肌松药残余作用预防.pptVIP

2007麻醉年会 专题报告(肌松药残留作用的预防)Residual Paralysis:- clinical consequences- incidence- strategies to prevent Claude Meistelman,M.D. Professor and Chair, Dept.of Anesthesia and Intensive Care Medicine School of Medicine, Nancy University,FRANCE c.meistelman@chu-nancy.fr Swallowing and residual paralysis clinical consequences incidence strategies to prevent strategies to prevent Choice of NMBA Reversal US-approach European-approach Perspective Limits of visual fade detection TOF-Watch to detect residual paralysis Need for a new NMBA reversal agent Rapid in onset of action Minimal side effects Ability to antagonise deep block Effective in presence of potent anaesthetics Cyclodextrins Linked sugar molecules Centre- hydrophobic Outside- hydrophylic Used as solubilising agents ORG 29569, a Selective Relaxant Binding Agent (SRBA) ORG 25969 specificity Sugammadex in volunteers Rocuronium 0.6 mg/kg followed by sugammadex at reappearance of T2 Rocuronium 0.6 mg/kg followed by increments to maintain deep block at 10 PTCs Reversal after 2hrs of deep block at recovery of T2 Doses of Org 25969 0.5, 1.0, 2.0, 4.0 and 6.0 mg/kg Times to TOF ratio of 0.9 with reversal at T2 after deep block for 2 hours Dose (mg/kg) Time (Median (range)) 0.5 5:29 (4:50-11:26) 1.0 2:42 (1:49-3:40) 2.0 1:46 (1:00-2:31) 4.0 1:04 (0:57-2:19) 6.0 2:41 (1:08-3:56) Rocuronium reversal with sugammadex during propofol or sevoflurane anaesthesia Reversing a high dose deep rocuronium block with sugammadex 1.0 or 1.2 mg/kg of rocuronium Reversal at 3 or 15 min after rocuronium Doses of Org 25969 2.0, 4.0, 8.0, 12.0 and 16.0 mg/kg Reversal of 1.0 mg/kg rocuronium 3 min after relaxant administration Sugammadex for early reversal of high dose rocuronium block Org 25969 at reappearance of T2(Time to TOF ratio of 0.9) Heart rate and Systolic Arterial Pressure Sugammadex Effective at both superficial and deep blocks Excellent relaxation until the end of surgery May help in