title: Clinical pharmacology of mivacurium chloride (BW B1090U) in children during nitrous oxide-halothane and nitrous oxide-narcotic anesthesia.
abstract: We determined the dose-response relationships of mivacurium (BW B1090U) in children (2-10 years) during nitrous oxide-halothane anesthesia (0.8% end-tidal) and during nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, for each anesthetic background four subgroups of nine patients received single bolus doses of 20-120 micrograms/kg mivacurium. The ED50 and ED95 (estimated from linear regression plots of log-dose vs. probit of effect) were 52 micrograms/kg and 89 micrograms/kg during halothane anesthesia and 62 micrograms/kg and 103 micrograms/kg during narcotic anesthesia. Nine additional patients in each anesthetic group received 250 micrograms/kg mivacurium. Three of the 18 patients given 250 micrograms/kg mivacurium developed cutaneous flushing; in one of these mean arterial pressure decreased 32% for less than 1 minute; no significant changes in heart rate occurred. With the increase in mivacurium dose from 120 micrograms/kg to 250 micrograms/kg the times to onset of 90% and maximum neuromuscular block decreased by 0.5 to 1 minute, and the times to recovery of neuromuscular transmission to 5% (T5) or 25% (T25) increased by 2-4 minutes. The recovery index (T25-75) in patients anesthetized with halothane was 4.3 +/- 1.5 minute (mean +/- SD); the time to complete recovery (T4:1 greater than or equal to 0.75) was 19.8 +/- 7.4 minutes.
authors.affiliation: Department of Anesthesiology, Children's Hospital of Pittsburgh, Pennsylvania 15213-2583.
authors.forename: J B
authors.initials: JB
authors.lastname: Sarner
authors.forename: B W
authors.initials: BW
authors.lastname: Brandom
authors.forename: S K
authors.initials: SK
authors.lastname: Woelfel
authors.forename: M L
authors.initials: ML
authors.lastname: Dong
authors.forename: M C
authors.initials: MC
authors.lastname: Horn
authors.forename: D R
authors.initials: DR
authors.lastname: Cook
authors.forename: B F
authors.initials: BF
authors.lastname: McNulty
authors.forename: V J
authors.initials: VJ
authors.lastname: Foster
mesh_terms: D000367:Age Factors; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006207:Half-Life; D006221:Halothane; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007546:Isoquinolines; D000077590:Mivacurium; D009294:Narcotics; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics / Q000494:pharmacology*; D009609:Nitrous Oxide
chemical_list: D007546:Isoquinolines; D009294:Narcotics; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D009609:Nitrous Oxide; D006221:Halothane