mivacurium and Drug-Hypersensitivity

Numerous reports confirm the performance of intradermal tests for the diagnosis of anaphylaxis during anesthesia; however, there is controversy over their diagnostic value regarding the newer neuromuscular blocking agents (NMBAs).. One hundred eleven healthy volunteers were randomly assigned to receive intradermal injections of two NMBAs, at five increasing concentrations. A concentration was considered as a reactive concentration when it led to a positive reaction in more than 5% of the subjects. These concentrations were compared with the maximal concentration recommended for the diagnosis of sensitization to NMBAs.. The maximal nonreactive concentrations were 10 m for suxamethonium; 10 m for pancuronium, vecuronium, rocuronium, and cisatracurium; and 10 m for atracurium and mivacurium. Except for mivacurium, these nonreactive concentrations were close to the maximal concentrations used for the diagnosis of sensitization against NMBAs. For mivacurium, the nonreactive concentrations were higher than the maximal concentration currently recommended in clinical practice.. The aminosteroidal NMBAs pancuronium, vecuronium, and rocuronium and the benzylisoquinoline cisatracurium have a similar potency to induce a nonspecific skin reactivity. If the criteria for positivity and the maximal concentrations of the commercially available compounds recommended by French practice guidelines are used, the risk of false-positive results is limited, and only minor modifications of these recommendations could be suggested. A slight reduction in the maximal concentration used for rocuronium from 1:100 to 1:200 and an increase from 1:1,000 to 1:200 for mivacurium can be proposed.

Topics: Adolescent; Adult; Androstanols; Atracurium; Dose-Response Relationship, Drug; Drug Hypersensitivity; Female; Humans; Injections, Intradermal; Isoquinolines; Male; Middle Aged; Mivacurium; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pancuronium; Reference Values; Rocuronium; Skin; Skin Tests; Succinylcholine; Vecuronium Bromide

Topics: Apnea; Butyrylcholinesterase; Cholinesterases; Documentation; Drug Hypersensitivity; Follow-Up Studies; Humans; Isoquinolines; Medical Records; Metabolism, Inborn Errors; Mivacurium; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Succinylcholine

Topics: Adult; Anesthetics, General; Anti-Allergic Agents; Atracurium; Cervical Vertebrae; Contraindications; Cross Reactions; Diphenhydramine; Diskectomy; Drug Hypersensitivity; Humans; Hydrocortisone; Intubation; Intubation, Intratracheal; Isoquinolines; Joint Dislocations; Male; Mivacurium; Neuromuscular Nondepolarizing Agents; Preanesthetic Medication; Ranitidine; Skin Tests; Spinal Fractures; Spinal Fusion; Vecuronium Bromide

Recognition of butyrylcholinesterase (EC 3.1.1.8) variants in human serum is essential to identify patients who may be susceptible to a prolonged reaction of suxamethonium and mivacurium, short-acting muscle relaxants. Thus they can be given appropriate advice along with their relatives who may be similarly affected. Therefore, Cholinesterase Unit for detection of individuals, carriers of inherited suxamethonium sensitive butyrylcholinesterase variants was established at the Institute for Clinical Chemistry of the Clinical Hospital >>Merkur<<, Zagreb, Croatia. A study was conducted on sera from patients referred to the Unit. Butyrylcholinesterase variants were determined by measuring the enzyme activity and inhibition by specific inhibitors in the sera of 384 patients and of the members of seven families. Cholinesterase Unit issued >>Warning Cards<< to the carriers of inherited serum butyrylcholinesterase variants in order to avoid prolonged apnea that suxamethonium might cause.

Topics: Adolescent; Adult; Butyrylcholinesterase; Child; Child, Preschool; Contraindications; Croatia; Drug Hypersensitivity; Genetic Variation; Humans; Isoquinolines; Medical Records; Mivacurium; Neuromuscular Depolarizing Agents; Phenotype; Risk Management; Succinylcholine

Topics: Adult; Cholinesterases; Drug Hypersensitivity; Female; Genetic Markers; Heterozygote; Humans; Isoquinolines; Mivacurium; Neostigmine; Neuromuscular Nondepolarizing Agents; Phenotype

Topics: Adult; Anaphylaxis; Atracurium; Drug Hypersensitivity; Female; Humans; Isoquinolines; Mivacurium; Neuromuscular Nondepolarizing Agents; Skin Tests

The benzylisoquinolinium relaxants currently include the intermediate-acting agent, atracurium, and the short-acting agent, mivacurium. This class of relaxants has always retained the distinct advantages of rapid degradation, enzymatic metabolism, or both in the plasma, resulting in short half-lives and fast, complete recovery, unrelated to dose or duration of administration. Any improvements in this class of relaxants must focus on retaining this property at the same time as decreasing or eliminating histamine release, which has always been the major disadvantage of the benzylisoquinoliniums. The introduction of 51W89, an isomer of atracurium, may represent an advance in the development of this class of relaxants.

Topics: Anesthesia Recovery Period; Atracurium; Drug Design; Drug Hypersensitivity; Forecasting; Half-Life; Histamine Release; Humans; Isomerism; Isoquinolines; Mivacurium; Neuromuscular Nondepolarizing Agents