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Mivacurium in infants and children
1Department of Anesthesia, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
Paediatric Anaesthesia
|January 1, 1997
Summary
Mivacurium is a short-acting muscle relaxant hydrolyzed by plasma-cholinesterase. Its recovery is dose-independent, making it suitable for continuous infusion, especially in pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Mivacurium is the sole short-acting nondepolarizing muscle relaxant currently in clinical use.
- It is a benzylisoquinolinium ester metabolized by plasma-cholinesterase.
Purpose of the Study:
- To detail the pharmacodynamics and clinical application of mivacurium, particularly in pediatric patients.
- To highlight its suitability for continuous infusion and compare its effects with adult administration.
Main Methods:
- Review of existing literature on mivacurium's efficacy, dosage, and side effects.
- Analysis of neuromuscular depression and recovery times at various doses.
- Evaluation of infusion requirements and antagonism of neuromuscular blockade.
Main Results:
- Pediatric ED50 and ED95 are approximately 50 and 90 µg/kg, respectively, potentially lower in infants.
- A dose of 0.25 mg/kg provides rapid neuromuscular blockade and recovery within 15-20 minutes.
- Continuous infusion rates for children are 10-16 µg/kg/min, double that of adults.
- Histamine release and minimal hypotension can occur, but are generally manageable.
- Cholinesterase deficiency prolongs mivacurium's action; effects are reversible with edrophonium or neostigmine.
Conclusions:
- Mivacurium offers predictable recovery kinetics, ideal for continuous infusion anesthesia.
- Its use requires careful dosage titration, especially in pediatric populations and patients with cholinesterase deficiency.
- Effective reversal agents are available for mivacurium-induced neuromuscular blockade.