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包括欧美目前的文献,RSI诱导用肌松,仍然首选司可林。罗库溴铵虽然也有快速起效的特点,但不具备快速消退的特点,对于可能存在的困难气道,一旦插管不能成功,快速回复自主呼吸和气道通畅,司可林比罗库溴铵更有利。另外,从经济学看,司可林也具备一定的优势。新任麻醉主委于教授曾经探讨过非去极化取代去极化肌松的问题,但到目前为止,使用司可林插管的还是大有人在!麻省7版、miller7版也没有建议取缔司可林!以下是miller7版在产科RSI诱导的描述:After the drapes are applied and the surgeon is ready, initiate a rapid-sequence induction with thiopental, 4.0-5.0 mg/kg, and succinylcholine, 1.0-1.5 mg/kg. Apply cricoid pressure and continue until correct position of the endotracheal tube is verified and the cuff is inflated. In hypotensive crises, ketamine, 1.0-1.5 mg/kg, should be substituted for thiopental. A defasciculating dose of muscle relaxant is not necessary.司可林1-1.5mg/kg!有文献支持1倍ED95剂量的司可林就可以完成插管! |
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