Mivacurium in children with Duchenne muscular dystrophy

Abstract

The authors retrospectively reviewed their experience with mivacurium for neuromuscular blockade in seven children with Duchenne muscular dystrophy. Mivacurium was administered to seven children ranging in age from 8.3 to 14.4 years and in weight from 29 kg to 68 kg during either posterior spinal fusion or lower extremity release. An initial bolus dose of 0.2 mgkg-' was followed by a continuous infusion. Neuromuscular blockade was monitored with a standard twitch monitor and the TOF (2 Hz for 2 s). Complete suppression of all four twitches occurred in 1.5 to 2.6 min. The continuous infusion was started with the return of the first twitch and adjusted to maintain one twitch. Time to recovery of the first twitch varied from 12 to 18 min. Continuous infusion requirements varied from 3 to 20 Fgkg-' with an average for the case of less than 10 pg-kg-' min-' in five of the seven patients. A moderate increase in sensitivity to mivacurium in this patient population is suggested by a decrease in infusion requirements and a prolonged effect following the initial dose.

Sudden cardiac death under anesthesia in pediatric patient with williams syndrome: A case report and review of literature

“…[18] Patients with other co-morbid conditions with similar biopsy findings such as Duchennes muscular dystrophy may have variable responses to neuromuscular blocking agents (NMBA) including prolonged neuromuscular blockade after non-depolarizing agents. [19,20] Given the potential for such problems, titration of NMBA with train-of-four monitoring is suggested. Although succinylcholine was used in our patient, there is no data on which to make specific recommendations regarding its safety.…”

Perioperative care of a patient with neuronal ceroid lipofuscinoses

“…Prior to their withdrawal, rapacuronium and mivacurium, two short-acting neuromuscular blocking agents, offered the ability to achieve complete neuromuscular blockade to allow for endotracheal intubation with an acceptable recovery time even for briefer procedures. [2425] If available, rocuronium in combination with sugammadex is another option.…”

Anesthetic implications of neuromuscular disease

“…However, all patients appear to show a prolonged recovery from vecuronium [61,62]. Similarly, a variable response has been seen with mivacurium, although increased sensitivity does not seem to correlate with preoperative clinical status [63]. Patients with DMD frequently have delayed gastric emptying [64], which may predispose them to regurgitation and aspiration.…”