Clinical Pharmacology of Mivacurium Chloride (BW B1090U) in Children During Nitrous Oxide-Halothane and Nitrous Oxide-Narcotic Anesthesia

Sarner, J. B.; Brandom, Barbara W.; Woelfel, S. K.; Dong, M L; Horn, Michael; Cook, David; McNulty, Barbara; Foster, Vicki J.

doi:10.1213/00000539-198902000-00009

Cited by 63 publications

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“…However, a Canadian group of pediatric anesthesiologists found similar neuromuscular effects of mivacurium in patients aged between 2 mo. to 10 yr. [19,20], supporting our results.…”

Section: Discussionsupporting

confidence: 90%

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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“…However, a Canadian group of pediatric anesthesiologists found similar neuromuscular effects of mivacurium in patients aged between 2 mo. to 10 yr. [19,20], supporting our results.…”

Section: Discussionsupporting

confidence: 90%

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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“…It is equivalent to four times the ED50 of mivacurium. 13 The onset of block after 0.2 mg·kg -1 mivacurium, was slower than after rapacuronium in this study, but would 2 or 3 mg·kg -1 rapacuronium produce block faster than mivacurium 0.3 mg? In a larger study of mivacurium the time to 90% block was found to be related to age, from an average of 1.0 minute at one month of age to 2.3 minutes at 12.5 yr of age.…”

Section: Discussionmentioning

confidence: 50%

Neuromuscular effects of rapacuronium in pediatric patients during nitrous oxide-halothane anesthesia: comparison with mivacurium

Brandom

Margolis

Bikhazi

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To describe neuromuscular effects of rapacuronium in pediatric patients during N 2 O-halothane anesthesia and compare them with mivacurium in children.Methods: 103 pediatric patients, seven days -12 yr, received rapacuronium or mivacurium during N 2 O-halothane anesthesia. Onset and recovery of block were measured using EMG (Datex). Block was compared between groups based on drug treatment and age. Children < two years received 1 or 2 mg·kg Results: There were no differences in onset (1.7 ± 1.8 min) or maximum block (T1 2.4 ± 8%) among neonates, infants, and toddlers after either dose of rapacuronium. There was no difference between 1 and 2 mg·kg , produced maximum block 1.5 min earlier than did mivacurium, 0.2 mg·kg -1 (P < 0.001). There was no difference in block at 60 sec, maximum block or time to maximum block between 2 and 3 mg·kg -1 rapacuronium for children > two years of age. Maximum block occurred 1.0 ± 0.5 min after 2 or 3 mg·kg -1 when T1 was 0.2 ± 1.1% of baseline. T25 and T4/T1 > 0.7 occurred 10 to 11 min later after this dose of rapacuronium than after mivacurium.Conclusion: Rapacuronium produces block earlier than mivacurium. Recovery from rapacuronium block is dose related and slower than that following mivacurium during halothane anesthesia.Objectif : Décrire les effets neuromusculaires du rapacuronium pendant l'anesthésie avec N 2 O et halothane et les comparer avec ceux du mivacurium chez des enfants.Méthode : Cent trois enfants, de 7 jrs à 12 ans, ont reçu du rapacuronium ou du mivacurium pendant une anesthésie avec N 2 O et halothane. Le début et la fin du bloc ont été mesurés à l'aide de l'EMG (Datex). Le bloc a été comparé sur la base du traitement médicamenteux et de l'âge. Les enfants < 2 ans ont reçu 1 ou 2 mg·kg Résultats : Le rapacuronium, peu importe la dose administrée et l'âge des patients, n'a pas présenté de différence quant au début d'action (1,7 ± 1,8 min) du bloc ou au temps du bloc maximal (T1 2,4 ± 8 %). À 60 s, les blocs provoqués par 1 et 2 mg·kg de rapacuronium a produit le bloc maximal 1,5 min plus tôt que celle de 0,2 mg·kg -1 (P < 0,001) de mivacurium. Il n'y a pas eu de différence de bloc à 60 s, de temps pour le bloc maximal ou de temps pour atteindre ce bloc maximal chez les enfants > 2 ans qui ont reçu 2 et 3 mg·kg -1 de rapacuronium. Le bloc maximal a été noté 1,0 ± 0,5 min après 2 ou 3 mg·kg -1 quand T1 était à 0,2 ± 1,1 % de la mesure de base. T25 et T4/T1 > 0,7 sont survenus de 10-11 min plus tard après cette dose de rapacuronium qu'après le mivacurium.Conclusion : Le rapacuronium agit plus rapidement que le mivacurium. Pendant l'anesthésie avec de l'halothane, le renversement du bloc suivant l'utilisation de rapacuronium est relié à la dose et est plus lent que celui qui suit le mivacurium.

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“…O u r study protocol precluded us from using a dose of mivacurium greater than the maximum recommended for children in the current data sheet (0.2 mg.kg-I) [21]. However, higher doses have been studied in children and found t o produce a faster onset of neuromuscular blockade with no significant changes in heart rate or blood pressure [5]. Times t o 90% and 100% block following mivacurium 0.25 mg.kg-' were 1.1 and 1.6 rnin respectively, compared with 1.3 and 1.9 min in the present study.…”

Section: Discussionmentioning

confidence: 99%

Dose—response and minimum time to satisfactory intubation conditions after mivacurium in children

McCluskey

Meakin²

1996

Anaesthesia

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SummaryWe assessed neuromuscular blocking effects and tracheal intubation conditions following mivacurium in 121 anaesthetised children aged 1-10 years. The study was conducted in three parts. Parts Key wordsAnaesthesia; paediatric. Intubation; tracheal. Neuromuscular relaxants: mivacurium.Mivacurium is a newer non-depolarising neuromuscular blocking drug with a short duration of action due to its rapid metabolism by plasma cholinesterase [I, 21. In view of its short duration of action, mivacurium may be an alternative to suxamethonium for brief surgical procedures requiring profound muscle relaxation [3-51. While several authors have quantified the neuromuscular blocking effects of mivacurium in children in terms of twitch depression [5-71, there have been no studies to assess the minimum time to achieve satisfactory intubation conditions. Therefore, we undertook the present study to determine the dose-response relationship of mivacurium in children and compare intubation conditions at selected times following a dose of approximately 2 x EDss. Patients and methodsFollowing approval by the local ethics committee and informed parental consent, 61 children aged 1-10 years scheduled to undergo elective general anaesthesia with tracheal intubation were studied. All were ASA physical status 1 or 2 and none were taking drugs known to interfere with neuromuscular transmission. Children whose body weight deviated by more than 20% from the ideal for their height were not studied.All children were premedicated with oral midazolam syrup 0.5 mg.kg -I 3 M O min pre-operatively and EMLA cream was applied to possible venepuncture sites. The study was conducted in three parts: (1) determination of the dose-response relationship; (2) measurement of onset and recovery times after a dose of mivacurium approximately equal to twice the EDss; (3) assessment of intubation conditions at either 60 or 90 s after the same dose of mivacurium.In the first part of the study, anaesthesia was induced in 15 children with thiopentone 6-8 mg.kg-I and alfentanil 50 pg.kg -'. Tracheal intubation was performed after 1 min without using a muscle relaxant.

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Clinical Pharmacology of Mivacurium Chloride (BW B1090U) in Children During Nitrous Oxide-Halothane and Nitrous Oxide-Narcotic Anesthesia

Cited by 63 publications

References 0 publications

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

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

Neuromuscular effects of rapacuronium in pediatric patients during nitrous oxide-halothane anesthesia: comparison with mivacurium

Dose—response and minimum time to satisfactory intubation conditions after mivacurium in children

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