Studies Using The Sequential Method Of Rocuronium And Cis-atracurium

Objective: When using rocuronium and cis-atracurium by sequential method, Observed after application to maintain muscle relaxant muscle relaxant effect, duration of action and recovery index changes, analysis Sequential method using two different types of non-depolarizing muscle relaxants resulting changes in clinical pharmacodynamics, To learn more about the different interaction mechanisms of muscle relaxants, and provide reference for clinical application and research of muscle relaxants.Methods: 60 patients in our hospital under laparoscopic elective surgery, anesthesia opt to use the muscle relaxants total intravenous general anesthesia, ASA Ⅰ or Ⅱ, aged on 40±15 years old, BMI between 19 ~ 25 kg / m2. Were randomly divided into A, B, C, D four groups, and then using midazolam 0.05 mg / kg, sufentanil 0.5μg / kg, propofol 1mg / kg one by one. After the one sleeped, open the muscle relaxants detector, scaling, then A, Bgroups intravenous induction dose of rocuronium(2 ED95 0.6 mg / kg); C, D groups intravenous induction dose of cis atracurium(3 ED95 0.15 mg / kg), when T1 <5%, the use of oxygen was instantaneous visual laryngoscopy(ETT were chosen 7 #, surface smear 5% lidocaine cream).before started we dig the anesthesia machine on capacity control breathing, and let volume of 6 ~ 8ml / kg, respiratory rate 12 to 14 times / min, respiratory ratio of 1: 2. After intubation, connection visual laryngoscopy with anesthesia machine. Intraoperative ventilator settings were adjusted so that PETCO2 maintained between 35-45 mm Hg, continuous infusion of remifentanil(0.5μg /(kg ? min)), propofol(5mg /(kg ? h)), when T1 when restored to 25% A, C two bolus rocuronium 0.15 mg / kg; B, D two intravenous cis atracurium 0.05 mg / kg, depending on the patient and surgical muscle relaxants recovery process timely stops muscle application relaxants, deactivate remifentanil and propofol when sewing leather. Using TOF stimulation(2Hz, interval 15s) monitoring the contractile response of the adductor pollicis, observe and record the patient intubation time(T), intubating conditions; induce clinical effects of muscle relaxants time(T25), no reaction period(T0); to maintain muscle relaxant action time(T25 *), no reaction period(T0 *); neuromuscular recovery index(RI), ie T25% ~ T75% time spent; before using rocuronium and cis-atracurium(T1), on the time of intubation(T2), 5min after intubation(T3), surgery 30min(T4), surgery 1h(T5), at the end of surgery(T6), before extubation(T7), 5min(T8) vital signs during surgery long after extubation the total intake and output and the occurrence of adverse time and so on.Experimental Results:1.T(intubation time), giving the induction of muscle relaxants to T1 dropped by 5% of the time, A group, group B was significantly shorter than group C, D group, the difference was statistically significant(P <0.05); using the same kind of drug-induced neuromuscular A, B and groups C, D comparison between the two groups, the difference was not statistically significance(P> 0.05); each group’s intubation conditions, the difference was not statistically significant(P> 0.05).2.T25(induce clinical effects of muscle relaxants time), giving the induction of muscle relaxants used T1 recovered to 25% of the time, A group, group B was significantly shorter in group C, D group, the difference was statistically significant(P <0.05); using the same kind of drug-induced neuromuscular A, B and groups C, D, There was little significant, by compared between the two groups(P> 0.05).3.T25 *(maintaining the clinical effects of muscle relaxants time), maintain that the use of muscle relaxants after T1 recovery to 25% of the time, A group was significantly shorter in group B, C group, the difference was statistically significant(P <0.05); D group was significantly shorter in group B, group C; A group was significantly shorter than that in group D, the difference was statistically significant(P <0.05).4.T25 * Compared with the T25, Group B, Group C action time lengthen 29.47%, respectively, 10.69%, and the difference was statistically significant(P <0.05); A group, D group, the difference was not statistically significant(P> 0.05).T1 sustained after 5.T0(induced muscle relaxants no response period), that is given to induce the use of muscle relaxants to zero time, A group, group B longer than the group C, D group, the difference was statistically significant(P <0.05); A group difference was not statistically significant(P between group B, group C and group D with> 0.05).6.T0 *(maintaining muscle relaxants no response period), which continued to use T1 0 time maintaining muscle relaxants, A group, C group longer than group B, D group the difference between groups was not statistically significant(P> 0.05); the difference between group A and group C, was not statistically significant(P between group B and group D> 0.05).7. T0 * compared with T0, group B, group C, respectively, to extend the duration of action 33.70 percent, 22.07 percent, and the difference was statistically significant(P <0.05); A group, D group, the difference was not statistically significant(P> 0.05).8. RI ——neuromuscular recovery index, the time of T1 recovery from 25% to 75%, A group, group B, C group, D group, the difference between groups was not statistically significant(P> 0.05).9. The general condition of patients, MAP, HB, the total amount and length of time out of the surgery, the difference between groups was not statistically significant(P> 0.05). The experimental results:1. Sequential Method using rocuronium and cis atracurium exhibit synergistic effects to enhance the degree of neuromuscular blockade, time extended, but the muscle relaxant recovery index was no significant change;2. Sequential Method using muscle relaxants can be safely used in clinical anesthesia and recommend the use of rocuronium-induced muscle Song Wei holding ammonium cis atracurium.