哌库溴铵前处理对琥珀胆碱的肌震颤及肌松效应的影响

目的：观察哌库溴铵前处理对琥珀胆碱肌震颤的预防作用及对其肌松效应的影响。方法：３６例择期手术病人随机分成三组，Ⅰ组静注琥珀胆碱１ｍｇ／ｋｇ（对照组）。Ⅱ、Ⅲ组静注哌库溴铵１５μｇ／ｋｇ后３．５分钟分别注入琥珀胆碱１ｍｇ／ｋｇ和１．５ｍｇ／ｋｇ。结果：哌库溴铵前处理能有效地消除琥珀胆碱引起的肌震颤，但使１ｍｇ／ｋｇ琥珀胆碱的起效时间延长、阻滞程度降低、气管插管条件变差、肌松恢复时间缩短。当琥珀胆碱的剂量增至１．５ｍｇ／ｋｇ时，肌松效应恢复满意。结论：哌库溴铵前处理使琥珀胆碱的肌松效应减弱，故琥珀胆碱的插管剂量应增至１．５ｍｇ／ｋｇ，以获得满意的肌松。     

阿曲库铵前处理对琥珀胆碱肌松作用起效时间影响的临床研究

研究阿曲库铵作前处理对琥珀胆碱肌松作用的起效和持续时间的影响。２０例患者分为对照组和前处理组。前处理组在静注诱导药前５分钟预注阿曲库铵０．０６ｍｇ／ｋｇ，观察Ｔｈ降至Ｔ２５、Ｔ１０和Ｔ０的时间，Ｔ０的持续时间和Ｔｈ恢复至Ｔ１０、Ｔ２５、Ｔ７５的时间。结果表明，用阿曲库铵作前处理，既可缩短琥珀胆碱的起效时间，又不明显影响其肌松持续时间，也能有效地防止琥珀胆碱肌震颤对患者可能造成的多种危害。     

阿曲库铵前处理对琥珀胆碱胆松作用起效时间影响的临床研究

研究阿曲库铵作前处理对琥珀胆碱肌松作用的起效和持续时间的影响。２０例患者分为对照组和前处理组。前处理组在注诱前５分钟预注阿曲库铵０．０６ｍｇ／ｋｇ，观察Ｔｈ降至Ｔ２５．Ｔ１０和％０的时间，Ｔ０的持续时间和Ｔｈ恢复至Ｔ１０、Ｔ２５、Ｔ７５的时间。结果表明，用阿曲库铵作前处理，既可缩短琥珀胆碱的起效时间，又不明显影响肌松持续时间，也能有效地防止琥珀胆碱肌震颤对患者可能造成的多种危害。     

卡肌宁预注对琥珀胆碱不良反应的预防作用

卡肌宁预注对琥珀胆碱不良反应的预防作用方栋恩＊方晨＊近年来，我们采用卡肌宁预注来消除琥珀胆碱的不良反应，取得较满意的效果，现介绍如下。资料与方法全组４０例ＡＳＡⅠ～Ⅱ级择期手术病例，年龄２７～７０岁。术前用药如常规。病人入手术室后，即用Ｓｃｈｉｄｔｚ...     

卡肌宁与琥珀胆碱进行气管插管的比较

卡肌宁是一新型的非去极化肌松药,具有起效快、持续时间短、术毕肌张力恢复快的优点,是目前临床应用最佳的肌松药之一,也可用于气管插管.本文报道卡肌宁及琥珀胆碱用于气管插管的差异以供临床参考.     

异丙酚和硫喷妥钠对琥珀胆碱肌松效应的对比研究

目的：对比研究民丙酚和硫喷妥钠对琥珀胆碱肌松效应的影响。方法：３４例拟行喉显微手术病人随机分为两组,分别给予异丙酚或硫喷妥钠静脉复合麻醉。全麻诱导后,静注琥珀胆碱１．５ｍｇ／ｋｇ后气管插管,继之连续静滴０．１％琥珀胆碱溶液维持肌松松状态至术毕,以加速度仪监测。结果与结论：与硫喷妥钠组相比,异丙酚麻醉时琥珀胆碱的肌松起效更快,停药后肌松恢复也更快。     

预注小剂量琥珀胆碱减轻肌颤的临床观察

目的 观察预注小剂量琥珀胆碱对肌颤及肌病的影响。方法 ASA Ⅰ-Ⅱ级病人80例,随机分为两组,实验组于诱导前预注琥珀胆碱 0.2mg/kg。对照组预注生理盐水5 ml后诱导插管,观察诱导期病人肌颤及术后病人肌痛的发生率。结果 实验组Ⅱ级及Ⅲ级肌颤发生率为12.5％,明显低于对照组的80.5％(P<0.05),术后肌痛实验组为7.5％,明显低于对照组的55％(P<0.05)。结论 预注小剂量琥珀胆碱能有效地防止琥珀胆碱引起的肌颤和肌痛。     

不同麻醉诱导药对血钾浓度变化及肌颤和肌痛的影响

目的 观察硫喷妥钠、咪唑安定、依托咪酯以及异丙酚麻醉诱导对琥珀胆碱引起的血钾升高、肌颤和肌痛的影响。方法 ＡＳＡⅠ～Ⅱ级病人６０例,随机分为四组,分别采用硫喷妥钠、咪唑安定、依托咪酯或异丙酚静脉诱导,静注琥珀胆碱后行气管插管。于诱导前、气管插管前和插管后测定血清钾浓度,并观察诱导期病人肌颤及术后病人肌痛的发生率。结果 各组病人诱导前及气管插管前的血钾浓度组间及组内比较均无显著差异（Ｐ〉０．０５）,     

刺激方式对琥珀胆碱起效及恢复过程的影响

用两种临床常用的刺激方式 TOF 和 ST 观察去极化类肌松药琥珀胆碱对离体大白鼠膈肌肌力抑制作用及恢复过程。结果示 TOF 时琥珀胆碱(30μg/ml)起效过程较快.其起效时间为2.0±0.57min,而用 ST 刺激时为2.6±0.7min(P<0.05)。但 TOF 时琥珀胆碱作用后膈肌肌力恢复较慢,其恢复指数(RI)较用 ST 时长4.1min。作者认为,刺激方式本身能影响肌松剂的作用过程,包括起效及恢复过程,对临床应用不同刺激方式监测肌松剂作用及用药有意义。     

美维松前处理对琥珀胆碱的肌震颤及肌松效应的影响

目的与方法：３８例全麻病人随机分成三组，Ｉ组（ｎ＝１２）：琥珀胆碱１ｍｇ／ｋｇ；Ⅱ组（ｎ＝１２）：美维松２５μｇ／ｋｇ、琥珀胆碱１ｍｇ／ｋｇ和Ⅲ组（ｎ＝１４）：美维松２５μｇ／ｋｇ、琥珀胆碱１．３ｍｇ／ｋｇ。注射美维松和琥珀胆碱的间隔时间为３．５ｍｉｎ。结果：美维松（２５μｇ／ｋｇ）前处理能基本消除琥珀胆碱引起的肌震颤，但使琥珀胆碱（１ｍｇ／ｋｇ）的起效时间延长、阻滞程度降低、气管插管条件变差、肌     

Use of vecuronium bromide and atracurium besylate in continuous intravenous infusion in urologic surgery

The effects of continuous i.v. infusion of atracurium and vecuronium monitored by TOF supplied by an ABM monitor have been compared in 60 patients subdivided into four groups and submitted to anaesthesia with isoflurane for urological surgery interventions. Groups A and V received respectively an initial bolus of 0.5 mg/kg atracurium and of 0.08 mg/kg vecuronium followed immediately by continuous i.v. infusion of 5.5 micrograms/kg/min. Atracurium or 0.9 micrograms/kg/min of vecuronium; recovery of neuromuscular function happened spontaneously. Groups A' and V' differed by virtue of the use of 0.04 mg/kg prostigmin in the recovery phase. Average consumption of atracurium and vecuronium were respectively 5.1 +/- 1.75 micrograms/kg/min (2.6-9.03) and 0.75 +/- 0.20 micrograms/kg/min (0.5-1.2) in groups A-A' and V-V'. In groups A and V Recovery time 25-75" of T1 and TR presented a statistically significant difference (p less than 0.05) in favour of atracurium. In groups A' and V' the same parameters presented a statistically non-significant difference (p greater than 0.05). The ratio TI/TR does not vary to a statistically significant extent in the 4 groups. The number of infusion rate variations needed to maintain stable neuromuscular block was lower in the atracurium groups.     

Priming principle with atracurium

In order to substantiate the "priming principle" discussion, 44 patients admitted for elective gynecological surgery under modified neurolept anesthesia were randomized into two groups. In group I, atracurium was administered by a priming technique in which 0.1 mg/kg was given i.v. and, after 6 min, 0.5 mg/kg. In group II was given an atracurium bolus injection of 0.6 mg/kg. In group I onset time (median 61 sec, range 44-160 sec) was significantly more rapid than in group II (median 83 sec, range 60-128 sec). The median train-of-four ratio in group I was 0.80 (range 0.43-1.00, n = 23), 6 min after the priming dose, in 30% of these patients the TOF ratio was above 0.90 and in 22% below 0.70. It is impossible to determine a fixed pretreatment dose per kg body weight owing to the large individual variation in neuromuscular depression. Modification of the priming principle using incremental small doses of non-depolarizing neuromuscular blocking agents, with anesthetic induction, when the train-of-four ratio is between 0.90 and 0.70 or when there is clinical signs of neuromuscular block, might be an alternative in situations where rapid induction is required and where the use of suxamethonium is contraindicated.     

Atracurium during thoracic surgery: impaired efficiency in septic processes

OBJECTIVE: The aim of the study was to examine whether the neuromuscular blocking potency of atracurium changes in patients with a septic intrathoracic process. DESIGN: Prospective clinical study. SETTING: Community hospital. PARTICIPANTS: Thirty patients who underwent thoracic surgery for resection of a pulmonary carcinoma were examined. Fifteen patients showed typical signs of a concomitant bacterial superinfection (infection group), 15 age-matched patients without infection served as the control (no-infection) group. INTERVENTIONS: Relaxation was induced with atracurium, 0.6 mg/kg intravenously for intubation, followed by a continuous infusion to maintain a 90% neuromuscular blockade. Relaxometry was performed electromyographically using the Datex Relaxograph by stimulating the ulnar nerve next to the wrist. MEASUREMENTS AND MAIN RESULTS: The onset time was significantly longer (5.3 +/- 2.9 v 3.3 +/- 1.2 minutes; p < 0.05), and the recovery phase (DUR 10%) was significantly shorter (23.5 +/- 8.6 v 36.9 +/- 7.3 minutes; p < 0.001) in the infection group compared with the controls. The infusion rate within the first hour of continuous application was 77.4% higher in the infection group than in the control group (11.0 +/- 2.9 v 6.2 +/- 1.0 microg/kg/min; p < 0.001). CONCLUSION: The study showed that septic intrathoracic processes cause a clear reduction of the neuromuscular blocking potency of atracurium. To guarantee adequate muscle relaxation in such cases, precise neuromuscular monitoring is highly advisable.     

Cisatracurium am M. orbicularis oculi Vergleich der neuromuskulären Wirkung von Cisatracurium und Atracurium am M. orbicularis oculi und M. adductor pollicis

OBJECTIVES: Muscle relaxants have different pharmacodynamic profiles in various muscles. Therefore, results obtained for one muscle cannot be extrapolated to other muscles. In the adductor pollicis muscle cisatracurium exerts a pharmacodynamic profile comparable to atracurium, despite the known difference in onset time. However, studies evaluating the neuromuscular effect of cisatracurium in different muscles are lacking. Accordingly, this study compares the pharmacodynamic profile of cisatracurium and atracurium in the orbicularis oculi muscle (OO) - which shows a neuromuscular course similar to the diaphragm and the laryngeal muscles - and the adductor pollicis muscle (AP). METHODS: Forty-five patients (ASA I-II), scheduled for elective spinal surgery were anaesthetized with propofol and fentanyl. Endotracheal intubation was performed without using a muscle relaxant. Neuromuscular transmission was monitored using acceleromyography in both muscles. Patients received 0.1 mg/kg (2x ED(95)) or 0.15 mg/kg (3x ED(95)) cisatracurium, or 0.5 mg/kg atracurium (2x ED(95)) at random. Onset and recovery times were measured according to the recommendation of the Copenhagen Consensus Conference. RESULTS: Onset time was significantly shorter in the OO than in the AP following 0.15 mg/kg cisatracurium and 0.5 mg/kg atracurium (P<0.05). No differences in onset time between the two muscles were found after 0.1 mg/kg cisatracurium. The recovery of T(1) to 10% of its control was completed sooner in the OO than in the AP in all three groups (P<0.05). CONCLUSIONS: Cisatracurium shows a dose-dependent shorter onset time in the OO than in the AP. This is consistent with the current view that the onset of non-depolarizing neuromuscular blockers is more rapid in the OO than in the AP. However, at least a dose of 3x ED(95) of cisatracurium was necessary to show a difference in onset time between both muscles. In contrast, atracurium is reported to lead to a significantly shorter onset of neuromuscular block in the OO following 2x the ED(95). The more rapid recovery of T(1) to 10% of its control in all three groups in the OO is due to the relative resistance of this muscle to muscle relaxants.     

Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis

BACKGROUND: Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this alone would be the greatest advantage in replacing atracurium for the facilitation of tracheal intubation. On the other hand, 2 ED(95) doses of cisatracurium (100 micro g/kg) do not yield satisfactory intubating conditions such as those seen with equipotent doses of atracurium and therefore the recommended intubating dose of cisatracurium is 3 ED(95). To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium directly at the larynx adductors in humans. METHODS: The study was conducted in 54 patients (ASA class I or II) undergoing peripheral surgery requiring general anesthesia. Cisatracurium 25-150 micro g/kg or atracurium 120-500 micro g/kg intravenous (i.v.) boluses doses were administered during anesthesia with propofol, nitrous oxide, oxygen and fentanyl. Neuromuscular block was measured by electromyography (single twitch stimulation every 10 s) at the larynx and the adductor pollicis. The dose-response effect measured at both muscles included maximum neuromuscular blockade achieved (Emax), the time to maximum depression of twitch height (onset) and time to spontaneous recovery of the twitch height to 25%, 75% and 90% (T25, T75, T90) of control value. RESULT: The onset at the larynx was of 196 +/- 28 s after the 100 micro g/kg cisatracurium dose compared with 140 +/- 14 s after the 500 micro g/kg atracurium dose (P < 0.05). Emax at the larynx was 92 +/- 1% and 98 +/- 1% after 100 micro g/kg cisatracurium and 500 micro g/kg atracurium, respectively (P < 0.05). The time to onset of maximum suppression Emax = 100 +/- 0% after a 150 micro g/kg cisatracurium dose was 148 +/- 29 s. At the larynx, the ED(50) was 25 micro g/kg for cisatracurium and 180 micro g/kg for atracurium and the ED(95) was 87 micro g/kg for cisatracurium compared with 400 micro g/kg for atracurium. CONCLUSION: The slow onset time at the laryngeal muscles after cisatracurium can be explained by the higher potency as compared with atracurium.     

Atracurium: neuromuscular blockade in repeated administration

The neuromuscular blocking action of repeated injections of atracurium and vecuronium was studied in 74 surgical patients during balanced anaesthesia (methohexitone or etomidate, intubation after suxamethonium, fentanyl, droperidol, N2O). The initial bolus dose (ID) of atracurium was 0.25 mg/kg and of vecuronium 0.05 mg/kg followed by repeated increments (RD) of atracurium 0.1 mg/kg and vecuronium 0.0125 mg/kg when neuromuscular function (EMG) had recovered to about 30% of pre-relaxant control. Dose-response relationships revealed atracurium to be about 1/5 as potent as vecuronium; the ED50 of atracurium was 0.13 +/- 0.03 mg/kg and of vecuronium 0.023 +/- 0.007 mg/kg. The ID of both relaxants produced a neuromuscular blockade of about 90% within 4 min. The duration from the time of injection to 30% recovery was slightly longer in atracurium 26 +/- 9 min. In all patients the RD produced within 3.5 min satisfactory muscle relaxation with a neuromuscular block of about 85%. The mean duration of atracurium (18 min) was 5-10 min longer than of vecuronium (12 min). To maintain good surgical relaxation (more than 70% blockade) atracurium 0.32 mg/kg X h and vecuronium 0.056 mg/kg X h were required. No cumulation could be measured after repeated injections. The recovery time of atracurium and vecuronium at the end of anaesthesia was 10-12 min. Neither cardiovascular side-effects nor signs of histamine release were observed after both relaxants in our particular dose range. It is concluded, that atracurium is a favourable blocker for anaesthetic practice: The time of onset is approximately the same compared with vecuronium. The duration of action, however, is slightly longer but still truly intermediate long.(ABSTRACT TRUNCATED AT 250 WORDS)     

The pattern of train-of-four fade after atracurium: influence of different priming doses

This study was designed to investigate the effect of three different priming doses of atracurium--0.06, 0.07, and 0.08 mg/kg--followed 3 min later by the remainder of a 0.5 mg/kg dose on the relationship between the depression in the first twitch of the train-of-four (T1) and train-of-four (TOF) fade. This relationship was studied after the administration of the full dose of the relaxant in all groups. Of all the priming doses, 0.08 mg/kg atracurium, when followed 3 min later by 0.42 mg/kg atracurium, had a significantly greater fade in the TOF ratio at any given T1 value. This may indicate significant prejunctional activity. Acceleration of the onset of neuromuscular blockade was, however, evident in all groups that received atracurium in divided doses. The implication is, therefore, that prejunctional activity may not contribute significantly to the acceleration of onset of neuromuscular blockade after administration of atracurium in divided doses, as described in this study.     

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.     

Influence of age on the dose-response relationship of atracurium in paediatric patients

To assess the influence of age on the dose-response relationship of atracurium in paediatric patients during thiopental-fentanyl-N2O-O2-anaesthesia, we studied 85 patients from neonates to adolescents. Each patient was given two doses of atracurium: following the maximum EMG response to the first dose of 150 micrograms/kg, an individual second dose was given, to produce exactly 95% neuromuscular block. The onset time of atracurium (time from administration to maximum effect) was shortest in neonates (2.6 min) and infants (3.3 min) and longest in adolescents (5.5 min) (P less than 0.01). The dose-response curves were parallel in all patients aged 3 months or older. The ED95 of atracurium was comparable for neonates and infants (226 micrograms/kg). This was 28% less than the ED95 for patients aged 1 year or older (316 micrograms/kg) (P less than 0.01). The results explain the slightly longer-lasting neuromuscular block in infants as compared to children following a constant atracurium dose in micrograms/kg. The great individual variability of the neuromuscular response, however, indicates that neuromuscular monitoring is essential in paediatric patients.     

Pretreatment with atracurium: the influence on neuromuscular transmission and pulmonary function

The influence of pretreatment with atracurium on neuromuscular transmission was evaluated in 60 healthy volunteers using train-of-four (TOF) nerve stimulation and measurement of respiratory rate (RR), vital capacity (VC), inspiratory force (IF), and peak expiratory flow (PEF). The subjects were randomly allocated to one of four groups: Group I received atracurium 0.02 mg/kg, Group II 0.03 mg/kg, Group III 0.04 mg/kg, and Group IV atracurium 0.05 mg/kg. TOF ratio decreased significantly in all four groups. There was, however, no difference between the groups after injection. PEF decreased significantly in all four groups, VC decreased in Groups I and IV, and RF increased significantly only in Group IV. Three subjects (5%) had shallow, frequent respiration; however, none needed respiratory support. The majority of the volunteers experienced blurring of vision and heavy eyelids: 82% and 67%, respectively. All subjects were able to sustain head lift for 10 s or more after atracurium. Careful observation of respiration is necessary, especially when using the higher doses of atracurium.