THE EFFECT OF PERIPHERAL HYPOTHERMIA ON A VECURONIUM-INDUCED NEUROMUSCULAR BLOCK
THE EFFECT OF PERIPHERAL HYPOTHERMIA ON A VECURONIUM-INDUCED NEUROMUSCULAR BLOCK
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DOI：
10.1111/j.1399-6576.1991.tb03315.x
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发表时间：
1991-07-01
影响因子：
2.1
通讯作者：
LENNMARKEN, C
中科院分区：
文献类型：
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作者：
ERIKSSON, LI;VIBYMOGENSEN, J;LENNMARKEN, C
七名健康患者在咪达唑仑-芬太尼笑气-氧气麻醉期间接受了调查。 在对手腕尺神经进行双侧超最大四连组（TOF）刺激期间，同时记录拇内收肌的机械抽搐反应。 使用破伤风后计数（PTC）方法评估强烈的神经肌肉阻滞。 一只手臂的核心温度和周围皮肤温度保持正常和稳定。 将另一只手臂冷却至手部周围皮肤温度 27 摄氏度后，以 0.05 mg.kg-1 的推注剂量给予维库溴铵，随后维持剂量为 0.02 mg.kg-1。 在低温组和常温组中，推注剂量后的起效时间分别为 180 +/- 40（平均值 +/- s.d.）秒和 140 +/- 30 秒，作用持续时间为 26.4 +/- 4.5 和 16.5 +/- 4.0 分钟，恢复时间为 265 +/- 90 和 130 +/- 60 秒（P < 0.01）。 维持剂量后的作用时间过程在低温组和常温组之间显示出类似的显着差异。 在常温组中，发现强直后抽搐的次数与对 TOF 刺激的首次反应时间之间存在密切相关性。 相反，在低温组中，强直后抽搐的次数表现出很大的变化，与强烈的神经肌肉阻滞的持续时间相关性较差。 结论是，在外周低温期间，维库溴铵诱导的神经肌肉阻滞的作用时间明显延长，并且在低外周温度下使用 PTC 方法不能可靠地评估强烈的神经肌肉阻滞。 正常的核心和外周温度对于正确评估神经肌肉阻滞至关重要。
Seven healthy patients were investigated during midazolam-fentanyl nitrous oxide-oxygen anaesthesia. The mechanical twitch response of the adductor pollicis muscle was recorded simultaneously during bilateral supramaximal train-of-four (TOF) stimulation of the ulnar nerves at the wrist. Intense neuromuscular block was evaluated using the post-tetanic count (PTC) method. Core temperature and the peripheral skin temperature of one arm were kept normal and stable. Following cooling of the other arm to a peripheral hand skin temperature of 27-degrees-C, vecuronium was administered in a bolus dose of 0.05 mg.kg-1 followed by maintenance doses of 0.02 mg.kg-1. In the hypothermic and the normothermic arm the onset time following the bolus dose was 180 +/- 40 (mean +/- s.d.) seconds and 140 +/- 30 s, respectively, the duration of action was 26.4 +/- 4.5 and 16.5 +/- 4.0 min and the recovery time was 265 +/- 90 and 130 +/- 60 s (P < 0.01). The time course of action following maintenance doses showed a similar marked difference between the hypothermic and the normothermic arm. In the normothermic arm a close correlation was found between the number of post-tetanic twitches and the time to first response to TOF stimulation. In contrast, in the hypothermic arm the number of post-tetanic twitches showed great variation with a poor correlation to the duration of intense neuromuscular block. It is concluded that the time course of action of a vecuronium-induced neuromuscular block is markedly prolonged during peripheral hypothermia and intense neuromuscular block cannot reliably be assessed using the PTC method at low peripheral temperature. Normal core and peripheral temperature is essential for correct evaluation of a neuromuscular block.