Pharmacodynamics of mivacurium chloride in 13- to 18-yr-old adolescents with thermal injury

Abstract

In contrast to previous studies with non-depolarizers in burned patients, normal mivacurium doses can produce paralysis, at least as rapidly as in controls, but with a possibility of a prolonged recovery from block. The standard dose of mivacurium in the presence of decreased PCHE activity is in effect, a relative overdose that explains the above findings. Mivacurium is an effective drug for use in burns, irrespective of time after, or magnitude of burn injury.

Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review

“…and Table ). Butyrylcholinesterase deficiency prolongs succinylcholine and mivacurium neuromuscular blockade by minutes (mins) to hours, measured by: neuromuscular stimulation, using either mechanomyogram or electromyography with train‐of‐four stimulation ; single twitch stimulation or tactile monitoring or by ventilatory status or muscle strength . In genotypically normal adults the duration of succinylcholine or mivacurium neuromuscular blockade is proportionate to butyrylcholinesterase deficiency .…”

“…The action of mivacurium is normal in mild renal disease but it is prolonged in patients with creatinine clearance < 50 ml.min −1 , up to 1.5 times in end‐stage renal disease . Burn injuries prolong mivacurium neuromuscular blockade by around 15 min in adults and children, particularly within one week of extensive injury .…”

“…The dose of mivacurium should also be reduced in patients with liver disease, in whom its action may be prolonged three times . Less mivacurium may be required in patients with burns, despite their usual resistance to non‐depolarising neuromuscular drugs, due to deficient butyrylcholinesterase activity .…”

Burn Injury Pain: The Continuing Challenge

“…66,83,115,187 However, research suggests that elimination kinetics of morphine 68,153,156 and lorazepam 112 are not impaired after burn injury and that systemic clearance may actually be enhanced in larger burns (eg, up to 80% body surface area), beyond which clearance decreases toward control levels. 135 Kealey and colleagues 100 investigated the pharmacokinetics of morphine in patients with a mean body surface area burn of 21.5% in an attempt to ascertain a rational dosage schedule for patients with burns.…”