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Mivacurium infusion during nitrous oxide-isoflurane anesthesia: a comparison with nitrous oxide-opioid anesthesia
D M Powers1, B W Brandom, D R Cook
1Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, PA.
Study Objective:
To determine the potentiation of the neuromuscular blockade induced by a titrated infusion of mivacurium in the presence of isoflurane versus a nitrous oxide (N2O)-opioid anesthesia.
Design:
An open-label, controlled study.
Setting:
The inpatient anesthesia service of two university medical centers.
Patients:
Thirty adults divided into two groups.
Intervention:
An intravenous infusion of mivacurium during anesthesia with N2O-opioid or N2O-isoflurane.
Measurements And Main Results:
A neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. The mivacurium infusion rate was significantly less in the presence of isoflurane [4.0 +/- 0.8 micrograms/kg/min (mean +/- SEM)] than during N2O-opioid anesthesia (6.4 +/- 0.6 micrograms/kg/min). The recovery rates did not differ between anesthetic groups. After the termination of the infusion, spontaneous recovery to T4/T1 of at least 0.75 occurred in an average of 17.9 +/- 1.5 minutes, with a mean recovery index (T25-75) of 6.0 +/- 0.7 minutes.
Conclusion:
Isoflurane anesthesia reduces the infusion rate of mivacurium required to produce about 95% depression of neuromuscular function.
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