Abstract：
BACKGROUND: Deep neuromuscular blockade (d-NMB) is an essential requirement for carboperitoneum during laparoscopy surgery. However, sustaining d-NMB till the completion of surgery delays the reversal of the residual block. Therefore, there is a merit in exploring the effect of synergistic vecuronium-atracurium combination on the duration-of-action of d-NMB during \"laparoscopic\" surgery when we compare intubating bolus non-depolarizers (atracurium, vecuronium) administered alone. This study aims to evaluate whether the synergistic effect atracurium-vecuronium combination increases duration-of-action of d-NMB \"laparoscopic\" surgery settings.
METHODS: Forty-eight patients (18-60 years, American Society of Anesthesiologists physical status- II/III, either sex) undergoing laparoscopic cholecystectomy were randomly allocated to receive vecuronium (vecuronium group, n = 16) or atracurium (atracurium group, n = 16) or vecuroniumatr-acurium combination (vecuronium-atracurium combination group, n = 16) and analyzed for the effects on the duration-of-action (primary objective); onset-of-action, reversibility, and quality of intubating conditions (secondary objectives) profile of neuromuscular blockade in patients undergoing laparoscopic cholecystectomy.
RESULTS: Duration-of-action of neuromuscular blockade was significantly longer in patients who received atracurium-vecuronium combination (53.9 ± 9.7 minutes) versus atracurium-alone (41.1 ± 3.8 minutes) or vecuronium-alone (43.5 ± 9.2 minutes) (P = 0.000). No difference was found for the time to onset-of-action (vecuronium [198.1 ± 34.9 seconds], atracurium [188.5 ± 50.6 seconds], or atracurium-vecuronium combination [196.3 ± 46.3 seconds] [P = 0.829]); time for the reversal of muscle relaxation effect (vecuronium [559.9 ± 216.2 seconds], atracurium [584.7 ± 258.3 seconds], and atracurium-vecuronium combination [555.0 ± 205.4 seconds] [P = 0.925]); and quality-of-intubating conditions (vecuronium group [9.6 ± 1.3]; atracurium group [10.0 ± 0.0]; atracurium-vecuronium group [10.0 ± 0.0] [P = 0.182]).
CONCLUSIONS: The synergistic effect of the atracurium-vecuronium combination leads to an increased duration-of-action of d-NMB during laparoscopic cholecystectomy without impacting onset-of-action, quality of intubating conditions, and reversal of muscle relaxant effect.
METHODS: Forty-eight patients (18-60 years, American Society of Anesthesiologists physical status- II/III, either sex) undergoing laparoscopic cholecystectomy were randomly allocated to receive vecuronium (vecuronium group, n = 16) or atracurium (atracurium group, n = 16) or vecuroniumatr-acurium combination (vecuronium-atracurium combination group, n = 16) and analyzed for the effects on the duration-of-action (primary objective); onset-of-action, reversibility, and quality of intubating conditions (secondary objectives) profile of neuromuscular blockade in patients undergoing laparoscopic cholecystectomy.
RESULTS: Duration-of-action of neuromuscular blockade was significantly longer in patients who received atracurium-vecuronium combination (53.9 ± 9.7 minutes) versus atracurium-alone (41.1 ± 3.8 minutes) or vecuronium-alone (43.5 ± 9.2 minutes) (P = 0.000). No difference was found for the time to onset-of-action (vecuronium [198.1 ± 34.9 seconds], atracurium [188.5 ± 50.6 seconds], or atracurium-vecuronium combination [196.3 ± 46.3 seconds] [P = 0.829]); time for the reversal of muscle relaxation effect (vecuronium [559.9 ± 216.2 seconds], atracurium [584.7 ± 258.3 seconds], and atracurium-vecuronium combination [555.0 ± 205.4 seconds] [P = 0.925]); and quality-of-intubating conditions (vecuronium group [9.6 ± 1.3]; atracurium group [10.0 ± 0.0]; atracurium-vecuronium group [10.0 ± 0.0] [P = 0.182]).
CONCLUSIONS: The synergistic effect of the atracurium-vecuronium combination leads to an increased duration-of-action of d-NMB during laparoscopic cholecystectomy without impacting onset-of-action, quality of intubating conditions, and reversal of muscle relaxant effect.
摘要：
背景：深神经肌肉阻滞（d-NMB）是腹腔镜手术中脑腹膜的基本要求。然而,维持d-NMB直到手术完成，延迟了残留块的逆转。因此,当我们比较插管推注非去极化剂(阿曲库铵，维库溴铵）单独施用。这项研究旨在评估阿曲库铵-维库溴铵组合的协同作用是否增加d-NMB“腹腔镜”手术设置的作用时间。
方法：48名患者（18-60岁，美国麻醉医师协会的身体状况-II/III，任何性别)接受腹腔镜胆囊切除术的患者随机分配接受维库溴铵(维库溴铵组，n=16)或阿曲库铵(阿曲库铵组，n=16）或维库溴铵-阿曲库铵组合（维库溴铵-阿曲库铵组合组，n=16），并分析了对作用持续时间（主要目标）的影响；作用开始，可逆性,腹腔镜胆囊切除术患者神经肌肉阻滞的插管条件（次要目标）的质量。
结果：接受阿曲库铵-维库溴铵联合治疗（53.9±9.7分钟）与阿曲库铵单药（41.1±3.8分钟）或维库溴铵单药（43.5±9.2分钟）相比，神经肌肉阻滞的作用持续时间明显更长（P=0.000）。起效时间没有发现差异（维库溴铵[198.1±34.9秒]，阿曲库铵[188.5±50.6秒]，或阿曲库铵-维库溴铵组合[196.3±46.3秒][P=0.829]）；肌肉松弛效应逆转的时间（维库溴铵[559.9±216.2秒]，阿曲库铵[584.7±258.3秒],和阿曲库铵-维库溴铵组合[555.0±205.4秒][P=0.925]）；和插管质量条件（维库溴铵组[9.6±1.3]；阿曲库铵组[10.0±0.0]；阿曲库铵-维库溴铵组[10.0±0.0][P=0.182]）。
结论：阿曲库铵-维库溴铵组合的协同作用导致d-NMB在腹腔镜胆囊切除术期间的作用持续时间增加，而不影响作用的开始，插管条件的质量，和肌肉松弛作用的逆转。
方法：48名患者（18-60岁，美国麻醉医师协会的身体状况-II/III，任何性别)接受腹腔镜胆囊切除术的患者随机分配接受维库溴铵(维库溴铵组，n=16)或阿曲库铵(阿曲库铵组，n=16）或维库溴铵-阿曲库铵组合（维库溴铵-阿曲库铵组合组，n=16），并分析了对作用持续时间（主要目标）的影响；作用开始，可逆性,腹腔镜胆囊切除术患者神经肌肉阻滞的插管条件（次要目标）的质量。
结果：接受阿曲库铵-维库溴铵联合治疗（53.9±9.7分钟）与阿曲库铵单药（41.1±3.8分钟）或维库溴铵单药（43.5±9.2分钟）相比，神经肌肉阻滞的作用持续时间明显更长（P=0.000）。起效时间没有发现差异（维库溴铵[198.1±34.9秒]，阿曲库铵[188.5±50.6秒]，或阿曲库铵-维库溴铵组合[196.3±46.3秒][P=0.829]）；肌肉松弛效应逆转的时间（维库溴铵[559.9±216.2秒]，阿曲库铵[584.7±258.3秒],和阿曲库铵-维库溴铵组合[555.0±205.4秒][P=0.925]）；和插管质量条件（维库溴铵组[9.6±1.3]；阿曲库铵组[10.0±0.0]；阿曲库铵-维库溴铵组[10.0±0.0][P=0.182]）。
结论：阿曲库铵-维库溴铵组合的协同作用导致d-NMB在腹腔镜胆囊切除术期间的作用持续时间增加，而不影响作用的开始，插管条件的质量，和肌肉松弛作用的逆转。
