Related Experiment Video

Updated: Jun 1, 2026

An Improved Method for Rapid Intubation of the Trachea in Mice
08:46

An Improved Method for Rapid Intubation of the Trachea in Mice

Published on: February 22, 2016

Propofol, remifentanil and mivacurium: fast track surgery with poor intubating conditions

T Dieck1, J Steffens, B Sander

  • 1Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-strasse 1, Hannover, Germany. dieck.thorben@mh-hannover.de

Minerva Anestesiologica
|May 28, 2011
PubMed
Abstract

Insights

Mivacurium, a short-acting muscle relaxant, resulted in poor intubating conditions and uncertain muscle relaxation when combined with propofol and remifentanil. Its short duration benefit is negated by intubation complications, making it unsuitable for procedures requiring rapid muscle relaxation.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Mivacurium is a non-depolarizing muscle relaxant known for its short duration of action.
  • It is often considered for fast-track or ambulatory surgery due to its rapid offset.
  • However, its efficacy with certain anesthetic combinations remains unclear.

Purpose of the Study:

  • To evaluate the onset time and intubating conditions of mivacurium.
  • To assess muscle relaxation using acceleromyography.
  • To determine the suitability of mivacurium for rapid muscle relaxation in anesthesia.

Main Methods:

  • 35 ear, nose, and throat (ENT) patients were included.
  • Anesthesia induced with propofol and remifentanil.
  • Mivacurium administered, followed by intubation after three minutes.
  • Muscle relaxation measured at the adductor pollicis muscle (a.p.m.) via acceleromyography.

Main Results:

  • Only 20% of patients achieved optimal intubating conditions.
  • Complete block of the a.p.m. was not achieved in 60% of patients.
  • Prolonged onset time of 228±95 seconds was observed.
  • Difficulties including closed vocal cords, poor mouth opening, coughing, and bucking were frequent.

Conclusions:

  • Mivacurium, combined with propofol and remifentanil, leads to uncertain muscle relaxation and poor intubating conditions.
  • The study was aborted due to these findings.
  • Mivacurium may not be suitable when fast and deep muscle relaxation is required, negating its short duration advantage.

More Related Videos

Guidelines for Elective Pediatric Fiberoptic Intubation11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques01:30

Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques

Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway interventions are...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...