The efficacy and safety of mivacurium in pediatric patients

Abstract

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)

A comparison of the time course of action and laryngeal mask airway insertion conditions with different doses of mivacurium for day-case urologic surgery in children: a prospective cohort study

“…This study showed that the grading of conditions for the LMA insertion-18 score of 0.15 mg/kg mivacurium was lower than 0.2 mg/kg and 0.25 mg/kg mivacurium in children during ambulatory urologic surgery. In addition, the onset times of 0.2 and 0.25 mg/kg mivacurium were shorter than 0.15 mg/kg mivacurium, which was consistent with the results of Zeng et al ( 2 ). However, the duration of clinical action and RI of a medium induction dose of mivacurium did not prolong or shorten the onset times compared with a small or increasing dose.…”

“…In recent years, mivacurium, which has a short elimination half-life, has been widely used in clinical general anaesthesia procedures in day-case surgery in China ( 2 , 10 , 21 ). Because it has a shortened waiting time after deep neuromuscular blockage compared with intermediate-acting cisatracurium and rocuronium, no direct effect on liver and kidney functions, rapid postoperative recovery, no accumulative effect in the body and a slight effect on circulation ( 9 , 10 ), mivacurium has become the main muscle relaxant used for paediatric anaesthesia in some countries ( 4 ).…”

“…Therefore, in day-case surgery, non-depolarising neuromuscular blocking agents (NMBs) with a rapid onset and short duration are required for brief surgical procedures and endotracheal intubation or laryngeal mask insertion. Mivacurium, a bisbenzyltetrahydroisoquinolinium compound, is a short-acting, non-depolarising neuromuscular blocker that is quickly hydrolysed by plasma cholinesterase ( 2 ). Paralysis can rapidly recover after mivacurium, which means the use of reversal agents after the administration of mivacurium in normal patients is usually not necessary ( 3 ).…”

MRGPRX2 and Adverse Drug Reactions

“…Antihistamines block all these effects (72,78). It should be noted that occasional studies only reported average changes in histamine levels and/or mean arterial pressure, which sometimes did not achieve significance as a group (71,79,82,84). This does not mean that zero patients in the group suffered from an AE.…”

Effects of Natural Products on Neuromuscular Junction

“…Consequently, the use of an agent with the shortest probable clinical duration may be helpful [ 91 - 93 ]. When compared with healthy control subjects, though there was no difference noted in the onset times, patients with Duchenne muscular dystrophy confirmed only a modest prolongation of the clinical effect of mivacurium [ 94 ].…”