THE NEUROMUSCULAR EFFECTS OF ORG9426 IN PATIENTS RECEIVING BALANCED ANESTHESIA
THE NEUROMUSCULAR EFFECTS OF ORG9426 IN PATIENTS RECEIVING BALANCED ANESTHESIA
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DOI：
10.1097/00000542-199108000-00004
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发表时间：
1991-08-01
期刊：
影响因子：
8.8
通讯作者：
OHTA, Y
中科院分区：
文献类型：
--
作者：
FOLDES, FF;NAGASHIMA, H;OHTA, Y
为了寻找比目前可用的化合物更持久但起效更快的非去极化肌松剂，在接受芬太尼、氟哌利多、硫喷妥钠和一氧化二氮-氧气麻醉的两项研究中，研究了ORG9426对神经肌肉和循环的影响。80名患者随机分配到四组中的一组，每组20人，接受0。1 2、0.16、0.20或0.24 mg/kg ORG9426。在第一项研究中，用个体剂量-反应法确定了ORG9426引起50%(ED50)、90%(ED90)或95%(ED95)神经肌肉阻滞的剂量(以毫克/公斤为单位)，分别为0.170、0.268和0.305 mg/kg。在第二项研究中，麻醉诱导后，患者接受0.6 mg/kg(约2×ED95)的ORG9426单次注射(组1)或两次不等的递增(0.1和0.5 mg/kg)相隔4min(组2)。注射0.6 mg/kg ORG9426后，第1组出现最大神经肌肉阻滞时间为1.5±0.12min，第2组为1.2±0.14min。气管插管时，记录心率、收缩压和舒张压，达到最大神经肌肉效应后再插管。第1组插管持续时间为40.0±-3.2(15-73)min，第2组为39.3+/-2.4(19-57)min。首次重复给药0.1、0.15或0.2 mg/kg ORG9426的临床持续时间分别为11.0+/-1.0(4-16)、18.3+/-1.6(7-50)、0.1、0.15或0.2 mg/kg ORG9426。28.1+/-6.3(7-69)min。恢复指数为16.7+/-1.2min(4-)。89例病人麻醉结束后用0.5 mg/kg依得洛芬+0.015 mg/kg阿托品可在2~5min内拮抗残存神经肌肉阻滞。在麻醉后恢复室没有观察到ORG9426引起的循环或其他副作用，也没有复发瘫痪的迹象或症状。ORG9426的起效时间比之前在相同麻醉患者中研究的其他非去极化肌松药的起效时间更短。“预充”并不能缩短2×ED95 ORG9426的发病时间。由于其起效迅速，在目前可用的非去极化肌松药中，ORG9426可能被证明有助于促进快速顺序插管。
In searching for a nondepolarizing muscle relaxant with intermediate duration but more rapid onset of action than the presently available compounds, the neuromuscular and circulatory effects of ORG9426 were investigated in two studies in humans receiving fentanyl, droperidol, thiopental, and nitrous oxide-oxygen anesthesia. Eighty patients, randomly assigned to one of four groups of 20 each, received 0. 1 2, 0.16, 0.20, or 0.24 mg/kg ORG9426. In the first study, the doses (in milligrams per kilogram) of ORG9426 that caused 50% (ED50), 90% (ED90), or 95% (ED95) neuromuscular block were determined by the individual dose-response method; they were 0.170, 0.268, and 0.305 mg/kg, respectively. In the second study, after induction of anesthesia, patients received 0.6 mg/kg (about 2 X ED95) of ORG9426, either in a single bolus (group 1) or in two unequal (0.1 and 0.5 mg/kg) increments 4 min apart (group 2). After the administration of 0.6 mg/kg ORG9426, maximal neuromuscular block developed in 1.5 +/- 0.12 min in group 1 and in 1.2 +/- 0.14 min in group 2. Patients tracheas were intubated after development of the maximal neuromuscular effect of the intubating dose and after the recording of heart rate and systolic and diastolic blood pressure. There was no difference in the clinical duration of the intubating doses, which were 40.0 +/- 3.2 (15-73) min in group 1 and 39.3 +/- 2.4 (19-57) min in group 2. Clinical duration of the first repeat dose of 0.1, 0.15, or 0.2 mg/kg ORG9426, administered whenever the twitch tension elicited by the first train-of-four impulse recovered to 25% of control were 11.0 +/- 1.0 (4-16), 18.3 +/- 1.6 (7-50), and 28.1 +/- 6.3 (7-69) min, respectively. The recovery index was 16.7 +/- 1.2 (4-64) min. In 89 patients residual neuromuscular block at the end of anesthesia could be antagonized with 0.5 mg/kg edrophonium + 0.015 mg/kg atropine in 2 to 5 min. No circulatory or other side effects attributable to ORG9426 and no signs or symptoms of recurrent paralysis were observed in the postanesthetic recovery room. The onset time of ORG9426 was shorter than those of other nondepolarizing muscle relaxants previously studied in identically anesthetized patients. "Priming" did not shorten the onset time of 2 X ED95 ORG9426. Because of its rapid onset of action, of the currently available nondepolarizing muscle relaxants, ORG9426 may prove useful for facilitating rapid sequence intubation.