title: Efficacy and safety of divided dose administration of mivacurium for a 90-second tracheal intubation.
abstract: OBJECTIVE
  To compare the safety and effectiveness of 0.25 mg divided doses of mivacurium chloride to succinylcholine for a 90-second tracheal intubation.
  
  
  METHODS
  Randomized, double-blind, multicenter study in two groups.
  
  
  METHODS
  Operating rooms at four university medical centers.
  
  
  METHODS
  200 healthy ASA status I and II adult patients scheduled for elective surgery with general anesthesia and endotracheal intubation.
  
  
  METHODS
  Patients were premedicated with 1 to 2 mg midazolam and 2 micrograms/kg fentanyl. Anesthesia was induced with 2 mg/kg propofol. Group A received 0.25 mg/kg mivacurium given as a divided dose (0.15 mg/kg followed in 30 seconds with 0.1 mg/kg). Group B (control) received 1.5 mg/kg succinylcholine (SCh) preceded two minutes earlier by 50 micrograms/kg d-tubocurarine (dtc).
  
  
  RESULTS
  Tracheal intubation grading, train-of-four response of the adductor pollicis, heart rate (HR), and mean arterial blood pressure (MAP) were measured and evaluated. Chi-square analysis was performed for comparison between Group A and Group B with respect to the frequency distribution of intubation using the scores excellent, good, and poor and not possible (combined). Group B had a significantly higher excellent score of intubation than Group A, 84% versus 56% (p < 0.0001). No significant difference was found between the two groups when the scores excellent and good were combined (Fisher's Exact test, p = 0.28). The changes in MAP and HR were similar for the two groups.
  
  
  CONCLUSIONS
  When Sch is not desirable, mivacurium 0.25 mg/kg given as a divided dose provides good to excellent intubation conditions 90 seconds after the initial dose without significant changes in MAP or HR. It can be an appropriate alternative for short surgical procedures. It must be emphasized that this conclusion does not apply to rapid-sequence induction-intubation.
authors.affiliation: Department of Anaesthesia, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: H H
authors.initials: HH
authors.lastname: Ali
authors.forename: C A
authors.initials: CA
authors.lastname: Lien
authors.forename: T
authors.initials: T
authors.lastname: Witkowski
authors.forename: S J
authors.initials: SJ
authors.lastname: Brull
authors.forename: R G
authors.initials: RG
authors.lastname: Stout
authors.forename: R
authors.initials: R
authors.lastname: Bartkowski
authors.forename: D G
authors.initials: DG
authors.lastname: Silverman
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: J A
authors.initials: JA
authors.lastname: Ascher
authors.forename: N G
authors.initials: NG
authors.lastname: Goudsouzian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D007546:Isoquinolines / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D000077590:Mivacurium; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D013390:Succinylcholine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D007546:Isoquinolines; D009467:Neuromuscular Depolarizing Agents; D000077590:Mivacurium; D013390:Succinylcholine