使用Mivacurium在全身麻醉期间比较上臂 (TOF Cuff®) 和眼 (TOF Scan®) 之间的神经肌肉阻塞测量
Paweł Radkowski1,2, Jakub Ruść2,3, Mariusz Kęska1,2
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
概括
TOF-Scan®设备为监测神经肌肉阻塞提供了TOF-Cuff®的替代方案,特别是当四肢测量是不可行的时. 将TOF-Scan放松时间乘以8为大多数患者提供可靠的结果.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 医疗器械 医疗器械
背景情况:
- 米瓦是用于全身麻醉的非去极化神经肌肉阻断剂.
- TOF-Cuff®监测手术期间的神经肌肉阻塞和上臂的血压.
- TOF-Scan®通过面部波纹超肌肉测量肌肉放松状态.
研究的目的:
- 为了比较TOF-Cuff®和TOF-Scan®在测量神经肌肉阻塞方面的疗效.
- 为了评估上臂和面部肌肉放松监测之间的相关性.
- 评估TOF-Scan®作为TOF-Cuff®的替代品的实用性.
主要方法:
- 包括36名接受选择性手术的成年患者.
- 四列车 (TOF) 值在输入前每30秒和输入后每5分钟记录一次.
- 同时使用TOF-Cuff®在上臂和TOF-Scan®在面部肌肉上监测神经肌肉阻塞.
主要成果:
- 与TOF-Cuff®相比,TOF-Scan®显示神经肌肉阻塞的中位发病时间明显较短 (90秒对210秒,P<0.00001).
- 将TOF-Scan®放松时间乘以8的因子,与TOF-Cuff®达成一致,导致90%以上的患者在发病和康复方面都达成一致.
- 这两种方法都显示出相似的虚假阴性结果率,没有统计学上显著的差异.
结论:
- 当肢体测量是不可能的时,眼上的TOF-Scan®可以作为上臂TOF-Cuff®的可行替代品.
- 对TOF-Scan®放松时间施加的至少8的乘法因子可确保对约90%的患者进行可靠的监测.
- 这一发现支持在麻醉学中使用面部肌肉监测,当外围测量是禁忌或不切实际时.
相关概念视频
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
416
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
416
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
404
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
404
Depolarizing Blockers: Pharmocokinetics
323
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
323
Skeletal Muscle Relaxants: Therapeutic Uses
482
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
482
Depolarizing Blockers: Mechanism of Action
1.5K
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because...
1.5K
Neuromuscular Junction And Blockade
3.1K
The site of chemical communication between a motor neuron and a muscle fiber is called the neuromuscular junction (NMJ). The end of the motor neuron at the NMJ divides into a cluster of synaptic end bulbs. The cytoplasm of these bulbs consists of synaptic vesicles enclosing acetylcholine molecules, the principal neurotransmitter released at the NMJ. The region opposite the synaptic bulb that ends in the muscle fiber is called the motor end plate, which has acetylcholine receptors. Within the...
3.1K


