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Title: [Effects of sevoflurane and desflurane on pharmacodynamics of rocuronium in children].
Author: Kang DX, Rao YQ, Ji B, Li J.
Journal: Zhonghua Yi Xue Za Zhi; 2017 Feb 14; 97(6):429-433. PubMed ID: 28219129.
Abstract:
Objective: To observe the intraoperative influences on pharmacodynamics of rocuronium in children inhaling sevoflurane and desflurane for 40 min balance. Methods: Ninety children (ASAⅠ-Ⅱ) undergoing elective surgery with general anesthesia in Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University from July 2015 to May 2016 were randomly assigned into six groups (n=15): Sevoflurane group (group S1 and S2), Desflurane group (group D1 and D2) and Propofol group (group P1 and P2). Children in group D1, S1 and P1 were allocated to research the dose-effect relationship of rocuronium, children in group D2, S2 and P2 were allocated to research the time-effect relationship of rocuronium. TOF-Watch SX monitor was used to exert a train-of-four stimulation (TOF) at ulnar nerve in wrist, then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T(1, )T(2, )T(3) and T(4) respectively. After the success of the muscle relaxant calibration, 1.3 MAC sevoflurane and desflurane were inhaled and maintained for 40 min respectively in children in Sevoflurane group (group S1 and S2) and Desflurane group (group D1 and D2), Plasma target controlled infusion of 3.5-4.0 μg/ml propofol was always administered in Propofol group (group P1 and P2). 75 μg/kg rocuronium was injected each time in group S1, D1 and P1 respectively. Maximum inhibited effect of T(1) was recorded after every injection until inhibition of T(1) more than 95% eventually. The method of cumulative dose four times was used to calculate the efficiency curve of rocuronium[median effective dose (ED(50)), 90% effective dose (ED(90)) and 95% effective dose (ED(95))]. 0.6 mg/kg rocuronium was injected respectively through vein in group S2, D2 and P2. The recovery times of muscle relaxant were recorded which including time of T(1) disappeared (onset time), T(1) from 0% to 5% (peak effect time), T(1) from 0% to 25% (clinical effect time), T(1) from 25% to 75% (recovery index), T(1) from 0% to 70% (internal effect time), T(4)/T(1) (TOFr) from 0% to 70% and 90%. Results: ED(50, )ED(90) and ED(95) in group D1 were 128.73, 212.45 and 245.78 μg/kg respectively. ED(50, )ED(90) and ED(95) in group S1 were 132.46, 218.94 and 252.30 μg/kg respectively. ED(50, )ED(90) and ED(95) in group P1 were 230.56, 381.02 and 439.55 μg/kg respectively. ED(50, )ED(90) and ED(95) in group D1 and S1 were significantly lower than those in group P1 (all P<0.05), but there was no significant difference between D1 and S1 group (P>0.05). Compared with group P2, the shorter onset time, the longer peak effect time and clinical effect time was observed in group D2 and S2, the longer recovery index, internal effect time and TOFr from 0% to 70% and 90% was observed in group S2 (all P<0.01). Conclusions: 1.3 MAC sevoflurane and desflurane inhaling for 40 min significantly reduces ED(50) and ED(95) of rocuronium, prolongs the onset time and action time of rocuronium in children. Sevoflurane can significantly prolong the recovery characteristics of rocuronium. 目的：观察七氟烷和地氟烷吸入麻醉平衡40 min后对患儿罗库溴铵药效动力学的影响。 方法：本研究为前瞻性研究，选择2015年7月至2016年5月温州医科大学附属第二医院全麻下行择期手术患儿90例，美国麻醉医师协会(ASA)Ⅰ～Ⅱ级。采用随机数字表将患儿随机分为6组(n＝15)：地氟烷1组和2组(D1、D2组)、七氟烷1组和2组(S1、S2组)、丙泊酚1组和2组(P1、P2组)。D1、S1和P1组行罗库溴铵量效关系研究，D2、S2和P2组行罗库溴铵时效关系研究。采用TOF-Watch SX肌松监测仪对腕部尺神经行4个成串刺激(TOF)，拇内收肌依次出现4个肌颤搐分别记录为T(1)、T(2)、T(3)和T(4)。肌松定标成功后，S1组、S2组、D1组和D2组分别吸入1.3 MAC七氟烷或地氟烷并维持40 min，P1组和P2组则始终血浆靶控输注丙泊酚3.5～4.0 μg/ml维持麻醉。随后S1组、D1组和P1组静注罗库溴铵每次75 μg/kg，记录每次用药后T(1)的最大阻滞效应，最终T(1)抑制超过95%；采用4次累积剂量的方法计算罗库溴铵的量效关系曲线和肌松阻滞的半数有效剂量(ED(50))、90%有效剂量(ED(90))和95%有效剂量(ED(95))。S2组、D2组和P2组患者则分别静脉注射罗库溴铵0.6 mg/kg，记录罗库溴铵给药完毕至T(1)消失时间(起效时间)，T(1)从0%恢复至5%所需时间(高峰时间)、T(1)从0%恢复至25%所需时间(临床肌松时间)、T(1)从25%恢复至75%所需时间(恢复指数)、T(1)从0%恢复至70%所需时间(体内作用时间)及T(4)/T(1)比值(TOFr)恢复至70%和90%的时间。 结果： D1组ED(50)、ED(90)和ED(95)分别为128.73、212.45和245.78 μg/kg，S1组ED(50)、ED(90)和ED(95)分别为132.46、218.94和252.30 μg/kg，P1组ED(50)、ED(90)和ED(95)分别为230.56、381.02和439.55 μg/kg。D1组、S1组ED(50)、ED(90)和ED(95)均显著低于P1组(均P<0.05)，而D1组和S1组之间差异无统计学意义(P>0.05)。与P2组比较，D2组和S2组起效时间更快、高峰时间和临床肌松时间更长，而S2组恢复指数、体内作用时间、TOFr恢复到70%和90%的时间均延长(均P<0.01)。 结论： 1.3 MAC地氟烷和七氟烷吸入麻醉平衡40 min后患儿罗库溴铵的ED(50)、ED(95)显著降低，作用时间明显延长，七氟烷可明显延长罗库溴铵的肌松恢复时间。.

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