Prolonged paralysis following mivacurium administration.
Mivacurium is a benzylisoquinolone, choline-like, non-depolarizing muscle relaxant. Its onset of action is similar to that of atracurium but its duration of action is shorter (approximately 10-15 minutes). Mivacurium is metabolized by plasma cholinesterases at approximately 70% of the rate of metabolism of suxamethonium. Deficiency or abnormality of plasma cholinesterase may cause the duration of action of both suxamethonium and mivacurium to be greatly prolonged. We describe a case of prolonged mivacurium paralysis after day surgery. Laboratory investigations showed a genetic tendency toward abnormal cholinesterase levels, but markedly depressed cholinesterase activity was suggestive of additional acquired causes. This patient had a history of liver disease, malnutrition and anticholinesterase use, which we believe were the most significant factors involved.
Chung
D Y
DY
Department of Perioperative Medicine and Intensive Care, Royal Brisbane Hospital, Queensland.
Hardman
J
J
D000368:Aged; D000556:Ambulatory Surgical Procedures; D001707:Biopsy, Needle; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage* / Q000009:adverse effects*; D016399:Lymphoma, T-Cell / Q000473:pathology* / Q000601:surgery; D008297:Male; D000077590:Mivacurium; D010243:Paralysis / Q000139:chemically induced* / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014059:Tongue / Q000473:pathology
D007546:Isoquinolines; D000077590:Mivacurium