title: Combinations of high-dose vecuronium and mivacurium provide similar paralysis and intubation conditions to succinylcholine in paediatric patients.
abstract: This randomized blinded study tested the hypothesis that equipotent doses of vecuronium and mivacurium given in combination could achieve onset times to 90% neuromuscular block (B90) and intubation scores similar to succinylcholine. Thirty children were randomly assigned to one of three groups as follows. Group Sux received a single dose (1 mg.kg-1) of succinylcholine followed by normal saline. Group V1M1 received 0.08 mg.kg-1 of vecuronium followed by 0.1 mg.kg-1 of mivacurium. Group V2M2 received 0.16 mg.kg-1 of vecuronium followed by 0.2 mg.kg-1 of mivacurium. Anaesthesia consisted of propofol, fentanyl, and nitrous oxide. Neuromuscular response was monitored by adductor pollicis electromyography (Datex NMT). Sixty s after administration of the first injection, the laryngoscopy began, with the anaesthesiologist scoring the ease of intubation on a four category scale as excellent, good, poor, or inadequate. Time from injection to B90 was 39 (2.6)s after succinylcholine, which was not significantly different from 48 (3.5)s after vecuronium 0.16 mg.kg-1 and mivacurium 0.2 mg.kg-1 (V2M2). Mean time to B90 for group V1M1 was 64 (4.7)s, which was significantly different from that in group Sux. The intubation score was 'excellent' for all patients in groups Sux and V2M2 and for only seven of ten patients in group V1M1. Only combination of vecuronium (0.16 mg.kg-1) and mivacurium (0.2 mg.kg-1) provided rapid onset of neuromuscular blockade and excellent intubating conditions comparable to succinylcholine 1 mg.kg-1. This combination did result in prolonged recovery times.
authors.affiliation: Department of Anesthesiology, Alfred I. duPont Institute, Wilmington, DE 19899, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Theroux
authors.forename: B W
authors.initials: BW
authors.lastname: Brandom
authors.forename: M M
authors.initials: MM
authors.lastname: Zagnoev
authors.forename: L
authors.initials: L
authors.lastname: Drago
mesh_terms: D002648:Child; D004311:Double-Blind Method; D004576:Electromyography; D006801:Humans; D007442:Intubation, Intratracheal; D007546:Isoquinolines / Q000008:administration & dosage*; D000077590:Mivacurium; D019148:Neuromuscular Blockade; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D013390:Succinylcholine / Q000008:administration & dosage*; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage*
chemical_list: D007546:Isoquinolines; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D014673:Vecuronium Bromide; D013390:Succinylcholine