- 期刊
Succinylcholine在Atracurium誘發神經肌肉阻斷恢復期之作用
Effect of Succinylcholine on Recovery of Atracurium-induced Neuromuscular Blockade
摘要
本實驗的目的，在模擬atracurium肌肉鬆弛程度恢復到不適宜腹膜縫合時，探討不同劑量succinylcholine（Sch）對此時肌肉鬆弛度的影響，以找出適當劑量的Sch，來解決臨床麻醉的困擾。選擇64位ASA Class I-II，接受婦科例行手術的女性病患，分為六組。所有病患以diazepam, thiopental, 及fentanyl作麻醉誘導，以N_2O及isofluranc與氧氣來維持麻醉。然後以肌電圖（electromyogram, EMG, Datex Relaxography）監視及記錄其神經肌肉阻斷的程度。第一組病人（n=8），在麻醉誘導後，給予Sch 1,0 mg/kg。第二組至第六組共56位病人，在麻醉誘導後，以atracurium 0.4 mg/kg幫忙插管。當T_1恢復到50%時，則給予不同劑量之Sch。第二組至第六組，依次為0.4 mg/kg（n=11）,0.6 mg/kg（n=14）, 0.8 mg/kg（n=11）,1.0 mg/kg（n=10）及1.2 mg/kg（n=10）。這六組觀察Sch.的作用起始時間，作用時間，最大抑制程度（T_1）及T_1，由25%回復至50%的恢復指數。實驗結果發現Sch 0.4 mg/kg只有擷抗作用，而0.6 mg/kg至1.2 mg/kg各組之平均結果是加強atracurium阻斷作用，其加強阻斷的程度是隨著劑量的增加而增強。雖Sch 0.8 mg/kg對每一位病患皆是加強作用，但只有Sch 1.0-1.2mg/kg兩組可使每位病患T_1抑制至20%以下，所以臨床上我們建議使用Sch 1.0 mg/kg做為atracurium恢復至T_1小於或等於50%時的短暫肌肉鬆弛劑，以解決臨床問題。
並列摘要
If muscle relaxation is inadequate at the end of surgery, a transient increase in neuromuscular (NM) blockade should be needed to facilitate closure. Succinylcholine is the only agent of short duration available currently and could be used in the just mentioned circumstance. Therefore, the study was designed to investigate the effects of succinylcholine on the recovery of atracurium-induced NM blockade. Sixty-four female patients who underwent elective surgery under general anesthesia were allocated into 6 groups. Before anesthesia, no patient had received drugs which affect NM transmission. In all patients anesthesia was induced with thiopental, diazepam and fentanyl and maintained with 50% nitrous oxide in oxygen and 0.5-1.5% isoflurane. During anesthesia, blood pressure and electrocardiogram were monitored and end-tidal CO_2 was maintained at 30-40 mmHg. Control records of the integrated electromyography responsed to train-of-four supra-maximal stimulation using a Datex Relaxograph were obtained after induction of anesthesia before a block was produced with an initial dose of succinylcholine 1.0 mg in group I (n = 8) or atracurium 0.4 mg/kg in groups II-VI. On first twitch (T_1) recovering to 50% of control, 0.4 mg/kg, 0.6 mg/kg, 0.8 mg/kg, 1.0 mg/kg and 1.2 mg/kg of succinylcholine were given in groups II (n = 11), III (n = 14), IV (n = 11), V (n = 10), VI (n = 10) respectively. It was seen that succinylcholine 0.4 mg/kg antagonized NM blockade by atracurium but at 0.6 mg/ kg, 0.8 mg/kg, 1.0 mg/kg, 1.2 mg/kg it enhanced that. The enhanced NM blockade took 1.1-1.2 min to recover from 25% T_1 to 50% T_1 and 5.1-6.7 min to the extraploted recovering curves induced initially by atracurium 0.4 mg/kg. It is concluded that succinylcholine 1.0-1.2 mg/kg can be used to facilitate closure in case of inadequate muscle relaxation produced by atracurium partly because it increases atracurium-induced NM blockade and partly because the recovering times of enhanced NM blocks is similar to that of succinylcholine itself from 25% T_1 to 50% T_1.