Influence of plasma cholinesterase activity on recovery from mivacurium-induced neuromuscular blockade in phenotypically normal patients

Acta Anaesthesiol Scand. 1992 Oct;36(7):702-6. doi: 10.1111/j.1399-6576.1992.tb03548.x.


The significance of plasma cholinesterase (pChe) activity for the duration of action of mivacurium in phenotypically normal patients was evaluated in 35 patients during neurolept anaesthesia. The response to train-of-four nerve stimulation was recorded using a Myograph 2000. Ten patients with normal pChe (Group I) and five patients with decreased pChe activity (Group 2) were given a small test dose of mivacurium 0.03 mg kg-1. Mivacurium 0.1 mg kg-1 was administered following spontaneous recovery from the first dose. The mean suppression of the height of the first (T1) of the train-of-four responses following mivacurium 0.03 mg kg-1 patients with normal and decreased enzyme activity was 40% and 56%, respectively, and the mean T1 suppression after mivacurium 0.1 mg kg-1 was 100% in both groups. The times to different levels of twitch height recovery following the 0.1 mg kg-1 dose did not differ between the two groups of patients. Another 20 patients with normal or decreased pChe activity (Group 3) were given mivacurium 0.2 mg kg-1. In this group the time to maximum block was 1.4 min (1.0-4.0) mean (range) and the time to reappearance of the T1 response was 15.0 min (7.4-22.7) (range). An inverse relationship was found between the patients' pChe activity and the time to first response. It is concluded that mivacurium is short-acting in patients with normal pChe phenotype and normal to low-normal pChe activity. No patient with very low pChe activity was included in the study. A prolonged response to mivacurium may, however, be expected in these patients.

MeSH terms

  • Anesthesia Recovery Period
  • Cholinesterases / blood*
  • Cholinesterases / genetics
  • Dibucaine
  • Electric Stimulation
  • Flushing / chemically induced
  • Humans
  • Infusions, Intravenous
  • Isoquinolines / administration & dosage
  • Isoquinolines / adverse effects
  • Isoquinolines / antagonists & inhibitors
  • Isoquinolines / pharmacology*
  • Mivacurium
  • Muscle Contraction / drug effects
  • Neostigmine / pharmacology
  • Neuromuscular Junction / drug effects*
  • Neuromuscular Nondepolarizing Agents / administration & dosage
  • Neuromuscular Nondepolarizing Agents / adverse effects
  • Neuromuscular Nondepolarizing Agents / antagonists & inhibitors
  • Neuromuscular Nondepolarizing Agents / pharmacology*
  • Phenotype
  • Reaction Time / drug effects
  • Time Factors
  • Ulnar Nerve / drug effects


  • Isoquinolines
  • Neuromuscular Nondepolarizing Agents
  • Neostigmine
  • Mivacurium
  • Cholinesterases
  • Dibucaine