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Effect Of Pre-injection On Rapid Neuromuscular Blocking Induced By Cisatracurium

Posted on:2012-05-08Degree:MasterType:Thesis
Country:ChinaCandidate:K Q XieFull Text:PDF
GTID:2284330332496799Subject:Anesthesia
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Abstract: Objective: We compared different priming doses of agents (rocuronium and cisatracurium) at a priming time of 3 minutes and their effects on the intubation time, the onset time, the intubation conditions and the recovery phase of cisatracurium to investigate the safe and efficient priming-doses of cisatracurium or rocuronium on rapid neuromuscular blocking induced by cisatracurium. Methods: From March 2010 to July 2010, 140 cases (38 male and 102 female) of abdominal surgery patients aged 18 to 64 years old were selected in Sichuan Provincial People’s Hospital and graded from I to II with American Society of Anesthesiologists (ASA) physical status. General anesthesia was induced with propofol (TCI) (1.0μg/ml 4.0μg/ml). After the patients lost their consciousness, neuromuscular function was monitored by train-of-four (TOF) stimulation accelerometry and the first twitch response T1 reached 100%. The patients were randomized (using envelope randomization) into 7 groups : Group C0 received 3 mL of normal saline as a priming dose and served as the control group; Group C1, Group C2 and Group C3 received cisatracurium at a dose of 0.005mg/kg (10%ED95), 0.010mg/kg (20%ED95) and 0.015mg/kg (30%ED95) respectively as a priming dose; Group R1, Group R2 and Group R3 received rocuronium at a dose of 0.03mg/kg (10%ED95), 0.06mg/kg (20%ED95) and 0.09mg/kg (30%ED95) respectively as a priming. A 3-minute priming period, anesthesia was induced with the fentanyl (3.0ug/kg) and an intubation doses of cisatracurium (Group C0, 0.150mg/kg; Group C1and Group R1, 0.145 mg/kg; Group C2 and Group R2, 0.140mg/kg; Group C3 and Group R3 0.135 mg/kg). The priming and intubation doses of cisatracurium in Group C0, Group C1, Group C2 and Group C3 were 0.15mg/kg (3ED95) respectively. When T1 reached 5%, endotracheal intubation was performed. During anesthesia, propofol (4.0μg/ml 6.0μg/ml) and fentanyl (0.05mg/time 0.1mg/time) were used for maintenance. Additional muscle relaxants were not administered before T25. In all patients, indices were monitored and recorded, including hemodynamic parameters (the pre-injection , the end of 3-minute priming period and the 3-minute after introduction), TOFs at the end of priming interval, intubation time, intubation conditions, onset time, PTC counts, recovery phase (T5, T25 ) and adverse reactions. Results: Patient characteristics (sex, body mass indices, hemoglobins, total protein contents, PH values, temperatures and other general conditions) were not significantly different among the 7 groups (P>0.05) by statistical test. Compared with those in Group C0, the heart rate and mean arterial blood pressure were not significant changed (P>0.05) in the other 6 groups during the pre-injection , the end of 3-minute priming period and the 3-minute after introduction. Compared with that in the control group C0, TOFs at the 3-minute priming interval in Group R2 and Group R3 were significantly inhibited (P<0.05), and in the other four groups TOF levels were not suppressed significantly (P>0.05). It significantly reduced the onset time for cisatracurium by using cisatracurium (Group C1, Group C2 and Group C3) and rocuronium (GroupR1, GroupR2 and GroupR3) as priming drugs at an interval of 3 minutes. And rocuronium groups (Group R1 ,Group R2 and Group R3) got a shorter onset time for cisatracurium compared with cisatracurium groups (Group C1, Group C2 and Group C3).The more priming dose, the faster speed of onset (P<0.05). The speed of intubation in Group C3 (63.5±57.1s) and Group R3 (76.7±51s) were the most significant. The intubation conditions, PTC counts and recovery phase (T5, T25) among 7 groups were not significantly different (P>0.05). T5 and T25 were 39 min 60 min and 43 min 64min respectively. Two patients occurred facial flushing and erythema in face and chest after given the introduction dose of cisatracurium for 20 minutes. The phenomenon in one case went away without treatment. In another case those disappeared after using intravenous injection of 10 mg of dexamethasone. The remaining 138 patients had no allergic reactions or other adverse reactions. Conclusion: Priming with 0.03mg/kg (10% ED95) rocuronium or 0.015mg/kg (30%ED95) cisatracurium for 3 minutes significantly accelerated the onset of cisatracurium. It didn’t cause obvious clinical symptoms or side effects. Knowledge of time sequences for priming and associated side effects can help us make plans for safe and efficient induction in patients.
Keywords/Search Tags:Cisatracurium, Rocuronium, Priming dose, Neuromuscular blockade, Intubation time, Onset time, Intubation conditions, Recovery phase
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