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Mivacurium compared with succinylcholine in children with liver disease
D W Green1, M Fisher, I Sockalingham
1Department of Anaesthetics, Intensive Care and Pain Relief, King's College Hospital, London.
Insights
Mivacurium and succinylcholine were compared in pediatric liver disease patients. Mivacurium
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Medicine
Background:
- Neuromuscular blocking agents are crucial in pediatric anesthesia.
- Liver disease can alter drug metabolism and response.
- Mivacurium and succinylcholine are commonly used neuromuscular blockers.
Purpose of the Study:
- To compare the efficacy and safety of mivacurium versus succinylcholine in pediatric patients with liver disease.
- To investigate the impact of liver disease severity on neuromuscular block duration.
- To assess the correlation between plasma cholinesterase levels and mivacurium recovery time.
Main Methods:
- A comparative study involving 27 pediatric patients with mild to moderate liver disease undergoing OGD and variceal injection.
- A control group of 10 healthy children received mivacurium for ENT procedures.
- Neuromuscular block was monitored, and recovery times were recorded.
Main Results:
- Mivacurium's block duration did not correlate with liver disease severity.
- Recovery from mivacurium block inversely correlated with plasma cholinesterase concentrations.
- Tracheal intubation conditions at 2 minutes with mivacurium were comparable to 1 minute with succinylcholine in liver patients.
Conclusions:
- Mivacurium offers comparable intubating conditions to succinylcholine in pediatric liver disease patients.
- Plasma cholinesterase levels are a key determinant of mivacurium recovery time.
- Further research is needed to optimize neuromuscular blockade in pediatric patients with hepatic impairment.
Abstract:
We have compared mivacurium and succinylcholine in 27 paediatric patients with mild (Child's A) to moderate (Child's B) liver disease undergoing oesophagogastroduodenoscopy (OGD) and injection of oesophageal varices, with 10 healthy children receiving mivacurium for ENT procedures. With mivacurium 0.2 mg kg-1, the severity of liver disease did not correlate with duration of block compared with controls (time from bolus to T1 25%, P = 0.74; T1 25% to T4:T1 > 0.7, P = 0.545). However, initial recovery (time to T1 25%, P = 0.002) and overall recovery (bolus to T4:T1 > 0.7, P = 0.004) from mivacurium-induced neuromuscular block correlated inversely with pre-existing concentrations of plasma cholinesterase. Conditions for tracheal intubation at 2 min with mivacurium were comparable with conditions at 1 min with succinylcholine in the liver patients.