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Sensitivity to second dose of mivacurium
S A Feldman1, J R Hood, N T Campkin
1Magill Department of Anaesthetics, Chelsea and Westminster Hospital, London.
Anaesthesia
|August 1, 1994
Summary
Patients showed increased sensitivity to a second dose of mivacurium after full recovery from neuromuscular block. This heightened sensitivity was observed even when one arm was shielded from the drug
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Neuromuscular blocking agents like mivacurium are crucial in anesthesia.
- Understanding patient sensitivity to repeated doses is vital for safe drug administration.
Purpose of the Study:
- To investigate patient sensitivity to a second dose of mivacurium.
- To determine the influence of prior block duration and intensity on this sensitivity.
Main Methods:
- Assessed mivacurium sensitivity after complete recovery from a >95% neuromuscular block.
- Used a two-arm study design in patients to compare different block exposures.
- Administered a second dose of mivacurium to evaluate dose-response changes.
Main Results:
- A 50% reduction in the effective dose 95 (ED95) for mivacurium was observed after full recovery from an initial ED95 dose.
- Increased sensitivity to a second mivacurium dose was also noted in an arm shielded from the drug's peak effect for 100 seconds.
Conclusions:
- Second-dose sensitivity to mivacurium is not explained by receptor effects or residual plasma drug levels.
- The duration and intensity of the initial neuromuscular block significantly influence subsequent drug sensitivity.