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British Journal of Anaesthesia, 1994, Vol. 73, No. 4 494-498
© 1994 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Mivacurium in the myasthenic patient

I. G. PATERSON, MA, MB, BS, FRCA, J. R. HOOD, MB, CHB, FRCA, S. H. RUSSELL, MB, BS, FRCA, M. D. WESTON, MB, BS, FRCA and N. P. HIRECH, MB, BS, FRCA

Department of Anaesthesia, The National Hospital for Neurology and Neurosurgery, Queen Square London

Correspondence to I.G.P.

We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 µg kg–1 (approximately one-fifth of the normal intubating dose), we observed a mean 37.5 (SEM 5.6)% reduction in evoked twitch tension. Neuromuscular block was increased with incremental doses and maintained with repeat bolus doses of 15 µg kg–1 at 25% recovery. The interval between maintenance bolus doses remained constant (mean 5.9 (0.7) min). Spontaneous offset was rapid with a mean recovery index (T25-T75) of 11.9 (2.1) min. Provided anticholinesterase therapy is withheld in the immediate preoperative period, mivacurium would appear to be a safe and appropriate neuromuscular blocker in this variably sensitive group of patients. The cumulative dose required to establish full neuromuscular block varied between 60 and 90 µg kg–1 A maintenance infusion, commencing at 3 µg kg–1 min–1 is recommended, guided by neuromuscular monitoring.

Present address: Department of Anaesthesia, Chase Farm Hospital, The Ridgeway, Eafield, Middlesex EN2 8JL

Present address: Department of Anaesthesia, St Mary's Hospital, London

Present address: Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham


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