术前急性高容量血液稀释对罗库溴铵量效关系及作用时间的影响

目的 探讨术前急性高容量血液稀释(acute hypervolaemic haemodilution,AHH)对罗库溴铵量效关系及作用时间的影响。方法 选取2022年4—10月首都医科大学附属北京朝阳医院怀柔医院需择期进行全麻手术的患者80例,随机分成AHH组和对照组,每组40例。AHH组麻醉30 min内静脉输注15 ml/kg 6%羟乙基淀粉,对照组30 min内缓慢滴注1~2 ml/kg 6%羟乙基淀粉。比较两组患者的一般情况,AHH前(t1)、AHH完成即刻(t2)、4个成串刺激(train of four,TOF)=0.9即刻(t3)的血液及尿液相关指标,罗库溴铵的绝对作用时间[自T1(第1个颤搐反应)=0至T1=1%所需时间]、临床作用时间(自T1=0至T1=25%所需时间)、体内作用时间(自T1=0至TOF=0.9所需时间)和恢复指数(T1从25%恢复至75%所需时间)。结果 80例患者中男50例、女30例;平均年龄(53.2±4.6)岁;平均身高(167.41±6.35)cm;平均体质量(67.88±6.38)kg。与t1相比,AHH组t2和t3的Hb、红细胞压积、TP、ALB、K^(+)、Mg^(2+)、Ca^(2+)、HR均降低;与对照组t2和t3相比,AHH组同时段的Hb、红细胞压积、TP、ALB、K^(+)、Ca^(2+)、Mg^(2+)、HR均较低,MAP和尿量均较高;差异均有统计学意义(P<0.05)。AHH组和对照组罗库溴铵的量效关系方程分别为y=105.7lgX-172.7和y=104.9lgX-169.0。两组罗库溴铵的ED_(50)、ED_(90)、ED_(95)、绝对作用时间、临床作用时间、体内作用时间和恢复指数方面的差异均无统计学意义(P> 0.05)。结论 15 ml/kg 6%羟乙基淀粉进行AHH不明显改变罗库溴铵的量效关系及作用时间。

两种不同的非去极化肌松剂复合瑞芬太尼用于支撑喉镜下声带息肉手术的比较

目的比较1倍ED 95罗库溴铵和顺式阿曲库铵复合瑞芬太尼麻醉在支撑喉镜下声带息肉手术的效果。方法选取三峡大学人民医院2019年1~11月在全身麻醉下行支撑喉镜声带息肉切除术的50例患者,采用随机数字表法分为罗库溴铵组(R组,n=25)、顺式阿曲库铵组(C组,n=25)。观察2组患者血流动力学指标、肌松作用时间、自主呼吸恢复时间、气管拔管时间。结果两组患者并发症发生率差异无统计学意义(P>0.05)。罗库溴铵组气管插管条件更佳、放置支撑喉镜时患者呛咳和体动的发生率更低、手术医生满意度更高、血流动力学指标更稳定、肌松作用时间更短、自主呼吸恢复和气管拔管时间更短(P<0.05)。结论1倍ED 95罗库溴铵复合瑞芬太尼麻醉在支撑喉镜下声带息肉手术的效果优于等效剂量的顺式阿曲库铵,有利于加快此类短小手术的周转。

不同剂量罗库溴铵对腔镜甲状腺切除术中喉返神经监测的影响

目的探讨不同剂量罗库溴铵对腔镜甲状腺切除术中喉返神经监测的影响。方法选择2021年10月至2022年10月行经乳晕入路腔镜甲状腺切除术的患者116例,男30例,女86例,年龄18~64岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:罗库溴铵0.30 mg/kg组(R1组,n=39)、罗库溴铵0.45 mg/kg(R2组,n=39)和罗库溴铵0.60 mg/kg(R3组,n=38)。麻醉诱导后,R1组、R2组和R3组分别静脉注射罗库溴铵0.30、0.45、0.60 mg/kg。当TOF值为0后插入神经监测气管导管,术中全程监测肌松,神经监测结束前不追加肌松药。记录首次出现喉返神经肌电图(EMG)时间及EMG振幅、插管时间及气管插管质量(Cooper’s评分法)。记录术中低血压、高血压、心动过缓、心动过速、体动的发生情况。记录术后咽痛、声音嘶哑、肌肉疼痛的发生情况。结果三组首次出现喉返神经EMG时间差异无统计学意义。与R1组比较,R2组和R3组首次出现喉返神经EMG振幅明显降低(P<0.05)。与R1组比较,R2组和R3组插管时间明显缩短(P<0.05)。与R2组比较,R3组插管时间明显缩短(P<0.05)。与R1组比较,R2组和R3组气管插管质量明显升高(P<0.05)。与R1组比较,R2组和R3组术中体动、术后咽痛发生率明显降低(P<0.05)。结论在腔镜甲状腺切除术中,与罗库溴铵0.30 mg/kg比较,罗库溴铵0.45和0.60 mg/kg既能提供良好的气管插管条件,又能监测到喉返神经肌电信号,罗库溴铵0.60 mg/kg插管时间更短。

舒更葡糖钠与新斯的明肌松拮抗策略对肺叶切除患者肺功能影响效果分析

目的:探讨罗库溴铵-舒更葡糖钠与罗库溴铵-新斯的明肌松拮抗策略对肺叶切除术患者肺功能影响效果分析。方法:选取2021年1月至2022年12月于本院行肺叶切除患者86例作为研究对象,按照随机数字表法完全随机分为观察组(予以罗库溴铵-舒更葡糖钠肌松拮抗策)与对照组(予以罗库溴铵-新斯的明肌松拮抗策),每组43例。对比第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰流速(PEFR)、去甲肾上腺素(NE)、丙泊酚用量、皮质醇(Cor)、血氧分压(PaO_(2))、瑞芬太尼用量、氧合指数(PaO_(2)/FiO_(2))、术后自主呼吸恢复时间、术后意识恢复时间、肌松拮抗剂起效时间、气管拔管时间、PACU停留时间及术后并发症。结果:重复测量方差分析显示,两组FEV1、FVC、PEFR、NE、Cor、PaO_(2)、PaO_(2)/FiO_(2)存在时间效应、组间效应及时间与组间交互作用均有统计学意义(P<0.05);在术后拔除气管导管后、拔除胸腔引流管后时点,观察组的FEV1、FVC、PEFR高于对照组(P<0.05);在T1、T2、T3时点,观察组的NE、Cor均低于对照组(P<0.05);在切皮时、拔除气管导管前15min、出麻醉后监测治疗室即刻,观察组的PaO_(2)、PaO_(2)/FiO_(2)均高于对照组(P<0.05)。观察组丙泊酚用量、瑞芬太尼用量低于对照组,而术后自主呼吸恢复时间、PACU停留时间、术后意识恢复时间、肌松拮抗剂起效时间、气管拔管时间短于对照组(P<0.05)。观察组的恶心呕吐、寒战、低血压及术后1、7d肺部并发症发生率均低于对照组(P<0.05)。结论:罗库溴铵-舒更葡糖钠肌松拮抗策用于肺叶切除患者中有利于减轻对肺功能的影响,并降低术后并发症发生率。

罗库溴铵与苯磺顺阿曲库铵对结直肠癌根治术肌松效果及应激反应的影响

目的:探讨罗库溴铵与苯磺顺阿曲库铵对结直肠癌根治术患者肌松效果及应激反应的影响。方法:将110例行腹腔镜结直肠癌根治术患者按照麻醉方式不同分为观察组和对照组,每组各55例。对照组麻醉期间肌松药物为苯磺顺阿曲库铵;观察组麻醉期间肌松药物为罗库溴铵。比较两组肌松效果、临床指标及不良反应发生情况。结果:观察组肌松效果高于对照组(P<0.05),观察组四个成串刺激(TOF)起效时间短于对照组(P<0.05),平均动脉压与心率均低于对照组(P<0.05),观察组肌松药物维持时间长于对照组(P<0.05);两组患者麻醉诱导前(T0)时应激反应指标差异无统计学意义(P>0.05);手术开始时(T1)、手术30 min后(T2)及手术结束后30 min(T3)时,观察组肾上腺素、去甲肾上腺素水平均低于对照组(P<0.05);两组TOF恢复25%时间、TOF恢复75%时间及不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:罗库溴铵在结直肠癌根治术中肌松效果更佳,应激反应与不良反应发生风险相对更小。

肝移植术后气管导管拔管时间的影响因素

目的分析肝移植术后气管导管延迟拔管的影响因素。方法回顾收集2020年9月1日至2023年3月31日期间在东部战区总医院全身麻醉下行肝移植手术患者的病历资料,根据拔管时间分成为3组,3 h内拔管为早期拔管组、3~24 h之间拔管为延迟拔管组、24 h仍未拔管为拔管困难组。比较3组肝移植受者的临床资料,采用单因素分析和多因素Cox回归分析肝移植术后拔管时间延长的危险因素。结果共纳入237例患者,早期拔管组82例(34.60%)、延迟拔管组119例(50.21%)、拔管困难组36例(15.19%)。单因素分析结果表明3组之间年龄、体重指数(body mass index,BMI)、Child-Pugh评分、MELD评分、无肝期时间、肌松药类型、术中平均体温、再灌注后最低体温具有统计学差异(P<0.05)。多因素Cox回归分析结果显示年龄增加(HR=0.980,95%CI=0.966~0.994,P=0.005)、高MELD评分(HR=0.966,95%CI=0.941~0.991,P=0.009)、术中泵注罗库溴铵是术后拔管时间延长的因素,顺式阿曲库铵与罗库溴铵相比(HR=1.834,95%CI=1.244~2.703,P=0.002)、米库溴铵与罗库溴铵相比(HR=1.660,95%CI=1.073~2.567,P=0.023),平均体温升高(HR=2.447,95%CI=1.449~4.132,P=0.001)和再灌注后最低体温较高(HR=1.288,95%CI=1.023~1.622,P=0.031)为有利于拔管时间缩短。平均体温升高(HR=2.447,95%CI=1.449~4.132,P=0.001)和再灌注后最低体温较高(HR=1.288,95%CI=1.023~1.622,P=0.031)为有利于拔管时间缩短。结论年龄增加、高MELD评分、术中泵注罗库溴铵是术后气管导管拔管时间延长的因素,术中使用顺式阿曲库铵、米库溴铵和积极体温保护有利于术后快速拔管。

瑞马唑仑联合罗库溴铵用于急诊患者快速序贯诱导麻醉对HR、SpO_(2)、MAP及肌松作用的影响

目的:研究瑞马唑仑联合罗库溴铵用于急诊患者快速序贯诱导中对心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)及肌松作用的影响。方法:将80例拟行急诊手术的患者,随机分为对照组和研究组,各40例。麻醉诱导时,对照组给予咪达唑仑、罗库溴铵;研究组给予瑞马唑仑、罗库溴铵。监测并记录两组患者麻醉效果、呼吸循环指标水平、肌松作用。结果:两组患者镇静成功率均为100%。与对照组相比,研究组患者意识消失时间、麻醉诱导时间、睫毛反射消失时间、起效时间、麻醉后检测治疗室滞留时间及苏醒时间均较低,MAP、SpO_(2)、MAP、呼吸频率波动均较小,低血压发生率较低,肌松药的临床作用时间和恢复指数均较长(均P<0.05)。结论:瑞马唑仑和罗库溴铵联合用于快速序贯诱导麻醉,血流动力学稳定性良好,且可延长肌松作用时间。

常温贮存下罗库溴铵在妇科腹腔镜手术中肌松效应观察

目的探讨常温贮存下罗库溴铵对妇科腹腔镜手术中肌松效应的影响。方法选取2022年2—8月在深圳市龙岗中心医院行腹腔镜妇科手术的全身麻醉患者120例进行研究。以随机信封法将患者分为两组,每组各60例。观察组罗库溴铵贮存于手术室自然环境,对照组置于医用冰箱冷藏室。比较两组肌松效应指标、气管插管条件、增药时间及增药量。结果两组患者肌松效应起效时间、完全肌松时间、有效肌松时间及T1恢复至75%时间比较,差异均无统计学意义(P>0.05)。观察组气管插管条件优良率为96.67%,与对照组的98.33%比较,差异无统计学意义(P>0.05)。两组患者第一次增药时间、第一次增药量、第二次增药时间、第二次增药量比较,差异均无统计学意义(P>0.05)。结论常温贮存下罗库溴铵与低温储存在妇科腹腔镜手术中的肌松效应无显著性差异,且对气管插管质量与增药时间、增药量均无明显影响。

Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans

Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under itravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored.The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2％～10％. The total dose of each drug given during each of the three phases of OLT was recorded. Results: Rocuronium requirement, which were (0.468±0.167)unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed,which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.

Continuous Rocuronium Administration Method Based on Pharmacokinetic/Pharmacodynamics Model during Propofol, Sevoflurane, and Desflurane Anesthesia

Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P;propofol, S;sevoflurane, and D;desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (μg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (μg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.

右美托咪定对罗库溴铵药代动力学及药效学的影响

目的探讨右美托咪定对罗库溴铵的药代动力学及药效学的影响。方法选取2022年1月至6月温州医科大学附属第一医院收治的全身麻醉下行甲状腺手术的患者30例作为研究对象,采用随机数字表法分为右美托咪定组(n=15)及对照组(n=15)。右美托咪定组患者在麻醉诱导前给予1μg/kg的右美托咪定,对照组患者在麻醉诱导前给予相同剂量的生理盐水。抽取患者动脉血测定罗库溴铵药代动力学、记录4个成串刺激(train-of-four stimulation,TOF)为0(T_(0))、恢复至25%(T_(25%))、恢复至75%(T_(75%))和恢复至95%(T_(95%))的时间。结果右美托咪定组的起效时间和TOF为0的时间显著长于对照组(P<0.05),右美托咪定组半衰期、T_(25%)、T_(75%)、T_(95%)时间显著长于对照组(P<0.05)。结论麻醉诱导前预先给予右美托咪定会延迟罗库溴铵的起效,并且延长其半衰期及作用时间。

Effective Use of Sugammadex for Incomplete Pyridostigmine Reversal of Muscle Relaxation by Rocuronium: A Case Report

Anticholinesterase does not allow adequate reversal of the deep neuromuscular blockade (NMB) achieved using high doses of relaxants. A 71-year-old female patient (weight 70 kg, height 169 cm) was scheduled for a transurethral resection of a bladder tumor under general anesthesia. We administered rocuronium 30 mg (0.43 mg/kg) for tracheal intubation due to an estimated short surgical time. During the operation, an additional rocuronium 10 mg was injected. The surgical procedure ended abruptly 10 minutes after receiving the last dose of rocuronium. At the end of surgery, the patient received pyridostigmine as a reversal. However, residual NMB persisted, and neuromuscular monitoring did not show the expected degree of recovery. Sugammadex 2 mg/kg was used, and the patient experienced complete reversal from NMB in just 2 min.

Suspected Anaphylactic Shock Associated with Rocuronium in an Infant: A Case Report

We report a case of severe anaphylactic shock in a 5-month-old infant who was scheduled to undergo an external inguinal hernia repair under general anesthesia. Rocuronium used for anesthesia induction was the most likely cause of anaphylaxis. High levels of serum tryptase and histamine detected in the blood sample collected during the anaphylactic reaction confirmed the diagnosis of anaphylactic shock. The patient’s clinical status improved within 90 min of intervention by the intravenous injection of vasopressors and a steroid. Surgery was canceled, and the patient stayed in the pediatric intensive care unit (PICU) under artificial ventilation for 5 h before safe extubation. The patient achieved full recovery the next day, without any sequelae. The rescheduled surgery was successfully completed 5 months later under general anesthesia without the use of neuromuscular blocking agents.

Unexpected delayed reversal of rocuronium-induced neuromuscular blockade by sugammadex:A case report and review of literature

BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the surgery.Sugammadex,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of surgery.Most reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe extubation.However,very rare patients with neuromuscular diseases may respond poorly to sugammadex.CASE SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with gastroparesis.She underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 counts.Afterward,the TOF ratio recovered to 0.65 in 30 min.She was awake but could not fully open her eyelids.The tidal volume during spontaneous breathing was low.After additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly removed.After excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and mouth.Furthermore,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of rocuronium.CONCLUSION In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were noted.To optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.

Analysis of incidence of residue neuromuscular blockade for rocuronium and cisatracurium

Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.

罗库溴铵在不同程度烧伤患者体内的药代动力学研究

目的 探讨罗库溴铵在不同程度烧伤患者体内的药物代谢动力学(简称药动学)特征。方法 选取医院2018年6月至11月收治并择期行烧伤手术的患者45例,按烧伤程度的不同分为对照组(行瘢痕切除修复植皮术)、中度烧伤组(行切痂植皮术)、重度烧伤组(行切痂植皮术),各15例。3组患者均以0.4 ng/mL的速率靶控输注舒芬太尼,在达有效镇痛质量浓度(0.35 ng/mL)后依次静脉注射依托咪酯0.4 mg/kg及罗库溴铵0.9 mg/kg行麻醉诱导,麻醉维持采用静吸复合方式,术中均靶控输注舒芬太尼(速率为0.4 ng/mL),静脉持续泵注右美托咪定0.4μg/(kg·h),并联合吸入2%七氟烷。分别于麻醉诱导后1,3,5,10,15,20,30,40,50,60,90 min,停止靶控输注时,以及停药后1,3,5,8,10,20 min抽取动脉血,并用高效液相色谱串联质谱法测定罗库溴铵血药浓度,并拟合最佳房室模型,计算药动学参数。结果 重度烧伤组患者麻醉诱导后的罗库溴铵血药浓度,诱导后1 min明显低于对照组,其余时点均明显低于另两组(P <0.05)。重度烧伤组的罗库溴铵中央室分布容积、表观分布容积和清除率均明显大于另两组,消除半衰期、平均滞留时间均明显短于另两组,中央室消除常数明显小于另两组(P <0.05)。3组患者术中均未发生体动,术后30 min恢复自主呼吸,顺利拔管。结论 罗库溴铵在重度烧伤患者高代谢期的药动学变化明显,临床应用中可适当增加给药剂量,以提供充分的肌肉松弛条件,且重度烧伤患者单次给药时予0.9 mg/kg罗库溴铵的肌肉松弛效果良好。

Efficacy of different doses of sugammadex after continuous infusion of rocuronium

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively.The estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-OfFour is reached.

Sugammadex in the Management of Sinus Tachycardia after Rocuronium Administration: A Case Report

In rare cases, rocuronium has been associated with dose-related tachycardia, probably by a cardiac muscarinic M2 receptor blockade mechanism. We report the case of a 30-year-old female who underwent excision of a branchial cyst under general anesthesia. This patient presented an episode of sinus tachycardia (130 bpm) shortly after anesthesia induction with propofol, sufentanyl, and rocuronium. Tachycardia could not be explained by any cause other than the use of rocuronium, which was reverted with sugammadex. Two minutes after sugammadex administration, heart rate normalized, corroborating our hypothesis that rocuronium induced the sinus tachycardia observed in our patient. The patient recovered well from the anesthetic-surgical procedure and showed no further cardiovascular, ventilatory, or neurological changes, being transferred to the post-anesthesia care unit, and finally discharged to the ward.

罗库溴铵与顺苯磺酸阿曲库铵在老年腹腔镜手术中的比较

目的:探讨罗库溴铵与顺苯磺酸阿曲库铵在老年全麻腹腔镜手术中的应用效果。方法:选取医院收治的80例老年腹腔镜手术患者作为研究对象,随机分为罗库溴铵组与对照组,每组40例。罗库溴铵组患者在全身麻醉中应用罗库溴铵作为肌松药物,对照组患者应用顺苯磺酸阿曲库铵作为肌松药物,对比两组患者麻醉起效时间、插管时间、呛咳反应以及插管成功率,对比两组患者麻醉诱导前、诱导中、麻醉诱导后的生命体征与呼吸功能指标,并对比两组患者的不良反应情况。结果:罗库溴铵组麻醉起效时间、插管时间、呛咳反应发生率明显低于对照组(P<0.05),麻醉诱导前、诱导中、麻醉诱导后对照组HR、MAP、DBP、SBP差异具有统计学意义(P<0.05),诱导中和诱导后罗库溴铵组与对照组患者HR、MAP、DBP、SBP差异具有统计学意义(P<0.05);诱导中到麻醉诱导后两组患者PETCO_(2)均升高,但罗库溴铵组低于对照组,对照组患者诱导中到麻醉诱导后SpO_(2)降低,罗库溴铵组高于对照组(P<0.05);罗库溴铵组不良反应发生率明显低于对照组(P<0.05)。结论:在老年腹腔镜手术全麻诱导中,采取罗库溴铵更能够提升患者麻醉效果与苏醒质量,稳定患者术中生命体征,降低手术对呼吸功能带来的影响,减少不良反应,值得临床推广。

舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度及肌松恢复的影响

目的:评价舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度和肌松恢复的影响。方法:选择2021年9月20日至2022年7月5日首都医科大学附属北京胸科医院行全身麻醉下肺结核肺叶切除术的老年患者68例,采用计算机生成随机序列方法随机分为观察组与对照组,每组各34例。在排除观察组4例、对照组3例后,最终纳入观察组30例和对照组31例进行分析。使用0.6 mg/kg罗库溴铵麻醉诱导,术中用罗库溴铵维持4个成串刺激计数(train of four stimulation count,TOFC)为0。术毕当4个成串刺激计数中第2个肌颤搐(T_(2))再现时,观察组给予2 mg/kg舒更葡糖钠拮抗肌松,对照组给予0.05 mg/kg新斯的明+0.025 mg/kg阿托品拮抗肌松。使用液相色谱串联质谱法测定T_(2)、肌松拮抗后5 min和30 min时罗库溴铵的血药浓度;记录从T_(2)分别恢复到4个成串刺激比值(train of four stimulation ratio,TOFR)=0.7、0.8和0.9的时间;记录肌松拮抗前及拮抗后1、2、3、5 min的平均动脉压(MAP)和心率(HR);记录自主呼吸恢复时间、拔管时间和术后住院时间。结果:肌松拮抗后5 min和30 min,观察组罗库溴铵血药浓度分别为(82.9±13.9)μg/ml和(68.1±9.9)μg/ml,均明显高于对照组[(66.1±19.7)μg/ml和(44.0±16.0)μg/ml],差异均有统计学意义(t=3.837、7.046,P值均<0.001)。观察组TOFR恢复到0.7、0.8、0.9的时间分别为(2.0±0.9)min、(2.5±1.1)min和(3.9±2.8)min,均较对照组明显缩短[(7.3±3.6)min、(10.2±5.1)min和(15.8±7.8)min],差异均有统计学意义(t=-7.829、-8.087和-7.878,P值均<0.001)。观察组自主呼吸恢复时间、拨管时间和住院时间分别为(12.1±5.4)min、(15.5±6.6)min和(7.1±2.1)d,对照组自主呼吸恢复时间、拨管时间、住院时间分别为(17.4±7.3)min、(19.5±7.0)min和(8.6±3.4)d,两组比较差异均有统计学意义(t=-3.215、-2.295和-2.065,P=0.002、0.025和0.043)。结论:老年肺结核患者胸腔镜肺叶切除术后使用舒更葡糖钠能够快速增加血浆无活性罗库溴铵血药浓度,快速逆转肌松,明显缩短呼吸恢复时间、拔管时间和住院时间。