顺式阿曲库铵对兔定量药物脑电图δ、θ频段的影响

目的探讨顺式阿曲库铵对兔定量药物脑电图(QPEEG)δ、θ频段的影响。方法采用QPEEG功率谱分析法,分析兔静脉注射顺式阿曲库铵0.3mg/kg前后δ、θ频段功率百分比的变化。结果与给药前相比,枕区δ频段功率百分比在给药后各时间点均增加(P<0.05或P<0.01),而其它各脑区δ频段功率百分比的变化差异均无统计学意义(P>0.05)。与给药前相比,各脑区θ频段功率百分比在给药后各时间点均有所增加,其中枕区和颞区增加最明显(P<0.05或P<0.01)。结论顺式阿曲库铵能够增大兔QPEEG枕区δ频段功率百分比及各脑区θ频段功率百分比。     

Storage at room temperature does not change cisatracurium onset time: a prospective, randomized, double-blind controlled study

Objective

Storage of cisatracurium at room temperature seems to have no effect on its degradation in vitro contrary to the recommendations of storage at +4 °C. The purpose of this study was to evaluate the influence of cisatracurium’ s storage temperature on its onset time.

Study design

Prospective, randomized, double-blind trial study.

Patients and methods

Thirty patients were enrolled. The control group consisted of 15 patients receiving cisatracurium (0.15 mg/kg) stored at room temperature and the intervention consisted of 15 patients receiving cisatracurium (0.15 mg/kg) stored at +4 °C. The primary endpoint was to compare cisatracurium onset time depending on the storage temperature.

Results

Cisatracurium onset time was 235 (180–292) seconds in the “room temperature” group vs. 240 (210–292) seconds in the “refrigerated” group. There was no difference between the onset of cisatracurium depending on the temperature of storage (p = 0.51). Subgroups analysis in the “room temperature” group did not show any difference in cisatracurium onset depending on whether it was stored at room temperature for one, two or three weeks. Excellent intubation score was obtained for 100% of the patients.

Conclusion

This study demonstrated that cisatracurium's storage at room temperature had no influence on its onset time. It provides an argument for the preservation of cisatracurium at room temperature for a period not exceeding 21 days. Monitoring the onset of curarization may increase the quality score of intubation.     

Die klinische Pharmakologie von Cisatracurium

Cisatracurium (51W89) is one of the ten stereoisomers of atracurium, accounting for about 15% of the racemate. The ED₉₅ of cisatracurium was determined to be about 50?μg/kg (cation, molecular weight 929), while the ED₉₅ of atracurium (besylate salt, molecular weight 1245) was 250?μg/kg. Thus, on a molar basis in adult patients, cisatracurium is about 3.5 times as potent as the racemic atracurium mixture. We compared atracurium with cisatracurium in healthy adult patients and found an almost identical pharmacodynamic profile. In children, an ED₉₅ of about 40?μg/kg was determined, while a 1-min-longer onset of cisatracurium was found in geriatric than in young adult patients. The presence of chronic renal failure did not prolong the duration of action of cisatracurium. The recovery of neuromuscular transmission from a cisatracurium infusion of up to 145?h was investigated in intensive care unit patients. Their time from the end of infusion to a train-of-four ratio >0.7 (68±18?min) was on average only some 70% longer than after an infusion of cisatracurium for 2?h in normal surgical patients. In another study, no signs of histamine release nor any clinically relevant cardiovascular effects of cisatracurium were found in doses up to eight times ED₉₅.     

Die klinische Pharmakologie neuer Benzylisochinolin-Diester-Verbindungen Unter besonderer Berücksichtigung von Cisatracurium und Mivacurium

The benzylisochinoline muscle relaxants have a highly selective affinity to the motor endplate which is associated with an absence of autonomic side effects such as ganglionic and vagus block. The requirement of only low clinical doses also reduces histamine liberation. Muscle relaxants with high neuromuscular blocking potency have a slow onset. Both atracurium and cisatracurium undergo Hofmann-Elimination in the plasma whereas mivacurium is hydrolyzed by pseudocholinesterase. The difference in kinetics between these pathways render atracurium and cisatracurium muscle relaxants of intermediate duration of action while mivacurium is short acting. Cisatracurium, one of the ten stereoisomeres of atracurium, is 3 to 4 times as potent as atracurium, does not release histamine, has no cardiovascular side effects and, due to the small clinical doses resulting from its high neuromuscular blocking potency, produces only negligible quantities of laudanosine. Its ED₉₅ is 0.05 mg/kg. Good intubation conditions can be expected within 1.5 to 2 min following 3- to 4-times the ED₉₅. Thereafter is takes about 65 min for T1 to recover to 25% of control. Maintenance doses of 0.02 to 0.04 mg/kg have a duration of action of 15 to 20 min. An infusion of cisatracurium of 1.0 to 2.0 mcg/kg/min, is adequate to maintain a 90 to 95% neuromuscular block. The time of recovery is largely independent on the total dose of cisatracurium administered by either repeated injection or infusion. – Mivacurium is a racemate of 3 stereoisomeres of which the trans-trans- and the cis-trans-compound account for 95% of the neuromuscular blocking effect. In adults the ED₉₅ is 0.08 mg/kg. The ensuing recovery of T1 to 25% of control is about 15 min. Rapid injection of 3×ED₉₅ may transiently lower the arterial blood pressure and may produce skin flushing in an incidence of 30 to 40%. Larger doses should be injected slowly with 30 to 60 s. The onset of mivacurium neuromuscular block following 3×ED₉₅ is relatively slow (2 min). Maintenance doses of 0.05 to 0.1 mg/kg have a duration of action of 5 to 10 min. A 95% neuromuscular block may be maintained by an infusion of 3 to 12 μg/kg/min. The time of recovery does not depend on the total cumulative dose given by either repeated injection or by infusion. The duration of mivacurium neuromuscular block may be drastically prolonged in the presence of low or atypical plasmacholinesterase. Both neostigmine and edrophonium are suitable reversal agents. ? None of the presently available benzylisochinoline muscle relaxants has the potential to completely replace succinylcholine.     

预注不同剂量顺式阿曲库铵对其起效时间的影响

目的探讨预注不同剂量顺式阿曲库铵对其起效时间的影响。方法选择2014年11月至2015年4月南京医科大学第一附属医院择期手术全麻患者80例,男41例,女39例,年龄18~60岁,随机均分为四组,每组20例。对照组(C组)预注生理盐水3 ml,C1组、C2组、C3组分别预注顺式阿曲库铵15、30、50μg/kg,1min后再分别静脉注射剩余剂量顺式阿曲库铵0.15、0.135、0.12、0.10mg/kg,麻醉诱导顺序静脉注射咪达唑仑0.05mg/kg、芬太尼5.0μg/kg、依托咪酯0.3mg/kg,采用四个成串刺激(TOF)监测,记录静脉注射剩余插管剂量后T4/T1=0的时间,记录呼吸困难、荨麻疹、心律失常等不良反应的情况。结果C3组起效时间为(114.2±14.1)s,明显短于C2组(136.3±28.1)s、C1组(164.6±26.9)s和C组(165.9±10.8)s(P0.01)。四组患者均未见呼吸困难、荨麻疹、心律失常等不良反应。结论与顺式阿曲库铵15和30μg/kg比较,顺式阿曲库铵50μg/kg预注能明显缩短肌松起效时间。     

顺式阿曲库铵预注射联合无通气诱导在全麻剖宫产中的应用

目的：探讨顺式阿曲库铵预注射联合无通气快速诱导用于全麻剖宫产术的安全性和可行性。方法拟行全麻下剖宫产手术的产妇22例,诱导前给予1/8-1/10诱导剂量的顺式阿曲库铵预注射,面罩吸入纯氧3min后行静脉快速诱导,诱导期间不实施正压辅助通气,观察并记录诱导前后HR、SpO2、BP的变化及诱导过程中呛咳、呕吐、返流、误吸发生率。结果T0、T1、T2与T3各时点的SpO2分别为（96.57±0.61）%、（98.78±0.42）%、（97.94±0.35）%和（99.63±0.14）%。诱导过程平稳,气管插管前后SpO2无显著变化;诱导过程中无缺氧、呕吐、返流、误吸发生,且插管条件较为理想。结论对拟行全麻剖宫产的非困难气道产妇,采用顺式阿曲库铵预注射联合无通气快速诱导技术是安全、可行的。     

顺阿曲库铵引起过敏反应的概述

背景围手术期过敏反应是全身麻醉期间严重的并发症之一,麻醉期间使用的药物均可能导致发生,其中以神经肌肉阻滞剂（neuromuscular blocking agent, NMBA）多见。目的收集国内外的相关文献,综合分析顺阿曲库铵引起过敏反应的原因、临床表现及诊断方法。内容顺阿曲库铵是和种临床上较常用的非除极NMBA,早期认为顺阿曲库铵可释放少量组胺,对循环影响较小,应用前景广泛。但在使用过程中有研究报道,顺式阿曲库铵可引起严重的过敏反应,并伴有血流动力学改变和支气管痉挛症状。趋向随着顺阿曲库铵使用率的升高。由其引起的过敏反应的发生率也随之上升,麻醉医师对此现象应加以关注和重视。     

顺式阿曲库铵不同用药方式对老年全凭静脉麻醉肌松作用的影响

目的 探讨顺式阿曲库铵不同用药方式对老年患者全凭静脉麻醉肌松作用的影响.方法 60例掸期在全麻下行普外科手术的老年患者,ASA I～Ⅱ级.年龄7l～87岁,随机分为A组(η=20)和B组(η=40),其中B组再随机分为B1组(η=20)和B2组(η=20).肌松诱导:A组单次予顺式阿曲库铵0.2 mg·kg-1静注;B...     

预注法对缩短顺式阿曲库铵起效时间的影响

目的 探讨预注法对缩短顺式阿曲库铵(Cis)起效时间的影响.方法 成年择期手术全麻患者40例随机均分为Cis预注组(P组)和生理盐水组(N组).P组静脉预注Cis 0.025 mg/kg,N组静脉预注等体积生理盐水;第3分钟各组顺序静脉注射丙泊酚1.5 mg/kg、芬太尼4μg/kg;第4分钟P组静脉注射插管剂量Cis 0.125 mg/kg,N组静脉注射插管剂量Cis0.150 mg/kg.采用四个成串刺激(TOF)监测并记录静脉注射插管剂量Cis前的T1值、TOF值、起效时间和插管条件.结果 预注Cis后,两组SpO2均≥97％,未见呼吸困难、复视、吞咽困难等不良反应.P组患者静脉注射插管剂量Cis前的T1值、TOF值和起效时间均明显低于N组(P＜0.05).结论 预注法可以明显缩短Cis的起效时间.     

大剂量法和预注法对顺式阿曲库铵起效时间的影响

目的观察大剂量法（4倍ED95）和预注法对顺式阿曲库铵起效时间的影响。方法选择ASAⅠ～Ⅱ级全麻妇科择期手术30～55岁患者60例,随机分3组（n=20）。A组（标准组）：单次静脉注射顺式阿曲库铵0.15mg/kg（3倍ED95）;B组（大剂量组）：单次静脉注射顺式阿曲库铵0.20mg/kg（4倍ED95）;C组（预注组）：诱导前静脉注射顺式阿曲库铵0.03mg/kg,4min后再注射顺式阿曲库铵0.12mg/kg。采用TOF WATCH SX型肌松监测仪进行肌松监测,观察各组肌松药起效时间。结果 A组起效时间（285.1±41.6）s明显长于B组（143.4±28.1）s及C组（189.2±36.2）s,差异有统计学意义（P〈0.05）。B组与C组比较,差异无统计学意义（P〉0.05）。结论大剂量法与预注法均可明显缩短顺式阿曲库铵起效的时间,但4倍ED95与预注法（总量3倍ED95）两者之间差异无统计学意义。