七氟烷对罗库溴铵、维库溴铵及阿曲库铵临床药效的影响

目的 以丙泊酚为对照,观察1.3 MAC的七氟烷对罗库溴铵、维库溴铵及阿曲库铵临床药效的影响.方法 选择60例择期腹部手术的病人随机分为6组,每组10人.七氟烷罗库溴铵组(sR组)、七氟烷维库溴铵组(SV组)及七氟烷阿曲库铵组(SA组)分别吸入1.3 MAC的七氟烷及静注芬太尼维持麻醉,丙泊酚罗库溴铵组(CR组)、丙泊酚维库溴铵组(CV组)及丙泊酚阿曲库铵组(CA组)以丙泊酚6 mg·kg-1·h-1～8 mg·kg～·h-1及芬太尼维持麻醉.监测起效时间、最大抑制程度、作用时间、维持速率、恢复时间、恢复指数.结果 七氟烷组与相应的对照组在最大抑制程度、恢复指数方面的无统计学差异,起效时间、作用时间、维持速率、恢复时间有统计学差异.结论 七氟烷能明显延长罗库溴铵、维库溴铵以及阿曲库铵的作用时间和恢复时间并减少其起效时间、维持剂量,但对最大抑制程度和恢复指数则无明显影响.     

罗库溴铵和阿曲库铵联合应用的肌松效应分析

目的探讨罗库溴铵和阿曲库铵联合应用时的肌松效应。方法择期全麻手术女性成年患者147例,丙泊酚和舒芬太尼静脉诱导,输注丙泊酚维持麻醉。面罩辅助或控制呼吸,用加速度仪以连续4次刺激(TOF)方式透皮刺激腕部尺神经,获取肌松药作用起效时间和T1最大抑制程度(Tmax)。按观测项目将患者均分成四组。结果阿曲溴铵ED95为(220.8±3.6)μg/kg,罗库溴铵ED95为(286.3±3.1)μg/kg。0.5×ED95的罗库溴铵与阿曲库铵联合使用,肌松效应达到T1抑制93%~97%时,阿曲库铵的剂量为63.6μg/kg。罗库溴铵0.5×ED95与阿曲库铵63.6μg/kg联合使用,Tmax为(95.3±0.9)%,变异系数1.0%。Ⅳ组中三个亚组的Tmax基本相同,合用组作用起效时间比阿曲库铵组快(P<0.01)。给予肌松药前和注药后5min内,MAP和HR的波动幅度均小于5%。结论罗库溴铵与阿曲库铵合用呈协同作用。当罗库溴铵剂量为0.5×ED95时,为获得T1抑制95%的肌松效应,阿曲库铵的合理用量为63.6μg/kg,比阿曲库铵的ED95减少71.2%。     

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.     

罗库溴铵和阿曲库铵肌松作用的对比研究

目的 比较两种短效非去极化肌松药罗库铵在妇科腹腔镜手术全麻中的肌松作用。方法 选择妇科腹腔镜手术病人40例，术前检查无明显肝肾功能损害。随机分罗库溴铵组（Ⅰ组，n1=20例）和阿曲库铵组（Ⅱ组，n2=20例）。麻醉诱导；静注咪唑安定0.1mg/kg，芬太尼5μg/kg，琥珀胆碱1.5mg/kg，丙泊酚1.5mg/kg，经口明视插管，接Datex-OhmedaAS/3麻醉机，用TOF-guard肌松监测仪（丹麦），采用TOF刺激模式，当肌颤搐恢复至T125%时，静注罗库溴铵0.8mg/kg或阿曲库铵0.5mg/kg维持肌松；当T15%-10%时，分别追加罗库溴铵0.4mg/kg或阿曲库铵0.2mg/kg。麻醉维持丙泊酚80-120mg/h和苏太尼40-60μg/h速率用微量注射泵静脉注射，同时吸入氧化亚氮（N2O：O2为1：1）。结果 I组起效时间明显较Ⅱ组短，并且T125%时间，T190%时间以及恢复指数均较Ⅱ组短。Ⅱ组的循环变化主要表现在注药后1，3，5分钟的SBP较注射前呈明显下降，5分钟后呈回升趋势，结论 罗库溴铵比阿曲库铵肌松起效快，恢复较迅速，对循环影响小，是内腔镜手术麻醉时的良好肌松药选择。     

七氟醚麻醉诱导对顺式阿曲库铵起效时间的影响

目的 探讨七氟醚肺活量法吸入诱导和丙泊酚静脉诱导对顺式阿曲库铵起效时间的影响.方法 择期行胸外科或普外科手术的全麻患者60例,ASA Ⅰ或Ⅱ级,年龄18～65岁,随机均分为七氟醚组(S组)和丙泊酚组(P组).麻醉诱导:P组静脉注射咪达唑仑0.05 mg/kg、芬太尼2μg/kg、丙泊酚1 mg/kg;S组采用肺活量吸入法,七氟醚吸入浓度8%.两组患者意识消失后均给予顺式阿曲库铵0.15 mg/kg.监测肌松药起效时间,意识消失时间,血流动力学指标,并评价气管插管条件.结果 患者意识消失时间、顺式阿曲库铵起效时间S组明显短于P组(P<0.05或P<0.01).插管引起的心血管反应S组小于P组(P<0.05).结论 七氟醚吸入诱导能明显缩短顺式阿曲库铵的起效时间,且循环功能稳定.     

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.     

全凭静脉麻醉下罗库溴铵及顺式阿曲库铵起效和恢复时间的变异率的对比研究

目的 比较罗库溴铵及顺式阿曲库铵成年患者和老年患者起效和恢复时间上的变异率.方法 80例全凭静脉麻醉下择期手术的成年患者和老年患者,随机分为罗库溴铵成年组和老年组各20例,顺式阿曲库铵成年组和老年组各20例.TOF-Watch每12秒钟刺激尺神经并监测拇内收肌收缩力量.记录药物在每个患者的起效时间,作用时间及恢复指数.结果 两个年龄组的罗库溴铵的起效时间显著短于相应年龄组的顺式阿曲库铵,变异率小于相应年龄组的顺式阿曲库铵;与成年组相比,罗库溴铵老年组的作用时间显著延长,恢复指数及变异率显著增加,顺式阿曲库铵老年组的作用时间及其变异率差异无统计学意义(P>0.05).结论 丙泊酚和瑞芬太尼全凭静脉麻醉下,等效剂量的罗库溴铵的起效速度显著快于顺式阿曲库铵,而顺式阿曲库铵无论在老年患者成年患者,其作用时间及恢复指数都是相对恒定的.     

罗库溴铵和顺式阿曲库铵用于肝部分切除术肌松效应的比较

目的比较罗库溴铵和顺式阿曲库铵用于肝部分切除术的肌松效应。方法择期全麻下行剖腹单纯肝部分切除术患者40例,随机均分为罗库溴铵组(R组)和顺式阿曲库铵组(C组)。全麻肌松药诱导量R组和C组分别为2倍ED95的罗库溴铵0.6mg/kg及顺式阿曲库铵0.1mg/kg,采用TOF监测肌松程度,当TOFr至25%时追加肌松药。观察两组肌松药起效时间、气管插管条件、临床作用时间、术毕恢复指数、气管拔管时间及不良反应。结果 R组起效时间明显快于、临床作用时间及术毕恢复指数明显长于C组(P0.05);两组气管拔管时间差异无统计学意义。当TOFr为0时,R组气管插管条件为优的例数明显多于C组(P0.05)。R组静脉注射痛发生率为16例(80%),明显高于C组的3例(15%)(P0.05)。两组患者围术期均未发生皮肤潮红、BP降低、HR增快及支气管痉挛等不良反应,未观察到拔管后的肌松残余作用。结论与顺式阿曲库铵比较,应用罗库溴铵具有起效快,作用时间长,虽恢复指数略长,但对拔管时间并无影响,同时未有明显的肌松残余作用,可以安全用于肝部分切除术的患者。     

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.     

罗库溴铵和阿曲库铵的预注量对相互起效的影响

目的　研究罗库溴铵和阿曲库铵的预注量对相互起效和插管条件的影响。方法　 6 0例患者随机平均分成六组。麻醉诱导用地西泮、硫喷妥钠和芬太尼。Ⅰ组和Ⅳ组分别静注罗库溴铵0 6mg/kg和阿曲库铵 0 5mg/kg ,Ⅱ组和Ⅴ组预注罗库溴铵 0 0 6mg/kg ,Ⅲ组和Ⅵ组阿曲库铵0 0 5mg/kg。 3分钟后Ⅱ组和Ⅲ组静注罗库溴铵 0 5 4mg/kg ,Ⅴ组和Ⅵ组阿曲库铵 0 4 5mg/kg。观察插管量后的起效时间和气管插管条件。结果　Ⅲ组的起效时间为 (6 7 6± 14 2 )秒稍短于Ⅰ组的(73 1± 13 4 )秒和Ⅱ组的 (76 3± 15 3)秒 (P >0 0 5 )。Ⅴ组和Ⅵ组的起效时间为 (93 8± 2 2 4 )秒和(115 8± 14 9)秒 ,比Ⅳ组 (15 6 0± 37 2 )秒的短 (P <0 0 5和P <0 0 1) ,Ⅴ组的起效时间也显著短于Ⅵ组。气管插管条件Ⅴ组较Ⅳ组明显改善。结论　预注罗库溴铵不能使罗库溴铵的起效增快。预注罗库溴铵使阿曲库铵的起效明显增快 ,插管条件改善 ;预注罗库溴铵比预注阿曲库铵对阿曲库铵起效的增快作用更明显     

Desflurane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol

PURPOSE: The present study investigated the interaction between the cumulative dose requirements of cisatracurium and anesthesia with isoflurane, sevoflurane, desflurane or propofol using closed-loop feedback control. METHODS: Fifty-six patients (18-85 yr, vitrectomies of more than one hour) were studied. In the volatile anesthetics groups, anesthesia was maintained by 1.3 MAC of isoflurane, sevoflurane or desflurane; in the propofol group, anesthesia was maintained by a continuous infusion of 6-8 mg.kg(-1).hr(-1) propofol. After bolus application of 0.1 mg.kg(-1) cisatracurium, a T1%-level of 10% of control level (train-of-four stimulation every 20 sec) was maintained using closed-loop feedback controlled infusion of cisatracurium. The effective therapeutic infusion rate (ETI) was estimated from the asymptotic steady-state infusion rate Iss. The Iss was derived from fitting an asymptotic line to the measured cumulative dose requirement curve. The ETI of the different groups was compared using Kruskal-Wallis- test, followed by rank sum test, corrected for the number of comparisons, P <0.05 was regarded as showing significant difference. RESULTS: ETI in the isoflurane group was 35.6 +/- 8.6 microg.m(-2).min(-1), in the sevoflurane group 36.4+/- 11.9 microg m(-2).min(-1), in the desflurane group 23.8 +/- 6.3 microg.m(-2).min(-1). The ETI of the volatile anesthetic groups were all significantly lower than the ETI in the propofol group at 61.7 +/- 25.3 microg.m(-2).min(-1) (P <0.002). The ETI in the desflurane group was significantly lower than in all other groups (P <0.02). CONCLUSION: In comparison to propofol, isoflurane, sevoflurane and desflurane reduce the cumulative dose requirements of cisatracurium to maintain a 90% neuromuscular blockade by 42%, 41% and 60%, respectively.     

长期糖皮质激素用药对老年患者全麻手术中顺阿曲库铵肌松效应的影响

目的探讨长期糖皮质激素用药对老年全麻手术患者顺阿曲库铵肌松效应的影响。方法择期老年全麻手术患者40例,男28例,女12例,年龄≥65岁,BMI 18~22kg/m2,ASA分级Ⅱ或Ⅲ级,根据患者是否长期糖皮质激素用药分为两组(n=20):对照组(非激素组,C组)和激素组(J组)。静脉注射咪达唑仑0.03mg/kg,面罩吸入8%七氟醚,氧流量为8L,每30s递减2%,直至4%,睫毛反射消失后,静脉注射顺阿曲库铵0.15mg/kg,经1min静脉注射瑞芬太尼2μg/kg,30s后停止吸入七氟醚,气管插管后行机械通气,靶控输注丙泊酚和瑞芬太尼维持麻醉,采用TOFWatch SX加速度仪监测肌松程度,记录顺阿曲库铵起效时间、肌颤搐最大抑制程度、临床作用时间、恢复指数。结果与C组比较,J组顺阿曲库铵起效时间明显延长,肌颤搐最大抑制程度明显降低,临床作用时间明显缩短,恢复指数明显减小(P0.05)。结论长期糖皮质激素用药可减弱老年全麻手术患者顺阿曲库铵肌松效应。     

不同麻醉下脊柱侧弯矫形术患者术中唤醒试验的比较

目的 比较不同麻醉下脊柱侧弯矫形术患者术中唤醒试验.方法 选择拟行脊柱侧弯矫形术患者40例,年龄13～ 18岁,性别不限,BMI＜ 30 kg/m2,ASA分级Ⅰ级.采用随机数字表法,将患者随机分为2组(n=20):异丙酚复合舒芬太尼组(P组)和靶控吸入七氟醚复合舒芬太尼组(S组).麻醉维持时S组靶控吸入七氟醚,呼气末靶浓度0.8％～1.5％;P组靶控输注异丙酚,血浆靶浓度3～5μg/rml,两组均靶控输注舒芬太尼,效应室靶浓度0.2 ～ 0.3 ng/ml.唤醒试验前停止输注顺阿曲库铵,下调舒芬太尼效应室靶浓度至0.1.ml;5 min后,S组停用七氟醚,P组停用异丙酚;5 min后开始唤醒试验.于唤醒试验前、唤醒成功时及唤醒成功后10 min(T0～2)时记录MAP和HR,记录唤醒时间、唤醒期间呛咳、躁动的发生情况,术后随访记录患者术中知晓的发生情况.结果 与P组比较,S组术中唤醒时间短(P＜0.05).两组术中唤醒期间MAP和HR均在正常范围内,两组比较差异无统计学意义(P＞0.05).所有患者术中唤醒试验均成功,术中唤醒期间无一例发生呛咳、躁动及术中知晓.结论 靶控吸入七氟醚复合舒芬太尼可安全有效地用于脊柱侧弯矫形术患者术中唤醒试验,且唤醒时间短于靶控输注异丙酚复合舒芬太尼麻醉,更适用于术中唤醒试验.     

两种快通道麻醉方法在肾移植手术的应用比较

目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉诱导用药相同。Ⅰ组吸入0.8%-1.8%七氟醚,使用小剂量顺式阿曲库胺[0.05-0.10 mg/（kg.h）]持续输注和常规剂量瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,结束前15 min停止使用七氟醚,并将瑞芬太尼减低至维持量的1/10-1/5用至拔除气管导管。Ⅱ组使用丙泊酚[5-12 mg/（kg.h）]全凭静脉麻醉,以常规剂量顺式阿曲库胺[0.1-0.2 mg/（kg.h）]及瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,手术结束后观察两组患者的睫毛反射时间、睁眼时间、拔管时间、术中知晓例数以及苏醒期躁动评分。结果Ⅰ组与Ⅱ组的睫毛反射时间、睁眼时间、拔管时间比较差异无统计学意义（均为P〉0.05）。两组患者均未出现术中知晓。Ⅰ组的躁动发生率明显低于Ⅱ组（P〈0.05）。Ⅰ组的顺式阿曲库胺、瑞芬太尼用量均明显少于Ⅱ组（均为P〈0.05）。结论七氟醚＋瑞芬太尼＋顺式阿曲库铵或丙泊酚＋瑞芬太尼＋顺式阿曲库铵这两种快通道麻醉方法用于肾移植手术均具有可控性良好、安全性高、患者苏醒迅速等特点,而七氟烷＋瑞芬太尼＋顺式阿曲库铵的组合更节省药物用量,且苏醒质量更高。     

The effect of anesthetic technique on recovery from neuromuscular blockade with cisatracurium

OBJECTIVES: To assess the effect of four anesthetic techniques on recovery after a single dose of 0.2 mg/kg of cisatracurium. PATIENTS AND METHOD: After giving informed consent, 96 patients of both sexes, ASA I-III, were enrolled. Anesthesia was induced with fentanyl, propofol O2-N2O (FiO2 40%) after which the patients were randomly assigned to four groups according to maintenance technique: propofol by infusion, sevoflurane, desflurane or isoflurane at 1.3 MAC. Neuromuscular block was monitored (electromyographic recording of the pollicis adductor). Variables recorded were time of maximum block, duration of action of 1% and 25%, and recovery indices at T0-TR75 andT25%-T75%. ANOVA was performed ( = 0.05 and beta = 0.1). RESULTS: The groups were homogeneous. Time until recovery of 25% of baseline amplitude of the first response to a train of four (TOF) (T1) was longer in the desflurane group (68.4 +/- 11.1 min) than in the propofol group (60.2 +/- 9.4 min; p < 0.05). Time until recovery of 75% of the TOF-ratio was longer in the sevoflurane (96.8 +/- 13.1 min), desflurane (101.5 +/- 14.4 min) and isoflurane (94.1 +/- 13.9 min) groups than in the propofol group (83.7 +/- 1.3 min) (p < 0.0001).Times until recovery of T1 up to 1% were not statistically different: 45.8 +/- 10.7 (propofol), 50.6 +/- 11.0 (sevoflurane), 51.3 +/- 11.5 (desflurane) and 46.5 +/- 11.2 min (isoflurane). The 25% - 75% recovery index was also similar at 19.0 +/- 9.3 (propofol), 20.0 +/- 5.1 (sevoflurane), 25.7 +/- 12.4 (desflurane) and 20.9 +/- 7.9 (isoflurane). CONCLUSIONS: The inhaled anesthetics studied prolong the duration of clinical effect of cisatracurium more than does propofol.     

氯胺酮对腹部手术患者七氟醚MAC_(BAR)的影响

目的 评价氯胺酮对七氟醚抑制50%腹部手术患者切皮时应激反应的最低肺泡有效浓度(MAC_(BAR))的影响.方法 择期腹部手术患者44例,ASA Ⅰ或Ⅱ级,年龄30～60岁,随机分为2组(n=22):对照组(K_0组)和氯胺酮组(K_1组).麻醉诱导:静脉注射异丙酚2 mg/kg、芬太尼3 μg/kg和顺阿曲库铵0.15 mg/kg,气管插管后行机械通气.K_0组吸入七氟醚,K_1组吸入七氟醚的同时静脉输注氯胺酮14 μg·kg~(-1)·min~(-1).初始七氟醚呼气末浓度为3.0%.采用改良的序贯法进行试验,切皮时患者的心率或平均动脉压升高幅度≥基础值的15%定义为阳性反应,记录平衡点后各个由阳性反应到阴性反应的中点的浓度,取其平均值,即为MAC_(BAR),并计算其95%可信区间.结果 K_0组七氟醚MAC_(BAR)为3.25%(95%可信区间为3.05%～3.45%);K_1组七氟醚MAC_(BAR)为2.20%(95%可信区间为1.96%～2.44%),K_1组七氟醚MAC_(BAR)低于K_0组(P<0.05).结论 静脉输注氯胺酮14 μg~(-1)·min~(-1)可降低腹部手术患者七氟醚MAC_(BAR),增强七氟醚抑制应激反应的效应.     

不同性别患者预注顺阿曲库铵加快起效的半数有效剂量

目的 探讨不同性别患者预注顺阿曲库铵加快起效的半数有效剂量(ED50).方法 择期拟在全身麻醉下行腹部手术的患者90例,年龄18～55岁,分为2组(n=45):男性组(M组)和女性组(F组).采用TOF-Watch SX型加速度肌松监测仪对尺神经行单次颤搐刺激,监测拇内收肌肌颤搐情况.静脉注射咪达唑仑0.04 mg/kg、芬太尼1 μg/kg,患者意识消失后开启加速度肌松监测仪,静脉注射顺阿曲库铵预注剂量,3 min后静脉注射芬太尼5 μg/kg、异丙酚2 mg/kg,静脉注射预注量后4 min,静脉注射顺阿曲库铵剩余插管剂量(3×ED95即0.15 mg/kg减去预注量),当单刺激颤搐值与对照值的比值下降至10%,行气管插管.静脉输注异丙酚、瑞芬太尼,吸入异氟烷维持麻醉.预注量根据序贯法确定,预注量从5μg/kg(10%ED95)开始,各相邻剂量比值为1.2.记录给予预注量后4min时单刺激颤搐值与对照值的比值、90%起效时间、起效时间、最大阻滞程度、临床作用时间.计算预注顺阿曲库铵加快起效的ED50及其95%可信区间(CI).结果 M组90%起效时间长于F组(P＜0.05),其余肌松效应指标两组比较差异无统计学意义(P＞0.05).预注顺阿曲库铵加快起效的ED50:男性为21.36μg/kg,95%CI为20.52～22.23μg/kg;女性为14.53 μg/kg,95%CI为13.77～15.33μg/kg,男性高于女性(P＜0.05).结论 预注顺阿曲库铵加快起效的ED50:男性为21.36μg/kg,女性为14.53 μg/kg,男性高于女性.     

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children

BACKGROUND: We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. METHODS: All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. RESULTS: Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. CONCLUSIONS: Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.     

Propofol anesthesia enhances the pressor response to intravenous ephedrine

The induction of anesthesia with propofol is often associated with a decrease in arterial blood pressure (BP). Although vasopressors are sometimes required to reverse the propofol-induced hypotension, little is known about the effect of propofol on these drugs. We studied the effects of propofol and sevoflurane on pressor response to i.v. ephedrine. Thirty adult patients were randomly assigned to one of two groups. In the Propofol group (n = 15), patients received propofol 2.5 mg/kg i.v. for induction followed by 100 microg x kg(-1) x min(-1) i.v. for maintenance. In the Sevoflurane group (n = 15), anesthesia was induced with sevoflurane 3%-4% in oxygen and maintained with sevoflurane 2% in oxygen. All patients in both groups received ephedrine 0.1 mg/kg i.v. before and after the anesthetic induction. Ephedrine increased the heart rate significantly (P < 0.05) in awake patients in both study groups. In contrast, there was no increase in heart rate after the ephedrine administration under propofol or sevoflurane anesthesia. In awake patients, transient increases in mean BP were observed after i.v. ephedrine in both groups. In the Propofol group, 2 min after the administration of ephedrine, mean BP increased 16% +/- 10% under anesthesia but increased only 4% +/- 6% when the same patients were awake. The magnitudes of the pressor responses to ephedrine during propofol anesthesia were significantly greater (P < 0.05) than during the awake state. However, ephedrine 0.1 mg/kg i.v. showed no significant increases in BP during sevoflurane anesthesia. We conclude that propofol, not sevoflurane, anesthesia augments the pressor responses to i.v. ephedrine. IMPLICATIONS: The effect of anesthetics on vasopressor-mediated cardiovascular effects is poorly understood. We evaluated the pressor response to ephedrine during propofol or sevoflurane anesthesia. Our study suggests that anesthesia-induced hypotension may be easier to reverse with ephedrine during propofol anesthesia than during sevoflurane anesthesia.