Abstract
The mivacurium infusion requirements following vecuronium were evaluated in 15 adults and 15 children in an open prospective clinical study. This study was undertaken to elucidate whether potentiation of effect occurred when a mivacurium infusion was administered after vecuronium was used for the facilitation of tracheal intubation. The adult patients were anaesthetized with N2O:O2, propofol and fentanyl, the children with halothane (1%) N2O:O2 Vecuronium 100 μg · kg−1 was administered during stimulation of the ulnar nerve with train-of-four stimuli at 0.1 Hz. The force of contraction of the adductor pollicis was recorded. Upon recovery of the twitch response from vecuronium, a mivacurium infusion was started at 4 μg · kg−1 · min−1, thereafter adjustments were made to maintain the first twitch of the train-of-four (T1 at 1–10% of control. The mean (±SE) initial infusion requirements in children of mivacurium was 4.3 (0.4) μg · kg−1 · min−1 which increased linearly (P < 0.001) over the next 90 min to 10 μg · kg−1 · min−1. In adults the infusion requirement was lower than in children and remained at approximately 3 μg · kg−1 · min−1 over the next 75 min. At the end of the surgical procedure, the children recovered faster than the adults with no child requiring reversal. Because of prolonged recovery (>20 min), seven adults required reversal with 15–70 μg · kg−1 neostigmine. Mivacurium infusion requirements following vecuronium are higher in children than adults. Potentiation of the effects of mivacurium were seen when vecuronium preceeded mivacurium. This potentiation of effect lasted longer in adults than in children.
Résumé
Après l’administration de vécuronium, le besoin de mivacurium en perfusion est évalué chez 15 adultes et 15 enfants au cours d’une étude prospective ouverte. Le but de l’étude est de déterminer l’effet potentialisateur possible d’une perfusion de mivacurium à la suite de vécuronium administré pour l’intubation de la trachée. Les adultes sont anesthésiés au N2O:O2, propofol et fentanyl, les enfants à l’halothane (1%), N2O:O2. Le vécuronium 100 μg · kg−1 est administré pendant la stimulation du nerf cubital au train de quatre (TOF) à 0,1 Hz. La force de contraction de l’adducteur du pouce est enregistrée. Pendant le récupération du twitch après le vécuronium, une perfusion de mivacurium est débutée à la vitesse de 4 μg · kg−1 · min−1 et par la suite elle est réglée de façon à maintenir la première contraction du TOF(T1) à 1–10% du contrôle. Le besoin (moyenne± SD) de mivacurium en perfusion chez les enfants est de 4,3 (0,4) μg · kg−1 · min−1 et augmente de façon linéaire (P < 0,001) pendant les 90 min suivantes à 10 μg· kg−1 · min−1. Chez les adultes, le besoin en perfusion est moins élevé que chez les enfants et demeure à environ 3 μg · kg−1 · min−1 pendant les 75 min suivantes. A la fin de l’intervention, les enfants récupèrent plus vite que les adultes et n’ont pas besoin d’antagonisme. A cause d’une récupération prolongée (>20 min), sept adultes ont eu besoin d’antagonisme avec de la néostigmine 15–70 μg · kg−1. Le besoin de mivacurium en perfusion à la suite de vécuronium est plus élevé chez les enfants que chez les adultes. La potentialisation de l’effet dure plus longtemps chez les adultes que chez les enfants.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Debaene B, Meistelman C, d’Hollander A. Recovery from vecuronium neuromuscular blockade following neostigmine administration in infants, children, and adults during halothane anesthesia. Anesthesiology 1989; 71: 840–4.
Ferres CJ, Crean PM, Mirakhur RK. An evaluation of Org NC 45 (vecuronium) in paediatric anaesthesia. Anaesthesia 1983; 38: 943–7.
Muchhal KK, Viby-Mogensen J, Fernando PUE, Tamilarasan A, Bonsu AK, Lambourne A. Evaluation of intense neuromuscular blockade caused by vecuronium using posttetanic count (PTC). Anesthesiology 1987; 66: 846–9.
Brandom BW, Sarner JB, Woelfel SK, et al. Mivacurium infusion requirements in pédiatric surgical patients during nitrous oxide-halothane and during nitrous oxide-narcotic anesthesia. Anesth Analg 1990; 71: 16–22.
Alifimoff JK, Goudsouzain NG. Continuous infusion of mivacurium in children. Br J Anaesth 1989; 63: 520–4.
Ali HH, Savarese JJ, Embree PB, et al. Clinical pharmacology of mivacurium chloride (BW B1090U) infusion: comparison with vecuronium and atracurium. Br J Anaesth 1988; 61: 541–6.
Basta SJ. Clinical pharmacology of mivacurium chloride: a review. J Clin Anesth 1992; 4: 153–63.
Mirakhur RK, Gibson FM, Ferres CJ. Vecuronium and dtubocurarine combination: potentiation of effect. Anesth Analg 1985; 64: 711–4.
Lebowitz PW, Ramsey RM, Savarese JJ, Ali HH. Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine or pancuronium and d-tubocurarine. Anesth Analg 1980; 59: 604–9.
Waud BE, Waud DR. Quantitative examination of the interaction of competitive neuromuscular blocking agents on the indirectly elicited muscle twitch. Anesthesiology 1984; 61: 420–7.
Pollard BJ, Jones RM. Interactions between tubocurarine, pancuronium and alcuronium demonstrated in the rat phrenic nerve-hemidiaphragm preparation. Br J Anaesth 1983; 55: 1127–32.
Rashkovsky OM, Agoston S, Ket JM. Interaction between pancuronium bromide and vecuronium bromide. Br J Anaesth 1985; 57: 1063–6.
Meretoja OA, Brandom BW, Taivainen T, Jalkanen L. Synergism between atracurium and vecuronium in children. Br J Anaesth 1993; 71: 440–2.
Jalkanen L, Meretoja OA, Taivainen T, Brandom BW, Dayal B. Synergism between atracurium and mivacurium compared with that between vecuronium and mivacurium. Anesth Analg 1994; 79: 998–1002.
Popovic L, Kunec-Vajic E. Plasma cholinesterase inhibition by pancuronium and vecuronium. Lijec Vjesn 1990; 112: 142–3.
Stovner J, Ofiedal N, Holmboe. The inhibition of cholinesterases by pancuronium. Br J Anaesth 1975; 47: 949–54.
Mirakhur RK, Ferres CJ, Lavery TD. Plasma cholinesterase levels following pancuronium and vecuronium. Acta Anaesthesiol Scand 1983; 27: 451–3.
Wessler I. Pre-synaptic neuromuscular block. Anesthetic Pharmacology Review 1993; 1: 69–76.
Waud BE, Waud DR. Interaction among agents that block end-plate depolarization competitively. Anesthesiology 1985; 63: 4–15.
Neubig RR, Cohen JB. Equilibrium binding of [3H] tubocurarine and [3H] acetylcholine by torpedo postsynaptic membrane: Stoichiometry and ligand interactions. Biochemistry 1979; 18: 5464–75.
Bowman WC. Pharmacology of Neuromuscular Function, 2nd ed. London: Wright, 1990; 171–2.
Bowman WC. Prejunctional and postjunctional cholinoceptors at the neuromuscular junction. Anesth Analg. 1980; 59: 935–43.
Standaert FG. Release of transmitter at the neuromuscular junction. Br J Anaesth 1982; 54: 131–45.
Standaert FG. Donuts and holes: molecules and muscle relaxants. Seminars in Anesthesia 1984; 3: 251–61.
Van Der Spek AFL, Zupan JT, Pollard BJ, Schork MA. Interactions of vecuronium and atracurium in an in vitro nerve-muscle preparation. Anesth Analg 1988; 67: 240–6.
Taylor P. Are neuromuscular blocking agents more efficacious in pairs? (Editorial). Anesthesiology 1985; 63: 1–3.
Sine SM, Taylor P. Relationship between reversible antagonist occupancy and the functional capacity of the acetylcholine receptor. J Biol Chem 1981; 256: 6692–9.
Weiland G, Taylor P. Ligand specificity of state transitions in the cholinergic receptor: behaviour of agonists and antagonists. Mol Pharmacol 1979; 15: 197–212.
Changeux J-P, Devillers-Thiéry A, Chemouilli P. Acetylcholine receptor: an allosteric protein. Science 1984; 225: 1335–45.
Taylor P, Brown RD, Johnson DA. The linkage between ligand occupation and response of the nicotinic acetylcholine receptor. Current Topics in Membranes and Transport 1983; 18: 407–44.
Fisher DM, Castagnoli K, Miller RD. Vecuronium kinetics and dynamics in anesthetized infants and children. Clin Pharmacol Ther 1985; 34: 402–6.
Meretoja OA, Wirtavuori K, Neuvonen PJ. Agedependence of the dose-response curve of vecuronium in pediatric patients during balanced anesthesia. Anesth Analg 1988; 67: 21–6.
Goudsouzian NG, Denman W, Malta E. Mivacurium after atracurium in children. Anesth Analg 1994; 79: 345–9.
Feldman S. Biophase binding: its effect on recovery from non-depolarizing neuromuscular block. Anesthetic Pharmacology Review 1993; 1: 81–8.
Feldman SA, Fauvel NJ, Hood JR. Recovery from pancuronium and vecuronium administered simultaneously in the isolated forearm and the effect on recovery following administration after cross-over of drugs. Anesth Analg 1993; 76: 92–5.
Feldman S, Fauvel N. Potentiation and antagonism of vecuronium by decamethonium. Anesth Analg 1993; 76: 631–4.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Denman, W., Goudsouzian, N. Mivacurium infusion requirements following vecuronium: different response between adults and children. Can J Anaesth 42, 597–602 (1995). https://doi.org/10.1007/BF03011876
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011876