Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium
Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium
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DOI：
10.1017/s026502150800402x
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发表时间：
2008-07-01
影响因子：
3.6
通讯作者：
Marek, O.
中科院分区：
文献类型：
--
作者：
Adamus, M.;Gabrhelik, T.;Marek, O.
背景和目的：越来越多的证据表明氨基类固醇神经肌肉阻滞剂的药代动力学和药效学存在性别差异。与男性相比，女性更容易受到影响，达到相同程度的神经肌肉阻滞所需的罗库溴铵用量减少约 30%。然而，这种差异是否适用于现代苄基异喹啉（顺阿曲库铵）的信息很少。方法：总共研究了 848 例患者（423 名男性，425 名女性）在肌肉松弛、气管插管和机械通气全静脉麻醉下接受普外科手术。患者随机接受单次推注剂量的顺式阿曲库铵（0.1 mg kg(-1)，221名男性和199名女性）或罗库溴铵（0.6 mg kg(-1)，202名男性和226名女性）。使用 Datex-Ohmeda S/5 麻醉监护仪的 NMT 肌电图模块确定 T(1) 降低 95% 的起始时间、直至 25% 恢复的临床持续时间和恢复指数（T(1) 从 25% 至 75%）。将男性和女性组的数据与适当的统计检验（未配对 t 检验、Mann-Whitney 秩和检验和 Fisher 精确检验）进行比较。结果：在两组（顺阿曲库铵和罗库溴铵）中，男性显着高于女性（P < 0.001）和重（P < 0.001），但体重指数具有可比性。对于罗库溴铵，女性的起效时间较短，为 91.7 +/- 14.3 秒 vs 108.0 +/- 14.6 秒 (P < 0.001)，临床持续时间延长为 43.3 +/- 7.8 分钟 vs 31.3 +/- 5.5 分钟 (P < 0.001)。在顺式曲库铵组中，起效时间（男性 248.9 +/- 60.7 秒，女性 253.4 +/- 70.9 秒）和临床持续时间（男性 42.6 +/- 6.9 分钟，女性 43.1 +/- 6.9 分钟）相似。两组中男性和女性的恢复指数相同。结论：女性比男性对单次推注剂量的罗库溴铵更敏感。在所描述的研究条件下，女性患者的起效时间较短，临床持续时间较长。这表明与男性相比，女性罗库溴铵的常规剂量应减少。相反，我们可以证明顺式阿曲库铵的起效时间或临床持续时间没有性别差异。
Background and objective: There is increasing evidence of gender differences in the pharmacokinetics and pharmacodynamics of aminosteroid neuromuscular blocking agents. Compared to males, females are more susceptible, requiring approximately 30% less rocuronium to achieve the same degree of neuromuscular block. However, little information is available whether this difference is applicable to modern benzylisoquinolines (cisatracurium). Methods: In all, 848 patients (423 males, 425 females) undergoing general surgery under total intravenous anaesthesia with muscle relaxation, tracheal intubation and mechanical ventilation were studied. Patients were randomized to receive a single bolus dose of cisatracurium (0.1 mg kg(-1), 221 males and 199 females) or rocuronium (0.6 mg kg(-1), 202 males and 226 females). The onset time for 95% depression of T(1), clinical duration until 25% recovery and recovery index (T(1) from 25% to 75%) were determined with an NMT electromyographic module of the Datex-Ohmeda S/5 Anaesthesia Monitor. The data for male and female groups were compared with appropriate statistical tests (unpaired t-test, Mann-Whitney rank sum test and Fisher's exact test). Results: In both groups (cisatracurium and rocuronium), males were significantly taller (P < 0.001) and heavier (P < 0.001) than females, but the body mass index was comparable. For rocuronium, the onset time was shorter 91.7 +/- 14.3 s vs. 108.0 +/- 14.6 s (P < 0.001) and the clinical duration was increased in females 43.3 +/- 7.8 min vs. 31.3 +/- 5.5 min (P < 0.001). In the cisatracurium group, both onset times (248.9 +/- 60.7s for males vs. 253.4 +/- 70.9s for females) and clinical duration (42.6 +/- 6.9 min for males vs. 43.1 +/- 6.9 min for females) were similar. The recovery index was identical for males and females in both groups. Conclusions: Females were more sensitive than males to a single bolus dose of rocuronium. Under the study conditions described, the onset time was shorter and the clinical duration was increased in female patients. This suggests that the routine dose of rocuronium should be reduced in females compared to males. On the contrary, we could demonstrate no gender differences in the onset time or clinical duration of cisatracurium.