Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mivacurium is metabolized by plasma cholinesterase (PCHE). Metoclopramide inhibits PCHE in vitro and in vivo. We have assessed the effect of metoclopramide on duration of action of mivacurium and measured PCHE at baseline and at the time of maximal block. In a randomized, double-blind study, 30 patients received metoclopramide 0.15 mg kg-1 i.v. or saline, followed by propofol anaesthesia and mivacurium 0.15 mg kg-1. Using a TOF-Guard accelerometer, times to recovery of TI to 25%, 75% and 90% were 13.4, 19.3 and 21.9 min in the saline group and 17.8, 25.3 and 28.8 min in the metoclopramide group (P < 0.01, P < 0.05, P < 0.05, respectively). There were no differences in onset time or recovery index between the groups. PCHE activity at the time of maximum block decreased within each group (P < 0.01) but there was no difference between groups. In a second biochemical study of eight patients, a small decrease in PCHE activity was detected after metoclopramide 0.15 mg kg-1, but before administration of mivacurium (P < 0.025). We conclude that metoclopramide prolongs the duration of action of mivacurium.
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PMID:Influence of metoclopramide on plasma cholinesterase and duration of action of mivacurium. 1047 19

Mivacurium is a short-acting, nondepolarizing neuromuscular blocking agent hydrolyzed by plasma cholinesterase. Because it allows fast recovery, it is a commonly used muscle relaxant for patients undergoing short surgical procedures. We report the case of a 5-year-old boy who underwent outpatient inguinal herniorraphy and developed unexpected prolonged neuromuscular block after the use of mivacurium. He required mechanical ventilation support in the intensive care unit because he could not attain adequate muscle power 1 hour after termination of anesthesia; the muscular paralysis persisted for 5 hours after the bolus dose of 0.3 mg/kg mivacurium. Subsequent investigation revealed an extremely low plasma cholinesterase concentration (115 U/L), and this was later determined to be a congenital condition. This is the first reported case of cholinesterase deficiency diagnosed as a result of general anesthesia in Taiwan.
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PMID:Prolonged neuromuscular block with mivacurium in a patient with cholinesterase deficiency. 1096 12

We compared esmolol and remifentanil infusions with respect to their effect on intraoperative hemodynamic stability and early recovery after outpatient laparoscopic surgery when administered as IV adjuvants during desflurane anesthesia. After premedication with midazolam 2 mg IV, anesthesia was induced with propofol 2 mg. kg(-1) IV in combination with either esmolol 1 mg. kg(-1) IV (n = 27) or remifentanil 1 microg. kg(-1) IV (n = 26) and succinylcholine 1 mg. kg(-1) IV according to a randomized, double-blinded protocol. Anesthesia was initially maintained with desflurane 2.5% (subsequently titrated to maintain an electroencephalogram-bispectral index value of 60) and nitrous oxide 65% in oxygen. Before skin incision, an infusion of either esmolol (5 microg. kg(-1). min(-1)) or remifentanil (0.05 microg. kg(-1). min(-1)) was started and titrated to maintain the heart rate within 25% of the baseline value. Mivacurium, 0.04 mg/kg IV, bolus doses were administered to maintain a stable peak inspiratory pressure. Esmolol (12.8 +/- 13.1 microg. kg(-1). min(-1)) and remifentanil (0.04 +/- 0.02 microg. kg(-1). min(-1)) infusions were equally effective in maintaining a stable heart rate during these laparoscopic procedures. Although the mivacurium requirement was larger in the Esmolol group (7 +/- 5 vs 3 +/- 4 mg), the Esmolol group reported a smaller incidence of postoperative nausea and vomiting (4% vs 35%). Both drugs were associated with frequent "postanesthesia care unit bypass" rates (78-81%), short times to "home readiness" (119-120 min), excellent patient satisfaction (81-85%), and rapid resumption of normal activities (2.6-3.2 d). Fast-tracked patients were ready for discharge home significantly earlier (112 +/- 46 vs 151 +/- 50 min). We concluded that esmolol infusion is an acceptable alternative to remifentanil infusion for maintaining hemodynamic stability during desflurane-based fast-track anesthesia for outpatient gynecologic laparoscopic surgery.
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PMID:The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. 1115 31

BACKGROUND: Infants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 &mgr;g/kg results in faster onset of action than 200 &mgr;g/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated. METHODS: Twenty-four low surgical risk children, aged 6-24 months, undergoing an elective surgery and requiring tracheal intubation were selected. After anesthetic induction, patients randomly received an iv bolus dose of mivacurium 200 or 250 &mgr;g/kg. After maximal relaxation, the patient was intubated. Isoflurane was administered to maintain anesthetic level during the surgical procedure. Neuromuscular function was monitored by accelerometry (TOF-Guard) at the adductor pollicies. The first twitch (T) of the TOF and the T4/T1 were measured. The time-course of heart rate and systolic and diastolic blood pressure were analysed by transforming them into their respective areas under the curve. RESULTS: Mivacurium 250 &mgr;g/kg produced a maximal T block faster than 200 &mgr;g/kg, i.e. 2.4 +/- 1.1 vs. 3.5 +/- 1.4 min (p < 0.05). Spontaneous recovery times were similar in both groups. Heart rate was similar between doses while systolic and diastolic blood pressures were lower with the higher dose (p < 0.05). Flushing was observed in two cases, one in each group. CONCLUSIONS: The maximal effect of mivacurium 250 &mgr;g/kg, in infants under isoflurane anesthesia, was present one minute faster than 200 &mgr;g/kg. However, it produced a significant cardiovascular response.
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PMID:Effect of mivacurium 200 and 250 &mgr;g/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]. 1172 96

The control of the neuromuscular blockade is part of the standard monitoring in general anaesthesia. However, the degree of blocking is affected by different disorders. We describe the neuromuscular monitoring in four patients suffering from central hemiplegia by stimulation of the ulnar nerve simultaneously on the paretic and the normal side. After application of non-depolarising muscle relaxants (Atracurium, Mivacurium, Rocuronium, Vecuronium) a resistance of the paretic extremity against the relaxant used was shown in all cases. A possible explanation for this observation is the spreading out of abnormal acetylcholine receptors over the surface of denervated muscle cells which could lead to a false estimation of the depth of the neuromuscular blockade. Therefore, in the clinical practice, neuromuscular monitoring must always be carried out on the normal extremity of the patient.
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PMID:[Neuromuscular monitoring in a patient with hemiparesis. Resistance of the paralysed musculature to non-depolarising muscle relaxants]. 1239 24

The aim of this study was to evaluate the effectiveness of mivacurium (Mivacron--GlaxoWellcome) during combined general anaesthesia in the operations on the facial cranium, after tracheal intubation performed using suxamethonium chloride (Chlorsuccillin--Polfa PL). We examined 20 patients, 17-65 years old, who were underwent operations due to facial and neck neoplasms or trauma. Patients were divided into two 10-person groups. In first group the dose of Mivacron for the induction of anaesthesia was 0.15 mg/kg of body weight, in second group the dose was 0.1 mg/kg of body weight. Next doses used during maintenance of anaesthesia were 0.1 mg/kg of body weight in both groups. Metohexital, fentanyl, nitrous oxide and oxygen were used for the maintenance of anaesthesia. The level of neuromuscular block was estimated using Ministim MS IIIA instrument. The mean time to maintain 95-99% neuromuscular block after inductive dose 0.15 mg/kg Mivacron was 15 minutes 26 seconds, and after the dose of 0.1 mg/kg--13 minutes 55 seconds. The time from the injection of the drug to maintain neuromuscular block was 1 minute 52 seconds and 1 minute 50 seconds, respectively. We did not observe neither negative influence of drug on the cardiovascular system nor the reactions of histamine release. Injection of suxamethonium chloride before the tracheal intubation did not prolong the time of Mivacron activity. Anticholinesterase agents was not use in any case. By 4 patient with heart failure prolongation of the activity time of Mivacurium was observed. The dose of 0.1 mg/kg, is efficient to maintain of the neuromuscular block on the stabile level. This allows the reduction of the total dose, and the decrease of the costs of the operation.
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PMID:[Mivacurium--use for complications of facial-cranial surgery--personal experience]. 1281 77

This study was designed to compare the time course of action and the safety profile of Rapacuronium and Mivacurium in day case dental surgery. After Ethics Committee approval 61 healthy adult patients, scheduled for dental day case surgery, were randomised in an assessor-blinded manner to receive either 1.5 mg/kg Rapacuronium with and without 0.05 neostigmine 5 min later (19 patients each) or a total of 0.25 mg/kg Mivacurium (n = 16). Anaesthesia was induced using Propofol 2 - 5.1 mg/kg and Remifentanil 24 - 73 mcg/kg/h and maintained with Desflurane in N2O/O2 (2/1). Endotracheal intubation was performed when maximum blockade was achieved and scored by a blinded intubator. Neuromuscular block was monitored using the train-of-four response to supramaximal stimuli at the ulnar nerve every 15 seconds using acceleromyography (TOF Watch SX). Onset time, clinical duration (reappearance of the third twitch of a TOF-stimulation) and recovery to T4/T1 > 0.9 were recorded. Speed of recovery was evaluated by the time difference between reappearance of the third twitch and T4/T1 > 0.9. The intubating conditions at the time of maximum block revealed no statistically significant differences between the three groups. Changes in blood pressure, heart rate and airway pressure were not significant. Onset time in subjects who received Rapacuronium (99 +/- 29 s) was faster compared to the onset time in those who received Mivacurium (157 +/- 36 s). Also clinical duration was significantly shorter following Rapacuronium without reversal (12 +/- 4 min) as well as with reversal (9 +/- 1 min) compared with Mivacurium (21 +/- 5 min)). Patients treated with Rapacuronium and reversal recovered faster (14 +/- 8 min)) compared to the other two groups (Mivacurium: 20 +/- 6 min, Rapacuronium without reversal: 31 +/- 9 min). The fraction of clinical duration of the total duration was highest following Mivacurium (51 %) when compared with Rapacuronium/Neostigmine (43 %) and Rapacuronium (28 %).
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PMID:[The time-course of action of rapacuronium and mivacurium after early reversal following equally lasting relaxation]. 1297 39

The interaction between mivacurium and magnesium sulphate was investigated in a group of parturients undergoing caesarean section under general anaesthesia. Thirty parturients were studied; 10 normotensive controls (group NT), 10 hypertensive controls (group HT) and 10 hypertensives who received magnesium sulphate (group HTM). At induction group HT received 30 microg/kg of alfentanil and group HTM 10 microg/kg of alfentanil and 30 or 60 mg/kg of magnesium sulphate. Neuromuscular function was monitored by electromyography. Mivacurium 0.15 mg/kg was given after 60% recovery of T1 following succinylcholine. Magnesium concentrations and plasma cholinesterase activity were significantly elevated in group HTM (1.57 +/- 0.53 mmol/1 and 4.60 +/- 1.27 kU/1) compared with group HT (0.71 +/- 0.18 mmol/1 and 3.44 +/- 0.97 kU/1) and group NT (0.60 +/- 0.07 mmol/1 and 2.86 +/- 0.82 kU/1) (P < 0.005). Time to maximal recovery, and time from 25-75% of maximal recovery from mivacurium, were significantly prolonged in group HTM (60.9 +/- 15.3 min and 16.8 +/- 5.6 min) compared with group HT (34.9 +/- 7.6 min and 7.6 +/- 3.6 min) and group NT (37.4 +/- 14.4 min and 8.5 +/- 3.4 min) (P < 0.01). Time to 25% recovery was prolonged in group HTM (35.1 +/- 7.4 min) compared with the other two groups (HT: 21.6 +/- 6.4 min and NT: 22.8 +/- 10.2 min) (P < 0.01). Whilst the duration of action of mivacurium, determined by electromyography, is prolonged by subtherapeutic serum magnesium concentrations, of the available non-depolarizing relaxants mivacurium would seem to be most appropriate for caesarean section.
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PMID:Mivacurium for caesarean section in hypertensive parturients receiving magnesium sulphate therapy. 1532 Dec 40

Phonomyography (PMG) is a novel method to determine neuromuscular blockade (NMB) with high sensitivity and applicability at all muscles. The adductor pollicis muscle has long been used in research and clinical practice as reference for neuromuscular monitoring. The goal of our study was to compare PMG signals (train-of-four [TOF] ratios and T(1)/T(0) values) from both hands of the same patient to investigate the influence of hand dominance on neuromuscular monitoring. In 14 patients, PMG was recorded via small piezoelectric microphones taped over the thenar mass of both hands. After induction of anesthesia, both ulnar nerves were stimulated supramaximally using TOF stimulation every 12 s. Mivacurium 0.2 mg/kg was administered within 5 s. Onset, maximum effect, and offset of NMB were compared between both adductor pollicis muscles. Twelve patients were right-handed and two patients were left-handed. No statistical difference was found between the signals from the dominant or nondominant hand. Correlation was very good (r = 0.95). Agreement was excellent with a bias of -0.57% and limits of agreement of -17.9% to 16.7% (dominant - nondominant hand). This study shows minimal bias, good correlation and no statistical difference when NMB is monitored at both the dominant and nondominant adductor pollicis muscles. Both hands could be used interchangeably to assess NMB at the adductor pollicis muscle.
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PMID:Dominance of the hand does not change the phonomyographic measurement of neuromuscular block at the adductor pollicis muscle. 1572 58

Mivacurium- pancuronium combination proved to be more potent than either drug given alone. The goal of this study was to evaluate the safety and efficacy of this combination in elderly group and its correlation to plasma butyryl cholinesterase (Bche) activity. Forty patients, ASA I or II scheduled for elective open cholecystectomy were allocated into two groups of twenty patients each: young group (18- 55 years) and elderly group (60-75 years). Anesthesia was induced with midazolam, fentanyl, and propofol then maintained with isoflurane and opioid supplementation. Neuromuscular blockade (NMB) was monitored by train-of-four (TOF) stimulation of the ulnar nerve. After calibration, NMB was achieved by 16 microg kg(-1) pancuronium followed by 32 microg kg(-1) mivacurium. The following parameters were recorded: The onset time, clinical duration, recovery index and the total dose of mivacurium and pancuronium together with hemodynamic data. Three blood samples for Bche activity were collected: before pancuronium injection, 3 min. and 30 min. afterwards in both groups. The onset time and the recovery index of NMB were comparable in both groups. The duration of action was significantly prolonged in elderly group (49.8 +/- 10.48 min.) compared to young one (37.13 +/- 7.81 min.). The total dose of mivacurium was significantly less in the elderly group (22.56 +/- 2.39 microg kg(-1) hr(-1)) when compared to the young group (25.78 +/- 3.05 microg kg(-1) hr(-1)). For all patients, the preoperative Bche activity was within the normal range. After pancuronium injecttion, it showed a significant reduction in both groups at three and thirty minutes except a non significant value in young at thirty minutes. This reduction showed a significantly higher percent change in the elderly group (30.37 +/- 22.01) than the young group (8.60 +/- 19.19) at thirty minutes. There were significant intra operative variations in the percent changes of hemodynamic data compared to the preoperative values, yet, still within the clinically acceptable range. So, the use of a small dose of pancuronium followed by a small dose of mivacurium with a ratio of 1:2 can produce synergism without affecting either the recovery profile of mivacurium or the clinical hemodynamic stability even in the elderly group.
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PMID:Role of cholinesterase activity on pharmacodynamics of mivacurium preceded by pancuronium in elderly and young adults. 1758 May 81


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