新斯的明拮抗老年患者顺式阿曲库铵残余肌松的效应观察
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摘要
背景和目的：
顺式阿曲库铵是阿曲库铵的1-R构型和1’-R构型的顺式异构体,通过Hofmann降解反应而代谢,并且代谢不受年龄影响,属于中时效神经肌肉阻滞剂。其活性大约是阿曲库铵的四倍,在临床剂量范围内顺式阿曲库铵不会像阿曲库铵那样引起组胺释放,目前被广泛应用于老年患者。循证医学的实践要求临床医师应该常用客观监测量化说明神经肌肉的阻滞程度,如果在手术操作结束时不能客观地证实神经肌肉功能充分恢复(四个成串反应比值即TOF≥0.9),神经肌肉阻滞就必须拮抗。对于长时效和中时效肌肉松弛剂,由于难于判定在手术后是否残存轻微的神经肌肉阻滞作用,因此应常规使用抗胆碱酯酶药物予以拮抗。然而对于老年患者,由于病理生理的特殊改变,什么时间给予何种剂量的新斯的明合适目前还不是很清楚,在本试验中通过观察不同剂量新斯的明在不同时机拮抗老年患者应用顺式阿曲库铵时的肌松残余作用,探讨较佳的拮抗时机和拮抗剂量,使老年患者平稳度过麻醉恢复期,为临床合理安全使用肌松拮抗剂提供理论依据。
方法：
选择90例择期手术患者,男44例,女46例,年龄65-75岁,体重指数(BMI)在正常范围(18～25kg/m2),ASAⅠ～Ⅱ级,随机分为两组：T1值(TOF中第一个颤搐反应)恢复至10%时给予新斯的明组(T1a组),T1值恢复至25%时给予新斯的明组(T1b组),每组病人45例,每组又按新斯的明不同剂量分为三个亚组(n=15)：T1恢复到10%时给予新斯的明拮抗,新斯的明20μg/kg组(T1aN20组),新斯的明35μg/kg组(T1aN35组),新斯的明50μg/kg组(T1aN50组)；T1恢复到25%时给予新斯的明拮抗,新斯的明20μg/kg组(T1bN20组),35μg/kg组(T1bN35组),50μg/kg组(T1bN50组)。六组患者麻醉用药及麻醉方法相同,六组均以新斯的明：阿托品=2：1剂量伍用阿托品,术毕记录给予新斯的明前即刻,给药后1min、3min、5min、7min、10min、15min时的平均动脉压(MAP)、心率(HR)；四个成串反应比值(TOF)恢复到75%、90%时间。
结果：
1.患者一般情况,如性别、年龄、体重指数、给予新斯的明前即刻MAP、HR等比较均无统计学意义(p>0.05)。
2.血流动力学变化比较各组患者MAP、HR在给予新斯的明阿托品前即刻比较无统计学差异(p>0.05)。在T1a和T1b组中,各亚组给药后1min,3min时间点MAP出现增高；HR出现增快,但20μg/kg和35μg/kg组虽然MAP增高、HR增快,但变化与给药前即刻相比无统计学意义(p>0.05);50μg/kg组MAP增高和HR增快的变化与给药前即刻相比具有统计学意义(p<0.05)。
3.TOF恢复指数的比较组内比较：T1aN50组、T1aN35组与T1aN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1aN50组与T1aN35组比较,TOF恢复到75%和90%时间缩短,但缩短幅度无统计学意义(p>0.05)。T1bN50组、T1bN35组与T1bN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN50组与T1bN35组比较,TOF恢复到75%和90%时间缩短,但缩短幅度无统计学意义(p>0.05)。组间比较：T1bN20组与T1aN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN35组与T1aN35组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN50组与T1aN50组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)。
结论：
1.拮抗老年患者顺式阿曲库铵残余肌松作用推荐适宜的新斯的明剂量是35μg/kg(同时以新斯的明：阿托品=2：1剂量伍用阿托品),可以得到较快TOF恢复速度和较稳定的血流动力学变化。
2.在T1恢复到25%时给予新斯的明拮抗老年患者顺式阿曲库铵残余肌松作用是较适宜时机。
Background and Objective:
Cisatracurium is the 1R cis-1'-R cis isomer of atracurim.Cisatracurium is metabolized by Hofmann elimination and is unaffected by age.Cisatracurium is belongs to intermediate-acting muscule relaxants.It is approximately four times as potent as atracurium,and unlike atracurium.it does not cause histamine release in the clinical dose range.It is now widely used in elderly patients.Good evidence-based practice dictates that clinicans should always quantitate the exent of neuromuscular blockade using objective monitoring.If sufficient recovery (train-of-four rate TOF≥0.9)has not been documented objectively at the end of surgical procedure,the neuromuscular block should be antagonized.For all long-time acting and intermediate-acting muscule relaxants,because of the inability to detect subtle neuromuscular blocks clinically and persistence at the end of surgical procedure.The reversal by anticholinesterase drugs should be routine.Since specific changes in the pathophysiology of elderly patients,recommendations regarding the timing and dose of administration of neositigmine remain unclear.The purpose of this experiment is to explore more proper timing and dose of neostigmine by observing the effect of different doses of neostigmine using at different time on antagonizing residual neuromuscular blockade induced by cisatracurium in elderly patients, to make fo the smooth recovery from anesthesia in elderly patients and to provide theoretical basis for the proper use of the neuromuscular blockade antagonists in clinical practice.
Method:
90 patients scheduled for surgery included 44 males and 46 females, aged 65-75 years with the normal BMI range(18～25kg/m2) and ASAⅠ～Ⅱ. They were randomly divided into 2 groups with 45 cases each and given with neostigmine when T1 had recovered to 10%(T1a group) or 25%(T1b group) respectively. In each group, three subgroup (15 cases each) were given neostigmine 20μg/kg(T1aN20, T1bN20), 35μg/kg(T1aN35, T1bN35), or 50μg/kg (T1aN50, T1bN50) respectively. The cases in six groups were treated with the same anesthetic and anesthesia method.Neostigmine and atropine were administered for the six groups(The ratio of neostigmine and atropine is 1:2,when the surgery was finished, the MAP and HR were recorded at the time before using neostigmine as well as 1 min,3min,5min,7min, 10min,15min after neostigmine respectively. And the time were recorded when TOF had recovered to75% and 90%.
Results:
1. The patients showed significantly no differences in gender, age, BMI, and the MAP,HR before treated with neostigmine(p>0.05).
2. There was no statistical difference in the MAP,HR before all the cases were treated with neostigmine(p>0.05).In the two group T1a and T1b, the HR, MAP were higher than the basic value at the time lmin and 3min after they were given neostigmine.The HR, MAP were higher in the subgroup of 20μg/kg (T1aN20, T1bN20),35μg/kg(T1aN35,T1bN35), but there was no statistical difference in the MAP,HR compared to the level before the cases were treated with neostigmine (p>0.05); And the MAP, HR changes in the subgroup of 50μg/kg showed significantly differences compared to the level before the cases were treated with neostigmine(p<0.05).
3. The comparison of the recovery index of TOF intra-group comparison: Compared to the group of T1aN20, the time of TOF recovering to75% and 90% were shortened in the group of T1aN50 and T1aN35, and there were statistical differences(p<0.05). The time of TOF recovering to 75% and 90% were shorter in the group of T1aN50 than the group of T1aN35, but the changes had no significance; Group comparison:Compared to the group of T1aN2o, TlaN35 and T1aN50, the time of TOF recovering to75% and 90% were shortened in the group of T1bN20, T1bN35 and T1bN50 respectively, and there were all statistical differences(p<0.05).
Conclusion:
1. The recommend appropriate dose of neostigmine antagonizing residual neuromuscular blockade induced by cisatracurium is 35μg/kg in the elderly patients (the atropine were used compatiblely with neostigmine and the ratio of neostigmine/atropine is 1/2), which could induce the better recovery index of TOF as well as more stable hemodynamic changes.
2. The more proper timing to give neostigmine antagonizing residual neuromuscular blockade induced by cisatracurium was the time when T1 had recovered to 25% in the elderly patients.
顺式阿曲库铵是阿曲库铵的1-R构型和1’-R构型的顺式异构体,通过Hofmann降解反应而代谢,并且代谢不受年龄影响,属于中时效神经肌肉阻滞剂。其活性大约是阿曲库铵的四倍,在临床剂量范围内顺式阿曲库铵不会像阿曲库铵那样引起组胺释放,目前被广泛应用于老年患者。循证医学的实践要求临床医师应该常用客观监测量化说明神经肌肉的阻滞程度,如果在手术操作结束时不能客观地证实神经肌肉功能充分恢复(四个成串反应比值即TOF≥0.9),神经肌肉阻滞就必须拮抗。对于长时效和中时效肌肉松弛剂,由于难于判定在手术后是否残存轻微的神经肌肉阻滞作用,因此应常规使用抗胆碱酯酶药物予以拮抗。然而对于老年患者,由于病理生理的特殊改变,什么时间给予何种剂量的新斯的明合适目前还不是很清楚,在本试验中通过观察不同剂量新斯的明在不同时机拮抗老年患者应用顺式阿曲库铵时的肌松残余作用,探讨较佳的拮抗时机和拮抗剂量,使老年患者平稳度过麻醉恢复期,为临床合理安全使用肌松拮抗剂提供理论依据。
方法：
选择90例择期手术患者,男44例,女46例,年龄65-75岁,体重指数(BMI)在正常范围(18～25kg/m2),ASAⅠ～Ⅱ级,随机分为两组：T1值(TOF中第一个颤搐反应)恢复至10%时给予新斯的明组(T1a组),T1值恢复至25%时给予新斯的明组(T1b组),每组病人45例,每组又按新斯的明不同剂量分为三个亚组(n=15)：T1恢复到10%时给予新斯的明拮抗,新斯的明20μg/kg组(T1aN20组),新斯的明35μg/kg组(T1aN35组),新斯的明50μg/kg组(T1aN50组)；T1恢复到25%时给予新斯的明拮抗,新斯的明20μg/kg组(T1bN20组),35μg/kg组(T1bN35组),50μg/kg组(T1bN50组)。六组患者麻醉用药及麻醉方法相同,六组均以新斯的明：阿托品=2：1剂量伍用阿托品,术毕记录给予新斯的明前即刻,给药后1min、3min、5min、7min、10min、15min时的平均动脉压(MAP)、心率(HR)；四个成串反应比值(TOF)恢复到75%、90%时间。
结果：
1.患者一般情况,如性别、年龄、体重指数、给予新斯的明前即刻MAP、HR等比较均无统计学意义(p>0.05)。
2.血流动力学变化比较各组患者MAP、HR在给予新斯的明阿托品前即刻比较无统计学差异(p>0.05)。在T1a和T1b组中,各亚组给药后1min,3min时间点MAP出现增高；HR出现增快,但20μg/kg和35μg/kg组虽然MAP增高、HR增快,但变化与给药前即刻相比无统计学意义(p>0.05);50μg/kg组MAP增高和HR增快的变化与给药前即刻相比具有统计学意义(p<0.05)。
3.TOF恢复指数的比较组内比较：T1aN50组、T1aN35组与T1aN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1aN50组与T1aN35组比较,TOF恢复到75%和90%时间缩短,但缩短幅度无统计学意义(p>0.05)。T1bN50组、T1bN35组与T1bN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN50组与T1bN35组比较,TOF恢复到75%和90%时间缩短,但缩短幅度无统计学意义(p>0.05)。组间比较：T1bN20组与T1aN20组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN35组与T1aN35组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)；T1bN50组与T1aN50组比较,TOF恢复到75%和90%时间缩短,且缩短幅度具有统计学意义(p<0.05)。
结论：
1.拮抗老年患者顺式阿曲库铵残余肌松作用推荐适宜的新斯的明剂量是35μg/kg(同时以新斯的明：阿托品=2：1剂量伍用阿托品),可以得到较快TOF恢复速度和较稳定的血流动力学变化。
2.在T1恢复到25%时给予新斯的明拮抗老年患者顺式阿曲库铵残余肌松作用是较适宜时机。
Background and Objective:
Cisatracurium is the 1R cis-1'-R cis isomer of atracurim.Cisatracurium is metabolized by Hofmann elimination and is unaffected by age.Cisatracurium is belongs to intermediate-acting muscule relaxants.It is approximately four times as potent as atracurium,and unlike atracurium.it does not cause histamine release in the clinical dose range.It is now widely used in elderly patients.Good evidence-based practice dictates that clinicans should always quantitate the exent of neuromuscular blockade using objective monitoring.If sufficient recovery (train-of-four rate TOF≥0.9)has not been documented objectively at the end of surgical procedure,the neuromuscular block should be antagonized.For all long-time acting and intermediate-acting muscule relaxants,because of the inability to detect subtle neuromuscular blocks clinically and persistence at the end of surgical procedure.The reversal by anticholinesterase drugs should be routine.Since specific changes in the pathophysiology of elderly patients,recommendations regarding the timing and dose of administration of neositigmine remain unclear.The purpose of this experiment is to explore more proper timing and dose of neostigmine by observing the effect of different doses of neostigmine using at different time on antagonizing residual neuromuscular blockade induced by cisatracurium in elderly patients, to make fo the smooth recovery from anesthesia in elderly patients and to provide theoretical basis for the proper use of the neuromuscular blockade antagonists in clinical practice.
Method:
90 patients scheduled for surgery included 44 males and 46 females, aged 65-75 years with the normal BMI range(18～25kg/m2) and ASAⅠ～Ⅱ. They were randomly divided into 2 groups with 45 cases each and given with neostigmine when T1 had recovered to 10%(T1a group) or 25%(T1b group) respectively. In each group, three subgroup (15 cases each) were given neostigmine 20μg/kg(T1aN20, T1bN20), 35μg/kg(T1aN35, T1bN35), or 50μg/kg (T1aN50, T1bN50) respectively. The cases in six groups were treated with the same anesthetic and anesthesia method.Neostigmine and atropine were administered for the six groups(The ratio of neostigmine and atropine is 1:2,when the surgery was finished, the MAP and HR were recorded at the time before using neostigmine as well as 1 min,3min,5min,7min, 10min,15min after neostigmine respectively. And the time were recorded when TOF had recovered to75% and 90%.
Results:
1. The patients showed significantly no differences in gender, age, BMI, and the MAP,HR before treated with neostigmine(p>0.05).
2. There was no statistical difference in the MAP,HR before all the cases were treated with neostigmine(p>0.05).In the two group T1a and T1b, the HR, MAP were higher than the basic value at the time lmin and 3min after they were given neostigmine.The HR, MAP were higher in the subgroup of 20μg/kg (T1aN20, T1bN20),35μg/kg(T1aN35,T1bN35), but there was no statistical difference in the MAP,HR compared to the level before the cases were treated with neostigmine (p>0.05); And the MAP, HR changes in the subgroup of 50μg/kg showed significantly differences compared to the level before the cases were treated with neostigmine(p<0.05).
3. The comparison of the recovery index of TOF intra-group comparison: Compared to the group of T1aN20, the time of TOF recovering to75% and 90% were shortened in the group of T1aN50 and T1aN35, and there were statistical differences(p<0.05). The time of TOF recovering to 75% and 90% were shorter in the group of T1aN50 than the group of T1aN35, but the changes had no significance; Group comparison:Compared to the group of T1aN2o, TlaN35 and T1aN50, the time of TOF recovering to75% and 90% were shortened in the group of T1bN20, T1bN35 and T1bN50 respectively, and there were all statistical differences(p<0.05).
Conclusion:
1. The recommend appropriate dose of neostigmine antagonizing residual neuromuscular blockade induced by cisatracurium is 35μg/kg in the elderly patients (the atropine were used compatiblely with neostigmine and the ratio of neostigmine/atropine is 1/2), which could induce the better recovery index of TOF as well as more stable hemodynamic changes.
2. The more proper timing to give neostigmine antagonizing residual neuromuscular blockade induced by cisatracurium was the time when T1 had recovered to 25% in the elderly patients.
引文
[1]Eriksson LI, Sato M, Severinghaus JW.Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response.Anesthesiology 1993; 78:693-699.
[2]Sundman E, Witt H, Olsson R, Ekberg O, et al:The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans.Pharyngeal videooradiography and simultaneous manometry after atracurium. Anesthesiology 2000; 92:977-998.
[3]Eikermann M, Groeben H, et al:Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade.Anesthesiology 2003;98:1333-7.
[4]Beecher HK, Todd DP. A study of the deaths associate with anesthesia and surgery:based on a study of 599,548 anesthesias in ten institutions 1948-1952,inclusive.Ann Surg 1954:140:2-35.
[5]Epemolu O, Bom A,Hope F,Mason R.Reversal of neuromuscular blockade and simul-taneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agen Org25969. Anesthesiology 2003;99:632-7.
[6]Belmont MR,Horochiwsky Z,Eliazo RF,Savarese JJ.Reversal of AV430A with cysteine in rhesus monkeys. Anesthesiology 2004:A-1180.
[7]Adams WA,Mark Senior J,Jones RS,et al.Cisatracurium in dogs with and without porto-systemic shunts [J].Vet Anaesth Analg,2006,33(1):17-23.
[8]Bryson HM,Faulds D,Cisatracurium besilate.Areview of its pharmacology and clinical potential in anaesthetic practice[J].Drugs,1997,53(5):848-866.
[9]Imbeatult K, Withington DE, Varin F, Pharmacokinetics and pharmacodynamics of a 0.1mg/kg dose of cisatracurium besylate in children during N2O/O2/propofol anesthesia [J].Anesth Analg,2006,102(3):738-743.
[10]Ahuja TS,Freeman D,Mahnken JD,et al.Predictor of the development of hyperkalemia in patients using angiotensin converting enzyme inhibitors[J].Am J Nephrol,2005,20:268-272.
[11]Kisor DF,Schmith VD,Wargin WA,et al:Importance of the organ-independent elimination of cisatracurium. Anesth Analg 83:1065-1071,2001.
[12]Lien CA,Schmith VD,Belmont MR,et al:Phannacokinetics of cisatracurium in patients receiving nitrous oxide/opioid/barbiturate anesthesia.Anesthesiology 84:300-308,1996.
[13]Welch RM,Brown A,Ravitch J,et al:the in vitro degradation of cisatracurium,the R, cis-R'-isomer of atracurium,in human and rat plasma.Clin Pharmacol Ther 58:132-142,1995.
[14]闻大翔,蒋茹,杭燕南等.顺式阿曲库铵、维库溴铵在老年患者中的药效学研究[J].中华老年医学杂志,2004,5(23)：313-315.
[15]谭丹,桂智勇,杨天德.顺武阿曲库铵的临床应用研究[J].中国医药指南,2008,5(6)：27-28.
[16]Kisor DF, Schmith VD, Wargin WA,et al:Importance of the organ-independent elimination of cisatracurium.Anesth Analg 83:1065-1071,1996.
[17]De Wolf M,Freeman JA,Scott VL,et al:Phannacokinetics and pharmacodynamics of cisatracurium in patients with end-stage liver disease undergoing liver transplantation.Br J Anaesth 76:624-628,1996.
[18]莫利求,黄文起,谭洁芳。等.新的中效肌松药顺武阿曲库铵[J]国外医学(麻醉学与复苏分册),2000.21(3)：170-172.
[19]Lien CA, Belmont MR, Abalos A,et al.The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia[J]. Anesthesiology,1995,82(5):1131-1138.
[20]闻大翔,陈锡萌,杭燕南等.国人顺式阿曲库铵的剂量反应测定[J].中华麻醉学杂志,1999,19(7)：395-3.
[21]谢柯祺,兰志勋.顺式阿曲库铵在麻醉诱导期的应用[J].实用医院临床杂志,2001,7(3)：17-20.
[22]Belment MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology,1995, 82:1139-1145.
[23]Amin AM,Mohammad MY,Ibrahim MF.Comparative study of neuromuscular blocking and hemodynamic effects of rocuronium and cisatracurium under sevoflurane or total intravenous anesthesia[J].Middle East J Anaesthesiol,2009,20(1):39-51.
[24]Lin SP, Changq KY, Chen YJ,et al.Priming with rocuronium to accelerate the onset time of cisatracurium during intubation[J].Chin Med Assoc,2009,72(1):15-19.
[25]Moro ET, Nakamura G, Martino RS, et al.Effect of propofol in combination with ephedrine upon the onset time of cisatracurium [J]. Rev Assoc Med Bras,2007,53(3):272-275.
[26]Wastila WB,Maehr RB,Turner GL,et al:Comparative pharmacology of cisatracurium (51W89),atracurium,and five isomers in cats.Anesthesiology 85:169-177,1996.
[27]Doenicke A,Soukup J,Hoernecke R,et al.The lack of histamine release with cisatracurium:a double-blind comparison with vecuronium[J].Anesth Analg,1997;84(3):623-628.
[28]闻大翔,陈锡萌,杭燕南等.顺式阿曲库按的组胺释放作用及其对血液动力学的影响[J].中华麻醉学杂志,2001；21(2)：69-72.
[29]熊章荣,唐延先.多瑞吉联合罗呢卡因用于腹腔镜胆囊切除术后镇痛的临床研究[J]第三军医大学学报,2007；29(1)：634-645.
[30]Lirk P,Longato S,Rieder J,et al.Cisatracurium,but nont mivacurium,inhibits survival and axonal growth of neonatal and adult rat peripheral neurons in vitro[J].Neurosci Lett,2004,22,365(2):153-155.
[31]Rider J, Lirk P,Bodroqi F,et al.Cisatracurium,but not mivacurium,induces apoptosis in human umbilical vein endothelial cells in vitro[J].Eur J Anaeshtesiol,2005,22(1):16-19.
[32]SahniM, LowenthalDT, Mealeman. A clinica,l physiclogu and pharmacology evaluation of orthostatic hypotension in the elderly [J]. International urology & nephrology,2005,37 (3):669-674.
[33]Rooke G:Autonomic and cardiovascular function in the geriatric patient.Anesthesiol Clin North Am 18:31-46,2000.
[34]Priebe H:The aged cardiovascular risk patient.Br J Anaesth 85:763-778,2000
[35]Matteo RS, Backus WW, McDaniel DD, et al:Pharmacokinetics and pharmacodynamics of d-tubocurarine and metocurine in the elderly.Anesth Analg 64:23-29,2000.
[36]Ornstein E, Lien CA, Matteo RS, et al:Phannacodynamics and pharmacokinetics of cisatracurium in geriatric surgical patients.Anesthesiology 84:520-525,1996.
[37]Sorooshian SS, Stafford MA, Eastwood NB,et al:Pharmacokinetics and phannacodynamics of cisatracurium in young and elderly adult patients.Anesthesiology 84:1083-1091,1991.
[38]Cooper AL, Leigh JM,Tring IC.Admission to the intensive care unti after complications of anaesthetic techniques over 10 years.Anaethesia,1989,44:953-958.
[39]Eriksson LI, Sato M, Severinghaus JW:Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response.Anesthsiology 78:693,1993.
[40]Jonsson M, Kim C, Yamamoto Y, et al:Atracurium and vecuronium block nicotine-induced carotid body responses.Acta Anaesthesiol Scand 94:117,2002.
[41]Silvennan DG, Brull SJ:Assessment of double-burst monitoring an 10mA above threshold current.Can J Anaesth 40:502,1993.
[42]Brull SJ, Ehrenwerth J, Connelly NR,et al:Assessment of residual curarization using low-current stimulation. Can J Anaesth 38:164,1991
[43]Helbo-Hansen HS,Bang U,Nielsen HK,Skovgaard LT.The accuracy of train-of-four monitoring at varying stimulating currents.Anesthesiology 1992;76:199-203.
[44]Brand JB,Cullen DJ,Wilson NE,et al:Spontaneous recovery from non-depolarizing neuromuscular blockade:Correlation between clinical and evoked responses.Anesth Analg 56:55,1977.
[45]Kopman AF,Yee PS,Neuman GG.Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers[J]. Anesthesiology,1997, 86(4):765-771.
[46]Viby-Mogensen J.Postoperative residual curarization and evidence based anaesthesia[J].Br J Anaesth,2000,84(3):3301-303.
[47]Bowman WC:Pharmacology of Neuromuscular Function,2nd ed.London,Wright,1990.
[48]孙建良,宗酉明,孙磊.利多卡因脊麻加新斯的明或/和吗啡对下肢手术后的镇痛效果.临床麻醉学杂志,2000,16(10)：530.
[49]李书桐,乔宝安.新斯的明用于全麻后拮抗剂量的临床观察.西北药学杂志.2005,20(4),174.
[50]Marine J E,Watanabe MA,Smith TW,et al.Effect of atropine on heart rate t urbulence [J]. Am J Cardiol,2002,89 (6):767-769.
[51]Mirakhur R K,Dundee J W,Jones C J,et al.Reversal of neuromuscular blockade:dose determination studies with atropine and glycopyrrloate given before or in a mixture with neostigmine.Anesth Analg,1981,60(8):557-562.
[52]薛富善,廖旭。围术期肌松药的合理运用//安钢,薛富善.现代麻醉学技术.北京：科学技术文献出版社,2001：155-164.
[53]朱凡,沈亮,傅维安.不同剂量新斯的明拮抗国产阿曲库铵肌松效应的观察.蚌埠医学院学报2004；29：34-35.
[54]Tramer MR,Fuchs-Buder T. Omitting antagonism of neuromuscular block:effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review[J], Br J Anaesth,1999,82(3):379-386.
[55]Lovstad RZ,Thagaard KS,Berner NS, et al.Neostigmine 50μg/kg with glycopyrrolate increases postoperative nausea in women after laparoscopic gynaecological surgery[J]. Acta Anaesthesiol Scand.2001,45(4):495-500.
[56]Magorian TT, Lynam DP,Caldwell JE,et al:Can early administration of neostigmine,in single or repeated doses,alter the course of neuromuscular recovery from a vecuronium-induce neuromuscular blockade? Anesthesiology 73:410-414,1990.
[57]Donati F, McCarrloo SM, Antzaka C,et al:Dose-response curves for edrophonium neostigmine,and pyridostigmine after pancuronium and d-tubocurarine.Anesthesiology 66:471-476,1987.
[58]Goldhill DR,Carter JA,Suresh D,et al.Antagonism of atracurium with neostigmine:Effect of dose no speed of recovery[J].Anaesthesia,1991,46(6):496-499.
[59]Kirkegaard H,Heier T,Caldwell JE:Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 96:45-50,2002.
[60]Beemer GH, Goonetilleke PH, Bjorksten AR:The maximum depth of an atracurium neuromuscular block antagonized by edrophonium to effect adequate recovery. Anesthesiology 1995,82:852-858.
[61]Savarese JJ:Reversal of nondepolarizing blocks:More controversial than ever?Review Course Lectures,67th Congress,Clevedland,Ohio,International Anesthesia Research Society, 1993.
[62]Eriksson LL:Evidence-based practice and neuromuscular monitoring:It is time for routine quantitative assessment.Anesthesiology 98:1037-1039,2003.
[63]Deboene B, Plaud B, Dilly MP,Donati F:Residual paralysis in the PACU after a single intubating dose fo nondeploarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042-1048,2003
[64]Reid JE, Breslin DS, Mirakhur RK,et al:Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth 48:351-355,2001.
[65]刘威,孙大金,陈锡明等.异氟醚对罗库溴铵肌松效应影响的实验研究.临床麻醉学杂志,2005,21(2)：120-121.
[66]Whalley GD, Ebrahim Z:Influence of carbamazepine on the dose-response relationship of vecuronium.Br J Anaesth 72:125-126,1994.
[67]Eriksson LI,Lennmarken C,Jensen E,et al:Twitch tension and train-of-four ratio during polonged neuromuscular monitoring at different peripheral temperatures.Acta Anaesthesiol Scand 35:247,1991
[1]Hayes AH,Mirakhur RK,Breslin DS,et al:postoperative residual block after intermediate-acting neuromuscular blocking drugs.Anaesthesia 56:312,2001
[2]Debaene B,Plaud B,Dilly M-P,et al:Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042,2003
[3]Eriksson LI.Evidence-based practice and neuromuscular monitoring.Anesthesiology, 2003,98(5):1037-1039
[4]Cooper AL,Leigh JM,Tring IC.Admission to the intensive care unti after complications of anaesthetic techniques over 10 years.Anaethesia,1989,44:953-958.
[5]Berg HJ,Viby-Mogensen J,Mortensen CR,et al.Residual neuromuscular block is a risk factor for postoperative pulmonary complications.Acta Anaesthesia Scand,1997,41(9): 1095-1103
[6]Kopman AF,Yee PS,Neuman G.Relationsh ip of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiol,2002,86: 765-771.
[7]Viby-Mogensen J.Postoperative residual curarization and evidence based anaesthesia[J]. Br J Anaesth,2000,84(3):3301-303
[8]Baillard C,Clech C,Catineau J,et al.Postoperative residual neuromuscular block:a survey of management.Br J Anaesth,2005,95(5):622-626
[9]郑晖,苏跃,李明远.围术期TOF监测与残余肌松-潘库溴铵与维库溴铵的比较.中华麻醉学杂志,2001,21(5)：261-264.
[10]Eikermann M,Groeben H,et al.Fade of Pulmonary Function During Residual Neuromuscluar Blockade.CHEST,2005,127(5):1703-1709.
[11]Samet A,Capron F,Alla F,et al.Single acceleromyographic train-of-four,100-Hertz tetanus or double-burst stimulation:which test performs better to detect residual paralysis?Anesthesiology,2005,102 (1):51-56
[12]Viby-Mogensen J:Postoperative residual curarization and evidence-based anaesthesia. Br J Anaesth 84:301,2005
[13]Capron F,Fortier LP,Racine S,et al.Tactile fade detection with hand or wrist stimulation using train-of-four,double-burst stimulation,50-hertz tetanus,100-hertz tetanus,and acceleromyography.Anesth Analg,2006.102(5):1578-1584.
[14]Capron F,Alla F,Hottier C,et al.Can acceleromyography detect low levels of residual paralysis?A probability approach to detect a mechanomyographic train-of-four ratio of 0.9.Anesthesiology,2004,100(5):1119-1124.
[15]Dahaba AA,von Klobucar F,Rehak PH,et al:The neuromuscular transmission module versus the relaxometer mechanomyograph for neuromuscular block monitoring.Anesth Analg 94:591,2002
[16]Hemmerling TM,Michaud G,Trager G,et al:Phonomyography and mechanomyography can be used interchangeably to measure neuromuscular block at the adductor pollicis muscle.Anesth Analg 98:377,2004
[17]Goodmurphy CW,Ovalle WK. Morphological study of two human facial muscles: orbicularis oculi and corrugator supercilii.Clin Anat,2006,12:1-11.
[18]Larsen PB,Gatke MR,Frdensberg BB,et al. Acceleromyography of the orbicularis oculi muscle Ⅱ: comparing the oculi and orbicularis adductor pollicis muscles. Acta Anaesthesiol Scand,2002,46:1131-1136.
[19]Nepveu ME, Donati F, Fortier LP.Train-of-four stimulation for adductor pollicis neuromuscular monitoring can be applied at the wrist or over the hand[J]. Anesth Analg, 2005,100(1):149-154.
[20]Kuwabara S,Bostock H,Ogawara K,et al.Excitablitity properties of human median axons measured at the motor point[J].Muscle Nerve,2004,29(2):227-233.
[21]Saitoh Y,Nakajima H,Hattori H, et al.Neuromuscular blockade canbe assessed accelerographically over the vastus medialis muscle in patients positioned prone.Can J Anaesth,2003,50:342-347
[22]Saitoh Y,Narumi Y, Fujii Y, et al.Electromyographic assessment of neuromuscular block at the gastrocnemius muscle. Br J Anaesth,2001.82:329-332.
[23]Heier T,Hetland S. A comparison of train-of-four monitoring:mechanomyography at the thumb vs aceeleromyography at the big toe. Acta Anaesthesiol Scand,1999,43: 550-555.
[24]Saitoh Y,Fujii Y,Takahashi K,et al.Recovery of post-tetanic count and train-of-four responses at the great toe and thumb. Anaesthesia,1998,53:244-248.
[25]Hemmerling TM,Schurr C,Walter S,et al.A new method fo monitoring the effect of muscle realxants on laryngeal muscles using surface laryngeal electromyography [J]. Anesth Analg,2000,90(2:)494-497.
[26]Hemmerling TM,Schmidt J, Hanusa C, et al.Simultaneous determination of neuro-muscular block at the larynx,diaphragm,adductor pollicis,orbicularis oculi and corrugator supercilii muscles[J].Br J Anaesth,2000,85(6):856-860.
[27]Hemmerling TM,Babin D,Donati F,et al.Phonomyography as a novel method to determine neuromuscular blockade at the laryngeal adductor muscles:comparison with the cuff pressure method[J].Anesthesiology,2003,98(2):359-363.
[28]Hemmerling TM,Michaud G,Trager G,et al.phonomyographic measurements of neuromuscular blockade are similar to mechanomyography fo hand muscles[J].Can J Anesth,2004,51(8):795-800
[29]Hemmerling TM, Schmidt J, Schurr C, et al. A comparison between anterior and posterior monitoring of neuromuscular blockade at the diaphragm:both sites can be used interchangeably[J]. Anesth Analg,2002,95(4):940-943.
[30]Pavlin EG,Holle RH,Schoene RB. Recovery of airway protection compared with ventilation in humans after paralysis wit curare. Anesthesiology,1999,70:381-385.
[31]Kirov K,Motamed C,Dhonneur G.Differential sensitivity of abdominal muscles and the diaphragm to mivaeurium:an electromyographic study.Anesthesiology,2001,95: 1323-1328.
[32]Goldhill DR,Carter JA,Suresh D,et al.Antagonism of atracurium with neostigmine:Effect of dose no speed of recovery[J].Anaesthesia,1991,46(6):496-499.
[33]Beattie WS,Buckley DN,Forrest JB:Continuous infusions of atracurium and vecuronium, compared with intermittent blouses of pancuronium:Dose requirements and reversal.Can J Anaesth 39:925-931,1992.
[34]Bevan JC, Collins L, Fowler C,et al:Early and late reversal of rocuronium and vecuroniumwith neostigmine in adults and children.Anesht Analg 89:333-339,1999.
[35]Kirkegaard H,Heier T,Caldwell JE:Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 96:45-50,2002.
[36]Beemer GH,Bjorksten AR,Dawson PJ,et al:Determinants of the reversal time of competitive neuromuscular blokc by anticholinesterases.Br J Anaesth 66:469-475,1991
[37]Beemer GH, Goonetilleke PH, Bjorksten AR:The maximusm depth of an atracurium neuromuscular block antagonized by edrophonium to effect adequate recovery. Anesthesiology 82:852-858,1995
[38]Savarese JJ:Reversal of nondepolarizing blocks:More controversial than ever?Review Course Lectures,67th Congress,Clevedland,Ohio,International Anesthesia Research Society, 1993.
[39]Deboene B, Plaud B,Dilly MP,Donati F:Residual paralysis in the PACU after a single intubating dose fo nondeploarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042-1048,2003
[40]Reid JE, Breslin DS,Mirakhur RK,et al:Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth 48:351-355,2001.
[41]刘威,孙大金,陈锡明等.异氟醚对罗库溴铵肌松效应影响的实验研究.临床麻醉学杂志,2005,21(2)：120-121.
[42]Morita T, Tsukagoshi H,Sugaya T,et al:Inadequate antatonism of vecuronium-induced neuromuscular block by neostigmine during sevoflurae or isoflurane anesthesia.Anesth Analg 80:1175-1180,1995.
[43]Kumar N,Mirakhur RK,Symington MJ,et al:Potency and time course of action of rocuronium during desflurane and isoflurane anaesthesia.Br J Anaesth 77:488-491,1996
[44]Lowry DW, Mirakhur RK, McCarth GJ,et al:Neuromuscular effects of rocuronium during sevoflurane,isoflrane,and intravenous anesthesia.Anesth Analg 87:936-940,1998.
[45]Whalley GD,Ebrahim Z:Influence of carbamazepine on the dose-response relationship of vecuronium.Br J Anaesth 72:125-126,1994.
[46]Eriksson LI, Lennmarken C,Jensen E,et al:Twitch tension and train-of-four ratio during polonged neuromuscular monitoring at different peripheral temperatures.Acta Anaesthesiol Scand 35:247,1991.
[47]Al Ahdal O, Bevan DR:Clindamycin-induced neuromuscular blockade.Can J Anaesth 42: 614-617,1995.
[48]Martinez EA,Mealey KL,Wooldridge AA,et al:Pharmacokinetics,effects on renal function, and potentiation of atracurium-induced neuromusculal blockade after administration of a high dose of gentamicin in isoflurane anesthetized dogs.Am J Vet Res 57:1623-1626,1996.
[49]Gijsenberg F, Ramael S,Bruyn SD,et al.Preliminary assessment of Org5969 as revers-alagents for rocuronium in healthy male volunteers.Anaesthesilogy.2002,96:A1008
[50]Adam JM,Bennett DJ,Bom A,et al:Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocker rocuronium bromide:synthesis and structure-activity relationships.J Med Chem 45:1806-1816,2002
[51]Sorgenfrei IF, Norrild K, Larsen PB,et al.Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex:A dose-finding and safety study. Anaesthesilogy,2006,104:667-674.
[2]Sundman E, Witt H, Olsson R, Ekberg O, et al:The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans.Pharyngeal videooradiography and simultaneous manometry after atracurium. Anesthesiology 2000; 92:977-998.
[3]Eikermann M, Groeben H, et al:Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade.Anesthesiology 2003;98:1333-7.
[4]Beecher HK, Todd DP. A study of the deaths associate with anesthesia and surgery:based on a study of 599,548 anesthesias in ten institutions 1948-1952,inclusive.Ann Surg 1954:140:2-35.
[5]Epemolu O, Bom A,Hope F,Mason R.Reversal of neuromuscular blockade and simul-taneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agen Org25969. Anesthesiology 2003;99:632-7.
[6]Belmont MR,Horochiwsky Z,Eliazo RF,Savarese JJ.Reversal of AV430A with cysteine in rhesus monkeys. Anesthesiology 2004:A-1180.
[7]Adams WA,Mark Senior J,Jones RS,et al.Cisatracurium in dogs with and without porto-systemic shunts [J].Vet Anaesth Analg,2006,33(1):17-23.
[8]Bryson HM,Faulds D,Cisatracurium besilate.Areview of its pharmacology and clinical potential in anaesthetic practice[J].Drugs,1997,53(5):848-866.
[9]Imbeatult K, Withington DE, Varin F, Pharmacokinetics and pharmacodynamics of a 0.1mg/kg dose of cisatracurium besylate in children during N2O/O2/propofol anesthesia [J].Anesth Analg,2006,102(3):738-743.
[10]Ahuja TS,Freeman D,Mahnken JD,et al.Predictor of the development of hyperkalemia in patients using angiotensin converting enzyme inhibitors[J].Am J Nephrol,2005,20:268-272.
[11]Kisor DF,Schmith VD,Wargin WA,et al:Importance of the organ-independent elimination of cisatracurium. Anesth Analg 83:1065-1071,2001.
[12]Lien CA,Schmith VD,Belmont MR,et al:Phannacokinetics of cisatracurium in patients receiving nitrous oxide/opioid/barbiturate anesthesia.Anesthesiology 84:300-308,1996.
[13]Welch RM,Brown A,Ravitch J,et al:the in vitro degradation of cisatracurium,the R, cis-R'-isomer of atracurium,in human and rat plasma.Clin Pharmacol Ther 58:132-142,1995.
[14]闻大翔,蒋茹,杭燕南等.顺式阿曲库铵、维库溴铵在老年患者中的药效学研究[J].中华老年医学杂志,2004,5(23)：313-315.
[15]谭丹,桂智勇,杨天德.顺武阿曲库铵的临床应用研究[J].中国医药指南,2008,5(6)：27-28.
[16]Kisor DF, Schmith VD, Wargin WA,et al:Importance of the organ-independent elimination of cisatracurium.Anesth Analg 83:1065-1071,1996.
[17]De Wolf M,Freeman JA,Scott VL,et al:Phannacokinetics and pharmacodynamics of cisatracurium in patients with end-stage liver disease undergoing liver transplantation.Br J Anaesth 76:624-628,1996.
[18]莫利求,黄文起,谭洁芳。等.新的中效肌松药顺武阿曲库铵[J]国外医学(麻醉学与复苏分册),2000.21(3)：170-172.
[19]Lien CA, Belmont MR, Abalos A,et al.The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia[J]. Anesthesiology,1995,82(5):1131-1138.
[20]闻大翔,陈锡萌,杭燕南等.国人顺式阿曲库铵的剂量反应测定[J].中华麻醉学杂志,1999,19(7)：395-3.
[21]谢柯祺,兰志勋.顺式阿曲库铵在麻醉诱导期的应用[J].实用医院临床杂志,2001,7(3)：17-20.
[22]Belment MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology,1995, 82:1139-1145.
[23]Amin AM,Mohammad MY,Ibrahim MF.Comparative study of neuromuscular blocking and hemodynamic effects of rocuronium and cisatracurium under sevoflurane or total intravenous anesthesia[J].Middle East J Anaesthesiol,2009,20(1):39-51.
[24]Lin SP, Changq KY, Chen YJ,et al.Priming with rocuronium to accelerate the onset time of cisatracurium during intubation[J].Chin Med Assoc,2009,72(1):15-19.
[25]Moro ET, Nakamura G, Martino RS, et al.Effect of propofol in combination with ephedrine upon the onset time of cisatracurium [J]. Rev Assoc Med Bras,2007,53(3):272-275.
[26]Wastila WB,Maehr RB,Turner GL,et al:Comparative pharmacology of cisatracurium (51W89),atracurium,and five isomers in cats.Anesthesiology 85:169-177,1996.
[27]Doenicke A,Soukup J,Hoernecke R,et al.The lack of histamine release with cisatracurium:a double-blind comparison with vecuronium[J].Anesth Analg,1997;84(3):623-628.
[28]闻大翔,陈锡萌,杭燕南等.顺式阿曲库按的组胺释放作用及其对血液动力学的影响[J].中华麻醉学杂志,2001；21(2)：69-72.
[29]熊章荣,唐延先.多瑞吉联合罗呢卡因用于腹腔镜胆囊切除术后镇痛的临床研究[J]第三军医大学学报,2007；29(1)：634-645.
[30]Lirk P,Longato S,Rieder J,et al.Cisatracurium,but nont mivacurium,inhibits survival and axonal growth of neonatal and adult rat peripheral neurons in vitro[J].Neurosci Lett,2004,22,365(2):153-155.
[31]Rider J, Lirk P,Bodroqi F,et al.Cisatracurium,but not mivacurium,induces apoptosis in human umbilical vein endothelial cells in vitro[J].Eur J Anaeshtesiol,2005,22(1):16-19.
[32]SahniM, LowenthalDT, Mealeman. A clinica,l physiclogu and pharmacology evaluation of orthostatic hypotension in the elderly [J]. International urology & nephrology,2005,37 (3):669-674.
[33]Rooke G:Autonomic and cardiovascular function in the geriatric patient.Anesthesiol Clin North Am 18:31-46,2000.
[34]Priebe H:The aged cardiovascular risk patient.Br J Anaesth 85:763-778,2000
[35]Matteo RS, Backus WW, McDaniel DD, et al:Pharmacokinetics and pharmacodynamics of d-tubocurarine and metocurine in the elderly.Anesth Analg 64:23-29,2000.
[36]Ornstein E, Lien CA, Matteo RS, et al:Phannacodynamics and pharmacokinetics of cisatracurium in geriatric surgical patients.Anesthesiology 84:520-525,1996.
[37]Sorooshian SS, Stafford MA, Eastwood NB,et al:Pharmacokinetics and phannacodynamics of cisatracurium in young and elderly adult patients.Anesthesiology 84:1083-1091,1991.
[38]Cooper AL, Leigh JM,Tring IC.Admission to the intensive care unti after complications of anaesthetic techniques over 10 years.Anaethesia,1989,44:953-958.
[39]Eriksson LI, Sato M, Severinghaus JW:Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response.Anesthsiology 78:693,1993.
[40]Jonsson M, Kim C, Yamamoto Y, et al:Atracurium and vecuronium block nicotine-induced carotid body responses.Acta Anaesthesiol Scand 94:117,2002.
[41]Silvennan DG, Brull SJ:Assessment of double-burst monitoring an 10mA above threshold current.Can J Anaesth 40:502,1993.
[42]Brull SJ, Ehrenwerth J, Connelly NR,et al:Assessment of residual curarization using low-current stimulation. Can J Anaesth 38:164,1991
[43]Helbo-Hansen HS,Bang U,Nielsen HK,Skovgaard LT.The accuracy of train-of-four monitoring at varying stimulating currents.Anesthesiology 1992;76:199-203.
[44]Brand JB,Cullen DJ,Wilson NE,et al:Spontaneous recovery from non-depolarizing neuromuscular blockade:Correlation between clinical and evoked responses.Anesth Analg 56:55,1977.
[45]Kopman AF,Yee PS,Neuman GG.Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers[J]. Anesthesiology,1997, 86(4):765-771.
[46]Viby-Mogensen J.Postoperative residual curarization and evidence based anaesthesia[J].Br J Anaesth,2000,84(3):3301-303.
[47]Bowman WC:Pharmacology of Neuromuscular Function,2nd ed.London,Wright,1990.
[48]孙建良,宗酉明,孙磊.利多卡因脊麻加新斯的明或/和吗啡对下肢手术后的镇痛效果.临床麻醉学杂志,2000,16(10)：530.
[49]李书桐,乔宝安.新斯的明用于全麻后拮抗剂量的临床观察.西北药学杂志.2005,20(4),174.
[50]Marine J E,Watanabe MA,Smith TW,et al.Effect of atropine on heart rate t urbulence [J]. Am J Cardiol,2002,89 (6):767-769.
[51]Mirakhur R K,Dundee J W,Jones C J,et al.Reversal of neuromuscular blockade:dose determination studies with atropine and glycopyrrloate given before or in a mixture with neostigmine.Anesth Analg,1981,60(8):557-562.
[52]薛富善,廖旭。围术期肌松药的合理运用//安钢,薛富善.现代麻醉学技术.北京：科学技术文献出版社,2001：155-164.
[53]朱凡,沈亮,傅维安.不同剂量新斯的明拮抗国产阿曲库铵肌松效应的观察.蚌埠医学院学报2004；29：34-35.
[54]Tramer MR,Fuchs-Buder T. Omitting antagonism of neuromuscular block:effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review[J], Br J Anaesth,1999,82(3):379-386.
[55]Lovstad RZ,Thagaard KS,Berner NS, et al.Neostigmine 50μg/kg with glycopyrrolate increases postoperative nausea in women after laparoscopic gynaecological surgery[J]. Acta Anaesthesiol Scand.2001,45(4):495-500.
[56]Magorian TT, Lynam DP,Caldwell JE,et al:Can early administration of neostigmine,in single or repeated doses,alter the course of neuromuscular recovery from a vecuronium-induce neuromuscular blockade? Anesthesiology 73:410-414,1990.
[57]Donati F, McCarrloo SM, Antzaka C,et al:Dose-response curves for edrophonium neostigmine,and pyridostigmine after pancuronium and d-tubocurarine.Anesthesiology 66:471-476,1987.
[58]Goldhill DR,Carter JA,Suresh D,et al.Antagonism of atracurium with neostigmine:Effect of dose no speed of recovery[J].Anaesthesia,1991,46(6):496-499.
[59]Kirkegaard H,Heier T,Caldwell JE:Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 96:45-50,2002.
[60]Beemer GH, Goonetilleke PH, Bjorksten AR:The maximum depth of an atracurium neuromuscular block antagonized by edrophonium to effect adequate recovery. Anesthesiology 1995,82:852-858.
[61]Savarese JJ:Reversal of nondepolarizing blocks:More controversial than ever?Review Course Lectures,67th Congress,Clevedland,Ohio,International Anesthesia Research Society, 1993.
[62]Eriksson LL:Evidence-based practice and neuromuscular monitoring:It is time for routine quantitative assessment.Anesthesiology 98:1037-1039,2003.
[63]Deboene B, Plaud B, Dilly MP,Donati F:Residual paralysis in the PACU after a single intubating dose fo nondeploarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042-1048,2003
[64]Reid JE, Breslin DS, Mirakhur RK,et al:Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth 48:351-355,2001.
[65]刘威,孙大金,陈锡明等.异氟醚对罗库溴铵肌松效应影响的实验研究.临床麻醉学杂志,2005,21(2)：120-121.
[66]Whalley GD, Ebrahim Z:Influence of carbamazepine on the dose-response relationship of vecuronium.Br J Anaesth 72:125-126,1994.
[67]Eriksson LI,Lennmarken C,Jensen E,et al:Twitch tension and train-of-four ratio during polonged neuromuscular monitoring at different peripheral temperatures.Acta Anaesthesiol Scand 35:247,1991
[1]Hayes AH,Mirakhur RK,Breslin DS,et al:postoperative residual block after intermediate-acting neuromuscular blocking drugs.Anaesthesia 56:312,2001
[2]Debaene B,Plaud B,Dilly M-P,et al:Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042,2003
[3]Eriksson LI.Evidence-based practice and neuromuscular monitoring.Anesthesiology, 2003,98(5):1037-1039
[4]Cooper AL,Leigh JM,Tring IC.Admission to the intensive care unti after complications of anaesthetic techniques over 10 years.Anaethesia,1989,44:953-958.
[5]Berg HJ,Viby-Mogensen J,Mortensen CR,et al.Residual neuromuscular block is a risk factor for postoperative pulmonary complications.Acta Anaesthesia Scand,1997,41(9): 1095-1103
[6]Kopman AF,Yee PS,Neuman G.Relationsh ip of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiol,2002,86: 765-771.
[7]Viby-Mogensen J.Postoperative residual curarization and evidence based anaesthesia[J]. Br J Anaesth,2000,84(3):3301-303
[8]Baillard C,Clech C,Catineau J,et al.Postoperative residual neuromuscular block:a survey of management.Br J Anaesth,2005,95(5):622-626
[9]郑晖,苏跃,李明远.围术期TOF监测与残余肌松-潘库溴铵与维库溴铵的比较.中华麻醉学杂志,2001,21(5)：261-264.
[10]Eikermann M,Groeben H,et al.Fade of Pulmonary Function During Residual Neuromuscluar Blockade.CHEST,2005,127(5):1703-1709.
[11]Samet A,Capron F,Alla F,et al.Single acceleromyographic train-of-four,100-Hertz tetanus or double-burst stimulation:which test performs better to detect residual paralysis?Anesthesiology,2005,102 (1):51-56
[12]Viby-Mogensen J:Postoperative residual curarization and evidence-based anaesthesia. Br J Anaesth 84:301,2005
[13]Capron F,Fortier LP,Racine S,et al.Tactile fade detection with hand or wrist stimulation using train-of-four,double-burst stimulation,50-hertz tetanus,100-hertz tetanus,and acceleromyography.Anesth Analg,2006.102(5):1578-1584.
[14]Capron F,Alla F,Hottier C,et al.Can acceleromyography detect low levels of residual paralysis?A probability approach to detect a mechanomyographic train-of-four ratio of 0.9.Anesthesiology,2004,100(5):1119-1124.
[15]Dahaba AA,von Klobucar F,Rehak PH,et al:The neuromuscular transmission module versus the relaxometer mechanomyograph for neuromuscular block monitoring.Anesth Analg 94:591,2002
[16]Hemmerling TM,Michaud G,Trager G,et al:Phonomyography and mechanomyography can be used interchangeably to measure neuromuscular block at the adductor pollicis muscle.Anesth Analg 98:377,2004
[17]Goodmurphy CW,Ovalle WK. Morphological study of two human facial muscles: orbicularis oculi and corrugator supercilii.Clin Anat,2006,12:1-11.
[18]Larsen PB,Gatke MR,Frdensberg BB,et al. Acceleromyography of the orbicularis oculi muscle Ⅱ: comparing the oculi and orbicularis adductor pollicis muscles. Acta Anaesthesiol Scand,2002,46:1131-1136.
[19]Nepveu ME, Donati F, Fortier LP.Train-of-four stimulation for adductor pollicis neuromuscular monitoring can be applied at the wrist or over the hand[J]. Anesth Analg, 2005,100(1):149-154.
[20]Kuwabara S,Bostock H,Ogawara K,et al.Excitablitity properties of human median axons measured at the motor point[J].Muscle Nerve,2004,29(2):227-233.
[21]Saitoh Y,Nakajima H,Hattori H, et al.Neuromuscular blockade canbe assessed accelerographically over the vastus medialis muscle in patients positioned prone.Can J Anaesth,2003,50:342-347
[22]Saitoh Y,Narumi Y, Fujii Y, et al.Electromyographic assessment of neuromuscular block at the gastrocnemius muscle. Br J Anaesth,2001.82:329-332.
[23]Heier T,Hetland S. A comparison of train-of-four monitoring:mechanomyography at the thumb vs aceeleromyography at the big toe. Acta Anaesthesiol Scand,1999,43: 550-555.
[24]Saitoh Y,Fujii Y,Takahashi K,et al.Recovery of post-tetanic count and train-of-four responses at the great toe and thumb. Anaesthesia,1998,53:244-248.
[25]Hemmerling TM,Schurr C,Walter S,et al.A new method fo monitoring the effect of muscle realxants on laryngeal muscles using surface laryngeal electromyography [J]. Anesth Analg,2000,90(2:)494-497.
[26]Hemmerling TM,Schmidt J, Hanusa C, et al.Simultaneous determination of neuro-muscular block at the larynx,diaphragm,adductor pollicis,orbicularis oculi and corrugator supercilii muscles[J].Br J Anaesth,2000,85(6):856-860.
[27]Hemmerling TM,Babin D,Donati F,et al.Phonomyography as a novel method to determine neuromuscular blockade at the laryngeal adductor muscles:comparison with the cuff pressure method[J].Anesthesiology,2003,98(2):359-363.
[28]Hemmerling TM,Michaud G,Trager G,et al.phonomyographic measurements of neuromuscular blockade are similar to mechanomyography fo hand muscles[J].Can J Anesth,2004,51(8):795-800
[29]Hemmerling TM, Schmidt J, Schurr C, et al. A comparison between anterior and posterior monitoring of neuromuscular blockade at the diaphragm:both sites can be used interchangeably[J]. Anesth Analg,2002,95(4):940-943.
[30]Pavlin EG,Holle RH,Schoene RB. Recovery of airway protection compared with ventilation in humans after paralysis wit curare. Anesthesiology,1999,70:381-385.
[31]Kirov K,Motamed C,Dhonneur G.Differential sensitivity of abdominal muscles and the diaphragm to mivaeurium:an electromyographic study.Anesthesiology,2001,95: 1323-1328.
[32]Goldhill DR,Carter JA,Suresh D,et al.Antagonism of atracurium with neostigmine:Effect of dose no speed of recovery[J].Anaesthesia,1991,46(6):496-499.
[33]Beattie WS,Buckley DN,Forrest JB:Continuous infusions of atracurium and vecuronium, compared with intermittent blouses of pancuronium:Dose requirements and reversal.Can J Anaesth 39:925-931,1992.
[34]Bevan JC, Collins L, Fowler C,et al:Early and late reversal of rocuronium and vecuroniumwith neostigmine in adults and children.Anesht Analg 89:333-339,1999.
[35]Kirkegaard H,Heier T,Caldwell JE:Efficacy of tactile-guided reversal from cisatracurium-induced neuromuscular block. Anesthesiology 96:45-50,2002.
[36]Beemer GH,Bjorksten AR,Dawson PJ,et al:Determinants of the reversal time of competitive neuromuscular blokc by anticholinesterases.Br J Anaesth 66:469-475,1991
[37]Beemer GH, Goonetilleke PH, Bjorksten AR:The maximusm depth of an atracurium neuromuscular block antagonized by edrophonium to effect adequate recovery. Anesthesiology 82:852-858,1995
[38]Savarese JJ:Reversal of nondepolarizing blocks:More controversial than ever?Review Course Lectures,67th Congress,Clevedland,Ohio,International Anesthesia Research Society, 1993.
[39]Deboene B, Plaud B,Dilly MP,Donati F:Residual paralysis in the PACU after a single intubating dose fo nondeploarizing muscle relaxant with an intermediate duration of action. Anesthesiology 98:1042-1048,2003
[40]Reid JE, Breslin DS,Mirakhur RK,et al:Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth 48:351-355,2001.
[41]刘威,孙大金,陈锡明等.异氟醚对罗库溴铵肌松效应影响的实验研究.临床麻醉学杂志,2005,21(2)：120-121.
[42]Morita T, Tsukagoshi H,Sugaya T,et al:Inadequate antatonism of vecuronium-induced neuromuscular block by neostigmine during sevoflurae or isoflurane anesthesia.Anesth Analg 80:1175-1180,1995.
[43]Kumar N,Mirakhur RK,Symington MJ,et al:Potency and time course of action of rocuronium during desflurane and isoflurane anaesthesia.Br J Anaesth 77:488-491,1996
[44]Lowry DW, Mirakhur RK, McCarth GJ,et al:Neuromuscular effects of rocuronium during sevoflurane,isoflrane,and intravenous anesthesia.Anesth Analg 87:936-940,1998.
[45]Whalley GD,Ebrahim Z:Influence of carbamazepine on the dose-response relationship of vecuronium.Br J Anaesth 72:125-126,1994.
[46]Eriksson LI, Lennmarken C,Jensen E,et al:Twitch tension and train-of-four ratio during polonged neuromuscular monitoring at different peripheral temperatures.Acta Anaesthesiol Scand 35:247,1991.
[47]Al Ahdal O, Bevan DR:Clindamycin-induced neuromuscular blockade.Can J Anaesth 42: 614-617,1995.
[48]Martinez EA,Mealey KL,Wooldridge AA,et al:Pharmacokinetics,effects on renal function, and potentiation of atracurium-induced neuromusculal blockade after administration of a high dose of gentamicin in isoflurane anesthetized dogs.Am J Vet Res 57:1623-1626,1996.
[49]Gijsenberg F, Ramael S,Bruyn SD,et al.Preliminary assessment of Org5969 as revers-alagents for rocuronium in healthy male volunteers.Anaesthesilogy.2002,96:A1008
[50]Adam JM,Bennett DJ,Bom A,et al:Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocker rocuronium bromide:synthesis and structure-activity relationships.J Med Chem 45:1806-1816,2002
[51]Sorgenfrei IF, Norrild K, Larsen PB,et al.Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex:A dose-finding and safety study. Anaesthesilogy,2006,104:667-674.