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Decreased mivacurium constant infusion requirements with defasciculating doses of pancuronium
M D Wangler1, P Thapar, J H Skerman
1Department of Anesthesiology, School of Medicine in Shreveport, Louisiana State University Medical Center 71130-3932, USA.
Abstract:
This study was designed to verify a technique in which the pharmacologic profile of mivacurium infusions could be altered by small doses of pancuronium to reduce the infusion requirement without altering the subsequent recovery kinetics. Thirty ASA physical status I or II patients were randomized into two groups in a blinded fashion. One group was administered pancuronium 10 micrograms/kg followed by pancuronium 2.5 micrograms.kg-1.h-1 thereafter. The control group was given identical volumes of saline. Subsequently, all patients were given an initial bolus of mivacurium, and anesthesia was maintained using a nitrous oxide/ alfentanil technique. When the thenar electromyogram response to supramaximal train-of-four stimulation returned to 5% of baseline, a mivacurium infusion was begun in both groups, and the infusion rate required to maintain the electromyographic response at 1%-10% of baseline was determined. At the conclusion of the procedure, the infusion was terminated and the recovery profile ascertained. The mivacurium infusion requirement for the group receiving the pancuronium supplementation was 2.77 +/- 1.38 micrograms.kg-1.min-1 (mean +/- SD), which represented a 49% decrease compared with the group that used mivacurium alone which required an infusion rate of 5.43 +/- 1.85 micrograms.kg-1.min-1. No statistically significant difference was found in the recovery profiles of the two groups when the infusion was terminated. We conclude that the addition of a small amount of pancuronium decreased the required mivacurium infusion rate by nearly 50% without affecting the spontaneous recovery when terminating the infusion.
Insights
Adding small doses of pancuronium to mivacurium infusions significantly reduced the required mivacurium dose by nearly 50%. This technique altered the pharmacologic profile without affecting patient recovery kinetics after anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Mivacurium infusions are commonly used for neuromuscular blockade during anesthesia.
- Optimizing neuromuscular blocking agent requirements is crucial for efficient anesthetic management.
Purpose of the Study:
- To investigate if low-dose pancuronium can reduce mivacurium infusion requirements.
- To determine if this modification impacts recovery kinetics.
Main Methods:
- A randomized, blinded study involving 30 patients.
- One group received pancuronium supplementation with mivacurium, while the control group received saline.
- Neuromuscular blockade was monitored using train-of-four stimulation and electromyography.
Main Results:
- The mivacurium infusion requirement was 49% lower in the pancuronium group (2.77 ± 1.38 µg·kg⁻¹·min⁻¹) compared to the control group (5.43 ± 1.85 µg·kg⁻¹·min⁻¹).
- No significant differences in recovery profiles were observed between the groups after infusion termination.
Conclusions:
- Low-dose pancuronium effectively reduces mivacurium infusion rates.
- This strategy offers a method to decrease neuromuscular blocking agent requirements without compromising patient recovery.