MUSCLE RELAXANTS AND ANTAGONISTS IN PEDIATRIC ANESTHESIA

神经肌肉阻滞剂及其拮抗剂广泛应用于 儿科麻醉。因为精确的药理学研究还没有被 在儿童中进行，临床医生通常必须从数据中推断 在成人中获得，以确定儿童的剂量。然而，孩子们 在分布量、代谢和神经肌肉方面与成人不同 连接生理学，因此对这些药物的反应应该不同。 因此，我们建议测定药物动力学和 这些药物在新生儿、婴儿和儿童中的药效学 与成人的结果进行比较。到目前为止，我们已经确定了剂量 的反应关系、药代动力学和/或药效学研究 D-Tubocurarine，维库溴铵，一种新的神经肌肉阻断药物，以及 新斯的明。我们会完成这些研究，此外，我们会 确定新斯的明和新斯的明的量效关系 依德罗芬铵的药代动力学和量效关系 一种似乎比新斯的明有优势的拮抗剂 吡啶斯的明)。我们还将确定神经肌肉的作用 阻断药物对氧耗的影响并评价 当神经肌肉阻滞剂被 用在婴儿身上。这些研究应该允许改进 对这些药物的药理和生理作用的了解 在孩子们身上。反过来，神经肌肉松弛药及其拮抗剂可能是 在儿科麻醉中使用更合适。

Neuromuscular blocking drugs and their antagonists are widely used in pediatric anesthesia. Because precise pharmacologic studies have not been performed in children, the clinician often must extrapolate from the data obtained in adults to determine the dose in children. However, children differ from adults in distribution volumes, metabolism and neuromuscular junction physiology and thus should respond differently to these drugs. Accordingly, we propose to determine the pharmacokinetics and pharmacodynamics of these drugs in neonates, infants and children with comparison to those obtained in adults. To date we have established dose response relationships, pharmacokinetic and/or pharmacodynamic studies of d-tubocurarine, vecuronium, a new neuromuscular blocking drug, and neostigmine. We will complete these studies and, in addition, will determine the dose-response relationships for neostigmine and the pharmacokinetics and dose-response relationships for edrophonium (an antagonist which appears to have advantages over neostigmine and pyridostigmine). We also will determine the effect of neuromuscular blocking drugs on oxygen consumption and evaluate whether "respiratory-sparing" exists when neuromuscular blocking drugs are administered to infants. These studies should permit an improved understanding of the pharmacologic and physiologic effects of these drugs in children. In turn, neuromuscular relaxants and their antagonists may be used more appropriately in pediatric anesthesia.