不同静脉麻醉药对罗库溴胺快速诱导气管插管的影响

目的:观察硫贲妥钠、依托咪酯以及异丙酚麻醉诱导对罗库溴铵的插管条件和神经肌肉阻滞程度的影响。方法:选择39例全麻择期手术患者,ASAⅠ~Ⅱ级,随机分为三组,分别采用硫贲妥钠5.0mg.kg-1、依托咪酯0.3mg.kg-1及异丙酚1.5~2.0mg.kg-1静脉诱导,静注罗库溴铵60s后行气管插管。记录气管插管即刻的T1和T4/T1值、插管时间,记录血流动力学参数变化、脉搏血氧饱和度,根据气管插管评分标准进行插管评分。结果:各组病人气管插管即刻的T1和T4/T1及插管时间组间比较无明显差异(P>0.05),三组病人在静注罗库溴铵后60s气管插管条件综合评分均为优良(P>0.05),但是依托咪酯比硫贲妥钠和异丙酚气管插管反应略少。结论:依托咪酯伍用罗库溴铵在静注后60s行快速诱导插管略优于硫贲妥钠和异丙酚。如果患者禁忌使用琥珀胆碱可以改用依托咪酯与罗库溴铵来完成快速诱导和气管插管。     

Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans

INTRODUCTION Rocuronium bromide is a new steroidal nonde- polarizing neuromuscular blocking drug that has a faster onset of action than other nondepolarizing neuromuscular blocking drugs. The liver is the major route for its elimination. On the other hand, impaired liver function does not alter either atracurium’s elimination or plasma clearance (Ward and Neill, 1983; Pitter et al., 1990). The exclusion of the hepatic circulation and function during the anhepatic phase of orthotopic liv…     

Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans

Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%–10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results: Rocuronium requirement, which were (0.468±0.167) mg/(kg·h) during the paleohepatic phase, decreased significantly during the anhepatic phase to (0.303±0.134) mg/(kg·h) and returned to the initial values at the neohepatic period ((0.429±0.130) mg/(kg·h)); whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.