Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia

Study Objective: To determine the duration and recovery profile of maintenance doses of cisatracurium besylate following succinylcholine, and during propofol or isoflurane anesthesia.

Design: Randomized, open-label study.

Setting: Operating suite of a university-affiliated medical center.

Patients: Forty ASA physical status I and II adult patients having elective surgery with general anesthesia lasting longer than 90 minutes.

Interventions: Following a standardized induction sequence, a baseline electromyogram (EMG) was obtained. An intubating dose of intravenous (IV) succinylcholine 1.0 mg/kg was administered. Ventilation was maintained with a face mask until the first twitch (T₁) of the evoked train-of-four (TOF) reached 10% of control when tracheal intubation was performed. Spontaneous recovery from neuromuscular blockade was allowed to occur until the first twitch returned to 25% of control. Patients then were randomized to receive cisatracurium as follows. Group 1: 0.025 mg/kg [0.5 × 95% effective dose (ED₉₅)]; Group 2: 0.05 mg/kg (ED₉₅); Group 3: 0.05 mg/kg (ED₉₅); and Group 4: 0.1 mg/kg (2×ED₉₅). Anesthesia for Groups 1 and 2 were maintained with isoflurane 1% to 2%, 66% nitrous oxide (N₂O) in oxygen (O₂), and in Groups 3 and 4, anesthesia was maintained with propofol 80 to 160 μg/kg/min, 66% N₂O in O₂. The TOF-evoked EMG was recorded at 10-second intervals. The time for the evoked EMG to spontaneously return to 25%, 50%, and 75% of the original baseline was recorded.

Measurements and Main Results: There were 10 patients in each of the four groups. The duration of action of cisatracurium 0.05 mg/kg (ED₉₅) after an intubating dose of succinylcholine is 24.5 ± 10 minutes and 21.3 ± 9 minutes during anesthesia maintained with isoflurane and propofol, respectively. Doubling the dose of cisatracurium resulted in approximately twice the duration of action (40.2 ± 7 min) during propofol anesthesia. Following a dose of cisatracurium 0.025 mg/kg (0.5×ED₉₅), the T₁ of the EMG-evoked response did not decrease below 25% in 7 of 10 patients.

Conclusion: Following succinylcholine, the duration of action of a single dose of cisatracurium 0.05 mg/kg is 20 to 25 minutes during anesthesia maintained with propofol or isoflurane. The duration and recovery profile of cisatracurium is dose dependent during propofol and isoflurane anesthetics. Cisatracurium 0.025 mg/kg is an inadequate maintenance dose following recovery from succinylcholine and it fails to provide adequate surgical relaxation.     

肥胖患者应用顺苯磺酸阿曲库铵的肌松效应探讨

目的探讨肥胖患者应用顺苯磺酸阿曲库铵的肌松效应。方法选取该院收治的行全身气管插管静脉麻醉择期手术患者90例作为研究对象,按照患者体质量分为A组(正常体质量组)、B组和C组(肥胖组,C组体质量略高于B组)。3组均给予顺苯磺酸阿曲库铵麻醉诱导并采用肌松监测仪进行拇内收肌肌松监测,T1/Tc不足10%时给予气管插管,A组和B组按照患者实际体质量给药,C组按照理想体质量给药,比较3组患者的恢复指数、起效时间、作用时间以及气管插管条件评级等。结果 B组药物作用时间延长,药物起效时间缩短,C组药物作用时间缩短,药物起效时间延长,差异有统计学意义(P0.05)。结论按实际体质量给肥胖患者应用顺苯磺酸阿曲库铵肌松效果良好,起效时间短,作用时间长,改善患者耐受性,具有积极的临床使用和推广价值。     

不同体重指数对顺苯磺酸阿曲库铵药效学的影响

目的探讨不同体重指数对顺苯磺酸阿曲库铵药效学的影响。方法全身麻醉择期手术患者40例,ASAⅠ~Ⅲ级,按体重指数的不同分为四组:偏瘦组(Ⅰ组),BMI18.5 kg/m2;正常体重组(Ⅱ组),BMI 18.6~24.9 kg/m2;超重组(Ⅲ组),BMI 25.0~30.0 kg/m2;肥胖组(Ⅳ组),BMI≥30.0 kg/m2。四组均按实际体重分别给予0.15 mg/kg(3 ED95)顺苯磺酸阿曲库铵。使用加速度肌松监测仪(TOF-Watch誖SX)行TOF监测拇内收肌肉阻滞(NMB)程度。麻醉采用全凭静脉麻醉诱导及维持。当T1达最大抑制值(T1降至最低值并重复3次以上不变时)时进行气管插管。记录起效时间(从肌松药注毕至T1达到最大抑制值的时间)、临床作用时间(注药结束到T1恢复至25%的时间)、药理作用时间(注药结束到T1恢复至90%的时间)、恢复指数(T1从25%恢复到75%的时间)和气管插管条件评级。结果体重指数与3倍ED95顺苯磺酸阿曲库铵的临床作用时间呈线性相关,回归方程为Y=1.531X+8.479(R2=0.628,P0.01);BMI与3倍ED95顺苯磺酸阿曲库铵药理作用时间呈线性相关,回归方程为Y=1.954X+15.049(R2=0.585,P0.01)。4组患者的临床作用时间和药理作用时间差异有统计学意义(P0.05),而起效时间、恢复指数和插管条件差异均无统计学意义(P0.05)。结论顺苯磺酸阿曲库铵按实际体重3倍ED95给药,随着患者的体重指数增高,其临床作用时间和药理作用时间亦随之延长,体重指数是影响该药恢复时间的重要因素之一。     

Effects of pretreatment with cisatracurium, rocuronium, and d-tubocurarine on succinylcholine-induced fasciculations and myalgia: a comparison with placebo

Study Objective: To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery.

Design: Randomized, prospective, placebo-controlled trial

Setting: Teaching hospital.

Subjects: 80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia.

Intervention: A standardized balanced anesthetic technique was used for all patients.

Measurements and Main Results: Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (IV) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia was assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) in the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative myalgia.

Conclusion: Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery.     

不同诱导剂量顺式阿曲库铵的神经肌肉阻滞效果分析

目的观察单次静脉注射不同诱导剂量顺式阿曲库铵的起效时间、阻滞持续时间及对术中追加顺式阿曲库铵的阻滞持续时间的影响。方法将60例ASAⅡ～Ⅲ级择期腹部手术男性患者随机分为A、B、C组,各20例;分别单次静脉注射顺式阿曲库铵0.1mg/kg（A组,2×ED95）、0.15mg/kg（B组,3×ED95）、0.2mg/kg（C组,4×ED95）进行诱导,使用多功能肌松监测仪观察并记录阻滞开始起效时间、阻滞完全起效时间及T1恢复后再单次追加0.05 mg/kg顺式阿曲库铵的阻滞时间。结果 B组和C组的阻滞开始起效时间和完全起效时间均显著短于A组（P〈0.01）,而首剂阻滞时间和第1次追加1×ED95顺式阿曲库铵的阻滞持续时间显著长于A组（P〈0.01）,且C组较B组差异更显著（P〈0.01）,B组和C组第2次和第3次追加1×ED95顺式阿曲库铵的阻滞持续时间与A组相比,差异无统计学意义。结论顺式阿曲库铵用于成年男性麻醉诱导插管时起效时间随剂量增加而缩短,对于长时间手术通过加大诱导剂量来缩短诱导时间是安全可行的。     

预注顺阿曲库铵与增大其剂量在全麻诱导中的效果比较

目的：通过观察在全麻诱导插管中,预注顺阿曲库铵和增大其剂量两种给药方式对其起效时间、临床有效时间及肌松效果的影响,并进行对比,指导此药的临床应用。方法选择18~55岁,ASAⅠ~Ⅱ级择期行妇科手术的女性患者90例,随机分为3组,每组30例,分别为3ED95组、预注组（预注顺阿曲库铵0.015 mg/kg,4 min后给予0.135 mg/kg）和4ED95组。麻醉诱导使用芬太尼、咪达唑仑、丙泊酚,麻醉维持应用靶控微量泵输注丙泊酚、瑞芬太尼,TOF模式监测肌松情况。记录血压、心率及全身皮肤情况,记录肌松药起效时间、临床有效时间及气管插管条件评级。结果各组麻醉诱导期间血流动力学的变化比较均无统计学意义,各组肌松药起效时间分别是（184±56）s、（141±31）s、（135±45）s,预注组、4ED95组分别与3ED95组之间的比较均有统计学意义（P＜0.05）,但4ED95与预注组相比较无统计学意义（P＞0.05）;各组临床有效时间分别是（41±8）min、（44±6）min、（53±8）min,4ED95组分别与3ED95组、预注组相比较均有统计学意义（P＜0.05）,预注组与3ED95组比较无统计学意义（P＞0.05）。结论预注顺阿曲库铵与增大其剂量均能加快药物的起效时间,但前者比后者维持的临床有效时间更短,更有利于患者的苏醒及快速拔管。     

Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique

BACKGROUND: Muscle relaxants are believed to be responsible for 2/3 of the cases of anaphylactic reactions during anesthesia. This assumption is based mainly on positive skin tests obtained in individuals that have experienced anesthesia-related anaphylaxis. A positive skin test is supposed to be associated with mast cell degranulation of vasoactive amines. In the present study we tested the frequency of positive skin tests with two commonly used muscle relaxants, rocuronium and cisatracurium, in a selected group of volunteers with low potential for allergic reactions. METHODS: Thirty healthy volunteers without known allergy or previous exposure to muscle relaxants were studied. Low potential for allergic reactions was determined prior to inclusion in the study, using various allergy tests. Each individual was tested with intradermal and skin prick tests, and molar drug concentration thresholds for positive skin reactions were determined using a dilution titration technique. The presence or absence of mast cell degranulation was tested by electron microscopic investigation of skin biopsies obtained from positive and negative skin reactions. RESULTS: None of the volunteers had a positive skin prick test. More than 90% of the volunteers had a positive intradermal test with both rocuronium and cisatracurium. The highest molar drug concentration that was not associated with a positive intradermal test was 10(-6) M (rocuronium) and 10(-7) M (cisatracurium), equivalent to vial dilution 1 : 1000 for both drugs. In none of the volunteers was mast cell degranulation detected. CONCLUSION: Non-mast-cell-mediated positive intradermal skin reactions are frequently occurring with rocuronium and cisatracurium, even at vial dilution 1 : 1000. A clinically applicable test technique is needed that is able to separate positive skin tests associated with mast cell degranulation from non-mast-cell-mediated reactions.     

不同剂量顺苯磺酸阿曲库铵在神经外科全麻插管反应的观察

目的：观察不同剂量顺苯磺酸阿曲库铵用于神经外科手术全麻诱导后行气管插管时的心血管反应,探讨其最佳的全麻诱导剂量.方法：将60例择期行脑部脑肿瘤手术的患者随机均分为I-III组,15～65岁,质量平均40～80kg,ASAI-III.全麻诱导均采用咪唑安定0.03～0.05mg/kg,芬太尼4μg/kg,顺苯磺酸阿曲库铵剂量分别为0.15mg/kg（S1）,0.20mg/kg（S2）,0.30mg/kg（S3）,丙泊酚1～2mg/kg.并于给药5min后行气管插管,分别记录诱导前2min（T0,基础值）、插管前1min（T1）、插管后1min（T2）,3min（T3）,5min（T4）无创血压收缩压（SBP）、舒张压（DBP）、MAP、心率（HR）的变化.结果：所有患者均于给药5min后完成气管插管,插管条件达到1级47例（78.3%）,2级13例（21.7%）.S1组患者气管插管后血流动力学较诱导前明显增高,呈一过性; S2组患者气管插管后血流动力学较诱导前轻度增高; S3组患者气管插管后血流动力学较诱导前无明显变化.结论：麻醉诱导时顺苯磺酸阿曲库铵0.3mg/kg能有效减轻气管插管引起的应激反应并能缩短气管插管起效时间,用于颅脑肿瘤手术患者可能有利于减少气管插管引起的心脑血管意外情况的发生.     

离子对高效液相色谱荧光法测定人血浆中顺式阿曲库铵的浓度

目的:建立反相离子对高效液相色谱荧光法测定人血浆中顺式阿曲库铵浓度。方法:酸化的血浆样品采用乙腈沉淀蛋白处理,取上清液进样分析。色谱柱为Agilent Eclipse C18(150 mm×4.6 mm,5μm),流动相为1.5%三氟乙酸-乙腈(55∶45),流速0.5 mL·min-1,荧光的激发波长为280 nm,发射波长为320 nm。结果:顺式阿曲库铵在12.4～4960.0 ng·mL-1范围内线性关系良好(r=0.9998),检测限为1.24 ng·mL-1,平均提取收率为85.1%～88.5%,平均方法回收率为98.3%～102.1%,日内、日间RSD均<3.4%。结论:本方法操作简便、灵敏度高、专一性强、结果可靠,可满足临床检测和药代动力学研究的需要。     

顺式阿曲库铵和罗库溴铵在老年患者中的药效学比较

目的:观察单次静脉注射不同剂量的顺式阿曲库铵在老年患者中的药效学变化,并与壮年患者和罗库溴铵比较,为顺式阿曲库铵在老年患者麻醉中的应用提供参考。方法:择期全麻乳腺手术患者100例,根据年龄分为老年组(Ⅰ组)和壮年组(Ⅱ组),每组再分成4个亚组:罗库溴铵组(Ⅰ1,Ⅱ1)、顺式阿曲库铵2×ED95组(Ⅰ2,Ⅱ2),3×ED95组(Ⅰ3,Ⅱ3)和4×ED95(Ⅰ4,Ⅱ4),共8组。肌肉松弛监测采用4个成串刺激(train-of-four,TOF)。肌肉松弛效应观察指标包括:起效时间、TOF无反应期、T1恢复到25%,50%和75%的时间以及恢复指数。结果:老年组顺式阿曲库铵的起效时间稍长于壮年组,但差异无统计学意义;老年组顺式阿曲库铵的TOF无反应期、T1恢复到25%,50%和75%的时间及恢复指数均稍长于壮年组,但差异无显著性。老年组罗库溴铵起效时间明显长于其壮年组(P<0.05),且老年组肌肉松弛效应恢复的各项参数也均明显长于壮年组(P<0.05)。顺式阿曲库铵的肌松恢复指数在各组之间的差异无统计学意义。结论:对于女性而言,增龄对单次静脉注射顺式阿曲库铵的药效学无明显影响,对单次静脉注射罗库溴铵的药效学有显著影...