量化琥珀胆碱对声带开放的影响，使用肌电图单抽动促进面罩通气：一项前瞻性观察研究

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-05-25 DOI:10.1016/j.tacc.2025.101564

Sarah J. Werner , Adrian I. Georgevici , Thomas P. Weber , Mitja Klutzny , Stefanie Dencks , Nico Oblisz , Philipp Gude , Jennifer Herzog-Niescery

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引用次数: 0

摘要

背景：神经肌肉阻断药物打开声带，促进面罩通气，但可能阻碍恢复自主呼吸。目前德国S1气道管理指南推荐给高危患者使用短效神经肌肉阻断药物，如琥珀酰胆碱，但没有明确剂量或监测声带张开的方法。本研究探讨基于肌电图的单次抽搐反应振幅与声带开口的关系。次要终点是给药0.1和0.9 mg kg - 1 IBW后琥珀胆碱的神经肌肉阻断效应的量化。方法选取30例年龄≥18岁、经气管插管使用琥珀酰胆碱的患者。诱导麻醉包括瑞芬太尼和异丙酚。用脑电图监测仪测量麻醉深度。基线神经肌肉阻滞是通过对指外展肌尺神经的单次抽搐刺激来确定的。声带区域被录像以确定基线条件。然后，患者给予0.1 mg kg - 1 IBW琥珀胆碱，2分钟后再给予0.9 mg kg - 1 IBW。4分钟后插管。结果主要终点各变量间spearson相关系数为- 0.54±0.09 (P <；0.001)。非线性回归包括与镇静深度指数的相互作用，准确地估计了声带开口(R2 68.3%, P <；0.001)。琥珀酰胆碱0.1 mg kg−1致声带开口78% （IQR 65 ~ 86%）。结论琥珀胆碱给药后，肌电图单次抽搐刺激联合镇静深度监测可可靠地估计声带孔径。使用较低剂量的0.1 mg kg - 1琥珀胆碱支持后，可获得相当大的声带开放，以确保面罩通气。临床试验注册号：drks00021433。

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Quantifying the effect of succinylcholine on vocal cord opening using electromyographic single twitch for facilitated mask ventilation: a prospective observational study

Background

Neuromuscular blocking drugs open the vocal cords and facilitate mask ventilation but may impede the return to spontaneous breathing. Current German S1 airway management guidelines recommend short-acting neuromuscular blocking drugs such as succinylcholine for at-risk patients without defining doses or methods to monitor vocal cord opening. This study investigates the relationship between electromyography-based single twitch response amplitude and vocal cord opening. Secondary endpoint was the quantification of succinylcholine's neuromuscular blocking effect after administration of 0.1 and 0.9 mg kg⁻¹ IBW.

Methods

Thirty patients aged ≥18 years scheduled for surgery with tracheal intubation using succinylcholine were enrolled. Induction of anaesthesia included remifentanil and propofol. The depth of anaesthesia was measured with an electroencephalogram monitor. The baseline neuromuscular block was determined electromyographically with single twitch stimulation of the ulnar nerve at the abductor digiti minimi muscle. The vocal cord area was videorecorded to determine baseline conditions. Then, the patient received 0.1 mg kg⁻¹ IBW succinylcholine and additional 0.9 mg kg⁻¹ IBW after 2 min. After 4 min the trachea was intubated.

Results

Pearson's correlation coefficient between the variables of the primary endpoint was −0.54 ± 0.09 (P < 0.001). The non-linear regression including interactions with a sedation-depth-index estimated accurately the vocal cord opening (R² 68.3 %, P < 0.001). Succinylcholine 0.1 mg kg⁻¹ opened the vocal cords 78 % (IQR 65–86 %).

Conclusions

After succinylcholine administration, the electromyographic single twitch stimulation combined with sedation-depth monitoring reliable estimates vocal cord aperture. The considerable vocal cord opening achieved after 0.1 mg kg⁻¹ succinylcholine supports using lower doses for assuring mask ventilation.