Succinylcholine對Atracurium阻斷作用回復時之影響

The Effect of Succinylcholine on the Recovery of Atracurium-induced Neuromuscular Blockade

高忠漢(Chung-Han Kao) ； 蔡玉娟(Yu-Chuan Tsai) ； 張傳林(Chuan-Lin Chang)

《Acta Anaesthesiologica Sinica》 29卷1期 (1991/03) Pp. 514-517

摘要

腹部手術即將結束前，常需一個短暫的肌肉鬆弛以利外科醫師縫合腹膜及腹肌。本研究是在觀察於atracurium作用逐漸消失的不同程度時，給予1 mg/kg的succinylcholine（Sch）所產生的作用差異。40位接受常規手術，ASA體位分等I-II的病人隨機分成4組，每組10位，以每20秒間隔的supramaximal train-of-four（TOF）刺激作用於尺神經上，以relaxograph（Datex）記錄hypothenar muscle的肌電反應。麻醉誘導後，先記錄對照值，在給予Sch（1 mg/kg）後，當T_1值回到對照值的50%以上時，給予atracurium 0.5 mg/kg。第一組病人在T_1自然恢復至20%時給予Sch（1 mg/kg），第二、三及四組則分別恢復至40%、60%和80%時才給予相同劑量之Sch，然後觀察T_1，和TOF之反應至少5分鐘，若T_1回復至小於5%則視為有加強作用。結果發現，當atracunum作用回復中給予Sch（1 mg/kg），其效應與當時阻斷程度有關。若想獲得短暫的肌肉鬆弛而給予Sch，應於T_1恢復大於50%時為佳。

關鍵字

Succinylcholine ； Atracurium ； Train-of four刺激

並列摘要

At the end of abdominal surgery, a brief but profound neuromuscular blockade may be needed to facilitate closure of abdominal wall. Succinylcholine (Sch) was the agent used in this regard before. This study was undertaken to observe the effect after administration of Sch (1 mg/kg) at various levels of recovery from atracurium. 40 ASA I or II patients undergoing elective surgery were randomly assigned to one of four groups with 10 in each. Anesthesia was induced with thiopental 5 mg/kg and Sch 1.5 mg/kg i.v., and maintained with 0.7% isoflurane (end-tidal concentration) and 50% N_2O in O_2 The electromyographic response of the hypothenar muscle was recorded in response to supramaximal train-of- four stimuli delivered to the ulnar nerve at 20 s intervals using a relaxograph (Datex). Control records were obtained after induction of anesthesia. When the first twitch (T_1) had recovered above 50% from the intubating dose of Sch, atracurium 0.5 mg/kg was administered. Spontaneous recovery of T_1 was observed. Patients in group 1 received 1 mg/kg of Sch, when T_1 returned to 20% and those in groups II, Ill, and IV received the same dose of Sch when T_1 returned to 40 %, 60% or 80% of control respectively. The response was observed at 20s intervals for at least 5 min after the administration of Sch. It was regarded as effective response if the T_1 returned to less than 5% of control. The data demonstrate that the effect of Sch (1 mg/kg ) administered in the presence of atracurium is related to the level of block that exists at the time of administration and the effect in deep blocking level is unpredictable.