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Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy
E W Cheam1, L A Critchley, P T Chui
1Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., PRC.
Summary
Low dose mivacurium is not effective for modifying seizure activity during electroconvulsive therapy (ECT). Succinylcholine provided better seizure control, making mivacurium unsuitable for this application.
Area of Science:
- Anesthesiology
- Neurology
Background:
- Electroconvulsive therapy (ECT) utilizes muscle relaxants to mitigate seizure-induced muscle contractions.
- Current practice often involves low-dose succinylcholine, despite potential adverse effects.
Purpose of the Study:
- To compare the efficacy of low-dose mivacurium versus low-dose succinylcholine in modulating seizure activity during ECT.
- To assess the suitability of low-dose mivacurium as an alternative muscle relaxant in ECT.
Main Methods:
- A randomized, double-blind, cross-over study involving 16 patients undergoing ECT.
- Low-dose mivacurium (0.08 mg/kg) or low-dose succinylcholine (0.5 mg/kg) was administered prior to ECT.
- Seizure modification was scored, and recovery parameters were recorded.
Main Results:
- Succinylcholine demonstrated significantly better seizure modification compared to mivacurium (P < 0.05).
- Mivacurium resulted in unsatisfactory seizure control in a higher number of cases (8 vs. 2).
- The study was halted early due to mivacurium's inadequate efficacy.
Conclusions:
- Low-dose mivacurium is unsuitable for use in electroconvulsive therapy due to insufficient seizure control.
- Succinylcholine remains the preferred agent for muscle relaxation during ECT based on this study.