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A comparison of the intubation conditions between mivacurium and rocuronium during balanced anesthesia
R M Pino1, H H Ali, W T Denman
1Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston 02114, USA. RPino@therdome.mgh.harvard.edu
Background:
Comparisons of the intubation conditions with mivacurium and rocuronium from previous reports are confounded by the use of varied induction regimens. The authors compared intubation conditions of mivacurium, rocuronium, and a placebo at 90 s and their recovery profiles during anesthesia with nitrous oxide, oxygen, and propofol.
Methods:
After induction with midazolam, fentanyl, and propofol in a randomized blinded study, 100 patients received one of the following treatments: 0.25 mg/kg mivacurium in divided doses (0.15 mg/kg followed by 0.1 mg/kg 30 s later); 0.45, 0.6, 0.9, or 1.2 mg/kg rocuronium; or placebo. Evoked thumb adduction was measured throughout. Intubation was attempted 90 s after the initial dose of mivacurium and other treatment doses by a "blinded" physician. Intubating conditions were graded as excellent, good, poor, or not possible. Spontaneous recovery was studied until a 25% initial twitch height was reached. Mean arterial blood pressure and heart rate changes between groups were determined before induction through 6 min after administration of the study drugs.
Results:
There were no important changes or intergroup differences in mean arterial blood pressure and heart rate. Intubation conditions were good or excellent for both mivacurium and rocuronium at the 0.9 mg/kg dose (93%) and at the 1.2 mg/kg dose (100%). Rocuronium at the 0.6 mg/kg dose was excellent in 27% of patients, whereas rocuronium at the 0.45 mg/kg dose had the least number of excellent conditions and the most poor or not possible assessments. Patients given placebo could not be intubated. Times to maximum blockade for 0.9 and 1.2 mg/kg rocuronium were the shortest. The times to 25% recovery for 0.6 mg/kg rocuronium (mean +/- SD = 27 +/- 8.6 min), 0.9 mg/kg (43.1 +/- 10.8), and 1.2 mg/kg (62.3 +/- 17.4 min) were significantly longer than were those for mivacurium (17.4 +/- 6.2 min).
Conclusions:
Mivacurium in a 0.25 mg/kg divided dose and rocuronium at 0.9 mg/kg and 1.2 mg/kg provide good or excellent intubation conditions at 90 s in most patients. Rocuronium was faster in onset at the higher doses (0.9 and 1.2 mg/kg) but had more prolonged recovery times to 25% single twitch height.
Insights
Mivacurium and higher doses of rocuronium provide excellent intubation conditions. Rocuronium offers faster onset but longer recovery compared to mivacurium.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Previous studies comparing mivacurium and rocuronium for intubation conditions were limited by varied anesthetic regimens.
- This study aimed to compare intubating conditions and recovery profiles of mivacurium and rocuronium under a standardized anesthesia protocol.
Purpose of the Study:
- To compare the intubating conditions provided by mivacurium and various doses of rocuronium at 90 seconds post-administration.
- To evaluate and compare the recovery profiles of mivacurium and rocuronium during propofol-oxygen-nitrous oxide anesthesia.
Main Methods:
- A randomized, blinded study involving 100 patients undergoing anesthesia.
- Patients received either mivacurium (0.25 mg/kg divided dose), rocuronium (0.45, 0.6, 0.9, or 1.2 mg/kg), or placebo after induction with midazolam, fentanyl, and propofol.
- Intubating conditions were assessed 90 seconds after drug administration, and neuromuscular recovery was monitored until 25% of initial twitch height.
Main Results:
- Excellent or good intubating conditions were achieved with mivacurium (0.25 mg/kg) and rocuronium (0.9 and 1.2 mg/kg).
- Higher doses of rocuronium (0.9 and 1.2 mg/kg) demonstrated the shortest onset times to maximum blockade.
- Recovery times to 25% twitch height were significantly longer for rocuronium (0.6, 0.9, 1.2 mg/kg) compared to mivacurium.
Conclusions:
- Mivacurium (0.25 mg/kg divided dose) and rocuronium (0.9 and 1.2 mg/kg) are effective for achieving good to excellent intubation conditions.
- Rocuronium at higher doses offers a faster onset of action but results in more prolonged neuromuscular recovery than mivacurium.