The Infusion Rate of Mivacurium and Its Spontaneous Neuromuscular Recovery in Magnesium-Treated Parturients

Ahn, Eun Kyoung; Bai, Sun Joon; Cho, Bum Joon; Shin, Yong Sam

doi:10.1097/00000539-199803000-00014

Cited by 11 publications

(7 citation statements)

References 12 publications

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“…Magnesium sulphate inhibits the release of acetylcholine, decreases the sensitivity of the neuromuscular junction to acetylcholine and depresses the excitability of the muscle fibre membrane, potentially enhancing non‐depolarising neuromuscular blockade . Succinylcholine blockade seems unaffected by magnesium sulphate . However, magnesium sulphate doubles the duration of mivacurium blockade and reduces infusion dosage .…”

Section: Resultsmentioning

confidence: 95%

“…Succinylcholine blockade seems unaffected by magnesium sulphate . However, magnesium sulphate doubles the duration of mivacurium blockade and reduces infusion dosage .…”

Section: Resultsmentioning

confidence: 95%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

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

2019

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Summary Butyrylcholinesterase deficiency prolongs the effects of the drugs it degrades; succinylcholine and mivacurium. Existing literature on butyrylcholinesterase deficiency is dominated by genetic and biochemical studies. We searched MEDLINE, Embase, Web of Science and Biosis to systematically review the causes and clinical consequences of butyrylcholinesterase deficiency. We considered outcomes clinically relevant if neuromuscular blockade, induced by succinylcholine or mivacurium, was assessed using clinical criteria or neuromuscular monitoring. We included 66 studies: 25 randomised controlled trials; 13 clinically controlled trials; 26 prospective observational studies; 1 retrospective study; and 1 qualitative study. Data heterogeneity precluded quantitative synthesis. Studies described genetic, physiological, acquired or pharmacologically induced causes of butyrylcholinesterase deficiency. The prolongation of neuromuscular blockade by butyrylcholinesterase deficiency was most pronounced with homozygosity of a genetic variant, but other more common factors included increasing age, pregnancy, severe liver disease, burn injuries and drug interactions.

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Section: Resultsmentioning

confidence: 95%

“…Succinylcholine blockade seems unaffected by magnesium sulphate . However, magnesium sulphate doubles the duration of mivacurium blockade and reduces infusion dosage .…”

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

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

2019

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“…[9] It has been demonstrated that pretreatment with MgSO4 increases the clinical duration and recovery index of neuromuscular blocking agents. [10][11][12][13][14][15] This may have clinical consequences, leading to incomplete neuromuscular recovery and residual paralysis at the end of surgery. [16][17][18] Thus quantitative data on the effect of anti-cholinesterase drugs in patients receiving MgSO4 are needed for safe management of neuromuscular block.…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment with Magnesium sulphate before non depolarizing muscle relaxants: Effect on speed on onset, induction and recovery

Singh¹,

Malviya²,

Rai³

et al. 2014

Int J Med Sci Public Health

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Background: Magnesium sulphate is used during anaesthesia for its antihypertensive/ antiarrhythmic properties and attenuating the response to endotrachial intubation and as an anticonvulsant for women with eclampsia. At the motor nerve terminal, MgSO4 inhibits acetylcholine release. Thus, it enhances the effect of neuromuscular blocking agents. Aims & Objectives:To determine the effect of magnesium sulphate pre-treatment on the onset, duration and recovery of nondepolarizing muscle relaxant and to quantify the haemodynamic effects of administration of MgSO4 on the arterial blood pressure. Materials and Methods: One year old prospective, randomized, double blinded, controlled clinical study was conducted on randomly selected 45 patients of either sex, aged between 18-55 years, of grade I or II of American Society of Anaesthesiologists, undergoing elective surgery at a Medical College of eastern Uttar Pradesh. Patients were divided into three groups according to the doses of MgSO4 used for pre-treatment. Statistical evaluation was done by using student's 't' test for paired data. Results: The Mean Arterial Blood Pressure response to laryngoscopy, tracheal intubation, was almost abolished in Group A (p<0.05) followed by Group B (p<0.05) and maximum pressure response occurred in Group C where MgSO4 was not used (p<0.05). The speed of onset of neuromuscular block was accelerated by pre-treatment with MgSO4 before non-depolarizing muscle relaxants. The mean onset time was 144.3 ± 12.08 seconds (p<0.001) in Group A, 192.66 ± 19.81 second (p<0.001) in Group B and 286.33 ± 34.20 seconds in Group C. The clinical duration was prolonged in MgSO4 group as compared with control group. Mean value was 52.4 ± 8.97 minutes (p<0.001), 44.86 ± 6.59 minutes (p<0.01), and 34.2±8.05 minutes respectively in Group A, B and C. Pre-treatment with MgSO4 before non-depolarizing muscle relaxant, accelerated speed of onset of neuromuscular block, necessary for intubation of trachea. MgSO4, in the presence of non-depolarizing muscle relaxant, intensified and prolonged the neuromuscular blockade and recovery. Conclusion: Monitoring of neuromuscular function and reduction in dose of vecuronium are required when using these two drugs in combination.Cite this article as: Singh S, Malviya D, Rai S, Yadav B, Kumar S, Sharma A. Pre-treatment with Magnesium sulphate before non-depolarizing muscle relaxants: Effect on speed on onset, induction and recovery. Int

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“…It has been demonstrated that pretreatment with MgSO 4 increases the clinical duration and recovery index of neuromuscular blocking agents. [7][8][9][10][11][12] This may have clinical consequences, leading to incomplete neuromuscular © British Journal of Anaesthesia recovery and residual paralysis at the end of surgery. [13][14][15] Thus quantitative data on the effect of anticholinesterase drugs in patients receiving MgSO 4 are needed for safe management of neuromuscular block.…”

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confidence: 99%

Antagonism of vecuronium-induced neuromuscular block in patients pretreated with magnesium sulphate: dose-effect relationship of neostigmine

Fuchs‐Buder

Ziegenfuß

Lysakowski

et al. 1999

British Journal of Anaesthesia

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We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmine-induced recovery in patients pretreated with MgSO4 (group A) or saline (group B) (n = 12 each). The height of T1, 5 min after neostigmine, was 43 (7)% in group A and 65 (6)% in group B (P < 0.01). Respective values after 10 min were 59 (7)% and 83 (5)% (P < 0.01). TOF ratio, 5 min after neostigmine, was 29 (6)% in group A and 29 (5)% in group B. Respective values after 10 min were 38 (11)% and 51 (7)% (P < 0.01). To gain insight into the mechanisms leading to delayed recovery after MgSO4, we calculated assisted recovery, defined as neostigmine-induced recovery minus mean spontaneous recovery. Spontaneous recovery was assessed in another 24 patients. Patients in group C received MgSO4/vecuronium and patients in group D vecuronium only (n = 12 each). Five minutes after neostigmine, assisted recovery was 22 (7)% in the MgSO4 pretreated patients and 28 (6)% in controls (P < 0.05). Ten minutes after neostigmine, values were 24 (7)% and 22 (6)%. Maximum assisted recovery was not influenced by MgSO4 pretreatment (27 (6)% in group A and 32 (6)% in group B) and time to maximum effect was comparable between groups: 6 (4-10) min and 7 (5-8) min, respectively. We conclude that neostigmine-induced recovery was attenuated in patients treated with MgSO4. This was mainly a result of slower spontaneous recovery and not decreased response to neostigmine.

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The Infusion Rate of Mivacurium and Its Spontaneous Neuromuscular Recovery in Magnesium-Treated Parturients

Cited by 11 publications

References 12 publications

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

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

Pre-treatment with Magnesium sulphate before non depolarizing muscle relaxants: Effect on speed on onset, induction and recovery

Antagonism of vecuronium-induced neuromuscular block in patients pretreated with magnesium sulphate: dose-effect relationship of neostigmine

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