Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane

Wołoszczuk-Gębicka, Bogumiła

doi:10.1046/j.1460-9592.2002.00901.x

Cited by 9 publications

(8 citation statements)

References 52 publications

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“…In infants and children, the clinical duration of surgical relaxation would last approximately 20–35 min and complete recovery of neuromuscular function about one hour when 1.5 times ED95 dose of an intermediate‐acting muscle relaxant is used during intravenous anesthesia (53). Inhalation anesthetics intensify the effects of non‐depolarizing muscle relaxants in a clear time‐dependent way so that the maximal effects are reached only within one hour and faster in younger than in older children (54,55). During spontaneous recovery from NMB, the muscle relaxant molecules are eliminated via metabolism or spontaneous breakdown, or excreted via kidneys.…”

Section: Basic Pharmacology Of Reversalmentioning

confidence: 99%

Neuromuscular block and current treatment strategies for its reversal in children

Meretoja

2010

Pediatric Anesthesia

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Even though neuromuscular blocking agents are an essential part of balanced anesthesia and the risks of residual paralysis are well documented, many anesthetists seldomly monitor neuromuscular block. Classical reversal agent neostigmine is unable to antagonise a deep neuromuscular block and is rather slow to antagonise even a moderate block. These caveats may have introduced a practice to use muscle relaxants mainly for an endotracheal intubation. This review presents current views on the effects of muscle relaxants and their reversal agents in pediatric patients. This may help clinicians to reconsider the value of muscle relaxants during anesthesia in children.

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Section: Basic Pharmacology Of Reversalmentioning

confidence: 99%

Neuromuscular block and current treatment strategies for its reversal in children

Meretoja

2010

Pediatric Anesthesia

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“…In Germany, mivacurium is predominantly used for pediatric anesthesia [2]. Mivacurium has insignificant accumulation, which results in rapid spontaneous recovery from the neuromuscular blockade and does not significantly change cardiocirculatory parameters in pediatric patients [3, 4]. The use of reversal agent after administration of mivacurium in normal patients is not necessary due to the rapidity of spontaneous recovery [5].…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of mivacurium in pediatric patients

et al. 2017

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BackgroundMivacurium is the shortest acting nondepolarizing muscle relaxant currently available; however, the effect of different dosages and injection times of intravenous mivacurium administration in children of different ages has rarely been reported. This study was aimed to evaluate the muscle relaxant effects and safety of different mivacurium dosages administered over different injection times in pediatric patients.MethodsSix hundred forty cases of pediatric patients, aged 2 m-14 years, ASA I or II, were divided into four groups (Groups A, B, C, D) according to the age class (2–12 m, 13–35 m, 3–6 years and 7–14 years) respectively, also each group were divided into four subgroups by induction dose (0.15, 0.2 mg/kg in 2–12 m age class; 0.2, 0.25 mg/kg in other three age classes), and mivacurium injection time (20 s, 40 s), totally 16 subgroups. Neuromuscular transmission was monitored with supramaximal train-of-four stimulation of the ulnar nerve. Radial artery blood (1 ml) was sampled to quantify plasma histamine concentrations before and 1, 4, and 7 min after mivacurium injection (P0, P1, P2 and P3).ResultsFive hundred sixty-two cases completed the study. There were no demographic differences within the four groups. The onset time of 0.2 mg/kg groups in 2–12 m aged patients were shorter than those of 0.15 mg/kg groups (189 ± 64 s vs. 220 ± 73 s, 181 ± 60 s vs. 213 ± 71 s, P <0.05), and the recovery times were no statistical differences. The T1 25% recovery time of 0.2 mg/kg in 3–6 years aged patients was shorter than that of 0.25 mg/kg group (693 ± 188 s vs. 800 ± 206 s, P <0.05). The onset and recovery times of mivacurium were not different in 13–35 m and 7–14 years aged patients. The plasma concentrations of histamine at P0, P1, P2 and P3 were not different within four groups.ConclusionsThe induction dose and injection time of mivacurium had mostly insignificant effects on onset and recovery times. The main exception to this was that in 2–12 m aged patients, increasing the dose of mivacurium from 0.15 to 0.2 mg/kg accelerated the onset time by about 30 s. Mivacurium produced no significant release of histamine in any age group at the doses studied.Trial registrationClinicalTrials.gov Identifier-NCT02117401, July 14, 2014. (Retrospectively registered)

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“…It has insignificant accumulation and an almost constant rate of recovery irrespective of the total dose administered and mode of administration, bolus or infusion. This makes it well suited for continuous infusion and for maintenance of neuromuscular block during extended surgical procedures of unpredictable length [17] . The usual intubating dose of mivacurium is 0.15-0.2 mg ؒ kg -1 .…”

Section: Discussionmentioning

confidence: 99%

Partial Neuromuscular Blockage Levels with Mivacurium during Mastoidectomy Allows Intraoperative Facial Nerve Monitoring

Cengiz

Ganidagli

Alataş

et al. 2008

ORL

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Background: Facial nerve monitoring during otologic surgery is helpful for facial nerve preservation, but its usage is closely related to anesthetic procedures. Objectives: The aim of this study was to investigate the effectiveness of mivacurium-based partial neuromuscular blockade on facial nerve monitoring during otologic surgery. Methods: Forty-three patients scheduled for elective otologic surgery (mastoidectomy with and without tympanoplasty) participated in the study. After induction with propofol 2–3 mg · kg^–1, remifentanil 1 µg · kg^–1 and mivacurium 0.2 mg · kg^–1, anesthesia was maintained with isoflurane 0.6–1.6 minimum alveolar concentration and remifentanil 0.25 µg · kg^–1 · min^–1. Following complete recovery of neuromuscular blockade during induction, mivacurium infusion was initiated at 6 µg · kg^–1 · min^–1 in an adjusted dose to reflect adductor pollicis activity of 50, 75 or 100% of normal. The minimum stimulation thresholds obtained from each case were recorded. Results: Pre- and postoperatively, all 43 patients demonstrated clinically normal facial nerve function. In all cases, intraoperative facial nerve monitoring was performed successfully. There were no differences in threshold levels of the facial nerve stimulation between group I (1.84 ± 0.4 mA ) and group II (1.97 ± 0.2 mA). However, the stimulation thresholds of group III (1.53 ± 0.4 mA ) were found to be lower than those of groups I and II (p < 0.05). Conclusion: We conclude that partial neuromuscular blockade with mivacurium permits intraoperative facial nerve monitoring.

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Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane

Abstract: Spontaneous recovery from T1=10% to TOF ratio=0.7 was insignificantly prolonged from 6.3 to 12.5 min in the fentanyl group to 7-16.5 min in children anaesthetized with inhalational anaesthetics.

Cited by 9 publications

References 52 publications

Neuromuscular block and current treatment strategies for its reversal in children

Neuromuscular block and current treatment strategies for its reversal in children

The efficacy and safety of mivacurium in pediatric patients

Partial Neuromuscular Blockage Levels with Mivacurium during Mastoidectomy Allows Intraoperative Facial Nerve Monitoring

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