Abstract
Purpose: Mivacurium-rocuronium combinations have been demonstrated to be more potent than either drug given alone. Combinations were compared with mivacurium and rocuronium, with respect to onset, intubating conditions, and uration of action in young and elderly adults.
Methods: Fentanyl-propofol-N2O-isoflurane anesthesia was given to ASA I and II adults aged 18-–65 yr (45 patients) and over 66 yr (45 patients). In this blinded randomized study, we compared accelerographic adductor pollicis response and visual assessment of response to facial nerve stimulation after 0.25 mg·kg−1 mivacurium, 0.6 mg·kg−1 rocuronium, and a combination of 0.08 mg·kg−1 mivacurium plus 0.2 mg·kg−1 rocuronium. Intubating conditions at 2.5 min were rated as excellent, good, fair or poor.
Results: Onset times were similar for all drugs regimens and for both age groups (204–276 sec at the thumb; 142–196 sec at the eye) (P<0.05 between muscles). Intubating conditions were similar in all groups, and rated good or excellent, except in two subjects. In young patients duration to 25% recovery was longer (P<0.05) for rocuronium (mean±SD) (39±11 min) than for either mivacurium (23±6 min), or the combination (27±7 min). Duration was prolonged in the elderly for rocuronium (54 +- 17 min), and the combination (35±11 min), but not for mivacurium (24±6 min).
Conclusions: Mivacurium-rocuronium combinations yield onset times and intubating conditions similar to either parent agent with only two thirds as much total drug. Duration for such a mixture is similar to that of mivacurium in young adults and slightly prolonged in the elderly.
Résumé
Objectif: Le mélange de rocuronium et de mivacurium est plus puissant que l’un ou l’autre de ses composants donné seul. On a comparé ce mélange au mivacurium et au rocuronium quant au délai d’installation, aux conditions d’intubation et à la durée d’action chez des adultes jeunes et âgés.
Méthode: Une anesthésie au fentanyl, propofol, N2O et isoflurane a été administrée à 45 patients de 18 à 65 ans et à 45 sujets de plus de 65 ans. De façon randomisée et aveugle, on a comparé la réponse accélérographique de l’adducteur du pouce et l’évaluation visuelle de la réponse à la stimulation du nerf facial après 0,25 mg·kg−1 de mivacurium, 0,6 mg·kg−1 de rocuronium ou un mélange de 0,08 mg·kg−1 de mivacurium et 0,2 mg·kg−1 de rocuronium. Les conditions d’intubation à 2,5 min ont été classifiées comme excellentes, bonnes, passables ou inadéquates.
Résultats: Les délais d’installation étaient semblables pour tous les myorelaxants et pour les deux groupes d’âge (204–276 sec au pouce, 142–196 sec près de l’oeil (P<0,05 entre les muscles). Les conditions d’intubation étaient semblables dans tous les groupes et cotées bonnes ou excellentes, excepté chez deux sujets. Chez les jeunes, la durée d’action jusqu’à 25 % de récupération était plus longue (P<0,05) pour le rocuronium (moyenne±ET) (39±11 min) que pour le mivacurium (23±6 min), ou le mélange (27±7 min). Chez les sujets âgés, la durée était prolongée pour le rocuronium (54±17 min) et le mélange (35±11 min), mais pas pour le mivacurium (24±6 min).
Conclusion: Le mélange de mivacurium et de rocuronium produit des lélais d’installation et des conditions d’intubation semblables à ceux de l’un ou l’autre myorelaxant avec une quantité totale réduite au deux tiers. La durée du mélange est semblable à celle du mivacurium chez les jeunes, mais un peu plus longue chez les sujets âgés.
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References
Waud BE, Waud DR. Quantitative examination of the interaction of competitive neuromuscular blocking agents on the indirectly elicited twitch. Anesthesiology 1984; 61: 420–7.
Naguib M, Abdulatif M. Isobolographic and dose-response analysis of the interaction between pipecuronium and vecuronium. Br J Anaesth 1993; 71: 556–60.
Ferres CJ, Mirakhur RK, Pandit SK, Clarke RSJ, Gibson FM. Dose-response studies with pancuronium, vecuronium and their combination. Br J Clin Pharmacol 1984; 18: 947–50.
Naguib M, Samarkandi AH, Bakhamees HS, Megboul MA, El-Bakry AK. Comparative potency of steroidal neuromuscular blocking drugs and isobolographic analysis of the interaction between rocuronium and other aminosteroids. Br J Anaesth 1995; 75: 37–42.
Kim KS, Chun YS, Chon SU, Suh JK. Neuromuscular interaction between cisastracurium and mivacurium, atracurium, vecuronium or rocuronium administered in combination. Anaesthesia 1998; 53: 872–8.
Lebowitz PW, Ramsey FM, Savarese JJ, Ali HH. Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine for pancuronium and d-tubocurarine. Anesth Analg 1980; 59: 604–9.
Mirakhur RK, Gibson FM, Ferres CJ. Vecuronium andd-tubocurarine combination: potentiation of effect. Anesth Analg 1985; 64: 711–4.
Naguib M. Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination. Anesthesiology 1994; 81: 388–95.
Naguib M, Samarkandi AH, Ammar A, Elfaqih SR, Al-Zahrani S, Turkistani A. Comparative clinical pharmacology of rocuronium, cisatracurium, and their combination. Anesthesiology 1998; 89: 1116–24.
McCoy ÉP, Mirakhur RK, Connolly FM, Loan PB. The influence of the duration of control stimulation on the onset and recovery of neuromuscular block. Anesth Analg 1995; 80: 364–7.
Symington MJJ, McCoy EP, Mirakhur RK, Kumar N. Duration of stabilization of control responses affects the onset and duration of action of rocuronium but not suxamethonium. Eur J Anaesthesiol 1996; 13: 377–80.
Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block. Anesth Analg 1995; 80: 360–3.
Slavov V, Khalil M, Merle JC, Agostini MM, Ruggier R, Duvaldestin P. Comparison of duration of neuromuscular blocking effect of atracurium and vecuronium in young and elderly patients. Br J Anaesth 1995; 74: 709–11.
Bevan DR, Fiset P, Balendran P, Law-Min JC, Ratcliffe A, Donati F. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 1993; 40: 127–32.
Maddinei VR, Mirakhur RK, McCoy EP, Fee JPH, Clarke RSJ. Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium. Anaesthesia 1993; 48: 940–5.
Savarese JJ, Ali HH, Basta SJ, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U). A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology 1988; 68: 723–32.
Pino RM, Ali HH, Denman WT, Barrett PS, Schwartz A. A comparison of the intubation conditions between mivacurium and rocuronium during balanced anesthesia. Anesthesiology 1998; 88: 673–8.
Audibert G, Donati F. The onset of rocuronium, but not vecuronium or mivacurium, is modified by tourniquet inflation. Anesth Analg 1996; 82: 848–53.
Patel N, Kamath N, Smith CE, Pinchak AC, Hagen JH. Intubating conditions and neuromuscular block after divided dose of mivacurium and or single dose rocuronium. Can J Anaesth 1997; 44: 49–53.
Wierda MJKH, Hommes FDM, Nap HJA, van den Broek L. Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium. Anaesthesia 1995; 50: 393–6.
Naguib M, Samarkandi AH, Ammar A, Turkistani A. Comparison of suxamethonium and different combinations of rocuronium and mivacurium for rapid tracheal intubation in children. Br J Anaesth 1997; 79: 450–5.
Tang J, Joshi GP, White PF. Comparison of rocuronium and mivacurium to succinylcholine during outpatient laparoscopic surgery. Anesth Analg 1996; 82: 994–8.
Koscielniak-Nielsen ZJ, Horn A, Sztuk F, Eriksen K, Theil Skovgaard L, Viby-Mogensen J. Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch? Eur J Anaesthesiol 1996; 13: 130–5.
Donati F, Meistelman C, Plaud B. Vecuronium muscular blockade at the diaphragm, the orbicularis oculi, and adductor pollicis muscles. Anesthesiology 1990; 73: 870–5.
Ungureanu D, Meistelman C, Frossard J, Donati F. The orbicularis oculi and the adductor pollicis muscle as monitors of atracurium block of laryngeal muscles. Anesth Analg 1993; 77: 775–9.
Sayson SC, Mongan PD. Onset of action of mivacurium chloride. A comparison of neuromuscular blockade monitoring at the adductor pollicis and the orbicularis oculi. Anesthesiology 1994; 81: 35–42.
Abdulatif M, El Sanabary M. Blood flow and mivacurium-induced neuromuscular block at the orbicularis occuli and adductor pollicis muscles; Br J Anaesth 1997; 79: 24–8.
Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology 1991; 74: 833–7.
Rimaniol JM, Dhonneur G, Sperry L, Duvaldestin P. A comparison of the neuromuscular blocking effects of atracurium, mivacurium, and vecuronium on the adductor pollicis and orbicularis oculi muscle in humans. Anesth Analg 1996; 83: 808–13.
Palud B, Dufour A, Donati F. The corrugator supercilii, and not the orbicularis oculi, is resistant to the effect of rocuronium. Can J Anesth 1999; 46: A38.
Maddineni VR, Mirrakhur RK, McCoy EP, Sharpe TDE. Neuromuscular and haemodynamic effects of mivacurium in elderly and young adult patients. Br J Anaesth 1994; 73: 608–12.
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This work was presented in part at the European Society of Anaesthesiologists meeting in Barcelona, Spain, April 1998.
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Motamed, C., Donati, F. Intubating conditions and blockade after mivacurium, rocuronium and their combination in young and elderly adults. ja]Can J Anaesth 47, 225–231 (2000). https://doi.org/10.1007/BF03018917
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DOI: https://doi.org/10.1007/BF03018917