Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults

Abstract

Purpose: Mivacurium-rocuronium combinations have been demonstrated to be more potent than either drug given alone. Combinations were compared with mivacurium and rocuronium, with respect to onset, intubating conditions, and duration of action in young and elderly adults.Methods: Fentanyl-propofol-N 2 O-isoflurane anesthesia was given to ASA I and II adults aged 18-65 yr (45 patients) and over 66 yr (45 patients). In this blinded randomized study, we compared accelerographic adductor pollicis response and visual assessment of response to facial nerve stimulation after 0.25 mg·kg -1 mivacurium, 0.6 mg·kg -1 rocuronium, and a combination of 0.08 mg·kg -1 mivacurium plus 0.2 mg·kg -1 rocuronium. Intubating conditions at 2.5 min were rated as excellent, good, fair or poor.Results: Onset times were similar for all drugs regimens and for both age groups (204-276 sec at the thumb; 142-196 sec at the eye) (P < 0.05 between muscles). Intubating conditions were similar in all groups, and rated good or excellent, except in two subjects. In young patients duration to 25% recovery was longer (P < 0.05) for rocuronium (mean ± SD) (39 ± 11 min) than for either mivacurium (23 ± 6 min), or the combination (27 ± 7 min). Duration was prolonged in the elderly for rocuronium (54 ± 17 min), and the combination ( 35 ± 11 min), but not for mivacurium (24 ± 6 min).Conclusions: Mivacurium-rocuronium combinations yield onset times and intubating conditions similar to either parent agent with only two thirds as much total drug. Duration for such a mixture is similar to that of mivacurium in young adults and slightly prolonged in the elderly.Objectif : Le mélange de rocuronium et de mivacurium est plus puissant que l'un ou l'autre de ses composants donné seul. On a comparé ce mélange au mivacurium et au rocuronium quant au délai d'installation, aux conditions d'intubation et à la durée d'action chez des adultes jeunes et âgés.Méthode : Une anesthésie au fentanyl, propofol, N 2 O et isoflurane a été administrée à 45 patients de 18 à 65 ans et à 45 sujets de plus de 65 ans. De façon randomisée et aveugle, on a comparé la réponse accélérographique de l'adducteur du pouce et l'évaluation visuelle de la réponse à la stimulation du nerf facial après 0,25 mg·kg -1 de mivacurium, 0,6 mg·kg -1 de rocuronium ou un mélange de 0,08 mg·kg -1 de mivacurium et 0,2 mg·kg -1 de rocuronium. Les conditions d'intubation à 2,5 min ont été classifiées comme excellentes, bonnes, passables ou inadéquates.Résultats : Les délais d'installation étaient semblables pour tous les myorelaxants et pour les deux groupes d'âge (204-276 sec au pouce, 142-196 sec près de l'oeil (P < 0,05 entre les muscles). Les conditions d'intubation étaient semblables dans tous les groupes et cotées bonnes ou excellentes, excepté chez deux sujets. Chez les jeunes, la durée d'action jusqu'à 25 % de récupération était plus longue (P < 0,05) pour le rocuronium (moyenne ± ET) (39 ± 11 min) que pour le mivacurium (23 ± 6 min), ou le mélange (27 ± 7 min). Chez les sujets âgés, la durée était prolo...

Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium

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Efficacy, Safety, and Pharmacokinetics of Sugammadex for the Reversal of Rocuronium-induced Neuromuscular Blockade in Elderly Patients

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

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