Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium

• Published in: Anaesthesia 1993-11, Vol.48 (11), p.940-945
• Main Authors: MADDINENI, V.R., MIRAKHUR, R.K., McCOY, E.P., FEE, J.P.H., Clarke, R.S.J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Dose-Response Relationship, Drug; Female; Humans; Intubation; Intubation, Intratracheal; Isoquinolines; Male; Medical sciences; Middle Aged; Mivacurium; Neuromuscular Nondepolarizing Agents; Neuromuscular relaxants; Neuropharmacology; Pharmacology. Drug treatments; Succinylcholine; suxamethonium; Time Factors; tracheal
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.1993.tb07469.x

Summary Mivacurium chloride has been assessed in respect of intubating conditions and neuromuscular effects. The influence of suxamethonium on the onset and duration of subsequently administered mivacurium was also studied. A dose of 0.15 mg.kg−1 of mivacurium was found to provide unacceptable intubating conditions at 2 min in 9/9 patients and further studies were conducted using 0.2 mg.kg−1. Intubating conditions with this dose were acceptable in 65% and 80% of patients at 2 min and 2.5 min respectively. In comparison, intubating conditions were acceptable in 100% of patients at 1 min following 1 mg.kg−1 of suxamethonium. The onset of block occurred in 96 s and 97 s after 0.15 mg.kg−1 and 0.2 mg.kg−1 respectively, and the durations of block in terms of recovery of the first twitch (T1) to 25% and 90% of control, and to recovery of train‐of‐four ratio to 0.7, were 16.1 and 17.9; 24.1 and 25.8; and 24.2 and 27.0 min respectively with the two doses. The time for the onset of complete block with suxamethonium 1.0 mg.kg−1 was 50 s and the times to 25% and 90% recovery were 9.8 min and 13.3 min. The differences between suxamethonium and both doses of mivacurium were significant (p < 0.05) but there were no significant differences between the two doses of mivacurium in any of the neuromuscular measurements. Prior administration of suxamethonium had no influence on the effects of mivacurium. Cutaneous flushing was observed in 30 out of 75 patients but this was associated with transient hypotension in only two patients. Our results show mivacurium to have a duration of action approximately half that of comparable doses of the intermediate acting relaxants atracurium and vecuronium.