Purpose: Mivacurium, the shortest-acting benzylisoquinoline nondepolarizing neuromuscular blocker used in clinical practice, is suitable for short-term ambulatory operations under general anesthesia. We investigated the neuromuscular blockade effect of different maintenance doses of mivacurium during ambulatory vitreoretinal surgery under general anesthesia and tried to determine the appropriate maintenance dose.
Patients and Methods: Ninety-nine patients undergoing general anesthesia for elective ambulatory vitreoretinal surgery were randomly divided into three groups using the random number table method. Patients received three maintenance doses of mivacurium during surgery as follows: 3 μg/(kg·min) in group M1 (n = 33), 6 μg/(kg·min) in group M2 (n = 33), and 9 μg/(kg·min) in group M3 (n = 33). The primary outcome was the time from mivacurium withdrawal to a train-of-four stimulation ratio (TOFr) ≥ 0.9, and the secondary outcomes were the time from mivacurium withdrawal to TOFr ≥ 0.7, extubation time, incidence of TOFr < 0.9 after surgery and neuromuscular block effect.
Results: The time from mivacurium withdrawal to TOFr ≥ 0.9 and to TOFr ≥ 0.7 was significantly longer in group M3 than in groups M1 and M2 (25.6± 7.2 min vs 16.4± 5.9 min and 18.6± 5.3 min, P < 0.001; 22.1± 6.3 min vs 13.6 ± 5.8 min and 15.5 ± 4.8 min; P < 0.001, respectively). There was a significant difference in the extubation time, the incidence of TOFr < 0.9 during extubation and upon leaving the operating room between group M3 and group M1 (all P < 0.05), but there was no such significant difference between group M2 and group M1 (all P > 0.05). The intraoperative depth of neuromuscular blockade in the three groups was significantly different, with 69.7% shallow block in group M1, 75.8% moderate block in group M2 and 63.6% deep block in group M3 (P < 0.001). One patient in group M1 experienced slight body movement during the operation.
Conclusion: An intraoperative continuous infusion of 6 μg/(kg·min) mivacurium can not only achieve good postoperative recovery but also provide a satisfactory neuromuscular blockade effect during surgery, and this maintenance dose is suitable for neuromuscular blockade during ambulatory vitreoretinal surgery.

Keywords: mivacurium, vitreoretinal surgery, neuromuscular blocking agents, neuromuscular monitoring, postoperative period


中文翻译：

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全麻下动态玻璃体视网膜手术中连续输注米库溴铵的 3 种比率比较：一项前瞻性、随机、对照临床试验

目的：米瓦库铵是临床上使用的最短效的苄基异喹啉非去极化神经肌肉阻滞剂，适用于全身麻醉下的短期门诊手术。我们研究了全麻下动态玻璃体视网膜手术期间不同维持剂量米库溴铵的神经肌肉阻滞作用，并试图确定合适的维持剂量。
患者和方法：采用随机数字表法将99例因择期非卧床玻璃体视网膜手术行全身麻醉的患者随机分为三组。患者在手术过程中接受了以下三个维持剂量的米瓦库溴铵：M1组（n = 33）3μg/（kg·min），M2组（n = 33）6μg/（kg·min）和9μg/ (kg·min) 在 M3 组 (n = 33)。主要结局是从停药到四组刺激比 (TOFr) ≥ 0.9 的时间，次要结局是从停药到 TOFr ≥ 0.7 的时间、拔管时间、术后 TOFr < 0.9 的发生率和神经肌肉阻滞作用。
结果：M3组从停药到TOFr≥0.9和TOFr≥0.7的时间明显长于M1和M2组（25.6±7.2 min vs 16.4±5.9 min和18.6±5.3 min，P < 0.001；22.1±6.3 min vs 13.6 ± 5.8 分钟和 15.5 ± 4.8 分钟；分别为P < 0.001）。M3组与M1组拔管时间、拔管时及离开手术室时TOFr<0.9的发生率差异有统计学意义（均P <0.05），但M2组与M1组无显着性差异（所有P> 0.05)。三组术中神经肌肉阻滞深度差异有统计学意义，M1组浅部阻滞率为69.7%，M2组为中度阻滞率为75.8%，M3组为深部阻滞率为63.6%（P <0.001）。M1组1例患者在手术过程中出现轻微肢体移动。
结论：术中连续输注6 μg/(kg·min)米瓦库铵不仅术后恢复良好，而且术中神经肌肉阻滞效果满意，该维持剂量适用于动态玻璃体视网膜手术中的神经肌肉阻滞。

关键词：米瓦库铵，玻璃体视网膜手术，神经肌肉阻滞剂，神经肌肉监测，术后期