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Mivacurium Infusion Requirements in Pediatric Surgical Patients During Nitrous Oxide-Halothane and During Nitrous Oxide-Narcotic Anesthesia

Received from the Departments of Anesthesiology, Children's Hospital of Pittsburgh and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the Department of Clinical Neurosciences, Burroughs Wellcome Company, Research Triangle Park, North Carolina.

Abstract

We were interested in determining the infusion rate of mivacurium required to maintain approximately 95% neuromuscular blockade during nitrous oxide-halothane (0.8% end-tidal or nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity (Datex NMT) of the adductor pollicis muscle resulting from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s at 10-s intervals. Mivacurium steady-state infusion requirements averaged 315 ± 26 µg·m^–2·min^–1 during nitrous oxide-halothane anesthesia arid 375 ± 19 µg·m^–2·min^–1 (mean ± sem) during nitrous oxide-narcotic anesthesia. Higher levels of pseudocholinesterase activity were generally associated with a higher mivacurium infusion requirement. During both anesthetics, younger age was associated with a higher infusion requirement when the infusion requirement was calculated in terms of µg·kg^–1·min^–1. This difference was not present when the infusion rate was calculated in terms of µg·m^–2·min^–1. There was no evidence of cumulation during prolonged mivacurium infusion. There was no difference in the rates of spontaneous or reversal-mediated recovery between anesthetic groups. After the termination of the infusion, spontaneous recovery to T4/T1 0.75 occurred in 9.8 ± 0.4 min, with a recovery index, T_25–75, of 4.0 ± 0.2 min (mean ± sem). In summary, pseudocholinesterase activity is the major factor influencing mivacurium infusion rate in children during nitrous oxide-narcotic or nitrous oxide-halothane (0.8% end-tidal) anesthesia.

Key Words: NEUROMUSCULAR RELAXANTS mivacurium—infusion. • ANESTHESIA pediatric—mivacurium.

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