Priming reversal of profound atracurium blockade by edrophonium and neostigmine.

C. H. Liu, I. Lin, C. G. Liu, T. Peng, Y. Yeh, L. J. Chuu, S. Y. Lin
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Abstract

Accelerated reversal of moderate neuromuscular blockade has been reported to be effective by giving anticholinesterase in divided doses (priming reversal). To evaluate its effectiveness in profound blockade, forty ASA physical status I or II patients were studied. After receiving 0.5mg/kg of atracurium during N2O-O2-halothane anesthesia, they were reversed at 5% spontaneous recovery of first twitch height (T1) measured by train-of-four (TOF) stimulation. Edrophonium 1mg/kg was administered intravenously either in a single bolus dose (Group I, n = 10) or in an initial priming dose of 0.2mg/kg followed one minute later by 0.8mg/kg (Group II, n = 10). Neostigmine 0.05mg/kg was administered in a single bolus dose (Group III, n = 10) or in divided priming dose of 0.01 mg/kg followed one minute later by 0.04mg/kg (Group IV, n = 10). The recovery time from the first injection of the reversal agents until the TOF ratio reached 75% was significantly longer (p < 0.05) in Group III (681.5 +/- 77.5 sec) compared to Groups I, II, and IV (451.3 +/- 72.3 sec, 470.6 +/- 39.8 sec, and 448.1 +/- 42.5 sec, respectively; no statistical difference among these three groups). It is concluded that priming reversal by neostigmine, but not edrophonium, produced a significantly faster recovery of profound atracurium blockade. Using the priming method, neostigmine may reach a similar recovery time as edrophonium in profound blockade under equipotent doses.
艾络芬和新斯的明对阿曲库铵深度阻断的启动逆转。
据报道,通过分剂量给予抗胆碱酯酶(启动逆转),中度神经肌肉阻断的加速逆转是有效的。为了评估其在深度阻断中的有效性,研究了40例ASA身体状态I或II的患者。在n20 - o2 -氟烷麻醉期间给予0.5mg/kg阿曲库铵后,在5%的自发恢复时,通过四组训练(TOF)刺激测量首次抽搐高度(T1)。erophonium 1mg/kg静脉给予单次剂量(组I, n = 10)或初始剂量0.2mg/kg, 1分钟后再给药0.8mg/kg(组II, n = 10)。新斯的明0.05mg/kg单次给药(III组,n = 10)或分次给药0.01 mg/kg, 1分钟后再给药0.04mg/kg (IV组,n = 10)。从第一次注射逆转药物到TOF比率达到75%,III组的恢复时间(681.5 +/- 77.5秒)显著高于I、II、IV组(451.3 +/- 72.3秒,470.6 +/- 39.8秒,448.1 +/- 42.5秒)(p < 0.05);三组间无统计学差异)。由此得出结论,新斯的明而非伊曲芬铵的启动逆转能显著加快阿曲库铵深度阻断的恢复。在同等剂量下,新斯的明在深度阻断下可达到与依洛芬铵相似的恢复时间。
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