Age related variability in the effects of mivacurium in paediatric surgical patients

Brandom, Barbara W.; Meretoja, O. A.; Simhi, Eliahu; Taivainen, T.; Wolfe, Steven R.; Woelfel, S. K.; Gronert, Brian J.; Cook, David

doi:10.1007/bf03012575

Cited by 15 publications

(13 citation statements)

References 19 publications

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“…We did not find any geographical variation for mivacurium. This confirms earlier observations and is different from vecuronium where transatlantic differences were seen .…”

Section: Discussionsupporting

confidence: 88%

A systematic review and meta-regression analysis of mivacurium for tracheal intubation

et al. 2014

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SummaryWe systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.

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“…We did not find any geographical variation for mivacurium. This confirms earlier observations and is different from vecuronium where transatlantic differences were seen .…”

Section: Discussionsupporting

confidence: 88%

A systematic review and meta-regression analysis of mivacurium for tracheal intubation

et al. 2014

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“…In the present study similar spontaneous recovery was observed in the two groups, and our results are comparable to 15–20 min for T 90 of Goudsouzian's review article [3]. Furthermore, our T 25 values are longer than those obtained with 300 μg/kg of mivacurium under nitrous oxide-halothane or nitrous oxide-opioid anesthesia [15]. These considerations suggest that isoflurane does affect the spontaneous recovery similar to or higher than other anesthetic techniques.…”

Section: Discussionsupporting

confidence: 88%

Effect of mivacurium 200 and 250 μg/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]

et al. 2001

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Background: Infants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 µg/kg results in faster onset of action than 200 µg/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated.

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“…The degree of block was measured as a percentage at 90 s. More intense block was obtained in infants than in older children and those with more intense block were more likely to have intubating conditions scored as`excellent'. 23 Rapacuronium 0.9 mg kg ±1 produces 100% block in children in 62 s with no adverse haemodynamic effect. 62 No data have been reported as yet for the chlorofumarates or the tropinyl diesters regarding the effect of age on their pharmacology.…”

Section: Response Of Different Muscle Groupsmentioning

confidence: 99%

The new neuromuscular blocking agents: do they offer any advantages?

Moore

Hunter²

2001

British Journal of Anaesthesia

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The pharmacodynamics and pharmacokinetics of the two most recent aminosteroid neuromuscular blocking drugs to become available, rapacuronium bromide (Org 9487) and rocuronium bromide are reviewed. Two new classes of drug with neuromuscular blocking properties, the bis-tetrahydroisoquinolinium chlorofumarates and the tropinyl diester derivatives are introduced. Comparisons between these drugs and mivacurium and cisatracurium are made. Rapacuronium 1.5 mg kg(-1) (ED95 1 mg kg(-1)), produces maximal neuromuscular block in 54 s. Time to recovery of the train-of-four ratio to 0.7 is achieved within 20 min after neostigmiine 0.05 mg kg(-1) given at 2 min. The plasma clearance of rapacuronium is 7-8 ml kg(-1) min(-1). Rapacuronium undergoes hepatic metabolism: no prolongation of effect has been reported after a single bolus or a short infusion in patients with hepatic or renal failure. Org 9488 is the 3-desacetyl metabolite of rapacuronium, which has neuromuscular blocking properties. Its much lower clearance (1.28 ml kg(-1) min(-1)) and plasma equilibration constant (0.105 min(-1)) may limit the prolonged use of rapacuronium. Rocuronium given at 2xED95 produces maximal neuromuscular block in 1 min. Spontaneous recovery of the train-of-four ratio to 0.7 takes over 40 min. Rocuronium has a plasma clearance of 4 ml kg(-1) min(-1). Its pharmacodynamics are altered in hepatic and renal disease. A number of anaphylactoid reactions to rocuronium have been reported recently. The bis-tetrahydroisoquinolinium chlorofumarate GW280430A has an ED95 of 0.19 mg kg(-1). Given at three times this dose, onset of neuromuscular block occurs within 100 s; the duration of block is 8-9 min. Following a 2 h infusion, the recovery index does not seem to be increased. Early studies suggest that this drug has no adverse cardiovascular or respiratory side-effects. The tropinyl diester derivative G-1-64 will produce 80-90% neuromuscular block in less than 2 min using 3xED80. Ninety per cent recovery of the first twitch of the train-of-four occurs after 5-7 min using one ED80. A recovery index of less than 2 min has been reported in rats. All the tropinyl diesters appear to produce vagal block.

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Age related variability in the effects of mivacurium in paediatric surgical patients

Cited by 15 publications

References 19 publications

A systematic review and meta-regression analysis of mivacurium for tracheal intubation

A systematic review and meta-regression analysis of mivacurium for tracheal intubation

Effect of mivacurium 200 and 250 μg/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]

The new neuromuscular blocking agents: do they offer any advantages?

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