mivacurium and Muscular-Diseases

Ninety-four patients undergoing elective outpatient third molar extraction were recruited into a double-blind, randomized, prospective trial comparing mivacurium (group M) with succinylcholine (Group S) for conditions for endotracheal intubation and the occurrence of postoperative myalgia. Anaesthesia was induced with fentanyl 1 microgram.kg-1 and propofol 2.5 micrograms.kg-1 in all patients. Group S patients were given gallamine 20 mg while group M patients were given mivacurium 0.2 mg.kg-1. Manual ventilation was commenced and anaesthesia maintained with nitrous oxide 70% and isoflurane 1 to 2% in oxygen. After two minutes, group S patients were given succinylcholine 1.5 mg.kg-1 and group M patients 0.9% saline. Nasotracheal intubation was performed 30 seconds later. Intubating conditions in group M were significantly better than those in group S (P < 0.001). The incidence of postoperative myalgia was 9.5% in group M and 26% in group S but this was not statistically significant (P = 0.09). We propose that mivacurium is a suitable neuromuscular blocker to use for endotracheal intubation in outpatient dental surgery.

Topics: Adolescent; Adult; Ambulatory Surgical Procedures; Anesthesia, Dental; Double-Blind Method; Female; Humans; Intubation, Intratracheal; Isoquinolines; Male; Middle Aged; Mivacurium; Molar, Third; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Prospective Studies; Succinylcholine; Tooth Extraction

Because succinylcholine has obvious advantages for facilitating endotracheal intubation in the ambulatory setting (e.g., low cost, fast onset, and no need for reversal of neuromuscular block), it is important to determine whether this muscle relaxant is indeed associated with an increased incidence of postoperative myalgias, compared with alternative but more expensive nondepolarizing muscle relaxants. We studied 119 outpatients undergoing endoscopic nasal sinus surgery or septoplasty. The anesthetic technique consisted of propofol/lidocaine for induction, followed by isoflurane/nitrous oxide/oxygen for maintenance. Oral tracheal intubation was performed by using a fiberscope. Patients were randomly assigned to one of two muscle relaxant groups. Group 1 patients received d-tubocurarine 3 mg followed by succinylcholine 1.5 mg/kg. Group 2 patients received mivacurium 0.2 mg/kg. After recovery from anesthesia, patients were asked whether they had any muscle pain and/or stiffness. Pain was categorized by location and quantified by using a verbal scale (from 0 to 10). Analgesic usage and myalgias limiting ambulation were recorded. After discharge from the ambulatory surgery unit, patients were contacted by telephone on Postoperative Day 1. If patients complained of myalgias, they were contacted by telephone on Days 2 and 3. Only one patient (in the mivacurium-treated group) reported myalgia as a limiting factor in ambulation or resumption of normal activity. There were no differences between groups with respect to the incidence (21% in the succinylcholine-treated group and 18% in the mivacurium-treated group), location, or severity of myalgia. In conclusion, succinylcholine (preceded by pretreatment with d-tubocurarine and lidocaine) is not associated with an increased incidence of myalgias, compared with mivacurium, when used to facilitate tracheal intubation in patients undergoing ambulatory nasal surgery.. The results of this study show that the frequency of muscle pains after surgery in outpatients is approximately 20%, regardless of whether succinylcholine (after precurarization) or mivacurium is used to assist in insertion of the breathing tube.

Topics: Adult; Ambulatory Surgical Procedures; Anesthesia Recovery Period; Anesthetics, Local; Contraindications; Female; Humans; Intubation, Intratracheal; Isoquinolines; Lidocaine; Male; Mivacurium; Muscular Diseases; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Paranasal Sinuses; Succinylcholine; Surveys and Questionnaires; Tubocurarine

We describe the successful use of the short-acting, non-depolarizing neuromuscular blocking agent, mivacurium, in a 53-yr-old female patient with late onset congenital myopathy, undergoing elective submucous resection of the inferior turbinates. She was unable to climb stairs and walking was limited to periods of 15 min because of generalized weakness, fatigue and shortness of breath. A Datex Relaxograph was used to monitor the train-of-four count. No increase in sensitivity to mivacurium was demonstrated. A dose of 12 mg (three times the recommended ED95) resulted in 88% reduction of the first of the train-of-four count (T1) compared with control (TC). Spontaneous recovery of T1/TC to 100% took 11 min 20 s from the time maximum block was first achieved. The recovery index (25-75% T1/TC) was 4 min 40 s.

Topics: Female; Humans; Isoquinolines; Middle Aged; Mivacurium; Muscular Diseases; Neuromuscular Nondepolarizing Agents; Turbinates