title: Interactions between mivacurium, rocuronium, and vecuronium during general anesthesia.
abstract: This study was designed to examine the interactions between mivacurium and rocuronium or vecuronium when administered during a standardized anesthetic technique. Seventy healthy women undergoing abdominal hysterectomy procedures with a standardized thiopental-sufentanil-desflurane-nitrous oxide anesthetic technique were randomly assigned to one of seven treatment groups (10 patients each). After a tracheal intubating dose of vecuronium 100 micrograms/kg (Groups 1 and 2), rocuronium 600 micrograms/kg (Groups 3 and 4), or mivacurium 250 micrograms/kg (Groups 5, 6, and 7), patients received vecuronium, 25 micrograms/kg (Groups 1 and 6), rocuronium 150 micrograms/kg (Groups 3 and 7), or mivacurium 50 micrograms/kg (Groups 2, 4, and 5) for maintenance of neuromuscular blockade. Neuromuscular function was assessed using electromyography, with a train-of-four mode of stimulation at the wrist every 10 s. The clinical duration (time for T1 to return to 25% of baseline) of the maintenance dose of mivacurium was significantly longer after an intubating dose of rocuronium (40 +/- 8 min) and vecuronium (28 +/- 6 min) than after mivacurium (12 +/- 3 min). The clinical duration of maintenance doses of vecuronium (18 +/- 6 min) and rocuronium (13 +/- 2 min) were significantly shorter after an intubating dose of mivacurium than that after an intubating dose of vecuronium (30 +/- 5 min) or rocuronium (42 +/- 12 min), respectively. These data suggest that with consecutive administration of neuromuscular blocking drugs, the initial duration of action depends more on the kinetics of the first neuromuscular blocking drug than the subsequent drug. Thus, there appears to be no clinical advantage in using mivacurium for maintenance of neuromuscular blockade after initial administration of rocuronium or vecuronium.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Kim
authors.forename: G P
authors.initials: GP
authors.lastname: Joshi
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.forename: E R
authors.initials: ER
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000077335:Desflurane; D004347:Drug Interactions; D004558:Electric Stimulation; D004576:Electromyography / Q000187:drug effects; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D007546:Isoquinolines / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D008875:Middle Aged; D000077590:Mivacurium; D009119:Muscle Contraction / Q000187:drug effects; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D009609:Nitrous Oxide / Q000008:administration & dosage; D000077123:Rocuronium; D017409:Sufentanil / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage; D014673:Vecuronium Bromide / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D014673:Vecuronium Bromide; D017409:Sufentanil; D000077335:Desflurane; D007530:Isoflurane; D013874:Thiopental; D009609:Nitrous Oxide; D000077123:Rocuronium