Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000100006
Brazilian Journal of Anesthesiology
Scientific Article

Comparação do tempo de recuperação do mivacúrio em bolus e em infusão contínua

Comparison of recovery time of bolus and continuous infusion mivacurium

Maria Cristina Simões de Almeida

http://dx.doi.org/10.1590/S0034-70942005000100006 Braz J Anesthesiol, vol.55, n1, p.50-58, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: O mivacúrio é um bloqueador neuromuscular (BNM) de ação curta, que apresenta uma duração total não ultrapassando 24 minutos. As primeiras comunicações científicas relataram não haver diferenças significativas no tempo de recuperação, independentemente da forma de administração. No entanto, a experiência clínica aponta para recuperações mais prolongadas quando se administra o fármaco em infusão contínua. Este trabalho tem por objetivo comparar o tempo de recuperação do mivacúrio quando administrado em bolus e em forma contínua, em um grupo de pacientes jovens e adultos. MÉTODO: Foram analisados 40 pacientes jovens sem doenças neuromusculares. Após receberem midazolam como medicação pré-anestésica, foram monitorizados na sala de operação com ECG na derivação D II e realizada a aferição da pressão arterial indireta por método automático. Todos receberam propofol e fentanil, e a anestesia foi mantida com isoflurano, óxido nitroso e oxigênio. Após a indução, foram instalados o monitor da transmissão neuromuscular por acelerometria e, após a intubação, o capnógrafo e o analisador de gases. Foram divididos em 2 grupos iguais de acordo com o regime de administração de mivacúrio: os do grupo 1 receberam somente dose inicial em bolus e os do grupo 2, após a dose inicial e terem recuperado 10% de T1, receberam infusão contínua para manter uma T1 nesse valor. Foram anotados em ambos os grupos os valores de T1 e T4/T1 na fase de recuperação, a partir de T1 em 10% da resposta inicial, de minuto a minuto, até 30 minutos. RESULTADOS: Os grupos foram homogêneos em relação às variáveis antropométricas. O grupo 2 apresentou tempo de recuperação mais lenta do que os pacientes que receberam somente a dose inicial em bolus. Houve grande variação de doses de infusão entre pacientes e no próprio paciente no decorrer da infusão. CONCLUSÕES: Em pacientes jovens e adultos sem evidências de doenças, a recuperação do mivacúrio é mais lenta após infusão contínua do que sob forma única em bolus. Em decorrência das variações de dose de infusão entre os pacientes e em cada paciente em si, para manter um relaxamento constante e estável, recomenda-se o uso de monitor da transmissão neuromuscular.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, Não-despolarizante, MONITORIZAÇÃO, TÉCNICAS DE ADMINISTRAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Mivacurium is a short-acting neuromuscular blocker (NMB), with total duration not exceeding 24 minutes. Early publications have reported no significant differences in recovery time, regardless of the route administration. However, clinical experience points out to longer recovery times when the drug is administered in continuous infusion. This study aimed at comparing recovery time of bolus administration and continuous infusion of mivacurium in a group of young adult patients. METHODS: Forty young patients with no neuromuscular disease were enrolled in the study. Patients were premedicated with midazolam and monitored in the OR with ECG in D II and non-invasive automatic blood pressure. All patients received propofol and fentanyl and anesthesia was maintained with isoflurane, nitrous oxide and oxygen. Accelerometric neuromuscular transmission monitor was installed after induction and capnograph and gases analyzer were installed after intubation. Patients were divided in 2 equal groups according to mivacurium administration regimen: group 1 received initial bolus dose alone, and group 2, after the initial bolus dose and having recovered 10% of T1, received continuous infusion to maintain T1 within this value. For both groups, T1 and T4/T1 values were recorded during recovery, as from T1 in 10% of initial response, every minute up to 30 minutes. RESULTS: Demographics were homogeneous between groups. Group 2 had slower recovery as compared to group 1. There have been major variations in infusion doses among patients and for the same patient during infusion. CONCLUSION: In young adult patients without evidences of disease, mivacurium recovery is longer after continuous infusion as compared to bolus infusion. As a consequence of infusion dose variation among patients and for each patient, we recommend the use of neuromuscular transmission monitor to maintain constant and stable relaxation.

Keywords

ADMINISTRATION TECHNIQUES, MONITORING, NEUROMUSCULAR BLOCKERS, Non-depolarizing

References

Savarese JJ, Ali HH, Basta SJ. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U): A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology. 1988;68:723-732.

Savarese JJ. Mivacurium: a comparison with other benzylisoquinolinium non-depolarising muscle relaxants. J Drug Dev. 1993;5:1-5.

Viby-Mogensen J, Engbaek J, Eriksson LI. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74.

Goudsouzian N, Chakravorti S, Denman W. Prolonged mivacurium infusion in young and elderly adults. Can J Anaesth. 1997;44:955-962.

Ali HH, Savarese JJ, Embree PB. Clinical pharmacology of mivacurium chloride (BW B1090U) infusion: comparison with vecuronium and atracurium. Br J Anaesth. 1988;61:541-546.

Lien CA, Schmith VD, Embree PB. The pharmacokinetics and pharmacodynamics of the stereoisomers of mivacurium in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology. 1994;80:1296-1302.

Goldhill DR, Whitehead JP, Emmott RS. Neuromuscular and clinical effects of mivacurium chloride in healthy adult patients during nitrous oxide-enflurane anaesthesia. Br J Anaesth. 1991;67:289-295.

Savarese JJ, Ginsburg S, Braswell L. Actions at neuromuscular and esteratic cholinoceptive sites of some phenylene diacryloyl bis-cholinium esters. J Pharmacol Exp Ther. 1979;208:436-445.

Szenohradszky J, Fogarty D, Kirkegaard-Nielsen H. Effect of edrophonium and neostigmine on the pharmacokinetics and neuromuscular effects of mivacurium. Anesthesiology. 2000;92:708-714.

Shanks CA, Fragen RJ, Pemberton D. Mivacurium-induced neuromuscular blockade following single bolus doses and with continuous infusion during either balanced or enflurane anesthesia. Anesthesiology. 1989;71:362-366.

Wessler I, Rasbach J, Scheuer B. Effects of (+)-tubocurarine on [3H]acetylcholine release from the rat phrenic nerve at different stimulation frequencies and train lengths. Naunyn Schmiedebergs Arch Pharmacol. 1987;335:496-501.

Guyon T, Wakkach A, Poea S. Regulation of acetylcholine receptor gene expression in human myasthenia gravis muscles: Evidences for a compensatory mechanism triggered by receptor loss. J Clin Invest. 1998;102:249-263.

Milone M, Wang HL, Ohno K. Mode switching kinetics produced by a naturally occurring mutation in the cytoplasmic loop of the human acetylcholine receptor epsilon subunit. Neuron. 1998;20:575-588.

Feldman S. Second thoughts on the train-of-four. Anaesthesia. 1993;48:1-2.

Hart PS, McCarthy GJ, Brown R. The effect of plasma cholinesterase activity on mivacurium infusion rates. Anesth Analg. 1995;80:760-763.

Markakis DA, Hart PS, Lau M. Does age or pseudocholinesterase activity predict mivacurium infusion rate in children?. Anesth Analg. 1996;82:39-43.

Cook DR, Stiller RL, Weakly JN. In vitro metabolism of mivacurium chloride (BW B1090U) and succinylcholine. Anesth Analg. 1989;68:452-456.

Maddineni VR, Mirakhur RK. Prolonged neuromuscular block following mivacurium. Anesthesiology. 1993;78:1181-1184.

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