顺式阿曲库铵肌松效应的临床观察
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摘要
目的观察顺式阿曲库铵的肌松效应。
方法选择ASAⅠ～Ⅱ级择期腹部手术病人60例,随机分为顺式阿曲库铵A组(2min)、顺式阿曲库铵B组(3min)和顺式阿曲库铵C组(4min),每组各20例。麻醉诱导依次静脉注射咪达唑仑0.05mg·kg~(-1)、枸橼酸芬太尼2μg·kg~(-1)和依托咪酯0.3mg·kg~(-1),待患者意识消失后注入肌松药顺式阿曲库铵0.15mg·kg~(-1)(注药时间为5～10秒)。三组在分别给予肌松药后2min、3min和4min时行经口气管内插管。观察放置喉镜的难易程度及各时点能否顺利进行气管插管,记录诱导前(T_1)、诱导后(T_2)、气管插管后1min(T_3)、插管后3min(T_4)、插管后5min(T_5)、插管后10min(T_6)、插管后15min(T_7)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR),以及术中不良反应的发生情况。
结果①与A组相比,B组和C组的插管条件优秀率较高(P＜0.05);B组与C组比较无显著性差异(P＞0.05);②三组患者在不同时段自身比较,在T_3(气管插管后1min)时刻SBP、DBP、MAP和HR与麻醉前比较差异有显著性(P＜0.05),其余时刻各值比较差异无显著性;三组组间比较差异无显著性(P＞0.05);③全麻诱导期间不良反应的发生率A组、B组和C组比较差异无显著性(P＞0.05)。
结论在平衡麻醉时静注顺式阿曲库铵0.15mg·kg~(-1)(3×ED_(95))在3min时就可达到良好的插管条件,与同等强度剂量的阿曲库铵相比,前者起效较慢,为中时效非去极化肌松药。无组胺释放,无心血管不良反应,血流动力学稳定。
Objective To observe the neuromuscular blockade effects and side effects of cisatracurium on rapid endotracheal intubation.
Methods Sixty patients were randomized to three groups(n=20):A group(cisatracurium, 2min),B group(cisatracurium,3min),C group(cisatracurium,4min).All patients were anesthetized with intravenously injection of midazolam(0.05mg·kg~(-1)),fentanyl(2μg·kg~(-1))、etomidate(0.3mg·kg~(-1)) and cisatracurium(0.15mg·kg~(-1)).Then the haemodynamical changes before and 1～15min after administration of the relaxant were recorded,the neuromuscular blockade and side effects of groups were also observed.
Results The intubation situationof B、C groups was better than A group.The B,C groups had no significant differences(P＞0.05).The haemodynamical changes had no significant differences(P＞0.05).But the Bp and HR after lmin of intubation were higher than ante-intubation within group.The side effects had no significant differences in 3 groups (P＞0.05).
Conclusion The intubation situation can achieve best at 3min after administration of the cisatracurium(0.15mg·kg~(-1)).Cisatracurium does not affect plasma histamine concentration and haemodynamics.It can be safely used in the rapid endotracheal intubation of general anesthesia with satisfactory neuromuscular blocking effects.
方法选择ASAⅠ～Ⅱ级择期腹部手术病人60例,随机分为顺式阿曲库铵A组(2min)、顺式阿曲库铵B组(3min)和顺式阿曲库铵C组(4min),每组各20例。麻醉诱导依次静脉注射咪达唑仑0.05mg·kg~(-1)、枸橼酸芬太尼2μg·kg~(-1)和依托咪酯0.3mg·kg~(-1),待患者意识消失后注入肌松药顺式阿曲库铵0.15mg·kg~(-1)(注药时间为5～10秒)。三组在分别给予肌松药后2min、3min和4min时行经口气管内插管。观察放置喉镜的难易程度及各时点能否顺利进行气管插管,记录诱导前(T_1)、诱导后(T_2)、气管插管后1min(T_3)、插管后3min(T_4)、插管后5min(T_5)、插管后10min(T_6)、插管后15min(T_7)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR),以及术中不良反应的发生情况。
结果①与A组相比,B组和C组的插管条件优秀率较高(P＜0.05);B组与C组比较无显著性差异(P＞0.05);②三组患者在不同时段自身比较,在T_3(气管插管后1min)时刻SBP、DBP、MAP和HR与麻醉前比较差异有显著性(P＜0.05),其余时刻各值比较差异无显著性;三组组间比较差异无显著性(P＞0.05);③全麻诱导期间不良反应的发生率A组、B组和C组比较差异无显著性(P＞0.05)。
结论在平衡麻醉时静注顺式阿曲库铵0.15mg·kg~(-1)(3×ED_(95))在3min时就可达到良好的插管条件,与同等强度剂量的阿曲库铵相比,前者起效较慢,为中时效非去极化肌松药。无组胺释放,无心血管不良反应,血流动力学稳定。
Objective To observe the neuromuscular blockade effects and side effects of cisatracurium on rapid endotracheal intubation.
Methods Sixty patients were randomized to three groups(n=20):A group(cisatracurium, 2min),B group(cisatracurium,3min),C group(cisatracurium,4min).All patients were anesthetized with intravenously injection of midazolam(0.05mg·kg~(-1)),fentanyl(2μg·kg~(-1))、etomidate(0.3mg·kg~(-1)) and cisatracurium(0.15mg·kg~(-1)).Then the haemodynamical changes before and 1～15min after administration of the relaxant were recorded,the neuromuscular blockade and side effects of groups were also observed.
Results The intubation situationof B、C groups was better than A group.The B,C groups had no significant differences(P＞0.05).The haemodynamical changes had no significant differences(P＞0.05).But the Bp and HR after lmin of intubation were higher than ante-intubation within group.The side effects had no significant differences in 3 groups (P＞0.05).
Conclusion The intubation situation can achieve best at 3min after administration of the cisatracurium(0.15mg·kg~(-1)).Cisatracurium does not affect plasma histamine concentration and haemodynamics.It can be safely used in the rapid endotracheal intubation of general anesthesia with satisfactory neuromuscular blocking effects.
引文
[1]莫利求,黄文起,谭洁芳.新的中效肌松药顺式阿曲库铵.国外医学麻醉学与复苏分册,2000,(3):534
[2]刘威,闻大翔,杭燕南,孙大会.四种中时效非去极化肌松药组铵释放作用的研究.上海第二医科大学学报,2003,(5):912-914
[3]Lien CA,Belmont MR,Abalos A,et al.Dose-response relation-ships of 51W89 with nitrous oxide/opiod/barbiturate anesthesia.Anesthesiology,1998,79:948
[4]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1993,79:945-946
[5]Stevens JB,Walker SC,Fontenot JP.The clinical neuromuscular pharmacology of cisatracurium versus vecuronium during out-patient anesthesia.Anesth Analg,1997,85(6):1278-1283
[6]闻大翔,陈锡明,杭燕南,孙大金.国人顺式阿曲库铵的剂量反应测定.中华麻醉学杂志,1999,(7):2431-2432
[7]Boyd AH,Eastwood NB,Parker CJ,et al.Pharmacodynamics of the 1R cis-l′ R cisisomer of atracrium(51W89) in health and chronic renal failure.Br J Anaesth,1995,74:400-404
[8]Blusdtein LS,Bevan DR,Berrill A,et al.Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient.Anaesthesiology,1993,95:314-323
[9]Littlejohn IH,Abhay K,EI Sayed PJ.Intubating conditions following cisatracurium (51W89).Anaeshtesia,2001,50:499-502
[10]LittlejohnIH,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline,and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[11]Blusdtein LS,Bevan DR,Berrill A,et al.Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient.Anaesthesiology,1993,95:314-323
[12]Wastilia WB,Broek L,Proost JH,et al.Time course of action and endotracheal intubating conditiongs of Org 9487,a new short-acting steroidal muscle relaxnt,a comparison with cuccinylcholine.Anesth Analg,1993,79:579
[13]Belmont MR,Bikhazi G,Quassy S,et al.The clinic neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia.Anesthesiology,1995,82:1139-1145
[14]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1994,81:A9455
[15]Lien CA,Belmont MR,Abalos A,et al.The cardiovascular effects and histamine releasing properties of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1133-1138
[16]Merotoja OA,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[17]Belmint MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1139-1145
[18]Lepage JY,Melinovsky JM,Melinge M,et al.51W89:Dose-response,neuromuscular blocking profile and cardio vascular effects.Anesthesiology,1993,79:A943
[19]Lepage JY,Savarese JJ,Basta SJ,et al.Atracurium:clinical strategies for preventing histamine release and attenuating the haemodynamic response.Br J Anaeth,1994,81:A1090.
[20]Blusdtein LS,Meakin GH,Meretoja OA,et al.The safety and efficacy of cisatracurium 0.15mg/kg during nitrous oxide-opioid anaesthesia in infants and children.Anaesthesia,2001,79:A920
[21]冯艳华,李国华,刘环秋,麻海春.非去极化肌松药罗库溴铵、维库溴铵和阿曲库铵在全麻诱导气管插管时期安全性的比较.吉林大学学报(医学版),2006,(7)
[22]刘威,闻大翔,杭燕南,孙大金.四种中时效非去极化肌松药组胺释放作用的研究[J].上海第二医科大学学报,2003,(05):431-432.
[23]Krombach J,Hunzelmann N,Koster F,et al.Anaphylactoid-tions after cisatracurium administration in six patients.Anesth Analg,2001,93(5):1257-1259
[24]Legros CB,Orliaguet GA,Mayer MN.Severe anaphylactic reaction to cisatracurium in child.Anesth Analg,2001,92(3):648-649
[25]刘伟,邝贤宣,苏跃.两种剂型依托咪酯在全麻诱导期不良反应的对比观察.北京医学,2002,1:187
[1] Chappie KJ,Mirakhur RK,Clarke RS,et al. Comparison of intubatin conditions after administration of Org 9246(rocuronium) and suxam ethonium. Br J Anaesth,1992,69(3):269-273
[2] Boyd AH,Eastwood NB,Parker C2,et al. Pharmao-dynamics of the 1R cis-l}R cisisomer of stracrium(51W89) in health and chronicrenal failure.Br J Anaeath, 1995,74:400-404
[3] Kron SS . Severe bronchospasm and desaturation in a child associated with rapacuronium. Anesthesiology,2001,94 (5):923
[4] Mills KG,Wright PM,Pollard BJ,et al . Antagonismof rapacuroniumus-ing edrophoniumor neostigmine: pharmacodynamics and pharmacokinetics. Br J Anaesth, 1999,83 (5):727-733
[5] Kopman AF,Klewicka MM,Ghori K,et al . Dose-response and onset/off-set characteristics of rapacuronium. Anesthesiology,2000,93(4):1017-1021
[6] Nishan G,Goudsouzian NG. Rapacuronium and bronchospasm. Anesthesiology,2001, 94 (5):727
[7] Stuth EA,Stuck,Setlock MA,et al. Another possible mechnism for bron-chospasm after rapacuronium. Anesthesiology,2002,96(6): 1528-1529
[8] Welch RM,Rajchert DM,et al . Rapacuronium and risk of bronchpspasm in pediatric. Anesthesiology,1994,81:1082-1083
[9] Lien CA,Belmont MR,Abalos A,et al. Dose-response relation-ships of 51W89 with nitrous oxide/opiod/barbiturate anesthesia. Anesthesiology,1998,54:982-983
[10] Fahey MR,Rose M. Rocuronium:high rish for anaphylaxis. Br J Anaesth,2001,86(5): 678-682
[11] Eastwood NB,Bardoczky Gl,et al. Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia, 1995,75:431
[12] Smith CE,Savarese JJ,Bsata SJ,et al. Atracurium: clinical strategies for preventing histamine release and attenuating the haemodynamic response. Br J Anaesth,1995,75:550-553
[13] Lien CA,Belmont MR,Abalos A,et al . The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opiod/barbiturate anesthesia. Anesthesiology,1995,82:1131-1138
[14] Omstein K,Johnson JO,Sprague K, et al. Effects of Rapacuronium on respiratory function during general anesthesia:a comparison with cisatracuriu. Anesthesiology,1994, 81(4): 1092-1093
[15] Pillips L,Chetty MS,Wilson A,et al. Intubation conditions and time course of action of low-dose recuronium bromide in day case dental surgery. Eur J Anesth,1995,12(11):81-83
[16]龙跃,李准民,易礼清等,综述.新型肌松药—瑞库溴铵、罗库溴铵和顺式阿曲库铵的研究进展.河南医学研究,2006,15(3):267-271
[17]Body AH,Easlwood NB,Parker CJR,et al.Pharmacodynamics of the cis(51W89)in health and renal failure.Br J Anaesth,1996,76:38-39
[18]Dewolfj,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[19]Meretoja OA,Taivainen T,Wirtavuori K.Pharmacodynamic effects of 51W89,an isomer of atracurium,in children during halothane anaesthesia.Br J Anaesth,1995,74:431-432
[20]Belmint MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1139-1145
[21]Line CA,Belmont MR,Abalos A,et al.The cardiovascular effects and histamine releasing properties of 51W89 in patients receiving nitrous oxide/opioid,/barbitrate anesthesia.Anesthesiology,1995,82:948-949
[22]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1993,79:945-946
[23]Wastilia WB,Smarakandi AH,Bakhamees HS,et al.Histaminerelease haemodynma iechnages produced by recuronium,vecuronium,mivacurium,atracurium and tubocurarine.Br J Anaesth,1995,75:A946
[24]Deriaz,Kirov,Slavov V,et al.Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm:an electromyographic study in humans.Anesthesiology,1994,90(4):1092-1093
[25]张新建,综述.新肌松药拮抗剂Org25969的研究进展.中国医师杂志,2005增刊446-447
[26]Stevens JB,Walker SC,Fontenot JP.The clinical neuromuscular pharma-cology of cisatracurium versus vecuronium during outpatient anesthesia.Anesth Analg,1997,85(6):1278-1283
[27]Tullock WC,Adachi YU,Saubermann AJ,et al.Presynaptic inhibitory effects of rocuronium and SZ1677 on acetycholine releasefrom themousehemidiaphragm preparation.Neurochem Int,2002,40:655-659
[28]Body AH,Klewicka MM,Kopmna DJ,et al.Molra optencyis perdictive of the speed of onset of neuromuscular block for agents of intermidiate,short,nadutrashort duration.Aneshtesiology,1999,90:425-431
[29] Belmont MR,Lien CA,Quassy S,et al. The clinical neuromuscular pharmacology of 51W89 in paitents receiving nitrous oxide/opioid/barbiturate anaesthesia. Aneshtesiology, 1995,82:1139-1145
[30] Lepage JY,Vandenbrom RHG,et al. Hofmann elimination is the major clearance pathway of the nromuscular blocking agent 51W89 in man. Anesthesiology,1994,81:1090-1091
[31] Line CA,Eastwood NB, Parker CJ, et al. Pharmacodynamics of the 1R cis-1' R cis isomer of atracrium (51W89) in health and chronic renal failure . Br J Anaesth,1995,82:1130-1131
[32] Lepage JY,Melinovsky JM,Melinge M,et al. 51W89:Dose-response, neuromuscular blocking profile and cardiovascular effects. Anesthesiology, 1993,79:943-944
[33] Lepage JY. Pancoronium,gallamine and tubocurarine compared: Is speed of onset inversely related to drug potency. Anesthesiology,1994,81:1090-1091
[34] Blusdtein LS,Savarese JJ,Bsata SJ,et al. Atracurium:clinicalstarfe-glesofr preventing histamine release and atenuating the haemodynamic response. Br J Anaesth,1995,75:550-553
[35] Verburg KM,Savarese JJ,Ali HH,et al. Histamine releasing potencies of atracurium, dimethyl tubocurarine nad tubocurarine [J]. Br J Anaesth,1983,55:1058-1060
[36] Littlejohn IH,Kahwaji R,et al. Intubating conditions following 1R CIS, 1' R CIS atracurium(51W89). Anaesthesia, 1995,50:499-502
[37] Littlejohn IH,Bevan DR,et al. Clinical pharma-cokinetics of neuromuscular blocking drugs. Anaesthesia,1992,22:94-115
[38] Blusdtein LS,Bevan DR,Berrill A,et al. Concentration effect relationship of cisatracurium at three different dose levels in the anesthetized patient. Anesthesiology, 1993,95:314-323
[39] Deriaz JY,Kirov K,Slavov V,et al. Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm:an electromyographic study in humans. Anesthesiology, 1994,81(5):951-955
[40] Belmont MR,Lien CA,et al. The clinic neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia . Anesthesiologyl995, 82: 1139-1145.
[41] Meretoja OA,Taivainen T,Wirtavuori K. Pharmacodynamic effects of 51W89, an isomer of atracrium, in children during halothane anaesthesia. Br J Anaeth,1994,81:1126-1130
[42] Omstein K,Johnson JO,Sprague K,et al. Effects of Rapacuronium on respratory function during general anesthesia:a comparison with cis-atracuriu. Anesthesiology,2001, 95(4):908-912
[43] Verburg KM,Bowsher RR,Henry DP. A new radioenzymatic assay for histamine using purified histmaine N-methyltransferase. Life Scienses, 1994,81:2855-2867
[44] Prielipp RC,Beaufort TM,Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents. Drugs,2001,61(7):919-942
[45] Konstadt SN,Caldwell JE,Berry PD. Rapid tracheal intubation with rocuronium: a probability approach to deter mining dose. Anesthesiology,1999,91(1):131-136
[2]刘威,闻大翔,杭燕南,孙大会.四种中时效非去极化肌松药组铵释放作用的研究.上海第二医科大学学报,2003,(5):912-914
[3]Lien CA,Belmont MR,Abalos A,et al.Dose-response relation-ships of 51W89 with nitrous oxide/opiod/barbiturate anesthesia.Anesthesiology,1998,79:948
[4]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1993,79:945-946
[5]Stevens JB,Walker SC,Fontenot JP.The clinical neuromuscular pharmacology of cisatracurium versus vecuronium during out-patient anesthesia.Anesth Analg,1997,85(6):1278-1283
[6]闻大翔,陈锡明,杭燕南,孙大金.国人顺式阿曲库铵的剂量反应测定.中华麻醉学杂志,1999,(7):2431-2432
[7]Boyd AH,Eastwood NB,Parker CJ,et al.Pharmacodynamics of the 1R cis-l′ R cisisomer of atracrium(51W89) in health and chronic renal failure.Br J Anaesth,1995,74:400-404
[8]Blusdtein LS,Bevan DR,Berrill A,et al.Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient.Anaesthesiology,1993,95:314-323
[9]Littlejohn IH,Abhay K,EI Sayed PJ.Intubating conditions following cisatracurium (51W89).Anaeshtesia,2001,50:499-502
[10]LittlejohnIH,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline,and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[11]Blusdtein LS,Bevan DR,Berrill A,et al.Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient.Anaesthesiology,1993,95:314-323
[12]Wastilia WB,Broek L,Proost JH,et al.Time course of action and endotracheal intubating conditiongs of Org 9487,a new short-acting steroidal muscle relaxnt,a comparison with cuccinylcholine.Anesth Analg,1993,79:579
[13]Belmont MR,Bikhazi G,Quassy S,et al.The clinic neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia.Anesthesiology,1995,82:1139-1145
[14]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1994,81:A9455
[15]Lien CA,Belmont MR,Abalos A,et al.The cardiovascular effects and histamine releasing properties of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1133-1138
[16]Merotoja OA,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[17]Belmint MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1139-1145
[18]Lepage JY,Melinovsky JM,Melinge M,et al.51W89:Dose-response,neuromuscular blocking profile and cardio vascular effects.Anesthesiology,1993,79:A943
[19]Lepage JY,Savarese JJ,Basta SJ,et al.Atracurium:clinical strategies for preventing histamine release and attenuating the haemodynamic response.Br J Anaeth,1994,81:A1090.
[20]Blusdtein LS,Meakin GH,Meretoja OA,et al.The safety and efficacy of cisatracurium 0.15mg/kg during nitrous oxide-opioid anaesthesia in infants and children.Anaesthesia,2001,79:A920
[21]冯艳华,李国华,刘环秋,麻海春.非去极化肌松药罗库溴铵、维库溴铵和阿曲库铵在全麻诱导气管插管时期安全性的比较.吉林大学学报(医学版),2006,(7)
[22]刘威,闻大翔,杭燕南,孙大金.四种中时效非去极化肌松药组胺释放作用的研究[J].上海第二医科大学学报,2003,(05):431-432.
[23]Krombach J,Hunzelmann N,Koster F,et al.Anaphylactoid-tions after cisatracurium administration in six patients.Anesth Analg,2001,93(5):1257-1259
[24]Legros CB,Orliaguet GA,Mayer MN.Severe anaphylactic reaction to cisatracurium in child.Anesth Analg,2001,92(3):648-649
[25]刘伟,邝贤宣,苏跃.两种剂型依托咪酯在全麻诱导期不良反应的对比观察.北京医学,2002,1:187
[1] Chappie KJ,Mirakhur RK,Clarke RS,et al. Comparison of intubatin conditions after administration of Org 9246(rocuronium) and suxam ethonium. Br J Anaesth,1992,69(3):269-273
[2] Boyd AH,Eastwood NB,Parker C2,et al. Pharmao-dynamics of the 1R cis-l}R cisisomer of stracrium(51W89) in health and chronicrenal failure.Br J Anaeath, 1995,74:400-404
[3] Kron SS . Severe bronchospasm and desaturation in a child associated with rapacuronium. Anesthesiology,2001,94 (5):923
[4] Mills KG,Wright PM,Pollard BJ,et al . Antagonismof rapacuroniumus-ing edrophoniumor neostigmine: pharmacodynamics and pharmacokinetics. Br J Anaesth, 1999,83 (5):727-733
[5] Kopman AF,Klewicka MM,Ghori K,et al . Dose-response and onset/off-set characteristics of rapacuronium. Anesthesiology,2000,93(4):1017-1021
[6] Nishan G,Goudsouzian NG. Rapacuronium and bronchospasm. Anesthesiology,2001, 94 (5):727
[7] Stuth EA,Stuck,Setlock MA,et al. Another possible mechnism for bron-chospasm after rapacuronium. Anesthesiology,2002,96(6): 1528-1529
[8] Welch RM,Rajchert DM,et al . Rapacuronium and risk of bronchpspasm in pediatric. Anesthesiology,1994,81:1082-1083
[9] Lien CA,Belmont MR,Abalos A,et al. Dose-response relation-ships of 51W89 with nitrous oxide/opiod/barbiturate anesthesia. Anesthesiology,1998,54:982-983
[10] Fahey MR,Rose M. Rocuronium:high rish for anaphylaxis. Br J Anaesth,2001,86(5): 678-682
[11] Eastwood NB,Bardoczky Gl,et al. Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia, 1995,75:431
[12] Smith CE,Savarese JJ,Bsata SJ,et al. Atracurium: clinical strategies for preventing histamine release and attenuating the haemodynamic response. Br J Anaesth,1995,75:550-553
[13] Lien CA,Belmont MR,Abalos A,et al . The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opiod/barbiturate anesthesia. Anesthesiology,1995,82:1131-1138
[14] Omstein K,Johnson JO,Sprague K, et al. Effects of Rapacuronium on respiratory function during general anesthesia:a comparison with cisatracuriu. Anesthesiology,1994, 81(4): 1092-1093
[15] Pillips L,Chetty MS,Wilson A,et al. Intubation conditions and time course of action of low-dose recuronium bromide in day case dental surgery. Eur J Anesth,1995,12(11):81-83
[16]龙跃,李准民,易礼清等,综述.新型肌松药—瑞库溴铵、罗库溴铵和顺式阿曲库铵的研究进展.河南医学研究,2006,15(3):267-271
[17]Body AH,Easlwood NB,Parker CJR,et al.Pharmacodynamics of the cis(51W89)in health and renal failure.Br J Anaesth,1996,76:38-39
[18]Dewolfj,Flannery KB,Miller RD.Comparison of rocuronium,succinylchline and vecuronium for rapid-sequence induction of anaesthesia in adult patients.Anesthesiology,1993,79(5):913-918
[19]Meretoja OA,Taivainen T,Wirtavuori K.Pharmacodynamic effects of 51W89,an isomer of atracurium,in children during halothane anaesthesia.Br J Anaesth,1995,74:431-432
[20]Belmint MR,Lien CA,Quessy S,et al.The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/babiturate anesthesia.Ansthesiology,1995,82:1139-1145
[21]Line CA,Belmont MR,Abalos A,et al.The cardiovascular effects and histamine releasing properties of 51W89 in patients receiving nitrous oxide/opioid,/barbitrate anesthesia.Anesthesiology,1995,82:948-949
[22]Lepage JY,Malinovsky JM,Malinge M,et al.51W89:dose-response,neuromuscular blocking profile,and cardiovascular effects.Anesthesiology,1993,79:945-946
[23]Wastilia WB,Smarakandi AH,Bakhamees HS,et al.Histaminerelease haemodynma iechnages produced by recuronium,vecuronium,mivacurium,atracurium and tubocurarine.Br J Anaesth,1995,75:A946
[24]Deriaz,Kirov,Slavov V,et al.Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm:an electromyographic study in humans.Anesthesiology,1994,90(4):1092-1093
[25]张新建,综述.新肌松药拮抗剂Org25969的研究进展.中国医师杂志,2005增刊446-447
[26]Stevens JB,Walker SC,Fontenot JP.The clinical neuromuscular pharma-cology of cisatracurium versus vecuronium during outpatient anesthesia.Anesth Analg,1997,85(6):1278-1283
[27]Tullock WC,Adachi YU,Saubermann AJ,et al.Presynaptic inhibitory effects of rocuronium and SZ1677 on acetycholine releasefrom themousehemidiaphragm preparation.Neurochem Int,2002,40:655-659
[28]Body AH,Klewicka MM,Kopmna DJ,et al.Molra optencyis perdictive of the speed of onset of neuromuscular block for agents of intermidiate,short,nadutrashort duration.Aneshtesiology,1999,90:425-431
[29] Belmont MR,Lien CA,Quassy S,et al. The clinical neuromuscular pharmacology of 51W89 in paitents receiving nitrous oxide/opioid/barbiturate anaesthesia. Aneshtesiology, 1995,82:1139-1145
[30] Lepage JY,Vandenbrom RHG,et al. Hofmann elimination is the major clearance pathway of the nromuscular blocking agent 51W89 in man. Anesthesiology,1994,81:1090-1091
[31] Line CA,Eastwood NB, Parker CJ, et al. Pharmacodynamics of the 1R cis-1' R cis isomer of atracrium (51W89) in health and chronic renal failure . Br J Anaesth,1995,82:1130-1131
[32] Lepage JY,Melinovsky JM,Melinge M,et al. 51W89:Dose-response, neuromuscular blocking profile and cardiovascular effects. Anesthesiology, 1993,79:943-944
[33] Lepage JY. Pancoronium,gallamine and tubocurarine compared: Is speed of onset inversely related to drug potency. Anesthesiology,1994,81:1090-1091
[34] Blusdtein LS,Savarese JJ,Bsata SJ,et al. Atracurium:clinicalstarfe-glesofr preventing histamine release and atenuating the haemodynamic response. Br J Anaesth,1995,75:550-553
[35] Verburg KM,Savarese JJ,Ali HH,et al. Histamine releasing potencies of atracurium, dimethyl tubocurarine nad tubocurarine [J]. Br J Anaesth,1983,55:1058-1060
[36] Littlejohn IH,Kahwaji R,et al. Intubating conditions following 1R CIS, 1' R CIS atracurium(51W89). Anaesthesia, 1995,50:499-502
[37] Littlejohn IH,Bevan DR,et al. Clinical pharma-cokinetics of neuromuscular blocking drugs. Anaesthesia,1992,22:94-115
[38] Blusdtein LS,Bevan DR,Berrill A,et al. Concentration effect relationship of cisatracurium at three different dose levels in the anesthetized patient. Anesthesiology, 1993,95:314-323
[39] Deriaz JY,Kirov K,Slavov V,et al. Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm:an electromyographic study in humans. Anesthesiology, 1994,81(5):951-955
[40] Belmont MR,Lien CA,et al. The clinic neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia . Anesthesiologyl995, 82: 1139-1145.
[41] Meretoja OA,Taivainen T,Wirtavuori K. Pharmacodynamic effects of 51W89, an isomer of atracrium, in children during halothane anaesthesia. Br J Anaeth,1994,81:1126-1130
[42] Omstein K,Johnson JO,Sprague K,et al. Effects of Rapacuronium on respratory function during general anesthesia:a comparison with cis-atracuriu. Anesthesiology,2001, 95(4):908-912
[43] Verburg KM,Bowsher RR,Henry DP. A new radioenzymatic assay for histamine using purified histmaine N-methyltransferase. Life Scienses, 1994,81:2855-2867
[44] Prielipp RC,Beaufort TM,Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents. Drugs,2001,61(7):919-942
[45] Konstadt SN,Caldwell JE,Berry PD. Rapid tracheal intubation with rocuronium: a probability approach to deter mining dose. Anesthesiology,1999,91(1):131-136