罗库溴铵致深度神经肌肉阻滞后喉神经功能的恢复

V. Pavoni, L. Gianesello, C. Martinelli, Andrew Horton, A. Nella, G. Gori, Martina Simonelli, G. Scisciolo
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引用次数: 0

摘要

罗库溴铵是一种非去极化氨基类固醇神经肌肉阻断剂(NMB),高剂量(1.2 mg/kg)通常在不到2分钟内产生完全的长效神经肌肉阻断,可促进常规气管插管和快速插管。NMB的恢复和咽喉肌肉的完全控制对外科患者气道的维持和保护是重要的。神经肌肉阻滞可以使用加速肌图准确监测。Sugammadex是一类新型选择性肌肉松弛结合药物中的第一种,用于快速有效地逆转氨基类固醇神经肌肉阻断药物诱导的NMB。研究观察了不同肌肉的NMB逆转,没有一个与喉部肌肉的恢复完全相关。一项观察性研究通过神经生理监测来评估sugammadex逆转罗库溴铵诱导的喉肌功能NMB的疗效。本研究的另一个目的是利用运动诱发电位(MEPs)与加速肌图比较,确定糖madex 16 mg/kg后的恢复时间。所有统计检验均采用双侧检验,显著性水平为0.05,结果以均数(连续变量)±SD或百分比(分类变量)表示。试验结果显示,所有患者在给药时肌源性meps反应缺失,神经肌肉监测显示深度阻滞(训练-4比为0,破伤风后计数为1-2)。我们还观察到,完全恢复基础肌源性MEPs振幅的时间在喉内收肌为70±18.2秒,在指外展肌为135±14.1秒。相应的train-of-4比值为0.7±0.1。神经肌肉恢复不完全可引起患者呼吸障碍和低氧血症;因此,喉肌神经肌肉传导的完全恢复对气道保护至关重要。本神经生理学研究证实,给药16 mg/kg糖玛德可使罗库罗仑诱导的NMB的喉神经功能完全有效恢复。未观察到经皮刺激喉神经(如心律失常、皮肤刺激)的不良反应,也未见糖美酮引起的不良反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Recovery of Laryngeal Nerve Function With Sugammadex After Rocuronium-Induced Profound Neuromuscular Block
Tracheal intubation during routine and rapid-sequence intubation is facilitated by rocuronium, which is a nondepolarizing aminosteroid neuromuscular block (NMB) agent, higher doses of which (1.2 mg/kg) typically produces a complete neuromuscular blockade in less than 2 minutes that is long acting. Recovery from NMB and restoration of full control of pharyngeal and laryngeal muscles are important in airway maintenance and protection in surgical patients. Neuromuscular block can be accurately monitored using acceleromyography. Sugammadex, the first of a new class of selective muscle relaxant–binding drugs, is used to rapidly and effectively reverse NMB induced by aminosteroid neuromuscular-blocking drugs. Studies have looked at NMB reversal on various muscles, none of which correlate exactly with recovery of laryngeal muscles. An observational study was carried out to evaluate the efficacy of sugammadex in reversing rocuronium-induced NMB of laryngeal muscle function using neurophysiologic monitoring. Another aim of this study was to establish the time of recovery after 16 mg/kg of sugammadex using motor-evoked potentials (MEPs) compared with acceleromyography. All statistical tests were 2-sided with a significance level of 0.05, and the results were presented as the mean (continuous variables) ± SD or percentage (categorical variables). The test results showed that myogenicMEPs responses were absent, and neuromuscular monitoring showed a deep block in all patients (train-of-4 ratio of 0, posttetanic count of 1–2) at the time of sugammadex administration. It was also observed that the time to complete recovery of the basal myogenic MEPs amplitudes was 70 ± 18.2 at the laryngeal adductor muscles and 135 ± 14.1 seconds at the abductor digiti minimi. The value of the corresponding train-of-4 ratio was 0.7 ± 0.1. Incomplete neuromuscular recovery can cause respiratory impairment and hypoxemia in patients; hence, complete recovery of neuromuscular transmission at the laryngeal muscles is paramount for airway protection. This neurophysiologic study confirmed that administering 16 mg/kg sugammadex caused complete and effective recovery of laryngeal nerve function from rocuroniuminduced NMB. No adverse effects due to transcutaneous stimulation (such as cardiac arrhythmias and skin irritation) of the laryngeal nerve were observed, and no adverse effects due to sugammadex were noted.
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