mivacurium and Kidney-Diseases

In special patient groups, drug response may be different from that in the healthy adult patient. Mivacurium dose requirements vary with age, and children require larger doses to obtain any given degree of block, but the elderly often require smaller doses. However, the dose requirements of the neonate do not necessarily differ greatly from those of the adult. There is a relationship between the duration of action of a bolus dose as well as infusion requirements to maintain block and the plasma cholinesterase activity. Patients with renal disease may have a decreased cholinesterase activity and may require smaller doses of mivacurium. Patients with severe liver disease may have a marked decrease in cholinesterase activity, and in these patients a substantially smaller dose of the drug may be needed to obtain and maintain any given degree of block. If the variation in dose requirements is kept in mind and the degree of block appropriately monitored, mivacurium may be used with safety in special patient groups, such as children, the elderly, or those with renal or hepatic impairment.

Topics: Adult; Aged; Aging; Child; Cholinesterases; Dose-Response Relationship, Drug; Drug Monitoring; Humans; Infant, Newborn; Infusions, Intravenous; Isoquinolines; Kidney Diseases; Liver Diseases; Mivacurium; Neuromuscular Nondepolarizing Agents; Safety; Time Factors

Neuromuscular blocking agents have always shown wide inter-individual variability when it comes to their duration of action. This prevents clinicians from anticipating the evolution of the neuromuscular block for any given patient. With this study, we aimed to assess the nature of the relationships existing between different time course parameters used to describe paralysis onset and offset.. Sixty American Society of Anesthesiologists (ASA) score III-IV anaesthetised patients were randomised to receive a single equipotent dose (2ED95) of either rocuronium, mivacurium or atracurium. We used acceleromyography to monitor neuromuscular transmission. We described the relationships between the time-interval measurements of: onset, the first response (T1) reappearance, T1 25% of control, train-of-four ratio 0.25 and 0.75. Pearson correlation coefficients were calculated.. We found no significant relationships between onset and any of the four parameters used to describe the offset. On the other hand, we showed strong and highly significant linear relationships between all the parameters describing the offset for each of the muscle relaxants studied (correlation coefficients ranging from 0.850 to 0.992).. We evidenced strong linear correlations between the four offset time course parameters of spontaneous recovery after a single neuromuscular blocking agents (NMBAs) bolus. Such relationships open up new clinical perspectives concerning quantitative neuromuscular transmission monitoring: the scope of individual valuable anticipation of the patient's recovery.

Topics: Aged; Aged, 80 and over; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Atracurium; Calibration; Coronary Artery Bypass; Electromyography; Female; Humans; Isoquinolines; Kidney Diseases; Liver Diseases; Male; Middle Aged; Mivacurium; Monitoring, Intraoperative; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Time Factors; Treatment Outcome