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.     

顺式阿曲库铵闭环注射系统在腹腔镜手术中的应用

目的 探讨顺式阿曲库铵闭环注射在腹腔镜手术中的肌松效果.方法 选择腹腔镜手术患者20例,随机均分成闭环注射组(G组)和对照组(C组).C组持续输注顺式阿曲库铵1.5～2 μg·kg-1·min-1直至手术结束前30 min;G组输注顺式阿曲库铵0.8μg·kg-1 ·min-1,设定肌松深度反馈值T1=15％,近手术结束时由研究实施者根据术中肌松监测指标决定停药时机.记录麻醉时间、顺式阿曲库铵的总用量、恢复指数、TOFr75及TOFr90.结果 G组顺式阿曲库铵总用量均明显少于C组(P＜0.05),恢复指数、TOFr75及TOFr90明显缩短于C组(P＜0.05).结论 与持续输注方式相比,闭环肌松药注射方式肌松药用量更少,恢复指数、TOFr75和TOFr90明显缩短,实现个性化和合理化用药.     

顺式阿曲库铵两种不同给药方式对肌松残余作用的影响

目的比较顺式阿曲库铵持续输注与间断给药对肌松残余作用的影响。方法择期行腰椎管狭窄或胸腰椎体骨折手术患者80例,年龄18～70岁,随机分为A1、A2、B1和B2四组,每组20例。A1和A2组分别微量泵持续输注顺式阿曲库铵1.5和0.75μg·kg-1·min-1,B1和B2组分别静脉间断注射顺式阿曲库铵0.1和0.05mg·kg-1·h-1。A1组与B1组、A2组与B2组肌松药使用总量相同。记录肌松药使用总量,TOFr达25%、50%、75%、90%的时间,拔管时间,患者能够持续抬头5s的时间。结果与A2组比较,A1组TOFr恢复至25%、50%时间明显延长(P0.05);与B1组比药,A1组TOFr恢复至25%的时间明显延长(P0.05);与B2组比较,A2组TOFr恢复至50%、75%时间明显延长(P0.05);B1组TOFr恢复至50%、75%、90%时间明显延长(P0.05)。与A2组比较,A1组患者肌力恢复于Ⅳ～Ⅴ级的时间及能够持续抬头5s的时间明显延长(P0.05)。结论顺式阿曲库铵持续输注与间断给药对肌松残余作用均无明显影响,但持续输注可延长肌松恢复时间。     

小儿不同剂量顺式阿曲库铵的肌松作用

目的通过观察小儿不同剂量顺式阿曲库铵的肌松作用,评价是否存在封顶效应,探讨小儿合适的麻醉诱导剂量。方法45例择期手术的息儿,年龄15～50月,ASAⅠ或Ⅱ级,随机分为3组(n=15):顺式阿曲库铵0.1 mg/kg组(A组)、顺式阿曲库铵0.15 mg/kg组(B组)、顺式阿曲库铵0.2 mg/kg(C组)。采用TOF-Guard肌松监测仪对尺神经行连续四个成串(TOF)刺激,监测拇内收肌肌颤搐变化;静脉注射异丙酚2 mg/kg、芬太尼2μg/kg及相应剂量顺式阿曲库铵麻醉诱导,吸入O2-N2O和静脉持续输注异丙酚维持麻醉;评价气臂插管条件评估分级,监测诱导期间血液动力学变化,记录起效时间(肌松药注毕至T1达最大抑制的时间)、临床肌松维持时间(肌松药注毕至T1恢复5%的时间)、临床肌松有效作用时间(T1从最大抑制至恢复25%的时间)、恢复指数(T1恢复从25%至75%的时间)、体内肌松作用时间(肌松药注毕至T1恢复95%的时间)。结果3组气管插管条件评估分级比较差异无统计学意义;三组T1达最大抑制时心率、平均动脉压组间和组内比较差异均无统计学意义。与A组相比,B组、C组起效时间较短,临床肌松维持时间、临床肌松有效作用时间、体内肌松作用时间较长(P<0.01);三组恢复指数差异无统计学意义。与B组相比,C组起效时间差异无统计学意义,但临床肌松维持时间、临床肌松有效作用时间、体内肌松作用时间较长(P<0.05或0.01)。结论小儿芬太尼复合异丙酚时,顺式阿曲库铵0.15 mg/kg(3倍ED95)是麻醉诱导的适宜剂量。     

年龄对顺式阿曲库铵靶控输注药效学的影响

目的探讨靶控输注(TCI)顺式阿曲库铵时年龄对其药效学的影响。方法接受丙泊酚-N2O/O2-芬太尼复合麻醉的患者40例均分为Ⅰ组(62～85岁)和Ⅱ组(20～59岁)。在四个成串刺激(TOF)监测下静注顺式阿曲库铵0.15mg/kg。待TOF的T1为0时行气管插管,并对插管条件进行评级。待T1恢复至5%时开始TCI阿曲库铵,保持T1<10%。记录神经肌肉阻滞的起效时间、无反应期、阻滞维持时间和停药后肌松恢复时间,并记录顺式阿曲库铵的用药量。结果两组起效时间及恢复指数差异无统计学意义;Ⅰ组无反应期、阻滞维持时间和停药后肌松恢复时间明显长于Ⅱ组(P<0.05);顺式阿曲库铵的平均用药量明显少于Ⅱ组(P<0.05)。结论老年患者TCI顺式阿曲库铵用药量虽然相应减少,但其恢复过程仍较青壮年延长。     

急性高容量血液稀释对全麻患者顺式阿曲库铵药效学的影响

目的 探讨急性高容量血液稀释(AHH)对全麻患者顺式阿曲库铵药效学的影响.方法 择期腹部手术患者印例,年龄18～60岁,ASAI或Ⅱ级,随机分为对照组(C组)和AHH组,每组30例,各组按顺式阿曲库铵首剂量(首剂量分别为30、40、50μg/kg,总用量100 μg/kg)分为3个亚组,每亚组10例.采用TOF-Wateh~(R)SX肌松监测仪监测神经肌肉阻滞情况.AHH组经30～40 min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg行血液稀释,AHH后各亚组分别给予首剂量顺式阿曲库铵,当T_1达最大抑制后再注入余量.记录肌松起效时间、临床肌松作用时间、体内作用时间及恢复指数.采用概率单位法计算T_1抑制50%、90%、95%时顺式阿曲库铵的用量(ED_(50)、ED_(90)、ED_(95).结果 与C组比较,AHH组顺式阿曲库铵ED_(50)、ED_(90)、ED_(95)升高,肌松起效时间延长,临床肌松作用时间及体内作用时间缩短(P<0.05或0.01),恢复指数差异无统计学意义(P>0.05).结论 AHH可降低顺式阿曲库铵的肌松效应.     

老年患者顺式阿曲库铵不同用药方式的作用时效比较

目的观察顺式阿曲库铵两种不同用药方式在老年患者腹部手术中的肌松效应及对恢复速度的影响。方法 32例ASAⅡ～Ⅲ级择期老年腹部手术患者,随机分为两组（Ⅰ组和Ⅱ组,每组16例）。麻醉诱导均采用咪唑安定、异丙酚及芬太尼,以瑞芬太尼和异丙酚维持麻醉。Ⅰ组术中每当T1恢复到10%时单次静脉推注0.05～0.1mg/kg顺式阿曲库铵,Ⅱ组当T1恢复到5%时开始微量泵输注顺式阿曲库铵（2～3μg/（kg.min））,两组维持肌松T1〈10%,直到手术关腹后停止给药。术中记录肌松作用时间、最后注药或停药距T1为25%时间、恢复指数,并计算单位时间用药量。结果两组肌松效应和恢复指数相比均无统计学差异（P〉0.05）,单位时间用药量亦无统计学差异（P〉0.05）;最后注药或停药距T1为25%时间,Ⅰ组长于Ⅱ组（P〈0.05）。结论顺式阿曲库铵用于老年患者麻醉可产生良好的肌松效应,术中持续微量泵注射顺式阿曲库铵较为合理。     

不同给药方式对肝移植术中顺式阿曲库铵临床药效学的影响

目的 评价不同给药方式对肝移植术中顺式阿曲库铵临床药效学的影响.方法 择期肝移植术患者24例,年龄18 ～ 63岁,体重60 ～ 88 kg,BMI 20 ～ 30 kg/m2,性别不限,ASA分级Ⅲ级,采用随机数字表法,将其分为2组(n=12):连续静脉输注组(C组)和间断静脉注射组(I组).采用全凭静脉全身麻醉,麻醉诱导后待肌松监测仪显示T1恢复至10％时,C组开始静脉输注顺式阿曲库铵,初始速率1.5 μg· kg-1 ·min-1,调节输注速率,维持T1在10％左右,I组间断静脉注射0.03 mg/kg顺式阿曲库铵,维持T1≤10％,待腹膜关闭后即刻停止使用肌松药.记录顺式阿曲库铵的单位时间用药量、T1由10％恢复至25％的时间、恢复指数和术后自主呼吸恢复的时间.结果 与I组相比,C组顺式阿曲库铵单位时间用药量减少,术后自主呼吸恢复时间缩短(P＜0.05),T1恢复至25％的时间和恢复指数差异均无统计学意义(P＞0.05).结论 与间断静脉注射相比,肝移植术中静脉输注顺式阿曲库铵有助于提高临床肌松效应的效价,有利于减少麻醉恢复期相关并发症的发生.     

顺式阿曲库铵用于梗阻性黄疸手术患者的药效学研究

目的 观察梗阻性黄疸患者与肝功能正常患者行上腹部手术时顺式阿曲库铵肌松药效的变化.方法 选择无神经肌肉疾患,肾功能正常,在全麻下行择期手术的患者40例,分为两组:观察组(L组),20例,ASAⅢ级,有梗阻性黄疸;对照组(Ⅱ组),20例,ASAⅠ或Ⅱ级,肝功能正常.均采用静吸复合麻醉,顺式阿曲库铵首剂量为3×ED<,95>(0.15 mg/kg).术中用单刺激颤搐值/对照值(T/Tc)监测肌松,当其值达10%时追加肌松药顺式阿曲库铵1.5×ED<,95>(0.075 mg/kg).结果 与Ⅱ组相比,Ⅰ组患者顺式阿曲库铵的90%起效时间、临床时效、追加肌松药后90%恢复时间有延长趋势,但差异无统计学意义.结论 顺式阿曲库铵可以安全地用于梗阻性黄疽的患者,但应加强术中的肌松监测.     

不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌肌松效应的比较

目的 比较不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌的肌松效应.方法 全麻患者25例,ASA Ⅰ或Ⅱ级,年龄42～64岁,体重51～81 kg,随机分为2组,顺式阿曲库铵0.075ms/ks组(Ⅰ组,n=11)和顺式阿曲库铵0.15 mg/kg组(Ⅱ组,n=14).静脉注射咪达唑仑0.035～0.045mg/kg、异丙酚1.5～2 mg/kg、芬太尼0.1～0.2 mg、顺式阿曲库铵0.075 mg/kg或0.15 mg/kg行麻醉诱导,吸入50%氧化亚氮、间断静脉注射芬太尼维持麻醉.采用2台TOF-Watch SX加速度肌松监测仪同步监测眼轮匝肌和拇内收肌的神经肌肉阻滞情况,记录肌松起效时间、无反应期及T25%和T75%恢复时间.于眼轮匝肌肌颤搐抑制75%～80%时行气管插管,并评价气管插管条件.结果 2组气管插管条件良好且差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组拇内收肌和眼轮匝肌肌松起效时间缩短,T25%恢复时间、T75%恢复时间和无反应期延长(P<0.01);与拇内收肌比较,Ⅰ组眼轮匝肌T75%恢复时间缩短,Ⅱ组眼轮匝肌无反应期和T25%恢复时间缩短(P<0.05或0.01).结论 顺式阿曲库铵对拇内收肌和眼轮匝肌的肌松效应呈剂量依赖性,眼轮匝肌对顺式阿曲库铵的敏感性低于拇内收肌;监测顺式阿曲库铵对眼轮匝肌神经肌肉阻滞情况可有效指导气管插管.     

腹腔镜手术中持续输注与间断静注顺式阿曲库铵维持深度肌松的药效学比较

目的探讨持续输注顺式阿曲库铵维持深度肌松在腹腔镜手术中的有效性和安全性。方法择期行腹腔镜辅助胃肠道肿瘤根治术患者60例,年龄18~65岁,随机分为A、B两组,每组30例。A组使用顺式阿曲库铵0.15 mg/kg诱导插管,并在强直刺激后计数(post tetanic count,PTC)恢复至≥3时以初始速率0.2mg·kg-1·h-1开始泵注,术中维持肌松深度在PTC≤2。B组使用顺式阿曲库铵0.15mg/kg诱导插管,并在每次PTC恢复至≥3时间断追加0.05mg/kg,术中维持肌松深度在PTC≤2。记录肌松药使用总量,肌松药使用时间(A组:诱导至泵注结束时间;B组:诱导到最后一次加药时间),手术时间,手术开始0、1、2h及关腹时肌松满意度(0~10分),恢复指数(T1从25%恢复至75%的时间),TOFr比值恢复至0.7、0.9的时间,以及压舌板试验完成情况,低氧血症、肺不张、肺炎等情况。结果与B组比较,A组平均肌松药使用量明显增加(P0.05);在手术开始0、1、2h时手术医师对肌松满意度A组明显高于B组(P0.05);恢复指数、TOFr比值恢复至0.7的时间和TOFr比值恢复至0.9的时间两组差异无统计学意义。拔管后A组出现低氧血症2例(7.1%),B组出现低氧血症1例(4.2%);不能完成压舌板试验A组3例(10.7%),B组4例(16.7%),两组差异均无统计学意义。术后均未出现肺不张、肺炎。结论持续输注顺式阿曲库铵用于腹腔镜手术维持深度肌松安全有效。相较于间断静注给药,持续输注肌松药使用量较大,肌松满意度高,虽然停药后恢复时间稍长,但对术后肌松残余无明显影响。     

A comparison of fentanyl and buprenorphine in total intravenous anesthesia using propofol during spinal surgery

A retrospective study was performed to compare the hemodynamic effect and postoperative pain relief of fentanyl (Group F, n = 11) and buprenorphine (Group B, n = 11) in total intravenous anesthesia (TIVA) using propofol during spinal surgery. All patients were premedicated with midazolam (3-5 mg) i.m. Anesthesia was maintained with propofol infusion, and increments of fentanyl or single dose of buprenorphine with 40% oxygen in air. Total doses of fentanyl and buprenorphine were 7.6 +/- 1.0 micrograms.kg-1 and 2.0 +/- 0.4 micrograms.kg-1, respectively. Maintenance doses of propofol (Group F: 5.5 +/- 0.8 mg.kg-1.h-1, Group B: 5.9 +/- 1.1 mg.kg-1.h-1) and vecuronium were not significantly different. Mean arterial pressures from 2 hours after incision to the end of surgery were elevated significantly in Group F than in Group B. Recovery time (Group F 12.5 +/- 6.1 min vs Group B 11.8 +/- 6.1 min) and extubation time (Group F 19.5 +/- 10.3 min vs Group B 15.0 +/- 7.0 min) were not different. At the end of anesthesia, seven patients in Group F and one patient in Group B (P < 0.01) complained of severe pain. All patients in Group F, and only two in Group B (P < 0.02) received analgesics within 20 hours. Neither nausea nor respiratory depression was found in both groups. This study suggests that buprenorphine would provide a more stable hemodynamic state and better postoperative pain relief than fentanyl in TIVA using propofol.     

胃肠手术中右旋美托咪定对全麻复苏期的影响

目的 探讨全身麻醉中全程复合应用右旋美托咪定对患者复苏期拔管时间、睁眼时间和血流动力学等指标的影响.方法 90例入选患者被随机分成试验Ⅰ组（T1）、试验Ⅱ组（T2）和对照组（C）3组.试验Ⅰ组患者15 min内输注0.5 μg/kg右旋美托咪定,以0.25 μg· kg-1· h-1右旋美托咪定维持至拔管;试验Ⅱ组15 min内输注0.5 μg/kg右旋美托咪定,以0.5 μg· kg-1· h-1右旋美托咪定维持至拔管;对照组（C） 输注生理盐水.记录复苏期拔管时间、睁眼时间和血流动力学变化.结果 麻醉复苏期停止输注丙泊酚至拔出气管导管时间分别为C 组（26.6 ± 8.8）min、T1组（36.0 ± 12.9）min和T2 组（33.0 ± 7.7）min,3组间比较差异无统计学意义.停止瑞芬太尼输注到拔出气管导管时间分别为 C 组（12.4 ± 7.4） min,T1 组（17.2 ± 9.9） min和T2 组（16.1 ± 7.9） min,3组间比较无统计学差异（P 〉 0.05）.睁眼时间T1为（22.1 ± 9.5）min、T2为（37.3 ± 7.4） min,均较对照组C（13.2 ± 4.8）min明显延长（P 〈 0.05）.麻醉复苏期血压、心率变化试验组较对照组稳定,T2组尤为明显.结论 成人胃肠手术全凭静脉麻醉全程复合较大剂量（0.5 μg· kg-1· h-1）右旋美托咪定对麻醉复苏期气管拔管时间无明显影响,但可延长睁眼时间并与剂量相关;复苏期血流动力学指标更平稳.     

Large bolus dose vs. continuous infusion of cisatracurium during hypothermic cardiopulmonary bypass surgery

BACKGROUND AND OBJECTIVE: We investigated whether a high bolus dose of cisatracurium (8x ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product. METHODS: Twenty patients were randomly assigned either to Group 1 (n = 10) or Group 2 (n = 10). Those in Group 1 were given cisatracurium in a high bolus dose (0.4 mg kg(-1)). Those in Group 2 received cisatracurium 0.1 mg kg(-1) at induction followed after 30 min by a continuous infusion of cisatracurium. As an escape medication in case of patient movement, a bolus dose of cisatracurium 0.03 mg kg(-1) was given. RESULTS: In Group 1 (large cisatracurium bolus dose), the clinical duration of effect (until T1/T0 = 25%) was 110 min. Six of 10 patients in Group 1 required additional boluses of cisatracurium intraoperatively. Four of these six had received an additional bolus near the end of surgery and had a train-of-four (TOF) ratio = 0 at the end. The other four patients in Group 1 had a final TOF ratio >0.9. In Group 2 (continuous cisatracurium infusion), only two patients had a TOF ratio >0.9 at the end of surgery, no patient moved and none received additional boluses. The total amount of cisatracurium used in the bolus and infusion Groups was 34.5 +/- 7.8 and 21.3 +/- 5.7 mg, respectively (P = 0.0004). CONCLUSIONS: For continued neuromuscular block during hypothermic cardiac surgery, a high bolus dose of cisatracurium appears to be safe, although it is not an alternative to a continuous infusion, as its neuromuscular blockade does not cover the intraoperative period and a high incidence of movements occurs. In the patients who received a high bolus dose of cisatracurium, postoperative residual curarization appeared after additional boluses had been given. The consumption of cisatracurium by high bolus was significantly greater than with continuous infusion.     

The changes in hemodynamics and dose requirements in total intravenous anesthesia using propofol and buprenorphine

A retrospective study was performed to evaluate the changes in hemodynamics and dose requirements in total intravenous anesthesia (TIVA) using propofol and buprenorphine without (Group S: spinal surgery (3-6 h), n = 8, 28-79 Y) or with (Group A: abdominal surgery (5-10 h), n = 15, 36-83 Y) epidural anesthesia. All patients were premedicated with midazolam i.m. (2-5 mg). Anesthesia was maintained with a single dose of buprenorphine (Group S: 1.9 +/- 0.4 micrograms.kg-1, Group A: 2.0 +/- 0.5 micrograms.kg-1), propofol infusion and vecuronium with 40% oxygen in air. Group A was supplemented with continuous epidural anesthesia using 2% mepivacaine. In Group A, mean arterial pressure (MAP) and heart rate remained stable after the start of surgery. However, in Group S, 2 hours after the start of surgery MAP increased (P < 0.05) and remained elevated (P < 0.05) at higher levels than those in Group A. The maintenance dose of propofol in Group A (4.0 +/- 1.1 mg.kg-1.h-1) was significantly smaller than in Group S (6.5 +/- 0.9 mg.kg-1.h-1). In both groups, infusion rates of propofol were unchanged from 1 hour after the start to the end of surgery. Infusion rates of mepivacaine (5.2 +/- 0.9 ml.h-1) were unchanged following the increase 2 hours after the start of surgery. Awakening times were within 25 min (Group S 11.3 +/- 7.2 min vs Group A 14.7 +/- 7.3 min). There was no awareness during anesthesia in either group. The results suggest that additional continuous epidural anesthesia in TIVA would be useful to reduce propofol dose, to stabilize hemodynamic state and to obtain rapid recovery in anesthesia of long duration.     

Effect of intravenous hypnotics on the actions of pipecuronium.

Seventy-five ASA Grades I-III patients (18-85 years, 45-90 kg) were randomized into five groups. All patients received N2O/O2 (2/1) and alfentanil: loading dose (LD) 0.015 mg kg-1 and maintenance dose (MD) 0.045 mg kg-1 h-1 (groups 1-4). Group 1 received propofol (LD 2 mg kg-1 and MD 6 mg kg-1 h-1); Group 2 etomidate (LD 0.3 mg kg-1 and MD 0.6 mg kg-1 h-1); Group 3 midazolam (LD 0.2 mg kg-1 and MD 0.120 mg kg-1 h-1); Group 4 methohexitone (LD 1.5 mg kg-1 and MD 4 mg kg-1 h-1); Group 5 dehydrobenzperidol 0.05-0.23 mg kg-1 and alfentanil (LD 0.100 mg kg-1 and MD 0.060 mg kg-1 h-1). The neuromuscular block induced by pipecuronium (50 micrograms kg-1) was evaluated. No statistically significant differences were found between the five groups as concerned degree of block (expressed as % twitch amplitude in response to the first of the TOF stimuli (Ta1) at intubation, T1 minimum and recovery to Ta1 = 20%, 25% and 75%. Slightly faster intubation was possible when midazolam was used in comparison with propofol, methohexitone or NLA and when etomidate was used in comparison with propofol. A wide range of individual values of maximal neuromuscular blocking activity was found.     

Pharmacodynamic interactions between cisatracurium and rocuronium

The onset and duration of maintenance doses of neuromuscular blocking drugs may be influenced by the original neuromuscular blocking drug used. We assessed the effect of the interaction between steroidal and benzo-isoquinolinium compounds on the clinical duration of maintenance doses of cisatracurium. Sixty adult patients undergoing anesthesia with isoflurane, nitrous oxide, and oxygen were randomized to receive the following: Group I = rocuronium 0.6 mg/kg followed by cisatracurium 0.03 mg/kg when the first twitch in the train-of-four (TOF) recovered to 25%, Group II = cisatracurium 0.15 mg/kg followed by cisatracurium 0.03 mg/kg, and Group III = rocuronium 0.6 mg/kg followed by rocuronium 0.15 mg/kg. Neuromuscular blockade was monitored using acceleromyography (TOF-Guard, Boxtel, The Netherlands). The clinical duration (mean +/- SD) of the first 2 maintenance doses was 41 +/- 10, 31 +/- 7++, and 25 +/- 8++ min, and 39 +/- 11, 30 +/- 6+, 29 +/- 9* min in Groups I-III, respectively (*P < 0.05, +P < 0.01, ++P < 0.001; Group I versus II and III). Thus, the clinical duration of the first two maintenance doses of cisatracurium was prolonged when administered after rocuronium. IMPLICATIONS: We assessed the clinical effect of administering cisatracurium after an intubating dose of rocuronium in 60 patients undergoing isoflurane/nitrous oxide and oxygen anesthesia. The clinical duration of the first two maintenance doses of cisatracurium administered after rocuronium was significantly prolonged. This supports the contention that combinations of structurally dissimilar neuromuscular blocking drugs result in a synergistic effect.     

Recovery from total intravenous anesthesia with propofol and buprenorphine

A retrospective study was performed to evaluate recovery from total intravenous anesthesia (TIVA) with propofol and buprenorphine for various types of surgery. The patients of the study were divided into two groups; Group A: n = 85, age 66 +/- 12 Y, duration 282 +/- 102 min, with epidural block and Group B: n = 56, 52 +/- 20 Y, 172 +/- 90 min, without the block. All patients were premedicated with intramuscular midazolam (1-5 mg). Anesthesia was maintained with propofol infusion with 40% oxygen in air, and an intravenous bolus dose of buprenorphine (0.11 +/- 0.03 mg). Muscle relaxation was obtained by intravenous vecuronium. The patients of Group A were supplemented with continuous epidural anesthesia using 2% mepivacaine. The maintenance dose of propofol (Group A: 4.5 +/- 1.2 mg.kg-1.h-1, Group B: 7.0 +/- 1.8 mg.kg-1.h-1) and temperature at the end of surgery decreased significantly with age. Awakening time in all patients was 12.3 +/- 7.4 min and it was correlated significantly with age and hypothermia, but not correlated with the maintenance dose or duration of propofol infusion. In short-duration surgery (within 2 hours, n = 36) awakening time was correlated with neither age nor temperature. There was no difference in awakening time between genders. Requirement for analgesics within 20 hours was 18.8% in Group A and 14.3% in Group B. Four patients (2.8%) reported dreaming, but none of the patients recalled the intraoperative events. We suggest that in elderly patients the reduction of intravenous anesthetics, maintenance of normothermia and short-duration surgery would result in rapid recovery in TIVA.     

The cerebral effects of pancuronium and atracurium in halothane-anesthetized dogs

Pancuronium decreases the minimal alveolar anesthetic concentration (MAC) of halothane in humans, while atracurium has a metabolite, laudanosine, which is a known cerebral stimulant. To determine if these muscle relaxants significantly alter cerebral function, their effects on cerebral metabolic rate (CMRo2), cerebral blood flow (CBF), intracranial pressure (ICP), EEG, and the cerebral energy state were studied in halothane-anesthetized dogs. Group A dogs (n = 6) were maintained at 0.86% end-expired (1.0 MAC) halothane. Thereafter, a sequence of 1) pancuronium 0.1 mg . kg-1; 2) reversal of neuromuscular blockade with neostigmine plus glycopyrrolate; and 3) pancuronium 0.2 mg . kg-1 produced no changes in CMRo2, CBF, ICP, or EEG. Group B dogs (n = 6) also were maintained at 0.86% end-expired halothane and received the following in sequence: 1) atracurium 0.5 mg . kg-1; 2) reversal of neuromuscular blockade with neostigmine plus glycopyrrolate; 3) atracurium 1.0 mg . kg-1; and 4) atracurium 2.5 mg . kg-1. There were no changes in CMRo2, CBF, or ICP; EEG evidence of cerebral arousal occurred in only one dog with the final dose of atracurium. Group C dogs (n = 6) received tetracaine spinal anesthesia and the minimal halothane concentration (mean +/- SE = 0.69 +/- 0.03% end-expired) that would maintain an "anesthetic" EEG pattern. Each Group C dog received the following in sequence: 1) atracurium 1.0 mg . kg-1, and 2) atracurium 2.5 mg . kg-1. EEG evidence of cerebral arousal occurred in all six Group C dogs. Arousal was not accompanied by significant increases in CBF, CMRo2, or ICP.(ABSTRACT TRUNCATED AT 250 WORDS)