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Mivacurium as an alternative to succinylcholine during outpatient laparoscopy
S M Poler1, M F Watcha, P F White
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
Study Objectives:
To compare (1) the adequacy of conditions for tracheal intubation; (2) the onset, depth, clinically effective duration, and recovery profile; and (3) adverse effects associated with mivacurium as an alternative to succinylcholine during general (endotracheal) anesthesia for outpatient laparoscopy.
Design:
A randomized, controlled clinical trial.
Setting:
Barnes Hospital Outpatient Surgery Center.
Patients:
Sixty healthy consenting ASA physical status I or II adult female outpatients.
Interventions:
Following a standardized thiopental sodium-alfentanil induction, patients were randomly assigned to one of three groups: Group I-alfentanil-nitrous oxide (N2O)-succinylcholine; Group II-alfentanil-N2O-mivacurium; Group III-enflurane-N2O-mivacurium.
Measurements And Main Results:
Neuromuscular blockade was measured by electromyography of the stimulated adductor pollicis muscle contraction. Tracheal intubation was attempted after achieving 70% or greater blockade and was graded on a four-point scale. Onset and recovery were more rapid with succinylcholine than with mivacurium. The clinically effective duration of action of mivacurium was not significantly different in the enflurane-N2O group compared with the alfentanil-N2O group. Side effects with mivacurium included flushing and occasional wheezing.
Conclusions:
Mivacurium 0.15 mg/kg given intravenously provided good to excellent conditions for tracheal intubation in 2 to 3 minutes. This dose provided a clinically effective duration of action of 20 to 25 minutes, and the residual blockade was readily reversible with neostigmine. Mivacurium did not, however, offer any apparent advantage over succinylcholine in this outpatient population.
Insights
Mivacurium provided good conditions for tracheal intubation in outpatient laparoscopy, comparable to succinylcholine. While effective, mivacurium did not offer significant advantages over succinylcholine for this patient population.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Succinylcholine is a common neuromuscular blocking agent for tracheal intubation.
- Mivacurium offers a shorter duration of action, potentially beneficial in outpatient settings.
Purpose of the Study:
- To compare mivacurium with succinylcholine for tracheal intubation adequacy.
- To evaluate onset, duration, recovery, and adverse effects of mivacurium versus succinylcholine.
- To assess mivacurium's utility in outpatient laparoscopy under general anesthesia.
Main Methods:
- A randomized, controlled clinical trial involving 60 healthy adult female outpatients.
- Patients received standardized anesthesia induction followed by random assignment to succinylcholine or mivacurium.
- Neuromuscular blockade assessed via electromyography; intubation conditions graded on a four-point scale.
Main Results:
- Mivacurium provided good to excellent tracheal intubation conditions within 2-3 minutes.
- Onset and recovery were faster with succinylcholine compared to mivacurium.
- Mivacurium's effective duration was 20-25 minutes, with side effects including flushing and wheezing.
Conclusions:
- Mivacurium (0.15 mg/kg IV) is effective for tracheal intubation in outpatients, with rapid reversibility.
- Mivacurium did not demonstrate a clear advantage over succinylcholine in this outpatient laparoscopy population.
- Further research may explore optimal dosing or specific patient subgroups for mivacurium use.