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Duration of the pharmacodynamic interaction between pancuronium and mivacurium
M Beaussier1, H Deriaz, A De Traverse
1Department of Anaesthesiology and Intensive Care, St Antoine Hospital, Paris, France.
Abstract:
The aim of this study was to determine for how long the duration of action of increments of mivacurium can be influenced by previous pancuronium administration. Fifteen patients, ASA I or II, undergoing general anaesthesia for major abdominal surgery were investigated. The post-tetanic count (PTC) was measured at the adductor pollicis muscle. Pancuronium 0.1 mg kg-1 was injected first. At recovery of the 10th response of the PTC (PTC10), a second dose of pancuronium was injected (0.02 mg kg-1). On recovery to PTC10, a bolus of mivacurium (0.04 mg kg-1) was given and regularly repeated at recovery of PTC10 until the end of surgery. The mean duration of the second dose of pancuronium was 53 min (SD 13 min) and of the first dose of mivacurium, 66 min (SD 14 min) (P < 0.01). The duration of action of further mivacurium boluses decreased significantly until the fifth dose. It took 222 minutes (95% confidence interval 190, 253 min) after the second pancuronium dose before the duration of action of mivacurium returned to normal values and became constant and predictable.
Insights
Previous pancuronium administration significantly prolongs mivacurium
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Neuromuscular blocking agents are crucial in general anesthesia.
- Understanding drug interactions is vital for patient safety and effective anesthesia management.
Purpose of the Study:
- To investigate the duration of action of mivacurium after prior pancuronium administration.
- To determine how long pancuronium influences mivacurium's effects.
Main Methods:
- Fifteen patients undergoing major abdominal surgery received pancuronium followed by mivacurium.
- Post-tetanic counts (PTC) at the adductor pollicis muscle monitored neuromuscular blockade.
- Mivacurium doses were administered upon recovery to PTC10.
Main Results:
- The second dose of pancuronium lasted a mean of 53 minutes.
- The first mivacurium dose had a mean duration of 66 minutes (P < 0.01).
- Mivacurium's duration of action decreased with subsequent doses until the fifth dose.
Conclusions:
- Pancuronium significantly extends the duration of action of initial mivacurium doses.
- Normal, predictable mivacurium action recovery took approximately 222 minutes post-pancuronium.
- This interaction necessitates careful titration of neuromuscular blockers in anesthesia.