromuscular block at 25% single twitch recovery. Neuromuscular block was studied using both single twitch and train-of-four (TOF) nerve stimulation. The times to 100% single twitch recovery were significantly more rapid for patients receiving edrophonium (P less than 0.01) in both groups (atracurium and pancuronium); the TOF ratios were similar for atracurium, but for pancuronium they were greater after neostigmine than after edrophonium, and only at 25 min were these ratios similar. It is concluded that edrophonium in a dose of 0.5 mg/kg antagonizes neuromuscular blockade induced by atracurium, as does neostigmine in a dose of 0.04 mg/kg, but the former does not consistently antagonize neuromuscular blockade induced by pancuronium even at 25% of single twitch recovery.