Can succinylcholine be abandoned?
Can succinylcholine be abandoned?
复制标题
琥珀胆碱可以放弃吗？
DOI：
10.1097/00000539-200005001-00006
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发表时间：
2000
影响因子：
5.7
通讯作者：
D. R. Cook
中科院分区：
文献类型：
--
作者：
D. R. Cook
选择性使用琥珀胆碱在麻醉很大程度上已放弃，因为不必要的副作用。现在存在短期、中期或长期选择性外科手术的替代方案。nmbd通常仅用于促进气管插管；Rapacuronium填补了一个重要的利基，特别是对于短期选择性病例（例如，当天手术）。然而，同样关键的问题是，是否有一种可靠的替代琥珀胆碱用于治疗喉痉挛或用于“饱胃”患者的快速序列诱导。与维库溴铵、罗库溴铵、密库溴铵和雷帕库溴铵相比，琥珀酰胆碱在喉肌较短时间内产生更强烈的阻滞（30）。虽然80%-90%的神经肌肉阻滞可以促进大多数插管，但快速序列诱导的理想松弛剂应在1分钟内产生均匀完全的神经肌肉阻滞。通过使用标准偏差（表1）、变异系数（表2）或最大神经肌肉阻滞程度和达到最大阻滞时间的图，可以比较各种松弛剂在神经肌肉阻滞程度和起效时间上的可变性。图1显示了真空（13）的这样一个图。在大剂量的雷帕库溴铵下，最大阻滞的可变性较小，但在起效时间上仍有可变性。进一步的研究对于确定雷帕库溴铵在各种临床环境中快速序列诱导的作用将是重要的。
The elective use of succinylcholine in anesthesia has largely been abandoned because of unwanted side effects. Alternatives now exist for short, intermediate, or long elective surgical procedures. NMBDs are frequently used only to facilitate tracheal intubation; rapacuronium fills an important niche particularly for a short elective case (e.g., same-day surgery). However, an equally critical issue is whether there is a reliable replacement for succinylcholine for the treatment of laryngospasm or for rapid sequence induction in patients with "full stomachs." Succinylcholine produces more intense block in a shorter time at the laryngeal muscles, compared with the adductor pollicis, compared with vecuronium, rocuronium, mivacurium, and rapacuronium (30). Although most intubations can be facilitated with 80%-90% neuromuscular block, the ideal relaxant for a rapid sequence induction should produce uniformly complete neuromuscular blockade in 1 min. Variability in the degree of neuromuscular blockade and onset time can be compared for various relaxants by using the standard deviation (Table 1), the coefficient of variation (Table 2), or a plot of the degree of maximum neuromuscular block and the time to maximum block. Figure 1 shows such a plot for mivacurium (13). There is less variability in the maximum block at the larger dose of rapacuronium but still variability in onset time. Further studies will be important in defining the role of rapacuronium for rapid sequence induction in various clinical settings.