Document Detail


Is intramuscular mivacurium an alternative to intramuscular succinylcholine?
MedLine Citation:
PMID:  8311314     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mivacurium's rapid onset and short duration of action in children suggests that intramuscular administration might treat laryngospasm and facilitate tracheal intubation without producing prolonged paralysis. Accordingly, the authors measured the neuromuscular effects of intramuscular mivacurium in anesthetized infants and children. METHODS: Twenty unpremedicated infants and children (3 months to 5 yr of age) were anesthetized with nitrous oxide and halothane and permitted to breathe spontaneously. When anesthetic conditions were stable, mivacurium was injected into the quadriceps or deltoid muscle. Minute ventilation and adductor pollicis twitch tension were measured. The initial mivacurium dose was 250 micrograms/kg and was increased (to a maximum of 800 micrograms/kg, at which dose the trial was ended) or decreased according to the response of the previous patient, the goal being to bracket the dose producing 80-90% twitch depression within 5 min of drug administration. RESULTS: No patient achieved > 80% twitch depression within 5 min of mivacurium administration. Peak twitch depression was 90 +/- 13% (mean +/- SD) for infants and 88 +/- 15% for children at 15.0 +/- 4.6 min and 18.4 +/- 6.4 min, respectively. Ventilatory depression (a 50% decrease in minute ventilation or a 10-mmHg increase in end-tidal carbon dioxide tension) occurred at 9.0 +/- 4.4 min in nine infants and 13.6 +/- 7.5 min in 10 children; ventilatory depression did not develop in one infant given a dose of 350 micrograms/kg. Time to peak twitch depression or ventilatory depression was not faster with larger doses. CONCLUSIONS: Although ventilatory depression preceded twitch depression, both occurred later with intramuscular mivacurium than would be expected after intravenous mivacurium or intramuscular succinylcholine. The authors speculate that the onset of intramuscular mivacurium is too slow to treat laryngospasm or to facilitate routine tracheal intubation in infants or children, despite administration of large doses.
Authors:
C B Cauldwell; M Lau; D M Fisher
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  80     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-03-17     Completed Date:  1994-03-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  320-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, University of California, San Francisco 94143-0648.
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Inhalation
Child, Preschool
Halothane
Humans
Infant
Injections, Intramuscular
Isoquinolines / administration & dosage,  pharmacology*
Neuromuscular Junction / drug effects*,  physiology
Neuromuscular Nondepolarizing Agents / administration & dosage,  pharmacology*
Nitrous Oxide
Succinylcholine / administration & dosage,  pharmacology*
Surgical Procedures, Elective
Chemical
Reg. No./Substance:
0/Isoquinolines; 0/Neuromuscular Nondepolarizing Agents; 10024-97-2/Nitrous Oxide; 106791-40-6/mivacurium; 151-67-7/Halothane; 306-40-1/Succinylcholine

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


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