Prolonged mivacurium neuromuscular block in children

Abstract

The authors report two cases of prolonged neuromuscular block after administration of mivacurium in children with previously undiagnosed plasma cholinesterase deficiency related to homozygous atypical genotype. Their anaesthetic management is described as well as determination of the phenotype of both children and their family.

Personalized Pediatric Anesthesia and Pain Management: Problem-Based Review

“…Mivacurium is a non-depolarizing muscle relaxant metabolized by BChE. The duration of action may be prolonged from the usual 25-30 min to about 300 min in homozygotes with BChE deficiency [79,80]. Genetic variants in hepatocellular uptake protein OATP1A2 are known to influence biliary elimination of rocuronium [81].…”

Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane

“…Another reason to use monitoring is the risk, however small, of prolonged neuromuscular block in children with abnormal pseudocholinesterase (39,40).…”

Prolonged paralysis related to mivacurium: A case study

“…Ten of these variants, including normal Homozygote U, can be identified by dibucaine inhibition of pseudocholinesterase activity in a blood sample. 9 These inherited enzymatic variations are referred to as atypical pseudocholinesterase 10,11 and result in varying degrees of prolonged muscle paralysis following the administration of succinylcholine or mivacurium. Anesthesia providers assess for this condition by inquiring if the patient or any family member has experienced prolonged awakening after anesthesia.…”