Objective： To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation （OLT） in humans. Methods： Twenty male patients undergoing liver transplan...Objective： To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation （OLT） in humans. Methods： Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four （TOF） stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain Tl/Tc ratio of 2%-10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results： Rocuronium requirement, which were （0.468±0.167）mg/（kg·h） during the paleohepatic phase, decreased significantly during the anhepatic phase to （0.303±0.134）mg/（kg·h） and returned to the initial values at the neohepatic period （（0.429±0.130） mg/（kg·h））; whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions： This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.展开更多
Myasthenia gravis is an autoimmune disease involving the acetylcholine receptors atneuromuscular junctions.Perioperative management of patients with myasthenia gravis iscomplicated by their enhanced sensitivity to non...Myasthenia gravis is an autoimmune disease involving the acetylcholine receptors atneuromuscular junctions.Perioperative management of patients with myasthenia gravis iscomplicated by their enhanced sensitivity to nondepolarizing neuromuscular blocking agentsand their resistance to depolarizing drugs (1).Prolonged respiratory depression commonlyoccurs when these agents are used.Atracurium dibesilate is one of a new series of nonde-polarizing agents and is promising by virtue of its rapid degradation by‘Hoffmann elimina-tion’.leaving products with little or no muscle blocking activity.After encouraging resultswere obtained with atracurium (2-6),we investigated the neuromuscular blocking effect ofdifferent doses of the drug (0.2 mg/kg,0.5 mg/kg) in sixteen myasthenic patients undergoingthymectomy.with continuous monitoring of neuromuscular function.展开更多
To compare the characteristics of the dose response relationship and the time course of action between atracurium and rocuronium in adult patients anesthetized with N 2O O 2 fentanyl thiopene Methods Sixty pat...To compare the characteristics of the dose response relationship and the time course of action between atracurium and rocuronium in adult patients anesthetized with N 2O O 2 fentanyl thiopene Methods Sixty patients, ASA grade Ⅰ, aged 18-50 years, scheduled for elective plastic surgery were studied All patients were randomly divided into either the atracurium or rocuronium group General anesthesia was maintained with 60% nitrous oxide and 40% oxygen, thiopentone, and fentanyl Neuromuscular function was assessed using an accelograph with train of four (TOF) stimulation at the wrist every 12 seconds The percentage depression of the first twitch (T 1) was used as the study parameter The dose response relationship of atracurium and rocuronium was determined by the cumulative dose response technique Results According to the dose response curves established by a least squares linear regression, the potency ratio of atracurium to rocuronium was 1∶1 2 There were significant differences in the ED 50 , ED 90 , and ED 95 between the two drugs After the intravenous administration of equipotent doses of both drugs (1 5×ED 95 ), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their recovery indexes were similar Conclusions Atracurium and rocuronium are low potency nondepolarizing relaxants with intermediate duration As compared to atracurium, the neuromuscular blocking effect of rocuronium was about 20% less potent and its duration of action was shorter展开更多
文摘Objective： To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation （OLT） in humans. Methods： Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four （TOF） stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain Tl/Tc ratio of 2%-10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results： Rocuronium requirement, which were （0.468±0.167）mg/（kg·h） during the paleohepatic phase, decreased significantly during the anhepatic phase to （0.303±0.134）mg/（kg·h） and returned to the initial values at the neohepatic period （（0.429±0.130） mg/（kg·h））; whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions： This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.
文摘Myasthenia gravis is an autoimmune disease involving the acetylcholine receptors atneuromuscular junctions.Perioperative management of patients with myasthenia gravis iscomplicated by their enhanced sensitivity to nondepolarizing neuromuscular blocking agentsand their resistance to depolarizing drugs (1).Prolonged respiratory depression commonlyoccurs when these agents are used.Atracurium dibesilate is one of a new series of nonde-polarizing agents and is promising by virtue of its rapid degradation by‘Hoffmann elimina-tion’.leaving products with little or no muscle blocking activity.After encouraging resultswere obtained with atracurium (2-6),we investigated the neuromuscular blocking effect ofdifferent doses of the drug (0.2 mg/kg,0.5 mg/kg) in sixteen myasthenic patients undergoingthymectomy.with continuous monitoring of neuromuscular function.
基金This study was supported by the Scientific Research Fund of the Chinese Acadeny of Medical Sciences and Peking Union Medical College(Nom 954006)the Excellent Young Scientists Fund of the Ministry of Health,China(No.97004).
文摘To compare the characteristics of the dose response relationship and the time course of action between atracurium and rocuronium in adult patients anesthetized with N 2O O 2 fentanyl thiopene Methods Sixty patients, ASA grade Ⅰ, aged 18-50 years, scheduled for elective plastic surgery were studied All patients were randomly divided into either the atracurium or rocuronium group General anesthesia was maintained with 60% nitrous oxide and 40% oxygen, thiopentone, and fentanyl Neuromuscular function was assessed using an accelograph with train of four (TOF) stimulation at the wrist every 12 seconds The percentage depression of the first twitch (T 1) was used as the study parameter The dose response relationship of atracurium and rocuronium was determined by the cumulative dose response technique Results According to the dose response curves established by a least squares linear regression, the potency ratio of atracurium to rocuronium was 1∶1 2 There were significant differences in the ED 50 , ED 90 , and ED 95 between the two drugs After the intravenous administration of equipotent doses of both drugs (1 5×ED 95 ), the duration of peak effect, clinical duration, and total duration were significantly different between the two drugs, but their recovery indexes were similar Conclusions Atracurium and rocuronium are low potency nondepolarizing relaxants with intermediate duration As compared to atracurium, the neuromuscular blocking effect of rocuronium was about 20% less potent and its duration of action was shorter
