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[Mivacurium in pediatric anesthesia]
V R Hofmockel1, B Pohl, G Benad
1Aus der Klinik und Poliklinik für Anästhesiologie und Intensivtherapie der Universität Rostock.
Abstract:
Mivacurium is a potent, short-acting, nondepolarizing relaxant of the benzylisoquinoline series. In adults endotracheal intubation can be performed after a 2 x ED95 dose of 0.15-0.2 mg/kg within 2-2.5 minutes. In infants onset time and clinical duration of mivacurium are significantly shorter than in adults. Although the onset time of mivacurium is similar to that of other relaxants like vecuronium and atracurium, its clinical duration is unique in comparison with all other nondepolarizing relaxants currently available. Mivacurium shows no cumulative effect either after repeated injections or after continuous infusion. In contrast to other relaxants, an increasing dose of mivacurium leads only to a slight increase in clinical duration and has no effect on the recovery index. After spontaneous recovery has reached 10-25% of the control value, the neuromuscular block can be easily antagonized with neostigmine or edrophonium. The properties of mivacurium described above are related to patients with normal pseudocholinesterase activity. Particularly patients with atypical pseudocholinesterase show a marked increase in clinical duration. Side-effects due to significant histamine release with flush, tachycardia and hypotension are seldom observed if mivacurium is injected slowly over a period of more than 30 seconds and bolus injections of more than 2 x ED95 or 3 x ED95 are avoided.
Insights
Mivacurium is a short-acting muscle relaxant with a unique clinical duration, offering rapid intubation in adults and faster onset in infants. It shows no cumulative effects and can be reversed with neostigmine or edrophonium.
Area of Science:
- Anesthesiology
- Pharmacology
- Neuromuscular Pharmacology
Background:
- Mivacurium is a benzylisoquinoline-series, short-acting, nondepolarizing neuromuscular relaxant.
- Its unique pharmacokinetic and pharmacodynamic profile distinguishes it from other available neuromuscular blocking agents.
Purpose of the Study:
- To describe the clinical characteristics of mivacurium, including onset time, duration, and recovery.
- To compare mivacurium's effects in adults and infants.
- To evaluate the impact of pseudocholinesterase activity and administration techniques on mivacurium's effects.
Main Methods:
- Review of mivacurium's pharmacological properties and clinical data.
- Comparison of onset time and clinical duration in adults and infants.
- Assessment of cumulative effects, dose-response relationship, and antagonism.
- Evaluation of side effects, including histamine release and impact of pseudocholinesterase variants.
Main Results:
- Mivacurium facilitates endotracheal intubation in adults within 2-2.5 minutes at a 2x ED95 dose.
- Onset time is similar to vecuronium and atracurium, but clinical duration is unique and shorter in infants than adults.
- No cumulative effect observed with repeated doses or infusion; dose escalation minimally impacts duration and recovery index.
- Neuromuscular block is readily antagonized by neostigmine or edrophonium.
- Atypical pseudocholinesterase significantly prolongs clinical duration.
- Histamine release-related side effects are rare with slow injection and appropriate dosing.
Conclusions:
- Mivacurium offers a favorable profile for short-acting neuromuscular blockade.
- Its predictable recovery and lack of cumulative effects are advantageous.
- Careful administration and consideration of patient pseudocholinesterase status are important for optimal use.