Neuromuscular blocking drugs: Onset and intubation
Neuromuscular blocking drugs: Onset and intubation
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DOI：
10.1016/s0952-8180(97)00120-7
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发表时间：
1997-09-01
影响因子：
6.7
通讯作者：
Bevan, DR
中科院分区：
文献类型：
--
作者：
Bevan, DR
40多年来，琥珀酰胆碱一直是促进气管插管的传统肌松剂选择，特别是用于饱胃急诊患者的麻醉。本报告回顾了决定肌松起效的因素，特别是与气管插管有关的因素。测量神经肌肉阻滞，临床和通过神经刺激器，描述和比较，并与插管条件的相关性进行了尝试。在人类不同的肌肉群的行动的发病进行了检查，试图解释的时间差异，导致更快的发作的块看到喉和痉挛肌肉比在手部的肌肉，这是神经肌肉监测的常用网站。不同的松弛剂的发作进行了比较，并试图将差异与神经肌肉药理学，以了解琥珀胆碱（快速代谢）和罗库溴铵（效力差）的快速起效的原因。目前可用的药物或正在进行临床研究的药物都不具有琥珀胆碱的快速起效和迅速恢复。尽管琥珀胆碱的副作用很大，但在紧急情况下，它还没有被非去极化剂所取代。然而，替代品，特别是罗库溴铵和米伐库铵是具有更大安全性的药物，在许多情况下可以替代琥珀胆碱。(C)Elsevier Science Inc.出版。
For more than 40 years, succinylcholine has been the traditional choice of muscle relaxant to facilitate tracheal intubation, particularly for anesthesia in the emergency patient with a full stomach. This presentation reviews factors that determine the onset of neuromuscular blockade, particularly with regard to tracheal intubation. Measurement of neuromuscular block, both clinical and via nerve stimulators, is described and compared, and correlations with intubating conditions are attempted. The onset of action of different muscle groups in humans is examined in an attempt to explain timing differences leading to the more rapid onset of block seen in the laryngeal and ventilatory muscles than in the muscles of the hand, which are the usual site of neuromuscular monitoring. The onset of different relaxants is compared, and attempts are made to relate the differences to neuromuscular pharmacology so as to understand the reasons for the rapid onset of succinylcholine (rapid metabolism) and rocuronium (poor potency). None of the currently available drugs, or those undergoing clinical investigation, possesses the rapid onset and prompt recovery of succinylcholine. Despite the formidable side effect profile of succinylcholine, it has not been replaced by a nondepolarizing agent for use in emergency conditions. However, the alternatives, particularly rocuronium and mivacurium are drugs with a greater safety profile that, in many circumstances, can substitute for succinylcholine. (C) 1997 by Elsevier Science Inc.