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Prolonged paralysis following mivacurium administration
1Department of Perioperative Medicine and Intensive Care, Royal Brisbane Hospital, Queensland.
Abstract:
Mivacurium is a benzylisoquinolone, choline-like, non-depolarizing muscle relaxant. Its onset of action is similar to that of atracurium but its duration of action is shorter (approximately 10-15 minutes). Mivacurium is metabolized by plasma cholinesterases at approximately 70% of the rate of metabolism of suxamethonium. Deficiency or abnormality of plasma cholinesterase may cause the duration of action of both suxamethonium and mivacurium to be greatly prolonged. We describe a case of prolonged mivacurium paralysis after day surgery. Laboratory investigations showed a genetic tendency toward abnormal cholinesterase levels, but markedly depressed cholinesterase activity was suggestive of additional acquired causes. This patient had a history of liver disease, malnutrition and anticholinesterase use, which we believe were the most significant factors involved.
Insights
Prolonged mivacurium paralysis can occur in patients with abnormal plasma cholinesterase levels. Acquired factors like liver disease and malnutrition significantly contribute to extended muscle relaxation.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Mivacurium is a non-depolarizing muscle relaxant metabolized by plasma cholinesterases.
- Its action is typically shorter than other agents, lasting 10-15 minutes.
Observation:
- A case of prolonged mivacurium paralysis following day surgery is presented.
- The patient exhibited genetic predisposition to abnormal cholinesterase levels.
Findings:
- Markedly depressed cholinesterase activity suggested acquired causes.
- Liver disease, malnutrition, and anticholinesterase use were identified as significant contributing factors.
Implications:
- Highlights the importance of considering acquired factors in prolonged paralysis.
- Suggests careful patient evaluation for cholinesterase activity before mivacurium administration.
- Informs anesthetic management in patients with potential for prolonged neuromuscular blockade.