OBJECTIVE The aim of the study was to characterize the pharmacokinetics(PK) and pharmacodynamics(PD) profile of cisatracurium in 0-2 years and 2-5 years old children patients with cheilopalatognathus,to find if there ...OBJECTIVE The aim of the study was to characterize the pharmacokinetics(PK) and pharmacodynamics(PD) profile of cisatracurium in 0-2 years and 2-5 years old children patients with cheilopalatognathus,to find if there are some connections between the different muscle relaxation action and different PK procedure.METHODS 14 children patients were divided into two groups,≤2 years and 2-5 years group,venous samples were taken before injection of a 0.15 mg·kg-1 dose of cisatracurium and then at 2,5,10,30,60,90,and 120 min.Cisatracurium plasma concentrations were determined by ultra-performance liquid chromatography/electrospray ionization/triple quadrupole tandem mass spectrometer system(UPLC/MS/MS).The degree of neuromuscular block was measured by train of four(TOF) testing.An indirect PK-PD link model with a sigmoid E max model was established using Win Nonlin software.The model were applied to PK and PD data analysis,respectively.RESULTS The TOF monitor parameters showed that cisatracurium works very quickly,the onset time were(2.64±0.93) min and(2.59 ± 0.90) min for ≤2 years and 2-5 years group respectively.Young children ≤2 years have longer muscle blocking duration time(62.5 ± 6.01 min vs 53.86 ± 12.18 min) and slower recovery index(32.14±7.10 min and 27.43±10.63 min) than those children in group of 2-5 years.More children ≤2 years have postoperative complication than that in 2-5 children.PK parameters showed that there were no statistical differences in blood concentration and pharmacokinetic parameters.While the concentration of cisatracurium in muscle site calculated by using PK/PD model were higher and longer for ≤2 year children than that of 2-5 year children.This means that cisatracurium could stay at high concentration for a longer time in younger children' muscle tissue.CONCLUSION As a result young children tend to have postoperative complications related to slower muscle recovery action and increased concentration in skeletal muscle.So more careful observation and monitor are needed for younger children,our study could be of use in clinical practice for the administration of cisatracurium to children patients.展开更多
目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉...目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉诱导用药相同。Ⅰ组吸入0.8%-1.8%七氟醚,使用小剂量顺式阿曲库胺[0.05-0.10 mg/（kg.h）]持续输注和常规剂量瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,结束前15 min停止使用七氟醚,并将瑞芬太尼减低至维持量的1/10-1/5用至拔除气管导管。Ⅱ组使用丙泊酚[5-12 mg/（kg.h）]全凭静脉麻醉,以常规剂量顺式阿曲库胺[0.1-0.2 mg/（kg.h）]及瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,手术结束后观察两组患者的睫毛反射时间、睁眼时间、拔管时间、术中知晓例数以及苏醒期躁动评分。结果Ⅰ组与Ⅱ组的睫毛反射时间、睁眼时间、拔管时间比较差异无统计学意义（均为P〉0.05）。两组患者均未出现术中知晓。Ⅰ组的躁动发生率明显低于Ⅱ组（P〈0.05）。Ⅰ组的顺式阿曲库胺、瑞芬太尼用量均明显少于Ⅱ组（均为P〈0.05）。结论七氟醚＋瑞芬太尼＋顺式阿曲库铵或丙泊酚＋瑞芬太尼＋顺式阿曲库铵这两种快通道麻醉方法用于肾移植手术均具有可控性良好、安全性高、患者苏醒迅速等特点,而七氟烷＋瑞芬太尼＋顺式阿曲库铵的组合更节省药物用量,且苏醒质量更高。展开更多
基金supported by Top Young Innovative Talents of Beijing(CIT&TCD201404174)Basic Clinical Cooperation Project of Capital Medical University(14JL79)
文摘OBJECTIVE The aim of the study was to characterize the pharmacokinetics(PK) and pharmacodynamics(PD) profile of cisatracurium in 0-2 years and 2-5 years old children patients with cheilopalatognathus,to find if there are some connections between the different muscle relaxation action and different PK procedure.METHODS 14 children patients were divided into two groups,≤2 years and 2-5 years group,venous samples were taken before injection of a 0.15 mg·kg-1 dose of cisatracurium and then at 2,5,10,30,60,90,and 120 min.Cisatracurium plasma concentrations were determined by ultra-performance liquid chromatography/electrospray ionization/triple quadrupole tandem mass spectrometer system(UPLC/MS/MS).The degree of neuromuscular block was measured by train of four(TOF) testing.An indirect PK-PD link model with a sigmoid E max model was established using Win Nonlin software.The model were applied to PK and PD data analysis,respectively.RESULTS The TOF monitor parameters showed that cisatracurium works very quickly,the onset time were(2.64±0.93) min and(2.59 ± 0.90) min for ≤2 years and 2-5 years group respectively.Young children ≤2 years have longer muscle blocking duration time(62.5 ± 6.01 min vs 53.86 ± 12.18 min) and slower recovery index(32.14±7.10 min and 27.43±10.63 min) than those children in group of 2-5 years.More children ≤2 years have postoperative complication than that in 2-5 children.PK parameters showed that there were no statistical differences in blood concentration and pharmacokinetic parameters.While the concentration of cisatracurium in muscle site calculated by using PK/PD model were higher and longer for ≤2 year children than that of 2-5 year children.This means that cisatracurium could stay at high concentration for a longer time in younger children' muscle tissue.CONCLUSION As a result young children tend to have postoperative complications related to slower muscle recovery action and increased concentration in skeletal muscle.So more careful observation and monitor are needed for younger children,our study could be of use in clinical practice for the administration of cisatracurium to children patients.
