Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

Plaud, Benoît; Debaene, B.; Lequeau, Frank; Meistelman, Claude; Donati, François

doi:10.1097/00000542-199607000-00011

Cited by 47 publications

(16 citation statements)

References 16 publications

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“…Mivacurium (Mivacron ® ) und Atracurium besilat (Tracrium ® ) sind Mittel der Wahl. Die Wirkung auf die Larynxmuskulatur tritt innerhalb von 2,2-2,7 min nach Injektion ein [14,20]. Um eine sichere Relaxierung zu erzielen, werden Dosierungen von dem 2-bis 3fa-chen der ED 95 benutzt [6,7,22].…”

Section: Ergebnisseunclassified

“…Die am M. adductor pollicis gemessene Relaxation entspricht jedoch nicht der Relaxierung anderer Muskelgruppen [5,8]. An der Larynxmuskulatur ist die Anschlagzeit verschiedener nicht depolarisierender Muskelrelaxanzien verkürzt, bedarf aber höherer Dosen, um die gleiche Blockadetiefe wie am M. adductor pollicis zu erreichen [10,14,18,20]. Die Rückkehr der Reizantwort am Larynx ist früher als an der Peripherie [14,20,25].…”

Section: Ergebnisseunclassified

“…An der Larynxmuskulatur ist die Anschlagzeit verschiedener nicht depolarisierender Muskelrelaxanzien verkürzt, bedarf aber höherer Dosen, um die gleiche Blockadetiefe wie am M. adductor pollicis zu erreichen [10,14,18,20]. Die Rückkehr der Reizantwort am Larynx ist früher als an der Peripherie [14,20,25]. Dies entspricht der Beobachtung unserer Studie, dass bereits bei einer peripheren Restrelaxierung von ca.…”

Section: Ergebnisseunclassified

“…"post tetanic count") zur Verfügung [11,19,27]. Wird der optimale Intubationszeitpunkt mit dem vollständigen Verlust der Reizantwort auf eine TOF-Stimulation des M. adductor pollicis festgelegt, können bei adäquater Anästhesietiefe gute bis sehr gute Intubationsbedingungen erwartet werden [24].Studien zum Einfluss der Relaxanzien auf die Larynxmuskulatur führen in der Regel eine unspezifische transkutane Stimulation der Kehlkopfmuskulatur durch und messen die Ände-rung eines definierten Cuff-Druckes am Tubus [20,25]. In der von uns verwendeten Methode mit der direkten Stimulation des N. laryngeus recurrens ist uns lediglich die Studie von Kunath et al bekannt, die bei 30 Patienten eine eindeutige akustische Ableitung der Signale unter einem Relaxationsniveau von 90% angaben.…”

Section: Ergebnisseunclassified

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Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Jonas

Fischer

Kaissling

et al. 2002

Chirurg

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Section: Ergebnisseunclassified

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Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Jonas

Fischer

Kaissling

et al. 2002

Chirurg

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“…Bei Atracurium führt der HofmannMechanismus zusammen mit der unspezifischen enzymatischen Hydrolyse der Esterverbindungen zu verschiedenen möglichen Metaboliten, von denen nur der endgültige Metabolit, das tertiäre Amin Laudanosin, eine pharmakologische Bedeutung hat. Obwohl Laudanosin in hohen Dosen bei Labortieren konvulsiv wirken kann [21], ist dieses Symptom aus quantitativen Gründen äußerst unwahrscheinlich [17]. Laudanosinkonzentrationen, die Krampfpotentiale auslösen können, wurden bisher bei Patienten nicht beobachtet [16].…”

Section: Metabolismusunclassified

Die klinische Pharmakologie neuer Benzylisochinolin-Diester-Verbindungen

et al. 1997

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The benzylisochinoline muscle relaxants have a highly selective affinity to the motor endplate which is associated with an absence of autonomic side effects such as ganglionic and vagus block. The requirement of only low clinical doses also reduces histamine liberation. Muscle relaxants with high neuromuscular blocking potency have a slow onset. Both atracurium and cisatracurium undergo Hofmann-Elimination in the plasma whereas mivacurium is hydrolyzed by pseudocholinesterase. The difference in kinetics between these pathways render atracurium and cisatracurium muscle relaxants of intermediate duration of action while mivacurium is short acting. Cisatracurium, one of the ten stereoisomeres of atracurium, is 3 to 4 times as potent as atracurium, does not release histamine, has no cardiovascular side effects and, due to the small clinical doses resulting from its high neuromuscular blocking potency, produces only negligible quantities of laudanosine. Its ED95 is 0.05 mg/kg. Good intubation conditions can be expected within 1.5 to 2 min following 3- to 4-times the ED95. Thereafter is takes about 65 min for T1 to recover to 25% of control. Maintenance doses of 0.02 to 0.04 mg/kg have a duration of action of 15 to 20 min. An infusion of cisatracurium of 1.0 to 2.0 mcg/kg/min, is adequate to maintain a 90 to 95% neuromuscular block. The time of recovery is largely independent on the total dose of cisatracurium administered by either repeated injection or infusion. Mivacurium is a racemate of 3 stereoisomeres of which the trans-trans- and the cis-trans-compound account for 95% of the neuromuscular blocking effect. In adults the ED95 is 0.08 mg/kg. The ensuing recovery of T1 to 25% of control is about 15 min. Rapid injection of 3xED95 may transiently lower the arterial blood pressure and may produce skin flushing in an incidence of 30 to 40%. Larger doses should be injected slowly with 30 to 60 s. The onset of mivacurium neuromuscular block following 3xED95 is relatively slow (2 min). Maintenance doses of 0.05 to 0.1 mg/kg have a duration of action of 5 to 10 min. A 95% neuromuscular block may be maintained by an infusion of 3 to 12 micrograms/kg/min. The time of recovery does not depend on the total cumulative dose given by either repeated injection or by infusion. The duration of mivacurium neuromuscular block may be drastically prolonged in the presence of low or atypical plasmacholinesterase. Both neostigmine and edrophonium are suitable reversal agents. None of the presently available benzylisochinoline muscle relaxants has the potential to completely replace succinylcholine.

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Deep Neuromuscular Block for Endolaryngeal Surgery: A Systematic Review and Meta‐Analysis

Zheng

Zhang

et al. 2023

The Laryngoscope

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ObjectivesTo determine the safety and efficacy of deep neuromuscular block (NMB) for endolaryngeal surgery.Data SourcesPubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Wanfang, VIP databases, and trial registry database.MethodsInclusion criteria followed the PICOS principles: Participants, adults undergoing endolaryngeal surgery; Intervention, deep NMB performed during the surgery; Control, no‐deep NMB performed; Outcomes, primary outcome: the incidence of clinically acceptable surgical conditions. Secondary outcome: the incidence of intraoperative complications (including vocal fold movement and coughing) and total incidence of postoperative complications [including postoperative residual curarization (PORC), postoperative sore throat (POST), and postoperative nausea and vomiting (PONV)]. Study design, randomized controlled trials (RCTs). Duplicate publications, editorials, letters, abstracts, and reviews were excluded.ResultsFour articles with 242 patients were identified for analysis. The results indicated that compared with no‐deep NMB, deep NMB provides a higher incidence of clinically acceptable surgical conditions (98.36% vs. 76.67%; relative ratio [RR] = 1.29, 95% CI: 1.07–1.56), a lower incidence of intraoperative complications (10.83% versus 37.16%; RR = 0.32; 95% CI: 0.21–0.49) (lower incidence of vocal fold movement [1.85% vs. 34%; RR = 0.08, 95% CI: 0.02–0.41] and coughing [15.53% vs. 38.78%; RR = 0.42, 95% CI: 0.27–0.66]). There were no differences in the overall incidence of postoperative complications (RR = 2.10, 95% CI: 0.12–36.40).ConclusionsBased on current published evidence, deep NMB provides better surgical conditions with a higher incidence of clinically acceptable surgical conditions and a lower incidence of intraoperative complications (lower incidence of vocal fold movement and coughing) without increasing the overall incidence of postoperative complications.Level of Evidence1 Laryngoscope, 133:2055–2065, 2023

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Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

Abstract: With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.

Cited by 47 publications

References 16 publications

Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Relaxierung und elektromyographische Identifikation des N. laryngeus recurrens

Die klinische Pharmakologie neuer Benzylisochinolin-Diester-Verbindungen

Deep Neuromuscular Block for Endolaryngeal Surgery: A Systematic Review and Meta‐Analysis

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