Editor—Thank you for allowing us to respond to Dr Geoghegan's comments. We acknowledge his reservations concerning our use of mivacurium instead of rocuronium and there is good evidence of rocuronium adequately substituting succinylcholine as a drug for RSI. Our primary aim was to choose a neuromuscular blocking agent of relatively short duration of action with potentially less incidence of residual motor blockade because of the possibility of a difficult intubation and the patient's clinical condition. Mivacurium despite its slightly less suitability for RSI fulfilled this criterion better than rocuronium. It has been shown that intubating conditions are good or excellent with the method of administration used.2 3
Neostigmine is still the most common drug utilized for reversal of neuromuscular function block and the patient may have been adequately reversed without any anticholinesterase agent. However, because of the condition of the patient and the need to optimize her respiratory effort after operation, we decided to give half the usual dose recommended.
*E-mail: olufo001{at}mc.duke.edu
Footnotes
This letter was originally submitted as an E-letter.
References
1 Olufolabi AJ and Wee MYK. Caesarean section in a patient with torsion dystonia. Br J Anaesth 2006; 96:611–13
2 Naguib B, Samarkandi H, Ammer A, et al. Comparison of suxamethonium and different combinations of rocuronium and mivacuronium for rapid tracheal intubation in children. Br J Anaesth 1997; 79:450–5
3 Pino RM, Hassan HA, Denham WT, et al. Comparison of the intubation conditions between mivacuronium and rocuronium during balanced anaesthesia. Anesthesiology 1998; 88:673–8[CrossRef][Web of Science][Medline]
4 Ali HH, Lien CA, Witowski T, et al. Efficacy and safety of divided dose administration of mivacurium for a 90-second tracheal intubation. J Clin Anesth 1996; 8:276–81[CrossRef][Web of Science][Medline]
5 Perry J, Lee J, Wells G. Rocuronium versus succinylcholine for rapid sequence induction intubation. The Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002788. DOI: 10.1002/14651858.CD002788
6 Abdulatif M. Recovery characteristics after early administration of anticholinesterases during intense mivacurium-induced neuromuscular block. Br J Anaesth 1995; 74:20–5
7 Fleming NW and Lewis BK. Cholinesterase inhibitors do not prolong neuromuscular block produced by mivacurium. Br J Anaesth 1994; 73:241–3
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