- 期刊
Comparison of Neuromuscular Action of Rocuronium, a New Steroidal Non-depolarizing Agent, with Vecuronium
新型非去極化類固醇結構神經肌肉阻斷劑Rocuronium與Vecuronium的比較
摘要
Background: Rocuronium is a new nondepolarizing muscle relaxant. It features a rapid onset and lack of histamine release. It has an intermediate onset of action as vecuronium. The purpose of this study was to compare the neuromuscular action and condition of intubation after a bolus dose of rocuronium or vecuronium (2 x ED_(90)). We also compared the duration of relaxation after intubation and maintenance doses of each drug. Methods: Sixty male or female patients, age 18-65, scheduled for elective surgery under general anesthesia were divided randomly into two groups (rocuronium and vecuronium group). All patients were ASA class I-II and pre-operative laboratory data were normal. Anesthesia was performed with fentanyl, isoflurane and O_2. Rocuronium 0.6 mg/kg (2 x ED_(90)) or vecuronium 0.1 mg/kg (2 x ED_(90)) was given during induction of anesthesia. The response of adductor pollicis was measured with acceIeromyography. Neuromuscular block was maintained by bolus injection of rocuronium 0.15 mg/kg or vecuronium 0.025 mg/kg when T_1 reached 25% of control. Onset time, duration, recovery indices, intubation condition and T_4/T_1 ratio to 70% were recorded. Side effects were recorded during the study. Results: The onset time was significantly longer in vecuronium group than that of rocuronium group (102.8 ± 26.9 s vs. 54.9 ± 10.9 s, p ＜ 0.05). The clinical durations of action were respectively 44.2 ± 13.2 min in rocuronium group and 42.5 ± 9.1 min in vecuronium group (T_1 to 25%). The duration of the maintenance were respectively 28.8 ± 9.5 min in rocuronium group and 26.1 ± 6.8 min in vecuronium group (T_1 to 25%). No ad verse effect occurred with either drug. The intubation condition was similar in both groups. Conclusions: We conclude that rocuronium provides a more rapid onset of action than that of vecuronium. Rocuronium is an intermediate-acting muscle relaxant as vecuronium with good to excellent intubation condition. It may be an useful alternative to vecuronium for rapid tracheal intubation.
並列摘要
背景：Rocuronium是一種新發展中效型的肌肉鬆弛劑，它具有快速作用的特點，臨床上用來取代succinylcholine於氣管內插管。本研究目的在於比較投予單一劑量rocuronium（0.6 mg/kg）或vecuronium（0.1 mg/kg）後，患者可進行插管所需等候時間的差別及持續作用時間的長短，並評估兩藥品安全性的差異。方法：我們選取六十位屬於美國麻醉醫學會體位分級第I及第II級的病人。這些病人皆採用全身麻醉（fentanyl，thiopental，isoflurane）且執行一般非急診手術的病人，病人的年紀分佈在18到65歲，色括肝、腎等實驗室檢查值皆正常。所有實驗對象任意分成rocuronium及vecuronium兩組。在誘導期，分別接受0.6 mg/kg（2倍ED_(90)）rocuronium及0.1 mg/kg（2倍ED_(90)）vecuronium，當T_1小於10%，就施行插管並記錄插管的情形。在維持期，當T_1到達25%以上的時候，分別給與0.15 mg/kg rocuronium及0.025 mg/kg vecuronium的維持劑量。由acceleromyography來記錄神經肌肉阻斷的情形。並記錄發生作用的時間（T_1小於10%，插管時間），T_1到達25%，T_1到達75%，T_4/T_1比率到達70%的時間，及有關這兩種藥品所引起的不良副作用。結果：發生作用的時間分別為54.9秒及102.8秒；插管的劑量可維持44.2分及42.5分；維持的劑量可維持28.8分及26.1分。此外，沒有發生不良的副作用。結論：Rocuronium在兩倍ED_(90)的劑量下，可以很快的作用並提供較快又好的插管環境，是屬於中效型的肌肉鬆弛劑，甚至可以取代succinylcholine以利於迅速插管。