A Review of Current Literature of Interest to the Office-Based Anesthesiologist.
A Review of Current Literature of Interest to the Office-Based Anesthesiologist.
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办公室麻醉师感兴趣的当前文献综述。
DOI：
10.2344/0003-3006-66.4.235
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发表时间：
2019
影响因子：
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通讯作者：
M. Saxen
中科院分区：
文献类型：
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作者：
M. Saxen
对缺氧的通气反应是一种源自颈动脉体的救生化学反射，该化学反射会受到非去极化神经肌肉阻滞剂的损害。这项单中心、随机、对照实验研究评估了 34 名健康男性志愿者在化学反射上逆转部分神经肌肉阻滞的 3 种策略对通气控制的影响。假设四连组比率返回到 1 后，缺氧通气反应完全恢复。完全逆转后，根据拇指测量，缺氧通气反应持续残留钝化（0.45 6 0.16 l min 1 % 1；四连组比率，1.0；p，.001）。尽管拇指处的部分神经肌肉阻滞完全逆转，但在用新斯的明或舒更葡糖逆转后，或神经肌肉阻滞自发恢复后，周围化学反射的损伤可能会持续存在，四组比率大于0.9。评论：尽管拇指的四连测试表明完全恢复，但神经肌肉阻滞逆转后缺氧的化学反射并未完全恢复。无论使用哪种神经肌肉阻滞药物，都会观察到这种现象。在随附的社论中，潘迪特和埃里克森指出了神经肌肉阻滞药物和其他麻醉剂（包括吸入麻醉剂、苯二氮卓类药物和阿片类药物）之间潜在协同作用的证据。这项研究证明了实现神经肌肉完全恢复的重要性，同时认识到尽管神经肌肉阻滞完全逆转，但在恢复过程中呼吸调节和缺氧反应受损的风险可能仍然存在。
The ventilatory response to hypoxia is a lifesaving chemoreflex originating at the carotid bodies that is impaired by nondepolarizing neuromuscular blocking agents. This single-center, randomized, controlled experimental study evaluated the effect of 3 strategies for reversal of a partial neuromuscular block on ventilatory control in 34 healthy male volunteers on the chemoreflex. The hypothesis was that the hypoxic ventilatory response is fully restored following the return to a train-of-four ratio of 1. Following full reversal, as measured at the thumb, there was persistent residual blunting of the hypoxic ventilatory response (0.45 6 0.16 l min 1 % 1; train-of-four ratio, 1.0; p , .001). Despite full reversal of partial neuromuscular block at the thumb, impairment of the peripheral chemoreflex may persist at train-of-four ratios greater than 0.9 following reversal with neostigmine or sugammadex, or spontaneous recovery of the neuromuscular block. Comment: Although train-of-four testing of the thumb indicated full recovery, the hypoxic chemoreflex was not fully restored following reversal of neuromuscular blockade. This phenomenon was observed regardless of the drug class of neuromuscular blocking drug used. In an accompanying editorial, Pandit and Eriksson note evidence of potential synergism between neuromuscular blocking drugs and other anesthetic agents, including inhalational anesthetics, benzodiazepines, and opioids. This study demonstrates the importance of achieving full neuromuscular recovery while realizing the risk of impaired regulation of breathing and response to hypoxia may still be present during recovery despite complete neuromuscular blockade reversal.