RESUMO
Objective: To observe the effect of obstructive jaundice on the neuromuscular blocking effect and drug metabolism of rocuronium, so as to guide proper use of rocuronium during anesthesia for patients undergoing hepatobiliary surgeries. Methods: Thirty patients (with normal renal function and without muscle or nerves diseases, ASA I - II) receiving elective surgery were divided into 2 groups: obstructive jaundice group (group I, n=15) and control group (group II, n=15). All patients received continuous peridural anesthesia and general anesthesia. Neuromuscular blockade was evaluated with train-of-four (TOF) stimuli of the ulnsar nerve using TOF Watch SX nerve stimulators. The onset time, clinical duration of rocuronium, the time of TOFR from 0 to 70% and recovery index (T1 from 25%-75%) were observed. Liquid chromatography-tandem mass spectrometry (LC/MS/MS) was used to determine the concentration of rocuronium in the plasma at 30, 60, 90, 120, and 180 min after administration of 0. 9 mg/kg rocuronium. Results: The age, body mass index, and prothrombin time were matched between the two groups. The total bilirubin, direct bilirubin and indirect bilirubin in group I were significantly higher than that in group II (P<0.01). The onset time was similar between the two groups; the clinical duration of rocuronium, the time of TOFR from 0 to 70%, and the recovery index (to 10%, 25%, 50%, and 75% of T1) in group I were significantly longer than those in group II (P<0.01). The plasma concentrations of rocuronium in group I were significantly higher than those in group II at 60, 90, 120 min after administration of rocuronium (P<0. 01 or P<0.05). Conclusion: Obstructive jaundice may prolong the duration of rocuronium action and recovery time, and slows down the metabolism of rocuronium. So patients with obstructive jaundice should have a longer interval for drug addition. Peri- and post-operative monitoring of neuromuscular function is suggested for proper drug use and anesthesia extubation.
RESUMO
Objective To investigate the neuromuscular blocking effects and clinical pharmacology of different dosage of mivacurium chloride in infants during sevoflurane anesthesia. Methods Forty ASA I infants undergoing sevoflurane general anesthesia were randomly assigned to tow groups according to the dose level of mivacurium: group1: 200 μg/kg ( n =20) and group2: 250 μg/kg ( n =20) . TOFs were determined synchronously. The onset time of mivacurium, recovery time of spontaneous breathing and cardiovascular reactions were measured. Results The onset time was significantly shortened in group 2 compared with group 1 (P<0.05) . There was no significant difference in the recovery time of spontaneous breathing between the two groups. 2 minutes after mivacurium was injected, DBP in group 2 decreased significantly compared with baseline and group 1. 3 minutes after mivacurium was injected,SBP in group 2 decreased significantly compared with baseline and group 1. Conclusion In infants undergoing sevoflurane general anesthesia, the onset time of mivacurium can be shortened when 250μg/kg was administered,but the depression of cardiovascular system may occurr simultaneously.
RESUMO
In the human isolated arm preparation applied tourniquet on the upper arm, the neuromuscular blocking effects of ketamine were confirmed with the changes of first twitch height (T1) and train of four ratio (T4R) induced from 2Hz ulnar nerve stimulation (ABM Datex Co.) at 20 minutes after administration of ketamine. The results obtained were as follows; In the control group administered of saline, T1 was elevated to 6.48% compared with before tourniquet applied but T4R was not changed through the whole of the process. In the group I administered of ketamine 1 mg/kg, T1 and T,R were depressed of 8.68% and 29.59% respectively but T1 was not significant. In the group II administered of ketamine 2 mg/kg, T1 and T4R were depressed of 43.4% and 40.4% respectively. T1 and T4R in the group I and II were significantly depressed comparing with control group.