Mivacurium in the myasthenic patient.

Abstract:

:We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 micrograms kg-1 (approximately one-fifth of the normal intubating dose), we observed a mean 37.5 (SEM 5.6)% reduction in evoked twitch tension. Neuromuscular block was increased with incremental doses and maintained with repeat bolus doses of 15 micrograms kg-1 at 25% recovery. The interval between maintenance bolus doses remained constant (mean 5.9 (0.7) min). Spontaneous offset was rapid with a mean recovery index (T25-T75) of 11.9 (2.1) min. Provided anticholinesterase therapy is withheld in the immediate preoperative period, mivacurium would appear to be a safe and appropriate neuromuscular blocker in this variably sensitive group of patients. The cumulative dose required to establish full neuromuscular block varied between 60 and 90 micrograms kg-1. A maintenance infusion, commencing at 3 micrograms kg-1 min-1, is recommended, guided by neuromuscular monitoring.

journal_name

Br J Anaesth

authors

Paterson IG,Hood JR,Russell SH,Weston MD,Hirsch NP

doi

10.1093/bja/73.4.494

subject

Has Abstract

pub_date

1994-10-01 00:00:00

pages

494-8

issue

4

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(17)41753-3

journal_volume

73

pub_type

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