| Is intramuscular mivacurium an alternative to intramuscular succinylcholine? | |
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MedLine Citation:
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PMID: 8311314 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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C B Cauldwell; M Lau; D M Fisher |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 80 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 1994 Feb |
Date Detail:
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Created Date: 1994-03-17 Completed Date: 1994-03-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 320-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia, University of California, San Francisco 94143-0648. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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