Dissertation
Dissertation > Medicine, health > Surgery > Surgical operation > Anesthesiology

Pharmacodynamics Comparson of Rocuronium Adninistrated Accordin to Lean Body Mass and Weight

Author WangZuo
Tutor XuShiYuan
School Southern Medical University,
Course Anesthesiology
Keywords Muscle relaxants Rocuronium Pharmacodynamic Dose-effect relationship Lean body mass Gender
CLC R614
Type Master's thesis
Year 2011
Downloads 49
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Muscle relaxants application of dose and ED95 kg body weight, and found this method after administration pharmacodynamic large individual differences, especially different body mass index, gender, age, particularly significant in clinical work. Elderly patients by kilogram of body weight given muscle relaxants, postoperative muscle relaxants residual block (RNMB), a higher incidence of. Obese patients, use of muscle relaxants kg of body weight and ED95 onset time faster than normal-weight patients, the enhanced role of muscle relaxants, aging extend the analysis of the reasons may be related to body weight dose larger. Therefore, scholars estimate the amount of muscle relaxants medicinal reasonably questioned kg body weight and ED95 application of muscle relaxant drugs, it is recommended that the standard weight and ED95. Usually, the pharmacological effects of the drug efficacy depending on the drug, the blood concentration of the drug and its efficacy is proportional to the concentration of the target cells. Relative to the muscle tissue and adipose tissue of obese patients of normal body mass were increased, but the increase in adipose tissue than muscle tissue. Per kilogram of body weight in obese patients less muscle tissue, fat tissue. Usually less blood flow through the fat, accounting for about 5% of the cardiac output, while flowing visceral blood flow as compared to 73%, and muscle is 22%. That lean body mass and body blood volume ratio kg body weight and blood volume high, suggesting a significant impact on two related differences in the timeliness of muscle relaxants. Individual differences exist according to the the weight and ED95 administration of traditional kilogram of body weight to reduce muscle relaxants necessary research given muscle relaxants lean body mass clinical feasibility. In this study the determination of the dose-effect relationship of rocuronium (ROC) administration of single dose method lean body mass, determine the ED95 values, and the comparative pharmacodynamics and administered according to the weight differences, for clinical research and a more rational application ROC provides reference. The first part of ROC according to the purpose of the dose-effect relationship to fat weight administered a single injection the ROC go fat body weight administered dose - effect curve, determine the ROC administration of lean body mass dose-effect relationship and ED95 values ??for the ROC clinical studies and a more rational use of drugs to provide a reference. Method for elective surgery under general anesthesia 80 patients, ASA Ⅰ ~~ Ⅱ grade. Single dose of lean body mass the ROC dose, according to dose different: R1 group (go fat fat per kilogram body weight 0.15mg 0.15mg/kg), R2 (0.2mg/kg) were randomly divided into R3 group (0.3mg/kg), R4 (0.4mg/kg), 20 cases each. Anesthesia induced by intravenous injection of propofol and fentanyl. HXD-Ⅰ the multifunctional monitor in force - shift the transducer neuromuscular monitoring, stimulation of the ulnar nerve, adductor pollicis muscle of four clusters of stimulation (TOF) in the first twitch response (T1) The maximum percentage of inhibition, and its probability units conversion, single ROC dose on the digital conversion, to establish the dose-response regression equation by linear regression methods, and calculate the ROC ED50 of ED75, ED90, the ED95 values; record ROC onset time . SPSS13.0 statistical software for data analysis. All measurement data were expressed as mean ± standard deviation, the line of homogeneity of variance test. In general, T1 suppression value, onset time using one-way ANOVA. P lt; 0.05 difference was statistically significant. Outcomes for patients with general difference was not statistically significant (P gt; 0.05); the T1 maximum percentage inhibition with ROC dose increases (F = 102.029, P = 0.000); no statistically significant difference between the onset time of each dose group (F = 1.593, P = 0.198); ROC press the administration of lean body mass the ED50, ED75, ED90 (ED50), ED95 respectively 0.19,0.27,0.36,0.43 mg / kg. Conclusion single dose method measured lean body mass administration ROC ED50, ED75, ED90 (ED50), ED95 0.19,0.27,0.36,0.43 mg / kg; increase the amount of the ROC does not accelerate the onset of less than 1 times the ED95 time. The second part of ROC lean body mass and body weight administered pharmacodynamic comparative research purposes ROC according to body weight and lean body mass administration of clinical efficacy and individual differences. Method 80 cases of patients undergoing elective surgery under general anesthesia, ASA Ⅰ - Ⅱ grade, dose calculation method randomly divided into body the restructuring (W group) and go to the fat body the reorganization (L group), 40 patients in each induction of general anesthesia. Intravenous propofol 2mg/kg, the fentanyl 3μg/kg, ROC 0.86mg/kg (2 times the administration ED95 of lean body mass, L group) or 0.6mg/kg (2 times the body weight administered ED95, W group). TOF way to monitor the degree of neuromuscular blockade (NMB), T1 up to a minimum when the trachea was intubated. To maintain the anesthetic propofol plasma concentrations of 3 ~ 4μg/ml and intermittent intravenous fentanyl. Recorded before induction of anesthesia (TO), given muscle relaxants 5min (T1), 15min (T2), 30 min (T3), 45min (T4), 1h (T5) when MAP and HR; records intubating conditions, since The onset time T1 maximum degree of inhibition, clinical duration of action, recovery index, the pharmacological effects of time. SPSS13.0 software package for processing. The measurement data are expressed as mean ± standard deviation, the line of homogeneity of variance test. General Information, groups of MAP, HR, T1 maximal inhibition, onset time, clinical duration of action, pharmacological effects, recovery index and muscle relaxant dosages using two independent samples t-test. MAP, HR group using a repeated measures analysis of variance using the Greenhouse e-Geisser correction coefficient value does not satisfy the spherical assumption. Intubating conditions using two independent samples nonparametric tests (Mann-whitney U test). T1 maximal inhibition of the onset time, clinical duration of action, pharmacological effects of time, recovery index and the amount of variability u test. P lt; 0.05 difference was statistically significant. Results In general, hemodynamic changes, intubation conditions, muscle relaxant effect differences were not statistically significant (P gt; 0.05); the muscle relaxants dosages difference was statistically significant (P lt; 0.05), L group less medication in the W group. Between the two groups T1 maximal inhibition, onset time, recovery index the variability dosage differences were not statistically significant (P gt; 0.05); comparison with the W group, the clinical role of time (u = 2.0011, P lt; 0.05) and The pharmacological effects of time (u = 2.1273, P lt; 0.05) difference degree of variability differences were statistically significant, the small differences between different individuals. Conclusions lean body mass using ROC can reduce their arrest aging individual differences, and to reduce the dosage of muscle relaxants. The third part of rocuronium in patients with different gender single injection method to establish the purpose of adoption of lean body mass administration dose-effect relationship of lean body mass administered dose - response curve, the ROC at lean body mass to determine the different sex patients ROC drug dose-effect relationship and ED95 values, to provide a reference for clinical research and application of the ROC. The method of general anesthesia for elective surgery 80 patients, 40 cases of men and women, ASA Ⅰ ~ Ⅱ grade. Single dose method to calculate ROC dose lean body mass, male and female patients were divided according to dose different random: R1 group (per kilogram of lean body mass 0.15mg 0.15mg/kg), R2 (0.2mg/kg ), R3 (0.3mg/kg), R4 (0.4mg/kg), 10 cases in each group. Anesthesia induced by intravenous injection of propofol and fentanyl. HXD-Ⅰ the multifunctional monitor in force - shift the transducer neuromuscular monitoring, stimulation of the ulnar nerve, adductor pollicis muscle of four clusters of stimulation (TOF) in the first twitch response (T1) The maximum percentage of inhibition, and its probability units conversion, single ROC dose on the digital conversion, the application of linear regression method to establish the dose-response regression equation, and calculates the ROC ED50 of ED75, ED90, the ED95 values; record ROC onset time . SPSS13.0 statistical software analysis. All measurement data were expressed as mean ± standard deviation, the line of homogeneity of variance test. In general, T1 suppression value, onset time using one-way ANOVA. P lt; 0.05 difference was statistically significant. Results onset time of the general situation of men and women in some patients the differences were not statistically significant (p gt; 0.05); maximum percentage inhibition with the dose of the male patient group T1 plus the increase (F = 40.856, P = 0.000); since each dose group The difference was not statistically significant (F = 0.733, P = 0.539); male patients ROC administration of lean body mass the ED50, ED75, ED90 (ED50), ED95 were 0.18,0.27,0.38 and 0.46 mg / kg. Plus the T1 maximum inhibition percentage of female patients with dose increases (F = 73.024, P = 0.000); onset time between each dose group the difference was not statistically significant (F = 2.339, P gt; 0.05); female patients with ROC press ED50, ED75, ED90, ED95 lean body mass administration were 0.20,0.26,0.35 and 0.40 mg / kg. Conclusion single dose administration measured lean body mass was male patients ROC press the lean body mass administration of the ED50, ED75, ED90 (ED50), ED95 were 0.18,0.27,0.38 and 0.46 mg / kg, female patients ROC go fat weight administered ED50, ED75, ED90 (ED50), ED95 were 0.20,0.26,0.35 and 0.40mg/kg; increase the amount of the ROC does not accelerate the onset time less than 1 times the ED95. The fourth part of the male patients rocuronium lean body mass and body weight administered pharmacodynamic comparative research purposes Comparison of male patients with ROC by weight and lean body mass administration of clinical efficacy and individual differences. Method 40 cases of patients undergoing elective surgery under general anesthesia, ASA Ⅰ Ⅱ grade, dose calculation methods were randomly divided into lean body recombination (ML group) and body recombination (MW group), 20 patients in each. Intravenous propofol 2mg/kg, the fentanyl 3μg/kg, ROC 0.6mg/kg (2 times the body weight administered ED95 MW group) or 0.92mg/kg (2 times the men lean body mass administration ED95 ML group); to TOF way of monitoring neuromuscular blockade (NMB) the extent, T, minimum, endotracheal intubation. Target-controlled infusion of propofol of 3 ~ 4μg/ml and anesthesia was maintained with intermittent intravenous fentanyl. Recorded before induction of anesthesia (TO), given muscle relaxants 5min (T1), 15min (T2), 30 min (T3), 45min (T4), 1h (T5) when MAP and HR; records intubating conditions, since The onset time T1 maximum degree of inhibition, clinical duration of action, recovery index, the pharmacological effects of time. Data is statistically the same as the second part. Results of the general male patient group, hemodynamic changes, intubation conditions, muscle relaxant effect differences were not statistically significant (P gt; 0.05); muscle relaxant drug dosage differences with statistical significance (P lt; 0.05) ML group medication less than the MW group; between the two groups of male patients with T1 maximal inhibition onset time, recovery index, the the dosage variability differences were not statistically significant (P gt; 0.05); and MW group comparison, clinical role time (u = 3.015, P lt; 0.05) and the pharmacological effects of time (u = 3.654, P lt; 0.05) variability difference was statistically significant differences between different individuals within a group smaller. Conclusion male patients using ROC lean body mass can reduce its clinical role of time and the time of the pharmacological effects of individual differences in male patients lean body mass administration to reduce the dosage of muscle relaxants. Rocuronium, the fifth part of the female patients comparing female patients ROC lean body mass and body weight administered pharmacodynamic comparative research purposes according to body weight and lean body mass administration of clinical efficacy and individual differences. General with the fourth part of the results of female patients, hemodynamic changes, intubation conditions, the effects of muscle relaxants, dosage differences were not statistically significant (P gt; 0.05); female patients between the two groups T1 maximal inhibition onset time, recovery index, dosage variability difference was not statistically significant (P gt; 0.05); comparison with the FW group clinical duration of action (u = 3.272, P lt; 0.05) and the pharmacological effects of time (u = 3.689, P lt; 0.05) the variability difference was statistically significant, the differences between the different individuals in the group is small. Conclusion female patients can be reduced by lean body mass using ROC clinical duration of action and pharmacological effects of individual differences in time, women patients with muscle relaxant dosage according to body weight administered compare the difference was not statistically significant.

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