老年患者使用罗库溴铵或琥胺甲铵快速序列诱导期间的插管条件。一项随机研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：王波          编辑：王波          审校：曹莹


背景
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在快速序列诱导期间，罗库溴铵 1.0 mg kg-1或琥珀甲铵 1.0 毫克 kg-1可以给药以促进气管插管。我们假设，与琥米甲铵相比，罗库溴铵在老年患者中提供了更大比例的良好插管条件。

方法


共有 90 名 80 岁或以上的患者，美国麻醉医师协会身体健康等级为 I-IV，体重指数< 35 kg m-1-2随机分配至罗库溴铵 1.0 mg kg-1或琥珀甲铵 1.0 毫克 kg-1在使用视频喉镜插管进行快速序列诱导期间。60 秒后，盲法研究者使用 Fuchs-Buder 量表评估气管插管条件，主要结果是插管条件良好的患者比例。进一步的结局包括首过成功率、根据插管难度量表（IDS）的插管条件、发病时间以及术后肌肉酸痛、声音嘶哑和喉咙痛的发生情况。

结果


【罂粟摘要】老年患者使用罗库溴铵或琥胺甲铵快速序列诱导期间的插管条件。一项随机研究

对所有患者的主要结果进行了评估。罗库溴铵组和琥珀甲铵组分别有36例（73%）和31例（75%）患者出现良好的插管条件（95%置信区间[CI]：-16-20）（p = .82）。罗库溴铵组和琥珀甲铵组的首次通过成功率分别为 48 （98%） 和 40 （98%） （p = .90）。IDS评分无差异;中位数 0（四分位距 [IQR]：0-1）与中位数 0（IQR：0-1）（p = .48）。琥珀甲铵组的发病时间显著缩短，99 秒与 131 秒相比 （p = .01）（95% CI：7 至 57）。最后，术后肌肉酸痛、声音嘶哑或喉咙痛的发生没有发现差异。


结论


      在给予任何一种罗库溴铵 1.0 mg kg 后，在快速序列诱导过程中均未发现插管条件的重要差异-1或琥珀甲铵 1.0 毫克 kg-1在 80 岁或以上的患者中。

原始文献来源：Vested M, Creutzburg A, Meyhoff CS, Rovsing ML, Nielsen T, Rosa F, Aasvang EK, Mollerup H, Fuchs-Buder T, Rasmussen LS. Intubating conditions during rapid sequence induction with either rocuronium or suxamethonium in elderly patients. A randomised study. Acta Anaesthesiol Scand. 2025 Mar;69(3):e14589. doi: 10.1111/aas.14589. PMID: 39910022; PMCID: PMC11798891.

Intubating conditions during rapid sequence induction with either rocuronium or  suxamethonium in elderly patients.

A randomised study

Background: During rapid sequence induction, either rocuronium 1.0 mg kg 1 or suxamethonium 1.0 mg kg 1 can be administered to facilitate endotracheal intubation. We hypothezised that rocuronium provided a larger proportion of excellent intubating conditions compared to suxamethonium in elderly patients. 

Methods: A total of 90 patients 80 years or above with American Society of Anesthesiologists physical health Classes I–IV, and a body mass index < 35 kg m 1 2 were randomised to either rocuronium 1.0 mg kg 1 or suxamethonium 1.0 mg kg 1 during rapid sequence induction with intubation using a video laryngoscope. After 60 s, tracheal intubating conditions were evaluated using the Fuchs-Buder scale by a blinded investigator, and the primary outcome was the proportion of patients with excellent intubating conditions. Further outcomes included first pass success rate, intubating conditions according to the intubating difficulty scale (IDS), onset time and postoperative occurrence of muscle soreness, hoarseness and sore throat. 

Results: All patients were evaluated for the primary outcome. Excellent intubating conditions occurred in 36 patients (73%) versus 31 (75%) in the rocuronium group and suxamethonium group, respectively (95% confidence interval [CI]:  16 to 20) (p = .82). The first pass success rate was 48 (98%) versus 40 (98%) comparing the rocuronium group with the suxamethonium group, respectively (p = .90). No difference in IDS score was found; median 0 (interquartile ranges [IQR]: 0–1) versus median 0 (IQR: 0–1) (p = .48). Onset time was significantly shorter in the suxamethonium group 99 versus 131 s (p = .01) (95% CI: 7 to 57). Finally, no difference was found in the occurrence of muscle soreness, hoarseness or sore throat postoperatively. 

Conclusion: No important difference in intubating conditions was found during rapid equence induction after the administration of either rocuronium 1.0 mg kg 1 or sux amethonium 1.0 mg kg 1 in patients 80 years or above.

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