Effect of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery
XU Yingyang GAO Guangjie LONG Xiaohong SHANG Yu
Department of Anesthesia, 463th Hospital of PLA, Liaoning Province, Shenyang 110042, China
Abstract：Objective To compare the effect of of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery. Methods 60 cases of patients with ASA Ⅰ-Ⅱ underwent selective microlaryngoscopic surgery from June 2015 to September 2016 in 463th Hospital of PLA were selected, and divided into group Ⅰ, Ⅱ, Ⅲ by random number table, each gorup had 20 cases. The target effect-sit concentration of Propofol was 3.0, 4.0, 5.0 μg/mL respectively. After target controlled infusion of Propofol for 60 s, intravenous injection of Fentanyl 10 μg/kg, Mivacurium Chloride 0.2 mg/kg was given, and endotracheal intubation rapidly. Anesthesia was maintained with Remifentanil Hydrochloride 0.25 μg/(kg·min). Ulnar nerve train of 4 stimulation (TOF) was monitored continuously by using acceleration muscle relaxation monitor. Muscle relaxant indicators were recorded. Hemodynamics and BIS were monitored during the whole anesthesia. The pharmacokinetic effects of Mivacurium were measured. Results Comparison of the hemodynamic parameters in the three groups had no significant differences (P > 0.05). The onset time of Mivacurium in the three groups had no statistically significant difference (P > 0.05). 25%, 75%, 90% T1 recovery time of TOF and 70% T4/T1 recovery time in the group Ⅲ were significantly prolonged than those of the group Ⅰ, with statistically significant differences (P < 0.05). In the pharmacokinetic of Mivacurium, in addition to relative bioavailability (F), the rest of the indicators, compared with the groupⅠ, Ⅱ and group Ⅲ, the differences were statistically significant (P < 0.01). Conclusion The target effect-sit Propofol concentration and pharmacokinetics of Mivacurium has a dose-dependent correlation. Mivacurium pharmacodyn-amics is unsignificantly effected by target effect-sit propofol concentration of 4.0 μg/mL.
徐迎阳 高光洁 龙晓宏 尚宇. 不同效应室靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响[J]. 中国医药导报, 2017, 14(19): 65-68.
XU Yingyang GAO Guangjie LONG Xiaohong SHANG Yu. Effect of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery. 中国医药导报, 2017, 14(19): 65-68.
[1] 刘扬，刘清海，王天龙.环靶控系统启动精准麻醉控制的导航时代[J].北京医学，2016，51（6）：583-586.
[2] Simoni RF，Miziara LE，Esteves LO，et al. Comparative study between fast and slow induction of propofol given by target-controlled infusion： expected propofol concentration at the effect site. Randomized controlled trial [J]. Rev Bras Anestesiol，2015，65（2）：99-103.
[3] Hemmerling TM，Le N，Decarie P，et al. Total intravenous anesthesia with propofol augments the potency of mivacurium [J]. Can J Anaesth，2008，55（6）：351-357.
[4] 刘芳，徐志鹏，岳云，等.靶控输注异丙酚意识消失时血浆和效应室靶浓度的EC50与脑电双频谱指数的关系[J].中华麻醉学杂志，2007，27（3）：324-327.
[5] Mirzakhani H，Welch CA，Eikermann M，et al. Neuromuscular blocking agents for electroconvulsive therapy：a systematic review [J]. Acta Anaesthesiol Scand，2012，56（1）：3-16.
[6] 陈志扬，郑青山，孙瑞元.大型药理学计算软件DAS的功能介绍[J].中国临床药理学与治疗学，2002，7（6）：562-564.
[7] 徐迎阳，孙兴和.喉显微手术的麻醉方法选择[J].临床耳鼻咽喉科杂志，2000，14（6）：273.
[8] Mathew PJ，Sailam S，Sivasailam R，et al. Performance of target-controlled infusion of propofol using two different pharmacokinetic models in open heart surgery-a randomised controlled study [J]. Perfusion，2016，31（1）：45-53.
[9] 王玲玲.靶控输注应用现状[J].继续医学教育，2015，29（2）：114-115.
[10] 宋建平，王学军，张培福，等.丙泊酚联合瑞芬太尼靶控输注对患者血流动力学及脑电双频指数的影响[J].中国老年学杂志，2015，35（10）：5574-5575.
[11] 季蒙，陶军，王庆利，等.靶控输注丙泊酚联合瑞芬太尼对免疫及应激反应的影响[J].西南国防医药，2013，23（5）：499-502.
[12] Calzetta L，Soggiu A，Roncada P，et al. Propofol protects against opioid-induced hyperresponsiveness of airway smooth muscle in a horse model of target-controlled infusion anaesthesia [J]. Eur J Pharmacol，2015，76（10）：546-549.
[13] 毛仲炫，林艳，杨瑞敏，等.丙泊酚联合瑞芬太尼靶控输注全凭静脉麻醉患者术中知晓的发生情况[J].临床麻醉学杂志，2013，29（11）：1073-1075.
[14] Tripathi M，Pandey M. Pharmacodynamic evaluation of augmentation effect of isoflurane on mivacurium [J]. Indian Med Assoc，2009，107（6）：350-353.
[15] 李亚娟，李胜德，王世端.七氟烷或异氟烷对米库氯胺临床药效影响的研究[J].泰山医学院学报，2013，16（2）：65-68.
[16] 王敏，刘毅，米卫东.米库氯铵与罗库溴铵用于麻醉诱导时插管条件及安全性比较[J].解放军医学院学报，2013， 4（7）：729-731.
[17] Vanlinthout LE，Mesfin SH，Hens N，et al. A systematic review and meta-regression analysis of mivacurium for tracheal intubation [J]. Anaesthesia，2014，69（12）：1377-1387.
[18] 梅菊香，周泉华，尹永胜，等.靶控输注枸橼酸芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].中国医药科学，2015，5（2）：82-83，86.
[19] Cassel J，Staehr-Rye AK，Nielsen CV，et al. Use of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium：three case reports [J]. Acta Anaesthesiol Scand，2014，58（8）：1040-1043.
[20] 王玉玺，徐昌顺，蔡铁良，等.右美托咪定与丙泊酚在脑功能区术中唤醒麻醉中对应激反应的影响[J].中国医药，2016，11（11）：1644-1648.DOI：10.3760/cma.j.issn.1673-4777.2016.11.015.
[21] Basta SJ. Clinical pharmacology of mivacurium chloride：a review [J]. Clin Anesth，1992，4（2）：153-163.
[22] 周骞，吕东森，刘华，等.瑞芬太尼复合丙泊酚靶控输注在妇科腹腔镜手术中的应用效果[J].中国医药科学，2016， 6（7）：182-184，187.
[23] Motamed C，Donati F. Intubating conditions and blockade after mivacurium，rocuronium and their combination in young and elderly adults [J]. Can J Anaesth，2000，47（3）：225-231.
[24] 陈冬梅，闫建平.右美托咪定复合丙泊酚和瑞芬太尼用于脑动脉瘤夹闭术患者麻醉的效果分析[J].中国医药，2016，11（1）：38-41.DOI：10.3760/cma.j.issn.1673-4777.2016. 01.009.
2017, Vol. 14 
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