Substitution of mivacurium for succinylcholine for ECT in elderly patients

Three cases are reported where pre-existing medical conditions (severe osteoporosis, amyotrophic lateral sclerosis, cardiac arrhythmias) made the administration of succinylcholine during ECT potentially dangerous. Therefore, mivacurium was substituted as the muscle relaxant necessary for safe therapy. Full reversal of the non-depolarizing muscle relaxant was assured by post-reversal use of the peripheral nerve stimulator with full recovery of train-of-four response.