Reversal of Mivacurium: Neostigmine, Edrophonium, or Spontaneous Recovery — Which Makes More Sense?
The question, “is routine antagonism of neuromuscular block always necessary,” may never be settled to everyone’s satisfaction. Shortly after the introduction of atracurium and vecuronium into clinical practice Savarese suggested that “In many patients to whom these drugs have been given in proper dosage and with correct timing, reversal will not be required.”1 However, Miller states that “If one accepts the premise that even one case of severe, undetected respiratory depression and hypoxia in the PAW resulting in adverse effect is unacceptable, then .... complete reversal of neuromuscular blockade is the best prevention.”2 Prior to the availability of mivacurium, this latter position probably was most representative of clinical practice in North America. However, it is unclear that routine reversal of agents of mivacurium’s duration of action offers real benefits to the patient.
KeywordsNeuromuscular Blockade Neuromuscular Block Spontaneous Recovery Mivacurium Chloride Nondepolarizing Neuromuscular Block
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