EFFECT OF ANTAGONISM OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK ON POSTOPERATIVE EMESIS IN CHILDREN

被引:28
作者
WATCHA, MF [1 ]
SAFAVI, FZ [1 ]
MCCULLOCH, DA [1 ]
TAN, TSH [1 ]
WHITE, PF [1 ]
机构
[1] TEXAS SCOTTISH RITE HOSP CHILDREN,DEPT ANESTHESIOL & PAIN MANAGEMENT,DALLAS,TX
关键词
D O I
10.1097/00000539-199504000-00011
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
The routine use of cholinesterase inhibitors to antagonize residual neuromuscular block may be associated with increased postoperative emesis. Rapid spontaneous recovery from mivacurium may obviate the need for these drugs. In this randomized, double-blind, placebo-controlled study of 113 healthy children who had received mivacurium as part of a standardized anesthetic regimen, we compared the incidence of postoperative complications after spontaneous recovery and after the use of neostigmine-glycopyrrolate or edrophonium-atropine. The anesthetic regimen consisted of halothane, nitrous oxide, fentanyl, 2 mu g/kg intravenous (IV), mivacurium in an initial dose of 0.2 mg/kg, followed by an infusion, adjusted to maintain greater than or equal to 1 evoked contraction response to a supramaximum train-of-four stimulus. At the end of the procedure, patients received by random assignment one of three drug combinations: 1) neostigmine 70 mu g/kg + glycopyrrolate 10 mu g/kg, IV, 2) edrophonium 1 mg/kg + atropine 10 mu g/kg, IV, and 3) saline. The trachea was extubated when evoked responses to peripheral nerve stimulation and clinical signs of adequate neuromuscular recovery were present. Postoperative pain was treated with morphine and emesis with metoclopramide. There were no significant differences between the three groups with respect to age, surgery, intraoperative fentanyl, and mivacurium use, time from the end of surgery to tracheal extubation, postanesthesia care unit (PACU) arrival and discharge, or in postoperative oxygen saturation values and analgesic requirements. Compared to the placebo group, emesis occurred more often in the PACU in patients receiving the neostigmine-glycopyrrolate combination, but not after edrophonium-atropine. However, after discharge from the PACU, emesis rates were similar in the three study groups. We conclude that spontaneous recovery or reversal with edrophonium from a moderate degree of mivacurium-induced block may offer advantages over the use of neostigmine, without increasing time to PACU arrival.
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页码:713 / 717
页数:5
相关论文
共 15 条
[1]  
BELL CMA, 1968, BRIT MED J, V1, P587
[2]   REVERSAL OF NEUROMUSCULAR BLOCKADE [J].
BEVAN, DR ;
DONATI, F ;
KOPMAN, AF .
ANESTHESIOLOGY, 1992, 77 (04) :785-805
[3]   EFFECT OF ANTAGONIZING RESIDUAL NEUROMUSCULAR BLOCK BY NEOSTIGMINE AND ATROPINE ON POSTOPERATIVE VOMITING [J].
BOEKE, AJ ;
DELANGE, JJ ;
VANDRUENEN, B ;
LANGEMEIJER, JJM .
BRITISH JOURNAL OF ANAESTHESIA, 1994, 72 (06) :654-656
[4]   EVALUATION OF GLYCOPYRROLATE AND ATROPINE AS ADJUNCTS TO REVERSAL OF NON-DEPOLARIZING NEUROMUSCULAR BLOCKING-AGENTS IN A TRUE-TO-LIFE SITUATION [J].
COZANITIS, DA ;
DUNDEE, JW ;
MERRETT, JD ;
JONES, CJ ;
MIRAKHUR, RK .
BRITISH JOURNAL OF ANAESTHESIA, 1980, 52 (01) :85-89
[5]  
DING YF, 1994, ANESTH ANALG, V78, P450
[6]   ANAESTHESIA AND PREMEDICATION AS FACTORS IN POSTOPERATIVE VOMITING [J].
DUNDEE, JW ;
KIRWAN, MJ ;
CLARKE, RSJ .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1965, 9 (04) :223-&
[7]   CHOLINESTERASE-INHIBITORS DO NOT PROLONG NEUROMUSCULAR BLOCK PRODUCED BY MIVACURIUM [J].
FLEMING, NW ;
LEWIS, BK .
BRITISH JOURNAL OF ANAESTHESIA, 1994, 73 (02) :241-243
[8]   NEUROMUSCULAR AND CLINICAL EFFECTS OF MIVACURIUM CHLORIDE IN HEALTHY ADULT PATIENTS DURING NITROUS-OXIDE ENFLURANE ANESTHESIA [J].
GOLDHILL, DR ;
WHITEHEAD, JP ;
EMMOTT, RS ;
GRIFFITH, AP ;
BRACEY, BJ ;
FLYNN, PJ .
BRITISH JOURNAL OF ANAESTHESIA, 1991, 67 (03) :289-295
[9]  
GRASELA TH, 1994, ANESTHESIOLOGY, V81, pA1278
[10]   COMPARISON OF CAUDAL AND ILIOINGUINAL ILIOHYPOGASTRIC NERVE BLOCKS FOR CONTROL OF POST-ORCHIOPEXY PAIN IN PEDIATRIC AMBULATORY SURGERY [J].
HANNALLAH, RS ;
BROADMAN, LM ;
BELMAN, AB ;
ABRAMOWITZ, MD ;
EPSTEIN, BS .
ANESTHESIOLOGY, 1987, 66 (06) :832-834