Propofol in patients susceptible to malignant hyperpyrexia
Propofol in patients susceptible to malignant hyperpyrexia
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丙泊酚用于易发生恶性高热的患者
DOI：
10.1111/j.1365-2044.1989.tb11198.x
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发表时间：
1989
期刊：
影响因子：
10.7
通讯作者：
D. Cartwright
中科院分区：
文献类型：
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作者：
D. Cartwright
非常不同的患者组显示了相似的潘库溴铵的艾德，，剂量（62.2和64.4 pg/kg），但维库溴铵的艾德，，值不同（56.2和36.1 pg/kg）。Kong和库珀选择使用较小的剂量，但他们的患者接受60 pg/kg的维库溴铵。Krieg等人指出，在他们的研究中，静脉推注36 pg/kg维库溴铵仅产生79%的神经肌肉阻滞，但这一效果因预先使用琥珀胆碱而增加。这说明了两个报告之间的不同值。与临床使用的单次推注剂量相比，累积对数剂量反应曲线也可能产生较低的艾德，剂量值。在我的实践中，80 pg/kg剂量的维库溴铵可提供良好、快速的插管条件，正如Agoston等人3所建议的那样，他们发现声带在9&100秒内完全松弛。腹腔镜检查后重新使用该剂量似乎不会引起问题。使用较小剂量的松弛剂可能取决于使用挥发性药物进行长时间面罩通气以实现气管插管，这在某些患者组（即日间病例）中可能不可取。Kong和库珀报告了维库溴铵组患者咽喉痛的发生率较高，这可能反映了维库溴铵的剂量相对较小。相比之下，给予阿库溴铵（250 pg/kg）的患者咽喉痛的发生率较低，但术后肌力测量的缺陷最长。这种比较可能是不公平的，因为评估艾德的研究表明，阿库溴铵的剂量仅为140.8 pg/kg，几乎是所用剂量的一半。然而，在腹腔镜等短时间手术中，新型肌松药优于阿库溴铵，这一点在直觉上肯定是正确的。
very different patient groups, revealed a similar ED,, dose for pancuronium (62.2 and 64.4 pg/kg), but different ED,, values for vecuronium (56.2 and 36.1 pg/kg). Kong and Cooper chose to use the smaller dose, yet their patients received 60 pg/kg of vecuronium. Krieg et a1.l point out that a bolus dose of 36 pg/kg vecuronium produced a neuromuscular block of only 79% in their study, but this is increased by the prior use of suxamethonium. This accounts for the different values between the two reports. Cumulative log-dose response curves may also produce lower values for the ED,, dose when compared to the clinical use of a single bolus dose. In my practice a dose of 80 pg/kg vecuronium gives good, rapid intubation conditions, as suggested by Agoston et aL3 who found complete vocal cord relaxation in 9&100 seconds. Reversal of this dose after laparoscopy seems to cause no problem. The use of smaller doses of relaxant probably depends upon a prolonged period of mask ventilation with a volatile agent to achieve tracheal intubation which may not be advisable in some patient groups (i.e. day cases). Kong and Cooper reported a higher incidence of sore throat in the patients given vecuronium which may reflect the relatively small dose given. In comparison those given alcuronium (250 pg/kg) had a lower incidence of sore throat, but the most prolonged deficits in the measurements of postoperative muscle strength. This comparison may be unfair since the study referred to for the assessment of ED,, doses’ suggests a dose of only 140.8 pg/kg for alcuronium, nearly half of that used. However, the superiority of the newer muscle relaxants over alcuronium for short procedures such as laparoscopy must surely be intuitively correct.