The cardiovascular effects of mivacurium chloride (BW B1090U) in patients receiving nitrous oxide-opiate-barbiturate anesthesia

• Published in: Anesthesiology (Philadelphia) 1989-03, Vol.70 (3), p.386-394
• Main Authors: SAVARESE, J. J, ALI, H. H, BASTA, S. J, SCOTT, R. P. F, EMBREE, P. B, WASTILA, W. B, ABOU-DONIA, M. M, GELB, C
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analgesics, Opioid; Anesthesia, General; Anesthetics. Neuromuscular blocking agents; Barbiturates; Biological and medical sciences; Blood Pressure - drug effects; Clinical Trials as Topic; Dose-Response Relationship, Drug; Flushing - etiology; Heart Rate - drug effects; Histamine - blood; Humans; Isoquinolines; Medical sciences; Middle Aged; Mivacurium; Nerve Block; Neuromuscular Nondepolarizing Agents - pharmacology; Neuropharmacology; Nitrous Oxide; Pharmacology. Drug treatments
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-198903000-00003

The dose-effect relationship of mivacurium chloride on arterial blood pressure, heart rate, and plasma histamine was determined in 97 consenting ASA physical status I-II patients receiving nitrous oxide-oxygen-opiate-barbiturate anesthesia. In the absence of surgical stimulation during steady state anesthetic conditions with controlled ventilation, average maximum change in tachograph-counted heart rate was 7% or less after 10-15-s injection of mivacurium at all doses from 0.03 to 0.30 mg/kg. Average peak change in mean arterial pressure measured via radial arterial catheter was 7% or less after all doses from 0.03 to 0.15 mg/kg. Transient (0.2-4.5 min) decreases in arterial blood pressure were noted after 10-15-s injection in some patients at 0.20, 0.25, and 0.30 mg/kg. When they occurred, these changes were usually accompanied by facial erythema lasting 2-5 min and were correlated with increases in plasma histamine level (P less than 0.001). Facial erythema, decrease in blood pressure, and elevation of histamine level were all accentuated by increasing the dose of mivacurium and by more rapid injection of the drug. For example, mean blood pressure decreased an average of 13% after injection of mivacurium 0.25 mg/kg over 10-15 s. In contrast, during administration over 30 and 60 s of this dose, arterial pressure decreased 7.6 and 1.5%, respectively (P less than 0.001, 10-15 s vs. 60-s injection). Average peak histamine level, which increased to 132% of control after administration of 0.25 mg/kg over 10-15 s, did not change after injection over 60 s.