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Early neuromuscular recovery characteristics following administration of mivacurium plus vecuronium

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Abstract

Purpose

This study was designed to describe the early recovery characteristics, as well as the speed of onset of neuromuscular block, after a combination of mivacurium and vecuronium.

Methods

In this controlled, randomized study, 30 consenting ASA I–III patients were assigned to three treatment groups. The “2M2V” group received twice the dose necessary to cause 95% depression of the evoked twitch response (2 × ED95) of mivacurium (0.15 mg · kg−1) plus 2 × ED95 of vecuronium (0.1 mg · kg−1); the “2V” group received 2 × ED95 of vecuronium; and the “4V” group received 4 × ED95 of vecuronium. Evoked neuromuscular responses of the adductor pollicis were assessed with an adductor pollicis force transducer. The time until maximum block and times to 10% and 25% recovery (T10 and T25) in each group were expressed as mean ± standard deviation and compared using ANOVA.

Results

Onset of block in the 2M2V group was 27% faster than in the 2V group (2.0 ± 0.6 vs. 2.7 ± 0.8 min respectively, P < 0.05) and was similar to the 4V group (1.95 ± 0.3 min, P = NS). The times until 10% recovery were similar in the 2M2V and 4V groups (59.9 ± 12 vs 68.2 ± 25 min, P = NS) and were slower than in the 2V group (37.2 ± 9 min, P < 0.05). Between T10 and T25, recovery after 2M2V resembled that after 2V (6.7 ± 3 vs 5.7 ± 1 min, P = NS) and was faster than after 4V (10.9 ± 7 min, P<0.05).

Conclusions

When 2 × ED95 of mivacurium is added to 2 × ED95 of an intermediate or long-acting relaxant, recovery after T10 will proceed as if one had administered the longeracting agent alone.

Résumé

Objectif

Décrire les caractéristiques de la curarisation initiale et de la décurarisation après l’administration du mivacurium associé au vécuronium.

Méthodes

Au cours de cette étude contrôlée aléatoire, 30 adultes consentants ASA I–III ont été répartis en trois groupes. Le groupe 2M2V a reçu deux fois la dose (2 × ED95) de mivacurium (0,15 mg · kg−1) nécessaire pour causer une dépression de 95% de la réponse au twitch plus 2 × ED95 de vécuronium (0,1 mg · kg−1), le groupe 2V a reçu 2 × ED95 de vécuronium, et le groupe 4V, 4 × ED95 de vécuronium. Les réponses évoquées au niveau de l’adducteur du pouce ont été évaluées à l’aide d’un transducteur. Les temps nécessaires à une curarisation maximale et à 10% et 25% de décurarisation (T10 et T25) dans chaque groupe ont été exprimés en moyenne ± écart-type et comparés avec ANOVA.

Résultats

Le début de la curarisation dans le groupe 2M2V a été de 27% plus rapide que dans le groupe 2V (respectivement 2,0 ± 0,6 vs 2,7 ± 0,8 min, P < 0,05) et identique au groupe 4V (1,95 ± 0,3 min, P = NS). Le temps nécessaire à 10% de décurarisation a été identique dans les groupes 2M2V et 4V (59 ± 0,3 vs 68 ± 25 min, P = NS) et était plus prolongé que dans le groupe 2V (37,2 ± 0 min, P < 0,05). La décurarisation entre T10 et T25 était identique après 2M2V et 2V (6,7 vs 5,7 ± 1 min, P = NS) et était plus rapide après 4V (10,9 ± 7 min, P < 0,05).

Conclusion

Quand le mivacurium 2 × ED95 est ajouté à ≥ 2 × ED95 d’un relaxant intermédiaire ou de longue durée, la décurarisation après T10 a les mêmes caractéristiques qu’un agent de longue durée administré seul.

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Correspondence to Robert G. Stout.

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Stout, R.G., Brull, S.J., Kelly, D. et al. Early neuromuscular recovery characteristics following administration of mivacurium plus vecuronium. Can J Anaesth 43, 358–361 (1996). https://doi.org/10.1007/BF03011714

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Key words

  • Monitoring: neuromuscular block: onset, recovery
  • Neuromuscular relaxants: vecuronium, mivacurium, combination