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Intubating conditions and neuromuscular block after divided dose mivacurium or single dose rocuronium

  • Nileshkumar Patel
  • Nandan Kamath
  • Charles E. Smith
  • Alfred C. Pinchak
  • Joan H. Hagen
Reports of Investigation

Abstract

Purpose

To evaluate the tracheal intubating conditions and neuromuscular blocking charactenstics of divided dose mivacurium or single dose rocuronium.

Methods

Thirty-two patients undergoing elective surgery were studied. Anaesthesia was with propofol 2 mg · kg−1, followed by an infusion of l50 μg · kg−1 · min−1. Patients were randomized to receive either mivacurium-0.15 mg · kg−1 followed 30 sec later by 0.1 mg · kg−1, or rocuronium-0.9 mg · kg−1, followed 30 sec later by placebo. Tracheal intubating conditions were assessed 90 sec after the initial dose of relaxant by an anaesthetist who was unaware of patient group. The electromyographic (EMG) response of the first dorsal interosseus muscle to ulnar nerve train-of-four was measured.

Results

Successful tracheal intubation was performed in all patients after both mivacurium and rocuronium. Intubating conditions (jaw relaxation, open visible vocal cords) were judged to be good-excellent in all but one patient before insertion of the tracheal tube. However, patients receiving mivacunum were more likely to experience coughing and bucking after tracheal tube insertion (10/16 patients) than those receiving rocuronium (3/16 patients, P < 0.05). No patient in the rocuronium group experienced moderately vigorous coughing and bucking after insertion of the tracheal tube vs six patients in the mivacurium group (P < 0.05). Time to 10 and 25% recovery of neuromuscular function was faster (P < 0.05) after divided dose mivacunum (20 ± 1 and 23 ± 1 min, respectively) than after rocuronium (45 ± 5 and 57 ± 8 min, respectively).

Conclusion

The results suggest that, during conditions of the study, divided dose mivacurium is not recommended for a 90-sec tracheal intubation in patients where moderate coughing and bucking is deemed unacceptable.

Keywords

Tracheal Intubation Rocuronium Alfentanil Neuromuscular Blockade Tracheal Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Évaluer les conditions de l’intubation de la trachée et les caractéristiques du bloc neuromusculaire au mivacunum à dose fractionnée et au rocuronium à dose unique.

Méthodes

Cette étude réunissait 22 patients programmés pour une chirurgie non urgente. Lanesthésie était réalisée avec du propofol 2 mg · kg−1, suivi d’une perfusion de 150 μg · kg−1 · min−1. Les patients recevaient aléatoirement soit du mivacunum 0, 15 mg · kg−1 suivi 30 sec plus tard par 0, 1 mg · kg−1, sort du rocuronium 0, 9 mg · kg−1, suivi 30 sec plus tard d’un placebo. Les conditions d’intubation de la trachée étaient évaluées 90 sec après la dose initiale de myorelaxant par un anesthésiste ignorant le groupe auquel le patient appartenait. La réponse électromyographique (EMG) à la stimulation au train-de-quatre (TOF) du premier muscle interosseux dorsal était mesurée.

Résultats

Lintubation de la trachée a été réussie chez tous les patients des deux groupes. Les conditions d’intubation (relaxation de la mâchoire, visualisation de cordes vocales béantes) avant l’insertion de la canule tracheale étaient jugées de bonnes à excellentes chez tous les patients à l’exception d’un seul. Cependant, les patients sous mivacunum étaient plus sujets à la toux et au cabrage après l’insertion de la canule (10/16 patients) que ceux qui avaient reçu le rocuronium. (3/16 patients, P< 0,05). Aucun des patients du groupe rocuronium n’a présenté de toux et de cabrage notoires après l’insertion de la canule comparativement à six patients du groupe mivacunum (P< 0,05). Le temps de récupération à 10% et 25% de la fonction neuromusculaire était plus rapide (P< 0,05) après le mivacurium à dose fractionnée (respectivement 20±1 min et 23 ±1 min) qu’après le rocuronium (respectivement 45 ±5 et 57 ±8 min).

Conclusion

Ces résultats suggèrent que dans les conditions de l’étude, le mivacurium à dose fractionnée n’est pas recommandé après 90 sec pour une intubation de la trachée chez des patients chez qui une toux ou un cabrage d’intensité modérée sont jugés inacceptables.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Nileshkumar Patel
    • 1
  • Nandan Kamath
    • 1
  • Charles E. Smith
    • 1
  • Alfred C. Pinchak
    • 1
  • Joan H. Hagen
    • 1
  1. 1.Department of AnesthesiologyCase Western Reserve UniversityCleveland

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