Recovery from mivacurium block with or without anticholinesterase following continuous infusion in obstetric patients

Anaesth Intensive Care. 1996 Oct;24(5):585-9. doi: 10.1177/0310057X9602400514.

Abstract

Neostigmine antagonism after suxamethonium followed by mivacurium chloride bolus and infusion was studied. Thirty ASA group I or II patients were given mivacurium 0.15 mg/kg followed by infusion during nitrous oxide-enflurane-pethidine anaesthesia. Train of four (TOF) stimuli were applied to the ulnar nerve at the wrist and TOF twitch height and ratio measured by TOF-GUARD nerve stimulator. Mivacurium infusion was titrated to give a 90% block of first twitch height. Patients were randomized into two groups. Group I patients recovered from the mivacurium block spontaneously while Group II patients were given neostigmine 0.05 mg/kg and atropine 0.02 mg/kg. Time to reach train of four ratio (TOFR) of 25%, 50% and 70% were measured. This study demonstrated a mean infusion rate of 5.1 +/- 1.8 micrograms/kg/min to maintain a 90% neuromuscular block. In the spontaneous recovery group, time to reach TOFR of 25%, 50% and 70% were 9.3 +/- 2.7 min, 13.5 +/- 3.0 min and 16.7 +/- 3.0 min respectively while the corresponding times in the neostigmine group were 5.2 +/- 1.7 min, 10.9 +/- 2.2 min and 16.1 +/- 7.4 min respectively. There were significant differences in the time taken to TOFR of 25% (P < 0.0001) and 50% (P < 0.05) but no difference in the time taken for TOFR to return to 70%. We concluded that mivacurium is suitable for use in caesarean section despite a decrease in plasma cholinesterase activity. Neostigmine antagonism is not required as a routine.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adjuvants, Anesthesia / administration & dosage
  • Adult
  • Anesthesia Recovery Period
  • Anesthesia, Inhalation
  • Anesthesia, Intravenous
  • Anesthesia, Obstetrical*
  • Anesthetics, Inhalation / administration & dosage
  • Atropine / administration & dosage
  • Cesarean Section
  • Cholinesterase Inhibitors / therapeutic use*
  • Cholinesterases / blood
  • Electric Stimulation
  • Enflurane / administration & dosage
  • Female
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Isoquinolines / administration & dosage*
  • Isoquinolines / antagonists & inhibitors
  • Meperidine / administration & dosage
  • Mivacurium
  • Muscle Contraction / drug effects
  • Neostigmine / therapeutic use*
  • Neuromuscular Blockade*
  • Neuromuscular Nondepolarizing Agents / administration & dosage*
  • Neuromuscular Nondepolarizing Agents / antagonists & inhibitors
  • Nitrous Oxide / administration & dosage
  • Pregnancy
  • Ulnar Nerve / drug effects

Substances

  • Adjuvants, Anesthesia
  • Anesthetics, Inhalation
  • Cholinesterase Inhibitors
  • Isoquinolines
  • Neuromuscular Nondepolarizing Agents
  • Neostigmine
  • Mivacurium
  • Atropine
  • Enflurane
  • Meperidine
  • Cholinesterases
  • Nitrous Oxide