| Objective:To compare the effect of neuromuscular blockade and the recovery of cisatracurium between intermittent bolus injection and continuous infusion in patients experienced different length surgery under intravenous anesthesia.Methods:Forty-eight patients(ASAI-II) who had no neuromuscular disease and underwent selective surgery under intravenous anesthesia were randomly divided into group A(less than two hours of surgery) and B(more than three hours of surgery)(n=24). The group A and B were divided into subgroups(n=12) respectively:Al, A2, B1, B2. In group A1and B1, patients received cisatracurium by intermittent bolus injection and in group A2and B2,by continuous infusion. Anesthesia induction: midazolam0.05mg/kg,0.15mg/kg propofol,Remifentanil0.1ug/kg were used. Assisted respiration was carried out when the patients lost consciousness. At the same time, the TOF-GUARD muscle relaxant monitor was opened, selected AUTO1model calibration, stayed TOF (train-of-four) steady at100%followed by giving a single bolus of cisatracurium0.15mg/kg(3×ED95). After T1reached maximum blocking (response completely disappeared), tracheal intubation. Anesthesia maintain:All patients breathed in oxygen flow1L/min, were maintained PETCO2at35-45mmHg, were continuous infusion of propofol(target plasma concentration set in the range2.0-4.0μg/ml) and remifentanil (target plasma concentration set in the range2.0-5.0ng/ml) in TCI way, and were maintained the average arterial pressure based on the preoperative value plus or minus15%. When the post tetanic count of TOF at2,0.05mg/kg cisatracurium were injected in group A1and B1, and continuous infusion cisatracurium3ug/kg/min were started in group A2and B2, then adjusted speed to1-2ug/kg/min after15min after infusion, maintained the post tetanic count of TOF at1. Group A1and B1stoped bolus injection of cisatracurium, and group A2and B2stoped continuous infusion of cisatracurium at half an hour before the end of surgery, stoped propofol and remifentanil infusion while fastening the belly band. All patients recovered spontaneously without the rivalry of neuromuscle blockade. Recorded the change of MAP and HR at the moment of the base value(T1), after anesthesia induction(T2), after endotracheal tube intubation(T3), immediately after30min(T4) and lh(T5) after intubation, and5min before extubation (T6), immediately after extubation (T7),5min after extubation(T8); Recorded cisatracurium working time and endotracheal intubation conditions; Recorded T1reached25%and75%, recovery index (RI), TOF recovery to75%(TOFr0.75) and extubation time; Recorded operation duration and total dosage of propofol, remifentanil and cisatracurium respectively; Recorded amount of fluid and red cells infusion, and urine output; Recorded adverse events in patients in each group.ResultsrThere were no significant difference in age, body height and weight and preoperative hemoglobin level among the four groups(P>0.05). There were also no significant difference in loss of fluid volume and infusion quantity, and operation time length among the four groups(P>0.05). The hemodynamics was stable, ane no difference at the eight time-pionts mong the four groups(P>0.05),respectively, but MAP and HR at T2were lower than T1compared in every group. In48patients, no clinical manifestations of histamine release such as flushing, rash and bronchospasmoc curred.There was no significant difference in the onset time,duration of neuromuscular blockade, and the mean infuse rates between group A1and A2(P>0.05).There was no significant difference in the onset time and duration of neuromuscular blockade between group B1and B2(P>0.05).The mean infuse rate in group B2is less than that in group B1(P<0.05).Postoperative satisfaction measurement showed that the degreen of satisfaction of surgeons at operative muscle relaxant were high.Conclusion:(1)The effect of neuromuscular blockade and the recovery of cisatracurim as a new type of nondepolarizing muscle relaxant between intermittent bolus injection and continuous infusion were similar, and both were applied in different surgery time.(2)In short surgery (<2h), both intermittent bolus injection and continuous infusion of cisatracurium could meet the needs of the operation, and there was no significant difference in recovery of neuromuscular blockade.(3)In long surgery (>3h), there was no significant difference in recovery of neuromuscular blockade between intermittent bolus injection and continuous infusion of cisatracurium, but the mean infuse rate in continuous infusion group was less than that in intermittent bolus group, which showed continuous infusion of cisatracurium could have an advantage in long surgery. |
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