Skip Navigation

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (2)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Martyn, J. A. J.
Right arrow Articles by Patel, S. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Martyn, J. A. J.
Right arrow Articles by Patel, S. S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

British Journal of Anaesthesia, 2002, Vol. 89, No. 4 580-585
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Pharmacodynamics of mivacurium chloride in 13- to 18-yr-old adolescents with thermal injury

J. A. J. Martyn*,1, Y. Chang1, N. G. Goudsouzian1 and S. S. Patel2

1 Department of Anesthesiology and Critical Care, Harvard Medical School, Massachusetts General Hospital and Shriners Hospital for Children, Boston, MA 02114, USA. 2 Anaesthesia Clinical Research, GlaxoWellcome, Research Triangle Park, NC 27709, USA*Corresponding author

Background. Burned patients demonstrate resistance to the effects of non-depolarizing blocking drugs as a result of acetylcholine receptor changes. They also have decreased activity of plasma cholinesterase (PCHE), which metabolizes mivacurium. We hypothesized that decreased PCHE activity would decrease metabolism of mivacurium, and counteract the receptor-related resistance following burns.

Methods. Thirteen burned patients and six controls, aged 13–18 yr were followed in 27 studies. The burned patients were sub-classified as having 10–30% or >30% body surface area burn and were studied whenever possible at <=6 days, and at 1–12 weeks after the burn. Mivacurium pharmacodynamics were examined following a bolus (0.15 mg kg–1) dose, and during and after a continuous infusion.

Results. Following a bolus, the onset time and the maximal effect were similar to controls. Recovery was prolonged in the 10–30% burn group at 1–12 weeks (P<0.008), with a similar trend in the >30% burn group at <=6 days (P<0.082) compared with controls. The infusion requirements for mivacurium were not increased in the burned groups. The PCHE activity was decreased in all burn groups and was inversely related to recovery following the bolus (r=0.73, P<0.001) and the infusion (r=0.69, P<0.001).

Conclusion. In contrast to previous studies with non-depolarizers in burned patients, normal mivacurium doses can produce paralysis, at least as rapidly as in controls, but with a possibility of a prolonged recovery from block. The standard dose of mivacurium in the presence of decreased PCHE activity is in effect, a relative overdose that explains the above findings. Mivacurium is an effective drug for use in burns, irrespective of time after, or magnitude of burn injury.

Br J Anaesth 2002; 89: 580–5


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
T. Han, H. Kim, J. Bae, K. Kim, and J. A. J. Martyn
Neuromuscular Pharmacodynamics of Rocuronium in Patients with Major Burns
Anesth. Analg., August 1, 2004; 99(2): 386 - 392.
[Abstract] [Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.