RESUMO
Objective:To investigate the pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual in infants and young children undergoing daytime surgery.Methods:One hundred and four pediatric patients of either sex, aged 3-36 months, of American Society of Anesthesiologists Physical Status classification Ⅱ, with body mass index of 18.5-28.0 kg/m 2, diagnosed with oblique inguinal hernia and/or hydrocele, scheduled for laparoscopic high ligation of hernia sac and/or high ligation of sphingoid surgery, were included in the study. Intraoperative neuromuscle relaxation was assessed by transdermal stimulation of the ulnar nerve in the wrist using a TOF Guard monitor. Rocuronium 0.9 mg/kg, propofol 3 mg/kg, and sufentanyl 0.5 μg/kg were intravenously injected for anesthesia induction, and propofol 6-8 mg·kg -1·h -1 was intravenously infused to maintain anesthesia. The pediatric patients were divided into Ⅰgroup and Ⅱ group according to the degree of postoperative neuromuscular block. In group Ⅰ, sugammadex 2 mg/kg was intravenously injected when TOF returned to T 2 recurrence. In group Ⅱ, sugammadex 4 mg/kg was intravenously injected when the single stimulation count was 1 or 2 after tetanic stimulation. At 2 and 10 min after rocuronium administration, at the end of operation, 2 and 10 min after sugammadex administration, and when the children met the standard of leaving the resuscitation room, venous blood samples were collected for determination of plasma concentrations of rocuronium and sugammadex using ultra-high performance liquid chromatography-mass spectrometry. Pharmacokinetic parameters were determined using the Pheonix WinNonlin software. The onset of rocuronium and time for recovery of TOF ratio to 90% were recorded. Results:The pharmacokinetics of sugammadex was fitted to the nonlinear mixed-effect satrioventricular model.There was no significant difference in the peak concentration, area under the drug concentration-time curve, elimination half-life, apparent clearance, apparent volume of distribution, mean retention time, and time for TOF ratio returning to 90% between the two groups ( P> 0.05). Conclusions:The pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual is fitted to a nonlinear mixed-effect satrioventricular model, and sugammadex 2 and 4 mg/kg have similar pharmacokinetics in infants and young children undergoing daytime surgery.
RESUMO
Objective To determine the minimum alveolar concentration (MAC) of sevoflurane in Chinese neonates.Methods Thirty ASA Ⅰ or Ⅱ neonates,aged ≤ 28 days,with normal body weight,scheduled for elective surgery under general anesthesia,were enrolled in the study.Anesthesia was induced with inhalation of 6.00％ sevoflurane in oxygen.The infants were tracheal intubated and mechanically ventilated.The inhaled concentration of sevoflurane was adjusted to achieve the preset end-tidal concentration and maintained at this level for 20 min.Skin incision was then performed.The concentration of sevoflurane was determined by modified Dixon's up-and-down method.The initial end-tidal concentration of sevofluren was 3.00％.Each time the concentration increased/decreased by 0.25 ％ in the next infant according to the infant's response.Successful skin incision was defined as no body movement during skin incision.The MAC,ED95 and 95 ％ confidence interval of sevoflurane were calculated using logistic regression analysis.Results The MAC and ED95 (95 ％ confidence interval) of sevoflurane required for successful skin incision were 2.82％ (2.66％-2.98％) and 3.39％ (2.89％-3.89％),respectively,in neonates.Conclusion The MAC of sevoflurane is 2.82 ％ in Chinese neonates and lower than the present reference values previously described in foreign reports.