The nature of spontaneous recovery from mivacurium-induced neuromuscular block

• Published in: Anesthesia and analgesia Vol. 88; no. 3; pp. 648 - 653
• Main Authors: LIEN, C. A, BELMONT, M. R, ABALOS, A, HASS, D, SAVARESE, J. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-03-1999
• Subjects: Adult; Anesthesia Recovery Period; Anesthesia, General; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Humans; Intubation, Intratracheal; Isoquinolines - pharmacokinetics; Isoquinolines - pharmacology; Male; Medical sciences; Middle Aged; Mivacurium; Neuromuscular Nondepolarizing Agents - pharmacokinetics; Neuromuscular Nondepolarizing Agents - pharmacology; Neuropharmacology; Pharmacology. Drug treatments; Human; Alkaloid; Non depolarisant myorelaxant; Isoquinoline derivatives; Prediction; Blocking; General anesthesia; Neuromuscular transmission; Mivacurium chloride; Recovery; Neuromuscular blocking; Monitoring
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199903000-00033

The hypothesis of this study was that, in a given patient, recovery from a tracheal intubating dose of mivacurium would indicate the time course of spontaneous recovery after discontinuation of an infusion of mivacurium. Thirty-eight male patients consented to participate in the study. After induction of anesthesia and endotracheal intubation, the ulnar nerve was stimulated with train-of-four (TOF) stimuli at 12-s intervals. Patients received 0.3 mg/kg mivacurium in two evenly divided doses of 0.15 mg/kg each, separated by 30 s. Complete ablation of TOF responses occurred in most patients. Once the first twitch in the TOF (T ) had recovered to 25% of its baseline height, a mivacurium infusion was begun to maintain 95% suppression of T1. As surgery was nearing completion, the infusion was discontinued, and neuromuscular function was allowed to recover spontaneously. Data were analyzed for recovery intervals after the administration of the initial doses of mivacurium and after discontinuation of the infusion. Analysis of variance was used to determine the strength of correlation between the time from administration of the initial 0.3 mg/kg dose to 5% recovery of T1 and the times to recovery of TOF ratios of 70% and 90%. The 25%-75% recovery interval after discontinuation of the infusion ranged from 2.8 to 11.3 min. The time interval after administration of mivacurium 0.3 mg/kg to 5% recovery of T1 correlated with both the time to recovery of a TOF ratio of 70% and 90%. Recovery to a TOF of 90% after discontinuation of the infusion required approximately the same amount of time as recovery to 5% T1 after the administration of 0.3 mg/kg mivacurium. Each patient's recovery of neuromuscular function after discontinuation of a mivacurium infusion was related to his recovery after the administration of 0.3 mg/kg mivacurium. Therefore, the need for pharmacologic antagonism of block can be anticipated well before the end of an anesthetic.
Mivacurium (0.3 mg/kg) was administered to 38 patients. As they began to recover muscle strength, a mivacurium infusion was begun and later discontinued as surgery was nearing completion. Each patient's early recovery (administration to 5% recovery of T1) after the initial dose of mivacurium correlated well with more complete recovery of muscle strength after discontinuation of an infusion. This relationship enables early prediction of recovery speed after a mivacurium infusion.