單獨使用Rocuronium、Rocuronium與Atracurium混合或使用Rocuronium 1分鐘後，再給Atracurium插管之比較

Tracheal Intubation Condition-- A Comparison between One Minute after Rocuronium Alone, One Minute after Rocuronium Combined with Atracurium and One Minute after Atracurium with Rocuronium at One Minute Priming Interval

背景：Rocuronium，一種vecuronium的類固醇類似體，特別設計來縮短插管時間。實驗情形下，同時使用二種非去極化肌肉鬆弛劑，不是會產生加成作用(additive effect)，就是會產生協合作用(synergistic effect)。實驗觀察中建議rocuronium剛開始時是以協合作用(synergistic effect)來加快其他的非去極化肌肉鬆弛劑。方法：為了探討rocuronium是否能加快atracurium的插管速度，我們使用120位需要插管的志願選擇性手術病人，平均劃分為3組來接受以下三種方案：第一組2倍ED95的rocuronium (0.6 mg/kg)，第二組等強度混合ED95的rocuronium (0.3 mg/kg)和atracurium (0.25 mg/kg)，第三組使用rocuronium (0.1 mg/kg) 1分鐘後，再給atracurium (0.42 mg/kg)。在肌肉鬆弛劑給完1分鐘後，應用以下四種臨床標準給予計分並評估插管的困難度：(1)插管時之困難度（1～3分），(2)喉頭聲帶之鬆弛度（1～3分），(3)咳嗽的程度（1～3分），(4)有無四肢活動（1～3分）。評估後將所有分數加起來區分為：好（4～5分）、尚可（6～7分）、不好（8～12分）。結果：第一組和第二組的插管情況雷同，可是前二組比第三組略佳。但在使用Pearson ChiSquare Test下，並無達到統計學之差異。結論：在我們使用的劑量下，不管是單一使用rocuronium (0.6 mg/kg)，等強度混合rocuronium (0.3 mg/kg)和atracurium (0.25 mg/kg)，或先給rocuronium (0.1 mg/kg) 1分鐘後，再給atracurium(0.42 mg/kg,priming)所達成的滿意插管時間，在統計學上無明顯之不同。

Background: Rocuronium, a monoquaternary steroid analogue of vecuronium, is designed to provide a rapid onset of action. Experimentally, it has been shown that two non-depolarizing neuromuscular relexants administered together can produce either a neuromuscular block of a size expected to be the sum of the individual doses (additive effect) or a larger neuromuscular block (synergistic effect). Experimental observations have suggested that during onset rocuronium acts synergistically with other nondepolarizing agents, but that at a steady state the combined action is additive. Methods: To investigate whether rocuronium can speed up the onset of atracurium for intubation, 120 patients who consented to receive elective surgery requiring tracheal intubation were randomly assigned to 3 equally divided groups to receive one of the following three different combinations of muscle relaxants: twice ED95 of rocuronium (0.6 mg/kg group 1), an equipotent mixture of ED95 of rocuronium and atracurium (0.3 mg/kg and 0.25 mg/kg respectively, group 2), and rocuronium 0.1 mg/kg to prime atracurium 0.42 mg/kg at 1 min interval. Intubation conditions were assessed 1 minute after intravenous muscle relexant injection, and scored as good, acceptable and poor based on four clinical evaluators: the ease of laryngoscopy (score of 1-3), the relexation of vocal cord (1-3), the degree of coughing (1-3), and movement of extremity (1-3). Adding up together, intubation condition that scored 4-5 was considered to be good, 6-7 acceptable, and 8-12 poor. Results: The conditions produced in the rocuronium and the mixture groups were similar and both were moderately better than those of the priming group. Good intubation conditions were achieved in 58% patients of the rocuronium group, 63% of the mixture group and 43% of the priming group. By Pearson Chi-square test, the comparisons did not show statistical significance between groups. Conclusions: Statistically, rocuronium alone, mixture of equipotent atracurium and rocuronium, and using rocuronium to prime atracurium all provided similar onset for satisfactory intubation.