Is intramuscular mivacurium an alternative to intramuscular succinylcholine?

C. B. Cauldwell, M. Lau, D. M. Fisher

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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 μg/kg and was increased (to a maximum of 800 μg/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 μg/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.

Original languageEnglish (US)
Pages (from-to)320-325
Number of pages6
JournalAnesthesiology
Volume80
Issue number2
StatePublished - 1994

Fingerprint

Succinylcholine
Respiratory Insufficiency
Laryngismus
Intubation
Ventilation
Neuromuscular Agents
Deltoid Muscle
mivacurium
Quadriceps Muscle
Nitrous Oxide
Halothane
Carbon Dioxide
Paralysis
Anesthetics

Keywords

  • Anesthesia: pediatric
  • Muscle relaxants: mivacurium
  • Respiratory effects: muscle relaxants

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Cauldwell, C. B., Lau, M., & Fisher, D. M. (1994). Is intramuscular mivacurium an alternative to intramuscular succinylcholine? Anesthesiology, 80(2), 320-325.

Is intramuscular mivacurium an alternative to intramuscular succinylcholine? / Cauldwell, C. B.; Lau, M.; Fisher, D. M.

In: Anesthesiology, Vol. 80, No. 2, 1994, p. 320-325.

Research output: Contribution to journalArticle

Cauldwell, CB, Lau, M & Fisher, DM 1994, 'Is intramuscular mivacurium an alternative to intramuscular succinylcholine?', Anesthesiology, vol. 80, no. 2, pp. 320-325.
Cauldwell, C. B. ; Lau, M. ; Fisher, D. M. / Is intramuscular mivacurium an alternative to intramuscular succinylcholine?. In: Anesthesiology. 1994 ; Vol. 80, No. 2. pp. 320-325.
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abstract = "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 μg/kg and was increased (to a maximum of 800 μg/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 μg/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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AB - 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 μg/kg and was increased (to a maximum of 800 μg/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 μg/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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