Decreased mivacurium infusion rate and delayed neuromuscular recovery after metoclopramide: a randomized double blind placebo-controlled study.
OBJECTIVE
Metoclopramide is an antiemetic drug which inhibits plasma cholinesterase activity. We have compared the mivacurium infusion requirements and neuromuscular recovery after administration of metoclopramide to a group of adults compared to a control group.


METHODS
Forty-five patients were randomized into three groups. Two groups received either 10 or 20 mg of intravenous (i.v.) metoclopramide and the third group received i.v. saline. Metoclopramide and saline were given 5 min before i.v. induction of anaesthesia. Plasma cholinesterase activity was measured before induction and 30 min after metoclopramide or saline injection. Neuromuscular block was monitored by accelerography using single and train-of-four (TOF) stimulation. The mivacurium intubation dose was followed by an infusion titrated every 5 min to maintain 95% block until the end of surgery when the infusion was stopped. Recovery from mivacurium was then monitored until complete.


RESULTS
Mivacurium infusion rates were significantly lower in the metoclopramide groups. After 45 min of infusion, the infusion rates were 1.82 +/- 0.8 and 2.1 +/- 1 microg kg(-1) min(-1) in the 20 and 10 mg metoclopramide groups, respectively, and 6.8 +/- 2.7 in the saline group. Time to recovery of TOF to greater than 90% was significantly prolonged in both metoclopramide groups compared to the saline group: 33.2 +/- 7.2 and 29.5 +/- 10.3 min in the metoclopramide 20 and 10 mg groups, respectively, compared to 22 +/- 3.9 in the saline group (P < 0.001 for the 20 mg group compared to control).


CONCLUSIONS
Metoclopramide enhances the effect of a mivacurium infusion.
El Ayass
N
N
Hospital of Braine L'Alleud, Anesthesiology Department, Waterloo, Belgium. Nizar725@hotmail.com
Hendrickx
Ph
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000932:Antiemetics / Q000627:therapeutic use*; D002802:Cholinesterases / Q000097:blood; D004311:Double-Blind Method; D004347:Drug Interactions; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007546:Isoquinolines / Q000008:administration & dosage*; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D000077590:Mivacurium; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010919:Placebos; D012965:Sodium Chloride; D009435:Synaptic Transmission / Q000187:drug effects; D013997:Time Factors
D000932:Antiemetics; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D010919:Placebos; D012965:Sodium Chloride; D000077590:Mivacurium; D002802:Cholinesterases; D008787:Metoclopramide