Document Detail


Postpartum patients have slightly prolonged neuromuscular block after mivacurium.
MedLine Citation:
PMID:  9428856     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Postpartum patients have decreased plasma cholinesterase activity, which may slow the metabolism of mivacurium. We compared the duration of a mivacurium neuromuscular block in 11 women undergoing postpartum tubal ligation 36-99 h after delivery with that in 11 control women undergoing gynecological surgery. Anesthesia was induced with propofol and fentanyl and maintained with propofol and nitrous oxide. Neuromuscular block was monitored by electromyography, and the ulnar nerve was stimulated transcutaneously using a train-of-four pattern. Patients received a bolus dose of mivacurium 0.15 mg/kg. The median (range) duration of neuromuscular block until 25% recovery of the first twitch response was longer in the postpartum group, 19.4 (15.6-25.2) min, compared with the control group, 16.3 (11.0-23.4) min (P = 0.04). The median (range) plasma cholinesterase activity was decreased in the postpartum group, 4.0 (0.1-5.5) kU/L, compared with the control group, 7.1 (6.2-10.0) kU/L (P < 0.001). The duration of neuromuscular block was inversely correlated with cholinesterase activity (Kendall rank correlation tau = -0.43, P = 0.005). The slight prolongation of neuromuscular block should not be significant clinically. Implications: Postpartum patients have decreased amounts of the plasma cholinesterase enzyme. This would slow the metabolism of the muscle relaxant mivacurium. However, the duration of muscle paralysis is only prolonged by approximately 3 min, which would not normally cause any significant problems.
Authors:
T Gin; J L Derrick; M T Chan; P T Chui; T W Mak
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  86     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-01-29     Completed Date:  1998-01-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  82-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. tgin@chmeds.ac.nz
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Humans
Isoquinolines / pharmacology*
Middle Aged
Neuromuscular Junction / drug effects*
Neuromuscular Nondepolarizing Agents / pharmacology*
Postpartum Period / physiology*
Pregnancy
Time Factors
Chemical
Reg. No./Substance:
0/Isoquinolines; 0/Neuromuscular Nondepolarizing Agents; 106791-40-6/mivacurium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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